心搏骤停病人的急救Firstaidforasud课件讲解

心搏骤停病人的急救《应急救护技术》Emergencyrescuetechnique主讲人：安顺职业技术学院

曾露琳Speaker：AnshunTechnicalCollegeZengLulinFirstaidforasuddencardiacarrestpatient掌握心搏骤停、心肺复苏术的基本概念；MasterthebasicconceptsofSuddencardiacarrestandcardiopulmonaryresuscitation;掌握心搏骤停的临床表现MastertheclinicalmanifestationsofSuddencardiacarrest掌握心肺复苏的操作要点及注意事项；Mastertheoperationpointsandprecautionsofcardiopulmonaryresuscitation;掌握AED的操作要点。MastertheoperationpointsofAED.熟悉成人、儿童、婴儿心肺复苏术的异同Familiarwiththedifferencesbetweenadults,children,babyCPR了解电复律的基本概念与适用范围Tounderstandthebasicconceptandapplicationofelectricalcardioversion学习目标

相关概念

Concepts

是指心脏有效射血功能（搏动）突然终止，导致全身血液循环处于停止状态，是心脏猝死（SCD)的最主要的原因。是未预料的。Suddencardiacarrestisthesuddenterminationoftheheart'seffectiveejectionfunction(beating),andresultinginastateofcessationofbloodcirculationthroughoutthebody.Itisthemaincauseofsuddencardiacdeath(SCD)andisunexpected.心搏骤停suddencardiacarrest

心搏骤停时的常见心律失常Commonarrhythmiaduringsuddencardiacarrest心室颤动（VF）：QRS 波群消失Ventricularfibrillation(VF):TheQRSwavegroupdisappears无脉性室性心动过速（PVT）Pulselessventriculartachycardia无脉性电活动（PEA）Pulselesselectricalactivity心室停搏Ventriculararrest1、心源性原因（心脏疾病）Cardiogeniccauses(heartdisease)冠心病---主要病因（Coronaryheartdisease）非粥样硬化性冠状动脉病（Nonatheroscleroticcoronaryarterydisease）心肌疾病（Cardiomyopathies）主动脉疾病（Aorticdisease）瓣膜性心脏病（Valvularheartdisease）其他（Others）

心搏骤停的原因Causeofsuddencardiacarrest

心搏骤停的原因Causeofsuddencardiacarrest2、非心源性疾病原因non-cardiacdiseases呼吸停止（Stopbreathing）严重酸碱失衡及电解质紊乱（Seriousacid-baseimbalancesand

electrolytedisorder）药物中毒或过敏（Drugpoisoningorallergies）麻醉和手术意外（Anesthesiaandsurgicalaccidents）意外事件：电击、雷击、溺水Accidents:Electricshocks,lightningstrikes,drowning各种原因引起的休克和中毒Shockandpoisoningfromvariouscauses其他：临床诊疗技术操作等Others:clinicaldiagnosisandtreatmenttechnologyoperation,etc心跳停止3秒钟----头晕Heartstopsfor3seconds----Dizziness心跳停止5－10秒钟----晕厥Heartstopsfor5-10seconds----fainting心跳停止15秒钟----昏厥或抽搐Heartstopsfor15seconds----faintingorconvulsing心跳停止30－45秒钟----瞳孔散大Cardiacarrestfor30-45seconds----dilatedpupils心跳停止1－2分钟----瞳孔固定、呼吸停止大小便失禁Cardiacarrestfor1-2minutes----Fixedpupils,respiratoryarrestincontinence心跳停止4－5分钟----大脑细胞不可逆损害Theheartstopsfor4-5minutes----irreversibledamagetobraincells心跳停止6分钟----脑细胞全部死亡Heartstopsfor6minutes----allbraincellsdie

心搏骤停的原因Causeofsuddencardiacarrest4分钟内进行复苏者，可能一半人被救活Ifresuscitatedwithin4minutes,maybehalfofthemwillbesaved4--6分钟内进行复苏者10%被救活10%ofthoseresuscitatedwithin4-6minutesaresaved超过6分钟存活率仅4%Thesurvivalrateaftersixminutesisonly4%超过10分钟存活率几乎为0After10minutes,thesurvivalrateisalmostzero抢救的黄金时间是4分钟内Theprimetimeforarescueiswithinfourminutes

