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SAM > Oxygen therapy, cardiopulmonary resuscitation, euthanasia > Flashcards

Oxygen therapy, cardiopulmonary resuscitation, euthanasia Flashcards

1
Q

Oxygen delivery depends on?

A
  • Hemoglobin concentration (Hb) –> Anemia
    • transport of O2 from lungs to tissue
  • Oxygenisation of the arterial blood (PaO2) –> hypoxaemia
  • Cardiac output –> Hemodynamic disturbance
    • ​e.g. hypovolaemia
  • Hypoxia: PaO2 < 80 mmHg, Sa O2 <90%
  • Goal: to increase the inspired O2 concentration (FiO2)
  • FiO2 = fraction of inspired air
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2
Q

Clinical signs of hypoxaemia

A
  • restlessness (panic seen in the eyes,)
  • dyspnoe
  • increased respiratory rate ( > 32-40/min)
  • labial breathing
  • open mouth breathing (cats)
  • abnormal respiratory sounds
    • upper airway stridor
    • crepitation
    • respiration 0 (pleural effusion, pneumothorax)
  • Cyanosis
  • gasping
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3
Q

What do you do incase of hypoxaemia?

A
  • Sedation is necessary! to decrease stress and calm down to decrease hyperventilation
  • acepromazin
  • butorphanol
  • midazolam
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4
Q

Common causes of Hypoxia:

A
  • Upper respiratory obstruction
  • Brachycephal syndrome - laryngeal collapse
  • Laryngeal paralysis (large breed, old dogs)
  • tracheal collapse (small toy breeds)
  • Pulmonary diseases
  • Pneumonia
  • pulmonary edema/ARDS
  • congestive heart failure (edema formation)
  • pleural effusion
  • thoracic trauma (pneumothorax, lung contusion)
  • inhalation of toxic gases (smoke, CO)
  • severe anemia
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5
Q

Arterial blood gas analysis

  • when is it used, what do you measure?
A
  • to measure degree of hypoxia
  • you can use femoral or metatarsal arteries
  • You measure: PaO2, SatO2, PaCO2
  • A-a gradient: difference between alveolar O2 pressure and PaO2 (<10-15)
  • “rule of 120”: PaO2 + PaCO2, if <120 –> V/Q mismatch
  • PaO2/FiO2 ratio
  • normal: > 400. Hypoxaemia: 300-400
  • acute lung injury: 200-300
  • Acute respiratory distress syndrome < 200
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6
Q

How much O2 do you give by “flow by”?

A

2-3 Liter/min –> FiO2: 25-40%

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7
Q

How much oxygen do you give by Oxygen hood/collar?

A

1 Liter/10kg/min –> FiO2 40-60%

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8
Q

How much oxygen do you give by nasal oxygen catheter?

A

50-100 ml/kg/min –> FiO2: 40-50%

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9
Q

FiO2 value in Oxygen cage

A

30-50%

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10
Q

FiO2 value in endtracheal tube

A

21-100%

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11
Q

Indications of mechanical ventilation

A
  • Severe hypoxia (PO2 < 60mmHg)
  • severe hypercapnia (PCO2 > 60mmHg)
  • excessive work of breathing
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12
Q

Cardiopulmonary cerebral resuscitation (CPCR)

  • Indications
A
  • cardiorespiratory arrest (CPA)
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13
Q

Cardiopulmonary cerebral resuscitation (CPCR)

  • clinical signs
A
  • gasping/agonia breathing pattern
  • unconciousness
  • lack of spontaneous breathing
  • lack of palpable pulse
  • lack of cardiac sounds
  • Poor prognosis
  • < 10% ROSC (resuscitate)
  • < 1% survive to discharge
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14
Q

Cardiopulmonary cerebral resuscitation (CPCR)

  • Recover (steps)
A
  1. Prepareness and prevention
  2. Basic life support
  3. Advanced life support
  4. Monitoring
  5. Post-resuscitation care
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15
Q

Potentially reversible causes of CPA

A
  • 5 “H”:
  • hypovolaemia/haemorrhage
  • hypoxia/hypoventilation
  • hydrogen ions –> acidosis
  • hyperkalaemia/hypokalaemia
  • hypoglycaemia (very often in yorkshire due to parasiti inf.)
  • 5 “T”:
  • Toxins
  • tension pneumothorax
  • thromboembolism
  • tamponade (periardial)
  • trauma
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16
Q

