Thanks very much there. So yeah, so tonight, obviously the title of our talk is reptile emergencies. OK, and then, the talk tonight is, is really sort of split into two sections.

So the first section I'll talk to you about sort of things like triaging reptile emergencies and cover some of the basics of emergency care such as pain relief and fluid therapy. And then for the second half of the talk we're we're going through some of the common emergency presentations that you may well see coming to practise. So the first thing that I wanted to say really is that although a reptile may present for an acute emergency, it's always important to remember that a lot of these reptiles will have some degree of underlying pathology going on.

So this may be things like metabolic bone disease, respiratory disease, or sort of chronic, you know, gut, gut parasites and things like that as well. And it's important that we do take those underlying problems into account when we're treating them. So, for example, if you get a tortoise in that's suffered a sort of a trauma, you know, it's been dropped from a height or something like that, and it's got a shell fracture, and it would be important that we also recognise that it did have metabolic bone disease.

Because you know that may affect the sort of fracture fixation methods we can use and could also affect the prognosis of that tortoise longer term. So say it's important that we treat both the current emergency as well as the chronic disease process, and, and really sort of take the opportunity, the fact that the, the client's finally brought the reptile into the practise. So to sort of, you know, review the husbandry and to educate the owner so that you can improve the welfare and the health of that animal longer term as well.

The next thing that I wanted to say is that reptiles usually do do things very slowly. So they get ill slowly, they die slowly, and then they get better slowly. And I think it's always very important from the outset that we do make the owner aware that, you know, this is not a very quick recovery process from most, most sort of acute emergencies.

So whereas you may bring me a dog in that's had a dog bite, you know, and it has a stitch up or whatever. You know, I'm expecting that to be fully resolved really within 14 days. But if we then have a dog bite to a tortoise and we have some degree of shell damage, with that, you know, I could be managing that tortoise for the next 6 months.

So we need to make sure the owner's aware of sort of the length of the recovery recovery period, but they're also aware of their commitment that's required in terms of medicating the animal and bringing it back to the practise for checkups. And also the fact that this is going to cost quite a lot of money as well. So I think you know it's important that from the outset we are discussing these things with the owner, you know, and if they if they really can't commit to that animal, then we should potentially be considering euthanasia at quite an early point.

So the next thing to to sort of go on to now is sort of triaging our reptile patients. And my first bit of advice for you is do not panic. So, you know, you're all trained vets and vet nurses, you know how to assess an animal, you know how to take a history, you know how to form a clinical exam.

And just because it's not a fluffy little dog or a cat doesn't mean you don't know what you're doing. So to approach these cases in a similar way to what you would do for a dog or a cat. And on the whole, you can't really go too far wrong.

So the first thing you're gonna need to do is take a history, and with this, obviously if it's an emergency situation, it may be that you just take a capsule history initially. And then sort of filling the blanks later on. But with this, I say, it, it sort of take a history as you would do for another companion animal.

So you know, I need to know is it eating, is it passing faeces, and, you know, has it become more lethargic? But with reptiles, it is important that you also ask more questions about their husbandry. So, you know, I, I don't really mind what kind of bed your your dog sleeps on at night, but I do mind what substrates in your reptile's enclosure at the bottom.

So, you know, it is more important and we do ask these questions, and the reason for that is that many of the diseases and disorders that we see in reptiles are due to poor husbandry and the fact that they're just not looked after properly. So if you have a look online, there's certainly lots of different crib sheets that you can use that can help you to sort of make sure you ask all the appropriate questions for for history taking, particularly when you're new to sort of seeing reptiles. But, but in general, the major things we need to be asking are about what type of enclosure it's in, what's the lighting like, you know, what's the UV and heat sources that they've got, and does the owner know the humidity in the Bavarian?

What substrates on the floor? What food do they offer versus what food is actually consumed? Do they supplement the diet in any way, and how do they provide water as well?

All sorts of important things that we need to know. So moving on from there, obviously we need to examine them. And, and the first thing is obviously with an emergency when it comes running through the door, is obviously, you know, checking it's alive, you know, doing your airway breathing circulation assessment, of course.

But once you've, once you've done that, obviously we need to perform a a sort of a systematic review of the animals, so starting at the head, ending at the tail, the same as you would examine a dog or a cat. So I'm now just going to pick out a few things with reptiles that are particularly important to make sure you check on their exam. So the first thing is their mentation, you know, the the reptile should be bright, it should be alert, it should be responding to its environment, you know, they shouldn't be stuporous or sort of comatose when they're coming in.

The next thing is to check it's breathing. So we, we'd expect sort of a nice steady respiratory rate for from them. So typically, you know, sort of potentially 6 to 8 breaths per minute for a lot of reptiles.

And we expect them to be making a real minimal effort to breathe, you know, but we don't expect them to sort of be gasping or anything like that. Mucous membrane colour should also be assessed, so obviously we're expecting that sort of salmon pink colour as you would do for a dog or a cat. Sometimes with reptiles, it can be challenging because they can have a bit of pigmentation to their mucous membranes, which can make it difficult to assess.

So sometimes, you know, you just have to try and look for, for the pink bit in there. The next thing we would do is is auscultation. And so, you know, with reptiles, it is a bit limited because of the presence of the shell and the skin.

So obviously that that does sort of block the sort of contact between the stethoscope and the animal, which can make it more difficult to sort of hear the noises. But what you can do is put a wet gauze or a sort of a thin wet towel over the top of the shell and have a listen through that. And that can sometimes help you pick up more of the subtle noises.

But certainly auscultation is not as rewarding in reptiles as it would be in a dog or a cat. So the best thing you can do is to get out the Doppler, and I would do this with, with every reptile patient that I see. So, the Doppler is great because it helps you to be able to listen to the heart sounds and to count the heart rate.

So with chonium, so we're talking about tortoises and turtles here, with those guys, we will put the probe into the cervical window. So that's the space between the head and the front leg. And if you pointing in that way, sort of point down towards midline, you should be able to hear the heartbeat in that area.

With our lizard species, their heart tends to lay very cranily, so right up in between the four legs as you can see on this picture here at the bottom. So, so most lizards, it does lay really far forward. In some lizard species it can be a little bit further back in things like the monitor lizard, but say for most of them, you know, you're looking really far forward to find that heartbeat.

