2002
RECIPE BOOK:
DOING THINGS THE
“PETERSON & SMITH” WAY
Compiled by: Courtney Bolam
Tricia Salazar
Sarah Begley
P&S Hospital Interns 2001-2002
BASIC RECIPES
ADULT HORSES
GENERAL
Physical exam
CBC, Chemistry, +/- VBG (serial CBC’s on all colics/“sickies” every other day)
Any sick, pregnant broodmare should get some progesterone supplementation
 Regumate 10-20 cc (22-44 mg) PO SID
 Hydroxyprogesterone 500-1250 mg (2-5cc) IM q1 week
GI
Generic (Medical) Colic
NG intubation – Mineral Oil 1 gallon PRN
Rectal
IV Catheter Placement
Consider abdominocentesis (cytology [full slide] +/- culture)
Consider abdominal radiographs (sand, enteroliths, mini, weanling/yearling)
Fecal float (parasites, stall-side [in sleeve] for sand)
Muzzle +/- pull water bucket (based on presenting signs and presence of reflux)
Analgesia (sedation +/- flunixin meglumine)
Consider fluids (10 L boluses with 160 mEg KCl per “jug” and 500cc Cal MP every other
“jug”, maintenance for a 450 kg horse is TID)
“Water Off” any horse that has been NPO (offer water q1h until refuses, then bucket)
Aggressive feeding, once passing manure (1 flake q4-6hrs with oil after 2-3 flakes)
 LC simple problems (resolved impactions/gas, displacements) feed ASAP
 Any volvulus/resection/compromised bowel, more cautious re-introduction
 SI involvement usually completely NPO, therefore water off, then slow reintroduction to feed
 Monitor cecal impactions/dysfunctions carefully for recurrence of the problem –
Post-op Colics
New “post-op” catheter placed
K Pen 22,000 IU/kg IV QID for 5 days minimum (1 dose pre-op)
Gentamicin 6.6 mg/kg IV SID +/- for 5 days at DVM discretion (1 dose pre-op)
Metronidazole 15 mg/kg PO BID-TID (resections)
Polymixin B 2,500,000-3,000,000 IU qs to 60cc for 450 kg horse (600 IU/kg) IV BID to
TID (SI lesions, leukopenia, concerns of endotoxemia) often for 24-48 hrs
Flunixin meglumine 0.55 mg/kg IV TID for minimum of 3 days (1.1 mg/kg dose pre-op)
Heparin 15-20,000 units/450 kg SQ TID for minimum of 3 days (monitor mm colour/PCV)
Abdominal Lavage *usually if resection*
Fluids/plasma as indicated
DMSO 90% 250-500cc in 5-10L IV BID (0.5-1 g/kg) for inflamed/compromised bowel
*maximum of 10% solution*
Consider laminitis prophylaxis
Consider gastric ulcer prophylaxis
Consider CRI for analgesia
 Butorphanol – 12 ug/kg loading dose once IV then 12 ug/kg/hr IV in saline
*concerns re: decreased fecal output*
 Lidocaine – see AE for dose
Remove suture 12-14 days post-op
Stall confinement with hand walking for 2 weeks, 2 weeks turnout in round pen then free
choice turnout for 1 month prior to resuming training/work
Usually no grain fed while in hospital – gradual reintroduction over next 7-14 days
Sand
Fluids (overhydration)
Mineral Oil 1 gallon PNGT BID +/- Psyllium 16 oz PNGT SID for sand
Analgesia
Consider surgery (PF enterotomy)
Neostigmine 8-10 mg SQ q2h for up to 4 doses post enterotomy
Consider feeding alfalfa post-op (leafy hay)
Nephrosplenic Entrapments
U/S in left paralumbar fossa to image kidney and spleen
2 vials (20 mg total) of phenylephrine in 1L fluids 15-20 min pre-op
Attempt to roll in recovery stall (start with L side up) **need confirmatory U/S picture**
Surgery if rolling is unsuccessful
2 tubes (7200 mg total) Strongid (pyrantel pamoate) followed by 5 days of double dose (5700
mg/day) Panacur “Power Pac” (fenbedazole)
Consider prokinetics (neostigmine, erythromycin lactobionate) – risk of rupture??
