Lethal Love Dignity in Death How Euthanasia Can Save Lives (Including Your Own!) Main Goal 1/9/2015. Release!

Transcription

1 Lethal Love Dignity in Death How Euthanasia Can Save Lives (Including Your Own!) Release! Main Goal Stress Goals Minimize stress Balance suffering with probability of release Take care of ourselves! 1

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3 Compassion Fatigue What is it? Form of secondary PTSD; also called secondary traumatic stress (STS) Secondary traumatic stress from witnessing the suffering of others Compassion fatigue can reduce caretakers empathy which can decreases the quality of care given to patients Effects of Compassion Fatigue Normal displays of stress! 3

4 Individual Symptoms Excessive blaming Bottled up emotions Isolation from others Receives unusual amount of complaints from others Voices excessive complaints about administrative functions Substance abuse used to mask feelings Compulsive behaviors such as overspending, overeating, gambling, sexual addictions Poor self-care (i.e., hygiene, appearance) Legal problems, indebtedness Reoccurrence of nightmares and flashbacks to traumatic event Chronic physical ailments such as gastrointestinal problems and recurrent colds Apathy, sad, no longer finds activities pleasurable Difficulty concentrating Mentally and physically tired Preoccupied In denial about problems Organizational Symptoms High absenteeism tant changes in co-workers relationships Inability for teams to work well together Desire among staff members to break company rules Outbreaks of aggressive behaviors among staff Inability of staff to complete assignments and tasks Inability of staff to respect and meet deadlines Lack of flexibility among staff members Negativism towards management Strong reluctance toward change Inability of staff to believe improvement is possible Lack of a vision for the future Cuteness Interlude Including suicide How do we cope with compassion fatigue?? Ignoring the problem/bottle it up poor standard of care Become detached from our patients Loss of motivation ( loss of productivity...b/c less productivity means experiencing less secondary trauma) BURNOUT How do we avoid/treat compassion fatigue?? Awareness! Processing the secondary trauma By setting limits So we have time to fully process (grieve) the trauma Taking breaks Balance caring with the rest of your life 4

5 Bottom Line If you stretch your limits, the quality of care you give ALL your patients will be LOWER WRC Independent non-profit located in St Paul, MN One of the largest wildlife rehabilitation centers in the country Admit ~ 9000 animals/year Over 160 species 2 full-time DVMs and 2 CVTs 8 full-time staff members >500 volunteers WRC Example 100.0% 90.0% ~1500 TOTAL ECTR/yr <50g/yr 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% eoa dic/e released 20.0% 10.0% 0.0% How do we set limits? Dedicate time to the rest of your life know how much time AWAY from wildlife allows you to work optimally Analyze your past data (in the off season) to find your limits Guidelines for analyzing data Do NOT compare yourself to other centers/rehabilitators Variables are usually not the same Different types of facility (home vs center) Different budgets Different access to resources (volunteers, veterinary services, etc) Different amounts of available time. Different areas of the country Different seasons Different species Release rates are calculated differently!!! 5

6 100.0% 90.0% The Release Rate Riot Release Rate 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% eoa dic/e released Carolina Raptor Center 75% -EXCLUDES those that die/euth w/in 24 hrs of admission -INCLUDES placed raptors (100+ on site) -admit 700/year UK Paper 42% -EXCLUDES those that died w/in 48 hours of admit WRC nursery ECTR 35% -INCLUDES ALL ECTRs admitted WRC nursery ECTR 60% -EXCLUDES ONLY EOA and DOA E wild again- rehabber avg release rate E wild again-overall avg release rate 67% -based on each rehabber, regardless of admit size 52% -based on ALL animals admitted 0.0% E wild again numbers-ex. of calculations 100.0% # patients/year 90.0% Jane Doesaver 35 80% -only does baby mammals 80.0% John Studebaker Mcrehabberschmidt TE HS (TakesEverything Humane Society) 67 70% -does everything % -contract with city and has to take all widlife Total # admitted: 5102 AVG per rehabber: ( )/3= 65% AVG per animal: (0.8*35)+(0.7*67) +(0.45*5000)=23 25/ 5102=45.6% 28, 47, % 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% eoa dic/e released Guidelines for analyzing data Do NOT compare yourself to other centers/rehabilitators Compare YOUR past statistics to YOUR current statistics Euthanasia The How-To Very easy and quick to do based on an electronic state/fed report...hint hint... *coughwild-onecough* 6

