Approach to Dyspnoea in Dogs & Cats (PDF)

Approach to dyspnoea including common conditions in dogs and cats Simon Cook BSc BVSc MVetMed DACVECC DECVECC FHEA MRCVS Lecturer in Emergency and Critical Care [email protected] January 2024 Learning outcomes Develop a rational approach t...

Approach to dyspnoea including common conditions in dogs and cats Simon Cook BSc BVSc MVetMed DACVECC DECVECC FHEA MRCVS Lecturer in Emergency and Critical Care [email protected] January 2024 Learning outcomes Develop a rational approach to the investigation of signs of respiratory disease in small animals including dyspnoea Recognise differences in signs and diagnostic findings associated with upper respiratory tract disease, obstructive disease, pulmonary parenchymal disease and pleural space disease Recall and begin to prioritise management techniques for the common differential diagnoses in cats and dogs with dyspnoea. Appreciate the indications and importance of point of care ultrasound (POCUS) in respiratory patients, as well as recognising basic images. Rational approach - preparation Oxygen QUIET IV catheter trays prepared PRIMUM NON Quiet clippers NOCERE Thoracocentesis kits Ultrasound (Rushing, stressing, presuming intervening without stabilizing, being (Crash kit) too aggressive in handling or interventions, being unprepared…) Rational approach - Oxygen supplementation 25-30% 80-100 Dyspnoea – Difficult or laboured breathing Sensory experience (pain, nausea, thirst, hunger) Hypoxaemia and hypercapnia (decr O2, incr CO2) Concurrent pain may increase the perception of dyspnoea Lookalikes – examine your patient and complete the history! Cardiovascular instability Acid-base disorders Intracranial disease Drugs (eg opioids) Behavioural/environmental eg. response to fear, pain, anxiety, hyperthermia Methaemoglobinemia Observe your patient Remove from waiting room (/owner!) at triage Consent Observe from a distance or with minimal restraint ***Bare in mind amount of Attempt to localise… effort when deciding if breath “Upper” resp tract sounds are “Lower” resp tract increased/decreased*** Pulmonary parenchymal Pleural space Thoracic wall/diaphragm Observe your patient - localisation Inspiratory effort associated with extra-thoracic (upper) airway disease Expiratory effort associated with intrathoracic (lower) airway disease (eg asthma) Asyncronous/inverse breathing patterns with decreased lung sounds associated with pleural space disease Dull heart/lung sounds associated with pleural space disease Increased/moist auscultation findings associated with parenchymal disease Observe your patient ***Common things are common*** History What specific questions and why? Indoor vs outdoor – exclude trauma if possible Historical coughing/wheezing? Current medications or recent illnesses Subtle changes over previous few days? Recent surgery/anaesthesia or ‘insignificant’ trauma/event Complete the history later on. “Upper” respiratory tract Laryngeal paralysis Brachycephalic obstructive airway syndrome Polyps (cats) Viral infections (cats) Neoplasia (eg lymphoma, squamous cell carcinoma) Inspiratory dyspnea How does signalment help? Ageing large breed dogs (Labradors) with laryngeal paralysis? Brachycephalic conformation (French/English Bulldogs)… Fghj BOAS Fghj “Lower” respiratory tract (obstructive?) Feline inflammatory lower airway disease Tracheal/bronchial collapse Bronchitis Cough Systemically well Expiratory wheezes How does signalment help? Siamese cats with asthma? Yorkshire terriers with tracheal/bronchial collapse? “Lower” respiratory tract (obstructive?) “Lower” respiratory tract (obstructive?) Pulmonary parenchymal disease Pneumonia (Bacterial, viral, parasitic) Pulmonary oedema (cardiogenic vs non-cardiogenic? Neoplasia Contusions... May also cough How does signalment help? Cavalier King Charles Spaniels with congestive heart failure? Infectious causes potentially more likely in young animals? Dyspnoea in vomiting dogs à aspiration? Pleural space disease Pneumothorax Pleural effusions Chylothorax Pyothorax? Haemothorax? Exfoliative neoplasia? Congestive heart failure (cats, transudate/modified transudate) How does signalment help? Spaniels with pyothorax? Young, scavenging dogs ingesting rodenticides à haemothorax? Youg purebred cat with elevated globulins? à FIP? Pleural space disease Pleural space disease Thoracocentesis Ribs 7-9, cranial to rib – avoid VAN Dorsal for gas, ventral for fluid U/S guided if necessary Tips U/S guidance Rotate bevel Flush back Pleural space disease -Pyothorax Learning outcomes Develop a rational approach to the investigation of signs of respiratory disease in small animals including dyspnoea Recognise differences in signs and diagnostic findings associated with upper respiratory tract disease, obstructive disease, pulmonary parenchymal disease and pleural space disease Recall and begin to prioritise management techniques for the common differential diagnoses in cats and dogs with dyspnoea. Appreciate the indications and importance of point of care ultrasound (POCUS) in respiratory patients, as well as recognising basic images.  Point of Care Ultrasound (bedside) Point of Care Ultrasound (VetBLUE) (focused ultrasound) (TFAST) Point of Care Ultrasound (POCUS) is a goal directed, focused ultrasound examination that answers brief and important clinical questions The Neuromuscular System: LMN Patient side ultrasound Fghj Aims of Thoracic Point of Care Ultrasound Pleural/pericardial effusion Pulmonary parenchymal disease (B-lines) Pneumothorax (Glide Sign) Global heart assessment including LA:Ao The Neuromuscular System: LMN Fghj 33% of non-traumatised cats and dogs had a cavitary effusion 75% of unstable patients had a cavitary effusion 9% of stable patients had a cavitary effusion The Neuromuscular System: LMN Fghj  Normal lung: PP line: pulmonary- pleural interface A-lines: Reverberation artefact Glide sign: air filled lung movement - excluding pneumothorax B-lines Glide sign Rules out pneumothorax at that site Fghj 7m FN DSH 2 weeks post neuter Fghj L L R Non-cardiogenic pulmonary oedema Fghj Non-cardiogenic pulmonary oedema Fghj Aspiration Aspiration Oesophageal FB + aspiration Conclusions Interrogate the history Observe your patient from a distance, try to localize Get a true resting respiratory rate! Practice point of care ultrasound Feel free to call for advice! Summary: One health relevance of topics discussed § Significance to animal health and welfare Emergent investigation and management of dyspnoea will improve animal health and welfare § Significance to public health A rational approach to dyspnoea will minimise antimicrobial prescription § Significance to ecosystem health A rational approach to dyspnoea will minimise antimicrobial prescription