immersive simulations- CPR

Question 1

where do the leads go in an ecg

Answer 1

red= right fore
yellow= left fore
green= left hind

Question 2

what are the emergency drugs for arrest and their dosage

Answer 2

low epi= 0.01mg/kg
high epi= 0.1mg/kg
vasopressin= 08 u/kg
atropine= 0.05mg/kg

Question 3

what are the emergency drugs for anti-arhythmia and their dosage

Answer 3

amiodarone- 5mg/kg
lidocane= 2-8mg/kg

Question 4

what are the emergency drugs for reversal. what they reverse and their dosage

Answer 4

naloxone- opiods- o.04mg/kg
flumazenil- benzodiazepines- 0.01mg/kg
atipamazol- alpha 2- 50ug/kg

Question 5

describe the steps of a basic cpr protocall

Answer 5

cycle cheest compresions in lateral recumbrancy 100-120 bpm
1-2/3 of chest width
ventelate- either intubate in lateral with simaltaions compressions or mouth to mouth interpsed with compressions
10 breths per minute or a breath after every 30 compressions if mouth to snout

Larger dogs benefit from compressions over the widest portion of the thorax, using the thoracic pump theory (IIa-C) (Figure 3).
Barrel-chested breeds, such as bulldogs, may benefit from sternal chest compressions in dorsal recumbency (IIb-C).
Smaller dogs, keel-chested dogs, and cats may benefit from compressions directly over the heart, employing the cardiac pump theory (IIa-C) (Figure 4).
Smaller dogs and cats also benefit from circumferential compressions (IIb-C), although benefits are less clear

-advanced life support-
initate moitoring- electrocardiogram, end tidal co2 (>15 mmhg= good compressions)

obtain vascular access

administer reversals

evaluate patients

cycle the abouve avery 2 minites- change compressor every cycle

Question 6

if when evaluating the patient during cpr they are found to be in atrial fibrilation or pulslets ventricular tachycardia you should

Answer 6

use defibrilator
Or precordial thump

prolonged vf/vt-
aminodarone OR lidocane
Epinephrine/vasopressin every other cycle
increse defribrilator 50%

Question 7

if when evaluating the patient during cpr they are found to be in asystole or Pulsless electrical activity

Answer 7

low dose epi and or vassopressin every other cycle

consider atropine every other cylce

prolonged= >10 mind-
high dose epi
bicarbonate therapy

Question 8

5 domains of CPR for dogs and cats

Answer 8

preparedness and prevention, basic life support, advanced life support, monitoring, and post cardiac arrest care.

Question 9

Vasopressor Therapy

Answer 9

Vasopressor therapy is directed at increasing systemic vascular resistance in an effort to increase coronary and cerebral blood flow.6 Epinephrine, a nonselective adrenergic agonist, is the most commonly used vasopressor for CPR therapy; it affects both alpha and beta adrenergic receptors. Alpha adrenergic stimulation causes peripheral vasoconstriction. Beta adrenergic stimulation has positive inotropic and chronotropic effects, which increase myocardial oxygen demand and, therefore, may be detrimental in CPA patients

Epinephrine-
Low-dose epinephrine (0.01 mg/kg) is recommended for routine use every other BLS cycle (I-B) or every 3 to 5 minutes.2,6
High-dose epinephrine (0.1 mg/kg) may be considered after prolonged CPR (IIb-B)

Question 10

Vagolytic Therapy

Answer 10

During CPR, vagolytic therapy is usually provided by atropine.6 Limited data is available on atropine use in CPR, with no high-quality data available for dogs or cats.6

Current best-evidence suggests that:

Atropine can be used in patients with CPA related to increased vagal tone and associated asystole or pulseless electrical activity (IIb-B).
Routine use of atropine may be considered (IIb-C).2,6
In experimental studies in dogs, high-dose atropine is associated with poor outcomes; therefore, doses above 0.04 mg/kg should be avoided.

Question 11

Electrical Cardioversion

Answer 11

Electrical defibrillation is indicated in patients suffering from ventricular fibrillation (VF) (Figure 5) or pulseless ventricular tachycardia (VT), and has been shown to significantly improve ROSC in these patients.

RECOVER guidelines recommend:

Use of a biphasic defibrillator (I-A) has been shown to be more effective than monophasic current2,6
Single-shock therapy versus stacked-shock therapy in order to minimize interruption of chest compressions (I-B) (However, evidence on stacked shocks versus single shocks in dogs and cats is lacking.2,6)
Immediate defibrillation for pulseless VT/VF of less than 4 minutes duration as there is minimal ischemia during this time (I-B)2,6
Two-minute BLS cycle before defibrillation for pulseless VT/VF of greater than 4 minutes duration in order to maximize coronary perfusion (I-B)2,6
Immediate defibrillation may be considered if VF or pulseless VT is diagnosed during an intercycle pause (IIb-B).2,6

If defibrillation is unsuccessful, escalation of defibrillation energy is reasonable (IIa-B).2,6 Readers with electrical defibrillators should view the RECOVER drug dosage chart specific to their defibrillator type for recommendations on energy selection

Question 12

which drugs can be administered intratracheally

Answer 12

Naloxone Atropine Vasopressin Epinephrine Lidocaine

Question 13

ROSC

Answer 13

Return of spontaneous circulation (ROSC) is the restart of a sustained heart rhythm that permeates the body after a cardiac arrest

Question 14

End-Tidal Carbon Dioxide Monitoring

Answer 14

Since EtCO2 correlates well with cardiac output, EtCO2 monitoring during CPR to evaluate efficacy of chest compressions is reasonable if minute ventilation is held constant (IIa-B).2,5,9 Additionally, ROSC will cause a sharp increase in EtCO2, and EtCO2 monitoring should be used as an indicator of ROSC during CPR (

Question 15

post cardiac arrest monitoring

Answer 15

Continuous ECG
Arterial blood pressure measurement
Body temperature
Oxygenation/ventilation status.

Additional clinicopathologic monitoring, which is dependent on patient comorbidities, may include blood glucose and lactate concentrations, although the benefit of monitoring these parameters in all PCA patients is not clear

Question 16

Patients with CPA who experience ROSC are likely to have:

Answer 16

Some degree of hemodynamic instability related to vasopressor therapy during CPR or the underlying cause of CPA
Cardiac ischemia
Systemic inflammatory response syndrome (hallmarked by inflammatory system activation and excess circulating cytokines)
Anoxic brain injury.

Question 17

PCA care

Answer 17

REFERAL

When titrating IV fluids and vasopressors, the primary endpoints of central venous oxygen saturation (> 70%) and lactate (< 2.5 mmol/L) coupled with the following secondary endpoints may be considered (IIb-B):2,10,11

Arterial blood pressure (systolic, 100–200 mm Hg; mean arterial pressure, 80–120 mm Hg)
Central venous pressure (10 cm H2O)
Packed cell volume (> 25%)
Arterial oxygen saturation (SpO2 94–98%; PaO2, 80–100 mm Hg).

However, routine large-volume IV fluid administration is not recommended unless hypovolemia is strongly suspected or documented

Oxygen Supplementation-

Oxygen supplementation should be titrated to produce normoxia (PaO2, 80–100 mmHg, or SpO2, 94%–98%), but hyperoxia should be avoided (I-A).2,10 While routine, mechanical ventilation of all PCA patients is not recommended (III-B), mechanical ventilation of hypoventilating CPA patients is reasonable (IIa-C).2,10

Therapeutic hypothermia
PCA hypertension
Corticosteroids
Seizure prophylaxis
Osmotic agents.