Oh Behave!

Dr. Fletcher has been on the faculty of the Cornell University College of Veterinary Medicine since 2006. After receiving a BS in Electrical Engineering from Drexel University and a PhD in Bioengineering from the University of California Berkeley/San Francisco, he obtained his DVM from the University of California at Davis. He then completed a rotating internship and emergency and critical care residency at the University of Pennsylvania. He has received multiple teaching awards, including the 2020 Zoetis Distinguished Teaching Award and is co-chair of the RECOVER Initiative, which published the first evidence-based veterinary CPR guidelines. His research interests include disorders of fibrinolysis, epilepsy, and the use of immersive simulation in teaching. He has been building simulators for veterinary education since 2009 and opened the Tetlow and Roy Park Innovation Lab, an immersive simulation center at Cornell in the fall of 2015.

Transcript:

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Announcer: Pet Life Radio, this is Pet Life Radio.

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Announcer: Let's talk pets.

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Announcer: It's Oh Behave with Arden Moore.

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Announcer: This show that teaches you how to have Harmony in the household with your pets.

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Announcer: Join Arden as she travels coast to coast to help millions better understand why cats and dogs do what they do.

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Announcer: Get the latest scoop on famous faces.

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Announcer: They're perfectly pampered pets in Who's Walking Who in Renton Tinseltown.

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Announcer: From famous pet experts and best selling authors to television and movie stars, you'll get the latest buzz from Wagging Tongues and Tails, garner great pet tips and have a dog on fur flying fun time.

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Announcer: So get ready for the pause and applause as we unleash your Oh Behave Host, America's Pet Edutainer, Arden Moore.

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Arden Moore: Welcome to the Oh Behave Show on Pet Life Radio.

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Arden Moore: I'm your host, Arden Moore.

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Arden Moore: You love your dog.

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Arden Moore: You love your cat.

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Arden Moore: I mean, you try to give them the most nutritious food.

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Arden Moore: I bet you try everything you can to give them an enriched life.

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Arden Moore: But do you know what to do when a pet emergency arises?

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Arden Moore: Fortunately, help is here today on our show because our special guest is a real life saver and he's going to give us the ABCs on performing CPR and much more.

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Arden Moore: Please welcome to the show from Cornell University School of Veterinary Medicine.

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Arden Moore: He's got a lot of anti-white initials after his name is Dr.

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Arden Moore: Dan Fletcher.

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Arden Moore: welcome, welcome Dr.

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Arden Moore: Dan.

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Dr. Dan Fletcher: Thank you Arden, it's great to be here.

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Arden Moore: Hey, Dan is the man when it comes to helping us learn what to do and what not to do to help our pet in a pet emergency.

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Arden Moore: We're going to find out more but we got to take a quick break and you all know the drill.

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Arden Moore: We're going to sit, stay, we'll be right back.

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Announcer: Time for a pause, four furry ones actually sit and stay.

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Announcer: Oh Behave will be right back.

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Arden Moore: Paws up Pet Pals, Arden Moore here, your host of the Oh Behave Show.

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Arden Moore: Me-

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Arden Moore: Wow!

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Arden Moore: Did you know there's up to 100 million free roaming cats in the United States?

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Arden Moore: And without spay or neuter, that number is only going to keep growing.

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Arden Moore: Not only does spay, neuter, humanely reduce the community cat population, it keeps cats healthy.

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Arden Moore: Scooter, the neuter cat, is on a mission to give cats an extra life by making it hip to be snipped.

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Arden Moore: Hey, check them out.

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Arden Moore: Go to givethemten.org.

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Arden Moore: That's givethemten.org.

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Arden Moore: And help us make this a better world for cats.

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Announcer: Let's talk pets on petliferadio.com.

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Announcer: Oh Behave is back with more tail wagging ways to achieve Harmony in the household with your pets.

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Announcer: Now back to your fetching host, America's Pet Edutainer, Arden Moore.

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Arden Moore: welcome back to the Oh Behave Show on PetLife Radio.

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Arden Moore: I'm your host, Arden Moore.

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Arden Moore: I have one of my personal heroes on the show today.

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Arden Moore: He doesn't even know it.

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Arden Moore: I hope he's starting to blush.

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Arden Moore: Dr.

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Arden Moore: Dan Fletcher is an Associate Professor of Emergency and Critical Care Medicine at Cornell University in Ithaca, New York.

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Arden Moore: Okay, take another breath.

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Arden Moore: Ready?

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Arden Moore: Listen to these initials, PhD, DVM, DACVECC.

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Arden Moore: That's how we spell a very, very talented man.

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Arden Moore: Dr.

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Arden Moore: Dan, what got you even into veterinary medicine?

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Arden Moore: Because looking at your background, you got some degrees of PhD in, is it bioengineering?

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Dr. Dan Fletcher: Bioengineering.

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Arden Moore: Yeah, that's an easy one.

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Arden Moore: That was a cakewalk, right?

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Dr. Dan Fletcher: My parents are very excited I finally have a job.

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Dr. Dan Fletcher: So yeah, I had a bit of a meandering path to get here.

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Dr. Dan Fletcher: So yeah, I started out in engineering.

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Dr. Dan Fletcher: I was my bachelor's in electrical and computer engineering from Drexel University in Philadelphia.

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Dr. Dan Fletcher: I had no idea what I wanted to be when I was a kid, and my guidance counselor said, you're really good in math and science, so you should probably be an engineer.

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Dr. Dan Fletcher: I said, okay, that sounds good, so I'll do that.

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Dr. Dan Fletcher: So I got my bachelor's, and pretty early on I realized I really liked the biology side of things and the medicine side of things.

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Dr. Dan Fletcher: And so I started working in a lab at Drexel in biomedical engineering, and then wound up applying to graduate programs there, and then wound up out in California at UC Berkeley, UC San Francisco joint program in bioengineering, did a bioengineering PhD, really, really enjoyed it, loved what I did.

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Dr. Dan Fletcher: But when I was my second year of grad school, I started volunteering at a magical place in Sausalito, California called the Marine Mammal Center, which is a rehab facility for seals and sea lions that strand on the California coast.

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Dr. Dan Fletcher: And that was my first opportunity to actually work with vets and to work in a clinical setting.

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Dr. Dan Fletcher: And I fell in love with it.

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Dr. Dan Fletcher: So I worked the Wednesday night shift and I had a lot less gray hair back then.

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Dr. Dan Fletcher: I became the youngest shift supervisor.

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Dr. Dan Fletcher: I did, I earned every one of these.

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Dr. Dan Fletcher: Became the youngest shift supervisor there and just adored it.

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Dr. Dan Fletcher: So I would work all day and then I would go and spend the whole night at the Marine Mammal Center.

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Dr. Dan Fletcher: And I would feel so energized when I would leave and I would drink some coffee and then I would go to work again the next day and did that for about eight years.

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Dr. Dan Fletcher: Loved it.

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Dr. Dan Fletcher: Absolutely loved it.

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Dr. Dan Fletcher: Did a postdoc after I finished my PhD and then was starting to apply for faculty positions in engineering.

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Dr. Dan Fletcher: And it occurred to me that although I liked what I did, and I would say I loved what I did, I didn't have a passion for what I did.

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Dr. Dan Fletcher: But what I had a passion for was, was medicine, clinical medicine, veterinary medicine especially.

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Dr. Dan Fletcher: And yeah, and then I decided I was going to go for it.

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Dr. Dan Fletcher: So I had to take a few more classes to get ready, apply to the vet school and was very lucky to get into UC Davis.

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Arden Moore: And wait a minute everybody, just a little pause.

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Arden Moore: UC Davis is one of the renowned veterinary schools in our country.

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Arden Moore: And how old were you when you got your DVM?

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Dr. Dan Fletcher: I was 32 when I finished vet school, so a little bit on the older side.

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Dr. Dan Fletcher: It was nice to actually, I think it really helped me appreciate it more.

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Dr. Dan Fletcher: I think some of my classmates sort of went straight through from undergrad to into vet school and didn't really have a lot of life experience and weren't 100% sure what they wanted to do.

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Dr. Dan Fletcher: For me, it was my passion and I was so excited to be there.

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Dr. Dan Fletcher: So I didn't get the best grades, but I had the best time and had great experience and loved it.

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Dr. Dan Fletcher: And then ultimately wound up at University of Pennsylvania, where I fell in love with Emergency and Critical Care Medicines, where I did my internship and then stayed there for my residency.

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Dr. Dan Fletcher: And then I came here to Cornell in 2006 and have been here ever since.

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Dr. Dan Fletcher: I started the ECC program here.

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Dr. Dan Fletcher: And yeah, it's been a great ride.

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Dr. Dan Fletcher: I feel very, very lucky.

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Arden Moore: And all right, ECC, listen to the talk.

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Arden Moore: He's Mr.

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Arden Moore: Alphabet Soup, guys, Emergency and Critical Care.

