Emergency Veterinary Medicine

Chapter 61 Emergency Veterinary Medicine



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Trek personnel, their packs and supplies are usually transported by all-terrain motorized vehicles, helicopters, and fixed-wing aircraft to remote locations around the world. It may seem that animal transport is no longer a consideration. This is, in fact, a false premise. The wilderness experience often involves animals other than humans. Such domestic animals as horses, mules, burros, llamas, elephants, camels, oxen, and yaks may be used for packing or pulling supplies, relieving hikers of this burden. Horses and mules are also ridden by trekkers. Dogs may accompany owners into the wilderness as companions, as trackers of game, or in the Arctic and Antarctic as primary draft animals. A cat may accompany a trek as a mascot or as a companion animal. Any of these animals may become injured or fatigued or may fall ill with a variety of ailments that require emergency treatment and management by trek personnel.



Wild Animal Encounters


Observation of wild animals in their natural habitat enhances the wilderness experience, but encounters between wild animals and animals accompanying the trekkers may be less than pleasant. Healthy wild animals usually try to avoid humans, but this may not carry over to domestic animals.


Medical and paramedical personnel who may be called to render emergency medical care or assist in the rescue of injured or diseased humans or support animals should recognize that wild animals may be involved. Experienced trekkers can usually recognize when they are intruding into an animal’s domain. Unfortunately, some people lack a sense of courtesy for animals. When trekkers in the wilderness behave as if they are entering the home of a human friend, they show appreciation for the rights of wild animals and have less risk for injury or illness to themselves or their support animals. Understanding the biology and normal behavior of wild animals known to live in the wilderness areas to be visited enhances enjoyment and diminishes exposure to potentially dangerous situations.


Others who may be at risk are wildlife biologists, hunters, and people who choose to live in remote areas. Hunters come into intimate contact with wild animals as they pursue, dress, and eat game. Plant scientists, paleontologists, geologists, and other non–animal scientists may inadvertently encounter wild animals. Wild-animal biologists conducting field investigations may capture or immobilize wild animals to collect data. Such individuals are at potential risk for injury or disease, not only as a result of wild animal contact but also from tranquilizing drugs and the firearms used to administer the drugs.



Why and When Wild Animals are Dangerous


Few wild animals deliberately stalk humans, but they may stalk support animals. Most wild animals fear humans and, given an opportunity, avoid human contact. Injuries to humans caused by wild animals are usually the result of judgment errors (such as approaching too closely), ill-advised handling of diseased wild animals, or unlucky exposure to highly aggressive or protective animals (see Chapter 51). Such animals may be natural predators seeking food, prey species fearful for their lives or the lives of their young, or diseased and irrational animals (such as those with rabies). Attacks on support animals usually occur at night or when humans are absent.


Animals are most likely to respond adversely if startled from sleep or if their flight distance is violated. Flight distance is that distance at which, if approached by an enemy, an animal will either fight (attack) or flee. The distance is species specific and regionally specific, and it may become greater if animals in the area have been recently hunted. Flight distance may be greater for a person walking or carrying a gun than for a person riding on horseback or in a vehicle. Animals that find themselves cornered occasionally attack or risk injury trying to escape. Any animal may attack if its offspring are in danger. With any large animal, accidental or intentional positioning between a mother and her infant invites attack.


Equal danger exists for a person who comes between a territorial male and one or more females. Many wild animals are territorial. Males and females may establish feeding, breeding, and home territories. An animal may share feeding territories with other members of the same species or with different species, but home territories may be defended against any intruder, including humans.


Injuries have been inflicted on hunters who approached a recently shot animal, believing it to be dead, only to have the animal revive explosively in a final Herculean effort to fight or flee.





Support Animals


Expedition leaders and participants should consider the well-being of support animals and understand their physical capabilities with regard to maximal load, speed, and endurance. Humans should also be able to recognize signs of exertional stress, which is more likely to occur in horses that are ridden than in pack-horses that are led. A horse can generally match or exceed the physical endurance of a hiker, but adverse metabolic conditions may develop in horses pushed beyond their limits of endurance. The syndrome that arises from excessive exercise depends on intensity and duration, degree of prior conditioning, and nutritional status. Mules, donkeys, and llamas are less prone than horses to developing these problems, because they usually refuse to be pushed to extremes of exertion.


