Respiratory

Acetylcysteine (Mucomyst)

Opiates (like hydrocodone)

Opiate cough suppressants

Theophylline metabolism - will build up and cause seizures

Epinephrine

Inhalant beta-2 adrenergic agonists

• physical: turbulent air flow, anatomic barriers, protective reflexes, mucociliary clearance apparatus
• innate: chemical (antimicrobial substances), phagocytic cells (in alveoli), Natural killer cells, induction of adaptive immune response
• adaptive: cell-mediated for intracellular, humoral for parasitic or allergic, mucosal-associated lymphoid tissue (NasalALT, BALT)

• tachypnea
• dyspnea
• orthopnea
• open mouth breathing
• cyanosis

• short, rapid, shallow breaths
• R/O: "stiff lungs" (pneumonia, pulmonary edema, neoplasia) VS prevention of mechanical expansion (pleural space disease, thoracic wall disease

• prolonged, deep inspirations, stridor, stertor
• brachycephalic airway syndrome, lar par, tracheal collapse

• prolonged expiration, abdominal push
• chronic bronchitis, asthma

• opposing movements of the chest and abdominal wall during inspiration and expiration.  Associtaed with respiratory muscle fatigue or chest wall disturbances
• rib fractures, flail chest.  
• Can't take a deep breath, try so hard they suck abdomen in on inspiration

• decreased: pleural effusion, pneumothorax, airway obstruction, obesity
• increased: referred upper airway vs lower airway

snoring or snorting sounds due to soft tissue obstruction of the upper airways, can be inspiratory or expiratory

loud, musical sounds heard at a distance from the patient, typically during inspiration and due to upper airway obstruction of the larynx

short, explosive, nonmusical popping sounds caused by air bubbling through fluid in alveoli or rapid opening of airways, may be inspiratory or expiratory, "fine" or "course"

musical sounds generated by air passing through airways narrowed by intraluminal mucus, extraluminal compression, or by collapse or constriction.  Typically heard on expiration

normal, equivalent to PaO2 >80mmHg

indicates moderate hypoxemia, PaO2 60-80mmHg

severe hypoxemia, PaO2 <60mmHg

• the partial pressure of oxygen in the blood, represents the ability of the lung to oxygenate the blood (N = 80-120mmHg at sea level)
• PaO2 <80mmHg indicates hypoxemia, <60mmHg indicates severe hypoxemia

moving xray, great for watching dynamic things like swallowing

• minimally invasive technique to sample the respiratory tract of dogs and cats
• can be transtracheal (inject with catheter between tracheal rings) or endotracheal (sterile ET tube, oral)

• endoscope into bronchioles etc.  Pair with bronchoalveolar lavage, can collect specimens from one specific lung lobe
• collect primarily macrophages, lots of eosinophils in cats

• tracheal: cytologic and culture info for large airway disease and bacterial pneumonia, NOT GOOD for alveolar or interstitial.  Trans-tracheal performed in awake or lightly sedated animals, so good for LA. Endotracheal wash requires heavier sedation.  Could cause transient worsening of resp signs, could cause tracheal laceration or hemorrhage for TTW, not good for uncooperative or coag.  
• Bronchoalveolar lavage: deeper samples, good for tracheal or bronchial collapse, stenosis, masses or tears, can remove bronchial or tracheal FBs. Can get cytology or biopsy, get into one specific area.  more often IDs hemorrhage, infectious agents and neoplasia, but more invasive and requires advanced equipment and expertise

• nasal discharge
• sneezing
• reverse sneezing
• pawing or rubbing at muzzle
• facial deformity, asymmetry or ulceration
• epiphora (watering of eyes)
• loss of pigmentation of nasal planum
• open mouth breathing
• halitosis
• stertor
• coughing

• character of nasal d/c, unilateral?
• facial distortions or "holes" in the facial bones (neoplasia?)
• patency of airflow of EACH nostril, less suggests structural lesion, increased with turbinate destruction
• teeth and gums (tooth root abscess, oronasal fistula)
• examination of roof of mouth and pharynx (cleft palate, ulcers, possible mass effect of nasopharyngeal polyp)
• ability to retropulse eyes (space-occupying lesion in orbit)
• pain on opening mouth
• depigmentation of nasal planum (ASPERGILLOSIS)
• Tonsils and submandibular LN (enlarged with neoplasia, dental dz, cryptococcosis)
• retinal exam (chorioretinitis (crypto), hypertension
• epistaxis (petechiae or ecchymoses suggest systemic coagulopathy or vasculitis

• thoracic radiographs: rule out metastatic disease, concurrent bacterial pneumonia
• dental rads: integrity of tooth roots
• skull rads: Available and cheap, but least sensitive
• CT: preferred for nasal cavities and nasopharynx.  admin of contrast enhances neoplasia or inflammatory lesions
• rhinoscopy: caudal/retroflex scope through oral to view back of choanae.  Rostral shows nasal cavities for tumors, fungal masses, FBs, parasites, nasal polyps.  Usu can't do in cats.

• most common causes of nasal disease in dogs
• adenocarcinoma most common (squamous cell, undifferentiated), sarcomas (fibro, chondro, osteo) and lymphoma. Most locally invasive but rarely metastasize
• usu older dogs
• sneezing, epistaxis, stertor or nasal d/c.  Often unilateral, can become bilateral.  Neuro suggests invasion into CNS
• Loss of nasal airflow common, facial deformity possible.  Retropulsion can be abnormal, or regional lymphadenopathy
• Tx with radiation or palliative

• infected by inhalation, occasionally associated with trauma, neoplasia, FB, but usually from immune compromise (suspected usually LOCAL immune dysfunction)
• SNA causes marked destruction of nasal turbinates, can erode through frontal bone, periorbital soft tissue or through cribiform
• mostly mesocephalic and dolichocephalic, young to middle-aged males
• usu profuse mucopurulent nasal d/c, epistaxis later in disease process
• DEPIGMENTATION of nasal planum, often increased air flow due to destruction of nasal turbinates.  
• visualize fungal plaques via rhinoscopy, cytology or histopathology
• radiolucency in nasal passages on skull rads, destruction of turbinates on CT and soft tissue along bones, thickened bones, visualization of plaques on rhinoscopy.  Histopath shows plagues and definitive dx. Missed if not ON a plaque.  Culture and serology iffy, but few false positive.  Prolonged systemic tx, cure in 70%.  Topical has better success. Careful to use polyethylene glycol, not propylene (caustic)

• cause unknown (chronic inflamm/immune dysreg? No response to glucocorticoids)
• usu young to middle-aged dachshunds
• sneezing/reverse sneezing, bilateral nasal discharge
• just fluid accumulation in nasal cavities/sinuses in CT, hyperemic inflamed epithelium on rhinoscopy.  Lymphoplasmacytic infitrates on histo.
• no definitive therapy, etiology is unclear, cures are rare.  Glucocorticoids?  Immunomodulatory meds, Desensitization therapy (allergy testing), antimicrobials.

