(精编)【医学精品课件】常見內科疾病處置教学课件.pptVIP

6/22/2006 First Responder Training 中風到院前評估 暢通呼吸道 測量生命徵象 評估(頭頸外傷, 心臟病, 眼睛, 其他) 神經學檢查(意識喪失, 昏迷指數, 四肢肌力, 脖子僵硬) Af 心房震顫 irregular, chaotic不規則 ventricular waveforms varying from bradyarrhythmia to tachyarrhythmia. Irregular RR interval. P wave absent. P波消失 Af symptoms Sensation of feeling heart beat (palpitations) Pulse may feel rapid, racing, pounding, fluttering, or it can feel too slow Pulse may feel regular or irregular Dizziness, light-headedness 頭暈 Fainting 昏 Confusion 意識混淆 Fatigue 疲乏 Shortness of breath 喘 Breathing difficulty, lying down Sensation of tightness in the chest 悶 Atrial flutter , 心房撲動 very rapid, regular heart beat. starts in the atria, or upper chambers of the heart.  First degree AV block 心房心室傳導阻滯 prolonged conduction in the AV junction; P-R interval is 0.20 seconds. Rhythm is regular 規則心律 Etiology of first degree AV block inferior MI, 心肌梗塞 digitalis toxicity 毛地黃毒性 hyperkalemia 高血鉀 increased vagal tone 副交感活性增加 acute rheumatic fever 風濕熱 myocarditis. 心肌炎 PR 0.20 seconds P波與QRS的關係 (搭配) 1:1 - sinus rhythm PR 0.2 seconds: 1st degree AV block 2:1 to 4:1 - atrial flutter P波呈鋸齒狀 不規則 PR間隔愈來愈長,然後QRS消失: 2nd type1 AV block PR間隔固定,QRS突然消失: 2nd type2 AV block 沒有關係 3rd AV block Second degree type I Type I or Wenckebach: P-R interval becomes progressively longer with each cycle until a non-conducted atrial beat occurs. PR節段漸漸延長 After the dropped beat the P-R interval is shorter. PR 漸漸延長 Second degree type II Constant P-R intervals preceding a non-conducted atrial beat. Ventricular rate is irregular. Atrial rhythm is regular. 固定心房幾跳就有一跳傳不下去心室. Second degree type II 3rd degree AV block 心房和心室各跳各的. 互不相干. Intervention sequence Atropine 0.5—1 mg. IV TCP if available. 經皮心律調節器使用. Dopamine 5—20 μg/kg/min Bosmin 2--10 μg/min Isoproterenol 2--10 μg/min Consult CV doctor. 照會心臟專科. 心律不整, 到院前 呼吸道維持.A 呼吸.B 循環.C 自動體外電擊器(AED). (心室頻脈, 心室震顫) 頸動脈竇按摩. (心室上心搏過速) AED配置不足 AED(自動體外電擊器)並非每縣市都完備，內政部消防署93年7月統計，少數縣市的每輛救護車全面配置AED，有的縣市配置AED的數量少得可憐，台南縣35個消防分隊只有19台，高雄縣27個鄉鎮