心肺骤停与心肺复苏：英文教案及讲稿

PAGEPAGE2临床学院教案及讲稿课程名称教师题目章节

Emergency nursing职称SCAandCPCR

授课专业授课方式 学时 2出版社

Emergencynursing Peoplehealthpublishingcompany

ZhouxiuhuathefirsteditionOct.20031:Recall教 ThedefinitionofSuddenCardiacArrest.学 TheclinicalsymptomsofSuddenCardiac目 ThebasicstepsofCPRforadults.的 2:Application:要 Showthecompletesequencefor1-rescuer求教学 HowtoperformallthestepsofCPRin难点教学 HowtoperformallthestepsofCPRin重点外语CET-4要求教学方法Multimedia手段参考《Guideline2005ofCPRand资料教研室意见教学组长： 教研室主任年月日SCAandCPCRGoodafternooneverybody,todaywearegoingtodiscusstheSCAandCPCR,atfirstletmeintroducemyself.;;;Atbeginningoftheclass,wewillwatchashortvideo,pleasewatchitcarefully,therearetwoquestions,Whathappenedandwhataretheydoing?SCA(一)DEFINITIONButhowdowedefineSCASuddenCardiacArrest,wealsocallSCA,referstosuddenandunexpectedlossofheartfunction,ceasethebloodflowformthehearttotherestofthebody,thebrainandvitalorganslackofbloodandoxygen,Ifthevictimgettheproprietymedicalserviceimmediately,survivalispossiblenot,deathoccurs.becausewhenSCAhappens,lossofheartfunction,ceasethebloodflowfromthehearttherestofthebody,it causesthebrainandthevitalorganslackofthebloodandoxygen,Sometimesitoccurssuddenly,comeswithoutwarning,，.ithappensunexpected.sometimesitmayhappenedonsomebodywhoisthoughtingoodhealthsituation.（二）cuasesManydiseasesmayleadtoSCA,likeasheartdisease,ThepersonwhohasheartdiseasehasthehigherchancesofSCA.Seethepicture,ifthediseasecancauseDecreasedcontractility,Arrhythmia,LowercardiacoutputInsufficientCoronaryperfusion,thenitmayleadtoSCA.ThepersonwhohasheartdiseasehasthehigherchancesofSCA.Studiesreport,80%SCAwerecausedbycoronaryheartdisease,Andthetypicalsingsonelectrocardiogram,wemayseetheventricularfibrillation,andventricularsystole,themostcommonSCAarecausedbyventricularfibrillation.Approximately70%..（三）CLINICALSIGNSSCAcomessuddenlyandunexpected,buthowcanwerecognizeit.

PlayvideoQuestionTherearesixsignsinourtextbook1.suddenunconsciousness.You palpate the shoulder ,if no response ,you may say the victim unconsciousness.2.Absenceofmajorarterypulse(carotidorfemoral)3.Nobreathing.4.Pupillarydilationandnopupillaryreflextolight5.HeartsoundisnotobtainablePaleandnobloodintheface

