3 selected respiratory emergencies Flashcards
upper and lower airway emergencies occur in which anatomic areas?
- nose
- esophagus
- larynx
- trachea
what respiratory issues might originate in the nose?
- stenotic nares
parat of brachycephalic obstructive airway syndromme
contributes to heat stress - epistaxis can cause respiratory distress due to aspirated blood clots
common esophageal issue leading to respiratory issues?
- esophageal mass or foreign body impinging on trachea
common issues of larynx?
paralysis
trauma
neoplasia
how do laryngeal issues alter breathing?
inspiratory dynspea
treatments for laryngeal issues?
sedation
oxygen
maybe corticosteroids
surgery
what surgical options for larynx problem?
- temporary tracheostomy
- laryngoplasty [for paralysis]
common tracheal issues?
traumatic
obstructive lesions
How to Dx, Tx and repair tracheal tear:
Dx: sub Q emphyseam, pneumomediastinum, tracheoscopy or cervical/thoracic radiographs
tx: conservative - cage rest and rarely tube tracheostomy
sx: no advantage over conservative tx; sometimes resection and anastomosis
where is tracheal obstruction if patient has inspiratory distress?
extrathoracic
where is tracheal obstruction if patient has expiratory distress?
intrathoracis
Emergency Tx of tracheal obstruction?
- initial:sedation, o2, corticosteroids maybe
- sx: tube tracheostomy (cd to obstruction)
foreign body removal
rings/stents for tracheal collapse
what are anatomic regions of intrathoracic emergencies?
pleural space
mediastinum
lungs
how to dx pleural space emergencies?
what test should you be cautious with?
- observe
- auscult
- percuss
- thoracocentesis
- thoracic radiography - be cautious with this b/c stretching arms up makes it harder to breathe
during percussion, what does hyporesonance suggest?
and hyperresonance?
hypo: fluid, solid organs
hyper: air, gas filled
pleural space emergencies:
pleural effusions
pneumothorax
diaphragmatic hernia
what are some causes of pleural effusions:
- hydrothorax
- hemothorax
- pyothroax
- chylothorax
- serous pleuritis
- neoplastic effusion
pleural effusion Tx:
- thoracocentesis
- thoracostomy tube in intractable
what is the difference btwn typical and tension pneumothorax?
typical: some o2 escapes hole into thorax upon inhalation and some comes back in upon exhalation
tension: a flap of tissue covers hole - so air cannot escape and continues to accumulate
T/F: the medistinum of dog / cat is impermeable.
what are implications related to pneumothorax?
false
it is permeable - so both bilateral and unilateral pneumothorax are possible.
mediastinal emergencies:
- pneumomediastinum
- septic mediastinitis
- hemomediastinum
what occurs during pneumomediastinum?
disruption of trachea, bronchi, esophagus or central portion of lungs
what is common cause of septic mediastinitis?
prognosis?
esophageal perforation
high mortality rate - poor prognosis
what is common cause of hemomediastinum?
- traumatic vessel disruption
Tx of pneumomediastinum?
- address underlying cause
- or monitor and benign neglect
- could progress to pneumothorax
pulmonary emergencies
pulm edema pneumonia pneumonitis pulm contusion pulm thromboembolism end airway dz lung lobe torsion
definition of pulmonary edema?
accumulation of fluid in pulmonary interstitum and alveoli
what 3 things does pulmonary edema impair?
- pulm compliance
- vital capacity
- pulm gas exchange
why is pulm edema an emergency?
b/c of hypoxia
what are 2 general causes of pulm edema?
- inc pulm capillary pressure [cardiogenic]
- inc pulm capillary permeability
what are some specific causes of pulm edema?
- hypo proteinemia (along with other factors)
- high altitude
- thromboelbolism
- neurogenic
- acute respiratory distress syndrome
pulm edema tx?
tx underlying cause
o2
diuretic
bronchodilators
ventilation therapy [PEEP, CPAP]
Tx pneumonia?
- supportive tx (like pulm edema)
- abx (try to culture from transtracheal wash or bronchoalveolar lavage)
- nebulizaiton
- coupage
what is pneumonia vs pneumonitis?
which has better prognosis?
pneumonia: inflammation of lungs due to infectious cause [bacT, fungal, viral]
pneumonitis: noninfectious inflammation of the lungs [aspiration of gastric contents]
pneumonitis has better prognosis
pulmonary contusion definition?
- traumatic injury resulting in hemorrhage and edema in lung parenchyma
- most resolve but some cause death
pulm contusion tx:
- symptomatic
- o2
- resrt
- avoid fluid overload
- diuretic if fluid overload suspected
- ventilatory support if not responsive to o2 therapy
- abx NOT indicated [only if 2* pneumonia develops]
pulm thromboembolism dx?
Dx by exclusion
rare to Dx antemortem
pulm thromboembolism tx:
- symptomatic
- anticoaguulant (heparin or coumadin)
- thrombolytics [rare b/c high risk and low benefit]
end airway dz common in cats:
dog:
allergic bronchitis - more likely
feline asthma
dogs: infectious bronchitis
signs and Tx of feline asthma (allergic bronchitis)?
- paroxysmal cough, wheezing, respiratory distress, cyanosis
- bronchodilator
- corticosteroids
- o2
infectious bronchitis etiology?
Tx?
- assoc w viral infection, allergic bronchitis, aspiration
- Tx NOT emergency usually:
bronchodilation, nebulization, abx
lung lobe torsion: common presentation?
emergency Tx?
pleural effusion - may need emergency action
Tx: thoracocentesis or thoracostomy tube
should you untwist a torsed lung lobe? why or why not?
NO - it will release inflammatory mediators -> may cause SIRS
thoracic wall emergencies:
- rib fractures
- flail chest
- thoracic wall perforation
presentation of rib fractures:
prognosis typically?
emergency tx?
- not typically life threatening
- can cause pneumothorax, pulm contusion, myocardial injury
- hypoventilation due to pain
- tx: intercostal nerve block
avoid bandage b/c restrictive
what is flail chest?
- segment of thoracic wall w multiple ribs fractured dorsally and ventrally causing paradoxical motion
- segment moves in during inspiration and out during expiration
- resp distress due to underlying pulm injury - not flail chest itself
flail chest Tx:
- supportive - similar to pulm contusion
- intercostal nerve blocks
flail chest: surgical Tx
external splint
rarely necessary
under what circumstances can a thoracic wall perforation be fatal?
what is emergency tx?
if perforates mediastinum
- early closure of defect, thoracostomy tube
