心肺骤停与心肺复苏英文教案及讲稿.docx

心肺骤停与心肺复苏英文教案及讲稿.docx

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心肺骤停与心肺复苏英文教案及讲稿

临床学院教案及讲稿

课程名称

Emergencynursing

年级

授课专业

教师

职称

授课方式

学时

2

题目章节

SCAandCPCR

教材名称

Emergencynursing

作者

Zhouxiuhua

出版社

Peoplehealthpublishingcompany

版次

thefirstedition

Oct.2003

教

学

目

的

要

求

1:

Recall

ThedefinitionofSuddenCardiacArrest.

TheclinicalsymptomsofSuddenCardiacArrest

ThebasicstepsofCPRforadults.

2:

Application:

Showthecompletesequencefor1-rescuerCPR.

教

学

难

点

HowtoperformallthestepsofCPRinorder

教

学

重

点

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

SCAandCPCR

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

CPCR

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.\

2:

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:

Ccirculation

Wehaveknown,thepersoninSCAlossthefunctionoftheheart,ceasethebloodflow.theeasymeantoassessthepersonifheorshelosstheheartfunction,

Assessthepulseonmajorartery.Likecarotidorfemoral.

Maintainaheadtilt,Locatethetrachea,Slidethese2or3fingersbetweenthetracheaandthemusclesatthesideoftheneck,checkthecarotidpulse.

Palpatethearteryatleast5secondsbutnomorethan10seconds

Ifyoucanfindthedefinitepulse,

Give1breathevery5to6seconds

Recheckpulseevery2minutes.

Ifyouarenotsurewhetherthevictimhasapulse,youshouldstartthestepsofCPRwithchestcompression,

chestcompressionreferstocompressthechesttobuildcirculationagain,

createbloodcirculation

increasecoronaryperfusion

increase