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Clinical approach to respiratory distress

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Abstract

Respiratory distress is a common presentation in veterinary medicine, and prompt, effective management is paramount. Treating these animals can be challenging, as many are too distressed to be handled extensively. Excessive manipulation can result in exacerbation of respiratory distress, haemoglobin desaturation and respiratory arrest. Thus, in unstable animals, it is very important to limit diagnostic testing. Instead, initial efforts should be focused on stabilization and application of non-specific respiratory support modalities, such as oxygen supplementation. The history and signalment, observation of the pattern of respiration, and a brief physical examination are all used to make a clinical estimate of the anatomical location of disease within the respiratory tract, thereby directing effective emergency therapy to stabilize the patient prior to diagnostic testing. Depending on the cause of respiratory distress, a variety of emergency interventions may be necessary, including drug therapy, tracheostomy, thoracocentesis or thoracostomy tube placement, and positive pressure ventilation. This chapter looks at Physiology; History; Initial observation; Physical examination; Initial stabilization; Initial management based on disease location; and Initial diagnostic tests.

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Figures

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1.1 Algorithm for the initial management of animals with respiratory distress.
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1.2 Severe respiratory distress due to neurogenic pulmonary oedema after a choking incident in a 6-month-old Golden Retriever. Note the pale mucous membranes, extended neck, abducted elbows and reluctance to have an oxygen mask placed over the face. (Courtesy of K. Drobatz and reproduced from the )
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1.4 Cyanosis in a young dog secondary to methaemoglobinaemia.
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1.5 Delivery of supplementary oxygen via a facemask in an hypoxaemic dog.
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1.6 Use of nasal oxygen prongs (arrowed) to deliver supplementary oxygen to a postoperative patient.
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1.8 Dogs and cats with upper respiratory obstruction may benefit from sedation. To optimize oxygenation and minimize resistance to air flow, the head and neck should be stretched out in a horizontal position, with the tongue pulled forward and the mouth propped open.
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1.12 Thoracocentesis being performed in a cat with pleural effusion.

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