心肺复苏.英文班精选文档.ppt

Requirements of the teaching program,Familiar with the late recovery and recovery treatment,一、summary Resuscitation：All the measures taken to save lives。Cardiopulmonary resuscitation,CPR：For respiratory and circulatory arrest taking emergency measures,including artificial respiration and cardiac massage.Cardiopulmonary cerebral resuscitation,CPCR：The brain function recovery,the whole process of reversal of clinical death CPCR key factor to success：Early recovery started 4 minutes later,the late recovery started within 8 minutes,二、The steps of CPCR three steps,ALS,BLS,PRT,basic life support,Main task:（rapid and effective）restoring blood perfusion and oxygen supply)ABC:A.keep the airway unobstructedB.effective artificial respiration C.effective artificial cycleArtificial respiration and cardiac massage is the main measures of early recovery.,The artificial respiration:Recognition of breathing(listen to the air,look at the chest)The relief of airway obstruction(clear secretions)The artificial respiration(manual,instrument method),Determine spontaneous breathing,Methods:Keep ear close to the mouth and nose Eyes observe thoracic uplift or not at the same time Listen to breath sounds Time is not more than 5 seconds,A:Airway,Make patients lie on your back on the solid flat(ground)Keep respiratory tract unobstructed,removal and keep head position properly 仰头抬颈法 仰头举颏法 抬举下颌法,B:Breathing,Mouth to mouth/nose breathing(the most suitable for on-site resuscitation)Simple mask respiratorTracheal intubation,Mouth-to-mouth resuscitation,method:Start 3 4 times in a row,after blowing once every five seconds.Take a deep breath every time.The patient can be exhaled gas himself.notice：Avoiding excessive ventilation and decreasing cardiac output,Inspiratory time should be greater than 1 secondsTidal volume 500 600mlFrequency:adult 10 12 times/minChildren 18-20/minInfants with 30-40/minStart ventilation frequency:2 consecutive or 5 timesThoracic raised as a symbol of effective artificial respiration,C:Circulation,Cardiac compression is a method trough indirect or direct cardiac massage to form a temporary artificial cycle.,Cardiac compression,二、cardiac arrest Definitiontype asystoleventricular fibrillationelectromechanical dissociationThe cause Primary:coronary ischemia,electric shocks,anesthetic overdose,visceral traction,high potassiumSecondary:alveolar hypoxia,airway obstruction,acute massive blood loss.,diagnosis Mind suddenly lose,call for no response;no artery pulse,blood pressure measurement is less than,cant hear heart sounds;no spontaneous breathing corectasis,Four“no”：ConsciousnessRespirationHeart soundsArterial pulse,asystole,ventricular fibrillation,心肌纤维快速不规则颤动(不同步快速收缩)ECG:QRS波群消失，代之以振幅与频率极不规则的颤动波，频率200500次/分,electromechanical dissociation,EMD,缓慢无效的心室自主节律，QRS波群宽而畸形，低振幅，2030次/分以下,2.Cardiac compression1)Rapid diagnosis of cardiac arrest2)chest compression:Note:lying in the plane R:C:2:30,children 2:15 P/R（time）1:1(2)operation method:,胸外心脏按压,artificial circulationMechanism:press sternal lower 1/3 increase intrathoracic pressure(thoracic pump)or direct compression of the heart(heart),the blood flow to the lungs and other organs,Effective indication:Touch pulse,The pupil becomes smallgradually,red lip,autonomous respiration,Position:lie on your back on the solid flat(ground).The head is not higher than the heartThe press position:The finger to touch the costal margin,move toward the midline,into the ribs and sternum.up to 4cm(two fingers),4）open chest compression,OCCIndications:The longer time of cardiac arrest or ECC is not valid for more than 10 minutes.The existence of intrathoracic conditions,such as bleeding,pericardial tamponade,tension pneumothorax.The thoracic or spinal deformity with heart displacementThe multiple external defibrillation is invalid forVF or VTCardiac arrest occurred in operation,especially to open chest