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Applied Clinical Veterinary Nursing > Cardiorespiratory Emergencies > Flashcards

Cardiorespiratory Emergencies Flashcards

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1
Q

What are some possible causes of tachypnoea/dyspnoea?

A

Physiological - stress, pain, excitement, exercise
Hypoxaemia, hypercapnia
Resp. disease
Cardiac disease

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2
Q

Describe upper airway dyspnoea.

A

Nasal passages, pharynx, larynx, trachea
Inspiratory dyspnoea
Stertor (snoring) common with brachycephalics
Stridor (harsh, high-pitched) common with laryngeal paralysis
Abnormal sound easily heard without touching patient

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3
Q

What are some causes of upper airway dyspnoea?

A

Laryngeal paralysis
Brachycephalic syndrome
Neoplasia
Polyps
FBs
Inflammation
Tracheal collapse

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4
Q

How can we treat upper airway dyspnoea?

A

If obstructed - anaesthesia and intubation
Decompensation can be rapid

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5
Q

Describe lower airway dyspnoea.

A

Bronchi, bronchioli
Quick short inspiration, prolonged expiration
Harsh lung sounds on auscultation (wheezes, crackles) - bronchoconstriction, secretions blocking airways

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6
Q

What are some lower airway causes of dyspnoea?

A

Asthma
Bronchitis
Smoke inhalation
Bronchopneumonia
Chronic obstructive pulmonary disease

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7
Q

Describe lung parenchymal dyspnoea.

A

Inspiratory and expiratory components
Accordion-like resp. movements
Subtle, hard to recognise
Difficult inspiration and expiration

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8
Q

What are some lung parenchymal causes of dyspnoea?

A

Pulmonary oedema (cardiac e.g. CHF or non-cardiac e.g. electrocution/strangulation)
Pneumonia
Haemorrhage (RTA, rat poisoning etc.)
Contusion
Neoplasia
Thromboembolism
Parasites

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9
Q

Describe pleural space dyspnoea.

A

Restrictive pattern of breathing
Increased rate but reduced depth because lungs cannot expand
On auscultation: muffled heart and lung sounds ventrally, normal lung sounds dorsally

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10
Q

What are some pleural space causes of dyspnoea?

A

Pneumothorax
Pleural effusion
Masses
Diaphragmatic hernia

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11
Q

What are some causes of pleural effusions?

A

Haemorrhage
Infection (pyothorax)
Neoplasia
Heart failure
Chylothorax

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12
Q

How should we carry out the initial clinical exam of respiratory patients?

A

Oxygen supplementation
Physical exam
Upper resp. tract? - stridor/stertor
Resp. rate and effort
MMs
HR, arrhythmias, heart murmurs
Peripheral pulses

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13
Q

What are some methods of supplementing oxygen?

A

Flow-by
Mask
Nasal prongs
Oxygen catheter
Collar
Oxygen cage
Intubation/ventilation

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14
Q

How can we begin to diagnose and stabilise pleural effusion/pneumothorax?

A

Physical exam, thoracic radiographs/ultrasound (more common due to positioning allowing patient to breathe comfortably)
Thoracocentesis - sedate, collect samples for cytology/culture/biochem

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15
Q

What should we be monitoring in respiratory patients?

A

Physical exam (HR, RR and effort, MMs, peripheral pulses)
Arterial blood gas (PaO2 ideally 80-120mmHg)
Pulse oximetry (ideally >90%)

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16
Q

Describe the difference between left- and right-sided CHF.

A

Left-sided = pulmonary veins, fluid collects in lung tissue then alveoli
Right-sided = systemic veins (cranial and caudal vena cava), effusions outside organs e.g. ascites/pleural/pericardial effusion

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17
Q

What are the common causes of CHF in dogs?

A

Left-sided - myxomatous mitral valve disease, dilated cardiomyopathy
Right-sided - pericardial effusion
Congenital heart disease in young dogs

18
Q

What are the common causes of CHF in cats?

A

Biventricular failure - hypertrophic cardiomyopathy

19
Q

What can cause reduced cardiac output (forward failure)?

A

DCM, end-stage heart disease

20
Q

What are the clinical signs of left-sided CHF?

A

Heart murmur?
Tachypnoea/dyspnoea
Tachycardia
Pale MMs, prolonged CRT
Arrhythmias?
Weak peripheral pulses, pulse deficits?

