2010学会讲座心肺复苏2.pptVIP

In 1960 Kouwenhoven 14 病人 心跳骤停 闭式胸部心脏按压 存活 closed chest cardiac massage in 1962 单向直流电除颤 direct-current monophasic waveform defibrillation In 1966 American Heart Association (AHA) first CPR Guidelines 1995 2000 2005 心脏骤停的几种节律Cardiac arrest can be caused by 5 rhythms 室颤 VF 室速(无脉)VT 无脉性电活动PEA 心博停止asystole. 无脉性心动过缓 室颤 无脉性室速 VF/Pulseless VT 及早按压 chest compressions (CC) 及早除颤 early Defibrillation (DF) Early recognition cardiac arrest 不检查脉搏 Not check for a pulse 降低脉搏检查的重要性 Minimize the importance of pulse checks 2005 (Old): “Look, listen, and feel” 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. 心脏骤停cardiac arrest C-A-B Forget CPR, Give CCR Instead 胸外按压速率：每分钟至少 100 次* 2005（旧）：以每分钟大约 100 次的速率按压。  电击治疗ELECTRICAL THERAPIES AED Use in Children Now Includes Infants 2010 (New): 1 year of age. 2005 (Old): Not use of AEDs for infants 1 year of age. CPR 3min 除颤 立即CPR ADVANCED CARDIOVASCULAR LIFE SUPPORT 监测PETCO2 : 1.确定气管导管位置 2.监测CPR有效性 3.检查心跳恢复 药物New Medication Protocols 2010 (New): 阿托品不常规 用于PEA/心搏停止 心动过速tachycardia 规律的单型 宽QRS 心动过速 腺苷 (rhythm is regular) 不规律的宽QRS 心动过速 不用腺苷 (may cause degeneration of the rhythm to VF) 心动过缓Bradycardia 症状性不稳定心动过缓 变时性药物输注 避免过度通气Avoiding Hyperventilation 10 -12 次/min PETCO2 : 35 - 40 mm Hg PaCO2 : 40 -45 mm Hg. ACLS Cardiac Arrest Algorithm Post–Cardiac Arrest Care Central Nervous Systembrain injury Clinical manifestations : coma Seizures Myoclonus neurocognitive dysfunction (memory deficits to persistent vegetative state) brain death. Seizure Management EEG should be monitored frequently or continuously in comatose patients after ROSC (Class I ) Neuroprotective Drugs molecular events hours to days after ROSC