The sixth generation series cardio-pulmonary resuscitation simulation and training system.
Cardiopulmonary resuscitation, the international terms: Cardiopulmonary Resuscitation. Short title: CPR. Arrest (such as heart disease, myocardial infarction, shock, drowning, poisoning, mine, working at height, traffic accident, travel accident, natural disasters, accidents, etc. caused by cardiac arrest), while the first witness to take the scene for help CPR and other emergency relief measures. In taking on-site CPR A, B, C three steps: the A --- airway open. B --- artificial respiration.C---artificial cycle (chest), conditional can take D---automatic external defibrillator. Without onsite rescue personnel specification standard cardiopulmonary resuscitation A, B, C, D steps where the patient lives were saved in the shortest time. Therefore, medical and health medical workers and the general public must learn cardiopulmonary resuscitation techniques, learn this technique, you must have established teacher training and related equipment, Koko medical simulation will provide you with the heart-lung recovery technology training model.
Medical implementation of a new international standard CPR cardiopulmonary resuscitation. .
In November 2005, the American Heart Association (AHA) and the International Federation of cardiopulmonary resuscitation officially announced the 2005 international cardiopulmonary resuscitation (CPR), first aid & cardiovascular (ECC) Guide (hereinafter referred to as the 2005 international guidelines for cardiopulmonary resuscitation).
International CPR guidelines in 2005, the Basic Life Support (BLS) has been further attention, highlighted the significance of effective chest compressions without interruption. The standard ventilation of the compression ratio, press the ventilation cycle, press the ventilation parameters of CPR was radically changed in the core technologies, and promote the increasing use of AED. The main amendments:. .
● 2005 international guidelines recommend cardiopulmonary resuscitation in adults with single or twin rescuing patients according to the press-e; 30: 2 for children or babies when implementing single rescue is press-ventilation: 30 2, twin rescuing when pressing ventilation ratio 15: 2;.
● 2005 International Guidelines recommend CPR chest compressions and artificial respiration to 30:2 ratio for five cycles of the cycle, in which chest compression rate of 100 beats / min; artificial blowing each sustained more than 1 second;. .
● 2005 international guidelines recommend cardiopulmonary resuscitation in adults with chest depth of 4-5 cm, chest depth 2-3 cm, chest depth infants 1-2 cm.
With the 2005 implementation of the international CPR guidelines, the original 2000 version of standard cardiopulmonary resuscitation in the press and press the ventilation air ventilation 15:2 four cycles will repeal and stop enforcement of new guidelines is imperative to understand and use. On the medical model of Hai Keke Limited pioneered the development of this time line 2005 international CPR guidelines of the sixth generation (BLS) series of the latest skills training and evaluation standards for people with ACLS series modeling skills teaching. 2005 International guideline for cardiopulmonary resuscitation, the improved, simplified procedures and improved training in cardiopulmonary resuscitation success rate of CPR has great practical significance。.
2005 International cardiopulmonary resuscitation (CPR) guide to the latest standard ratio table. .
。.
Adult. .
1-8-year-old children.
Baby. .
Open airway.
Law held his head and chin. .
Looked up-lift the Chin method.
Law held his head and chin. .
Artificial respiration.
2 effective breathing. .
(Every time for 1 second or more).
2 effective breathing. .
(Every time for 1 second or more).
2 effective breathing. .
(Every time for 1 second or more).
Respiratory rate. .
10-12 times/minute.
(About 5-6 seconds of blowing time). .
10-20 times/min.
(About 3-5 seconds of blowing time). .
10-20 times/min.
(About 3-5 seconds of blowing time). .
Check cycle.
Carotid artery. .
Femoral artery.
Brachial artery. .
Press the position.
Sternal notch under the chest (chest xiphoid Office) on the two middle parts of the sternum, or chest that middle level of the nipple connection. .
Nipple connection the next finger.
Compression method. .
Two Palms root overlap.
Two overlapping palm root / root of a palm. .
2 means (in the hands around the chest, the second person of the thumb).
Compression depth. .
4-5cm。.
2-3cm. .
1-2cm。.
Pressing frequency. .
100 times per minute.
100 times / min. .
100 times per minute.
Compression ventilation ratio. .
30: 2 (single or double occupancy).
30:2 / single or 15:2 / double. .
30: 2/single or double: 2/15.
Moisture ratio. .
500ml-600ml。.
Per kg / 8ml (about 150ml-200ml). .
30ml-50ml。.
CPR cycle. .
2 time blowing, and then press effectively and ventilation CPR five cycles.
AED. .
With AED equipment condition, please use the AED defibrillator once and then for 5 cycles CPR.
Not recommended. .
2005 International for cardiopulmonary resuscitation and emergency cardiovascular care science with first aid guides (1).
Overview and ethical issues. .
Compiled by: 1974, the American Heart Association (AHA) to develop the world's first cardio-pulmonary resuscitation (CPR), and in 1980, 1986, 1992, amended three times; at the same time, the European Resuscitation Council (ERC) was published in 1992 by the European guidelines for cardiopulmonary resuscitation and, in 1996, 1998, the second amendment; many other countries have also established their own guidelines for cardiopulmonary resuscitation. Although the great influence of these guidelines, but also the development of cardiopulmonary resuscitation played a significant role in promoting, but a lot of controversial issues in the national guidelines is not uniform, has not formed an international counterparts are jointly agreed international guidelines for cardiopulmonary resuscitation. To this end, in 1992 by the American Heart Association, the European recovery in the Canadian Heart and Stroke Foundation (HSFC) and other relevant national organizations, have launched the International Federation of resuscitation (ILCOR), its purpose is to draw worldwide cardiopulmonary resuscitation scientific basis and would apply to countries in the world. .
In February 2000 by the American Heart Association and the International Federation of the participation of the recovery of the cardio-pulmonary resuscitation guide arguments evaluate Conference to be held in the United States, the Conference on the guidelines for a wide range of comments, disputes and reach consensus, and finally in 2000, August 15, the first international guidelines for CPR — the 2000 for cardiopulmonary resuscitation and emergency cardiovascular care science with first-aid guide published. Since 2000, guidelines for cardiopulmonary resuscitation, the world has considered important the references in the cardio-pulmonary resuscitation, in China have also been relevant experts and Government ministries and actively recommended and used as training in cardiopulmonary resuscitation. In order to further improve and concluded, "2000 International cardiopulmonary resuscitation and emergency cardiovascular care guidelines", for the past five years to get the new arguments for further assessment of evidence-based medicine, 2005 years in January to meet again in Texas, "Guide "revise the meeting and in November 2005 in the" circle "journal. Is the "2005 International cardiopulmonary resuscitation and emergency cardiovascular care guidelines" Excerpt make the following, in order to promote the practice of cardiopulmonary resuscitation guidelines in our province, standardization. .
2005 International for cardiopulmonary resuscitation and emergency cardiovascular care science with first-aid guide catalog.
The first part of the Introduction (Introduction). .
The second part of the ethical issues (Ethical Issues).
The third part of the CPR Overview (Overview of CPR). .
The fourth part of the adult basic life support (in Adult Basic Life Support).
Part V of electrophysiological treatment: In vitro automatic defibrillators, defibrillation, cardioversion, pacing therapy. .
（Electrical Therapies：Automated External Defibrillators，Defibrillation，Cardioversion，and Pacing）。.
Part VI of the technology and methods of CPR (CPR Techniques and Devices). .
