Midterm Flashcards
Define CPR
Emergence procedure performed in order to manually maintain perfusion until spontaneous circulation can be restored
Define CPA (cardiopulmonary arrest)
Cessation of normal circulation due to failure of the heart to contract effectively
What is the biggest influence on whether CPR will work or not
If CPA does not have a reversible cause, CPR is unlikely to be successful - example, if it is due to anesthesia it is likely reversible, if it is due to a terminal disease, it probably is not
What is the success rate of CRR
5%
What are 3 key features in recognizing CPR
Loss of consciousness, loss of normal spontaneous breathing, loss of palpable pulses
What are common preceding events to CPR
Bradycardia, worsening mentation, sudden increase in vagal tone (vomiting, straining to defecate), sudden change in breathing pattern
Which pose are you going to feel if concerned about CPA
Femoral pulses
What are common diseases that predispose to CPA, warranting intense monitoring and aggressive therapy
Sepsis, sirs , heart failure , pulmonary disease, trauma, neoplasia, general anesthesia
What are the 6 roles of a CPR crash team
Leader, ventilator, compressor, time keeper, recorder, drug administrator
When performing CPR, do you follow the ABC rule (airway, breathing , circulation)
No - start compressions immediately before securing airway (because it takes too long together supplies ) - it is circulation , airway and breathing
How many breaths per minute do you give when patient is intubated and you are giving manual breaths
8-12 breaths/minute
What amount of oxygen do you use when giving manual breaths
100% oxygen
What is our ultimate goal in CPR
Get the heart beating again _ we con manually give breaths for while but without circulation it doesn’t matter
When do you use the thoracic pump theory in CPR
Over 15 kg dog, wide chest
When do you use the cardiac pump theory
Less than 15 kg
How many compressions per minute do you do with CPR
100 compressions per minute
How do you give chest compressions
Depress the chest by one third then allow complete chest recoil to allow venous blood return to heart
When is open chest CPR indicated
Large dogs with thoracic trauma, pleural or pericardial disease, intra operative arrest, ineffective chest compressions
If you are successful with open chest CPR I what do you need to be prepared for
Thoracotomy - cut into the there to reach lungs or other organs
What are examples of pleural or pericardial disease that would indicate open chest CPR
Pneumothorax, pleural or pericardial effusion, diaphragmatic hernia
What are the 4 recognized arrest rhythms
Ventricular tachycardia, ventricular fibrillation, systole, pulseless electrical activity
What are the two shockable rhythms
Ventricular fibrillation and pulse less ventricular tachycardia
Is the goal of defibrillation to start the heart again
No - goal is to shut down the electrical activity to let the heart and sinus node do its thing
What is the shock dose for external defibrillation
2-10 joules/ kg
What position is the dog in when you do defibrillation
Dorsal
How long after defibrillation do you recheck the rhythm
2 minutes
What is the most common CPR drug used and how is it given
Epinephrine - give IV at 1 ml/10 kg every 4 minutes
When would no use atropine in a CPA
Before arrest for bradycardia - give 1ml/10kg IV
What 2 things do you monitor with CPA
ECG and end tidal co2
What does end tital co2 tell you during CPA
Confirms ET tube placement and identifies ROSC (return to spontaneous circulation) I also assesses quality of CPR compressions
When do you give fluids during a CPA
Only if the patient was hypovolemic prior to arrest - otherwise can reduce coronary perfusion
Do yo use antiarrhytmic agents like lidocaine in CPA
no - can decrease success of defibrillation and suppress ventricular activity
How do you assess brain function during triage
Mention - due, stuporous , comatose, death. And if patient is seizing
What is the difference between dull and stuporous and comatose
Dull - responds to all stimuli with less Vigor,
Stuporous - only responds to noxious stimuli
Comatose - no response to noxious stimuli
How do you check lung function with triage
Breathing rate and effort , abdominal effort on expiration , neck extension, stressed look
Do we care about crackles or where’s on triage exam
No
What is the only cause for panting in dog
Thermoregulation - trying to cool off
What do you check on triage to assess perfusion
Heart rate , mm, CRT, mention, temperature, pulse quality, thermometer!
On cardiovascular triage, we are looking for - in dogs and - in cats
Tachycardia in dogs (60 - 120 bpm), bradycardia in-cats (180 - 240 bom)
When do cats usually become bradycardic
When in shock and decompensating
When there is low perfusion ( in dogs especially) , what is the first thing the body does
Heart rate increases
Where does gum color come from
Hemoglobin
What do mm colors indicate - pink, red, brown, blue yellow, white
Pink - enough hemoglobin
Red -oxyhemoglobin
Brown - toxins leading to methemoglobin
Blue - deoxhemoslobin (no oxygen bonding to hemoglobin)
Yellow - bilirubin which is a by product of hemoglobin break down
While - decreased hemoglobin (anemia or vasoconstriction)
What is CRT look like with vasoconstriction? Vasodilation?