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Arden Moore: But what is it about?

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Arden Moore: There's different types of specialties in veterinary medicine.

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Arden Moore: To be board certified in Emergency and Critical Care, that's a big deal.

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Arden Moore: Why that?

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Arden Moore: Why not internal medicine?

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Arden Moore: Why not dermatology?

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Dr. Dan Fletcher: Yeah, I think at the end of the day, I have a short attention span.

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Dr. Dan Fletcher: I didn't hear what you said.

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Dr. Dan Fletcher: Exactly.

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Dr. Dan Fletcher: So when I started my internship at Penn, I had decided I wanted to be a neurologist, and that fit with what I did my PhD work on, and I really did enjoy my time working in neurology at Davis.

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Dr. Dan Fletcher: But when I got to Penn, I realized that in the emergency room and in the ICU, you get to treat all different types of patients, and you don't know what's coming in.

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Dr. Dan Fletcher: I think in most other specialties, you have an appointment, you have a history, you know sort of what they're coming in for.

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Dr. Dan Fletcher: In emergency critical care medicine, you have no idea what's coming through the door, and you have to, there are a lot of puzzles that come in rapid succession.

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Dr. Dan Fletcher: And I love it.

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Dr. Dan Fletcher: I just really enjoy that aspect of taking an animal.

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Dr. Dan Fletcher: I tell my students all the time, when an animal comes into the emergency room, it really comes down to, does he need fluids or does he need Lasix?

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Dr. Dan Fletcher: That's the only decision you have to make initially.

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Dr. Dan Fletcher: And the challenge is figuring out which of those, because they kind of do the opposite things.

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Dr. Dan Fletcher: And then, you know, once you start your treatment, you reassess and it's just, I don't know, like watching an animal come in, you know, laying on a side, minimally responsive, and you give a little bit of fluid into his vein and he perks up and he starts wagging his tail and he licks you on the face.

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Dr. Dan Fletcher: Like there's no no better feeling in the world, right?

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Dr. Dan Fletcher: It's just the best ever.

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Dr. Dan Fletcher: So love it.

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Arden Moore: And what's the Lasix aspect?

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Arden Moore: What would be the time where you would do that?

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Dr. Dan Fletcher: The Lasix is for heart failure.

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Dr. Dan Fletcher: So if they come in and they look really bad as well, they're laying on their sides, they're not breathing very well, but it's a heart problem.

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Dr. Dan Fletcher: Then they need Lasix, which is the diuretic.

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Dr. Dan Fletcher: So that's take fluid away because animals could come in in that kind of shape because of heart failure, have too much fluid on board.

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Dr. Dan Fletcher: So it's either they need more fluid, or they need to take some of that fluid away.

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Dr. Dan Fletcher: That's kind of the initial decision you have to make though.

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Dr. Dan Fletcher: And then after that, you have lots of different directions things can go.

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Dr. Dan Fletcher: But I think that initial taking a patient on the brink and being able to pull them back is just such an amazing experience.

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Dr. Dan Fletcher: So I wouldn't trade it for the world.

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Arden Moore: I wish we lived closer.

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Arden Moore: Seriously, I'm in Dallas, you're in New York.

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Arden Moore: But what you do, you do save lives and you help people learn how to save lives.

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Arden Moore: And I think I saw a Metropolitan Life Survey and only about 2% of people have ever actually taken a veterinary approved pet first aid course.

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Arden Moore: What can we do to change those numbers, Dr.

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Arden Moore: Dan?

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Dr. Dan Fletcher: Yeah, I think it's so important.

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Dr. Dan Fletcher: I think that what we know for sure when there's a really sudden change in a patient status and animal status, when they have something very sudden happen, like they choke, or they collapse because of a heart arrhythmia, or they have some trauma and they have an injury and they're bleeding.

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Dr. Dan Fletcher: Right.

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Dr. Dan Fletcher: Seconds count in those cases.

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Dr. Dan Fletcher: And I think knowing how to manage those things that you can, I mean, I think at the end of the day, I think the most important thing for pet owners to remember is learning first aid and maybe learning CPR to know how to sort of start to take care of a pet is really important.

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Dr. Dan Fletcher: But really importantly is knowing where's your closest emergency vet that's open 24 hours, how can you get there, you have to know the directions to get there, really knowing how to get to a vet because what we can teach the pet owner is how to sort of buy some time and try to start to get that pet stable.

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Dr. Dan Fletcher: But it's really important that they get to a vet really quickly and as soon as possible to get that definitive care.

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Dr. Dan Fletcher: So yeah, I think there's a lot we can do and I'm sure we're going to talk about the cover of this project that we've been working on, but I'm really excited we've just published the CPR guidelines, but I'm excited that we also had a whole domain on first aid that we're working on finishing up and that'll be public soon.

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Dr. Dan Fletcher: It'll be our first evidence-based first aid guidelines as well, which I'm really excited about.

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Arden Moore: I think the definition of pet first aid to me is the life-saving bridge between the uh-oh and the veterinary clinic.

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Arden Moore: I think the role is to on the scene and stabilize and transport to the vet.

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Arden Moore: There's this thing on our phones, Dr.

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Arden Moore: Dan, it's called a speaker.

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Arden Moore: And I think as a veterinarian, don't you appreciate someone calling the veterinary clinic ahead of time in route, telling you that they have a pretty bad situation with the dog or cat?

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Dr. Dan Fletcher: 100% so that the team can be ready as soon as you arrive to come up and grab your pet, bring them in and get started on things.

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Dr. Dan Fletcher: So yeah, 100% I think.

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Dr. Dan Fletcher: And that's why I think on your phone, having the phone with the speaker is great.

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Dr. Dan Fletcher: Having the phone with the speaker programmed with the closest emergency vet's phone number and your local vet.

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Dr. Dan Fletcher: So if it's during the day, by all means, your local vet can manage a lot of these things.

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Dr. Dan Fletcher: But I think also making sure that you know where the closest 24-hour emergency facility is and having that programmed to your phone is really critical.

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Arden Moore: Hey everybody, we're speaking with Dr.

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Arden Moore: Dan Fletcher.

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Arden Moore: He's from Cornell University and he also wears many collars in the world of pets.

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Arden Moore: He is one of the co-chairs of a program called Recover.

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Arden Moore: And it is revolutionizing, updating, changing, modernizing the way that CPR is given to a dogging cat and other things with Pet First Aid.

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Arden Moore: We're going to dive into that after we take this break.

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Arden Moore: Sit, stay, we'll be right back.

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Announcer: Time for a walk on the red carpet, of course.

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Announcer: Oh Behave will be back in a flash right after these messages.

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Announcer: On Pet Life Radio.

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Announcer: Pet Life Radio.

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Katherine Heigl: Hey, this is Katherine Heigl and you are listening to Ms.

00:14:55.300 --> 00:14:58.960
Katherine Heigl: Arden Moore on Oh Behave on Pet Life Radio.

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Katherine Heigl: Tune in for more fun, practice ideas and tips for your dogs and cats and pets.

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Announcer: We're back from the lot.

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Announcer: Just check the paper and we had a record showing at the box.

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Announcer: The letter box that is.

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Announcer: Now back to Oh Behave.

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Announcer: Here's Arden.

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Arden Moore: welcome back to the Oh Behave Show on Pet Life Radio.

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Arden Moore: I'm your host Arden Moore and we have on our show Dr.

00:15:23.680 --> 00:15:25.080
Arden Moore: Dan Fletcher.

00:15:25.080 --> 00:15:31.240
Arden Moore: He is an emergency and critical care veterinary associate professor at the University of Cornell.

00:15:31.240 --> 00:15:37.500
Arden Moore: Boy, if you're on an elevator ride, man, you can't get everything you do on that 10 second ride, can you?

00:15:38.880 --> 00:15:40.380
Dr. Dan Fletcher: I don't know about that.

00:15:40.380 --> 00:15:44.340
Dr. Dan Fletcher: It took a long time to get here, but what I do is not that complicated.

00:15:44.340 --> 00:15:45.940
Arden Moore: But folks, this is a big deal.

00:15:46.400 --> 00:15:59.020
Arden Moore: I got some news release from Cornell, and the way we do cardiopulmonary resuscitation on a dog or a cat, it keeps evolving just like in human medicine.

00:15:59.020 --> 00:15:59.380
Arden Moore: Dr.

00:15:59.380 --> 00:16:07.360
Arden Moore: Dan, try to help explain what's going on because you all, I want to make sure we get the other, you got two other co-chairs.

00:16:07.360 --> 00:16:10.140
Arden Moore: Do you want to give a shout out to your colleagues?

00:16:10.140 --> 00:16:10.720
Dr. Dan Fletcher: Yeah.

00:16:11.180 --> 00:16:17.120
Dr. Dan Fletcher: This is a collaborative initiative, the Reassessment Campaign on Veterinary Resuscitation, our Recover Initiative.

