《心肺复苏CPR-教学课件（英文）.ppt》由会员分享，可在线阅读，更多相关《心肺复苏CPR-教学课件（英文）.ppt（112页珍藏版）》请在三一文库上搜索。
1、Cardiopulmonary Resuscitation (CPR),教学大纲要求,掌握心跳骤停的诊断； 掌握基础生命支持的内容和方法； 掌握进一步生命支持的主要内容和方法； 熟悉导致心跳骤停的常见原因； 熟悉心脑后期生命支持的治疗原则；,Vital Organ Function,Oxygen Supply,Sufficient Oxygenated Blood,Sufficient Oxygen,Blood,Good circulation,Insufficient or cease of Oxygen supply,Vital organ ischemia or death,Hypoxi
2、a,Low CBV or Desaturation,Circulation problem,Ventilation,Airway,Hemorrhage or Hb abnormal,Cardiac Pump,hemodynamics,microcirculation,Definition of Cardiac Arrest -Clinical Death,Medical emergency with absent or inadequate contraction of the left ventricle of the heart that immediately causes bodywi
3、de circulatory failure. The signs and symptoms include loss of consciousness; rapid shallow breathing progressing to apnea (absence of breathing); profoundly low blood pressure (hypotension) with no pulses that can be felt over major arteries; and no heart sounds. Cardiac arrest is one of the greate
4、st of all medical emergencies. Within several minutes, there is lack of oxygen (tissue hypoxia), leading to multiple organ injury. Unless cardiac arrest is quickly corrected, it is fatal.,Ventilation,Airway,Hemorrhage or Hb abnormal,Cardiac Pump,Hemodynamics,microcirculation,Cardiac Arrest,Tissue Hy
5、poxia,Breathing,Brain ischemia,Ventilation,Airway,Hemorrhage or Hb abnormal,Hemodynamics,microcirculation,Cardiac Arrest,Heart,MI,arrhythmia,Heart failure,reflex,Summery of Mechanisms of CA,Reduction of Coronary Blood Flow Critical Cardiac Arrhythmia Absent of inadequate Contraction of the Left Vent
6、ricle Severe Reduction of Cardiac Return Volume,Cardiac Arrest,Brain ischemia,Signs of Cardiac Arrest,Unconscious,Dilated Pupils,No pulse,BP o/o,Cyanosis,No Breathing,No bleeding,No SPO2,无脉性室速,Pulseless,VT,室颤,VT,无脉性电活动,Pulseless,Electrical,Activity,心室停搏,Asystole,Pulseless,VT,VF,Pulseless,Electrical,
7、Activity,Asystole,ECG Patterns of Cardiac Arrest,Cardio-Pulmonary Resusitation,An emergency procedure in which the heart and lungs are made to work by manually compressing the chest overlying the heart and forcing air into the lungs. CPR is used to maintain circulation when the heart stops pumping,
8、usually because of disease, drugs, or trauma. An emergency procedure consisting of external cardiac massage and artificial respiration; the first treatment for a person who has collapsed and has no pulse and has stopped breathing; attempts to restore circulation of the blood and prevent death or bra
9、in damage due to lack of oxygen,The factors most related to poor outcome from cardiac arrest,long arrest time before CPR prolonged ventricular fibrillation without definitive therapy inadequate coronary and cerebral perfusion during cardiac massage. rapid application of closed chest compression and
10、early defibrillation,Early Access Early CPR Early Defibrillation Early Advanced Care,Chain of Survival for Adults,Chain of Survival for Children,Prevention of Arrest Early and Effective Bystander CPR Rapid Activation of the EMS Early Advanced Life Support,Basic Life Support (RABC),Objectives: to del
11、iver oxygenated blood to vital organs Response (consciousness) Airway Control Ventilation (Breathing) Chest Compression,Help! Help ! Help!,Initial steps of CPR,Unresponsive?,Open airway,Check breathing (10s),Breathing,Check Pulse (10s),Circulation present ?,EAR,yes,Chest compression,no,Shake and sho
12、ut,Head tilt/chin lift,Look, listen and feel,Two effective breaths,Signs of circulation,Check signs of circulation every 2min,Call for help and AED,Adult BLS Healthcare Provider Algorithm:. Boxes bordered with dotted lines indicate actions or steps performed by the healthcare provider but not the la
