外来动物急诊Word文档下载推荐.docx
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外来动物急诊Word文档下载推荐.docx
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8.-TraumaticInjuriesinExoticPets(35)
9.-TreatmentandManagementoftheAvianPatientinShock(40)
AVIANMEDICINE:
THEBASICS
AUTHOR(S):
NATALIEANTINOFF,DVM,DABVP(AVIAN)
Ofanyspeciesencounteredincompanionpetmedicine,birdsmaybethemostalien,andthereforemostintimidatingtopractitioners.Whileitmaybepossibletoadapttheknowledgeofonemammaltotreatanother,theuniqueanatomyandphysiologyofbirdsmakesevensaferestraintachallenge.Thisdiscussionwillfocusonanintroductiontothehandling,restraint,andadministrationoftreatmentofbirds,aswellastoeducateveterinariansandtheirstaffaboutthe"
don'
ts"
ofavianmedicine.
RESTRAINT/EXAMINATION
Inemergencysituations,patientassessmentmustbeperformedefficientlyandeffectively,inamannerthatissafetothepatient.Excessivehandling,evenwhenappropriate,maycausepatientstress,resultinginincreasedcatecholaminereleaseandsubsequentcardiaccompromise.Itmaybenecessarytoperformaportionofthephysicalexamination,andthenreturnthepatienttoitscageforafewminutesbeforecompletingtheexam.
Removingthepatientfromthecagecanbeachallenge.Besurethattheroomisescape-proofandwindowsareclosedandcovered.Theweaponisthebeak.Useatowelcoveringyourhandtointroduceyourhandintothebird'
scage.Thencoverthehead(andbodyifpossible)withthetowelandpositionyourhandsaroundthemandible.Wraptherestofthetowelgentlyaroundthebody.Inmostcases,avoidtheuseofleatherorheavygloves,astheywillnotonlyinterferewithyourabilitytoperformathoroughphysicalexam,butmayalsobeextremelyfrighteninganddistressingtothebird.Turningoffthelightsmayhelpcalmafranticbirdsothatitcanbemoreeasilycaught.Itisalsohelpfulifthebirddoesescapefromthecage.Itisgenerallynotrecommendedtoremoveabirdfromitsowners'
shoulderorhand;
placethebirdonatable,floor,orinacagebeforerestraint.
PROPERRESTRAINT
Psittacines.-Onehandbelowthemandibles,gentlyextendingthenecktomaintaincontroloftheheadandbeak.Theotherhandgraspsthefeet.Dependingonthesizeofthebird,theholdercan"
cup"
thebirdinthepalmofthehandtostabilizethewings,orholdthewingsagainstthebody.Useofatowelcanimprovecontrol.Donotrestrictthemovementofthekeel,orrestrainacrossthepectoralregion,asthismustexpandforeffectiverespiration.Maintainthepatientinanuprightpositionforevaluation.
Alternatetechnique.-Thumbandsecondfingeroneithersideofthemandibles,gentlyholdingthemandiblesbehindthebeak.Theindexfingercanbeplacedontopoftheheadforgreatercontrol.Bruisingofthefacemayoccur;
donotuseexcessiveforce.Thistechniquecanbemoredifficultforpeoplewithsmallhands,especiallyinlargerbirds.
Passerines/softbills.-Theheadisgentlyrestrainedbetweentheindexfingerandthesecondfinger,cuppingthebirdinthepalmofthehandforsupport.
Pigeons/doves.-Graspthewingsandtailinonehandoverthedorsaltailbase,wrappingthehandaroundthebody.Theheaddoesnotrequirerestraintunlessaprocedureisperformedinthisarea.
Raptors/Birdsofprey.-Weaponsinthesebirdsareprimarilythefeet,secondarilythebeak.Forthesebirdstheuseofleatherglovesisappropriate.Coveringtheheadofthebirdwithatowelorfalconer'
shoodgenerallycalmsthesebirds,andthecovershouldremainovertheheadforasmuchoftheexamaspossibletominimizestress.Oncetheheadiscovered,graspthefeet(wearingleathergloves)fromthetop,andrestrainthefeetwhileremovingthebirdfromitscageorenclosure.Inmostbirds,onlylightrestraintoftheheadisnecessaryiftheheadiskeptcovered.Ifprolongedhandlingisrequired,thefeetcanbetemporarilytapedintoaballbandage.
PHYSICALEXAM--UNIQUEASPECTS
Mentalalertness/attitude.-Ahealthybirdshouldbealert,attentive,andgenerallyfearful.Evenwhenveryill,theirinstinctshouldbeto"
appear"
healthytopotential"
predator"
veterinarians.Abirdwhoisfluffed,orclosingitseyesorhavingdifficultybreathingintheexamroommaybeingreatdistress.
Hydration.-Skintentismosteasilyassessedattheuppereyelid.Sometimesaskintentcanbeperformedovertheaxillaorlateralflankarea,butthismaybedifficultinheavilyfeatheredbirds.
Mucousmembranecolor/Capillaryrefilltime.-Checkmucousmembranecolorbyvisualizingtheoralcavity;
thisisdifficultasmanybirdshaveblackpigmentedtongues.Otherareasthatcanbeassessedincludeconjunctivaandcloacalmucosa.Capillaryrefilltimeismoreofachallenge,butcanbeassessedatthecutaneousulnarveinattheventralaspectofthewingandblanchingitasonewouldanymucousmembrane.Thisstepisnotalwaysfeasible.
