home Endocrinology Cardiopulmonary resuscitation. Intensive therapy for acute exogenous poisoning. Further life support

Cardiopulmonary resuscitation. Intensive therapy for acute exogenous poisoning. Further life support

Resuscitation is a set of measures aimed at reviving an animal in a state of clinical death, allowing to restore the function of vital organs, the functioning of which was disrupted as a result of an accident, disease or its complications.

In resuscitation, the time factor plays a significant role - the success of treatment depends on how quickly a set of resuscitation measures is performed. That is why the effectiveness of resuscitation is largely influenced by professionalism. veterinarian, namely his ability to make decisions quickly. At the same time, even the most qualified specialist will not be able to help in any way without the appropriate equipment and tools. Therefore, in our clinic the resuscitation room is equipped with the highest quality and most effective equipment.

Resuscitation and intensive care

In veterinary medicine, as in medicine, resuscitation is directly related to intensive care. The fact is that after emerging from a state of clinical death, the functioning of all organs and systems of the body is extremely unstable. It needs constant monitoring and correction if necessary. Therefore, successful resuscitation cannot be an indication for discharge of a quadruple patient; he must remain in the hospital.

Emergency animal resuscitation on your own

Unfortunately, it is not always possible to deliver an animal to a resuscitation specialist as quickly as possible. In these cases, the owners of their pets need to know the basic principles of resuscitation.

Clearing the airways. To restore the animal’s breathing, it is necessary to open its mouth and extend its tongue forward. After examining the pharynx, you need to remove foreign objects, vomit or mucus blocking Airways. If the animal is not large, you can lift it by hind legs while supporting your head.

Artificial ventilation. If the chest is not damaged, breathing stimulation can be used by stretching and squeezing it. Due to such movements, the lungs suck in and then push out air. In case of injury, this technique is unacceptable and it is recommended to use artificial respiration"mouth to nose"

Restoration of blood circulation. To make sure the heart has stopped, you need to check the pulse for inside hips. If there is no heartbeat, you need to perform an indirect cardiac massage, which is performed as follows - put left hand on the animal's chest in the area of the heart, and then with the palm of your hand right hand press the left one five to ten times. Then take a few artificial breaths and check your pulse. If necessary, the massage should be continued.

After successful resuscitation, it is necessary to immediately deliver the animal to a specialist who can conduct a course of intensive therapy aimed at restoring all body functions.

Do you know what to do if your dog stops breathing and has no palpable pulse? If not, we highly recommend reading this article to the end.

It is necessary to start resuscitating the animal no later than 2-3 minutes from the moment of cardiac arrest

Every owner should know, at least theoretically, how to resuscitate a dog. Do you agree? This also applies to cat owners. After all, only the owner can save his pet in such emergency situation. Moreover, when the heart and breathing stop, minutes count. And only through cardiopulmonary resuscitation can brain function be preserved until blood circulation and breathing are restored.

So let's talk right now:

About the causes of cardiac arrest in a dog
how to quickly recognize that there is no pulse
how to do artificial respiration and indoor massage hearts to the dog
what to do after the animal starts breathing

Causes

The causes of cardiac arrest in dogs and cats can be very different. The most common are these:

Hit electric shock
large blood loss
concussion
anaphylactic shock
suffocation
drowning
poisoning
heart failure
foreign body in the respiratory tract
other reasons

How to understand that cardio is needed pulmonary resuscitation?

The first and main sign is a loss of consciousness. The absence or presence of heartbeat and breathing should be quickly checked.

To check your breathing, look for movement chest or bring a mirror, glasses or screen to the dog’s mouth mobile phone, if it is covered with protective glass. In a word, any mirror-glass surface that may be at hand. If the mirror is fogged up, then there is breathing.

You can check your dog's heartbeat by placing your ear against his chest. If heartbeats are not heard, immediately begin cardiac massage.

Begin resuscitation at the first suspicion of cardiac arrest. Don't waste time looking for a pulse. It won't do anything. Finding a weak pulse in a dog is not easy

Second sign - This is a pale mucous membrane that gradually acquires a bluish tint.

Third sign. It is necessary to direct a beam of light onto the pupil using a flashlight or mobile phone. If the pupil does not react at all, then the heart has stopped.

What to do and how to resuscitate a dog?

Immediately after losing consciousness, try hitting the left side of your chest with your palm. If this method does not help, immediately begin cardiac massage:

Step 1. Place your dog on his right side on a flat surface

Step 2. Align the neck position to create an air path.

Step 3. Quickly release your mouth from foreign objects. For example, silt or sand during drowning.

Step 4. Cup your dog's face with your hands so that the nostrils are open.

Step 5. Take a full lungful of air and blow it into your dog’s nose. Take 5-6 quick mouth-to-nose breaths. Small dogs and puppies need short, shallow breaths. Large ones - long and deep. Inhalation rate: 1 breath per 3 seconds. Or 20 breaths per minute.