And then when it comes to the snakes, their heart tends to lay about about a third of the way down the body. And what you can do is either look for the apex beat or or try and palpate the apex beat and then just pop your Doppler probe over that area. The next thing we're checking for is obviously checking, you know, body condition score, checking how well muscled the animal is, and also how strong it is.

So it's, you know, you sort of a snake should try and wrap itself around your hand, you know, it should feel quite strong. But the other thing to assess is also, you know, can they support themselves on their legs. So with tortoises and turtles and with sort of lizards, they should be able to push up, push themselves up onto their legs and sort of you know, not have to necessarily drag the routing along the floor.

So this picture at the bottom here, we can see this bearded dragon is able to support itself on its legs, which is a really good sign. The other thing we can assess with reptiles is their writing reflex. So to do this, we just pop the, the lizard or the snake onto its back, and it should quickly try to correct itself and get itself the right way up again.

And you can see this corn snake at the top picture here has got a loss of the writing reflex. And this can be due to things just like muscle weakness, or can also be seen, due to neurological disease as well. The next thing to assess would be the animal's hydration.

So signs of dehydration would include things like sunken eyes, a very sort of thick saliva in the mouth, and also prolonged skint. So you can see in this picture down the bottom here. That this bearded dragon does a really quite wrinkly skin, and this is because he is quite dehydrated.

So so certainly have a look out for that sign when you're trying to assess hydration status. And then the last thing sort of we're examining is obviously just to do a sort of a general body palpation as well. And obviously check an event for any signs of sort of prolapses and things like that.

Now when it comes to lizards, you know, it's, it's fairly sort of straightforward, you know, obviously we're just trying to fill the, the sort of abdominal space there. But when it comes to Archeonia, obviously they're very limited because of the fact that they have this massive shell in the way. But what you can do is have a feel in the prefemoral fossa.

So that's the area just in front of the back leg, so between the shell and the back legs. And if you fill in that gap there, you can sometimes feel things like eggs, follicles, bladder stones, or you know appreciate things like ascites in that location. When it comes to our snakes, the area that you're feeling is along the, the ventruum, so, along the ventral aspect of them.

Because remember they have a spine that sits along the middle of the back, and then they have ribs that come down either side. And so it's only the sort of underneath that you'll be able to feel anything. So have a feel along there for any sort of masses or or distension in that area.

So we're now gonna move on to looking at the basics of emergency care, and the first thing I wanna talk to you about is some is analgesia, so obviously a really important part of our work. So for analgesia for reptiles, we have very little data on efficacy, on therapeutic ranges, on, on sort of safety ranges and things like that. So, you know, it is sort of a sort of a best guess situation at the moment, really, and we've just got to use the information that we have available to try and make the best choices that we can.

The other thing to remember is obviously all these drugs are off licenced, you know, there's very few medications that are licenced for our reptile species. So it's important that you explain that to the owner and get those off licence consent forms signed. So the first thing that we tend to think of obviously when it comes to analgesia is thinking about opioids.

And with, with reptiles, it tends to be morphine and tramadol that are more likely to be effective in the majority of our reptile patients, so they're the ones we tend to go for. But with morphine, we know that that can cause quite severe respiratory depression. So it's perhaps not the, the first, you know, sort of the best choice in, in a lot of reptiles because, you know, we, we obviously want them to keep breathing.

So tramadol does appear to be just as effective as morphine, but causes much less respiratory depression. So it does tend to be the one that I would tend to favour. Long, you know, when we're thinking about the other opioids that are available, they have shown that, fentanyl patches, have shown some promise in, in some snake species.

So, so certainly that may be something that, you know, further down the line maybe be something that we're recommending. Other pain relief that we could use would include our non-steroidals, and so the one that we would most commonly use would be meloxicam, and it does seem to be safe in a lot of exotic species, so we, we use it in a lot of them. But it is important that we're ensuring that reptile is well hydrated when they're on this pain relief.

So, just because obviously we're worried about those sort of renal effects the same as we are in other species. So I would always recommend that if, if I'm prescribing Metacam, that, that, you know, the, the animal does have frequent baths, so maybe a couple of times a day while it's on the medication just to just to make sure I say that, that we're sort of protecting the kidneys as best as we can. Other things that we could use would include obviously ketamine and alpha 2s that obviously have some degree of analgesic effects.

And, and you could also consider using local anaesthesia as well, so things like lidocaine, always being careful to make sure we calculate the dose correctly and avoid overdose, the same as we would do in other species as well. When it comes to fluid therapy, the maintenance rate that's commonly quoted for reptiles is between 5 to 10 mL per kg per day. So, obviously an awful lot less than we would give for our dogs and our cats.

Some textes do sort of, quote up to sort of 30 mL per kg per day, and I do think it's very sort of species dependent on the actual maintenance rate that they need. And often when they're not well, we, we sort of will give them a bit of a high rate of fluid anyway. And the fluid that I would use most commonly is, is just Hartman's, so, you know, I think Hetman's is generally a good choice for sort of most, most patients, to be honest.

And then how are we gonna give the fluids? Well, certainly we, we can give, intravenous fluids, so we could consider using things like the jugular in, in, in a tortoise, which is, is sort of being shown in this picture at the bottom here, obviously they're taking blood rather than giving fluids, but it, it shows you where the jugular is. You know, we can use things like the, the ventral coccygeal vein in in sort of lizards and things like that.

Certainly when we're thinking about giving IV fluid, you know, you can give a obviously an off the needle bonus to them. But if you are thinking you're gonna need to have an IV catheter in place, it's just to say that this often does require some degree of sedation or anaesthesia to place those. And for some of them, you will need to do sort of a cut down and things like that, so to get to the jugular and snakes and things like that.

And so, so it can be a bit more of an invasive procedure for them. And then the other thing I would think about as well is that, you know, in comparison to sort of my dog or cat emergencies where you know they're coming in in hypovolemic shock and I need to get a bolus into them quickly. And when it comes to reptiles, often they're more sort of chronically dehydrated and they don't necessarily need those sort of big fluid bolus, you know, very, very rarely.

So with those, you know, I'm not always too panicked about needing a lot of fluid into them quickly, so using other routes other than IV is often more than adequate for them. So certainly I will consider doing subcut fluids. So sort of I do those fairly frequently in reptile patients, you know, and obviously you can use whichever sites you can get to on a reptile.