Seventh part 1, auxiliary airway control and ventilation (Airway Adjuncts for Control and Ventilation).
2, treatment of cardiac arrest (Management of Cardiac Arrest). .
3, symptomatic bradycardia and tachycardia (Management of Symptomatic Bradycardia and Tachycardia).
4, monitoring and drug treatment (Monitoring and Medications). .
5 after the treatment, recovery support (Postresuscitation Support).
Part VIII of acute coronary syndrome (Stabilization of the Patient With Acute Coronary Syndromes). .
Part IX stroke in adults (Adult Stroke).
The tenth part of a life-threatening electrolyte abnormalities (Life-Threatening Electrolyte Abnormalities). .
2, cardiovascular toxicology of (Toxicology in ECC.).
3, drowning (Drowning). .
4, hypothermia (Hypothermia).
5, near-death asthma (Near-Fatal Asthma). .
6, allergic reactions (Anaphylaxis).
7, trauma-related cardiac arrest (Cardiac Arrest Associated With Trauma). .
8, pregnancy-related cardiac arrest (Pregnancy Associated With Cardiac Arrest).
9, electric shock and electric shock (Electric Shock and Lightning Strikes). .
Eleventh part of children's basic life support (Pediatric Basic Life Support).
Part XII of the pediatric advanced life support (Pediatric Advanced Life Support). .
Part XIII of neonatal resuscitation guidelines (Neonatal Resuscitation Guidelines).
14th part of the aid measures (First Aid). .
(A) introduction.
2005 cardiopulmonary resuscitation and emergency cardiovascular care guide new development. .
Guide to the most important change is that simplifies the CPR, CPR increases every minute during the chest to reduce the number of times and the chest of the batch.
Here is "2005 Guide" some of the most important new recommendations:. .
(1) delete a non-qualified first aider start chest before vital signs assessment: for non-professional training in first aid are to encounter the unconscious patients with respiratory arrest, the first 2 artificial respiration begins immediately after the chest.
(2) simplify the procedures for artificial respiration: All respirators (both mouth, mouth on the mask, balloon - mask, or balloon on the artificial airway) should be continued to blow more than 1 second, to ensure sufficient amount of gas into and to significantly raise the thorax. .
(3) remove first aid for non-professional without chest of artificial respiration training.
(4) is recommended for all ages (except newborns) and first aid for patients with single, the compression / ventilation ratio of 30:2. The proposal aims to simplify teaching and provide longer uninterrupted chest compressions. .
(5) introduced by the healthcare of paediatric basic life support guidelines, the "paediatric patients".
Revised definition of pre-adolescent patients, but the application by non-professional first-aid personnel cardiopulmonary resuscitation guidelines for children (1 to 8 years old) has not changed. .
(6) stresses the importance of chest: emphasizes the first aider should "push, quick compression" (100 times per minute rate) to ensure sufficient resilience and thoracic chest intermittent minimum.
(7) suggested that emergency medical personnel were no witnesses to the cardiac arrest before defibrillation can be considered first for about five groups (about 2 minutes) cardiopulmonary resuscitation, especially in the site of the incident response from the call to EMS arrival time of more than 4 to 5 minutes. .
(8) no veins of the heart, it is recommended during treatment of patients with two heartbeat check given between about 5 groups (or about 2 minutes) cardiopulmonary resuscitation. First aider should not be checked immediately after the shock heart or pulse-instead, you should reinstall cardiopulmonary resuscitation, chest, and heartbeat check in five groups (or about 2 minutes) after cardiopulmonary resuscitation.
(9) recommend that all first aid measures, including advanced airway open (such as endotracheal intubation, esophageal - tracheal tube [Combitube], or laryngeal mask airway [LMA]), administration and re-evaluation of patients are should ensure that the shortest interval of chest compression. .
(10) ventricular fibrillation/pulseless ventricular tachycardia, recommended a shock 1 times instead of shock 3 times immediately after cardiopulmonary resuscitation (chest), this is because the new defibrillator first electric shock has a high success rate, and you have to know if the first fails, give shock chest can improve oxygen and nutrients to the heart muscle to make subsequent defibrillation shock is more likely to succeed.
(11) to increase ventilation during neonatal resuscitation stressed the importance of de-emphasizing the importance of the use of high concentrations of oxygen. .
(12) once again confirmed compliance with the US National Institute of neurological diseases and stroke (NINDS) criteria for acute ischemic stroke patients treated with intravenous fiber solvent (tPA) to improve their prognosis.
(13) proposed a new on-site first aid. .
Future trends → recovery of cardiac arrest survival of the most important determinant of the scene is trained in first aid, and the first aider are ready, willing and able and equipped to fully. Despite the recent independent cycle recovery after proved systemic hypothermia can improve certain ventricular fibrillation cardiac arrest survival rates for patients discharged from hospital, but the most advanced life support techniques can improve cardiac arrest patient prognosis or just confirmed that can improve the survival rate of short-term (e.g. during hospitalization). In fact, the advanced life support treatment for any improvement in survival rates were less than successful in the community to promote non-professional rescuers CPR and automated external defibrillation project results. Therefore, should be to improve the education of non-professional rescuers as our biggest task. We must increase the CPR education, increase the effectiveness and efficiency of teaching, improve memory and reduce the skills of basic and advanced life support emergency barriers were implemented. .
(Ii) ethics issues.
Emergency treatment of cardiovascular disease the goal is to save lives, restore health, relieve pain, reduce disability and clinical death. CPR's decision to rescue those who are often made in a few seconds, the rescue of patients who may not know whether the heart will recover after the cessation of existence do not want to. Thus, for CPR, sometimes with the patient's wishes or best interests of the conflict. Stop and not to standard CPR:. .
Scientific assessment shows that very few standards correctly forecast the ineffectiveness of CPR. In view of this uncertainty, all patients in cardiac arrest should be made, unless the cardio-pulmonary resuscitation:.
● patients effective "to give up the recovery," Wills (Donot Attempt Resuscitation, DNAR). .
? Patient irreversible death signs (such as a zombie, breakage, carrion or clear dead spot).
● do the maximum treatment efforts are still deteriorating organ function, no signs of improvement in vital signs (such as progressive deterioration of sepsis or cardiogenic shock). .
Out-patient does not stop the CPR CPR and related issues:.
● the patient is dead, there is no reversible signs of death (such as zombies, Livor mortis, decapitation, or carrion). .
● Carry out rescues CPR may cause personal injury.
● the patient / guardian will clearly show (DNAR) have the desire to give up the recovery. .
In-hospital resuscitation: BLS is terminated.
The rescue has begun to BLS should continue until one of the following situations:. .
● Effective self-recovery cycle and ventilation.
● has been transferred to a higher level of medical relief workers, he decided to revive the patient can void. .
? There has been a reliable signs of irreversible death.
● rescuer as physically frail, or the environment may cause harm to rescue those who own, or as a lasting recovery in treatment affect the lives of others. .
● Find valid DNAR directive.
Provide family emotional support: Despite our efforts, but most of recovery is still failed. Recovery process, recovery team members should be concerned about the presence of family members, arrangements for staff to answer family questions, clarify information, provide a comfortable place, full of compassion to the family members informed of the death of their relatives is an important part of recovery efforts, and should focus on cultural, religious and family. .
First, the scientific consensus (Consensus on Science).
To "cardiopulmonary resuscitation and emergency cardiovascular care international guidelines (2000-2005)" as the basis to introduce on-site CPR. .
