The first thing to do is to properly evaluate the problem.
Is it an open catastrophic wound that has profuse bleeding ? Is it an open catastrophic wound with damaged tendons and no bleeding ? Is there exposed bone ? Is there a penetration or puncture into a joint ? Is there extensive muscle damage ? Is there a possibility of a broken bone with no external damage at the site ? Is it a badly lame horse with an abscess in the hoof ?
These are the basic situations to look for first. Establish your problem and consider your options for solution. Becoming panicked or hysterical is a poor start.
In all cases, you are likely to be there without a veterinarian. The more accurate description of the injury you are able to develop, directly affects the action you will take and the effectiveness of the telephone conversation you will conduct with your friend or veterinarian.
Trying to discuss with everyone on how it occurred is useless - at least 80% of all the people that walk up to watch us treating an injury in our practice ask "How did this happen ?" My answer is "I don't know, since I didn't ask the owner." The reason I don't ask the owner is I don't want to get caught up in this conversation, which has nothing to do with dealing with the problem at hand.
The issue is - what is the problem and how do I care for my horse -
1) Horse behavior - Is the horse able to be handled ? 2) Can the horse be moved ? A horse with a broken leg can be loaded into a trailer. 3) Is there profuse bleeding ? Hold on to this fact - very few horses have ever bled to death due to extremity injuries. 4) Is this injury life threatening or can I employ adequate treatment until assistance is available. a) Life threatening - Which neighbor do I have that I can call who will be helpful, resourceful and have some of the supplies that I may need ? i.e. Banamine for pain, Bandaging supplies for creating a pressure bandage on a bleeding wound, objectivity about the extent of the injury and whether it is in fact life threatening, do they have a trailer or the ability to pull your trailer, the ability to help load a horse, and good horse handling skills. The wrong person enhances the disaster. (Especially if the person thinks he/she knows more than the veterinarian you want to call to help) b) Maintaining your composure and thinking resourcefully are of utmost importance. With modern technology, it is possible to take a picture with your cell phone, and send it to your vet. Then your vet can discuss with you immediately what steps to employ. After seeing a picture, the vet may be able to council you on how to deal with the situation until more help is available. c) With life threatening injuries, the first vet may be the best with a referral vet in mind for follow up treatment.
The first step is to decontaminate the wound without destroying the tissue.
Medications - The wrong medication is worse than no medication. Why put something on a fresh wound that inhibits healing under the guise of thinking that you are killing bacteria and stopping infection ? Applying the wrong medication at the wrong time can prolong healing from weeks to months. 80% of all topical medications on the market are designed to kill proud flesh (or exuberant granulation tissue). 90% of these products destroy circulation and circulation is the most critical factor in wound healing. The body has it's own response to injury, sending blood and platelets, with platelet derived growth factors, serum and white cells, all designed by nature, to deal with infection and exposure to bacteria. Trapping these fluids at the wound site is an important part of wound healing.
Cleaning the wound - Spraying a wound down with water decontaminates the site, but it also ruptures the red blood cells. If you wash a wound with water long enough, you will see it turn from red to gray. That means you have destroyed all the cells and you only have connective tissue left. (Final proof - If you give patients transfusions of water, you will rupture all the blood vessels and they die.) Saline solution, if available, in a spray bottle, if possible, is the most effective way to decontaminate a wound site until you have better options. i.e. Lacerum or Eclipse Wound Wash, which are non-cytotoxic and antibacterial and antifungal, could be used very effectively. In many cases, we put these products on, wrap the wound and leave it overnight, and then proceed the following day with the follow-up therapy. As a start, if you have nothing else to use, 5cc of penicillin sprayed on a wound site topically may be more effective than 25cc put in the muscle.
Bandaging - Correct bandaging is a MUST. i.e. A pressure bandage to stop profuse bleeding left on too long can cut off circulation and cause a hoof to slough off due to lack of blood supply. We have a DVD available on proper bandaging techniques, including how to bandage difficult parts of the body for prolonged periods of time with a minimum of time and cost involved.
Profuse bleeding wounds:
First step - Stop the bleeding with pressure. Don't release the pressure every five minutes to check to see if it has stopped bleeding. Keep the pressure on the site, prolonged pressure can create problems due to impairing circulation. We suggest that you purchase a trail riding safety kit that has a wound wash, gauze pads, an elastic bandaging (like Power Flex) that has a reduced amount of elastic tractability along with all the "regular" supplies.
Second Step - How to re-locate the horse to a treatment area that is adequate for the horse and accessible to the caretaker. It may be more cost effective to hospitalize the horse than to pay the vet for multiple trips to your stable to treat the horse. A vet that is serious about catastrophic wound therapy will arrange his operation so that you can afford him and he can afford you. If this problem is not resolved, then it does not work for either party.
A cut or damaged tendon is more susceptible to infection. It is important to establish if there is a damaged tendon, but it may require professional help. The healing time on a damaged tendon is also substantially longer than in an injury with no tendon damage. In any case, the above procedures for decontaminating the wound are still the First Step. We have had several cases that were referred to us when the owner was not aware that the tendon had been cut or damaged. A non-functional tendon alters the healing procedures that will be employed, the amount of IV (intravascular) and IM (intramuscular) medications used, and the length of healing time required. In some cases, a Kimsey brace may need to be employed for the horse to be able to stand on the leg - most vets have access to this type of support. This is especially true if the flexor tendons have been severed. Fiberglass casts can be employed, but if bandaging is a requirement, then the cast will need to be cut on each side so that it can be removed for treatments and re-bandaging, then it can be re-applied using an ace bandage.
The location of the exposed bone is an important factor due to the fact that it controls your ability to keep the area bandaged. Exposed bone, as in the case with damaged tendons, is also susceptible to infection but is even more serious. The initial bandaging instructions apply, and in the case of a de-gloved wound, we elevate all tissue back into place before we bandage. Traditionally, the veterinary profession trims off rough elevated edges of tissue to create a more cosmetic healing. Our practice is to not cut off any tissue that is alive. These knots of tissue will contract down as the wound heals, and become cosmetic. Below the knees and hocks, the overgrowth of granulation tissue, due to over-bandaging, becomes a critical factor. The owner should consider the fact that it will take from three to five months to granulate a major wound site back to the level that hair will grow on the wound. Improper use of caustic materials can prolong this healing time and create a much larger scar than may have been achieved. Damage to the bone surface can lead to a condition called avascular necrotic bone, and this will prevent closure of the wound. Please see case 34 for an example of this development. It usually occurs at about the 30th day of healing. Once these wounds are covered with granulation tissue, the owner should no longer be concerned about deep tissue infection. The blood supply and the granulation tissue is adequate to take care of normal bacterial contamination.
This is a Red Light Zone. The size of the puncture wound has NOTHING to do with the seriousness of the situation. This is an opportunity for you and your vet to become close friends.
Extensive Muscle Damage:
These horses may demonstrate an inability to move limbs initially. They can be rehabilitated back to full performance. Cosmetically, there usually will be a dimple, because these injuries heal by fibrous union, but the strength of the healed muscle is adequate.
If the leg flops, either the bone is broken, or the tendon is cut. In both cases, you need a vet. He may be able to help you stabilize the leg. (See damaged tendon for bracing info)
Lame - No Apparent Injury:
Diagnosing hoof lameness - Use pliers or hoof testers on the hoof, to ascertain if there is a tender spot. Soaking in hot Epsom salt water is an asset to bringing an abscess to the surface, and once the abscess opens and drains, the horse should become sound in a matter of days.