So, hello, my name's Louise Azet and welcome to this talk today on avian emergencies. So on the agenda today, we're gonna start off with an introduction to avian emergencies and then go on to look at triage in avian patients. We'll then step through the basics of avian emergency care, so everything from analgesia fluid therapy through to CPR and euthanasia.
And then we'll finish up by going through some of the more common emergencies that you may well see in practise. Please note that some of the medications discussed in this webinar are off licence and are therefore used under the cascade. So let's make a start with introduction to avian emergencies.
So first things first, just a few comments around bird emergency cases. So even though it is a bird, do not panic. There is still a huge range of different diagnostics and treatment options that we can offer.
And I would recommend approaching a bird patient by thinking, what would I do if this was a dog or a cat? Because I do think this approach can help you think back to first pri principles and guide you in the right direction. The next point is that these are very fragile patients.
So any bird that the owner reports isn't quite right, should be seen as an emergency. And a wise vet once said to me that by the time an owner notices a problem with their bird, it's already 95% dead. And sadly, this is often true.
So with any sick bird, you need to see it as soon as possible to give it the very best chance of survival. The other side of this comment, however, is the fact that because they are fragile, we do need to be open and honest with the owner from the beginning and ensure that we've discussed expectations, owner commitment and financial implications from the outset. The next thing I wanted to mention was the fact that there is thought to be approximately 11,000 different bird species in the world.
And this ranges from parrots and passerines, pigeons and birds of prey, all the way to our chickens, ducks and quails. And even in the UK alone, there are hundreds of different species that are kept as pets. And because of this, you're never gonna know everything about a single bird species off the top of your head.
And so what I'd recommend is trying to find out what species of bird is coming in to see you beforehand, so that you can at least do a Google search to prepare yourself and find out some of the key information. So we know there's a lot of bird species in the world, but let's just quickly summarise which bird species I am referring to today. So first up, we've got our smaller cage in avery birds, which includes things like budgies, lovebirds and cockatiels.
These species all eat seeds, pelleted diets, plus a small amount of fruit and veg. Then we have our larger parrots, such as African greys, Amazon parrots and cows, and these will be kept either in an aviary or a cage. Diet wise, they are fed fruit, some veg, seeds, nuts, and pelleted diets.
Next, moving on to birds of prey, which includes Harris hawks, barn owls, and kestrels, for example. These should be kept in outdoor aviaries and they are carnivorous species, so they're fed things like chicks, rabbits and rodents. And then finally, onto our poultry and, also things like pigeons as well.
So with poultry, we've got things like chickens, ducks, and quails. And poultry are generally omnivorous species. So they eat things like grains, seeds, grasses, layer pellets, insects, veg, and fruit.
And then I'm also referring to pigeons today. So these are usually fed on things like cereals, pulses, seeds, fruit and veg, but they will eat most things. So we're now gonna move on to triaging avian patients.
So when a bird emergency arrives at your practise, the very first thing you should do is give it oxygen. And I'd often place the entire bird cage straight into the oxygen cage, assuming that it fits. This way we can avoid the stress of immediate handling.
As already mentioned, birds are incredibly fragile, so it's essential to let them settle and catch their breath before you begin any examination. Also, darkness calms birds as well. So I'd recommend covering the cage with a towel to help them relax.
And whilst that bird is sitting in the oxygen, you can move on to taking your history from the owner. If the patient is very critical, I'll take a capsule history first, so just the essential information, and then I'll come back for the full details later on. So let's have a little look at history taking aspects.
And I've covered on this slide some of the key things that I would go into if I was taking more of a full history from a client. So first up, it's important to ask about husbandry, and there are various different questionnaires available which may help you with this. The key things we need to know is, is the bird indoors or outdoors?
Are there any other birds kept by the owner? And what does the enclosure design look like? It can be very useful to ask the owner if they've got a picture of the enclosure, because a picture can definitely tell you a lot of information in a very quick glance.
We also need to ask for details about the current problem, particularly thinking about the duration and the clinical signs. Next, ask about eating and drinking. So how much is it consuming?
Is it being selective with what it eats? Is there any regurgitation or vomiting, and also, what are the droppings like? Has there been any change to the colour, the size and the volume of them?
If it's a bird of prey, it's important to ask, did it, when did it last cast? So casting is regurgitating up the the indigestible parts of the mill, such as feathers, fur, and bones, and birds of prey will typically cast after every meal. We also need to know if there's been any changes to the bird's routine or its behaviour.
And then with supplements, which ones are required will vary depending on the species. But there are things like hiding blocks which are required for budgies to support their thyroid health. And then grit is often provided to birds, particularly those that eat seeds, to help mechanically break down the food in the gizzard.
Is a bird lamp provided, or does the bird get access to outside light? Many species of birds, if denied access to unfiltered sunlight, would benefit from UV light to support their behaviour, their wellbeing, and vitamin D and calcium metabolism. And UV light provision is especially important for African grey parrots.
