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VTS (ECC) > RECOVER > Flashcards

RECOVER Flashcards

(53 cards)

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1
Q

How long after failing at an attempt of placing a peripheral catheter should an IO catheter be placed?

A

Two minutes

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2
Q

What is the preferred route of administration for drugs during CPR? List order of preference.

A

IV > IO> ETT

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3
Q

If drugs have to be given through ETT, how would you go about doing that?

A

Double the drug dose (epi diluted 1:1) and follow with a saline flush and strong rush of air from ambu bag

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4
Q

What drugs can be given through ETT during CPR?

A

epinephrine, vasopressin, or atropine

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5
Q

Is epinephrine recommended for nonshockable rhythms during CPR?

A

Yes, it is a strong recommendation

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6
Q

How often should epinephrine be dosed?

A

Every 3-5 minutes

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7
Q

What is the current recommendation for high dose epinephrine?

A

Strongly recommended AGAINST using high dose epinephrine. There’s no evidence that it improves neurological outcome or survival in dogs, cats, and other species. Some information in humans suggest that high dose epi worsens neurological outcome and short term (24h) survival

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8
Q

What drug is recommended NOT to be used prior to shocking a shockable rhythm? Why?

A

Epinephrine. It increases myocardial demand and worsens neurological outcome, survival to discharge, and ROSC
0.01mg/kg

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9
Q

What vasopressor should be used in shockable rhythms and when?

A

Vasopressin, when the shockable rhythm persists beyond the first shock.
0.8u/kg

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10
Q

How often and when should Atropine be given during CPR?

A

Give once as early in CPR as possible

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11
Q

Why is repeat doses of atropine NOT recommended during CPR in animals with nonshockable arrest rhythms?

A

Associated with decreased survival times in humans and dogs. The half-life of atropine is 4 hours so repeated dosing may result in excessive plasma concentrations, potentially increasing myocardial oxygen consumption during the post-cardiac arrest period

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12
Q

What drug is recommended to use for patients that are bradycardic secondary to high vagal tone?

A

Atropine

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13
Q

Is a monophasic or biphasic defibrillator preferred and why?

A

Biphasic, requires lower energy resulting in lower cardiac injury

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14
Q

What is the standard dose for biphasic defibrillation?

A

2 J/kg

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15
Q

At what point should the shock dose increase, by how much, and for how long?

A

If the initial defibrillation was unsuccessful, doubling the dose (4J/kg) of the second and all subsequent shocks is indicated

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16
Q

What antiarrythmic is recommended to use with refractory pulseless vtach?

A

Lidocaine at 2mg/kg

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17
Q

What antiarrythmics is recommended if the patient has VF and the initial shock has been unsuccessful?

A

Lidocaine 2mg/kg

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18
Q

If lidocaine is unavailable, what antiarrythmic is recommended for PVT or VF refractory to the first shock?

A

Amiodarone 5mg/kg

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19
Q

What formulation of amiodarone is avoided in dogs and why?

A

Amiodarone formulations containing polysorbate-80 due to adverse hemodynamic effects

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20
Q

What antiarrythmic is not recommended for use in cats

A

Lidocaine due to its reported sensitivity to its central nervous and cardiovascular effects including cardiotoxicity with lidocaine CRIs

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21
Q

Why are cats sensitive to lidocaine?

A

Suspected that the species has reduced hepatic glucurondiation capacity

Glucuronidation in cats is significantly impaired due to a lack of key UDP-glucuronosyltransferase (UGT) enzymes, such as UGT1A6 and UGT1A9. This deficiency leads to slower elimination of certain drugs, including acetaminophen and propofol, which can result in serious adverse effects if not managed properly

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22
Q

What antiarrythmic is recommended for all refractory shockable rhythms and what is the dosing?

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A

Esmolol 0.5mg/kg IV over 3-5 min then a CRI at 50 mcg/kg/min

23
Q

What is the dose recommended for nalaxone?

24
Q

When are crystalloid boluses recommended during CPR?

