CPR

Question 1

What does CPR stand for?

Answer 1

Cardio
Pulmonary
Resuscitation

Question 2

Patients at risk for needing CPR (6)

Answer 2

1. Anesthesia
2. Vomiting
3. Heart disease
   - Failure, Arrhythmias
4. Sepsis
5. Airway disease
6. Lung disease
   - Inadequate o2 (SPO <95%)

Question 3

What are warning signs of arrest? (7)

Answer 3

1. Respiration changes
   - Depth, Rate, Effort
2. Weak or irregular pulse
3. Bradycardia
4. Hypotension
5. Unexplained Anesthesia depth change
6. Cyanosis
7. Hypothermia

Question 4

What are steps of respiratory support that can be taken prior to cardiac arrest? (5)

Answer 4

1. O2
2. Intubation
3. Suction
4. Correct electrolytes
5. Drugs to normalize heart

Question 5

What are the different roles in CPR? (5-6)

Answer 5

1. Code leader (usually DVM)
2. Ventilations
3. Compressions (rotate q 10min)
4. Drug administrator
5. Event recorder
6. Floater, may rotate in

Question 6

Cardiopulmonary Arrest
Diagnosis (4)

Answer 6

1. Absence of ventilation & cyanosis
   - “respiratory arrest”
2. Absence of palpable pulse
   - pulse will disappear when systolic pressure <60mmHg
3. Absence of heart sounds
   - will disappear when systolic pressure <50mmHg
4. Dilation of pupils

Question 7

CPR Goals (5)

Answer 7

1. Regain spontaneous, effective heartbeat
   - generates a pulse!
2. Tissue perfusion
3. Protect brain from damage
4. Regain spontaneous ventilation
5. Correct underlying problem that led to arrest

Question 8

Basic Life Support (3)
The ABC’s

Answer 8

a. Airway establishment
b. Breathing support
c. Circulation support

Question 9

Advanced Life Support (3)
DEF’s

Answer 9

d. Diagnosis & Drugs
e. Electrocardiography
f. Fibrillation control

Question 10

Prolonged Life Support (3)
GHI’s

Answer 10

g. Gauging a patient’s response
h. Hopeful measures for brain
i. Intensive care

Question 11

Airway
1. Priority level
2. How to establish it (3)

Answer 11

1. # 1 priority!!!
   • Bleeding, broken bones, etc are secondary!
2. Establish airway
   - Tilt head back gently
   - Pull tongue forward gently
   - Check for foreign objects

Question 12

Breathing
How to evaluate if it’s present or not (3)

Answer 12

1. Look
   - Chest rise & fall?
2. Listen
   - Hear air moving?
3. Feel
   - Feel airflow on your hand or face?

Question 13

Is there a situation where a patient could have the movements of breathing but no gas exchange?

Answer 13

Yes.
If the airway is blocked, the Pt may still make resp efforts using diaphragm, chest muscles, & abdominal muscles to try and pull air in & out of the lungs.

Question 14

When ventilating, how often should you give breaths?

Answer 14

Give 4-5 rapid breaths then give 1 every 6 seconds

Question 15

Canine Heimlich (5)

Answer 15

1. Invert animal
   - Use gravity to your advantage
2. 3 sharp abdominal thrusts
   - First under xiphoid
   - In & up (aim for left shoulder)
3. Finger sweep mouth
4. If no object, 2 sharp back slaps
5. Repeat abdominal thrusts

Question 16

Small animal Heimlich (5)

Answer 16

1. Lift and suspend in the air
2. Give 5 back blows between the shoulder blades
3. Check the mouth to see if something got
   dislodged (finger sweep)
4. Try to ventilate patient again
5. Repeat

Question 17

Large animal Heimlich (3)

Answer 17

1. Lift the dog up by the forelegs with their back to you (like human Heimlich)
2. Give 5 abdominal thrusts just caudal to the ribs (up and out)
3. Check the mouth for any dislodged objects (look and finger sweep)

Question 18

Rescue breathing
1. When to do it
2. Methods (6)

Answer 18

1. When Pt is not breathing!
2. Methods
   - Mouth to nose
   - Mouth to mask
   - Mouth to ET tube
   - Ambu-bag to ET tube (w/O2)
   - Anesthesia machine to ET tube
   - Ventilator apparatus to ET tube

Question 19

When performing mouth to muzzle… (4)

Answer 19

1. Make sure you enclose the mouth and nose with your hands
2. Pt has a mouthful of teeth
3. If successful, they could regain consciousness or reflex bites if agonal
4. Don’t get bitten!!

Question 20

Where would a needle be placed on the snout and why?

