Plus-Hex CLINICAL
ABSTRACT Myiasis is the most common emergency and cause of death of rabbits in veterinary practice [ 1 , 4 ] . Due to increasing numbers of cases of this condition , it is important for veterinary professionals to understand the nursing implications for the critical myiasis rabbit .
Studies confirm the rise in popularity of the domestic rabbit . However , clients are not confident in managing and handling rabbits in accordance with their health needs . In addition , a high proportion of veterinary nurses and veterinary surgeons lack confidence in managing pain in rabbits , indicating the need for education in pain management . Intravenous fluid therapy is the gold standard in stabilising critically ill patients in veterinary practice [ 2 ] . Despite this , it is not routinely used in the critical myiasis rabbit .
The aim of this article is to understand the nursing care implications for managing the critical myiasis rabbit , in terms of pain and fluid management . This includes exploring the current limitations in veterinary medicine and the confidence of veterinary professionals .
Pain management is an important part of rabbit nursing care but there are several pain scales in use , with no clear gold standard . The new Bristol Rabbit Pain Scale is more inclusive and is assessed in this article . The article also explores the indications for resuscitation fluid therapy in combination with a eutectic mixture of local anaesthetics ( EMLA ) cream to treat these patients . Overall , the results show that there is limited literature on pain management and fluid therapy in rabbits .
Keywords myiasis , rabbit , critical , emergency , pain management , intravenous fluid therapy
Introduction
In 2021 , the Pet Food Manufacturers ' Association ( PFMA ) [ 3 ] stated there were over 1.1 million pet rabbits in the UK , making them the third most popular pets , after cats and dogs . This explains why veterinary practices are seeing an increase in rabbit admissions . In rabbit consultations , Turner et al . [ 1 ] found that blowfly strike ( myiasis ) was identified in more than 0.6 % of rabbits . Similarly , myiasis has been identified as the most common reason for euthanasia and death in this species [ 1 , 4 ] . This is a concern , as myiasis is a preventable and often treatable condition [ 1 ] . Veterinary nurses ( VNs ) are likely to be faced with more rabbit cases and need to know how to manage these patients .
Myiasis , commonly known as fly strike , occurs after fly eggs that are laid on the rabbit ' s skin hatch into larvae and develop into maggots [ 1 ] . Bluebottle and greenbottle ( blowfly ) maggots are considered the most dangerous . They feed on damaged tissue , often as a result of trauma or soiling , which can lead to necrosis and death [ 5 ] .
Several conditions can increase the risk of myiasis , including nutritional deficiencies , dental disease , obesity , or reduced mobility , which affects grooming [ 5 ] . Geriatric rabbits , which are more likely to have arthritis , are especially vulnerable to myiasis [ 5 ] . Myiasis occurs mostly in the perineal region , where faecal and urine soiling may be present as a result of poor or absent grooming . Geriatric patients should be monitored closely , and owners should seek veterinary attention if pain relief is required [ 6 ] .
Current predictions for climate change indicate the potential for longer periods of myiasis , with increased incidences through spring , as has been seen in sheep [ 1 , 7 ] . Warmer weather means there are more blowflies in the environment and provides the perfect environment for maggots to thrive [ 7 ] . The combination of high demand for pet rabbits and predictions for global warming indicate a likely further increase in rabbit myiasis admissions to veterinary practices .
DeCubellis [ 8 ] states that when treating myiasis , the main considerations include :
• immediate pain relief
• clipping and cleaning the affected area with a chlorohexidine-based shampoo
• the removal of maggots
• skin debridement
• treating the wound with silver sulfadiazine .
Harcourt-Brown [ 9 ] recommends fluid therapy for these shocked patients , and nursing care around the perineum .
Managing pain and stress levels is important in critically ill rabbits , as these can affect gut motility ( which can cause inappetence ) and result in shock , hypothermia and even death [ 10 ] . VNs should therefore be well-versed in assessing and monitoring pain in rabbits , to prevent further harm due to stress , and should be prepared to administer fluid therapy if necessary [ 1 ] .
According to Benato et al . [ 11 ] , 5 % of VNs claimed they were ‘ not happy at all ’ with their knowledge of rabbit analgesia . Clearly , there are limitations in veterinary medicine for rabbits , including a lack of knowledge about analgesia , few research studies on effective pain management in rabbits , and no gold standard composite pain scale for rabbits [ 4 , 11 ] .
Volume 38 ( 4 ) • August 2023
19