Hey Venty, another alpha-2 vet question

[Orthonut]

It's me again Margaret Such a dumb question, but I had a WTF moment last night (I could see my license flashing before my eyes)

Had a thought the other night. One of my mentors saw a very bad colic (gastric torsion) the other night-dispensed some detomidine w/butorphenol to the client...was telling me he'd left the injectables with the client (DVM had to go back to the clinic to get the trailer in order to ship the horse to the surgical facility)

I kinda freaked, I mean...what if the client had accidentally injected him/herself with the alpha2? I remembered you replying to my precedex question, and I could swear it seemed like humans were much more sensitive to the alpha2s than my patients...do you guys have reversal agents like we do? Would a trip to the ED have any hope for a dumb*** client that injected themself?

Mentor adamant that nothing would happen to a client but I'm too chicken to dispense such things, even in emergencies like the other night.

Am I the dummy here?

---

Members don't see this ad.

 

[kraphtymac]

They ETC may be able to manage the blood pressure but I'm guessing the guy would expire first from whatever rhythm the detomidine threw him into.

 

[Planktonmd]

It's me again Margaret Such a dumb question, but I had a WTF moment last night (I could see my license flashing before my eyes)

Had a thought the other night. One of my mentors saw a very bad colic (gastric torsion) the other night-dispensed some detomidine w/butorphenol to the client...was telling me he'd left the injectables with the client (DVM had to go back to the clinic to get the trailer in order to ship the horse to the surgical facility)

I kinda freaked, I mean...what if the client had accidentally injected him/herself with the alpha2? I remembered you replying to my precedex question, and I could swear it seemed like humans were much more sensitive to the alpha2s than my patients...do you guys have reversal agents like we do? Would a trip to the ED have any hope for a dumb*** client that injected themself?

Mentor adamant that nothing would happen to a client but I'm too chicken to dispense such things, even in emergencies like the other night.

Am I the dummy here?

May I ask you a question and excuse my ignorance in advance:
Why would you think that the owner of the horse is going to inject himself with the horse medicine?
Do you see that type of behavior frequently in your "clients"?
And if the owner of the horse actually does that, why would that be your fault?
and to answer your question: yes, there are many things that we can do to a patient who injected himself with a horse dose of alpha 2 agonist if he is smart enough or lucky enough to make it to the ER.
These things could be as simple as just watching the patient closely to as advanced as external or intravenous pacing and vasoactive drugs.

 

[Orthonut]

May I ask you a question and excuse my ignorance in advance:
Why would you think that the owner of the horse is going to inject himself with the horse medicine?

Not ignorance at all-the horse in this particular instance was a 1600lb very big/tall horse-who was thrashing and crashing about in extreme distress. I typically worry in these cases that the client might be attempting to administer the meds and should the horse flip out at the wrong time, the client may accidentally stick him/herself.

Do you see that type of behavior frequently in your "clients"?

Oh we have drug seekers too, but not usually in this situation-but accidental exposure to meds isn't all that uncommon when working with the larger animals such as horses, cows, exotics

And if the owner of the horse actually does that, why would that be your fault?

Probably-we can be held liable if the owner's pet bites/kicks him/her during an appointment/exam, so it's not really a stretch that the client could sue in such a situation.

Thanks for the reassurances that I'm not some crazy lunatic worry wart.

 

[eventualeventer]

I was reading through the archives and thought I had a relevant anecdote (sorry for resurrecting a ghost thread, wasn't sure whether it was better to start a new thread out of the blue).

For background, I am an equine veterinary assistant on my way towards vet school (eventually).

OK, this will probably make you faint in horror and think that vet med types are crazy, but I thought I'd shed a little light on the vet world for you one-species types (I say that with love, don't hit me, please!).

A not uncommon bad habit among vets and vet techs is to uncap needles (and occasionally even recap them!) by clenching the needle cap in one's mouth and yanking the needle and syringe away. This habit is often picked up when trying to restrain the animal with one hand and inject with the other. In field situations, after the injection is finished and the animal released or handed off to the owner*, the needle cap is removed from the mouth, placed back on the needle, and shoved into one's pocket until one can get back to the truck.

