对于住院患者心脏骤停.ppt

Unit 12,Emergency Medicine,Word Formation,1. re- (again) e.g. resuscitation 2. cardi/o ( heart ) 3. pulmon/o ( lung ) 4. graph ( instrument) e.g. cardiograph/ cardiogram 5. therm/o ( temperature ) 6. pre- ( before ) e.g. precordial,Questions to consider:,1. If someone fainted in front of you , what would you do ? 2. Do you have any knowledge about first aid ? 3. What do you know about cardiac resuscitation ?,Cardiopulmonary resuscitation,Definition Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart has stopped (cardiac arrest). Cardiopulmonary resuscitation, commonly called CPR, combines rescue breathing (one person breathing into another person) and chest compression in a lifesaving procedure performed when a person has stopped breathing or a persons heart has stopped beating.,The medical term for the condition in which a persons heart has stopped is cardiac arrest (also referred to as cardiorespiratory arrest). CPR is used on patients in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive. If the patient still has a pulse, but is not breathing, this is called respiratory arrest and artificial respiration is more appropriate. However, since people often have difficulty detecting a pulse, CPR may be used in both cases, especially when taught as first aid.,Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals.,Description CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition of the problem and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat normally), and advanced cardiac life support measures.,CPR must be performed within four to six minutes after cessation of breathing so as to prevent brain damage or death. It is a two-part procedure that involves rescue breathing and external chest compressions. To provide oxygen to a persons lungs, the rescuer administers mouth-to-mouth breaths, then helps circulate blood through the heart to vital organs by external chest compressions.,When performed by a bystander, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When performed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.,According to the American Heart Association, early CPR and defibrillation combined with early advanced emergency care can increase survival rates for people with a type of abnormal heart beat called ventricular fibrillation by as much as 40%. CPR by bystanders may prolong life during deadly ventricular fibrillation, giving emergency medical service personnel time to arrive.,However, many CPR attempts are not ultimately successful in restoring a person to a good quality of life. Often, there is brain damage even if the heart starts beating again. CPR is therefore not generally recommended for the chronically or terminally ill or frail elderly. For these people, it represents a traumatic and not a peaceful end of life.,Purpose When performed quickly enough, CPR can save lives in such emergencies as loss of consciousness, heart attacks or heart “arrests,“ electric shock, drowning, excessive bleeding, drug overdose, and other conditions in which there is no breathing or no pulse. The purpose of CPR is to bring oxygen to the victims lungs and to keep blood circulating so oxygen gets to every part of the body. When a person is deprived of oxygen, permanent brain damage can begin in as little as four minutes and death can follow only minutes later.,There are three physical symptoms that indicate a need for CPR to be performed immediately and for emergency medical support to be called: unconsciousness, not breathing, and no pulse detected.,Unconsciousness Unconsciousness is when the victim seems to be asleep but has lost all awareness and is not able to respond to questions or to touch or gentle shaking. An unconscious person will not respond to noise or shaking. When unconscious, a person can not cough or clear the throat, which can block the windpipe and cause suffocation and death. People with a major illness or injury or who have had recent surgery are at risk for losing consciousness.,If the person has fainted, which is brief unconsciousness, the cause may be dehydration (lack of body fluids), low blood pressure, or low blood sugar. This is a temporary condition. If the victim is known to have diabetes, a bit of fruit juice may revive the person once they have regained consciousness.,Not Breathing Not breathing, which is also called apnea, is the lack of spontaneous breathing. It requires immediate medical attention. The victim may become limp and lifeless, have a seizure, or turn blue. Prolonged apnea is called respiratory