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ECC > Cardiopulm resuscitation (Corrie) > Flashcards

Cardiopulm resuscitation (Corrie) Flashcards

1
Q

Crash cart box

A
  • Rescuscitation drugs
  • Laryngoscope with small and large blades
  • Syringes with needles attached
  • Fluids and delivery sets
  • Catheters wtih t-sets/tape, etc
  • Heparinised saline flushes
  • Scalpels
  • Basic laceration pack
  • Suture
  • Ambubag
  • Thoracocentesis kit made up
  • Blood collection tubes
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2
Q

The emergency area

A
  • Selection of endotracheal tubes
  • Oxygen source
    • anesthesia machine
  • EKG
  • Defibrillator and gel
  • Capnograph
  • Drug dose chart
  • Clippers
  • Clock/timer and record sheets
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3
Q

Recognising a crisis

10 second patient assessment

A
  • The 10 second patient assessment
    • cessation of breathing/agonal breaths
    • No palpable pulses
    • No heart sounds
    • Unresponsive
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4
Q

Recognising a crisis

Under anesthesia

A
  • Under anesthesia
    • cessation of respiration
    • sudden EKG changes
    • rapidly falling blood pressure/loss of doppler sound
    • reduced CO2 output on capnograph
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5
Q

Patient selection

A
  • respect owners wishes
  • post-rescucitation care can be expensive
  • Is cause of death reversible
    • anesthesia/drug overdose
    • restraint
    • anemia
    • hypovolemia
    • vagal event
      • vomiting
      • straining to defecate
    • Airway obstruction
    • pericardial effusion
    • unexpected arrest

*Age is not a disease!

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6
Q

Avoiding futile CPR

A
  • Avoiding waste of resources
  • Avoiding wastage of owners money
  • Reducing emotional impact on staff
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7
Q

Aim of CPR

A
  • Perfuse heart and brain with oxygenated blood
    • Cerebral perfusion pressure
      • mean arterial pressure - intracranial pressure
    • Coronary perfusion pressure
      • aortic diastolic pressure - right atrial diastonlic pressure
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8
Q

Do not…..

A
  • Do an intracardial stick
  • Do precordial thump
  • Give glucose
    • can cause hypoglycemia
  • Give Ca and sodium bicarb
    • very limited uses
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9
Q

Ventilation

Artificial respiration

A
  • Artificial respiration with oxygen
    • ideally endotracheal tube
    • tracheostomy
    • tight fitting face mask
    • alternative airway device
    • ambubag
    • anesthesia machine
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10
Q

Ventilation

Technique

A
  • Rate of artificial respiration
    • between 10-12 breaths/minute
  • Depth
    • cause visible rise in chest wall
  • Avoid excessive pressures
    • > 20mmHg bad
  • Avoid rapid respiration
    • reduces chance of success by lowering CO
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11
Q

Perfusing heart and brain

A
  • Circulation
    • Chest compressions
      • direct cardiac compression: small patients < 15 kg
        • compresses directly over heart - causes artificial systole
      • Thoracic pump mech: patients > 15 kg
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12
Q
A

Direct cardiac compression

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13
Q

Thoracic pump mech

A
  • chest is a pump
  • relaxation allows blood flow back towards heart
  • one way valves ensure mostly one way
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14
Q
A

Thoracic pump mechanism

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15
Q

Chest compressions

Technique

A
  • Rate between 100-120
  • push hard
  • allow complete relaxation
    • allows ventricular filling
  • Don’t stop
    • pauses associated with reduced survival
    • have someone else monitor pulses, capnograph
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16
Q

Open chest CPR

A
  • Technique for maximising blood flow by direct cardiac massage
  • May allow dealing with underlying cause of arrest
  • Sometimes expensive aftercare
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17
Q

Indications for open chest CPR

A
  • Pleural effusion
  • Pneumothorax
  • Pericardial effusion
  • Chest trauma
  • Recent thoracic surgery
  • Dead on arrival
  • Large dog: external chest compressions not effective
  • Intra-operative arrests
18
Q

Open chest CPR

Technique

A
  • Cut at 5th or 6th rib space
    • usually on right side
  • Clipping ideal
    • not essential
  • If successful: close check
    • antibiotics
    • flush routinely
    • thoracostomy tube
    • remember internal thoracic artery
    • routine closure
19
Q

Monitoring CPR

A
  • Return of pulses, spontaneous apex
  • Capnograph
  • EKG
  • CO2 thru roof means reperfusion
20
Q

EKG Rhythms

A
  • Asystole
  • Pulseless electrical activity
  • Ventricular fibrillation
    • defib
  • Pulseless Ventricular tachycardia
    • defib
  • Sinus bradycardia
  • Sinus tachycardia
  • Ventricular tachycardia
21
Q

Capnograph

A
  • Sudden increase in CO2 output
    • indicates ROSC
  • Zero CO2 output
    • innefective chest compressions
    • accidental extubation
    • zero blood flow
22
Q
A

Asystole

23
Q
A

Pulseless electrical activity

-seen in euthanasia: take off EKG

24
Q
A

Course ventricular fibrillation

-shockable rhythm

25
Q
A

Pulseless Ventricular fibrillation

-I think you shock this one…?

