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SA DX & TX I > Exam 2 - Approach to the Dyspneic Patient > Flashcards

Exam 2 - Approach to the Dyspneic Patient Flashcards

1
Q

what is tachypnea?

A

increased respiratory rate

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2
Q

what is dyspnea?

A

increased respiratory effort

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3
Q

what is orthopnea?

A

body position used to ease breathing - elbows abducted, extended neck, & open mouth

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4
Q

what is hypoxemia?

A

low partial pressure of oxygen in arterial blood, <80mmHg

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5
Q

what are signs of dyspnea?

A

open mouth breathing (especially in cats), vigorous chest excursions, flaring nostrils, using abs to breath, orthopnea, cyanosis

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6
Q

if a patient is in respiratory distress, what should be done?

A

urgent & emergent treatment

often empirical therapies

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7
Q

what is reverse sneezing?

A

paroxysms of abrupt inspiratory effort (snorts) that indicates obstruction/irritation of the nasopharynx

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8
Q

what is the general presentation of a patient experiencing reverse sneezing?

A

patient is standing with the neck extended, head tilted backward, lips pulled back, & nostrils flared

event may last seconds to minutes and is distressing to owners

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9
Q

during the distance exam of a patient in respiratory distress, what should be determined first?

A

the phase in which difficulty is occuring

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10
Q

if an animal has inspiratory dyspnea, what anatomic locations are typically involved?

A

upper respiratory tract & pleural space

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11
Q

what are the clinical signs of inspiratory dyspnea?

A

long inspiratory time & short shallow breaths

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12
Q

if an animal has expiratory dyspnea, what anatomic locations are typically involved?

A

lower airways

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13
Q

what is the difference between stertor & stridor?

A

stertor - snore, upper respiratory tract, above the thoracic inlet

stridor - high-pitched coo sound, narrowed larynx, almost always laryngeal disease

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14
Q

if an animal has both inspiratory & expiratory dyspnea, what anatomic locations are typically involved?

A

bronchioles, alveoli, or pulmonary interstitium

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15
Q

upper respiratory tract disease is often associated with a _______ inspiratory phase & will often have audible noise

A

prolonged

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16
Q

what causes stertor?

A

turbulent airflow - localizes lesions to the upper respiratory tract

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17
Q

what causes stridor?

A

airflow through a narrowed larynx - indicative of laryngeal disease

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18
Q

what is included in ‘pleural space disease’?

A

pleural effusion, pneumothorax, & diaphragmatic hernias

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19
Q

what is a restrictive breathing pattern? what is it associated with?

A

short, shallow breathing pattern

pleural space disease - increased inspiratory effort

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20
Q

what is increased expiratory effort indicative of?

A

small airway disease

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21
Q

what causes increased expiratory effort associated with small airway disease?

A

air is trapped in the lungs

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22
Q

small airway disease is most commonly due to what condition?

A

feline asthma - may occur with other disorders such as severe collapse of mainstem bronchi

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23
Q

a patient with both inspiratory & expiratory effort is common with what disease?

A

disease of the bronchioles, alveoli, or pulmonary interstitium

or metabolic disease

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24
Q

upon thoracic auscultation, decreased lung sounds indicate what disease?

A

pleural space disease

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25
Q

T/F: crackles heard upon thoracic auscultation is specific for cardiogenic pulmonary edema

A

false

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26
Q

what are ‘crackles’ in regards to thoracic auscultation?

A

popping sound heard on inspiration

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27
Q

what causes the ‘crackles’ sound?

A

fluid in the bronchioles or alveoli

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28
Q

what are the risks associated with using an oxygen hood for your patient?

A

risk of CO2 accumulation, risk of overheating, & requires 24-hour supervision

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29
Q

what causes oxygen toxicity?

A

100% oxygen for more than 12 hours

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30
Q

what is the pathogenesis of oxygen toxicity?

A

free radical formation - endothelial & epithelial damage occur

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31
Q

gentle palpation of the ventral cervical region may elicit a cough in patients with what condition?

A

tracheal irritation - infectious tracheobronchitis or tracheal collapse

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32
Q

T/F: hyperthermia may develop secondary to upper respiratory disease

A

true

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33
Q

what factors should be considered when supplying oxygen to a patient in respiratory distress?

A

available options, minimizing stress, & severity of hypoxemia

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34
Q

when is mechanical ventilation required in a patient in respiratory distress?

A

conventional oxygen therapy fails or patient has impending respiratory fatigue

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35
Q

what are the pros & cons of using flow-by oxygen for your patient?

A

pros - simple, available, & allows patient handling

cons - requires a person to hold the patient & tubing & only a short-term option

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36
Q

what are the pros & cons of using a face mask when supplying oxygen for your patient?

