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Protocols

CPR
Basic Life Support:
Airway patency (ET intubation): lateral recumbency if possible
Breathing: 10 breaths/min or 1 breath/6 seconds (1 sec inhale:5 sec exhale)
Avoid airway trauma (pressure <20mmHg)
Mouth-to-snout (C:V 30:2)
Circulation: 100-120 compressions/min (1/3-1/2 chest depth)
Cardiac pump theory (<15kg or skinny) or thoracic pump theory (ICS 5-6)
Change roles every 2 minutes (1 cycle)
Advanced Life Support:
IV access
Fluid therapy
Hypovolemic?
Shock rate crystalloids: 60ml/kg (cat), 90ml/kg (dog)
Blood of plasma: 20ml/kg (cat, dog)
Hypertonic saline: 2ml/kg (cat), 4ml/kg (dog)
Synthetic colloids: 5ml/kg (cat), 10ml/kg (dog)
Normovolemic? AVOID FLUIDS
ECG rhythm
Asystole →
Pulseless electrical activity →
Ventricular fibrillation → defibrillate
Pulseless ventricular tachycardia →
Drugs: one tenth rule (0.1ml/kg IV,IO or x2 in trachea)
Epinephrine: all causes of arrest
Low dose (<10 min) = 0.01mg/kg or 0.01ml/kg standard epinephrine [1mg/ml]
High dose (>10 min) = 0.1mg/kg or 0.1ml/kg standard epinephrine [1mg/ml]
Repeat q4 minutes
Vasopressin: alternative to epi
0.2-0.8u/kg ONCE or replace with epinephrine
Atropine: asystole, PEA, post-arrest bradycardia
0.04mg/kg [0.5-0.6mg/ml] or 0.1ml/kg
Repeat q4 minutes with epinephrine
Lidocaine: VPCs, VF, pulseless VT
2mg/kg [20mg/ml] or 0.1ml/kg
Sodium bicarbonate: pH <7.1 or >10min
1mEq/kg [1mEq/ml] or 1ml/kg followed by 0.5ml/kg q10 minutes
Calcium gluconate: hyerkalemia, hypocalcemia, Ca2+ channel blocker overdose
50-100mg/kg or 0.5-1ml/kg
Reversal agents:
Opioids → Naloxone (0.1ml/kg)
Benzodiazepines → Flumazenil
Alpha-2 agonists → Atipamezole
Precordial thump (”defibrillator”)
Assessment During CPR:
MM colour: pink, improved CRT
ECG rhythm/return of heart beat
Blood pressure: femoral or on globe
ETCO2: higher levels indicate perfusion
<15mmHg → poor outcome
20-25mmHg → good
40-45mmHg → normal
SpO2: >90%
Assessment Post-CPR:
Return of spontaneous circulation
Return of spontaneous ventilation
Otherwise reduce to 6-8 breaths/min
Aim for normoxia SpO2 (95-98%)
Arrhythmias common
Ventricular ectopy?
2mg/kg or 0.1ml/kg BOLUS (dog), 0.75-1mg/kg SLOW PUSH (cat)
Repeat (toxic dose is 5 doses)
Follow with CRI lidocaine 30-80ug/kg/min
Bradycardia?
Atropine 0.1ml/kg (1/2 volume at a time)
Blood pressure
Normotension (MAP 80-120, SAP 100-120)
Fluids (avoid pulmonary edema)
Pressors (dopamine, NE, epi)
Lactate (<2)
Urine output (1-2ml/kg/hr)
Mild therapeutic hypothermia (33.5-35.5C) → rewarm slowly 0.25-0.5C/hr
Analgesics → opioids (NOT NSAIDs and corticosteroids not recommended)
RABIES EXPOSURE
OMAFRA Post-Exposure Management for Dogs and Cats
Animal fully vaccinated for rabies (at least 2 consecutive vaccines and still within label interval):
Booster within 7 days of exposure → Observation Period (OP) for 45 days
No booster within 7 days → Precautionary Confinement Period (PCP) for 3 months
Animal primarily vaccinated for rabies (only 1 vaccine and not yet due for 12 month booster):
Booster within 7 days of exposure → OP for 45 days
No booster within 7 days of exposure → PCP for 3 months
Animal not up-to-date with rabies vaccine (previous rabies vaccine expired):
Case-by-case (duration since last vaccine, total # vaccines, delay between exposure and revaccination, overall health status)
Booster within 7 days of exposure → PCP for 3 months
No booster within 7 days of exposure → PCP for 6 months
Animal never vaccinated for rabies or unknown vaccine history:
Booster within 7 days of exposure → PCP for 3 months
No booster within 7 days of exposure → PCP for 6 months
Observation Period (OP):
Minimize animal’s contact outside of household
Dogs allowed off the property with a responsible age-appropriate handler but must be kept on a leash at all times
Cats must remain indoors at all times
Precautionary Confinement Period (PCP):
Animal must remain on owner’s property at all times unless medical attention is required
Contact with animal limited to 1 age-appropriate caretaker
No contact with other people or animals
Dogs can only go outside on a leash and in a fenced area (ie. double barrier)
When indoors, animal must be kept in a secluded area with double-door entry that allows caretaker to observe the animal before direct contact, and prevents accidental escape
ANAESTHESIA
Diagnosis:
Treatment:


Diagnosis: Giardia ELISA SNAP, Fecal Flotation (ZnSO4)
Treatment:
Fenbendazole 50mg/kg PO SID +/- Metronidazole 25mg/kg BID for 5 days
If treatment + bathing does not eliminate infection, extend for additional 10 days
Treat same household species with one course of therapy
Monitoring:
Recheck fecal flotation (ZnSO4) 24-48h after treatment if still clinical
Control:
Bathe on last day of treatment.
Remove feces daily and dispose with municipal waste.
Environmental areas (e.g., soil, grass, standing water) are difficult to decontaminate, but surfaces can be sanitized by steam-cleaning or use of commercially available disinfectants. Allow surfaces to dry thoroughly after cleaning.
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