The avian practitioner will be presented with three classes of birds: the well-bird, the obviously sick bird, and the bird harboring a sub-clinical infection. The first two classes of birds are very straightforward to deal with, but it is the sub-clinically ill bird that is most problematic for most avian practitioners. Birds are masters at hiding signs of illness as a protective mechanism. A sick bird will attract predators to the flock, so a bird will hide that it is ill for as long as possible. A sick bird will usually be pushed out of the flock when it can no longer keep up with it. So, the ill bird will act as normal as it possibly can for as long as it can. This means that the bird that is presented to you for clinical illness has been sick for quite some time. Inexperienced or unknowledgeable owners are likely to miss the subtle signs of illness, such as decreased vocalization, change in volume, character or consistency of droppings, change in appetite, weight loss or decreased activity level.

DO educate your staff about what to tell bird owners prior to the bird coming in to your office Instruct your staff to make sure to emphasize to bird owners that all birds coming in to your practice MUST be contained in a cage or carrier, for the safety of the birds. A bird on a human hand or shoulder of an owner is at risk, because if it is frightened, it may bite the owner, and your clinic may be responsible. If it is startled and jumps off the shoulder, it may be attacked by a dog or cat, resulting in the death of the bird. Your clinic may be responsible if this occurs, as well. If the bird is flighted, it could end up flying out an open door, and your clinic could be responsible if the bird is lost. Are you beginning to see a trend here? Owners should be instructed to bring small birds in their cage, which has not been cleaned, so that the vet can evaluate the droppings. Large birds may be brought in a carrier. Ask the owners to bring in papers from the bottom of the cage, if possible.

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The receptionist should also instruct the owner to bring in any medications, supplements or alternative medicine treatments that he or she has been giving. It must be stressed that this is very important, and the owner should not be embarrassed if they sought to use over-the-counter or alternative treatments prior to seeking professional help.

DO see a sick bird as soon as possible
It is very important to teach your staff about the differences between avian medicine and dog and cat medicine. If an owner calls about a sick bird, it is vital that the bird be seen as soon as possible, even if there are no scheduled openings in the appointment book. I can't tell you the number of letters I have read that were written to me at Bird Talk magazine by very unhappy and inconsolable bird owners who were told by the staff at a clinic that their sick bird couldn't be seen for several days, and the bird died before the scheduled appointment! Remember, a sick bird that has "crashed" and is showing clinical signs has been ill for quite some time, so any delay in providing diagnosis and treatment may result in the death of the bird! If a sick bird needs to come in and you have no openings, suggest that the owner drop off the bird. Make sure that the staff gets a thorough history and lets you know when the bird comes in, so that you may take a few minutes to evaluate the bird. Most sick birds require supplemental heat, which is easy to provide with an incubator, aquabrooder or heating pad. If the bird appears critical, provide the bird with heat and supplemental oxygen before you attempt to do anything else to it. But, please don't allow your staff to put off a bird owner who feels that their bird is ill. You may occasionally make room for a bird that could have waited, but more often than not, you will make the correct decision by seeing the bird immediately.

DON'T handle a sick bird until a thorough history and visual evaluation have been performed
Any bird presented for a check up or even grooming should not be handled until a thorough history has been taken by the veterinarian. While taking the history and after, observe the bird in the cage or carrier. A bird can be emaciated and weak, yet when it fluffs out its feathers, it may look normal. By carefully observing the bird prior to catching it up for examination, you can be prepared and know what to expect. Nothing is worse than catching up a bird for routine grooming and having it expire in your hands because it was on the threshold of death. If the bird looks bad, you can warn the owner about the possibility that the stress of handling may be enough to precipitate a crisis. This way, if the bird does "crash" in your hands, the owner will be better prepared. Have oxygen ready, warmed lactated ringers in a syringe, perhaps a syringe of warm hand-feeding formula and a stainless steel feeding tube, and any other equipment or medications that you feel might be necessary.

DO assess the avian patient's condition every moment during the time it is being handled
This means that while you are examining the bird and procuring the tests, your technician is focusing all of his or her attention on how the bird is handling the stress. It doesn't help if you successfully draw enough blood for a CBC and chem panel, but the patient died two minutes ago! Actually, you both must remain focused on the bird at all times while it is in your hands. This means that this is NOT the time to discuss treatment options or to answer the owner's questions about diet. All discussions should take place after the bird is safely back in its cage.
At the first signs of distress, the procedure should cease, and the bird should be immediately placed back in its cage, released to the owner or placed in a bird intensive care unit.
In cases where the bird is very ill, it may be most important to stabilize the bird first, and procure tests later. With a critically ill bird, tests may need to be performed in stages, or sometimes, they must be forgone, so that all efforts are directed towards support care.

