Page 470 - WSAVA2018
P. 470

 25-28 September, 2018 | Singapore
Personnel factors include high-level team member training, specific leadership training, and appropriate intervals of retraining and debriefing. Improved outcomes require consistent improvement in resuscitation education and the implementation of support systems to allow the streamlined delivery of CPR in the clinic setting. Above all else the Veterinary team should practice CPR in their clinic on a regular basis at least every 3 – 6 months so everyone knows what their role is and the techniques that will be used. This is simple to achieve by using a stuffed toy dog, cat or even teddy bear!
Crash Cart
An emergency box or “crash cart” is a vital part of emergency procedures as it contains all the vital equipment and drugs required to deal with an emergency in the one location. The emergency box can be as simple as a large tool box with the basic necessary items or a large storage cart on wheels with multiple draws. The emergency box should be located in the treatment area or surgery of the clinic and divided into sections of similar equipment.
On top of the cart would be all resuscitation equipment such as an Ambu bag, Pulse Oxmeter, oxygen supply, suction unit and ECG unit. The top draw could contain airway equipment such as Laryngoscope, endotracheal tubes, stylets, tracheostomy tubes, lubricating jelly, ties and swabs. The second draw could contain circulation equipment such as Intravenous catheters, tape, tourniquet, feeding tubes, swabs and fluids. The bottom draw could contain emergency drugs, syringes and needles. Carts may be divided into further sections with more drawers if available and to the specifications of the Veterinarians in the veterinary clinic.
Equipment and usage · Ambu Bag
An Ambu bag is a self-inflating device that is used to provide artificial ventilation to the patient. An oxygen source is connected to the bag and the bag then attached to the endotracheal tube. Ambu bags are preferable to using an anaesthetic machine for assisted ventilations as there could be residual anaesthetic gases in the machine and the circuit must be closed. Using an Ambu bag also creates a shorter distance for the oxygen to travel to the patient.
· Oxygen Supply
100% oxygen is ideally required for assisted ventilations. This may be via an anaesthetic machine or from a direct oxygen source (such as an Ambu bag) with a flowmeter attached.
· Pulse Oximeter
A Pulse Oximeter is a vital piece of equipment in monitoring the percentage of arterial haemoglobin- oxygen saturation. This is important in assessing the need for supplemental oxygen and also when it is no longer required. It consists of an infrared sensor placed on the tongue, lip or paw to obtain a reading. Normal values are between 98 – 100%
· Electocardiogram (ECG)
An ECG may be used in advanced life support after basic life support has been established. An ECG shows the heart rate and rhythm and the presence of arrhythmias that may have developed and therefore appropriate therapy can be administered. Ventricular fibrillation is the most common arrhythmia and an Electrical Defibrillator if available may be used to help stimulate and regulate the electrical activity in the heart.
· Suction Unit
A suction unit may be used to clear the airway of fluids and debris which may include mucous, blood, vomit or saliva and hence aid in endotracheal intubation.
Other Equipment
Endotracheal Tubes, Stylets, Swabs & Ties, Lubricating jelly, IV Catheters, loaded syringes e.g saline, feeding tubes or urinary catheters, tracheostomy tubes, chest drains and 3 way stopcock taps, bandage material and tape, gloves, syringes and needles.
· Fluids
Fluid therapy is the primary method of circulatory support in the emergency patient. The goal of fluid therapy is
to restore circulating volume, perfusion and oxygen to the tissues to a desired level (e.g. normal heart rate, mucous membrane colour and capillary refill time) without causing a volume overload. A volume overload could lead to pulmonary and cerebral oedema. The correct type of fluid and the rate of administration will depend on the patient’s condition. Crystalloid fluids are isotonic fluids (being of equal osmotic strength) that
pass readily through cell membranes. These fluids will help to balance out between the Extracellular space and Intracellular space. Hartman’s and 0.9% Sodium Chloride are crystalloids and are given where there is a need to replace the extracellular fluid and for volume expansion. They are inexpensive and easily available. A downside to crystalloids however is that they do not remain in the vascular space for very long.
Colloids are also isotonic fluids but they contain higher molecular weight particles that will remain intravascular for a longer period of time. Therefore the volume of fluid required will be less. Examples of colloids are Voluven and 5% Dextrose. Hypertonic saline draws fluid from the

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