Respiratory Distress in the Dog and Cat | Veterinary Videos & Podcasts

Good evening. My name is Josh Rayner, and I would like to introduce to you JHP recruitment. JHP recruitment are a specialist recruitment company within the veterinary industry.

We're able to provide both locum and permanent candidates of all levels. Our team has many years of experience within the sector, and we pride ourselves in providing a professional service. If you are a veteran, surgeon, veterinary nurse, veterinary care assistant, practise manager or receptionist seeking work in the veterinary industry, please feel free to get in contact via email or telephone.

I would like to welcome everyone currently logged in for this webinar, especially to all of those who have received complimentary tickets through JHP recruitment sponsorship. Thank you for all your continued support, loyalty and for your hard work be our agency. We hope you enjoy the virtual congress.

For those of you that aren't aware, the JHP team is currently made up of 14 consultants, including 2 who worked within the veterinary industry in a nursing capacity for many years. So we are well placed to assist you with any recruitment requirements. We've recently partnered with the webinar vet as we are keen to give something back to the fantastic candidates and locums who work with us.

We feel they are the perfect company to assist us with this. It would be great if you could visit our website after this webinar or pass our details on to a friend that may be interested. We're also on social media, so please do follow us on LinkedIn, Twitter and Facebook to be the first to hear about new vacancies that are available, as well as opportunities to gain top quality CPD through the webinar vet.

We can help to supply staff, whether it be for one day to cover sickness or annual leave to ongoing full-time locum roles and permanent roles on a part-time or full-time basis. Our consultants will listen to your needs and we'll do our very best to find the perfect role for you or the perfect team member for your clinic. As well as dealing with thousands of first opinion clinics, we also deal with many referral centres and hospitals across the UK as well as having clients in Europe, Australia, India, and the Middle East.

If your current clinic is seeking staff or if you are seeking your next role, please feel free to contact us via email or telephone. We also offer a referral fee, so if you have a friend seeking work and you pass us their details, once we have placed them in a local or permanent role, you'll be sent vouchers to say thank you. If you are seeking work in the UK or abroad, we are confident we can help you find your dream role.

I hope you enjoy this next webinar and please feel free to browse our website to see if you like the sound of any of the vacancies on offer, including a head nurse role in Dubai. OK, oh, thank, thank you very much. So, so I'm now going to attempt to go to switch the screen here so you guys can see the talk.

So, if you're just coming on, the this is gonna be a little bit different than the normal, virtual congress and that might talk to different little, different lengths. So the first talk we're gonna do, which is approach to emergen emergency, this approach to emergency respiratory distress in the dog and cat, is gonna be about 1 hour and 15 hours. 20 minutes long because it combines both species and most efficient to do it that way.

Then we'll take the break. Then we're gonna talk about smoke inhalation. It's more of a kind of a short talk, 20 minutes or so to do that one.

And then the final talk about CPR will be the normal kind of standard 45 to 50 minutes sort of talk just so you're aware. So, OK, so we'll, we'll start off with if you wonder why I'm not stopping talking, that's why on the first one. So, OK, so we're gonna start off with the approach to emergency.

Respiratory distress the dog and cat. I'm over here in in America, so I'm speaking American, and I just have to say it's very strange to me when you guys in the UK say that the UK is different than Europe because in my mind, I was, I was thinking just now during Josh is saying, what is it the UK part of Europe, but I, I guess it's not. So I'm over here in, in, in the United States, and, so it's the middle of the afternoon for me, so thank you for coming this evening.

OK, so with no further ado, we'll get going here. OK, so our objective today is this talk is more designed to be for something for first responders. So it was originally designed actually as a talk for shelter medicine veterinarians, who tend to kind of get stuff brought in by animal control over here in this country.

And so the animal control find stuff on the street or somebody's called in, brings the cases in, and then the shelter vet ends up dealing with them. Also, obviously this bleeds over to emergency veterinarians as well, and obviously my training is emergency and critical care. So it'll be kind of like what do you do as a first responder sort of thing we're not gonna get into a tonne of information on like advanced diagnostics and things like that.

And so our goal will be to present the most common reasons for acute respiratory distress, and how we would tell between them based largely on physical exam and some of the really basic diagnostics that pretty much every clinic should have available to them, and then we'll just talk about how we would approach treatment as more the emergency kind of stabilisation style treatment rather than any of the long term style of stuff. So that's kind of our goal and our approach here going forward. So kind of initial assessment, I mean, you always ask yourself, you know, how do you recognise an animal in respiratory distress, right?

So this is fairly common sense. They're breathing faster, they're breathing harder. They might be ourop nick where they've got the neck outstretch, they've got the nostrils flared, their elbows are abducted to kind of extend the chest and make it easier for them to breathe, and they may or may Not have some associated noise with it.

And obviously dogs are going to be easier to tell noise than cats. So you know dogs across the room, if they're breathing loudly, you'll be able to hear it. Cats, you know, you probably have to get closer to them to hear it, but you know, in general rule of thumb is a normal cat should not have any noise associated with their breathing.

So if you are hearing something, you know, with your ears, not your stethoscope, it's probably significant in the cat. OK, so here's an example of a dog, you know, just kind of one example of a dog in respiratory distress. The weird, shadow on the screen here is from the oxygen cage that we see.

So here what kind. So that's why it looks like that. So kind of things to notice, you can see this guy's ribs, you can't hear anything because it's in the oxygen cage, but you can see his ribs, as he breathes, you know the rate is relatively rapid.

I don't have his face included because he looks fairly normal face wise. He's got his tongue hanging out, but, . But you can kind of see that's kind of a classic example of a dog in respiratory distress.

Here's another dog in an action cage, again, it's, it's too loud to hear anything, but, he was hit by a motorcycle, this guy, and so you can see he's got kind of a panting position. He's a little bit mentally. Inappropriate.

That's why he's not sitting up sternal, but you can see he's got kind of a a panting. He's pulling his lips back a little bit as he's breathing. He's breathing very rapidly and it's more than just kind of a standard pan.

It's a little bit more effort to it than than you might expect. So that's kind of another kind of classic example. All right, so once you've kind of done the common sense thing and said, hey, this animal's in distress, then, and we're gonna talk about dogs first and move to cats.

So we're talking about a dog. You say, hey, this dog's in distress. What do we do?

Well, number one thing we're going to do is give him oxygen, right? So you can give him things like flow by oxygen where we just hold the tube in front of his nose, and there is a degree that helps somewhat, but obviously the oxygen is not contained, so it's not maybe the most effective way. But certainly during a brief exam, this is probably one of the best ways to give oxygen.

You can also attach that oxygen tube to a mask, which we'll look at in a future slide, and that contains the oxygen a little bit more around the animal's face. My experience though as an animal, especially during the initial exam when they're really distressed, the last thing they want is you a stranger coming at them with this plastic cone, to, you know, kind of contain the action around them, so. Another option you always tap is to put them in an oxygen cage, and so this is just an example of the cage we have in our ICU.

And so the nice thing about an oxygen cage is the environment, once the cage is up to the level you set it to, the oxygen is all contained in there, and every breath they take should be that percentage of oxygen. The downside obviously is that I can't do anything with the animal when it's in there, so I can look at it. But I can't actually touch the animal, so you have to kind of figure out what it makes the most sense.

Sometimes they'll put them in the oxygen cage for a bit and then take them out with flow by and look at them after we've given them a chance to relax a little bit or give them some medication, things like that. So, give them some oxygen. So with the cat, obviously the same thing.

The cat also needs Oxygen and flow by is a way to do it. Here's an example using the flow by attached to a cone to contain the oxygen a little bit more. For me, it really depends on the cat, which is going to be better for the cat.

Some cats are OK with the cone. Some cats, it's a total no go. So it just depends.

You don't want to stress them out more with the oxygen administration. And then obviously we use a lot of oxygen cages and chambers with cats, and so the nice thing about it is a little bit more hands off. We all know when cats show you distress, they're always worse off than a dog is, and they're closer to dying than a dog is.

So sometimes putting a cat just hands off in a cage for 15 minutes and then going back to them is going to be the best thing you can do for them. So we tend to use it, I think, more, more cages for cats, and we tend to do a little bit more of the flow by for initial examination in dogs. But either way.

So you know what I realised I forgot to do. I forgot to click on here computer audio. So I'm gonna, I think I can leave this real quick and go back so you can hear the audio.

So bear with me for one second here. I'm gonna go back and I'm going to really quickly share the screen again and I forgot to share the sound. My apologies.

I'm gonna share it again. OK, here we go. All right, so hopefully you can hear the audio now on these, these slides from now on.

OK, so let's project this again. OK, so now after you've given them oxygen because the animal's in distress, you have to ask yourself, OK, you're in distress. I've given you oxygen.

What is going on with you? And so the very first step in kind of the tree of tree of decision making is, are you upper or lower airway? And so upper airway animals tend to have louder breathing you hear across the room like we mentioned before.

They tend to really be visibly anxious a lot of times when you're looking at them. They may have the cyanotic component and remember, cyanosis doesn't have to mean blue. Like they could be purple because remember blue haemoglobin mixing with red equals purple.

So if you see that mauve colour to their tongue, not that nice healthy pink, that's probably indicative of some degree of cyanosis in these guys, and dogs by far have more upper hyroid disease than cats do. So let's take a look at a couple ones. So this is an inspiratory discy and a Yorkie right here, so.

Ah So you guys can kind of hear the high pitch sound he has as he breathes in, right? So that's kind of, that's one example of kind of an upper airway type of thing. Another example we have is the turderus dogs, this cavalier here.

Yeah. So obviously nice and loud, it's kind of that snorting sort of sound because it's going through the nasal passages, so that's kind of another example again of an upper airway type of problem. Here's a classic strider dog, Labrador.

Yeah. So you can kind of hear that loud that the raspy sort of sound as he breathes through his his oral pharynx. And then we have this is this kind of a nondescript upper airway type dog.

It happens right at the beginning, so you have to listen. And then he proceeds to be quiet. It's a very strange case.

And then later on, he would repeat that if you had the video clip for long enough. So that's an example of kind of and during that inhalation, he had that really loud upper airway sound. And here's another dog, he's post craniotomy, hence the incision on his head.

