Abstract

On August 23, 2000, a 30.6 kg loggerhead sea turtle (Caretta caretta) presented to the North Carolina Aquarium on Roanoke Island in a debilitated state. The turtle had a deep head wound, lacerations of the left neck and right elbow, and fractures of the carapace that were estimated to be more than one week old based on the extensive contamination and reaction. The animal's estimated white cell count was 29,000 and other hematology and plasma chemistry values were unremarkable. The wounds were debrided, flushed with saline, and the turtle was placed in freshwater for 24 hours. A course of amikacin (5.0 mg/kg IM) was started and the animal was given lactated ringers solution and vitamin B complex intracoelomically. During the next 5 days the salinity in the holding tank was gradually elevated and the amikacin dose reduced to 2.5 mg/kg q. 72 hours. The turtle presented to the North Carolina State University College of Veterinary Medicine (NCSU-CVM) on August 29, 2000 for further evaluation and clinical work up.

On presentation to the NCSU-CVM the turtle weighed 33.0 kg and was depressed, quiet, and responsive. Computed tomography of the head revealed multiple calvarial fractures, fractures of the cranial vault, and suspect involvement of the olfactory bulb region. The turtle was anesthetized with 5.0 mg/kg ketamine hydrochloride and 50.0 mcg/kg medetomidine intravenously in the dorsal cervical sinus. The turtle's trachea was then intubated with a #5 endotracheal tube and the turtle maintained on sevoflurane anesthesia (1.0-2.0%) for 135 minutes. A catheter was placed in the dorsal cervical sinus and approximately 700 mls of Plasmalyte A was administered while the turtle was under anesthesia. The wounds were carefully debrided and irrigated with sterile saline. Necrotic tissue, bone fragments, and other debris were removed from the head wound. The opening in the skull could not be reduced without risk of damage to the brain so the primary fragments were stabilized in their displaced position. Bone screws were placed into the skull on either side of the fracture gap and were joined by two bridges of epoxy putty. The medetomidine was reversed with 250.0 mcg/kg atipamezole intramuscularly and after extubation the turtle was given 0.15 mg/kg of butorphanol intramuscularly for pain management. The turtle was sent to the Karen Beasley Sea Turtle Rescue and Rehabilitation Center where it continued its amikacin regimen for one week as well as a one month course of intramuscular ceftazidime (20.0 mg/kg q. 72 hours).

After a month of intensive nursing and supportive care, including frequent wound irrigation with saline and a course of the nonsteroidal anti-inflammatory drug ketorolac tromethamine (0.25 mg/kg IM q. 24 hours for 5 days), the turtle began to eat on her own. The animal continued to improve with the skull becoming more stable as time progressed. The estimated white count was 6,000 on December 14, 2000. On January 24, 2001 (5 months after she began treatment) the epoxy bridges were removed and the skull was stable.

This patient currently has no motor deficits and will continue to be regularly evaluated. The prognosis for recovery and eventual release to the wild is excellent.

Acknowledgements

We thank Michael Stoskopf, Beth Chittick, the staff of the Roanoke Island Aquarium, Karen Sayles, Candace Williams, Millie Overman, and the Network for Endangered Sea Turtles for their input, assistance, and support. Thanks also to the dedicated staff of the Karen Beasley Sea Turtle Rescue and Rehabilitation Center.