CPCR Flashcards
What does CPCR stand for? What is it?
Cardiopulmonary Cerebral Resuscitation
Attempt to restore spontaneous circulation in a patient with CPA
What is CPA?
Cardiopulmonary Arrest
Sudden cessation of spontaneous and effective respiration/ventilation and heartbeat/circulation
Signs of impending arrest
Severe dyspnea Hypoxemia Severe hypotension Weak pulses Bradycardia Tachycardia
Signs of CPA
Apnea/agonal breathing
Absence of heart beat and palpable pulse
Fixed dilated pupils
Lack of bleeding from Sx site
Causes of CPA
Usually systemic illness (MODs)
Arrhythmias Acid/Base/electrolyte abnormalities Hemorrhage/hypovolemia Neoplasia Sepsis Myocardial ischemia/failure Trauma (polytrauma)
Cardiac Arrest Arrhythmias
Asystole (heart standstill, nothing contracting)
Pulseless Electrical Activity (PEA)
Pulseless ventricular tachycardia
Ventricular fibrillation
Causes of Asystole
Increased vagal tone
GI tract or thoracic cavity issue
Brachycephalic dogs
Severe ophthalmic disease
Neurologic
“Treatment” of Asystole
Do NOT defibrilate (do this for ventricular fibrilation)
Treat with anti-cholenergic (atropine)
Pulseless Electrical Activity
Can be seen with ventricular tachycardia; heart pumping so fast not having much CO
Basic Life Support for Vet Med
A: Airway
B: Breathing
C: Circulation (cardiovascular)
Usually doing things simultaneously; chest compressions while intubating
Chest compression rate
100 compressions/min
Respiration rate
10 breaths/min
Give a breath for 1 second
Too much breaths can decrease CO2 too drastically; can cause vasoconstriction which will decrease perfusion to brain
Tidal volume: 10 mL/kg
Basic Life Support
Compressions - How to
Lateral recumbency
1/3 and 1/2 width of the chest
Allow full chest wall recoil between compressions (do NOT lean on patient)
2 minute cycles
Can do interposed abdominal compressions (opposite of chest compression) -> moving blood to top half of body
Chest Compressions:
Large and Giant breed
Chest compressions with the hands placed over the widest portion of the chest
Chest Compressions:
Keel-chested dogs
Chest compressions with hands directly over the heart
Chest Compressions:
Barrel-chested dog
Sternal chest compressions in dorsal recumbency may be considered
Chest Compressions:
Cats and Small Dogs
Circumferential compressions rather than lateral compressions
Cardiac Pump Theory
Pumping on heart
Squeezing and relaxing of the heart directly
Thoracic Pump Theory
Movement from changes in pressure
Entire chest moving
Moving blood through the lungs and heart
Epinephrine Dosage
Low dose: 0.01 mg/kg administered every 3-5 minutes
High dose: 0.1 mg/kg (1 mL/10 kg) considered after prolonged CPR
Atropine Usage (why)
Asystole or PEA
Increased vagal tone
Vasopressin Dosage
- U/kg as a substitute or in combination with epinephrine every 3-5 minutes
Defibrillation
Treatment of ventricular fibrillation/pulseless ventricular tachycardia (must have been occuring for <4 minutes)
Administer single shock
2 minute cycle of CPR should precede defibrillation if suspected duration of V-Fib is greater than 4 minutes
Defibrillation
“Doses”
Little: 50 joules
Medium: 100 joules
Large: 150-200 joules
Monitoring
EtCO2
??
Should be monitored as indication of perfusion and assess effectiveness of CPCR (should be at a certain level)
Once it reads 30-40 patient has come back
Monitoring
ECG
See what your patient is reading at; evaluate rhythms which may require specific therapeutic interventions
Can rule out CPA
Post Arrest Care
Hemodynamic optimization strategy (give blood)
Do not warm too quickly or potentially not at all; neurologic benefit of mild hypothermia - decreased metabolic rate
Do not give corticosteroids, anti-seizure prophylaxis, mannitol (increase ICP), or metabolic protectants
Prognosis for Survival
Overall 4-9.6%
Anesthesia related: survival 47%