The animal best suited to the terrain, climate, and task to be performed should be selected. Horses, mules, burros (donkeys), and llamas are traditional beasts of burden in North America, wherever sufficient forage and water are available. Each animal has both admirable and undesirable qualities. Horses are usually the largest and can carry the heaviest loads. Mules and burros tend to be more difficult for novices to handle. Llamas have become popular support animals with backpackers in North America. The llama requires less feed, can subsist better on sparse native forages, and is less damaging to the environment than is the horse. No animal should be used on a trek unless at least one member of the party has considerable experience in handling and caring for the chosen animal.


In South America, the llama is the beast of burden. Adventurers traveling into rugged and remote areas above 3000 m (9843 feet) will probably use llamas for support.


Dogs are necessary draft animals for winter travel in the Arctic and Antarctic. Some hikers place small packs on dogs to carry light items or food for the dog. In other regions, dogs function more as companions. Cats must be placed in an appropriate carrying container, such as an airline shipping container, during transport, because a cat walking on its own would not be able to keep up.


Many expeditions are mounted in countries unfamiliar to both leaders and participants. In various parts of Asia, the horse is replaced by the elephant, water buffalo, yaks, oxen, or Bactrian camel. In North Africa, the Middle East, and Australia, the dromedary camel carries the load. In Australia, horses and llamas may be used as well. Each species has specialized requirements for handling, packing, and health care.


Expedition physicians may be asked to treat the ailments of support animals. Basic medical training provides the foundation necessary to diagnose and treat many conditions that may be encountered on the trail. This chapter provides an overview and specific anatomic and therapeutic information for some common problems. If in doubt, expedition members should handle an ailing support animal as if it were a human. When support animals carry all or part of the load, there is often capacity for a more sophisticated emergency medical kit to be carried.



Pre-Trip Animal Health Considerations


Treks involving support animals are carried out worldwide. Often, animals are supplied by a person or firm specializing in a given type of animal. The animals may be leased directly to the trek leader, or a handler may be contracted to supply and care for the animals. In either case, it is the responsibility of the trek leader to ensure that the animals meet the requirements necessary for the trek. This is particularly true in foreign countries.


The author accompanied a trek in the high Andes in Peru. The trek leader had made arrangements for a certain number of llamas to carry the gear. The requested number of llamas was present, but many were small, thin, and immature. Most of the animals had never carried a pack before and bucked and kicked every time they were turned loose with the pack on. The trek leader had failed to specify details on what was necessary to control the animals.


Any trek leader who is not animal savvy should ask for help from someone with animal handling or veterinary experience. Topics that should be covered include conditioning, foot care, and required immunoprophylaxis.


In North America, health certificates are required for travel and entry into the state or province of destination and possibly any intervening states to be traversed. Regulations are extremely variable, so inquiries should be made at least 4 weeks before departure. It is recommended that each animal receive a physical examination by a qualified veterinarian before an extended trip. Conditioning is as important for trek animals as it is for human participants. Training should be in terrain similar to that expected on the trek, with special attention given to toughening the footpads of llamas and dogs by appropriate exercise. The expected terrain to be encountered on the trek should be communicated to the animal supplier well in advance of the trek.


Immature animals should not be taken on expeditions. Dogs should be at least 1 year old. Llamas and horses should be older than 3 years. Well-conditioned and trained horses, mules, burros, and dogs can carry approximately 30% of their body weight. Llamas usually carry only 25% of their body weight (Table 61-1).



Frequently, arrangements are made to contract for support animal service from suppliers in the trek locale. Persons providing these services do not always understand the trek requirements and may supply animals that are poorly shod, unconditioned, poorly trained, or otherwise unsuitable for the needs of trek participants. Trek leaders must clearly stipulate specifications well in advance of the trek and be adamant about compliance.



Horses, Mules, and Donkeys


A tetanus booster should have been given within the past year. Vaccination against rabies is appropriate if the trek itinerary includes travel in an endemic area. Encephalomyelitis vaccine should be used in endemic areas, especially during the insect seasons of summer and fall. Internal parasite levels should be evaluated by fecal flotation and appropriate medication given to reduce the parasite burden.


