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CPR & IVFT Flashcards

(105 cards)

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1
Q

What does a CPA stand for?

A

Cardio-pulmonary arrest

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2
Q

What is a cardio-pulmonary arrest?

A

When patient has stopped breathing (respiratory arrest) heart has stopped beating (cardiac arrest)

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3
Q

How serious is a CPA?

A

An emergency because the animal is almost dead

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4
Q

What does CPR stand for?

A

Cardio-pulmonary resuscitation

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5
Q

What is basic life support?

A

CPR

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6
Q

What is the risk posed to patient if CPR is delayed?

A

Greater likelihood of not recovering and brain damage occurring from oxygen deprivation

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7
Q

What is the intention behind performing CPR?

A

Achieving return of spontaneous circulation (ROSC)

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8
Q

What are the two main components of CPR?

A

Chest compressions Ventilation

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9
Q

When should chest compressions be started?

A

Immediately

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10
Q

How many theories are there for achieving blood flow once more? What are these?

A

2: cardiac pump theory thoracic pump theory

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11
Q

In what recumbency should most dogs and cats be placed for CPR?

A

Lateral - L or R

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12
Q

When should ventilation be performed?

A

Ideally simultaneously with chest compressions

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13
Q

How many people are needed to achieve CPR?

A

2 - chest compressions + ventilation

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14
Q

How should ventilation be achieved?

A

Via ET intubation + intermittent positive pressure ventilation, using pure O2 and reservoir bag of a breathing circuit

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15
Q

What alternative methods are there for providing methods?

A

Can blow down ET tube

If not intubated, can perform mouth-snout ventilation

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16
Q

What is the problem associated with blowing air down an ET tube as an alternative means of ventilation?

A

Exhaled air only contains around 15% O2 therefore this is of limited benefit to patient

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17
Q

Describe the cardiac pump theory.

A

Ventricles are directly compressed between sternum and spine in dorsal recumbency/between ribs in lateral recumbency

Blood is forced from heart to lungs and periphery

Relaxation of ventricles returns blood to heart from lungs and periphery

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18
Q

Describe the underlying theory of the thoracic pump.

A

Intra-thoracic pressure is increased

This compresses aorta and collapses vena cava, leading to blood flow out of the thorax

During elastic recoil of the chest, decreased intra-thoracic pressure results in blood flow from the periphery back into the thorax and lungs

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19
Q

Describe the process of ABC patient assessment.

A

Airway

  • ensure airway is patent - best done by ET intubation

Breathing

  • watch chest
  • feel for exhaled breath - mirror misting, fur displacement

Circulation

  • feel for pulse via femoral artery
  • if no pulse detected, start CPR immediately
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20
Q

What is the problem with pulse palpation (ie. femoral artery)?

A

Pulse palpation is very insensitive, so unless an obvious pulse is detected, CPR should be started anyway

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21
Q

What is the best CPR technique for round-chested dogs?

A

In lateral recumbency

Use thoracic pump mechanism - applies chest compressions over widest portion of chest

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22
Q

How should CPR be performed in narrow-chested dogs?

A

Patient in lateral recumbency

Cardiac pump theory - apply chest compressions directly over heart

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23
Q

What technique should be used for barrel-chested dogs?

A

Dorsal recumbency

Cardiac pump theory - apply chest compressions directly over heart

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24
Q

How should CPR be performed in small dogs with a compliant chest or most cats?

A

Place patient in lateral recumbency

Use cardiac pump theory - achieved by wrapping fingers of one hand around sternum at level of heart

