VISION“It is a terrible thing to see and

have no vision.”-Helen Keller

CPCRCARDIOPULMONARY CEREBROVASCULAR

RESUSCITATION

Cardiopulmonary Arrest and Resuscitation (CPR)

Cardiopulmonary Arrest (CPA)— sudden ________ of effective __________ and circulation.

• Causes• Anesthesia

• ______________

• Infections (e.g. pneumonia)

• Heart disease

• Autoimmune disease

• Malignancy

Cardiopulmonary Resuscitation

• Resuscitation Team Members– Should be _____________ members

• Team leader—Veterinarian or RVT with most experience

• All members have several responsibilities– Provide ventilation

– Chest compression

– Establish _______________

– Administer drugs

– Attach monitoring equipment

– ____________ resuscitation efforts

– Monitor team’s effectiveness

• Teams should practice on a regular basis to stay sharp

Cardiopulmonary Resuscitation

• Facilities– Adequate room for entire team and equipment– ____________ source– Good lighting– ______________ with all needed Rx

(should be checked at beginning of each shift)• Defibrillators• Electrocardiogram• Suction

– Table to perform chest compression• Grated surgery prep table _________________ enough for chest compression

– Use board underneath patient

• Recognition– RVT should ID patients at risk and observe any deterioration– Preventing an arrest is easier than __________________

Cardiopulmonary Resuscitation

• Standard Emergency Supplies (on crash cart)– Pharmaceuticals --Venous access supplies

• __________________ ● Butterfly cath• Epinephrine ● IV caths• Vasopressin ● IV drip sets• 2% lidocaine (w/o epi) ● ________________________________________

• Na+ bicarb ● Syringes• Ca++ chloride or gluconate ● Hypodermic needles (var sizes)• Lactated Ringer’s, hypertonic saline, ● Adhesive tape

dextran 70, hetastarch ● Tourniquet

– Airway access supplies --Miscellaneous supplies• Laryngoscope ● Gauze pads (3 x 3)• Endotracheal tubes (variety of sizes) ● Stethoscope• Lubricating jelly ● Minor surgery pack• Roll gauze ● Suture material

● Scalpel blades● Surgeon’s

gloves

Emergency Drugs in Dogs

Emergency Drugs in Cats

CPR

• Basic Life Support:

– A -- Establishment of an Airway.

– B -- Breathing support.

– C -- Circulation support.

• Advanced Life Support:

– D -- Diagnosis and Drugs.

– E -- Electrocardiography.

– F -- Fibrillation control.

• Prolonged Life Support:

– G -- Gauging a patient's response.

– H -- Hopeful measures for the brain

– I -- Intensive care.

Cardiopulmonary Resuscitation

• Basic Life Support (_____________)– Remember the priorities (ABC; Airway, Breathing, Circulation)

• Establish _______________ Airway– Endotracheal tube– Tracheostomy tube for upper airway obstruction– Suction to remove blood, mucus, pulmonary edema fluid, vomit

• Artificial ventilation (Breathing)• _____________________» Anesthetic machine» Ventilate once every 3-5 sec

– Chest compressions in between breaths if working alone» 1 to 2 times per second (____________ times per minute for a large

dog and _______________ times for a small dog or cat)» 10 compression for every 2 breaths (or_________________)

CPR

• http://www.youtube.com/watch?v=VJGlsYHI9cU

Cardiopulmonary Resuscitation Intubation

• Basic Life Support (Phase I)– Circulation

• External cardiac compression– ____________________ recumbency—one/both hands on thorax over heart

(4th-5th intercostal space)

– In larger patients, arms extended, elbows locked

– In small patients, thumb and first 2 fingers to compress chest

– Rate of compression: ___________________ /min

Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation• Basic Life Support (Phase I)

– Circulation • Internal cardiac compression

– ___________________ than external compression» ↑CO, ↑BP, higher survival rate

– Indications» Rib fractures» Pleural effusion» Pneumothorax» If not responsive after ________________ of external cardiac

compression– Preparation

» Clip hair ASAP, no surgical scrub» Incision at __________________ intercostal space» With a gloved hand, compress heart between fingers and palm (Do

not puncture heart with finger tips or twist heart)» After spontaneous beating returns, flush chest cavity with saline,

perform sterile scrub of skin and close

Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)– Assessing effectiveness (must be done frequently)

• Improved color of mm

• Palpable pulse during cardiopulmonary resuscitation (difficult)

• If efforts are not effective, do something differently– Use different hand

– __________________ person performing compression

– Ventilate with every 2nd or 3rd chest compression

– Compress chest where it is widest in lg breed dogs

– Apply ____________________ to abdomen (hand, sandbag)

» Prevents posterior displacement of diaphragm and increases intrathoracic pressure

Cardiopulmonary Resuscitation• Advanced Life Support (Phase II)

Add 2 priorities to ABC--D E (administer Drugs, Electrical—defibrillate)

– Drugs• Fluids

– Lactated Ringer’s is standard (do not use Dextrose)» Initial dose: Dogs—_________ /kg (rapidly IV) Cats—____________/kg

• Atropine—parasympatholytic effects (blocks parasympathetic effects)

– 0.02-0.04 mg/kg– ↑HR– ↓secretions

• Epinephrine—adrenergic effects– 0.02-0.2 mg/kg– Arterial and venous _______________ → ↑BP

Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)Add 2 priorities to ABC--D E (administer Drugs, Electrical—

defibrillate)

– Drugs (continued)• 2% Lidocaine (Used to treat____________________)

– Dogs: 1-2 mg/kg

Cats: 0.5-1.0 mg/kg

• Sodium bicarb (For metabolic acidosis)

– 0.5 mEq/kg per 5 min or cardiac arrest

• Vasopressin (ADH) – 0.8 U/kg

CPR

Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)Add 2 priorities to ABC--D E (administer Drugs, Electrical—defibrillate)

– Drugs (continued)• Route of drug administration

– Jugular vein—close to heart; drugs will get to heart quicker– Cephalic, saphenous—follow drugs with ________________ saline flush– Intraosseous—intramedullary cannula into femur, humerus, wing of ilium,

tibial crest– Intratracheal—for limited # of drugs: atropine, lidocaine, epinephrine– Intracardiac—last resort; several complications can occur

• Depends on– Speed of access– Technical ability– Difficulties encountered– Rate of drug delivery

Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)Add 2 priorities to ABC--D E (administer Drugs, Electrical—

defibrillate)

– Electrical—Defibrillate• Purpose—eliminate asynchronous electrical activity in heart

muscles by __________________________ all cardiac muscle fibers; hopefully, the fibers will repolarize uniformly and start beating with coordinated contractions

• Paddles (with electrical gel) placed on each side of chest• Yell “CLEAR” before discharging electrical current• Start with low charge and increase as needed

– External: 3-5 J/kg– Internal: 0.2-0.4 J/kg

Cardiopulmonary Resuscitation

DEFIBRILLATORSFISH

Cardiopulmonary Resuscitation

NORMAL EKG VENTRICULAR FIBRILLATION

Cardiopulmonary Resuscitation• Prolonged Life Support (Phase III)

– Once heart is beating on its own, monitor the following:• HR and rhythm

– Antiarrhythmic drugs– Correct electrolyte abnormalities

– ____________________• Peripheral perfusion

– Color of mm– Cap refill time– urine output

• RR and character of breathing– Adequate breathing– Auscultory sounds

• Mental status• Improving or deteriorating

UC Davis study: survival rate at 1 wk for cardiac resuscitation patientsDogs: 3.8%Cats: 2.3%

CPR