心肺复苏术 techniques of cardiopulmanory resucitation (cpr)

心肺复苏术心肺复苏术Techniques of Cardiopulmanory Resucitation (CPR)Techniques of Cardiopulmanory Resucitation (CPR)

Dr. Zhao Gang ( 赵钢 )

The Emergency Department, the 6th peoples’ hospital of Shanghai, Shanghai jiaotong Unive

rsity

病人呼吸心跳停止时采取的一切抢救措施称心肺复苏病人呼吸心跳停止时采取的一切抢救措施称心肺复苏 Rescue approach and treatment for the patients suffering respiratory or Rescue approach and treatment for the patients suffering respiratory or

cardiac arrest.cardiac arrest.

复苏目的复苏目的 :: 恢复呼吸、循环及病人的神志恢复呼吸、循环及病人的神志 Aim : recovery of breath, circulation, consciousnessAim : recovery of breath, circulation, consciousness

内容包括内容包括 :: 评估判断，人工呼吸，电击除颤，胸外心脏按压评估判断，人工呼吸，电击除颤，胸外心脏按压 ,, 生命支生命支持持

Contents: assessments, artificial, ventilation, defibrillation, chest comprContents: assessments, artificial, ventilation, defibrillation, chest compression, life supportession, life support

一系列的评估和干预的过程一系列的评估和干预的过程 (a series of assessments and interventions)(a series of assessments and interventions)

概念 conceptiong

评估与判断评估与判断 (assess and gauge)(assess and gauge)

意识意识 :: 反应、瞳孔反应、瞳孔

Consciousness: response, pupilConsciousness: response, pupil

呼吸呼吸 : : 胸廓及腹部运动、呼吸形式胸廓及腹部运动、呼吸形式 (( 濒死样呼吸濒死样呼吸 ))

Respiration: movement of chest and abdomen, type of respiratory movRespiration: movement of chest and abdomen, type of respiratory movement, (agonal respirations)ement, (agonal respirations)

心脏搏动：心音、脉搏、心电图心脏搏动：心音、脉搏、心电图

Heart beat : cardiac sound , pulse , ECGHeart beat : cardiac sound , pulse , ECG

心跳骤停有三种情形心跳骤停有三种情形sudden cardiac arrest (SCA)sudden cardiac arrest (SCA)

心室颤动心室颤动 ((ventricular fibrillation)ventricular fibrillation)

心室停顿心室停顿 ((ventricular standstill)ventricular standstill)

心电机械分离心电机械分离 ((electromechanical dissociation)electromechanical dissociation)

20002000 指南基本生命支持顺序指南基本生命支持顺序The sequence of BLS in 2000 AHA GuidelineThe sequence of BLS in 2000 AHA Guideline

基本生命支持基本生命支持

Basic Life Support Basic Life Support (BLS)(BLS)

评估评估assessmentassessment

呼救呼救EMS activationEMS activation

包括包括 ABCABC 和除颤和除颤 DD 心肺复苏心肺复苏术术

ABCs of CPR, and the D of DefibrilABCs of CPR, and the D of Defibrillationlation

AA 气道通畅气道通畅 airwayairway

BB 人工呼吸人工呼吸 BreathBreath

CC 人工循环人工循环 CirculationCirculation

DD 除颤除颤 DefibrillationDefibrillation

为了培训和记忆 for training and remembering

气道通畅技术气道通畅技术Techniques for the establishment of airwayTechniques for the establishment of airway

