Surgery Lab 4: Anesthetic Emergencies and Cardiopulmonary Resuscitation

Comprehensive vocabulary flashcards covering veterinary cardiopulmonary arrest (CPA), cardiopulmonary cerebral resuscitation (CPCR), Basic and Advanced Life Support (BLS/ALS), CABD protocols, monitoring, emergency pharmacology, fluid rates, and defibrillation.

Cardiopulmonary Resuscitation (CPR)

An emergency medical procedure utilized in both human and veterinary medicine to treat cardiopulmonary arrest (CPA).

Cardiopulmonary Cerebral Resuscitation (CPCR)

An expanded term for CPR emphasizing that resuscitation aims not only to keep the patient alive, but also specifically to maintain brain function.

Human vs. Animal CPA Differences

Four critical distinctions between humans and animals: the etiology of CPA, response to physical resuscitation, response to drugs, and prognosis for survival and return to normal function.

Canine CPA Resuscitation Prognosis

Survival statistics in dogs showing that $13\%$ are initially resuscitated, but only $4.1\%$ survive to leave the hospital.

Feline CPA Resuscitation Prognosis

Survival statistics in cats showing that $15.6\%$ are initially resuscitated, and $9.6\%$ survive to leave the hospital.

Human CPA Resuscitation Prognosis

Survival statistics in human patients showing that up to $40\text{--}60\%$ are initially resuscitated, while $17\%$ survive to leave the hospital.

Basic Life Support (BLS)

The foundational level of resuscitation addressing Airway, Breathing, Circulation, and some drugs, which can be performed by most clinics.

Advanced Life Support (ALS)

The advanced resuscitation tier consisting of BLS plus additional drugs, ECG, defibrillation if warranted, and optional internal cardiac massage.

CABD Resuscitation Sequence

The prioritized emergency resuscitation algorithm denoting Circulation, Airway, Breathing, and Drugs.

Circulation Assessment in CPA

The initial step in resuscitation evaluated by auscultating the chest, palpating the pulse, assessing mucous membrane colour, and checking capillary refill time (CRT).

Heartbeat Compression Precaution

The essential safety guideline stating that chest compressions must NEVER be performed when the heart is still beating.

Right Lateral Recumbency

The primary recommended positioning of a patient for chest compressions, with dorsal recumbency serving as an alternative.

5th–6th Intercostal Space Compression Site

The designated anatomical thoracic landmark over which external chest compressions are performed.

Small Patient Compression Technique

Hand positioning for cats and small dogs where fingers are placed underneath the chest and the thumb on top, compressing the thorax between them.

Medium Patient Compression Technique

Hand positioning where one hand is placed underneath the chest and the heel of the opposing hand is placed on top to perform compressions.

Large Patient Compression Technique

Chest compression method utilizing a book or sandbag underneath, interlocked hands on top with stiff arms, and rocking forward to use body weight.

Chest Compression Rate

The target compression frequency of $100\text{ compressions/minute}$ (approximately $2\text{ compressions/second}$), administered faster for small patients and slower for large patients.

Chest Compression Depth

Compressing approximately $1/3$ of the chest depth to alter intrathoracic pressure, improve venous return to the heart, and increase cardiac output.

Solo Rescuer CPR Protocol

The protocol stating that an individual rescuer working alone must concentrate on compressions ONLY, as air moves naturally with chest compression.

Interposed Abdominal Compressions

An adjunctive CPR technique where abdominal compressions are alternated with thoracic compressions to increase venous return from the caudal body.

Distal Pulse Palpation

Palpating the lingual or digital pulse during compressions to verify whether blood flow is being effectively delivered to the most distal parts of the body.

Femoral Pulse Palpation

An initial assessment during CPR to determine if compressions are producing any circulatory output, where a pulse should be felt with each compression.

Doppler Flow Monitoring

Placing a Doppler probe on the eyeball or under the tongue over the lingual artery to verify an audible pulse during CPR compressions.

Capnometry in CPR

An objective monitor of compression efficacy where $PaCO_2$ should gradually increase if chest compressions are producing effective circulation.

Pulse Oximetry in CPR

Monitoring via a probe placed on the tongue, where effective compressions should produce an observable improvement in $SpO_2$.

Three-Minute Compression Cycle

Continuing chest compressions for approximately $3\text{ minutes}$ continuously before briefly stopping to assess whether a spontaneous pulse persists.

Indications to Halt Compressions

Parameters prompting cessation of compressions: patient consciousness, spontaneous breathing, or a palpable pulse/heartbeat outside of compressions.

Troubleshooting Ineffective Compressions

Systematic adjustments made when compressions fail to produce circulation: alter patient position, hand position, compression strength, operator, or consider internal compressions.

Internal Cardiac Compressions

An invasive intervention that severely decreases prognosis, considered in patients $>20\text{ kg}$, pneumothorax, pleural or pericardial effusion, penetrating wounds, chest wall trauma, hemoperitoneum, or diaphragmatic hernia.

Scoop and Drain Airway Clearing

Physical clearance techniques used to remove obstructions, foreign material, fluid, or vomitus to establish an open airway.

Mouth-to-Snout Ventilation

The most basic airway management option, performed at trauma scenes like house fires or HBC incidents, though resuscitators may have squeamishness concerns.

