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Cert VNECC Sample Question Feb 16 vs Page 1 of 6 Open Learning Assignment: SAMPLE Please complete the following assignment and upload it for marking by your tutor. Advised minimum word count ~ 1200- 1500 words (excluding questions, assignment instructions, reference and bibliography list). Resuscitation A 7 year old male West Highland White Terrier, Mac, is brought to your clinic as an emergency. His owners reported that he was very dull that morning, did not want to eat and was reluctant to move. They were concerned ‘he had maybe eaten something he shouldn’t have on his walk the previous night’. As Mac is being carried through to the consulting room, he retches and then collapses. He is not breathing and you cannot detect a heartbeat or pulse. a. Discuss, using supporting references, the initial approach to a patient like Mac in cardiopulmonary arrest (CPA). b. Discuss the role of capnography in monitoring the success of CPR ******* c. Discuss how the effectiveness of CPR could be assessed******* MODEL ANSWER- PASS a. The main goal of the Reassessment Campaign on Veterinary Resuscitation (RECOVER) initiative was to develop a set of clinical consensus guidelines for the practice of CPR in dogs and cats based upon an extensive, systematic review of the literature (Fletcher et al., 2012). The current guidance for how to manage dogs and cats with cardiopulmonary arrest (CPA) is found within the RECOVER guidelines which were created in an attempt to standardise treatment of veterinary patients with CPA; and improve their chances of recovery (Cornell University College of Veterinary Medicine, 2014). Commented [LK1]: Well done- good to introduce with a direct quote from this reliable source. Try to avoid too many direct quotes though. It is good to show evidence of research by rewording (paraphrasing) the source but make it clear it is someone else’s words by referencing. Commented [LK2]: Good- it is essential that you refer to this resource Unit 1: Sample submission Model answer

Cert VNECC Sample Question Feb 16 vs Page 2 of 6 It is recognised (O’Dwyer, 2014) that being prepared for such an emergency situation is crucial, if meaningful patient survival is to be achieved. A team approach is most likely to be successful, especially where the protocol has been well-rehearsed and everyone is aware of their role (O’Dwyer, 2014). In general practice, there is unlikely to be a full team of people available to assist but Aldridge and O’Dwyer (2013) recommend that a minimum of 2 people are required: O’Dwyer, (2014) suggests that in smaller practice, additional staff remembers e.g. receptionist could be trained in CPR. Where possible there should be a team leader to coordinate the CPR effort (O’Dwyer, 2014). Aldridge and O’Dwyer (2013) explain that the aim of cardiopulmonary pulmonary resuscitation (CPR) is to provide support to the cardiovascular and respiratory system, whilst performing procedures intended to encourage return of spontaneous circulation (ROSC). The ultimate aim is to have an animal with normal neurological function. Additionally, Aldridge and O’Dwyer 2013 explain that the purpose of CPR is to ensure provision of oxygen to the vital organs especially the brain: consequently, other than in cases of asphyxiation, there has been a shift from the traditional airway, breathing circulation (ABC) approach to a circulation/airway and breathing (CAB). Immediately it is suspected/ known that Mac has developed CPA, it is important to shout for assistance and note the time. As discussed by Fletcher et al. (2012), in Mac’s situation, it is imperative to start basic life support (BLS), with high quality chest compressions, immediately. An uninterrupted, two minute cycle of cardiac compressions should commence at a rate of 100-120 compressions/minute. The ACVECC (2012) algorithm, outlines the recommended protocol to be followed. Mac should be quickly placed in lateral recumbency, on a hard surface, either on the floor or a nearby table, as long as the table is not so high that it prevents meaningful compressions, or is adjustable. Cardiac compressions should not be delayed by moving Mac: if he needs to be moved cardiac compressions should continue without interruption. O’Dwyer (2014) explains that cardiac compressions should be started Commented [LK3]: How could you be prepared? Commented [LK4]: True. Commented [LK5]: Good Commented [LK6]: Why? Try to fully explain your answers to show your true knowledge and understanding. Commented [LK7]: Good. Why is this number recommended? Commented [LK8]: Why a hard surface?

