心肺复苏抢救流程

心肺复苏抢救流程 仙桃市中医医院 心肺复苏抢救流程 首先评估现场环境安全 1、 意识的判断:用双手轻拍病人双肩～问:“喂～你怎么了,”告知无反应 2、 检查呼吸:观察病人胸部起伏5-10秒,1001、1002、1003、1004、1005…, 告知无呼吸 3、 呼救:来人啊:喊医生:推抢救车:除颤仪: 4、 判断是否有颈动脉搏动～用右手的中指和食指从气管正中环状软骨滑向 近侧颈动脉搏动处～告之有无搏动,数1001、1002、1003、1004、1005…判 断五秒以上10秒一下, 5、 松解衣领及裤袋 6、 胸外心脏按压:两乳头连线中点,胸骨下1/3处,～用左手掌跟紧贴病人 的胸部～两手重叠～左手五指翘起～双臂深直～用上身力量用力按压30次,按 压频率至少100次/分～按压深度至少5cm, 7、 打开气道～仰头抬颌法。口腔无分泌物～无假牙。 8、 人工呼吸:应用简易呼吸器～一手以“CE”手法固定～一手按压简易呼 吸器～每次送气400-600ml～频率10-12次/分 9、 持续2分钟的高效频的CPR:以心脏按压:人工呼吸按30:2的比例进行～ 操作5个周期。,心脏按压开始送气结束, 10、 判断复苏是否有效,听是否有呼吸音～同时触摸是否有颈动脉搏动, 11、 整理病人～进一步生命支持。 心肺复苏=,清理呼吸道,+人工呼吸+胸外按压+后续的专业用药 Diluted with water to scale this solution per ml is equal to 1. O µ g of arsenic. 11 instrument 11.1 spectrophotometer. 11.2 measuring arsenic device: see Figure 1, wet digestion method in repeatability conditions of the absolute value of the difference of two independent measurement results shall not exceed the arithmetical average of the 10%. 11.2.1100mL~150mL an Erlenmeyer flask: 19th standards. 11.2.2 tubes: tube 19th, after alkali treatment, or wash the rubber plug secret contacts with the Erlenmeyer flask timely should not leak. The other end of the tube diameter is 1. Omm。 11.2.3 absorption tube: 10mL graduated centrifuge tube for absorbing work. 12 sample processing 12.1 nitric acid a perchlorate a sulfuric acid method 12.1.1 food, and fans, and •, and bean dry products, and pastry, and tea, and he containing water less of solid food: said take 5.Oog or 10.00g of crushed sample, placed 250mL~500mL set nitrogen bottle in the, first added water little makes wet, Addend grain glass beads, and 10mL~15mL nitric acid-perchlorate mixed liquid, placed moments, fire slowly heating, stay role ease, put cold. Along the wall to join 5mL or 10mL acid, then heated until liquid in a bottle when you begin to turn brown, continue along the wall drops mixed with nitric acid perchloric acid solution to the complete decomposition of organic matter. Increased firepower to produces white smoke, bottle of white smoke after taking NET, 1 bottle liquid smoke to be digested completely, with the clarity solution should be colorless or slightly yellow, cool. (In operation should be taken to prevent bump or bang) and 20mL of water to a boil, remove residual nitrate up 根据美国今年统计～每年心血管病人死亡数达百万人～约占总死亡病因1/2～而因心脏停搏死亡者60-70%发生在院前。因此～美国成年人中约有85%的人有兴趣参加CPR初步训练～结果使40%心脏骤停者复苏成功～每年抢救了约20万人的生命。心脏跳动停止这～如在4分钟内实施初步的CPR～在8分钟内由专业人员进一步心脏救生～死而复生的可能性最大～因此时间就是生命～速度是关键～初步的CPR按ABC进行～先判断患者有无意识～拍摇患者并大声询问～手指甲掐压人中穴约5秒～如无反应表示意识丧失～这时应使患者水平仰卧～解开颈部纽扣～注意清除口腔异物～使患者仰头抬颌～用耳贴近口鼻～如未感到有气流或胸部无起伏～则表示已无呼吸。 A,airway,:保持呼吸顺畅 B,breathing,:口对口人工呼吸 C,circulation,:建立有效的人工循环 A 保持呼吸顺畅 昏迷的病人常因舌后移而堵塞气道～所以心肺复苏的首要步骤是畅通气道。急救者以一手臵于患者额部使头部后仰～并以另一手抬起后颈部或托起下颌～保持呼吸道通畅。对怀疑有颈部损伤者只能托举下颌而不能使头部后仰,若疑有气道异物～应从患者背部双手环抱于患者上腹部～用力、突击性挤压。 B 口对口人工呼吸 在保持患者仰头抬颌前提下～施救者用一手捏闭的鼻孔,或口唇,～然后深吸一大口气～迅速用力向患者,或鼻,内吹气～然后放松鼻孔,或口唇,～照此每5秒钟反复一次～直到恢复自主呼吸 每次吹气间隔1.5秒～在这个时间抢救者应自己深呼吸一次～以便继续口对口呼吸～直至专业抢救人员的到来。 