Step 6. Place your hand on the dog's ribs behind his elbow and begin to apply rhythmic pressure - 1 time per second. The interval between pressures should not exceed 5 seconds. For most dog breeds, heart massage is performed on the widest part of the chest:

a) for dogs with a narrow chest, apply pressure closer to the armpits, that is, right above the heart (greyhounds, hounds)

b) dogs with a wide and powerful chest are placed on their back and pressure is applied from above, just like a person (English bulldogs)

c) for small dogs and cats, apply pressure to the chest by clasping it around with both hands

d) miniature dogs and puppies are pressed with one hand or finger

e) large dogs press with one hand on top of the other, just like a human

Step 7 Apply pressure in a ratio of 30:2, that is, 30 pressures and 2 breaths.

Step 8 Continue resuscitation of the dog for at least 10-15 minutes. If the dog shows signs of life, its mucous membranes turn pink and it begins to breathe, continue to resuscitate until it fully regains consciousness. This may take an hour or more because the heart may stop and beat again.

Step 9 When the heart is working steadily, call the veterinarian, because it is impossible to transport the animal in this condition. Or this will require a special car. At the same time, describe the situation in detail so that the doctor can come with all the necessary medications.

Step 10 Observe the dog's condition until the veterinarian arrives.

Acute respiratory failure (ARF) is a pathological condition in which arterialization of venous blood is not ensured or this is achieved by maximum tension of compensatory mechanisms. It can develop in pathological conditions that cause disruption, mainly, of pulmonary ventilation - ventilation ARF (rib fracture, obstruction of the tracheobronchial tree, ascites, etc.) or diffusion of O 2 and CO 2 through the alveolo-capillary membrane - parenchymal (diffusion) ARF (pneumonia , pulmonary edema, etc.). When these two mechanisms are combined, we speak of mixed type ARF (lung collapse, atelectasis due to obstruction of the tracheobronchial tree, etc.)

Clinically, acute respiratory failure is manifested primarily by a violation of the frequency, rhythm and depth of breathing:

1.Apnea(complete cessation of breathing). Observed in cardiac arrest, electrical trauma, acute exogenous, including drug poisoning, traumatic brain injury

2.Stenotic breathing - severe inspiratory (on inspiration) shortness of breath with the participation of all auxiliary respiratory muscles. Occurs with obstruction of the upper respiratory tract (foreign body, Quincke's edema, trauma, compression of the larynx)

3.Cheyne-Stokes respiration, Biota(rare, irregular periodic breathing). It is observed, as a rule, in the agonal stage, with lesions of the brain stem.

4.Bradypnea. Observed in case of poisoning (especially barbiturates, narcotic analgesics).

5. Tachypnea. It is observed with acidosis, fever, circulatory failure, and mental overexcitation.

With any manifestations of ARF, pronounced cyanosis of the mucous membranes is noted.

The principles of treatment of ARF are as follows:

1 Ensuring airway patency (stretching a sunken tongue, straightening the head, removing foreign bodies, tracheal intubation, tracheostomy).

2 Provision drainage function lungs (removal of mucus, foam from the tracheobronchial tree, stimulation of the cough reflex, bronchial lavage, oxygen humidification).

Oxygen therapy (through nasal catheters, creating a “head tent” - supplying oxygen to the enclosed space in which the head is located).

Artificial pulmonary ventilation (ALV). Indications for mechanical ventilation are:

respiratory arrest;
bradypnea and shallow breathing;
severe disturbances in breathing rhythm.

Treatment of certain types of one

1. Foreign bodies of the pharynx, larynx

In this case, a sharp cough, retching, drooling, foaming from the mouth, and anxiety are noted. If the animal’s condition allows, it is necessary, after premedication, to carry out anesthesia with barbiturates and carry out a complete inspection of the oropharynx - examine the glottis and proximal parts of the larynx. If a foreign body is detected, it must be removed. It should be remembered that a similar clinical picture can be observed in acute infectious laryngotracheitis, peripharyngeal or retropharyngeal abscess, and vocal cord abscess.

If the emergency of the situation does not allow full examination, it is necessary, first of all, to apply a tracheostomy, and after breathing has been restored, to carry out a thorough inspection of the upper respiratory tract and carry out the necessary therapeutic measures.

2. With increasing allergic swelling of the larynx, antihistamines and glucocorticosteroids are immediately administered and, if necessary, the animal is intubated. Intubation is performed under anesthesia (barbiturates, sodium hydroxybutyrate, xylazine, ketamine). The endotracheal tube sometimes needs to be left in place for a day or more. In such cases, it is necessary to take care of its secure fixation and protection from possible damage (biting). Sometimes they resort to prolonged medicinal sleep (sodium hydroxybutyrate) against the background of intensive antiallergic, decongestant and detoxification therapy.

If technical conditions allow, then in such situations it is better to resort to tracheostomy. This will greatly facilitate caring for the animal and allow it to eat in the usual way and will ensure reliable airway patency for a long period (until allergic swelling of the larynx resolves). In our clinic, we have repeatedly had the opportunity to verify the effectiveness of this operation for all types of upper respiratory tract obstruction.

3. Acute strangulation asphyxia (hanging).

Unfortunately, in our practice we have repeatedly encountered similar cases caused by various reasons (accidental hanging on a leash, deliberate actions of people).

When hanging, there is direct compression of the trachea, blood vessels and nerve trunks of the neck, which leads to a reflex cessation of breathing and collapse. Clinically, coma, convulsions, severe muscle hypertonicity are observed, sharp violation breathing - bradypnea.

