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3. Cat & Dog 3 > Respiratory Emergencies > Flashcards

Respiratory Emergencies Flashcards

1
Q

Respiratory Disease - Clinical Signs

A
  • Increased Respiratory rate
  • Increased Respiratory effort
  • Open mouth breathing
  • Abdominal effort
  • Abducted elbows
  • Neck extension
  • Retraction of lips at the commissures
  • Cyanosis
  • Blood / foam from the mouth
  • Respiratory noise
  • Paradoxical breathing
    > Chest sucks in during inspiration, belly out & vice versa
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2
Q

Most important basic principle of respiratory emergency

A

Give O2 & Sedate

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3
Q

basic principles for handling respiratory emergencies

A

Give O2 & Sedate
<><>
Fragile patients
— Minimal reserve function
— Minimize handling / stress
<><>
Location:
— Quiet
— O2 source
<><>
Options (based on degree of distress)
1. Initial survey assessment
2. Sedation & pause > give it 15 minutes to let anxiety of patient pass…
3. Emergency Intervention > unless emergency in which case we need to do something to make it survive

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4
Q

resuscitation for respiratory emergency patient

A

— Provide supplemental O2 Always!!
— Minimize restraint & stress
> Sedate!! Wait?
— Survey assessment
— Point of care thoracic ultrasound
— Place IV catheter
> Promptly
> Following sedation
— Consider diagnostic thoracocentesis
— Emergency intubation +/- ventilation
<><><><>
Initiate therapeutics & diagnostics

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5
Q

sedation for respiratory emergency patient

A
  1. Butorphanol IV, IM, SQ
    — If additional sedation is required: Benzodiazepines
    — Diazepam (IV only)
    — Midazoloam (IV or IM)
    <><><><>
  2. Hydromorphone / methadone
    — If traumatic injuries / Pain appreciated
    <><><><>
  3. Acepromazine (for Upper Respiratory Distress)
    — Confirm strong pulses
    <><><><>
    It’s better to sedate/anesthetize than resuscitate
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6
Q

Emergency Intubation
- wjen to do it, and why?

A

— For severe respiratory distress
— Allows airway patency & delivery of 100% O2 — Improves oxygenation
— decrease Stress

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7
Q

Emergency Intubation
- induction options

A
  • proporfol if IV access
  • alfaxalone if no IV access
    <><>
  • Ketamine : valium (1:1 or 1:2) IV to effect
  • Ketamine : midazolam (as above) IM
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8
Q

Intubation & Resuscitation for resp emergency patient
- when to ventilate? how?

A

— If not breathing / oxygenating well without
— Ambubag / rebreathing bag on anesthetic machine

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9
Q

7 Localizations for Respiratory Distress

A
  1. Upper airway
  2. Lower Airway
  3. Pulmonary parenchyma
  4. Pleural space
  5. chest wall
  6. pulmonary vasculature
    > thromboembolism
  7. abdominal distension
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10
Q

The Cat with Dyspnea
- etiology

A

— 38% - cardiogenic
<><>
— 32% - respiratory
> non-infectious: Asthma (7), laryngeal paralysis (3), tracheal FB / stenosis (2), polyp
> Infectious : FIP (3), pyothorax (4), URTI (2), pneumonia (1)
<><>
— 20% - neoplastic
> Lymphoma, thymoma, bronchogenic carcinoma, nasal adenocarcinoma
<><>
— 9% - traumatic
> Diaphragmatic hernia, pneumothorax, tracheal trauma

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11
Q

resp emergency - things to think about moslty for young patients

A

— Infectious disease
— FIP, Bot larval migrans, lungworm

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12
Q

resp emergency - things to think about moslty for older patients

A

— Heart disease, Neoplasia

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13
Q

tracheal collapse common in what breeds?

A

— Yorkies, Pomeranians

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14
Q

Laryngeal paralysis more common in what animals?

A

Older hunting dogs: Labs, Spaniels, Setters

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15
Q

Mitral valve disease more common in what animals?

