Emergency and Critical Care of Sick Birds

Stacey Gelis BVSc(Hons) MACVSc ( Avian Health)Animal Referral Hospital

250 Parramatta Rd Homebush 2140

Patient AssessmentTo handle or not to handle…

…that is the question!

Ooops!!

Contraindications To HandlingExtreme dyspnoea

Prostration

Unresponsive to stimuli

Beware of Small Patients

Stop a Clinical Examination when..Bird closes its eyes in your handSudden weaknessFailure to grasp with both feetNo pressure when item inserted in beakImmediately place into heated hospital cage

+/- oxygenObtain a thorough history

Hospitalisation FacilitiesHeat 28-32 degrees CHumidityOxygenNebulisationQuietSubdued LightAvailable food

Fluid TherapyIntravenous

Jugular (right)UlnarMedial tarsal

SubcutaneousInguinal ( bilaterally)interscapular

IntraosseousUlnatibiotarsus

OralCrop gavage

Calculating Fluid RequirementsDaily maintenance: 5% BW/dayPlus % dehydrationAim to replace 50% deficit first 24 hrs

In acute fluid loss, 20-25% of deficit is replaced in first 4-6 hrs.

Then the other 50% over next 24-48 hrs

Fluid VolumesIV fluid Rates

Crystalloids: bolus 10 ml/kg or 10-25ml/kg over several mins

Colloids: 3-5 ml/kgTransient bradycardiaDecompensatory phase of shock (bradycardia,

hypotension, hypothermia) Slow IV/IO bolus over 10 mins of 7.5% hypertonic saline (3ml/kg)

+ colloids (3ml/g)Fluid overload:

Increased RR Cardiac dysrhythmia Agitation Collapse

Subcutaneous Fluid Volumes5-10% bodyweight bid-tid

Ensure all fluids are WARMED 37-39 DegC

Crop Volumes30ml/kg q 6-8 hrs or 3-5% bodyweightInitial to Max Crop Volumes

Finch: 0.1-0.5 q 4hrsBudgie: 0.5-3.0 q 6 hCockatiel: 1-8 q 6hSun conure: 7-15 q 6hCockatoo: 10-40 q 8-12 hrs

Oral Rehydration/Nutrition

Fluid TypesHartmann’s solution0.45% NaCl and 2.5% glucose0.9% NaClColloids eg Gelofusin (10-15 ml/kg IV q 8hrs)Fluids should be WARMED

Blood transfusionsIndicated when PCV <15-20%**Circulating Blood volume= 7-10% BWCan easily tolerate 30% acute blood lossPCV can take 24 hrs to stabiliseTransfusion volume: 10-20% blood volumeHomologous vs Heterologouss

Homologous: RBC survival 9-11 dayHeterologous: 1-3 daysReactions rare

Medication Injection SitesIntravenousIntramuscular

Pectoral musclesStart low, alternate sites

Subcutaneous eg enrofloxacin diluted with saline for

repeated injections

Dyspnoeic PatientsUpper Vs Lower Respiratory DiseaseUpper:

Open beak breathing with high pitched squeakForward leaning postureAcute- good body condition

Lower:Poor body condition- chronic?Coelomic distension

Stabilising Dyspnoeic PatientsOxygen therapyNebulisationRelieve upper respiratory obstructionCoelomocentesisOvocentesisAir sac cannulation

Nebulisation ProtocolsF10 concentrate

1ml to 250 ml tap waterNebulise 10-20 mls for 30 mins tid-qid

Acetylcysteine 20% (Mucomyst)22mg/ml sterile water

Piperacillin 10mg/ml saline 10-30 mins q 6-12 hrs

Amphotericin B

Diagnostic SamplingFaecal Exam

Wet prep, D-Q, Gram Stain Crop washBlood Sampling

Li Hep and blood smearRadiology

Lat AND VD viewsUltrasonographyEndoscopyCoelomocentesis

Assessing Urofaeces

Cardiopulmonary ArrestIntubation , 100% oxygen; PPV q 4-5 sec

Don’t overinflate birdDon’t blow into ET tube- zoonoses!!

CPRAdrenaline 0.5- 1 mg/kgAtropine 0.5mg/kgPlus fluid bolusDoxapram 20 mg/kgNaHCo3: 5mmol/Kg IV oncePrognosis is better for acute arrest eg Iso

overdose than with chronic illness

Other Emergency MedicationsAnalgesics

Butorphanol 1-2 mg/kg IM q 4-8 hrsMeloxicam 0.3-0.5 mg/kg PO, IM sid-bidTramadol 4-5 mg/kg

AntibioticsEnrofloxacin 15 mg/kg bid PO or diluted IM/SCAmox/Clav; ticarcillin- 100-150 mg/kg bidTrim/Sulph- 30 mg/kg bid

Chelating agentsCaEDTA 50-75 mg/kg IM BID

Thank You!