Case Study: 16-0116
For school I have to write up a case study once a week on a patient at the center. This week I chose patient 16-0116: An Eastern American Toad. I’ve gotten to do a lot of cool things so far but this case was definitely my favorite to be a part of so I thought I’d share it.
Signalment: Eastern American Toad, adult, sex undetermined
History: Public citizen was gardening and accidentally injured toad with pruners.
Chief Complaint: Loss of deep pain and motor function in right distal forelimb, exposure of distal articular surface of humerus, superficial laceration over right mid-dorsolateral back, open luxation of right elbow.
Clinical Signs: Right forelimb dragging along below the elbow without any obvious movement of the digits. No deep pain response and no motor function in the distal right forelimb. Right forelimb digits swollen.
Diagnostics: Two dorsoventral views were taken with the right forelimb laid caudal and then laid in normal cranial position. The technique was slightly underexposed with a grainy appearance to the image and loss of fine detail. The positioning is diagnostic, though the caudal portion of the frog is not straight in one view. Both radiographs show a luxation at the right elbow joint.
Diagnosis: Loss of deep pain and motor function in right distal forelimb, superficial laceration over right mid-dorsolateral back, open luxation of right elbow.
Treatment: Pain medication and antibiotics due to exposure of distal articular surface of humerus. Amputation of right distal forelimb necessary.
Prognosis: Guarded to fair
Patient outcome: Patient was taken to surgery two days post admittance. Surgery was successful. However, patient was euthanized during recovery post-op since patient remained non-responsive despite epinephrine administration and assisted ventilation. Euthasol administered intracoelomic.
Extern reflection: First of all I have to say how impressed I was with the public citizen who brought in the toad. I don’t know many people who would transport a toad to a wildlife hospital. I think most people would feel bad about accidentally snipping them with a pair of gardening shears, but probably would just let nature take its course. Second, I am both honored and impressed with the care given to this toad by everyone involved with this case.
The day of surgery we began inducing the patient around 2:05 pm EST. Amphibians can be somewhat difficult to induce. This is by no means anything like inducing a dog or cat. You can’t just premed them with sedatives and analgesics (pain medication). Well, you can but it’s not the preferred method. All the vet staff on the case read up on different methods to induce amphibians. The night before surgery I was reading several articles relating to amphibian anesthesia since I was to be the primary anesthetist on the case.
The thing with amphibians is that their skin absorbs everything. Although they do have lungs, they also use their skin as part of their respiratory system. After reading about several different ways to induce an amphibian patient, we all decided to induce our toad patient via topical anesthetic. We used a mixture of 1.5 mL of distilled water, 3.5 mL of lubricant, and 3 mL of isoflurane and applied the mixture to the patient’s dorsum (back).
Initially we applied a very low dose of anesthetic, careful not to cause anesthetic toxicity. The problem we encountered, however, was our patient would not stay sedated long enough to begin the surgery. Every time we adequately sedated the toad, he would wake up just as I finished prepping the right forelimb for surgery causing the surgical site to become unsterile. Finally after several hours of going back and forth trying to sedate the patient, we decided to apply the highest dose of anesthetic and immediately begin the surgery. At this point my “scrub” became more of a “drip chorhexidine on the surgical site and flush with saline three times” – which was really not ideal but time wasn’t on our side.
The surgery went great. Patient’s heart rate remained steady through most of the procedure, only increasing during the amputation itself. My main problem as being the anesthetist on this case was that I had almost no way of monitoring the patient’s respiratory rate. This is REALLY not ideal in any surgery since the first sign your patient is too deep is their respiratory rate will decrease. The only thing I had to go on was the doppler to monitor the heart rate, which like I said remained mostly steady. Everything we read prior to surgery was that intubation should be reserved for large amphibians only. And since our little toad was only 30.2 grams, we decided against intubation.
For two hours post surgery I monitored the patient’s recovery. Part of my job as being a tech (my favorite part) is providing animals with good nursing care. We are the ones who make sure the patient wakes up and feels comfortable. It’s our job to report any signs of pain to the veterinarian on the case. So I did my job and I sat by my patient the whole time, while intermittently dousing the patient with Reptile Ringers solution and Saline to A. keep the patient moist and hydrated, and B. to flush the isoflurane from their system. The heart rate remained at a steady 60 bpm, increasing slightly every so often. At one point the toad opened its eyes and mouth. I took this as a sign we were on the right path to recovery. However, that was the last sign of recovery I observed.
The other weird thing with amphibians is that their heart will continue to beat after they’ve died. This was a growing fear as we reached the first hour mark of recovery. Around 6:00 pm we decided to take a chance and intubate the patient. We used a size 1 cole tube (a non-cuffed endotracheal tube) which fit perfectly in the patient’s trachea. This was when we realized we should have intubated the patient from the start. After ventilating the patient with an Ambu bag for 15 minutes we administered an intramuscular injection of diluted epinephrine. As I was handling the patient, I realized some of the limbs were becoming stiff. The patient was going into rigor mortis – meaning that our patient had been dead for a couple hours.
Euthasol was administered via intracoelomic to stop the heart and time of death was called at 7:20 pm.
The total time spent on this case from time of initial attempt of induction to time of death was 6 hours. Our clinic closes at 5:00 pm and I did not leave the hospital until 8:00 pm. The lengths that we went to for this toad was remarkable. We did everything we could to keep this toad alive and to make sure the if or when they woke up, they would have a good enough quality of life to be released back into its natural habitat – the sole goal of our clinic.
To most people ventilating a toad with an Ambu bag may seem extraneous and a bit ridiculous. But what kind of wildlife clinic would we be if we didn’t treat every animal with the same respect? Just because they’re lower on the food chain doesn’t mean they don’t deserve the same respect as a cat or dog. We appreciate the circle of life and we understand how it works. But we will still do our best to give every animal a fair shot at survival. It is not up to us to decide who lives and who dies. We are given the daunting task of deciding whether an animal is able to be saved or should be euthanized. But if there’s any chance of survival we will do everything we can to help our patients get there. Sometimes though, we have to euthanize because we know that sometimes there’s nothing we can do. Sometimes nature has already taken its course when the patients arrive at our clinic. It is definitely hard, but at the same time it’s rewarding to be able to rehabilitate an animal and release them back into the wild. And it’s an amazing feeling to know that you did everything you could to help something as little as an Eastern American Toad.
NOTE: if anyone has any questions about the case or the procedure I would be happy to answer them to the best of my knowledge. If I don’t know the answer, I will direct the question to the vet.