Also consider in ileal impactions
Impactions
Oil (up to 2 gallons at a time, SID-BID)
Fluids (overhydration)
Flunixin meglumine (0.55 mg/kg IV TID but can have up to 1.1 mg/kg QID per DVM
**skip scheduled doses**)
Serial rectals to assess resolution
Surgery (last resort) – PF enterotomy
Small colon
 typically low WBC
 enema (enema bell or stomach tube, water +/- mineral oil)
 consider systemic antibiotics
AE (Anterior Enteritis)
NPO
Must differentiate from surgical SI lesions – abdominocentesis can be helpful (WBC normal
to high/high TP with AE, generally serosanguinous if surgical)
K Pen 44,000 IU/kg IV QID
Gentamicin 6.6 mg/kg IV SID
Metronidazole 30 mg/kg per rectum TID
Flunixin meglumine 0.55 mg/kg IV TID
Polymixin B 3,000,000 IU for 450 kg horse IV BID to TID (often for 24-48 hrs)
Ranitidine 1 – 1.5 mg/kg IV TID
Erythromycin lactobionate 50 mg IV QID
Reflux q4-6h
Alamag 2 bottles PNGT post reflux OR
K Pen 20 million IU PNGT post-reflux
Fluids (consider ongoing losses)
Lidocaine – loading dose 1.3 mg/kg IV bolus over 10 min (30cc 2% lidocaine for 450kg)
then 0.05 mg/kg/min CRI (600 mls 2% lidocaine in 3L saline run at 450 ml/hr for 450kg
[~0.04mg/kg/min])
Consider laminitis prophylaxis
Consider surgical decompression and intraluminal instillation of 40 million units of K Pen if
poor response after 24 hrs of aggressive treatment
Colitis
Fecal samples for Salmonella PCR, C. difficile toxin test, BID Salmonella cultures x5
Allow/encourage eating
Consider using less thrombogenic catheters (MILA – polyurethane)
K Pen 44,000 IU/kg IV QID
Gentamicin 6.6 mg/kg IV SID
Metronidazole 15 mg/kg PO TID
Flunixin meglumine 0.55 mg/kg IV TID
Polymixin B 3,000,000 IU for 450 kg horse IV BID to TID (often for 24-48 hrs or until
WBC improving)
Ranitidine 6.6 mg/kg PO TID or 1 – 1.5 mg/kg IV TID
Probios 30g tube PO SID - BID
Charcoal 16 oz in water PNGT BID until feces “sit” on the straw
Loperamide 0.1-0.2 mg/kg PO QID once WBC WNL and horse not toxic
*if diarrhea still present*
Fluids (consider ongoing losses)
Hetastarch 10 ml/kg IV once followed by crystalloids
Plasma as indicated
Bicarb replacement (IV or PO [baking soda <12.5-50 g BID–QID>] as dictated by serial
VBG)
Biolyte (electrolytes) PRN in 2nd bucket
Consider laminitis prophylaxis
Right Dorsal Colitis
Treat as a regular colitis EXCEPT:
No NSAIDs
Add sucralfate 20-40 mg/kg PO TID-QID
Minimize/eliminate roughage – feed a complete pelleted ration (Purina Equine Sr.)
*low residue diet*
Plasma IV PRN
Gastric Ulcers
Poor correlation between severity of clinical signs and severity of the lesion(s)
Gastroscopy for definitive diagnosis (muzzle at midnight, pull water at 5A)
Bethanecol SQ/IV (0.02-0.05 mg/kg) to promote gastric emptying to improve visualization
*xylazine if excitement, split total dose half and half SQ and IV*
Ranitidine 6.6 mg/kg PO TID or 1-1.5 mg/kg IV TID
Gastrogard minimum of 250# dose PO SID for 28 days
Cytotec (misoprostol) 3-5 ug/kg PO BID - QID
Sucralfate (mainly in foals) 20-40 mg/kg PO TID-QID
Alamag (foals with esophageal ulceration) 60 cc PO TID (stagger with other PO meds)
Consider Doxycycline 10 mg/kg PO BID
Consider Metronidazole 15 mg/kg PO TID
RESPIRATORY
Pleuropneumonia
Chest radiographs
Serial Thoracic U/S (don’t forget the cranial thorax!!)
CBC, Chemistry, VBG
TTW for cytology and culture/sensitivity
Thoracocentesis (samples for cytology, culture/sensitivity)
K Pen 44,000 IU/kg IV QID
Gentamicin 6.6 mg/kg IV SID
Metronidazole 15 mg/kg PO TID
Enrofloxacin 2.5-3 mg/kg PO BID or 5-7 mg/kg IV SID
Difloxacin 25 mg/kg once PO (loading dose) then 3 mg/kg PO SID
Rifampin 5-10 mg/kg (adults) PO BID
Chloramphenicol 50 mg/kg PO TID
Doxycycline 10 mg/kg PO BID
Flunixin meglumine 0.55 mg/kg IV TID
Phenylbutazone 1-2 grams PO SID (2.2-4.4 mg/kg IV or PO SID-BID)
Heparin 20,000 units/450 kg horse SQ TID
Aspirin 12 cc syringe capful PO SID (10-20 mg/kg)
Thoracic lavage with warm Norm R or saline, then instill with antibiotic spiked fluids (10
million IU K Pen or 10 cc Enrofloxacin, plus 10 cc Gentamicin in 1L) and cork for 2-4 hrs
Probios 30g tube PO SID- BID
Gastric ulcer prophylaxis
Allow/encourage eating and consider appetite stimulants (Quik Start ¼ tube PO QID)
Arytenoid chondritis
Treat respiratory distress/difficulty ASAP – minimize stress
Temporary tracheostomy
Endoscopy for definitive diagnosis and monitoring resolution
NSAIDs to reduce inflammation (2 gram Phenylbutazone PO SID then slowly taper off)
Systemic antibiotics (K Pen/Gentamicin/TMS) – until scope WNL with horse off
phenylbutazone
CNS
CBC, SMAC (liver enzymes)
Serum for EHV-1, West Nile, EEE/WEE
Consider spinal tap for EPM testing + CSF cytology
Consider cervical/cranial rads to rule out wobbler and trauma
Flunixin meglumine 1.1 mg/kg IV SID-BID
Dex SP 0.05-0.1 mg/kg IV SID-TID (more rapid onset of action) then slowly taper dose
Dex 0.05-0.1 mg/kg IV SID-TID then slowly taper dose
Solu-delta-cortef 500-1000mg IV SID-BID
Solu-medrol **Human dose 30 mg/kg IV then 5.4 mg/kg q1h for 23 hr**
DMSO 90% 250-500 mls in 5L IV BID (0.5-1 g/kg)
Mannitol 20% 500-1000 mls IV BID- TID (0.25-1g IV BID-TID)
Lasix 1 mg/kg IV BID - TID
Consider EPM treatment (Baycox [toltrazuril], pyrimethamines/sulfas, Marquis [ponazuril])
Nursing care (rolling, decubiti management <Alamag, A & D>, gastric ulcer prophylaxis)
Diazepam 25-100mg IV PRN (for seizures, not with hepatoencephalopathy – try xylazine,
etc.)
