高级急救技能.ppt
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参见附件(2664kb)。
Advanced Skills
高级急救技能
Dr. Baxter Larmon, MICP
Professor
UCLA School of Medicine
Dr. Atilla üner, MD, MPH
Assistant Professor
UCLA School of Medicine
Airway Skills
呼吸道技能
Initial approach
初步步骤
* Assess breathing评估呼吸: Look 看, listen 听, feel 感觉.
(< 10 sec.) Absent 无呼吸? Inadequate 呼吸不恰当?
* If no spontaneous respirations, position victim 如没有自主呼吸，给予患者适当体位.
* Head-tilt chin-lift or jaw-thrust 头颈提高，下巴抬起， .
* Reassess breathing: If not adequate, begin ventilations 重新评估呼吸，如仍没有适当呼吸，开始协助换气.
Dangers of ventilation
辅助呼吸的危险
* The thorax has a compliance curve 胸部有顺应的弧线.
* The thorax is more pliable at lower volumes, and stiffens when inflated to higher volumes 胸部在低容量时较容易扩张，在高容量时较紧张.
* Too vigorous ventilation inflates the thorax, making it harder to ventilate 太用力的换气会扩充胸部导致较难换气.
* Now you're squeezing even harder, producing more inflation 如用力过渡会产生更多的充气.
Dangers of ventilation
辅助呼吸的危险
* An inflated thorax has a higher intrathoracic pressure 充气的胸部有较高的胸腔内压力.
* Higher intrathoracic pressure compresses the vena cava, causing decreased blood return to the heart 高的胸腔内压压迫腔静脉导致回心脏的血液下降.
* The heart is a pump: Less goes in, less comes out 心脏是一个泵，进来少，出去少.
* Blood pressure decreases 血压下降.
Not good.
Dangers of ventilation
辅助呼吸的危险
* Vigorous ventilation leads to pressure exceeding the lower esophageal sphincter tone 用力的换气导致对食道扩约肌肌张力有过多的压力.
* Gastric inflation 胃部膨胀.
* Regurgitation and aspiration 反流及吸入.
* Patients with hiatal hernia, obese, full stomach are at increased risk 病人如有肥胖、胃充满则会增加危险.
* Dead people have decreased sphincter tone死者有扩约肌张力下降.
Dangers of ventilation
辅助呼吸的危险
* Gastric inflation leads to elevated abdominal pressure 胃部的膨胀导致腹压上升.
* Elevated abdominal pressure inhibits diaphragm movement腹压上升抑制横膈的活动.
* Decreased diaphragm movement makes it more difficult to bag降低的横膈的活动使使用呼吸皮囊更加困难.
* Now you're ventilating even harder, producing more gastric inflation 换气更用力将导致更多的胃部膨胀.
Dangers of ventilation
辅助呼吸的危险
* Hyperventilation leads to alkalosis 过渡换气导致碱中毒.
* Alkalosis leads to cerebral vasospasm 碱中毒导致脑血管痉挛.
* Cerebral vasospasm leads to decreased blood flow to the brain脑血管痉挛导致流到脑部的血流减少.
* This can't be good 这是不好的现象.
* You and I breathe at a tidal volume of about 500 cc 10-12 times per minute 您与我所呼吸的潮气量是500 西西 约 10-12次每分钟.
Dangers of ventilation
辅助呼吸的危险
* For an 80 kg person, that's 500:80 = 6.25 cc/kg 一位80 公斤的人，约6.25 西西/公斤.
* That's way less than 10-15 cc/kg 少于10-15西西/公斤
* An Ambu-bag has 1600 cc volume
一个充气皮囊有 1600 西西的容量.
* A good squeeze will produce 800-1000 cc or more. 一个好的压缩会产生 800-1000西西或更多
* Let's relax, and stop hyperventilating our patients 放松!停止我们对病人的过度换气
Bag-Valve-Mask
皮囊-阀门-面罩
* This is your most important airway skill 这是您最重要的呼吸技能!
* Best a two or three rescuer procedure 最好在2 或3 人的急救过程 ......
