What is the emergency treatment protocol for acute laminitis in horses?

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The emergency treatment protocol for acute laminitis centers on continuous digital hypothermia (CDH), multimodal analgesia, and mechanical offloading of the toe region, initiated as rapidly as possible after onset. CDH is the standard of care for both prevention and early treatment of acute laminitis. The target hoof temperature is below 10°C, achieved by immersion in ice water or application of ice boots filled with crushed ice or iced water.8 CDH reduces the severity of sepsis-related and hyperinsulinemic laminitis in experimental models and reduces the incidence of laminitis in clinical colitis cases.2 At the lamellar level, CDH decreases pro-inflammatory gene expression and provides histological protection.8 CDH carries a low risk of adverse effects.8 Pain management requires a multimodal approach. First-line analgesia includes nonsteroidal anti-inflammatory drugs (NSAIDs), which are also recommended alongside antibiotic therapy when infection is a contributing factor.110 NSAIDs should be combined with opioids and/or constant rate infusions of alpha-2 agonists, ketamine, and lidocaine.10 Local techniques including long-acting local anesthetics or epidural catheterization provide potent analgesia with a lower risk of systemic adverse effects.10 No single drug or agent stops the onset of laminitis, and there is no universally accepted standard pharmacologic protocol.3 Mechanical support is directed at shifting load away from the toe region. The goal of supportive orthopedic therapy is to transfer load from the diseased, most painful areas of the hoof to undamaged areas.4 Heel elevation — for example, via a hoof cast with heel wedge — shortens the breakover phase and reduces vertical force in the toe region during breakover.4 Additional orthopedic options include lily pads, toe beveling, and wooden shoes.4 Hoof trimming and corrective shoeing provide temporary stabilization.1 Treatment should be considered an emergency and aimed at controlling or interrupting rotat