Key points of adult cardiopulmonary resuscitation?

Compared with other artificial respiration methods, the blowing method has the following advantages: ① No special instruments are needed; ② No one needs or evacuates; 8 can dilate alveoli. ① The operator can change the patient's position by hand to make the airway unobstructed, or touch the pulse condition and press the upper abdomen to prevent the stomach from inflating and expanding. Wood does not get tired easily. During artificial respiration, you can tell that you are holding a precious fruit. Mouth-to-sky z breathing; The patient lies on his back, raises his head back, presses his forehead to make the airway unobstructed, and pinches his nostrils with his thumb and forefinger. After inhaling deeply, the rescuer opens his mouth and tightly wraps the patient's mouth, blowing into it, so that the patient's chest slightly bulges. Form warm air and then leave the mouth, so that the blown gas can be exhaled naturally. At this time, the operator puts his ear close to the patient's mouth and listens to the sound of gas exhalation to judge the effect of artificial respiration. You can also lift your forehead at the mandibular angle with your hands and block the patient's nostrils with your cheeks for mouth-to-mouth resuscitation. The first four rapid blowing of sugarcane should be continued, and the blowing intensity should not be too strong, and then at the rate of 16~20 times per minute. When blowing, you need to dub the chest history, blue wall and external heart compressions. Generally, the ratio of air blowing to the number of cardiac compressions is: press the chest l5 times after a single cardiopulmonary resuscitation and then air blowing twice, that is, 15t2. Then, after inhaling deeply, the operator puts his lips on the periphery of the patient's nose and blows in gas to form the patient's inhalation. When exhaling, open the patient's mouth and exhale gas, and observe the effect of artificial respiration as mentioned above. Blow in gas with instruments: after artificial respiration through the mask, the snorkel of the mouth and the tracheal intubation inserted into the trachea, the operator inhales deeply, blows at the opening of the above instruments to form the patient's inhalation, and then the operator leaves the mouth to form the exhalation. Observe the effect of artificial respiration in the same way as above. C2) Mechanical artificial respiration The use of simple respirators, anesthesia machines and automatic artificial respiration machines to assist breathing is called mechanical artificial respiration. ① Simple respirator. It consists of a mask and a breathing bag. The airbag is made of sponge rubber, which is elastic and can automatically inflate. Oxygen can be connected to the tail of the balloon. The surgeon lifts the mandible with his left hand and tilts his head backward to keep the airway unobstructed. Close the mask around the patient's nose and mouth, and then squeeze the airbag with the right hand at the frequency of 15 ~ 30 times/min ② Anesthesia machine: after keeping the airway unobstructed, press the mask connected with the airbag tightly around the patient's nose and mouth with the thumb and forefinger of both hands to close it, and open the carbon dioxide absorber to inflate the airbag, then pressurize the airbag, and release the pressure with both hands immediately after squeezing the airbag. The initial compression frequency is controlled at 20 ~ 30 times/minute, and the compression frequency is adjusted to l5 times after the condition is stable. Automatic respirator: tracheal intubation or tracheotomy is performed in an emergency, and artificial respiration is performed with a simple respirator or anesthesia machine. After the condition is stable, use automatic artificial warmer to assist breathing. This will enable the surgeon to carry out other rescue work. When using artificial respirator, adjust ventilation, breathing frequency, inhaled oxygen concentration, gas pressure, etc. according to the patient's time state. It can maintain good oxygen saturation, carbon dioxide partial pressure, pH value and electrolyte balance. , and does not affect cardiac output and blood pressure, and has no damage to lung banquet. (-)C (artificial circulation) (1) Cardiac compression: Cardiac compression is suitable for cardiac arrest caused by various reasons. The clinical manifestations of ventricular arrest caused by ventricular fibrillation and high atrioventricular block are that peripheral arterial pulse cannot reach, heart sounds disappear, blood pressure and cyanosis cannot be measured, and pupils gradually expand with time. (2) Timing: If the blood circulation