Transcript vision - Dr. Roberta Dev Anand

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
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Anesthesia
Trauma
Infections (e.g. pneumonia)
Heart disease
Autoimmune disease
Malignancy
Trauma
Hypoxemia
Shock
anemia
Cardiopulmonary Resuscitation
 Resuscitation Team Members
◦ Should be 3-5 members
 Team leader—Veterinarian or RVT with most experience
 All members have several responsibilities
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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
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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
Cardiopulmonary Resuscitation
• Standard Emergency Supplies (on crash cart)
– Pharmaceuticals
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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
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Laryngoscope
Endotracheal tubes (variety of sizes)
Lubricating jelly
Roll gauze
--Venous access supplies
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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
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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=VJGlsYHI9
cU
Cardiopulmonary Resuscitation
Intubation
Cardiopulmonary Resuscitation
• 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
• Basic Life Support (Phase I)
– Circulation
• Internal cardiac compression
– More effective than external compression
» ↑CO, ↑BP, higher survival rate
– Indications
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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 8th 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
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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
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 mEq/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
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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