Avian Critical Care and Emergency Medicine

There are several facts that you need to know about birds before you get started. Birds are masters at hiding their illnesses, as a preservation response, allowing a bird to compensate for disease. As with all creatures, the crisis arises when the bird can no longer compensate for illness and signs of the problem become evident.

Critically ill birds are often presented in an advanced state of decompensation. When an owner states that "the bird was fine yesterday" and today it is sitting on the bottom of the cage, the owner is usually being truthful, in that it appeared to be acting normally until it finally could no longer compensate and "crashed." Had the owner purchased a good quality scale to measure the bird's weight in grams, and monitored its weight weekly, chances are the problem could have been identified much sooner.

If an owner calls to alert the staff at the clinic ahead of time, inform the owner to bring supplemental heat with the bird, and to transport it in a carrier, with towels inside, or to place the bird in a small box, so that it will be kept in a warm and dark location for transportation to the clinic, which will keep it warm and quiet. Tell the owners to bring the papers from the bottom of the cage, so that droppings can be evaluated. As with other emergencies, have the owners bring in any suspected poisons, if applicable.

If the bird is sick enough to be seen at an emergency clinic, chances are it is critically ill. I strongly suggest that you prepare a release form that explains how ill the patient is and how you will be attempting life-saving procedures for this patient. Include an estimate for treatment on this form, so that there are no misunderstandings.

Another subject that should be discussed is whether the bird should be taken to the back for treatment, or whether the owner should be present during the initial evaluation. Many owners are very nervous about being separated from their beloved pet, especially during a crisis when they are seeing a new veterinarian for the first time. You should be competent and confident enough with your skills that you should allow your client to be present with your patient, if they wish. However, under NO circumstances should an owner be allowed to hold, restrain or pet their bird during treatment and examination. Owners tend to let go during moments of stress and they cannot be relied upon to correctly and safely hold their bird without causing injury to themselves, the bird or you!

For the sake of time and space here, I am assuming that the veterinarians and technicians have a good idea of proper restraint techniques for both adult and baby birds. Restraint techniques should be practiced, if necessary, so that ill birds won't be injured or stressed unduly, by awkward or dangerous restraint. The chest should never be restricted, as birds breathe like a bellows, in and out, and not up and down, as mammals do (birds have no diaphragm). Also, birds with bare facial skin are prone to bruising, and care must be taken to not leave finger-prints, bruises or abrasions on the facial skin. Learn how to hold a bird safely, but loosely, to prevent injury.

While grooming should never be a priority in emergency cases, it is important to ascertain whether or not your patient is flighted or not. One should always keep TWO closed doors between a flighted bird and the outside world. If a patient is flighted, it might be safest to ask the owner if it would be alright to clip the wings to prevent escape, especially if the patient is lively. Learn proper wing clipping techniques! Your clients will judge your skill and ability as an avian practitioner by how you handle their pet and by how you clip the wings. Clip the wing feathers, beginning at the outermost primary and clip each feather at the base, after identifying each shaft to ensure that it is not a blood feather. Using this technique (and not the older method of clipping the feathers at or just below the level of the coverts) you should only need to clip about five feathers on each wing, for most species. Lighter birds, such as cockatoos and cockatiels, may need a few more feathers removed from each wing to prevent upward flight.

Again, while grooming shouldn't be a priority in sick birds, I recommend quickly removing the points of the claws, for the safety of you and your staff, as sharp toenails can cause serious punctures to human skin. Use a Dremel tool, nail clippers or an emery board to file down the sharp points.

