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Hello everybody, and welcome. Welcome to the Baker Institute for Animal Health and the Cornell Feline Health Center. And welcome to Baker Pet Talks. And our topic tonight, is, as you know, pet CPR. Our specialists on hand is Dr. Dan Fletcher. But first, I'd like to introduce the Institute and Feline Health Center's director, Dr. Luis Schang.
[APPLAUSE]
DR. LUIS SCHANG: Good evening, everybody. Thank you very much for coming. I will try not to take up much of your time. Thank you very much for your presence here. As you were just introduced, the talk is being organized by the Baker Institute. And the Baker Institute, for all of you who don't know about it, is [INAUDIBLE] researchers. So some of you may wonder why our institute is giving a talk about pet CPR. The short answer is because we care. The long answer, I'm going to spend a couple of minutes explaining what we do here.
Here we do research, active research, which is-- if you want an analogy-- like the voyagers of discovery out of Europe in the Renaissance or the Lewis and Clark expedition. We go into the unknown. There are no charts. There are no maps. We don't know what we're going to find. After we find it, many people will come after and will go to those places because of what we have found, and it will be useful for many people. But at the time when we are going, we don't know where we are going.
Now, the difference between what we do and what many other institutes do with our research, we keep our feet on the ground, with you, with the pets, with everything. We're trying to find out what are the problems right here, right that what we are doing may be useful. So we try to keep wonderful colleagues [INAUDIBLE] making the discovery and trying to find out how that this useful.
We live in this day. While it has never been easy, these days it's not any easier. It's difficult to get the money and the resources to do those things and so forth. But we all think that it's worth it. And there are many examples of the very important discoveries that have been made with [INAUDIBLE]. Speaking about [INAUDIBLE] we have quite a few dogs here. I'm sure everybody has heard about parvo virus. And the ones who are old enough, like myself, would remember that [INAUDIBLE] and the antiviral was discovered, the vaccine was developed, just to give to one example. But [INAUDIBLE] quite a few of us will remember that time.
OK, I'm not going to take any more of your time because it's actually my main project to talk about Fletcher, who is our guest speaker. We're extremely happy. Thank you very much for coming and for giving your time. And he has been practicing animal medicine since 2003 in the [? departments ?] of emergency and critical care. And I want to emphasize that actually, you're going to get a talk about CPR in pets by one of the co-chairs of the committee that actually is writing the guidelines of evidence-based CPR in pets. So it's just coming from anybody. It's literally one of the world experts, or the world expert, which by the way, you'll likely know that if you come to Cornell University and the College of Veterinary Medicine, you can find expertise in almost any area, [INAUDIBLE].
So but coming from Cornell, I have to recognize he came from the competition, from the University of California at Davis. He has [INAUDIBLE] University of California at Davis. And he did his residency at University of Pennsylvania. He worked through all the competition before actually coming to see the light at Cornell.
[LAUGHTER]
Thank you very much. [INAUDIBLE]
DR. DANIEL FLETCHER: Great. Thank you very much.
[APPLAUSE]
Thanks. I'm very excited to see so many people out there in the audience, especially because it's a beautiful sunny evening, and I was worried that it was going to be me and two people from the institute. And my parents are watching online, so I figured they would be here too. And I'm hoping my parents are watching online. We'll see. Hi, Mom and Dad, if you're there. They often have difficulty with the computer, and I'm their tech support. So if they're stuck, they're going to be in a little bit of trouble.
But what we're going to talk about tonight is pet CPR. So what I'm going to try to go through tonight with you are some of the basic things that you can do at home if your pet were to suddenly collapse. The goal here is to try to keep some blood flowing and keep some oxygen going to the tissues long enough for you to get your pet to the vet.
I am not going to teach you how to save your pet and fix them all at home. Right? So you can't fix this at home. If your pet suddenly collapses, the most important thing is you need to get them to the closest vet as soon as possible. So what we're going to talk about tonight are hopefully some things that you can do to maximize the chance you can keep things going long enough to get to the vet, to get the primary problem fixed. And we'll talk about some of the things that can lead to this problem in dogs and cats. And some of the things are not so bad, and some of the things are pretty bad. And whether we get these patients back depends largely on what caused this to happen in the first place.
So how many of you have seen this video online of a boxer who-- usually the headline is something like, Trainer Saves Dog with CPR, something like that. I don't know if any of you have seen it. I'm going to go ahead and play the video of it. So this dog collapsed suddenly out there. Someone started doing CPR on him. And at the end of the video, you'll see that he actually will jump up and start to move around again. And this was a successful attempt at getting this patient back.
So have any of you have seen this online? Yeah, OK, so a few of you have. It was on CNN and all different kinds of places. And it shows up for a while, and then it goes away again. So he's doing some mouth-to-snout breathing for the dog. And then you see the dog moved a little bit there. And then ultimately, the owner will come back over. And you'll see that this patient, this pet, actually survives.
So the take home message, I think, that most people come away from this with is CPR can work. Right? So you see this and you're like, yay, CPR can work. This is so exciting.
What I would like you to do is keep this picture in your mind. And as we go through this lecture for the next little while and we talk about the things that we have to do in order to get a patient back, I want you to decide did CPR really work in this situation or not. So we're going to talk a little bit about the way we do CPR. And then we're going to come back to this at the end. This is going to be your final exam, to point out where maybe some of these things weren't done quite the way we recommend.
So you guys are all here tonight to learn how we do CPR in pets. And there's a little dirty secret about this. And the reality is that until 2012, we didn't really know how to do CPR in pets, which is a little bit scary.
So in human medicine for decades now, there's been an organization called the International Liaison Committee on Resuscitation that every five years or so goes through all the information we've collected in those last five years about how best to do CPR on people. And they develop evidence-based guidelines for CPR. And they release them to the public. And training is done for all the people in human medicine about how to do CPR.
In veterinary medicine, we've never had that before. Every five years or so when these guidelines would come out, somebody would read that paper. And then they would write something about how maybe we should do it in dogs and cats. But nobody actually went through that process trying to figure out how do we best do CPR on dogs and cats until about 2011. And that's where this RECOVER Initiative came from.
So this is just a very busy diagram that I don't want you to get too bogged down in. The point of this is that this was an initiative that was carried out by over 100 board-certified veterinary specialists from all over the world who decided we really wanted to get to the bottom of what is the best way to do CPR on dogs and cats. And we wanted to figure that out by looking at all the information that was out there. And so this is just a diagram that's trying to show these groups of people who worked on this for over a year to try to come up with these guidelines.
At the end of the day, we asked 74 specific questions that we researched and read every paper we could find on each of those 74 questions. And ultimately, this yielded 101 specific guidelines about how to do CPR. So I hope you guys had some caffeine before you came in, because we have 101 things to get through. No, just kidding. We're not going to talk about all 101 tonight. I promise.
But there was a lot that we looked at here. And again, the thing that was a little bit different this time is we went back, and these groups of people read that primary research and really tried to figure out how do we adapt this to dogs and cats. There's some research in dogs and cats. But mostly, we're trying to adapt to what we're learning from studies that have been done on people.
One thing that was beneficial to us is a lot of the experimental research in CPR that was done initially back in the early '80s was done in dogs. So there's a lot of data from dogs. It's experimental data, but it's data that maybe applies a little more directly. So we do have some information to pull from. And now that CPR is being talked about a lot more in veterinary medicine, it's kind of exciting because new studies are coming out, clinical studies specifically, about how to do CPR in dogs and cats and what things we might be able to do even better than what we figured out in 2012. So I think the future is bright.
The bad news is everything I teach you tonight is probably going to change again in five years. Right? So you're going to have to come back again to the Baker Institute and learn how to do it again. So what I'm going to teach you tonight is what we know now. But science is always changing. We're always learning more. And the only way to stay abreast is to keep your ears open and to continue doing that research. And as Luis brought up, that's why institutions like Cornell exist, because we want to keep pushing those boundaries. We want to learn how to do things better. And things are always going to change. So it's exciting times. It's fun for us.
So ultimately, this was published in 2012 in the Journal of Veterinary Emergency and Critical Care in a special issue. We had seven different papers in this issue that we put together to really describe how to do CPR. And what we're going to talk about tonight is just some of the pieces of that, what we learned, and how best to try to keep your pet alive while you're trying to get him to the vet if something like this were to happen.
So why is this important? It's important because I'm sure you're all aware that Dr. Google has lots of answers to lots of questions. So if you go to Google and you enter "pet CPR," you're going to get millions of hits. Right? And you can click on links, and you can read all kinds of stuff that's out there that people say you should do. And they'll say it very definitively and with great authority. But the reality is that, again, until very recently, that was all just made up. That was just somebody's personal opinion. So it's really important to think about, no matter what you're reading on the internet, but especially if you're thinking about something related to your health or your pet's health, to really understand where it's coming from and make sure that you're comfortable that it's actually real information and then it's based on something.
And that's why we felt this was so important. And really, where this came from, the RECOVERY Initiative was from two specialty organizations in veterinary medicine-- the American College of Veterinary Emergency and Critical Care-- and this is a group of board-certified specialists like me who did a lot of advanced training in emergency and critical care-- and then the Veterinary Emergency and Critical Care Society, which is the sister organization to the American College. And these are people who aren't board-certified, but who have a special interest in emergency and critical care medicine. And these organizations are what the RECOVER Initiative came out of.
You may be wondering what RECOVER stands for. It's the Re-assessment Campaign on Veterinary Resuscitation. We came up with RECOVER first, and then we tried to figure out words that would make it work, like most acronyms do. So we liked the recover part, and then we made something up that worked. But that's where it comes from. And RECOVERY is easier to say than all those other things.
So at the end of the day, this is an important thing to remember. Right? Everything you read on the internet is not going to be correct. So make sure you're thinking about where the source comes from. And the stuff I'm going to teach you tonight, again, came from a lot of hard work by a lot of people who are really invested in this and who really looked at the science behind it. So just be cautious if you see other things out there, really about anything.
