Emergency medicine is a new medical interdisciplinary subject. It not only has its own theoretical system, but also is closely connected with clinical medicine and basic medicine. Its main purpose is to study how to quickly rescue the seriously injured from the brink of death and reduce its complications and disability rate.
Section 1 History and Present Situation of Emergency Medicine
The earliest development of emergency medicine in the world is the United States. At present, there is an emergency physician training college in the United States, and provincial and state health authorities have set up emergency medical service offices, which are responsible for planning, organizing and providing technical assistance for emergencies such as critical diseases, injuries and disasters, and for leading, training and assessing emergency personnel. The national emergency physicians implement the general practitioner system. At present, there are 25,000 emergency physicians in China providing medical services to about 654.38 billion emergency patients in more than 6,000 emergency rooms.
The development of modern emergency medicine in China has a history of only 10 years. At present, most hospitals above the county level have established emergency departments, and large hospitals have established intensive care units (ICU), equipped with a certain professional team. More than 80 large and medium-sized cities in China have a certain scale of emergency centers, and the national unified emergency telephone number is "120".
Section 2 Categories of Emergency Medicine
Emergency medicine can include the following aspects:
(1) Pre-hospital first aid
Pre-hospital first aid is also called first aid, including on-site first aid and on-way first aid. The first responders at the scene first give the patients the necessary preliminary first aid, such as hands-on cardiopulmonary resuscitation and clearing foreign bodies in the respiratory tract. And then call for help from the emergency center (station) through the emergency phone, while waiting for the arrival of the emergency medical staff, while carrying out uninterrupted on-site first aid. Pre-hospital medical first aid includes on-site first aid and on-the-way rescue by emergency medical technicians. It is a medical activity carried out by professionally trained personnel. Its purpose is to maintain the patient's main vital signs and send the patient to the hospital emergency room as quickly and smoothly as possible.
resuscitation
Resuscitation medicine is the rescue of cardiac arrest and respiratory arrest. Resuscitation can be roughly divided into three stages: ① Basic life support (BLS), including airway control (a), artificial oxygen supply and respiration (b) and cardiac resuscitation (c); ② Enter a life support (ALS), the purpose of which is to restore the spontaneous circulation, including the use of resuscitation drugs and fluids (D), ECG diagnosis and treatment of arrhythmia (E) and electric defibrillation (F); ③ Prolonged life support (PLS), mainly used for cerebral resuscitation. Specifically, it mainly studies how to restore spontaneous circulation in time after cardiac arrest and promote the heart to beat again; Establish a breathing channel in time; Rational use of adrenaline; Correct use of electric defibrillation in early stage; Don't use respiratory stimulants prematurely: "acid is better than alkali", and use sodium bicarbonate correctly; Actively prevent and treat "reperfusion injury"; And enhance brain resuscitation.
(3) Critical care medicine
Critical care medicine, as an important part of emergency medicine, is defined as comprehensive monitoring and treatment of complex complications (such as acute organ injury) secondary to various serious diseases or injuries by specially trained medical personnel in the intensive care unit (ICU) equipped with advanced monitoring equipment and emergency equipment.
Disaster medicine
The sudden occurrence of disasters not only destroyed the ecological environment, but also hurt a large number of people. How to organize rescue effectively and quickly, reduce casualties and prevent the occurrence and prevalence of acute infectious diseases, that is, to study medical first aid and disaster prevention after disasters, is called disaster medicine. Disaster medicine involves all clinical medicine and preventive medicine.
(5) Traumatology
Trauma is the first cause of death among young people (under 44 years old). The principle of severe trauma treatment is early treatment, first "rescue" and then "examination". The research scope of traumatology is not only how to treat and recover the trauma itself, but also how to prevent the occurrence of trauma.
(6) Toxicology and acute poisoning
The research, diagnosis and treatment of acute poisoning are important contents of emergency medicine. How to diagnose, treat and prevent acute poisoning is an important part of this discipline, which often involves occupational diseases, toxicology, forensic medicine and other disciplines. It is a new and rapidly developing clinical discipline.
(7) Emergency medical management
How to organize the first-aid network, establish an effective modern first-aid call-for-help and communication system, research and equip all kinds of equipment and means of transportation for rescuing the wounded and sick, and standardize the training of first-aid professionals are all contents of first-aid medical management.
