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单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Guidelines Writing Group Chairs,Michael R.Sayre,MD,贵阳医学院附院麻醉科,曾庆繁,2021年AHA 心肺复苏指南介绍,1960-2021,Kouwenhoven,2021心肺复苏50周年,356,位专家,来自,29,个国家,历时,36,个月讨论,2021 International Consensus Conference,Robert A.Berg,University of Pennsylvania,Professor of Anesthesiology,and Critical Care Medicine,Division,Chief,Pediatric Critical Care,Cardiac arrest can be caused by,室颤,VF,室速,(,无脉,)VT,无脉性电活动,PEA,心博停止,asystole.,无脉性心动过缓,Pulseless bradycardia,4 rhythms,室颤 无脉性室速,VF/Pulseless VT,chest compressions(CC),early Defibrillation(DF),Early recognition,cardiac,arrest,及早识别心跳骤停,外行急救,lay rescuer,1.,突然晕倒,suddenly collapse,2.,意识消失,Unresponsive,3.,无呼吸或无正常呼吸,not breathing,4.Seizure,(not normally,gasping),.,cardiac arrest,降低脉搏检查的重要性,Minimize the importance of pulse checks,不检查脉搏,Not check for a pulse,2005(Old):,“Look,listen,and feel,2021(New):,NO:“Look,Listen,Feel,for Breathing*,30 compressions 2 breaths,NO:“Look,Listen,Feel for Breathing*,不看 不听 不觉,A Change From A-B-C to C-A-B,“Adults,Children,infants,(excluding the,newly born),复苏步骤,What about Oxygen?,VF-CA,:,中心血液中富含氧,Experimental work has shown Arterial Sats remain acceptable for,up to 10 min of CCC,呼吸停,-,通气,!,Respiratory Arrest-Different,!,Ventilation crucial to replace Oxygen,关键,:,CCC,心 脑,C-A-B,chest compressions,initiated sooner,及早按压,Forget CPR,Give CCR Instead,心脑复苏新概念,Cardiocerebral Resuscitation,忘了,CPR,代之,CCR,Standard CPR:30:2,Continuous Chest Compressions,心脑复苏概念,Cardiocerebral Resuscitation,200 chest,compressions,200 chest,compressions,Single shock,without pulse,Check or rhythm,analysis,BVM or Passive,Insuflation 100%FIO2,Begin IV,Analysis,200 chest,compressions,Single shock if,Indicated without,pulse check or,rhythm analysis,Analysis,Single shock if,Indicated without,pulse check or,rhythm analysis,Resume Standard ACLS,Consider Endotracheal,Intubation,200 chest,compressions,CC,Only,EMS,arrival,Administer 1 mg,IV Epinephrine,Analysis,If adequate bystander chest compressions are provided,EMS providers,perform immediate rhythm analysis,Three-Phase Model of Resuscitation,0,2,4,6,8,10,12,14,16,18,20,Arrest Time(min),Circulatory,Phase,Electrical,Phase,Metabolic,Phase,0,100%,Myocardial ATP,Weisfeldt ML,Becker LB.,JAMA,2002:288:3035-8,rapid,defibrillation,good chest,compressions,little we can do,外行成人,CPR,简化成人根本生命支持,:,CCC+DF,Chest Compressions*,2021(New):,Hands-Only,“push hard and fast,on the center of the chest,动手不动口,30 compressions to 2 breaths,Chest Compression Rate,:,At Least 100 per Minute*,2021(New):,chest compressions at a rate of,at least 100/min.(快!不间断),2005(Old):,Compress at a rate of about 100/min.,Chest Compression,Depth*,2021(New):hard!,The adult sternum should be depressed,at least 2 inches(5 cm).,2005(Old):,approximately 1,1/2 to 2 inches,(approximately 4 to 5 cm).,C A B,电击治疗,ELECTRICAL THERAPIES,AED Use in Children Now Includes Infants,2021(New):,1 year of age.,2005(Old):,Not use of AEDs for infants 1 year of age.,先除颤,VS,先,CPR?,CPR,65 mm Hg,心律失常再发及治疗,昏迷 脑损伤,保证灌注,昏迷,:,插管,SBP 90 mm Hg,不预防性抗心律失常药,判断预后,K 3.5 mEq/L,调节通气,:,治疗低血压,去除心律失常原因,对语言 刺激反应,避免低钾,(,心律失常,),PETCO2:,Fluid bolus,12-lead ECG/,瞳孔光反射,尿量,血清肌酐,35,40 mm Hg,Dopamine 5,10mcg,ACS STEMI QT,角膜反射,发现,ARF,Paco2:,Norepinephrine,治疗急性冠脉综合征,自主眼球活动,等容,euvolemia,40,45 mm Hg,Epinephrine,Aspirin/heparin,动嘴 呛咳 自主呼吸,肾替代治疗,脉搏氧 血气,0.1,0.5mcg/kg.mi,PCI or,脑电图,:,replacement,降低,FIO2,fibrinolysis,惊厥,血糖监测,SpO2 94%,抗惊厥治疗,治疗低血糖,37.7C,Local insulin protocols,VT 6-8,mL/kg,Ventilation,Hemodynamic,Cardiovascular,Neurological,Metabolic,Chest X-ray:,心脏超声,:,治疗性低温,:,确定气道,检查室壁运动,Cold IV fluid bolus,30 mL/kg,AvoidHypotonicFluis,检查,CA,原因并发症,心肌病,Surface or endovascular,increase edema,pneumonitis,心肌顿抑,cooling for 32C34C,(cerebral edema),pulmonary edema,Treat Myocardial Stunning:,24 hours,Fluids to optimize volume,After 24 hours,Dobutamine 5,10 mcg/kg,slow rewarming 0.25C/hr,动脉气囊反博,(IABP),CT,镇静肌松,控制寒战,机控呼吸,(,非同步,),谢谢,!,
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