Transcript Lecture 9 - First aid

Equine first aid
The kit, procedures and first
aid treatment
The role of first aid
• The main role of first
aid is to deal with minor
injuries, e.g. superficial
cuts & grazes, kicks,
overreaches & wire cuts.
• Also, first aid is used to
care for the horse in a
more serious situation
before the vet arrives,
with the aim of
preventing the situation
from getting any worse.
The equine first aid kit
• Must be complete & readily accessible,
e.g. tack / feed room.
• A second kit may be required for
travelling.
• The human first aid kit may be kept
next to the equine kit, so they must
both be clearly marked.
• The vet’s name & number should be
written on the inside lid.
What items should be included
in the equine first aid kit?
•
•
•
•
•
•
•
•
•
•
Bowl
Cloth
Antiseptic solution
Wound powder / spray?
Hydrogel
Fly repellent
Antiseptic ointment
Clean crepe bandages
Adhesive bandages
Dressings – sterile &
non-adhesive
• Hibiscrub
• Cotton wool
• Curved, blunt-ended
scissors
• Poultice
• Veterinary thermometer
& vaseline
• Forceps / tweezers
• Money (for travelling
kits) / mobile phone
• Syringe
• Latex gloves
• Tape
What additional items might be
kept in a medicine cupboard?
• Cling film / plastic bags
• Gamgee / fybagee
• Antiseptic / purple
spray?
• Udder cream
• Wormers
• Cooling gel / clay
• Poultices
• Icepack
• Stable bandages
• Eye ointment
• Germicidal shampoo /
soap
• Hoof care preparations
• Witch hazel lotion
• Salt
• Liniment / cream rub
• Fly repellent
• Sun cream
• Poultice boots
Types of wounds
• Closed / contused wounds
• E.g. bruises, sprains, muscle damage & tendon
strain.
• Usually internal bleeding without breaking of
skin.
• Leads to swelling, heat & pain.
• Treatment: Immobilise & cold hose / ice
packs.
• Once heat has gone, use heat treatments.
• Causes: fall / blow / kick.
• Incised wounds
• Clean straight edges & often bleed freely.
• Usually, there is little bruising & they
normally heal quickly.
• Cause: surgical incisions / cuts by metal or
glass.
• Abrasion wounds
• Very superficial skin wounds, e.g. saddle sores
/ grazes from falling.
• Laceration & tear
wounds
• Torn edges & irregular
shape, with some
bruising.
• Amount of bleeding
depends on position of
wound.
• Frequently, there are
torn flaps of skin that
die before healing.
• Cause: barbed wire /
protruding nails & other
hazards.
• Puncture wounds
• Often more serious than they look.
• Often overlooked due to the small size
externally.
• Opening may be small, but penetration can be
of varying depths
• Cause: bites / stakes / thorns / treading on
nails & splinters.
• Bacteria is carried deep into the wound 
infection.
• Treatment: ensure tetanus vaccinations are
up to date. Treat the wound to heal from the
inside out. Usually involves poulticing.
Preparing a poultice
Poultice
boots
First aid procedure
• Control the horse quietly but firmly.
• Move the horse to a safe place if possible / necessary, to
reduce the chance of further injuries.
• Keep the horse still – it may be necessary to use a method of
restraint, e.g. twitch.
• Maintain a calm atmosphere.
• Assess the injury (position, depth, severity, blood loss) and call
the vet if necessary.
• Control of bleeding
• Capillary bleeding will ooze from the wound and is usually not
serious.
• Venous bleeding flows gently & is dark red.
• Arterial bleeding runs freely & may spurt under pressure from
the heartbeat. It is bright red.
• Venous & arterial bleeding require immediate veterinary
treatment.
• Control any bleeding by applying a pad directly on the wound &
secure it firmly with a pressure bandage. Several layers can be
used.
When to call the vet
• Always contact your vet if:
• Any wound is bleeding profusely
• The horse is very lame, even if the wound itself is
small
• Any wound is more than a couple of inches long and
has gone right through the skin, so that it gapes open
and may need to be stitched
• There is any suspicion of a foreign body in the wound
• There is any suspicion that a vital structure such as a
joint may be involved
• The horse has NOT had an anti-tetanus vaccination
• If you think a wound may need to be sutured
(stitched or stapled), you should consult your vet as
soon as possible, since a wound will heal more
effectively if it is sutured while still fresh.