The feet should be trimmed and shod properly at least 2 weeks and not more than 4 weeks before a trek begins. Sole pads should be affixed if sharp rocky terrain is expected. Extra shoes for fore and hind feet of the different-sized horses should be carried, along with the appropriate nails and hammer to reattach a shoe, should one be cast.


Selecting the breed of horse for a trek may depend on the experience and horsemanship of the trekkers. Horses for riding should be selected for gentleness, ease of mounting, and conformation that fosters a smooth gait and comfortable ride. Correct conformation includes angulation of the joints and a long, sloping pastern that provide good cushioning when a foot strikes the ground. Certain breeds are well known for this, including the Tennessee walking horse and the Missouri fox-trotter. Arabian horses are known for their stamina and endurance but may be high strung and require more expertise on the part of the rider than do other breeds. Thoroughbred or thoroughbred crosses are excellent if they are not flighty or too tall (16 hands or 1.6 meters [64 inches] or more). Quarter horses are also good trail horses unless they have short, upright pasterns that make for a jolting ride (Figure 61-1). Often, there are more differences within a given breed of horse than between breeds. Avoid typical riding-academy horses that have to be prodded to a gait faster than a slow walk.



The same poor conformation that produces a rough ride may also foster trauma to joints and ligaments, which can lead to lameness and unsoundness. Trek leaders are not likely to have a significant choice in animals used as packers. It is important to have sound horses that are properly trained and that are conditioned to accommodate packs.





Oxen, Yaks, and Water Buffalo


An ox is a castrated male of any breed of cattle that has been trained to work as part of a team, having been paired at a young age (Figure 61-2). Castrated males are more docile and grow larger than do intact males; thus they are able to carry or pull heavier loads. Oxen were the mainstay for agriculture and for transporting people and goods in North America before establishment of the transcontinental railroad in 1869. They are still used for these purposes in many places in the world where access to mechanized agriculture is limited.



The yak is the primary draft animal for native people living at high elevations in Central Asia and China (Figure 61-3). Yaks and their handlers are frequently employed by trekkers in these locales.



The water buffalo is the beast of burden in wet environments (marshes, rice fields, jungles) of Southeast Asia.


The pre-trip care of oxen, yaks, and water buffalos is essentially the same. It is difficult to generalize about immunizations because there are significant regional differences in infectious and parasitic diseases. These animals should receive the general vaccines administered to them in their native countries. If there are known endemic infectious diseases, for which there are vaccines, in the region where the trek will take place, arrangements should be made to have vaccination completed at least a month before the trek. Routine evaluation for parasites and necessary therapies should likewise be done at least 2 weeks before a trek.



Elephants


Asian elephants have been used for carrying loads, harvesting timber, carrying people, and engaging in warfare since antiquity (Figure 61-4, online). They are also used as beasts of burden for wilderness treks in forested areas of Southeast Asia, India, and southern China. Elephants are often considered to be domestic animals, whereas in reality they are wild animals that respond to taming and training to produce reliable beasts of burden that are useful for many tasks. Elephants should only be used under the care and guidance of a skilled handler, called a mahut or ozzie.



Elephants should be immunized against tetanus (toxoid) and in endemic areas against rabies using a killed vaccine. Parasites may be important regionally.






Watering and Feeding


All animals require daily access to potable water. It is not practical to filter or disinfect water for large animals, but this may be considered in extremely filthy conditions. Dogs may be susceptible to giardiasis, and theoretically, it is desirable to provide filtered water for them. However, preventing a free-running dog from drinking from a stream or lake is virtually impossible. Heavily mineralized or silted water may be as unpalatable for animals as for humans and may cause similar gastrointestinal upsets.


The basic fluid requirement for a horse or other large trek animal is approximately 40 mL (1.5 oz)/kg/day, or 18 L (5 gal) for a 450-kg (1000-lb) horse. With work and heavy sweating, the requirement may be tripled. Horses sweat profusely and should be given the opportunity to drink along the trail. Llamas and burros may require one-third less water than a horse. However, although they tolerate dehydration better than do other species, they function better if well hydrated. Some llamas refuse to drink until evening. The camel is noted for its ability to tolerate a number of days (2 to 7) without drinking water.