OK, so where do we start? Where do we start when we're thinking about doing CPR? So the question first is, do they need CPR? / So these guys looked like they've collapsed. Right? Hopefully, hopefully though, these guys don't need CPR. They're just taking a nap. So the first question is, if you find a pet who's unresponsive on the ground, how do you figure out whether that pet actually needs to have CPR or not?
So this leads to the question of the unresponsive pet, which is scary for you as a pet owner for sure, if you find your pet collapsed and unresponsive. But I will tell you as a veterinarian who's been doing emergency and critical care medicine for almost 15 years, it makes me nervous too. It's really scary when you have this pet who you can't figure out what's going on with. It's just suddenly not responding to you.
So we have to think in terms of an approach to that unresponsive pet. Our top priority initially has to be has this patient experienced what we call a cardiopulmonary arrest, or CPA? And cardiopulmonary arrest means that the heart has stopped beating, and the pet's not breathing. That means there's no blood flow to the tissues. There is no oxygen being delivered to the tissues. And those tissues are going to start to die very quickly. So if it happened very suddenly and we don't do something about it quickly, this is going to become irreversible, and we're not going to be able to save this animal.
So rapid recognition, really, really critical. Seconds count, and minutes are deadly. Within about four minutes of an arrest, if you haven't started CPR, it's pretty much game over. So that means you don't have time to take this pet who's collapsed, load him in the car, and not do anything until you get to your vet, because by the time you get there, it's probably going to be too late, even if it's something that is sudden and reversible. And that's why knowing the basic skills of how to do CPR is so important once you've identified that the patient has experienced a cardiopulmonary arrest.
So why do pets experience cardiopulmonary arrest? Generally, they aren't good things. There are many different reasons that can cause an animal to experience them. So we have to think about when is it likely to be treatable, and when is it likely to not be treatable.
Treatable things are things like choking. So dogs and cats like to chew on things they shouldn't. And if it gets stuck in the airway and it blocks airflow, then once the patient stops being able to get air into the lungs, the heart will stop beating, and they'll experience a cardiopulmonary arrest. If you figure that out really quickly and you support them, you can turn that kind of thing around.
Things like irregular heart rhythm, some dogs are predisposed to that. We have a cardiologist in the audience who can tell you all about it. But there are some dogs who have this irregularity in their heart rhythm that can cause them to suddenly collapse. And if it's bad enough, it can cause the heart to stop. And in those cases, if we can get the blood flowing again, we might be able to turn those around. And that's probably most akin to the sudden cardiopulmonary arrest that happens to people in public. When a person collapses in public somewhere very suddenly, it's often because of an irregular heart rhythm. And dogs can get that too. It's just not quite as common.
Things like trauma-- so trauma's a little bit of a double-edged sword. If it's really, really bad trauma, we probably can't turn that around. But if it's a trauma that caused some very sudden, but reversible problem in that pet, it may be that doing CPR while we're getting him to the vet may allow us to identify the problem and turn it around. And then really, any reversible disease-- so if there's a disease that's developed in a pet that we know it's something that can be reversed, like a sudden drop in blood sugar or other electrolyte problems, things like that that happen very suddenly, maybe we can turn those around if we can keep them alive long enough to get them to the vet.
But there may be things that are not treatable. And I don't want you to feel like you're going to leave here and be able to resurrect any animal that collapses. Right? So there are definitely things that won't be treatable. And that's going to be things like pets who have ongoing diseases that are progressing over time, and ultimately, it has taken that pet's life. We're not going to be able to turn that around with CPR. And then if it's a severe injury or a severe illness, even if it comes on very suddenly, we may not be able to turn it around. So I don't want you to think that I'm saying you can save every pet that collapses out there. The key point is, if it's something very sudden and something reversible, we may have a chance. And that's where this might help you and get you to the vet in time to turn things around.
OK. So what do we do? If you find your pet unresponsive, how do you deal with that? The first step is to make sure they're not just taking a nap. Right? So we don't want to start CPR on a dog that's just dozing or a cat that's just dozing. So the first step is to stimulate them. And you want to stimulate them pretty aggressively. Right? Shake them, call their names, and see if you get a response. If you get any kind of response from them, even if it's a weak response and it's not normal, they probably don't need CPR if they can respond to you.
But if you stimulate them, you call their names, and they don't respond, then your next step is to check the breathing. See if the pet's breathing or not. If the pet is breathing, if the chest is moving-- again, if he's not responsive, but he's breathing-- load him in the car and get him to the closest vet that's open, because he should be responsive. And if he's not responsive, he still needs to be seen. But if he's breathing, he doesn't need CPR.
If he's not breathing, the next step is to make sure that he can actually breathe, that he can get air in his through his windpipe into his lungs. And the way we're going to do that is by looking in the mouth. And you can see that happening in this cat here. We're going to open the mouth and get a good look in there. And this is just a little video that'll show you that. You want to pull that mouth open, grab the tongue, pull the tongue toward you and get a look all the way back to the back of the throat. And if you see something in there, you have to get it out. If you don't deobstruct that airway, there's no way you're going to turn this patient around. So you want to make sure there's nothing in there. Dogs like that get stuff stuck back there-- rawhides, balls, things like that. So if you see something like that, get it out.
Now, if you go to do this and he does any kind of responding to you-- if anything happens, he shows you any sign that he's alive-- stop. This is a great way to get yourself bitten. If you've got a really sick patient and you start messing around with his mouth, that's a great way. He won't even know that he's doing it. He might bite you. So any response at all, you stop right away.
So this is another good way to test whether he's truly arrested. You look and see if he's breathing. And then you're going to stimulate him even more by messing around with his mouth. But you want to make sure that you stop immediately if there's any sign of any kind of response.
If there's no response, then before you start CPR, the next thing you need to do is call for help. So especially for you as a pet owner at home, CPR is a team sport. It is not an individual sport. You need extra help, because really, your primary goal is to get that pet to the closest open veterinarian. And you can't do that while you're doing CPR. So you need help. If there's somebody else in the house, scream for them to come and help you while you get started. If there's not anybody in the house, grab your phone and call somebody to help you, and then start CPR on them. But you need to get somebody there to help you to get this pet to a vet. I cannot overemphasize that enough. You can't fix them at home. Cardiopulmonary arrest is really, really, really important to deal with. And you've got to get them to a vet.
OK, so then once we have identified that the patient has experienced a cardiopulmonary arrest and we've gotten help on the way, our next step is to start CPR. So CPR is actually pretty simple. We vets like to pretend that everything is really hard. But most of what we do is actually pretty simple. And this is no different. It's not hard to do this.
So it really consists of two things. The first thing we're going to do is chest compressions. We'll do 30 chest compressions, squeezing the chest. And the goal of that is to try to get blood flowing to the tissues. So the heart's not beating right now. I'm going to try to make up for that by pushing on the chest and squeezing the heart to get blood flowing. That's step one. And I'm going to do that 30 times.
Then after I do those 30 chest compressions, I'm going to pause and give two quick breaths through the nose. And we're going to talk about how to do both of these things in more detail in a second. So 30 chest compressions, two quick breaths. And then I'm going to go back and do 30 more chest compressions and two quick breaths and keep circling and circling and circling with that until I have someone there to help me and I get him in the car and take him to the vet. And I'm going to keep doing this in the car, if I can, on my way to the vet. OK? So it's really just chest compressions and breathing. And that's what we're going to spend most of our time talking about.
Then once the car gets there and you're ready to go, load that pet into the car and get him to the vet.
So it's unfortunate that for our pets, we don't have the same kinds of resources that we have for ourselves. So obviously, if a person experiences a cardiopulmonary arrest, hopefully, someone is around who knows how to do CPR and you call the ambulance. Right? And the ambulance comes and gets you. In most places in the United States and in the world, we don't have that option. And so that's why it's so important to call somebody to help you right away.
It would be great if we could call 911. Don't call 911. It's a waste of time. They're not going to come and help you, unfortunately. I wish they would. But they're not going to come and help you. So call somebody who can actually help you. Don't waste time calling 911. You got to get somebody who can get you to the vet.
OK, so we're going to talk about chest compressions first. So even when I speak to veterinarians and veterinary technicians who have all of the technology at their disposal, this is the thing that's most important. So you can have all the drugs and fancy equipment and everything in the world, and you will not turn a patient around who's had a cardiopulmonary arrest unless you do chest compressions correctly. And hopefully, by the end of tonight, you're going to be just as good as your vet at doing chest compressions because you'll learn the techniques behind doing it, and you'll get some practice at it.
So this is really important. It's not that difficult, but it's really important. And then we're going to spend some time talking about the right way to do this.
So the first thing to think about is your posture when you're doing chest compressions. And this is an example of really good posture for doing chest compressions. So there are four key things you want to think about. One is that you want to put one hand on top of the other and do your compressions that way. So you don't want to put your hand splayed off to the side. Hand over hand, fingers interlocked or interlaced. And you're going to focus the force of your compression on that heel of the hand that's touching the chest. And that's important because we're going to talk in a minute about where to push on the chest. But it's really important that you're pushing at the right location. And if you do this, you're going to spread it over the whole chest and you're not going to get an effective compression. So hand over hand, keep those fingers interlocked, and focus the force of the compression on that palm of that hand.
The next thing is you want to have your shoulders directly above your hands, and you want to keep your elbows locked. So your tendency, because it makes sense to you, is you're going to want to do compressions like this. Right? You're going to bend at the elbows. If you do that, the muscles you're using are going to be your biceps and your triceps, these are muscles.
I don't go to the gym nearly as often as I should. I'm sure all of you go more often than I do. But regardless of how often you go to the gym, these are not your strongest muscles. Where are your strongest muscles? Your core muscles, right? So these muscles here that hold you upright that you use every day when you're walking around. So the way we achieve compression is by bending at the waist and engaging those core muscles.