• most common cause of nasal disease in cats.  Most common are lymphoma and carcinoma (adenocarcinoma, undiff)
• nasal d/c, sneezing, stertor, change in phonation, epiphora, epistaxis, facial deformity.  
• nasal lymphoma: radiation or CHOP, cribiform plate and anemia are poor prognostic
• nasal carcinoma: radiation, MST of a year

• second most common cause of nasal disease in cats
• primary viral infection? FHV-1 damages mucosal epithelium = recurrent bacterial rhinitis
• young to middle-aged, history of "cat flu"
• Upper Respiratory PCR panel detects DNA from a swab.  Can't tell if carrying vs actively infected.
• abx, nasal flush, decongestants, antivirals, antihistamines, anti-inflammatories (glucocorticoids, NSAIDs).  Guarded prognosis

• dimorphic fungus in yeast form in animal. Mostly in CA.
• Lots of siamese and Abyssinians
• sneezing, mucopurulent nasal d/c, stertor, facial distortion. Firm swelling on nose, possible chorioretinitis. 
• ID fungal org!  serology.  
• prolonged tx with oral -azole therapy (4-12 months)
• latex agglutination titer to follow disease and response.  Two fold reduction per month is desired, tx continued until <1:1.

• inadvertant inhalation of gastric acid and/or ingesta.  
• pulmonary injury: chemical pneumonitis, inflammatory response, bacterial pneumonia

• viral colonization and infection of the upper resp tract
• opportunistic bacteria colonize damaged resp tract
• bronchopneumonia

• inhalaed FB brings bacteria into lungs, associated with focal pneumonias that relapse after abx
• grass awns!  Hx of spontaneous pneumothorax or pyothorax.  Young sporting breeds

• congenital immunodeficiencies: primary ciliary dyskinesia, complement deficiency, immunoglobulin deficiency, severe combined immunodeficiency, leukocyte adhesion deficiency
• systemic immunocompromise: FeLV, Diabetes mellitus, hyperadrenocorticism, chemotherapy, immunosuppressant medications

• aspiration
• community-acquired
• foreign body
• immune dysfunction

• vomiting
• esophageal dysfunction
• post-anesthesia
• neurologic disorders
• laryngeal/pharyngeal dysfunction

• antibiotics (monotherapy, dual therapy, etc)
• IV fluids
• nebulization
• supplemental oxygen
• mucolytics

• dimorphic fungi: blactomyces dermatiditis, histoplasma capsulatum, coccidioides immitis.  Also pneumocystis carinii in immunocompromised (CKCS, mini dachshunds)
• inhaled spores created localized or systemic infections
• most often present with lesions of lymph nodes, skin, bones, GI, ocular changes, etc
• Tx is systemic anti-fungals for months to years.

• infiltration of lower airways by eosinophils
• young adults
• rottweilers
• alaskan malamutes
• siberian huskies

• pred for months, may need long term steroids, consider inhaled to decrease side effects
• hyposensitization? (allergy shots?)

• non-infectious non-malignant (inflammatory) interstitial dz, repair causes structural changes and fibrosis, collagenous thickening fo pulmonary interstitium leading to impairment in gas exchange
• West Highland White Terriers, middle-aged to older (occasionally other terriers or small-breed)
• usu BAR, bilateral inspiratory crackles, abdominal breathing, R-side murmur

• carcinomas.  
• VERY rare in dogs and cats, older most common.  Urban living and second hand smoke predispose.  
• Bronchoalveolar carcinoma in dogs, adenocarcinoma in cats.  
• weirdly, get lameness.

• painful periosteal reaction with soft tissue swelling of limbs, usu bilaterally symmetrical, all four distal limbs
• paraneoplastic, secondary to metastatic pulmonary neoplasia

• primary lung tumor with digital metastasis
• cats usu
• extensive bony lysis of distal phalanx, grave prognosis.
• can metastasize EVERYWHERE

• Upper: large-breed adult or brachycephalic animals with inspiratory difficulty and loud breathing that is worse with heat or exercise. Stertor, stridor, referred upper airway sounds and inspiratory effort
• Lower: older toy breed dogs, coughing cats, hacking or honking cough, possible irritant or allergen exposure, normal lung sounds, prolonged expiratory effort +/- abdominal "push"

• cough following exertion or tracheal irritation
• chronic: wheeze at end of cough, expiratory effort, exercise intolerance, cyanosis, syncope
• PE: inspiratory crackles, expiratory wheezes, ABS OF STEEL, tracheal sensitivity, normal to decreased HR, abdominal push on expiration

• Cardiovascular: dogs only, enlarged LA
• Allergic: asthma, eosinophilic bronchopneumopathy
• Trauma: FB, collapsing trachea
• Neoplasia: primary or secondary lung, ribs, LN
• Inflammatory/Infectious: pharyngitis, bronchitis, pulmonary fibrosis / kennel cough, pneumonia, abscess
• Parasites: lung worm, heartworm, migrating GI parasites

• inflammation of airways resulting in chronic cough (>2mo) with no other cause
• DIAGNOSIS OF EXCLUSION
• middle-aged to senior small-breed dogs
• treatment: eliminate environmental pollutants, weight loss, harness not collar, Prednisone, Fluticasone inhaler, +/- bronchodilators, abx, cough suppressants, nebulization.  
• MANAGED NOT CURED

• weakness of bronchial walls due to softening of supportive cartilage
• secondary to airway irritants, chronic bronchitis, respiratory infection, obesity

• irreversible dilation of bronchi with accumulation of suppurative airway secretions
• congenital or acquired from chronic
• dx: CT, rads, bronchoscopy
• tx: long term abx, sx if local.  Px guarded (recurrent pneumonia)

• T lymphocytes secrete IL-5 which recruit eosinophils and mast cells
• feline asthma

• Reversible bronchoconstriction via serotonin and histamine release from mast cells
• Goblet cell hyperplasia leads to excessive mucus production
• inflammatory eosinophilic infiltrate leads to mucosal edema

• R/O: lung worms, heartworm, infectious respiratory disease, chronic bronchitis
• Tx: reduce environmental allergens, anti-inflammatories (steroid), fluticasone with aerokat.  Bronchodilators for acute attack--albuterol inhaler, terbutaline.  Methylxanthines poor choice

• dx: airway sampling or fecal
• tx: fenbendazole or ivermectin

• feline Herpesvirus: dsDNA, rhinitis, corneal disease and severe ulcerative eosinophilic facial dermatitis, latent, reactivate on stress and shed 1-3 weeks
• Feline Calicivirus: ssRNA, oral ulcers, rhinitis, synovitis. Shed for 1 month after infection, 25% shed forever, continuously.

• bordetella bronchiseptica: mild fever, cough, sneeze, ocular d/c, lymphadeopathy, pneumonia, cyanosis, death.  Dx vial culture on nasal swab, oropharyngeal swab, BAL fluid. 
• Chlamydia felis: conjunctivitis, rhinitis.  Dx via PCR.
• mycoplasma felis: rhinitis, conjunctivitis, pneumonia.  Commensal
• all in URD PCR panelall sensitive to doxy!