13、y rescuer.,BLS,BLS,Open Airway,Why open airway is important? CA may be caused by airway blockage Unconscious patients tend to have airway obstructed by posterior displacement of the tongue or epiglottis due to the decrease of muscle tone decreased tone of the genioglossus muscle (颏舌肌） in particular
14、It is essential to provide adequate respiration for victims (functional respiration),Normal airway vs Obstructed airway,How to Open Airway?,Tilt the head back- head tilt (dont do this if cervical spine injury is suspected) Lift the jaw-chin lift Jaw thrust (First Choice if cervical spine injury is s
15、uspected) Clear the airway (very important for infant),Open Airway,Jaw Thrust,Head Tilt-Chin Lift,Oropharyngeal Airways OPA,Nasopharyngeal Airways NPA,Breathing,Signs and symptoms of respiratory emergencies?,Breathing is :,Too fast or too slow Irregular Too shallow or too deep Noisy or rasping,Perso
16、n is :,Struggling or gasping for air Becoming tired from trying to breathe Semi-conscious Dizzy or anxiety Lips, ears and fingernails bluish Abnormal chest movement Air cannot be felt moving out of mouth or nose,In out-of-hospital or hospital ward settings, initial airway control and ventilation usu
17、ally are accomplished by mouth-to-mouth or mouth-to-mask techniques. 10-12/min with pulse 8-10/min without pulse Vt=400-500ml in an adult (amount to produce visible chest lifting) A deliberate pause is incorporated after every 30th chest compression,Expired air resuscitation,EAR,Mouth to mask ventil
18、ation,BAG-Mask ventilation,Signs of circulation Assessment,Look for any movement, including swallowing or breathing Observe colour of skin on face Check if carotid pulse present or brachial for children.,Take no more than 10s to do this,Effective CPR is based on the artificial delivery of oxygenated
19、 blood to systemic circulatory beds at rates that are sufficient to preserve vital organ function and at the same time providing the physiologic substrate for the rapid return of spontaneous circulation,Chest Compression,Crucial for oxygenated blood delivery,Mechanisms of Cardiac Compression,Cardiac
20、 pump,Thoracic pump,Chest Compression Skills,Find the right place: Center of the Chest lower half of the sternum Rate: 100/min compression/release=1:1 4-5cm deep for adults Pressure be firm, controlled and applied vertically CC/EAR=30:2,Push hard and fast Allow the chest fully recoil Minimal interru
21、ptions Rotate every 2 mins,Cardiac output is severely decreased during CPR, ranging from 10 to 33 percent of pre-arrest values in experimental animals. Total blood flow also tends to decrease with time during closed chest compression although changes in technique and the use of epinephrine may help
22、sustain cardiac output. Nearly all of the cardiac output is directed to organs above the diaphragm. Brain blood flow is 50 to 90% of normal and myocardial blood flow 20 to 50% of normal lower extremity and abdominal visceral flow is reduced to less than 5% of normal.,Efficiency of CPR,Assessing the
23、Adequacy of Circulation During CPR,myocardial blood flows of 15 to 30 ml/min/100g aortic diastolic pressure exceeds 40 mm Hg and myocardial perfusion pressure (aortic diastolic minus right atrial diastolic pressure) exceeds 20-25 mm Hg. end-tidal CO2 is an excellent noninvasive guide (end-tidal CO2
24、does correlate well with cardiac output during CPR) usually to 20 mm Hg during successful CPR) Earliest sign is a sudden increase in end-tidal CO2 to greater than 40 mm Hg ,when spontaneous circulation resumes. no patient with an end-tidal CO2 10 mm Hg could be successfully resuscitated. not be usef
25、ul for three to five minutes following bicarbonate administration.,Defibrillation,Ventricular fibrillation is common in adults non-traumatic cardiac arrest Earlier defibrillation is important for survival The chances for survival decline 7-10% every minute lapse Be defibrillated at the earliest poss
