CPR + Fluid Theray

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CPR

Describe general principles of CPR and its application in cardiopulmonary Arrest (CPA)

CPA

Heart not beating

Patient stoped breathing

CPR as quickly as poss.

Delay ? Brain damage

Aim to return spontaneous circulation (ROSC)

Chest compressions

Start immediately

Lateral recumbancy - Cats + Dog

Theories that describe mechanisms leading to blood flow

Cardiac pump

Ventricles compressed directly

Between sternum + spine (dorsal)

Between ribs ( lateral)

Blood forced out of heart to lungs

Relaxation - blood from lungs + extremities returns to heart

Thoracic pump

Intra- thoracic pressure Inc

Compresses Aorta

Collapses vena cava

Blood flows out of thorax

Elastic recoil

Depressed intra-thoracic pressure

Blood back into thorax

Ventilation

Performed w chest compressions

Et intubation + intermittent positive pressure ventilation (IPPV)

Pure Oxy + reservoir bag of a circuit

Blow down tube - not great% Oxy

Mouth to snout

Perform CPR

Rapid assessment - ABC

Airway

Patent

Check with fur

Not breathing - press on chest

ET intubation

Breathing

Watch

Feel

Not breathing - start CPR

Circulation

Pulse

No pulse- start CPR

Dog - femoral

Horse - Mandibular

Chest compressions

Round chested dogs

Lateral recumbency

Thoracic pump theory

Hands spread over as wide an area as poss.

Narrow chested dogs

Lateral recumbency

Cardiac pump theory

Compressions directly over heart

Barrel chested dogs

Dorsal recumbancy

Cardiac pump theory

Directly over heart

Most cats + small dogs with compliant chests

Lateral recumbancy

Cardiac pump

Fingers of one hand round sternum at level of heart

Large cats + small dogs with incompliant chest

Lateral recumbency

Cardiac pump

Directly over heart

Minimal rate of 100-120 per min

Deep chest compressions

1/3 to 1/2 the width of thorax

Allow full elastic recoil of chest wall before next compression

Dont lean on chest

Ventilation

Via ET tube

Insert

Don't delay compressions

Lateral recumbency

Tie in place

Inflate cuff

Simultaneous with chest compressions

Pure Oxy w reservoir bag

Can blow down ET tube

10 breaths /min

10ml/kg tidal vol

Too much damages lungs

Short inspiratory period - 1 s

Mouth to snout

Hold mouth tightly closed

Mouth over patients nares - seal with snout

Blow into nares

Chest compression

Compression : Ventilation 30:2

Cycles

CPR performed 2 mins

Changeover - prevent fatigue

Interposed Abdo compressions

Lacerate liver / spleen if not performed carefully

Abdo compression during elastic recoil phase of chest minimises this

Applied with overlapping hands cranial to umbilicus

Rate similar to chest

Reasonable to use sufficient trained personnel

Fluid therapy

Describe general principles of fluid therapy , distribution of fluids within the body and broad categories of fluids

65% BW = water

40% = intracellular

25% = extracellular

8% intra vascular space

15% = Intersitial space

Semi permeable membrane

Capillary

Between blood + interstitial space

Permeable to

Water

Electrolytes

Cell

Between interstitial space + cell

Freely permeable to water

Fluid movement

Governed by Hydrostatic pressure

Hydrostatic pressure affected by osmotic pressure + oncotic pressure

Oncotic = protein

Osmotic = electrolytes , glucose + urea

Usually administered IV, can be Subcut, Intraperitoneal + Intra osseous fluid

Fluid types

Crystalloids

Water, salt + solutes

Colloids

Water, salt , starch + solutes

Protein based

Non Oxycarriers (Plasma)

Oxy carriers (blood)

Concentrations ?

Described by tonicity

Effective osmolarity in relation to plasma

Movement of fluid dependent

Isotonic = no net movement = 0.9% saline

Hyptonic = fluid Intravasc. ->Interstitial

Hypertonic = fluid Interstitial -> Intravasc.

Perform fluid therapy calculations

Treatment of dehydration

Calculate to return body fluid to normal

Maintenance (2ml/kg/hr)

Deficit (%dehydration)

Vol (ml) = %dehydration x BW (kg) X 1000

Ongoing losses

Sml/kg per episode

Vol (ml) = Vol per episode x freq over 24hrs

Vomit diarrhoea etc

Fluid replaced over 24hr

Drip rate

Gravity or infusion pump

Re-evaluate each time

HR

RR

mm

Pulse quality

Estimating dehydration

<5% no signs

5%

Sticky to dry mm

Skin doesn't return to body normal

7%

Mildly depressed

Mildly dec skin tugor

Dry mm

10%

Moderately depressed

Moderately dec skin turgor

Dry mm

Slightly sunken globe

12%

Skin tent

Moribund

Dry mm

Deeply sunken globe

Treatment of shock

Hypovolaemia

Loss of fluid - intravascularly

Inc fluid to maintain CO

Admisister fluid ASAP

Restricted size of cathete

2?

Fluids normally administered using gravity - slow

Apply pressure

Can be in shock and dehydrated

Bolus admin of fluid

10-20ml per kg in 15-30mins

Reevaluate

RR

HR

mm

Still in shock - repeat

Stop when patient no longer in shock

Administer fluids to patient

Too much fluid - pulmoary oedema animal drown

Fluid giving set

Not vol of drip

Varies according to set

20 drops /ml

Slow run through

Eliminate bubbles

Stop when ready to attach catheter

Intravenous Catheterisation

Clip area

Insert catheter + needle to half its length

Hold needle hub

Fluid should drip from needle hub

Push catheter over needle into vein up to hub

Withdraw needle

Never pull catheter back over needle!

Needle can sever the catheter into vein

If necessary withdraw both together

New catheter

Hold catheter in place

Tape catheter in place

Flush catheter checking that its still in vein

Attach giving set + start fluids running