Recommended by international guidelines..
Evidence-icu. . Cn '> medicine (EBM) is based on:. .
※ Confirms many safe and effective treatment methods.
※ proved to be ineffective in some way be denied emergency treatment;. .
* Recommended to undergo a rigorous evidence icu. .cn ' > medicine confirmed the new method.
※ In the present conditions the most effective and easy guide for teaching;. .
?? provide the most up-to-date knowledge, research and clinical experience.
History. .
In the 1950s American doctor Peter sand method (Peter Safar) professors reissued mouth-blown and surgery.
In 1960, Cowen doctors (Kouwenhoven), who observed strength during chest compressions, blood flow can be maintained. .
Sand and Cowan confirmed the mouth-blown and chest heart massage combined with the rationality of the applied technology.
Method with two methods of sand to lay the foundation of modern CPR. .
* 40 years CPR in fashionable, American popular 70 million passengers.
CPR brought hope, Europe and the United States could save an average of 1000 cases per day outside the hospital cardiac arrest cases;. .
China's power sector from the 1950s began CPR first aid training, consisting mainly of the 70 's started CPR, in electric shock treatment on achievements.
"International CPRECC Guide 2000" in February 2000 was finalized in Dallas, August 15, 2000, at the American Heart Association's "Cycle" magazine enacted. .
In January 2005 on the CPR and ECC guidelines 2000 "has been amended, as the international guidelines for CPR and ECC, and 2005 will be held in November 2005 in the u.s." loop "magazine to 100 pages of published. The Guide agglutination global 110 countries, regional icu. .cn ' > medical experts work.
Widespread and accepted, is a scientific basis, icu. . Cn '> medical personnel, professional emergency personnel involved. .
2. ethical principles (Ethical Aspects).
CPR's goal:. .
1. life-saving restoring health to relieve pain and reduce disability.
2. . However, CPR is a special goal is to reverse the clinical death, it has limitations. .
The principle of patient autonomy.
In ethics is respected in many countries is subject to legal protection. .
Hospice will make their own medical: covers CPR.
Type: conversation, writing a will, living will and power of attorney on a permanent medical staff. .
Meets the following conditions without CPR.
1. . A scientific evaluation has shown no clear criteria can accurately predict CPR ineffective. Therefore, recommended that all patients in cardiac arrest should be treated with CPR, unless:. .
Patients have a valid wills;.
Patients with irreversible death signs: dead, decapitated or Livor mortis;. .
Forecast not physiological benefits, on the severe sepsis, and cardiogenic shock was the most active treatment, important organ function is still deteriorating or disease advanced (cardiac arrest is the inevitable result).
2. . In the implementation of CPR, the rescue will be running the risk of injury. .
The following situation: you can terminate the CPR.
1. . Effective restoration of spontaneous circulation and ventilation; with professional medical personnel take over. .
2. reliable indications hint exist irreversible death; ambulance due to exhaustion, surrounding environment, the continuing recovery can cause other people in danger and have to be terminated.
3. . To provide an effective end to the ambulance CPR will. .
Termination and extension of the CPR.
1. . In the hospital: doctors treatment depend upon. .
2. scientific research has shown that after 30 minutes of advanced life support, patient there is still no better, you can terminate the CPR for infants, where fifteen minutes is invalid may terminate.
3. . An appropriate extension CPR: younger age; drug overdose; severe hypothermia (such as drowning); toxins and electrolyte abnormalities; these are factors that can change the predictions. .
Announcement of the patient's death.
Many countries, particularly the United States to provide the death certificate issued in the field can not. .
Europe, with the ambulance doctor, can be pronounced dead.
Truck doctors generally do not announce our death and decided to stop all resuscitation, or against the icu. . Cn '> Medical Ethics. .
Withdraw life support.
For families and medical staff, it is a very complex and emotional decision, as the situation may withdraw life support:. .
1. doctors and family members that therapeutic purposes cannot implement or continue treatment and no benefits, its decision was appropriate.
2. . Studies show that the coma is unable to re-awake, in the first 3 days without pupillary light response, the lack of autonomic response to pain or a weekend without bilateral cortical somatosensory evoked potentials are to be removed life support. .
3. advanced incurable disease, regardless of whether conscious or timely, rigorous treatment cessation of heartbeat is the inevitable result.
3. . Basic Life Support (Basic Life support). .
CPR BLS is the most important and fundamental and core content, at the latest international guide, made some changes.
(A) Early start EMSS:. .
* "Quick call" or "call".
* BLS order: assessment, for help EMS, CPR. .
ABC and Cardioversion/defibrillator AED.
* "Adult" is defined as any person over 8 years. .
(1) the majority of non-traumatic for sudden cardiac arrest patient-VF:.
Onset to defibrillation / cardioversion time for the successful recovery of decisive significance. .
(6) the majority of infants and young children (1-year-old page〈) and children (1 to 8 years old) of respiratory cardiac arrest causes and airway or ventilation, non-sudden cardiac events, first aid, CPR is important.
First of all, first aid, to 1 minute of CPR then call EMSS. .
(2) treatment of apoplexy and BLS in acute coronary syndrome: ambulance staff on not sober adults should "first call" the ambulance crew, ambulance transferred as soon as possible and advance notification to accept the hospitals, in order to increase their rapid intravenous thrombolysis.
(3) drowning, trauma, drug allergy patients, should provide CPR, then "quick phone call." .
(4) a clear airway obstruction in adults.
In to the EMSS for help before, first aid should keep airway open. .
Immediately call EMSS, CPR and first aid measures and others.
EMSS personnel until the arrival, transfer conditional hospital. .
(5) in the event of airway obstruction:.
On the 'first ambulance' does not require treatment in adults is not clear foreign body airway rescue procedures;. .
Such as suspected or confirmed may have airway, can be piloted to CPR, after lifting the airway;.
Line respirators, the attention to check the foreign body;. .
Professional ambulance staff are not clear when a patient should be lifted airway rescue.
(6) Two ambulance at the scene. .
The first one to start CPR;.
The second call for help EMSS, if circumstances permit, should be conducted to identify AED shock cardioversion. .
(2) the order and change BLS.
1. . Resuscitation:. .
The mouth, face mask, air ventilation, times change.
Anaerobic: 700-1000 ml tidal volume, 2 seconds;. .
There are oxygen supply: 400-600 ml, 1-2 seconds.
Check pulse. .
Does not require the master of the first ambulance.
Cycle signs: normal breathing, coughing, movement away, start chest compressions. .
Medical staff demand check, assessment of circulating signs.
2. . External Cardiac compression:. .
Adults 100 times/minute.
Single / double CPR, compression / ventilation: Guide 2000 15 / 2,2005 to 30:2;. .
Press and mouth-to-mouth; at the same time.
The use of voice metronome to improve the implementation of CPR efforts. .
(3) the BLS's "gold" at all times.
(1) the edge of death of patients, BLS's initial 4 to 10 minutes is the most critical patients can survive the "golden moment" to decide whether to continue the rescue program. .
(2) the "golden hour" rescuing patients living in the most critical measures are BLS.
1. . BLS content:. .
Rapid identification and treatment of myocardial infarction and stroke to prevent respiratory, cardiac arrest.
Respiratory arrest when resuscitation;. .
Respiratory and cardiac arrest at the chest heart massage and artificial respiration;.
On the occurrence of ventricular fibrillation or ventricular tachycardia who, with the AED for defibrillation / cardioversion;. .