Cert VNECC Sample Question Feb 16 vs Page 3 of 6 immediately with the aim of providing an effective circulation: any delay decreases the likelihood of return to spontaneous circulation (ROSC). In a dog of Mac’s size, unless he is barrel-chested, compressions should be provided directly over the heart, with a compression depth of 1/3–1/2 the width of the thorax (O’Dwyer, 2014). It is important to allow for full recoil of the chest. In larger dogs, the thoracic pump technique should be performed, at the same rate, but at the highest point of the thorax (O’Dwyer, 2013). To maintain the quality of the chest compressions the person performing them should, ideally, be replaced after 2 minutes (Fletcher et al., 2012). Having instigated circulatory support, the next priority is ventilation. Mac’s head and neck should be extended, an ET tube placed and intermittent positive pressure ventilations (IPPV) provided at a rate of 10/minute, with a tidal volume of 10 ml/kg and an inspiratory time of 1 second. It is important not to hyperventilate him as decreased arterial carbon dioxide levels (PaCO2) can lead to vasoconstriction of cerebral arteries and decreased perfusion (O’Dwyer, 2014). In addition, monitoring should be instigated as soon as feasible (ACVECC, 2012): ideally this should be by electrocardiography (ECG) and capnography. Once BLS has been started, if possible, additional staff should prepare for and start advanced life support (ALS) (O’Dwyer, 2014). In addition to monitoring, this involves the use of drug therapy and defibrillation if available. (672 words) REFERENCE LIST ACVECC (2012) CPR Algorithm http://www.acvecc-recover.org/ accessed 4.2.16 Aldridge, P. and O’Dwyer, L. (2013) Practical Emergency and Critical Care Veterinary Nursing. Chichester: Wiley Commented [LK9]: Why? Commented [LK10]: Well done! This is very well-researched and relevant material. Commented [LK11]: This is a very well-compiled reference list. It is good that you have used the correct Harvard protocol and used a good variety of reliable, credible and current sources.

Cert VNECC Sample Question Feb 16 vs Page 4 of 6 Cornell University College of Veterinary Medicine (2014) Penn/Cornell Research Spearheads the Development of New Guidelines for Veterinary CPR http://www.vet.cornell.edu/news/recover.cfm accessed 4.2.16 Fletcher, D. J., Boller, M., Brainard, B. M., Haskins, S. C., Hopper, K., McMichael, M. A., Rozanski, E. A., Rush, J. E. and Smarick, S. D. (2012), RECOVER evidence and knowledge gap analysis on veterinary CPR. Part 7: Clinical guidelines. Journal of Veterinary Emergency and Critical Care, 22: S102–S131. doi: 10.1111/j.1476-4431.2012.00757.x http://onlinelibrary.wiley.com/doi/10.1111/j.1476-4431.2012.00757.x/full accessed 2.2.16 O’Dwyer, L. (2013) An Update on Veterinary CPR http://ecpd-vetnurse.com/wp-content/uploads/2013/03/An-Update-on-Veterinary-CPR.pdf accessed 4.2.15 O’Dwyer, L. (2014) Preparation and Techniques for Cardiopulmonary Resuscitation http://www.vettimes.co.uk/article/preparation-and-techniques-for-cardiopulmonary-resuscitation/ accessed 4.2.15 BIBLIOGRAPHY LIST Davis, H. (2007) Cardiopulmonary Cerebrovascular Resuscitation. In Battaglia, A. ed. Small Animal Emergency and Critical Care for Technicians. Missouri: Saunders Elsevier. Commented [LK12]: SUMMARY COMMENT. Well done, Laura! This is an excellent first assignment. It is very well-written and supported by very good evidence of appropriate research. You have demonstrated a very good knowledge and understanding of this important area. I have added some comments and questions for you to note. If you have any comments/questions, please do not hesitate to contact me. Keep it up! Thanks Laura

