心肺复苏.英文班课件

1、Cardiopulmonary cerebral resuscitation ICU Dr.XI NO.4Requirements of the teaching programMaster the methods of early recovery 1Familiar with the late recovery and recovery treatment一、 summary Resuscitation： All the measures taken to save lives 。 Cardiopulmonary resuscitation,CPR： For respiratory and

2、 circulatory arrest taking emergency measures, including artificial respiration and cardiac massage. Cardiopulmonary cerebral resuscitation,CPCR： The brain function recovery, the whole process of reversal of clinical death CPCR key factor to success ： Early recovery started 4 minutes later, the late

3、 recovery started within 8 minutes二、 The steps of CPCR three stepsALSBLSPRTBLSA: Recognition B:AirwayC:BreathingD:Circulation PRTA: ensure airway unobstructedB: oxygenC: assessment of vital signsD: differential diagnosisALSA: artificial airway B: Evaluation of the adequacy of ventilationC: establish

4、 vein channel, use intravenous drug D: To find the causebasic life supportMain task:（ rapid and effective） restoring blood perfusion and oxygen supply) ABC:A. keep the airway unobstructedB .effective artificial respiration C .effective artificial cycleArtificial respiration and cardiac massage is th

5、e main measures of early recovery.The artificial respiration:Recognition of breathing (listen to the air, look at the chest)The relief of airway obstruction (clear secretions)The artificial respiration (manual, instrument method)Determine spontaneous breathing Methods: Keep ear close to the mouth an

6、d nose Eyes observe thoracic uplift or not at the same time Listen to breath sounds Time is not more than 5 seconds A:AirwayMake patients lie on your back on the solid flat (ground) Keep respiratory tract unobstructed, removal and keep head position properly 仰头抬颈法 仰头举颏法 抬举下颌法B:BreathingMouth to mout

7、h / nose breathing (the most suitable for on-site resuscitation)Simple mask respiratorTracheal intubationMouth-to-mouth resuscitation method : Start 3 4 times in a row, after blowing once every five seconds. Take a deep breath every time . The patient can be exhaled gas himself. notice ： Avoiding ex

8、cessive ventilation and decreasing cardiac outputInspiratory time should be greater than 1 secondsTidal volume 500 600mlFrequency: adult 10 12 times /minChildren 18-20 /minInfants with 30-40 /minStart ventilation frequency: 2 consecutive or 5 timesThoracic raised as a symbol of effective artificial

9、respirationC:CirculationCardiac compression is a method trough indirect or direct cardiac massage to form a temporary artificial cycle.Cardiac compression二、 cardiac arrest Definitiontype asystoleventricular fibrillationelectromechanical dissociationThe cause Primary: coronary ischemia, electric shoc

10、ks, anesthetic overdose, visceral traction, high potassiumSecondary: alveolar hypoxia, airway obstruction, acute massive blood loss. diagnosis Mind suddenly lose, call for no response; no artery pulse, blood pressure measurement is less than, cant hear heart sounds; no spontaneous breathing corectas

11、isFour “no”：ConsciousnessRespirationHeart soundsArterial pulseasystoleventricular fibrillation心肌纤维快速不规则颤动(不同步快速收缩)ECG: QRS波群消失，代之以振幅与频率极不规则的颤动波，频率200500次/分electromechanical dissociation, EMD 缓慢无效的心室自主节律 ，QRS波群宽而畸形，低振幅，2030次/分以下2.Cardiac compression1) Rapid diagnosis of cardiac arrest2) chest compres

12、sion:Note:lying in the plane R:C: 2:30, children 2:15 P/R（time） 1:1(2) operation method:胸外心脏按压 artificial circulationMechanism: press sternal lower 1/3 increase intrathoracic pressure (thoracic pump) or direct compression of the heart (heart), the blood flow to the lungs and other organs Effective i

