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Questions and Answers
What is the primary function of the right atrium and right ventricle in the cardiovascular system?
What is the outermost layer of tissue in the wall of the heart?
What is the purpose of the valves in the heart?
Which of the following is NOT a part of the cardiovascular system?
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What is the term for the thin tissue or sheath that protects the heart?
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What is the primary function of oxygenation in the respiratory process?
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What is the consequence of high CO2 levels (above 50mmHg) in the blood?
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What is the primary goal of ventilation in the respiratory process?
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What is the primary indication for supplemental oxygen therapy in emergency patients?
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What is the primary consideration when selecting an oxygen delivery method for a patient?
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What is the primary consequence of cardiac tamponade?
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Which of the following is a common clinical sign of cardiogenic shock?
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What is the primary diagnostic tool used to diagnose pericardial effusion?
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What is the primary goal of initial stabilization in patients with pericardial effusion?
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What is the primary consequence of FATE in feline patients?
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What is a common feature of the affected limb in a patient with FATE?
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Which of the following diagnostic tools is used to determine if hypertrophic cardiomyopathy is present in a patient with FATE?
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What is the primary focus of ongoing management in patients with FATE?
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What is the primary goal of providing supplemental oxygen and sedation in dyspnoeic patients?
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What is the implication of delayed or inadequate treatment in respiratory patients?
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In respiratory compromised patients, what is the primary reason for placing IV access as soon as possible?
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What is a potential consequence of overheating and hyperthermia in patients with dyspnoea?
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Why is it important to avoid suctioning cats that are drooling or frothing at the mouth?
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What is an important part of ongoing care for dyspnoeic patients?
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What is the primary consideration when caring for patients in respiratory or cardiac distress?
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What is the main function of the atrioventricular (AV) valves?
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Which breed is particularly prone to heart murmurs?
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Which artery is unique in carrying deoxygenated blood?
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What occurs if the negative pressure within the pleural cavity is lost?
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What phase of respiration involves the rapid intake of air into the lungs?
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Which oxygen delivery method provides the highest FiO2?
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What potential risk is specifically associated with the flow-by method of oxygen delivery?
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Which complication can arise from pericardial effusion occurring rapidly?
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Which method of oxygen delivery is most appropriate for a patient simultaneously undergoing assessment and treatment?
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What monitoring should be performed every 4-6 hours on patients receiving oxygen therapy, if safe to do so?
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What commonly causes increased respiratory effort in dyspnoeic cats?
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Which clinical sign would most clearly indicate an upper airway cause of dyspnoea?
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Why is cyanosis a critical sign in both upper and lower airway causes of dyspnoea?
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Which sedation method is commonly used for dyspnoeic patients with brachycephalic obstructive airway syndrome (BOAS)?
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What clinical sign helps to differentiate between upper airway and cardiac-related dyspnoea in canine patients?
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Which medication should be administered with caution due to the risk of exacerbating issues in dyspnoeic patients?
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Why is it critical to secure the airway when an upper airway obstruction is suspected?
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What is the benefit of placing IV access as soon as possible in respiratory compromised patients?
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What should be avoided in cats that are drooling or frothing at the mouth to prevent further complications?
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Which of the following is not an indication for initial sedative therapy in dyspnoeic patients?
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What role does active cooling play in dyspnoeic patients, specifically those with BOAS?
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What is the critical action to take after initial stabilization of a dyspnoeic patient?
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To minimize stress in dyspnoeic patients post-stabilization, what is a recommended practice?
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What is a common consequence of dyspnoeic patients' inability to pant effectively?
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What should be the demeanor of the healthcare professional when obtaining a full TPR for a patient undergoing oxygen therapy and sedation?
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Study Notes
The Cardiovascular System
- The heart is a four-chambered muscle responsible for pumping blood via the circulatory system to the body.
- The heart consists of two atria, two ventricles, valves, nodes, arteries, and veins.
- The wall of the heart consists of three layers: outer epicardium, myocardium, and inner endocardium.
- The heart is protected by a thin tissue or sheath known as the pericardium.
Blood Flow through the Heart
- Deoxygenated blood from the body enters the right atrium via the inferior and superior vena cava.
