Emergency Room

EMERGENCY ROOM 2007

We are well into our sixth season here at the KTTC, and have had a lot of interesting cases come in.

Some of these we have had to euthanize, but many have been treated successfully and we have implemented new ways to repair fractures and new medical management.

We have started using such materials as orthopedic wire and screws, dental braces, splints and Kirschner apparatus (bone pins held in position by an external fixation device, acrylic in our case). We are very pleased with the wound healing using these new techniques, and anticipate experimenting with other new materials and methods in the future.

Harriet Forrester and John Satta of the New Jersey Turtle Rescue have documented a shell repair method using cable ties and 2 ton epoxy (PDF). We are trying to minimize the use of fibreglass patches that often develop areas of infection underneath, despite adequate wound management.

In addition to new repair methods, we are also trying out different antibiotics, anaesthetics and analgesics (painkillers) and are seeing some great results. In particular, it has been wonderful to offer pain relief to our reptile friends who are dealing with horrendous injuries.

When a turtle is brought in to the Centre, many things must be taken into consideration when treating the patient. One of the most important factors in a turtle’s outlook for the future (prognosis) is whether it is bright and alert, or depressed, on admission. We have successfully treated turtles that remained alert despite being severely injured.

Every year we have turtles brought in with broken jaws. Typically these turtles do not eat voluntarily for several weeks. Studies have shown that turtles can lose 15-20% of their bodyweight after 3 weeks without food at warm temperatures. In an injured and stressed animal this can severely impede its recovery. Because of this, we have placed feeding tubes (esophagostomy tubes- see Feeding Tubes) in these turtles to provide nutritional support as they heal. This has been successful in both Snapping turtles and a Blanding’s turtle.

Initial wound management continues to and will always be one of the most important procedures involved with trauma. The wound is flushed, and flushed, and flushed with copious amounts of saline or lactated ringers solution, and sometimes an antibacterial solution as well.

Cleaning and flushing the wound can sometimes take up to 30 minutes- imagine washing your hands for that length of time! This is perhaps the step most critical to a turtle’s survival. Wound cleaning reduces or eliminates bacteria and helps to remove necrotic (dead) or damaged tissue. If a wound is more than a few hours old or if it has been contaminated with dirt etc., shell repair is delayed until infection is controlled. Our patients are suffering both from the trauma of an injury and the stress of captivity and are immune-suppressed, so they are placed on injectable antibiotics for several days.

The patch consists of two layers of fiberglass and epoxy, and a topcoat to seal the patch. Placing of the patch can be a challenge; enough resin must be used to create a waterproof patch but care must be taken to ensure no resin drips into the wound. Turtles are often sedated or anaesthetized during this procedure as moving the shell fragments can be very painful. Once the patch has dried, they are placed in their temporary home at the Centre.

HOSPITAL NOTES 2003

To Patch of Not To Patch

For the most part, the turtles we have treated with fiberglass patches have done very well and we are pleased with their recovery. However, we have found the fiberglass patch to be a less than satisfactory method of repair in some cases. In veterinary medicine, one of the most important rules is to above all, do no harm. When evaluating a treatment protocol, we ask whether the turtle did well because of us, would have done well anyway, or did it do well despite what we did. Looking at our patients, we are concerned that despite adequate wound treatment and sterile technique, some of our patients developed areas of necrosis underneath the patch. Those whose patch was removed earlier had less tissue damage. Based on the results we have seen, we cannot at this time recommend fiberglass patching as a satisfactory method of repair for most shell injuries.

A big concern for us is the number of people we have spoken to who have attempted shell repairs in turtles they have found. Placing a patch over a contaminated wound seals in infection and can result in sepsis and death- in most cases the wound would be better left open to heal. If our patients have had damage underneath the patch, I shudder to think of the damage that would occur in turtles that are patched without proper wound management, medical care and the use of antibiotics. Unless you have considerable education in medicine, please do not attempt to treat an injured turtle. Take it to a rehabilitation centre or your local veterinarian for treatment. Your well-intentioned care could be a death sentence for the very animal you are trying to help.