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Plunkett Emergency > CPR > Flashcards

CPR Flashcards

1
Q

What are the “ABC”s of Basic life support

A

Airway
Breathing
Cardiac massage

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2
Q

How should you assess the airway when a patient becomes apnic?

A

Extend patients mouth, extend tongue, palpate pharynx
Give 2-3 abdominal thrusts
If patient is still obstructed, perform tracheostomy
If no obstruction is noted, place an ET tube

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3
Q

How should you maintain breathing for basic life support?

A

Supply oxygen and give 1-2 gentle breaths lasting 1-2 seconds
If no continuous breathing noted, supply 15-20 breaths per minute at 20 cm H20 oxygen

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4
Q

Why is doxapram contraindicated in patients in arresting patients?

A

Decreases cerebral bloodflow

Increases cerebral oxygen consumption/ requirements

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5
Q

How should you maintain cardiac massage for basic life support?

A

Supply continuous, uninterrupted chest compressions

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6
Q

Where should you stand when performing chest compressions?

A

Have patient in left lateral recumbency (dorsal for a large-chest dog)
Begin compressions on 4-6 rib spaces
Press down with moderate force and allow the chest wall to completely rebound (repeating before this causes decreased survival chances)
Abdominal compression concurrently is not recommended

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7
Q

When is internal cardiac massage indicated?

A 
Dog > 20 kg
Unsuccessful external compressions
Pleural space dz (pneumo-, hemo-, chylo-, pyo-, hydrothorax)
Diaphragmatic hernias
Pericardial effusion
Hemothorax
Severe obesity
Intraoperative cardiac arrest
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8
Q

What four arrhythmias cause cardiac arrest?

A

Asystole
Ventricular tachycardia
Ventricular fibrillation
Pulseless electrical activity

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9
Q

What are causes of asystole?

A

Numerous medical cuases
Trauma
Increased vagal tone

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10
Q

What treatment options should be performed for asystole?

A

Treat underlying cause
Do not use defibrillation
Can use epinephrine, atropine, vasopressin

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11
Q

What causes ventricular tachycardia?

A 
Hypoxia
Pain
Ischemia
Sepsis
Electrolyte dysfunctions
Trauma
Pancreatitis
GDV
Cardiac disease
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12
Q

What are treatment options for V Tach?

A

Lidocaine
Amiodarone
Defibrillation

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13
Q

What is ventricular tachycardia?

A

Repetive firing of an ectopic foci in the ventricular myocardium or purkinje system –> can lead to ventricular fibrillation

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14
Q

What is ventricular fibrillation?

A

Unorganized ventricular excitement leading to poorly synchronized/ inadequate myocardial contractions leading to cardiac pump failure

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15
Q

How do you treat ventricular fibrillation?

A

Defibrillation

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16
Q

What is pulseless electrical activity?

A

Normal EKG and heart rate with no myocardial contractions

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17
Q

What treatment options are available for pulseless electrical activity?

A

Do not use defibrillation
Can try epinephrine, vasopression, atropine
Chest compressions
Prognosis is poor

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18
Q

What is defibrillation?

A

Electrical activity that depolarizes electrical activity

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19
Q

What are the two types of defibrillation?

A

Monophasic (uses higher enerygy)

Biphasic (uses lower energy)

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20
Q

What should the starting energy be used for a defibrillator?

A

2-5 J/kg

Chest compressions should be performed before and directly after a single shock for at least 2 minutes

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21
Q

What methods of drug administration can be used for CPR?

A

IV, intratracheal, intraosseous

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22
Q

What dosage should medications be given when intratracheal

A

Double the IV dose and diluted with sterile water

Give triple the IV dose for epinephrine

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23
Q

What is the mechanism of action of epinephrine?

A

Mixed adrenergic agonist, causes peripheral vasoconstriction

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24
Q

What is the effects of vasopressin?

A

This is a non-adrenergic endogenous pressor that causes peripheral, coronary, and renal vasoconstrictions
Causes preferential bloodflow to CNS and heart
Vasopressin doses can be repeated every 3-5 minutes