You could also consider placing IO catheters, so into osseous access. But what I would say with this is obviously you do need to be careful if they're suffering from metabolic bone disease, because obviously your, your limbs and that are gonna fracture more readily. So do obviously have that in your back of your mind if you're planning to place an IO catheter.

Intra-salamic fluids could also be considered, but the same as we sort of worry with other animals, you know, there is a risk involved here in the fact that, you know, we could, you know, inadvertently punch, an organ or cause issues giving fluids that way. So I must say it's not something that that I really do. Other routes of fluid administration will obviously be oral fluids, and then soaking is really important in reptiles.

So, reptiles, do have the ability to take water up through the cloaca. For a lot of the species. So actually giving them, you know, sort of popping them in a shallow bath, sort of several times a day, can actually really a great way of improving their hydration as well.

So, next up I'm just gonna talk about euthanasia. So, when we, when we're putting them to sleep, the same as with a dog or a cat, you know, I'd always rather just be able to get an IV, you know, to do it via the IV routes, obviously it's nice and quick, and it's a bit more humane for them. So if you can get IV access, then that's great.

If you can't, then, you can do things like, like giving them some alfaxan, I, and you can use that just as a sedate them, and then obviously you could do your Pento injection intracardiacly. The other option I wanted to point out in Tilonia is that they have this subcaripacial sinus. So this sort of lays midline above the head, OK, and it sort of lays just at the top of the shell.

So sometimes I do find it easier if I bend the needle up upwards and say if you just come into this area, you should be able to hit it. And the great thing with this site is that you can access it with a tortoise's head pulled out, as in this picture, or with the tortoise's head pushed in. So if it is quite a stubborn tortoise and you, you can't sort of get the head out, then you can still utilise this route quite easily in them.

And I say that this subcapatrial sinus, it's just an area where you get a lot of vessels sort of coming together, and you also get a lot of the lymph system sort of drained into there as well. But so it's a really handy site to use for for euthanasia when that's necessary. And then obviously once I've, once I've given the Pentaget, obviously I need to check to make sure they're gone.

So I would get the Doppler out again and use that to assess for a heartbeat. And remember that reptile heart rates can drop really low and then still be alive, you know, it can be sort of down to 1 or 2 beats per minute. So I would make sure I listen for, you know, a good few minutes before I confirm that the reptile seems to have died.

And then after we've, we've done that, I would always piss the brain afterwards as well. So to do this, you just pop a needle in through the mouth through the top of the, the oral cavity and direct that towards the, where the brain sits, and then you just agitate the needle back and forward a few times to, to sort of damage the brain tissue and cause brain death. And that just helps to ensure that, you know, the reptile has passed on basically.

And then confirming death can be difficult in reptiles. So if you're a paranoid penguin like I am, then, you certainly can consider keeping them in the practise overnight just to make sure they're gone before, before, you know, they, they go off to be buried at home, or put in the freezer to send for cremation. The next part of the basics of emergency care I want to discuss was, was just anaesthesia.

And the reason for discussing it with you guys is just that obviously as part of your emergency treatment, you may well need to anaesthetize the animal. So the first thing to mention is that do try to warm the reptile up to its preferred optimum temperature zone before you try to anaesthetize it. And the reason for this is that the reptiles' metabolism, or the enzymes and things like that are gonna be working at their best when the reptile is at the best temperature for that species.

So, you know, if you want your drugs to work and you want them to work fairly quickly, then warming them up is sort of the best way of doing that. When it comes to pre-medications, obviously we'd always consider using an opioid as part of that. The other things you could consider would be things like midazolam, ketamine, and metaomidine, and what I would say is I would just check a textbook or a formulary.

And look for a recipe that you're happy using, you know, I say, but, but otherwise, you know, if it's an emergency situation, you know, if you give pain relief and then just give it an induction agent, then, then that's, that's fine in most cases. But so, you know, if you do think you need to add something extra in, then I say, you know, do consult a textbook and see if you can get a range that's appropriate for the animal in front of you. And then, When it comes to inducing anaesthesia, obviously we could use propofol, which you need to use via the IV or the IO route, obviously that that works quite well in reptiles.

Otherwise, my favourite would be Alfaxan. And the reason I quite like that is because I can also give it IM or subcutaneously. And you know, when you get these reptiles in and and you can't get that IV access, then certainly, you know, being able to sedate them via via different route is obviously really helpful.

The other option of induction is to gas, to gas them down, so either on isofluorine or sevaflurane, which works fine in, in most reptiles, but with Tilonia, you do sometimes need to be, you know, very, very patient because they, they do, hold their breath when they're, when they're in the gas box. So sometimes it can take a very long time for them to fall asleep. And what I would say is sort of overall, the thing to remember is that that whatever route you're using, you do need to be patient.

Because as I said at the start, reptiles do things slowly. So they don't fall asleep, very quickly at all. So, you know, whereas I put a hamster in a gas box, you know, I expect it to be down within 5 minutes, you know, I could quite easily wait in 20 minutes for a snake to fall asleep if I just put it in Io and wait for that to happen.

So say with everything, you know, it does take time with reptiles. It's not the sort of thing that you can operate on a reptile, you know, for the 10 minutes in between consults or or something like that. You need to, you need to have enough time to, to do the job properly.

And so once they're asleep, the next step is to intubate them. And, and intubation is very, very easy in reptiles. So, so you should be able, you should, you know, you're more than capable of doing this, and I say it's easy to do, so, so you should do it.

But sometimes you do need to be a bit inventive, because obviously these guys often have very small windpipes and our sort of standard ET tubes that we use for our dogs or cats and simply just won't fit. And if you have a look at this top picture here, you can see how obvious the glottis is actually. So it sits here right at the front and this is the entrance to the windpipe here, and then everything else behind that is all down to the oesophagus.

And the picture down the bottom here is a very similar, you can see I've got an IV catheter in, in place for this, this guy here. And When you, when you have got them asleep, oh yeah, sorry, the, the other thing I was gonna say is if you, if you're struggling to see the glottis, then if you just put, your thumb sort of in between the mandibles at the bottom, and push up, then, then that should make the glottis a bit easier to see as well. And then when, so when they are asleep, the 02 flow flow rates that they commonly need are, are very low, so usually less than 1 litre per minute is more than adequate for, for the majority of reptiles that you will see.

