Clinical Topic: Critical Care - Page 2 of 2

Article

Abdominocentesis or coelomocentesis may be indicated for the accumulation of fluid within one or more of the peritoneal cavities. Peritoneal fluid can accumulate with a variety of diseases, including chronic liver disease, amyloidosis in waterfowl, iron storage disease in mynah birds and toucans, coelomic tumors in budgerigar parakeets, viral infections like Marek’s disease (resulting in cardiac tumors), peritonitis, congestive heart failure, ovarian cysts, and trauma. This article reviews the potential complications of this clinical technique, the equipment needed, sample handling, and cytodiagnosis.

Article Presenting Problem

Beak trauma is a common problem in the companion parrot. Beak injury most often occurs secondary to bird bites and other forms of aggression. Other potential causes include damage from inappropriate caging or toys and iatrogenic damage during…

Article Presenting Problem

Unfortunately respiratory disease is common in pet rats. Although most cases of respiratory disease in the rat are multifactorial, the most significant and serious bacterial pathogen is Mycoplasma pulmonis. Institute medical therapy as soon as possible in rats with respiratory disease since this improves…

Article

This brief article was created to serve as a synopsis of LafeberVet’s longer, more detailed “Analgesia in Small Mammals” authored by veterinary anesthesiologist, Dr. Paul Flecknell.

Article

Fasting may be expected in lizards during certain times of the year. Many gravid females eat less or go off feed entirely due to the large number of eggs filling the coelom. Some species also fast for weeks or months as an adaptation to excess heat or cold, drought, or lack of food. This dormancy in reptiles is called…

Article Presenting Problem

Detecting a shelled egg on physical examination is not necessarily a problem—birds lay eggs everyday! However palpation of a shelled egg is an important clinical finding that can be associated with dystocia. The egg is shelled in a distal part of the oviduct called the uterus or shell gland. Therefore a shelled egg would normally be palpable in either the…

Article

Gastrointestinal problems are common in the pet rabbit. A thorough history, including a detailed dietary history, can provide invaluable clues to the problem at hand. Signs of gastrointestinal discomfort in the rabbit may include bruxism, reluctance to move, and anorexia. If there is a history of anorexia, it is imperative to differentiate whether the rabbit is not eating because it has no interest in food, or if it is showing an interest in food but unable to eat. A complete lack of appetite is most commonly seen with physiological problems such as renal failure, whereas a reluctance to eat is a classic presentation in rabbits with dental disease.

Article

Exotic animal practice is challenging! To approach any exotic animal patient requires a balancing act between the principles of “One Medicine-One Health” and species-specific information. The basic principles of avian medicine are the same as for a human being or a horse or a cat or a dog, and in many instances, veterinary care of birds may be extrapolated from basic medical principles. However this approach can only take one so far and these basic principles must be weighed against species-specific information.

Article Presenting Problem

Thermal burns are a common injury in snakes and lizards. Companion snakes and lizards may come in contact with poorly protected heat sources or old “hot rocks” that short circuit. Even free-ranging reptiles may be at risk for thermal injuries during grass or forest fires. This presenting problem article “Burns in Snakes and Lizards”, explores a basic understanding of burns in reptiles, then moves onto key points of urgent care as well as general aspects of case management, including patient history, physical examination, differential diagnoses, diagnostics, therapy, and finally prognosis.

Article Presenting Problem

Anorexia may be the only indication of poor health in the critically ill bird and by the time other clinical signs are apparent disease may be quite advanced. This means that all reports of poor appetite in the avian patient must be taken very seriously.

