Small Animal Nursing I Lab 9 - Respiratory Support & CPR Basics

Brachycephalic syndrome and collapsing trachea

List structural problems of the respiratory system that patients may suffer from

• Pneumonia

• Hemorrhage

• Edema

• Cancer

List problems associated with the lung tissue that may cause respiratory issues in patients

Fractured ribs

*Patient will be taking shallow breaths

What is an example of an extra-pulmonary problem that may cause respiratory issues in patients?

Thoracic percussion or auscultation

What can help identify the presence of pleural effusion?

• Respiratory effort and pattern

• Mucous membrane color

• Patients with poor respiratory function may have pale, gray, or cyanotic MM

• Monitor O2 function in critical patients

Identify aspects of a respiratory assessment

Deoxyhemoglobin (<5 g/dL)

A significant amount of _____ is present when the patient appears blue

Certain drugs can interfere with respiration, and the patient may require intubation

Why is careful monitoring of sedated patients necessary?

Thoracocentesis and/or a drain (chest tube)

How is pleural effusion or pneumothorax treated?

• Chest tube

• Nasal prongs or cannulas

• Flow-by oxygen

• Face mask

• Oxygen cage

List methods of providing oxygen support to dyspneic patients

The percent of hemoglobin molecules that are saturated with oxygen

What does pulse oximetry measure?

• Poor perfusion to the probe site

• Hypothermia

• Interference from hair

• Skin pigmentation

• Patient movement

What are common errors that can effect a pulse oximetry reading?

Capnograph (end-tidal CO2)

Name the device that reflects the amount of CO2 present in expired air at exhalation

• Provides information about respiratory system function

• End-tidal CO2 reflects amount of CO2 present in expired air at exhalation

What is the function of a capnograph?

• Hypoventilation

• Rebreathing CO2 in an anesthetic circuit with exhausted soda lime

What is a high end-tidal CO2 reading associated with?

• Hyperventilation

• Decreased cardiac output

What is a low end-tidal CO2 reading associated with?

• Central line maintenance

• Central venous pressure monitoring

• Maintaining ventilator every 4-6 hours

• Keeping eyes moist

• Swabbing oral cavity

List methods of long-term support necessary for a ventilated patient

• Pressure ulcers

• Peripheral edema

• Edematous tongue

• Pneumonia

List complications associated with patients on a ventilator

Cessation of spontaneous respirations and lack of perfusing heart rhythm

Define cardiopulmonary arrest (CPA)

• Underlying cardiac disorders or respiratory disease

• Severe trauma or shock

• Seizures

• Anemia

• Increased vagal tone

• Patients under general anesthesia

List common indications for CPR

Vagally mediated arrest

Increased parasympathetic nervous system stimulation associated with high levels of norepinephrine

• Patients with sudden tachycardia or bradycardia

• Pallor

• Alteration of pulse strength

• Increased respiratory effort

Some patients have respiratory arrest before cardiopulmonary arrest occurs. Which patients are predisposed?

• Continuous chest compressions (2 minute cycles)

• Intubation

• Ventilation

What are the components of basic life support (BLS)?

• Medications

• Defibrillation

• Open-chest procedures

What are the components of advanced life support (ALS)?

• Place in lateral recumbency with hand encircling the ventral chest

• Compressions performed directly over the heart

• 120 to 130 compressions per minute

Describe quality compressions of a cat or small dog

Cardiac pump

This CPR method uses direct compression of the heart's ventricle that contribute to forward blood flow

Thoracic pump

The passive movement of blood away from the body when

the chest is compressed

• Application of compressions depends on the conformation of the patient

• Compression using two interlocked hands and straight arms

• Shoulders are in line with the heel of the hands, directly over the compression point

• Compression force is delivered by bending the waist, using a step stool, or on a table over the patient

Describe quality compressions of medium to large dogs

Has a narrow thoracic cavity

What does a keel-chested dog look like?

Cardiac pump method used on the laterally recumbent patient to compress the heart at the 5th intercostal space

How should you perform CPR on a keel-chested dog?

Compression is applied to the widest portion of the chest at the 7th intercostal space with patient in lateral recumbency

How should you perform CPR on a barrel or round-chested dog?

Changes in intrathoracic pressure that occur with each compression and recoil of the thorax

What promotes blood flow when performing CPR using the cardiac pump method?

• Blood is forced out of the heart (intrathoracic pressure exceeds extravascular pressure

• Venous return to the R atrium occurs when pressure is released

What happens to the blood when the chest is compressed at 30-50% using the cardiac pump method?

• Doppler blood pressure probe

• End-tidal CO2 rises

• Interposed abdominal compressions at recoil

List signs of effective chest compressions

• Endotracheal tube

• Emergency tracheostomy

• Suction to remove airway secretions/foreign material from the oropharynx

What may securing the airway during CPR entail?

8-12 breaths/min

How many breaths/min should be given during ventilation support?

