對于住院患者心臟驟停

1、Unit 12,Emergency Medicine,Word Formation,1. re- (again) e.g. resuscitation2. cardi/o ( heart )3. pulmon/o ( lung )4. –graph ( instrument) e.g. cardiograph/ cardiogram5. therm/o ( temperature )6. pre- ( before

2、 ) e.g. precordial,Questions to consider:,1. If someone fainted in front of you , what would you do ?2. Do you have any knowledge about first aid ?3. What do you know about cardiac resuscitation ?,Cardiopulmonary resus

3、citation,Definition Cardiopulmonary resuscitation (CPR) is a procedure to support and maintain breathing and circulation for a person who has stopped breathing (respiratory arrest) and/or whose heart h

4、as stopped (cardiac arrest). Cardiopulmonary resuscitation, commonly called CPR, combines rescue breathing (one person breathing into another person) and chest compression in a lifesaving procedure per

5、formed when a person has stopped breathing or a person's heart has stopped beating.,The medical term for the condition in which a person's heart has stopped is cardiac arrest (also referred to a

6、s cardiorespiratory arrest). CPR is used on patients in cardiac arrest in order to oxygenate the blood and maintain a cardiac output to keep vital organs alive.If the patient still has a pulse, but is not

7、 breathing, this is called respiratory arrest and artificial respiration is more appropriate. However, since people often have difficulty detecting a pulse, CPR may be used in both cases, especially w

8、hen taught as first aid.,Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest. CPR is performed in hospitals, or in t

9、he community by laypersons or by emergency response professionals.,Description CPR is part of the emergency cardiac care system designed to save lives. Many deaths can be prevented by prompt recognition

10、of the problem and notification of the emergency medical system (EMS), followed by early CPR, defibrillation (which delivers a brief electric shock to the heart in attempt to get the heart to beat nor

11、mally), and advanced cardiac life support measures.,CPR must be performed within four to six minutes after cessation of breathing so as to prevent brain damage or death. It is a two-part procedure that i

12、nvolves rescue breathing and external chest compressions. To provide oxygen to a person's lungs, the rescuer administers mouth-to-mouth breaths, then helps circulate blood through the heart to vital or

13、gans by external chest compressions.,When performed by a bystander, CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over. When perfo

14、rmed by healthcare personnel, it is used in conjunction with other basic and advanced life support measures.,According to the American Heart Association, early CPR and defibrillation combined with early ad

15、vanced emergency care can increase survival rates for people with a type of abnormal heart beat called ventricular fibrillation by as much as 40%. CPR by bystanders may prolong life during deadly vent

16、ricular fibrillation, giving emergency medical service personnel time to arrive.,However, many CPR attempts are not ultimately successful in restoring a person to a good quality of life. Often, there

17、is brain damage even if the heart starts beating again. CPR is therefore not generally recommended for the chronically or terminally ill or frail elderly. For these people, it represents a traumatic a

18、nd not a peaceful end of life.,Purpose When performed quickly enough, CPR can save lives in such emergencies as loss of consciousness, heart attacks or heart "arrests," electric shock, drowning,

19、 excessive bleeding, drug overdose, and other conditions in which there is no breathing or no pulse. The purpose of CPR is to bring oxygen to the victim's lungs and to keep blood circulating so oxyg

20、en gets to every part of the body. When a person is deprived of oxygen, permanent brain damage can begin in as little as four minutes and death can follow only minutes later.,There are three physical sympt

21、oms that indicate a need for CPR to be performed immediately and for emergency medical support to be called: unconsciousness, not breathing, and no pulse detected.,Unconsciousness Unconsciousness

22、is when the victim seems to be asleep but has lost all awareness and is not able to respond to questions or to touch or gentle shaking. An unconscious person will not respond to noise or shaking. When

23、 unconscious, a person can not cough or clear the throat, which can block the windpipe and cause suffocation and death. People with a major illness or injury or who have had recent surgery are at risk for

24、losing consciousness.,If the person has fainted, which is brief unconsciousness, the cause may be dehydration (lack of body fluids), low blood pressure, or low blood sugar. This is a temporary condition. If the victi

25、m is known to have diabetes, a bit of fruit juice may revive the person once they have regained consciousness.,Not Breathing Not breathing, which is also called apnea, is the lack of spontaneous breathing. It re

26、quires immediate medical attention. The victim may become limp and lifeless, have a seizure, or turn blue. Prolonged apnea is called respiratory arrest. In children, this can lead quickly to cardiac arres

27、t in which the heart stops beating. In adults, cardiac arrest usually happens first and then respiratory arrest.,The common causes of apnea in adults are obstructive sleep apnea (something blocks the airway du