- Blood then passes from the right atrium, through the tricuspid valve, and into the right ventricle.
- Blood then travels to the lungs via the pulmonary artery, where carbon dioxide is exchanged for oxygen.
- Oxygenated blood returns to the left atrium via the pulmonary veins.
- Blood then passes from the left atria, through the mitral valve, into the left ventricle.
- Blood then exits the heart via the aorta and is delivered to the body via the arterial system.
Normal Heart Rate Values
- Dog: 60-120 bpm (adult), >180 bpm (neonates), <60 bpm (bradycardia), >150 bpm (tachycardia)
- Cat: 160-200 bpm
The Respiratory System
- The respiratory system provides the body with oxygen and removes carbon dioxide.
- Oxygen travels down through the pharynx, into the trachea, and divides into left and right mainstem bronchi.
- Bronchi branch into bronchioles and clusters of alveoli, where gas exchange occurs.
- The right lung has three lobes, while the left lung is bilobar.
Oxygen Delivery Methods
- Flow-by: short-term use, 25-40% FiO2
- Mask: 50-70% FiO2, suitable for obtunded patients
- Hood: 30-40% FiO2, suitable for patients who can't tolerate masks or nasal lines
- Cage: 95% FiO2, suitable for stressed patients
Congestive Heart Failure
- Leading cause of morbidity and mortality in small animal patients
- 80% of acute cases can survive with treatment
- Long-term prognosis: less than 2 years with treatment
Pericardial Effusion
- Accumulation of fluid in the pericardial space
- Causes restriction on the heart's ability to contract normally
- Can lead to cardiac tamponade, cardiogenic shock, and death
- Causes: neoplasia, idiopathic, inflammatory, infectious, congenital
- Clinical signs: weakness, lethargy, cough, tachypnoea, syncopal episodes
Feline Aortic Thromboembolism (FATE)
- Embolization from a thrombus in the left atrium
- Can cause occluded blood supply to the limbs
- Clinical signs: severe pain, hyperventilating, crying, acute non-weight bearing lameness
- Diagnosis: based on clinical signs, lack of peripheral pulses, hypothermia, echocardiography, and abdominal aortic scanning
Caring for the Dyspnoeic Patient
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Upper airway: mouth, nares, and larynx
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Lower airway: trachea and lungs
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Dyspnoea implies significant respiratory impairment### Appropriate Intervention in Respiratory Patients
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Delayed or inadequate treatment can lead to death in respiratory patients, emphasizing the need for rapid and logical intervention.
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Stabilization is the top priority, which includes providing supplemental oxygen and sedation (when indicated) to reduce stress and improve oxygen levels.
Common Causes of Dyspnoea
- Upper Airway:
- Brachycephalic obstructive airway syndrome (BOAS)
- Elongated soft palate
- Laryngeal paralysis
- Foreign body
- Neoplasia
- Infection
- Lower Airway:
- Tracheal collapse
- Hypoplastic trachea
- Airway foreign bodies
- Pulmonary oedema (cardiac or non)
- Pneumothorax
- Bronchopneumonia
- Pulmonary fibrosis
- Pulmonary haemorrhage
- Pulmonary neoplasia
- Feline asthma syndrome
- Thoracic Space:
- Pleural space/chest wall disease
- Pleural effusion
- Trauma
- Paralysis
Approach to the Dyspnoeic Patient
- Clinical Presentation:
- Patients often exhibit obvious respiratory distress, including extended head and neck, external rotation of elbows, and stress.
- Cats may hide signs of illness, making them more susceptible to stress and tip-over.
- Clinical Signs:
- Increased respiratory rate (tachypnoea)
- Tachycardia (or sometimes bradycardia)
- Mild to severe respiratory effort
- Cyanotic, muddy, or injected mucous membranes
- Hypoxaemia (SpO2 < 93%)
Stabilization and Initial Treatment
- Dyspnoeic patients require sedation, minimization of stress and handling, and oxygen therapy as initial treatment.
- Minimize stress by approaching patients calmly, reducing noise, and using gentle handling/restraint.
- Don't immediately focus on obtaining a full set of vitals if not indicated, as this can exacerbate the patient's condition.
