Hello, everyone. My name is Katherine Pleasenberry. I'm the head of the Avian and exotic Pet Service at the Animal Medical centre in New York.

I'm also the chief medical officer. I'm gonna talk to you today about the basics of emergency and critical care and companion birds, principles and techniques. We're gonna, we're gonna talk about these techniques and then we're gonna get into some of the basic common disease presentations.

Obviously, I can't discuss every presentation of an emergency case, but I'm gonna try to cover the most common presentations. So we're gonna start off talking about defining what is an avian emergency, and this is really questions to ask your client, the breeder, whoever's bringing the bird in or, or calling you by telephone. Has the bird stopped eating or drinking?

Is the bird bleeding or did it experience trauma? Is the bird breathing abnormally? Is the bird not moving or on the bottom of the cage?

Is the bird straining to lay an egg? If the answer to any of these questions are yes, then we do consider this an emergency. So what is the approach to the critical avian patient?

We do do a triage just like you would in any small mammal. But in birds, it, it's slightly different because what we're first doing is visually assessing the bird. We're looking at it in its carrier, in its cage, and we want to see if there's any evidence of respiratory distress, watching the way it's breathing, if it's tail bobbing.

We want to see if there's any evidence of weakness. Is the bird hanging onto the side of the cage with its beak? Is it, is it leaning on the side?

Any evidence of trauma, blood, or wounds? If you can visually assess that there's abdominal enlargement, and then we do triage, and the basics of triage probably in the beginning are oxygen. A warmth in an incubator and fluids.

While you're doing this visual assessment, you wanna obtain a brief history while assessing the bird. So it's a you can do it in a detailed history later, but you're just trying to get an idea of what's going on so you can focus on the bird. And before, during and after any sort of triage with a critical patient, you wanna be upfront with the client on how the bird looks.

If you're concerned that it could die acutely because some birds certainly are so severe when they are brought in that they could die just from the handling of the bird distress and handling. What to assess on the visual exam, you want to look at the breathing pattern of the bird, you want to look for any evidence of trauma on the bird. You want to look at the character of the droppings, you want to see if there's any evidence of blood, any evidence of hematuria.

Polyuria, if the droppings appear scant if the bird's not been eating, or if the droppings appear very dry, and that would be an indication that there is the bird's not drinking and could be dehydrated. So in this photo we see there's evidence of frank blood here, but there's also evidence of hematuria, this little pink spot around the dropping. So those are two different things to look at in this, in this cage.

So you're getting an idea of that. And then during your initial triage, you're going to want to provide oxygen as needed if certainly if the bird is having respiratory difficulty, and oxygen cage before you do anything would be advised. Whether or not you put the bird in an incubator, if it's very, very, it appears very unstable, providing heat, and the initial treatments generally consists of some type of fluids, subcutaneous fluids or bolus IV fluids as needed, any type of pain medication if the bird has experienced trauma.

Or if there's indication of bite wounds or any indication of, of possible infection, you wanna probably provide antibiotics. So on your initial examination in a critical bird, and this is after you've done your triage, you want to assess the body condition score, you want to see if the bird appears thin, you want to palpate over the keel, see if the birds, if the bird's thin, it's been sick for a long time usually. You wanna check to see if the crop is full or empty, so you're palpating here at the base of the neck.

You wanna check for any obvious signs of bleeding or trauma. And while you're doing this, you really need to pay attention to the bird's breathing. And it's always a good idea if you can to use oxygen flow by as we're doing here, providing oxygen face masks because we're doing an exam on this bird.

You wanna set the mucous membrane colour. It's, it's, that will tell you a couple of things. It will tell you if the bird appears anaemic, so you wanna look in the back of the oropharynx.

It's a good place to look in a Citizen bird, and also the conjuncti of it. The bird appears very pale, the conjunct type of feels pale, or the mucus or the oral cavity feels appears pale. This bird could be very anaemic.

Auscultation is important. Birds do, especially, birds as they age, do have a high incidence of cardiac disease we're finding. So you wanna make sure you cult for any evidence of arrhythmias, a heart murmur, and you also want to cult the heart rate if the bird appears bradycardic, if the bird appears tachycardic.

Now, heart rates in birds can vary tremendously from You know, 100 to 400, but in general, if you have very high rapid heart rates in a bird that presents on emergency, then That their blood pressure is dropping their tachycardic. We also wanna also listen for any evidence of the air sac rubs, and that sounds kind of like two pieces of sandpaper that are rubbing against each other. And that will tell you that perhaps there's an abdominal mass in there, that there's something in there that's causing this rub that you shouldn't be hearing.

So what toes on physical exam, you wanna look at the head, you wanna see if there's any evidence of trauma, you wanna check the eyes, if there's any evidence of swelling or femur, of course, the beak, you're sculpting the birds, you're checking the abdomen for any sort of mass effect. Check the wings and the legs for any evidence of fracture or masses or abnormal joints. You wanna look at the neurologic status.

Is the bird dull? Can it stand up? Can it, does it fall over?

Is it knuckling like in this bird, bird is standing abnormally, so that tells you there's something wrong, usually neurologically with the bird, and also check the feathers, make sure there's no blood feathers, cuts, bruising, or abrasions on the bird. Hydration and profusion can be a little tricky to assess if you're just getting used to treating birds because we can't use the same parameters that we would in a dog or cat. You can look at the mucous membrane moisture, but that's really difficult to assess in most birds because they don't produce a lot of saliva like they do, like small mammals.

