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Anesthesiology > Cardiopulmonary Arrest and Resuscitation > Flashcards

Cardiopulmonary Arrest and Resuscitation Flashcards

1
Q

What is cardiopulmonary arrest?

A

Cessation of function ventilation and circulation

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2
Q

What is cardiopulmonary cerebral resusucitation (CPR/CPCR)?

A

Restoration of ventilation, circulation, and CNS activity

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3
Q

What are poor CPCR candidates?

A

Terminal disease
Irreversible organ failure
>15 minutes since arrest
Massive trauma

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4
Q

What is the percentage of those that return to spontaneous circulation in dogs?

A

13%

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5
Q

What is the rate of hospital discharge in dogs?

A

4%

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6
Q

What is the percentage of those that return to spontaneous circulation in cats?

A

15%

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7
Q

What is the rate of hospital discharge in cats?

A

10%

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8
Q

How can you prepare for CPR readiness?

A

Designated area
Equipment
Training and practice

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9
Q

What is the team approach to CPR?

A

Person 1: compressions
Person 2: intubation and ventilation
Person 3: record time of events and drugs given
Person 4: apply monitors/belly band and get drugs

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10
Q

What are common causes of arrest?

A

Excessive anesthetic depth
Fluid, electrolyte, acid-base distrubances
Excessive vagal tone
Cellular hypoxia

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11
Q

What are signs of impending arrest?

A 
Wear or irregular pulse
Cyanosis
Prolonged CRT
ECG changes
Respiratory dysfunction
Loss of bodily control
CNS alterations
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12
Q

What are the 5 H’s for recognition and intervention of patient at risk?

A 
Hypovolemia or hemorrhage
Hypoxia or hypoventilation
Hydrogen ions (acidosis/alkalosis)
Hyperkalemia
Hypokalemia
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13
Q

What are the 5 T’s for recognition and intervention of patient at risk?

A 
Toxins
Tension pneumothorax
Thromboembolism
Tamponade
Trauma
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14
Q

What are signs of actual arrest?

A 
Loos of consciousness
Apnea, gasping
No pulse or heart sounds
Dilated pupils
Lack of bleeding
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15
Q

What is basic cardiac life support (BCLS)?

A

ABC: airway breathing, circulation
Early recognition, rapid initiation, reinstate oxygenated blood flow
Initiate before starting advanced life support measures

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16
Q

What should be done to the airway for BCLS?

A

Open airway
Assess breathing
Establish patent airway

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17
Q

What should be done for breathing in BCLS?

A

Begin ventilation with 100% O2 if available
Initially give 2 breaths
Ventilation: 10 breaths/min

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18
Q

What is done for circulation in BCLS?

A

Give a quick precordial thumo
Chest compressions should begin immediately if the animal is pulseless
Push hard, push fast

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19
Q

How should CPR be done with small dogs and cats?

A

Right lateral recumbency
Compress over left 5-6 ICS
100-120 compressions/minute
Force- decrease thorax 30%

20
Q

How should CPR be done with large dogs?

A

Dorsal or right lateral recumbency
Compress lower 1/3 sternum or the highest part of the chest
80-100 compressions/minute
Force- decrease thorax 30%

21
Q

What indicates compression success?

A

ETCO2 > 15 mmHg
Doppler over cornea to detect blood flow
Pulse oximeter- wave form

22
Q

What are the mechanisms of blood flow during CPR?

A

Cardiac pump; direct compression of heart; effective in small animals
Thoracic pump: compression of entire thorax; large dogs

23
Q

How can you improve blood flow?

A

Time inspirations to coincide with compressions
Bind abdomen or pelvis
Interpose abdominal compressions with thoracic compressions

24
Q

What is used if BCLS measures fail?

A

Advanced cardiac life support

25
Q

What is ACLS?

A

Use of equipment and drugs to air in CPR

26
Q

What are the drugs used in ACLS?

A 
Epinephrine
Atropine
Lidocaine
Naloxone
Vasopressin
27
Q

What are routes for drugs in ACLS and are the excellent, good, or dangerous?

A 
IV central- excellent
IV peripheral- good
Intratracheal- good
Intraosseous- good
Intracardiac- dangerous
28
Q

Where can you place a catheter for fluids?

A

IV access- large bore jugular or cephalic catheter

Intraosseous is a good alternative

29
Q

At what rate should fluid be given?

A

Rapid rate if hypovolemia is present; careful administration otherwise

30
Q

What fluids are used?

A

Type of arrest determines fluid therapy, but typically crsytalloid or colloid

31
Q

What is ventricular asystole?

A

Flat line- no electrical activity or only p waves

32
Q

What is the drug of choice for ventricular asystole?

A

Epinephrine

33
Q

What does epinephrine cause?

A

Alpha adrenergic agonist: vasoconstriction

Beta adrenergic agonist: cardiac contractility

34
Q

What does vasopressin produce?

A

Peripheral vasoconstriction

Increases preload

35
Q

What does vasopressin work on?

A

Specific V1 receptors

36
Q

What is ventricular fibrillation?

A

Chaotic ventricular causing heart to look like bag or writhing worms

37
Q

What is used in ventricular fibrillation?

A 
Electrical defibrillation
Start low and increase
Cardiac compressions before defibrillation
Never use alcohol
Epinephrine
38
Q

What is used in chemic defibrillation?

A

Acetylcholine and potassium chloride

39
Q

What is pulseless electical activity (PEA)/electromechanical dissociation (EMD)?

A

Near normal ECG complex

No mechanical activity (pulseless)

40
Q

What is used in PEA/EMD?

A

Epinephrine as it may produce mechanical activity

41
Q

What is pulseless idioventricular rhythm (PIVR)?

A

Wide bizarre ventricular activity; pulseless

42
Q

What causes PIVR?

A

ATP depletion

43
Q

What drug can be used with PIVR?

A

Dexamethasone sodium phosphate, which facilitates ATP release

44
Q

What are reversal drugs and what do they reverse?

A

Naloxone reverses opioids
Atipamazole reverses alpha 2’s
Flumazenil revers benzos

45
Q

What should closed CPR be used on?

A

Small animals

46
Q

What should open CPR be used on?

A

Large animals, any animal with poor pulse generation

47
Q

When may sodium bicarbonate be useful?

A

Evidence of acidosis exists
Prolonged unsuccessful CPR
Delayed start of CPR

Anesthesiology (27 decks)

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