VISION

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VISION

• It is a terrible thing to see and have no
  vision.
• -Helen Keller

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CPCR

• CARDIOPULMONARY CEREBROVASCULAR RESUSCITATION

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Cardiopulmonary Arrest and Resuscitation (CPR)

• Cardiopulmonary Arrest (CPA) sudden cessation of
  effective ventilation and circulation.
• Causes
• Anesthesia
• Trauma
• Infections (e.g. pneumonia)
• Heart disease
• Autoimmune disease
• Malignancy
• Trauma
• Hypoxemia
• Shock
• anemia

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Cardiopulmonary Resuscitation

• Resuscitation Team Members
• Should be 3-5 members
• Team leaderVeterinarian or RVT with most
  experience
• All members have several responsibilities
• Provide ventilation
• Chest compression
• Establish IV line
• Administer drugs
• Attach monitoring equipment
• Record resuscitation efforts
• Monitor teams effectiveness
• Teams should practice on a regular basis to stay
  sharp

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Cardiopulmonary Resuscitation

• Facilities
• Adequate room for entire team and equipment
• O2 source
• Good lighting
• Crash cart with all needed Rx (should be checked
  at beginning of each shift)
• Defibrillators
• Electrocardiogram
• Suction
• Table to perform chest compression
• Grated surgery prep table not solid 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 treating one

Agonal breaths, apnea, collapse, fixed gaze, no
palpable pulse
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Cardiopulmonary Resuscitation

• Standard Emergency Supplies (on crash cart)
• Pharmaceuticals --Venous access supplies
• Atropine ? Butterfly cath
• Epinephrine ? IV caths
• Vasopressin ? IV drip sets
• 2 lidocaine (w/o epi) ? Bone marrow needles
• Na bicarb ? Syringes
• Ca chloride or gluconate ? Hypodermic needles
  (var sizes)
• Lactated Ringers, 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
• ? Surgeons gloves

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Emergency Drugs in Dogs
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Emergency Drugs in Cats
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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.

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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Remember the priorities (ABC Airway, Breathing,
  Circulation)
• Establish patent Airway
• Endotracheal tube
• Tracheostomy tube for upper airway obstruction
• Suction to remove blood, mucus, pulmonary edema
  fluid, vomit
• Artificial ventilation (Breathing)
• Ambu-Bag
• Anesthetic machine
• Ventilate once every 3-5 sec
• Chest compressions in between breaths if working
  alone
• 1 to 2 times per second (80 times per minute for
  a large dog and 120 times for a small dog or cat)
• 10 compression for every 2 breaths (or 51)

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(No Transcript)
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CPR

• http//www.youtube.com/watch?vVJGlsYHI9cU

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Cardiopulmonary Resuscitation Intubation
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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Circulation
• External cardiac compression
• Lateral recumbencyone/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 80-120/min

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Cardiopulmonary Resuscitation

• Basic Life Support (Phase I)
• Circulation
• Internal cardiac compression
• More effective than external compression
• ?CO, ?BP, higher survival rate
• Indications
• Rib fractures
• Pleural effusion
• Pneumothorax
• If not responsive after 5 min of external cardiac
  compression
• Preparation
• Clip hair ASAP, no surgical scrub
• Incision at 7th and 8th 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

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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
• Change person performing compression
• Ventilate with every 2nd or 3rd chest compression
• Compress chest where it is widest in lg breed
  dogs
• Apply counter-pressure to abdomen (hand, sandbag)
• Prevents posterior displacement of diaphragm and
  increases intrathoracic pressure

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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• Drugs
• Fluids
• Lactated Ringers is standard (do not use
  Dextrose)
• Initial dose Dogs40 ml/kg
• (rapidly IV) Cats20 ml/kg
• Atropineparasympatholytic effects (blocks
  parasympathetic effects)
• 0.02-0.04 mg/kg
• ?HR
• ?secretions
• Epinephrineadrenergic effects
• 0.02-0.2 mg/kg
• Arterial and venous vasoconstriction? ?BP

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CPR
Common arrhythmias electrical mechanical
dissociation, (no pulse), asystole (flatline),
ventricular tachcardia, bradycardia
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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• Drugs (continued)
• 2 Lidocaine (Used to treat cardiac arrhythmias)
• 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

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CPR
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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• Drugs (continued)
• Route of drug administration
• Jugular veinclose to heart drugs will get to
  heart quicker
• Cephalic, saphenousfollow drugs with 10-30 ml
  saline flush
• Intraosseousintramedullary cannula into femur,
  humerus, wing of ilium, tibial crest
• Intratrachealfor limited of drugs atropine,
  lidocaine, epinephrine
• Intracardiaclast resort several complications
  can occur
• Depends on
• Speed of access
• Technical ability
• Difficulties encountered
• Rate of drug delivery

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Cardiopulmonary Resuscitation

• Advanced Life Support (Phase II)
• Add 2 priorities to ABC--D E (administer Drugs,
  Electricaldefibrillate)
• ElectricalDefibrillate
• Purposeeliminate asynchronous electrical
  activity in heart muscles by depolarizing 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

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Cardiopulmonary Resuscitation
DEFIBRILLATORS
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Cardiopulmonary Resuscitation
VENTRICULAR FIBRILLATION
NORMAL EKG
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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
• BP
• 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 patients
• Dogs 3.8
• Cats 2.3

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CPR