00:16:17.120 --> 00:16:34.860
Dr. Dan Fletcher: It was a joint program of the American College of Veterinary Emergency and Critical Care, that's the specialty board that I'm boarded through, and the Veterinary Emergency and Critical Care Society, which is a large international organization dedicated to veterinarians and veterinary technicians who are interested in emergency and critical care medicine.

00:16:34.860 --> 00:16:47.240
Dr. Dan Fletcher: So we started the Recover Initiative back in 2010 and it was me and one collaborator, Manu Bowler, who at the time was working in a resuscitation lab at the University of Pennsylvania.

00:16:47.240 --> 00:16:56.920
Dr. Dan Fletcher: We were resident mates, so he's a veterinarian, but he had then gone on to do some research in CPR because with Nari, he was very interested in.

00:16:56.920 --> 00:17:08.620
Dr. Dan Fletcher: So when I started my position here at Cornell, one of the things I was really interested in was developing sort of standardized CPR training for veterinarians and veterinary nurses, because nothing like that existed.

00:17:09.380 --> 00:17:11.280
Dr. Dan Fletcher: And so I contacted him because it was-

00:17:11.280 --> 00:17:12.660
Arden Moore: Wait a minute, let's take a pause on that.

00:17:12.660 --> 00:17:19.780
Arden Moore: Can you believe in 2010, we still had not standardized how to do CPR on a dog or cat?

00:17:19.780 --> 00:17:22.400
Arden Moore: Thank you both for thinking of doing that.

00:17:22.400 --> 00:17:23.360
Dr. Dan Fletcher: Yeah, I know.

00:17:23.620 --> 00:17:33.100
Dr. Dan Fletcher: It's everyone sort of took the human guidelines, adapted them, did what they thought they should do with them, but nobody had really looked at the evidence primarily through the lens of dogs and cats.

00:17:33.100 --> 00:17:41.760
Dr. Dan Fletcher: So I reached out to him because I wanted to put a course together, and he said, I would love to put a course together with you, but the problem is we don't really know how to do CPR on dogs and cats, right?

00:17:41.760 --> 00:17:44.960
Dr. Dan Fletcher: Nobody's ever really looked at this, and so that's what launched this.

00:17:45.080 --> 00:17:56.300
Dr. Dan Fletcher: So he had some connections in the human resuscitation community, and we were very, very lucky that we had amazing support from some collaborators from the International Liaison Committee on Resuscitation or ILCOR.

00:17:56.300 --> 00:18:07.540
Dr. Dan Fletcher: That's the international organization that really does the groundwork of trying to develop CPR guidelines in people, and then ultimately they feed that information to places like the American Heart Association here in the US.

00:18:07.540 --> 00:18:11.940
Dr. Dan Fletcher: That runs courses in the American Red Cross, and then also organizations around the world.

00:18:11.940 --> 00:18:16.920
Dr. Dan Fletcher: So we worked with them to try to develop a process to do this, and it was fantastic.

00:18:16.920 --> 00:18:18.960
Dr. Dan Fletcher: We couldn't have done it without their help.

00:18:18.960 --> 00:18:26.180
Dr. Dan Fletcher: So we did our first round back in 2010 to 2011, published in 2012, where we actually picked specific questions about how to do CPR.

00:18:26.180 --> 00:18:33.820
Dr. Dan Fletcher: We did an evidence review for every one of those questions, looked up at all the literature both in human medicine and veterinary medicine to try to answer those questions.

00:18:34.260 --> 00:18:39.640
Dr. Dan Fletcher: And then from those answers to those questions, we were able to write the first recovered guidelines.

00:18:39.640 --> 00:18:44.560
Dr. Dan Fletcher: And so those had been in place, took a little while for people to figure out what we were doing.

00:18:44.560 --> 00:18:47.860
Dr. Dan Fletcher: It took a few years before they really started to take off.

00:18:47.860 --> 00:18:52.300
Dr. Dan Fletcher: And then we ultimately got to my dream, which was to get standardized training in place.

00:18:52.300 --> 00:18:56.480
Dr. Dan Fletcher: So we developed online courses and an in-person certification process.

00:18:56.480 --> 00:19:05.100
Dr. Dan Fletcher: And to date, since 2013, when those launched, we have about 95,000 veterinarians and veterinarian technicians who have taken the online course.

00:19:05.100 --> 00:19:08.500
Dr. Dan Fletcher: And over 20,000 who have done the in-person rescuer training.

00:19:08.500 --> 00:19:12.780
Dr. Dan Fletcher: So we're really proud that we've gotten this word out and people have really bought into it.

00:19:12.780 --> 00:19:14.920
Arden Moore: Yeah, let's bring it home real simple.

00:19:14.920 --> 00:19:16.440
Arden Moore: I'm talking real simple.

00:19:16.440 --> 00:19:17.340
Arden Moore: As you know, Dr.

00:19:17.340 --> 00:19:20.640
Arden Moore: Dan, I'm a master instructor in Pet First Aid and CPR.

00:19:20.640 --> 00:19:22.980
Arden Moore: My own company is called Pet First Aid 4U.

00:19:22.980 --> 00:19:28.520
Arden Moore: I am so blessed to have Pet Safety Dog Kona and Pet Safety Cat Casey as my teammates.

00:19:28.520 --> 00:19:31.300
Arden Moore: But I work with a lot of ER and critical care veterinarians.

00:19:32.360 --> 00:19:34.280
Arden Moore: That help me help others.

00:19:34.280 --> 00:19:40.440
Arden Moore: So my role is to help people and pet professionals, not the vets, not your area.

00:19:40.440 --> 00:19:43.900
Arden Moore: But the point is, we do CPR because of CPA.

00:19:43.900 --> 00:19:44.980
Arden Moore: Can you explain that?

00:19:44.980 --> 00:19:45.680
Dr. Dan Fletcher: Yeah.

00:19:45.680 --> 00:19:53.960
Dr. Dan Fletcher: So cardiopulmonary arrest is the sudden onset or CPA of an animal stopping breathing and the heart stopping.

00:19:53.960 --> 00:19:57.860
Dr. Dan Fletcher: We think in dogs and cats most commonly, they stop breathing first and then the heart stops.

00:19:57.860 --> 00:20:11.320
Dr. Dan Fletcher: Although occasionally some dogs, especially dogs who tend to have heart diseases that cause arrhythmias like boxers and doberman pinchers and those kinds of dogs, they all occasionally have a primary cardiac arrest when the heart stops first.

00:20:11.320 --> 00:20:14.700
Dr. Dan Fletcher: Either way, very quickly the other will stop once you stop with one of those.

00:20:14.840 --> 00:20:21.920
Dr. Dan Fletcher: So really starting CPR immediately is the only way to buy enough time to get to the vet, to try to reverse that.

00:20:21.920 --> 00:20:25.580
Dr. Dan Fletcher: So I think a couple of things about cardiopulmonary arrest that are really important.

00:20:25.580 --> 00:20:27.740
Dr. Dan Fletcher: So some animals experience cardiopulmonary arrest.

00:20:27.860 --> 00:20:33.580
Dr. Dan Fletcher: So that's a sudden or an acute onset of some problem that causes them to stop breathing or the heart to stop.

00:20:33.580 --> 00:20:35.140
Dr. Dan Fletcher: So that can be a heart problem.

00:20:35.140 --> 00:20:39.720
Dr. Dan Fletcher: That could be choking or an airway obstruction where they can't, they just can't get oxygen anymore.

00:20:39.720 --> 00:20:42.620
Arden Moore: The avocado has completely sealed the airway.

00:20:42.620 --> 00:20:43.300
Arden Moore: Avocado pig.

00:20:43.300 --> 00:20:44.540
Dr. Dan Fletcher: Yeah, exactly.

00:20:44.540 --> 00:20:48.600
Dr. Dan Fletcher: Or a ball or a chew toy or something like that.

00:20:48.600 --> 00:20:48.920
Dr. Dan Fletcher: Yeah.

00:20:48.920 --> 00:20:58.860
Dr. Dan Fletcher: So those are the kinds of things that it's very sudden and if we act quickly, we can reverse that and get them back and hopefully have them going to have a good quality of life.

00:20:58.860 --> 00:21:05.040
Dr. Dan Fletcher: There are, however, some cases where I would argue an animal doesn't have an arrest, but an animal actually passes away, right?

00:21:05.040 --> 00:21:17.740
Dr. Dan Fletcher: And so EPR is not something that I would recommend people try at home for, say, an older dog or cat who has many concurrent health issues and maybe these have sort of added up to cause that pet to pass away.

00:21:17.740 --> 00:21:18.700
Dr. Dan Fletcher: It's not a miracle, right?

00:21:19.400 --> 00:21:20.880
Dr. Dan Fletcher: It's not going to reverse the disease.

