Critical care for small exotic patients (Proceedings)


Critical care for small exotic patients (Proceedings)

Aug 01, 2009

Although the principles of critical care are universal in all species, veterinarians face a unique set of challenges when dealing with small mammals. In true emergencies, time is critical. The nearest veterinarian, who may be unfamiliar with that species, must render care. However, the basic guidelines for critical care can be modified and adapted to address any species. Once stable, general medical principles can be applied to any small exotic species – as long as the veterinarian is aware of the unique aspects of these species. Most needs can be met by adapting equipment found in most veterinary practices.

General Concerns When Caring for Small Patients

Small patients have a much more rapid metabolism than the more familiar domestic pets. This can lead to very rapid use of glucose reserves, and more rapid disturbances in fluid and electrolyte parameters. Perhaps the most important consequence is the much greater susceptibility to hypothermia in most species. (*Exception – chinchilla, hedgehog) Smaller patients are often more difficult to properly restrain without injury to the patient (or veterinarian), and many have a unique predisposition to stress that can cause catecholamine release, cardiac arrhythmia, and even death due to handling and treatment alone. In addition, drug doses are often minuscule, sometimes leaving a negligible difference between dosing and overdosing.

Anesthesia poses a far greater risk to these small patients unless proper precautions are taken. Many species are extremely difficult to intubate, and catecholamine surges can cause cardiac arrhythmias and respiratory depression. These dangers are compounded by a lack of appropriately sized anesthetic monitoring equipment.

Vascular access sites are limited, yet effective catheter placement and fluid therapy is essential in most patients. In addition, because of the very small patient size, even small volumes of blood loss can leave a patient critically hypovolemic.

Therapy for Small Patients

Therapy for small exotic patients should proceed as in any pet. The basic principles of care are universal – provide fluids, heat as necessary, and oxygen. Once these basic needs have been achieved, then the practitioner can address wound care, nutritional support, and appropriate antimicrobial therapies. Always perform a complete physical examination – do not be intimidated by the size or species of the patient. However, it may be preferable to perform the exam in stages, to avoid excessive restraint or distress to the patient. Utilize the systematic approach that is most familiar to you – the approach you use in assessing your canine and feline patients. The most important factor is consistency, which decreases the potential for missing problems.

Emergency Care

When rendering care to the patient presented as an emergency, be sure to assess the entire patient. In the case of an emergency, rapid and limited assessment is appropriate. However, do not assume that the obvious injury is the most severe. For example, a patient appearing weak or even neurologic may have a severe enough anemia to be causing all the other signs; conversely, a patient with a hemorrhaging injury may also have severe head trauma that can be equally life threatening. Always treat the most critical conditions first; stabilize the patient, THEN provide proper wound and supportive care.

Initial Emergency Assessment

The principles of life support and emergency care are universal amongst species. (These principles will be demonstrated below, incorporated with general care techniques.) Follow suggested protocols to assess airway, breathing, and cardiovascular support (ABC's of triage). Control hemorrhage, provide heat, and evaluate for wounds. Assess thoracic and abdominal cavities for penetrating injuries, ruptured organs, masses, or fluid or air accumulations. Postpone care of fractures or non-life-threatening wounds until the patient has been stabilized.