1. preparedness and prevention 2. bls 3. als 4. monitoring 5. post reuscitation care

18. Cardiopulmonary resuscitation. Basics of the fluid therapy and parenteral feeding Flashcards by Holly Barr

indications of CPR

cardiac arrest
pulmonary arrest
cardiopulmonary arrest

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Clinical signs of an arrest

Loss of consciousness
Loss of spontaneous ventilation
Loss of palpable pulse
Loss of cardiac sounds on auscultation

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Predisposition of an arrest

Heart Failure
Severe pul disease
coagulopathy
trauma
Brain trauma
SIRS
sepsis
neoplasia
toxicosis
anaesthesia

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Potential reversible causes of an arrest

Hypovolemia
Hypoxia
Hydrogen ions (acidosis)
Hyper/ o kalaemia
Hypoglycaemia
Toxins
Tension ptx
Thromboembolism
tamponade
trauma

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considerations before cpr

underlying disease
will of owner
timing (perform cpr within 3-5mins of arrest)
equipment needed
staff

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5 stpes of cpr

preparedness and prevention
bls
als
monitoring
post reuscitation care

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aim of CPR

provide oxygen and blood to the heart and brain

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Process of CPR

10second physical exam to detect breaths, heartbeats, degree of bradycardia
1. airways
2. breathing
3. circulation
4. drugs
5. ecg
6. fluid therapy

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how to stimulated the ren zhong acupuncture point

on ventral philtrum until you reach bone
spontaneous breathing can be stimulated
10-12breaths/ min

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where to place hands for compressions

Large dog - widest part of chest
Medium dog - over heart
Small dog / cat - fingers & thumb over heart

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how many compression per min

100-120

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what are the emergency drugs

adrenaline
atropine
NaHCO3
glucose
furosemide

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function of adrenaline

peripheral arteriolar vasoconstrictor
coronary and cerebral perfusion pressure increase

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function of atropine

used during vagotonia induced asytole and severe brady cardia
increased HR, BP, systemic vascular resistance

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Function of NaHCO3

Used in metabolic acidosis & hyperkalaemia

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function of furosemide

only in pulmonary oedema

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why perform an ecg

evaluate arrhythmias

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if animal is in asystole

give adrenaline then atropine

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if the animal is in ventricular tachycardia

defib x3
lignocaine/ amiodarone

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if animal is in ventriuclar fib / flutter

defib x3
adrenaline / lignocaine

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if animal is in sinus bradycardia

atropine –> adrenaline –> atropine -> adrenaline

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when to give adrenaline

asystole
VF
PEA

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when to give atropine

asystole
sinus brady cardia

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when to give sodium bicardonate

severe met acidosis
during cpr

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when to give amiodaron

refractory VF pulseless - VT

when to give lidocaine

v. flutter VF after failed defibrillation

when to give naloxone

reversal of opioids

what is the goal of fluid therapy post cpr

the normalisation of vital signs contraindicated in pulmonary oedema cases

Isotonic balanced crystalloid solution shock dose

Dog - 60-90ml / kg Cat - 45-60ml / kg

Synthetic colloids shock dose

expand intravascular colume Dog - 5ml / kg Cat - 1-3ml / kg given in IV boluses over 20mins

Hypertonic saline dose

1-2ml / kg over 4mins

crysalloid bolus to give if animal is euvolemic

Dog - 20ml/ kg Cat - 10ml / kg

Monitorring of critically ill patients

Temperature Pulse Resp rate CRT Blood Glucose ECG BP SPO2

Possible consequences of CPR

irreversible nervous system damage shock dic reperfusion injuries increased intracranial pressure

RDA of fluids

40-60ml . kg/ day

how is fluid lost

Sensible loss - urine, faeces insensible loss - panting, evaporation pathological - vomit, salivation, diarrhoea, polyuria

what is hypovolemia

lack of fluid in intravascular space

causes of hypovolemia

haemorrhage diarrhoea maldistribution anaphylaxis

what is dehydration

lack of fluid in the interstitium and intracellularly

causes of dehydration

lack of fluid / food intake excessive loss of fluid

history when evaluating hydration status

anorexia hypodipsia vomitting diarrhoea

physical exam of evaluating hydration status

skin turgor eye position perfusion parameters - mm, crt, hr, pulse quality, jugular distension

5% dehydration

no clinical signs

5-6% dehydration

slightly dry mucosa

6-8% dehydration

dry mucosa loss of skin turgor

8-10% dehydration

enophthalmos

10-12% dehydration

skin tent stays dull corneas hypovolaemia

>12% dehydration

hypovolemiac shick death

stages of shock

compensatory stage decompensatory stage

compensatory stage

increased HR, red mm <1 crt strong pulse

decompensatory stage

decreased HR pale mm crt > 2 or none weak / absent pulse hypothermia

types of infusions

Crystalloid colloid

Crysalloid infusion

small molecular weight compounds isotonic - .9% NaCl Hypotonic - 5% glucose, .45% NaCl Hypertonic - 10% NaCl

Colloid infusions

Large molecular weight solutes Synthetic - starch, gelatine Natural - albumin, plasma, blood

Rehydration equation

Deficit = BWkg x 10 x % dehydrated

Speed of Rehydration

Acute - 2-4hrs Subacute - 12-48hrs -> 4-8hrs Chronic - 12-48hrs

Maintenance fluid

if patient is not eating/ drinking sterofundin B 40-60ml/ kg / day 2-3ml / kg/ day

subcutaneous Rehydration

for stable patients with mild dehydration warmed isotonic crystalloids no glucose or hypertonic dorsal part of neck

complications of fluid therapy

overhydration

what can overhydration lead to

tachycardia coughing tachypnoea dyspnoea diarrhoes ascites exophthalmos vomiting pu serous nasal discharge tremor restlessness

types of parenteral treatment

subcutaneous injection IM injection IV injection blood transfusions

types of SC injections

injectable drugs fluids microchip hormone implants

contraindications of SC injections

oily injections tissue irritative injections

location of SC injections

caudal neck / thorax insulin in area with thinner skin FeLV & rabies given in abdomen

types of IM injections

injectable drugs oily injections tissue irratitive drugs

contraindication of IM injections

haemorrhagic diathesis

location of IM injections

m. semi tendinosus/ membranosus m. quad femoris m. triceps brachii m. supraspinatus et infraspinatus dorsal lumbar muscles

Types of IV injections

injections situations where fast onset is required

contraindications of IV injections

oily

location of IV injections

cephalic femoral saphena jugular (central line not for drugs)

Preparations for blood transfusions

Fresh whole blood whole blood in CPDA rbc suspension platelet rich plasma fresh frozen plasma frozen plasma

what should the frozen plasma be deficient in

clotting factors V, VIII, WF

When are blood transfusions given

acute blood loss / haemolysis chronic anaemia

crossmatching blood groups in dogs

No preformed antibodies in dogs develop 1-2 weeks after incompatible infusion therefore must perform xmatch befrore 2nd transfusion

crossmatching blood groups in cats

98% of DSH are group A other groups - B, AB

18. Cardiopulmonary resuscitation. Basics of the fluid therapy and parenteral feeding Flashcards

(76 cards)