Respiratory Disease and Thoracic Trauma- Emergency considerations

What does oxygen do

increase partial pressure in blood

What are the quick PE parameters for stable vs emergent case

HR/RR, PP, extremities

what is able to be diagnosed on PE

Hemothorax and pneumothorax

What do abnormal bronchial noises sound like

wheezes

What do abnormal vesicular noises sound like

crackles- CHF, and pneumonia

When you can’t hear lung sounds what should you do?

tap it

PaO2 arterial blood

85-100mmHg

PaCO2 arterial blood

35-45 mmHg

HCO3 arterial blood

21-27 mmol/L

ph arterial blood

7.35-7.45

What is important to do with trauma

TFAST ultrasound point of care ultrasound

When do you thoracocentesis

Prior to radiographs when you have a RESTRICTIVE respiratory pattern

How do you perform a thoracocentesis

between 7-9 ICS cranial edge of rib, bevel angled flat to lungs

What do we assume in all dogs with thoracic trauma

pulmonary contusions

Flail chest has what signs

Paradoxical chest wall motion, hypoventilation

What should you do for a dog with flail chest

oxygen, local blocks, systemic pain control, Monitor ABG and A-a gradient

What are two big cardiac injuries

Traumatic myocarditis and myocardial contusions

Direct trauma or ischemia-arrhythmias ventricular Vtach

What is the diagnostic choice for Pericardial effusion

Echocardiography

What are some signs for a diaphragmatic hernia

± clinical signs, decreased ventral/diffuse lung sounds, borborygmi on thoracic auscultation

What tells you if lung function is working

Arterial blood gases-hypoxemia, respiratory acidosis, heartworm tests

What is the MRI good for?

Bullae and blebs

What does Restrictive Respiratory Pattern cause on the lungs

Compression

What is an example of an open pneumothorax

stab, gunshot, bite

What is an example of a closed pneumothorax

impact, chest compress w/ closed glottis, tension pneumothorax, rib fracture

What dogs often get spontaneous pneumothorax

Deep chested large breed huskies

Tension Pneumothorax has what occurring on inspiration

air enters pleural space

Tension pneumothorax has what occurring on expiration

air trapped

What can cause a spontaneous pneumothorax

Cavitary lesions- blebs, bullae, cysts, abscess/ granulomas

What causes iatrogenic pneumothorax

FNA, intubation, ventilation, chest tap/tubes, chronic effusions-chylothorax, pyothorax, malignant effusions

Hemothorax can become what

hypovolemic from shock and monitor

How to measure chest tube

Size=size of mainstream bronchus

How to place chest tube

10th or 11th ICS tunnel to 3rd or 4th ICS perpendicular cranial to a rib, brisk thrust parallel to chest advance tube off stylet

Chest tubes on Pradiographs are done where

cranioventral pleural space to level of 2nd rib

When to remove a chest tubes

2-4ml/kg/day