Cardiopulmonary Arrest and Resuscitation

Question 1

What is cardiopulmonary arrest?

Answer 1

Cessation of function ventilation and circulation

Question 2

What is cardiopulmonary cerebral resusucitation (CPR/CPCR)?

Answer 2

Restoration of ventilation, circulation, and CNS activity

Question 3

What are poor CPCR candidates?

Answer 3

Terminal disease
Irreversible organ failure
>15 minutes since arrest
Massive trauma

Question 4

What is the percentage of those that return to spontaneous circulation in dogs?

Answer 4

13%

Question 5

What is the rate of hospital discharge in dogs?

Answer 5

4%

Question 6

What is the percentage of those that return to spontaneous circulation in cats?

Answer 6

15%

Question 7

What is the rate of hospital discharge in cats?

Answer 7

10%

Question 8

How can you prepare for CPR readiness?

Answer 8

Designated area
Equipment
Training and practice

Question 9

What is the team approach to CPR?

Answer 9

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

Question 10

What are common causes of arrest?

Answer 10

Excessive anesthetic depth
Fluid, electrolyte, acid-base distrubances
Excessive vagal tone
Cellular hypoxia

Question 11

What are signs of impending arrest?

Answer 11

Wear or irregular pulse
Cyanosis
Prolonged CRT
ECG changes
Respiratory dysfunction
Loss of bodily control
CNS alterations

Question 12

What are the 5 H’s for recognition and intervention of patient at risk?

Answer 12

Hypovolemia or hemorrhage
Hypoxia or hypoventilation
Hydrogen ions (acidosis/alkalosis)
Hyperkalemia
Hypokalemia

Question 13

What are the 5 T’s for recognition and intervention of patient at risk?

Answer 13

Toxins
Tension pneumothorax
Thromboembolism
Tamponade
Trauma

Question 14

What are signs of actual arrest?

Answer 14

Loos of consciousness
Apnea, gasping
No pulse or heart sounds
Dilated pupils
Lack of bleeding

Question 15

What is basic cardiac life support (BCLS)?

Answer 15

ABC: airway breathing, circulation
Early recognition, rapid initiation, reinstate oxygenated blood flow
Initiate before starting advanced life support measures

Question 16

What should be done to the airway for BCLS?

Answer 16

Open airway
Assess breathing
Establish patent airway

Question 17

What should be done for breathing in BCLS?

Answer 17

Begin ventilation with 100% O2 if available
Initially give 2 breaths
Ventilation: 10 breaths/min

Question 18

What is done for circulation in BCLS?

Answer 18

Give a quick precordial thumo
Chest compressions should begin immediately if the animal is pulseless
Push hard, push fast

Question 19

How should CPR be done with small dogs and cats?

Answer 19

Right lateral recumbency
Compress over left 5-6 ICS
100-120 compressions/minute
Force- decrease thorax 30%

Question 20

How should CPR be done with large dogs?

Answer 20

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%

Question 21

What indicates compression success?

Answer 21

ETCO2 > 15 mmHg
Doppler over cornea to detect blood flow
Pulse oximeter- wave form

Question 22

What are the mechanisms of blood flow during CPR?

Answer 22

Cardiac pump; direct compression of heart; effective in small animals
Thoracic pump: compression of entire thorax; large dogs

Question 23

How can you improve blood flow?

Answer 23

Time inspirations to coincide with compressions
Bind abdomen or pelvis
Interpose abdominal compressions with thoracic compressions

Question 24

What is used if BCLS measures fail?

Answer 24

Advanced cardiac life support

Question 25

What is ACLS?

Answer 25

Use of equipment and drugs to air in CPR

Question 26

What are the drugs used in ACLS?

Answer 26

``` Epinephrine Atropine Lidocaine Naloxone Vasopressin ```

Question 27

What are routes for drugs in ACLS and are the excellent, good, or dangerous?

Answer 27

``` IV central- excellent IV peripheral- good Intratracheal- good Intraosseous- good Intracardiac- dangerous ```

Question 28

Where can you place a catheter for fluids?

Answer 28

IV access- large bore jugular or cephalic catheter | Intraosseous is a good alternative

Question 29

At what rate should fluid be given?

Answer 29

Rapid rate if hypovolemia is present; careful administration otherwise

Question 30

What fluids are used?

Answer 30

Type of arrest determines fluid therapy, but typically crsytalloid or colloid

Question 31

What is ventricular asystole?

Answer 31

Flat line- no electrical activity or only p waves

Question 32

What is the drug of choice for ventricular asystole?

Answer 32

Epinephrine

Question 33

What does epinephrine cause?

Answer 33

Alpha adrenergic agonist: vasoconstriction | Beta adrenergic agonist: cardiac contractility

Question 34

What does vasopressin produce?

Answer 34

Peripheral vasoconstriction | Increases preload

Question 35

What does vasopressin work on?

Answer 35

Specific V1 receptors

Question 36

What is ventricular fibrillation?

Answer 36

Chaotic ventricular causing heart to look like bag or writhing worms

Question 37

What is used in ventricular fibrillation?

Answer 37

``` Electrical defibrillation Start low and increase Cardiac compressions before defibrillation Never use alcohol Epinephrine ```

Question 38

What is used in chemic defibrillation?

Answer 38

Acetylcholine and potassium chloride

Question 39

What is pulseless electical activity (PEA)/electromechanical dissociation (EMD)?

Answer 39

Near normal ECG complex | No mechanical activity (pulseless)

Question 40

What is used in PEA/EMD?

Answer 40

Epinephrine as it may produce mechanical activity

Question 41

What is pulseless idioventricular rhythm (PIVR)?

Answer 41

Wide bizarre ventricular activity; pulseless

Question 42

What causes PIVR?

Answer 42

ATP depletion

Question 43

What drug can be used with PIVR?

Answer 43

Dexamethasone sodium phosphate, which facilitates ATP release

Question 44

What are reversal drugs and what do they reverse?

Answer 44

Naloxone reverses opioids Atipamazole reverses alpha 2's Flumazenil revers benzos

Question 45

What should closed CPR be used on?

Answer 45

Small animals

Question 46

What should open CPR be used on?

Answer 46

Large animals, any animal with poor pulse generation

Question 47

When may sodium bicarbonate be useful?

Answer 47

Evidence of acidosis exists Prolonged unsuccessful CPR Delayed start of CPR