21
Q

How do we approach left-sided CHF patients?

A

History-taking
Physical exam
Stabilise BEFORE performing diagnostics - very fragile and may decompensate

22
Q

How can we stabilise left-sided CHF patients?

A

Minimise stress - consider sedation e.g. butorphanol
O2 supplementation
Furosemide IV - diuretic for pulmonary oedema
Pimobendan PO/IV - improves myocardial contractility / stroke volume / cardiac output

23
Q

What diagnostic tests can we run for left-sided CHF?

A

Echocardiography - diagnosis, severity
Thoracic radiography - pulmonary oedema
Electrocardiography - arrhythmias
Blood pressure measurement - hypotension
Blood tests - electrolytes, renal parameters

24
Q

What should we monitor when stabilising left-sided CHF patients?

A

RR and effort - aim for <40brpm
BP - concern if systolic <80mmHg
HR and pulse quality
ECG if arrhythmias detected
Radiographs if no improvement

25
Q

How do we manage left-sided CHF patients once they are stabilised?

A

Life-long medications
Feed ASAP - cardiac cachexia (lose bodyweight/muscle mass)
Revisit for blood tests/echocardiography etc.

26
Q

What are some causes of right-sided CHF?

A

Pulmonic stenosis
Tricuspid dysplasia
Pericardial effusion

27
Q

How can we diagnose right-sided CHF?

A

History, physical exam
Echocardiography - diagnosis, neoplasia
Thoracic radiography - heart size
Electrocardiography - arrhythmias
CT - neoplasia

28
Q

Describe pericardial effusion.

A

Increased fluid in pericardium
Right atrium collapses due to increased external pressure (tamponade)
Filling of right side of heart impaired (leads to impaired filling of left side) - decreased cardiac output

29
Q

How can we stabilise patients with pericardial effusion?

A

Pericardiocentesis
IV fluid administration - increase venous return

30
Q

How do we carry out pericardiocentesis?

A

Mild sedation
Left lateral recumbency
Prepare area 3rd-8th intercostal space
Echo to guide needle
Send samples in EDTA for cytology

31
Q

How do we treat pericardial effusion post-stabilisation?

A

Hospitalise for 12-24hrs
Monitor for improvement of parameters e.g. HR, pulse strength, demeanour, arrhythmias
Unpredictable recurrence - owners know what to look out for in future!

32
Q

What clinical signs can cats in heart failure present with?

A

Murmur (can be stress-related or not present)
Gallop sound (more specific for heart disease but may be not present)
Tachypnoea, dyspnoea, open-mouth breathing
Tachy/bradycardia
Weak peripheral pulses
Hypothermia

33
Q

How do cats with ATE present?

A

Sudden-onset hindlimb paresis/paralysis
Often hard gastrocnemius (essentially rigor mortis in legs)
Five Ps - Pain, Pallor/cyanosis (purple) of pads and nail beds, Paresis/paralysis, Pulselessness, Poikilothermy (cold leg)

34
Q

How can we stabilise cats with cardiac emergencies?

A

Avoid stress!
O2 supplementation
Furosemide IV/IM - pulmonary oedema
Drain pleural effusion
Gentle warming
Analgesia!

35
Q

How can we diagnose feline cardiac emergencies?

A

Echocardiography - diagnosis, severity
Thoracic radiography - pulmonary oedema
Electrocardiography - arrhythmias
BP measurement - hypotension
Bloods - electrolytes, renal parameters

36
Q

How can we treat cats post-stabilisation of a cardiac emergency?

A

Lifelong treatment
Offer food
Thromboembolism - warm soft bedding, physiotherapy
Home ASAP - minimise stress, monitor appetite
Revisit for blood tests
Guarded prognosis, can die suddenly

37
Q

What are the normal HRs for dogs and cats?

A

Dogs = 60-160bpm
Cats = 160-220bpm

38
Q

How can patients with arrhythmias present?

A

Syncope/collapse
Weakness/exercise intolerance
Signs of CHF
Abnormal heart rhythm - irregular, too fast/slow
Weak peripheral pulses, pulse deficits

39
Q

Describe 3rd degree AV block.

A

Bradyarrhythmia, HR 40bpm
P and QRS not associated

40
Q

Describe ventricular tachycardia.

A

HR 300bpm
Some normal complexes present
Some wide and bizarre complexes

41
Q
A

Applied Clinical Veterinary Nursing (40 decks)

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