【正文】 ing CPR: ? Consider and correct reversible causes. If not already: ? Check electrodes, paddle position and contact. Secure and verify the airway, administer oxygen, obtain IV access. (Once the trachea has been intubated, chest pressions at a rate of 100 min_1 should continue uninterrupted, with ventilations performed at about 12 min_1 asynchronously) ? . Give 1 mg adrenaline IV. ? If venous access has not been established consider giving 2–3 mg adrenaline via the tracheal tube in a 1:10 000 solution. ? . The interval between the third and fourth shocks should not be more than 1 min. ? (d) Reassess the rhythm on the monitor. ? Check for signs of a circulation, including the carotid pulse, but only if the ECG waveform is patible with cardiac output. ? (e) If the rhythm is nonVF:VT, follow the path of the algorithm. 37 38 ? (f) If VF:VT persists: ? Consider amiodarone in VF:VT refractory to three initial shocks. ? Attempt defibrillation with three further shocks ? at 360 J with a monophasic defibrillator or an ? equivalent energy for an alternative waveform defibrillator. ? . Give 1 mg adrenaline IV. ? The process of rhythm reassessment, delivery of three shocks and 1 min of CPR will take 2–3 min. One mg of adrenaline is given in each loop every 3 min. ? Repeat the cycle of three shocks and 1 min of CPR until defibrillation is achieved. ? (g) Each period of 1 min of CPR offers a new opportunity to check electrode:paddle positions and contact, secure and verify the airway, administer oxygen, obtain IV access, if not already done. ? . Consider the use of other medications (., buffers). 39 Advanced Life Support,ALS Non VF:VT — asystole, pulseless electrical activity ? (a) Check for signs of a circulation, including the carotid pulse. ? (b) Perform 3 min of CPR (30:2), if the patient is in cardiac arrest. ? NB: If the nonVF:VT rhythm occurs after defibrillation,perform only 1 min of CPR before reassessing the rhythm and giving any drugs. ? (c) During CPR: Consider and correct reversible causes. If not already: ? Check electrodes, paddle position and contact ? Secure and verify the airway, administer oxygen, obtain IV access. (Once the trachea has been intubated, chest pressions should continue uninterrupted, with ventilations performed at 12 min_1 asynchronously) ? . Give 1 mg adrenaline IV. If venous access has not been established, consider giving 2–3 mg adrenaline via the tracheal tube in 1:10 000 solution. 40 ? (d) Reassess the rhythm after 3 min of CPR. ? Check for signs of a circulation, including the carotid pulse, but only if the ECG waveform is patible with cardiac output. ? (e) If VF:VT, follow the path of the algorithm. ? (f) If nonVF:VT, perform 3 min of CPR (30:2). ? . Give 1 mg adrenaline IV. ? As the process will take 3 min, 1 mg of epinephrine (adrenaline) is given in each loop every 3 min. ? (g) Each period of 3 min of CPR offers a new opportunity to check electrode paddle positions and contact, secure and verify the airway, administer oxygen, obtain IV access, if not already done. ? (h) Consider the use of other medications (atropine, buffers) and pacing. 41 Advanced Life Support,ALS medications ? Consider the use of other measures (medications and pacing) ? (a) Antiarrhythmics ? There is inplete evidence to make firm remendation on the use of any antiarrhythmic drug. ? Amiodarone is the first choice in patients with VF:VT refractory to initial shocks. The initial dose is 300 mg diluted in 20 ml 5% dextrose given as an IV bolus. An additional 150 mg of amiodarone may be considered if VF:VT recurs. ? Consider the use of amiodarone after three shocks, but do not delay subsequent shocks. 42 ? (b) Buffers ? Consider giving sodium bicarbonate (50 ml of an % solution) or an alternative buffer to correct a severe metabolic acidosis (). When blood analysis is not possible, it is reasonable to consider sodium bicarbonate or an alternative buffer after 20–25 min of cardiac arrest. ? (c) Atropine ? A single dose of 3 mg of atropine, given as an IV bolus, should be considered for asystole and pulseless electrical activity (rateB60 beats min_1). ? (d) Pacing ? Pacing may play a valuable role in patients with extreme bradyarrhythmias, but its value in asystole has not been established, except in cases of trifascicular block where P waves are seen. 43 Sequence of actions ? Consider:treat reversible causes. ? In any cardiac arrest patient, potential causes or aggravating factors for which specific treatment exists should be considered:(4H 4T) ? Hypoxia ? Hypovolaemia ? Hyper:hypokalaemia ? Hypothermia ? Tension pneumothorax ? Tamponade ? Toxic:therapeutic disturbances ? Thromboemboli 44 The guideline of CPR 階段 步驟 無(wú)需設(shè)備措施 要采用設(shè)備措施 現(xiàn) 場(chǎng) 救 治Basic Life Support A保持氣道通暢 Airway 頭后仰 ， 提起下頜 ， 手法清理口咽部 ， 推舉上腹部 ， 扣打背部 咽部抽吸 ， 置入鼻咽導(dǎo)管 ， 置入食管填塞器 ， 置入氣管內(nèi)導(dǎo)管氣管內(nèi)抽吸 ， 氣管切開 B人工呼吸 (Breathing) 口對(duì)口 (鼻 )呼吸 口對(duì)面罩呼吸 (有 2O或無(wú) O2)簡(jiǎn)易呼吸器人工呼吸 （ 有 O2或無(wú)O2） 機(jī)械通氣 C人工循環(huán) Circulation) 胸外心臟按壓 胸外心臟肺復(fù)蘇機(jī) 進(jìn)一步生命支持Advanced LifeSupport D用藥輸液 (drugs) E心電圖監(jiān)測(cè) (ECG) F電除顫 (Fibrillation) 開放靜脈 、 腎上