心搏驟停病人的急救Firstaidforasud課件講解

心搏驟停病人的急救《應急救護技術》Emergencyrescuetechnique主講人：安順職業(yè)技術學院

曾露琳Speaker：AnshunTechnicalCollegeZengLulinFirstaidforasuddencardiacarrestpatient掌握心搏驟停、心肺復蘇術的基本概念；MasterthebasicconceptsofSuddencardiacarrestandcardiopulmonaryresuscitation;掌握心搏驟停的臨床表現(xiàn)MastertheclinicalmanifestationsofSuddencardiacarrest掌握心肺復蘇的操作要點及注意事項；Mastertheoperationpointsandprecautionsofcardiopulmonaryresuscitation;掌握AED的操作要點。MastertheoperationpointsofAED.熟悉成人、兒童、嬰兒心肺復蘇術的異同F(xiàn)amiliarwiththedifferencesbetweenadults,children,babyCPR了解電復律的基本概念與適用范圍Tounderstandthebasicconceptandapplicationofelectricalcardioversion學習目標

相關概念

Concepts

是指心臟有效射血功能（搏動）突然終止，導致全身血液循環(huán)處于停止狀態(tài)，是心臟猝死（SCD)的最主要的原因。是未預料的。Suddencardiacarrestisthesuddenterminationoftheheart'seffectiveejectionfunction(beating),andresultinginastateofcessationofbloodcirculationthroughoutthebody.Itisthemaincauseofsuddencardiacdeath(SCD)andisunexpected.心搏驟停suddencardiacarrest

心搏驟停時的常見心律失常Commonarrhythmiaduringsuddencardiacarrest心室顫動（VF）：QRS 波群消失Ventricularfibrillation(VF):TheQRSwavegroupdisappears無脈性室性心動過速（PVT）Pulselessventriculartachycardia無脈性電活動（PEA）Pulselesselectricalactivity心室停搏Ventriculararrest1、心源性原因（心臟疾?。〤ardiogeniccauses(heartdisease)冠心病---主要病因（Coronaryheartdisease）非粥樣硬化性冠狀動脈病（Nonatheroscleroticcoronaryarterydisease）心肌疾?。–ardiomyopathies）主動脈疾病（Aorticdisease）瓣膜性心臟?。╒alvularheartdisease）其他（Others）

心搏驟停的原因Causeofsuddencardiacarrest

心搏驟停的原因Causeofsuddencardiacarrest2、非心源性疾病原因non-cardiacdiseases呼吸停止（Stopbreathing）嚴重酸堿失衡及電解質(zhì)紊亂（Seriousacid-baseimbalancesand

electrolytedisorder）藥物中毒或過敏（Drugpoisoningorallergies）麻醉和手術意外（Anesthesiaandsurgicalaccidents）意外事件：電擊、雷擊、溺水Accidents:Electricshocks,lightningstrikes,drowning各種原因引起的休克和中毒Shockandpoisoningfromvariouscauses其他：臨床診療技術操作等Others:clinicaldiagnosisandtreatmenttechnologyoperation,etc心跳停止3秒鐘----頭暈Heartstopsfor3seconds----Dizziness心跳停止5－10秒鐘----暈厥Heartstopsfor5-10seconds----fainting心跳停止15秒鐘----昏厥或抽搐Heartstopsfor15seconds----faintingorconvulsing心跳停止30－45秒鐘----瞳孔散大Cardiacarrestfor30-45seconds----dilatedpupils心跳停止1－2分鐘----瞳孔固定、呼吸停止大小便失禁Cardiacarrestfor1-2minutes----Fixedpupils,respiratoryarrestincontinence心跳停止4－5分鐘----大腦細胞不可逆損害Theheartstopsfor4-5minutes----irreversibledamagetobraincells心跳停止6分鐘----腦細胞全部死亡Heartstopsfor6minutes----allbraincellsdie