A

Older, small breed dogs eg. Shih Tzu, Toy poodles, Cavalier King Charles spaniel

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16
Q

PE for resp energency animal? considerations?

A

Handle with care!
— Abbreviated GPE:
— Respiratory rate & character
— Thoracic auscultation > heart, lungs
— MM – colour & CRT
— Cervical evaluation > Jugular distension
— Temperature
— Blood pressure
<><><><>
- LIMIT handling!! STERNAL recumbency preferred
- provide O2

17
Q

Thoracic Auscultation for resp emergency:
- what should we think if we hear:
- Murmur / gallop rhythm / arrhythmia

A

Cardiac disease

18
Q

Thoracic Auscultation for resp emergency:
- what should we think if we hear:
- crackles

A

— Pulmonary parenchymal involvement
— Edema (cardiogenic or non-cardiogenic)
— Pulmonary contusions, pneumonia
— Pulmonary fibrosis
<><>
> something in the lung

19
Q

Thoracic Auscultation for resp emergency:
- what should we think if we hear:
- wheezes

A

— Asthma, Bronchial disease

20
Q

Thoracic Auscultation for resp emergency:
- what should we think if we hear:
- absent lung sounds

A

— Pleural effusion/ pneumothorax
— Intrathoracic masses
— Severe (non-aerated) parenchymal disease
<><>
> something in the pleural space?

21
Q

what parts of our PE should we postpone in a resp emergency?

A

— Abdominal palpation
— Lymph node & T4 assessment
— Orthopedic examination
— Full neurological examination

22
Q

imaging for resp emergency patients - when should we do it? what can we do and why?

A

Radiographs
— Postpone in patients with significant respiratory distress
— Recommended in all trauma patients
> Diaphragmatic hernia, pulmonary contusion
<><>
Point of Care Ultrasound
<><>
Thoracic ultrasound
— Pleural effusion
— Pneumothorax
<><>
Lung ultrasound
— Pulmonary pathology
<><>
Cardiac ultrasound

23
Q

Point of Care Ultrasound for resp emergency - how do we do it? what are we looking for?

A

— ASSESSMENT from the patient’s RIGHT side
— Cross-section (short axis view)
— Left atrial (LA) size to aorta (Ao) ratio
— LA:Ao ratio (Normal 1:1.5) ; LA : Ao ≥1:2+ Cardiac Dz

24
Q

Hypoxemia - pulse oximiter values for normal, hypoxic, and severely hypoxic animals

A

Normal lung function
SpO2%: 98-100
Blood gas PaO2 mmHg: ~100
<><><><>
Hypoxemia
SpO2%: <95
Blood gas PaO2 mmHg: <80
<><><><>
Severe Hypoxemia
SpO2%: <90
Blood gas PaO2 mmHg: <60

25
Q

Urgent Clinical Goal SpO2

A

SpO2 > 93+%

26
Q

Fluid Therapy in Respiratory Distress
- considerations based on etiology

A

— Cautious Intravenous Fluids
— Etiology:
1. Heart Failure
> Fluids are CONTRAINDICATED
<>
2. Trauma & shock
> Low volume resuscitation
> Quickly add hypertonic saline, blood products
<>
3. Other
> Fluids delivered cautiously

27
Q

CASE:
— Chevy, 4-year-old male neutered German Shepherd
— HBC, tachypnea & dyspnea
<><>
— Auscultation > Quiet lung sounds
— Multiple limb fractures
<><><><>
DDX? therapeutic plan?

A

DDX:
Pleural space disease
* Pneumothorax
* Hemothorax
Severe pulmonary contusions
Diaphragmatic hernia
<><><><>
Therapeutic Plan
— O2 supplementation
— Pain management
> Hydromorphone 0.05 mg/kg IV
— Fluid resuscitation (1/2 shock rate)
> 10 ml/kg fluid bolus in 15 min (~40 ml/kg/hr)
> Reassess & repeat if necessary
— Thoracocentesis
— Chest radiographs

28
Q

when should we do thoracocentesis in a respiratory emergency?
how?

