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Anesthesiology > CPR > Flashcards

CPR Flashcards

1
Q

What is cardiopulmonary arrest?

A

Cessation of both the respiratory and circulatory systems

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2
Q

Is apnea the same as respiratory arrest?

A

No, apnea usually is a temporary cessation but it can least to complete respiratory arrest

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3
Q

What is respiratory arrest typically due to?

A

A pathologic process where the patient cannot initiate a breath (medullary ischemia)

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4
Q

What are the survival to discharge rates following CPR?

A

Dogs- 3-6%

Cats- 2-10%

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5
Q

How long does it take for cerebral death due to ischemia take?

A

> 4-7min

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6
Q

What kind of pathology has the least likelihood of survival even with CPR?

A

Cardiopulmonary arrest due to progressive illness

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7
Q

What is the most important aspect of resuscitating a CPA patient?

A

Early recognition and response

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8
Q

What conditions are classified as a respiratory emergency?

A

Tension pneumothorax, pulmonary or airway disease

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9
Q

What is a crash cart?

A

A box/cart that is stocked with all drugs and equipment necessary to resuscitate a patient

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10
Q

How many people are required for proper CPR?

A

At lease 4

Compressions, prepare drugs/monitors, provide ventilation, keep records

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11
Q

What drug is used to sedate animals in respiratory distress?

A

Acepromazine

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12
Q

What are the CS of upper airway obstruction and what breeds are predisposed?

A

Brachycephalics are predisposed

Inspiratory stridor, cynosis

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13
Q

What is the immediate step necessary for upper airway obstruction?

A

Induction and intubation

May need immediate surgery

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14
Q

What procedure can be done until definitive correction of an upper airway obstruction can be performed?

A

Tracheostomy

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15
Q

What are the CS due to an airway obstruction from a foreign body or tumor?

A

Inspiratory effort with abdominal effort and cynosis

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16
Q

Can a tracheostomy be performed with an airway obstruction?

A

Yes- go below the obstruction

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17
Q

What procedure is performed to visualize the obstruction?

A

Bronchostomy

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18
Q

What are the CS of a collapsed trachea and what breeds are predisposed?

A

Small and toy breed dogs

Marked inspiratory and exspiratory effort with a goose-honking noise

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19
Q

Should tracheal collapse patients be intubated?

A

Yes

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20
Q

What are the clinical signs of a pneumothorax?

A

Dyspnea, rapidly decreased SpO2, collapse

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21
Q

What are some causes of pneumothorax?

A

Thoracic trauma, spontaneous, barotrauma (closed pop-off!)

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22
Q

Can a pneumothroax lead to respiratory arrest?

A

Yes

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23
Q

What is done to treat a pneumothorax?

A

Oxygenation and evacuation of air from the chest (needle of chest tube)

Fluids recommended to improve circulation

Atropine if HR is decreased

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24
Q

If an anesthetized patient on a ventilator stops breathing, does this count as respiratory arrest?

A

Nope!

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25
Q

What value will suddenly decrease in an anesthetized patient in respiratory arrest?

A

EtCO2 (

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26
Q

How with the MMs look in animals in CPA?

A

Blue/gray

May still be pale pink if early

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27
Q

What is the procedure for CPA during anesthesia?

A
  1. Turn off anesthesia and flush circuit
  2. Start compression
  3. Ventilate 10bpm
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28
Q

What is the procedure for CPA walking through the door?

A

Compressions and “mouth to snout” ventilation until you can intubate

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29
Q

What should be restarted first in CPR? Circulation, breathing or airway?

A

Circulation- start compressions

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30
Q

What percentage of CO is generated in closed CPR?

A

25-40%

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31
Q

What should you use for your compression rate?

A

100-120 bpm

32
Q

How far should you compress the chest?

A

1/3-1/2 the width of the chest

33
Q

Where should compressions be performed on the chest with thoracic pump theory?

A

With hands over the highest point of the thorax

34
Q

Is the thoracic pump theory more effective in larger or smaller animals?

A

Larger

Dogs especially

35
Q

Where are compressions performed in cardiac pump theory?

A

Over the heart and compress with thumb and fingers

Similar to open chest CPR

36
Q

Cardiac pump theory is more effective in what kind of animals?

A

Smaller

37
Q

What is the inspiratory/expiratory times for ventilation?