Article Presenting Problem

Disseminated idiopathic myofasciitis (DIM) is a severe inflammatory disease that primarily affects skeletal, smooth, and cardiac muscles as well as surrounding connective tissues. This recently identified disease typically affects young ferrets, less than 18 months of age. The cause of DIM is unknown, but this condition is suspected to be an acquired immune-mediated disease. The onset of DIM is usually acute to subacute, followed by a rapid decline over 12-36 hours. The most prominent clinical signs include a high fever ranging from…

Article Presenting Problem

It is critical to approach the dyspneic rabbit quietly, carefully, and gently. Many rabbits with respiratory disease are unstable upon presentation, given the stress of their condition compounded by the stress of transport and the strange smells, sights and sounds of the veterinary clinic. In many cases, it is prudent to delay handling the patient. Transfer the rabbit to…

Article

The basic principles of fluid therapy are the same in the reptile as seen in birds and mammals, however reptile anatomy and physiology make some features of this crucial supportive care procedure unique. This article reviews fluid resuscitation with the use of crystalloid fluids and colloids, indications for replacement fluids including signs of dehydration and osmolarity values reported in reptiles. Routes of fluid administration in reptiles are described include subcutaneous, oral, soaking, intracoelomic, intraosseous, and intravenous via the cephalic vein, jugular vein, and in rare instances intracardiac catheter placement. Patient monitoring, including blood pressure measurement and signs of overhydration, are also explored.

Article Presenting Problem

Pet ferrets are routinely vaccinated against canine distemper virus and rabies virus. Anecdotally, hypersensitivity reactions to vaccines are common in the ferret, and can potentially be fatal.

Article Presenting Problem

Unfortunately, neurologic disease is a common presenting problem in the ferret. Neurologic deficits may include an altered level of consciousness, paresis, ataxia, or even pelvic limb paralysis or collapse.

Article

When planning to accept avian patients, prepare yourself and your staff, prepare your hospital including hospital caging and exam rooms, and consider the equipment necessary for proper care…

Article

The crop or ingluvies is a diverticulum of the esophagus present in many but not all, bird species. The crop serves as a food storage organ, regulating the flow of food through the gastrointestinal tract. Food within the crop is also softened by mucus glands. Crop stasis is a common clinical sign in which the crop fails to empty in a timely manner…

Article

Most amphibians do not drink water. Fluid instead diffuses across semipermeable skin, and sometimes gills, directly from water or moist substrates. Excess fluid is excreted primarily by the kidneys, while conserving electrolyte levels. In some amphibians, skin is also involved in osmoregulation and respiration.

Article

Water is the single most important medium for sustaining life. Although there are unique considerations for avian, exotic companion mammal, and reptile patients, the basic principles of fluid therapy hold true for all animals. This brief article reviews 10 important facts related to water and organ homeostasis.

Article

Rewarming is an important part of the resuscitation plan for small patients. As body temperature falls, adrenergic receptors are theorized to become refractory to catecholamine release. Therefore active rewarming is indicated for patients with moderate to severe hypothermia. Use forced warm air blankets, incubators, circulating warm water blankets, and/or…

Article

Traumatic wounds are frequently seen in exotic animals, and are particularly common in wildlife patients. Appropriate wound management of wounds has significant impact on healing time and success.

Article

Physical examination parameters used to assess hydration are essentially the same in birds and mammals. Reduced elasticity of the skin or decreased skin turgor is seen with dehydration however normal bird skin is relatively inelastic and checking skin turgor is not as straightforward as in mammals. To check skin turgor in birds, tent the skin on the on the…

Article

In no way, should the reader believe the use of tracheostomy tubes is common in exotic companion mammals like the guinea pig. This technique is exceedingly rare. However given the frequent lack of airway control and the particular concerns when anesthetizing guinea pigs, those concerned with emergency and critical care should be aware of this technique as a “back up” option. In most instances, use of this surgical approach would mean that the clinician has failed to exercise foresight and planning for their patient’s airway control. Nevertheless anyone who sees rodents, particularly on an emergency basis, should consider compiling a tracheostomy kit and practicing this technique on cadavers.

Article Presenting Problem

Bite wounds are not confined to small animal practice. Bite wounds are a common and significant problem in clinical practice, and LafeberVet’s presenting problem article features urgent care tips for this universal problem of veterinary patients. The incidence of bite wounds increases with a history of exposure to the outdoors or to other animals. The owner may even report a fight or interaction that results in a bite wound.

Article

Nowhere is the mystery of life and death more apparent than when dealing with reptiles.

