室颤与急救3

室颤的识别与急救Ventricular FibrillationEmergency Management,1,学习目标 Learning Objectives,2,概念 Definition,最严重的心律失常之一 (most severe arrhythmia),心室丧失有效的整体收缩能力(uncoordinated contraction of ventricle),心肌快而不协调的颤动(rapid and disorganized fibrillation),室颤,3,临床表现 Clinical Manifestation,4,1.面色苍白或青紫 Cyanosis2.意识丧失 Loss of consciousness3.全身抽搐 Convulsion4.阿斯综合症 Adams-Stokes Syndrome5.呼吸循环骤停 Sudden arrest of Respiration and Circulation,心电图 ECG Manifestation,5,In VF,there is no clear P and QRS waves,the waveform amplitude and frequency are disorganized,frequency could be 250-500 beats per minute.,室颤急救处理Emergency Management,病人呼之不应，无心跳及呼吸，心电监护示室颤,即刻胸外心脏按压，以C-A-B顺序开始CPR同时呼叫医生让另一护士去取除颤仪,立即电击除颤,床边没有除颤仪,有除颤仪,电击:单向波360J 双相波200J马上进行5个CPR循环评估节律，必要时再次电击,6,早期除颤Early Defibrillation,不及时救治，室颤在几分钟内导致猝死除颤是终止室颤最为有效的方法除颤成功的可能性随时间推移而下降从室颤发作到给予电击的时间不应超过3分钟,7,除颤 Defibrillation,对心脏的电击 electric shock,消除原有的异位心律 let random action to stop,使心脏转复为窦性心律Convert heart to normal sinus rhythm,除颤,8,除颤适应症 Indications,9,除颤三步 3 Main Steps,10,除颤操作 Basic Operation Steps,1.打开电源,11,3.充电,2.选择合适的能量,4.生理盐水纱布置于病人胸壁,除颤操作 Basic Operation Steps,12,7.提醒大家离床,8.同时按下放电键,5.放置电极板,6.心电图确认为室颤,电极板位置 Position of Paddles,心尖部：Apex 放于左腋前线第四肋间心底部：Sternum 放于胸骨右缘第二肋间两电极板位置距离10cm以上除颤时避开皮肤破溃处，永久起搏器植入部位放电时按压力量：10kg,心尖部,心底部,13,除颤后处理 After Defibrillation,恢复窦性心律-成功！,心脏一直线：1.心脏按压2.肾上腺素1mgiv 3-5min重复一次,仍为室颤 1.继续胸外心脏按压，再次除颤 2.遵医嘱给药，胺碘酮或利多卡因,14,总结 Conclusion,P和QRS波群消失，代之以波形、振幅及频率极不规则的细颤波,频率达到250-500次/分,立即以C-A-B顺序开始CPR，呼叫医