Equine Emergencies

The following 9 equine emergencies are described in terms of observable signs, the degree of urgency, and first-aid steps that should or, depending on the nature of the emergency, should not be taken prior to seeking immediate veterinary attention.

Choke: While many cases of choke will clear up spontaneously, or resolve within half an hour, some do not, as such, it should be treated as an emergency. Signs of choke include stretching out the neck, excess salivation, food material coming out of the nose, clenching of neck muscles. Horses that have experienced choke are susceptible to aspiration pneumonia and a range of other, although less likely, potentially life-threatening complications including esophageal rupture and kidney failure. Prior to calling the vet, try to ascertain what is causing the choke, food, bedding, another foreign body. Most importantly, move the horse to a quiet space and encourage it to relax with its head lowered to prevent any more saliva or food from entering the trachea or lungs. Do not allow the horse to eat or drink. Continuing to ingest anything after the onset of choke may worsen the blockage.
Colic: There are multiple types of colic, some of which are mild and will pass on their own, others that are more severe and life-threatening. Regardless, all suspected cases of colic require emergency medical attention to determine the cause and intervene if necessary. If left untreated, some forms of colic can be fatal. Prior to calling the vet, check the horse’s temperature, pulse, respiration, and mucous membranes, and listen for gut sounds. If the horse is standing or lying quietly, let it rest. If it is thrashing or behaving violently, attempt to walk or move it to an open space to avoid injury. It is very important to remove all food and water from the stall or paddock. Allowing the horse to ingest anything could further complicate an impaction or torsion, or rupture the stomach. Do not administer banamine or phenylbutazone unless advised to do so by the vet, as it may mask symptoms.
Ocular Trauma: It is impossible to ascertain the degree of damage present in a case of ocular trauma without prompt and proper evaluation from a veterinarian. Depending on the nature of the injury, there could be damage to the eyelid, conjunctiva, cornea, or lens, and in the case of a direct blow to the eye, there could be a fracture or retinal detachment. Left untreated or improperly treated, something as seemingly superficial as minor scratch on the surface of the eye (a corneal ulcer) can lead to a bacterial or fungal infection, and a loss of vision. Call the vet immediately and describe the condition of the horse’s eye as best as you can. It is very important to protect the eye from further damage and prevent the horse from rubbing its eye on anything. If the horse is accustomed to wearing one, put a fly mask on the horse to protect the eye from dirt, insects, and if outside, sunlight. Do not attempt to remove a foreign body embedded in the eye. If done improperly, the structure of the eye may collapse. It is also inadvisable to apply any ophthalmic ointment containing steroids (cortisone, dexamethasone, hydrocortisone). If the horse has a scratched or ulcerated cornea, a steroidal ointment may delay healing and increase the risk of infection.
Grain Overload: A horse that has consumed a large amount of food in a short period of time is susceptible to colic, laminitis, endotoxemia, and in severe cases, a ruptured stomach. Prior to calling the vet, check the horse’s temperature, digital pulse, respiration, and mucous membranes, and listen for gut sounds. Note the presence of any manure, the amount of food consumed and estimate the period of time in which it was ingested. This information will help the vet determine the urgency of the case. The most important thing to do is secure the horse in a stall with no access to food or water. Adding more food or liquid to any already distended stomach could cause further complications. Do not attempt to insert a nasogastric tube oneself. The tube passes through the nostril to the pharynx, which connects to both the esophagus and the trachea. It is vitally important that the tube is inserted correctly! Accidentally inserting the nasogastric tube into in the trachea and then administering mineral oil or liquid charcoal could be fatal.
Heat Stroke: When a horse’s rectal temperature exceeds 104.9°F (40.5°C) it is suffering from heat stroke and is highly susceptible to organ and brain damage due to the increased oxygen demand created by the hyperthermic state. If left untreated, heat stroke is fatal. Immediate veterinary attention is required to assess the presence and degree of damage to internal organs so treatment can begin as soon as possible and fluids can be administered intravenously. Prior to calling the vet, begin cooling the horse with water applied with a sponge or hose to lower the body temperature. Pay particular attention to the neck (large veins) and groin area (thin skin). It is imperative to immediately cease all physical activity and remove tack to initiate cooling. If is safe to do so and if shade is available nearby, move the horse out of the sun. Do not delay cooling. If cooling is delayed, the oxygen required by the horse’s metabolic system can exceed the amount produced by the respiratory system, resulting in a coma and/or death.
