CPR Cardiopulmonary Resuscitation in the Veterinary Hospital Dawn

CPR Cardiopulmonary Resuscitation in the Veterinary Hospital Dawn Elza, LVMT Nashville Pet Emergency Clinic

Introduction • What is CPA? • Cause and Prevention • Recognizing CPA • How to respond • Proper CPR techniques

Cardiopulmonary Arrest (CPA) • Sudden, unexpected loss of heart function, breathing, and consciousness • Ventricles of the heart fail to contract, leading to lack of oxygen, and eventually, death.

Causes of Arrest • • • Hypothermia Abnormally low levels of oxygen in arterial blood (hypoxemia) Low oxygen supply; possibly due to anemia Heart disease (e. g. , infections, inflammation, trauma, neoplasia of heart) Metabolic diseases Electrolyte imbalances (e. g. , hyperkalemia, hypocalcemia, hypomagnesemia) Abnormally low bodily fluid levels Shock Use of anesthetic drugs Blood poisoning caused by bacterial toxic substances in the blood (toxemia) Brain trauma Electrical shock

Prepare, Do, Learn • Crash Cart • Well stocked • Readily available • Routine Training • Hands on training every 6 months for all team members • Delegation of Team Responsibilities • Four to Five team members with assigned tasks • Debriefing post arrest events

How to Begin 1) Recognize Arrest 2) Call "Code" 3) Begin basic life support 4) Advanced life support

Recognizing Arrest • Changes in breathing § Heavy, or gasping • Unresponsiveness • Very slow or absence of heart rate • Lack of pulses

Time is Valuable!!! • EVERY SECOND COUNTS! • Do not spend much time trying to find a pulse • Get great at monitoring and recognizing signs • Call code ASAP—Even if unsure— Then start basic life support

Basic Life Support • 1 Full Cycle= 2 minutes uninterrupted • 1) Chest Compressions • Lateral or Dorsal recombancy • 2) Ventilation

Proper Position and Compressions • Small dogs and cats • Lateral recombancy • Compress where elbow meets chest • Place hands over heart or cupped around thorax • Medium to Large Breed • Lateral recombancy • Compress over widest portion of chest • Barrel chested dogs (Greyhounds, Danes) • Lateral recombancy • Compress over heart where elbow meets chest • (Greyhounds, Great Danes) • Keel chested dogs (bulldogs) • Dorsal recombancy • Compress over heart

Position for Compressions

Proper Compressions • Get OVER patient • LOCK arms • Bend at waste NOT elbows • DO NOT STOP • Switch at 2 minutes • DO NOT STOP

Chest Compressions • 100 -120 compressions per minute • 1/3 to ½ Chest Width • Compression: Relaxation = 1: 1 qallowing full elastic recoil of chest wall • “Staying Alive” or “Another One Bites the Dust” • DO NOT STOP

Ventilation • Intubate while doing compressions • Do not stop compressions • 10 Ventilations per minute (Every 6 seconds) • Ventilate as normal breath

Ventilation • Emergency tracheostomy? • Non-Invasive • Mouth to snout • Tight fitting mask • If not intubated, administer 30 compressions, then 2 quick rescue breaths

Advanced Life Support • Administer Reversals • Monitor • Obtain Vascular Access

Administer Reversals • Discontinue Anesthesia • Administer Reversals • Administer Drug Therapy v. Atropine v. Epinephrine

Monitoring • Electrocardiogram (ECG) • Re-Evaluate every 2 minutes • End Tital CO 2 (ETCO 2) ü >15 mm. Hg = Good Compressions ü Low due to ineffective compresssions or poor ET tube placement • Pulse palpation

Drug Therapy Sites • Peripheral-Follow with Saline fluid bolus • Central- Preferred • Either may require cut down • Intratracheal • Double—Triple IV dose • Red rubber catheter • Follow with 0. 9% Na. Cl or Sterile water • Intraosseous

Drug and Fluid Therapy • Repeat atropine and epinephrine dose IV every 3 -5 minutes • IV Fluids? • Considered in patients w/Hypovolemia as underlying cause of arrest

Other • Counter compress abdomen and chest • Wrap legs to prevent pooling

Post Arrest Care • Most patients who survive CPA will not survive to be released from the hospital • Post-arrest systemic inflammatory response • • Cardiogenic Shock Anoxic brain injury Multiple organ failure Death

Post Arrest Care • Maintain oxygenation and ventilation • Slow rewarming • • 0. 25 -0. 5 degrees C over each hour No more than 1 degrees C per hour Leave at low temp if patient doing well Slowly increase temp if patient is shivering • Continue monitoring and treat as needed • May repeat arrest

Overview • #1 Call code and start compressions • #2 Place ET tube, ventilate patient • #3 Place IV catheter, fluids? • #4 Administer reversals (if any) • #5 Hook up monitoring equipment • #6 Record event and monitor time

Know and be confident about what Know your patient needs Keys to successful CPR Act immediately Comm- Call out your job unicate Help each other

Practice Makes Perfect!

References • New guidelines for CPR in dogs, cats. (n. d. ). Retrieved November 28, 2017, from https: //www. avma. org/news/javmanews/pages/120715 g. aspx