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ECC/Critical Care > CPR > Flashcards

CPR Flashcards

1
Q

Compressions

A 
100bpm
1/3-1/2 width of thorax
swap q2min
lateral if keel, dorsal if barrel (bulldog)
<10kg over heart, >15kg widest chest
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2
Q

Steps at CPA

A
  1. Check for heart beat
  2. Start compressions
  3. Someone else checks airways - patency, intubate - ventilate
  4. ALS
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3
Q

Ventilation

A

10bpm
<30cm H2O
TV = 10ml/kg

Aim ETCO2 >15mmHg

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4
Q

NAVEL drugs?

A 
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
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5
Q

Intraosseous sites

A
  • proximal humerus
  • intertrochanteric fossa of prox. femur
  • tibial tuberosity
  • wing of iliac
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6
Q

MOA of atropine

A

anticholinergic drug that binds to and antagonises muscarinic cholinergic receptors, leading to w/drawal of parasymp. stim.

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7
Q

atropine dose in CPA

A

0.04mg/kg q3-5min

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8
Q

MOA of epinephrine

A

a sympathomimetic drug that binds to and antagonises the alpha and beta adrenergic receptors
Alpha – vasoconstriction
Beta - chrono + inotrope

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9
Q

epinephrine dose

A

0.01mg/kg q3-5min

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10
Q

Vasopressin MOA

A

non-adrenergic vasopressor that binds to and agonises the V1A receptor on vasc. smooth muscle causing vasoconstriction

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11
Q

advantage of vasopressin over epinephrine

A

functions better in acidic environments (CPA often acidic environment dt lack of tissue perfusion)

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12
Q

opioid reversal

A

naloxone

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13
Q

dexmedetomidine, medetomidine reversal

A

atipamezole

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14
Q

xylazine reversal

A

yohimbine

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15
Q

benzos reversal

A

flumazenil

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16
Q

Amiodarone MOA

A

potassium channel blocker used to tx patients w/ a perfusing ventricular arrhythmias, defibrillation resistant pulseless ventricular tach/fib

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17
Q

Lidocaine MOA

A

class 1b antiarrhythmic –> sodium channel blocker to tx. pulse ventricular tachy/fibs

18
Q

indications to use calcium gluconate

A

IF there is documented ionized hypocalcaemia OR documented hyperkalaemia during CPR resulting from poor tissue perfusion + subsequent cell death

19
Q

indications to use sodium bicarbonate

A

only if severe metabolic acidosis prior to CPA

20
Q

a large spike in end-tidal CO2 is indicative of…

A

ROSC

21
Q

> 20mmHg ETCO2 in cats indicates..

A

adequate chest compressions in closed chest CPR

22
Q

> 15mmHg in dogs indicates…

A

adequate chest compressions in close-chest CPR

23
Q

How do you use an ECG during CPR?

A

leads places, compressions stopped for <10sec every 2min to allow interpretation of heart rhythm

24
Q

what is the goal of electrical defibrillation?

A

depolarise all of myocardial tissue simultaneously to achieve asystole in hope that a pacemaker cell will take over to generate a perfusing rhythm

25
Q

when is electrical defibrillation indicated?

A

pulseless ventricular tachy/fibrillation are the only pulseless rhythms that should be treated w/ electrical defib ASAP once IDed

26
Q

what dose of fluids is recommended during CPA?

A

a full shock dose (unless arrested dt congestive heart failure)

27
Q

Myocardial perfusion is dictated by…

A

perfusion pressure (CoPP) = the difference between the pressure at the starting point in the aortic sinus (DAP = diastolic aortic pressure) and the pressure at the finishing point (RAP = right atrial pressure)

28
Q

CoPP =

A

DAP - RAP

29
Q

CoPP >/= (???) in order to achieve ROSC

A

25mmHg

30
Q

describe the thoracic pump theory

A

> 15kg animals - when pressure is applied to the widest part of the thoracic cavity, intrathoracic pressure is maximally increased forcing blood w/in the large vessels either out of the thorax via the aorta, or up to and through the heart via the intrathoracic CV. Valves w/in veins prevent backward flux of blood out of the thorax. Chest recoil post compression causes pressure w/in thorax to decrease, opening large vessels and allowing them to fill w/ blood from extra-thoracic space.

31
Q

describe the cardiac pump theory

A

<10kg animals - blood flow during chest compression where the hand is directly over the heart, is dt compression of the ventricles btwn the lateral chest walls (in lateral recumbency) or btwn the sternum and spine (in dorsal)

32
Q

how is the preload provided for next cardiac cycle in CPR?

A

after the compression, chest recoil occurs as ribs return to normal anatomic position –> creates low pressure region w/in thorax drawing blood to fill the heart and great veins –> provides preload for next cardiac cycle

33
Q

what are the risks of hyperventilating a patient during CPR?

A

decreased venous return and preload, decreased CO and compromised CoPP and decreased ROSC/survival dt persistent positive pressure on the thorax

34
Q

explain the theory of interposed abdominal compressions

A
  • performed by 2 people - abdominal and chest compression alternatively
  • increases abdominal pressure during diastole forces abdominal aortic blood cranially towards the aortic sinus –> inc DAP –> inc CoPP
  • inc. CO by improving venous return to heart via compression of CdVC
  • -> v. technically challenging
35
Q

why might the application of constant pressure to the abdomen be beneficial in CPR?

A

= abdominal counterpressure

- may improve blood flow through cranial body by decreasing blood flow through abdominal aorta

36
Q

when is it reasonable to stop CPR?

A

after 20-30mins w/ no ROSC

37
Q

Characteristics of pulseless electrical activity on ECG?

A
  • coordinated electrical activity/repeats
  • rates <200bpm (commonly <50bpm)
  • narrow QRS complexes commonly (but can look like normal sinus rhythm or have wide/bizarre complexes)
38
Q

characteristics of asystole on ECG?

A
  • no electrical activity/flat line
39
Q

name the two common non-shockable rhythms

A
  • PEA

- Asystole

40
Q

name the two common shockable rhythms

A
  • pulseless VTach

- VFib

41
Q

characteristics of pulseless VTach?

A
  • organised, rpt, wide QRS complexes

- >200bpm w/out accompanying pulses

42
Q

characteristics of Vfib?

A
  • wavy, chaotic line (lack of consistent, rpt waveform)

- fine (low amp, high freq) vs. coarse (high amp, low freq)

ECC/Critical Care (5 decks)

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