CPCR

Question 1

What does CPCR stand for? What is it?

Answer 1

Cardiopulmonary Cerebral Resuscitation

Attempt to restore spontaneous circulation in a patient with CPA

Question 2

What is CPA?

Answer 2

Cardiopulmonary Arrest

Sudden cessation of spontaneous and effective respiration/ventilation and heartbeat/circulation

Question 3

Signs of impending arrest

Answer 3

Severe dyspnea
Hypoxemia 
Severe hypotension 
Weak pulses
Bradycardia 
Tachycardia

Question 4

Signs of CPA

Answer 4

Apnea/agonal breathing
Absence of heart beat and palpable pulse
Fixed dilated pupils
Lack of bleeding from Sx site

Question 5

Causes of CPA

Answer 5

Usually systemic illness (MODs)

Arrhythmias
Acid/Base/electrolyte abnormalities
Hemorrhage/hypovolemia
Neoplasia
Sepsis
Myocardial ischemia/failure
Trauma (polytrauma)

Question 6

Cardiac Arrest Arrhythmias

Answer 6

Asystole (heart standstill, nothing contracting)
Pulseless Electrical Activity (PEA)
Pulseless ventricular tachycardia
Ventricular fibrillation

Question 7

Causes of Asystole

Answer 7

Increased vagal tone

GI tract or thoracic cavity issue

Brachycephalic dogs

Severe ophthalmic disease

Neurologic

Question 8

“Treatment” of Asystole

Answer 8

Do NOT defibrilate (do this for ventricular fibrilation)

Treat with anti-cholenergic (atropine)

Question 9

Pulseless Electrical Activity

Answer 9

Can be seen with ventricular tachycardia; heart pumping so fast not having much CO

Question 10

Basic Life Support for Vet Med

Answer 10

A: Airway
B: Breathing
C: Circulation (cardiovascular)

Usually doing things simultaneously; chest compressions while intubating

Question 11

Chest compression rate

Answer 11

100 compressions/min

Question 12

Respiration rate

Answer 12

10 breaths/min
Give a breath for 1 second

Too much breaths can decrease CO2 too drastically; can cause vasoconstriction which will decrease perfusion to brain

Tidal volume: 10 mL/kg

Question 13

Basic Life Support

Compressions - How to

Answer 13

Lateral recumbency
1/3 and 1/2 width of the chest

Allow full chest wall recoil between compressions (do NOT lean on patient)

2 minute cycles

Can do interposed abdominal compressions (opposite of chest compression) -> moving blood to top half of body

Question 14

Chest Compressions:

Large and Giant breed

Answer 14

Chest compressions with the hands placed over the widest portion of the chest

Question 15

Chest Compressions:

Keel-chested dogs

Answer 15

Chest compressions with hands directly over the heart

Question 16

Chest Compressions:

Barrel-chested dog

Answer 16

Sternal chest compressions in dorsal recumbency may be considered

Question 17

Chest Compressions:

Cats and Small Dogs

Answer 17

Circumferential compressions rather than lateral compressions

Question 18

Cardiac Pump Theory

Answer 18

Pumping on heart

Squeezing and relaxing of the heart directly

Question 19

Thoracic Pump Theory

Answer 19

Movement from changes in pressure
Entire chest moving
Moving blood through the lungs and heart

Question 20

Epinephrine Dosage

Answer 20

Low dose: 0.01 mg/kg administered every 3-5 minutes

High dose: 0.1 mg/kg (1 mL/10 kg) considered after prolonged CPR

Question 21

Atropine Usage (why)

Answer 21

Asystole or PEA

Increased vagal tone

Question 22

Vasopressin Dosage

Answer 22

8. U/kg as a substitute or in combination with epinephrine every 3-5 minutes

Question 23

Defibrillation

Answer 23

Treatment of ventricular fibrillation/pulseless ventricular tachycardia (must have been occuring for <4 minutes)

Administer single shock

2 minute cycle of CPR should precede defibrillation if suspected duration of V-Fib is greater than 4 minutes

Question 24

Defibrillation

“Doses”

Answer 24

Little: 50 joules
Medium: 100 joules
Large: 150-200 joules

Question 25

Monitoring
EtCO2
??

Answer 25

Should be monitored as indication of perfusion and assess effectiveness of CPCR (should be at a certain level)

Once it reads 30-40 patient has come back

Question 26

Monitoring

ECG

Answer 26

See what your patient is reading at; evaluate rhythms which may require specific therapeutic interventions

Can rule out CPA

Question 27

Post Arrest Care

Answer 27

Hemodynamic optimization strategy (give blood)

Do not warm too quickly or potentially not at all; neurologic benefit of mild hypothermia - decreased metabolic rate

Do not give corticosteroids, anti-seizure prophylaxis, mannitol (increase ICP), or metabolic protectants

Question 28

Prognosis for Survival

Answer 28

Overall 4-9.6%

Anesthesia related: survival 47%