【正文】 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。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 。 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? ? Cardiopulmonary resuscitation (CPR) CPR is a bination of rescue breathing and chest pressions delivered to victims thought to be in cardiac arrest. When cardiac arrest occurs, the heart stops pumping blood. CPR can support a small amount of blood flow to the heart and brain to “buy time” until normal heart function is restored.. 16 Treatment of cardiac arrest CPR ? Basic life support (CPR) ? A: Airway ? B: Breathing ? C: Circulation ? D: defibrilation 17 Basic Life Support —Airway ? 1. Clear the airway Quick inspection of the mouth and throat may reveal a blocked airway. the patient should be placed on his/her back on a firm surface. tilting the head, lifting the chin will lift the tongue away from the back of the mouth, opening the airway. ? In the possibility of a neck injury, lifting the chin or jaw may be enough to stabilise the airway。s chest. ? Remove, open or cut the patient‘ s excess clothes. (doing CPR through a thin clothing is acceptable). ? Place your hands directly above the sternum, one on top of the other, two fingers‘ width (45cm) above the point where the lower ribs meet. To avoid injuring ribs, only the heel of your hand should touch the chest. (The American Heart Association suggests using the CPR landmark described as, in the center of the chest, between the nipples.) ? Shift your weight forward on your knees until your shoulders are directly over your hands. 28 Begin chest pressions: ? Keeping your elbows locked straight, repeatedly bear down and then e up, bear down and e up. You must depress the chest of an average adult about 2 inches (45cm) with each pression. It is important to release pletely after each chest pression. ? Compress the chest about 100 times every minute. To get the right speed and rhythm, count out loud as you do the pressions, saying 1, 2, 3, 4, 5, 1, 2, 3, 4, 5, 1, 2, 3, 4, 5. Try to press and release for equal periods of time. ? After each 30 pressions, give the victim 2 rescue breaths, p182 ? Return to the victim39。 多器官功能支持 45 Defibrillation electromechanical dissociation, EMD 46 CPR on babies aged under 1 year ? Open the airway. Remove any visible obstructions from the mouth and nose ? Breathing Attempt 5 initial rescue breaths ? Place 2 fingers in the middle of the chest and press down one third of the depth of the chest. After 30 chest pressions give 2 breaths ? Continue with cycles of 30 chest pression and 2 rescue breaths until emergency help arrives. 47 48 Advanced life support Advanced Life Support ? (Drugs) ? (ECG) ? (Fibrillation) Resuscitation success ? no treatment 0% ?Delayed defibrillation 2% ?Early CPR+ Delayed defibrillation 8% ?Early access+Early CPR+ Delayed defibrillation 20% ?Early access+Early CPR+ Delayed defibrillation +early ACLS 3040% 49 Advanced life support procedures ? (a) Secure a definitive airway ? Attempt tracheal intubation. When undertaken by experienced personnel, tracheal intubation remains the optimal procedure. ? The laryngeal mask airway (LMA) or Combitube are acceptable alternatives to tracheal intubation ? (b) Establish ventilation ? Ventilate the patient’s lungs with 100% oxygen using a selfinflating bag with a reservoir or an automatic resuscitator. 50 Advanced life support procedures ? (c) Establish vascular access ? The central veins are the optimal route for delivering drugs rapidly into central circulation. However, these routes require special training and may have plications, some of which are potentially lifethreatening. Peripheral venous cannulation is often quicker, easier, a