Avian ER Care at a Glance

  1. If bird will not be seen immediately, provide HEAT (latex glove filled with hot water, or place in brooder/ICU cage with supplemental heat, or microwaveable heating pad, or plug-in heating pad). Ambient temperature should be 85-92 degrees F. If dyspneic, take the bird immediately, and put in the prepared ICU unit with supplemental oxygen. Patient should be kept warm, quiet, well-ventilated environment with minimal to no disturbances.
  2. Before handling, get the history, find out if it is flighted
  3. Observe the bird in the cage or carrier
  4. Weigh the bird in grams
  5. Perform a thorough, but brief physical exam, including auscultation of the lungs, heart and air sacs, use magnification and light source to examine oropharynx, choanal slit, eyes, ears, skin, feathers, cloaca, palpate crop, abdomen, limbs, procure any samples
  6. Put the bird back on heat (and oxygen, if necessary), to formulate a plan, calculate fluid and drug doses, draw up meds for administration
  7. Administer medications, fluids, etc.
  8. Of course, if there is excessive bleeding, dyspnea or other problems requiring immediate attention, treat these immediately.

Organization and advance preparation are required to provide necessary care with the least amount of stressful handling.

The goal of the emergency vet should be to stabilize the patient until it can be referred to its regular avian veterinarian. While it is always a good idea to procure culture swabs and blood for testing upon initial presentation, it is often too dangerous to attempt those procedures until the bird has been stabilized. That said, it is probably okay to use a moistened sterile culturette to swab the oropharynx and/or cloaca (or fresh dropping) to save for later bacterial testing. Another sterile cotton tipped applicator that has been moistened in sterile saline can be used to swab the choana and cloaca for possible DNA PCR testing. This swab should be placed in a sterile red top tube for storage. Swabs for DNA PCRs should never be pushed into transport medium meant for bacterial cultures. This way, there will be swabs taken prior to any medications being administered. Unless there are special circumstances, it is probably best to not draw blood during the initial examination period.

The majority of avian cases you will see on emergency will be the decompensated adult or neonate, traumatic injuries (from cagemates, cage or cage accessories, ceiling fans or flying into windows or mirrors), toxicoses, bite wounds from other family pets (dogs, cats, ferrets, etc.), electrical burns from biting through cords, egg-binding/dystocia and drowning.

As with all emergency medicine, the patient must be treated within the "golden period" which is defined as the period of time following the injury in which appropriate therapy will result in the most satisfactory outcome. Not only survival, but return to normal function, are the goals.

If the owner has not transported the bird with heat, take the bird immediately and place it in a pre-warmed brooder, ICU unit or bird incubator, set at 85-92 degrees F. Do not leave a sick bird sitting in the waiting room without checking to see if the bird requires heat or oxygen. The air in the brooder should also be humidified, by placing a cup of water where the patient can not reach it, or by wetting a towel and hanging it inside the unit. The temperature is too warm if the bird is panting, open-mouth breathing or holding with wings out from the body.

Fluid Therapy for the Avian Patient

It is safe to say that any avian patient brought into the ER for any reason is going to suffer from some degree of dehydration. Diarrhea, polyuria, regurgitation/vomiting and decreased water consumption all will result in dehydration. Regurgitation is from the crop, while vomiting is from the proventriculus (glandular stomach). While textbooks will recommend running an initial PCV and total solids, unless you are skilled in avian venipuncture techniques, it is probably best to NOT attempt such tests as the additional stress may not be worth it to the patient.

The importance of maintaining fluid and electrolyte balance and blood volume is obvious, and correction of fluid shifts must be a priority. Most hospitalized patients should receive replacement fluids, based on estimated losses from evaporation, hemorrhage and presumed vasodilation. The replacement fluid volume equates well to maintenance requirements, provided there is no significant blood loss and the bird is not regurgitating or polyuric. Calculated fluid replacement volumes for severely ill or traumatized patients must include fluids lost form the vascular compartment resulting from physiologic response to illness and fluids sequestered from the circulation as a result of trauma. Absolute losses (blood lost to hemorrhage) and fluid shifts into areas of injury, infection or tissues with compromised blood flow must also be considered. The fluid deficit can be calculated based on body weight and perceived degree of dehydration with the following formula:

Fluid deficit (ml) = degree of dehydration (%) x body weight (g)

The daily maintenance fluid requirements for raptors and psittacine birds has been estimated at 50 ml/kg/day (5% of body weight). Estimating hydration status is based on clinical signs and history. The turgescence, filling time and luminal volume of the ulnar vein and artery are good indicators of hydration status. A filling time of greater than 1-2 seconds in the ulnar vein indicates dehydration greater than 7%. Severely dehydrated birds (10%+) may have sunken eyes and tacky mucous membranes. The skin of the eyelids may tent when pinched. Estimate at least 5% dehydration in all ER patients.

