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Small Animal Medicine Exam 3 (Spring 2016) > L39: Respiratory Distress (Specht) > Flashcards

L39: Respiratory Distress (Specht) Flashcards

1
Q

Steroids may predispose to PTE

HW prophylactics may –> thromboembolism

A

:)

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2
Q

INSPIRATORY distress or prolonged inspiratory phase often indicates:

A

EXTRA-THORACIC airway obstruction

-ie. Cervical tracheal collapse, lar par

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3
Q

EXPIRATORY distress or prolonged expiratory phase often indicates:

A

INTRA-thoracic airway obstruction:

  • intra-thoracic tracheal collapse
  • Chronic bronchitis
  • Asthma
  • pneumonia
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4
Q

True respiratory distress automatically localizes problem to (in the dog):**

A

Level of the larynx or lower

Reason: if it is nasal disease, dogs generally open their mouths. In cats, if YOU open the mouth and it is still in distress, this also localizes to below the larynx

Laryngeal or other upper airway dz is generally loud (stridor) with head/neck extension posturing and inspiratory component

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5
Q

Cardiac disease significant enough to cause distress usually associated with:

A

Tachycardia
Murmur
Pulse abnormalities

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6
Q

Expiratory effort with auscultable wheezes is highly suggestive of:

A

Bronchoconstrictive disease

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7
Q

Absence of lung sounds (esp. In vental or dorsal lung fields) in the face of tachypnea/dyspnea is suggestive of:

A

Pleural space disease (or PT)

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8
Q

5 basic mechs. Of hypoxemia**

A

1) decreased inspired O2 (ie. During anesthesia)
2) hypoventilation
3) diffusion abnormalities (usually not clinically sig.)
4) anatomic shunts
5) V/Q mismatch

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9
Q

Resp. Distress Ddx

A 
Upper airway (lar par, tracheal collapse, obstructions)
Lower airway (asthma, mainstem bronchi collapse, airway obstruction, infectious bronchitis)

Lungs (pneumonia, CHF, NCPE, PTE, neoplasia, hemorrhage, fibrosis, PHT)

Pleural space (air, fluid)

Other (anemia, smoke, drowning, aortic aneurism, resp. Paralysis)

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10
Q

Respiratory distress

A

Abnormal breathing rate or effort resulting in distress to the patient

  • sign of ineffective oxygen delivery to tissues
  • underlying cause may be a respiratory problem
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11
Q

CS of lar par

A 
Resp. Distress
Stridor
Bark change
Cyanosis
Syncope

*exacerbated by increased resp. Effort

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12
Q

Dz associated with lar par

A

Hypothyroidism

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13
Q

Arytenoids close during ____ in lar par

A

Inspiration

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14
Q

Tx of lar par

A
  • emergency airway mgmt PRN (O2, anxiolytic, anti-inflammatory, intubation or tracheostomy)
  • address underlying dz if possible
  • sx intervention (tie back
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15
Q

Components of brachycephalic syndrome

A

1) stenotic nares
2) elongated soft palate
3) everted laryngeal saccules
4) hypoplastic trachea (?)
5) +/- laryngeal collapse, laryngeal paralysis

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16
Q

Dx of brachy syndrome

A
  • may be presumptive

- laryngoscopy and rads help with definitive characterization

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17
Q

Tx of brachy syndrome**

A
  • emergency airway mgmt (as with lar par)
  • sx correction (elongated soft palate, stenotic nares, and everted saccules can be fixed)
  • hypoplastic trachea and laryngeal collapse CANNOT be corrected
18
Q

Feline asthma char. By:

A

wheezing, coughing, dyspnea due to spontaneous bronchoconstriction

19
Q

Factors that can contribute to feline bronchitis (Asthma)

A
  • airway hypersensitivity –> bronchospasm
  • bronchial smooth muscle or epithelial hypertrophy
  • increased mucous production –> decreased clearance
  • inflammation w/n airway walls
  • exudate w/n lumen
  • fibrosis
  • emphysema
20
Q

CS of feline bronchitis (Asthma)

