心肺骤停与心肺复苏英文教案及讲稿文档格式.docx
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出版社
Peoplehealthpublishingcompany
版次
thefirstedition
Oct.2003
教
学
目
的
要
求
1:
Recall
ThedefinitionofSuddenCardiacArrest.
TheclinicalsymptomsofSuddenCardiacArrest
ThebasicstepsofCPRforadults.
2:
Application:
Showthecompletesequencefor1-rescuerCPR.
难
点
HowtoperformallthestepsofCPRinorder
重
HowtoperformallthestepsofCPRinorder
外语要求
CET-4
教学方法手段
Multimedia
参考资料
《Guideline2005ofCPRandECG》
教研室意见
教学组长：
教研室主任：
年月日
辅助手段
时间分配
Goodafternooneverybody,todaywearegoingtodiscusstheSCAandCPCR,atfirstletmeintroducemyself.;
;
Atbeginningoftheclass,wewillwatchashortvideo,pleasewatchitcarefully,therearetwoquestions,Whathappenedandwhataretheydoing?
SCA
（一）DEFINITION
ButhowdowedefineSCASuddenCardiacArrest,wealsocallSCA,referstosuddenandunexpectedlossofheartfunction,ceasethebloodflowformthehearttotherestofthebody,thebrainandvitalorganslackofbloodandoxygen,Ifthevictimgettheproprietymedicalserviceimmediately,survivalispossible,ifnot,deathoccurs.becausewhenSCAhappens,lossofheartfunction,ceasethebloodflowfromthehearttherestofthebody,itcausesthebrainandthevitalorganslackofthebloodandoxygen,Sometimesitoccurssuddenly,comeswithoutwarning,，.ithappensunexpected.sometimesitmayhappenedonsomebodywhoisthoughtingoodhealthsituation
.
（二）cuases
ManydiseasesmayleadtoSCA,likeasheartdisease,ThepersonwhohasheartdiseasehasthehigherchancesofSCA.
Seethepicture,ifthediseasecancauseDecreasedcontractility,Arrhythmia,LowercardiacoutputInsufficientCoronaryperfusion,thenitmayleadtoSCA.
ThepersonwhohasheartdiseasehasthehigherchancesofSCA.
Studiesreport,80%SCAwerecausedbycoronaryheartdisease,
Andthetypicalsingsonelectrocardiogram,wemayseetheventricularfibrillation,andventricularsystole,themostcommonSCAarecausedbyventricularfibrillation.Approximately70%.
（三）CLINICALSIGNS
SCAcomessuddenlyandunexpected,buthowcanwerecognizeit.
Therearesixsignsinourtextbook
1.suddenunconsciousness.
Youpalpatetheshoulder,ifnoresponse,youmaysaythevictiminunconsciousness.
2.Absenceofmajorarterypulse（carotidorfemoral）
3.Nobreathing.
4.Pupillarydilationandnopupillaryreflextolight
5.Heartsoundisnotobtainable
6.Paleandnobloodintheface
（四）DIAGONOSIS
Doweneedtocollectalltheevidencestoestablishthediagonosis?
Hereifyouseethevictiminunconsciousness,youcantpalpatethepulseoncarotidorfemoral,youcanestablishthediagnosisSCA.
WehavediscussedthatwhenthevictiminSCA,lossofheartfunction,ceaseofblood,thebrainandthevitalorganslackofbloodandoxygen,
Whatmedicalserviceisproprietyandcansavethelife
CPCR
Herearetwoconcepts,CPRandCPCR.
CPR
Butwhatthedifferencesbetweenthem,theprotectionofbrain,
CPRisresultsfrommanyyearsclinicalexperiencesandmanymedicalprofessionalscontributedtoit,PeterJSafar,whocreatedmouthtomouthbreathingin1958,heproposedtheA-BC（airway,breathing,circulation）sequenceofresuscitation,includingthetechniqueof'
mouth-to-mouth'
rescuebreathing."
SoheisknownasthefatherofCPR.
CPRsavemanylife,butthepersonswhowassurvivalfromSCA,butApproximately10-40%ofthemsufferedobviousnon-reverseablebraindamage
Moreandmoremedicalprofessionalspaymoreattentiontotheprotectionofbrainfunction.
ThebecomesCPCR,sothemostimportantdifferencebetweenCPRandCPCR,istheprotectionofbrain.
ThemodernResuscitationCPRconsistofthreemainelements:
•Mouthtomouthbreathing
•Chestcompression
•Defibrillation
ThepresentstandardofCPRis《guidelinesCPRandECC2005》.Anditwaspubulishedonthejournal《Circulation》Nov.2005wecallitguidelines2005.
CompletelyCPCRincludesthreeparts
BasiclifesupportBLS
BdvancedcardiaclifesupportACLS
ProlongedlifesupportPLS
一BLS
ThemainaimofBLSistodeliveroxygentomusclesoftheheartandalloftheimportantorgans
BLSConsistsof4parts
Aairway
Bbreathing
Ccirculation
Ddefibrillation
Buttoday,wejustdiscusstheABCsequence,thestepDplaceonthenextclass,
Nowweknow,SCAisthelifeanddeathdisease,let’swatchthestatisticshere
TherelationshipofthestartingCPRandtheratioofsurvival.
