June 22, 2018
Advancements in Stall Side Treatment
Disaster and field trauma medicine are emerging fields in veterinary medicine. What this means for horses and their owners is that medical products and diagnostics used in this new field are becoming more and more point of care or “stall side.” In a disaster setting, whether it is post-barn collapse due to a natural disaster or a single horse trailer accident, time is of the essence and decisions on treatment must be made very quickly. Equipment is now being manufactured that allows ambulatory veterinarians to do advanced diagnostics right on the farm. Here at Dunlap EquineServices we do a lot of emergency work and have a lot of experience in trauma medicine, and it’s really beneficial to be able to gather a great deal of information in a short period of time right in the field for a down horse, a colic, or a catastrophically injured patient.
Blood analyzers, which check how dehydrated a horse is, electrolyte balance, red blood cell volume and organ values, used to be cumbersome and too heavy to move. They are now handheld and no bigger than a cell phone and can analyze blood in 15 seconds right in the field, helping to target fluid therapy and treatment in critical cases. The i-Stat handheld is a rugged little machine that is very easy to use. Chemistry analyzers, which give even more data on organ function, such as kidneys and liver values, are now no bigger than a shoebox and are made for use in the field. We have used our analyzers in a lot of different situations and they have been very reliable.
Musculoskeletal diagnostics, such as digital x-ray and ultrasound, are also rugged and highly portable. Veterinarians can now consult on therapeutic shoeing faster and easier than ever before, sending a radiograph to the farrier via an aircard within seconds for real time consultation. Advancements in portable ultrasound allow veterinarians to image everything from a tendon injury to lung disease to a gastrointestinal problem. And with the more powerful x-ray generators that are now available, veterinarians can image everything from the skull and spine to the tiniest foal hoof. We can immediately target treatment to the problem at hand. Latest advances now allow veterinarians to do digital radiographs completely wirelessly – with no cords and no electricity required – which literally means one can take an x-ray while standing in the middle of a pasture.
Advancements in mobile endoscopy have been more rapid than in any other area. Video endoscopy used to require a lot of heavy equipment, including the scope itself, a videomonitor to see the image, a light source, and other equipment – all placed on a big stacked cart and requiring hospitalization to do. Within the last year, heavy equipment and in-clinic only scoping are becoming a thing of the past with the advent of digital endoscopy. High powered scopes are now lightweight and only require a laptop to plug into, allowing the scoping to be completely wireless, requiring no electricity. Packed into a hard case, I have been able to carry my scopes (upper airway and gastroscope) into extreme conditions and they have performed beautifully, allowing us to image upper airway issues, stomach ulcers (gastroscopy), sinus problems, and even into deep penetrating wounds to assess body cavity involvement. The benefit is that the patient doesn’t even have to be in a barn to get “scoped,” whether it is upper airway or gastroscopy.
In any emergency and even for non-emergencies, the development of high tech portable wireless equipment for field veterinarians gives us the ability to diagnose rapidly and treat quickly, allowing us to alleviate pain more quickly, saving patients time, clients time and money and getting patients on the road to recovery even sooner. The high tech world of smaller, lighter machinery with a wide array of capabilities is vastly improving the “stall side” treatment of equine patients.
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