急救知识_first aid

1、First Aid现场急救現代版的“鞠躬盡瘁” 目前中國每年大約有60萬人發生猝死， 三類高危人群：新闻工作者、科研人員、企业高管 2004均瑶集团总裁王均瑶英年早逝； 爱立信中国区负责人杨迈猝死在跑步机上（2004） 中国记者郑立在雅典奥运会上不幸殉职 39岁的球报朝鲜语编辑朴成灿因心脏骤停突然去世。 2005年春节前短短4天内，清华大学相继有两位年龄不到45岁的教师“突然”死亡： 1月22日晚，36岁的清华大学电机系讲师焦连伟突然发病去世。 中国社科院学者萧亮中，猝死时年仅32岁。 2006年华为员工猝死2004-08-27 00:00:00 中国记者郑立不幸殉职发生在我们身边的悲剧200

2、4北京国际马拉松赛跑中中国社科院学者萧亮爱立信中国区负责人杨迈 First Aid 现场急救现场急救 First Aid means the initial treatment or assistance given to a casualty for any injury or sudden illness until the arrival or transfer to professional medical support services. 现场急救：在医务人员到来之前，给予受伤者或突发疾病的病人以最初的治疗和救护。Role of first aid 现场急救的任务现场急救的任务 T

3、o preserve life To prevent the condition from becoming worse To promote recovery 保存生命 防止情况恶化 改善预后First Aid / Pre-hospital CareAccident Occurs事故发生Ambulance Arrival 救护车到达Transfer Patient to Hospital 病人被送到医院First Aid 现场急救Pre-hospital Care 院前急救Non-medical staff非专业人员Professional staff 专业医务人员Content 目 录 B

4、asic Information基 础 知 识 Priorities 优 先 原 则 CPR 心 肺 复 苏 Recognition and Management of Bleeding 辨 别 和 处 理 出 血 Asphyxia 窒 息q Respiratory System 呼吸系统q Circulatory System 循环系统Basic Information 基础知识Without blood supply, any part of body will eventually die.Neuron cells can survive only 5-10 minutes when b

5、lood supply is stopped.身体的任何部分丧失了血液供应，都会坏死。神经细胞在丧失血液供应之后，只能存活大概510分钟。Respiratory System 呼吸系统Nose 鼻Mouth 口Pharynx 咽Larynx喉Trachea 气管Bronchi 支气管Bronchioles 细支气管Alveoli 肺泡Respiratory System 呼吸系统呼吸系统Oxygen and carbon dioxide exchange in the alveoli.Red blood cells carry the oxygen to the body tissue.氧气和

6、二氧化碳在肺泡进行气体交换。红细胞将氧气运输到全身各器官Inhalation: 吸气 O2 CO2Exhalation: 呼气 O2 CO2Respiratory System 呼吸系统21%0.4%16%4%Normal breathing in an adult Breaths times/min Quiet, shallow, rhythmic Frequency will increase with additional physical exercise正常成人呼吸 每分钟 次 平静，表浅，有节律 进行体力活动时，呼吸频率会加快Respiratory System Respirato

7、ry System 呼吸系统呼吸系统8-208-20Assessment of Breathing ？ Close your cheek to the mouth of the victim- 看 观察呼吸时胸部的起伏 听 听呼吸时的声音 感觉 感觉呼吸时的气流Check for 5 10 seconds Check for 5 10 seconds 检查检查5-105-10秒秒Circulatory System Circulatory System 循环系统循环系统Heart 心臟Blood vessels 血管Blood 血液Elements of circulatory system循

8、环系统的构成Heart and blood vessels 心臟和血管心臟和血管Heart pumps the blood to the whole body through blood vessels心臟通过血管将血液泵送到全身组织Heart Rate:times/min心率: 每分钟 次Heart stops = Death 心臟停跳 临床死亡60-100Blood Vessels 血管血管ARTERIES carry blood away from the heart 动脉：将血液运离心臟VEINS carry blood to the heart静脉：将血液带回心臟CAPILLARIE

9、S, The meeting of artery and vein毛细血管：动静脉交汇处Blood 血液血液Adult : about of weight成人血量约占体重的Severe bleeding can cause DEATH!严重失血可以导致死亡!8% 8%Assessment of Circulation？Pulse脉搏脉搏 Feel for where the arteries are close to surface of skin radial, carotid or femoral 桡动脉桡动脉,颈动脉颈动脉,腹股沟动脉腹股沟动脉 Rate频率频率 feel for at