What about bathing? So some birds like to dust bath, while others like a water bath, depending on the species. It's also important to ask about any previous health problems or recent stressors, plus, has there been any toxin exposure, such as the Teflon pan fumes or heavy metals?
And then finally, has there been any trauma? So now we've taken a history, let's move on to the clinical exam. And I want to start off by sharing a few tips.
So first up, I always pre-warn the owner that sadly there is a risk that the bird might die during handling. Even with really gentle handling, the stress can sometimes be too much, especially if they're unwell. So just make sure you warn the owner of this.
As I mentioned earlier, I always pre-oxygenate the bird before attempting any handling. And I make sure that I've got everything I need ready beforehand. So things like scales, a small syringe to help open the beak, a box to put them in for weigh in, and whatever else I'm planning to do.
The goal is to minimise handling time as much as possible, so preparation is key. It can also help to examine them in a darker room to reduce stress. And I always take in a small towel into the consult room with me, which serves two purposes.
So it protects me from bites and gives the bird somewhere safe to hide and to protect itself. Also, think carefully about whether you want the owner present during the exam. This is particularly important with parrot species.
So parrots often form strong bonds with their humans, and if the owner is present during a stressful event like exam, then the bird may blame the owner for it. So it can work better to ask the owner to step out of the consult room briefly and then come back in after the exam. From the bird's point of view, this looks like the owner is rescuing the bird.
When they return, and this can really help to preserve that bond. When you're handling a bird, be very gentle with the feathers, especially the primary wing feathers as damage to these can prevent flight. And then in raptors, be extra cautious with the tail feathers which are vital for hunting.
Birds breathe by expanding the chest up and outwards. So if you hold them too tightly, you can accidentally suffocate them. So just be careful and always keep a loose but secure grip.
Plus, remember, they're expert escape artists. So check the room and block escape routes beforehand. Hygiene matters too, so always wash your hands before and after the exam to prevent zoonotic disease transmission.
And it's also important to weigh the bird, and I usually just pop small birds into a plastic tub to allow them to be weighed without flying away. And lastly, let's talk about the three finger hold and controlling the part of the bird that can cause the most damage to you. So whenever you think about handling birds, think about which bit will hurt you the most.
And I always think parrots' beaks and raptor's feet. So with parrots, the beak is the most dangerous part. So head control is vital.
Whereas with raptors, it's the feet. So as a priority, make sure you have the feet under control to avoid getting caught by their talons. The image here shows the three finger technique, which is great for smaller birds or parrots with larger beaks.
It lets you control the head safely and reduces the risk of being, of, of you being bitten. So you have your thumb and second finger on either side of the head, and then your first finger on top of the head. So how do we actually examine a bird?
Well, what I recommend is starting at the head and working your way down the body, just as you would do with any small animal. Begin with the eyes and the nose, especially looking for signs of nasal or ocular discharge. Check the ears too.
So birds do have an ear opening on each side of the head, which is usually visible as just a small hole. You can gently part the feathers on the side of the head to inspect it. Also, assess hydration status.
So we're looking for moist mucous membranes in the mouth and you can also look for skin tenting around the eyes. Next, have a look inside the mouth. So check the beak area and the glottis, and you may spot things like white plaques inside the mouth which can suggest canker.
Some birds also have a crop, so have a gentle feel of that as well, and that lies just on the front of the chest. Then I'd listen to the heart, the lungs, and the air sacs. So birds have a 4 chambered heart and have two static lungs that don't expand.
Instead, they rely on air sacs, so these act like bellows to move air through the lungs. Depending on the species, most birds will have 8 or 9 air sacs, and the system works in a one directional flow, with air continually passing through the lungs, making it a highly effective system. Also note that in birds, both inspiration and exploration are active processes.
Next, assess the salamic cavity by palpating the abdominal region for any abnormalities. Birds lack a diaphragm, so the thoracic and abdominal organs all share a single internal space known as a salamic cavity. Also, check the body condition score by palpating the kill, so you're feeling how prominent the kill is in relation to the surrounding muscle.
Then take a look at the cloaca. This is where the digestive, urinary and reproductive tracts all converge and empty to the outside world. And a quick note, note as well on the reproductive system of birds.
So in female birds, it's usually just the left side of the reproductive traps that's active. And in males, the testes are internal. Plus, in species that have a phallus like waterfowl, this is tucked inside the cloaca as well.
After that, examine the skin and the feathers, pay close attention to the wings, checking for breaks or damage, and I usually do a flight test, if appropriate, to see whether the bird is able to fly. Lastly, check the legs and the feet and look for any rings that may have been embedded in the tissue or caused irritation, and also assess their grip strength. So now we're gonna move on to the basics of avian emergency care.
So I want to start off with just making some points around medications. So many of the medications we use in birds are off licence, so you need to follow the cascade. Also, bear in mind that dose ranges can vary greatly between species.
