Memorial Day Miracle
by Dr. Julie Bryngelson

While serving as the on-call veterinarian on Memorial Day, I received an early morning page requesting a response to a trauma situation.  I quickly contacted the individuals to discover that two horses had collided in a pasture. One of the horses, we’ll call him Trigger, was stuck on his side and flipped over onto the ground. The impact was so great that his withers had dug into the dirt several inches. Following the incident, Trigger was standing, but not breathing well and in need of veterinary care.

Upon arrival at the farm, Trigger was quiet, but had a very difficult time breathing. His temperature, pulse, and respiratory rate were within normal limits.  However, crackles were detected in the left lung field and there was a large painful swelling on the left chest approximately 12” X 12.” The lung sounds were also decreased in several areas of the lung fields. Due to the painful swelling and the abnormal lung sounds, a thoracic and abdominal ultrasound were performed by our internal medicine specialist, Dr. Janet Han. Blood samples were also submitted for a complete blood cell count and chemistry profile.

During the ultrasound examination, we discovered fluid accumulating in Trigger’s belly and chest.  We also detected a mild pneumothorax (entry of air into the pleural cavity). However, no rib fractures were detected.  An abdominocentesis (“abdominal tap” or “belly tap“) was performed to collect and further evaluate the fluid accumulating in the abdominal cavity. The fluid was blood. Trigger was bleeding internally into his abdomen (hemoabdomen). Ultrasound evaluation of the spleen was normal, and the source of the bleeding could not be determined by ultrasound examination. At this time, Trigger was transported to the hospital for intensive care therapy. 

After arriving at the hospital, Trigger received intravenous fluid therapy infused with a medication to stop the hemorrhaging. He also received an anti-inflammatory pain reliever, intravenous antibiotics and 100% oxygen via a nasal cannula. His complete blood cell count and chemistry profile were normal, but he was placed under intense monitoring. After arriving at the hospital, a re-check ultrasound revealed additional accumulation of fluid in the thoracic cavity, mainly the left side, but no change in the amount of fluid in the abdomen. The large amount of fluid in the chest was making breathing a very difficult chore for Trigger. A chest tube was carefully placed in the left thorax to drain the fluid from the thoracic cavity. A large percentage of the volume of fluid was blood. Trigger was also bleeding into his thorax (hemothorax)! 

In order to prevent a pneumothorax (air accumulating in the pleural cavity-which can lead to collapse of the lung), a one-way valve was placed on the end of the chest tube.  The valve allowed drainage of the fluid, but prevented air from entering through the tube.  At this time, the packed cell volume (PCV-percentage of the volume of whole, unclotted blood occupied by the red blood cells) and total protein values were re-checked.  The PCV was decreasing to significantly lower levels due to the internal hemorrhage. Trigger was closely watched and his PCV was evaluated several times that evening. Finally around midnight, Trigger’s PCV has decreased significantly enough to warrant a blood transfusion. I called Dr. Blohowiak to ask if we could use one of his horses as a blood donor and made the trip to his farm. 8 liters of blood was taken was taken from his horse, Billy, and collected in bags with anti-clotting fluid in them. Once back at the clinic, this blood was slowly administered to Trigger. Trigger was closely monitored during the transfusion to be sure he would not have a negative immune response. The transfusion went very well. Interestingly enough, any healthy gelding can potentially be a blood donor for an initial blood transfusion. Subsequent transfusions require typing and cross matching.

Throughout the following six days, Trigger’s PCV was checked 2-4 times daily, he received around-the-clock monitoring and treatments, and his condition gradually began to improve.  The chest tube was removed when the fluid draining through the tube stopped, and ultrasound examinations were performed to ensure fluid did not accumulate in the thorax following removal of the tube.

When he was stable enough to go home, his dedicated owners continued medical therapy with antibiotics every six hours and anti-inflammatory pain medications every 12 hours.  He also received daily oral medication to prevent ulcers that can occur as a result of long-term therapy with non-steroidal anti-inflammatory medications.