- Sedation choices depend on the patient's signalment, concurrent disease pathology, and IV access.
- IV access should be placed as soon as possible to provide access to further sedation, diuretics, or life-saving treatment.
Ongoing Care
- Investigate and treat the underlying cause of dyspnoea
- Provide ongoing oxygen supplementation
- Minimize stress and provide sedation when required
- Avoid hyperthermia
- Close monitoring of respiratory signs is crucial.
Oxygenation and Ventilation
- Oxygenation refers to the ability of the lungs to oxygenate the blood, measured by the concentration of dissolved oxygen in arterial blood (PaO2).
- Ventilation is the movement of air in and out of the lungs, with the goal of removing carbon dioxide.
- Inability of the lungs to oxygenate the blood and remove CO2 requires immediate intervention due to the toxic effects of CO2 and hypoxaemia.
Hypercapnoea
- CO2 above 50mmHg (normal range is 35-45mmHg) is considered Hypercapnoea and is indicative of a ventilation issue.
- Supplemental oxygen therapy cannot correct Hypercapnoea.
- Hypercapnoea may be permissive up to 60mmHg only if there are no signs of respiratory fatigue/failure, there is a sustainable breathing pattern, and there is no accompanying acidosis.
Hypoxaemia
- Hypoxaemia is described as low arterial oxygen (PaO2) in the blood.
- It is common in dyspnoeic patients and if not treated immediately will lead to hypoxia (reduced oxygen tissue perfusion) and death.
- Supplemental oxygen is needed in many scenarios in the emergency patient, especially in those with known respiratory pathology.
Oxygen Delivery Methods
- Flow-by: provides FiO2 25-40%, for short-term use only, and does not provide high-flow O2.
- Mask: provides FiO2 50-70% (when appropriately fitted), but may not be tolerated by awake patients and can cause CO2 rebreathing.
- Hood: provides FiO2 30-40%, but may not be tolerated, especially in cats, and can cause hyperthermia.
- Cage: provides FiO2 95, but requires monitoring of temperature and humidity.
Congestive Heart Failure
- Congestive heart failure is a leading cause of morbidity and mortality in small animal patients.
- Up to 80% of acute congestive heart failure cases can survive until discharge with appropriate treatment.
- Long-term prognosis is generally less than 2 years with treatment.
Pericardial Effusion
- Pericardial effusion is fluid accumulation in the pericardial space, causing restriction on the heart's ability to contract normally.
- Causes of pericardial effusion include neoplasia, inflammatory disease, and peritoneopericardial diaphragmatic hernia.
- Clinical signs include weakness, lethargy, and tachypnoea.
- Diagnosis is via ultrasound or radiographs, and treatment involves pericardiocentesis.
Feline Aortic Thromboembolism (FATE)
- FATE occurs when an embolus from a thrombus in the left atrium lodges in a smaller vessel, causing occlusion of peripheral blood supply.
- Clinical signs include severe pain, hyperventilating, and crying, with acute non-weight-bearing hindlimb lameness.
- Diagnosis is based on clinical signs, evidence of extreme distress, and lack of peripheral pulses.
Caring for the Dyspnoeic Patient
- Dyspnoea is a common clinical presentation in patients with respiratory disease, implying significant respiratory impairment.
- Appropriate and rapid intervention is crucial, as death is often the consequence of delayed/inadequate treatment in respiratory patients.
- Stabilization is critical, and providing supplemental oxygen and sedation (where indicated) is immensely valuable.
- Understanding the common causes of dyspnoea and their clinical presentations is fundamental to intervention and survival.
Approach to the Dyspnoeic Patient
- Clinical presentation may include tachypnoea, tachycardia, and cyanosis.
- Clinical signs of upper airway, lower airway, and cardiac-related dyspnoea are distinct and must be differentiated to provide appropriate treatment.
- Stabilization and initial treatment involve providing oxygen therapy, sedation, and minimizing stress.
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Description
This quiz assesses your knowledge on providing nursing care to emergency patients with respiratory or cardiac diseases. Topics covered include normal heart and lung function, oxygen delivery methods, and recognizing common cardiac emergencies.
