2010年AHA心肺复苏新进展.pptVIP

新指南心脏骤停后监护 Avoid excessive ventilation Titrate to target PETCO2 Titrate FiCO2 to SPO2≥94% Infusion fluid 4°C Epinephrine 0.1-0.5mcg/kg.min Dopamine IV infusion(5-10mg/kg.min) Norephinephrine IV infusion(0.1-0.5mg/kg.min) Reversible causes Hypovolemia Hypothemia Toxins Thrombosis Hypo/hyperkalemia The initial objectives Optimize cardiopulmonary function and vital organ perfusion After out-of-hospital cardiac arrest, transport patient to an appropriate hospital with a comprehensive post–cardiac arrest treatment system of care that includes acute coronary interventions, neurological care, goal-directed critical care, and hypothermia Transport the in-hospital post–cardiac arrest patient to an appropriate critical-care unit capable of providing comprehensive post– cardiac arrest care. Try to identify and treat the precipitating causes of the arrest and prevent recurrent arrest Subsequent objectives Control body temperature to optimize survival and neurological recovery Identify and treat acute coronary syndromes (ACS) Optimize mechanical ventilation to minimize lung injury Reduce the risk of multiorgan injury and support organ function Objectively assess prognosis for recovery Assist survivors with rehabilitation services when required 伦理学考虑 要不要去救？ 什么时候去救？ 什么时候停止抢救？ 停止抢救后该做什么？ 2010心肺复苏新进展 心脏骤停的病因与分类 Myocardial infarction Stroke Electrocution Drowning Choking Trauma Drug overdosage Poisoning In hospital SCA Out of hospital SCA Witnessed arrrest Unwitnessed arrest ventricular fibrillation (VF) Pulseless ventricular tachycardia (VT) Pulseless electric activity(PEA) Asystole 心肺复苏的历史 1961 1966 1992 2000 2005 2010 复苏成功关键因素 影响复苏的因素 生存链的变化 早期识别和启动EMS 早期CPR 早期除颤 早期高级生命支持 立即确认心脏停止并启动EMS 尽早CPR，强调先做胸部按压 快速除颤 有效的高级生命支持 综合的心脏骤停后处理 新指南BLS部分 1. Immediate recognition of SCA based on assessing unresponsiveness and absence of normal breathing 理由：医务人员应电话指导非专业施救者于患者「没有反应，沒有呼吸或沒有正常呼吸 (即仅有喘息)」時开始 CPR，而无需检查脉搏 ，对医务人员亦不强调一定要先检查清楚脉搏（控制在10秒内