Study These Flashcards
A

When they have known or suspected hypovolemia during CPR. 20ml/kg dogs and 10-15ml/kg for cats

25
In what circumstances would we recommended giving calcium?
DOCUMENTED hypocalcemia <0.8mmol/L. 10% CaGluc 50mg/kg IV over 205 min or 10% Ca Chloride at 15mg/kg IV over 2-5 min OR hyperkalemia
26
Are glucocorticoids recommended during CPR and why or why not?
No. Weak evidence that it's helpful but there's many negative side effects to glucocorticoid administration, especially with those with poor perfusion.
27
What are the only circumstances in which we may use glucocorticoids during CPR?
The only circumstances where it may be considered would be if hypoadrenocorticism is suspected to have caused the arrest or if they have vasopressor-resistant hypotension
28
If a patient has arterial BP access, what is our DBP goal?
No less than 30mmHg
29
When is alkalinization therapy recommended in regards to CPA?
When pH is below 6.9 or with prolonged CPR (greater than 10-15 minutes) at 1mg/kg
30
When is OCCPR recommended?
In dogs and cats with abdominal organs in the thoracic cavity or with substantial accumulations of fluid or gas in the pleural or pericardial spaces.
31
What is the best method of CPR in patients undergoing surgery?
Direct cardiac massage
32
Why is serial plasma lactate concentration monitoring recommended in the PCA period?
Indicates if there's is still hypoperfusion present and can help guide medical treatment
33
When is it recommended to monitor serial blood glucose concentration?
When hypo or hyperglycemia are known or suspected
34
Why and how often would we measure serum creatinine concentrations during the PCA period?
Check of AKI asap after ROSC then no less often than every 24 hours.
35
If EtCO2 is reading < 12mmHg what could that indicate?
Improper placement of ETT
36
What is the minimum EtCO2 we strive for during CPR?
18mmHg
37
What EtCo2 may indicate ROSC?
<35mmHg
38
List the ways to give nonintubated small animals breaths in order of highest to lowest priority.
1. Tight fitting facemask 2. Mouth-to-snout (if no zoonotic risk) 3. Skipping breathings and just giving compressions
39
What is the ideal compression:ventilation ratio in individual CPR?
30 chest compressions:2 breaths
40
What is the recommended tidal volume of positive pressure ventilation during CPR and how fast?
10mL/kg at a 1 sec inspiratory time
41
In dogs that have undergone CPA while on mechanical ventilation, what setting should be used?
Manual ventilation
42
If a mechanical ventilator is being used, what settings should it be set at?
TV 10ml/kg, RR 10rpm, PEEP 0 cmH2O, pressure limit 40cm H2)
43
What rate of chest compressions is recommended for CPR?
100-120 compressions per minute
44
How deep should chest compression be on a dog or cat in lateral recumbency?
1/3 to 1/2 of the lateral diameter with full recoil of the chest.
45
How deep should chest compressions be on a dog in dorsal recumbency?
1/4 of the diameter of the chest.
46
In an unresponsive patient, do pulses need to be felt before beginning CPR?
No
47
What are the steps to seeing a patient prior to starting CPR?
Shake and shout, check airway for obstruction
48
If a single rescuer is present are compressions or intubation more important?
Chest compressions
49
Where would you place your hands when doing compressions on a dog with a wide chest in lateral recumbency?
Over the widest part of the chest until the ET tube is in, then switch to dorsal recumbency
50
Where would you place your hands when doing compressions on a dog with a wide chest in dorsal recumbency?
Over the sternum, directly over the heart
51
Where do you place your hands for keel chested dogs?
Directly over the heart in lateral recumbency
52
Where do you place your hands in medium to large round chested dogs?
Over the highest point of the thorax in lateral recumbency
53
What are the three recommended methods of performing chest compressions on cats and small dogs?
1. Circumferential two-thumb technique 2.1 handed with had wrapping around the sternum at the level of the heart using the flat portion of the fingers and the flat part of the thumb 3. 1 handed with heel of the dominant hand compressing 1/3 to 1/2 of the chest over the heart while other hand supports the dorsal thorax

VTS (ECC) (1 decks)

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