So in this mannequin here, the way we would do this, we want to get up high enough that we can keep those hands interlocked, shoulders directly above the hands, elbows locked. And I'm doing the compression by bending at the waist. OK? That's how I'm going to achieve that compression. I'm not doing this. I can't do nearly as effective a compression, and I'm going to get really tired. So I want to bend at the waist to achieve the compression. OK? So we're going to practice that in just a little bit. But that's the basic approach to how you need to position yourself to do an effective compression.
And this is the really hard part. It's exhausting. You don't have to go to the gym if you do this. So that's good. But you'll find you're going to get really tired. And it's always interesting in the clinic when my students do this for the first time, they're always like, holy crap. They're all sweaty and exhausted after doing that. So it's really a lot of work to do this. In a medium to large breed dog, you're going to have to push pretty much as hard as you can to get an effective compression. So you want to make it as easy as you can for yourself by using good posture to do it.
OK, so now we know how we're supposed to be, how do we actually do this? When we do the compression, we want to get a good deep compression, a third to a half the width of the chest. So this is my dog Henry. He is not arrested. He's just sleepy. And so I'm putting my hand there. So I need to compress a full third to half the width. So I want a good deep compression on this dog. So you have to push really hard on a dog of this size to get that depth of compression.
Now, the flip side of that is that this is not a dog. Well, none of these are dogs. This is not a dog. This is a cat, sort of. It's a little scary looking, I know. But cats are much smaller. Right? And they also have much softer chests. It's much easier to compress a cat chest. So if I were to do that same approach that I did in that dog, I can pretty much flatten this cat on the table right.
[BLOWS RASPBERRY]
Squat him on the table. And what I'm going to do if I do that is I'm going to just bruise the heart really badly. And I'm never going to get that guy back.
So in dogs, in medium to large breed dogs, the main problem is that we don't push hard enough, and we don't get a deep enough compression. In cats, it's the opposite problem. Sometimes we push too hard. So we don't ever want to go more than half the width of the chest. And we don't want to go less than a third the width of the chest. So that's something that's important to practice and think about and think about your own pets and how big they are.
But what you really want to be mindful of is the fact that if I'm standing here doing chest compressions, can I tell how deeply I'm compressing? Not really. It's really hard for me to see that from up here. So this is another reason CPR is a team sport. If your whole family is ready to go, you can watch each other and make sure you're not going too far and that you're going far enough in these cases.
The other thing that's important is to do chest compressions by kneeling or standing behind the pet. You don't want to do compressions from this side, because what you tend to do is you push the pet away from you. And he kind of walks across the floor. If you get behind him and do your compressions, you're more likely to sort of push him into you so he doesn't get away from you. So I'm pushing him towards me as opposed to away from me. The other problem is there are these leg things that get in the way when you're on the other side of the dog. And you have to lean way over to get to him. So it's much better to do it from behind the dog, like you see here.
And then we're going to shoot for about 100 to 120 compressions per minute. So that's fast. Right? That's two compressions every second. And that's important. This is sort of a newish guideline. And it's very interesting. In veterinary medicine, most people go to vet school. They learn how to do CPR, and they never learn about it again. And so many of our current veterinarians who have gray hair like me learned in vet school that they were supposed to do compressions at 60 per minute, so half this frequency. And what we know now based on research that's been done in the interim is that 60 beats per minute, you get almost nothing back. At 120 beats per minute, you do a whole lot better. You get much more effective blood flow.
So this is another reason it's important to keep up to date and make sure you know how things are changing and another reason that research is so important. We need to keep on top of this and just keep learning. And when we did 60, we thought that was the right thing to do. But that's not the case anymore. We know better now.
So that's going to look like this. We don't have audio, but it's very quiet. Well, she was counting out. Hopefully, the audio will get better. So she was doing those compressions pretty fast. I mean, she was counting out each one she was giving because she's going to give a total of 30.
But it's difficult. When you're doing compressions, how do you know you're going 100 to 120 per minute? That's difficult to know. And so the best thing to do is just to sing a song in your head. I think the best one is that one. Sorry, we tested the audio before this started, and it was working great. Now we seem to have lost it.
But anyway, so hopefully, you could barely hear in the background there, Stayin' Alive. So great song, good beat.
[SINGING] Ah, ah, ah, ah, stayin' alive.
So it works very well. It sends a good message to the pet. And I think it's a really good one.
So another song that has the right tempo is Another One Bites the Dust.
[SINGING] Another one bites the dust. Right? I don't like it though. It sends the wrong message. I want the good ones. So Stayin' Alive is a great one.
The problem is what I see all the time when I'm in my clinic and I see especially junior doctors and students doing this is they'll do compressions like this. Ah, ah, ah, ah, stayin' alive, stayin' alive, ah-- right? So you have to sing it at the right tempo. Pay attention to how you're singing it.
And that's another reason that CPR is a team sport. Right? You can look at each other. If you can tell that they're singing that song way too fast in their head, what I just do is start singing. I sing it out loud. Or I'll clap my hands to try to get them on the right tempo. So you want to watch each other and help each other out with those kinds of things.
That rate is very important. Going too slow is bad. Going too fast is bad. We want to right at that 100 to 120 per minute.
OK, so we talked about how we want ourselves to be organized? We've talked about the general approach to how to do these compressions? Then the next question is where do I push on the chest. And that is a little bit of a complicated question.
So in human medicine, it's very simple, because we're all shaped pretty much the same. We have wide chests that are not very deep. Right? We all have the same formation. And so there's one approach that works. How many of you have taken a human CPR course? I'm really happy to see so many of you have. It's really important to do. If you haven't, I really recommend it.
So you probably all learned. You put the patient on the back, and you put your hand right over the breastbone, right between the nipples. That's the place you do your compression. And you do them in the same place for every person.
The problem is, all of our pets don't look the same. Right? So we have this type of dog-- this is a Bernese Mountain Dog-- that is pretty wide and deep. It's a big dog. It's got a wide chest. It's also pretty deep. If you cut him in half, he looks round almost as opposed to this Greyhound, who has a very deep chest, but is very narrow. Right? He's a much, much skinnier than that Bernese Mountain dog. Then we have cats. And we talked a little bit about the fact that cats have very compliant or soft chests. They're very easy to compress. And then we have things like this. I don't know what to say about it. It's a bit of a genetic mystery, right? But shaped very differently than these other pets that we're looking at here.
So thinking that one approach to chest compressions is going to work equally well in each of those is probably pretty naive. It's probably not going to work that way. So we really have to think about what's the shape of the pet in order to determine where is the best place to push on the chest.
And at the end of the day, it comes down to four different basic shapes that we have to think about. So the most common that I see in my practice, because I live in Ithaca, New York, and it's in the country, and everybody's got big dogs, is these large round-chested dogs. And when I say round-chested, I mean basically that his chest is just about as wide as it is deep. And that's the way these dogs, these mannequins are set up.
So when he's laying on his side and you look at his chest, it looks like a dome. Right? This looks like the top of the capitol or something. It's a nice dome-shaped chest. That's what we call a round-chested dog.
In these dogs, if you think about doing chest compressions on an animal, what you're probably going to immediately think is OK, if I'm going to do a chest compression, I want to compress over the heart, as I'm trying to squeeze the heart. I want to get blood moving, so I'm going to go over the heart.
So if you look at this diagram though, you can see that if we focus the chest compressions right over the heart-- that's where this red arrow is right here-- if we push right here, yes, we're over the heart. But the problem is there's all this tissue on this part of the body wall-- the ribcage and all that muscle and all these tissues-- that I'm actually pushing against because he's got this round shape. It's almost like the edge of a box, right? And if I push right here over the heart, it's going to be very hard for me to very effectively squeeze his chest at all. There's just too much stuff in the way for me to get a good deep compression.
But if I move my hands back and up a little bit over to the highest point on the chest, I'm now in the middle of the top of the box. If I think about this as a box, I'm now in the middle up here. I have a lot more space that I can compress. I have a lot more compressible stuff that I'm pushing right over. And I can probably get a much deeper compression of that chest.
I'm not going to be directly squeezing the heart. But I am going to have my best chance at really compressing this chest and increasing the pressure inside of the chest. And that pressure is what's going to push the blood out to the tissues. So rather than thinking about going right over the heart, I really want to focus my compressions in this type of dog over the widest part of the chest.
So in this Bernese Mountain dog who's got this round conformation, I'm not going to focus my compressions right over the heart, which you can see here. I'm going to move back here. I'm going to feel over the chest for the highest point. And that's where I'm going to focus my compression. That's where I'm going to put my heel of my hand that's touching the chest. So in this case, in my dog Henry, it would be right over that location. Again, I'm just feeling for the highest point in the chest when he's laying on his side.
And definitely, we know that doing compressions in this type of dog on their side is going to be much better than doing it like they do in people. Rolling him up on his back and trying to do compressions this way is going to be really difficult. So this is not going to be effective. And there actually is a couple of studies looking at this. Much better to do it with them on their sides, not on their backs, when they have this type of conformation.
OK, then there are these keel-chested dogs, like this greyhound here. And in this case, rather than being round if you cut them in cross-section they're more triangular. They've got this deep, narrow chest. And so if I'm thinking about doing chest compressions in this guy, I don't have that wall of tissue down here that I have to fight against. And if I focus my compression right over the heart-- this has got this more triangular shape-- I'm actually probably going to get a pretty good compression of that heart and squeeze the blood directly out of the heart. So in this case, rather than moving my hands over the widest part, I want to go directly over the heart to try to squeeze the heart.
So how do I figure out where the heart is? You could count ribs and do all kinds of fancy things. But actually, the easiest thing to do is just to pull the elbow back until it goes about a third of the way up the chest. So if you think about the chest, starting from the bottom of the chest to the top of the spine, if you think about breaking this into a third, a third, a third, breaking it into thirds, if you pull that elbow up about a third of the way, that elbow is going to be pointing right over the heart. So take it up a third. That's your location. And you're going to focus your chest compression right there. OK? Really quick and easy thing to do when they're laying on their sides. So if your pet has more of a keel shape to the chest, that's the way you're going to figure out where you're going to do your compression.
