18. Cardiopulmonary resuscitation. Basics of the fluid therapy and parenteral feeding. Flashcards

1
Q

Before resuscitation indications?

A

BEFORE RESUSCITATION

Indications

§ Cardiac arrest

§ Pulmonary arrest

§ Cardiopulmonary arrest (CPA)

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2
Q

Clinical signs before resuscitation?

A

Clinical signs

§ Loss of consciousness (LOC)

§ Loss of spontaneous ventilation; Agonal breathing

§ Loss of palpable pulse

§ Loss of cardiac sounds upon auscultation

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3
Q

Predisposing factors of Cardio pulmonary resuscitation?

A

Predisposing factors of CPA

§ Heart failure § SIRS*

§ Severe pulmonary disease § Sepsis

§ Coagulopathy § Neoplasia

§ Polytrauma § Toxicosis

§ Brain trauma § Anaesthesia

*Systemic inflammatory response syndrome

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4
Q

Potentially reversible causes of CPA(5Hs, 5Ts)?

A
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5
Q

Considerations before CPR?

A

Considerations before CPR

§ Underlying disease (treatment of the cause of CPA)

§ The will of the owner

§ Timing; CPR should be performed within 3-5 mins of CPA

§ Equipment needed

§ Trained staff (>3 nurses needed, ideally)

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6
Q

Reassesment campaign on veterinary medicine?

A

Reassessment campaign on veterinary medicine

The acronym “RECOVER” is used

  1. Preparedness & prevention
  2. Basic life support (BLS)
  3. Advanced life support (ALS)
  4. Monitoring
  5. Post-resuscitation care
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7
Q

Performing CPR?

A

PERFORMING CPR

Aim of CPR: Provide oxygen & blood to the heart & brain

Process: First, a 10 second physical exam should be performed to

detect for breaths, heartbeats and the degree of bradycardia if any.

The following prioritisation should be followed throughout CPR:

  1. Airways
  2. Breathing } Basic Life Support
  3. Circulation
  4. Drugs/Defib

} Advanced Life Support 48. ECG

  1. Fluid

therapy

A. Airways

  1. Establishment of free airways

Remove materials that may cause occlusion

Placement of the ET tube otherwise use mouth-to-nose resuscitation

If ET tube isn’t possible → Tracheostomy
Breathing

Check for breathing; Ø or agonal breathing → Ventilate the

patient!

§ If the patient is in respiratory arrest, stimulate the

Ren-zhong acupuncture point (see Fig. 18.1) on the

ventral philtrum until you reach the bone → This

can stimulate spontaneous breathing

§ Ventilation with AMBU-bag/balloon attached to an

oxygen line.

§ Ventilate 10-12 breaths/min; 10ml/kg

E. Circulation

Check the heart rate → Absent → Chest compressions →

  1. Put patient in lateral recumbency
  2. Clutch hands and place hands on the patient:
    a. Large dog: Widest part of chest
    b. Medium dog: Over heart
    c. Small dog/cat: Fingers & thumb over

heart

  1. 100-120 compressions/minute

Internal cardiac massage/open chest CPR in cases of

penetrating chest wound, rib fracture or diaphragmatic hernia.

F. Drugs/Defibrillation

Pharmacological support of circulation

Routes of administration

Central venous catheter (best)

Peripheral IV catheter: Drug bolus + 5ml flush

Intratracheal route (IT)

Adrenaline

Drugs must be solved in 5ml of saline

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8
Q

Drugs/ defibrillation?

A
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9
Q

ECG?

A

ECG

Evaluate for arrhythmias

§ Asystole: Adrenaline → Atropine

§ Pulseless electrical activity (PEA)

§ Ventricular tachycardia: Defib x 3 →

Lignocaine/Amiodarone

§ Ventricular fib/flutter: Defib x 3 →

Adrenaline/lignocaine

§ Sinus bradycardia: Atropine → Adrenaline →

Atropine → Adrenaline

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10
Q

Drugs?

A

Epinephrine (Lo→Hi) Asystole; VF; PEA

Atropine Asystole; Sinus bradycardia

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11
Q

Fluid therapy?

A

Fluid therapy

I. Goal is not the administration of a certain amount of

fluid, but the normalisation of the vital signs

J. Contraindicated in pulmonary oedema cases

K.

L. If the animal is hypovolaemic

Isotonic balanced crystalloid solution: Shock dose → Dog: 60-

90ml/kg

→ Cat: 45-60ml/kg

It is recommended to give 25% dose in 20 mins

→ Revaluate & repeat if necessary

Synthetic colloids: Rapidly expand intravascular volume with less

infusion volumes required

Shock dose

→ Dog: 5ml/kg

→ Cat: 1-3ml/kg

Given in IV boluses over 20 mins

Hypertonic saline (10% NaCl)

→ 1-2 ml/kg over 5 mins

If the animal is euvolemic (normal)

Crystalloid bolus at max speed

→ Dog: 20ml/kg

→ Cat: 10ml/kg

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12
Q

Monitoring critically ill patients?

