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?????????? Cardiac arrest and sudden cardiac death

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Title: ?????????? Cardiac arrest and sudden cardiac death


1
??????????Cardiac arrest and sudden cardiac death
  • ??????? ???

2
? ? ? ? (Cardiac Arrest,CA)
? ?????????? ????????????? ??,??????????????????
?????,????,?????????,??????
3
?????Sudden cardiac death
  • ???????1?????????????????????????????
  • Natural
  • Rapid
  • Unexpected

4
???????
5
???????
  • 1.?????,????
  • ??????
  • ?????????
  • ???????
  • ????

6
??????????????
? ??? (?80)????????????????????????? ?
????????????????????????????????????? ? ????
???Q-T?????Brugada???? ??????????
7
???????
? ?!
8
????????????
? CO2???????? ? ?????????????? ?
??????????
???????????,ATP????????????1/191/20??????,?
????????46???????????,???????,??????????
9
????????????
? ???????? 46min,?? 1015min ??
2030min,????? 60min ? ??????30min ?
???12h ? ?????
10
????4???
  • ??? Prodromal symptoms
  • ????? Onset of the terminal event
  • ???? Cardiac arrest
  • ????? Biological death

11
? ? ? ? (Cardiopulmonary Resuscitation, CPR )
???????????????????????????????????????????
12
??????????????????!
lt4?? 50????
4-6?? 10????
gt6?? ????4
gt10?? lt1
13
???????
  • ? ??????CA?1200?2/3??1h????
    1/2??????????1.2-1.4?
  • ? ???????CA?????60,???1-2??????50,???50??16.6
    ??,?25-30???
  • ? ????????????,CA????10,?87.8??????
  • ? ??????????1?3500-4000???,??1??

14
?????
15
???????
? ???????????????? ? ????????????????,????? ?
1984?AHA??????????????(Cardiopulmonary
cerebral resuscitation, CPCR)?
16
CPR???
  • 1956? Zoll ?????????????????,??????????
  • 1958? Peter Safer???????????,?????????????????????
    ????
  • 1960? William Kouwenhoven ?????1????????????,????
    ????????

17
???????????????
  • ??1974,1980,1986,1992
  • ?? 1992,1996,1998
  • 1992????????????(ILCOR)
  • 2000? AHA?ILCOR????????(CPR)??????(ECC)??,???????
    ?
  • 2005? AHA?ILCOR??????2005CPR? ECC????
  • 2010?AHA ????CPR??

18
???????
19
  • ?????????( ?????)???????10??,
    ?10???????????,?????

20
??CA???????
  • ? ???????????????????????,
  • ?????CPR
  • ? ??????????????
  • ? ?????????????????????
  • ? ???????????????

21
????????
  • ???????????????????
  • ??????????

22
?????? ( Basic life support, BLS )
  • ????(Airway)
  • ????(Breath)
  • ????(Circulation)
  • 2010?AHA???C ? A B

23
??????
  • ???????????
  • ???? ??100?/?
  • ?????????
  • ???? 5cm
  • ???????30 2

24
???????
  • ??/????302
  • ????????????????
  • ????(2???1?)????????

25
?????????( A)
??????????? ??,?????????,????,????510?
????? ????
26
??????????????
27
??????
??????????? ???????? ??????????? ?????????10?
28
????(B)
  • ???????,??1?
  • ??????????,????
  • ???????,?????????
  • ???????????
  • ????1012?/min (lt8??1220?/min )

29
???????
30
????????????????
  • 2007?Lancet(???)???????????????,????????,???????
    ?
  • Gordon Ewy ????????????????????40?!
  • ????????????????????????CPR??,????????????
    (6.2?3.1)?
  • ????????????????????????,???????
  • ???????????

31
???? (D)
?????(AED)
32
???????
  • ? ?????????????????
  • ? ??????VF??????
  • ? ???????,????????????

33
??????
  • ?????,????
  • ?????(???????)???
  • ????
  • ??
  • ??

34
????
? ??( 8?) ???????360J ???
150200J(??) (class IIa) ? ??
???2J/Kg ??????4J/Kg
35
  • ? ?????????,???CPR (class IIa) 2min? CPR 302
    5 ??????,?????????? (class IIb)

36
????????
  • ????
  • ????
  • ??????
  • ????
  • ???????

37
???????
  • ????????? ??????????????????????30???,????????
    ?????????(1)???????(2)??????(3)??????(4)??????
    ? (5)???????
  • ?????????????,??????????????????????????????????

38
?????? (Advanced life support, ALS)
  • ?????????
  • ?????????,????
  • ??????,??,???????
  • ???????????
  • ????ICU??????????????

39
?????
  1. ?????????(100),???????????????????
  2. ????????????????
  3. ????????????????????,??????30??

40
????/??????
  1. ??????????????????????
  2. ???????????????,??????
  3. ??????1995???????????,??????????,???????(?b)
  4. ???????????????,????????,?????????(????)

41
????
  1. ????????????,1mg iv,?3-5??1?,?????????5mg
  2. ??????1mg???????,????40 IU?????1?
  3. ?????????????????????????

42
??????????
???(????)?? 150mg ?? iv ,
5GS 44ml ??? 300mg / 3ml/h ???? ??????
1-1.5mg/kg iv, 3-5?????,
???NS 25ml ???? 500mg/ 6ml/h ???? ß?????
???? 5mg iv,
????0.5mg/kg iv ???1-2g ??,
43
???????
  • ????
  • ????????????????,1mg iv,?3-5???????
  • ?????

44
????????
  • ????????????,?????????
  • ???? 1 mmol/kg (5????100ml60mmol),
  • ??15??????,????????????
  • ???????????????????
  • ????????????

45
???????
  1. ???????????????
  2. ?????????,??33-34 ?
  3. ?????????????,????DXM
  4. ???????????????????????
  5. ?????
  6. ??????????????

46
? ?!
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