Long-term vascular access is difficult to obtain and maintain in chelonians. Fortunately, central venous catheters provide flexibility and length to avoid catheter dislodgement. Central lines are an effective tool that allow serial blood measurements and can be used for anesthesia administration, intravenous drug delivery, blood product transfusions, and continuous fluid therapy or continuous rate infusions.This photo tutorial article describes this simple technique step-by-step.
Save the Date for a RACE-approved webinar by Royal Veterinary College reptile #veterinarian, Joanna Hedley: February 27, 2019.
Save the date for this free R.A.C.E.-approved continuing education webinar, Emergency and Critical Care of Rabbits, presented by Charly Pignon, DVM, DECZM (Small Mammal) on November 7, 2018. Lecture topics will include emergency triage, cardiopulmonary resuscitation, analgesia, fluid therapy, and critical care nutrition. Register today and join us for this interactive event.
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Capnometry measures the maximum value of carbon dioxide (CO2) obtained at the end of expiration or end-tidal carbon dioxide (ETCO2). There is good correlation between ETCO2 and arterial CO2 in birds and mammals and capnography can be used as a reliable tool to evaluate the adequacy of ventilation in these species. Capnography can only be used to identify trends in reptiles because of cardiac shunting of blood past the reptilian lungs.
Even the most steadfast and seasoned veterinary anesthetist can find themselves intimidated by exotic animal patients. Standard veterinary anesthesia monitors are not designed to read the extremely high (or extremely low) heart rates and respiratory rates of some exotic animal patients. Despite these challenges, valuable information can be gathered from monitoring tools as well as hands-on techniques. Essential vital signs, such as heart rate and rhythm, respiratory rate and depth, body temperature, and mucous membrane color should all be evaluated.
Arterial blood pressure is a function of heart rate, blood volume, stroke volume, and arterial compliance. Indirect arterial blood pressure is most commonly measured by Doppler ultrasound or non-invasive oscillometric monitors. What are the limitations of indirect blood pressure measurements in exotic animal patients? How is this technique unique in exotic companion mammals when compared to dogs and cats? How is this technique performed in birds and can this procedure be used in reptiles?
Electrocardiography can be used to detect and diagnose arrhythmias and conduction abnormalities, particularly during long-term anesthesia. How are leads attached to exotic animal patients? And what is the normal appearance of normal electrocardiogram tracings in birds or reptiles?
Heart rate and oxygenation should ideally be monitored during every anesthetic event. Patient size can limit the accuracy of pulse oximetry readings in exotic companion mammals and this technique has not been validated in birds or reptiles, however trends during the course of anesthesia can still provide useful clues to patient clinical status.
This learning aid is designed to assist the participant in meeting the needs of VECCS-certified facility. The basics of emergency medicine and critical care universal, however veterinarians face a unique set of challenges when caring for birds, exotic companion mammals, and reptiles. Level 1 of this teaching module reviews the basics of exotic animal critical care. To learn more in Level 2, review the key points on critical care or supportive care for each taxonomic group: birds, exotic companion mammals, and reptiles. Each summary page includes a brief quiz that tests your knowledge and reinforces fundamental principles. Delve deeper into critical care of exotic animal patients in Level 3 by browsing pertinent exotic animal content on LafeberVet.
There is little empirical information available on cardiopulmonary resuscitation in most exotic animals. Fortunately, the basic principles of CPR are the same for all species, however there are important species-specific considerations. This review article explores techniques for establishing airway control, ventilation and cardiac compression recommendations as well as considerations for emergency drug selection.
Reptiles lack an epiglottis and the glottis is ready visualized, making intubation readily accomplished in most species. If the glottal folds are closed, apply topical lidocaine to facilitate intubation. The tracheal rings are complete in reptiles. Use of an inflated, cuffed endotracheal tube can lead to pressure necrosis because there is no elastic ligament to accommodate tracheal expansion. Always select an uncuffed endotracheal tube in small reptiles and never inflate a cuff in large reptiles …
Although the principles of emergency medicine critical care are universal for all species, this approach must be balanced with an understanding of the unique aspects of small mammal medicine. Use this summary page to review the basic approach to the exotic companion mammal patient and select additional links to supplement your knowledge base.