Cert VNECC Sample Question Feb 16 vs Page 5 of 6 POOR ANSWER- RESUBMIT b. Discuss the role of capnography in monitoring the success of CPR Capnograpphy is important in patients in CPA. Capnography is the monitoring of the concentration of exhaled carbon dioxide (CO2) by a patient. This measurement allows us as vets or veterinary nurses to assess the physiological status of our patient and, therefore, determine the adequacy of ventilation during anaesthesia. It not only provides information about CO2 production, but also pulmonary perfusion, alveolar ventilation, respiratory patterns and elimination of CO2 from the anaesthetic circuit and ventilator. It is proven that using capnography, especially in conjunction with pulse oximetry, is effective in the early detection of adverse respiratory events and, therefore, preventing avoidable anaesthetic emergencies says Amy Thorne in the Veterinary Times article that she wrote in 2009. Capnography is the monitoring of the concentration or partial pressure of carbon dioxide (CO 2) in the respiratory gases. Its main development has been as a monitoring tool for use during anesthesia and intensive care. It is usually presented as a graph of expiratory CO 2 (measured in millimeters of mercury, "mmHg") plotted against time, or, less commonly, but more usefully, expired volume. The plot may also show the inspired CO 2, which is of interest when rebreathing systems are being used (from Wikipaedia) I think capnography is not very helpful. It is very hard to undersntad the tracing and set up the equipment. The beeping can be irritating and sometimes the trace is confusing. ………… In our practice we don’t have a capnograph machine- this means that we cant monitor ptients well enough. Commented [LK13]: Watch the spelling- please remember to spellcheck before you submit. Commented [LK14]: Why is it important? What does it do and why is it useful? If you explain your answers, it helps you to learn and it shows you really know and understand what you are writing about. Commented [LK15]: It is very important to make it clear when you have used another author’s words. A direct quote should be placed in italics or apostrophes. The reference technique is not correct- it should have been the quote followed by ‘…..’ Thorne, (2009). The full author and journal details are located in the reference list. Please try to avoid using large chunks of another author’s work. This does not show that YOU know or understand the subject. It is far better for you to research using a credible source and then reword what the author is saying into your own words (paraphrasing). You show that you are not claiming to have written this entirely yourself by acknowledging the author…As discussed by Thorne (2009) capnography is ……. Commented [LK16]: As above, it is important not to use a large direct quote. Please keep the formatting and font the same throughout. Hyperlinks should be removed. While Wikipedia may help you research your answer, it is not recommended that you use it for referencing in your assignment. As Wikipedia entries can be altered, they cannot be considered to be credible or reliable sources. Commented [LK17]: The assignments should be written in the third person. Unless what you have said is supported by evidence that you have researched, i.e. a reference, this sounds like your personal opinion and it does not have any credibility. Commented [LK18]: Watch the spelling. Commented [LK19]: Please watch the spelling. Also avoid making judgements. Remember the most important monitoring tool is a well-trained, knowledgeable individual who knows what to look for, understands the importance of close, regular monitoring, the significance of any changes and how to react should these be noticed.

Cert VNECC Sample Question Feb 16 vs Page 6 of 6 In the Veterinary Nursing, 2003 book, artificial respiration is described. It is important that this is done correctly. I think capnography is important but it has some problems. References http://www.vettimes.co.uk/article/how-using-capnography-can-help-prevent-anaesthetic-emergencies/ Wikipedia https://en.wikipedia.org/wiki/Capnography Vet nursing textbook by David Lane and Barbera Cooper Commented [LK20]: Whilst this is a very good book, there are many more up to date books/journal/ websites that could be accessed. There have been huge developments in veterinary ECC in the past few years and it is important to read up to date (current) sources, credible (dependable/ valid) sources to ensure you have the best information. Commented [LK21]: The current terminology is intermittent positive pressure ventilation (IPPV) Commented [LK22]: That is true but why? If you explain, it shows that you understand. Commented [LK23]: SUMMARY COMMENT Laura, what you have included is generally good. Unfortunately, you have not discussed the subject in sufficient detail to show that you really know and understand. Please see all my comments in relation to the use of quotes and how to reference. I am going to have to ask you to resubmit- this is not a fail but your assignment needs some work to meet the standards required for the qualification. Please note all my comments and questions. All new material should be added in red. This assignment should be resubmitted within 2 weeks and before you start the next unit. I hope this is all clear. If you have any queries, please do contact me as we want to support our students in achieving this qualification. The greater the effort, you put into the assignments, the better you are likely to be prepared for the exams at the end  Thanks Laura Commented [LK24]: Well done for including a conclusion- it is somewhat brief. Why is it important? What are the problems? Commented [LK26]: This needs to be referenced correctly. The author name, date and title of the article is required. You should also state when the article was last accessed- Thorne, A. (2009) How Using Capnography can Help Prevent Anaesthetic Emergencies http://www.vettimes.co.uk/article/how-using-capnography-can-help-prevent-anaesthetic-emergencies/ accessed 4.2.16 Please refer to this source for guidance http://libweb.anglia.ac.uk/referencing/harvard.htm Commented [LK25]: Before the next submission, please address the referencing otherwise you will be asked to resubmit. Commented [LK27]: Again this is not the correct technique Commented [LK28]: This is wrong, it should be Denis. This is also not the correct Harvard referencing technique. You need to include the author of the chapter, the year written, the title of the chapter, the editors, the place published and the publisher. Please refer to this source for guidance http://libweb.anglia.ac.uk/referencing/harvard.htm ...Commented [LK29]: You must spell the author/editor’s name correctly.