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
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
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
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
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!
6
Q
Avoiding futile CPR
A
- Avoiding waste of resources
- Avoiding wastage of owners money
- Reducing emotional impact on staff
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
- Cerebral perfusion pressure
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
9
Q
Ventilation
Artificial respiration
A
- Artificial respiration with oxygen
- ideally endotracheal tube
- tracheostomy
- tight fitting face mask
- alternative airway device
- ambubag
- anesthesia machine
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
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
- direct cardiac compression: small patients < 15 kg
- Chest compressions
12
Q
A
Direct cardiac compression
13
Q
Thoracic pump mech
A
- chest is a pump
- relaxation allows blood flow back towards heart
- one way valves ensure mostly one way
14
Q
A
Thoracic pump mechanism
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
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
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
Pulseless Ventricular fibrillation
-I think you shock this one...?
26
Venous Access
* Jugular cut down
* usually needed to do this
* do it quickly
* Saphenous, cephalic, medial femoral (cats)
27
Drug choices in CPR
* Vasopressors
* epinephrin
* vasopressin
\*cause vasoconstriction, inc arterial pressure
28
Epinephrine
* 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
Vasopressin
* 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
Atropine
* for bradycardia
* can reverse vagally mediated arrest
* dose: 0.04 mg/kg
31
Anti arrhythmics
* 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
Sodium bicarb
* 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
Calcium gluconate
* Use in arrests only if
* hyperkalemia was cause of arrest
* blocked cat
* Severe pre-existing hypocalcemia
* eclampsia
* contraindicated for all other arrest reasons
34
Reversals
* Opioids
* Benzodiazepines
* Alpha 2 agonists
* Opioids
* Naloxone
* Benzodiazepines
* Flumazenil
* Alpha 2 agonists
* Atipamezole
* Yohimbine
35
Defibrillation
* 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
open chest CPR
Defib
* Internal defib paddles
* put saline soaked gauze between heart and paddles
* place directly across heart and press firmly before shocking
37
Fluid therapy
* 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
Post-resuscitation care
Myocardial dysfunction
* 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
Post resuscitation care
Neurological dysfunction
* Neuro dysfunction
* can take hours to regain cranial nerve function
* young animals tolerate ischemia better than old
* serial neuro monitoring
* consider therapeutic hypothermia
40
Post resuscitation monitoring
* EKG
* Blood pressure
* Pulse ox
* PCV/TS
* Blood gases
41
Post-resuscitation: survival
* some may need ventilators
* **nursing care**
* 2-8% survival rate to hospital d/c
