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Plunkett Emergency > CPR > Flashcards

CPR Flashcards

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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
Q

What is atropine and what is its mechanism of action?

A

Anticholinergic parasympatholytic that effects muscarinic receptors
Reverses parasympathetic stimulation to the heart, reduces hypotension, and increases systemic vascular resistance –> used for vagal-induced asystole

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26
Q

What is amiodarone and what is its mechanism of action?

A

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

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27
Q

What is amiodarone used for?

A

V fib refractive to defibrillation
A fib
Narrow-complex superventricular tachycardia
Ventricular tachycardia

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28
Q

What is lidocaine and what is its mechanism of action?

A

Class 1b antiarrhythmic that stabilized cell membranes by block Na channels

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29
Q

What can magnesium sulfate be used for?

A

Refractory ventricular arrhythmias

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30
Q

When should sodium bicarbonate be used as an emergency drug?

A

Tricyclic antidepressant overdose
Pre-existing severe metabolic acidosis
Severe hyperkalemia

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31
Q

When is IV calcium gluconate indicated? What is the dose?

A

Calcium channel blocker toxicity
Hyperkalemia
Ionized hypocalcemia
Dose is 0.5 - 1.5 mL/kg slow over 10 minutes

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32
Q

Why is eTCO2 useful for monitoring?

A
  • Decreased ETCO2 in humans was associated with decreased survival in humans
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33
Q

How can you assess cerebral bloodflow?

A

Place a dopple probe on a lubricated cornea

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34
Q

What is permissive hypothermia and why is it useful?

A

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

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35
Q

Why are glucocorticoids contraindicated with head trauma?

A

Causes hyperglycemia –> worsens the prognosis

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36
Q

What four prognostic indicators indicate a poor prognosis in humans 24 hours after a neurologic event?

A

Absent corneal reflex
Absent pupillary response
Absent withdrawal from pain
Absent motor response

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37
Q

What are common complications seen after resuscitation?

A 
Cerebral edema 
Hypoxemia
Reperfusion injury
Abnormal hemostasis
Acute renal failure
Sepsis
Multiple organ dysfunction syndrome
38
Q

What radiographic signs can you see with left-sided heart failure?

A

Tracheal displacement
Prominent pulmonary veins
Pulmonary edema

39
Q

What radiographic signs can you see with right-sided heart failure?

A

Pleural effusion
Enlarged caudal vena cava
Hepatomegaly

40
Q

What is the normal vertebral heart score in dogs?

A

8.5 - 10.5

41
Q

What is the normal vertebral heart score in cats?

A

6.7-8.0

42
Q

What is the prognosis for congestive heart failure?

A

Fair to grave depending on clinical signs

43
Q

What is the ideal Sp02 for a dog with congestive heart failure?

A

> 95% at room temperature

44
Q

What medications are useful for congestive heart failulre?

A 
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
Q

What dog breeds are most commonly affected with dilated cardiomyopathy?

A 
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
Q

What clinical signs are associated with DCM

A 
Lethargy/ exercise intolerance
Anorexia and weight loss
Cough
Dyspnea
Tachypnea
Abdominal distension
Syncope
Sudden Death
47
Q

What physical exam findings are seen with DCM?

A 
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
Q

What radiographic signs are noted with DCM?

A 
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
Q

What arrhythmias are seen with DCM?

A

Tachycardia (common)
Atrial premature contractions
Atrial fibrillation
Ventricular tachycardia

50
Q

What are differentials/causes for dilated cardiomyopathy?

A 
Taurine deficieny
Chronic degenerative AV valve disease
Myocarditits
Pericardial effusion
Heartworm
Boxer arryhthmia
51
Q

What is the prognosis for DCM in dogs?

A

Guarded to poor
Average life span is 6 mo - 2 years
Sudden cardiac death is a possibility

52
Q

What medications should be used to treat occult DCM?

A

ACE inhibitors
Beta blockers
Spironolactone

53
Q

What are physical exam findings of dogs with hypertrophic cardiomyopathy?

A

Dyspnea
Moist rales
Systolic murmur
Gallop rhythm

54
Q

What EKG findings are noted with HCM in dogs?

A

ST segment abnormalities
T-wave abnormalities
Atrial or ventricular arrhythmias

55
Q

What is the prognosis for HCM in dogs?

A

Guarded to grave

56
Q

What breeds of cats are predisposed to hypertrophic cardiomyopathy?

A 
DSH
Maine Coon
Persians
Ragdolls
American Shorthair
Mean age is 4-7 years old
57
Q

What clinical signs are noted with cat in HCM?