But they often will need, IPPV or a ventilator. They often don't breathe under anaesthesia, so obviously be prepared for that, you know, prepared to be able to do that before you anaesthetize the reptile. The next tip I've got for you is that reptiles do fall asleep under general anaesthesia from their head down to their tail, and then they wake up in reverse.

So it's important to remember this, for example, if you're going to operate on a snake's eye, you need to make sure it's not still moving its tail before you make that first incision. And the reverse is true, so if you've got an angry reptile, then, you know, as soon as that tail starts to move, then I would sort of get everyone's fingers out of the way before the head wakes up and it bites everybody. And then when you're monitoring them, don't Opplers are great from their heart rate during anaesthesia as well.

So I would always sort of take them onto the reptile and and make sure they're sort of sat in place really throughout the surgery, but so they are your most useful, piece of monitoring equipment you can use. A lot of the other monitoring equipment, so things like your pulse ox or your camenographs and things like that, are really not very useful when it comes to reptiles. You certainly can connect things up, but we are really looking to monitor trends rather than looking at the exact numbers.

And the reason for that is that these machines are just not designed to, to sort of deal with, with the reptile patients and, and sort of how slow the metabolism is and that sort of thing. So say certainly not as useful as it would be in a dog or a cat. And then how do I know it's asleep?

Well, say a surgical plane of anaesthesia, we're really looking for that lack of response to a tail or a toe pinch with them. They also should lose the rapebr reflex at a surgical plane of anaesthesia, but that corneal reflex should typically persist. So what we would tend to do is have some cotton bud sitting there, you know, some moist cotton buds sitting there, just so that we can keep testing that corneal reflex.

And if that corneal reflex disappears, then we'll start to worry that that reptile's potentially getting a bit too deep there. However, do remember that those, those reptiles, so all our snakes and some of our lizards that have spectacles over their eyes, so that the ones that don't have any eyelids, so they have a layer of skin over the eye instead. And with those guys, you just can't assess the papeba or the corneal reflex.

So with those, we really are looking at that sort of lack of response to, to sort of a pain stimulus instead. And then the next tip I've got for you is that when you're recovering a reptile from anaesthesia, you should turn off the oxygen. And just ventilate them on room air for their recovery.

Now the reason for that is that the reptiles' drive to breathe is a low partial pressure of oxygen, rather than a high partial pressure of carbon dioxide as it is for our mammal species. So if you leave them on oxygen, basically the, the, the drive for them to, to sort of spontaneously respirate is not gonna be there, OK? So we will want that return of spontaneous ventilation.

So turn off the oxygen and say just ventilate them on the room air instead, and then hopefully your reptile will wake up a lot quicker. And then the last bit of our, our basics emergency care is, is thinking about CPR, OK. So, obviously, you know, as I said before, airway breathing circulation is obviously what we're assessing for and and sort of obviously confirming initially that, that the heart stopped beating or, or the respiratory, you know, the respiratory systems failed.

So, so with them, ideally we will intubate them and as I, as I've told you, that's pretty easy to do in reptiles, so I would recommend you doing that. And then we are providing a sort of a breeding rate for them at a rate that matches their normal resting respiratory rate. So quite often, you know, doing sort of 6 to 10 breaths per minute in a reptile will be more than sufficient for them.

And again, generally we're using room air because we want to get that return of spontaneous ventilation going on. And then thinking about cardiac compressions, OK. And with this, again, we're, we're, we're trying to match the normal resting heart rate that the reptile would have.

And we should say it's difficult for me to give you a set number because obviously, you know, we can range from these tiny geckos up to these sort of massive boa constrictors. But in general, you know, sort of potentially sort of 60 beats per minute, would probably be sufficient in a lot of them. And so if you get a sort of dorsoventrally compressed lizard, so something like a bearded dragon, OK, that's squashed sort of top to bottom, and with those guys, we would turn them onto their back and then obviously compress directly over that heart that we know lays very cranially in the majority of our lizards.

And if you get lizards that are squashed the other way, so like a chameleon, if you think about those, they're sort of squashed from side to side. With those guys, lay them in lateral, and then compressed directly over the heart. And then with our snakes, we would lay those in dorsal recumbency and then compress directly over the heart to do the cardiac compressions.

And then what about our tortoises and our turtles, because obviously with those guys, that shell gets in the way and we can't get direct access to their heart. So with them, although it sounds really silly, what we do is we pump their front legs in and out of the shell, to try and get some sort of blood flow going around and, you know, sort of change the pressure within that salamic cavity to get some oxygen and sort of blood flow around the body. So I say, although it sounds really stupid, it does work, you know, and I, I certainly have got, several tortoises back by by performing CPR on them by by doing the pumping in and out of their, of their legs.

And then on here is just, and it's in the notes as well, it's just some drug dosages when, when we're thinking about adrenaline and atropine in these cases. And obviously if they, if they have arrested and you've given some medication, you know, obviously reverse those drugs where you can. So, you know, if you've given an opioid, you know, give it some naloxone, OK.

And then, always we check their glucose level, you know, we'd always do that in sort of any, any sort of crash situation, because obviously hypoglycemia can, can cause arrests. So, so check that it's easy to do and then obviously you can supplement it as needed. And then the last point I wanted to make is that reptiles can actually cope with really long periods of hypoxia.

So if you've got a healthy reptile that's arrested, particularly if it's due to sound like a GA, then they are worth a really good CPR effort. So you know, our other tortoises that have have sort of drowned in sort of ponds and things like that, for goodness knows how long. And you know we've managed to get them back because they can cope with with being in that situation for a long time.

So they are worth a really good effort from you. However, obviously, you know, use your brain, and if it's a chronically ill reptile that looks awful, then, you know, just give it a standard sort of, you know, 1015 minute approach and, and if we're not getting recovery, then, then I would give up at that time. But say if they were previously really healthy, they they're definitely worth a good effort from you.

So we're on to the second part of the talk now, so we're going to talk about some common emergencies. And I'll just talk you through this picture here because it's obviously quite, quite an interesting, but very sad case. So this is a picture of a tortoise that, that, I have a euthanas, so, so it's passed away in this picture.

But you can see these, these horrific injuries to these front legs here, and this guy was just sort of was chewed on, by rodents out in the garden. And you can see all the bones exposed and everything looks really dirty, and it's just terrible. But with this case, if you notice, its beak is also very long and its shell was soft, and it was just in really poor condition.

