Respiratory distress can be stressful for the entire veterinary team.
There are 8 main causes of respiratory distress that can be quickly narrowed with a brief physical exam and POCUS.
| Examples | Findings | |
| Upper airway | Laryngeal Paralysis Brachycephalics Collapsing trachea | Stertor; stridor Obstructive: prolonged effort -Inspiratory (extrathoracic dz) -Expiratory (intrathoracic dz) |
| Lower airway | Asthma Chronic bronchitis | Expiratory effort Wheezes |
| Pulmonary parenchyma | Pneumonia Edema (C vs NCPE) Contusions ARDS Neoplasia Fibrosis | Restrictive: rapid, shallow Variable Crackles B-lines (POCUS) Cardiogenic: -murmur -increased La/Ao (POCUS) +/- tachycardia, hypothermia |
| Pulmonary thromboembolism | Wedge sign (POCUS) | |
| Pleural space | Pneumothorax Pyothorax Hemothorax Chylothorax | Restrictive: rapid, shallow Paradoxical Decreased lung sounds |
| Chest wall | Flail chest | Focal paradoxical |
| Abdominal distention | Ascites Organomegaly | |
| Look-alikes | Behavioral (fear, pain, anxiety) Metabolic (acidosis, anemia) Environmental (hyperthermia) Neurologic (CNS disease, neuropathy) |
Life-saving therapy should be instituted as soon as possible. Remember that the lungs have two main jobs: oxygen in & CO2 out. Sedation and oxygen supplementation usually help. If you’re thinking you might need to intubate, you should likely go ahead and intubate. If safe, place the patient in an oxygen cage and everyone should take a breather.
| Treatment | |
| Upper airway | Relieve obstruction Sedation: butorphanol, acepromazine, dexmedetomidine +/- Steroids +/- Intubate, tracheostomy +/- Cooling if hyperthermic |
| Lower airway | Bronchodilators: terbutaline, aminophylline, albuterol Steroids Minimize stress Oxygen |
| Pulmonary parenchyma | Oxygen Treat underlying cause +/-Nebulization and coupage |
| Pulmonary thromboembolism | Oxygen Antiplatelet (clopidogrel) Anticoagulants (heparin, enoxaparin, etc) +/- tPA +/- sildenafil |
| Pleural space | Thoracocentesis +/-Chest tube |
| Chest wall | Lateral recumbency with flail side down Analgesia |
| Abdominal distention | Abdominocentesis (if applicable) |
| Look-alikes | Treat underlying cause |
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