心肺腦復(fù)蘇課件

匯報(bào)人：xxx20xx-03-14心肺腦復(fù)蘇ppt課件目錄引言心臟驟停的識(shí)別與診斷心肺腦復(fù)蘇的基本流程心肺腦復(fù)蘇的注意事項(xiàng)與誤區(qū)心肺腦復(fù)蘇的預(yù)后與康復(fù)心肺腦復(fù)蘇的培訓(xùn)與普及01引言提高醫(yī)護(hù)人員對(duì)心臟驟停及心肺腦復(fù)蘇的認(rèn)知和應(yīng)對(duì)能力，降低死亡率，改善患者預(yù)后。心臟驟停是一種嚴(yán)重的臨床急癥，具有極高的死亡率和致殘率。隨著醫(yī)學(xué)技術(shù)的發(fā)展，心肺腦復(fù)蘇已成為搶救心臟驟?；颊叩闹匾侄?。目的和背景背景目的心臟驟停是指心臟突然停止跳動(dòng)，有效泵血功能消失，導(dǎo)致全身嚴(yán)重缺氧、缺血。定義心臟驟?？蓪?dǎo)致意識(shí)喪失、呼吸停止、瞳孔散大，若不及時(shí)搶救可引起死亡。即使復(fù)跳也往往會(huì)遺留不同程度的后遺癥。危害心臟驟停的定義與危害以下附贈(zèng)各項(xiàng)管理制度英文版（不需要可刪）急救藥品、器材管理制度:1.Rescuedrugsandequipmentshouldbe"fivefixed"(fixedquantityandvariety,designatedplacement,designatedpersonstorage,regulardisinfectionandsterilization,regularinspectionandmaintenance)and"twotimely"(timelyinspectionandmaintenance,timelyreceiptandsupplementation).Theitemisclearlymarkedandcannotbeusedarbitrarily.2.Thenecessaryrescueequipmentiscomplete,ingoodperformance,andinstandbycondition.3.Therescuedrugsarecomplete,withcleardruglabelsandnodiscoloration,deterioration,expiration,ordamage.Theyshouldbeplacedandusedintheorderofdrugexpirationdates(fromrighttoleft).4.Emergencydrugsanditemsforeachdepartment'srescuevehicleshallbeuniformlyequippedaccordingtorequirements.Specializedemergencydrugsanditemsmustbereviewedandapprovedbythedepartmentdirectortodeterminethetype,quantity,specifications,anddosagetobeequipped.Rescuevehiclesmustbeplacedindesignatedlocationsandmanagedbydesignatedpersonneltoensuresafetyandeaseofuse.5.Afterusingrescuedrugsandequipment,theyshouldbefullyreplenishedwithin24hours.Iftheycannotbereplenishedduetospecialreasons,theyshouldbenotedonthehandoverregistrationformandreportedtotheheadnurseforcoordinationandresolutiontoensuretimelyuseduringpatientrescue.6.Thereisaregistrationbookfortheprovisionofdrugsandequipment.Ensureconsistencybetweenaccountsandmaterials,andhandoverbetweenshifts.7.Managementofsealedrescuevehicles:Beforesealing,theheadnurse(ornurseincharge)andanothernurseshallcountthedrugsandequipmentaccordingtotheregistrationbookofdrugandequipmentequipment,verifytheiraccuracy,andsealthemwithaseal.Twopeopleshallsignandfillinthesealingtime.Nurseschecktheconditionofthesealsoncepershiftandcompletethehandover.Theresponsiblenursescheckonceaweek,andtheheadnurseandresponsiblenursesopenthesealsandinspectthedrugsandequipmentintheambulanceonceamonth,withrecordskept.8.Nonsealedrescuevehiclemanagement:Eachshiftshallcountthedrugsandequipmentaccordingtotheregistrationbookandcompletethehandover.Theresponsiblenurseshallinspectonceaweek,andtheheadnurseshallinspectonceeverytwoweeksandkeeprecords,ensuringthattheaccountsmatchthematerials.護(hù)理文書書寫制度:

1.Nursingstaffstrictlyfollowthelatestrequirementswhenwritingnursingmedicalrecords.2.Thecontentofnursingrecordsshouldbeobjective,truthful,accurate,timely,complete,andstandardized.3.Allnursingdocumentsshouldbewrittenwithablueblackorcarboninkpen.4.AllnursingdocumentsshouldbewritteninArabicnumeralsfordateandtime,withdatesinyears,months,anddays,usinga24-hoursystem,specifictominutes.5.WritingshoulduseChinese,medicalterminology,andcommonlyusedforeignlanguageabbreviations;Completerecorditems;Thetextisneat,thehandwritingisclear,andthelayoutisclean;Accurateexpression,fluentsentences,simpleandconcise:correctformatandpunctuation,notypos.6.Whenerrorsoccurduringthewritingprocess,doublelinethemonthewrongwords,keeptheoriginalrecordclearanddistinguishable,signthemodifier,indicatethemodificationtime,continuetowritethecorrectcontent,anddonotusescraping,sticking,paintingorothermethodstocoveruporremovetheoriginalhandwriting.Eachpageshouldbemodifiednomorethantwotimes,otherwisetheoriginalrecorderwillpromptlycopyagain(exceptformodificationsmadebysuperiors).7.Nursingrecordswrittenbyinternnurses,probationarynurses,orunregisterednursesshouldbereviewedandsignedbynurseswithlegalprofessionalqualificationsinthismedicalinstitution.8.Furthertrainingnursescanonlywritenursingdocumentsafterbeingrecognizedbythemedicalinstitutionreceivingthetrainingfortheirworkability.9.Superiornursingstaffhavetheresponsibilitytoreviewandmodifythewrittenrecordsofsubordinatenursingstaff.Whenmakingmodifications,reddoublelinesshouldbeusedtomarkerrors,writethemodifiedcontent,signandindicatethemodificationtime.10.Temperaturerecords,medicalorders,patientcarerecords,andsurgicalinventoryrecordsshouldbearchivedontime.心肺腦復(fù)蘇是搶救心臟驟?；颊叩奈ㄒ挥行Х椒ǎ軌虮M快恢復(fù)患者的心跳和呼吸，挽救生命。搶救生命改善預(yù)后提高醫(yī)療質(zhì)量及時(shí)、有效的心肺腦復(fù)蘇能夠減輕患者腦損傷程度，降低致殘率，改善患者預(yù)后。加強(qiáng)醫(yī)護(hù)人員對(duì)心肺腦復(fù)蘇的培訓(xùn)和實(shí)踐，能夠提高醫(yī)療質(zhì)量，提升醫(yī)院救治水平。030201心肺腦復(fù)蘇的重要性02心臟驟停的識(shí)別與診斷心臟驟停的臨床表現(xiàn)心音消失心臟驟停后，心音聽診器無(wú)法聽到心音。大動(dòng)脈搏動(dòng)消失在心臟驟停后，大動(dòng)脈（如頸動(dòng)脈、股動(dòng)脈）的搏動(dòng)會(huì)消失，這是心臟驟停最明顯的體征之一。突然意識(shí)喪失或抽搐心臟驟停后，由于腦部供血不足，患者會(huì)立即失去意識(shí)，或出現(xiàn)短暫的抽搐。呼吸停止或嘆息樣呼吸心臟驟停后，患者的呼吸會(huì)立即停止，或出現(xiàn)不規(guī)律的嘆息樣呼吸。瞳孔散大由于腦部缺氧，患者的瞳孔會(huì)散大，對(duì)光反射消失?；颊咄蝗皇ヒ庾R(shí)，對(duì)任何刺激均無(wú)反應(yīng)。神志喪失通過(guò)觸摸頸動(dòng)脈或股動(dòng)脈，無(wú)法感受到搏動(dòng)。頸動(dòng)脈、股動(dòng)脈搏動(dòng)消失觀察患者胸廓無(wú)起伏，聽診器無(wú)法聽到呼吸音。呼吸停止心電圖呈直線或室顫波形。心電圖表現(xiàn)心臟驟停的診斷標(biāo)準(zhǔn)心臟驟停的鑒別診斷暈厥暈厥患者雖然也會(huì)出現(xiàn)短暫的意識(shí)喪失，但大動(dòng)脈搏動(dòng)和呼吸通常不會(huì)停止，且恢復(fù)較快。癲癇癲癇患者發(fā)作時(shí)可能出現(xiàn)抽搐、意識(shí)喪失等癥狀，但癲癇患者發(fā)作后通常會(huì)自行恢復(fù)，且大動(dòng)脈搏動(dòng)和呼吸不會(huì)停止。急性腦血管意外急性腦血管意外患者可能出現(xiàn)意識(shí)喪失、偏癱等癥狀，但該類患者通常會(huì)有高血壓、糖尿病等病史，且大動(dòng)脈搏動(dòng)和呼吸不會(huì)停止。藥物中毒某些藥物中毒患者可能出現(xiàn)昏迷、呼吸抑制等癥狀，但該類患者通常有明確的服藥史或毒物接觸史，且心電圖表現(xiàn)與心臟驟停不同。03心肺腦復(fù)蘇的基本流程初步評(píng)估與呼叫急救檢查患者意識(shí)和呼吸通過(guò)拍打患者肩膀、呼喊患者姓名等方式判斷患者意識(shí)狀態(tài)，并觀察患者胸廓起伏判斷呼吸情況。呼叫急救如患者無(wú)意識(shí)、無(wú)呼吸或呼吸異常，應(yīng)立即呼叫急救電話，尋求專業(yè)醫(yī)療救助。準(zhǔn)備心肺復(fù)蘇在等待急救人員到來(lái)的過(guò)程中，應(yīng)迅速做好心肺復(fù)蘇的準(zhǔn)備工作，如將患者平臥于硬板床上或地面上，解開衣領(lǐng)、腰帶等緊身衣物。定位患者胸骨中下1/3交界處，以掌根為著力點(diǎn)進(jìn)行快速、有力、連續(xù)的按壓，頻率保持在100-急救電話次/分鐘，深度5-6厘米。胸外按壓每進(jìn)行30次胸外按壓后，給予2次人工呼吸。