心肺復(fù)蘇LANDINGSLIDE匯報人：X.XLOGO心肺復(fù)蘇醫(yī)療培訓(xùn)醫(yī)療教育djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka目錄LOGO010203心臟驟停定義與原因心臟驟停的臨床表現(xiàn)與診斷心肺復(fù)蘇操作方法djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kaLOGOPART01心臟驟停定義與原因djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka心臟驟停(cardiacarrest)是指心臟射血功能的突然終止，大動脈搏動與心音消失，重要器官如腦嚴(yán)重缺血、缺氧，導(dǎo)致生命終止。這種出乎意料的突然死亡，醫(yī)學(xué)上又稱猝死。是公共衛(wèi)生和臨床醫(yī)學(xué)領(lǐng)域中最危急的情況之一，表現(xiàn)為心臟機(jī)械活動突然停止，患者刺激無反應(yīng)，無脈搏，無自主呼吸或?yàn)l死喘息等，如不能得到及時有效救治常致患者即刻死亡，即心臟性猝死（suddencardiacdeath，SCD）。心臟驟停定義與原因djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka心臟疾?。ü谛牟∽疃嘁姡﹦?chuàng)傷、淹溺、藥物過量、窒息、出血等成人發(fā)生SCA最常見原因?yàn)樾呐K疾病，尤其是冠心??；其他包括創(chuàng)傷、淹溺、藥物過量、窒息、出血等非心臟性原因。小兒發(fā)生SCA的主要原因?yàn)榉切呐K性的，包括呼吸疾?。ㄈ鐨獾拦Ｗ?、煙霧吸入、溺水、感染、嬰兒猝死綜合征），中毒（包括藥物過量），神經(jīng)系統(tǒng)疾病等。非心臟性如氣道梗阻、煙霧吸入、溺水、感染，中毒等心臟驟停定義與原因成人兒童djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka心電-機(jī)械分離心臟停搏心室顫動點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題點(diǎn)擊輸入標(biāo)題輸入標(biāo)題心臟驟停定義與原因djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka心室顫動或撲動

心臟停搏和心電-機(jī)械分離心臟驟停定義與原因djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kaLOGOPART02心臟驟停的臨床表現(xiàn)與診斷djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka診斷心音消失。脈搏捫不到,血壓測不出。意識突然喪失或伴有短陣抽搐。呼吸斷續(xù),呈嘆息樣,后即停止。瞳孔散大。面色蒼白兼有青紫。意識突然喪失。大動脈(頸動脈、股動脈)搏動消失。心臟驟停的臨床表現(xiàn)與診斷臨床表現(xiàn)djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kaLOGOPART03心肺復(fù)蘇操作方法djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kaLOGOPART03心肺復(fù)蘇操作方法djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka10秒—意識喪失，突然倒地。60秒—自主呼吸逐漸停止。30秒—全身抽搐。心肺復(fù)蘇操作方法4分鐘—開始出現(xiàn)腦水腫。6分鐘—開始出現(xiàn)腦細(xì)胞死亡。8分鐘—“腦死亡”“植物狀態(tài)”。djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka開始搶救時間心肺復(fù)蘇成功率＜4分60％4-6分10％＞6分4％＞10分0.09％“黃金4分鐘”時間與搶救成功率心肺復(fù)蘇操作方法djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka是指對心跳、呼吸驟停的患者采取緊急搶救措施（人工呼吸、心臟按壓、快速除顫等）使其循環(huán)、呼吸和大腦功能得以控制/部分恢復(fù)的急救技術(shù)2010年10月-美國心臟協(xié)會（AHA）公布最新心肺復(fù)蘇(CPR）指南，重新安排了CPR傳統(tǒng)的三個步驟,從原來的A-B-C改為C-A-B。生存鏈：由2005年的四早生存鏈改為五個鏈環(huán)。心肺復(fù)蘇操作方法55%15%djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka早期CPR：強(qiáng)調(diào)胸外心臟按壓，對未經(jīng)培訓(xùn)的普通目擊者，鼓勵急救人員電話指導(dǎo)下僅做胸外按壓的CPR；完整的心臟驟停后處理。有效的高級生命支持（ALS）早期除顫：如有指征應(yīng)快速除顫；早期識別與呼叫；心肺復(fù)蘇操作方法01020304djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka進(jìn)一步生命支持ACLS基礎(chǔ)生命支持BLS延續(xù)生命支持PLS心肺復(fù)蘇操作方法djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka基礎(chǔ)生命支持(BLS)識別心肺復(fù)蘇（CPR）胸部按壓（C，compression）開放氣道（A，airway）人工呼吸（B，breathing）除顫心肺復(fù)蘇操作方法呼救同時，迅速將病人擺成仰臥位，頭側(cè)。解開病人衣領(lǐng)、領(lǐng)帶以及拉鏈。擺放地點(diǎn)：地面/硬板床。翻身時整體轉(zhuǎn)動，保護(hù)頸部。保持身體平直、無扭曲。救護(hù)：跪于病人右側(cè)。djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka昏迷變淺，出現(xiàn)各種反射身體出現(xiàn)無意識的掙扎動作自主呼吸逐漸恢復(fù)觸摸到規(guī)律的頸動脈搏動面色、口唇轉(zhuǎn)為紅潤雙側(cè)瞳孔縮小、對光反射恢復(fù)心肺復(fù)蘇操作方法清除呼吸道雜物：假牙、嘔吐物、血液等。體位：病人平臥在平地或硬板上，采用仰頭抬頜法使病人口腔與咽喉成直線。心肺復(fù)蘇操作方法開放氣道（A，airway）A1清理口腔A2開放氣道操作方法：術(shù)者站在病人的右側(cè)，左手放在病人的前額，用力將頭部下壓，右手置于病人下頜骨下緣將顏部向上，向前抬起，可以起到通暢呼吸道的作用。djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka至少100次/min按壓與放松的時間各占50%C4按壓頻率:地上：采用跪姿，雙膝平病人肩部床旁：應(yīng)站立于腳踏板，雙膝平病人軀干雙臂繃直、與胸部垂直,不得彎曲C4按壓頻率:心肺復(fù)蘇操作方法胸骨下1/3交界處雙乳頭與前正中線交界處C2按壓部位胸骨下陷至少5cm有效標(biāo)準(zhǔn)：能觸摸到頸或股動脈搏動C3按壓深度djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7ka專業(yè)人士摸頸動脈脈搏，在喉結(jié)左右約兩指幅處，單側(cè)觸摸、力度適中,時間＜10秒非專業(yè)人士立即胸外心臟按壓!!心肺復(fù)蘇操作方法呼救；撥打急救電話（先急救，再求救）二叫判斷有無意識（＜10秒）1.拍打雙肩;2.大聲呼換;3.掐壓穴位一叫djqihd91hkjdsajbasdhiuqh123jkhjkcaksjdiqnsamdkl7kadjqihd91hkjdsajbasdhiuqh123