CPR Protocol

Re: CPR Protocol

Rebecca MacMillan — Thu, 11 Jul 2013 17:57:48 GMT

Thanks Jane, that's great!

Re: CPR Protocol

Michael Woodhouse — Tue, 09 Jul 2013 18:43:05 GMT

[quote user="Hanna Bennett"]because you aerosolise bacteria and dirt? [/quote]

I'm not even slightly convinced. I can see that using a vacuum cleaner MAY cause some extra material in the air but unless you have full blown positive pressure ventilation that will move through into theatre anyway! We usually have the vacuum and clippers going at the same time.

IF we were having problems (and many, many other vets) were then I would concede.

Re: CPR Protocol

Hanna Bennett — Tue, 09 Jul 2013 18:35:12 GMT

because you aerosolise bacteria and dirt? my nurses could answer that far better than I can. would you want to be operated on in a room that was used for other things? I know we are now lucky to be in a purpose built building but we used to be in a similar type building so I know how it works, but you can find a way.

Re: CPR Protocol

Michael Woodhouse — Tue, 09 Jul 2013 18:28:40 GMT

[quote user="Hanna Bennett"]do the standards not require a separate prep room? if not then they should do - how can you guarantee sterility if you clip and prep in the same room you operate in[/quote]

We clip on the same table we operate. Vacuum loose hair. How is it magically cleaner clipping in another room? So long as you clean up properly?

We are in an old narrow building. One day we will move somewhere bigger but we are stuck with what we have. You have to walk through theatre to get to our office. We use the table for blood samples and various other things. Said in the other thread that I cannot remember the last post op wound infection.

Re: CPR Protocol

jd2008 — Tue, 09 Jul 2013 18:14:45 GMT

Hi Rebecca, You should find most of the info you need here : http://acvecc-recover.org/ Cheers, Jane

Re: CPR Protocol

Hanna Bennett — Tue, 09 Jul 2013 17:56:28 GMT

[quote user="Sarah Keir"]

[quote user="Niall Taylor"]

[quote user="Sarah Keir"]Unfortunately after our last RCVS Tier 2 inspection the endotracheal tubes that used to be on the wall of the operating theatre had to be moved to outside (theroetically the 'prep' room).[/quote]

Did they tell you where in the regulations this was a requirement - can't find it in ours.

Niall

[/quote]

I'm not involved in this aspect of practice so can't say where in the regulations this is mentioned but after the inspection, we were told that ET tubes where not to be kept ON THE WALL in theatre. They are to be in the prep room where animal are 'supposed' to be anaesthetised and clipped before moving to the other end of the corridor to theatre! My feeling is they can't pass you without finding something that needs 'fixing'

[/quote]

do the standards not require a separate prep room? if not then they should do - how can you guarantee sterility if you clip and prep in the same room you operate in - even when we were tier 2 we had a small separate prep/induction room where et tubes lived

Re: CPR Protocol

Hanna Bennett — Tue, 09 Jul 2013 17:53:36 GMT

[quote user="Michael Woodhouse"]

[quote user="Evelyn Barbour-Hill"]

Something there ought to be in a "Crash Box" (why the melodramatic name?) is a reserved complete set of endotracheal tubes (and it should be a disciplinary offence to "borrow" one). Everyone got that?

[/quote]

No. The tubes are on the wall in the operating room hanging in size order. I can select from there faster than I can sort through them in a box. I wouldn't do CPR anywhere else in the practice.

[/quote]

what happens when the 50kg Dogue de Bordeaux crashes five minutes after going back into its kennel post anaesthetic? got that one back...

Re: CPR Protocol

Rebecca MacMillan — Tue, 09 Jul 2013 17:36:16 GMT

I know this is an old topic but I'm getting so confused at the moment! I've just started working at a newly opened practice and we don't yet have any drug doses/protocols for emergencies. I'm getting bogged down with different doses in the formulary and emergency textbooks and don't know which to go with!

