18. Cardiopulmonary resuscitation. Basics of the fluid therapy and parenteral feeding Flashcards
indications of CPR
cardiac arrest
pulmonary arrest
cardiopulmonary arrest
Clinical signs of an arrest
Loss of consciousness
Loss of spontaneous ventilation
Loss of palpable pulse
Loss of cardiac sounds on auscultation
Predisposition of an arrest
Heart Failure
Severe pul disease
coagulopathy
trauma
Brain trauma
SIRS
sepsis
neoplasia
toxicosis
anaesthesia
Potential reversible causes of an arrest
Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hyper/ o kalaemia
Hypoglycaemia
Toxins
Tension ptx
Thromboembolism
tamponade
trauma
considerations before cpr
underlying disease
will of owner
timing (perform cpr within 3-5mins of arrest)
equipment needed
staff
5 stpes of cpr
- preparedness and prevention
- bls
- als
- monitoring
- post reuscitation care
aim of CPR
provide oxygen and blood to the heart and brain
Process of CPR
10second physical exam to detect breaths, heartbeats, degree of bradycardia
1. airways
2. breathing
3. circulation
4. drugs
5. ecg
6. fluid therapy
how to stimulated the ren zhong acupuncture point
on ventral philtrum until you reach bone
spontaneous breathing can be stimulated
10-12breaths/ min
where to place hands for compressions
Large dog - widest part of chest
Medium dog - over heart
Small dog / cat - fingers & thumb over heart
how many compression per min
100-120
what are the emergency drugs
adrenaline
atropine
NaHCO3
glucose
furosemide
function of adrenaline
peripheral arteriolar vasoconstrictor
coronary and cerebral perfusion pressure increase
function of atropine
used during vagotonia induced asytole and severe brady cardia
increased HR, BP, systemic vascular resistance
Function of NaHCO3
Used in metabolic acidosis & hyperkalaemia
function of furosemide
only in pulmonary oedema
why perform an ecg
evaluate arrhythmias
if animal is in asystole
give adrenaline then atropine
if the animal is in ventricular tachycardia
defib x3
lignocaine/ amiodarone
if animal is in ventriuclar fib / flutter
defib x3
adrenaline / lignocaine
if animal is in sinus bradycardia
atropine –> adrenaline –> atropine -> adrenaline
when to give adrenaline
asystole
VF
PEA
when to give atropine
asystole
sinus brady cardia
when to give sodium bicardonate
severe met acidosis
during cpr
when to give amiodaron
refractory VF
pulseless - VT
when to give lidocaine
v. flutter
VF after failed defibrillation
when to give naloxone
reversal of opioids
what is the goal of fluid therapy post cpr
the normalisation of vital signs
contraindicated in pulmonary oedema cases
Isotonic balanced crystalloid solution
shock dose
Dog - 60-90ml / kg
Cat - 45-60ml / kg
Synthetic colloids shock dose
expand intravascular colume
Dog - 5ml / kg
Cat - 1-3ml / kg
given in IV boluses over 20mins
Hypertonic saline dose
1-2ml / kg over 4mins
crysalloid bolus to give if animal is euvolemic
Dog - 20ml/ kg
Cat - 10ml / kg
Monitorring of critically ill patients
Temperature
Pulse
Resp rate
CRT
Blood Glucose
ECG
BP
SPO2
Possible consequences of CPR
irreversible nervous system damage
shock
dic
reperfusion injuries
increased intracranial pressure
RDA of fluids
40-60ml . kg/ day
how is fluid lost
Sensible loss - urine, faeces
insensible loss - panting, evaporation
pathological - vomit, salivation, diarrhoea, polyuria
what is hypovolemia
lack of fluid in intravascular space
causes of hypovolemia
haemorrhage
diarrhoea
maldistribution
anaphylaxis
what is dehydration
lack of fluid in the interstitium and intracellularly
causes of dehydration
lack of fluid / food intake
excessive loss of fluid
history when evaluating hydration status
anorexia
hypodipsia
vomitting
diarrhoea
physical exam of evaluating hydration status
skin turgor
eye position
perfusion parameters - mm, crt, hr, pulse quality, jugular distension
5% dehydration
no clinical signs
5-6% dehydration
slightly dry mucosa
6-8% dehydration
dry mucosa
loss of skin turgor
8-10% dehydration
enophthalmos
10-12% dehydration
skin tent stays
dull corneas
hypovolaemia
> 12% dehydration
hypovolemiac shick
death
stages of shock
compensatory stage
decompensatory stage
compensatory stage
increased HR,
red mm
<1 crt
strong pulse
decompensatory stage
decreased HR
pale mm
crt > 2 or none
weak / absent pulse
hypothermia
types of infusions
Crystalloid
colloid
Crysalloid infusion
small molecular weight compounds
isotonic - .9% NaCl
Hypotonic - 5% glucose, .45% NaCl
Hypertonic - 10% NaCl
Colloid infusions
Large molecular weight solutes
Synthetic - starch, gelatine
Natural - albumin, plasma, blood
Rehydration equation
Deficit = BWkg x 10 x % dehydrated
Speed of Rehydration
Acute - 2-4hrs
Subacute - 12-48hrs -> 4-8hrs
Chronic - 12-48hrs
Maintenance fluid
if patient is not eating/ drinking
sterofundin B
40-60ml/ kg / day
2-3ml / kg/ day
subcutaneous Rehydration
for stable patients with mild dehydration
warmed isotonic crystalloids
no glucose or hypertonic
dorsal part of neck
complications of fluid therapy
overhydration
what can overhydration lead to
tachycardia
coughing
tachypnoea
dyspnoea
diarrhoes
ascites
exophthalmos
vomiting
pu
serous nasal discharge
tremor
restlessness
types of parenteral treatment
subcutaneous injection
IM injection
IV injection
blood transfusions
types of SC injections
injectable drugs
fluids
microchip
hormone implants
contraindications of SC injections
oily injections
tissue irritative injections
location of SC injections
caudal neck / thorax
insulin in area with thinner skin
FeLV & rabies given in abdomen
types of IM injections
injectable drugs
oily injections
tissue irratitive drugs
contraindication of IM injections
haemorrhagic diathesis
location of IM injections
m. semi tendinosus/ membranosus
m. quad femoris
m. triceps brachii
m. supraspinatus et infraspinatus
dorsal lumbar muscles
Types of IV injections
injections
situations where fast onset is required
contraindications of IV injections
oily
location of IV injections
cephalic
femoral
saphena
jugular (central line not for drugs)
Preparations for blood transfusions
Fresh whole blood
whole blood in CPDA
rbc suspension
platelet rich plasma
fresh frozen plasma
frozen plasma
what should the frozen plasma be deficient in
clotting factors V, VIII, WF
When are blood transfusions given
acute blood loss / haemolysis
chronic anaemia
crossmatching blood groups in dogs
No preformed antibodies in dogs
develop 1-2 weeks after incompatible infusion
therefore must perform xmatch befrore 2nd transfusion
crossmatching blood groups in cats
98% of DSH are group A
other groups - B, AB