So I'd always recommend using something like Carpenter's exotic Animal formulary, which is a lot more species specific dosages. Also note that we have very little data on efficacy, safety ranges, etc. So a lot of the doses we have are based on very small case studies.
Also, just note that with poultry, we need to be especially cautious if the owner plans to eat either the eggs or the bird, as that will change how we approach medication choices. Some drugs are specifically licenced for laying hens, but many aren't. So if you're using an unlicensed drug via the prescribing cascade, you must follow statutory withdrawal times, and that means at least 7 days for eggs and a minimum of 28 days for meat, as a minimum.
A common example to watch out for is baitrel. It's not licenced for use in layers or even birds within 14 days of coming in to lay. So this is a key restriction to keep in mind.
And then also a quick, a quick word on penicillin as well, so if the owner or anyone who might consume the eggs is allergic to it, it is best to avoid using them altogether. In terms of giving medications, there is quite a lot of different options available. So generally, with a Purros medication, we are always recommending to give the drug directly into the mouth rather than just giving meds and water because birds will often detect that there's something in the water and will refuse to drink it.
You can also consider subcutaneous routes such as the preco fold. And in, and with intramuscular injections, these are usually given into the pectoral muscles. The recommendation is usually to avoid IM injections into the legs as there is a risk of nerve injury.
IV and IO routes of medication admin administration can also be considered. And with IO we usually use the tibiotarsus or ulna and not the other bones, as many of them are pneumatized, so they connect up with the air sac system. You also cannot give medications into the salamic cavity because there's a high risk of hitting an air sac and drowning the bird.
Another very useful way of giving medications in birds is nebulisation, and there's lots of different drugs we can give via this route, which I'll go through in a moment. And then also, don't forget about topical roots as well. So first up, in terms of what medications may be given in an emergency setting, we're gonna talk about analgesia.
And there's some species variation as to the doses that are recommended. Starting off with opioids, so birds primarily have kappa receptors and therefore butorphenol is commonly used as it's a kappa agonist. It's a short-acting drug, lasting about 2 to 4 hours in most species.
Tramadol might help in some species, although its effects are variable. Non-steroidals like meloxicam and Carpafen are often chosen with meloxicam with meloxicam remaining the most commonly used. And it does seem well tolerated in most birds.
Local anaesthetics like lidocaine and buppivacaine can be effective, but just take care of dosing, especially in small birds, as overdose is a serious risk. Ultimately, do consider a multi multimodal approach tailored to the individual species and clinical situation. Although do bear in mind, because we have very little data on efficacy, it's really important to look at response to treatment and regularly reassess the pain relief given to ensure that it's having the desired impact.
And now on to some of the other medications you may prescribe as part of your emergency treatment. So let's start off with some antibiotics. So infloxacin is one of the few antibiotics that's licenced for use in companion birds, and it can be effective against many gram-negative and some gramme positive organisms.
Comoxaclav can be a good choice for poultry, especially for respiratory and GI infections. However, you often need to give quite high doses to achieve therapeutic levels. Doxycycline is a drug of choice for chlamydia, and we can consider things like metronidazole for anaerobic infections, and then TMPS is licenced for pigeons.
With antifungals, we can use things like nystatin, which is not absorbed from the GI tract and is therefore a good choice for avian gastric yeast. Veronoconazole is highly effective against Aspergillus, and itraconazole can be used in some species, but bear in mind in African greys, they can experience lethal idiosyncratic reactions. With nebulization, this is a really useful tool in avian medicine for getting medications directly into the respiratory tract while minimising systemic effects.
And you can nebulize certain antibiotics, antifungals, bron bronchodilators, mucolytics, and also F10 disinfectant can be used as well, as long as it, as long as you do dilute it appropriately according to the instructions. Now let's talk about fluid therapy in birds, which is critical in emergencies and post anaesthesia care. So for maintenance we work with a general rate of 50 to 100 mL per kg per day depending on the species and the age of the bird.
If your bird patient is recovering from a general anaesthesia or sedation, you often need to give a fluid bonus. So typically 10 to 20 mL per kilo, depending on how they're doing clinically. For fluids, I tend to stick with Hartman's as a good go to option in most cases.
Now, in terms of route of administration for fluids, you have got a few options. So IV access, you can use the basilic or ulnar vein in the wing or the medial metatarsal vein in the leg. The ulnar vein is quite is quite a fragile vein in a lot of birds, but if you're careful, you can place an IV catheter here.
If you're gonna go subcutaneous, I would always tend to go for the prechoral fold. So this fold is a potential space between the abdominal wall and the inner aspect of the thigh in birds, and it's a really useful space for putting in some subcut fluids. In a budgie, you can give 1 to 1.5 mLs in this area, and for bigger birds like a sulphur crested cockatoo, you can put in 15 to 20 mLs here if you need to.