Can anyone point me in the best direction? Maybe some examples of doses that people have on their laminated sheets?

Maybe I'm overthinking it - in my last job we just had a sheet on the wall saying 'adrenaline can be given IV or down the trachea = Dogs 0.5ml - 1ml repeatedly and cats 0.25-0.5ml' and 'Lignocaine = 5ml boluses to convert fibrillation'. I know that by following those vague guidelines I managed to bring a very elderly scottie back to life when he crashed at the end of a horrendous dental (death gasps and no heartbeat) and he lived for another year.... (not that he ever thanked me, grumpy thing...)

Re: CPR Protocol

Rebecca MacMillan — Tue, 09 Jul 2013 17:36:10 GMT

Can anyone point me in the best direction? Maybe some examples of doses that people have on their laminated sheets?

Re: CPR Protocol

Sarah Keir — Wed, 30 May 2012 14:52:37 GMT

[quote user="Niall Taylor"]

Did they tell you where in the regulations this was a requirement - can't find it in ours.

Niall

[/quote]

Re: CPR Protocol

Evelyn Barbour-Hill — Tue, 29 May 2012 23:52:52 GMT

[quote user="Rajat"]Do it as best as you can, and probably not as well (IMHO) as you could have, had you had more staff[/quote]

Ah, of how many things one could say that........................

Re: CPR Protocol

Rajat — Tue, 29 May 2012 19:22:23 GMT

[quote user="Evelyn Barbour-Hill"]So, whaddya do if y'ent got four people?[/quote]

Do it as best as you can, and probably not as well (IMHO) as you could have, had you had more staff. No one has 4 members of staff around at night in GP, I bet many referral institutions don't either.

Re: CPR Protocol

bob lehner — Tue, 29 May 2012 19:07:21 GMT

PSS Manual para 5.6 - in the yellow bit rhs.

Re: CPR Protocol

Niall Taylor — Tue, 29 May 2012 16:53:05 GMT

Did they tell you where in the regulations this was a requirement - can't find it in ours.

Niall

Re: CPR Protocol

Evelyn Barbour-Hill — Tue, 29 May 2012 15:01:41 GMT

[quote user="Rajat"] I find it really tough to run a crash with less than 4 people -[/quote]

So, whaddya do if y'ent got four people?

Re: CPR Protocol

Rajat — Tue, 29 May 2012 08:35:38 GMT

Given recent changes in human guidelines I wouldn't be surprised if the veterinary guidelines also changed to reflect the greater importance of cardiac compressions over breathing. While we should secure an airway it seems more and more that the most important thing is to continue compressions un-interrupted and to give them a priority over breathing. I find it really tough to run a crash with less than 4 people -

1. compressions

2. breathing

3. assisting- getting drugs pulled up, hooking up ECG machine

4.The 'Lead' Checking for femoral pulses, trying for IV /IO access if not already obtained and keeping an eye on time and determining timing of drugs and further interventions i..e open cardiac massage.

Evelyn's suggestion of ET tubes is very good -I reckon one only needs a small selection of sizes. Luckily our ET tubes are not far away at all and we have a few complete sets so easy to reach at all times.

Raj

Re: CPR Protocol

Rajat — Tue, 29 May 2012 08:23:59 GMT

Alex - I reckon it is useful only if there is reduced ventilatory drive/damage to the respiratory centre in the brain. . Also neonates who are intubated and ventilated who aren't breathing yet on their own say e.g. resp depression from drugs given to the mom -admittedly its rare a breeder wants us to go to that trouble but there is the odd one who will. I once had almost an entire litter of bulldog puppies intubated as none wanted to breathe.! After an hour, 3 out of 8 made it. We used dopram when it became clear they weren't going to breathe on their own (apart from one where the nurse gave it without checking, that one got intubated super quick!!)

Similarly used it on a cat who developed respiratory arrest following aspiration and hypoxemia - suspected damage to resp centre in brain.

