Hi, and thank you all for joining us this afternoon for our lunchtime webinar, dealing with a critical reptile patient. I'm Vicky, head of memberships here at the webinar vet, and we are joined this afternoon by our guest speaker, Dean Feller. Dean graduated from the Royal Veterinary College in 2012.
He went on to obtain his SARE AVP and RCVS Advanced Practitioner status. After working in the UK for seven years, Dean relocated to work in Hong Kong, an exotic animal-focused hospital. Although exotic animal medicine encompasses many species, his main passion is working with reptilian patients.
He has treated exotic animals at first opinion, referral level, and emergency out of hours. Dean is the founder and CEO of the online teaching service Exotic Vet Support, which aims to help vets and students of all abilities to provide the best patient care for exotic species. A big thank you to the exotic vet Support too for sponsoring this session.
So just a couple of things to mention before I hand over to Dean. The session will be available on demand from tomorrow morning, and you will see in the chat box, towards the end of the session, there'll be a short survey, which would hugely appreciate it if you have the time to fill out. And can I just remind you all to pop the questions in the Q&A box, and we'll come to those at the end of the session.
So over to you, Dean. Thank you very much for the introduction. And yes, thank you everyone for taking the time out of your day to come and listen to this webinar and the title, obviously, dealing with the critical reptile patient.
Quite frequent, quite frequent occurrence in practise. So I've tried to make this, both theoretical and also as practical as possible, so you can use it in your, day to day work schedule really. So.
I'll start off by going through the overview. We'll start off, what is the critical reptile. I think it's quite important to know what the critical reptile is, how they're presented, and what sort of critical patients there are, really.
So I'll cover that. We'll go through what initial steps you should, should cover, whether it's a, a true emergency, so something that's life threatening or collapsed, and also more of those chronically sick cases as well. We can go through some diagnostics, what will be useful, and what is essential really, and also some supportive care, fluids, nutritional supports, pain relief, things like this as well.
And I'll finish the session by going through some specific examples for us. So starting off, like I said, there's true emergencies, and I class true emergencies as something that's painful. So for instance, this, this ball python here, large, wound on its side.
Also life threatening, abnormalities or life threatening issues, so collapsed patients, respiratory disease, and also those that, you don't wanna lose that viable tissue, so we're talking more prolapses in this case. Yes, there's chronically sick patients, and the majority of what you'll see is probably gonna come under this category rather than true emergencies. And those are usually down to poor husbandry or diseases that have gone unnoticed and quite frequent with patients that don't come out very much or nocturnal.
So frequently snakes is a, is a common example there. It's also important to know when you're speaking to the client, what's actual genuine poor husbandry knowledge versus actual true neglect because either way you do need to have a conversation about that, but you need to sort of pitch it at the right level. So yes, we have this ball python which is the acute emergency or the true emergency, and we have this terrapin at the bottom, which clearly has not had the best husbandry.
The carapace is clearly abnormally shaped, and general metabolic bone disease is, is, is present here, as well as probably a number of other things as well. So how's the critical patients presented? Typically, like I said, they're usually chronically, chronically sick, so we're talking malnourished and dehydrated.
This bearded dragon, clearly both of those, you can see the sunken eyes, the, the dehydration, very malnourished, and that typical painful posture, eyes closed, hunched up, and most likely there's multiple, disease processes or diseases affecting multiple body systems here. I wanted to point out the difference what a. Typical sick reptile looks like compared to a normal, healthy reptile.
So at the top we can see the water dragon looking quite bright, head up, looking inquisitive, normal posture. Complete opposite to the bearded dragon at the bottom, it's looking very, very dull, again, ice sunken, head down, not looking very happy at all. Now what sort of diseases can cause or or end up with a critical reptile?
Everything basically, so, I'm not gonna go through all these on the side here, but I just want to point out, it's not usually for one body system, it can be renal, liver, respiratory, any number of these as well. Some of them are more obvious, trauma, some of them you do need to go digging to find out what is going on. Now, so what sort of initial steps do you wanna do, much like if you've got a collapsed cat or a dog, you want to triage it.
However, you probably do have a bit more time with a reptile compared to other exotic species. So birds, rabbits, very, very stressed, very, very quickly, and you literally just want to triage them, pop them in oxygen. You do have that, significantly more time with reptiles.
They tend to display stress as easily. So yes, you can absolutely listen to the heart, listen to the chest, take a res rate, take your heart rate, check, with, with lizards, snakes, palpate the slamic cavity, check the musculoskeletal system. But I'd say probably the most important thing is those basic ones.
Take the heart rate, generally 30 to 100 beats per minute, depending on the species, depending on the size. So you wanna make sure that's relatively normal, not low, so like 10 beats per minute or so. That probably will change what you do next.
But you do want to make sure you've got normal reflexes and don't forget weight. Obviously lots of people check the animal, but they don't always find out what the weight is. Very important for obviously giving medications, especially in emergency situations.
And also if you've seen the patient for a long period before, you wanna know, is this patient losing weight? Now, yes, you can triage yourself, and, you can maybe go undertake your history by yourself afterwards or before. However, depending on the hospital you work with or work in, you can actually do the examination yourself, maybe in a dedicated room, and you have maybe a nurse or if you're lucky enough to have vet assistants, they can go in, take a history, so you can get every or get all the information as quick as possible.
Now, no reptile webinar or lecture is complete without er including husbandry. But I'm not gonna go into too much detail about this because we've got more fun things hopefully to, to go into, but I do need to say. Temperature is extremely important, for all bodily functions, so you do need to make sure you record what their, what their temperature is and you can obviously let them know what it should be.
Equally, they need correct humidity, especially depending on the species, light cycles, UVB and you want to know what sort of feed the . The reptiles eating all the patients eating. Are there any supplementations?
Is the enclosure correct for this species? We have lots of, terrapins running around the room or the bathroom in Hong Kong. So clearly we do need to have like a dedicated, enclosure for them so they can sit there, bask in the, in the, in the hotspots, rather than just run around, like a lot of these, species do here sometimes, unfortunately.
Also, correct substrates. I want to make sure, if we all got a high humidity species, or a species that needs high humidity, you wanna make sure the substrate can reflect that and absorb and retain that rather than just dry very quickly. You wanna make sure species probably doesn't eat that one as well, and if, if it's on sand or, or, or some pebbles, and they're not passing faeces, you've already got in the back of your mind, OK, we could have an impact on here.
So in terms of, other initial steps, once we've done our triage or our physical exam, we've got our history. We want to. Move on, where do we go next?
So I feel like that's different for a. Semi bright responsive patients. First thing you should do is, well I've got this traffic light system just to try and make it as easy as possible, green being, probably should prioritise this.
You've got amber and red, probably a little bit lower down the list, and definitely green, top things you wanna do, you wanna be, after examining that, putting it into its preferred optimal temperature zone, which is just. The temperature it wants to be at, to be happy, nice and warm, make sure it's bodily functions are, are firing at its optimal rate. Also, you wanna make sure it's as stress free as possible, even though they are less stressy than birds and rabbits and other small mammals, you still want to make them as confident as possible as well.
So nowhere too louder and noisy and busy. Hopefully you've got like a dedicated, hot water or exotic ward for them. And when you put them in there, you can just give some pain relief, .