And then for intraosseous access, you can use the tibitarsus or the ulna. So now on to your nutritional support for avian patients. Remember that feeding frequency varies depending on both species and age.
Passerines often need feeding every few hours whilst larger parrots can manage longer intervals and birds of prey may only eat once a day. One golden rule is to avoid drastic diet changes, for example, moving from a seeded based diet to a pelled diet, especially when the bird is unwell. Their gastrointestinal systems are really sensitive and so sudden switches can increase stress or lead to dysbiosis, which may worsen their condition.
So stick to what they know and if a diet change is needed, then transition carefully once they've been stabilised. If the bird isn't eating voluntarily, then we need to provide supplemental feeding using recovery formulas, and there's several different options available, including Harrison's food, critical care formula and the Emirade range. So which one do you use?
Well, it depends greatly on the species. So birds span the full dietary spectrum from seed eaters to meat eaters and everything in between. So be sure to choose an appropriate formulation.
The ERAI website has got a really helpful guide showing how to mix the different formulas to suit the bird to suit the individual bird that's in front of you. And when you do need to support, supportively feed a bird patient, then I would always recommend you calculate the daily volume required to ensure you're providing adequate nutrition. You've also got a few routes to consider.
So oral feeding is a great option if the bird will take food willingly. Syringe feeding can be done too, but be cautious as it does carry a risk of aspiration. And then crop tubing is very effective and it's easy to perform.
So you introduce the crop tube through the mouth, and then I would tense the end of the crop tube up against the crop wall just to check placement, and then slowly introduce the food. Just make sure the food isn't too hot, because crop burns can and do occur, especially in young parrots receiving warmed supplemental feeds. So now we're gonna move on to emergency diagnostics, starting off with some blood tests.
So birds have a blood volume of approximately 10% of their body weight, and many species can tolerate a surprising amount of blood loss. So in healthy birds, signs of hypovolemic shock may not appear until blood loss reaches approximately 40 to 50% of total blood volume. And even unwell birds can often tolerate blood loss of up to 2 to 3% of their body weight, which is roughly equivalent to 10 to 15% of their blood volume.
But that said, always aim to take a little blood as necessary. Thanks to this tolerance, it is often possible to obtain diagnostic volumes even from a very small patient. So for example, in a 60 gramme budgie, 2% of body weight would be 1.2 mL, which is enough blood for several tests.
Always perform the calculation before sampling, so you know the maximum safe volume you could take. And then when collecting blood samples, we use heparin for biochemistry and then either EDTA or heparin for haematology. So EDTA does lise cells in some avian species such as corvids and cranes.
So it's important to be aware of this and use heparin instead in these cases. As for sampling sites, the right jugular vein is preferred in most birds, as it's larger and more developed than the left. The ulnar vein on the wing is another useful site, especially for small volumes, and the medial metatarsal vein on the leg is also very effective, particularly in waterfowl and larger birds.
And once you've collected the blood, apply some pressure to reduce the hematoma development. So now we've got our blood, what tests can we run? So starting with Epoch or ISA.
So these are incredibly useful for rapid patient side diagnostics, and they allow for assessment of things like electrolytes, glucose, calcium and hematocrit, which are all vital for stabilisation and triage. Their low sample volume also makes them ideal for small avian patients, and the real-time results are crucial for guiding urgent treatment decisions. CBC and blood smear, so avian red blood cells and platelets are nucleated which can cause misleading results if you're using a standard haematology machine.
Always pair automated hematologies with a manual smear to assess things like cell morphology, platelet clumping, and also look for blood parasites which are more common in birds than many other species. Biochemistry and electrolytes, so here's where birds really differ from mammals. So urea increases with dehydration, but otherwise offers little clinical value in birds.
Creatinine, not useful. So birds excrete nitrogen as uric acid and not creatinine. Uric acid, much more helpful.
So uric acid can increase with renal compromise, dehydration, and also it does increase post eating, especially in raptors. So if you are working with birds of prey, be sure to fasten them for 12 to 24 hours before sampling to ensure accurate interpretation. AST is sensitive but non-pacific as it increases with liver or muscle damage.
And therefore you need to always interpret it alongside CK. So if CK is elevated, then AST is likely reflecting muscle trauma and not hepatic hepatic pathology. And finally, ionised calcium can spike in breeding females, so don't be alarmed by mild elevations in reproductively active hens.
Now let's move on to imaging. So radiography is often very helpful in avian patients, but it usually requires a general anaesthesia or sedation. So be sure to stabilise the patient as much as possible beforehand.
There are two standard views we typically use. So dorsal ventralral, which is taken with the bird lying on its back with the wings extended laterally, and then a lateral view where the wings are elevated and extended above the body to prevent them being superimposed. Ultrasound can sometimes be a bit challenging in birds due to the presence of the air sacs.
