CPR and Triage Flashcards
Identify the important components of a triage assessment
- Does it need immediate care/assessment?
- What is affected?
Cardiovascular? Breathing?Neurological?Skeletal? Soft tissue?
Discuss life sustaining interventions in primary triage and use of point of care diagnostics
Primary triage focuses on life-sustaining systems and their preservation/management. These systems are ABCD or Airway, Breathing, Circulation and Demeanour (brain). Supportive treatments include cpr, intubation, oxygenation, , defibrillation, fluids, pan relief, anti-seizure medication, thoracocentesis,bandaging, warming/cooling as required.
Point of care diagnostics include bg,tp, electrolytes, lactate, pcv, blood gases, acid/base balance, afast/tfast u/s.
Explain the secondary triage survey and assessments
Once out of immediate danger, more thorough examinations can be performed. Plans for further diagnostic work up can be made. Full bloods and imaging etc.Implement meds such as pain relief, anti-emetics, antibiotics etc.
List the clinical signs of cardiopulmonary arrest (CPA)
No breathing (or agonal gasping), no heart beat, no pulse, dilated pupils, no mentation.
Explain basic life support (BLS) and cardiopulmonary resuscitation (CPR)
Basic life support= support of heart and or breathing. Cardiopulmonary resuscitation is a form of basic life support.
Describe recommended techniques for chest compressions and ventilatory support
COMPRESSIONS;
Technique will vary with size of animal. 100-120
chest compressions /minute. Do for 2 minutes before changing personnel/reassessing. Even good quality compressions might only achieve 30% normal cardiac output.
a) Cardiac pump; results in compression of cardiac ventricles. Method varies with patient size. Keel-chested dogs do in lateral with both hands same position over heart. Barrel-chested dogs in sternal with both hands over heart. Little dogs/cats in lateral with one hand around chest.
b) Thoracic pump; results in compressions of the thorax, resulting in increased intra-thoracic pressure therefore blood flows out of thorax. Then recoils and decreased intra-thoracic pressure and blood flows back. Only used on giant breeds. Lateral recumbency. both hands are on widest part of chest, not directly over heart.
PRE-CORDIAL THUMP direct thump applied over heart if there is a shockable rhythm but no defibrillator available. Far less successful than defibrillation.
VENTILATORY SUPPORT;
a) non intubated or single operator; ventilate by mouth to patient nose. 30 chest compressions then 2 breaths. repeat.
b) intubated and multiple operators: do not delay intubation but do so very quickly Cuff should be inflated. Use 100% oxygen. 10 breaths per minute. Tidal volume 10ml/kg.Inspiratory time is only 1 sec. Allow time for expiration. Too high an inspiratory rate will result in increase intrathoracic pressure and which leads to decreased coronary and cerebral perfusion.
Describe monitoring devices used in advanced life support (ALS)
Advanced Life support includes ecg monitoring, CO2 monitoring at ET tube, i/v access and i/v drugs.
Ideally ECG will be one not malfunctioning if still connected to patient when use defibrillation (or might be part of a defibrillation machine).
Note pulse oximetry inaccurate during chest compressions.
DEFIBRILLATORS usually have dial up power setting. Usually start at 2-4 joules per kg. Must reach charge before can use. Then to use, need to hit discharge buttons on both paddles simultaneously. Patient must be in dorsal recumbency to use defibrillator. Shave patient and apply gel. Must not touch paddles to table or self or others. Some machines have smaller sized paddles for smaller patients. Some machines have pacemaker ability. When have defibrillated, tales 30-60 seconds to see if been successful, so need to go from chest compressions to defib, back to chest compressions immediately.
ETC02; helps assess correct et tube placement. If cpr is effective, CO2 exchange operates and CO2 increases in expired air. During chest compressions, aim to keep ETCO2 at >15mmHg dogs, and >20mmHg cats. If return of spontaneous respiration is achieved, the ETCO2 will suddenly markedly increase.
Identify shockable and non-shockable rhythms in CPR and how to treat
ASYSTOLE;most common arrest rhythm. Flatline. NOT a shockable rhythm. Tx with vasopressors and adrenaline.
PULSELESS ELECTRICAL ACTIVITY; normal or abnormal repeatable traces on ecg but no heart sounds or pulse. NOT a shockable rhythm. Use vasopressors and adrenaline.
PULSELESS VENTRICULAR TACHYCARDIA;
Wide QRS complexes, no P waves, rapid heart rate.
Organised electrical activity is present and the rate is high, but there is no detectable cardiac output.
Repeated firing of ectopic focus in ventricular myocardium or Purkinje system. Can precipitate ventricular fibrillation. Shockable rhythm. Treat with defibrillation.
VENTRICULAR FIBRILLATION;
Lack of recognizable P waves and QRS-T complexes. Unorganised ventricular excitation resulting in poorly synchronised, inadequate myocardial contractions.
More coarse VF with higher amplitude waves may be more amenable to defibrillating shock therapy. Shockable rhythm. Treat with defibrillation.
Discuss medications potentially used during CPR
AMIODARONE; 5mg/kg i/v. Indications; VFib or VTachy which has been resistant to defibrillation. Side effects; allergic reaction (dogs) and hypotension.
LIGNOCAINE; 2mg/kg slow i/v (1-2min). Indications: pulseless Vtachy or Vfib if resistant to defibrillation or if amiodarone not available.
I/V FLUIDS-not if euvolaemic.
CORTICOSTEROIDS; not recommended (unless anaphylaxis)
ELECTROLYTES; can tx documeneted severe hypocalcaemia or hyperkalaemia. consider sodium bicarb to treat acidosis eg after prolonged (10-15min) of cpr. (1mEq/kg slow i/v may cause paradoxical cerebral acidosis).