A 
Dyspnea, tachypnea,
Cyanosis
Hypothermia
Harsh lung sounds and rales
Poor body condition
58
Q

What radiographic findings are noted with Feline HCM?

A

Generalized cardiomegaly
Pulmonary venous dilation
Possible valentine heart

59
Q

What is an underlying cause of feline HCM?

A

Hyperthyroidism

60
Q

What is the prognosis for feline HCM?

A

Fair to guarded

61
Q

What is the common signalment for feline DCM?

A

Middle-aged to older male:
Siamese
Burmese
Abyssinians

62
Q

What is the prognosis for feline DCM?

A

Guarded to poor

63
Q

What is a thormbus?

A

Aggregation of platelets and other elements that occludes a vessel in the heart

64
Q

What is an embolus?

A

A fragment of a thrombus that breaks off the heart and travels to a distal location

65
Q

What is Virchow’s triad?

A

Static/ slowed blood flow
Enothelial structure/ function abnormalities
Hypercoaguable state secondary to procoagulant substances or decreased anticoagulant substances

66
Q

What is the most common cause of thromboemboli in cats?

A

HCM

67
Q

What is the most common cause of thromboemboli in dogs?

A 
PLN
PLE
Pulmonary thromboembolism
IMHA
Major surgery (e,g. hip replacement)
DIC
Diabetes mellitus
68
Q

What are the 5 Ps of thromboemboli?

A 
Pain
Paresis
Pallor
Pulselessness
Poikilothermy (fluctuating body temperature)
69
Q

What lab findings are seen with thromboemboli?

A 
Azotemia
Increased CK
Lactate
Hyperglycemia
Lymphopenia
Thrombocytopenia, prolonged PT/ PTT
70
Q

How can you check for blood flow to a distal limb?

A

Feel for pulses

Attach a doppler

71
Q

What is the prognosis for thromboemboli?

A

Guarded to poor

Permanent limb paralysis and gangrene are secondary complications

72
Q

What are causes of pericardial effusion?

A 
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
Q

What physical exam findings are common with pericaridal effusion

A 
Weakness
Dyspnea
Collapse
Ascites 
Weak femoral pulses
Muffled heart sounds
Jugular pulse
Sinus Tachycardia
74
Q

What radiographs findings are noted with pericardial effusion?

A

Rounded globoid heart

Tracheal displacement if right atrial mass present

75
Q

What is the prognosis with pericardial effusion?

A

Guarded to poor.

MST with HSC is 3-5 months with chemotherapy

76
Q

What medications should be avoided with pericardial effusion?

A

Furosemide

ACE inhibitors

77
Q

What is considered hypertension?

A

Arterial blood pressure (sys/dia) > 150/95 mmHg

78
Q

What meds should be used for a pheochromocytoma?

A

Prazosin, phenoxybenzamine, phentolamine mesylate (alpha-adrenergic antagonist)

79
Q

What is caval syndrome?

A

Condition with heartworm disease characterized by hemolytic anemia, decreased hemodynamics
Occurs in large male sporting dogs
Occurs in spring and early summer

80
Q

What history is common with caval syndrome?

A

Sudden weakness, coughing, and collapse
Hematuria
Hemotypsis

81
Q

What radiograph findings are seen with caval syndrome?

A

Distended caudal vena cava
Enlarge main pulmonary arteryt
Torturous pulmonary arteries

82
Q

What is the prognosis for caval syndrome?

A

Guarded to grave

83
Q

What is syncope?

A

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
Q

What are cardiac causes of syncope?

A 
Arrhythmias
Congenital heart disease
Acquired heart disease
Thromboembolic disease
Acute blood loss
Hypotension
85
Q

What are pulmonary causes of syncope?

A 
Tracheal collapse
Chronic bronchitis
Violent coughing - cough drop syndrome
Pulmonary hypertension
Pulmonary emboli
86
Q

What are neurogenic causes of syncope?

A 
Glossopharyngeal neuralagia
Vasovagal stimulaiton
Postural hypotension
Hyperventilation
Embolic disease
Neoplasia
87
Q

What are miscellaneous causes of syncope?

A

Anemia
Medications (acepromazine, digoxin, diuretics, vasodilators)
Starvation
Hypoglycemia

88
Q

What are differential for syncope?

A 
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
Q

How are sycopal episodes diagnosed?

A

See what events occur before and after event

See if any medications (insulin, vasodilators, tranquilizers) are given before

90
Q

How should syncopal episodes be treated?

A

Treat underlying cause

Use cough suppresants for cough-drop syndrome

Plunkett Emergency (8 decks)

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