Respiratory Distress

Question 1

What muscles are important for INSPIRATION?

Answer 1

1. diaphragm ** (most impt)
2. external intercostals
3. accessory muscles: sternohyoid/scalene, sternomastoids, alae nasi

Question 2

what is the function of the diaphragm during inspiration?

Answer 2

when the diaphragm contracts, the abdominal contents are moved caudally and ventrally. The chest cavity volume INCREASES and the pressure DECREASES. The ribs are lifted.

Question 3

what is the function of the external intercostal muscles during inspiration?

Answer 3

when contracted, ribs are pulled cranially and ventrally.

Question 4

T/F: The muscles of expiration are employed during normal tidal breathing

Answer 4

false – they are passive and not emplyed during normal tidal breathing

Expiration involves the diaphragm simply relaxing and the elastic properties of the lung and chest wall leading to recoil back to equilibrium.

Question 5

when necessary (during distress/dyspnea), what muscles aid in expiration?

Answer 5

abdominal wall contraction leads to an increase in intra-abdominal pressure which pushes the diaphragm cranially and results in expiration. (volume of thoracic cavity decreases, so pressure increases)

Question 6

_________ is outward signs of breathing difficulty

Answer 6

labored breathing

Question 7

_________ is the sensation of breathlessness

Answer 7

dyspnea

Question 8

__________ is positional increases in diffculty breathing

Answer 8

orthopnea

Question 9

If a patient is having trouble on inspiration, where can you generally localize the problem to?

Answer 9

upper airway

Question 10

If a patient is having trouble on expiration, where can you generally localize the problem to?

Answer 10

lower airway

Question 11

If a patient is having increased effort during all phases of breathing, where can you generally localize the problem to?

Answer 11

parenchymal

Question 12

If a patient is having short, shallow breaths, where can you generally localize the problem to?

Answer 12

pleural space

Question 13

What are the THREE things to do when presented with a patient having respiratory difficulties?

Answer 13

1. minimize stress
2. oxygen supplementation
3. sedation (bc dyspnea is stressful) with butorphanol IV (rapid onset, multiple routes of admin, minimal cardiac or resp effects, and reversible)

if all else fails, heavily sedate/induce and intubate (reduces stress and work of breathing and facilitates diagnostics)

Question 14

What is a part of the “brief” physical exam for a patient in respiratory distress?

Answer 14

1. visual inspection
2. brief auscultation
3. TPR
4. mucous membrane assessment

give patient lots of breaks in between if necessary

Question 15

Once a patient that presented for respiratory distress is calmer and stable, what diagnostics could you perform to get a better understanding of the underlying cause?

Answer 15

1. full physical exam
2. blood sample
3. imaging – thoracic xrays, fluoroscopy, echocardiography, bronchoscopy, CT, ultrasound

Question 16

what are upper airway diseases that can cause respiratory distress?

Answer 16

1. laryngeal paralysis
2. tracheal collapse
3. foreign body
4. polyps (cats)
5. brachycephalic airway syndrome

Question 17

what are 3 lower airway diseases that can cause respiratory distress?

Answer 17

1. chronic bronchitis
2. asthma
3. eosinophilic bronchopneumonia

Question 18

what are parenchymal diseases that can cause respiratory distress?

Answer 18

1. pneumonia
2. pulmonary edema

Question 19

When assessing a patient who has all breathing phases affected (meaning parenchymal disease is most likely the cause), how can you differentiate between cardiac versus non-cardiac causes and provide therapy based on the difference?

Answer 19

history, signalment, and triage
if its CHF, the patient would be tachycardic and hypothermic
if its lung problem, the patient would have a normal HR and normal temp most likely.

once you’ve distinguished between the 2, you can give furosemide, bronchodilators, or steroids based on the most likely problem.

Question 20

what is a characteristic radiographic feature for congestive heart failure?

Answer 20

pulmonary venous distention

(also left atrial enlargement)

Question 21

what are radiographic findings that point you more towards a bronchial disease as opposed to heart disease causing respiratory difficulty?

Answer 21

bronchial pattern – donuts and rail road tracks.

Question 22

what are pleural space diseases that can cause a patient to present with short, shallow breaths?

Answer 22

1. pleural effusion
2. pneumothorax
3. diaphragmatic hernia

Question 23

how can you definitively diagnose and treat a pleural effusion and/or pneumothorax?

Answer 23

thoracocentesis

Question 24

How can you diagnose thoracic wall disease in patients with atypical signs of respiratory distress?

Answer 24

blood gas – high CO2

Thoracic wall disease can be things like neuro disease, muscular disease, or orthopedic disease that causes the patient to be unable to show typical signs of respiratory distress.
A high CO2 is supportive of a patient who is hypoventilating.