2018年国际心肺复苏指南ppt课件.ppt

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1、1960------------2010Kouwenhoven2010心肺复苏50周年356位专家来自29个国家历时36个月讨论2010InternationalConsensusConferenceRobertA.BergUniversityofPennsylvaniaProfessorofAnesthesiologyandCriticalCareMedicine,DivisionChief,PediatricCriticalCareCardiacarrestcanbecausedby室颤VF室速(无脉)VT无脉性电活动PEA心博停止asystole.无脉性心动过缓Pulsel

2、essbradycardia4rhythms室颤无脉性室速VF/PulselessVTchestcompressions(CC)earlyDefibrillation(DF)Earlyrecognitioncardiacarrest及早识别心跳骤停外行急救layrescuer1.突然晕倒suddenlycollapse2.意识消失Unresponsive3.无呼吸或无正常呼吸notbreathing4.Seizure(notnormally,gasping).cardiacarrest降低脉搏检查的重要性Minimizetheimportanceofpulsechecks不检查脉

3、搏Notcheckforapulse2005(Old):“Look,listen,andfeel”2010(New):NO:“Look,Listen,FeelforBreathing”*30compressions2breathsNO:“Look,Listen,FeelforBreathing”*不看不听不觉AChangeFromA-B-CtoC-A-B“Adults”Childreninfants(excludingthenewlyborn)复苏步骤WhataboutOxygen?VF-CA:中心血液中富含氧ExperimentalworkhasshownArterialSat

4、sremainacceptableforupto10minofCCC呼吸停-通气!RespiratoryArrest-Different!VentilationcrucialtoreplaceOxygen关键:CCC心脑C-A-Bchestcompressionsinitiatedsooner及早按压ForgetCPR,GiveCCRInstead心脑复苏新概念CardiocerebralResuscitation忘了CPR代之CCRStandardCPR:30:2ContinuousChestCompressions心脑复苏概念CardiocerebralResuscitati

5、on200chestcompressions200chestcompressionsSingleshockwithoutpulseCheckorrhythmanalysisBVMorPassiveInsuflation100%FIO2BeginIVAnalysis200chestcompressionsSingleshockifIndicatedwithoutpulsecheckorrhythmanalysisAnalysisSingleshockifIndicatedwithoutpulsecheckorrhythmanalysisResumeStandardACLSConsi

6、derEndotrachealIntubation200chestcompressionsCCOnly•EMSarrivalAdminister1mgIVEpinephrineAnalysisIfadequatebystanderchestcompressionsareprovided,EMSprovidersperformimmediaterhythmanalysisThree-PhaseModelofResuscitation02468101214161820ArrestTime(min)CirculatoryPhaseElectricalPhaseMetabolicPhas

7、e0100%MyocardialATPWeisfeldtML,BeckerLB.JAMA2002:288:3035-8rapiddefibrillationgoodchestcompressionslittlewecando外行成人CPR简化成人基本生命支持:CCC+DFChestCompressions*2010(New):Hands-Only™“pushhardandfast”onthecenterofthechest动手不动口30compressionsto2breath