Renal > CPR > Flashcards

CPR Flashcards

(55 cards)

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1
Q

Goal - CPR

A

support body, restart circulatory and respiratory systems

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2
Q

Success rate - animal CPR

A

low, about 10% (animals under GA have a better success rate as this is a reversible cause of CV or respiratory arrest vs terminal diseases and close monitoring allows prompt detection of arrest)

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3
Q

When is CPR most likely to be effective?

A

before major organs have undergone a prolonged period without blood supply

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4
Q

Define respiratory arrest

A

cessation of effective breathing

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5
Q

Define CPA

A

Cardiopulmonary arrest = cessation of effective CO and respiration

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6
Q

Define ROSC

A

Return of spontaneous circulation = re-establishment of sustained CO without assistance

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7
Q

Define BLS

A

= basic life support

- chest compressions and assisted ventilation

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8
Q

What is ACLS?

A
  • Advanced cardiac life support

- BLS + medical + electrical interventions

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9
Q

What is CPR?

A

= resuscitative efforts (BLS and/or ACLS) required to elicit ROSC and emphasising the importance of neurological outcome

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10
Q

Factors to consider performing CPR

A
  • owner’s wishes
  • nature of underlying dz
  • QoL should resuscitation be succesful
  • availability of ongoing intensive care
  • finances
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11
Q

What happens if CPR is initially succesful?

A

= result in restarting heart beat, detectable circulation (i.e. ROSC) and spontaneous ventilation

  • ongoing management (24-48hrs, depends on patient health status) can be highly intensive, demand continuous nursing, monitoring, expensive
  • many cases, high risk of a crash recurring (>80% animals rearrest within 24 hours)
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12
Q

Long-term survival of patients undergoing cardiopulmonary arrest

A

poor to grave (people - poor)

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13
Q

What % animals are discharged after CPR?

A

-

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14
Q

Name different resuscitation statuses

A
  • DNR
  • Closed-chest CPR
  • Open-chest CPR
  • establish before CPA
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15
Q

When is a DNR order appropriate?

A
  • hopeless prognoses (metastatic neoplasia, end-stage CRF, end-stage CHF, end-stage hepatic failure, profound neurological dysfunction, DIC, overt coagulopathies, owner’s wishes, inability to provide adequate post-resuscitation care and finances)
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16
Q

How do you recognise CPA?

A
  • can be harder than you think!
  • ABC triage (airway patent, breathing efforts, circulation - audible heart sounds, palpable pulses)
  • often preceded by hypoventilation and bradycardia
  • don’t rely on MM alone (respiratory distress may be cyanotic or grey but some patients have a normal CRT minutes following death)
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17
Q

Impending signs of CPA

A
  • certain arrhythmias –> degenerate into potentially fatal arrhythmias (VT, ventricular flutter, 3rd degree AV block)
  • other ECG changes (atrial standstill, ST depression, R on T phenomenon)
  • sustained tachycardia that doesn’t respond to appropriate fluids
  • patients where dyspnoea cannot be alleviated
  • patients with refractory hypotension despite adequate therapy
  • severe metabolic acidosis (pH 9mmol/L)
  • high vagal tone (patient population at risk, sometimes in these individuals, stimulating vagu nerve –> life-threatening bradycardia aka vasovagal syncope and vagal arrest)
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18
Q

When can vagal stimulation occur?

A
  • V
  • defecation
  • respiratory/abdominal dz (esp splenic diseases)
  • ocular or neck sx
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19
Q

Action - when a vasovagal arrest is recognised

A
  • provide O2

- give atropine (refer to emergency dosage chart)

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20
Q

What is needed to provide CPR in CPA cases?

A
  • provide O2
  • perform CPR
  • crash cart/box
  • monitoring equipment (at least an ECG)
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21
Q

What should a crash box include?

