Does seeing dyspneic patients make you hyperventilate? Even the most seasoned emergency room veterinarian can become tachypneic when a patient presents in respiratory distress. In this VETgirl blog, we will review 3 pearls of wisdom to help you better assess and treat patients that present in respiratory distress.
PEARL #1: Use the tools you brought to work…
Especially in our feline patients…when they present in severe respiratory distress, their last wish is to be strapped down to a radiograph table for thoracic x-rays. They were distressed at home, distressed in the transport cat carrier, distressed in the car, and now stressed during the ER evaluation. In these patients there are several phrases I like to use, “slow down to speed up” and “an answer in a deceased patient does no good for anybody.”
Before you even stress the patient with a hands-on evaluation, take a step back and watch and think about the patient. How are they breathing?
Upper airway disease (stertor, stridor, inspiratory effort)
- Brachycephalic airway disease
- Laryngeal paralysis
Lower airway disease: (cough, wheezing, increased bronchovesicular sounds)
- Feline asthma
- Chronic bronchitis
Lung (pulmonary parenchyma) disease: (increased bronchovesicular sounds, crackles, rapid shallow breathing)
- Pulmonary fibrosis
- Congestive heart failure
Pleural space disease: (dull lung sounds on auscultation, muffled heart sounds, restrictive, shallow respiratory pattern)
- Pleural effusion
In these patients, rushing them to the radiology room in your practice may push them over the edge, leading to increased morbidity and even mortality. Use your senses, your eyes to examine their breathing pattern and your auscultation abilities to determine if there is evidence of pleural space or pulmonary parenchymal disease.
As pleural space disease (i.e. pleural effusion) is a very common cause of respiratory distress in cats, consider both a diagnostic and therapeutic thoracocentesis rather than diagnose a clinically significant effusion on a patient in respiratory distress radiographically.
PEARL #2: Being more comfortable with needles…
As discussed above, pleural space disease such as pleural effusion and pneumothorax is a common cause of respiratory distress in small animal medicine. Rather than diagnose this via radiographs, the clinician should be comfortable with their triage and examination assessment, visual inspection, and auscultation. Moreover, not only may your thoracocentesis be therapeutic, but it may also be diagnostic and life saving for your patient.
Especially if the patient presents in respiratory distress with a short and shallow, restrictive breathing pattern, dull and muffled lung and heart sounds, and suspicion of pleural space disease, a thoracocentesis should be considered.
PEARL #3: Oxygen is your friend…
Oxygen supplementation is one of the mainstays of therapy for a patient with respiratory difficulty. Initially, as clinicians we often provide oxygen via face mask or flow-by to permit an initial assessment. While oxygen cages may allow a higher percentage of oxygen to be delivered, it is difficult to assess the patient once in the closed oxygen cage, and therefore placement into the oxygen cage is often delayed until after initial assessment has been performed.
Moreover, prior to sedation or anesthesia, preoxygenating for at least 5 minutes increases the reservoir of the lungs and replaces the air with 100% oxygen. Especially in cats where intubation is often difficult, any degree of pulmonary disease, airway obstruction, difficult intubation, or even apnea may lead to decreased oxygenation and ventilation. In these cases, preoxygenation may increase the pulmonary oxygen reservoir and permit a lapse of 3–4 minutes before the patient becomes hypoxic, as compared to the 90 seconds it will take a non-preoxygenated patient breathing room air to become hypoxic.
Remember...slow down to speed up!
Hopefully these VETgirl PEARLS make YOU less tachypneic next time a respiratory distress patient shows up at your clinic doors!