diagnosa klinik_cardiorespiratory

Drh. Dian Vidiastuti, MSi Diagnosa Klinik-PKH UB 2015

Inspeksi

Palpasi

Auskultasi

Pemantauan umum, Gejala Klinis

Lokasi (Precordium, Apex), Pulse rate, Blood

pressure

Heart rate, Suara jantung

Stethoscope

Doppler flow detector

Sphygmomanometer ECG

USG

Dyspneu

Syncope Peripheral

edema

Palpitasi

Evaluasi heart rate (HR) Suara jantung normal ‘Lub-Dub’ S1 Lub : penutupan mitral v dan trikuspid v, (awal sistole) S2 Dub : suara aortic v dan pulmonalis v (awal diastole)

• Sinus aritmia HR ↑ pd saat inspirasi

• Normal pd brachychepalic SINUS

ARRYTHMIA

• Slow Heart Rate <65 beat/mnt

• Systemic disease, intracranial press, drugs (transquilizer, morphine)

SINUS BRADYCARDI

• Increase HR >160 beat/mnt

• Stress, ↑ metab & O2 , pathology, drugs (ATS,eph,ketamin)

SINUS TACHYCARDIA

• Common pathological arrythmia in dog ATRIAL

FIBRILATION

• Produce by turbulent blood flow

• Heart disease (degeneration valve)

MURMURS

A. Femoralis, A. Coccygealis Predispotition factors :

Breed

Sex

Gestation, Partus, Lactation

Nervous Body size

Temperature

Activity

CRT < 2 s Gingiva, palmar, cutaneus

Systemic arterial BP is created by : 1. the pumping action of the heart, 2. circulating arterial blood volume, 3. the smooth muscle tone of blood vessel walls. Methode : Direct & Indirect Systolic & Diastolic

Doppler ultrasound Flow Detector

USG

Heart Structure

Congenital / Acquired heart disease

Size & functioning of heart

M mode echocardiogram

B mode Echocardiogram

Doppler ultrasound

Normal ECG 3 Leads

the number of times per minute that air is inhaled and exhaled

degree of chest movement : normal, shallow, deep

RESPIRATION SIGN

DYSPNEU

TACHYPNEA ORTHOPNEA

Breath sounds Planum Nasale

Nasal discharge :

Serouse/ Mucous, epistaksis

Sinus

Palpation Laryngitis catarrhalis frequent cough Pain Size and location change Auscultation Trachea Stridor

NORMAL RESP SOUND

• vesicular / bronchial

• soft, breezy/rustling sounds

ABNORMAL RESP SOUND

• Wheezes’ (continuous high pitched hissing heard more often on expiration) - occur with small airway diseases such as asthma

• ‘Rales/crackles’ (obstructed airway, more commonly on inspiration) may be heard when fluid in the lungs

• Rhonchi’ (musical sounds-low or high pitched)

• Stridor, upper airway obstruction

COTTON LIKE DENSITIES

PLEURAL EFUSSION

Since airway obstructions may impede oxygenation, ventilation

Pulse Oximeter) (normal : >95 %, anesth >90 %)

Arteri / venous Hypoventilation (PaCO2) >43 mmHg

(dogs), >36 mmHg (cats) respiratory acidosis

Waddell LS, Brown AJ. Hemodynamic monitoring. In Silverstein DC, Hopper K (eds): Small Animal Critical Care Medicine, 2nd ed. St. Louis: Elsevier, 2015

Walker et al, Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition

King L, Clarke D. Emergency care of the patient with acute respiratory distress. Veterinary Focus , Vol 20 No 2 ,2010