The Dyspnoeic Patient

Question 1

Upper Airway Definition

Answer 1

• Mouth
• Nares
• Larynx

Question 2

Lower Airway Definition

Answer 2

• Trachea

- Lungs

Question 3

Dyspnoea

Answer 3

• Common clinical presentation in patients with respiratory disease
• Implies a significant degree of respiratory impairment

Question 4

Upper Airway Common Causes

Answer 4

• Brachycephalic airway syndrome
• Extended soft palate
• Laryngeal paralysis
• Foreign body

Question 5

Lower Airway Common Causes

Answer 5

• Tracheal collapse
• Hypoplastic trachea
• Foreign body
• Pulmonary Oedema
• Bronchopneumonia
• Pulmonary fibrosis
• Pulmonary haemorrhage
• Pulmonary neoplasia
• Feline asthma syndrome

Question 6

Chest Common Causes

Answer 6

• Pleural space/chest wall disease
• Pleural effusion
• Trauma
• Pneumothorax
• Paralysis

Question 7

Approach to the Dyspnoeic Dog - Clinical Presentation

Answer 7

• Minimise stress

- O2 therapy

Question 8

Approach to the Dyspnoeic Dog - General Clinical Signs

Answer 8

• Increased RR (tachypnoea)
• Mild to severe respiratory effort
• Tachycardia (sometimes bradycardia)
• Cyanosis or muddy MM (sometimes injected if hyperthermic)
• Hypoxaemia (SPO2 <50%)

Question 9

Stabilisation and Initial Treatment of the Dyspnoeic Dog

Answer 9

• Sedation (butorphanol, acepromazine - CARE)
• O2
• Securing airway if upper airway obstruction or compromised airway
• ICV
• Diurectics in cardiac patients
• TPR (focus on RR and effort, HR, MM and SPO2)
• Respiratory sounds to determine if upper/lower/cardiac origin
• Active cooling with caution if hyperthermic

Question 10

Common Clinical Signs of Dyspnoea - Upper Airway

Answer 10

• Inspiratory stridor
• Exercise intolerance
• Noisy respiration
• Vocal changes
• Cyanosis
• Coughing
• Wheezing
• Hacking
• Honking

Question 11

Common Clinical Signs of Dyspnoea - Lower Airway

Answer 11

• Thoracic pain
• Coughing (often wet)
• Cyanosis
• Wheezing
• Harsh lung sounds
• Heart murmur (if cardiac disease in origin)

Question 12

Common Clinical Signs of Dyspnoea - Chest

Answer 12

• Cyanosis
• Unable to auscultate heart beat
• Dull/absent lung sounds
• Restrictive breathing

Question 13

Ongoing Care for Dyspnoeic Dog

Answer 13

• Finding cause via diagnostics
• Ongoing O2 if required
• Minimise stress +/- sedation
• Avoiding overheating
• Close monitoring

Question 14

Approach to the Dyspnoeic Cat

Answer 14

• More susceptible to stress
• Risk vs benefit
• O2 and sedation, intubation and ventilation if required but O2 cages often effective
• IVC and life saving medications
• Brief to full exam
• Diagnostics (likely to require staging)
• Other tasks when stable
• Avoid suctioning if frothing at mouth/drooling (often associated with stress, doing so could cause laryngospasm or stress causing respiratory arrest)