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1、心肺复苏术 Techniques of Cardiopulmanory Resucitation CPR Dr Zhao Gang 赵钢 The Emergency Department the 6th peoples hospital of Shanghai Shanghai jiaotong University v病人呼吸心跳停止时采取的一切抢救措施称心肺复苏 Rescue approach and treatment for the patients suffering respiratory or cardiac arrest v复苏目的 恢复呼吸 循环及病人的神志 Aim reco
2、very of breath circulation consciousness v内容包括 评估判断 人工呼吸 电击除颤 胸外心脏按压 生命支持 Contents assessments artificial ventilation defibrillation chest compression life support 一系列的评估和干预的过程 a series of assessments and interventions 概念 conceptiong 评估与判断 assess and gauge 意识 反应 瞳孔 Consciousness response pupil 呼吸 胸廓
3、及腹部运动 呼吸形式 濒死样呼吸 Respiration movement of chest and abdomen type of respiratory movement agonal respirations 心脏搏动 心音 脉搏 心电图 Heart beat cardiac sound pulse ECG 心跳骤停有三种情形 sudden cardiac arrest SCA v心室颤动 ventricular fibrillation v心室停顿 ventricular standstill v心电机械分离 electromechanical dissociation 2000指南基
4、本生命支持顺序 The sequence of BLS in 2000 AHA Guideline 基本生命支持 Basic Life Support BLS 评估 assessment 呼救 EMS activation 包括ABC和除颤D心肺复苏 术 ABCs of CPR and the D of Defibrillation A气道通畅 airway B人工呼吸 Breath C人工循环 Circulation D除颤 Defibrillation l为了培训和记忆 l for training and remembering 气道通畅技术 Techniques for the est
5、ablishment of airway 舌与会厌阻塞气道 The tongue and epiglottis obstruct the pharynx 仰头举颏法 Head Tilt Chin Lift Maneuver 气道通畅技术 Techniques for the establishment of airway 推举下颌法 Jaw Thrust Maneuver 气道通畅技术 Techniques for the establishment of airway 异物梗阻气道 Foreign bodies cause airway obstruction FBAO 横膈下腹部冲击手法
6、Subdiaphragmatic abdominal thrust Heimlich maneuver 气道通畅技术 Techniques for the establishment of airway 口咽通气道 Oropharyngeal airways 鼻咽通气道 Nasopharyngeal airways 气道通畅技术 Techniques for the establishment of airway l食管气管导管 Esophageal Tracheal Combitube l喉罩气道 Laryngeal Mask Airway l气管内导管 Endotracheal Intub
7、ation 人工呼吸 Provide Rescue Breathing 口对口人工呼吸 Mouth to mouth rescue breathing 口对鼻人工呼吸 Mouth to nose rescue breathing 人工呼吸 Provide Rescue Breathing 球囊面罩通气装置 bag mask ventilation device 人工呼吸 Provide Rescue Breathing 球囊面罩通气 bag mask ventilation 人工呼吸 Provide Rescue Breathing 人工气道通气 ventilation with an adv
8、anced airway l食管气管导管 Esophageal Tracheal Combitube l喉罩气道 Laryngeal Mask Airway l气管内导管 Endotracheal Intubation 接呼吸机或呼吸囊 Connect with ventilator or bag 人工呼吸 Provide Rescue Breathing 先进行两次人工呼吸 每次人 工呼吸时间超过1秒 潮气量500 600ml 有胸廓起 伏 避免迅速而强力的人工呼 吸 有人工气道二人进行CPR 则 没分钟通气8至10次 人工呼吸 时 胸外按压不应停止 没有人工气道 救助者复苏的 每周期为30
9、次按压和2次呼吸 在按压暂停进行人工呼吸 每 次呼吸超过1秒 Give 2 rescue breaths each over 1 seco nd with tidal volume of 500 to600 mL to produce visible chest rise avoid rapid or forceful breaths When an advanced airway is in place during 2 person CPR ventilate at a rate of 8 to 10 bpm no pause in chest compressions for deliv
10、ery of ventilations without an advanced airway in place the rescuer s should deliver cycles of 30 compressions and 2 breaths The rescuer delivers the breaths during pauses in compressions and delivers each breath over 1 second 循环Circulation l胸外心脏按压 external chest compression l除颤 defibrillation l药物治疗
11、 drug 肾上腺素 Epinephrine 多巴胺 Dopamine 抗心律失常药 antiarrhythmic 胸外心脏按压 external chest compression ECC 心泵机制 cardiac pump 胸泵机制 thoracic pump Pump the blood to the organs 按压部位 position of compression 胸骨下半部 双乳头之间 The lower half of the sternum between nipples 胸外心脏按压 external chest compression ECC techniques 一只
12、手的掌跟在胸骨 下半部 另一只手放 于其上 双手平行 掌跟的长轴放在胸骨 的长轴上 手指伸展 或交锁 但应离开胸 部 Place the heel of one hand on the lower half of the sternm and the other hand on top of the first so that the hands are parallel Be sure the long axis of the heel of your hand is placed on the long axis of the sternm your hand may be either
13、extended or interlaced but should be kept off the chest 胸外心脏按压 external chest compression ECC techniques 双肘关节固定 双臂 垂直 双肩在双手正上方以 使每次胸部挤压的冲 击直接使胸骨下压 每次挤压后必须完全 解除压力 使胸部回 到正常位置 使手与胸骨接触以保 持正确手的位置 Lock the elbows in position with the arms straightened Position your shoulders directly over your hands so th
14、at the thrust for each chest compression is straight down on the sternum Release the pressure completely and allow the chest to return to its normal position after each compression Keep your hands in contact with the victim s sternum to maintain proper hand position 胸外心脏按压 external chest compression
15、 ECC techniques l按压频率100次 分钟 l按压幅度4 5cm l按压 通气比值30 2 l按压与放松时间1 1 l每2分钟更换按压者 l尽量不间断 间断不超过10 秒 lCompression rate 100 min lDepress the sternum 4 to 5cm lCompression ventilation ratio 30 2 lCompression relaxation time 1 1 lSwitch the compressor every 2 min lMinimize interruption of chest compression lim
16、it interruption to no more than 10 seconds 除颤 fibrillation treatment defibrillation lSCA 最常见和最初发生的心律 失常是心室纤颤 VF l电除颤是终止 VF 最有效的方 法 l随着时间的推移 成功除颤的 机会迅速下降 l短时间 VF 既可恶化并导致心 脏停搏 lthe most frequent initial rhythm in witnessed SCA is ventricular fibrillation VF lthe treatment for VF is electrical defibrillation l the probability of successful defibrillation diminishes rapidly over time l VF tends to deteriorate to asystole within a few minutes 电除颤与人工除颤仪 electrical defibrillation and defibrillator 手动除颤
