cardiac arrest新

cardiac arrest心脏骤停,山东大学齐鲁医院安丰双,患者XX，男，58岁。因阵发性胸骨后疼痛5小时于2005年7月10入院。入院诊断：冠状动脉粥样硬化性心脏病；急性广泛前壁心肌梗死。入院后行PCI治疗后病情趋于稳定。入院第14天，病人于晚餐后突然出现抽搐、意识丧失，大动脉搏动消失，血压测不到。心音听不到。,诊断？,病例：,Case report,Sudden cardiac death(心脏性猝死) is the sudden death which is caused by unexpected cardiac reasons. （是指由于心脏原因引起的无法预料的自然死亡）。 Cardiac arrest (心脏骤停) is the abrupt loss of cardiac ejective function (心脏射血功能的突然丧失)。,Definition（定义）,1、Heart diseases：(1) coronary heart disease: especially in acute myocardial infarction)(2) aortic stenosis (主动脉瓣狭窄）(3) hypertrophic obstructive cardiomyopathy (梗阻性肥厚型心肌病)(4) acuteical critical myocarditis (急性重症心肌炎)(5) cardiac arrhythmia (心律失常)(6) congestive Heart failure (充血性心力衰竭) ect.2、Other common diseases(1) Electric injury (电击伤)(2) Drowsiness (溺水)(3) Acute anoxia (急性缺氧)(4) Drugs poisoning (药物中毒) (5) Allergic reaction (过敏反应),Etiology (病因学),Pathophysiology（病理生理）,1、Manifestation before onset(发作前) usually no special symptoms2、onset stage (发作时) (1) unconsciousness （意识丧失） (2) carotid or femoral impulseless(颈、股动脉搏动消失) (3) heart sound disappeared （心音消失) (4) Convulsion （抽搐 ） (5) skin cyanosis （皮肤紫绀) (6) Apnea （呼吸停止) (7) platycoria （瞳孔散大) (8) light reflex disappeared （对光反射消失） Carotid impulseless 颈动脉,Clinical manifestation（临床表现）,？,1、malignant ventricular arrhythmias (恶性室性心律失常）(1) persistent ventricular tachycardia (持续性心动过速)(2) Torsades de points (TdP 尖端扭转型室性心动过速)(3) Ventricular flutter (心室扑动)(4) Ventricular fibrillation (心室颤动) 70%,Typical ECG（心电图特点）,Typical ECG（心电图特点）,2、Critical bradycardia (缓慢性心律失常) sinus bradycardia (窦性心动过缓) sinus arrest (窦性停搏) conduction block (传导阻滞) Sick-sinus syndrome (病态窦房结综合征)3、pulseless electrical activity (无脉搏性电活动) | | electrical-mechanical disassociation (电-机械分离)4、Cardiac electric diaspperance (心电静止),Time is life!,Treatment,1、Basic life support （BLS基本生命支持） (1) airway (A 保持气道通畅) patients position taking out artificial tooth (清除假牙) clearing oral secretion or vomiting (清除口腔呕吐物) (2) breath (B 人工呼吸) mouth to mouth breathing (口对口呼吸) R:C ratio 1:5(two doctors); 2:15(one doctor)P147教材有误 endotracheal incubation (气管内插管) artificial mechanical positive pressure breath (人工机械正压通气),BLS-A,Time is life!,Treatment,1、Basic life support (BLS基本生命支持) (3) Circulation (C 人工循环) cough-version (咳嗽复律) thumpversion (捶击复律) chest compressions (胸外按压) 1) mechanism 2) methods: compression position: 胸骨中下1/3交界处 compression raet: 80100bpm compression length 35cm 3) Complication: fracture (骨折) cardiac tamponade (心包积血) pneumothorax (气胸) contusion of lung (肺挫伤) rupture of liver (肝破裂) fatty embolism (脂肪栓塞),Time is life!,Treatment,2、advanced life support (ALS 进一步生命支持、高级生命支持) (1) drugs (D 药物治疗) (2) electricity (E 电技术) electrocardiogram (E 心电监护） electric cardioversin (E 电除颤) electric pace-maker (E 电起搏) (3) fibrillation (F 电除颤) (4) gauge (G 全面评估)3、prolonged life support (PLS 长程生命支持) (1) hypothermia (H 低温疗法) (2) intensive care (I 加强监疗),Drugs（D药物治疗）,Electric cardioversin (E 电除颤),Electric pace-maker (E 电起搏),(1) hypothermia (H 低温疗法)： 降低颅内压和脑代谢，肛温32左右； 冰帽、冰袋等物理降温； 冬眠药物（氯丙嗪、异丙嗪各2550mg肌注）。 (2) dehydrolyzing method (脱水疗法)： 渗透性利尿剂：20%甘露醇12g 25%山梨醇12g，快速静滴； 呋塞米 (速尿)： 2040mg首次，必要时100200mg iv。 (3) antispasm (防止抽搐)： 冬眠药物（氯丙嗪、异丙嗪各2550mg肌注） 地西泮（安定）10mg iv 缓 (4) hyperbaric oxygenation (高压氧治疗),Prolonged life support (PLS 长程生命支持)Cardiopulmonary and Brain resuscitation (心肺脑复苏),intensive care (I 加强监疗)=复苏后处理1、 criteria of effective CPB resuscitation (1) femoral impulse (扪及股动脉搏动) (2) BP 4580mmHg (3) ECG (4) Autonomous respiration (自主呼吸) (5) heart sound appeared (听到心音) etc.2、overall treatment (1) monitoring of vital signs and nursing (生命体征与护理) (2) to protect renal function (肾功能) (3) to prevent cerebral edema (脑水肿) (4) to keep homeostasis (内环境平衡) (5) anti-complication (防治并发症) (6) causal treatment (病因治疗),prolonged life support (PLS 长程生命支持),1、Heart diseases： AMI Shock HF malignant and irreversible HCM AS etc.2、Other common diseases (1) Electric injury (2) Drowsiness (3) Acute anoxia usually benign and reversible (4) Drugs poisoning (5) Allergic reaction,Prognosis (预后),The nursing principles for patients with cardiac arrest,1、Daily nursing 2、Psychogenic nursing 3、monitoring for therapy 4、Taking care of complications 5、Medical education 6、 Prognosis,Summary,1、 Outline of cardiac arrest Definition Etiology Pathophysiology Clinical manifestation Typical ECG Cardiopulmonary resuscitation (CPR)2、 Advance in SCD (1) SCD and cardiac arrest (2) Cardiopulmonary and Brain resuscitation (3) BLS Education “window time” of resuscitation (4) ALS: femoral impulseless drugs are used acco