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Shock and CPCR > CPCR > Flashcards

CPCR Flashcards

1
Q

Described the adminstration of chest compressions during CPR

A

High-quality chest compressions should be delivered in uninterrupted cycles of 2 minutes with most patients in lateral recumbency, at a compression rate of 100–120/min and a compression depth of 1/3–1/2 the width of the chest while allowing for full elastic recoil of the chest between individual compressions.
Source - RECOVER Ch 7

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2
Q

Decribes the administration of ventilation during CPR

A

Endotracheal intubation, 10 breaths per minute, 10ml/kg inspiratory time of 1 second. If intubation not available may be able to mouth to snout with 2 breaths every 30 compressions.

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3
Q

How often should the person doing chest compressions be swapped during CPR

A

Every cycle (2 mins) - with an attempt to avoid interruptions to compressions

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4
Q

What does basic life support include?

A

Recognition of CPA, chest compressions, airway management, provision of ventilation

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5
Q

Equipment and supply failure/inaccessibility has been implicated delayed CPR in up to what % of CPA

A

18%

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6
Q

How often is refresher training recommended

A

Every six months

Source - RECOVER Ch 7

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7
Q

From human literature is there a benefit of having a physician (vet) as the team leader?

A

No

Source - RECOVER Ch 7

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8
Q

Describe closed loop communication?

A

Closed loop communication
is accomplished by a clear, directed order being
given to one team member by another, after which the
receiving team member repeats the order back to the
requestor to verify the accuracy of the receiver’s perception.
This simple technique drastically reduces medical
errors, especially in an emergency situation, due to misunderstanding
of orders and prevents the possibility of
an order not being carried out because the receiver did
not hear the request
Source - RECOVER CH 7

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9
Q

During CPA what should theoretically be administered first?

A

Chest compressions

Source - RECOVER

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10
Q

What are the 2 main theories of how external compressions result in flow during CPR

A

Thoracic pump and cardiac pump

Source - RECOVER CH 7

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11
Q

Described the cardiac pump therory?

A

The cardiac pump theory
postulates that the cardiac ventricles are directly compressed
between the sternum and the spine in patients in dorsal recumbency or between the ribs in patients
in lateral recumbency.
Appropriate in keel chested large dogs or small dogs and cats
Source - RECOVER CH 7

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12
Q

Described thoracic pump therory?

A

The thoracic pump theory proposes
that chest compressions increase overall intrathoracic
pressure, secondarily compressing the aorta and
collapsing the vena cava leading to blood flow out of the
thorax.During elastic recoil of the chest, subatmospheric
intrathoracic pressure provides a pressure gradient that
favors the flow of blood from the periphery back into
the thorax and into the lungs where oxygen and carbon
dioxide exchange occurs.
Appropriate for barrel chested large dogs
Source - RECOVER CH 7

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13
Q 
List chest compression style and recumbancy for the following: 
Golden retriever 
English Bulldog
DSH 
Greyhound
A 
Golden - lateral, thoracic pump 
Bulldog - dorsal cardiac pump
DSH - lateral circumferntial cardiac pump 
Greyhound - lateral thoracic pump
Source - RECOVER Ch 7
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14
Q

In what recumbency should intubation occur during CPR?

A

Lateral to allow compressions to continue

Source - RECOVER Ch 7

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15
Q

What percentage of normal cardiac output is roughly achieveable to during CPR?

A

25-30%

Source - RECOVER Ch 7

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16
Q

Why is 10 breaths per min at 10ml/kg tidal volume with a insp time of 1 sec recommended?

A

Higher respiratory rates, longer inspiratory
times, and higher tidal volumes can lead to impaired
venous return due to increased mean intrathoracic pressure
as well as decreased cerebral and coronary perfusion
due to vasoconstriction, and have been documented
to lead to poorer outcomes in people during
CPR
Source - RECOVER Ch 7

17
Q

Describe mouth to snout ventilation

A

the rescuer holds the patient’s mouth
tightly closed, places his or her mouth over the patient’s
nares making a seal with the snout, and blows
into the nares.
There have been no studies investigating the optimal compression-to-ventilation (C:V) ratio during CPR in nonintubated dogs and cats and the results of studies in other species are somewhat conflicting. The preponderance of the evidence suggests C:V ratios of at least 30:2 should be maintained.
Source - RECOVER Ch 7

18
Q

How long is the intial assessment phase recommended to be when determining if a patient is in CPA?

A

5-10 seconds to avoid delay in CPR. There is little evidence that patients experience serious harm from CPR. If there
is any doubt as to whether the patient has experienced
CPA, CPR should be initiated immediately while further
assessment to support the diagnosis of CPA is accomplished
simultaneously by other personnel or after an
initial cycle (2 min) of CPR.