A

pros - better oxygenation than flow by, simple, available, patient handling

cons - not tolerated by some animals, short-term option, & requires a person to hold the tubing & patient

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37
Q

what are the pros & cons of an oxygen hood for your patient?

A

pros - no special equipment (use an e-collar), better tolerated than a mask, & doesn’t require restraint

cons - careful monitoring, CO2 accumulation, & risk of overheating

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38
Q

what are the pros & cons of using an oxygen cage for your patient?

A

pros - well tolerated, no restraint, can monitor visually, temperature & humidity control

cons - cost, availability, no access to the patient because oxygen concentration drops when the door is opened

39
Q

what are the pros & cons of using a nasal cannula for supplying oxygen for your patient?

A

pros - minimal equipment, easy to place, well tolerated most of the time, & no ongoing restraint

cons - more invasive, less effective if panting, & requires a humidified oxygen source

40
Q

what are the pros & cons of using high flow oxygen therapy for your patient?

A

pros - non-invasive & useful when other methods are not effective

cons - special equipment required

41
Q

what are the pros & cons of using positive pressure ventilation for your patient?

A

pros - provides ventilation & useful when other methods fail

cons - special equipment required & need staff trained for chronic therapy

42
Q

why should IV access be established in a patient in respiratory distress?

A

allow administration of therapeutic drugs & to induce anesthesia if intubation is required

43
Q

sedatives/anxiolytics are especially helpful in patients with what disease? why?

A

upper respiratory tract disease patients

help reduce stress associated with respiratory difficulty

44
Q

what sedatives/anxiolytics are commonly used in patients with respiratory distress?

A

low dose butorphanol & acepromazine

45
Q

what animals are predisposed to developing hyperthermia with respiratory distress?

A

dogs with upper respiratory tract disease, brachycephalic breeds, & dogs with laryngeal paralysis

46
Q

what are some differentials for upper airway disease?

A

intraluminal masses, extraluminal masses, trauma, foreign bodies, laryngeal paralysis, BOAS, & extrathoracic tracheal collapse

47
Q

why is secondary edema a problem in upper airway disease?

A

edema of the tissues can develop secondary to the disease & further increase the resistance to airflow

48
Q

what should be done if your dyspneic patient remains in distress after oxygen supplementation, sedative administration, & anti-inflammatories have been given?

A

emergency intubation

49
Q

what is the general pathogenesis of lower airway disease?

A

narrowing of the lower airways causes increased resistance & effort during exhalation & may result in an expiratory push

50
Q

what is the general history of an animal with suspected lower airway disease?

A

chronic history of coughing - especially in dogs

51
Q

T/F: it is common for dogs to have an expiratory push with chronic bronchitis

A

false - uncommon

52
Q

what are the main differentials for lower airway disease in dogs & cats?

A

cats - feline asthma

dogs - collapse/compression of mainstem bronchi

53
Q

what may be considered for empirical treatment in cats with suspected lower airway disease?

A

empirical administration of a bronchodilator - injectable aminophylline or terbutaline

empirical administration of a glucocorticoids - if feline asthma is suspected

54
Q

what may be considered for empirical treatment in cats with suspected feline asthma?

A

empirical administration of glucocorticoids

55
Q

T/F: in pulmonary parenchymal disease, they are often signs of both increased inspiratory & expiratory effort & may have other systemic signs present

A

true

56
Q

what are the general differentials for pulmonary parenchymal disease?

A

cardiogenic edema, non-cardiogenic pulmonary edema, pneumonia, & pulmonary hemorrhage

57
Q

what drug can be given in a patient with pulmonary parenchymal disease if you suspect left-sided heart failure?

A

furosemide

58
Q

what is commonly heard on thoracic auscultation in a patient with pulmonary parenchymal disease?

A

crackles in the lungs

59
Q

what does PTE stand for?

A

pulmonary thromboembolism

60
Q

what is a pulmonary thromboembolism?

A

life-threatening disorder where a thrombus obstructs a pulmonary vessel or vessels

61
Q

what is the clinical presentation of an animal with suspected PTE?

A

acute, severe respiratory distress with normal pulmonary auscultation

62
Q

what is PTE associated with?

A

diseases that cause hypercoagulability

63
Q

what is the general pathogenesis of pleural space disease?

A

accumulation of fluid, air, or tissue reduces functional residual capacity & lung expansion

64
Q

what is the clinical presentation of an animal with suspected pleural space disease?

A

increased inspiratory effort with shallow breaths (restrictive breathing pattern) & decreased lung/heart sounds on thoracic auscultation

65
Q

typical pleural effusion results in muffled _____ lung sounds & pneumothorax causes muffled ____ lung sounds

A

ventral

dorsal

66
Q

what are the differentials for pleural space disease?

