Cardiorespiratory emergencies Flashcards
Define dysponea Tachyponea Orthoponea Hyperponea Stridor Stertor
Difficulty breathing
Increased rate of breathing
Only able to breath standing or sitting up
Increased depth of breathing
Harsh sound obstruction of trachea or larynx
Heavy snoring nasopharynx pharynx
Describe the 7 causes of upper airway obstruction
Tracheal collaps Polyps Foreign body Laryngeal paralysis BOAS Neoplasia Anaphylaxis
Describe the 15 causes of lower respiratory tract obstruction
Asthma Pleural effusion Pneumothorax Chylothorax Haemothorax Narrowing of the bronchi Bronchitis Pulomanary odema Smoke inhalation Pulmonary contusions Pulmonary fibrosis Pulmonary embolisms Pyothorax Hydrothorax
List the emergency interventions required for the dysponeaic patient
Do not stress patient Oxygenate (oxygen kennel, nasal prongs, mask, nasal catheters Leave alone If fluid present drain Emergency tracheostomy
How do you preform a tracheostomy and what equipment do you need?
Et tube ventilate Surgical kit blade Clippers Tracheostomy tube Suture material Sedate or induce patient Cut placed between the thoracic inlet and the larynx Flow by or attach anaesthetic circuit Stay sutures upper and lower tracheal ring labelled
What equipment do you need to preform a thoracentesis and how is it preformed?
Sedate patient oxygenate Large clip 7th-9th rib IIf fluid ventral (2/3 up chest) if air dorsal (1/3 down chest) Prep area Chlorhex Sterile gloves Butterfly catheter 21g 23g Three way tap attached to syringe Insertion site 7th to 8th rib Measure volume me of fluid/air removed if effusion sample fluid
What actions should you take if a BOASpatient comes into practice?
Oxygenate
Sedate (prevent stress)
Cool if 40.9 (pour tap water over patient focus on paws inguinal areas cool until 39.9 towel dry
Fan
What do audible crackles caudally or cranially indicate?
Caudal=pulmonary odema
Cranial=aspiration pneumonia
What do dull lung sounds dorsally or ventrally indicate
Ventrally=pleural effusion
Dorsally=pneumothorax
What equipment and measurements can be used to monitor oxygen delivery?
Pulse oximetry spO2
Blood gass PaO2
What determinants effect oxygen delivery?
Cardiac output=SV *HR Paranchymal happiness SpO2 PAO2 Hb concentration
What is the equation for the A-a gradient?
((760-47)xFiO2-PaCO2/0.8)-PaO2
The lower the better
What are the breathing patterns associated with restrictive conditions?
Rapid shallow breaths
Pulomary fibrosis
Pulmonary odema
Pleural effusions
What are the breathing patterns associated with obstructive conditions?
Increased respiratory effort (upper trachea)
Increased expiratory efforct (lower bronchioles)
Feline asthma
What process should you take when a dyspneoic patient comes into practice?
Physical exam Respiratory rate and effort SpO2 MM CRT Auscultation lung quadrants Oxygenate Pulse quality and heart rate
What is important to monitor and consider in the dyspnoeoc patient?
Resp rate and effort CRT MM SpO2 Careful with toxic oxygen radicals (<60% o2 for long term) Position keep in sternal Monitor temperature Check eyes for dryness Portable oxygen Have ET use available Monitor blood gas HR and pulse quality Ventilation Nebulisation Postural feeding Behaviour
List right sided cardia emergencies
Tricuspid valve disease
Pulmonary stenosis
Pericardial effusion
Left sided cardiac emergencies
Mitral valve degenerative disease
Whole cardiac diseases
Dilated cardiac myopathy Hypertrophic cardiomyopathy Congenital defects (patent ductus arteriosus, stenosis large vessels, ventricular septal defect) Endocarditis Atrial fibrillation Ventricular fibrillation 3rd degree av block Sick sinus syndrome
Nursing management cardiac patient
Iv access ECG HR pulse quality MM CRT SPO2 Blood pressure Oxygen PUPD after furosemide RR Water
Clinical signs of right sided heart failure
Ascities Distended jugulars Poor pulse quality Peripheral odema Pulse deficits Hepatomegaly Splenomegaly Pale MM prolonged CRT Electrical alterans(tamponade)
Clinical signs left sided heart failure
Coughing Pulmonary odema Tachypnoea Dysponea Arrhythmia Murmur Poor pulse quality Pulse deficits pale or cyanotic MM
Diagnostic tools for heart failure
Ultrasound radiographs pro BNP Echo bloods electrolytes haem bichem
What is dilated cardiomyopathy?
Common in large dog breeds dilation if the ventricles
poor contractility
Atrial fibrillation
Enlargement of atrium
Aims to decrease congestion and improve contractility
What is hypertrophic cardiomyopathy?
Affects cats thickening of the ventricle walls
Reduced cardiac filling less cardiac output
Atrial enlargement
Pulomary odema treated with frusomide
Hypotension!!!
Goals decrease resistance improve diastolic function
What is cardiac tamponade?
Pericardial effusion Always affects the right side more than the left less muscle Effects CO Obstructive shock Pericardiocentesis Likely neoplasia
How do you preform pericardiocentesis?
Clip and prep over the apex of the heart Long needle ultrasound guided Check fluid drained is not clotting Culture and cytology Mild sedation
What is endocarditis?
Inflammation of the endocardium due to bacteria infection
Commonly effects mitral and aortic valves
Anti arrhythmia
Antibiotic and supportive care
What is degenerative value disease?
Genetic disease cavies
Valves degenerate allow for regurgitate of blood back into atrium
Heart failure
Frusomide ACE inhibitors
List the 6 types of arrhythmia and describe each of them
Ventricular tachycardia- HR above 180 treat lidocaine
Supra-ventricular-tachycardia HR above 180 treat ditaziem
3rd degree AV block- bradycardia pacemaker
Atrial fibrillation- HR above 180 pimobendan
Ventricular fibrillation- dying defibrillator
Sick sinus syndrome- bradycardia pacemaker
Describe each grade of heart murmur
Grade one- difficult to localise very quiet
Grade two- quieter than heart sounds
Grade three- the same sound as heart sounds obvious murmur
Grade four- louder than heart sounds
Grade five- very loud associated with pericardial thrill
Grade six- can hear without stethoscope touching the chest with pericardial thrill