When providing assistance to such an animal, it is necessary to immediately begin cardiopulmonary resuscitation. Tracheal intubation and mechanical ventilation are the first measures that the doctor should begin. The oxygen content in the inhaled gas mixture should be 50-100%.

Next (preferably via an intravenous catheter) the following is administered: 40% glucose solution at the rate of 2-4 ml per kg of weight with the appropriate amount of insulin; 20% sodium hydroxybutyrate - 0.3 ml/kg; 5% solution of ascorbic acid - up to 0.2 ml/kg; thiamine chloride - 0.1 ml/kg 5% solution; then, to correct acidosis, a 4% sodium bicarbonate solution is administered at a dose of 3-4 ml/kg. To prevent and treat cerebral edema, mannitol and Lasix are administered in therapeutic dosages. Then heparin is administered subcutaneously at a rate of 50-100 units/kg. Ventilation is stopped after restoration of spontaneous breathing. Subsequently, symptomatic therapy, intensive correction of metabolic disorders, and therapy aimed at restoring the functions of the central nervous system are carried out.

4. Acute pulmonary edema develops with left ventricular failure, toxic damage, traumatic pulmonitis (fall from a height, sudden compression of the chest, auto injuries, burn of the upper respiratory tract with hot air, steam, with excessive infusion therapy, especially with pneumonia or in the presence of cardiac pathology) .

When diagnosing acute edema lungs, 0.1-0.5 ml of 0.06% corglycone is slowly injected intravenously in 5 ml of a 20% glucose solution, 1-4 ml of a 2.4% solution of aminophylline, diluted in the same amount of 20% glucose solution; 1-2 ml of Lasix. If necessary, the administration of Lasnx is repeated after 30-40 minutes. 30-60 mg of prednisolone is administered intravenously or intramuscularly, regardless of body weight. Then inhalation is carried out with oxygen passed through 96% alcohol. If ineffective - intravenous drip (So slow!) 30% alcohol is introduced (as an antifoam). It should be remembered that if pulmonary edema has developed, any, even slight, excess fluid administration can lead to death.

The lack of effect from conservative therapy is an indication for mechanical ventilation with a mixture of air with an oxygen content of 70-90% with a frequency of respiratory cycles of up to 20 per minute and a tidal volume of up to 3/4 of normal.

5. Bilateral severe pneumonia.

In severe double pneumonia, regardless of its etiology, the respiratory surface of the lungs is significantly reduced, which causes severe respiratory failure. Thus, damage to more than 50% of the pulmonary parenchyma is a serious threat to life.

The basic principles of intensive care include massive antibacterial treatment in the fight against pulmonary respiratory failure.

Treatment of pulmonary insufficiency is based on lavage of the tracheobronchial tree by introducing proteolytic, mucolytic agents through a catheter located in the trachea (see above), intravenous administration of a 5% solution of aminocaproic acid at a rate of 1 ml/kg (slowly!). steam-alkaline inhalations and oxygen therapy.

In addition, conventional therapy for pneumonia is carried out, including antibiotics, cardiac glycosides, aminophylline, mucolytics, vitamin therapy, and physiotherapy.

6. Thoraco-abdominal insufficiency.

In our practice, there are quite often cases of both open and closed chest trauma, accompanied by rupture lung tissue, one- or two-sided hemopneumothorax, traumatic pulmonitis, cardiac contusion, damage to the rib cage, open pneumothorax, closed tension pneumothorax. As a rule, chest injuries are combined with organ injuries abdominal cavity, skeleton; accompanied by severe hemorrhagic and traumatic shock. (Therapeutic tactics for polytrauma are described in Chapter 8.)

One of the most severe injuries in chest trauma is cardiac contusion. Clinically, this condition manifests itself in rhythm disturbances of varying degrees, up to ventricular fibrillation, cardiopulmonary failure. Treatment of cardiac contusion consists of stopping the arrhythmia (in case of ventricular fibrillation, defibrillation is necessary. In the absence of this possibility, a sharp strong blow to the chest sometimes gives the effect, directed to the heart area), restoration of hemodynamics and its stabilization. Drainage is carried out at the same time pleural cavity to relieve tension pneumothorax or closed pneumothorax (thoracentesis technique described above). Sometimes these events are enough to resolve ODN.

In case of massive hemothorax, the collected blood must be reinfused immediately. If the Ruvilois-Gregoire test is positive, indicating ongoing bleeding, after 2-3 hours of unsuccessful conservative hemostatic therapy, thoracotomy and surgical stop of bleeding are resorted to.

With multiple comminuted, “fenestrated” rib fractures, even without the presence of pneumothorax, severe ARF is observed, associated with the occurrence of paradoxical breathing (Fig. 34). In this case, inhalation does not cause an increase, but, on the contrary, a decrease in the volume of the lung on the affected side, which leads to a displacement of the mediastinum and causes a sharp deterioration general condition injured animal.

Rice. 3-1. Scheme of development of paradoxical breathing

In such cases, it is impossible to carry out mechanical ventilation until the rib frame is stabilized, since this will lead to aggravation of the situation. Only after applying a pressure stabilizing bandage can you begin mechanical ventilation and the final resolution of ARF. As a rule, after 2 weeks the bandage leads to complete stabilization of the rib cage. But, if with the help of this bandage it is not possible to achieve fixation of the ribs, they resort to surgical intervention (the surgical technique will be described in the next book in this series, dedicated to surgical issues).

