It’s probably no coincidence that several of the speakers in the afternoon session on “How to manage critical field emergencies” referenced the Winston Churchill quote-turned-Internet-meme “Keep Calm and Carry On.” Emergencies are a huge part of the ambulatory equine practitioner’s bread and butter. After all, horses are emergencies on the hoof.
Still, certain situations can make even the most seasoned veterinarian cringe. Our emergency cases are often more acute, larger, and more public than those seen by our small animal colleagues. There is no back room into which the field practitioner can take his or her patient to evaluate the patient quietly, or to stabilize the patient without a hysterical owner hovering nearby. Stabilization of equine emergencies takes place not only in front of the owner, but often the trainer, neighbor, other boarders, assorted children, and the guy who happened to drive by and wondered what all the fuss was about.
Given all of this, it is perfect that this afternoon’s session opened with a talk entitled “How to communicate with clients in an emergency setting.” Most equine practitioners are already pretty good horsemen and women, and our veterinary colleges pound a solid medical training into our heads, but unfortunately, none of that is of any use unless we can communicate with the client. And, often, we aren’t trained for that. Going back to communications basics, Dr. Amy Grice gave some excellent tips on building those skills in order to better serve our patients.
It’s easy in a crisis to forget the fundamentals or to lose track of the details. When the adrenaline runs high, everyone tends to get tunnel vision. Speaker after speaker went back to the basics on their emergency topic, and multiple speakers stressed the need for a complete history and complete physical exam, even when the problem appears obvious.
In his talk on managing non-weight-bearing lameness, Dr. Ryan Penno said, "Always perform a full and comprehensive exam even though the affected limb may be readily apparent.” He also reminded us that things are not always as they seem. In the limb, swelling may be below the site of the injury, because fluid follows gravity. However, if the injury is to the hoof the tissues above the hoof may swell as the excess fluid is forced proximally by the rigid hoof wall.
In addition to cracking up the room with her comparison of the kidney to a champagne fountain (you’ll have to trust me on that one) Dr. Emma Adam took us back to the basic sciences when evaluating and treating the dehydrated horse, pointing out that the peculiar composition of horse sweat means that excessive losses result in a metabolic state that actually produces a decreased thirst, so often the horse will fail to drink, worsening the problem.
Every horse person’s worst nightmare is the broken leg. But, Dr. Scott Palmer, who was on the team at the track that stabilized Barbaro, walked us through the basics of evaluating and stabilizing a fracture in the field. Even for someone who has seen a number of fractures in the field, it’s good to have a reminder to approach the situation as thoroughly and methodically as I would any other case.
Thorough and methodical was the name of the session. Many emergencies can be stabilized or even treated in the field, and ambulatory practitioners are at the front line of equine disasters. However, when discussing fevers of unknown origin, Dr. Amy Leibeck made one of the most important comments of the afternoon. “Referral is not an admission of failure; it is a commitment to the patient.”