Equine Emergencies and First Aid

If you have owned a horse for a period of time, chances are you have or will encounter a situation in which veterinarian attention is necessary. When this time comes, you must be able to assess the situation and determine if it is an emergency, or can the situation wait for a scheduled visit from your veterinarian. To determine if the situation truly is an emergency, it is first important to know what is normal for your horse. The following table lists the normal vital signs for an adult horse.
Temperature 99-101.5 °F
Pulse/Heart Rate 28-40 beats per minute
Respiration Rate 20 breaths per minute
Mucus Membrane Color Pale pink
Capillary Refill Time < 2 seconds

It is a good practice to check your horse’s vital signs regularly so that you can quickly recognize when something is abnormal and react to the situation in the appropriate manner. If you do encounter an emergency situation gather the following information before you call the veterinarian. Vital signs such as temperature, pulse, respiration rate, mucus membrane color and capillary refill time, will inform the veterinarian on the seriousness of the injury or illness. Be prepared to list specific details such as the location and nature of the injury, the horse’s attitude (agitated/depressed), the time that the injury has occurred, and if the horse is lame and the degree of lameness.

There are several situations that are true emergencies and require immediate veterinary attention. Below is a list of the most common emergencies, but of course the list is not inclusive.

Injury with profuse bleeding Obvious or Suspected Fractures Cut that requires sutures
Nail in the Hoof Sudden Lameness Respiratory distress
Choke Seizures Tying Up
Eye Injury Colic Allergic Reaction

Injuries with Profuse Bleeding

Due to the horse’s natural instinct to flee from scary situations, they tend to run into (or through) sharp objects such as fences, tree branches, and metal doors. These injuries tend to bleed profusely. The good news is that horse’s can loose up to 10 liters of blood before any major circulatory damage is done. If you do encounter an injury that is bleeding profusely, you should take certain steps as you are waiting for the veterinarian to arrive. First apply pressure to the wound with a clean dressing to slow down the bleeding. The dressing may be secured in place with a bandage if possible. The bandage should be secured tightly enough to slow down the bleeding, however be sure that it is not too tight and cuts off the circulation. The use of a tourniquet is not recommended because these often do more damage than good. If the wound is severely dirty, first gently rinse the wound with cold water. Do not use too much water pressure or scrub the wound, because it may cause the wound to bleed more. If there is a chance that the wound can be sutured, it is best to do as little as possible to the injury before the veterinarian arrives. Do not apply any medication, disinfectant or ointment to such a wound. These materials may cause tissue damage that can interfere with suturing and the healing process. In such cases, the less that is done to these injuries before the veterinarian arrives the better.

Fractured Limb

If you suspect that your horse has a fractured limb it is very important to call the veterinarian immediately. Report the horse’s vital signs to the veterinarian. Often times these horses will go into shock due to the pain and immediate action is critical for the life of the animal. Attempt to keep the horse calm and do not administer any medication unless directed by a veterinarian. Certain tranquilizers can lower the blood pressure of the animal and cause them to go into circulatory distress. The injured limb should be stabilized to prevent further injury. A splint can be made out of PVC pipe that is split lengthwise. It is important to pad the injury well before applying the splint. A temporary splint can be made out of a pillow and several rolls of elastikon tape, Vet-wrap, or duct tape. If the horse needs to be transported it is important to protect them during the hauling procedure. If the injury is on a front limb, it is best to haul the horse backwards, so that if a sudden stop is to be made, the horse will be putting more pressure on his hind limbs rather that the injured limb. It is also important to wrap the uninjured limbs to give the horse extra support to the remaining three legs. Unfortunately horses were not designed to distribute their weight on less than four limbs. Therefore, with a severe injury such as a fracture, often times the supporting limb may experience a bowed tendon due to the excessive weight bearing.

Eye Injury

Due to the large, protruding eye on the side of the head, eye injuries are common in horses. The most common injuries include foreign bodies (gravel, dirt, twig, hay, insects) in the eye tissue, corneal ulcers, conjunctivitis, and bruised eyelid. If you notice signs such as excessive blinking, tearing, discharging, swelling or reddening or a blue cloudiness to the cornea, call the veterinarian immediately. Eye injuries are very treatable if they are acted upon quickly. However, if they are left untreated, small problems can turn into huge problems and blindness may result. Do not apply anything to the eye without directions from veterinarian.


If you have ever witnessed a horse that has an obstruction in its throat, it is a dramatic situation that you will never forget. Choke is defined as an obstruction in the esophagus and can be caused by a horse that eats too quickly or does not chew properly. Also pelleted grain or unsoaked beet pulp can cause choke because these items expand when they are moistened. The signs of a horse that is experiencing choke included large amounts of saliva and food particles discharging form the nostrils. The horse cannot eat and may show signs of pain such as pawing, coughing and panicking. As long as the obstruction is only in the esophagus, the horse is not in grave danger, however choke is an emergency and should be relieved as soon as possible. Aspiration pneumonia is a complication from choke because the horse can inhale food particles that it is coughing up. As you wait for the veterinarian, remove all food sources. Warm water can be offered to the horse if it would like to drink. You can palpate the left side of the horse’s neck for an abnormal lump in the esophagus. If you feel a lump you can apply a warm compress to the lump to aid in relieving the choke.