You can look at the skin trigger and colour, and that's a really good indication the cause, for example. People will have sometimes when you can see the skin on their facial area, the skin may appear very, the, the underlying tissues may appear dark red instead of nice kind of painful fleshy colour. The skin, if you raise the conjunctiva, the conjunctiva can tent instead of falling back into the place and also the position of the eyes, birds that are very dehydrated sometimes have the appearance of the sunken eye.

Assessing profusion also is difficult in birds sometimes you can look at their mucus membrane colours we looked at before. You can use the venous refill time of, for instance, the basilic vein, the wing vein to see if that refills, normally. Again, listening to the heart to see if the bird is tachycardic.

Blood pressure, is difficult to assess in birds. This was a study that was done, back in 2011. It's probably one of the, few studies that have been done in birds looking at measurement of blood pressure, and basically what it found is that the blood pressure measurement in birds in conscious citizen in birds has very poor precision.

In this study, they use both the wing and the leg to for cup placement. They measured the blood pressure by Doppler of the basilic vein or the cranial tibial artery, and what they found was the blood pressure measurements vary significantly between the cuff place placements on the same limb from the same bird and also among individual birds. And the difference was quite dramatic, from anywhere from 3 to 113 millimetres of mercury.

So basically, it, it tells us that even in the same individual bird, you can get a very different measurement of blood pressure even with the cup placed at the same site. So at the most we can just use rely on blood pressure to maybe provide us with trends, more than anything else. So the routes of fluid administration, subcutaneous fluids, intravenous fluids, IV catheters, or IO catheters, these are all used to different extents, and the, the choice in choosing the route really depends on the, the clinical status of the bird.

Is it mobile, is it moving around? Is it fairly alert versus if it's really depressed, not reactive. The severity of the dehydration, is it in shock, and the stress tolerance of the bird and, and what you have to do to, for instance, place an IV catheter or an intraosseous catheter.

So subcutaneous fluids are used for the most part initially. This is done usually in the lateral front flank area under the wings. We use a 25 gauge needle.

You want to keep that needle parallel to the body wall because of course if you don't, if you go in more perpendicular, you can accidentally perforate the air sacs, and that would result in immediate death, drowning death of the bird. So very important to stay parallel to the body wall. You want to divide it into two or more sites, just until you get a nice bubble, and then if you're using subcutaneous fluids, for a long time, over time you can get some cooling in the ventral abdominal area, especially if an animal is hyperpronemic, so you may want to change your fluid administration, in those cases to more oral, but at least in the initial stages, subcutaneous fluids are, are certainly the first line, that you pick.

IV bolus is used in really, really debilitated birds, birds that come in in shock. These birds you want to use a 25 gauge butterfly catheter or in a small syringe. You would pick which vein you use depending on the species of the bird, for instance, its most likely you're gonna use a jugular vein, for answerriforms or raptors, you may want to use a brachial vein or a leg vein.

You want to prepare all your fluids beforehand and then you want to give the slow bowl of of fluids over about 5 to 15 minutes. So this is showing of course the site for an IV fluid bolus in the jugular vein of this cockatoo, here in this bird we're showing a wing vein here and this vein is a little trickier to use in the smaller species because you can get quite a significant haemorrhage, after you use this vein. The IV catheter really the use depends on the presentation and the initial triage.

IV catheters, of course, are very difficult to place in small birds. It usually requires sedation to place in almost any siting birds, not in in other species, but siting birds it does. And this sedation could be just a, a, a little touch of midazolam, for instance.

But if you do place an IV catheter in a bird, it does require continuous monitoring, particularly in Citize birds, that use their be form raptors. My metatarsal vein is the most common site initizeine birds for placing an IV catheter, certainly in that are 300 grammes and up in size. Some people use a jugular vein.

I don't use the jugular vein cast, because I think it's a little bit too risky in my hands to do that, and you definitely have to have continuous monitoring if you can use a jugular vein cap. Intraosteocasts are used quite successfully by many people, certainly in the initial stages. This is from, illustrations from Brian Spear's book, Current Therapy in Avian Medicine and Surgery, and here you can see the technique for placing the intraosseous catheter in the ulna or in the tibial tarsus.

So either some people prefer the ulna, some people prefer the tibial tartarsus, it's really personal preference, which, which bone that you use. Example of placing inosseous catheter, you have a bird that usually wanna do this either with sedation or with local anaesthetic or both. So you're, you're cleaning the area on the distal radius and ulna here.

You're gonna palpate that site which is lateral. You can feel sort of a little lip of the bone of the ulna and you're going to just kind of, here we're using a bone marrow needle because it's got a nice stylet in there. So we're going into the bone, it should pop right in, and then here you have it, you can flush it with fluids to make sure that you're in the correct spot.

Same thing in the tibial tarsus. You're gonna clean the area, you're gonna palpate the area, and then you're gonna place your intraosteo catheter and flush to make sure that you're in the correct area. So what is the shock fluid therapy?

It's hard to remember this when you're in an emergency situation, but just kind of keep the number 3 in your head. So if you're using hypertonic saline, which we use for head trauma, neurologic, conditions, anywhere from 3 to 7%, you're going to, use 3 to 4 mL per kilo, IV bos over 10 minutes. If you're using head of starch or bed starch.