Detecting the reptile heart rate: Even in the active, healthy reptile the stethoscope is generally a useless piece of equipment. The presence of scales or the shell makes auscultation of the heart difficult, if not impossible, in many instances. Therefore ancillary testing such as ultrasonography or electrocardiography is required.

Article Presenting Problem

Heatstroke is the most severe form of heat-related illnesses. In this life-threatening condition, the body is unable to dissipate heat load at a rate that accommodates excessive heat levels.

Begin treatment immediately once heatstroke is suspected. Intensive care is aimed at reducing body temperature while supporting organ function. A variety of techniques can be used to lower core body temperature. Administration of intravenous or intraosseous fluids is a popular internal cooling technique that also serves to support organ function…

Article

Among exotic animals, venous cutdown is most commonly employed in reptiles like lizards and snakes although intraosseous catheters are also placed in lizards. Similarly, when an exotic companion mammal like a ferret or rabbit suffers from severe hypovolemia, dehydration, hypotension, and vascular collapse, intraosseous catheters have largely replaced venous cutdowns but this technique is occasionally employed.

Article

Common reproductive conditions of the reptile include prolapse of the cloaca, oviduct or copulatory organ, yolk coelomitis, dystocia or egg binding, as well as follicular stasis. This review article on twelve key facts explores clinically relevant anatomy and physiology and appropriate husbandry as well as key points of urgent care and general principles of case management.

Article Presenting Problem

Prolapse in reptiles can involve the cloaca, a common receiving chamber for the reproductive, urinary, and gastrointestinal tracts. Prolapses can also originate from the distal gastrointestinal tract, reproductive organ, or urinary bladder—in those species with a bladder like the green iguana and leopard gecko…

Article

Exotic animal veterinarians are well aware of the differences between energy expenditure in small and large species. Larger animals use more energy overall, however when energy expenditure is divided by body weight (kcal/kg/day), large animals use relatively less energy than small animals

Article

Nebulization is used in avian medicine to deliver certain medications, usually antibiotics or antifungals, directly to the respiratory tract. Nebulization can provide hydration to the mucous membranes as well as provide an expectorant effect to help clear debris from the respiratory tract.

Article Presenting Problem

Shell fractures are one of the more common presentations of turtles and tortoises to the private exotic animal practitioner. Shell fractures are frequently caused by vehicular trauma, lawn mowers, predation by dogs and raccoons, or drops from balconies or porches. This presenting problem article reviews the key points of urgent care for this traumatic injury as well as the principles of case management.

Client Education Handout

First aid is the initial treatment given to an injured or ill bird during an emergency. The goal of first aid is to stabilize the bird until veterinary medical care can be provided. Donated by Dr. Greg Burkett, this client educational handout helps owners prepare for emergencies. Topics covered include the creation of a home hospital cage, stocking a first aid kit, the basics of owner supportive care as well as specific advice for emergencies like bite wounds, bleeding, and head trauma.

Client Education Handout

This client education handout reviews the basics of this essential technique, from the indications for syringe feeding and the equipment needed to potential complications as well as step-by-step instructions.

Client Education Handout

It is a natural instinct for parrots to hide signs of illness. In the wild, this skill serves them well, and in fact, may save their lives…

Client Education Handout

Keeping your pet healthy is everyone’s goal. However if your bird becomes ill, effective treatment will require that medications are given at the right dose and frequency for the…

Article

Due to their unique anatomy, physiology, and behavior, critically ill reptiles pose special challenges. Fortunately there are a host of tips and tricks that can increase clinical success in an intensive care setting… This Exotic ICU article is part of a series exploring nursing care of special species.

Article

At the Ontario Turtle Conservation Centre, previously the Kawartha Turtle Trauma Centre, we encourage private practices, emergency clinics, and rehabilitation centers to aid in the initial treatment of these injured turtles. We admit turtles from across the province, and it is extremely beneficial to the turtle to get immediate care locally before transfer. Snapping turtles are incredible in their ability to heal (albeit slowly!) and we cannot stress enough that the injuries can appear horrific, and yet can go on to heal, with subsequent release of the turtle back into the wild…

Article Video

Fluid therapy is an important part of supportive care, and there are several routes available for fluid support in the reptile. Subcutaneous and/or oral fluids are appropriate for mild to moderate dehydration, while intracoelomic, intravenous, or intraosseous fluids are administered to critically ill reptiles or to patients with moderate to severe dehydration.