Tying Up

A horse that suddenly experiences extreme muscle cramping and pain is most likely tying up. Tying up is a common name for a condition known as exercise related muscle degeneration. Clinical signs of tying up include a sudden reluctance or inability to move and the muscles (especially the hindquarters) become hard and tense. The horse may experience excessive sweating, resting heart rate over 60 beats per minute, and resting respiratory rate over 30 breaths per minute. If you suspect your horse is tying up, immediately dismount, stop working the horse, keep the horse as still as possible, and call your veterinarian. Do not administer any medication unless directed by your veterinarian. If the episode is acted up quickly, most horses recover fully, however the urine may be discolored for the first 48 hours. If the urine is very dark in color, this indicates kidney damage and the horse should have a follow up visit with the veterinarian.


One of the most common emergencies that we encounter are colics. Colic is a term to describe any abdominal pain in a horse. There are many causes of colic and they fall under three main categories. The first category is due to intestinal dysfunction such as increased gas production, impaction, smooth muscle spasms and paralysis of gut motility. A second category is due to intestinal accidents such as displacements, torsions, and hernias. The final category includes enteritis and ulceration of gut which may due to inflammation, infection or lesions. Signs of colic can vary and may include looking at the flank, pawing, kicking or biting at sides, stretching out to urination, yet not voiding, rolling, decreased gut sounds, increased heart rate and lack of defecation. If you suspect your horse is experiencing colic, first remove all food sources from the stall and call your veterinarian immediately. As you are waiting for the veterinarian to arrive, monitor vital signs such as temperature, pulse and respiratory rate. The horse should be watched closely and keep him calm and comfortable. It is ok for the horse to lie down, however it should not be allowed to roll.

Items to have on hand in an Equine first aid kit

  • Important phone numbers, veterinarian, horse ambulance and farrier.
  • Thermometer
  • Stethoscope
  • Saline Solution to rinse eyes
  • Leg wraps
  • Cotton Wraps
  • Vaseline
  • Wound ointment
  • Scissors
  • Electrolytes
  • Dilute Iodine solution
  • Twitch
  • Hoof pick
  • Fly lotion
  • Hoof pick
  • Ophthalmic ointment
  • Latex gloves
  • Syringes
  • Sterile Needles
  • Antibiotic spray
  • Epson Salts

It is also a good idea to keep a some medication on hand. Do not administer any medication with out the direction of a veterinarians. Phenylbutazone and banamine are both nonsteriodal anti-inflammatory agents and aid in controlling inflammation and pain.

Lower back pain in horses


Have you ever bent over and suddenly been unable to stand up straight from lower back pain? Have you ever woken up, rolled over and thought “ouch” this isn’t going to be a very good day, as the pain radiates from your lower back down your leg to behind your knee? Lower back pain affects our quality of life and our job performance. It affects your horse’s life and performance as well.

We are able to share our symptoms of lower back pain with our family, friends and medical professionals. How do our horses share their symptoms? If we listen, they are trying to tell us. Some of the outwards signs would include: lack of drive from their hindquarters, hind end lameness that is hard to diagnose, tenderness to the touch over the rump, and not wanting to round or lift the back while being worked. If your horse has some of these symptoms, what can you do to diagnose and treat them? First understand how horses’ backs function.



Figure 1. Drawing of the equine vertebral column within the horse’s body. Reprinted with permission from the illustrator Dr. Robin Peterson.

The horse’s vertebral column is made up of approximately 54 vertebrae that surround and protect the horse’s spinal cord (Fig.1). Starting at the poll area of a horse there are 7 cervical (neck) vertebrae and 18 thoracic (chest) vertebrae. Each thoracic vertebra has a rib attachment. In the lower back, most horse have 6 lumbar vertebrae, except for some “short backed” Arabians that only have 5 lumbar vertebrae. The sacrum is made up of 5 fused vertebrae. The last set of coccygeal (tail) vertebrae can range in number from 5-18 depending on the breed and tail length of the horse. The sacrum and the ilium (part of the pelvis) are attached together at the sacroiliac joint (Fig 2.). This joint is the link between the hind limb extremities and the spine in a horse. The sacroiliac joint sustains high loading force during athletic activity and can be the source of low back pain in horses.


figure2Figure 2. Picture of an equine skeletal model from behind showing the pelvis, sacroiliac joint, and the coxofemoral (hip) joint.