7 Euthanasia From the greek euthanatos (Merriam-Webster, 2008): Eu= good Thantos= death Ideal euthanasia (AVMA, 2007): rapid loss of consciousness cardiac or respiratory arrest loss of brain function. + minimize distress and anxiety experienced by the animal prior to loss of consciousness **With out these requirements termination of life, NOT euthanasia** Indications (companion animals) Terminal disease Overpopulation Laboratory testing Herd health Slaughter Indications (wildlife rehabilitation) Illegal Low chance/will not be able to survive in the wild Low chance/will not be able to reproduce in the wild Too much pain/suffering Lack of time/resources Methods How do we know which are best? Standards American Veterinary Medical Association) (AVMA) reviews euthanasia in the scientific literature every few years and states which methods it considers humane (FREE) s/euthanasia.pdf AVMA Ability to induce loss of consciousness and death WITHOUT causing pain, distress, anxiety, or apprehension =suffering happens in cerebral cortex Time required to induce loss of consciousness Reliability Safety of personnel Irreversibility Compatibility with purpose Emotional effect on observers or operators Compatibility with species, age and health status Ability to maintain equipment in proper working order Safety for predator/scavengers should the carcass be consumed 7

8 Euthanasia Euthanasia Methods This procedure involves first rendering the animal unconscious and THEN stopping the heart... Steps: 1. Render animal unconscious 2. Stop heart Euthanasia Euthanasia Methods Physical Captive Bolt Penetrating Adjunct: Non-penetrating Exsanguination Gunshot Manual blunt force trauma Pithing Cervical dislocation KCl Percussive stunning Chemical Injection IV, IP, intra-liver, intra-kidney Barbituates, Tributame, T-61 Inhalation CO2, anesthetics, nitrogen, argon, helium Lethal dose of intoxicant to food or water 8

9 This method of euthanasia is NOT aimed between the eyes Euthanasia Methods- Physical Gunshot Target (Gunshot, Captive Bolt) Line from the base of the horns to the lateral canthus of the opposite eye where 2 lines cross Angle so bullet will exit foramen magnum (brainstem) NOT middle of the eyes Chart of calibers online NAHEMS 2011 Rapid and Humane Death Target cerebral region and brainstem for immediate unconsciousness Good for hoofstock No carcass residues Distance or close proximity Silencers available <400# = 300ft lbs ; >400# = 1000ft lbs muzzle energy Skilled in technique NEVER in contact with skull Appropriate equipment Varies by species and distance hollow pointed bullets; frangible iron plastic composition bullets; or powdered iron missiles PPE head and eye gear Potential for collateral damage large Penetrating Captive Bolt Non-penetrating Captive Bolt Rapid and Humane Death Target cerebral region and brainstem for immediate unconsciousness Good for hoofstock No carcass residues Energy required is 200 J Skilled in technique Appropriate equipment Seals and stop washers replaced regularly Must be in contact with skull Only more recent bolt guns kill without second step (extended length penetrating bolt) Concussive trauma to brain Target cerebral region and brainstem for immediate unconsciousness Must be prepared to use adjunct method to ensure rapid death Neonatal animals only without adjunct method 9

10 This method of euthanasia requires no special equipment... Cervical Dislocation Blunt Trauma by Manual Force Immediate unconsciousness Quick death No tissue contamination No special equipment or supplies Technique requires practice Aesthetically unappealing Continued muscular movement undesirable Limited to small birds, mice, immature rats, rabbits No equipment Single sharp blow delivered to the central skull bones in the region over the brain Neonates ONLY Aesthetically objectionable Skilled technique Requires practice Requires strength Requires resolve Remember... Although Physical Methods of Euthanasia render unconsciousness immediately... Should drop to the ground instantaneously Muscles may continue to convulse 10

11 These methods of euthanasia are not physical in nature... Euthanasia Methods Chemical Injection IV, IP, intrahepatic, intrarenal Barbituates, KCl, Tributame, T-61 Inhalation CO2, anesthetics, nitrogen, argon Lethal dose of intoxicant to food or water None identified without risk to humans or environment ider cost and disposal of contaminated carcasses May need chemical restraint beforehand Euthanasia Methods - injection Intra-hepatic AVMA 2013 IC AVMA 2013 Intra-renal AVMA 2013 This is the most common type of chemical euthanasia... Rapidity, effectiveness Chemical restraint generally not needed IV injection preferred IP, intra-liver, intra-kidney Sodium Pentobarbital 1cc per 10 lbs mammals 1cc per 2 lbs birds Barbituates Controlled substances Beuthasol, FatalPlus Carcass contaminated MUST absolutely determine that death has taken place (vs deep anesthesia) 11