Recognition and disarm the airway.
2. . What is life chain? . .
The so-called "life chain", refers to the sudden cardiac arrest patient, a series of sequential steps, standardized effective rescue measures to rescue the sequence to chain link x form, constitute a life-saving "life chain" (the Chain of Survival). American College of Cardiology in October 1992 in page〈 American icu. .cn ' > medical journal > formally describing enabled. Modern first-aid, especially in emergency, life-saving programs often to describe.
3. . A key link in the chain of life - Early electrical cardioversion. .
International standards: received first aid distortion call centre 5 minutes given the intra-hospital electric cardioversion, requires an electric shock 3 minute; cardioversion.
Support the establishment of public access defibrillation / cardioversion program;. .
BLS staff (***, firemen, security guards, coach, high risk, public officers) for training (not rated).
Community: through training, can make emergency calls, electric shock interval <5 minutes using the AED;. .
"Adult" is defined as greater than 8 years of age, do not recommend to anyone under the age of 8 application AED. (1) the principle of early: cardioversion.
Initial rhythm of cardiac arrest with ventricular fibrillation (85 ~ 92%) were the most common treatment of ventricular fibrillation of the most effective measures to electrical shock. .
The likelihood of success and reduce with time extension (see diagram), ventricular fibrillation in a matter of minutes, there is a change to the tendency of ventricular pause.
Even as late as after cardiac arrest in 6-10 minutes cardioversion can also be successful recovery, the survivors may be no neurological damage, especially in the case of giving CPR. .
Waiting for the implementation of the AED CPR seems to extend the time of rescue, ventricular fibrillation, conducive to the protection of the heart and brain function.
If there is no basis for AED, CPR does not make changes to the normal rhythm of ventricular fibrillation. .
Every 1 minute delay, ventricular fibrillation of cardiac arrest survival rates will decrease 7% ~ 10%, defibrillation sooner, the better the prognosis.
If 'the first ambulance', the survival rate of cardiac arrest can be improved significantly. .
Use indications:.
Confirm whether the cardiac arrest;. .
Cardiac arrhythmias such as supraventricular tachycardia and ventricular tachycardia and ventricular fibrillation are indications for cardioversion.
Four basic steps:. .
Turn on the power supply;.
Paste shock films (Khan, hairy chest - check the shock film);. .
Analysis of rhythm (5-15 seconds, distance).
From patients and by "shock" button. .
Cardioversion + press + ventilation combined.
3 no sinus rhythm after the shock, re-CPR1 minutes, and check the cycle signs. .
Non-circulating signs, continue pressing the heart.
A cycle of signs, no breathing is artificial ventilation;. .
If the recurrence of ventricular fibrillation, the electric cardioversion again.
Emphasized the combination CPR and AED application. .
(4) public use of AED.
AED is simple, non-specialists can grasp. .
Public places (1/10000) can be placed.
Community as "the ultimate heart care unit." .
According to reports 49% survival rate is as high as that for the past most effective EMS system in 2 times.
(D) BLS indication. .
1. respiratory arrest:.
Cause: drowning, stroke, FBAO, smoke inhalation, drug overdose, electrocution, suffocation, trauma. .
Respiratory arrest, cardiac and pulmonary blood oxygenation can last a few minutes and continue on the brain and other vital organs of oxygen supply.
Patients may have signs of circulation. .
To quickly open the airway and breathing can save lives.
Continuous supply of oxygen to prevent cardiac arrest. .
2. cardiac arrest:.
Loop termination, so that vital organs hypoxia. .
Invalid "asthmatic" breathing (near-death-like breathing) occurred in cardiac arrest earlier, should not be confused with effective breathing.
Associated with the following arrhythmias: ventricular fibrillation, ventricular tachycardia, pulseless electrical activity or ECG static (a straight line). .
(5) the implementation of the BLS.
BLS is composed of a series of continuous operation technology, including the assessment of technical, support or intervention techniques. .
(1) assessment:.
Include:. .
On-site security and causes, casualties, etc?.
Ambulance itself, the patient and bystanders are at risk? . .
The casualty is still in danger exists?.
Field can be applied to judge what kind of resources and support actions taken by ambulance. .
(2) security:.
First of all, to ensure their own safety, such as electric shock first aid, you must cut off the power before you can take measures to protect the safety of the ambulance. .
To clear the limit the ability of their rescue, cannot eliminate the potential risk factors, you should try to ensure that the injured and their distance from the safety of rescue.
In the field to remain calm, careful responsible, rational scientific judgments, prioritizing, and decisive implementation of the rescue measures. .
(3) personal protective equipment.
The first ambulance ambulance at the scene, the personal protective equipment should be used to prevent pathogens entering the body:. .
Oral quarantine measures.
Good personal protective equipment, wearing medical gloves, goggles, overalls, masks and so on. .
(5): evaluation of mental patients.
Whether patients with a clear mind: will open eyes or physical exercise, is that conscious patients. If no response to stimuli in patients, then that loss of consciousness, had fallen into critical condition. He suddenly fell to the ground, and then not call the situation were more serious. .
2. hue to EMSS.
Found that patients with critical injuries, immediate ambulance in time to the professional emergency medical system (Emergency Medical Service System, EMSS) or near the shoulder the task of health care outside the hospital emergency departments, community health units report. EMSS should immediately send professional rescue personnel, ambulance to the scene of the incident. Effective EMSS, on the protection of critically ill patients receive timely treatment is essential. .
American model: fire-fighting system---911.
Police system. .
Medical care system.
Community volunteers. .
** * Mode: the Medicaid system.
Fire brigade. .
Community volunteers.
China's current situation: first aid centers (stations) --- 120. .
Red Cross rescue system-999.
Traffic Police / Traffic -110/122. .
Community volunteers (1) ambulance body:.
Aid in the implementation of CPR technology, according to the site around the situations of patients, select the patient side of the (often choose the right side), the legs apart, shoulder width distance *** affixed to (or stand) patients shoulder, waist, and benefit operations. .
(2) where the ambulance patient positioning:.
Supine --- flat, solid surface - CPR position. .
Recovery order of ABC, CAB:.
U.S. ABC;. .
CAB; Norway.
No direct comparison, but are effective. .
A.-open airway:.
Common methods: to mention his head and chin law; double chin reference (elected mandibular Act); lift his head and neck method. .
Mechanism: respiratory and cardiac patients after the muscles relax, mouth glossal muscle relaxation also falling and respiratory tract. Open the airway of the methods that you can make the obstruction of respiratory tract on the tongue, the respiratory tract unimpeded.
Note: Use 3-5 seconds, the patient first collar mouth, ties, scarves, etc. can be answered, quickly put on gloves, remove the sludge within the patients mouth and nose, clods, sputum, vomit and other foreign matter, to facilitate the smooth flow of breath, and then open the airway. .
Normal human inhalation of oxygen in the air as .94% 20. carbon dioxide (CO2) is 0. .04 percent.
Oxygen content in the lungs can only absorb 20% of the remaining 80% of the exhaled gas stood. Therefore, in the exhaled gas, the oxygen content decreased to 16%, carbon dioxide increased by 4%. A small amount of carbon dioxide are excited about the role of the respiratory center. .
Implementation of the mouth (nose) artificial respiration and "breathe" ambulance "breath", the oxygen concentration in gas is low, the higher the concentration of carbon dioxide. However, in patients after stroke, lung and respiratory arrest in half collapsed State, in case of respiratory tract unimpeded, blown pulmonary gas can cause lung tissue expansion, there is sufficient oxygen gas for patients ' needs. (2): artificial respiration.