However, it is still a very useful tool and something I would often use in the emergency setting. With ultrasound, you can detect things like ascites and look at the liver, heart, intestine and the kidneys. Plus you can look for eggs as well as shown in this image here.
Birds were made for endoscopy. It is a really useful tool in these patients as the air sacs offer the inflation during a laparoscopy. You can perform oral endoscopy, so have a look at the upper GI tract.
You can do a bronchoscopy, obviously for the respiratory system, and you can also introduce the endoscope into the cloaca, and then you can also obviously do a laparoscopy as well, which is really useful to visualise many of the internal organs with minimal invasive technique. There's also just a few final diagnostics I wanted to mention. So you can learn a lot from a bird about, from just looking at its droppings.
So it's always wise to have a look at some, some bird poo and collect a sample. Bird droppings are made up of three key parts, OK? So you've got the faecal matter, urate, and then a small volume of clear urine.
Remember for birds, they do not have a urinary bladder and they pass that white part of the drop-in which is uric acid. In terms of analysis, we can look at the gross appearance, look for parasites, and also do a cytology and culture. And looking at the drop-ins can also point us towards particular diseases.
So for example, you may see green urate with hepatitis and improved ventricular dilatation disease. Undigested seeds commonly appear in the faeces. There is a lot of PCRs that you can also perform on samples from birds.
So for example, there's PCRs available for a range of different infectious diseases such as Borna virus, sitine beacon feather disease, Aspergillus and herpes virus. There's also some other samples we might take, so things like feather plucks, crop washes, biopsies and FNAs. So even though it's a bird, there is a lot of different diagnostics you could do.
So I do recommend again, stopping and thinking what tests would I do if this was a dog or a cat, as I think that can help to open your mind up as to what tests might also be available for birds. Now moving on to anaesthesia in birds, and so let's start off with some some preoperative considerations. So one of the key risks during anaesthesia in avian patients is regurgitation and aspiration.
So we need to be proactive in minimising that risk. A bird's crop, if it's full, can lead to complications. So always check that the crop is empty prior to induction, and if it's not empty, then you may need to manually empty it.
Starvation times will vary depending on species and size. So for, for a small bird, a short fast for around 1 hour is typically sufficient, and for larger birds, especially those with bigger crops, fasting may need to be extended to up to 8 hours. With raptors, we take a slightly different approach, so they should ideally have cast prior to surgery, and food should be withheld for at least 6 to 12 hours before anaesthesia.
You could also consider offering a casting free meal as a last meal before the GA. Before induction, pre-oxygenation is highly recommended and also consider IV or IO access. Now moving on to sedation and pre-medication.
So always consider analgesia, as discussed earlier, and then we often use midazolam as a first line agent. A fairly common combination to use is butorphenol a midazolam, and an alternative option to consider will be ketamine. However, do bear in mind that GI sorry, GA delirium can be quite common post ketamine.
To induce avian patients, we often consider isoflurane or sevoflurane, and in larger birds, we may need to consider IV induction, so using something like propofol or alfaxan. IV induction is often required in waterfowl with dive reflexes, as they're often breathhold if you're trying to induce using gas. Then on to intubation.
So in birds, the glottis is usually easy to visualise, making intubation relatively straightforward. But we do sometimes need to be inventive with small birds. So consider using things like large bore IV catheters as ET tubes if your ET tubes are too large.
Also note that intubation is often not recommended in the cows, as strictures can develop very readily in this species. And crucially, never use a cuffed endotracheal tube. So birds have complete tracheal rings, so inflating a cuff can cause serious damage to the trachea.
I also just wanted to cover airsat cannulation, as this procedure can be life saving in certain avian cases by offering a very handy bypass route for ventilation. We typically consider air sac cannulation where there's been an obstruction or disease affecting the upper respiratory tract. So indications include things like tracheal foreign bodies, strictures, aspergillus infections, or situations where we need to perform oral or upper respiratory surgery, or even when we're doing a bronchoscopy.
In terms of placement, the bird is positioned in lateral recumbency. And then we aim for a triangular zone bordered by the last rib, the cranial aspect of the thigh, and then the spine dorsally. So this forms our landmark for entry.
You then just need to make a small incision just caudal to the last rib and carefully use forceps to open up the tissue and then introduce the tube into the caudal thoracic air sac. In larger birds, you may choose to cough, you may choose to cuff the tube to help maintain placement and then make sure you secure secure the tube with either sutures or tape. And then these air sat tubes can then be left in place for a number of days if required.
Now let's have a little look at how to monitor a bird under a GA or sedation. So to start with, Doppler devices are incredibly useful for tracking heart rate in birds. If the procedure is prolonged, especially in large species, you'll often need to use a ventilator or provide IPPV.
Birds are particularly vulnerable to hyperventilation under anaesthesia, so active ventilation support becomes essential. Temperature monitoring is another critical piece. So birds have a core body temperature ranging from 39 up to around 42 degrees.
