CPR & Placing An Airway

Question 1

How do you assess an unconscious patient?

Answer 1

Assessment should be undertaken rapidly, within 5-10 seconds

1. Airway: is the airway patent?
   - best way to ensure airway is patent is to undertake endotracheal (ET) intubation
   - patient should be positioned so snout is aligned with the spine, ensures airway is open and prevents positional occlusion of airway
2. Breathing: can you see evidence of the patient breathing?
   - pluck a little fur and place near the mouth/snout; if animal exhales you should notice displacement of fur
   - take care when watching chest for evidence of movement
   - if animal is NOT breathing, start CPR immediately
3. Circulation: is there evidence of cardiac function?
   - pulse palpation; (SA) femoral artery located on the medial thigh

Question 2

What is cardiopulmonary arrest (CPA)?

Answer 2

CPA is a severe emergency

-> patient has stopped breathing (respiratory arrest)
-> patient’s heart has stopped beating (cardiac arrest)
-> patient is close to death so basic life support must be administered ASAP using CPR

The longer CPR is delayed the more likely a patient will not recover or will suffer brain damage

Question 3

What are the components of CPR?

Answer 3

1. Chest compressions
2. Ventilation
3. Chest compressions:
   Should started immediately and usually in lateral recumbency for most dogs/cats
4. Ventilation:
   2 personnel available - ventilation should be performed simultaneously with chest compressions
   Ideally ached via ET intubation and intermittent positive pressure ventilation (IPPV) using pure oxygen and reservoir bag of breathing circuit
   Can also blow down ET tube if you do not have access to pure oxygen (will only be 15% O2)
   If ET tube not readily available, mouth to snot ventilation can be utilised

Question 4

What is the cardiac pump theory?

Answer 4

During CPR cardiac ventricles are directly compressed
Lateral recumbency - between ribs
Dorsal recumbency - between sternum and spine

Increases pressure in ventricles -> forces blood out of heart to lungs and tissues

Between compressions - relaxation of ventricles - allows blood to return to the heart from lungs and periphery - filling of ventricles

Question 5

What is the thoracic pump theory?

Answer 5

During CPR chest compressions increase intra-thoracic pressure
-> compresses aorta and vena cava - blood forced out of thorax

Between compressions - elastic recoil of chest leads to reduced intrathoracic pressure - draws blood back into the thorax and lungs fro periphery

Question 6

How should CPR be performed in “round-chested” dogs?

Answer 6

-> In lateral recumbency (left or right)
-> Direct compression of heart unlikely
-> Thoracic pump more easily achieved -apply compressions over widest portion of chest

Question 7

How do you perform CPR in a “round-chested” dog?

Answer 7

-> In lateral recumbency (left or right)
-> Direct compression of heart unlikely
-> Thoracic pump theory more easily achieved - apply compressions over widest portion of chest

Question 8

How do you perform CPR in a “narrow-chested” dog?

Answer 8

-> In lateral recumbency (left or right)
-> Cardaiac pump theory more easily achieved - apply compressions directly over heart

Question 9

How do you perform CPR in “barrel-chested” dogs?

Answer 9

-> In dorsal a recumbency
-> Cardiac pump theory more easily achieved - apply compressions directly over heart

Question 10

How do you perform CPR in small dogs with compliant chests/most cats?

Answer 10

• <10kg

-> In lateral recumbency
-> Cardiac pump theory more easily achieved - wrap fingers of one hand around sternum at level of heart