Surgery Dr Q: CPCR
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Signs that cardiac arrest is imminent
- Respiratory arrest
- Prolonged CRT
Signs of cardiac arrest
- No heartbeat seen, heard, or felt
- Pupils dilated and no corneal or PLR
- Agonal breathing/gasps (body reactively trying to get O2)
Permanent brain damage can occur if not corrected within how many minutes?
Staff roles while performing CPCR
- Chest compressions
- Assesses palpable pulse during compressions and pulse/ECG when compressions paused Draws up and administers drugs (could be combined with breathing)
- Records efforts, medications, results (could be combined with pulse ECG assessment)
Ideally how many people involved in CPCR
Cardio-Pulmonary Cerebrovascular Resuscitation
During resuscitation the animal is laying on which side?
- A – Airway = immediately establish an open airway with the ET tube
- B – Breathing = positive pressure ventilation (ambu bag or blowing directly into the ET tube) with 12 breaths per minute. Tidal Volume = 5/10mL/#
- C – Cardiac = external pressure at a rate of 60 compressions per minute. Above 30 # use both hands, below 30 use thumb and fingers.
- D – Drugs – wait 1 minute before starting iv.
- E - ECG - stabilize cardiac rhythm
For anesthetic arrest CABDE
C- Circulation= must be started immediately, 1-2 compressions per second (goal 100bpm) compress chest to ⅓ normal width (should be able to feel femoral pulse) bagging every 10-12 seconds (timed with a compression)
If external compressions not effective in creating a pulse within ___ minutes begin internal cardiac massage
Internal cardiac massage procedure
- Lateral thorax very quickly clipped, scrubbed and rinsed with alcohol
- Self adhering sterile drape ideally (clearly not required)
- Incision between ribs 7-8 with care to not traumatize lungs
- Retractor may be needed
- Gloved hand to apply gentle but firm pressure to ventricles 100x per min.
Dogs weighing over ___ very likely to need internal compressions to get adequate CO2
It is necessary to stop compressions how often to see if the heart has resumed spontaneous contractions.
Compressions are unlikely to be effective if its been how long since cardiac arrest occurred?
Over 15 minutes
The anesthetist can stop bagging if...
CRT, MM color, and HR are normal
If giving drugs intratracheal the dose is...
Twice the drug dose
Drugs given during cardiac arrest
Epinephrine, vasopressin, atropine, dopamine, dobutamine
- Epinephrine and pressors every 3-5 minutes
- Atropine every 15-20 minutes
- Dopamine/Dobutamine CRI
Rhythms observed on an ECG during a pause in compressions
- Asystole - no activity - “flatline”
- Ventricular Fibrillation - coarse, vertical zig-zag lines
- Pulseless Electrical Activity - organized activity that could resemble normal complexes. Electromechanical Dissociation (EMD).
Many patients will undergo cardiac arrest again within ___ of recovering
When cardiac function is reestablished what may occur
Pulmonary and cerebral edema may occur which manifest themselves as the inability to spontaneously ventilate, seizures, failure to regain consciousness, or temporary to permanent neurologic damage.
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