Small Animal Respiratory Management Quiz

Approach to Dyspnea in Dogs and Cats

• Presentation covered a rational approach to investigating respiratory distress (dyspnea) in small animals.
• Learning objectives included developing a rational investigation approach, recognizing different respiratory tract diseases, prioritizing management techniques, and appreciating point-of-care ultrasound (POCUS).

Preparation for a Rational Approach

• Essential preparation includes having oxygen readily available.
• Prepare intravenous catheter trays, quiet clippers, and thoracocentesis kits.
• Ensure ultrasound and crash kit are on hand.
• Note that rushing, stressing, & aggressive interventions should be avoided.

Oxygen Supplementation

• Oxygen supplementation is a key part of the initial response to pets showing respiratory distress.
• Gradual increases in oxygenation are important, ranging from 25-30% up to 80-100%.
• This slide demonstrates different animal cases requiring varying levels of oxygen supplementation.

Dyspnea - Difficult or Labored Breathing

• Sensory experiences such as pain, nausea, thirst, or hunger can influence dyspnea perception.
• Hypoxia (low blood oxygen) and hypercapnia (high blood carbon dioxide) exacerbate dyspnea.
• Concurrent pain can increase the perceived severity of dyspnea.

Look-alikes and History

Look-alike conditions needing investigation include:

• Cardiovascular instability

• Acid-base imbalances

• Intracranial issues

• Medication reactions (e.g., opioids)

• Behavioral/environmental responses (fear, pain, anxiety)

• Methemoglobinemia

• Thorough history taking is vital; consider indoor/outdoor status to rule out trauma, historical coughing/wheezing, current medications, recent illness changes, and recent surgical/anesthesia events.

Observing the Patient

• Remove the patient from the waiting area at triage.

• Observe from a distance, aiming to localize the source of the respiratory distress focusing on:

  • Upper respiratory tract
  • Lower respiratory tract
  • Pulmonary parenchymal
  • Pleural space
  • Thoracic wall/diaphragm

• Breath sounds should be assessed to evaluate their intensity and effort required for breathing.

Localization of Respiratory Effort

• Inspiratory effort associated with extra-thoracic (upper) airway disease
• Expiratory effort associated with intrathoracic (lower) airway disease
• Asynchronous/inverse breathing patterns with reduced lung sounds point towards pleural space disease.
• Dull heart/lung sounds may accompany pleural space disease.
• Increased/moist auscultation findings suggest parenchymal disease.

"Upper" Respiratory Tract Conditions

• Laryngeal paralysis
• Brachycephalic obstructive airway syndrome (BOAS)
• Polyps
• Viral infections
• Neoplasias (e.g., lymphoma, squamous cell carcinoma)

"Lower" Respiratory Tract (Obstructive?) Conditions

• Feline inflammatory lower airway disease
• Tracheal/bronchial collapse
• Bronchitis
• Cough
• Systemically well animals with expiratory wheezing

Pulmonary Parenchymal Disease

• Pneumonia (infectious)
• Pulmonary edema (cardiogenic or non-cardiogenic)
• Neoplasia
• Contusions

Pleural Space Disease

• Pneumothorax
• Pleural effusions (chylothorax, pyothorax, haemothorax)
• Exfoliative neoplasia
• Congestive heart failure

Thoracentesis

• Thoracocentesis procedure uses ribs 7-9, cranial to the rib to avoid the VAN (vasculature).
• U/S guidance is beneficial.
• Tips for thoracocentesis include U/S guidance, bevel rotation, and flushing back.

Point-of-Care Ultrasound (POCUS)

• POCUS is a targeted ultrasound examination used to answer key clinical questions.
• Thoracic POCUS is used to assess pleural/pericardial effusions, pulmonary parenchymal disease (B-lines), and pneumothorax (Glide Sign).
• POCUS can be used to assess global heart function, including determining the relation between the aorta and left atrium.

Aspiration

• Aspiration involves foreign material entering the lungs, often indicated by X-ray images revealing diffuse interstitial markings

Conclusions

• Thorough history, patient observation from a distance, & identifying a true resting respiratory rate are essential steps.
• Point-of-care ultrasound (POCUS) is crucial for diagnostic investigation.
• Call for advice when necessary.

Summary (One Health Relevance)

• Improved animal health and welfare through prompt and accurate dyspnea investigation.
• Reduced antimicrobial prescriptions through proper diagnostic approach.
• Preservation of ecosystem health through minimized antimicrobial use.

Test your knowledge on the critical management steps for addressing dyspnoea in small animals. This quiz covers diagnostic techniques, differential diagnoses, and management strategies relevant to respiratory conditions in dogs and cats. Assess your understanding of how various factors contribute to respiratory distress.