ER/ICU techniques in reptile patients (Proceedings)
Reptiles take a very long time to get sick. Likewise, amphibians tend to hide disease for prolonged periods. By the time they show signs of disease, their pathology is usually advanced. There are very few true emergencies in reptile medicine. The exceptions to this are acute traumas and hemorrhage.
Trauma management should be no different in herps than it is in mammals. Remember the ABC's of emergency medicine: A = airway, B = breathing, and C = circulation. Always control hemorrhage.
Basics of ER careAlways take the patient's core body temperature. This is done in a fashion similar to the procedure in mammals. Caution should be taken when inserting the thermometer in the vent as there is a blind pocket in the cranial portion of the cloaca (the corprodeum). This is easily, accidentally, penetrated, when using a pointed or sharp plastic thermometer. Soft, flexible, electronic thermometers are the best to use.
As odd as this sounds, with reptiles, oftentimes, the first diagnostic evaluation that you need to do is to assess whether or not the patient is still alive. With reptiles, especially those that are housed too cool, this is not always an easy thing to do.
First off, a sick, cold herp can be almost completely motionless. It is hard enough to determine if a reptile is breathing, or its heart is beating, when it is asleep. The heart beat goes from "beats per minute" to "minutes per beat" when cold or ill. A doppler or ultrasound may be needed to assess cardiac motion. Bear in mind, a reptile's heart may beat even after death.
It is not unheard of for an owner to bring a reptile in for emergency care, only to find out that it has already died.
If you do nothing else, you must always remember one thing: keep the sick or injured reptile warm.
All reptiles have a broad "Active Temperature Range," which is the temperature range where reptiles are capable of normal, voluntary activity. For instance, early in the morning, before the sun comes up, the animal will wake, and move around to find a basking place. Once in the basking spot, it will stay there until it reaches its next temperature target.
The Preferred Optimal Temperature Range, or POTZ, refers to a specific temperature range selected by a particular species of reptile when presented with a thermal gradient. Each reptile species has its own unique POTZ. The animal's physiology is functioning at its optimum while within this range. Foraging, eating, reproduction etc., all occur within this POTZ. Most importantly, for the sake of this discussion, when a reptile is ill, its ability to heal and recover is most efficient while within the POTZ.
Any veterinarian that chooses to treat reptiles must have the knowledge of the animal's POTZ, AND, must also have the proper caging/heating/lighting that can be adjusted to the different requirements of the different species. That means that the clinician MUST KNOW the POTZ for any potential herp patients. Keep a chart in the ER wards so that the caretakers will know how to prepare hospital cages. Animals that are not housed or hospitalized correctly, as in a proper ambient temperature, will not respond to medications in any predictable fashion. This diminishes the effectiveness of any medical treatment.
To warm a sick animal, just put it into a container of the proper temperature. You don't need to "gradually" warm the animal. Be careful not to OVERHEAT it. There is a species specific temperature called the "Critical Thermal Maximum" where the animal loses voluntary control and is incapable of thermoregulating. If maintained at or above this temperature the animal will die.
Some of the most severe burns that I have seen in veterinary patients over the years (this includes dogs and cats, as well) are from over anxious caregivers trying to warm up their patients too fast. Perhaps the most common mistake that people make is to take a hot water bottle and fill it with scalding hot water. When the person touches the outside of the rubber water bottle, it does not seem to be too hot. However, when you place the hot water bottle in direct contact with a sick, immobile animal, the heat transfer is maximized, and burns, secondary to the increased contact time, are often severe.