4 cardiopulmonary cerebral resuscitation Flashcards
CPCR = ?
CPR =?
cardiopulmonary cerebral resuscitation
cardiopulmonary resuscitation
what is CPA?
CPA = cardiopulmonary arrest
- absence of both respirations and heart beat
why is CPA a “3 minute emergency”?
b/c neurons in the brain can only be deprived of o2 for 3 minutes w/o dying
t/f
the absence of pulse means that the heart has stopped
false
absence of pulse means that the heart requires resuscitative action, not that it has necessarily stopped
absence of respirations alone may respond to what 2 interventions?
intubation
and
ventilation
why do human rates for CPCR seem more successful and why is this potentially misleading?
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
what are 3 major categories of animals with cardiopulmonary arrest?
- anesthesia related
- trauma related
- associated w chronic or debilitating dz
what is CPA during anesthesia commonly due to?
hypoxia - failure to provide adequate ventilation - respiratory arrest that progresses due to CPA
less common: due to anesthetic overdose
what is prognosis of CPA when it is due to anesthesia?
why does it carry this prognosis?
- better than other forms of CPA
- generally reversible - turn off gas anesthetic agent and ventilate AND patient is already intubated
CPA in trauma is usually do to what?
MC - hypoxia
hypovolemia - hemorrhagic shock
airway trauma / obstruction possible
head trauma
prognosis of CPA induced by trauma?
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
prognosis of CPA in cases of chronic or debilitating dz?
- many causes so depends on cause: cardiac, pulm, hemic-lymphatic, metabolic/endocrine, electrolyte, organ failure
POOR PROGNOSIS
keys to CPCR success?
- prepared
- anticipation next bad thing that can happen to patient
- prompt recognition of CPA
- quick response to CPA
what is code status?
designates as to whether or not CPCR will be attempted in the event of CPA
what is designation for patients who will not receive CPCR?
no code
DNR
DNAR
what was CPR initially designed to prevent?
is is always appropriate to code a patient?
sudden unexpected death
may not always be appropriate - sometimes it is just the patient’s time to pass
some reasons for “no code” status for patient:
- 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
what is appropriate patient selection for CPCR?
inappropriate patient selection?
- sudden unexpected death: anesthesia, sx, trauma, reversible dzz
- avoid CPR in cases where death due to condition is probable
what is the CPCR method ABC(DE) scheme?
airway establishment breathing circulatory support drugs / defibrillation evaluation (CPCR effectiveness and patient CV and neuro status)
2 forms of circulatory support:
chest compressions [basic life support]
cardiac massage [advanced life support]
how many resuscitators is considered basic life support?
how many for advanced?
basic - 2
advanced - 3
how do you evaluate basic life support before the ABC’s?
- establish lack of responsiveness/consciousness
- look/listen/fee for over 10 seconds for pulse and respirations
- call for help
- turn OFF inhalant anesthetic agent
how do you secure a patient’s airway?
- endotracheal tube
inflate cuff, tie securely to prevent dislodgement
how do you assist a patient to breathe?
- ambu bag - preferably attached to o2 source
- 10 breaths per minute - each breath about 1-2 seconds in duration
guidelines for proper external chest compressions for circulatory support?
- right lateral recumbence
- 100 compressions per minute, continuous, allow chest to fully recoil
- depth of compression: 1/3 to 1/2 chest width
what is the appropriate ratio for compression:relaxation?
1:1
what is appropriate size patient to consider cardiac pump for external chest compression?
cats and small dogs
less than 15 kg
what size patient is appropriate for thoracic pump external chest compression?
over 15 kg
to coordinate chest compressions with breathing, how many compressions per each breath?
3
- breathe simultaneously with a compression
- breathing at regular intervals btwn compressions
when is open chest cardiac massage considered to give advanced life support?
what cases would this be utilized as first method?
- 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)
how many minutes of unsuccessful closed chest CPCR occurs before resorting to open chest cardiac massage?
4 minutes
how much cardiac output can external chest compression vs open chest cardiac massage achieve?
20 % external
85% open chest
what drugs may be given during CPCR?
- epinephrine (venous catheter or intratracheal)
- vasopressin (potent vasopressor)
higher or lower dose of epinehprine for intratracheal administration compared to IV?
higher
what is dose of epinephrine given IV?
0.1 mg/kg IV
defibrillator paddles are for internal or external use?
there are both external and internal paddles
what are the 3 cardiac arrest rhythms?
- asystole
- pulseless electrical activity
- ventricular fibrillation
which 2 cardiac arrest rhythms is a cat more likely to experience?
- asystole
- pulseless electrical activity
in general, animals are more or less likely to fibrillate than humans?
less likely than humans
for open chest cardiac massage, what is the landmark for incision?
caudal to caudal border of scapula
what muscles are cut during incision for open chest cardiac massage?
latissimus dorsi
then serratus ventralis, intercostal Mm and pleura at the 5th intercostal space
at what intercostal space is incision for open chest cardiac massage?
5th
once inside the pericardial sac, what structure is cut?
phrenicopericardial ligament
what nerve is important to avoid during open chest cardiac massage?
phrenic N
during open chest cardiac massage, what major vessel should be occluded? using what method? and why?
- descending aorta
- via rumel tourniquet
- to direct blood flow cranial, through carotid Aa, rather than caudal
for electrocardiagraphic monitoring, what lead isused?
lead 2
right arm - left leg
when to stop CPCR:
- return to spontaneous circulation - successful
- resuscitator are exhausted
- failure of spontaneous circulation to return after 20 minutes of CPCR
what to do after successful CPCR?
- vigilance
- close monitoring: vital signs, blood pressure,
- intensive support
where to monitor direct arterial blood pressure?
- dorsal pedal A
