All of these challenges illustrate the importance of properly caring for birds when they are brought to your clinic for an
emergency, as well as proper follow-up. Follow-up care becomes much more of a necessity compared with that needed in mammalian
emergencies. Many of these avian patients, when stabilized, will require extensive follow-up evaluation to complete the diagnostic
picture, correct any husbandry deficits, improve the birds' nutritional status, and implement other actions to avoid future
Figure 3A. & 3B. The excessively short clipped wings of this young Umbrella cockatoo (3A) were likely responsible for its
uncontrolled fall, which resulted in the split skin of the ventral tail base (3B). Unfortunately, these types of wing-clip-associated
injuries are common. The wound was surgically repaired, but the follow-up was key in the ultimate resolution and prevention
of the problem. The bird was trained to perch only on the hand, where a fall was easiest to prevent, and owners were made
aware of the risks associated with excessive wing clipping. The bird began its juvenile molt at about 10 months of age and
ultimately replaced all of those feathers successfully.
EMERGENCY CARE PRINCIPLES
As in any emergency, the ABCs—airway, breathing, and circulation—must be addressed in pet birds before you initiate diagnostic
testing and further treatment. Samples for pretreatment laboratory tests may be collected in many cases, but in most emergency
situations, stabilization is the primary goal. Although radiography may be helpful in some cases, in inexperienced hands,
an effort to obtain a detailed radiographic diagnosis can sometimes be as life-threatening as the patient's medical condition.
Take time to learn proper avian handling and restraint techniques before you're faced with an emergency. Avoid causing excessive
fear, pain, or discomfort and be efficient with your technique. Frequently, a towel is used to help restrain companion birds,
but this is not mandatory. Avoid, if possible, pouncing on your patient, similar to the way a predator may attack, and try
to be respectful of the patient's instinctual predator or prey behavioral differences.
Quickly assess the adequacy and pattern of respiration, and auscultate the chest and air sacs. If a bird is not breathing
adequately, place an endotracheal tube. The glottis of birds, located at the base of the tongue, is not covered by an epiglottis.
This anatomical feature makes endotracheal intubation much easier than in mammalian patients of similar size. Hold the beak
open and pull the tongue rostrally to easily see the glottis. Most of the common pet bird species have complete tracheal rings,
so be careful when inflating the cuff of an endotracheal tube or use an uncuffed endotracheal tube.
To bypass the trachea in patients with a tracheal obstruction, cannulate the abdominal or caudal thoracic air sacs. Place
the bird in right (preferred) or left lateral recumbency, incise the skin caudal to the last rib, and use a curved or right-angled
hemostat to penetrate the body wall. Choose a tube that is nearly equal to the size of the trachea, and place the tube through
the hemostat jaws and into the caudal thoracic or abdominal air sac. Cut the tube to a comfortable length for the bird, and
then tape and suture it into place just as you would suture a tomcat catheter. Ventilate intubated birds with slow, deep respirations
(10 to 20 breaths/min for birds weighing less than 100 g [3.5 oz]).
If airway patency is adequate, observe the rate, depth, and quality of respiration. Rapid, shallow respirations may be due
to pain from rib trauma. Birds with head trauma may have slow, shallow respirations. Hypoventilation commonly occurs with
hypovolemic shock and acid-base disturbances. A tail bob is commonly observed when there is a marked abdominal component to
expiration, often seen with pulmonary disease or obstructive tracheal disease. If the patient is conscious and breathing,
oxygen may be delivered through a face mask or by placing the bird in an oxygen-rich environment.