26、ible moment In hospital CA, defibrillation should be delivered in 3 min Out hospital CA, defibrillation better down in 5 min,Management of VT,Rapid defibrillation is key,Minutes: collapse to 1st shock,In Hospital Defibrillation,A new study using data collected by NRCPR: 6789 VF/VT patients in 369 ho
27、spitals Enrolled in NRCPR between Jan.1, 2000, and July 31, 2005. Defibrillation in 2 min：Survival rate to hospital discharge: 39% Defibrillation more than 2 min: decreased to 22%. And Less likely to have no major neurological disability,Mechanisms of Defibrillation,External current depolarize entir
28、e myocardium simultaneously Entire myocardium is in refractory phase Ectopic discharges of myocardium is not able to induce abnormal electro-activities Sinus rhythm take control,Energy for Defibrillation,Too low will not provide successful cardiovert Too high may cause myocardium injury Use unsynchr
29、onized defibrillation 360J for monophasic damped sine (MDS) defibrillators Start with120- 150J for biphasic, defibrillators Give 200 J for unknown defibrillators,Position of electropad,Automated external Defibrillator (AED),Commonly used by non-health workers Capable of electrocardiographic analysis
30、 Recognition of cardiac rhythm and VF Deliver biphasic shock Disadvantage for health worker is too slow to deliver a shock,Tips for Defibrillation,Must put wet gauges (soaked with saline) or gels under the electropads Must clear the people surrounded before giving the shock Perform CPR if defibrilla
31、tor is not ready and continue CPR if shock is not successful,Summery of BLS,A Airway: open the airway B Breathing: positive-pressure ventilation C Circulation: Chest compression D defibrillation: shock for VF/pulseless VT,Advanced Cardiac Life Support,A Airway: place airway device B Breathing: comfi
32、rmation airway device B Breathing: secure airway device B Breathing: effective oxygenation C Circulation: establish IV access C Circulation: identify rhythm C Circulation: administer drugs for rhythm D differential diagnosis: identify reversible causes,ENDOTRACHEAL INTUBATION,LARYNGEAL MASK AIRWAY(c
33、ontroversial in CPR),THE COMBITUBE,Ventilation,Intubate the patients for airway protection and better oxygenation Cardiac compression should not stop during intubation process Ventilate manually or by ventilator Cardiac compression is not required to discontinue during lung inflation,ECG Monitoring,
34、Connect ECG monitors as soon as CPR started Four common cardiac rhythms in CA Pulseless VT Ventricular fibrillation Asystole Pulseless Electrical Activity,Pharmacologic Agents for CPR,1. Epinephrine Initial Dose: 1mg IV(0.01 mg/kg, IV/IO for children) tracheal route : 2-3times of IV dose diluted in
35、10ml saline Subsequent Doses (every 3-5 minutes) Repeat initial dose Subsequent Doses (every 3-5 minutes) May consider high-dose protocol; 0.1 mg/kg, IV,The efficacy of epinephrine lies entirely in its-adrenergic properties epinephrine helps develop the critical coronary perfusion pressure High dose
36、 epinephrine has no improvement in survival to hospital discharge or neurological outcome, high dose epinephrine was used as rescue therapy.,Epinephrine,2. Vasopressin,as an alternative to the first dose of epinephrine during ventricular fibrillation cardiac arrest dose : 40 units IV, single dose, 1
37、 time only is a potent non-adrenergic vasoconstrictor, acting by stimulation of smooth muscle V1 receptors. half-life in the intact circulation is 10 to 20 minutes,3. Amiodarone (胺碘酮）,Block sodium, potassium, calcium, alpha- channels and beta-adrenergic receptors Indication: should be considered in
