The EquineVeterinaryNursingManualEDITED BY

Karen M CoumbeMA VetMB CertEP MRCVSBell Equine Veterinary ClinicMereworthNear MaidstoneKent ME18 5GSUK

For the BRITISH EQUINE VETERINARY ASSOCIATION

The Equine VeterinaryNursing Manual

The EquineVeterinaryNursingManualEDITED BY

Karen M CoumbeMA VetMB CertEP MRCVSBell Equine Veterinary ClinicMereworthNear MaidstoneKent ME18 5GSUK

For the BRITISH EQUINE VETERINARY ASSOCIATION

© 2001 byBlackwell Science Ltd© 2001 by Vicki Martin for some line illustrations

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First published 2001

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Library of CongressCataloging-in-Publication Data

The equine veterinary nursing manual/[edited by]Karen Coumbe.

p. cm.Includes bibliographical references.ISBN 0-632-05727-0 (alk. paper)1. Horses — Diseases. 2. Veterinary nursing.

I. Coumbe, Karen.

SF951 .E68 2001636.1¢089073 — dc21

2001025149

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DISCLAIMER: Every effort has been made to check the few drug dosages given in this book. However, as it is possible that dosage schedules have been revised, the reader in strongly achvised to consult the companies’ literature before administering any form of medication.

List of Contributors, vi

Foreword, ix

Preface, xi

Abbreviations and Acronyms, xiii

1 Basic Management, 1L. C. Marlborough & D. C. Knottenbelt

2 Anatomy and Physiology, 25P. D. Clegg, C. L. Blake, R. C. Conwell, E. Hainisch,S. A. Newton, E. M. Post, M. J. Senior, S. L. Taylor & A. J. Wise

3 Genetics, 74G. A. Munroe

4 Reproduction, 81J. F. Pycock

5 Nutrition, 101P. A. Harris

6 Clinical Nutrition, 126P. A. Harris & J. M. Naylor

7 Basic First Aid, 140N. E. Haizelden & H. J. Hangartner

8 General Nursing, 162R. J. Baxter

9 Safety Management in the Practice, 175A. Jones & E. R. J. Cauvin

10 Basic Hospital Practice, 185J. Masters

11 Medicines and their Management, 196R. J. Baxter & R. D. Jones

12 Laboratory Diagnosis, 205L. L. Hillyer & M. H. Hillyer

13 Fluid Therapy, 228J. C. Boswell & M. C. Schramme

14 Medical Nursing, 249J. D. Slater

15 Foal Nursing, 284S. J. Stoneham

16 Lameness and Orthopaedic Nursing, 298E. Jones & T. J. Phillips

17 Diagnostic Imaging, 323E. R. J. Cauvin

18 General Surgical Nursing, 362D. Lloyd & B. M. Millar

19 Theatre Practice, 382D. P. McHugh

20 Anaesthesia, 414J. C. Murrell & C. B. Johnson

Appendix, 438

Index, 439

v

Contents

R. J. BaxterMA,VetMB, MRCVSThe Old Golfhouse Veterinary GroupBrandon RoadThetfordNorfolk IP24 3ND

C. L. BlakeBVSc, CertES, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

J. C. BoswellMA,VetMB, CertVA, CertES (Orth), MRCVS, DipECVSThe Liphook Equine HospitalForest MereLiphookHampshire GU30 7JG

E. R. J. CauvinDVM, MVM, CertVR, CertES (Orth), DipECVS, MRCVSClinique Vétérinaire EquineSCE StockwellL’Attache14700 FalaiseFrance

P. D. CleggMA,VetMB ,CertEO, DipECVS, PhD, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

R. C. ConwellBVetMed, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

E. HainischMRCVSKlinik für Chirurgie und AugenheilkundeVeterinärmedizinische Universistät WienVeterinärplatz 11210 WienAustria

N. E. HaizeldenBSc, BVetMed, MRCVSThe Ridgeway Veterinary GroupValley Equine HospitalUpper Lambourn RoadLambournBerkshire RG16 7QG

H. J. HangartnerVNHomeleaGreat WaldingfieldSudburySuffolk CO10 0RY

P. A. HarrisMA,VetMB, PhD, MRCVSWaltham Centre for Pet NutritionFreeby LaneWaltham on the WoldsMelton MowbrayLeicestershire LE14 4RT

L. L. HillyerBVSc, CertEM (IntMed), MRCVSDivision of Companion AnimalsDepartment of Clinical Veterinary ScienceUniversity of BristolLangford HouseLangfordBristol BS40 5DU

M. H. HillyerBVSc, CertEP, CertEM (IntMed), CertES (Soft tissue), MRCVSDivision of Companion AnimalsDepartment of Clinical Veterinary ScienceUniversity of BristolLangford HouseLangfordBristol BS40 5DU

vi

List of Contributors

C. B. JohnsonBVSc, PhD, DVA, DipECVA, MRCA, MRCVSInstitute of Veterinary,Animal and Biomedical SciencesMassey UniversityPrivate Bag 11-222Palmerston NorthNew Zealand

