Palpation
Gently palpate the foal ' s ribs , paying close attention to any defects and soft tissue swelling , especially over the costochondral junctions . These areas are prone to fracture or dislocation , which may occur in the case of traumatic birth . The presence of crepitus with a ‘ flail ’ chest , where it caves in with inspiration , will necessitate urgent intervention and very careful handling .
Mucous membranes and capillary refill time level as the heart . The air-filled bladder within the cuff should fit snugly against the artery . The correct size of cuff recommended for the monitor being used should be placed around the tailhead and must encircle at least 100 % of the tail ' s circumference ( Figure 7 ). The same cuff should be used at each reading to maintain consistency . Take several readings when the foal is quiet or asleep and calculate the average mean arterial pressure ( MAP ) measurement . The normal MAP of a Thoroughbred foal is 69 – 111 mmHg , which is lower than in an adult . A reading within the normal range indicates adequate organ and tissue perfusion [ 1 ] .
Check the foal ' s mucous membrane colour and capillary refill time , in good natural light . The mucous membranes should be pale pink , moist and with no signs of haemorrhage . The time between pressing the gum line and the blanched area returning to colour ( the capillary refill time ) should be less than 2 seconds .
Heart / pulse rate
Check that the foal ' s peripheral pulses are regular , strong and consistent with the heart rate . Auscultate the heart base on the left side , just behind the elbow , listening for a regular rhythm . A normal heart rate in a newborn will increase and stabilise at 90 – 120 beats per minute a few hours after birth . This is due to the normal cardiopulmonary adaptation of the foal as it transitions to an extrauterine environment [ 4 ] . A systolic murmur is not unusual or abnormal in a healthy neonate until the closure of the ductus arteriosus ( over 3 – 4 days ) and the foramen ovale ( over the first few weeks of life ).
Temperature
Use a digital thermometer to check the foal ' s rectal temperature . If the foal has had a recent enema the temperature may be temporarily lower than expected .
Faecal output
Note the presence or absence of faecal output and its consistency . A pale , yellowish , pasty and slightly loose consistency is normal in foals on a milk diet . The dark , firm and formed faecal balls associated with meconium should pass within 12 hours of birth .
Figure 7 . A blood pressure cuff in place around the proximal tail .
Intravenous fluid lines and catheters
An important aspect of every critical care examination is checking that all IV fluid lines are patent , running without leaks , and have fully functioning and accurate infusion pumps and syringe drivers . Check that the fluid rates actually being delivered correspond with the rates written up on the IV fluid plans . Most fluid administration lines will require changing every 24 hours , especially when being used for TPN . This task must be completed using meticulous aseptic technique , with the new lines being marked to indicate when the next change is due . Check IV catheters and jugular integrity , and ensure there is not a physiological issue that could interfere with fluid therapy , which would require immediate attention . Recumbent neonates are prone to jugular trauma , caused by rubbing catheter sites on floors , leading to thrombosis . Therefore , the jugular veins must be frequently monitored for signs of heat , swelling and discharge .
Blood pressure
Indirect blood pressure ( BP ) measurements , using the coccygeal artery , are often required at each examination . Serial non-invasive BP measurements can be helpful in detecting trends , but they are not as accurate as invasive BP measurements because they do not provide absolute values of arterial blood pressure . The BP cuff should be placed around the same part of the tail for every reading , at the same
Oxygen levels
Oxygen insufflation is a common treatment for the recumbent foal . Whether this is provided by mechanical ventilation or intranasal oxygen , the delivery lines will need to be examined for kinks , splits , leaks or obstructions that may prevent oxygen delivery . Flowmeter rates will also need to be checked against treatment orders . Nasal oxygen catheters and delivery lines should be scheduled for replacement every 24 hours .
34 Veterinary Nursing Journal