ventilation
Side effects of positive pressure ventilation? (2) what is the most common ventilator used in vet med?
decrease CV function (lower CO, hypotension)
Decrease FRC
Ascending bellows (hallowell) (ascending have some PEEP, descending bellows don’t, special ventilator = tafonius in LA, no bellows, piston driven)
oxygen therapy minimum for hypoxemia, also what causes of hypoxemia does it target?
FiO2 greater than or equal to 0.3 (flow at least 50-100ml/kg/min), treats hypoxemia due to low FiO2, v/q mismatch, diffusion impairment, and hypoventilation (does not tx right to left shunt)
greater than 250mmhg can cause oxygen tox
true or false: cyanosis is the only way to tell hypoxemia
false cyanosis is when patient is severely hypoxemic (pao2 less than 60, or spo2 less than 90%)
tx for tracheal collapse
anxiolytic meds and cough suppressant, anti inflam like pred, abx if secondary inf present
how to treat stable patient with resp infection? moderate clin signs? critical patient?
1: amoxiclav OR doxy (monotherapy)
2: same as before (monotherapy) or amoxiclav OR clind AND enrofloxacin OR amikacin (dual therapy)
3: dual therapy, but consider parenteral admin
7-10d
What is the function of PEEP?
Reinflate collapsed alveoli (prevent de-recruitment, keep some air in lungs, wont allow you to expire everything)
antitussive: MOA, drugs (3), side effects
most work directly on cough center, can also work on mu and kappa opioid receptors in airways to inhibit cough reflex and laryngeal spasm
drugs: hydro/oxy- codone, codeine, torb
typical opioid effects and sometimes paradoxical excitement
emergent approach physical assessment and sedation
LPEFOTCRS (limited physical exam, focus on the cardio respiratory system); usu safe to use torb, alternate option is ace but may cause hypotension so caution in shock
canine chronic bronchitis tx
is it the same for feline asthma?
same for eosinophilic bronchopneumonopathy?
idiopathic pulmonary fibrosis?
reduce inflam (environment, glucocorticoids), control cough (dont eliminate, give hydrocodone), improve exercise tolerance (manage obesity), slow progression (same as reducing inflam)
feline asthma: same, control bronchoconstriction acutely (inhaled bronchodilator) dont want to overdo or b receptors will downregulate
EBP: only need oral immunosuppressive steroids tapered down
ICPF: no treatment :( sad westie dz, can use steroids and theophyliline to reduce cough but only when symptomatic, can do proton pump inhibitor to reduce micro aspiration and sildenafil to manage pulm hypertension
monitor CRP - treat for 5-7 days post CRP normalization
What drugs decrease co2 responsiveness? (5)
opioids, a2 agonists, propofol, alfaxalone, inhalants
bronchodilators: MOA, drugs and their receptors/effects
relax bronchial smooth muscle. epi (non selective adrenergic alpha and beta agonist) anticholinergics (cholinergic stim causes bronchoconstriction, so anticholinergics block that to cause bronchodilation, also decrease mucous secretion in airways) b2 agonists like terbutaline, albuterol, and clenbuterol (bronchiole smooth muscle relax, bind mast cell for less inflam mediator release, uterine relax, more mucociliary clearance - DONT USE IN FOOD ANIMAL)
list 4 causes of respiratory distress from an anatomical perspective
extrathoracic airway dz, intrathoracic airway dz, pulmonary parenchymal dz, pelural space dz, chest wal, diaphragm/abd dz
pyothorax: who is the culprit for dogs and cats and how do you treat
cat: pasteurella, actinomyces, other oral anaerobes
dog: nocardia, other anaerobes
broad spec abx (like amoxiclab and fluroquinalone until culture comes back, place thoracostomy tube for drainage)
list 3 factors that do not affect the outcome of a patient with bacterial pneumonia
type of bacteria, monomorphic vs polymorphic bacterial infection, underlying cause of asp pneumonia (unless its something that can cause repeat infection like megaesophagus)
What are parameters for failure to oxygenate and failure to ventilate, and name 3 causes for each.
failure to ventilate: paco2 >60 (CNS: drugs, peripheral neuropathy, trauma, pain; anatomic: pneumothorax, trauma, pleural fluid, space occupying mass)
Failure to oxygenate: pa02 <60 (v/q mismatch, hypo ventilation, r->l shunt, low FiO2, diffusion impairment)
how much inhaled drug gets to lung and what is the best way to get there?
20% (impaction is large particles, sedimentation is middle, diffusion is small - makes it all the way down)
treatment for the different types of shock
hypovolemic: fluids, blood
obstructive: fluids, relieve obstruction
maldistributive: fluids, pressors
cardiogenic: positive inotrope, anti arrhythmic, NO FLUIDS
anemic: RBC
hypoxemic: o2, ventilation
metabolic: dextrose (hypoglycemia), symptomatic supportive care
describe the stage of laryngeal collapse that can be treated without a permanent trach
stage 1: everted laryngeal saccules can be treated by removal (stage 2 = medial displacement of cuneifom process, stage 3 = corniculate process collapse and airway obstruction)
drug options for fungal infection (3)
azole antifungals (block cell wall production by inhibiting cytochrome P-450 enzyme; ketoconazole - largely replaced by itraconazole since it is less toxic; itraconazole - oral only, doesnt enter eye or urine or cns; fluconazole - attacks crypto, blasto, coccidia, and histo. ASPERGILLUS IS RESISTANT.; voriconazole and posaconazole are new)
amphotericin B (binds fungal cell membrane and causes ion leak, activity against all major SA fungal pathogens, must be IV)
terbinafine (blocks lanosterol and ergosterol synthesis of fungal cell wall, oral dog use only, good for ringowrm and malassezia)
What are the 2 most important factors for o2 delivery?
CO and Hb
DO2 = CO * [(1.39*Hb*SaO2) + (0.003*PaO2)]
Hb is 1/3 of PCV
1: Caffeine, theobromine, and theophylline are all what class of drug, and list 2 clinical effects of that drug class
2: prednisolone/prednisone and fluticasone are what class of drug, and what is their clinical effect
3: doxapram - what is it and what does it do
1: methylxanthines; bronchodilation, anti-inflam (common in LA, not in SA; side effects are like drinking caffeine)
2: glucocorticoids; anti-inflam (systemic effects if PO, bronchial if inhaled - prevent transcription of genes that produce mediators of airway inflam) used to treat chronic airway dz
3: resp stimulant (centrally acting, inhibits k channels on carotid body cells, increasing sens to co2), reversal of anesthetic induced resp depression
list adjective therapy for shock patient
analgesia (opioids), abx (concern for sepsis from GI translocation of bac), thermal support (part of lethal triad)
old dog comes in, neuro signs and long term history of dyspnea. what do you want to do and what is the most likely dx, how do you treat
bloodwork, chest rads, functional UAE, musk and neuro exam
sus of GOLPP
medical management with nsaids to decrease laryngeal swelling, lifestyle changes (harness walk only, keep BCS lean. if QOL is bad enough, gold standard sx is arytenoid lateralization unilateral, could also do a partial arytenoidectomy or a permanent trach
cat and dog resp worms and their treatments
cats: aelurostrongylus abstrusus (FEEMoS), eucoleus aerophilus (FEpMo)
dogs: eucoleus aerophilus (FEpMo), oslerus osleri (fbz), crenosoma vulpis (FMM)
only treat after abx have been tried and did not work