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25
What method should be used for performing CPR in larger cats or small dogs with a incompliant chest?
Patient is in lateral recumbency Cardiac pump theory - apply chest compressions directly over heart
26
For which patients is the cardiac pump method used for CPR?
Narrow-chested dogs Barrel-chested dogs Small dogs with compliant chest Most cats Small dogs with non-compliant chest Larger cats
27
Which kinds of patients is the thoracic pump method used?
Round-chested dogs
28
Which patients must be placed in lateral recumbency for CPR?
Round-chested dogs Narrow-chested dogs Small dogs with compliant chest Small dogs with non-compliant chest Most cats Larger cats
29
Which patients must be placed in dorsal recumbency for CPR to be performed?
Barrel-chested dogs
30
What is the minimal rate at which chest compressions must be performed?
100-120/min
31
To what depth should chest compressions go?
1/3 to 1/2 depth of thorax
32
Why must you not lean on the chest of the patient?
To permit full elastic recoil of chest wall in between chest compressions
33
How often should CPR cycles be performed in a CPA patient?
Uninterrupted cycles of 2mins
34
For what reasons may brief interruptions of CPR cycles occur?
Allow changeover of people - prevent fatigue Allow mouth-snout ventilation - if only 1 person is present
35
What is the procedure for normally ventilating a patient?
Insert ET tube - may need to be done with patient in lateral recumbency Tie in place Inflate cuff - not in cats
36
How should ventilation be applied?
10 breaths/min 10mL/kg tidal volume Short inspiratory time of 1s
37
How is mouth-snout ventilation performed?
Hold patient's mouth tightly closed Place mouth over patient's nares, making a seal with the snout Blow into nares 30 chest compressions: 2 breaths -\> repeat
38
What is the alternative method for performing compressions?
Interposed abdominal compressions
39
What are the benefits of interposed abdominal compressions?
Shown to double blood flow during CPR Doubles CPR success rate
40
What is the potential risk posed by performing interposed abdominal compressions?
Potential for compressions to lacerate liver or spleen if not performed correctly
41
How is the risk of lacerating the spleen or liver minimised in interposed abdominal compressions?
Application of abdominal pressure interposed during elastic recoil phase of chest compressions minimises this risk
42
How should interposed abdominal compressions be administered?
Apply abdominal pressure with overlapping hands just cranial to umbilicus Hand position, depth, rhythm and rate of compressions similar to those of chest compressions
43
What percentage of the total body weight does water make up?
60-65%
44
How is the total body water divided?
25% extracellular 40% intracellular
45
Where is extracellular fluid found?
8% intravascular space 15% interstitial space
46
Where is intracellular fluid found?
Purely within cells
47
How many different kinds of semi-permeable membranes are there? What are they?
2: capillary membrane cell membrane
48
What do capillary membranes separate?
Found between blood and interstitial space
49
What is a capillary membrane permeable to? And what is it impermeable to?
Freely permeable to H2O and electrolytes NOT permeable to proteins or macromolecules
50
What does a cell membrane separate?
Cells from interstitial space
51
What are cell membranes freely permeable to?
H2O
52
What determines the movement of fluid across semi-permeable membranes?
Hydrostatic pressure
53
Based on hydrostatic pressure, which way does fluid move?
From areas of high hydrostatic pressure to areas of low
54
What factors is hydrostatic pressure governed by?
Osmotic and oncotic pressures
55
How is osmotic pressure generated?
From electrolytes (e.g. Na+, K+), glucose and urea
56
What kind of pressure is generated by proteins?
Oncotic pressure
57
What is the only destination for administering fluids?
Intravascular spaces only
58
How does fluid reach other body fluid compartments?
Fluid composition determines its movement between fluid compartments
59
How many different types of fluid are there? What are they?
3: crystalloids Colloids Protein-based solutions
60
What constituents are crystalloids composed of?
H2O + NaCl (+ other additions)
61
H2O + NaCl + starch (+ other additions) are the constituents for which kind of fluid?
Colloids
62
What different sorts of protein-based solutions are there?
Non-O2 carriers = plasma O2 carriers = whole blood
63
By what means are the concentrations of fluids described?
Their tonicity
64
What does a fluid's tonicity refer to?
The effective osmolarity in relation to plasma
65
What does fluid tonicity affect?
Movement of fluid between intravascular and interstitial spaces
66
What different kinds of tonicity are there?
Hypotonic Isotonic Hypertonic
67
Name an example of an isotonic fluid and describe the movement of H2O between intravascular and interstitial spaces.
e.g. 0.9% saline No net movement of fluid
68
If there is 0.4% saline administered, what tonicity is this? What will be the result?
Hypotonic solution Net movement from intravascular space to interstitial fluid
69
Describe a hypertonic solution and the effect that this has on the movement of fluid?
e.g. 7.5% saline Net movement of fluid occurs from interstitial space to intravascular space