A 450-kg (1000-lb) camel may lose 25% of its body weight via dehydration. That amounts to 114 kg (250 lb). A 114-kg (250-lb) water loss would equal approximately 114 L (30 gal) of water. The camel is unique in that it can drink, at one time, sufficient water to replace the loss without disastrous effects. A human being would be close to death at a 12% loss of body weight caused by dehydration and could not be orally rehydrated all at once.








Emergency Restraint


It is assumed that one or (preferably) more persons on the trek are acquainted with the general care and handling of any domestic species involved in the expedition. Methods of haltering and leading are specific for each animal. Securing animals at night may require hobbling or tethering. Skill and experience are necessary to accomplish this without risking injury to the animal or handler. Animal handlers should be able to examine and clean the feet and hoofs of their charges. All people who deal with the animals should know how to create a halter tie (Figure 61-5) so that a safe and secure tie can be made at rest stops or whenever an animal is to be tethered. Knowledge of temporary rope halter construction is desirable in the event of loss or breakage of halters (Figure 61-6).11







Camels


A knowledgeable and experienced handler should be in charge of camels. Restraint procedures should be left to him or her except in emergencies. Camels used for trekking should be trained to be led and to kush (lie down) for ease of loading baggage and people. Sturdy halters and lead ropes should be supplied for each camel. Persons without experience with camels must appreciate that camels are capable of kicking or striking with all four limbs. The lack of a hind flank fold frees the limb to swing in an extended arc. Keep in mind that a camel is able to scratch its ear with a hind foot. It also has a formidable array of canine teeth and is capable of opening the mouth widely to bite. Known biters should be kept muzzled except when eating. An unhappy camel may exhibit its displeasure by regurgitating stomach contents (called spitting) on a person.


Most examination and treatment procedures should be carried out with a camel in the kushed position. Camels may be ridden or packed with equipment and supplies. When ridden, they are usually guided by voice commands or touching with a goad or whip. A single lead rope is either attached to a halter or to a wooden peg inserted through the lateral side of the nostril. Camels are usually secured at night by tethering to a picket line or a stake. The tether may be attached to a sturdy halter or by a hobble on one front ankle. The method employed will depend upon the area of the world where the camel is being used and according to the culture of the camel handler.



Oxen, Yaks, and Water Buffalos


These animals are usually docile and easy to handle. They should be trained (usually from the time they are juveniles) to respond to voice commands or touching with a goad (stick) on a specific area of the body or limbs. Oxen may be driven by a handler walking alongside or by leading. If two animals are yoked together to pull a cart or wagon, the handler walks beside the animal on the left. Oxen are not usually trained to allow a foot to be picked up as would be done with a horse. Any examination or treatment of the bottom of the hoof may necessitate casting the animal (forcing it to lie down). This may be easily accomplished by using a half-hitch method (Figure 61-8).



The animal is tied securely by the head to a solid structure (tree, post, fence or large rock) near the ground. The procedure requires the use of a rope 6 to 9 m (20 to 30 feet) long and 1.27 cm (0.5 inches) in diameter. Tie a loose bowline around the neck of the animal. Then place a half hitch behind the forelegs (see Figure 61-8). Place another half hitch over the caudal aspect of the rib cage. Take up all slack in the loops, so that when pulled from behind, the half hitches will not slip caudally but will tighten on the chest wall. One or two persons begin to exert a steady pull on the rope from behind the ox, and should be persistent. If the ox spreads its hind legs and refuses to go down, place a short rope hobble on the hind legs to prevent the straddle. Then renew the pressure. The pressure exerted on the chest will cause the ox to become recumbent. Tie the forelimbs together and the hindlimbs together; then stretch them forward and backward.



Dogs and Cats


Dogs usually accompany their owners, who are able to handle them under difficult circumstances. If mildly painful medical procedures must be performed, the head and mouth should be secured. The dog’s body can be securely held against the handler’s body by reaching across the back of the dog and grasping the base of the neck while pulling the opposite shoulder with the elbow toward the handler. The other hand should tuck the dog’s head under the handler’s arm. To secure a dog in lateral recumbency, it is vital to control the down-side legs as well as the head to prevent the dog from being able to effectively rise.


