Triage of Horses_ Pinery Fires 2016 Dr. Lidwien Verdegaal
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. 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. •
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. 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. • 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. 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. 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. • 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. 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. Triage
of
burned
cases
Priority
is
cooling!
Immediately
cool
all
body
areas:
Ice
&
cold
water
>
for
20
minutes
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. Ø 15-‐20%
burned
surface
area
requires
IV
fluids
&
intensive
care
Courtesy
Wendy
Ducke0
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. 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
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. Burn
shock:
emergency
treatment
>
15%
surface
area
•
IV
fluids
•
IV
plasma
and/or
Hetastarch®
•
NSAIDs
(flunixin,
meloxicam)
•
Pulmonary
oedema
• Humidified
oxygen
•
AnGbioGcs
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
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. 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. Management
of
1st
degree
burns
Treatment
• Water
lavage
• Silver
sulfadiazine
• Aloe
vera
• Pain
relief
(flunixin,
meloxicam)
24. Management
of
2nd
degree
burns
Treatment
•
Usually
not
fatal
•
Manage
as
for
superficial
burn
•
Vesicles
&
blisters
•
Apply
anGbacterial
dressing/
cream
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. 1. Swollen
muzzle/
face
2. Increased
RR
3. Low
protein
(blood)
4. Assess
wounds
Day
2
at
hospital
28. Triage
of
the
burned
case
Pain
management
One
of
the
most
challenging
issues
is
the
management
of
pain!
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.
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!!