Advanced Skills
高级急救技能
Dr. Baxter Larmon, MICP
Professor
UCLA School of Medicine
Dr. Atilla üner, MD, MPH
Assistant Professor
UCLA School of Medicine
Airway Skills
呼吸道技能
Initial approach
初步步骤
* Assess breathing评估呼吸: Look 看, listen 听, feel 感觉.
(< 10 sec.) Absent 无呼吸? Inadequate 呼吸不恰当?
* If no spontaneous respirations, position victim 如没有自主呼吸，给予患者适当体位.
* Head-tilt chin-lift or jaw-thrust 头颈提高，下巴抬起， .
* Reassess breathing: If not adequate, begin ventilations 重新评估呼吸，如仍没有适当呼吸，开始协助换气.
Dangers of ventilation
辅助呼吸的危险
* The thorax has a compliance curve 胸部有顺应的弧线.
* The thorax is more pliable at lower volumes, and stiffens when inflated to higher volumes 胸部在低容量时较容易扩张，在高容量时较紧张.
* Too vigorous ventilation inflates the thorax, making it harder to ventilate 太用力的换气会扩充胸部导致较难换气.
* Now you're squeezing even harder, producing more inflation 如用力过渡会产生更多的充气.
Dangers of ventilation
辅助呼吸的危险
* An inflated thorax has a higher intrathoracic pressure 充气的胸部有较高的胸腔内压力.
* Higher intrathoracic pressure compresses the vena cava, causing decreased blood return to the heart 高的胸腔内压压迫腔静脉导致回心脏的血液下降.
* The heart is a pump: Less goes in, less comes out 心脏是一个泵，进来少，出去少.
* Blood pressure decreases 血压下降.
Not good.
Dangers of ventilation
辅助呼吸的危险
* Vigorous ventilation leads to pressure exceeding the lower esophageal sphincter tone 用力的换气导致对食道扩约肌肌张力有过多的压力.
* Gastric inflation 胃部膨胀.
* Regurgitation and aspiration 反流及吸入.
* Patients with hiatal hernia, obese, full stomach are at increased risk 病人如有肥胖、胃充满则会增加危险.
* Dead people have decreased sphincter tone死者有扩约肌张力下降.
Dangers of ventilation
辅助呼吸的危险
* Gastric inflation leads to elevated abdominal pressure 胃部的膨胀导致腹压上升.
* Elevated abdominal pressure inhibits diaphragm movement腹压上升抑制横膈的活动.
* Decreased diaphragm movement makes it more difficult to bag降低的横膈的活动使使用呼吸皮囊更加困难.
* Now you're ventilating even harder, producing more gastric inflation 换气更用力将导致更多的胃部膨胀.
Dangers of ventilation
辅助呼吸的危险
* Hyperventilation leads to alkalosis 过渡换气导致碱中毒.
* Alkalosis leads to cerebral vasospasm 碱中毒导致脑血管痉挛.
* Cerebral vasospasm leads to decreased blood flow to the brain脑血管痉挛导致流到脑部的血流减少.
* This can't be good 这是不好的现象.
* You and I breathe at a tidal volume of about 500 cc 10-12 times per minute 您与我所呼吸的潮气量是500 西西 约 10-12次每分钟.
Dangers of ventilation
辅助呼吸的危险
* For an 80 kg person, that's 500:80 = 6.25 cc/kg 一位80 公斤的人，约6.25 西西/公斤.
* That's way less than 10-15 cc/kg 少于10-15西西/公斤
* An Ambu-bag has 1600 cc volume
一个充气皮囊有 1600 西西的容量.
* A good squeeze will produce 800-1000 cc or more. 一个好的压缩会产生 800-1000西西或更多
* Let's relax, and stop hyperventilating our patients 放松!停止我们对病人的过度换气
Bag-Valve-Mask
皮囊-阀门-面罩
* This is your most important airway skill 这是您最重要的呼吸技能!
* Best a two or three rescuer procedure 最好在2 或3 人的急救过程 ......
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