舌与会厌阻塞气道

The tongue and epiglottis obstruct the pharynx

仰头举颏法

Head Tilt-Chin Lift Maneuver


推举下颌法

Jaw-Thrust Maneuver


异物梗阻气道

Foreign bodies cause airway obstruction FBAO

横膈下腹部冲击手法

Subdiaphragmatic abdominal thrust

Heimlich maneuver


口咽通气道

Oropharyngeal airways

鼻咽通气道

Nasopharyngeal airways


食管气管导管食管气管导管 Esophageal-Tracheal CombitubeEsophageal-Tracheal Combitube

喉罩气道喉罩气道 Laryngeal Mask AirwayLaryngeal Mask Airway

气管内导管气管内导管 Endotracheal IntubationEndotracheal Intubation

人工呼吸人工呼吸 Provide Rescue BreathingProvide Rescue Breathing

口对口人工呼吸

Mouth-to-mouth rescue breathing

口对鼻人工呼吸

Mouth-to-nose rescue breathing


球囊面罩通气装置 bag-mask ventilation device


球囊面罩通气

bag-mask ventilation


人工气道通气 ventilation with an advanced airway

食管气管导管食管气管导管 Esophageal-Tracheal CombitubeEsophageal-Tracheal Combitube

喉罩气道喉罩气道 Laryngeal Mask AirwayLaryngeal Mask Airway

气管内导管气管内导管 Endotracheal IntubationEndotracheal Intubation

接呼吸机或呼吸囊

Connect with ventilator or bag


先进行两次人工呼吸先进行两次人工呼吸 ,, 每次人每次人工呼吸时间超过工呼吸时间超过 11 秒。秒。

潮气量潮气量 500-600ml500-600ml ，有胸廓起，有胸廓起伏伏 ,, 避免迅速而强力的人工呼避免迅速而强力的人工呼吸。吸。

有人工气道二人进行有人工气道二人进行 CPRCPR ，，则没分钟通气则没分钟通气 88 至至 1010 次次 ,, 人人工呼吸时工呼吸时 ,, 胸外按压不应停止。胸外按压不应停止。

没有人工气道没有人工气道 ,, 救助者复苏的救助者复苏的每周期为每周期为 3030 次按压和次按压和 22 次呼次呼吸吸 ,, 在按压暂停进行人工呼吸在按压暂停进行人工呼吸 ,,每次呼吸超过每次呼吸超过 11 秒。秒。

Give 2 rescue breaths, each over 1 secGive 2 rescue breaths, each over 1 second.o- nd.

with tidal volume of 500 to600 mL to with tidal volume of 500 to600 mL to produce visible chest rise, avoid rapid produce visible chest rise, avoid rapid or forceful breaths. or forceful breaths.

When an advanced airway is in place When an advanced airway is in place during 2-person CPR, ventilate at a rduring 2-person CPR, ventilate at a rate of 8 to 10 bpm, no pause in chest cate of 8 to 10 bpm, no pause in chest compressions for delivery of ventilatioompressions for delivery of ventilations.ns.

without an advanced airway in place,without an advanced airway in place, the rescuer(s) should deliver cycles of the rescuer(s) should deliver cycles of 30 compressions and 2 breaths. The r30 compressions and 2 breaths. The rescuer delivers the breaths during paescuer delivers the breaths during pauses in compressions and delivers eacuses in compressions and delivers each breath over 1 second.h breath over 1 second.

循环循环 CirculationCirculation

胸外心脏按压胸外心脏按压 ((external chest compression)external chest compression)

除颤除颤 (defibrillation)(defibrillation)

药物治疗药物治疗 (drug):(drug):

肾上腺素肾上腺素 ((Epinephrine)

多巴胺多巴胺 ((Dopamine)

抗心律失常药抗心律失常药 ((antiarrhythmic)


ECCECC

心泵机制心泵机制 ((cardiac pump)cardiac pump)

胸泵机制胸泵机制 ((thoracic pump)thoracic pump)Pump the blood to the organs

按压部位 (position of compression)

胸骨下半部 , 双乳头之间

The lower half of the sternum between nipples


ECC techniquesECC techniques

一只手的掌跟在胸骨下半部，另一只手放于其上，双手平行。掌跟的长轴放在胸骨的长轴上。手指伸展或交锁，但应离开胸部。

Place the heel of one hand on the lower half of the sternm and the other hand on top of the first ,so that the hands are parallel. Be sure the long axis of the heel of your hand is placed on the long axis of the sternm your hand may be either extended or interlaced but should be kept off the chest.



双肘关节固定，双臂垂直。

双肩在双手正上方以使每次胸部挤压的冲击直接使胸骨下压。

每次挤压后必须完全解除压力，使胸部回到正常位置。

使手与胸骨接触以保持正确手的位置。

Lock the elbows in position, with the arms straightened.

Position your shoulders directly over your hands so that the thrust for each chest compression is straight down on the sternum.

Release the pressure completely and allow the chest to return to its normal position after each compression.

Keep your hands in contact with the victim’s sternum to maintain proper hand position.



按压频率按压频率 100100 次次 // 分钟分钟按压幅度按压幅度 4-5cm4-5cm按压按压 -- 通气比值通气比值 30:230:2按压与放松时间按压与放松时间 1:11:1每每 22 分钟更换按压者分钟更换按压者尽量不间断尽量不间断 ,, 间断不超过间断不超过 1010秒秒

Compression rate 100/minCompression rate 100/min

Depress the sternum 4 to 5cmDepress the sternum 4 to 5cm

Compression-ventilation ratio 30:2Compression-ventilation ratio 30:2

Compression /relaxation time 1:1Compression /relaxation time 1:1

Switch the compressor every 2 min.Switch the compressor every 2 min.

