室顫與急救 ppt課件

1、室顫的識(shí)別與急救Ventricular Fibrillation＆Emergency Management,,1,,學(xué)習(xí)目標(biāo) Learning Objectives,2,概念 Definition,,最嚴(yán)重的心律失常之一 (most severe arrhythmia),心室喪失有效的整體收縮能力(uncoordinated contraction of ventricle),心肌快而不協(xié)調(diào)的顫動(dòng)(rapid and di

2、sorganized fibrillation),室顫,3,臨床表現(xiàn) Clinical Manifestation,4,1.面色蒼白或青紫 Cyanosis2.意識(shí)喪失 Loss of consciousness3.全身抽搐 Convulsion4.阿斯綜合癥 Adams-Stokes Syndrome5.呼吸循環(huán)驟停 Sudden arrest of Respiration and Circulat

3、ion,心電圖 ECG Manifestation,,5,In VF,there is no clear P and QRS waves,the waveform amplitude and frequency are disorganized,frequency could be 250-500 beats per minute.,室顫急救處理Emergency Management,病人呼之不應(yīng)，無(wú)心跳及呼吸，心電監(jiān)護(hù)示室顫,

4、即刻胸外心臟按壓，以C-A-B順序開(kāi)始CPR同時(shí)呼叫醫(yī)生讓另一護(hù)士去取除顫儀,立即電擊除顫,,床邊沒(méi)有除顫儀,,有除顫儀,,,電擊:單向波360J 雙相波200J馬上進(jìn)行5個(gè)CPR循環(huán)評(píng)估節(jié)律，必要時(shí)再次電擊,6,,早期除顫Early Defibrillation,不及時(shí)救治，室顫在幾分鐘內(nèi)導(dǎo)致猝死除顫是終止室顫最為有效的方法除顫成功的可能性隨時(shí)間推移而下降從室顫發(fā)作到給予電擊的時(shí)間不應(yīng)超過(guò)3分鐘

5、,7,,除顫 Defibrillation,,對(duì)心臟的電擊 electric shock,消除原有的異位心律 let random action to stop,使心臟轉(zhuǎn)復(fù)為竇性心律Convert heart to normal sinus rhythm,除顫,8,除顫適應(yīng)癥 Indications,9,,,,除顫三步 3 Main Steps,10,除顫操作 Basic Operation Steps

6、,1.打開(kāi)電源,11,3.充電,2.選擇合適的能量,4.生理鹽水紗布置于病人胸壁,除顫操作 Basic Operation Steps,12,7.提醒大家離床,8.同時(shí)按下放電鍵,5.放置電極板,6.心電圖確認(rèn)為室顫,電極板位置 Position of Paddles,,心尖部：Apex 放于左腋前線第四肋間心底部：Sternum 放于胸骨右緣第二肋間兩電極板位置距離10cm以上除顫時(shí)避開(kāi)皮膚破潰處，永久起搏器植

7、入部位放電時(shí)按壓力量：10kg,,心尖部,,心底部,,13,,,,除顫后處理 After Defibrillation,恢復(fù)竇性心律-成功！,心臟一直線：1.心臟按壓2.腎上腺素1mgiv 3-5min重復(fù)一次,仍為室顫 1.繼續(xù)胸外心臟按壓，再次除顫 2.遵醫(yī)囑給藥，胺碘酮或利多卡因,,,,14,總結(jié) Conclusion,P和QRS波群消失，代之以波形、振幅及頻率極不規(guī)則的細(xì)顫波,頻率達(dá)到250-500次/分,立即