Re: CPR Protocol

Evelyn Barbour-Hill — Mon, 28 May 2012 19:16:45 GMT

[quote user="Sarah Keir"]

[quote user="Michael Woodhouse"]

No. The tubes are on the wall in the operating room hanging in size order. I can select from there faster than I can sort through them in a box. I wouldn't do CPR anywhere else in the practice.

[/quote]

Unfortunately after our last RCVS Tier 2 inspection the endotracheal tubes that used to be on the wall of the operating theatre had to be moved to outside (theroetically the 'prep' room). Bit of a pain in the a** !!!!!!!!!

Sarah

[/quote]

Inspection over, move 'em back again?

Re: CPR Protocol

Sarah Keir — Mon, 28 May 2012 16:15:27 GMT

[quote user="Michael Woodhouse"]

No. The tubes are on the wall in the operating room hanging in size order. I can select from there faster than I can sort through them in a box. I wouldn't do CPR anywhere else in the practice.

[/quote]

Sarah

Re: CPR Protocol

Mark Holmes — Mon, 28 May 2012 10:23:50 GMT

I once managed an open cardiac massage through the diaphragm, dog (labrador) crashed mid caesar and due to position and size external massage was completely hopeless. Got the dog stabalised, closed diaphragm closed caesar and the dog recovered. Unfortunately about an hour later it was clear dog not doing so good and we found a haemothorax. 500ml of packed cells and 500ml of blood later dog went home with 13 pups. Very luckily the owner was visiting when the bleed became clear and had the dog's brother in the car otherwise I don't think we wounld have managed to get blood quick enough.

Re: CPR Protocol

Martin Atkinson — Mon, 28 May 2012 09:42:36 GMT

[quote user="Evelyn Barbour-Hill"]Open heart massage is often unsuccessful but occasionally successful. Naturally we all hesitate to do it........ and that's one reason why it might be unsuccessful. If you start too late, it's certainly going to be NBG. On the other hand if you start too early, it might have been unnecessary. Tricky one, eh? I haven't had to consider it for some years, fortunately, but I'd plunge in any time if it looked necessary. Preparation? At the most, run the clippers once over the site and pour some Hibitane over the site and your hand.[/quote] I've only ever performed open heart massage once, on a 12 month Doberman in for routine castration, exactly the technique Evelyn promotes. I think we made the decision to go for it after one minute of failed external CPR and intra-cardiac adrenaline. It took all of another minute to get in there and start the heart (took a lot longer to sew it up!) dog was fine, antibiotics post op, no infections. I think another reason why we don't perform this very often is that the majority of cases are poor risk to start with and it may be considered it isn't worth reviving them as they probably won't be around much longer afterwards anyway.

Re: CPR Protocol

Alex Gough — Mon, 28 May 2012 09:18:42 GMT

Why would you need Dopram if you can intubate?

Re: CPR Protocol

Glen McIntosh — Mon, 28 May 2012 02:39:31 GMT

A review of this whole topic will be published in June:

http://veterinarynews.dvm360.com/dvm/Veterinary+news/Standardized-CPR-guidelines-developed-for-dogs-and/ArticleStandard/Article/detail/775123?contextCategoryId=378

Re: CPR Protocol

Evelyn Barbour-Hill — Sun, 27 May 2012 22:43:49 GMT

[quote user="Iain McAllister"]

Protocol

This is a 3 Person Procedure

No.1 - breathing No.2 - chest compressions - swap this person every 2 mins No.3 - drugs

[/quote]

Whatcha gonna do if there aren't three persons handy?

Re: CPR Protocol

Michael Woodhouse — Sun, 27 May 2012 22:40:24 GMT

[quote user="Evelyn Barbour-Hill"]

[/quote]

No. The tubes are on the wall in the operating room hanging in size order. I can select from there faster than I can sort through them in a box. I wouldn't do CPR anywhere else in the practice.