CPR and Its Goal
The most essential emergency care in veterinary practice is immediate cardiopulmonary resuscitation (CPR). The process is required when the animal’s heart stops beating, further stopping blood flow (Dazio et al., 2022). The process involves rapidly compressing the animal’s chest to and fro until it starts breathing again. Therefore, CPR can be defined as an immediate treatment of chest compressions required to restore breathing and blood flow in a life-threatening condition. CPR’s ultimate goal is to restore oxygenated blood flow to the heart and brain.
Recognition of CPR
There are four steps followed in performing CPR in a veterinary clinic. The four steps, mainly focusing on a Labrador retriever, include recognition of CPR, chest compressions, ventilation, and airway management (Dazio et al., 2022). Looking at how the steps are performed, recognition of CPR involves assessing the dog to determine whether it is unresponsive and has stopped breathing. Hence, the veterinarian checks whether the dog is unconscious, gasping, or not breathing to determine whether CPR is needed.
Chest Compressions
The second step involves chest compressions, which should be performed when the dog is lying on its side, as a Labrador retriever is a medium to large breed. This position is referred to as lateral recumbent. The veterinarian then compresses the dog’s chest at 120 compressions per minute (Dazio et al., 2022). One hand is placed on the widest part of the dog’s chest, and the second hand is placed on top of the first hand.
Notably, the compressions should be challenging, aided by the shoulder being directly above the hands. The chest compression process should take place in cycles of 2 minutes each. The compression force should stem from the veterinarian’s chest, and he should not compress the animal too profoundly. Also, the compressions should not be switched out at any point.
Ventilation
The third step of CPR is ventilation. Ventilation is administered simultaneously with the chest compressions. This can be achieved using a cuffed endotracheal tube, which is placed at the outset of the chest compression process (Dazio et al., 2022). This step helps deliver oxygen to the lungs. This means that the oxygen can come from the ventilated room air or the hospital oxygen store.
Ventilation should be delivered at 15 breaths per minute or with every 30 chest compressions (Dazio et al., 2022). It is also essential for the veterinarian to observe the patient’s chest wall movement during ventilation. However, a mouth-to-nose ventilation measure is taken if an endotracheal tube takes too long in an emergency. In doing so, the dog’s mouth is closed, and then the veterinarian places his mouth on the dog’s nose (Dazio et al., 2022). He then exhales into the dog’s nose until its chest enlarges. Notably, the breaths are administered at 20 breaths per minute during intubation.
Airway Management
The last step, airway management, entails gently and slowly pulling the dog’s neck forward or upward to open its airway (Dazio et al., 2022). This will increase the chances of oxygenation, hence the dog’s survival. The veterinarian must know the efficacy of their CPR efforts. This can be achieved by assessing the patient for signs of circulation and breathing. For example, checking the pulse rate and chest movement are the primary ways to monitor efficacy. The pulse rate should return to normal to indicate circulation, and the chest should start moving up and down to show signs of breathing.
If CPR is unsuccessful, the patient will show signs of respiratory distress, such as gasping for air or breathing stopping. It is also common for the patient to have no pulse or heartbeat in an unsuccessful CPR. This is when advanced CPR comes in.
Advanced CPR consists of a Basic Life Support (BLS) process in an emergency. The patient is put under emergency drug therapy, where alternative drugs are administered. For instance, electrolytes can be delivered directly via electrocardiogram (ECG) drugs. Emergency drugs are often effective because they are administered in concentrated doses and travel through the heart more quickly.
Emergency Crash Cart
An emergency crash cart assists the veterinarian in performing CPR. It contains the necessary equipment used in emergency care. As such, an emergency crash cart is a collection of hospital equipment or medications stored on shelves, trays, or drawers that can be used to save a life in an emergency quickly (Jamil et al., 2021). Some equipment or medications in an emergency crash cart include oxygen masks, nasal airways, IV fluids, a laryngoscope, and Advanced Cardiac Life Support (ACLS) drugs (Jamil et al., 2021). For dog CPR, items from an emergency crash cart include nasal airways, oxygen masks, and a laryngoscope to manage the airway, deliver oxygen, and monitor chest movements, respectively.
A crash cart must be set up according to the needs of the different drawers. The first drawer contains emergency drugs, further divided into compartments to separate the most commonly used ones. These emergency drugs include amiodarone and epinephrine as cardiac arrest drugs; adenosine, atropine, and diltiazem as heart medications; methylprednisolone and diphenhydramine as allergy drugs; and pain medication such as aspirin and nitroglycerin spray.
Drawer 2 should contain IV fluids clearly labeled. The 3rd drawer contains intravenous supplies, including tubes, wipes, IV catheters, and syringes. The 4th drawer consists of large equipment, such as respiratory equipment and intubation supplies.
Lastly, the 5th drawer is the largest, containing procedure equipment such as trays, chest tubes, central venous catheters, and delivery kits. The crash cart will be maintained by labeling all contents and attaching the laminated label to the front of the cart. The cart will also be supported through regular checks to ensure drugs have not expired and equipment is not distorted. Used and expired items must also be replaced and restocked.
References
Dazio, V. E., Gay, J. M., & Hoehne, S. N. (2022). Cardiopulmonary resuscitation outcomes of dogs and cats at a veterinary teaching hospital before and after publication of the Recover Guidelines. Journal of Small Animal Practice, 64(4), 270–279.
Jamil, M., Congenie, K., Bartjen, L., & Hoffman, P. (2021). Standardizing crash carts using collaborative design methods and usability testing. Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care, 10(1), 229–232.