You must know how to carry out cardiopulmonary resuscitation since if an animal goes into cardiac arrest you do not have time to consult your notes! Drugs are not usually needed until the recovery phase - when a knowledge of pharmacology really is required! Prevention of cardiac arrest is much better than cure!! Prevent hypoxia and acidosis.

Cardiopulmonary resuscitation

If the animal has stopped breathing (do not count gasps) and there is no peripheral pulse, check apex beat.
If there is no apex beat, start CPR; if there is an apex beat ventilate with 100% oxygen.

Airway

Visually check / insert endotracheal tube, or,
Emergency tracheotomy (14SWG catheter through cricothyroid membrane), or,
Extend neck and pull tongue forward.
Stop giving anaesthetic drugs, flush circuit with oxygen and set high oxygen flow.

Concurrent activity

Shout for help.
Note time.

Breathing

Squeeze bag 3 times checking for chest expansion - if chest expands, check pulse again: if no chest expansion, check airway again, or,
Ventilate mouth to nose.
Ventilate every 5 seconds; allow chest to deflate between breaths.

 When an assistant arrives, they take over ventilation.

Circulation

Lay animal on right side.
Extenal cardiac massage at 2 beats / second.
Continue ventilation.
Stop and check for pulse every 2 minutes.
Internal cardiac massage is only justified if chest is open or if there are major chest wounds.

Establish iv access - big catheter in a big vein - cut down if necessary (movie (6.7MB)).

Start fluids at a slow rate to keep vein open.

Drugs

No drugs necessary in the first 5 minutes, then:
adrenaline 20microg/kg iv, or 40microg/kg intratracheally. Repeat in five minutes with a double dose if no response.
atropine 20microg/kg iv, or 40microg/kg intratracheally.

After 10 mins CPR:
sodium bicarbonate 1mEq (=mmol)/kg slowly iv into running infusion, preferably 0.9% NaCl. Do not give intratracheally!
Repeat 0.5mEq/kg iv every 10 minutes of CPR.

In hyperkalaemia or hypocalcaemia only:
calcium (boro)gluconate 1mg/kg iv - do not give with bicarbonate.

Attach ECG

 

Flush drugs in with 5 - 50mL saline

 

 

 

Check potassium first.

After heart restarts

Continue ventilation with 100% oxygen and consider:

 monitor ECG

positive inotropes

 adrenaline 5 - 10microg/kg/min iv - titrate to effect on blood pressure
dobutamine 2.5 - 10microg/kg/min iv - titrate to effect
dopamine 1 - 10microg/kg/min iv - titrate to effect		  

fluids

 sodium bicarbonate in normal saline, Hartmann's, colloids - beware overdose! monitor blood gases and central venous pressure

antiarrhythmics

 tachydysrhythmias
lignocaine (without adrenaline) 1mg/kg slowly iv; repeat every 10 mins if necessary up to 3 times, then 20microg/kg/min if necessary
verapamil 20microg/kg iv over 10 mins, repeat if necessary.
bradydysrhythmias
isoprenaline 20 - 200microg/kg/min iv, or,
dobutamine 2.5 - 10microg/kg/min iv to effect		 monitor ECG

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