Cardiopulmonary Arrest and Resuscitation Flashcards
What is cardiopulmonary arrest?
Cessation of function ventilation and circulation
What is cardiopulmonary cerebral resusucitation (CPR/CPCR)?
Restoration of ventilation, circulation, and CNS activity
What are poor CPCR candidates?
Terminal disease
Irreversible organ failure
>15 minutes since arrest
Massive trauma
What is the percentage of those that return to spontaneous circulation in dogs?
13%
What is the rate of hospital discharge in dogs?
4%
What is the percentage of those that return to spontaneous circulation in cats?
15%
What is the rate of hospital discharge in cats?
10%
How can you prepare for CPR readiness?
Designated area
Equipment
Training and practice
What is the team approach to CPR?
Person 1: compressions
Person 2: intubation and ventilation
Person 3: record time of events and drugs given
Person 4: apply monitors/belly band and get drugs
What are common causes of arrest?
Excessive anesthetic depth
Fluid, electrolyte, acid-base distrubances
Excessive vagal tone
Cellular hypoxia
What are signs of impending arrest?
Wear or irregular pulse Cyanosis Prolonged CRT ECG changes Respiratory dysfunction Loss of bodily control CNS alterations
What are the 5 H’s for recognition and intervention of patient at risk?
Hypovolemia or hemorrhage Hypoxia or hypoventilation Hydrogen ions (acidosis/alkalosis) Hyperkalemia Hypokalemia
What are the 5 T’s for recognition and intervention of patient at risk?
Toxins Tension pneumothorax Thromboembolism Tamponade Trauma
What are signs of actual arrest?
Loos of consciousness Apnea, gasping No pulse or heart sounds Dilated pupils Lack of bleeding
What is basic cardiac life support (BCLS)?
ABC: airway breathing, circulation
Early recognition, rapid initiation, reinstate oxygenated blood flow
Initiate before starting advanced life support measures
What should be done to the airway for BCLS?
Open airway
Assess breathing
Establish patent airway
What should be done for breathing in BCLS?
Begin ventilation with 100% O2 if available
Initially give 2 breaths
Ventilation: 10 breaths/min
What is done for circulation in BCLS?
Give a quick precordial thumo
Chest compressions should begin immediately if the animal is pulseless
Push hard, push fast
How should CPR be done with small dogs and cats?
Right lateral recumbency
Compress over left 5-6 ICS
100-120 compressions/minute
Force- decrease thorax 30%
How should CPR be done with large dogs?
Dorsal or right lateral recumbency
Compress lower 1/3 sternum or the highest part of the chest
80-100 compressions/minute
Force- decrease thorax 30%
What indicates compression success?
ETCO2 > 15 mmHg
Doppler over cornea to detect blood flow
Pulse oximeter- wave form
What are the mechanisms of blood flow during CPR?
Cardiac pump; direct compression of heart; effective in small animals
Thoracic pump: compression of entire thorax; large dogs
How can you improve blood flow?
Time inspirations to coincide with compressions
Bind abdomen or pelvis
Interpose abdominal compressions with thoracic compressions
What is used if BCLS measures fail?
Advanced cardiac life support
What is ACLS?
Use of equipment and drugs to air in CPR
What are the drugs used in ACLS?
Epinephrine Atropine Lidocaine Naloxone Vasopressin
What are routes for drugs in ACLS and are the excellent, good, or dangerous?
IV central- excellent IV peripheral- good Intratracheal- good Intraosseous- good Intracardiac- dangerous
Where can you place a catheter for fluids?
IV access- large bore jugular or cephalic catheter
Intraosseous is a good alternative
At what rate should fluid be given?
Rapid rate if hypovolemia is present; careful administration otherwise
What fluids are used?
Type of arrest determines fluid therapy, but typically crsytalloid or colloid
What is ventricular asystole?
Flat line- no electrical activity or only p waves
What is the drug of choice for ventricular asystole?
Epinephrine
What does epinephrine cause?
Alpha adrenergic agonist: vasoconstriction
Beta adrenergic agonist: cardiac contractility
What does vasopressin produce?
Peripheral vasoconstriction
Increases preload
What does vasopressin work on?
Specific V1 receptors
What is ventricular fibrillation?
Chaotic ventricular causing heart to look like bag or writhing worms
What is used in ventricular fibrillation?
Electrical defibrillation Start low and increase Cardiac compressions before defibrillation Never use alcohol Epinephrine
What is used in chemic defibrillation?
Acetylcholine and potassium chloride
What is pulseless electical activity (PEA)/electromechanical dissociation (EMD)?
Near normal ECG complex
No mechanical activity (pulseless)
What is used in PEA/EMD?
Epinephrine as it may produce mechanical activity
What is pulseless idioventricular rhythm (PIVR)?
Wide bizarre ventricular activity; pulseless
What causes PIVR?
ATP depletion
What drug can be used with PIVR?
Dexamethasone sodium phosphate, which facilitates ATP release
What are reversal drugs and what do they reverse?
Naloxone reverses opioids
Atipamazole reverses alpha 2’s
Flumazenil revers benzos
What should closed CPR be used on?
Small animals
What should open CPR be used on?
Large animals, any animal with poor pulse generation
When may sodium bicarbonate be useful?
Evidence of acidosis exists
Prolonged unsuccessful CPR
Delayed start of CPR
