CPCR Flashcards
What are the warning signs of cardiopulmonary arrest?(7)
•Changes in the respiratory rate, depth, or pattern
–Especially under anaesthesis
–Marked nystagmus – this can be due to hypoxaemia and actually people then turn them up as they think they are light!!
- Weak or irregular pulse
- Bradycardia
- Hypotension
- Unexplained changes in the depth of anaesthesia
–Can appear lighter especially nystagmus
- Cyanosis
- Hypothermia
How can you diagnose cardiopulmonary arrest (4)
1) Absence of ventilation and cyanosis
- respiratory arrest
2) Absence of a palpable pulse
- pulse will disappear when systolic pressure < 60 mm Hg
3) Absence of heart sounds
- heart sounds will disappear when systolic pressure < 50 mm Hg
4) Dilatation of the pupils
What are the causes of cardiac arrest in a sick animal? (4)
–Cardiovascular collapse due to hypovolaemia
- GDV
- Colic
- Pancreatitis
- Pyometra
–Severe electrolyte derangements (esp potassium)
- GDV - dogs
- Urethral obstruction
- Ruptured bladder – foals, cats
–Small animals with severe underlying cardiac disease
- DCM, HCM
- Rare in large animals
–Trauma
•Cardiac or respiratory arrest!
What can cause arrest in healthy animals? (2)
- Neonates at term
- Anaesthesia
Is this cardiac or pulmoanary arrest:
A) Vagal stim?
B) Probs with breathing circuit?
C) Drug overdose?
D) At exubation?
A) Resp
B) Resp
C) Cardiac or resp
D) Cardiac or resp
What can help CPCR be successful? (5)
- BUT YOU NEED TO CHOOSE YOUR CASES CAREFULLY – you do not attempt it in every single animal
- Need trained staff
- Need a team
- Need to act swiftly
- Need one person – YOU (veterinary surgeon) – to take charge
What is the approach in resp arrest?
- Stick with the traditional A, B, C, D (E,F)
- (airway, breathing, circulation, drugs)
- Or D, A, B, C
- If the animal is intubated – this is easy!
- If not and you don’t have the equipment or are struggling then treat as if cardiac arrested
- Ensure you can intubate in lateral
What is the apporach to cardiac arrest? And when to do it?
•In a sick patient have a thought in your mind whether you will resuscitate
–They have arrested for a reason
–Can you sort underlying problem?
–HF – DNR!!
- Adult horses with colic – NO esp if in dorsal recumbency under anaesthesia
- Small animals with severe underlying cardiac disease – NO
- Electrolyte derangements
- Vagally induced
–Absolutely!
•Anaesthesia related
–Absolutely
•George
–3 year old Texel cross tup
–Acute onset neurological disease
–Arrested whilst performing AO (alanto-occipital) tap
Why has this happened is it caridac or resp?
–Why?
•Touched the brainstem (too acute angle). Near to or in medulla
–Cardiac or respiratory?
•Respiratory
–Still had a heart beat. Started mouth to nose resus!
•3 day old Thoroughbred foal
–Ruptured bladder
–Arrested as closing body wall following surgery
–Prior to arrest ET CO2 had started to fall (see capnograph)
–Had a high K pre surgery – was got down to 6.5mmol
Why has this happened is it caridac or resp? What would you have done differently?
–Why?
- To expire CO2 you need breathing and circulation
- This was likely indicating a reduction in CO before the heart stopped.
- Hyperkalaemia – electrolyte derangement in myocardium
–Cardiac or respiratory?
•Resp
–What would you have done differently?
•Wait until K normal
•Spike
–15 year old Cob gelding
–Presented with a history of up to 18 hours of signs of severe abdominal pain. Colicking
–In addition the horse had two septic tarsocrural joints
–6 hours of surgery
–Horse was hypoxic and severely hypotensive for much of surgery (not too uncommon in colic)
–Horse observed to stop breathing in the recovery box
Why has this happened? Is it cardiac or resp? What to do next? What may we do next time?
•Why?
–Sick horse with dead intenstine
–SIRS and sepsis
–Could be anaesthesia – less likely
•Cardiac or respiratory?
–Cardiac
•What next?
–CPR
•What might you do differently next time?
–Realised it was a sick horse and then chances of getting it back were minimal
–Shouldn’t have done both surgeries at the same time! Done the colic surgery and then flushed standing or brought back in a few days later
- Taloolah
- 12 year old pony mare presented for with a septic fetlock joint
- Called by intern to say pony not breathing
- On arrival pony is profoundly hypotensive, hypoxic and has atrial fibrillation and occasional VPD’s (ventricular ectopic)
- Pony has nystagmus (so they thought to turn up iso)
- What are you going to do next?
–Turn off iso – have injectable ready to keep asleep
–Check the ET tube was in. The cuff was let down and the pony was then cuffed. So the tube was too small and the cuff had then come across the eye of tube.
–Wake the pony up – severely hypoxic and cardiac rhythm. Can do surgery tomorrow
How do we do compressions?
What is the rate? Depth? Time?
•High-quality chest compressions should be delivered in uninterrupted cycles of 2 minutes with (most) patients in lateral recumbency
–compression rate of 100–120/min
•Current recommendations – may be increased to recommend 150/min
–compression depth of 1/3–1/2 the width of the chest
•allowing for full elastic recoil of the chest between individual compressions
–SWAP person after a couple of minutes if there is the option
What does this show?
>10Kg – Thoracic pump – dogs and foals
High up behind heart – thoracic recoil to push blood out of thoracic cavity around the body
What does this show?
<10Kg – Cardiac pump – small dogs and cats. Grab round the heart – get the blood to flow round
How do you do mouth to snout resuscitation in a dog?
make a seal and go round both nostrils
How can you mouth to snout in farm animal?
Cover one nostril
