Exotics Molly

Fish/aquatics kit
Mega-vertebrate kit
Venomous kit
Hoofstock kit
Avian kit
"General" kit
(FMVHAG, Feisty monkeys visit hospitals after giraffes)

If you plan to see exotic pets in your emergency practice, you must have 6 separate emergency kits ready to go. What are these 6 kits?

Airway, breathing, circulation

What are the ABCs of emergency intervention?

Oral cavity (ensure unobstructed, look at color/jaw tone/saliva)
Nasal passage (ensure unobstructed* esp in obligate nasal breathers, look at mucus quality, ST or FB)
Palpation (pharynx, trachea, thoracic inlet for obstruction)
Chest compliance (for intrathoracic barriers to ventilation)

When you have an exotic come in on emergency, what 4 airway components should you quickly evaluate? (Entire process should take 8 sec)

Ensure nasal passage is clear (as they are obligate nasal breathers)

In species like the rabbit that comes in on emergency, what is a REALLY important airway assessment that needs to be done that is special to them?

Open oral exam with extension of the tongue and visualization of arytenoid cartilages
Rabbits and guinea pigs due to small oral aperture and pharyngeal anatomy

An oral cavity exam is an important part of the airway assessment for exotics on emergency.
How do we do this?
In what species may this not be possible in?

Ensure nasal patency (unobstructed)
Obligate nasal breathers (rabbits, guinea pigs)
May assist in intervention technique (i.e. mouth to snout CPR may not be an option)

A nasal exam is an important part of the airway assessment for exotics on emergency.
How do we do this?
This part of the exam is really important in what species?
But why should you still do it for everyone?

Larynx/pharynx, trachea, etc.
Unable to visualize the aboral airway in exotics
Recumbent animals without airway control can get tracheal/oral FB secondarily

Palpation is an important part of the airway assessment for exotics on emergency. It is unique to exotics.
What do we palpate?
Why do we do this?
What kind of FB can they get secondarily?

Intrathoracic disease can be the cause of airway obstruction (i.e. thymoma in rabbits common)
Because unnecessary chest compressions are associated with higher morb/mort in exotics

Looking for chest compliance is an important part of the airway assessment for exotics on emergency. It is unique to exotics
What disease process are we looking for?
Why is this especially important in exotics as opposed to other SA?

Return of spontaneous circulation (ROSC)

What is our primary goal with CPR?

Dorsal pedal, femoral, carotid
Superficial ulnar, direct heart palpation

Establishing pulses and perfusion is important with our circulation assessment for exotics on emergency.
What are normal locations for strong superficial pulses in mammals?
Where in birds?

False, does NOT

T/F: major vessel perfusion (like having a femoral pulse) indicates we are getting perfusion to the microvasculature and capillary beds

False, heart beat doesn't mean there is vascular perfusion to tissues

T/F: if there is a heartbeat, we do not need to do CPR in exotics

Pelvic respiratory skin
Air sac auscultation
Fanning of gills
Lateral line visualization

Direct airway visualization may be impossible in some of our exotics but we can use an analogous structure to evaluate it. What would you look for to evaluate the airways in…
Amphibians
Birds
Fish
Tarantulas/roaches

Look for opercular movement (bony flap that covers gills) (agonal breathing doesn't count, do CPR)

Breathing is hard to evaluate in fish. How can we do it?

Lactate

What is the best/most sensitive way to evaluate microvascular circulation in an emergency setting?

True

T/F: start compressions as SOON as arrest is identified

33-55% of diameter, 100-120bpm in mammals, 150-170bpm in birds

When doing CPR, how deep should you compress the chest? (%)
What rate should you do? In mammals vs birds?

During compressions, don't stop compressions

intubate while compressing

With CPR, when should intubation occur in the process?
A. Before you start compressions
B. During compressions, but pause them for a moment to allow intubation
C. During compressions, don't stop compressions

intubate while compressing
D. After compressions are done

2 minutes, swap compressors (to prevent fatigue) and give drugs (epinephrine/glycopyrrolate/atropine) every OTHER cycle

One cycle of CPR is how long? What should you do at the end of each cycle?

The dose is increased and duration of activity is reduced

still a worthwhile resuscitation drug for rabbits

Due to atropine esterase activity that occurs when giving rabbits atropine…
A. The dose is decreased and duration of activity is reduced

still a worthwhile resuscitation drug for rabbits
B. The dose is increased and duration of activity is reduced

still a worthwhile resuscitation drug for rabbits
C. The dose is increased and duration of activity is reduced

not a worthwhile resuscitation drug for rabbits
D. Atropine does not work at all in rabbits for resuscitation and can actually be toxic

Tight fitting face mask (research shows it works! Esp in rabbits)

In small herbivores, fast intubation during CPR can be quite difficult. What can we do instead?