Mouth resuscitation:. .
More than 2 seconds per time;.
10-12 times / minute;. .
Ensure each lift; the chest.
700-1000 ml / second;. .
Artificial respiration, the esophagus, stomach bloating pressure:.
Short of blowing time; large tidal volume and high airway pressure. .
Initial ventilation is not successful, the reopening of the airway;.
Still valid, should be FBAO lifted. .
Cast on nasal breathing.
Mouth breathing to tracheal stoma. .
Cast on barrier implementation breathe..
Mask, face mask, bag mask. .
Cricoid cartilage pressure respiration.
To prevent swelling and reduce gastric reflux. .
Circulation: C..
(1) Assessment: the 'new standard' does not check the pulse: The study concluded: Check the pulse as a diagnostic cardiac arrest in accuracy, sensitivity, specificity, there are serious limitations. .
Ambulance, judged for a long time (more than 24 seconds).
1 / 10 does not recognize, 4 / 10 chance errors, only 15% of them within 10 seconds to correctly recognized;. .
Specificity of 90% (non-pulse for cardiac arrest), 10% error.
55% sensitivity (correct identification of pulse without cardiac arrest), 4 / 10 is wrong;. .
All 65% accuracy rate, rate of 35%.
(2) the assessment of circulating signs:. .
On the unconscious, no breathing patients with initial artificial respiration.
Inspection cycle signs:. .
A look at the second hearing, three feel (normal breathing or coughing);.
Quick check of any patient movement observed signs. .
If not, you should immediately begin chest cardiac massage.
Carotid artery: The hand index finger and middle finger placed in the central neck (thyroid cartilage) middle, middle finger slide from the neck between the thyroid cartilage and the sternocleidomastoid depression, a little touch to the intensity of the carotid artery pulse. .
Brachial artery: Brachial artery located inside of the arm, elbow and shoulder, with a little effort to check and restless.
* Note: Check the carotid artery pressure is not hard to avoid the carotid sinus stimulation makes the vagus nerve excitability caused by reflex cardiac arrest. .
(3) press the chest heart.
Continuous rhythmic pressure to push the lower sternum 1 / 3, by increasing intrathoracic pressure or squeeze the heart directly generate blood flow. .
The circulation of blood to the lungs, with artificial ventilation, oxygen.
Conveying the brain and other vital organs, until the completion of addition. .
Fibrillation/cardioversion.
CPR, the compression frequency should be 100 times per minute,. .
You can have the most satisfied forward blood flow.
Whether single or double recovery, press: breathing are 30:2 ratio. .
Cardiac arrest:.
Coronary perfusion pressure with the continuous increase in external chest compression;. .
30 times more than 15 high coronary perfusion pressure.
Ventilation pause, press several times to go through the cerebral and coronary perfusion pressure to restore the original level. .
Scheduled audio pacemaker will attain 100 times/minute.
CPR, effective artificial respiration and closed chest cardiac compression should be coordinated, recovery can only be effective. .
CPR process flow resulting from changes in intrathoracic pressure (breast pump mechanism) or directly in the heart of extrusion (heart pump mechanism).
The duration of CPR affects the mechanism of CPR: CPR in a short time, the blood flow produces more dependent on cardiac pump, speed recovery time prolonged, the heart of compliance variation, breast pumps work. But this time the pressure produced by chest cardiac output will be significantly reduced. .
Heart pump mechanism:.
When squeezed in the chest at the sternum and the heart is squeezed between the spine and promote forward blood flow. When chest compression lift, the ventricular diastolic state to restore, create attraction, so that blood back, filling the heart. .
Pleural pump mechanism:.
On chest compressions, the heart is only a passive channel. Chest compression to increase the chest vein, artery and thoracic artery pressure, but the chest vein pressure is still low, and thus the formation of arteriovenous pressure gradient to flow from the artery into the vein in front. Chest press release, the intrathoracic pressure dropped to zero, and venous blood back into the right heart and lungs. Anti-blood flow back from thoracic aortic artery, internal thoracic artery bed capacity, but small, and aortic valve, reflux of blood is limited. .
A properly implemented chest heart massage:.
Can produce l 60mmHg-80mmHg of arterial pressure;. .
Diastolic blood pressure is very low, carotid arteries mean arterial pressure seldom exceed 40mmHg;.
Cardiac output may be only a normal cardiac output of 1 / 4 or 1 / 3 (continuous extension of CPR will be reduced);. .
100 times/min, maximum satisfaction of forward blood flow.
Operation:. .
Ambulance-hand index finger, middle finger is placed near the side of one side of the sick; and the rib arch.
Index finger, middle finger slide up along the costal arch costal arch bilateral convergence point cut in the lower specified occasion, said that close to the middle finger;. .
Ambulance from the other hand the roots to the first hand index finger, so that the Palm at the root of the horizontal axis and the long axis of the sternum; coincide.
Positioning of the hand on the back of the hand on the other hand, the two palm root overlap, interlocking fingers, hands cocked, fingers left chest wall;. .
Ambulance ' upper body leaning forward with both hands, shoulders is located just above the arms straight (elbow extension), and vertical down, with the help of their upper body weight and strength of the shoulder and arm muscles?.
Depth of 4-5 cm under the pressure of the sternum;. .
Relax, don't leave the Palm; chest wall.
Press speed of 100 beats / min;. .
Press and respiratory ratio of 30: 2.
Determine the patient unconscious, no coughing, no movement, no pulse, begin chest cardiac compression;. .
Extrusion press well-distributed, not too;.
After each compression pressure must be completely lifted, the chest back to normal position;. .
Massage and relaxation time required equal.
Press rhythm, frequency can not suddenly fast, suddenly slow;. .
Throughout each press cycles, to maintain the correct location for the press.
Children:. .
Sternum in 1/2;.
Ambulance-hand index finger, middle finger placed on the patient side of the costal arch proximal to the lower edge;. .
Index finger and middle finger along the costal arch up to the double-side rib arch merging point, located at the specified time, cut close to the middle finger; the index finger.
Ambulance the other hand palm root paste on the first hand of the index finger flat so that the palm horizontal roots coincide with the long axis of the sternum;. .
Arm straight, vertical down;.
Compression depth 2. .5-4 Cm;. .
Press speed 100 times/minute.
Relaxed, the fingers do not leave the chest wall;. .
Press and inflatable ratio 30: 2.
Baby:. .
Younger than 1 year old. Selected sternum in 1/2, and two nipple connection under one finger in the Centre of the Department.
Location, operation. .
Ambulance with hand index finger is placed two nipple line junction with the sternum, Corazón and refers to the merger on the sternum.
The index finger up, middle finger, ring finger close together vertically downward extrusion force. .
Extrusion depth 1. .5 .5 cm-2...
Extrusion rate of 110-120 beats / minute. .
Relax, don't leave the Palm to ensure correct positioning of the chest wall.
Extrusion and blowing ratio of 5:1. .
(VII) emergency airway obstruction.
Clinically, airway obstruction (Foreign Body Airway Obstruct, FBAO) is very common, where the principle is foreign to lift as soon as possible. Mid-70s of the 20th century, the rise of the Heim gram of aid method (Heimlich First-aid, or management,), referred to as the sea's aid method. .