7. Postoperative ARF occurs in the post-anesthesia period and is associated with the residual effect of anesthetics and muscle relaxants.

Treatment in such cases consists of administering antidotes to the anesthetics used, tracheal intubation and assisted ventilation. In this case, intensive detoxification therapy with forced diuresis is carried out. A positive effect is provided by drugs that improve cerebral circulation (piracetam, aminophylline) and fractional administration of proserin. As a rule, restoration of breathing is observed 2-3 hours after surgery.

8. Electrical trauma is quite common, especially in puppies and kittens; This is due to an active interest in electrical wires, which manifests itself precisely at this age.

The pathogenesis of terminal conditions during electrical trauma is determined by the direction of the passage of the current “loop” through the animal’s body:

1) fibrillation of the ventricles of the heart (if the current passes through the heart);

2) depression of the respiratory center (with damage to the head);

3) tonic spasm of the respiratory muscles (when current passes through the chest or along the body).

The location of the “electric loop” can be determined by electrical marks, which are caused by electrothermal burns at the point of entry and exit of the electric current.

In connection with the identified genesis of ARF, appropriate therapy is carried out, which is not fundamentally different from therapy for any terminal states- fight against heart failure, mechanical ventilation, correction of acidosis. However, the doctor should remember that in the future, even after successful resuscitation, secondary violation heart rate, late cerebral edema with all the ensuing consequences.

In order to take advantage of the slim chance of bringing the animal back to life, you should immediately carry out cardiopulmonary resuscitation in order to deliver the required amount of oxygen to the brain and vital important bodies and fabrics.

One of the most important steps leading to success with CPR is the ability to anticipate cardiac and respiratory arrest. If the patient's condition may, in your opinion, require cardiopulmonary resuscitation, it is necessary to prepare a set of instruments and drugs, having previously calculated the doses.

Conditions that can lead to cardiac and respiratory arrest:

vagal stimulation;
hypoxia;
septicemia;
endotoxemia;
serious acid-base and electrolyte disturbances;
long lasting seizures;
pneumonia;
pleural or pericardial effusion;
multiple trauma;
electric shock;
disturbances in the formation or excretion of urine;
spicy respiratory distress syndrome;
use of drugs for anesthesia and anesthesia.

Urgent actions in case of cardiac and respiratory arrest

Goals of cardiopulmonary resuscitation:

Ensure unobstructed air access.
Provide artificial ventilation lungs and additional oxygenation.
Perform indirect or direct cardiac massage.
Recognize and correct dysrhythmia and arrhythmia.
In case of successful resuscitation, ensure stabilization of work and cardiac support. vascular system, respiratory tract and lungs, central nervous system.

Even with fast, precise and aggressive actions, the success of resuscitation measures is less than 5% in seriously ill or injured animals, 20-30% in cases of complications during anesthesia.

Basic life support

Basic life support is the initial set of resuscitation measures consisting of intubation (to provide access to air), artificial ventilation of the lungs, chest compressions (heart compression), the purpose of which is to create artificial blood flow and deliver oxygen to the brain and other vital organs and tissues.

In the primary resuscitation complex, there are three main stages, which are named with the letters of the English alphabet ABC, although it is more accurate to use the abbreviation CAB, where C is the creation of artificial circulation, A is providing access to air (oxygen), B is artificial ventilation. While one member of the resuscitation team grabs the endotracheal tube, clears the upper airway and performs intubation, the second member performs chest compressions to deliver oxygen that is in the blood to vital organs and tissues.

If the patient's weight is less than 7 kg, then he should be placed in the dorsal position, if more than 7 kg, then he should be placed on his side. It is necessary to perform 80-120 chest compressions per minute. One of the team members checks the peripheral pulse at the moment of compression (to determine whether chest compressions are effective); if the pulse is not palpable, then indirect massage more hearts need to be attracted strong man or move on to open heart massage.

After intubation has been performed, air supply to the lungs should be started immediately. To do this, you can use a ventilator or an Ambu bag. It is necessary to provide additional oxygenation of 150 ml/kg/min. First you need to do two deep breaths, and then 12-16 air blows per minute.

If possible, a third team member should apply abdominal compression in opposition to chest compression to ensure blood return.

If CPR is performed by one person, give two deep breaths every 15 compressions.

Further life support

Further maintenance of life consists of restoring independent blood circulation, normalizing and stabilizing blood circulation and breathing parameters. At this stage of resuscitation, an ECG, pulse oximeter and capnograph should be connected. Should start using medicines And intravenous administration liquids (in some cases). Most of medications used in intensive care are injected directly into the lungs through an endotracheal tube.

If the cause of cardiac and respiratory arrest is extensive hemorrhage or hypovolemia, then it is necessary to replenish the circulating blood volume (CBV); if it is not possible to install intravenous catheters, then intraosseous administration of solutions can be used.

Recognizing and correcting common non-perfusion cardiac rhythms during CPR

Asystole

Asystole is one of the most common disorders heart rate, leading to cardiac arrest in small domestic animals.