A. JonesBScDivision of Companion AnimalsDepartment of Clinical Veterinary ScienceUniversity of BristolLangford HouseLangfordBristol BS40 5DU

E. JonesMA,VetMB, MRCVSDepartment of Veterinary Clinical StudiesRoyal (Dick) School of Veterinary StudiesThe University of EdinburghLarge Animal HospitalEaster BushRoslinLothian EH25 9RG

R. D. JonesMA,VetMB, CertEP, MRCVSBell Equine Veterinary ClinicMereworthNear MaidstoneKent ME18 5GS

D. C. KnottenbeltBVM&S, DVM, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

D. LloydBVMS, MRCVSRossdale & PartnersBeaufort Cottage Equine HospitalCotton End RoadExningNewmarket CB8 7NN

L. C. MarlboroughBVM&S, MRCVSThe Coach House Veterinary ClinicBurlynsEast WoodhayNewburyBerkshire RG20 0NU

J. MastersVNVetlink School of Veterinary NursingAdministrative OfficeCats Drove HouseAshcottNear BridgwaterSomerset TA7 9QP

D. P. McHughDipAVN (Surg), EVN,VNGreenwood,Ellis & PartnersReynolds House166 High StreetNewmarket CB8 9QA

B. M. MillarCVT(USA), EVN,VNRossdale & PartnersBeaufort Cottage Equine HospitalCotton End RoadExningNewmarket CB8 7NN

G. A. MunroeBVSc, PhD, CertEO, DESM, DipECVS FRCVSFlanders Veterinary ServicesCowrig CottageGreenlawDunsBerwickshire TD10 6UN

J. C. MurrellBVSc, PhD, CVA, MRCVSUniversity of UtrechtFaculty of Veterinary MedicineDepartment of Clinical Sciences of Companion AnimalsPO Box 801543508 TD UtrechtThe Netherlands

J. M. NaylorBVSc, PhD, BSc, DipACIVM, DipACVN, MRCVSDepartment of Vet Internal MedicineWestern College of Vet MedicineUniversity of Saskatchewan52 Campus DriveSaskatoonSaskatchewan S7N 5B4Canada

S. A. NewtonBVSc, CertEM, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

List of Contributors

vii

T. J. PhillipsBVetMed, CertEP, CertEO, DESTS, DipECVS, MRCVSThe Liphook Equine HospitalForest MereLiphookHampshire GU30 7JG

E. M. PostDVM, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

J. F. PycockBVetMed, PhD, DESM, MRCVSEquine Reproductive ServicesMessenger FarmRytonMaltonNorth Yorkshire YO17 6RY

M. C. SchrammeMedVet, CertEO, PhD, MRCVS, DipECVSThe Equine UnitAnimal Health TrustLanwades ParkKentfordNewmarketSuffolk CB8 7UU

M. J. SeniorBVSc, CertVA, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

J. D. SlaterBVM&S, PhD, MRCVSDepartment of Clinical Vet MedicineUniversity of CambridgeMadingley RoadCambridge CB3 0ES

S. J. StonehamBVSc, CertESM, MRCVSRossdale & PartnersBeaufort Cottage StablesHigh StreetNewmarket CB8 8JS

S. L. TaylorBVetMed, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

A. J. WiseBVSc, MRCVSDivision of Equine StudiesDepartment of Veterinary Clinical Science and Animal HusbandryUniversity of LiverpoolSouth Wirral CH64 7TE

List of Contributors

viii

ix

Foreword

The dramatic advances in equine medicine andsurgery of the last twenty-five years, have neces-sitated the development of a group of support staff,which has carried the label of ‘equine nurses’. Theyhave performed increasingly sophisticated dutieswith skill and good humour, but illegally! ScheduleThree of the Veterinary Surgeons Act in the UK hasspecifically precluded the nursing of equidae. Notsurprisingly, there has been an increasing clamourfor this apparently illogical law to be changed. I amdelighted to say that after much hard work behindthe scenes by the Royal College of Veterinary Surgeons, the British Equine Veterinary Associationand the British Veterinary Nursing Association, thesituation is about to be remedied. In fact the year 2000saw the first batch of qualified Equine VeterinaryNurses (EVN).

Currently these people must already haveachieved VN status, before sitting the examination.However it is hoped that the qualification will beavailable soon to people who do not wish to undergotraining in small animal nursing.

How appropriate it is then, to welcome the first book devoted to the subject of equine nursing.

The gestation of the manual was under the care of Karen Coumbe who has had a particular interest in equine nursing and who was one of the first examiners for the EVN Certificate. She has had the most demanding task of obtaining manu-scripts from a variety of highly experienced clinicians, scientists and nurses, whilst simultane-ously nurturing her own second child; two majorachievements!

I would like to congratulate her in particular and all those involved with the production of what I confidently expect to become the definitive work on the subject.

