急救通用流程 universal algorithm
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急救通用流程 Universal Algorithm. 國泰綜合醫院急診醫學科 陳健驊醫師. 心臟及呼吸停止 人腦細胞於四分鐘開始死亡,於十分鐘內腦死 基本救命術 (BLS) :四分鐘以內 高級救命術 (ACLS) :八分鐘以內. 基本救命術( Basic Life Support ). 生命之鏈. 求救. 心肺復甦術. 去顫術. 高級心臟救命術. 資料來源:美國心臟學會. 取自 1997-99 Advanced Cardiac Life Support AHA p4-2. ACLS 的流程. 1. 口訣 : 叫 , 叫 ,A,B,C - PowerPoint PPT PresentationTRANSCRIPT
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急救通用流程急救通用流程Universal AlgorithmUniversal Algorithm
國泰綜合醫院急診醫學科陳健驊醫師
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心臟及呼吸停止 人腦細胞於四分鐘開始死亡,於十分鐘內腦死
基本救命術 (BLS) :四分鐘以內 高級救命術 (ACLS) :八分鐘以內
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基本救命術(基本救命術( Basic Life SupporBasic Life Supportt ))
生命之鏈
求救 心肺復甦術 去顫術 高級心臟救命術
資料來源:美國心臟學會
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取自 1997-99 Advanced Cardiac Life Support AHA p4-2
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ACLSACLS 的流程的流程1. 口訣 : 叫 , 叫 ,A,B,C
2.IV, O2, monitor
叫:評估病患意識狀況 叫:求救、啟動緊急救護系統( 119) Phone First( 先打電話 ) : VT(-)/VF Phone Fast( 先急救 ) : 創傷、溺水、中毒、小於 8 歲
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A:A: 打開呼吸道打開呼吸道 AirwayAirway 壓額抬下巴( Head tilt-chin lift ) 非創傷
下顎推擠法 (推下顎法 )Jaw Thrust
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B:B: 檢查呼吸檢查呼吸 BreathingBreathing
看:胸部起伏聽:呼吸聲感覺: 病患鼻息檢查時間:小於 10 秒無呼吸:吹兩口氣( 1 秒 / 每次)、觀察胸部起伏 ( 吹氣時需捏住鼻子、蓋住病患嘴巴 )
無呼吸有脈博:成人每五秒一次(含吹氣時間 1秒)
袋瓣罩的使用( BVM )
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C:C: 檢查脈博檢查脈博 CirculationCirculation
檢查頸動脈 檢查時間:小於 10 秒(低體溫者例外)
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心外按摩心外按摩 壓放比率:各佔 50﹪
成人每分鐘按摩 100 下 按摩及吹氣比率為 30 : 2, 小孩和嬰兒為 15:2
心輸出量 ( 正常的 25-33%)
5 個週期之後 , 再檢查脈搏 ( 約 2 分鐘 )
有氣管插管者
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心外按摩心外按摩 (C(Cardiac Output ardiac Output 25-33 %) 25-33 %)
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Cardiac dysrhythmiaCardiac dysrhythmia
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ACLSACLS 的流程的流程1.Tachycardia Stable:drug Unstable:cardioversion (Unstable signs: conscious change, persist chest pain, hypote
nsion, or shock)2.Bradycardia Atropine, Transcutaneous pacing, dopamine,
epinephrine
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電擊器
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ACLSACLS 的流程的流程 -Tachycardia-Tachycardia
1.Narrow QRS:PSVT, atrial fibrillation, atrial flutter, multiple atrial tachycardia, junction tachycardia
2.Wide QRS: VT, Vf ,SVT with abrrant conduction
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ACLSACLS 的流程的流程 -Tachycardia-Tachycardia
Cardioversion:
Synchronized:PSVT (50J), atrial flutter (50J), 其餘多是 100J 開始 (monomorphic VT)
Unsynchronized: Vf, polymorphic VT (360J)
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ACLSACLS 的流程的流程 -Tachycardia-Tachycardia
Drug:
1.Adenosine:PSVT
2.Amiodarone
3.B-block
4.Calcium channel block
5.Digoxin
6.MgSO4
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PSVTPSVT
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ACLSACLS 的流程的流程 -Bradycardia-Bradycardia
1. 定義 : < 60 次 / 分2. 相對性的心搏過緩3. 無症狀不需治療4. 有胸痛 , 意識改變 , 低血壓 , 昏厥 , 癲癇 ,
心臟衰竭 , 或其它休克症候則需立刻治療
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ACLSACLS 的流程的流程 -Bradycardia-Bradycardia
1.Sinus Bradycardia
2.First degree AV block
3.Second degree AV block (Mobitz I and Mobitz II)
4.Complete AV block
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Sinus bradycardiaSinus bradycardia
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First degree AV blockFirst degree AV block
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2nd degree AV Block Type I2nd degree AV Block Type I
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2nd degree AV block Type II2nd degree AV block Type II
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Complete AV blockComplete AV block
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治療治療1.Atropine (0.5 mg IV,3~5 分鐘重覆注射 , 最大劑
量 3mg)
2.TCP (high degree AV block 要立刻使用 )
3. 二線藥物 Dopamine
Epinephrine
Glucagon (B blocker 或 Ca channel blocker,3 mg)
( 等候節律器或節律器無效時使用 )
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AtropineAtropine
1. 勿使用低於 0.5mg 的劑量2. 勿因為使用 Atropine 而延誤使用 TCP
3. 使用在 Acute coronary syndrome 的病人要小心
4. 心臟移植的病患可能無效
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使用使用 TCPTCP 的注意事項的注意事項
1.Symptomatic bradycardia (class I)
2.Mobitz type II and complete AV block 要立刻使用
3. 疼痛控制 4. 非侵襲性 , 緊急時暫時使用5. 儘快會診專家
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使用使用 TCPTCP 的準備事項的準備事項
1.Prepare the patient
2.Clean and dry skin
3.Apply pads
4.Turn the pacer functionality on
5.Select mode (demand or fix)
6.Capture the heart rate
7.Evaluate the patient
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Transcutaneous PacingTranscutaneous Pacing
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Transcutaneous PacingTranscutaneous Pacing
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Thanks for your attentionThanks for your attention