Respiratory emergencies (Conner)

Question 1

Muscles of inspiration

Answer 1

• Diaphragm most imp
  
  • contraction:
    
    • abdominal contents move caudally and ventrally
    • chest cavity increases in volume in craniocaudal direction
    • ribs lifted
• External intercostals
  
  • contraction
    
    • pulled cranially and ventrally
• Scalene: accessory moscle of inspiration
• Sternomastoids: pull sternum cranially
• Alae nasi: nasal flare

Question 2

During normal breathing abdomen

Answer 2

• DOES move
  
  • abdominal muscles not involved in normal breathing

Question 3

Muscles of expiration

Answer 3

• Not emplyed during normal tidal breathing
• Elastic properties of lung & chest wall
  
  • recoil to equilibrium
• When needed
  
  • adbominal wall contraction
  • inc intraabdominal pressure
  • pushes diaphragm cranially

Question 4

Labored breathing

Def

Answer 4

• Outward signs of breathing difficulty
  
  • often includes engagement of accessory muscles of inspiration and/or expiration

Question 5

Dyspnea

def

Answer 5

• Sensation of breathlessness
  
  • patient in trouble and panicking

Question 6

Tachypnea

def

Answer 6

Increased respiratory rate

Question 7

Orthopnea

Def

Answer 7

• Positional increases in difficulty
  
  • vet patients often extend head, and neck, abduct elbows

Question 8

Rapid localization of problem

Answer 8

• Upper respiratory
  
  • problems on inspiration
• Lower airway
  
  • problems on expiration
• Parenchymal
  
  • increased effort during all phases
• Pleural space
  
  • short, shallow breathing

*combinations are common

Question 9

Minimize stress in cats

Answer 9

• don’t scruff
• hands off is better
• minimize stress

Question 10

Approach to respiratory distress

Oxygen

Answer 10

• Doesn’t always help
• doesn’t hurt
• method of delivery may induce stress
  
  • Oxygen cage
  • Mask/flow by
  • Hood
  • Nasal cannula

Question 11

Approach to respiratory distress

Sedation

Answer 11

• Dyspnea is stressful
• Ideal sedative
  
  • rapid onset
  • multiple routes admin
  • minimal cardiac/resp effects
  • reversible
• Butorphanol
  
  • 0.1-0.3 mg/kg IV or IM
  • repeat if needed

Question 12

Three keys to approaching resp distress

TQ

Answer 12

1. Minimize stress
2. Oxygen
3. Sedation

Question 13

Contraindications for oxygen

Answer 13

• If your patient is on fire

Question 14

If all else fails

Answer 14

• Sedate and intubate
  
  • reduces stress and work of breathing
  • Short-term solution to facilitate diagnostics
  • May need to continue with mechanical ventilation

*Better to intubate a living patient than a dead patient that just suffered resp distress

Question 15

Diagnostics

Initially

Answer 15

• Brief physical exam
  
  • visual inspect
  • brief auscultation
  • (T)PR
  • mm
• Take step-by-step approach
• Give patient lots of breaks

Question 16

Diagnostics

When patient more calm and stable

Answer 16

• Full physical exam
• Blood sample
• Imaging
  
  • thoracic rads
  • Fluoroscopy
  • echocardiography
  • bronchoscopy
  • comuted tomography

Question 17

Rule #1 of diagnostics in respiratory cases

Answer 17

Don’t kill your patient to get diagnostics

-that’s a necropsy!

Question 18

Common upper airway dz

Answer 18

• Lar par
• Tracheal collapse
• foreign bodies
• polyps
• brachycephalic airway syndrome

Question 19

Lower airway disease

Answer 19

• Feline bronchial disease (asthma)
• Chronic bronchitis

Question 20

Parenchymal disease

Primary Cardiac Disease

Answer 20

• Very young and very old
• small breed dogs
• Maine coon cats
• Presence of murmur or arrhythmia
• history of cough (dog)

*TX WITH LASIX (FUROSEMIDE)

Question 21

Parenchymal Disease

Non-cardiac dz

Answer 21

• any age or breed
• history of vomiting or recent anesthesia
• coughing
  
  • cats or dogs
• severe concurrent dz

*TX with Bronchodilators: these can exacerbate heart failure

Question 22

Cats with heart dz don’t

Answer 22

cough

Question 23

Radiographs

Answer 23

Get good at differentiating heart failure from parenchymal dz

Question 24

Answer 24

Big left atrium

Question 25

On rads what will tel you it’s heart dz instead of pulmonary dz?

Answer 25

• Pulmonary arteries and veins
  
  • A, B, V: artery, bronchus vein
  • Is artery distended compared to vein

Question 26

3 Radiographic lung patterns

Answer 26

1. Alveolar dz: gunk in alveoli
   
   • looks like tree in the snowstorm in winter
   • primary parenchyal problem
2. Airway dz: thickening of airways
   
   • looks linke tramlines and donuts
3. Interstial pattern
   
   • white noise one

Question 27

Answer 27

• Alveolar pattern

Question 28

Pleural space disease

Answer 28

• Pleural effusion
• Pneumothorax
• Diaphragmatic hernia

Question 29

Radiographs of pleural space disease

Answer 29

• lose ability to see vasculature
• lose ability to see airways
• rounded lungs

Question 30

Answer 30

Pleural space disease

Question 31

Thoracic wall disease

Answer 31

• Neurologic disease
• Muscular disease
• Orthopedic disease

*Harder to recognize, don’t look dyspnic, can’t become orthopnic

Question 32

Tetraparetic dog with inc abdominal effort and open mouth breathing

Answer 32

• Hypoventilating
  
  • get a blood gas to confirm high CO₂ (normal 40, 50 high)
• Then intubate and breath for him
  
  • because of his high CO₂ and respiratory paralysis

Question 33

Labored breathing cat, short in all phases (restricted breathing)

Short and shallow breathing, lung sounds quiet bilaterally

Answer 33

• Tap the chest (can do diagnostic tap)
  
  • pneumo-go higher in chest
  • fluid-go more ventral on chest

Question 34

5 month old male lab mix hit by car

Severe resp distress probs severe pulmonary contusions (diffuse, alveolar pattern)

Answer 34

• Knock him out and intubate him
• Maybe dump him…if lots of fluid/blood in airways
  
  • this may not work when alive b/c of resistance