Respiratory Module 4 Flashcards
Two mechanisms of pulmonary edema
- High pressure edema: CHF, volume overload
- Increased permeability edema: any disease process that damages the capsular endothelium or alveolar epithelium - increases vascular permeability within the lungs
Management of cardiogenic pulmonary edema
- Frusemide 2-3mg/kg IV or IM
- pink froth: 4-6mg/kg
-repeat q30mins - 10-30mins to see effects
How does frusemide work to reduce PE
Clears PE by reducing blood volume and reduction in pulmonary capillary pressure
- works directly by affecting pulmonary vascular effects and bronchodilatory effects
What are 4 non-invasive ways of delivering oxygen therapy?
- Oxygen tents
- Oxygen mask - FiO2 35% if loose, 50-60% if tight, tightfitting
- Flow by - 25-40%
- CPAP (continuous positive airway pressure) - need heavy sedation required, poorly tolerated
What are 5 invasive ways of delivery oxygen therapy?
- Intubation
- Transtracheal O2 40-60%
- Nasal prong/High flow O2 25-50%
- Nasal catheters 40-70% - jet lesions
- Naso-pharyngeal catheter - BOAS (deeper in phayrnx
How to preform a thoracocentesis?
- O2 therapy flow by
- Clip both sides of chest and sterile prep
- Mild sedation: Butorphanol/Midaz + ketamine
- Ideally 3 people, to hold, to hold needle and one
for syringe - Location: 8/9th rib intercostal space (ventral 1/3 fluid, dorsal 1/3 air)
- Lidocaine LA - 1mg/kg both sides cats/dogs
What are the chest drain techniques?
- Seldinger
- Over the wire
- Narrow bore drains
- GA or sedation
- Better tolerated
- Less traumatic
- Can be used for pyothorax
- Trochar Drain
- GA only
- Must be tunnelled
- Forceps insertion
- GA only
- Must be tunnelled
How to place a seldinger chest drain?
- Measure from tip of axilla (2nd rib) to 8th/9th
intercostal space - Infiltrate LA
- Measure a releasing incision with number 11
blade - Advance a large catheter (14g) perpendicular in to
the chest - Turn catheter toward ipsilateral elbow and
remove stylet - thumb over the top - Slide in the guide wire to the marked amount
(hold on to the whole time) - Remove catheter over the wire
- Slide on the drain, twisting motions, remove
guide-wire and place thumb over the top - Thumb over the end after removal of the guide
wire or clamp - Sutures through wings of butterfly and then
neck of drain - Orthogonal views of x-rays
What are options for relieving a complete obstruction?
- Needle Tracheostomy
- Clip a patch over ventral neck
- Large bore needle inserted between tracheal
rings - IV catheter
- Cricothyroid ligamnet - easier to palpate, distal to
adams apple
- Attach O2 - Surgical Tracheostomy
- 2-5cm midline incision extending caudally from
cricoid cartilage
- Use retractors to see field, dont dissect lateral to
tracheal as recurrently laryngeal nerve is there
- Identify the midline raphe between the
sternohyoid muscles (white line)
- Blunt dissection through raphe then dissect
muscle bellies to trachea
- Loop sutures through 3-4 or 4-5th ring and label
up/down
- Incise through annular liagment - NEVER more
than 50% circumference
- Place in tracheostomy tube
- Connect to O to and get tape one
- Close skin around incision
- Heat and moisture exchanger
What are causes of non-cardiogenic pulmonary edema?
Broad category of increased permeability edema - inflammatory diseases
- Neurogenic PE: seizures, head trauma,
electrocution - Negative PE: dry drowning,
strangulation, sudden/sharp tug on lead - Aspiration pneumonitis/pneumonia
- Vaculitis
- ARDs
- Pneumonia
- Re-expansion PE
- Drowning Injury
- PTE
- Smoke inhalation
What are predisposing factors to aspiration?
- LP
- Megaoesophagus
- V+
- Regurgitation
- Sedation/GA
- Delayed gastric emptying
- Gastric intubation
- Seizures
What causes aspiration pneumonitis?
This is inflammation of the lung secondary to inhaling a chemical irritant - may or may not progress to pneumonia
- persists up to 48hrs, vascular permeability occurs 1-2 hours after incident
Treatment of aspiration pnuemonitis?
- Oxygen
- Nebulisation
- Light exercise - to promote expectorisation
- Mucolytic - n-acetyl
If progresses to pneumonia
- E.coli most common - 20mg/kg IV q8hrs
- Doxy if puppies
What causes ARDs and how is it diagnosed clinically?
ARDs is a syndrome that is usually a life threatening complication of critical illness - massive inflammatory process leading to alveolar damage characterised by protein rich inflammatory edema within the alveoli followed by fibrotic changes
- pulmonary or extra-pulmonary causes
Diagnostic criteria
1. Acute onset dyspnoea <72hrs
2. Pre-existing severe acute clinical illness
3. Bilateral pulmonary infiltrates
4. Severe hypoxaemia on room air or PaO2
<45mmHg, SPO2 <85%, A-a gradient >50
5. No heart disease
What are causes of PTE?
- Immune mediated disease
- Sepsis
- Trauma
- Neoplasia
- Pancreatitis
- Surgery
- DIC
- Endocarditis
- Myocardial diseases
- FIP
