Lecture 16 - Respiratory cases (specht) Flashcards
to guide emergency care for respiratory distress patients it is most critical to
recognize basic respiratory patterns based on observation and PE than to obtain imaging and blood gas
which dz would you expect to have predom inspiratory distress
laryngeal paralysis
tracheal collapse
brachycephalic syndrome
pleural space dz
which dz would you expect to have predom expiratory distress
asthma pneumonia CHF PTE pulmonary edema
an SPO2 of 88% is concerning and __ may occur
hyoxic tissue damage
spo2 ~ < 60mmHg PaO2
increased inspiratory effort and stridor localizes to
upper resp tract
ddx: lar par, tracheal collaspe, FB, obstructive mass
emergency tx for upper resp tract dyspnea
O2
sedate
intubate
+/- steroids
stridor, paradoxical breathing, increased inspiratory effort are classic for __ dz
laryngeal paralysis
once intubate the paradoxical breathing should resolve even if only breathing room air this rules out diaphragmatic issues causing it
once intubated the paradoxical breathing should resolve even if only breathing room air; this rules out __ causing the breathing pattern
diaphragmatic issues
SPO2 80%, RR 20, minimal effort. Is this SPO2 a problem?
no, pulse ox is wrong. look at your patient!
post op lar par sx concerns
aspiration pneumonitiis
degenerative neuropathy
almost all dogs with idiopathic laryngeal paralysis have concurrent __
degenerative neuropathy, need to warn owners that pet may develop weakness, ataxia, swalloing disorders, etc if lives long enough
nasopharyngeal polyps cause __ noise
sterdor
laryngeal paralysis causes __ noise
stridor
if you hear stridor like or wheezing noises in a cat worry about
oral/laryngeal masses!
in a cat with suspected oral or layrngeal mass causing upper airway obstruction must be prepared for __ when sedating for oropharyngeal exam
difficult intubation
tracheostomy
difficult recovery
euthanasia or emergency surgery :(
T/F: The absence of crackles or wheezes rules out pneumonia and asthma
false, CAN’T R/O these ddx based on absence of these sounds!
It is weird to not hear crackles with CHF so in this case can move CHF lower on list but not r/o
cat in acute respiratory distress with increased expiratory effort and auscultable wheezes; localize
lower respiratory tract (expiratory, wheezes)
emergency tx for lower respiratory distress
O2
BRONCHODILATORS
+/- steroids
NOT sedatives
why shouldn’t you give sedatives to a mixed or expiratory pattern respiratory distress patient
anxiolytics depress RR and effort (good for upper resp distress) but p with lower resp distress NEED to breath hard so depressing RR/effort = p gets less O2
all cats in respiratory distress should get a
bronchodilator (injectable terbutaline)
after 10 mins will see less distress and 30mins will seem more stable
cat CXR with severe bronchial pattern, hyperinflated lungs, that presented in expiratory distress
asthma
most common therapy for feline asthma/bronchitis
long term steriods
+/- bronchodilator PRN
what are some indications for using inhaled steroids rather than PO steroids in feline asthma
diabetic patient
reduce systemic SE
cat is hard to pill
if oral steroids are not helping tx feline asthma then what should be considered
missed something; parasites, etc
average onset for PO steroid at proper dose is about 2 hours
in feline asthma, __ are more important for CS of distress and will not tx inflammation
bronchodilators
causes of non-cardiogenic edema include
electrocution
strangulation
fire/smoke inhalation
laryngeal collapse
NOT; asthma, parasites
which components of brachycephalic airway syndrome can be surgically corrected
stenotic nares
elongated palate
everted saccules
laryngeal collapse
not hypoplastic trachea
increased sx risks for brachycephalic dogs
obesity
environmental factors
other airway abnormalities
post-op swelling
O2, sedation, intubation is tx for
inspiratory distress
O2, bronchodilator, steroids is tx for
expiratory distress
O2 and diagnostics is tx for
mixed distress
100% O2 with a PAO2 300
Know there is something wrong bc should be 400-500 pao2 (VQ mismatch, diffusion barrier?)
can use the __ to tell if patient is improving/which way its trending even if CS loo similar
A-a gradient
