中國心肺復蘇指南(五)（Guidelines for cardiopulmonary resuscitation in China (five)）

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9、ucation physician Handbook, nursing garden equipment, exhibition hall, leisure and entertainmentContains BBS searchGuidelines for cardiopulmonary resuscitation in China (five)2003-12-11 23:05:41 Chinese Medicine Association Emergency Medicine Branch resuscitation group read 759 timesFour. Recovery u

10、nder special circumstancesIn particular, the heartbeat and respiration stops, and the recovery method is needed for resuscitation. These special conditions include: stroke, hypothermia, drowning, trauma, electric shock, lightning, pregnancy and other conditions appear heartbeat and respiratory arres

11、t. Emergency personnel should pay close attention to the intensity of recovery and technical differences in all cases.1. strokeIt is a disease caused by cerebral infarction and hemorrhage, and nearly 75% of the patients are ischemic: vascular obstruction caused by migration or embolism from distant

12、vessels, such as the heart, to the brain. Hemorrhagic stroke is the rupture of the cerebral vascular into the ventricular membrane system (subarachnoid hemorrhage) or into the brain parenchyma (intracerebral hemorrhage).The possibility of stroke is suspected for any sudden focal neurological deficit

13、 or altered consciousness. If there is a coma, airway obstruction is the biggest problem in acute stroke, because of hypoxia and hypercapnia can aggravate stroke, therefore, open the airway is the key measures, if necessary, endotracheal intubation. At the same time pay attention to improper ventila

14、tion or aspiration.2. low temperatureA serious accident at low temperature (temperature <30 C) aerobic cerebral blood flow, obvious drop, decreased cardiac output, blood pressure decreased, patients due to cerebral vascular function and inhibition performance for clinical death, but complete neur

15、ological recovery is possible.Defibrillation: if the patient is not breathing, start breathing first, and if VF is diagnosed, the first responders should be given 3 defibrillation. If VF still exists after defibrillation, do not defibrillation unless the body temperature is above 30 degrees celsius.

16、 After that, CPR and rewarming should be performed immediately. Defibrillation is often ineffective because the core temperature is <30 degrees centigrade.Rewarming: the treatment of cardiac arrest caused by hypothermia is very different from that of sudden cardiac arrest at normal temperature. L

17、ow temperature heart for drug and pacing stimulation,Defibrillation is unresponsive and drug metabolism is reduced. Epinephrine, lidocaine and Procaine can accumulate poisoning. Active central rewarming is the first step in the treatment of patients without heart rate or unconsciousness and slower h

18、eart rate.3. drowningThe most serious consequence is hypoxemia, and the duration of hypoxia is the key to prognosis. Therefore, the recovery of ventilation and perfusion should be completed at the same time as quickly as possible.Early treatment of drowning includes mouth to mouth breathing, use of

19、diving mask, mouth to face breathing or buoyancy help, and can be ventilated by special trained resuscitation in water. Chest compressions: don't do chest compressions in the water unless you have special training. After the effluent, the circulation should be determined immediately, because the

20、 peripheral blood vessels of drowning patients, cardiac output decreased, it is difficult to touch the pulse. No pre pulse, chest compressions immediately.Immediate further advanced life support. On the way to the hospital, CPR can not be interrupted, while drowning in cold water at the same time to

21、 do a good insulation measures.4. traumaTreatment of heart failure and respiratory arrest after injury is different from the treatment of primary heart and / or respiratory arrest.In the field of severe fatal trauma, no vital signs, no light reflex or can not be defibrillation, do not carry out resu

22、scitation rescue.For a patient to be resuscitated, ready to transport to definitive areas for definitive trauma treatment.Patients with no pulse after trauma should immediately use simple lead ECG monitoring, and complete ventilation and respiratory evaluation.The value of chest compressions for car

23、diac arrest after trauma remains uncertainFor patients without pulse, chest compressions can only be performed after defibrillation and airway control.In open chest injuries, if respiratory sounds are asymmetric or any airway resistance increases. Close examination and closure of any form of open pn

24、eumothorax should be performed to monitor and treat tension pneumothorax.If the trauma patient of the above reason develops to cardiac arrest, the definitive treatment should be started immediately. VF patients need immediate defibrillation, endotracheal intubation or tracheotomy if necessary.When m

25、any people are injured, emergency personnel should give priority to the treatment of critically injured patients. When the number exceeds the strength of the first aid system personnel, the pulse free person is generally abandoned and is allowed to declare death before the hospital.5. electric shock

26、Heart arrest is the leading cause of electrical death. Ventricular fibrillation and ventricular arrest can be directly caused by electrical shocks.Respiratory arrest can be secondary to: (1) the inhibition of the respiratory center of the medulla caused by the current passing through the head; (2) t

27、etanic convulsions of tetanus like diaphragmatic muscle and chest wall muscle; (3) long term respiratory muscle paralysis.Immediate respiratory / circulatory failure after electric shock. Immediately after the power is removed, the patient is immediately identified. If you do not have voluntary circ

28、ulation and breathing, start the first aid according to this guide. If an electric shock occurs in a place that is not quickly approaching, the electric shock should be put on the ground as soon as possible, and the ventilation and chest compressions should be performed immediately when the heartbea

29、t stops. Burn clothes, shoes and belts to be removed to avoid further burns. If there is any head and neck injury, deliver the hospital in time and carry out ACLS.6. lightning strokeThe basic cause of death by lightning is cardiac arrest. The effect of lightning is instantaneous strong DC shock, imm

30、ediately myocardial depolarization, and cause cardiac arrest. In many cases, the automaticity of the heart can be restored and sinus rhythm recovered. However, respiratory arrest and respiratory depression following thoracic muscle spasm persist after recovery of the autonomic circulation. Hypoxia c

31、an lead to cardiac arrest again without assisted ventilatory support.In patients with cardiac arrest, BLS and ACLS should be established immediately until the heart beats again. Patients with respiratory arrest need only ventilation to avoid secondary hypoxemia induced cardiac arrest.7. pregnancyDue

32、 to changes in cardiovascular and respiratory physiology of pregnant women, namely normal pregnancy, heart rate, blood volume increased 50%, heart rate, minute ventilation, oxygen consumption increased; pulmonary residual volume, systemic and pulmonary vascular resistance, colloid osmotic pressure,

33、colloid osmotic pressure and pulmonary capillary r decreased; decline in these disorders in pregnant women on injury susceptibility and tolerance. When they lie on their back, the uterus can compress the splanchnic vessels, vena cava and abdominal aorta, resulting in hypotension and cardiac output d

34、ecrease by 25%. Therefore, the CPR of pregnant women is unique.Emergency pregnant women of cardiac arrest include: pulmonary embolism, trauma, hemorrhage, labor led to the low blood volume, amniotic fluid embolism, congenital or acquired heart disease, treatment of obstetric complications (including

35、 arrhythmia, congestive heart failure and myocardial infarction).In order to reduce the influence of pregnancy uterus on the venous and cardiac output during the period of cardiac arrest in pregnant women undergoing chest compressions,You can put a mat (such as pillow) on the right side of the abdom

36、en, below the hips, the uterus moved to the left abdomen, the implementation of CPR. Epinephrine, norepinephrine and dopamine should be used in time when clinical indications are given.If the fetus has the potential to survive, consider the rapid completion of prenatal surgery. If you want CPR first, move the uterus to the left, restore the blood volume, and continue to use the ACLS program. An emergency caesarean