CPCR Flashcards
which patients are most at risk of arrest?
trauma
systemically unwell
paediatrics and geriatrics
iatrogenic (anaesthetic overdose)
recently arrested
what is respiratory arrest?
apnoea - where the patient is not breathing
what is cardiac arrest?
where the patient has no cardiac output
patient will also not be breathing
what does CPCR stand for?
cardiopulmonary cerebral resuscitation
what are we aiming to achieve through CPCR?
perfusion of the heart, lungs and brain
return of spontaneous circulation (ROSC)
when do we start CPCR?
as soon as we think the patient has crashed
remember respiratory arrest will quickly lead to cardiac arrest
who can help with CPCR?
anyone - ideally personnel trained in CPCR
what are the key 3 preparation steps for effective CPCR?
regular CPCR training
well-stocked crash kit/box/trolley
crash alarm (call for help!)
what is involved in basic life support?
CPCR cycle
oxygen therapy
what is involved in advance life support?
drug therapy
fluid therapy
cardioversion
should all crash trolleys/boxes be the same?
no - reflects the case load that it represents, always evolving
whose responsibility is the crash trolley/box?
one person’s primary responsibility to check stock and equipment
everyone’s responsibility to ensure stock is replaced as soon as it has been used
how often should the crash trolley/box be checked?
once a month at least - contents, expiry dates
what sections should be included in the crash trolley/box?
airway access
IV/IO access
ventilation
drugs
what could be included in the airway access section?
ET tubes (cuffed, whole sizes) and ties laryngoscope cuff inflator guide wire plain gauze swabs (slippery tongue) lidocaine (cats) dog urinary catheter with ET tube connector
what could be included in the IV/IO access section?
various IV catheters IO needle IV/IO connectors, aseptically primed superglue tape (elastoplast) scissors cut down kit scalpel blade (size 11)
what should be included in the ventilation section?
paediatric ambu-bag with capnograph connector and flow regulator
adult ambu-bag with capnograph and flow regulator
what could be included in the drugs section?
low and high dose adrenaline atropine 50% dextrose propofol naloxone drug dosing charts ECG pads 0.9% NaCl (10ml syringes)
what additional equipment could be used during CPCR?
capnography
ECG
defibrillator and conduction gel
crash record chart
why is it helpful to have capnography during CPCR?
ensures that there is perfusion, gaseous exchange and metabolism
with which animals would you use a cardiac pump?
cats and small dogs
with which animals would you use a thoracic pump?
medium-large breed dogs
in what position should cardiac compressions be performed?
ideally right lateral recumbency
compressor on dorsal side of patient
what rate should cardiac compressions be performed?
100-120 bpm
how much should the chest be compressed?
1/2 - 2/3rds the width/depth of thorax
how can you tell if cardiac compressions are adequate?
should be able to feel a femoral pulse with every compression
what is a cardiac pump?
compression of the thorax directly over the heart
what is a thoracic pump?
compression of the widest point of the thorax - caudal thorax or over xiphysternum in barrel chested dogs
when might direct inter-thoracic cardiac compressions be performed?
large breed dogs at thoracotomy
when external compressions are not effective
what rate should IPPV be given?
20 breaths/min
what is important to remember in the aftermath of arrest?
patient has potential to re-arrest at any time
must address original conditions/cause
inform/update owners
debriefing can be helpful afterwards