So this is what I mean, that although, you know, we've got this acute trauma injury to the legs, you know, this is suffering from chronic metabolic bone disease and sort of poor husbandry. So we know that we're on a, a really sort of, you know, on the back foot here when we're trying to start treatment for him. So you know, he's, he's not going to survive a bilateral leg amputation and sort of the treatment that's involved here.

So definitely euthanasia, is, is the kindest thing for him based on welfare grounds. So the first emergency I want to talk you through was respiratory emergencies, OK, and and the causes for these, most commonly there is some degree of infectious agent involved. So it's not like bacteria or or a viral infection.

And with these cases, obviously, you know, the, the poor husbandry obviously adds to the issue and, and obviously can sometimes be the root cause of, of why the respiratory problems happening. The other things that can cause respiratory problems is, is things like space occupying things in the salamic cavity. So remember with reptiles that they haven't got that separate thorax and abdomen, it's just this one space called the, the salamic cavity instead.

So you can imagine if you get loads of eggs in there or follicles, or you've got a massive liver or something like that, it's taking up a lot of space. It's gonna reduce the space that's available for the reptile to, to sort of expand its its lung. You know, it's lungs, and so it's gonna struggle to breathe.

So sometimes they say they're coming in with dyspnea, but actually it's due to abdominal problems. The other thing that they, they can get is neoplasia. So certainly when we, when we see older reptiles, we, we do see a lot of neoplasia in those guys.

So certainly it's important to be having that on our list as well. And then what sort of clinical signs will we see? Well, one of the common signs we see in our snake species is this head elevation.

So they commonly sit with their head up against the side of the bavarian. And they do this to try and move any fluid or mucus further down the respiratory tract so that they can use a cranial portion of their lung to breathe. They also will do sort of some periodic sort of yawning or or gasping movements as well is really commonly seen sign.

The other thing that we see quite commonly in snakes is sort of these these sort of bubbles at the back of the mouth. So often, you know, people that keep snakes will say, oh, he's got, he's got RI, so respiratory infection, you know, and he's he's bubbling out of the mouth, and this is what they mean when they say that. With our tortoises, we often get like a nasal or ocular discharge from, from those guys as a common sign of, of sort of upper respiratory tract disease.

And all of our reptiles can make sort of gulping movements when, when they're struggling to breathe. And you may obviously appreciate increased respiratory sounds and an increased respiratory rate as well when, when they're suffering from, from these problems. Another sort of interesting clinical sign we sometimes see is altered buoyancy in aquatic turtles.

So basically, the owner will say that the turtle when it's swimming along, is sort of at an angle and sort of tilted down one side. And that can be due to the fact that they get more of a Unilateral pneumonia, and I'll show you an X-ray of that on the next page. With those guys, as I say, you, you have a lot more fluid or, or sort of, mucus and less air on one side with the turtle.

So when it swims, it's sort of, sunk down on, on one side. So it's quite, quite an interesting sign to look out for. So when we're diagnosing respiratory problems, you know, certainly consider doing your blood work, you know, looking at sort of signs of infection and sort of ill health elsewhere.

And then I say, X-rays are are brilliant to to do to assess the respiratory system. So this x-ray we've got over here is a, is a cranial caudal view of a tortoise, and so it goes basically through the head and out the back end of the tortoise. It is the way the beam's head in.

And you can either do this with a horizontal beam, or you can, if you can suspend the, the tortoise up vertically, you can also get this view. And you can see in this guy that he's got a really sort of unilateral pneumonia going on. So this side of the, the, lung looks much worse than this side.

You can certainly see obviously if this was an aquatic species, how, how this would end up being tilted over to one side there. We can also perform different viral swabs in in reptiles who checking for things like herpes virus in our tortoises and bacterial swabs as well. And then how do we treat these guys?

Well, well, the first thing to think about is actually should we give them oxygen. So, you know, you get a cat that comes in with dyspnea, of course, straight in that oxygen tent, you know, immediately. But with our reptiles, that may not be the best thing to do.

And again, that's because it will reduce their spontaneous respiration rate, so it could cause more harm than good. So if you do feel that the reptile really needs oxygen because it's hypoxemic, then the best thing you could do would be to GA them, place you know, intubate them and then ventilate them on that, using, using oxygen. Other parts of our treatment may include fluid therapy, so obviously some of these guys will be chronically dehydrated.

We may consider analgesia. We need to make sure they're they're kept nice and warm, so we would keep them at the higher end of their preferred optimum temperature zone. Also, obviously consider antibiotics.

Nasal flushing can be performed in, in tortoises to sort of try and clear all the mucus out of their nose. You could also consider antivirals in tortoises if they're suffering from things like herpes. And also nebulization can be done.

And obviously with nebulization, we can nebulize with various agents such as F10 or or Beryl and things like that. Next up we're thinking about ocular emergencies. And so with these, obviously remember that our our tortoises and some of our lizards have sort of normal type eyes, you know, they have the cornea exposed to the outside world, and they have their eyelids that they shut to to sort of protect the eye.

But remember, obviously that some of our reptiles, or our snakes and some of our lizards, they instead have this spectacle. So they have that layer of skin that lays over the eye and sort of protects it that way instead. So obviously with our ones with the sort of cornea cornea exposed, obviously they can have corneal injuries, the same as sort of a dog or cat could.

So with those cases, do approach them the same way you would do a dog or a cat. Use your ophthalmoscope, have a good look, do your flourishing test, etc. And then often with those, you know, treating them with pain relief and antibiotics are usually your first aid treatments.

So, you know, giving them some Ioho and some Metacam, you know, is, is generally more than an acceptable route of treating those eye problems. With our spectacle, bearing animals, and with those, some of the common problems we see will be things like retained spectacles. So with these, basically, the snake fails to shed the layer of skin over the eye each time it shed its skin.

And so these build up layer upon layer over their eyes and you end up getting this sort of appearance. So with these, we, we need to sort of gently soak those layers and sort of lift them off for the snake. And it is important that you're very careful to not damage that that lowest layer of the, of the spectacle, because obviously if you pull that lower layer off, you're then gonna leave the cornea cornea open to to the outside world.

Another thing that snakes can get are the, are these subs spectacular abscesses, which I just think is a really cool name anyway. But with these, you can see on this picture at the bottom here, you get puss basically building up between the spectacle layer and the surface of the eye. And so to treat these, we tend to make a little window.