00:21:20.980 --> 00:21:32.100
Dr. Dan Fletcher: And so what I think about the benefit of CPR, it's really for that patient who has a very sudden problem that caused the arrest and that we can hopefully support them long enough to get that reversed.

00:21:32.100 --> 00:21:35.660
Dr. Dan Fletcher: And sometimes they need to get to the vet to get the primary condition reversed.

00:21:35.660 --> 00:21:37.700
Dr. Dan Fletcher: But if we can start the CPR, it can help.

00:21:37.700 --> 00:21:38.680
Arden Moore: Oh, absolutely.

00:21:38.680 --> 00:21:45.200
Arden Moore: It's the statistic accurate that every minute the heart stops, the chance of survivability goes down 10 percent.

00:21:45.200 --> 00:21:45.500
Dr. Dan Fletcher: Yeah.

00:21:45.500 --> 00:21:47.040
Dr. Dan Fletcher: So in people, that's true for sure.

00:21:47.040 --> 00:21:51.060
Dr. Dan Fletcher: We don't have good data in dogs and cats about that, but I would suggest that it's about the same.

00:21:51.060 --> 00:21:54.920
Dr. Dan Fletcher: But yes, certainly we know that minutes actually seconds count in this case.

00:21:54.920 --> 00:22:05.780
Dr. Dan Fletcher: And that's why I think knowing how to do the basics of CPR can be really life-saving in these patients, knowing how to do a quick airway exam to see is there something in there that's obstructing the airway that you can remove.

00:22:05.780 --> 00:22:11.940
Dr. Dan Fletcher: Those are the kinds of things that I think a pet owner can do that could potentially be the difference between turning that around and not.

00:22:11.940 --> 00:22:13.700
Arden Moore: And is the formula the same?

00:22:14.660 --> 00:22:19.260
Arden Moore: 30 chest compressions, 2 rescue breasts, 30 chest compressions, 2 rescue breasts?

00:22:19.260 --> 00:22:20.340
Dr. Dan Fletcher: Yeah, exactly.

00:22:20.340 --> 00:22:21.280
Dr. Dan Fletcher: So we've-

00:22:21.280 --> 00:22:22.080
Arden Moore: And then assess?

00:22:22.080 --> 00:22:22.520
Dr. Dan Fletcher: Right.

00:22:22.520 --> 00:22:22.780
Dr. Dan Fletcher: Yeah.

00:22:22.780 --> 00:22:27.760
Dr. Dan Fletcher: So we've developed an initial algorithm to get started and really, it's not that, it's not complicated.

00:22:27.760 --> 00:22:31.040
Dr. Dan Fletcher: So if a pet is unresponsive, the first thing we recommend is that you stimulate them.

00:22:31.040 --> 00:22:32.900
Dr. Dan Fletcher: So this cat is unresponsive.

00:22:32.900 --> 00:22:34.160
Dr. Dan Fletcher: I'm going to shake him.

00:22:34.160 --> 00:22:34.680
Arden Moore: Hang on.

00:22:34.680 --> 00:22:36.820
Arden Moore: For those on my YouTube, they get to see him.

00:22:36.820 --> 00:22:37.580
Arden Moore: Go for it, man.

00:22:37.580 --> 00:22:37.960
Arden Moore: Go for it.

00:22:37.960 --> 00:22:38.600
Dr. Dan Fletcher: Yeah.

00:22:39.120 --> 00:22:44.300
Dr. Dan Fletcher: So if this cat is unresponsive, I'm going to stimulate and call and see if I can get him to respond.

00:22:44.300 --> 00:22:49.880
Dr. Dan Fletcher: If he doesn't respond, then the only thing I'm going to do before I start CPR is to see if he's breathing.

00:22:49.880 --> 00:22:52.780
Dr. Dan Fletcher: So I'm going to look at his chest and see if there's a chest rise.

00:22:52.780 --> 00:22:59.480
Dr. Dan Fletcher: If there's no chest rise, if there's no sign that this patient is breathing and I can't stimulate him, then I'm going to move on to start CPR.

00:22:59.480 --> 00:23:06.100
Dr. Dan Fletcher: If I have someone else with me, I'll start chest compressions right away and that other person, I will ask to check the airway.

00:23:06.180 --> 00:23:09.080
Dr. Dan Fletcher: So what they're going to do is open the mouth, pull out the tongue.

00:23:09.080 --> 00:23:11.660
Arden Moore: Well, if you wouldn't mind, just do a whole set right now.

00:23:11.660 --> 00:23:12.280
Arden Moore: Just go for it.

00:23:12.380 --> 00:23:14.560
Arden Moore: I want to just go 10, 20, 30.

00:23:14.560 --> 00:23:15.480
Dr. Dan Fletcher: Do the compressions?

00:23:15.480 --> 00:23:15.840
Arden Moore: Yeah.

00:23:15.840 --> 00:23:16.560
Dr. Dan Fletcher: Yeah, sure.

00:23:16.800 --> 00:23:19.720
Dr. Dan Fletcher: So they're going to be checking that airway while I start chest compression.

00:23:19.720 --> 00:23:25.940
Dr. Dan Fletcher: So the chest compression in a cat or a small dog, we generally recommend single-handed approach.

00:23:25.940 --> 00:23:27.540
Dr. Dan Fletcher: So there are three new techniques.

00:23:27.540 --> 00:23:32.480
Dr. Dan Fletcher: So one of the things that's changed in the new guidelines is that we have three techniques for cats and small dogs.

00:23:32.480 --> 00:23:43.300
Dr. Dan Fletcher: So one is this one-hand technique where you wrap your hand around the chest like this, and you're going to bring your thumb against your hand like this to try to milk blood out of the heart.

00:23:43.300 --> 00:23:45.040
Arden Moore: You're kind of a lobster claw.

00:23:45.040 --> 00:23:46.380
Dr. Dan Fletcher: Yeah, it's like a lobster claw.

00:23:46.380 --> 00:23:50.040
Dr. Dan Fletcher: So what you're going to think you're supposed to do is pitch your fingers together, right?

00:23:50.040 --> 00:23:52.340
Dr. Dan Fletcher: That doesn't work because I have a prop here.

00:23:52.340 --> 00:23:54.180
Dr. Dan Fletcher: So this is what a heart looks like.

00:23:54.180 --> 00:23:57.960
Dr. Dan Fletcher: So this is kind of the size of a heart and a little big for a cat actually.

00:23:57.960 --> 00:24:05.800
Dr. Dan Fletcher: And so if I put my other heart in my hand and I squeeze my fingers together, I'm actually squeezing up here at the base of the heart.

00:24:05.800 --> 00:24:07.680
Dr. Dan Fletcher: This is not the ventricle where the blood is.

00:24:07.800 --> 00:24:12.200
Dr. Dan Fletcher: So what I wanna do is I wanna bring that thumb against my hand like this.

00:24:12.200 --> 00:24:18.820
Dr. Dan Fletcher: That allows me to milk the blood out of the ventricle, which is the part that's holding that blood and move it out to both the lungs and to the rest of the body.

00:24:18.820 --> 00:24:20.980
Dr. Dan Fletcher: So we're gonna bring our hand in like this.

00:24:20.980 --> 00:24:22.500
Dr. Dan Fletcher: So this can be pretty tiring.

00:24:22.500 --> 00:24:27.100
Dr. Dan Fletcher: And if you don't go to the gym and do a lot of forearm exercises, you're probably gonna get tired pretty quickly.

00:24:27.100 --> 00:24:30.400
Dr. Dan Fletcher: So they have two other options that we can use.

00:24:30.400 --> 00:24:33.220
Dr. Dan Fletcher: The next one is what we call circumferential chest compression.

00:24:33.220 --> 00:24:45.840
Dr. Dan Fletcher: So the idea here is with the cat or dog laying on its side, I'm gonna wrap both hands around the chest and I'm gonna put my two thumbs together right over the location of the heart and I'm gonna squeeze both fingers at the same time.

00:24:45.840 --> 00:24:49.500
Dr. Dan Fletcher: So I'm doing the compressions with my thumbs like this.

00:24:49.500 --> 00:24:55.500
Dr. Dan Fletcher: And that way you're using two hands to do the compression instead of one and hopefully you won't get quite as tired.

00:24:56.120 --> 00:25:04.180
Dr. Dan Fletcher: If the small cat or the dog is too large to get your hands around the chest like this, the third approach you can use is what we call the one hand technique.

00:25:04.640 --> 00:25:14.620
Dr. Dan Fletcher: So with this I'm going to put my non-dominant hand along the spine and I'm going to take my dominant hand, the heel of that hand, I'm going to put it right over the heart and I'm going to do my compressions like this.

00:25:14.620 --> 00:25:17.600
Dr. Dan Fletcher: So I'm going to use my whole arm to do the compression.

