Crashing animals and IPPV please help!!

Re: Crashing animals and IPPV please help!!

annaschu — Fri, 21 Oct 2011 03:14:55 GMT

Had a crash last night - suspected botulism posioning. I'm in a referral centre as a night nurse and unfortunately crashing patients although uncommon are part of my job. Last night's case was already hooked up to a ventilator, doppler, kontron and virtually every machine in the building. My intern was down with him so there were two of us to deal with him when he crashed. It's human nature not to know how you would manage in a critical situation and you won't find out until it happens to you but to reassure you the majority of vet professionals I've worked with down the years switch to autopilot and jump in and deal with it. It's VERY unlikely that you'd do anything to make the situation any worse, the patient will die without any intervention anyway!

As we were expecting a crash last night we had our crash box open and ready to hand - I'd certainly suggest familiarising yourself with yours and what the different drugs do. I'm sure everyone works differently but our crash box has the key drugs ready drawn up into syringes (regularly refreshed) and hepsal syringes as well to clear iv's in a hurry. The upkeep of our crash box is vitally important, finding no adrenaline the one time you need it should NEVER happen.

The human Airway, Breathing, Circulation (heart) mantra is just as useful for us. If there's two of you, one concentrates on respiration, the other on the heart. As with anything else, experience is the best teacher - although no-one hopes for a crashing patient once it's happened and you've been through it you will feel far less anxious about being caught in that situation again.

The other option is to do some occaisional shifts for an OOH provider, far more likelihood of a crashing patient out of hours!

Re: Crashing animals and IPPV please help!!

emvn80 — Sat, 15 Oct 2011 08:10:12 GMT

Hi I would breathe down the ETT ONLY if I didn't have access to oxygen. 100% oxygen is recommended during CPCR wherever available. You are correct that in normal situations CO2 is the main respiratory drive but in a crash situation the most important thing is to maintain oxygen delivery to tissues via chest compressions and adminstration of 100% oxygen and IPPV. Remember room air contains only 21% oxygen and mostly nitrogen, (about 78%) (therefore your breath will be only providing 21% oxygen The CPD day will be ner Newmarket in Suffolk, I will be posting full info on the events calendar very shortly.

Re: Crashing animals and IPPV please help!!

Phrin Vernon RVN — Fri, 14 Oct 2011 23:54:59 GMT

[quote user="hissycat"]

Does anyone here breath down the ET tube themselves instead of ventilating with oxygen? I think it must have been recommended at a CPD event maybe but in my previous practice we did this a couple of times for crashing animals with good outcomes (obv. not sure but they may have been fine with O2 aswell). I believe the thinking behind it is that the CO2 will stimulate ventilatory drive and there will still be sufficient oxygen present leading to faster recovery (assuming the cardiac side is also taken care of). Just wondering what everyone elses thoughts are on this?

[/quote]

Yes I do this - with very good effect! We even saved a baby lamb doing this once, after the vet walked away saying 'but it's only a lamb' VN's Kirsty & Phrin saved the baba lamb that the vet and farmer had both written off!

Yes we both did a high five then cried

Re: Crashing animals and IPPV please help!!

hissycat — Fri, 14 Oct 2011 23:34:05 GMT

Re: Crashing animals and IPPV please help!!

emvn80 — Fri, 14 Oct 2011 21:38:26 GMT

Yes, you are correct, over ventilation causes hypocapnia/ carbia & which leads to cerebral vasoconstriction, decreasing cerebral blood flow. I can send u a copy of the article but not until after it is published- send me a message with your email on if you like? Definitely practice IPPV on anaesthetised patients to get a feel for it. :)

Re: Crashing animals and IPPV please help!!

Doubledippy — Fri, 14 Oct 2011 19:22:19 GMT

Just to add a little information.... I launched a new business at BVNA congress for nursing- CPD in your own practcie ... have a read of the website... www.veterinarynursingconsultancy .com and I can come to you complete with the CPR manikins for complete hands on training for all the veterinary staff.... Such a difficult topic to get practcial hands on training with which is the important concept for all staff members --- I hope you fidn the guidence that you need..

Re: Crashing animals and IPPV please help!!

Cloudy Weather — Fri, 14 Oct 2011 17:00:50 GMT

is this because over ventiliation causes hypocarbia which leads to cerebral vasoconstriction and so cerebral hypoxia? If so does that mean you should always do there average breaths per min or slightly lower? Is there anywhere I can access the article if I do not have a copy? when would you stop IPPV to check animal is breathing on its own?

