心肺复苏

CPCR 三期九步
基本生命支持（Basic Life Support，BLS） A：Airway 开放气道 B：Breathing 人工呼吸 C：Circulation 人工循环 高级生命支持（Advanced Life Support，ALS） D： Drugs 药物 E： Electrocardiogram 心电监测 F： Fibrillation 除颤 长期生命支持（Prolonged life support，PLS） G：gauging 病情估计 H：Human mentation 脑复苏 I： Intensive care 加强监护治疗
Hands- only- CPR
鼓励未受过培训的救援者进行单纯胸外按 压的CPR
胸外心脏按压要领
按压部位 按压深度 按压频率 按压姿势
患者仰卧于硬板床 或地上,如为软床,身下 应放一木板,以保证按 压有效。
按压部位
一只手的食、中指放在肋缘下
沿肋骨缘向上滑 到胸骨底部（剑 突处），把另一 只手掌根靠在手 指上（胸骨下半 部，乳头连线中 点）
大脑----------------4-6分钟 小脑----------------10-15分钟 延髓----------------20-25分钟 交感神经节----------45-60分钟 心肌和肾小管细胞----30分钟 肝细胞--------------1-2小时 肺组织--------------大于2小时
强调CPR时持续有效胸外按压的重要意义 尽量减少按压中断，中断按压时间不得超过10秒钟； 急救者不应在电击后立即检查患者心跳或脉搏，而是 应该重新进行CPR，先行胸外按压，心跳检查应在实 施5个周期CPR(约2分钟)后进行； 双人或多人在场实施CPR时，应每2分钟或每5个周期 CPR(每个周期CPR包括30次按压和2次人工呼吸)更换 按压者； 施救者应在5秒钟内完成转换；
早期除颤（1分钟内）成功率97% 强调做一次除颤，立即CPR 多次除颤延误CPR 先按压后除颤
正确与错误的除颤电极安放位置
思考
先除颤还是先CPR
为什么除颤后 需立即进行5个周期的CPR?
思考
除颤器可1次终止室颤，没必要检查分 析心律 除颤后即使心律恢复，数分钟内, 心脏 并不能有效泵血 因此指南要求除颤后立即实施5个周期 CPR
对于心脏病因导致的心脏骤停，单纯胸外按压心肺复苏或 同时进行胸外按压和人工呼吸的心肺复苏的存活率相近。
高质量的心肺复苏
1）按压速率至少为每分钟 100 次 2）按压幅度至少为5cm或胸部前后径的 三分之一（婴儿大约为 4 厘米，儿童大 约为 5 厘米） 3）保证每次按压后胸部回弹 4）尽可能减少胸外按压的中断 5）避免过度通气
美国前总统克林顿就AED致全美人民电台演讲
Clinton Announcement 21 May 2000 04:28 RADIO ADDRESS BY THE PRESIDENT TO THE NATION THE PRESIDENT: Good morning. For the last seven years, we've worked hard to enhance the health and safety of the American people. Today I'd like to talk about new measures we're taking to save the lives of many thousands of men and women who fall victim to one of America's biggest killers, sudden cardiac arrest. Every day -- every day -- more than 600 Americans die from sudden cardiac arrest. In some cases, the cause is long-term coronary artery disease. In others,it can be triggered by intense emotional or physical stress. Either way, the heart starts beating chaotically and cannot send blood to the brain and other vital organs. The key of survival is the speed of response. In addition to CPR, most cardiac arrest victims need an immediate electrical shock to restore the heart's normal rhythm. When victims receive that shock within a minute, there's a 90-percent chance of resuscitation. When it takes 10 minutes, the odds fall to less than 5 percent. Keep in mind, in a big city with a lot of traffic, it can often take far more than 10 minutes for emergency medical technicians to arrive. But thanks to new devices called automated external defibrillators, or AEDs, a person with moderate training can now administer life-saving shocks to someone in cardiac arrest. An AED, which is about the same size and price as a good laptop computer, uses voice commands to lead the rescuer through every step, and delivers a shock only if it's necessary. Mike Tighe, a public health official in Boston, spent several years on a Crusade to put AEDs in police cars and fire trucks. A year and a half ago, Mr. Tighe needed an AED himself. Four hours into a flight from Boston to Los Angeles, His arm started flailing and his HEAD fell forward. A flight attendant used an on-board AED and saved his life. The device had been installed on the plane only two days before. There are countless other stories of AEDs saving people's lives. In the First six months, after AEDs were installed at Chicaago's O'Hare Airport, nine out of 11 people who went into cardiac arrest were saved. In Las Vegas, AEDs in hotels and casinos have increased the survival rate from 14 percent to a remarkable 57 percent. Just last week a visitor here at the White House collapsed and would have died if not for one of the AEDs that our medical unit acquired last year. On the basis of successes like these, it's time for the national government to help bring AEDs to public places all over America. Today I'm pleased to announce three major steps to achieve that goal. First, I'm directing the Department of Health and Human Services and the General Services Administration to develop guidelines for putting AEDs in all federal buildings. To help with this effort,the American Heart Association and the American Red Cross have volunteered to train federal employees to use AEDs. Second, I'm working with Congress to complete a vital piece of legislation that would not only encourage the installation of AEDs in federal buildings, but also grant legal immunity to good Samaritans who use them, whether in public or private buildings. And third, I'm proposing a new rule that would require all commercial planes with at least one flight attendant to include an AED in their in-flight Medical kit. If this entire nation comes together to place AEDs in airplanes, federal buildings and other key locations, we can save more than 20,000 lives every single year. I expect there are very few people listening today who don't know someone who has been struck down by sudden cardiac arrest. Perhaps a father, a great aunt, a cherished teacher, a dear friend. With this new technology, we have the ability to turn around the odds. We can give average citizens the power to restart a heart and save a life. It is now our responsibility to bring this technology, this modern miracle, to every community in America. Thanks for listening.