Hoof Puncture: Without a radiograph there is no way of knowing the depth or severity of the puncture and which structures of the hoof may be impacted. Depending on where the object entered the hoof, for example, in the case of a nail puncture in the middle of the hoof, the synovial structures (coffin joint, navicular bursa, deep digital flexor tendon sheath) could be affected. These cases are urgent! A puncture is also an easy way for bacteria to enter the hoof and if left untreated can lead to infection (sepsis, tetanus). Prior to calling the vet, move the horse to an area with clean, dry footing and clean the hoof. It is important to carefully clean and cover the sole of the foot with a protective bandage or clean boot to prevent further contamination of the area. Do not remove the object from the hoof before the vet can take a radiograph to see what internal structures are affected. Furthermore, attempting to remove the object oneself has potential to cause more harm, i.e. the end of the object may break off, making extraction more difficult. However, if the object is protruding past the bottom of the foot and will be impacted further by the horse stepping on it, it is advisable to gently remove the object and mark the entry point with a hoof knife or marker prior to covering the foot.
Lacerations and Puncture Wounds: Any laceration or puncture wound over a joint will require immediate attention because a) healing will be hindered by movement, and b) it is possible that synovial tissue has been penetrated, which would be indicated by the presence of a viscous, yellowish transparent fluid. Any wounds with prolonged or excessive bleeding require the application of a pressure bandage and also require immediate veterinary attention, as do wounds with gaping skin edges. Prior to calling the vet, note the location, general size, and nature of the wound. If there is excessive bleeding, the priority is to apply the pressure bandage, otherwise, it may be advisable to gently rinse the wound with clean water or a saline solution and apply pressure to reduce blood loss. Do not try to inspect the injury to see how deep or severe it is. Doing so may further damage and contaminate the tissue. Wait for the vet to do a proper and thorough cleansing of the wound, with sedatives if deemed necessary.
Sudden Onset Severe Lameness: Sudden onset severe lameness occurs when a horse is only able to bear minimal weight on a limb or is unable to move, which may be the result of a hoof puncture, subsolar hoof abscess, tendon or ligament injury, or most severely, a fracture. Prior to calling the vet, ensure the horse is calm and secure to prevent any unnecessary movement, which could exacerbate the injury. While many sources suggest trotting a horse to determine which leg is lame, this is not advised in cases of severe lameness. Do not force the horse to move! Doing so could cause further distress for the horse, increase damage to affected tissues, and in the case of a fracture, potentially displace the bones beyond the point of repair. The most important thing to do is keep the horse as still as possible, especially if a fracture is suspected to minimize further damage and distress. Do not provide pain-relieving medication to a horse with severe lameness, as further movement may cause further instability or damage if a fracture is present. It is also inadvisable to administer any anti-inflammatory medications if an abscess is suspected because the medication will reduce inflammation, thereby making the abscess less likely to open and drain, potentially leading to a severe infection.  
Acute Exertional Rhabdomyolysis: Commonly known as ‘tying-up’, exertional rhabdomyolysis can cause muscle necrosis and in severe cases, kidney failure. Veterinary attention is necessary within 24 to 48 hours of mild cases, and immediately in acute cases. In suspected acute cases, the vet will test blood levels for myoglobin, which is toxic to the kidneys, administer intravenous fluids to counter dehydration and flush toxins from the body, as well as assess the extent of both muscular and kidney damage. Blood serum levels will be tested again for creatine kinase (4 to 6 hours after the episode) and aspartate aminotransferase (18 to 24 hours after). Prior to calling the vet, if the horse is able to move without too much strain or distress, move it to a stall and ensure it has access to water. It is important to stop exercise at the first sign of exertional rhabdomyolysis to prevent it from worsening. In mild cases, a horse will experience slight muscle stiffness while in more acute cases, the horse may be completely unable to move. Do not force the horse to move if it is reluctant to do so. Exertional rhabdomyolysis can be a source of excruciating muscular pain (cramping) for the horse.
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