Flashcards in Respiratory introduction Deck (41)
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1
Define the following:
Hypoxia
Hypoxemia
Hypercapnia
- Hypoxia = oxygen levels in the blood, lungs, and/or tissues is low
- Hypoxemia = insufficient oxygenation of the blood
- Resp. stimulant when PaO2 < 50mmHg (normal = 90-110mmHg)
- Hypercapnia = inc. CO2 levels, resp. stimulant
- Most powerful
- Resp. stimulant when PaO2 < 50mmHg (normal = 90-110mmHg)
- Most powerful
2
Cyanosis
What is it?
What's normal?
When will it occur?
- Bluish to red-purple color in the tissues due to increased amounts of deoxygenated or reduced hemoglobin
- Animal w/ normal hematocrit
- Needs an arterial SaO2 73 and 78% pulse ox (PaO2 39-42mmHg) before cyanosis is found
3
Dyspnea
Definition
What should you avoid?
What should you give to the animal?
- Difficult or labored breathing
- Avoid excessive stress or struggling, and avoid dorsal recumbency for rads
- Give animal additional oxygen immediately
4
Define the following:
Stridor
Stertor
Orthopnea
- Stridor = high pitched inspiratory noise, rapid flow of air passed a rigid obstruction or paralysed/collapsed larynx
- Stertor = low-pitched inspiratory noise, gurgling or snoring sound, produced as air passes soft tissue obstruction
- Normal in brachycephalic dogs
- Orthopnea--adopt a strange position
- Sternal recumbency w/ elbows abducted, the neck extended and open-mouth breathing
- Normal in brachycephalic dogs
- Sternal recumbency w/ elbows abducted, the neck extended and open-mouth breathing
5
Respiratory disease
Diagnostic approach (steps)
4 disorders
- Diagnostic approach
- History/clinical signs
- PE/localization of disease
- Diagnostics/procedures
- Common drugs used in therapy
- Disorders
- Nasal disorders
- Airways--laryngeal, tracheal, bronchial disorders
- Pulmonary parenchymal diseases
- Pleural space diseases
- History/clinical signs
- PE/localization of disease
- Diagnostics/procedures
- Common drugs used in therapy
- Nasal disorders
- Airways--laryngeal, tracheal, bronchial disorders
- Pulmonary parenchymal diseases
- Pleural space diseases
6
Respiratory diseases
What is included in the history (diagnostic approach)?
- What is the signalment
- Ciliary dyskinesia--generally younger
- Neoplastic--generally older
- Breed
- Brachycephalic--stertor
- Mesocephalic
- Dolichocephalic--obstructions, fungal inf.
- How long has it been going on for?
- Acute signs
- Progressive
- Chronic
- Where is the location
- Ciliary dyskinesia--generally younger
- Neoplastic--generally older
- Breed
- Brachycephalic--stertor
- Mesocephalic
- Dolichocephalic--obstructions, fungal inf.
- Acute signs
- Progressive
- Chronic
7
Differentiate between clinical signs of upper and lower respiratory diseases
- Upper = nares to larynx
- Lower = larynx to lungs
8
What should you look for during the physical exam?
- What can you see
- Look for nasal discharge/disease
- Is there respiratory distress
- What can you hear
- Sneezing
- Breathing louder than normal
- Evidence of a cough
- What can be heard on auscultation
- What can you feel/touch
- What can you palpate
- Look for nasal discharge/disease
- Is there respiratory distress
- Sneezing
- Breathing louder than normal
- Evidence of a cough
- What can be heard on auscultation
- What can you palpate
9
Nasal disease
Signalment
Age, breed
10
Nasal disease: physical exam
Airflow
Facial palpation
- Bilateral airflow?
- Glass slide technique, wisp of cotton wool
- Facial palpation
- Pain?
- Symmetry vs. asymmetry?
- Normal ocular retropulsion?
- Place thumbs over eyelids and gently press backwards, upwards, medially, laterally (checks for masses)
- Glass slide technique, wisp of cotton wool
- Pain?
- Symmetry vs. asymmetry?
- Normal ocular retropulsion?