Oh, wait a minute, he didn't want to do, he didn't want to play for us. Let's try him again. One thing to notice here in a second, they're going to come over and they're going to open his mouth.

He's breathing a whole lot So he's got kind of that snorting component in the beginning and then when they kind of open up the airway, in this case, he has some, inflammation in the back and when they open his, lifts his maxil up for some reason it would, you know, kind of relieve a little bit of the compression from the inflammation he breathes easier. So classic thing in an upper airway dog is that once you can open up the airway, the noise goes away and the effort and then a lot of the dis goes away. So he's a kind of a classic example of that.

OK, so what are things that cause upper airway disease in dogs? So obviously, the classic is gonna be the brachycephalic airway syndrome. So that's gonna be the dog, like the, the bulldogs, pugs have the short fat nose, you know, this kind of facial confirmation.

Obviously that's a real classic one. And as they get older, they tend to be affected more than the younger ones, although we'll have puppies come in with very bad braysalic airway cidermao. Laryngeal paralysis is the next one.

That's your Labrador, your golden retrievers, kind of your classic breeds, . And then you're collapsing trachea dog. So, and that tends to be like Yorkies on small breed dog.

So you can do a little bit of grouping based on what's your breed, what's your age, that sort of thing. So the bigger dogs tend to be more like the lapa, brachycephalic tend to be the bracephallic syndrome, collapsing trachea tends to be your really small breed, Malteses, you know, Yorkies, things like that. So you're going to group them up and you can get your differentials fairly easily.

All right, so cats do get upper airway disease as I kind of alluded to. So here's an example of a cat with that. Oh.

And the video doesn't do him justice because he's in an oxygen cage, but you can see his mouth is open and there is a degree of noise with him. It's it's not as easy to appreciating the video. But that's, this is a cat with kind of the, so he's got kind of that weird look in his eye.

He's not over hugely distressed and that his respiratory rate is relatively slow, but there, there is, especially when he's not in that cage is a very loud component of the breathing that you can hear. So cats, what are gonna be the differentials for it? So it's not very common.

But in kittens especially, you're going to think about infectious viral type disease with their nose is so clogged up, with, you know, viral associated, you know, inflammation and things that they can get a degree of upper airway disease. And those are fairly easy to diagnose. They have nasal discharge most of the time.

They're from a shelter setting, they're on vaccinated, stuff like that. Nasop phrasal polyps, like as pictured in this picture on the left is your next most common thing, and that's gonna be, You know, that tends to be a kitten or young cat disease, you know, where they're gonna come in with distress related to that. They can also have masses anywhere in the nasopharyngeal or laryngeal region, and cats do get laryngeal paralysis.

It's not as common as dogs, but it does exist, so don't forget about it. And what I will say about it is that dogs although, you know, there's more and more talk about laryngeal paralysis being part of a larger neurologic condition in dogs, in cats, it's almost always secondary to something else like perineoplastic, something like that. So cats rarely get just.

Neopathic larva like dogs do, they can tend to get it secondary to something else. So these are the most common things that cats will get. In my life I've seen masses by far, polyps in the little young ones and masses by far and the old ones are the most common.

So the cat in the video that we just looked at this orange and white cat here, when we opened his mouth, had a giant mass in that area. Presumably cancer, the owner didn't allow us to biopsy. We just euthanized him and took the photo later, but he had, he had a large mass, and we presumed it was neoplastic.

OK, so upper airway disease. You hear it, you see the distress, you're like it's upper airway disease. So what I usually call the acronym NOS, so you hear noisy breathing, so you want to give them oxygen like we said, which is for all respiratory distress, and then we want to think about sedation and intubation spelled incorrectly.

And I know intubation is spelled with an I, but to work with me on the acronym, we're gonna spell it with an E. So, so we give them oxygen in the interim. Period we try to sedate them to calm them down because anxiety is a huge part of this disorder.

So the more trouble they're having moving air, the more anxious they get and the worse it gets. So sedation helps a tonne. And then like I say, worst case scenario to open up the air, we will intubate them.

The other E stands for extra, so you want to remember temperature and glucose with these guys because we'll talk about it in a bit, but they can get hypothermic and hypoglycemic pretty easily. So again, we talked about giving oxygen, so we mentioned the mass, we mentioned the flow by, we mentioned the cage. So here's a couple more examples of flow by.

Remember things like putting nasal oxygen cannules in and this guy's wearing e-collar, so he didn't paw it back out, and those are really, really effective and you can still work with the dog's body. I like to do things in a pinch like take a Carrier for a cat or small dog covered with a trash bag. There's a whole punch in the back of the trash bag to let out excess gas, and you just stick the oxygen tubing in the front and voila, you have a temporary oxygen cage set up which is extremely handy, especially if you've got multiple animals there or you don't have a great oxygen cage kind of available in your clinic.

We use sometimes nasal prongs. It's a fantastic example of a bulldog here, and he's got nasal prongs and just like a person would have kind of stuffed into his little nostrils, and he's sutured on either side kind of by the lateral campus of his eyes. And then for certain confirmation dogs, these little nasal prongs work quite well.

So you've got a variety of things, be creative, give oxygen some way kind of is the bottom line. So then, in addition to the oxygen, when you believe it's upper airway, we tend to use sedation, and I'll use a classic combination of butyphenol Aromazine. I have the doses written down for you.

Note that I give a fairly high dose of ACE in these cases because I'm not fooling around. Like if you're having respiratory distress, we're gonna give you enough ACE to make a difference. And the reason I tend to go for a little bit higher dose up front, and then go up from there if necessary is remember that ACE is going to take at least 20 to 30 minutes to work.

So if you're gonna hit it with a tiny dose of ACE and then keep redosing, all it's gonna do is prolong your effectiveness, so you won't see any effect for a longer period of time. So I'll tend to be a little bit higher in my dose up front, knowing I can give more if I need to. It's unlikely you're gonna cause like hypotension to that, that's clinically significant at this type of dose in these kind of dogs.

I always pair my ace with butterfrenol or another opioid because those opioids have a much faster onset of action than the ACE will, so you get some degree of sedation from the opioid first and then the Aceromaine, and that's a shorter acting drug if it's torb, and then as the bunil is wearing off, the ace chromazine should be coming on and working. So that's a classy combination. I've used Xmetotoline in my time as well.

We used actually just last week on a dog, and again, the range is huge, 2 to 10 mcg per kg IM or IV in dogs, and I wouldn't start any less than 10, to be honest with you, and a cat, 10 mcg per keg, because cats are so need so much more X-meatomidine. Depending on sometimes the dose I'll give depends on whether or not I already gave AC or butrophenol or something like that with it. I usually pair my meatomidine with an opioid as well.

If I've already given Aceromazine, I'm adding this in, I might go a little bit lower on the dosing range. And then if I haven't given anything else, I'll go higher on the dosing range, and you can do constant rate infusions of dexamettatoine as well. The nice thing about dex meatominine is you just reverse it if you don't like the effects of it.

So anything you want, sedate them in some way, shape, or form, basically. All right, so here's an example, and this is how sedated I like these dogs to be quite honestly. So this dog on the left actually is actually being given propofol to cause a little bit more sedation, and we're doing kind of a low rate of propofol at a constant, constant infusion, but I want them to be quiet enough for their resting, they're lying there.

They've got their nose, you know, tolerating oxygen, whatever way I'm giving it. And because they're nice and sedate, you know, I will sometimes throw an ECG or something of that nature on them as well. All right, so if oxygen sedation, oh, so let me give you an example of oxygen sedation working.

So here's this dog here, so we saw him before breathing. So this is him after getting some sedation. So he's still loud, but he's resting.

You know it's a little bit of, he looks a little bit sedate, he's drooling a little bit from the sedation. He's a little bit pinker than he was before, so this is not bad. He's not getting any oxygen, obviously.

But he's kind of settling down a little bit more sedation works is this is kind of the way we want them it's not a little bit quieter than this after sedation. This guy had Lapa obviously, by the way. Now, later on, when we gave him a little bit more sedation.

Look how much better he got. So we were able to give him, we actually gave him more sedation from the picture on the left, and he got nice and quiet. Yes, he was drooling from the sedation, but he sat down, he rested.

So that's kind of the effect that you wanna see with it. And, and so this is one where sedation worked basically. All right, now if the sedation does not work, then we're gonna have to think about intubation spelled incorrectly.

And so generally I'll give it, you gotta give it at least 10 minutes to have your, your ACE even start to do anything. Sometimes I'll give it longer. It depends how bad they look, but you give them at least 10 minutes with the ACE and the butorphn on board, and see what it works, see how it's going.

But if it's not working, then you're gonna have to give something like propofol to effect, place your endotracheal tube and be done with it. So here's a cat. Getting intubated, for example, and I will leave these endotracheal tubes in until the animal indicates they want the tube out.

So usually it's a minimum of a half an hour, sometimes it's 1 hour, sometimes it's longer than that. And so usually I'm gonna be giving them oxygen during that time and keeping them nice and nice and sedated. And so it's very common that we'll see animals sitting here like this with their endotracheal tubes.

They're nice and calm, you know, they've, they've had their sedation on board. They, they have the tube and they don't want to give it up, and if they don't want to give it up, it's fine. When you do extubate them, I'm sorry, if they seem disn again, you're gonna give them some more propofol or whatever you use to induce anaesthesia and you're gonna reintubate them.

And then at that point, I'm gonna leave that tube in until I get something more definitive done because if you failed extubation once, the tube stays in. And just last weekend we had a dog post bite wound that all of a sudden had an upper airway obstruction. We're not honestly, to this day, I'm not sure why.

He ended up getting intubated for an hour or so. Extubate him. We gave him some steroids because we presumed it was inflammation.

We extubated him like we like had to immediately intubate him again. It was like the middle of the night. It was one o'clock in the morning, so we kept him intubated overnight.

And then actually in the morning we got a CT scan done and did some other, you know, a better laryngeal exam and stuff and did some other diagnostics to kind of get to the bottom of what was going on with him. So, so to me if you feel extubation once you remain intubated so I, so I figure out exactly what's wrong with you, and get a better handle on your, your disease. All right, and here's a cat enjoying his tube as well.

