心肺复苏术 Techniques of Cardiopulmanory Resucitation (CPR)

1. 心肺复苏术Techniques of Cardiopulmanory Resucitation (CPR) Dr. Zhao Gang (赵钢) The Emergency Department, the 6th peoples’ hospital of Shanghai, Shanghai jiaotong University

2. 概念 conceptiong • 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 cardiac arrest. • 复苏目的:恢复呼吸、循环及病人的神志 Aim : recovery of breath, circulation, consciousness • 内容包括:评估判断，人工呼吸，电击除颤，胸外心脏按压,生命支持 Contents: assessments, artificial, ventilation, defibrillation, chest compression, life support • 一系列的评估和干预的过程(a series of assessments and interventions)

3. 评估与判断(assess and gauge) • 意识:反应、瞳孔 Consciousness: response, pupil • 呼吸: 胸廓及腹部运动、呼吸形式(濒死样呼吸) Respiration: movement of chest and abdomen, type of respiratory movement, (agonal respirations) • 心脏搏动：心音、 脉搏、心电图 Heart beat : cardiac sound , pulse , ECG

4. 心跳骤停有三种情形sudden cardiac arrest (SCA) • 心室颤动 (ventricular fibrillation) • 心室停顿(ventricular standstill) • 心电机械分离(electromechanical dissociation)

5. 2000指南基本生命支持顺序The sequence of BLS in 2000 AHA Guideline • 为了培训和记忆 • for training and remembering

6. 气道通畅技术Techniques 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

7. 气道通畅技术Techniques for the establishment of airway 推举下颌法 Jaw-Thrust Maneuver

8. 气道通畅技术Techniques for the establishment of airway 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

9. 气道通畅技术Techniques for the establishment of airway 鼻咽通气道 Nasopharyngeal airways 口咽通气道 Oropharyngeal airways

10. 气道通畅技术Techniques for the establishment of airway • 食管气管导管 Esophageal-Tracheal Combitube • 喉罩气道 Laryngeal Mask Airway • 气管内导管 Endotracheal Intubation

11. 人工呼吸Provide Rescue Breathing 口对鼻人工呼吸 Mouth-to-nose rescue breathing 口对口人工呼吸 Mouth-to-mouth rescue breathing

12. 人工呼吸Provide Rescue Breathing 球囊面罩通气装置 bag-mask ventilation device

13. 人工呼吸Provide Rescue Breathing 球囊面罩通气 bag-mask ventilation

14. 人工呼吸Provide Rescue Breathing 人工气道通气 ventilation with an advanced airway • 食管气管导管 Esophageal-Tracheal Combitube • 喉罩气道 Laryngeal Mask Airway • 气管内导管 Endotracheal Intubation 接呼吸机或呼吸囊 Connect with ventilator or bag

15. 先进行两次人工呼吸,每次人工呼吸时间超过1秒 。 潮气量500-600ml，有胸廓起伏,避免迅速而强力的人工呼吸。 有人工气道二人进行CPR，则没分钟通气8至10次,人工呼吸时,胸外按压不应停止。 没有人工气道,救助者复苏的每周期为30次按压和2次呼吸,在按压暂停进行人工呼吸,每次呼吸超过1秒。 Give 2 rescue breaths, each over 1 seco- nd. with tidal volume of 500 to600 mL to produce visible chest rise, avoid rapid or forceful breaths. When an advanced airway is in place during 2-person CPR, ventilate at a rate of 8 to 10 bpm, no pause in chest compressions for delivery of ventilations. without an advanced airway in place, the rescuer(s) should deliver cycles of 30 compressions and 2 breaths. The rescuer delivers the breaths during pauses in compressions and delivers each breath over 1 second. 人工呼吸Provide Rescue Breathing

16. 循环Circulation • 胸外心脏按压(external chest compression) • 除颤(defibrillation) • 药物治疗(drug): 肾上腺素(Epinephrine) 多巴胺 (Dopamine) 抗心律失常药(antiarrhythmic)

17. 胸外心脏按压(external chest compression)ECC 心泵机制(cardiac pump) 胸泵机制(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

18. 胸外心脏按压(external chest compression)ECC techniques 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. 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。

19. 胸外心脏按压(external chest compression)ECC techniques 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. 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。

