6.心肺复苏指南介绍What is CAB

AHAHighlightsforCPRandACLS美国心脏协会心肺复苏和高级心血管生命支持的重点2010EvidenceBased背景356expertsfrom29countries来自29个国家的专家356Considerationsfor:考虑到Effectiveness效率Easeofteachingandapplication易于教学和应用Localsystemsfactors本地因素Extensivereviewofresuscitationliteratureandmanydebatesanddiscussions复苏回顾及许多讨论Emphasis重点GoodqualityCPR高质量CPRImprovingtheconsistencyofcareinprehospital改善院前护理的一致性Developingstandardsforpost-cardiacarrestmanagement制定心脏骤停后的管理标准CPR心肺复苏Compressions“atleast”100perminute.每分钟按压“至少”100下。Compressiondepth按压深度Atleast2inchesinadults成人至少有2英寸Atleast1/3oftheanteriortoposteriordepthinchildrenandinfants儿童和婴儿至少1/3的深度Approximately2inchesinchildrenand1.5inchesininfants儿童大约2英寸，婴儿1.5英寸Ventilations通气Continuetostress重点NOHYPERVENTILATION不要过度换气CABChestcompressionimmediatelywillbenefitmostviablepatients.立即胸外按压对患者有益Complete30compressionsBEFOREassessingairwayandbreathing评估气道，呼吸前完成30次按压MayincreasethenumberofpatientsreceivingbystanderCPR受路人进行心肺复苏的患者人数可能增加DecisionsforHCPHCPDidthepatientmostlikelysufferaprimarycardiacevent病人是否发生了原发性心脏病Didthepatienthavearespiratoryeventpriortocollapsingincardiacarrest病人是否有呼吸问题TheFifthLinktotheAdultChainofSurvival成人5级生存链1.Activateemergencyresponsesystem启动应急响应系统2.EarlyCPRwithemphasisoncompressions早期心肺复苏，按压3.Rapiddefibrillation快速除颤4.EffectiveALS有效的ALS5.Integratedpost-cardiacarrestcare心脏骤停后完整的护理LayRescuer救助者的任务Unresponsive没有反应Nobreathingorgaspingbreathing无呼吸或呼吸喘气Activateemergencyresponsesystem启动应急响应系统Getthedefibrillator除颤器StartCPR开始CPRLonerescuer单个救助者Teamapproach一组救助员Checkrhythm,shockifindicatedevery2minutes.检查的心脏节律，每2分钟电击。CABNomore“Look,Listen,andFeel”不再“看，听和感觉”Briefcheckofbreathing简要检查呼吸Nobreathing无呼吸Gaspingonly只有喘气Compressions按压Atleast100perminute每分钟至少100次Completerecoil完整的按压Minimizeinterruptions不要中断HCPGettwopiecesofinformationatonce获得两条信息Unresponsiveness反应迟钝Breathing?有呼吸吗？ActivateemergencyresponseandretrieveAED启动应急响应和准备除颤仪Pulsechecknolongerthan10seconds脉搏检查不超过10秒Compressions按压Ideallyprovidecompressionsandventilations理想的情况下提供按压和通气HCPTeamapproach一组救助人员Activatesemergencyresponsesystem启动应急响应系统Chestcompressions胸部按压Ventilations通气AED除颤仪AEDs除颤AHAcontinuestoemphasizetheimportance美国心脏协会强调其重要性EstablishingAEDprogramsinpubliclocations在公关场所建立除颤点Providetraining提供培训LinkingwithEMS同急救医疗服务系统联系QARecommendationforAEDsinhospital提倡院内除颤AEDsforPediatrics儿童除颤器Lessthan88岁以下Usepediatricdose-attenuatorsystemifavailable如果可以，使用儿童剂量MayuseadultAED可能用成人除颤仪Lessthan1year1岁以下Manualdefibrillatorisrecommended推荐手动除颤器AEDwithpediatricdose