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VTT ER Procedures
Resp. & Cardiac Emergencies
| Question | Answer |
|---|---|
| The condition of excessive collapsibility of the trachea, usually resulting in the flattening of the tracheal lumen | Tracheal Collapse |
| why do tracheal lumen collapse? | because the cartilages lose the ability to maintain their rigidity |
| What are the most common breeds to suffer from tracheal collapse? | small breeds, Poms, toy poodles, pugs, etc |
| What are the clinical signs of tracheal collapse? | mild to severe respiratory distress, exercise intolerance, abnormal respiratory noises (wheezing, hacking, coughing), stridorous breathing, |
| What are the signs of pleural space disease? | dyspnea, coughing, hemoptysis; cyanotic MMs, hypoxemia, abdominal component on inspiration(abnormal), painful, hypoventilation secondary to pain, sQ emphyseme, fractured ribs, tachypenia, trauma patient - weak pulses (pneumothorax) |
| If pleural space disease is caused by fluid what will you hear? | decreased or absent airway sounds on auscultation |
| what is hemoptysis | Exhalation of blood / blood coming up through the nares (foamy) |
| What is the treatment for pleural space disease? | O2 supplementation, analgesics, IVF +/-, corticosteroid and antibiotic therapy, depending on diagnosis |
| How do we diagnose for pleural space disease | PE, abdominal palpation (feel fewer organs than normal palpated suggested suggest a diaphragmatic hernia, auscultation, increased bronchovescular sounds or crackles, radiographs or ultrasound |
| What is a pneumothorax? | Air in the chest cavity / pleural thorax |
| what is Chylothorax | Lymph fluid in the thoracic cavity |
| What is Pyothorax | PUS in the thoracic cavity |
| What is Thoracocentesis | Go in and tap that thorax and remove the air or fluid with in the pleural space |
| Fluid in a thoracocentesis is analyzed to determine what? | prognosis and diagnosis - what kind of fluid is it? |
| What are the common signs of respiratory distress? | tachypnea, open mouth breathing, paradoxical respiration, elbows bowed laterally, |
| What does cyanosis indicate? | reduced oxygen within the capillaries |
| In a non- anemic animal, cyanosis is not usually detected until when? What does this represent? | 50mmHg, severe hypoxia |
| What is pleural effusion? | condition in which excess fluid builds up between the lungs and the chest wall. |
| With pleural effusion, What will be heard upon auscultation? | crackles |
| Pleural effusion interferes with lung _________ | Expansion |
| What is pulmonary edema? | Fluid that has built up in the alveoli, making respiration difficult |
| What is pneumonia? | lung inflammation caused by bacterial or viral infection, in which the air sacs fill with pus and may become solid, results in inability to oxygenate, causing weakness and lethargy |
| What is aspiration pneumonia? | Inhalation of GI contents w/ vomiting & regurgitation (can be food, vomit, saliva, or other liquids) |
| What is pneumothorax? | Air inside the chest cavity (specifically in the pleural space) |
| When in pneumothorax commonly seen? | HBC, dog fight, puncture into thoracic cavity, FB |
| What is Chylothorax? | Lymph fluid in the pleural space |
| What is hemothorax? | blood in the pleural space |
| What is pyothorax? | Pus in the pleural space |
| What is bronchitis? | inflammation of the bronchioles ( include compression of the main stem bronchus from mild-severe left atrial enlargement, as seen w/ CHF) |
| What is asthma? | respiratory condition marked by spasms in the bronchi of the lungs, increased mucous production which causes difficulty breathing |
| Asthma is commonly the result of what? | allergies or other hypersensitivities |
| Is asthma infectious? | no |
| What are the common symptoms of asthma? | wheezing, coughing, shortness of breath, dyspnea (usually on expiration) |
| How is obstructive upper airway disease characterized? | Slow but deep respiratory pattern w/ harsh upper airway noise |
| What is stridor? | harsh, shrill breathing sound upon inspiration |
| stridor is commonly due to what? | laryngeal obstruction of some kind |
| What are the symptoms of obstructive upper airway disease? | infection (causing coughing), retching/vomiting, excessive salivation/mucous, reverse sneeze |
