CPR - Cardiopulmonary Resuscitation and Recover Guidelines Flashcards
1
Q
What is cardiopulmonary arrest (CPA)?
A
It is acute failure of the respiratory and circulatory systems
2
Q
What three things does CPA cause?
A
- lack of oxygen to tissues (Do2)
- Unconciousness and systemic cellular death
- Cerebral hypoxia
3
Q
Name 13 reasons which might cause CPA?
A
- anaesthetic complications
- Severe trauma
- severe electrolyte disturbances
- Hypovolaemia - volume loss
- Vagal stimulation e.g. eye surgery
- Cardiac arrhythmias
- cardiorespiratory disorders
- Debilitating or end-stage diseases (metastases)
- Myocardiac hypoxia
- Drugs and toxins
- pH abnormalities
- Electrolyte disturbances
- Temperature problems
4
Q
What is the prognosis in aminals following resuscitation?
A
Poor
5
Q
Why has the highest rate of CPR success, dogs or cats?
A
Cats
6
Q
There are two types of arrest, what are they?
A
- reversible disease process e.g. bradycardia or hyperkalaemia
- Advanced disease state e.g. sepsis, cancer, severe cardiac disease
7
Q
What is sensible to discuss before anaesthesia?
A
DNR - do not resuscitate
8
Q
Name 7 ways in which a team can show preparedness?
A
- CPCR protocol available
- Regular staff training of all staff
- Team leader
- Crash cart/ box - location, storage and content regularly checked., drugs drawn up and refreshed every month
- contains necessary drugs and equipment
- Preferably portal
- contains checklists and algorithms and dosing charts.
9
Q
Name 13 signs of cardiopulmonary arrest?
A
- Apnoea or agonal gasping
- No palpable pulse
- Central eye position
- Bleeding stops at surgical site
- CRT altered (can be normal)
- Mucus membrane grey/ blue/ white
- Pupils fixed and dilated
- Dry cornea
- No corneal reflex or palpebral reflex
- general muscle Faccidity
- Loss of consciousness
- ECG arrythmias (VF, asystole, PEA/EMD)
- No heart sounds
10
Q
What is PEA?
A
Pulseless Electrical Activity
11
Q
What is EMD?
A
Electrochemical Dissociation
12
Q
When would you discuss not responding with an animal?
A
With an old, sick animal.
13
Q
What are the 5 stages to basic life support?
A
- Chest compressions (1 full cycle = 2 minutes)
- Ventilation (30:2) or 10/min once intubated and simultaneous compressions
- Initiate monitoring - ECG, End tidal volume Co2 (>15mmHg) = good compressions
- Obtain vascular access
- Administer reversals
14
Q
What is the opioid reversal?
A
Naxalone
15
Q
A2 agonist reversal?
A
Atipamezole
16
Q
Benzodiazepines?
A
Flumazenil
17
Q
Once the patient has been re-evaluated, what are the two possible outcomes?
A
- VF/ pulseless VF
2. Asystole/ PEA
18
Q
What do you do if animal is pulseless VT/ VF? 5 things.
A
- continue BLS, charge defibrilator
- clear and give 1 shock or precordial thump
- amiodarone or lidocaine
- epinephrine or vasopressin every other cycle
- increase defibrillator dose by 50%
19
Q
What do you do if there is no defibrillator available?
A
Precordial thump
20
Q
What do you do if there is Asystole/ PEA following BLS?
A
- low dose epinephrine/ or vasopressin every other cycle
- Atropine every other cycle
- high dose epinephrine
- Bicarbonate therapy
21
Q
How long is one full cycle of basic life support in CPR?
A
2 minutes.
22
Q
What is the first thing you should do if an animal goes into cardiac arrest?
A
Call for help!
23
Q
What is the minimum number of people you need for effective CPR?
A
3
24
Q
What follows calling for help?
A
Beginning compressions
25
What to do if apnoea is identified and no ET tube/AMBU bag?
Give 2-5 'rescue breaths' - mouth to nose.
26
What else can you stimulate if the animal is not breathing and where is this and with what?
GV26 acupoint which is in the T of the philtrum below the nose. Stimulate by inserting 22G needle.
27
What needs to be placed to aid ventilation?
Perform orotracheal intubation
28
which recumbency can lead to a single person intubating?
Dorsal.