I just find my cursing, a little window just in the ventral aspects of the eye, so somewhere down here. And then we can let the pus out, we can flush it all out, all out properly, and then we can give them, obviously antibiotics and pain relief as well. And you obviously can instil some antibiotics underneath that spectacle into that space where the infection is.

So obviously remember with the spectacle there, you can't just pop antibiotics over the top of that, it's, it's just not gonna penetrate down into, into the area you need it. So next up, thinking about bites, traumas, and shell damage. OK.

And obviously this picture was up on the first slide, so I'll just explained to you what happened with this little guy. So he, he was just, it was, it's a really quite a little, tortoise, you know, probably no more than the sort of 67 centimetres long. And he'd been roaming around the front room and, and the owner had moved their reclining chair, back onto him and crushed the crushed the shell there.

Now, obviously with this, this, this is a big deficit. It's got, you can see obviously we've got guts outside as well, and it's also quite close to the spine. So the owner did opt to, to euthanize, this guy.

Now, I'm not telling you that these cases are completely hopeless because they're not providing the, the owners willing to, sort of commit to the, the level of care that these guys need. But it certainly does obviously hold a much more guarded prognosis if our solomic cavity has been breached, through the shell injury. The other thing to remember is the spine.

So remember that that they do have a spine which lays up along here, along the, the sort of inside of the shell. So obviously if I get a fracture over these areas, that's gonna be much more concerning, because certainly, you know, I can end up getting a paralysis of sort of the hind limbs and sort of affecting the, the sort of nerves to the back end of the animal. So obviously that's gonna be a lot more serious if that happens.

So once we've decided that, you know, the injuries aren't too bad and we're gonna treat the animal, then obviously the first thing we need to do is, is obviously pain relief, OK, so probably looking for that, that tramadol in, in most cases. Obviously stem any haemorrhage you can see, the, the same as you would do with a dog or cat, so we can obviously apply pressure, we can use list and things like that, obviously, isolate any, any bleeding vessels and sort of like ligate those as well. It's important obviously we consider some fluid therapy.

So, if they've lost a large amount of blood, you know, we, we may well need to give a bit of a bolus of fluid, or otherwise, obviously, considering that the, the ongoing losses, you know, particularly if they become anorexic and things like that as well. And then antibiotics, we, we would obviously recommend are given in these cases too. So the important thing, to ensure, to, to make sure basically before you try and close any wounds, is obviously that they are infection free before you close it.

So if you get a wound and you don't know when it occurred or or you know it was more than 12 hours ago, then you should be considering those wounds as contaminated and infected, treating initially as an open wound, you know, with sort of irrigation and sort of wet to dry dressings and things like that. Obviously we don't want to just sort of close these things up and sort of attract that infection there, OK, because obviously it won't heal very well. When it comes to closing skin wounds in reptiles, we would typically use nylon or PDS for those.

And the reason being is that we need a suture material that's gonna last a long time because we usually leave these sutures in for about 6 to 8 weeks before we remove them. And then just to say, if you look at this picture here, you, you can see that with reptile skin, it does tend to want to invert. So when we do our sutures, we, we tend to do an inverting pattern instead, to, to sort of make sure that, that we're not getting this happening.

Because basically, if scales, are turned around and sort of touching scales, then it will not heal. So you need the underlying tissue to make contact with each other, to, to get these wounds to heal up properly. And then when we're thinking about fractures, you know, we, we can certainly use sort of screws and plates and that type of thing for, for our sort of, you know, limb fractures and things.

Also when we come to shell fractures, obviously, we're also sometimes a little bit inventive. So we may use things like cable ties or sort of hook and eyes, wires and sort of different hooks and things like that to help get these shell fractures to sort of heal up. You can also use, epoxy resins and sort of things like technovi as well to close these wounds.

But again, it needs to be, you need to ensure that they are infection free because we don't want to just pop a load of resin over that and then pretend that there's nothing happening underneath, because, you know, if we, if we live a bit of infection there, then, then that's not going to go away, without sort of treatment. And then just to say that if you have got quite severe shell damage it is worth taking some x-rays or, or ideally obviously doing a CT and the reason for this is to assess the, the bony portions of the shell underlying. So remember that you've you've got these sort of keratinized scoots which lay over the top, but you have got a bone layer underneath.

And just to point out that the margins of those scoots don't, don't necessarily line up with the sort of edges of the bone plates either. So you can get fractures in one and not the other and things like that as well. But obviously, you know, we, we need to know if there's any deeper injuries to the bone underneath that we need to address.

Next up we think about burns. So burns obviously can occur in any of your reptiles, but they are particularly common in snakes, and that's where they climb up and they wrap themselves around a heat source and they can suffer from really sort of quite severe burn injuries that way. And how do we treat them?

Well, obviously, rapidly calling them is important, the same as you would do, you know, if you've got a burn yourself, you know, pop it under the cold tap, to reduce the damage to the deeper tissues. And then we need to be thinking about giving them pain relief, obviously, you know, these things are gonna be in a lot of discomfort, and then making sure the wound's really clean, so sort of copious flushing of that wound. And then you can apply things like flamazine, and it works really well for these burn injuries.

Popping on non-adherent dressings is also important to prevent these things getting stuck to, to sort of their environment. And then obviously you do need to consider fluid therapy. So you'll know from sort of other species that when we do get these very deep burns, they will lose a lot of fluid through the wound, so obviously we need to account for that and make sure we're replacing the fluids that are lost by by our by our other means.

And then systemic antibiotics should also be given. And then the other thing to warn the owner of is when they do get these bad burns, they may well suffer from long-term dysectiasis. So that means difficulty shedding.

So we need to monitor these areas longer term to make sure the reptile can shed those areas of skin off. And, and they, you know, there's, they're sort of doing that properly and sort of we're not getting loads of layers of sort of old dead skin, attached to those sites. And so obviously warn the owner of that and then, you know, say they may well come back for issues with those sites.

Next we're gonna talk about cloacal prolapses, OK, so the major thing with these things is to keep it moist initially. So when you get that phone call from the client to say that. To say that oh it's hanging out at the back end of my reptile.

