Resp procedures (Buckley)

Question 1

Challenge of resp dz

Answer 1

• unstable patients
  
  • may not tolerate dx tests

Question 2

Sedated airway examination

Indication

Answer 2

• Suspected upper airway dz
  
  • stridor
  • upper airway obstruction
  • brachycephalic conformation

Question 3

Airway exam

Technique

Answer 3

• Sedate with propofol to effect
  
  • avoid: opioids, acepromazine
• Good light source
• Be prepared to intubate
  
  • monitor pule/ox +/- EKG
• Examine
  
  • laryngx
    
    • check for arytenoid movement
    • foreign bodies
    • masses (cats)
    • can give doxopram to make larynx move more for exam
  • tissues around larynx
    
    • saccules
    • palate
  • ​check for oral masses
  • proximal trachea

Question 4

Thoracocentesis

Indications

Answer 4

Diagnostic or therapeutic

Question 5

Thoracocentesis

Technique

Answer 5

• Landmarks: 8th/9th IC space
• Clip and sterile prep
• Catheter or needle inserted into IC space
  
  • avoid caudal edge of rib
• Aspirate fluid or air
  
  • ensures proper placement
  • Fluid: bottom 1/3 of chest
  • air: top 1/3 of chest, avoid epaxial muscles tho

Question 6

Risk of thoracocentesis

Answer 6

• Higher in cats with chronic pleural effusion
  
  • can cause pneumothorax, lungs don’t seal hole as well

Question 7

Suction units

Answer 7

• Can use in big dog
• Don’t use in small animals
  
  • colappse lung I think

Question 8

THoracostomy tube

Over the wire

Answer 8

• Seldinger technique
• kits are like 50$
• Need
  
  • scalpel
  • syringe
  • catheter
• NEVER LET GO OF THE GUIDEWIRE
• Can place this with an awake patient
  
  • little sedation
  • local lidocaine block

Question 9

Thoracostomy tube

Surgical

Answer 9

• Performed under general anesthesia with patient intubated
• Can use
  
  • red robber
  • trochar thoracostomy tube

Question 10

Nasal oxygen placement

Answer 10

• Great for larger dogs requiring O₂ supplementation
• No need for specialized equiptment
• Allows dogs to be moved around
  
  • taken for walks
  • physical therapy
  • transport
• Works less efficiently when dog is panting

Question 11

Nasal oxygen placement

Technique

Answer 11

• Red rubber tube
  
  • 8-14Fr
• Suture/stapler
• Adapter
• Humidifier
• Local anesthetic
  
  • tetracaine (instill a few drops into nose)
• Measure red rubber from external nare to medial canthus of eye
• insert in a ventro-medial direction until you reach your mark
  
  • suture, maybe use hypodermic needle to poke skin

Question 12

Temporary tracheostomy

Indications

Answer 12

• Emergency management of upper airways obstruction
• Elective stabilization
  
  • while intubated

Question 13

Scenarios indicating tracheostomy

Answer 13

• Laryngeal mass
• Severe airway swelling
• BOAS
• Laryngeal paralysis (rarely)
• Oral lesions
  
  • mass, severe tongue swelling

*be careful about damaging trachea in bulldogs

Question 14

Tracheostomy

Technique

Answer 14

• Preferably intubated
• In dorsal recumbency
• Clip and prep skin from larynx to thoracic inlet
• Incise skin and SQ longitudinally
  
  • IN THE MIDLINE
• Separate strap muscles
• Incise between tracheal rings
  
  • < 1/3 the circumference
• Stay sutures above and below

Question 15

Tracheostomy tips

Answer 15

• Make sure patient is straight
  
  • if not you’ll miss midline
• Always use stay sutures
  
  • label them UP and DOWN with tape and words
• Don’t close the hole
  
  • let it heal by secondary intention