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TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.----《2010年国际心肺复苏与心血管急救指南》学习心肺复苏指南更新张雪好厦门大学附属第一医院急诊部TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.2010达拉斯共识•2010年版国际心肺复苏与心血管急救指南推荐会–国际复苏联合会(ILCOR)和美国心脏学会(AHA)共同举办–2010年2月1日~6日–对2005~2010的5年间研究实践作一科学总结–2010年10月刊于《CIRCULATION》and《RESUSCITATION》TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.针对所有施救者的主要问题•继续强调实施高质量心肺复苏–按压速率•至少为每分钟100次而不再是每分钟“大约”100次–按压幅度•成人至少为5厘米•婴儿和儿童至少为胸部前后径的三分之一(婴儿大约4厘米,儿童大约5厘米)–保证每次按压后胸部回弹–尽可能减少胸外按压的中断–避免过度通气TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.•从A-B-C更改为C-A-B(新生儿除外)–绝大多数CA的初始心律是VF或无脉性VT•BLS的关键操作是胸外按压和早期除颤–在A-B-C程序中胸外按压往往被延误•开放气道以进行口对口人工呼吸•寻找防护装置•收集并装配通气设备–C-A-B程序可以尽快开始胸外按压,同时能尽量缩短通气延误时间–A-B-C程序可能妨碍旁观者进行心肺复苏TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.救?怎么救?“没救!”大多数心脏骤停患者院前未得到任何旁观者的心肺复苏,如果先进行胸外按压或仅胸外按压,可能会鼓励更多施救者实施心肺复苏TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.非专业施救者进行单纯胸外按压的心肺复苏•存活率–单纯胸外按压≥传统CPR•易行性–单纯胸外按压对于未经培训的施救者更容易实施–更便于调度员通过电话进行指导•机理–在心脏停止的最初几分钟,患者仍有氧气存留在肺和血液里,及早开始胸外按压,可以提早促进血液循环到患者的大脑和心脏TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.基础生命支持(BLS)判断意识:拍双肩,呼双耳,轻拍重叫识别:不呼吸或仅仅是喘息施救步骤(CAB)TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.无意识–立即CPR–呼救请人帮助拨打急救电话取体外自动除颤仪AED取体外自动除颤仪AED胸外心脏按压30次TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.开放气道——“不用一听二看三感觉来判断呼吸”TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.人工呼吸2次,开始30:2的CPRTheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.医务人员基础生命支持一、调度员确认濒死喘息二、调度员应给予CPR指令三、不建议常规环状软骨加压四、强调高质量胸外按压五、强调以团队形式进行CPRTheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.CPR并使用AED查看:1,有无反应;2有无呼吸,或呼吸是否正常则怀疑发生心脏骤停无启动EMS,并找到AED,或有其他人寻找AED检查脉搏,时间小于10秒如没有明确触摸到脉搏取消了:看,听,感觉呼吸TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.电击治疗TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.•自动体外除颤器–社区非专业施救者AED项目•建议公共场所安保人员进行第一目击者心肺复苏并使用AED,以提高院外心脏骤停的存活率–院内使用AED•建议配备AED以便早期进行除颤(3min),特别是在员工不具备节律识别技能或者不经常使用除颤器的区域–为儿童包括婴儿使用AED•1至8岁儿童使用儿科剂量衰减型AED–若无,则使用普通AED•1岁以下婴儿,建议使用手动除颤器–如无,使用儿科剂量衰减型AED–二者皆无,使用普通AEDTheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNationalCongressandthethirdPlenarysessionofthe16thCPCCentralCommittee.•先给予电击与先进行心肺复苏–重新确认的2005版建议•施救者应从胸外按压开始心肺复苏,并尽快使用AED•可以考虑进行1½至3分钟的心肺复苏,然后再尝试除颤•但对于有心电监护的患者,从心室颤动到给予电击的时间不应超过3分钟,并且应在等待除颤器就绪时进行心肺复苏TheguidingideologyshouldbeguidedbyDengXiaoping'stheory,theimportantthoughtofthreerepresentsandthespiritofthe16thCPCNation
本文标题:2020年国际心肺复与心血管急救指南解读
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