OPINION: introduction to CPR

I had several aims when going into my internship, ranging from increasing my confidence with ultrasound scanning and x-ray interpretation to honing the basics of triaging emergencies.

And while it is mostly true that a lot of what you get out of an internship is what you put in – that is, reading up on topics ahead of time, asking questions and always actively seeking opportunities to practice your skills – I was not expecting the large amount of passive learning that has come from the first half of the year.

What I mean by this is that by simply being surrounded by cases that are generally more complicated, intensive and life-threatening than you would regularly see in first opinion, I have experienced a noticeable reduction in that large surge of adrenaline that used to seize my new-grad heart at the mere announcement of a new emergency, or when I’d walk in to find our kennels chock-full of inpatients.

The exposure alone has been a very effective teacher, for which I am so grateful – even when it comes to the cases that don’t go to plan. For most of my career so far, I had been fortunate enough not to be present for any CPR events, in the specialist hospital environment or in my previous job, and so the universe of-course saw fit to send my first crash scenario my way in an OOH setting.

Whether an animal acutely deteriorates in the normal 9-5 or during OOH, the protocol is largely the same. A priority is made to initiate basic life support, followed by advanced life support including monitoring and emergency medications. It was not until this experience that I could fully appreciate how training for these scenarios can only take you so far, and that there really is no substitute for a real-life event.

Adrenaline kicks in for every member of the team, no matter their experience. Contacting owners out of hours can be a difficult task, and interpreting an ECG is never as simple as the study examples would have you believe.

I think that the post-CPR experience is also an event in and of itself. Whether it’s your first or your 100th, it affects the people involved in very unpredictable ways. I felt a lot of emotions following my first Crash event, and being able to talk to senior members of my team did a lot to help me work through that- another thing I’m infinitely grateful for.

There’s also no getting away from the truth that, whatever the outcome of CPR, you learn from the experience, and it will make you more prepared and more resilient for the next one. That can be a hard pill to swallow in the moment because as vets we always strive for excellence, and losing a patient is never easy.

In the setting of veterinary medicine, for patients that do not crash while intubated and under general anaesthesia, survival to discharge is just 5% to 6%. Of course, as a cohort of perfectionists this figure is disturbing, and can be difficult to accept. But those 5% to 6% also come from the lessons that are learned in the times we are unfortunately unable to bring a patient back, and it’s only by being kind to ourselves, reflecting, observing and improving, rather than beating ourselves up, that we will ever move that number in the right direction.