• Ambu bag - room air (21%) or O2 (30 compressions to 2 ventilations)

• Anesthetic machine or ventilator

• Acupuncture

Identify methods of ventilation support

• 10-20 cm of water/breath

• 10 respirations/minute with 1 sec inspiration and 5 seconds expiration

What is the desired outcome when providing ventilation support using an anesthetic machine or ventilation machine?

Governor vessel 26

What acupuncture technique is helpful in stimulating respiration?

When the patient is still in CPA after the 1st cycle of compressions (2 minutes)

When does advance life support begin?

1. Asystole

2. Pulseless electrical activity (PEA)

3. Pulseless ventricular tachycardia

4. Ventricular fibrillation

List the four main arrest rhythms

Asystole

Absence of contractions of the heart

A flatline or absence of contractions of the heart

What is asystole?

When ECG waves are present without heart contraction

What is pulseless electrical activity (PEA)?

Pulseless electrical activity (PEA)

Arrest rhythm where ECG waves are present without heart contraction

• Epinephrine

• Vasopressin (anti-diuretic hormone)

• Atropine every other BLS cycle (every 4 minutes)

How can pulseless electrical activity (PEA) treated?

Pulseless ventricular tachycardia

Arrest rhythm where waves form but the heart does not contract

Waves form but the heart does not contract

What occurs during pulseless ventricular tachycardia?

Ventricular fibrillation

Rapid, irregular contractions of the ventricles

Defibrillation after a cycle of CPR followed by continued compression for at least a cycle if the rhythm does not convert

What is the treatment for ventricular fibrillation?

• Intraosseous catheter in small and young patients

• Endotracheal administration with use of a red-rubber catheter at 2x the IV dose

IV is the preferred method of administration in CPR. List two additional methods if IV access is not possible.

Epinephrine, vasopressin, and atropine

List the three most common IV drugs used during CPR

82%

What percent of resuscitated patients will experience another CPA within 24 hours?

4-9%

*Odds of survival increase to 30% of dogs, and 58% of cats if interventions are taken when the patient is in respiratory distress only

What is the overall survival rate for a patient who experienced CPA?

To treat the cause of CPA

What is the primary focus when providing post-arrest care to a patient?

• Continuous ECG and blood pressure monitoring

• Patients supplemented with 100% O2 for days after arrest

What may post-arrest care and assessment include?

• Risk of ischemia (reduced blood flow causes lack of O2)

• Reperfusion injury of heart tissues

• Fluid balance

• Antibiotics

• Monitor urine production and renal profusion

• Hourly neurological assessment

• Watch for stress-related hyperglycemia

What are post-arrest complications associated with the cardiovascular system?

Ischemia

Term for reduced blood flow resulting in a lack of oxygen

• Pulmonary edema

• Atelectasis (collapsed lung)

• Thromboembolism

• Respiratory distress

• Injuries sustained during chest compressions

What are post-arrest complications associated with the lungs?

Atelectasis

Identify the term for collapased lung

Breakdown of mucosal barrier releases bacteria to the body, potentially causing sepsis

How is the gastrointestinal tract traumatized during CPA?

• Pupillary light response

• Pupil size and symmetry

• Spontaneous respiratory efforts

• Response to stimulus

• Motor responses

What may neurological assessment for a post-arrest patient include?

Lidocaine

Anti-arrhythmic drug for rapid heart rates

To treat arrhythmias in patients with rapid heart rates

How is lidocaine used for post-arrest care?

Mannitol

*To be used with care in renal failure patients as it acts as a diuretic

Drug with high osmolality used to decrease cerebral edema post-arrest

To decrease cerebral edema post-arrest

How is mannitol used for post-arrest care?

Dopamine

Drug used to increase blood pressure by causing peripheral vasoconstriction

To increase blood pressure by causing peripheral vasoconstriction

How is dopamine used for post-arrest care?

Vasopressin (Can also cause arrhythmias so ECG monitoring is required)

Commonly used to increase blood pressure during CPR

Increases blood pressure

How is vasopressin useful during CPR?

Furosemide

Drug used to increase urine output

Increase urine output

*Care must be taken with patients that have low blood pressure

How is furosemide used for post-arrest care?

• Abdominocentesis

• Thoracocentesis

• Thoracic drain placement

List advanced emergency techniques that may be used during CPA

Fluid delivered to the abdomen to see if bacteria and/or blood is present in the abdomen

How can abdominocentesis be used as an emergency technique?

To remove fluid or air from the pleural space from the thorax

How can thoracocentesis be used as an emergency technique?

Thoracocentesis

A diagnostic and therapeutic technique to remove fluid or air from the pleural space of the thorax

To remove substantial amounts of fluid from the pleural space of the thorax

How can chest tube placement be used as an emergency technique?

In the 7 to the 9th upper intercostal spaces at the junction between the upper third and lower two-thirds of the thorax

Where is a chest tube placed?