The purpose of first aid is to minimize the damage done by disease or injury and prevent infection, so that healing can proceed as rapidly as possible, writes Dr Robert N. Oglesby DVM.
Sometimes first aid is all you need, other times it is a temporary measure until further help arrives. First aid can remarkably affect the outcome. Once principles are understood, common sense must be applied. Remember, if you are in a panic, you will not be able to help anyone, so step back from the situation and gather your wits before you tackle the problem. You may not be the only animal who is excited. The injured horse will also be confused and excited which makes him dangerous. If you cannot safely approach him: do not.
The Rules are as important as the first aid.
- RULE ONE: Keep calm.
- RULE TWO: Do not let the horse hurt anyone.
- RULE THREE: Get the horse to a quiet familiar location to work on him. Actively assess: “can this horse be worked on safely?” “What can I do to make it safer for the horse and me?”
People tend to overestimate the severity of bleeding. Remember that a 1000 lb. horse has over 7 gallons of blood in his system and he can lose one gallon without serious effects. Of course, if a laceration has profuse bleeding, steps should be taken to slow it down.
Bleeding can be markedly slowed by applying pressure over the source of the blood. This should be done with a clean cloth, if available. Fold the cloth several times on itself to create a thick pad and apply a stretchy tape, Vetwrap-like material is excellent, firmly over the bleeding wound. This type dressing must be dry to adhere to itself so you must keep pressure on the bleeder as you apply the first few layers of the wrap. You can slow down the bleeding considerably using this method. Too much padding or too loose will prevent you from getting adequate pressure. For instance towels wrapped around the bleeder are not going to help, though I see this done frequently. If the tape is very tight around the leg, change it every 10 minutes to allow circulation to the rest of the leg. If the location of the bleeding is such that you can not tape it, hold the bandage firmly in place until the bleeding stops.
Deep Cut in the Skin Versus A Full Skin Thickness Cut
Many horse owners have trouble differentiating a deep cut in the skin and a full skin thickness laceration. From a treatment standpoint they are very different. Whereas deep cuts in the skin do not require stitches and antibiotics, full skin thickness lacerations do. The deeper layers of the skin can be white to pink resembling the tissue under the skin. One of the easiest ways to tell is that cuts which do not penetrate the skin all the way cannot have the edges of the wound separated. You cannot pull the edges of the wound apart because at the bottom the skin is still connected. How deep can a partial thickness wound be? In some areas where the skin is thick it may be 1/4 to 3/8’s of an inch deep on the other hand in some areas the skin is as thin as 1/8 inch.
Cuts Which Do Not Penetrate the Skin
Clean with soap and water and twice daily apply a nitrofurazone based spray. Antibacterial ointments are OK but do not last as long. If the area will be subjected to dirt like the lower legs a clean bandage kept dry is good. These wounds do not require suturing but a careful examination is in order to be sure there are no punctures (see below).
Full Skin Thickness Wounds
Whether this type of wound should be sutured or not depends on many factors: age of the wound, location, contamination, blunt trauma, and even the first aid care all factor into the equation.
Many people misunderstand the dynamics of serious infection thinking suturing ensures this will not happen, when the opposite is true. Contaminated or badly traumatized wounds are safer left open and cared for properly than when sutured. The reason is drainage. Proper drainage helps insure the prevention of ascending infection. Obviously a sutured wound cannot drain. Before a wound is sutured it is imperative that it be clean, free of contamination, and badly traumatized tissue.
- Open wounds that will not receive medical attention for several hours or more should be flushed out with clean water and bandaged, using an antibacterial ointment such as Neosporin. A garden hose with the nozzle set on a firm spray is ideal for flushing.
- If a wound is to be stitched, flushing and bandaging will help minimize infection until the wound can be sutured. Avoid applying medications to the wound, as they may interfere with healing. If medical help is more than two hours away ask the opinion of the vet as to what you might dress the wound with. I like petroleum based triple antibiotic ointments, Furacin ointment or Nolvasan creme. A spray with diluted (somewhere between the appearance of strong tea or coffee) Betadine is good also.
- If the wound is badly contaminated with dirt, it should be gently cleaned with a antibacterial soap, thoroughly flushed, then bandaged with ointment. Seek professional help with contaminated wounds, as these may have life-threatening complications such as tetanus or gangrene.
- Avoid peroxide or blue wound sprays, as they will kill healthy tissue. The one exception would be a contaminated sole wound. Peroxide can be used to clean these out initially.
What Deeper Structures Are Injured?
With all wounds and particularly with full skin thickness lacerations you must consider what other structures are traumatized. With lower limb injuries penetration into a joint capsule or tendon sheath can turn a routine laceration into a lifetime performance-compromising injury. Deep injuries to these areas should always be examined by a veterinarian.
Punctures: the worst of all wounds
Punctures can really fool you. They frequently look like minor wounds, but depending on the depth and contamination they can rapidly become infected. The first signs of problems are usually pain and swelling 24 to 72 hours after the accident. The puncture seals up rapidly, so the infection has no place to go and will spread to surrounding tissues. When in doubt about how deep the puncture is or you doubt that it is draining well, have it examined by a vet. Punctures need to be open and explored for foreign bodies, thoroughly cleaned and may be left open or sutured.
If your horse receives a hard blow that does not break the skin consider ice compresses for a minimum of 30 minutes and oral bute (1 gm. per thousand lbs. twice daily for 3 days) to limit swelling and pain. Bruised tissues are far more susceptible to serious infection so penetrating wounds with a lot of bruising are more serious. Where heat and swelling is present cold compresses or hosing will help.
An area where bruising is particularly serious is to the back of the thigh. These large muscle masses are prone to forming scars from deep bruises. These scars contract and will effect the gait of the horse for life. These horses cannot reach forward as far with the effected limb and slap the ground during the anterior phase. Special care to get the inflammation out as quick as possible and keeping the horse moving with controlled exercise during the next 60 to 90 days is imperative.
A first-class equine first-aid kit
Stabling a sick horse
Proper wound treatment reduces complications
Wound First Aid in Horses
Hints on proud flesh
Immunisation gives long-term tetanus protection
Tetanus on the increase
The Accident: To Treat and Spell or to Spell and Treat?
This article reprinted with permission from Horseadvice.com, an internet information resource for the equestrian and horse industry since 1994. On the WWW at www.horseadvice.com we have tens of thousands of documents on the web about horse care, diseases, and training. © 2005
First published on Horsetalk.co.nz in 2007.