Emergency + critical care of exotics

Question 1

What are poor prognosis indicators in birds?

Answer 1

Birds often mask their clinical signs = advance stage when noticed
* Species sensitivity
* Small patient size
* Duration of disease / problem
* Dyspnoea

Question 2

What is your general approach to the sick bird?

Answer 2

• Visual exam while inside carrier - mental state, lesions/trauma, breathing (open mouth breathing), Droppings

Question 3

What is approach to the collapsed bird?

Answer 3

• Supplemental O2 - face mask / ETT / air sac intubation
• Supplemental heat - heat mat, incubation, warm fluids
• Fluids - IV / IO access
• Emergency drugs

Question 4

Where would you get IV / IO access in birds?

Answer 4

• IV = ulnar / medial metatarsal vein
• IO = distal ulna / proximal tibiotarsus

Question 5

What are emergency drugs in birds?

Answer 5

• Atropine
• Adrenaline
• Dextrose

NOT STEROIDS

Question 6

How would you monitor critical avian patients?

Answer 6

• Mentation / behaviour
• HR
• RR
• BP
• Temp

Question 7

How would you approach a dyspnoeic bird?

Answer 7

• Limit handling
• Supplemental O2 in incubator;
• Sedation – Midazolam 0.5mg/kg + Butorphanol 0.5mg/kg intranasal, IM
• Meloxicam 1mg/kg SC
• Terbutaline 0.01-0.1mg/kg IM
• Nebulization

Question 8

How would you approach an ‘unwell bird’?

Answer 8

• Incubator With heat + O2
• Fluid therapy
• Supplemental feeding by crop tube

Question 9

What analgesia can be used in birds?

Answer 9

• NSAIDs - meloxicam
• Gabapentin
• Opioids - butorphanol
• Local anaesthesia - bupivicaine + lidocaine

Question 10

What are common emergency presentations in birds?

Answer 10

• Dyspnea
• Non-specific illness
• Trauma/bleeding
• Reproductive – e.g. egg binding, egg yolk coelomitis, etc
• Neurological – seizures, paresis/paralysis, etc.
• GI – regurgitation
• Prolapses

Question 11

What is step by step approach to critical birds?

Answer 11

1. initial assessment - collapse, dyspnoea
2. Is patient going to crash
3. Stabilization - heat, O2, fluids, analgesia
4. Reassess - when more stable
5. Further investigation - depending on presentation - start from least to more risky tests (radiographs, bloods, coelomic US scan, Radiographs under sedation)
6. Adjust Tx accordingly
7. Consider advising euthanasia if keeps deteriorating

Question 12

What are proper emergencies in reptiles?

Answer 12

• Trauma
• Prolapses
• Reproductive - retained eggs, follicular stasis
• Neurologic - seizures, muscle fasciculations
• Most ‘emergencies’ = chronic cases recently decompensated, unnoticed disease

Question 13

What is approach to the collapsed reptile?

Answer 13

• ETT placement
• IPPV with ambu bag - Room air, 4-6bpm
• IV access - Jugular (chelonia), Difficult in other species
• IO access on proximal tibia
• Warm fluids IV, IO bolus:
• Emergency drugs: Adrenaline, Atropine

Question 14

What is approach to the unwell reptile?

Answer 14

• Warm them - gradual 4-6hrs
• Fluid therapy
• Assisted feeding - oesophageal tube
• Antibiotics depending on case - Ceftazidime

Question 15

What analgesia can be used for emergencies?

Answer 15

• NSAIDs = Meloxicam
• Lidocaine / Bupivicaine
• Opioids =
• Tramadol (lizards + chelonia)
• Morphine (bearded dragons
• Methadone

Question 16

What is step by step approach to reptile emergencies?

Answer 16

1. Initial assessment – collapsed? Unwell? Any obvious problems/conditions?
2. Warm patient – 4-6h; use incubator, heat bulb;
3. Start supportive care – fluids, analgesia, ABs, other specific medication or treatment?
4. Start further investigations – depending on case:
   - Radiography, US scan, Bloods
5. Review case and adjust therapy accordingly

Question 17

Atropine isn’t effective in 50% of rabbits, what should be used instead?

Answer 17

• Glycopyrrolate

Question 18

What does blood glucose in rabbits indicate?

Answer 18

• Stress / pain
• NOT diagnostic of GI obstruction

Question 19

How should gut stasis be managed in rabbits / rodents?

Answer 19

• Gut stasis NOT a disease + is secondary to something else
• Key points of Tx =
• Fluids (IV, SC)
• Analgesia
• Prokinetics
• Supplemental feeding
• Supportive Tx

Question 20

What are common emergencies in rabbits?

Answer 20

• Gut stasis
• Trauma - fractures, bite wounds …
• Respiratory - URT, pneumonia, Heart disease, neoplasia
• Neuro - seizures, paresis/paralysis, sudden + progressive head tilt
• Urogenital - haematuria
• Ophthalm - sudden blepharospasm, bupthalmia / exophthalmia
• Flystrike

Question 21

What are common emergencies in ferrets?

Answer 21

• Trauma
• Vomiting if frequent and > 24h duration
• Non-specific illness w/ anorexia >24h
• Neuro – seizures, ataxia, collapse, paralysis
• Dyspnoea

Question 22

What are common emergencies in hystricomorph rodents?

Answer 22

• Gut stasis
• Dyspnea (sp. Guinea pigs)
• Trauma
• Neuro – seizures, collapse, paralysis
• Non-specific illness
• Urogenital =
• Bleeding + straining/vocalizing
• Dystocia

Question 23

What are common emergencies on other rodents? (myomorphs)

Answer 23

• Non-specific illness
• Trauma
• Dyspnoea
• Neuro – seizures, paralysis, head tilt
• Abnormal perineal discharge = “wet tail”