Equine emergencies can be challenging for veterinarians and emotionally charged for owners. Preparation before an emergency occurs is key. Discuss the best facilities for treatment with your veterinarian ahead of time. Have phone numbers and other information on hand. Know how to get to the facility you have chosen, plan how you are going to transport the horse, and keep driving directions handy. Assemble and keep a first aid kit on hand to deal with immediate needs and transport in case your horse requires emergency treatment.
The most common types of equine emergencies are abdominal pain (colic), trauma and lacerations, and ill foals.
Common Emergency Procedures in Horses
Emergency procedures for horses follow the same general principles as those for small animals. However, there are special considerations for horses. Because horses cannot lie down for extended periods of time, some conditions that are considered less serious in other animals are emergencies in horses. Also, treatments often vary between smaller animals and horses.
Monitoring a horse in an emergency situation is crucial. In a horse that is in severe shock, pulse and breathing must be closely monitored.
Preventing and treating dehydration is a primary concern. Horses require about 60 milliliters per kilogram of fluids per day normally. For an adult horse, this is about 1 liter (about 1 quart) per hour. Athletic horses often require more fluids. Heart rate, pulse, urine production, and other tests help determine whether a horse is dehydrated. Dehydration often develops along with other injuries and illnesses. Diarrhea is a major cause of dehydration, particularly in foals. If the horse is losing fluids, such as with diarrhea, very large quantities of fluids may be needed to correct the fluid loss. For example, a 1,000‑pound horse that has become 5% dehydrated will need 25 liters (about 6¼ gallons) of fluids to correct that loss.
If a lot of blood has been lost, or the horse is exhausted or overheated, emergency fluid replacement is needed.
Nasogastric intubation is an essential and possibly life-saving procedure commonly used in cases of equine colic. A tube is placed through the nostril down into the stomach to remove fluid that has accumulated in the stomach due to a blockage in the small intestine. Removing the fluid not only relieves the pain of the distended stomach, it may also prevent rupture of the stomach.
In abdominocentesis, a needle or syringe is inserted through the abdominal wall to obtain a fluid sample. The fluid is used in the evaluation of abdominal diseases such as colic and weight loss. If the horse has suffered an intestinal rupture, this test will generally detect the problem. For the first 2 to 4 hours after a rupture of the intestine, the horse may not show any signs. Internal bleeding can also be detected by abdominocentesis.
Trocarization is a technique used to relieve the pressure in the abdomen when it becomes distended with gas due to an intestinal blockage. Such blockage can result in severe bloating (distention), pain, and rapid or uneven breathing. The veterinarian will identify the segment of intestine that is involved by rectal examination in adult horses. In foals or small horses, x-rays or ultrasonography can be used. If the problem is in the large intestine, trocarization may be used. After the pressure is relieved, the trocar is removed, and an antibiotic is infused. Because infection and other problems are possible after trocarization, the horse is usually monitored carefully for 24 hours for signs of any complications. Trocarization may not solve the blockage problem, and the horse may still need additional treatment or even abdominal surgery.
If the trachea is blocked due to swelling, a foreign object, or excessive bleeding, the airway needs to be opened. An emergency procedure for inserting a tube through the neck to allow breathing is called a tracheostomy. A local anesthetic may be given. The incision is made in the neck, and a tube is inserted into the trachea to help the horse breathe.
Once the horse can breathe without using the tube, it is removed. The incision site generally closes in 10 to 14 days and heals in 3 weeks. During that time, antibiotics may be used, and the site is cleaned and monitored.
Transporting an Injured Horse
In many equine emergencies, your veterinarian will travel to your location to assess and treat your horse. However, in some cases it may be necessary to transport your ill or injured horse for treatment.