Phenobarbitol 5-10 mg/kg IV (for uncontrolled seizures) or 10 mg/kg PO SID-BID (for
maintenance) *monitor the degree of sedation, serum levels and fine tune dose, remember to
taper dose before discontinuing*
MUSCULOSKELETAL
Tying Up (Myositis)
Monitor SGOT/AST and CPK
Dantrolene 10 mg/kg PO once (loading dose) then 2 mg/kg PO SID
Methocarbamol (Robaxin) 10-20 mg/kg (5 – 10 grams for 450 kg horse) IV TID (DES)
Fluids +/- DMSO (for inflammation and diuresis)
NSAIDs for analgesia
Lasix 0.5-1 mg/kg IV BID
HYPP
Prevention
 Acetozolamide 2-4 mg/kg PO BID
 NaCl as fluids with no supplemental KCl
 **No K Pen** use Ampicillin 10-15 mg/kg IV BID-TID instead
 No alfalfa
Acute Attacks
 5% Dextrose 6 ml/kg IV (in 0.9% NaCl) or to effect
 NaHCO3 1-2 mEq/kg IV
 23% Calcium gluconate 0.2-0.4 ml/kg slow IV (dilute in fluids if possible)
 reduce stimulation/stress
 monitor respiration (for laryngeal paresis)
Laminitis
Phenylbutazone 4 grams IV once initially, then 2 gram PO SID
Ice feet QID
DMSO 90% 250-500 mls in 5-10L IV BID
ACS pads
Lateral P3 radiographs (repeat at 7 days)
Clay stall (or other appropriate bedding – peat moss)
Pentoxyfilline 8 mg/kg PO BID (longterm - deformity of rbc, improve perfusion) to TID
(acute - anti-endotoxin effects)
Acepromazine 50-75 mg IM SID-BID for vasodilatory effects
Consider nitroglycerine patches – on 12 hrs/off 12 hrs *not as a preventative*
Infected Synovial Structures (joints, tendon sheaths)
Radiographs – monitor q7 days
Initial fluid sample gets cytology/culture/sensitivity, subsequent samples WBC/TP only
IV antibiotics for minimum of 3 weeks (for all infected synovial structures in all age horses)
Monitor lameness
Consider surgical debridement/lavage
Regional limb perfusion
 pre-drill (4.0 mm) thru cortex of bone proximal to involved structure
 tourniquet
 appropriate antibiotic, qs volume to min of 35cc, injected intramedullary (extension
set, “Puerto Rican infusion pump”)
 20 min lag time, remove tourniquet, bandage
 4 treatments (often the first time is at surgery)
K Pen 44,000 IU/kg IV QID
Gentamicin 6.6 mg/kg IV SID *also IA or Amikacin IA*
DON’T EXCEED THE SYSTEMIC DOSE OF
AMINOGYCOSIDES WHEN USING IA
Ceftiofur 2-4 mg/kg IV TID or IM BID *also IA*
Phenylbutazone 2.2-4.4 mg/kg IV or PO SID-BID
Consider serial tap/inject with antibiotics
Consider gastric ulcer prophylaxis
Poultice for diffuse limb swelling
U/S any “soft” spots – could be soft tissue abscess (tap, lance, lavage)
Adequan 500mg IM q7d for 8 weeks (start at resolution of the infection)
UROGENITAL
Retained Placenta
Oxytocin 2cc (20 units/ml) IM q2h until 3 hrs post-foaling (now “retained” by definition)
Oxytocin 2 cc IM q15min for 4 doses
Oxytocin 5cc in 1L fluids IV over 20 min
Uterine infusion of 10cc gentamicin in 1 L post-foaling
Uterine lavage and placental massage PRN (salt water with 10cc gentamicin instillation)
Consider systemic antibiotics
Consider flunixin meglumine/xylazine for analgesia
Aborting Mares
Phenylbutazone 2g/day PO SID or split into 1g BID
Pentoxyfilline 8 mg/kg PO BID (for increased deformation of rbc and improved perfusion)
Dexamethasone 20mg x 2 doses (to promote fetal lung maturation if close to foaling
anyways)
Anitbiotics (Pen/Gen or TMS)
Regumate 20-40cc (double dose) SID PO
Renal Failure
CBC, VBG and Serum Chemistry *PCV/TP/VBG/electrolytes serially*
Abdominocentesis (+/- ultrasound) *don’t forget adult horses can have ruptured bladders*
U/A (free catch vs catherterized sample)
K Pen 22,000 IU/kg IV QID
Enrofloxacin 5 mg/kg IV SID
IV fluids *cautious of fluid overload if anuric* (use electrolyte values to guide fluid selection)
Mannitol 20% 500 ml IV TID
Furosemide 0. 12mg/kg IV loading dose, followed by 0.12mg/kg/hr IV CRI (add 12 ml to
1L 0.9% NaCl for 500 kg horse) and run for 8 hours (800 ml). When CRI complete, start
furosemide 1.0 mg/kg IV q 4 hr (decrease to 0.5 mg/kg if urinating well)
Dopamine 1-10 ug/kg/min IV CRI if still an-oliguric w/ lasix (40 ml [8 vials of 200 mg] in 1
liter 0.9% NaCl, run at 100 ml/hr will give approx. 5/ug/kg/min for 500 kg horse)
Monitor for pulmonary edema and abdominal distention
OTHER
Pericarditis
Can be life-threatening *tamponade*
U/S for diagnosis, serial monitoring
Pericardiocentesis (samples for cytology, culture/sensitivity)
Pericardial lavage with warm Norm R or saline, then instill with antibiotic spiked fluids
