心肺脑复苏.ppt

Cardiopulmonarycerebralresuscitation心肺脑复苏心肺脑复苏Rescuer?nEveryone can be a lifesaving rescuer for a cardiac arrestnvictim.CPR skills and their application depend on thenrescuers training,experience,and confidence.Introduction1.Thedevelopmentofresuscitation2.Basiclifesupport,BLS(2010AHAGuideline)3.AdvancedLifeSupport,ALS4.Post-resuscitationtreatment,PRT5.GeneralManagementPrinciplesAreyouconfidenttodosomething?n1.ToperformCPRforavictimn2.Toguideothers1.ThedevelopmentofresuscitationnTheprimaryconceptofresuscitationistorestoreabeatingheartforafunctioningcirculationandrestoreventilationCPRCerebralhypoxia Thebrainismoresensitivetohypoxiathananyotherorgan.Thecerebralcortexisdamagedpermanentlybyischaemiaofmorethan4-5minduration.Therefore,whencirculatoryarresthasoccurred,itisessentialtostartCPRasrapidlyaspossible.CPR-CPCP-Allmanagementtotreatorpreventcardiacarrestorotherdisorders.Preventionisthebestresuscitation预防重于治疗，防患于未然预防重于治疗，防患于未然 -危重病人的管理原危重病人的管理原则则n早期识别并恰当处理可以预防远期恶化早期识别并恰当处理可以预防远期恶化n早期发现危重病情可以用一些简单的方法解决早期发现危重病情可以用一些简单的方法解决n早期识别就是给临床医生时间，给病人生命早期识别就是给临床医生时间，给病人生命n早期识别能给病人最早最佳的治疗早期识别能给病人最早最佳的治疗n健康科普惠及民众解放医生健康科普惠及民众解放医生n3P Medicine(Predictionpreventionpersonalization)3P Medicine(Predictionpreventionpersonalization)The 2010 AHA Guidelines for CPR nmark the 50th anniversary of modern CPR.nOver the past 50 years,these modern-era basic life support fundamentals of early recognition and activation,early CPR,and early defibrillation have saved hundreds of thousands of lives around the world.What is EBM?nEvidence-basedmedicineistheintegrationofbestresearchevidencewithclinicalexpertiseandpatientvalues.Patient Concerns Clinical ExpertiseBest research evidence EBMWhyhavesomanycliniciansandeducatorsembracedEvidence-BasedMedicine?EBMisanewmodelforcontinuallylearningandpracticingMedicine.EBMis:clinicaldecision-makingprocess.EBMisalsoabouttranslationthetranslationofresearchfindingsintoclinicalpractice.ClassificationnTwotypesofevidence-basedpracticehavebeenproposed:nEvidence-basedguidelinesnEvidence-basedindividualdecisionmaking2.Basiclifesupport,BLS(2010AHAGuideline)TheGuidelinesforCPRin2000nAdult Basic Life SupportnThecompression-ventilationratiofor1-and2rescuerCPRis15compressionsto2ventilations.Theratiois5:1before2000for1rescuer.TheGuidelinesforCPRin2005nAdult Basic Life SupportnAcompression-ventilationratioof30:2isrecommended.Still:A-B-CTheGuidelinesforCPRin2010nAdultBasicLifeSupportnUseacompressiontoventilationratioof30chestcompressionsto2ventilationsnBeginningCPRwith30compressionsratherthan2ventilationsleadstoashorterdelaytofirstcompression.How to perform CPR nCheck safety very important nWhenapproachingapatientwhoappearstohavesufferedacardiacarresttherescuershouldcheckthattherearenohazardstohimselfbeforeproceedingtotreatthepatient.nPatientsmaysufferacardiacarrestduetoelectricshocksortoxicsubstances.ChecksafetyCheckingresponsiveness?Checking the pulseCarotid颈颈AFemoral股股ANomorethan10sCheck for breathing LookListenFeelshout for helpTeam worknItisessentialtotelephoneforhelpassoonastheassessmenthasbeencompleted.Thisearlycallforhelpdecreasesthetimetothefirstdefibrillation（除颤）（除颤）,shortensthetimetothedeliveryofadvancedlifesupport,decreasesthelengthoftimeofperformanceofbasiclifesupportandimprovessurvival.AdultBasicLifeSupportExternalChestCompressions胸外心脏按压胸外心脏按压GetthepatientonafirmsurfaceatfirstnChestcompressionsareperformedonthe lower half of the sternum（胸骨）（胸骨）placetheheelofthesecondhandonthesternum.Locationthe lower half of the sternum（胸骨）（胸骨）How to perform chest compresskeep your elbows straightpressure is directed through the sternum and not through the ribs above the patientMechanismsofchestcompressionsthoracicpumpmechanismcardiacpumpmechanismMechanismsofchestcompressionsnCompressions create blood flow by increasing intrathoracic pressure and directly compressing the heart.This generates blood flow and oxygen delivery to the myocardium and brain.high-quality CPRnproviding chest compressions of adequate rate(at least 100/minute 120/minute)nproviding chest compressions of adequate depthnadults:a compression depth of at least 2 inches(5 cm)high-quality CPRn infants and children:a depth of least one third thenanterior-posterior(AP)diameter of the chest or aboutn(4 cm)in infants and about (5 cm)in childrenn allowing complete chest recoil after each compressionn minimizing interruptions(5s)in compressionsn avoiding excessive ventilationnIf multiple rescuers are available,they should rotate the task of compressions every 2 minutes.high-quality CPRnDefibrillation Complications:nfracturedribs（肋骨骨折）（肋骨骨折）nlungcontusion（挫伤）（挫伤）npneumothorax气胸气胸visceraldisruption内脏破裂内脏破裂Why?Open-ChestCPRn Useof this technique generates forward blood flow and coronarynperfusion pressure that typically exceed those generated bynclosed chest compressions.AirwayandVentilationsnOpening the airway followed by rescue breaths can improve oxygenation and ventilation.How to keep the airway open tiltingtheheadback（头后仰）（头后仰）andliftingthejawforwards.nThisdisplacesth