Stabilizing Respiratory Emergencies Flashcards
What might cause respiratory distress (broad)
1) Cardiac
2) Respiratory
3) Neuromuscular
4) Non-respiratory look alikes
Broadly, respiratory issues can be caused by
1) Upper airway
2) Lower airway
3) Parenchyma
4) Pleural space
What are the objectives of stabilizing respiratory emergencies
1) Execute visual and hands on PE
2) Localize disease from respiratory patterns
3) Understand initial stabilizing steps
4) List indications for intubating
5) Trouble shoot intubation
for respiratory emergencies what is your initial approach
1) Decrease stress and minimize handling
2) PE - to see if in respiratory distress
3) Oxygen supplementation
4) Multimodal sedation
5) Intubate
6) Ventilate
an obstructive pattern is very
slow and deep
a restrictive pattern is very
rapid and shallow (cant expand the lungs)
with laryngeal paralysis is inhalation or exhalation easier
exhalation is easier
inhalation is difficult
cyanosis indicates
severe hypoxia
orthopnea
when the animal’s head and neck is extended.
the animal is putting all their effort into breathing
What should you be looking for in your hands on exam
-HR
-Femoral pulses
-Temp of extremities
-lung fields (crackles, wheezles)
what do crackles mean on respiratory exam
fluid in alveoli
what do wheezes mean on respiratory exam
bronchoconstriction
If you have pleural effusion, you wont hear sounds
ventrally
If you have pneumothorax, you wont hear sounds
dorsally
Why does increasing the resistance lead to longer inspiration
because T = c x R
if you increase R then you are increasing the time it takes
Why do dogs with obstructive pattern take deep slow breathes
because if you increase Resistance then you increase the time
the animal will take a breathe over a longer amount of time
A restrictive pattern is
rapid and shallow
Why is a restrictive pattern rapid and shallow
if lungs cant fill all of the way (ex: 25% of tidal volume) then you need to take rapid breathes
decreasing c
T=CxR then the time for inspiration will decrease
this consumes a lot of O2
What is dyssynchronous breathing
normally diaphragm pushes into the abdomen on breathing, causing it to push outward
however with this the abdomen goes inward
1) Obstructive Disease - not able to get enough air into it
2) Pleural space disease - fluid leads to negative intrathoracic pressure
What are the ways to supplement oxygen
Low flow
1) Flow by
2) oxygen cage
3) face mask
4) Nasal prongs
5) Nasal catheter
High flow
1) CPAP
2) HFNOT
3) Mechanical ventilation
What is the FiO2 of room air
21% or 0.21
What determines the delivery of oxygen
DO2= CO [(1.39 x Hgb x SaO2) + (PaO2 x 0.003) ]
cardiac output, oxygen content in blood, diffused and in hemoglobin
supplying oxygen is to pack hemoglobin with oxygen and diffuse more oxygen into the plasma
What is the sensation of dyspnea
when the input into the higher CNS centers does not match those of the medullary respiratory center, sensory receptors, and respiratory muscles
How can opioid sedation help patients with dyspnea from an airway obstruction
patient has hypoxemia, hypercapnia, and hyperthermia this is collected by sensory receptors and inputed into the medulla. This then increases the work (resp rate and RE) leading to turbulence and edema
Butorphanol aims to dull signs (respiratory centers) to breathe slower and air passes more laminar
It can also dull anxiety, panic, and dyspnea
Benefit of butorphanol for respiratory distress patient *
1) Decreased work (less central processing of dyspnea from respiratory centers of hypercapnia)
2) Decreased turbulence (more laminar flow)
3) Decreased edema
4) Mild anxiolytic
What is dose of butorphanol for respiratory distress
0.1 - 0.4 mg/kg IV
-cough suppressant
-respiratory depressant
What drug can be given as an anxiolytic for respiratory distress
Acepromazine (better anxiolytic than butorphanol)
but make sure they can handle it cardiovascularly
-casues vasodilation (a1 blockade)
-can help cool a dog
Dose: 0.05-0.1 mg/kg IV
What is a major downside to giving acepromazine for anxiolysis
Vasodilation
a1 blockade
can also cool and animal which is good for respiratory distress patients
What are the indications for intubation
1) Upper airway obstruction *
2) Unprotected airway - to prevent aspiration
3) Hypoventiliation
4) Respiratory fatigue
5) Respiratory failure
What is needed to intubate an animal
1) IV access - IV, IO, IV injection (yikes)
2) Ready drugs for sedation (math)
3) Supplies
4) Rapid induction
if you dont have time for this then do Cricothrotomy
What do you do in respiratory distress patients where there is not enough time to prep for intubation
Cricothrotomy
How should you sedate an 8yr old MC lab with laryngeal paralysis that is vigorous
Can use Ace, Butorphanol, Propofol
How should you sedate a 6 year old MC Dalmation with megaesophagus and 3 days of progressive cough, dyspnea, pyrexia
Give opioid, ketamine, and midazolam
*propofol is a bit more risky
How should you sedate a 14 yo FS Shih Tzu with 1.5 year history of left CHF with marked dyspnea, cyanosis, and orthopnea
Fentanyl and/or Midazolam
How can you intubate a patient really quickly
1) Suction or swab
2) Laryngoscope
3) Stylette - straightens tube and can hold of arytenoids
4) Smaller tubes
if no then cric or trach
After intubating what monitoring equipment should you use
-EKG
-End Tidal CO2 and SpO2
-Blood Pressure
What should you give a sedated patient for respiratory distress to keep them sedated for a surgical procedure
-Give whatever you used to induce, can be:
1) Fentanyl: 5mcg/kg IV bolus followed by 5mcg/kg/hr CRI
2) Midazolam: 0.5mg/kg IV bolus followed by 0.5mg/kg/hr CRI
Where do you cut for a cricothyroidotomy
feel for notch between tracheal cartilage and the cricoid cartilage
go through the cricothyroid membrane
(first ridge)
What are the pros of circothyroidotomy
1) patient stays in sternal
2) No sedation required
3) 30 second procedure
4) Simple technique
5) Easy landmarks
6) dogs or cats
What are the cons of a cricothyroidotomy
not ideal for working dogs