10、least 30 seconds multiply by 2 for rate/min Pulse volume脉搏强弱脉搏强弱 strong & bounding or weak and feeble Rhythm节律节律 regular, erratic, regularly irregularColor颜色颜色Pale, blue ( cyanosis ), red, nail bed refill苍白苍白,兰兰(紫绀紫绀),潮红潮红,甲床再充盈测定甲床再充盈测定Priorities 优先原则In A Real Emergency? 遇到紧急情况时？遇到紧急情况时？ Emerge

11、ncies often result in confusion. Those nearby may not know what to do first, who should take charge or how to get help. Following a sequence of actions help to ensure that a safe, appropriate first aid is given. 在面对紧急情况时，人们经常容易慌乱，在场的人或许不知道应该做些什麽，谁应该负责组织急救， 如何求助？所以需要正确，连续的行动保障安全， 适当的急救措施的实施。 In A Rea

12、l Emergency? 遇到紧急情况时？ What are the dangers that present to you, bystanders and the casualty?How many casualties are there?What caused the injury?Is the casualty conscious?Is the airway clear and open?Is resuscitation needed? 伤员， 旁观者和你处于何种危险情况？ 有多少伤员？ 伤员受伤原因？ 伤员是否意识清醒？ 伤员是否呼吸道通畅？ 伤员是否需要复苏急救？DRABC D =

13、 Danger/危险 R = Response/反应 A = Airway/气道 B = Breathing/呼吸 C = Circulation/循环This plan helps you to find out if the casualty has any life-threatening conditions and helps you to give any immediately necessary first aid.D-Danger/危险危险Always check possible dangers before you start.Never expose yourself

14、to any danger.Think about of the safety of victim and by standers as well.行动前， 确认没有危险永远不要把自己暴露在危险环境中同时考虑旁观者， 伤员的安全Your Safety Is the First Priority, ALWAYS！你自身的安全是第一位的！R-Response/反应反应 Check the response of the victim by shouting and shaking the victims shoulder. -“Are You All right?” 通过呼喊， 轻轻晃动伤员的肩膀

15、确认其意识反应程度 -“你还好吗？” A-Alert 清醒 V-Verbal Response 言语的反应 P-Response to painful stimuli 疼痛刺激的反应 U-Unconsciousness/No response 意识丧失/无反应No Response Call For HelpHow to Call for helpTry to speak slowly and clearlyNever hang up the phone firstUse the landmark to make your location more clear or use by stand

16、ers to waiting for the ambulanceWhen will the ambulance arrive 如何求助 说话的语速不要过快并且言语清晰。 不要先挂断电话 利用标志物或让旁观者在指定地点等待救护车的到来。 确认救护车需要多久到达 A-Airway/气道气道 Check and Open the airway by using Head tilt-Chin lift maneuver. 通过头后仰，抬下颏打开气道Make sure a clear and open Airway清理呼吸道， 保持气道通畅For all unresponsive victims, ev

17、en if the victim is injured. 所有无意识反应的伤员 B-Breathing/呼吸呼吸 Close your cheek to the mouth of the victim- 看 观察呼吸时胸部的起伏 听 听呼吸时的声音 感觉 感觉呼吸时的气流Check for 5 10 seconds Check for 5 10 seconds 检查检查5-105-10秒秒B-Breathing/呼吸呼吸 If no breathing is present, the rescuer should give 2 rescue breaths. 如果无呼吸， 立刻进行2次人工呼吸

18、take a normal breath each rescue breath Over 1 secondReopening of airway if first breath does not make chest riseC-Circulation/循环循环 有严重的出血吗 Check for Pulse 有脉搏吗？Gloves!Checking your pulse over the carotid artery颈动脉测量法颈动脉测量法2. Secondary Assessment第二步评估第二步评估 Question the casualty and bystanders to fin

19、d out what happened 通过询问伤员/旁观者了解发生了什麽事情 Check the vital signs (level of consciousness, temperature, breathing, pulse and skin color) regularly. 规律重复检查生命体征（意识反应程度， 体温， 呼吸， 脉搏， 皮肤颜色） Check Symptoms (e.g Pain) 检查症状 （例如：疼痛） Check signs of injury (e.g. Bleeding, deformed limbs) or of a specific medical c

