triage of horses_ pinery fires 2016 dr. lidwien verdegaal
TRANSCRIPT
Horses in the Pinery bush fire Nov 2015
Lidwien Verdegaal DVM, Dipl. ECEIM, Dipl. RNVA School of Animal and Veterinary Science [email protected]
Triage of horses
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?
• Do horses need to move to safe zone: • Where to move them to? • Fire brigade?
• Consider the human safety above all
On-‐scene consideraDons
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
• 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
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
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?
• 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?
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
Triage of burned cases Priority is cooling!
Immediately cool all body areas:
Ice & cold water > for 20 minutes
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
Ø 15-‐20% burned surface area requires IV fluids & intensive care
Courtesy Wendy Ducke0
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
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
• 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
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
Burn shock: emergency treatment
> 15% surface area • IV fluids • IV plasma and/or Hetastarch® • NSAIDs (flunixin, meloxicam) • Pulmonary oedema
• Humidified oxygen • AnGbioGcs
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
Smoke InhalaDon Treatment
• Maintain airway open • Upper airway obstrucGon –
tracheotomy • Humidified oxygen • Broad spectrum anGmicrobials • NebulisaGon (saline) • Bronchodilators
Smoke InhalaDon Endoscopy and airway sampling
!
The long-‐term prognosis is uncertain
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
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
Management of 1st degree burns Treatment
• Water lavage • Silver sulfadiazine • Aloe vera • Pain relief (flunixin, meloxicam)
Management of 2nd degree burns Treatment
• Usually not fatal • Manage as for superficial burn • Vesicles & blisters • Apply anGbacterial dressing/
cream
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
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…
1. Swollen muzzle/ face 2. Increased RR 3. Low protein (blood) 4. Assess wounds
Day 2 at hospital
Triage of the burned case Pain management
One of the most challenging issues is
the management of pain!
Days post injury treatment
Wound care
Wound care
PruriDs, non-‐ healing wounds and pain
Coronary band injury and laminiDs
Weight loss, negaDve energy balance, colic, kidney problems, lung injury
Triage of the burned case: Survival!
• 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..
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!!
Thank you!
Triage of the burned case The goal is survival