贵阳医学院附院麻醉科.ppt

Guidelines Writing Group Chairs Michael R. Sayre, MD 贵阳医学院附院麻醉科 曾庆繁 2010年AHA 心肺复苏指南介绍 1960-2010 Kouwenhoven 2010心肺复苏50周年 356 位专家 来自29 个国家 历时36个月讨论 2010 International Consensus Conference Robert A. Berg University of Pennsylvania Professor of Anesthesiology and Critical Care Medicine, Division Chief, Pediatric Critical Care Cardiac arrest can be caused by 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Pulseless bradycardia 4 rhythms 室颤 无脉性室速 VF/Pulseless VT chest compressions (CC) early Defibrillation (DF) Early recognition cardiac arrest 及早识别心跳骤停 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 (not normally,gasping) . cardiac arrest 降低脉搏检查的重要性 Minimize the importance of pulse checks 不检查脉搏Not check for a pulse 2005 (Old): “Look, listen, and feel” 2010 (New): NO: “Look, Listen, Feel for Breathing”* 30 compressions 2 breaths NO: “Look, Listen, Feel for Breathing”* 不看 不听 不觉 A Change From A-B-C to C-A-B “Adults” Children infants (excluding the newly born) 复苏步骤 What about Oxygen?What about Oxygen? VF-CAVF-CA: : 中心血液中富含氧中心血液中富含氧 Experimental work has shown Arterial Experimental work has shown Arterial SatsSats remain acceptable for remain acceptable for up to 10 min of CCCup to 10 min of CCC 呼吸停呼吸停- - 通气通气! ! Respiratory Arrest-Different Respiratory Arrest-Different ! ! Ventilation crucial to replace OxygenVentilation crucial to replace Oxygen 关键:CCC 心 脑 C-A-B chest compressions initiated sooner 及早按压 Forget CPR, Give CCR Instead 心脑复苏新概念心脑复苏新概念 CardiocerebralCardiocerebral Resuscitation Resuscitation 忘了CPR 代之CCR Standard CPR: 30:2Standard CPR: 30:2Continuous Chest CompressionsContinuous Chest Compressions 心脑复苏概念心脑复苏概念 CardiocerebralCardiocerebral Resuscitation Resuscitation 200 chest compressions 200 chest compressions Single shock without pulse Check or rhythm analysis BVM or Passive Insuflation 100% FIO2 Begin IV Analysis 200 chest compressions Single shock if Indicated without pulse check or rhythm analysis Analysis Single shock if Indicated without pulse check or rhythm analysis Resume Standard ACLS Consider Endotracheal Intubation 200 chest compressions CC Only EMS arrival Administer 1 mg IV Epinephrine Analysis If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analysis Three-Phase Model of Resuscitation 02468101214161820 Arrest Time (min) Circulatory Phase Electrical Phase Metabolic Phase 0 100% Myocardial ATP Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8 rapid defibrillation good chest compressions little we can do 外行 成人 CPR 简化成人基本生命支持 : CCC+DF Chest Compressions* 2010 (New): Hands-Only “push hard and fast” on the center of the chest 动手不动口 30 compressions to 2 breaths Chest Compression Rate: At Least 100 per Minute* 2010 (New): chest compressions at a rate of at least 100/min.(快 ! 不间断) 2005 (Old): Compress at a rate of about 100/min. Chest Compression Depth* 2010 (New): hard ! The adult sternum should be depressed at least 2 inches (5 cm). 2005 (Old): approximately 1,1/2 to 2 inches (approximately 4 to 5 cm). C A B 电击治疗ELECTRICAL THERAPIES AED Use in Children Now Includes Infants 2010 (New): 65 mm Hg心律失常再发及治疗昏迷 脑损伤 保证灌注 昏迷: 插管SBP 90 mm Hg 不预防性抗心律失常 药判断预后K 3.5 mEq/L 调节通气:治疗低血压去除心律失常原因对语言 刺激反应避免低钾(心律失常 ) PETCO2: Fluid bolus12-lead ECG/瞳孔光反射尿量,血清肌酐 3540 mm Hg Dopamine 5 10mcgACS STEMI QT角膜反射发现ARF Paco2:Norepinephrine治疗急性冠脉综合征自主眼球活动等容euvolemia 4045 mm HgEpinephrineAspirin/heparin动嘴 呛咳 自主呼吸肾替代治疗 脉搏氧 血气 0.1 0.5mcg/kg.miPCI or脑电图 :replacement 降低 FIO2 fibrinolysis惊厥血糖监测 SpO2 94% 抗惊厥治疗治疗低血糖37.7C Local insulin protocols VT 6-8mL/kg Ventilation Hemodynami cCardiovascularNeurologicalMetabolic Chest X-ray: 心脏超声:治疗性低温: 确定气道 检查 室壁运动 Cold IV fluid bolus 30 mL/kg AvoidHypoton icFluis 检查 CA原因并发 症 心肌病 Surface or endovascular increase edema pneumonitis 心肌顿抑 cooling for