Half of the total fluid deficit is given over the first 12-24 hours along with the daily maintenance fluid requirements. The remaining 50% is divided over the following 48 hours along with the daily maintenance fluids.

Lactated Ringers solution or a similar balanced isotonic solution should be given, warmed to 100.4-102.2 degrees F. Warmed fluids are most important for neonates and for any intravenous or intraosseous administration of fluids, especially in cases of hypothermia or shock. In my opinion, avian patients should always receive warmed fluids.

There is evidence that hemorrhagic shock does not occur in birds. Severe blood loss is tolerated much better in birds than in mammals, especially in flighted birds. This tolerance is a result of the increased rate of absorption of tissue fluids to replace lost blood volume and baroreceptor reflexes, which maintain normal blood pressure. Prostaglandins, which potentiate shock in mammals, have been shown to have no effect in chickens. Birds may suffer great blood loss and survive, which is contrary to the old wife's tale that says how dangerous, or even life-threatening it is for a small bird, such as a canary, finch or budgie, to lose a drop of blood.

While intraosseous or intravenous routes are necessary in cases of shock or to facilitate rapid rehydration, these catheters are difficult to place and maintain in most birds. If you can add hyaluronidase (Wydase, Ayerst Labs) at 75-150 U/L of fluids, this will greatly facilitate the absorption of sub-q fluids in most patients. It has been my experience that if hyaluronidase is added to the fluids, then there is little need to worry about the IV or IO route.

Sub-cutaneous fluids are commonly administered in the axilla and lateral flank areas. The intrascapular area may also be employed, however, it is important to avoid the area around the base of the neck, due to the extensive communications of the cervicocephalic air sac system. Use a small gauge needle, 25-28 ga. to prevent fluids from leaking out the injection sites. The total volume of fluid (5-10 ml/kg/site) should be given in several sites, to prevent disruption of blood flow and subsequent poor absorption.

Intravenous fluids may be administered with an IV catheter in the jugular vein, or in large birds, in the ulnar or medial metatarsal vein. A butterfly catheter, with a 25 ga. needle, can be used for bolus administration of fluids, and a 27 ga. needle can be used in small birds. All medications and fluids should be drawn up and prepared in advance, so once the catheter or butterfly is in place, the medications can be administered immediately. The amount of fluid that can be administered at one time depends on the size of the bird. An injection of 10 ml/kg given slowly over 5-7 minutes is usually well-tolerated. Bolus injections can be repeated every 3-4 hours for the first 12 hours, every 8 hours for the next 48 hours, and then BID.

Intraosseous catheters can be placed in the distal ulna or the proximal tibia. Please note that the intraosseous catheter cannot be placed in pneumatic bones, such as the humerus or femur. For medium-sized or large birds, an 18-22 ga., 1.5-2.5 inch spinal needle can be used as the cannula. In smaller birds, a 25-30 ga. hypodermic needle may be used. It has been shown that 50% of the fluids administered in the ulna enter the systemic circulation within 30 seconds. The rate of infusion into the marrow cavity is limited. Fluids should be administered through the cannula using an infusion pump, buretrol or Control-a-Flow regulator. A flow rate of 10 ml/kg/hr is suggested for maintenance. Fluid extravasation may occur if the infused volume is too large or if several holes were made in the cortex while attempting to place the cannula. Cannulas may safely remain in place for up to 72 hours without complications, as long as they were placed aseptically and maintained with heparinized flush every 6 hrs.