20. 按压频率100次/分钟 按压幅度4-5cm 按压-通气比值30:2 按压与放松时间1:1 每2分钟更换按压者 尽量不间断,间断不超过10秒 Compression rate 100/min Depress the sternum 4 to 5cm Compression-ventilation ratio 30:2 Compression /relaxation time 1:1 Switch the compressor every 2 min. Minimize interruption of chest compression, limit interruption to no more than 10 seconds. 胸外心脏按压(external chest compression)ECC techniques

21. SCA 最常见和最初发生的心律失常是心室纤颤（VF）。 电除颤是终止 VF 最有效的方法。 随着时间的推移，成功除颤的机会迅速下降。 短时间 VF 既可恶化并导致心脏停搏。 the most frequent initial rhythm in witnessed SCA is ventricular fibrillation (VF) the treatment for VF is electrical defibrillation, the probability of successful defibrillation diminishes rapidly over time, VF tends to deteriorate to asystole within a few minutes. 除颤(fibrillation treatment)defibrillation

22. 电除颤与人工除颤仪electrical defibrillation and defibrillator

23. 手动除颤manual defibrillation 电极放置 Electrode Placement 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.

24. 单向波形除颤仪: 360J Monophasic Waveform Defibrillators 双向波形除颤仪:150J-200J Biphasic Waveform Defibrillators 电除颤的能量选择Shock Energies

25. 除颤步骤steps to operate defibrillator • 打开电源 • 粘贴电极板 • 选择能量 • 离开病人按电击按钮 • Power on • Attach electrode pads • Select energy • Clear the victim and press the shock button

26. 除颤+心肺复苏术Defibrillation Plus CPR • 关键性联合 A Critical Combination • 早期除颤对于救活心脏骤停（SCA）病人至关重要 Early defibrillation is critical to survival from SCA

27. 存活链概念(Chain of Survival)

28. 早期识别和启动急救医疗系统（EMS）或联系当地急救反应系统120早期识别和启动急救医疗系统（EMS）或联系当地急救反应系统120 早期由旁观者进行CPR 早期进行电击除颤 早期由医务工作者进行复苏后的高级生命支持 Early recognition of the emergency and activation of the emergency medical services (EMS) or local emergency response system: “phone 120” Early bystander CPR Early delivery of a shock with a defibrillator Early advanced life support followed by postresuscitation care delivered by healthcare providers. 生存链(Chain of Survival)

29. 越快越好 the sooner the better

31. BLS法则(algorithm) BLS algorithm

32. 小结：CPR操作流程 • ①判断意识：拍打肩部并呼叫病人 • ②求救呼叫：急呼120，或者通知身旁其他人呼叫救护人员 • ③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，使头颈后仰 • ④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） • ⑤检查呼吸：面感鼻孔气流、耳听呼吸声音、眼观胸廓起伏（专业人员需同时检查脉搏，时间小于10秒） • ⑥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1秒，两次吹气间留有呼气时间，吹气同时要观察到胸廓起伏） • ⑦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）；频率100次/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，幅度4到5厘米；按压通气比为30比2 • ⑧再次检查：完成5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） • ⑨即刻除颤：涂抹电极膏，取360J功率，充电后招呼周围人远离病人身体，非同步电击一次（部位：胸骨右缘第二肋间、左腋前线第五肋间） • ⑩继续抢救：继续5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“除颤－按压通气－检查”步骤；若心跳呼吸已恢复，摆放复苏体位）

33. Sequence of CPR Step 1 Step 2 Step 3 Step 4

34. One rescuer CPR • Compression rate 100/min • Depress the sternum 4 to 5cm • Compression-ventilation ratio 30:2 • Compression /relaxation time 1:1 • Switch the compressor every 2 min. • Minimize interruption of chest compression, limit interruption to no more than 10 seconds.

35. Two rescuer CPR • Give 2 rescue breaths, each over 1 seco- nd. • with tidal volume of 500 to600 mL to produce visible chest rise, avoid rapid or forceful breaths. • When an advanced airway is in place during 2-person CPR, ventilate at a rate of 8 to 10 bpm, no pause in chest compressions for delivery of ventilations. • without an advanced airway in place, the rescuer(s) should deliver cycles of 30 compressions and 2 breaths. The rescuer delivers the breaths during pauses in compressions and delivers each breath over 1 second.

36. Master the important technique Thank you !