A cat or a dog in respiratory distress can be one of the most daunting and stressful clinical presentations for any vet in general practice. Last week’s webinar led by Elke Rudloff DVM, DACVECC, CVMA offered practical tips on how to manage these cases efficiently and effectively and is a must see for anyone who wants to alleviate not only the respiratory distress of their patient but also the stress these type of cases can place on themselves.

Deciphering whether a dog or cat has pleural space disease was the first challenge addressed by Elke. Asynchronous breathing (the chest expanding and abdomen being pulled in during inspiration) and dull lung sounds are strong indicators of pleural space disease and should alert the clinician to investigate this area further. So what is the next step for this patient in severe respiratory distress? Do we try and x-ray them and find out out if pleural disease is present or do we perform a thoracocentesis? Elke’s advice is to avoid any form of unnecessary stress and placing a patient with respiratory problems in lateral recumbency for an x-ray may just push them beyond coping.  Thoracocentesis is a straightforward procedure which can be performed with minimal stress and can not only aid in making a diagnosis but can also aid in alleviating a patient’s respiratory distress. Elke demonstrated how to perform a thoracocenetesis in both a cat and a dog and gave some invaluable tips. One of those included adding saline to the hub of a 1.5inch 18 gauge needle which can then be introduced between ribs seven and nine of the dog. This drop of saline will then either be expelled or sucked in when this needle enters the pleural space giving a clear indicator of its correct placement. This technique is not so effective in the cat and Elke advised, for our feline friends, we should intermittently aspirate on introduction of the needle into the pleural space of the cat and once in the correct space the handler should either be able to aspirate air or fluid dependant on the underlying pleural space disease.

Ultrasound of the pleural space is another effective diagnostic tool which can be utilised with minimal stress to the patient. A T-FAST ultrasound can be performed where either an anechoic or complex fluid can be seen in the case of a pleural effusion or where the glide sign, which is seen as lung movement at the edge of a lung field, is not evident indicating the presence of a pneumothorax.

Pleural drainage is key to treating these cases and Elke dedicated the majority of her webinar to demonstrating the most effective techniques for successfully achieving this. Thoracocentesis has already been discussed but when repeated centesis’ are required or where larger volumes of either air or fluid need to be drained the placement of either a pleural catheter or a thoracostomy tube becomes necessary. Pleural catheters are smaller than a thoracostomy tube and are placed using the Seldinger technique which was demonstrated by Elke in a video. They are useful where repeated centesis is necessary and good for short term drainage but are not ideal for patients with pleural space disease where larger volumes of air or fluid need to be removed and in patients where more than or equal to 3 thoracocentesis’ are required over 24 hours. It is at this point that the placement of a thoracostomy tube becomes necessary and Elke once again demonstrated how to perform this technique on both a dog and cat in a video. She also explained that although general anaesthesia would give more control whilst performing tube placement, it is not necessary and often she will perform this technique using either butorphanol and or alfaxalone as sedatives alongside local anaesthesia.

This is a webinar which uses a lot of video aids to demonstrate how to perform a variety of techniques and can only really be appreciated by logging in and watching it. A number of practical tips were also offered and included how to choose the right sized thoracostomy tube (which should be between one third and one half the size of an intercostal space) and how to create the necessary tunnelling of the skin when placing a thoracostomy tube in a dog by having an assistant pulling the thoracic skin cranially. We know how daunting these cases can be and sometimes making the right decisions quickly, as is so often necessary in theses patients, can be challenging. For those of you who want to make this decision process easier and want to perfect their thoracocentesis and chest drain placement techniques  – this has to be the webinar for you.