Steroids 30 mg dexamethasone taper over 1 month (fluid may re-acculumate as dose is
tapered) *need negative culture and no pyrexia*
Long-term follow-up to monitor for restrictive pericardial disease
Broad spectrum antibiotics (Pen/Gen)
Hemorrhage
Address primary problem
Avoid NSAIDs, heparin
Serial PVC/TP
Naloxone 8 mg (2 x 10cc bottles) IV BID
Aminocarproic Acid 10g in 1L fluids IV over 30 min BID - QID
Formalin (10%) 20-50cc in 1L fluids IV over 30 min BID
Yunnan Paiyao ½ -1 vial (2-4 grams) in water PO QID
Acepromazine 3cc IM once
Blood Tranfusion as indicated by PCV or clinical signs
Eye Problems
Block for thorough ophthalmic exam
Stain +/-Scrape (cytology PRN)
 fluoroscein for discontinuous corneal epithelium
 rose bengal for discontinuous tear film
Treat with solutions (subpalpebral lavage) or ointments
Atropine *Mydriatic*
Flurbiprofen *NSAID*
Fortified Gentamicin (1cc (100 mg) injectable gentamicin added to 15 ml bottle of
ophthalmic gentamicin solution) *Antibiotic*
Tobramycin *Antibiotic*
Chloramphenicol *Antibiotic*
all treatments q1-24 hrs depending on
Miconazole *Antifungal*
severity of lesion
Natamycin *Antifungal*
Serum
Intra-ocular or systemic steroids only if indicated
Consider sub-conjunctival injections
Consider systemic antibiotics
NSAIDs for analgesia
Intracameral (anterior chamber) injection of TPA for severe fibrin deposition (R. equi)
FOALS
GENERAL
Work up/Routine Management
Complete PE at admission then TPR q4h
Sterile blood collection for CBC, Chemistry, aerobic/anaerobic culture, IgG if >12h old
ABG or VBG and blood glucose (monitor q6-24h)
Urine specific gravity (monitor q6h)
IV catheter placement
Digital rectal and soapy water enema as indicated
Staining of eyes at admission, then q24h if recumbent or diseased
Oral exam (cleft palate, suckle)
Orthopedic assessment (conformation, joint effusion, lameness)
Assess for fractured ribs (handle carefully, lay with fractured side down)
Ensure adequate nutrition (see below)
Abdominal/thoracic radiographs as indicated
Mare
 PE
 oil if <24hrs post-foaling
 oxytocin 2cc IM BID for 7 days post-foaling
 re-introduce grain slowly
 uterine lavage PRN
 domperidone (10 g PO SID) as indicated
 reserpine 2.5-3.75 mg (10-15 tabs) PO SID-BID to effect
Neonatal Nutrition
Mare’s milk, milk replacer or mixture of the two (to improve palatability)
Colostrum can be F/C, others should start at 5% BW and increase by 2.5% increments q1224hrs (CKC likes a max of 25% BW initially if bucket fed)
*very weak/sick preemies, start at approx 2.5% d/t concerns of delayed gastric emptying
when recumbent + susceptibility to enterocolitis. If can stand/walk, start at 10%*
 Encourage nursing
 Bottle feed
 Bucket feed (from top or via nipple)
 Consider intermittent NG intubation if foal is starting to “get the hang of it”
 Feeding tube (see below)
 TPN
Feeding Tube Placement
Lube tube and guide wire
Flex head to pass through larynx
Extend head neck to pass through cardia
Confirm placement of tube in stomach (radiographs, reflux, palpation)
Tape “butterfly” at nostril level, suture through nostril and tape, then Chinese finger trap
over tape to secure
Always reflux before feeding
Male injection cap to prevent sucking air
Basic “Sick/ADR” Foal Protocol (Dummy Foal)
K Pen 44,000 IU/kg IV QID
Amikacin 20 mg/kg IV SID or Gentamicin 6.6 mg/kg IV SID
Metronidazole 15 mg/kg PO BID – TID
Flunixin meglumine 1.1 mg/kg IV SID
Ranitidine 6.6 mg/kg PO TID or 1 – 1.5 mg/kg IV TID
Lasix 1 mg/kg IV BID-TID
Naloxone 4 mg (10 cc vial) IV BID x 3 doses
Mannitol 20% ~0.5 g/kg (~1 ml/lb) IV BID-TID (run slowly over 20 min)
Fluids (Norm R or M with 5% Dextrose) 80 ml/kg/24hr if not nursing and no losses
*frequency of q2h for glucose maintenance*
Plasma (IV +/- PNGT) as dictated by IgG results
Sterile eye Ointment +/- antibiotics
Entropion management (staples, sutures)
Umbilical care (dip TID, monitor for patency or thickening)
O2 Therapy (as dictated by serial ABG [want PaO2 to be at least 60], often a minimum of 24
hrs)
Caffeine (for PaCO2 >50) 10 mg/kg PO once (loading dose) then 3 mg/kg PO BID *this is
for foals that are not ventilating appropriately; ie: apnea, decreased chest excursions (not
pneumonias)*
Doxapram 0.02-0.05 mg/kg/min CRI (indications as for caffeine)
Phenobarb 5 mg/kg BID starting dose to effect.