A

MONITORING CRITICALLY ILL PATIENTS

§ Temperature

§ Pulse

§ Respiratory rate

§ CRT

§ Blood glucose

§ ECG

§ BP

§ SPO2

End-tidal CO2

§ < 10mmHg indicates oesophageal intubation

§ 12-18 mmHg indicates ROSC (return of spontaneous

circulation)

§ >45 mmHg indicates hypoventilation of ↑ CO2 delivery to

lungs after ROSC

Possible consequences of CPR

§ Irreversible nervous system damage

§ Shock

§ DIC

§ Reperfusion injuries

§ ↑ Intracranial pressure

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13
Q

Baics of fluid therapy?

A

Basics of Fluid Therapy

Fluid intake: 40-60ml/kg/day

Fluid loss

§ Sensible loss: Urine; Faeces

§ Insensible loss: Panting; Evaporation

§ Pathological: Vomit; Salivation; Diarrhoea; Polyuria

Hypovolaemia

Lack of fluid in the intravascular space

§ Haemorrhage

§ Diarrhoea

§ Maldistribution

§ Anaphylaxis

Dehydration
Lack of fluid in the interstitium and intracellularly
§ Lack of fluid/food intake
§ Excessive loss of fluid (but not bleeding)

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14
Q

Evaluating Hydration status?

A
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15
Q

Stages of shock and types of infusion?

A

STAGES OF SHOCK

§ Compensatory stage: ↑HR; Red MM; CRT <1; Strong

pulse

§ Decompensatory stage: ↓ HR; Pale MM; CRT >2/Ø;

Pulse weak/absent; Hypothermia

TYPES OF INFUSION

Crystalloid

§ Small molecular weight compounds (electrolytes; glucose)

§ Isotonic: 0.9% NaCl

§ Hypotonic: 5% glucose; 0.45% NaCl

§ Hypertonic: 10% NaCl

Colloid

§ Large molecular weight solutes (starch; proteins)

§ Synthetic: Starch; Gelatine

§ Natural: Albumin; Blood plasma; Blood

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16
Q

Rehydration of patients?

A
17
Q

Complications of fluid therapy?

A

COMPLICATIONS OF FLUID THERAPY

Overhydration

This may lead to…

§ Tachycardia; Coughing; Tachypnoea; Dyspnoea; Diarrhoea

Deficit (ml) = BWkg x 10 x % dehydration

43

§ Ascites; Jelly-like subcutis; Exophthalmos; PU; Vomiting

§ Serous nasal discharge; Chemosis; Restlessness; Tremor

18
Q

Parenteral treatment?

A

Parenteral Treatment

SUBCUTANEOUS INJECTION

§ Injectable drugs labelled for SC use

§ Fluids

§ Microchip

§ Hormone implants

Contraindications: Oily injections; Tissue irritative injections

Location of SC injection

§ Caudal neck/thorax

§ Give insulin at an area with thinner skin

§ FeLV & rabies vaccines given in the abdomen

INTRAMUSCULAR INJECTION

§ Injectable drugs labelled for IM use

§ Oily injections – Always give IM

§ Tissue-irritative drugs (Imidocarb; Melarsomine)

Contraindications: Haemorrhagic diathesis (thrombocytopenia;

coagulopathy)

Location of IM injection

§ M. semitendinosus or semimembranosus – Ischiatic nerve!

§ M. quadriceps femoris

§ M. triceps brachii

§ M. supraspinatus et infraspinatus

§ Dorsal lumbar muscles

INTRAVENOUS INJECTION

§ Injections labelled for IV use

§ Situations where fast onset of action is required

Contraindications: Oily injections

Location of IV injection

§ V. cephalica antebrachia

§ V. cephalica lateralis (dog)

§ V. femoralis

§ Ø v. jugularis externa!

When injecting, make sure you aspirate and inject slowly.

BLOOD TRANSFUSION

Preparations:

§ Fresh whole blood

§ Whole blood in CPDA

§ RBC suspension in CPDA

§ Platelet rich plasma

§ Fresh frozen plasma

§ Frozen plasma (deficient in clotting factors V, VIII & vWF)

Blood should be warmed gently to body temperature (38℃)

Give the blood slowly, monitoring for signs of anaphylaxis; Try to

finish infusion withing 2-4 hours.

When are they given?

§ Acute blood loss/haemolysis

§ Chronic anaemia

Crossmatching blood groups in dogs

§ Ø Performed antibodies in dogs → First transfusion isn’t

problematic; Antibodies develop in negative dogs within

1-2 weeks after an incompatible infusion

§ Perform crossmatching before the second transfusion!

Crossmatching blood groups in cats

§ Most important blood groups: A; B; AB

§ 98% of domestic shorthairs are blood group A