上交大外科学课件09心肺脑复苏（英文版）

ClinicalAnaesthesiology

（CardiopulmonaryCerebralResuscitation）内容(教学大纲)CPCR的基本概念心跳骤停的原因心跳骤停的诊断CPCR的三个阶段和处理原则ContentsConsidermostfrequentcausesSignsofcardiacarrestManagementofcardiacarrestManagementofbraindamageCardiopulmonaryCerebralResuscitation

心肺脑复苏复苏时要考虑到心肺功能更要考虑到脑只有脑功能的最终恢复才能称为完全复苏故把逆转临床死亡的全过程称为心肺脑复苏（cardiopulmonarycerebralresuscitation，CPCR）Considermostfrequentcauses1)Hypovolemia2)Hypoxia3)Hydrogenion-acidosis4)Hyper-/Hypokalemia,othermetabolic5)HypothemiaConsidermostfrequentcauses6)‘Tables’(DrugOD,accidents)7)Tamponnade,cardiac8)Tensionpneumothorax9)Thrombosis,coronary10)Thrombosis,pulmonary(embolism)SignsofcardiacarrestSuddendeepunconsciousnessAbsentcarotidandfemoralpulseDilatedpupilsAshencyanosisApnoeaorgaspingManagementofCardiacArrestBasicLifeSupport,BLSAdvancedLifeSupport,ALS

ProlongedLifeSupport，PLSCardiopulmonaryResuscitation

TheCABsofcardiopulmonaryresuscitationCirculation，Airway,BreathingC:CIRCULATIONExternalChestCompressionIntravenousAccessDysrhythmiaRecognitionDrugAdministrationDefibrillaionandCardioversion

ExternalcardiacmassageLieonahardsurface(patient)UseweightoftheupperbodyArmstraighttoreducefatigueHeelsofhandscrossedFingersclearofchestApplypressureoverthelowhalfofthesternumThesternumisdepressed4-5cminadult,2-4cminchildren,andthenallowtoreturntoitsnormalpositionA:AIRWAYHead-tiltandChin-liftJaw-trustwithoutHead-tilt------wheneveracervicalspineinjuryissuspectedHeimlichManeuverA:AIRWAY

A.TrachealintubationB.Cricothyroidpuncture

Cricothyrotomy

TracheostomyB:BREATHING

Mouth–to-mouth:mouth-to-mouth-and-nosesupplementaloxygenMouth-to-mask:bag-valve-maskbag-valve-endotrachealtubeCardiacArrest(PatternsofECG)Ventricularfibrillation(VF)VentriculartachycardiawithnocardiacoutputAsystoleElectromechanicaldissociation(EMD)DisorganizedventricularelectricalactivityRatetoorapidanddisorganizedtocountRhythmirregularNodiscerniblePwavesofQRScomplexesIrregularundulationsinelectrocardiographbaselineAlwaysresultsonnoeffectivecardiacoutputDefibrillationassoonaspossibleandrepeatedanecessaryEpinephrine(0.5-1mgI.V.)every5minutesLidocaine(1mg/kgI.V.)Rate100-220/minRhythmregularofirregularPwavesusuallynotpresentQRScomplexesappearlikeprematureventricularcontractionsUsuallyassociatedwithdramaticdeclineinbloodpressureandcardiacoutputIfbloodpressureisstable,deliveraprecordialthumporgivelidocaine(1.5mg/kgI.V.repeatedonce)Ifpulseispresentbutbloodpressureisunstable,beginimmediatecardioversionIfpulseless,treatasventricularfibrillation

TotalabsenceofventricularactivityAbsolutelyflatbaseline(exceptpossiblePwaves)ConsiderpossibilityoffineventricularfibrillationandneedfordefibrillationEpinephrine(0.5-1mgI.V.)every5minutesAtropine(1mgI.V.)every5minutesPacemaker(externalortransvenous)VENTRICULARASYSTOLE

Electro-MechanicalDissociation,EMDEpinephrine(0.5-1mgI.V.)every5minutesAtropine(1mgI.V.)every5minutesPacemaker(externalortransvenous)

DefibrillaionandCardioversion

AlgorithmforTreatingCardiacArrest

（BasicLifeSupport）PrimaryCABDSurvery

CCirculation:givechestcompressionsAAirway:OpentheairwayBBreathing:providepositive-pressureventilationsDDefibrillation:assessforandshockVF/pulselessVT,upto3times(200J,200Jto300J,360Jorequivalentbiphasic)ifnecessaryAlgorithmforTreatingCardiacArrest

（AdvancedLifeSupport）MoreadvancedassessmentsandtreatmentsAAirway:placeairwaydeviceassoonaspossibleBBreathing:confirmairwaydeviceplacementbyexamplusconfirmationdevice;secureairwaydevice;purpose-madetubeholderspreferred;confirm

effectiveoxygenationandventilationCCirculation:establishIVaccess;identifyrhythm;administerdrugsappropriateforrhythmandconditionDDifferentialDiagnosis:searchforandtreatidentifiedreversiblecauses

ManagementofBrainDamage

（ProlongedLifeSupport）GeneralmeasuresPreventionofhypoxaemiaandhypercapniaDepressionofcoughandswallowingSpecialisedtreatmentHyperventilationOsmotherapySteroidsBarbituratesandCNSdepressantsCalciumantagoni