Cardiopulmonary cerebral resuscitation (CPCR)

  • Common critical patients:
A
  • SIRS (systemic inflammatory response syndrome)
  • due to e.g IHA or pancreatitis
  • septicaemia
  • congestive heart failure (furosemide dose adjustment)
  • severe respiratory disease, ARDS
  • cerebral diseases (seizures)
  • multiple trauma
  • coagulopathy, toxicosis, anaesthesia
  • ill puppies bodyweight < 2kg!
17
Q

Things to consider before CRCP

A
  • underlying disease
  • owners will (expensive)
  • timing - within 3-5min after CPA
  • equipment
  • trained staff (3+n)
18
Q

The ABC of cardiopulmonary resuscitation

A
  • BLS (Basic life support)
  • Airways
  • Breathing
  • Circulation
  • ALS
  • Drugs
  • ECG
  • Fluids
19
Q

Basic Life Support (BLS)

A
  • A: Airways
  • clean the airways (mucous, FB)
  • encotracheal tube
  • B: breathing
  • with AMBU-ballon 10-12/min rate
  • Circulation:
  • thoracic compressions
  • right lateral recumbency
  • position of the hands
    • medium large breed: both hands on the widest points of the thorax
    • medium breeds: one hand over the heart (4-6 intercostal space)
    • small breed and cats: 1 hand over the cardiac area, thumb on the other side of the chest.
20
Q

D: Drugs

A
  • Drug application: IV, IM
  • safe: atropin, epinephrine/adrenalin, lidokain, nloxon, vasopressin
  • 2-2.5 x dose is necessary (epinephrine: 3-10 x IV dose)
  • drug should be solved in 5-10 ml sterile water or saline
  • CAVE: severe pulmonary disease (edema). (cave means avoid)
  • Commonly used drugs:
  • Adrenalin (tenogen inj)
    • mainly alpha2 adrenergic stimulatory effect: peripheral arteriolar vasoconstriction increase –> cerebral and coronarial perfusion pressure increases
    • 0,01 mg/kg IV
    • dosage can be repeated in 3-5min (max: 0.1mg/kg IV)
  • Atropin
    • heart rate increase, vascular resistance increase, blood pressure increase
    • most effective in case of vagotonia induced asystole
    • 0.04 mg/kg IV
    • can be repeated in 3-5 min 3times
21
Q

E: ECG

A
  • Background:
  • asystole
  • electric activity without pulse
  • ventricular tachycardia
  • ventricular fibrillation
  • severe sinusbradycardia
22
Q

F: Fluid therapy

A
  • Patients with hypovolaemia: shock dosis
  • crystalloids: dog (90 ml/kg) cat (45 ml7kg)
  • colloids (HAES): dog (5ml/kg) cat (2-3ml/kg)
  • hypertonic saline: NaCl 3%
  • patients with euvolemia: crystalloids in bolus with maximum speed
    • dog: 20 ml/kg bolus
    • Cat: 10 ml/kg bolus
23
Q

Reasons for euthanasia

A
  • incurable disease or injury
  • control of infectious diseases
  • unavertable attack
  • scientific research
  • high treatment cost
24
Q

When to do euthanasia?

  • quality of life measured by
A
  • Pain (1-10)
  • Appetite (1-10)
  • Hydration (1-10)
  • Hygine (1-10)
  • mood (1-10)
  • locomotion (1-10)
  • more good than bad days (1-10)

> 35: acceptable QOL (quality of life)

25
Q

Performing euthanasia

  • drugs
A
  • general anesthesia
  • Acepromazin/ketamin+diazepam/propofol, IV
  • drugs for euthanasia
  • pentobarbital 600-200 mg/ttkg
    • Release inj (1ml/5ttkg)
    • Euthasol 40% inj
  • T-61 inj., 0.3 ml/ttkg (?)
  • If IV catheterusation is not possible, induce anaesthesia IM and apply euthanaisia i.c
  • monitor heart, respiration, cornea reflexes

SAM (6 decks)

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