Totally fine if your cat wants to keep the tube in. All right, so extras for upper airway. So if you've got to the point of, you know, you've identified upper airway, you're treating it, remember again, if we said about temperature and glucose, right?

So animals get hypothermic very, very readily, and the fatter they are, the more stressed they are, and often if they're kept in an oxygen cage, those are the times you're gonna get hypothermic. Because remember, especially the oxygen cages that are just like a cage door and a cage, those cages get really, really hot and really, really humid very easily. And so, You have to know that sometimes you'll put an animal in there and their airway stuff is better, but now it's so hot in the cage that you'll see them panting.

And I've actually, get another memory here, but not that long ago we had internal medicine was working with the cat. I'm forgetting that what was wrong with it again, but it was an obese cat and they had done some airway, they had done some airway sampling. I think they did a wash and things, and he seemed to be in distress.

They put him in the oxygen cage post anaesthesia and He was in there for an hour or so, seemed to be awake from anaesthesia, but was continuing to actually open mouth breathe, and they came and got me for a little bit of help and conversation. And actually one of the first things we did was to check his temperature and ended it with a cat in an oxygen cage, and he was up to like 105, presumably, and he hadn't gotten any opioids, so it's specifically from the cage. So we got him out of the oxygen cage, gave him oxygen a different way, and then he actually cooled right down and did great.

So just remember temperature will make him continue to pan. And then glucose, if you've been having seizures related to your airway, it can lead to hypoglycemia obviously can lead to you having seizures, but if you're hypothermic for long periods, you're a small breed dog, you know, you're distressed, you're stressed for long periods of time related to this, sometimes you can get hypoglycemic, and that can obviously lead to Worsening clinical signs of, you know, maybe not respiratory, but other clinical signs you don't necessarily want to have. So when they tolerate getting a blood draw, I always try to prioritise getting a glucose for these guys.

And obviously, I'm not gonna run in and force a blood draw on an animal super disic. It's later on after I've tried to get a handle on things, I'll try to make sure I check the glucose sooner rather than later. OK.

And so here's your classic hot cat. This was his cat will get hot inside an oxygen cage, so just be aware of him. So, all right.

OK, so once I figured out if it's upper or lower airway, or upper airway, I've done my thing. Now, let's say I've decided it's lower airway instead. Let's say it's not upper airway, you don't have any of the classic signs.

I believe you're a lower airway disease. What am I gonna do? OK, so what, and what are the signs look like?

So lower airway disease tends to have, again, still the increased respiratory rate. They can be open or closed mouth breathing though. So it's not uncommon you'll have an animal that's very, very tip with a closed mouth, and that's very indicative of lower airway disease.

You may or may not hear them cough. Sometimes that's more of a historical. Rather than in the hospital during a crisis, but copy may be a part of their history, and you obviously, sometimes you'll see increased effort.

So sometimes it's just like to keep the, it just, it just seems fast but not full of effort, but sometimes you'll actually see them like maybe the, the, the respiratory rate's not as fast, but they're breathing fairly hard as well, you know, at the same time. There's a couple of examples here. This guy's in an oxygen cage again, but take it from me he's quiet.

So you'll notice he's pulling his lip back. He's got a very distressed look. He's got a good orthopic posture with his neck outstretched.

His legs are a little akimbo as well, the front legs, but definitely if you look at forearm, but he's definitely got the outstretched neck posture, can't lay down, can't sit down, can't get comfortable, real common, you know, respiratory distress in general, and that dog's showing all that. And you're the cat. Oh sorry, I'm talking in the background.

Yeah, I'm gonna actually mute this one because you don't need to hear all the conversation on this one here. So here's the cat just coming and breathing here. And so increased effort, you know, cats think quietly but definitely increased effort, you know, you shouldn't see a cat breathe, you know, that, that much.

All right, so now once I figure out it's lower airway or I suspicious it's lower airway, the next kind of decision making part in the tree is, OK, I think it's lower airway. Now I'm going to ask myself, does it have a loud auscultation or does it have a quiet auscultation? So loud auscultation, if I put my stethoscope on, I'm hearing noise in the lung fields.

I'm gonna think about three main things, OK, as my top differentials. One is pulmonary edoema, that's either cardiogenic or non-cardiogenic, that's kind of two things. And then the other thing is gonna be the pneumonia and a dog, at least, either by far the most common thing I'm gonna think about.

So canines, I'm thinking edoema making noise in the lungs and I'm thinking pneumonia making noise. Remember to help you make a decision between these things. Cariogenic pulmonary edoema is classically a dog, a disease, I'm sorry, of middle age or older dogs, the, the exception being the, the ones that are born with congenital defects of their heart, right?

But has to be a middle aged, or older dog, they're, they're almost. Always is a heart murmur in a dog, almost always in a dog that has pulmonary edoema. They may or may not have an arrhythmia, and yet there's certain breeds cavaliers, chihuahuas, you know, they're gonna get mitral valve disease.

If you see a larger breed dog, you're gonna think about DCM. So if you see giant breed dogs, DCM will come to your mind. So there's a little bit of a breedist thing you can do to help you determine it.

But you know, it's uncommon to not have either an arrhythmia or a murmur or both in a dog. It's very, very uncommon. Non-cardiogenic in contrast, you know, unless you happen to have a heart murmur.

Oh, by the way, non-cardiogenic pulmonary edoema is not characterised by a murmur, not characterised by an arrhythmia, and they tend to have a history that's gonna support non-cardiogenic pulmonary edoema, strang, strangulation, coughing, sorry, strangulation. You know, chewing on the electrical cord, drowning, going to the groomer and being up at the grooming table that where they get kind of that semi-strangulation thing, you know, those kinds of things, you know, have prolonged seizure activity. Those are all things that I think about for non-cardiogenic pulmonary edoema.

And then pneumonias are trickier because they can be any age. It depends on what kind of pneumonia you're dealing with. They may or may not have a fever.

In the case of like fungal pneumonias, you may have like supported skin lesions like in blastomycosis, which we get here in the Midwest and in the US a lot, and then they may have a travel history in the US because certain parts of our country have fungal disease and I have no idea whether or not you guys have fungal disease, but depending where you are, you may or may not have, have been to an area where like a fungus is endemic that goes to the lungs. So, OK. So, generally speaking, if I'm gonna, you know, kind of take my lower airway disease, if you're less than 2 years old, you know, I've kind of listed the things that have come to my mind.

So, you know, congenital kind of, cardiac pulmonary edemas, the non-cardiogenics puppies like to chew on cords and do stupid things and get strangled by their leashes and stupid stuff like that. And then, you know, dogs can also get some pleural effusion or pneumothorax as well. We'll talk about those in just one second as well.

If they're kind of middle aged dogs, you know, I've got some things listed, but there's different reasons why you get floral effusions. And then when you're older, you start to think more about heart disease, you know, maybe aspiration style pneumonias and then pleural effusions of a different sort, which we'll talk about those different reasons in one second. So I kind of like, after I've determined slow airway disease, I kind of start to group them a lot by breeding, especially by age when I'm coming up with differentials.

All right, so, and again, we've kind of been talking about the cardiogenic and non-cardiogenic pulmonary edoema. So let's take a little bit closer look at those. So, you know, just physiologically what's happening.

So with cardiogenic pulmonary edoema, the problem is gonna be if this is your alveolus right here, and this is your wall of your alveolus here, this is the blood flowing past your alveolus. With cardiogenic pulmonary edoema, you're gonna have an increased hydrostatic pressure. So increased volume of blood being delivered to the alveolus, and that's because your heart isn't working right.

And so when you get increased hydrostatic pressure in the capillary, it's gonna push fluid inside the alveus and that's where your pulmonary edoema comes from. Remember, with non-cardiogenic, the, the hydrostatic pressure is completely fine. The problem is you're gonna increase permeability of the vasculature that surrounds the capillary.

And so when you get increased capillary permeability from those causes strangulation, drowning, you know, eating electric cord, or whatever, then the fluid is gonna leak from those vessels into the, into the alveolus, and then you're gonna get your pulmonary edoema that way. It's a little bit different mechanisms. So when you treat them, it's a little bit different.

So we already kind of touched on this, but cardiogenic can be your congenital heart diseases, your mitral valve disease, and your dilated cardiomyopathy. You're more likely to have the most classic times to have an arrhythmia with your heart failure is if you have dilated cardiomyopathy and it's gonna be afib, but certainly it's, it's not exclusive, that you might see that. And again, you almost always see a murmur in a dog.

We've mentioned the cause of non-cardiogenic a couple of times. It's gonna be more of like a historical thing that you can get information on that tells you it's more likely that. Now how do we differentiate them though, so you can get some clues by history and exam and all that business and and signalment, but when it comes down to it, you're gonna end up taking radiographs to try to figure out what's going on.

And so the radiographic patterns are gonna be different between the two, and we're still talking dogs still right now. So a dog cardiogenic pulmonary edoema, it should be an interstitial alveolar pattern. It becomes, the worse it gets, the more alveolar it is, and it's gonna have the strongest pattern in the perihilar region right up right around the heart.

We'll look at a picture, I'll look at a radiograph in a second. And so it's perihercato dorsal, whereas non-cardiogenic pulmonary edoema is often alvear as well, sometimes some degree of interstitial, but it tends to be symmetric in the caudal lung fields. So it doesn't have that perihilar cao dorsal clustering thing.

It has the caudal, the straight up caudal lung fields, that are symmetrical right and left. So here's some, some radiographs. So this is cardiogenic pulmonary edoema, fairly classic.

Also, I didn't mention, but you're gonna see a cardiomegaly, if your heart is gonna be big, if you're in failure failure. And if you're able to see the vessels, your pulmonary veins should be bigger than your pulmonary artery. However, you know, if your heart failure is bad enough, as in this particular radiograph, I can't make the vessels out at all, so I'm not gonna be able to use that to help me.

But he does have a large heart. But notice he's got a very strong perihier sort of pattern, and that he definitely has, you know, pattern in his caudal lung fields. There is obviously some cranial lung field involvement as well, which as it progresses, it will go up there, but this is kind of a classic look of a cardiogenic canine pulmonary edoema.