It is mainly used in the trachea lead to respiratory obstruction at the end of road, respiratory arrest of first aid. Trachea not only occurs in young children, as the population ages, older persons occurred trachea has increased significantly. Therefore, Heidegger Jijiufa with sophistication and has become the new "CPR members".
1. . Pathogenesis and prevention. .
(1) cause: traditional consciousness, FBAO common maternal, newborn and child children, in particular, just walk up to a maximum of 2 years of age. In practice, especially the elderly adults occur trachea is obviously more than children.
Eating words, particularly in the large eat hard food such as chicken, ribs, too fast, chewing insufficiency, swallowing too fast, so that food is stuck in the throat, airway obstruction caused by suffocation. .
(2) prevention:.
Early identification of FBAO the performance of the judge;. .
Implementation of the abdomen to shock, positioning, do not put your hands in the process of the sternum or subcostal;.
Should pay attention to the impact of the abdomen led to aspiration of gastric reflux;. .
Preventing airway, such as food, cut into small strips, fully chew slowly, children have food in your mouth, don't run or play, etc..
2. . Identification FBAO:. .
Recognition is the key to successful treatment;.
Among some, completely obstructed, "the restaurant coronary heart disease." .
Special features: due to foreign body inhaled trachea, patients feel extremely unwell, often involuntarily to hand a "V" shaped snugly to the anterior throat, pain in the neck.
3. . Lifted FBAO. .
Adult treatment method.
Self belly impact method;. .
Each other abdominal impact (standing, decubitus);.
Chest impact method (upright, supine);. .
Baby treatment method.
Children's treatment method. .
Hand crocheted foreign bodies.
4, Training and Education:. .
(A) the CPR has global training and education, especially in developed countries have penetrated into communities and families. China, as well as some developing countries, is in the ascendant. Therefore, training and education to become a global concern.
1. . In CPR training and the safety of the actual rescue situations:. .
In 1978, the United States Centers for disease control and prevention has developed a human model of disinfection and ambulance personnel safety recommendation.
Already by the AHA, the American Red Cross, Centers for Disease Control and Prevention revised twice. .
2. training in the spread of diseases, .CPR?.
A very small risk of disease transmission. .
The result of the use of CPR model lead to the outbreak of infection.
Surface model has risk factors, attention to surface cleaning and disinfection. .
3. the great majority of first aid and CPR are made by professionals and the public, security personnel.
4. .70% -80%, Respiratory cardiac arrest cases occurred at home, it is particularly necessary at home, the implementation of CPR. .
5. training and implementation of CPR's methodological issues: human nature.
CPR began in the last century 60's, since 1973, like a prairie fire, spread across the world. .
The 20th century, icu. .cn ' > medicine spread is the most widely used and successful a life-saving technology.
Is "the most successful public health start." .
6. European report: hospital cardiac arrest.
Survival rate of men, a total of 15%. .
7. .CPR is a humanized technology, whether it is training, rescue, rescue success or invalid, should intelligently.
(B) CPR training and education. .
Professional and academic organizations to develop BLS training plan.
Ambulance staff should regularly attend training to learn CPR. And accept the support of the assessment unit. .
You should use the cardio-pulmonary resuscitation model CPR training, is strictly prohibited in normal human body for training; training of trainers to on-site guidance.
BLS training should be as simple as possible so that students master the core technology, CPR (process simple + skilled). .
Instruction, interactive and hands-on combined.
Practical (skills training) standardization. (C) of the modern electronic / multimedia. .
Unified teaching materials and technical standards.
Visual Education (CPR CD-ROM) + look and learn refining;. .
Learner-centered classroom teaching;.
Voice beat auxiliary press, and enhancing operating skills. .
International meeting, the expert is strongly recommended to become CPR training; basic strategy.
Household equipment, AED training program, more time at home, school-age youth, CPR for the home;. .
1990s, studies show that school CPR training is very valuable;.
The cause of death caused by school-age children: unintentional injuries, drowning, suffocation, etc., to conduct CPR training is a powerful educational strategy. .
Closing remarks:.
Emergency icu. . Cn '> Medical eminent Professor of sand method to carry out CPR training in China attach great importance, he said: "The world is watching with great expectations of the Chinese in order to understand this has been able to establish a vibrant and well-organized social system, the most populous country , how will the development of modern emergency and resuscitation icu.. cn '> medical potential, and with the traditional icu.. cn'> medicine combined. " .
In particular, he mentioned that the Chinese and American society is not the same in China, how to take advantage of government authority, community efforts to carry out the popularity of the CPR, the majority of beneficiaries.
Professor Saffa unfortunate in August 2003 just died, he sounded the "CPR" zhong who is world known as the "father of CPR," the contemporary emergency icu. . Cn '> Medical eminent. .
Part II: ethical issues (Part 2: Ethical Issues).
Emergency cardiovascular disease aims to save lives, restore health, relieve pain, reduce disability and clinical death. CPR's decision to rescue those who are often made in a few seconds, the rescue of patients who may not know whether there is a will save or not save there. Thus, for CPR, sometimes with the patient's wishes or best interests of the conflict. This section provides a way for the rescuers guidelines that make it difficult to rescue them, or stop the cardiovascular emergency treatment decisions to help. .
Ethical principles.
Made the decision to start or stop the recovery must take into account ethical and cultural backgrounds. Despite the decision of the doctor doing the recovery plays an important role, but they should be in accordance with scientific evidence and the patient's circumstances. .
The principle of patient autonomy.
Patient autonomy is usually based on ethical and legal. Presumptive treatment of patients to understand what measures will be accepted and make approval or rejection decision. Adult patients often presumed to have the right to self-determination, unless the court declared that they did not or does not have full capacity. The formation of the correct decision to require acceptance and understanding of patients about their condition, prognosis, may be the nature of interventions, options, risks and benefits. Patient choice of treatment should be carefully considered and measures, and can correctly estimate the relevant decision. When the power of self-determination by temporary factors such as disease, drugs, depression and other effects, this decision should be temporarily discontinued.When the specific situation of patients is unknown, diagnosis and treatment should be regularly carried out, unless he has full clarification of patient's wishes.
Wills, living will and patient self-determination. .
A will is a person of his or her own Hospice treatment ideas, wishes, or other circumstances. Will originate and he/she talks, a written decision, usually living will or life care agents. Legally valid will form for permission. Courts usually found that writing wills than oral wills and more reliable.
Life of patients to the doctor will authorize the death of his or her decisions or can not make a written note of medical measures. Life will clearly show that the patient's wishes, the efficiency of law in many places. .
Living will and a will be considered as a time-limited, because the patients ' wishes and icu. .cn ' > medical conditions may change over time. The 1991 Act of self-determination in patients, health agencies and medical authorities asked whether a patient has a will. Health and medical institutions should as much as possible to meet the testamentary wishes of the patient.
Representative (guardian) is determined. .
When the patient loses the ability of medical acts decided, their close relatives or friends can act as agent for the patient to make a decision. Most States have enacted a law that clearly identified agent/guardian, you can for the patient, to make any decisions on medical measures. Legal persons can be identified the following as a previously not persons proxy will: (1) the spouses; (2) adult children; (3) of the parents; (4); (5) is recognized as one of their patients in the incapacity of the specified when making the decision; (6) the legal recognition of specialized health care. In addition, the agent should be in accordance with the wishes of the patient's best decision. .