For mildly dehydrated birds, fluids may be given by the oral route, as long as the patient is not seizuring, laterally recumbent, regurgitating, in shock or has gastrointestinal stasis. Fluid containing 5% dextrose has been shown to be more effective for rehydration than oral administration of Lactated Ringer's solution. Gatorade or other sports drink may be used for oral rehydration, and mixing fluids with psillium may increase fluid and calcium absorption from the intestinal villi. Critical care formulas, prepared especially for avian use, or baby bird hand-feeding formula can be used to provide necessary nutritional support once oral rehydration has begun.

Volumes that Can Be Gavaged

Species

Volume

Frequency

Finch

0.1-0.3 ml

q4h

Parakeet

0.5-1.0 ml

q6h

Cockatiel

1.0-2.5 ml

q6h

Conure

2.5-5.0 ml

q6h

Amazon

5.0-8.0 ml

q8h

Cockatoo

8.0-12.0 ml

q12h

Macaw

10.0-20.0 ml

q12h


Tube feeding a bird is a skill that should be mastered by avian ER vets and their technicians. Two people should perform this together. First, palpate the crop to feel for any residual food, foreign bodies, thickenings, scab areas or other problems. Hold the bird around the neck, straightening the neck out and tipping the head back slightly. The tube selected for feeding should be larger than the glottis and trachea to prevent introduction of the tube into the respiratory tract instead of the esophagus and crop. The safest way to keep the beak open and to prevent the bird from biting down and swallowing the tube, is by preparing a Nylabone (petite) by drilling a hole in the center, to be used as a speculum to hold the beak open and to prevent medium and large birds from biting through a rubber tube. This is much safer and gentler than the metal bird speculums that are commercially available, and can damage fragile beak tissue. Once the Nylabone is in place, it is easy to pass the tube through it, down the esophagus on the right side, and into the crop. Alternatively, you can use stainless steel tubes especially made for gavage feeding birds. These are bite-proof, and have a ball on the tip that will prevent accidental introduction through the glottis and into the trachea.

Whichever tube is used, once it is in place, make sure the tube is correctly placed in the ingluvies (crop). If there is any doubt, you can wet the feathers over the crop to visualize the tube, or you can palpate it in the crop. If the tube has mistakenly been placed in the esophagus, the bird will be frantic, as it will not be able to breathe. However, if you use a tube of the correct diameter and length, this cannot happen. Once the tube has been confirmed to be in the crop, the fluid or formula can be slowly administered, watching all the time for fluid in the oropharynx. After the food has been delivered, the tube should be carefully withdrawn to prevent regurgitation or reflux. If at any time, fluid can be visualized in the oropharynx, stop immediately, and withdraw the tube. Immediately put the bird down and allow it to clear the fluid from the oropharynx itself. Trying to turn the bird upside-down or suction the fluid out will cause undue stress. As long as the bird has a swallowing reflex, it will clear the fluids on its own.

So far, we have covered heat and rehydration. Now, let's talk about specifics.

Physical Examination

Perform systematic, thorough physical examination as you would on any patient. Use focused light source and magnification. Make sure you examine external auditory meatus, eyes, choanal slit, infundibular cleft, oropharynx, tongue, glottis, beak (symmetry), commissures, skin, feathers, follicles, wings, legs, uropygial gland (not present in Amazons, Hyacinth macaws), pygostyle, scales, claws, joints, external and internal cloaca, abdomen, crop (palpate, watch for peristaltic waves), auscultate heart, lungs and air sacs. Examine droppings.

In neonates, the skin is quite transparent, and you should be able to visualize supraduodenal loop, umbilicus, yolk sac, ventriculus, lungs, liver (if enlarged), possibly other organs. Since feathers are not present, you can visualize peristaltic waves of crop, and crop is easy to palpate.