A

pleural effusion, pneumothorax, & diaphragmatic hernia

67
Q

if your patient has pleural effusion, what else should you evaluate for?

A

pericardial effusion

68
Q

what location is an emergency thoracocentesis performed on the patient?

A

side of the thorax where fluid is suspected based on ultrasound/auscultation

7-8th intercostal space - ventrally for fluid & dorsally for air

69
Q

if the fluid collected from a thoracocentesis is bloody, what should you run next?

A

PCV of the fluid & patient’s peripheral blood

70
Q

what are some potential complications of thoracocentesis?

A

hemorrhage, infection, pneumothorax, lung puncture, & cardiac puncture

71
Q

what are your main differentials for thoracic wall disease?

A

trauma (flail chest) or neuromuscular disease

72
Q

what is the typically clinical presentation of an animal with thoracic wall disease?

A

lack of chest wall movement or a paradoxical breathing pattern

73
Q

why don’t animals with thoracic wall disease respond to oxygen supplementation?

A

their primary problem is ventilation - consider mechanical ventilation

74
Q

when running diagnostics on a dyspneic patient, what should be considered?

A

may not be appropriate until after the patient is stabilized

should be selected & performed in a step-wise order to obtain a diagnosis without jeopardizing patient stability

75
Q

what are the pros of using SpO2 for monitoring?

A

non-invasive option that provides a crude estimate of PaO2

instrument also measures a pulse so it can be matched to patient’s peripheral pulse

76
Q

what is a normal SpO2? what is an abnormal SpO2?

A

normal - >97%, correlates with a PaO2 of 80-100mmHg

abnormal - 90-95%, correlates with a PaO2 60-80mmHg

77
Q

what does it mean if there is a discrepancy between the pulse oximeter & your patient’s peripheral pulse?

A

discrepancy - pulse ox reading is invalid

78
Q

what can affect results of the pulse ox?

A

probe positioning, patient movement (respiration/shivering), weak or irregular pulses, vasoconstriction, & anemia

79
Q

what is the gold standard for assessing patient oxygenation?

A

arterial blood gas

80
Q

why is arterial blood gas measurements the gold standard for patient oxygenation?

A

allows evaluation of acid-base & actual patient oxygenation

81
Q

what does it mean if you have an arterial blood gas reading of PaO2 <80 mmHg? what if it’s PaO2 <60 mmHg?

A

PaO2 <80 - hypoxemia

PaO2 <60 - severe hypoxemia

82
Q

in response to a metabolic acidosis, how does the respiratory system compensate?

A

hyperventilation to decrease PaCO2

83
Q

in response to a metabolic alkalosis, how does the respiratory system compensate?

A

hypoventilation to increase PaCO2

84
Q

what are the pros & cons of using thoracic radiographs for the dyspneic patient?

A

pros - readily available & allows for assessment of airways & cardiopulmonary structures

cons - stress of positioning can result in respiratory decompensation & respiratory/cardiac arrest

85
Q

what are the pros & cons of using ultrasound for the dyspneic patient?

A

pros - TFAST scan to look for pleural effusion/pericardial effusion/pneumothorax, VETBLUE to look for b-lines (lung rockets) that indicate fluid/cells in the interstitium or alveoli

cons - none listed

86
Q

how can ultrasound be used to evaluate the heart in the dyspneic patient?

A

measure left atrial-to-aortic-root ratio

normal - 1:1

abnormal - >1.5, suggests CHF in cats

87
Q

what is a proBNP?

A

measures the n-terminal fragment of the proBNP which is released during myocardial stretch

88
Q

what is proBNP used for?

A

help differentiate cardiac from non-cardiac causes of respiratory distress in cats

89
Q

what other conditions may have a release of proBNP?

A

pulmonary hypertension, arrhythmias, renal disease, & systemic hypertension due to myocardial stretch

90
Q

what parasite tests may be used in a dyspneic patient?

A

heartworm snap tests to look for antigens in dogs & antibodies in cats

lung worm antigen snap tests for cats

91
Q

if available, why may a thromboelastography or viscoelastic coagulation monitor be useful in a dyspneic patient?

A

help support the diagnosis of pulmonary thromboembolism

92
Q

what oxygen supplementation provides up to 100% inspired oxygen with continuous positive airway pressure without intubation?

A

high flow oxygen therapy

93
Q

how is a nasal oxygen cannula placed?

A

topical anesthetic applied to nostril

measure distance of nostril to medial canthus

apply water soluble lube to cannula

insert to the pre-marked distance

secure with suture or glue

put an e-collar on the patient

SA DX & TX I (59 decks)

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