The turtle is held in this position after tube removal until it swallows to reduce the chances of regurgitation. A padded speculum is used to keep the mouth open. Steady downward pressure will cause the lower jaw to fatigue and open. The head and neck should be extended to straighten the esophagus for tube passage, with the head secured by grasping on either side behind the mandible. The patient is placed at a 45-degree incline on a padded board or held in this position in smaller patients to avoid regurgitation. The distance from the beak to the estimated anterior portion of the stomach should be marked on the tube. Vegetable oil is used to lubricate the tube. A variety of feeding tube sizes and types are used, depending on the size of the turtle. The volume of material accepted is usually less than predicted because gastric tubes often do not pass into the stomach, increasing the likelihood of regurgitation. Tube feeding may be a challenge in sea turtles. Begin with smaller volumes and more dilute solutions and steadily increase both to meet the turtle’s nutritional requirements. The patient should be well hydrated, have a normal blood glucose level, and some evidence of active gastrointestinal tract (GIT) motility prior to starting oral nutritional support. Nutrition in Critically Ill and Healthy Sea Turtles A standardized neurologic examination and workup should be performed if the patient exhibits neurologic signs. Heart rate and rhythm may be assessed with a Doppler probe placed on the skin between the distal cervical region and proximal front flipper. A digital, distant laser, thermal monitoring device (Raynger ST, Raytek, Santa Cruz, Calif) directed at the prefemoral area correlates well with core body temperature. Deep cloacal temperature may be representative of the turtle’s recent environmental temperature and is an important parameter to obtain and monitor. A subjective and calculated body condition score (weight/carapace length ) 3 should be recorded and then measured serially during rehabilitation. Body weight and standardized morphometric measurements should be obtained. 23 Digital images may be used to document specific lesions or injuries. A thorough history, visual examination, and detailed systematic physical examination should be performed. Live stranded sea turtles should be confined in a sturdy container with foam padding and transported in a temperature-controlled vehicle to the closest rehabilitation facility. 17 (See the following websites for further information: Transport, History, and Physical Examination Significant threats to sea turtle populations include loss of habitat, light pollution, marine debris ingestion or entanglement, contaminant exposure, poaching and legal use of their meat, eggs, and body parts for a variety of purposes, fishery and boat strike mortality, harmful algal blooms, cold stunning, and infectious disease (Fig. waters are listed as either “threatened” or “endangered” under the Endangered Species Act (ESA). All species of sea turtles residing in U.S. 17 Sea turtles are found in all oceans except for the Arctic. There are seven living species of sea turtles, including the flatback (Natator depressus), green sea turtle (Chelonia mydas), hawksbill (Eretmochelys imbricata), Kemp’s Ridley (Lepidochelys kempii), leatherback (Dermochelys coriacea), loggerhead (Caretta caretta), and olive Ridley (Lepidochelys olivacea).
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