Polyuria/diarrhea/regurgitation/vomiting

Bird is likely dehydrated. Rehydrate using warmed fluids and provide support. Place in warmed brooder, incubator, ICU unit. Collect regurg/vomitus on slide for possible Gram's staining, acid-fast testing, cytology, etc. Perform wet mount for protozoa. Collect urine (not urates or feces) in bullet tube for urinalysis, if necessary. Please note: urine dipsticks are designed for acidic urine, and granivorous birds have alkaline urine, so they may cause false readings. On physical exam, dip q-tip in white vinegar and evert cloacal mucosa to look for papillomas. They turn white with application of 5% acetic acid.

Consider Pepto-Bismol (2-5 mg/kg PO once), or Reglan (metoclopramide 0.5 mg/kg q 8-12 hr PO, IM, IV). Cisapride (0.5-1.5 mg/kg PO q8 hrs.) can also be used as a GI stimulant. If toxin is considered, give activated charcoal by gavage (use 1 g/5-10 ml water, 1 tsp=1.6 gm, 2-8 g/kg PO). Collect bacterial swab of vomitus/feces. Give injection of antibiotic, if warranted. Baytril, 15 mg/kg IM one time. Multiple injections of Baytril have been shown to cause severe muscle necrosis, tissue damage and pain, causing elevated CK levels.

If bird is passing droppings that are dark green/blackish and sticky, most people mistakenly think this is melena, however it is almost always biliverdin. Birds pass these dark green/blackish droppings after not eating for 24 hours. To confirm biliverdin, take a dropping and smear it with tap water. If it is green, it is biliverdin.

GI Stasis

Usually occurs in baby birds. Cause may be chilling, feeding formula that is too cool, crop burn, internal parasites, foreign body, bacterial infection, GI candidiasis, protozoal infections, overfeeding (stretched out crop, muscles and nerve function impaired, causes flaccid crop), some toxins, and others. May occur in adult birds, as well, usually from foreign body, internal parasites, bacterial or fungal infection, internal papillomas, some toxins, others.

In baby birds, this is often called "sour crop." This is not a disease, but a description of the clinical signs. If formula has been in crop for 12-24 hours, after hand-feeding, this is a medical emergency. Crop should be emptied, flushed out (save some material for culturing, wet mount, cytology, Gram's staining, etc.) Once crop is flushed out, dilute formula may be instilled. Usually instill oral medications first (cisapride, 0.5-1.5 mg/kg PO q 8 hr.), fluconizole/Nystatin (100 mg. fluconizole crushed and added to 20 cc Nystatin, 100,000 u/ml, dosed at 0.5 ml/kg PO BID, stable at room temperature for 6 months), injectable Baytril (15 mg/kg IM, note: unlike mammals, enrofloxacin is safe to use in neonates, and does not cause cartilage/joint damage). If cisapride is not available, metoclopramide can be used as a GI stimulant.

For neonates, hopefully, owners brought in the brand of hand-feeding formula that they were feeding, as it is best to use the same formula that they were feeding, if you are going to feed after emptying out the crop and instilling meds. Feed - 1 hour after oral medications.

Any baby bird receiving antibiotic therapy should ALWAYS receive concurrent antifungal therapy. Nystatin alone does not seem very effective in preventing candidiasis, so I always use the combination of systemic and topical antifungals.

Many birds with GI stasis are dehydrated. Assess and administer SQ fluids with hyaluronidase (75-150 U/l of fluids), if warranted. Oral rehydration may not be effective if GI tract is not functioning properly.

Trauma

Ceiling fan injuries

Flighted birds may fly into ceiling fan. This can result in fractures, concussion, lacerations or bruising. Fractured wings and legs will be discussed separately.

Concussion is always serious. Head trauma can be life-threatening. Use of steroids in birds is controversial, should NEVER be given without serious medical need, as the immunosuppression and clinical signs it causes can result in bacterial septicemia, aspergillosis, polyuria, polydipsia, hypoproteinemia, weight loss and possible malpractice suit!!! For head trauma, give prednisolone sodium succinate, 10-20 mg/kg, IM, IV q15 min. prn or dexamethasone sodium phosphate, 2-4 mg/kg IM, IV q 12 h. With dex, give until signs abate or for shock, give one dose.