Although the principles of emergency medicine critical care are universal for all species, this approach must be balanced with an understanding of the unique aspects of avian medicine. Use this summary page to review the basic approach to the avian patient and select additional links to supplement your knowledge base.
The approach to analgesia and sedation in exotic companion mammals faces special challenges, including small patient size and unique features of the prey species mentality. Recognition of pain is more difficult in rabbits and rodents because many small mammals are very good at hiding the signs of pain commonly observed in predator species. Instead pain in a rabbit or rodent is often inferred from the patient’s clinical condition as well as the absence of normal behaviors. The diagnostic and therapeutic plan frequently requires some form of chemical restraint in exotic mammal medicine. When compared to general anesthesia, sedation is a safer option for the debilitated or critically ill small mammal.
Test your knowledge after completing the reptile portion of the LafeberVet Emergency and Critical Care teaching module.
Test your knowledge after completing the exotic companion mammal portion of the LafeberVet Emergency and Critical Care teaching module.
Signs of illness in birds are often quite subtle until disease is advanced. Fortunately, quite a bit of information can be gleaned from a detailed history and careful observation. View this brief slideshow for tips on the visual examination.
This live webinar event was presented by James Morrisey, DVM, DABVP (AvianPractice). View a recording of this AAVSB R.A.C.E.-approved web-based seminar, then take the brief post-test to earn 1 hour of continuing education credit. The avian respiratory system has several unique and fascinating adaptations for flight that are important to clinicians. This webinar overviews the anatomy and physiology of the avian respiratory tract. Clinical correlates are pointed out as the presenter goes through anatomy and physiology. Clinical signs of respiratory disease in birds are then discussed along with how the clinician can use these signs to anatomically locate the origin of the problem to the upper respiratory tract, the major airways, the pulmonary parenchyma, and/or the coelomic cavity.
This presenting problem article reviews the basic approach to the dyspneic ferret beginning with clinical signs of the dyspneic ferret, key points of urgent care, as well as case management. This latter section reviews tips on taking the history, performing the physical exam, important differential diagnoses, as well as the diagnostic/therapeutic approach.
The Five Common Reptile Emergencies webinar was reviewed and approved by the American Association of Veterinary State Boards (AAVSB) Registry of Approved Continuing Education (R.A.C.E.) program for 1 hour of continuing education, in jurisdictions which recognize AAVSB R.A.C.E. approval…
View a recording of this AAVSB R.A.C.E.-approved web-based seminar presented by Eric Klaphake, DVM, DACZM, DABVP (Avian Practice), DABVP (Reptile & Amphibian), then take the brief post-test to earn 1 hour of continuing education credit. This webinar explores five common reptile clinical presentations in detail: trauma, gastrointestinal foreign body, neurological deficits, respiratory difficulty, and reproductive problems.
Placement of an enteral feeding tube is a recognized method of supportive care, and the esophagostomy tube is an accepted route that is generally well tolerated by avian patients and relatively easy to place. In clinical patients, esophagostomy tube placement has been described in psittacine birds, raptors, and ostriches.
Esophagostomy tube placement is indicated in cases of severe beak trauma or disease, as well as diseases of the oral cavity or proximal esophagus, such as abscesses and neoplasia. Esophagostomy tubes may also be used to…
Many people have been curious about the way we at International Bird Rescue were able to clean the birds affected by the San Francisco Bay Mystery Goo Spill in January 2015.
