外科学-心肺脑复苏2014-3

Consider most frequent causes
1)Hypovolemia 2)Hypoxia 3)Hydrogen ion-acidosis 4)Hyper-/Hypokalemia, other metabolic 5)Hypothemia
Consider most frequent causes
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
Airway Breathing Circulation Drugs Electrical therapy
Management of cardiac arrest
Basic Life Support, BLS Advanced Life Support, ALS
Cardiopulmonary Resuscitation
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
arrhythmias during CPR
Management of brain 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
Algorithm for treating Cardiac arrest
If blood pressure is stable, deliver a precordial thump or give lidocaine (1.5 mg/kg I.V. repeated once) If pulse is present but blood pressure is unstable, begin immediate
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
Key points for treating Cardiac arrest
Check responsiveness Activate emergency response system Call for help
ponents of resuscitation from cardiac arrest are ABCDE
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
* Tracheal intubation * Cricothyrotomy, Cricothyroid puncture, Tracheostomy * Artificial ventilation * Intravenous infusion * Administer drugs: Adrenaline * Massive transfusion:Crystalloid or colloid solutions * Correction of metabolic acidosis * ECG monitoring: Management of important
Mouth-to-mask: bag-valve-mask bag-valve-endotracheal tube
C: CIRCULATION
External Chest Compression Intravenous Access Dysrhythmia Recognition Drug Administration Defibrillaion and Cardioversion
Epinephrine (0.5-1 mg I.V.) every 5 minutes Atropine (1 mg I.V.) every 5 minutes Pacemaker (external or transvenous)
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Electro-Mechanical Dissociation, EMD
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
Clinical Anaesthesiology
Qiu Wei Fan(范秋维）
Associate professor Department of Anaesthesiology
Rui Jin Hospital School of Medicine Shanghai Jiao Tong University
equipment and drugs
A: AIRWAY
Head-tilt and Chin-lift Jaw-trust without Head-tilt------whenever a
cervical spine injury is suspected Heimlich Maneuver
* External cardiac massage * Airway and artificial ventilation * Operator expired-air resuscitation * Bag and mask ventilation
Advanced Life Support, ALS
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
Cardiopulmonary Resuscitation
Contents
* Consider most frequent causes * Signs of cardiac arrest * Management of cardiac arrest * Management of brain damage
Heimlich Maneuver
A: AIRWAY
A. Tracheal intubation B. Cricothyroid puncture
Cricothyrotomy Tracheostomy
B: BREATHING
Mouth –to-mouth: mouth-to-mouth-and-nose supplemental oxygen
Electrical Therapy
* Defibrillaion and Cardioversion
Defibrillation: shock VF/ pulseless VT (200J,200J to 300J, 360J ) up to 3 times
Basic Life Support, BLS
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
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
Cardiac arrest (Patterns of ECG)
* Ventricular fibrillation (VF) * Ventricular tachycardia with no cardiac
output * Asystole * Electromechanical dissociation (EMD)