OK, so then there's the mutant dog. Right? So this mutant dog-- interestingly, many bulldogs, not all, but many bulldogs, and many of these squishy-faced-- we call them brachycephalic-- but squishy-faced dogs will have this confirmation where they're actually shaped kind of like us. They're wide and not very deep. They're kind of narrow. Right? So they're wider than they are deep. And because of that, these guys actually might benefit from chest compressions the same way we do them in people, by flipping them up onto their backs and doing the compressions that way.
So my general rule is, if I have a dog like this and I flip him up on his back and he stays there, then I can usually do compressions that way. If I flip him on his back and he keeps rolling over to his side, he's probably not really flat-chested, and it's probably not going to work. So for many of these guys, we can do this flipping up on the back. Put your hands directly over the breastbone. You'll feel a nice solid piece of bone right there. And you'll push right there to try to get your compression. And that'll compress the heart directly.
So this is an example of a dog that has that conformation. So I don't know if any of you have seen this video. His brothers are like, what is going on over there? So this dog is sound asleep. And he's flat as a pancake. And I don't know how they were able-- and then he wakes up. He's like, whoa! What's going on? And he knocks the whole thing over.
So that kind of dog obviously can stay on his back. He fell asleep that way. And that would probably be the type of dog that we could do this type of chest compression on. But if he won't stay on his back, probably not. And you probably should do them on the side like the other round-chested dog.
OK, and then finally the fourth shape that we think about are associated with the small dogs and cats. And these guys are pretty much always going to have that keel-chested transformation, that narrow, triangular shape to the chest. And so in these guys, we're generally going to focus our compressions directly over the heart. In this case though, we can potentially, to try to minimize the chance that we're going to squeeze too hard, we can potentially try to do compressions with one hand, rather than that two-handed approach.
So same basic approach though-- identifying the heart in these patients, pull the elbow back until it goes about a third of the way up from the bottom of the chest up to the back, a third the way up. And that's going to be where the heart is. And that's where you're going to focus your compression on this guy.
So this is just an example of identifying that location and then doing that one-handed approach to do that chest compression. And again, if you're singing in your head--
(SINGING) Ah, ah, ah, ah, stayin' alive, stayin' alive.
So even in cats, we do that same rate, about 100 to 120 per minute.
The important thing when you're doing that type of compression is what you're going to want to do is this. Bring your fingers together like this. But if you squeeze like that on his chest, you're actually going to be squeezing at the base of the heart, not the actual ventricle, which is what contains all the blood. So when you do that compression, think about doing it like this. You're pulling your thumb against your hand and really squeezing, squeezing that ventricle, squeezing that blood up out of the heart and into the aorta and then out to the tissues. So this kind of approach is what we want to do. And you'll have a chance to practice this in a little bit.
OK, and then if you get tired though, or if it's a big cat-- like, my cat's pretty big. I think I would get tired pretty fast doing this-- you can do the two-handed approach instead, just like you do on a dog. You just have to be careful, again, not to overcompress because it is very easy to go too far in cats. So this is where having your buddy look at you and tell you whether you're going too deeply is going to be important. So a third to a half, no more than that.
OK, so that's chest compressions. Again, by far, the most important part of CPR. This is where we really need to make sure that we're comfortable and that we're doing it correctly because if we're not doing that part correctly, nothing else we can do is going to help. If we're not getting blood flow, the game is over. So we want to make sure we're doing that well.
So the guidelines for breathing in dogs and cats are a little different. So a lot of you raised your hands and said you had taken CPR courses for people. How many of you learned to give breaths to patients? OK, so actually, most of you did. How many of you learned just hands-only CPR? OK, a few of you did.
So the newer courses that are coming out now are focusing very much on what they call compression-only or hands-only CPR. So this the classic theme that you'll see around now, put out by the American Heart Association, Stayin' Alive theme, as you can see. We developed an online course. And we tried to license Stayin' Alive for the course. I'm not even going to tell you what they wanted to charge us for that. So the American Heart Association has a lot more money than we do. That's all I can say. But you can see, their goals when there's an acute cardiopulmonary arrest-- number one, call 911. Number two, hands-only CPR. And that's all they recommend. And in fact, this has taken off so much in human medicine that even Ryan Gosling has gotten into the facts here. So is this is something that is really being emphasized now in the human CPR guidelines.
So there are a couple of reasons for this. And I think it's important to understand the reasons and really understand why it's probably different in dogs and cats. At the end of the day, dogs and cats are not people. And these probably don't apply to us.
So the reason they've made this push in human medicine is number one, most people who have a sudden cardiopulmonary arrest in the wild, walking through the mall, and drop have it because they have an arrhythmia of the heart, and the heart stops pumping blood. So their heart stopped first, and then they stopped breathing because there was no blood flow to the brain to tell them that they needed to breathe. Because of that, the blood that's sitting in their arteries has got a lot of oxygen in it already. So if we just do compressions, we'll get that oxygenated blood moving around, getting out to the tissues. And we'll also, by compressing the chest, give them a little bit of ventilation. We'll squeeze the lungs, and we'll actually get some air flow. And we probably can do OK at least for some period of time.
In our dogs and cats, most of them, we think, have a primary respiratory arrest. That means they stop breathing first, and the heart stops because there's no oxygen in the blood that's getting to the tissues. And so the heart stops beating. So they have blood that has no oxygen in it in the arteries. So if we just start doing chest compressions, we'll get a little bit of oxygen in that blood, but probably not enough. So we really do think that it's important to do breathing, as well as chest compressions.
And this is true of children as well. So children who have sudden cardiopulmonary arrests often have those arrests because they stopped breathing primarily. And so the recommendations in human medicine for children are that you get ventilation going earlier. So our dogs and cats are more like kids than they are like adult people.
So that means that we recommend breathing for them. And that would be using this mouth-to-snout breathing approach. So again, as we said before, the plan is, you'll do 30 chest compressions first if you diagnose cardiopulmonary arrest. Then you'll do two quick breaths. I'm going to talk now about how to do that. And then you just keep cycling back and forth between those things-- 30 compressions, two breaths, 30 compressions, two breaths.
What's really important is that you don't compress the chest and breathe at the same time. So if someone is compressing on that chest and you have someone helping you and they blow into the nose at the same time someone's pushing on the chest really hard, where is that air going to go most likely? Will it go into the lungs? It probably won't, because we're squeezing the lungs. So where's that air likely going to go? It's going to go into the stomach. Right? So we're going to actually go into this esophagus rather than into the trachea and in the windpipe and go down into the stomach.
So in order to effectively give those breaths, you do have to pause compressions very briefly to give those two breaths. So really important to do that pause.
SPEAKER 1: Can I ask a question?
DANIEL FLETCHER: Yeah.
SPEAKER 2: Hi, we have folks tuning in online and there were a couple of questions.
DANIEL FLETCHER: Maybe it's my parents.
[LAUGHTER]
SPEAKER 1: Well, is your dad's name Carl?
DANIEL FLETCHER: No.
SPEAKER 1: OK.
[LAUGHTER]
Well, Carl asked, when you give chest compressions to a dog, isn't it easy to break a rib?
DANIEL FLETCHER: Good question. So it is. And we used to say-- we're a little hardcore in veterinary medicine. So we used to say, if you don't break a rib, you're not pushing hard enough. I don't think that's true. I think that hopefully it doesn't happen all that often. It can certainly happen though. It can certainly happen that you break the rib. As long as you're not going more than half the width of the chest though, it's a reasonable compromise. Right?
So I'd rather be alive with a broken rib than not alive. So that's why it does happen. I would say-- I hate this term-- but not uncommonly it happens. It's not the end of the world. It will heal if you get that pet back. So if you break a rib, it's OK. But if you do feel something pop, again, have somebody look at you and make sure you're not pushing too hard.
SPEAKER 1: OK. And the next question comes from Jeff. He asks, for a smallish dog that has a round chest, is there a rule of thumb based on the weight of the dog as to whether you use regular compression technique or just using the one-handed technique?
DANIEL FLETCHER: Sure. So dogs are a pain. Right? Unfortunately, we've done all kinds of crazy things with breeding dogs. And we've made all these different shapes and sizes of dogs. And sometimes, we do have small dogs that have a little bit more of a round chest. I think at the end of the day, it depends on how well you feel you can compress that chest. So most small dogs, regardless of breed, are going to mostly have that keel-chest conformation, most of them. There are definitely some that are going to be a little bit rounder. Most are going to have that keel-chest conformation.
If, however, you look at him and you're like, this is definitely round-- he's little, but it's round-- I would use that round-chested approach, which means you're pushing on the widest part of the chest. And that probably means you're not going to be able to do the one-handed approach. You're not going to be able to get your hand around and up far enough to do that. So most likely, you're going to have to use the two-handed approach focused over the highest point on the chest, but being very careful not to go more than half the width of the chest. So just be very careful with that in little dogs and cats. It's very easy to go too deep. Good questions from these online people. Excellent.
OK. So how do we do these mouth-to-snout breaths? The first step that's really important is close the mouth. So if you leave this mouth open and you blow into the nose, the air is going to go through the nose and right back out through the mouth. Right? So we have to close the mouth to prevent that air from just leaving right out through the mouth again. So you wrap your hand around and close it.
Then you want to make sure that the airway, that your windpipe, your trachea, is as straight as possible. If it's kinked at all, it's going to make it harder for the air to get into the lung and more likely for it to go into the stomach. So if you pull that head up to make it easy for you to give the breath, it's going to be really hard to get that air into the lungs. So the head has to be flat on the table. And you don't want the head tilted down or up. You want a nice straight line from the snout to the spine.
