The respiratory distress patient Flashcards by Laura Westman

Key phrases on the phone regarding respiratory distress.

Heavy breathing
* Cat : panting; breathes mouth open, hyperventilating.
* Dog: does not want to lie down, breathes with whole body, gagging.

Collapse
* Fainting, unconscious, collapse
* Tongue is blue, unwilling to walk

Cough
* Coughing and choking, coughs pink foam, coughs with whole body

Cat: hindleg paralysis/paresis (FATE)
Enlargement of abdomen (ascites etc.)

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Minimum preparation for a respiratory distress case. (7)

At least two people: doctor and nurse

Oxygen!

Emergency drugs: sedation, diuretics (butorphanol, furosemide etc.)

Intubation equipment

IV catheter placement

Primary diagnostics (e.g. TFAST)

Specific equipment for procedures (thoracocentesis; tracheostomy)

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1 cause of resp. distress in cats

cardiac disease with pleural effusion

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infectious diseases that can cause resp. disease in dogs (4)

kennel cough (complex)
angiostrongylus vasorum
crenosoma vulpis
leptospirosis

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irish wolf hounds are predisposed to what disease that can result in resp. distress? (2)

DCM
&
immune mediated ciliary deficiency / ciliary dyskinesia

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describe immune mediated ciliary deficiency / ciliary dyskinesia / Rhinitis/Bronchopneumonia Syndrome

a rare congenital defect where the ciliary throughout the body do not function properly.

This can cause respiratory issues such as coughing, nasal congestion and exercise intolerance.

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westies are predisposed to what disease that can result in resp. distress? (1)

Canine idiopathic pulmonary fibrosis (CIPF)

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huskies & malamutes are predisposed to what disease that can result in resp. distress? (1)

spontaneous pneumothorax due to congenital air bullae in the lungs

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describe CIPF in westies

Canine idiopathic pulmonary fibrosis (CIPF) affects middle-aged to older dogs of a single breed, mainly the West Highland white terrier (WHWT), which is suggestive of a genetic predisposition.

CIPF causes exercise intolerance, restrictive dyspnea and coughing. Coarse crackles are heard on thoracic auscultation.

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Clinical exam of resp. distress patient, first 3 points. (3)

Observe from a distance
Auscultation
Temperature (infectious, heat stress, shock etc.)

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Upper airway obstructive diseases in dogs (6)

Laryngeal paralysis (labradors, malamutes, St. Bernhards etc., onset 1 y/o)
Tracheal collapse
Brachiocephalic syndrome
Polyps
Foreign bodies
Neoplasia

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Describe laryngeal paralysis in dogs.

Voice change, honking, coughing etc. Commonly onset 1 y/o.

Secondary innervation issues to esophagus resulting in megaesophagus.

But can also be geriatric onset in Labradors (geriatric onset laryngeal paralysis and polyneuropathy (GOLPP)).

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Airway polyps more common in

cats (originate from inner ear and infiltrate)

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Most common lower airway obstructive diseases in cats. (2)

Asthma from allergic-cause
* Siamese and Burmese especially
* Coughing cat
* Risk for secondary pneumothorax

Chronic bronchitis (diagnosis of exclusion, challenging, more commonly used in dogs)

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Aspiration pneumonia most commonly caused by (2)

Anaesthesia
Megaoesaphagus

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Most common causes of Lung edema (2 + 4)

Cardiogenic

Non-cardiogenic
* Neurogenic (seizures, head trauma,
electrocution)

Post-obstructive (choking, laryngeal
paralysis)
Due to systemic disease (sepsis,
shock)
Primary lung damage (pneumonia,
lung torsion, smoke inhalation)

Characterize the Pleural effusions dogs are more likely to experience (5)

pyothorax,
chylothorax,

cardiac insufficiency,

neoplasia,
diaphragmatic hernia

Characterize the Pleural effusions cats are more likely to experience (6)

cardiac insufficiency,
systemic disease,

neoplasia,
FIP,

chylothorax,
diaphragmatic hernia

6 points to consider with respiratory distress Trauma patient

Pain & Analgesia!

Lung contusion
Lung hemorrhage

Damage to the chest

Tracheal injury
Pneumothorax

What complication can tracheal injury cause even years later?

laryngeal paralysis

If you see the above in a non-typical breed, inquire whether there was tracheal injury in the dog’s history.

Pathologies that can mimic/cause resp. distress.

electrolyte abnormality: hypokalemia, hypoglycemia, hypocalcemia

endocrinological: hyperadrenocorticism-pulmonary thromboembolism, hyperthyroidism

systemic dz

neuro: acute polyradiculoneuritis, myasthenia gravis, tick borne paralysis

describe acute polyradiculoneuritis

Idiopathic Acute Polyradiculoneuritis (Coonhound Paralysis)

Acute polyradiculoneuritis produces acute flaccid quadriparesis or quadriplegia in any breed of dog or cat.