In terms of what the best pain relief is, probably morphine and hydromorphine have the the most data to support their effectiveness. So I always jump in with, with one of those. I generally go one m per gig, once daily, I am, but it depends on, on the, the situation really.
Non-steroidals, that's our mainstay for for most species. Now, one thing to bear in mind is, how many reptiles do you see that's well hydrated? Probably very few, to be honest, especially when they're presented with a, like a, a chronically, poor, poor husbandry, or they've been, chronically sick.
So just be careful giving non-steroidals to, to these patients. Either give morphine or hydromorphine, put them in their, their warm closure, stress free. And then we can maybe take some bloods and then just confirm that their hydration's optimal before you go ahead and use some nonsteroidals, anything that's something you need to jump in with straight away?
Now what do we do next? Oxygen, there's a little bit of debate about if you should be given, critical reptiles oxygen or not. I'll come to that a little bit later.
Fluid therapy, probably a good idea. Like I said, most of them are, dehydrated. So again, we'll cover that a little bit later, what's the, the best way to, to give fluid to each individual.
And we want to cover diagnostics. Now, diagnostics probably not the priority in most situations. However, you can get basics like a bit of blood, maybe some X-rays or an ultrasound, to get general health status and, and try and sort of work out what you're dealing with really.
Then lower down on the priority list, we have nutrition, reptiles, they've got such a slow metabolic rates, you wanna make sure they're well hydrated before you worry yourself too much with nutrition. But obviously it is part of the . The treatment plan, but just a little bit lower down on the list.
Same as antibiotics, if you feel like there's an infection on board, I don't see it being a problem waiting a few hours, to run some correct diagnostics, find out what the problem is, maybe take some cultures. A few hours is not gonna make any difference, to the outcome of the patient, in my opinion. And blood pressure, I've put that down there as well because.
I don't tend to do it too much, er I just find it's quite inaccurate, especially if you're seeing lots of small species. You probably, the, the cuff's probably not gonna fit too well. So practically, I don't take blood pressure too often with reptiles.
Now, that was for a responsive patient. If we've actually got a true emergency and the patient's collapsed, we wanna, again from our triage, make sure it doesn't have a heart rate, is it breathing? And if it's not breathing, we probably need to intubate.
A couple of ways you can intubate, or a couple of tubes I should say you should intubate. I like the cold tubes, which is, on the bottom right here. I just feel like you've got a good fit.
Obviously this section goes into the trachea, and then you've got a, a bit of a seal there. Just going back there, no, reptile has complete rings, so you don't wanna use a, a cuffed, endotracheal tube. Next one down is just a standard uncuffed endotracheal tube.
Just make sure if the patient's got a short trachea, and you've got a long tube, you don't accidentally just intubate a single bronchus. If you use a capnograph, you should be able to, confirm that you've got, that you're inflating both lungs. And for those tiny reptiles, maybe geckos, you can intubate with an IV catheter and just remove the style, and you can give, or you can ventilate that way.
And that's absolutely what we do. After we intubate, we can either use an ambu bag or we can use the anaesthetic machine to provide ventilation, intermittent ventilation. And then depending on the heart rate, depends what you do with your, your drugs as well.
Do we give adrenaline, do we give atropine, those are both viable choices. I tend to go, . Well, if you have an IV or an intraarsus, that's perfect, you can obviously go in with that.
If not, you can use adrenaline, down the trachea, just obviously make sure you dilute it 1 mL per 100 grammes of body weight of the patients. You can also go IM, but obviously if you've got no heart rates, it's gonna be difficult for, for the body to, to react to that. Doxopram, probably don't use very much, especially in reptiles.
There's a bit of controversy about it in the human literature and the small animal literature as well. Just bear in mind, it can, reduce blood flow to the, cerebral area and also can cause, or increase oxygen demand of the, of the heart muscle of myocardial as well. So just be aware of that.
So it's not my go to. Chest compressions, not standard in my opinion for er reptiles. The majority of them do not have a diaphragm, so you're probably not gonna find that your chest compressions are very, effective.
In my mind, you're better off intubating, ventilating, giving appropriate drugs if needed, and then go from there really. Usually, unfortunately, if it does get to the stage where there's no heart rate or the heart rate is very low, prognosis, unfortunately is very, very poor, but obviously by all means, give it a go. Now just looking at these images at the top here, we've got our, our red feed tortoise already incubated here.
I've just pointed out the, the trick here or the glottis for this, this python here as well, just so you know where you're aiming. Now, again, for true collapsed patients, we've got this, actually, very rare patient. This is a, a bicephalic, alligator snapping turtle.
So we've actually, we're actually CT scanned it first, just so we get our anatomy right to make sure there is actually genuinely two sets of lungs. So we've actually intubated both heads and we're inflating, both sets of lungs as well to try and sort of bring it back for us. One of them, we're on the.
The ventilator and the other one on the ambu bag. You can see both intubated and we've got a mouth gagging just so if it does wake up, it doesn't just bite straight through the endotracheal tube, so obviously safety there. Now in terms of monitoring, what do we use to monitor?
Not too much in my opinion. Definitely the most important is the Doppler, and we tend to use the, the pencil probe in Tulanian species, and we can tape it in place just so you've got that audible, that noise, so you know what the heart rate is and you, you're aware if it's dropping or if it's becoming more normal. Equally, other species, lizards, snakes, you can, again, tape a doppler on it, but just obviously the flat ones that are fine.
Pulse ox don't tend to find that useful in monitoring er reptile patients. Probably the skin or the scales are too thick and you don't get a true reading. You can use it for trends, but again it's not a go to equally ECG.
You can definitely attach an ECG machine to your reptile patients and that can give you some information as well. Now moving on to diagnostic testing, to be honest, it's probably not gonna change, what diagnostic tests you do through most of these emergencies. However, what you do with that information probably will change.
So let's go through what we can do. Starting off with the, the gold standard blood test, . One thing to bear in mind is of a normal patient, maximum of 1% total body weight is the volume you should take.
So if you've got 100 gramme reptiles, you can take 1 millilitre of body weight safely or blood safely. However, just bear in mind if they are dehydrated or they're hypovolemic, that percentage will, will drop, so you just take that into consideration. Now we're lucky enough to have in-house testing, so we can run, biochemistry in-house, haematology in-house as well.
But I know a lot of you may need to send those away, so that does make things a little bit tricky with the biochemistry. However, definitely you can do PCV total protein, you can do a blood smear, get a CBC. You can get lots of information from that as well, and that can actually guide you on fluid therapy as well.
Many of you may have an ISA machine as well that can give you some, electrolytes too. But I use it for ionised calcium a lot of the times, especially with my, reproductive, disease patients. And you can get, a reading of blood gases as well.
Now, blood gases can be useful, just bear in mind, there's not too much data or, or, or specific reference ranges there. So just, you just need to take that into consideration as well. Blood culture, I quite like doing blood cultures, but it depends on the situation, it's not really an emergency thing because it's gonna take a bit of time to come on through, so, I'll just put that in there cos it's a useful thing to do.
Now, where do we collect blood from? Most lizards quite easy, or probably the easiest reptiles to take blood from. You want to be going for the, the ventral tail vein, with bearded dragons and, and similar species, I just ask my nurse to, or vet assistant to hold the, the beardy up for me, and I go through the scales or in between the scales, midline, at quite a perpendicular angle, and as soon as I go in.
