CPR Flashcards
Define cardiopulmonary arrest
Cessation of normal circulation d/t failure of the heart to contract effectively
What is CPR?
Cardiopulmonary Resuscitation
Emergency medical procedure performed to manually maintain perfusion until spontaneous circulation can be restored
T/F: Success rates with CPR are pretty good, most patients come back.
False - success rates around 5%
3 key features to recognize when CPR might be necessary
Loss of consciousness
Loss of normal, spontaneous breathing
Loss of palpable pulses
Why should you not use a stethoscope what trying to assess a patient’s pulse?
Might hear a heartbeat, but that doesn’t mean you have a palpable pulse
What are some common preceding events to the need for CPR?
Bradycardia
Sudden increase in vagal tone (vomiting, straining to defecate)
Sudden change in breathing pattern
Worsening mentation
T/F: Some diseases predispose to a patient to CPA and therefore warrant intense monitoring and aggressive therapy
True - Diseases like sepsis, SIRS, HF, pulmonary disease, trauma, neoplasia, and general anesthesia
______ people minimum for CPR
3
When is the best time to to communicate with a client about CPA and CPR?
Preferable before arrest, but if not before ASAP
What do we mean by “ABCs”?
Basic life support
Airway
Breathing
Circulation
Upon initiating CPR, what is the first step that should be taken?
Establish an airway with endotracheal intubation or, if needed, emergency tracheostomy
HOWEVER this doesn’t mean chest compressions shouldn’t be started
______ breaths/min are given during CPR
8-12
Why do we need to make sure we aren’t giving too many breaths?
The breaths being given during CPR are positive pressure breaths
Every time a breath is given, venous return to the heart is reduced
We want to limit the number of breaths given to limit the effects on venous return
Discuss the two methods that can be used to provide compressions
Cardiac pump: squeezing heart itself to push blood where the point of the elbow meets the chest
Thoracic pump: putting hands over the widest part of the chest to get greatest change in intrathoracic pressure to pump the heart
Depress the chest by _______, allow complete chest recoil, and deliver compressions at a rate of __________/minute
1/3
100 compressions
Why is it important to allow complete recoil of the chest between compressions?
That is when venous blood can return to the heart
When is open-chest CPR indicated?
Large and giant breed dogs
Thoracic trauma
Pleural or pericardial space disease (ex. Pneumothorax, pericardial or pleural effusion)
Intra-operative arrest
Ineffective chest compressions
Name the four arrest rhythms
Asystole
Pulseless ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity
What rhythms are shockable?
Pulseless ventricular tachycardia
Ventricular fibrillation
What is the point of shocking a patients?
Ventricular fibrillation and pulseless ventricular tachycardia occur when there is too much electrical activity going on
Shocking the heart shuts down the electrical activity in hopes of conversion to normal sinus rhythm
Patients should be in ______ recumbency when delivering shocks
Dorsal
Shock dose is _________joules/kg
2-10
T/F: Compressions should never stop, even during defibrillation
False - person shocking should call “clear” and person delivering compressions will keep hands off until shock has been delivered
How soon after defibrillating should you recheck the rhythm?
2 minutes
Check during hand-off between those giving compressions
A patient goes into CPA. You are cleared to perform CPR, but the patient does not have a catheter in place for drug administration. What can you do?
Administer intratracheally
IO catheterization
Venous cut-down
What two drugs are commonly used in CPR?
Epinephrine = #1
Atropine
When is atropine most useful?
Before arrest for bradycardia
When are fluids indicated for CPR?
Patients in hypovolemic shock prior to arrest
Why might fluids be contraindicated during CPR?
Can reduce coronary perfusion
T/F: Lidocaine is commonly used during CPR to increase success of defibrillation
False - not routinely indicated in CPA
Suppresses ventricular activity and may reduce likelihood of successful defibrillation
A patient arrests after being induced for surgery. Midazolam and butorphanol were used in the pre-med protocol. What do you do? (Patient has been approved for CPR)
Initiate CPR
Reverse those drugs!!!! (Naloxone for the torb, flumazenil for the midazolam, and if dexmed was used, atipamezole)
What is the most important monitoring device during CPR?
ET CO2
Can confirm ET tube placement
Identification of return of spontaneous circulation
Assessment of quality of CPR
What is ROSC?
Return of Spontaneous Circulation
During arrest, all the CO2 that is being produced by the tissues stays at the tissues because we don’t have good perfusion
CO2 only comes back to the lungs based on our chest compressions
If heart starts beating again, will see ET CO2 shoot up
T/F: blindness, stupor, and comas are common following CPR
True - should see improvement in first 24-48 hours
Having your chest slammed on for 15 minutes is painful. What should you do for patients post-resuscitation?
Provide analgesia using reversible drugs
Opioids preferred