You know, the first thing to tell them is just try and keep the area moist so get something like a wet kitchen towel, over that area while they're bringing them down to the vets. Next up, you need to work out what on earth is hanging out of the reptile. So the things that can come out will include things like the phallus.

And so in our, in our loan species, they have a single phallus or sort of penis that comes out there. And with this guy, this was a Soarti horse that came into us that had been following his girlfriend around, but then he trod on his, his phallus and damaged it. It was bleeding quite a lot and then it wouldn't go back in.

When it comes to our snakes and our lizard, these guys have henepes instead. So they have two organs, OK, so, one on either side here that come out of the cloaca, and the henepes can look very different depending on the species. So some of them will have sort of birds on, you know, spurs on them or or barbs or little hooks and things like that.

Some of them will be quite smooth in nature. So I say they, they do vary quite, quite a lot. Obviously say there are two, so often if it's, if it's this organ, it would sort of seem like it's sticking out from one side of the vent only.

If it's a female reptile, obviously they can also prolapse their oviduct, and that will usually look like a very thin structure, and you may see some eggs within that. Otherwise they can just prolapse bits of the cloaca can just come out it's in this picture in the bottom here. They can prop prolapse large portions of the intestine, this is this really nasty looking, colon prolapse in this beardy here.

And the other thing that can prolapse is the bladder as well in the species that have them. So our, our cheonian species have bladders and also some of the lizards as well, and that again will be a thin wall structure potentially with, with some urine in it, unless it's sort of tear, you know, tear and then sort of picked open. And then the next thing to think about is why has this happened, because obviously it's not normal for you just to push out your organs out of your back end.

So there's always going to be something that's triggered it. And obviously, if we don't address that underlying issue with them, then the chance of them reprolapsing is obviously going to be very high. So if it is something like the phallus or the hemipee, you know, they can get obviously trauma traumatise it, which means that it is coming out and it's not going back in.

They can also get impactctions of things like the hemipes, and they can get infections in those areas as well. With with gastrointestinal prolapses, obviously it can be due to things like diarrhoea, inactions, parasites, obviously they, they can sometimes prolapse things due to neoplasia. Bladder stones are common in our, our tortoises, so sometimes we we see prolapses due to those, otherwise, sort of dystopia, you know, sort of causing cloacal or overduct prolapses in our females.

And then generally just hypercalcemia and metabolic bone disease can also cause cloacal prolapses, and that is just purely down to sort of muscle weakness. And so when they're trying to go to the toilet, everything just falls out. So how do we treat these guys?

Well, if the, if the tissue looks OK and it seems viable, then we can just pop it back in. Generally, you will need to sedate them, or give a, a general anaesthesia, to do, to do that. And obviously we need to provide some pain relief, and some antibiotics, and then clean the prolapse as best as possible.

You can certainly use things like sugar solutions to try and shrink the size of the prolapse before you're putting it back in. Obviously lots of lube, and then cotton buds I find very useful to help me replace everything. And obviously it's important that you make sure you replace that, that thing back in fully.

So you don't want it sort of concertinaed up in just inside the animal, you don't want any interceptions going on, because obviously that's going to mean that they're probably gonna prolapse that back out again. So as you say, make sure it's back in and it's back in and it's sort of flat, you know, back in a normal position. Just to note here that that if it is the phallus that has come out, so it's something like a tortoise, then with those organs, we are pushing those cranially back into the, into the sort of body of, of the animal.

But when it is a hemipene, these should be replaced downwards into the tail and because that's where they, they normally sit. So say, you know, try and push those back, back the other way to, to every other organ. And then once we've got those back in, we we're often placing some sort of sutures, OK.

So the most often ones we, common ones we would do would be two lateral sutures, so on either side of the vent is in this picture here. And we usually do them at sort of, right angles, say to, to work the, the line of the fence. Depending on the vent anatomy, and we'll also consider placing purse strings instead.

So particularly things like elonian, they tend to have a much more circle event, so, so they may be better in those, those situations. However, there is some argument that potentially doing a purse string can cause more damage to the tissue around the cloaca and sort of could cause sort of nerve damage and things like that. And it's nothing that I've seen happen, but obviously it's something to, to sort of bear in mind when you're doing these, these stitches.

And then I would always put a cotton bud, or, you know, if it's a big animal, potentially even a syringe, into the cloaca when I'm placing my sutures. And I do this to make sure that I've left enough room, basically for the animal to defecate through the sutures. Because obviously I want it to be able to pass its motions, but I don't want it to, to pass the organs out.

So it's sort of that that balancing that between doing that and I say often sort of just having a cotton bud in place here while I'm placing these things just to make sure I've left enough room it is a good idea. And so, what if that tissue is not viable? Well, when it comes to the, the phallus or the henepe, you can just chop it off.

And so these organs are purely a reproductive organ. So they've got nothing to do with the urinary tract at all. So you can just cut them out and be done with it.

Obviously, bearing in mind that they're not going to be able to breed in the future, but say, you know, they're, they're easy to just say, just, just chop them off and get rid of them. With a gastrointestinal tract, obviously if that tissue is not viable, then we're gonna be need to consider in doing things like a resection or an an an anastomosis, which obviously is gonna involve you going in into the salamic cavity and doing surgery that way. And then with our oviduct prolapses, you know, it may be necessary to spay the female as well.

But obviously with these situations, you know, it's not, it's not great if you're gonna need to remove a large portion of the gut, and the prognosis is gonna be guarded, particularly if there's some chronic issue on the line as well. So obviously, you know, although we can do all these things, you know, and I'm quite, quite readily just to say remove the hemipes without, without an issue. But say if it's some of the other other tissues that are severely damaged, then I would, would definitely sort of strongly consider euthanasia as a reasonable option.

And then we're just on the, the final hurdle now, so this is just the last topic to discuss, which is dystopia and follicular stasis. So the first thing to say here is that gestation periods differ greatly when it comes to reptiles. So actually diagnosing dystopia or follicular stasis can be very challenging because it could just be that the reptile's going through its normal cycle and we just need to be a bit more patient and let things happen.

So if the patient is quite bright and active and seems to be doing fine, then, you know, the presence of follicles or eggs and you know, on exam may not actually be an emergency. But if the reptile is showing signs of depression and lethargy, then they're likely to require immediate intervention to sort of fix this problem. And then reproductive issues, just as I know, obviously do tend to occur secondary to poor husbandry and sort of dietary deficiencies.