Alternatively, a muzzle can be constructed from a nylon cord or even a shoelace. A loop should be formed with an overhand knot on one side. The loop is placed over the muzzle of the dog, with the knot on top, and tightened (Figure 61-9). The ends of the loop should be wrapped around the muzzle, crossed beneath the jaw, and tied behind the ears (Figure 61-10).




Cat restraint is accomplished by wrapping the cat in a towel. Grasp the cat by the nape of the neck close to the head. Place the cat on an outstretched towel and press down on the back while another person begins to roll one end of the towel over the cat and continues to roll the cat into the towel. A limb may be withdrawn from the towel roll. Chemical immobilization of a cat is easily accomplished using ketamine HCl at a dose of 10 to 20 mg/kg administered intramuscularly or subcutaneously.


Intramuscular injections are administered in the paraspinal muscles to either side of the lumbar spine or in the muscles of the upper rear lumb, making note that injecting in the upper rear limb may cause inadvertent sciatic nerve injury. For subcutaneous injections, grasp a fold of skin on the dorsal aspect of the neck just in front of the shoulders. Lift the skin and inject beneath the tented skin.



Conditions Common to All Species


Support animals may injure each other or their human handlers, or they may spread disease (such as ringworm or lice). Human injuries are discussed in Chapter 21.




Foot, Hoof, and Nail Problems


Foot injuries may incapacitate an animal and possibly the expedition.7,12 The hoof of the horse covers the distal extremity and the third phalanx (P-3). The specialized horn of the hoof and nail is roughly analogous to the human nail. Horses are digitigrade, walking on the tip of P-3 (see Figure 61-1). In llamas, P-2 and P-3 lie in a horizontal plane within the foot, with only P-1 in the vertical position. The nails of the llama and dog are inconsequential in weight bearing, but if torn or contused, become extremely painful.


The weight-bearing surface of the horse’s hoof contains the firm sole and more flexible frog, overlying soft fibroelastic tissue called the digital cushion. Dogs have footpads similar to those of llamas.


Oxen, yak, and water buffalo may require hoof trimming just as do horses, mules, and donkeys. Oxen are rarely shod with metal shoes, but it is possible. Any trimming of the hooves should be performed at least a month before a trek. The feet, muscles, tendons, and ligaments should be conditioned for the trek by walking on terrain similar to that of the trek.


The structures of the foot are subject to contusions, abrasions, lacerations, and penetration by foreign bodies (such as nails, stones, and sticks). Segments of the hoof wall and nail may be avulsed, exposing the sensitive laminae. Infection may invade the foot and undermine the outer layers, with abscess formation. Not all lesions are visible. Stone bruises of the sole or frog of a horse may be evident only when pressure is exerted on the site of the contusion. Foreign body penetrations and abscesses may cause reluctance to place any weight on the limb. The penetrating object may have been withdrawn or still be in place; in either case, a discolored tract leads to the depth of the wound. Erosions and ulcerations of the footpads are common in unconditioned dogs and llamas. Dogs working in ice, snow, mud, and water may suffer from maceration, cracks, erosions, lacerations, and frostbite.


Foot and limb trauma is accompanied by varying degrees of lameness (limping). It may be difficult to establish which leg is painful, but the principles are similar to evaluation of such pain in humans, with the obvious differences of two extra limbs to evaluate and the animal’s inability to communicate.


Cellulitis may develop on the limbs or body. The signs include heat, swelling, and redness and are the same in all species, as is therapy.


Therapy for foot injuries includes providing drainage of infected lesions, disinfection, and protection of exposed sensitive structures. Antibiotics are not indicated for most wounds unless a joint surface is exposed. It may be necessary to bandage the foot to provide protection while in camp and to fashion special shoes or boots to keep an animal functioning on the trail. Special booties are available commercially for dogs, but a temporary moccasin can be constructed from soft leather (such as the leather used by craftspeople to make moccasins) or duct tape.



