6.心肺復蘇指南介紹What_is_CAB

1、What is CAB?CAB是什么？AHA Highlights for CPR and ACLS美國心臟協(xié)會心肺復蘇和高級心血管生命支持的重點2010 1Evidence Based背景356 experts from 29 countries來自29個國家的專家356Considerations for:考慮到Effectiveness效率Ease of teaching and application易于教學和應用Local systems factors本地因素Extensive review of resuscitation literature and many debates

2、and discussions復蘇回顧及許多討論2Emphasis重點Good quality CPR高質量CPRImproving the consistency of care in prehospital改善院前護理的一致性Developing standards for post-cardiac arrest management制定心臟驟停后的管理標準3CPR心肺復蘇Compressions “at least”100 per minute.每分鐘按壓“至少” 100下。Compression depth按壓深度At least 2 inches in adults成人至少有2英寸A

3、t least 1/3 of the anterior to posterior depth in children and infants兒童和嬰兒至少1 / 3的深度Approximately 2 inches in children and 1.5 inches in infants兒童大約2英寸，嬰兒1.5英寸4Ventilations通氣Continue to stress重點NO HYPERVENTILATION不要過度換氣5CABChest compression immediately will benefit most viable patients.立即胸外按壓對患者有益C

4、omplete 30 compressions BEFORE assessing airway and breathing評估氣道，呼吸前完成30次按壓May increase the number of patients receiving bystander CPR受路人進行心肺復蘇的患者人數可能增加6Decisions for HCPHCPDid the patient most likely suffer a primary cardiac event病人是否發(fā)生了原發(fā)性心臟病Did the patient have a respiratory event prior to colla

5、psing in cardiac arrest病人是否有呼吸問題7The Fifth Link to the Adult Chain of Survival成人5級生存鏈Activate emergency response system啟動應急響應系統(tǒng)Early CPR with emphasis on compressions早期心肺復蘇，按壓Rapid defibrillation快速除顫Effective ALS有效的ALSIntegrated post-cardiac arrest care心臟驟停后完整的護理8Lay Rescuer救助者的任務Unresponsive沒有反應No

6、breathing or gasping breathing無呼吸或呼吸喘氣Activate emergency response system啟動應急響應系統(tǒng)Get the defibrillator除顫器Start CPR開始CPRLone rescuer單個救助者Team approach一組救助員Check rhythm, shock if indicated every 2 minutes.檢查的心臟節(jié)律，每2分鐘電擊。9CABNo more “Look, Listen, and Feel”不再“看，聽和感覺”Brief check of breathing簡要檢查呼吸No brea

7、thing無呼吸Gasping only只有喘氣Compressions按壓At least 100 per minute每分鐘至少100次Complete recoil完整的按壓Minimize interruptions不要中斷10HCPGet two pieces of information at once獲得兩條信息Unresponsiveness反應遲鈍Breathing?有呼吸嗎？Activate emergency response and retrieve AED啟動應急響應和準備除顫儀Pulse check no longer than 10 seconds脈搏檢查不超過1

8、0秒Compressions按壓Ideally provide compressions and ventilations理想的情況下提供按壓和通氣11HCPTeam approach一組救助人員Activates emergency response system啟動應急響應系統(tǒng)Chest compressions胸部按壓Ventilations通氣AED除顫儀12AEDs除顫AHA continues to emphasize the importance 美國心臟協(xié)會強調其重要性Establishing AED programs in public locations在公關場所建立除顫點

9、Provide training提供培訓Linking with EMS同急救醫(yī)療服務系統(tǒng)聯(lián)系QARecommendation for AEDs in hospital提倡院內除顫13AEDs for Pediatrics兒童除顫器Less than 8 8歲以下Use pediatric dose-attenuator system if available如果可以，使用兒童劑量May use adult AED可能用成人除顫儀Less than 1 year 1歲以下Manual defibrillator is recommended推薦手動除顫器AED with pediatric d

10、ose-attenuator if available如果可以，使用兒童劑量May use adult AED可能用成人除顫儀14CPR or SHOCKCPR還是除顫Evidence is unclear證據不明In hospital sudden cardiac arrest院內心臟驟停CPR until defibrillator is prepared做CPR直至除顫儀到位Out of hospital witnessed院外心臟驟停CPR until defibrillator is prepared做CPR直至除顫儀到位Out of hospital unwitnessed院外心臟

11、驟停，無人救援CPR 1 to 3 minutes of CPR may precede defibrillationCPR1.5-3分鐘1516Adult Defibrillation成人除顫No changes with biphasic or monophasic defibrillators!單相或雙相除顫器沒有區(qū)別Biphasic preferred雙相除顫器更好No evidence that increasing joules for subsequent shocks is successful沒有證據表明，增加焦耳數就一定會成功Subsequent shocks should

