ClinicalAnaesthesiology

（CardiopulmonaryCerebralResuscitation）內(nèi)容(教學(xué)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(fù)蘇復(fù)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(fù)才能稱為完全復(fù)蘇故把逆轉(zhuǎn)臨床死亡的全過程稱為心肺腦復(fù)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