So when they are having issues, it's usually just because they've not been looked after in the best way. So it may be that they've not been offered an appropriate nesting sight, or it could be that, you know, they've got hypercalcemia, their eggs just haven't calcified properly, and they're just purely too weak to lay them. And how do we diagnose these issues?

Well, doing an ultrasound is really useful, so we can look for eggs and follicles, and also obviously assess for free fluid as well. So remember, obviously eggs or or follicles that rupture can result in a septic sla mitres from them, for them, which obviously is a very serious problem. And then X-rays really useful as well to looking for for sort of more calcified eggs.

And obviously you can see if they're present, you know, how many they are and where they're sitting as well. And also you can look for over calcified eggs. So if you've got eggs that seem to have a very, very thick wall, then that can be an indication that they've been in the overduct for just too long.

And when that happens, they can end up getting adhered to the walls, and then you end up getting, getting more of like an obstructive dystopia going on. So, you know, it's not gonna come out without assistance. As part of your diagnostics, you obviously can also do bloods checking for hypercalcemia, doing your CBC and your biochemistry as well.

And then to treat follicular stasis, if they're well, you know, I would consider doing things like improving husbandry, providing a nesting site, you know, contact with males, and things like that to see whether we can just get the cycle to continue, as it should be doing. But if they're sick with it, then obviously we're gonna need to do something else. So we, we would stabilise them first and then take them to surgery.

And you're either just removing the ovaries and the follicle, or obviously if the oviducts are involved as well, then, then obviously we take that out at the same time. And then with dystopia, obviously we need to consider if it's obstructive or non-obstructive dystopia that's going on. So say, you know, thinking about, you know, where, where the egg is, is it abnormal size egg?

Is it just too big for that reptile to pass? So, so if, if it does seem to be non-obstructive, then we have got the option of using oxytocin in some species. So obviously consider whether you need to give calcium supplementation, but then say oxytocin does work in Tilonia.

So this is a tortoise, that, that came to see us, that was having some difficulty and a jab of of oxytocin and sort of 20 minutes later she'd laid 3 eggs and so she was doing fine. . So say works in those guys, but it is rarely effective in our lizard species and it just does not work in snakes, so it's not worth not worth the effort in those guys.

So if you can't get them out, you know, if, if you can't get them out by medical means, then we sometimes we just need to try and manipulate the egg out of the cloaca, and you can obviously consider doing ocentesis as well where you pop a needle into the egg and drain out the contents, just to reduce the size of it and make it easier to pass, or otherwise, you obviously may need to take them to surgery and sort of do a caesarean and take the eggs out for them. So that's all from me guys. I hope that you found that interesting and I've sort of, you know, learned something, hopefully.

And I'm happy to take any questions now. Louise, thank you very much. That was absolutely fascinating.

And I think, I think it's not a question of hope you learned something. I think it was a question of learning something per minute as we went through. That was really fantastic.

Thank you so much for your time. Oh, you're welcome. Thanks thanks for coming.

We, we don't have any questions that have come through, and I think that's because your explanations were so clear and, and so precise. I mean, I personally have, have done some snake work and, and, done self pingotomies and everything else on them and, your, your tips and your tricks were just fascinating. It really, they really were.

Oh, brilliant. Oh, we've got a question that came through from Susan. She wants to know if checking for hypocalcemia, in reproductively active.

Oh, OK. I think that's half a message. But I, I, I'm guessing she's asking, would you check for hypocalcemia?

Yes, so you, you can, check for, for hypercalcemia in them. I mean you can use, a lot of the blood gas analysis machines, will often be able to run reptile blood, so you certainly can try that. So if you've got an epoch or a radiometer or something like that or an ISA, then it's worth, you know, you can, you can do that in an emergency situation.

Obviously, do do you remember that because reptile blood is a bit strange, you know, they've got nucleated red cells and things like that, a lot of our standard machines in practise just just can't cope with their blood, and so often we are having to send it out externally, . Instead to to sort of other, other labs to run things. So sometimes you obviously have got that delay, to know, you know, to know what's going on.

But obviously, you know, if you are worried about hypercalcemia, you, you can obviously start, you know, particularly things like, Zocal, oral calcium supplementation, things like that if if you're worried. Excellent. Susan has sent through the rest of her message.

She wants to know, would calcium, be high, even in hypocalcemia, when the, the reptiles are reproductively active? Yes, it certainly can be. So it's, yeah, it, it can be high in those cases.

I, I think it's always difficult unless you're, measuring it to really know what it's doing. But we will sometimes see sort of hypercalcemia just simply due to, them being reproductively active as well. OK, cool.

Catherine wants to know and I'm, I'm thinking this is a a whole drug talk on its own, but she's asked specifically what antibiotics you recommend in your reptile patients. So, so, generally, you know, sort of obviously Beryl, so our antifloxacin is licenced, so we, we certainly can use that. Otherwise, you know, for some injections and things like that are, are very useful because, with, with those things, you know, we can give them.

Via injection, and we can give them, you know, less frequently as well, particularly in those reptiles where it's really hard to give, oral, antibiotics. The other thing to remember with Bayres is it can quite commonly cause, abscesses when we're giving it subcutaneously. So, you know, it's something to, to sort of be very aware of and I say, you know, it's not generally something I do inject, you know, into exotic patients, because of the risk of abscesses developing.

Yeah, yeah. Been there, done that. You just it it it's one of those things that actually happens quite commonly, but you just don't think of it.

Yes, yeah. Yeah, fantastic. Folks, I know we've run over.

I'm really sorry about that, but I'm sure that you will all absolutely agree with me that tonight was fascinating and we would have run an even more a half an hour over, just to keep listening to Louise sharing her fantastic knowledge with us. Louise, once again, thank you very much for your time tonight. And we look forward to seeing you and welcoming you back on the webinar vet going forward.

Thank you very much. Thanks. And folks, one last reminder of our virtual congress, 22nd to 28th of February, 100 hours as members, you get it free, but you still need to register and you can click on that link or if you can't, .

That link then get onto the website and go and register. If you've got any friends who are non-members, convince them of their shortcomings of not being members, but tell them that they haven't lost out because it's just 99 pounds for those 100 hours. And that's it for tonight, to my controller Pam in the background.

Thank you very much to all of you for attending tonight. Thank you to and from myself, Bruce Stevenson, it's good night.