CPR

Question 1

indications for CPR

Answer 1

cardiopulmonary arrest

respiratory arrest - if treated quickly may prevent cardiac arrest

Question 2

how can respiratory arrest be treated

Answer 2

Intubate and ventilate

Acupuncture point GV26 – use a 25 g. needle

NO DOXAPRAM – increases cerebral O2 demand

Question 3

underlying cause of cardiac arrest

Answer 3

inadequate cardiac oxygenation

Question 4

what is the goal of CPR

Answer 4

maximize myocardial and cerebral oxygenation

Question 5

T/F CPR success rates are poor overall in dogs and cats

Answer 5

True

35-45% have a return to spontaneous circulation (ROSC)

survival to discharge is only 2-10% → majority arrest again

Question 6

CPA had a better/worse prognosis

Answer 6

better

50% survival at discharge

Question 7

considerations for providing CPR

Answer 7

Owners will require counselling to aid in decision-making

Is this a rapidly correctable problem?

What is the longer-term prognosis?

What is the expected cost?

Question 8

code status

Answer 8

DNR

CPR - open vs. closed

ask BEFORE patient is admitted

Question 9

how can you indicate the crash cart is ready for use

Answer 9

put tape over the front - if broken, its been used and should be stocked

Question 10

what is the most important part of basic life support

Answer 10

chest compressions

Question 11

an apneic, unresponsive patient should be assessed for less than _______ before startin compressions

Answer 11

5-10 secs

interruptions should be minimized - can have significant impact on blood flow

Question 12

chest compressions only achieve _________of normal cardiac output

Answer 12

less than/equal to 25-30%

Question 13

how often should you trade off person doing compressions

Answer 13

every 2 min

trade off without interruption

Question 14

2 theories of chest compressions

Answer 14

cardiac pump theory - direct compression of ventricles, smaller patients

thoracic pump theory - increase intrathoracic pressure, larger patients

Question 15

what determines where to do chest compressions

Answer 15

size and shape of patient

Question 16

where are compressions performed with thoracic pump theory

Answer 16

over the widest part of the chest

Question 17

rate and deptht of chest compressions

Answer 17

100-120 per min

1/3 -1/2 width of thorax - allow full thoracic recoil

Question 18

indications for inernal cardiac massage

Answer 18

Conditions which prevent effective external cardiac compressions - Pericardial effusion, Pleural space disease

Other - Intraoperative cardiac arrest if abdomen is already open (diaphragmatic approach)

Question 19

T/F intubation should be completed ASAP but without interruption of chest compressions

Answer 19

True

keep in lateral recombency

Question 20

ventilation parameters

Answer 20

10 breaths/min

tidal volume 10 ml/kg

inspiratory time 1 second

Question 21

what provides an indication of adequacy of cardiac compressions

Answer 21

EtCO2

should be >15-20 mmHg

Question 22

sudden increase in EtCO2 indicates

Answer 22

ROSC - return to spontaneous circulation

draumatic increase in cardiac output and pulmonary circulation

Question 23

what is an impedance threshold device (ITD)

Answer 23

fits between endo of ETT and ambubag/breathing circuit

created negative intrathroacic pressure→increases venous return (preload)

only useful in animals >10kgs

Question 25

advanced life support systems

Answer 25

drugs and defibrillation

tx depends on arrest rhythm - determined by ECG

Question 26

3 main arrest ryhthms seen on ECG

Answer 26

asystole

pulseless electrical activity

ventricular fibrillation

Question 27

Is dedibrilation indicated with asystole/PEA

Answer 27

no - requires drug tx

vasopressor q EO cycle (3-5min) - epi or vasopressin

atropine q EO cycle (3-5min) - esp with high vagal tone

Question 28

what are the shockable rhythms

Answer 28

Vfib /pulseless Vtach

should occur ASAP once Dx is made

Question 29

MoA of defibrillation

Answer 29

Depolarizes ventricular myocardial cells all together, forcing refractory period → Allows pacemaker cells in SA node to take over

Goal is to establish a sinus rhythm

Question 30

welcome back to SAM - what rhythm is this

Answer 30

ventricular fibrillation

Question 31

welcome back to SAM - what rhythm is this

Answer 31

ventricular tachycardia

Question 32

how is a defibrillator used

Answer 32

dorsal recumbency → Paddles placed on opposite sides of thorax over costochrondral junction over heart

Make sure no one is in contact with the patient or steel table!

Make sure no alcohol is on patient fur – fire hazard

Resume compressions for 2 minutes before rechecking ECG

Question 33

what may be considered if defibrillation is not effective

Answer 33

amiodarone and lidocaine

Question 34

what is used for torsades de pointes

Answer 34

magnesium

Question 35

T/F all reversible anesthetic drugs that have been administered should be reversed during CPR

Answer 35

True

Question 36

T/F calcium should not be routinely administered

Answer 36

True

documented hypoglycemia may be treated

Question 37

T/F documented hyperK should be treated and hypoK may be treated

Answer 37

True

Question 38

are corticosteroids recommended

Answer 38

NO!

Question 39

when is administration of bicarb considered

Answer 39

after prolonged (10-15 min) CPR

Question 40

IV fluids should be given only to _______patients

Answer 40

hypovolemic

Question 41

which drugs can be given intratracheal

Answer 41

epi, atropine, vasopressin

only if cant get IV or IO access

deliver via catheter at the level of the carina or distal

dilute in sterile water/saline

Question 42

injections should NEVER be made into _________

Answer 42

myocardium (intracardiac)

Question 43

what are some post cardiac arrest (PCA) syndromes

Answer 43

multiorgan failure

cardiogenic shock

anoxic brain injury

Question 44

T/F physiologic (low) doses of steroids may be indicated post cardiac arrest

Answer 44

true

for stress - maintain GLU and vascular tone