IfthevictimgettheCPR
•Within4min50%
•Within4~6min10%
•Morethan6min4%
•Morethan10min0%
Thispictureshowsthechainofsurvival.itconsistsof4links,
Earlyacces,earlyCPR,earlydefibrillationandearlyadvancecare.
Earlyaccessreferstorecognizeandactivatetheemergencymedicalsystemearly,andearlyCPR,wejusttalkedabouttherelationshipofstartingCPRandtheratioofsurvival,andweknowearlyCPRincreasetheratioofsurvival,earlydefibrillationalsoincreasetheratioofsurvival,thereasonis（question）,ok,themostcommonSCAwerecausedbyventricularfibrillation.andearlyadvancedcarereferstobringequipmenttosupportventilationandestablishtheintravenousaccessandstabilizedthevictimtotransfer.thechainofsurvivalsummarizethepresentunderstandingofthebestapproachtothetreatmentthepersoninSCA.
1：
position
WhenyoumeetapersoninSCA,atfirst,puthimorheronbackonafirmplantsurface.Putthehandbesidethebodynaturally.\
assess
Shoutforthevictim,andpalpatethevictim’sshoulder.ifnoresponse,call120andactivetheEMS.
3:
openingairway
ThentakethestepsofABCsequence
TheAoftheABCsequenceisairway
thenopeningtheairway,
Thecommoncauseoftheairwayobstructionintheunresponsivevictimisthetongueblocktheupperairway.Atthesametimecleartheforeignobjectiveintheairway.
Therearetwoposturestoopentheairway
Headtilt-chinlift
jawthrust
Themostcommonpostureweuseisheadtilt-chinlift,
1.Putonehandonthevictim‘sforeheadandpushwithyoupalmtotilttheheadback.
2.placethefingersoftheotherhandunderthebonypartofthelowerjawnearthechin.
3.Liftthejawtobringthechinforward.
Pleasenote.youjustneedtoputthefingersonthebonypartofthelowerjaw,don’tputonthesofttissue,itwouldobstructtheairway.
Butwhenyoususpectthevictimhascervicalspineinjure,youmustopenairwaywiththemanuvaurjawthrust,
Afteropeningtheairway,taketherescuerbreathing
4：
Bbreathing
Atfirst,assessthebreathing
Assessthebreathingbylooking,listening,feeling.
Putyoufaceclosetothevictim’smouthandnose
LOOKforthechesttoriseandfall
LISTENforairescapingduringexhalation
FEELfortheflowofairagainstyourcheek
Thetimeyoumusttakeatleast5secondsbutnomorethan10seconds.
Ifyoucantlookforthechesttoriseandfall,youcantlistenforairescapingduringexhalation,andyoucantfeelfortheflowofairagainstyourcheek
Thenthevictimhasnobreathing.Thehealthcareprovidermustdeliveryrescuerbreathingtothevictim.
Mouthtomouthbreathingisaquick,effectivewaytoprovideoxygentothevictim,therescuer’sexhaledaircontainsapproximately17%and4%carbondioxide,Thisisenoughoxygentosupplythevictim’sneeds.
•Holdthevictim’sairwayopenwithaheadtilt-chinlift.
•Pinchthenoseclosedwithyourthumbandindexfinger（usingthehandontheforehead.）
•Takearegular（notdeep）breathandsealyourlipsaroundthevictim’smouth,creatinganairtightseal.
•Give1breath（blowfor1second）.Watchforthechesttoriseasyougivethebreath.
•Ifthechestdoesnotrise,repeattheheadtilt-chinlift.
•Giveasecondbreath（blowfor1second）.Watchforthechesttorise
Pleasenote:
Take1secondtodelivereachbreath
Deliverenoughairtomakethevictim’schestrise.
Ifyougivebreathstooquicklyorwithtoomuchforce,airislikelytoenterthestomachratherthanthelungs.Thiscancausegastricinflation
•TheriskofinfectionfromCPRisverylowbutifyoumeetthevictimintheworkplacewhenthereisanyexposuretobloodorbodilyfluids.Standardprecautionsincludeusingbarrierdevicesuchasafacemaskorabagmaskdevicewhengivingbreaths.
•Somemaskshaveanoxygeninletthatallowsyoutoadministersupplementaryoxygen.
Mouthtomaskbreathinghastwoobviousadvantages
Preventtheinfectionandcanadministerthesupplementaryoxygen,
Now,wehavejusttalkabouttheABstepsofABCsequence.let’swatchashortvideotorecallthecontents.
Ok,fromthevideo,weknowafterdelivery2rescuerbreathing,thenextstepis
5:
Wehaveknown,thepersoninSCAlossthefunctionoftheheart,ceasethebloodflow.theeasymeantoassessthepersonifheorshelosstheheartfunction,
Assessthepulseonmajorartery.Likecarotidorfemoral.
Maintainaheadtilt,Locatethetrachea,Slidethese2or3fingersbetweenthetracheaandthemusclesatthesideoftheneck,checkthecarotidpulse.
Palpatethearteryatleast5secondsbutnomorethan10seconds
Ifyoucanfindthedefinitepulse,
Give1breathevery5to6seconds
Recheckpulseevery2minutes.
Ifyouarenotsurewhetherthevictimhasapulse,youshouldstartthestepsofCPRwithchestcompression,
chestcompressionreferstocompressthechesttobuildcirculationagain,
createbloodcirculation
increasecoronaryperfusion
increase
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