Resp DISTRESS

Patterns

Ways of giving Oxygen

Mechanical ventilation

How to Stabilise

Buy yourself some time

Sedation/ anxiolytics

Intubate +/- ventilate

INSP distress, externally audible noise

1. URT Obstruction

EXP distress, wheeze

  1. LRT Obstruction (struggle to get air out)

Insp/ exp distress, rapid shallow breathing

  1. Pulmonary parenchymal dz

Insp, paradoxical, rapid shallow

4. Pleural space Dz

Nothing specific

  1. Pulmonary Thromboembolism (PTE)
  1. Look-a-like Dz

Focal paradoxical movement of chest

  1. Flail Chest

Insp with large abdomen

  1. Abdominal Distention

Supplement O2

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

What

Pharynx: polyp, mass, FB, hematoma

Larynx: paralysis, collapse

Trachea (extrathoracic): collapse, FB, stenosis, stricture, tear, mass

BOAS: combination

Next Steps

PE: CS, hyperthermia?

Initial Tx

Sedation, anxiolytics (aceprozamine, butorphanol etc)

Cooling

O2

Anti-inflam does of steroids

Dex SP @ 0.15 mg/kg IV once

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?

Fluroscopy

Medical Mx vs Sx

What

Next Steps

Hx/Sx

Initial Tx

When Stable

Narrowed bronchial lumen from

Bronchospasm Ddx: feline asthma, lung worm, HW

Diffuse Bronchomalacia- severe chronic bronchitis

Accumulation of exudate/mucus

Oedema of bronchial wall= ANAPHYLAXIS

O2

Bronchodilator trial: E.g. single puff salbuterol from MDI with spacer OR terbutaline.

Adrenaline for ANAPHYLAXIS

Feline Asthma: cough, siamese breed, young

CHronic bronchitis= cough, old small breed dog

PE: CS< exp grunt/ push?

Thoracic radiographs

TW/BAL cytology

HW test

Lung worm test- Baermann fecal

Tx: corticosteroids, bronchodilators, deworming with fenbendazole-cats

What

Dz of terminal and resp bronchioles, interstitium, alveoli and vasculature

Pneumonia

Infectious vs aspiration

Pulmonary oedema: cardiogenic?

Interstitial lung Dz: pulmonary fibrosis, EBP

Neoplasia

Contusions, haemorrhage

Next Step

PE: wheezes, crackles, murmur-CHF/arrhythmia-Gallop

Initial Tx

O2

Frusomide (2mg/kg) trial to see if CHF

When Stable

Thoracic radiography

Echocardiography

CYtology (TTW, BAL, FNA +/- culture)

Biopsy

Tx for specific Dz

Cardiogenic: furosemide, etc

Microbial pneumonia- antimicrobials, supportive care

Interstitial Dz: anti-inflam/ immunosuppressive

Neoplasia: Sx/ chemo

Indications

NEEDS 24hr intensive care

  1. Severe Hypoxaemia
    despite oxygen supp.

PaO2 <60mmHg,
SpO2 <90%

  1. Severe hypercapnea

paCo2/PvCo2 > 60mmHg

  1. Increased work of breathing
    despite sustained resp distress

COMMON

What

Abnormal accumulations within pleural space that IMPAIRthoracic expansion on inhalation

Fluid: pleural effusion, water/pus, chyle/blood

Air: pneumothorax

Mass

Organs
(e.g. diaphragmatic hernia)

Next Step

PE: insp distress without stridor
OR rapid shallow breathing
OR generalised paradoxical breathing
OR decreased sounds on auscultation

Dx

tFAST

Thoracocentesis: diagnostic (if not coagulopathy)

Thoracic radiographs: when stable

Tx

O2

Thoracocentesis

Address underlying Dz

What= obstruction of BF in pulmonary vasculature from a thrombus in the systemic venous system/ right heart

Aetiology

anything that disturbs VIrchow's triad

Dx

difficult

Thoracic radiographs

Echo

Thoracic CT + angiography

Predisposing conditions

Neoplasia

Cardiac Dz

Protein losing dz

Cushings/ exogenous Csts

IMHA

Sepsis

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

Dx

usually obvious

Thoracic radiography

Usually resp problem due to concurrent pulmonary contusions/ pneumothorax

Tx

Lateral recumbency, flail segment facing downward

O2

Pain: local n. block, systemic

External splint/ bandage

Exploratory thoracotomy if penetrating wounds

E.g. Pain, acidosis, severe anaemia, hyperthermia, drugs, hypotension

Dx

Thoracic radiographs

Blood tests

Tx: O2 DOESNT RESOLVE GENERALLY, Tx underlying

Indications

Decreased O2 delivery

decreased CO
Decreased CaP2-hypoxaemia

Hypoventilation (SpO2 <95%, PaO2 <80mmHg)

PE: abnormal perfusion parameters, pale/cyanotic mm, dyspnoea

image

Flowby

Facemask

O2 Hood

O2 Cage

Nasal prongs/catheter

Transtracheal

Endotracheal via ETT

+ve: well tolerated, easy access

-ve: wasteful of O2, short term, labour intensive

-ve: if tight fitting= Co2 rebreathing, not tolerated if awake, labour, hyperthermia

+ve: high FiO2, easy administration and patient access

+ve: well tolerated, economical, min equiptment

-ve: CO2 accumulation- need vent, hyperthermia, condensation= cant see

+ve: tight control, temp and humidity control ($$$)

-ve: CO2 accumulation (need soda lime), $$$, no direct patient access

+ve: well tolerated, allow patient access

-ve: irritating- sneezing etc, sedation to place, LA to reduce irritation

+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

RARELY INDICATED