Lecture 16 - Respiratory cases (specht)

Question 1

to guide emergency care for respiratory distress patients it is most critical to

Answer 1

recognize basic respiratory patterns based on observation and PE than to obtain imaging and blood gas

Question 2

which dz would you expect to have predom inspiratory distress

Answer 2

laryngeal paralysis
tracheal collapse
brachycephalic syndrome
pleural space dz

Question 3

which dz would you expect to have predom expiratory distress

Answer 3

asthma
pneumonia
CHF
PTE
pulmonary edema

Question 4

an SPO2 of 88% is concerning and __ may occur

Answer 4

hyoxic tissue damage

spo2 ~ < 60mmHg PaO2

Question 5

increased inspiratory effort and stridor localizes to

Answer 5

upper resp tract

ddx: lar par, tracheal collaspe, FB, obstructive mass

Question 6

emergency tx for upper resp tract dyspnea

Answer 6

O2
sedate
intubate
+/- steroids

Question 7

stridor, paradoxical breathing, increased inspiratory effort are classic for __ dz

Answer 7

laryngeal paralysis

once intubate the paradoxical breathing should resolve even if only breathing room air this rules out diaphragmatic issues causing it

Question 8

once intubated the paradoxical breathing should resolve even if only breathing room air; this rules out __ causing the breathing pattern

Answer 8

diaphragmatic issues

Question 9

SPO2 80%, RR 20, minimal effort. Is this SPO2 a problem?

Answer 9

no, pulse ox is wrong. look at your patient!

Question 10

post op lar par sx concerns

Answer 10

aspiration pneumonitiis

degenerative neuropathy

Question 11

almost all dogs with idiopathic laryngeal paralysis have concurrent __

Answer 11

degenerative neuropathy, need to warn owners that pet may develop weakness, ataxia, swalloing disorders, etc if lives long enough

Question 12

nasopharyngeal polyps cause __ noise

Answer 12

sterdor

Question 13

laryngeal paralysis causes __ noise

Answer 13

stridor

Question 14

if you hear stridor like or wheezing noises in a cat worry about

Answer 14

oral/laryngeal masses!

Question 15

in a cat with suspected oral or layrngeal mass causing upper airway obstruction must be prepared for __ when sedating for oropharyngeal exam

Answer 15

difficult intubation
tracheostomy
difficult recovery
euthanasia or emergency surgery :(

Question 16

T/F: The absence of crackles or wheezes rules out pneumonia and asthma

Answer 16

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

Question 17

cat in acute respiratory distress with increased expiratory effort and auscultable wheezes; localize

Answer 17

lower respiratory tract (expiratory, wheezes)

Question 18

emergency tx for lower respiratory distress

Answer 18

O2
BRONCHODILATORS
+/- steroids

NOT sedatives

Question 19

why shouldn’t you give sedatives to a mixed or expiratory pattern respiratory distress patient

Answer 19

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

Question 20

all cats in respiratory distress should get a

Answer 20

bronchodilator (injectable terbutaline)

after 10 mins will see less distress and 30mins will seem more stable

Question 21

cat CXR with severe bronchial pattern, hyperinflated lungs, that presented in expiratory distress

Answer 21

asthma

Question 22

most common therapy for feline asthma/bronchitis

Answer 22

long term steriods

+/- bronchodilator PRN

Question 23

what are some indications for using inhaled steroids rather than PO steroids in feline asthma

Answer 23

diabetic patient
reduce systemic SE
cat is hard to pill

Question 24

if oral steroids are not helping tx feline asthma then what should be considered

Answer 24

missed something; parasites, etc

average onset for PO steroid at proper dose is about 2 hours

Question 25

in feline asthma, __ are more important for CS of distress and will not tx inflammation

Answer 25

bronchodilators

Question 26

causes of non-cardiogenic edema include

Answer 26

electrocution
strangulation
fire/smoke inhalation
laryngeal collapse

NOT; asthma, parasites

Question 27

which components of brachycephalic airway syndrome can be surgically corrected

Answer 27

stenotic nares
elongated palate
everted saccules
laryngeal collapse

not hypoplastic trachea

Question 28

increased sx risks for brachycephalic dogs

Answer 28

obesity
environmental factors
other airway abnormalities
post-op swelling

Question 29

O2, sedation, intubation is tx for

Answer 29

inspiratory distress

Question 30

O2, bronchodilator, steroids is tx for

Answer 30

expiratory distress

Question 31

O2 and diagnostics is tx for

Answer 31

mixed distress

Question 32

100% O2 with a PAO2 300

Answer 32

Know there is something wrong bc should be 400-500 pao2 (VQ mismatch, diffusion barrier?)

Question 33

can use the __ to tell if patient is improving/which way its trending even if CS loo similar

Answer 33

A-a gradient