Question（四）DIAGONOSISDoweneedtocollectalltheevidencestoestablishthediagonosis?Hereifyouseethevictiminunconsciousness,youcantpalpatethepulseoncarotidorfemoral,youcanestablishthediagnosisSCA.WehavediscussedthatwhenthevictiminSCA,lossofheartfunction,ceaseofblood,thebrainandthevitalorganslackofbloodandoxygen,WhatmedicalserviceisproprietyandcansavethelifeCPCRHerearetwoconcepts,CPRandCPCR.CPRCPCRButwhatthedifferencesbetweenthem,theprotectionofbrain,CPRisresultsfrommanyyearsclinicalexperiencesandmanymedicalprofessionalscontributedtoit,PeterJSafar,whocreatedmouthtomouthbreathingin1958,heproposedtheA-BC(airway,breathing,circulation)sequenceofresuscitation,includingthetechniqueof'mouth-to-mouth'rescuebreathing."SoheisknownasthefatherofCPR.CPRsavemanylife,butthepersonswhowassurvivalfromSCA,Approximately10-40%ofthemsufferedobviousnon-reverseablebraindamageMoreandmoremedicalprofessionalspaymoreattentiontotheprotectionbrainfunction.ThebecomesCPCR,sothemostimportantdifferencebetweenCPRandCPCR,istheprotectionofbrain.ThemodernResuscitationCPRconsistofthreemainelements:MouthtomouthbreathingChestcompressionDefibrillationThepresentstandardofCPRis《guidelinesCPRandECC2005》.Anditpubulishedonthejournal《Circulation》Nov.2005wecallitguidelines2005.CompletelyCPCRincludesthreepartsBasiclifesupport BLSBdvancedcardiaclifesupport ACLSProlongedlifesupport PLSBLSThemainaimofBLSistodeliveroxygentomusclesoftheheartandalloftheimportantorgansBLSConsistsof4partsairwaybreathingcirculationdefibrillationButtoday,wejustdiscusstheABCsequence,thestepDplaceonthenextclass,Nowweknow,SCAisthelifeanddeathdisease,let’swatchthestatisticshereTherelationshipofthestartingCPRandtheratioofsurvival.IfthevictimgettheCPRWithin4min 50%Within4~6min 10%Morethan6min 4%Morethan10min 0%Thispictureshowsthechainofsurvival.itconsistsof4links,Earlyacces,earlyCPR,earlydefibrillationandearlyadvancecare.Earlyaccessreferstorecognizeandactivatetheemergencymedicalsystemearly,andearlyCPR,wejusttalkedabouttherelationshipofstartingCPRandratioofsurvival,andweknowearlyCPRincreasetheratioofsurvival,earlydefibrillationalsoincreasetheratioofsurvival,thereasonis(question),okmostcommonSCAwerecausedbyventricularfibrillation.andearlyadvancedcarereferstobringequipmenttosupportventilationandestablishtheintravenousaccessandstabilizedthevictimtotransfer.thechainofsurvivalsummarizethepresentunderstandingofthebestapproachtothetreatmentthepersoninSCA.1：positionWhenyoumeetapersoninSCA,atfirst,puthimorheronbackonafirmplantsurface.Putthehandbesidethebodynaturally.\2: assessShoutforthevictim,andpalpatethevictim’sshoulder.ifnoresponse,call120andactivetheEMS.3:openingairwayThentakethestepsofABCsequenceTheAoftheABCsequenceisairwaythenopeningtheairway,Thecommoncauseoftheairwayobstructionintheunresponsivevictimisthetongueblocktheupperairway.Atthesametimecleartheforeignobjectiveintheairway.TherearetwoposturestoopentheairwayHeadtilt-chinliftjawthrustThemostcommonpostureweuseisheadtilt-chinlift,Putonehandonthevictim‘sforeheadandpushwithyoupalmtotilttheback.placethefingersoftheotherhandunderthebonypartofthelowerjawnearchin.Liftthejawtobringthechinforward.Pleasenote.youjustneedtoputthefingersonthebonypartofthelowerjaw,don’tputonthesofttissue,itwouldobstructtheairway.Butwhenyoususpectthevictimhascervicalspineinjure,youmustopenairwaywiththemanuvaurjawthrust,Afteropeningtheairway,taketherescuerbreathing4：BbreathingAtfirst,assessthebreathingAssessthebreathingbylooking,listening,feeling.Putyoufaceclosetothevictim’smouthandnoseLOOKforthechesttoriseandfallLISTENforairescapingduringexhalationFEELfortheflowofairagainstyourThetimeyoumusttakeatleast5secondsbutnomorethan10seconds.Ifyoucantlookforthechesttoriseandfall,youcantlistenforairescapingduringexhalation,andyoucantfeelfortheflowofairagainstyourcheekThenthevictimhasnobreathing.Thehealthcareprovidermustdeliveryrescuerbreathingtothevictim.Mouthtomouthbreathingisaquick,effectivewaytoprovideoxygentothevictim,therescuer’sexhaledaircontainsapproximately17%and4%carbondioxide,Thisisenoughoxygentosupplythevictim’sneeds.Holdtheairwayopenwithaheadtilt-chinlift.Pinchthenoseclosedwithyourthumbandindexfinger(usingtheontheforehead.)Takearegular(notdeep)breathandsealyourlipsaroundthemouth,creatinganairtightseal.Give1breath(blowfor1second).Watchforthechesttoriseasyouthebreath.Ifthechestdoesnotrise,repeattheheadtilt-chinlift.Giveasecondbreath(blowfor1second).WatchforthechesttoPleasenote:Take1secondtodelivereachbreathDeliverenoughairtomakethevictim’schestrise.Ifyougivebreathstooquicklyorwithtoomuchforce,airislikelytoenterthestomachratherthanthelungs.ThiscancausegastricinflationTheriskofinfectionfromCPRisverylowbutifyoumeetthevictiminthe workplace when there is any exposure to blood or fluids.Standardprecautionsincludeusingbarrierdevicesuchasamaskorabagmaskdevicewhengivingbreaths.Some masks have an oxygen inlet that allows you to supplementaryoxygen.MouthtomaskbreathinghastwoobviousadvantagesPreventtheinfectionandcanadministerthesupplementaryoxygen,Now,wehavejusttalkabouttheABstepsofABCsequence.let’swatchashort