A
  • usually in younger cats
  • sudden onset dyspnea +/- cough or wheeze
  • increased expiratory effort with wheezes and crackles
  • slowly progressive
  • may be exacerbated by env. Changes
21
Q

Dx of feline bronchitis (Asthma)*

A
  • Hx/CS
  • rads: bronchial pattern, hyperinflation, +/- aerophagia
  • HW test and fecal to rule out other causes

**Definitive dx: airway wash cytology: eosinophilic, neutrophilic, or mixed inflammation

22
Q

Tx of feline bronchitis (asthma)

A
  • emergency airway mgmt with steroids
  • short-acting bronchodilators if steroids don’t work
  • env. Mod.
  • long-term corticosteroids (oral or inhaled)

*sudden death always a possibility

23
Q

2 classes of bronchodilators**

A

1) Sympathomimetics (B agonists)
- Terbutaline, Albuterol
- minimal cardiac effects

2) Methylxanthines
- long acting theophylline

*should not use bronchodilators without anti-inflammatories also on board

24
Q

How is resp. Function affected by PTE?

A
  • increased V/Q in non-perfused areas
  • release of various humoral factors and stimulation of neurogenic reflexes –> decreased CO, increased PVR, bronchoconstriction, loss of surfactant, infarct, etc.
25
Q

CS of PTE

A
  • SUDDEN onset of resp. Distress, tachypnea, dyspnea, depression
  • crackles, wheezes, “dull” sounds
  • increased breath sounds due to edema, hemorrhage, bronchial constriction
  • tachycardia due to increased sympathetic stimulation from anxiety, pain, or dec. CO
  • also: shock, syncope, collapse, sudden death, coughing up blood
26
Q

Dx of PTE

A
  • presumptive
  • CBC/Chem to ID predisposing conditions
  • Thoracic rads (not Se/Sp)

Pulmonary angiography, scintigraphy, CT/MRI give specific dx

27
Q

Tx of PTE

A
  • supportive: O2, +/- diuretics, bronchodilators
  • reverse prothrombotic state: give anticoagulants
  • fibrinolytic meds (ie. Streptokinase, TPA)
  • mechanical ventilation if severe
28
Q

Other causes of resp. Distress

A
  • pneumonia
  • neoplasia
  • CHF
  • PHT
  • pulmonary fibrosis
  • hemorrhage
  • lung lobe torsion
  • eosinophilic infiltrates
  • ARDS
  • non-cardiogenic edema
29
Q

Which dzs have predominantly inspiratory distress?**

A

Lar par
Tracheal collapse
Brachycephalic syndrome
Pleural space dz*

30
Q

Which dzs have predominantly expiratory distress?

A
  • asthma
  • pneumonia
  • CHF
  • PTE
  • non-cardiogenic pulmonary edema
31
Q

2 times see paradoxical breathing**

A

Near complete upper airway obstruction

Diaphragmatic paralysis or injury

32
Q

Lar par post-op concerns

A
  • aspiration pneumonia

- degenerative neuropathy

33
Q

PaO2 less than ___ is dangerous

A

60

34
Q

Indications for inhaled rather than oral steroids

A
  • diabetic patient
  • excessive side effects
  • client can’t pill
35
Q

Causes of non-cardiogenic edema

A
  • electrocution
  • strangulation
  • house fire/smoke inhalation
  • lar collapse
36
Q

Cardiogenic edema tends to be perihilar, whereas non-cardiogenic tends to be diffuse and/or in caudodorsal lung field

A

:)

37
Q

Generic tx for INSPIRATORY distress**

A

Sedative
Anxiolytic
Oxygen

38
Q

Generic tx for EXPIRATORY distress

A

Bronchodilators

Oxygen

39
Q

Arterial concentration of oxygen should be __x that of the air they are breathing

A

4-5x

40
Q

Normal dog PaO2

A

400-500

41
Q

A-a gradient

A

Helps determine V/Q mismatch vs. hypoventilation or other problem (DNK)

Small Animal Medicine Exam 3 (Spring 2016) (9 decks)

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