26
Q

Venous Access

A
  • Jugular cut down
    • usually needed to do this
    • do it quickly
  • Saphenous, cephalic, medial femoral (cats)
27
Q

Drug choices in CPR

A
  • Vasopressors
    • epinephrin
    • vasopressin

*cause vasoconstriction, inc arterial pressure

28
Q

Epinephrine

A
  • Beta adrenergic agonist - looking for alpha 2 properties
  • Low dose way to go
    • 0.01-0.02 mg/kg
  • admin IV every 3-5 minutes
  • can give endotracheally
    • double dose
29
Q

Vasopressin

A
  • Potent peptide pressor
    • remains more effective in toxic, acidic environments
  • dose: 0.8 units/kg
  • can be given endotracheally
  • rescue therapy if epinephrine fails
  • benefecial in severe acidosis/prolonged arrest
30
Q

Atropine

A
  • for bradycardia
  • can reverse vagally mediated arrest
  • dose: 0.04 mg/kg
31
Q

Anti arrhythmics

A
  • Lidocaine
    • poor efficacy
    • electrical defibrillation first
      • diminishes effectiveness of defibrillation
    • cautious use in cats
  • Amiodarone
    • can help convert ventricular fibrillation and electrical defibrillation
    • can cause anaphylaxis
    • consider if 2 defibrillations are unsuccessful
32
Q

Sodium bicarb

A
  • Generally overused
  • Only use if
    • severe pre-existing metabolic acidosis
    • OR in arrests due to hyperkalemia
    • And if other methods haven’t resolved problem
  • Used guided by blood gasa
33
Q

Calcium gluconate

A
  • Use in arrests only if
    • hyperkalemia was cause of arrest
      • blocked cat
    • Severe pre-existing hypocalcemia
      • eclampsia
  • contraindicated for all other arrest reasons
34
Q

Reversals

  • Opioids
  • Benzodiazepines
  • Alpha 2 agonists
A
  • Opioids
    • Naloxone
  • Benzodiazepines
    • Flumazenil
  • Alpha 2 agonists
    • Atipamezole
    • Yohimbine
35
Q

Defibrillation

A
  • Converts ventricular fib into a perfusing rhythm
  • temporarily stuns heart muscle
  • IT CAN KILL PEOPLE
    • person holding paddles is responsible
    • clear people of pet and table
  • Dose (external)
    • 2-4 J/kg
  • clip fur away if possible
  • use gel
  • alcohol will light on fire
  • deliver one shock them resume chest compressions 2-3 minutes
36
Q

open chest CPR

Defib

A
  • Internal defib paddles
  • put saline soaked gauze between heart and paddles
  • place directly across heart and press firmly before shocking
37
Q

Fluid therapy

A
  • Use if hypovolemic or severely dehydrated
    • Isotonic crystalloid: LRS
    • hypertonic crystalloid: 7.2% saline
    • Colloids: hetastarch
    • blood products/oxyglobin
      • if arrest was due to anemia

*overuse of fluids can reduce cardiac perfusion

38
Q

Post-resuscitation care

Myocardial dysfunction

A
  • Myocardial dysfunction
    • pressors usually needed
    • dobutamine for myocardial contractility
      • careful in cats
    • dopamine commonly used
      • start at 10 mcg/kg/min
      • monitor EKG
      • reduce dose if sig arrhythmia, tachycardia or hypertension
    • norepinephrine
39
Q

Post resuscitation care

Neurological dysfunction

A
  • Neuro dysfunction
    • can take hours to regain cranial nerve function
    • young animals tolerate ischemia better than old
    • serial neuro monitoring
    • consider therapeutic hypothermia
40
Q

Post resuscitation monitoring

A
  • EKG
  • Blood pressure
  • Pulse ox
  • PCV/TS
  • Blood gases
41
Q

Post-resuscitation: survival

A
  • some may need ventilators
  • nursing care
  • 2-8% survival rate to hospital d/c

ECC (18 decks)

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