CPR

Question 1

Define cardiopulmonary arrest

Answer 1

Cessation of normal circulation d/t failure of the heart to contract effectively

Question 2

What is CPR?

Answer 2

Cardiopulmonary Resuscitation

Emergency medical procedure performed to manually maintain perfusion until spontaneous circulation can be restored

Question 3

T/F: Success rates with CPR are pretty good, most patients come back.

Answer 3

False - success rates around 5%

Question 4

3 key features to recognize when CPR might be necessary

Answer 4

Loss of consciousness

Loss of normal, spontaneous breathing

Loss of palpable pulses

Question 5

Why should you not use a stethoscope what trying to assess a patient’s pulse?

Answer 5

Might hear a heartbeat, but that doesn’t mean you have a palpable pulse

Question 6

What are some common preceding events to the need for CPR?

Answer 6

Bradycardia
Sudden increase in vagal tone (vomiting, straining to defecate)
Sudden change in breathing pattern
Worsening mentation

Question 7

T/F: Some diseases predispose to a patient to CPA and therefore warrant intense monitoring and aggressive therapy

Answer 7

True - Diseases like sepsis, SIRS, HF, pulmonary disease, trauma, neoplasia, and general anesthesia

Question 8

______ people minimum for CPR

Answer 8

3

Question 9

When is the best time to to communicate with a client about CPA and CPR?

Answer 9

Preferable before arrest, but if not before ASAP

Question 10

What do we mean by “ABCs”?

Answer 10

Basic life support

Airway
Breathing
Circulation

Question 11

Upon initiating CPR, what is the first step that should be taken?

Answer 11

Establish an airway with endotracheal intubation or, if needed, emergency tracheostomy

HOWEVER this doesn’t mean chest compressions shouldn’t be started

Question 12

______ breaths/min are given during CPR

Answer 12

8-12

Question 13

Why do we need to make sure we aren’t giving too many breaths?

Answer 13

The breaths being given during CPR are positive pressure breaths

Every time a breath is given, venous return to the heart is reduced

We want to limit the number of breaths given to limit the effects on venous return

Question 14

Discuss the two methods that can be used to provide compressions

Answer 14

Cardiac pump: squeezing heart itself to push blood where the point of the elbow meets the chest

Thoracic pump: putting hands over the widest part of the chest to get greatest change in intrathoracic pressure to pump the heart

Question 15

Depress the chest by _______, allow complete chest recoil, and deliver compressions at a rate of __________/minute

Answer 15

1/3

100 compressions

Question 16

Why is it important to allow complete recoil of the chest between compressions?

Answer 16

That is when venous blood can return to the heart

Question 17

When is open-chest CPR indicated?

Answer 17

Large and giant breed dogs

Thoracic trauma

Pleural or pericardial space disease (ex. Pneumothorax, pericardial or pleural effusion)

Intra-operative arrest

Ineffective chest compressions

Question 18

Name the four arrest rhythms

Answer 18

Asystole

Pulseless ventricular tachycardia

Ventricular fibrillation

Pulseless electrical activity

Question 19

What rhythms are shockable?

Answer 19

Pulseless ventricular tachycardia

Ventricular fibrillation

Question 20

What is the point of shocking a patients?

Answer 20

Ventricular fibrillation and pulseless ventricular tachycardia occur when there is too much electrical activity going on

Shocking the heart shuts down the electrical activity in hopes of conversion to normal sinus rhythm

Question 21

Patients should be in ______ recumbency when delivering shocks

Answer 21

Dorsal

Question 22

Shock dose is _________joules/kg

Answer 22

2-10

Question 23

T/F: Compressions should never stop, even during defibrillation

Answer 23

False - person shocking should call “clear” and person delivering compressions will keep hands off until shock has been delivered

Question 24

How soon after defibrillating should you recheck the rhythm?

Answer 24

2 minutes

Check during hand-off between those giving compressions

Question 25

A patient goes into CPA. You are cleared to perform CPR, but the patient does not have a catheter in place for drug administration. What can you do?

Answer 25

Administer intratracheally
IO catheterization
Venous cut-down

Question 26

What two drugs are commonly used in CPR?

Answer 26

Epinephrine = #1
Atropine

Question 27

When is atropine most useful?

Answer 27

Before arrest for bradycardia

Question 28

When are fluids indicated for CPR?

Answer 28

Patients in hypovolemic shock prior to arrest

Question 29

Why might fluids be contraindicated during CPR?

Answer 29

Can reduce coronary perfusion

Question 30

T/F: Lidocaine is commonly used during CPR to increase success of defibrillation

Answer 30

False - not routinely indicated in CPA

Suppresses ventricular activity and may reduce likelihood of successful defibrillation

Question 31

A patient arrests after being induced for surgery. Midazolam and butorphanol were used in the pre-med protocol. What do you do? (Patient has been approved for CPR)

Answer 31

Initiate CPR
Reverse those drugs!!!! (Naloxone for the torb, flumazenil for the midazolam, and if dexmed was used, atipamezole)

Question 32

What is the most important monitoring device during CPR?

Answer 32

ET CO2

Can confirm ET tube placement

Identification of return of spontaneous circulation

Assessment of quality of CPR

Question 33

What is ROSC?

Answer 33

Return of Spontaneous Circulation

During arrest, all the CO2 that is being produced by the tissues stays at the tissues because we don’t have good perfusion

CO2 only comes back to the lungs based on our chest compressions

If heart starts beating again, will see ET CO2 shoot up

Question 34

T/F: blindness, stupor, and comas are common following CPR

Answer 34

True - should see improvement in first 24-48 hours

Question 35

Having your chest slammed on for 15 minutes is painful. What should you do for patients post-resuscitation?

Answer 35

Provide analgesia using reversible drugs

Opioids preferred