Put a bit of backwards pressure on and as soon as you get into the blood vessel, you get blood back. With comedians, you can actually do that as well. But I just prefer the lateral approach.
I just find it, yeah, it's just easier for me really. And when we are, doing these blood samples, just make sure you prep the skin area. We tend to use iodine, but whatever skin prep you prefer.
Now a gecko's a little bit different, a little bit more tricky because I'm sure many of you are aware, they can drop their tails. So we tend to avoid the tail vein as much as possible. My go to is the jugular vein.
You can see it obviously located on the bottom left here. Quite obvious, and if you restrain them correctly, you should be able to get a good blood sample from that as well. However, if they're quite debilitated, might not be so easy, or even if they're quite wriggly, might not be so easy either.
So, another option is, do we take blood from the tail vein? Obviously dropping the tail is a conscious response. So if we make them unconscious, put them under an anaesthetic, then hopefully that reflex, is not present anymore.
I've done it a number of times, never had a problem, but obviously you've just got to wear, we've got to make the owner aware that there is that possibility it could drop. Now just to let you know, what can happen is. Yes, unfortunately the tail can drop off, just point out, this wasn't my patient.
One of my friends sent me this, but that's, what can happen if you, take blood from the tail or you handle the tail too much. It's just one of their responses you need to be aware of. Chilean species, jugular vein, definitely the, the best, site to obtain blood from.
The right jugular is generally larger than the left, so you can always go for that one first, and it's located, obviously the side of the neck. It's usually roughly in line with the panic membrane as well. One difficulty you can have is if the patient is too big or too strong, you might not be able to extract the head, from the shell very easily.
But if we're talking collapsed patients. Should be pretty easy because they're, they should be quite weak unfortunately, by this stage. Now there are other sites you can take blood from.
We've got the subcapacial venous sinus here. You can also go dorsal tail vein in these species. Just bearing in mind, you can see this blood is quite dilute.
We've probably got some he hemodilution there. And in terms of what hemodilution is, it's probably you've advanced through a lymph vessel, and you've just diluted your sample. Not ideal, but you can, there are ways to work around it.
So I've taken blood from Suatta with both of these, blood samples here. The first one, I advanced a needle into the dorsal to vein, and I drew back and I got, obviously I I a diluted sample. I didn't believe that was correct, so I just advance my needle further, drew back, got fresh blood, left the needle in place, and you can just remove the syringe and, put a fresh one on, and then you've got your, your better sample.
There may well be still some. He hemo dilution there, but again, you just need to take that into consideration, you need to be aware of it really. Now snakes, ventral tail vein is probably the, the go to for snakes.
However, smaller species, it can be very, very difficult. And also you do have to be careful because the scent glands and the hemipene extend quite far in male snakes. So just be careful, again, take that into consideration.
So the other option is cardiac puncture. I always anaesthetize or sedate the patient, and I use the ultrasound scanner to, to locate it, stabilise it with your thumb, and obviously you can obtain it that way. Just don't go poking around too much because obviously you can cause significant trauma.
Other diagnostics go to would be imaging, radiography, obviously, quite easy to do. Lots of reptiles just sit there for you and look at you whilst you take the X-rays. But if it is particularly wriggly, you can put it in a little box and take the x-rays that way.
Sometimes you can tape them, just be careful you don't need to struggle and fracture something if they've got metabolic bone disease, but generally. And get some good views, with lizards and snakes, you want a DUV or a dorsal ventral and a lateral view with tortoises or chile on you in general, you can add in a, a cranial cordal view to check those lung fields to see how symmetrical they are. That's absolutely what we would check, we would check the lung fields, we'll be checking for eggs, and also any fractures, as well as other things, obviously, as well.
Ultrasonography, very useful. We'll be looking for free synomic fluids, any pericardial effusion if you're worried about heart disease, and frequently, I'm sure you're aware, we do see lots of, of follicles as well. And then CT we're starting to use CT more and more now.
You can see we, we do a pre and post-contrast CT, with all our reptile patients. Just make sure they're not dehydrated or too dehydrated because you shouldn't really be giving IV contrast, it's, it's contraindicated in in significantly dehydrated patients. So again, just make sure you're aware of that.
Imaging, continuing on to that, we can do endoscopy. The previous three, X-rays, CT, and ultrasounds. You just get black and white images.
With endoscopy, you get obviously colour, you can do biopsies, you can do sampling. So huge, benefit of, of this method as well. And we can see top right corner, we've got this, this terrapin blood coming from its nares.
We don't know where it's coming from. Is it trachea? Is it oesophagus?
Is it stomach? So we can certainly put our camera into the trachea. This is a normal terrapin for reference, and we've gone down and you can see the bifurcation there.
With this one, we can see there is blood in there. So most likely it is coming from the respiratory tract. True, it could be aspirated, but, this one did have significant pneumonia.
Now also, we can do a gastroscopy, have a little look into the oesophagus, have a little look into the stomach as I'm doing with this tegu here. And we can also do a cloeoscopy as well. So, pop in the rigid scope into the cloaca, and usually advance into the bladder, and they've got a thin bladder lining, you can actually see into the salamic cavity.
I've got a little video for you of that later as well. I just mentioned a few other diagnostics because it's quite important. Faecal samples, quite easy to get, and you can do those in house, get a quick answer.
Is there endoparasites present? And also you do want to be getting your, samples, you want your cultures and cytology, if you're worried about, infection or inflammatory processes, and you need to be aware of, obviously mycoplasma may be around, and also some viruses you may need to consider. Testing for as well, but again, these aren't gonna be emergency situations, it's gonna be.
A few days before you get your results. Now fluid therapy, mainstay of emergency care, how do we assess if our reptile is dehydrated? Sunken ice is a big one, probably if it's reached this stage, probably they're at least, well, around 10% dehydrated.
Also, we can do skin tint as well, not as reliable as other species, but this, bearded dragon, I literally did the skin tint, and I had time to pick up my camera, take a photo, and it was still, had that significant skin tint there, so quite hap, quite happy, quite confident to say that it was dehydrated. And again we've got thick tacky mucous membranes here. Now, even though those are great to look at hydration status, you actually want to be able to get a more accurate reading and especially for monitoring purposes as well.
So you can generally be guided by your PCV and your total protein. Other parameters, uric acid, for instance, are useful as well, but as a minimum PCV and total protein. What type of fluids do we give, if you're in the UK, apartments, we use lactated rings over here, very little difference.
So that would be my, my go to really. Lots of vets do have a saline and dextro saline concoction. I don't generally use this.
Maybe it works for some vets. I just generally stick on my lactating and ringers. But you can use blood products as well.
Depends on the situation, whether a blood transfusion's needed or not. But just a little side note on blood transfusion, I don't do too many, what's the indication? They do very well with very low PCVs especially if it happens over like a, a slow period of time.
So chronic illness, you're probably not too bothered by it, to a certain extent, obviously you want to correct the underlying cause. I've seen tortoises with PCV 5% running around, so they do cope very well with low PCV but I would, I would use it for acute blood loss. I think that's where it comes into its owner.
Now in terms of how you do a blood transfusion, obviously you wanna make sure you've got a healthy compatible donor, and by that I mean. You wanna make sure there is close to the species that you're transfusing, ideally from the same household, so less chance of transferring other diseases as well. And you do wanna do a bit of a cross match.