| What specific diseases present as obstructive upper airway disease***** WORDING HELP??****** | Elongated soft palate & strictured nares(brachycephalic), neoplasia tracheal laceration, tracheal collapse |
| What type of neoplasia is commonly found with obstructive upper airway disease? | squamous cell carcinoma |
| What are common causes of tracheal laceration? | bite wounds to the neck, traumatic intubation |
| Tracheal collapse is common in what type of animals? | Middle age & small breed dogs |
| What specific breed is tracheal collapse most commonly seen in? | Pomeranians |
| What is laryngeal paralysis? | complete or partial failure of the arytenoid cartilages to abduct on inspiration and adduct on expiration ( can be unilateral or bilateral) |
| What are the clinical signs of laryngeal paralysis? | Loud, harsh sounds on inspiration& expiration, voice changes, exercise& heat intolerance, varying levels of dyspnea, cyanosis, panting, gagging associated w/eating/drinking, vomiting, restlessness, anxiety |
| Often the first indication of laryngeal paralysis in an undiagnosed animal is what? | Aspiration pneumonia |
| How is laryngeal paralysis diagnosed? | Lateral cervical/thoracic radiographs are required to rule out other diseases, laryngeal exam under general anesthesia |
| How is laryngeal paralysis treated? | Asymptomatic laryngeal paralysis often requires no treatment w/ strict activity monitoring and elevated dishes. Corrective surgery is the definite therapy "tieback" |
| What is tracheal collapse? | The condition of excessive collapsibility of the trachea, usually resulting in the flattening of the tracheal lumen |
| What causes tracheal collapse? | Tracheal cartilages lose the ability to maintain rigidity, tracheal lumen size decrease due to the upper portion of the trachea collapsing during inspiration & the thoracic portion collapsing during expiration, resulting in the air flow being obstructed |
| What are the clinical signs of tracheal collapse? | mild=severe respiratory distress, exercise intolerance, abnormal respiratory sounds, stridorous breathing, cyanosis, syncope, open mouth breathing, abducted forelimbs w/labored breathing |
| How is tracheal collapse diagnosed? | Lateral radiographs, tracheal ultrasound, fluoroscopy |
| How is tracheal collapse treated? | conservative medical management, decrease respiratory irritants*, weight loss, surgical correction in the form of tracheal stents |
| What can increase the frequency/ severity of the clinical signs shown by a dog with tracheal collapse? | excitement, eating, drinking, tracheal compression (neck collar) |
| What are some of the abnormal respiratory sounds that can be heard with tracheal collapse? | wheezing, hacking, coughing |
| Is surgical correction with tracheal stents a surefire cure for tracheal collapse 100% of the time? | no, even after placement of tracheal stents, the trachea can collapse again either above or below where the stent is placed |
| What are the different types of respiratory emergencies? | obstructive, restrictive, lower airway diseases |
| What are the different restrictive respiratory diseases?? | Pleural space disease, pleural effusion, pulmonary edema, pneumonia, pneumothorax |
| How is pleural space disease characterized? | Short shallow breaths with intermittent attempts at deeper breaths, decreased/absent airway sounds on auscultation |
| Pleural space disease can be caused by what? | pleural effusion, thoracic wall injuries/trauma |
| If Pleural space disease is caused by fluid, airway sounds will be decreased where? | ventrally |
| If Pleural space disease is caused by air (pneumothorax), airway sounds will be decreased where? | Dorsally |
| Absent airway sounds (no sounds anywhere) indicates what (in regards to pleural space disease)? | severe condition of either pleural effusion or pneumothorax |
| Flail chest results from what? | Fractures in 2 or more consecutive ribs in 2 places |
| What are the clinical sigs of pleural space disease? | Dyspnea, coughing, hemoptysis, cyanotic MM, hypoxemia, abnormal abdominal component on inspiration, hypoventilation secondary to pain, SQ emphysema, fractured ribs, tachypnea |
| What is hemoptysis? | The coughing up or exhalation of blood ( can be from nose or mouth) |
| What is subcutaneous emphysema? | A condition of air or gas being trapped under the skin |
| Weak pulses in a trauma patient should make one think what? | Pneumothorax |
