VISION It is a terrible thing to see

VISION “It is a terrible thing to see and have no vision. ” -Helen Keller

CPCR CARDIOPULMONARY CEREBROVASCULAR RESUSCITATION

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

Cardiopulmonary Resuscitation Team Members ◦ Should be 3 -5 members Team leader—Veterinarian 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 team’s effectiveness Teams should practice on a regular basis to stay sharp

Cardiopulmonary Resuscitation • Facilities – – Adequate room for entire team and equipment O 2 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

Cardiopulmonary Resuscitation • Standard Emergency Supplies (on crash cart) – Pharmaceuticals • • Atropine Epinephrine Vasopressin 2% lidocaine (w/o epi) Na+ bicarb Ca++ chloride or gluconate Lactated Ringer’s, hypertonic saline, dextran 70, hetastarch – Airway access supplies • • Laryngoscope Endotracheal tubes (variety of sizes) Lubricating jelly Roll gauze --Venous access supplies ● ● ● ● Butterfly cath IV caths IV drip sets Bone marrow needles Syringes Hypodermic needles (var sizes) Adhesive tape Tourniquet --Miscellaneous supplies Gauze pads (3 x 3) Stethoscope ● Minor surgery pack 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 (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 5: 1)

CPR • http: //www. youtube. com/watch? v=VJGls. YHI 9 c. U

Cardiopulmonary Resuscitation Intubation

Cardiopulmonary Resuscitation • Basic Life Support (Phase I) – Circulation • External cardiac compression – Lateral recumbency—one/both hands on thorax over heart (4 th-5 th 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

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 7 th and 8 th 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 Change person performing compression Ventilate with every 2 nd or 3 rd 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

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: (rapidly IV) Dogs— 40 ml/kg Cats— 20 ml/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 vasoconstriction→ ↑BP

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

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 cardiac arrhythmias) – Dogs: Cats: 1 -2 mg/kg 0. 5 -1. 0 mg/kg • Sodium bicarb (For metabolic acidosis) – 0. 5 m. Eq/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 10 -30 ml 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 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

Cardiopulmonary Resuscitation DEFIBRILLATORS

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 • 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%

CPR