Then you want to use again 3Ls per kilo as a bolus. If you're using a combination, a 1 to 1 combination, you can use that as well at the initial bolus of 3D miles per kilo. You wanna follow with crystalloids, In shock therapy again with Ebola's 5 to 10 mL per kilo and you wanna administer this over 3 to 5 minutes and then you want to stabilise the patient with heat in an incubator, force air warmer, whatever you have, and then of course if you need to repeat the fluid.

Maintenance fluid therapy, with crystalloids, we wanna make sure the fluids are warmed, maintenance that most people use is about 150 mL per kg per day and that seems to work well for most citizen birds, . Again, with subcu fluids, you can either give it as one treatment or divide it 2 to 3 times a day. If you're using a CRI rate continuous rate infusion, it works out about 2 mL per kg per hour.

So what are the initial diagnostic steps you might choose to use in an emergency situation? You may want to use an initial PCV, or glucose, it's a young bird. So here I would probably, if I'm suspicious of anaemia, if I'm suspicious that the bird is showing neurologic signs because it's, it's hypoglycemic.

Then I would, you know, obtain a blood sample. You can clip a nail for this, if you wanna save your veins and just do an initial PC and glucose and see where you're at. We do a lot of what we call standing dorsodental radiographs, and this is just a quick, quick and dirty, radiograph to see, just give us an idea of what's going on with the bird.

And for instance in this DV radiograph you can see that this bird ingested some metal particles, these bright particles here in the gizzard, so we can get a good idea that this could be some sort of toxicity, right. In the get go, and this does not require sedation, we just put the bird in a plexiglass box or something to that the bird will stand in and, and we can get this quick radiograph. It's not good for assessing lungs or anything like that.

It's just a quick, quick, easy way to see if there's something, an egg or something in there. And then of course, an abdominal ultrasound and that depends on the stress tolerance of the bird. You really want to take a blood sample in initial stages only if the bird is stable, only if the bird is anaemic.

You don't want to stress the bird that you're afraid that could die just from the handling for a blood sample. So again, checking for anaemia, sometimes we just check a quick, . Heel volume by doing a quick nail clip, you always want to check it in a critical bird before obtaining a blood sample because you don't want to take a blood sample from you know, 100 gramme bird with a PCV 15.

You don't wanna just jump in and take a blood sample for our chemistry, analysis. So here's our the containers that you can use just for a quick standing dorsoventral a radiograph give you an idea of what's going on in the bird. Blood collection, this is pretty basic, but where you're gonna get it from either the jugular vein, the metatarsal vein, the wing vein, nobody really uses a toenail clip anymore.

It's painful for the bird to put a nail to get a blood sample, so you don't want to do that except in in obtaining a quick cap of volume. So it's really those, three veins that we use most commonly in birds. So again, obtaining a blood sample from the jugular vein here, different techniques.

Some people use two people holder and then the person obtaining the sample, some people do it one-handed, the, the, wing vein or the basilic vein again depends on the species and citizen birds, we don't use it that much, but in other species it's used quite commonly. And the metatarsal vein is also a really good, . Veins use, particularly in birds that are larger, 300, 350 grammes and up, usually they have quite a decent, metatarsal vein.

Of course, in all these veins you want to use a small gauge needle, in a small syringe, you don't want the vein to collapse, so minimum 25 gauge, usually 26, 27 gauge needle in these small veins, at least not in the jugular. So initial supportive care, we've talked about heat, we've talked about pain medication and antibiotics, gauge feeding depending on the status of the birds. Some birds is in a situation where they can't, tolerate gaage feeding, but you certainly don't want a bird to go very long without eating, so you wanna provide geage feeding as soon as the bird you think can tolerate.

The feeding for the feeding, there's many commercial, formulas available now. Hopefully there are, similar formulas that are available all over the world, but in the US we have, Harrison's recovery formula, Era omnivore or carnivore, depending on the species, some, if you don't have those, you can use hand feeding formulas. The first two formulas are formulated for easy absorption.

Usually they have some component of glucose or rose in them. And then, protein, easily digestible protein. You want to feed in 2 to 3 times a day at the end of treatments, always feed last, so the bird doesn't regurgitate while you're feeding it.

And of course you want to feed reduced amounts, especially if the bird is weakened because of the risk of regurgitation. Pain medication, again depends on the situation that the bird is in, but the pain medications we most commonly use are meloxicam. The standard dose of 1 mg per kg, I am so you wanna avoid it and really dehydrated or shocking patients until you know the renal function, if the uric acid is high or if it's really dehydrated.

That being said, we've rarely, seen any direct injury to the kidneys using meloxicam, appropriate for traumatic injuries in hydrated patients. Borphinol is a great drug. The problem with borphinol, it's got a very short half-life.

It only lasts for 1 or 2 hours, so it doesn't provide us with long-term care, like meloxicam. Buprenorphine has been, there's been a lot more research on the use of buprenorphine recently, and it is shown to be effective in some birds of prey. It's a new opioid receptor agonist.

The reason it sort of fell out of favour was many years ago, but then the research showed that at least in the pigeon that most of the receptors, the opioid receptors are kappa. What we don't know is that in, other species they have on you, so it's really dependent on the species. The good thing about the buprenorphine SR is that.

It does last a longer period of time. Antibiotics really, some people at the, you know, whenever a bird comes in, they put them on antibiotics. I'm more of the, the, in the, in the group that only uses an antibiotic if I feel like it's indicated.

