Dyspnea Flashcards
“Darn if you do and darn if you don’t”
cannot perform all diagnostics-may worsen animal
decisions based on: PE Hx SIG
minimize stress for all
prioritize checks: cant do all at once
Abnormal Breathing Patterns
Dyspnea - any visible resp distress. animal may invest up to 30% of total energy on breathing
Tachypnea-might be caised by stress or heat
Orthopnea-extreme dyspnea-extended neck, rotated elbows
Trepopnea-breathing is easier in a specific position
Apnea
Dyspnea classifications
Upper respiratory obstruction Lower respiratory obstruction Lung parenchymal disease Pleural disease Flail chest PTE Abdominal enlargement lookalikes - reverse sneezing
Inspiratory Sounds
Stridor - larynx
Strertor - nasopharynx
Reverse sneeze-nasopharynx, not serious
Mega esophagus may dilate and be heard during breathing
Expiratory Lung Sounds
Increased lung sounds:
Crackles – pus/blood/water:
fluids in alveoli. most common
Wheezes – allergic/inflammatory:
not common. Chronic. thick bronchioles-resistance
Friction rubs - pleuraitis
Decreased/no lung sounds:
Dorsally: pneumothorax
Ventrally: Pleural effusion
Diaphragmatic Hernia/Mass effect: one sided focal decreased lung/heart sounds
Referred upper respiratory:
Stertor, Megaesophagus
Murmur
lack of lung sound may be indication for thoracocentesis
always look in the mouth!
Emergency Treatments
Oxygen - never CI
sedation/analgesia
Thoracocentesis - may be done prior to any Dx other than FAST
FAST
Focused Assessment with Sonography for Trauma/Triage:
T-FAST - thorax
A-FAST - abdomen
addition to PE, may negate the need for other Dx (which may be CI). probe at 4 points- bladder diaphragm, sides - for detection of fluids in abd thrx prcrd pneumothorax
Oxygen
mask - 40-60% cage - 60% nasal tube-40% two nasal tubes - 60-70% ET-100%
CI for Nasal O2-
head trauma
glaucoma
severe stress
Analgesia/sedation
the sicker they are the lower the dose!
Butorphanol - safe, expensive
butor.+midazolam - if no IV. may relax breathing mm.
for pain- fentanyl, demerol-CI on cats and IV
Thoracocentesis
Syringe, stop-cock, extension set, needle or butterfly
7-9th ICS, Cranial to rib
Objective ways for evaluating Resp. function
to gauge hypoxia
Pulse oximetry
used more in anesthesia
noninvasive
SpO2 estimates PaO2
lots of FN - environmental/patient factors
dose not evaluate tissue usage, ventilation
not good with CO/metHb
Arterial blood gas
GS
provides info on oxigenation, ventilation, acid/base
invasive
hard to take
painful
usually in sedated&ventilated - to evaluate when to disconnect
Radiographs
After stabilization!
be prepared with ET, O2, ambu
Consider DV view only
Common Thoracic Emergencies
Thoracic Trauma (HBC)
Rule out:
Lung contusions (increased lung sounds, radioopaque-bleeding)
Pneumothorax (decreased lung sounds dorsally)
DH (muffled heart sounds, decreased lung sounds ventrally)
Hemothorax (decreased lung sounds ventrally)
Broken ribs - Dyspnea from pain
CHF
CHF-dog
PE- increased sounds-crackles (very rarely effusion) tachycardia mumur cold extremities cachexia ascites(if bilat CHF)
Hx -
cough, exercise intolerance
CXR-
cardiomegaly
(perihilar) pulmonary edema
venous congestion
CHF - cat
PE-
difficult to hear normal sounds in healthy cat
increased/decreased sounds, crackles
tachycardia/bradicardia
usually no murmur (intermittent gallop in 50%), no cough
hard to notice exercise intolerance
Hx-
usually acute, usually arrive in chf