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A PATIENT in respiratory distress affords the practitioner very little margin for error or hesitation. Fortunately, the majority of dyspnoeic patients respond well to oxygen therapy and a few key management strategies. These techniques allow the veterinary surgeon to alleviate life-threatening distress and allow time for definitive diagnostics and treatments to be accomplished.
All veterinary practice staff, including receptionists, should be trained to recognise the signs of dyspnoea. Postural manifestations of dyspnoea such as open-mouth breathing, an extended neck, abducted elbows and an anxious facial expression may be seen. Some patients will appear distressed by the respiratory effort whereas others may seem behaviourally normal; the second group commonly have a more insidious onset to their respiratory signs.
Initial treatment
Minimise stress
Minimising stress is vital in the dyspnoeic patient. Animals with severe hypoxaemia should have their movement limited in order to maintain sufficient oxygenation. Any increase in non-essential tissue oxygen consumption, such as that caused by struggling against a restraint, may precipitate cardiorespiratory arrest. All patients with severe hypoxaemia should have their activity restricted. Any potentially stressful procedures, such as catheter placement or radiography, should be carried out cautiously and incrementally, while providing supplemental oxygen and allowing time for recovery between steps. When working with dyspnoeic patients, one should always be prepared for emergency intubation. This includes assembly of the appropriate equipment, including a good light source, which should be kept ready for use when the patient is stabilised.
Patient positioning
Patient position can significantly affect arterial oxygen concentration. Putting the animal in sternal recumbency is a simple but effective way of increasing oxygenation.
Provide oxygen
It is never wrong to administer oxygen and it should be the first therapy given to any dyspnoeic patient. Oxygen supplementation can be provided by a variety of methods. An oxygen source and non-rebreathing anaesthetic circuit plus or minus a face mask are all that are necessary to provide immediate oxygen to almost any patient for the first 15 to 30 minutes. The oxygen source can be from an anaesthetic machine, from a single cylinder with a regulator or from a piped gas supply.
Flow-by oxygen can be administered simply by holding the open end of the breathing circuit in front of the patient's nose or mouth. A...