28、ring sleep), choking, drug overdose, near-drowning, head injury, heart irregularities (arrhythmia, fibrillation) or cardiac arrest, nervous system disorders, or metabolic disorders. In children the causes may

29、 be different, such as prematurity, bronchial disturbances or pneumonia, airway blockage or choking on a foreign object, holding the breath, seizures, meningitis, regurgitating food, or asthma attacks.,No Pul

30、se Detected If the rescuer is unable to detect a pulse or has difficulty in feeling a pulse it can be an indication of the use of improper technique by the rescuer, or shock or cardiac arrest in the victim

31、. If a sudden, severe decrease occurs in pulse quality (such as pulse weakness) or pulse rate (how many beats in a minute) when other symptoms are also present, life-threatening shock is suspected.,The rescue

32、r may need to explain to a doctor or medical professional where on the victim's body the pulse was measured, if the pulse is weak or absent altogether, and what other symptoms are present. Medical help an

33、d CPR are needed immediately if any of these symptoms is found.,Time is critical. A local emergency number should be called immediately. If more than one person is available to help, one can call a local e

34、mergency medical service, while the other person begins CPR. Ideally, someone CPR certified performs the procedure. If a critically ill patient or post-operative patient is being cared for at home, it is a go

35、od idea for a family member to take a CPR course to be better prepared to help in case of an emergency.,CPR in Basic Life Support Figure A: The victim should be flat on his back and his

36、mouth should be checked for debris. Figure B: If the victim is unconscious, open airway, lift neck, and tilt head back. Figure C: If victim is not breathing, begin artificial

37、 breathing with four quick full breaths. Figure D: Check for carotid pulse. Figure E: If pulse is absent, begin artificial circulation by depressing sternum. Figure F: Mouth

38、-to-mouth resuscitation of an infant.,Understanding the Text,Para. 1cardiac arrest----心跳驟停 ischemic cardiovascular disease----缺血性心血管疾病 lethal----fatalventricular fibrillation----心室纖顫 infarcted myocardium----心肌梗塞 pr

39、imary electrical disturbance----原發(fā)性心肌電活動紊亂Question:1. What are the causes of cardiac arrest ?,Para. 2emergency-medical-services system ----急癥醫(yī)療服務(wù)體系 code team----a specially trained and equipped team of physicians

40、, nurses, and technicians that is available to provide advanced cardiac life support when summoned by an emergency code set by the institution. A code team usually includes a physician, registered nurse, respiratory

41、therapist, and pharmacist. 急救醫(yī)療小組,advanced help----further aid 進一步的救助 chance----possibilityrange from----vary fromvariously----ranging from 在美國，尚沒有醫(yī)院外心室纖顫存活的全國性統(tǒng)計數(shù) 據(jù)，社區(qū)報告存活率為4-33%不等，能夠快速提供救 助的社區(qū)中存活率較高。對于住院患者心

42、臟驟停， 存活率為0-29%不等。,Question:2. How do you understand the chain of survival ? Explain.,Para. 3rhythm----心律collapse (witnessed/unwitnessed)----other than----except Question:3. As a medical student, would you of

43、fer your first aid to a stranger who collapsed suddenly? And how ?,Para. 4a collapsed person----encounter----meetunresponsive----無反應(yīng) summon----callagonal respirations----臨終前呼吸 Question:4. In what condi

44、tion is a person whose heart suddenly stops beating ?,Para. 5fundamentals----(pl.) basic facts or principles 基本事實或原則chest compression----胸部按壓 intrathoracic pressure----胸廓內(nèi)壓 via

45、bility (viable)----存活;活力;生機e.g. 1) The viability of the fetus before the 22nd week is doubtful. 2) A fetus is viable by about the 28th week of pregnancy.contract----(心臟)收縮 cardiac output----心輸出量,Ques

46、tion:5. What are the basic principles of cardiopulmonary resuscitation ? Explain.,Para. 6definitive----conclusive 果斷的; 明確的pulseless ventricular tachycardia----無脈性室性心動過速take/have precedence over 先于…;比…重要---- com

47、e before, appear more important than,Question:6. What comes first , cardiopulmonary resuscitation or rapid defibrillation ? Why ?,Para. 7airway control----(文中指氣管插管) intravenous access----(文中指靜脈點滴)constitute----m

48、ake up; formsustain a perfusing rhythm----維持灌注節(jié)律perfusion----passing of a liquid through vessels or an organ or tissue, especially the flow of blood into lung tissue 灌注Que

49、stion:7. What procedures are involved in advanced care ?,Para. 8administer----vt.observational study----interpret the form and amplitude of----(未來的除顫器可能能夠詮釋心電圖的形狀和振幅，能建議直接除顫或先實施一段時間的心肺復(fù)蘇。) envision----v. imagineb