29
What guides intubation?
Laryngoscope and blades.
30
Name two other methods that will aid ventilation?
Suction or an emergency tracheotomy.
31
Where is tracheaotomy tube inserted?
3-5cm incision ventral aspect of the neck, parallel to trachea about 2-4 cm caudal to the larynx.
32
What flow rates should be used initially if the animal is connected to oxygen release valve?
50ml/kg initially on 100% oxygen.
33
What needs to be done for the A in ABC 'airways? 5 things
1. ET tube
2. AMBU bag
3. Nose to mouth
4. Stimulation of GV26 acupoint
5, Tracheostomy
34
Absence of breathing means what is needed?
IPPV
35
What do you need to do for IPPV?
Connect ET tube to AMBU bag or anaesthetic machine ore demand valve to clip into oxygen.
36
What rate of PPV needs to be delivered?
10 breaths/ min
37
What happens if you over-ventilate?
hyocapnia, haemorrhage of the lungs and pneumothorax
38
Name 5 reasons the ventilation might not work?
1. tube malposition
2. obstruction
3. pneumothorax
4. diaphragmatic hernia
5. pleural disease
39
When should the femoral pulse, colour and heart sounds be checked after starting IPPV?
Within 30 seconds of initiating IPPV.
40
what are the two main methods to stimulate normal heart activity to resume circulation?
1. compressing the thorax (externally)
| 2. squeezing the ventricles of the heart (internal cardiac compressions)
41
What is it known as when blood is forced through the heart and vessels with compressions?
The cardiac pump
42
How should the patient be placed during the cardiac pump?
in lateral recumbency on a hard surface.
43
Where should the thorax be compressed?
Over the ventral 1/3 of the thorax between the 3rd and 6th ribs, directly over the heart.
44
How many compressions a minute?
100-120
45
What abut in big dogs?
probably around 80 compressions a minute.
46
How often does the compressor change roles?
every 2 mins.
47
Where should chest compressions take place in barrel or broad chested dogs?
The dog should be in dorsal recumbency and compressions should take place over the sternum
48
Name three situations in which the cardiac pump is inefficient?
1. deep chested animals >20kg
2. obese animals
3. Animals with microcardia, pericardial effusion or low thoracic compliance e.g. a pneumothorax.
49
In animals over 20kg, what is the major contributor to cerebral blood flow?
The thoracic pump.
50
What is the thoracic pump?
this relies on the hearts ventricles and the intrathoracic vascular system to generate a stroke volume.
51
What recumbency should animals be in for the thoracic pump?
lateral recumbency on a hard surface
52
Where should thoracic pump compressions take place?
compress over the widest part of the rib cage (the junction of the dorsal and middle 1/3 of the 6-7th rib)
53
What does the thoracic pump cause?
Change of pressure which draws blood into the heart from the blood vessels.
54
how many thoracic pump compressions are we aiming for a minute?
60-120 per min
55
How many inflation of the lung per minute?
10
56
Name two situations where the thoracic pump will not be effective?
Severe hypovolaemia
| Incompetent tricuspid valves.
57
What is the golden rule when doing chest compressions?
DO NOT STOP!
58
What should take priority over difficult intubations?
Chest compressions
59
Name two things which might improve the efficiency of cardiac compressions?
Alternate abdominal compressions (would need another person), put tape around hind legs to push blood towards heart,
60
What happens if none of these signs are seen within the first 2 minutes?
1. Decide to proceed to advanced life support (ALS)
2. Emergency thoracotomy and internal cardiac compressions
3. resuscitate drugs and externally defibrilate
61
What is the CO following external cardiac chest compressions?
13-17%
62
What is the CO following internal cardiac compressions?
50-71%
63
Drugs should never replace what?
ABC/CAB or resuscitation
64
What determines the drugs which are administered?
ECG
65
What are the 4 rhythms of ECG that could be seen?1 .
1. Asystole
2. Ventricular fibrillation
3. Sinus bradycardia
4. PEA/EMD
66
What does PEA/EMD look like on ECG?
A normal ECG
67
If there is no ECG available, what would you administer the animal?
Often just administer adrenaline.
68
What receptors does adrenaline/ epinephrine stimulate?
Alpha and beta receptors
69
Is epinephrine a vasoconstrictor or a vasodilator? What could this mean?
