Changes

==Introduction==

==Introduction==

'''Feline respiratory emergencies''' are '''common''' in general practise. It is essential that these cases are handled in an appropriate way as the patients are normally very '''fragile''' and may go into respiratory arrest if they become too stressed.  

'''Feline respiratory emergencies''' are '''common''' in general practice. It is essential that these cases are handled in an appropriate way as the patients are normally very '''fragile''' and may go into respiratory arrest if they become too stressed.  

The aims of the work up of a feline dyspnoea case are:

The aims of the work up of a feline dyspnoea case are:

* Dilated pupils

* Dilated pupils

Oxygen reserve is generally very low in dyspnoeic cats and you should avoid stressing them if at all possible. This is achieved by '''gentle handling, minimal procedures, and the use of a quiet, dimly-lit room'''.   

Oxygen reserve is generally very low in dyspnoeic cats and you should avoid stressing them if at all possible. This is achieved by '''gentle handling, minimal procedures, and the use of a quiet, dimly lit room'''.   

==Stabilisation==

==Stabilisation==

On presentation the cat should immediately be placed in an '''oxygen cage'''. This increases the animals oxygen reserve and allows it to relax following the journey to the practise. If an oxygen cage is not available then 'flow-by' oxygen should be supplied in a stress-free manner.

On presentation the cat should immediately be placed in an '''oxygen cage'''. This increases the animals oxygen reserve and allows it to relax following the journey to the practice. If an oxygen cage is not available then 'flow-by' oxygen should be supplied in a stress-free manner.

If the cat appears to be going into respiratory arrest then a '''general anaesthetic''' can be used to stabilise the animal, however this should be avoided if possible.

If the cat appears to be going into respiratory arrest then a '''general anaesthetic''' can be used to stabilise the animal, however this should be avoided if possible.

In some cases, the method of stabilisation is the same as the therapy, for example the drainage of pleural fluid.

In some cases, the method of stabilisation is the same as the therapy, for example the [[Thoracocentesis|drainage of pleural fluid]].

==Diagnosis==

==Diagnosis==

Whist the cat is in an oxygen cage, a '''thorough history''' should be taken, including the '''duration and progression of the dyspnoea''', any '''previous/current medical problems and medications''', '''husbandry''', '''appetite and thirst''' of the cat and whether they may be a history of '''trauma'''.

Whilst the cat is in an oxygen cage, a '''thorough history''' should be taken, including the '''duration and progression of the dyspnoea''', any '''previous/current medical problems and medications''', '''husbandry''', '''appetite and thirst''' of the cat and whether there may be a history of '''trauma'''.

A physical exam should then be performed to establish the location of the respiratory signs:

A physical exam should then be performed to establish the location of the respiratory signs:

==== Parenchymal Disease====  

==== Parenchymal Disease====  

Parenchymal disease produces crackles at the end respiration. Differenial diagnoses include cardiogenic pulmonary oedema, [[Pneumonia|pneumonia]], contusions (post-trauma), [[PIE|pulmonary eosinophilic infiltration (PIE)]] and neoplasia.

Parenchymal disease produces crackles at the end respiration. Differential diagnoses include cardiogenic [[Pulmonary Oedema|pulmonary oedema]], [[Pneumonia|pneumonia]], contusions (post-trauma), [[PIE|pulmonary eosinophilic infiltration (PIE)]] and neoplasia.

====Lower Airway Disease====

====Lower Airway Disease====

====Pleural Space Disease ====

====Pleural Space Disease ====

Lung sounds are decreased on auscultation. Causes include [[Feline Infectious Peritonitis|FIP]], [[Pyothorax|pyothorax]], [[Pneumothorax|pneumothorax]], [[Neoplasia - Pathology|neoplasia]], [[Haemothorax|haemothorax]], [[Chylothorax|chylothorax]] and [[Heart Failure|congestive heart failure]]. Th history may help identify the cause of the disease.  

Lung sounds are decreased on auscultation. Causes include [[Feline Infectious Peritonitis|FIP]], [[Pyothorax|pyothorax]], [[Pneumothorax|pneumothorax]], [[Neoplasia - Pathology|neoplasia]], [[Haemothorax|haemothorax]], [[Chylothorax|chylothorax]] and [[Heart Failure|congestive heart failure]]. The history may help identify the cause of the disease.  

