Approach to dyspnoeic patient Flashcards
Normal respiration
Chest excursions visible but minimal effort apparent
Abdominal muscles should not be engaged
Patient comfortable and relaxed
Increased respiratory effort
Muscular movement of both chest wall and abdomen increase
May extend head and neck, abduct elbows and show reluctance to lie down
Nostril flaring and mouth breathing if severe (cats may just be stressed)
Decreased respiratory effort
Rarely seen
C1-C5 spinal lesions involving phrenic nerve and paralysing diaphragm
Muscular movements decrease
Patients may be tetraplegic but often concious
Upper airway localisation
Inspiratory effort
Dont need a stethoscope to hear
Bypass obstruction (sedate and intubate)
Lower airway localisation
Expiratory effort
Wheezes
Use a bronchodilator
Pulmonary localisation
Variable resp pattern
Harsh sounds or crackles
Give oxygen and treat underlying cause
Pleural space localisation
Shallow breathing
Dull and distant heart and lung sounds
Empty pleural space (thoracocentesis)
When should thoracic radiography be performed?
Once the patient is more stable - additional stress may tip them over the physiological knife edge
Thoracic point of care ultraound (POCUS)
used to assess for the presence of air, fluid, or soft tissue in the pleural space
as well as the presence and location of pulmonary parenchymal disease (‘wet lungs’)
Finally, the left atrium diameter can be assessed and compared with that of the aorta (LA:Ao ratio) to determine whether congestive heart failure is a likely underlying cause
What does a collapsed lung look like from apical window on US
Fox tail
What does a atelectatic lung appear as on US
‘Scorpion sting’
What do ‘B lines’ indicate on ultrasound
Fluid in alveolar interstitium
E.g. congestive heart failure
Flow-by oxygen
Simple and quick
provided via an oxygen port and tubing or anaesthetic machine and circuit
flow rate of 2-5 L/min with tubing held around 2 cm from the patient’s nose gives an inspired fraction of oxygen (FiO2) of 30-50%
Change position if patient distressed
tight face mask provides FiO2 up to 70% but is stressful in conscious patients
Short nasal prongs designed for people can be used in dogs, 50-100 mL/kg/min provides FiO2 of around 40-50%
Nasal cannulae extend to medial canthus of the eye, sutured in place
Can make an oxygen hood with cling film over a Buster collar
Stabilisation of upper airways
Sedate and bypass obstruction
Stabilisation of lower airways
Bronchodilator
Common causes of upper airway obstruction in dogs
BOAS
Laryngeal paralysis
Sedation for upper airway obstruction
Butorphanol, acepromazine, or dexmedetomidine
Most common lower airway crisis
Feline asthma
Oxygen supplementation, mild sedation, bronchodilator
Common causes of pulmonary parenchymal disease
Aspiration pneumonia
Congestive heart failure
Pulmonary contusions
No quick fix
What should you use for thoracocentesis?
Dog: IV catheter
Cat: butterfly needle
Where in the chest do you do a thoracocentesis?
Mid chest (IC space 8ish)
Cranial to rib
What to do is air or fluid re-accumulates quickly?
Thoracostomy tube placement may be required
WHat to do if thoracocentesis is required more than three times and reasonable volumes of air or fluid are drained wach time
Thoracostomy tube
Types of thoracostomy tube
Over the wire (Seldinger) - preferable in emergency setting
Trochar
