CPCR

Question 1

what patients are most at risk of cardiac arrest?

Answer 1

trauma 
systemically unwell
paediatrics
geriatrics
iatrognic
recently arrested

Question 2

what is one of the main iatrogenic causes of cardio-pulmonary arrest?

Answer 2

anaesthetic overdose

Question 3

what is respiratory arrest?

Answer 3

the patient is not breathing, apnoea

Question 4

what is cardiac arrest / cardio-pulmonary arrest?

Answer 4

patient has no cardiac output
no functional heart beat
patient will also not be breathing

Question 5

what does CPCR stand for?

Answer 5

cardio pulmonary cerebral rescusitation

Question 6

what is the aim of CPCR?

Answer 6

perfusion of heart, lungs and brain

return of spontaneous circulation (ROSC)

Question 7

what is the goal of CPCR?

Answer 7

ROSC

Question 8

when should CPCR be started?

Answer 8

as soon as we think the patient has crashed

Question 9

what will lead to cardiac arrest?

Answer 9

respiratory arrest

Question 10

what should be assumed about the apnoeic patient?

Answer 10

they are likely to arrest

Question 11

who can help with CPCR?

Answer 11

anyone

ideally those trained in CPCR

Question 12

what is key for successful outcomes of arrest?

Answer 12

preparation

Question 13

what are the 3 main areas of preparation for arrest?

Answer 13

regular CPCR training
crash kit/box/trolley
crash alarm (or just call for help)

Question 14

what are the 2 main elements of CPCR?

Answer 14

BLS

ALS

Question 15

what is the key area of CPCR?

Answer 15

BLS - without this ALS will not succeed

Question 16

what are the key areas of BLS?

Answer 16

CPCR cycle

oxygen therapy

Question 17

what is involved in ALS?

Answer 17

drug therapy
fluid therapy
cardioversion

Question 18

what should the crash trolley reflect?

Answer 18

case load - if mostly large dogs seen then equipment should be tailored to them. Same for if mostly rabbits etc

Question 19

does the ICU crash trolley remain the same?

Answer 19

no - always evolving depending on what works/doesn’t and any new suggestions

Question 20

who is responsible for the crash trolley?

Answer 20

one person primarily responsible and will check stock and equipment monthly
restocked by those who have used it straight after crash in case of re-arrest

Question 21

what must be checked monthly in the crash trolley?

Answer 21

if everything is in date

all equipment works

Question 22

what should be kept in the airway access draw of the crash trolley?

Answer 22

ET tubes, cuffed, whole sizes
laryngoscope and blades
ET tube tie
cuff inflator
guide wire
plain gauze swabs
intubeaze (lidocaine) 
8FG dog urinary catheters with ET tube connector attached

Question 23

why is a dog urinary catheter needed for a crash trolley?

Answer 23

helps intubate a difficult airway

can give intratracheal drugs if IV access difficult

Question 24

what equipment is needed in a crash trolley for IV and IO access?

Answer 24

various IV catheters
IO needle
IV and IO connectors which have been aseptically prepped (flushed)
superglue (attachment of IV if in awkward location)
tape
scissors
cut down kit
size 11 scalpel blade

Question 25

what is needed in a cut down kit?

Answer 25

scalpel handle and swabs

Question 26

what equipment is needed in a crash trolley for ventilation?

Answer 26

pediatric ambu-bag with capnograph connector and flow regulator adult ambu-bag with capnograph connector and flow regulator

Question 27

what drugs are needed in the crash trolley?