OK, so non-cardiogenic and yes, this is a cat, but non-cardiogenic pulmonary edoema, real classic radiographs, the heart size is normal. And you're going to notice that we've got this alveolar pattern that's fairly symmetric and it's strongest in the caudal lung fields. Yes, there's a little bit here in the right middle lung lobe as well, especially, but you're definitely seeing the strongest pattern in the caudal lung lobes, and that's going to be most consistent with non-cardiogenic pulmonary edoema.

All right, so if you have cardiogenic pulmonary edoema, you're gonna remember FOM, so like phone, phone for help, right? So furosemide, 2 makes per kg IM or IV, and I start at that dose and then I give more if I need to, and I'll keep repeating for me, I repeat 2 makes per kg every time I do it and I go up to a total of 6 to 8 makes per keg typically if I've hit 8 makes per kg and I'm not seeing improvement. I'm gonna rethink my diagnosis because maybe it's not cardiogenic pulmonary edoema.

It's possible the dog might need more, but most of them will be improved by the time you hit 6 or 8 makes per k. And I'm going to wait 20 to 30 minutes between doses. Super important because furosemide has to go to the kidney.

It has to activate, electron, oh my gosh, electron transporters in the. Tulles and that takes time. So you can't give furosemide and expect an immediate effect.

It's gonna take 20 or 30 minutes to work. So I work with an emergency doctor actually who gives his furosemide, sets a timer on his phone, puts the dog in oxygen, and walks away. And he doesn't even look at the dog.

He tells the techs not to look at it because there's really not a lot more we could do at that point. Obviously we'll glance at it and make sure he hasn't, you know. The animals not suddenly getting worse, but basically just wait it out for 20 or 30 minutes, then he goes back and reassesses, and then he decides if he needs to give more.

Typically, you know, you've given enough furosemide when they've urinated. So if the animal has peed in the cage, you're like, All right, I've given enough furosemide, and I've waited the time, that it's gone to the kidney. It's created urine.

All right, fantastic. And most of the time, by the time they urinate, you're going to see a significant improvement in the way they're breathing. And then obviously if with FON furosemide and oxygen go together and so while you're giving your furosemide they're getting oxygen.

And then the Ns used to stand for nitroglycerin. We used to put nitroglycerin in the ears to reduce afterload. That's most people probably believe that doesn't do too much anymore.

So now the end is kind of started to to describe narcotic in my mind because there's a greater and greater push to give these animals things like morphine, buorphenol, some sort of opioid that's going to cause a little bit of a degree of sedation, take away some of the anxiety that goes along with it. And I don't know why this week we've had a lot of heart failures at 3 this week, and I will say that we had a great example of one who had gotten his furosemide, had urinated, sounded better, but was still breathing, not exactly the way that we want him to, and we gave him a little bit of burophrenol, smoothed them out, and the animal was resting very, very comfortably afterwards. So, definitely, yeah, you don't have to hesitate.

You can give your furosemide and your burophrenol like right off the bat if you wanted to, for example. All right. So non-cardiogenic pulmonary edoema, what do we do?

So with non-cardiogenics, we're gonna give them oxygen again. But you're gonna give them time. Basically, you have to just wait.

So there's nothing you can do to relieve the vascular permeability issue that you have. So, and giving furosemide is not, because the furosemide works to reduce hydrostatic pressure. It takes the fluid that's being presented to the kidney and gets rid of that.

But if you don't have increased hydrostatic pressure, which we do not, in non-cardiogenic pulmonary edoema, furosemide will not really work, so you're gonna give oxygen in time. Now some of you might be saying, well, wait a minute, I've had a case of non-cardiogenic that I gave furosemide. I swear it helped.

And so the way it helps is not reducing fluid. If furosemides seem to have an effect, it's because furosemide is also a fantastic bronchodilator. It's probably one of the best bronchodilators that we have.

And so if you did feel like you saw an effect by giving furosemide to What ends up being a non-cardiogenic pulmonary edoema dog is probably more the bronchodilation than the actual movement of fluid. And so you can give other bronchodilators potentially the non-cardiogenic pulmonary edemas. They may or may not help.

And so a lot of times in a lower airway disease dog, I'm like, you have lower airway disease, you know, you're just nick, I'm gonna give you oxygen. I'm gonna. I told you, wow, there's a lot of noise.

It could be pulmonary edoema, but I'm not sure, but, but I don't want to take X-rays yet because you're too unstable. I'm gonna go ahead and get them all furosemide. So the non-cardiogenics get instead of the cardiogenics, and, and both of them potentially can get effects from the drug, and then I'll go take my x-rays and try to parse out what's going on.

And a single dose of furosemide never hurt anybody. So, OK. Now, the other thing we talked about as far as cause of lower airway disease are the pneumonias, right?

The ones that skult loudly, I should say. Lower airway with loud auscultation. The other big category is going to be pneumonias.

And so if I'm a young animal, I'm gonna think you're more likely infectious, you know, viral diseases, you know, kennel-related diseases, as I'm middle. Age I still could have some infectious component. I've been to the dog park and I've interacted with other dogs and my vaccines, my border he vaccine is not up to date, what have you, but middle aged dogs tend to start showing some aspiration pneumonia and then obviously the older you get, the more likely it is it's going to be aspiration pneumonia, because you got something else wrong with you that cause you to aspirate.

So infectious type stuff, what could it be, right? So infectious stuff could be bacterial, viral, or fungal. If you see infectious pneumonia on a radiograph, you're gonna expect to see a ventral alveolar to interstitial pattern, but it's gonna be in the ventral lung lobes and most commonly cranial ventral if you're bacteria or you're viral.

So cranial ventral distribution of your alveolar or interstitial pattern, it tends to be more bacterial or viral type diseases. If you see in contrast the diffuse nodular style pattern, you're gonna think about fungal disease and here where I live, blastsomycosis is the most likely. Also neoplasia is your other big differential for a diffuse nodular pattern.

And then if you're more concerned it's aspiration ammonia, what you expect to see is still a ventral pattern, ventral distribution to your, to your pattern. It's still alveolar to interstitial, but it's, but you know, the most classic is gonna be the right middle lung lobe. Certainly the left, the caudal aspect of the left cranial lung lobe is also another spot we'll see it, but, but the most classic aspiration is right middle lung lobe.

You may also be evaluating your X-rays, your radiographs for concurrent mega oesophagus or any other disease that might secondarily cause this dog to aspirate. So I feel really bad because I have cancer, so I aspirate it. You know, I have, a big mass pressing on my, my stomach, causing me to not be able to eat very well, so I'm regurgitating and I'm vomiting, you know, things like that, so.

All right, so let's look at some X-rays. So lower airway dog again, so I, I, you look lower airway, you have quiet breathing, but your auscultation is loud. Here's what your pneumonia looks like.

So again, it's got an alveolar pattern, pretty strong alveolar pattern in the ventral aspect of the cranial lung lobes, and this guy happens to have it fairly bilaterally. This is a real classic, classic infectious, pneumonia, but what this would look like, like a viral infection or something like that. A classic aspiration, and this guy happens to have a feeding tube because he was regurgitating, is this right middle lung lobe right here is completely consolidated, and you can see it kind of overlying the heart here on the lateral view.

And again, we're seeing a fairly strong alveolar pattern present in that lung lobe, so classic aspiration pneumonia. All right, so classic fungal pneumonia would look like this. So you're seeing your diffuse very, very diffuse, and this is a very miliary nodular pattern.

Sometimes it's, it's not quite so miliary, it's a little bit bigger nodules, but regardless, you're seeing a very diffuse nodular style pattern, and that's going to be classic for what fungal pneumonia can look like. So here's what metastasis can look like in contrast. So, and again, it can be very, very hard to tell because this could also be fungal.

I happen to know this animal had, you know, hemangiosarcoma that it metastasized, but, basically with, one of the things the radiologist will sometimes use is you see this variability to the size of the nodules throughout the lung fields and sometimes that can be more. Consistent with metastasis, but it is very, very difficult to tell between them sometimes. So, so metastasis and fungal in this country, at least in this area in this country, are very, very like 50/50 chance you have either one with these kind of X-rays, depending where you live, you know, especially here in this country, if I live on the east coast, they almost never get fungal disease.

So if I saw these radiographs, I would be like, yeah, that's cancer until proven otherwise, that sort of thing. Alright, so here's one. Here's a question.

What do you, would you guys think this is fungal or do you think this is metastasis right here? I actually polling question is, what do you think, fungal or metastasis? Let me go back so you guys can look at a little closer here.

So I'll give you a second. Mm, and this dog actually was referred into us from another clinic because they weren't sure if it was a fungal or metastasis. It's like a 6 year old dog, male neutered, just kind of a nondescript history of like lethargy, anorexia, really nothing too terribly specific.

So he came in and I was like, and I actually called the radiology resident that day as well, came in on Saturday, of course, and the radiology resident and I were both guessing it was going to be fungal disease. That's what we had our money on. It was a fairly young dog, you know, 6 years old.

He was, you know, he's from this area where we get a lot of fungal disease. We're like, oh, we think it's gonna be that. The poor dog.

Ends up having cancer, so we end up finding a primary tumour later on ultrasound. So it ended up being, metastatic, but I mean, quite honestly, we were both, like I said, both the radiology resident and I were like if we put, we were in Las Vegas putting all our money on it, we would put all our money on fungal and we were wrong, but that's OK. So anyway, there's just another example.

OK. So, if the animal does, you decide it does have pneumonia, how do you treat it, right? So in brief, if it's bacterial pneumonia, you're gonna cover it with antibiotics, obviously, right?

You need to think a little bit about what antibiotics you're gonna use, right? And so we tend to see gram-positive aerobes and gram-negative aeros as far as what you're gonna see in the lungs. It's very uncommon to get anaerobes in a, in an ammonia, not that you cannot, but it's very uncommon.

So most of the time when you're treating, you want to make sure you're treating with something that covers both. Positives and gram-negative er at least in the beginning. If you end up doing a wash of the airways and culturing it, then obviously you can tailor your antibiotics.

But in an emergency setting, I'm gonna cover for both, right? So I'm gonna typically use either a 2nd or 3rd generation cephalosporin or a penicillin to get my gramme positive type aerobic coverage. And then if I'm using a like a cefoxitin or something like a 2nd generation cephalosporin, I may just leave it at that because there is some degree of gram-negative coverage.