心搏驟停的原因Causeofsuddencardiacarrest4分鐘內(nèi)進行復蘇者，可能一半人被救活Ifresuscitatedwithin4minutes,maybehalfofthemwillbesaved4--6分鐘內(nèi)進行復蘇者10%被救活10%ofthoseresuscitatedwithin4-6minutesaresaved超過6分鐘存活率僅4%Thesurvivalrateaftersixminutesisonly4%超過10分鐘存活率幾乎為0After10minutes,thesurvivalrateisalmostzero搶救的黃金時間是4分鐘內(nèi)Theprimetimeforarescueiswithinfourminutes

心搏驟停的原因Causeofsuddencardiacarrest心肺腦復蘇二

現(xiàn)場心肺復蘇On-siteCardiopulmonaryresuscitation(CPR)

相關概念

Concepts

是針對心跳、呼吸停止所采取的搶救措施，即用胸外按壓形成暫時的人工循環(huán)，用人工呼吸代替自主呼吸，以達到促進蘇醒和挽救生命的目的。

CPRisarescuemeasuretakenforthetreatmentofcardiacarrestandbreathingarrest.Itusesexternalchestcompressionstocreateatemporaryartificialcirculation.andthistimeartificialventilationinsteadofspontaneousbreathingtopromoterecoveryandsavelives.心肺復蘇Cardiopulmonaryresuscitation(CPR)目

的Target針對心臟、呼吸停止的人采取的搶救措施Resuscitationmeasuresforpeopleincardiacandrespiratoryarrests促進發(fā)生心搏驟?；颊叩膹吞K，挽救生命Facilitatetheresuscitationofpatientswithcardiacarrestandsavelives.生存鏈Survivalchain年齡劃分標準Thestandardofage心肺復蘇指南對年齡的劃分標準Divisionstandardcardiopulmonaryresuscitation(CPR)guidelinesforage出生1h——1個月

新生兒Born1hour--1monthNewbornbaby出生后1個月——1歲

嬰兒1monthafterbirth-1yearoldinfant1歲——8歲

兒童1-8yearsoldChildren≥8歲

同成人Atleast8yearsoldAdult評

估Evaluate意識突然喪失，可伴有全身短暫性的抽搐和大小便失禁

Noconsciousnesssuddenly,maybeaccompaniedbytransientgeneralizedconvulsionsandincontinenceofurineandfeces.大動脈搏動消失

Thelargearterypulsationdisappeared.呼吸停止或呈嘆息樣呼吸，繼而停止Breathingstopsorlikesighs,thenstops面色蒼白或青紫Paleorpurplecomplexion雙側瞳孔散大bilateralpupildilation心臟驟停的臨床表現(xiàn)三聯(lián)征triadsyndrome即可判斷為心臟驟停recogonizethecardiacarrestthroughthesefeaturesClinicalmanifestations01首先確定現(xiàn)場安全?。?！Firstofall,ensurethesafetyofthescene一叫：判斷有無意識（＜10秒）

1.拍打雙肩

2.大聲呼喚二叫：呼救；撥打急救電話

（急救與呼救并重）

操作流程stepsJudgeconsciousness(<10seconds)Slapshoulderscallhimloudlyaskforhelpandcall120askforhelpandfirstaid

判斷與識別Judgeandidentify01判斷與識別Judgeandidentify01

判斷脈搏：非專業(yè)人士不要求judgethepluse：butNotrequiredfornon-professionals摸頸動脈脈搏，在喉結左右約兩指深處，單側觸摸、力度適中,時間＜10秒

操作流程

stepsPalpatethecarotidpulse,abouttwofingersdeeparoundtheadam'sappleandunilaterally

withmoderateforce,for<10seconds.判斷與識別Judgeandidentify01判斷呼吸：Judgebreathing

一聽、二看、三感覺First:hear,then:observe,finally:feel

操作流程

steps胸外心臟按壓Circulation:give

chestcompression02C1按壓體位Pressingpositions::呼救同時，迅速將病人擺成仰臥位。Firstofall,askforhelpandkeepthepatientinthesupinepositionquickly.解開病人衣領、領帶以及拉鏈。unfastenthepatient'scollar,tie,andzipper.擺放地點：地面/硬板床。pleasebecaution：ontheground/hardboardbed翻身時整體轉動，保護頸部。wehavetoprotectthepatient’sneckwhenturninghisbody.保持身體平直、無扭曲。keepthepatient’sbodystraightallthetimeandwithouttwist.操作流程