00:25:17.600 --> 00:25:23.740
Dr. Dan Fletcher: So I can get a little bit, that's a little less tiring to do it this way because rather than just using a hand you're using your whole arm.

00:25:23.740 --> 00:25:30.660
Dr. Dan Fletcher: So those are the three approaches that we recommend in cats and small dogs, dogs less than about 15 pounds or so.

00:25:31.140 --> 00:25:44.000
Arden Moore: And let's stop because I want to review because you just showed three different hand movements, thank you, and you're trying to get that heart pumping again to get the oxygenated blood to all the vital organs and all that.

00:25:44.000 --> 00:25:46.040
Arden Moore: That's a game changer, isn't it?

00:25:46.040 --> 00:25:49.100
Dr. Dan Fletcher: Yeah, it's the most important part of CPR.

00:25:49.100 --> 00:25:53.460
Dr. Dan Fletcher: So really getting those chest compressions going immediately is so, so, so critical.

00:25:53.460 --> 00:25:57.280
Dr. Dan Fletcher: So you can use any of those three approaches in cats and small dogs.

00:25:57.280 --> 00:25:58.700
Arden Moore: And what about the breathing?

00:25:58.860 --> 00:25:59.820
Arden Moore: What about the breathing?

00:25:59.920 --> 00:26:02.220
Arden Moore: You're going your breath into the nose?

00:26:02.220 --> 00:26:03.200
Dr. Dan Fletcher: Yeah, yeah.

00:26:03.200 --> 00:26:04.360
Dr. Dan Fletcher: So the breathing, yeah.

00:26:04.360 --> 00:26:06.620
Dr. Dan Fletcher: So we can finish up with the breathing for sure.

00:26:07.500 --> 00:26:14.680
Dr. Dan Fletcher: So what we would recommend if you're out in the wild and you have a patient that you're doing CPR on would be what we call mouth-to-nose breaths.

00:26:14.680 --> 00:26:19.420
Dr. Dan Fletcher: So to do a mouth-to-nose breath, we're gonna blow in through the pet's nose.

00:26:19.420 --> 00:26:23.980
Dr. Dan Fletcher: So we have to make sure that that air is gonna go into the lungs and not out the mouth or somewhere else.

00:26:23.980 --> 00:26:27.600
Dr. Dan Fletcher: So first step is we're gonna close the mouth, make sure we close it very tightly.

00:26:28.280 --> 00:26:34.000
Dr. Dan Fletcher: Second step is that we want to tilt head back so that the nose and the spine make a straight line.

00:26:34.000 --> 00:26:37.460
Dr. Dan Fletcher: And that's what opens up the trachea, the windpipe, if we make a nice straight line.

00:26:37.460 --> 00:26:49.900
Dr. Dan Fletcher: If the head is tilted down or back, or if you lift the head up off the ground, you're gonna tilt, you're gonna sort of kink the trachea, and less air is gonna go into the lungs, more of it will go into the stomach basically.

00:26:49.900 --> 00:27:21.340
Dr. Dan Fletcher: So we want that neck nice and straight, we want to close that mouth, and then we're gonna get two very quick breaths, make a seal over the nostrils, and we're gonna get two very quick breaths, so like that, and then we'll go immediately back to those chest compressions, and we'll do that 30 to two, so 30 compressions, count them out loud, and then when you get to the 30th compression, you get two quick breaths, and then you immediately go back to those chest compressions again, and you keep doing that until somebody comes, hopefully with a car, and then you get it in that car, and you start driving to the vet, and you can do this while you're traveling.

00:27:21.340 --> 00:27:26.980
Arden Moore: Now you don't open the airway and get the tongue out of the way, do any finger sweeps anymore?

00:27:26.980 --> 00:27:37.700
Dr. Dan Fletcher: Not typically, because again, we're going through the nose and back, so as long as we get that nose lined up with the spine, we should be opening up the airway from the nasopharynx, which is that part back here and back.

00:27:37.700 --> 00:27:39.680
Dr. Dan Fletcher: We don't typically have to worry too much about the tongue.

00:27:39.680 --> 00:27:41.220
Dr. Dan Fletcher: It's usually not going to be in the way.

00:27:41.220 --> 00:27:44.520
Dr. Dan Fletcher: Now having said that, we did kind of skip over that airway assessment a little bit.

00:27:44.520 --> 00:27:48.480
Dr. Dan Fletcher: So before we start that, we would want to check the airway and make sure it's clear.

00:27:48.480 --> 00:28:00.480
Dr. Dan Fletcher: So we will open the mouth and we'll pull the tongue out as far as we can and look all the way back, and you should be able to see back to the tonsils and you should see the arytenoids, which are these two little guys that stick up, that can bounce back and forth a little bit.

00:28:00.880 --> 00:28:06.220
Dr. Dan Fletcher: Hopefully you can see all the way back there, and as long as there's nothing obstructing, then you just go on and do the breathing.

00:28:06.240 --> 00:28:15.300
Dr. Dan Fletcher: If you pull that tongue out, you and you look back there and you see something back there, there's a ball or there's fluid or something like that, then you want to do a finger sweep to try to get that out of there.

00:28:15.300 --> 00:28:24.180
Dr. Dan Fletcher: So it's very important to be very careful with this because if there's an object back there that's kind of small and you just kind of poke it, you could push it back further into the airway where you can't get it.

00:28:24.180 --> 00:28:35.400
Dr. Dan Fletcher: So I would be thinking about if I see something, I'm going to put my finger in the side of the mouth and I'm going to sweep to the side to try to dislodge it and knock it out as opposed to pushing it back into the airway.

00:28:35.400 --> 00:28:37.760
Dr. Dan Fletcher: So really important that you avoid that.

00:28:37.760 --> 00:28:39.280
Arden Moore: Show us for a dog.

00:28:39.280 --> 00:28:40.440
Arden Moore: Yeah, absolutely.

00:28:40.440 --> 00:28:41.480
Dr. Dan Fletcher: I'm going to do that one.

00:28:41.480 --> 00:28:48.720
Dr. Dan Fletcher: So then for a larger dog like this guy here, we're going to do chest, it doesn't matter which side they're laying on, either side is fine.

00:28:49.200 --> 00:28:50.940
Arden Moore: Can I give you a rhyme that I teach?

00:28:50.940 --> 00:28:51.120
Dr. Dan Fletcher: Yeah.

00:28:51.360 --> 00:28:59.120
Arden Moore: Because dogs and cats have teeth and claws and they don't speak English, we do belly to back like you are because we don't want to run.

00:28:59.120 --> 00:29:02.780
Arden Moore: But I say the hand that does the pump is closest to the rump.

00:29:02.780 --> 00:29:06.040
Dr. Dan Fletcher: The hand that does the pump is closest to the rump.

00:29:06.040 --> 00:29:11.020
Arden Moore: Because this way if there's a startled response, you can go down with your forearm against the head.

00:29:11.200 --> 00:29:12.900
Dr. Dan Fletcher: Got it to keep them from bouncing up.

00:29:12.900 --> 00:29:14.080
Arden Moore: What do you think of my rhyme?

00:29:14.080 --> 00:29:16.660
Dr. Dan Fletcher: Yeah, I think that's good.

00:29:16.660 --> 00:29:19.320
Dr. Dan Fletcher: That way this up arm you're saying is facing that way.

00:29:19.400 --> 00:29:21.940
Dr. Dan Fletcher: Yeah, that's good if they do jump up for sure.

00:29:21.940 --> 00:29:23.140
Arden Moore: Okay, so go for it Dr.

00:29:23.140 --> 00:29:23.500
Arden Moore: Dan.

00:29:23.500 --> 00:29:30.080
Dr. Dan Fletcher: Yeah, so for medium and large breed dogs, they have two different chest shapes and we have to figure out in each patient which one they have.

00:29:30.080 --> 00:29:32.220
Dr. Dan Fletcher: Well, three different, we'll talk about the third in a second.

00:29:32.220 --> 00:29:36.340
Dr. Dan Fletcher: So this dog has what we call a round chested conformation.

00:29:36.340 --> 00:29:37.280
Dr. Dan Fletcher: So if I run my hand-

00:29:37.280 --> 00:29:37.980
Dr. Dan Fletcher: Like a beagle.

00:29:37.980 --> 00:29:42.040
Dr. Dan Fletcher: Yeah, like a beagle, Labrador, most of them will have this shape.

00:29:42.040 --> 00:29:43.940
Dr. Dan Fletcher: Within a breed, you can have some variation.

00:29:43.940 --> 00:29:45.780
Dr. Dan Fletcher: So I would encourage you to assess each patient.

00:29:45.780 --> 00:29:53.360
Dr. Dan Fletcher: But the way I figure out if a dog is round chested is with them running on their sides, I run my hand over the chest, front to back and bottom to top.

00:29:53.360 --> 00:30:02.280
Dr. Dan Fletcher: And if I do that and I feel a dome in the middle of the chest, if it feels like a sphere and there's a dome poking up at me, that's probably a round chested dog.