A

1 sec for inspiration

5-6 sec for expiration

38
Q

If only one person is performing CPR, what is the protocol?

A

Continuous compression with 1-2 breaths every 2-3min

39
Q

Why is an ECG necessary in cardiac arrest?

A

Determine the rhythm of arrest

40
Q

What is the most common arrest ECG in small animals?

A

Asystole

41
Q

What is the most common arrest ECG in humans?

A

Ventricular fibrillation

42
Q

What drug can induce ventricular fibrillation?

A

Epiephrine

43
Q

What does pulseless electrical activity look like on ECG?

A

Wide QRS, no perception of heart function

Looks almost normal

44
Q

PEA is often observed in animals after what procedure?

A

Euthanasia

45
Q

Is a slower PEA or faster PEA a better prognosis?

A

Faster has a better prognosis

46
Q

What is the concern with PEA arrhythmias?

A

Depletion of global myocardial energy substrates

47
Q

What three drugs are administered in advanced support?

A

Vasopressors (vasopressin/epi)

Atropine

48
Q

How long can compressions be halted to check ECG?

A

No longer than 10 seconds

49
Q

Is there any advantages between the vasopressor drugs during CPR?

A

Nope

50
Q

Which vessels are preferred to gain IV access in an arrested patient?

A

Jugular > cephalic > saphenous

51
Q

Can drugs be administered intratracheally?

A

Yes!

52
Q

What drug cannot be given intratracheally?

A

NaHCO3

53
Q

Can intraossesous catheters be used in an arresting patient?

A

Yes, may be the only option if very small

54
Q

What are interposed abdominal compressions?

A

Compressions timed in between chest compressions to enhance venous return to the heart

55
Q

What are three complications of abdominal compressions?

A
  1. Diaphramatic hernia
  2. Hemoabdomen
  3. Hepatobilliary sx

All are rare but possible

56
Q

Where is open chest CPR performed?

A

On the left lateral at the 6th rib space

or

Via the diaphragm in abdominal sx

“Hack and slash” thorocotomy

57
Q

What are some indications for open chest CPR?

A
  • Cardiac tamponade
  • Large volume pericardial effusions
  • Chest trauma/fractures
  • Diaphragmatic hernia
  • If closed chest is not effective after ~5-10min
  • If EtCO2
58
Q

Is palpating a pulse useful to assess compression quality?

A

No

59
Q

What should be done to assess quality of compression?

A

Doppler probe over the cornea or over an artery

60
Q

What is the EtCO2 expected to be if compressions are working?

A

> 15 mmHg

61
Q

Is SpO2 useful for assessing compressions?

A

No

62
Q

What fluids should be given in cases of hypovolemia?

A

Colloids or crystalloids

63
Q

When is giving NaHCO3 appropriate?

A

Arrest due to metabolic acidosis

64
Q

When is giving Ca gluconate appropriate?

A

Arrest due to hypocalcemia, hyperkalemia, or Ca channel blocker toxicosis

65
Q

When should CPR be discontinued?

A

If EtCO2

66
Q

When is a defibrillator appropriate?

A

In ventricular fibrillation cases

67
Q

Can alcohol be used with defibrillator paddles?

A

NO

68
Q

If defibrillation is unsuccessful the first time, how long should compressions be continued before trying again?

A

At least 2min

69
Q

Should the energy of the shock be increased for successive shocks?

A

Yes, 50%

70
Q

What does ROSC stand for?

A

Return of spontaneous circulation

71
Q

Should ventilation be maintained after ROSC?

A

Yes

72
Q

What is the prognosis of a patient after ROSC depend on?

A
  1. Cause of arrest
  2. Duration of arrest
  3. Other physiologic/pathologic processes after reperfusion
73
Q

Medullary ischemia is likely unless circulation is restored in how many minutes?

A
74
Q

What is a beneficial treatment to prevent hypoxic injury to neural tissues?

A

Therapeutic hypothermia

Use either cold packs or cooled fluids

75
Q

When should CPR patients be extubated?

A

When they can ventilate adequately to maintain PaCO2 on their own and is actively objecting to the tube

76
Q

If spontaneous breathing has not returned withing in how many hours, the prognosis is poor.

A

6-12

Anesthesiology (27 decks)

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