Cardiopulmonary Resuscitation

Question 1

what is cardiopulmonary arrest (CPA)

Answer 1

sudden cessation of spontaneous and effective ventilation and circulation lack of systemic perfusion

Question 2

what are some examples of CPA

Answer 2

hypovolemia, metabolic derrangemnt, electrolyte abnormalities, cardiac dx, brain injury, drug overdose, pulmonary dx, anemia

Question 3

what is the goal of cardiopulmonary resuscitation

Answer 3

the return of spontaneous circulation

Question 4

what things may you need in a resuscitation area

Answer 4

crash cart, venous access, airway management, drug therapy, doppler, oxygen, EKG, defibrillator

Question 5

what drugs may in used for drug therapy with this

Answer 5

Epinephrine, atropine, diazepam, lidocaine, reversal agent

Question 6

if airway is obscured what do we do

Answer 6

use a suction device

Question 7

how can we verify airway intubation

Answer 7

proper chest movement, direct visualization, palpation, ETCO2

Question 8

what patients cannot be intubated orotracheally

Answer 8

foreign bodies, pharyngeal swelling/mass, trauma, dental fixation

Question 9

what we do use to ventilate a patient with

Answer 9

100% oxygen

Question 10

what is the goal of cardiac compression

Answer 10

to pump blood to the lungs for as exchange -> systemic arterial blood flow, or to maximize blood flow to the coronary and cerebral vascular beds

Question 11

what are the 2 theories of chest compression

Answer 11

thoracic pump, and cardiac pump

Question 12

when do we use the thoracic pump

Answer 12

larger patients - over 10 kg

Question 13

when do we use the cardiac pump

Answer 13

smaller patients, keel-chested dogs, flat chested dogs

Question 14

what is the thoracic pump theory for circulation

Answer 14

overall increase in intrathoracic pressure

• promotes blood flow from the aorta into the systemic circulation
• blood is suctioned into the vena cava during recoil phase

Question 15

what is the thoracic pump theory for chest compression

Answer 15

the heart acts a channel (blood flows passively through the heart)
-use the widest portion of the thorax

Question 16

what is the cardiac pump theory for chest compression

Answer 16

direct compression of the heart, lateral recumbency, directly over the heart

Question 17

what is interposed abdominal compression (3rd way/ 2ppl)

Answer 17

abdomen is compressed during relaxation phase of chest compression, increased effectiveness venous return and forward flow

Question 18

when do we not use interposed abdominal compressison

Answer 18

known abdominal trauma, hemoperitoneum, recent abd sx

Question 19

what are the current recommendations for chest compressions

Answer 19

lateral recumbency, 100-120 bpm, 1/3 to 1/2 chest diameter, 2 min cycle

Question 20

what is internal compression direct internal cardiac compression

Answer 20

greater CO + BP, better perfusion, direct assess to ventricles, aortic inclusion

Question 21

when might we do a direct interal cardiac compresion

Answer 21

very large dog, rib fractures, severe plerual effusion, pneumothorax, cardiac tamponade, when ROSC is not achieved in approx 5 min.

Question 22

what should we do for BLS

Answer 22

ABC assessment (don't do if patient is apneic) -> CPR
Chest compression, intubate and ventilate full 2 min cycle without interruptions. Connect EKG and Capnograph

Question 23

what fluids do we use

Answer 23

crystal/colloid fluid therapy

Question 24

what is a intracardiac injection not recommended

Answer 24

risk of lacerating lung tissues, coronary vasculature, arrhymias

Question 25

what should we know about atropine

Answer 25

vagolytic, vagal arrests, V/D, urinating/ defecating, laryngeal manipulation

Question 26

what should we know about epinephine

Answer 26

vasoconstriction
ino/chronotropic
low dose every other compression cycle
high dose with prolonged CPR >10 min
may become ineffective in an acidic environment

Question 27

what should we know about Lidocaine and Amiodarone

Answer 27

antiarrhythmic, (Amiodarone - do not use to IT admin), indicated for prolonged CPR, reversal agents

Question 28

what is electrical defibrillation

Answer 28

application of an electrical shock to terminate a cardiac arrhythmia, global depolarization of myocadium

Question 29

what is monophasic defibrillation

Answer 29

current is delievered in one direction between paddles

Question 30

what is biphasic defibrillation

Answer 30

positive currect followed by a negative currect, lower energy setting -> more efficient and les myocardial damage

Question 31

what is the setting for monophasic defibrillator

Answer 31

4-6J/kg with monophasic defibrillator

Question 32

what is the setting for biphasic defibrillator

Answer 32

2-4J/kg with biphasic defibrillator

Question 33

what should we do after each attempt with electrical defibrillation

Answer 33

increase energy by 50% with each attempt, up to 10 J/kg

Question 34

what is mechanical defibrillation

Answer 34

precordial thump, generate approx 5- 10 J of energy