Eyes,ears,nares.-Assessasinotherspecies.Ophthalmoscopesandotoscopescanbeused,althoughsometimesdeepoticexamisnotpossible.Birdshaveastructurecalledthepectin,usuallyvisibleventromediallyonophthalmicexam,whichwillappearasabrownish-black"
curtain"
offolds.Thisstructureisnormalandisbelievedtocontributetothenourishmentoftheeye.
Lymphnodes.-Donotexistinbirds.
Heart/lungs.-Heartratesinmostsmallpatientsareveryrapid,makingdetectionofmurmursmoredifficult;
however,arrhythmia'
scanbeauscultedinanyspecies.Mostbirdheartrateswillbeover300beatsperminute,andsometimescanbeauscultedbetterfurthercaudallydownthekeel.
Abdomen.-Itisuncommontofeelanydefinitivestructureswithintheavianabdomen.Insomeshort-chestedbirdslikecockatoos,thefirmventriculuscanbefeltextendingbeyondthecaudaledgeofthekeelontheleft.
Urogenital.-Birdshaveacloaca,acommonopeningthereproductive,gastrointestinal,andurinarysystems.Thecloacacansometimesbegentlyevertedbyusingacotton-applicator.
Musculoskeletal.-Besuretoobserveambulationincageifpossible.Palpateallmusclesandbones;
assessformusclewastingoverkeel.Checkthebottomsofthefeetforabnormalwearorabscess.
Integument.-Partfeathersandevaluateforabnormalities.Althoughownersoftenbelievethatmitesarecommon,intruththeyareextremelyrareinindoorpetbirds.Checkfordryskinatfeet.ThismaybeasignofvitaminAdeficiency.
CLINICALTECHNIQUES
FLUIDADMINISTRATION/CATHETERIZATION
Maintenancefluidrate:
50ml/kg/24hrs;
deficits=%dehydrationxbodyweight+ongoinglosses.
LRS,Plasma-Lyte,Normalsaline,D5W;
Half-strengthsaline.Canbegivenas3-4IVbolusesthrougha24-hourperiod.Stable,alertpatientsoftenwillnottolerateIVcatheters;
subcutaneousfluidsmaybepreferableinthesesituationsifotherparametersdonotmandateIVfluidreplacement.
Intravenous
Jugularvein--rightsideonly;
leftusuallyvestigial
Note:
pigeonshaveavenousplexus;
jugularcatheterizationwillnotbeasfeasibleinthesebirds.
Cutaneousulnarvein(Brachial,basilic,wingvein)-ventralaspectofthewing,runninglateraltothehumerus.Bestvisualizationatthepointwherethisveincrossestheradiusandulnaattheelbow.Placecatheterslightlyproximaltothispointtoavoidthebones.Veinisverysuperficial.Note:
cancauseexcessivebruising.
Medialmetatarsalvein--medialtibiotarsusextendingacrossthemedialaspectofthetarsometatarsalbone.Besttoaccessnearthejunctionofscaledandsmoothskinofthefoot.Maybruise.
Intraosseous
Administerfluidsslowly;
greaterpressureandincreasedpatientdiscomfortwithintraosseouscatheteruseincomparisontointravenousfluidadministration.
Ifaspinalneedleofappropriatesizeisnotavailable,useastandardhypodermicneedle(22-25ga).Ifaboneplugoccludestheneedle,withdrawtheoriginalneedle,andreplaceitwithanewsterileneedle.Theboneplugisremovedwiththeoriginalneedle,anditisusuallyquitesimpletolocatethesiteofentryoftheoriginalneedle.
Proximaltibiotarsus:
Withthestifleflexed,palpatethecranialtibial(cnemial)crestdistaltothefemoralcondyles.Introduceaspinalneedleofappropriatesize(generally20-22ga)alongthetibialcrestintothemarrowcavity.Removethestyletandaspirate;
ifbloodappearsinthehub,flushandtapeintoplace.
Distalulna:
Thedorsalcondyleofthedistalulnaislocatedonthedorsalaspectofthecarpus.Flexthecarpusandpalpatedorsallyjustproximaltotheangleofthecarpus.Theulnaisthelarger,moreventralbone.Insertaspinalorhypodermicneedleofappropriatesizeunderthedorsalcondyleintothemarrowspacewhileholdingtheulnastable.
Flush;
thecutaneousulnarveinwillblanchwithflushingiftheneedleiscorrectlypositioned.
Subcutaneous
Lateralflank--extendthelegcaudally;
identifytheskinfoldinthecraniolateralaspectoftheflank.Insertneedlejustunderneaththeskin;
visualizethefluid"
bubble"
asyouadministerfluids.Beneaththeskinisathinmusclelayer;
deeptothatisairsac.Usecautiontoavoidadvancingtheneedleintotheairsac,asfluidsadministeredinthisfashionmaycause"
drowning"
.
Medialthigh--extendtheleglaterally;
administerfluidsintheskinfoldunderthethigh.Thereislesspotentialspaceinth
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