So if there's any suspicion of an infectious disease, if you have a bite wound or if there's contaminated wounds where you're worried about infections, and of course, you want to use an antibiotics. But it's not in all cases and certainly in emergency situations, you want to use a parental route of administration. Sedation of critical avian patients, we wanna avoid that if at all possible.

It depends on the situation. Sometimes it's necessary in fractious birds that don't want to be held for a period of time. The most common and easily used, sedative is midazolam.

And you can use it at a dose of 1 to 2 mg per kid. You can give it IM, you can give it intranasal, you can give it in. Usually we use it either IM or intranasal.

And then, of course, it is reversible with lunazinol. So that's great. You can do what you need to do.

You can use it with eorinol if you want to get a higher degree of sedation. Borpinol, will, add in a more sedative quality as well, provide pain medication. And then of course you can use local anaesthetics too, so you can sedate a bird, use a local if you're putting in a catheter or whatever you need to do, use a local.

Inha an anaesthesia, depends on the situation. You can certainly provide an inhalant, but it's certainly risky in critical cases and you would want to intubate if it's a longer procedure. Blood transfusion in birds really depends on the indication.

If the PCD is greater than 20, usually transfusion is not necessary. If it's between 15 and 20, it really depends on the case. Birds are pretty good at regenerating their blood red blood cells very, very quickly.

If the PCV is less than 15, then I. I would say transfusion is indicated. The problem with transfusion is, of course, you have to for it to be effective, you want to use the same species because if you use a different species, like a pigeon to a parrot, those red blood cells are not gonna last very long.

It may get you through the initial 24 hours, but it's not gonna last much longer than that. For blood transfusion, you collect from the donor bird, usually you have to collect it with some sort of anaesthetic. You want to measure the Paxil volume in the donor bird, so the volume that you take from the donor bird really is probably about maximum of 10% of the total blood volume.

So when you estimate the total blood volume is about 10% of the body weight, so you're taking about 1% of the body weight is the maximum safe. Of course, a smaller volume is usually safer. It depends on what bo donor bird you have.

You want to collect it into a syringe with an anticoagulant, acid citrate dextrose, the ratio of 1 part ACD to 9 parts blood, and then you want to use a microfilter when you're administering this into the recipient bird. CPR seconds really counts. CPR, they're, they're, now, of course, in small animals there the recovered guidelines that give you, a pretty clear, path of how to do CPR.

But the main thing in birds is remember you want to give many cardiac compressions, 100 to 200 compressions per minute. You want to provide oxygen by a face mask or if you can, if you have time. Get a tube in the bird and anytime you're doing a procedure in a bird that's really critical, you wanna have your emergency birds ready, you wanna have your tube ready to intubate whenever this if the situation arises where the bird goes into cardiorespiratory arrest and then of course ventilation.

So, . It does work in birds, CPR you can bring birds back, but, contrast to many thoughts. So, it is good to at least try it, in, in many situations.

Venous access, as we talked about is the wing vein, the jugular vein, intraosteous vein. And then your fluid bow was 3 to 5 mL per kilo, epinephrine doses 0.01 in small mammals, that's the dose, but up in birds you can go up to, it's been published up to 0.1 mg per kilo, IV or IO.

And then at the pain So the focus of emergency and critical care in birds is to stabilise the bird initially. You want to form your diagnostic rule out. You want to plan your steps in the diagnosis and treatment depending always on the stress tolerance of the birds.

The result, of course, if you want to have a bird. Alive at the end, so you don't want the bird to die with your handling or what you're trying to do to get to a diagnosis. You want to really focus on the bird and do what you're doing step wise to make sure that the bird doesn't, pass just from what you're trying to do.

So we're gonna start talking about some common emergency presentations that in the beginning, there's no way I can cover all the common emergency presentations nor the the in-depth care of each bird, but I'm just gonna try to touch on some common presentations that certainly we see at the Animal Medical centre in birds that come in. So, of course, fractures are a very common presentation in birds, leg fractures, wing fractures, toe fractures, could be anywhere. If it's a leg fracture, the tibial tarsus is usually the most common, and when you think about it, it makes the most sense because the femur, at least in most birds, is really closely attached to the body wall, and there's a lot of muscle mass around it.

It's not where it's not exposed, like in a dog or a cat. Whereas the tibial tarsus, you know, it's, it's fully away from the body. They can get, they commonly snap this bone when, they get their legs caught in something that's the bone that's gonna snap, and certainly in peering birds, it's a the tibialtarsal bone can be very, very long, so that's the bone that snaps most commonly.

Usually a femoral fracture is result of a force, a blunt force trauma. The bird falls, birds hit with something, and that's how they fracture the femur. Wing fractures, again, depends on what it is.

Radius and ulnar fractures are common. Humeral fractures again, they can break their humerus just from getting their wing caught or blunt force trauma. Metacarpal fractures, can occur from trauma, and then digit injuries they get their feet caught in something or bite wounds can cause digit injury.

The initial treatment are leg fractures. Really depends on the species and the size of the bird. So if it's a tarsus, you can sometimes, oftentimes put on a lateral sprint.

And again, I'm only talking here about the initial phases. I'm not talking about the eventual repair, which may be surgery repair. I'm just talking about the initial emergency presentation.

So the tibial tarsal fracture, you definitely want to stabilise that fracture. And sometimes that's all you need to do. You don't need to do surgery in many species.