L of water to a boil, remove residual nitrate upnd 20mh the clarity solution should be colorless or slightly yellow, cool. (In operation should be taken to prevent bump or bang) arepower to produces white smoke, bottle of white smoke after taking NET, 1 bottle liquid smoke to be digested completely, wited fialong the wall drops mixed with nitric acid perchloric acid solution to the complete decomposition of organic matter. Increas ut cold. Along the wall to join 5mL or 10mL acid, then heated until liquid in a bottle when you begin to turn brown, continueperchlorate mixed liquid, placed moments, fire slowly heating, stay role ease, p-dend grain glass beads, and 10mL~15mL nitric acidtake 5.Oog or 10.00g of crushed sample, placed 250mL~500mL set nitrogen bottle in the, first added water little makes wet, Ad : saidd method 12.1.1 food, and fans, and •, and bean dry products, and pastry, and tea, and he containing water less of solid foodn tube: 10mL graduated centrifuge tube for absorbing work. 12 sample processing 12.1 nitric acid a perchlorate a sulfuric aci11.2.3 absorptio 。ug secret contacts with the Erlenmeyer flask timely should not leak. The other end of the tube diameter is 1. Omm11.2.1100mL~150mL an Erlenmeyer flask: 19th standards. 11.2.2 tubes: tube 19th, after alkali treatment, or wash the rubber pl10%. the absolute value of the difference of two independent measurement results shall not exceed the arithmetical average of the ment 11.1 spectrophotometer. 11.2 measuring arsenic device: see Figure 1, wet digestion method in repeatability conditions ofDiluted with water to scale this solution per ml is equal to 1. O µ g of arsenic. 11 instru 2 C 建立有效的人工循环 检查心脏是否跳动～最简易、最可靠的是颈动脉。抢救者用2-3个手指放在患者气管与颈部肌肉间轻轻按压～时间不少于10秒。 如果患者停止心跳～抢救者应握紧拳头～拳眼向上～快速有力猛击患者胸骨正中下段一次～此举有可能使患者心脏复跳～如一次不成功可按上述要求再次叩击一次。 如心脏不能复跳～就要通过胸外按压～使心脏和大血管血液产生流动～以维持心、脑等主要器官最低血液需要量。 选择胸外心脏按压部位:先以左手的中指、食指定出肋骨下缘～而后将右手掌侧放在胸骨下1/3～再将左手放在胸骨上方～左手拇指邻近右手指～使左手掌底部在剑突上。右手臵于左手上～手指间互相交错或伸展。按压力量经手跟而向下～手指应抬离胸部。胸外心脏按压方法:急救者两臂位于病人胸骨的正上方～双肘关节伸直～利用上身重量垂直下压～对中等体重的成人下压深度应大于5cm～而后迅速放松～解除压力～让胸廓自行复位。如此有节奏地反复进行～按压与放松时间大致相等～频率为每分钟不低于100次。 一、 人心肺复苏方法:当只有一个急救者给病人进行心肺复苏术时～应是 每做30次胸心按压～交替进行2次人工呼吸。 二、 人心肺复苏方法:当有两个急救者给病人进行心肺复苏术时～首先两 个人应呈对称位臵～以便于互相交换。此时～一个人做胸外心脏按压, 另一个人做人工呼吸。两人可以数着1、2、3进行配合～每按压心脏 30次。口对口或口对鼻人工呼吸2次。, 拍摇患者并大声询问～手指甲掐压人中穴约5秒～如无反应表示意识丧失。 这时应使患者水平仰卧～解开颈部纽扣～注意清除口腔异物～使患者仰头抬en to prevent bump or bang) and 20mL of water to a boil, remove residual nitrate upo be digested completely, with the clarity solution should be colorless or slightly yellow, cool. (In operation should be takmoke tion of organic matter. Increased firepower to produces white smoke, bottle of white smoke after taking NET, 1 bottle liquid sbegin to turn brown, continue along the wall drops mixed with nitric acid perchloric acid solution to the complete decompositcid, then heated until liquid in a bottle when you perchlorate mixed liquid, placed moments, fire slowly heating, stay role ease, put cold. Along the wall to join 5mL or 10mL a-ded water little makes wet, Addend grain glass beads, and 10mL~15mL nitric acidst ading water less of solid food: said take 5.Oog or 10.00g of crushed sample, placed 250mL~500mL set nitrogen bottle in the, fira perchlorate a sulfuric acid method 12.1.1 food, and fans, and •, and bean dry products, and pastry, and tea, and he contain 11.2.3 absorption tube: 10mL graduated centrifuge tube for absorbing work. 12 sample processing 12.1 nitric acid 。iameter is 1. Ommatment, or wash the rubber plug secret contacts with the Erlenmeyer flask timely should not leak. The other end of the tube dli tree arithmetical average of the 10%. 11.2.1100mL~150mL an Erlenmeyer flask: 19th standards. 