Traumatic orthopedic injuries are relatively common in the avian patient. Although bird bones are strong when intact, they tend to shatter on impact as the cortices are thin and brittle. A lack of abundant soft tissue coverage often leads to open fractures…
All raptors consume a meat-based diet ranging from the specialist diet of the fish-eating osprey (Pandion haliaetus) to a generalist diet that can include insects, mammals, birds, reptiles, amphibians, and even carrion. Other than poultry, the exact nutritional requirements of birds are unknown, however the natural raptor diet is always relatively high in protein and fat and low in carbohydrates. Whole prey diets have a calcium/phosphorus ratio of 1.5:1 as the bird actually consumes the bones as well as the meat…
The approach to a prey species like the rabbit often calls for a profound paradigm shift for clinicians used to dealing only with cats and dogs. Rabbits can stress very easily in a clinical setting and the challenge of managing a small mammal like the rabbit increases exponentially when they are presented for illness or injury.
Exotic small mammals can be challenging to safely induce, maintain and recover from general anesthesia. View the recording of this AAVSB R.A.C.E.-approved webinar, which explores clinical anesthesia in exotic companion mammals from patient assessment and anesthetic induction to monitoring and recovery. The use of common premedications, induction agents, maintenance drugs, and post-operative analgesics will be compared and contrasted in exotic companion mammals. Multimodal anesthetic techniques, such as epidural anesthesia and constant rate infusions, will also be discussed. After reviewing the recording, take the brief post-test to earn 1 hour of continuing education credit.
The Vets Now Surgical Safety Checklist includes a list of safety issues that should be read aloud, with both the veterinarian and veterinary nurse or veterinary technician present. This checklist is divided into three categories: induction of anesthesia, before the skin incision, and before the patient leaves the operating room…
View the recording of this free, interactive webinar, presented by Neil Forbes, BVetMed DECZM (Avian) FRCVS. Many sick or injured exotic animals are presented in critical condition. More of these patients can be saved by appropriate fluids and nutritional support, than by any single medical or surgical procedure. In practical terms, providing this support is often easier said than done. Dr. Forbes’ presentation serves to demystify some of the challenges encountered; practical solutions for all exotic patients are described and discussed.
Red leg syndrome, also known as “pink belly disease” or bacterial dermatosepticemia, is one of the most common clinical conditions of captive frogs. Associated with peracute to acute bacterial septicemia, red leg is generally a disease of captive animals although the condition has also been implicated in rare mass mortalities of wild amphibians. This presenting problem article reviews clinical findings in red leg syndrome, pathogenesis of disease, as well as key points of urgent care and prognosis. The basics of case management are then reviewed: differential diagnoses, diagnostics, treatment, prevention and control.
Gastric dilatation or “bloat” and gastrointestinal obstruction is an acute and life-threatening condition of pet rabbits commonly caused by an obstruction with pellets of compressed hair. The discussion portion of this Case Challenge reviews onset, clinical signs, and diagnostic test results of obstructive and non-obstructive gastrointestinal disease. This condition is considered a surgical emergency and key points of urgent care strive to stabilize the patient through analgesia, decompression when indicated, and supportive care. Surgery is discussed as well as recommendations for patients that cannot go to surgery due to clinical or financial constraints. Follow-up care as well as homecare recommendations, disease prevention, and prognosis are also explored.
Gastrointestinal obstruction and a stomach distended with gas and fluid or “bloat” is a serious health problem of pet rabbits. Use this client educational handout to answer owner questions: What causes bloat and obstruction? Why is bloat a serious condition? What does bloat look like in the rabbit? This handout also explains the basics of a diagnostic workup, treatment, follow-up care, and prevention for this critical condition.
A 5-year old female spayed lop rabbit presents with a history of acute anorexia (<24 hours) and lethargy. Use history, physical examination findings, laboratory results and survey radiographs to solve this case challenge.
The use of esophagostomy tubes (E-tubes) allows administration of oral medications and critical care nutrition to turtles and tortoises while minimizing stress and the risk of esophageal trauma associated with repeated rigid gavage tube feeding. Esophagostomy tubes are very well tolerated in chelonians and the patient can even eat normally with the tube in place. Patients can be medicated and fed on an outpatient basis, and once fully recovered, the E-tube is easily removed in the veterinary clinic.