is clinically suspected to be stopped, the heart should be pressed immediately. The earlier the operation, the higher the recovery rate and the more complications. The tolerance of human organs to hypoxia is different, and the brain tissue is seriously damaged 4 ~ 6 minutes after the blood circulation stops, which cannot be recovered. After the heartbeat stopped LOM [n], catfish tissues basically died. When the body temperature is normal, patients with cardiac arrest for 3s feel dizzy; Syncope occurred in10 ~ 20s; Spasms occur around the age of 40; Pupils dilated after 30~ 40s; After 60 seconds, breathing stopped and defecation was out of control; After 4 ~ 6 m [n], the brain cells were irreversibly damaged. A lot of practice shows that half of those who recover within 4 hours may be saved. Only 1O can be preserved after 4 ~ 6min, and the survival rate after 6min is only 4. Those who are revived have little chance of surviving. In recent years, there are more and more patients with cardiac arrest (sudden death) in China. Heartache caused by coronary heart disease is the most common cause of sudden cardiac death. Among them, 70 cases died outside the hospital, 40 cases died within 1 stein after onset, and 30 cases died within 2 hours after onset 1 stein. If people around or their families can learn the correct rescue methods, they can avoid wasting precious time. Sudden cardiac death is mostly a temporary severe arrhythmia, not a fatal disease. As long as the rescue is timely, correct and effective, most patients are expected to be saved. The key is that many people should learn CPR correctly and devote themselves to rescue every second. (3) Cardiac compression methods: divided into chest compression and chest compression. ① Chest compressions: Let the patient lie on his back on a hard bed or flat ground, with the operator standing on the patient's side, the root of his left palm on the lower half of the sternum, the right palm on the back of his left hand, his fingers crossed, and his fingers lifted off the chest wall. The forearm is vertical and presses down with the weight of the operator's upper body. Press the sternum 3 ~ 5 cm, and the pressing method is steady and regular. Do not interrupt, do not press violently, and relax downward and upward for the same time. When you press the lowest point, there should be a clear pause. Don't swing from side to side When relaxing, don't leave the sternum anchor point, but try to relax and ensure that the sternum is not under any pressure. The pressing frequency is 80 ~ 650. Common mistakes and complications of cardiac compression: when pressing, the palm root is attached to the sternum, and the fingers are also pressed against the chest wall, which is easy to cause rib fracture from the arch F. Incorrect positioning of compression is easy to cause xiphoid fracture and liver rupture. It is easy to cause rib or costal cartilage to break to both sides, leading to pneumothorax and hemothorax; The compression force is not vertical, which leads to ineffective compression or failure to fully relax the chest when the rib fracture is relaxed, and the chest is under pressure, making it difficult for blood to return to the heart. Contraindications of pericardial effusion caused by extrathoracic heart compression. Acute myocardial infarction complicated with heart rupture ② Thoracotomy and cardiac compression. Indications: invalid chest compression, suspected acute myocardial infarction complicated with cardiac rupture and pericardial tamponade, obvious deformation of chest and spine (funnel chest), 8-9 months of pregnancy, avoiding blind use of chest compression bow F after heart valve replacement. Methods: Clean and disinfect the skin locally as much as possible, but in an emergency, it is not strict to cut the left intercostal skin and intercostal muscle with a scalpel and then cut the pleura with scissors. If there is a thoracoscope, install the thoracoscope to open the intercostal muscle, cut the pericardium and expose the heart cup. When rescuing adults, put the right thumb in front of the right ventricle and the other four fingers behind the left ventricle, and squeeze the heart at a frequency of about 80 times per minute. There should be enough diastolic period after each extrusion, and the intensity of extrusion should be enough to touch the peripheral artery. For larger heart-shaped cups, please put your left hand in front of the heart-shaped cup. Put your right hand behind the heart cup and squeeze it with both hands. When rescuing young children, because the surgeon can't put his hand into the chest all the time, he can only put 2 ~ 5 fingers of his right hand behind the left ventricle and