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EBCM Lab > Respiratory Exam Lectures > Flashcards

Respiratory Exam Lectures Flashcards

1
Q

What should be a part of your equine respiratory exam?

A

RR - eupnea = 8-16bpm adult, 20-24bpm foal
Check I:E ratio (Inspiratory shorter than expiratory)
Listen to lungs (3-4 locations), trachea, larynx
Check Sinuses

HX - sign, medical, clinical sign, duration, other therapy, new horses, change in diet or feed, desired activity level
PE: Visual - BCS, RR and effort, heave line, lymph node, larynx and trachea, nares and oral cavity odor, auditory
Assess the environment - dusty, hay, bedding, storage
Overall condition
Very thorough exam

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2
Q

What is the point of including a rebreathing bag in your exam?

A

Increase sensitivity of auscultation
Pulmonary function test

-Increases respiratory depth and rate

Don’t perform if very compromised

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3
Q

What kind of respiratory sounds should you be listening for?

A

Vesicular, bronchial
Crackles, Wheezes, Rales

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4
Q

When placing a rebreathing bag, what are some good practices?

A

Make sure the nostrils are not restricted/occluded, use a basket muzzle to prevent it getting sucked up into the nose

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5
Q

What is the lung field of a horse?

A

Just in front of the shoulder, down to the point of elbow, meeting up at the tuber coxae

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6
Q

Where should you percuss a horse?

A

Sinuses
Chest (ultrasound replaces it)

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7
Q

What ancillary tests may help your diagnosis?

A

CBC - if infection suspected - increase WBC, fibrinogen, SAA
Endoscopy
Transtracheal Aspirate
Bronchoalveolar Lavage
Ultrasonography
Radiology
Thoracocentesis

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8
Q

What is an indication to perform an exam before and after exercise?

A

Abnormal resp sounds
-Laryngeal hemiplegia, DDSP, epiglotic entrapment, subepiglottic cyst

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9
Q

What are some indications for guttural pouch endoscopy?

A

Nasal discharge, pharyngeal swelling, facial nerve paralysis, dysphagia

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10
Q

What are some indications for Dynamic Endoscopy?

A

-Normal upper airway during resting endoscopy, noise when exercising
-Abnormal upper airway during resting want to see move
-Poor performance with or without noise

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11
Q

What kind of samples can you submit from a transtracheal aspirate?

A

Cytology, culture and sensitivity

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12
Q

How do you perform a TTW with endoscope?

A

Need: sedation, endoscope, triple lumen guarded catheter, sterile saline (3x60cc), collection container

-Sedate
-Pass endoscope (to thoracic inlet)
-Guarded part advanced and sterile saline inserted (in then aspirate back)

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13
Q

How do you perform BAL?

A
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14
Q

What is BAL useful for?

A

Recovering sample from small airways and alveolar cells
-Asses lower airway inflammation

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15
Q

What is the normal population of cells in a BAL or TTW?

A

Mononuclear, macrophages and lymphocytes

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16
Q

What indicates active inflammation?

A

More than 5% neutrophils, 2% eosinophils and mast cells

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17
Q

When should you ultrasound a horse?

A

Abnormal auscultation, percussion, fluid, intrathoracic, abscesses/masses and pulmonary consolidation

18
Q

When should radiographs be performed in respiratory cases?

A

Prior to invasive procedures/endoscopy

19
Q

When is thoracocentesis indicated?

A

pleural fluid on rads and ultrasound

20
Q

What is the normal respiration rate for equine?

A

8-14bpm

21
Q

What should be part of your respiratory PE?

A

Check the larynx, trachea, left and right side lungs ( 3-4 spots), percuss the sinus and chest

22
Q

What drugs can be used to reduce cough?

A

Lidocaine and butorphanol

23
Q

How do you perform an endoscopy exam and what do you see?

A

Pass the scope through the ventral nasal meatus, once in the pharynx look at the larynx (see the arytenoid cartilages, aryepiglottic folds, epiglottis, vocal folds, ventricles) and then proceed into the trachea, then come back, look at the pharyngeal recess, the pharyngeal ostium (into guttural pouch if needed (medial and lateral (external in lateral where mycosis occurs)), then look up to ethmoids and lateral to that is the sinus drainage angle, as you are exiting investigate the dorsal and ventral conchae.

