Dealing with thoracic trauma including pneumothorax and thoracolumbar spine trauma

Thoracic trauma is one of the most visually devastating traumas in horses and can be life threatening. Fortunately despite the often dramatic presentation these horses can have an excellent prognosis with appropriate treatment. Factors that distinctly change that prognosis are the involvement of areas other than the thorax such as the abdomen and the dorsal spine. Fractures of the ribs will be covered in the subsequent presentation.

Sheila Laverty published a retrospective in 1996 that established the good prognosis associated with these injuries despite their dramatic appearance. Since that time excellent articles in the Vet Clinics of North America have covered the diagnosis and management of horses with penetrating thoracic trauma. This authors experience has been in agreement with the generally good prognosis associated with these injuries and management of cases will be presented to illustrate the techniques and outcome. The assessment of exactly which structures have been affected and to what degree can be the most challenging part of these injuries. Additionally management by the veterinarian at the farm can be challenging in order to safely prepare the ship the horse to a nearby facility for treatment. In small animals and humans the dictum is to never remove the penetrating object and send the animal or person in to a facility with the object still in place. In horses this may also be ideal but may not be practical. In some instances the object can be left in place and padding can be applied around the penetrating object to prevent it being pushed in further during transport but the amount of movement that a horse undergoes during transport must be considered. Often the object must be removed and veterinarians counselled to quickly pack the wound and apply an airtight barrier with an occlusive barrier such as kitchen plastic wrap. Removal should be performed after a careful assessment by the veterinarian at the farm including observation of respiration, vital parameters and systemic status. If the object has already been removed then occluding any wounds should be done initially prior to any examination in the assumption that a pneumothorax or pneumomediastinum is present. Pain management, both initially and as the examination progresses, is crucial as injuries to the thorax are intensely painful. [...]