steps胸外心臟按壓Circulation:give

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

Centerofchest,lowerhalfofsternum雙乳頭與前正中線交界處junctionofthetwonipplesandtheanteriormidline.劍突上2-3cm2-3cmabovethexiphoidprocess.嬰兒定位：兩乳頭連線中點稍下方thecompressionsiteforinfants：Slightlybelowthemidpointofthelinebetweenthetwonipples

成人、兒童定位Foradultsandchildren胸外心臟按壓Circulation:give

chestcompression02操作流程stepsC3按壓深度:Chestcompressiondepth成人：

胸骨下陷5-6cm

Foradults,thecompressiondepthis

5-6cmdepressionofthesternum.兒童和嬰兒：胸廓前后徑的1/3Forchildrenandinfants,thecompressiondepthisone-thirdtheanteroposteriordiameterofthechest.嬰兒：約4cm兒童：約5cm

Infantisapproximately4cmandtheChildisapproximately5cm.

胸外心臟按壓Circulation:give

chestcompression02C4按壓頻率:100-120次/minC4

Compressionfrequency:100-120times/min

按壓與放松的時間各占50%Thetimespentonchestcompressionandrelaxationwasequalto50%C5按壓姿勢Compressionposture:地上：采用跪姿，雙膝分開與肩同寬OntheGround:usekneelingposition,kneesandshoulderwidthapart床旁：應站立于腳踏板上，雙臂繃直、與胸部垂直,不得彎曲Besidethebed:shouldstandonthefootpedal,armsstretchstraight,perpendiculartothechest,notbend操作流程steps?以掌跟按壓

Presswiththepalm十指相扣，雙掌根重合，兩手手指蹺起離開胸壁Thefingersareinterlocked,therootsofthepalmscoincide,andthefingersofbothhandsareliftedawayfromthechestwall操作流程steps胸外心臟按壓Circulation:give

chestcompression02C6按壓—通氣比率Compression—

breathingratio

：成人：30次按壓，2次人工呼吸，C：B=30：2Adult:CompressionandbreathingForaratioof30:2,give2artificialbreathsforevery30compressions.兒童和嬰兒Childrenandinfants:單人施救：C：B=30：2；Singlerescue:C:B=30:2雙人施救：C：B=15：2Doublerescue:C:B=15:2操作流程steps胸外心臟按壓Circulation:give

chestcompression02操作流程steps兒童

Children按壓方式：單手掌根或雙手掌根重疊Methodofcompression：singlepalmrootordoublehandsoverlap按壓深度：胸廓前后徑的1/3（約5cm）compressiondepth：one-thirdtheanteroposteriordiameterofthechest(about5cm).單掌按壓法：適用于1-8歲Singlepalmcompression:suitablefor1-8yearsold

胸外心臟按壓Circulation:give

chestcompression02操作流程steps嬰兒

Infants按壓方式：中指與無名指；或雙拇指按壓Methodofcompression：weusethemiddlefingerandringfingerordoublethumbsforcompression,雙指按壓法：適用于新生兒、小嬰兒

thedouble-fingercompressionmethod：suitablefornewborns,babies按壓深度：胸廓前后徑的1/3（約4cm）thecompressiondepth：

one-thirdanteroposteriordiameter

ofthechest(about4cm).

