【正文】 1 Cardiopulmonary Resuscitation (CPR) Jieyu Fang Department of Anesthesia, The First Affiliated Hospital, 2 CPR ? BLS diagnosis A,B,C effectiveness CPR for children and infants ? ALS Advanced Life Support PLS scoring system 搶救過(guò)程可分為： 基本生命支持（ Basic Life Support,BLS） 「 A」 =Air Way 開放氣道 。 「 B」 =Breathing 人工通氣 。 「 C」 =Circulation 人工循環(huán) . 高級(jí)生命支持 （ Advanced Cardiac Life Support,ACLS） 3 BACKGROUND ? Approximately 700,000 cardiac arrests per year in Europe ? Survival to hospital discharge presently approximately 510% ? Bystander CPR vital intervention before arrival of emergency services ? Early resuscitation and prompt defibrillation (within 12 minutes) can result in 60% survival 4 What is Cardiac arrest? ? Cardiac arrest is the cessation of normal circulation of the blood due to failure of the heart to contract effectively during systole. ? if the patient still has a pulse, respiratory arrest (the bined term cardiorespiratory arrest) is also used. ? lack of blood supply results in cell death from oxygen starvation. ? Cerebral hypoxia, or lack of oxygen supply to the brain, causes victims to lose consciousness and stop breathing. ? Cardiac arrest is a medical emergency that, if left untreated, invariably leads to death within seconds to minutes. ? The primary firstaid treatment for cardiac arrest is cardiopulmonary resuscitation. 5 Etiology ? Coronary artery disease (CAD) is the predominant disease process associated with sudden cardiac death in the United States. ? In apparently healthy adults, cardiac arrest is often caused by ventricular fibrillation during myocardial infarction (heart attack). ? In children, cardiac arrest is typically caused by hypoxia from other causes such as neardrowning. With prompt treatment survival rates are high. ? Every fatal injury or illness ultimately terminates in cardiac arrest, which is a natural part of the processes of death. 6 Diagnosis ? The state of cardiac arrest is diagnosed in an unconscious (unresponsive to vigorous stimulation) person who does not have a pulse . ? An ECG clarifies the exact diagnosis and guides treatment. but treatment should begin without awaiting an ECG. 7 cardiac arrest four rhythms ? Ventricular fibrillation % ? Ventricular standstill (asystole) % ? Electromechanical dissociation(EMD) % ? Ventricular tachycardia % ? There are 4 rhythms which result in a cardiac arrest. VF and VT are both responsive to a defibrillator and so are colloquially referred to as shockable rhythms, whereas asystole and EMD are nonshockable. 8 Cardiopulmonary Resuscitation (CPR) Definition 是指對(duì)于早期心臟呼吸停止的病人，通過(guò)采取人工呼吸，人工循環(huán)，電除顫等方法幫助病人恢復(fù)自主心跳和自主呼吸的一種急救技術(shù)。 9 What is Electromechanical dissociation (EMD)Pulseless electrical activity ? Refers to anized electrical depolarization without mechanical contractions, (persistence of electrical activity in the heart but there is ineffective cardiac contraction). ? The primary mechanisms are cardiac rupture, acute tamponade, global ischemia, acute MI, obstructing by intracardiac tumor or thrombus, and chronic heart failure,hypovolemia, hypothermia, significant acidosis,medication overdose (tricyclic agents, digitalis, betblockers,calcium channel blockers). 10 Asystole ? Asystole is the absence of electrical activity on ECG, with absent perfusion, BP, and pulse. ? Causes include severe generalized myocardial ischemia, ventricular rupture, and ? hyperpolarization of cardiac cell membranes in severe hyperkalemia (serum K+ 7 mEq/L) or hypermagnesemia. 11 Diagnosis ? Cardiac arrest strikes immediately and without warning. Here are the signs: ? Unconscious inadequate cerebral perfusion ? stopped breathing ? lack of circulation In many cases, lack of carotid pulse is the gold standard for diagnosing cardiac arrest, but lack of a pulse (particularly in the peripheral pulses) may be a result of other conditions (. shock) If cardiac arrest occurs, begin CPR immediately for 1 min amp。 call 120. 12 Common causes of cardiac arrest PRIMARY: Sudden cessation of heart function Myocardial ischemia Electric shock Drugs,. potassium Secondary Asphyxia,hypoxia,hypercarbia Exanguination Central nervous system failure Metabolic/electrolyte disorders Temperature extremes Toxins Acute anaphylaxis 13 Treatment of cardiac arrest ? Basic Life Support (CPR) Continous of effective Basic Life Support remains important to maintain vital an perfusion assure circulation of lifesaving drugs ? Advanced life support: treats cardiac arrest definitively with drugs, fluids, DC countershock or artificial pacemaker when appropriate 14 Treatment Chain of Survival ? Outof –hospital arrest,several anization promote the idea of “Chain of survival” ? Early recognition/access ? Early CPR ? Early defibrillation ? Early advanced care 及早進(jìn)入急救程序 及早 CPR 及早電除顫 及早進(jìn)一步治療 15 What is CPR? ? Cardiopu