Anesthetic Problems 3 CPR

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  1. What does CPA stand for?
    cadiopulmonary arrest
  2. What does CPR stand for?
    cardiopulmonary resuscitation
  3. What is respiratory arrest?
    the patient stops trying to breathe
  4. When is RA not so serious?
    brief apnea
  5. What causes brief apnea?
    • IV drug injection (example: barbiturates, propofol)
    • Overbagging (low CO2)
  6. What can serious RA lead to?
    cardiac arrest
  7. What are some causes of RA?
    • anesthetic overdose
    • lack of oxygen
    • preexisting respiratory disease
  8. What preexisting respiratory disease could cause RA?
    • pneumothorax
    • pulmonary edema
  9. What are the clinical signs of RA?
    • not breathing
    • dyspnea
    • cyanosis
    • weak pulse
    • slow CRT
    • mydriasis
    • abnormal heart rate
  10. How do we treat RA?
    • inform veterinarian immediately
    • intubate, inflate cuff and give O2
    • give fluids
    • keep warm
  11. What are the different types of oxygen sources?
    • anesthesia machine
    • Ambu bag
    • mouth to tube or snout
  12. What is an Ambu bag?
    small tank of O2 with its own regulator bag
  13. How do we treat RA?
    • check heartbeat
    • make sure vaporizer and N2O are turned off
    • check flowmeter and O2 tank
    • check airway of patient
    • bag with O2
  14. How do we know if a patient is being ventilated properly?
    • patient's chest rises and falls
    • pulse oximeter is over 95%
    • pressure manometer (20 cm H2O)
    • blood gases
    • capnography (are they getting rid of CO2)
  15. How do we bag with oxygen?
    • 6 - 20 breaths per minute
    • once every 3 - 5 seconds, once every 3 - 10 seconds
  16. Once the patient is back to normal, how do we wean the patient of bagging?
    stop for 15 - 30 seconds to see if the patient starts to breath on their own
  17. What is cardiac arrest?
    • heart stops beating
    • also no breathing (CPA)
  18. What is the general rule for CA?
    as long as the patient is breathing, the heart is beating
  19. What are the warning signs for CA?
    • cyanosis
    • dyspnea
    • respiratory arrest
    • prolonged CRT
  20. What are ways to monitor the heart?
    • auscultation
    • palpation of chest
    • palpation of pulse
    • blood pressure monitor
    • EKG
  21. What are the clinical signs of CA?
    • no heartbeat ausculted, palpated, or on EKG
    • no palpable pulse (BP 25 mm Hg or less)
    • mucous membranes gray or cyanotic (CRT may be prolonged)
    • pupils widely dilated and no pupillary light reflex
    • no respiration
    • cardiopulmonary arrest
  22. How successful is CPR?
    • 14% success CPR alone
    • 23% success with CPR and defibrillation
  23. Permanent brain damage occurs if oxygenated blood does not get to the brain within _____.
    4 minutes
  24. How do we resume blood flow?
    • by CPR
    • by patient recovery (resumes normal cardiac and respiratory function)
  25. What does ABCDEF stand for?
    • A: airway
    • B: bag or breathing
    • C: cardiac
    • D: drugs
    • E: EKG
    • F: fluids
  26. What is the goal of CPR?
    to circulate oxygenated blood and to keep patient alive without brain damage
  27. How do we bag the patient?
    • 1 breath every 3 - 5 seconds
    • bag at the same time as cardiac compressions
  28. What are the different components of "C" (cardiac)?
    • cardiac
    • circulation
    • chest
    • compressions
  29. What are external compressions?
    from outside the chest
  30. What are internal compressions?
    surgically enter chest
  31. How do we position the patient for external cardiac compressions?
    • right lateral recumbency
    • feet away from you
    • heart is "up"
    • widest part of the chest
  32. How do we position round chested dogs?
    • lay on back - presssure mid-sternum
    • if possible, place patient's head lower than rest of body - gets blood flow to head quicker
  33. How do you do CPR on a large dog?
    • put a rolled up towel under chest behind elbow to prevent "rocking" during compressions
