VISION

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 ________ of effective __________ and circulation. • Causes • Anesthesia • ______________ • Infections (e.g. pneumonia) • Heart disease • Autoimmune disease • Malignancy

4. Cardiopulmonary Resuscitation • Resuscitation Team Members • Should be _____________ members • Team leader—Veterinarian or RVT with most experience • All members have several responsibilities • Provide ventilation • Chest compression • Establish _______________ • Administer drugs • Attach monitoring equipment • ____________ 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 • ____________ source • Good lighting • ______________ with all needed Rx (should be checked at beginning of each shift) • Defibrillators • Electrocardiogram • Suction • Table to perform chest compression • Grated surgery prep table _________________ 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 __________________

6. Cardiopulmonary Resuscitation • Standard Emergency Supplies (on crash cart) • Pharmaceuticals --Venous access supplies • __________________ ● Butterfly cath • Epinephrine ● IV caths • Vasopressin ● IV drip sets • 2% lidocaine (w/o epi) ● ________________________________________ • 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 (_____________) • Remember the priorities (ABC; Airway, Breathing, Circulation) • Establish _______________ Airway • Endotracheal tube • Tracheostomy tube for upper airway obstruction • Suction to remove blood, mucus, pulmonary edema fluid, vomit • Artificial ventilation (Breathing) • _____________________ • Anesthetic machine • Ventilate once every 3-5 sec • Chest compressions in between breaths if working alone • 1 to 2 times per second (____________ times per minute for a large dog and _______________ times for a small dog or cat) • 10 compression for every 2 breaths (or_________________)

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

15. Cardiopulmonary Resuscitation Intubation

16. Basic Life Support (Phase I) Circulation External cardiac compression ____________________ 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: ___________________ /min Cardiopulmonary Resuscitation

17. Cardiopulmonary Resuscitation • Basic Life Support (Phase I) • Circulation • Internal cardiac compression • ___________________ than external compression • ↑CO, ↑BP, higher survival rate • Indications • Rib fractures • Pleural effusion • Pneumothorax • If not responsive after ________________ of external cardiac compression • Preparation • Clip hair ASAP, no surgical scrub • Incision at __________________ 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

18. 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 • __________________ person performing compression • Ventilate with every 2nd or 3rd chest compression • Compress chest where it is widest in lg breed dogs • Apply ____________________ to abdomen (hand, sandbag) • Prevents posterior displacement of diaphragm and increases intrathoracic pressure

19. 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—_________ /kg (rapidly IV) Cats—____________/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 _______________ → ↑BP

21. 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____________________) • 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

22. CPR

23. 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 ________________ 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

24. 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 __________________________ 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

25. Cardiopulmonary Resuscitation FISH DEFIBRILLATORS

26. Cardiopulmonary Resuscitation VENTRICULAR FIBRILLATION NORMAL EKG

27. 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 • ____________________ • 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%

28. CPR