高級急救技能.ppt
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Advanced Skills
高級急救技能
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
初步步驟
* Assess breathing評估呼吸: Look 看, listen 聽, feel 感覺.
(< 10 sec.) Absent 無呼吸? Inadequate 呼吸不恰當?
* If no spontaneous respirations, position victim 如沒有自主呼吸，給予患者適當體位.
* Head-tilt chin-lift or jaw-thrust 頭頸提高，下巴抬起， .
* Reassess breathing: If not adequate, begin ventilations 重新評估呼吸，如仍沒有適當呼吸，開始協(xié)助換氣.
Dangers of ventilation
輔助呼吸的危險
* The thorax has a compliance curve 胸部有順應的弧線.
* The thorax is more pliable at lower volumes, and stiffens when inflated to higher volumes 胸部在低容量時較容易擴張，在高容量時較緊張.
* Too vigorous ventilation inflates the thorax, making it harder to ventilate 太用力的換氣會擴充胸部導致較難換氣.
* Now you're squeezing even harder, producing more inflation 如用力過渡會產生更多的充氣.
Dangers of ventilation
輔助呼吸的危險
* An inflated thorax has a higher intrathoracic pressure 充氣的胸部有較高的胸腔內壓力.
* Higher intrathoracic pressure compresses the vena cava, causing decreased blood return to the heart 高的胸腔內壓壓迫腔靜脈導致回心臟的血液下降.
* The heart is a pump: Less goes in, less comes out 心臟是一個泵，進來少，出去少.
* Blood pressure decreases 血壓下降.
Not good.
Dangers of ventilation
輔助呼吸的危險
* Vigorous ventilation leads to pressure exceeding the lower esophageal sphincter tone 用力的換氣導致對食道擴約肌肌張力有過多的壓力.
* Gastric inflation 胃部膨脹.
* 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、胃充滿則會增加危險.
* Dead people have decreased sphincter tone死者有擴約肌張力下降.
Dangers of ventilation
輔助呼吸的危險
* Gastric inflation leads to elevated abdominal pressure 胃部的膨脹導致腹壓上升.
* Elevated abdominal pressure inhibits diaphragm movement腹壓上升抑制橫膈的活動.
* Decreased diaphragm movement makes it more difficult to bag降低的橫膈的活動使使用呼吸皮囊更加困難.
* Now you're ventilating even harder, producing more gastric inflation 換氣更用力將導致更多的胃部膨脹.
Dangers of ventilation
輔助呼吸的危險
* Hyperventilation leads to alkalosis 過渡換氣導致堿中毒.
* Alkalosis leads to cerebral vasospasm 堿中毒導致腦血管痙攣.
* Cerebral vasospasm leads to decreased blood flow to the brain腦血管痙攣導致流到腦部的血流減少.
* This can't be good 這是不好的現(xiàn)象.
* You and I breathe at a tidal volume of about 500 cc 10-12 times per minute 您與我所呼吸的潮氣量是500 西西 約 10-12次每分鐘.
Dangers of ventilation
輔助呼吸的危險
* For an 80 kg person, that's 500:80 = 6.25 cc/kg 一位80 公斤的人，約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
一個充氣皮囊有 1600 西西的容量.
* A good squeeze will produce 800-1000 cc or more. 一個好的壓縮會產生 800-1000西西或更多
* Let's relax, and stop hyperventilating our patients 放松!停止我們對病人的過度換氣
Bag-Valve-Mask
皮囊-閥門-面罩
* This is your most important airway skill 這是您最重要的呼吸技能!
* Best a two or three rescuer procedure 最好在2 或3 人的急救過程 ......
Advanced Skills
高級急救技能
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
初步步驟
* Assess breathing評估呼吸: Look 看, listen 聽, feel 感覺.
(< 10 sec.) Absent 無呼吸? Inadequate 呼吸不恰當?
* If no spontaneous respirations, position victim 如沒有自主呼吸，給予患者適當體位.
* Head-tilt chin-lift or jaw-thrust 頭頸提高，下巴抬起， .
* Reassess breathing: If not adequate, begin ventilations 重新評估呼吸，如仍沒有適當呼吸，開始協(xié)助換氣.
Dangers of ventilation
輔助呼吸的危險
* The thorax has a compliance curve 胸部有順應的弧線.
* The thorax is more pliable at lower volumes, and stiffens when inflated to higher volumes 胸部在低容量時較容易擴張，在高容量時較緊張.
* Too vigorous ventilation inflates the thorax, making it harder to ventilate 太用力的換氣會擴充胸部導致較難換氣.
* Now you're squeezing even harder, producing more inflation 如用力過渡會產生更多的充氣.
Dangers of ventilation
輔助呼吸的危險
* An inflated thorax has a higher intrathoracic pressure 充氣的胸部有較高的胸腔內壓力.
* Higher intrathoracic pressure compresses the vena cava, causing decreased blood return to the heart 高的胸腔內壓壓迫腔靜脈導致回心臟的血液下降.
* The heart is a pump: Less goes in, less comes out 心臟是一個泵，進來少，出去少.
* Blood pressure decreases 血壓下降.
Not good.
Dangers of ventilation
輔助呼吸的危險
* Vigorous ventilation leads to pressure exceeding the lower esophageal sphincter tone 用力的換氣導致對食道擴約肌肌張力有過多的壓力.
* Gastric inflation 胃部膨脹.
* 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、胃充滿則會增加危險.
* Dead people have decreased sphincter tone死者有擴約肌張力下降.
Dangers of ventilation
輔助呼吸的危險
* Gastric inflation leads to elevated abdominal pressure 胃部的膨脹導致腹壓上升.
* Elevated abdominal pressure inhibits diaphragm movement腹壓上升抑制橫膈的活動.
* Decreased diaphragm movement makes it more difficult to bag降低的橫膈的活動使使用呼吸皮囊更加困難.
* Now you're ventilating even harder, producing more gastric inflation 換氣更用力將導致更多的胃部膨脹.
Dangers of ventilation
輔助呼吸的危險
* Hyperventilation leads to alkalosis 過渡換氣導致堿中毒.
* Alkalosis leads to cerebral vasospasm 堿中毒導致腦血管痙攣.
* Cerebral vasospasm leads to decreased blood flow to the brain腦血管痙攣導致流到腦部的血流減少.
* This can't be good 這是不好的現(xiàn)象.
* You and I breathe at a tidal volume of about 500 cc 10-12 times per minute 您與我所呼吸的潮氣量是500 西西 約 10-12次每分鐘.
Dangers of ventilation
輔助呼吸的危險
* For an 80 kg person, that's 500:80 = 6.25 cc/kg 一位80 公斤的人，約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
一個充氣皮囊有 1600 西西的容量.
* A good squeeze will produce 800-1000 cc or more. 一個好的壓縮會產生 800-1000西西或更多
* Let's relax, and stop hyperventilating our patients 放松!停止我們對病人的過度換氣
Bag-Valve-Mask
皮囊-閥門-面罩
* This is your most important airway skill 這是您最重要的呼吸技能!
* Best a two or three rescuer procedure 最好在2 或3 人的急救過程 ......
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