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VISION

Learn about the causes of cardiopulmonary arrest and the steps involved in performing effective CPR. Discover the necessary equipment and supplies, as well as the key roles of the resuscitation team. This comprehensive guide will equip you with the knowledge and skills needed to save lives in emergency situations.

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VISION

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

  2. CPCR CARDIOPULMONARY CEREBROVASCULAR RESUSCITATION

  3. 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

  4. Cardiopulmonary Resuscitation • 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

  5. 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

  6. 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 Ringer’s, 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 ● Surgeon’s gloves

  7. Emergency Drugs in Dogs

  8. Emergency Drugs in Cats

  9. 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.

  10. 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)

  11. CPR http://www.youtube.com/watch?v=VJGlsYHI9cU

  12. Cardiopulmonary Resuscitation Intubation

  13. Basic Life Support (Phase I) Circulation External cardiac compression Lateral recumbency—one/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 Cardiopulmonary Resuscitation

  14. 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 8thintercostal 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

  15. 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

  16. 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: Dogs—40 ml/kg (rapidly IV) 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

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

  18. 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: 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

  19. CPR

  20. 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—intramedullarycannula 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

  21. 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

  22. Cardiopulmonary Resuscitation DEFIBRILLATORS

  23. Cardiopulmonary Resuscitation VENTRICULAR FIBRILLATION NORMAL EKG

  24. 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%

  25. CPR

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