EMERGENCY - Cardiopulmonary Resuscitation (CPR) Flashcards
What is cardiopulmonary arrest?
Cardiopulmonary arrest is the sudden cessation of functional ventilation and effective circulation
What are eleven clinical signs of cardiopulmonary arrest?
Unresponsive
Absent heart sounds
ECG showing arrest arrhythmias
Absent palpable pulse
Apnoea or agonal breathing
Blood looks thick, dark and is not free flowing
Changes in mucous membrane colour
Prolonged capillary refill time (CRT)
No cranial nerve reflexes
Eye central with a dilated pupil
Dry corneas
What are the two key signs of cardiopulmonary arrest you should check for before beginning CPR?
Unresponsive
Apnoea
List eight possible causes of cardiopulmonary arrest
Hypoxaemia/Hypercapnia
Myocardial hypoxia
Pre-existing cardiac disease
Acute hypotension
Toxins
pH extremes
Temperature extremes
Electrolyte imbalances
What steps should you take when dealing with a patient in cardiopulmonary arrest regarding their airway?
Check for physical obstruction of the airway
Endotracheal intubation if the patient isn’t already intubated (if already intubated make sure the tube isn’t obstructed)
What can you do to provide your patient with an airway if you are unable to carry out endotracheal intubation?
Tracheostomy
Percutaneous catheter placement into the trachea
What steps should you take when dealing with a patient in cardiopulmonary arrest regarding their breathing?
As soon as an airway is established, begin intermittent positive pressure ventilation (IPPV) with 100% O2
How many breaths should you provide per minute during intermittent positive pressure ventilation (IPPV)?
Approximately 10 breaths per minute (1 breath every 6 seconds)
What should you do if you are own your own and are thus unable to intubate whilst doing compressions?
Mouth to snout ventilation
How often should you provide mouth to snout ventilation whilst doing compressions?
2 breaths for every 30 compressions
How do you carry out mouth to snout ventilation?
Try to keep the head and neck extended and the mouth closed to prevent the breaths delivered through the nose escaping through the mouth
What steps should you take when dealing with a patient in cardiopulmonary arrest regarding their circulation?
Check pulses and heart sounds and monitor these continuously
Maintain continuous compressions
What are the three forms of extenal compressions?
Cardiac pump compressions
Thoracic pump compressions
Dorsal recumbency compressions
How do cardiac pump compressions produce cardiac output?
Cardiac pump compressions produce cardiac output through indirect compression of the heart
Which animals are cardiac pump compressions appropriate for?
Cats and dogs under 15kg
Narrow chested dogs
How should you carry out cardiac compressions on very small dogs and cats?
For very small dogs and cats, carry out compressions using your fingers and thumb across the heart
How do you carry out thoracic pump compressions?
Carry out compressions over the highest point of the thorax with the patient in right lateral recumbency
How do thoracic pump compressions produce cardiac output?
Chest compressions increase the intrathoracic pressure which encourages the blood to move out of heart into the arteries and out to the periphery. When the thorax fully recoils between compressions, the intrathoracic pressure will decrease which will encourage the blood to flow back towards the heart via the venous system
Which animals are thoracic pump compressions appropriate for?
Dogs over 15kg
How do you carry out dorsal recumbency compressions?
Carry out compressions over the highest point of the thorax with the patient in dorsal recumbency
Which animals are dorsal recumbency compressions appropriate for?
Flat chested - English bulldog type - dogs
What rate should your external compressions be?
Apporximately 100 - 120 beats/min
How much of the thorax should you compress during extenal compressions?
Compress approximately 1/3 of the depth of the thorax for cardiac and thoracic pump compressions, and 1/4 of the depth of the thorax for dorsal recumbency compressions
How often should you change staff members during external compressions?
You should switch staff members approximately every two minutes
Which three drugs types can be administered during cardiopulmonary arrest?
Adrenaline
Atropine
Lidocaine
What are the four indicators for administering adrenaline during cardiopulmonary arrest?
Asystole
To coarse a fine ventricular fibrillation
To increase ionotropy
To trigger vasoconstriction
What dose of adrenaline should be administered during cardiopulmonary arrest?
0.01mg/kg
What are the indicators for administering atropine during cardiopulmonary arrest?
Atropine should be administered if the cardiopulmonary arrest was preceded by bradycardia
What dose of atropine should be administered during cardiopulmonary arrest?
0.04mg/kg
(T/F) You can only administer atropine once during cardiopulmonary arrest
TRUE.
What are the indicators for administering lidocaine during cardiopulmonary arrest?
Ventricular arrhythmias
What dose of lidocaine should be administered during cardiopulmonary arrest?
2mg/kg
Why is ECG monitoring useful when a patient is in cardiopulmonary arrest?
ECG allows you to monitor the arrest rhythms
What are the four arrest rhythms?
Asystole
Ventricular fibrillation
Pulseless ventricular tachycardia
Pulseless electrical activity
Identify this arrest rhythm
Asystole
Identify this arrest rhythm
Ventricular fibrillation
What are the two classifications of ventricular fibrillation?
Coarse ventricular fibrillation
Fine ventricular fibrillation
Initially coarse and will progress to fine
Identify this arrest rhythm
Pulseless ventricular tachycardia
(T/F) Not all ventricular tachycardia’s are arrest rhythms
TRUE. It is important to check for a pulse, if there is not pulse then this is a pulseless ventricular tachycardia which IS an arrest rhythm
Identify this arrest rhythm
Pulseless electrical activity
For which two arrest rhythms is electrical defibrillation not as effective?
Asystole
Pulseless electrical activity
What charge should you use when carrying out electrical defibrillation?
2 joules/kg and double the dose for second and subsequent shocks
What are the four main signs of effective CPR?
Palpable pulses during compressions
Carbon dioxide detected on capnography
ECG changes
Improvement of mucous membrane colour
What are five signs that the patient is recovering during CPR?
Lacrimation
Miosis
Return of cranial nerve reflexes
Return of other neurological functions
Return of spontaneous ventilation
What supportive care should you provide your patient following cardiopulmonary resuscitation?
Oxygen supplementation
Fluid therapy
Monitor urine production to ensure renal perfusion
Gradual and gentle warming (to prevent sudden peripheral vasodilation)
Analgesia