A leg splint is, is great. A tape splint is really size dependent on the bird. Femur usually we say no splint because any splint that you put on, is going to cause, weight and cause that, .

Usually cause the fracture to displace. So we would say in, in a bird, a femoral fracture, usually you just put them in a small cage, cage dress, and usually you wanna repair these surgically. Sometimes they heal on their own.

So leg fractures, leg splints of a tibial tarsal, metatarsal fracture, there's a great, people out a couple of years ago looking at leg fracture repairs and small birds and basically showing that birds that are less than 200 grammes, a tape splint works really well. And, generally healing is about 3 weeks. You just want to check it probably in a week or 2 weeks.

I wouldn't take off the tape splint unless it's, it's . Loose, you just want to check to make sure there's no swelling, the toes are OK and stuff, but you would not replace the splint. So you put the splint on, leave it on, and generally it heals in about 3 weeks.

Birds over 200 grammes, you might want to use something else. Take splints usually is not strong enough for those birds, so you want to use something like vet bite or orthoplast, which I'll show you maybe called different. Name and other countries, and those split materials you can mould in the shape of the leg, you may or may not need a collar in any of these.

Usually we try to avoid collars if we, if we can. I think if a bird's got a broken leg and you put a collar on it, it really kind of is a double whammy and the bird doesn't get around very well. Some cases you have to use a collar if the birds are really on the leg.

Surgical repair, of course, may be necessary. So to put on initial tape splints, many of you know how to do this, but just to go over it, there's good indicate, good instruction if you go to Lefever vet, they have great videos on how to do a lot of these things. So a leg splint, you want to remove any feathers that are gonna cause issues with placing the splint on the leg.

You wanna make sure you put your layers on. You just kind of put layer and layer sort of butterfly, and then you cut the layers to mould to the shape of the leg. You want to put that normal angle in the leg, so the bird can perch, and you also want to usually take the the foot out there with a stirrup or even a more broader stirrup that makes the toes stand out flat because usually at least in the initial phases, they don't have neurologic control of their toes, and their toes tend to curl, so as the leg heals, they will regain function of their toes.

Usually, so you wanna just make it so the toes are out flat. So you just clamp that down close to the leg, make it as tight as possible, and that works really well. And again, here's the indication.

And again, a lot of times I will just put a piece of tape around these toes, tape it up to the splint here to keep those front toes forward and sometimes even the back to back, the front toes for you. Tibial tarsal fractures and larger birds, you want to use some sort of splinting material. These are two, the vet light which you've seen it's kind of a netting.

The thing about this is that it's very easy to use. You can put it in a warm water. If you mould it to the size that you or the shape that you need to cut it.

You can remould it, put it back in the water, remould it if it's not fitting well. And the, the other is like this orthoplastic material which is a harder plastic. It doesn't move quite as easily, but it's I think a little, you know, it's a good thing to use in some birds and again, you wanna put it up as high as you can on the leg, of course you have cast pattern beneath this with the lateral splint, shape it to the sides of the leg and how the leg with the bird would stand normally with a little.

Bump here so the bird can put pressure on his feet and not on his leg, and also to keep the toes open. Wing fractures, stabilising the wing fracture in the bird, radius and the ulna and metacarpal fractures, you want to use for the most part of the great bandage, humerus, shoulder, cor cord fractures, you probably wanna use more of a body wrap. So again, on the theme of that, there's some really good videos on how to place a figure 8 bandage.

But the basics of this are that you just, shape the wing so it's in contraction and then you start placing the bandage around the upper part of the wing and then around the lower part of the wing and you go back and forth and your 8 until you get a nice bandage here and for. The vagus ulnar fracture or metacarpal fracture, this is all you need to do because it's secured to the humerus sphere. So that's a good way to initially stabilise the radius ulnar.

If you have to go around the, the, if it's a funeral fracture, we want to provide some support around the body, so you would do some sort of body wrap with a piece of tape or something to, to keep the wound closer to the body. For toe injuries, usually you just want to do some sort of, wrap, including the you wanna include the usually the carcinotic parts at the joint. You wanna allow the soft tissues to declare because a lot of times in these toe injuries you don't know what's dead, what's not dead.

So, you have to continue a bandages until you get a good idea. Sometimes with severe toe injuries you do end up And so Again, another examples of toe wraps here in a bird, what we do for toe injuries a lot of times is use a dental film because it gives us a really good view of the Bones in the toes much better than you would get on a radiograph so we can see very clearly if there's any toe injuries or bone injuries in the toes. So if you have a dental radiograph, I would encourage you to use that for looking at small bird toe injuries and, leg injury.

Self-mutilation and trauma we see is very common in these very social birds, the cocktoons, the condors and the parrots. What initiates this can be extremely variable the social lack of stimulation, lack of grooming, mutual grooming between different birds. It could be a bacterial infection.

It could be some other noxious agent on the leg, but these birds come in sometimes in very severe conditions where they just mutilate all parts of your body. So the main, the two main points here are to treat the wounds but also prevent the birds from getting access. So, different things you can do, you can use psychotropic drugs in some species, things like alperidol works, pain medication.

Gabapentin works well in some birds and also has a quite, depending on the dose of sedative quality to it. So gabapentin can be used quite successful in some of these birds. Meloxicam, of course, if you're treating pain and inflammation, and then if you suspect there's a hormonal component to it, you can use withroli acetate.

