CPR Flashcards
(33 cards)
Wha happens if you get cerebral hypoxia?
• brain death within 4 to 6 minutes
What characterises CPA?
Cardiopulmonary arrest (CPA) is characterized by acute failure of the respiratory and circulatory systems. – Lack of oxygen delivery to tissues (DO2)
What can cause CPA? (Just name a few)
- anaesthetic complications
- severe trauma
- severe electrolyte disturbances
- hypovolemia
- vagal stimulation
- cardiac arrhythmias
- cardiorespiratory disorders
- debilitating or end-stage diseases
- Myocardial hypoxia
- Drugs and toxins
- pH abnormalities
- Electrolyte disturbances
- Temperature problems
What is a Reversible disease process arrest?
e.g. Anaesthetic overdose, Bradycardia prior to arrest, Electrolyte imbalances e.g. hyperkalaemia (urethral obstruction)
With aggressive resuscitation these animals may survive
What is Advanced disease state arrest?
E.g. Sepsis, Cancer, Severe cardiac disease, Severe lung disease, Severe CNS disease
Assess if survival is likely. Reasonable to consider whether it is humane or appropriate to perform advanced life support in some cases
Some animals are resuscitated and the owner is faced with the responsibility for euthanizing their animal when faced with a dismal prognosis and mounting cost
Discuss DNR (do not resuscitate) order or DNAR (do not attempt resuscitation)
What are the signs of cardiopulmonary arrest? (make a diagram of this)
- Apnoea or agonal gasping
- No palpable pulse
- Central eye position
- Bleeding stops at surgical site
- CRT altered (can be normal!)
- Mucous membrane grey/blue/white
- Pupils fixed and dilated
- Dry cornea
- No corneal reflex or palpebral reflex
- General muscle flaccidity
- Loss of consciousness
- ECG arrhythmias (VF, asystole, PEA/EMD)
- No heart sounds
What is BLS?
Basic life support describes
– Establishing an airway & ventilation
– Providing chest compressions
What is the A in CPR?
Establish an Airway
If apnoea is identified give 2-5 ‘rescue breaths’
If no ET tube/Ambu bag, use mouth to nose technique, room air is better than nothing!
Stimulation of the GV26 (Jen Chung) acupoint
– Intersection of the ’T’ formed below the nose, in the philtrum
Perform orotracheal intubation (which position)
– You will need laryngoscope and blades and suction
If you cannot establish an airway what should you do?
Emergency tracheostomy
– 3-5 cm midline incision ventral aspect of the neck parallel to the trachea about 2-4 cm caudal to the larynx
– Blunt dissection of tissue
– Insert trachesotomy tube between the rings
Absence of breathing means positive pressure ventilation (PPV) is needed, how do we do this?
Connect the ET tube to
– a self inflating resuscitation bag (AMBU bag)
– or an anaesthetic machine via a breathing circuit
– or to a demand valve
Current recommendations for veterinary CPR are to provide PPV at what rate?
PPV with oxygen at a rate of approx 10 breaths/minute
The femoral pulse, colour and heart sounds should be checked when?
within 30 seconds of initiating PPV
Normal heart activity is reliant on early restoration of myocardial oxygenation and blood flow - achieved by artificially generated stroke volumes, how do we do this?
– compressing the thorax (external cardiac compressions)
– or by squeezing the ventricles of the heart (internal cardiac compression)
How can the efficiency of external cardiac compressions be improved?
- Efficiency of external cardiac compressions can be improved by either by performing alternate abdominal compressions (pushes the blood towards the heart during ‘diastole’)
- This procedure requires another pair of hands…
When should you initiate the cardiac pump?
» Start as soon as CPA identified
How do you do the cardiac pump?
» Place patient in lateral recumbency on a hard surface
» Compress the thorax over the ventral 1/3 of the thorax between the 3rd and 6th ribs (directly over or encircling the heart)
» Aim for 100-120 compressions per minute devoting equal time to compression and relaxation
How do you do the cardiac pump in cats and small puppies/ large dogs ?
• For cats and small puppies the thorax can be compressed between thumb and forefinger
In barrel or broad chested dogs
– sternal compressions in dorsal recumbency may be needed to provide the cardiac pump
When is the cardiac pump inefficient?
The cardiac pump is inefficient in:
– Deep chested animals >20kg
– Obese animals
– Animals with microcardia pericardial effusion or low thoracic compliance e.g. a pneumothorax
When the cardiac pump is inefficient what should you do instead?
» In animals over 20kg the major contributor to cerebral blood flow is the thoracic pump
» This describes using both the ventricular chambers of the heart and the intrathoracic vascular system for generating stroke volume
How do you do the thoracic pump?
» Tilt head down slightly
» Compress the thorax over the widest part of the rib cage (the junction of the dorsal and middle 1/3rd of the 6-7th rib
» Aim for 60 -120 compressions per minute devoting equal time to compression and relaxation
» Inflate the lungs simultaneously (10 breaths/min)
» Do 30:2 ratio if you are alone (30 compressions, then 2 breaths)
» Remember you are trying to increase intrathoracic pressure and not compress the ventricle of the heart
How can you tell if you are making progress with the CPR?
– During compression a pulse can be palpated
– Colour of mucous membrane improves
– Eye position changes (central à ventromedial)
– Pupil changes size
– ECG changes
– Palpebral, corneal, gag reflex may be noticed
– Breathing or chest movements (twitches) resume
– Lacrimation
– Animal regains consciousness
If you cannot see progress with 2 mins what should you do?
advanced life support (ALS)
» (Emergency thoracotomy and internal cardiac compressions – unusual see below for further notes) Supervet style
» (resuscitative drugs and externally defibrillate)
What are the 4 possible outcomes of the ECG? Draw them
- Asystole
- Ventricular fibrillation (maybe preceded by ventricular tachycardia)
- Sinus bradycardia
- Electromechanical dissociation (EMD) now known as pulseless electrical activity (PEA)
What will administering Adrenaline/Epinephrine during CPR do?
Adrenergic agonist: stimulates alpha & beta receptors
Causing increased myocardial contractility, increased heart rate, increased myocardial automaticity and increased myocardial oxygen consumption
The drug is administered during CPR mainly for its alpha 2 adrenergic receptor stimulating effects
• This result in the shunting of blood to the brain, heart and lung
• Adrenaline increases heart rate, blood pressure and blood flow