• famciclovir: prodrug DNA polymerase inhibitor, safe and effective, reduces shedding in severe or recurrent FHV-1
• L-lysine: amino acid interfering with viral replication (antagonizes Arginine). Eating it makes signs MORE severe, may not help much.

• viral infection of URT, activates Bord virulence factors, attach to cilia and kill, prevent bacterial clearance, injury to cells, impaired immune recog and clearance.  Bronchopneumonia and cough
• Viral: parainfluenza, adenovirus, distemper, resp coronavirus, herpesvirus, influenza, reovirus
• Bacteria: bordetella bronchiseptica, mycoplasma (CYNOS), streptococcus equi ssp zooepidemicus, etc
• usu self-limiting if uncomplicated, doxy or supportive for pneumonia

• IN: avirulent live, prevents shedding in secretions, protective within 72h, occasional mild URI signs, safe for 3-4wk puppies
• SQ: antigen vax, does not prevent shedding, protective 7-10 days after 2nd, does not cause URI, safe for >6wk puppies
• oral: avirulent live, prevents shedding? protective within 72h? maybe doesn't cause URI?  safe >8wks

• emerging.  H3N8.  Racing Greyhounds in FL, spread to >30 states, cats
• Dogs very naive, so virulent. 
• lethargic, purulent nasal d/c, febrile.  Pleural/Pulmonary/Mediastinal hemorrhage in greyhounds!
• dx: serology titers or PCT
• vax available, tx supportive or abx

• Primary: stenotic nares, distorted nasal passages with abnormal conchae, redundent pharyngeal tissue, long thick soft palate, hypoplastic trachea
• GI: sliding esophageal hiatal hernia, GI reflux and esophagitis, atony of cardia, chronic vomiting
• secondary: tonsillar hypertrophy and eversion, everted laryngeal saccules, chondromalacia of trachea and broncheal supports, chronic generalized pulmonary vasoconstriction secondary to chronic hypoxia resulting in RV hypertrophy and failure
• chronic respiratory acidosis with switch from CO2 to O2 drive

• stertor, stridor PLUS difficulty with exercise, severe snoring or abnormal posture while sleeping, poor heat tolerance, chronic GI signs, syncope, obvious stenotic nares
• Resp signs and cough don't always mean BAS!

2-3x the size of the 3rd rib at the level of the trachea

• pharyngeal, laryngeal or tracheal foreign body
• neoplasia of pharynx, larynx or trachea
• trauma/abscess
• phayngeal mucocele, sialocele (swelling full of mucus, saliva)

• O2
• sedation to reduce O2 demand
• cooling with fans
• intubation

• stenotic nares: can be only issue in cats, rarely alone in dogs. pie-shaped wedge resection
• abnormal conchae: laser-assisted turbinectomy
• elongated soft palate: Staphylectomy = surgical removal vs CO2 laser ablation (minimal hemorrhage and swelling, no sutures in small, ignite O2!) vs ligasure cautery forceps (computer-regulated bipolar cautery
• everted laryngeal saccules: oral resection, no sutures.
• treating upper airway dysfunction usually resolves GI signs (omeprazole, cisapride)

• midline incision, separate sternohyoid muscles to expose trachea
• horizontal incision <50% circumference between 3-4 or 4-5 tracheal rings, avoid lateral dissection
• stay sutures - leave in place and label to change tube
• tube <50% of tracheal lumen diameter.  Don't inflate cuff (unless PPV)
• heals by 2nd intention in 10-14d

• congenital cyst in one or both false nostrils
• fluctuant swelling in false nostril(s)
• surgical removal of cyst lining

• failure of choanae to open during development.  Unilateral or bilateral, bony or membranous, partial or complete.
• Presents as exercise intolerance (or stillbirth, dyspnea).  
• Find on PE, can't pass nasal tube, imaging and endoscopy
• surgically open choanae

• strep equi zooepidemicus common
• unilateral d/c
• sinus centesis, c/s, flush sinus, abx.  Flap sinusotomy if too much pus in ventral conchal sinus.

• sinus infection due to periapical infection of tooth root in maxillary sinus, often 109/209 or caudal 108/208 cranial and 110/210 and 111/211 caudally
• fetid unilateral discharge
• remove tooth by extraction or retropulsion, then sinus lavage

• paraneoplastic growth involving sphenopalatine sinus +/- ethmoid turbinate
• unilateral small volume epistaxis at rest in middle aged to older horses
• intralesional formalin injection, laser ablation, snare for smaller, sx removal via bone flap in larger

• congential?  Degenerative?  
• facial swelling, nasal d/c, stertor, epiphora
• removal of cyst lining via flap sinusotomy

• SCC most common, adenocarcinoma or mesenchymal tumors like osteoma/osteosarcoma, fibrosarcoma, myxosarcoma etc.  Tooth germ tumors in young (odontoma, amelioblastoma, adamantoma etc)
• facial swelling, nasal d/c, stertor, epiphora
• can really only remove osteoma or tooth germ tumors

• diverticulum of auditory tube
• cools the blood going to the brain
• divided by stylohyoid into medial and lateral compartments.  Medial is bigger
• Viborg's triangle: sternocephalicus tendon, linguofacial vein, mandible

• chronic bacterial infection of one (rarely both) pouches (strep equi or strep equi zoo)
• purulent unilateral nasal d/c, swelling in viborg
• pouch lavage and abx, sx for drainage or chondroids (inspissated pus)

• fungal infection, usu aspergillus involving roof of medial compartment
• epistaxis (internal carotid, maxillary artery, can be fatal), dysphagia (cranial nerves IX, X), mucoid nasal d/c, Horner's (sympathetic trunk)
• occlusion of at-risk vessels, pouch lavage with anti-fungals

• excessive accumulation of air into guttural pouch
• congenital in neonates - abnormal pharyngeal opening.  Acquired via swelling in foals or yearlings (URI)
• swelling over parotid, dysphagia or resp distress in severe (nasopharynx compression
• unilateral -- fenestrate septum between pouches.  Bilateral -- surgical resection of lateral lamina of auditory tube

• damage to temporohyoid joint due to middle ear infection resulting in fracture of temporal bone, may damage nerves (facial = paralysis, vesibular = ataxia, head tilt)
• tx with abx, surgery in severe cases

• establish an airway first!  Dx testing to find primary problem, fix (abx vs sx)
• strangles, anaphylaxis, myopathies, swelling, neoplasia, surgical conditions

