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Applied Clinical Veterinary Nursing > CPCR > Flashcards

CPCR Flashcards

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1
Q

What does CPCR stand for?

A

cardio pulmonary cerebral resuscitation

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2
Q

what are we aiming to achieve wit CPCR?

A

perfusion of he lungs, heart and brain

ROSC

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3
Q

what is respiratory arrest?

A

where the patient is not breathing, apnoea

patient could become hypoxic, decompensate

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4
Q

what is cardiac/cardiopulmonary arrest?

A

patient has no cardiac output

patient will also not be breathing

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5
Q

who is most at risk of cardiopulmonary arrest?

A

paediatrics and geriatrics

trauma

systemically unwell

iatrogenic (anaesthetic overdose)

recently arrested

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6
Q

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

A

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

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7
Q

when do we start CPCR?

A

as soon as we suspect the patient has crashed

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8
Q

who can help with CPCR?

A

ideally personnel trained in CPCR, but anyone can help

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9
Q

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

A

regular CPCR training

crash kit/box/trolley well stocked and available

crash alarm/call for help

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10
Q

what is involved in basic life support?

A

CPCR cycle

oxygen therapy

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11
Q

what is involved in advanced life support?

A

drug therapy

fluid therapy

cardioversion

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12
Q

which patient and compressor position is ideal for cardiac compressions?

A

patient in right lateral recumbency

compressor on dorsal side of patient

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13
Q

what is the ideal rate for cardiac compressions?

A

100-120 per min

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14
Q

what is the ideal depth for cardiac compressions?

A

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

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15
Q

what is important to remember when performing cardiac compressions?

A

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

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16
Q

which patients should we perform a cardiac pump on?

A

cats and small dogs

keel chested dogs

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17
Q

which patients should we perform the thoracic pump on?

A

medium to large breed dogs

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18
Q

what is the cardiac pump?

A

compression of the thorax directly over the heart

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19
Q

where is the thoracic pump performed?

A

lateral - widest point of the thorax

dorsal - caudal thorax over the xiphisternum

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20
Q

which patients are suitable for direct internal cardiac compressions?

A

large breed dogs

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21
Q

what should direct internal cardiac compressions be performed?

A

when external compressions are not effective

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22
Q

can nurses perform direct internal cardiac compressions?

A

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

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23
Q

what is the ideal rate for ventilation during CPCR?

A

10-12 breaths per min

1 breath every 6 secs

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24
Q

when should you start ventilation during CPCR?

A

as soon as you suspect respiratory arrest

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25
Q

how much should we inflate the thorax during ventilation?

A

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

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26
Q

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

A

250ml bag will provide adequate ventilation for most patient sizes

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27
Q

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

A

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

28
Q

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

A

various IV catheters

IV/IO connectors, aseptically primed

tape (elastoplast)

scissors

cut down kit

scalpel blade (size 11)

29
Q

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

A

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

adult ambu-bag with capnograph and flow regulator

in-line capnograph

30
Q

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

A

low and high dose adrenaline

atropine

0.9% NaCl in pre-drawn syringes

pre-prepared syringes

ECG pads

31
Q

when is adrenaline given?

A

when patient is in asystole

32
Q

why is adrenaline useful?

A

it is a positive inotrope and chronotrope

potent vasopressor

33
Q

what are the systemic effects of adrenaline?

A

profound vasoconstriction

increases systemic vascular resistance

increases mean arterial pressure

34
Q

how is adrenaline given?

A

IV, IO or intra-tracheal (double dose)

NOT intra-cardiac

35
Q

when is atropine given?

A

when patient is profoundly bradycardic or showing PEA

36
Q

how does atropine have an effect?

A

positive chronotrope - increases rate at which heart contracts

37
Q

how is atropine given?

A

IV, IO or intra-tracheal

NOT intra-cardiac

38
Q

what is the antagonist for opioids?

A

naloxone

39
Q

what is the antagonist for benzodiazepines?

A

flumazenil

40
Q

what is the antagonist for dexmedetomidine?

A

atipamezole

41
Q

what is amiodarone?

A

an anti-dysrhythmic

42
Q

when is amiodarone given?

A

second-line treatment for prolonged VT or Vfib

43
Q

how is amiodarone given?

A

IV (ideally central) or IO

NOT intra-cardiac

44
Q

when is glucose given?

A

if patient hypoglycaemic

45
Q

how is glucose given?

A

IV (ideally central) , IO or trans-mucosally

NOT intra-cardiac

46
Q

what should be considered if giving glucose IV?

A

increased risk of phlebitis

47
Q

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

A

0.5ml/kg (50%) dextrose

48
Q

what is propofol?

A

phenol as lipid IV anaesthetic agent

49
Q

when is propofol given?

A

when patients are in severe respiratory distress

50
Q

how is propofol given?

A

IV (ideally central) or IO

NOT intra-cardiac

51
Q

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

A

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

52
Q

what are the desired additional equipment for CPCR?

A

capnography

suction unit

crash record chart

ECG

defib and conduction gel

IO access

53
Q

what are the unnecessary additional equipment during CPCR?

A

pulse ox

NIBP

invasive BP

54
Q

why is capnography important in CPCR?

A

indicates perfusion, gaseous exchange and metabolism

55
Q

what ETCO2 are we aiming for during CPCR?

A

12mmHg

56
Q

why is it useful to have suction during CPCR?

A

removal of airway secretions

improve larynx visualisation

reduce aspiration risk

57
Q

what can ECG tell us during CPCR?

A

info on electrical impulse/conduction, complex formation and rate

58
Q

when might a defibrillator be used during CPCR?

A

when a patient is displaying ventricular fibrillation and pulseless ventricular tachycardia

59
Q

what is important to consider when using a defibrillator?

A

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

60
Q

what are the location options for intraosseous access?

A

greater tubercle of the humerus

trochanteric fossa of the femur

flat medial surface of the proximal tibia

tibial tuberosity

wing of the ilium

61
Q

what is the easiest location for IO access in cats?

A

greater tubercle of the humerus

62
Q

what is the preferable location for IO access in dogs?

A

flat medial surface of the proximal tibia

63
Q

are fluids indicated in a crash situation?

A

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

64
Q

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

A

if revived, patient has potential to re-arrest

try to identify and treat original condition/cause

65
Q

what should occur during the debrief period?

A

talk through what happened - what went well and what didn’t

suggest improvements

no blame culture - be kind

66
Q
A

Applied Clinical Veterinary Nursing (31 decks)

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