国际心复苏指南ppt课件

1、guidelines writing group chairs michael r. sayre, md贵阳医学院附院麻醉科贵阳医学院附院麻醉科 曾庆繁曾庆繁2010年年aha 心肺复苏指南介绍心肺复苏指南介绍 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 conferencerobert a. berg university of pennsylvaniaprofessor of anesthesiology and critical care medicine,

2、divisionchief, pediatric critical carecardiac 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 bradycardia4 rhythms 室颤 无脉性室速 vf/pulseless vt chest compressions (cc) early defibrillation (df)early recognition cardiac arrest及早识别心跳骤停及早识别心跳骤停外行急救lay rescuer 1.突然晕倒 suddenly

3、 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 breath

4、sno: “look, listen, feel for breathing”* 不看不看 不听不听 不觉不觉a change from a-b-c to c-a-b“adults” childreninfants (excluding thenewly born)复苏步骤关键:ccc心 脑c-a-b chest compressions initiated sooner 及早按压 forget cpr, give ccr instead忘了忘了cpr代之代之ccr200 chestcompressions200 chestcompressionssingle shockwithout pul

5、se check or rhythm analysisbvm or passiveinsuflation 100% fio2begin ivanalysis200 chestcompressionssingle shock if indicated without pulse check orrhythm analysisanalysissingle shock if indicated without pulse check orrhythm analysisresume standard aclsconsider endotracheal intubation200 chestcompre

6、ssionscconlyemsarrivaladminister 1 mg iv epinephrineanalysis if adequate bystander chest compressions are provided, ems providers perform immediate rhythm analysisthree-phase model of resuscitation02468101214161820arrest time (min)circulatoryphaseelectricalphasemetabolicphase0100%myocardial atpweisf

7、eldt ml, becker lb. jama 2002: 288:3035-8rapid defibrillationgood chest compressionslittle 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 breathschest compression rate: at least 100 per minute* 2

8、010 (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

9、b电击治疗电击治疗electrical therapies aed use in children now includes infants 2010 (new): 1 year of age. 2005 (old): not use of aeds for infants 1 year of age.先除颤先除颤 vs 先先cpr ? cpr 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 bolus

10、12-lead ecg/瞳孔光反射尿量,血清肌酐3540 mm hgdopamine 510mcgacs stemi qt角膜反射发现arfpaco2:norepinephrine治疗急性冠脉综合征自主眼球活动等容euvolemia4045 mm hgepinephrineaspirin/heparin动嘴 呛咳 自主呼吸肾替代治疗脉搏氧 血气0.10.5mcg/kg.mipci or脑电图:replacement 降低 fio2fibrinolysis惊厥血糖监测spo2 94%抗惊厥治疗治疗低血糖37.7clocal insulin protocolsvt 6-8ml/kgventilationhemodynamiccardiovascularneurologicalmetabolicchest 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/kgavoidhypotonicfluis检查ca原因并发症心肌病surface or endovascularincrease edemapneumonitis心肌顿抑cooling for 32c34c(cerebral edema