• bacteria inhaled or ingested (NOT commensal), access tonsillar crypts and LN within 48h
• shed nasally by 96h, 2-10wks.  Internal abscesses AFTER lymph or hematogenous spread
• evade phagocytosis: hyaluronic acid capsule, M surface protein (SeM protein)
• Transmission via direct contact (nasal or LN secretions) or fomites on equipment
• dies in 3 days in sunlight, but lives longer when protected, barns vs carriers (guttural pouch)
• Stop all movement of horses onto or off farm
• FEVER PRECEEDS SHEDDING, isolate fevers (all infected) immediately! ID asymptomatic with PCR.  Re-test post tx to ensure not shedding
• tx: guttural pouch and systemic abx (PPG for 1 week then TMS for 3 weeks).  Disinfect EVERYTHING. Tracheotomy for airway obstruction. Hot pack then drain LN. Dexamethasone for purpura hemorrhagica.
• protected for 4 years. 
• Vax: IN, but causes symptoms in foals or muscle abscess when fly bite transfers into muscle.  Don't give IM after IN, could inject IN accidentally. Don't vax in face of outbreak

• Bastard (metastatic) strangles: abscesses in lungs, mesentery, liver, spleen, etc
• aspiration pneumonia (dysphagia)
• guttural pouch empyema, chondroid formation
• myocarditis, endocarditis, cardiac arrhythmia
• myopathies
• purpura hemorrhagica: pitting edema of trunk, head and extremities, petichiae, ecchymoses, urticaria (EMERGENCY)

• establish airway: tracheostomy or nasotracheal tube until tracheostomy
• epinephrine" slowly, IV, intratracheal or IM
• dexamethasone or methylprednisolone sodium succinate: IV
• Tripelenamine: anti-histamine
• Furosemide: for pulmonary edema and acute renal failure
• AVOID Alpha-2: worsen stridor by relaxing upper airway muscles
• don't ever use that product again.

• vitaminE/selenium deficiency: <3months, free-radical-induced injury of lipid membranes = myositis. Serum levels, increased CK, AST. Tracheotomy PRN, Se supplementation, supportive for aspiration pneumonia. 
• clostridial myonecrosis: secondary to injury or IM injections, cause anaerobic environment, release cholesterolases and lecithinases to break down cell membranes.  Toxemia or acute renal failure. Gram+ rods in serosanguinous fluid in area, culture. Tracheotomy PRN, high-dose penicillin, fasciotomy/drain to O2 area, IVF for heart and kidneys.  NSAIDs. 
• Hyperkalemic Periodic Paralysis (HYPP): quarter horses, autosomal dominant defect, mutation in Na channel, depolarization of muscle membranes = laryngeal spasms and weakness. PCR for DNA encoding Na channel. Endoscopy shows arytenoid spasms. Tracheotomy PRN, IV Ca gluconate (increases membrane threshold potential and glc transports K intracellular), acetazolamide for insulin release and K excretion.  No feed high in K+.  Lots of carb diets.

• Equine Influenza: H3N8, rapid spread
• Equine Herpes I (and 4): latency! abortion, EHM
• equine viral arteritis: stallion carriers
• Equine Rhinovirus A: urine shedding

supportive.  Antimicrobials for 3-5 days (secondary bacterial), anti-inflammatories for fever (keep eating, drinking, comfortable).  Anti-virals not given--fear of developing resistance and not effective at reducing nasal shedding.  Maybe antivirals in EHV to prevent EHM.

• long-distance transport
• stress (anesthesia, surgery, hospitalization) or steroid administration
• neuro-muscular disorders (dysphagia, choke)
• inhalation of foreign objects or particulates (smoke, chemicals from barn fires)
• viral infections

• G+: Strep equi zooepidemicus, staph aureus
• G-: pasteurella/actinobacillus, klebsiella, E coli, bordetella
• anaerobes: bacterioides, fusebacterium, provetella, clostridia, peptostreptococcus

• oral itraconazole or voriconazole
• oral TMS and dapsone for pneumocystosis
• supportive therapy

• Broad-spectrum abx: K+Penicillin + gentamicin/enrofloxacin + metronidazole, oxytetracycline, ceftiofur + KPen, chloramphenicol
• anti-endotoxemia: flunixen meglumine, IVF, polymixin B, hyperimmune plasma
• nebulization: albuterol, N-acetylcysteine, ceftiofur, gentamicin
• Chest drain infusions: tissue plasminogen activator, rhDNAse (clear fibrous adhesions)
• anti-laminitis: pentoxyfylline

• Equine Multi-nodular Pulmonary Fibrosis
• dx via intranuclear inclusion bodies (EHV-5) in broncho-alveolar lavage fluid.  
• treat with acyclovir or valacyclovir.  Anti-inflammatory therapy.

lameness, kyphosis (rounding of back) from metabolic bone disease (bone resorption)

• RAO: horses in NE and Midwest, stabled and fed dusty hay.  In the SE have Summer Pasture Associated Obstructive Pulmonary Disease, SPAOPD.  Reaction to dust, mold, endotoxin in poorly cured hay, or in pasture in SE.  O2 if necessary
• IAD: young athletic horses or older sport horses, from pulmonary bleed, inhalation of aerosolized particulates or stall gasses. Keep horses outside!  Feed steamed/wet hay, improve ventilation.  Lasix and/or nasal strips for pulmonary bleeding.  
• Put outside!  Wet hay.  Decrease particulates in stalls.  Bronchodilators, corticosteroids, expectorants

• Donkeys and mules!
• eosinophils in TBA and BALF.

• microfilaria/pre-larvae in mammal blood (live 2.5 years), mosquito bites and ingests
• develop to infective stage (L1-L3) in mosquito, time dep on temperature
• Mosquito bites dog, L3 mature to L4 in TISSUES, between muscles then inside, access vessels, float.  
• L5-adult in pulmonary vasculature (get stuck there).  Live up to 7 years in dogs.

• intracellular bacteria-like organisms in D. immitis
• elimination of them decreases D. immitis fertility, which decreases size.  
• may be responsible for some clinical signs of HW like inflammation, resp signs.

• USUALLY NORMAL
• respiratory signs: COUGHING, tachypnea, dyspnea
• exercise intolerance
• rarely: syncope with exercise, hemptysis, R heart failure and associated signs.  
• RARE: aberrant locations, signs in arteries, brain, liver etc. 
• PE: usually normal, can be spontaneous/easily elicited cough, weight loss, abnormal resp rate or sounds, fever, R heart failure.

• antigen test is the BEST WAY, detects adult female antigen, so 6 months or more after infestation. + for >3 adult females.  
• false negatives: immature/<6 months, only males, light infection (<3 females), dog forms antigen-antibody complexes (7%)

• lack of owner compliance - 1 missed dose might be enough.  
• Resistance
• not started early enough in puppies
• Targets stage 3 and 4 in tissues, some adulticide and microfilaricide properties.  Advantage Multi is first FDA-approve microfilaricide

• exercise restriction and macrocytic lactone preventative for 2-3 months (let all larvae mature until sensitive, kill all younger and prevent re-infection)
• doxycycline for 1 month to eliminate wolbachia (also stabilize P as much as possible, steroids if needed)
• first dose of immiticide (deep IM in epaxials)
• 30 days cage rest
• 2nd and 3rd dose of immiticide, 24h apart, IM
• 30 days cage rest
• Antigen test repeated 6-9 months after tx
• deep injection prevents superficial necrosis
• injection is painful!!  
• effects: coughing, gagging, depression, lethargy, anorexia, fever, lung congestion, emesis, diarrhea, dyspnea, hypersalivation, panting, pulmonary thromboembolism (peak 7-10d when worms are dying)
• decrease by strict exercise restriction and the split-dosing regimen of immiticide.

