18. Cardiopulmonary resuscitation. Basics of the fluid therapy and parenteral feeding. Flashcards
Before resuscitation indications?
BEFORE RESUSCITATION
Indications
§ Cardiac arrest
§ Pulmonary arrest
§ Cardiopulmonary arrest (CPA)
Clinical signs before resuscitation?
Clinical signs
§ Loss of consciousness (LOC)
§ Loss of spontaneous ventilation; Agonal breathing
§ Loss of palpable pulse
§ Loss of cardiac sounds upon auscultation
Predisposing factors of Cardio pulmonary resuscitation?
Predisposing factors of CPA
§ Heart failure § SIRS*
§ Severe pulmonary disease § Sepsis
§ Coagulopathy § Neoplasia
§ Polytrauma § Toxicosis
§ Brain trauma § Anaesthesia
*Systemic inflammatory response syndrome
Potentially reversible causes of CPA(5Hs, 5Ts)?
Considerations before CPR?
Considerations before CPR
§ Underlying disease (treatment of the cause of CPA)
§ The will of the owner
§ Timing; CPR should be performed within 3-5 mins of CPA
§ Equipment needed
§ Trained staff (>3 nurses needed, ideally)
Reassesment campaign on veterinary medicine?
Reassessment campaign on veterinary medicine
The acronym “RECOVER” is used
- Preparedness & prevention
- Basic life support (BLS)
- Advanced life support (ALS)
- Monitoring
- Post-resuscitation care
Performing CPR?
PERFORMING CPR
Aim of CPR: Provide oxygen & blood to the heart & brain
Process: First, a 10 second physical exam should be performed to
detect for breaths, heartbeats and the degree of bradycardia if any.
The following prioritisation should be followed throughout CPR:
- Airways
- Breathing } Basic Life Support
- Circulation
- Drugs/Defib
} Advanced Life Support 48. ECG
- Fluid
therapy
A. Airways
- Establishment of free airways
Remove materials that may cause occlusion
Placement of the ET tube otherwise use mouth-to-nose resuscitation
If ET tube isn’t possible → Tracheostomy
Breathing
Check for breathing; Ø or agonal breathing → Ventilate the
patient!
§ If the patient is in respiratory arrest, stimulate the
Ren-zhong acupuncture point (see Fig. 18.1) on the
ventral philtrum until you reach the bone → This
can stimulate spontaneous breathing
§ Ventilation with AMBU-bag/balloon attached to an
oxygen line.
§ Ventilate 10-12 breaths/min; 10ml/kg
E. Circulation
Check the heart rate → Absent → Chest compressions →
- Put patient in lateral recumbency
- Clutch hands and place hands on the patient:
a. Large dog: Widest part of chest
b. Medium dog: Over heart
c. Small dog/cat: Fingers & thumb over
heart
- 100-120 compressions/minute
Internal cardiac massage/open chest CPR in cases of
penetrating chest wound, rib fracture or diaphragmatic hernia.
F. Drugs/Defibrillation
Pharmacological support of circulation
Routes of administration
Central venous catheter (best)
Peripheral IV catheter: Drug bolus + 5ml flush
Intratracheal route (IT)
Adrenaline
Drugs must be solved in 5ml of saline
Drugs/ defibrillation?
ECG?
ECG
Evaluate for arrhythmias
§ Asystole: Adrenaline → Atropine
§ Pulseless electrical activity (PEA)
§ Ventricular tachycardia: Defib x 3 →
Lignocaine/Amiodarone
§ Ventricular fib/flutter: Defib x 3 →
Adrenaline/lignocaine
§ Sinus bradycardia: Atropine → Adrenaline →
Atropine → Adrenaline
Drugs?
Epinephrine (Lo→Hi) Asystole; VF; PEA
Atropine Asystole; Sinus bradycardia
Fluid therapy?
Fluid therapy
I. Goal is not the administration of a certain amount of
fluid, but the normalisation of the vital signs
J. Contraindicated in pulmonary oedema cases
K.
L. If the animal is hypovolaemic
Isotonic balanced crystalloid solution: Shock dose → Dog: 60-
90ml/kg
→ Cat: 45-60ml/kg
It is recommended to give 25% dose in 20 mins
→ Revaluate & repeat if necessary
Synthetic colloids: Rapidly expand intravascular volume with less
infusion volumes required
Shock dose
→ Dog: 5ml/kg
→ Cat: 1-3ml/kg
Given in IV boluses over 20 mins
Hypertonic saline (10% NaCl)
→ 1-2 ml/kg over 5 mins
If the animal is euvolemic (normal)
Crystalloid bolus at max speed
→ Dog: 20ml/kg
→ Cat: 10ml/kg
Monitoring critically ill patients?
MONITORING CRITICALLY ILL PATIENTS
§ Temperature
§ Pulse
§ Respiratory rate
§ CRT
§ Blood glucose
§ ECG
§ BP
§ SPO2
End-tidal CO2
§ < 10mmHg indicates oesophageal intubation
§ 12-18 mmHg indicates ROSC (return of spontaneous
circulation)
§ >45 mmHg indicates hypoventilation of ↑ CO2 delivery to
lungs after ROSC
Possible consequences of CPR
§ Irreversible nervous system damage
§ Shock
§ DIC
§ Reperfusion injuries
§ ↑ Intracranial pressure
Baics of fluid therapy?
Basics of Fluid Therapy
Fluid intake: 40-60ml/kg/day
Fluid loss
§ Sensible loss: Urine; Faeces
§ Insensible loss: Panting; Evaporation
§ Pathological: Vomit; Salivation; Diarrhoea; Polyuria
Hypovolaemia
Lack of fluid in the intravascular space
§ Haemorrhage
§ Diarrhoea
§ Maldistribution
§ Anaphylaxis
Dehydration
Lack of fluid in the interstitium and intracellularly
§ Lack of fluid/food intake
§ Excessive loss of fluid (but not bleeding)
Evaluating Hydration status?
Stages of shock and types of infusion?
STAGES OF SHOCK
§ Compensatory stage: ↑HR; Red MM; CRT <1; Strong
pulse
§ Decompensatory stage: ↓ HR; Pale MM; CRT >2/Ø;
Pulse weak/absent; Hypothermia
TYPES OF INFUSION
Crystalloid
§ Small molecular weight compounds (electrolytes; glucose)
§ Isotonic: 0.9% NaCl
§ Hypotonic: 5% glucose; 0.45% NaCl
§ Hypertonic: 10% NaCl
Colloid
§ Large molecular weight solutes (starch; proteins)
§ Synthetic: Starch; Gelatine
§ Natural: Albumin; Blood plasma; Blood
Rehydration of patients?
