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Triage of Horses_ Pinery Fires 2016 Dr. Lidwien Verdegaal

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Presented at the 'Pinery Fires Horse Owners Get Together' 21 Dec. 2016. at the University of Adelaide, Roseworthy Campus, South Australia

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Triage of Horses_ Pinery Fires 2016 Dr. Lidwien Verdegaal

  1. 1. Horses  in  the  Pinery  bush  fire   Nov  2015       Lidwien  Verdegaal  DVM,  Dipl.  ECEIM,  Dipl.  RNVA   School  of  Animal  and  Veterinary  Science     lidwien.verdegaal@adelaide.edu.au       Triage  of  horses  
  2. 2. Lidwien Verdegaal DVM, Dip ECEIM   •  On  scene   •  Triage  of  burned  horses   •  Clinical  findings  and  treatment   •  DescripGon  of  cases  at  the  EHPC   •  Recovery,  complicaGons  and  challenges   •  What  did  we  learn?   Triage  of  horses   What  is  the  first  thing  to  do?  
  3. 3. •   Do  horses  need  to  move  to  safe  zone:   •   Where  to  move  them  to?   •   Fire  brigade?   •   Consider  the  human  safety  above  all   On-­‐scene  consideraDons  
  4. 4. First  aid  quesGons     •  How  many  horses?   •  What  is  the  behaviour  of  the  horse?     Advice:   •  Calm  (people  &  horses)   •  Apply  water  lavage  (hose,  buckets)   On-­‐scene  consideraDons:     telephone  call      
  5. 5. •  Always  consider  horses  may  have  explosive  acGon   •  Flight  is  insGncGve   •  Find  people  experienced  in  horse  handling   •  Calm,  quiet   •  Have  the  right  equipment  and  medicine  on  hand   •  Restraint/  rescue   •  SedaGon,  medicaGons  &  bandages   On-­‐scene  consideraDons:   emergency  handling       Under  no  circumstances  enter  an  acDve  fire  zone  
  6. 6. Structure  fires   High  fatality  rate  due  to   • radiant  heat   • smoke  inhalaGon   • contact  burns     Surviving  horses:   • extensive  dorsal  burns   • smoke  inhalaGon  injury   • ash  or  noxious  gases   Bush  fires   High  fatality  due  to   • radiant  heat   • contact  burns   • injury  limbs     Surviving  horses:   • extensive  limb  burns   • smoke  inhalaGon  
  7. 7. Heat  à  causes  cell  death   à  Inflammatory  response  &/or  oedema   Airways:  à  respiratory  distress   •  ParGal  airway  obstrucGon  upper  part  of   respiratory  tract     •  Protein  leakage  into  lungs  (oedema  and   hypoxia)     Other  organs:  Injury  of  Gssues   •  systemic  shock  (circulatory  collapse)   Burn  –  thermal  injuries   Why?    
  8. 8. •  Airways   •  DehydraGon/  shock   •  Hoofs:  coronary  bands  and  laminiGs   •  Skin  burns:  direct  and  radiant  heat:   •  Eyes   •  Face   •  Distal  limbs   •  Ventral  body   •  Perineum   Burn  –  thermal  injuries   Where?    
  9. 9. Arrival  at  the  hospital   Triage  of  the  burned  case   Principles   •  PrioriGse:  cooling   •  Assess  %  burned  body  surface  area     •  Clinical  exam  and  problem  list     Treatment:   •  Treatment  of  shock  (IV  fluids)   •  Treatment  of  smoke  inhalaGon   •  Burn  skin  injury   •  ClassificaGon  and  prognosis     •  Treatment  
  10. 10. Triage  of  burned  cases   Priority  is  cooling!     Immediately  cool  all   body  areas:   Ice   &   cold   water   >   for  20  minutes  
  11. 11. Triage  of  the  burned  case   Principles   •  PrioriGse:  cooling  þ •  Assess  %  burned  body  surface  area     •  Clinical  exam  and  problem  list     Treatment:   •  Treatment  of  shock  (IV  fluids)   •  Treatment  of  smoke  inhalaGon   •  Burn  skin  injury   •  ClassificaGon  and  prognosis     •  Treatment  
  12. 12. Ø  15-­‐20%  burned  surface  area    requires  IV  fluids  &  intensive  care   Courtesy    Wendy  Ducke0  
  13. 13. Unconscious  or  semi-­‐ conscious   Down  &  unable  to  walk   Respiratory  difficulGes   Major  swelling  of   the  limbs     Extensive  burns  to  bare   areas     Extensive   damage  to   underlying   structures   Triage  of  the  burned  case:   Humane  euthanasia  
  14. 14. Triage  of  the  burned  case   Principles   •  PrioriGse:  cooling  þ •  Assess  %  burned  body  surface  area  þ     •  Clinical  exam  and  problem  list     Treatment:   •  Treatment  of  shock  (fluids)   •  Treatment  of  smoke  inhalaGon   •  Burn  skin  injury   •  ClassificaGon  and  prognosis     •  Treatment  
  15. 15. •  1  horse  or  more  horses  involved?   •  Appearance/  behaviour   •  Vital  signs     •  DehydraGon/  shock?   •  Respiratory  distress,  cough   •  Skin  injuries:   –  Oozing  skin,  oedema     –  Ocular  wounds,  joint,    tendon,   coronary  band   Triage  of  cases   IniDal  clinical  exam  