24
Q

What equipment is needed for a TTW?

A

Endoscope
Triple Lumen Kit
30-50cc sterile saline (in 60cc syringe)
Sterile container or red top tube
Fridge

25
Q

How do you perform a TTW?

A
  1. Pass endoscope through ventral meatus, larynx and into trachea
  2. Pass 1/3-1/2 down trachea and hold in place
  3. Then push catheter forward middle then inner into lacuna
  4. Inject saline in and pull back
  5. Hope to get at least 5 ml back
  6. Remove triple and continue exam
26
Q

What diagnostics can you run on TTW?

A

Cytology, gram stain, PCR, Culture and Sensitivity

27
Q

What equipment is needed for a BAL?

A

BAL tubing with foley catheter
12cc air syringe
KY Jelly
5 x 60cc syringe with sterile saline
1 x 60 cc syringe (40ml saline, 10-15ml lidocaine)
Sterile container
Funixin?

28
Q

How do you perform a BAL?

A
  1. Sedate
  2. Open BAL tube and test foley catheter (see how much air to fill it)
  3. Place KY Jelly on tube
  4. Pass through ventral meatus and hold head up to get through trachea
  5. once in trachea inject the 1 syringe with lidocaine
  6. then push tube in as far as it will go
  7. Inflate the foley catheter
  8. inject 2 syringe sterile staline and draw back
  9. do the same with next 2
  10. use empty to pull back rest (gentle no hematoma)
  11. place sample in container and fridge
  12. deflate foley and remove tube
29
Q

What diagnostics can you perform on BAL?

A

Cytology, gram stain, PCR

30
Q

What kind of probe do you need for thoracic ultrasound?

A

5-10 MHZ

31
Q

How do you know a horse has pleural effusion on ultrasound?

A

There is a space visible between the parietal pleura (doesnt move) and visceral pleura (moves). (Should oppose each other)

32
Q

Is it normal to see the tissue character of the lung?

A

Consolidated or collapsed lung, abscess or a tumor

33
Q

What is thoracocentesis?

A

Aspiration of fluid from the thoracic cavity - diagnostic and therapeutic

34
Q

What supplies do you need for a thoracocentesis?

A

Clippers, sterile scrub, local anesthesia, 5ml syringe and 25G needle, 5/8 inch, sterile scapple blade (12) and handle, sterile teat cannula, urinary catheter 10.5inch, blunt tip, 3-way stopcock and extension set, 60ml syringe and non-absorbable suture

35
Q

How do you choose your site for thoracocentesis?

A

Ultrasound guided- lower 1/3 thorax between 7th and 8th intercostal space
(both side cause intact mediastinum)

36
Q

Which side of the rib should you make a stab incision on to avoid intercostal vessels and nerves?

A

Cranial, nerves are on the caudal side

37
Q

Why do you need a stopcock?

A

To prevent air from entering when fluid not coming out

38
Q

What are all the possible trephine locations?

A

Frontal (Left and right)
Caudal Maxillary
Rostral Maxillary

39
Q

What are the landmarks for the above trephine hole?

A

Frontal: 60% distance from midline to medial canthus of eye, 0.5cm caudal to medial canthus

Caudal Maxillary: 2cm rostral and 2cm ventral to medial canthus

Rostral Maxillary: 40% distance from rostral end of facial crest to the level of medial canthus and 1cm ventral to line joining infraorbital foramen and medial canthus

40
Q

What are the steps to making a trephine hole?

A

-Sedate well
-Clip and aseptically prepare patient for surgery
-Local anesthesia - supraorbital nerve block, SC line block
-Make U shaped incision with scaple blade that’s just wider than your site
-Use metzenbaum scissors and tissue forceps to elevate skin to see bone
-Use glat trephine by twisting into bone (1/4 turn) - keep even pressure
-When cracked through pull out with forceps

41
Q

What separates the rostral and ventral sinus from the others?

A

Ventral conchal bulla

42
Q

What is sinoscopy?

A

Putting the endoscope through the trephine to ID structures

EBCM Lab (4 decks)

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