Lacerations should be sutured within 12 hours. Unless the laceration involves the crop, abdomen or air sacs, or there is excessive bleeding, you can cover the wound with a saline dressing for the regular vet to suture the following morning. If a wound needs to be sutured, and anesthesia is necessary, supply the patient with supplemental heat during anesthesia, as small patients (who are often wet) will rapidly become hypothermic. For skin sutures, use monofilament, non-absorbable in Ford's interlocking (best) or simple interrupted or simple continuous.

DO NOT USE lidocaine or other topical anesthetics for local anesthetic for suturing, as these medications have a very, very low LD 50 and the stress associated with restraint during the procedure are detrimental. For example, if 0.2 ml of 2% lidocaine is used in a 200 gram bird, the dose is 20 mg/kg, which is greater than the toxic dose of 4-10 mg/kg reported in mammals. Procaine is also very toxic in birds, so antibiotics, such as procaine penicillin G should never be used in avian patients. Clinical signs of lidocaine toxicosis are dose-dependent and may include initial excitement and seizures, to depression, respiratory arrest and cardiovascular collapse.

Control seizures from head trauma with diazepam (0.1-1.0 mg/kg IV, IM or intracloacally).

If there is respiratory depression from head trauma, give doxapram, 20 mg/kg, IM, IV or IO.

CPR

If bird has respiratory failure, cardiac failure, and requires CPR, give: Doxapram 20 mg/kg IM, IV or IO, prednisolone sodium phosphate 10-20 mg/kg IM, IV q 15 min. prn., epinephrine 1:1000, 0.5-1.0 ml/kg IM, IV, IO or IT, atropine 0.5 mg/kg IM, IV, IO or IT, sodium bicarbonate 1 mEq/kg q15-30 min. to maximum of 4 mEq/kg total dose for metabolic acidosis OR for CPR 5 mEq/kg IV or IO once. Diphenhydramine may be given PO, IM or IV as an antihistamine. If a diuretic is needed, furosemide may be used for pulmonary congestion, ascites, edema or heart failure, dosed at 0.15-2.0 mg/kg SQ, IM or PO q 12-24 hrs.

Approximate respiratory rates in breaths/min.

Weight of bird (gms)

Rate

100

45-52

200

35-50

300

30-45

400

25-30

500

20-30

1000

15-20

*Restraint can increase respiratory rate by 1.5-2 x resting rate


Fractured Wing

From Petrac's book, this is the best, most effective, simplest splinting method. If you are uncomfortable splinting the wings, consider applying stockinette to immobilize wings until it can be referred to the regular veterinarian.

Fractured Leg

Fractured femur may require pinning, Spica splinting or external fixators. Fractures of tibiotarsus or tarsometatarsus are easily stabilized. Please note that the anatomy is different in the pelvic limb of birds, as bones have fused. Using a tape splint for fractures below the femur are easily applied.

Lacerated Crop

If the crop is lacerated from a ceiling fan injury, it must be surgically repaired. The crop is sutured, using 4-0 to 5-0 absorbable suture (Vicryl) in a simple continuous pattern, followed by a Cushing's oversew (which inverts the wound edges). The skin is then sutured, using monofilament non-absorbable, 3-0 to 4-0 (Prolene, nylon), in Ford's interlocking.

Seizuring

Seizures may be caused by trauma, hypoglycemia, hypocalcemia, viruses (West Nile Virus, Eastern Equine Encephalitis virus, etc.), migrating parasites, toxins, aspergillosis, granulomas, otitis progressing to encephalitis, chlamydiosis, bacterial septicemia or they may be idiopathic.

Idiopathic seizures are most common in lovebirds and red-lored Amazon parrots. Otitis is most common in lovebirds.