Now ideally you want to do a major and minor cross match. But you can do a modified version where you just take a drop of blood, or whole blood from the, from the donor and mix it with two drops of serum from the recipients, and you're aiming for it not to clot within 1 minute basically. So as long as that's done well, then you can obviously go ahead and do your blood transfusion collection and .
Transfusing, pretty much exactly the same as you would have a cat or a dog, but just bearing in mind, we do need to be realistic about these transfusions, it's not. Gonna save the patient unless you treat the underlying cause. So in terms of how much you're gonna increase your PCV by, realistically, it's not gonna go from 5% to a healthy 25%, you're probably gonna get it up by maybe an extra 5% or 7% or so.
So just bear that in mind, and yes, like I said, treat the underlying cause that's, that should be your, your main goal basically. Now other fluids, lots of . Debate of differences between what maintenance should be.
I generally go by 10 to 20 mL per kilo, per day is sort of what I would count as maintenance. And if they're severely dehydrated, I would say maybe go up to 40 mL per kg per day. I wouldn't really go higher than that because you don't want fluid overload your patient.
But for a short period of time, 2 or 3 hours, you can use, maybe 3 to 5 mL per kg per hour. But again, don't go beyond the 40 mL per kg per day mark. As you're using whole blood for the blood transfusion, maybe go for 5 to 10 mL per kg per hour as sort of the, the, the, the end goal.
However, much like with cats and dogs, when you do blood transfusion, keep it slow at first. Maybe start at the 5, mal per kg per hour, and then monitor the, the patient. Make sure they don't have some increase in heart rate or rest rate.
They don't become agitated, if they do obviously stop the transfusion. Bonuses, I don't tend to give bonuses very often, but you can use, crystalloyd's bonuses, again, 5 to 10 mLs per kilo. And in colloids, again, I don't really tend to use colloids.
I feel like if they're significantly dehydrated, do you want to be taking more fluid away from the, extravascular space and bringing it into the, into the, the circulation. Maybe short term wise, if we've got a hyperalemic patient, that's great, but obviously just make sure you, you follow through with crystalloids as well. You can use hypertonic, bonuses as well.
Again, that's something I tend to do, and again, make sure you follow up with, appropriate, Chris Lloyd, therapy as well. Now, where are we gonna give these these fluids? You can give by mouth, not something that I I tend to do, but obviously you can give that in in all these species.
Most of them are similar, but I'll just go through the the main differences here cause it's quite a busy slide. With Chionian species, if we're talking, IV, we're talking jugular, intraosseous femur, which is quite different, well, quite different. It's different to, lizard's where you began the ventral tail vein and the tibia.
Also, with all three species you can go, intraslamic, and with, epi with chilean species you do have an extra epiynomic cavity, which is the cavity in front of the yum, which includes the heart. But just to go through these in a bit more detail. Starting with oral fluids, honestly, very rarely use it.
The only reason I would use it is if we've got, dehydrated ingestor in our digestive tract and you want to soften that rehydrate it, that may help things pass through. It can also be physically difficult if you have a, in cooperative tortoise. It just wants to hide away.
And, obviously the more fluid you put in, less food you can actually get into the body as well. Also, patient safety can cause trauma to the oesophagus, the oral cavity. It's got metabolic bone disease, you don't want to be yanking the, the tortoise's head out as well and fighting with it.
You can cause trauma that way. And certainly it's gonna be stressful for the patient as well. So, generally try to avoid it, but it is an option if you need it.
Now, if we're talking . What should be ideal? Yes, you absolutely should be giving, IV fluids, not the easiest to place an IV in a reptile.
Most of the time you can't see the, the, the blood vessel, especially with tortoises. And they've got so much loose skin round there, it can be difficult to, to place the IV. That you can place jugular in tortoises, tail vein in, in, in lizard species as well.
Snakes, you can try the, the tail vein too, or you can actually use the palatine, vessel in the mouth as well. Obviously they need to be sedated or, quite collapse for you to access that. Now obviously you're gonna get your, your 100% distortion rates, and you can .
Give as much fluid or as little fluid as you want that way as well. Drawbacks being what I've mentioned, difficult to access in the collapsed patients, and sometimes maintaining the catheter can be difficult. Tortoises when they just tuck their head back in, it can dislodge or keep the catheter.
As always, risk of haemorrhage or, or infection, . Now, intraosseous, probably my go to for a lot of lizard species. I just find it, it's great, like the IV catheter, but I just find them easier to, maintain really.
So I go for the tibia quite a lot in, in lizard species. Still, there's risk of infection, and also, unfortunately, a risk of, causing trauma to the bone, especially if they've got metabolic bone disease. It can cause damage to the articular surface, or, of, of the, of the joint.
Painful, maybe a little bit painful, but obviously try and cover as best you can with pain relief. I generally give morphine, ideally a few hours beforehand, but obviously we need to take that into consideration. I've done a quick little video for you, of how to place an intraosteous catheter.
So I've already prepped this, this leg up, with iodine, just give it one final scrub, and then I'm just gonna do a bit of a local block with, with lidocaine. So just around the joint there. And then I'm just gonna give it a few minutes to take effect.
Then we go ahead, give it a bit of a another scrub of iodine. And then we're gonna use, I generally use a hypodermic needle, you can use spinal needles. I call it a hypodermic needle, just make sure you fill the er the needle with fluid just so that you don't get a bone core in there.
And you just need to sort of rotate the the needle in until you're into the the cavity. And then you can flush a little bit just to make sure you're in, you can move the the needle around just to make sure the whole limb is moving. Just to confirm that really.
Obviously you want to take X-rays, but er initially that's what you wanna, wanna be looking for. And then unscrew the syringe and I just feel a little bit of fluid in there just so you're not putting any gas into the the intraosseous. There we go.
There we go ahead, take our views, you want orthogonal views, and these ones correlate to these, these X-rays on the side here. You can go ahead, tape it in place. We've got a bung on here.
You can use a butterfly catheter to place in there and you can put it on a syringe driver, pump, whatever's most suitable for that patient. And finally we've got intrasalamic fluids. One thing to note about this is, I think it's great, it's probably the most common route I use, but you do need to be careful about damaging internal organs.
You wanna make sure you rotate the patient's side, like in this terrapin, so you put it on its side and then hopefully the organs fall down the opposite way, so you've got less chance of perforating them. And obviously you don't aim too high cos you've got lungs up there as well, so just be careful. Snakes, you can go about 2/3 of the way down, snout to, to vents and just going between the lateral and and the ventral scales, and with this beardy, they've got quite loose skin, so you can quite safely pinch up a bit of skin and give some fluids that way.
As I mentioned, terrapin tortoises, they do have an epinomic cavity. And some studies suggest maybe it's absorbed a little bit better that way, so you can give in the front half. I don't think it makes too much difference in the, at the end of the day, but I generally give it this way, if we're worried about reproductive disease, we've got a load of follicles or or eggs inside us, you don't wanna be, damaging anything.
So I'd go in the epistyomic route. But again, downsides, you have that, risk of organ perforation, infection, you want to be scrubbing these before you, inject fluids. Also got repeated injections, so it might be painful and patient compliance might be compromised when they know what's coming.
Subcutaneous, not ideal in reptiles because of the slower absorption rates, but, it is less invasive, you're not gonna perforate any organs, so less risk there. I like it with little geckos because I feel like they're. Skin and muscle around the abom's quite tight, so probably a bit of a greater risk of giving fluids in slamically.
