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X Clinical Veterinary Nursing Theory > CPCR > Flashcards

CPCR Flashcards

1
Q

what patients are most at risk of cardiac arrest?

A 
trauma 
systemically unwell
paediatrics
geriatrics
iatrognic
recently arrested
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2
Q

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

A

anaesthetic overdose

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3
Q

what is respiratory arrest?

A

the patient is not breathing, apnoea

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4
Q

what is cardiac arrest / cardio-pulmonary arrest?

A

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

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5
Q

what does CPCR stand for?

A

cardio pulmonary cerebral rescusitation

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6
Q

what is the aim of CPCR?

A

perfusion of heart, lungs and brain

return of spontaneous circulation (ROSC)

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7
Q

what is the goal of CPCR?

A

ROSC

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8
Q

when should CPCR be started?

A

as soon as we think the patient has crashed

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9
Q

what will lead to cardiac arrest?

A

respiratory arrest

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10
Q

what should be assumed about the apnoeic patient?

A

they are likely to arrest

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11
Q

who can help with CPCR?

A

anyone

ideally those trained in CPCR

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12
Q

what is key for successful outcomes of arrest?

A

preparation

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13
Q

what are the 3 main areas of preparation for arrest?

A

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

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14
Q

what are the 2 main elements of CPCR?

A

BLS

ALS

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15
Q

what is the key area of CPCR?

A

BLS - without this ALS will not succeed

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16
Q

what are the key areas of BLS?

A

CPCR cycle

oxygen therapy

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17
Q

what is involved in ALS?

A

drug therapy
fluid therapy
cardioversion

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18
Q

what should the crash trolley reflect?

A

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

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19
Q

does the ICU crash trolley remain the same?

A

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

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20
Q

who is responsible for the crash trolley?

A

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

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21
Q

what must be checked monthly in the crash trolley?

A

if everything is in date

all equipment works

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22
Q

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

A 
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
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23
Q

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

A

helps intubate a difficult airway

can give intratracheal drugs if IV access difficult

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24
Q

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

A 
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
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25
Q

what is needed in a cut down kit?

A

scalpel handle and swabs

26
Q

what equipment is needed in a crash trolley for ventilation?

A

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

27
Q

what drugs are needed in the crash trolley?

A 
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
28
Q

what is the role of naloxone?

A

opioid antagonist

29
Q

what equipment may be useful in a crash situation?

A

capnography
crash record chart
ECG
defibrillator and conduction gel

less crucial:
pulse ox
non-invasive or invasive BP

30
Q

what can be provided by capnography?

A

visual graph of ventilation

EtCO2 reading

31
Q

why is capnography important during CPR?

A

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

32
Q

what should be recorded on a crash chart?

A

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

33
Q

is recording everything during a crash situation always practical?

A

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

34
Q

what information can be gained from an ECG?

A

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

35
Q

what does ECG not give information about?

A

perfusion

36
Q

what organs are we trying to perfuse during CPR?

A

heart
lungs
brain

37
Q

what animals are cardiac pump compressions performed on?

A

cats and small dogs

38
Q

what animals are thoracic pump compressions performed on?

A

medium to large breed dogs

39
Q

what position should patients be in for cardiac compressions?

A

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

40
Q

why is right lateral recumbancy best for chest compressions?

A

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

41
Q

what is the required compression rate for patients?

A

100-120 bpm (stayin’ alive)

42
Q

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

A

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

43
Q

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

A

femoral pulse should be felt with every beat

44
Q

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

A

full elastic recoil of chest

45
Q

what happens during cardiac pump compressions?

A

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

46
Q

what happens during thoracic pump compressions?

A

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

47
Q

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

A

caudal thorax

xiphysternum

48
Q

what patients may have compressions performed in dorsal recumbancy?

A

barrel chested breeds

49
Q

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

A

patient is very difficult to intubate

50
Q

what is the other type of cardiac compression?

A

direct inter-thoracic cardiac compressions

51
Q

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

A

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

52
Q

are vet nurses allowed to perform direct compressions?

A

yes

53
Q

how may IPPV be performed?

A

breathing system or ambu bag

54
Q

what is the rate of IPPV required during CPCR?

A

10 bpm or one every 6 seconds

55
Q

when should ventilation commence?

A

as soon as you suspect respiratory arrest

56
Q

how much should the thorax be inflated?

A

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

57
Q

what should patients be ventilated on?

A

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

58
Q

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

A

they have the potential to re-arrest

59
Q

what must be treated once patient arrest has been managed?

A

original condition or cause

60
Q

who should you communicate with following an arrest?

A

owners

personnel involved as the situation is stressful and upsetting

61
Q

when should a debrief take place after a crash?

A

once patient is stable and trolley is restocked

X Clinical Veterinary Nursing Theory (70 decks)

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