The first thing to do if you see an ECG pattern similar to asystole is to check that all electrodes are connected to the patient and that they are connected correctly. If the ECG does indicate asystole, then all previously used opiates, α2-antagonists, or benzodiazepines should be discontinued using their immediate antidotes.

Low doses of epinephrine (0.02-0.04 mg/kg, diluted to 5 ml with sterile saline) can be injected into the lungs directly through an endotracheal tube or, if an intravenous catheter is available, epinephrine can be injected intravenously at the same dose.

No drugs should be administered intracardially!

The exception is situations in which the heart is in the hands of a veterinarian.

Intracardiac injections are dangerous and can cause rupture coronary artery or the drug may be injected into the myocardium, leading to its increased irritability and will make him insensitive to further therapy.

After adrenaline, atropine is immediately administered (0.4 mg/kg, IV, intraosseous or into the endotracheal tube). Atropine is a vagolytic, it inhibits the effect of the vagus on the sinoatrial and atrioventricular nodes and increases the heart rate. Adrenaline and atropine are administered every 2-5 minutes during asystole, while chest compressions, artificial ventilation and compressions are continued abdominal wall.

If there is no return to the perfusion rhythm within 2-5 minutes from the start of resuscitation, it is recommended to proceed to open cardiac massage.

Give sodium bicarbonate (1-2 mEq/kg, IV) every 10-15 minutes. It is not recommended to use it before recovery independent work hearts. This is due to the fact that acidosis with the introduction of sodium bicarbonate will be reduced only if CO 2 formed during its dissociation is removed through the lungs. In the case of inadequate pulmonary blood flow and CO 2 ventilation, extra- and intracellular acidosis increases. However, the administration of sodium bicarbonate is considered indicated if the resuscitation process drags on for more than 15-20 minutes.

Electromechanical dissociation

Electromechanical dissociation - the absence of mechanical activity of the heart in the presence of electrical activity - is one of the most common rhythms electrical activity during cardiac arrest. The EEG rhythm may be irregular and vary from patient to patient.

If electromechanical dissociation is detected, it is necessary to begin resuscitation measures as described above.

Electromechanical dissociation is a cardiac disorder caused by high concentration in the blood of endogenous endorphins and a pronounced influence of the vagus.

The treatment in this case is to use high doses atropine (4 mg/kg, IV or intratracheal) and naloxone (0.03 mg/kg, IV, intraosseous or intratracheal). Adrenaline is also prescribed (0.02-0.04 mg/kg, diluted to 5 ml with sterile saline).

If resuscitation measures are not successful within 2 minutes, it is recommended to proceed to open cardiac massage.

Ventricular fibrillation

Ventricular fibrillation is a form of cardiac arrhythmia characterized by complete asynchrony of contraction of individual fibers of the ventricular myocardium, causing loss of effective systole and cardiac output.

According to the ECG picture, fibrillation can be divided into large-wave and small-wave. It is usually easier to resuscitate a patient with large-wave fibrillation than with small-wave fibrillation. If an electrical defibrillator is available, electrical defibrillation (5 J/kg DC) is immediately administered if ventricular fibrillation is detected. When performing defibrillation, it is important that no flammable liquids are applied to the patient's skin.

In order to convert small-wave fibrillation to large-wave fibrillation, you can try to inject adrenaline (0.02-0.04 mg/kg, diluted to 5 ml with sterile saline).

If electrical defibrillation is not possible, then drug (chemical) defibrillation can be tried. First, magnesium chloride (30 mg/kg, IV) is administered; if an electric defibrillator is available, the administration of magnesium chloride can help convert fibrillation to asystole or another rhythm. Amiodarone (5 mg/kg, IV, intraosseous or intratracheal) can be used to convert fibrillation.

If there is no positive dynamics within 2 minutes, it is recommended to move on to direct cardiac massage.

Direct cardiac massage

Indications for immediate open cardiac massage during SRL

To perform direct cardiac massage, the patient is placed in the right lateral position. A wide strip is cut (or shaved) from the fifth to seventh intercostal space on the left, then processed antiseptic solution. An incision is made with a scalpel into the skin and intercostal muscles, being careful not to damage the vessels; the depth of the incision should not reach the pleura. The pleura is torn with the fingers and the cut is continued with scissors. The pleural puncture must be carried out in the interval between artificial air injections so as not to damage the lungs.

After visualization of the heart, it is freed from the pericardium, taking care not to damage the phrenic nerve and vagus. The heart is carefully taken in the hand and gently squeezed, trying not to disturb its axis and without twisting it.

Between two compressions, you need to wait until the chambers of the heart are filled with blood. If the chambers of the heart fill slowly, fluid must be given intravenously or directly into the right atrium. During direct cardiac massage, you can gently compress the descending aorta so that blood flows only to the heart and brain.

Post-resuscitation period

In the post-resuscitation period Special attention address damage caused by hypoxia and reperfusion.

The most dangerous period are the first 4 hours after resuscitation, since during this period of time cardiac and respiratory arrest may recur.

Damage to the brain and heart should be corrected with medication.

In the post-resuscitation period, the myocardium is prone to dysrhythmias, so it is worth monitoring to correct these pathologies.

It is imperative to monitor urine filtration. Minimum filtration is 1-2 ml/kg/hour, impaired filtration is corrected with dopamine (3-5 mcg/kg/min, IV).