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25
What is atropine and what is its mechanism of action?
Anticholinergic parasympatholytic that effects muscarinic receptors Reverses parasympathetic stimulation to the heart, reduces hypotension, and increases systemic vascular resistance --> used for vagal-induced asystole
26
What is amiodarone and what is its mechanism of action?
Class III antiarrhythmic, prolongs myocardial cell action potential and refractory periods by altering Na, K, and Ca channels. Also is non-competitive for alpha and beta adrenergic inhibition
27
What is amiodarone used for?
V fib refractive to defibrillation A fib Narrow-complex superventricular tachycardia Ventricular tachycardia
28
What is lidocaine and what is its mechanism of action?
Class 1b antiarrhythmic that stabilized cell membranes by block Na channels
29
What can magnesium sulfate be used for?
Refractory ventricular arrhythmias
30
When should sodium bicarbonate be used as an emergency drug?
Tricyclic antidepressant overdose Pre-existing severe metabolic acidosis Severe hyperkalemia
31
When is IV calcium gluconate indicated? What is the dose?
Calcium channel blocker toxicity Hyperkalemia Ionized hypocalcemia Dose is 0.5 - 1.5 mL/kg slow over 10 minutes
32
Why is eTCO2 useful for monitoring?
- Decreased ETCO2 in humans was associated with decreased survival in humans
33
How can you assess cerebral bloodflow?
Place a dopple probe on a lubricated cornea
34
What is permissive hypothermia and why is it useful?
Intentionally lowering the temperature of an animal. Has been shown to reduce oxygen demand, reduces neuro impairment, and may improve chance of recovery from CPR Temp range is 90-93 F
35
Why are glucocorticoids contraindicated with head trauma?
Causes hyperglycemia --> worsens the prognosis
36
What four prognostic indicators indicate a poor prognosis in humans 24 hours after a neurologic event?
Absent corneal reflex Absent pupillary response Absent withdrawal from pain Absent motor response
37
What are common complications seen after resuscitation?
``` Cerebral edema Hypoxemia Reperfusion injury Abnormal hemostasis Acute renal failure Sepsis Multiple organ dysfunction syndrome ```
38
What radiographic signs can you see with left-sided heart failure?
Tracheal displacement Prominent pulmonary veins Pulmonary edema
39
What radiographic signs can you see with right-sided heart failure?
Pleural effusion Enlarged caudal vena cava Hepatomegaly
40
What is the normal vertebral heart score in dogs?
8.5 - 10.5
41
What is the normal vertebral heart score in cats?
6.7-8.0
42
What is the prognosis for congestive heart failure?
Fair to grave depending on clinical signs
43
What is the ideal Sp02 for a dog with congestive heart failure?
> 95% at room temperature
44
What medications are useful for congestive heart failulre?
``` Lasix Pimobendan ACE inhibitors Sedative (e.g. butorphanol) Bronchodilator as needed (e.g. aminophylline, theophyline, terubatline) Spironolactone for chronic therapy Do not use IV fluid unless necessary ```
45
What dog breeds are most commonly affected with dilated cardiomyopathy?
``` Older dogs: Doberman Pinschers Boxers Scottish Deerhounds Irish Wolfhounds Great Danes German Shepherds English/ American Cocker Spaniels ``` ``` Young dogs (< 6 mo) Portugese water dogs ```
46
What clinical signs are associated with DCM
``` Lethargy/ exercise intolerance Anorexia and weight loss Cough Dyspnea Tachypnea Abdominal distension Syncope Sudden Death ```
47
What physical exam findings are seen with DCM?
``` Poor peripheral pulses and pulse deficits Dull mentaion Cool extremities Decreased temp Prolonged CRT Harsh lung sounds Systolic L-sided heart murmur Gallup rhythm Jugular distension Hepatojugular reflex (pressure applied to cranial abdomen causes jugular distension) ```
48
What radiographic signs are noted with DCM?
``` Generalized cardiomegaly Alveolar or interstitial pattern or mixed pulmonary parenchymal pattern at the caudodorsal or perihilar areas --> seen with pulmonary edema Pulmonary venous distension Left mainstem bronchi compression Caudal vena cava enlargement Ascites Hepatomegaly ```
49
What arrhythmias are seen with DCM?
Tachycardia (common) Atrial premature contractions Atrial fibrillation Ventricular tachycardia
50
What are differentials/causes for dilated cardiomyopathy?
``` Taurine deficieny Chronic degenerative AV valve disease Myocarditits Pericardial effusion Heartworm Boxer arryhthmia ```
51
What is the prognosis for DCM in dogs?
Guarded to poor Average life span is 6 mo - 2 years Sudden cardiac death is a possibility
52
What medications should be used to treat occult DCM?
ACE inhibitors Beta blockers Spironolactone
53
What are physical exam findings of dogs with hypertrophic cardiomyopathy?
Dyspnea Moist rales Systolic murmur Gallop rhythm
54
What EKG findings are noted with HCM in dogs?
ST segment abnormalities T-wave abnormalities Atrial or ventricular arrhythmias