If I'm just using a Penicillin, they're fairly strongly gramme positive and very little coverage in gramme negative, so I often will add a second drug, example fluoroquinolone, because those are really strongly gramme negative aerobes. Amioglycosides are a good choice in puppies if you're worried about the cartilage and things. We have done a fair amount of amioglycosides in puppies, where we want to cover for pneumonia.

Just remember that, you do need to do some renal, you know, kidney testing and these guys and make sure they're well hydrated before you give munoglycosides, right? If it's fungal pneumonia, you got your antifungals to choose from. And fungal pneumonia is to me, in my experience, are the most likely to end up needing to go on a ventilator down the road, which is never a good situation.

And viral pneumonia is, remember, there's not a lot of, you know, nothing you could do besides supportive care. Unless you believe they have secondary bacterial component, at which point you can obviously treat them with some additional drugs. And one thing I will throw out is that according to that really new JVIM consensus statement, if you are worried about, you know, like a Bordetella type, what are we calling it now, CIRD, which is like the canine infectious respiratory disease complex, which is.

Botella, so they've come from a shelter setting and you're worried there's a viral plus and minus bacterial component. Doxycycline is being reached for more and more as kind of a first line drug over the penicillin and stuff we used to use. So it depends a little bit on the background of the dog as far as whether you get the best choices, but if it's pure viral, there's just supportive care.

OK. So now, we're gonna take a little another look see at lower airway disease here. I don't think we need the sound, but here we go.

OK. So the thing to notice on this dog is other than us coughing in the background, there's actually not a lot of noise coming out of this dog, but he's very, very technik. Let me just play it one more time here.

Look at how his neck is outstretched as well. You can see the degree of no flare and while he's very alert, you can see that he's definitely not super comfortable, right, with the way he's breathing. This guy was hit by a car.

So this guy, when I, I looked at this guy and I said, OK, you, you, you're closed mouth, you have a quiet way you're breathing, but obviously you're some degree of distress. So then I put my stethoscope on, and when I sculpted him, he had a very quiet auscultation, this particular guy. And so when you have a quiet auscultation, it's gonna be one of two things you're dealing with.

It's either gonna be pneumothorax or pleural effusion. There's really nothing else that's gonna be. If it's pneumothorax, you're gonna ask yourself, is there some kind of a history of trauma or something that would support that, that that would make sense?

Is it a breed that tends to get spontaneous pneumothorax? Example, huskies and things tend to get spontaneous pneumothorax. In contrast, you know, pleural effusion is your other reason for acquired auscultation.

And so in those cases, I'm gonna ask myself more what age group are you? Are you a puppy? Are you an old dog as far as reasons why you might have pleural effusion.

I might ask myself, is there any history of toxin ingestion like that might cause a hemothorax like rodenoide ingestion, for example. Do you have a murmur where this could be cardiogenic in nature? That's more in cats and in dogs, where you get pleural effusion with heart failure, and then do you have something like a fever because pyotthoracs, for example, you know, you could have a tonne of pleural effusion, you have a fever with that.

So you kind of ask yourself some additional the history will kind of help you with that as well. So again, pneumothoracs tend to be diseases of younger dogs, whose younger dogs are getting hit by cars or having spontaneous pneumos typically. The one caveat to that is if you have very, very chronic lung disease, you can definitely rupture, you know, part of your lung like have Ebola that ruptures and things, because you've got chronic airway disease, and so those would be older dogs a lot of times.

But most of the time it's a disease of young to middle aged dogs if you're dealing with pneumothorax. So how do I confirm pneumothorax? Obviously you can always tap it before you do anything, and if you get air, it's pneumothorax.

But if I was to go down and take a radiograph, this is what it would look like. So you're gonna see the heart elevated off of the sternum. And if you look, you know, if you were able to blow this radiograph up, you would see the lung markings don't go down in this area.

You also often will see, and you can kind of make it out here, that the remaining lungs that are there tend to start getting collapsed. And so you'll start to see the edges of the lung fields. And here on the lateral view, you can kind of see I'm trying to trace down where the lung ends and kind of between the ribs and where I just trace down is where there are no lung markings.

Because the lungs don't extend out there, so, so lateral view is easier to diagnose a pneumothorax, but you can also, you know, tell on a, on a, on a VD as well. This dog has some, concurrent, we believe pulmonary contusions leading to some of this elpay that you're seeing on the rats here, because it was these are radiographs of the dog we just looked at. All right, so now if I have a pneumothorax that it is spontaneous, like nothing happened.

You were just sitting in your house and boom, all of a sudden the dog was having trouble breathing. As I mentioned, you can get, you can't get these spontaneous pneumos. Siberian huskies are your classic one, although some other large breed dogs have been published like the mastiffs have been published as having a higher degree of spontaneous pneumos, and usually it means you had a leb or a bullet in your lung feels to start with, and we'll look at a picture of that in just one second, but that's basically where the lung kind of forms a bubble, basically the thing could pop.

And as I mentioned, sometimes off chronic lung disease also. So here's what the lungs look like. Here, here's an example of kind of the outer layer of the lungs, the plural layer kind of, bubbling up into into a nice little bubble filled with air that can rupture.

And then, so one of them it's kind of terminology is always confusing like the the bullet is anywhere in the lung and the blood is along the edges of the lung fields, but basically the bottom line is a little, little, a little pocket of air forms and then the wall gets thin and it pops. Now, trauma obviously is the other big thing as we said, and traumas can be open or closed pneumothorac. So you can have no external wounds and still cause enough trauma to cause the pneumothorax, but you can also have a hole in the chest or a wound in the chest or something like that, like it was a bite wound style of trauma, for example, that can penetrate in and cause the pneumothorax.

That way, look for things like flail chest or rib fractures, flail chest is when you have 3 or 4 ribs in a row that are broken and that whole segment of the lung of the chest walls moving, but look for indicate, you know, other concurrent type of injuries, to the bony structures when there's no external wounds, especially, but also with the external wounds. And you can check your radiographs for that. So regardless of whether or not I had, you know, spontaneous, traumatic, it doesn't really matter.

I'm gonna end up needing to tap the air out of the chest. So here's a picture of just us and this is the same dog and then we looked at him breathing before. We're just sticking a needle in and using a syringe and stopcock to remove the air.

Worst case scenario, you cannot get negative pressure. Like I'm pulling and pulling and pulling and pulling and pulling and pulling the air, and I can't get negative pressure. You may need to place.

The chest tube into one of these patients, and then you can, and worst worst case scenario you have to attach that chest tube to a continuous drainage unit. I mean, honestly, it's probably 1 out of 10 cases we need to actually do that, but it's something to keep on the back of your mind because if you have to do it, you have to do it, you know, there's no, you can't be like, oh, let me send you 2 hours in the car to get a chest tube and have some continuous suction plate, so you're gonna need to potentially place the chest tube and if you do have to refer the patient, you may need to have. A, a technician, a nurse, whatever, go with the owner to to help to evacuate the air all the way down.

And those are, you know, uncommon, like I said, but they can happen sometimes. OK, so, if it's not pneumothorax and you have acquired auscultation, it's going to be pleural effusion. And again, I have a kind of that I mentioned before, grouped into different groupings.

So my Group A pleural effusions tend to be my younger dogs. And so those are dogs they're gonna have a bite wound, a wound from a cat, and end up with a pyothorax. Inhale a grass on, get a pyothorax, or they're gonna have congenital heart disease and have a fluid fluid accumulation for that reason, or they get more stupid and ate rodeocide or got hit by a car and end up with hemothorax.

Group B is more of my middle aged dogs, and they can have a lot of the same reasons as the young dogs. I would throw things like Kylothorax on there and neoplastic effusion will start to show up in those middle aged dogs. And then the oldest dogs I'm gonna worry most about heart failure and neoplastic type stuff.

Now, obviously this is just me making broad generalisations, you know, not everybody reads the book, but if I'm guessing what the effusion's going to be, I'm going to use their age a lot to help me tell. So how do you tell what the floral effusion is from? Well, as you might imagine, you're gonna do a thoraocentesis.

If it looks red, the fluid, you're gonna do a PCB on it and see if it's consistent with haemorrhage. If you have a hemorrhagic effusion, the PCV of the of the chest fluid should be very equivalent to the PCV or equivalent or higher to the PCV in the bloodstream. At the PCB is like less than 5% in that red fluid, you have a sero sang with effusion is not blood, and then you want to go back and do cytology.

If the fluid is not bloody coming out, you're gonna go straight to cytology, and the cytology will tell you what you're dealing with, right? Is it, is it septic effusion? Is it non-septic effusion?

And do you see lymphocytes like a yothorax, things like that. And I'm not gonna go through this. You can read this, you know, in your own on the notes, but basically, depending what the type of fluid it is, it's gonna kind of tell you what you're going to do next as far as treatment.

So the big goal in an emergency setting is get the fluid out so they can breathe cause you're gonna take out enough that they're breathing better, and then look at the fluid and get a rough idea of where you need to go next with treatments. And obviously things like doing CT scans, you know, chemotherapy, thoracotomy, that's obviously not stuff we're doing on an emergency basis. We're gonna take the fluid out and make them breathe better, tell the owner what needs to come next and let the owner decide they wanna pursue that.

All right. So now we're gonna move on to felines here for the last bit here. So felines, we're gonna talk about, so we talked about upper airway and felines already.

It's very, very similar to dogs as far as how you treat it. Cats is gonna be a little bit different with the lower airway disease. So, cats, again, I group it by their age again.

So to me, if you're a young cat less than 5 years old, the things I'm gonna think about are asthma, some of the pleural effusions, heart failure if you're like a Maine Coon, a breed that's gonna get heart disease at a young age, and then pneumothoracs. Middle aged cats, it's mostly gonna be pleural fusion, a slightly different cause and heart failures. And then when I move on, I get old.

I'm thinking you have profe and heart failure, but I threw pneumothorax on there because this, you have like a bimodal distribution with that in cats because if cats are gonna have chronic airway disease that they get, they get a, you know, a rupture of the airway and get pneumothorax, it's gonna be when they're older. So that's kind of a bimodal distribution. So it's either from trauma when they're young or when they're older it's from, you know, chronic lung disease, that sort of thing.

