SA Surgery Final > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

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1
Q

Green LO How do you examine a patient in mild to moderate dyspnea?

A
  • No more stress!
  • Allow to assume preferred position
  • Respiratory rate and breathing effort observed from a distance
  • If severely dyspneic or cyanotic important to do emergency treatment before complete PE
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2
Q

How does chronic disorder become an emergency?

A
  • Heat, humidity, excitement, and stress
  • Anatomic obstruction or other
  • Hypoventilation and accumulation of CO2
  • Respiratory acidosis
  • Vigorous breathing (negative pressure)
  • Lowered airway pressure
  • Edema and eversion of laryngeal saccules
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3
Q

Why is it so important for a dog that has turbulent breathing to breathe more slowly?

A
  • Turbulent airflow creates an obstruction of sorts

- Vs laminar airflow which is smooth

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4
Q

Green LO If you need to provide emergency treatment in severely dyspneic animals with UAO, what are the components of such treatment?

A
  • Oxygen and cooling
  • Sedation (IV opioids and acepromazine in dogs; acepromazine in cats)
  • Steroids (dexamethasone SP or prednisolone
  • Dexmedetomidine
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5
Q

How responsive to steroids is laryngeal edema?

A
  • VERY steroid responsive
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6
Q

What to do if dyspnea is not improving after oxygen, cooling, sedation, and steroids?

A
  • Intubation then assess if the obstruction can be immediately resolved
  • If not, tracheostomy
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7
Q

Why do animals that have small airways tend to become hyperthermic?

A
  • AIrflow is important for cooling
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8
Q

Why can overzealous IV fluids be harmful in patients with upper airway obstruction?

A
  • Laryngeal edema!

- If you over-hydrate them, that can be exremely problematic

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9
Q

Clicker question Which of the following IS a fundamental emergency treatment for upper airway obstruction?

A. Antibiotics
B. Sedation
C. IV fluids
D. Bronchodilators

A

B. Sedation

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10
Q

Green LO What are the clinical signs of moderate to severe dyspnea? List 4.

A
  • Noisy breathing
  • Gagging, retching
  • Swallowing problems
  • Exercise intolerance
  • Cyanosis
  • Restless sleep
  • Collapse
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11
Q

Green LO Do an air temporary tracheostomy

A
  • Midline skin incision
  • Separate the sternohyoid muscles
  • Retract carefully
  • Place circumcostal stay sutures - keep caudal
  • Transect less than 50% of circumference of trachea; can also make an elliptical incision (dogma is between 3 and 4 but can take awhile)
  • Compress cranially with a hemostat when inserting the tube
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12
Q

What anatomy do you need to be careful with when doing a temporary tracheostomy?

A
  • Thyroid glands
  • Carotid artery
  • Vagosympathetic trunk
  • Recurrent laryngeal nerve
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13
Q

Blue LO WHat is the name of the nerve which arborizes to become the caudal laryngeal nerve?

A
  • Recurrent laryngeal nerve
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14
Q

Green LO During which circumstance does one inflate the cuff on a tracheostomy tube?

A
  • Do not cuff unless anesthesia/ventilation (tracheitis or ischemia)
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15
Q

Which type of tracheostomy tube is easier to clean?

A
  • Double lumen
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16
Q

How big should the tracheostomy tube be?

A
  • <50% of trachea diameter ideally, but really shoot for <75%
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17
Q

Green LO How do you care for a case with tube tracheostomy? Provide 3 different principles - no added detail like timing and doses are needed.

A
  1. Hand wash and exam gloves for skin care
  2. Avoid obstruction by suctioning as often as needed but not more or no less
  3. Humidification or 1-5 cc sterile saline instilled every 1-2 hours
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18
Q

How should a tracheostomy tube site be closed?

A
  • 2nd intention
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19
Q

Should you give prophylactic antibiotics with a tracheostomy tube?

A
  • No as that can promote resistant bacteria

- Biofilm formation

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20
Q

Clicker question Which of these statements correctly represent postop care of a tube tracheostomy patient?

A. Tube is always cuffed to protect the airway from aspiration

B. Care is often on an out-patient basis

C. Tube cleaning occurs once per day

D. Injection of 1 mL of saline in tube as often as needed to loosen secretions

A

??? Not sure

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21
Q

What are the four key modes of diagnosing an upper airway obstruction?

A
  • History and clinical signs
  • Physical examination
  • Radiographs (chest and cervical)
  • Nasal-oro-laryngeal examination
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22
Q

Green LO In addition to signs of respiratory distress, what clinical signs are common in the history of patients with an upper airway obstruction (UAO)?

