Term
| What are the common human errors for CPCR? |
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Definition
-lack of recognition of patient problems
-lack of monitoring
-false sense of security
=misinterpretation of ECG changes |
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Term
| What are some possible equinpment and breathing circuit problems? |
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Definition
-machine malfunction: unidirectional valves = rebreathing CO2 & exhausted CO2 absorbent
-oxygen supply issues
-inadequate O2 flow used with non rebreathing circuit
-endotrachal tube issues: missed intubation, tubes too deep |
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Term
| What are some of the possible issues leading to inappropriate intubation? |
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Definition
-esophageal intubation: depravation of oxygen
-bronchial intubation/ one lung intubation: dec oxygen saturation
-over-inflation of ET tube fucc: tear the trachea |
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Term
| What are the 4 keys to success in CPCR? |
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Definition
-early detection
-proper technique
-accurate ECG interpretation
-proper drug selection and dosing |
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Term
| What does CPCR stand for? |
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Definition
| -cardiopulmonary cerebral resuscitation |
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Term
| What are the signs of necessary CPCR intervention? |
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Definition
-apnea
-no palpable pulse
-no audible heart sounds
-cyanotic or pale mucous membranes
-dark blood or no blood in the surgery fiels
-no muscle tone |
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Term
| What do you do if you confirm a cardiac arrest? |
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Definition
-CALL FOR HELP!!!
-inform surgery/medicine team
-not the time
-dicontinue all anesthetics: inhalants and CRI |
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Term
| What constitutes basif life support? |
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Definition
-airway
-breathing
-circulation |
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Term
| What is the first step of basic life support? |
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Definition
| -establish airway:: intubate with a cuffed ET tube in lateral recumbency |
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Term
| What are the two times when CV issues are most likely ot occur? |
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Definition
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Term
| After establishing an airway, then what? |
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Definition
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Term
| What do we do before rescue breathing starts? |
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Definition
-confirm inhalant is off
-clear inhalant from breathing circuit by removing breathing hoses from the patient, occluding the wye piece and forcing waste gases into scavenge |
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Term
| How do we administer rescue breaths? |
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Definition
-slow and gentle with 100% oxygen at 10 breaths/min
-do not exceed airway pressures of 20 cm H2O |
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Term
| What are our major concerns when adminitering rescue breaths? |
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Definition
| -avoid hyperventilation: can compromise venous return & CO (inc in mean intrathoracic P) and dec cerebral and coronary perfusion, inc vasoconstriction |
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Term
| HOw do we perform cardiac compressions? |
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Definition
-100-120 compressions per min
-compression time should equal relaxation time
-don't stop unless absolutely necessary!!!
-rotate team members every 2 mins
-External compressions (thoracic or cardiac) or internal compressions |
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Term
| Which patients are eligible for the cardiac pump technique? |
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Definition
| -cats and small dogs <75 kg |
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Term
| Describe the cardiac pump technique. |
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Definition
-either single-handed or two-handed
-causes blood flow through compression of the heart |
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Term
| Which patients require the thoracic pump technique? |
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Definition
| -medium and large dogs > 75 kg |
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Term
| Describe the thoracic pump technique. |
|
Definition
-blood flow is derived from the changes of intrathoracic pressure
-thoracic wall is compressed by 33-50% with hands placed at highest point of lateral thorax |
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Term
| When do we use internal cardiac compressions? |
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Definition
| -intra-operative patients: throacotomy, abdominal exploratory |
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Term
| How do we assess compressions? |
|
Definition
-palpation of peripheral pulses: most common but not perfect
-arterial blood gases are not accurate due to poor tissue perfusion
-ETCO2 > 15 mmHg |
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Term
| What are the possible routes of drug administration? |
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Definition
-IV
-IO for puppies and kittens
-Intratracheal: inc dose 2-2.5X and dilute in 5-10 ml sterile water |
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Term
| When do we use an intratracheal route of drug admin? |
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Definition
| -all emergency drugs except sodium bicarb |
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Term
| Why do we not use intracardiac drug administration? |
|
Definition
-risk of coronary vessel laceration and drug resistant arrhythmias
-thus contraindicated unless the heart can be visualized |
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Term
| What are the general drugs for resuscitation? |
