【正文】 circumstances of ICU admission now responsible for approx. 190。 72 hours ? Series of true/false questions ? Weighted according to their individual contribution to mortality 72 TISS (Therapeutic Intervention Scoring System) ? Measuring sickness severity based on type amp。L–1 using insulin infusions, and PaO2 100 mmHg for the first 24 hr. 52 53 54 DEFIBRILLATION 55 SWITCH ON AEDautomated external defibrillator ? Some AEDs will automatically switch themselves on when the lid is opened 56 ATTACH PADS TO CASUALTY’S BARE CHEST 57 ANALYSING RHYTHM DO NOT TOUCH VICTIM 58 SHOCK INDICATED ? Stand clear ? Deliver shock 59 SHOCK DELIVERED FOLLOW AED INSTRUCTIONS 30 2 60 Intensive care and resuscitation ? CPR basic life supportABC advanced life supportDEF prolonged life supportGH ? ICU scoring system APACHE scoring system 61 62 ICU Scoring Systems ? Why are scoring systems needed? ? Classifying scoring systems ? History of scoring systems ? Examples of scoring systems ? Recent developments ? Selecting a scoring system ? Discussion 63 “It’s more important to know what sort of person this disease has, than what sort of disease this person has.” William Osler 18491919 64 Why are scoring systems needed? ? Scoring systems can provide: Casemix adjustment for evaluative research A tool for parative audit SMR A mechanism to decide resource allocation An aid for the clinical management of patients 65 History ? 1953 – Virginia Apgar ? 1974 – Glasgow Coma Scale ? Quantifying relationship between disease severity and oute ? 1980s – acute physiology and chronic health evaluation (APACHE) amp。 neurologic care。nitroglycerin。dopamine。βblokers。 頭部冰袋降溫 ， 腦復(fù)蘇 。s nose with one hand, while lifting the chin with her other hand to keep the mouth open.. ? Initially, two rescue breaths are given. Conventional ventilation techniques during singleresponder CPR require the lungs to be inflated twice in succession every 30 chest pressions. 22 Bag –mask ventilator 23 Mechanical ventilation A definitive airway will be established by the placement of an endotracheal tube which is attached to a mechanical ventilation. 24 Basic Life Support —circulation ? To check for a pulse place your fingers on the victim‘ s neck and slide them to the side until you find a groove in the neck above the carotid artery. Check for pulse for no more than ten seconds. ? Pulse can also be found in the wrists and the ankles, although in an emergency situation there is not usually time to check for pulse here. (In patients with a low blood pressure, the pulse may disappear in the wrists and ankles, and can only be felt in the neck or femoral arteries.) On infants it can be found on the inside of the upper arm. 25 Basic Life Support —circulation ? If there is no circulation: Begin chest pressions ? Chest pression is based on the assumption that cardiac pression allows the heart to maintain a pump function by sequential filling and emptying of its chambers, with petent valves maintaining forward direction of flow. The palm of one hand is placed ? Send a bystander to call for help using the emergency telephone number. 26 ? In some places, including the UK and the United States, some experts no longer advise laypersons to assess the carotid pulse because it wastes time and studies have shown it leads to an incorrect conclusion in up to 50% of cases. Instead they remend looking for other visible signs of circulation. Health professionals are still advised to perform a carotid pulse check, taking no more than 10 seconds, whilst also checking the other signs of a circulation. 27 Begin chest pressions ? Place the victim on their back on a firm surface. (a soft surface will render the pression pletely useless). ? Kneel next to the victim39。 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