23 Respiratory distress
Dogs and cats with respiratory distress are a relatively common presentation to emergency clinics. These patients are often extremely unstable and a rational approach to their management can make the difference between life and death in the initial period following presentation. This is especially true of cats and the bulk of this chapter will therefore focus on this species. However, many of the principles discussed are equally applicable to dogs, about which some information is provided at the end.
Approach to Feline Respiratory Distress
Respiratory distress can occur as a result of an abnormality affecting any one or more of the following areas:
Being able to identify the area affected is extremely important with respect to patient management.
It is often possible to make sensible judgements as to the most likely causes of a cat’s respiratory distress on the basis of its signalment and a very brief history. For example:
The author’s initial approach to a cat that presents with moderate or severe respiratory distress is as follows.
The cat is first briefly observed in its carrier as much information can often be obtained from this approach (see Table 23.1).
|Mental alertness and pupil size|
|Respiratory rate, effort and pattern|
Observing respiratory patterns can be difficult but may yield very useful information. Reported associations include: mixed (inspiratory and expiratory) dyspnoea with a fixed upper respiratory tract obstruction (e.g. laryngeal mass); mixed dyspnoea, in particular with prolonged expiration and an expiratory push, in feline bronchial disease
|Position and posture|
Lateral recumbency is often an ominous sign indicating impending respiratory arrest and should prompt rapid intervention
|External evidence of trauma||Raises the index of suspicion for common traumatic causes of respiratory distress (e.g. pulmonary contusions, pneumothorax)|
An extremely brief examination is then performed. This is done with the cat in its carrier, if that is the cat’s preferred option and the carrier design allows. Otherwise, it is done in close proximity to a prepared oxygen cage and only if the cat has not been distressed in any noticeable way by removal from its carrier. Attention is paid to the following: