产房抢救设备及流程管理.ppt

1、产房抢救设备及流程管理 Rescue equipment and process Administration in Delivery room,中南大学湘雅医院 刘静 Xiangya Hospital Obs. Ward liujing,主要内容Main content,产房抢救设备 Rescue equipment 产房抢救流程 Salvage process,产房抢救设备Rescue equipment,抢救车 Rescue vehicle 新生儿窒息复苏抢救用物 Salvage materials of Resuscitation of neonatal asphyxia,1、产房抢救

2、制度 Rescue system 2、产房抢救组织Rescue organization 3、产房急救车内备药（15种药品名称与排序）The first aid medicine is prepared for emergence in delivery room Nikethamidenikismaid ( Coramine) Used to stimulate respiration Lobeline洛贝林Adrenaline hydrochloride盐酸肾上腺素 Isoproterenol异丙肾上腺素 Enhance myocardial contractility, accelera

3、te heart rate, constrict the blood vessel, gastrointestinal and relax bronchial non-striated muscle 增强心肌收缩力，加快心脏速率，收缩血管，胃肠和松弛支气管平滑肌,利多卡因 Lidocaine Reduc myocardial excitability AF(AtrialFibrillation降低心肌的兴奋性，房颤 propafenone 普罗帕酮 decreases the myocardial contractility , it is used early in therapeutic

4、room , Inhibition of paroxysmal阵发性的 ventricular vntrkjl心室的 tachycardia 心动过速的and Wolff-Parkinson-White syndrome Verapamil Reduce myocardial excitability 降低心肌收缩力，在治疗室中使用的早期，阵发性室性心动过速和预激综合征的抑制作用 维拉帕米降低心肌的兴奋性,Atropine - M muscarinic 毒蕈硷的 receptor antagonists阿托品 - M胆碱受体拮抗剂。 Anti shock effects, and excite

5、 the respiratory center.抗休克作用，并兴奋呼吸中枢。 654-2 (Anisodamine ANI ) - M muscarinic receptor antagonists. and its effect is similar to the atropine , Aminophylline - antiasthmatic drugs. Directly dilatatedl,tet bronchia支气管 ,excite respiratory center , enhance myocardial contractility, increased renal blo

6、od flow and diuresis 654-2（山莨菪碱ANI） - M胆碱受体拮抗剂。效果与阿托品相似， 氨茶碱的 - 平喘药。直接扩张支气管，兴奋呼吸中枢，增强心肌收缩力，增加肾血流量和利尿,Furosemide ( Lasix ) - a potent diuretic. it is used for congestive heart failure,ascitesesulted from liver cirrhosi , renal failure edema disease and so on , it is effective for acute pulmonary edem

7、a and acute cerebral edema when combined with other drugs, can also be used for hypertension, hyperkalemia, acute druggery toxicosis and prevention of acute renal failure. Dexamethasone - adrenal cortical hormone. Antitoxic anti-inflammatory, anti-allergy, has a stronger impact on inhibition of pitu

8、itary adrenal cortex . it Mainly is used for allergic and inflammatory disease and alsofor neonatal respiratory distress syndrome, intracranial pressure. 呋塞米（速尿） - 一种强效利尿剂。充血性心脏衰竭，肝硬化腹水，肾功能衰竭等水肿疾病，与其他药物合用于急性肺水肿和急性脑水肿的治疗，也可用于高血压，高钾血症，急性药物中毒及预防急性肾功能衰竭。 地塞米松 - 肾上腺皮质激素。抗毒，消炎，抗过敏，对垂体 - 肾上腺皮质的抑制作用更强。主要用于过

9、敏性和炎症性疾病;也用于新生儿呼吸窘迫综合征，颅内压。,4、15种急救药品名称、常用剂量、药理作用与用途、不良反应与禁忌症 4、15 kinds of first-aid medicine s name、Usual dose、Pharmacological effect Adverse reaction、Contraindication 5、产房急救车内备物 emergent ambulance is equiped with goods in th delivery room:a blood pressure monitor,stethoscope ,flashlight,electrica

10、l connector receptacle, face mask for oxygen inhalation,breathing bag.,6、产后流血抢救流程图 Flow chart of rescuing postpartum bleeding 7、产后流血的护理应急处理措施 Emergent treatments and measures for postpartum bleeding 8、子痫抢救流程图 Flow chart of rescuing eclampsia 9、子痫抢救的护理应急处理措施 Emergent treatments and measures for eclam

11、psia,10、羊水栓塞抢救流程图 Flow chart of rescuing Amniotic fluid embolism 11、羊水栓塞抢救的护理应急处理措施 Emergency treatment measures of Amniotic fluid embolism 12、新生儿窒息复苏流程图 Rescue Flow chart of Resuscitation of neonatal asphyxia 13、新生儿窒息复苏的护理操作技术Nursing operation technique in Resuscitation of neonatal asphyxia,14、心、肺复

