DM3 Pt2-3 The Dyspnoeic Cat

Question 1

Why are dyspnoeic cats considered fragile patients?

Answer 1

Dyspnoeic cats are at a high risk of decompensation and death due to respiratory compromise, and handling or stress can worsen their condition.

Question 2

What is the basic rule when handling dyspnoeic cats?

Answer 2

Dyspnoeic cats should be handled minimally, kept in a calm, quiet environment, and given oxygen supplementation to stabilise before performing further assessments.

Question 3

What position should a dyspnoeic cat be kept in?

Answer 3

Dyspnoeic cats should be kept in standing or sternal recumbency to minimise respiratory compromise.

Question 4

Why is preparation essential for managing a dyspnoeic cat?

Answer 4

Being prepared with vital equipment and drugs saves time and can be life-saving. Accessing the patient’s clinical history early also helps identify any underlying conditions contributing to the dyspnoea.

Question 5

What are some key pieces of equipment needed when managing a dyspnoeic cat?

Answer 5

Key equipment includes: oxygen supply (cage/tent/incubator), laryngoscope, ET tubes with stylet, X-ray and ultrasound machines, thoracocentesis equipment, blood collection supplies, and equipment for placing an IV catheter.

Question 6

What medications should be pre-prepared for dyspnoeic cats?

Answer 6

Useful medications include sedatives (e.g., ketamine, midazolam), general anaesthetic agents (e.g., propofol), bronchodilators (e.g., terbutaline, salbutamol), diuretics (e.g., furosemide), corticosteroids (e.g., dexamethasone), and IV antibiotics (e.g., Augmentin).

Question 7

What sedative agents are useful for a dyspnoeic cat?

Answer 7

Ketamine and midazolam are recommended sedative agents for dyspnoeic cats.

Question 8

What are the recommended bronchodilators for dyspnoeic cats?

Answer 8

Injectable terbutaline or inhalational salbutamol (used with a spacer device) are the recommended bronchodilators for dyspnoeic cats.

Question 9

What diuretic is typically used in dyspnoeic cats?

Answer 9

Injectable furosemide is commonly used as a diuretic in dyspnoeic cats.

Question 10

What precautions should be taken when performing diagnostics or interventions on a dyspnoeic cat?

Answer 10

All diagnostics and interventions should be performed with minimal handling and stress, keeping the cat in a quiet and calm environment, with necessary equipment ready beforehand to prevent decompensation.

Question 11

What are the four major groups of dyspnoea causes?

Answer 11

Upper respiratory tract, lower respiratory tract, pleural space disease, and non-respiratory causes.

Question 12

What are common upper respiratory tract causes of dyspnoea?

Answer 12

Nose/nasopharynx: rhinitis, neoplasia, polyp, nasopharyngeal stenosis, foreign body. Larynx: oedema, neoplasia, inflammation, spasm, paralysis. Cervical trachea: foreign body, neoplasia.

Question 13

What are common lower respiratory tract causes of dyspnoea?

Answer 13

Airways: asthma, bronchitis, neoplasia. Lung parenchyma: pneumonia, pulmonary oedema (cardiogenic, non-cardiogenic), neoplasia, contusions.

Question 14

What are common effusive pleural space diseases that cause dyspnoea?

Answer 14

Transudate (e.g., hypoalbuminaemia), modified transudate (e.g., neoplasia, congestive heart failure), exudate (septic: pyothorax, non-septic: FIP), chylothorax, haemothorax.

Question 15

What are common non-effusive pleural space diseases that cause dyspnoea?

Answer 15

Pneumothorax, diaphragmatic rupture, neoplasia.

Question 16

What are non-respiratory causes of dyspnoea?

Answer 16

Anxiety, pain, hyperthermia, anaemia, acidosis, abdominal enlargement.

Question 17

What are common causes of laryngeal dyspnoea?

Answer 17

Laryngeal oedema, neoplasia, inflammation, spasm, paralysis.