Seizuring in African Grey parrots is most often caused by hypocalcemia. There is a complex relationship between calcium absorption, uropygial gland secretion, calcium ingestion, vitamin A ingestion, and exposure to full-spectrum lighting (esp. UV-B) or natural sunlight (not filtered through glass or plastic). If possible, draw blood for blood calcium level while Grey is seizuring or in immediate post-ictal period, for the optimal chance of diagnosing hypocalcemia. A normal blood calcium level in a Grey does not rule out hypocalcemia, since the levels may fluctuate from minute to minute. Treatment is calcium glubionate at 50-100 mg/kg IV slowly or IM, diluted to 50 mg/ml. Ionized blood calcium levels are not usually helpful in procuring a diagnosis of hypocalcemia, either.

Seizuring birds may be hyperthermic, so use good judgment about whether or not to provide supplemental heat to these birds. Use an aural digital thermometer to take the temperature of a seizuring bird when in doubt.

Hyperthermia

Hyperthermic birds (left in a hot car, left in a cage in the full sun with no shade, for example) will have very hot feet, often red skin, will usually be panting (unless unconscious), and may have tacky mucous membranes. Cool the bird down with cool compresses to feet, or immerse the lower half of the bird in cool water.

Hypothermia

Hypothermia usually occurs secondarily to illness, or in neonates, may occur from malfunctioning brooder or if the baby is not supplied with adequate heat. Warm up slowly in a brooder.

Egg-binding or Dystocia

Egg-binding is when the egg does not pass out of the bird in a timely manner, and dystocia is a more advanced state, where the bird is suffering from the effects of the retained egg.

Most egg-bound birds are dehydrated to some degree and should receive warmed fluids, either by the SQ, IV or IO route. SQ fluids should be administered with hyaluronidase. Calcium lactate/glycerophosphate should be given at 5-10 mg/kg IM or calcium gluconate 50-100 mg/kg IV slowly or IM, diluted 50:50 with sterile saline or LRS. Vitamins A, D3, and E, 10,000 IU vitamin A and 1,000 IU vitamin D3/300 gm IM, are given to facilitate calcium absorption.

Most egg-bound birds will have a swollen abdomen, staining around the vent, and will be sitting fluffed up, usually on two legs. The bird may periodically strain, as if to pass a dropping. Droppings may be scant. An egg may be palpable in the ventral abdomen (be careful to not mistake the ventriculus for an egg). Radiographs can confirm the presence of a retained egg. Eggs that are not well calcified may be difficult to visualize radiographically.

Sometimes, after rehydrating the bird and administering parenteral calcium and vitamins, and placing it in brooder with heat and humidity, the hen may successfully pass the egg, unless the egg is too large, misshapen or the hen is too weak due to uterine inertia.

Depending on the state of the hen, it may be advisable to just maintain her, providing fluids, heat and humidity, until she can be transferred to her regular veterinarian the following morning. However, in many cases, the hen may be quite debilitated, and it would be in her best interest to deal with the dystocia immediately. Once fluids, minerals and vitamins have been administered, and the hen has had time to absorb the fluids, if she has not passed the egg within a few hours, it is time to proceed with medical therapy.

While oxytocin has classically been used for dystocias, it is not the safest or most effective method of treatment. If the egg appears to be able to pass through the pelvis, delivery of the intact egg may be attempted. If the egg is visible inside the cloaca, water-soluble lubricant can be instilled into the vent. However, if no egg is visible, the application of lubricant or mineral oil will not be effective. A prostaglandin gel used for human obstetrics, prostaglandin E2, dinoprostone, trade name Prepidil Gel, by Upjohn, dosed at 0.1 ml/100 gm, is a much more effective and safe treatment for egg-binding. This is applied topically inside the cloaca and causes uterovaginal sphincter relaxation and may cause uterine contractions. A lower dose than listed may also be effective. Care must be taken to not allow any of the gel to contact human skin (especially women) as it can cause serious problems to the reproductive tract of women.

If it appears that the hen's condition is serious, it is usually safe to implode the egg, by inserting a 22 ga. needle with syringe attached, into the cloaca or transabdominally, to aspirate the contents of the egg. This causes implosion of the egg, which usually immediately relieves the pressure caused by the retained egg. The hen will usually pass the egg or pieces within 72 hours. Rarely, this can result in laceration to the reproductive tract or cloaca. It is usually a very safe procedure.

