CPR Flashcards
indications for CPR
cardiopulmonary arrest
respiratory arrest - if treated quickly may prevent cardiac arrest
how can respiratory arrest be treated
Intubate and ventilate
Acupuncture point GV26 – use a 25 g. needle
NO DOXAPRAM – increases cerebral O2 demand
underlying cause of cardiac arrest
inadequate cardiac oxygenation
what is the goal of CPR
maximize myocardial and cerebral oxygenation
T/F CPR success rates are poor overall in dogs and cats
True
35-45% have a return to spontaneous circulation (ROSC)
survival to discharge is only 2-10% → majority arrest again
CPA had a better/worse prognosis
better
50% survival at discharge
considerations for providing CPR
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?
code status
DNR
CPR - open vs. closed
ask BEFORE patient is admitted
how can you indicate the crash cart is ready for use
put tape over the front - if broken, its been used and should be stocked
what is the most important part of basic life support
chest compressions
an apneic, unresponsive patient should be assessed for less than _______ before startin compressions
5-10 secs
interruptions should be minimized - can have significant impact on blood flow
chest compressions only achieve _________of normal cardiac output
less than/equal to 25-30%
how often should you trade off person doing compressions
every 2 min
trade off without interruption
2 theories of chest compressions
cardiac pump theory - direct compression of ventricles, smaller patients
thoracic pump theory - increase intrathoracic pressure, larger patients
what determines where to do chest compressions
size and shape of patient
where are compressions performed with thoracic pump theory
over the widest part of the chest
rate and deptht of chest compressions
100-120 per min
1/3 -1/2 width of thorax - allow full thoracic recoil
indications for inernal cardiac massage
Conditions which prevent effective external cardiac compressions - Pericardial effusion, Pleural space disease
Other - Intraoperative cardiac arrest if abdomen is already open (diaphragmatic approach)
T/F intubation should be completed ASAP but without interruption of chest compressions
True
keep in lateral recombency
ventilation parameters
10 breaths/min
tidal volume 10 ml/kg
inspiratory time 1 second
what provides an indication of adequacy of cardiac compressions
EtCO2
should be >15-20 mmHg
sudden increase in EtCO2 indicates
ROSC - return to spontaneous circulation
draumatic increase in cardiac output and pulmonary circulation
what is an impedance threshold device (ITD)
fits between endo of ETT and ambubag/breathing circuit
created negative intrathroacic pressure→increases venous return (preload)
only useful in animals >10kgs
advanced life support systems
drugs and defibrillation
tx depends on arrest rhythm - determined by ECG
3 main arrest ryhthms seen on ECG
asystole
pulseless electrical activity
ventricular fibrillation
Is dedibrilation indicated with asystole/PEA
no - requires drug tx
vasopressor q EO cycle (3-5min) - epi or vasopressin
atropine q EO cycle (3-5min) - esp with high vagal tone
what are the shockable rhythms
Vfib /pulseless Vtach
should occur ASAP once Dx is made
MoA of defibrillation
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
welcome back to SAM - what rhythm is this
ventricular fibrillation
welcome back to SAM - what rhythm is this
ventricular tachycardia
how is a defibrillator used
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
what may be considered if defibrillation is not effective
amiodarone and lidocaine
what is used for torsades de pointes
magnesium
T/F all reversible anesthetic drugs that have been administered should be reversed during CPR
True
T/F calcium should not be routinely administered
True
documented hypoglycemia may be treated
T/F documented hyperK should be treated and hypoK may be treated
True
are corticosteroids recommended
NO!
when is administration of bicarb considered
after prolonged (10-15 min) CPR
IV fluids should be given only to _______patients
hypovolemic
which drugs can be given intratracheal
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
injections should NEVER be made into _________
myocardium (intracardiac)
what are some post cardiac arrest (PCA) syndromes
multiorgan failure
cardiogenic shock
anoxic brain injury
T/F physiologic (low) doses of steroids may be indicated post cardiac arrest
true
for stress - maintain GLU and vascular tone