• worms embolized in cardiac chambers.  LIFE-THREATENING EMERGENCY associate with LARGE worm burden.  Can be secondary to thromboembolism and reduction in CO.  
• lethargy, dyspnea, pale mm, hemoglobinuria (dirofilarial hemoglobinuria), r-sided systolic murmur = tricuspid regurg, jugular pulse.  
• HW extraction performed under GA, retrieval basket via fluoroscopy.  STILL NEED IMMITICIDE TX

• resp signs due to immature HW but no adults, 90-120days post-infection, worms die.  
• inflammatory lesions in arteries, bronchioles, lung parenchyma, clinical signs like asthma.  
• Tx with steroids and bronchodilators.

small abnormalities lead to HUGE changes in performance, very little tolerance

• dorsal displacement of soft palate
• nasopharyngeal collapse
• recurrent laryngeal neuropathy (roaring)
• epiglottic entrapment
• arytenoid chondritis
• aryepiglottic fold collapse

• Tongue-tie or "cornell Collar": mimic function of thyrohyoid muscle
• Thermocautery: this is barbaric, don't do it!!
• Laryngeal tie-forward: prosthetic suture mimics thyrohyoideus muscle
• Llewellyn procedure: sternothyroideus myectomy

• 1 and 2 resting will probably be A exercising, very little/no problems.  3 will be C >50%, so bad!  4 is guaranteed C, but we already knew that.
• Grade 2 sell at a discount.  Grade three need endoscope and surgery

• unilateral: sinonasal origin of disease
• bilateral: gutteral pouch or pulmonary
• horses can be jerks about following this rule

• trauma: (most often). from passing tube, fractures (kicks or rearing backwards), lung biopsy (iatrogenic).  Diagnostics - history, neuro exam, skull rads/CT, endoscopic of resp for fractures, U/S for biopsy (smoky appearance)?
• Exercise-Induced Pulmonary Hemorrhage (EIPH): strenuous (duration unimportant) exercise causes hemorrhage from caudodorsal pulmonary vasculature, causes epistaxis in older, sprinters or steeplechasers.  Diagnose: endoscope vs bronchoalveolar lavage
• Neoplasia: SCC, HSA, Lymphoma in nasal, pharyngeal. diagnosis  via endoscopy, biopsy, CT, rads.
• nasal granulomas and amyloid: ulcerate and bleed. 
• pulmonary abscesses or pleuropneumonia: severe enough cause necrotic or ischemic tissue that bleeds.
• Systemic disorders: thrombocytopenia or clotting disorders (DIC vs decreased production)

• bleeding from caudo-dorsal lung, pleural angiogenesis and small airway disease.
• theories: 1. Stress failure of pulmonary capillary epithelium, 2. veno-occlusive pulmonary disease (venous remodeling increases resistance, inflammation), 3. inflammatory airway dz = more negative intrathoracic pressure, 4. locomotary forces, jockeys push in one spot on lungs, this isn't real. other species: humans, racing greyhounds, racing camels
• Performance: impaired, 4x to win and 2x to finish in $
• 60% of the 5% of racehorses that die suddenly are due to EIPH, so rare

• furosemide: reduce pulmonary artery pressure during exercise
• nasal strips: prevent or reduce collapse of nasal passages to reduce airway resistance (inspiratory pressure)
• side effects of continued furosemide: Na and Cl wasting and metabolic alkalosis.

• carbazachrome salicylate
• oxyepinephrine derivative used to treat hemorrhage secondary to capillary fragility syndrome in humans.  
• Might be helpful?

• bacteria: rhodococcus equi (most devastating, usu 4-8wks, pyogranulomatous with abscesses, extrapulmonary infections like GI, lameness, ataxia from CNS, ocular, IMHA, thrombocytopenia), strep. zooepidemicus (ALSO LUNG ABSCESSES), e coli, actinobacillus equuli, pasteurella, kebsiella, (tx like adults) esp after viral, stress, parasite, congenital defects, neuromuscular disorders. Usually no extrapulmonary signs like R. equi. 
• verminous pneumonia: parascarus equorum, with ill-thrift and colic. 
• bronchointerstitial pneumonia: unknown etiology. Acute vs chronic. Bronchointerstitial pattern on rads

• diagnostic: chest rads, bronchoalveolar wash c/s, BW, endoscope for congenital defects
• therapeutic: antimicrobials (macrolide and rifampin for R. equi), hyper-immune plasma (unless immune complexes), possible anti-inflammatories for lameness, nebulization, anti-ulcer medication, nasal O2.  Selenium for white muscle disease. 
• serological: no, maternal antibodies present.
• antimicrobials: macrolides = thermoregulation, keep cool.  Erythromycin = fatal colitis in dams.  Clarithromycin causes foal diarrhea.  Azithro doesn't work quite as well.

• parascarus equorum
• no - life cycle 80-90 days (in feces 80 days after infection) and in lungs within 3-4 weeks. Dx with TBA
• fenbendazole and mineral oil (resistant to ivermectin and pyrantel)
• keep foals and yearlings on separate pastures, get rid of manure!

• acute: most die in a week.  Increased HR but not RR is best prognostic indicator for survival. 
• chronic: most live.

• URT: 
• strangles, purpura
• myopathies - hyperkalemic paradoxical paralysis, clostridial diseases, nutritional
• Neuropathy (bilateral) of recurrent laryngeal nerves (hepatoencephalopathy, perivascular injection)
• anaphylaxis
• LRT: 
• pulmonary edema (cardiac and non-cardiogenic diseases)
• pneumothorax
• hemothorax and pleural effusion (restrictive lung disease)
• severe bacterial, fungal, interstitial pneumonia; severe equine asthma

• increased pulmonary capillary hydrostatic pressure: valvular disease/endocarditis (rupture of chordae), myocardial dysfunction (inflammation, ionophore toxicity, selenium deficiency, neoplasm), anuric renal failure/IVF overload, negative pressure pulmonary edema (head pressing + recurrent laryngeal nerve neuropathy, post-op in recovery)
• increased pulmonary capillary permeability: endotoxemia, inhalation pneumonia (smoke, near-drowning, accidental tube into trachea), anaphylaxis, pulmonary emboli (air, fat from orthopedic, thrombophlebitis)

• pneumo: absense of lung sounds DORSALLY
• hemothorax: decreased or absent lung sounds VENTRALLY