So I just go, there's a little bit of flap, there's a flap of skin behind the, the forelimbs, just make sure you restrain correctly, so you're restraining the patient, you're supporting the spine, you're not touching the tail because we all know what happens then, and you're holding the forelimb as well. You can either use your fingers or you can just ask an assistant or a nurse to, to hold for you, and you can just give the fluid that way there. And water bathing, probably the least invasive.
You just put them in a, a water bath and you can add things like reptor boost, which has got electrolytes and multivitamins in there. They can drink that or elonian species can take it up into the bladder and absorb, fluids that way. Just bear in mind, you're relying on the patient this way, so you're obviously physically not putting it into the body.
And if they're too debilitated, nothing's gonna happen. So just bear that in mind as well. Now when it comes to nutritional support, as I mentioned, obviously rehydration, you prioritise that first.
If you just go ahead and feed them straight away, the food's probably just gonna sit in the guts and rot away, so not ideal. Rehydrate, and then maybe the next day you can give a small feed, and, sort of build it up slowly. They've got such slow metabolic rates, it's not gonna be a concern really, by delaying feeding by a day.
They've probably not been eating for about 3 months anyway, so, 1 day's not gonna make a difference. In terms of how we do that, we can syringe feed, so we can just syringe, a little bit slowly into the mouth. Just bearing in mind, if they've got metabolic bone disease, you don't want them to be munching down on that, syringe.
They can fracture their jaw, so just be careful about that. But geckos, bit of dragons, you can syringe feed. Gauge tubing's probably more applicable to Chilean species.
Just make sure the garage tube goes about halfway down the platron, and then you can, that's as a guide, make sure you lubricate your garage tube and you can start feeding that way as well. Obviously we can place an OTube as well. I just do a a Chinese finger trap to, to secure it in place there.
And then that's a nice stress free way to to give food, some of the medications down there and we just confirm it's placement with a contrast X-ray as well. Now refeeding syndrome is a real thing with exotics and reptiles too, so that's why I say start off slow. You can start off at 5% of body weight, you can even start slower than that, even 0.2% of their body weight.
It just depends on the species, their presentation, and the length of anorexia as well. There is a calculation for maintain maintenance energy requirements. Honestly, I don't use this very often.
I tend to just start off slow and then build up to maybe 1% of their body weight, to twice a day, and then hopefully they start eating and maintaining body weight themselves. Some vets give up to 2% body weight, that's fine, personal preference, so I think we need to sort of overload the, the digestive tract at this stage. There's more important things to, to sort of concentrate on there.
And obviously supplementation, you can give injectables, ADC and B complex, probably the two I give mostly. Just bearing in mind you shouldn't be giving A or vitamin A to herbivorous reptiles, can cause, vitamin A toxicity, skin sloughing, which you don't really want to be explained to the owner. So just be careful giving vitamin A to, to herbivorous reptiles, but I do give it to.
Omnivorous and carnivorous reptiles if I feel it's it's needed. Also you can give oral supplementation, calcium, er, by mouth is, is a common one we use. I've just got two examples here of critical care formula that we like to use the MAD one, I think that's great.
And also we use the Oxburg Critical Care 2. There's other good brands out there, but those are the two that I use. Now just to go on to some case examples, I've tried to choose some, some interesting cases for you, so let's start looking at those.
So trauma, probably one of the biggest traum emergencies that we see. What are we gonna do first? Yes, we're gonna triage like we said earlier, we're gonna stabilise, give supportive care, and what diagnostics are we gonna do?
Blood work, imaging, culture if needed, so that doesn't change. So we've got one example here, this is a rat bite in hibernation, so tortoises tucks away and the, the rat just bites through the leg. So obviously you make sure, you speak to your clients how to hibernate correctly, big thing in the UK.
This is a tortoise that's been chewed up by a dog. You can see, typical, painful, eyes closed, not a very happy looking tortoise at stool. I think dogs don't really mean this, they just think it's a toy and they start chewing it.
So again, a common presentation in the summer, summer months really. This is a gecko er that fell off the table, er and obviously damaged its tail. And then this one's an interesting one, this was a, a dwarf crocodile, that had a fight with its cagey mate and grabbed, twisted and obviously fractured the femur.
Obviously CT scanned that and got a nice 3D model. So, obviously, pain relief is a big thing here. Antibiotics in some cases, yes, probably these two, rat and rat and dog attacks, these other two, probably not so much, as long as it's .
Kept clean. You can, it's not wrong to jump in with antibiotics here cos it's a, a nice big open wounds, but maybe it's like topical cleaning, and ointments would be good enough here. And obviously, wounded bridement and care if needed, definitely with these two, and fracture stabilisation and fixation if needed as well.
Here's a recent case I had, er, in fact last week, and I saw this patient again today. This one was the, the bull python on the first page. It was actually fed a live rat, which obviously frowned upon slash illegal in lots of places, so you have that chat with your owner.
So the rats started eating the snake, damaged the eyes, some superficial wounds as well. So straight away we jumped into some morphine. I took some cultures from this, this area as well.
Then we immediately sedated him, or her, I should say, and we flushed the wounds. I started flushing with eth antiseptic solution, and I generally hold the snake upside down, reason being if there is a. Hole leading into the slamic cavity, you don't really want to be flushing gun infection in there, you want it to be dripping out, so flashing with some F10 there.
And then I vince off with saline er afterwards as well. So we have nice clean wound here, unfortunately you can see spine, you can see ribs, quite a big deficit there. So this is gonna take months to heal.
I did have a chat about euthanasia to this client, but he wanted to give it a go. So obviously hospitalised for a few days, pain relief, antibiotics. And we've put a dressing on here, hopefully you can see this, I've put some non-absorbable suture material loops here and then I've just er stitched .
Addressing over that. We have used a hydrogel here. I quite like it in non-infected, wounds.
I've got some good success with those with reptiles, so highly recommended. And then, yeah, we wanna do some diagnostics. Ower was a little bit money concerned, so only allowed to do some bloods, so we, like I said earlier, we ultrasound the heart just to make sure we know where we're going, we don't wanna keep on jabbing, the snake gonna cause as little trauma as possible.
So, I've Lennox here holding the sedated snake for me. I've gone and cleaned it with some iodine. And I'm just gonna use my left hand to stabilise the heart and then I'm gonna go and take the sample.
Just bear in mind you wanna go in between the scales, midline, just so you don't damage the actual scales themselves and hopefully you're in 11 poke and you've got the, the sample that way. Also I'd say probably don't use too large a a needle or a syringe just because you don't want to have too much of a negative pressure on the heart. There we go, obviously put some pressure on afterwards.
So I do find it quite straightforward, and yes it is invasive, but at the same time it's just one needle, so, I've not had too much of, or any problems actually, touch wood, with any, cardiac puncture sites. Now here we've got another traumatic injury. This is day one, this still car has fallen off the table.
So we've given it a nice, nice clean and everything, and this is what it looks like on day two. So we have given it a good clean. I used the Hydrogel as well.
And just to stabilise it, we've put, some people use screws and wires. I just quite like using it like an epoxy and you just include the the cable tie there and you get either side and you just pull them together, and that stabilises the, the shell fracture quite nicely. Obviously you wanna do, daily cleaning, daily dressings at first.
