Ideally, any and all triage staff (technicians, front desk) should be able to recognize a bird that is too debilitated to wait in the lobby. Generally this bird is lying on his ventrum in the bottom of the transport carrier, possibly fluffed, with wings drooping, or eyes closed, poorly responsive to his surroundings, or with difficulty breathing. If any of these are present, the bird should be brought to be placed on heat and oxygen right away, and the appropriate doctor alerted.
A bird in this condition is likely too debilitated to tolerate much handling. In that situation, it is useful to be able to estimate weight, just as one may do for a dog or cat in crisis (Table 1).In general, these birds are usually some combination of: hypothermic, hypoxic (anemia, respiratory, or cardiac disease, increased metabolic demands), dehydrated/hypovolemic, hypoglycemic (anorexia, sepsis, increased demand, maldigestion), and/or septic, toxic, or traumatized. Emergency support can be initiated on the basis of these suspicions and estimated weight. Treatment and a limited examination will often need to be performed in incremental steps, with breaks in between to allow the bird to rest and recover, usually in heat and oxygen. It is not unusual for examination and initial treatment of a very debilitated bird to take close to an hour in this fashion, and clients are usually accepting of this once their expectations are set accordingly.
In addition to heat and oxygen support, a very debilitated bird may be profoundly hypoglycemic, and can respond well to 50% dextrose applied to mucous membranes. (Intravenous or intraosseus is more efficient, but can be overly stressful for a very compromised bird.) Subcutaneous warmed fluids (LRS at 25 mL/kg) can be given ¾ the interscapular site is acceptable if the pet is too weak to be held for long. Empirical antibiotics are often given at this stage, with the reasoning being that if the bird is this weak due to sepsis, it will likely die before the need for antibiotics can be proven. Since pet birds are often very susceptible to gram negative infections, a high dose (30 mg/kg) of enrofloxacin can be given. Although the acidic pH of this drug can make it somewhat caustic to administer intramuscularly, this route can usually be tolerated for a single injection, and will have faster absorption than oral or subcutaneous administration. Dyspneic birds can benefit from an intramuscular injection of the bronchodilator terbutaline (0.01-0.1 mg/kg).
Figure 1: Assessing hydration by eyelid turgor. In a hydrated patient, the upper lid returns quickly to its normal position. In a dehydrated patient, the lid returns only slowly to position if at all.
While the bird is recovering and absorbing the first round of treatments, a thorough history should be elicited. Most sick birds (like sick cats) look similar, and history details may be the only distinguishing feature to guide support and treatment, particularly history of exposure to other birds, or toxins such as lead, zinc, Teflon, avocado, salt, or garlic/onions. Diet including pellets, seed, table food, treats, and any supplements should be discussed, as well as any systemic signs the owner may have noted at home. Duration of inappetance or anorexia should be noted, as even 24 hours is enough to weaken most birds, particularly smaller species such as budgies, lovebirds, and cockatiels. Be alert for false histories, as birds will frequently attempt to hide illness until too sick to hide it any longer. This may result in “false polyphagia,” in which a bird may seem voracious, but present with an empty crop, and scant droppings, bile-stained feces, or decreased fecal output.
Birds which are standing and alert may be able to tolerate handling for slightly longer periods, although they should still be monitored closely while handling, and the examination or treatment aborted if dyspnea or weakness occurs. These birds may still benefit from oxygen and heat support for 15-20 minutes prior to handling, and owners are usually appreciative of this extra precaution when it is communicated to them. Respiratory rate, effort, and character can be assessed with little to no handling. If the bird requires frequent breaks, 50% dextrose may be applied to the mucous membranes at each stage of handling. Eyelid turgor can be quickly assessed to estimate hydration (a lifted eyelid should drop back in place quickly ¾ a sluggish return indicates dehydration. See Figure 1.) and the amount of pectoral musculature on either side of the keel can be quickly palpated to assess body condition.
If the handling must be done in stages, warmed LRS SQ may be given at the next handling. The next PE priority is auscultation, and assessing the caudal coelom for distention. If distention is present, the caudal coelom can be transilluminated with an ophthalmoscope to assess whether the distention is due to ascites or solid, such as a mass or organomegaly. Fluid can be percutaneously aspirated if present, which can provide rapid relief of dyspnea when the fluid compresses abdominal air sacs, leading to labored breathing. The fluid may be submitted for culture, cytology, and fluid analysis to help identify the cause (usually coelomitis, ovarian cyst, neoplasia, liver disease, or cardiac disease).
Next phase of assessment
Birds which are more stable (stronger, standing, eupneic, reasonably hydrated, pink) can sometimes have a small amount of blood (0.02-0.05cc) drawn either from the right jugular or tarsometarsal vein drawn, especially following 15-20 minutes on heat and pre-oxygenation. For these mini-blood draws, I prefer a U-100 insulin syringe, which wastes less blood in the hub of the needle. After the blood is drawn, I usually will cut off the needle and hub using guillotine-style nail clippers, to prevent red blood cell lysis that may occur from forcing the blood back through the small gauge needle. I will use 1 drop of blood for a point-of-care blood glucose via a handheld glucometer (normal is >280 mg/dL), a drop or two for a microhematocrit PCV and total solids, and a few drops for blood smears for a white blood cell count. In addition to the physical examination findings, this can help identify which birds are sick enough to be hospitalized, and which birds may require an IO catheter for dextrose CRI. In most cases when birds present as emergencies, further testing may be indicated, but usually must be deferred until the bird is stronger, euglycemic, and better hydrated. Owners are usually accepting of this once we help them recognize that their pet is in crisis and explain the plan to attempt stabilization.
“Supportive Therapy” Doneley, Bob. Avian Medicine and Surgery in Practice: Companion and Aviary Birds. CRC Press, Boca Raton, FL, 2016.
“Critical Care” Lichtenberger, Marla. In Speer, Brian (Ed): Current Therapy in Avian Medicine and Surgery. Elsevier, St. Louis, MO, 2016.