CPR Guidelines
Posted: Tuesday, January 4th, 2022 | Updated: Tuesday, January 25th 2022
Posted: Tuesday, January 4th, 2022 | Updated: Tuesday, January 25th 2022
Assess for Pulse or Heart Beat
If no pulse or heart beat, start compressions at 2 per second. Small breed dogs and cats may have compressions performed directly over the heart. Keel chested dog breeds may benefit with support from a towel placed beneath their chest to facilitate compressions over the heart. Large dog breeds should have compressions performed over the widest portion of their chest. This is the thoracic pump method. Barrel chested dog breeds, such as the English Bulldog, may benefit from laying dorsally while compressions are being done over the heart
Proceed to Intubation If Not Breathing
Check for patency of the tube once placed. Make sure the tube is tied, extends down to approximately the thoracic inlet, and the cuff is inflated appropriately. Ventilate the patient by giving 1 breath every 6 seconds. Provide oxygen therapy at a rate of 150 ml/kg/min
Place an Intravenous Catheter and Prepare to Administer Emergency Drugs
Atropine, Epinephrine, Lidocaine, Calcium Gluconate, and Sodium Bicarbonate should all be in your crash box. You may need to have filter straws to draw up some drugs stored in glass ampules. Atropine and Norepinephrine are used most frequently. If IV access or IO access is unable to be obtained, drugs may be delivered down the endotracheal tube via a red rubber catheter so long as they are flushed adequately with a crystalloid fluid afterward in order to reach the heart. Often times, the drug may be drawn up or flushed with at least 5 ml of sterile 0.9% NaCl
Attach a Capnograph to the Endotracheal Tube
End tidal CO2 values >15 mmHg indicate that the compressions are effective and are providing reasonable circulation
Attach an ECG Monitoring Device
Pause compressions every 2 minutes or so to check for any sign of a pulse or heart beat. If there is no heart beat or pulse continue CPR. Ventricular arrhythmias, such as ventricular fibrillation, may need to be addressed with defibrillation or lidocaine. Be careful to avoid the use of alcohol when defibrillating a patient. Also, make sure everyone stands clear of the table and/or the patient when the shock is being delivered. Defibrillator gel is placed on the device pads to ensure proper contact for delivery of the shock to the patient
After Successful Return of a Heart Beat
Blood pressure may be maintained with positive inotropic agents like dobutamine. Urine output of 1-2 ml/kg/hr should be witnessed. If urine output is decreased, a low-dose dopamine cri may be provided in an attempt to dilate the renal vessels and improve renal perfusion. Should cerebral edema occur due to reperfusion and cellular hypoxia, mannitol and furosemide may be considered. Once the patient is able to be extubated, provide oxygen at a rate of 50 to 100 ml/kg/min
If no pulse or heart beat, start compressions at 2 per second. Small breed dogs and cats may have compressions performed directly over the heart. Keel chested dog breeds may benefit with support from a towel placed beneath their chest to facilitate compressions over the heart. Large dog breeds should have compressions performed over the widest portion of their chest. This is the thoracic pump method. Barrel chested dog breeds, such as the English Bulldog, may benefit from laying dorsally while compressions are being done over the heart
Proceed to Intubation If Not Breathing
Check for patency of the tube once placed. Make sure the tube is tied, extends down to approximately the thoracic inlet, and the cuff is inflated appropriately. Ventilate the patient by giving 1 breath every 6 seconds. Provide oxygen therapy at a rate of 150 ml/kg/min
Place an Intravenous Catheter and Prepare to Administer Emergency Drugs
Atropine, Epinephrine, Lidocaine, Calcium Gluconate, and Sodium Bicarbonate should all be in your crash box. You may need to have filter straws to draw up some drugs stored in glass ampules. Atropine and Norepinephrine are used most frequently. If IV access or IO access is unable to be obtained, drugs may be delivered down the endotracheal tube via a red rubber catheter so long as they are flushed adequately with a crystalloid fluid afterward in order to reach the heart. Often times, the drug may be drawn up or flushed with at least 5 ml of sterile 0.9% NaCl
Attach a Capnograph to the Endotracheal Tube
End tidal CO2 values >15 mmHg indicate that the compressions are effective and are providing reasonable circulation
Attach an ECG Monitoring Device
Pause compressions every 2 minutes or so to check for any sign of a pulse or heart beat. If there is no heart beat or pulse continue CPR. Ventricular arrhythmias, such as ventricular fibrillation, may need to be addressed with defibrillation or lidocaine. Be careful to avoid the use of alcohol when defibrillating a patient. Also, make sure everyone stands clear of the table and/or the patient when the shock is being delivered. Defibrillator gel is placed on the device pads to ensure proper contact for delivery of the shock to the patient
After Successful Return of a Heart Beat
Blood pressure may be maintained with positive inotropic agents like dobutamine. Urine output of 1-2 ml/kg/hr should be witnessed. If urine output is decreased, a low-dose dopamine cri may be provided in an attempt to dilate the renal vessels and improve renal perfusion. Should cerebral edema occur due to reperfusion and cellular hypoxia, mannitol and furosemide may be considered. Once the patient is able to be extubated, provide oxygen at a rate of 50 to 100 ml/kg/min
Sources:
Ford, Richard B., and Elisa M. Mazzaferro. Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment. 8th ed., Saunders Elsevier, 2006.
Poli, Gerardo. MiniVet Guide: Companion Animal Medicine. InHouse Publishing, 2016.
Ford, Richard B., and Elisa M. Mazzaferro. Kirk and Bistner's Handbook of Veterinary Procedures and Emergency Treatment. 8th ed., Saunders Elsevier, 2006.
Poli, Gerardo. MiniVet Guide: Companion Animal Medicine. InHouse Publishing, 2016.