12、 stay the same or increase后續(xù)震顫應保持不變或增加17Pad Placement安置點Three choices三種選擇Anterior lateral前外側Anterior posterior前后Anterior R infrascapular and L infrascapular前RLTry to avoid implanted defibrillators and pacemakers盡量不要使用植入式除顫器和起搏器18Pediatric Defibrillation兒童除顫2 joules/kg for initial defibrillation初始除顫2

13、焦耳/公斤4 joules/kg for subsequent defibrillations隨后4焦耳/公斤May use a higher joule setting up to 10 joules/kg not to exceed the adult dose可以使用更高的焦耳至10焦耳/公斤但不超過成人劑量19Synchronous Cardioversion同步復律Atrial fibrillation心房纖維性顫動Monophasic 200 J單相200 JBiphasic 120-200 J雙相120-200JAtrial Flutter and SVT心房撲動和SVTMono

14、phasic 50-100 J單相50-100JBiphasic 50-100J雙相50 -100JIncrease joule setting in a stepwise fashion if initial shock is unsuccessful如果最初不成功，則逐步增加焦耳量20Synchronous Cardioversion同步復律Monomorphic V-tach with pulse單形性V -轉速與脈沖Monophasic or Biphasic 100 J單相或雙相100焦耳Increase joule settings in stepwise fashion if i

15、nitial shock is unsuccessful如果最初不成功，則逐步增加焦耳量Do not synchronous cardiovert不同步復律Polymorphic VTVF多形性VTPulseless VT無脈VTVF21Pacing安置點No changes!不變22Remember the Precordial Thump?還記得心前區(qū)重擊么？May be considered in witnessed unstable VT or pulseless VT when defibrillator is not readily available.除顫器不能獲得時，對不穩(wěn)定的

16、VT或無脈VT使用Should not delay cardioversion or defibrillation.不能延遲復律或除顫23CPR DevicesCPR設備No evidence that mechanical CPR devices are superior to manual CPR.沒有證據表明，機械CPR設備優(yōu)于手動心肺復蘇。They should never cause interruption of delay of CPR均不能中斷CPR24ACLS高級心血管生命支持Capnography recommended建議分析二氧化碳To confirm and moni

17、tor intubation確認和監(jiān)測插管To monitor CPR quality監(jiān)測心肺復蘇的質量To detect ROSC監(jiān)測自主循環(huán)復蘇To detect rearrest監(jiān)測再次驟停25A New Circular Algorithm一種新的方法Emphasizes強調High quality, uninterrupted CPR高質量，不中斷的CPRAvoiding hyperventilation防止過度通氣ACLS actions organized around periods of CPR高級生命支持在CPR時就開始De-emphasizes不強調Devices, Dr

18、ugs and other Distractors設備，藥物及其他因素26Atropine阿托品NO longer recommended for PEA or Asystole不再推薦為PEA或心跳停止使用May be used for symptomatic bradycardia可用于有癥狀的心動過緩27Chronotropic Infusions輸液Considered equally effective as pacing for symptomatic bradycardia when atropine is ineffective.阿托品無效時使用，效果與起搏相當28Adenos

19、ine腺苷May be used for stable, undifferentiated, monomorphic, wide complex, REGULAR, tachycardia可用于穩(wěn)定，未分化，單形性，廣泛復雜，正常的心動過速29ACS急性冠脈綜合癥Supplementary oxygen is not needed in patients without respiratory distress and oxyhemoglobins 94%患者無呼吸窘迫且氧飽和度 94時無需補氧Morphine should be used with caution in patients w

20、ith unstable angina不穩(wěn)定型心絞痛患者應謹慎使用嗎啡Morphine is indicated for patients with STEMI not relieved with nitrates嗎啡與硝酸鹽同時使用不能緩解STEMI患者的情況30Post-Cardiac Arrest Care心臟驟停后護理PCI經冠脈介入治療Therapeutic hypothermia低溫治療Electroencephalogram for seizure detection腦電圖監(jiān)測癲癇Tapering inspired oxygen concentration監(jiān)測吸入氧濃度Maint

21、ain oxyhemoglob in 94-99保持氧合血紅蛋白94-9931Fifteen Special Situations十五種特殊情況Asthma哮喘Anaphylaxis過敏性反應Pregnancy妊娠Morbid obesity病態(tài)性肥胖Pulmonary edema肺水腫Electrolyte imbalance電解質不平衡Trauma創(chuàng)傷Accidental hypothermia意外低熱AvalancheElectric shock / lightening電擊/閃電Drowning溺死Toxic ingestions誤食毒物PCI經冠脈介入治療Cardiac tamponade心臟填塞Cardiac surgery心臟手術32Prehospital 12 Lead ECG院前12導聯(lián)心電圖Reduces time of reperfusion with fibrinolytics縮短纖維蛋白溶解及再灌注時間New study demonstrates time reduction for PCI新研究表明經冠脈介入治療的時間減少Acti