CPCR

Question 1

What does CPCR stand for?

Answer 1

cardio pulmonary cerebral resuscitation

Question 2

what are we aiming to achieve wit CPCR?

Answer 2

perfusion of he lungs, heart and brain

ROSC

Question 3

what is respiratory arrest?

Answer 3

where the patient is not breathing, apnoea

patient could become hypoxic, decompensate

Question 4

what is cardiac/cardiopulmonary arrest?

Answer 4

patient has no cardiac output

patient will also not be breathing

Question 5

who is most at risk of cardiopulmonary arrest?

Answer 5

paediatrics and geriatrics

trauma

systemically unwell

iatrogenic (anaesthetic overdose)

recently arrested

Question 6

why are patients who have recently arrested at risk of it happening again?

Answer 6

cardiac failure is big insult to body - difficult to recover from

Question 7

when do we start CPCR?

Answer 7

as soon as we suspect the patient has crashed

Question 8

who can help with CPCR?

Answer 8

ideally personnel trained in CPCR, but anyone can help

Question 9

what are the main things we can do to prepare for CPCR?

Answer 9

regular CPCR training

crash kit/box/trolley well stocked and available

crash alarm/call for help

Question 10

what is involved in basic life support?

Answer 10

CPCR cycle

oxygen therapy

Question 11

what is involved in advanced life support?

Answer 11

drug therapy

fluid therapy

cardioversion

Question 12

which patient and compressor position is ideal for cardiac compressions?

Answer 12

patient in right lateral recumbency

compressor on dorsal side of patient

Question 13

what is the ideal rate for cardiac compressions?

Answer 13

100-120 per min

Question 14

what is the ideal depth for cardiac compressions?

Answer 14

1/2 - 2/3rds the width/depth of thorax

Question 15

what is important to remember when performing cardiac compressions?

Answer 15

need to allow for full elastic recoil of the chest between compressions

Question 16

which patients should we perform a cardiac pump on?

Answer 16

cats and small dogs

keel chested dogs

Question 17

which patients should we perform the thoracic pump on?

Answer 17

medium to large breed dogs

Question 18

what is the cardiac pump?

Answer 18

compression of the thorax directly over the heart

Question 19

where is the thoracic pump performed?

Answer 19

lateral - widest point of the thorax

dorsal - caudal thorax over the xiphisternum

Question 20

which patients are suitable for direct internal cardiac compressions?

Answer 20

large breed dogs

Question 21

what should direct internal cardiac compressions be performed?

Answer 21

when external compressions are not effective

Question 22

can nurses perform direct internal cardiac compressions?

Answer 22

can perform the compressions once the chest is open but cannot open the chest itself (entering body cavity)

Question 23

what is the ideal rate for ventilation during CPCR?

Answer 23

10-12 breaths per min

1 breath every 6 secs

Question 24

when should you start ventilation during CPCR?

Answer 24

as soon as you suspect respiratory arrest

Question 25

how much should we inflate the thorax during ventilation?

Answer 25

the "normal" amount for that patient - difficult to see during compressions, often less required than ventilating person thinks

Question 26

what size ventilation bad should you reach for in an emergency?

Answer 26

250ml bag will provide adequate ventilation for most patient sizes

Question 27

what equipment is useful to have in the airway access section of a crash box?

Answer 27

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

Question 28

what equipment is useful to have in the IV access section of a crash box?

Answer 28

various IV catheters IV/IO connectors, aseptically primed tape (elastoplast) scissors cut down kit scalpel blade (size 11)

Question 29

what equipment is useful to have in the ventilation section of a crash box?

Answer 29

paediatric ambu-bag with capnograph connector and flow regulator (if available) adult ambu-bag with capnograph and flow regulator in-line capnograph

Question 30

what equipment is useful to have in the drugs section of a crash box?

Answer 30

low and high dose adrenaline atropine 0.9% NaCl in pre-drawn syringes pre-prepared syringes ECG pads

Question 31

when is adrenaline given?

