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  • Chantal Faraudo,CVT, CVPP

How to Save A Life. Step One.





Imagine if you will…


You are playing with your beloved 10-year-old Border Collie at the dog park and he suddenly collapses. You panic and a bystander steps in and determines that he is not breathing and immediately starts CPR by giving chest compressions and mouth to snout breaths. After several minutes your buddy starts breathing again and regains consciousness. Your best friend gets to go home with you to live another day. This was an actual real-life event.


You are a local firefighter and are on scene of an apartment fire and the elderly resident has just been rescued from the fire and you discover the resident’s dog lying unconscious on the sidewalk. You have been trained in CPR and are able to determine that the dog is not breathing. You start chest compressions, mouth to snout breaths then administer oxygen. After about 30 seconds, the dog starts breathing on his own and you continue to give oxygen by mask as the dog is transferred to the local veterinary emergency hospital for treatment of smoke inhalation and burned pads on his feet. After several days in the hospital the dog is discharged to his grateful owner and the two go on to spend many more years together thanks to you. True story.


You are a groomer at a pet grooming business and one of your clients drops off a cute pup who hasn’t been groomed in a while due to some liver issues but has recently been doing well so was brought in for a much, needed grooming. As you are preparing your equipment you notice she is lying on her side, which seems abnormal to you. You go over to check on her and she is limp, not breathing. You start chest compressions and start mouth to snout breathing. After a couple of minutes your pup is breathing again and starting to move. The client arrives within minutes of the successful resuscitation event and takes the pup to her veterinarian for further evaluation and care. Tragedy was averted.


You are a Certified/Registered/Licensed Veterinary Technician and you are running anesthesia on a routine feline cat neuter. Your patient is a Maine Coon kitten who is 7 months old. On exam, all findings are normal without any murmurs auscultated. Preanesthetic bloodwork was normal and today is the day of the neuter. Your hospital always places IV catheters and intubates all cat neuter patients as a gold standard practice. You also have your emergency drug sheet printed out with pre-calculated emergency drug doses specific to this patient. You are monitoring your patient while your DVM is making the first incision when you notice that the patient is in asystole, has cyanotic mucous membranes and is not breathing. Your ETCO2 has dropped to zero. You immediately know what to do by alerting the DVM, turning off the gas and starting chest compressions. Other members of your team step over to assume roles on the resuscitation team and the owner is notified as to what is happening. Another CVT helping with the code suggests reversing the premedication and Naloxone and atipamezole are administered. As you continue compressions, another member is ventilating with the ambu bag connected to oxygen at 10 breaths per minute, the DVM orders Epinephrine IV and another team member draws up the drug and it is administered. Another team member is recording all events on the Recording sheet that sits on the crash cart. Members of the resuscitation team speak up as they see things. Someone mentions that ETCO2 is less than 15mmHg and suggest making the compressions a little deeper. With this reminder, you adjust and see the ETCO2 improve. At the two-minute mark compressions are briefly stopped to access the ECG and your patient is back in normal sinus rhythm with a strong palpable femoral pulse. His color is nice and pink again with good capillary refill time is at 2 seconds. The kitty is closely monitored in recovery and spends the night at the local emergency hospital for monitoring. Ultimately, this kitty sees a cardiologist and is diagnosed with HCM (hypertrophic cardiomyopathy) that is subsequently treated with medication and this kitty goes on to live a good quality of life for several years to come. The dream team.


You are a staff member of a large, busy, general practice veterinary hospital and a man bursts through the door with his young dog who suddenly collapsed after chewing on a toy. Your entire team has been trained in RECOVER CPR and the team immediately mobilizes and starts the RECOVER CPR algorithm. The team is organized, calm and immediately discovers an obstructed airway with part of a rubber ball and the obstruction is removed. The patient is not breathing and compressions are started immediately as other team members start attaching the ECG leads and each team member assumes their role in the resuscitation. One staff member seamlessly intubates the patient in lateral recumbency and starts ventilating the patient as the ETCO2 capnograph is attached. Another team member is simultaneously gaining IV access and all of this has taken place in a matter of a few minutes. As a team, you briefly evaluate the ECG and decide the patient is in asystole and you resume compressions and ventilations as a low dose of Epinephrine is ordered and administered. While the team is working on the patient, other staff in the hospital are continuing to take care of other patients and appointments and someone on the team is in direct communication with the owner as the event unfolds. Another full cycle of CPR is completed and a dose of atropine is ordered and given as compressions resume.


A team member from reception has assumed the role of Recorder as other staff members are involved in another case in the surgical suite. She is able to feel competent and confident in assuming this role as she too has been certified in RECOVER CPR. After two full cycles of CPR the team evaluates the ECG and you see there is a return to normal sinus rhythm and after some additional evaluation and care this lucky good boy goes home to his family and is only allowed to chew on and play with safe toys he cannot choke on. He grows up to be “the best boi ever”.


Thanks to your forward-looking practice owner who invested in getting the staff RECOVER CPR certification training and the skilled RECOVER CPR trained team, this patient survived. The team debriefs after the event and talks through what went well and what they could improve on. The team walks away feeling accomplished, successful and knows they saved a life. Today’s event empowered the team to be leaders, to collaborate and work together, to make a huge difference in the life of that owner and that “good boi”. Today was a good day.


