Veterinary Basics: Advanced Tools and Techniques
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What equipment do you need to properly care for venomous snakes when they get sick? Safe capture and restraint gear such as hooks, tongs and tubes are first on the list no matter what the size of your collection. Click here for some basic tutorials on safe venomous snake handling and restraint.

Basic equipment: For administering oral medications or enteral nutrition, you will need syringes and feeding tubes. Feeding tubes can be improvised from soft plastic aquarium tubing with the ends smoothed and rounded over a flame. Red rubber catheters, tomcat catheters and stainless steel ball tip livestock dosing needles are all good options for delivery. Intramuscular, subcutaneous and intracoelomic injections can be delivered with the appropriate sized needles, and blood samples can be taken. You can also obtain biopsy and sampling swab kits which will help you take other kinds of samples from your snakes and send them in to a lab to help determine exactly what disease organism is making your snake sick. Click here for some good places to find these tools.

Advanced diagnostics: If you are caring for a large collection (more than 40-50 animals) it is a good idea to invest in equipment that will allow you to do simple diagnostics and accurate drug dosing on your premises. You can spend anywhere from $100 to $1,000 or more on a microscope depending on your needs. Any good quality "toy" microscope capable of at least 100X magnification is adequate for doing fecal exams, but there are better scopes available that will let you do cytology and look for traces of bacterial or fungal infections in biopsy samples. You will also need a supply of Fecasol (or make your own saturated salt or sugar solutions), slides and cover slips and fecal floatation cups. If you want to do cytology (or look for certain kinds of parasites) you will also need various kinds of stains. You will also need a gram scale for getting accurate weights for drug dosing, and a good stock of the most commonly used snake drugs.

Commonly used drugs: You can purchase all of the standard antiparasiticals (Panacur, Flagyl, Droncit, Albon, Ivermectin, Levamisole) from a livestock supply catalog such as Valley Vet or Vet Med Direct, assuming you want to buy in bulk for a large collection. Two disinfecting solutions which are excellent for basic wound management in reptiles as well as for cleaning instruments are Nolvasan (chlorhexadine) and Betadine (povidone iodone). These can also be purchased in bulk from the same source. While the old standby of triple antibiotic ointment can be used to help manage minor epidermal injuries, we have had excellent results with Thermazine or Silvadine (silver sulfadiazine cream). If you are buying smaller quantities to help you manage a small private collection, it is best to purchase through a local veterinarian.

Prescription drugs: You will also find it handy to stock the most commonly used reptile antibiotics, but you will need a veterinarian's prescription to purchase them. The 100mg/ml cattle injectable formulation of Baytril (enrofloxacin) is quite cost effective for managing large collections, but this should under no circumstances be administered through any route other than orally in a reptile. Other useful antibiotics to have on the shelf include Amikacin, Fortaz (ceftazidime) and chloramphenicol. Your debilitated patient will not always have the time for you to send out for a full C&S (culture and sensitivity test) to pinpoint sensitive and resistant drugs after your cytology tells you that there are bacterial chains present in your sample. Consequently you may find yourself doing some guesswork and loading up patients with an antibiotic chosen mainly for its route of administration.

Controlled drugs: To practice anesthesia and pain management, you will need to be under the direct supervision of a veterinarian as these drugs are legally controlled. Lidocaine is an excellent local anesthetic and you can do many minimally invasive procedures (biopsies, small abscess debriedment) with this drug alone. Lidocaine can also help extend the depth and duration of general anesthesia by acting as a local block.

General anesthesia: You can induce a moderate plane of surgical anesthesia in snakes for a short duration by placing them in an isoflourane box. This mechanism is simple to construct and requires only a sealed transparent box of known volume (eg, Tupperware), a small mesh sieve, a few cotton balls and a microprocessor fan (available at any computer parts store). Click here for a more detailed description of this technique. Injectable drugs such as Telazol and Diazepam (Valium) may also be used for chemical restraint. Buprenenorphine and Butorphanol can be used for post-operative pain management, a very appropriate protocol after painful procedures. Snakes lose their reflexes cranially to caudally (head to tail) and regain mobility caudally to cranially (tail first), so you can safely assess their plane of anesthesia by continually checking for muscle tone and withdrawal reflexes at the tail. A snake under anesthesia cannot thermoregulate and must be kept within the optimum temperature zone for its species until it has recovered . Overheating an anesthetized snake can be rapidly fatal; overcooling may increase immunosuppression.