|
Definition
-Antagonistis
-Epinepherine
-Vasopresin
-Atropine
-Lidocaine |
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|
Term
| How do we reverse alpha-2 agonists? |
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Definition
| -alpha-2 antagonist: Atipamezole, Tolazoline, Yohimbine |
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Term
| How do we reverse opioids? |
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Definition
| -opioid antagonists: Naloxone |
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|
Term
| How do we reverse Benzodiazepines? |
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Definition
| -Benzodiazepine antagonists: Flumazenil |
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Term
| What are the effects of Epinepherine, an alpha and beta agonist? |
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Definition
| -alpha affects include peripheral vasoconstriction overriding beta-2 induced vasodilation = inc systemic vascular resistance, arterial BP, shunt blood toward core organs, incr coronary and cerebral perfusion P |
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Term
| What are the beta-1 agonistic effects of epinepherine? |
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Definition
| -inc HR, contractility, oxygen consumption, automaticity |
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Term
| What are the beta-2 effects of epinepherine? |
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Definition
| -dilation of peripheral vessels, bronchial SM (opens airways) |
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Term
| What is the major advantage of Vasopressin over Epinepherine? |
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Definition
| -when arresting, the animal becomes acidic and Vasopressin works in acidic environments while Epi does not |
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Term
| What are the effects of Vasopressin? |
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Definition
| -non-adrfenergic peripheral vasoconstrictor: peripher V1 Rc, no ionotropic or chronotropic effects |
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Term
| What are the effects of Atropine? |
|
Definition
-parasypatholytic (vagolytic)
-inc AV node conduction, inc sinus node automaticity, vagal induces asystole and pulseless electrical activity |
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Term
| What is Pulseless electrical activity? |
|
Definition
| -looks like a slow normal but actually nor heartbeat |
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|
Term
| What is ventricular asystole? |
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Definition
| -no cardiac activity at all (flatline) |
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Term
| What is ventricular fibrillaiton? |
|
Definition
-Coarse fib: large amp electrical activity with lower rate
-Fine fib: small amp activity but high rate |
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Term
| How do you treat Ventricular Fibrillation & Pulseless Ventricular Tachycardia? |
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Definition
| -external paddles inc E by 50% if rhythm does nto convert |
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|
Term
| Why do we not use alcohol with external paddles? |
|
Definition
|
|
Term
| What are the 3 lethal heart rhythms? |
|
Definition
1) pulseless electrical activity
2) ventricular asystole
3) ventricular fibrillation |
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|
Term
| What are the only two reasons to admin high volume fluids? |
|
Definition
| -hypovolemic secondary to dehydration or a bleed |
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Term
| What type of fluid do we admin prior to arrest? |
|
Definition
| -euvolemic or hypovolemic crystalloid fluid therapy |
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Term
| What are our fluid options for fluid therapy? |
|
Definition
-euvolemic or hypovolemic colloids
-hetastarch
-hypetrtonic saline: contraindicated for dehydration
-dextrose: only if hypoglycemia is a problem
-blood prodcuts |
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|
Term
| What is the most common complication with anesthesia? |
|
Definition
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Term
| What are some possible post resuscitation issues? |
|
Definition
-hypotension
-acid/base changes
-resp insufficiency
-arrythmias
-temp management
-protection of neuro function
-antibiotic therapy
-re-arrest |
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|
Term
| What is the most effective CPCR? |
|
Definition
| -the one that is anticipated and successfully prevented |
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|
Term
| Who is most at risk for CPCR issues? |
|
Definition
|
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Term
| Which type of trauma patients are most at risk? |
|
Definition
-pneumothorax
-hemothroax
-pumonary hemorrhage
-pulmonary pathology
-uncorrected hyperkalemia
-intracranial lesions or surgery
-neonates
-Geriatric: hyperthyroid cats: cardiac dz, arrhythmias, hypertrophic changes, multi-organ dysfunction |
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Term
| What are some examples of moderate to high risk patients? |
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Definition
| -cardiac patients: 3rd degree AV block, Sick Sinus syndrome (pacemaker) |
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Term
| What are some examples of moderate risk patients? |
|
Definition
-portosystemic shunts
-intraocular surgery
-splenectomy
-thoracotomy
-morbid obesity |
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|
Term
| What are some examples of high risk equine patients? |
|
Definition
-geriatric
-extreme emaciation
-ethmoidal hematoma
-septic shock
-intra-abdominal hemorrhage
-severe abdominal distension |
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|
Term
| How should we plan for CPCR issues? |
|
Definition
-avoid complications
-cross match
-appropriate fluid therapy
-total intravenous anesthesia |
|
|
Term
| What are the most common problems associated with anesthesia? |
|
Definition
-hypotension
-bradycardia
-hypoventilation
-hypoxia
-hypothermia |
|
|
Term
| What are some causes of cardiac arrest? |
|
Definition
-hypoxia
-hypercapnea
-hypotension
-cardiac arrhythmias
-excessive hemorrhage
-acid/base inbalance |
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