Hyperthermia (Heat Stress, Heat Exhaustion)


Hyperthermia is elevation of the core body temperature above normal limits. Chapters 10 and 11 discuss hyperthermia in humans, and it is important to recognize that animals associated with a trek may become overheated as well.12,13




Clinical Signs


Signs vary according to species and the stage of hyperthermia, but all affected animals have increased heart and respiratory rates, usually accompanied by open-mouth breathing. Rectal temperatures may vary from 41.1° to 43.3° C (106° to 110° F). Horses, mules, burros, and llamas sweat in the early stages of hyperthermia, but sweating may cease if the animal becomes severely dehydrated. Sweating is evident in horses but imperceptible in llamas, because most sweating in llamas occurs on the ventral abdomen in what is known as the thermal window, where the fibers are less dense and the fiber length is short.


Dogs cool themselves by evaporation of respiratory fluids while panting. The mouth is held open, and the tongue lolls from the mouth. The respiratory rate increases from a normal of 30 breaths/min to 200 to 400 breaths/min. Moisture may be observed dripping from the tongue. As dehydration intensifies, salivation and dripping may slow or cease. Dogs that are unable to effectively pant because of an injury or anatomic conformation are at particular risk for this disorder. Special care needs to be taken when bringing brachycephalic (short-nosed) breeds, such as English Bulldogs or pugs, into the wilderness because these dogs all have a significant degree of respiratory compromise.


Hyperthermia causes a shift of blood volume from the viscera and muscles to the skin, resulting in hypovolemia and varying degrees of hypotension. Hypotension causes hypoxemia of the brain, resulting in dullness, restlessness, and incoordination. Hypoxemia may lead to convulsions and collapse. The shift of blood from the gastrointestinal tract may cause decreased motility and the potential for ileus and tympany. Signs of colic in horses and llamas (kicking at the belly, looking back at the side, treading, attempting to lie down and roll) may be noted.


A 1° C (1.8° F) rise in body temperature requires 10% more oxygen for proper function of the energy systems of the body. When body temperature reaches 41° C (105.8° F), the respiratory system is no longer able to supply sufficient oxygen by normal respiration. Respiratory acidosis and electrolyte imbalances associated with sweating may produce a syndrome similar to septicemia.


Hyperthermia may affect most of the organ systems of the body. The severity of the syndrome cannot be assessed in the field. It is important to recognize the conditions that lead to hyperthermia, to watch for early signs of heat stress, and to stop any activity that contributes to the problem. Mules and burros are not likely to become severely affected because they refuse to go on if stressed. Horses may be driven past their endurance and die of thermal stress. As mentioned previously, dogs that cannot pant effectively (particularly the brachycephalic breeds like bulldogs) can develop heat stress easily.




External Parasites


The order Diptera, class Insecta includes thousands of species that are annoying or parasitic to humans and domestic and wild animals (see Chapter 47). Trek animals suffer in much the same way as do their human companions. Certain destinations are notorious for insect swarms (flies in Australia, mosquitos and gnats in the Arctic summer). Dipterans are also important disseminators of infectious microorganisms. It is sometimes difficult to differentiate venomous from parasitic species. The saliva of hematogenous dipterans may contain a toxin that aids in altering the endothelium of capillaries to induce free flow of blood, which is then ingested by the fly. Many humans are extremely sensitive to bites from certain flies, and some are sensitive to the toxins in the saliva.


Animals may also be sensitive to the toxins in the saliva. Even nonbiting species, such as the housefly (Musca domestica) or the face fly (Musca autumnalis), if feeding on lacrimal secretions or open wounds, may produce a local reaction causing blepharitis, conjunctivitis, and keratitis. Biting flies (mosquitos, gnats, and midges) may produce local reactions in animals. An attack by immense numbers of simulid gnats may cause debility and even death in animals. In the Mississippi River Valley, horses and mules were killed by massive attacks of the buffalo gnat (Cnephia pecuarium). Swarms of biting insects may cause alarming behavioral responses in horses, including crowding together, head shaking, tail switching, and running. As a youngster, the author was mowing alfalfa hay using a team of horses. A cloud of simulid gnats descended on them. It was difficult to control the horses from bolting and at the same time protect oneself from the biting insects.9



Bee Stings


Most of the aculeate Hymenoptera group of insects have a stinger apparatus, used to paralyze prey species or for defense. Most are small or lack the power to thrust the stinger through vertebrate skin and thus are of no consequence in envenoming people or animals. Other species—bees, wasps, yellow jackets, and hornets—inflict, at the least, a transient, painful sting and sometimes kill animals and people.