A
  • Brachycephalic dogs > cats
  • Often <4 years
  • Noisy breathing
  • Gaggin, retching
  • Swallowing problems
  • Exercise intolerance*
  • Cyanosis*
  • restless sleep*
  • Collapse and death*
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23
Q

Describe an obstructive breathing pattern

A
  • Stertor (nasal/nasopharyngeal disease)
  • Stridor (pharyngeal/laryngeal/tracheal disease)
  • Pay attention to the inspiratory phase getting longer and more filled with effort
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24
Q

Describe a restrictive breathing pattern

A
  • Shallow, breathing faster than average

- Increased effort

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25
*Green LO* How soon do you extubate an upper airway obstructive patient after surgery?
- Wait as long as possible
26
*Green LO* What complication may a cuffed tracheostomy tube lead to if the cuff is inflated?
- Pressure necrosis of the tracheal mucosa or cartilages and stenosis of the trachea
27
*Green LO* What acutely and immediately life-threatening complication can occur after upper respiratory surgery and what is causing this complication?
- Laryngeal edema from the trauma of surgery - Be prepared for reintubation and tracheostomy - Careful feedings - Observe for upper airway edema for 24-72 hours - "No" IV fluids
28
Where can dyspnea localize?
- Upper airways (larynx? trachea?) - Small airways - Lungs - Pleura
29
What radiographs should always be done with upper airway obstruction and why?
- Chest and cervical radiographs | - Predisposed for aspiration pneumonia and looking for signs of esophageal disease
30
What is the association between upper airway obstruction and GI disease?
- Chronic upper airway obstruction can put a lot of pressure on the abdominal contents - Hiatal hernia could happen - GI lesions (esophagus, stomach, duodenu, inflammation) are common and secondary to UAO - Vomiting, regurgitation, and vasovagal syncope
31
What can happen to GI lesions with correction of the brachycephalic syndrome?
- Resolution
32
*Blue LO* How do you perform a laryngeal examination?
- Requires anesthesia - Hang upper jaw - Tongue depressor - Laryngoscope - Q-tips/suctioning - Endotracheal tube - Be prepared for surgery
33
Why is anesthesia required for oro-laryngeal examination (skipped)?
- Laryngeal reflex is vigorous and prohibiting manipulation in awake or sedated animals
34
Why is anesthesia risky in cases of UAO?
- Anesthesia hinders the animal's adaptation to living with an obstructed airway
35
*Green LO* What PE findings are signs of increased inspiratory effort? List at least 5.
- Retraction of lip commissures* - Open-mouth breathing or constant panting* - Forelimb abduction - Exaggerated use of abdominal muscles - Paradoxical movement of the thorax and abdomen - Recruitment of accessory respiratory muscles* - Inward collapse of the intercostal spaces and thoracic inlet - Orthopneic posutre (extended head and neck; broad stance; and reluctance to lie down)* - Extended neck* - Hyperthermia as a result of ineffective cooling may happen - Mucous membranes can be normal to pale or cyanotic depending on severity
36
*Green LO* What is often the mental status of a patient with an UAO?
- I think depressed?
37
*Green LO* Name one common abnormality of TPR (excluding changes of breathing pattern) which often is noted in acute UAO?
- Hyperthermia
38
What age of animal benefits from upper airway surgery?
- Benefits all ages if obstructed
39
Why are candidates for surgery of the upper airway at such high risk under anesthesia?
- During all stages (sedation, induction, recovery) | - Defense mechanisms to keep the airway open are hindered
40
What steps to take in surgery to minimize complication risks with UAO?
- Gentle tissue handling (minimal handling and suctioning) - Avoid electrocautery (laser or CO2 is advantageous - Monitor oxygenation
41
*Green LO* List the 5 classic and common concurrent components of brachycephalic airway syndrome.
Classic: 1. Elongated soft palate 2. Stenotic nares 3. Everted laryngeal saccules Concurrent: 1. Hypoplastic trachea 2. Aryepiglottic collapse 3. Nasopharyngeal turbinates that are crowded (new)
42
*Green LO* Which is the most common component of brachycephalic airway syndrome?
Elongated soft palate
43
*Green LO* What disease complex is everted saccules the first stage of?
Laryngeal collapse
44
*Green LO* What medical management can be recommended in cases of mild UAO? List 3 principles.
- Weight loss (fat deposits) - Temperature control - Exercise restrictions - Humidity control - Steroids as needed
45
*Clicker Question* Is surgery of brachycephalic airway syndrome indicated even in mildly affected dogs? A. Yes because the disease is progressive B. No because the surgery is risky C. Yes because the disease is progressive and long-term complications are rare. D. No because the clinical signs are too mild.
A. It's not low morbidity surgery, but this is a progressive disease
46
At what point does surgery become a necessity for brachycephalic airway syndrome?
- Ideally preventive, but at the point where they have exercise intolerance is a big part of it.
47
When is surgery recommended for BAS?
- Surgery EARLY in life - Better prognosis if <2 years of age? - Correct at any age if obstructed - Owners often are not aware - Educate your clientele
48
Pathophysiology of stenotic nares