And then of course a collar and a bandage, collars may or may not be necessary. Bandages usually definitely necessary. You can't just leave these open like this cause a lot of times they don't heal.

You have to put some sort of hydrophilic dressing usually on these to get them to heal. So prevention of further mutilation, the collar, you can use a flat or a cone collar. Sometimes these birds require quite elaborate collars, sometimes we use a flat collar with like this.

This one is slightly bent, sometimes you have to put a little neck extension, so it really depends on the bird, what type of collar is gonna work, and then some sort of bandage the wound covering, you can see this bird had a bandage and . And didn't have a collar and just she wiped through the bandage, a sort of a ball bandage in the cockatoo. So different types of wound dressing material work well.

We usually use some sort of hydrophilic bandage. So these are products that are available that we use, people use other products. I like to use the silver sword which has a silver antimicrobial and means that are potentially infected.

The good thing about these is you can leave them on for 5 to 7 days. Duoderm is also really good, and this is a great hydrophilic dressing. You get it in extra thin.

Some people use manuka honey dressings, and those can be left on for variable periods of time. Sometimes they have to be changed every day. So it just depends on the bird and how often you need to change the wound.

You can use various things. This is using Ioan to keep the bandage on. So it depends on, you know, where the wound is in the body, what you would use to keep the wound dressing in place.

We just recently had a case where we use a codfish skin graft which are available now for companies and this work really well. This is a non-healing wound in a bird and we use the codfish skin and that is healed up after months of not healing, use the codfish skin on the wound and it healed up within about 3 or 4 weeks. So I'll just throw that out there for you.

Dog bite, cat bite, and injuries or scratch injuries. A lot of times these birds present either in shock or they're, they're perfectly fine and you don't even know that something happened. So you want to really examine all areas of the body for any sort of puncture wounds, because sometimes, especially with cat bites, you don't see these cat bites are usually puncture wounds where dog bites are usually a combination of puncture and crushing injuries.

So internal injuries are a problem, that you look for with dog bite wounds. Deep infections may develop days after the injuries, especially with cat bites and scratch injuries. So you wanna make sure with cat bite injuries that you put that bird on a broad spectrum antibiotic.

I usually use lavanoxin and refloxacin together in cat bite injury. Some of these, of course, are very severe, and, either you treat for shock and you have to amputate or, you know, in some cases like in this, usually euthanasia may be indicated, because of the tissue necrosis in these cases. Bird aggression, trauma, this is bird to bird aggression, like in this little parrot that was the leg was bitten off by, usually it's a big bird, little bird type situation.

Birds, of course, most of you know do quite well with only one leg. They get around OK, and this one healed up quite well just with me. Big trauma is another common thing that we see.

This can occur from many different things. Animals can be stepped on, they can be slammed in the door. It can be usually a big bird, little birds type situation where one bird fights the the beat off, usually the top beat of another bird, .

If it's the upper beak, usually we say it's a more guarded prognosis. It really depends on how severe it is and if the bird can mechanically eat. So how much of the, the beak is affected.

It's the lower beak, prognosis is fair, good to fair, depending on again, if the bird can eat. Going to eat well and they can. The good thing about the lower beak is they can use their tongue against their upper beak to for him food so it doesn't affect them quite so much in prehension as it would if it was the upper beak.

So you want to use small pellets or crumbles or mash and have the owners use some sort of hand feeding them. Head trauma, that's usually from an impact injury. The bird flies into a window, a ceiling fan.

A lot of these birds have some sort of concussion, you think. Eye injuries are common, so again, you wanna treat these birds usually for with hypertonic saline if you suspect a traumatic brain injury, and then of course, treat the trauma. This bird be treated with a hydrophilic dressing and that healed up quite well in about 3 or 4 weeks.

So impact injuries to the head. Hypertonic saline, you want to give at least one dose of slow I Ebolas. Make sure the animals are hydrated.

That's very important. You wanna assess the eyes for evidence of hyema or ulcers, supportive care, NSAIDs, only if you don't suspect, continuing haemorrhage, but you can use them for inflammation and pain, if the eyes are affected, topical ophthalmic medications and then manage the wounds. Bird comes in for signs of haemorrhage.

The first thing you wanna look at is evidence of a blood feather. That's the most common injury. A lot of these birds that are wing clipped, sometimes very severely wing clipped.

They are the most common ones that have the blood feather injuries. So you just need to find the blood feathers. A lot of times by the time they're in they're not bleeding anymore, but you might, probably in most situations, you wanna go ahead and pull that blood feather and apply direct pressure to, to keep it from bleeding.

So again, trauma, a blood feather. A lot of times they'll have injury to the tip of their feet, or blood in the droppings. If there's blood in the droppings, you think about other things.

The most common thing, of course, is acute lead poisoning can just result in blood in the droppings or it can be hematuria. If there's a papilloma in the, in the vent area of the bird, the birds can be bleeding directly from the papilloma. If the bird is egg bound, they can be bleeding.

Or if it's a dietary, sometimes there's dyes in the food and that will cause it to look like there's blood in the drops, but not really. Bleeding disorders we don't really see in birds. I've only seen one bird where I thought it had a bleeding disorder.

That bird was on a high dose of of I ferberro for quite a while, and that bird developed what we think was a bleeding disorder. Iiatrogenic, of course, the venna puncture. Anytime you do a veal puncture, especially in a small bird, you risk, causing severe injury to the bird or even death if the bird continues to bleed for for these situations, the main thing you wanna do is apply some sort of pressure if it's a .

