Impact injuries

Impact injuries can happen for a variety of reasons.  Free flying raptors may hit a window, fencing, moving vehicles and even prey species. Nestling raptors may fall from great heights if the nest gives way. Certainly, our first instinct is to look at the bird and decide if it appears normal. However, it is always important to remember that impact injury = internal trauma.  Impact injuries can involve multiple organs such as the heart, liver, eyes, brain, kidney and lungs to name a few. The bird may present with a fractured wing or leg, but what we cannot see could be more devastating than the fracture itself. How we approach, stabilize and treat the bird with impact injury will ultimately affect the outcome for this individual. Here are some examples of what to be aware of:

• Head trauma patients should be kept quiet with very low stimuli. It is important to keep the bird protected from the cold, however supplemental heat must be used with   caution to avoid causing peripheral dilation of the vessels, especially of the head and neck.
• Head or eye injuries can have devastating consequences following impact trauma. Any injury to the eye should be evaluated ASAP by a veterinarian. Cornel injuries may require immediate surgery. Certainly bleeding into the anterior chamber of the eye or retinal dysfunctions must be identified to try and reverse any potential for permanent damage. With any head or eye trauma, even if the eye appears normal, traumatic cataracts can form at a later date affecting the bird’s vision.
• Heart and lungs are certainly affected with impact injuries. The injuries to these organs can be progressive. Contusions to the lungs may worsen within the first 24 hours and significantly affect the respiratory function of the bird. Significant impact injuries may result in the slow death of cardiac muscle causing muscle necrosis and myocardial infarct up to 2-3 weeks post trauma.
• The liver and heart lie directly under the keel and can be affected by any impact injury. The liver if injured has the  great ability to heal itself given the proper support and time.
• The kidneys can be damaged with impact injury either directly from the trauma or secondary to disruption of cardiovascular perfusion to this organ.

Clinical signs

Signs of trauma will vary greatly with the degree of trauma and what parts of the body have been impacted. Certainly fractured limbs can be seen, but it is the internal damage that must be assessed. Following trauma, the birds may show signs of weakness, ataxia, increased respiratory effort, regurgitation, bloody mutes and depression. Certainly as signs of internal trauma progress, the bird can become stuporous and semi-comatose. Seizures can also be present with impact injuries especially injuries involving the head.

Recommended treatment

A veterinarian should evaluate any bird with significant impact injury. The care given to this type of patient is critical within the first 24 hours. Stabilization of the patient is the key to slowing the progression of organ involvement and obtaining the best outcome. Birds with traumatic injuries need quiet and calm housing with cautious supplemental heat. Restraining birds with injuries must be done gently and with the understanding that prolonged restrain may cause irreversible damage to the patient. All birds with traumatic injuries will need fluid therapy. Depending on the severity of impact, fluids will be given subcutaneously, intravenously or intraosseous. Isotonic fluids like lactated Ringer’s solution are always warmed before being given to the patient.  Supportive care may also require the use of injectable antibiotics, non- steroidal anti-inflammatories , analgesics and specialized medications to control the detrimental effects on the internal organs.  Nutritional support is initially administered by gavage/ tube feeding an easily digestible balanced liquid diet.

Diagnostics

It is highly recommended that birds suffering from impact injury have a complete blood count and chemistry evaluation. This will identify the hidden dangers of impact injury and evaluate organ function. Radiographs when the patient is stable are also recommended to identify shoulder, spine and pelvis injuries as well as trauma to the internal organs.