CPCR

Question 1

Warning signs of cardiopulmonary arrest?

Answer 1

• Changes in the respiratory rate, depth, or pattern
• Weak or irregular pulse
• Bradycardia
• Hypotension
• Unexplained changes in the depth of anaesthesia
  
  • Can appear lighter especially nystagmus
• Cyanosis
• Hypothermia

Question 2

Diagnosis of cardiopulmonary arrest?

Answer 2

1. Absence of ventilation and/or cyanosis
2. Absence of a palpable pulse
3. Absence of heart sounds
4. Dilatation of the pupils

Question 3

When will pulse disappear?

Answer 3

Pulse will disappear when systolic pressure < 60 mm Hg

Question 4

When will heart sounds disappear?

Answer 4

Heart sounds will disappear when systolic pressure < 50 mm Hg

Question 5

Reasons for cardiac arrest in sick animals?

Answer 5

• Cardiovascular collapse due to hypovolaemia
  
  • GDV
  • Colic
  • Pancreatitis
  • Pyometra
• Severe electrolyte derangements (esp potassium)
  
  • GDV – dogs
  • Urethral obstruction
  • Ruptured bladder – foals, cats
• Small animals with severe underlying cardiac disease
• Trauma

Question 6

Reasons for cardiac or respiratory arrest in healthy animals?

Answer 6

• Neonates at term due to dystocia/no drive to breathe
  
  • RESPIRATORY ARREST
• During or after anaesthesia
  
  • VAGAL STIMULATION
  • PROBLEMS WITH BREATHING CIRCUIT
  • DRUG OVERDOSE
  • AT EXTUBATION

Question 7

What should your focus be with respiratory arrest?

Answer 7

• A, B, C, D (drugs) Or D, A, B, C
• If not intubated just start chest compressions
• But try intubate if you can

Question 8

Which cardiac arrest cases should you NOT attempt resuscitation on?

Answer 8

• Adult horses with colic – esp if in dorsal recumbency under anaesthesia (We cannot do compressions on these)
• Small animals with severe underlying cardiac disease

Question 9

Recommendations for compressions?

Answer 9

• Uninterrupted cycles of 2 minutes with patients in lateral recumbency
• Compression rate of 100–120/min
• Compression depth of 1/3–1/2 the width of the chest

Question 10

What type of compression should be carried out in animals over 10kg?

Answer 10

Thoracic pump

Question 11

What type of compression should be carried out in animals under 10kg?

Answer 11

Cardiac pump

Question 12

How is CPCR carried out in an adult horse?

Answer 12

• Lateral recumbency
• Stay on dorsal side for safety
• Need LOTS of people
• Throw entire weight onto dorsal side of the thorax
• Need to swop in every 2 minutes
• AIM highest compression rate you can

Question 13

Recommended ventilation rate for CPCR?

Answer 13

ventilation rate of approximately 10 breaths/min

Question 14

Recommended rate of compressions to breaths if doing both together?

Answer 14

Repeated rounds of 30 chest compressions followed by 2 rapid breaths in cycles of 2 minutes

Question 15

Best route for administration of drugs during CPR?

Answer 15

Intravenous (IV)-Preferred route.

(Follow each drug with a bolus of saline or water for injection to encourage transport towards the heart)

Question 16

Possible routes of administration of drugs during CPR?

Answer 16

1. Intravenous (IV)
2. Intratracheal (IT)
3. Intraosseous (IO) or Intramedullary
4. Intracardiac (IC)

Question 17

Advantages of Intratracheal administration of drugs during CPR?

Answer 17

accessibility, close proximity to the left heart via PVs, and large surface area for drug absorption

Question 18

Disadvantages of Intratracheal administration of drugs during CPR?

Answer 18

Increased dose required for many drugs (10 times that given IV), decreased efficacy in the presence of pulmonary disease, and some drugs cannot be given IT as irritant (ie, sodium bicarbonate).

Question 19

What does electrical defibrillation do?

Answer 19

• Convert chaotic electrical activity of the fibrillating heart to sinus rhythm
• Discharge of an electrical current through the myocardium aims to allow SA node to resume its normal rhythm
• Perform as soon as ventricular fibrillation diagnosed

Question 20

What could you try in ventricular fibrillation if there is no electrical defibrillator available?

Answer 20

• • precordial thump may be effective
    
    • Sharp blow with a clenched fist over the precordium

Question 21

What follow-up measures should be implemented following successful resuscitation?

Answer 21

• Continue IPPV until patient breathing spontaneously
• Correct Acidosis
• Cardiac Support
• Fluid Therapy
• Minimise cerebral oedema
• Assess neurological function
• Monitor and maintain urinary output at 1-2ml/kg/hr.
• Maintain body temperature