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66 Cards in this Set

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What is cardiopulmonary arrest defined as?
Cessation of functional and effective ventilation & circulation
-much harder to diagnose in anesthetized patient
**Neuronal injury occurs within ____ minutes of hypoxia.
5 minutes
**1 reason we record parameters every 5 minutes
What are 3 components to cardiopulmonary arrest?
1) Absence of ventilation (respiratory arrest)
-cyanosis, agonal "gasps"
2) Absence of cardiac activity
3) Absence of CNS activity
-unconsciousness
-fixed, dilated pupils
What are 2 ways to assess MECHANICAL activity of the heart?
1) Palpable pulse
2) Heart sounds
How do you assess the ELECTRICAL activity of the heart?
ECG
What does the capillary refill assess?
Vasomotor tone
Fluid balance
What are the 4 ECG "rhythms of death"?
1) Asystole
2) Ventricular fibrillation
-coarse = better-easier to defibrillate
-fine= worse
3) Pulseless idioventricular rhythm
4) Pulseless electrical activity (PEA)
What is pulseless electrical activity?
Normal rhythm with no mechanical activity
-occurs 5-8 minutes after euthanasia
What is a pulseless idioventricular rhythm?
Wide abnormal complexes
What are 5 causes of cardiopulmonary arrest?
1) Primary pulmonary or cardiovascular disease
-cellular hypoxia
2) Severe metabolic derangements
-acid/base disturbances
-electrolyte disturbances
3) Trauma
4) Profound vagal stimulation
5) Drugs
-overdose of anesthetic drugs
What are 7 perianesthetic causes of cardiopulmonary arrest?
1) Machine/equipment related
2) Drug administration errors
3) Air emboli
4) Severe respiratory and cardiovascular depression
5) Severe hypothermia
6) Vagal stimulation
7) Regurgitation /aspiration
What are 3 machine/equipment related errors that can cause cardiopulmonary arrest?
1) Closed APL (pop-off) valve
2) Airway obstructions
3) Improper machine/ breathing circuit set up
Is the prognosis better in an animal that has a significant preexisting disease goes into cardiopulmonary arrest or if its in unexpected event in an otherwise healthy animal?
Significant preexisting disease= very poor
healthy= much better
Time is your enemy! what happens > 20 minutes after CPA? > 5 minutes?
> 20 minutes since arrest--> very poor chance of resuscitation
> 5 minutes- cerebral hypoxia--> neurological pathology
What is the definition of successful outcome to CPCR?
Survival to discharge w/ normal neurological outcome
What does CPCR stand for?
Cardiopulmonary cerebral resuscitation
What are the 3 options for owner wishes for resuscitation/
1) DNAR- do not ATTEMPT resuscitation
2) External CPR- make a significant effort
3) Internal CPR- go for broke!
What are 6 factors that influence successful CPCR?
1) Time--> rapid diagnosis, institution of CPCR
2) Size of patient
3) Circumstances of arrest
4) Operator skill, training
5) Support staff skill, training
-team event
6) Readiness/ preparedness
What are 2 ways to always be prepared to perform resuscitation?
1) "crash cart"
2) Trained personnel
-practice makes perfect
What are the 4 must have drugs on hand for resuscitation?
1) Epinephrine
2) Atropine
3) Lidocaine
4) Dopamine
What is one way to prepare your drugs for emergency CPR?
Calculate emergency drug doses ahead of time
-know where the drugs are
What is the goal of CPCR?
To maintain cardiac output to vital organs until spontaneous circulation can be restored
Successful resuscitation depends on achieving adequate _____ and _______.
Myocardial blood flow
Cerebral blood flow
What are the ABCs of CPR (what's necessary for basic life support)?
Airway
Breathing
Circulation (chest compressions)
What are the 2 components of advanced life support?
Selection & administration of appropriate drugs
any invasive methods
What are 3 ways to provide oxygen for airways when providing basic life support?
Intubate- preferred!!
Mask
Mouth to nose
What can you do for the breathing component of basic life support?
100% oxygen and 8-12 breaths/ min
-don't exceed 20 to 25 cm H2O pressure
How many compressions per minute do we want to provide in hopes of maintaining circulation?
80-120 compressions/ min
-even when done well its barely sufficient, barely exceeds 25 to 30% of normal CO
What is the first thing you should do for basic life support in the anesthetized patient? What else can you do?
TURN OFF THE VAPORIZER
-discontinue any CRIs of anesthetic adjuncts
-reverse any reversible drugs
-check anesthetic delivery system integrity
-flush breathing circuit w/ O1
-turn up O2 flow rate
What are 4 components of providing airway support?
1) Check mouth, pharynx, endotracheal tube for obstruction
2) Check ApL (pop-off) valve
3) Intubate
-proper size, inflate cuff
-use laryngoscope
4) Ensure correct ETT placement
-2 quick breaths
-observe proper chest excursion
-auscultate
How often should you ventilate the patient when performing CPR?
8-12 breaths /min
unless alone then 2 times /min
When should you ventilate between compressions instead of with compressions?
<10 kg ventilate b/w compressions
> 10 kg ventilate w/ compressions
What can be done to provide circulatory support?
