1.1.2: Breathlessness Flashcards
How to manage a cat/dog with respiratory distress
- Calm, stress-free environment
- Remove collars
- Oxygen: flow-by or mask, oxygen cage, nasal catheters
- Obtain IV access to allow anaesthesia and intubation if required
What is your diagnosis?
Left-sided congestive heart failure
What is furosemide and how does it work?
Furosemide
* Loop diuretic
* Inhibits the reabsorption of sodium and chloride (and therefore water) in the thick ascending loop of Henle
What are your immediate next steps for this case?
- Stabilise with oxygen
- Reduce preload with vasodilators and diuretics (e.g. furosemide)
- Reduce afterload with arteriodilators
- Provide positive ionotropic support (oral pimobendan)
- Treat any complications e.g. arrhythmias, cardiac cachexia
- Thoracocentesis/abdominocentesis if required to remove fluid
You diagnosed a dog with left-sided congestive heart failure, and treated it appropriately when it presented with acute respiratory distress. What might you suggest to the owner for long-term monitoring and treatment of this disease?
- Book in for ultrasonography/radiography to stage the heart disease (and consider appropriate drugs for each stage)
- Consider sodium-restricted diet
What elements of your physical exam could you use to localise disease to a specific area of the respiratory tract?
- Auscultate lung fields and thoracic inlet
- Assess inspiratory vs expiratory noise
- Dyspnoea ± abdominal effort
- Observe respiratory rate and pattern
- Posture: head elevated? Standing vs lying down?
- Mucous membrane colour
In the normal animal, which phase of respiration is longer than the other? How might this change depending on the location of the respiratory disease?
- Normal: inspiratory phase is longer than expiratory phase
- This is often reversed in lower airway disease
An animal presents with a slow respiratory rate, exaggerated inspiratory effort (long inspiratory phase), and elevated inspiratory effort. Where will you localise this to?
a) URT
b) Lower respiratory tract
c) Pleural space disease
d) Non-CRS condition
a) URT
An animal presents with fast, shallow breaths. Both phases of breathing are altered. There is an increase in inspiratory effort, but is no marked increase in expiratory effort. Where do you localise this to?
a) URT
b) Lower respiratory tract: pulmonary parenchymal disease
c) Pleural space disease
d) Non-CRS condition
b) LRT: pulmonary parenchymal disease
* e.g. Idiopathic pulmonary fibrosis
* There is increased inspiratory effort
* Increased expiratory effort is not possible in this case due to reduced lung compliance
An animal presents with fast, shallow breaths. Both phases of breathing are altered. There is marked increase in both inspiratory and expiratory effort. Where do you localised this to?
a) URT
b) LRT (pulmonary parenchymal disease)
c) Pleural space disease
d) Non-CRS condition
c) Pleural space disease
e.g. pleural effusion
* Loss of pleural adhesion increases the effort required to breathe
* Both inspiratory and expiratory effort are increased
Tachypnoea
Increased respiratory rate
Hyperpnoea
Increased respiratory effort
Orthopnoea
Dyspnoea in any position other than standing or erect sitting; usually due to bilateral pulmonary oedema
Trepopnoea
Dyspnoea in one lateral recumbency but not the other
* Unilateral lung or pleural disease, or unilateral airway obstruction
* Often seen when patients are hospitalised and put into lateral
* Deterioration can be rapid -> be vigilant!
Rhonchi
- Low-pitched wheezes or coarse crackles
- Non-repetitive and non-musical
- Low-pitched sounds produced during early inspiration and expiration
- Signs of turbulent airflow through secretions in large airways
