國際心肺復(fù)蘇指南

1、Guidelines Writing Group Chairs Michael R. Sayre, MD,貴陽醫(yī)學(xué)院附院麻醉科 曾慶繁,2010年AHA 心肺復(fù)蘇指南介紹,,,1960------------2010 Kouwenhoven,2010心肺復(fù)蘇50周年,,,356 位專家來自29 個國家 歷時36個月討論,2010 International Consensus Confe

2、rence,,Robert A. Berg University of PennsylvaniaProfessor of Anesthesiology and Critical Care Medicine, DivisionChief, Pediatric Critical Care,Cardiac arrest can be caused by,室顫 VF室速(無脈)VT 無脈性電活動PEA心博停止asystole.無脈

3、性心動過緩Pulseless bradycardia,4 rhythms,,室顫 無脈性室速 VF/Pulseless VTchest compressions (CC)early Defibrillation (DF),,Early recognition cardiac arrest,及早識別心跳驟停,外行急救lay rescuer,1.突然暈倒 suddenly coll

4、apse 2.意識消失 Unresponsive 3.無呼吸或無正常呼吸 not breathing 4.Seizure (not normally,gasping). cardiac arrest降低脈搏檢查的重要性Minimize the importance of pulse check

5、s,,不檢查脈搏Not check for a pulse,2005 (Old): “Look, listen, and feel”,,NO: “Look, Listen, Feel for Breathing”*,不看 不聽 不覺,,,A Change From A-B-C to C-A-B,“Adults” Childreninfants (excluding thenewly born),復(fù)蘇步驟,,,What

6、 about Oxygen?,VF-CA: 中心血液中富含氧 Experimental work has shown Arterial Sats remain acceptable for up to 10 min of CCC呼吸停- 通氣! Respiratory

7、Arrest-Different !Ventilation crucial to replace Oxygen,關(guān)鍵:CCC,心 腦,,C-A-B,chest compressions initiated sooner,及早按壓,Forget CPR, Give CCR Instead,心腦復(fù)蘇新概念Cardiocerebral Resuscitation,,忘了CPR,代之CCR,Standard CPR: 30:2,

8、Continuous Chest Compressions,心腦復(fù)蘇概念Cardiocerebral Resuscitation,200 chestcompressions,,200 chestcompressions,Single shockwithout pulse Check or rhythm analysis,BVM or PassiveInsuflation 100% FIO2Begin IV,Analysi

9、s,,200 chestcompressions,Single shock if Indicated without pulse check orrhythm analysis,Analysis,,Single shock if Indicated without pulse check orrhythm analysis,Resume Standard ACLSConsider Endotracheal Intuba

10、tion,200 chestcompressions,CCOnly?,EMSarrival,,Administer 1 mg IV Epinephrine,,,,Analysis,If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analysis,,,Three-Phase Model

11、of Resuscitation,,,,,,,,,,,,,0,2,4,6,8,10,12,14,16,18,20,Arrest Time (min),,,,,,,,,,0,100%,Myocardial ATP,Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8,rapid defibrillation,good chest compressions,little we can do,外行

12、成人CPR,簡化成人基本生命支持,:CCC+DF,Chest Compressions*,2010 (New): Hands-Only? “push hard and fast” on the center of the chest動手不動口30 compressions to 2 breaths,Chest Compression Rate: At Least 100 per Minute*,2010 (New):

13、 chest compressions at a rate of at least 100/min.(快 ! 不間斷)2005 (Old): Compress at a rate of about 100/min.,Chest Compression Depth*,2010 (New): hard !The adult sternum should be depressed at least 2 inches (5 cm).

14、2005 (Old): approximately 1,1/2 to 2 inches (approximately 4 to 5 cm).,,,,C A B,電擊治療ELECTRICAL THERAPIES,AED Use in Children Now Includes Infants2010 (New):<1 year of age.2005 (Old)

15、:Not use of AEDs for infants <1 year of age.,先除顫 VS 先CPR ?,CPR <3minDefibrillationHowever, in monitored patients, the time from VF to shock delivery should be under 3 minutes,,1次除顫 vs 3連續(xù)除顫?,2010 (

16、No Change From 2005): 一次電擊后 立即CPR,,200 chestcompressions,,200 chestcompressions,Single shockwithout pulse Check or rhythm analysis,BVM or PassiveInsuflation 100% FIO2Begin IV,Analysis,,200 chestcompre

17、ssions,Single shock if Indicated without pulse check orrhythm analysis,Analysis,,Single shock if Indicated without pulse check orrhythm analysis,Resume Standard ACLSConsider Endotracheal Intubation,200 chestcomp

18、ressions,CCOnly?,EMSarrival,,Administer 1 mg IV Epinephrine,,,,Analysis,If adequate bystander chest compressions are provided, EMS providers perform immediate rhythm analysis,,,CC200 -shockcc200(不檢查脈搏/心律分析),電極放置El

19、ectrode Placement,2010 (Modification of Previous Recommendation): AED electrode pads positions : lateral posterior

20、 Anterior left infra scapular right infrascapular,,,,,胸骨旁(鎖骨下),2005 (Old):,conventional sternal-apical (anteriorlateral) position. Right pad lef

21、t pad Sternal apical胸骨旁(鎖骨下) 心尖right or left upper back.,,,ADVANCED CARDIOVASCULAR LIFE SUPPORT,,監(jiān)測PETCO2 :,1.確定氣管導(dǎo)管位置 confirming tracheal tube placement 2.監(jiān)測C

22、PR有效性 monitoring CPR quality3.檢查心跳恢復(fù) detecting ROSC,CPR質(zhì)量,,藥物New Medication Protocols,2010 (New): 阿托品不常規(guī)用于PEA/asystoleAtropine not routine use for PEA/asystole,2005 (Old):,阿托品用于高級心血管生命支持 Atropine included in

23、 the ACLS 心搏停止 asystole or slow PEA 可用阿托品Atropincould be considered..,心動過速tachycardia,規(guī)律的Regular單型monomorphic寬QRS 心動過速wide-complex tachycardia 腺苷Adenosine(rhythm is regular),,2010 (New),,adenosine只用于規(guī)則的

24、窄QRS 的折返性室上速only for suspected regular narrow-complexreentry supraventricular tachycardia,2005 (Old):,不規(guī)律的寬QRS 心動過速irregular wide-complex tachycardias不用腺苷Adenosine should not be used(may cause degeneration of the r

25、hythm to VF),心動過緩Bradycardia,癥狀性不穩(wěn)定心動過緩symptomatic unstable Bradycardia變時性藥物輸注chronotropic drug infusions (an alternative to pacing),,atropine while awaiting a pacer or if pacing was ineffective.chronotropic d