Minimize interruption of chest Minimize interruption of chest compression, limit interruption to no compression, limit interruption to no more than 10 seconds.more than 10 seconds.

除颤除颤 (fibrillation treatment)(fibrillation treatment)defibrillationdefibrillation

SCA SCA 最常见和最初发生的心律最常见和最初发生的心律失常是心室纤颤（失常是心室纤颤（ VFVF ）。）。

电除颤是终止电除颤是终止 VF VF 最有效的方最有效的方法。法。

随着时间的推移，成功除颤的随着时间的推移，成功除颤的机会迅速下降。机会迅速下降。

短时间短时间 VF VF 既可恶化并导致心既可恶化并导致心脏停搏。脏停搏。

the most frequent initial rhythm in the most frequent initial rhythm in witnessed SCA is ventricular fibriwitnessed SCA is ventricular fibrillation (VF)llation (VF)the treatment for VF is electrical dthe treatment for VF is electrical defibrillation, efibrillation, the probability of successful defithe probability of successful defibrillation diminishes rapidly over brillation diminishes rapidly over time, time, VF tends to deteriorate to asystolVF tends to deteriorate to asystole within a few minutes. e within a few minutes.

电除颤与人工除颤仪电除颤与人工除颤仪electrical defibrillation and defibrillatorelectrical defibrillation and defibrillator

手动除颤手动除颤manual defibrillationmanual defibrillation

右侧电极板放在病人右锁骨下方，左电极板放在与左乳头齐平的左胸下外侧部

The right (sternal) chest pad is placed on the victim’s right infraclavicular chest ,the apical (left) pad is placed on the victim’s inferior-lateral left chest, lateral to the left breast.

电极放置

Electrode Placement

电除颤的能量选择电除颤的能量选择 Shock EnergiesShock Energies

单向波形除颤仪单向波形除颤仪 : 360J: 360JMonophasic Waveform DefibrillatorsMonophasic Waveform Defibrillators

双向波形除颤仪双向波形除颤仪 :150J-200J:150J-200JBiphasic Waveform DefibrillatorsBiphasic Waveform Defibrillators

除颤步骤除颤步骤steps to operate defibrillatorsteps to operate defibrillator

① 打开电源

② 粘贴电极板

③ 选择能量

④ 离开病人按电击按钮

① Power on

② Attach electrode pads

③ Select energy

④ Clear the victim and press the shock button

除颤除颤 ++ 心肺复苏术心肺复苏术 Defibrillation Plus CPRDefibrillation Plus CPR

关键性联合关键性联合

A Critical CombinationA Critical Combination

早期除颤对于救活心脏骤停（早期除颤对于救活心脏骤停（ SCASCA ）病人至关重要）病人至关重要Early defibrillation is critical to survival from SCAEarly defibrillation is critical to survival from SCA

存活链概念存活链概念 ((Chain of Survival)Chain of Survival)

生存链生存链 ((Chain of Survival)Chain of Survival)

早期识别和启动急救医疗早期识别和启动急救医疗系统（系统（ EMSEMS ）或联系当）或联系当地急救反应系统地急救反应系统 120120

早期由旁观者进行早期由旁观者进行 CPRCPR

早期进行电击除颤早期进行电击除颤

早期由医务工作者进行复早期由医务工作者进行复苏后的高级生命支持苏后的高级生命支持

Early recognition of the emergency Early recognition of the emergency and activation of the emergency meand activation of the emergency medical services (EMS) or local emergdical services (EMS) or local emergency response system: “phone 120”ency response system: “phone 120”

Early bystander CPR Early bystander CPR

Early delivery of a shock with a defEarly delivery of a shock with a defibrillatoribrillator

Early advanced life support followeEarly advanced life support followed by postresuscitation care delivered by postresuscitation care delivere

d by healthcare providersd by healthcare providers..