press his heart on the sternum for cardiac compression. When the heart is effectively squeezed and the arch F bleeds, stop bleeding and give blood transfusion if necessary. If sinus rhythm is restored, place the arch F flow tube and close the chest. After operation, we should pay attention to the observation of heart rhythm, pulse rate, blood pressure and urine volume, and at the same time give oxygen inhalation, use antibiotics to prevent infection, correct acidosis, water and electrolyte imbalance and so on. In addition, continuous cardiac compression should be combined with other methods of cardiac resuscitation, such as intratracheal and intravenous injection of drugs, electric cardioversion and pacing. Pre-cardiac boxing: This method can be used at the beginning of cardiac arrest. When the mechanical energy generated in the precordial area of boxing is transmitted to the heart, it can generate 3 ~ 5 watt seconds of electrical energy. When the heart is in ventricular flutter, it can be stopped once. If the heart doesn't rebound, you should change the pressure in your chest. (5) The key point of O-type pulmonary resuscitation is T. In cardiopulmonary resuscitation, children under 65,438+0 years old are infants. 10。 0000000000015 (1) broke consciousness. If the child can't respond to language, he can pat his heel or pinch other acupoints with his hand. If you can cry, you are conscious. @ jingjing jingjing. Mouth-nose artificial respiration is the main method to clean the respiratory tract by lifting the forehead. Because children's ligaments and muscles are slack, their heads should not be tilted back too much, so as to avoid the trachea being compressed and affecting the airway patency. You can also hold your neck with one hand and keep your airway straight. ③ Check brachial artery. Because the neck is obese, the carotid artery is not easy to touch, so you can check the cerebral artery. ④ The location and method of chest compressions. The baby's pressing position is the next finger at the junction of the nipple line and the sternal midline. Most pressing methods are embracing method (also called back support method). Overlap your thumbs and press down. ⑤ The ratio of chest compression frequency to artificial respiration. The frequency of chest compressions should be ~ "; 10o times/minute. Because babies can do external riding and manual breathing for 1 person at the same time, which is 5- 1 L more than adults. Artificial cardiac compression and electrocoagulation-cardioversion are important measures to restore circulation and maintain the life of important organs during cardiopulmonary resuscitation after cardiac arrest. Artificial cardiac compression is the most basic method that must be carried out immediately to rescue cardiac arrest on the spot. In a medical unit with electrical equipment, if ECG (on-site) monitoring proves that cardiac arrest is caused by Room 1, cardioversion should be performed immediately first. If you can't confirm whether it is caused by Room 1, it is feasible to eliminate blind electricity. 80 ~ 90% of cardiac arrest is caused by room one. First, artificial heart compression artificial chest compression should be carried out in conjunction with artificial respiration, usually after artificial respiration for 2 times, and immediately after judging that the heartbeat stops. Oxygen-containing blood is transported to the main chest cavity of the whole body through the heart and arteries. Effective chest compression is quite dry, the normal heart volume is 25 ~ 5 O, and the cerebral blood flow is about 30%. In some patients, it is also possible to eliminate the room. Recently, our department has done chest compressions under ECG monitoring. For those who think it is worthwhile to continue resuscitation because chest compressions are ineffective, or those who have indications for chest compressions, chest compressions can be performed. 1. Mechanism of cardiac compression (1); One hundred years ago, people thought that the blood circulation after chest compressions was not the result of directly pressing and chasing the heart, but the pressure in the chest cavity increased after pressing Bow L, which promoted the blood to flow to amidine. When relaxing, the pressure in the chest cavity decreased, which promoted the venous blood to be stored in the right heart, thus maintaining effective blood circulation. In other words, the chest pump turned over. Rudokof thinks that the forward rather than backward blood pool produced by compression is related to the following factors: (1) there is an ointment vein valve in t 1 venous system; The resistance of l 2 artery to blood bud depression is greater than that of