CPCR Flashcards
what patients are most at risk of cardiac arrest?
trauma systemically unwell paediatrics geriatrics iatrognic recently arrested
what is one of the main iatrogenic causes of cardio-pulmonary arrest?
anaesthetic overdose
what is respiratory arrest?
the patient is not breathing, apnoea
what is cardiac arrest / cardio-pulmonary arrest?
patient has no cardiac output
no functional heart beat
patient will also not be breathing
what does CPCR stand for?
cardio pulmonary cerebral rescusitation
what is the aim of CPCR?
perfusion of heart, lungs and brain
return of spontaneous circulation (ROSC)
what is the goal of CPCR?
ROSC
when should CPCR be started?
as soon as we think the patient has crashed
what will lead to cardiac arrest?
respiratory arrest
what should be assumed about the apnoeic patient?
they are likely to arrest
who can help with CPCR?
anyone
ideally those trained in CPCR
what is key for successful outcomes of arrest?
preparation
what are the 3 main areas of preparation for arrest?
regular CPCR training
crash kit/box/trolley
crash alarm (or just call for help)
what are the 2 main elements of CPCR?
BLS
ALS
what is the key area of CPCR?
BLS - without this ALS will not succeed
what are the key areas of BLS?
CPCR cycle
oxygen therapy
what is involved in ALS?
drug therapy
fluid therapy
cardioversion
what should the crash trolley reflect?
case load - if mostly large dogs seen then equipment should be tailored to them. Same for if mostly rabbits etc
does the ICU crash trolley remain the same?
no - always evolving depending on what works/doesn’t and any new suggestions
who is responsible for the crash trolley?
one person primarily responsible and will check stock and equipment monthly
restocked by those who have used it straight after crash in case of re-arrest
what must be checked monthly in the crash trolley?
if everything is in date
all equipment works
what should be kept in the airway access draw of the crash trolley?
ET tubes, cuffed, whole sizes laryngoscope and blades ET tube tie cuff inflator guide wire plain gauze swabs intubeaze (lidocaine) 8FG dog urinary catheters with ET tube connector attached
why is a dog urinary catheter needed for a crash trolley?
helps intubate a difficult airway
can give intratracheal drugs if IV access difficult
what equipment is needed in a crash trolley for IV and IO access?
various IV catheters IO needle IV and IO connectors which have been aseptically prepped (flushed) superglue (attachment of IV if in awkward location) tape scissors cut down kit size 11 scalpel blade
what is needed in a cut down kit?
scalpel handle and swabs
what equipment is needed in a crash trolley for ventilation?
pediatric ambu-bag with capnograph connector and flow regulator
adult ambu-bag with capnograph connector and flow regulator
what drugs are needed in the crash trolley?
low dose adrenaline (0.1 mg/ml) high dose adrenaline (1mg/ml) atropine (0.6mg/ml) 50% dextrose propofol naloxone drug dose charts ECG pads 0.9% NaCl drawn up in 10ml syringes for flush
what is the role of naloxone?
opioid antagonist
what equipment may be useful in a crash situation?
capnography
crash record chart
ECG
defibrillator and conduction gel
less crucial:
pulse ox
non-invasive or invasive BP
what can be provided by capnography?
visual graph of ventilation
EtCO2 reading
why is capnography important during CPR?
if there is an EtCO2 reading then we know we have perfusion, gaseous exchange and metabolism is occurring
this means CPR is effective
what should be recorded on a crash chart?
clear record of what has happened with timings of doses etc to show when next needed
is recording everything during a crash situation always practical?
no - there may not be enough people and providing the CPR is more important
information can be added retrospectively
what information can be gained from an ECG?
electrical impulse or conduction
ECG complexes / formation (is defibrillation needed or useful)
ECG rate
indication of drug therapy needed
what does ECG not give information about?
perfusion
what organs are we trying to perfuse during CPR?
heart
lungs
brain
what animals are cardiac pump compressions performed on?
cats and small dogs
what animals are thoracic pump compressions performed on?
medium to large breed dogs
what position should patients be in for cardiac compressions?
right lateral recumbancy ideally although don’t necessarily need to turn if compressions are effective
why is right lateral recumbancy best for chest compressions?
apex of the heart is upper most in this position and so there can be greater compression of the ventricles
what is the required compression rate for patients?
100-120 bpm (stayin’ alive)
how much of the chest should be compressed during cardiac compressions?
half to 2/3 of the width/depth of the thorax
what can be used to indicate that cardiac compressions are deep/effective enough?
femoral pulse should be felt with every beat
what should you allow for between each compression of the chest?
full elastic recoil of chest
what happens during cardiac pump compressions?
compression of thorax directly over the heart either by using one or both hands wrapped around the chest in small animals (e.g. cats) or 2 hands directly over apex of the heart in slightly larger animals
what happens during thoracic pump compressions?
compression of the widest part of the thorax (will vary between individuals)
what are of the thorax can compressions occur at during thoracic pump compressions?
caudal thorax
xiphysternum
what patients may have compressions performed in dorsal recumbancy?
barrel chested breeds
what is the downside of thoracic pump compressions in dorsal recumbancy?
patient is very difficult to intubate
what is the other type of cardiac compression?
direct inter-thoracic cardiac compressions
in what animals are direct inter-thoracic cardiac compressions performed?
large breed dogs
if thoracotomy has already been performed
if external compressions have not been effective
are vet nurses allowed to perform direct compressions?
yes
how may IPPV be performed?
breathing system or ambu bag
what is the rate of IPPV required during CPCR?
10 bpm or one every 6 seconds
when should ventilation commence?
as soon as you suspect respiratory arrest
how much should the thorax be inflated?
normal amount of the patient - always do less than you think
what should patients be ventilated on?
100% O2 if possible but room air is fine if not
what must you be aware of about the patient following arrest and successful treatment?
they have the potential to re-arrest
what must be treated once patient arrest has been managed?
original condition or cause
who should you communicate with following an arrest?
owners
personnel involved as the situation is stressful and upsetting
when should a debrief take place after a crash?
once patient is stable and trolley is restocked