Valium 1cc IV as needed may increase as needed but may consider phenobarb therapy
Ensure adequate nutrition
GI
Enteritis Foal
NPO (including meds)
K Pen 44,000 IU/kg IV QID
Amikacin 20 mg/kg IV SID or Gentamicin 6.6 mg/kg IV SID
Metronidazole 30 mg/kg per rectum TID
Flunixin meglumine 1.1 mg/kg IV SID
Ranitidine 1 – 1.5 mg/kg IV TID
Bethanecol 0.02-0.05 mg/kg SQ q8h (usually alternate bethanecol /metaclopramide
Metaclopromide 0.1-0.3 mg/kg IM q8h
so foal is getting a prokinetic q4h)
Reflux q4h and adjust PRN
Milk mare
Fluids (consider ongoing losses)
Consider nutrition - TPN (start sooner rather than later ie/ NPO for >24hrs)
Consider abdominocentesis
Consider U/S and radiographs of abdomen to assess degree of intestinal distention, motility
and presence of gas in intestinal walls (pneumatosis intestinalis)
Diarrhea (Colitis) Foal
Fecal samples as in adult + Rotavirus
K Pen 44,000 IU/kg IV QID
Amikacin 20 mg/kg IV SID or Gentamicin 6.6 mg/kg IV SID
Metronidazole 15 mg/kg PO TID
Flunixin meglumine 1.1 mg/kg IV SID
Ranitidine 6.6 mg/kg PO TID or 1 – 1.5 mg/kg IV TID
Probios 1 gram/10 lbs PO BID
Pediasorb ½ package PO BID
Epic ½ package PO BID x 3 days
Toxiban 8 oz bottle + 4 oz water PNGT BID. V
Psyllium 4 oz/100 lbs PNGT SID-BID
Immodium 0.1-0.2 mg/kg PO up to QID as long as diarrhea continues (want WBC WNL)
Fluids (consider ongoing losses)
Bicarb replacement (IV or PO [baking soda <12.5-25 g BID – QID>]as dictated by serial
VBG)
+/- Lasix/Mannitol as dictated by USG and renal values
Allow to nurse if desired and comfortable
Consider abdominocentesis
Consider U/S and radiographs of abdomen to assess degree of intestinal distention, motility
and presence of gas in intestinal walls (pneumatosis intestinalis)
Meconium Impactions
NPO
Barium enema for radiographs
Systemic antibiotics/NSAIDS as per colitis foal
Sedation PRN (IV or IM)
Soapy water enemas q4-12h
(alternate enemas so foal
Acteylcysteine retention enemas q12h
gets one q6h)
Mineral Oil 4-6 oz/100# PNGT (try to wait until at least 12-18hr of age d/t gut
closure/colostrum absorption issues)
Consider surgery
“Turd Herders”- long handled towel clamps to carefully extract hard fecal balls
RESPIRATORY
Foal Pneumonia (R. Equi)
Thoracic radiographs
TTW for cytology, culture and sensitivity
Erythromycin stearate 25 mg/kg PO TID (pull water/wipe mouth *limit mare ingestion*)
Erythromycin Lactobionate 5 mg/kg IV QID
Doxycycline 10 mg/kg PO BID
Azithromycin 10 mg/kg PO SID
Rifampin 10 mg/kg PO BID
O2 therapy as indicated
Climate control (A/C)
Monitor for other signs – uveitis, polysynovitis, diarrhea
MUSCULOSKELETAL
Lame (Joint) Foal
Radiographs q7days – monitor for areas of osteomyelitis
Serial tap and inject/lavage under GA (in front of stall)
 lavage until WBC < ~20,000
 tap and inject until WBC < ~10,000 or clinical signs dictate
 wipe site with 1:1 water:hydrogen peroxide after procedure to help minimize “skin
scurf” from repeated sterile scrubs
 +/- sterile bandage
Initial fluid sample gets cytology/culture/sensitivity, subsequent samples WBC/TP only
Direct injection of sites of osteomyelitis or physitis
IV antibiotics for minimum of 3 weeks (for all infected synovial structures in all age horses)
Monitor lameness and watch other joints closely
Consider surgical debridement of accessible foci of osteomyelitis
K Pen 44,000 IU/kg IV QID
Amikacin 20 mg/kg IV SID or Gentamicin 6.6 mg/kg IV SID *also IA*
DON’T EXCEED THE SYSTEMIC DOSE OF
AMINOGYCOSIDES WHEN USING IA
Ceftiofur 2-4 mg/kg IV TID or IM BID *also IA*
Flunixin meglumine 1.1 mg/kg IV SID
Gastric ulcer prophylaxis (add sucralfate 2-4 mg/kg PO TID-QID)
Poultice for diffuse limb swelling
U/S any “soft” spots – could be soft tissue abscess (tap, lance, lavage)
Don’t forget about the foot – nerve blocks, soak booties etc.
Adequan 250 mg IM q7d for 8-16 weeks (start at resolution of infection or 2 weeks post-op)
Contracted foal
Splints (place under sedation, 12h on/12h off)
Oxytetracycline 2-3 grams IV q24h up to 3 doses (monitor renal values)
Do not use or use judiciously if foal already has tendon laxity in any other limb(s)
Limited turnout until relaxed
UROGENITAL
Ruptured Bladder/Urachus
Identify (U/S, rads)
Confirm (abdominocentesis <creatinine>, serum BUN/creatinine/electrolytes)
Abdominal drain – 28 Fr (omentum least likely to clog tube if located caudally)
Indwelling urinary catheter
Fluids (address electrolyte issues)
Monitor electrolytes, BUN/creatinine *address hyperkalemia with saline +/- dextrose*
Systemic antibiotics/NSAIDS
Surgery once stabilized (cath for 48hrs post-op)
May have confounding clinical signs (enteritis, colitis, etc.)
