3 selected respiratory emergencies

Question 1

upper and lower airway emergencies occur in which anatomic areas?

Answer 1

• nose
• esophagus
• larynx
• trachea

Question 2

what respiratory issues might originate in the nose?

Answer 2

• stenotic nares
  parat of brachycephalic obstructive airway syndromme
  contributes to heat stress
• epistaxis can cause respiratory distress due to aspirated blood clots

Question 3

common esophageal issue leading to respiratory issues?

Answer 3

• esophageal mass or foreign body impinging on trachea

Question 4

common issues of larynx?

Answer 4

paralysis
trauma
neoplasia

Question 5

how do laryngeal issues alter breathing?

Answer 5

inspiratory dynspea

Question 6

treatments for laryngeal issues?

Answer 6

sedation
oxygen
maybe corticosteroids

surgery

Question 7

what surgical options for larynx problem?

Answer 7

• temporary tracheostomy

- laryngoplasty [for paralysis]

Question 8

common tracheal issues?

Answer 8

traumatic

obstructive lesions

Question 9

How to Dx, Tx and repair tracheal tear:

Answer 9

Dx: sub Q emphyseam, pneumomediastinum, tracheoscopy or cervical/thoracic radiographs

tx: conservative - cage rest and rarely tube tracheostomy
sx: no advantage over conservative tx; sometimes resection and anastomosis

Question 10

where is tracheal obstruction if patient has inspiratory distress?

Answer 10

extrathoracic

Question 11

where is tracheal obstruction if patient has expiratory distress?

Answer 11

intrathoracis

Question 12

Emergency Tx of tracheal obstruction?

Answer 12

• initial:sedation, o2, corticosteroids maybe
• sx: tube tracheostomy (cd to obstruction)
  foreign body removal
  rings/stents for tracheal collapse

Question 13

what are anatomic regions of intrathoracic emergencies?

Answer 13

pleural space
mediastinum
lungs

Question 14

how to dx pleural space emergencies?

what test should you be cautious with?

Answer 14

• observe
• auscult
• percuss
• thoracocentesis
• thoracic radiography - be cautious with this b/c stretching arms up makes it harder to breathe

Question 15

during percussion, what does hyporesonance suggest?

and hyperresonance?

Answer 15

hypo: fluid, solid organs
hyper: air, gas filled

Question 16

pleural space emergencies:

Answer 16

pleural effusions
pneumothorax
diaphragmatic hernia

Question 17

what are some causes of pleural effusions:

Answer 17

• hydrothorax
• hemothorax
• pyothroax
• chylothorax
• serous pleuritis
• neoplastic effusion

Question 18

pleural effusion Tx:

Answer 18

• thoracocentesis

- thoracostomy tube in intractable

Question 19

what is the difference btwn typical and tension pneumothorax?

Answer 19

typical: some o2 escapes hole into thorax upon inhalation and some comes back in upon exhalation
tension: a flap of tissue covers hole - so air cannot escape and continues to accumulate

Question 20

T/F: the medistinum of dog / cat is impermeable.

what are implications related to pneumothorax?

Answer 20

false

it is permeable - so both bilateral and unilateral pneumothorax are possible.

Question 21

mediastinal emergencies:

Answer 21

• pneumomediastinum
• septic mediastinitis
• hemomediastinum

Question 22

what occurs during pneumomediastinum?

Answer 22

disruption of trachea, bronchi, esophagus or central portion of lungs

Question 23

what is common cause of septic mediastinitis?

prognosis?

Answer 23

esophageal perforation

high mortality rate - poor prognosis

Question 24

what is common cause of hemomediastinum?

Answer 24

• traumatic vessel disruption

Question 25

Tx of pneumomediastinum?