    • use both hands to compress chest against towel
    • use heel of hands
  34. How do you do CPR on a medium sized dog?
    • place one hand under chest
    • other hand on left side over heart
    • compress between hands
  35. How do you do CPR on a small dog or cat?
    • use one hand
    • place fingers under chest
    • compress heart with thumb
  36. Where do you do the compressions on the patient?
    at widest point of chest at 5th intercostal space
  37. How do you do compressions on a patient?
    compress for count of 2, release for count of 1
  38. What should the rate of compressions be?
    • 1 - 2 per second
    • 120 bpm - good average
  39. What is the purpose of compressions?
    • to force blood through the heart into blood vessels to tissue (especially the brain)
    • to increase thoracic pressure
  40. How do you check for effectiveness of compressions?
    • palpate for femoral or lingual pulse during compressions
    • doppler probe on eye - check for blood flow to brain
    • pulse oximeter
    • ETCO2 - end-tidal CO2 - capnography
    • blood gases
    • blood pressure monitore
    • mucous membrane color
  41. What do you do if there is no pulse or improvment in color?
    • adjust rate and strength
    • change compressor person
  42. What is the purpose of bagging during compressions?
    increases intrathoracic pressure, pumps more blood
  43. If there is not another person to bag while doing compressions what should you do?
    give 10 compressions then stop and give 2 breaths, repeat
  44. How do you monitor during CPR?
    • check to see if heart has resumed beathing on its own
    • check pulse
    • palpate chest
    • auscultation
    • EKG
    • pulse oximetry
    • blood pressure monitor
    • capnograph
  45. If the patient has not responded to CPR after 15 minutes...
    not likely to respond
  46. When do we use defibrillation?
    when EKG shows ventricular fibrillation (irregular wavy lines, "quivering" heart)
  47. When the heart improves...
    • stop compressions
    • continue bagging until patient breathes on their own
  48. How do you do internal compressions?
    • quick shave and prep
    • open between ribs 7 - 8
    • retract ribs, insert gloved hand, squeeze heart
  49. What is the best route for administering drugs after CPR?
    IV catheter - jugular
  50. How do you give drugs intratracheally?
    • stop ventilating and chest compressions, give drug, give 2 deep breaths
    • inject between tracheal rings or through urinary catheter placed down trach tube
  51. What drugs do we usually use in CPR?
    • epinephrine
    • steroids
    • dopamine, dobutamine
    • atropine, lidocaine
    • Na bicarbonate
  52. Why would we use epinephrine?
    increases rate and force of cardiac contractions
  53. What is the dose for epinephrine for cat, small dog, medium dog, and large dog?
    • cat: 0.5 ml
    • small dog: 1 ml
    • medium dog: 2 ml
    • large dog: 3 ml
  54. Why would we use dopamine, dobutamine?
    increase force and rate of cardiac contractions
  55. What are steroids used for?
    treat shock
  56. What do you do if the patient does not respond to the drugs?
    continue CPR and repeat drugs in 1 minute
  57. When do you discontinue CPR?
    if pupils remain fixed and dilated for 10 - 15 minutes
  58. What do we use EKG for?
    helps to determine drugs or treatment to be used?
  59. What 3 forms of arrest do EKG's detect?
    • asystole
    • ventricular fibrillation
    • elecrtomechanical dissociation
  60. What is asystole?
    flat line on EKG
  61. How do we treat asystole?
    epinephrine, atropine, Na bicarbonate
  62. What is ventricular fibrillation?
    disorganized, wavy pattern on EKG
  63. How do we treat ventricular fibrillation?
  64. What is electromechanical dissociation?
    may be normal QRS complexes, but heart is not beating effectively
  65. How do we treat electromechanical dissociation?
    • epinephrine
    • glucocorticoids
  66. Why do we give fluids? How do we give fluids?
    • for low blood pressure
    • dogs: up to 90 ml/kg/hr
    • cats: up to 50 - 70 ml/kg/hr
  67. What kind of supportive care do we need to provide after giving CPR?
    • keep warm
    • eye ointment
    • turn every 10 - 15 minutes
    • control any bleeding
  68. What could potentially happen after CPR?
    • pulmonary edema
    • cerebral edema - coma, seizures, permanent neurological damage
    • repeated cardiopulmonary arrests
Card Set
Anesthetic Problems 3 CPR
Clinical Practice
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