Released for National Veterinary Technician Week 2014, Nursing Care for Exotic Companion Mammals is part of an Exotic ICU series providing advice on the management of small exotic companion mammals in a critical care setting. Specific recommendations on caging, medicating, feeding, and monitoring the critical small mammal are explored as well as important potential sequelae to the stress of hospitalization.
It is 10 p.m. in your veterinary emergency hospital and a dreaded call comes in. A panicked owner is in tears because their beloved pet is in crisis. In most cases, your team will quickly gather supplies and move swiftly to prepare for the emergent patient. This patient may strike fear in many veterinary professionals, however, because it is the dreaded avian patient presenting to a general veterinary practice.
Released for National Veterinary Technician Week 2014, Tips and Tricks for the Avian Patient is part of an Exotic ICU series that provides advice on the management of birds in a critical care setting.
Wing injuries may present as a wing droop or an inability to fly. The figure-of-eight bandage, or wing wrap, is the standard method for stabilizing the wing short-term. See the NEW and improved version of LafeberVet’s wing wrap placement video clip.
Because of a lack of identified blood groups in companion bird species, compatibility for transfusion is based on the use of major and minor cross matches. A major cross match is performed by mixing donor red cells with recipient plasma and a minor cross match uses recipient cells and donor plasma. The appearance of agglutination or cell lysis indicates incompatibility.
Unlike mammals, a single transfusion between different bird species can be safe and efficacious. Transfusions will be most effective if the donor is…
Reproductive emergencies are most commonly seen in small psittacine birds like the cockatiel, lovebird and budgerigar parakeet. This article reviews conditions commonly seen on an emergency basis such as dystocia, egg yolk peritonitis, cloacal or oviductal prolapse, and/or chronic egg laying. Pertinent anatomy and physiology as well as case management, including the reproductive history, physical examination, diagnostic imaging, and behavioral modification techniques are also discussed.
Although the overall incidence of urethral obstruction is probably low, this condition is an important reason for emergency presentation of the male ferret. n the United States, urethral obstruction is most frequently caused by…
If the gut works, use it. The preferred route for providing nutrition is enteral feeding since this preserves intestinal structure and function. Parenteral nutrition is indicated to prevent malnutrition when patients cannot consume adequate nutrients by oral feeding or tube feeding or when the respiratory tract cannot be protected. Parenteral nutrition is 100% bioavailable since nutrients reach tissue without the variations associated with gastrointestinal digestion.
One of the most valuable items in avian practice is a reliable formulary. Although pharmacokinetic and pharmacodynamic data is slowly growing, the vast majority of drug doses in companion parrot medicine rely on extrapolation and/or clinical experience. It is crucial that the clinician have access to this wide range of information and experience.
Feeding excessively hot formula (>110°F) causes crop burns. This problem is particularly common when formula is heated in a microwave without thorough mixing. Early signs of crop burn include…
Looking for an emergency equipment checklist? Review general recommendations for preparing yourself, your staff, and your practice to special species.
Guinea pigs tend to be shy, sweet-natured creatures. Guinea pigs are prey species. Their survival depends on the ability to be alert and respond quickly, and they possess acute senses of smell and hearing. Approach guinea pigs in a calm, quiet manner…
Rabbits are prey species. Their survival depends on the ability to be alert and respond quickly, and they possess acute senses of smell and hearing. Approach rabbits in a calm, quiet manner. Stressed or critically ill rabbits may not tolerate prolonged handling. Evaluation and treatment may need to proceed slowly in stages.
Lethargy, total or partial anorexia, a reduction in fecal output, or scant fecal size can all indicate critical illness in rabbits. Problems that slow the gut are often uncomfortable, however rabbits tend to mask pain and discomfort, especially when frightened. Signs of fear and pain in the rabbit can include…
Depending on their age and size, snakes may be fed multiple times in one week or every 2 to 4 weeks. If nutritional support is truly needed, then assisted feeding is indicated in the hospitalized snake. Tube feeding is commonly performed in critically ill snakes after fluid therapy and supplemental heat is provided.
A collection of online resources related to emergency medicine and critical care. This list of links come from a variety of academic institutions and professional organizations.