-attenuatorifavailable如果可以，使用儿童剂量MayuseadultAED可能用成人除颤仪CPRorSHOCKCPR还是除颤Evidenceisunclear证据不明Inhospitalsuddencardiacarrest院内心脏骤停CPRuntildefibrillatorisprepared做CPR直至除颤仪到位Outofhospitalwitnessed院外心脏骤停CPRuntildefibrillatorisprepared做CPR直至除颤仪到位Outofhospitalunwitnessed院外心脏骤停，无人救援CPR1½to3minutesofCPRmayprecededefibrillationCPR1.5-3分钟AdultDefibrillation成人除颤Nochangeswithbiphasicormonophasicdefibrillators!单相或双相除颤器没有区别Biphasicpreferred双相除颤器更好Noevidencethatincreasingjoulesforsubsequentshocksissuccessful没有证据表明，增加焦耳数就一定会成功Subsequentshocksshouldstaythesameorincrease后续震颤应保持不变或增加PadPlacement安置点Threechoices三种选择Anteriorlateral前外侧Anteriorposterior前后AnteriorRinfrascapularandLinfrascapular前RLTrytoavoidimplanteddefibrillatorsandpacemakers尽量不要使用植入式除颤器和起搏器PediatricDefibrillation儿童除颤2joules/kgforinitialdefibrillation初始除颤2焦耳/公斤4joules/kgforsubsequentdefibrillations随后4焦耳/公斤Mayuseahigherjoulesettingupto10joules/kgnottoexceedtheadultdose可以使用更高的焦耳至10焦耳/公斤但不超过成人剂量SynchronousCardioversion同步复律Atrialfibrillation心房纤维性颤动Monophasic200J单相200JBiphasic120-200J双相120-200JAtrialFlutterandSVT心房扑动和SVTMonophasic50-100J单相50-100JBiphasic50-100J双相50-100JIncreasejoulesettinginastepwisefashionifinitialshockisunsuccessful如果最初不成功，则逐步增加焦耳量SynchronousCardioversion同步复律MonomorphicV-tachwithpulse单形性V-转速与脉冲MonophasicorBiphasic100J单相或双相100焦耳Increasejoulesettingsinstepwisefashionifinitialshockisunsuccessful如果最初不成功，则逐步增加焦耳量Donotsynchronouscardiovert不同步复律PolymorphicVTVF多形性VTPulselessVT无脉VTVFPacing安置点Nochanges!不变RememberthePrecordialThump??还记得心前区重击么？MaybeconsideredinwitnessedunstableVTorpulselessVTwhendefibrillatorisnotreadilyavailable.除颤器不能获得时，对不稳定的VT或无脉VT使用Shouldnotdelaycardioversionordefibrillation.不能延迟复律或除颤CPRDevicesCPR设备NoevidencethatmechanicalCPRdevicesaresuperiortomanualCPR.没有证据表明，机械CPR设备优于手动心肺复苏。TheyshouldnevercauseinterruptionofdelayofCPR均不能中断CPRACLS高级心血管生命支持Capnographyrecommended建议分析二氧化碳Toconfirmandmonitorintubation确认和监测插管TomonitorCPRquality监测心肺复苏的质量TodetectROSC监测自主循环复苏Todetectrearrest监测再次骤停ANewCircularAlgorithm一种新的方法Emphasizes强调Highquality,uninterruptedCPR高质量，不中断的CPRAvoidinghyperventilation防止过度通气ACLSactionsorganizedaroundperiodsofCPR高级生命支持在CPR时就开始De-emphasizes不强调Devices,DrugsandotherDistractors设备，药物及其他因素Atropine阿托品NOlongerrecommendedforPEAorAsystole不再推荐为PEA或心跳停止使用Maybeusedforsymptomaticbradycardia可用于有症状的心动过缓ChronotropicInfusions输液Consideredequallyeffectiveaspacingforsymptomaticbradycardiawhenatropineisineffective.阿托品无效时使用，效果与起搏相当Adenosine腺苷Maybeusedforstable,undi