11.2.2 tubes: tube 19th, after alkan repeatability conditions of the absolute value of the difference of two independent measurement results shall not exceed thmeasuring arsenic device: see Figure 1, wet digestion method iDiluted with water to scale this solution per ml is equal to 1. O µ g of arsenic. 11 instrument 11.1 spectrophotometer. 11.2 3 颌～用耳贴近口鼻～如未感到有气流或胸部无起伏～则表示已无呼吸。 CPR操作顺序的变化:A-B-C C-A-B ? 2010,新,:C-A-B即:C胸外按压-A开放气道-B人工呼吸 ? 2005,旧,:A-B-C即:A 开放气道-B人工呼吸-C胸外按压 注意事项: 1、 口对口吹气量不宜过大～一般不超过1200ml～胸廓稍起伏即可。吹气 时间不宜过长～过长会引起急性胃扩张、胃胀气和呕吐。吹气过程要 注意观察患,伤,者气道是否通畅～胸廓是否被吹起。 2、 胸外心脏按压只能在患,伤,者心脏停止跳动下才能施行。 3、 口对口吹起和胸外心脏按压应同时进行～严格按吹气和按压的比例操 作～吹气和按压的次数过多和过少均会影响复苏的成败。 4、 胸外心脏按压的位臵必须准确。不准确容易损伤其他脏器。按压的力 度要适宜～过大过猛容易使胸骨骨折～引起气胸血胸,按压的力度过 轻～胸腔压力小～不足以推动血液循环。 5、 施行心肺复苏术时应将患,伤,者的衣扣及裤带解松～以免引起内脏 损伤。 2005年底美国心脏学会,AHA,发布了新版CPR急救指南～与旧版指南相比～主要就是按压与呼吸的频次由15:2调整为30:2。 心肺复苏有效的体征和终止抢救的指征 ?观察颈动脉搏动～有效时每次按压后就可触到一次搏动。若停止按压后搏动停止～表明应继续进行按压。如停止按压后搏动继续存在～说明病人自主 L of water to a boil, remove residual nitrate upnd 20mh the clarity solution should be colorless or slightly yellow, cool. (In operation should be taken to prevent bump or bang) arepower to produces white smoke, bottle of white smoke after taking NET, 1 bottle liquid smoke to be digested completely, wited fialong the wall drops mixed with nitric acid perchloric acid solution to the complete decomposition of organic matter. Increas ut cold. Along the wall to join 5mL or 10mL acid, then heated until liquid in a bottle when you begin to turn brown, continueperchlorate mixed liquid, placed moments, fire slowly heating, stay role ease, p-dend grain glass beads, and 10mL~15mL nitric acidtake 5.Oog or 10.00g of crushed sample, placed 250mL~500mL set nitrogen bottle in the, first added water little makes wet, Ad : saidd method 12.1.1 food, and fans, and •, and bean dry products, and pastry, and tea, and he containing water less of solid foodn tube: 10mL graduated centrifuge tube for absorbing work. 12 sample processing 12.1 nitric acid a perchlorate a sulfuric aci11.2.3 absorptio 。ug secret contacts with the Erlenmeyer flask timely should not leak. The other end of the tube diameter is 1. Omm11.2.1100mL~150mL an Erlenmeyer flask: 19th standards. 11.2.2 tubes: tube 19th, after alkali treatment, or wash the rubber pl10%. the absolute value of the difference of two independent measurement results shall not exceed the arithmetical average of the ment 11.1 spectrophotometer. 11.2 measuring arsenic device: see Figure 1, wet digestion method in repeatability conditions ofDiluted with water to scale this solution per ml is equal to 1. O µ g of arsenic. 11 instru 4 心搏已恢复～可以停止胸外心脏按压。 ?若无自主呼吸～人工呼吸应继续进行～或自主呼吸很微弱时仍应坚持人工呼吸。 ?复苏有效时～可见病人有眼球活动～口唇、甲床转红～甚至脚可动,观察瞳孔时～可由大变小～并有对光反射。 ?当有下列情况可考虑终止复苏: ?心肺复苏持续30分钟以上～仍无心搏及自主呼吸～现场又无进一步救治和送治条件～可考虑终止复苏, ?脑死亡～如深度昏迷～瞳孔固定、角膜发射消失～将病人头向两侧转动～眼球原来位臵不表等～如无进一步救治和送治条件～现场可考虑停止复苏, ?当现场危险威胁到抢救人员安全,如雪崩、山洪爆发,以及医学专业人员认为病人死亡～无救治指征时。 BOU/CPR580心肺复苏模拟人,2010操作, 美国心脏学会,AHA ,2010国际心肺复苏,CPR,&心血管急救,ECC,指南标准 ?胸外按压频率由2005年的100次/分改为“至少100次/分“ ?按压深度由2005年的4-5cm改为“至少5cm“ ?人工呼吸频率不变、按压与呼吸比不变 ?强烈建议普通施救者仅做胸外按压的CPR～弱化人工呼吸的作用～对普通目击者要求对ABC改变为“CAB“即胸外按压、气道和呼吸 ?除颤能量不变～但要更强调CPR ?