DON'T forget your sound medical background when dealing with the avian emergency
Remember your medical skills when working on a critical, injured or traumatized bird. The same medical skills apply, with some exceptions. You already know the basics of emergency medicine, so let's go over the differences.
Remember that birds have air sacs, and if there is serious damage to the beak, oropharynx or glottis, and establishing an airway is difficult, an air sac can be cannulated, and the bird can safely and easily breathe through the tube.
Birds may be treated for "shock" although their physiological response to injury does not result in shock as occurs in mammals. We must always remember that steroid use in birds has potentially more serious and long-standing consequences than its use in mammals does. One injection of a steroid in a critical bird is worth the risk, however, its use will increase the chance that the bird may develop aspergillosis, a serious fungal disease. Steroids have limited benefit in avian species, and topical preparations are also dangerous.
Birds also have some pneumatized bones, and a fracture may result in extensive SQ emphysema. This is often puzzling to the beginning avian vet, who may suspect rib fractures. However, SQ emphysema is a common sequela to a fractured pneumatized bone and will usually spontaneously resolve with 24 hours.
Many ill birds are dehydrated. Fluids may be given SQ (over the back of the neck, where there is lots of loose skin, just beware of the jugular veins), intraosseously or intravenously. Hydrating a critical bird is very important.
Many sick birds also require supplemental heat, as they are not thermoregulating properly. Keeping a sick bird in a cage with a controlled temperature and humidity is very important. Birds will do well in an incubator set at between 87-92 degrees F. Humidity should be over 75%.
Sick baby birds often become ill from being kept at too low of a temperature. When this happens, the GI tract slows down dramatically. Therefore, giving any medications orally is usually not a great idea, as absorption will be erratic and slower than normal. Parenteral antibiotics and therapeutics are a better choice.
When bandaging or splinting a bird, make sure that the sternum moves freely. Birds breathe like a bellows, in and out, not up and down, as mammals do. If the sternum's movement is restricted, the bird may asphyxiate.

DO plan to clip the wings of hospitalized birds
If a very sick bird is flighted, request permission to quickly trim the wings. If a sick bird escapes and can fly, much metabolic energy may be spent by the bird. Also, smaller birds may fly from perch to perch, becoming more stressed than necessary, when they must be captured several times per day for treatment. Clipping the wings prevents these problems. If the owner does not wish the bird to be clipped, you can wrap a rubber band around the last four or five primary remiges on each wing to temporarily render a bird flightless.

DO minimize stress in sick birds
Keep critical birds in a stress-free environment. Don't put them in Premier Cages where they can see their reflection. Keep them in a warm, quiet, dark environment. Don't keep a sick bird in a cage on the clinic floor. Birds are most comfortable up high, so take that into consideration when deciding where to put birdcages.

DON'T forget to weigh hospitalized birds daily
Monitoring a bird's weight daily is very important in assessing how your treatment plan is working. Make sure that the bird is weighed every morning prior to being tube fed and medicated, and that the weight (in grams) is recorded in the chart.

DO learn how to perform a complete physical exam on a bird quickly and efficiently, using magnification
A physical exam may be performed on a bird just as it can be in a mammal. Make sure to record the weight. Assess the choanal slit and choanal papillae, as this area is often the best area to visualize to determine the overall health of a bird. Perform the physical exam by organ system or from top to bottom, methodically, however you prefer. Make sure to evert the cloacal mucosa, as this area also provides good diagnostic information.

DO maintain total hemostasis when working on a bird
Although it is not true that a bird will die from losing a few drops of blood, it is very important to minimize any bleeding. If a bird is bleeding badly, it is vital to stop the bleeding as quickly as possible. If a bird won't stop bleeding after venipuncture, a pressure bandage may be applied for 20 minutes or so, until clotting has occurred. Clotisol, a liquid clotting agent, is safe and effective to use in birds. Use of a radiosurgical unit (and NOT an electrocautery unit) is very helpful in stopping bleeding.
Avian emergency medicine requires the same fundamentals as mammalian emergency medicine, however, there are some major differences that must be understood, as well. Once the differences are learned, the practice of avian medicine will prove much easier. A good understanding of avian anatomy, physiology and pharmacology is essential to the avian practitioner.