Respiratory Module 3 Flashcards
What is pulse oximetry used for and how does it work
Used to measure SpO2
Measures the percentage of Hb saturation
- Works by emitting 2 wavelenght of light (red and infrared) from on side of the detector to the other
-Oxyhaem absorbs infrared light and deoxy absorbs more red light
Why must the pulse oximeter have a plethesmograph
All tissues measure light and the probe differentiates the light absorption via the pulsatile flow of blood. If not present can not tell if reading is accurate
What are 5 causes of false results on the pulse oximeter
- movement
- dark skin
- fur
-ambient light
-anything that decreases blood flow: hypothermia, hypotension
What is capnography used for?
Capnography measures the end-tidal CO2
What 3 things affect the CO2 exhaled?
Amount of CO2 produced by respiring tissue, cardiac output, alveolar ventilation
What is the best view for assessing for aspiration pneumonia
Left lateral view as the right bronchus runs almost directly in to the right middle lube lobe and this is most likely to be affected
What are views of the TFAST
Chest tube site bilateral
Pericardial site bilateral
Diaphragmatic site bilateral
What is a DDX for inspiratory effort?
URT obstruction
What are some DDX for expiratory effort
Pulmonary/small airway disease
- pneumonia
-asthma
What are some DDX for a mixed respiratory effort
chest wall D
pleural space D
pulmonary D
What are the 3 respiratory effort that can present
Expiratory, inspiratory and mixed
What are three respiratory patterns
Restrictive, obstructive and mixed
How will an obstructive respiratory pattern present and what are DDX
Rapid, shallow breathing
Severe pulmonary or pleural disease
How will restrictive pattern present and what are DDX
Slow, deep, deliberate effort on inspiration (URT obstruction) or expiration (LA problem)
What are 4 invasive ways of providing oxygen
Intubation
Naso-phayngeal catheter
Transtracheal O2
Nasal Prongs/High Flow O2
-mechanical ventilation
What are 3 non-invasive ways of providing oxygen
Mask
Oxygen tent
Flow by
CPAP
What are 3 methods to sample the airway
- Transtracheal wash
- Blind BAL
- Guided BAL
What are 3 ways to diagnose a pneumothorax on US
- Loss of glide sign
- Lung point
- M-mode: Barcode sign
What is the glide sign and how is it visualised on a scanner
Visualised as a hyperechoic line moving back and forth. Represents the visceral pluera moving against the chest wall during breathing
- decrease gain to see easier and tilt probe to hit it at an angle
What is lung point and how is it diagnosed
Lung point is the area where normal lung comes back in to view. This is found by sliding the probe dorsal to ventral till the lung comes back
- move in time with patients breathing
What are b-lines
Hyperechoic lines originating from the pleural line and extending all the way through the field
- does not fade
- will efface A-lines
- caused by fluid trapped between lung and probe
Priorities when treating a patient with upper respiratory tract obstruction
- Sedative to calm
- O2 provision
- Active cooling
- GA to intubate - if desaturating + inflammation
- If edematous: dexamethasone 0.1-0.2mg/kg
- Tracheostomy
Causes of laryngeal paralysis
- congenital recurrent laryngeal neuropathy
- iatrogenic damage
- Myasthenia gravis
- Hypothyroidism
- Peripheral neuropathy
What is the cause of tracheal collapse
Progressive degenerative disease of the tracheal cartilage
-Loss of glycosaminoglycan, chondroitin, Ca2+ leading to loss of rigidity of cartilage and flaccidity of dorsal tracheal membrane
- collapse during inspiration
What are common sequele of tracheal injuries and how can they present
pneumomediastinum/tension pneumothorax
common in cats with blunt trauma, endotracheal cuffing, RTA (acceleration-deceleration injury as carina fixed in cats)
How is allergic airway disease differentiated
predominance of eosinophils in mucosa/submucosa
- cats can have 20-30% population of eosinophils normally
Explain emergency management of animal presenting with allergic airway disease
- Oxygen
- Steroids - dexamethasone 0.2-0.5mg/kg IV/IM
- Bronchodilator: terbutaline (beta-agonist) or salbutamol/albuterol
- TPOCUS - rule out pneumothorax, CHF
- Radiography v. CT + BAL
Long term management of dogs with allergic airway disease
- Steroids for 2 weeks orally
- Aerodawg
- fenbendazole - if no improving
- if infection: 2-3 weeks doxy
-not anti-tussives: secretions need to be expectorated - pneumonia
What is primary dyskinesia
Inherited disease affecting microtubule formation in cilia - affects the resp tract, auditory canal, urogenital system (weird sperm)
- young dog with a cough, pnuemonia, exercise intolerance
What would be considered hyperthermia in need of active cooling + how to actively cool
At 41.6C - more O2 is consumed than absorbed
Active cooling
- Clipping fur on thorax/abdo
- Lukewarm water to skin (paddling pools)
- Fans on patients
- Cold isotonic fluid IV
- Crystalloid bladder lavage, gastric lavage, enema
- Discontinue when 39.5 readed
Things that make up BOAS
- Stenotic nares
- Hypoplastic trachea
- Nasopharyngeal stenosis
- Elongated soft palate
- Everted laryngeal saccules
- Laryngeal collapse
- Tonsillar eversion
- Tracheal collapse
- Hiatal hernias
What is the medical management of BOAS prior to surgery?
- Weight control - pickwickian syndrome
- Harness walks
- Minimise stress
- Cool environment
- Omeprazole of GI signs
What are the surgical options for BOAS
- Soft palate resection
- Resection of everted saccules
- Partial tonsillectomy
- Nasal vestibuloplasty - widen the nasal vestibule,
both external and internal nares relieved - Laser assisted turbinectomy
- Folded flap palatoplasty
- Partial cuniformectomy (grade 2-3 LP collapse)