From being a puncture. So control of haemorrhage, if it's a nail, you can use silver nitrate or stop with powder. If it's a big tip trauma, you can use silver nitrate.

You want to make sure the bird doesn't grab the silver nitrate, and you pull it out of your hands. If it's a blood feather. Mhm.

If it's a blood feather, you want to pull that broken blood feather, apply direct pressure, and sometimes you have to apply direct pressure for quite a period of time. It could be 5 or 10 minutes. You could use something like hema block, which is a hemostatic agent that's safe to use on the skin.

You don't want to apply silver nitrate to the skin, and I would also tell you to not apply so powder to an open skin wound because that can. Also cause irritation. I've seen that happen and cause severe irritation to the skin.

So for a skin injury, it's best to apply some sort of, safe, hemolo agent or most commonly just direct pressure. If it's iatrogenic again, the most common thing is to just apply direct pressure for 5 to 30 minutes, and I certainly put direct pressure on bleeding jugular veins for 25 to 30 minutes of birds. If it's a toe injury, compression bands usually work quite well in these situations.

So we're gonna move on to respiratory distress. We'll try to get through some of this, respiratory distress, we look at exposure to airborne toxins. You wanna know about the onset and the progression of signs of respiratory distress, any other signs of illness, are there other birds in the household, what the diet is, and also what the reproductive history is.

So severe respiratory distress, you wanna look for tail bob and small birds, open mouth breathing, expansion of the intraorbital sinus, pronounced sternal expansion, because that means the bird is working hard if the sternum is going up and down and up and down, . Respiratory noise if the bird is staying on the cage floor or ruffled feathers which are a general sign of illness. So the respiratory exam, distress, your physical exam can exacerbate the sign.

So you really wanna minimise it. You wanna use an oxygen mask or flow by, and you wanna put it down the minute you find the bird is becoming more disney. You've got to put it down.

You wanna check the oral cavity and make sure there's nothing in the oral cavity that is causing the respiratory distress. You wanna inspect the Marys. And you want to palpate the abdomen to make sure it's not an extra abdominal cause of respiratory distress and the skulking the bird as we talked about earlier.

So this is an example, a radiograph of a bird with an extra res respiratory system signed with distress. This is a love bird with reproductive history and basically there's no visible, air sex space left, so this bird is gonna exhibit signs of respiratory distress even though the respiratory tract itself is not is not involved. So the diagnostic approach to respiratory distress.

You can do your box shot radiograph or positioned radiograph if you feel comfortable, using anaesthesia or doing it just with manual restraints and providing oxygen. The problem with Radiographs is they don't give us the same information that we now can get with a standing CT or sedated CT. So for the respiratory disorders that we see, we always use this CT and that gives us so much information about the respiratory system.

If you look at my other lecture on diagnostic imaging, there will be some information in there. So if it's an abdominal mass or fluid, you can just aspirate the fluid in the abdomen and remove the fluid and that will, Provide some relief. If it's tracheal, if there's a tracheal obstruction, then you wanna place an airsect tube before you start diagnostic workup.

This is an example of a bird with a reproductive. Issue, got a lot of fluid in its abdomen, and there you wanna, if you're gonna aspirate the fluid, from an enlarged, abdomen like this, you can certainly do an ultrasound to see what it is, but anytime you aspirate, you wanna stay right on midline because over here or over here you're gonna get to the caudal abdominal or the caudal thoracic or abdominal sacs. So you wanna stay midline to aspirate the fluid.

Use a 25 or 26 stage needle and use the oxygen force it mainly restraining the bone. And then quickly I'm gonna move on to seizures, neurologic disease. It's kind of weighing what we are seeing.

Well, it does, it varies, but for seizures, neurologic disease can mean any number of things. It could be in juvenile birds, hypoglycemic, it can be some sort of toxicosis, heavy metal, . That can cause neurological signs, lead poisoning, could be chemical, could be infectious.

Now we see a lot of birds with coronavirus that are showing neurologic signs. It could be chlamydia. It could be a fungal infection, it could be mycobacterium, could be idiopathic.

Head trauma, we've talked a little bit about seeing more and more cardiovascular signs, especially in these birds as they age in the population after sclerosis and stroke. And then of course hypocalcemia and African grey parrots used to be quite commonly, but we can't really don't see that very much anymore because birds are there that died. So seizures, you wanna, if a birds coming in an active seizure, first thing is to stop the seizure.

So use midazolam, 1 to 2 mg per pig. If it's hypoglycemic, you check that blood sugar. You wanna give it some dextrose.

If you suspect hypercalcemia, then you would want to get calcium. You wanna do just supportive care, had the cage to reduce any trauma, with the bird off of any part so it can't hurt itself and provides supportive therapy, long-term therapy if it's truly seizures. Keppra seems to work well.

It's very safe in birds, so Keppra at a dose of 100 mix per pig for 12 hours. Monitor response veenobarb we used to use quite often. We don't use it so much anymore at all since we now using more Keppra, which you can use Penobar.

And I'm gonna quickly talk about egg binding because it is a very common presentation. You can have various presentations of egg binding, uncomplicated, which is just simply the bird is calcium depleted. Complicated, which means either a prolapse over the oviduct, a portion of the over deck.