Thermal (ROSC won't occur if P hypothermic)

In exotic emergencies, support is often under-prioritized. It should be though as ROSC will not be achieved if this is not fixed.

True

T/F: Return of spontaneous circulation (ROSC) won't happen in hypothermic exotic patients

True (be fast! Its ok if doses are a lil high or low)

T/F: In CPR, it is better to be close than slow with drug dosages

ET tube, oral cavity (especially sublingual)

Vascular access is challenging in emergencies with debilitated and shocky animals. Consider administration of epi/atropine via if IV isn't available. Also don't forget about veins in the ____!

Pulse oximetry, NIBP (non-invasive BP), capnography, electrocardiography

What 4 monitoring tools should be placed early and monitored continuously while the animal in still critical in ER settings?

Lingual, NIBP, put on back of tight fitting face mask

Best place to place a pulse oximeter in an exotic emergency setting?
Is NIBP or IBP better for exotic emergencies?
How can you use capnography if the animal cannot be intubated?

Hyperkalemia

If you've given medetomidine, you need to make sure you monitor for __. This has been noted in big cats but seems to affect an unknown number of exotic species. (Species-specific anesthetic complication)

Malignant hyperthermia, regurgitaiton

If you're using isoflurane in pot bellied pigs, be sure to watch for . If you're using narcotics in hoof stock, be sure to watch for .
(Species-specific anesthetic complications)

Hyperthermia in chinchillas, regurgitation in guinea pigs

There are some species-specific anesthetic complications that need to be monitored with guinea pigs and chinchillas. What are they for each? (Species-specific anesthetic complications)

Blood-gas values

Generally, most critical exotic patients under anesthesia should have intra-procedural _ collected every 90 minutes at a minimum.

Increase inhaled O2 concentration (PaO2)
Resolve underlying acid/base imbalances impairing O2 absorption and delivery (esp from acidosis)
Increase minute volume and ventilatory rate (don't want shallow or slow breaths)

WHAT ARE THE THREE PRIMARY INTERVENTIONS TO REDUCE HYPOXIA?

Leaf blower
Oxygen bubbler
Chamber oxygen

How can we support oxygen in these exotic patients?
Large hoof stock (like giraffes)
Fish/amphibians
High stress patients (small primates/carnivores/herbivores)

Flow-by

With zoo emergencies, provide _ oxygen as early as possible, then intubate and ventilate.

Cephalic
Ventral coccygeal
Basilic (or medial metatarsal)

Intravenous access is important in exotic emergencies. What is the preferred site for…
Mammals?
Reptiles?
Birds?

Intra-osseous

_ catheterization is used a lot in exotic emergencies especially in really small exotics like rabbits and guinea pigs. It is best done with sterile/aseptic prep but if patient is in decompensatory sock it can be done anywhere anyhow.

Sublingual (esp if thick fur coat), medial metatarsal (birds or hypothermic patients), jugular vein, sub-carapacial (in chelonians/turtles)

For urgent sampling or challenging patients, what are some alternative venous sites?

10mL/kg hypertonic saline over 10 minutes then reevaluate

Large shock boluses without time for assessment are not indicated due to damage they can cause to endothelial glycocalyx. This results in leakier vessels hindering response to treatment. What fluid therapy amount is good to start with?

10mL/kg hypertonic saline over 10 minutes then reevaluate

HOW MUCH FLUIDS SHOULD YOU GIVE FOR FLUID RESUSCITATION IN EXOTIC EMERGENCIES (and tbh all animal emergencies)???

ACID/BASE

Stabilization of is paramount in exotic emergencies because without stabilizing this NO2 receptors don't work as well, oxygen carrying capacity is diminished, and vasodilation occurs.

Oxygen carrying capacity is reduced and vasodilation occurs with acidosis, also NO2 receptors need high pH to work

STABILIZATION OF ACID/BASE BALANCE IS PARAMOUNT IN EXOTIC EMERGENCIES. WHY?

Marsupials, small mammals

What kind of mammals have a LOWER core temperature than other mammals?
What kind of mammals have a HIGHER core temperature than your typcial dogs/cats?

Foil blankets, forced air warmers (but need electricity or portable unit)

Always provide thermal support prior to transport with emergency situations. What are ways we can do this?