A

** Pre radiographs for severe respiratory distress!! **
** Sedation / Local anesthesia**
<><><><>
Options:
* Butterfly needle
* Over the needle IV catheter
* Needle & extension set
<><><><>
— Sterile technique - prep
— 7th - 9th intercostal space
> Dorsal 1/3rd – Air
> Ventral 1/3rd – Fluid
— Never let go of the needle!
— Save sample
> Red top tube: C+S, triglyceride levels
> Purple top tube: PCV, TS, Cytology

29
Q

Thoracocentesis
— Complications

A

— Lung laceration > Pneumothorax
— Puncture of vasculature > Bleeding
> usually minor, hemothorax unlikley
> chest wall hematoma
> re-expansion pulmonary edema
— Infection

30
Q

if we perform a thoracocentesis for respiratory distress, in what situations should we insert a chest tube / catheter? where do we put it?

A

— Remains in the thorax for repeat / continuous evacuation
<><>
Indications:
— ≥2x thoracocentesis ≤ 24 hours
— Continuous pneumothorax
— Tension pneumothorax
<><><><>
Placement
— Dorsal 1/3rd entry site
— Enter thorax (X) at 7-9th ICS
— Catheter angled ventrally towards the axilla
<><><><>
— Placed with mild sedation & local analgesia

31
Q

what do pulmonary contusions look like on U/S?

A

confluent B-lines = white sheet = pulmonary contusions

32
Q

Pulmonary Contusions
— History
- what is it?
- what we see radiographically?

A

— History - TRAUMA
— Hemorrhage into the lung parenchyma
<><><><>
— Pulmonary infiltrates worsen
— Radiographic signs worsen
> Over first 12-24 hours
> Be prepared / Forewarn owners

33
Q

Pulmonary Edema
- types, which is more common?
- cause / distribution?

A

Non-cardiogenic and cardiogenic edema
<><><><>
Cardiogenic edema most common:
- Causes:
> Heart failure (myocardial /valvular failure; arrhythmogenic)
- Distribution
> Central / Perihilar (Dogs)
> Anywhere (Cats)
<><><><>
Non-cardiogenic edema causes:
- post-obstructive
- direct lung injury
- neurogenic
- systemic disease
- near drowning
- blood transfusion
- anaphylaxis

34
Q

If you can hear it across the room …
where is the airway obstructed?

A

— It’s UPPER airway obstruction!!!

35
Q

Upper Airway Obstruction – Initial Management

A

— Supplemental O2
<><>
— Sedation
> Acepromazine
> Opioid Butorphanol
<><>
Active cooling of core
— Wet towels
— Fan
— Cool IV fluids
— Ice – axillas/groin
<><>
Anti-inflammatory
— Dexamethasone

36
Q

Upper airway distress - what do we do if intubation is not possible?

A

Tracheotomy

37
Q

Tracheotomy procedure - how to?

A

— Dorsal recumbency
— Elevate neck
> Towel under the neck
— Clip, shave & prep (as time permits)
— Midline incision over trachea
<><><><>
* Manually isolate trachea
* Incise between ~2nd-3rd or 3rd - 4th tracheal rings
<><>
Horizontal tracheal incision - between 2 rings (>10kg)
* Not more than 50% of tracheal circumference
<><>
Patient ≤ 10 kg
* Vertical tracheal incision - through tracheal ring(s)
* Do not want to transect the trachea!!

38
Q

respiratory emergecny cases overarching points:

A

Assess the patient:
— Work of breathing
— Hypoxia
Primary Goal:
— Alleviate distress:
— Provide oxygen
— Sedate
— Gain control of the airway / Intubate / Ventilate

39
Q

Brachycephalic obstructive airway syndrome (BOAS) history, presentation

A

— Dog collapsed in pool of saliva with severe dyspnea
- increased temperature
- tachycardia
- tachypnea
- cyanotic
- Inspiratory stridor
- noise on auscultation
- bounding pulses

3. Cat & Dog 3 (26 decks)

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