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Anesthesia 2 > CPR > Flashcards

CPR Flashcards

1
Q

Survival rate of patients following CPR

A

4-9.6%

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2
Q

3 categories of patients needed CPR

A

**usually needed due to human error 90%

  1. Anesthesia and drug related
  2. Underlying disease
  3. Reversible disease/injury
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3
Q

Anesthesia and drug related CPR

A

-highest survival, 35-48% recovery
-witnessed events in controlled circumstances, on life support

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4
Q

Underlying disease and CPR

A

2% chance of recovery
-grave prognosis

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5
Q

Reversible disease/injury and CPR

A

-5% will leave hospital
-quick resolution of underlying disease allows chance for recovery

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6
Q

5 steps of CPR

A
  1. Readiness and preparation
  2. Basic life support
  3. advanced life support
    4.monitoring
  4. postcardiac arrest care
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7
Q

Readiness and prep

A

-know resuscitation status
-Team of at least 3 (communication, and leader, know jobs)
-table
-equipment
-oxygen
-ventilation-anesthesia machine
-monitoring equipment
-crash cart: drugs, dose chart

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8
Q

Clinical signs of cardiopulmonary arrest

A

-unresponsive
>stimulate and if no response call for help
>check airway
>check breathing (chest rise)
-lack of spontaneous ventilation
-lack of heart beat
*but don’t check heart rate/pulse because takes too much time

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9
Q

Basic life support

A

Start as soon as possible
-delays associated with worse outcome
-turn off anesthesia

3 minute emergency
-brain damage after 3 mins without O2 and glucose, brain uses all ATP, Na/K pump fails=edema

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10
Q

Basic life support steps

A

Use early ventilation and compressions
*humans just use hands only because they are from acute cardiac arrest; not in animals

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11
Q

Single rescuer compressions

A

30 compressions: 2 breaths

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12
Q

Goal of CPR

A

-restore blood flow to provide oxygen delivery
-compressions start immediately; confirm heart beat later

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13
Q

Patient positioning during CPR

A

-lateral recumbency
-barrel chested dogs in dorsal

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14
Q

Compressions

A

Rate: 100-120 bpm
Depth: 25% of depth/width

Lock elbows
Cycle rescuer every 2 mins; minimize interruptions 2-5secs
1:1 compression to relaxation ratio= Full recoil

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15
Q

Importance of full recoil

A

-no leaning on chest because it will increase intrapleural pressure, reduce venous return and affect ventricular filling

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16
Q

Ventricular filling

A

Systole (alive) or compressions: coronary blood flow negligible or even retrograde

Diastole (alive) or decompression: majority of coronary blood flow

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17
Q

compressions: <10kg or dogs with narrow keel chest

A

Direct compression of the heart (3rd to 6th IC space)
-pushes blood out into circulation
-can also cup hand around sternum to squeeze with one hand OR fingertips

Eg. one handed thumb to finger OR circumferential OR one handed palm OR cardiac pump

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18
Q

Compressions: animals >10kg

A

-compression over widest part of thorax
>increased overall intra thoracic pressure and compressing aorta= blood flow out of thorax
>Elastic recoil= sub atmospheric intra thoracic pressure favours blood flow from periphery to thorax

-Brachysephalics: flat chested confirmation

19
Q

Ventilation

A

-use 100% oxygen
-anesthetic machine or Ambu bag
-turn off vaporizer

Room air=21% O2 vs. Own breath= 14% O2

20
Q

Airway

A
  1. MASK
    -not ideal, only if intubation not available
    -provides O2, extend head and neck
    -must stop compressions to ventilate
  2. MOUTH TO SNOUT
    -hold mouth tightly closed
    -low fraction of inspired O2
  3. Intubation!
21
Q

Intubation during CPR

A

-best option
-lateral recumbency, neck extended
-use laryngoscope, inflate cuff, secure in plate, provide 100% O2

22
Q

Ventilation RR

A

RR: 10 breaths per min
Tidal volume 10ml/kg
inspiratory time: 1 sec

Airway pressure: 30-40 cmH2O during chest compression; less than 20 in between chest compressions

