心肺復(fù)蘇英文班ppt課件

1、Cardiopulmonary cerebral resuscitation ICU Dr. XI NO.4Master the methods of early recovery 1Familiar with the late recovery and recovery treatmentA: Recognition B:AirwayC:BreathingD:Circulation A: ensure airway unobstructedB: oxygenC: assessment of vital signsD: differential diagnosisA: artificial a

2、irway B: Evaluation of the adequacy of ventilationC: establish vein channel, use intravenous drug D: To find the cause Main task: rapid and effective restoring blood perfusion and oxygen supply) ABC: A. keep the airway unobstructed B .effective artificial respiration C .effective artificial cycle Ar

3、tificial respiration and cardiac massage is the 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 bre

4、athing Methods: Keep ear close to the mouth and nose Eyes observe thoracic uplift or not at the same time Listen to breath sounds Time is not more than 5 seconds Make patients lie on your back on the solid flat (ground) Keep respiratory tract unobstructed, removal and keep head position properly 仰頭抬

5、頸法 仰頭舉頦法 抬舉下頜法B:Breathing Mouth to mouth / nose breathing (the most suitable for on-site resuscitation) Simple mask respirator Tracheal 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

6、exhaled gas himself. notice ： Avoiding excessive ventilation and decreasing cardiac output Inspiratory time should be greater than 1 seconds Tidal volume 500 600ml Frequency: adult 10 12 times /min Children 18-20 /min Infants with 30-40 /min Start ventilation frequency: 2 consecutive or 5 times Thor

7、acic raised as a symbol of effective artificial respiration Cardiac compression is a method trough indirect or direct cardiac massage to form a temporary artificial cycle.Cardiac compression diagnosis Mind suddenly lose, call for no response; no artery pulse, blood pressure measurement is less than,

8、 cant hear heart sounds; no spontaneous breathing corectasisFour “no：ConsciousnessRespirationHeart soundsArterial pulseasystoleventricular fibrillation心肌纖維快速不規(guī)那么顫心肌纖維快速不規(guī)那么顫抖抖(不同步快速收縮不同步快速收縮)ECG: QRS波群消逝，代波群消逝，代之以振幅與頻率極不規(guī)那之以振幅與頻率極不規(guī)那么的顫抖波，頻率么的顫抖波，頻率200500次次/分分electromechanical dissociation, EMD 緩慢無(wú)效

9、的心室自主節(jié)律 ，QRS波群寬而畸形，低振幅，2030次/分以下2.Cardiac compression1) Rapid diagnosis of cardiac arrest2) chest compression:Note:lying in the plane R:C: 2:30, children 2:15 P/Rtime 1:1(2) operation method:胸外心臟按壓胸外心臟按壓 artificial circulationMechanism: press sternal lower 1/3 increase intrathoracic pressure (thorac

10、ic pump) or direct compression of the heart (heart), the blood flow to the lungs and other organs Effective indication:Touch pulse, The pupil becomes smallgradually, red lip, autonomous respiration Position: lie on your back on the solid flat (ground) .The head is not higher than the heart The press

11、 position: The finger to touch the costal margin, move toward the midline, into the ribs and sternum.up to 4cm (two fingers) 4open chest compression,OCC Indications: The longer time of cardiac arrest or ECC is not valid for more than 10 minutes. The existence of intrathoracic conditions, such as ble

12、eding, pericardial tamponade, tension pneumothorax. The thoracic or spinal deformity with heart displacement The multiple external defibrillation is invalid forVF or VT Cardiac arrest occurred in operation, especially to open chest surgery Advantage. Provide near normal MBF (myocardial blood flow) a

13、nd CBF (cerebral blood flow,) is beneficial to the recovery of spontaneous circulation and protection of brain Disadvantages: high technology and conditions, there is the possibility of infectionopen chest compression,OCC Methods: open the chest, direct compression of the heart by hand 80 times freq

14、uency Characteristic. 1 myocardial blood flow and brain blood flow increased 2 animal experiments that can improve survival rate 3 be in hospital, arrest 25 is invalid Severe chest trauma, thoracic deformity,Pericardial tamponade should open chest compressions二二advanced life support,ALS1 the managem

15、ent of respiratory tractWith spontaneous breathing: mouth airway (nose)No autonomous respiration: tracheal intubation or incision of trachea2 monitoringECG, BP (the best record), blood gas analysis (PaO2 60mmHg ;PaCO2 36 40mmHg), urine volume, specific gravity, CVP.3 drug treatmentObjective: to stim

16、ulate the recovery of heart beat and enhance myocardial contractility, prevention and treatment of arrhythmia,Adjust the acidbase imbalance, fluid and electrolyte replacement.Medication Objective: Excitation of cardiac autonomic rhythms and enhance myocardial contractility, prevention and treatment

17、of arrhythmia, adjust the acidbase imbalance, fluid and electrolyte replacement, when recovery the medication must be quickly and accurately. Injection way: The intravenous injection (preferred); intratracheal injection (injection be diluted to10ml); The intracardiac injection (complicationsCommonly

18、 used drugs1 Catecholamine and adrenergicEPepinephrine: first choicedose ：0.51mg once ，或0.01 0.02mg/kg repeated every 5 minutesNE： A significant increase in MBF.CBF The incidence of arrhythmia is higher after defibrillation Isopropyl epinephrine and dobutamine Mainly excite receptor, MBF does not in

19、crease after the selection 2) Sodium bicarbonate According to the results of blood gas analysis , correct acute acidosis When the base excess (SEB) above -10mmol/L, application of sodium bicarbonateSodium bicarbonate(mmol/L)SBE weight kg46. Fluid therapy In the process of CPR low blood volume is not

20、 conducive to the recovery and autonomous rhythm stability, reduces the sensitivity of vasoactive drugs.Expansion of crystal fluid, the appropriate colloid, generally without blood transfusion.The CVP is maintained at 10 15 mmHg. 4. Ventricular fibrillation and defibrillation Defibrillation time: VF

21、/VT sudden, defibrillation within 30 seconds of Other should be CPR at least 2 minutes (give epinephrine pre-) Method： External defibrillation adult: 360 J; Children with 2-4J/kg Thoracic defibrillation adult 20 80J;5 50J children Indications: VF/VT Electrical cardioversion; The medication invalid s

22、upraventricular (50J) Ventricular heartbeat tachycardia (50J) Atrial flutter (25J)External defibrillation左側(cè)第五肋間腋前線左側(cè)第五肋間腋前線胸骨右緣第二肋間胸骨右緣第二肋間5. heart pacemaker Restoration of spontaneous rhythm, but must rely onIsoproterenol to maintain normal heart rate三三post-resuscitation treatment,PRT prolonged life support,PLS Objective: prevention and treatment of multiple organ failure and hypoxic brain injury Maintain good respiratory function A detailed examination of the airway, lung and catheter