Triage, First-Aid, Diagnostics & Common procedures

Question 1

What are the steps involved in assessment of non-critical patients?

Answer 1

1. Stabilise (dark quiet room 30-60 minutes)
2. Distance exam
3. Physical exam (manual or chemical restraint)

Question 2

What are the critical patient management considerations?

Answer 2

1. Ideally, collect a minimum database of PCV, TP, blood smear in all patients and USG in mammals.
2. Ideally, treat dehydration/shock/hypovolaemia/haemorrhage
   BUT:
   Need to consider the risk of sampling and treatment to animal, how useful is this test in this specific species? and will sampling/treatment bring risk of zoonotic disease transmission?

Question 3

What are the principles of first aid? (Which 6 things should we consider and treat/provide these patients with?)

Answer 3

1. Warmth and Humidity (care with over warming, provide gradient and check species specifics)
2. Fluids (Assume 10% dehydrated, give via least stressful route)
3. Nutritional support (species specific, least stressful route)
4. Oxygen (ensure administration is not stressful)
5. Analgesia (check latest species based recommendations)
6. Anxiolytics (may help with short and long term management care, reduce capture myopathy in high risk species)

Question 4

How do we calculate the fluid deficit based on dehydration? (assume 10% dehydrated)

Answer 4

= % dehydration x body weight (kg) x 1000 ml

Give fluid deficit volume in divided doses:
- 50% of deficit volume during 12-24 hours
- remaining volume over next 48 - 72 hours

Warm fluids prior to administration!

Question 5

A bird weighs 600 g and is 10% dehydrated, what is the fluid deficit? And how much volume do we give over the first 24 hours?

Answer 5

Daily maintenance requirements = 100 ml/kg/day = 60 ml (100x0.6)
Deficit = 0.1 x 0.6 x 1000 = 60 ml

Volume to give: maintenance + half deficit
60 + 30 = 90 ml

Question 6

Can we use meloxicam for all wildlife species?

Answer 6

Good to use for birds, small mammals and marsupials but poor efficacy data in reptiles.

Question 7

Which analgesia drug can we use in reptiles, birds, small mammals and marsupials?

Answer 7

Fentanyl (IV or patch)

Question 8

Can we use Butorphanol for reptiles?

Answer 8

No, it causes respiratory depression and there is poor efficacy data.
We can however use it in birds in combo with midazolam as pre med (is the opioid of choice in birds), can also use it in small mammals but care with sedative/respiratory depression, can also use it in marsupials.

Question 9

List the drugs of choice for analgesia in reptiles

Answer 9

• Fentanyl (IV or patch)
• Morphine (but can cause respiratory depression)
• Tramadol (limited data)
• Bupivacaine, lidocaine/lignocaine (excellent for regional anaesthesia in surgery

Question 10

List the drugs of choice for analgesia in birds

Answer 10

• Meloxicam (dose rates higher and frequency q4-6 hours)
• Fentanyl (IV doses have anaesthetic sparing effect)
• Tramadol (good for more severe pain or if NSAID’s risky)
• Butorphanol (in combo with midazolam as pre med is anaesthetic sparing, opioid of choice in birds)
• Bupivacaine, lidocaine/lignocaine has limited use

Question 11

List the drugs of choice for analgesia in small mammals

Answer 11

• Meloxicam (doses higher in rabbits/guinea pigs/rodents
• Fentanyl (excellent choice for more severe pain)
• Buprenorphine (commonly utilised analgesic in rabbits and guinea pigs, less sedative)
• Butorphanol (care with sedative/respiratory depression)
• Bupivacaine, lidocaine/lignocaine

Question 12

List the drugs of choice for analgesia in marsupials

Answer 12

• Meloxicam
• Fentanyl
• Tramadol
• Buprenorphine
• Butorphanol
• Bupivacaine, lidocaine/lignocaine

Question 13

Which is a good drug to use for reptiles, birds, small mammals and marsupials for sedation/anxiolytic?

Answer 13

Midazolam
(Also Diazepam but no data for the use in reptiles)

Diazepam is longer acting than Midazolam but stings on injection whereas midazolam is non-painful to inject.

Question 14

What is a simple and informative way of assessing bloods in wildlife species?

Answer 14

Blood smear and PCV/TP

Question 15

What does a normal erythrocyte look like in a bird?

Answer 15

Elliptical with central elliptical nuclei, cytoplasm uniformly eosinophilic, nuclei dark purple

Question 16

What do you call a neutrophil if it’s from a bird?

Answer 16

Heterophil

Question 17

Which tube would you use for biochemistry for birds and reptiles?

Answer 17

Heparin (or serum/PC)

Question 18

What are some other standard diagnostics we can carry out on birds/reptiles?

Answer 18

-> Crop sampling
-> Faecal float
-> Gram stain (crop wash, faecal cytology)
gram stain should be mostly gram positive rods and cocci, no yeast

Question 19

What are some examples for the use of scoping in birds and reptiles?

Answer 19

-> Sexing
-> Air sac and coelomic evaluation
-> Biopsies (e.g. liver/internal pathology)
-> Tracheal foreign bodies and debulking of granulomas (e.g. aspergillosis)

Need specialised equipment and training for scoping of birds/reptiles

Question 20

What are some common procedures that we would carry out in birds?

Answer 20

Crop tubing
- Cytology - take samples
- Administer medications, fluids, nutrition

Wing clipping (does not prevent flight, reduces ability to gain height and speed)
two options:
- clip primary flight feathers (5-10)
- cosmetic: leave 9/10, and clip remaining primary flight feathers

Beak trim
- overgrowth uncommon in healthy bird (can be due to lack of chewing, liver disease, malocclusion. Trim under GA.

Question 21

What is important for surgical prep in birds?

Answer 21

• Fast to empty crop (small birds 2-4 hours, larger birds 5-8 hours, longer for raptors)
• Avoid prolonged ventral recumbency
• Keep it as short as possible
• Warmth is critical!
• Provide analgesia
• Surgical prep with chlorhex and saline rinse (alcohol can increase heat loss)