00:30:02.280 --> 00:30:07.060
Dr. Dan Fletcher: And in that case, I'm going to do my compressions directly over the highest point on the chest.

00:30:07.060 --> 00:30:14.540
Dr. Dan Fletcher: So I'll take my hand that I'm going to have touching, and I like that the dominant hand, the hand on the chest is toward the rump.

00:30:14.540 --> 00:30:19.120
Dr. Dan Fletcher: And I'm going to make sure the heel of that hand is over the highest point on the chest.

00:30:19.120 --> 00:30:20.560
Dr. Dan Fletcher: That's where I'm going to focus my compression.

00:30:20.560 --> 00:30:32.060
Dr. Dan Fletcher: I'm going to put my other hand above it and interlock those fingers, and I'm going to make sure my elbows are locked, and I'm going to bend at the waist to achieve my compressions like this.

00:30:32.060 --> 00:30:35.540
Dr. Dan Fletcher: So you're going to have a tendency to want to do compressions by doing this.

00:30:35.540 --> 00:30:41.220
Dr. Dan Fletcher: Now you guys all out there probably do go to the gym more often than I do, but it doesn't really matter how often you go to the gym.

00:30:41.220 --> 00:30:44.900
Dr. Dan Fletcher: Your core muscles are always going to be stronger than your biceps and triceps.

00:30:45.380 --> 00:30:49.500
Dr. Dan Fletcher: So you want to keep those elbows locked and do the compression by bending at the waist.

00:30:49.500 --> 00:30:56.400
Dr. Dan Fletcher: The easiest way to do this when you're at home is to make sure that your pet is on the floor and just kneel behind them on the floor.

00:30:56.400 --> 00:31:07.400
Dr. Dan Fletcher: So you're kneeling right up against the spine and you're going to get yourself in that position and you just want to make sure that you're up and over and those shoulders are directly above the hands, making a straight line down the chest.

00:31:07.400 --> 00:31:09.940
Dr. Dan Fletcher: So that's really important in terms of posture.

00:31:09.940 --> 00:31:13.440
Arden Moore: And what's the other hand positions based on different chest dimensions?

00:31:13.720 --> 00:31:14.960
Dr. Dan Fletcher: So there are two other possibilities.

00:31:14.960 --> 00:31:17.920
Dr. Dan Fletcher: So one is that this is what we call a keel-chested dog.

00:31:17.920 --> 00:31:20.540
Dr. Dan Fletcher: So like the keel of a ship where it comes to a triangle.

00:31:20.540 --> 00:31:23.420
Dr. Dan Fletcher: And the way I would determine that in this cat is a little bit more like that.

00:31:23.420 --> 00:31:24.640
Arden Moore: That's like an Afghan, right?

00:31:24.640 --> 00:31:28.040
Dr. Dan Fletcher: Yeah, like an Afghan, a Borzoi, a Greyhound.

00:31:28.040 --> 00:31:35.920
Dr. Dan Fletcher: And so if I run my hand from the bottom of the chest to the top of the chest and my hand just kind of goes up, up, up, up, up, up, up, and then drops off.

00:31:35.920 --> 00:31:43.820
Dr. Dan Fletcher: And if I go front to back, if I'm at a particular location, if it just stays sort of at the same elevation, when I go front to back, it doesn't go up or down.

00:31:43.820 --> 00:31:45.620
Dr. Dan Fletcher: I don't get that dome feeling.

00:31:45.620 --> 00:31:48.240
Dr. Dan Fletcher: That's probably more the keel chested dog.

00:31:48.240 --> 00:31:53.640
Dr. Dan Fletcher: And in that case, I'm going to focus the compression right over the heart, just like I would in a cat or small dog.

00:31:53.640 --> 00:32:08.560
Dr. Dan Fletcher: And to figure out that location, if you take the front leg and you bend the elbow and rotate the arm up along the chest wall, you just rotate until the elbow is about a third of the way up the chest.

00:32:08.660 --> 00:32:14.040
Dr. Dan Fletcher: So think about the bottom of the chest and the top of the chest come one-third of the way up, rotating that arm.

00:32:14.040 --> 00:32:18.740
Dr. Dan Fletcher: That elbow will be pointing pretty much right over the location of the ventricles of the heart.

00:32:18.740 --> 00:32:22.120
Dr. Dan Fletcher: So that's where we're going to focus our compression there, right over that location.

00:32:22.120 --> 00:32:27.860
Dr. Dan Fletcher: So it's going to be a little lower and a little further to the front of the patient that we're going to be doing our compressions in this case.

00:32:27.860 --> 00:32:30.340
Dr. Dan Fletcher: So heel chest to dogs right over the heart.

00:32:30.340 --> 00:32:35.200
Arden Moore: And tell people, I think they used to go down one-third to one-half, but you say now one-quarter?

00:32:35.200 --> 00:32:36.840
Dr. Dan Fletcher: So that's only in certain cases.

00:32:36.940 --> 00:32:50.400
Dr. Dan Fletcher: So the third type of dog, so for these guys, for cats and small dogs, like this guy and medium to large breed dogs that are doing compressions on their sides, we go one-third to one-half the depth of the chest.

00:32:50.400 --> 00:32:52.020
Dr. Dan Fletcher: That's what we're focusing for.

00:32:52.020 --> 00:32:58.660
Dr. Dan Fletcher: And it's really hard when you're the one doing compressions, if you're doing this two-handed approach like this, to know how deeply you're going.

00:32:58.660 --> 00:33:03.320
Dr. Dan Fletcher: So ask the other people who are with you to look and tell you how deep you're going.

00:33:03.320 --> 00:33:10.060
Dr. Dan Fletcher: So you don't want to go any less than one-third, but you don't want to go any more than one-half that width because you could over compress and injure the heart.

00:33:10.060 --> 00:33:14.960
Dr. Dan Fletcher: So the third type of dog is this monstrosity here, right?

00:33:14.960 --> 00:33:17.940
Dr. Dan Fletcher: So this guy is a little bit shaped, a little bit more like us.

00:33:17.940 --> 00:33:20.640
Dr. Dan Fletcher: We call these wide-chested dogs.

00:33:20.640 --> 00:33:23.220
Dr. Dan Fletcher: So they are more wide than they are deep.

00:33:23.220 --> 00:33:25.880
Dr. Dan Fletcher: And if you cut them in cross-section, they make kind of an oval.

00:33:25.880 --> 00:33:27.700
Dr. Dan Fletcher: And so they're shaped like us.

00:33:27.700 --> 00:33:32.520
Dr. Dan Fletcher: And so in these patients, we actually do say you can put them up on their backs like this.

00:33:32.720 --> 00:33:37.500
Arden Moore: Well, aren't they said because their shoulders are wider, that they can actually sleep like this?

00:33:37.500 --> 00:33:38.540
Dr. Dan Fletcher: Yeah, yeah.

00:33:38.540 --> 00:33:44.440
Dr. Dan Fletcher: And so in general with these dogs, so English Bulldogs, Pugs, French Bulldogs, a lot of them have this type of confirmation.

00:33:44.440 --> 00:33:50.740
Dr. Dan Fletcher: And I would say the general approach I take is if they have that confirmation, then I'll put them on their backs.

00:33:50.740 --> 00:33:54.580
Dr. Dan Fletcher: And if they stay on their backs without me touching them, they probably are shaped this way.

00:33:54.580 --> 00:34:00.540
Dr. Dan Fletcher: If I put them on their backs and they keep rolling over onto their sides, they're probably more likely round-chested and I would do it that way.

00:34:00.540 --> 00:34:05.480
Dr. Dan Fletcher: But if they stay that way, and you guys have probably all seen videos or have little dogs who can't get off their back.

00:34:05.480 --> 00:34:07.020
Dr. Dan Fletcher: They look like turtles when they get back there.

00:34:07.020 --> 00:34:09.040
Dr. Dan Fletcher: Those are the perfect ones for that.

00:34:09.040 --> 00:34:12.840
Dr. Dan Fletcher: So for these guys, we're going to focus our compressions right over the heart again.

00:34:12.840 --> 00:34:14.520
Dr. Dan Fletcher: So same basic idea.

00:34:14.520 --> 00:34:17.620
Dr. Dan Fletcher: Pull that elbow third of the way up the chest here.

00:34:17.620 --> 00:34:31.080
Dr. Dan Fletcher: That location is where I'm going to then come across to the middle of the chest, and I'm going to focus my compressions right at that location on the chest, and I'm going to do the compression this way on the patient, sort of like you would in a person right over the breastbone, right?

00:34:31.400 --> 00:34:32.700
Dr. Dan Fletcher: We're going to focus the same place.