• pulmonary edema: mechanical intubation, O2, diuretics, cautious IVF for CV support?, abx/anti-inflammatories PRN, bronchodilators, analgesics
• NO DIGOXIN IN IONOPHORE/MONENSIN TOXICITY
• pneumothorax: re-establish negative pressure, abx probably, O2 PRN, treat inciting cause, analgesics.
• hemothorax: drain blood unless ruptured lung, lung biopsy or coagulopathy, nasal O2, cautious IVF, aminocaproic acid to decrease fibrinolysis

• progressive: Pasteurella multocida type D. 
• non-progressive: bordetella
• 3-8wk pigs, UR signs, dark patches of lacrimation, +/- deviation of snout
• atrophy of scrolls
• decreased weight gain in progressive, no effect in nonprogressive
• tx and vax not effective, optimize ventilation and early medicated weaning or specific pathogen free herd
• ddx bullnose (facial cellulitis/abscesses from wounds) and inclusion body rhinitis (porcine cytomegalovirus)

• mycoplasma hyopneumoniae
• dry nonproductive cough in young (5-8wk)
• 4% of lung tissue = 1 month later to market weight, unthrifty, very prevalent, only high mortality with concurrent PRRS
• cranioventral lobes
• abx
• specific pathogen free herd, vax improves growth but doesn't stop shedding, medicated early weaning, all-in all-out!

• pasteurella multocida A
• older pigs with stress
• cough, dyspnea, fever, prostration.  cranioventral bronchopneumonia, often mixed with mycoplasma hyopneumoniae.  Uncommon alone. 
• tx with abx
• prevention with ventilation, controlling atrophic rhinitis, vax (not great, but often in combination products)

• actinobacillus pleuropneumoniae, exotoxins
• sudden death with bloody froth, fever, dyspnea, cyanosis, cough, hemorrhagic pneumonia in ANY lobe, PLEURITIS
• 1-24% mortality
• abx
• vax if high mortality, correct ventilation and overcrowding, all-in-all-out, pathogen free herds

• Enveloped arterivirus (RNA), VERY contagious (one viral particle = infectious dose!)
• SOWS/PIGS late abortion, mummified fetus, fever, anorexia, poor doers, resp disease in NURSERY PIGS.  Blue ear tips rare and non-specific.  virus replicates/kills macrophages, die from secondary bacterial infection, very common in US herds
• virus isolation, immunoperoxidase, serology, ORAL SAMPLE PCR, ELISA
• ~$560 million loss/year
• poor response to abx or vax
• all-in-all-out, quarantine boars 60d, isolate gilts, vax twice, early weaning, gene editing for resistance.

• dust: organic dust toxic syndrome
• ammonia: resp irritation
• pit gases
• CO from heaters: suddenly dead piglets with pale carcass and pink blood

• chronic vegetative endocarditis or septic joints, ligaments
• dx via necropsy.  Any lobe, multifocal

• blood in airways from slaughter
• any part of lung, huge dark red center surrounded by lighter red alveoli

• small ssDNA
• weight loss with chronic pneumonia, high mortality at 6-18wk
• rubbery tan lungs, icterus, inclusion bodies in tonsils
• vax available and effective

• herpesvirus, very contagious
• rhinitis, mild cough, fatal neuro dz with convulsions, abortions.  
• maternal protects 10-12wks
• death of swine of all ages, Aujesky's in other mammals (fatal)
• Eradication of most domestic, still in wild

• orthomyxovirus with neuraminidase and hemaglutinin (H1N1, H3N2), also infects turkeys and people
• grow-finish pigs, sudden onset in herd.  Signs in young (maternal abx), thumps (distinguish from lungworms or ascarids)
• rarely fatal unless PRRS
• tx secondary infections with abx
• vax?  Quarantine

• oestrus ovis
• nasal exudate, sneezing, could penetrate into brain (ddx mycoplasma)
• rare now, because Ivermectin kills all life stages

• retroviruses (dif for sheep, goats, infect mucosal nasal glands)
• stertor, often unilateral, possible exophthalmos, weight loss
• dx via DV rads, necropsy (tumor blocking nasal passage)
• herd outbreaks!  
• slaughter, maybe sx but will recurr
• CLOSE HERD

• mannheimia haemolytica (septicemia in young lambs, pneumonia in older)
• pasteurella multocida
• bibersteinia trehalosi (sudden death of feeder lambs, pharynx and esophageal erosions)
• mycoplasma ("atypical" or "chronic nonprogressive pneumonia")
• Parainfluenza 3
• signs: often found dead, froth at mouth, dyspnea.  
• dx: rads = cranioventral, air bronchograms.  
• Economic: death and poor-doers
• tx: abx
• prevent: colostrum!  metaphylactic abx, vitamin E and selenium, ventilation, no overcrowding, separate age groups, NO cattle vax, don't work.

• mycoplasma mycoides ssp capri: goats in Ca
• mycoplasma capricolum ssp capripneumoniae
• mycoplasma ovipneumoniae: less severe, USA
• dx: mastitis, conjunctivitis, arthritis, septicemia.  Culture with SPECIAL MEDIA
• economy: big deal in California goat herds
• tx: macrolides and tetracyclines, animals may still carry
• prevent: pasteurize colostrum and milk, CLOSED herd, check external ear canal and ear mites!

• from drenching, white muscle disease (selenium or vitamin E, moldy feeds) or cleft palate
• dx at necropsy, looks like mannheimia.  Right apical/cranioventral lung affected first in ALL inhaled including Mannheimia

• corynebacterium pseudotuberculosis, sheep and goats with incubation of 6 months or more
• retropharyngeal LN may put pressure on trachea, cough, wasting, dyspnea, cough with pulmonary abscess.  
• Internal or external abscesses.  
• Culture transtracheal wah 48+ hours, tiny colonies, easy to miss
• pull elbows forward for rads, hard to differentiate from ovine pleuropneumonia
• acid fast stain or culture will differentiate from mycobacterium (tuberculosis)
• economic: condemned corpses, chronic weight loss
• tx: slaughter or euthanize, long term abx for a pet, marsupialize or extirpate LN
• prevent: cull!  Shear youngest first and disperse, vaccinate

• similar retroviruses, cross-react and cross-infect.  Bacterial infections upregulate.
• ADULTS, often infected as neonates. weight loss, secondary bacterial bronchopneumonia
• interstitial pattern on rads, U/S-guided percutaneous lung biopsy
• economic: chronic weight loss, early culling
• no tx
• prevent with test-and-cull programs, artificial rearing, pasteurize colostrum and milk (kids more than lambs).

• Retrovirus (different from enzootic nasal tumor and OPP/CAE)
• dx: Wheelbarrow!! Not pathognomonic, weight loss (incubation 2-4y).  Tumors look like OPP at necropsy
• economic: Rare in USA, killed Dolly!
• no tx
• prevent: don't buy infected, no test available.  CULL THE SKINNY ONES

• fever, cough, drop in milk, diarrhea
• pick up at shows!  
• abx for secondary bacterial pneumonia, BRSV vax? quarantine after shows

• dictyocaulus filaria: trachea and bronchi, RARE
• Protostronylus rufescens: snails and slugs, trachea and bronchi, RARE
• Muellerius capillaris: indirect life cycle, in alveoli, COMMON
• cough, secondary bacterial bronchopneumonia
• chronic weight loss in goats
• baermann test on feces, worms have dorsal spine
• triangular lesions in lungs, dorsal diaphragmatic lobes, white is dictyocaulus or red is protostronylus.  Muellerius are scattered and rounded, parenchyma may look green. 
• regional
• keep worms off the pasture!  Or keep the goats off...