- Place thumbs over eyelids and gently press backwards, upwards, medially, laterally (checks for masses)
11
Nasal disease: physical exam
Oral exam
Nasal discharge
- Oral exam
- Check dentition and dental arcade
- Check hard palate for abnormalities
- Check soft palate to see that it can be easily pressed upwards (anesthetized)
- Nasal discharge
- Characterize discharge:
- Serous (clear), mucoid (not clear), mucopurulent (cloudy), purulent (white/yellow), hemorrhagic (bloody)
- Unilateral vs. bilateral (doesn't really matter when hemorrhagic)
- Persistent vs. intemittent
- Duration, has it changed over time
- Acute nasal disease often accompanied w/ sneezing
- Chronic nasal disease often has purulent to hemorrhagic discharge
- Check dentition and dental arcade
- Check hard palate for abnormalities
- Check soft palate to see that it can be easily pressed upwards (anesthetized)
- Characterize discharge:
- Serous (clear), mucoid (not clear), mucopurulent (cloudy), purulent (white/yellow), hemorrhagic (bloody)
- Unilateral vs. bilateral (doesn't really matter when hemorrhagic)
- Persistent vs. intemittent
- Duration, has it changed over time
- Acute nasal disease often accompanied w/ sneezing
- Chronic nasal disease often has purulent to hemorrhagic discharge
12
Nasal disease: physical exam
Sneezing
- Localizes disease to nasal cavity
- Protective mech. of upper airways
- May have concurrent nasal discharge
- Normal sneezing: expiratory, forceful
- Occasional, intermittent, persistent, paroxysmal
- Reverse sneezing
- Inspiratory
- Duration?
- Occasional, intermittent, persistent, paroxysmal
- Inspiratory
13
Physical exam
Breathing sounds
- Stertor (low pitch, snoring)
- Brachycephalic airway syndrome
- Stridor
- Laryngeal paralysis
- Tracheal collapse
- Nasopharyngeal stenosis
- Brachycephalic airway syndrome
- Laryngeal paralysis
- Tracheal collapse
- Nasopharyngeal stenosis
14
Physical exam
Cough--hallmark of?
- Hallmark of a tracheal or pulmonary disease (lower airways) or cardiac failure
- Use the signalment, history, clinical finding and rads to be able to distinguish between these causes
- Forceful expiratory effort/protective reflex
- Use the signalment, history, clinical finding and rads to be able to distinguish between these causes
15
Physical exam
Cough--triggers? Classification?
- Triggers include:
- Irritant receptors that lie between epithelial cells lining the airways (cough receptors)
- Inflammatory products of neutrophils or eosinophils
- Excessive secretions
- Airway compression or collapse
- Classified as
- Dry/non-productive
- Moist/productive
- Harsh/intermittent or paroxysmal (once it starts, gets progressively worse)
- Irritant receptors that lie between epithelial cells lining the airways (cough receptors)
- Inflammatory products of neutrophils or eosinophils
- Excessive secretions
- Airway compression or collapse
- Dry/non-productive
- Moist/productive
- Harsh/intermittent or paroxysmal (once it starts, gets progressively worse)
16
Beautiful massive chart of cardiogenic vs. non-cardiogenic coughing?
17
Respiratory distress terms
Panting
Respiratory distress
- Panting
- Dissipates heat--can be normal in dogs
- Cats: assoc. w/ stress or resp distress
- Resp distress
- Most frequently assoc. w/ lower airway disease
- Dogs w/ bilateral laryngeal paralysis (upper airways) are also in distress
- Dissipates heat--can be normal in dogs
- Cats: assoc. w/ stress or resp distress
- Most frequently assoc. w/ lower airway disease
- Dogs w/ bilateral laryngeal paralysis (upper airways) are also in distress
18
Respiratory distress (dyspnea)
Cause?
