CPR Flashcards
What is cardiopulmonary arrest?
Cessation of both the respiratory and circulatory systems
Is apnea the same as respiratory arrest?
No, apnea usually is a temporary cessation but it can least to complete respiratory arrest
What is respiratory arrest typically due to?
A pathologic process where the patient cannot initiate a breath (medullary ischemia)
What are the survival to discharge rates following CPR?
Dogs- 3-6%
Cats- 2-10%
How long does it take for cerebral death due to ischemia take?
> 4-7min
What kind of pathology has the least likelihood of survival even with CPR?
Cardiopulmonary arrest due to progressive illness
What is the most important aspect of resuscitating a CPA patient?
Early recognition and response
What conditions are classified as a respiratory emergency?
Tension pneumothorax, pulmonary or airway disease
What is a crash cart?
A box/cart that is stocked with all drugs and equipment necessary to resuscitate a patient
How many people are required for proper CPR?
At lease 4
Compressions, prepare drugs/monitors, provide ventilation, keep records
What drug is used to sedate animals in respiratory distress?
Acepromazine
What are the CS of upper airway obstruction and what breeds are predisposed?
Brachycephalics are predisposed
Inspiratory stridor, cynosis
What is the immediate step necessary for upper airway obstruction?
Induction and intubation
May need immediate surgery
What procedure can be done until definitive correction of an upper airway obstruction can be performed?
Tracheostomy
What are the CS due to an airway obstruction from a foreign body or tumor?
Inspiratory effort with abdominal effort and cynosis
Can a tracheostomy be performed with an airway obstruction?
Yes- go below the obstruction
What procedure is performed to visualize the obstruction?
Bronchostomy
What are the CS of a collapsed trachea and what breeds are predisposed?
Small and toy breed dogs
Marked inspiratory and exspiratory effort with a goose-honking noise
Should tracheal collapse patients be intubated?
Yes
What are the clinical signs of a pneumothorax?
Dyspnea, rapidly decreased SpO2, collapse
What are some causes of pneumothorax?
Thoracic trauma, spontaneous, barotrauma (closed pop-off!)
Can a pneumothroax lead to respiratory arrest?
Yes
What is done to treat a pneumothorax?
Oxygenation and evacuation of air from the chest (needle of chest tube)
Fluids recommended to improve circulation
Atropine if HR is decreased
If an anesthetized patient on a ventilator stops breathing, does this count as respiratory arrest?
Nope!
What value will suddenly decrease in an anesthetized patient in respiratory arrest?
EtCO2 (
How with the MMs look in animals in CPA?
Blue/gray
May still be pale pink if early
What is the procedure for CPA during anesthesia?
- Turn off anesthesia and flush circuit
- Start compression
- Ventilate 10bpm
What is the procedure for CPA walking through the door?
Compressions and “mouth to snout” ventilation until you can intubate
What should be restarted first in CPR? Circulation, breathing or airway?
Circulation- start compressions
What percentage of CO is generated in closed CPR?
25-40%
What should you use for your compression rate?
100-120 bpm
How far should you compress the chest?
1/3-1/2 the width of the chest
Where should compressions be performed on the chest with thoracic pump theory?
With hands over the highest point of the thorax
Is the thoracic pump theory more effective in larger or smaller animals?
Larger
Dogs especially
Where are compressions performed in cardiac pump theory?
Over the heart and compress with thumb and fingers
Similar to open chest CPR
Cardiac pump theory is more effective in what kind of animals?
Smaller
What is the inspiratory/expiratory times for ventilation?
1 sec for inspiration
5-6 sec for expiration
If only one person is performing CPR, what is the protocol?
Continuous compression with 1-2 breaths every 2-3min
Why is an ECG necessary in cardiac arrest?
Determine the rhythm of arrest
What is the most common arrest ECG in small animals?
Asystole
What is the most common arrest ECG in humans?
Ventricular fibrillation
What drug can induce ventricular fibrillation?
Epiephrine
What does pulseless electrical activity look like on ECG?
Wide QRS, no perception of heart function
Looks almost normal
PEA is often observed in animals after what procedure?
Euthanasia
Is a slower PEA or faster PEA a better prognosis?
Faster has a better prognosis
What is the concern with PEA arrhythmias?
Depletion of global myocardial energy substrates
What three drugs are administered in advanced support?
Vasopressors (vasopressin/epi)
Atropine
How long can compressions be halted to check ECG?
No longer than 10 seconds
Is there any advantages between the vasopressor drugs during CPR?
Nope
Which vessels are preferred to gain IV access in an arrested patient?
Jugular > cephalic > saphenous
Can drugs be administered intratracheally?
Yes!
What drug cannot be given intratracheally?
NaHCO3
Can intraossesous catheters be used in an arresting patient?
Yes, may be the only option if very small
What are interposed abdominal compressions?
Compressions timed in between chest compressions to enhance venous return to the heart
What are three complications of abdominal compressions?
- Diaphramatic hernia
- Hemoabdomen
- Hepatobilliary sx
All are rare but possible
Where is open chest CPR performed?
On the left lateral at the 6th rib space
or
Via the diaphragm in abdominal sx
“Hack and slash” thorocotomy
What are some indications for open chest CPR?
- Cardiac tamponade
- Large volume pericardial effusions
- Chest trauma/fractures
- Diaphragmatic hernia
- If closed chest is not effective after ~5-10min
- If EtCO2
Is palpating a pulse useful to assess compression quality?
No
What should be done to assess quality of compression?
Doppler probe over the cornea or over an artery
What is the EtCO2 expected to be if compressions are working?
> 15 mmHg
Is SpO2 useful for assessing compressions?
No
What fluids should be given in cases of hypovolemia?
Colloids or crystalloids
When is giving NaHCO3 appropriate?
Arrest due to metabolic acidosis
When is giving Ca gluconate appropriate?
Arrest due to hypocalcemia, hyperkalemia, or Ca channel blocker toxicosis
When should CPR be discontinued?
If EtCO2
When is a defibrillator appropriate?
In ventricular fibrillation cases
Can alcohol be used with defibrillator paddles?
NO
If defibrillation is unsuccessful the first time, how long should compressions be continued before trying again?
At least 2min
Should the energy of the shock be increased for successive shocks?
Yes, 50%
What does ROSC stand for?
Return of spontaneous circulation
Should ventilation be maintained after ROSC?
Yes
What is the prognosis of a patient after ROSC depend on?
- Cause of arrest
- Duration of arrest
- Other physiologic/pathologic processes after reperfusion
Medullary ischemia is likely unless circulation is restored in how many minutes?
What is a beneficial treatment to prevent hypoxic injury to neural tissues?
Therapeutic hypothermia
Use either cold packs or cooled fluids
When should CPR patients be extubated?
When they can ventilate adequately to maintain PaCO2 on their own and is actively objecting to the tube
If spontaneous breathing has not returned withing in how many hours, the prognosis is poor.
6-12