Answer 25

- address underlying cause - or monitor and benign neglect - could progress to pneumothorax

Question 26

pulmonary emergencies

Answer 26

``` pulm edema pneumonia pneumonitis pulm contusion pulm thromboembolism end airway dz lung lobe torsion ```

Question 27

definition of pulmonary edema?

Answer 27

accumulation of fluid in pulmonary interstitum and alveoli

Question 28

what 3 things does pulmonary edema impair?

Answer 28

- pulm compliance - vital capacity - pulm gas exchange

Question 29

why is pulm edema an emergency?

Answer 29

b/c of hypoxia

Question 30

what are 2 general causes of pulm edema?

Answer 30

- inc pulm capillary pressure [cardiogenic] | - inc pulm capillary permeability

Question 31

what are some specific causes of pulm edema?

Answer 31

- hypo proteinemia (along with other factors) - high altitude - thromboelbolism - neurogenic - acute respiratory distress syndrome

Question 32

pulm edema tx?

Answer 32

tx underlying cause o2 diuretic bronchodilators ventilation therapy [PEEP, CPAP]

Question 33

Tx pneumonia?

Answer 33

- supportive tx (like pulm edema) - abx (try to culture from transtracheal wash or bronchoalveolar lavage) - nebulizaiton - coupage

Question 34

what is pneumonia vs pneumonitis? which has better prognosis?

Answer 34

pneumonia: inflammation of lungs due to infectious cause [bacT, fungal, viral] pneumonitis: noninfectious inflammation of the lungs [aspiration of gastric contents] pneumonitis has better prognosis

Question 35

pulmonary contusion definition?

Answer 35

- traumatic injury resulting in hemorrhage and edema in lung parenchyma - most resolve but some cause death

Question 36

pulm contusion tx:

Answer 36

- symptomatic - o2 - resrt - avoid fluid overload - diuretic if fluid overload suspected - ventilatory support if not responsive to o2 therapy - abx NOT indicated [only if 2* pneumonia develops]

Question 37

pulm thromboembolism dx?

Answer 37

Dx by exclusion rare to Dx antemortem

Question 38

pulm thromboembolism tx:

Answer 38

- symptomatic - anticoaguulant (heparin or coumadin) - thrombolytics [rare b/c high risk and low benefit]

Question 39

end airway dz common in cats: dog:

Answer 39

allergic bronchitis - more likely feline asthma dogs: infectious bronchitis

Question 40

signs and Tx of feline asthma (allergic bronchitis)?

Answer 40

- paroxysmal cough, wheezing, respiratory distress, cyanosis - bronchodilator - corticosteroids - o2

Question 41

infectious bronchitis etiology? Tx?

Answer 41

- assoc w viral infection, allergic bronchitis, aspiration - Tx NOT emergency usually: bronchodilation, nebulization, abx

Question 42

lung lobe torsion: common presentation? | emergency Tx?

Answer 42

pleural effusion - may need emergency action Tx: thoracocentesis or thoracostomy tube

Question 43

should you untwist a torsed lung lobe? why or why not?

Answer 43

NO - it will release inflammatory mediators -> may cause SIRS

Question 44

thoracic wall emergencies:

Answer 44

- rib fractures - flail chest - thoracic wall perforation

Question 45

presentation of rib fractures: prognosis typically? emergency tx?

Answer 45

- not typically life threatening - can cause pneumothorax, pulm contusion, myocardial injury - hypoventilation due to pain - tx: intercostal nerve block avoid bandage b/c restrictive

Question 46

what is flail chest?

Answer 46

- segment of thoracic wall w multiple ribs fractured dorsally and ventrally causing paradoxical motion - segment moves in during inspiration and out during expiration - resp distress due to underlying pulm injury - not flail chest itself

Question 47

flail chest Tx:

Answer 47

- supportive - similar to pulm contusion | - intercostal nerve blocks

Question 48

flail chest: surgical Tx

Answer 48

external splint | rarely necessary

Question 49

under what circumstances can a thoracic wall perforation be fatal? what is emergency tx?

Answer 49

if perforates mediastinum - early closure of defect, thoracostomy tube