Competitive horse recovering from impale injury after treatment at Equine Medical Center
“We can't say enough about the care he received at the Marion duPont Scott Equine Medical Center,” owner Lauren Parr said. “They saved his life; he never would have survived without them and it was a very complicated case.”
After sustaining a particularly nasty puncture wound to the chest, Patrick, a striking and much loved 8-year-old roan gelding, was referred to the Marion duPont Scott Equine Medical Center (EMC) for emergency treatment.
Owned by Lauren Parr from Mount Airy, Maryland, Patrick, a thoroughbred-Connemara crossbreed, is a talented eventer horse ridden by her son, James Power. He is known in competition as Brambleridge Ponder the Truth.
“We can't say enough about the care he received at the Marion duPont Scott Equine Medical Center,” Parr said. “They saved his life; he never would have survived without them, and it was a very complicated case. Dr. [Sophia] Boorman, Dr. [Alexandra] Grobman, and Dr. [Bruno] Malacarne were very committed to him and very diligent in their efforts to find solutions for such a complicated and unique case.”
The EMC is a premier, full-service equine hospital located in Leesburg and one of three animal care and teaching hospitals of the Virginia-Maryland College of Veterinary Medicine, based on the Virginia Tech campus in Blacksburg.
Patrick is now in a rehabilitation facility to rest and recover away from the hospital setting. He has adopted one of the facilities’ chickens -- an emotional support chicken -- as his new best friend and he is receiving excellent care. Patrick is expected to make a full recovery.
“We would have been happy just to see Patrick survive and have a good quality of life,” Parr said, “but to know that he and James still have a future in eventing together is something we are incredibly grateful for.”
Freak injury
During a freak accident while out on a leisurely ride at a Maryland farm, Patrick stepped on an old, bent, rusty metal T-post that was buried in the dirt. The post popped up as he put his full weight on it, and as Patrick tried to get himself over the post, he impaled himself in the chest.
Primary care veterinarian Will Engel, from Ridgeview Veterinary Practice in Mount Airy, Maryland, evaluated Patrick on the farm, flushed the wound, and provided medication for pain alongside a broad-spectrum antibiotic. Initially, it was thought that the wound had not penetrated Patrick’s thoracic cavity. The thoracic cavity contains the heart, lungs, thoracic vertebrae, and the ligaments and muscles that connect them.
The following morning, Patrick looked as if he was filling up with air. Engel referred Patrick to the EMC for emergency evaluation and treatment.
Sophie Boorman, clinical assistant professor of equine surgery and her clinical support team, noticed diffuse emphysema extending from his chest and neck all the way along his body to his stifles.
Caused by the trauma Patrick had sustained, air was accumulating under Patrick’s skin. They were fearful that he may develop pneumothorax, which is air accumulation in the thoracic cavity that leads to a collapsed lung. It was imperative to prevent additional accumulation of air in Patrick’s skin and thoracic cavity.
Admitted to EMC
The puncture wound was on the right side of his chest, measuring 1.5 by 2 inches, and approximately 5 inches deep. Initial radiographs did not identify the presence of a foreign body, but he had soft tissue swelling around the wound.
The wound was packed with a sterile lap sponge soaked in an antibiotic solution to prevent further suction of air during movement. Patrick was admitted to the hospital for continued monitoring and management of his puncture wound.
“Wounds in this location act like a one-way valve and suck air into the subcutaneous space and into the thorax,” Boorman said. “It was important to seal the wound to prevent this and to monitor closely for any sign that air had entered the thorax, which could deflate the lung, and be life-threatening.”
Broad spectrum antimicrobial, a sedative, anti-inflammatory, and gastroprotection were administered, and the wound was packed daily with gauze, an antiseptic solution, and manuka honey – which has antioxidant and antibacterial properties to help keep the wound from getting infected. The packing was changed daily to ensure an airtight seal.
“Patrick’s medical team took all of our questions and observations about what we saw when we visited, and they acted in his best interest with efforts to not stress or hurt him unnecessarily,” Parr said. “It took time and patience; wound care wasn't something that could be rushed. Additionally, the patient care staff were excellent, always kind and caring to Patrick and to us.”
Despite every precaution, Patrick developed a fever, and his appetite and manure production decreased. More alarmingly, he began to suffer from respiratory distress, and his heart rate began to increase.
Repeat radiographs confirmed pneumothorax (air or gas in the pleural cavity). A procedure was performed to remove fluid and air from around the lungs. Patrick’s respiratory rate and effort significantly improved. A tube was passed into Patrick’s left nostril to provide him with oxygen and help him to breathe more easily.
The following day, Patrick’s respiratory rate was worsening again. Radiographs showed recurrence of the pneumothorax despite the wound being sealed which suggested that the air trapped under his skin continued to move from the subcutaneous space into Patrick’s thoracic cavity. A tube, sealed with a one-way valve was inserted into his chest. This allowed trapped air to escape from the thoracic cavity, providing Patrick with immediate respiratory relief.
Recovery
Over the next few days, Patrick remained comfortable, his appetite began to improve, and fevers resolved. He started passing more manure, and over time the trapped air in his tissues decreased and his wound granulation increased.
After Patrick spent a week breathing normally, the chest tube was removed without complication and the wound had almost completely healed. Patrick was ready to leave the hospital and head to a rehabilitation facility, accompanied by a comprehensive list of instructions for continued care.
Parr was visibly moved when she arrived at the EMC to take Patrick home.
“What we appreciated most was the very clear communication about upside and downside risks for treatments, especially at the most critical moments where we were making hard decisions related to survivability and quality of life,” Parr said.
Before the accident, Power and Patrick were competing at the Preliminary level in eventing, preparing to contest their first CCI2* in the fall after a top 5 finish at CCI1* in the USEF Eventing Young Rider Championships in July.
“James and Patrick have always had a special relationship,” Parr said. “They never give up on each other and trust each other completely. Thanks to the EMC, they'll have the opportunity to continue that partnership, and we look forward to watching them ride out on a cross-country course in the spring.”