2分钟videotorecallthecontents.Ok,fromthevideo,weknowafterdelivery2rescuerbreathing,thenextstepis5:CcirculationWehaveknown,thepersoninSCAlossthefunctionoftheheart,ceasethebloodflow.theeasymeantoassessthepersonifheorshelosstheheartfunction,Assessthepulseonmajorartery.Likecarotidorfemoral.Maintainaheadtilt,Locatethetrachea,Slidethese2or3fingers betweentracheaandthemusclesatthesideoftheneck,checkthecarotidpulse.Palpatethearteryatleast5secondsbutnomorethan10secondsIfyoucanfindthedefinitepulse,Give1breathevery5to6secondsRecheckpulseevery2minutes.Ifyouarenotsurewhetherthevictimhasapulse,youshouldstartthestepsofCPRwithchestcompression,chestcompressionreferstocompressthechesttobuildcirculationagain,createbloodcirculationincreasecoronaryperfusionincreasethebloodsupplyingforbraintherearetwotheorytosupportchestcompressionhasthefunctionswetalkedabove,heartpump.asweknow,theheartbetweenchestandspine,whenpushchestdownspine ,the pressure on the heart ,grasp the heart , like the heart contract,pushthebloodfromthehearttotherestofthebody,andwhenrecoilthechest,thepressureawayfromtheheart,theheartrecover,liketheheartindiastole,thenthebloodfromtherestofthebodybacktotheheart!thenthechestcompressioncreatedcirculation,chestpumptheheartinthechestcavity,whenpushdownthechest,reducethespaceofchestcavity,thepressurewithinitincrease,thispressurepushthebloodoutofheart,andwhenrecoilthechest,thepressurewithinchestcavitydecrease,thenbloodbacktoheart,but through this simple action to establish circulation ,you must do correctly.otherwiseyoucantsupplyadequatebloodtomeettheneedsofthevital

Playvideoorgans.first,makesurethevictimislyingonhisbackonafirm,flatsurface.ifthevictimislyingfacedown,carefullyrollhimontohisback.ifthevictimonasoftplace,likeinthebed,putaboardbetweenthebackandbed,positionyourselfbesidethevictim,moveorremovealloftheclothingofthevictimandyouareabletoseetheskinofthechest.locatethehandplacement,one,thebreastbonebetweenthenipplesthesecond,atthelowerofhalfsternum.Youcanfindthispartlikethisway,grapesyourfingersalonefromthelowerribtothebaseofthesternum,thenputtheheeloftheotherhandabovethefingers,relievethefingersfromthechestwall,theotherhandonthetopofthehand,Youjustputtheheelofonehandonthechest,andallofthefingersmustkeepawayfromthechest,Straightenyourarmsandpositionyourshouldersdirectlyoveryourhands.Makesurethe strengthfromyourshoulderuprightthechest.PushhardanddeepPushfastcompressatarateof100timesperminute,Rescuersshouldallowthechesttorecoilcompletelyaftereachcompression.Rescuersshouldnotinterruptchestcompressionoftenorforlong.Pushhardmeanspressdown4-5CMwitheachcompression,foreachchestcompression,makesureyoupushstraightdownonthevictim’sbreastone.Ifnot,shallowchestcompressionmaynotproduceadequatebloodflow.Pushfast,pressatarateof100timesperminute.Completechestrecoilmaximizesrefillingoftheheart,thisisnecessaryforeffectivebloodflowduringchestcompression,incompletechestrecoilwillreducethebloodflowcreatedbychestcompression.Minimizetheinterruptionbecausewhenyouarenotcompressingthechest,blooddoesnotflow.Thosearethecharactersofthechestcompression,but,duringcompressing,therearesomedetailsyoumustpaymoreattention,Youjustneedto puttheheelofyourhandonthechest,andthefingersmustkeepawayfromthechest,don’tmovehandawayfromthelocationonthechestduringcompression.Aftercompression,2breathing,sotheratioofcompressionandbreathing30:2.Ok,let’swatchashortvideotorecallthestepstoperform1-rescuersCPRassessthevictimforaresponse