**Remember it is a MEDICAL, not surgical, emergency!!**
“Red Flags” – male, newborns (~3-5 days), decreased or absent urination but may continue
to urinate, abdominal distention, history of dystocia, respiratory distress
Patent Urachus
Can be “acquired” in a debilitated/ill foal
PPG 2cc topically QID to umbilicus to assist in drying
Systemic antibiotics
U/S and assess umbilical structures
OTHER
NI
Monitor renal values, total bilirubin, PCV/TP
K Pen 44,000 IU/kg IV QID
Amikacin 20 mg/kg IV SID or Gentamicin 6.6 mg/kg IV SID
Metronidazole 15 mg/kg PO BID – TID
Flunixin meglumine 1.1 mg/kg IV SID
Ranitidine 6.6 mg/kg PO TID or 1 – 1.5 mg/kg IV TID
Phenobarb (to promote bilirubin metabolism) ~13 mg (0.2 ml of 65 mg/ml) IV BID
Solu-delta-cortef 100 mg IV initially, followed by 50 mg IV BID
Blood Transfusion when PCV <12 or as indicated by clinical signs
Oxyglobin 5-10 ml/kg IV PRN *max of 10 ml/kg/hr*
Fluids (for diuresis in addition to meeting requirements)
Lasix 1 mg/kg IV BID - TID
Off mare until 48 hrs of age (supplement colostrum)
OTHER HELPFUL HINTS
GENERAL
Sedation
1 ½ cc xylazine/1 ½ cc butorphanol IV for analgesia (colic)
1-2 cc detomidine IM for heavy duty analgesia (colic)
1 – 1 ½ cc xylazine +/- butorphanol for NG intubation, gastroscopy, radiographs
1/3 cc detomidine / 2/3 cc butorphanol for thoracocentesis, TTW
1 ½ - 2 cc xylazine / 2 ½ - 3 cc acepromazine for mares when foals being restrained, taken
to sx, euthanized
Routine Surgeries (Primarily arthroscopies)
Pre/Post Operative radiographs +/- intra-operative radiographs
Pre-op CBC/muzzle (~6-8 hr pre-op)
Temporary Catheter
K Pen 2 x 10 million IU doses (pre and post-op)
Tetanus toxoid / anti-toxin (foals < 4 months)
Phenylbutazone 2 grams PO SID/ flunixin meglumine (foals)
Bandage changes PRN for 2 weeks post-op
Adequan 500mg IM q7d for 8 weeks (start 2 weeks post-op) for arthroscopies and fx
Remove arthroscopy sutures 10-14 days post-op
Reduced grain while stall confined
Stall confinement only for 2 weeks, followed by 6 weeks hand walking before turnout in a
round pen or small paddock for 2 months prior to resuming training/work
Stifle arthroscopy (FP pouch) – use laproscopy cannula in supra patellar pouch to allow
flushing of debris from joint
Nasal Edema (Post Anaesthesia)
20 mg (2cc) phenylephrine qs to 20 cc or Afrin intranasally in the recovery stall
GI (COLICS)
VML - 3 layer closure
“Clear” the linea first with mayos and use electrocautery for hemostasis
Surgeon and assistant to start from either end
Linea - 3 Vicryl soaked in Biosol – SC pattern
SQ - 2-0 PDS – SC pattern
Skin – 1 Braunamid – continuous horizontal mattress (extra “pull” tabs)
Suture Line is then sprayed with “Aluspray”
**Linea – 2 PDS <250#, 2 Vicryl 250-750#, 3 Vicryl or 2 Vicryl doubled >750#**
PF Enterotomy
Grasp edges with Allis tissue forceps (ensure mucosa everted)
TA-90 across incision
Trim edges
Rinse with saline with biosol, then with heparin
Other enterotomies (SI for foreign body) - longitudinal incision, closed transversely
Omentectomy
Isolate omentum
Split into reasonable size segments (3-4), clamp
Transfix and ligate with 1 PDS (“flash” the hemostat)
Transect with mayos in “crush”
Inspect stump for bleeding and release
Abdominal Lavage (in surgery)
Final step prior to closure
Warm, sterile saline
Suction until clear
Leave 1L with 2cc heparin +/- extra litre in abdomen *unless hemorrhage*
2cc heparin IV
Decompression of Gas Distention
12 g thru mattress suture (2-0 PDS)
16 g for stomach
18 g (tunneled)
Resections
LC




TA-90 across mesentery (2 proximal <stay in>, 1 distal <removed>) then hand
ligate all large blood vessels
Handsewn (2 layer, inverting)
Copious abdominal lavage in surgery
Abdominal drain (described below)


generally handsewn (end to end, end to side jejunocecostomy)
GIA-90 for ileocecal anastomosis (ileal bypass)
SI
Abdominal Drain (for peritonitis, post LC resections, ruptured bladder)
Stab incision lateral to VML
Chinese finger trap suture
Condom as one-way (Heimlich) valve
10L Norm R lavage at immediately-2 hrs post-op, 6-8 hrs post-op, (12 hrs post-op) then
q12h (gravity flow)
Can be done standing, under sedation, with U/S guidance (caudal third of abdomen to
minimize omental interference and visceral trauma)
Ileal Impactions
60 cc DSS in 1L saline instilled intraluminally and subsequent mixing with intestinal contents
Must ensure that resolved impaction passes thru ileocecal valve easily, otherwise consider
ileocecal anastomosis (bypass)
Cecal Trocarization
Use when surgery is not an option or to stabilize prior to surgery
Must be able to auscult a “ping” in right flank
Clip and prep (QUICKLY)
+/- Carbocaine bleb (if time permits)
Stab (skin) incision with 15 blade
Cecal trocar into peritonem/cecum
Inject 5cc gentamicin as withdraw
Rectal Tear After-care (Beavis)
Ring and liner placed in surgery
Concerns re: impaction at site of ring
Laxative diet (alfalfa!!) *complete pellets*
Mineral Oil enemas (bell enema) q6h to assist fecal passage
Mineral Oil PNGT PRN
Eventually developed abscess at tear site – flushed with dilute Nolvasan BID rectally via
NGT
RESPIRATORY
Laryngoplasty/Throat Surgery (laser)
Mineral oil early AM pre-op
