Respiratory introduction Flashcards Preview

• Indications
  • Foreign body suspect
  • Clean airways prior to rhinoscopy
  • Obtain samples for cytology
• Procedure
  1. GA and cuffed endotracheal tube
  2. Pack back of throat w/ gauze
  3. Fill 20-30cc syringe w/ 0.9% saline
  4. Place tapered end in nostril
  5. Hold other nostril closed w/ finger
  6. Flush saline quickly w/ a bit of force
  7. Repeat several times
  8. Cats: use dorsal recumbency w/ small towel rolled under neck
  9. Can use Foley catheter for antegrade and retrograde flushes

Nasal flush--normograde

Nasal flush--retrograde

• Alternative to nasal flushing
• Easier technique
• Good quality cytological material
• Cytology and culture
• Local block, place into nose, swirl around, smear on slide
  • No need to anesthetize patient

• Indications: lung disease involving small airway, alveoli, interstitium (flush out certain sections of lungs)
• Can be undertaken via bronchoscope or blindly
• BAL: can sample specific diseased lung lobes

• Transtracheal wash and aspirate
  • Medium-larger breed dogs
  • +/- sedation
  • Landmark: cricothyroid ligament
  • Go through transtracheal rings (less likely to hit nerve)
• Endotracheal or transoral wash & aspirate
  • Cats and tiny dogs
  • GA required
  • Catheter down ET tube

• Intrathoracic mass lesions in contact w/ thoracic wall
• Ultrasound guidance improves diagnostic yield and safety
• Complications
  • Hemothorax
  • Pneumothorax
  • Potentially pyothorax later on

• Treatment of pyothorax
• Management of pneumothorax when air is continually accumulating

• Antibiotics--considerations
  • What organisms are likely?
  • What antibiotics penetrate resp tissue?
  • Which part of resp system are you treating?
  • Which species of animal are you treating?
• Glucocorticoids:
  • Differences between anti-inflammatory doses vs. immunosuppressive doses?
  • Difference btn prednisolone, dexamethasone, methylprednisone?

• Bronchodilators--usually for bronchitis
  • May allow dose reduction of glucocorticoids in some cases of allergic bronchitis
• Antitussives--used mainly in dogs w/ dry and non-productive cough due to airway collapse or irritant tracheitis
  • Avoid in moist coughs
• Nebulization + coupage
  • Improves hydration of lower airways
  • Can administer some antibiotics via this method

• Indications
  • To treat hypoxemia (PaO2 < 90%)
  • To dec. workload of heart and lungs
• Methods
  • Face mask--quick, cheap
    • Requires high O2 flow
    • Must stay w/ patient
  • Nasal catheter
    • Patient can move around more
    • Watch flow rate
  • Cage--more expensive
    • Humidity and temp controlled
    • Opening doors decreases O2
  • Intratracheal--emergency
    • +/- sedation/anesthesia or tracheostomy tube
    • Continual monitoring