How can we help with CPCR on placements? Flashcards
Overall survival rate of a patient in vet med that has received CPR?
<10%.
- Feline = 10-19%.
- Canine = 6%.
What does RECOVER stand for?
What are these guidelines?
Survival rates of patients in practices that use these guidelines vs those that do not.
Goals of the guidelines.
Reassessment Campaign on Veterinary Resuscitation.
Consensus guidelines combined with standardised training to give the best care for CPA (cardiopulmonary arrest) patients.
17% survival rates in practices that fail to use guidelines vs 43% in practices that do use the guidelines.
Goals = develop evidence-based guidelines for dogs and cats experiencing CPA and identify knowledge gaps or areas of CPA management that require further investigation.
The 5 domains of RECOVER guidelines.
- Preparedness and prevention.
- Basic life support (BLS) - recognition of CPA / chest compressions / ventilation / airways.
- Advanced life support (ALS) - vasopressor therapy / vagolytic therapy / electrical cardioversion / correction of condition that lead to arrest.
- Monitoring - diagnosing CPA and confirmation of ETT / monitoring during CPR.
- Post cardiac arrest (PCA) care - IVFT, O2 therapy, referral.
Being prepared for CPA event.
- Have equipment ready and know where it is.
- Have a range of emergency drugs ready to use.
- Ensure staff are trained on what to do and that protocols are in place.
- As student, ensure YOU ask where this equipment lives when on placements.
- Ensure YOU know what the emergency drugs are used for.
- Identifying and initiating CPCR.
- What does CPR stand for?
- What does CPCR stand for?
- Should be initiated of the patient is unresponsive, apnoeic.
In anaesthesia, should be initiated if you lose pulses/apex beat and/or the patient is apnoeic.
Do not waste time in an unresponsive animal to try and set up ECG to confirm, start CPCR immediately. - Cardiopulmonary resuscitation.
- Cardiopulmonary cerebral resuscitation.
Immediate basic life support if dog brought in unresponsive off the street.
Rapidly recognise CPA and rapidly initiate CPR.
Immediately initiate chest compressions and intubate.
Perform ventilation simultaneously – at 10bpm w/o interruption of chest compressions.
Lateral recumbency and compress the chest 1/3 to 1/2 its width at at least 100 compressions per minute, allowing full recoil between compressions.
Use 2-minute cycles of uninterrupted chest compressions w/ alternation of compressors between cycles.
Cardiac compressions.
Initiate immediately!
Aim for normal HR – 100 bpm.
Allow full recoil of the heart.
Compress 1/3 to 1/2 of chest wall.
Swap after 2 min cycles.
Tips for effective cardiac compressions.
Position animal with their back to your front.
Use non-slip surface where possible.
Use step to higher your position.
Extend the elbows.
Animal in lateral recumbency.
Large dogs, use both hands.
Small dogs/cats, use thumb and fore fingers.
Ventilation.
Need to gain airway security i.e. ETT.
Can use breathing system w/ O2 or ambu-bag.
Aim for 10bpm.
Tips for effective ventilation.
Gain airway access if possible i.e. ETT.
If not, consider tight fitted mask.
Take normal precautions i.e. cut tube to correct length / prevent one lung ventilation.
Secure tube in place.
1 breath every 6 sec.
Use capnography.
- What drug therapy may we use in CPCR?
- What monitoring may we use in CPCR?
- What additional care may be provided?
- Other important actions.
- Adrenaline, atropine, lidocaine.
- ECG, capnography, pulse ox.
- Fluid therapy, ocular care, warmth provision.
- Recording of all actions.
Gain IV access.
Initiation of CPCR in animal that is under GA.
Call for help, notify surgeon, note time, start cardiac compressions.
Ask someone to continue manual ventilation.
STOP anaesthetic drugs i.e. CRI/Isoflurane.
Consider adrenaline / drug therapy administration as per VS direction.
Record keeping in CPR.
Vital.
Record drugs, IV line placement, monitoring.
Record timings, watch the clock.
