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What does CPA stand for?
cadiopulmonary arrest
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What does CPR stand for?
cardiopulmonary resuscitation
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What is respiratory arrest?
the patient stops trying to breathe
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When is RA not so serious?
brief apnea
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What causes brief apnea?
- IV drug injection (example: barbiturates, propofol)
- Overbagging (low CO2)
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What can serious RA lead to?
cardiac arrest
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What are some causes of RA?
- anesthetic overdose
- lack of oxygen
- preexisting respiratory disease
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What preexisting respiratory disease could cause RA?
- pneumothorax
- pulmonary edema
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What are the clinical signs of RA?
- not breathing
- dyspnea
- cyanosis
- weak pulse
- slow CRT
- mydriasis
- abnormal heart rate
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How do we treat RA?
- inform veterinarian immediately
- intubate, inflate cuff and give O2
- give fluids
- keep warm
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What are the different types of oxygen sources?
- anesthesia machine
- Ambu bag
- mouth to tube or snout
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What is an Ambu bag?
small tank of O2 with its own regulator bag
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How do we treat RA?
- check heartbeat
- make sure vaporizer and N2O are turned off
- check flowmeter and O2 tank
- check airway of patient
- bag with O2
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How do we know if a patient is being ventilated properly?
- patient's chest rises and falls
- pulse oximeter is over 95%
- pressure manometer (20 cm H2O)
- blood gases
- capnography (are they getting rid of CO2)
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How do we bag with oxygen?
- 6 - 20 breaths per minute
- once every 3 - 5 seconds, once every 3 - 10 seconds
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Once the patient is back to normal, how do we wean the patient of bagging?
stop for 15 - 30 seconds to see if the patient starts to breath on their own
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What is cardiac arrest?
- heart stops beating
- also no breathing (CPA)
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What is the general rule for CA?
as long as the patient is breathing, the heart is beating
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What are the warning signs for CA?
- cyanosis
- dyspnea
- respiratory arrest
- prolonged CRT
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What are ways to monitor the heart?
- auscultation
- palpation of chest
- palpation of pulse
- blood pressure monitor
- EKG
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What are the clinical signs of CA?
- no heartbeat ausculted, palpated, or on EKG
- no palpable pulse (BP 25 mm Hg or less)
- mucous membranes gray or cyanotic (CRT may be prolonged)
- pupils widely dilated and no pupillary light reflex
- no respiration
- cardiopulmonary arrest
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How successful is CPR?
- 14% success CPR alone
- 23% success with CPR and defibrillation
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Permanent brain damage occurs if oxygenated blood does not get to the brain within _____.
4 minutes
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How do we resume blood flow?
- by CPR
- by patient recovery (resumes normal cardiac and respiratory function)
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What does ABCDEF stand for?
- A: airway
- B: bag or breathing
- C: cardiac
- D: drugs
- E: EKG
- F: fluids
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What is the goal of CPR?
to circulate oxygenated blood and to keep patient alive without brain damage
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How do we bag the patient?
- 1 breath every 3 - 5 seconds
- bag at the same time as cardiac compressions
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What are the different components of "C" (cardiac)?
- cardiac
- circulation
- chest
- compressions
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What are external compressions?
from outside the chest
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What are internal compressions?
surgically enter chest
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How do we position the patient for external cardiac compressions?
- right lateral recumbency
- feet away from you
- heart is "up"
- widest part of the chest
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How do we position round chested dogs?
- lay on back - presssure mid-sternum
- if possible, place patient's head lower than rest of body - gets blood flow to head quicker
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How do you do CPR on a large dog?
- put a rolled up towel under chest behind elbow to prevent "rocking" during compressions
- use both hands to compress chest against towel
- use heel of hands
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How do you do CPR on a medium sized dog?
- place one hand under chest
- other hand on left side over heart
- compress between hands
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How do you do CPR on a small dog or cat?
- use one hand
- place fingers under chest
- compress heart with thumb
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Where do you do the compressions on the patient?
at widest point of chest at 5th intercostal space
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How do you do compressions on a patient?
compress for count of 2, release for count of 1
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What should the rate of compressions be?
- 1 - 2 per second
- 120 bpm - good average
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What is the purpose of compressions?
- to force blood through the heart into blood vessels to tissue (especially the brain)
- to increase thoracic pressure
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How do you check for effectiveness of compressions?
- palpate for femoral or lingual pulse during compressions
- doppler probe on eye - check for blood flow to brain
- pulse oximeter
- ETCO2 - end-tidal CO2 - capnography
- blood gases
- blood pressure monitore
- mucous membrane color
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What do you do if there is no pulse or improvment in color?
- adjust rate and strength
- change compressor person
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What is the purpose of bagging during compressions?
increases intrathoracic pressure, pumps more blood
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If there is not another person to bag while doing compressions what should you do?
give 10 compressions then stop and give 2 breaths, repeat
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How do you monitor during CPR?
- check to see if heart has resumed beathing on its own
- check pulse
- palpate chest
- auscultation
- EKG
- pulse oximetry
- blood pressure monitor
- capnograph
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If the patient has not responded to CPR after 15 minutes...
not likely to respond
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When do we use defibrillation?
when EKG shows ventricular fibrillation (irregular wavy lines, "quivering" heart)
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When the heart improves...
- stop compressions
- continue bagging until patient breathes on their own
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How do you do internal compressions?
- quick shave and prep
- open between ribs 7 - 8
- retract ribs, insert gloved hand, squeeze heart
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What is the best route for administering drugs after CPR?
IV catheter - jugular
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How do you give drugs intratracheally?
- stop ventilating and chest compressions, give drug, give 2 deep breaths
- inject between tracheal rings or through urinary catheter placed down trach tube
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What drugs do we usually use in CPR?
- epinephrine
- steroids
- dopamine, dobutamine
- atropine, lidocaine
- Na bicarbonate
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Why would we use epinephrine?
increases rate and force of cardiac contractions
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What is the dose for epinephrine for cat, small dog, medium dog, and large dog?
- cat: 0.5 ml
- small dog: 1 ml
- medium dog: 2 ml
- large dog: 3 ml
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Why would we use dopamine, dobutamine?
increase force and rate of cardiac contractions
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What are steroids used for?
treat shock
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What do you do if the patient does not respond to the drugs?
continue CPR and repeat drugs in 1 minute
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When do you discontinue CPR?
if pupils remain fixed and dilated for 10 - 15 minutes
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What do we use EKG for?
helps to determine drugs or treatment to be used?
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What 3 forms of arrest do EKG's detect?
- asystole
- ventricular fibrillation
- elecrtomechanical dissociation
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What is asystole?
flat line on EKG
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How do we treat asystole?
epinephrine, atropine, Na bicarbonate
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What is ventricular fibrillation?
disorganized, wavy pattern on EKG
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How do we treat ventricular fibrillation?
lidocaine
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What is electromechanical dissociation?
may be normal QRS complexes, but heart is not beating effectively
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How do we treat electromechanical dissociation?
- epinephrine
- glucocorticoids
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Why do we give fluids? How do we give fluids?
- for low blood pressure
- dogs: up to 90 ml/kg/hr
- cats: up to 50 - 70 ml/kg/hr
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What kind of supportive care do we need to provide after giving CPR?
- keep warm
- eye ointment
- turn every 10 - 15 minutes
- control any bleeding
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What could potentially happen after CPR?
- pulmonary edema
- cerebral edema - coma, seizures, permanent neurological damage
- repeated cardiopulmonary arrests
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