arrest. In children, this can lead quickly to cardiac arrest in which the heart stops beating. In adults, cardiac arrest usually happens first and then respiratory arrest.,The common causes of apnea in adults are obstructive sleep apnea (something blocks the airway during sleep), choking, drug overdose, near-drowning, head injury, heart irregularities (arrhythmia, fibrillation) or cardiac arrest, nervous system disorders, or metabolic disorders. In children the causes may be different, such as prematurity, bronchial disturbances or pneumonia, airway blockage or choking on a foreign object, holding the breath, seizures, meningitis, regurgitating food, or asthma attacks.,No Pulse Detected If the rescuer is unable to detect a pulse or has difficulty in feeling a pulse it can be an indication of the use of improper technique by the rescuer, or shock or cardiac arrest in the victim. If a sudden, severe decrease occurs in pulse quality (such as pulse weakness) or pulse rate (how many beats in a minute) when other symptoms are also present, life-threatening shock is suspected.,The rescuer may need to explain to a doctor or medical professional where on the victims body the pulse was measured, if the pulse is weak or absent altogether, and what other symptoms are present. Medical help and CPR are needed immediately if any of these symptoms is found.,Time is critical. A local emergency number should be called immediately. If more than one person is available to help, one can call a local emergency medical service, while the other person begins CPR. Ideally, someone CPR certified performs the procedure. If a critically ill patient or post-operative patient is being cared for at home, it is a good idea for a family member to take a CPR course to be better prepared to help in case of an emergency.,CPR in Basic Life Support Figure A: The victim should be flat on his back and his mouth should be checked for debris. Figure B: If the victim is unconscious, open airway, lift neck, and tilt head back. Figure C: If victim is not breathing, begin artificial breathing with four quick full breaths. Figure D: Check for carotid pulse. Figure E: If pulse is absent, begin artificial circulation by depressing sternum. Figure F: Mouth-to-mouth resuscitation of an infant.,Understanding the Text,Para. 1 cardiac arrest-心跳骤停 ischemic cardiovascular disease-缺血性心血管疾病 lethal-fatal ventricular fibrillation-心室纤颤 infarcted myocardium-心肌梗塞 primary electrical disturbance-原发性心肌电活动紊乱 Question: 1. What are the causes of cardiac arrest ?,Para. 2 emergency-medical-services system -急症医疗服务体系 code team-a specially trained and equipped team of physicians, nurses, and technicians that is available to provide advanced cardiac life support when summoned by an emergency code set by the institution. A code team usually includes a physician, registered nurse, respiratory therapist, and pharmacist. 急救医疗小组,advanced help-further aid 进一步的救助 chance-possibility range from-vary from variously-ranging from 在美国，尚没有医院外心室纤颤存活的全国性统计数 据，社区报告存活率为4-33%不等，能够快速提供救 助的社区中存活率较高。对于住院患者心脏骤停， 存活率为0-29%不等。,Question: 2. How do you understand the chain of survival ? Explain.,Para. 3 rhythm-心律 collapse (witnessed/unwitnessed)- other than-except Question: 3. As a medical student, would you offer your first aid to a stranger who collapsed suddenly? And how ?,Para. 4 a collapsed person- encounter-meet unresponsive-无反应 summon-call agonal respirations -临终前呼吸 Question: 4. In what condition is a person whose heart suddenly stops beating ?,Para. 5 fundamentals-(pl.) basic facts or principles 基本事实或原则 chest compression-胸部按压 intrathoracic pressure-胸廓内压 viability (viable)-存活;活力;生机 e.g. 1) The viability of the fetus before the 22nd week is doubtful. 2) A fetus is viable by about the 28th week of pregnancy. contract-(心脏)收缩 cardiac output-心输出量,Question: 5. What are the basic principles of cardiopulmonary resuscitation ? Explain.,Para. 6 definitive-conclusive 果断的; 明确的 pulseless ventricular tachycardia-无脉性室性心动过速 take/have precedence over 先于;比重要 - come before, appear more important than,Question: 6. What comes first , cardiopulmonary resuscitation or rapid defibrillation ? Why ?,Para. 7 airway control-(文中指气管插管) intravenous access-(文中指静脉点滴) constitute-make up; form sustain a perfusing rhythm-维持灌注节律 perfusion-passing of a liquid through vessels or an organ or tissue, especially the flow of blood into lung tissue 灌注 Question: 7. What procedures are involved in advanced care ?,Para. 8 administer-vt. observational study- interpret the form and amplitude of- (未来的除颤器可能能够诠释心电图的形状和振幅， 能建议直接除颤或先实施一段时间的心肺复苏。) envision-v. imagine biosensors-生物传感器,end-tidal carbon dioxide monitors -呼气末二氧化碳监测器 adequacy-sufficiency Question: 8. What are the new changes in future first aid procedures according to this paragraph ?,Para. 9 placebo-controlled studies-安慰剂对照研究 setting-condition; situation intravenous-(静脉内注射胺碘酮 ) optimal-the best, most desirable have/has yet to-肯定句中用 yet 表示”还没”, 或表示”到目前为止” e.g. 1) I have yet to hear your explanation. 