黄培志-心肺复苏ppt课件.ppt
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1、Cardiopulmonary Resuscitation,Peizhi Huang Zhongshan Hospital,Diagnosis of cardiac and respiratory arrest,Traditional methods : 1. Carotid pulse check by lay rescuers 2. Loss of consciousness 3. Pupil dilation 4. Respiratory arrest,Guideline 2000,Elimination of the pulse check for lay rescuers Evalu
2、ate for signs of circulation in 10 seconds breathing , coughing , movement in response to rescue breath,Assess for a pulse,Time is too longer Accurate rate 75 % Sensibitity 90% Specificity 60%,Rate of false- positive(40%),Results Pulseless Pulse Mistakenly loss the saving opportunity,Rate of false-n
3、egative (10 %),Results Pulse Pulseless Unnecessarily do CPR,Electrocardiogram changes of Cardiac arrest,Ventricular fibrillation A flat line or only atrial wave Pulseless Electrical Activity, PEA,The chain of Survival,Early access Early CPR Early Defibrillation Early advanced life support * patient
4、with Coma ( immediately do CPR , not clear obstructed airways at first),Basic Life Support - the first ABCD,Airway A Breathing B Circulation C Defibrillation D,Airway,Tilt the head backwards Lift the jaw Open the mouth Clearing obstructed airways from choking Subdiaphragmatic abdominal thrust (Heiml
5、ich maneuver),Breathing,Mouth to mouth or mouth to nose Mouth to oropharyngeal tube Mouth to shield Mouth to mask(compressing the cricoid cartilage in order to decrease gastric distention and prevent gastric reflu) Bag-mask ventilation challenged endotracheal intubation resuscitations “gold standard
6、”,Circulation external chest compression,High-frequency(100 compressions per min) aortic pressure myocardial perfusion pressure cardiac outputs rise survival rate Reduce interrupted compression ( compression ventilation ratio simplified to 15:2) Compression-only CPR: unwilling or unable to perform m
7、outh to mouth or cardiogenic cardiac arrest,Circulation Compression-only CPR,Research suggests: Survival rate with compression-only CPR in first 612 minutes is 40.8% Survival rate with chest compression add artificial ventilation is 34.1% , because artificial ventilation may be result in respiratory
8、 alkalosis.,Mechanism of external chest compression,Chest pump - sequential increased and decreased pressure in the thoracic cavity - valves maintaining forward direction of flow Cardiac pump -sequential filling and emptying of cardiac chambers -valves maintaining forward direction of flow,Circulati
9、on,Thump version from 20-25 cm high to chest Cough Version in 10-15 second Intermittent abdominal compression-cardiopulmonary resuscitation(IAC-CPR) Activated compression-decompression(ACD-CPR) PhasedChest and Abdominal ACD-CPR (Life-stick Resuscitation) increase mean pressure,coronary and cerebral
10、perfusion pressure,left ventricular and cerebral blood flow,Automated external defibrillator - AED, Ventricular fibrillation : may be used by 200J*3 times) or 200J、200-300J、300J If polymorphic ventricular tachycardia can not be clearly distinguished from ventricular fibrillation (VF), treatment woul
11、d refer to be as VF Atrial fibrillation :100-200J synchronized Atrial flutter or supraventricular tachycardia 50- 100J synchronized Ventricular tachycardia 100J synchronized,Biphasic waveform defibrillation,A compensated defibrillation for the second time in limited time Low-energy levels(150J corre
12、spond to 200-300J) Reduce the myocardial injury,Advanced Life Support - the second ABCD,Endotracheal intubation (A) Mechanical ventilation and oxygen therapy (B) Intravenous injection (C) electrocardiogram and blood pressure monitoring, resuscitation drug , open chest cardiac compression (C) Differe
13、ntial diagnosis (D),Confirmation of Endotracheal tube placement,Mark estimated depth Breath sounds by auscultation at 5 locus Thorax rise as inspiration increase of SaO2 Steam in canal of artificial ventilation device Use a specific technique or device to prevent tube dislodgment,Mechanical ventilat
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