A 
ESSENTIAL:
- ETT
- IV catheters
- bandaging material
- laryngoscope
- syringes/ needles
- drugs
OPTIONAL (BUT IDEAL):
- defibrilator
- scalpel blades
- suture material
- IV fluids
- pressure bag
- ETCO2 monitor
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22
Q

Personnel resources - CPR

A
  • minimum 3 people
    1. provide ventilation
    2. compression
    3. written record and/or get necessary equipment or other items
    (4. another person to evaluate for effective pulse generation from compressions and monitor to TOSC)
  • a team leader must take responsibility for ‘running the crash’
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23
Q

What is the first step of CPR?

Study These Flashcards
A
  • can start alone
  • secure Airway, Breathe for the patient and get Circulation going by chest compressions (start compressions before intubating!!!)
24
Q

How do you secure the airway in CPR?

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A
  • ETT intubation
  • verify correct placement (laryngoscope, palpate neck to ensure you feel ‘only 1 tube’ - that being an ETT within trachea)
  • hold tube in place until securely tied and then inflate cuff
  • right lateral recumbency
  • continuous ECG (NOT spirit but coupling gel)
25
How do you provide positive pressure ventilation in CPR? How many breaths/minute?
- 100% O2 (via an Ambubag) - connected to O2 supply or anaesthesia machine - 12-15 breaths/minute (more breaths is detrimental) - ensure assisted breathing leads to adequate thoracic expansion
26
Why is hyperventilation not desired in CPR?
--> increases in intrathoracic pressure which compromises CO and reduces cerebral and coronary perfusion
27
What to do if you encounter difficulty ventilating a CPR patient:
``` CHECK FOR: - Displacement of tube - Obstruction of tube - Pneumothorax - Equipment failure (REMEMBER by the acronym 'DOPE') ```
28
How do you perform chest compressions? how does it vary for cats and small dogs vs. larger dogs?
- already under GA --> consider direct cardiac massage - CLOSED-CHEST: either cardiac pump or thoracic pump theory are appropriate - small dogs and cats: compressions should encompass heart from both sides (hands both sides of chest = cardiac pump theory) - larger dogs (>7kg): compression should be focused on widest part of chest (thoracic pump theory) - done forcefully but let thorax spring back completely - switch after 2 minutes - OPEN-CHEST CPR: for very large dogs (>40kg) thoracic compressions may be ineffective and open chest CPR should be performed
29
How many compressions should you aim to do?
approx 100/minute (v important)
30
Considerations for open-chest CPR
- significant pleural space dz - pericardial effusion - large dogs - chest wall dz - pericardial effusion - penetrating chest wounds - intra-operative arrests - haemoabdomen - unwitnessed arrests - unsuccessful closed chest CPR (after 5-10 mins)
31
T/F: providing concurrent or interposed abdominal counterpressure is valuable during CPR
Actually this is unknown - interposed abdominal compressure with each breath almost impossible so limited value - continuous abdominal pressure (to limit back-flow of blood from heart) if sufficient personnel are present
32
Outline how to perform ACLS. How does this vary with different ECG findings?
- once BLS begins, the normal progression is to start ACLS - administer drugs with hope of achieving ROSC - must interpret ECG for this: > some electrical activity on ECG + no detectable pulse this is Pulseless Electrical Activity (PEA) --> adrenaline > absensce of any electrical activity (asytole) --> adrenaline > ventricular fibrillation --> electrical defibrillation > sinus bradycardia --> atropine > sinus tachycardia --> lidocaine
33
Outline use of adrenaline
- adrenergic agonist - used to 'restart' the heart in patients with asytole or PEA - standard vasopressor for cardiac arrest - alpha-mediated vasoconstriction - increases aortic pressure - increases myocardial perfusion
34
Outline use of atropine in CPR
