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Unit 1 > CPR > Flashcards

CPR Flashcards

1
Q

What are the 6 H’s?

A

Hypovolaemia
Hypoxia
Hydrogen ion (acidosis)
Hypo/hyperkalaemia
Hypothermia
Hypoglycaemia

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2
Q

What are the 5 T’s?

A

Tamponade (cardiac)
Toxins
Trauma
Tension penumothorax
Thrombosis

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3
Q

What are warning signs of CPA?

A

Change in heart rate or rhythm
Decreasing responsiveness
Weakening pulses
Abnormal breathing patterns such as cheyne-stokes respiration

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4
Q

What is a quick 10-15 second assessment that should be completed on a collapsed, unresponsive patient?

A

Is it breathing?
Is there any airway obstruction?
Is there a femoral pulse?

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5
Q

What is the order that should be followed if a cardiac or respiratory arrest has occurred?

A

Call for assistance
Note time
Turn of anaesthetic agent (if relevant)
Start CPR
Determine a lead

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6
Q

If a patient is bradycardic with no pulses then you should…

A

Complete compression’s to ensure perfusion

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7
Q

When might dorsal recumbency be preferred for CPR?

A

In barrel-chested dogs

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8
Q

What posture and positioning should the person completing compression adapt?

A

Shoulders and elbows locked (to avoid leaning on the patient during rebound)
Shoulders should be aligned over the hands
Compressions should be mainly controlled from the core of the abdomen

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9
Q

When is the cardiac pump technique preferable?

A

Cats
Small dogs
Narrow/keel chested dogs

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10
Q

Describe the cardiac pump technique

A

Direct external compression of the heart between the sternum and spine

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11
Q

What is cardiac output comprised of?

A

Stroke volume X heart rate

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12
Q

When is the thoracic pump technique preferable?

A

Dogs with a round thorax

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13
Q

Describe the thoracic pump technique

A

Thorax is compressed over the widest part to increase overall intrathoracic pressure which forces blood from the vessels into the circulation

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14
Q

How much is the stroke volume reduced during CPR?

A

20%

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15
Q

At what rate should compressions be applied?

A

100-120BPM

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16
Q

Why should compressions not exceed 120bpm?

A

Reduced effectiveness through reduced stroke volume and not enough time for full thoracic recoil

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17
Q

By what percentage should the chest be compressed?

A

30-50%

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18
Q

How long should viewing of the ECG be completed during change over of compressors?

A

No longer than 5-10 seconds

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19
Q

If you are completing CPR on your own, how often should you provide breaths and by what manner?

A

Two rapid mouth to snout breaths followed by 30 chest compressions

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20
Q

What ventilation rate should be provided to patients during CPR?

A

10 breaths per minute

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21
Q

What should the inspiratory time be during CPR?

A

1 second

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22
Q

What should be the ratio of inspiration to expiration be during CPR?

A

1:3

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23
Q

What tidal volume should you aim to provide through ventilation during CPR?

A

10ml/kg

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24
Q

What does ALS include?

A

Monitoring
Obtaining vascular access
Drug administration
Defribillation

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25
Q

When should surgical spirit not be used with placing ECG clips during CPR?

A

If electrical defibrillation is a possibility

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26
Q

What are the four main arrest rhythms?

A

Asystole
Pulseless electrical activity (PEA)
Ventricular fibrillation (VF)
Pulseless ventricular tachycardia (VT)

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27
Q

Define pulseless electrical activity (PEA)

A

Looks like a normal trace but there are no pulses

28
Q

Define ventricular fibrillation (VF)

A

Fine and course chaotic deflections with no p waves

29
Q

Define pulseless ventricular tachycardia (VT)

A

Rapid, tall/wide, bizarre complexes with no p waves (and no palpable pulses)

30
Q

If an ECG (during CPR) is showing sinus rhythm, what should be assessed and why?

A

Palpation of pulses to determine if the heart is contracting or if it is PEA

31
Q

Why should EtCO2 be monitored during CPR?

A

To indicate if compressions are effective

32
Q

What EtCO2 should be achieved during CPR?

A

15mmHg as this indicates that there is perfusion to the lungs and that compressions are adequate

33
Q

What would a rapid rise in EtCO2 indicate during CPR?

