Veterinary emergency management of equine burn victims

Veterinary emergency management of equine burn victims

As a first responder to a barn fire, would you know how to treat a burn-compromised horse?
Apr 01, 2013

More than 1,000 structure fires strike barns and stables annually (data reported from 2002 to 2005), leaving their equine inhabitants vulnerable to smoke inhalation, severe burns and even death.1 See Table 1 for common causes of barn and stable fires.2

Potential for injury

Table 1: Common causes of barn and stable fires
"There are two major concerns of damage to the burn-compromised horse: thermal injury to the epithelial surfaces—skin, eyes, cornea, including the entire airway—and smoke inhalation damage to the lungs," says Ray Sweeney, VMD, DACVIM, of the Department of Clinical Studies at New Bolton Center, University of Pennsylvania School of Veterinary Medicine.

"These horses can develop complications such as laminitis," says Michelle Harris, VMD, DACVIM, Department of Clinical Studies, New Bolton Center, University of Pennsylvania School of Veterinary Medicine. "Depending on where the burns are, it may be very difficult to even treat them due to loss of venous access."

"More life-threatening to the burn-compromised horse, besides skin thermal injury, is probably the damage to the airway and the lungs, especially the smoke inhalation insult, which can include carbon monoxide and other toxins," says Sweeney. "Thermal injury can also damage the lining of the respiratory tract from the tip of the nose all the way down to the alveoli. You can also get thermal damage to the upper airway and burn damage to the inside of the nasal passages and the throat.

Suki: A case study
"With tissue death, the airway can become swollen, which may cause partial obstruction of the airway," continues Sweeney. "You can also have damage to the lower airway to the alveoli that can incite an inflammatory cascade and cause protein to exude into the lungs, which can cause a respiratory distress-type syndrome."

According to Emma Adam, BVetMed, DACVIM, DACVS, of Gluck Equine Research Center at the University of Kentucky, the thermal insult also causes microvascular damage and direct tissue coagulation, which can lead to systemic shock.3

"Systemic shock can lead to triggering of the inflammatory and coagulation cascades and decreased cardiac output," says Adam. "Microvascular damage—both direct and inflammatory cytokines—leads to an increased capillary pressure, with leaky capillaries followed by the formation of edema. As shock progresses, tissue perfusion is further compromised, vascular permeability increases and protein leaks into interstitial spaces, furthering circulatory collapse and edema formation."3