Bienert-Zeit A, Müller J-M V, Feige K
Klinik für Pferde, Stiftung Tierärztliche Hochschule Hannover, Hannover.
Tierarztl Prax Ausg G Grosstiere Nutztiere. 2012;40(1):53-61.
The article provides hands-on advice and scientific background information regarding the management of the equine acute colic patient. It summarizes essential information on the patient's history, clinical examination, and legal aspects. The scope of the history is based on the clinical appearance of the patient. In horses with violent and barely controllable signs of pain, it is limited to colic-associated information such as onset, course and severity of colic signs, and the last time of defecation, as well as prior therapeutic intervention. In these patients, the clinical examination is focussed primarily on the assessment of cardiovascular parameters, rectal temperature, and the patient's behaviour. The nasogastric intubation is an essential part of the examination of a horse with colic to prevent a gastric rupture due to gastric distension. Transrectal palpation is equally important and should always be performed unless there are important reasons to object to this procedure. In most cases, a thorough patient history and clinical examination of an acute colic patient allows the examining veterinarian to make a tentative diagnosis and a prognostic evaluation. This helps with the decision to start a conservative or a surgical therapy. Due to the existing obligatory documentation requirement and the duty to inform patient owners, it is of utmost importance to promptly document one's findings, therapeutic measures, consultations, and information of the patient owner in written form. This supports further therapy and it can also be of relevance in a potentially resulting lawsuit.
本文提供了有关马急性腹痛病患者管理的实用建议和科学背景信息。它总结了关于患者病史、临床检查和法律方面的重要信息。病史的范围基于患者的临床表现。对于有剧烈且几乎无法控制的疼痛体征的马匹,病史仅限于与腹痛相关的信息,如腹痛体征的发作、病程和严重程度、最后一次排便时间以及先前的治疗干预。在这些患者中,临床检查主要集中在评估心血管参数、直肠温度和患者的行为。鼻胃插管是马腹痛检查的重要组成部分,以防止因胃扩张导致胃破裂。直肠触诊同样重要,除非有重要理由反对该操作,否则应始终进行。在大多数情况下,对急性腹痛患者进行全面的病史和临床检查可使检查兽医做出初步诊断和预后评估。这有助于决定开始保守治疗还是手术治疗。由于现有的强制记录要求以及告知患者主人的义务,以书面形式及时记录自己的检查结果、治疗措施、会诊情况以及向患者主人提供的信息至关重要。这有助于进一步治疗,在可能引发的诉讼中也可能具有相关性。