Exam 1 - Emergency Respiratory Decision Making Flashcards
what is the normal I:E ratio of respiration in a eupnic patient?
1:3
if you can hear respiratory sounds without touching the patient, where does this localize your problem to?
pharynx & carina - large airway!!
what are some action steps if you have localized your respiratory problem to the nose?
hemorrhage control, humidification, foreign body removal, & sedation
what clinical signs are associated with a respiratory problem that has been localized to the nose?
stertor/sneezing - inspiratory!
what er diagnostics are used for a respiratory problem that has been localized to the nose?
dependent on the nature of condition - bleeding vs. airflow, CHECK PLATELETS
baseline minimum database, met check, skull films, & set them up for advanced diagnostics
what are some clinical signs of a respiratory problem that has been localized to the larynx?
heard on inspiration, +/- wheeze
dyspneic, long inspiration, vocal change, history of coughing/retching, & heat/humidity intolerant
what action steps may be taken for a respiratory problem that has been localized to the larynx?
sedation, oxygen therapy, intubation, foreign body removal, tracheostomy, treatment for hyperthermia
why should you do thoracic rads for a respiratory problem that has been localized to the larynx?
assessing for non-cardiogenic pulmonary edema - potential for aspiration pneumonia
what er diagnostics are used for a respiratory problem that has been localized to the larynx?
oral exam, baseline testing, chest rads, set them up for surgery, make sure they aren’t hyperthermic
what clinical signs are associated with a respiratory problem that has been localized to the trachea?
inspiratory turbulence more common than expiratory turbulence
honking cough
heat/humidity intolerance
what action steps can be taken for a respiratory problem that has been localized to the trachea?
sedation, oxygen therapy, intubation, maybe give them a steroid/antibiotic if indicated
what er diagnostics are used for a respiratory problem that has been localized to the trachea?
baseline testing & chest rads to look at the trachea!
set them up later for advanced imaging & surgery
what diseases commonly affect small airways in the lung?
asthma & neoplasia
what diseases commonly affect the alveoli in the lungs?
pneumonia, edema, & neoplasia
what animals are most commonly affected by bronchial disease?
cats - history of a cough, change in season/moving
what clinical signs are associated with bronchial disease?
expiratory dyspnea, abdominal press, wheeze, dry rales/rub
what are the action steps that should be taken for bronchial disease?
oxygen!!!! sedation, bronchodilator
later - steroid & inhalation meds (feline asthma)
what er diagnostics should be used for bronchial disease?
baseline testing & chest rads
later - do a fecal for lungworms, a heart worm test, CT, & potential lung wash
T/F: pneumonia in cats out of the south is abnormal
true
T/F: cats with alveolar disease is not as common for cats as it is in dogs
true
what should be assessed in the case of potential alveolar disease?
inspiratory dyspnea - cats can have a bronchiolar response
crackles - fine or coarse
murmur? temp? wet or deep cough? at night? history of vomiting (aspiration)? anybody else sick?
what action steps are required for alveolar disease?
sedation, oxygen, potential antibiotic/furosemide
what er diagnostics should be used for alveolar disease?
baseline testing, thoracic rads, HWT, & ecg
later - potential echo & lung wash
paradoxical abdominal motion seen during respiration is specific for what localization?
pleural space disease
what clinical signs are associated with pleural space disease?
paradoxical abdominal motion, air hunger, decreased lung sounds, & clear heart sounds with fluid
what action steps should be done for pleural space disease?
sedate & provide oxygen
do a TFAST & thoracocentesis - could be anticoagulant rodenticide or trauma
sample fluid for cytology & culture or quantify air removed
what er diagnostics should be used for pleural space disease?
baseline testing, chest rads, fluid analysis & culture
for later - echo, CT, surgery
what should be monitored on a patient with pleural space disease?
hourly heart rate, respiratory rate, & respiratory effort
recheck tfast
what criteria must be met for an emergency chest tube?
more than 2 taps required or excessive air volume
what action steps should be taken for chest wall problems?
sedation, oxygen therapy, intubation, pain management, & possible ventilation
what er diagnostics should be used for chest wall problems?
baseline testing, chest rads, arterial blood gas
later - ct & surgery
why does panting cause more respiratory problems?
increased frequency, decreased tidal volume, increased percentage of breath is dead space, & increased energy requirement
dyspnea is painful!! relaxed breathing is more efficient
what are some indications for oxygen therapy?
hypoxemia, increased work of breathing, & hypoventilation
what are the parameters that define hypoxemia?
SpO2 <95%
PaO2 < 75mmHg
room air!!!
what are some contraindications for oxygen therapy?
evil patient that is fractious
what is hypoventilation?
PaCO2 > 45 mmHg
what are the exceptions to hypoventilation?
lower airway obstruction, increased metabolism, & rebreathing CO2
T/F: LMN/CNS patients may not be in distress when hypoventilating
true
T/F: hypoventilation requires ventilation for correction
true
50-150 ml/kg/min gets you how much oxygen supplementation through a cannula?
30-50% oxygen
what is required for an oxygen-rich environment for oxygen supplementation?
need a CO2 monitor/scrubber
limited patient access
hard to get over 60%
what is required for high flow oxygen therapy?
air-oxygen bender generates up to FiO2 = 1.0
compressor creates a flow rate of up to 60L/min
active heated humidifier for 100% humidity
what are the pros & cons of intubation for a patient in respiratory distress?
pros - decreases airway resistance
cons - difficult to control FiO2 & requires sedation