Before loading an injured horse, be sure that the horse is stabilized and the injury immobilized as much as possible. A low ramp facilitates loading and unloading of an injured horse. While in the trailer, the horse may lean on the wall or partitions to help reduce the weight load on the injured leg. It will be easier for the horse to travel with partitions in place rather than loose in a makeshift stall. A sling can be placed under the abdomen to help the horse take weight off the injured limb. Many trailers have standing stalls at 45° angles (slant load trailers), which help horses balance during transport. If a regular straight-load trailer is used, the horse should face backward for a foreleg injury, and forward for a hindleg injury, to help cushion sudden stops. Providing hay helps relieve anxiety. Frequent stops should be made to check on the status of the horse and provide drinking water.
If the horse is severely injured and cannot stand, it can be pulled onto the trailer using a large tarp or blanket. The horse should be kept sedated during transport, to avoid injuries. A head protector or bandage can be used to protect the eyes and head from self-induced trauma. Bandages should also be applied to the lower legs to avoid trauma caused by paddling or thrashing.
Trauma and First Aid
Common traumatic injuries of horses include fractures, cuts, puncture wounds, infections, and a muscle weakness syndrome called exertional rhabdomyolysis. These conditions require immediate veterinary care. In cases of trauma, keeping the horse calm is a primary concern. This can help prevent further injury. Emergency first aid may also be required.
Eye injuries are usually caused by trauma. They include cuts, scratches, and penetrating injuries from foreign bodies. Direct blows to the eye can cause retinal detachment. The eyes should be protected from direct sunlight as much as possible (see Emergencies: Eye Emergencies).
Fractures and Dislocations
Bone fractures, particularly in the legs, are one of the more common musculoskeletal injuries in horses. Luxations, or dislocations, are also common. Initially, the goals are to relieve anxiety, prevent further injury, and allow safe transportation to the veterinary facility. Emergency splinting or other stabilization of injured legs should be performed.
Horses usually cannot bear weight on a leg with a traumatic fracture. Certain stress fractures and other skeletal and tendon injuries may take some weight. Generally, the first indication of a fracture is the sound of a loud crack (if you are present at the time of the injury) or sudden lameness. Other indications of a break are a misaligned or visibly unstable leg. A horse may lie down, or be unable to get up after a fall, if the injury is severe. If the horse is lying down, it should be examined before attempts are made to get it to stand. If the horse is standing, it should be examined before attempts are made to move it.
For examination, the horse should be restrained and sedated, if necessary, to relieve pain and anxiety. Fractures are often accompanied by significant skin and other tissue injuries. The veterinarian will begin by locating and assessing the injury. Bleeding must be controlled. Wounds are cleaned and debrided (foreign matter and dead tissue are removed), then bandaged. The fracture is then stabilized. A splint is usually used to stabilize the leg to prevent further injury during transport. Many splints are commercially available and are part of equine first aid kits. The splints should be well padded to avoid the development of sores.
Head injuries can result in severe damage to the central nervous system. In many head injuries, swelling and bleeding continue after the initial injury, and quick veterinary care is needed to minimize the damage. Causes of head injury in horses include direct trauma from a fall, blows to the head, and falling over backward.
Horses with head injuries should be handled and moved with extreme caution. If the horse is down, it may need short-term general anesthesia.
Heat stroke is an emergency. A rectal temperature of more than 104.9°F (40.5°C) in a horse indicates overheating. Foals are especially susceptible to heat stroke. The first sign of heat stroke is that a horse stops sweating. Horses may also breathe heavily and begin to breathe through the mouth instead of the nose. Horses with heat stroke should be continuously hosed with cold water, stood in the shade and, if possible, placed in a cooling breeze. Seek veterinary attention immediately.
Wounds and Lacerations
Wounds and lacerations are common in horses. The steps involved in the management of these injuries are similar to those for small animals (see Emergencies: Wound Management). Control of bleeding is an immediate concern. In addition to wound management, a tetanus shot may be required.
Other Common Conditions Requiring Emergency Treatment
Two other common conditions that require emergency treatment in horses are esophageal obstruction (commonly called choke) and postcastration evisceration.