20、ondition (e.g.Epilepsy) 检查伤员体征 （例如： 出血， 肢体变形） 及了解伤员的特殊病史 （例如：癫痫） Decide which injuries or conditions need care 确认需要现场救助的外伤或病情3. Ongoing casualty care: 进一步救助进一步救助 Monitor the casualtys condition 观察伤员的病情 Record details of events/situation 记录具体事件/环境/救助行为等情况 Stay with the casualty until medical aid arri

21、ves 在医疗专业人员到达前，一直陪伴伤员 Report what first aid has been given 向医疗专业人员报告现场急救的实施情况复苏体位复苏体位 Recovery PositionRescue Breathing 人工呼吸人工呼吸When to start rescue breathing?何时应开始人工呼吸？ IF: No hazards 现场安全 No response 病人没有意识 The airway is open and clear 气道开放清洁 No breathing 没有呼吸 （给2次人工呼吸） Principles of rescue breath

22、ing:人工呼吸原则人工呼吸原则：Each rescue breath should be delivered in 1 second.每次呼吸应持续1秒钟。 Should produce visible chest rise.确保胸廓抬起。Should avoid delivering too many breaths or breaths that are too large, too rapid or too forceful. 避免多次、过量、过快及用力呼吸。Steps of rescue breathing:人工呼吸步骤：Lie down flatly让病人平躺Make sure t

23、he airway is open and clear保持呼吸道持续开放Check breathing检查呼吸Seal the nose with finger, allow the mouth to open but maintain chin lift.用手指捏闭鼻孔，保持下颌抬高，张开病人的嘴。Take a normal breath正常吸一口气Mouth to mouth seal the patients airway (Use barrier protection if available)用嘴封闭病人的嘴Steps of rescue breathing: (cont.)Give

24、 each breath over 1 second. Each breath should make the chest rise.用1秒钟的时间平稳吹气，每次吹气应确保病人胸廓抬起。If the victims chest does not rise, perform the head tiltchin lift again before giving the second breath. 如果病人胸廓没有抬起，重新用抑头抬下颌法打开气道。Maintaining head tilt and chin lift, take your mouth away from the victim an

25、d watch for the chest to fall as air passes out.保持气道开放状态，移开嘴，观察胸廓自然回落。Take another normal breath to achieve a total of two effective rescue breaths.进行第二次正常吹气，确保达到两次有效人工呼吸。CPR (adult) for lay rescuer 心肺复苏心肺复苏When to start CPR?何时应开始心肺复苏？IF No hazard 没有危险 No response 没有反应 The airway is open and clear 气

26、道开放清洁 No breathing 没有呼吸 （给2次人工呼吸） (Lay rescuers are not taught to assess for pulse or signs of circulation for an unresponsive victim. Lay rescuers should immediately begin cycles of compressions and rescue breaths after delivering 2 rescue breaths.) 对于目击者（非专业医疗人员），一旦确认伤者没有有效呼吸，无须判断其有无心跳，可在实施两次人工呼吸后

27、立即开始心肺复苏。Hand Position 手的胸外按压部位Compression point is in the centre of the victims chest (lower half of sternum, between nipples).按压点位于胸廓的中点（即胸骨中下部位，两乳头之间）。Principles of chest pressure?胸外按压原则 Should push hard, push fast to give effective chest compressions.“用力压、快速压！” At a rate of 100 compressions per

28、minute速率为100次/分钟 allow complete chest recoil between compressions 在两次按压间确保胸廓充分复位 minimize interruptions in compressions 尽量避免中断胸外按压How to pressure?按压方法按压方法How to pressure? (cont.)按压方法按压方法position yourself vertically above the victims chest and, with your arms straight press down on the sternum 45 cm身

29、体置于病人胸部正上方，手臂挺直，垂直向下按压于胸骨上，下压深度约4-5cm。after each compression, release all the pressure on the chest without losing contact between your hands and the sternum每次按压后完全释放压力，但仍保持手掌与病人胸骨接触。repeat at a rate of about 100 min per minute.按压速率约为100次/分钟compression and release should take equal amounts of time按压

30、及释放时间应相等CPR -Compression-Ventilation Ratio胸外按压与人工呼吸比例胸外按压与人工呼吸比例Follow the same step despite one or two personsContinue with chest compressions and rescue breaths in a ratio of 不论救助者人数，胸外按压与人工呼吸均采用同一比例：30 : 2 5 cycles of CPR is about 2 minutes2分钟约可进行5次循环Stop to recheck the victim only if he starts b