心搏骤停的原因Causeofsuddencardiacarrest心肺脑复苏二

现场心肺复苏On-siteCardiopulmonaryresuscitation(CPR)

相关概念

Concepts

是针对心跳、呼吸停止所采取的抢救措施，即用胸外按压形成暂时的人工循环，用人工呼吸代替自主呼吸，以达到促进苏醒和挽救生命的目的。

CPRisarescuemeasuretakenforthetreatmentofcardiacarrestandbreathingarrest.Itusesexternalchestcompressionstocreateatemporaryartificialcirculation.andthistimeartificialventilationinsteadofspontaneousbreathingtopromoterecoveryandsavelives.心肺复苏Cardiopulmonaryresuscitation(CPR)目

的Target针对心脏、呼吸停止的人采取的抢救措施Resuscitationmeasuresforpeopleincardiacandrespiratoryarrests促进发生心搏骤停患者的复苏，挽救生命Facilitatetheresuscitationofpatientswithcardiacarrestandsavelives.生存链Survivalchain年龄划分标准Thestandardofage心肺复苏指南对年龄的划分标准Divisionstandardcardiopulmonaryresuscitation(CPR)guidelinesforage出生1h——1个月

新生儿Born1hour--1monthNewbornbaby出生后1个月——1岁

婴儿1monthafterbirth-1yearoldinfant1岁——8岁

儿童1-8yearsoldChildren≥8岁

同成人Atleast8yearsoldAdult评

估Evaluate意识突然丧失，可伴有全身短暂性的抽搐和大小便失禁

Noconsciousnesssuddenly,maybeaccompaniedbytransientgeneralizedconvulsionsandincontinenceofurineandfeces.大动脉搏动消失

Thelargearterypulsationdisappeared.呼吸停止或呈叹息样呼吸，继而停止Breathingstopsorlikesighs,thenstops面色苍白或青紫Paleorpurplecomplexion双侧瞳孔散大bilateralpupildilation心脏骤停的临床表现三联征triadsyndrome即可判断为心脏骤停recogonizethecardiacarrestthroughthesefeaturesClinicalmanifestations01首先确定现场安全！！！Firstofall,ensurethesafetyofthescene一叫：判断有无意识（＜10秒）

1.拍打双肩

2.大声呼唤二叫：呼救；拨打急救电话

（急救与呼救并重）

操作流程stepsJudgeconsciousness(<10seconds)Slapshoulderscallhimloudlyaskforhelpandcall120askforhelpandfirstaid

判断与识别Judgeandidentify01判断与识别Judgeandidentify01

判断脉搏：非专业人士不要求judgethepluse：butNotrequiredfornon-professionals摸颈动脉脉搏，在喉结左右约两指深处，单侧触摸、力度适中,时间＜10秒

操作流程

stepsPalpatethecarotidpulse,abouttwofingersdeeparoundtheadam'sappleandunilaterally

withmoderateforce,for<10seconds.判断与识别Judgeandidentify01判断呼吸：Judgebreathing

一听、二看、三感觉First:hear,then:observe,finally:feel

操作流程

steps胸外心脏按压Circulation:give

chestcompression02C1按压体位Pressingpositions::呼救同时，迅速将病人摆成仰卧位。Firstofall,askforhelpandkeepthepatientinthesupinepositionquickly.解开病人衣领、领带以及拉链。unfastenthepatient'scollar,tie,andzipper.摆放地点：地面/硬板床。pleasebecaution：ontheground/hardboardbed翻身时整体转动，保护颈部。wehavetoprotectthepatient’sneckwhenturninghisbody.保持身体平直、无扭曲。keepthepatient’sbodystraightallthetimeandwithouttwist.操作流程

steps胸外心脏按压Circulation:give

chestcompression02操作流程stepsC2按压部位:胸部中央，胸骨下半部C2Chestcompressionsite:

