1
History and Clinical Examination

Nico J. Schoemaker and Yvonne R.A. van Zeeland

Division of Zoological Medicine, Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, The Netherlands

CONTENTS

1. Initial Phone Consultation
   1. Is it an Emergency?
      1. Signalment and (Abbreviated) History
   2. Owner Instructions
      1. First Aid at Home
      2. Transport
      3. Materials to Bring Along for the Emergency Visit
2. History
   1. Presenting Signs
   2. Diet and Husbandry
   3. Preventative Treatments
3. Physical Exam
   1. Primary Survey
      1. General Impression
      2. ABCDE Protocol
   2. Secondary Survey
      1. Full Physical Examination
      2. Ferrets
      3. Rabbits
      4. Guinea Pigs
      5. Chinchillas
      6. Rats, Mice, Hamsters, and Gerbils
      7. Hedgehogs
      8. Sugar Gliders
   3. Gender Determination
      1. Ferrets
      2. Rabbits
      3. Guinea Pigs
      4. Chinchillas
      5. Rats, Mice, Hamsters, and Gerbils
      6. Hedgehogs
      7. Sugar Gliders
4. Reference
5. Further Reading

Initial Phone Consultation

During the phone call, an initial evaluation of the patient's status needs to be made. Based on the information obtained during the initial phone call, the reception staff or veterinarian can assess whether and when the animal should come. Proper instructions regarding basic first aid procedures and transport instructions to optimize the chances of the patient arriving alive at the clinic should also be relayed during this call.

Is it an Emergency?

Small mammals may present with a variety of emergency signs (see Box 1.1 for an overview). Similar to dogs and cats, emergencies can be broken down into two categories, i.e. "acute" (i.e. resulting from a sudden, recent event, e.g. bite wounds, fall injuries, intoxications) and "chronic" (i.e. resulting from a more chronic, ongoing process, e.g. dental disease, gastritis, vitamin C deficiency in guinea pigs). Especially in small mammal patients, "chronic" emergencies are common due to the animal hiding signs of disease and/or the owner not being experienced enough to recognize signs of illness until the animal is in a severely debilitated condition. As a result, these conditions may be just as life-threatening as "acute" emergencies, thereby warranting a proper assessment to be made during the initial phone call. This emphasizes the importance of having properly trained reception staff, whose primary task is to establish whether the animal can be scheduled for a regular appointment, or whether it needs to come in as an emergency case. If the case classifies as an emergency, it should be determined whether the owner needs to come in immediately (e.g. in case of severe trauma involving blood loss and an open fracture), or whether the appointment can be scheduled later on the same day, but within the next 24?hours (e.g. a rabbit with anorexia for more than 12?hours).

Box 1.1 Common Emergency Presentations of Small Mammals

Presenting signs noted by the owner that generally warrant immediate attention

Anorexia, decreased appetite

Behavior changes, e.g. hiding, sitting still in a corner, restlessness

Bloated abdomen

Blood loss

Breathing abnormalities, labored breathing

Collapse

Diarrhea, reduced production of droppings (particularly in herbivores)

Dysuria, stranguria

Dystocia (particularly in guinea pigs)

Exophthalmos

Fly strike (particularly in rabbits)

Hematuria

Hypothermia or hyperthermia (including fever, heat stress)

Intoxications (including suspected cases)

Lameness (sudden onset, e.g. due to fractures)

Lethargy, stupor, coma

Lumps, masses (especially in case of sudden onset)

Nasal discharge, sneezing

Neurologic signs, e.g. head tilt, seizures

Paresis/paralysis

Posture changes, e.g. hunched up

Polyuria, altered water intake

Teeth grinding

Traumatic injuries, e.g. bite wounds, fall injuries

Vomitinga, choking

Weakness

Weight loss

a Not in herbivorous small mammals, e.g. rabbits, guinea pigs, chinchillas.

Signalment and (Abbreviated) History

To properly assess the patient's condition over the phone, the information should be obtained regarding the patient's signalment and the presenting problems.

The signalment includes the species, breed, sex, neutering or breeding status, and age of the animal. This information is essential for the initial evaluation of the patient's status. For example, a juvenile that has not eaten for six?hours will often be a greater emergency than an adult animal of the same species. Moreover, the information can help to establish an initial differential or tentative diagnosis for the presenting signs.

The owner should also be questioned on the clinical signs that the animal is displaying, including when those signs became apparent. Obvious questions that should be asked are: What is the problem? What signs does the animal show? When did you first notice these signs? Did you notice any changes since then, and if so, what are they?

In cases of trauma, it is helpful to inquire about the nature of the trauma and when it occurred, whether the animal has been unconscious, and if so, for how long. If bleeding was present, the owner should be asked to provide an estimate on the extent of the blood loss. When dealing with or suspicious of an intoxication, the nature of the poison and an estimate of the ingested amount and elapsed time since the ingestion are essential. This preliminary information helps to establish an initial differential or tentative diagnosis, e.g. the sudden onset of severe vomiting in a ferret following ingestion of a foreign body is highly suggestive for an obstruction.

Owner Instructions

The initial phone call should be used to provide the necessary instructions to help stabilize the patient and transport it safely to the clinic. Similarly, instructions can be provided to help calm the animal and minimize its stress during the handling and transport and to ensure that the owner brings along any and all necessary items and/or materials, where applicable.

First Aid at Home

Dependent on the severity and type of emergency, the owner may need to provide basic first aid at home to stabilize the patient and allow the animal to be transported to the clinic safely. Guidelines for first aid in the home environment can be found in Table 1.1.

Transport

The animal should be safely contained during transportation to prevent additional trauma or stress. This is usually best achieved by placing the animal in a suitable carrier (Figure 1.1). Towels can be used to provide a soft bedding. Transportation without a carrier should only be considered if the animal is in shock at which time the animal can be placed on the lap of the co-driver while preferably being wrapped in a blanket. For further guidelines on safe transportation, the reader is referred to Chapter 2.

Materials to Bring Along for the Emergency Visit

Dependent on the presenting signs, the owner can be advised to bring the following along for the visit: feces and urine (when available), vaccination documentation, and photos of the enclosure and living environment. For patients with intermittent clinical signs, videos can be very helpful. When hospitalization may be required, the owner can be asked to bring along familiar food, bedding, and enrichment to increase patient comfort. In some cases, it may be advised to bring a companion animal as this both helps to reduce stress from hospitalization and prevent problems during reintroduction of the animal to its cage mate(s). When poisoning or toxin exposure is suspected or confirmed, the owner should be instructed to bring along any relevant product packaging, or a photograph or sample of the poison (e.g. plant).

Table 1.1 Basic first aid procedures for specific small mammal emergencies.

Type of emergency Instructions to be provided to the owner Bleeding (external)

• Apply pressure to stop the bleeding. Hold pressure for at least 3?min before checking if a clot has formed. Alternatively, a bandage may be used for applying pressure to the site
• If possible, use a sterile gauze pad to put pressure over the wound. A clean towel, cloth, or handkerchief can be used as an alternative
• Do not remove the pad or cloth if it becomes saturated with blood. Instead, apply another one over it and continue applying pressure
• If bleeding is severe and, on the legs, a tourniquet (e.g. an elastic band or gauze) can be applied between the wound and the body. To prevent ischemia, the tourniquet can be loosened for 20?s every...