In dogs, the condition was originally called “Coonhound paralysis” as it was first described in Coonhounds 7–10 days after exposure to an antigen in raccoon saliva.

The inciting cause is often unknown although recent vaccination or illness can be documented in some cases.

describe tick borne paralysis

Tick paralysis (also known as tick toxicosis) is an acute, progressive, symmetrical, ascending motor paralysis due to salivary neurotoxins produced by certain species of ticks.

With some species, other clinical signs of systemic “single-organ” toxicity (eg, cardiac, airway, bladder, lung, esophagus, etc) may be observed separate from or within the typical paretic-paralysis presentation.

Very severe cases require intensive care, including artificial ventilation.

Analgesia and sedation for resp. distress cases.

Butorphanol: 0.1-0.4mg/kg (0.2mg/kg) IM/IV/SC

Midazolam: 0.1-0.3mg/kg (0.1mg/kg) IM/IV/SC

Others:
* Acepromazine (good for brachys, takes time for onset)
* A2-agonists (might need intubation)
* Ketamine
* Propofol (might need intubation)

Main 2 inhalatory drugs for resp. distress.

Bronchodilator: Salbutamol (albuterol sulfate): Ventonil product Steroid: Fluticasone (Flixotide inhaler)

Describe Salbutamol (albuterol sulfate) use

Product Ventonil 100μg/dose * Bronchodilator * Cat/dog: one puff q30min up to 4-6h * Used in acute cases Animal needs to breathe in and out 5-10 times before removal of mask.

Describe Fluticasone use.

Flixotide inhaler 50μg/dose * Inhaled glucocorticoid * Cats one puff q12 * Dogs 2-4 puffs q12 Needs time to work; systemic hormone treatment. Needs a bronchodilator before steroid administration, otherwise the steroid can't reach deep enough into the airways where its needed.

Indications for Furosemide? (2) Doses?

* Cardiogenic lung edema * Cardiogenic pulmonary edema * 1-4 (up to 8) mg/kg IM/IV * Max dose 12mg/kg/q24 * CRI 0,66-1mg/kg/h Take bloodwork before 1st admin. of furosemide as it can cause hypokalemia.

Why shouldn't use give NSAIDS to a heat stress case of resp distress?

can cause severe kidney damage if you administer NSAIDS to hyperthermic patient + GI ulceration and severe GI upset

Explain the gator sign in tFAST.

The "gator sign" is a specific sonographic finding observed in the tFAST examination, which is used to evaluate patients for conditions such as pneumothorax or pleural effusion following trauma. The "gator sign" is seen in a normal lung, where the pleura is intact and smoothly sliding with respiration. The gator sign typically rules out pneumothorax in that region. This sign contrasts with abnormal findings, such as the barcode or stratosphere sign, which are indicative of conditions like pneumothorax where the lung and pleural layers are separated. You can't view it on a still as its a movement to be observed.

Explain: Dry vs wet lung

the terms dry lung (normal air content) and wet lung (excess fluid) refer to different sonographic patterns observed in the lung parenchyma, often related to the presence or absence of fluid in the lungs. In a dry lung, the ultrasound typically shows a clear pleural line with A-lines, which are horizontal, regularly spaced lines that are reverberation artifacts. These A-lines indicate air-filled lungs. "wet lung" Ultrasound Appearance, B-lines are observed. These are vertical, laser-like, comet-tail artifacts that arise from the pleural line and extend all the way to the bottom of the ultrasound screen. B-lines move with respiration and represent the presence of fluid in the lung. An occasional B-line is considered normal; excessive B-lines are indicative of interstitial-alveolar lung abnormality.

Xray in resp. distress patients.

Only when patient is stable! Exclude easy things * Pleural effusion * Pneumothorax * Ribcage * Hernias * Etc. In case of trauma, xray multiple places.

identify

pleural effusion In this case, you could do tFAST first instead of xray. Take fluid off the lungs and only then xray. Removing the fluid could allow other structures to come into view in the xray (e.g. neoplasia).

identify

pneumothorax cardiac tip and sternum should not have space between

Hematology in resp. distress patients.

Hematology * Leucocytosis and left shift (Infectious) Peripheral eosinophilia * Eosinophilic bronchopneumonia, parasites, fungal (blasto) Thrombocytopenia * Hemorrhage

Biochemistry in resp. distress patients.

T4 Electrolytes; GLU, K, Ca Hypoalbuminemia (can cause pleural effusion, lung edema and ascites) Coagulation factors

In clinic snap-tests useful for resp. distress cases. (6)

* proBNP (espesh cats) * FIV/FeLV * FIP snap in some countries * AngioDetect: Angiostrongylus vasorum * IDEXX 4Dx: Dirofilaria immitis * lepto snap test (insome cases lepto can cause resp signs)