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Module 14 > Cardiopulmonary Resuscitation > Flashcards

Cardiopulmonary Resuscitation Flashcards

1
Q

what is cardiopulmonary arrest

A

the sudden cessation of functional ventilation and effective circulation

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2
Q

what are signs of arrest (10)

A
  1. no heart sounds
  2. ECG shows asystole or arrhythmia
  3. no palpable pulse
  4. apnea or jerky, gasping breathing
  5. blood looks thick, dark and is not freely
  6. mucous membrane colour
  7. prolonged CRT
  8. no cranial nerve relfexes
  9. eye central with a dilated pupil
  10. dry cornea
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3
Q

what are causes of arrest (9)

A
  1. myocardial hypoxia
  2. toxins: includes anethetics
  3. pH extremes
  4. electrolyte imbalances (potassium)
  5. temperature extremes
  6. hypoxmia/hypercapnia
  7. pre-existing cardiac disease
  8. acute hypotension
  9. vagal reflexes (traction on extra-ocular muscles, during enucleation)
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4
Q

what is ABCDEF

A

A = airway

B = breathing

C = circulation

D = drugs

E = electrical defibrillation/ECG

F = follow-up

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5
Q

what are the steps in assessing airway

A

check for physical obstruction

ET intubation (use narrow catheter or tracheostomy)

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6
Q

what is done during breathing resuscitation

A

IPPV with preferably 100% O2 at approx 10 breaths per minute

watch chest rise and allow adequate time for deflation

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7
Q

what is done to assess circulation

A
  1. check pulses/heart sounds ASAP
  2. monitor these continuously
  3. maintain continuous compressions
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8
Q

what chest compressions are done on small dogs and narrow chested breeds

A

cardiac pump in right lateral recumbency

compress 3rd-6th intercostal space

100-120 bpm

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9
Q

what compressions are done on cats and tiny dogs

A

cardiac pump

finger and thumb across heart

compress at 100-120 bpm

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10
Q

what compressions are done on large, barrel chested breeds

A

thoracic pump

compress over highest point of thorax

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11
Q

what is the difference between cardiac pump and thoracic pump

A

cardiac: indirect compression of heart
thoracic: chest compression increase intrathoracic pressure –> increases pressure on outside of heart, lungs and great vessles –> blood to flow forward in arteries and backwards in veins (minimized by venous valves/collapse)

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12
Q

what categories can be used to decide compression technique

A
  1. cats/dog under 15 kg
  2. dogs over 15kg except sighthound type build
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13
Q

what things ensure successful external compressions (5)

A
  1. rate of 100-120 bpm
  2. table position
  3. compress approx 1/3 of thorax
  4. allow adequate time to refill
  5. change staff freq.
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14
Q

how are internal cardiac compressions done (6)

A
  1. rapid clip (3-6 IC spaces)
  2. in expiration, incise 5th interspace
  3. locate by using olecranon to point
  4. open pleura and pericardium
  5. milk ventricles into arteries
  6. continue ventilation
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15
Q

when is ICC preferred

A
  1. if thorax is already open
  2. large dogs (ECC less likely to be effective)
  3. disease process mean ECC unlikely to be effective (rib fractures, pleural effusion, diaphragmatic rupture)
  4. if ECC ineffective
  5. may be suitable to enter via diaphragm
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16
Q

what needs to be done to ensure circulation is corrected

A

rapid IV fluids

but rapid fluids not suitable for all cases

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17
Q

what route of drugs is best for successful resuscitaiton and why

A
  1. central/jugular injection

peripheral injection may not reach heart (flush saline after)

18
Q

what other routes can be used for drugs

A
  1. intracardiac if done properly (risk of myocardial damage, avoid unless open thorax)
  2. transtracheal: need high doses (min 2x of atropine or adrenaline)
  3. intraosseous: exotics
19
Q

when would adrenaline be used

A
  1. asystole
  2. to coarsen “fine” VF
  3. increase ionotropy
  4. increase systemic vascular resistance
20
Q

what is the dose of adrenaline used

A

0.01 mg/kg IV (high dose of 0.1 has been used esp after prolonged CPR)

21
Q

what is atropine used for

A
  1. atrioventricular block
  2. asystole which has been preceded by bradycardia (vagus mediated)
22
Q

what is the dose of atropine

A

0.04 mg/kg IV

23
Q

what is lidocaine used for

A

ventricular arrhythmias

24
Q

what is the dose of lidocaine used

A

2-4 mg/kg (as a bolus) or 25-75 microgram/kg/min infusion

25
Q

what is ECG used for

A

determine arrest rhythm

26
Q

what are the types of arrest rhythms (4)

A
  1. asystole
  2. ventricular fibrillation
  3. ventricular tachycardia
  4. pulseless electrical activity
27
Q

what arrest rhythm is this

A

asystole

28
Q

what arrest rhythm is this

A

ventricular fibrillation

29
Q

what arrest rhythm is this

A

coarse ventricular fibrillation

30
Q

what arrest rhythm is this

A

fine ventricular fibrillation

31
Q

what arrest rhythm is this

A

pulseless electrical activity

electromechanical dissociation

slightly wider complexes

32
Q

what arrest rhythm is this

A

pulseless ventricular tachycardia

33
Q

what arrest rhythm is this

A

ventricular tachycardia

no cardiac output

34
Q

what rhythms is electrical defibrilation not effective for

A

less likely to be effective in asystole or PEA

35
Q

what are the steps to electrical defibrillation

A
  1. charge
  2. apply conducting gel to paddles and dog
  3. current applied across heart
  4. stand clear
  5. 1-5 joules/kg external
  6. 0.1-0.5 joules/kg if using internal paddles

if monphasic upper end of range, biphasic lower end of range

36
Q

what needs to be done in follow up (5)

A
  1. fluids
  2. ensure renal perfusion (urine production)
  3. warmth (caution)
  4. analgesics
  5. may need other drugs to support (dopamine)
37
Q

what are signs of effective CPR (5)

A
  1. palpable pulse during cardiac compression
  2. retinal blood flow (as detected by using a doppler probe on the cornea)
  3. carbon dioxide detectable on capnography (gold standard)
  4. improvement in colour of mucous membranes
  5. ECG changes (normal rhythm)
38
Q

what are signs of CPR recovery (5)

A
  1. lacrimation
  2. pupillary constriction
  3. return of cranial nerve reflexes
  4. return of other neurological function (response to sound, righting reflexes)
  5. return of spontaneous ventilation
39
Q

when should you give up CPR

A

why did animal arrest in the first place

are we able to correct the reason for arrest

are there disease processes which we cant correct

15-20 mins is adequate to start seeing a response in most animals that are going to respond

40
Q

what equipment is needed

A

crash cart handy

stocked and checked frequently

41
Q

what are the actions during an arrest

A
  1. directing situation, making decisions, assessing patient
  2. compressions
  3. ventilation
  4. drawing up drugs, attaching ECG, keeping records

ideally 3-4 people

CAB?

42
Q

recite the CPR algorithm

A

Module 14 (29 decks)

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