And then you can see how well this has healed. This is 2 weeks in, you can see, it's actually looking a lot cleaner, and actually the granulation layer is, is already present. And then at 4 weeks, it looks, looks pretty good.
It's got a, it's watertight basically at this point. No rush to take off these, cable ties. It's not invasive, not causing any discomfort, so you can actually leave it on for months if needs be, and then you just take them off.
Obviously, we want to do our diagnostics, bloods, imaging, and we've done this CT here, and you can see the fracture sites where these blue arrows are, and yes, there's been some bleeding into the soft tissue layer underneath. Luckily, not into the lung field, but you can see, it is, compressing the, the lung field at this, at this point here. Now we did have the option, do we.
Remove a part of the shell and go cleaning that out, you're probably gonna cause more trauma than good, so you can repeat the CT later or or X-rays later, and see or just monitor what's going on there, but I didn't have any issues with this tortoise afterwards. Foreign bodies, lots of foreign bodies in reptiles, substrate is probably the most common one. Maybe they feel like they're lacking certain minerals, calcium, so they can eat sand, they can eat stones and pebbles.
This gecko, obviously ate quite a lot of sands, and then it got stuck in its cave and the owner tried to pull it out and it got caught, so we've got that lesion there. This one needed a celiotomy to, to remove the sands. Clothing, socks can be eaten by big silatters, metal.
Now lots of times these just pass through quite nicely. So the sock passes through the silkatter nicely, the, nuts and bolts can, they're not, sharp. Just wear fish hooks and screws.
Yeah, they can start to cause some trauma, so you don't have the option, do you jump in with a, an endoscope, try and fish them out of the stomach, or do you, perform a celiostomy and, and try and remove them that way. I've had fish hooks pass through, not causing issue, but obviously not all patients are as lucky. And here's a tortoise with some stones that's causing obstruction.
Clinical signs, quite nonspecific, anorexia. No faecal outputs, sometimes just less faecal outputs, sometimes they're just lethargic, but obviously do the diagnostics to find out, yes, they will be painful and most likely they'll be straining if it's towards the cloaca as well. And yes, we've just gone through those.
Constipation or obstipation is a big one, probably caused by chronic dehydration or in inappropriate husbandry, too cold environment, for instance. The GI tract just slows down and yeah, more fluid just gets absorbed by from the GI tract and it's just impacted feed them, or inappropriate diet, lack of fibre. So again, we do our investigations and then we do our medical management, stabilise, fluids, pain relief, whatever else is needed.
You can use warm water bathing, that can help, some, some, reptiles pass, mild to moderate obstructions. You can use fluids, like water, like I said earlier by mouth. You can even place a feeding tube to, to use this, and you can add in some lactulose to help with the passage.
Vibration therapy, we use vibration therapy in quite a lot of our species. You can let your imagination run wild with what sort of equipment you use. We've got a few of these lying around, so we use these for our tortoises, but equally, you can use.
A pair of clippers, just obviously make sure it doesn't overheat. And you can use the vibration therapy for maybe 30 minutes or so, 3 times a day. Just make sure it's not had surgery, because obviously that might be uncomfortable, so it's have a plastrootomy, don't use vibration therapy.
Most of these unfortunately do end up in surgery cases, so you can do a celiotomy or plastrootomy or sometimes prefemoral approach in a Chilean species as well. Sort of following on from, obstructions to dualists, they can get stuck in a cloaca. Again, we've got generic signs, anorexia, poor faecal output, pain, sometimes, and again, more specifically, straining, or you can actually see a bladder stone, at the, at the cloacal sites.
Treatment wise, or I should say actually diagnostics doesn't change, blood test imaging, and then we go ahead and, and stabilise with supportive care as well. Couple of ways you can remove the stone, manual breakdown like I'm doing here, just make sure your boss doesn't mind you damaging a pair of forceps. Hopefully my boss is not watching.
But yeah, just make sure you can, . Use an old pair, for instance. So forceps are good.
Alice tissue forceps are great as well at eating away at the, the, the al stone. You can also go in, if it's further in, you can use endoscopic assisted, looscopy, use the camera and then go and grab it and break it down. Or you can actually do proper surgery, go and prefemoral or a plasterotomy.
Just bear in mind if you see one stone here, that does. There we go. That does not mean there's not another stone there as well, so another reason you want to be doing survey radiographs here.
Another obstruction, this one initially looked like a, a bladder stone as well. In fact, after we took the X-rays, we've just got highly calcified egg here, or lots of eggs here. So we actually had to use a drill, to, to break this one down.
We did try, and remove it, but it was not budging. So, and it wouldn't even break down. We actually had to use a drill to drill through it, and then break it down and remove it in pieces.
And that allowed others to pass, and we just did the same with them as well. Just bear in mind it doesn't go without trauma. These are severe ulcerations to the clinical lining, so again you just need to be aware of that.
And just going through diagnostics, much the same as before, and again, very similar to the Eurolifts, you can stabilise and supportive care, and then you've got the same options to, to break it down, break the eggs down or or physically only remove them. This is definitely more common in Tilonia species, very relieved you get this in lizards or snakes. But .
When we will move on to . More normal eggs, I should say, or reproductive disease. Lots of these aren't emergencies, but I'll just touch on them because it's so sort of common.
I'll split this into pre or post obuly disease, so pre-ovulatory being obviously fol follicles, post ovulatory being obviously these eggs here. Again, you wanna be running your standards, X-rays, ultrasounds, ideally endoscopy into the bladder. Which we have here.
So you wanna do the ultrasound to look for follicles. CT again this shows follicles, pick up some eggs as well, and if we go in with sort of endoscopy. You can see this is actually already in the bladder.
You can see how thin the bladder lining is. You can see all these follicles, around there. You've definitely got significant disease here.
You can see others coming up. And when you back out, you can actually see there's also eggs present as well. But I would do X-rays and ultrasound or or CT before this, but this gives you more information as well.
And yes, as I said, haematology, biochemistry, essential in all, in all, workups. And again, I said earlier, ionised calcium, very important here. To manage these, obviously you wanna correct the underlying abnormalities, whether it's nutritional and fluids, electrolytes, is there any other disease processes that's preventing him from, or her, from passing these eggs?
Analgesia in some cases, definitely is an obstruction. Probably a lot of the time you don't need analgesia, if it's just a standard tortoise that's not laid its eggs yet, probably not gonna be too painful. Just a note with calcium, glucinate and oxytocin.
Lots of people jumping with this. Just be aware, if the ionised calcium is normal, probably not gonna get a benefit of injecting more calcium into the body. And actually it can be quite detrimental if you've got higher phosphorus.
And you're injecting more calcium into the body, you can actually mineralize tissues with this. So, so just be aware of that. You, you do want to be running a, a blood profile first, not just jumping in with additional calcium.
Oxytocin is great, minimal side effects really. However, very effective in Chilean species, not so much in reptiles and snakes. So just bear that in mind.
You should be taking x-rays beforehand, just so you know there's not a, an obstruction or anything else going on, because you can definitely run into problems with that. Digital removal, absolutely, you can see we removed these two large eggs from the snake, managed to do it conscious in the consult room. Owner was very, very happy, no sedation required.
However, sometimes if that doesn't work, you do want to relax the patient, and you can just use some, sedation agents or, or even a full anaesthetic just to relax everything and and move those eggs out. Just be careful, you don't push too hard, very easy to rupture these or even the oviduct itself, so just be careful. Sometimes again, these do go to surgery, celiotomy or plasphotomy.