- Insufficient oxygen in inspired air
- Insufficient ventilation
- Insufficient circulation
- Insufficient erythrocytes
- Abnormal or low hemoglobin concentrations
19
Hypoxemia
- Insufficient oxygen can result in cyanosis
- Color of mucous membranes
- Causes
- Lack of O2--upper/lower resp disease
- Abnormal hemoglobin--toxins
- Cardiac dz
- Pulmonary dz
- Cardiopulmonary arrest
- Color of mucous membranes
- Lack of O2--upper/lower resp disease
- Abnormal hemoglobin--toxins
- Cardiac dz
- Pulmonary dz
- Cardiopulmonary arrest
20
Respiratory patterns
Inc. inspiratory effort
Inc. expiratory effort
Shallow breaths and tachypnea
- Inspiratory
- Usually upper resp dz
- Expiratory
- Usually lower resp dz
- Shallow/tachypnea
- Indicates restrictive resp pattern
- Pulmonary/pleural/mediastinal dz
- Often orthopneic posture
- Discordant motion of chest and abdominal muscles--> suspect flail chest or resp muscle fatigue
- Usually upper resp dz
- Usually lower resp dz
- Indicates restrictive resp pattern
- Pulmonary/pleural/mediastinal dz
- Often orthopneic posture
- Discordant motion of chest and abdominal muscles--> suspect flail chest or resp muscle fatigue
21
Pulmonary sounds
Normal lung sounds
- Normal lung sounds are bronchovesicular
- Bronchial--loudest over hilus during expiration
- Mvt of air through tracheal bifurcation region
- Vesicular--loudest on inspiration at periphery of lungs, normal air filling lungs "rustling of leaves" (very soft sounds)
- Normal lungs will have normal bronchovesicular sound, but w/ disease you can have harsh or increased bronchovesicular sound
- Mvt of air through tracheal bifurcation region
22
Pulmonary auscultation (various sounds)
- Parynchymal disease--adventitial sounds
- Crackles--snapping open of airways that have closed due to fluid in/around them (rice krispies)
- Wheezes--caused by airflow through narrow opening--airways are constricted/narrowed
- Snaps--loud snaps over hilus at end of expiration indicates collapse of the intrathoracic trachea, carina, or mainstem bronchi
- Goose honks--sound w/ tracheal collapse
- Pleural friction rubs--creaking/grating sound due to roughened pleural surfaces rubbing against each other
23
Pulmonary auscultation
Pleural disease
- Pleural effusion
- Lung sounds auscultated dorsally
- Lungs floating in fluid
- Muffled sounds ventrally
- Heart sounds also reduced
- Pneumothorax
- Abscence of lung sounds dorsally due to compression
- Only present in ventral field
- Both are emergencies--need to aspirate ASAP
- Lung sounds auscultated dorsally
- Lungs floating in fluid
- Muffled sounds ventrally
- Heart sounds also reduced
- Abscence of lung sounds dorsally due to compression
- Only present in ventral field
24
Pulmonary percussion: distinguish between air and fluid density
- Use your finger/small mallot to strike chest cavity and listen to the sound
- Fluid gives dull sound
- Pneumothorax will give inc. resonance
- Difficult in small dogs and cats
- Fluid gives dull sound
- Pneumothorax will give inc. resonance
25
Minimum data base
- Remember: stabilize patient before doing any tests
- Cats often will need a couple of hours in oxygen chamber before any additional tests are done
- CBC, biochem, fecal, HW check (if required)
- Thoracic rads required in most situations (stabilize first)
- Cats often will need a couple of hours in oxygen chamber before any additional tests are done
26
T/F: X-rays are usually helpful in nasal disease cases
FALSE--x-rays are not sensitive at all with nasal diseases
27
Rhinoscopy
Performed when?
Otoscope vs. endoscope
Endoscopy steps?
- Performed after imaging
- Otoscope--limitations of depth, visibility, biopsy
- Endoscope--rigid or flexible; video-endoscope ideal
- GA, cuff endotrach tube
- Often perform pharyngoscopy at this stage to assess nasopharynx
- Block off oropharynx w/ swabs
- Enter each nare--examine dorsal, middle, ventral, and common meatus
- Biopsy abnormal or normal areas if required
- GA, cuff endotrach tube
- Often perform pharyngoscopy at this stage to assess nasopharynx
- Block off oropharynx w/ swabs
- Enter each nare--examine dorsal, middle, ventral, and common meatus
- Biopsy abnormal or normal areas if required
28
Rhinoscopy
Blind biopsies
Do not pass medial canthus of eye (will go into brain--> bad news bears)
29
Bronchoscopy
Evaluation of what?
- Evaluates the larynx, trachea, and bronchi
- Evidence of tracheal collapse, foreign body, or neoplasm?
- Look at tracheal bifurcations and at the dif. bronchi
- Samples taken for cytology, culture and sensitivity and sometimes a fine needle aspirate or a biopsy is taken
- Contraindicated in patients w/ severe respiratory distress (procedure requires general anesthesia)
- Evidence of tracheal collapse, foreign body, or neoplasm?
- Look at tracheal bifurcations and at the dif. bronchi
- Samples taken for cytology, culture and sensitivity and sometimes a fine needle aspirate or a biopsy is taken
- Contraindicated in patients w/ severe respiratory distress (procedure requires general anesthesia)
30
What is included in the extended data base (9)?