So this should be a straight line coming down here, which means you kind of have to stand on your head to do mouth-to-snout. If they're on the floor, deal with it. It's life. It's what you have to do. Right? But you have to get down there. Don't let yourself fall to that temptation to lift it up to make it easier for yourself. It's going to make the breath much less effective. So a nice straight line from the nose to the spine, just like you see in this cat here. And then, like I said, don't lift the head. That's going to be not a good thing.
And then once you have him in position, you're going to open your mouth, put it over both nostrils-- sounds fun, doesn't it?-- and make a seal. And then you're going to blow into the nose two times. And you're going to watch for the chest to move when you do that. You're expecting that you're going inflate those lungs, so blow hard and make sure that you see that chest come up. And give those breaths quickly. So that's the basic approach to mouth-to-snout breath.
So here is an example of that. So we close the mouth. We straighten it, keep it all the way down, and then blow. And you can see the chest move when she blows into the nose. And that's what you want to watch for as you're giving the breaths. So again, close that mouth, straighten it, and then two quick breaths into the nose. OK? So that's our approach.
She's so relaxed, isn't she's? Just like, I'm just going to blow into this dog's nose.
So this leads to the other point I wanted to make about the hands-only CPR. The other major reason that they did away with ventilation, mouth-to-mouth resuscitation in people is because they found in multiple studies that if someone had to do mouth-to-mouth, they just would not do CPR. Especially if it was someone they didn't know, they just wouldn't do it. And so by going to compression only, they actually increased compliance.
And this is something, every time I talk to people about doing CPR, I always bring it up. My experience so far in talking to people-- you usually have to talk to them more in private than in a public setting-- is they don't have any concern with putting their mouths over a dog or a cat's nose. We all see where dogs put their noses. And I understand if you have concerns. And they're reasonable concerns. But in the absence of having some kind of barrier that you can use, I think it really is important to do if you can stomach it. And hopefully your immune system is OK to take care of anything you pick up from the nose. OK?
OK. So putting all of these concepts about chest compressions and ventilations together, let's just take a look.
[VIDEO PLAYBACK]
- 25, 26, 27, 28, 29, 30. One, two, three four--
DANIEL FLETCHER: So she's counting out each compression because you want to make sure that you do 30. Nice and straight elbows, bending at the waist.
- 18, 19, 20, 21, 22, 23, 24, 25, 26--
DANIEL FLETCHER: And when she gets to 30, she's going to pause very briefly, two quick breaths with that that tongue sticking out. That's fun, isn't it? And then right back to those chest compressions. OK, so 30 compressions. Count them out loud. Otherwise, you'll miss them. And then do the two quick breaths.
[END PLAYBACK]
OK, so let's look now if you have two people, how to do it.
[VIDEO PLAYBACK]
- One, two, three, four--
DANIEL FLETCHER: So again, counting it out. It's much easier to do this with two people. So if you have two available, take advantage of both of them. The person breathing is going to do a lot of standing around.
- 18 19, 20, 21--
DANIEL FLETCHER: But you'll see that, as you're getting close to that 30 of compressions, get into position and you get ready to go. And as soon as they take the break, two quick breaths, and then immediately back to chest compressions. So minimizing those pauses in chest compressions, really important. That's why you want to get yourself into position.
And then after two minutes, if you have two people, you want to switch positions, because you're going to get really tired doing these compressions.
[END PLAYBACK]
So do them for two minutes. And then let someone else take-- swap the compressor and the ventilator so that you can maximize your ability to actually get through that. All right?
So that's what it's going to look like. And that's what you guys are going to practice in just a minute.
OK, so let's say we get started with this and the pet starts responding, either because he hadn't really arrested-- and when you start pounding on his chest, he's going to notice. I promise-- or because you're successful and you've gotten blood flow back, and the patient is now resuscitated. What are you going to do? Well, obviously, stop CPR right away. And then if the patient needed CPR or fooled you into thinking he needed CPR, you still want to get to the closest open vet at that point. So something is obviously not right here.
So something I hear a lot from folks is that they're scared to do it because they don't know for sure. They can convince themselves that the animal has actually arrested. And they're worried that they're going to do harm. So we don't have good data in veterinary medicine, unfortunately. But there's quite a bit of data in the human literature looking at what happens when a patient hasn't actually arrested and you start doing chest compressions on them. What's going to happen to that? How much injury is going to happen?
And it turns out that in less than 2% of cases is there any kind of serious injury like a rib fracture or a bruising of the lung. Less than 2% of the time that happens. Any idea why it's so infrequent? If somebody starts pounding on your chest, you're going to tell them. Right? So they're not going to lay there and not respond. If they are not really dead, they are going to tell you that it's happened.
So what we know for sure though is the longer we wait to start CPR in a patient who has arrested, the less likely we are to get them back. Like I said, within minutes it's game over if you don't get started. So the risks of starting are much less than the risks of not starting if the patient has truly arrested. Very, very low.
And about 12% of people say they have chest pain, not surprisingly. But less than 2% have any kind of serious injury associated with it. So because of that, we do recommend that very quick assessment at the beginning, no more than 10 to 15 seconds to decide is the airway clear and is he breathing or not. And then if you decide that he's not breathing, then you should get going on CPR right away. Waiting any longer is just going to reduce the risk that you get him through it.
OK, quiz time! Hopefully, you were all paying attention. Wake up! So looking at this patient, where would you do compressions on this patient? Just shout it out!
SPEAKER 3: The highest point.
DANIEL FLETCHER: The highest point? Everybody agree?
SPEAKER 4: Over the heart.
DANIEL FLETCHER: Over the heart. How many people say over the heart? How many people say the highest point? Yeah, so it's not so easy to tell from here. But looking at the top and the side, looking at the depth from that side view compared to the width from that top view, he's pretty keel-chested. He's pretty deep. And it's much easier to tell when you can see him in three dimensions instead of seeing him projected on the screen.
When you look at him laying on the table, if you see a dome, that's what we do over the widest point. If you see a ski slope, if it just sort of gradually goes up, but it doesn't make that dome, then that's more likely one of these keel-chested guys. OK? So if they're deeper than they are wide, you want to think about doing those compressions directly over the heart.
How about this guy? That's the highest point. Yeah, so this is the round-chested guy. So we're going to go over the highest point on the chest as he's laying on his side.
What about this one?
SPEAKER 5: Try it on the back.
DANIEL FLETCHER: OK, we can try it on the back. And then if we get her back, we can put a board on her and put some caps on her for fun. But yes, so this would be one that we would try probably on her back. She's got that very wide and not so deep chest.
SPEAKER 6: What about getting the dog between your legs?
DANIEL FLETCHER: Between your legs to do--
SPEAKER 6: To keep it on its back.
DANIEL FLETCHER: So if they won't stay on their backs though, I worry that they're not actually flat-chested. If they keep rolling over, I would guess they're probably more likely the round-chested conformation.
SPEAKER 6: Like a pug, not real wide.
DANIEL FLETCHER: Yeah, and if they're not real wide, you probably want to do it with them on their sides. Yeah, so if they won't stay on their backs, I would do it on the side like this. That's most likely what you're dealing with. Really, it's a very small percentage of dogs that are going to have this conformation. Mostly, they're English bulldogs. Those are the ones that I've seen that fit that build.
OK, I want you to watch this video. And I want you to tell me what they did wrong here.
[VIDEO PLAYBACK]
[PEOPLE SHOUT ANSWERS]
[END PLAYBACK]
You guys are so good. Yes, exactly. So they didn't pause compressions to do the breathing. Right? So where's all that air going to go? Into the stomach. It's not going to go into the lungs. So this is a great example of how not to do the ventilation. They're doing the compressions. That's great. But that ventilation was not going to be effective at all.
OK, so now we're going to go back to that video that we look-- oh, yeah. You have a question.
SPEAKER 7: Do the pets vomit like people do?
DANIEL FLETCHER: Do they vomit? I can't say I've seen-- so the vomiting requires an active thing. And if they're able to vomit, that probably means they're back. And I would stop at that point. They can have regurgitation, just a passive flow of stuff out. Lovely, I know. And I would maybe get out of the way if that happens. But if they're truly actively vomiting, then I would say they're probably back. And they should not be able to vomit if they truly arrested. But yeah, I would say not very often do we see regurgitation. But it's possible definitely.
OK, so this video is a little bit longer. But as you're watching it, if you see something that you think is a problem, I want you to call it out. And just shout it out to the world. Be proud.
[VIDEO PLAYBACK]
[PEOPLE SHOUT ANSWERS]
Oh, yeah. That's way too slow. Do you think it's deep enough?
CROWD: No.
DANIEL FLETCHER: No, no, these are not. And what do you think about his hands?
[PEOPLE SHOUT ANSWERS]
Spreading out the force over the whole chest, so not so ideal there. OK. What's he doing here?
[PEOPLE SHOUT ANSWERS]
So this is good, right? So he probably should have done that first. But he did it, so that's good.
[PEOPLE SHOUT ANSWERS]
OK, so he's making it really easy for himself, but not so good for the dog. Right? So that's not going to be such a wonderful way.
OK, we're back to these wonderful chest compressions. Probably aren't accomplishing a whole lot. And you can see at this point, the dog is starting to move a little bit. We're stimulating him a bit to see. He's looking around. And then he's going to lift his head up.
So they got this dog back. Do you think they got this dog back-- do you think there was great blood flow happening and that's why they got-- no, probably not. So most likely, what was going on with this case is he probably had an arrhythmia in his heart. He probably collapsed because his heart was beating kind of crazily. But I doubt this dog truly had arrested arrested. And I certainly think it's unlikely that that CPR is what got him back.
And I call this out only because this is on the internet all over the place. If you do a little search for a video of dog CPR, this is often at the very top of it. And this is just a great example of why it's so important to really think about where is this coming from, what's the source. Did somebody actually look at this and say this is right? This is sort of my secondary mission in my life right now is to make sure that people know that that's not the way you do CPR because you're not going to get a dog back doing CPR that way. So just keep that in your mind. And when you're looking at these things on the internet, think about where they came from.
It looks like we have another question from the internet.
