CPCR Flashcards
What does CPCR stand for?
cardio pulmonary cerebral resuscitation
what are we aiming to achieve wit CPCR?
perfusion of he lungs, heart and brain
ROSC
what is respiratory arrest?
where the patient is not breathing, apnoea
patient could become hypoxic, decompensate
what is cardiac/cardiopulmonary arrest?
patient has no cardiac output
patient will also not be breathing
who is most at risk of cardiopulmonary arrest?
paediatrics and geriatrics
trauma
systemically unwell
iatrogenic (anaesthetic overdose)
recently arrested
why are patients who have recently arrested at risk of it happening again?
cardiac failure is big insult to body - difficult to recover from
when do we start CPCR?
as soon as we suspect the patient has crashed
who can help with CPCR?
ideally personnel trained in CPCR, but anyone can help
what are the main things we can do to prepare for CPCR?
regular CPCR training
crash kit/box/trolley well stocked and available
crash alarm/call for help
what is involved in basic life support?
CPCR cycle
oxygen therapy
what is involved in advanced life support?
drug therapy
fluid therapy
cardioversion
which patient and compressor position is ideal for cardiac compressions?
patient in right lateral recumbency
compressor on dorsal side of patient
what is the ideal rate for cardiac compressions?
100-120 per min
what is the ideal depth for cardiac compressions?
1/2 - 2/3rds the width/depth of thorax
what is important to remember when performing cardiac compressions?
need to allow for full elastic recoil of the chest between compressions
which patients should we perform a cardiac pump on?
cats and small dogs
keel chested dogs
which patients should we perform the thoracic pump on?
medium to large breed dogs
what is the cardiac pump?
compression of the thorax directly over the heart
where is the thoracic pump performed?
lateral - widest point of the thorax
dorsal - caudal thorax over the xiphisternum
which patients are suitable for direct internal cardiac compressions?
large breed dogs
what should direct internal cardiac compressions be performed?
when external compressions are not effective
can nurses perform direct internal cardiac compressions?
can perform the compressions once the chest is open but cannot open the chest itself (entering body cavity)
what is the ideal rate for ventilation during CPCR?
10-12 breaths per min
1 breath every 6 secs
when should you start ventilation during CPCR?
as soon as you suspect respiratory arrest
how much should we inflate the thorax during ventilation?
the “normal” amount for that patient - difficult to see during compressions, often less required than ventilating person thinks
what size ventilation bad should you reach for in an emergency?
250ml bag will provide adequate ventilation for most patient sizes
what equipment is useful to have in the airway access section of a crash box?
cuffed ET tubes, whole sizes
laryngoscope
ET tube ties
cuff inflator
guide wire
plain gauze swabs
intubeaze
dog ucath with size 3 ET tube connector
what equipment is useful to have in the IV access section of a crash box?
various IV catheters
IV/IO connectors, aseptically primed
tape (elastoplast)
scissors
cut down kit
scalpel blade (size 11)
what equipment is useful to have in the ventilation section of a crash box?
paediatric ambu-bag with capnograph connector and flow regulator (if available)
adult ambu-bag with capnograph and flow regulator
in-line capnograph
what equipment is useful to have in the drugs section of a crash box?
low and high dose adrenaline
atropine
0.9% NaCl in pre-drawn syringes
pre-prepared syringes
ECG pads
when is adrenaline given?
when patient is in asystole
why is adrenaline useful?
it is a positive inotrope and chronotrope
potent vasopressor
what are the systemic effects of adrenaline?
profound vasoconstriction
increases systemic vascular resistance
increases mean arterial pressure
how is adrenaline given?
IV, IO or intra-tracheal (double dose)
NOT intra-cardiac
when is atropine given?
when patient is profoundly bradycardic or showing PEA
how does atropine have an effect?
positive chronotrope - increases rate at which heart contracts
how is atropine given?
IV, IO or intra-tracheal
NOT intra-cardiac
what is the antagonist for opioids?
naloxone
what is the antagonist for benzodiazepines?
flumazenil
what is the antagonist for dexmedetomidine?
atipamezole
what is amiodarone?
an anti-dysrhythmic
when is amiodarone given?
second-line treatment for prolonged VT or Vfib
how is amiodarone given?
IV (ideally central) or IO
NOT intra-cardiac
when is glucose given?
if patient hypoglycaemic
how is glucose given?
IV (ideally central) , IO or trans-mucosally
NOT intra-cardiac
what should be considered if giving glucose IV?
increased risk of phlebitis
what can be given to patients with critically low glucose during CPCR?
0.5ml/kg (50%) dextrose
what is propofol?
phenol as lipid IV anaesthetic agent
when is propofol given?
when patients are in severe respiratory distress
how is propofol given?
IV (ideally central) or IO
NOT intra-cardiac
what equipment is useful to have in the thoracotomy section of a crash box (if applicable)?
long-sleeved surgical gown, surgical gloves 6.6/7.5, surgical drape, chloraprep (large and small)
thoracotomy kit and scalpel blade
small and lap swabs
small and large rib retractors
internal defib paddles
small bag saline
what are the desired additional equipment for CPCR?
capnography
suction unit
crash record chart
ECG
defib and conduction gel
IO access
what are the unnecessary additional equipment during CPCR?
pulse ox
NIBP
invasive BP
why is capnography important in CPCR?
indicates perfusion, gaseous exchange and metabolism
what ETCO2 are we aiming for during CPCR?
12mmHg
why is it useful to have suction during CPCR?
removal of airway secretions
improve larynx visualisation
reduce aspiration risk
what can ECG tell us during CPCR?
info on electrical impulse/conduction, complex formation and rate
when might a defibrillator be used during CPCR?
when a patient is displaying ventricular fibrillation and pulseless ventricular tachycardia
what is important to consider when using a defibrillator?
have fire blanket available, do not use on wet patients/patients with spirit on
what are the location options for intraosseous access?
greater tubercle of the humerus
trochanteric fossa of the femur
flat medial surface of the proximal tibia
tibial tuberosity
wing of the ilium
what is the easiest location for IO access in cats?
greater tubercle of the humerus
what is the preferable location for IO access in dogs?
flat medial surface of the proximal tibia
are fluids indicated in a crash situation?
usually unnecessary - unlikely to be in crash due to hypovolaemia unless clearly have haemoabdomen/effusion in thorax
what should be considered in the immediate aftermath of a crash?
if revived, patient has potential to re-arrest
try to identify and treat original condition/cause
what should occur during the debrief period?
talk through what happened - what went well and what didn’t
suggest improvements
no blame culture - be kind