So your probebe must be capable of accurately reading in that range. One of the most common signs of hypothermia in birds is a decreased respiratory rate. So stay alert to subtle changes.
And now moving on to blood pressure, a normal reading is anything above 90, and then with pulse oximetry, most devices obviously aren't calibrated for birds. So I would tend to focus on trends over time rather than exact numbers. And then finally, with haography, it's particularly helpful for confirming obviously ventilation quality.
And in birds, the normal end tidal CO2 range is typically 20 to 40 and a rise in value can indicate hypoventilation or another underlying concern. When it comes to assessing the surgical plane of the GA there's also a few key things to look at. So the muscle tone and cloacal tone should be severely decreased or lost at the surgical plane of the GA.
You can also assess for the disappearance of pain reflexes such as a toe pinch. The rapebril reflex, so the blink response when you touch the periocular area, should also be absent. And then the corneal reflex should persist until a very deep plane of anaesthesia is reached.
So during surgery, it should be sluggish but should never be lost because this would indicate a dangerously deep anaesthesia. Both the repeal and corneal reflex can be easily tested in birds just using a moistened cotton mud. Post anaesthesia, I would always recommend to hold the bird on recovery until it's able to support itself.
So birds can often panic when they wake up from an anaesthesia, and if they start to flap around and fall about, this can really damage their feathers and the wings. So make sure you just say, hold them until they're able to support themselves. Providing oxygen and recovery is also a very good idea.
Next up, let's talk about CPR. So first of all, we think ABC. So air weight, breathing, circulation.
So first up, establish airway support. So a tight fitting face mask is acceptable, but intubation is ideal wherever possible. You then start ventilation, so ideally at a rate that matches the bird's normal resting respiratory rate.
So for many parrots, this means around 20 to 40 breaths per minute, but always adjust this based on the species and size. Next up is cardiac compressions, so these are delivered over the kill. Aim to match the bird's normal heart rate.
However, obviously with small birds, their normal heart rate can be 200 to 300 beats per minute, which you're not gonna be able to achieve. So with these, I aim for around 100 to 120 compressions per minute. If the bird has undergone sedation or anaesthesia, obviously reverse any drugs where possible.
And then also make sure you check the blood glucose as well. So a low glucose is a common issue in small and sick birds. So recognising and treating it can improve your prognosis during a recess effort.
There is some species variation in the dosages of emergency drugs, however, I've put some standard doses of adrenaline and atropine on this slide that you may want to consider. And then euthanasia is also sadly fairly common in avian emergencies. And you generally have two options.
So you can either give pentobarbital intravenously or intracardiac poster sedation. I do prefer to give pentobarbital IV if I can. And I'll either go off the needle or I'll place an IV in the ulnar vein or the medial metatarsal vein and I'll give the pentobarb that way.
With some birds, you may need to give a sedation beforehand to reduce stress, and you can consider either gas sedation or Io or Sio for, for the gas sedation or an injectable sedation such as midazolam or alfaxan. So now let's move on to common avian emergencies. So the first emergency I want to talk about is respiratory disease.
And in birds we can get both infectious and inflammatory respiratory diseases fairly commonly. There are several different infectious causes of respiratory disease, including bacterial disease like mycoplasma, viral conditions like avian influenza, and then also fungal conditions like Aspergillus. And do remember some, with some of these conditions, they are zoonotic, like psittaosis, and then avian flu is obviously notifiable.
Diagnosis requires a multi-modal approach and common investigations include things like radiography to assess the air sac capacity and pulmonary changes, blood work including haematology and biochemistry, PCRs to pinpoint specific pathogens, and endoscopy, which is especially useful in identifying plaques, granulomas or airway obstructions. Treatment always begins with stabilisation. So provide some oxygen, obviously gently warm the patient if they're cold and create a low stress environment.
Then move on to your targeted micro antimicrobials. So based on likely pathogen, clinical signs and diagnostic results. And then finally, don't forget about the power of nebulization.
And you may want to consider medications such as antibiotics, antifungals, and eucalytics, depending on the individual case. And then another important cause of respiratory disease in birds is inflammation. And this is usually triggered by environmental irritants.
So birds are especially sensitive to airborne toxins, and common triggers include overheated Teflon pans, aerosol sprays, air fresheners, and cigarette smoke. Even strong perfumes and cleaning agents, if they use an enclosed room, they can also cause an issue. These irritants can lead to lung congestion, pulmonary edoema and bronchial spasm, which can cause an audible wheezing noise and an increased respiratory effort.
Treatment focuses on supportive care and inflammation control. So oxygen supplementation is vital. Non-steroidal, such as meloxicam can be used for mild inflammation.
You may want to consider tibutyle, which is a bronchodilator, and that can be used off label. And then steroids such as dexamethasone may be indicated in very severe cases, especially where inflammation is acute and infection is unlikely. But do be aware of the potential adverse side effects and risks of steroid administration.