Centerofchest,lowerhalfofsternum双乳头与前正中线交界处junctionofthetwonipplesandtheanteriormidline.剑突上2-3cm2-3cmabovethexiphoidprocess.婴儿定位：两乳头连线中点稍下方thecompressionsiteforinfants：Slightlybelowthemidpointofthelinebetweenthetwonipples

成人、儿童定位Foradultsandchildren胸外心脏按压Circulation:give

chestcompression02操作流程stepsC3按压深度:Chestcompressiondepth成人：

胸骨下陷5-6cm

Foradults,thecompressiondepthis

5-6cmdepressionofthesternum.儿童和婴儿：胸廓前后径的1/3Forchildrenandinfants,thecompressiondepthisone-thirdtheanteroposteriordiameterofthechest.婴儿：约4cm儿童：约5cm

Infantisapproximately4cmandtheChildisapproximately5cm.

胸外心脏按压Circulation:give

chestcompression02C4按压频率:100-120次/minC4

Compressionfrequency:100-120times/min

按压与放松的时间各占50%Thetimespentonchestcompressionandrelaxationwasequalto50%C5按压姿势Compressionposture:地上：采用跪姿，双膝分开与肩同宽OntheGround:usekneelingposition,kneesandshoulderwidthapart床旁：应站立于脚踏板上，双臂绷直、与胸部垂直,不得弯曲Besidethebed:shouldstandonthefootpedal,armsstretchstraight,perpendiculartothechest,notbend操作流程steps✔以掌跟按压

Presswiththepalm十指相扣，双掌根重合，两手手指跷起离开胸壁Thefingersareinterlocked,therootsofthepalmscoincide,andthefingersofbothhandsareliftedawayfromthechestwall操作流程steps胸外心脏按压Circulation:give

chestcompression02C6按压—通气比率Compression—

breathingratio

：成人：30次按压，2次人工呼吸，C：B=30：2Adult:CompressionandbreathingForaratioof30:2,give2artificialbreathsforevery30compressions.儿童和婴儿Childrenandinfants:单人施救：C：B=30：2；Singlerescue:C:B=30:2双人施救：C：B=15：2Doublerescue:C:B=15:2操作流程steps胸外心脏按压Circulation:give

chestcompression02操作流程steps儿童

Children按压方式：单手掌根或双手掌根重叠Methodofcompression：singlepalmrootordoublehandsoverlap按压深度：胸廓前后径的1/3（约5cm）compressiondepth：one-thirdtheanteroposteriordiameterofthechest(about5cm).单掌按压法：适用于1-8岁Singlepalmcompression:suitablefor1-8yearsold

胸外心脏按压Circulation:give

chestcompression02操作流程steps婴儿

Infants按压方式：中指与无名指；或双拇指按压Methodofcompression：weusethemiddlefingerandringfingerordoublethumbsforcompression,双指按压法：适用于新生儿、小婴儿

thedouble-fingercompressionmethod：suitablefornewborns,babies按压深度：胸廓前后径的1/3（约4cm）thecompressiondepth：

one-thirdanteroposteriordiameter

ofthechest(about4cm).

胸外心脏按压Circulation:give

chestcompression02开放气道

Airway:Opentheairway03A1清理口鼻腔：Cleanupthemouthandnose:清除呼吸道杂物：活动性假牙、呕吐物、血液等Removerespiratorydebris:suchastheactivedentures,vomit,blood,etc操作流程steps仰头举颏/颌法托颌法开放气道的手法thewaystoopentheairway操作流程stepsliftheadandchinjaw-lifting开放气道

Airway:Opentheairway03A2开放气道Openingtheairway:体位：病人平卧在平地或硬板上，采用开放气道的方法打开气道Position:Thepatientislyingflatoronahardboard,andtheairwayisopenedwith

anopenairwaymethod成人：下颌角、耳垂连线与地面垂直。Adults:mandibularAngle,theearlobeattachmentverticaltotheground.儿童：下颌角、耳垂连线与地面成60º。Children:MandibularAngle,earlobelineandthegroundat60º.婴儿：下颌角、耳垂连线与地面成30º。Infant:MandibularAngle,earlobelinetothegroundat30º.操作流程steps开放气道

