新版心肺復(fù)蘇術(shù)cpr

2011CPR奇美醫(yī)院神經(jīng)外科主治醫(yī)師王哲川Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.92歲翁無心跳呼吸CPR救回成效=復(fù)生Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.學(xué)習(xí)?模仿?Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.WHY??

4min8minEvaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.

患者接受心肺復(fù)甦術(shù)及高級心臟救命術(shù)的時間與救活率之關(guān)係心肺復(fù)甦術(shù)時間(分)高級心臟救命術(shù)時間(分)救活率(%)0-40-48-128-12>120-8>168-16>16>124310600FormEisenbergetal.Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.儘早進行心肺復(fù)甦術(shù)(CPR)的重要性4分鐘後會造成腦內(nèi)損傷10分鐘後會造成腦死Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.4min

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.AEDACLS8min

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.誰會在4分鐘內(nèi)進行心肺復(fù)甦術(shù)?一般民眾(家人、朋友、或路人)第一時間進行心肺復(fù)甦術(shù)救護技術(shù)員得知有患者後趕往現(xiàn)場進行心肺復(fù)甦術(shù)醫(yī)護人員在醫(yī)院等待患者Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.4分鐘內(nèi)

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.您到醫(yī)院急診室,醫(yī)生處理的步驟是?ABCorCABorBCA

步驟??Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.根據(jù)~2010年美國心臟協(xié)會(AHA)心肺復(fù)甦(CPR)緊急心臟照護(ECC)準則1Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.CPR急救流程的重大改變叫叫A-B-C叫叫

C-A-B2Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.非專業(yè)施救者心肺復(fù)甦術(shù)流程◆叫-叫病人，檢查病人反應(yīng)?！艚?確定病人沒有反應(yīng)，立即求救?！鬋-沒有反應(yīng)、沒有呼吸或僅有喘息，應(yīng)立即施行胸部按壓30下?！鬉-壓額抬下巴，打開呼吸道?！鬊-人工呼吸，吹兩口氣，每一口氣一秒。3Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.叫叫C-A-BC4Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.胸部按壓與人工呼吸比率不論單人或雙人CPR皆為30:2CPR第五個周期吹氣後(約二分鐘後)快速檢查病人有無反應(yīng)及呼吸狀況

5Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.非專業(yè)施救者心肺復(fù)甦術(shù)提醒★當病人無反應(yīng)且沒有呼吸或沒有正常呼吸(亦即患者僅有喘息)時的CPR應(yīng)立即開始實施。檢查呼吸(查看、聽和感覺是否有呼吸)已經(jīng)從流程中移除。★6Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.高品質(zhì)CPR★胸部按壓至少100次/分鐘的按壓速率(原本為「大約」100次/分鐘)。★胸部按壓深度至少應(yīng)為成人5公分兒童5公分嬰兒4公分7Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.按摩位置??

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.按壓位置與舊版相同胸部兩乳頭連線中央處，一隻手掌根置於此，另一隻手指與此交叉相扣翹起Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.治療壓胸用力壓、快快壓、胸回彈、莫中斷速率:100-120次/分Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.別壓錯??

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.手臂伸直用身體的重量垂直向下壓至少5公分深度??

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.胸部按壓100至120次/分Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.CPR注意事項胸部按壓每次按壓後確保完全的胸部回彈。儘量避免中斷胸部按壓的施行。避免過度通氣。8Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.單人施救者的建議步驟有所變動在進行急救前開始胸部按壓(C-A-B而非A-B-C)。單人施救應(yīng)以30次按壓開始CPR，而非先進行2次通氣，以減少第一次按壓前的延遲。按壓速率應(yīng)至少為每分鐘100次(而非「大約」100次/分鐘)

9Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.未經(jīng)CPR訓(xùn)練的施救者建議徒手CPR(於胸部中央「用力按壓-快速按壓」)或依照緊急醫(yī)療服務(wù)派遣員的指示進行。未經(jīng)訓(xùn)練的施救者或不願做口對口人工呼吸的經(jīng)訓(xùn)練的施救者，可只做胸部按壓?！镞@些變更的目的，在簡化非專業(yè)施救者訓(xùn)練，並持續(xù)強調(diào)為突發(fā)性心臟停止病人提供及早胸部按壓的必要性。10Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.打開呼吸道壓額抬下巴Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.打開呼吸道(Airway)方法壓額抬下巴法headtilt-chinlift

