Plus-Hex REFERRAL NURSING
ABSTRACT Non-cardiogenic pulmonary oedema can occur in canine patients as a result of various events . Post-obstructive oedema can occur post choking and results in a rapid accumulation of fluid in the extravascular spaces of the lung . Arterial blood gas analysis and intense patient monitoring are vital to determine the need for further intervention . Treatment can include ventilation , oxygen therapy and medication .
Keywords pulmonary , oedema , canine
Introduction
Pulmonary oedema is the accumulation of fluid in the extravascular spaces of the lung ( Bouyssou et al ., 2017 ). It can be categorised into cardiogenic or non-cardiogenic , with the latter being less commonly encountered ( Glaus , 2012 ). This article reports on the multidisciplinary team approach to caring for a puppy diagnosed with negative pressure pulmonary oedema , which developed after choking on a treat . This is a form of non-cardiogenic pulmonary oedema that occurs following obstruction of the upper airway .
The case report describes the pathophysiology of the disease , and discusses the effectiveness of nursing interventions based on current evidence . This includes the team approach to triage , patient monitoring and record keeping , ventilation and oxygenation status , and the medication prescribed to the patient . were no significant changes on full biochemistry , and complete blood counts . Orthogonal thoracic radiographs revealed a diffuse bilateral alveolar to interstitial pattern . There was no obvious obstruction to the main airways and no cardiac abnormalities .
Patient assessment
The patient was triaged immediately on arrival by the veterinary nurses , while the clinician obtained a history and gained owner consent . The respiratory , cardiovascular , neurological and renal systems were assessed systematically during the primary survey .
Buddy was tachypnoeic with a respiratory rate between 60 and 80 breaths per minute , with an orthopnoeic posture . This was a concern as , in human medicine , tachypnoea is documented as a discrete and early sign of deterioration ( Latimer-Jones , 2020 ). Additionally , the ribcage of paediatric patients is more compliant , resulting in less competent ventilation and increased respiratory effort ( Louro et al ., 2019 ). This could lead to worsened hypoxia and ventilatory fatigue ( Louro et al ., 2019 ).
On auscultation of the chest , crackles were identified in all lung fields . These sounds are helpful when considering differentials for diagnosis , as crackles could indicate pulmonary oedema , whereas wheezes are the result of airway narrowing , and absent sounds a result of pleural disease ( Latimer-Jones , 2020 ).
The cardiovascular assessment identified tachycardia , weak and narrow peripheral pulses , cyanotic mucous membranes and an extended capillary refill time ( CRT ). A prolonged CRT is an indicator of poor peripheral perfusion , which was assumed to be because of peripheral vasoconstriction associated with hypovolaemic shock . Buddy was weak and unwilling to stand but had a normal mentation .
Differential diagnoses
Case presentation and investigations
Buddy , a 4-month-old border collie , was presented to the referring veterinary practice 24 hours after a choking event . The patient was eating a treat when he collapsed and began choking . Buddy dislodged the obstruction but deteriorated rapidly .
Prior to arrival at the clinic , the patient underwent conscious thoracic radiographs , along with blood analysis at the referring veterinary practice . There
The problems included tachypnoea , cyanotic mucous membranes , and a diffuse alveolar to interstitial pattern on radiographs . There were several differentials , including cardiogenic oedema , non-cardiogenic oedema , aspiration pneumonia or haemorrhage within the alveoli . In addition , systemic disease such as sepsis or acute pancreatitis may result in acute respiratory distress syndrome ( ARDS ), which can cause a marked non-cardiogenic pulmonary oedema ( Glaus , 2012 ). Furthermore , infections such as leptospirosis are well documented to cause a protein-rich non-cardiogenic pulmonary oedema due to vasculitis ( Glaus et al ., 2010 ). Haemorrhage may be due to a multitude of conditions including trauma , coagulopathies , parasites such as Angiostrongylus and , potentially , neoplasia such as haemangiosarcoma ( Powell , 2002 ).
VOL 37 • May 2022
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