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Respiratory distress, IV access ASAP! - Coggle Diagram

- - - - increased mucus production, mucosal hyperaemia and oedema, as well as early collapse of abnormal and weakened small airways
  - - - Dexamethasone at 0.1–0.2 mg/kg i.v., i.m. q12h or• Prednisolone at 0.5–1 mg/kg i.v., i.m., orally q12h
  - - - bronchodilators, corticosteroids
      - in agonal cases, adrenaline should be administered for its profound vasoconstrictive, inotropic and bronchodilator effects
      - if no response to medical management - anaesthesia (halothane particularly useful for bronchodilators effects) and intubation may be required
      - may have pneumothorax 2ry to rupture of hyper inflated alveoli
    - - persistent cough occurring for at least 2 consecutive months
      - hyperplasia and hypertrophy of the bronchial glands, increased goblet cells, increased airway secretions and increased infiltrates of inflammatory cells are seen
        
        thickened, hyperaemic bronchial walls, obstruction of small airways with mucus and proliferation of epithelial surfaces
      - PE: increased airway sounds with wheezes and coarse crackles on chest auscultation caused by opening and closing of small bronchi
      - --> bronchiectiasis
    - - Fbs can be retrieved with aid of bronchoscopy or fluoroscopy or removed at the time of thoracotomy
      - thoracic radiographs and bronchoscopy can aid in diagnosis and biopsy assists in its confirmation
      - debunking or removal of mass (often inc. lung lobectomy) may be necessary unless biopsy reveals lymphoma which may respond to chemo
- - - - enrofloxacin 5-15mg/kg orally q24h
      - or co-amoxiclav 14-22mg/kg orally q12h
    - - –Enrofloxacin at 5–15 mg/kg i.v. 24h and ampicillin at 22 mg/kg i.v. q8h or–Amikacin at 15 mg/kg i.v. q24h and ampicillin at 22 mg/kg i.v. q8h or–Cefotaxime and clindamycin at 11 mg/kg i.v. q12h or–Ticarcillin/clavulanate at 50 mg/kg i.v. q6h (currently not available in the USA)–Nebulization and coupage
- - - - primary components of syndrome
        
        stenotic nares
        
        redundant pharyngeal soft tissue
        
        excessively long soft palate
        
        hypoplastic trachea
      - chronic obstruction of the upper airway causes increased negative inspiratory pressure
        
        leads to further airway occulusion
        
        inflammation and oedema of redundant tissue
        
        eversion of the laryngeal saccules
        
        complete laryngeal collapse
    - - older small breed dogs
      - progressive hx of cough and exercise intolerance
        
        cough easy to induce of tracheal palpation
        
        excitement --> paroxysmal honking cough and dyspnoea
        
        tracheal rings abnormally C shaped and fibrodysplastic and dorsal tracheal membrane is stretched, floppy and weak.
        
        complete obstruction or hypoxaemia during coughing spasms
      - differentiate: compression of mainstream bronchi in dogs with mitral regurgitation and enlargement of the left atrium, before CHF occurs.
      - diagnosis
        
        observation of trachea whilst coughing under fluoroscopy
        
        bronchoscopy - (anaesthesia)
        
        high risk upon recovery if surgery not performed at same time
        
        surgical placement of extraluminal rings for patients with extra thoracic or thoracic inlet collapse or non surgical placement of intraluminal stents for intrathoracic collapse may produce good results even w end stage disease
      - anti-inflammatory drugs and cough suppressants
        
        opioids esp. butorphanol and hydrocodone are antitussive at low doses and often beneficial
    - - often associated w inflammatory disease of tympanic bull or auditory calnals
      - inspiratory stridor, nasal discharge and otitis externa
      - examine soft palate and otoscope for polyps
      - radiographs of skull, bull and nasal cavity
    - - retropharyngeal masses, abscesses, haematomas
        
        e.g. neoplasia often lymphoma, but can be any oral, tracheal or laryngeal neoplasm
        
        if mass in proximal trachea or above can undergo emergency tracheostomy
        
        if mass in thoracic trachea and cannot be stabilised medically --> intubation, thoracotomy, or palliative placement of intraluminal stent are only options.
    - - nasal and ocular discharge, sneezing, fever, debilitation
      - feline calicivirus, feline herpes virus most common
        
        following exposure 2-5 day incubation period
      - calicivirus
        
        acute onset lethargy and fever
        
        mild hyper salivation, sneezing, conjunctivitis, oculonasal discharge
        
        ulcers evident on tongue and soft palate
        
        cat usually recovers in 7-10d
      - herpes virus
        
        more severe illness
        
        profound serous-mucopurulent oculonasal discharge and excessive salivation
        
        respiratory distress and open mouth breathing due to nasal obstruction or viral pneumonia
        
