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CPCR
WK 4
| Question | Answer |
|---|---|
| RECOVER initiative | - Aims to improve outcome for patients using evidance base to inform guidelines - Improving training for veterinary profeshionals - Improving ROSC and survival to discharge |
| CPR algorithm for cats and dogs | see picture |
| When has cardiopulmonary arrest occurred | mentation ... the unresponsive patient changes in breathing, apnoea altered MM colour BP or absence of pulse changes in HR or rhythm capnography (decreased ETCO2) Absence of bleeding pupillary dilation |
| CPR Initial Assessment Algorithm, Recover | should take < 10 seconds shake and shout call for help! ABC exam Airway - any obstruction? breathing- watch for chest rise circulation - no longer recommended |
| Start basic life support | chest compressions 100-120 compression per min 1:1 cycle need to allow chest to fully recoil ventilation 1 breath every 6s (10breaths per min) Single rescuer/can’t intubate use tight fitting mask Multiple rescuers – intubate uninterrupted for 2 min |
| chest compressions (see pictures) standard dog - round chest (Labrador) | place hands over the highest point of the chest utilises the thoracic pump mechanism compression 1/2 to a 1/3 of chest width |
| chest compressions (see pictures) keel chested dogs (greyhounds) | place hands directly over the heart utilises the cardiac pump mechanism compression 1/2 to a 1/3 of chest width |
| chest compressions (see pictures) wide-chested dogs (Bulldogs) | place hands over sternum patient in dorsal compressions 1/4 chest depth |
| chest compressions (see pictures) small dogs/cats, 10-15kg or less | directly over heart, hold sternum in palm, brace dorsum with nondominant hand use flat thumbs + fingers utilise cardiac pump approach can use one hand over heart can use 2 thumb approach where you wrap hands around the whole animal |
| chest compressions, small dogs/cats | do not use 2 hands ! over compression can damage the heart |
| chest compression hands in correct position = | one over the other heel over heel hands interlocked shoulders over hands lock elbows use core and abdominal muscle and bend ae the waist (see pictures) |
| what if you are too short or table is too high CPR | use a stool get on the table drop the height of the table put patient on the floor Ensure on a firm hard surface, remove mattresses |
| interposed abdominal compressions | useful to increase return from caudal vena cava better blood flow and perfusion |
| ventilation | use laryngoscope to ensure correct placement capnography best indicator to ensure correct suction tracheostomy if necessary dont get bitten |
| ventilation - 1 breath every = | 6 seconds, 1 second inspiratory time Do Not over ventilate |
| Advanced Life Support (ALS) | this can happen at the same time as BLS if you have enough people - monitoring - IV access - Reversals |
| ALS - Monitoring Capnography - | - monitors how effective chest compressions are - Aim for ETCO2>18mmHg - Best indicator of ROSC - ↑ suddenly by ≥15mmHg or the value ≥35mmHg |
| ALS - Monitoring ECG | - Diagnose an arrest rhythm - guides drug therapy |
| ALS - IV Access | IV access BEST – superior to IO Cephalic Jugular Other options: Intraosseous Intra-tracheal |
| ALS - Reversals | Turn of anaesthetic, flush oxygen, empty bag Naloxone Atipamezole Flumazenil |
| All Within 2 Minutes | BLS - Airway - Compressions ALS - Monitoring - IV access - Reversals |
| ECG - shockable Rhythms Pulseless Ventricular Tachycardia (pulseless VT) | - No pulse - Fast, rapid electrical activity - Generates a very high HR>200 see picture |
| ECG - shockable Rhythms ventricular Fibrillation (VF) | No pulse Heart muscle ‘quivering’ Rapid, discordant electrical activity No significant mechanical function No normal looking waveform see picture |
| ECG - Non-shockable rhythms Asystole | No pulse No electrical activity No mechanical activity Flat line see picture |
| ECG - Non-shockable rhythms Pulseless Electrical Activity (PEA) | No pulse No mechanical activity Residual electrical activity Will see something on the waveform see picture |
| No Pulse Shockable Rhythm Defibrillator (electrical) dont have a defibrillator | Precordial thump (mechanical) see picture |
| defibrillator technique | Patient in dorsal Paddles on opposite sides DO NOT touch dog or table ‘CLEAR!’ Use ELECTRODE GEL |
| No Pulse Non-shockable Rhythm Drug Therapy | Epinephrine (adrenaline) Vasopressin ? Atropine |
| Drug Therapy Aim | Peripheral vasoconstriction Redirect blood flow from periphery to core Maximise blood flow to brain & heart Help BLS (excellent compressions only getting 30% normal CO) |
| Drug Therapy – Epinephrine (adrenaline) Catecholamine Non-specific, targets: | Non-specific, targets: Α1 receptors – peripheral vasoconstriction β1 receptors – ↑ cardiac contractility and rate β2 receptors – vasodilation & bronchodilation A1 are the effects most beneficial to CPR! HIGH DOSE NO LONGER RECOMMENDE |
| Drug Therapy – Vasopressin | Antidiuretic hormone Acts on the V1 receptor, so NO beta effects Causes peripheral vasoconstriction No effect on the heart VERY EXPENSIVE!!!! |
| Drug Therapy – Atropine | Anticholinergic No harm in giving, but there is no strong evidence that it benefits Only give once! ½ life 20-30mins! |
| PCA | - monitoring - fluid therapy, only if needed - oxygen supplementation |
| Team Roles Whole team approach – someone needs to be Team Leader Ideal world – 5-6 people PRIORITY = | chest compressions Airway and IPPV Monitoring IV access Record keeping and timer! Runner (if enough people) |
| Be prepared - | ASA score- highlight ant at risk patients going under anaesthesia CPR training and refreshers crash box stocked and organised |
| Crash Trolley can contain: | IV catheters, bungs/T-ports Syringes & needles (some pre-prepared) Drugs Dose charts ET tubes with tie + laryngoscope Fluids + giving sets Airway access, Urinary catheter, suction Defibrillator |
| RECOVER Guidelines: Newborn | Now released guidelines for newborn cats and dogs Goal is to support the transition from intra- to extrauterine physiology Most commonly used in the context of C-section deliveries Parturition is a predictable event, allows for preparation! |
| Definitions - Newborn | Brith → 1st few hours of life Spans transition from intrauterine foetal life to extrauterine life |
| Definitions - Neonatal | Birth → weaning (3 – 4 weeks) |
| Definitions - Paediatric | Until sexual maturity (6 months) |
| newborn preparation | Towels!!! LOTS! Nice if they are warmed Suction bulb Incubator or warm, safe area to put puppies in Suture and iodine for umbilicus Oxygen and mask |
| What do you do when the vet hands you the newborn | First resuscitation measures immediately after birth: Dry and stimulate newborn Clear airway Keep warm Determine HR and assess RR within first minute of delivery Expect newborns to start vocalising and moving moments after birth |
| Apgar Score (see table) | Need to do this 5 minutes, 30 minutes and 60 minutes after birth Target score 7-10 |
| When do we consider resuscitation | Non-vigorous newborn Not crying or weakly crying Sluggish or no reflexes Low muscle tone or flaccid HR <120 bpm RR <15 bpm |
| Ventilation | Ventilate with room air initially 100% oxygen considered if no response after 1-2 mins Tight fitting mask most suitable Nose, neck and spine all in a line |
| Chest compressions | If newborn has NO heartbeat, need to initiate CPR Chest compressions and breaths 4:1 |
| When is it futile to resuscitate | Congenital defects After 15-20 mins and Apgar score 0 Current thinking for length of CPR in newborns is around 15 minutes |
Created by:
lucy.fox