55
What is the prognosis for HCM in dogs?
Guarded to grave
56
What breeds of cats are predisposed to hypertrophic cardiomyopathy?
``` DSH Maine Coon Persians Ragdolls American Shorthair Mean age is 4-7 years old ```
57
What clinical signs are noted with cat in HCM?
``` Dyspnea, tachypnea, Cyanosis Hypothermia Harsh lung sounds and rales Poor body condition ```
58
What radiographic findings are noted with Feline HCM?
Generalized cardiomegaly Pulmonary venous dilation Possible valentine heart
59
What is an underlying cause of feline HCM?
Hyperthyroidism
60
What is the prognosis for feline HCM?
Fair to guarded
61
What is the common signalment for feline DCM?
Middle-aged to older male: Siamese Burmese Abyssinians
62
What is the prognosis for feline DCM?
Guarded to poor
63
What is a thormbus?
Aggregation of platelets and other elements that occludes a vessel in the heart
64
What is an embolus?
A fragment of a thrombus that breaks off the heart and travels to a distal location
65
What is Virchow's triad?
Static/ slowed blood flow Enothelial structure/ function abnormalities Hypercoaguable state secondary to procoagulant substances or decreased anticoagulant substances
66
What is the most common cause of thromboemboli in cats?
HCM
67
What is the most common cause of thromboemboli in dogs?
``` PLN PLE Pulmonary thromboembolism IMHA Major surgery (e,g. hip replacement) DIC Diabetes mellitus ```
68
What are the 5 Ps of thromboemboli?
``` Pain Paresis Pallor Pulselessness Poikilothermy (fluctuating body temperature) ```
69
What lab findings are seen with thromboemboli?
``` Azotemia Increased CK Lactate Hyperglycemia Lymphopenia Thrombocytopenia, prolonged PT/ PTT ```
70
How can you check for blood flow to a distal limb?
Feel for pulses | Attach a doppler
71
What is the prognosis for thromboemboli?
Guarded to poor | Permanent limb paralysis and gangrene are secondary complications
72
What are causes of pericardial effusion?
``` Neoplasia (hemangiosarcoma - **most common, chemodectoma, adenocarcinoma, lymphoma, thymoma, carcinoma undiffernetiated) Idiopathic CHF PPDH Pericardial cyst Infectious pericarditis (bacterial -Nocardia, Actinomyces, fungal - coccidiomycosis, viral - FIP, trypanosmal Uremia Cardiac rupture Trauma Foreign body Hypoalbuminemia Anticoagulant rodenticide ```
73
What physical exam findings are common with pericaridal effusion
``` Weakness Dyspnea Collapse Ascites Weak femoral pulses Muffled heart sounds Jugular pulse Sinus Tachycardia ```
74
What radiographs findings are noted with pericardial effusion?
Rounded globoid heart | Tracheal displacement if right atrial mass present
75
What is the prognosis with pericardial effusion?
Guarded to poor. | MST with HSC is 3-5 months with chemotherapy
76
What medications should be avoided with pericardial effusion?
Furosemide | ACE inhibitors
77
What is considered hypertension?
Arterial blood pressure (sys/dia) > 150/95 mmHg
78
What meds should be used for a pheochromocytoma?
Prazosin, phenoxybenzamine, phentolamine mesylate (alpha-adrenergic antagonist)
79
What is caval syndrome?
Condition with heartworm disease characterized by hemolytic anemia, decreased hemodynamics Occurs in large male sporting dogs Occurs in spring and early summer
80
What history is common with caval syndrome?
Sudden weakness, coughing, and collapse Hematuria Hemotypsis
81
What radiograph findings are seen with caval syndrome?
Distended caudal vena cava Enlarge main pulmonary arteryt Torturous pulmonary arteries
82
What is the prognosis for caval syndrome?
Guarded to grave
83
What is syncope?
Brief and temporary loss of consciousness due to a disturbance in cerebral blood flow from decreased cardiac output, cerebral vascular accident, hypoxemia, or hypoglycemia
84
What are cardiac causes of syncope?
``` Arrhythmias Congenital heart disease Acquired heart disease Thromboembolic disease Acute blood loss Hypotension ```
85
What are pulmonary causes of syncope?
``` Tracheal collapse Chronic bronchitis Violent coughing - cough drop syndrome Pulmonary hypertension Pulmonary emboli ```
86
What are neurogenic causes of syncope?
``` Glossopharyngeal neuralagia Vasovagal stimulaiton Postural hypotension Hyperventilation Embolic disease Neoplasia ```
87
What are miscellaneous causes of syncope?
Anemia Medications (acepromazine, digoxin, diuretics, vasodilators) Starvation Hypoglycemia
88
What are differential for syncope?
``` Seizure (syncope does not have pre or post ictal phases - may see opisthotonous, urination, crying in both) Addison's Hypokalemia Hemorrhage Hemangiosarcoma Narcolepsy Catalepsy ```
89
How are sycopal episodes diagnosed?
See what events occur before and after event | See if any medications (insulin, vasodilators, tranquilizers) are given before
90
How should syncopal episodes be treated?
Treat underlying cause | Use cough suppresants for cough-drop syndrome

Plunkett Emergency (8 decks)

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