  16. 16. Triage  of  the  burned  case   Principles   •  PrioriGse:  cooling  þ •  Assess  %  burned  body  surface  area  þ     •  Clinical  exam  and  problem  list  þ       Treatment:   •  Treatment  of  burn  shock  (fluids)   •  Treatment  of  smoke  inhalaGon   •  Burn  skin  injury   1.  ClassificaGon  and  prognosis     2.  Treatment  
  17. 17. Burn  shock:     emergency  treatment   >  15%  surface  area     •   IV  fluids   •   IV  plasma  and/or  Hetastarch®   •   NSAIDs  (flunixin,  meloxicam)   •   Pulmonary  oedema   •  Humidified  oxygen     •   AnGbioGcs  
  18. 18. Triage  of  the  burned  case   Principles   •  PrioriGse:  cooling  þ •  Assess  %  burned  body  surface  area  þ     •  Clinical  exam  and  problem  list  þ       Treatment:   •  Treatment  of  burn  shock  (IV  fluids)  þ   •  Treatment  of  smoke  inhalaGon   •  Burn  skin  injury   •  ClassificaGon  and  prognosis     •  Treatment  
  19. 19. Smoke  InhalaDon   Treatment   •   Maintain  airway  open   •   Upper  airway  obstrucGon  –   tracheotomy   •   Humidified  oxygen       •   Broad  spectrum  anGmicrobials     •   NebulisaGon  (saline)     •   Bronchodilators  
  20. 20. Smoke  InhalaDon   Endoscopy  and  airway  sampling   The  long-­‐term  prognosis  is   uncertain  
  21. 21. Triage  of  the  burned  case   Principles   •  PrioriGse:  cooling  þ •  Assess  %  burned  body  surface  area  þ     •  Clinical  exam  and  problem  list  þ       Treatment:   •  Treatment  of  burn  shock  (IV  fluids)  þ   •  Treatment  of  smoke  inhalaGon  þ   •  Burn  skin  injury   •  ClassificaGon  and  prognosis     •  Treatment  
  22. 22. ClassificaDon  burn  wounds   ! 1st  degree:      Superficial  epidermis:  painful   2nd  degree:      ParGal  thickness  and  deep:  minimal  pain   3rd  degree:      Full  thickness:  no  cutaneous  sensaGon            and  fluid  loss    
  23. 23. Management  of  1st  degree  burns   Treatment   •  Water  lavage   •  Silver  sulfadiazine   •  Aloe  vera   •  Pain  relief  (flunixin,  meloxicam)    
  24. 24. Management  of  2nd    degree  burns     Treatment   •   Usually  not  fatal   •   Manage  as  for  superficial  burn   •   Vesicles  &  blisters     •   Apply  anGbacterial  dressing/          cream  
  25. 25. Management  of  3rd    degree  burns   Treatment   •  PotenGally  life  threatening   •   Manage  shock   •   Manage  respiratory  distress   •   Euthanasia?   •   Clip  surrounding  hair   •   Clean  wound  2-­‐3  x  daily   •   Dilute  chlorhexidine   •   AnGbacterial  topical  treatment?   •   Permeable  dressings   •   Debride  necroGc  Gssue  
  26. 26. Triage  of  the  burned  case   EHPC:    night  of  25th  of  November  2015     •  6  severely  burned  horses     •  different  breeds,  age  range  2  –  18  years  old   •  arrival  range  2  to  6  hours  post  thermal  injury   The  second  day…  
  27. 27. 1.  Swollen  muzzle/  face   2.  Increased  RR   3.  Low  protein  (blood)   4.  Assess  wounds   Day  2  at  hospital  
  28. 28. Triage  of  the  burned  case   Pain  management   One  of  the  most  challenging   issues  is     the  management  of  pain!    
  29. 29. Days  post  injury     treatment    
  30. 30. Wound  care  
  31. 31. Wound  care  
  32. 32. PruriDs,  non-­‐  healing   wounds  and  pain  
  33. 33. Coronary  band  injury     and  laminiDs  
  34. 34. Weight  loss,   negaDve  energy  balance,  colic,   kidney  problems,  lung  injury    
  35. 35. Triage  of  the  burned  case:   Survival!  
  36. 36. •  Severity  of  burns;  unpredictable    unGl  up  to  weeks   later     •  During  1st  2  weeks:  every  day  seems  to  be  different!     ComplicaGons  of  Pinery  fires  include:     •  Severe  coronary  band  injury  (no  laminiGs)   •  Severe  pain:  due  to  coronary  band  and/  or  skin   burns   •  Respiratory  effects  (good  recovery  in  our  cases)   •  Deep    2nd  and  3rd  degree  burns:  long  term  recovery   •  Weight  loss  due  to  high  metabolic  demand  but  also   less  appeGte  due  to  high  triglycerides  and  pain   What  have  we  learned..  
  37. 37.   Acknowledgement   •  The  team  of  EHPC!!     •  Excellent  veterinary  students  Michelle,  JusGna,  Katelyn  for  2   weeks  and  many  other  students!   •  Many  volunteers!!:  nurses,  students,  daughters  of  staff   members  etc.!!   •  PharmaceuGcal  companies         Triage  of  the  burned  case   Team  effort!!  
  38. 38. Thank  you!  
  39. 39. Triage  of  the  burned  case   The  goal  is  survival  

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