Cardiopulmonary resuscitation.docx

1、Cardiopulmonary resuscitationCardiopulmonary resuscitationFrom Wikipedia, the free encyclopediaCPR redirects here. For other uses, seeCPR (disambiguation).Cardiopulmonary resuscitationInterventionCPR being performed on a medical-trainingmanikinICD-9:99.60MeSHD016887OPS-301code:8-771MedlinePlus000010

2、Cardiopulmonary resuscitation(CPR) is anemergency procedureperformed in an effort to manually preserve intact brain function until further measures are taken to restore spontaneous blood circulation and breathing in a person who is incardiac arrest. It isindicatedin those who are unresponsive with n

3、o breathing or abnormal breathing, for example,agonal respirations.According to theInternational Liaison Committee on Resuscitationguidelines, CPR involves chest compressions at least 5cm (2in) deep and at a rate of at least 100 per minute in an effort to create artificial circulation by manually pu

4、mping blood through the heart and thus the body. The rescuer may also provide breaths by either exhaling into the subjects mouth or nose or using a device that pushes air into the subjects lungs. This process of externally providing ventilation is termedartificial respiration. Current recommendation

5、s place emphasis on high-quality chest compressions over artificial respiration; a simplified CPR method involving chest compressions only is recommended for untrained rescuers.CPR alone is unlikely to restart the heart. Its main purpose is to restore partial flow of oxygenated blood to thebrainandh

6、eart. The objective is to delaytissue deathand to extend the brief window of opportunity for a successful resuscitation without permanentbrain damage. Administration of an electric shock to the subjects heart, termeddefibrillation, is usually needed in order to restore a viable or perfusing heart rh

7、ythm. Defibrillation is effective only for certain heart rhythms, namelyventricular fibrillationorpulseless ventricular tachycardia, rather thanasystoleorpulseless electrical activity. CPR may succeed in inducing a heart rhythm that may be shockable. In general, CPR is continued until the patient ha

8、s areturn of spontaneous circulation(ROSC) or is declareddead.Contentshide 1Medical uses 2Methodso 2.1Standardo 2.2Compression onlyo 2.3Prone CPRo 2.4Pregnancyo 2.5Other 3Effectiveness 4Pathophysiology 5Complications 6Adjunct deviceso 6.1Timing deviceso 6.2Manual assist deviceso 6.3Automatic devices

9、o 6.4Mobile apps 7Prevalenceo 7.1Chance of receiving CPRo 7.2Chance of receiving CPR in time 8Society and cultureo 8.1Portrayed effectivenesso 8.2Stage CPRo 8.3Self-CPR hoaxo 8.4CPR learned from movies and televisiono 8.5Hands-Only CPR portrayed as more palatable version 9History 10Administering CPR

10、 to animals 11See also 12References 13External linksMedical useseditCPR is indicated for any person unresponsive with no breathing or breathing only in occasionalagonalgasps, as it is most likely that they are incardiac arrest.1:S643If a person still has apulsebut is not breathing (respiratory arres

11、t)artificial respirationsmay be more appropriate, but, due to the difficulty people have in accurately assessing the presence or absence of a pulse, CPR guidelines recommend that lay persons should not be instructed to check the pulse, while giving healthcare professionals the option to check a puls

12、e.2In those with cardiac arrest due totraumaCPR is considered futile but still recommended.3Correcting the underlying cause such as apneumothoraxorpericardial tamponademay help.3MethodseditCPR technique as demonstrated on a dummy.CPR training: CPR is being administered while a second rescuer prepare

13、s fordefibrillation.In 2010, theAmerican Heart AssociationandInternational Liaison Committee on Resuscitationupdated their CPR guidelines.1:S6404The importance of high quality CPR (sufficient rate and depth without excessively ventilating) was emphasized.1:S640The order of interventions was changed

14、for all age groups exceptnewbornsfromairway, breathing, chest compressions (ABC)to chest compressions, airway, breathing (CAB).1:S642An exception to this recommendation is for those believed to be in arespiratory arrest(drowning, etc.).1:S642The most important aspect of CPR are: few interruptions of

15、 chest compressions, a sufficient speed and depth of compressions, completely relaxing pressure between compressions, and not ventilating too much.5StandardeditA universal compression to ventilation ratio of 30:2 is recommended by the AHA.6:8With children, if at least 2 trained rescuers are present