Touching on follicular stasis, these are frequently presented to us when they're very, very sick. Obviously short term, not a problem. Chronic cases, yes, they can be septic, they can have, peritonitis or, or selomitis, and can be a nutritionally, critical really.
So as always, stand work up, stabilise, find out what's going on. And then you can perform surgery, either plastronotomies or you can do your prefainal approach there. But obviously you want to avoid surgery as much as possible.
If I saw some follicles, and ultrasound scan, I wouldn't immediately jump in the next day for surgery. You can monitor these because you don't know if it's just normal follicular growth, or is it genuine follicular stasis, basically. So maybe repeat the scan 2 or 3 weeks' time and see what the follicles are doing.
They may well be regressing, in which case no surgery requires. Just touching on true emergencies again, prolapses, probably the biggest one we, we, we see, trauma and prolapses, yeah, quite frequent. Number one thing you have to do, identify what tissue has been prolapsed.
Easier said than done. Now phallus, hemipes, quite obvious, however, it's easy to mistake OV ducts and GI tracts. You do need to differentiate between those two.
And bladder and ovarian tissue can be prolapsed, very infrequently seen though. But here's a, a tortoise penis, been prolapsed. You can see the tissue here is unviable.
And this hemipe in the Euromastics. This has quite a distinct shape, so quite easy to tell a penis on the tortoise. With, hemipee, you can actually see a unilateral, so they're off to the side and you can, you can use your thumb to pull the cloaca down and you can actually see where it's coming out from.
So, this is definitely gonna be hemi peeing. You just wanna make sure everything's kept lubricated before, you do anything really. You wanna keep the tissue as viable as possible because you don't know what you're gonna do.
Are you gonna try and replace it, are you gonna amputate it? So just keep it well lubricated. And what we tend to do, we tend to use sterile lube in a, in a glove, and we just tape it to the back end, provides a nice environment, and then no irritation if it's running around as well.
Yeah yeah, number one, you want to find out what the underlying cause is, why has it prolapsed, and then you can either replace or amputate. They don't need their penis or hemiene for urination, it's just a reproductive thing in reptiles, so you're quite safe to to amputate these other than standard, anaesthetic and, and surgical risks. Now what do we have here, can be difficult to tell whether it's OV duct or or GI tract.
They do tend to have a bit of a difference of texture, or consistency, but if you wanna, if you know it's got eggs, you've taken some X-rays, you can quite easily put a, an endoscope in there. And carefully sort of go through and if it's over docked, you're gonna have eggs in there, so we can go through and safely confirm. Yes, this is indeed overly ducked.
Alright. Now what else do I say, bladder. So we have bladder down here, very thin wool, quite easy to differentiate but very rare.
This is just cloacal lining that's come out with it as well. Very poor prognosis, unfortunately. We did try and replace this one, so I pushed it back in, using endoscopy, and it, the body literally suctioned it back up into place, which was great.
Then we did a purse string suture. Unfortunately, when we removed the purse string, it did reprolapse again. So this one unfortunately was euthanized.
And this one as well, ovarian tissue being prolapsed, very poor prognosis. It will need a, surgery, celiotomy, and remove the oviducts and the ovaries as well, but yeah, poor prognosis when with both these cases. Now final thing we're gonna cover is respiratory disease, it does vary, the severity, sometimes runny nose, sometimes watery eyes, and most of the time these are bacterial infections, can be mycoplasma as well though.
So I would say, obviously you do your diagnostics for, for all these really. You can get much much more severe cases, open mouth breathing, this is not an aggressive snake. This was a, respiratory or a dyspneic, emerald tree boa, and then bearded dragon as well.
And in his case of like quite. Don't know if you could hear that. It's quite a significant wheeze with this guy and you can see neck extended, that is very significant pneumonia going on as well.
Now, do we use oxygen in the reptiles? A lot of the time, no. So if we have a sick rat or a sick bird, we put them in oxygen straight away a lot of the time.
However, reptiles are generally stimulated to breathe if they have low oxygen tension or high, carbon dioxide within their body. So if you are giving them lots of oxygen, they're probably not gonna breathe so frequently, so probably not a good idea. However, if they're open mouth breathing, yes, they're obviously lacking oxygen, and you can go and, provide it via face mask.
I'll find that the least stressful way. If they collapsed, like I said earlier, intubate and give them oxygen that way. And, I would start off at high oxygen if they're collapsed, then gradually taper down to try and at least stimulate them to breathe by themselves, but they will be on, the, IPPV anyway.
Obviously really stress as much as possible with all respiratory cases. Now what workups do we do? Much the same, haematology, biochemistry, that's not gonna change.
We want to find out how bad the lungs are, or is even the lungs, it could be elsewhere, it could be upper respiratory tracts. So we want to be doing our radiographs, ideally CT endoscopy, we could go down the trachea, and there's other ways you can, you can examine the lungs with endoscopy as well. As always, we want to be using antibiotics, we wanna be, guided by our culture.
So lots of times I will do a BAL, or even a lung wash or a nasal flush, and take samples that we can send to the lab. Definitely cultural sensitivity, and ideally you want a cytology as well, just to confirm. That's the actual inflammatory response and causing the disease there.
Now one note, these actually can be therapeutic, so if you do a BA or a lung wash, you're actually clearing those lungs out, and, same with nasal flush your, you're flashing the nays as well. Now a couple of ways we can do these samples. If we've got nasal discharge, we can do a nasal swab.
Is that gonna be that useful? Maybe, but you're gonna get lots of contaminants there. Much since we have this ball python, or a snake in general, respiratory disease, lots of fluids coming up.
Ideally, you want to be doing a BAL to, to sample the airways. But if the owner doesn't want to do an anaesthetic, or they're worried about the risks, then you can just maybe syringe some of this out, or just use a, a swab to, culture this area. But again, you're not getting the, bacteria direct from the source, you're just getting contaminants there as well.
Again, it may be useful, may not be. Ideally you want to do a BAL and you can put the sterile red rubber cast down there or or in the tracheal tube and then you can use the urinary castheter to go down there and take a sterile sample. .
And like I said earlier, there are other tests you can do, not so much emergency, but you need to be aware, mycoplasma, tortoise herpes virus, Ferla virus, paramyxovirus comes underneath, Ferla virus. These can cause respiratory disease, so you wanna be aware of these that can cause this. Now, what sort of treatments do we have?
Obviously we've mentioned antibiotics, you wanna be cultured, you wanna be guided by your culture. You can start on broad spectrum antibiosis whilst you're waiting for this because you don't really wanna wait a week, to, to get the culture and then start antibiotics, so you can start with a broad spectrum, quite a few to choose from. Cceftazoine is generally a good choice.
There's others out there, that you can use as well. Ideally you want to be using some sort of cascade, . So you can start with TMPS maybe, depends on what you've got available in your practise.
Also mobilisation, quite good for . Short trachea, so we're talking Chionian species, not so good for snakes where there's such a long distance for the nebuliization, particles to travel, but short tracheas, yes, you can use F10 a lot of the time, or you can add an antibiotic like gentamicin and a eucalyptic, like acetylcysteine in there as well. Again, 30 minutes, maybe an hour, you can nebulize them for, and we find that quite effective in these real runny nose patients or, or lots of mucus buildup patients.