        resolves 2-3 weeks
        
        nasal turbinate damage can be so severe that the cat is prone to bacterial infections for prolonged time
        
        remain persistently infected and act as carriers that continuously or intermittently shed virus
      - supportive care (palatable food e.g. heating, clean discharge, feed tube) and antibiotics if 2ry infection
      - minimal data available regarding use of non-specific immune stimulants e.g. feline interferon
        
        anti-viral drugs are usually unnecessary
      - routine vaccines, but not recommended if showing clinical signs. The vaccines reduce the clinical signs of disease, but do not prevent infection and subsequent development of a carrier state
    - - bordetella bronchiseptica
        
        others: streptococcus, staphylococcus, klebsiella
        
        adapted to ciliated epithelium of URT, attaches via fimbriae to cilia of the mucocilliary escalator. Secretes exotoxins that's causes paralysis of the cilia - eliminates important lung defence mechanism
        
        doxycycline or fluoroquinolones
        
        adequate penetration through the blood bronchus barrier into the mucus lining the bronchi
        
        in puppies consider doxycycline or azithromycin
      - viruses: canine parainfluenza virus, canine adenovirus-1 and -2, canine distemper virus, canine influenza virus, canine herpesvirus and reoviruses 1,2 and 3.
      - incubation 2-7 days --> acute hacking cough often systemically well. If fever/systemic illness/depression consider pneumonia 2ry or other ddx
      - thick viscous mucus and acute inflammation
      - antitussives, expectorant, anti-inflame drugs
  - - - acepromazine
        
        if animal not hypovolaemic
        
        phenothiazines associated w vasodilation, which exacerbates signs of hypovolaemia
        
        brachycephalic have increased sensitivity to phenothiazines - lower dose
        
        keep dose to minimum
        
        0.001-0.005mg/kg IV or IM if stable
        
        may be more effective if combined with opioid (opioid can be used alone if hypovolaemia - minimal cardiovascular effects)
        
        morphine, methadone, butorphanol
        
        combine w sedative e.g. diazepam if excessive panting
        
        anti-inflammatory dose of corticosteroids
        
        dexamethasone at 0.1-0.2mg/kg IV or IM
    - - useful if significant airway oedema or inflammation present
      - avoid initially if neoplasia a differential (can cause lysis of malignant lmypyhocytes making diagnosis difficult)
    - - should not remain intubated through the larynx for more than a few hours, tube triggers swelling that may exacerbate problem following extubation
  - - - gases produced in largest concentration during combustion: carbon monoxide, hydrogen cyanide and carbon dioxide
      - noxious gases + low o2 --> narcosis
      - gases combine rapidly with haemoglobin, diminishing its o2 transferring function
    - - to displaces the gases from haemoglobin
      - continue for at least 1hr
      - saline nebulisation
      - bronchodilators
      - avoid corticosteroids and prophylactic antibiotics
        
        if signs develop follow with tracheal wash for cytology and c+s
    - - airway damage often includes severe necrotising tracheobronchitis, accompanied by exudate and cough
        
        bacterial pneumonia can follow due to damage
        
        diffuse inflammatory damage to lung --> generalised acute lung injury (ALI) that can progress to ARDS
- - - - so prefer to stand or lie in sternal recumbency and abducting their elbows to minimise compression of chest wall and to recruit the accessory muscles of ventilation such as the latissimus dorsi
- - - - only severe hyperaemia (<80% saturation of arterial blood)
      - at least 50% of desaturated Hgb must be present for blue colour to be detectable
        
        so anaemia and peripheral vasoconstriction also lead to inability to detect cyanosis
  - - - associated w narrowing of airways
        
        inflammation
        
        mucosal oedema
        
        mucus
        
        masses
        
        if during inspiration suspect upper airway pathology
        
        expiratory wheezes
        
        disease of small bronchi or lower airways
        
        e.g. feline allergic bronchitis
    - - presence of fluid in alveoli and airways
      - soft end-inspiratory crackles
        
        parenchymal disease
        
        indicate pulmonary oedema, haemorrhage or purulent exudate in alveoli
      - loud, snapping crackles during inspiration
        
        dogs with pulmonary fibrosis or chronic bronchitis
    - - pneumothorax
      - pleural effusion
      - diaphragmatic hernia
      - neoplastic masses
      - in cats, diminished chest compressibility can suggest effusion or mediastinal mass
    - - in cats with heart disease can be intermittent or absent
- - - - absence of 'glide sign'
        
        lack of normal dynamic interface between the lung margins and thoracic wall during respiration
    - - step sign = glide sign that deviates from normal linear continuity of the pulmonary-pleural interface and is assumed to represent thoracic injury