Signs of sacroiliac pain in horse may include poor performance or lack of hind end impulsion. Horses with this problem also have had mild, chronic hind end lameness that is difficult to diagnose and does not resolve with traditional lower leg joint blocks or therapy. In a necropsy survey of 36 Thoroughbred racehorses, all specimens had various degrees of arthritis in their sacroiliac joint.1 In fact 92% of the specimens had moderate to severe degenerative changes in the pelvic area. To determine if the horse has a problem in the pelvis or sacroiliac region, a thorough physical and soundness exam should be performed by a veterinarian. The lameness exam should be started at the lower leg, proceed with joint flexions, diagnostic nerve or joint blocks, radiographs, ultrasound scan, and possibly nuclear bone scintigraphy. If a pelvic problem is suspected, one must determine if it is the primary cause of lameness or if the pain secondary to another sore area. More often than not, sore muscles or “trigger points” in the sacroiliac region are due to compensation of pain elsewhere in the body and are not a “true” pelvic problem. Keeping this in mind, a comprehensive lameness diagnostic exam is crucial.


figure3Figure 3. Nuclear Bone Scintigraphy scan of a horse with increased rate of absorption of the isotope in the left sacroiliac joint.

Nuclear bone scintigraphy is the best way to diagnose pelvic problems. This is a non-invasive technique in which the horse is given an intravenous injection of a radioactive isotope. The whole horse is scanned to see where the isotope is taken up by the horse’s skeleton (Fig. 3). The most painful areas have in increased rate of absorption of the radioactive isotope and can be detected by the scan.2 This procedure has a high percentage of detecting a pelvic problem if there is one.

The sacroiliac region also involves several ligaments and soft tissue structures. An ultrasound scan of the area may detect bone and ligament injuries. This technique is also non-invasive. It requires high level ultrasound skills, high quality machine and probe, and knowledge of the pelvic bone and soft tissue anatomy. The veterinarian should scan the external pelvic structures and also perform an internal rectal ultrasound exam.

Radiographs of the pelvis may also be performed depending on the size of the horse. In some smaller or young horses, with less muscle, the coxofemoral (hip) joint can be x-rayed standing. However most pelvis or hip radiographs must be taken under general anesthesia so the horse can be laid on its back. One must always keep in mind that there are always risks involved in putting a horse under or recovering from general anesthesia. These risks are increased in horses with hind end lameness.

Treatment Options

If a pelvic problem is diagnosed, there are some treatment options. Most pelvic problems are managed, however not always cured. A stress fracture of the pelvis as long as there is not major displacement will heal with time. Shockwave therapy can speed healing time. If the pelvis is completely fractured there is a poor prognosis. The sacroiliac area can be can be injected with corticosteroids, sarapin, or other counter-irritants. The joint itself is difficult to inject, however the medication around the area has been shown to provide some pain relief.

Chiropractic and acupuncture therapy can also help this area. When discussing equine chiropractic therapy you may have heard the term subluxation complex. This term means different things to different people. In traditional veterinary medical terms, subluxation is defined as a partial dislocation of a joint. This has a poor prognosis and requires medical and possibly surgical attention. A subluxation complex in chiropractic terms means that the joint surfaces are not in the correct position by millimeters. The joint itself still functions, but not as well. The subluxation complex may also cause impingement of the spinal nerve in that area and thus decrease nervous enervation to the surrounding area. There is loss of normal motion due to pain, muscle spasms, or joint stiffness. Chiropractic therapy involves examining the entire horse to locate subluxation complexes and tight muscle and painful areas. The subluxation complexes are adjusted by delivering a short, sharp thrust with the doctor’s hands or an instrument to a specific joint at a specific angle on the horse’s spine or limbs. One joint is worked on at a time. Many times the doctor must stand on a stool or bale to achieve the correct alignment angle. If the incorrect angle or thrust is applied, great damage can be done to the animal. It is important to make sure that the doctor you have work on your animal is properly trained and certified in animal chiropractic. The chiropractic therapy should be performed by a doctor certified in Animal Chiropractic through the American Veterinary Chiropractic Association. You can locate a qualified doctor in your area by searching the AVCA website at www.animalchiropractic.org. The goal of the chiropractic therapy is to restore normal range of motion in the horse’s vertebral column and limbs, release impinged nerves and thus muscle spasms, and alleviate pain in the animal.

Acupuncture and chiropractic therapy can be mutually enhancing and it is beneficial to integrate both modalities for treating pelvic problems in horses. Equine acupuncture therapy originates from Traditional Chinese Veterinary Medicine over 3000 years ago. The therapy involves stimulating a particular point on the body with a particular method to produce a therapeutic effect. Acupuncture points are located throughout the body on acupuncture meridians. There are several important and effective acupuncture points around the sacroiliac region of the horse. The overall goal of acupuncture is to stimulate internal anti-inflammatory and pain relief mechanisms to balance the body, facilitate tissue repair and prevent injury or disease. Integrating the various forms of therapy can decrease the possibilities of injuries and optimize the health and performance of our equine athletes.

Recognizing, diagnosing, and treating your horses’ lower back pain is critical to their comfort and to their success as a performance horse.


1. Haussler, KK. Functional Anatomy and Pathophysiology of Sacroiliac Joint Disease. AAEP Proceedings 2004; 50:361-366.

2. Dyson, SJ, Murray, RC, Branch M. Uses and Limitations of Nuclear Scintigraphy for Evaluation of the Sacroiliac Region. AAEP Proceedings 2004; 50:379-384.