CPR Flashcards
1
Q
When is the safest time for an animal to arrest?
A
Under anaesthesia
2
Q
Is it likely that you will be able to revive a animal dead on arrival?
A
no but always try and help even if just taking them out the back
3
Q
What is CPR?
A
- patient stops breathing OR its heart stops beating
(minute after respiratory arrest before cardiac arrest follows, if under GA oxygen levels ^ so 5 minutes) - means to support circulation and oxygenation
4
Q
define rsp/cardiorespiratory arrest
A
- cessation of effective breathing
- cessation of effective cardiac activity (CO) and respiration
5
Q
Define return of spontaneous circulation (ROSC)
A
- re-establishmenet of sustained CO without assistance (not just electrical activity - pulseless electrical activity)
6
Q
Define basic life support
A
- chest compressions and assisted ventilation
7
Q
Define advanced life support
A
- BLS + medical and electrical intervention
8
Q
What is CPCR?
A
- cardiopulmonary CEREBRAL resuscitation
- rescusitative efforts required to elicit ROC and emphasising the importance of neuroplogical outcome
- mainly in humans (dropping core temperature etc.)
- dogs and cats more tolerant of periods of hypoxia
9
Q
How can impending cardiopulmonary arrest be recognised?
A
- not easy in critically ill patients
- hypoventilation and bradycardia esp if sudden
> pre-arrest rhythms - ventricular tachycardia with R on T phenomenon (no return to baseline, no repolarisation)
- ventricular flutter/fibrillation (needs defib within mins)
- third degree AV block (dissociated of atria and ventricles, ventricles will beat d/t escape complexes @ 40bpm, needs pacemaker)
10
Q
How can an arrested patient be identified?
A
- spontaneous breathing efforts
- auscult heart
- feel for apex beat
- palpate pulses
11
Q
Most common cause of CPA in animals cf. people?
A
- airway obstruction (always intubate)
- humans more likely myocardial infarction
12
Q
How many people are needed for effective CPR?
A
3-4 people min - ventilation - compressions - IV access - ECG - runner - scribe - pulse taker (spontaneous or compressions) - abdominal counterpressure to divert blood to cranial vena cava and brain > one person should take charge
13
Q
What is vasovagal syncope and vagal arrest?
A
- stimulation of vagus nervie -> life threatening bradycardia
> causes of vagal stimulation - V+
- defeacation/urination
- respiratory arreat
- ocular or neck surgery
- patients with pre-existing high vagal tone pdf
14
Q
Tx high vagal tone?
A
Atropine (parasympatholytic)
- intubate
- oxygenate
- can anaesthesise
15
Q
Causes and tx of anaesthetic related arrest?
A
- OD anaesthetic (stop giving anaesthetic, reverse)
- hypoventilation/hypxia/hypercarbia
16
Q
Complications of anesthetic CPA?
A
hypoxia leads to... - blindness - dysphoria - neuro dysfunction > most go away with time and good nursing care
17
Q
How can positive pressure respiration be given?
A
- positive pressure on anaesthetic machine
- Ambu bag (regulates pressure so you cant overdo it)
- 10-12 breaths per minute (don’t hyperventilate!! CO2 taken off too much -> vasoconstriction)
- 100% oxygen
- deliver breaths simultaneous with compressions
- max pressure 15cmH20 cat, 20cm H2O dog)
- inspiratory time
18
Q
What does too much ventilation do
A
- ^ intrathoracic pressure
- v CO
- v cerebral and coronary perfusion
19
Q
Aim of circulatory support?
A
- maximise myocardial/cerebral perfusion
- myocardial perfusion depends on DIASTOLIC pressure
- cerebral perfusion depends on MAP
- minimise interruption of compressions
20
Q
How is CPR physically carried out?
A
7kg
- compress thorax (thoracic pump mechanism)
~ 100bpm
~ 50:50 duty cycle (let chest expand between compressions)
21
Q
How often should you switch people compressing?
A
2 minutes
22
Q
Indications ofr open chest CPR?
A
- large dogs
- significant pleural space disease
- chest wall disease
- pericardial effusion
- penetrating chest wounds
- intra-operative arrests (esp abdo, cut through diaphragm)
- haemoabdomen
- unwitnessed arrests
- unsuccessful closed chest CPR (after 5-10mins? no proof for this)
23
Q
Advantages of open chest CPR
A
- diastolic filling assessment
- pericardial tamponade avoided
- aorta cross clamped
- ventricular fibrillation visually diagnosed
- myocardial flaccidity assessed directly
24
Q
Disadvantages of open chest CPR?
A
- need experienced personel
- need more personnel
- significant procedure
- financial and surgical backup
- infection (non-sterile)
25
What is involved in advanced life support?
- determin arrest rhythem
- defib
- cardiac pacing
- vascular access
> drugs
- vasopressor (adrenaline)
- vagolytic (atropine)
- antiarrythmic (lidocaine)
- buffer (acidosis eetc.)
- electrolyte
- IVFT
26
Is VF common in small animals? Wht is the only tx method?
No (cf. humans)
- need defib to convert
- can try pre-cordial thump
27
Which drugs can be given ET if no venous accccess present?
```
Lipid soluble:
N- naloxone
A - atropine
V - vasopressin
E - Epinephrine
L - Lidocaine
> NOT ca or bicarb
```
28
Has any drug tx been shown to ^ survival?
NO
29
What does atropine do? Indications?
> vagally mediated arrests
- parasympatholytic
- accelerates pacemakers
- ^ AV conduction
30
What does epinephrine do? Indications?
> standard vasopressor for cardiac arrest
| - a-- mediatedvasoconstriction, ^ aortic pressure, ^ myocardial perfusion
31
What does calcium do? Indications?
> previous hx of hyperkalaemia, hypoclcaemia
| - specific indications only
32
What does glucose do? Indications?
> Tx hypoglycaemia pre/during arrest
| - check glucose during CPA, tx hypoglycaemia as required
33
What does lidocaine do? Indications?
> ventricular tachycardia
| - v automacity an suppresses ventricular arrhythmias, less effective than amiodarone
34
What is sodium bicarbonate? Indications?
> hyperkalaemia/metabolic acidosis
| - routine administration does not improve outcome
35
What is vasopressin? Indications?
> Vasopressor
- some theoretical advantages over epi
- inconsistent results
- only neeed to give once
36
What is always indicated for severe bradycardia?
Atropine
37
Side effects of atropine?
- may contribute to development and maintainence of PEA/asystole
- may potentiate sinus tachycardia
- may encourage VF when given in the vicinity of epinephrine
> give one dose in early CPR
38
When are IV fluids indicated?
```
> NOT AS STANDARD
- following drug administration
- pre-existing severe hypovolaemia
- bleeding out
> overhydrating decreases coronary perfusion (^ right sided heart pressure)
```
39
When is the majority of ROSC successful? When can you ggive up?
8-10 minutes
- check end tidal CO2, if zero give up
- after 30 mins probably ok to give up if no signs of life
