Page 60 - Problem-Based Feline Medicine

52 PART 2 CAT WITH LOWER RESPIRATORY TRACT OR CARDIAC SIGNS

not in the least concerned with our welfare and well- Pyrexia often occurs within 24 hours of cat-bite
being. wounds.
These cats often require much less restraint than a
well cat. If there is the slightest resistance to restraint – Diagnosis
STOP RESTRAINING THEM – and proceed with
Diagnosis is based on the history and physical exam
supportive care in as least a stressful manner as
findings.
possible.
Radiographic assessment of the severity of lung trauma
may be misleading in the early stages. Often there is a
lag time of 12–18 hours from the time of blunt trauma
DISEASES CAUSING DYSPNEA
OR TACHYPNEA of the chest wall to appearance of interstitial fluid den-
sities in the lung. This is analogous to deep bruising on
the skin and muscle after trauma – it takes time for the
UPPER AIRWAY/CHEST WALL TRAUMA*** bruise to fully develop.

Complete focal lung consolidation with severe contu-
Classical signs
sion may be evident radiographically after chest wall
● Inspiratory dyspnea (in upper airway trauma.
trauma).
● +/– Subcutaneous emphysema. Differential diagnosis
● +/– Paradoxical chest wall motion with flail
chest. Upper airway neoplasia or foreign body in some situa-
● Evidence of superficial trauma. tions may present similarity to trauma, but can be dif-
ferentiated on diagnostic findings such as radiography
or endoscopy.
Clinical signs Pleural space disease, pneumonia and pulmonary neo-
plasia can be differentiated based on history, physical
The character of the dyspnea corresponds to the area of
exam and diagnostic findings.
injury and whether the upper or lower respiratory tract
is involved.
Blunt (car injury, horse kick or fall) or penetrating Treatment
(bite or firearm wound) trauma to the larynx or tra-
Treatment involves supportive care, wound cleaning
chea, may cause inspiratory dyspnea.
and microbial therapy. Surgical repair of upper respira-
Air leakage from a wound to the upper or lower respira- tory tract trauma may be required.
tory tract may lead to subcutaneous emphysema and
Flail chest is defined as a segment of the rib cage with
pneumomediastinum. Crepitus is evident on palpation
proximal and distal fractures, resulting in an unstable
with subcutaneous emphysema.
segment of the chest wall.
Dyspnea, cyanosis, abnormal or decreased lung ● Temporary stabilization may be provided with
sounds occur with severe pulmonary contusions, and techniques using Bachaus towel clamps, wooden
signs of shock may be evident. tongue depressors, etc.
● Rapid definitive surgical correction of the flail
Paradoxical chest wall motion of a flail chest segment
chest is not as important as stabilizing the patient
can occur, that is, inward motion during inspiration.
from the severe trauma, and treating the severe
Traumatic hemothorax may produce increased chest wall pulmonary contusion with oxygen supplementa-
motion with poor air movement. tion, antibiotics, analgesics, bronchodilators, etc.

Other signs of superficial trauma and shredded nails are Tube thoracostomy and intermittent or continu-
usually evident with automobile trauma. ous drainage of the pleural space is indicated when