Equine First Aid

Original Editor - Ansi van der Walt Top Contributors - Jess Bell, Kim Jackson, Tarina van der Stockt and Chelsea Mclene

Introduction

Equine first aid is always an interim measure that should be provided until a qualified veterinarian arrives to take over an animal's care. When working with horses, it is necessary to first assess whether or not it is safe to approach the animal. Horses in pain are unpredictable and can be dangerous. To assess a horse’s condition, you will need to assess its general appearance and attitude, look for bruises and swelling, and measure vital signs (see below) and intestinal sounds.

Vital Signs

When horses appear to be unwell, checking their vital signs can help to determine the cause. The following are normal ranges for temperature, respiratory and heart rate:

• Temperature: 36.6 - 38.3 degrees Celsius

• Respiratory rate range: 8 to 20 breaths per minute
• Heart rate:
  • Normal mature horses - 28 to 40 beats per minute
  • Newborn foals  - 80 to 120 beats per minute
  • Weanlings - 60 to 80 beats per minute
  • Yearlings - 40 to 60 beats per minute

Other Basic Considerations

Dehydration

In order to assess for dehydration, you can pinch a fold of skin on the horse’s neck and release it. Normally, the skin will quickly return to its starting position, but in dehydrated horses the skin:

• Returns more slowly
• Stays in a fold

Mucous Membranes

A horse’s mucous membranes (i.e. gums, inside lips of a mare's vulva and nostrils) should be pink. Changes in colour suggest specific issues:

• Fire engine red is typically a sign of illness
• Pale colour is a sign of anaemia
• Bluish-purple colour is a sign of poor circulation 

Quantity and Condition of Circulating Blood

You can assess the quantity and condition of circulating blood by measuring the rate of capillary refill (i.e. the time it takes for blood to return to an area). Capillary refill time may suggest anaemia, colic, congestion and shock. To measure capillary refill time, press your thumb on the horse's gum and then release the pressure. It typically takes around two seconds for normal colour (i.e. blood flow) to return. An increase in capillary refill time can indicate dehydration or circulatory problems.

Wounds

Step One: Inspect the Patient

You should wait for 5 to 10 minutes for the horse to settle down. Blood loss or shock may result in:

• Elevated heart rate (more than 60 beats per minute)
• Increased capillary refill time (4 seconds or more)
• Cool extremities and shivering

Step Two: Inspect the Wound

Cuts that do not extend all the way through the skin are not usually severe. Wounds above the knee or hock that go through the skin layer, but have no associated deeper tissue damage may heal without complications. However, wounds below the hock or knee, which have associated tissue damage below the skin, or that occur near joints or tendons require medical review as soon as possible.

Step Three: Clean the Wound

It is essential to clean and flush the wound. All debris needs to be removed. The wound should be flushed a number of times in order to effectively remove all dirt and bacteria.

If the horse has a bleeding vessel, clamping and twisting (10-15 times) with a haemostat forceps will often stop the haemorrhage. If this does not work, pressure wraps may be effective. Pressure should be applied to the wound until the bleeding stops.

Step Four: Medicating the Wound

The area around the wound needs to be dried (through blotting). You can then apply an antiseptic ointment. Do NOT use:

• Hydrogen peroxide
• Tincture of iodine
• Purple wound dressing
• Petroleum products

If sutures are required, wound ointments should not be applied as the wound must be kept fresh and moist. Preferably, wound suturing will be done in the first six hours post-injury.

Red Alerts

The following are signs of serious issues:

• Horses who have a wound and appear cold, very tired, have pale mucous membranes, and irregular breathing, maybe in shock. This horse should be covered and kept as warm as possible
• Horses who have uncontrollable bleeding from a wound even when direct pressure is applied for more than ten minutes
• Horses who are very lame or thrashing following an injury
• Horses who have clear yellow fluid coming out of joint wounds
• Horses who have wounds on their joints, or below the hock / knee. With these injuries, there is a risk of infection getting into a joint and there may be a lack of blood supply below knee / hock, which can slow healing and cause infection

Colic

Colic is a significant cause of mortality in horses. The following table adapted from Squaw Butte Back Country Horseman summarises the signs of mild, moderate and severe colic in horses:

Mild	Moderate	Severe
Lies down	Paws at the ground	Wildly thrashes and rolls
Pulse elevated (50 - 60 bpm)	Pulse elevated (60 - 80 bpm)	Pulse elevated (over 80): - If the pulse rate is over 100, the horse will usually die - If the pulse rate is over 120 and membranes are blue, the horse is close to death
Capillary refill time of 2 seconds		Capillary refill time of 3 seconds or more
Pink membranes		Pale membranes
No gastrointestinal motility or excessive motility	No gastrointestinal motility
Lethargic, yawns	Lies down, gets up, stretches
Looks at flank	Sweating
No appetite
Grinds teeth

First Aid for Colic

The two most important factors to help determine a horse’s condition are:

• Heart rate
• Gum colour

You can walk the horse, but you should let it lie down if it wants to (being careful it does not roll on you) and you should withdraw all access to feed.

Colic Prevention

• Avoid sudden changes in feed, excess grain, or working the horse on a full stomach
• Avoid giving the horse cold water until it has cooled out - and only provide small amounts at first
  • Horses have been found to prefer warm water to cold water in winter
• Do not feed horses on the ground or in sandy areas (ingesting sand can lead to sand colic)