Phenylbutazone 10cc (2 grams) IV once pre-op then 2 grams PO SID
Gentamicin 30cc IV SID (to start pre-op)
K Pen 2 x 10 million IU IV (pre and post-op, may continue on TID-QID)
Recover with “sticky” Ioban drape over sx site (staples for closure)
Doxycycline 10 mg/kg PO BID (to go home for 5 days)
Stall confinement with hand or mechanical walking for 8 weeks then resume training/work
(want to minimize movement of the larynx while scar tissue forms to mimic the suture)
Other particulars
 Contact Nd:YAG for cordectomies (standing, under neuroleptanalgesia)
 Hooked blade (intranasally) under GA for epiglotic entrapment Sodium Thiopentol
for anaesthesia induction to inhibit gag reflex
 “Bikini” vs “Boxer” trim for staphlectomy
 Post-op tracheotomy for aretynoidectomies
Nasal septum resection
Skull films (DV/lateral)
Consider alar fold resection
Post-op packing of nasal cavity/suture nostrils shut (pull ~48 hr post-op)
Monitor PCV/TP PRN
Post-op temporary tracheotomy
Post-op antibiotics
Sinus flap
Pack in surgery
Pull packing ~24hr later
Monitor PCV/TP PRN
Flush SID with saline
Thoracocentesis
U/S to confirm location of fluid
Clip hair, sterile prep of area
Carbocaine block
Stab incision thru skin
28 or 32 Fr thoracic drain
Condom as one-way valve
Chinese finger-trap suture
CNS
Myelogram
Pre-op temporary catheter, 500 mg flunixin meglumine and 20 mg dexamethasone IV once
Anaesthetize and place on sx table in R lateral recumbency
Neutral plain films (to set positioning and technique)
AO/LS tap (18g spinal needle, sterile extension set)– drain 60-80 cc CSF under sterile
technique over ~5 min
AO tap – inject 60-80 cc omnipaque (iohexol) under sterile technique over ~5 min
Elevate front of table for ~5 min to encourage caudal flow of iohexol (may need longer)
3V (with contrast)
 neutral
 +/- extended (increase kVp by 5)
 flexed (increase kVp by 5)
Recover in lateral with head elevated (encourage CSF flow caudally to help minimize risk of
seizures)
Post-op 2 grams Phenylbutazone PO SID
Examine films for
 >70% reduction in the width of the dorsal dye column
 decrease of 20% or greater in the total dural diameter (dorsal and ventral dye
columns included) when comparing intravertebral and intervertebral measurements
Post mortem
 Euthanize with head uphill
 Starting techniques for the yellow “sub” x-ray machine
o Cranial 80/0.14
o Middle 80/0.18 (increase kVp by 5 for flexed)
o Caudal 80/0.20-0.22 (increase kVp by 5 for flexed)
“Wobbler” Films
Assess films subjectively looking for obvious stenosis, malalignment, physeal flaring, etc
Measure sagittal ratios for C4-7
 Narrowest part of the canal (within the vertebral body) – may be cranial or caudal
 Widest part of the vertebral body (cranial aspect)
 Want >0.5 when divide
Also measure the shortest oblique distance between the caudal aspect of C3 and the cranial
aspect of C4 (repeat for C4/5, C5/6, C6/7)
 Supposed to be a better predictor of disease *should always be >> than
intravertebral sagittal ratios
 No numbers yet
MUSCULOSKELETAL
Medial Condylar Fracture
Cast ASAP (pre-op)
Radiographs (need to “pick-off” the fracture line)
Full limb cast post-op
Tether initially with cast and then when cast removed
Assist to stand if “bad” leg down (+/- roll PRN)
Clay stall (or other appropriate bedding – peat moss)
Cast Application
Stockinette – 2 layers, with felt over pressure points in between layers
Yellow cast foam – 1 layer
Fibreglass casting tape
Build up heel if desired with plaster rolls
Elasticon at top to prevent debris falling into cast
Must cure for 20 min (GA)
Block +/- ACS pad on contralateral limb to even out length and for support
Hoof Abscess
Pare out hoof – attempt to establish ventral drainage
Consider foot radiographs (5 views)
Soak boot with Betadine “tea” QID
Animalintex or icthammol poultice
ALD
Measure the angle from the distal radial physis (grossly or radiographically) with a
goniometer
Must consider if horse is bench-kneed
 “Straight” horse will measure ~4 degrees valgus, however if bench-kneed “straight”
may be 6-8 degree valgus
Examine at rest and at walk (want MCIII to be perpendicular to ground when placed)
Transphyseal bridge preferred to periosteal elevation/transection
 6.5 mm cancellous bone screws (25-35 mm long)
 18 g wire
UROGENITAL
Penile Prolapse/Hematoma
Vaseline and massage to return penis to prepuce
Probang and surcingle to retain penis and promote resolution of edema
Probang assembled from PVC pipe fitted with cotton taped onto one end (Q-tip) to fit
snugly into prepuce
Surcingle assembled primarily from 2” white tape – around barrel, through hind legs, around
tail
RV Tears/Perineal Lacerations
Wait for initial healing to occur
Muzzle for minimum of 24 hrs
Mineral Oil 1-2 gallons PNGT upon arrival (~24 hr pre-op)
Sedation/neuroleptanalgesia for restraint in stocks
Epidural (¾ cc xylazine + ¾ carbocaine qs to 10cc)
Clip hair (~2” wide) over hamstrings
Scrub of rectum/vulva/perineum with Ivory soap then betadine
Stay sutures to retract labia and improve visualization
Tight seal of repair with no palpable suture (from rectal side in particular)
Close dead space with SC running suture
Long tails on Braunamid (vaginal side)