2) That is the largest sapphire(蓝宝石) yet discovered.,refractory -unresponsive: applied to a condition that fails to respond satisfactorily to a given treatment. 难治性的, 治疗无效的(指治疗 未获得满意疗效的状况) Question: 9. What does this paragraph mainly talk about ?,Para. 10 hypoxic brain damage-缺氧性脑损伤 induce/induction- (目前的研究正致力于诱导体温下降以及以降低脑损伤 为目标的药物干预。) Question: 10. What procedures are helpful in dealing with brain damage ?,Para. 11 precordial thump-胸前区击打(能产生一定能量 ) for a monitored arrest- Question: 11. What is the function of precordial thump ?,Para. 12 mechanical vests-机械充气背心 compress/decompress-主动式胸外按压-减压复苏） randomized studies-随机抽样研究 equivocal-indefinite interposed abdominal compression cardiopulmonary resuscitation-插入式腹部按压心肺复苏术技术 alternate ( with )-交替(进行胸部和腹部按压) equivalent-as good as superior-better than,Question: 12. How to improve cardiopulmonary resuscitation according to this paragraph ? Give your advice.,Para. 13 automated external defibrillators-全自动体外除颤器 interpret-detect shock-电击 Question: 13. What can automated external defibrillators do ?,Para. 14 prolong/prolonged/prolongation- be compounded by- (除非患者心跳停止的同时还有以下情况，患者体温降 低、浸在冷水中、用药过量、其它可确定也可治疗的疾 病或间歇性心室纤颤或室性心动过速) intermittent -间歇性的 community setting-社区环境 in preference to- Question: 14. At what time cardiac resuscitation is to stop ?,Para. 15 strike down-(illnesses) have a disastrous or disabling effect upon 使受到摧残;使一蹶不振;使倒下 e.g. be struck down with a serious illness 重病不起 be struck down by heart disease 患心脏病倒下 prime-n. (sing.) the time when sb. is strongest, most beautiful, most successful ,etc. 壮年, 盛年; 最美好的岁月; 颠峰时期 e.g. 1) He is past his prime as a tennis player. 2) to be in the prime of life 正值盛年/壮年,productive- e.g. land/discussion/cough/lives avert-vt. to prevent something unpleasant; to avoid 避免 e.g. The accident could have been averted. preclude-vt. 排除, 消除 e.g. all doubts 排除一切疑虑 regardless of- Question: 15. How do you understand the phrase “hearts too good to die” in this paragraph ?,Para. 16 prolongation-delay address-vt. terminal - fatal, advanced in the event of-(formal) if something happens e.g. In the event of fire, leave the building as quickly as possible. premises (pl.)-房屋及其产权范围空地; 宅邸内 e.g. The thief was still on the premises. Keep off the premises. 禁止入内,crews-staff members honor-vt. respect Question: 16. How do you understand the phrase “hearts to bad to live” in this paragraph ?,Para.17 Question: 17. What is the authors opinion about the effect of cardiac resuscitation ? Do you agree ?,Do-Not-Resuscitate (DNR) Orders A do-not-resuscitate (DNR) order placed in a persons medical record by a doctor informs the medical staff that cardiopulmonary resuscitation should not be performed. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life.,Doctors discuss with patients the possibility of cardiopulmonary arrest (when the heart stops and breathing ceases), describe CPR procedures, and ask patients about treatment preferences. If a person is incapable of making a decision about CPR, a surrogate may make the decision based on the persons previously expressed preferences or, if such preferences are unknown, in accordance with the persons best interests.,A DNR order does not mean “do not treat.“ Rather, it means only that CPR will not be performed. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided. Treatment that keeps the person free of pain and comfortable (called palliative care) should always be given.,Most states also provide for special do-not-resuscitate orders that are effective outside of hospitals, wherever the person may be in the community. These are called out-of-hospital DNR orders, Comfort Care orders, No CPR orders, or other terms. Generally, they require the signature of the physician and patient (or patients surrogate), and they provide the patient with a visually distinct quick identification form or bracelet or necklace that emergency medical services personnel can identify and comply with.,These orders are especially important for terminally ill people living in the community who want only comfort care and no resuscitation if their heart or breathing stops. L