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POS 2 > CPR > Flashcards

CPR Flashcards

1
Q

When is the safest time for an animal to arrest?

A

Under anaesthesia

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2
Q

Is it likely that you will be able to revive a animal dead on arrival?

A

no but always try and help even if just taking them out the back

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3
Q

What is CPR?

A
  • patient stops breathing OR its heart stops beating
    (minute after respiratory arrest before cardiac arrest follows, if under GA oxygen levels ^ so 5 minutes)
  • means to support circulation and oxygenation
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4
Q

define rsp/cardiorespiratory arrest

A
  • cessation of effective breathing

- cessation of effective cardiac activity (CO) and respiration

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5
Q

Define return of spontaneous circulation (ROSC)

A
  • re-establishmenet of sustained CO without assistance (not just electrical activity - pulseless electrical activity)
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6
Q

Define basic life support

A
  • chest compressions and assisted ventilation
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7
Q

Define advanced life support

A
  • BLS + medical and electrical intervention
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8
Q

What is CPCR?

A
  • cardiopulmonary CEREBRAL resuscitation
  • rescusitative efforts required to elicit ROC and emphasising the importance of neuroplogical outcome
  • mainly in humans (dropping core temperature etc.)
  • dogs and cats more tolerant of periods of hypoxia
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9
Q

How can impending cardiopulmonary arrest be recognised?

A
  • not easy in critically ill patients
  • hypoventilation and bradycardia esp if sudden
    > pre-arrest rhythms
  • ventricular tachycardia with R on T phenomenon (no return to baseline, no repolarisation)
  • ventricular flutter/fibrillation (needs defib within mins)
  • third degree AV block (dissociated of atria and ventricles, ventricles will beat d/t escape complexes @ 40bpm, needs pacemaker)
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10
Q

How can an arrested patient be identified?

A
  • spontaneous breathing efforts
  • auscult heart
  • feel for apex beat
  • palpate pulses
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11
Q

Most common cause of CPA in animals cf. people?

A
  • airway obstruction (always intubate)

- humans more likely myocardial infarction

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12
Q

How many people are needed for effective CPR?

A 
3-4 people min
- ventilation
- compressions
- IV access
- ECG
- runner
- scribe
- pulse taker (spontaneous or compressions) 
- abdominal counterpressure to divert blood to cranial vena cava and brain 
> one person should take charge
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13
Q

What is vasovagal syncope and vagal arrest?

A
  • stimulation of vagus nervie -> life threatening bradycardia
    > causes of vagal stimulation
  • V+
  • defeacation/urination
  • respiratory arreat
  • ocular or neck surgery
  • patients with pre-existing high vagal tone pdf
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14
Q

Tx high vagal tone?

A

Atropine (parasympatholytic)

  • intubate
  • oxygenate
  • can anaesthesise
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15
Q

Causes and tx of anaesthetic related arrest?

A
  • OD anaesthetic (stop giving anaesthetic, reverse)

- hypoventilation/hypxia/hypercarbia

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16
Q

Complications of anesthetic CPA?

A 
hypoxia leads to... 
- blindness
- dysphoria
- neuro dysfunction
> most go away with time and good nursing care
17
Q

How can positive pressure respiration be given?

A
  • positive pressure on anaesthetic machine
  • Ambu bag (regulates pressure so you cant overdo it)
  • 10-12 breaths per minute (don’t hyperventilate!! CO2 taken off too much -> vasoconstriction)
  • 100% oxygen
  • deliver breaths simultaneous with compressions
  • max pressure 15cmH20 cat, 20cm H2O dog)
  • inspiratory time
18
Q

What does too much ventilation do

A
  • ^ intrathoracic pressure
  • v CO
  • v cerebral and coronary perfusion
19
Q

Aim of circulatory support?

A
  • maximise myocardial/cerebral perfusion
  • myocardial perfusion depends on DIASTOLIC pressure
  • cerebral perfusion depends on MAP
  • minimise interruption of compressions
20
Q

How is CPR physically carried out?

A

7kg
- compress thorax (thoracic pump mechanism)
~ 100bpm
~ 50:50 duty cycle (let chest expand between compressions)

21
Q

How often should you switch people compressing?

A

2 minutes

22
Q

Indications ofr open chest CPR?

A
  • large dogs
  • significant pleural space disease
  • chest wall disease
  • pericardial effusion
  • penetrating chest wounds
  • intra-operative arrests (esp abdo, cut through diaphragm)
  • haemoabdomen
  • unwitnessed arrests
  • unsuccessful closed chest CPR (after 5-10mins? no proof for this)
23
Q

Advantages of open chest CPR

A
  • diastolic filling assessment
  • pericardial tamponade avoided
  • aorta cross clamped
  • ventricular fibrillation visually diagnosed
  • myocardial flaccidity assessed directly
24
Q

Disadvantages of open chest CPR?

A
  • need experienced personel
  • need more personnel
  • significant procedure
  • financial and surgical backup
  • infection (non-sterile)
25
Q

What is involved in advanced life support?

A
  • determin arrest rhythem
  • defib
  • cardiac pacing
  • vascular access
    > drugs
  • vasopressor (adrenaline)
  • vagolytic (atropine)
  • antiarrythmic (lidocaine)
  • buffer (acidosis eetc.)
  • electrolyte
  • IVFT
26
Q

Is VF common in small animals? Wht is the only tx method?

A

No (cf. humans)

  • need defib to convert
  • can try pre-cordial thump
27
Q

Which drugs can be given ET if no venous accccess present?

A 
Lipid soluble: 
N- naloxone
A - atropine
V - vasopressin 
E - Epinephrine
L - Lidocaine
> NOT ca or bicarb
28
Q

Has any drug tx been shown to ^ survival?

A

NO

29
Q

What does atropine do? Indications?

A

> vagally mediated arrests

  • parasympatholytic
  • accelerates pacemakers
  • ^ AV conduction
30
Q

What does epinephrine do? Indications?

A

> standard vasopressor for cardiac arrest

- a– mediatedvasoconstriction, ^ aortic pressure, ^ myocardial perfusion

31
Q

What does calcium do? Indications?

A

> previous hx of hyperkalaemia, hypoclcaemia

- specific indications only

32
Q

What does glucose do? Indications?

A

> Tx hypoglycaemia pre/during arrest

- check glucose during CPA, tx hypoglycaemia as required

33
Q

What does lidocaine do? Indications?

A

> ventricular tachycardia

- v automacity an suppresses ventricular arrhythmias, less effective than amiodarone

34
Q

What is sodium bicarbonate? Indications?

A

> hyperkalaemia/metabolic acidosis

- routine administration does not improve outcome

35
Q

What is vasopressin? Indications?

A

> Vasopressor

  • some theoretical advantages over epi
  • inconsistent results
  • only neeed to give once
36
Q

What is always indicated for severe bradycardia?

A

Atropine

37
Q

Side effects of atropine?

A
  • may contribute to development and maintainence of PEA/asystole
  • may potentiate sinus tachycardia
  • may encourage VF when given in the vicinity of epinephrine
    > give one dose in early CPR
38
Q

When are IV fluids indicated?

A 
> NOT AS STANDARD 
- following drug administration 
- pre-existing severe hypovolaemia 
- bleeding out 
> overhydrating decreases coronary perfusion (^ right sided heart pressure)
39
Q

When is the majority of ROSC successful? When can you ggive up?

A

8-10 minutes

  • check end tidal CO2, if zero give up
  • after 30 mins probably ok to give up if no signs of life

POS 2 (28 decks)

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