Answer 27

``` low dose adrenaline (0.1 mg/ml) high dose adrenaline (1mg/ml) atropine (0.6mg/ml) 50% dextrose propofol naloxone drug dose charts ECG pads 0.9% NaCl drawn up in 10ml syringes for flush ```

Question 28

what is the role of naloxone?

Answer 28

opioid antagonist

Question 29

what equipment may be useful in a crash situation?

Answer 29

capnography crash record chart ECG defibrillator and conduction gel less crucial: pulse ox non-invasive or invasive BP

Question 30

what can be provided by capnography?

Answer 30

visual graph of ventilation | EtCO2 reading

Question 31

why is capnography important during CPR?

Answer 31

if there is an EtCO2 reading then we know we have perfusion, gaseous exchange and metabolism is occurring this means CPR is effective

Question 32

what should be recorded on a crash chart?

Answer 32

clear record of what has happened with timings of doses etc to show when next needed

Question 33

is recording everything during a crash situation always practical?

Answer 33

no - there may not be enough people and providing the CPR is more important information can be added retrospectively

Question 34

what information can be gained from an ECG?

Answer 34

electrical impulse or conduction ECG complexes / formation (is defibrillation needed or useful) ECG rate indication of drug therapy needed

Question 35

what does ECG not give information about?

Answer 35

perfusion

Question 36

what organs are we trying to perfuse during CPR?

Answer 36

heart lungs brain

Question 37

what animals are cardiac pump compressions performed on?

Answer 37

cats and small dogs

Question 38

what animals are thoracic pump compressions performed on?

Answer 38

medium to large breed dogs

Question 39

what position should patients be in for cardiac compressions?

Answer 39

right lateral recumbancy ideally although don't necessarily need to turn if compressions are effective

Question 40

why is right lateral recumbancy best for chest compressions?

Answer 40

apex of the heart is upper most in this position and so there can be greater compression of the ventricles

Question 41

what is the required compression rate for patients?

Answer 41

100-120 bpm (stayin' alive)

Question 42

how much of the chest should be compressed during cardiac compressions?

Answer 42

half to 2/3 of the width/depth of the thorax

Question 43

what can be used to indicate that cardiac compressions are deep/effective enough?

Answer 43

femoral pulse should be felt with every beat

Question 44

what should you allow for between each compression of the chest?

Answer 44

full elastic recoil of chest

Question 45

what happens during cardiac pump compressions?

Answer 45

compression of thorax directly over the heart either by using one or both hands wrapped around the chest in small animals (e.g. cats) or 2 hands directly over apex of the heart in slightly larger animals

Question 46

what happens during thoracic pump compressions?

Answer 46

compression of the widest part of the thorax (will vary between individuals)

Question 47

what are of the thorax can compressions occur at during thoracic pump compressions?

Answer 47

caudal thorax | xiphysternum

Question 48

what patients may have compressions performed in dorsal recumbancy?

Answer 48

barrel chested breeds

Question 49

what is the downside of thoracic pump compressions in dorsal recumbancy?

Answer 49

patient is very difficult to intubate

Question 50

what is the other type of cardiac compression?

Answer 50

direct inter-thoracic cardiac compressions

Question 51

in what animals are direct inter-thoracic cardiac compressions performed?

Answer 51

large breed dogs if thoracotomy has already been performed if external compressions have not been effective

Question 52

are vet nurses allowed to perform direct compressions?

Answer 52

yes

Question 53

how may IPPV be performed?

Answer 53

breathing system or ambu bag

Question 54

what is the rate of IPPV required during CPCR?

Answer 54

10 bpm or one every 6 seconds

Question 55

when should ventilation commence?

Answer 55

as soon as you suspect respiratory arrest

Question 56

how much should the thorax be inflated?

Answer 56

normal amount of the patient - always do less than you think

Question 57

what should patients be ventilated on?

Answer 57

100% O2 if possible but room air is fine if not

Question 58

what must you be aware of about the patient following arrest and successful treatment?

Answer 58

they have the potential to re-arrest

Question 59

what must be treated once patient arrest has been managed?

Answer 59

original condition or cause

Question 60

who should you communicate with following an arrest?

Answer 60

owners | personnel involved as the situation is stressful and upsetting

Question 61

when should a debrief take place after a crash?

Answer 61

once patient is stable and trolley is restocked