Here's an example of a cat lower airway disease cat here. All right, he's in the action case. So other than our voices, the cat is quiet, mouth is closed.

You can see the abdominal effort in this cat here. He's sitting sternal, but I bet you he wouldn't like to lay lateral because he wouldn't be able to breathe very well, this cat, a classic example here. He's got kind of that glazed look a lot of these animals will get when they're in distress, like they're just hanging on enough that they're, they know you're there, but they don't have a lot of energy to spend on you otherwise, that sort of thing right?

So, Same as with dogs. If I see that kind of a presentation, I'm gonna say, let me get my stethoscope on there, and what am I going to hear. So again, if it's a loud auscultation, I should also comment.

The reason I'm just saying loud and quiet, yes, crackles and there's wheezes and things that you could tell sometimes between them, but in an emergency setting most of the time, honestly, I just put my stethoscope on. It's so loud because they're in such distress that you can't tell what it is. As far as you know, is it, is it more of a crackle, is it more of a wheeze, whatever, is there a rail, you know, whatever.

So I just go with I hear something in there versus I don't. I think that's the best way in emergency setting. Go back in the skull them later when they're more stable and try to parse out things like, you know, is, is a crackle or a weed, that sort of thing.

But loud auscultation in a cat, it's gonna be cardiogenic pulmonary edoema or it's gonna be non-cardiogenic pulmonary edoema. Or it's gonna be asthma. So cardiogenics again, how do I tell between them?

So middle aged cats are gonna be more like any cardiogenic pulmonary edoema, the exception being breeds like the Maine Coon that get it when they're really young. They almost always have a murmur. That being said, 2 out of our 3 heart failures this week were cats without murmurs, but they should have a murmur or an arrhythmia.

And then again, as we said, there's a breed a predisposition. The non-cardiogenics should have some kind of a history. Cats are drowned.

Cats have bitten an electrical cord. They have burns in their mouth because they, they, they bit the electrical cord, that sort of scenario. They were shaken around the neck by an animal.

They had prolonged seizures, stuff like that. And then asthmatic cats tend to be, not always, but tend to be. Younger cats that tend to be indoor outdoor tend to be acute onset.

They often have some degree of open mouth breathing at some point in their history, whether maybe it's not in the hospital with you, but the owners noticed it, and they may, if you question the owners further, have had shorter bouts where they had a little bit of stress and then seem to get better and the owners didn't think anything of it. That's kind of that kind of a history usually, although, oh, you know, you can, you can absolutely have asthmatics present when they're older as well. And then of course, cats can get pneumonia.

That's my 4th differential for a lot of auscultation because it's actually fairly uncommon for cats to get pneumonia. They can, but it's just not nearly as common as you would see in a dog. The exception probably being if you have asthma and get a secondary pneumonia, that sort of thing.

So, I was talking about the kind of the pulmonary edemas first as cardiogenic and non-cardiogenic and kind of talked about the, the breeze that inherit it. Cats can get mitral valve disease, but cats, the big thing is gonna be HCM, right? And again, Maine Coon is your poster child, but lots and lots of cats get HCM.

Especially as they get older, HCM should have a murmur at the time they're in failure, we hope, and they often have that either an atrial fibrillation style murmur or they have a gallop rhythm, which is not really an arrhythmia, but they have a gallop rhythm. And then they often will have a tendency of thrombo MLI, right? Not every cat that comes in a heart thromboembolism, but certainly that's part of the, of the appearance of HCM.

Non-cardiogenic causes we already talked about and so again, that's your naughty kitten running around the house doing something silly, you know, that sort of thing. So, OK, so what does it look like? So here is A cardiogenic pulmonary edoema that does not have pleural effusion, and a lot of times cats will have pleural effusion.

That's why it's actually kind of hard. This is less common to see this kind of presentation, but you are seeing a cardio, a cardiomegaly in this cat. You are seeing definitely an alveolar pattern, too interstitial that's kind of present.

It's really very diffuse. It's very patchy in cats. And that's kind of the difference between cats and dogs.

Dogs like to have their pulmonary edoema be really that strong, very hier pattern. Cats don't have to have that. They don't always read the book.

So these cats, this cat has like patchy locations where the pulmonary edoema is worse, and that's, you know, that's just the way cats are. So it makes it much harder to diagnose cardiogenic pulmonary edoema and these guys. Here's a non-cardiogenic pulmonary edoema cat, which again, we looked at already, but here he is again.

So difference is he has a smaller heart. Let me go back one second. This guy, you know, one thing to notice the increased external contact and the heart, if you were to measure it, especially on the VED is definitely large.

This guy has a much smaller heart right here. He has an alve interstitial pattern that's much more strongly in the coal lung fields, and it's going to be that that bilateral symmetrical style pattern. And this cat actually was in, I didn't tell you before, but this cat, apparently the basement flooded in these people's house and the cat fell in the water in the basement.

I'm not sure how you do that, and that's that's how it had its surrounding events, so. OK. Here's an asthmatic cat as a as a contrast.

So this particular cat again has fairly normal heart size, maybe it's a little bit plump, but fairly normal heart size. I can see the vessels in this cat and they look fairly symmetrical as far as pulmonary artery and pulmonary vein. And what I'm seeing here.

It's more of the bronchial pattern where you can see these end on bronchi that we always call them the doughnuts, and then you can see occasionally like the train tracks, which are the longitudinal appearance of some of the airways as well. So this guy is kind of the way an asthmatic cat would look, for example. All right, so if I do decide, remember you can have pleural effusion with heart failure in cats as well.

But if I had this heart failure scenario where I do, I believe the cats in heart failure, I'm still gonna do FON just like a dog. I'm gonna give him furosemide. I'm gonna wait 20 or 30 minutes in between.

I'm gonna give him the auction. I'm gonna think about a narcotics such as brophenol. I'd probably avoid morphine in cats, so I'd probably stick to brophenol.

Brenex is OK, but it takes really long time to work. Like, again, buprenex is like another 30-minute onset type drug. So I, I prefer to do full view agonists like methadone, hydromorphone, oxymorphone is my favourite, or something like be on cats.

Non-cardiogenic is oxygen time just like before, you can still choose to bronchodilate them if you want, because again, maybe bronchodilation helps a bit with non-cardiogenic pulmonary edoema. And then your asthmatic cats, you're gonna think about giving, in addition to your oxygen or bronchodilator for sure, and you can do injectable trabutyle, which is what I personally tend to use it at least for the first dose emergently so I don't have to wrestle with them for the albuterol thing here, the albuterol inhaler thing. But definitely especially if they're a little bit more stable, the albuterol works extremely well in these guys to kind of give them a little bit of relief.

So, yeah, any of those options will work for your asthmatic feline. And if you give bronchodilators by mistake to a heart failure because you're not sure what it is, again, a single dose of a bronchodilator won't really hurt them. If you end up giving furosemide to an asthmatic cat, it seems to get better, it's probably the bronchodilation effects of the furosemide that helped you.

But it's OK. The cat got some relief and you can pursue further diagnostics. All right, now if it was pneumonia, cats obviously can get infectious pneumonia, and most cats with infectious pneumonia start with an upper respiratory component.

So usually, at least in the history, if not while you're looking at the cat, there's an upper respiratory scenario with nasal discharge and that sort of thing. They may also more strongly have that multi-cat household sort of history, be from a shelter, that sort of thing. The pattern that you expect to see on X-rays is a ventral pattern again, alveolar to interstitial, again, cranial ventral lung lobe type scenario, and that's again for your bacteria and virus, just like a dog.

Excuse me. If I'm gonna choose antibiotics for those guys, I'm gonna try to cover again gramme positive and gramme negative. So I'm gonna either use again the higher generation cephalosporins will work for both, or I'm gonna do something like a penicillin and adding in like a fluoroquinolone for these guys.

And if I am worried that there is a mycoplasma component, which, you know, a, a chronic asthma cat, a cat from a shelter, mycoplasma might be a little bit higher up in my, my list. And so having that fluoroquinolone on board is definitely helpful for those cases as well. OK, so now, here's another video of a cat with lower airway disease here.

Yeah we've looked at before me talking about radiographs again, sorry. So again, things to look at again. Here's that classic lower airway cat breathing.

It's a little bit paradoxic. There's more of an abdominal component with it, that sort of thing. And again, if I were to skull this feline, this particular cat happened to have a quiet auscultation when we actually took a closer look at him.

And so quiet auscultation, just like in a dog, I'm going to think about air, I'm going to think about fluid. Pneumothorax is a lot less common in a cat than a dog, so pl fusion is gonna be way more, way more likely if I'm just guessing again in Las Vegas. But the way to tell between them is always to tap, right?

Just stick, stick a needle in 7th to 9th rib space, roughly in the middle of the widest point of the chest, the middle of the chest, and you can get either the fluid or air if it's there. You know, if there's a little tiny bit of fluid or a tiny bit of air, you won't get it there, but that's probably not causing the stress either. So if there's enough fluid or air to cause the stress, you should get it by just going in the middle of the chest, and that's dog or cat.

And if it is fluid, I'm gonna analyse it, obviously, again, just like we talked about in the dog to try to figure out what it is, right? And ouch, and then that will kind of lead me and guide me. So here's a radiograph of a pleural effusion cap.

And there are times where the cat actually looks pretty stable and you don't feel the need to tap it before you go to radiology. You go down there and you're actually surprised by how much fluid there is, or sometimes you tapped it, they still have this much fluid left, right? So here we are taking a radiograph, thanks to note for pleural effusion.

Lungs are pulled away from the body wall on the lateral and the VD, you get that leafing appearance of the lung lobes because they have, plural fissure lines. The heart is obscured by the fluid, so is the diaphragm, so you get that silhouetting, and that's again a real classic way that your pleural effusions will look. So fusion again in cats I group them by age.

So the youngest cats, like less than 5, I think of pyothorax because that's cats fighting with each other who are younger. Kylothorax can happen in cats, sometimes even at the younger ages, and then transita for heart failure certainly could appear again in the cats who are prone to heart failure. The group B cats, you get the Kylosaurus.