00:34:32.700 --> 00:34:58.960
Dr. Dan Fletcher: In this case, we only want to go a quarter the depth of the chest because you guys have a whole lot of tissue up here in the spine that takes up space, and so if you go that half that depth, you're going to be probably over-compressing the heart, so in this case, we're trying to squeeze the heart between the sternum, the breastbone, and the spine, and we just want to go a little bit less deep because of that extra tissue that's in our way when we're doing that compression that won't compress.

00:34:58.960 --> 00:35:00.340
Dr. Dan Fletcher: So those are the three different ways.

00:35:00.980 --> 00:35:06.080
Arden Moore: So once you do the chest compressions, do you then roll them to their side to do the rescue breast?

00:35:06.080 --> 00:35:09.220
Dr. Dan Fletcher: Yeah, it's probably best to roll them to the side to straighten things up.

00:35:09.220 --> 00:35:15.680
Dr. Dan Fletcher: Otherwise, especially with a bulldog, because anybody who has ever experienced them knows they have so much tissue back here.

00:35:15.680 --> 00:35:17.980
Dr. Dan Fletcher: So yeah, it would be better to roll them on their sides.

00:35:17.980 --> 00:35:23.460
Dr. Dan Fletcher: Same thing, straighten that snout as much as you can, close the mouth and blow right into the nose for those two rescue breaths.

00:35:23.460 --> 00:35:34.560
Arden Moore: So in summary, everybody, I want people to go check out the Recover Program because we want people to know how to save a pet's life and how to do it right, CPR.

00:35:34.560 --> 00:35:34.920
Arden Moore: Dr.

00:35:34.920 --> 00:35:38.520
Arden Moore: Dan Fletcher, how do people find out about how to do this?

00:35:38.520 --> 00:35:47.700
Dr. Dan Fletcher: Yeah, so our website is recoverinitiative, alloneword.org, or you can just search for Recover Vet and you'll find it.

00:35:47.700 --> 00:35:51.400
Dr. Dan Fletcher: And we have a bunch of information on our website about it.

00:35:51.400 --> 00:35:55.840
Dr. Dan Fletcher: We have online courses, there is an online pet owner course you can take to get some of the basics.

00:35:55.960 --> 00:36:08.300
Dr. Dan Fletcher: I do think that going to a lab with someone like Arden is a really, really important next step because learning in theory how to do these things is one thing, but learning how to actually do these physical skills and get feedback on them is so critical.

00:36:08.300 --> 00:36:12.120
Dr. Dan Fletcher: And we know that from human medicine, how important it is to have those skills labs.

00:36:12.120 --> 00:36:21.040
Dr. Dan Fletcher: So I think you could take the online course, it takes about an hour, you can get the basics there and then you could go to a lab with someone like Arden to learn how to do those hand skills.

00:36:21.040 --> 00:36:22.840
Dr. Dan Fletcher: And there's just a lot of information up there about that.

00:36:23.200 --> 00:36:29.700
Arden Moore: Well, I'm blessed because I team up with ER and critical care veterinarians and they have helped me.

00:36:29.700 --> 00:36:33.240
Arden Moore: My mission is to give out veterinary approved information.

00:36:33.240 --> 00:36:35.840
Arden Moore: But I've actually done CPR four times.

00:36:35.840 --> 00:36:36.580
Arden Moore: I've saved two.

00:36:36.580 --> 00:36:36.980
Arden Moore: Wow.

00:36:36.980 --> 00:36:37.700
Dr. Dan Fletcher: That's amazing.

00:36:38.240 --> 00:36:39.480
Dr. Dan Fletcher: That's really great.

00:36:39.480 --> 00:36:40.560
Dr. Dan Fletcher: And I think the other thing.

00:36:41.160 --> 00:36:41.480
Dr. Dan Fletcher: Yeah.

00:36:41.480 --> 00:36:49.040
Dr. Dan Fletcher: I think the other thing that pet owners can do is just talk to your vets about whether they had CPR training, whether they're aware of recover or not.

00:36:50.140 --> 00:36:53.760
Dr. Dan Fletcher: My, you know, this all started out of the emergency and critical care community.

00:36:53.760 --> 00:37:02.800
Dr. Dan Fletcher: And when I go to emergency and critical care conferences, like our International Veterinary Emergency and Critical Care Society meeting, I'm basically preaching to the converted people, know about it.

00:37:02.800 --> 00:37:03.760
Dr. Dan Fletcher: They're excited about it.

00:37:03.760 --> 00:37:05.800
Dr. Dan Fletcher: They're excited to have guidelines.

00:37:05.800 --> 00:37:11.380
Dr. Dan Fletcher: I think that in veterinary medicine, there's been sort of a history or a suspicion, I guess.

00:37:11.380 --> 00:37:13.120
Dr. Dan Fletcher: People didn't know how to do CPR.

00:37:13.120 --> 00:37:14.840
Dr. Dan Fletcher: They were afraid to try to do it.

00:37:14.840 --> 00:37:16.800
Dr. Dan Fletcher: So they would do it not very well.

00:37:16.800 --> 00:37:18.500
Dr. Dan Fletcher: They would rarely get any patients back.

00:37:18.600 --> 00:37:20.040
Dr. Dan Fletcher: And so they kind of gave up on it.

00:37:20.040 --> 00:37:29.780
Dr. Dan Fletcher: And so there are unfortunately still among, especially the gray haired vets like me, sort of this feeling that CPR is futile and then it's not worth trying.

00:37:29.780 --> 00:37:51.800
Dr. Dan Fletcher: What we know from the literature and even from our own data in veterinary medicine now, which is just we're just starting to collect, is that especially in these very sudden and reversible cases, and the classic would be you take your local vet, see the patient who is coming in for a spay, a routine surgery that they do all the time, and they have a weird reaction to the anesthesia, and they arrest under that anesthetic agent.

00:37:51.800 --> 00:38:02.560
Dr. Dan Fletcher: Even before we had guidelines, about 50 percent, if we started CPR right away, about 50 percent of those patients would survive to discharge and would do fine if we started CPR right away.

00:38:02.560 --> 00:38:14.960
Dr. Dan Fletcher: The most recent data that we have from UC Davis about these arrests that happened around the time of anesthesia, is that pets that arrest in that peri-anesthetic period are 15 times more likely to survive to discharge.

00:38:14.960 --> 00:38:20.580
Dr. Dan Fletcher: And so a lot of the studies that we have that give us this data are from places like where I work.

00:38:20.580 --> 00:38:23.760
Dr. Dan Fletcher: I work at what we call a tertiary referral facility.

00:38:23.760 --> 00:38:31.140
Dr. Dan Fletcher: So we're not only the first referral, we're usually the second referral for someone who's taking their patient in and they have really complex problems.

00:38:31.140 --> 00:38:34.880
Dr. Dan Fletcher: So we see the sickest of the sick here, and that's where a lot of our data come from.

00:38:35.480 --> 00:38:48.860
Dr. Dan Fletcher: We have every reason to think that your vet in general practice could have really good success rates with CPR, because they're mostly going to be dealing with acute sudden reactions to something like an anesthetic or sedative, and we know that they can do really well.

00:38:48.860 --> 00:39:00.760
Dr. Dan Fletcher: So I think that's another thing that I'm most excited about now, is really trying to get this word out to veterinarians who are working in general practice as opposed to emergency people like me, who see the worst to the worst cases.

00:39:00.920 --> 00:39:05.640
Dr. Dan Fletcher: We get a lot of them back, but I think that our colleagues in general practice could get even more back.

00:39:05.640 --> 00:39:06.920
Dr. Dan Fletcher: And I guess just one thing to…

00:39:06.940 --> 00:39:07.940
Dr. Dan Fletcher: Oh, yeah, good.

00:39:07.940 --> 00:39:19.360
Dr. Dan Fletcher: I was going to say, just one thing to finish up with the recover stuff is just the reason that we just sent out a press release is because we did do just a major update, and that's where these new approaches to chest compressions just came from.

00:39:19.360 --> 00:39:26.480
Dr. Dan Fletcher: So that was just published June 24th, they finally, or 26th, they just came out in the Journal of Veterinary Emergency and Critical Care.

00:39:26.480 --> 00:39:28.600
Dr. Dan Fletcher: So we have a whole new set of guidelines.

00:39:28.600 --> 00:39:35.080
Dr. Dan Fletcher: A lot of it's the same, but we do have some pretty significant updates like the different approaches to chest compressions in small dogs and cats.

00:39:36.040 --> 00:39:40.420
Dr. Dan Fletcher: So yeah, getting the word out to your vets to maybe take a look at that is also a helpful thing.

00:39:40.420 --> 00:39:53.060
Arden Moore: Well, I appreciate you doing the demos because folks, you're going to see it on my YouTube channel, polished and edited, but we're also going to have you back when you get into more pet first aid guidelines coming up.

00:39:53.060 --> 00:40:01.360
Arden Moore: But we wanted to focus on CPR on this show, but you can't leave the show without doing a shout out to two of your special dogs.

