cardiopulmonary arrest n.
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Cardiopulmonary Arrest

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Cardiopulmonary Arrest

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  1. Cardiopulmonary Arrest • Cessation of breathing and effective blood circulation

  2. Readiness! • Having a CPCR protocol • Appropriate fluid therapy • Drug chart with calculated dosages • Crash cart supplies • O2 source, suction • Laryngoscope • Hemodynamic monitoring tools

  3. Cardiopulmonary Arrest Complication of any critical illness Potential complication in healthy patients undergoing anesthesia

  4. Definitions CPR = Cardiopulmonary Resuscitation Providing ventilation and assisted circulation CPCR = Cardiopulmonary Cerebral Resuscitation Acronym emphasizes the importance of maintaining perfusion and oxygen delivery to the central nervous system during and after an arrest

  5. Patients at Risk For an Arrest Respiratory difficulty Heart disease Severe hypothermia Multi-organ failure Trauma Shock

  6. Patients at Risk for an Arrest Anesthetized patients Monitor for unexplained changes in anesthetic depth Frequently monitor vital signs during entire procedure Monitor closely after anesthesia Support perfusion with fluids, heating pads

  7. Vagal Arrest Caused by heightened vagus nerve stimulation or vagal tone Common diseases associated with vagal arrests Gastrointestinal disease Respiratory disease Neurological disease Ophthalmic disease

  8. CPCR Protocols First step: Call for help!

  9. CPCR Protocols • Second step: Basic life support • Airway • Breathing • Circulation • Current protocols may advocate the “CABs” to reflect the importance of restoring perfusion during the resuscitation efforts.

  10. CPCR Protocols • A = Airway • If respirations are absent or weak, the mouth should be opened and examined for possible obstruction

  11. CPCR Protocols B = Breathing If the animal does not begin to breathe, the patient must receive ventilation assistance Mouth-to-nose resuscitation may be performed by sealing the lip margins and blowing into the animal’s nose Neonates may be intubated with a small red rubber catheter; oxygen can be delivered carefully by blowing through the tube

  12. CPCR Protocols B = Breathing Visualizeairway with laryngoscope Pull tongue forward with dry gauze to facilitate tube passage Suction readily available Stylets readily available

  13. CPCR Protocols B = Breathing Begin ventilation First two breaths administered should be long breaths lasting a full 2 seconds followed by patient assessment If voluntary breathing is not immediate, manually ventilate

  14. CPCR Protocols Ventilation Manually ventilated at a rate slightly higher than the expected normal Goal: expand the chest by 30% with a slightly longer expiration than inspiration Inspiratory Pressures 20 cm H2O dog 15 cm H2O cat

  15. CPCR Protocols Failed respiratory resuscitation may respond to acupuncture to labial fulcrum Insert 25 g needle 1.0 mm and twist

  16. CPCR Protocols • C = Circulation • Once the airway is established and ventilation provided, assess circulation • Palpation of pulses (or apex heart beat) • Auscultation of the heart

  17. CPCR Protocols Once cardiac arrest has been confirmed, initiate chest compressions Positioning of animal Depends on the animal’s size Shape of the chest (barrel chest vs. deep and narrow chest) The caregiver’s ability to deliver adequate compressions

  18. CPCR Protocols Place palm over heart; hand-over-hand Compress with elbows and weight of body Place stack of towels under patient’s heart Small dogs or cats may place sternal and compress ventrally “Tennis-ball” technique

  19. CPCR Protocols Allow time between compressions for adequate ventricular filling Intermittent abdominal compression Alternate with external chest compression

  20. CPCR Effectiveness of CPCR Assessed by palpating for a pulse and evaluating mucous membrane color Use ECG if available Use ultrasound if available to assess the heart

  21. Open-Chest CPCR Indicated in animals with chest trauma Open-chest CPCR is only beneficial if initiated early in the resuscitation effort Open-chest CPCR should be made within 2 minutes of cardiopulmonary arrest