CPCR Flashcards
המוח בהחייאה
If blood flow is interrupted for >10 seconds – unconsciousness. > 60 sec – fixed, dilated pupils. Clamping of descending aorta, mannnitol – may help
יש 3 קבוצות מטופלים בהחייאה
- succumb to systemic/terminal illness - consider DNR 2. serious but reversible condition - urine obstruction 3. overdoses anesthetic mishap - best prog
CPR success rates
in animals - mostly asystole
in humans - more VF/pulsless VT - better success rates: up to 50.
up to 20 for all human CPRs.
standard guidelines improve survival.
better outcome if defib+cpr, rather than just defib
in animals:
dogs: 3-6
cats: ~3
ROSC occurs in about 58% of patients during CPR
only 5% end up being discharged
IV,palpebral, decreased CPA to CPR time, and
SHORTER CPR
all associated with ROSC
perform CPR for 10-15 mins. sometimes 20
Preceding signs
Bradycardia or other cardiac arrhythmias
Hypotension
Hypothermia
Irregular respiratory pattern
Vagally-mediated activities -
vomiting or urination in a critically-ill patient.
Confirm CPA before starting a code!
Respiratory arrests carry a better prognosis and does not require chest compressions.
take 10-15 secs to auscultate
Anesthetic code
turn off vepe/narcotics
pop off valve - open
reverse drugs:
for opioids - naloxone
alpha2 - yohimbine
benzodiazepines - flumazenil
Goals pf CPR
- Optimize O2 delivery to tissues and CO2 elimination
- maximize blood flow to tissues (push hard and fast)
- maintain neuro function post CPR
***BLOOD FLOW DEPENDENT ON VESSEL DIAMETER***
Basic Life Support
A – airway
B – breathing
C – circulation
A - clean secretions, remove FB (suction/shake)
B- ALWAYS INTUBATE:
make sure tube right length
RR-10-12
Titrate to CO2 of 35-45 mmHg
TV-10-15
if chest does not rise - tube placement, pneumpthorzx, pleural effusion
do not excessivly ventilate - lowers VR CO and CO2 and lowers success rates
c- vardiac pump theory in small dogs cats greyhounds and eblldogs vs thoracic pump theory in large dogs
Chest compressions - –Rate 100-120 (both dogs and cats). staying alive
cycles of 2 minutes then rotate
minimize interruptions
lateral in most
allow recoil
1/3-1/2 depth of chest
mouth to snoute - 30:2 if alone. if not alone- parallel vent-comp
ABC vs CAB - if int delayed, start comp
ALS - drugs
- Drugs
- Defibrillation
- ECG
- Electrolytes & acid- base
- Fluids
Drugs - mostly epi. alpha and beta agonist
**EPI - EVERY OTHER CYCLE**
alpha affects blood vessels - most useful. beta-HR
high dose0.2 - tachycarida necrosis cardiomyopathy
low dose0.02 - preferred
IV best. if no IV-IT, but x5 dose
all but bicarb can go IT
central IV bet - closer to heart
Vasopressin
different mech than epi. V1 peripherla receptors
works betterin acisosis
no difference with ROSC compared to epi
may replace but still expensive
dose 0.01-0.8
for resp arrest&bradycardia - atropine
ALS -Defibrillation
Defibrillation- ex - 2-10kj. int-0.2-1kj - one shock then return to cpr
“Shockable” rhythm: VF, pulseless VT
Start with 5 J/kg and escalate by 50%
Monophasic 4-6 J/kg; Biphasic 2-4 J/kg
shock once, return to CPR
Precordial thump - strike above the heart. if no defib available
ALS - ECG
in animals - asystole most likely
VF - best chance for defib to help
PEA
ALS-Electrolites
If possible – reverse underlying cause
arrhythmias due to hyperkal. hypocal–Electrolytes
anaphylaxis–Glucocorticoids
heart failure–Furosamide
anemia–Blood products
pericardial diz–Pericardiocentesis
pleural disease–Thoracocentesis
CATHETER LOCATIO
Catheters in the cranial body, whether jugular, cephalic, or humeral IO result in efficient delivery
The volume is not statistically significan
Use of the saphenous site during CPR is not recommended.
Monitoring
- ECG, heart rate and rhythm
- Brain stem responses - palpebral.
PLR wont work cause of atropine
- Capnography - MOST IMPORTANT
BP, PULSOX - not practical during CPR
CAPNO -
Increasing ETCO2 levels – better prognosis - n> 15 mmHg. 30 - excelent
Prolonged Life Support
re-arrest likly
intesive monitoring
mechanical vent
BP support - norepi, dobutamine
