Please enable JavaScript.
Coggle requires JavaScript to display documents.
Resp DISTRESS - Coggle Diagram
Resp DISTRESS
Patterns
INSP distress, externally audible noise
1. URT Obstruction
What
Pharynx: polyp, mass, FB, hematoma
Larynx: paralysis, collapse
Trachea (extrathoracic): collapse, FB, stenosis, stricture, tear, mass
-
Next Steps
-
Initial Tx
Sedation, anxiolytics (aceprozamine, butorphanol etc)
-
-
-
LAST RESORT: secure airway (ototracheal, tracheostomy. note: makes it hard to see during Sx
When Stable
URT examination (laryngoscopy, tracheostomy)
Cervical and thoracic radiographs: mass, tracheal collapse?
-
-
EXP distress, wheeze
- LRT Obstruction (struggle to get air out)
-
Next Steps
Hx/Sx
Feline Asthma: cough, siamese breed, young
CHronic bronchitis= cough, old small breed dog
-
When Stable
-
-
-
-
-
Tx: corticosteroids, bronchodilators, deworming with fenbendazole-cats
Insp/ exp distress, rapid shallow breathing
What
Dz of terminal and resp bronchioles, interstitium, alveoli and vasculature
-
-
Interstitial lung Dz: pulmonary fibrosis, EBP
-
-
Next Step
PE: wheezes, crackles, murmur-CHF/arrhythmia-Gallop
-
When Stable
-
-
CYtology (TTW, BAL, FNA +/- culture)
-
Tx for specific Dz
Cardiogenic: furosemide, etc
Microbial pneumonia- antimicrobials, supportive care
-
-
Insp, paradoxical, rapid shallow
4. Pleural space Dz
What
-
Fluid: pleural effusion, water/pus, chyle/blood
-
-
-
Next Step
PE: insp distress without stridor
OR rapid shallow breathing
OR generalised paradoxical breathing
OR decreased sounds on auscultation
-
-
Nothing specific
- Pulmonary Thromboembolism (PTE)
What= obstruction of BF in pulmonary vasculature from a thrombus in the systemic venous system/ right heart
-
-
E.g. Pain, acidosis, severe anaemia, hyperthermia, drugs, hypotension
-
Tx: O2 DOESNT RESOLVE GENERALLY, Tx underlying
-
Insp with large abdomen
Impeded thoracic expansion during insp, resp condition not usually dire
Ddx
ascites, gastric dilation, hepatosplenomegaly, abdominal masses, preg.
Dx
visually obvious, palpation and imaging (know aetiology)
Tx
O2 therapy, abdominocentesis if fluid, address underlying
Ways of giving Oxygen
Indications
Decreased O2 delivery
-
Hypoventilation (SpO2 <95%, PaO2 <80mmHg)
PE: abnormal perfusion parameters, pale/cyanotic mm, dyspnoea
-
Flowby
+ve: well tolerated, easy access
-ve: wasteful of O2, short term, labour intensive
Facemask
-ve: if tight fitting= Co2 rebreathing, not tolerated if awake, labour, hyperthermia
+ve: high FiO2, easy administration and patient access
O2 Hood
+ve: well tolerated, economical, min equiptment
-ve: CO2 accumulation- need vent, hyperthermia, condensation= cant see
O2 Cage
+ve: tight control, temp and humidity control ($$$)
-ve: CO2 accumulation (need soda lime), $$$, no direct patient access
Nasal prongs/catheter
+ve: well tolerated, allow patient access
-ve: irritating- sneezing etc, sedation to place, LA to reduce irritation
Transtracheal
+ve: higher FiO2, CPAP, bypass URT obstruction, useful during tracheobronchoscopy, easy to maintain if immobile patient, easy pattient access
-ve: labour intensive, high skill, need sedation/ Sx to place, Easy to dislodge/kink, SQ emphysems, DONT USE in coagulopathy
-
-
Mechanical ventilation
Indications
- Severe Hypoxaemia
despite oxygen supp.
-
-
- Increased work of breathing
despite sustained resp distress
-
-
-
Dx Options
Assess oxygenation: SpO2, BG
Screening blood test: NOT specific but good ie pneumonia
Upper airway examination
Lower airway examination: tracheobronchoscopy
Imaging: thoracic radiographs, CT
Airway sampling: TW/BAL for C&c)
Drug Trials ie frusemide, bronchodilators