As a surgeon I have always recognised the value ofhighly trained nursing staff. I have also had the goodfortune to have been involved with the challenge ofsetting up an officially recognised equine nursingqualification. Although there is clearly still muchwork to do, the future of equine nursing in the UK issecure. Furthermore, there is potential for the evolu-tion of a profession with its own specialties, whichwill provide satisfying opportunities for people withan equine interest, who want a career in veterinarynursing.

Tim Greet FRCVS(Immediate Past President of the British

Equine Veterinary Association)

xi

Preface

The purpose of this manual is to provide the defini-tive textbook for equine veterinary nurses. It will alsobe useful to all those involved in the care and man-agement of the sick horse. There are a multitude ofexcellent books available on managing the wellhorse. For this reason, the basics of equine manage-ment such as routine bandaging techniques are notincluded here, since they are well explained else-where. Instead the aim of this book is to provide newinformation on the care and consideration, as well asthe art and science involved in looking after any sickhorse or pony.

The Royal College of Veterinary Surgeons has devised an extremely detailed objective equine veterinary nursing syllabus, which this book has followed as comprehensively as possible. This explains the breadth and depth of subject matter. Theauthors include some of the first veterinary nurses to obtain the qualification in Equine Veterinary Nursing (EVN), following the first examinationsheld in July 2000. They are to be congratulated on

writing their chapters and passing the exam in the same year! Also included amongst the authors,are many of those involved in drafting the originalsyllabus and all those involved in examining for this qualification. As such it should be a very use-ful guide for any would be equine nurse. Horsesshould benefit from those who read it and so improve their knowledge of equine nursing and welfare.

I am extremely grateful to all the contributing authors for all their hard work and for the many people who helped and advised throughout the project. In particular Adam Coumbe, Sue Dyson,Louise Harvey, Tim Mair, Katie Snalune and SarahStoneham provided invaluable editorial assistanceand advice.

This is the first edition of a textbook on a new syl-labus on the evolving subject of equine nursing. In-evitably there will be areas that need improvement,but I hope this is a suitable start. Feel free to commentand constructively criticise.

Karen CoumbeKent

Easter 2001

Figures 2.1, 2.3, 2.4, 2.7, 2.8, 2.10, 2.14, 2.19, 2.20, 2.22, 2.23, 2.30–2.44, 2.46–2.48, 2.50–2.53, 3.1, 3.3, 3.4, 4.16, 5.1, 5.2, 8.4, 13.1,16.7, 17.3, 17.7–17.12, 17.16, 17.18, 17.21, 17.34 17.35, 20.3, 20.4 redrawn courtesy of Vicki Martin.

ACTH adrenocorticotrophic hormoneADH antidiuretic hormoneAI artificial inseminationANS autonomic nervous systemAP alkaline phosphataseASA American Society of AnaesthesiologyASIF Association for the Study of Internal

FixationAST aspartate aminotransferaseBAL bronchoalveolar lavageBAR Bright Alert ResponsiveBP blood pressureBUN blood urea nitrogenBW bodyweightCBC complete blood countCD controlled drugCDE common digital extensorCFT complement fixation testCID combined immunodeficiency diseaseCNS central nervous systemCOPD chronic obstructive pulmonary diseaseCOSHH Control of Substances Hazardous to

HealthCPK creatinine phosphokinaseCPR cardiopulmonary resuscitationCRT capillary refill timeCSF cerebrospinal fluidCT computed tomographyCVS cervical vertebral stenosisDCP dynamic compression plateDDF deep digital flexorDDSP dorsal displacement of the soft palateDE digestible energyDM dry matterDOD developmental orthopaedic diseaseECF extracellular fluideCG equine chorionic gonadotrophinECG electrocardiogramEDTA ethylenediaminetetraacetic acidEED early embryonic death

EGT exuberant granulation tissueEHV equine herpes virusEIPH exercise-induced pulmonary

haemorrhageEIV equine influenza virusELISA enzyme-linked immunosorbent assayEMEA European Medicines Evaluation

AgencyERS equine rhabdomyolysis syndromeERV equine rhinovirusEVA equine viral arteritisEVN equine veterinary nurseFEI Federation Equestre InternationaleFFA free fatty acidFFD film focal distanceFSH follicle-stimulating hormoneGGE glyceryl guaiacolate etherGGT gamma-glutamyl transferaseGIT gastrointestinal tractGLDH glutamate dehydrogenaseGnRH gonadotrophin-releasing hormoneGSL general sales list medicineHb haemoglobin concentrationhCG human chorionic gonadotrophinHSAWA Health and Safety at Work ActHSE Health and Safety ExecutiveHYPP hyperkalaemic periodic paresisICF intracellular fluidICL inferior check ligamentILRD infectious lower respiratory tract

diseaseIPPV intermittent positive pressure

ventilationIURD infectious upper respiratory tract

diseaseLDH lactate dehydrogenaseLH luteinising hormoneLMN lower motor neuroneMAC minimum alveolar concentrationMCH mean corpuscular haemoglobin

xiii

Abbreviations and Acronyms