- vagolytic drug - increases HR once it has restarted or reverse a vasavagal event - avoid inducing tachycardia as this will increase O2 demands of the heart - for vagally mediated arrests and severe bradycardia - parasympatholytic - accelerates pacemakers - increases AV conduction - routine use may not improve outcome - may potentiate sinus tachycardia - may encourage VF if given with epinephrine
35
Outline use of lidocaine in CPR
- used to treat fast VT before they degenerate into fibrillation - decreases automaticity - suppresses ventricular arrhythmias - less effective than amiodarone
36
How are drugs administered during CPR?
- through existing catheters - catheres placed via cut-downs - via intra-osseous catheters - intra-tracheal catheters - last resort route = intra-cardiac injections - through ETT (double dose and follow with 10 sterile water - a hypotonic solution to increase absorption, follow with big breath from Ambu bag or anaesthesia machine)
37
What other drugs may be useful during CPR?
- calcium gluconate (v slowly, IV, 3ml for cat, 5ml small dog, 10ml large dog) if severely hypocalcaemic or hyperkalaemic - sodiumm bicarbonate (1 mEq/kg usually = 1ml/kg, IV over 20-30minutes) if pH
38
Outline fluid administration during CPR
- to help circulate drugs that are administered - vital with hypovolaemia (one of commonest causes of arrest) - give via pressure bags +/- administer colloids or hypertonic saline - only CI is when fluid overload caused the arrest
39
Outline defibrillation in CPR
- usually trained individual - everyone must be alert and respond to 'CLEAR' - only coupling gel should be used to improve skin contact (NEVER SPIRIT) - voltage (joules) should be determined from crash cart chart: usually 100J for cats and small dogs, 200J larger dogs, 50J for internal defibrillation (open-chest CPR)
40
Ouline post-resuscitation challenges to overcome
- severe neurological dysfunction - myocardial injury - rib fractures - renal failure - 'shock gut' - DIC - respiratory failure * monitor for these and tx appropriately
41
How long is a successful CPR patient in a critical state?
- at least next few hours (if healthy beforehand) - if systemically ill before or were undergoing invasive sx (may remain critical for at least 2-48 hours). High risk of cardiac or respiratory arrest recurring. Thus close monitoring, appropriate support until CV and respiratory function return to normal.
42
Indications - CPR
patient that has arrested or is having an impending arrest
43
T/F: sometimes you have a heart beat but not CO
True - this is still a cardiac arrest
44
What is the 1st goal of CPR?
ECG rhythm + pulse
45
What happens in R on T phenomenon?
- this is an arrhythmia that is an impending sign of a CPA | - electrical pulseline doesn't return to baseline
46
Behavioural signs - impending CPA in a cat
- lateral recumbency - open mouth breathing - thrashing
47
What type of arrest do animals/ humans usually have?
- ANIMALS: respiratory arrest (focus on compressions first) | - HUMANS: cardiac arrest
48
What is the 50:50 duty cycle?
refers to time spent doing chest compressions versus time spent waiting for the chest to recoil.
49
T/F: time b/w VF onset and defibrillation is inversely correlated with survival.
True
50
What drugs can you administer by ETT?
- lipid soluble only - acronym 'NAVEL': = Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine * never give Ca or bicarbonate through ETT.
51
Outline use of vasopressin in CPR
- vasopressor - some thorectical advantages over epinephrine - limited data - inconsistent results - only need to give once
52
Advantages - open chest CPR
- diastolic filling assessed - pericardial tamponade avoided - aorta can be cross-clamped - VF visually diagnosed - myocardial flaccidity assessed directly
53
Disadvantages - open-chest CPR
- experienced personnel - more personnel - significant step - finances and sx - risk of infection
54
Complications post-CPR
- blindness - dysphoria (dissatisfaction with life) - neuro dysfunction
55
Determinants - CPR termination
- time between CPA and starting CPR - length of resuscitative efforts - comorbidity - senior staff consensus - inform owner early - VF survival decreases by 7-10%/min - >12 mins survival is 2-5% - ROSC >30 mins or >10 mins asystole
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