Form-Questionnaire

Do you have everything? Shared by registered veterinary technician and veterinary technician specialist, Jill Murray of Oklahoma State University, review our collection of procedure equipment checklists. Checklists are used in clinical practice to make preparation for procedures more efficient and more consistent, thereby improving the quality of care. Use these equipment checklists to train students and staff, or simply to jog your memory for procedures performed only sporadically.

Article Video

Esophagostomy tube placement is an excellent choice for nutritional support of the debilitated small mammal patient requiring long-term feeding or for individuals that have suffered major orofacial trauma. Use this video clip or text with still images to review this important technique in the ferret.

Article Presenting Problem

Why is this bird bleeding? Anticoagulant rodenticide exposure in birds of prey has been documented in the United States, Canada, and Europe. Anticoagulant rodenticides have been commonly used over the past decades for control of rodent populations and these rodenticides can cause toxicosis in birds of prey via consumption of poisoned prey.

Anticoagulant rodenticides are divided into two categories: first generation rodenticides like warfarin and second generation rodenticides, such as brodifacoum. Second generation anticoagulant rodenticides are more toxic and also have…

Article

Hemorrhage in the critical patient can occur from a number of reasons. Before a blood sample is collected, carefully weigh the risk to the exotic animal patient against the clinical value of the test results. What will you do with this information? How will it affect your clinical plan? EDTA is the most commonly used anticoagulant in small mammals; lithium heparin is commonly used in birds and reptiles. Whenever possible, make a blood film immediately after venipuncture using fresh blood free of anticoagulant. Most adult small mammal hematocrits range from…

Article Video

Intravenous catheters are commonly placed in ferrets and rabbits to administer fluids and medications, induce anesthesia, and for delivery of analgesic drugs during and after surgery. Intravenous catheters are also placed with growing frequency in chinchillas, guinea pigs and other small exotic companion mammals. Use this video clip or text with still images to review patient selection, potential complications, equipment needed and step-by-step instructions for this technique, as well as daily fluid requirements, catheter maintenance, and patient monitoring.

Article Video

Nasogastric tube placement in the rabbit is an excellent choice for the weak, dehydrated patient that requires enteral nutritional support. Use of a nasogastric tube can be less stressful and more successful than syringe feeding. Nasogastric intubation is also indicated in rabbits that will undergo surgery involving the oral cavity, esophagus, stomach, or biliary tract. Use this video clip or text with still images to review contraindications and potential complications, equipment needed as well as the technique involved.

Article Presenting Problem

Crop burns are commonly caused by thermal injury in young birds and, in rare instances, by ingestion of caustic chemicals in adult birds. Crop burn is generally caused by feeding formula that is too hot (>110ºF or 43.3ºC) or less commonly, contact with a heat lamp or heating pad. Damage typically occurs in the gravity dependent right ventral region of the crop where the weight of the food bolus presses heated material against the skin. This increased thermal exposure can lead to necrosis of the crop wall and skin forming a fistula that can leak food.

Article Presenting Problem

Ferrets are small, flexible, mischievous, and curious. This combination means that traumatic injury is a common problem, particularly when owners do not supervise their pets or “ferret proof” their living quarters. For instance, reclining chairs have been implicated in the injury and even death of many ferrets. Ferrets may also be accidentally stepped on or become trapped within a confined space. Trauma can result in a constellation of injuries that may affect the head, thorax, abdomen, spine, and limbs.

Article Video

Endotracheal intubation of the rabbit is challenging because it difficult to directly visualize the tracheal opening in all but the largest individuals. Rabbits have a long, narrow oral cavity and the larynx, which sits on a ventral slope, is prone to spasm.

Use this video clip or text with still images to review equipment needed, potential complications as well as the techniques involved for blind intubation and intubation using visualization.