70
What different categories of fluids are there?
Replacement fluids Maintenance fluids Volume expansion fluids
71
Give an example of a replacement fluid
e.g. isotonic crystalloids
72
How do replacement fluids work?
Fluids distribute among intervascular and interstitial space
73
Which fluids are used for treatment of shock and dehydration?
Replacement fluids
74
Give an example of a maintenance fluid
e.g. hypotonic crystalloids (+ glucose for energy)
75
What is the purpose of maintenance fluids?
Equal distribution of fluid amongst intravascular, interstitial and intracellular space Used for animals that are not dehydrated but that have not been eating/drinking
76
Provide an example of a volume expansion fluid.
e.g. hypertonic crystalloids
77
What is the aim of using volume expansion fluids?
For fluid to move from interstitial space to intravascular space Used in shock/trauma patients
78
In what situation must volume expansion fluids never be used?
In dehydrated patients
79
What is hypovolaemia?
Loss of fluid from intravascular space
80
Why is it necessary to increase the vascular volume in cases of hypovolaemia?
To maintain cardiac output
81
How serious is hypovolaemia in patients
Very - this is a clinical emergency
82
How should fluids be administered in cases of hypovolaemia?
Administer as fast as possible: - consider using 2 catheters - catheter size restricts fluid administration - apply pressure to force fluids in - gravity produces too slow an administration rate
83
In what scenarios might shock occur +/- dehydration?
RTA = shock WITHOUT dehydratoin Chronic D++ = shock WITH dehydration
84
How does bolus technique of administering fluids work?
Administer 10mL/kg over 15-30 mins Then re-evaluate by examining HR, RR, mm - if still in shock, then repeat bolus Once normal circulatory volume is restored, switch to continuous rate infusion fluid administration
85
What will happen if too much fluid is administered to a patient?
Pulmonary oedema
86
In what situations is the bolus technique of administering applied?
For patients with shock +/- dehydration
87
What is the definition of dehydration?
Loss of fluid from intravascular and interstitial spaces
88
What calculations have to be made to restore body fluids to normal levels in a dehydrated patient?
Total volume = maintenance + deficit + ongoing losses
89
How should fluids be administered to dehydrated patients?
Fluid replacement should occur over 24hrs Via continuous rate infusion - using gravity or controlled pressure pump
90
How does fluid administration differ in patients suffering from shock compared with those affected by dehydration?
Patients in shock must receive a fluid bolus (at 10ml/kg over 15-30 mins) before re-evaluation Dehydrated patients should receive fluids at a continuous rate infusion over 24hrs, by calculating total volume (maintenance + ongoing losses + deficit)
91
What do maintenance fluids correct in patients?
Fluids lost by natural mechanisms e.g. evaporation from respiration, urination
92
What is the standard maintenance fluid administration rate?
2ml/kg/hr
93
How is fluid deficit calculated?
Estimate percentage of dehydration Volume in mls = % dehydrated (5-12%) x BW (kg) x 1000
94
Where do ongoing losses arise from in patients?
Vomiting +/- diarrhoea
95
How should ongoing losses fluid therapy be calculated?
Estimate mL lost each time through V +/- D
96
What general principle is applied when calculating ongoing losses fluid therapy?
This volume is often underestimated; to be safe the estimation should be multiplied by 2
97
How should fluid therapy for ongoing losses be calculated?
Volume (mLs) = volume of loss (mL) x frequency of loss over 24hrs x 2
98
How many different percentages of dehydration are there?
4 estimates
99
If a patient demonstrates normal demeanour, normal skin turgor, sticky-dry mm and normal globe position, what estimate of dehydration is this?
5%
100
How is a patient's condition described at 7% dehydrated?
Mildly depressed demeanour, mildy decreased skin turgor, dry mm, normal globe position
101
If a patient is estimated to be 10% dehydrated, how is its condition?
Moderately depressed demeanour and skin turgor, dry mm, and slightly sunken globes
102
If a patient's condition is described as moribund, skin forms tents, mm are dry and globes are deeply sunken, what estimate of dehydration is this?
12% dehydration
103
What is the procedure for setting up a fluid giving set?
1. Attach fluid bag to drip stand 2. Note volume of drip - varies between giving sets * \* normally 20 drips/mL* 3. Eliminate all air bubbles and get fluids running at an appropriate rate. 4. Stop fluid running until ready to attach to catheter
104
How should an IV catheter be inserted?
1. Insert catheter and needle half of its length into vein - check that it is within vein 2. Holding needle hub, slide catheter into vein over needle up to its hub 3. Withdraw needle 4. Hold catheter in place 5. Tape catheter into position 6. Place catheter stopper until ready 7. Flush catheter, checking that it is still within vein 8. Attach giving set and start fluids running
105
When catheterising patients, what must you not do?
Never pull catheter back over needle because this will sever the catheter into the venous system

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