Conclusion

It should be remembered that the main components of success are the coherence of the resuscitation team and the timeliness of all its actions, therefore it is necessary to practice resuscitation actions on corpses or mock-ups. When an animal enters the clinic, it is necessary to discuss and record in writing the consent or refusal of the animal owners to resuscitation measures and, in particular, to open cardiac massage.

Vet clinic " White Fang» Tikhonova A.V.

The dying process consists of three successive stages - clinical, social and biological death, in veterinary medicine, the indication for resuscitation measures is only the first stage. According to statistics, CPR in dogs and cats is successful in less than 25% of cases. Signs of cardiac arrest are lack of consciousness, dilated pupils, lack of breathing movements and pulse in large vessels. Precursor symptoms of CPR may include sudden bradycardia, slow respiratory rate and irregular breathing, sudden pallor or cyanosis of the mucous membranes, acute arterial hypotension, disturbances of consciousness, tachy- and bradyarrhythmias.

The ABC(D) concept includes sequential measures to ensure airway patency, mechanical ventilation and oxygenation, chest compressions and defibrillation. For maximum efficiency of the resuscitation process, it is necessary to clearly distribute the actions of each member of the resuscitation team, as well as adherence to the algorithm.

The minimum composition of the resuscitation team consists of three or four people - a leading doctor and two or three assistants. At the first stage, two resuscitators perform airway patency and mechanical ventilation with 100% O2, as well as assess the pulse wave and perform chest compressions. For animals weighing less than 15 kg, cardiac massage is performed in the lateral position, by compressing the chest above the heart or on both sides of the heart (in patients less than 3 kg), up to 150 r/min. Animals weighing more than 15 kg are placed on the right side and the chest is compressed in the middle at the level of the 7th intercostal space, up to 100 r/min. The criterion for the effectiveness of indirect massage is the pulse wave on the femoral artery. A third resuscitator performs ECG monitoring and, depending on the results, provides venous access or performs defibrillation. Every 1–2 minutes it is recommended to stop the indirect massage for a short time For ECG assessments. The effectiveness of direct cardiac massage will be low with hypovolemia, tamponade, pneumo- and hydrothorax, diaphragmatic hernia, chest deformation, and severe hypothermia.

Algorithm further actions depends on the ECG results. For asystole, the drug of choice is adrenaline 0.01 mg/kg, in the absence of a response - repeated twice, a possible dose of up to 0.1 mg/kg. The second choice drug is atropine 0.03 mg/kg, 0.04 mg/kg provides complete cholinergic blockade. For large-wave fibrillation, three successive shocks are administered: 3-5 J/kg, 5-7 J/kg, then 7-10 J/kg (total no more than 360 J). Small-wave fibrillation must be converted to large-wave fibrillation (adrenaline 0.01 mg/kg, calcium chloride 10% 0.1-0.3 ml/kg), then defibrillation must be performed. In the absence of a response to defibrillation, it is advisable to use adrenaline 0.01 mg/kg, lidocaine 2% 2 mg/kg, magnesium sulfate 30 mg/kg, potassium chloride 0.25 ml/kg (for hypokalemia), producing a shock after the administration of each drug, repeating defibrillation is possible twice in a row with maximum energy. For electromechanical dissociation, the drug of choice is adrenaline 0.01-0.02 mg/kg; in the absence of a response, repeated injection of adrenaline after 1–2 minutes, dopamine infusion from 5 mcg/kg/min, calcium chloride 10% 0.1–0.3 ml/kg. For bradycardia, the drug of choice is atropine 0.03 mg/kg.

The restored heart rate should represent a compensatory sinus tachycardia, not requiring drug effects.

If the rhythm is ventricular tachycardia with the absence of a pulse wave, the same actions are carried out as for fibrillation. In the presence of a pulse wave, it is advisable to use lidocaine 2% 2-4 mg/kg for dogs, 0.75-1 mg/kg for cats. In the absence of a response, procainamide 10% 5-15 mg/kg IV drip over 15 minutes, cordarone 5 mg/kg in glucose solution 5% IV drip over an hour are used. If the restored rhythm is sinus rhythm with increasing frequency ventricular extrasystoles, an infusion of dopamine 5 mcg/kg/min and adrenaline 0.1-1.5 mcg/kg/min is performed. At sinus bradycardia- atropine 0.03 mg/kg, dopamine/adrenaline infusion.

Fluid support is provided throughout the duration of resuscitation. For normovolemia, crystalloids are used (Trisol/Chlosol 10-20 ml/kg for dogs, 5-10 ml/kg for cats), for hypovolemia - 20-40 ml/kg for dogs, 10-20 ml/kg for cats). For large acute blood loss, whole blood or colloidal solutions are used (refortan, voluven 2-5 ml/kg for cats, 5-10 ml/kg for dogs). The use of sodium bicarbonate is justified if resuscitation measures are carried out for longer than 10-15 minutes and only under conditions of adequate ventilation. After successful resuscitation, administration of sodium bicarbonate is advisable at pH

The key to success in the immediate post-resuscitation period is careful monitoring of parameters such as ECG, saturation, temperature, blood pressure, central venous pressure, blood gases, electrolytes (potassium/sodium/chlorine/magnesium), blood glucose, diuresis.