12 T-61 Rapid, humane death Terminal gasps not seen Works similarly well in birds Not available in the US Must be slow IV injection to avoid dysphoria Controlled substance IV only These options do NOT require a controlled substance license... Readily available Inexpensive Alcohols Dose-related irritation to tissue Large volumes required for most animals CO2 CO Not controlled Easily administered (chambers) Nonflammable Nonexplosive Use gradual increases in concentrations to avoid stress from hypoxemia Analgesic and anesthetic properties Safety equipment for gas Oxygen must rapidly decrease to <2% AVMA recommends heavy sedation prior Carefully regulate gas so does not freeze animal Time to death longer, may exhibit stress Drastic species differences Loss of consciousness without pain, with minimal distress Rapid death with concentrations of 4-6% Danger to humans Potential for explosions Aversive to rodents 12

13 N2, Ar Helium Readily available compressed gasses Nonflammable Nonexplosive Nonaversive to poultry Must combine with CO2 to make heavier than room air Aversive to rodents Exposure times up to >7min Even 6% O2 before death will results in immediate recovery These euthanasia agents work by inhalation... Anesthetics Easily administered (chambers) Minimal risk to handlers vs physical or injectable methods ether, halothane, methoxyflurane, isoflurane, sevoflurane, desflurane, enflurane Methoxyflurane and halothane not available in the US Enflurane can cause seizures Breath holding, esp. aquatic or diving species Aversive vapors Special equipment vaporizers Human abuse potential 13

14 These euthanasia agents can be dissolved in liquid... Soluble in fresh water Soluble in salt water Commercially avaiable Not controlled Tricaine (MS222) Expensive Species variability Retinal toxicity to humans Cannot inject (rapid excretion) Possible detrimental environmental effects Benzocain Hydrochloride Clove oil Not controlled Fast acting, effective for fish and amphibians Low toxicity to humans Little environmental risk Does not dissolve in water Cost Must be buffered Impact on scavengers not determined Eugenol, isoeugenol Widely available Not controlled Inexpensive Short induction time Effective at wide range of water temps Carcass disposal Some derivatives are potential carcinogens Impact on environment not studied These euthanasia agents are ONLY secondary means... 14

15 Euthanasia Methods - adjunct KCl Animal must first be rendered unconscious by other means KCl injection Exsanguination Pithing Not controlled IV or IC = cardiac arrest mg/kg, mg/lb Also Magnesium chloride or magnesium sulfate Carcasses less toxic No analgesia Adjunct method only, MUST be unconscious first Muscle fasiculations, spasms can be violent Pithing Exsanguination Immediate unconsciousness Can be used as secondary method Technique Practice MUST be rendered unconscious first Involuntary movement post-procedure Not controlled Carotid or brachial arteries MUST be rendered unconscious first Aesthetics These species large size can make euthanasia difficult... 15

16 Euthanasia Methods By Species Bovidae (deer) Gunshot Penetrating Captive Bolt Injectable usually impractical Euthanasia Methods By Species Ovidae, Caprinae Penetrating Captive Bolt Gunshot (no contact!) NAHEMS 2011 NAHEMS 2011 Euthanasia Methods By Species Euthanasia Methods By Species Ovidae, Caprinae, cont Pithing acceptable after anesthesia (30-50mg Xylazine IV or IM, wait 20min) KCl acceptable after anesthesia Chloral hydrate (900mg/kg) - acceptable after anesthesia (difficult to obtain) Injectable usually impractical CO2 generally impractical due to required chamber size Electrocution conditionally acceptable (equip) Equidae Gunshot Penetrating Captive Bolt Injection (barbituates) KCl with anesthesia first: xylazine 0.5mg/lb IV or1mg/lb IM NAHEMS 2011 Euthanasia Methods By Species Euthanasia Methods By Species Wild Boar Gunshot (slug) 1 above brow line Thicker skull NAHEMS 2011 Penetrating Captive Bolt (.25 caliber) CO2 for <70 lbs (32kg) See AASV ; concentration 80-90% for minimum 5min Wild Boar, cont Electrocution (specialized equipment required) Injection usually impractical Xylazine does not work Adjunct methods Pithing KCl NAHEMS

