1) RECOMMENDATIONS
a) General Approach
i) Cardiac arrest is characterized by an absence of auscultable heart
beat, no palpable pulse, cyanotic or grey mucous membranes, dilated
pupils, and an absence of spontaneous respiration
ii) Recovery from a true cardiac arrest is difficult
iii) Having an emergency drug sheet prepared in advance
based upon patient species and weight is a key, potentially life saving,
measure (see links below for free emergency drug
calculator)
b) Compensatory Steps
i) A = ESTABLISH AN
AIRWAY VIA ENDOTRACHEAL INTUBATION
ii) B= BREATH/VENTILATE
PATIENT AT 5 BREATHS PER MINUTE
(1) Ventilate to 15 to 20 cm H2O
(2) Tidal volume estimated @ 10 ml/kg (5 ml/lb)
(3) Hyperventilate if overdose of gas anesthetic is suspected
iii) C = CARDIAC
COMPRESSIONS AT 80 TO 100 PER MINUTE
(1) External thoracic compression
(a) Thoracic Pump – square wave pattern compressions with slight
hesitation at top and bottom
(2) If ineffective after 2 minutes, go to internal compression
(a) Some promote immediate internal compression of verified arrest
(b) Enter chest at 4th –5th rib space on left
side
iv) D = DRUG THERAPY - USE LARGE VOLUMES OF FLUSH IF USING PERIPHERAL VEIN
(1) Epinephrine (1:1000) @ 1cc/10 kg (20 lb) IV
(2) Atropine @ 1cc/10 kg (20 lb) IV
(3) Fluids IV
(a) Dogs @ 20 ml/kg/hr (40 ml/lb/hr)
(b) Cats @ 10 ml/kg/hr (20 ml/lb/hr)
(4) Sodium bicarbonate
(a) Not acidotic for 10 – 12 minutes after arrest
(b) After 10 – 12 minutes post arrest, give 2 meq/kg (1 meq/lb) IV
(5) Defibrillation
(a) Potassium Chloride @ 3.5 to 7.5 meq/kg (7 to 15 meq/lb) followed by
10% Calcium Chloride @ 1 ml/10 kg (1 ml/20 lb)
c) Newer Thoughts
i) Recovery may be enhanced by:
(1) Moderate hypothermia to 930 to 940 F
(a) Ice packs around head and neck
(2) Moderate hypertension – SAP of 200 mm Hg
(a) Norepinephrine may be required
(3) Moderate hemodilution – Reduce PCV to 30%
(a) Dextran-40 is one recommended option
(i) 10% in isotonic saline
(ii) Maximum of 20 ml/kg (10 ml/lb)
(4) Maintain ETCO2 at 30 mm Hg |
