Emergency medicine in birds (Proceedings)


Emergency medicine in birds (Proceedings)

Apr 01, 2008

This lecture will provide an overview of emergency management of critical avian patients by addressing emergency preparedness, supportive care, empirical drug therapy (e.g. antibiotics and supplements), nutritional support, oxygen therapy and oxygen therapy

Initial Consideratons

Preparation—Preparation for an avian emergency begins well before the patient arrives. Remember the 5 Ps—Proper Preparation Prevents Poor Performance or Proper Preparation Provides for Peak Performance (Jones 2007). The veterinary team should prepare the following prior to the patient's arrival: warm fluids, a warm (and humidified) environment/cage, an anesthetic machine ready to provide oxygen/anesthetic support and a "crash cart" with emergency drugs and necessary supplies. Assess the patient (visually/physically) on arrival, then placed the bird in the supportive care enclosure in a quiet area. During the visual examination note the patient's posture, respiratory character and degree of alertness and manage problems that require immediate attention (i.e. cardiopulmonary arrest, active hemorrhaging, respiratory distress, external coaptation of fractures). If the patient presents in cardiopulmonary arrest then the ABCs of cardiopulmonarys resuscitation (now referred to as cardiopulmonary-cerebral resuscitation [CPCR])) should be immediately instituted.1 The clinician should calmly delegate responsibilities to the veterinary team including asking someone to make a record of all CPR activity.

Airway—Establish and maintain an open airway via endotracheal intubation or an air sac cannula;

Breathing—Provide positive pressure ventilation manually or use a appropriately sized small animal ventilator

Circulation—Maintain circulation with cardiac compressions as well and fluid expansion.

Appropriate drugs for CPR include epinephrine (1:1,000; 0.5-1.0ml/kg IT, IV, IC or IO), Atropine—0.5 mg/kg IM, IV, IO, IT and doxapram HCL (5-10 mg/kg once IM, IV or SC.2 The prognosis for successful CPR is very poor owning to the anatomy of birds and the ability to perform adequate "chest" compression; however, every effort should be made to resuscitate a patient unless the owner/agent declines resuscitative efforts.

Diagnostic And Therapeutic Plan

The next step in successful case management is to develop a diagnostic and therapeutic plan as quickly as possible. Making a plan serves to coordinate and focus your thoughts for the benefit of the patient. Once the patient is made comfortable or stabilized in as stress free of an environment as possible it is imperative to get a complete history of the problem as well as notify the owner of the patient's prognosis and obtain informed consent for further treatment. Once a plan is developed and other initial steps are completed then reassess the patient. If the patient is stable perform a physical examination, provide supportive care as needed, obtain samples for appropriate primary and ancillary diagnostic tests, administer appropriate empirical drug therapy and provide analgesia and nutritional support. The order of those events may vary depending upon the clinical situation. In some instances it may be more prudent to minimize handling, provide supportive care and forgo diagnostic testing for a time until the patient more stable. Remember that no procedure is more important than the patient unless that procedure is necessary to save the patient's life.

Physical Examination—A physical exam may be performed on the patient depending upon the initial assessment, the severity of disease, and whether the patient is able to tolerate some degree of stress. In some cases I have an anesthetic machine set up and ready before removing the bird from its enclosure. The physical exam should be quick and with a specific goal in mind. Remember to perform only those procedures that are determined to be necessary to evaluate the patient and begin appropriate therapy. Above all else minimize handling of the sick patient and Do No Harm! If necessary perform a brief physical exam as you are transferring the patient into its cage.