vein, which leads to the collapse of vein at the exit of thoracic cavity when the pressure in thoracic cavity increases. The number of arterial pits is less than that of veins, which means that the same amount of blood produces more pressure in the arterial system. (2) Press the program t① Patient Position T and immediately place the patient on a hard bed or on the ground. If it is a spring bed, a hard plate with a length, width and foot L should be placed on the back to ensure that the patient's body will not move up and down or left and right after pressing the sternum, but don't delay the pressing time because of finding a cushion; @ Determine the pressing position: find the correct pressing position at the joints Z/3 above the sternum and13 below. The performer puts the root of one palm in the pressing position, and the other palm vertically overlaps the back of this palm} @ Pressing method: According to the standard scheme of artificial mental resuscitation published by American Seven Heart Association (AHA) in 1988, The frequency of receiving pressure is 80 ~ 100 times/minute, and it can reach 100 times/minute in the first 2 ~ 3 minutes, which makes the blood pressure increase by 60 ~ 70 mmHg(8. O ~ 9.33 kPa), and may make the time of I- pressing and shaking equal, each accounting for 50, at this time, the cardiac ejection capacity is the largest. The ratio of cardiac pressure to the number of artificial slaps is 15-2 (single cardiopulmonary resuscitation) or 5- 1 (double cardiopulmonary resuscitation)} The sternum pressure of adults is 4 ~ 5 ERA, and that of infants is 2era. (3) Position and method of infant pressing: the pressing position is at the lower finger of the intersection of the connecting line between the two nipples and the sternum midline, and the thumb is pressed with overlapping hands (the newborn can use single manipulation, and the pressing frequency is 100 times/minute). (4) Precautions for pressing: ① Pressing should be carried out smoothly and regularly in different periods until Zhang Dou recovers; ② Improper pressure connection position is not only ineffective, but also dangerous. If the position is too low (such as under xiphoid process), it will damage abdominal organs or cause gastric reflux. If the position is too high, it will hurt the big blood arm. If the position is not on the center line, it will cause rib fracture, even pneumothorax and hemothorax. ③ When the operator presses, his shoulders and elbows should be straight. The shoulder should be in the middle of the patient's sternum. He should use the weight of his upper body and the muscle strength of his shoulders and arms to press down vertically, instead of shaking from side to side. ④ If you don't press the sternum hard, the effect will be poor and it will easily lead to fracture. When relaxing, don't leave the palm root at the position of sternum to avoid making mistakes in the next pressing position, but relax as much as possible and ensure that the sternum is not under any pressure, which is beneficial to venous return to the right heart. I⑤ When pressing, don't stop heart pressing because of auscultation of the heart and tracking of the cardiac electric field. Necessary treatments such as electric shock and gas bud insertion should be carried out by experienced doctors, and the pressing interval should not exceed 65. You can feel the carotid pulse every time you press it effectively. If the pulse still beats when the compression is stopped, it means that the patient's heartbeat has recovered. 2. Indications of intracervical cardiac compression (1); ① Because of sternum or spinal deformity, external cardiac compression can not judge carotid pulse, so it is difficult to estimate; Cardiac pathological conditions, such as cardiac arrest with cardiac damage, ventricular aneurysm, severe mitral stenosis, C- tamponade, pulmonary embolism, tension pneumothorax, ④ Intractable cardiac cavity-The heart is still in a non-contractile state after repeated electrical expansion and resuscitation medication. Experiments show that the resuscitation rate can be increased from 0 to 75 when extracorporeal cardiac compression is ineffective. If the time of chest compression exceeds 25 minutes, the benefit saddle of chest compression is small. (2) Pressing method: After simply disinfecting the skin, quickly make an arc incision from the sternum edge of the left 4th rib to the axillary front line to enter the chest cavity, open the intercostal space to expose the heart, cut the pericardial cavity if necessary, put your right hand in the chest cavity, put your thumb in front of the heart, put your four fingers behind the heart, and put the heart straight in your palm.