00:40:01.500 --> 00:40:04.580
Arden Moore: I've seen you guys on trails and camping and hiking.

00:40:04.580 --> 00:40:05.560
Arden Moore: Come on, they're listening.

00:40:05.560 --> 00:40:06.660
Dr. Dan Fletcher: They are the best.

00:40:06.660 --> 00:40:10.260
Dr. Dan Fletcher: I have an Irish wolf how named Orla who turned eight in April.

00:40:10.260 --> 00:40:14.980
Dr. Dan Fletcher: She's had a few health problems, but she's doing great.

00:40:14.980 --> 00:40:15.640
Dr. Dan Fletcher: She's a happy girl.

00:40:15.640 --> 00:40:20.760
Dr. Dan Fletcher: We just had a beautiful hike this morning before I came to work, and I'm very, very blessed to have her in my life.

00:40:20.760 --> 00:40:30.080
Dr. Dan Fletcher: Then my Stamford, our great Dane mix, Eleanor who turns 11 next month, so I'm running a geriatric board at home right now, who is a wonderful, wonderful dog.

00:40:30.080 --> 00:40:30.720
Dr. Dan Fletcher: She's the sweetest.

00:40:30.720 --> 00:40:36.240
Dr. Dan Fletcher: She is also a therapy dog and she loves nothing more than to snuggle up with her friends.

00:40:36.240 --> 00:40:40.200
Dr. Dan Fletcher: Then I also have to make a shout out to my kitty, Apple.

00:40:40.200 --> 00:40:40.880
Dr. Dan Fletcher: He's a rescue.

00:40:40.880 --> 00:40:48.360
Dr. Dan Fletcher: He was a barn cat who loves to go and visit the people who would come to see the horses at the barn when they came to feed him apples.

00:40:48.360 --> 00:40:54.420
Dr. Dan Fletcher: They started calling him Apple and then he wound up in my house and is great with the big dogs.

00:40:54.420 --> 00:40:54.900
Dr. Dan Fletcher: He loves them.

00:40:54.900 --> 00:40:55.660
Arden Moore: Is he an orange tabby?

00:40:55.660 --> 00:40:57.220
Dr. Dan Fletcher: He's an orange tabby.

00:40:57.220 --> 00:40:58.080
Dr. Dan Fletcher: He's a sweetheart.

00:40:58.080 --> 00:41:00.560
Dr. Dan Fletcher: He's such a good boy and he just loves his girls so much.

00:41:01.120 --> 00:41:03.740
Dr. Dan Fletcher: They're thick as thieves, those three.

00:41:03.740 --> 00:41:05.200
Arden Moore: I know I'm not a veterinarian.

00:41:05.200 --> 00:41:18.160
Arden Moore: I don't play one on TV, but what do you think when we say that we're here to try to teach veterinary approved courses to people, pet professionals in the boarding, pet sitters, dog trainers, pet parents.

00:41:18.160 --> 00:41:20.400
Arden Moore: I can't do my job without people like you.

00:41:20.400 --> 00:41:20.820
Dr. Dan Fletcher: No.

00:41:20.820 --> 00:41:23.260
Dr. Dan Fletcher: I think it's so critical what you do.

00:41:23.260 --> 00:41:31.260
Dr. Dan Fletcher: I think a major difference between veterinary medicine and human medicine is we don't have ambulance services in most places, and we don't have EMTs who can get out there.

00:41:31.260 --> 00:41:40.940
Dr. Dan Fletcher: Unfortunately, that burden falls on the pet owner to figure out what they can do in the short term while they're transporting, unfortunately, the pet themselves to the veterinarian.

00:41:40.940 --> 00:41:45.620
Dr. Dan Fletcher: I think getting this kind of information out for these very sudden problems is so important.

00:41:45.980 --> 00:41:47.060
Dr. Dan Fletcher: I think it can make a difference.

00:41:47.060 --> 00:41:55.380
Dr. Dan Fletcher: I've had multiple cases that have made it to this hospital where the owner started CPR on the way, and we were able to turn those around.

00:41:55.380 --> 00:42:01.060
Dr. Dan Fletcher: I do think it can save lives, and I think it's just critical in the absence of those kinds of systems.

00:42:01.060 --> 00:42:03.460
Arden Moore: We definitely need to have you back, Dr.

00:42:03.460 --> 00:42:04.560
Arden Moore: Dan Fletcher.

00:42:04.560 --> 00:42:07.660
Arden Moore: Everybody, please check out the Recover Initiative.

00:42:07.660 --> 00:42:09.360
Arden Moore: He is at Cornell University.

00:42:09.360 --> 00:42:11.280
Arden Moore: He is my personal hero.

00:42:11.920 --> 00:42:16.260
Arden Moore: For the YouTubers, you get to see him do the demos right there.

00:42:16.260 --> 00:42:17.660
Arden Moore: We appreciate that, Dr.

00:42:17.660 --> 00:42:18.220
Arden Moore: Dan.

00:42:18.220 --> 00:42:22.940
Arden Moore: I also at this time want to give a shout out to my producer, Mark Winter.

00:42:22.940 --> 00:42:25.680
Arden Moore: He is the executive producer of Pet Life Radio.

00:42:26.120 --> 00:42:30.360
Arden Moore: We are the largest radio network on the planet with dogs, cats and others.

00:42:30.360 --> 00:42:31.520
Arden Moore: Check out my YouTube.

00:42:31.520 --> 00:42:32.620
Arden Moore: It's Arden Moore.

00:42:32.620 --> 00:42:33.540
Arden Moore: God-given name.

00:42:33.540 --> 00:42:34.540
Arden Moore: That's my real name.

00:42:34.540 --> 00:42:37.640
Arden Moore: And we have a newsletter on 4-legged life.

00:42:37.640 --> 00:42:40.820
Arden Moore: You want to take a course that is approved by veterinarians.

00:42:40.820 --> 00:42:42.660
Arden Moore: It is Pet First Aid for you.

00:42:42.660 --> 00:42:43.940
Arden Moore: But take a course anywhere.

00:42:43.940 --> 00:42:44.900
Arden Moore: I don't care.

00:42:44.900 --> 00:42:52.560
Arden Moore: The more people that know how to do Pet First Aid and safely get the pet to the veterinary clinic makes Arden a happy person.

00:42:52.560 --> 00:42:53.200
Arden Moore: And makes Dr.

00:42:53.200 --> 00:42:54.800
Arden Moore: Dan Fletcher a happy man, right?

00:42:54.900 --> 00:42:55.440
Dr. Dan Fletcher: You bet.

00:42:55.440 --> 00:42:55.800
Dr. Dan Fletcher: You bet.

00:42:55.800 --> 00:43:00.800
Dr. Dan Fletcher: And I think I love that you called out all these people who make a difference here and who make this possible.

00:43:00.800 --> 00:43:10.040
Dr. Dan Fletcher: And I would be remiss to not also call out the fact that these guidelines were not something that just that well, there's a third coach here this time around, Jamie Burkett from UC Davis, who's amazing.

00:43:10.040 --> 00:43:16.840
Dr. Dan Fletcher: And then we had a group of over 300 veterinarians and veterinary technicians who volunteered their time to review all of this literature.

00:43:16.840 --> 00:43:18.560
Dr. Dan Fletcher: It was a huge number of questions.

00:43:18.560 --> 00:43:22.660
Dr. Dan Fletcher: Over 1200 individual studies were evaluated for these new guidelines.

00:43:22.720 --> 00:43:25.020
Dr. Dan Fletcher: And we couldn't have done it without the hard work in the community.

00:43:25.020 --> 00:43:27.900
Dr. Dan Fletcher: So it takes a village in all of our realms.

00:43:28.180 --> 00:43:34.960
Dr. Dan Fletcher: And I think it's so important to remember it's these contributions from these people are just incredibly valuable.

00:43:34.960 --> 00:43:35.900
Arden Moore: I agree.

00:43:35.900 --> 00:43:45.580
Arden Moore: So everybody, until next time, this is your Flee Free host, Arden Moore, delivering just two words to all you two, three and four leggers out there.

00:43:45.580 --> 00:43:47.300
Arden Moore: Oh, behave.

00:43:47.300 --> 00:43:51.320
Announcer: Coast to coast and around the world, it's Oh Behave with Arden Moore.

00:43:51.700 --> 00:43:59.340
Announcer: Find out why cats and dogs do the things they do and get the latest buzz from wagging tongues and tails in Rin Tin Tinsel Town.

00:43:59.340 --> 00:44:07.400
Announcer: From famous pet experts and best selling authors to television and movie stars, you'll get great tail wagging pet tips and have a fur flying fun time.

00:44:07.400 --> 00:44:14.720
Announcer: Oh Behave with America's pet edutainer, Arden Moore, every week on demand, only on petliferadio.com.