17 These methods are preferred for canine and feline-type species... Euthansia Methods By Species Coyotes, fox, bobcats, raccoons, skunks, ferrets/ermine, mink... Injection of barbituate preferred method Injection of non-barbituate anesthetic Ketamine/xylazine Tributame, T-61 not currently manufactured in US Inhaled anesthetics, <7kgs CO, CO2 Gunshot, Penetrating Captive Bolt Euthansia Methods By Species Canidae/Felidae, adjunct methods KCl N2, Argon Electrocution (specialized equipment required) These species make up the bulk of our rehabilitation mammals... 17

18 Euthansia Methods By Species Rodentia/Lagomorphs (muskrats, woodchucks, squirrels, mice, bunnies...) Injectable (barbituates, barbituate derivatives, dissociatives agent combinations) Inhaled anesthetics (not N2O alone) CO2, CO (CO not rabbits) Tribromo-ethanol (not currently avail in US) Cervical Dislocation, <200g Decapitation Penetrating Captive Bolt The preferred method of euthanasia for birds is... Euthanasia Methods By Species Avian Injection (barbituates, barbituate derivatives, dissociative agent combinations) IV preferred IP if necessary prolonged time Intrahepatic in small birds Cervical dislocation, decapitation (<200g) Manually applied blunt force trauma (<200g) Gunshot (larger birds, use appropriate shot) Euthanasia Methods By Species Avian, cont. CO2, CO, N2, Argon Latter 3 with CO2 combinations only Adjunct Methods Exsanguination KCl Thoracic compression 18

19 These difficulties present when under water... Euthansia Methods By Species Aquatics Tricaine (MS222) Benzocaine CO2-saturated water Ethanol (concentrations of 10-30mL of 95% ethanol per Liter) Eugenol, isoeugenol, clove oil Isoflurane, sevoflurane liquids added to water Euthansia Methods By Species Aquatics, cont. Injectable (barbituates, barbituate derivatives, dissociative agent combinations) Decapitation followed by pithing Cervical transection followed by pithing Manually applied blunt force trauma followed by pithing Captive Bolt (larger fish) Electrocution Percussive stunning Euthanasia Methods By Species Marine Mammals Injectable anesthetics (barbituates, barbituate derivatives, dissociative agent combinations) Gunshot Implosive decerebration (not practical) Adjunctive KCl or succinylcholine Unacceptable Inhalant anesthetics (remember they re divers) Exsanguination End of Jeopardy Cuteness Interlude... 19

20 Chelonian Euthanasia Euthanasia (review) From the greek euthanatos (Merriam-Webster, 2008): Eu= good Thantos= death Ideal euthanasia (AVMA, 2007): rapid loss of consciousness cardiac or respiratory arrest loss of brain function. + minimize distress and anxiety experienced by the animal prior to loss of consciousness **With out these requirements termination of life, NOT euthanasia** Why am I concerned? Sk MqYo Why am I concerned? Evidence suggests that biochemical and electrical activity persists within an anoxic turtle brain for some considerable time. This means that euthanasia with some agents could result in unexpected recovery due to the ability of chelonian brains to survive prolonged anoxia. (McArthur et al, 2004, page 398) Why am I concerned? Google search how to kill a turtle Drowning: check on it every hour-make SURE IT S DEAD Freezing: I ll have to make room in the deep freeze a.44 mag to the head will quickly incapacitate the critter Why am I concerned? TURTLES ARE HARD TO KILL! 20