If no cardiac activity, start cardiac compressions
Initiate appropriate fluid therapy
-shock dose
When do you want to perform a thoracic pump instead of cardiac pump?
Large dogs
How do you perform cardiac pump on animals < 10 kg?
lateral recumbency
compress chest directly over heart
80-120 compressions/ min
How do you perform cardiac compressions on a dog < 5 kg?
Compress heart w/ thumb & fingers
80-120 compressions /min
When ventilating b/w compresions, how many breaths/ compression do you want?
1 breath/ 5-10 compressions
How do you perform a thoracic pump on an animal > 10 kg?
Lateral or dorsal (barrel chested) recumbency
-compress at widest part of chest @ 60-100 /min
External compression for thoracic pump compressions are ideally delivered at _______ pressure.
Peak ventilatory pressure
-every 5-10 compressions
How can forward flow be enhanced when performing a thoracic pump?
Sudden, forcible compression on thorax
-simulate cough
How hard do you want to compress the chest when performing a thoracic pump?
May require 35-45 kg of pressure to adequately compress the chest
-aim to compress chest by 1/3
External CPR may only generate _____ % of normal CO.
10%, 25% is probably best case scenario
Does external or internal CPR provide better CO?
Internal
-improves blood flow to heart & brain
-improves neurological function
How much time do you have to decide if you're going to perform internal or external CPR?
*Early
within 5 minutes of external CPR
What are 8 indications for internal cardiac massage?
1) Space occupying pleural lesions
-air, blood, effusion
2) Open chest (thoracotomy, thoracic wall trauma)
3) Pericardial disease
4) Rib fractures
5) Diaphragmatic hernia
6) Open abdomen
-can go in through diaphragm
7) Large dog, operator ability?
8) > 5 minutes of unsuccessful external chest compressions
How do you perform internal cardiac massage?
-right lateral recumbency
-quick save/ prep of thoracic wall
-incision over 5th or 6th IC space
-blunt penetration of pleural cavity
-Pericardectomy
-massage cardiac apex to base 60-100 beats/min
-if success lavage, debride, close, antibiotics
What are 6 ways to assess the success of chest compressions?
1) Palpation- pulses
2) Doppler- ligual, corneal
3) Pulse oximetry
4) Capnography*****
ETCO2<10: poor diagnosis
ETCO2> 20 associated w/survival
5) tongue/ mm color, CRT
6) Stop compressions briefly every few minutes to check for spontaneous activity
What should you do for hypovolemic patients going into cardiopulmonary arrest?
Shock dose of crystalloids
-place multiple catheters if possible
-hypertonic saline
-colloid
Should you give a normovolemic patient in CPA fluids?
Yes,
fluid bolus
surgical maintenance rate
-caution w/ smaller patient- easy to overload
What are the 6 routes of administration used for drugs in cardiopulmonary arrest?
1) Central venous catheter- ideal
2) Peripheral venous catheter- next best
3) Intratracheal- increase dose 2-10 fold
4) Intraosseous- very small patients
5) Intralingual
6) intracardiac- last resort
What's the purpose of the drugs we give during cardiopulmonary arrest?
Trying to get fibrillation so we can defibrillate
What are 3 ESSENTIAL DRUGS for patients in cardiopulmonary arrest?
Epinephrine-push towards coarse fibrillation
Lidocaine-arrhythmias
Atropine
What are the 3 most common arrhythmias in patients with cardiopulmonary arrest?
1) Asystole
2) Ventricular fibrillation
3) Pulseless electrical activity
What are 3 pre/post arrest arrhythmias?
1) Sinus bradycardia
2) Sinus tachycardia
3) Ventricular tachycardia
What do you want to give an animal with a severe bradyarrhythmia?
Atropine
What are 3 causes of sinus tachycardia?
1) Pain
2) Hypoxia
3) Hypercarbia
What are 2 things you can do for ventricular tachycardia?
-treat underlying cause
-lidocaine
*What do you give an animal in asystole?
Epinephrine***
Vasopressin
What are the effects of epinephrine?
-alpha and beta adrenergic effects
-intense peripheral vasoconstriction (increased aortic diastolic pressure, increased coronary perfusion)
3) + inotropy
4) + chronotropy
What is the purpose of administering epinephrine to a patient in asystole?
Asystole--> ventricular fibrillation
OR
Convert fine ventricular fib to coarse
What is electrical defibrillation?
Converts chaotic myocardial electrical activity to synchronous electrical activity
-"reboot' the heart
What drug can be used for refractory ventricular fibrillation?
Amiodarone
When is NaHCO3 used in patients in CPA?
Animals with preexisting metabolic acidosis
-may play more of a role post- resuscitation
When do you want to administer calcium in an animal in CPA?
Only if preexisting hypocalcemia
-worsens neurological outcome
What are 10 considerations post resuscitation?
1) Monitor closely!
-high incidence of recurrence
2) Ventilation
3) Oxygenation
4) Cardiac antiarrhythmic therapy
5) Cardiac inotropic support
6) fluid balance
7) Acid base balance
8) Treatment for cerebral edema/ neurological integrity
9) oxygen radical scavenger
10) pain
-chest compressions hurt!
How can you attempt to perform CPCR on a large animal?
Drop on chest w/ knees behind point of elbow
Larger the person the better
Faster the rate, the better..