16、a ratio of 15:2 is preferred.6:8In newborns a rate of 3:1 is recommended unless a cardiac cause is known in which case a 15:2 ratio is reasonable.1:S647If an advanced airway such as anendotracheal tubeorlaryngeal mask airwayis in place, artificial ventilation should occur without pauses in compressi

17、ons at a rate of 810 per minute.7The recommended order of interventions is chest compressions, airway, breathing or CAB in most situations,1:S642with a compression rate of at least 100 per minute in all groups.6:8Recommended compression depth in adults and children is at least 5cm (2inches) and in i

18、nfants it is 4 centimetres (1.6in).6:8As of 2010 theResuscitation Council (UK)still recommends ABC for children.8As it can be difficult to determine the presence or absence of a pulse, the pulse check has been removed for lay providers and should not be performed for more than 10 seconds by healthca

19、re providers.6:8In adults, rescuers should use two hands for the chest compressions, while in children they should use one, and with infants two fingers (index and middle fingers).9Compression onlyeditCompression-only (hands-only or cardiocerebral resuscitation) CPR is a technique that involves ches

20、t compressions withoutartificial respiration.1:S643It is recommended as the method of choice for the untrained rescuer or those who are not proficient because it is easier to perform and instructions are easier to give over a phone.1:S6436:810In adults with out-of-hospitalcardiac arrest, compression

21、-only CPR by the lay public has a higher success rate than standard CPR.10The exceptions are cases ofdrownings,drug overdoseand arrest in children. Children who receive compression-only CPR have the same outcomes as those having received no CPR.1:S646The method of delivering chest compressions remai

22、ns the same, as does the rate (at least 100 per minute). It is hoped that the use of compression-only delivery will increase the chances of the lay public delivering CPR.11As per theAmerican Heart Association, the beat of theBee Geessong Stayin Alive provides an ideal rhythm in terms of beats per mi

23、nute to use for hands-only CPR.12One can also humQueens Another One Bites The Dust, which is exactly 100 beats-per-minute and contains a memorable repeating drum pattern.13For those with non cardiac arrest and people less than 20 years of age, standard CPR is superior to compression-only CPR.1415Pro

24、ne CPReditSimultaneous maintenance of blood circulation and ventilation can be obtained by compressing the back if the victim is in prone position, by turning the head to the side and compressing the back. Due to the heads being turned, the risk of vomiting and complications caused byaspiration pneu

25、moniais significantly reduced, and the method means the patient continues to get air into their lungs without the need for mouth-to-mouth respiration.16PregnancyeditDuringpregnancywhen a woman is lying on her back, theuterusmay compress theinferior vena cavaand thus decrease venous return.3It is the

26、refore recommended that the uterus be pushed to the womans left; if this is not effective, either roll the woman 30 or healthcare professionals should consider emergencyCaesarean section.3OthereditInterposed abdominal compressions may be beneficial in the hospital environment.17There is no evidence

27、of benefit pre-hospital or in children.17Internal cardiac massage is manual squeezing of the exposed heart itself carried out through a surgicalincisioninto thechest cavity, usually when the chest is already open for cardiac surgery.EffectivenesseditType of ArrestROSCSurvivalSourceWitnessed In-Hospi

28、tal Cardiac Arrest52%19%18Unwitnessed In-Hospital Cardiac Arrest33%8%18Out-of-Hospital Cardiac Arrest Overall59%10%19Unwitnessed Out-of-Hospital Cardiac Arrest21%4%19Witnessed Out-of-Hospital Cardiac Arrest41%15%19Witnessed and Shockable with Bystander CPR53%37%19Bystander Compression-onlyResuscitat

29、ion-13%20Bystander Conventional CPR-8%20CPR serves as the foundation of successful cardiopulmonary resuscitation, preserving the body fordefibrillationandadvanced life support. Even in the case of a non-shockable rhythm, such asPulseless Electrical Activity(PEA) where defibrillation is not indicated

30、, effective CPR is no less important. Used alone, CPR will result in few complete recoveries, though the outcome without CPR is almost uniformly fatal.21Studies have shown that immediate CPR followed by defibrillation within 35 minutes of suddenVFcardiac arrest dramatically improves survival. In cit

31、ies such as Seattle where CPR training is widespread and defibrillation by EMS personnel follows quickly, the survival rate is about 20 percent for all causes and as high as 57 percent if a witnessed shockable arrest.22In cities such as New York, without those advantages, the survival rate is only 5 percent for witnessed shockable arrest.23Compression-only CPR may be less effective in children than in adults, as cardiac arrest in children is more likely to have anon-c