SPEAKER 1: We do. We have a couple of questions and a comment. The comment is from your dad.
DANIEL FLETCHER: Oh, hi, Dad!
SPEAKER 1: He says, you're doing a great job. Keep it up. And we have a question from Tina, who says, what about flat-faced pups where it's hard to close their snout? Any variation there?
DANIEL FLETCHER: Yeah, so if they have-- malocclusion is what we call it, like the bottom jaw protrudes out over the-- either way, the top jaw or the bottom jaw protrude out. It can be really difficult to make that seal and hold that mouth closed. Do the best you can. That's all you can do. Could you grab some Saran Wrap around-- maybe. I don't know. I probably wouldn't do that. I would just squeeze it as well as you can.
SPEAKER 1: OK. And Jolene writes in and asks, are obese keel-shaped dogs, such as a greyhound, compressed over the heart? Or should they be compressed over the largest part due to the large amount of fat in the way?
DANIEL FLETCHER: [LAUGHS] Yeah, it's a good question. And this is true of cats too. Right? So most cats are keel-chested. But sometimes, when they get a little rotund, they'll be a little bit rounder when you look at them.
So the fat in the chest, most of the fat is on the outside of the actual ribcage. It's not inside of the ribcage pushing the ribcage out. It's just on the outside. So you could make the argument that if the animal has that conformation, it probably still makes sense to focus your compression over the heart because basically, you'll push the fat, which will then push the chest wall and compress that heart. So I would still, based on that conformation, stick with what the lean dog or cat would look like. It's a great question though.
SPEAKER 1: And the last one, or the last one for now, is when do you check for pulse or respiration? Kittens and older cats, with two fingers and quick puffs?
DANIEL FLETCHER: OK, good question too. When do I check a pulse? So I check a pulse only if they're moving around. So interestingly, even among trained health care professionals-- and again, human data. We don't have good data in veterinary medicine yet. But with trained health care professionals, 30% of the time when a patient has no pulse, the health care professional assessing it will think they feel a pulse. So a third of the time, they think there's a pulse when there's not. And this is why they took pulse checks out of the human guidelines, and why we took them out of ours as well. It's a very unreliable thing.
So we look for breathing because it's much more objective. You see the chest moving or you don't. And you can ask your friend to look. And it's very quick. But it's not wrong to check a pulse. I'm a big fan. I love pulses. I'm a criticalist. I love pulses. So it's totally fine to feel them.
The easiest place to feel a pulse on a dog is the femoral pulse, which runs right along the inside of the leg, right up where the leg touches the body, kind of right in the middle. And what I would encourage those of you who have dogs to do if you haven't ever felt your dog's pulse is go home tonight and feel your dog's pulse. He'll love the attention. And you'll figure out where it is so you know where to look for it if there's ever a problem. But it's going to be right up against the body wall in the groin area and right in the middle of the leg on the inside. You should be able to feel it on both sides. It is never wrong to feel it if you have enough people to do that.
If you are by yourself and the patient is not moving and not responding at all, I wouldn't pause chest compressions to feel a pulse. I wouldn't trust it if I felt it if the patient's not moving and not breathing on his own. So I just think you can get distracted by it.
And then there was something about the puffs. What was that? About breathing, it's really just looking for that chest to move. Unfortunately, there's not a lot we can do aside from looking for that chest movement. Mara, you had a question. Yeah.
SPEAKER 8: Drowning.
DR. DANIEL FLETCHER: Drowning.
SPEAKER 8: Anything different?
DR. DANIEL FLETCHER: If they've arrested, if they're not breathing at that point, I would do everything exactly like we described. If they drowned and they're in distress, but they're still breathing, unfortunately, the best thing to do is to get them to a vet right away so they can get extra oxygen on them and be ready to jump in. You can, if they're small dogs-- you have a lot of small dogs, which is good. You can do the picking up and that kind of thing. And hopefully, gravity will get some of that water out. But if they drown and truly aspirated and they're still breathing, really, getting them to the vet is going to be the most important thing. I think you had a question as well.
SPEAKER 9: Can a dog [INAUDIBLE] because you didn't say it. Is it not worth it to try and look and see if it's breathing or feel for a pulse just to start the CPR?
DR. DANIEL FLETCHER: Sorry. Say that again. If you've got a dog--
SPEAKER 9: Should you bother to look and see if you can tell if a dog is breathing?
DR. DANIEL FLETCHER: You should.
SPEAKER 9: Or feel for a pulse, or just skip that?
DR. DANIEL FLETCHER: No, if the patient, if the dog is unresponsive, then I would shake him.
[SHAKING]
He's very hard, isn't he? I would shake him and call his name. If I get nothing, my next step is to look. I'm going to spend maybe three or four seconds. I'm going to look and see if there's anything obvious. If there's nothing obvious, my next step is to open that mouth, look inside. If he responds then, I stop. I don't do CPR. If I look in there and there's nothing-- and if I do that and he doesn't respond, I'm definitely going to start CPR. But I always do that. You want to do all those steps.
SPEAKER 9: So if I look at my dog and he's alive and sleeping. He sleeps really hard.
DR. DANIEL FLETCHER: Yeah, that's why-- absolutely. Stimulate them aggressively. I have a dog who does that too. It's scary sometimes. I'm like, are you alive? And then I have to shake him. And he gets all mad at me. But yeah, no, shake him vigorously. Call their names. And then, again, I would not start CPR until I do this. And if that dog is just sleeping, he's going to wake up when you pull his tongue out.
SPEAKER 9: Don't sit there looking.
DR. DANIEL FLETCHER: I wouldn't sit there looking for 10 minutes. No. But three or four seconds, uh-oh, not breathing. Shake, and look in the mouth. Yep, absolutely, good. Yeah.
SPEAKER 10: It seems like it would be really hard to do it too hard.
DR. DANIEL FLETCHER: Yeah, it is. And that's why I said, to the extent you can. Especially with a bigger dog, right, really difficult. In a cat, you can often do it. So do what you can do. Right? You can only do what you can do. But try. Even if what you're doing is sitting in the back seat doing this kind of thing, you're doing the best you can. You may not be able to do all that stuff that we talked about in terms of posture and stuff. But anything you do will hopefully get a little bit of blood flow and help a little and just drive as quickly as you can to that vet. The idea would be that we would call an ambulance. We just don't have them unfortunately. Yeah.
SPEAKER 11: If you have two people, should one of them start the CPR? Or one person does it in the back seat while the other one's driving?
DR. DANIEL FLETCHER: Yeah, if there are only two of you total, then I would say doing single rescuer CPR while the one person gets the car, gets it as close as possible. You load him in, and one person does CPR. The most important thing is getting to a vet as quickly as you can because again, you're not going to fix this just with CPR. There's some reason he arrested. And we got to get to a vet to figure that out. Any other questions?
All right, just a couple of more things, and then we'll start practicing.
OK, so this is the pet CPR algorithm. And we've gone through this a million times now. So I'm not going to belabor it. But again, if he's unresponsive, and he's not breathing, and you check the airway and it's clear, then we're going to call for help and start CPR, 30 compressions, two breaths, cycle, cycle, cycle. And then as soon as the car is available, get him to the vet while you're continuing CPR in the car. So get it going as early as you can.
So just some other quick tips. Really important to know where your closest emergency vet is. Hopefully, you all know very well where your regular vet is. And if your vet is open, by all means go there. But it's also really important to know where the closest 24-hour facility is. Don't wait until there's a crisis to try to figure that out. And post that number. Put it on your refrigerator and make sure it's in your phone so you know where it is. And hopefully, put the address in your phone too so you can use Google Maps because I don't know how to get anywhere anymore. I need Google Maps. So make sure that's all done so you're not scrambling.
Here in Ithaca, you've got Cornell up on the hill. I'm happy to see you any time. I'm often there late at night, so come and visit me. But make sure you know where the closest place is that's actually open overnight because you just want to be prepared.
Also be prepared to administer first aid. So we were talking just about CPR right now. But there are other first aid things that you can do to try to keep them stable if they're bleeding, if they got overheated, those kinds of things. So a pet first aid course is a great idea. Again, really think about where you're getting that information from.
The Red Cross has good resources. They don't do as much first aid in-person training as they used to, but they have some good resources. They also have an app that you can get for your phone that's got some basic first aid resources on it as well. But being prepared is good.
And then having a first aid kit available so you can deal with things. Again, you're not running around the house. My house is a disaster. But I know where my first aid kit is. And I can find it.
If you go to the redcross.org website, they have a really nice list of things that you want to have in your pet first aid kit. I think it's a really great one. And a very good friend of mine, who's a critical care specialist, helped them develop that. So it's a source that I really do trust. And I would encourage you to take a look at that as well.
And then the other option is to actually get certified in pet CPR. So we're going through the basics here tonight. But there are options for getting certified. Some are better than others. Of course, the one that I'm going to tell you about is the one I like. It's the one that we developed here. There are others out there. Again, just look at whether they're using those references to develop them.
OK, what about automated electric defibrillators? So people often ask me about this. So I thought I would just throw this in. How many of you know what an AED is? OK, so all of you who took CPR courses probably know.
So in human medicine, if you take a basic CPR course, it's going to probably include this defibrillator. This is something that shocks the heart if it's in an abnormal rhythm. And so they're all over the place. I'm sure there's one in this building somewhere close by. And the reason for that is, again, because people tend to get these weird arrhythmias when they collapse. And some of them respond to being shocked by one of these defibrillators.
So they're widely available in public places. And they are extremely valuable in people. They've been shown to really increase survival rates for people who have sudden cardiopulmonary arrest. So really, really good thing for people. If you don't know how to use one, take a course so you know how to use one. They are real life savers.
However, I would say they are not recommended in dogs and cats. So not a good idea to hook it up to especially cats. And most dogs, I would say, is probably not a good idea mostly because of incorrect dosing. So that is much smaller than me. And if I apply the same shock to that as would be applied to me, I'm likely to cause a lot of damage and not actually get the result I want.
