Avian Exam Pt. 2 Flashcards
Examples of avian emergencies (6)
1) Hemorrhage
2) Trauma
3) Neurologic signs (seizures, tremors, ataxia)
4) Fluffed bird on the bottom of the cage
5) Egg binding, cloacal prolapse
What should you instruct a client to do before bringing in an avian emergency?
1) Stop any bleeding - direct pressure, styptic, corn starch
2) Provide heat
3) Reduce stress on the bird - quiet and dark room
4) Bring bird in a carrier (never allow loose birds in your waiting room)
What does fluffing at the bottom of a cage indicate?
Birds response to loss of body heat - need to keep them warm
Initial assessment of avian ER cases
Visual exam in cage - respiratory rate (tail bob), mentation, ambulation, posture, droppings
Things in the history you want to think about with avian emergencies
> Improper husbandry = common cause of illness
- Diet
- Droppings, equal amount of urine, feces, urate
- Any new pets in the household
- Exposure to toxins - lead paint
- Cage type and location
- Perches, substrates, or toys
What to keep in mind with PE’s of avian emergencies
- KNOW THE PATIENT’s LIMITATIONS AND STRESS LEVEL
- Establish priorities
- May need to pre-oxygenate or stage PE’s = have O2 or sedation ready
- MONITOR stress level during restraint (open mouth breathing?)
- Only perform PE if the bird is stable
- Careful not to compress the keel during restraint
What sedation can be used in avian emergencies?
- Intranasal or IM midazolam +/- butorphanol (for deeper sedation)
- Reversed with flumazenil (IM, IN, IV)
- Decreases the acute stress response
- Anamnestic = makes them forget the stress
How much blood should you take from a normal or severly compromised bird?
- Safely take 1% of body weight
- Compromised birds = aim for <1% of BW = already anemic? hypoproteinemic?
*Blood volume = 10% of body weight
Where do we take veinpuncture from in birds?
- Best choice = RIGHT jugular
- IV catheter = ulnar in small birds (hematomas common, difficult to hold off)
- Median metatarsal vein in bigger birds
Basic emergency avian PE
- Auscultate heart, air sacs, lungs
- Palpate coelomic cavity
- BCS from keel (thin = more chronic disease)
- Examine nares, oral cavity
- Examine neck, crop
- Palpate wings, legs
- WEIGH
+/- Cloacal inversion
+/- Skin and feather exam
+/- Feet
+/- Back or uropygial gland if present
Reliable and non-reliable ways to assess hydration in birds
- Assume any sick bird is dehydrated and will need fluids
- Move upper eyelid upward = should spring back normally
- Sternal skin test over the keel = skin should normally be freely moveable
- Ulnar vein refill time
Preferred and other routes of fluid administration (and where?)
- Preferred = SQ in the inguinal region (large volumes, non-invasive), small gauge (23-25g)
- IV (+ sedation) = R jugular, metatarsal, ulnar
- IO (+ anesthesia) = ulnar, tibiotarsal (NOT humerus, femur)
Why can’t you do IO fluids in the humerus or femur?
Pneumatic bones that connect to air sac, will drown the bird
What is a good choice for fluid therapy?
- Warmed fluids
- Crystalloids
> 40-60 ml/kg/day + dehydration or fluid deficits - Colloids for IV use in volume depleted cases
Why do we make sure we can see a bleb when we give fluids SQ?
To ensure we’re not enstilling it in an air sac
Materials to use and things to remember when placing IO catheters/fluids
- Site = distal ulna, proximal tibiotarsus
- Usually requires anesthesia or analgesia
- Can stay in place for several days if needed
- Materials = 22-g spinal needle, figure-8 bandage, suture into place
- Aspirate to ensure placement
+/- Flush to observe ulnar vein fill more proximal on the wing
Things to remember when hospitalizing sick birds
- House them in a room separate from cats and dogs
- Incubate 80-90 degree F
- Use cages and perches that are easy to disinfect
- Use oxygen/nebulization cages
- Be conscious of infectious agents with other cases in the hospital
Further diagnostics you can do if the bird is stable (3)
1) Imaging = rads, U/S = take TWO views of the entire body, line up keel with spine in VD, requires anesthesia/sedation
2) Cytology and culture from coelomic fluid, choana, fecal or nasal flushes, crop samples
3) Endoscopy - has to be very stable
Order of treatment in stable birds (first to last)
1) Know the bird’s weight
2) O2 if necessary
3) SC fluids or injections
4) Meds SC, PO, IM
5) Monitor patient stress levels at all times
6) LAST = tube or force feeding - put them in the incubate immediately after feeding (reduces aspiration risk, can shake head and cough)
Why do we place birds in their cage/incubator quickly after force feeding?
To avoid aspiration - allows them to clear their airways and/or cought
What/where is the most common route for injectable medications?
IM in the pectoral muscle
What IM medication can cause muscle necrosis? What can you do to avoid it?
Enrofloaxacin - pH = 11, dilute it out and give it SQ to avoid (buffers and absorbs)
What nutritional support do we offer for avian patients?
> Critical care hand feeding formulas, mixed with warm water as directed
- Tube fed with feeding needles or red rubber feeding tubes
Do’s and don’ts of crop lavage
- Metal tubes = good for parrots
- Red rubber catheters for raptors or large birds (goes farther)
- Assistant retrains, enter the oral cavity with feeding needle from the commissure, advancing slowly
- Palpate the instrument as it passes into the crop
- Should feel TWO tubes = feeding tube and trachea
- Administer food and watch for it coming back into the mouth from the crop
- Put down the bird immediately so it can clear it’s airway
What crop lavage volume do you generally shoot for?