Airway:Opentheairway03人工呼吸Breathing041、口对口人工呼吸

用左手小鱼际用力压伤者前额，之后手的拇指和食指捏住其两侧鼻翼，正常吸气后充分张嘴完全包住伤者口腔并密合，缓缓吹气1s以上，同时眼睛余光观察胸廓明显上抬；放开捏鼻手，胸廓自然回落后第二次吹气，连续吹气2次。Mouth-to-mouthresuscitation:Presstheforeheadofthepatientwithourlefthand,afterwhichthethumbandforefingerofthehandpinchedbothsidesofthenose,Afternormalinhalation,ourmouthwasfullyopenedtocompletelycoverthemouthoftheinjuredpersonandclose,thenblowairslowlyformorethan1second.Atthesametime,

weshouldobservewhetherthechestriseobviouslyornot.

Afterthat,releasethehandpinchingthenose,thenthechestnaturallyfallsbackandblowstwiceinarow.操作流程常用于成人、1-8岁的儿童thewaysMouth-to-mouthartificialrespiration

iscommonlyusedinadultsorchildrenaged1-8.2、口对口鼻：主要用于婴儿操作流程stepsthewayMouth-to-noseartificialrespirationismainlyforinfantsbabies.人工呼吸Breathing04心肺脑复苏三

电复律术Cardioertersurgery

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Concepts

是指在严重快速心律失常时，将一定强度的电流直接或经胸壁作用于心脏使全部或大部分心肌在瞬间除极，然后心脏自律性最高的起搏点（通常是窦房结）重新主导心脏节律的治疗过程，也就是说通过电击的方式将异常心脏节律转复为正常窦性节律。Itreferstothetreatmentprocessinwhichacertainintensityofcurrentisappliedtotheheartdirectlyorthroughthechestwalltodepolarizeallormostofthemyocardiuminaninstant,andthenthepacemakerwiththehighestautomaticityoftheheart(usuallythesinusnode)dominatestheheartrhythmagain.Thatistosay,theabnormalheartrhythmisconvertedtonormalsinusrhythmbymeansofelectricshock.心脏电复律cardioversion主要用于心室颤动、心室扑动、无脉性室速Mainlyusedforventricularfibrillation,ventricularflutter,pulselessventriculartachycardia非同步电复律主要用于急性快速异位心律失常、持续性房颤、心室扑动Mainlyusedforacuteectopicarrhythmias,persistentatrialfibrillation,ventricularflutter同步电复律

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Concepts1.手动电复律AED瞬间发放出的电流通过心脏Fromthecurrentthroughtheheartofamoment终止心脏所有的电活动Stopallelectricalactivityintheheart使心脏电流重新自我正常化Itre-normalizestheheart'scurrent操作流程steps语言示意不要接触患者建议除颤Suggestdefibrillation等待AED充电确定无人接触患者WaitingfortheAEDtochargeMakesurenoonetouchedthepatient2分钟后AED再次自动分析心律After2minutesTheAEDagainautomaticallyanalyzedtherhythm根据语音提示继续操作AccordingtothevoicepromptContinuetooperate无需除颤Noneedfordefibrillation打开开关按语音操作Turnontheswitchandpressvoiceoperations按图示贴电极Attachelectrodesasshown分析心律是否需除颤Analysisofheartratewhetherdefibrillation按键电击除颤Pressthebuttontoshockdefibrillation继续CPRContinueCPR操作流程steps贴电极片前，应先清除患者过多的胸毛Pasteelectrodeslicebefore,shouldfirstclearinpatientswithchesthairtoomuch迅速擦干患者胸部过多的水分或汗液，再贴电极片Quicklydrythepatient'schestexcessmoistureorsweat,andattachtheelectrodeshee不能在水中或金属等导电物体表面使用AED。如果患者躺在水中，要先将患者抬出，并擦干胸部再使用AEDDonotuseAEDsonconductivesurfacessuch