Ventilation: Snakes will cease voluntary respirations at a surgical plane of anesthesia. While reptile tissues are optimally designed to operate under hypoxic conditions for a surprising length of time, it is a good idea to keep your patient ventilated. Use an uncuffed endotracheal tube or a well-smoothed red rubber catheter tip to intubate and secure it to the lower jaw with soft cloth tape.. A snake's glottis is inflexible and easy to injure, so be extremely careful during this procedure. Manual ventilations may be given with a syringe of appropriate volume. In an emergency you may ventilate by gently blowing into the catheter tube. Do not overinflate; watch for a slight rise similar to what you would see in the animal's normal respiration and stop there. It is generally a bad idea to experiment with general anesthesia if you are not within easy reach of a small-animal ventilator, as full recovery can take hours and you will need to closely monitor the patient's temperature, heart rate and breathing until mobility is regained. Click here for a more detailed discussion of anesthesia, chemical restraint and pain management in venomous snakes.

Minor surgery: Obviously if a snake is in need of surgery, you should make every effort to have that procedure performed by a qualified veterinarian using appropriate anesthesia and pain management drugs. However there may be emergency situations when this is not an option. Eg, you have an injured rattlesnake in your pillowcase and no vet within hundreds of miles will treat this animal. If you think you are likely to run into these circumstances, it might be a good idea to see if you can get your hands on some of those controlled drugs ahead of time. Check the laws in your local area and discuss the matter with a sympathetic veterinarian - and make sure that you acquire the skills you will need to appropriately manage these cases.

Basic trauma management: If possible, the injured animal should be sedated for humane analgesia and for safe chemical immobilization. Consider intracoelomic fluid support with Reptile Ringer's (50% Lactated Ringer's Solution, 25% 0.9% saline, 25% D5W 5% dextrose water) and injectable B complex. If this is not an immediately available option, you may deliver fluids orally at 1% of body weight per 24 hours. An electrolyte solution such as Pedialyte can be used orally. Wounds should be well irrigated with dilute chlorhexadine or povidone iodine. Swelling that threatens the integrity of the spinal nerves or the airway may be reduced with corticosteroids, but this may interfere with the healing process and is not recommended except under these circumstances. Learn more about Fluids and Fluid Therapy in Reptiles from Melissa Kaplan's Herp Care collection.

If you need to close a wound without sutures or staples, you can purchase veterinary tissue glue, but ordinary cyanoacrylate (Crazy Glue) can also be substituted. Do not close a wound completely without leaving a drainage site. In many cases it is a better idea not to close a wound at all than to do a makeshift job without adequate veterinary supervision. Prophylactic antibiotics are a good idea for trauma cases.

Critical Care Patient Management: A seriously ill or injured snake may not be able to thermoregulate or to voluntarily drink. You will need to carefully monitor the temperature and hydration status of your patient at all times. You should also manage its airway. If the animal regurgitates any food or medication given it may aspirate as it may be too weak to clear its mouth. Fluid support is appropriate for seriously debilitated snakes, but you should ascertain that peristalsis is taking place before giving enteral nutrition. A debilitated patient's GI tract may not be functional, so food placed there may actually rot before it is properly digested. A very thin slurry of electrolyte solution (Pedialyte can be purchased in any drugstore) and a small amount of a high calorie concentrate such as NutriCal will be more readily absorbed by extremely debilitated snakes.

Euthanasia: The best euthanasia protocol I have found for snakes is inducing them to a deep plane of surgical anesthesia (an isoflourane box or any of the injectables can be used) and severing the spine at the occipital condyle (just behind the head). The brain may also be pithed. I have had some markedly bad experiences with commonly used veterinary euthanasia solutions in crotalids.

Learn more about Fluids and Fluid Therapy in Reptiles at Melissa Kaplan's Herp Care collection.
Read an article on reptile parasites from Melissa Kaplan's Herp Care collection.
Emaciation (Starvation) Protocol article from Melissa Kaplan's Herp Care collection.
Visit the Herp Vet Connection to find a local reptile veterinarian.

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