*下顎推前法jaw-trustEvaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.人工呼吸??Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.1.吹兩口2.每口氣1秒鐘3.可見胸部起伏Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.美國心臟醫(yī)學(xué)會已廢除口對口、口對鼻吹氣一般民眾只要徒手CPR即可能救人一命。2008.3.21Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.意外的來臨突然間,小強的胸口嚴重胸痛起來…天有不測風(fēng)雲(yún)人有旦夕禍福Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.CPR操作口訣叫 評估意識叫119求救壓C 壓胸維持循環(huán)開A 打開呼吸道吹B 吹氣維持呼吸電D自動電擊器電擊叫叫CABD

Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.叫—檢查意識檢查意識：輕拍傷患肩膀並問「你怎麼了？」以確定有無意識。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.叫—求救若無反應(yīng)則高聲求救，請人或自己撥打119〈手機撥119、112〉。若傷患為8歲以下孩童，應(yīng)先進行5個循環(huán)〈30：2，約2分鐘〉的CPR再求救。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.C(Circulation)--胸外按摩胸部按壓：按壓位置為兩乳頭連線中央胸骨處，速率為100次/分，用力壓、快快壓，連續(xù)30次後再接著2次人工呼吸。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.正確的壓胸姿勢反覆進行30：2的循環(huán)：重複胸部按壓與人工呼吸30：2的循環(huán)，直到醫(yī)療救護人員抵達現(xiàn)場或傷患恢復(fù)呼吸、心跳為止。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.胸部按壓要訣1.跪?qū)?，腿同肩寬?.雙臂伸直，雙手掌根重疊，十指交叉互扣翹起。3.每次下壓深度約4~5公分。4.放鬆時不移動手掌位置。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.打開呼吸道並清除異物固體的異物用食指清除，若有假牙也一並移除(右圖)。液體的異物(如嘔吐物)以布或衣服包住食指和中指後再清除異物手指清除法FingersweepEvaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.A(Airway)—打開呼吸道暢通呼吸道：壓額提下巴，使頭部盡量後仰、頸部伸直，以保持呼吸道通暢。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.壓額提下巴

(Headtilt-Chinlift)Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.B(Breathing)--評估呼吸檢查呼吸5~10秒：臉頰靠近傷患口鼻，看胸部有無起伏，聽有無呼吸聲，感覺有無氣體呼出。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.吹氣人工呼吸：若傷患無呼吸，維持其頭部後仰，以拇、食指捏住傷患鼻孔，將口罩住其嘴吹2口氣，每口1秒鐘。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.D(Defibrillation)—去顫應(yīng)由受過專業(yè)訓(xùn)練之醫(yī)療人員操作。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.全民CPR壓胸最重要叫醒病患叫求救兩乳間壓胸用力壓快快壓每分1百下CPR之歌Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.

AHAECC成人生存之鏈確認心臟停止並立即啟動緊急應(yīng)變系統(tǒng)儘早CPR，並強調(diào)先作胸部按壓儘快的施行去顫術(shù)儘早施行高級救命術(shù)心臟停止急救後的整合照護11Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.異物哽塞以拇指與食指呈V字形放置在頸部，另一手則握V字手的手腕或手背。國際通用異物哽塞的手勢Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.氣道部份阻塞患者患者意識清醒、可以呼吸、咳嗽、或說話。此時應(yīng)立急打119通報可鼓勵患者儘量咳嗽，密切觀察是否有演變成完全阻塞之情形。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.氣道嚴重阻塞患者患者漸漸失去意識、不可以呼吸、咳嗽、或說話。此時應(yīng)立急實施哈姆立克急救法(Heimlichmaneuver)以及使用叫-叫-C-A-B-處理方式。Evaluationonly.CreatedwithAspose.Slidesfor.NET3.5ClientProfile.Copyright2004-2011AsposePtyLtd.哈姆立克急救法

(Heimlichmaneuver)哈姆立克急救法是以外力擠壓患者上腹部，使橫隔膜迅速上升，以致肺部及氣管內(nèi)的壓力增加，最後導(dǎo)致氣管內(nèi)空氣及異物向外擠出。Evaluationonly.Createdwi