I do find lung washes more appropriate for snakes, so we sedate them, pass the tube straight into the, trachea and into the lung, and then you could flush, saline or even dilute F10 down there, shake the, snake around, gently, obviously, and then turn them upside down like me and Lennox are doing here. And you can use, . Coupage to, to remove as much of that fluid as possible.
Just bear in mind if you are using something like F10, I would make sure you flush it afterwards, maybe leave it like 5 minute contact time, obviously remove it after . Flush with F10, and then remove it, leave at 5 minutes contact time, and then flush out with celluline again, and that helps break down mucus and and remove all the, all the, all the gunk build up basically. And then oxygen if required.
Now, I do have to let you know we can't save every reptile unfortunately, as much as I'd love to. There are some hopeless cases and I think you just need to be realistic with some clients. So, here's one example.
We've got significant trauma here. Definitely this is gonna be painful, it's not gonna be a quick, easy fix at all. Internal structures were, damaged as well.
So a patient like this probably not gonna heal very well, and I would euthanize a patient like this. Obviously, see what the anyone wants to do, but, but that's my thoughts of a patient here. Also, if they are collapsed, non-responsive, and have a very low heart rate, probably they're not with us anymore.
The patient has died, but their heart rates still beats after they've died if they've got no reflexes. So just bear in mind, if you've got a heart rate doesn't mean it's still alive, probably poor prognosis here, and, and just let the owner know that you don't wanna be. Putting the animal through anything unnecessary and also spending a lot of the owner's money as well, so just bear in mind, don't try and save every animal if you feel like, It's gonna be significantly painful and prognosis is poor.
So just to summarise everything, you've probably noticed more spectrum diagnostic testing throughout the, bloods, imaging, whether it's X-rays, ultrasounds, CT, try and get some, endoscopy in there as well. You're gonna be culturing, and doing some cytology, where you can. Appropriate stabilisation, so talking to fluids, pain relief, nutrition, and then treating the underlying cause, obviously being the, the gold or the, the, the main aim here.
Now, hopefully the patient survives and then you can correct the owner's long term husbandry. Have handouts ready, so you can obviously give it to owners, and they can go home and read it. Don't just talk at them because they're probably not gonna remember half of what you say.
But, yeah, get print out some handouts for them and hopefully they'll listen to you and, correct the, the temperature, humidity, whatever needs to be done at home. There we go. So I hope you found that useful and obviously feel free to ask any questions you have.
Hopefully we've got time for as many now as possible, but if not, I'm sure those will be emailed through to me and and we can have a little chat about . Any concerns you have or questions you have, maybe I need to elaborate on some things, let me know. Fab.
Thank you, Dean. You stole my spiel there, cause that was about what, what I was about to say. But no, fantastic.
That was really interesting. And again, huge thank you to Exotic Great Support for sponsoring the session. We've got quite a few questions coming through, so I'll ask a few now, and then what we'll do, get all those questions across to you.
You can put them, put any answers in, and we can email them out to all our participants, cause I'm aware that everyone's gonna be need to be getting back to their practises and back to work. Yeah, absolutely, far away. So, I've got one, well, I've got two questions here, but they kind of linked together.
So how do we select blood donors? Is there any blood typing test available? How much blood can be safely administered to a patient, and then somebody else had asked how much can be safely removed from a healthy animal?
So that's all around transfusion. So starting from the beginning, how do you. A donor, you wanna be selecting as close a species as possible.
So if you've got a, a red ear slider that's, needs a blood transfusion, you want to get it from another red ear slider, ideally from that same household, because if you're introducing blood from a separate, donor, you may introduce infection. Which you don't really want to do. The, donoring, slider may have mycoplasma, for instance, not showing clinical signs, and you may actually be passing that on to, the, the recipient, really.
So, yeah, so you wanna be same household, same household, same species, ideally. I have done cross species, however, not very successful really, the, the blood cells, in my opinion for what I've done, have died off quite quickly, so, avoid that as much as you can. You'll want to do a cross match, like I said, there's no actual blood types in reptiles, so you can just take one drop of, fresh blood from the donor, two drops of the serum, and mix them together on a slide, and you don't want to, to, to clot or glucinate within the first minute, otherwise that's not a match, and you need to find a different donor.
Other question I think you said was how much blood can you take from the the donor? I would say it's much the same as taking blood from a reptile for a a blood profile. You don't wanna be taking more than 1% of their body weight.
Obviously important to find out they're not anaemic beforehand. I have had that where a guy had lots of tatters, and, he, we want to transfuse from one to another. And actually, the one he wanted to donate from was actually anaemic as well.
So, you wanna make sure that's not the case. So, 1% of your body weight is, is the answer there. Was there another part of that question as well?
And then it was how much you can give to the patient as well. Yeah, I would have to double check that, . Yeah, I'd have to double check that and email it to you, I just, I don't know off the top of my head.
OK. One question I've seen crop up a couple of times is how did you sedate the snake or what did you use to sedate the snake? So good question.
Depends what for, if you're, you're talking about the the, the, the rat bite wounds, then I gave it morphine for analgesia, and then I just sedated it with IMmidazz off the top of my head, I think I went one per gig IM. And it's, gone into a nice sedative plane in about 1510 to 15 minutes or so. Brill, that was last, yeah, a few times, so hopefully that's one, that one's covered.
Let's have a see. I'm just looking for one that's a cookish one. There's so many coming through, .
Bear with me a second. Oh Do you use any glue to apply on tissues, so for closing wounds? So, any, any tissue glue was that?
Yes. So it depends on the situation, . Some surgeries I do, the only reason I'd use that is if I'm doing like a prefemoral, approach to a semi-aquatic species like a radio slider or maybe something like a.
I know, an aquatic lizard, like a, like a water dragon, for instance. I'll do standard inverting sutures, and then you can actually just put a, a layer of tissue glue along the incision side. That, that can just help with waterproofing on the sites.
That'll probably be. We need to, maybe if there's a small lesion that, or, or a small, surgical site, then I can use tissue glue, but honestly, most times I just put sutures in. I think, reptile skin takes a lot longer to heal.
You're better off with the, the safety margin of, of, longer acting sutures. Fab. And honestly there's so many questions I could ask you Dean, but I think I'll finish on this one because I, I'm quite interested.
Is there a good resource out there for normal blood parameters in reptiles? Yes, your best bets, I believe Carpenters has actually brought out a new book. I, I don't actually have that one at the moment, but I'm sure we'll get hold of it soon.
So yeah, the Carpenters, Fay, has a reptile section. At the end of that section, you've got lots of species blood parameters there. As far as I'm aware, it doesn't include blood gases.
You're probably better off going to look for some, published papers for that one. But. I'm not sure if the new carpenters does have a, a blood gas section.
Hopefully it does. Yeah, one tip is if you purchase it, you may be able to download it on your phone as well. And then you've got quick access to that rather than having to go to the library or, or whatever section your hospital has the books.
Fantastic. Right then, we'll make sure we get, we could be here all afternoon, I think going through the questions. So, I will make sure I get all these popped in an email to you.
There's some really good ones, yeah, and as we're talking more, I think we're creating more questions. So yeah, we could go on. No problem send them through and I'll get to them as soon as I can.
Amazing, thank you so much, Dean, really enjoyed it. Thank you everyone for watching. See you later.
Bye bye. Bye bye for now, bye bye.
