ECC Respiratory Flashcards
if an animal is in respiratory distress what are the big 4 rule outs
cardiac
respiratory
neuromuscular
non-resp look alikes
describe an obstructive breathing pattern
- where it usually occurs
- in terms of T = C x R
upper airway
stertor, stridor
obstructive - deep, slow breath
resistance increases, time increases
describe a restrictive breathing pattern
- where it usually occurs
- in terms of T = C x R
lower airways, parenchyma, pleural space
rapid shallow breaths
compliance decreases, time decreases
what is a great choice for sedation in a patient with respiratory distress? why?
butorphanol
respiratory and cough suppressant; decreased work, turbulence, edema
airway obstructions cause 3 main consequences
- hypoxemia
- hypercapnia
- hyperthermia
what other sedative can you give for anxiety and to help cool the patient if hyperthermic?
acepromazine - vasodilation
5 indications for intubation
which is the most common?
upper airway obstruction (most common)
unprotected airway
hypoventilation
respiratory fatigue
respiratory failure
Describe proper probe placement on the thorax for a TPOCUS
perpendicular to the ribs
notch towards the head
where should the probe placement be for the R short axis view of the heart?
R long axis view of the heart?
short axis - notch faces elbow
long axis - parallel to heart
what are some signs of a normal thorax on POCUS?
gator sign
glide sign
A lines
what are some signs of a pneumothorax?
caudodorsal lung field
no glide sign
differentiate from SQ emphysema w/ rads and push SQ emphysema out of the way if trying to look at lungs with POCUS
what are some signs of pleural effusion?
middle or ventral lung field
no glide sign
should see anechoic fluid between parietal and visceral pleura
what side do you do a pericardiocentesis? why?
right side due to left coronary artery
how can you recognize a wet lung? what causes this?
B lines
fluid cuffed by air filled alveoli
what type of fluid can cause B lines
cardiogenic edema
noncardiogenic edema
contusion
inflam
hemorrhage
how can you identify consolidation of the lungs on POCUS
“hepatization” - takes appearance of solid organ
what can a wedge consolidation indicate
pulmonary thromboembolism
primary ddx for a wet right middle lung lobe
aspiration pneumonia
if a cat has bilaterally wet lungs in >2 sites, what is your main ddx
left CHF
Bilaterally symmetric caudodorsal to perihilar distribution that is the same on the left and right hemithorax, main ddx?
noncardiogenic pulmonary edema
Understand limitations of lung US
only evaluate 2-3mm
can’t characterize type of fluid
can’t evaluate parenchyma in presence of effusion or air
can’t replace thoracic rads or CT
what are the two differentials if there is a bilateral alveolar pattern on caudodorsal lung field on thoracic rads and coalescing B lines in caudodorsal lung field on TPOCUS
cardiogenic edema
noncardiogenic edema
what are some consequences of BOAS
noncardiogenic pulmonary edema
vomiting, regurg, hiatal hernia
aspiration pneumonia
recurrent laryngeal collapse and everted laryngeal saccules
hyperthermia
hypoxemia, hypercapnia = hypertension, exercise intolerance, chemodectomas
what are the immediate treatments for BOAS
sedation (torb + ace)
oxygen
cooling
nebulized epinephrine
intubate
what are the most common adverse effects of nebulized epi
excitement
nausea
pressure inside pleural space?
average amount of fluid?
-5 cm H2O
2-5ml
feline pyothorax main source of bacteria
upper resp infection
cat bite wounds
feline pyothorax treatment options
bilateral chest tubes
evacuate pleural space
lavage
IV antibiotics
thoracic rads or CT
maybe surgery
feline pyothorax abx choices
IV enrofloxacin/marbofloxacin
IV clindamycin or penicillin
canine pyothorax main source of bacteria
mixed anaerobes, E.coli
canine pyothorax treatment
surgical debridement
transudate
TP
TNCC
TP < 2.5
TNCC 1500
transudate cause
low albumin
modified transudate
TP
TNCC
TP 2.5-7
TNCC 1000 - 7000
modified transudate causes (5)
R CHF
neoplasia
inflam
lung torsion
hernia
exudate
TP
TNCC
TP > 3
TNCC > 7000
exudate causes
septic
non-septic
neoplasia
hemorrhage
chyle
how do you know if the pleural fluid is hemorrhagic?
PCV > 10%, non clotting
conducting airway anatomy
nasopharynx
trachea
bronchi
bronchioles - non resp and terminal
conducting airway disease clinical signs
hacking/honking/dry cough
stertor or stridor
inspiratory, expiratory effort
obstructive pattern
clear BV sounds
dyspnea
normoxemia
bacterial and viral components of CIRCD
which are most common
bordetella & mycoplasma
adenovirus 2
parainfluenza virus
resp coronavirus
influenza H3N2, H3N8 (more common)
herpesvirus (more common)
distemper
how long do you want to isolate a dog after its done coughing
2 weeks after cough stops
cough suppressant options for CIRCD
hydrocodone
butorphanol
codeine
dextromethorphan
antibiotic therapy for CIRCD
only if evidence of bacterial infection
doxycycline if B.bronchiseptica or M.cynos - NO evidence of secondary pneumonia
clavamox - if secondary bacterial pneumonia
risk of doxycycline in young animals
dental enamel hypoplasia
discoloration
structures within the respiratory zone
resp bronchioles
alveolar ducts
alveolar sacs
alveoli
respiratory zone disease clinical signs
restrictive pattern
crackles
dull/absent BV sounds
hypoxemia
resp fatigue
systemic illness, fever
indications for initiating mechanical ventilation
- severe hypoxemia despite O2 supplementation (PaO2 < 60mmHg, SpO2 < 90%)
- severe hypoventilation despite therapy PaCO2 > 60mmHg
- resp fatigue
- severe hemodynamic compromise
physiology of positive pressure ventilation
keeps alveoli open, causing them not to collapse, minimizing damage that can occur when they keep closing/opening
2 Differential Diagnoses for Bilateral Wet Lungs in the Caudodorsal and Perihilar Lung Regions
cardiogenic pulmonary edema
noncardiogenic pulmonary edema
equation for normal PaO2 for an animal receiving supplemental oxygen
PaO2 = FiO2 x 5
equation for assessing hypoxemia in a patient receiving supplemental oxygen
PF Ratio = PaO2 / FiO2
500 if NORMAL
equation for assessing hypoxemia in a patient breathing room air (21% O2)
Aa Gradient = PAO2 - PaO2
if the A-a gradient is normal < 10 - hypoxemia is due to what?
hypoventilation
if the A-a gradient is abnormal > 10 - hypoxemia is due to what?
lung pathology