A friend (licensed vet tech) won a trip to the ER a while back because, while she was preparing to sedate a horse with xylazine (another alpha-2 agonist), she cracked the needle cap with her teeth and absorbed a small amount of the drug that was still in said needle cap. This happened before I knew her, so I don't know the exact details, but her BP dropped enough that she passed out and spent the rest of the night hooked up to an EKG in the ER.

A classmate of my boss who was going to sew up her (the classmate's) own lac but grabbed the xylazine instead of the xylocaine and started blocking away. I think she survived, but was not 100% neurologically intact.

IME, alpha-2 agonists are dispensed relatively readily to horse people for IM sedation without a peep about the potential hazards of accidental self-injection. Yes, since these drugs are licensed for use by or under the supervision of a veterinarian, the vet is liable for anything that happens with that drug.

One of the vets I work for said that xylazine would be the perfect murder weapon, since it wouldn't show up on any tox screen unless they knew to look for horse drugs.

Out of curiosity, are there any specific alpha-2 antagonists licensed for use in people? Atipamezole is used for reversal in dogs, and yohimbine is licensed for use in horses, but I've never seen either in equine practice.

The vets that I worked for never carried naloxone or naltrexone, either, but EMT's have plenty of experience reversing resp. dep. secondary to opioid overdose.

RE: needlesticks -- I think of every horse as a moving target until proven otherwise. A lot of them are surprisingly good, but it's like having a kid who is non-verbal and then adding the fact that you physically can't strap them down unless they are under GA. IME, the most needlesticks actually happen when trying to inject something into a catheter -- I stabilize the injection port with my left hand and inject with my right, and if the horse flips its head at the wrong time (some of them hate having you mess with the catheter, since it pulls on the sutures a bit when you mess with it), BAM, I'm cursing up a storm and looking for another needle. The worst are sub-palpebral lavage catheters -- the horses hate the sensation of the eye meds, and many start shaking their heads as soon as you approach their necks. FTR, natamycin burns like a mother f u kk er if it ends up in your finger.

* You would be surprised (actually, no, you wouldn't, you work with the public, too) how many horse owners can not restrain their animals for the vet, ranging from praising the animal for trying to kick to dropping the lead rope in the middle of a procedure to whacking the horse for misbehaving while the vet is crouching down under the horse, has an arm in an orifice, or is otherwise vulnerable.

Sorry for the novel, and thanks for the interesting thread.

 

[Planktonmd]

IOut of curiosity, are there any specific alpha-2 antagonists licensed for use in people?

Yohimbine is available for humans but not as an antidote to alpha2 agonists, it's actually used to treat impotence.

 

[amyl]

as a doctor and a horse person i can tell you horse people do medicate themselves...while i haven't seen any diversion of controlled substances (horses don't do most fun stuff like opioids) i don't know a single horse person that won't pop smz's (bactrim for the non-horsey crowd) or break into the horses' robaxin tablets for muscle aches. vets in general are pretty cavalier with medications. competition horse people get pretty familar with these drugs and often self medicate in my experience. veterinary medicine is not regulated like people medicine. my vet has a guy in a golf cart at the horse shows that he sells meds out of...just a guy, not even a tech, dispensing meds without a prescription....very little regulation.

 

[Planktonmd]

as a doctor and a horse person i can tell you horse people do medicate themselves...while i haven't seen any diversion of controlled substances (horses don't do most fun stuff like opioids) i don't know a single horse person that won't pop smz's (bactrim for the non-horsey crowd) or break into the horses' robaxin tablets for muscle aches. vets in general are pretty cavalier with medications. competition horse people get pretty familar with these drugs and often self medicate in my experience. veterinary medicine is not regulated like people medicine. my vet has a guy in a golf cart at the horse shows that he sells meds out of...just a guy, not even a tech, dispensing meds without a prescription....very little regulation.

when you say "they medicate themselves" does that mean they abuse the animal drugs or they give the animal drugs without a prescription??

 

[amyl]

i meant the people take the animal drugs. btw, they also give the drugs to the horses without a prescription from the vet. not regulated at all