If a portion of the reproductive tract is prolapsed, it may be possible to reduce the prolapse with sugar and then replace the tissue, using a purse-string suture placed loosely enough to allow droppings to pass. If the tissue is necrotic, it is possible to amputate the tissue, and then replace the stump, again then placing a purse-string suture.

Subcutaneous Emphysema

This may occur due to acute trauma or infection, usually involving the cervicocephalic air sacs. Air under the skin, while alarming to the owner, is not usually life-threatening. The condition may be temporarily relieved by the insertion of an appropriate gauged needle or IV catheter, which allows the air to escape. However, unless the cause is uncovered and treated, the air may reoccur. Stress, vocalizations or increased respirations will usually cause the SQ emphysema to come back, and in some cases, it may come and go. SQ emphysema may be present anywhere from the top of the head, to the neck, under the wings and across the chest. This must be differentiated from aerophagia resulting in air in the crop. A fractured pneumatic bone may also result in SQ emphysema.

Blood Feather

A blood feather is one with an active blood supply. It is shorter than a mature feather, and it has a thicker shaft that is soft, purplish-blue and sensitive. If a blood feather is cut or broken, it can result in life-threatening hemorrhage. Definitive treatment is to stabilize the wing or tail, grab the shaft near the base with a hemostat, and pull the feather out in the direction of the growth. Application of pressure using a sterile gauze square to the follicle for about a minute will usually result in hemostasis. If the bird has liver damage or other problems related to clotting, the follicle may not clot properly. It can be dangerous to apply clotting agents to the follicle, as it may result in permanent damage to the follicle, causing abnormal feather development. To prevent a bird from flapping the wings, dislodging a clot, it may be advisable to apply a wing splint temporarily to immobilize the wings, or wrap the bird loosely in a towel, until you are sure hemostasis is accomplished.

Severe Dyspnea

If an owner suspects that the bird has inhaled a seed, it may be necessary to insert an air sac cannula to provide an alternative breathing site. Since birds breathe in two directions, it is possible to cannulate an air sac to allow a bird to breathe if it has an occlusion or partial occlusion of the trachea or severe damage to the oropharynx. Use left lateral approach. Anesthetize and place in right lateral recumbency. If bird is in critical condition, this can be performed without anesthesia. Extend the wings dorsally and tape to restraining board. Extend the left leg cranially, and incise just caudal to the last rib, just ventral to the flexor cruruis medialis muscle. Bluntly dissect the muscle with a mosquito forceps, and then gently push the forceps through the body wall in a craniomedial direction and hold them open to allow passage of a sterile tube. Insert the tube through this opening in a craniomedial direction into the caudal thoracic air sac space. You can use a feeding tube, plastic intravenous catheter or small endotracheal tube as a breathing tube. A tape butterfly is placed on the tube to allow suturing of the tube to the skin with small non-absorbable suture material. The tube can remain in place for up to three days, and can be cleaned or flushed with saline as needed. Anesthesia can be administered through the cannula.

Burns

Crop burns occur from hand-feeding formula that is fed too hot, usually from hot spots in food from microwaving it. If it has just occurred, flush the crop with cool water, and begin antibiotic and antifungal therapy. Surgery should not be attempted until the crop has developed a scab or fistula. If performed too soon, it will dehisce. Wait at least five days before performing surgery.

For birds that have flown into a pot of boiling fluid, or landed on a hot stove, flush with cool water, treat as you would other burn patients, except avoid using ointments, instead use creams or lotions, as ointments can prevent normal thermoregulation.

While I cannot cover every reason why a bird would be presented to an ER clinic, this covers the basics. When in doubt, keep the patient warm, hydrated and cover with antibiotics/antifungals.

Cadeusus
Copyright 2013 Margaret A. Wissman, D.V.M., D.A.B.V.P.
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