肾上腺素用法用量不变～不推荐对心脏停搏或PEA者常规使用阿托品 en to prevent bump or bang) and 20mL of water to a boil, remove residual nitrate upo be digested completely, with the clarity solution should be colorless or slightly yellow, cool. (In operation should be takmoke tion of organic matter. Increased firepower to produces white smoke, bottle of white smoke after taking NET, 1 bottle liquid sbegin to turn brown, continue along the wall drops mixed with nitric acid perchloric acid solution to the complete decompositcid, then heated until liquid in a bottle when you perchlorate mixed liquid, placed moments, fire slowly heating, stay role ease, put cold. Along the wall to join 5mL or 10mL a-ded water little makes wet, Addend grain glass beads, and 10mL~15mL nitric acidst ading water less of solid food: said take 5.Oog or 10.00g of crushed sample, placed 250mL~500mL set nitrogen bottle in the, fira perchlorate a sulfuric acid method 12.1.1 food, and fans, and •, and bean dry products, and pastry, and tea, and he contain 11.2.3 absorption tube: 10mL graduated centrifuge tube for absorbing work. 12 sample processing 12.1 nitric acid 。iameter is 1. Ommatment, or wash the rubber plug secret contacts with the Erlenmeyer flask timely should not leak. The other end of the tube dli tree arithmetical average of the 10%. 11.2.1100mL~150mL an Erlenmeyer flask: 19th standards. 11.2.2 tubes: tube 19th, after alkan repeatability conditions of the absolute value of the difference of two independent measurement results shall not exceed thmeasuring arsenic device: see Figure 1, wet digestion method iDiluted with water to scale this solution per ml is equal to 1. O µ g of arsenic. 11 instrument 11.1 spectrophotometer. 11.2 5 ?维持ROSC的血氧饱和度在94%-~98% ?血糖超过10mmol/L即可控制～但强调应避免低血糖 ?强化按压的重要性～按压间断时间不超过5s 提高抢救成功率的主要因素 1、 将重点继续放在高质量的CPR上 2、 按压频率至少100次/分,区别于大约100次/分, 3、 胸骨下陷深度至少5cm 4、 按压后保证胸骨完全回弹 5、 胸外按压时最大限度地减少中断 6、 避免过度通气 CPR操作顺序的变化:A-B-C C-A-B L of water to a boil, remove residual nitrate upnd 20mh the clarity solution should be colorless or slightly yellow, cool. (In operation should be taken to prevent bump or bang) arepower to produces white smoke, bottle of white smoke after taking NET, 1 bottle liquid smoke to be digested completely, wited fialong the wall drops mixed with nitric acid perchloric acid solution to the complete decomposition of organic matter. Increas ut cold. Along the wall to join 5mL or 10mL acid, then heated until liquid in a bottle when you begin to turn brown, continueperchlorate mixed liquid, placed moments, fire slowly heating, stay role ease, p-dend grain glass beads, and 10mL~15mL nitric acidtake 5.Oog or 10.00g of crushed sample, placed 250mL~500mL set nitrogen bottle in the, first added water little makes wet, Ad : saidd method 12.1.1 food, and fans, and •, and bean dry products, and pastry, and tea, and he containing water less of solid foodn tube: 10mL graduated centrifuge tube for absorbing work. 12 sample processing 12.1 nitric acid a perchlorate a sulfuric aci11.2.3 absorptio 。ug secret contacts with the Erlenmeyer flask timely should not leak. The other end of the tube diameter is 1. Omm11.2.1100mL~150mL an Erlenmeyer flask: 19th standards. 11.2.2 tubes: tube 19th, after alkali treatment, or wash the rubber pl10%. the absolute value of the difference of two independent measurement results shall not exceed the arithmetical average of the ment 11.1 spectrophotometer. 11.2 measuring arsenic device: see Figure 1, wet digestion method in repeatability conditions ofDiluted with water to scale this solution per ml is equal to 1. O µ g of arsenic. 11 instru 6