The Exotic Emergency

Presenter: Molly Varga BVetMed CertZooMed DZooMed (Mammalian) MRCVS currently runs first opinion and referral exotics service, Cheshire Pet

Have you ever had to resuscitate a reptile, a small bird or even a rabbit? At some point in our career it’s feasible that we will, and last week’s veterinary webinar organised by ‘The Webinar Vet’ provides an
excellent base from which to deliver emergency care to exotics with Molly Varga offering advice across a spectrum of species.

Molly offered a number of tips on the resuscitation of exotics and explained that even finding a heart beat on examination can be challenging. Cardiac auscultation in a tortoise, snake or lizard is notoriously difficult and Molly advises applying a doppler probe, readily available in practice, for measuring blood pressure in cats and dogs. In the case of snakes the heart will most often be found in the anterior third of the body. IPPV was also discussed and once again ascertaining whether some of the smaller exotics are actually in respiratory arrest can be difficult even when using the mirror or hair test to check for air movement. Molly advises that if in doubt IPPV should be instigated by intubating or placing an air sac tube and implementing rapid gentle squeezes of the resuscitation bag rather than the ‘squeeze; release; pause’ pattern performed in cats and dogs.

Fluid therapy was also discussed and as for all species is the cornerstone for treating shock. Crystalloids are at the core of resuscitation and are excellent for restoring volume short term and rehydrating but are not long lived enough for maintaining blood volume in hypovolaemic patients. Colloids are very useful in these cases and can be administered at a dose of 20mls/kg alongside crystalloids whose dose can be reduced by 40-60%. Molly uses the medial tarsal vein in birds and jugular vein in reptiles to administer fluids and also  reminded us of the merits of using interosseous administration if venous access is difficult.

Once a patient has been stabilised, nutritional support is essential and Molly explains care has to be taken to ensure re-feeding syndrome doesn’t develop, a problem not uncommon in anorexic exotics. Upon feeding an anorexic patient, glucose spikes and causes production of insulin which drives glucose into the cells along with potassium and phosphorus eventually leading to bradycardia and death. In order to avoid this Molly advises working out the full calorific requirement for an individual and feeding only one third of this on day one. This amount of food, however, needs to be divided into 10 parts with only one part being fed initially. After 1-2 hours if there are no ill effects, 2 parts should be fed, and if all still okay then 3 parts fed followed by four. Two thirds of the calorific requirements should be fed this way on day 2 and by day 3 the full calorific requirements can be fed.

Molly offered a vast array of information within this veterinary webinar which proved to be a great inspiration for getting stuck into those exotic emergencies and was an equally useful reminder for emergency care across the species.

The Stethoscope (MRCVS)

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