Transcript Cardiopulmonary Arrest - Dr. Roberta Dev Anand

Chapter 33
Emergency Nursing
Emergency Care Area

Requirements
 Central
 Easy
location
access
 Dedicated

“crash table”
Basic necessary equipment
 Oxygen
 Suction
source
unit
 Surgical
lighting
 Multiple
electrical outlets
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Crash Cart
 Organize
and prioritize drawers according to
the ABC’s
 A=airway
 B=breathing
 Thoracocentesis
patient
 Venous
materials for emergency respiratory
access (C=circulation)
 Venous
access drawer
 Various
sizes and lengths catheters
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4
Emergency Drugs

Well organized and labeled

Current dose chart

Syringes and saline flush nearby
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Laboratory Equipment
 Minimum
 Lactate
database “QATS”
testing
 Additional
 Blood
testing
gases
 Coagulation
 Commercial
 Ethylene
testing
test kits
glycol
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Fluid Therapy
 Goals
and objectives
 Maintaining
hydration
 Replacing
fluid losses
 Treatment
of shock
 Treatment
of hypoproteinemia
 Increase
urine output
 Correcting
 Providing
acid–base or electrolyte disturbances
nutritional support
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Fluid Therapy in Shock

To correct poor perfusion, replace deficits
rapidly

Goal: expand and maintain the
intravascular space

Shock fluid rates

Combination of therapy crystalloids and
colloids
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Principles of Triage
 Set
protocols for a consistent, thorough
response
 CRASH
 Be
PLAN
well-organized
 Expect
the unexpected
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Cardiopulmonary Arrest
 Cessation
of breathing and
effective blood circulation
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Cardiopulmonary Arrest
 Complication
 Potential
of any critical illness
complication in healthy
patients undergoing anesthesia
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Definitions

CPR = Cardiopulmonary Resuscitation


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Providing ventilation and assisted circulation
CPCR = Cardiopulmonary Cerebral Resuscitation
 Acronym
emphasizes the importance of maintaining perfusion and
oxygen delivery to the central nervous system during and after an
arrest
Patients at Risk For an Arrest

Respiratory difficulty

Heart disease

Severe hypothermia

Multi-organ failure

Trauma

Shock
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Patients at Risk for an Arrest

Anesthetized patients
 Monitor
for unexplained changes in anesthetic depth
 Frequently
monitor vital signs during entire procedure

Monitor closely after anesthesia

Support perfusion with fluids, heating pads
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Vagal Arrest

Caused by heightened vagus nerve stimulation or
vagal tone

Common diseases associated with vagal arrests
 Gastrointestinal
 Respiratory
disease
disease
 Neurological
 Ophthalmic
disease
disease
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CPCR Protocols
 First
step:
Call for help!
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CPCR Protocols
 Second

step: Basic life support

Airway

Breathing

Circulation
Current protocols may advocate the “CABs” to
reflect the importance of restoring perfusion during
the resuscitation efforts.
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CPCR Protocols
A
= Airway
 If
respirations are absent or weak, the
mouth should be opened and
examined for possible obstruction
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CPCR Protocols

B = Breathing

If the animal does not begin to breathe,
the patient must receive ventilation
assistance

Mouth-to-nose resuscitation may be
performed by sealing the lip margins and
blowing into the animal’s nose

Neonates may be intubated with a small
red rubber catheter; oxygen can be
delivered carefully by blowing through the
tube
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An endotracheal tube connected to an Ambu bag and
oxygen source provides an ideal means to supply 100%
oxygen and manual assisted ventilation.
CPCR Protocols

B = Breathing
 Visualize
airway with laryngoscope
 Pull
tongue forward with dry gauze
to facilitate tube passage
 Suction
 Stylets
readily available
readily available
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CPCR Protocols
B
= Breathing
 Begin
ventilation
 First
two breaths administered should be long breaths
lasting a full 2 seconds followed by patient assessment
 If
voluntary breathing is not immediate, manually
ventilate
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CPCR Protocols
 Ventilation
 Manually
ventilated at a rate slightly higher than
the expected normal
 Goal:
expand the chest by 30% with a slightly
longer expiration than inspiration
 Inspiratory
Pressures
 20
cm H2O dog
 15
cm H2O cat
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CPCR Protocols

Failed respiratory resuscitation may
respond to acupuncture to labial fulcrum

Insert 25 g needle 1.0 mm and twist
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CPCR Protocols
C
= Circulation
Once
the airway is established and
ventilation provided, assess circulation
Palpation
of pulses (or apex heart beat)
Auscultation
of the heart
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CPCR Protocols

Once cardiac arrest has been confirmed, initiate
chest compressions

Positioning of animal
 Depends
 Shape
chest)
 The
on the animal’s size
of the chest (barrel chest vs. deep and narrow
caregiver’s ability to deliver adequate compressions
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CPCR Protocols
 Place
palm over heart; hand-over-hand
 Compress
 Place
with elbows and weight of body
stack of towels under patient’s heart
 Small
dogs or cats may place sternal and
compress ventrally
 “Tennis-ball”
technique
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CPCR Protocols

Allow time between compressions
for adequate ventricular filling

Intermittent abdominal compression
 Alternate
with external chest
compression
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CPCR
 Effectiveness
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of CPCR
 Assessed
by palpating for a pulse and
evaluating mucous membrane color
 Use
ECG if available
 Use
ultrasound if available to assess the heart
Open-Chest CPCR
 Indicated
in animals with chest trauma
 Open-chest
CPCR is only beneficial if initiated
early in the resuscitation effort
 Open-chest
CPCR should be made within 2
minutes of cardiopulmonary arrest
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