Article

Intravenous catheters are commonly placed in rabbits to administer fluids, medications, induce anesthesia, and for delivery of analgesic drugs during the perioperative and postoperative periods. Catheterization techniques used in dogs and cats can also be used for rabbits. To reduce the time in handling and reduce stress, supplies needed for catheterization should be set out and ready to go, prior to removing the patient from the cage.

Article Presenting Problem

A relaxed, comfortable bird may briefly fluff out its feathers before its plumage again appears flat and sleek. The critically ill bird may exhibit persistently fluffed and ruffled plumage…

Article Presenting Problem

Cloacal prolapse is a serious and potentially life-threatening problem. Prolapses can originate from the cloaca, oviduct or intestinal tract. The cloaca normally prolapses during egg laying or oviposition, and normal retraction of the cloaca may be slowed or absent in an obese hen or one with hypocalcemia. Excessive abdominal contractions caused by an abnormal egg, dystocia, cloacal disease, gastrointestinal disease or chronic mastubatory behavior can also promote prolapse.

Article Presenting Problem Video

When a bird is presented for bleeding as with a broken blood feather, it is important to distinguish between frank hemorrhage and blood on the cage or bird without active bleeding. This brief presenting problem article on hemorrhage in birds reviews the key points of urgent care: Hemorrhage that has stopped is best left undisturbed initially, while active bleeding requires immediate intervention by applying firm, steady pressure.

Article Presenting Problem Video

Why is a broken blood feather an emergency? When the blood feather breaks, the feather shaft acts like a straw making the vessels bleed much longer than they would otherwise due to capillary action. The degree of blood loss can be significant, particularly in small birds. Use this video clip or article with still images to review the basic structure of the blood feather, key points of urgent care as well as follow-up care.

Article Video

Fluid therapy is a vital part of avian medicine, and appropriate administration of fluids is essential. Intravenous catheters are commonly used intraoperatively or in more stable hospitalized patients. Unfortunately intravenous catheter placement in birds can be challenging. The veins can be difficult to access and the vessels are also prone to hematoma formation.

Use this video clip or text with still images to review the equipment needed, the technique involved, and potential venipuncture sites including the jugular vein, medial metatarsal vein and basilic or ulnar vein.

Article Video

Loss of appetite is a common finding in the sick ferret and nutritional support is often required. Ferrets with insulinoma may also require regular assist feedings to help maintain normal blood glucose levels. Fortunately syringe feeding the ferrets is a relatively straightforward process. The short, simple gut of the ferret has only a limited ability to absorb nutrients. So even healthy ferrets require a highly digestible diet. Use this video or article to review the equipment needed and the technique involved.

Article Video

Mild to moderately ill exotic companion mammals are often syringe fed, and proper syringe-feeding technique is an essential skill for critical care nutrition of ferrets, rabbits, and rodents. Gastrointestinal stasis is one of the most common medical problems seen in small herbivores. A cornerstone of treatment is delivery of food containing high dietary fiber. Aggressive fluid therapy, often in the form of oral and subcutaneous fluids, is also crucial for successful management. Always address dehydration before beginning nutritional support. Get specific tips to improve your clinical success with this video clip or read the article with still images.

Article Video

Urethral catheterization of the male ferret is challenging due to the animal’s small size and J-shaped os penis, however the principles of catheterization as well as monitoring during catheter placement are essentially the same as in the domestic cat. Use this video or the article with still images to review equipment needed, potential complications and the steps involved in this critical care technique.

Article Video

The subcutaneous route is the most common method of fluid administration in the avian patient. Subcutaneous fluids are an excellent way to provide maintenance fluids or to correct mild dehydration in birds. This video clip and article with still images describe the equipment needed and the technique involved in this supportive care procedure.

Fluids are most commonly given in the inguinal space (crural patagium). With the bird secured by an assistant, have them extend one of the bird’s legs out and to one side. Wet down the area on the inner thigh to see the skin better at a point about halfway between…

Article Video

Fluid therapy is indicated in critical patients including exotic animals. Vascular access can be extremely difficult or even impossible during shock, making intraosseous or IO catheterization necessary in the bird. Fortunately fluids and medications given through IO catheters are immediately taken up into the vasculature. The distal ulna is the site of choice for intraosseous catheter placement in the bird.