Answer 20

Nasal philtrum at the ventral limit of the nares. Twirl the needle and move up & down.
This is an attempt to encourage breathing

Question 21

Places to locate a pulse (2)

Answer 21

1. Heartbeat over the heart apex on chest
2. Femoral pulse

Question 22

T/F: If an EKG picks up a rhythm, arrest patient is probably fine

Answer 22

False! You must always feel for a pulse

Question 23

Compressions ratio
1. Single rescuer
2. Two people
3. Giant breeds

Answer 23

1. 1 breath per 15 compressions
2. Don’t interrupt compressions
3. 1 breath per 6 compressions for single rescuer

Question 24

Compressions
1. Pets <30lbs (2)
2. Pets >30lbs (3)

Answer 24

1. <30lbs
   - Hand on each side of chest
   - 1/2” to 1” compression of the chest between the hands
2. > 30lbs
   - Keep arms straight & elbows locked
   - Place one hand on top of the other & press down with heel of hand
   - 1”-3” depth of compressions (1/3 chest depth)

Question 25

Hand positioning for compressions 1. Large breed dogs 2. Barrel-chested breeds 3. Smaller dogs & cats (2)

Answer 25

1. Widest portion of the thorax, using the thoracic pump theory. 2. Sternal chest compressions in dorsal recumbency. 3. Directly over the heart, employing cardiac pump theory - May also benefit from circumferential compressions, although benefits less clear.

Question 26

Compression rate

Answer 26

100-120bpm

Question 27

how to know if your compressions are effective?

Answer 27

ETCO2 - Effective CPR will see an increase in ETCO2

Question 28

1. What should be done after 2min of CPR? 2. When should you stop? (3)

Answer 28

1. Check for pulse again then Repeat process 2. After 20min with no return of pulse or breathing - Owner request to cease - Rescuer exhaustion

Question 29

What is the only exception to cease CPR protocols?

Answer 29

HYPOTHERMIA! - Rewarm Pt before pronouncing death (very slowly) - Cooling of the brain may prolong cell survival

Question 30

1. How many ventilations per minute? 2. How can effective chest compressions & ventilations be measured? (4)

Answer 30

1. 10-20bpm 2. MM color, SpO2, CO2 measurements, and femoral pulse

Question 31

1. What does ventilation actually effect in the body? 2. What does it not effect?

Answer 31

1. Oxygenation, CO2, & pH of arterial & venous blood. 2. Tissue conditions

Question 32

T/F: Ventilation is most beneficial in the first few minutes of CPR

Answer 32

False! It is most beneficial under conditions of prolonged untreated cardiac arrest. It affects the return of spontaneous circulation & is important for survival.

Question 33

Abdominal compressions (2)

Answer 33

1. Interposed by another person, alternating chest & abdominal compressions. 2. Increases blood flow from lower extremities back towards the heart.

Question 34

Describe "Shock Pants"

Answer 34

Compression on the rear legs of the patients. May use MAST pants or more likely Vetwrap

Question 35

CPR drugs & indications (7)

Answer 35

1. Epinephrine - Initiate heartbeat, HR, & contractility 2. Atropine - Increase HR & Tx asystole (flat line) 3. Lidocaine - Tx Ventricular arrhythmias (VPC's, V-tach) 4. Furosemide - Pulmonary & cerebral edema 5. Mannitol - Cerebral edema 6. Hetastarch / Hypertonic saline - Rapid IV volume expansion 7. Defibrillation - Tx of V-Fib

Question 36

Methods of administering CPR drugs in order (3)

Answer 36

1. Central venous catheter 2. ET tube 3. Peripheral or intraosseous catheter (IO) **Follow with goof flush of saline 5-20ml to ensure drug in bloodstream**

Question 37

How does administering drugs in the ET tube work?

Answer 37

1. Absorbed across the alveolar membranes 2. Double the IV dose & injected via catheter down the ET catheter 3. Followed by deep ventilation to distribute the drug

Question 38

IV fluids during CPR (3)

Answer 38

1. Not indicated during CPR! May worsen diastolic pressure 2. IVF should be restarted as soon as pulse has recurred 3. Hang brand new bag of warm LRS or Saline as DVM orders

Question 39

How to set up for a Defibrillator (4)

Answer 39

1. NO ALCOHOL on patient! 2. EKG gel best 3. Pt off of metal! 4. No one touching Pt during "shock"

Question 40

What happens after return of a pulse? (5)

Answer 40

1. High risk of re-arrest (sec-hrs) 2. Underlying cause of arrest tbd & Tx 3. Post arrest Pt are very intensive care 4. Return of spontaneous breathing may take some time, Pt will be on ventilator 5. May take time to determine what level of CNS function is going to return.

Question 41

Cerebral ischemia & Re-perfursion Injury 1. What is it? 2. Monitoring (5)

Answer 41

1. CNS is v sensitive to injury during shock, arrest, & post-resuscitation. 2. Hourly neuro exams: - Assess pupils, blink reflexes - Resp pattern - Level of consciousness: `Motor responses & posturing `Response to sound, painful stimulus, & movement.