12、苏 （Cardiopulmonary resuscitation CPR） 抢救流程Rescuing Flow chart 15、心、肺复苏（CPR）相关知识 Related knowledge about CPR 16、药物过敏性休克防范与应急处理措施 Prevention and emergent treatment measures for Drug anaphylactic shock17、输液反应防范与应急处理措施 Prevention and emergent treatment measures for Infusion reaction18、输血反应防范与应急处理措施 Prev

13、ention and emergent treatment measures for Blood transfusion reaction,新生儿窒息复苏抢救用物,气流充气式气囊和氧气面罩 Air inflatable airbag and Oxygen mask T-组合复苏器T- combination recovery device T-组合复苏器（T-piece）是一种正压通气装置，它的主要优点是能保持呼气末正压。此装置需压缩气源。吸气峰压或呼气末正压是用手和可调的控制器来建立的。当操作者的手指交替的关闭和开放装置上的开口时，此装置即给予婴儿间断的肺膨胀压。T- resuscitati

14、on (T-piece) is a kind of positive pressure ventilation device, its main advantage is to maintain end- expiratory positive pressure. This device needs compressed air. inspiratory Peak pressure or end -expiratory positive pressure controller is established by hand and adjustable controller . When the

15、 operators finger open and close opening of device alternately, the device gives the baby intermittent lung expansion pressure. 脐静脉导管Umbilical venous catheter导液管,药物Drug： 肾上腺素Epinephrine 生理盐水 Physiological saline 乳酸林格氏液Lactated Ringers solution 或Rh阴性的O型血Rh negative blood type O 扩容剂Expansion agent 纳洛酮

16、Effect of Naloxone,产房抢救流程,产后出血Postpartum bleeding 羊水栓塞Amniotic fluid embolism 子痫Eclampsia 心肺复苏Cardiopulmonary resuscitation CPR 新生儿窒息复苏neonatal asphyxia,产后出血救治路径Treatment path,静脉通道12条，给氧，监测生命体征，留置导尿，记出入量，求助 Venous channel、oxygen、Monitoring of vital signs、Indwelling urethral catheterization,病史，体查，估计出

17、血量，抗休克同时进行初步诊断Medical history、phisical exam , estimate blood loss ,anti-shock treatment coincide with a preliminary diagnosis,按摩子宫，宫缩剂促进子宫收缩，检查软产道，胎盘，凝血功能 Massage the uterus、Contractions agents to promote uterine contractions，exam Soft birth canal、Placenta plsnt 、Coagulation function,宫缩乏力Uterine ato

18、ny,按摩子宫 宫缩药物Contractions agents 宫腔填塞uterine tamponade,盆腔血管结扎Pelvic vascular ligation或介入栓塞术 embolization surgury,胎盘因素 placetal factor,排空膀胱empty bladder 处置胎盘 placental management 宫缩药物,软产道裂伤 Laceration of birth canal,迅速查找出血部位，清除血肿缝合裂伤压迫止血Quickly find bleeding sites , remove hematoma suture laceration o

19、ppression to stop bleeding,凝血功能障碍Blood coagulation dysfunction,明确病因 find the etiology 补凝血因子add clotting factor 抗DIC 输液、输血Infusion, transfusion,严密监测close observation，及时会诊Group consultation或转诊Referral,子宫切除Hysterectomy,广谱抗生素Broad spectrum antibiotics,防治心肾衰竭Prevention and treatment of heart and kidney f

20、ailure,Reminder：,1、预防出血比最好的治疗方法更重要。Prevention of bleeding is more important than the best treatment 2、呼叫院内抢救小组，降压产后出血患者严重并发症，可按照3P原则处理 Call in the rescue team, after lowering blood pressure, the patients have postpartum hemorrhage with serious complications ,deal with it according to 3 p principle 预

21、测（Prediction), 预防（Prevention) 个体化（Personnalization)。 3、表示有条件时采用。Apply it when it is possible,羊水栓塞救治途径,边抢救边诊断,一般处理,1、开放静脉，尽量置沉静脉管，同时留取腔静脉血 2、生命休征监测，记出入量，留置导尿管 3、完善化验（血常规，IC筛查，试管法凝血试验，配血，肝肾功能，电解质，氧饱和度必要时血气分析）,缓解肺动脉高压 缓解支气管痉挛 抗低氧血症,1、给氧正压洽氧，必要时气管插管 2、罂粟碱30-90mg静滴（总量300mg/日）；或氧茶碱250mg+5葡萄糖100mL,静滴. 或阿托品

