Assess an avian patient's cardiovascular status in a manner similar to that used in mammals. Evaluate mucous membrane color
by observing the conjunctiva, the everted cloaca, or the choanal slit. Common clinical signs of hypoperfusion and diminished
cardiac output include weakness, depression, pale mucous membranes, prolonged basilic vein (located along the ventral aspect
of the elbow) refill time, tachycardia, and weak pulses. In the event of cardiac arrest, cardiopulmonary resuscitation may
be attempted, but the success of cardiopulmonary resuscitation in birds is generally poor in most emergency situations. To
perform cardiopulmonary resuscitation, place an endotracheal or air sac breathing tube, administer positive-pressure ventilation,
and give an intramuscular injection of doxapram (0.2 ml for a large bird and 0.1 ml for a small bird).3 If the heart is not beating, perform 60 to 80 sternum compressions per minute.3 Epinephrine and atropine can be given intravenously, intraosseously, or endotracheally.3
Relieving pain in companion birds
Fluid replacement therapy is essential in birds with signs of hypoperfusion or hypovolemic shock. Fluids may be administered
through an intravenous or intraosseous catheter or subcutaneously. Corticosteroid use in birds is, at best, controversial;
it is contraindicated in many cases. There are many concerns about immunosuppression and suppression of the hypothalamic-pituitary-adrenal
system in birds, so consider the side effects of glucocorticoid use to be at least as frequent and severe in birds as they
are in mammals, if not more.4
Intravenous catheters may be placed in the jugular vein, the basilic vein, or the medial metatarsal vein. Intraosseous catheters
may be placed in the proximal tibiotarsus or distal ulna. The humerus and femur are not acceptable sites for intraosseous
fluid administration because they are pneumatic and connect to the bird's respiratory system. Keep in mind that receiving
intraosseous fluids is most likely quite painful in birds, as it is in people. A slow fluid infusion rate of intraosseous
fluids may help defray discomfort. In addition, consider initial intraosseous catheter and fluid bolus administration in a
patient that is already anesthetized.
The most popular site for subcutaneous fluid administration is the inguinal region, but the interclavicular space and propatagial
web sites can also be used. These sites have much more limited volume capacity for fluid compared with the inguinal region.
If fluid pools in the ventral abdominal area, discontinue subcutaneous fluid therapy.
Initially, fluids may be infused at a rate of up to 1 blood volume of fluid over one hour. Lactated Ringer's and normal saline
solution are common choices for fluid administration in birds. The total blood volume in birds ranges from 6% to 11% of body
weight,5 with 8% to 10% used as an average in psittacines. Therefore, an initial intravenous infusion rate of up to 90 ml/kg/hr has
been suggested for birds with suspected hypovolemic shock.6 Closely monitor birds for signs of overhydration or fluid extravasation. As perfusion improves, adjust the infusion rate
until a maintenance rate of 10 ml/kg/hr is reached.6 Subcutaneous fluids can be given at a rate of 50 to 100 ml/kg and can be delivered into multiple sites as needed.
COMMON EMERGENCY PRESENTATIONS
Once the patient is stabilized, you can initiate additional treatment (Table 1). Some common problems you may face are hemorrhaging, lacerations, bite wounds, fractures, seizures, and hypothermia or hyperthermia.
Table 1. Possible Contributing Factors in Common Bird Emergencies