同步电击tachycardia的治疗.pptVIP

Cardiovascular care of neurocritically ill patients 王忠信醫師 MD, MS 部立雙和醫院急診醫學科 105.08.13 情境案例 一個60歲EKG技術員在幫病人做12導程的EKG時突然倒下，他在倒下之前並無訴任何不適… 你若正好在他身旁，該作何處理? 旁邊的一位同事立即幫他開始進行CPR，當你推著急救器材趕到現場後該如何處置？ Sudden Collapse? 一度評估 (Primary CABD) 著重於基本心肺復甦術與早期電擊 Circulation: 給予胸部按壓 Airway: 打開呼吸道 Breathing: 給予正壓呼吸 Defibrillation: 給予適當電擊 A:打開呼吸道 - 壓額舉頷法 Bag-valve-mask , BMV  ( 俗稱 Ambu bag) 二度評估 (Secondary ABCD) 著重於詳細評估與及時處置 Airway: 建立安全的呼吸道 Tracheal intubation LMA (喉罩呼吸道) Endotracheal tube intubation Advanced Airway 二度評估 (Cont.) Breathing: 檢查通氣與給氧是否適當 Primary confirmation of the tube placement Secondary confirmation of tube placement Monitoring of CO2 and O2 level Active effort to prevent tracheal tube dislodgement 二度評估 (Cont.) Circulation: 建立血管通路 (O2-IV-Monitor) 判讀心律 (Change Rhythm →Check Pulse ) 給予適當的藥物 Differential Diagnosis: 找到可治療的原因並處理之 牢記在心、時時活用 一度CABD Circulation 壓胸 Airway 打開呼吸道 Breathing 正壓呼吸 Defibrillation 電擊 二度ABCD Airway 插管 Breathing 確認位置及有效換氣 Circulation O2-IV-Monitor及給藥 Differential Diagnosis 鑑別診斷 Sudden Collapse? Shock!! VF / Pulseless VT PA-BOX1: 5H and 5T PEA: often caused by reversible condition! 尋找及治療可能的病因： 5H- 低血容、低血氧、酸血症、高/低血鉀、低體溫 5T- 藥物中毒、心包膜填塞、張力性氣胸、梗塞(肺動脈或冠狀動脈) 團隊合作 1st rescuer: leader 2nd rescuer: helps with CPR 3rd rescuer: assumes airway control 4th rescuer: obtains IV access 5th rescuer: defibrillation 6th rescuer: recording Bradycardia 及Tachycardia 之處置 Bradycardia (HR60) Sinus bradycardia Atrio-ventricular blocks - 1 degree - 2 degree (Mobitz type I II) - 3 degree (complete) Bradycardia的治療 設定TCP Tachycardia (HR100) Narrow complex tachycardia regular: sinus tachycardia reentry supraventricular tachycardia junctional tachycardia atrial flutter (AF) irregular: atrial fibrillation (Af) multifocal atrial tachycardia (MAT) Wide complex tachycardia regular: ventricular tachycardia SVT with aberrancy irregular: atrial fibrillation with