Nursing management of rabbit and parrot emergencies

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Exotic animal emergencies often present unique challenges for the veterinary team, according to Lorelei D'Avolio, LVT, VTS (Exotics), CVPM, practice manager at The Center for Avian and Exotic Medicine in New York City. During her talk at Fetch dvm360 conference in Baltimore, D'Avolio described emergency problems in parrots and rabbits, two patient groups commonly seen in exotic pet practice. She also emphasized the important role of veterinary technicians in ensuring proper triage, handling and long-term management of these often critical cases.

“As technicians, we shouldn't forget that it's not just about fixing the immediate health issue,” D'Avolio said. Follow-up care is an important step of effective nursing, especially for exotic species with unique husbandry requirements. Even after the patient recovers, the technician can help reduce the risk for repeat illness or injury by educating owners on proper home care.

What is a true emergency?

Although clients may arrive in a panic, the technician is often the one to decide which cases are true emergencies. “Technicians are usually the first people to look at the animal, talk to the clients and get the basic triage history,” D'Avolio noted. Obtaining appropriate background information and conducting a quick cursory exam will help you organize the right equipment and prepare the veterinarian for diagnostic workup. 

For rabbits and parrots, indicators of an emergency include a history of trauma, anorexia or reproductive problems. Also, patients presenting with neurologic signs, respiratory distress or hemorrhage need to be evaluated quickly. However, D'Avolio added, most exotic patients are more fragile than dogs and cats, so the technician needs to work in a calm and quiet manner.

“We have to exercise a lot more caution with these species,” she elaborated. “You have a better chance at saving them if you take things slowly and less intensely. I'm not saying they don't come in super sick, but their stress response will not permit them to survive” if restrained extensively or rushed into diagnostics. She emphasized the importance of continuous monitoring during hospitalization, as well as adjusting the pace of workup based on the patient's response. Also, it's important to provide a warm, dark and comfortable environment during hospitalization, as stress greatly impedes recovery in prey animal species.

Parrot emergencies

Respiratory distress. Their unique respiratory anatomy makes birds particularly susceptible to respiratory issues, which can be caused by infection, space-occupying coelomic masses, aspiration or heart disease. Birds are also extremely sensitive to airborne toxicities from nonstick cookware, scented candles or air fresheners, and cigarette smoke. Signs of respiratory distress include open-beak breathing, tail bobbing, increased sternal effort and wing pumping.  

According to D'Avolio, “the stress of being restrained can be too much” for a parrot in respiratory distress. If the veterinarian approves, first place the bird in a humidified oxygen chamber warmed to 80 to 85 F and obtain a respiration rate from a distance. Only after stabilization is it appropriate to pursue hands-on diagnostics, such as weight and peripheral oxygen saturation (SpO2) measurements, blood work and radiographs. 

Trauma. Cases of suspected trauma, which can result from collision (into a mirror, window or fan), a bite or scratch from another pet, or being stepped on or crushed, should be triaged quickly. The bird should be placed in a quiet, warm, dark environment with padding and food until stable enough to tolerate handling. Supplemental oxygen is indicated if the patient is in respiratory distress, and tools should be on hand for pain management, fluid therapy, and splinting or bandaging. 

Bleeding. Common causes of acute hemorrhage include a broken blood feather, chipped beak tip, self-inflicted wound, compound fracture, dog bite, neoplasia, papillomatosis and reproductive abnormalities. Lead toxicity from exposure to paint, jewelry or antiques can also cause bleeding.

Because birds have a relatively low blood volume compared with other species, hemostasis should be attempted right away. A broken blood feather should be removed completely, whereas other wounds may require firm pressure, penlight cautery or styptic powder. Pain management, antibiotics and supportive care should follow.

Anorexia. Anorexia in parrots has a variety of viral, bacterial, fungal, metabolic, neoplastic and environmental causes. Therefore, a thorough history and diagnostic workup are important components of managing this condition. It's important to find out the patient's age, diet, feeding history and quality of droppings. Tarry or watery droppings, as well as undigested seeds in the stool, are all abnormal findings.

Anorectic parrots are usually stable enough to handle, according to D'Avolio, so she first measures body condition by feeling the musculature on either side of the keel bone. Emaciation indicates the anorexia is likely chronic in nature.