50、iosensors----生物傳感器,end-tidal carbon dioxide monitors----呼氣末二氧化碳監(jiān)測器 adequacy----sufficiencyQuestion:8. What are the new changes in future first aid procedures according to this paragraph ?,Para. 9placebo-control

51、led studies----安慰劑對照研究 setting----condition; situationintravenous----(靜脈內(nèi)注射胺碘酮 )optimal----the best, most desirablehave/has yet to----肯定句中用 yet 表示”還沒…”, 或表示”到目前為止”e.g. 1) I have yet to

52、 hear your explanation. 2) That is the largest sapphire(藍寶石) yet discovered.,refractory ----unresponsive: applied to a condition that fails to respond satisfactorily to a given

53、 treatment. 難治性的, 治療無效的(指治療 未獲得滿意療效的狀況)Question:9. What does this paragraph mainly talk about ?,Para. 10hypoxic brain damage----缺氧性腦損傷 induce/induction----(目前的研究正致力于誘導(dǎo)體溫下降以及以降低腦損

54、傷為目標的藥物干預(yù)。)Question:10. What procedures are helpful in dealing with brain damage ?,Para. 11precordial thump----胸前區(qū)擊打(能產(chǎn)生一定能量 )for a monitored arrest----Question:11. What is the function of precordial thump

55、?,Para. 12mechanical vests----機械充氣背心 compress/decompress----主動式胸外按壓-減壓復(fù)蘇） randomized studies----隨機抽樣研究 equivocal----indefiniteinterposed abdominal compression cardiopulmonary resuscitation----插入式腹部按壓心肺復(fù)蘇術(shù)技術(shù) altern

56、ate ( with )----交替(進行胸部和腹部按壓) equivalent----as good assuperior----better than,Question:12. How to improve cardiopulmonary resuscitation according to this paragraph ? Give your advice.,Para. 13automated extern

57、al defibrillators----全自動體外除顫器 interpret----detectshock----電擊 Question:13. What can automated external defibrillators do ?,Para. 14prolong/prolonged/prolongation----be compounded by---- (除非患者心跳停止的同時還有以下情況，患者體溫降低

58、、浸在冷水中、用藥過量、其它可確定也可治療的疾病或間歇性心室纖顫或室性心動過速) intermittent ---間歇性的community setting----社區(qū)環(huán)境 in preference to----Question:14. At what time cardiac resuscitation is to stop ?,Para. 15strike down----(illnesses) have a dis

59、astrous or disabling effect upon 使受到摧殘;使一蹶不振;使倒下e.g. be struck down with a serious illness 重病不起 be struck down by heart disease 患心臟病倒下prime----n. (sing.) th

60、e time when sb. is strongest, most beautiful, most successful ,etc. 壯年, 盛年; 最美好的歲月; 顛峰時期e.g. 1) He is past his prime as a tennis player. 2) to be in the prime of life 正

61、值盛年/壯年,productive----e.g. ～ land/discussion/cough/livesavert----vt. to prevent something unpleasant; to avoid 避免e.g. The accident could have been averted.preclude----vt. 排除, 消除e.g. ～ all doubts 排除一切疑慮regardless o

62、f----Question:15. How do you understand the phrase “hearts too good to die” in this paragraph ?,Para. 16prolongation----delayaddress----vt.terminal ---- fatal, advancedin the event of----(formal) if somethin

63、g happense.g. In the event of fire, leave the building as quickly as possible.premises (pl.)----房屋及其產(chǎn)權(quán)范圍空地; 宅邸內(nèi)e.g. The thief was still on the premises. Keep off the premises. 禁止入內(nèi),crews----staff member

64、shonor----vt. respectQuestion:16. How do you understand the phrase “hearts to bad to live” in this paragraph ?,Para.17Question:17. What is the author’s opinion about the effect of cardiac resuscita

65、tion ? Do you agree ?,Do-Not-Resuscitate (DNR) OrdersA do-not-resuscitate (DNR) order placed in a person's medical record by a doctor informs the medical staff that cardiopulmonary resuscitation should no

66、t be performed. This order has been useful in preventing unnecessary and unwanted invasive treatment at the end of life.,Doctors discuss with patients the possibility of cardiopulmonary arrest (when the heart st

67、ops and breathing ceases), describe CPR procedures, and ask patients about treatment preferences. If a person is incapable of making a decision about CPR, a surrogate may make the decision based on th

68、e person's previously expressed preferences or, if such preferences are unknown, in accordance with the person's best interests.,A DNR order does not mean "do not treat." Rather,

69、 it means only that CPR will not be performed. Other treatments (for example, antibiotic therapy, transfusions, dialysis, or use of a ventilator) that may prolong life can still be provided. Treatment tha