I'm not saying you can't see a pyothorax, so most of the time that tends to be most of the time a disease of younger cats. You can get heart failure transitates and then neoplasia starts to come on your list. And then as you get to the oldest cats, heart failure and neoplasia until proven otherwise, typically for those guys.

Again, not they can't get in a fight with another cat and get a pyothorax, but it's just much less common. And again, what's gonna help you, you're gonna do your thoracentesis, you're gonna look at your fluid and then the fluid is gonna tell you what to do, just like in a dog, and the fluid will, you know, lead you to, sorry, what kind of treatment that you need to do next, that sort of thing. OK.

Now, in contrast, let's say I did my quiet auscultation, and instead I'm seeing, I'm, I'm, I find out that it's air. So I tap my chest it's a pneumothorax or I take my radiographs and I see this appearance. And so, again, just like in a dog, you're gonna see the heart lifted off the chest, off the sternum.

If you're dealing with a pneumo. Thorax, you're gonna see the lungs kind of consolidated and squished by all the pressure from the air in the in the floral space, and you know, sometimes you'll see a mediasinal shift where the heart is moved more dramatically to one side versus the other if, if the pneumoor is a little bit worse on one side or the other. All right, and the diaphragm you'll note looks very flat here, and that's because again the increased pressure in the chest is pushing on the diaphragm, and this can happen at aeropasia from the way it was breathing before it was intubated because this cat obviously got bad enough it got intubated.

So this particular feline, so again, pneumothorax is not super common in cats, but it can happen. And so this particular feline did not have any kind of a traumatic history. So it seemed to be more of a spontaneous style of pneumothorax.

So spontaneous again with casts will be blobs or bulla, but it almost always comes with the chronic. Lung disease first, so I have cancer in my lungs and that led to a blubber bow that ruptured. I have chronic pneumonia.

I have an abscess in my lung that ruptured, things like that. Every once in a while you also get a cat with a foreign body. I've never seen one, but it's definitely listed in differentials in books, you know, if you go look it up.

And then of course you can always have traumatically induced pneumothoracis. I was hit by a car and brought in off the street. I had a bite wound or other penetrating injury, same as dogs, that sort of thing.

So the cat we just looked at the X-ray. This is a cat and it has a pneumothorax and it ended up actually getting bilateral chest tubes and he's actually attached to the continuous suction unit here, the flurava, and there's a little bit of fluid removed but mostly air from this cat. And so looking at this cat's chest tube, here's the chest tube insertion site, his head's up here, his back's here, and this is just the chest tube entering into the body right there.

And the reason they end up placing the chest tubes was they were evacuating the pneumothorax and they never got negative pressure, and they ended up having to put the chest tubes in. So this cat ended up going as far as getting a CT scan to figure out why he had a pneumothorax, and he ended up, you can kind of see him here on the CT at the ventral aspect. He had kind of multiple coalescing bulla, both in the left cranial and right middle lung lobes, and they, they end up, he got a thoracotomy, and a lung lobectomy to to stop the pneumothorax and end up coming back as carcinoma.

So this is kind of your classic. I think that cat was 12 or 13 as well. So it's kind of your classic.

Why does my old cat have a pneumothorax? Oh, he's got some terrible lung disease I was unaware of, sort of presentation. All right, so now I'm gonna go through just a couple of quick case studies here.

I'm just checking the time here, a couple of quick case studies to see, you know, just kind of illustrate a couple of points. So first case study is going to be squeak. I will preface this to say squeak is my own cat, so you can judge me as much as you want and my level's crazy.

So Squeak is a, she's actually a little older now, but at this time with a seven year old female spayed indoor outdoor feline. And so she had all of a sudden I was actually here sitting at my desk doing some work. All of a sudden she jumps up on the desk with an acute onset of marked expiratory effort.

So respiratory rate was still about 40, but she was like really like pushing and pushing while breathing. I was like, What the heck is going on with you? Of course it was 10 o'clock at night, you know, of course she was up, she's up to date on vaccines.

She does get a topical heartworm preventative that covers her fleas and ticks as well every 1 to 2 months, and she does like to hunt, so she gets dewormed topically every 3 to 4 months as well. So here she is 10 o'clock at night breathing. I wish I had thought to video I because it was a great video, but of course I was in a panic panic mode at that time.

So what do I do at 10 o'clock at night, of course, I go rushing into work. And so we did a CPR when she arrived and it was pretty normal. There was no murmur on auscultation, and we could maybe hear the most mild of crackles in the ventral lung feels, but essentially she had a pretty unremarkable auscultation, really like a little bit of noise like you could hear air air airway sounds like it wasn't muffled, like, like you would see with pleural effusion or air or pneumothorax, but, you know, so but you could definitely hear noise on your auscultation.

So we were thinking lower airway diseases of the lungs themselves what we're kind of thinking. So, based on what I've told you so far, she's got some oscultory changes that are fairly mild. She's indoor, outdoor acute onset.

We don't have the polling thing set up, set up, but you can kind of think for a second, what do you think, would be your most likely thing here based on what I've told you. All right, so obviously at this point we're thinking D is the least likely because we could hear lung sounds. So we're thinking one of the top three at this point was kind of our thought process.

So we ended up taking some X-rays, because when she got there, of course, when I got her in the hospital, she was like 10,000 times better, of course, if she was at home. So we just gave her a little bit of oxymorphone and took her down with some radiographs that that initially. And so these are what chest rads look like so.

You know, you could say, well, there's a little bit of increased sterile contact perhaps in her heart. When you measure it, it's a little bit at the, it's like the higher end of the normal range, so it wasn't, I can't remember the exact vertigo heart score, but it was a little bit at the higher end of normal range. It's a little difficult to see her vessels, I think they're symmetric, but it was difficult to make them out and there's definitely kind of this diffuse.

Institially sort of pattern that's kind of present throughout her lung fields. There's some of the cranial ventil or some in the the caudal lung fields, so it's, it's kind of everywhere, kind of patchy type of pattern. So, Then I said to myself, of course that night I just took her home, like any good vet.

I was like, oh never mind, I'll just take her home, of course, but we did do a few diagnostics before I left and then I did come back for some stuff. So, here's a list of other diagnostics what like what you wanna do first, just kind of think to yourself, here what you might wanna do first. It is, remember it is almost midnight now, so it's the middle of the night, so stuff is not quite as rarely available.

So especially based on the X-rays, we, we didn't have anything to tap. So basically, you know, honestly of the choices as far as what can we do emergently, we did the CBC chemistry just to make sure there wasn't any indications of like anneumonia scenario. She wasn't anaemic, you know, things like that.

So she was super mildly anaemic, like right on the cusp of where you ask yourself and a cat, is that too low or is that OK for this cat, you know, type thing. White count was normal. She had to use aenia.

Our platelets were adequate. Chemistry, the only thing abnormal is the glucose is a little bit high. No, no glucose ureate or specific gravity is well concentrated.

So essentially pretty unremarkable blood work minus possibly a little bit of a mild anaemia maybe type thing. The leukaemia test again. I've done it before, we tested leukaemia FIV and that was negative.

And I had this horrible thought, even though, even though we've taken those X-rays that maybe she was bleeding into her parankum of her lungs because she got, she gets mice sometimes. And I was like, oh my gosh, maybe she ate a mouse that had rodenoside and that caused her to bleed. She's bleeding into the lung rancu and and that's the problem.

So we actually did a PT, PTT which was normal. So hey, it wasn't that. So anyway, OK, so the following day, I was like, oh my God, I need to take heart failure off the list.

So I take her back in and we got her set up for an echo, and there was no significant finding. They thought her systolic function was fine, no thick of the heart. So really unremarkable echo.

So did not appear to be cardiogenic pulmonary edoema. So that thank goodness for that. All right, so now I'm like, all right, it's not cardiogenic pulmonary edoema, you know, it didn't appear to be pneumonia, at least based on anything we're finding on the lab work that would support classic pneumonia.

She didn't have a fever. So here are some other things that I was thinking about. So feline heartworm.

Feline asthma because asthma has a weird appearance sometimes. It's not always that classic look. Could it be something like lung worm because she is indoor outdoor.

And again, I actually didn't know this, but I spoke with the medicine department and toxoplasmosis is something that they threw out as another possibility to cause that diffuse interstitial pattern on a cat. So you guys to take your best guess here for a second. I'll tell you what we did next.

So, let's just look at what these things look like. So I just want to review. Here's what an asthmatic cat looks like again.

So, you know, thinking back to what squeak looks like, you know, some of it looks similar, you know, you can make an argument that it's similar to what squeak looked like, you know, like, ah, maybe it is asthma. The thing is I've never actually seen, at least I never noticed any clinical signs leading up to this would be consistent with asthma, but certainly, you know, you can't say it's not, you know, asthma maybe she had unwitnessed bouts of asthma that I didn't know about. Could it be feline heartworm?

So feline heartworm, again, these are pulled out of a journal article, so they're not quite digitally reproduced, but feline heartworm can cause an interstitial type pattern like you see in the caudal lung fields on this radiograph. So I'm like, you know, she is indoor outdoor. She could have been, you know, definitely mosquito access, you know, she is on the heartworm prevention monthly, but you never know type thing.

Lung worm apparently can cause this sort of an appearance with a diffuse pattern throughout the lung field. I was actually unaware of how this exactly looked graft release is what it looks like, . And apparently again Taxoplasmos, this is an older article, so I apologise the radiographs.

I couldn't find one in our system because it's so uncommon, but you can kind of see it. I, I, broncho interstitial type marking ignore the fact that there's a bullet here, but you can see kind of a diffuse bronchoitial markings on this, on this, radiograph, and I was like, well, you know, heck, I can't say it's not. She's got a diffuse bronchoit pattern, you know, type thing.

So those are what we were thinking about. So what did I end up doing with this cat? So I did a heartworm antibody and antigen, those were negative, so it didn't appear to be heartworm.

I gave her fenbendazole cause I was like, what the heck? It could be, could be, could be lung worm, although that was fun times medicating her. This little devil is not easy to medicate.