The other issue is fur. I know some pretty hairy people, but none of them as hairy as any of the dogs I know. And so because the automated electric defibrillators have sticky patches that you have to put on. They have to make contact with skin. If you put them on top of the fur, they're probably not going to make contact at all. So it's very unlikely you're actually going to get anything out of putting that on them. Yeah.
SPEAKER 12: I was just wondering--
SPEAKER 1: You can use the microphone.
SPEAKER 12: Oh, yeah. I was just wondering if there is any value, and maybe specifically with the Cornell hospital, with calling to let them know you're on your way.
DR. DANIEL FLETCHER: You're coming? Yeah, I do think there is value in calling any emergency clinic. That's why I think having that phone number handy is good just so that they're ready for you. They can meet you up front, especially in a case like this. My dog collapsed. I don't think-- he's not breathing. I'm doing CPR. I'm on my way. That's really helpful. As an emergency person, that helps me a lot. I have a team up front waiting for you when you get there. So absolutely good to call. Yeah, really good question.
And then the other thing about AEDs in our patients is they're usually not needed because they have different types of arrests, as I said. These types of arrests where they have the wonky arrhythmias are not very common in our dogs, the exception to that being some boxers who have heart disease that can be similar to what people get. But in most cases, it's not something that's probably going to be all that beneficial. And you're going to waste a lot of time trying to get it slapped on and all that stuff.
If you're going to use an automated electric defibrillator in anything-- I'm going to sit on my soapbox for one minute-- remember, the goal of electrical defibrillation is not to start the heart, regardless of what you see on Grey's Anatomy. It's to stop the heart. So it is not like jump-starting the car, right? When you shock a heart, our goal is to stop it. And we use it for rhythms where the heart is doing crazy things and not pumping blood out of it.
Most of the time, dogs and cats don't have those kinds of rhythms. So if we shock them, we're actually probably doing more harm than good. We're causing damage to the heart, and it's not likely to help them. So stay away from them in dogs and cats. They're not going to be something that's going to be useful to you out there. Do your basic life support.
If you're interested in taking it to the next level and getting certified, we do through eCornell offer a vacation course. It's an online course that you can take. And at the end, you'll get a certificate saying I am certified in CPR. It goes through the stuff we talked about in a bit more detail and a worthwhile thing if it's something you're interested in. I put a little QR code there. But you can always just go to eCornell.com and search for it. I may be a little biased because I helped to write it. But I think it's good information and interactive course. I think it's a fun course to take.
SPEAKER 1: We'll also share the link on our website, on the page that it's about, the Baker Pet Talks tonight.
DR. DANIEL FLETCHER: I don't make any money from that, by the way. So I'm not shilling something. I promise. Cornell make some money out of it, but not me. But I think it's good information, and it's another way to reinforce it for you. I'm going to take a-- oh, go ahead.
SPEAKER 13: Is starting compressions on a dog who is actually breathing, is that dangerous?
DR. DANIEL FLETCHER: Yeah, so that was those studies that were done on people. We don't have good studies in dogs. There have been studies done in people. It's certainly not a good thing to do compressions on a patient, a pet that doesn't need them. So while there is a risk of doing it, the hope is that if that heart is really beating and there is adequate blood flow to the tissues, he's going to find a way to tell you that you're pounding on his chest and he doesn't like it.
And we always think about risk-benefit ratio. What's the risk? What's the benefit? The risk-benefit ratio is definitely in favor of doing chest compressions on a patient who hasn't arrested over not doing chest compressions on a patient who has. So there is definitely a risk. And that's why you want to keep reassessing, keep watching them, see if you see signs of life, of breathing, of moving, and stopping CPR at that point. Yeah.
SPEAKER 13: One time, I heard [INAUDIBLE] 50. [INAUDIBLE] a person whose heart is beating, could you screw up the heart?
DR. DANIEL FLETCHER: Yeah, certainly, any time we do chest compressions-- again, our goal is to squeeze that heart, right? So like any other tissue, when we do it, we're bruising the heart when we do it. We're bruising the lungs when we do it. We're causing damage when we do CPR, no question. And you don't want to do it if you don't have to.
But on the other hand, again, you have a limited window. And so that risk-benefit ratio probably falls in favor of doing it.
I'm going to take one-- I promise it's going to take two seconds-- one quick personal detour. Now that I especially know that my father and mother are watching, I just wanted to call out their 60th anniversary is tomorrow.
CROWD: Aw!
DR. DANIEL FLETCHER: There they are on their wedding day.
[APPLAUSE]
And there they are with my niece right now, just a little while ago. So Mom and Dad, happy anniversary. I sent you some ice cream.
OK, so with that, I'm happy to take any other questions that we have. And then we'll get you down here to do some compressions and stuff. Yeah.
SPEAKER 1: Let me give you a microphone. Just a sec.
DR. DANIEL FLETCHER: Oh, yeah. Hang on one second. She wants you to have a mic for the people online.
SPEAKER 1: So our people online can hear you fully.
SPEAKER 14: Where does the legality lie? I know that there's laws that say if we're helping a person--
DR. DANIEL FLETCHER: Right, the Good Samaritan laws.
SPEAKER 14: Does that carry over, I mean, if we're at a dog park or something? And where--
DR. DANIEL FLETCHER: Yeah, it's a massive gray--
SPEAKER 14: It's such a grey area.
DR. DANIEL FLETCHER: It's a massive one.
SPEAKER 14: And if everybody's scared to help. But I didn't know if you have any--
DR. DANIEL FLETCHER: Yes, so the challenge is that the Good Samaritan laws for human medicine would say that if a person-- Good Samaritan laws would apply if you were to do CPR on a person you saw out in public if you're trained. If you're trained to do CPR, then you can do it. And you wouldn't be held liable for being sued.
What happens in dogs and cats?/ We don't know because we don't have laws around that for dogs and cats. And that's where it becomes dicey. I would say, if you have a dog, you find a dog that's collapsed and there's no one around, I can't tell you for sure that no one would sue you. It seems unlikely that it would hold up in court. But unfortunately, there are no laws about this. Right? It's different for animals.
The good news, sort of, is that animals are still, for better or worse, considered property in the United States. And so you could be sued maybe for damage to property, but not the kind of lawsuit that you would get for injuring a person, for sure. But again, it's a gray zone for sure. If there's no one around, I would certainly start it. And if I got sued, I got sued. That's the way it is. But I can't tell you guys that that works for you. So you would have to decide for yourself that risk.
Certainly, if you're at a dog park and the owner is there and you say, I've taken a CPR course, do you want me to do this, and they give you permission, then you should be fine. But yeah, it's a gray zone, for sure. I agree.
SPEAKER 14: Can anybody sue anybody?
DR. DANIEL FLETCHER: Anybody can sue anybody for anything. It's sad, but true. Welcome to the United States of America. Yes.
SPEAKER 1: Dr. Fletcher, we have a few questions online, but I think only time for a few. Caroline asks, is the same pulse spot for a dog apply to a cat?
DR. DANIEL FLETCHER: Yeah, I'm glad you asked that. There is the femoral pulse. You can feel it in the same place. It's a little bit harder to find in cats. Most cats though, if you just put your hand over the heart-- and we talked about how to find that. Pull that elbow back and put your hand right there. And you can often feel what we call an apex beat. You can actually feel the heart beating under your hand in a lean cat. My cat, you wouldn't be able to feel it. But in a lean cat, you should be able to. So that's usually a little more reliable in cats is to over the heart.
SPEAKER 1: Great. And I just want to remind our online viewers and everybody in the audience that this recording of this event will be available on the CornellCast website. You can access it through the Baker Institute website.
DR. DANIEL FLETCHER: Great. Thanks. Any other questions? Yeah.
SPEAKER 15: What about cats who have a small mouth and noses?
DR. DANIEL FLETCHER: Cats with small mouths and noses? About doing the mouth-to-snout part? Is that what you're worried about?
SPEAKER 15: Yes.
DR. DANIEL FLETCHER: Yeah, so the good news is that actually makes it easier for you because you don't have to open your mouth quite as wide. So you're going to do the same thing. These guys are pretty small. So you're going to close their mouths, and then open your mouth and just get it over the nose and make a good seal. It's going to be a little furry. But that's how you'll do it. But the smaller the nose, actually, the easier that is to do. It's the big-nosed dogs that sometimes it can be hard to get your mouth around.
SPEAKER 15: But wouldn't it be harder to close their mouth?
DR. DANIEL FLETCHER: To close the mouth? Usually, again, unless they have something that causes the mouth not to close normally, you can usually get-- even if you have to hold them like this. So put one hand up over the head and put your other hand on the lower jaw and then give the breath that way, that would work. So you may not be able to wrap your hand around. Now I see where you're going. You can't get it around the snout. But you could do this kind of thing to close it. So yeah, really good question, absolutely. Yeah.
SPEAKER 16: I just had a follow-up [INAUDIBLE] what the snout and the mouth are [INAUDIBLE].
DR. DANIEL FLETCHER: [LAUGHS] Well, so you don't have to get your mouth over the mouth. That's why you close the mouth. You're just going over the nose, yeah. You're getting over the snout. Yeah, exactly. So hopefully, those juicy bulldog noses are fun to blow into. Definitely. Yeah.
SPEAKER 17: Where the dog's muzzle mouth, but its snout and nose aren't close enough together like a pug, would it be bad to cover the mouth and--
DR. DANIEL FLETCHER: And blow into both of them. I think it would be fine if you can get your mouth around it. Yeah, it may make it less likely you'll get leak through the mouth. So yeah, I don't see any reason not to, unless you feel like-- my only concern with that is if you're having to open your mouth so wide, then maybe you wouldn't get as good a seal as if you just went over the nose. But if you feel like you can get the whole thing in, yeah. In cats, often, you do wind up with the whole face in your mouth. That's lovely. Any other questions? Yeah.
