Steven Berkowitz, DVM

Chief, Emergency and Critical Care

Saint Francis Veterinary Center

Outline Anatomy

Common Diseases

Interventions

Oxygen Therapy

Medications

Nebulization

Coupage

Respiratory Tract

Lower Respiratory Tract

Airways

Common Diseases of Lower Airways Pneumonia

Infectious

Aspiration

Infiltrative Neoplasia

Asthma

Chronic Obstructive Pulmonary Disease

Common Diseases of Lower Airways Allergic/Anaphylaxis

Pulmonary Contusions

Smoke Inhalation

Pulmonary Bullae

Pulmonary Blebs

Acute Respiratory Distress Syndrome

ARDS

Outline Anatomy

Common Diseases

Interventions

Oxygen Therapy

Medications

Nebulization

Coupage

Interventions Oxygen Therapy

Room air = 21% O2

Flow by Oxygen

Oxygen Cage

O2 Tent

Nasal Oxygen

Intubation

Medications Classes of Medications

Bronchodilators

Mucinolytics

Expectorants

Anti-tussives

Anti-Inflammatories

Pulmonary Arterial Vasodilator

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)

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)

Inhalers

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)

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

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

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

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

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

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

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

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

Outline Anatomy

Common Diseases

Interventions

Oxygen Therapy

Medications

Nebulization

Coupage

Interventions Nebulization

Nebulizer Saline

Mucomyst ®

Antibiotics (Gentamicin)

Coupage Percussion of the thorax

to aid in the removal of secretions

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!!!

Any Questions???

Works cited available on request