21 Outline Turtle Physiology Basics of euthanasia Turtle physiology Analyze suggested methods of euthanasia Turtles can tolerate anoxia for longer periods of time than other vertebrates Not all turtles tolerate anoxia to the same degree (not much is known) Painted turtles and sliders (Chrysemys picta, Pseudemys scripta/trachemys scripta) tolerate exceptionally long periods of time without oxygen and have been studied the most (Lutz, 1992, Johlin & Moreland, 1933) Turtle physiology The brain of the freshwater turtle Trachemys scripta [slider] is able to withstand anoxia for days at room temperature (Lutz et al., 2003; Bickler et al., 2002) The anoxic turtle suppresses brain activity to such a degree that it becomes virtually comatose (Nilsson, G.E., and P.L. Lutz, 2004) Via releasing GABA (and conserving adenosine receptors) EEG in turtles EEG of turtles does not fluctuate throughout the same range across states as in mammals (declining in frequency and amplitude during sleep) spikes and sharp waves during sleep (Eiland et al 2001) Anoxic turtle brains had 3-8Hz EEG (~human sleep), about 20% of normoxic control with mixed bursts of activity =turtle brain down-regulates in anoxia Can the anoxic turtle brain feel pain???? Physiology summary Questions so far? Apnea alone may not be enough to cause death (McArther, 2004) Whether the brain is actually conscious and/or feeling pain in the anoxic state is still unknown 21

22 Methods of Euthanasia Volatile anesthetic (ie isoflurane) Freezing Captive bolt Decapitation Pithing Sodium Pentobarbital injection Combo Volatile Anesthetic Turtles will hold their breath for a loooooooong time doesn t work (Mader, 2006) (AVMA, 2007) Freezing Rapid freezing: (ie dipping in liquid nitrogen) for turtles less than 40 grams (AVMA, 2007) Putting turtles in the regular freezer: Animals may experience pain as ice crystals form within tissues and skin (Cooper et al 1984) (AVMA, 2007) This is not an acceptable or humane method of euthanasia, even if combined with other methods (ie anesthesia, stunning, etc) (AVMA, 2007) (McArthur, 2004) (Mader, 2006) Captive bolt Diagrams and manuals exist for landmarks on where to place a captive bolt gun Should only be performed by a trained individual (Mader, 2006) Only penetrating should be used Decapitation Because the central nervous system of reptiles, fish, and amphibians is tolerant to hypoxic and hypertensive conditions death is not immediate Cooper et al (1989) believes decapitated reptiles may still be able to perceive pain for up to an hour after the spinal cord has been severed Must be followed by pithing (AVMA, 2007) Needs to be preceeded by anesthesia (Mader, 2006) Pithing Definition: to destroy the brain or spinal cord by passing a pick or wire into it Because the animal may still be conscious, pithing should only be performed by trained individuals (National Research Committee on Pain and Distress in Laboratory Animals, 1992) No other source talked about pithing as a sole method Personally, pithing without prior anesthesia is inhumane 22

23 Pithing sites Sodium Pentobarbital Action: GABA-like Mammals: (Rhoades, R., 2002, Lumb & Jones, 2007) CNS is more sensitive, so causes unconsciousness first Then acts on the medulla oblongata to depress vital signs stops breathing BP drops heart stops Turtles:??? Heart often beats for considerable time after administration of euthanasia agent (Frye, 1991) possibility of metabolism of agents and recovery (McArthur, 2004) If the heart does stop since their brains can tolerate anoxia, are they feeling pain?? Sodium Pentobarbital If dehydrated, cold, or moribund circulation may be poor delay/inhibit absorption (Mader, 2006) (try placing the animal on a heating pad to increase circulation) Site: Intracardiac (only if anesthetized first) (Mader, 2006) Intracoelomically (slow acting) Dorsal tail vein Subcarapacial sinus Combo Euthanasia Ideal Anesthetic plus pithing/intracranial injection of formalin Anesthetic plus sodium pentobarbital plus pithing Sodium pentobarbital plus cardiotoxic agent plus pithing Small? 23

24 Cuteness Interlude... Questions? Pre-fabricated topics Nonindigenous Species Allocation of resources Euthanasia on admission Specialized individual rehabilitators Obtaining Euthasol Vet relationship ALL VETS CAN EUTHANIZE ANYTHING Can choose not to Dealing with Volunteers Who are very attached to specific animals Being able to explain reasons for euthanasia Being confident that euthanasia IS an appropriate treatment option 24

25 Dealing with the Public Nuisance species please euthanize this healthy raccoon Animal rights groups with problems that you euthanize at all Dealing with the Emotion Compassion Fatigue Coping Mechanisms Struggling with when How long do you give them a chance? Who do you decide to give a chance? Why? Why not? Specific Injuries Go to Triage lecture on Saturday... No orthopedic vet nearby, to rehab or not? Keeping the Goal in Mind Remember why you re doing what you re doing Learn from euthanasias Learn from successes Learn from mistakes Use that knowledge to help the next ones 25