Esophageal Obstruction (Choke)
Esophageal obstruction, or choke, is common in horses (see Digestive Disorders of Horses: Disorders of the Esophagus in Horses). It is generally caused by feed blocking the esophagus. A horse is more likely to develop choke if it bolts its food or does not chew it completely, has been recently sedated, is dehydrated, or is fed poor-quality feed.
Coughing, drooling, and frequent attempts to swallow are obvious signs of choke. There may also be a discharge from the nose containing saliva and feed material. A veterinarian should be called immediately if choke is suspected.
If esophageal obstruction is confirmed, the horse is muzzled to prevent any further feed intake. The horse is then sedated to relax the muscles of the esophagus. This clears many obstructions without surgery. However, if the obstruction has not cleared after about 1 hour, a tube is usually inserted through the nose and into the esophagus. Water or saline solution is passed through the tube to flush the esophagus. Mineral oil should never be used because of the risks associated with aspiration. If repeated attempts to clear the obstruction are unsuccessful, further tests may be required to determine the cause of blockage (such as a foreign object).
Horses that have choked are at risk of recurrence for the next 2 to 4 weeks. In addition, the damaged esophagus may take 4 weeks or longer to heal. Feeding a slurried, pelleted diet or grass can help prevent recurrence. Permanent damage, resulting in a narrowed esophagus, sometimes develops as a result of choke.
Evisceration, or internal tissue such as intestine protruding through the incision, is a risk after open castrations. The risk is increased in Standardbred and Belgian horses or after castration of an adult stallion.
Evisceration is first identified by a structure hanging out of the surgical incision. It is important to keep the horse quiet and to support the structure with a clean, moistened towel to avoid further stretching or damage. The horse is generally anesthetized for treatment, which often requires surgery.
Emergencies in Foals
Critically ill foals are common. Immediately after birth, the foal must begin breathing on its own and adapt to its new environment. These critical events are particularly difficult if the lungs are undeveloped, viral or bacterial infection is present, or the birth is abnormal.
The foal should begin breathing within 1 minute of birth. During the first hour of life, the breathing rate of a healthy foal can be high, but the rate should decrease to 30 to 40 breaths per minute within a few hours. It is not unusual for a newborn foal to appear slightly blue initially. This should resolve within minutes of birth.
The heart rate of a healthy newborn foal has a regular rhythm and should be at least 60 beats per minute. Heart murmurs are normal during the first few days. Murmurs that persist beyond the first week of life in an otherwise healthy foal should be investigated.
Slow or difficult labor or delivery (called dystocia) is associated with many emergency medical issues for both mares and foals. The goal in a normal birth of a healthy foal is to minimally disturb the bonding process. This also applies to high-risk births, although some disruption of normal bonding is inevitable.
A slow heart rate (less than 40 beats per minute) is expected during forceful contractions. The pulse rate should increase rapidly once the foal's chest clears the birth canal. If the heart rate does not increase, immediate intervention is required. Chest compressions may be used if no rib fractures are present in the foal.
Foals that are not spontaneously breathing are generally resuscitated using mouth-to-nose or artificial ventilation such as a squeeze bag attached to a face mask. The airway is checked to ensure that it is clear. The airway may be suctioned if necessary. If the foal does not breathe or move spontaneously within seconds of birth, it should be rubbed vigorously over its body. If vigorous rubbing does not result in spontaneous breathing, intubation is sometimes necessary to help the foal breathe.
Because approximately 5% of foals are born with fractured ribs, the ribs should be examined. Fractures are usually multiple and consecutive on one side of the chest. These fractures normally heal without intervention. However, chest compressions may not be possible on a foal with rib fractures.
Last full review/revision July 2011 by Rebecca Kirby, DVM, DACVIM, DACVECC; Kirk N. Gelatt, VMD; Pamela Anne Wilkins, DVM, MS, PhD, DACVIM-LA, DACVECC