Evolution of Critical Care in Private Equine Practice (AAEP 2009)

There have been marked changes in the level of equine critical care, noted Fairfield Bain, DVM, MBA, Dipl. ACVIM, ACVP, ACVECC, at the 2009 American Association of Equine Practitioners (AAEP) convention, held in Dec. 5-9 in Las Vegas, Nev. These changes, he said, are in large part due to improved skills, training, and experience of practitioners that facilitate expeditious case assessment. In today's electronic world, this is coupled with networking opportunities to obtain information and guidance from other clinicians. Also noteworthy are the improved availability of tools for rapid diagnosis and improved quality of facilities outfitted with high-tech equipment and qualified personnel for thorough patient care and monitoring.

Bain reported that all these improvements have increased the knowledge base and resources of today's veterinarian. Now the critical care patient is viewed with a longer list of differential diagnoses along with improved understanding of diagnostic strategies. Advanced technology, such as ultrasound, endoscopy, digital radiography, and patient-side lab testing, allows for more rapid answers on site.

Using colic as an example, Bain noted that such equipment and diagnostic techniques allow the practitioner to corroborate findings from the physical and rectal exams, information gleaned from passing a nasogastric (stomach) tube, and abdominal fluid analysis. The clinician's ability to manage pain still remains an important indicator of the need for surgery.

Bain stressed that the goal with any critical care patient is to make the most accurate diagnosis in the most expedient manner. Abdominal ultrasound adds invaluable information to the work-up and hastens the speed of diagnosis, along with isolating the area of bowel involved in colic. Other changes include the variety of available pain control methods and medications and the equipment available, such as nonthrombogenic (non-clot-forming) IV catheters to administer large quantities of intravenous fluid therapy. Bain remarked that in the past two decades, equine veterinarians have made significant advancements in shock management through the use of anti-endotoxemia drugs and large volumes of specialized fluid therapy, such as crystalloid fluids, hypertonic saline, and/or colloids.

Communication between referring veterinarians and referral hospitals has greatly improved, which hastens the care response for cases. Timely intervention is linked to successful outcomes. Practitioners also continue to discuss a case with the client as the horse's medical condition changes, which allows the client time to process the progression of a critical care situation. This facilitates more rapid decision-making to proceed to surgery when necessary. Bain pointed out that while some horses are beyond our ability to fix them, now veterinarians have better opportunities to make more accurate and speedier diagnoses, so as not to unnecessarily prolong pain and suffering. A post-mortem exam often puts everyone's mind at ease and provides information that improves practitioner diagnostic skills; this is a tribute to patients that couldn't be saved.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.