If it's a soft-shelled egg, the bird is calcium depleted but still laying eggs, and then you can have birds that are paralysed from binding as well. So you can see various things again, you can either take full position radiographs like this, or you can do, just a standing DV radiograph. Get a quick, easy view to know what's going in there, what's going on in there, but it's important to get some idea of what, what you're dealing with before you try to remove the egg.

So for egg binding, you're gonna palpate the abdomen. You do a standing DVD radiograph to see what's going on. You try medical management first unless the bird is in distress.

If the bird is actively trying to lay straining, you might want to go ahead or if the egg is partially collapsed, you've got to go ahead and try to get the egg out of there. If not, you can just do the, the medical management providing calcium, vitamin D, fluids, a warm place, lubricate prevent, and sometimes the birds will just be given that calcium, they'll just go ahead and lay the egg, . So if there's no response to your medical management, you want anaesthetize and manually remove the egg.

So the medical management again, you want to use a lubricant, you want to provide fluids, calcium, vitamin A and D, oxytocin plus or minus, we don't really, oxytocin doesn't really work that well in birds. Humidified cage if you can, warmth and just give it some time. You can see in this, shot shot that this bird treated medically in the bird la not one but two eggs in the cage.

If you wanna, if you have to manually remove the egg, if the egg is palpable in the pelvic inlets, you can lubricate the vent and just very gently put digital pressure cranial to the egg. This is with the bird under anaesthesia, of course, you don't want to do this in a, in a wake bird. If the bird, if you can't get it to move out or if you can't see the bird, the egg, then you can use some sort of speculum to, to visualise the eggshell through the oviductal opening, and sometimes you have to go way up in there, use magnifying glasses or some sort of endoscopy to go up and see the egg.

And then you would put in an 18 to 22 gauge needle, just push it right into the eggshell. You have to stabilise the egg with your other hand, push, push that in sometimes quite force, and then what you do when you're in the shell is you aspirate the contents out. Once you aspirate the contents out, then you can collapse the shell.

And then you can, usually I try to make the opening where I put my 18 gauge needle in. I try to just make it, move it around a little bit, make the opening larger, and then I try to place a cotton swab inside the eggshell itself, inside the egg, and then pull the egg out through the vent. In some situations, if you can't see the egg through the the ale open and you try and try, you can perform a percutaneous synthesis of the egg against the body wall.

So you want to move it right up through the body wall or right in, and then again, once you aspirate the contents, you can collapse the shell. The thought is that once you remove that pressure and treat the bird medically, the bird will go ahead. Usually the bird will go ahead and pass the shell.

So again, this is showing the The The egg through here we've got a nasal speculum. We're going in there we can see the the shell here. So what you would do at this place is just pass an 18 gauge needle and right into the shell, aspirate the contents out and then Make that opening a little bit bigger and then, put your, your cotton swab into the shell and then slowly with gentle pressure pull it out.

You can use non-traumatic traumatic forceps or hemostats also to try to remove the shell. Here's with cotton swabs in the smaller bird, this bird we were able to remove the shell intact just with lubrication and gentle digital pressure, again the bird relaxed under an infusion. If you have an overductive prolapse, where the tissue of the oviduct is around the shell, the main thing we have to do here is just lubricate this, this tissue just give it lots of fluid, make sure it's well, well lubricated, and then once the tissues are lubricated, you can try to remove this is usually adhered to the eggshell itself.

It's dry tissue, so that's why you wanna lubricate it well. And then you try to collapse down the shell and move it piece by piece. A lot of times if you catch these early within 24 hours, once you remove the shell, the tissues will heal.

You just put your tissues back up into the oviduct and the birds usually do fine. Sometimes you might need to put sutures on either side. The bird is recollapsing the tissues, but usually once you invert it back into the bird, and then, and then we usually also give leucoli acetate because we want to shut down the in these birds.

Mm So if the tissue is necrotic, you could consider exercising the necrotic portion. And again, you wanna use leroli, you wanna use NSAIDs for inflammation, pain, fluids, antibiotics, especially if the tissues can pull that for quite a while, supportive care, and then ultimately, You may want to do self appendectomy, but a lot of times now we're not doing these types of surgeries so much anymore because we do so well with managing leroide or desper. So again, in these areas, this is a, a vent collapse, this is unrelated to egg laying, but this is bird the bird was straining, all the urates impacted.

So some species of birds will go into the straining and we don't understand exactly what's going on. I've seen it in liers and then of course the, the bigger problem is in cockatoos, where they collapse the la and . Well, people don't, it's hard to kind of imagine, but the reason they're collapsing the floea is because they're, they're blowing out the air sacs, their abdominal air sac that expanding and pushing that floeca out and, and that's where we see this, this prolapse.

A lot of times we feel like this is an emotional problem. The bird is, down very fonded to them, especially in cos. So these coal prolapses initially you want to flush, you want to lubricate the tissues and replace it with a cotton swab may require one or two sutures on either side of the dent.

Usually it does, and then usually try treating these with lu on in case there's a reproductive. So, I'll end up with this picture of this bird Aurora. This was an amazing call I treated for over 25 years.

This bird had two strokes and ended up dying at the age of 50 from cardiovascular disease, aposclerosis, but it was a learning, learning journey for me. It was wonderful to her, but. We can really provide these words with the long and with some really good care.

So thank you for your attention. I appreciate and I hope you gain something from this lecture.