CPR Basic Life Support

causes of cardio pulmonary arrest

-anaesthetic complications

-severe trauma

-severe electrolyte disturbances

-hypovolaemia

-vagal stim

-cardiac arrhythmias

-cardioresp disorders

-debilitating or end stage disease

-myocardial hypoxia

-drugs and toxins

-pH abnormalities

-electrolyte disturbances

-temp problems

what can cause acute failure of cardio resp systems

-lack of oxygen to tissues

-unconsciousness and systemic cellular death

-cerebral hypoxia (brain death within 4-6 mins)→ Tells you how long you have to get o2 to brain and get supply back to the brain

signs of cardiopulmonary arrest

Loss of consciousness

Apnoea or agonal gasping

No corneal reflex or palpebral reflex

No heart sounds

No palpable pulse

Central eye position

Pupils fixed and dilated

Bleeding stops at surgical site

Mucous membrane grey/blue/white

CRT altered (can be normal!)

Dry cornea

General muscle flaccidity

ECG arrhythmias (VF, VT, Asystole, PEA/EMD)

can you rely on apnoea to know if CPA

takes a long time so cannot rely on this, must see sooner

CPR initial assessment

what 2 components make up basic life support

1. chest compressions

2. ventilation

how quick should you want to make a decision if dead or not

15s

how basic life support should run

2 full minutes with no pauses

-chest compressions 100-120/min

-ventilation every 6 secs

CPR algorithm

what are the 2 types of chest compressions

• cardiac pump

• thoracic pump

cardiac pump done in

-cats

-small dogs

-keel chested dogs (e.g. greyhound)

-rabbits

thin or compliable chest

how is cardiac pump carried out

-compress ventricles

-in smaller patients: wrapping the hand around the chest

-in a larger, narrow chested breed: is the normal hand position in terms of you're holding your hands over each other and then you're compressing

down onto the chest, but you're aiming to compress over where the heart directly is

thoracic pump used in

-medium to large dogs

-foals

-calves

-sheep

how is thoracic pump carried out

-don't have the ability to compress directly over the heart because they've got a wider chest.

-place hand over widest part of chest

-or on their back if v wide chest

CPR in bull dogs

on back

cardiac pump focus

-pumping ventricles of heart

-ventral 1/3 thorax, ribs 3-6

how many pumps per mins in cardiac pump

100-120 per 2 mins

when is the cardiac pump less effective

-obesity

-pericardial effusion

-pneumothorax

thoracic pump focus

-thorax, not heart

-works through changes intrathoracic pressures

positioning of thoracic pump

-lateral recumbency

-widest part of chest

-compress to 1/3-1/2 width

-in dorsal recumbancy 1/4 width

what is a danger with the positioning of the thoracic pump

Sternum directly over heart, sternum can damage heart

beats per mins thoracic pump

100-120 per 2 mins

what is the internal cardiac compressions

-trans diaphragmatic or lateral thorax approach

-in surgery already

-better than external compressions

-hand is acc on the heart

drawbacks of internal cardiac compressions

-takes time

-training required

-post arrest care more complex and intensive → bc have open chest

large animal cpr

-need lots of people

-tiring

-aim for highest compression rate can

potential options for large animals

pline up and throw body onto caudo-dorsal lung field (conga line)

OR

-one person at a time for two mins jumping up and down in horse chest

horse positioned for cpr

lateral recumbency on solid surface

ventilation steps

-assess airways (clear it manually or with suction)

-secure control (ET tube or tracheostomy

how can you assess the airways

•May need to clear this manually e.g a tennis ball

•Or with suction e.g. blood or vomit

how can you get secure control of the airways

•Orotracheal intubation with ET tube.

•Or

•Emergency Tracheostomy

emergency tracheostomy

-3-5mm incision and blunt disection

-trachea entered 2-4 cm caudal to larynx, ET tube between rings

-large gauge needle with syringe and ET for instany access

once an airway is established what is required

positive pressure ventilation (PPV)

how do you do positive pressure ventilation

-ET tube connected to MABU bag, anaesthetic machine or demand valve

-mouth to snout/nose/mask vent

what risks of mouth to snout are there

zoonotic

what is the max inspiratory pressure

40cmH2O

what is the tidal volume max

10ml/kg

too high tidal volume can cause

iatrogenic barotrauma, pulmonary haemorrhage, pneumothorax

what is the ventilation rate

10 breaths per min