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Animal resuscitation

Resuscitation in animals is carried out according to the primary resuscitation complex - ABC (Airway - airway patency, Breathing - breathing, Circulation - blood circulation). Like cardiopulmonary-cerebral resuscitation (CPCR), it is universal for all animals. The principles of qPCR and its applications will be described below.

If animals have extreme difficulty breathing, or breathing open mouth, or if the animal is unconscious or in a weakened state, then emergency respiratory support must be provided before any examination begins. At the beginning of resuscitation, the animal is given oxygen therapy with simultaneous measurement of the frequency and depth of breathing.

Anti-shock and infusion therapy very important during intensive care. Nutritional and external supportive care will also be discussed.

Cardiopulmonary cerebral resuscitation in animals

The goal of animal cardiopulmonary resuscitation (CPR) is to restore spontaneous circulation. The American Heart Association changed its guidelines to include preservation of neurological function as a goal of successful resuscitation, and the term cardiopulmonary cerebral resuscitation (CPCR) was introduced.

The International Heart Association guidelines for the use of measures in qPCR and emergency cardiac care in humans (American Heart Association guidelines, 2005) have been revised and modified for the use of resuscitation in animals (Costello, 2004). The primary resuscitation complex is based on the ABC principle. Advanced specialized life support includes the use of a resuscitation electrocardiograph to detect rhythm depression and defibrillation, administration of fluids and medications, and post-resuscitation care. To maximize the chances of a successful outcome of resuscitation measures, a table with background information for drugs for cardiopulmonary-cerebral resuscitation in animals should be in the direct access zone.

qPCR in animals

According to the experience of veterinarians, during inhalation anesthesia, bradycardia occurs in animals until breathing stops. It is recommended to always measure during an operation of any duration. blood pressure using a Doppler sensor or organizing ECG monitoring. Bradycardia may be audible on a Doppler monitor or detected on an ECG. If breathing stops, inhalation anesthesia should be immediately turned off.

Most common reason cardiac and respiratory arrest in veterinary patients is associated with anesthesia. Doxapram is administered as a respiratory stimulant when animals stop breathing. Intubation with an endotracheal tube and 100% oxygen support is ideal for resuscitation, but most small animals are difficult to intubate and the following is recommended:

If it is impossible to intubate the animal, then during resuscitation, forced intensive ventilation of the lungs with oxygen should be performed using a tight-fitting mask over the nose and mouth. Supply and exhaust ventilation is carried out using 100% oxygen at a rate of 20-30 breaths per minute. The disadvantage of this technique is the accumulation of air in the stomach and bloating, which can limit the movement of the diaphragm. However, initial ventilation is more important for resuscitation in animals, and air in the stomach can be eliminated using an orogastric tube.
The second method is tracheostomy.

Cardiac arrest in an animal involves cessation of circulation and is recognized by loss of consciousness and collapse. The animal's pulse is not palpable, the mucous membranes are pale or cyanotic, and respiratory arrest occurs (i.e., cardiopulmonary shock). Primary life support (ABC) should be started immediately. The animal is intubated and ventilated with 100% oxygen, or alternatively, forced oxygen flow ventilation is used as described above. Chest compressions at a rate of 80-100 compressions per minute directly contract the myocardium, which leads to an increase in cardiac output during resuscitation in the animal. It is important to use both hands, placing each on different sides of the chest, massaging the widest area of the chest. The duration of compression during resuscitation in animals should take half the time general cycle compression - relaxation.

The medical team should continually evaluate the outcome of the animal's resuscitation, checking to see if there is a palpable pulse. If there is no pulse, the force of chest compression should be increased under the control of an electrocardiogram. Various cardiac arrhythmias (bradycardia, ventricular fibrillation, electromechanical dissociation, asystole) may require special treatment. At this time, intraosseous or intravenous access should be provided.

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The presence of a palpable pulse is not a sign of adequate blood flow. Although such pulses can be used to assess the animal's response to resuscitation, they do not indicate sufficient organ perfusion during CPR. Two other measurements, expiratory CO2 and blood gas measurements, can provide a more accurate assessment of organ perfusion (American Heart Association Guidelines). Measurement of CO2 during exhalation is only possible in intubated patients weighing more than 350 g. Measurement of blood gases is only possible with arterial or venous access; however, normal values in animals are not standardized.

Respiratory assessment and support

During the clinical examination, the patient should be kept in vertical position, and if there are signs respiratory failure or the presence of palpable fluid or a mass in the abdominal cavity, provide oxygen support. Clinical signs Respiratory problems may be silent but may include symptoms such as discharge from the eyes and nostrils, tachypnea, abnormal breathing sounds, and open-mouth breathing. Due to the small size of the chest during resuscitation in animals, it is sometimes difficult to auscultate breathing; Using a stethoscope for newborn babies often makes this procedure easier.

The rate and depth of breathing should always be assessed before handling animals. Airway assessment is very important point resuscitation in animals. If there is airway obstruction or the patient has stopped breathing, the animal is intubated.

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Cardiopulmonary (cardiopulmonary-cerebral) resuscitation (CPR) technique

In order to take advantage of the slim chance of bringing the animal back to life, cardiopulmonary resuscitation should be performed immediately to deliver the necessary amount of oxygen to the brain and vital organs and tissues as quickly as possible.