Question 18

What are potential causes of dyspnoea originating from the trachea?

Answer 18

Foreign body, intraluminal or extraluminal neoplasia.

Question 19

What are the main causes of lower respiratory tract dyspnoea affecting the lung parenchyma?

Answer 19

Pneumonia, pulmonary oedema (cardiogenic and non-cardiogenic), neoplasia, contusions.

Question 20

What are causes of haemothorax in cats?

Answer 20

Trauma, neoplasia, coagulopathy.

Question 21

What is stertor and what does it indicate?

Answer 21

Stertor is a snoring-type noise indicating naso-pharyngeal disease, such as nasopharyngeal lymphoma, polyps, or stenosis.

Question 22

What is stridor and what does it indicate?

Answer 22

Stridor is a high-pitched inspiratory sound that indicates laryngeal disease.

Question 23

How is dyspnoea characterized in upper respiratory tract disease?

Answer 23

Dyspnoea is characterized by increased inspiratory effort with slow deep inspirations.

Question 24

What are the key clinical features of upper respiratory tract disease?

Answer 24

History of nasal discharge and/or sneezing, audible upper airway noise (stertor or stridor), increased inspiratory effort.

Question 25

What history might a cat with lower respiratory tract airway disease have?

Answer 25

A history of coughing (often mistaken for hairballs), and previous tachypnoeic/dyspnoeic episodes.

Question 26

How is dyspnoea characterized in lower respiratory tract airway disease?

Answer 26

Dyspnoea is characterized by increased expiratory effort.

Question 27

What are common lung sounds and findings in lower respiratory tract airway disease?

Answer 27

Wheezes on auscultation and hyper-resonance to last rib may be present, indicating lung hyperinflation.

Question 28

What are common features of lung parenchymal disease?

Answer 28

History of upper respiratory tract infection, regurgitation (in pneumonia), or signs of congestive heart failure (e.g., heart murmur, tachycardia, gallop rhythm). Lung sounds may include harsh, crackles, and may be unilateral or bilateral depending on the cause.

Question 29

How is dyspnoea characterized in pleural space disease?

Answer 29

Dyspnoea is characterized by increased inspiratory effort with rapid shallow breathing.

Question 30

What additional signs may be present in pleural space disease?

Answer 30

Muffled heart and lung sounds, dullness on percussion (effusion), or hyper-resonance (pneumothorax), and signs related to underlying disease (e.g., pyrexia in pyothorax, regurgitation with mediastinal mass).

Question 31

What are the typical findings in non-respiratory causes of dyspnoea?

Answer 31

Non-respiratory causes often result in tachypnoea rather than dyspnoea. Common causes include stress, pain, or anxiety, which can contribute to or combine with other causes of dyspnoea.

Question 32

What signalment details might help narrow down the cause of dyspnoea in cats?

Answer 32

Age, breed, and lifestyle can provide clues. For example, mediastinal lymphoma is common in young cats, heart disease and asthma are most common in middle-aged cats, and neoplastic diseases are more common in older cats. Siamese and Oriental cats are predisposed to asthma.

Question 33

What key history points are important when assessing a dyspnoeic cat?

Answer 33

Indoor/outdoor lifestyle, contact with other cats, vaccination status, previous illness or trauma, current clinical signs, duration and pattern of onset, progression of signs, and response to any treatments.

Question 34

How can a ‘hands-off’ approach help in assessing a dyspnoeic cat?

Answer 34

Observing the cat without restraint can help determine the nature of dyspnoea, such as increased inspiratory or expiratory effort, rapid shallow breathing, or slow deep breaths, which helps assess the likely cause.

Question 35

What does stertor indicate, and what causes it?

Answer 35

Stertor is a snoring-type inspiratory noise associated with partial occlusion of the nasal passages, choanae, or nasopharynx, indicating upper respiratory tract disease.

Question 36

What does stridor indicate, and what causes it?

