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CPS > CPR > Flashcards

CPR Flashcards

1
Q

Wha happens if you get cerebral hypoxia?

A

• brain death within 4 to 6 minutes

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2
Q

What characterises CPA?

A 
Cardiopulmonary arrest (CPA) is characterized by acute failure of the respiratory and circulatory systems. 
–	Lack of oxygen delivery to tissues (DO2)
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3
Q

What can cause CPA? (Just name a few)

A
  • anaesthetic complications
  • severe trauma
  • severe electrolyte disturbances
  • hypovolemia
  • vagal stimulation
  • cardiac arrhythmias
  • cardiorespiratory disorders
  • debilitating or end-stage diseases
  • Myocardial hypoxia
  • Drugs and toxins
  • pH abnormalities
  • Electrolyte disturbances
  • Temperature problems
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4
Q

What is a Reversible disease process arrest?

A

e.g. Anaesthetic overdose, Bradycardia prior to arrest, Electrolyte imbalances e.g. hyperkalaemia (urethral obstruction)
With aggressive resuscitation these animals may survive

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5
Q

What is Advanced disease state arrest?

A

E.g. Sepsis, Cancer, Severe cardiac disease, Severe lung disease, Severe CNS disease
Assess if survival is likely. Reasonable to consider whether it is humane or appropriate to perform advanced life support in some cases
Some animals are resuscitated and the owner is faced with the responsibility for euthanizing their animal when faced with a dismal prognosis and mounting cost

Discuss DNR (do not resuscitate) order or DNAR (do not attempt resuscitation)

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6
Q

What are the signs of cardiopulmonary arrest? (make a diagram of this)

A
  • Apnoea or agonal gasping
  • No palpable pulse
  • Central eye position
  • Bleeding stops at surgical site
  • CRT altered (can be normal!)
  • Mucous membrane grey/blue/white
  • Pupils fixed and dilated
  • Dry cornea
  • No corneal reflex or palpebral reflex
  • General muscle flaccidity
  • Loss of consciousness
  • ECG arrhythmias (VF, asystole, PEA/EMD)
  • No heart sounds
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7
Q

What is BLS?

A

Basic life support describes
– Establishing an airway & ventilation
– Providing chest compressions

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8
Q

What is the A in CPR?

A

Establish an Airway
If apnoea is identified give 2-5 ‘rescue breaths’
If no ET tube/Ambu bag, use mouth to nose technique, room air is better than nothing!
Stimulation of the GV26 (Jen Chung) acupoint
– Intersection of the ’T’ formed below the nose, in the philtrum
Perform orotracheal intubation (which position)
– You will need laryngoscope and blades and suction

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9
Q

If you cannot establish an airway what should you do?

A

Emergency tracheostomy
– 3-5 cm midline incision ventral aspect of the neck parallel to the trachea about 2-4 cm caudal to the larynx
– Blunt dissection of tissue
– Insert trachesotomy tube between the rings

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10
Q

Absence of breathing means positive pressure ventilation (PPV) is needed, how do we do this?

A

Connect the ET tube to
– a self inflating resuscitation bag (AMBU bag)
– or an anaesthetic machine via a breathing circuit
– or to a demand valve

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11
Q

Current recommendations for veterinary CPR are to provide PPV at what rate?

A

PPV with oxygen at a rate of approx 10 breaths/minute

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12
Q

The femoral pulse, colour and heart sounds should be checked when?

A

within 30 seconds of initiating PPV

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13
Q

Normal heart activity is reliant on early restoration of myocardial oxygenation and blood flow - achieved by artificially generated stroke volumes, how do we do this?

A

– compressing the thorax (external cardiac compressions)

– or by squeezing the ventricles of the heart (internal cardiac compression)

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14
Q

How can the efficiency of external cardiac compressions be improved?

A
  • Efficiency of external cardiac compressions can be improved by either by performing alternate abdominal compressions (pushes the blood towards the heart during ‘diastole’)
  • This procedure requires another pair of hands…
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15
Q

When should you initiate the cardiac pump?

A

» Start as soon as CPA identified

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16
Q

How do you do the cardiac pump?

A

» Place patient in lateral recumbency on a hard surface
» Compress the thorax over the ventral 1/3 of the thorax between the 3rd and 6th ribs (directly over or encircling the heart)
» Aim for 100-120 compressions per minute devoting equal time to compression and relaxation

17
Q

How do you do the cardiac pump in cats and small puppies/ large dogs ?