In a decision on the child, you should make a decision in favour of its growth, if possible, you should consult their own approved health decisions. Although the 18-year-old age very few determines their own health, unless there are legal requirements for special health conditions (i.e., without limitation, minors and special health conditions such as sexually transmitted diseases and pregnancy), and larger children his opinion should be carefully considered. If parents and children their own larger views when there is a conflict, you should take full account of the various advantages and disadvantages of the efforts to resolve their differences. For young people to make arbitrary medical measures rarely is appropriate.
Principle useless. .
If you cannot reach the medical purposes, and that such treatment is ineffective. Invalidity of the key determinants of the time and the quality of life. Some medical measures cannot extend life or improve the quality of life is invalid. Patients or their family members may ask the doctor some unreasonable medical requirements, if not scientific, social media is not recognized, then the doctor has the right to refuse such a medical service requirements. A typical example is that a no reversibility of death for CPR. In addition, medical workers have no obligation to do CPR, and an even advanced life support (ACLS) patients do not have any role in CPR (or CPR can restore circulation). In addition to the clinical situation, and left no will or living will of any patient we would have to make recovery. .
Seriously evaluate the patient's prognosis, including extended life and improve the quality of life, will determine the appropriateness of the CPR. If the expected survival impossible, CPR is inappropriate. If critical survival chances in cable, the relatively high incidence of the patients, the heavy burdens on desires or (if the patient wishes unknown) law of the agent for the recovery, the recovery should be carried out. No recovery and recovery or resuscitation interrupted life support is the same. The prognosis is uncertain, you can consider a pilot treatment and should collect more relevant information, to determine the survival potential and expected clinical process.
Stop and not to standard CPR. .
Scientific assessment shows that very few standards correctly forecast the ineffectiveness of CPR (see part7. 5: "resuscitation support"). In view of this uncertainty, all patients in cardiac arrest should be made, unless the cardio-pulmonary resuscitation:.
Patients have an effective "no recovery will" (Dol Not Attempt Resuscitation, DNAR). .
Patients have irreversible death signs (that is, explicit commit them signs, breakage, carrion or clear dead spot) l..
Treatment of their best efforts to organ deterioration, no improvement in physical signs (ie, sexual degradation sepsis or cardiogenic shock) l. .
In the maternity ward, if newborns during pregnancy, birth weight or congenital abnormality associated with premature death and case-fatality rate is extremely high, not to proceed with the recovery is appropriate. There are two examples of the literature is extremely Preterm Labor: (gestational age in 23 weeks following or birth weight in 400g below) and anencephaly.
Termination of recovery. .
To disconnect the recovery decisions, physicians should carefully consider many factors, including start time, start CPR defibrillator, merge, arrest the former (prearrest) status, arrest former rhythm. These factors do not have a separate one or several combinations can clear prediction of prognosis.
Witnessed the collapse, witnesses CPR, a very short time after the fall of the rescue professional rescuers arrived on the scene, can increase the success rate of resuscitation. .
Many pediatric resuscitation result shows that the survival rate of decline and recovery time is inversely proportional to the time. Many recovery results reports, patient survival rate of discharge and the nervous system dysfunction reduced recovery time and inversely. Experienced doctors, if you clear the patient no response on the ACLS, you should stop the recovery.
Of the newborn, in specification, the correct recovery after 10 minutes, still no signs of life, they should stop the recovery. More than 10 minutes in the continued recovery in the absence of any response the survival chance of survival is very low or no function. .
In the past, to extend the recovery time and use 2 dose of adrenaline loop is not restored, was considered impossible to survive. But the extension of the recovery time in hospital without neurological defect of survivors have also been reported. In recurrent or refractory or ventricular fibrillation ventricular tachycardia in newborns and children, drug poisoning, hypothermia, should extend the recovery time.
In the absence of signs of improvement, to extend the recovery time is unlikely to succeed. No matter how long, if restoration of spontaneous circulation and prolong the recovery time is appropriate. Other cases, such as drug overdose and severe hypothermia (ie ice-water drowning), should consider extending the recovery time. .
DNAR instructions (Do Not Attempt Resuscitation order).
Unlike other icu. . Cn '> medical interventions, CPR start without a doctor's instructions, based on first-aid treatment of indirect recognition. Stop CPR, doctor's orders is necessary. Doctors have with any hospitalization and surgical treatment of adults or agent of the discussion or start CPR. End-stage patients, and pain of abandonment is more fear than death. So doctors should comfort patients and their families, even to stop the recovery, the pain and other medical care will continue. .
The attending physician at the patient's medical history, writing, and indicate on its DNAR reasons and also special medical restrictions. Restrictive measures should include medical and possible special emergency medical measures (such as using boost, blood products, or antibiotics). DNAR directive should indicate what measures are not in operation. A DNAR does not exclude such as parenteral infusion, nutrition, oxygen, analgesic, sedative, arrhythmias or vasoactive drugs and other measures, unless indicated in the directive. Some patients may choose to accept the defibrillator and chest, but does not accept intubation and mechanical ventilation.
Oral DNAR order is not according to subject, unless the presence of doctors, nurses, doctors DNAR received telephone and confirmed doctors will be compensated in the Kam the directive. DNAR should be time-limited in nature, particularly in the patient's condition constantly changing. .
A doctor should be nurses, counsellors, family practitioners, patients or their agents ' clarity DNAR directive and its future plans for the diagnosis and treatment, and full discussion and resolution of conflicts. Basic nursing care and comfort of the treatment measures (i.e., oral care, skin care, the patient's body and relieve the pain and other symptoms improved) should be conducted on a continuous basis. DNAR directive does not imply other forms of treatment measures, other aspects of the treatment plan should also indicate, and notify the staff.
Before surgery, anesthesiologist, surgeon, patient or guardian should be retried DNAR order to determine its operating room and postoperative recovery room, the applicability of the directive. .
There are patients who start DNAR CPR instructions.
Research on the DNAR directive that medical workers for those in the heart or respiratory arrest were not shown the irreversibility of death (table), shall make every effort to provide rapid recovery measures, unless or until they received a legal description of the efficiency of (clear will, DNAR orders, or legal guardian instructions) not to deal with. Outside hospitals, DNAR orders apply only to those who do not vital signs. .
Stop life support.
Withdrawal of life support to the families and medical staff are very emotionally complex. Not to and withdrawal of life support is ethically equivalent. If doctors and patients or guardians agree that the treatment can not achieve the target, or if further treatment burden than the benefit, make sure to end his life, the decision to stop life support is justified. .
Some patients in cardiac arrest and independent cycle recovery (ROSC) consciousness is no longer recoverable. Most adult patients in cardiac arrest in persistent coma (Glasgow integral-GCS <5分）超过2-3天，其预后可准确预测。> Special physical examination or laboratory checks help further judging. A study on the containing 33 hypoxic-ischemic coma data Meta-analysis shows that the following three factors associated with poor prognosis:.
Day 3 no pupillary light reflex l. .
Day 3 l without pain response.
Moderate stimulation of the somatosensory cortex response to the lack of hypoxic coma, but patients with normal muscle tone, and more than 72 hours were l. .
A recent study contains 11 1914 patients: a meta-analysis found that 24-72 hours after check five clinical signs contains 4, strongly predicts outcome of death or very poor: the nervous system.
24 hours a lack of cortical reflex l. .
24 hour lack the pupillary light reflex l..
The lack of pain 24 hours to avoid reflection l. .
24 hour response to the lack of active l..
72 hours, the lack of active response to l. .
These stop life support ethically permissible.