Conditions that can lead to cardiac and respiratory arrest:

vagal stimulation;
hypoxia;
septicemia;
endotoxemia;
serious acid-base and electrolyte disturbances;
prolonged convulsive seizures;
pneumonia;
pleural or pericardial effusion;
multiple trauma;
electric shock;
disturbances in the formation or excretion of urine;
acute respiratory distress syndrome;
use of drugs for anesthesia and anesthesia.

Urgent actions in case of cardiac and respiratory arrest

Goals of cardiopulmonary resuscitation:

Ensure unobstructed air access.
Provide mechanical ventilation and supplemental oxygenation.
Perform indirect or direct cardiac massage.
Recognize and correct dysrhythmia and arrhythmia.
In case of successful resuscitation, ensure stabilization and support of the cardiovascular system, respiratory tract and lungs, central nervous system.

Even with fast, precise and aggressive actions, the success of resuscitation measures is less than 5% in seriously ill or injured animals, 20-30% in cases of complications during anesthesia.

Basic life support

If the patient's weight is less than 7 kg, then he should be placed in the dorsal position, if more than 7 kg, then he should be placed on his side. It is necessary to perform 80-120 chest compressions per minute. One of the team members checks the peripheral pulse at the time of compression (to determine whether chest compressions are effective); if the pulse is not palpable, then a stronger person must be involved in chest compressions or proceed to open cardiac massage.

After intubation has been performed, air supply to the lungs should be started immediately. To do this, you can use a ventilator or an Ambu bag. It is necessary to provide additional oxygenation of 150 ml/kg/min. First you need to take two deep breaths, and then 12-16 breaths of air per minute.

If possible, a third team member should apply abdominal compression in opposition to chest compression to ensure blood return.

If CPR is performed by one person, give two deep breaths every 15 compressions.

Further life support

Further maintenance of life consists of restoring independent blood circulation, normalizing and stabilizing blood circulation and breathing parameters. At this stage of resuscitation, an ECG, pulse oximeter and capnograph should be connected. Medications and intravenous fluids (in some cases) should be started. Most drugs used in intensive care are administered directly into the lungs through an endotracheal tube.

Recognizing and correcting common non-perfusion cardiac rhythms during CPR

Asystole

Asystole is one of the most common cardiac arrhythmias leading to cardiac arrest in small pets.

No drugs should be administered intracardially!

The exception is situations in which the heart is in the hands of a veterinarian.

Intracardiac injections are dangerous and can lead to rupture of the coronary artery or the drug can be injected into the myocardium, which will lead to increased irritability and make it insensitive to further therapy.

If there is no return to the perfusion rhythm within 2-5 minutes from the start of resuscitation, it is recommended to proceed to open cardiac massage.

Give sodium bicarbonate (1-2 mEq/kg, IV) every 10-15 minutes. It is not recommended to use it until the heart has restored its independent function. This is due to the fact that acidosis with the introduction of sodium bicarbonate will be reduced only if CO 2 formed during its dissociation is removed through the lungs. In the case of inadequate pulmonary blood flow and CO 2 ventilation, extra- and intracellular acidosis increases. However, the administration of sodium bicarbonate is considered indicated if the resuscitation process drags on for more than 15-20 minutes.

Electromechanical dissociation

Electromechanical dissociation—the absence of mechanical activity of the heart in the presence of electrical activity—is one of the most common rhythms of electrical activity during cardiac arrest. The EEG rhythm may be irregular and vary from patient to patient.

If electromechanical dissociation is detected, it is necessary to begin resuscitation measures as described above.

Electromechanical dissociation is a disorder of the heart caused by a high concentration of endogenous endorphins in the blood and the pronounced influence of the vagus.

Treatment in this case is the use of high doses of atropine (4 mg/kg, IV or intratracheal) and naloxone (0.03 mg/kg, IV, intraosseous or intratracheal). Adrenaline is also prescribed (0.02-0.04 mg/kg, diluted to 5 ml with sterile saline).

If resuscitation measures are not successful within 2 minutes, it is recommended to proceed to open cardiac massage.

Ventricular fibrillation

In order to convert small-wave fibrillation to large-wave fibrillation, you can try to inject adrenaline (0.02-0.04 mg/kg, diluted to 5 ml with sterile saline).

If there is no positive dynamics within 2 minutes, it is recommended to move on to direct cardiac massage.

Direct cardiac massage

Indications for immediate open cardiac massage during SRL

To perform direct cardiac massage, the patient is placed in the right lateral position. A wide strip is cut (or shaved) from the fifth to seventh intercostal space on the left, then treated with an antiseptic solution. An incision is made with a scalpel into the skin and intercostal muscles, being careful not to damage the vessels; the depth of the incision should not reach the pleura. The pleura is torn with the fingers and the cut is continued with scissors. The pleural puncture must be carried out in the interval between artificial air injections so as not to damage the lungs.

Between two compressions, you need to wait until the chambers of the heart are filled with blood. If the chambers of the heart fill slowly, fluid must be injected intravenously or directly into the right atrium. During direct cardiac massage, you can gently compress the descending aorta so that blood flows only to the heart and brain.