CPR

Question 1

Thoracic vs cardiac pump

Answer 1

Thoracic: big, square chest
Cardiac: keel-chested, small dogs and cats

Question 2

Cats/small dogs options for compressions

Answer 2

Circumferential 2-thumb over heart
1handed wrapped around sternum
1handed heel of dominant hand

Question 3

Compression depth

Answer 3

1/3-1/2 in lateral
1/4 in dorsal to avoid impaired venous return

Question 4

Single-rescuer

Answer 4

Airway eval first before starting compressions
Tight fitting mask
If not available: mouth to snot 30:2
If zoonotic: compressions only

Question 5

When can we stop mid cycle?

Answer 5

Fatigue/inadequate compressions: switch in less than 1sec

Sudden persistent increase ETCo2 > 35mmHg or >10 to reach 35 AND palpable pulse

Question 6

Target ETcO2

Answer 6

18

Question 7

TV, inspiratory time, RPM, BPM

Answer 7

10, 1, 10, 100-120

Question 8

When IO instead that IV?

Answer 8

IV attempt failed after 2min

Question 9

Minimum CoPP to obtain ROSC and formula

Answer 9

15mmHg
CoPP= diast Ao prex - RA prex

Question 10

When to give bicarb

Answer 10

HyperK > 7.5 venous and pH< 7.2

Question 11

Phases of cardiac arrest

Answer 11

Eccome!
ELectrical: first 4min, still ATP store to sustain demand and minimize ischemic damage.
Circulatory: next 6min: ATP depletion. Reversible ischemic injury
Metabolic: after 10min. Irreversible

Question 12

Shockable rhythm: when do you give epi?

Answer 12

Shock first, restart compressions, then give vasopressin or epi if still shockable after + anti arrhythmia (lido dog, aniodarone cat) + esmolol

Question 13

Post ROSC algorhythm

Answer 13

Resp optimization: spontaneous breathing? Ventilation (paCO2 or ETCO2 32-43dog, 26-36cat), Oxygenation (80-100, 94-98%)

Hemodynamic: SAP 100-200, MAP 80-100. If hypertension and reduced pressure dose and treated pain= CRI nitroprusside

If normal ABP= DO2? ScvO2 > 70%, lact < 2.5

Neuroprotection: hypothermia if comatose, mannitol/hts, seizure prophylaxis

Question 14

How fast rewarming?

Answer 14

< 1C per h

Question 15

Mechs of hypoxic/ischemic brain injury

Answer 15

Neuronal excitotoxicity, cerebral acidosis, reperfusion injury

Question 16

Open chest CPR

Answer 16

CoPP 3x higher

R lateral: cut L side 6th ICS
Transect latissimus dorsi, serratus ventralis, scalenus, pectorals
Enter pleura carefully (stop ventilation briefly)
Retract ribs with finocchietto
Incise ventral to phrenic nerve if pericardial effusion

Massage: one hand, 2 (best), hand against thoracic wall
If defibrillation: 1/10 of dose

Augmentation technique: compression of descending aorta to increase CoPP and cerebral perfusion (to be removed gradually over 10min)

Lavage+ culture

Closure: non-absorbable around adjacent ribs, square knots. Thoracostomy tube vs thoracocentesis