31、reathing normally; otherwise do not interrupt resuscitation.只在病人恢复正常呼吸后才可停止心肺复苏，尽量避免中断复苏过程。 Compression-Only CPRCompression-Only CPR单纯胸外按压单纯胸外按压CPRCPR The outcome of chest compressions without ventilations is significantly better than the outcome of no CPR for adult cardiac arrest. 即使不做人工呼吸，单纯胸外按压的效

32、果也远远大于不做心肺复苏。 Laypersons should be encouraged to do compression-only CPR if they are unable or unwilling to provide rescue breaths , although the best method of CPR is compressions coordinated with ventilations.如果不会或者不愿意实施人工呼吸，仍应鼓励非专业人员进行单纯胸外按压术，虽然结合人工呼吸是最佳的心肺复苏方法。Recognition and Management of Bleed

33、ing 辨 别 和 处 理 出 血Internal Bleeding内出血n Suspect by nature of injury可根据受伤的性质而产生怀疑i Such as trauma, fall, blow, penetrating abdominal wound, crushing or blunt injuryi Common in fractured pelvisi 例如外伤,高处跌落,击打,腹部穿透伤,挤压或钝 器伤i 通常为骨盆骨折n Check for检查i Tenderness, bruising, wounds or clothing marks over vascul

34、ar organsi Rigid abdomen, blood in vomit, rectal bleedingi 检查血管丰富器官的体表部位有无压痛,青肿,伤口或衣服压痕 i 板状腹,呕血,便血n May be indicated by “shock” developing without obvious causen 无明显原因的休克也提示内出血Internal Bleeding Treatment内出血 - 治疗g 请求紧急医疗救助g 保持休息和安静 保持平静并避免不必要搬动g 千万不要吃或喝任何东西g 控制外出血g 监测 脉率,呼吸和皮肤颜色 皮肤 -? 是否湿冷 抬高下肢除非头部外

35、伤g 准备处理休克Get medical assistance urgentlyKeep at rest & reassure Keep calm and avoid unnecessary movementDo NOT give anything to eat or drinkControl any external bleedingMonitor Pulse, respiration & colour Skin - ? Cold and clammy Elevate legs unless Head InjuryBe prepared to treat for SHOCKT

36、wo Main Types of Bleeding 出血分为两大类: i Usually capillaryi 通常为毛细血管性出血i Commonly abrasioni 常见于擦伤External Bleeding 外出血May be slight可能为轻微伤口May be obvious and severe可能是明显和严重的出血May be concealed可能为隐性出血i Usually arterial or venousi 通常为动脉或大静脉i May be laceration or incisioni 可能为撕裂伤或割伤i Check clothingi 检查衣服i May

37、 be puncture wound ( ie fractures or stabbing )i 可能为贯通伤( 如骨折或刀刺伤 )External Bleeding - Treatment外出血 - 治疗g 检查危险性g 查ABCg 若严重出血i 控制出血 抬高患处-若可能将腿和患处抬高 压迫止血-直接压迫止血或用敷料 纱布 -一旦运用不要去除 将受伤者放下,观察并监测i 若出血轻微 预防感染 清洁伤口并适当地包扎Check for dangerCheck ABCIf Bleeding is SevereCONTROL THE BLEEDINGElevation - legs and aff

38、ected part if possiblePressure - direct or with dressingPad - do not remove once appliedLay casualty down, observe & monitorIf Bleeding is SlightPrevent infectionClean the wound and apply an appropriate dressingDressings 敷 料iHelp control bleedingi帮助控制出血iProtect from further injuryi预防进一步损伤iObscur

39、e wound from casualtyi避免受害者直视伤口iProtect against germsi预防细菌感染Bandages 绷带q- Hold dressings in placeq- 固定敷料q- Control bleedingq- 控制出血q- Support and immobilize qCheck tension frequently and monitor the circulation q- 支持和制动 - 需反复检查张力及远端循环q- Prevent or reduce swellingq- 预防或减轻肿胀Triangular Bandage 三角巾Confor

40、ming gauze roll bandage 卷带三角巾单眼包扎三角巾单眼包扎三角巾头部包扎三角巾头部包扎屈肢加垫止血法屈肢加垫止血法如何打方结如何打方结Asphyxia 窒 息 Asphyxia is the medical term for suffocation, caused not only by smothering, but by any condition that prevents oxygen being taken up by the blood, resulting in Hypoxia 窒息是一个医学术语,不仅仅呼吸道的堵塞可导致窒息,任何阻止血液摄氧,引起低氧血症的因素均可导致窒息。Hypoxia 缺缺 氧氧 This term describes the depletion of oxygen in the bod