• A wound may need to be sutured if:
• The edges are gaping apart, leaving a large gap for
dirt to enter
• It is very large or deep
• It is in an awkward place that will scar
• In most cases, deep punctures, injuries with very
swollen or crushed wound edges or severely
contaminated or infected wounds will not be suitable
for suturing, nor will wounds that are more than
8hours old.
• Surgical skin staples are now often used instead of
stitching for certain types of skin wounds.
• They can be inserted very quickly and may be ideal
when a horse does not want to stand still.
• Staples do not work well for jagged injuries or when
the wound edges are under a lot of tension, but they
are often a neat and efficient way to repair clean
cuts.
Cleanliness
• Once bleeding has been controlled, the wound will
need to be cleaned.
• Remove hair from the edges of the wound (protect
wound with for example, vaseline).
• Hose for 5-10 minutes (mechanically loosens the dirt).
• Wash with warm salt water / hibiscrub solution.
• Cotton wool – work from the inside of the wound, out,
and discard each piece of cotton wool once used.
• Syringe.
• Tubbing.
• In some cases, debridement of the wound is
necessary (cutting away of devitalised tissue with
scissors / scalpel).
Hosing a wound
Hosing boot
Tubbing
Cleaning a wound
Cleaning & dressing wounds
• When cleaning a wound, be aware that:
• Bathing with cotton wool can introduce
contamination.
• Some topical treatments are detrimental to
healing, some even slowing healing by
irritating the wound / causing cell death.
• Coloured sprays and wound powders can act as
foreign bodies and be caustic to cells.
• Strong antiseptics can kill cells as wells as
bacteria - use very mild solutions or salt
water.
• Avoid "second skin" sprays, as they can seal in
infection.
•
It is best to use:
•
A mild salt solution that matches the electrolyte content of equine
tissue: ½ teaspoon table salt to 1L water.
•
•
•
•
Povidine-iodine (e.g. betadine) - an excellent antibacterial.
Add to salt water: 10ml or less to 1L salt solution.
Antibacterial activity lasts ~4-6 hours.
Humans handling it frequently, must wear rubber gloves, as it is toxic in
larger amounts.
•
Chlorhexidine (e.g. hibiscrub) – an excellent cleaning solution, effective
against bacteria, viruses & fungi.
Mix 25ml with 1l of salt water.
Long lasting effect, as it binds to skin proteins.
•
•
•
•
•
•
Water-soluble wound gels (hydrogel) - originally designed for human
burns patients.
Wound hydrogels help to keep the wound clean and moist.
It is thought hydrogels reduce the number of bacteria in the wound and
can speed healing.
Examples include Derma-gel, Vetalintex, Intrasite gel and Nugel.
Protecting the wound - dressings
• Hot poulticing may be required for drawing out
infection / foreign bodies.
• Otherwise, once the wound is clean, especially if likely
to get dirty again, it may be necessary to protect the
wound by applying a dressing.
• Consider applying a hydrogel to the wound.
• Vaseline can be applied to the skin surrounding a
weeping wound.
• Use a sterile non-stick dressing, e.g. (dry) animalintex /
melolin.
• Secure the dressing with tape if necessary.
• Wrap with gamgee / fybagee & bandage in place.
Healing
•
•
•
•
•
•
•
•
•
•
•
•
•
Normal immune mechanisms  effectively deal with up to 1 million bacteria /
gram of tissue.
More than 1million / gram  overwhelms immune system, creating infection.
Wound margins are colonised with bacteria within 2-4 hours after injury. Topical
antibiotics will do little to fend off infection
Healing begins with fibrous connective tissue collagen (fibrin strands), made of
proteins.
Fibroblasts (which manufacture the fibrin) migrate into the wound by the 3rd
day.
As granulation tissue (made of capillaries & fibroblasts) fills in the wound, it
provides a surface along which epithelial cells (new skin cells) will migrate.
Bacteria – slows healing & produces enzymes that destroy fragile newly formed
skin cells.
Contraction (reduction of wound size) occurs at a rate of 0.2mm / day during the
first few months.
Continued remodelling of a scar occurs over the next 6-12 months.
Contraction rates are not affected by the size of the wound, but by skin tension.
Taut edges, e.g. on a leg wound, contract slowly.
Dry wounds are tighter, so contract more slowly than a moist wound.
Any excess tension, oedema or movement of a wound interferes with the
function of the myofibroblasts, limiting contraction, sometimes even ceasing it
prematurely.