I think that would be so useful, however I am based in west yorkshire. Where in south east would it be held.

Re: Crashing animals and IPPV please help!!

emvn80 — Fri, 14 Oct 2011 16:38:37 GMT

Be very careful not too over- ventilate! Over ventilation commonly occurs and reduces cerebral perfusion and decreases the chance of successful outcome. IPPV rates should be 10-12 breaths/ min (sl more for cars) Chest compressions should be 100-120 bpm Practice IPPV on anaesthetised patients to get used to doing it. I agree that you should practice scenarios in your practice. Check out my CPCR review article in Decembers edition of The Veterinary Nurse Also we are running a CPD day on this exact topic in March 2012. We are in the south East, where are you?

Re: Crashing animals and IPPV please help!!

Geniverger — Fri, 14 Oct 2011 10:31:16 GMT

This is from the education section of this website. It doesn't cover crashing animals specifically but it's a fairly good theoretical base in anaesthetic emergencies.

http://www.vetnurse.co.uk/wikis/vet-nurse-revision-2/anaesthetic-emergencies-answers.aspx

Re: Crashing animals and IPPV please help!!

Cloudy Weather — Fri, 14 Oct 2011 09:26:23 GMT

That sounds like a really great idea, I will suggest the frequent training to my practice. I know they are in the process of producing protocol sheets as well which will be beneficial. Could you explain the circuits in more detail and about dead space. I know we must use bain or lack re-breathing system and not a circle but could you explain a little more about it? Just really want to know I have my head around everything and understand it fully.

Thank you everyones been really helpful :)

Re: Crashing animals and IPPV please help!!

Steph Worsley — Fri, 14 Oct 2011 00:52:29 GMT

protocols should be explained and practiced on a regular basis

we are lucky that we have fully trained anaesthetists who take charge of anything like that

basically the loudest person will yell "crash" and people will come running, anaesthetist will usually intubate while another starts compressions and then a nurse/student/other vet will do the IPPV while another person sets up the ecg etc and another gets the drugs

all this time someone is stood in the background writing down what is happening when (e.g. how much adrenaline given, when and route)

it is all kinda a mish mash but it always comes together as we are constantly talking to each other throughout the procedure, we can have as little as 2 people to as many as 5 or 6 working on a patient depending on the time of day,

I have to say all our critical patients are in the ICU which has a door through to anaesthesia, all critical patients needing sedation etc MUST have an anaesthetist with them.

there have been a couple of times we have had o go pelting into prep room (not allowed in our normal scrubs) as we have had to pull an animal out of a consult as it's been closer than ICU and we needed the people there and then....the look on some peoples faces when they see an intruder in prep is quite funny when you look back as they look horrified that you dare where your nomal stuff into the surgical area!

We all have crash practice once a year at least, lead by one of the anaesthetists.

Re: Crashing animals and IPPV please help!!

Stuart McQueen RVN MBVNA — Thu, 13 Oct 2011 23:57:28 GMT

[quote user="Gillian Mostyn"]

Ideally you need to be simulating this in practice and going through the equipment, emergency box etc so you can feel a little more confidence.

[/quote]

I agree - the practice should have a protocol in place that is practiced with the nurses and vets when they arrive... and maybe even once or twice after that too...

Our protocol is something like:

The anaesthetists blows a fog horn when the patient crashes... they (being already in the room) become the lungs of the patient, switches the animal straight into oxygen and starts IPPV...

Person 2 in the room is the heart of the patient - they start cardiac massage (or take over from the first nurse if they have already started)...

The 3rd person is the drugs... they get the adrenaline / dorpram etc etc etc whatever is required...

Anyone after that is a bonus... they might set up an IV line (no we don't have IVs in all the GA animals (but we're getting there)...

If it's an out of hours crash ... the nurse and vet (being the only 2 people in the building) work like crazy between them to cover all the bases!

I hope this helps, you would be best talking to your head nurse and asking them about a protocol!!!

Re: Crashing animals and IPPV please help!!

Gillian Mostyn — Thu, 13 Oct 2011 23:16:25 GMT

Ideally you need to be simulating this in practice and going through the equipment, emergency box etc so you can feel a little more confidence.