| How is pleural space disease diagnosed? | Physical exam, abdominal palpation, Auscultation |
| What can be heard on auscultation with pleural space disease? | increased bronchovesicular sounds or crackles |
| When are bronchovesicular sounds considered normal? | When heard the 1st and 2nd intercostal spaces anteriorly and posteriorly between scapulae |
| How is pleural space disease treated? | Oxygen supplementation, analgesics +/- corticosteroid and antibiotic therapy depending on diagnosis |
| List non-invasive oxygen supplementation techniques | Flow-by, oxygen cage/incubator, oxygen canopy, oxygen mask |
| List invasive oxygen supplementation techniques | Nasal cannula, intubation, tracheostomy |
| What are the pros of using an oxygen cage? | 1 of the fastest ways to deliver oxygen to the animal, good for prolonged delivery of O2 and non-invasive, act as incubators for heat support as well |
| What are the cons of using an oxygen cage? | cages are expensive and use ALOT of o2, cage needs to be filled every time the cage is opened, cages must be calibrated every time it is turned off and back on |
| What is the oxygen rate for flow-by/oxygen mask supplementation? | 100-200ml/kg/min |
| What are the pros of using flow-by/ oxygen mask supplementation? | good for providing oxygen during initial evaluation period to stabilize or calm the patient down from being overstimulated with distress |
| What are the cons of using flow-by/oxygen mask supplementation? | requires restraint in an awake patient and is not well tolerated |
| Is flow-by/ mask supplementation always ran through the anesthetic machine? | no, you can use separate o2 lines w/ their own separate flow meters, masks can also be hooked up to an ambu bag for manual ventilation |
| How can you make an oxygen canopy? | E-collar wrapped with plastic wrap, place flow-by line into e-collar by coming up from under the chin, always leave an opening at the top for heated gasses and co2 to escape |
| When is an oxygen canopy a good option? | for large breed dogs that cannot fit in an oxygen cage, if the oxygen cages are occupied, during IVC placement, radiography, blood draws, etc... |
| What is nasal insufflation? | blowing are into the nasal cavity |
| How is a nasal cannula measured? | from the end of the nares to the bifurcation of the trachea, |
| What local anesthetic is used when placing a nasal cannula? | proparicaine is placed in both nares and allowed to sit 5-10mins |
| How is the nasal cannula held in place? Why? | using tape for suture wings and suturing each side to the animal, To keep nasal cannula secure and from falling out |
| Dogs with heart disease usually have a history of what? | coughing (moist, nocturnal) exercise intolerance, labored breathing, cachexia, +/- collapse/syncope |
| Dogs with what condition are often tachycardic at rest OR develop increased heart rate with mild exercise (walking)? | Congestive heart failure |
| Absent pulses and posterior paralysis can be seen in cats with what condition? | cardiomyopathy and saddle thrombus |
| What conditions can be indicated by a pulse deficit? | atrial fibrillation, premature beats, ventricular tachycardia |
| Jugular vein pulses and ascites may indicate what? | right sided heart failure |
| When performing CPCR what rate should breaths be given? | 1 breath every 3-5 seconds |
| When performing CPCR what rate should compressions be given?? | 80-100/min OR 2-3/second |
| What does a murmur sound like? | a whooshing noise, similar to that of a washing machine |
| What is a gallop rhythm? | A gallop rhythm has 3-4 sounds and resembles a horse galloping |
| What is an arrhythmia? | A condition in which the heart beats with an irregular or abnormal rhythm |
| When auscultating the heart, What are you listening for? | Murmurs, gallop rhythm, arrhythmias, muffled sounds, ALWAYS make sure you are listening to the lungs as well |
| What is an ECG/EKG? | Diagnostic tool that measures the electrical activity of the heart |
| What is an echocardiogram? | An ultrasound of the heart which helps to look for masses, evaluates valves and their function, thickness, and chamber size |
| Who performs and echocardiogram? | DVM/ Veterinary cardiologist |
| What is syncope? | fainting |
| Coughing cats usually have what? | Asthma or other pulmonary diseases |