Supportive care is the mainstay of treatment. It's possible to overfeed anorectic birds, so focus on rehydration first through an intravenous or intraosseous catheter. The hospital enclosure should be heated and provide low perches and a variety of favorite foods, although gavage feeding may be necessary at first.

Reproductive problems. Although reproductive issues can occur in any bird, knowing the patient's sex helps narrow down the list of potential causes. Diet, daylight cycles and the presence of a companion bird and/or perceived nest can all induce reproductive behavior.

Patients with egg retention may appear in respiratory distress. Although eggs are occasionally palpable in the coelom, radiographs are the best way to visualize egg size and location. Medical treatment typically involves keeping the bird comfortable in a warm, dark environment and providing tools to stimulate egg laying, such as vitamin D3, calcium, pain control, supplemental fluids, and vent lubrication. Other reproductive issues include bleeding or prolapse of the vent.

Rabbit emergencies

Anorexia. Anorexia and subsequent gastrointestinal (GI) stasis are the most common emergency issues seen in rabbits, according to D'Avolio. Causes include pain, parasitism, inappropriate diet, reproductive issues, bladder stones, dehydration, trauma, dental issues, arthritis, lead toxicity and infection with the microsporidian parasite Encephalitozoon cuniculi.

Most anorectic rabbits are stable enough for diagnostics, which should start with measurement of temperature, pulse and respiration rate. Hypothermia (body temperature <100°F) is considered an emergency and should be managed quickly. According to D'Avolio, abdominal palpation is an easy way to detect pain and gas buildup in the GI tract, and radiographs can confirm GI stasis. Gut motility can be encouraged with exercise, prokinetic medication and fluid therapy. Subcutaneous fluids are more readily tolerated than intravenous fluids by extremely stressed rabbits.

Neurologic disease. E. cuniculi, ear mites, ear infection, toxicity, spinal trauma, brain tumor and stroke can all cause neurologic disease in rabbits. Physical examination, including close attention to the ears, is important. Also, a well-padded cage devoid of sharp objects should be used to minimize the risk of further injury. Fluid therapy and assistance feeding of high-fiber foods are important steps to prevent GI stasis, and analgesic and anti-vertigo therapies can help manage neurologic signs.

Respiratory problems. As obligate nasal breathers, rabbits can experience serious illness from respiratory problems. Patients typically present in significant distress, with an extended neck, open-mouth breathing and mucus covering the nose and front legs. 

Any diagnostic steps should be performed slowly and quietly, as handling puts patients at high risk for respiratory arrest. Open-mouth breathing warrants immediate transfer to a dark, warm oxygen chamber or, alternatively, placement of an endotracheal tube or supraglottic airway device. Gentle cleaning of the nasal passages with a warm, wet sponge or washcloth can be attempted, albeit with extreme caution.

Heatstroke. D'Avolio stated that heatstroke, a common presentation, is “definitely an emergency situation. Rabbits don't sweat very much and they don't pant like dogs, so they have trouble releasing heat.” This condition can occur once environmental temperatures exceed 80°F, particularly if rabbits lack access to shade, fresh water, fans and cooling blocks.

Signs of heatstroke include reddened ears, open-mouth breathing, nostril flaring, salivation and convulsions. Severely affected patients may be recumbent or even nonresponsive. A body temperature of 104°F or higher is diagnostic for heatstroke.

Treatment should be immediate but gentle, consisting of room-temperature fluid therapy, administration of alcohol to the pinnae and application of cool, wet towels. If the patient is capable of swallowing, offer cool water with a syringe. Once hydrated, nonsteroidal anti-inflammatory drug therapy is usually warranted.

Trauma. Broken bones, especially the toes, legs, pelvis and vertebrae, commonly result from improper handling. Blood pressure, body temperature, SpO2 and mucus membrane color can all help identify whether the patient is in shock. If so, notify the veterinarian immediately. 

Diarrhea. True diarrhea, which is distinct from the normal, soft cecotropes produced by the cecum, can result from dysbiosis, parasitism or other intestinal disease. Packed cell volume and total protein measurement are important to help determine hydration status, and diarrheic patients often need intravenous or subcutaneous fluids.

Dr. Natalie Stilwell provides freelance medical writing and aquatic veterinary consulting services through her business, Seastar Communications and Consulting. In addition to her DVM obtained from Auburn University, she holds a MS in fisheries and aquatic sciences and a PhD in veterinary medical sciences from the University of Florida.