Emergency Protocols

Question 1

why would a patient arrest under GA?

Answer 1

obstruction
hypovolaemic shock
hypoxia
too deep - underlying condition or overdose
electrolyte imbalance

Question 2

how would you define IPPV?

Answer 2

intermittent positive pressure ventilation
- intermittent manual inflation of lungs
- ideally use oxygen
- mask or ET tube

Question 3

what is the difference between CPR and CPCR?

Answer 3

CardioPulmonary Resuscitation
- supports ventilation and circulation until function can be restored and maintained

CadioPulmonary Cerebral Resuscitation
- alternative term
- emphasises the importance of preserving cerebral function
- may restore CV and Resp function but may be brain-dead

Question 4

how would you define ROSC?

Answer 4

Return Of Spontaneous Circulation
- return of patients circulation after cardiac arrest

Question 5

CPR survival rates?

Answer 5

not under GA = 6-19%
- patients trying to die

under GA = 42-47%
- likely due to drugs
- reverse and CPR gives high chance of survival

Question 6

what needs to be considered with a crash box?

Answer 6

checked regularly
- fully stocked and ready

easily accessible
- easily to identify with clear location

no general use
- eg add breakable seal tags so know when used

Question 7

what should you do when a patient has crashed?

Answer 7

shout for help and press the crash alarm

start chest compressions

dont try to feel for a pulse
- often feel your own due to adrenaline

Question 8

how should you apply chest compressions?

Answer 8

100-120bpm
compress to 1/3-1/2 width of chest
allow for full recoil between compressions
- maximises cardiac filling
have another person feel a femoral pulse or use a capnograph
- determine effectiveness
2min cycles
- min 60ses to maintain venous return

Question 9

thoracic vs cardiac pump

Answer 9

both lateral recumbency

thoracic
- compress widest part of thorax
- one hand over the over and locked elbows
- shoulders directly over patient
- pushing down with palms

cardiac
- normally <10kg patients
- compress directly over heart
- thumbs over heart
- fingers/palm wrapped around thorax

Question 10

how does CPR vary for barrel or deep-chested dogs?

Answer 10

barrell
- bulldogs on their back for maximum output
- compress as would a human

deep chested
- cardiac pump for any size
- open chest CPR may be most effective

Question 11

what needs to be considered when intubating an arrested patient?

Answer 11

if already intubated check tube isn’t kinked or obstructed

if not intubated:
- one person holds, another intubate
- have a difficult intubation kit ready - very likely
- still use Intubeaze for cats
- regurgitation is likely so cuff tube
- tie tube!!

Question 12

how should you ventilate an arrested patient?

Answer 12

give 10 breaths a minute
- 1 every 6 seconds
- give breath quickly - 1 second

too many breaths = hyperventilation
- causes hypocapnia
- leads to cerebral hypoperfusion

Question 13

what monitoring equipment is useful during CPR?

Answer 13

capnograph
- aim for 10-15mmHg
- sudden increase in ETCO2 = ROSC
pulse-ox
blood pressure
ECG

Question 14

ways to administer drugs during an arrest?

Answer 14

Intravenous
– choose central line over peripheral

Intratracheal
– Give 2 x the dose and dilute with saline.
- Can give adrenaline and atropine

Intraosseus
– Can be used to administer fluids/ bloods as well as drugs

Question 15

what drugs can you give on arrest?

Answer 15

low dose epinephrine
- peripheral vasoconstriction
- increases systolic BP
- more coronary and cerebral blood flow

atropine
- parasympatholytic
- fix high vagal tone/bradycardia

Question 16

what drugs can you give as reversals?

Answer 16

naloxone
- reverse opioids
atipamezole
- reverse alpha-2 agonists
flumazenil
- reverse benzodiazepine

Question 17

when to use a defibrilator?

safety checks when using?

Answer 17

for ventricular fibrillation or pulseless ventricular tachycardia

Make sure:
- no one is touching the table or the patient
- none of the gel is on your hand
- patients tube is well cuffed to prevent O2 leakage

do not use if
- patient has had spirit applied them at any point
- there is an open oxygen source in use - eg flowby
- if the patient is excessively hairy – clip first

Question 18

team roles during an arrest?

how should you communicate?

Answer 18

ventilator
compressor
monitoring placer
drug administrator
scribe
leader
facilitator

closed loop
- say name and give instruction
- person instructed repeats instruction back
- reduces errors or missed instructions