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1、 1960-2010 Kouwenhoven 2010心肺复苏50周年356 位专家来自29 个国家 历时36个月讨论2010 International Consensus ConferenceRobert A. Berg University of PennsylvaniaProfessor of Anesthesiology and Critical Care Medicine, DivisionChief, Pediatric Critical CareCardiac arrest can be caused by室颤 VF室速(无脉)VT 无脉性电活动PEA心博停止asystole.
2、无脉性心动过缓Pulseless bradycardia4 rhythms 室颤 无脉性室速 VF/Pulseless VTchest compressions (CC)early Defibrillation (DF)Early recognition cardiac arrest及早识别心跳骤停及早识别心跳骤停外行急救lay rescuer 1.突然晕倒 suddenly collapse 2.意识消失 Unresponsive 3.无呼吸或无正常呼吸 not breathing 4.Seizure (not normally,gasping). cardiac arrest降低脉搏检查的
3、重要性Minimize the importance of pulse checks 不检查脉搏不检查脉搏Not check for a pulse2005 (Old): “Look, listen, and feel”2010 (New): NO: “Look, Listen, Feel for Breathing”* 30 compressions 2 breathsNO: “Look, Listen, Feel for Breathing”* 不看不看 不听不听 不觉不觉A Change From A-B-C to C-A-B“Adults” Childreninfants (exclu
4、ding thenewly born)复苏步骤What about Oxygen?VF-CA: 中心血液中富含氧 Experimental work has shown Arterial Sats Experimental work has shown Arterial Sats remain acceptable for remain acceptable for up to 10 min of CCCup to 10 min of CCC呼吸停- 通气! Respiratory Arrest-Different !Ventilation crucial to replace OxygenV
5、entilation crucial to replace Oxygen关键:CCC心 脑C-A-Bchest compressions initiated sooner 及早按压Forget CPR, Give CCR Instead心脑复苏新概念心脑复苏新概念Cardiocerebral Resuscitation忘了忘了CPR代之代之CCRStandard CPR: 30:2Standard CPR: 30:2Continuous Chest CompressionsContinuous Chest Compressions心脑复苏概念心脑复苏概念Cardiocerebral Resus
6、citation200 chestcompressions200 chestcompressionsSingle shockwithout pulse Check or rhythm analysisBVM or PassiveInsuflation 100% FIO2Begin IVAnalysis200 chestcompressionsSingle shock if Indicated without pulse check orrhythm analysisAnalysisSingle shock if Indicated without pulse check orrhythm an
7、alysisResume Standard ACLSConsider Endotracheal Intubation200 chestcompressionsCCOnlyEMSarrivalAdminister 1 mg IV EpinephrineAnalysis If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analysisThree-Phase Model of Three-Phase Model of ResuscitationResuscita
8、tion02468101214161820Arrest Time (min)CirculatoryPhaseElectricalPhaseMetabolicPhase0100%Myocardial ATPWeisfeldt ML, Becker LB. JAMA 2002: 288:3035-8rapid defibrillationgood chest compressionslittle we can do外行成人CPR简化成人基本生命支持:CCC+DF Chest Compressions*2010 (New): Hands-Only “push hard and fast” on th
9、e center of the chest动手不动口30 compressions to 2 breathsChest Compression Rate: At Least 100 per Minute*2010 (New): chest compressions at a rate of at least 100/min.(快 ! 不间断)2005 (Old): Compress at a rate of about 100/min.Chest Compression Depth*2010 (New): hard !The adult sternum should be depressed
10、at least 2 inches (5 cm).2005 (Old): approximately 1,1/2 to 2 inches (approximately 4 to 5 cm).C A B电击治疗电击治疗ELECTRICAL THERAPIESAED Use in Children Now Includes Infants2010 (New):1 year of age.2005 (Old):Not use of AEDs for infants 1 year of age.先除颤先除颤 VS 先先CPR ?CPR 65 mm Hg心律失常再发及治疗昏迷 脑损伤 保证灌注昏迷: 插
11、管SBP 90 mm Hg不预防性抗心律失常药判断预后K 3.5 mEq/L调节通气:治疗低血压去除心律失常原因对语言 刺激反应避免低钾(心律失常)PETCO2: Fluid bolus12-lead ECG/瞳孔光反射尿量,血清肌酐3540 mm HgDopamine 510mcgACS STEMI QT角膜反射发现ARFPaco2:Norepinephrine治疗急性冠脉综合征自主眼球活动等容euvolemia4045 mm HgEpinephrineAspirin/heparin动嘴 呛咳 自主呼吸肾替代治疗脉搏氧 血气0.10.5mcg/kg.miPCI or脑电图:replaceme
12、nt 降低 FIO2fibrinolysis惊厥血糖监测SpO2 94%抗惊厥治疗治疗低血糖37.7CLocal insulin protocolsVT 6-8mL/kgVentilationHemodynamicCardiovascularNeurologicalMetabolicChest X-ray:心脏超声:治疗性低温:确定气道检查室壁运动Cold IV fluid bolus 30 mL/kgAvoidHypotonicFluis检查CA原因并发症心肌病Surface or endovascularincrease edemapneumonitis心肌顿抑cooling for 32C34C(cerebral edema)pulmonary edemaTreat Myocardial Stunning:24 hoursFluids to optimize volumeAfter 24 hoursDobutamine 510 mcg/kgslow rewarming 0.25C/hr动脉气囊反博(IABP)CT镇静肌松控制寒战机控呼吸(非同步)谢谢谢谢!