====Space Occupying Lesions ====

====Space Occupying Lesions ====

'''1) Pleural Effusion'''  

'''1) Pleural Effusion'''  

[[Pleural Cavity and Membranes - Pathology|Pleural effusion]] produces muffles heart and lung sounds ventrally. The cat will normally have a short, shallow respiratory pattern. The presence of fluid can be rapidly confirmed using ultrasound.

[[Pleural Cavity and Membranes - Pathology|Pleural effusion]] produces muffled heart and lung sounds ventrally. The cat will normally have a short, shallow respiratory pattern. The presence of fluid can be rapidly confirmed using ultrasound.

'''2) Heart Disease'''  

'''2) Heart Disease'''  

A cardiac murmur (with or without a gallop) and diffuse crackles across the thorax should be auscultated. An echocardiogram and radiography can be used to confirm the diagnosis of heart disease, however in a very unstable case with cardiac signs it is best to use frusemide as a trial therapy and monitor the response to therapy for diagnosis. Only once the cat has stabilised, or if it is responding poorly to treatment should radiography or echocardiography be performed to confirm the diagnosis.   

A [[Heart Murmurs|cardiac murmur]] (with or without a gallop) and diffuse crackles across the thorax should be auscultated. An echocardiogram and radiography can be used to confirm the diagnosis of heart disease, however in a very unstable case with cardiac signs it is best to use frusemide as a trial therapy and monitor the response to therapy for diagnosis. Only once the cat has stabilised, or if it is responding poorly to treatment should radiography or echocardiography be performed to confirm the diagnosis.   

'''3) Feline Allergic Airway Disease (Feline Asthma)'''

'''3) Feline Allergic Airway Disease (Feline Asthma)'''

A cough, diffuse harsh sounding lung sounds and an expiratory wheeze may be auscultated. The diagnosis of [[Feline Asthma Syndrome|FAAD]] can be confirmed by radiography, which may show a flattened diaphragm, air trapping, rib fractures and a bronchial pattern. However you as a clinician should consider the risk-benefit of this before performing the procedure as the cat may no be able to deal with the procedure with its low oxygen reserve.

A cough, diffuse harsh sounding lung sounds and an expiratory wheeze may be auscultated. The diagnosis of [[Feline Asthma Syndrome|FAAD]] can be confirmed by radiography, which may show a flattened diaphragm, air trapping, rib fractures and a bronchial pattern. However you as a clinician should consider the risk-benefit of this before performing the procedure as the cat may not be able to deal with the procedure with its low oxygen reserve.

Treatment involves:

Treatment involves:

* The administration of '''bronchodilators'''. Either torbultaline administered intravenously or salbutamol via nebulisation (this may be stressful for the animal).  

* The administration of '''bronchodilators'''. Either torbutaline administered intravenously or salbutamol via nebulisation (this may be stressful for the animal).  

* The administration of '''[[Steroids|steroids]]''' to reduce inflammation. Either dexamethosone intravenously or fluticasone via nebulisation (this may be stressful for the animal).

* The administration of '''[[Steroids|steroids]]''' to reduce inflammation. Either dexamethasone intravenously or fluticasone via nebulisation (this may be stressful for the animal).

Before steroids are administered it is best '''rule out [[Lymphoma|lymphoma]]''' as the cause of the dyspnoea. The reasons behind this are; that steroids may mask the signs of the neoplasia and, since chemotherapy protocols include steroids, the effectiveness of the chemotherapy is reduced if the cat has been already treated with steroids. In addition, if the respiratory disease is infectious in origin clinical signs may worsen with steroid administration.  

Before steroids are administered it is best to '''rule out [[Lymphoma|lymphoma]]''' as the cause of the dyspnoea. This is because steroids may mask the signs of the neoplasia and, since chemotherapy protocols include steroids, the effectiveness of the chemotherapy is reduced if the cat has been already treated with steroids. In addition, if the respiratory disease is infectious in origin clinical signs may worsen with steroid administration.  

==Summary==

==Summary==

[[Category: To Do - Siobhan Brade]]

[[Category:To Do - Manson review]]

 

 

[[Category:Respiratory Diseases - Cat]]

[[Category:Expert Review - Small Animal]]