Patients with end-stage disease can not be governed, regardless of whether the response should be to maintain their comfort and dignity. Treatment of major help to reduce pain, breathing difficulties, fidget, twitch, and other end-stage complications of discomfort. Gradual increase of these anesthetics and sedatives, patients reduce the amount of pain and other symptoms, even if they shorten the life of patients with time ethically acceptable. .
Out-patient does not stop the CPR CPR and related issues.
BLS training stress after cardiac arrest the first witnesses began CPR. BLS and ACLS health workers as part of their duties. There are several exceptions to this rule:. .
Patients have died and there was no death of reversible signs (that is, explicit death, dead spots, breakage or carrion) l..
CPR may cause those who carry out their own rescue bodily harm l. .
Patient/guardians clearly indicate a will (DNAR) have no desire to do recovery l..
General rescue and medical conditions based on field or expected nerves are unable to determine cardiac arrest are present or the future quality of life, and this is usually not rashly judge correctly. Quality of life can not serve as the standard CPR, because irreversible brain damage or brain death situation, it is impossible to make a reliable assessment or prediction. .
Extramural DNAR agreement should involve all relevant personnel (i.e. doctors, patients, family members, lovers and pre-hospital medical workers). Will have a variety of forms (i.e., medical records at the bedside, identity cards, identity bracelet, and other local emergency medical services [EMS]-approved credentials).
Ideal EMS DNAR form should be with the transfer of patients to carry, plus pre-hospital DNAR orders, forms, EMS should provide a direct message that the patient no pulse and stops breathing, whether to start or continue life-support measures. .
Prehospital advanced instruction set.
List of important numbers, cardiac arrest call 911 (Note: Domestic 120) let us know when there is chronic, disease, late, or have written a will (DNAR orders). State and other agencies for pre-hospital DNAR and will have different requirements. Sometimes, DNAR disagreements with family members, it is difficult when deciding whether to start CPR, EMS personnel should start CPR and ACLS, if reason to believe that:. .
There is a genuine reason to doubt the validity of wills DNAR or l..
The patient change his or her decision l. .
In the best interests of patients with suspected l..
Sometimes started minutes after resuscitation, family members or other medical personnel arrived and confirmed that the patient has clearly expressed the desire not to recover. When other information confirmed, CPR and other measures can be interrupted. .
If the out-of-hospital sudden death, family members may be concerned about EMS staff does not comply with the doctor's Hospital has been opened. This may require appropriate unprescribed extramural form of DNAR directive that might arise out of EMS. The DNAR instruction in EMS staff arrive at the treatment of patients, and operability. DNAR didn't give in to provide EMS, recovery should be carried out. To prevent a dilemma, the patient's physician should provide the directive.
Terminate in the recovery of pre-hospital BLS. .
Started by BLS should continue fighting until one of the following conditions:.
Effective restoration of spontaneous circulation and ventilation l. .
Now go to a higher level of medical aid, he can decide that the patient is not valid on l. ..
Has emerged a reliable sign of irreversible death l. .
Rescues are manual, or the environment may result in personal injury, directly or as a lasting recovery affect other people's lives where l..
Found valid DNAR order l. .
In most States, defibrillator is an essential standard equipment in ambulances, therefore, in the absence of ACLS, continued after CPR still no cardiac defibrillator, as an important stop BLS standards. The ACLS cannot quickly reached or likely to be a long time to time, State, or local EMS agencies should develop a start and stop the BLS procedures/specifications, on-site environment, resources and potential users of personal safety should be taken into account.
Transport cardiac arrest patients. .
If EMS is not allowed to non-medical practitioner rescues announce death and stop the recovery, the staff may be forced to transfer those to your beatting has confirmed it is difficult to complete a BLS/ACLS, it is immoral.
This difficulty may arise as follows: If the serious implementation of the BLS and ACLS procedures can not successfully treat patients outside the hospital, that medical institutions to deal with the same success to a patient? A series of ongoing studies that continue to transport patients survived to hospital discharge were CPR <1%. .
Delay or symbolic, also called "slow code" (i.e. provide invalid recovery), provide incorrect CPR and ACLS. Medical personnel that violate the ethical integrity of negative practices that undermine the physician-patient/patient-nurse relationship.
Most EMS agencies have developed outside the hospital's motion to terminate the recovery, provided that the death and determine the non-EMS transport vehicles. EMS personnel should be trained as focus on the care of family members and friends. .
Provide emotional support to families.
Despite our efforts, but most of the recovery still failed. Sympathetic to the family members informed of the death of their relatives is an important part of recovery efforts should focus on cultural, religious and family. .
In a child resuscitation or other relatives, family members often absent. The survey showed that doctors within the resuscitation of the family, will have to pay attention to several possible scenarios: family members become fragile or concerned about the recovery process, family members may be blacked out, their liability to the statutory obligation.
However, several studies showed that most family members want their loved ones to be present in their own recovery. No icu. . Cn '> medicine-based family members pointed out that next to their loved ones can make a final farewell is a relief. Family members also said that this will help them adjust to the death of loved ones love the mood, most people said they would continue to do so. Several family members for retrospective research, most family members said that this would express a love for the deceased and to reduce their own suffering. Most of the parents surveyed expressed the desire to give their children is the presence of the recovery options..
However, there is a lack of relevant and effective for the benefit of evidence-based literature, selectively provide families in recovery site, seems reasonable and worth it (assuming that the parents, if you are an adult, and has not previously rejected). The recovery process, recovery team members should pay attention to the presence of family members, arranging staff answer questions to clarify family information, provide a comfortable place.
Ethics of organ and tissue donation. .
ECC support for organ and tissue donation. EMS agencies should consider their bodies of organ donation procedures:.
Needs within the region has announced the death of donors to donate tissue l. .
How to get from the patients ' relatives of organ and tissue donation license l..
How clearly establish procedures to facilitate the organs and tissues will be fair to hospitals and hospital patients l. .
In organ gets face legal and social values conflict l..
Research and training issues. .
Use just died as training materials, become important ethical and legal issues. Just died of family members in favour is the ideal and respectable, but in cardiac arrest is not always possible or practical. Support the researchers said in this case, the consent is good for better living. Others believe that there is no need to be approved (family) because the body is one feature that has no autonomy and wishes. This view does not take into account the potential harm to the family, they may oppose the use of the death of their loved ones just to do research or training, this view has not take into account the agree or not agree to use the body of cultural differences. Using cardiopulmonary arrest patients to conduct clinical research is challenging. .
Usually involves the study of the human family in favour of the request, or in some places, are the legal guardian. Some studies are recognized before the coming into operation is not possible, so that such research more challenging. According to published findings, recognized the value of this research, the Government, although the FDA and the NIH has developed a rule, in some cases, allow for such research needs to be approved. Strict pre research, expert advice and consultation, the detailed research methodology. The researcher must devote the necessary recovery of selfless and public demonstration. Acknowledge that the lack of evidence-based practice, and they explain the benefits of research. .
In 1996, Congress passed the Health Insurance Act, which is usually the feasibility of HIPPA. As its name, HIPPA, one of the legislative purpose which is to ensure the viability and on health insurance coverage, but after a few years has been amended, including the protection of the patient's personal information confidentiality and keep their medical records. For details please see http://www. .hhs. .gov/ocr/hipaa/finalreg. .html. Medical staff involved in training and research, patients must be careful to keep secret, guarantee the confidentiality of patient information.