- Nasal cartilages too soft | - Medial collapse (inspiration especially)
49
Where should the soft palate stop?
- At the caudal tonsilar crypt
50
What happens if you resect too much soft palate?
- Nasal regurgitation
51
What can happen if you resect too little soft palate?
- No relief
52
Everted laryngeal saccules - what is the correction?
- Resection
53
*Blue LO* Which 3 surgical procedures are recommended before 2 years of age in animals with BAS?
- Soft palate resection - Resection of everted laryngeal saccules - Widening of stenotic nares
54
What complications must you be prepared for post-op with BAS?
- Edema, swelling --> obstruction - Hemorrhage --> coughing and obstruction - Be prepared for emergency tracheostomy
55
How well do patients do with BAS surgery long term?
- 90% do well long-term | - Really depends on how they were doing before surgery
56
*Blue LO* What other organ system may have to be concurrently treated for success with BAS?
- Not sure? - Turbinectomy? - 32% of brachycephalic dogs have nasopharyngeal turbinates that reflect back out - Resection may lead to reformation though
57
*Blue LO* What is the outcome of BAS without sx treatment?
- Guarded usually because respiratory signs and laryngeal collapse progress over time - If advanced laryngeal collapse has developed, the prognosis is often poor unless additional surgery is considered
58
*Blue LO* What is the most common mechanism for development of laryngeal collapse?
- Advanced form of brachycephalic airway syndrome - Thought to be malacia due to over-pressurizing - If they have laryngeal collapse it won't get better on its own
59
*Blue LO* Which surgical procedures led to clinical improvement in 84% of cases with concurrent laryngeal collapse?
- Permanent tracheostomy? I have no idea - check
60
What are the three stages of laryngeal collapse?
1. Everted laryngeal saccules 2. Aryepiglottic collapse 3. Corniculate collapse
61
Which muscle is the abductor muscle for the larynx? What nerve innervates this muscle?
- Only abductor is the dorsal cricoarytenoid | - Innervated by the recurrent laryngeal nerve (caudal laryngeal nerve)
62
*Green LO* Which laryngeal muscle atrophies in many cases of laryngeal paralysis (LP) and which nerve innervates this muscle?
- Cricoarytenoideus dorsalis | - Innervated by the recurrent laryngeal nerves
63
Which two nerves innvervate the larynx?
- Cranial laryngeal nerve and caudal laryngeal nerve (recurrent vagal) - Both come off the vagus
64
Which neuropathies are associated with lar par?
- Masythenia gravis - Trauma (iatrogenic) - Hypothyroidism - Chronicpolyneuropathy - Lead nad OP toxicity - Retropharyngeal infection - Congenital (or young dog) neuropathy (Bouviers, Huskies, Rottweiler, Dalmatian, Pyrenean) - inherited - Usually <1 year
65
*Green LO* What is the cause of Laryngeal paralysis in most cases of LP?
- Chronic polyneuropathy
66
*Green LO* Why are radiographs indicated in LP when they are not diagnostic for the disorder?
- Looking for two things: - Megaesophagus - Aspiration pneumonia
67
Presentation of laryngeal paralysis
- Old large breed dogs - Slow progression (months to years) - Voice changes - Gagging and coughing when eating or drinking - Exercise intolerance - laryngeal stridor - Collapse or acute dyspnea
68
WHat is the line in the sand where laryngeal paralysis is generally considered to be recommended for surgery?
- Exercise intolerance
69
Diagnostic goals for laryngeal paralysis
1. Verify diagnosis 2. Look for underlying reason to treat (but return to laryngeal function is uncertain) 3. Identify concurrent diseases or complications to know if anesthesia is safe
70
How to verify diagnosis of laryngeal paralysis?
- LIGHT anesthesia - Assistant is necessary - Ensure they are light enough by touching the arytenoid cartilages with a Q tip to ensure the laryngeal reflex is working - Give Dopram as a central stimulator of breathing
71
*Green LO* Which is the most common breed affected by LP?
- Labrador retriever
72
*Green LO* Which type of scope is usually best for laryngeal examination?
- Rigid laryngoscope
73
*blue LO* When and why would you use Doxapram in the diagnosis of UAO?
- Suspect laryngeal paralysis
74
*Green LO* What laryngeal movements can be mistaken for normal movement? How do you differentiate between these?
- Paradoxical vocal fold movement may occur and may be confused with normal movement - However, a normal larynx maximally abducts during inspiration, not expiration
75
*Black LO* In which patients are surgery recommended for laryngeal paralysis?
- Only those with exercise intolerance
76
*Black LO* Which surgery is the best choice in most dogs and cats with LP?
- Unilateral arytenoid lateralization - Goal is to open rima for airflow without exaggerating aspiration of food or saliva - Requires trained surgeon
77
*Black LO BUT important* Which is the most common complication (any time after surgery - not only early on) after surgery for LP?
- Aspiration pneumonia and can occur at any time
78
*Clicker Question* Is surgery of laryngeal paralysis indicated even in mildly affected dogs? A. No because the sx carries high risk for long-term complications. B. No because the clinical signs are too mild. C. yes because the disease is progressive. D. Yes because the disease is progressive, and the long-term complications are rare.
A. We wait until severe disease
SA Surgery Final
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