22、1-2mg静滴，15-30分钟，重复34次。,抗过敏,地塞米松20mg静推，继续以20mg静滴，或氢化可的松200300mg静滴。,生命支持，防治多器官功能衰竭,补液：,1、晶体液（生理盐水或平衡液）2000mL/第1小时，其中1000mL静滴1520min内输完. 2、胶体液，如低分子右旋糖苷或代血浆500mL静滴（晶体按3：1输入）.,升压药：多巴胺40mg+5葡萄糖100mL 静滴.5Ug/kg/min,根据血压调整,输血（RBC）指征：血红蛋白70g/L,或者血细胞比容25,西兰地0.20.4mg静滴，呋塞米40mg静滴，必要时重复。,纠正酸中毒,5%碳酸氢钠6080mL静滴（根据血气

23、结果，再小剂量分次给,抗 感 染,广谱抗生素,纠正DIC,肝素2550mg+0.9%生理盐水100mL静滴1小时内输完（发病早期即高凝期），若再次使用需用监控凝血功能,补充凝血因子： 1、新鲜血液，冰冻血浆，血小板悬液 2、纤维蛋白24g静滴 3、凝血酶原复合物800U,纤溶期抗纤容治疗,止血对症处理： 如缝合裂伤，血管栓塞，采取血管结扎或子宫 动脉栓塞，或子宫切除等。,须防及纠正产后出血，必要时切除子宫,尽快结束分娩,条件具备阴道产,条件差剖宫产,温馨提示：呼叫院内抢救小组，多学科合作，尽量留腔静脉血有助于诊断,routine treatment:open vein, indwell vei

24、n tube if it is possible,obtain the vena cava blood at the same timemonitor vital sign , record the intake and output volume , indwell catheterperfect relevant testing (blood routine, IC screening, blood coagulation test by tube method, blood matching， liver and kidney function, electrolyte, oxygen

25、saturation blood analysis when is necessary). alleviate the pulmonary hypertension, relieve bronchial spasm, resist anti-hypoxiagive oxygen - positive pressure aerobic, when it is necessary, give tracheal intubationIV 30-90mg papaverine (total 300mg/); or aminophylline 250mg+5% glucose 100mL,ivgtt.O

26、r IV atropine1-2mg, 15-30 minutes, repeat 34 times. antiallergic intravenous injection of Dexamethasone 20mg, continue ivgtt with the 20mg, ivgtt hydrocortisone 200300mg . Life support, multiple organ failure prevention and treatment Rehydration: the crystal liquid (normal saline or Ringers solution

27、) 2000mL/ in first hours, complete intravenous infusion of 1000mL in the first 1520min .colloid solution , such as ivgtt 500ml low molecular dextran or plasma substitute , (input proportion of crystals and colloid is 3:1 ) Hypertension drugs: dopamine 40mg+ intravenous drip of 5% glucose 100mL.5Ug/k

28、g/min, make adjustment according to the blood pressure Blood transfusion (RBC) indications: hemoglobin 70g/L, or hematocrit 25% ivgtt 0.20.4mg cedilanid , ivgtt 40mg furosemide, repeat it if necessary. Correct acidosis ivgtt 5% sodium bicarbonate 6080mL (repeat adminstrating small dose by several ti

29、mes according to blood gas analysis) Anti-infection treatment use broad-spectrum antibiotics,correct DIC: 1 finish ivgtt of Heparin 2550mg+0.9% 100mL normal saline within 1 hours (patitent is hypercoagulable status in the early period of the disease )before repeating it , monitor blood coagulation f

30、unction anti-fibrinolysis treatment in the fibrinolysis period 2 Supply blood coagulation factor: the fresh blood, frozen plasma, platelet suspension fibrin 24g intravenous drip prothrombin complex 800U 3 Hemostatic treatment: Such as suture laceration, embolization, uterine vessel ligation ,Arteria

31、l embolization, hysterectomy . correct or prevent postpartum hemorrhage, remove the uterus when necessary end the delivery as soon as possible, choose the Vaginal delivery cesarean section depending on maternal condition Reminder: call the hospital emergency rescue team can achieve multidisciplinary

32、 cooperation, obtaining vena cava blood is helpful to precise diagnosis,子痫前期（重度）临床路径Pre eclampsia (severe) clinical pathway,一般处理routine treatment,完善相关化验及检查Improve the relevant testing and inspection,血尿常规 电解质 凝血功能 肝肾功能 尿蛋白定量 眼底检查 ECG：血液动力学监测 （有条件）Blood and urine routine Electrolyte ,Coagulation funct