Cuffed Endotracheal Tube

The optimal airway access device during veterinary CPR, requiring careful confirmation of tracheal placement in apneic patients.

Emergency Tracheostomy

A surgical airway intervention generally performed by a DVM when an ET tube cannot be placed due to foreign bodies or obstructions, requiring extensive aftercare.

Transtracheal Catheter

A less invasive alternative to tracheostomy providing high oxygen concentrations, though overall oxygen delivery is restricted by its small catheter diameter.

Resuscitation Ventilation Rate

Delivering approximately $1\text{ breath every } 6\text{ seconds}$ (approx. $10\text{ breaths/minute}$), ideally utilizing $100\%\text{ }O_2$.

Ambu Bag

A self-refilling resuscitation bag that can be connected to an anesthetic machine or oxygen tank to provide $100\%\text{ }O_2$ rather than ambient room air.

Anesthetic Machine Safety Checks

Essential machine precautions during CPR: verify the vaporizer is turned completely OFF and ensure the soda lime is active and not exhausted.

Resuscitation Tidal Volume

The delivery of approximately $10\text{--}15\text{ mL/kg}$ per breath to avoid overinflating the patient's lungs during artificial ventilation.

Peak Inspiratory Pressure Limits

Maximum circuit pressures during bagging: do not exceed $20\text{ cmH}_2\text{O}$ in dogs or $15\text{ cmH}_2\text{O}$ in cats.

Mid Nasal Philtrum Acupuncture Point

A respiratory stimulation point located below the nose and before the lip, stimulated by inserting a $25\text{-gauge}$ needle to bone contact and twisting.

Criteria to Discontinue Respiratory Support

Continuing artificial breaths even with a spontaneous pulse until mucous membranes turn pink and spontaneous breathing resumes, followed by intermittent bagging during recovery.

Emergency Drug Route Hierarchy

The prioritized routes for emergency medications: 1. IV central vein, 2. Intratracheal, 3. IV peripheral vein, 4. Intraosseous, 5. Intralingual, and 6. Intracardiac (not recommended).

Central Venous Catheterization

The preferred vascular route during CPR, placing a large-gauge catheter into a vein as close to the heart as possible, usually the jugular vein.

Intratracheal Drug Administration

Administering double the standard drug dose diluted in $3\text{--}5\text{ mL}$ sterile saline down the ET tube using a red rubber feeding tube or urinary catheter.

Intraosseous Drug Administration

Vascular access via the trochanteric fossa, proximal humerus, or tibial crest, particularly useful in pediatric, avian, and exotic patients.

Intralingual Drug Administration

Direct injection into the extensive vascular bed of the tongue, providing emergency systemic drug access close to cerebral circulation.

Intracardiac Injection Hazards

Severe potential complications including pulmonary laceration, cardiac trauma, and pneumothorax, which make the intracardiac route not recommended.

Vasopressin

An antidiuretic hormone synthesized in the hypothalamus and released by the posterior pituitary that improves cerebral $O_2$, blood flow, and neurologic outcomes in asystole, PEA, and ventricular tachycardia.

Epinephrine

A sympathetic stimulant producing vasoconstriction within seconds, administered every $3\text{--}5\text{ minutes}$ during CPR, starting prudently with a low dose.

Dopamine

An inotropic cardiac stimulant that alters the force or speed of contractions, administered via slow IV drip when the heart is still beating.

Atropine

An anticholinergic emergency drug that acts within several minutes to treat bradycardia during resuscitation.

Glycopyrrolate

An anticholinergic alternative to atropine used in emergency treatment that is less likely to induce tachycardia.

Lidocaine NEAT

A lidocaine formulation containing no epinephrine, administered for antiarrhythmic effects to prevent ventricular tachycardia and ventricular fibrillation while raising the defibrillation threshold.

Doxapram

An analeptic restorative respiratory stimulant that increases myocardial oxygen demand, currently difficult to access in Canada.

Corticosteroid Contraindication in CPA

Emergency drugs no longer generally indicated due to unproven efficacy, carrying the danger of causing circulatory collapse if given without concurrent IV fluids.

Sodium Bicarbonate

An alkalinizing agent used to treat acidosis and hyperkalemia, ideally guided by blood gas analysis or withheld until at least $10\text{ minutes}$ after cardiopulmonary arrest.

Calcium Gluconate

An emergency electrolyte medication not used routinely in CPR, specifically indicated for hypocalcemia, hyperkalemia, and calcium channel blocker overdoses.

Updated CPR Shock Fluid Rates

Administering $1/4$ of traditional shock rates every $15\text{ minutes}$ ($22\text{ mL/kg/h}$ in dogs, $11\text{ mL/kg/h}$ in cats in 15-minute blocks), initially utilizing crystalloids.

Ventricular Fibrillation Species Discrepancy

The species-specific finding that VF is uncommon in dogs and rare in cats, explaining why defibrillation is not often effective or commonly used in veterinary CPA compared to humans.

Defibrillation Technique and Energy Dosing

Defibrillation protocol in dorsal or lateral recumbency with shaving and gel while strictly avoiding alcohol, delivering an initial shock of $3\text{--}5\text{ J/kg}$ (increased by $50\%$ if needed) or $0.5\text{--}1\text{ J/kg}$ with internal paddles.