CPR/Recover

Question 1

____ is cessation of normal circulation due to failure of the heart to contract effecively?

Answer 1

Cardiopulmonary arrest (CPA)

Question 2

___ is an emergency procedure performed in order to MANUALLY maintain perfusion until spontaneous circulation is resorted?

Answer 2

Cardiopulmonary resuscitation (CPR)

Question 3

T/F if CPA does not have a reversible cause, CPR is unlikely to be successful so you should not attempt?

Answer 3

True

Question 4

T/F CPR has a 25% success rate regardless of the inciting cuase of the CPA

Answer 4

False- 5%
if anesthetic-related it is 25%

Question 5

What are 3 key features to recognize CPA?

Answer 5

1) loss of consciousness
2) loss of normal, spontaneous breathing
3) loss of palpable pulses

Question 6

What are 4 common events that precede CPA?

Answer 6

1) bradycardia
2) worsening mentation
3) sudden increase in vagal tone (vomiting, straining to defecate)
4) sudden change in breathing pattern

Question 7

What are a few common conditions that predispose a patient to CPA and therefore warrant intense monitoring and aggressive therapy?

Answer 7

sepsis
SIRS
heart failure
pulmonary disease
trauma
neoplasia
general anesthesia

Question 8

T/F you should have 2 people at minimum for CPR

Answer 8

False- THREE

Question 9

What are some roles that can be given to persons involved in CPR?

Answer 9

Leader (directs everyone, best for this person to be the one who knows the patient the best)
Ventilator
Compressor
Time keeper
Recorder
Drug administrator

Question 10

What are some things to make handy on your crash cart?

Answer 10

ET tubes
Ambu bags
laryngoscope
gauze squares
ET tubes ties and cuff syringe
ECG and supplies
defibrillator
drugs – epi and atropine
drug chart
catheter supplies
suction supplies
end tidal CO2 monitor

Question 11

At what point should you discuss CPA with an O?

Answer 11

BEFORE the patient has arrested/ Always discuss the likelihood of CPA occurring with the patients current condition or status and explain the success rates of CPA.
obtain their wishes.

Question 12

What are the 3 components of BASIC life support?

Answer 12

1) circulation
2) airway
3) Breathing

Question 13

T/F you should establish an airway prior to starting compressions?

Answer 13

False – opposite
start manual compressions immediately, then place ET tube and start providing manual breaths.

Question 14

Once a patient is intubated and compressions are continuing, you should be giving manual breaths. What % oxygen should you put the patient on and how many breaths/min should you give the patient?

Answer 14

100% oxygen
8-12 breaths/min
if you give too many, this can decrease venous return to the heart

Question 15

What is the difference between the thoracic pump theory and the cardiac pump theory in regard to manual chest compressions during CPR?

Answer 15

Thoracic pump for large breed dogs; we have to place our hands over the widest part of the chest in order to cause the greatest change in intrathoracic pressure to generate adequate blood flow.

Cardiac pump – for smaller animals; placing hands directly over heart space to push blood forward

Question 16

How many compressions do you give a patient per minute during CPR and how hard should these compressions be?

Answer 16

100 per minute
you should do them to depress the chest by 1/3 and allow COMPLETE recoil of the chest (this is when the venous blood returns to the heart, which is required)

Question 17

What are indications for open chest CPR?

Answer 17

large and giant breed dogs
thoracic trauma
pleural or pericardial space disease
intraoperative arrest
ineffective chest compressions

Question 18

What are the 4 heart rhythms of CPA?

Answer 18

asystole
pulseless electrical activity
pulseless VTACH
ventricular fibrillation

Question 19

What are the shockable rhythms?

Answer 19

Ventricular fibrillation
pulseless ventricular tachycardia

Question 20

How can you obtain emergency venous access in patients during CPA?

Answer 20

Venous cut down
intraossesous catheter

Question 21

What is the most common drug used in CPA?

Answer 21

Epinephrine

Question 22

What drug can be used BEFORE arrest for bradycardia?

Answer 22

Atropine

Question 23

T/F lidocaine is routinely used in CPA for correction of arrhythmias?

Answer 23

False its not routinely used
it suppresses ventricular activity and many reduces likelihood of successful defibrillaiton

Question 24

When should you give fluid therapy during CPA?

Answer 24

Not in all cases
only if the patient was hypovolemic
can reduce coronary perfusion

Question 25

T/F you should give patients in CPA steroids in order to suppress an inflammatory reaction associated with CPA

Answer 25

False – steroids are not routinely recommended/ only in cases of anaphylactic shock.

Question 26

T/F electrolytes are not routinely indicated during CPA

Answer 26

True
if hypoglycemic or hyperkalemic give calcium gluconate.

Question 27

What reversal agents should you have available on your crash cart?

Answer 27

Atipamezole, naloxone, flumazenil, or just turn off anesthetic gasses.

Question 28

What are 2 monitoring parameters you need to do during CPR?

Answer 28

1) end tidal CO2 to confirm ET tube placement, identify ROSC, assess quality of CPR
2) Electrocardiogram- rhythm diagnosis and evaluating therapy success

Question 29

T/F post- resuscitation care is just as vital as resuscitation care

Answer 29

True these patients frequently have cardiovascular instability and may require CRIs of norepi, dopamine, or dobutamine. Arrhythmias are common too. Neurologic dysfunction is very common

Question 30

What is involved in post-resuscitation care?

Answer 30

1) pain management – use reversible drugs (opioids preferred)
2) postpone procedure if you can
3) watch for additional complications (coagulopathies, organ dysfunction, contusions)