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66 Cards in this Set
- Front
- Back
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What is cardiopulmonary arrest defined as?
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Cessation of functional and effective ventilation & circulation
-much harder to diagnose in anesthetized patient |
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**Neuronal injury occurs within ____ minutes of hypoxia.
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5 minutes
**1 reason we record parameters every 5 minutes |
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What are 3 components to cardiopulmonary arrest?
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1) Absence of ventilation (respiratory arrest)
-cyanosis, agonal "gasps" 2) Absence of cardiac activity 3) Absence of CNS activity -unconsciousness -fixed, dilated pupils |
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What are 2 ways to assess MECHANICAL activity of the heart?
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1) Palpable pulse
2) Heart sounds |
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How do you assess the ELECTRICAL activity of the heart?
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ECG
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What does the capillary refill assess?
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Vasomotor tone
Fluid balance |
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What are the 4 ECG "rhythms of death"?
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1) Asystole
2) Ventricular fibrillation -coarse = better-easier to defibrillate -fine= worse 3) Pulseless idioventricular rhythm 4) Pulseless electrical activity (PEA) |
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What is pulseless electrical activity?
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Normal rhythm with no mechanical activity
-occurs 5-8 minutes after euthanasia |
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What is a pulseless idioventricular rhythm?
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Wide abnormal complexes
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What are 5 causes of cardiopulmonary arrest?
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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 |
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What are 7 perianesthetic causes of cardiopulmonary arrest?
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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 |
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What are 3 machine/equipment related errors that can cause cardiopulmonary arrest?
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1) Closed APL (pop-off) valve
2) Airway obstructions 3) Improper machine/ breathing circuit set up |
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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?
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Significant preexisting disease= very poor
healthy= much better |
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Time is your enemy! what happens > 20 minutes after CPA? > 5 minutes?
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> 20 minutes since arrest--> very poor chance of resuscitation
> 5 minutes- cerebral hypoxia--> neurological pathology |
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What is the definition of successful outcome to CPCR?
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Survival to discharge w/ normal neurological outcome
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What does CPCR stand for?
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Cardiopulmonary cerebral resuscitation
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What are the 3 options for owner wishes for resuscitation/
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1) DNAR- do not ATTEMPT resuscitation
2) External CPR- make a significant effort 3) Internal CPR- go for broke! |
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What are 6 factors that influence successful CPCR?
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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 |
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What are 2 ways to always be prepared to perform resuscitation?
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1) "crash cart"
2) Trained personnel -practice makes perfect |
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What are the 4 must have drugs on hand for resuscitation?
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1) Epinephrine
2) Atropine 3) Lidocaine 4) Dopamine |
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What is one way to prepare your drugs for emergency CPR?
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Calculate emergency drug doses ahead of time
-know where the drugs are |
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What is the goal of CPCR?
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To maintain cardiac output to vital organs until spontaneous circulation can be restored
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Successful resuscitation depends on achieving adequate _____ and _______.
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Myocardial blood flow
Cerebral blood flow |
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What are the ABCs of CPR (what's necessary for basic life support)?
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Airway
Breathing Circulation (chest compressions) |
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What are the 2 components of advanced life support?
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Selection & administration of appropriate drugs
any invasive methods |
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What are 3 ways to provide oxygen for airways when providing basic life support?
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Intubate- preferred!!
Mask Mouth to nose |
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What can you do for the breathing component of basic life support?
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100% oxygen and 8-12 breaths/ min
-don't exceed 20 to 25 cm H2O pressure |
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How many compressions per minute do we want to provide in hopes of maintaining circulation?
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80-120 compressions/ min
-even when done well its barely sufficient, barely exceeds 25 to 30% of normal CO |
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What is the first thing you should do for basic life support in the anesthetized patient? What else can you do?
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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 |
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What are 4 components of providing airway support?
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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 |
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How often should you ventilate the patient when performing CPR?
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8-12 breaths /min
unless alone then 2 times /min |
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When should you ventilate between compressions instead of with compressions?
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<10 kg ventilate b/w compressions
> 10 kg ventilate w/ compressions |
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What can be done to provide circulatory support?