In summary, environmental respiratory disease is preventable and so the key is awareness. So educating clients about avian safe environments can dramatically reduce exposure risk. Now onto hypercalcemia in birds, and this is something we we see surprisingly often, particularly in African grey parrots.
So African greys are especially prone to calcium deficiency, which is largely due to seed-based diets and limited access to UV light. Without proper UV exposure, these birds can't synthesise vitamin D effectively, which is essential for calcium absorption and bone health. So clinical signs may include things like falling off the perch, muscle tremors, seizures, and in female, in breeding female birds, you may also see egg binding as well.
Diagnosis typically involves confirming low ionised calcium levels on bloods, which can be done on an epoch or an ISA. And then treatment focuses on three key pillars. So calcium supplementation using formulations like Zolcal, dietary change, so introducing pelleted foods, or foods rich in calcium.
And then finally, UV light exposure. So either through safe outdoor time or a full spectrum UV lamp placed near the enclosure. Hypocalcemia is a preventable condition.
So with the right husbandry and making sure that the owner is educated around this, you can hopefully avoid this happening with the birds that you see. Now moving on to cloacal prolapses, which are fairly common emergency presentations for birds. The first thing is to identify what's prolapsing.
So possible when possible structures that could come out include the oviduct, especially reproductively active hens, the cloaca itself, the intestinal tract, or in certain species such as ducks, it may be the phallus that prolapses and doesn't go back in due to something like trauma. And do note that non-viable fallacs can be surgically removed as it is purely a reproductive organ, so it can be removed if you need to. Once you've identified the prolapse tissue, stabilisation and reduction come next.
So begin by flushing the tissue gently and assessing its viability. And you can then use cotton buds to carefully guide it back inside the bird. I would then place two interrupted sutures placed at right angles to the vet.
And to help prevent the prolapse. And generally, purse string sutures are not recommended, as there is a worry they can cause nerve damage or compromise the tissue. A useful trick is to place a cotton bud or a syringe casing in larger birds into the cloaca whilst placing the sutures.
Because this ensures you leave a large enough opening for drop-ins to pass through. You also could consider placing a coacal plexi suture to reduce the risk of recurrent prolapse. And this can be performed surgically by entering the synomic cavity and securing the cloaca to the body wall, or alternatively you can do this percutaneously.
So for the percutaneous technique, I use the following trick. So I insert a cotton bud into the cloaca and then I tint it up against the body wall, either on the ventral midline or slightly to one side. Then I passed the suture through the body wall into the lovare and through the cotton bud, and then back out.
Once the suture is in place, I then gently remove the cotton bud. I tease the suture free and then I carefully tighten the suture material, so pulling it back into the bird, and then I place a knot externally on the body wall. Using this technique does confirm that you've gone all the way through the cloacal wall when you're placed in the suture and offers excellent control over placement.
And don't forget, it's really important you treat the underlying cause. So whether it's excessive sexual behaviour, reproductive tract disease like egg binding or chronic diarrhoea, you must address the root issue to reduce the risk of reoccurrence. Now moving on to egg binding.
So, egg bound birds present fairly frequently in practise, especially budgies and cockatiels, which are really prone to excessive egg laying. Clinical signs to watch out for include things like lethargy, a wide-based stance, which is often due to abdominal discomfort. You can get abdominal distension, and then dystonia and tail bobbing can be seen, due to the presence of the egg, basically impairing respiration.
And then you can also see lameness or leg precess, which is due to pressure on the nerves. If you leave this untreated, it can also progress to septic selomitis where the egg ruptures or becomes infected and releases contents into the salamic cavity. In terms of diagnostics, if the egg isn't calcified, you may not see it on a, on an X-ray.
So ultrasound is a very useful alternative in these cases. Treatment may include topical prostaglandin E2 gel applied to the vent, which can stimulate smooth muscle contraction, but oxytocin, in birds should be avoided because it can compromise cardiovascular stability. So say, don't use oxytocin.
In some cases you may see, you may need to collapse the egg as well via a needle aspiration before carefully removing it. And then for chronic or recurrent layers, a Deslorein implant can help manage reproductive drive and reduce future risk. I also wanted to mention about these two toxicities.
So the first one is heavy metal toxicity. So birds are very curious by nature, and they chew on all sorts of things such as cage fittings and toys. And this makes lead and zinc toxicity quite common.
Clinical signs can vary depending on the dose of heavy metal ingested, but typically include things like blindness, convulsions, tremors, recess. They can get vomiting and PUPD and then you can also see haemoglobin urea and anaemia. Diagnosis often begins with radiographs, so you might see the radioaque metal metal particles in the GI tract, and a heavy metal blood panel will also confirm systemic absorption.
Treatment involves supportive care, so fluids, warmth, nutritional support, you can give diazepam if the bird is actively seizuring, and then intramuscular calcium EDTA can be given. So this is a chelating agent to help bind circulating metals. And in some cases, surgical removal of large or persistent fragments of metal may be needed.
