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A patient in severe respiratory distress is at risk of death as a consequence of minimal diagnostic or therapeutic interventions, but is also at risk if you do nothing; it would be well to advise your client of this at your initial contact!I have a great deal of experience with this situation, and strong convictions as well.

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Substitute midazolam for the diazepam (0.2 mg/kg again) and give it IM for the patient that can't even sit still for an IV.

If your practice is narcotic friendly, you can substitute oxymorphone (0.05 – 0.10 mg/kg) or hydromorphone (0.10 – 0.20 mg.kg) in place of the butorphanol; use the lower end dosage of the narcotic for cats. If you give this to a fractious patient, you will likely still have a fractious patient after this medication.

I can usually tell with a few seconds of echocardiography whether heart failure is the cause of the effusion.

However I believe that this patient needs a thoracocentesis before any diagnostics and would give the sedation even before the flash echo.

However it's usually just the ticket for the critically dyspneic pet or one with significant heart disease.

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