It is a vasoconstrictor therefore at high doses, might stop blood flow to the brain.
70
Name 4 effects that adrenaline will have on the heart?
1. increased myocardial contractility
2. increased heart rate
3. increased myocardial automaticity
4. increased myocardial oxygen consumption
71
What is the main reason adrenaline is administered during CPR?
For its alpha 2 adrenergic receptor stimulating effects - VASOCONSTRICTION!
72
Stimulation of the alpha 2 adrenergic receptors will result in what?
Shunting of the blood to the brain, heart and lung
73
What does adrenaline increase?
heart rate, blood pressure and blood flow.
74
What is the heart resistant to when there is asystole?
Atropine
75
What else could we administer and what does it cause?
Vasopressin - causes vasoconstriction and improved cerebral perfusion by causing dilatation of cerebral vasculature.
76
What does atropine do and why is it important in small animals?
Increases heart rate and is important due to the high incidence of vagally mediated bradycardia.
77
Describe three things that atropine achieves?
1. increases heart rate
2. controls hypotension
3. increases systemic vascular resistance
78
What type of drug is atropine and what does this mean?
it is a vagolytic therefore effective in treating vagal induced asystole.
79
Name 4 drugs which can be given for arrest?
1. low dose epinephrine
2. high dose epinephrine
3. atropine
4. vasopressin
80
Name 2 drugs which can be given for anti-arrythms?
1. amiodarone
| 2. lidocaine
81
What is the route of choice for drugs and fluids?
Cranial vena cava (IV)
82
How does the drug reach the heart?
Needs to be pushed to the heart with 20ml fluid behind it - this gives adequate stroke volume to push it around the body.c
83
What is the speed of uptake of intraosseous route?
As rapid as the peripheral veins
84
what is the downfall of intraosseous injection?
Need enough stroke volume for blood to reach bones.
85
What is the third route of drug administration when in cardiac arrest?
Intratracheal (IT)
86
What happens during IT administration?
Dilute and use urinary catheter inserted beyond carina.
87
how do we distribute the IT administration?
Give several large chest inflations to distribute the drugs. Follow the drugs with 5ml water (will not drown)
88
When can the pulmonary vein be accessed?
Rarely during open chest resuscitation.
89
What is another administration route that is not recommended to to lack of accuracy?
Intra-cardiac (1/2 IV dose)
90
Name another route which might be possible for very small patients e.g. paediatric dogs and cats?
Intralingual
91
When are intravenous fluids not required?
With hypervolaemic or euvolaemic patients.
92
When are intravenous fluids required?
Cats or dogs with hypovolaemia
93
What is the only way to convert AF arrest rhythm (20%)?
Electrical defibrillation
94
What is required for use of a defibrillator?
Training
95
What do we want to see on capnography?
>15-20mmHg
96
What are animals that have undergone return of spontaneous circulation (ROSC) prone to?
Re-arresting and will usually require significant support.
97
What % of dogs re-arrest?
68% dogs
98
what % of cats re-arrest?
37.5%
99
Name 6 conditions animals are at risk of following ROSC?
1. Brain injury - blindness, seizures and coma.
2. SIRs (systemic inflammatory response)
3. Acute anuric renal failure
4. DIC (disseminated intravascular coagulation)
5. Shock gut (gut will not re-perfuse)
6. Hypothermia
100
What can help to protect cerebral perfusion?
Making sure the arterial pressure is not too high or too low. MAP control is important.
101
What controls the MAP? 3 things.
Vasopressin, fluid therapy and inotropes.
102
Which animals should be treated with vasopressins or anticholinergic drugs?
PEA/EMD or Asystole
103
Which animals should be treated with a defibrilator?
VF or Pulseness VT.
104
describe 8 things that are important in the follow up treatment of the animal?
1. A head up position will also help alleviate increases in ICP
2. Animals that are breathing un-assisted will benefit from an oxygen-enriched environment
3. seizures can be common
4. Don't overheat the animal
5. Renal function is very important
6. the bladder should be catheterised and urine output monitored
7. consider analgesia and sedation
8. good nursing is essential
105
Why must animals not be post ROSC over-heated?
Because this increases the cerebral oxygen demand.
106
What therefore increases the success rate following CPR?
permissive hypothermia - diminishes oxygen demands and reduces neurological impairment.