Answer 31

when patient is in asystole

Question 32

why is adrenaline useful?

Answer 32

it is a positive inotrope and chronotrope potent vasopressor

Question 33

what are the systemic effects of adrenaline?

Answer 33

profound vasoconstriction increases systemic vascular resistance increases mean arterial pressure

Question 34

how is adrenaline given?

Answer 34

IV, IO or intra-tracheal (double dose) NOT intra-cardiac

Question 35

when is atropine given?

Answer 35

when patient is profoundly bradycardic or showing PEA

Question 36

how does atropine have an effect?

Answer 36

positive chronotrope - increases rate at which heart contracts

Question 37

how is atropine given?

Answer 37

IV, IO or intra-tracheal NOT intra-cardiac

Question 38

what is the antagonist for opioids?

Answer 38

naloxone

Question 39

what is the antagonist for benzodiazepines?

Answer 39

flumazenil

Question 40

what is the antagonist for dexmedetomidine?

Answer 40

atipamezole

Question 41

what is amiodarone?

Answer 41

an anti-dysrhythmic

Question 42

when is amiodarone given?

Answer 42

second-line treatment for prolonged VT or Vfib

Question 43

how is amiodarone given?

Answer 43

IV (ideally central) or IO NOT intra-cardiac

Question 44

when is glucose given?

Answer 44

if patient hypoglycaemic

Question 45

how is glucose given?

Answer 45

IV (ideally central) , IO or trans-mucosally NOT intra-cardiac

Question 46

what should be considered if giving glucose IV?

Answer 46

increased risk of phlebitis

Question 47

what can be given to patients with critically low glucose during CPCR?

Answer 47

0.5ml/kg (50%) dextrose

Question 48

what is propofol?

Answer 48

phenol as lipid IV anaesthetic agent

Question 49

when is propofol given?

Answer 49

when patients are in severe respiratory distress

Question 50

how is propofol given?

Answer 50

IV (ideally central) or IO NOT intra-cardiac

Question 51

what equipment is useful to have in the thoracotomy section of a crash box (if applicable)?

Answer 51

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

Question 52

what are the desired additional equipment for CPCR?

Answer 52

capnography suction unit crash record chart ECG defib and conduction gel IO access

Question 53

what are the unnecessary additional equipment during CPCR?

Answer 53

pulse ox NIBP invasive BP

Question 54

why is capnography important in CPCR?

Answer 54

indicates perfusion, gaseous exchange and metabolism

Question 55

what ETCO2 are we aiming for during CPCR?

Answer 55

12mmHg

Question 56

why is it useful to have suction during CPCR?

Answer 56

removal of airway secretions improve larynx visualisation reduce aspiration risk

Question 57

what can ECG tell us during CPCR?

Answer 57

info on electrical impulse/conduction, complex formation and rate

Question 58

when might a defibrillator be used during CPCR?

Answer 58

when a patient is displaying ventricular fibrillation and pulseless ventricular tachycardia

Question 59

what is important to consider when using a defibrillator?

Answer 59

have fire blanket available, do not use on wet patients/patients with spirit on

Question 60

what are the location options for intraosseous access?

Answer 60

greater tubercle of the humerus trochanteric fossa of the femur flat medial surface of the proximal tibia tibial tuberosity wing of the ilium

Question 61

what is the easiest location for IO access in cats?

Answer 61

greater tubercle of the humerus

Question 62

what is the preferable location for IO access in dogs?

Answer 62

flat medial surface of the proximal tibia

Question 63

are fluids indicated in a crash situation?

Answer 63

usually unnecessary - unlikely to be in crash due to hypovolaemia unless clearly have haemoabdomen/effusion in thorax

Question 64

what should be considered in the immediate aftermath of a crash?

Answer 64

if revived, patient has potential to re-arrest try to identify and treat original condition/cause

Question 65

what should occur during the debrief period?

Answer 65

talk through what happened - what went well and what didn't suggest improvements no blame culture - be kind