Leave anal sphincter discontinuous (do not attempt to repair – risk of stricture)
Caslicks to protect repair
Continue with SID-BID mineral oil PRN post-op
Post-op antibiotics
REMOVE sutures at 14 days
Dystocia
Assess vitals (P, R, mm)
IV catheter
Preliminary bloodwork (PCV/TP/VBG)
Stabilize mare
Sedation/neuroleptanalgesia for restraint in stocks
Epidural (¾ cc xylazine + ¾ carbocaine qs to 10cc)
Vaginal exam (bare arm, lots of lube)
Limited manipulation/mutation in stocks**especially if foal is the priority (watch the
clock!)**
May elect to manipulate/mutate under GA in recovery stall **time is still IMPT**
Otherwise
 terminal C-section (if foal is the only priority)


C-section via VML under GA (if delivery of a live or dead fetus is otherwise
impossible or where mare and foal are both the priority)
fetotomy (if foal is dead and/or mare is the only priority)
C-section
Hemostasis of uterus (clear placenta) with running stitch or isolate vessels and transfix
Copious lavage of abdomen
Ovariectomy (usually unilateral GCT)
Palpation/ultrasound pre-op to confirm diagnosis and side/size of affected ovary
Oblique paramedian ventral incision over affected ovary
Consider VML for exceptionally large ovaries
“Corkscrew” to assist with traction of ovary
TA-90 to “ligate” mesovarium
Endometrial Cysts
Sedation/neuroleptanalgesia for restraint in stocks
Contact ablation with Nd:YAG laser
Post-foaling Broodmares (immediate)
Consider clamping vulva when placing in dorsal recumbency for sx to prevent/minimize
uterine/bladder prolapse
RADIOLOGY CHEAT SHEET
GENERAL
Labels always lateral to the limb, except dorsal when shooting a lateral view
Soft tissue should just be visible without a hot light (DES)
STANDARD ORTHOPEDIC SERIES
Front Fetlock
Straight lateral
Flexed lateral
AP
DMPLO
DLPMO
Carpus
Straight lateral
Flexed lateral
AP
DMPLO
DLPMO
Skyline (distal row)
Elbow
Flexed Lateral (pull limb forward to ensure joint is isolated)
AP (abduct limb to assist in placing plate to image olecranon)
Can use the bucky for lateral, otherwise need to use GRID
Shoulder
Flexed lateral (pull limb forward to isolate joint over trachea)
Position bucky first
Hind Fetlock
Straight lateral
+/- Flexed lateral
AP
DMPLO
DLPMO
“Up/down” obliques – for plantar pieces, sesamoid fractures
Skyline (sesamoids) – for apical fractures
Hock
Straight lateral
AP
DMPLO
PLDMO
Skyline (calcaneus)
Stifle
Straight lateral (condyles should overlap)
Flexed lateral
PA
PLDMO (pick off the medial condyle)
MC or MT II-IV *splint/cannon bone fractures (condylar, stress)*
Straight lateral
AP
Obliques
Attempting to pick off the fracture line and/or highlight the affected area
Hip (foal)
GA
GRID
Foot
Prep the foot – hoof knife, clean, pack with play-do
Lateral (paperclip at coronary band) – use block
AP (foot) – use block, shoot parallel to the ground
Coffin bone – use tunnel, collimate, 60 degree angle
Skyline (navicular) – use tunnel, collimate, 45-60 degree angle
AP (navicular) – use “notched” block to hold toe and gridded plate, collimate
C-spine
3V (standard 450 kg horse)
C1-3 (include occipital protuberances)
C2-? (need to have C2 to “name” other vertebrae)
C?-7 (C6 generally is shorter and has a flatter ventral border, may be transposed with C7;
technique should allow visualization of C7 and the dorsal spinous process of T1)
Occasionally need DV view
Skull
Lateral
AP
Obliques
Alter technique depending on “target”
 “light” for ethmoid turbinates
 “hot” for teeth
STANDARD SOFT TISSUE VIEWS
Thorax
3V (standard 450 kg horse)
Inspiratory exposures
Need to be able to see
 mediastinum
 caudal border of heart
 entire diaphragm
Abdomen
Need “hot” technique
Can use sand in viscera to assess if technique is appropriate
Corresponding diagram to illustrate where films were centered
Foals
 can be standing or recumbent (standing preferred)
 one shot to assess feeding tube placement or to identify free fluid,/intestinal
distention
FORMULA CALCULATIONS
1) NaHCO3 Replacement
[(BW in kgs) (base deficit) (0.4)]/(0.6) =
amount of NaHCO3 required (mls)
Eg: 50 kg foal w/ BE (ecf) = –5.2
[(50) (5.2) (0.4)]/(0.6)= 173 mls deficit
2) Neonatal Feeding (by % body weight in POUNDS)
(BW in pounds)(% of BW to be fed)= total pounds milk
needed in 24 hours. To figure out number of ounces per
feeding:
(pounds of milk)(16 ounces/pound) = total ounces in 24 hr
(total ounces in 24 hours)/12 feedings = oz needed q 2 hours
Eg: 50 lb foal that needs 2.5% BW feeding q 2 hours
(50 pounds)(0.025)=1.25 total pounds of milk needed
(1.25 pounds)(16 oz/pound)=20 ounces total needed in 24 hr
(20 ounces)/12 =1.7 (round to 2) ounces every two hours
3) Neonatal Feeding (by % body weight in KILOGRAMS)
(BW in kgs)(%BW to be fed)=liters needed in 24 hours
(liters needed) x 1000 = milliliters needed
(milliliters needed)/(30)= ounces needed in 24 hours(*since
there are 30 mls per ounce). Divide total by 12 for amount
needed q 2 hours
3) DILUTIONS
(volume) (concentration)= (volume) (concentration)
Eg: You want a 20 mls of a 3.3 % Natacyn sol’n and have a 5%
solution
5%= 50 mg/ml
(50 mg/ml)(“x” mls) = (33mg/ml)(20 ml)
50 x = 660 mg
x = 13.2 ml of 5% needed. Bring up to a total of 20 ml