38、CA due to VF or pulseless VT after third shock (refractory ventricular fibrillation). Dose: 300mg IV Push, maintanace1mg/min for 6h , then 0.5mg /min, maximum daily dose of 2 grams Cause hypotension and bradycardia when infused too rapidly,4. Lidocaine,Lidocaine: tends to reverse the reduction in VT
39、 threshold. as second-line treatment for VF/VT after 3 unsuccessful shocks. A starting dose of 1-1.5mg/kg. Repeat dose 0.5-0.75% within 5 to 10 min.Total dose should be lower than 300mg(200-300mg in an hour). followed by a maintenance dose of 2mg/min.,5 Bicarbonate best administered on the basis of
40、blood-gas analysis. It is recommended in the presence of severe acidosis (arterial pH7.1, base excess-10). Dose: 1moml/kg(1moml=0.6ml 5% NaHCO2),6. Magnesium,Indications: (1) Hypomagnesemia (2) Torsades de pointes even with normal serum levels of magnesium Dose: 1-2g in 50-100ml 5% GS over 5-10min,
41、followed by infusion 0.5-1g/h Not recommended in Cardiac arrest except when arrhythmia suspected,Cardiac arrest,Basic life support,Attach defib/monitor,Assess rhythm,Pulse present?,no,PEA/Asystle,CPR for 3 min,Adrenaline 1mg,During CPR Correct any reversible causes Connect ECG Set up IV access Advan
42、ced airway control Give adrenaline every 3 min Consider alternative medications,no,VF/VT,Defibrillate X1,CPR for 2min,Adult protocol,Rescuers and health care providers must assume that all un-monitored adult cardiac arrests are due to VF/VT.,Ventricular Fibrillation and Pulseless Ventricular Tachyca
43、rdia,The monitor shows:,Probability of Survival Is Related to 2 Intervals: (1) Collapse to Defibrillation and (2) Collapse to CPR,Collapse to start of CPR: 1, 5, 10, 15 (min),Collapse to defibrillation interval (min),Probability of survival to hospital discharge,Background: Defibrillation and Time,A
44、pproximately 50% survival after 5 minutes Survival reduced by 7% to 10% per minute (if no CPR) Rapid defibrillation is key CPR prolongs VF, slows deterioration,Minutes: collapse to 1st shock,VF-Pulseless VT Algorithm,Pulseless Electrical Activity (PEA) & Asystole,The monitor shows:,Sinus Tachycardia
45、 With No Pulse,Pulseless Electrical Activity,Pulseless Electrical Activity?,Pulseless Electrical Activity?,PEA? Asystole?,PEA & Asystole,Reversible Causes of PEA/Asystole,Bradycardia,Identify and treat possible causes: the 6 Hs and 5 Ts Atropine dose for bradycardia is 0.5 mg with the maximum total
46、dose at 3 mg Pacing is used when the patient fails to respond to atropine or has a high-degree block Dosages for epinephrine: 2-10g/min and dopamine 2-10 g/kg/min.,Emergency Pacemaker Therapy-Transcutaneous cardiac pacing(TCP),Indications: to treat atropine-resistant symptomatic bradyarrhythmias Fea
47、tures: defibrillator model; disposable pacing electrodes positioned anterior-posterior manner.(negative on V2 electrocardiograph position, positive on the left posterior chest beneath the scapula and lateral to the spine Application: Current output is slowly increased until the pacing stimuli obtain
48、 electrical and mechanical capture Tips: Patients may be sedated due to discomfort of skeletal muscle contraction TCP is a temporary measure, transvenous pacing or other definitive treatment should be initiated.,Bradycardia,Bradycardia,Tachycardia,Supraventricular Tachyarrhythmia,include atrial flut
49、ter, atrial fibrillation, AV junctional tachycardia, multifocal atrial tachycardia, paroxysmal reentrant tachycardias,250/min,180/min,Ventricular Tachyarrhythmia,280/min,potentially life-threatening need of urgent intervention Find out the causes is very important(Hypoxia, hypercarbia, hypokalemia and/or hypomagnesemia, digitalis toxicity, and acid-base derangements,Tachycardia,Post-resuscitation therapy,3/10 in hospital resuscitation survive the initial resuscitation procedures 1.5/10 to