23
Q

Advanced life support

A

-monitoring: ECG, capnography, femoral pulse

-IV access

-Reversals

24
Q

ECG monitoring

A

-diagnosis of arrest rhythm
-never interrupt 2min cycle of chest compression
-leader calls out rhythm and asks if everyone agrees

25
Q

Common arrest rhythms

A
  1. non shockable
    -asystole
    -pulseless electrical activity
  2. shockable
    -pulseless ventricular tachycardia
    -ventricular fibrillation

**can change during CPR

26
Q

Asystole

A

-most common in dogs and cats
-non shockable
-flat line

Treatment: Basic life support, Epi +/- vasopressin
AND Atropine (once early on)

27
Q

Pulseless electrical activity

A

-common in vet patients
-overdose GA (barbiturates)
-non shockable
-normal HR and rhythm on ECG, but no myocardial activity
-HR less than 200bpm

Treatment: Basic life support, Epi +/- vasopressin
AND Atropine (once early on)

28
Q

Shockable arrest rhythms

A
  1. pulseless ventricular tachycardia
  2. Ventricular fibrillation
29
Q

Ventricular fibrillation

A

-unorganized activity in heart= poor myocardial contractions and loss of CO
- most common in people; uncommon in cats and dogs

Treatment: electrical defibrillation, precordial thump

30
Q

Electrical defibrillation

A

-electrical impulse depolarizes myocardial cells reset button
-allow regular pacemaker cells to regain control= sinus rhythm; asystole if SA node does not refire

31
Q

Electrical defibrillation key points to using paddles

A

-lubricate paddles with conductive gel (No alcohol)
-patient in dorsal
-place paddles on opposite sides of thorax, over heart at costo-chondral junction

32
Q

After Defibrillation

A

-restart chest compressions immediately; complete full 2mins before next shock
-outcome: normal ECG or asystole
-if shockable rhythm continues, increase shock energy and stay there for next shocks, los dose EPI

33
Q

End tidal CO2

A

tells you about CO and pulmonary perfusion AND measures efficacy of chest compressions!
-less than 18mmHg means poor perfusion
-more than 15, greater rate of return of spontaneous circulation

34
Q

Cardiovascular Drugs

A

vasopressive agents, vagolytic drugs

35
Q

non cardiovascular drugs

A

Reversals:
-opioids (naloxine)
-Alpha 2 agonists (atipamezole)
-Benzodiazepines (Flumazenil)

Anti-arrythmic drugs

36
Q

Routes of drug administration

A
  1. IV - preferred, flush with large volumes after drug given. Decreased CO means poor distribution of drugs
  2. Intraosseous
    -handheld electric drills
    -only if can’t do IV
  3. Intratracheal
    -simple, rapid; drugs absorbed into pulmonary circulation. Dilute drugs in NaCl. Drug dose doubled
37
Q

What drugs can be used intratracheal?

A

-atropine
-Epi
-Vasopressin
-Lidocaine
-Naloxone

38
Q

Epi

A

Vasoconstriction resulting in increased myocardial and cerebral blood flow

Also results in increased contractility and HR and arrhythmias

Repeat after every other 2min cycle

39
Q

Vasopressin

A

Not a catecholamine
Causes vasoconstriction, but not in heart and cerebral regions

Good for hypoxemic, hypothermic, acidic environments.. making it different than epi

Give every 3-5 mins. With Epi or as a substitute

40
Q

Atropine

A

-used only in patients (not humans) that arrested due to high vagal tone
-inhibits parasympathetic tone (increased HR, AV nodal conduction)

**early in CPR, only use once!

41
Q

Monitoring effectiveness of CPR

A

-after 30-60secs, need to feel femoral pulse or read capnogram

-if ineffective then switch person, position, augmentation, open chest if already in surgery (but not recommended anymore)

42
Q

Post cardiac arrest care

A

2-10% of dogs and cats survive to hospital discharge

43
Q

Issues from CPR

A
  1. ischemia-reperfusion injury
    -sepsis like syndrome
    -hemodynamic optimization, glycemic control, adrenal function
  2. Brain injury
    -mannitol to increase intracranial pressure, hypothermia, seizure prophylaxis
  3. Myocardial dysfunction- arrythmias
  4. Original issue

Anesthesia 2 (17 decks)

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