3-5% BW - start low and increase volume if the bird tolerates it
Problem and treatment of blood feather hemorrhage
- Blood feather = new, actively growing feather with a large nutrient artery in shaft, can cause life threatening hemorrhage if broken
- Tx = remove using hemostats or needle-nosed pliers
- Pull in the same direction as the feather is growing
- Should see the bulbous end when you pull it out = means the shaft has been completely removed from the follicle
Treatment of fractures
- Assume most are open = bones are sharp, poke through skin easily
- Open fracture = clean, debride, administer antibiotics
- Analgesia = NSAID’s +/- butorphanol
- Stabilize the fracture = temporary with bandage (figure-8, robert jones), surgical if the bird is stable
When do we use figure 8 bandages?
Stabilizes most wing fractures (keeps it in a fixed position) - add body wrap if it includes humerus or coracoid fracture
When do we use Robert jones or tape splint bandages?
For fractures distal to the femur with sedation/anesthesia, based on the size of the bird
Tape splint = smaller birds, wrap tape and krimp with hemostat to add rigidity
What is important to remember about fracture immobilization?
Need to immobilize the affected limb to the extent of a joint above and below the fracture
Treatment of avian bite wounds
- Analgesia
- Anti-inflammatories
- Fluids
- Cleaning and surgical debridement (CAUTION with air sacs and flushing cavities)
- Use of antibiotics = depends on the circumstance of the bite (bird on bird vs. cat/ferret bite wounds)
Clinical signs of avian dyspnea
+ Open mouth breathing
+ Tail bobbing
+ Increased thoracic excursions
Handling of dyspneic birds (do’s and dont’s)
- Minimal handling of the bird = already stressed and unstable
- Place in warmed incubator with supplemental O2
- SEDATE
- Observe and characterize breathing, gather the supplies while the bird is resting in oxygen chamber
- Delay diagnostics until the bird is more stable
ER treatments for a dyspneic bird
*Based on suspected etiology
- O2
- Empirical antibiotics or anti-fungals
+/- Furosemide
- Nebulization for URI’s
+/- Air sac cannula placement
Diagnostics for a dyspneic bird
- Radiographs = differentiate between lungs, air sacs, heart, coelom
- CBC = leukocytosis may indicate Chylamdophila, Mycoplasma, Aspergillosis
+/- Chem panel to check liver and renal values - Specific disease testing = tracheal or choanal cultures, Chlamydophila PCR/serology
+/- CT if stable
+/- Laparoscopy of trachea or air sacs
What should you do with a bird that is in severe respiratory distress and will likely die without assistance?
Place an air sac tube (ONLY if it’s an upper airway obstruction)
Do’s and dont’s for air sac tube placements
- ONLY for upper airway obstructions
- Target = caudal thoracic or abdominal air sacs
- Animal is in RIGHT lateral recumbency
- Insert the tube caudal to the last rib, in the flank region
- Use short ET tubes or sterilized red rubber tubing
- Suture in place
DDx? Abdominal distension, dyspnea, +/- straining, weakness
Egg binding - unshelled, soft-shelled, or broken egg shell in oviduct
*Whole egg stuck in cloaca = can block urine and feces
Pre-disposing factors to egg binding (2)
1) Obesity
2) Low Ca++ diet
Diagnostics for egg binding
- PE
- Palpation
- Radiographs
Prognostic indicators for egg binding
- How long has it been going on? LONGER = worse
- Overall health status of the bird?
- Location of the egg
- Invasiveness of the procedures
+ Bird may bright, alert, responsive, or extremely sick
Medical and surgical of egg binding
> Med = support and stabilization = fluids, analgesia
+/- Antibiotics if coelomitis is present
- Ca++ IM = to restore depleted body stores
- Oxytocin = ONLY for suspected uterine inertia
- EGG REMOVAL w/ heavy sedation or anesthesia, can try lubrication/manual manipulation, also transvaginal or percutaneous egg implosion/collapse
> Surgical = if needed, after stabilization
Prevention of egg binding (2)
- Discuss behavior cues with owner (avoid mirrors, nest boxes, etc)
- Administer hormone therapy
Differentials for avian neural disease (5)
- Lead/zinc toxicity
- Avian bornavirus
- Hepatopathy = lipidosis, Chlamydophila psittaci
- WNV
- Trauma
Diagnostics for avian neural diseases
- Radiographs for foreign bodies (i.e. metal)
- Blood lead or zinc levels
- Avian bornavirus serology
- Chlamydophila psittaci PCR
Treatment for avian neurologic disease
- Supportive fluids and/or tube feeding
- Anti-microbials
- Chelation therapy (Ca++ EDTA), even without blood Pb results
+/- Anti-convulsant meds
+/- NSAID’s
+/- Remove metal from GI tract
What is fun with bird PLR reflexes?
Birds have striated muscle in their iris, allows them to control their response to a PLR, makes the PLR difficult to interpret
True or false - you can retrieve objects, from the ventriculus, with an endoscope
FALSE - too far distal
Dx? Inappetence, weakness, vomiting/regurgitation, green diarrhea, PU/PD, +/- CNS signs, anemia, +/- pancreatic damage
Lead or zinc toxicity
CNS signs = Pb toxicity
Pancreatic damage = Zn toxicity
Treatment of Pb or Zn toxicosis
- Ca++ EDTA chelation
- Fluid therapy
- Gavage feeding when ileus has resolved
+/- Antibiotics if you suspect GI damage