33、ion The function of liver and kidney The quantity of urinary protein Fundus examination ECG: hemodynamic monitoring,间接吸氧 Indirect oxygen 侧卧位休息rest Lateral position,胎儿宫内 安危评估Fetal safety assessment,药物治疗 drug therapy,镇静sedation,解痉 relieve spasm,降压Lower BP,安定或鲁 米那口服 oral diazepam luminal,首次用药剂量（仅用一次）：1

34、5%硫酸镁20ml5%GS100ml，快速静脉滴注30分钟内滴完The first drug dose (only use once): 15%Magnesium sulfate 20ml + 5%GS100ml, rapid ivgtt complete within 30 minutes,15%硫酸镁60ml5%GS100ml，12g/小时（严格控制滴数）15% Magnesium sulfate 60ml + 5%GS100ml, 12g/ hours (strictly control the number of drops),口服用药指征：舒张压95-110mmHg。用药举例，如：心

35、痛定10mg.3次/日，口服,静脉用药指征：收缩压160mmHg或平均动脉压140mmHg。用药举例，如：5%GS250ml酚妥拉明10mg静滴（根据血压调滴数）,终止妊娠end delivery,经积极处理2448h病情无好转the condition did not get better after active treatment,危及胎儿生命，如胎盘功能低下，胎儿宫内窘迫等。 endanger fetal life, such as the placenta dyfunction, fetal distress,孕34周,温馨提示：1、所有子痫前期（重度）应转诊上级医院； 2、转运途中

36、须防抽搐；3、早产前促胎肺成熟； 4、宫内转运；Reminder: 1, all severe pre eclampsia should be referral to upper hospital;2, prevent convulsions in transit;3, accelerate lung maturation of prenatal fetal ;4, intrauterine transfer;,Intravenous medication indications: SBP 160mmHg or mean arterial pressure 140mmHg. such as:

37、5%GS250ml + ivgtt 10mg phentolamine ( regulate drops according to the blood pressure ),子痫抢救临床路径 clinical pathway of Save a eclampsia,呼抢救小组，病情告知签字等Call the rescue team, inform family members relevant things and ask them to sign etc.,了解病情，监测生命体征及胎儿情况，查血尿常规，肝肾功能，电解质，凝血功能，记出入量 monitor vital signs and fe

38、tus condition, routine exam of urine and blood , liver and kidney function, electrolyte, blood coagulation function, record intake and output volum,药物治疗drug therapy,吸氧、吸痰，防声光刺激，防坠床 开口器inhale oxygen suck sputum Anti sound light stimulation, anti- dropping from bed mouth gag,镇静sedation,安定diazepam10mg+

39、10%Gs20mL,iv injection,仍有抽搐两者取其一,安定diazepam10mg ivgtt 5min or IM,冬眠1号 1/3量+10%Gs 500mL IVGTTor IM,解痉relieve spasm,未用药,已用药,25%MgSO4 20mL(5g)+5%Gs 100mlivgtt（30min）；25%MgSO4 20ml(5g)+5%Gs20mLiv injection 25%MgSO4 30ml(7.5g)+5%Gs500mL ivgtt12g/h 监测腱反射，呼吸，尿量，备好10%葡萄糖酸钙拾抗镁中毒 Monitor tendon reflex,respira

40、tory, urinary volume, prepare 10% calciumGS pick resistant magnesium poisoning,25%MgSO4 30ml(7.5g)+5%GS 500mL ivgtt 12g/h,降压lower BP,降压指征indicaton： 舒胀压DBP110mmHg或平均动脉压MABP140PmmHg,酚妥拉明或其他降压药物Phentolamine or other antihypertensive drugs,保护重要脏器功能protect major organs function,20%甘露酎如心肾功能不好，则呋塞米2040mg可6

41、h后重复20% mannitol if cardiac and renal function is not good, choose 2040mg furosemide ,it can be repeated after 6H,预防感染prevent infection,对肾毒性小的广普抗生素choose The broad-spectrum antibiotics with less renal toxicity,胎儿宫内缺氧the fetus intrauterine hypoxia,难控制的抽搐可用大伦丁，还可用硫喷妥钠use dilantin or thiopental for unc

42、ontrollable spasm,抽搐停止后2h停止妊娠 end delivery within 2h after stopping convulsions,Hibernation No. 1:Chlorpromazine (Thorazine) 50mg, meperidine (pethidine) 100mg, promethazine (phenergan) 50mg. In 5% glucose or saline intravenously,新生儿复苏新流程图,大约时间,出生,足月吗？is a full-term fetus? 胎粪清除了吗？does meconium cleared? 有呼吸或哭吗？is breathing or crying? 肌张力好吗？ is muscle tension good?,常规护理（一级）Routine nursing (level) 保暖 keep warm 吸净粘液 absorb mucus 擦干 dry The observation of complexion观察肤色,30秒,保暖 keep warm 摆好体位，吸净粘液put in the proper position