So, I also gave her two doses of, the, she was getting, revolution at that time. So I actually gave an extra dose of Revolution that month as well because I looked it up and if you do 2 doses of those kind of topical, heartworm medications, they can actually get lung worms. So I, I did 2 doses that month as well.

I considered doing, randomly treating with clindamycin for Toxo, but as I mentioned, it's very difficult to treat this cat, so I didn't do that. And what ended up happening with her was, I don't know, 2 days after the 1st 2 days after she first, she went to the vet, there was increased effort. Like it wasn't as dramatic as the first night, but it was significantly improved it was still there.

And by like 3 days afterwards, I, I didn't notice it again. However, A week or two later, I noticed her quote unquote, which I think I in retrospect had noticed before, coughing up a hairball know she's a short-haired cat, and I was like, wait a minute, I think she's coughing. I think she probably has asthma.

So I'm pretty confident she has asthma in retrospect now. But heck, I. Trained her and I treated her.

The only thing I didn't do is go back and take more X-rays just for curiosity, but, I, I don't want to sedate her and go back into the hospital. That's why we haven't done it. So, but now we're about a year out, and a half out from this, and we've been pretty, pretty good, and she hasn't really had another bout of this, so.

OK, one more quick case study just to finish this off here because I think this is a cool case here is our K9 case here. So this is Skyler we saw briefly Skyler in a previous, on a previous slide, so I'm just gonna run this video here. So Skyler presented about 10 o'clock in the morning on a Saturday, of course.

She had been let out about 6 o'clock in the morning and run free on the owner's property, and then she'd come in and the owner's noticed that she has some increased efforts. You can kind of see a little bit head out stretch, a little bit of abdominal component and kind of see the rib markings when she's breathing, that sort of thing, still wagging her tail though when she came in. We're tempted to give unsuccessfully flow by to this dog.

All right, so. Over, you know, maybe the course of 30 minutes because remember we're an academic institution. We gotta have the students go up and get a history and then we got the intern come and look at the dog.

So over the course of 30 minutes she went from kind of standing up and wagging to preferring to sit and a little on this video again. I'll just get rid of our voices here, but you can see she's sitting. She looks more orthoptic than she did before.

That's still the abdominal component to the breathing, but the head outstretch is markedly different. I notice how unconcerned the student is. She comes and sits down.

I'm just kidding. But anyway, and if you get close here, we're gonna look and we're gonna see that she's got Skyler hair is a little bit of a nostril flare, which is definitely more marked than we were seeing at the initial presentation. All right, so what do we do here?

So again, I didn't give you a full signal a 2 year old female spayed mixed breed. Like I say, she'd been out early in the morning, came home about 9 a.m.

Owner saw the effort to hit our door about 10, sorry, 1 o'clock I said 10, 1 o'clock, so a couple hours after she came in, and we saw her and she had gotten progressively worse over the time that the owners had noticed. So, what do you think could be wrong with this dog? So, you know, there's, she's quietly breathing and then I don't hear with my ear, but she definitely has the increased effort.

So just kind of make your best guess again. I didn't tell you what the auscultation was like yet. So, upper respiratory is probably not very likely, right?

Because she doesn't have that that that noise when, you know, when we were videoing her. So it's probably gonna be one of the other ones that we're thinking about, right? She's a younger dog, so congestive heart failure is a little bit less likely given her breed.

So you're wondering more about some of these other lung parenchyma related things, right? So, or plural cavity related things, I'm sorry. So what do we do here?

We, we decided we'll go take some radiographs, and this is what we saw on the radiograph. We're like, whoa. So we saw, you know, there looks like there's, you know, an alveolar pattern here, but we suspect it's because as long as they're being pushed over rather than true alvelar pattern, and obviously there's a whole bunch of air here present on the left side.

So we're like, wow, we better tap that. So we tap it and removed about 2.3 litres of air from the left side of her of the thorax, and we're like, OK, all right, she's breathing better after that.

So here she is after the tap, breathing better. So you can see the the orthopy is improved, the nostril flarings improved. She's still a kipnick, but it's better than it was when we first started, you know, type scenario.

So, of course, again we have to discuss it. There's a student we have to discuss what's going on, so we didn't, but you know, the dog is looking better, so we ended up after that taking more radiographs. And so after we did the thoracocentesis, this is what we saw instead and we're like, wait a minute.

So obviously you see these lungs have reinflated on the right side, but now we're seeing a lot of stuff here that doesn't look like it should be there. And when you look here on the little bit of lateral view we had, we were kind of asking ourselves, where is the stomach present on this view? And we took some more views and we're like, mm, I think this is the wall, the stomach right here highlighted by air on either side, and we're like, I really can't see the diaphragm.

Oh, I think this dog is a diaphragmatic hernia, and we took a VD and you're like, wait a minute, I'm pretty sure this is a diaphragmatic hernia. So, she did have a diaphragmatic hernia. There must have been some trauma on witnessed when she had gone out for her morning stroll in the morning before she came home from the owners.

She did have surgery. Stomach, spleen and liver were all on the thorax, so it's a pretty dramatic hernia. And she ended up recovering really, really well from this, and she was sent home and did great afterwards.

So just one more thing to keep on your differential is is diaphragmatic hernia. I didn't actually tell you her auscultation was, depending which side of the chest you listened to, the right side of the chest, you could actually hear lung sounds. The left side was, we were having trouble telling what we were hearing on the left side.

There was noise there and we were and what it was in retrospect was the air you could, you could hear some of the gut sounds and stuff on the left side when we first sculted her. Later on, when her, when I think. Happened was her stomach was not originally entrapped in her chest and the stomach split up there and then then we got that big appearance of the quote unquote pneumothorax and at that point you could not hear any lung sounds on the left side.

So hers was a very dynamic auscultation depending on if the stomach was up in the chest and filled with air, if the stomach was like less full and slipping down, that type of thing. So anyway, just something else to keep on your differentialist. All right, well thank you for your attention, and if you have any questions, we can go over those now.

Brilliant, thanks, Liz. Yeah, you've got a couple of questions of, of come in. Someone's asked in regard to antibiotics for pneumonia, what in your view, what is your view on, doxycycline, use in light of its lipid solubility in bronchial secretions?

OK, the question was about doxycycline and bronchial secretion. So I, you know, honestly, I kind of grew up not using doxycycline, but just like the end of 2017, they had this big consensus statement come out about respiratory disease in dogs and cats and, and like I say, Journal of Vet Internal Medicine. And in that they were very adamant that doxycycline should be your first choice for like shelter style animals like dogs or cats that are from a shelter background, and they felt that it was getting the effects that they wanted, you know, despite, you know, questions about whether or not it was maybe the best drug in the past.

So I would say based on that consensus. The statement, if I get a shelter animal in that I believe has like a secondary pneumonia, I will use doxycycline. Quite honestly though, if it's your like normal pet, I'm just going to use something like a, a potentiated like like amoxicillin clavulanic acid, you know, Clavamox, you know, type thing, and most other animals are not in the shelter setting.

So I would say, you know, shelter animals, I'm going to use it. Non-shelter animals, I only use doxy if the if the. You know, if for some reason that's the only choice I have on like a culture and sensitivity.

So, and I'm getting asked about Longworms being mentioned as a as a DDX and how, if they exist in, in USA much. You said lung worms. Apparently they do.

The lung worms in the US, I guess so. Have I ever seen one? Me personally, no.

I do know that the medicine department maybe 6 to 8 months ago was all very excited about a lung worm case that had come in, and that dog, I think that dog had some degree of travel history where it was from a little bit warmer part of the country and then had moved with the owners up to us. So we do see it. I have personally not seen one, but it is .

Yeah, we do see them from time to time, but that's super duper common. I do believe in the South though they see them more than we do here in kind of the Midwest so. Really?

And, last question before we have a little break, someone's asked if Skyler, er, had sedation to X-ray and drain. Also, is it assumes he got, pneumothorax due to lung trauma, as doesn't always happen with diaphragmatic hernia. OK, so I had two questions.

The first was what kind of sedation for thoracocentesis, and then what was the second question? Is it assumed she got a pneumothorax, due to lung trauma? Oh, got you.

And in the last case example that we had. Yeah. OK, so first question, sedation for thoracentesis.

So I do it if I need to. I would say 8 times out of 10 if they're in true distress they don't need any sedation. But if I was gonna sedate them, I would use, I usually just start with like my borphrenol.

That's kind of my go to drug for like, let me give you a little bit of mild sedation. I've used other opioids though as well, so if it's like a hit by car case, I would use hydromorphone or methadone or something like that. So I'll.

Use an opioid typically first, and I, I would say an opioid coupled with the fact that you're in respiratory distress, most of the time that's gonna be good enough to get thracentesis done. Many times in my life I've done thoracentesis though with no sedation and, and things have gone great. If they are fighting me at all though, I will definitely give them the opioid, and if I need to give more, I will.

So if I need to give him a little touch of dexammeatominine because I can reverse it real quick. Or a little touch of ace, and I want him to wait, you know, I want to wait 20-30 minutes, so I'm not in a rush. So Ace is my less favourite choice because it takes longer to work than index metatoinine.

So if I'm like, oh my gosh, you really need to tap you quick, quick sedate him and tap them, I'll give an opioid if that doesn't work within about 23 minutes, 5 minutes max. I'll give dexametatominine and then I'll, I'll, I'll, do the tap. But I would say most of the time I don't need the dexmeatton.

As far as, oh yeah, go ahead, I'm sorry. No, it's alright, I was go on to the next question. So, so just ask what er the treatment for squeak's asthma.

Oh, squeaks, squeaks good old treatment. OK, yeah, so wait, let me just finish with the other one. I think the other dog Skyler, the dog had pneumothorax from from lung trauma.

No, the pneumothorax is actually a fake pneumothorax and Skyler. The pneumothorax we saw was all the stomach filled with gas. That was all the new one.

There was no other pneumothorax that exists in the dog, just good old squeak what. Treatment that I do, I, I like I say, I just dewormed her extra, and I gave her the, panicure, the fambendazole, and I gave her the topical, topical, heartworm medication, and I've done nothing additional since and we've been OK. Now come on.

So brilliant. Thanks very much for that. No, no, that's the end of those questions for our first presentation.

Thank you very much for that one.

Description

Transcription

Sponsored By

Reviews