Source - RECOVER Ch 7

19
Q

What is advanced life support (ALS)

A

Encompasses the components of CPR performed after BLS - vasopressors, positive
inotropes, and anticholinergics, correction of electrolyte
and acid-base disturbances and volume deficits,
and prompt defibrillation.
Source - RECOVER Ch 7

20
Q

What aspect of epinephrine be harmful in CPR?

A

B agonism may increase myocardial O2 demand and exacerbate ischemia if ROSC is achieved.
Source - RECOVER Ch 7

21
Q

What dose and frequency of epi administration is recommended in CPR?

A

0.01mg/kg every 3-5 mins IV, (every other cycle)
0.1mg/kg may be administered after prolonged CPR
Source - RECOVER Ch 7

22
Q

How may vasopressin be utilised in CPR?

A

peripheral V1 receptor located on vascular
smooth muscle. This mechanism of action is completely
independent of the a1 effects of epinephrine. Unlike 1
receptors, V1 receptors remain responsive in the face
of an acidic pH, and vasopressin has no inotropic or
chronotropic effects that could worsen myocardial ischemia.
Literature divided however may be of benefit??
0.8U/kg IV every other cycle as a substitute for or administered with epi
Source - RECOVER Ch 7

23
Q

Discuss the use of atropine in CPR

A

May be considered, has not been associated with worse outcomes unless at very high doses. Most likely helpful in cases of asystole or PEA caused by high vagal tone.
Dose 0.04mg/kg IV
Source - RECOVER CH 7

24
Q

What is the goal of defibrillation?

A

Used in VF or VT
to depolarize
as many of these cells as possible, driving them into
their refractory period, and stopping the random electrical
and uncoordinated mechanical activity, that is, to
stop the ventricles from fibrillating.
Source - RECOVER Ch 7

25
Q

What are recommended shock doses for monophasic and biphasic defibrillation?

A

4–6 J/kg with a monophasic defibrillator or 2–4 J/kg with a biphasic defibrillator
Biphasic is more ideal
Source - RECOVER Ch 7

26
Q

Increasing defibrillation dose by how much after an initially unsuccessful shock is reasonable?

A

50%

Source - RECOVER CH 7

27
Q

How should defib paddles be placed?

A

should be placed on opposite sides of the thorax
approximately over the costochondral junction directly
over the heart. To facilitate this, the patient will likely
have to be placed in dorsal recumbency. The use of a
plastic trough may facilitate this. Defibrillator paste or
gel should be liberally applied to the paddles,
Source - Recover Ch 7

28
Q

What three phases does the ichemic heart pass through once perfusion stops?

A
  1. The electrical phase during which minimal ischemic damage occurs - lasts 4 mins
  2. The circulatory phase during
    which reversible ischemic damage occurs, lasting 6
    minutes;
  3. The metabolic phase during which potentially
    irreversible ischemic damage begins to occur, and
    which may necessitate more advanced techniques such
    as therapeutic hypothermia and cardiopulmonary bypass
    to reverse
    Source - RECOVER Ch 7
29
Q

When should anti-arrhythmic drug therapy be considered in CPR?

A

In cases of VF/pulseless VT that are refractory to defibrillation
Source - RECOVER Ch 7

30
Q

When should bicarbonate therapy be considered in CPR?

A

After 10-15 mins
Several experimental studies in dogs have documented
improved survival with bicarbonate therapy with prolonged (>10 min) duration of CPA.
However may worsen metabolic derangements in early CPR.
Source - RECOVER ch 7

31
Q

How should intra-tracheal drugs be administered?

A

With a catheter longer than the ETT, diluted in saline or sterile water and doses of up to 10x have been advocated.
Source - RECOVER Ch 7

32
Q

When should open-chest CPR be utilsied?

A

During cases of pericardial or pleural space disease, or in cases where external chest compressions are considered unlikely to be effective.
Source - Recover Ch 7

33
Q

Should pulse palpation be intiatied before commencing CPR?

A

No

Source RECOVER Ch 7

34
Q

What is involved in a CPA airway assessment?

A

visual inspection, opening mouth, pulling out tongue. Suction if necessary. If the patient responds this likely rules out CPA.
Source Emergency Medicine Textbook Ch 150

35
Q

During initation of chest compressions how long does it take to reach a stable BP?

A

1 minute

Source: textbook emergency medicine Ch 150

36
Q

What is often the first sign of ROSC?

A

An increasing EtCO2, often to 45-50 or above

Source - Textbook of emergency medicine

37
Q

How long is considered ‘prolonged CPR’

A

10-15mins

Source: Textbook of emergency medicine Ch 150

38
Q

What is the prognosis for CPA patients

A

overall CPA patient population (6–7%) survive to discharge

Source textbook of emergency medicine Ch 150

Shock and CPCR (5 decks)

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