• old sheep and goats, space-occupying lesion in thorax.  neoplastic cell is epithelial. 
• ddx: lymphosarcoma
• sporadic, not rare, often in pets.  Can be incidental finding.

• RARE: nasal granulomas, FBs, trauma, tumor/polyp
• sinusitis: follows dehorning
• MOST COMMON: viral URI, can cause bacterial pneumonia

• iatrogenic: balling gun or oral Ca2+ tube injuries
• necrotic laryngitis/calf diptheria: fusobacterium necrophorum, infection.  Tx with abx.  1-2% on feedlots

• bronchial pneumonia
• metastatic pneumonia
• interstitial pneumonia

• Right lung twice as large as left
• bronchus to right apical branches directly off trachea cranial to carina
• very thick pleura with separate left and right pleural sacs
• small lungs relative to body size

• acute inflammation of bronchioles and lungs
• infection spreads from upper respiratory tract in COMPROMISED (so bacteria can reach lungs)
• dehydration, acidosis, stress, viral infection etc let bacteria grow in nasal cavity, impair normal defense mechanisms. 
• cranioventral distribution, caused by both infection and immune reaction
• feedlot: bovine respiratory disease complex/"shipping fever" (some viral)
• dairy calves: enzootic calf pneumonia

• #1 disease of cattle in feedlots (72%  slaughterhouse, 16% affected)
• vaccination and prevention don't seem to work

• 2nd most common disease after scours
• pneumonia = 24-30% mortality

• host: immunity (colostrum, vaccination, prior exposure, stress, disease), concurrent diseases, malnutrition, vitamin or mineral deficiencies.  must be COMPROMISED
• disease agent:
• environmental management: weaning/comingling, ventilation, transportation time, multi-source cattle, dust, rumen acidosis, temperature

fluoroquinolones

• vena caval syndrome
• ruminal acidosis, liver abscess, lung abscess, epistaxis

• gram positive coccobacillus
• ubiquitous opportunist
• chronic or recurrent infections (secondary invader, inhalation pneumonia, caudal vena caval syndrome)
• poor px

• vena caval syndrome
• pharyngeal trauma or abscess
• facial or skull trauma
• endocarditis
• clotting disorders

• trueperella pyogenes
• salmonella dublin
• e coli
• mycobacterium bovis

• dictyacaulus viviparous
• primary infection in young animals <12 months, usually after introduction to pasture

• larvae passed in feces (infective 3-7 days)
• ingested to lymphatics to blood stream to lungs within one week
• wet to moist cough and dyspnea 1-2 weeks after moving to pasture.
• reinfection syndrome from grazing pasture contaminated by calves.  Immune rxn to killed larvae.  Cough, tachypnea, emphysema, agalactia, diffuse crackles
• moxidectin - no milk or meat withdrawal!

• baermann technique
• larvae or eosinophils seen on tracheal wash
• fecal float.

• DIFFUSE disease, not cranioventral
• acute onset of dyspnea
• congestion and edema
• histology: hyaline membranes, alveolar epithelial hyperplasia
• interstitial emphysema
• sudden death

• "fog fever": adult cattle moved from poor to lush pasture, acute onset of severe dyspnea
• Moldy sweet potato toxicity: toxin-producing fungus
• hypersensitivity pneumonia: dust from moldy hay or grain.  cow version of "farmer's lung"

• bovine herpes virus 1.  LATENT infections
• respiratory, genital, enteric, conjunctivitis, fever, nasal d/c, hyperemia of muzzle ("red nose"), white plaques, peripheral corneal edema, high morbidity, low mortality, abortion
• component of bovine respiratory vaccines

• sheep-associated in North America (ovine herpes 2), related to bovine herpes 3 (mammary pustular dermatitis).  Africa has wildebeest associated form (gamma Herpes)
• low morbidity, high mortality
• inflammation of mucous membranes

• paramyxovirus
• fever, tachypnea, nasal d/c, SQ edema
• biphasic disease--mild cases resolve, followed by severe disease
• pathology similar to atypical interstitial pneumonia
• component of bovine respiratory vaccines
• could be caused by poor ventilation, TMR can also help, decrease ruminal acidosis

• major signs are GI, abortion, congenital abnormalities, but there are resp signs too.  Can be fever, tachypnea.  
• Decreased cellular immunity (could also have infectious bovine rhinotracheitis, bacterial pneumonia)
• prevent via vaccine, test-and-cull persistent infections

• paramyxovirus
• upper respiratory signs, may predispose to bacterial pneumonia
• component of 4-way respiratory vaccines

• gram negative rod
• opportunistic
• bronchopneumonia (subacute to chronic, septicemia)

• gram negative rod
• opportunistic
• pathogenesis: capsule, leukotoxin, endotoxin, conversion to virulent serotype (2 to 1)
• subacute fibrinous pleuropneumonia
• higher mortality and morbidity than pasteurella
• abx resistance more common

• gram negative rod, occasionally isolated in healthy cattle
• septicemia, sudden death, depression, fever, myocarditis, neuro signs, arthritis, tendosynovitis
• often in feedlot, where CNS, polyarthritis, tendosynovitis predominate (thromboembolic meningoencephalitis TEME)

• no cell wall (limiting membrane)
• require special culture medium
• M. bovis most common respiratory species
• also cause arthritis-synovitis, mastitis
• mixed infections common
• (M. mycoides = contagious bovine pleuropneumonia.  Eradicated in US by 1892)

fusobacterium necrophorum

0 days milk, 13 days meat

cranioventral

mannheimia haemolytica

• timely mass medication of a group of animals to eliminate or minimize an expected outbreak of a disease.  
• Ex. administering tilmicosin to a group of feedlot steers on arrival

fluoroquinolones

• no labelled drug exists to treat condition
• valid client-patient relationship
• available for follow-up
• extended withdrawal times
• animal-medicinal drug use clarification act (AMDUCA)
• there is a list of drugs FDA has prohibited for extra-label use or any use at all.
• Fluoroquinolones only for resp
• cephalosporins only at label dose/route
• many things approved for resp, so probably not going to be able to use anything off-label.
• FARAD - food animal residue avoidance databank, can check published or ask questions

we are getting fluoroquinolone resistance, so STOP USING IT unless you need it

ceftiofur (dose and route as on label), tulathromycin, micotil, florfenicol, oxytetracycline, ampicillin, enrofloxacin (only as labelled)

• ceftiofur, oxytetracycline, ampicillin
• extralabel only with good evidence that others won't work

keep nose low and put into cheek, less likely to swallow with mineral oil so tube that?

