Emergency Response and Communication

Question 1

What needs to happen immediately?

Answer 1

Basic life support:
-Chest compressions
-Ventilation

Question 2

Chest compression choices

Answer 2

Cardiac pump (small animal, pliable chest, <10kg): ventral 1/3 thorax, ribs 3-6, 100-120bpm

Thoracic pump (large animal, >10kg): widest part of chest, compress to 1/3-1/2 width of chest, 60-100bpm

Question 3

Ventilation

Answer 3

Tidal volume 10ml/kg (> leads to iatrogenic barotrauma)
10BPM or less (one breath every 6s, > leads to oxygen toxicity due to low cardiac output)

Question 4

Answer 4

Ventricular fibrillation

Convert to asystole/PEA: one shock or precordial thump, if prolonged Amiodarone/Lidocaine
Continue with basic life support

Question 5

Answer 5

Ventricular tachycardia

Convert to asystole/PEA: one shock or precordial thump, Amiodarone/Lidocaine
Continue with basic life support

Question 6

Answer 6

Asystole

Continue with basic life support
Drugs for enhancement: adrenaline/epinephrine, vasopressin, atropine? (every other cycle)

Question 7

Pulseless Electrical Activity

Answer 7

Looks normal, don’t get caught out

Continue with basic life support
Drugs for enhancement: adrenaline/epinephrine, vasopressin, atropine? (every other cycle)

Question 8

Reaction if there is consciousness/movement/reflexes

Answer 8

Stop immediately

Question 9

Reaction if there is a sudden increase in ETCO2 on capnography

Answer 9

May be improved compressions or animal may be alive = continue cycle and reassess

Question 10

Post-ROSC (return of spontaneous circulation) care

Answer 10

Supportive oxygen +/- ventilation (target PaO2 80-100, SpO2 94-98%, too high = oxidative damage with reperfusion)
Cardiovascular optimisation (hypotensive = beware of fluid overload, vasopressor therapy sensible)
Hypothermia beneficial to cardiac and neurological outcomes, rewarm slowly (0.5oC/h)

Question 11

Talking to the owner about the events

Answer 11

Mr/Mrs Cole and Sally
Let them know Sally is safe and happy in her kennel if possible
During the dental procedure Sally crashed (explain how once you know, e.g. insufficient pulse)
How did you manage the situation? Explain who was involved (yourself and a Senior Nurse)
Sally should be okay now but they can contact the practice at any time if they have any concerns or further questions