Triage for colic patients

Triage for colic patients

Practitioners should devise decision-making tree for each operation, owner and animal
Sep 01, 2006

The degree of shock will dictate the need for referral, so even if pain can be controlled, a horse with a high heart rate, discolored gums, delayed capillary refill time, or any of the above will need to be treated with fluids.
The term "triage" is not used frequently in veterinary medicine, but is an integral method of managing emergency cases in human hospitals. The term, first developed in times of war, literally referred to the prioritization and rapid implementation of the proper treatments for injured soldiers.

In order to imagine this process, it is helpful to think about the way MASH units worked. After checking into human hospital emergency rooms, the first stop is the triage nurse. This key person determines whether the patient needs to have immediate medical attention or wait for further evaluation in the waiting room.

In veterinary medicine, a good application of the triaging process is management of colic in horses. Triaging requires the veterinarian to switch thought process from pursuing a precise diagnosis to determining if a horse needs to be referred for intensive care, including surgery. Interestingly, this is a process veterinarians have been working on for years, but we still have a long way to go to perfect the process when evaluating horses with colic.

Triaging and survival in horses with colic

Table 1 Pain Management
In thinking about how to increase the survival rate of horses suffering from colic, most veterinarians likely focus on the latest operative and postoperative treatments, but the impact of changes in these areas is ultimately very small when considering the entire population of horses suffering from colic.

In general, the time between examination and referral has by far the largest impact on survival. An excellent example is treatment of large colon volvulus. This form of colic has the highest mortality rate, frequently about 50 percent at referral hospitals with the most up-to-date intensive care because they simply receive the case too late in the course of disease.

On the other hand, in high-density equine communities, where the farm managers and referring veterinarians make very rapid decisions on referral and the hospitals are very close, the survival rate is well more than 80 percent in some studies. There are certain realities to factor into these differences, including geographical location, and the ability of owners to make a rapid decision on potentially expensive care.

Considerations prior to referral

Colic events
How can veterinarians in practice make use of this information? First, it is vital to have farms that each practice attends regularly to prepare for emergencies. This means that a decision on whether an owner would pursue referral, given the expense and the horse in question, is made before each horse has an episode of colic. The optimal approach to financial emergency planning is to suggest insurance to owners, particularly those that commit to referral of their horses. All owners should be encouraged to seek mortality and major medical insurance policies. Alternative policies, such as surgical insurance or loss of use policies are far more complex and will not protect the owner when an immediate decision on full medical care is required.

Someone who can make triage decisions always should be present on the farm so if an owner is unavailable, then they can be reached easily or can transfer the decision-making to the trainer or farm manager.

A truck and trailer always should be readily available and fully functional, and every horse must be completely trained to load rapidly. This will avoid searching for suitable transportation in the middle of the night. As far as the role of the veterinarian, the relationship with the owner and trainer is critical.