13、ndication:Touch pulse, The pupil becomes smallgradually, red lip, autonomous respirationPosition:lie on your back on the solid flat (ground) .The head is not higher than the heartThe press position:The finger to touch the costal margin, move toward the midline, into the ribs and sternum.up to 4cm (t

14、wo fingers)4）open chest compression,OCCIndications:The longer time of cardiac arrest or ECC is not valid for more than 10 minutes.The existence of intrathoracic conditions, such as bleeding, pericardial tamponade, tension pneumothorax.The thoracic or spinal deformity with heart displacementThe multi

15、ple external defibrillation is invalid forVF or VTCardiac arrest occurred in operation, especially to open chest surgeryAdvantage.Provide near normal MBF (myocardial blood flow) and CBF (cerebral blood flow,) is beneficial to the recovery of spontaneous circulation and protection of brainDisadvantag

16、es: high technology and conditions, there is the possibility of infectionopen chest compression,OCCMethods: open the chest, direct compression of the heart by hand 80 times frequencyCharacteristic.1 myocardial blood flow and brain blood flow increased2 animal experiments that can improve survival ra

17、te3 be in hospital, arrest 25 is invalidSevere chest trauma, thoracic deformity,Pericardial tamponade should open chest compressions（二）advanced life support,ALS1 the management of respiratory tractWith spontaneous breathing: mouth airway (nose)No autonomous respiration: tracheal intubation or incisi

18、on of trachea2 monitoringECG, BP (the best record), blood gas analysis (PaO2 60mmHg ;PaCO2 36 40mmHg), urine volume, specific gravity, CVP.3 drug treatmentObjective: to stimulate the recovery of heart beat and enhance myocardial contractility, prevention and treatment of arrhythmia,Adjust the acidba

19、se imbalance, fluid and electrolyte replacement.Medication Objective: Excitation of cardiac autonomic rhythms and enhance myocardial contractility, prevention and treatment of arrhythmia, adjust the acidbase imbalance, fluid and electrolyte replacement, when recovery the medication must be quickly a

20、nd accurately. Injection way: The intravenous injection (preferred); intratracheal injection (injection be diluted to10ml); The intracardiac injection (complicationsCommonly used drugs1） Catecholamine and adrenergicEP（epinephrine）: first choicedose ：0.51mg once ，或0.01 0.02mg/kg repeated every 5 minu

21、tesNE： A significant increase in MBF.CBF The incidence of arrhythmia is higher after defibrillationIsopropyl epinephrine and dobutamineMainly excite receptor, MBF does not increase after the selection2) Sodium bicarbonateAccording to the results of blood gas analysis , correct acute acidosisWhen the

22、 base excess (SEB) above -10mmol/L, application of sodium bicarbonateSodium bicarbonate(mmol/L)SBE weight （kg）46. Fluid therapy In the process of CPR low blood volume is not conducive to the recovery and autonomous rhythm stability, reduces the sensitivity of vasoactive drugs.Expansion of crystal fl

23、uid, the appropriate colloid, generally without blood transfusion.The CVP is maintained at 10 15 mmHg.4. Ventricular fibrillation and defibrillation Defibrillation time:VF/VT sudden, defibrillation within 30 seconds ofOther should be CPR at least 2 minutes(give epinephrine pre-)Method：External defib

24、rillation adult: 360 J;Children with 2-4J/kgThoracic defibrillation adult 20 80J;5 50J childrenIndications: VF/VTElectrical cardioversion;The medication invalid （supraventricular ）(50J)Ventricular heartbeat tachycardia (50J)Atrial flutter (25J)External defibrillation左侧第五肋间腋前线胸骨右缘第二肋间5. heart pacemaker （Restoration of spontaneous rhythm, but must rely onIsoproterenol to maintain normal heart rate）（三）post-resuscitation treatment,PRT prolonged life support,PLSObjective: prevention and treatment of multiple organ failure and hypoxic brain injuryMaintain go