ClinicalAnaesthesiology

（CardiopulmonaryCerebralResuscitation）內容(教學大綱)CPCR的基本概念心跳驟停的原因心跳驟停的診斷CPCR的三個階段和處理原則ContentsConsidermostfrequentcausesSignsofcardiacarrestManagementofcardiacarrestManagementofbraindamageCardiopulmonaryCerebralResuscitation

心肺腦復蘇復蘇時要考慮到心肺功能更要考慮到腦只有腦功能的最終恢復才能稱為完全復蘇故把逆轉臨床死亡的全過程稱為心肺腦復蘇（cardiopulmonarycerebralresuscitation，CPCR）Considermostfrequentcauses1)Hypovolemia2)Hypoxia3)Hydrogenion-acidosis4)Hyper-/Hypokalemia,othermetabolic5)HypothemiaConsidermostfrequentcauses6)‘Tables’(DrugOD,accidents)7)Tamponnade,cardiac8)Tensionpneumothorax9)Thrombosis,coronary10)Thrombosis,pulmonary(embolism)SignsofcardiacarrestSuddendeepunconsciousnessAbsentcarotidandfemoralpulseDilatedpupilsAshencyanosisApnoeaorgaspingManagementofCardiacArrestBasicLifeSupport,BLSAdvancedLifeSupport,ALS

ProlongedLifeSupport，PLSCardiopulmonaryResuscitation

TheCABsofcardiopulmonaryresuscitationCirculation，Airway,BreathingC:CIRCULATIONExternalChestCompressionIntravenousAccessDysrhythmiaRecognitionDrugAdministrationDefibrillaionandCardioversion

ExternalcardiacmassageLieonahardsurface(patient)UseweightoftheupperbodyArmstraighttoreducefatigueHeelsofhandscrossedFingersclearofchestApplypressureoverthelowhalfofthesternumThesternumisdepressed4-5cminadult,2-4cminchildren,andthenallowtoreturntoitsnormalpositionA:AIRWAYHead-tiltandChin-liftJaw-trustwithoutHead-tilt------wheneveracervicalspineinjuryissuspectedHeimlichManeuverA:AIRWAY

A.TrachealintubationB.Cricothyroidpuncture

Cricothyrotomy

TracheostomyB:BREATHING

Mouth–to-mouth:mouth-to-mouth-and-nosesupplementaloxygenMouth-to-mask:bag-valve-maskbag-valve-endotrachealtubeCardiacArrest(PatternsofECG)Ventricularfibrillation(VF)VentriculartachycardiawithnocardiacoutputAsystoleElectromechanicaldissociation(EMD)DisorganizedventricularelectricalactivityRatetoorapidanddisorganizedtocountRhythmirregularNodiscerniblePwavesofQRScomplexesIrregularundulationsinelectrocardiographbaselineAlwaysresultsonnoeffectivecardiacoutputDefibrillationassoonaspossibleandrepeatedanecessaryEpinephrine(0.5-1mgI.V.)every5minutesLidocaine(1mg/kgI.V.)Rate100-220/minRhythmregularofirregularPwavesusuallynotpresentQRScomplexesappearlikeprematureventricularcontractionsUsuallyassociatedwithdramaticdeclineinbloodpressureandcardiacoutputIfbloodpressureisstable,deliveraprecordialthumporgivelidocaine(1.5mg/kgI.V.repeatedonce)Ifpulseispresentbutbloodpressureisunstable,beginimmediatecardioversionIfpulseless,treatasventricularfibrillation

TotalabsenceofventricularactivityAbsolutelyflatbaseline(exceptpossiblePwaves)ConsiderpossibilityoffineventricularfibrillationandneedfordefibrillationEpinephrine(0.5-1mgI.V.)every5minutesAtropine(1mgI.V.)every5minutesPacemaker(externalortransvenous)VENTRICULARASYSTOLE

Electro-MechanicalDissociation,EMDEpinephrine(0.5-1mgI.V.)every5minutesAtropine(1mgI.V.)every5minutesPacemaker(externalortransvenous)

DefibrillaionandCardioversion

AlgorithmforTreatingCardiacArrest

（BasicLifeSupport）PrimaryCABDSurvery

CCirculation:givechestcompressionsAAirway:OpentheairwayBBreathing:providepositive-pressureventilationsDDefibrillation:assessforandshockVF/pulselessVT,upto3times(200J,200Jto300J,360Jorequivalentbiphasic)ifnecessaryAlgorithmforTreatingCardiacArrest

（AdvancedLifeSupport）MoreadvancedassessmentsandtreatmentsAAirway:placeairwaydeviceassoonaspossibleBBreathing:confirmairwaydeviceplacementbyexamplusconfirmationdevice;secureairwaydevice;purpose-madetubeholderspreferred;confirm

effectiveoxygenationandventilationCCirculation:establishIVaccess;identifyrhythm;administerdrugsappropriateforrhythmandconditionDDifferentialDiagnosis:searchforandtreatidentifiedreversiblecauses

ManagementofBrainDamage

（ProlongedLifeSupport）GeneralmeasuresPreventionofhypoxaemiaandhypercapniaDepressionofcoughandswallowingSpecialisedtreatmentHyperventilationOsmotherapySteroidsBarbituratesandCNSdepressantsCalciumantagoni