And then avocado toxicity. So any part of the avocado fruit is toxic to birds. So whether that's the skin, the flesh, the pit, and even, even the oils.
And it affects the bird by causing heart failure. So in severe cases, especially in small birds, acute death can occur within 10 minutes of ingestion. And in some birds, you can see more of a delayed onset of symptoms, so appearing sort of some 10 to 15 hours later.
And this may include things like anorexia, a fluffed feathers, appearance, dyspnea and subcar edoema. Treatment is supportive only, OK? And it is time critical.
So consider things like IV fluids, activated charcoal, oxygen therapy, and warmth if needed. Avocado ingestion is almost always accidental. So again, client education and giving them things like, say, food lists is really important.
Next up is wounds and trauma management in birds. So, birds are surprisingly prone to injury, from collisions to cage trauma. And the image here shows a bird that got his head strapped in a door, which is, which is sadly not that uncommon.
Traumatised birds often present in shock, so oxygen therapy on arrival is essential. Equally important is analgesia. So, non-steroidals and or opioids should be considered, depending on the clinical picture.
Interestingly, avian skin can heal rapidly as long as the bird isn't interfering with the sight, but some wounds do pose particular challenges. So things like kill injuries, especially split kills, are problematic due to constant motion from respiration and flight, which can cause repetitive trauma and delayed healing. Also, injuries to the stretch of skin between the shoulder and the carpus can also need, it also does need really special attention.
So if you get damage in this area, it can compromise flight long term. So postoperative physiotherapy is really vital. You may want to suture any dressings in place to help prevent slippage, especially in active or anxious birds.
And then for patients that are prone to self trauma, which is most of them, a collar or modified, t-shirt wrap may be needed to protect the wound during recovery. And then as for wound closure, PDS sutures are generally the go to. They're absorbable, strong and well tolerated in delicate avian tissues.
Virall tends to provoke more of an intensive inflammatory response, and staples are also generally not well tolerated in birds. So, let's just talk about bleeding, bleeding blood feathers quickly. So blood feathers are actively growing feathers with a blood-filled shaft, and they're commonly found on the wings and in the tail.
When they are broken, they can cause a surprisingly rapid blood loss, which can be really distressing for both the owner and the bird, and it can look pretty dramatic. The first step is to apply firm pressure to the base of the feather and if available, you can use a clotting agent as well. If the bleeding doesn't stop, you may need to remove the feather, and we do this by pulling it swiftly and cleanly from the base using the appropriate restraint and then apply some pressure afterwards if needed.
After, after you've treated the bleeding feather, it is essential to keep that bird as calm as possible, as stress can restart the bleeding. And so gentle handling and a quiet environment will make a real difference. And now on to wind fractures in birds.
So always start with the basics, so pain relief and appropriate bandaging are essential in the emergency setting. For pectoral girdle and humorous injuries, consider things like body wraps. With the pectoral girdle in birds, this includes a scapular, coracoid, and clavicle.
And together, those bones basically anchor the wing to the body, and through muscular attachment, they enable flight. Damage to this, area does often lead to a drop wing, and it can be catastrophic for birds that rely on flight, such as birds of prey. If the fracture involves humerus, take care during flushing, because that bone can be pneumatized.
For radial and ulnar fractures, a figure of 8 bandage can be a good choice, but it is important to remove and replace bandages every couple of days to allow for gentle physio and also to monitor for pressure sores or displacement. Whilst conservative management can be successful in select cases, surgical fixation is typically the best option because this is most likely to give the best functional outcome for birds that need to regain flight. And then just to finish up today, I wanted to mention about gastrointestinal disease as well, because these diseases can commonly present to the emergency vet.
We will sometimes see birds eating things they shouldn't have. So for example, I once had a chicken patient that came to see me that had eaten a pearl earring. And these sorts of foreign bodies may well need removal via scope or surgery, depending on what it is.
Gastrointestinal upset is also fairly common in birds, so we may see them presenting with things like vomiting, regurgitation, diarrhoea, dehydration, and weight loss. And there's multiple causes for this, including stress and dietary causes. But remember, there's multiple infectious causes too.
We can see bacterial diseases, so things like mycobacterium, we can see yeasts, so things like avian gastric yeast, which is seen in lots of budgies. We can also see viral diseases like PD PDD, so proventricular dilatation disease, which you can see in this X-ray. So with PDD, The proventriculous basically becomes enlarged due to degeneration of the ganglia, leading to vomiting, regurge, weight loss, and undigested seed passing in the faeces.
Although in the emergency setting, you won't necessarily be doing a full work up on these cases, it will be important to at least offer emergency supportive care. So consider things like fluid therapy, antimicrobials if indicated, nutritional support, and of course nursing care. So, many thanks for your time today and I hope that's been useful.