No one wants to find themselves in a position where an animal collapses and you don’t know what to do. When a patient codes the adrenaline flows and chaos can be your enemy. Can you imagine being in a practice without any formal CPR training and when an arrest event occurs people are in a panic, climbing over each other, arguing over what to do, snapping at each other out of fear? Can you imagine being a new student in a veterinary technology program and it’s your first week of school. You are on kennel duty and you find one of the program dogs collapsed and you don’t know what to do except pick up the animal and start running looking for help. Or maybe, being a new veterinary student and you are faced with a collapsed patient and people look to you to know what to do and you don’t know what to do because you’ve never been taught or haven’t been taught that information yet. Can you imagine graduating from an AVMA accredited veterinary technology program, passing the VTNE and never receive training or certification in RECOVER Initiative CPR? Or graduating from Veterinary School and becoming a DVM and never receive certification in RECOVER Initiative CPR training? Or be a K9 Police Officer handler or work for ATF (Alcohol Tobacco and Firearms) and not receive RECOVER Initiative CPR training in case something happens to your partner in the field? Or work in a VECCS Level I, ll or lll emergency and critical care facility in a 24-hour acute care facility and not have anyone certified in RECOVER Initiative CPR?


Unfortunately, this is more reality than fiction today.


Many people with CVT, RVT, LVT, DVM and even board-certified Diplomats aren’t yet certified in RECOVER Initiative CPR. Our time has come to take the veterinary profession up another level and get everyone certified in RECOVER CPR. As I write this, the folks at Cornell University who created the RECOVER Initiative are figuring out how to make RECOVER CPR part of the standardized education of all veterinary professionals. But the opportunity exists right now to get your team or yourself RECOVER Initiative CPR Certified.


RESPOND CPR for the Veterinary Team has been created to help make this training available to all! I want to shout it from the roof tops that all of us in veterinary medicine need to get certified in RECOVER CPR, as well as pet parents, anyone working or volunteering in a veterinary hospital or shelter, doggie daycare and boarding facility workers, pet sitters, police officers with K9 partners, ATF officers with K9 units and anyone else who works with animals who is interested in getting certified.


Training in RECOVER Initiative ALS and BLS is available to you now! We have a high-fidelity computer simulator mannikin that is used to deliver the hands-on RECOVER CPR training and we have the capability of providing services at your location. This hands-on training is not only good medicine but it creates confidence in the team, empowers each member to be a leader and makes the team feel accomplished. The difference it makes to patients and their owners is dramatic. It can be the difference between life and death.


The courses are designed with the adult learner in mind, recognizing students come with experience that they draw from. Learners are seen as a significant resource of knowledge to the trainers and fellow learners alike. The course is interactive, hands-on, will improve your professional competence in CPR and build confidence and leadership skills. The skills and knowledge you gain will be directly applicable to your team when you take your skills back to your work.


Moreover, it is the author’s opinion that veterinary professionals have a duty and responsibility to pet owners and animals to provide the most researched and validated evidence-based model for veterinary resuscitation available, the RECOVER CPR initiative Guidelines. The RECOVER Initiative Guidelines are the first consensus guidelines on veterinary resuscitation, which to date is the most comprehensive in-depth look at the available evidence on veterinary resuscitation.[1] I have included a link to the RECOVER Initiative Guidelines that I encourage you to review.

https://onlinelibrary.wiley.com/toc/14764431/22/s1


https://recoverinitiative.org


https://todaysveterinarypractice.com/cardiopulmonary-resuscitation-the-recover-guidelines/


https://todaysveterinarynurse.com/articles/critical-components-to-successful-cpr-the-recover-guidelines-preparedness-and-team/


RECOVER CPR certification brings standardization to the training in the area of veterinary resuscitation and allows veterinary professionals to provide the best standard of care for cardiopulmonary arrest patients.


In RESPOND CPR hands-on training you will be a part of a team that will run simulated mega-codes applying what you’ve learned in the 8.5 Hours of RACE Approved CE

Basic Life Support (BLS) and Advanced Life Support (ALS) online modules on https://recoverinitiative.org/veterinary-professionals/


Basic Life Support will focus on the importance of providing high-quality BLS to patients and, therefore, increasing the likelihood of return of spontaneous circulation (ROSC)

· Recognition of CPA

· Chest compressions

· Ventilation

· Airway management.

In Advanced Life Support Training you will learn:

· Vasopressor therapy

· Vagolytic therapy

· Electrical cardioversion

· Correction or reversal of condition(s) that led to arrest.

· Additional therapies such as IV fluids, other medications used in resuscitation

· Reversal medications

· Intratracheal Administration and Drugs

· CPR monitoring

· Post Cardiopulmonary Arrest Care

Other benefits of RECOVER CPR training include:

· Managing code scenarios utilizing mutual respect 

· Collaboration and teamwork

· Improve your practice’s preparedness and equipment availability in the event of an arrest

· Scheduled refresher training both online and hands on to keep your practice and team up to date

· Learn to be preemptive in preparing for anesthesia and to give prompt, high quality CPR should an anesthetic-related CPA occur since these patients have a significantly higher survival rate of 47%. (2,3)

If your practice is delivering anesthesia to patients, your team and clients will want you to be RECVOVER CPR certified.

· Acquire communication skills that will help you and your team learn to communicate with respect and clarity in a collaborative manner

· Give constructive feedback to each other 

· Use closed loop communication

· Learn to lead 

Our courses have an element of fun and humor to help you remember what you’ve learned, with unexpected surprises throughout the course to keep everyone engaged!


Contact https://www.respondcprveterinaryteam.com to schedule a hands-on training! We look forward to training with you!


1. Fletcher DJ, Boller M, Brainard BM, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR—Part 7: Clinical guidelines. J Vet Emerg Crit Care 2012; 22(S1):S102-S131.

2. Fletcher DJ, Boller M, Brainard BM, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR—Part 7: Clinical guidelines. J Vet Emerg Crit Care 2012; 22(S1):S102-S131.

3. McMichael MA, Herring J, Fletcher DJ, et al. RECOVER evidence and knowledge gap analysis on veterinary CPR—Part 2: Preparedness and prevention. J Vet Emerg Crit Care 2012; 22(S1):S13-S25.


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