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If no cardiac activity, start cardiac compressions
Initiate appropriate fluid therapy -shock dose |
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When do you want to perform a thoracic pump instead of cardiac pump?
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Large dogs
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How do you perform cardiac pump on animals < 10 kg?
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lateral recumbency
compress chest directly over heart 80-120 compressions/ min |
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How do you perform cardiac compressions on a dog < 5 kg?
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Compress heart w/ thumb & fingers
80-120 compressions /min |
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When ventilating b/w compresions, how many breaths/ compression do you want?
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1 breath/ 5-10 compressions
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How do you perform a thoracic pump on an animal > 10 kg?
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Lateral or dorsal (barrel chested) recumbency
-compress at widest part of chest @ 60-100 /min |
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External compression for thoracic pump compressions are ideally delivered at _______ pressure.
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Peak ventilatory pressure
-every 5-10 compressions |
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How can forward flow be enhanced when performing a thoracic pump?
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Sudden, forcible compression on thorax
-simulate cough |
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How hard do you want to compress the chest when performing a thoracic pump?
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May require 35-45 kg of pressure to adequately compress the chest
-aim to compress chest by 1/3 |
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External CPR may only generate _____ % of normal CO.
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10%, 25% is probably best case scenario
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Does external or internal CPR provide better CO?
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Internal
-improves blood flow to heart & brain -improves neurological function |
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How much time do you have to decide if you're going to perform internal or external CPR?
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*Early
within 5 minutes of external CPR |
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What are 8 indications for internal cardiac massage?
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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 |
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How do you perform internal cardiac massage?
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-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 |
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What are 6 ways to assess the success of chest compressions?
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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 |
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What should you do for hypovolemic patients going into cardiopulmonary arrest?
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Shock dose of crystalloids
-place multiple catheters if possible -hypertonic saline -colloid |
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Should you give a normovolemic patient in CPA fluids?
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Yes,
fluid bolus surgical maintenance rate -caution w/ smaller patient- easy to overload |
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What are the 6 routes of administration used for drugs in cardiopulmonary arrest?
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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 |
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What's the purpose of the drugs we give during cardiopulmonary arrest?
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Trying to get fibrillation so we can defibrillate
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What are 3 ESSENTIAL DRUGS for patients in cardiopulmonary arrest?
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Epinephrine-push towards coarse fibrillation
Lidocaine-arrhythmias Atropine |
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What are the 3 most common arrhythmias in patients with cardiopulmonary arrest?
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1) Asystole
2) Ventricular fibrillation 3) Pulseless electrical activity |
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What are 3 pre/post arrest arrhythmias?
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1) Sinus bradycardia
2) Sinus tachycardia 3) Ventricular tachycardia |
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What do you want to give an animal with a severe bradyarrhythmia?
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Atropine
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What are 3 causes of sinus tachycardia?
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1) Pain
2) Hypoxia 3) Hypercarbia |
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What are 2 things you can do for ventricular tachycardia?
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-treat underlying cause
-lidocaine |
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*What do you give an animal in asystole?
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Epinephrine***
Vasopressin |
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What are the effects of epinephrine?
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-alpha and beta adrenergic effects
-intense peripheral vasoconstriction (increased aortic diastolic pressure, increased coronary perfusion) 3) + inotropy 4) + chronotropy |
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What is the purpose of administering epinephrine to a patient in asystole?
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Asystole--> ventricular fibrillation
OR Convert fine ventricular fib to coarse |
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What is electrical defibrillation?
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Converts chaotic myocardial electrical activity to synchronous electrical activity
-"reboot' the heart |
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What drug can be used for refractory ventricular fibrillation?
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Amiodarone
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When is NaHCO3 used in patients in CPA?
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Animals with preexisting metabolic acidosis
-may play more of a role post- resuscitation |
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When do you want to administer calcium in an animal in CPA?
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Only if preexisting hypocalcemia
-worsens neurological outcome |
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What are 10 considerations post resuscitation?
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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! |
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How can you attempt to perform CPCR on a large animal?
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Drop on chest w/ knees behind point of elbow
Larger the person the better Faster the rate, the better.. |
