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 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.  

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.

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.

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 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.

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'''.

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, contusions (post-trauma), pulmonary eosinophilic infiltration (PIE) and neoplasia.

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.

====Lower Airway Disease====

====Lower Airway Disease====

Lower airway disease causes wheezing on expiration. Causes of this include FAAD.

Lower airway disease causes wheezing on expiration. Causes of this include [[Feline Asthma Syndrome|FAAD]].

====Upper Airway Disease ====

====Upper Airway Disease ====

====Pleural Space Disease ====

====Pleural Space Disease ====

Lung sounds are decreased on auscultation. Causes include pyothorax, chylothorax, neoplasia, CHF, FIP, haemothorax and heart failure.

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.  

====Space Occupying Lesions ====

====Space Occupying Lesions ====

Space occupying lesions cause displacement of heart sounds caudally and loss of 'rib-spring' on palpation of the chest wall. Diferential diagnoses include neoplasia, abscess and cysts.   

Space occupying lesions cause displacement of heart sounds caudally and loss of 'rib-spring' on palpation of the chest wall. Differential diagnoses include [[Thymus Neoplasia|neoplasia]], abscess and cysts.   

The physical exam should be performed in the most stress-free manner possible: the cat should first be observed from a distance to identify the phase of respiration that is affected. Then the clinician should auscultate, palpate and percuss the chest to identify any respiratory or cardiac abnormalities. A full clinical exam should not be performed until the animal is more stable.

The physical exam should be performed in the most '''stress-free manner''' possible: the cat should first be '''observed from a distance to identify the phase of respiration that is affected'''. Then the clinician should '''auscultate, palpate and percuss the chest''' to identify any respiratory or cardiac abnormalities. A full clinical exam should not be performed until the animal is more stable.

There are three differentials that are common causes of feline dyspnoea. It is important to keep these in your mind when working up the case and ruling-out each one can bring you to a rapid diagnosis.:

There are three differentials that are common causes of feline dyspnoea. It is important to keep these in your mind when working up the case and ruling-out each one can bring you to a rapid diagnosis:

'''1) Pleural Effusion'''  

'''1) 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 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.

'''2) Heart Disease'''  

'''2) Heart Disease'''  

'''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 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 no be able to deal with the procedure with its low oxygen reserve.

===Pleural Effusion===

===Pleural Effusion===

Initial treatment is thoracocentesis. This procedure also stabilises the animal. It should be noted that even if only a portion of the fluid is drained there should still be a significant improvement in respiratory signs. Cytology should be performed on the fluid to achieve a diagnosis and prognosis.   

Initial treatment is '''[[Thoracocentesis|thoracocentesis]]'''. This procedure also stabilises the animal. It should be noted that even if only a portion of the fluid is drained there should still be a significant improvement in respiratory signs. Cytology should be performed on the fluid to achieve a diagnosis and prognosis.   

===Heart Disease===

===Heart Disease===

Frusemide should be administered to any cat suspicious of heart disease to clear cardiogenic pulmonary oedema. Frusemide can be administered intravenously or intramuscularly and it should be given every half an hour until the respiratory rate drops below 40 breaths per minute. When appropriate, the frusemide should be given orally. Radiography can be used to monitor the response to treatment.   

'''[[Heart Failure, Treatment|Frusemide]]''' should be administered to any cat suspicious of [[Heart Failure|heart disease]] to clear cardiogenic pulmonary oedema. Frusemide can be administered intravenously or intramuscularly and it should be given every half an hour until the respiratory rate drops below 40 breaths per minute. When appropriate, the frusemide should be given orally. Radiography can be used to monitor the response to treatment.   

===Feline Allergy Airway Disease (Feline Asthma)===

===Feline Allergy Airway Disease (Feline Asthma)===

Ideally the underlying cause of the FAAD should be identified.  

Ideally the underlying cause of the [[Feline Asthma Syndrome|FAAD]] should be identified.  

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 torbultaline administered intravenously or salbutamol via nebulisation (this may be stressful for the animal).  

* The administration of 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 dexamethosone intravenously or fluticasone via nebulisation (this may be stressful for the animal).

Before steroids are administered it is best rule out 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.

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.  

==Summary==

==Summary==

The management of emergency dyspnoea case is very important. If the cat can be stabilised then a full diagnostic work-up can be performed, but the is essential that the cat survives the initial episode before then.  

The management of emergency dyspnoea case is very important. The cats survival is dependent on your ability to stabilise it.

==References==

==References==

Adamantos, S (2011) '''Feline Dyspnoea''' ''RVC Emergency and Critical Care Elective''

Adamantos, S (2011) '''Feline Respiratory Emergencies''' RVC Emergency and Critical Care Elective Course, ''Royal Veterinary College''

 

RVC staff (2009) '''Respiratory System''' RVC Intergrated BVetMed Course, ''Royal Veterinary College''

[[Category: To Do - Siobhan Brade]]

[[Category: To Do - Siobhan Brade]]