High

Murines have a (high/low) metabolic rates

In retrobulbar space
Produces lipid and porphyrin secretions, ocular lubrication, hormonal communication

Murines have harderian glands
Where are they located?
What is their role?

2(I 1/1, C 0/0, P 0/0, M 3/3)

Murine dental formula

Elodont incisors, brachyodont molars
1:3
Yellow-orange

Murines only have incisors and molars
What kind of teeth are they?
What is the crown-length ratio?
What color are they normally?

Monogastric, omnivores

What kind of GI tract do murines have? What kind of eaters are they?

Rigid LES, unique diaphragm innervation, lack of emetic centers

Murines are unable to vomit, why?

Yes (eating of feces..)

Do murines participate in coprophagy?

Polyestrous, sponanteous ovulations
Yes, separate vaginal 2/urethral 3 orifices (1 is anus)

With murines, what kind of estrous cycle/ovulators?
Are they easy to sex?

It covers almost their entire body! Shoulder to tail!

What is special about murine mammary tissue?

T-rex grip (pictured), cupping, scruffing, apparatus

What are the 4 ways to restrain murines?

Alfaxalone, midazolam, dexmed, ketamine

What are 4 options to sedate murines with?

False, need high doses

T/F: murine animals are really sensitive to anesthetics and only need really small doses

Lateral saphenous, femoral, jugular, lateral and ventral tail veins
Dorsal tail vein, cranial vena cava

What are 5 common venipuncture sites for rats and mice?
What 2 sites are good for in rats only?

Dorsal tail vein

All of these venipuncture sites are acceptable in rats

there is one option that is only okay in rats and NOT okay in mice, which is it? (All other options but this one okay in mice)
A. Lateral saphenous
B. Dorsal tail vein
C. Ventral tail vein
D. Lateral tail vein

1% of body weight, 10% of blood volume

How much blood volume is acceptable to take in our murines?

Dorsal, ventral, and lateral tail veins
Femur, tibia

Where are good locations for IV catheters in murines?
What about IO catheters?

Incisor malocclusion and overgrowth
Congenital or secondary to tooth root trauma (bar chewing)
Abcessation
Extraction, FREQUENT occlusal adjustments, AB (amoxiclav/enro), pain control (meloxicam/buprenorphine)

What dental issue is common in mice and rats?
Causes of it?
What can occur secondarily to this?
Tx?

Pinworms (Syhpacia abvelata, aspicularis tetaptera)

_ are endoparasites in mice that are ubiquitous and non-pathogenic, usually an incidental finding.

Incisor malocclusion and overgrowth (yellow color is normal tho)

The mouse to the left is normal. What is wrong with mouse to the right?

Spironucleus muris and giardia muris
Immunocompromised mice
Fecal cytology
Metronidazole

What 2 protozoa can mice get?
What is the typical signalment of mice with this?
Dx?
Tx?

Helicobater, rectal prolapse
Fecal PCR
Amoxiclav, metronidazole

Bacterial enteritis in mice
Pathophysiology?
Dx?
Tx?

S. abvelata, A. tetraptera
Yes, ubiquitous
Tape prep cytology
Fenbendazole, ivermectin

What are the 2 pinworm species that mice can get?
Are they very common?
Dx?
Tx?

Mice
Maurine paramyxovirus
Direct contact
Adults mild resp signs, neonates die
PCR, rads (for pneumonia evaluation)
Supportive (AB if secondary bact component)

Sendai virus
Affects what species?
Cause?
Transmission?
Signs? (In adults vs neonates)
Dx?
Tx?

Sendai virus and mycoplasma pulmonis

What 2 agents cause respiratory disease in mice?

Mice (any age)
Ubiquitous

causes bronchopneumonia, otitis, suppurative rhinitis
Aerosol, in utero/at birth
PCR/culture/serology, rads (for pneumonia evaluation)
Doxycycline & enrofloxacin, mucolytics (acetylcysteine), AB/bronchodilator inhalant, fix environment (overcrowding, ventilation)

Mycoplasma pulmonis
Affects what species?
What does this cause?
Transmission?
Dx?
Tx?

Mycoplasma pulmonis
Tx unlikely to resolve signs

You have a mouse present with severe respiratory signs and suppurative rhinitis. What do you think caused this? What is the prognosis?

Hierarchical - dominant mice chew whiskers of less dominant mice
Behavioral - secondary to stress

Hierarchical barbering vs behavioral barbering?

