KEY NOTES

1. Place the animal in right lateral recumbency with the forelegs pulled forward to give optimum access to the thoracic wall (the head should be tilted downwards in the event of a drowning accident to enable the drainage of fluid).
2. Remove any constricting collars or dressings and assess whether visible respiration is apparent (a mirror placed in front of the nose will show condensation).
3. Extend the head and pull the tongue forward checking for and removing any obstructions.
4. Intubate the animal if facilities available.
5. Assess whether a heart-beat is detectable by using mediate auscultation between the 5th and 6th ribs on the left hand side, or by flexing the elbow and placing flat fingers between 2 ribs on the area immediately behind the elbow in order to detect the apex beat.

YOUR ACTIONS NOW WILL DEPEND UPON THE FACILITIES AVAILABLE & WHETHER OR NOT A HEART BEAT IS PRESENT

OPTION 1: Animal intubated, anaesthetic machine with oxygen supply available, heart beat present, cessation of respiration.

• Ensure that the endotracheal tube is in place, cuffed and secured.
• Attach the patient to the anaesthetic machine using a suitable circuit for IPPV.
• Ensure that the dial on the vaporiser is set to 0%.
• Administer oxygen via gentle compressions of the rebreathing bag taking care not to over-inflate the lungs (every 2 seconds in cats and small breeds of dog and every 5 seconds in larger dog breeds).
• Monitor the heart (ideally by means of an oesophageal stethoscope) and observe for signs of unaided respiration.
• Keep a close eye on pupil size, reflexes and mucous membrane colour.
• Cease supply of oxygen to allow CO2 (Carbon Dioxide) to naturally accumulate in the patient and stimulate respiration.
• The use of respiratory stimulant drugs such as Doxapram (Dopram drops or injectable) may be indicated.

OPTION 2: Animal not intubated, no anaesthetic equipment available, heart beat present, cessation of respiration.

• Apply intermittent pressure with the palm/s of the hand to the thoracic wall immediately behind the scapula in order to expel air from the lungs - the sudden release of pressure will allow the chest to expand and draw in air (every 2 seconds in cats and small breeds of dog and every 5 seconds in larger dog breeds).
• Monitor the heart (ideally by means of an oesophageal stethoscope) and observe for signs of unaided respiration.
• Keep a close eye on pupil size, reflexes and mucous membrane colour.
• It may be necessary to stimulate the return of unaided respiration by ceasing administration of oxygen and allowing the accumulation of CO2 in the patient.
• The use of respiratory stimulant drugs such as Doxapram (Dopram drops or injectable) may be indicated.

OPTION 3: (ONE PERSON METHOD): Animal intubated, anaesthetic machine with oxygen supply available, heart beat absent, cessation of respiration.

• Call for assistance.
• Ensure that the endotracheal tube is in place, cuffed and secured.
• Attach the patient to the anaesthetic machine using a suitable circuit for IPPV.
• Ensure that the dial on the vaporiser is set to 0%. Request assistant draws up CPR drugs (eg. adrenaline and atrophine) in readiness for the vets arrival.
• The palm of the hand is placed over ribs 3-4 and 15 compressions applied with half second intervals between each.
• Administer pure oxygen by applying 2 gentle compressions of the rebreathing bag.
• Repeat cardiac compressions and artificial respiration, checking for a heart beat at 60 second intervals.
• If 3 minutes pass with no heart beat, the brain will become irreparably damaged due to hypoxia and the animal may sadly be declared dead.
• If the heart beat returns, continue as per Option 1 and endeavour to re-establish unaided respiration.

OPTION 4: (TWO PERSON METHOD): Animal intubated, anaesthetic machine with oxygen supply available, heart beat absent, cessation of respiration.

• Ensure that the endotracheal tube is in place, cuffed and secured.
• Attach the patient to the anaesthetic machine using a suitable circuit for IPPV.
• Ensure that the dial on the vaporiser is set to 0%. Request assistant draws up CPR drugs (eg. adrenaline and atrophine) in readiness for the vets arrival.
• Apply 5 cardiac compressions at half second intervals whilst the second person administers 2 gentle compressions of the rebreathing bag.
• Repeat cardiac compressions and artificial respiration, checking for a heart beat at 60 second intervals.
• If 3 minutes pass with no heart beat, the brain will become irreparably damaged due to hypoxia and the animal may sadly be declared dead.
• If the heart beat returns, continue as per Option 1 and endeavour to re-establish unaided respiration.

OPTION 5: Worst case scenario - no equipment, heart beat absent, cessation of respiration, no assistant.

• Stay calm!
• The palm of the hand is placed over ribs 3-4 and 15 compressions applied with half second intervals between each.
• Hold the mouth closed and gently blow into the nostrils. This is, though, contrary to health and safety regulations.
• Repeat cardiac compressions and artificial respiration, checking for a heart beat at 60 second intervals.
• If 3 minutes pass with no heart beat, the brain will become irreparably damaged due to hypoxia and the animal may sadly be declared dead.
• If the heart beat returns, continue as per Option 1 and endeavour to re-establish unaided respiration.