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Cardiopulmonary resuscitation

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Abstract

Cardiopulmonary resuscitation (CPR) continues to command a great deal of interest. Evidence suggests that cardiac arrest could be survivable for a considerably higher proportion of veterinary patients. This chapter provides the most important principles and guidelines on small animal CPR; covering preventative measures, preparedness measures, recognition of cardiopulmonary arrest and initiation of cardiopulmonary resuscitation, basic and advanced life support, post-cardiac arrest care and prognostication.

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Figures

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20.2 Crash cart, including defibrillator, drugs, endotracheal tubes of various sizes, syringes, needles and catheters, manual resuscitator (Ambu) bags, and surgical sets for thoracotomy and surgical haemostasis.
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20.4 Cardiopulmonary resuscitation (CPR) algorithm. Basic life support (BLS) is started immediately after recognition of cardiopulmonary arrest (CPA), continued throughout the resuscitation effort and only interrupted every 2 minutes for short patient evaluations (electrocardiogram (ECG) and pulse). Advanced life support (ALS) measures occur whilst BLS is ongoing. C:V = compression:ventilation; ETCO = end-tidal carbon dioxide; PEA = pulseless electrical activity; ROSC = return of spontaneous circulation; VF = ventricular fibrillation; VT = ventricular tachycardia.
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20.5 Hand position in a cat or small dog. One hand stabilizes the back while the other, stronger hand reaches around the sternum to compress the ventral aspect of the thorax between the thumb and opposing digits.
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20.6 Hand position in a round-chested dog. Chest compressions occur over the widest part of the chest.
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20.7 Hand position in a keel-chested dog. Chest compressions occur over the heart.
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20.8 Hand position in a flat-chested dog. The animal is positioned in dorsal recumbency with chest compressions occurring over the sternum.
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20.9 Posture of rescuer for delivery of chest compressions. The shoulders are positioned vertically over the compression site, the elbows are locked and force is transmitted to the chest via the heels of the hands. Compression force is generated by the core musculature and not the arms.
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20.10 Cardiac rhythms commonly identified during cardiopulmonary arrest. (a) Severe bradycardia: very slow heart rate (<30–40 bpm) in conjunction with loss of consciousness and respiratory arrest or agonal breathing, and a palpable pulse. (b) Pulseless electrical activity: slow heart rate in conjunction with loss of consciousness and respiratory arrest or agonal breathing, but without a palpable pulse. (c) Asystole: complete absence of electrical activity. (d) Pulseless ventricular tachycardia: rhythm with repeating complexes of variable regularity and typically very high rate (>250 bpm) in conjunction with loss of consciousness, apnoea or agonal breathing and no palpable pulse. (e) Ventricular fibrillation: chaotic rhythm at a high rate. May occur as coarse (high amplitude) or fine (low amplitude) ventricular fibrillation.
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20.13 (a) Defibrillator paddle position in dorsal recumbency. (b) Anterior–posterior paddle assembly. A flat paddle can be placed underneath the patient, allowing defibrillation in lateral recumbency.

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