Over 2 seconds with vasoconstriction
Les than one second with vasodilation
How can mentation indicate perfusion
Brain reeds ouch and sugar to work (gets these by blood fow) - correct perfusion then reassess the mention
Poor mention in the absence of other neuro signs indicates
Poor perfusion
How can temperature indicate perfusion
Hypothermia concerning - when cold you vasoconstrictor and when u vasoconstriction you get cold (shunt blood away from periphery to maintain blood now to the core organs)
A low body temp and cold toes can indicate
Perfusion problems
Describe weak pulse
Distance between systole and diastole is shortened - less volume per bolus
Define shock
Severe imbalance between oxygen supply and demand, leading to inadequate cellar energy production significant decrease in oxygen supply to tissues or an overconsumption of oxygen
Shock is a balance between
Oxygen deliver and oxygen consumption
Oxygen delivery = - x -
Cardiac output times arterial content of exigen
What does art trial content of oxygen mean
How much oxygen is in the bloodstream
What are the 3 types of shock
Circulatory, hypoxic, metabolic
What are the types of circulatory shock
Hypovolemic, distributive, obstructive, cardigenic
The majority of shocks are - and due to
Most are circulatory and due to decreased oxygen delivery
What’s the most common type of circulatory shock? Describe it
Hypovolemic - decreased intravascular volume, decreased preload, decreased cardiac output
What are causes of hypovolemic shock
Hemorrhage, severe dehydration (GI or renal losses), third space fluid loss, severe burns (loss of proteins and electrolytes)
Describe distributive shock
Mal distribution of fluid from changes in vascular tone and increased vascular permeability (there is enough volume but it is not getting to the tissues , decreased systemic vascular resistance (deficits in preload or contractiling)
What are causes of distributive shocks
Anaphylactic Shock ( histamine induced vasodilation) , septic shock (endothelial dysfunction) , neurogenic shock, extreme fear
Describe obstructive shock
Compression of heart or great vessel that interferes with venous return, decreased diastolic filling and preload, decreased cardiac output
What are causes of obstructive shock
GDV ,obstruction of vena cava ,tension pneumothorax, cardiac tamponade from periodical effusion, positive pressure ventilation
When there is pericardial effusion and increased pressure over the heart - which part of the heart collapses first
The right atrium (least pressure)
Describe cardiogenic shock
Decrease in forward flow from heart due to pump failure - primer decrease in cardiac output due to an issue with the heart and tie pump failure
What are causes of cardiogenic shock
Systolic failure (dcm), diastolic failure (hcm), atrioventricular valve degeneration, Brady or tachy arrhythmias
Describe hypoxia shock - what are causes
Decreased arterial oxygen content and decreased oxygen deliver to tissues - caused by severe pulmonary disease, anemia, dyshemoglobinemias
Describe metabolic shock and its causes
Deranged cellular metabolism leading to inappropriate oxygen tissue use due to severe hypoglycemia and mitochondrial dysfunction
What do catecholimines cause
Increased heart rate, contractility and peripheral vasoconstriction
What are 4 compensatory mechanisms of shock
Barocreceptor reflex, chemoreceptors I RAA S activation, antdiruetic hormone
- Is often considered hallmark for decompensatory shock
Hypotension - map determines peripheral perfusion
What ave 2 types of distributive shock? Describe them
Anaphylactic and septic - initial vasodilation then vasoconstriction
What are clinical signs of anaphylactic or septic shock
Tachycardia, CRT less than 1second (because of the vasodilation), red to injected mucus membranes , elevated temp, bounding pulses
, Bradycardia in cats is - until proven other wise
Shock
What is the shock organ for dogs? For cats?
Dogs - git
Cats - lung
Hypothermia in dogs indicates what type of shock
Crudiogenic - in cats it can indicate any type of shock
What is the goal of shock treatment
Restore oxygen delivery to tissues as soon as possible - flow by oxygen, obtain IV access, IV find bolus UNLESS in cordiogenic shock
What are indications for peripheral venous catheters
Emergency like CPA, fluid admin, sedation , euthanasia
When do you often place auricular catheters
Mostly GDVs
What type of catheter is best for fluid administratrion and blood products especially in shock patients
Large bore, short catheters