Answer 36

Stridor is a high-pitched inspiratory noise associated with partial occlusion of the larynx or trachea, indicating laryngeal or tracheal disease.

Question 37

What might percussion reveal in a dyspnoeic cat?

Answer 37

Dullness on percussion indicates fluid in the pleural space, while increased resonance suggests hyperinflation or pneumothorax.

Question 38

Why might ultrasound be preferred over radiography in a dyspnoeic cat?

Answer 38

Ultrasound requires less restraint and stress than radiography, making it a safer option for confirming or excluding pleural effusion and assessing the left atrium in congestive heart failure. It also avoids the need for ventro-dorsal radiographs, which can stress the cat.

Question 39

When is thoracocentesis indicated in a dyspnoeic cat?

Answer 39

Thoracocentesis is indicated when pleural effusion or pneumothorax is suspected based on clinical assessment. It is both a diagnostic and emergency therapeutic procedure.

Question 40

How is thoracocentesis performed in cats?

Answer 40

The cat is restrained in sternal recumbency, and a 21-23G Butterfly catheter is inserted into the 7th or 8th intercostal space near the costo-chondral junction. Fluid is aspirated and collected in EDTA/plain tubes for cytology, protein/triglyceride/cholesterol, and bacterial culture.

Question 41

What further management or investigation may be performed after stabilizing a dyspnoeic cat?

Answer 41

Further management includes radiography, thoracocentesis, and routine haematology/biochemistry once the cat is stable. Radiography should be avoided if it worsens dyspnoea, and echocardiography or ultrasound can be used for further diagnostic assessment.

Question 42

What is the first and most important step in treating a dyspnoeic cat?

Answer 42

Keep calm and quiet, place the cat in a quiet room away from barking dogs, telephones, and other stressors to minimize handling and stress.

Question 43

How should oxygen be administered to a dyspnoeic cat?

Answer 43

Oxygen is best administered in an oxygen cage, but if the cat is collapsed, oxygen can be provided via a mask, if tolerated.

Question 44

What emergency treatment can be rapidly administered to an asthmatic cat?

Answer 44

Salbutamol inhaler (2 puffs initially, then give to effect) may result in rapid improvement in an asthmatic cat.

Question 45

What dosage of furosemide should be given to a dyspnoeic cat?

Answer 45

Furosemide 1-2 mg/kg can be administered intramuscularly (i/m) or intravenously (i/v) for emergency dyspnoea management.

Question 46

What is the recommended dosage of terbutaline for a dyspnoeic cat?

Answer 46

Terbutaline should be administered at 0.015 mg/kg either subcutaneously (s/c) or intramuscularly (i/m) in cases of emergency dyspnoea.

Question 47

When should dexamethasone be used in a dyspnoeic cat, and at what dosage?

Answer 47

Dexamethasone is useful in emergency cases and should be given at 0.1-0.2 mg/kg either subcutaneously (s/c) or intravenously (i/v).

Question 48

Why is minimising stress so critical in treating a dyspnoeic cat?

Answer 48

Dyspnoeic cats are very fragile, and stress can cause decompensation, leading to worsening of their condition or death. Keeping them in a calm environment reduces the risk of fatal deterioration.

Question 49

What is a non-specific treatment that can be administered in emergency dyspnoea?

Answer 49

Furosemide can be given for potential pulmonary oedema, terbutaline for bronchodilation, and dexamethasone for its anti-inflammatory effects, even before the specific cause of dyspnoea is identified.

Question 50

What is the risk of delaying pleural effusion treatment in a dyspnoeic cat?

Answer 50

Delaying thoracocentesis in a cat with suspected pleural effusion can lead to further deterioration of the cat's condition, potentially making the situation more dangerous.

Question 51

What should be done if the exact cause of dyspnoea remains unknown during initial treatment?

Answer 51

Administer non-specific emergency treatments (such as furosemide, terbutaline, or dexamethasone) for stabilisation, while preparing for further diagnostic tests once the cat is stable.