胸外心臟按壓Circulation:give

chestcompression02開放氣道

Airway:Opentheairway03A1清理口鼻腔：Cleanupthemouthandnose:清除呼吸道雜物：活動性假牙、嘔吐物、血液等Removerespiratorydebris:suchastheactivedentures,vomit,blood,etc操作流程steps仰頭舉頦/頜法托頜法開放氣道的手法thewaystoopentheairway操作流程stepsliftheadandchinjaw-lifting開放氣道

Airway:Opentheairway03A2開放氣道Openingtheairway:體位：病人平臥在平地或硬板上，采用開放氣道的方法打開氣道Position:Thepatientislyingflatoronahardboard,andtheairwayisopenedwith

anopenairwaymethod成人：下頜角、耳垂連線與地面垂直。Adults:mandibularAngle,theearlobeattachmentverticaltotheground.兒童：下頜角、耳垂連線與地面成60o。Children:MandibularAngle,earlobelineandthegroundat60o.嬰兒：下頜角、耳垂連線與地面成30o。Infant:MandibularAngle,earlobelinetothegroundat30o.操作流程steps開放氣道

Airway:Opentheairway03人工呼吸Breathing041、口對口人工呼吸

用左手小魚際用力壓傷者前額，之后手的拇指和食指捏住其兩側鼻翼，正常吸氣后充分張嘴完全包住傷者口腔并密合，緩緩吹氣1s以上，同時眼睛余光觀察胸廓明顯上抬；放開捏鼻手，胸廓自然回落后第二次吹氣，連續(xù)吹氣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歲的兒童thewaysMouth-to-mouthartificialrespiration

iscommonlyusedinadultsorchildrenaged1-8.2、口對口鼻：主要用于嬰兒操作流程stepsthewayMouth-to-noseartificialrespirationismainlyforinfantsbabies.人工呼吸Breathing04心肺腦復蘇三

電復律術Cardioertersurgery

相關概念

Concepts

是指在嚴重快速心律失常時，將一定強度的電流直接或經(jīng)胸壁作用于心臟使全部或大部分心肌在瞬間除極，然后心臟自律性最高的起搏點（通常是竇房結）重新主導心臟節(jié)律的治療過程，也就是說通過電擊的方式將異常心臟節(jié)律轉復為正常竇性節(jié)律。Itreferstothetreatmentprocessinwhichacertainintensityofcurrentisappliedtotheheartdirectlyorthroughthechestwalltodepolarizeallormostofthemyocardiuminaninstant,andthenthepacemakerwiththehighestautomaticityoftheheart(usuallythesinusnode)dominatestheheartrhythmagain.Thatistosay,theabnormalheartrhythmisconvertedtonormalsinusrhythmbymeansofelectricshock.心臟電復律cardioversion主要用于心室顫動、心室撲動、無脈性室速Mainlyusedforventricularfibrillation,ventricularflutter,pulselessventriculartachycardia非同步電復律主要用于急性快速異位心律失常、持續(xù)性房顫、心室撲動Mainlyusedforacuteectopicarrhythmias,persistentatrialfibrillation,ventricularflutter同步電復律

相關概念

Concepts1.手動電復律AED瞬間發(fā)放出的電流通過心臟Fromthecurrentthroughtheheartofamoment終止心臟所有的電活動Stopallelectricalactivityintheheart使心臟電流重新自我正?；疘tre-normalizestheheart'scurrent操作流程steps語言示意不要接觸患者建議除顫Suggestdefibrillation等待AED充電確定無人接觸患者WaitingfortheAEDtochargeMakesurenoonetouchedthepatient2分鐘后AED再次自動分析心律After2minutesTheAEDagainautomaticallyanalyzedtherhythm根據(jù)語音提示繼續(xù)操作AccordingtothevoicepromptContinuetooperate無需除顫Noneedfordefibrillation打開開關按語音操作Turnontheswitchandpressvoiceoperations按圖示貼電極Attachelectrodesasshown分析心律是否需除顫Analysisofheartratewhetherdefibrillation按鍵電擊除顫Pressthebuttontoshockdefibrillation繼續(xù)CPRContinueCPR操作流程steps貼電極片前，應先清除患者過多的胸毛Pasteelectrodeslicebefore,shouldfirstclearinpatientswithchesthairtoomuch迅速擦干患者胸部過多的水分或汗液，再貼電極片Quicklydrythepatient'schestexcessmoistureorsweat,andattachtheelectrodeshee不能在水中或金屬等導電物體表面使用AED。如果患者躺在水中，要先將患者抬出，并擦干胸部再使用AEDDonotuseAEDsonconductivesurfacessuch