The honey bee (Apis mellifera) is one of two domesticated insect species (the other is the silk worm, Bombyx mori). Native honey bees in tropical Southeast Asia were the original source of the North American domestic honey bee. When early American colonists missed honey as a sweetener, they imported European strains of the honey bee to Jamestown, Virginia, and the bees became known as European honey bees. The aggressive African honey bee, Apis mellifera adamsonii, a native of tropical southern Africa, was introduced into Brazil in 1956 in the hope of improving the local European strain’s ability to cope with warm weather. The bees readily adapted, but swarms escaped and have been moving northward at a rate of 150 to 200 miles per year. They are now found in California. The African honey bee hybridizes with the domestic honey bee, from which it can be distinguished only by apicultural entomologists.


A sting from a single insect is not likely to cause a problem in a horse, llama, or dog. The classic anaphylactic response of humans has not been documented in livestock or companion animals. A local reaction consists of a swollen, edematous, and erythematous plaque. A tiny abscess may form at the injection site. Multiple stings may produce numerous urticarial wheals and cause a severe systemic response as a direct toxic effect of the venom.


The pain associated with multiple stings may cause excitement or frenzy in a horse, followed by tachycardia, diarrhea, hemoglobinuria, icterus, and prostration. If the stings are on the head, or near the nostrils or mouth, swelling may occlude air passages, causing dyspnea.


Dogs may yelp at the initial sting. Cats are less likely to vocalize. Most victims of single stings are presented to the veterinarian with facial, aural, or periorbital angioedema. If a dog snaps at a bee or wasp and the sting occurs in the oral or pharyngeal cavity, swelling may occlude the passageway, resulting in severe dyspnea. Multiple bee stings may result in cardiovascular and respiratory collapse with death ensuing in minutes.


As soon as the injection site has been identified, the area should be inspected for the remains of the stinger. The stinger of the honey bee has retrograde barbs that oppose extraction of the stinger, causing the caudal insect abdomen to be torn away. A honey bee is thus unable to inflict multiple stings, as do wasps and hornets, which do not have barbed stingers. A retained stinger should be removed by the most rapid method available.



Tick Bites


Members of the order Acarina, class Arachnida (ticks, mites, spiders, and scorpions) pose minimal risk for horses and llamas but may incapacitate dogs. Envenomation should be managed as for a human. Ticks are known to transmit a variety of infectious disease agents, including Borrelia burgdorferi (borreliosis, Lyme disease) and Ehrlichia risticii (Potomac horse fever, ehrlichiosis) in horses, but the biggest hazard of tick infestation in trek animals is tick paralysis.9 Tick paralysis occurs in horses, llamas, dogs, and many species of mammals and birds in North America, Europe, Africa, Australia, and Russia. Usually, only female ticks produce the neurotoxin, which localizes in saliva and is injected into the host when the tick takes a blood meal. Numerous species of ticks are known to produce the toxin.


Signs may not appear until 5 to 7 days after the tick bite. Initially, there is paresis of the legs, progressing to unsteady gait, knuckling, ataxia, and ultimately, flaccid paralysis of the hind limbs. Loss of motor function ascends cranially, causing paralysis of the forelimbs. Pain perception remains. Even with paralysis of the limbs, the animal is bright and alert and able to eat and drink if feed is placed within reach. Ultimately, paralysis involves the neck, throat, and face, causing difficulties in chewing, swallowing, and breathing. Respiratory failure is the cause of death. This sequence of clinical signs is the only sure method of diagnosis, unless the tick is found. That may be quite difficult on an animal the size of a horse. The differential diagnosis includes encephalitides, head or spinal trauma, and hyperthermia.


There is no antidote for the toxin. The offending tick or ticks must be removed, which may produce a dramatic response. Look in the lightly haired areas of the axillary space, perineum, and behind the ears if tick paralysis is suspected. In a hospital situation, the animal should be endotracheally intubated and respiration supported until the effect of the toxin is dissipated. This is not an option in the field.

Sep 7, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Emergency Veterinary Medicine

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