Veterinario respiracion

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Proceeding of the LAVECCS
Congreso Latinoamericano de Emergencia y
Cuidados Intensivos
Sep. 2-5, 2009 - León, Guanajuato, México

www.laveccs.org
Next LAVECCS Congress:

3 – 5 June 2010 - Buenos Aires, Argentina

Reprinted in IVIS with the permission of the LAVECCS
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Reprinted in the IVIS website with
thepermission of LAVECCS

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Triage and Approach to the Patient With Respiratory Distress
Elisa M. Mazzaferro, MS, DVM PhD, Diplomate ACVECC
Wheat Ridge Veterinary Specialists, Wheat Ridge, CO, USA

Disorders of the respiratory system can broadly be classified based on the
location of the primary pathology. The clinician must first quickly assess thepatient from
afar, evaluating what respiratory pattern the patient is exhibiting. An obstructive
respiratory pattern is associated with inspiratory dyspnea, often with harsh upper airway
noise called stridor on inspiration. Diseases associated with upper airway obstruction
include laryngeal paralysis, tracheal collapse, oropharyngeal masses including polyps,
abscesses, cysts, foreign bodies,pharyngeal collapse and everted saccules, and
various forms of neoplasia. In many cases, animals with upper airway obstruction are
extremely stressed and may easily become hyperthermic due to anxiety and increased
respiratory effort.
In many cases of upper airway obstruction, supplemental oxygen and anxiolytic
agents such as acepromazine (0.025 - 0.1 mg/kg IV, IM) should be administered withminimal handling until the anxiolytics take effect. If the obstruction is life-threatening,
immediate airway control must be established. Intravenous anesthetic agents such as
propofol (4 - 7 mg/kg IV), Thiopental (8.8-13.2 mg/kg), or ketamine 5.5 mg/kg IV with
0.3-0.5 mg/kg diazepam IV) should be administered. The cause of the upper airway
obstruction can then be determined, airway controltaken through intubation or other
supportive measures, and a more complete physical examination be performed. Patient
signalment combined with a thorough history is often helpful in guiding your list of
differential diagnoses. How quickly have the clinical signs become apparent? Has there
been any change in bark or voice? Does the animal have difficulty swallowing? Are the
clinical signs worsewith exercise? Has there been exercise intolerance? Are there any
abnormal sounds associated with breathing? What does it sound like? A goose honk or
a harsh wheezing in the animal’s throat?
Larger, older breeds such as Labrador and Golden Retrievers are predisposed to
the development of laryngeal paralysis, although congenital forms have been
documented in Bouvier des Flandres and SiberianHuskies. Small breed dogs such as
Pomeranians and Yorkshire Terriers are predisposed to the development of tracheal
collapse. Bracycephalic breeds such as pugs, Pekingese and Boston terriers most
frequently develop bracycephalic airway syndrome with elongated soft palates, stenotic
nares, and hypoplastic tracheas. With time and chronicity, everted saccules and
laryngeal collapse may occur.Diagnostic tests that can cause stress to the patient should be avoided at all
costs until the patient’s respiratory status is more stable. Then, cervical and thoracic
radiographs should be performed, with fluoroscopy if possible to identify pharyngeal or
tracheal foreign bodies or the presence of a dynamic airway collapse. In cases where
laryngeal paralysis is suspected, evaluation of laryngealfunction should be performed
with the patient under heavy sedation. Following heavy sedation to induction of a light
plane of anesthesia, the larynx should be evaluated using a laryngoscope during all
phases of respiration. Doxapram hydrochloride ( 1 - 5 mg/kg IV) can also be used to
assess laryngeal function. Normally, the vocal folds and arytenoid cartilages abduct or
open in the airway...