A

• For cats and small puppies the thorax can be compressed between thumb and forefinger

In barrel or broad chested dogs
– sternal compressions in dorsal recumbency may be needed to provide the cardiac pump

18
Q

When is the cardiac pump inefficient?

A

The cardiac pump is inefficient in:
– Deep chested animals >20kg
– Obese animals
– Animals with microcardia pericardial effusion or low thoracic compliance e.g. a pneumothorax

19
Q

When the cardiac pump is inefficient what should you do instead?

A

» In animals over 20kg the major contributor to cerebral blood flow is the thoracic pump
» This describes using both the ventricular chambers of the heart and the intrathoracic vascular system for generating stroke volume

20
Q

How do you do the thoracic pump?

A

» Tilt head down slightly
» Compress the thorax over the widest part of the rib cage (the junction of the dorsal and middle 1/3rd of the 6-7th rib
» Aim for 60 -120 compressions per minute devoting equal time to compression and relaxation
» Inflate the lungs simultaneously (10 breaths/min)
» Do 30:2 ratio if you are alone (30 compressions, then 2 breaths)
» Remember you are trying to increase intrathoracic pressure and not compress the ventricle of the heart

21
Q

How can you tell if you are making progress with the CPR?

A

– During compression a pulse can be palpated
– Colour of mucous membrane improves
– Eye position changes (central à ventromedial)
– Pupil changes size
– ECG changes
– Palpebral, corneal, gag reflex may be noticed
– Breathing or chest movements (twitches) resume
– Lacrimation
– Animal regains consciousness

22
Q

If you cannot see progress with 2 mins what should you do?

A

advanced life support (ALS)
» (Emergency thoracotomy and internal cardiac compressions – unusual see below for further notes) Supervet style
» (resuscitative drugs and externally defibrillate)

23
Q

What are the 4 possible outcomes of the ECG? Draw them

A
  • Asystole
  • Ventricular fibrillation (maybe preceded by ventricular tachycardia)
  • Sinus bradycardia
  • Electromechanical dissociation (EMD) now known as pulseless electrical activity (PEA)
24
Q

What will administering Adrenaline/Epinephrine during CPR do?

A

Adrenergic agonist: stimulates alpha & beta receptors
Causing increased myocardial contractility, increased heart rate, increased myocardial automaticity and increased myocardial oxygen consumption

The drug is administered during CPR mainly for its alpha 2 adrenergic receptor stimulating effects
• This result in the shunting of blood to the brain, heart and lung
• Adrenaline increases heart rate, blood pressure and blood flow

25
Q

When would you use Adrenaline/Epinephrine?

A

Use when you have asystole, atropine resistant bradyarrhythmias & poor diastolic filling

26
Q

The alpha 2 adrenergic effects of adrenaline/epi include…

A

peripheral arteriolar vasoconstriction, which leads to increased coronary and cerebral perfusion pressure.
This overcomes the beta2 agonist effects (hypotension)

27
Q

The alpha 1-agonist effects of administering adrenaline/epi can be

A

detrimental to the myocardium by increasing myocardial oxygen demands and causing intramyocardial coronary arteriolar vasoconstriction and enhancing the reduction in myocardial perfusion

28
Q

What are the effects of atropine?

A
  • Atropine increases heart rate, controls hypotension, and increases systemic vascular resistance
  • As a vagolytic, it is most effective in the treatment of vagal induced asystole
  • Atropine sulfate is an anticholinergic parasympatholytic that is effective at muscarinic
29
Q

When would you use atropine in CPR?

A

• In dogs and cats with asystole or PEA potentially associated with increased vagal tone, use of atropine is reasonable.

30
Q

How can you administer CPR drugs by IV?

A

» Cranial vena cava (IV)
– Route of choice for drugs & fluids
– Tricky during CPCR because of the movement

31
Q

How can you administer CPR drugs intraosseously?

A

» Intraosseous route (IO)
– As rapid as peripheral veins
– Useful in small animals, very collapsed animals and birds
– Sites used include the greater tubercle of the humerus, tibial crest or trochanteric fossa of the femur

32
Q

How can you administer CPR drugs by the trachea?

A

» Intratracheal (IT)
– Dilute and use urinary catheter inserted beyond carina
– Give several large chest inflations to distribute the drugs
– Higher doses are needed

33
Q

After resuscitation animals are at risk of…

A

– Acute anuric renal failure
– DIC (disseminated intravascular coagulation)
– Shock gut (gut reperfusion syndrome)
– SIRS (systemic inflammatory response syndrome)
– Brain injury – blindness, coma, seizures
– Hypothermia

CPS (16 decks)

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