SPEAKER 18: When checking the airway on a cat-- I've put my finger down my dog's throat before, but is there something that you can harm? I don't know the-- can you do damage checking--
DR. DANIEL FLETCHER: Sure, the anatomy is not really that different between dogs and cats. And so there's nothing else down there that you could hurt. It does bring up a good point. And I'm glad you did. So if you open and you look in the mouth, and you either see something in there, or it's really foamy, or you can't really see what's going on-- so this is a little bit more controversial. We still do, in veterinary medicine, recommend doing what we call a finger sweep, where you gently go in with your finger as far back as you can and gently sweep from one side to the other to see if you feel something behind the foam or whatever is back there. The danger of that, and the thing to be really mindful of, is if there is something there, there's the danger that you push it in further, which is why you don't want to go in there and crank all around. Very, very gently, go in there and just sweep by.
In the human guidelines these days, they don't recommend doing this anymore. We made the conscious decision to say we think we should because our patients, unfortunately, are much more likely to do this and much more likely to have something in there. And we really want to make sure there's not something occluding the airway that we could remove. So we did leave it in there. But it is really important to be very careful not to push it further in.
So nothing about the anatomy makes it any more dangerous. But just be very careful not to push any foreign object in. Good. Any other questions?
All right. So we now need some volunteers from the audience who want to come down and practice this. So we can do up to eight people at one time down here. But we'd like you to come down. And if you don't-- Mary's going to come around and just grab you and drag you down. She's not afraid to do it. Yeah. Yeah, great. Come on down, any of you who would like to.
Well, in Ithaca, it's always cold and flu season. But since it's cold and flu season, we have these little manikin face shields so you don't have to worry about giving each other diseases. So anybody should grab a face shield from when you get to doing the mouth-to-snout part of this.
And then we'll have you guys come in groups of two. And you can practice this. So for those of you who are at the dogs, we put a little step stools by the dogs that might make it a little bit easier for you to get high enough to do the compressions.
And what we're going to do, when everybody is in position, I'm going to start some music for you so you have a soundtrack to practice by. Those of you on the cats are welcome to do either one-handed or two-handed compressions.
If the stools aren't high enough, feel free to put the mannequins on the floor too. That's a viable option if you would like to do that.
So everybody, get into place. Everybody grab a shield.
What we're going to do is two full minutes of compressions. So you're going to count out 30 compressions. And then the other person is going to give two quick breaths, 30 more compressions, two breasts. At the end of two minutes, it will ding. And I want you to switch positions. And then you'll do the opposite thing. OK? All make sense? And then we'll come around to give you some feedback.
Is everybody in position and ready to go? Everybody feeling awesome about this? OK, let's see if the audio works. Audio does not seem to be working. Very quietly.
[MUSIC - THE BEE GEES, "STAYIN' ALIVE"]
There you go. All right, go for it. Good job. So push real hard. That's good! Good, so you can come around and watch.
THE BEE GEES: [SINGING] --use my walk. I'm a woman's man. No time to talk. DR. DANIEL FLETCHER: You are. You're gonna close that and you're going to put that right over the nose like that. And [INAUDIBLE] OK? Good job. Good job.
THE BEE GEES: [SINGING] We can try to understand The New York Times effect on man. Whether you're a brother, or whether you're a mother, you're stayin' alive, stayin' alive. Feel the city breakin' and everbody shakin', stayin' alive, stayin' alive. Ah, ah, ah, ah, stayin' alive.
DR. DANIEL FLETCHER: Those are beautiful chest compressions. That looks great.
THE BEE GEES: [SINGING] Ah, ah, ah, ah, stayin' alive.
DR. DANIEL FLETCHER: I see the chest is moving. Awesome. That was a good breath. So as you're doing that, watch him. Make sure the chest moves.
THE BEE GEES: [SINGING] doo, doo, doo, doo, doo.
Push hard. Let's go! They're behind you. All right, so you close that mouth. Good. Put that right over the-- and then push it right up against there. You should see the chest move. So give a good hard breath. Really push like you mean it. Hoo! Oops, sorry. You got to make that seal and flow really hard. So really open your mouth and put it over. Like that. And blow just really-- there you go. Look at that. Good! Good job. Awesome! That's beautiful. Nicely done.
THE BEE GEES: [SINGING] Stayin' alive. Stayin' alive.
DR. DANIEL FLETCHER: All right, you got 30 seconds. Oh, you guys switched already. That's fine. Those are very nice chest compressions. Awesome. Great. Hold that nose. A few quick breaths. You should see the chest move. Nicely done, excellent, excellent. Then right back to those chest compressions.
[LAUGHS]
All right, 10 seconds, you're going to switch.
[CHIME]
So I know you guys-- did everybody rotate already? Or did you-- no. So go ahead and rotate and get ready to start. We're going to do the second round. Are we in position?
[MUSIC - CYNDI LAUPER, "GIRLS JUST WANNA HAVE FUN"]
[PEOPLE CLAPPING]
Yeah, get a clean one. That's good.
[LAUGHS]
Absolutely, absolutely.
CYNDI LAUPER: [SINGING] I come home in the morning light. My mother says, when you gonna live your life right? Oh, mother, dear, we're not the fortunate ones. And girls, they wanna have fun. Oh, girls just wanna have fun.
[MUSIC PLAYING]
DR. DANIEL FLETCHER: I agree.
CYNDI LAUPER: [SINGING] The phone rings in the middle of then night. My father yells, what you gonna do with your life?
DR. DANIEL FLETCHER: So you be just a little too short. So let's do that. Let's go on the floor. Let's do it. Make this as easy as possible. There you go. Now this is going to be much better. All right, ready? Go for it.
CYNDI LAUPER: [SINGING] --just wanna have-- that's all they really want.
DR. DANIEL FLETCHER: Good job. Yeah, it's hard. Right? It's a lot of force to make that compression on these big dogs. So that looks great.
CYNDI LAUPER: [SINGING] They want to have fun. Oh, girls, they wanna have fun.
DR. DANIEL FLETCHER: I'll bring some more over.
CYNDI LAUPER: [SINGING] Girls wanna have fun. The girls wanna have--
DR. DANIEL FLETCHER: Make a good seal. So I think your problem is you have to put that part over there. So now, yeah, there you go, because that's where the air will go through. Look at that. Beautiful! Two quick breaths, good. Nicely done. Excellent.
CYNDI LAUPER: [SINGING] --hide her away from the rest of the world. I wanna be the one to walk in the sun. Oh, girls, they want to have fun.
[CHIME]
DR. DANIEL FLETCHER: All right. Whoo! That was awesome, awesome, awesome, awesome. You guys look great. Is everybody really tired and sweaty now? If you're not, you weren't working hard enough. All right, really good.
So does anybody have any questions about it, those guys of you who were up here doing it? Any lingering problems? You guys all feel like you're ready? You're experts and pros. All right, good.
It looks like we have other people who want to come down. So maybe we'll rotate some other people in. And we'll do another round, if that works.
[PEOPLE CHATTING]
All right. Don't be shy. Come on up, guys.
[PEOPLE CHATTING]
There's so many people online. That's cool.
SPEAKER 1: Yeah, 110.
DR. DANIEL FLETCHER: Really? Awesome! That's great. All right, are people in position? You're feeling like you're ready to get started. Anybody want to come down and play with the cat? Aw, the poor-- nobody wants the cat. Yeah.
SPEAKER 19: Do you have any words of wisdom for [INAUDIBLE]
DR. DANIEL FLETCHER: Yeah, in terms of--
SPEAKER 19: [INAUDIBLE]
DR. DANIEL FLETCHER: Yeah. Yeah, so the trauma cases are tough. Sometimes it's because maybe they're bleeding into the abdomen or something, and they collapse because of that, sometimes just because they have a leak of air into the chest. And that is going to be something that's going to be very difficult to deal with out in the wild. So if they are still alive and they haven't arrested yet, I think the big thing is getting them to a vet as quickly as you can. If there's bleeding, putting pressure on it to stop that. If they've arrested, then the best thing you can do is just try CPR and just get them to a vet as quickly as possible. There's just not a lot of stuff we can do in the field, unfortunately, because you need equipment to do that stuff.
So yes, you can click start. Absolutely. OK, everybody is ready. Here we go.
[MUSIC - U2, "I STILL HAVEN'T FOUND WHAT I'M LOOKING FOR"]
U2: [SINGING] I have climbed the highest mountains. I have run through the fields.
DR. DANIEL FLETCHER: Good job.
U2: [SINGING] Only to be with you.
DR. DANIEL FLETCHER: So that's beautiful. The one thing I do is hands like this. And then get that-- feel that hand right over the heart.
U2: [SINGING] I have run. I have crawled.
DR. DANIEL FLETCHER: Beautiful, beautiful. Nicely done.
U2: [SINGING] I have scaled these city walls, these city walls.
DR. DANIEL FLETCHER: Yeah, it is really hard, especially with the shield. It's actually easier with the shield gone. And open your mouth wide, make a good seal, and blow really hard. There you go! Nice! Beautiful! Well done. Well done.
U2: [SINGING] I still haven't found what I'm looking for.
I have kissed honey lips. Felt the healing in the fingertips. It burned like fire, this burning desire.
DR. DANIEL FLETCHER: All right, you have just under a minute left before you switch. Get these patients back!
U2: [SINGING] I have held the hand of the devil. It was warm in the night.
DR. DANIEL FLETCHER: That's good.
U2: [SINGING] I was cold as stone. But I still haven't found what I'm looking for.
DR. DANIEL FLETCHER: You just pass them right over there. Yeah, thank you.
U2: [SINGING] I still haven't found what I'm looking for.
[MUSIC PLAYING]
Do you know what to do if your pet suddenly collapses? In the next session of Baker Pet Talks, learn the basics of cardiopulmonary resuscitation (CPR) so you can help your dog or cat until they can get to a veterinarian. Co-sponsored by the Baker Institute for Animal Health and the Cornell Feline Health Center.
