课件：心肺脑复苏的新进展三军医大级五制本科.ppt

* * * * * * * * * * * * * * Characteristics of VF Organized QRS complexes and absent P waves Wavy, chaotic, inconsistent baseline Irregular rhythm VF may occur spontaneously or be preceded by VT. * The universal control steps are called universal because they are used to operate every AED. Because of the concept of “user-critical steps,” more of these universal steps are done automatically and not always by the operator. Ask providers to demonstrate use of the specific AED that they will use in their work setting. User-critical steps are any operational steps that must be performed by the operator; otherwise the device will fail. All AEDs require similar user-critical steps: Attach the defibrillator pads to the patient Attach the pads to the AED cables Attach the AED cables to the AED Power on the AED Analyze the patient signal for VF Charge the AED if VF is present Press the shock button to deliver the shock Notice how each step is critical. If any one step is omitted or done incorrectly, the person in VF will not be defibrillated. Any error here would mean the loss of a chance to save a person’s life. Some brands of AEDs perform these steps. The more an AED performs the user-critical steps, the lower the chance of error. For example, some AED models power up automatically when the AED lid is opened; in some the cables are preattached to the AED and the adhesive defibrillator pads. Some perform constant background analysis and will automatically “precharge” if VF is detected. One model has reduced the number of actions required of the operator to just 3: open the lid, attach the pads to the patient, and press the shock button. 血管加压素 被认为是与肾上腺素相比在心搏骤停时可能同样有效的一线选择药物(40 u) 心搏骤停患者CPR时潜在的缺血程度复杂，优先选择血管加压素要比使用肾上腺素效果好(高40% ) 血管加压素和肾上腺素有交互作用，特别是在长时间缺血情况下，两者联合使用的效果是单用肾上腺素或血管加压素的3倍 1999-2002年 1219例心搏骤停 血管加压素 589例 40U 肾上腺素 597例 1mg 室颤入院存活率 46.2% 43.0% 无脉搏电活动入院存活率 33.7% 30.5% 心搏骤停入院存活率 29.0% 20.3% P=0.02 出院存活率 4.7% 1.5% P=0.04 无ROSC，加用肾上腺素可使血管加压素组的入院存活率(2