外科学-心肺脑复苏2014-3

Algorithm for treating Cardiac arrest
Signs of cardiac arrest
* Sudden deep unconsciousness * Absent carotid and femoral pulse * Dilated pupils * Ashen cyanosis * Apnoea or gasping
ponents of resuscitation from cardiac arrest are ABCDE
Airway Breathing Circulation Drugs Electrical therapy
Management of cardiac arrest
Basic Life Support, BLS Advanced Life Support, ALS
Cardiopulmonary Resuscitation
Electrical Therapy
* Defibrillaion and Cardioversion
Defibrillation: shock VF/ pulseless VT (200J,200J to 300J, 360J ) up to 3 times
Basic Life Support, BLS
Cardiac arrest (Patterns of ECG)
* Ventricular fibrillation (VF) * Ventricular tachycardia with no cardiac
output * Asystole * Electromechanical dissociation (EMD)
in children, and then allow to return to its normal position
Lie on a hard surface (patient) Use weight of the upper body Arm straight to reduce fatigue Heels of hands crossed Fingers clear of chest Apply pressure over the low half of the sternum
* External cardiac massage * Airway and artificial ventilation * Operator expired-air resuscitation * Bag and mask ventilation
Advanced Life Support, ALS
Airway Breathing Circulation Drugs Electrical therapy
Algorithm for treating Cardiac arrest
Primary ABCD Survery A Airway: Open the airway B Breathing: provide positive-pressure ventilations C Circulation: give pressions
VENTRICULAR ASYSTOLE
Total absence of ventricular activity Absolutely flat baseline (except possible P waves)
Consider possibility of fine ventricular fibrillation and need for defibrillation
6)‘Tables’(Drug OD, accidents)
7)Tamponnade, cardiac 8)Tension pneumothorax 9)Thrombosis, coronary 10)Thrombosis, pulmonary (embolism)
Check responsiveness Activate emergency response system Call for help
Epinephrine (0.5-1 mg I.V.) every 5 minutes
Atropine (1 mg I.V.) every 5 minutes Pacemaker (external or transvenous)
Drugs
* Epinephrine * Vasopressin * Amiodarone * Lidocaine * Sodium bicarbonate
Mouth-to-mask: bag-valve-mask bag-valve-endotracheal tube
C: CIRCULATION
External Chest Compression Intravenous Access Dysrhythmia Recognition Drug Administration Defibrillaion and Cardioversion
Defibrillation as soon as possible and repeated a necessary Epinephrine (0.5-1 mg I.V.) every 5 minutes Lidocaine (1 mg/kg I.V.)
Rate 100-220/min Rhythm regular of irregular P waves usually not present plexes appear like premature ventricular contractions Usually associated with dramatic decline in blood pressure and cardiac output
Consider most frequent causes
1)Hypovolemia 2)Hypoxia 3)Hydrogen ion-acidosis 4)Hyper-/Hypokalemia, other metabolic 5)Hypothemia
Consider most frequent causes
Cardiopulmonary Resuscitation
Contents
* Consider most frequent causes * Signs of cardiac arrest * Management of cardiac arrest * Management of brain damage
Epinephrine (0.5-1 mg I.V.) every 5 minutes Atropine (1 mg I.V.) every 5 minutes Pacemaker (external or transvenous)
Electro-Mechanical Dissociation, EMD
equipment and drugs
A: AIRWAY
Head-tilt and Chin-lift Jaw-trust without Head-tilt------whenever a
cervical spine injury is suspected Heimlich Maneuver
arrhythmias durinain damage
General measures * Prevention of hypoxaemia and hypercapnia * Depression of cough and swallowing Specialised treatment * Hyperventilation * Osmotherapy * Steroids * Barbiturates and CNS depressants * Calcium antagonists
Basic Life Support: life support without the use of special
equipment
Cardiopulmonary Resuscitation
Advanced Cardiac Life Support: life support with the use of special
External cardiac massage
Lie on a hard surface (patient) Use weight of the upper body Arm straight to reduce fatigue Heels of hands crossed Fingers clear of chest Apply pressure over the low half of the sternum The sternum is depressed 4-5cm in adult,2-4cm
Dysrhythmia Recognition Drug Administration
Disorganized ventricular electrical activity Rate too rapid and disorganized to count Rhythm irregular No discernible P waves of plexes Irregular undulations in electrocardiograph baseline Always results on no effective cardiac output
Key points for treating Cardiac arrest
Check responsiveness Activate emergency response system Call for help
ponents of resuscitation from cardiac arrest are ABCDE