Respiratory Exam Lectures Flashcards
(42 cards)
What should be a part of your equine respiratory exam?
RR - eupnea = 8-16bpm adult, 20-24bpm foal
Check I:E ratio (Inspiratory shorter than expiratory)
Listen to lungs (3-4 locations), trachea, larynx
Check Sinuses
HX - sign, medical, clinical sign, duration, other therapy, new horses, change in diet or feed, desired activity level
PE: Visual - BCS, RR and effort, heave line, lymph node, larynx and trachea, nares and oral cavity odor, auditory
Assess the environment - dusty, hay, bedding, storage
Overall condition
Very thorough exam
What is the point of including a rebreathing bag in your exam?
Increase sensitivity of auscultation
Pulmonary function test
-Increases respiratory depth and rate
Don’t perform if very compromised
What kind of respiratory sounds should you be listening for?
Vesicular, bronchial
Crackles, Wheezes, Rales
When placing a rebreathing bag, what are some good practices?
Make sure the nostrils are not restricted/occluded, use a basket muzzle to prevent it getting sucked up into the nose
What is the lung field of a horse?
Just in front of the shoulder, down to the point of elbow, meeting up at the tuber coxae
Where should you percuss a horse?
Sinuses
Chest (ultrasound replaces it)
What ancillary tests may help your diagnosis?
CBC - if infection suspected - increase WBC, fibrinogen, SAA
Endoscopy
Transtracheal Aspirate
Bronchoalveolar Lavage
Ultrasonography
Radiology
Thoracocentesis
What is an indication to perform an exam before and after exercise?
Abnormal resp sounds
-Laryngeal hemiplegia, DDSP, epiglotic entrapment, subepiglottic cyst
What are some indications for guttural pouch endoscopy?
Nasal discharge, pharyngeal swelling, facial nerve paralysis, dysphagia
What are some indications for Dynamic Endoscopy?
-Normal upper airway during resting endoscopy, noise when exercising
-Abnormal upper airway during resting want to see move
-Poor performance with or without noise
What kind of samples can you submit from a transtracheal aspirate?
Cytology, culture and sensitivity
How do you perform a TTW with endoscope?
Need: sedation, endoscope, triple lumen guarded catheter, sterile saline (3x60cc), collection container
-Sedate
-Pass endoscope (to thoracic inlet)
-Guarded part advanced and sterile saline inserted (in then aspirate back)
How do you perform BAL?
What is BAL useful for?
Recovering sample from small airways and alveolar cells
-Asses lower airway inflammation
What is the normal population of cells in a BAL or TTW?
Mononuclear, macrophages and lymphocytes
What indicates active inflammation?
More than 5% neutrophils, 2% eosinophils and mast cells
When should you ultrasound a horse?
Abnormal auscultation, percussion, fluid, intrathoracic, abscesses/masses and pulmonary consolidation
When should radiographs be performed in respiratory cases?
Prior to invasive procedures/endoscopy
When is thoracocentesis indicated?
pleural fluid on rads and ultrasound
What is the normal respiration rate for equine?
8-14bpm
What should be part of your respiratory PE?
Check the larynx, trachea, left and right side lungs ( 3-4 spots), percuss the sinus and chest
What drugs can be used to reduce cough?
Lidocaine and butorphanol
How do you perform an endoscopy exam and what do you see?
Pass the scope through the ventral nasal meatus, once in the pharynx look at the larynx (see the arytenoid cartilages, aryepiglottic folds, epiglottis, vocal folds, ventricles) and then proceed into the trachea, then come back, look at the pharyngeal recess, the pharyngeal ostium (into guttural pouch if needed (medial and lateral (external in lateral where mycosis occurs)), then look up to ethmoids and lateral to that is the sinus drainage angle, as you are exiting investigate the dorsal and ventral conchae.
What equipment is needed for a TTW?
Endoscope
Triple Lumen Kit
30-50cc sterile saline (in 60cc syringe)
Sterile container or red top tube
Fridge
