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EQUINE VETERINARY EDUCATION / AE / APRIL 2018
1 h
3 days
1 month
18 month
Fig 1: Case 1: The visual stages of healing after being caught in an Australian bushfire.
creatine kinase 592 l/L (reference range 120–470 l/L), aspartate aminotransferase 468 l/L (reference range 175– 340 l/L), decreased albumen 22 g/L (reference range 22– 37 g/L), decreased total protein 51 g/L (reference range 57–80 g/L), decreased calcium 2.64 mmol/L (reference range 2.88–3.55 mmol/L) and increased glucose 9.5 mmol/L (reference range 3.6–6.1 mmol/L). Urea and creatinine, which were monitored for several weeks, were within normal limits. It was considered likely that the red urine discolouration was due to haemolysis associated with the severe heat (Norman et al. 2005). Over the next few days the mare’s skin, appetite and
pain levels were monitored. Oedema increased over 3 days (Fig 1). The skin became dry and sensitive to touch and she began to show hair loss on her legs, neck, perineum and abdomen. Despite her pain, her appetite was always good and she showed interest in other horses and her environment over the next few days. The corneal ulcer medication was continued and she was given flunixin twice daily for pain. She was placed on omeprazole (Gastrozol Daily)7 1 mg/kg bwt per os q. 24 h. She was also started on trimethoprim/ sulphadimidine (Trimidine)8 30 mg/kg per os q. 12 h for 4 days. On Day 6, she had a small abscess from her i.v. catheter
which had been removed on Day 4. E. coli and b haemolytic Streptococcus were cultured. She was given ceftiofur (Norocef)1 2 mg/kg bwt i.m. q. 24 h for 4 days. Over the next 2 weeks, she lost more hair and pigment.
Her neck and thorax became dry, and there was a noted loss of elasticity. Areas that had not been painful to touch were now very sensitive. At this stage, Aloe vera gel9 was introduced and applied twice daily to exposed areas before washing and debridement. The observable burns now covered about 60–70% of her body surface area (Fig 1). Most of the affected areas would be classified as deep second degree burns with some small areas of third degree burns on
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the distal limbs and face. The general impression of staff was that the worst of the visual damage was realised on about Day 18. The pinna of both ears began to show signs of erosion; they both eventually contracted, resulting in a permanent contracture (Fig 2). Unlike the other horses burned in the fire, this mare was very slow to heal especially in the perineal and mammary regions (Fig 2). Daily skin care initially required sedation with detomidine
HCl (Dozadine)7 0.01 mg/kg bwt i.v. and xylazine (Ilium Xylazyl-100)10 0.22 mg/kg bwt i.v. The legs, ventral abdomen and perineal area were washed with a mild soap (L.O.C.).11 Antibacterial soaps such as a chlorhexidine or betadine scrub were tried, but they were irritating to the skin and induced erythema and exudation. The L.O.C. soap was also found to soften the eschar and allowed for easier removal. Cotton wool stuck to the eschar and on advice from a burn specialist nurse, a sterilised woven fibre cloth (Chux)12 was used to clean the wounds. At first, locally produced raw honey was used on one side
of her legs and body and SSD cream on the other. After 1 week, the raw honey appeared to be superior with less exudation and erythema and the SSD cream was discontinued for a few weeks, except on her exposed unbandaged areas where honey dried quickly and attracted insects. We were cautioned that SSD cream was degraded by sunlight to colloidal silver as noted by the darkening of the product, so precautions were taken to prevent exposure to direct sunlight (Kunkely and Vogler 2007; Fuller 2009). Oral ulceration was noted around her gums and tongue. Concern was raised that this could be from licking SSD cream, which can be severely irritating to the mucous membranes and conjunctiva in people. The oral ulcers eventually resolved without confirmation of the source. Initially, the mare was heavily bandaged and slings
created using human medical arm slings (Actimove Sling)13 were used to hold the bandages high on both the front and
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