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Small Animal ECC > 4 cardiopulmonary cerebral resuscitation > Flashcards

4 cardiopulmonary cerebral resuscitation Flashcards

1
Q

CPCR = ?

CPR =?

A

cardiopulmonary cerebral resuscitation

cardiopulmonary resuscitation

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2
Q

what is CPA?

A

CPA = cardiopulmonary arrest

  • absence of both respirations and heart beat
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3
Q

why is CPA a “3 minute emergency”?

A

b/c neurons in the brain can only be deprived of o2 for 3 minutes w/o dying

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4
Q

t/f

the absence of pulse means that the heart has stopped

A

false

absence of pulse means that the heart requires resuscitative action, not that it has necessarily stopped

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5
Q

absence of respirations alone may respond to what 2 interventions?

A

intubation
and
ventilation

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6
Q

why do human rates for CPCR seem more successful and why is this potentially misleading?

A

humans have higher success rates

BUT humans have a different measure of success: humans accept more neurologic deficit as considered successful, than is accepted in vet med

also - many animals can be successful resuscitated but then return to arrest and/or severely damaged after and end up euthanized in the long run

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7
Q

what are 3 major categories of animals with cardiopulmonary arrest?

A
  • anesthesia related
  • trauma related
  • associated w chronic or debilitating dz
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8
Q

what is CPA during anesthesia commonly due to?

A

hypoxia - failure to provide adequate ventilation - respiratory arrest that progresses due to CPA

less common: due to anesthetic overdose

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9
Q

what is prognosis of CPA when it is due to anesthesia?

why does it carry this prognosis?

A
  • better than other forms of CPA

- generally reversible - turn off gas anesthetic agent and ventilate AND patient is already intubated

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10
Q

CPA in trauma is usually do to what?

A

MC - hypoxia

hypovolemia - hemorrhagic shock
airway trauma / obstruction possible
head trauma

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11
Q

prognosis of CPA induced by trauma?

A

can be okay - depends on extent of trauma

much worse prognosis if due to head trauma - damaged neurons from trauma set the patient back further

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12
Q

prognosis of CPA in cases of chronic or debilitating dz?

A
  • many causes so depends on cause: cardiac, pulm, hemic-lymphatic, metabolic/endocrine, electrolyte, organ failure

POOR PROGNOSIS

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13
Q

keys to CPCR success?

A
  • prepared
  • anticipation next bad thing that can happen to patient
  • prompt recognition of CPA
  • quick response to CPA
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14
Q

what is code status?

A

designates as to whether or not CPCR will be attempted in the event of CPA

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15
Q

what is designation for patients who will not receive CPCR?

A

no code
DNR
DNAR

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16
Q

what was CPR initially designed to prevent?

is is always appropriate to code a patient?

A

sudden unexpected death

may not always be appropriate - sometimes it is just the patient’s time to pass

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17
Q

some reasons for “no code” status for patient:

A
  • terminal dz or condition for which there is little/no hope for return to acceptable state of health
  • financial constraints of owner
  • religious or philosophical bias against life support
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18
Q

what is appropriate patient selection for CPCR?

inappropriate patient selection?

A
  • sudden unexpected death: anesthesia, sx, trauma, reversible dzz
  • avoid CPR in cases where death due to condition is probable
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19
Q

what is the CPCR method ABC(DE) scheme?

A 
airway establishment
breathing
circulatory support 
drugs / defibrillation
evaluation (CPCR effectiveness and patient CV and neuro status)
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20
Q

2 forms of circulatory support:

A

chest compressions [basic life support]

cardiac massage [advanced life support]

21
Q

how many resuscitators is considered basic life support?

how many for advanced?

A

basic - 2

advanced - 3

22
Q

how do you evaluate basic life support before the ABC’s?

A
  • establish lack of responsiveness/consciousness
  • look/listen/fee for over 10 seconds for pulse and respirations
  • call for help
  • turn OFF inhalant anesthetic agent
23
Q

how do you secure a patient’s airway?

A
  • endotracheal tube

inflate cuff, tie securely to prevent dislodgement

24
Q

how do you assist a patient to breathe?

A
  • ambu bag - preferably attached to o2 source

- 10 breaths per minute - each breath about 1-2 seconds in duration

25
Q

guidelines for proper external chest compressions for circulatory support?

A
  • right lateral recumbence
  • 100 compressions per minute, continuous, allow chest to fully recoil
  • depth of compression: 1/3 to 1/2 chest width
26
Q

what is the appropriate ratio for compression:relaxation?

A

1:1

27
Q

what is appropriate size patient to consider cardiac pump for external chest compression?

A

cats and small dogs

less than 15 kg

28
Q

what size patient is appropriate for thoracic pump external chest compression?

A

over 15 kg

29
Q

to coordinate chest compressions with breathing, how many compressions per each breath?

A

3

  • breathe simultaneously with a compression
  • breathing at regular intervals btwn compressions
30
Q

when is open chest cardiac massage considered to give advanced life support?

what cases would this be utilized as first method?

A
  • when normal chest compressions will not create enough intrapleural pressure
  • pleural space compromise: pleural effusion and diaphragmatic hernia
  • cardiac tamponade (pericardial effusion)
  • thoracic wall compromise (rib fractures)
31
Q

how many minutes of unsuccessful closed chest CPCR occurs before resorting to open chest cardiac massage?

A

4 minutes

32
Q

how much cardiac output can external chest compression vs open chest cardiac massage achieve?

A

20 % external

85% open chest

33
Q

what drugs may be given during CPCR?

A
  • epinephrine (venous catheter or intratracheal)

- vasopressin (potent vasopressor)

34
Q

higher or lower dose of epinehprine for intratracheal administration compared to IV?

A

higher

35
Q

what is dose of epinephrine given IV?

A

0.1 mg/kg IV

36
Q

defibrillator paddles are for internal or external use?

A

there are both external and internal paddles

37
Q

what are the 3 cardiac arrest rhythms?

A
  • asystole
  • pulseless electrical activity
  • ventricular fibrillation
38
Q

which 2 cardiac arrest rhythms is a cat more likely to experience?

A
  • asystole

- pulseless electrical activity

39
Q

in general, animals are more or less likely to fibrillate than humans?

A

less likely than humans

40
Q

for open chest cardiac massage, what is the landmark for incision?

A

caudal to caudal border of scapula

41
Q

what muscles are cut during incision for open chest cardiac massage?

A

latissimus dorsi

then serratus ventralis, intercostal Mm and pleura at the 5th intercostal space

42
Q

at what intercostal space is incision for open chest cardiac massage?

A

5th

43
Q

once inside the pericardial sac, what structure is cut?

A

phrenicopericardial ligament

44
Q

what nerve is important to avoid during open chest cardiac massage?

A

phrenic N

45
Q

during open chest cardiac massage, what major vessel should be occluded? using what method? and why?

A
  • descending aorta
  • via rumel tourniquet
  • to direct blood flow cranial, through carotid Aa, rather than caudal
46
Q

for electrocardiagraphic monitoring, what lead isused?

A

lead 2

right arm - left leg

47
Q

when to stop CPCR:

A
  • return to spontaneous circulation - successful
  • resuscitator are exhausted
  • failure of spontaneous circulation to return after 20 minutes of CPCR
48
Q

what to do after successful CPCR?

A
  • vigilance
  • close monitoring: vital signs, blood pressure,
  • intensive support
49
Q

where to monitor direct arterial blood pressure?

A
  • dorsal pedal A

Small Animal ECC (5 decks)

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