Page 541 - WSAVA2018
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WSV18-0075
NURSES (HILLS)
THE INS AND OUTS OF ANESTHETIC MONITORING FOR OPTIMUM PATIENT OUTCOMES
J. Hatcher1
1Provet AIRC, Airc, Brisbane, Australia
CARDIOPULMONARY RESSUCITATION PRACTICAL FOR NURSES
Jo Hatcher Cert IV VN, TAE, Dip VN, AVN
Brisbane Australia, jhatcher@provet.com.au
When to Resuscitate
Many factors need to be considered when deciding if to proceed with resuscitation of the patient depending on the patient’s condition, financial concerns, post CPR care etc.
• What is the potential outcome of CPR? – does the patient have such extensive injuries that chance of full recovery from them is already compromised?
• What have you agreed with the owner – we must honour their decisions, whether we feel they are correct or not.
• Does the patient have a treatable disease? – if we resusitate the patient – can we treat / cure the underlying disease / problem?
• Is the patient in the terminal stages of an incurable disease? – e.g. cancer, renal failure etc
• We must consider if we will be able to restore a near- normal mentation.
• When did the arrest occur – have we suffered brain damage due to prolonged hypoxia etc. we can get a heart back but we cannot resolve brain damage from hypoxia.
Your clinic may have a classification system on when or not to resuscitate. As part of the Recover guidelines the following system was derived:
CRT: 1 – 2 seconds
Your Singapore, the Tropical Garden City
Order of Priority & Team Roles
The patient has arrived, a quick visual assessment has been completed and the patient is in a critical condition. What do you do now and in what order?
Firstly establish if the patient is in just pulmonary arrest (not breathing) or cardiopulmonary arrest (not breathing and no heartbeat).
Use the acronym CAB:
C – Circulation – No heartbeat, audible heartbeat or pulse then start compressions
A – Airway – Check for a patent airway and provide oxygen supplementation or intubate
B – Breathing – Start Intermittent Positive Pressure Ventilation
Circulation is the most important priority when starting CPR. It has been shown that there will be potentially enough residual oxygen in the body for up to 3 minutes post arrest but in a cardiac arrest that oxygen is not going anywhere so we need to start compressions immediately to help with circulation. Then ensure
a patent airway and intubate to provide oxygen supplementation or start Intermittent Positive Pressure Ventilation (IPPV). Compressions should NEVER be stopped for intubation.
If you are in the unfortunate circumstance of being the first responder to a patient in cardiac arrest and do not have any assistance the first priority is to start chest compressions. If after 3 minutes you are still the only responder then stop compressions to intubate and breathe for the patient in between compressions. 2 breaths to every 30 compressions.
All staff available in the hospital should assist with CPR. Often I have seen Vets or Nurses come in to the room
and see ventilation and compressions occurring and someone getting drugs and they think there is nothing
for them to do. Even if you aren’t taking an active role in performing CPR, recording all the actions taken such as start time of CPR and timing the 2 minute cycles along with all observations and drugs administered is very important. Roles that each team member can perform are:
Compressions – This is performed in 2 minute cycles. It is important that this person swaps out this role to another team member after each cycle as performing compressions is tiring and compressions will not be effective after this time.
Airway and ventilation – This person could swap with the team member performing compressions and vice versa.
Circulation - Placing an IV Catheter and collecting and administering drugs and fluids
Monitoring - Attaching monitoring equipment and
  Class Risk/Benefit Ratio
1 High Benefit, low risk
2 Medium benefit, medium risk
3 Benefit and risk equal
4 High risk, low benefit
Vital Signs
Recommendation
Should be performed Reasonable to perform May be considered
Should not be performed
Vital signs are, as they are called “vital” in assessing a patient’s condition and status. All staff must know the normal ranges for the species they are treating.
Heart rate: Pulse: Respiration rate: Sp02:
ETC02: Temperature: Mucous Membranes:
Dog
80 – 140 bpm Strong & rhythmic 10 – 30 bpm
98 – 100%
35 – 45 mm Hg 37.5 – 38.5C
Pink & Moist
Cat
110 – 180 bpm Strong & rythmic 15 – 40 bpm
98 – 100%
35 – 45 mm H 38 – 38.5C Pink & Moist
1 – 2 seconds
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