A

ROSC

34
Q

What is not effective in terms of monitoring during CPR?

A

Pulse oximetry
Blood pressure

35
Q

Why might drugs be administered during CPR?

A

Arrest (epinephrine)
Reversal agents (naloxone/atipamozole)
Arrhythmia (i.e. in ventricular tachycardia)

36
Q

Why should intracardiac drugs nto be admnistered during CPR?

A

Risk of myocardial damage

37
Q

What should be done after administering drugs IV during CPR?

A

Flush IV catheter with 5-20mls of isotonic fluids to ensure the drug reaches central circulation

38
Q

How can drugs be adminstered intratacheally?

A

Through a long catheter advanced to the carina

39
Q

When administering drugs intratracheally, what should you do to the drugs?

A

Double the dose and dilute in 2-5mls of isotonic saline (dependant on patient size)

40
Q

What should be done AFTER administering drugs intratracheally?

A

A large breath should be given to ensure good dispersal of the drug within the lung tissue

41
Q

When providing effective cardiac compressions, what percentage of the normal cardiac output is acheievd?

A

25-30%

42
Q

Why are vasopressures an essential part of ALS?

A

Peripheral resistance is requires to encourage more for the circulating volume to be diverted centrally

43
Q

If a patient has a non-shockable rhythm such as PEA or asystole, what drugs can be administered

A

Epinephrine (adrenaline) +/- atropine to be administered every 4 minutes

44
Q

What is a catecholamine?

A

Hormones produced by the adrenal glands that stimulate the central nervous system

45
Q

Which CPR drug is a catecholamine?

A

Epinephrine (adrenaline)

46
Q

What is an adrenergic agonist?

A

A drug which mimics the sympathetic nervous system

47
Q

What does a vasopressor do?

A

Causes vasoconstriction, therefore improving blood flow to vital central structures such as the heart and brain

48
Q

Why might the b-1 adrenergic activity of epinephrine be harmful during CPR?

A

It increases the heart rate and contractility leads to higher myocardial oxygen demands causing further myocardial ischaemia and possible predispose the patient to arrhythmia once ROSC is achieved

49
Q

What are the RECOVER guidelines regarding epinephrine during BLS?

A

Low dose (0.01mg/kg IV) administered every other cycle (every 4 minutes approxamitely)

50
Q

Under the RECOVER guidelines, if a patient has a non-shockable rhythm, when may high dose epinephrine be administered and at what dose?

A

After 3 rounds of low dose epinephrine/atropine have failed

0.1mg/kg

51
Q

Categorize vasopressin

A

antidiuretic hormone

52
Q

How does vasopressin work?

A

Acts on peripheral V1 receptors present in vascular smooth muscle which leads to peripheral vasoconstriction

53
Q

Why will vasopressin not worsen myocardial ischaemia?

A

It has no inotropic or chronotropic effects

54
Q

Is vasopressin still active in an acidic pH?

A

Yes

55
Q

What impact does atropine have on the body?

A

Accelerates the transmission of electrical impulses through the heart

56
Q

When is atropine most effective during CPR?

A

During asystole or PEA

57
Q

When might lidocaine or amiodarone be used during CPR?

A

Ventricular arrhythmia such as ventricular tachycardia

58
Q

Why should a patient be disconnected from the circuit before flushing?

A

Flushing with the patient attached to the circuit leads to increased airway pressures and barotrauma

59
Q

What reversal agents are available?

A

Naloxone for opiates
Flumazenil for benzodiazepines (diazepam)
Atipamezole for alpha-2 agonist

60
Q

When might IVFT be used during CPA?

A

If the patient is hypovolaemic

61
Q

What fluids may be used if a patient requires them during hypovolaemic CPA?

A

Isotonic crystalloids

62
Q

What should be used when administering isotonic crystalloids during CPA?

A

Pressure bag or infusion pump to ensure rapid infusion

63
Q

When is electrical defibrillation advised?

A

In patients with a shockable rhythm such as ventricular fibrillation or pulseless ventricular tachycardia

64
Q

When might many dogs develop ventricular fibrillation?

A

After adrenaline administration and chest compressions

65
Q

What are signs of ROSC?

A

Rapid rise in EtCO2
Return of normal ECG rhythm
Palpable central pulses i.e. femoral

Unit 1 (6 decks)

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