越快越好 the sooner the better

BLS 法则 (algorithm) BLS algorithm

小结：小结： CPRCPR 操作流程操作流程

①①判断意识：判断意识：拍打肩部并呼叫病人拍打肩部并呼叫病人②②求救呼叫：求救呼叫：急呼急呼 120120 ，或者通知身旁其他人呼叫救护人员，或者通知身旁其他人呼叫救护人员③③开放气道：仰头抬颏法开放气道：仰头抬颏法，左手小鱼际按压额部，右手食指中指抬举颏部，使头颈后，左手小鱼际按压额部，右手食指中指抬举颏部，使头颈后仰仰④④去除异物：去除异物：用单手食指钩出口腔中固体异物（未见异物，可省去此操作）用单手食指钩出口腔中固体异物（未见异物，可省去此操作）⑤⑤检查呼吸：面感检查呼吸：面感鼻孔气流、鼻孔气流、耳听耳听呼吸声音、呼吸声音、眼观眼观胸廓起伏（专业人员需同时检查脉胸廓起伏（专业人员需同时检查脉搏，时间小于搏，时间小于 1010 秒）秒）⑥⑥人工通气：人工通气：吸一口气，一手食指拇指捏住鼻孔，口对口密闭，两次缓慢人工通气吸一口气，一手食指拇指捏住鼻孔，口对口密闭，两次缓慢人工通气（每次吹气时间不少于（每次吹气时间不少于 11 秒，两次吹气间留有呼气时间，吹气同时要观察到胸廓起秒，两次吹气间留有呼气时间，吹气同时要观察到胸廓起伏）伏）⑦⑦胸外按压：部位胸外按压：部位取胸骨中下三分之一处，也可简便取两乳头连线中点（右手沿一侧取胸骨中下三分之一处，也可简便取两乳头连线中点（右手沿一侧肋弓向上摸到剑突，左手掌根紧贴剑突上两横指处，两手掌根重叠，手指翘起不得按于肋弓向上摸到剑突，左手掌根紧贴剑突上两横指处，两手掌根重叠，手指翘起不得按于肋骨上）；肋骨上）；频率频率 100100 次次 // 分，按下与松开的时间相同（松开时手掌不得离开胸壁）；两分，按下与松开的时间相同（松开时手掌不得离开胸壁）；两手臂肘关节伸直，垂直用力，手臂肘关节伸直，垂直用力，幅度幅度 44 到到 55厘米；按压通气比为厘米；按压通气比为 3030 比比 22⑧⑧再次检查：再次检查：完成完成 55个循环的按压通气后评估心跳呼吸（面感鼻孔气流、耳听呼吸声个循环的按压通气后评估心跳呼吸（面感鼻孔气流、耳听呼吸声音、眼观胸廓起伏，同时手指触摸颈动脉搏动）音、眼观胸廓起伏，同时手指触摸颈动脉搏动）⑨⑨即刻除颤：即刻除颤：涂抹电极膏，取涂抹电极膏，取 360J360J功率，充电后招呼周围人远离病人身体，功率，充电后招呼周围人远离病人身体，非同步非同步电电击一次（击一次（部位部位：胸骨右缘第二肋间、左腋前线第五肋间）：胸骨右缘第二肋间、左腋前线第五肋间）⑩⑩继续抢救：继续抢救：继续继续 55个循环的按压通气，然后再次检查心跳呼吸（若心跳呼吸无恢复个循环的按压通气，然后再次检查心跳呼吸（若心跳呼吸无恢复可重复“可重复“除颤－按压通气－检查除颤－按压通气－检查”步骤；若心跳呼吸已恢复，摆放复苏体位）”步骤；若心跳呼吸已恢复，摆放复苏体位）

Sequence of CPRSequence of CPR

Step 1

Step 2

Step 3

Step 4

One rescuer CPROne rescuer CPR

Compression rate 100/minCompression rate 100/min

Depress the sternum 4 to 5cmDepress the sternum 4 to 5cm

Compression-ventilation ratio 30:2Compression-ventilation ratio 30:2

Compression /relaxation time 1:1Compression /relaxation time 1:1

Switch the compressor every 2 min.Switch the compressor every 2 min.

Minimize interruption of chest Minimize interruption of chest compression, limit interruption to no compression, limit interruption to no more than 10 seconds.more than 10 seconds.

Two rescuer CPRTwo rescuer CPR Give 2 rescue breaths, each over 1 secGive 2 rescue breaths, each over 1 sec

o- nd.o- nd.

with tidal volume of 500 to600 mL to with tidal volume of 500 to600 mL to produce visible chest rise, avoid rapid produce visible chest rise, avoid rapid or forceful breaths. or forceful breaths.

When an advanced airway is in place When an advanced airway is in place during 2-person CPR, ventilate at a rduring 2-person CPR, ventilate at a rate of 8 to 10 bpm, no pause in chest cate of 8 to 10 bpm, no pause in chest compressions for delivery of ventilatioompressions for delivery of ventilations.ns.

without an advanced airway in place,without an advanced airway in place, the rescuer(s) should deliver cycles of the rescuer(s) should deliver cycles of 30 compressions and 2 breaths. The r30 compressions and 2 breaths. The rescuer delivers the breaths during paescuer delivers the breaths during pauses in compressions and delivers eacuses in compressions and delivers each breath over 1 second.h breath over 1 second.

Master the important techniqueMaster the important technique

心肺复苏术 techniques of cardiopulmanory resucitation (cpr)

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