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FA2 Anesthesiology > Lecture 19 11/19/24 > Flashcards

Lecture 19 11/19/24 Flashcards

1
Q

What are the rates of perioperative fatality in different species?

A

dogs: 0.17%
cats: 0.24%
horses: 0.9%

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2
Q

What are the stats on patients that are revived with CPR outside of anesthetic events?

A

less than 6% survive to discharge

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3
Q

What are the stats on patients that are revived with CPR during an anesthetic event?

A

50% of dogs survive to discharge

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4
Q

What is the easiest way to be prepared for cardiopulmonary arrrest?

A

well stocked, well organized crash cart

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5
Q

What can lead to a delay in CPR?

A

-missing equipment
-failure to do preventative maintenance
-equipment failure

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6
Q

How long of a delay in starting CPR can lead to a gue decrease in survival?

A

10 to 20 seconds

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7
Q

In addition to a good crash cart, how else can veterinary professionals prepare for CPR?

A

-learn on manikins
-undergo standardized training
-have one confident leader during CPR
-have one individual per job during CPR
-debrief following CPR about what did and did not go well

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8
Q

What are the characteristics of CPA recognition?

A

-early diagnosis is crucial
-eval. should only take 5-10 second
-start CPR immediately in unresponsive, apneic patients
-risk of CPR in animals not in CPA is minimal; better to start CPR than do a lengthy assessment

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9
Q

How can CPA be recognized on monitoring tools?

A

-loss of pulse on doppler
-stair-step waveform on EtCO2

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10
Q

What are the characteristics of chest compression set up?

A

-airway management and ventilation should not delay start
-place most patients in lateral, barrel-chested dogs in dorsal
-cardiac pump in cats and pointed chest dogs
-thoracic pump in other dog breeds

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11
Q

What percent of cardiac output is achieved with chest compressions?

A

20%

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12
Q

What is the purpose of the cardiac pump mechanism?

A

directly compress heart

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13
Q

What is the purpose of the thoracic pump mechanism?

A

rely on elastic recoil of chest to move blood

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14
Q

How should chest compressions be carried out?

A

-100 to 120 compressions/minute
-1/3 to 1/2 of thorax compressed with each compression
-2 minutes uninterrupted
-no leaning on patient; reduced coronary and cranial partial pressures

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15
Q

What are the characteristics of open chest CPR?

A

-better than closed chest CPR in patients with pulmonary or cardiac disease
-must make decision to do open chest CPR promptly
-intra-abdominal procedures can cut through diaphragm to perform open chest CPR
-must be prepared to manage open chest

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16
Q

What are the characteristics of airway management and ventilation during CPR?

A

-does not take priority over starting chest compressions
-must intubate in lateral
-want 10 breaths/minute with a tidal vol. of 10 ml/kg
-inspiratory time should last for 1 second

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17
Q

What are the characteristics of compressions and ventilation when there is a single rescuer?

A

-neck is extended
-30 compressions to 2 breaths
-no evidence for use, but no harm

18
Q

Which monitoring steps are preferred in CPR if available?

A

-EtCO2
-ECG
-doppler
-electrolytes

19
Q

What are the characteristics of EtCO2 during CPR?

A

-verification of tracheal intubation
-effectiveness of compressions
-sudden rise in EtCO2 correlates with return of spontaneous circulation
-want measurement of 18mmHg or higher for dogs and cats

20
Q

What are the characteristics of ECG during CPR?

A

-susceptible to artifact
-used to guide advanced therapy/defibrillation
-brief interruption during CPR changes to evaluate ECG

21
Q

What are the ECG rhythms of death and their shockability?

A

-asystole: not shockable
-pulseless electrical activity: not shockable
-pulseless ventricular tachycardia: shockable
-ventricular fibrillation: shockable

22
Q

What are the characteristics of defibrillation?

A

-prompt shocking of shockable rhythms has greater chance of ROSC
-will always do 2 minutes of compressions before a shock
-CPA greater than 4 minutes requires compressions/basic life support first

23
Q

What are the three phases of myocardial ischemia?

A

-electrical: 4 minutes
-circulatory: 6 minutes
-metabolic

24
Q

How does a biphasic defibrillator differ from a monophasic?

A

-monophasic sends electricity through chest once; biphasic sends electricity twice
-biphasic requires less energy
-biphasic causes less myocardial damage

25
Q

How does defibrillator energy dose differ with each shock?

A

increase dose by 50% with each subsequent shock

26
Q

Which drugs are used in advanced life support?

A

-vasopressors
-parasympatholytics
-IV fluid therapy
-anti-arrhythmics
-reversal agents

27
Q

How can emergency drugs be administered?

A

-IV if access is obtained
-intra-osseus
-intra-tracheal

28
Q

Which emergency drugs can be delivered via the trachea?

A

-naloxone
-atropine
-vasopressin
-epinephrine
-lidocaine

29
Q

What are the characteristics of vasopressors?

A

-cause high peripheral vascular resistance
-divert blood from the limbs to the viscera
-include epinephrine and vasopressin

30
Q

What are the characteristics of epinephrine?

A

-vasopressor acting at alpha1
-inotropic/chronotropic acting at beta1
-inotropic/chronotropic function harmful; increases heart rate and heart O2 requirements
-only recommended in low doses

31
Q

What are the characteristics of vasopressin?

A

-vasopressor acting at V1
-no chronotropic or inotropic effects
-works better than epinephrine in an acidic environment
-used in place of or in combo with epinephrine

32
Q

What are the characteristics of atropine?

A

-no evidence for benefit or detriment
-higher dose associated with worse outcome
-drug of choice for CPA with high vagal tone

33
Q

What are the characteristics of fluid therapy during CPR?

A

-indicated in cases with hypovolemia
-not recommended in euvolemic/hypervolemic cases
-improper admin. can oppose blood delivery to brain and heart

34
Q

What are the characteristics of amiodarone?

A

-non-selective class III anti-arrhythmic
-used for resistant pulseless v-tach and v-fib

35
Q

What are the characteristics of lidocaine?

A

-class 1B anti-arrhythmic
-consider in pulseless v-tach or v-fib resistant to shock and amiodarone

36
Q

What are the characteristics of magnesium?

A

-currently not part of RECOVER guidelines
-increasing number of case reports indicating magnesium helps in CPR cases

37
Q

Which reversal agents are considered in CPR?

A

-naloxone
-flumazenil
-atipamazole
-turn off vaporizer, disconnect patient, and flush to remove inhalants

38
Q

What are the characteristics of hypocalcemia?

A

-calcium is necessary for muscle contraction and cell communication
-not routinely administered
-replace calcium in moderate to severe hypocalcemia cases

39
Q

What are the characteristics of hyperkalemia?

A

-common in prolonged CPA
-improved outcome when treated with hemodialysis
-recommended to treat

40
Q

What are the characteristics of corticosteroid use in CPR?

A

-lack of evidence
-not recommended for routine use
-adverse effects outweigh benefits
-should be used in patients arresting due to Addison’s disease
-can delay ROSC and alter vascular tone

41
Q

What are the characteristics of sodium bicarb?

A

-thought to promote alkalosis in acidotic patients
-can make patient more acidotic if not ventilating well
-evidence of worse outcome in early CPR
-used in CPR that goes longer than 10-15 minutes

42
Q

What are the characteristics of oxygen therapy?

A

-want FiO2 of 100%
-maximize PaO2 in face of decreased CO
-hypoxemia and reactive oxygen species can prevent ROSC
-target PaO2 of 85-100mmHg

FA2 Anesthesiology (21 decks)

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