人工呼吸前應(yīng)確?；颊吆粑劳〞?，可采用仰頭抬頦法或推舉下頜法開放氣道。吹氣時(shí)應(yīng)捏住患者鼻孔，用口對(duì)口或口對(duì)鼻的方式吹氣，每次吹氣時(shí)間應(yīng)持續(xù)1秒以上。人工呼吸胸外按壓與人工呼吸電除顫對(duì)于室顫等惡性心律失常導(dǎo)致的心臟驟停，應(yīng)盡早進(jìn)行電除顫治療。電除顫前應(yīng)確保患者身上無(wú)金屬物品，選擇適當(dāng)?shù)某澞芰窟M(jìn)行除顫。藥物治療在心肺復(fù)蘇過(guò)程中，可根據(jù)患者病情給予相應(yīng)的藥物治療，如腎上腺素、阿托品、利多卡因等。藥物治療應(yīng)遵循醫(yī)囑，注意藥物劑量和使用方法。電除顫與藥物治療監(jiān)測(cè)生命體征01復(fù)蘇后應(yīng)密切監(jiān)測(cè)患者的生命體征，包括呼吸、心率、血壓、體溫等指標(biāo)，及時(shí)發(fā)現(xiàn)并處理異常情況。維持內(nèi)環(huán)境穩(wěn)定02加強(qiáng)液體管理，維持患者內(nèi)環(huán)境穩(wěn)定，糾正電解質(zhì)和酸堿平衡紊亂。腦保護(hù)治療03對(duì)于心臟驟停后出現(xiàn)的腦損傷，應(yīng)采取腦保護(hù)治療措施，如降低顱內(nèi)壓、控制癲癇等。同時(shí)加強(qiáng)康復(fù)訓(xùn)練和心理治療，促進(jìn)患者神經(jīng)功能恢復(fù)和心理健康。復(fù)蘇后的監(jiān)測(cè)與治療04心肺腦復(fù)蘇的注意事項(xiàng)與誤區(qū)按壓位置胸骨中下1/3交界處或兩乳頭連線中點(diǎn)處。按壓手法一手掌根部放于按壓部位，另一手平行重疊于此手背上，手指并攏，只以掌根部接觸按壓部位，雙臂位于患者胸骨的正上方，雙肘關(guān)節(jié)伸直，利用上身重量垂直下壓。按壓幅度與頻率使胸骨下陷5~6cm，按壓頻率100~急救電話次/分鐘。注意事項(xiàng)避免過(guò)度用力導(dǎo)致肋骨骨折、氣胸等并發(fā)癥。01020304胸外按壓的正確方法與力度人工呼吸前準(zhǔn)備人工呼吸方法注意事項(xiàng)頻率與按壓配合人工呼吸的技巧與注意事項(xiàng)01020304保持呼吸道通暢，取出口內(nèi)假牙、異物等?？趯?duì)口吹氣或口對(duì)鼻吹氣，吹氣時(shí)間持續(xù)1秒以上，保證足夠的氣量使胸廓起伏。避免過(guò)度通氣導(dǎo)致胃脹氣、氣胸等并發(fā)癥。每進(jìn)行30次胸外按壓后，進(jìn)行2次人工呼吸，即30:2的比例。心室顫動(dòng)和無(wú)脈性室性心動(dòng)過(guò)速。適應(yīng)癥涂抹導(dǎo)電糊，選擇合適能量，放置電極板于正確位置，充電后雙手同時(shí)按壓放電按鈕進(jìn)行除顫。操作方法避免在潮濕環(huán)境下進(jìn)行除顫，避免對(duì)患者或操作者造成電擊傷。注意事項(xiàng)電除顫的適應(yīng)癥與操作方法03注意事項(xiàng)遵循藥物使用說(shuō)明和醫(yī)生建議，嚴(yán)格控制藥物劑量和使用時(shí)間，避免藥物過(guò)量或不足導(dǎo)致的不良反應(yīng)。01首選藥物腎上腺素，可提高心肌和腦的供血。02其他藥物如阿托品、利多卡因等，根據(jù)患者病情和醫(yī)生指導(dǎo)進(jìn)行選擇。藥物治療的選擇與劑量05心肺腦復(fù)蘇的預(yù)后與康復(fù)持續(xù)監(jiān)測(cè)患者的呼吸、心率、血壓、體溫等生命體征，及時(shí)發(fā)現(xiàn)并處理異常情況。生命體征監(jiān)測(cè)觀察患者的意識(shí)、瞳孔、肢體活動(dòng)等神經(jīng)系統(tǒng)表現(xiàn)，評(píng)估腦復(fù)蘇效果。神經(jīng)系統(tǒng)評(píng)估進(jìn)行血常規(guī)、生化、血?dú)夥治龅认嚓P(guān)實(shí)驗(yàn)室檢查，了解患者內(nèi)環(huán)境及器官功能狀況。實(shí)驗(yàn)室檢查復(fù)蘇成功后的病情評(píng)估神經(jīng)系統(tǒng)損傷評(píng)估通過(guò)影像學(xué)檢查、神經(jīng)電生理檢查等手段，評(píng)估患者神經(jīng)系統(tǒng)損傷的