| Cats with what condition are often hypothermic with a slow heart rate (100-120) with weak pulses? | Congestive heart failure |
| Heart murmurs are usually heard best where? Why? | low along the sternum, due to the position of the heart, lower in the chest |
| When performing an ECP the animal should be positioned how? | right lateral recumbency IF possible |
| If an animal is dyspenic, and unable to be placed in right lateral recumbency can we still obtain an ECG? | Yes, a standing ECG strip can be taken |
| What is an ECG used to evaluate ( not just electrical activity) | rhythm, identify P waves & QRS complexes and determine their relationship (P- wave for every QRS complex) as well as to classify arrhythmias and determine if treatment is needed |
| What sounds will often be heard with pulmonary edema? | crackles, wheezing |
| What is congestive heart failure? | A degenerative disease which cause the valve leaflets to become knobby and thickened, regurgitating blood causes enlargement of the left atrium and ventricle |
| What is the most common cause of CHF? | Mitral regurgitation |
| What breeds are predisposed to congestive heart failure? | Chihuahuas, King Charles cavalier spaniels, poodles, mini schnauzers, cocker spaniels, boston terriers and fox terriers |
| What % of small breed dogs over the age of 10 are affected by mitral regurgitation? | 30% |
| How do dos with CHF present? | Tachypnea, harsh lung sounds, inspiratory crackles that progress to crackles throughout respiration with a distinguishable heart murmur, |
| CHF dogs need what upon arrival at the clinic? | 02 supplementation, IVC, furosemide, nitroglycerine, blood pressure monitoring, +/- morphine |
| What is the dosage rate for furosemide (Salix, Lasix) in dogs w/ CHF? | 4-8MG/KG |
| What is the easiest way to administer nitroglycerine to cats? | gel that goes in the ear |
| What are the signs of canine dilated cardiomyopathy? | dyspnea, tachypnea, exercise intolerance, weight loss, ascites, syncope |
| What is significant about the weight loss seen with canine dilated cardiomyopathy? | it can be dramatic and sudden occurring over 2-3 weeks time |
| Canine dilated cardiomyopathy is most commonly seen in what type of dogs? | Dobermans, "giant" breed dogs and other misc. large dog breeds |
| Boxer cardiomyopathy is characterized by what? | severe ventricular arrhythmias and sudden death |
| If arrhythmias can be controlled what is the prognosis for a dog with DCM? | 1-3 YEARS before DCM and heart failure take them |
| What will you see upon physical exam of a dog with DCM? | Weak pulses, +/- pulse deficit, soft mitral or tricuspid murmurs, muffled heart and lung sounds (with pleural effusion) OR inspiratory crackles (with pulmonary edema) |
| In addition O2 supplementation and IVC, dogs with DCM need what? | furosemide, Dobutamine, digoxin (PO), procainamide for arrhythmias |
| What are the 3 kinds of feline cardiomyopathy? | Dilated, Hypertrophic, Restrictive |
| Dilated feline cardiomyopathy is caused by what? | taurine deficiency |
| Hypertrophic feline cardiomyopathy is most commonly seen in what cats? | middle age, fat male cats (PRESENTS WITH ACUTE ONSET OF SIGNS) |
| Restrictive feline cardiomyopathy is most commonly seen in cats that are? | middle age, or older |
| What causes restrictive feline cardiomyopathy? | muscles in the heart become fibrous |
| Feline heart disease can often lead to what? | feline thromboembolism |
| What is the classic presentation of feline thromboembolism a.k.a saddle thrombus? | posterior paresis, with weak of absent pulses in rear limbs, foot pads are pale, toe nail does not bleed when cut, |
| the calf and tibial muscles are rock hard by _________ post clot | 10-12 hours |
| What is the treatment for feline thromboembolism? | aggressive thrombolytic therapy |
| Aggressive thrombolytic therapy is only an option if the clot is recent, meaning how many hours post clot? | 2-4 |
| Even if aggressive thrombolytic therapy is initiated quickly after a clot is thrown, and the heart disease is manageable, the prognosis is still guarded, why? | |
| Name a cammon thrombolytic drug | Heparin |
| What is the most common site for feline thromboembolism to occur? | aortic trifurcation |
| Clinical signs of feline thromboembolism depend on what? | degree of heart disease and the site of the thromboembolism |
Created by:
Adeprey4311
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