surgeryAdvantage.Provide near normal MBF(myocardial blood flow)and CBF(cerebral blood flow,)is beneficial to the recovery of spontaneous circulation and protection of brainDisadvantages:high technology and conditions,there is the possibility of infection,open chest compression,OCC,Methods:open the chest,direct compression of the heart by hand 80 times frequencyCharacteristic.1 myocardial blood flow and brain blood flow increased2 animal experiments that can improve survival rate3 be in hospital,arrest 25 is invalidSevere chest trauma,thoracic deformity,Pericardial tamponade should open chest compressions,（二）advanced life support,ALS1 the management of respiratory tractWith spontaneous breathing:mouth airway(nose)No autonomous respiration:tracheal intubation or incision of trachea2 monitoringECG,BP(the best record),blood gas analysis(PaO2 60mmHg;PaCO2 36 40mmHg),urine volume,specific gravity,CVP.3 drug treatmentObjective:to stimulate the recovery of heart beat and enhance myocardial contractility,prevention and treatment of arrhythmia,Adjust the acidbase imbalance,fluid and electrolyte replacement.,Medication,Objective:Excitation of cardiac autonomic rhythms and enhance myocardial contractility,prevention and treatment of arrhythmia,adjust the acidbase imbalance,fluid and electrolyte replacement,when recovery the medication must be quickly and accurately.Injection way:The intravenous injection(preferred);intratracheal injection(injection be diluted to10ml);The intracardiac injection(complications,Commonly used drugs,1）Catecholamine and adrenergicEP（epinephrine）:first choicedose：0.51mg once，或0.01 0.02mg/kg repeated every 5 minutesNE：A significant increase in MBF.CBF The incidence of arrhythmia is higher after defibrillation,Isopropyl epinephrine and dobutamineMainly excite receptor,MBF does not increase after the selection2)Sodium bicarbonateAccording to the results of blood gas analysis,correct acute acidosisWhen the base excess(SEB)above-10mmol/L,application of sodium bicarbonate,Sodium bicarbonate(mmol/L),SBE weight（kg）4,6.Fluid therapy In the process of CPR low blood volume is not conducive to the recovery and autonomous rhythm stability,reduces the sensitivity of vasoactive drugs.Expansion of crystal fluid,the appropriate colloid,generally without blood transfusion.The CVP is maintained at 10 15 mmHg.,4.Ventricular fibrillation and defibrillation Defibrillation time:VF/VT sudden,defibrillation within 30 seconds ofOther should be CPR at least 2 minutes(give epinephrine pre-),Method：External defibrillation adult:360 J;Children with 2-4J/kgThoracic defibrillation adult 20 80J;5 50J childrenIndications:VF/VTElectrical cardioversion;The medication invalid（supraventricular）(50J)Ventricular heartbeat tachycardia(50J)Atrial flutter(25J),External defibrillation,左侧第五肋间腋前线,胸骨右缘第二肋间,5.heart pacemaker（Restoration of spontaneous rhythm,but must rely onIsoproterenol to maintain normal heart rate）,（三）post-resuscitation treatment,PRT prolonged life support,PLS,Objective:prevention and treatment of multiple organ failure and hypoxic brain injuryMaintain good respiratory function A detailed examination of the airway,lung and catheter,whether there is a fracture of rib,pneumothorax.(PaCO2 2535mmHg can reduce brain edema),Ensure the stability of circulationClose monitoring of hemodynamic parameters,avoiding hypotension,as soon as possible out of vasoactive drugs.Prevention and treatment of renal failurePrevention,maintain circulation stability,avoid renal damage drug,correcting acid,monitoring of renal function.,cerebral resuscitationThe characteristics of cerebral metabolism:High rates of metabolism,high oxygen consumption(2025%),less energy conservation(1015 seconds),poor resistance to ischemiaThe indications:Early resuscitation is not timely and has shown signs of hypoxic brain injury(body temperature,muscular hypertonia,cramps,seizures and convulsions),