Hierarchial barbering

You have lots of mice friends all living together. One chews off all the whiskers of the other. What is going on?!

M. musculi, M. musculinus, R. affinis

Name 3 ectoparasites that we see in mice?

Opportunistic bacteria
Pasturella pneumotropica, ,step pyogenes, staphylococcus aureus
Culture, PCR
Surgical debridement, AB (amoxiclav, cephalexin), pain control (meloxicam/buprenorphine)

How does subcutaneous abscessation occur in mice?
What bacteria cause it?
Dx?
Tx?

Skin cytology
Sela/ivermectin and environmental management

Myobia musculi, mycoptes musculinus, and radfordia affinis are all ectoparasites of mice.
Dx?
Tx?

Annular tissue constrictions along tail, feet, digits
Secondary to low humidity
Increase enclosure humidity to >50%, surgical tail amputation if necrosis

"Ring tail" in mice and rats
What is it?
Causes?
Tx?

Mammary

neoplasia is common in all murines. Prognosis is really poor in mice but somewhat okay in rats.

Alopecia of head/thorax, pruritus
Suspicion, culture
Omega 3 fatty acids, trim nails, clean wounds, pain management (gabapentin), AB (TMS), topicals

Idiopathic ulcerative dermatitis in mice
Signs?
Dx?
Tx?

Major: mycoplasma pulmonis, corynebacterium kutcsheri, streptococcus pneumoniae
Minor: sendai virus, pneumonia virus of mice, CAR bacillus, haemophilus, pneumocystis carnii

Major and minor pathogens of rat respiratory disease complex?

Lab genetic strain C57BL/6, pruritic secondary to deposition of immune complexes within dermal vessels, leads to inability to process fatty acids

Pathophysiology/cause of idiopathic ulcerative dermatitis in mice?

Sialodacyraodenitis virus, good will resolve on own

You have a rat present with cervical and lacrimal gland inflammation. The owner says he hasn't been eating much lately and he always has this red gunk around his eyes. What is your likely diagnosis? Prognosis?

Rats
Coronavirus
Cervical salivary and lacrimal gland inflammation, anorexia, cervical lymphadenopathy, porphyrin staining
Serology
Supportive and will resolve well! (Clinical course of 1 week, signs may take 1-2 months to fully resolve)

Sialodacyroadenitis virus
Seen with what species?
What kind of virus is it?
Signs?
Dx?
Tx?

Adenocarcinoma, fibrocarcinoma
FNA, rads, BW
Surgical removal
Poor, high reoccurrence rate (even with resection)

Mammary neoplasia in mice
Common types?
Dx?
Tx?
Prognosis?

Rads, culture/sensitivity, serology
Bronchodilators, AB (doxy, enrofloxacin, azithromycin)

Rat respiratory disease complex
Dx?
Tx?

Streptococcus pneumoniae, mycoplasma pulmonis
Rads (bromchoalveolar pattern, pleural effusion, abscesses)
AB (amoxiclav), pain management (meloxicam, buprenorphine), nebulization

Rats can get bacterial pneumonia
What kinds of bacteria cause it?
Dx?
Tx?

Older rats
LMN dz, spinal nerve root degeneration
Hindlimb paresis and paralysis
Hard, MRI
Pain management (meloxicam, buprenorphine)

Degenerative myelopathy in rats
Signalment?
Pathophysiology?
Signs?
Dx?
Tx?

Ornithonyssus bacoti

WHAT ECTOPARASITE OF RATS IS ZOONOTIC?

Demodex, ornithonyssus bacoti, radfordia affinis
Skin cytology, culture, PCR
Sele/ivermectin, AB (TMS), environment management

Ectoparasites in rats
Types of parasites seen?
Dx?
Tx?

Mice, rats

(Rats/mice) more commonly have malignant mammary neoplasms
(Rats/mice) more commonly have benign mammary neoplasms

Benigns

fibroadenoma (less commonly adenocarcinoma)
FNA, rads, BW
Surgical removal
Spay prior to tumors
Good! Surgery may be curative

Mammary neoplasia in rats
Common types?
Dx?
Tx?
Prevention?
Prognosis?

Adenoma, adenocarcinoma
Neuro issues (hindlimb weakness, CP deficits, decreased ability to chew)
CT scan, MRI, US
Caergoline dec inflammation
Poor

Pituitary tumors in rats
Common types?
Signs?
Dx?
Tx?
Prognosis?

Oryctolagus cuniculus

DOMESTIC RABBIT GENUS AND SPECIES?