steven berkowitz, dvm chief, emergency and critical … · steven berkowitz, dvm chief, emergency...
TRANSCRIPT
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Steven Berkowitz, DVM
Chief, Emergency and Critical Care
Saint Francis Veterinary Center
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Outline Anatomy
Common Diseases
Interventions
Oxygen Therapy
Medications
Nebulization
Coupage
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Respiratory Tract
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Lower Respiratory Tract
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Airways
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Common Diseases of Lower Airways Pneumonia
Infectious
Aspiration
Infiltrative Neoplasia
Asthma
Chronic Obstructive Pulmonary Disease
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Common Diseases of Lower Airways Allergic/Anaphylaxis
Pulmonary Contusions
Smoke Inhalation
Pulmonary Bullae
Pulmonary Blebs
Acute Respiratory Distress Syndrome
ARDS
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Outline Anatomy
Common Diseases
Interventions
Oxygen Therapy
Medications
Nebulization
Coupage
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Interventions Oxygen Therapy
Room air = 21% O2
Flow by Oxygen
Oxygen Cage
O2 Tent
Nasal Oxygen
Intubation
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Medications Classes of Medications
Bronchodilators
Mucinolytics
Expectorants
Anti-tussives
Anti-Inflammatories
Pulmonary Arterial Vasodilator
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Medications- Bronchodilators Drugs: Aminophylline and Theophylline
Doses: Dogs: Aminophylline 7-10mg/kg q8-12hr
Theophylline 20mg/kg q12-24hrs
Cats: Aminophylline 7-10mg/kg q8-12hr
Theophylline 12.5-25mg/cat q12-24hrs
Onset of Action: approx. 30-60 minutes if injected
Side effects: (think chocolate toxicity- increased heart rate, anxiousness, increased gastric acid secretions)
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Medications- Bronchodilators Drug: Albuterol
Doses: Dogs: 0.05mg/kg q8-12hr or 90-180mcg (2 puffs) total dose
Cats: same
Onset of Action: approx. 5 minutes if inhaled
Side effects: CNS excitement, increased heart rate,
hypokalemia (low potassium)
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Inhalers
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Medications- Bronchodilators Drug: Terbutaline
Doses: Dogs: 0.01mg/kg q4hr IM, 0.03mg/kg q8hr PO
Cats: 0.01mg/kg q4hr IM, 0.312-0.625mg per cat q8-12hr PO
Onset of Action: approx. 15-30 minutes if injected
Side effects: CNS excitement, increased heart rate, hypokalemia (low potassium)
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Medications Drug: Epinephrine
relaxes bronchial smooth muscle
inhibits histamine release
Doses: Dogs: 0.01-0.02mg/kg, CRI 0.1-1mcg/kg/min
Cats: same
Onset of Action: almost immediate
Side effects: increased heart rate, increased blood pressure, arrhythmias
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Medications- Mucinolytics Drug: N-Acetylcysteine (Mucomyst)
Doses: Dogs: 140mg/kg, then 70mg/kg q6-8hrs for 7 treatments(PO/IV)
Nebulized: 50mL/hr for 30-60mins q6-12hr
Cats: same
Onset of Action: approx. 5-10 minutes if inhaled, 1-2 hours if injected
Side effects: nausea, vomiting, can cause bronchospasms if sensitive and inhaled
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Medications- Expectorant Drug: Guaifenesin
Doses: Dogs: 44-88 mg/kg q8-12hr
Cats: not labeled for cats
Onset of Action: within hours
Side effects: nausea, vomiting, gagging
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Medications- Anti-Tussives NOT ALWAYS OK TO USE!!!!
Drug: Narcotics (Codeine, butorphanol, etc.)
Doses: depends on choice
Onset of Action: depends on choice
Side effects: CNS depression, nausea, ileus, respiratory depression
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Medications- Anti-Inflammatories Drug: Prednisone/Prednisolone
Doses: Dogs: 0.5-1mg/kg q24hr
Cats: 1-2mg/kg q24hr
Onset of Action: several hours
Side effects: PU/PD/PP, weight loss, water retention, immune suppression, bone marrow suppression, GI bleeding
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Medications- Anti-Inflammatories Drug: Dexamethasone
Doses: Dogs: 0.07-0.14mg/kg q24hr
Cats: 0.14-3mg/kg q24hr
Onset of Action: minutes to hours
Side effects: PU/PD/PP, weight loss, water retention, immune suppression, bone marrow suppression, GI bleeding
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Medications- Anti-Inflammatories Drug: Fluticasone (Flovent ®)
Doses: Dogs: 110mcg q12-24hr
Cats: same
Onset of Action: approx. 2 weeks to reach peak effects
Side effects: very little systemic absorption, may increase potential for local infections
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Medications- Pulmonary Arterial Hypotensive Agent Drug: Viagra ® (Sildenafil)
Doses: Dogs: 1-3mg/kg q8-12hr
Cats: no documented dosing
Onset of Action: within 30minutes- several hours
Side effects: systemic hypotension, headaches, weakness, sinusitis
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Outline Anatomy
Common Diseases
Interventions
Oxygen Therapy
Medications
Nebulization
Coupage
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Interventions Nebulization
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Nebulizer Saline
Mucomyst ®
Antibiotics (Gentamicin)
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Coupage Percussion of the thorax
to aid in the removal of secretions
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Summary Lower Airway Disease is a Common Problem
Oxygen Therapy can be Life Saving
Multiple Types of Medications Used for Treatment
Nebulization and Coupage are Often Quite Helpful
Limit stress!!!
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Any Questions???
Works cited available on request