Article Video

Fluid therapy is an important part of supportive care in the critical patient. When intravenous catheter placement fails or when veins are too small or too fragile, an intraosseous or IO catheter is an excellent option in exotic companion mammals. Use this video or text with still images to review equipment needed, potential complications, as well as the technique for intraosseous catheter placement in small mammals.

Article Video

Tube feeding, also known as gavage feeding, is an essential part of avian supportive care. Sick birds are often presented with a history of anorexia and glycogen stores may be depleted within hours in small species with relatively high metabolic rates. Another important indication for gavage feeding is a documented drop in body weight of 5% to 10%.

Article Video

Emeraid Omnivore can be hand fed or gavage fed to companion birds like parrots and songbirds and to omnivorous rodents like rats and mice. Emeraid Omnivore may be fed in combination with Emeraid Herbivore, to species like gerbils, hamsters, and the African pygmy hedgehog (Atelerix albiventris). Combinations of Emeraid Omnivore with Emeraid Carnivore can be used to meet the dietary requirements of these species…

Article Video

Nutritional support is indicated in reptiles with a 10% drop in body weight, and force-feeding is sometimes indicated with a history of anorexia. Interpretation of anorexia can be difficult in some reptiles, particularly snakes and chelonians. Never rush to feed a reptile. The patient must first be warm, housed at its preferred optimal temperature zone, and must be adequately hydrated.

Article

The basic principles of cardiopulmonary-cerebral resuscitation may be applied to birds. The prognosis for respiratory arrest, especially when caused by isoflurane anesthesia overdose, is good. Cardiac arrest in birds carries a poor prognosis, because direct compression of the heart is not possible due to the overlying sternum. Also, because birds lack a diaphragm, closed-chest compressions cannot utilize the thoracic pump mechanism to increase overall negative intrathoracic pressure. Therefore early recognition of cardiovascular instability is particularly important in avian species.

Article

Pain assessment in birds is very complex because it requires consideration of differences in age, gender, species, individual behaviors and environmental factors. Birds may exhibit different behaviors or may hide painful behaviors when outside of their home cage. Predatory species may exhibit painful behaviors more readily than prey species. Many clinical signs may be associated with pain in birds including…

Article

Burns are common in avian medicine. Many burns result from contact with hot liquids such as scalding water or cooking oil. Electrical burns arise from chewing on electrical wires and burns may also occur when pre-weaning birds are fed hot formula. Burns resulting from entrapment in burning buildings or inside containers, such as chick incubators with burning bedding, are not as common but are much more difficult to treat due to the complication of smoke inhalation.

Article

Small birds face an enormous task in maintaining their body temperature, especially in a cold environment, but fortunately plumage provides an effective barrier to heat loss. Down feathers trap air and allow little convective movement of heat to occur. Fluffing feathers increases insulation and…

Article

The cranial nerve exam differs little from that of mammals, however there are differences in innervation. As in mammals, menace and pupillary light response (PLR) require use of cranial nerves II (optic) and III (oculomotor), however menace is difficult to interpret in birds. Also, PLR may be overridden in birds due to the presence of striated iridal muscle. Evaluate PLR early in the exam using a sudden, bright light directed toward the medial canthus. Consensual PLR is absent due to…

Article

Arterial blood pressure measurement is an important tool in the management of the critically ill bird. Systolic blood pressure is the pressure exerted against the blood vessel wall during contraction of the heart. Although direct arterial pressure measurement is ideal, it is not commonly used because of the need for specific technical skill, invasive nature of the procedure, and cost of equipment.

Article Video

After recognizing a dyspneic bird, the clinician’s initial response should be: Hands Off!! Dyspneic birds can die soon after presentation with the additional stress of restraint and handling. Therefore minimize handling and place the bird in an oxygen-rich cage. Humidify air and provide 40 to 50% oxygen. As in mammals, oxygen therapy is potentially toxic if given for prolonged periods at high levels.

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