• Trueperella pyogenes
• gram postitive coccobacillus
• causes big abscesses
• ubiquitous opportunist
• chronic or recurrent infections, secondary invader, caudal vena caval syndrome

• lung abscesses first!
• vena caval syndrome
• pharyngeal trauma or abscess
• facial or skull trauma
• endocarditis
• clotting disorders

• HOST-ADAPTED serotype in cattle
• rarely found in fecal samples, so miss if monitoring fecal samples

• symptom
• patient's perception of difficult or labored breathing

• Clinical sign
• physician's perception of difficult or labored breathing
• differentiated from tachypnea with increased effort by orthopneic postures

• Standing or sternal recumbancy (or sphinx) (optimize V/Q)
• abducted elbows (increased tidal volume)
• extended head and neck (decreased resistance)
• open-mouth breathing (decreased resistance)

• Increased RR and effort
• abnormal posture (orthopnea)
• pallor due to vasoconstriction from catecholamines
• +/- cyanosis (need 3-5g/dL to be visible, anemic may not have that, Hb = 1/3 of HCT)f

• The ability to move air in and out of the alveoli
• reflected in partial pressure of carbon dioxide dissolved in arterial blood (PaCO2)

• Ability to get O2 into the blood
• reflected in partial pressure of oxygen dissolved in arterial blood (PaO2)
• also reflected in percent saturation of arterial hemoglobin with oxygen SaO2 (SpO2)

• decreased FiO2: anesthesia with no O2, barometric pressure/altitude
• Hypoventilation:neurologic, anesthesia/sedation, obstruction, airway disease
• diffusion impairment: pulmonary fibrosis, interstitial disease (edema/hemorrhage)
• V/Q mismatch: atelectasis, alveolar disease, pulmonary hypertension
• Shunting: blood missing lungs and going through unoxigenated

• Upper airway: stridor, stertor, noisy
• lower airway: wheeze/whistle, expiratory push
• pulmonary parenchyma: +/- crackles, +/- asymmetry, usu inspiratory with good chest excursions
• Pleural space: restrictive pattern, inspiratory distress, +/- muffled or asymmetric
• chest wall: palpate and observe
• pulmonary throboembolism: ddx of exclusion
• abdominal distension: observe
• look-alikes: go looking!  At low risk.

• noisy to the naked ear (stridor from laryngeal obstruction or stertor/snoring)
• Change in voice or cough
• inspiratory (cervical) or expiratory (intrathoracic)
• blood gas: hypercarbia, hypoxemia (caused by hypoventilation secondary to obstruction
• lar par, collapsing trachea, brachycephalic, neoplasia, swelling, fracture, FB, granuloma, abscess, hematoma etc
• tx: O2, decrease stress, relieve obstruction, treat HYPERTHERMIA

• noise (whistles and wheezes) with stethoscope, cough/hx of cough, expiratory distress or push/grunt
• Blood gas: hypercarbia and hypoxemia
• Cause of hypoxemia: hypoventilation secondary to obstruction
• ddx: asthma in cats
• tx: O2 cage, decrease stress, bronchodilators (B2 best, phosphodiesterase inhibitors okay), short-acting steroids

• Findings: normal harsh or asymmetric lung sounds, +/- crackles  (but dx if you have them), primarily inspiratory distress
• blood gas: hypoxemia,+/-hypercarbia in SEVERE, fatigued, young
• causes of hypoxemia: V/Q mismatch and/or shunt, diffusion barrier, +/- hypoventilation
• ddx: cardiogenic (perihilar edema, pulm veins > arteries, cardiomegaly, murmur/gallop/arrhythmia, hypothermia); non-cardiogenic (caudodorsal edema, normal heart and vessels, hx of strangulation, electrocution, sz, near-drowning), blood (contusions, coagulopathy), soft tissue (neoplasm), interstitial (pulmonary fibrosis), pus (pneumonia, cranioventral)
• tx: O2, minimize stress.  Cardiogenic - furosemide, vasodilator, morphine, no fluids.  Non-cardiogenic - time +/- furosemide, contusions - conservative IVF, pneumonia - abx

• Findings: lung sounds normal, dull or asymmetric. Restrictive = asynchronous inspiration (chest out and abdomen in) vs inverse inspiration (chest in and abdomen out, fully abdominal breathing)
• Blood gas: hypoxemia +/- hypercarbia
• cause of hypoxemia: V/Q mismatch, shunt, +/- hypoventilation
• ddx: pneumothorax (trauma), hydrothorax (CHF, hypoproteinemia), pyothorax, hemothorax (trauma, coagulopathy), chylothorax (idiopathic, heart dz, neoplasia, HWD), other exudate (neoplasia, FIP), soft tissue (diaphragmatic hernia, mass)
• to: O2, minimize stress, thoracocentesis (all unless hemothorax, both therapeutic and diagnostic).  Thoracostomy tube for pneumothorax.

• Hx of trauma, paradoxical chest mvmt (FLAIL), pain on palpating, concomitant pulmonary contusion
• Blood gas: hypercarbia, hypoxemia
• cause of hypoxemia: Hypoventilation secondary to flail and altered lung mechanics, VQ mismatch
• ddx: Flail chest/segment
• tx: O2 cage, decrease stress, AFFECTED SIDE DOWN (up lung ventilated better, fractures stabilized, ANALGESIA, rarely need for sx stabilization (sew to fiberglass splint on outside, Don't catch the LUNG

• Findings:  hypoxemia unresponsive to O2
• Blood gas: hypoxemia, hypocapnea
• cause of hypoxemia: VQ mismatch and shunt (decreased surfactant production causing alveolar collapse, inflammatory mediators cauase lung injury, increased PA pressure increases intrapulmonary and intracardiac shunt)
• ddx:diagnosis of exclusion.  Look for a reason for hypercoagulability (sepsis, neoplasia, immune-mediated, cardiac, HW, endothelial damage, etc)
• tx: supportive, heparin and antiplatelet drugs, thrombolytic therapy (LIMITED with d/c, $$$$), tx underlying dz

• Findings: abdominaldistension
• blood gas: hypoxemia +/- hypercapnia
• cause of hypoxemia: VQ mismatch or shunt, +/- hypoventilation
• ddx: fluid (R-sided heart failure etc), organomegaly, neoplasia, fat
• tx: abdominocentesis

• Non-respiratoryproblem that LOOKS like respiratory distress
• Blood gas; hypocarbia, normoxemia 
• NO HYPOXEMIA
• ddx: behavior (stress, fear, pain), metabolic (acidosis compensation), anemia (low O2), environment (hyperthermia, hypothermia uncommon)
• tx: anxiolytics, analgesics, tx acidosis, transfuse anemia if symptomatic

• Heart failure: hypothermic, increased jug vein dissension, +/- hypotension
• primary resp failure: Normo- or hyperthermic, normal or decreased jug vein.