Cardiopulmonary exam: Is this patient OK? (Proceedings)

Cardiopulmonary exam: Is this patient OK? (Proceedings)

Apr 01, 2009

Initial assessment

When first alerted to a patient presenting in crisis, the goal of the initial examination is to rapidly identify any imminently life-threatening problems via a streamlined, efficient, clinical examination. Evaluation of the cardiovascular and respiratory systems is a high priority, both because these systems need to function well to maintain life and also because in many of these patients it is cardiopulmonary dysfunction that is causing the crisis. Although initial assessment must also include evaluation of the central nervous system, abdominal palpation and body temperature, most of this lecture will focus on examination of the cardiopulmonary system. For any patient, the initial survey of each major body system is abbreviated such that the clinical signs that yield the most important information are examined first. Stabilization measures should be initiated for any major problems prior to the remainder of the full physical evaluation.

A very brief history should be obtained at presentation, focusing on the owner's chief complaint. Does the information suggest the patient is at high risk? Preliminary physical exam focuses on the basics: Can the patient draw a breath? Does it look sick or dehydrated? Any gross abnormalities of vital signs? What is the level of consciousness (LOC) - is the patient depressed or agitated? Can it walk? Next, a more focused exam concentrates attention on the organ system referred to in the owner complaint and other high-risk possibilities. Are there skin wounds, active bleeding, is the abdomen distended or painful?

Cardiovascular system

Vital signs provide very useful information. Hypothermia may be due to environmental causes or severe illness (including heart failure and in cats, septic shock). Occasionally animals with respiratory difficulty will have hyperthermia; this is usually due to obstruction of upper airways causing resistance to breathing and the extra muscular effort required to pull or push gas past the obstruction generates excess heat. These patients should receive assistance in cooling.

The heart rate should be assessed. A quietly resting or sleeping dog will have a heart rate between 40 and 90 BPM; this is inappropriately slow in an alert dog presented to a veterinary clinic. If the dog does appear depressed or obtunded, a heart rate > 120 BPM is considered tachycardia. Most cats presented to a clinic in health or disease have high heart rates (> 180 BPM). Persistent tachycardia (> 220 BPM) in quiet cats is normal in some but may indicate that underlying pathology is present and driving the heart rate high. Relative bradycardia (< 160 BPM) is the most common serious rhythm disturbance in sick cats and is routinely accompanied by hypothermia, often an ominous sign.