Section 3 Modern Emergency Medical Service System
At the scene of the accident or at the initial stage of the disease, first aid is given to the wounded and sick, and then they are safely and quickly escorted to the emergency room of the hospital for further rescue and diagnosis. After their main vital signs are stable, they are transferred to the intensive care unit (ICU) or specialized ward, organically connecting pre-hospital first aid, in-hospital first aid and intensive care treatment (Figure 1). The system that aims to rescue critically ill patients more effectively is called Emergency Medical Service System (EMSS).
First, pre-hospital first aid
As the initial and important part of EMSS, pre-hospital first aid refers to the process of on-site rescue, monitoring and transportation to the hospital before the sick and wounded arrive at the hospital. At present, more than 80 cities across the country have opened "120" emergency telephones, and there are more than 200 emergency centers (including some hospitals engaged in pre-hospital emergency).
Perfect and efficient pre-hospital first aid should meet the following conditions: sensitive and reliable communication network, as large as possible communication coverage area; Emergency network with reasonable layout and small emergency radius; There are many medical technicians with good professional quality; Good first-aid vehicles, first-aid equipment, equipment and medicines, etc.
At present, there are five modes of pre-hospital first aid in Chinese cities: ① Independent first aid center mode; (2) The mode of taking pre-hospital first aid as the main task without beds; ③ Relying on the pre-hospital emergency mode of general hospitals; (4) There is a unified emergency communication command center in the city, and all pre-hospital first aid is done by hospitals. ⑤ Three-level emergency network mode in small cities (counties).
Second, the hospital emergency room and intensive care of critically ill patients
(1) Hospital emergency room
Hospital emergency department (room) is the most important intermediate link in EMSS system and the first line of hospital first aid.
1, emergency room construction
① Pre-screening and triage: At the entrance of the emergency department, experienced nurses are generally responsible for triage and registration. Specifically, it includes sorting out the condition of emergency patients and guiding medical treatment, and carrying out consultation and contact matters related to emergency, such as inquiring about the diagnosis and treatment of patients' past diseases in hospitals through computers, and so on.
② Emergency rescue room: large and medium-sized hospitals should set up operating rooms and intensive care units, with 3-6 rescue beds, which can be located in places where ambulances can directly reach. The rescue room must be on duty by full-time medical staff 24 hours a day, ready to meet the ambulance and be responsible for the rescue work.
③ Emergency operating room: Its scale should depend on the distance between the emergency department and the hospital operating room, the staffing of the operating room and other factors, but it must meet the aseptic requirements and adapt to various emergency rescue operations.
④ Emergency consultation room: internal medicine, surgery, pediatrics, obstetrics and gynecology, orthopedics and other emergency consultation rooms. Usually set in the emergency room of a large hospital. Ophthalmology, Otolaryngology and Stomatology should have specially equipped consulting rooms, surgery should often be equipped with debridement rooms, pediatrics should have independent emergency reception areas, and infectious diseases and intestinal emergencies should be isolated areas.
⑤ Emergency infusion room: A considerable number of emergency patients need infusion treatment, which is usually completed within 24 hours.
⑥ Emergency intensive care unit (see next section).
2, the task of the emergency department
The emergency department, as the front-line department of hospital clinical discipline, undertakes important medical tasks, including:
① Reception and treatment of common emergency patients (90%).
② Acute, critical and severe patients (5% ~ 10%) were rescued and treated.
(3) According to all kinds of emergencies and major disasters, formulate emergency rescue implementation plans, and command, organize, coordinate and arrange a large number of wounded people for emergency after the accident.
④ Actively carry out the teaching and training of emergency medicine, and train doctors and nurses specialized in emergency medicine.
⑤ Pay attention to the management and scientific research of emergency, such as the research on the etiology, pathogenesis, course, diagnosis and treatment of emergency, how to make the process of emergency patients more optimized and reasonable, how to improve the quality of emergency and do a good job in quality control.
(2) Intensive care unit for critically ill patients
Intensive care unit (ICU) is a medical unit specialized in treating various critical patients. In ICU, patients receive comprehensive and systematic examination, accurate and meticulous monitoring and care, timely and accurate treatment, to maximize the safety of patients and effectively improve the success rate of rescue.
1, ICU mode
ICU can be divided into specialist and comprehensive. The former refers to a clinical specialty set up to treat critically ill patients in this specialty, such as surgical intensive care unit (SICU). Comprehensive ICU is mainly set up to treat all kinds of critically ill patients in a certain department or hospital, such as emergency intensive care unit (e ICU).
2.ICU professionals
ICU staffing and organizational structure: ICU staffing adopts different staffing according to its functional orientation. In principle, ICU has 1 chief physician or deputy chief physician, 2 ~ 3 attending physicians and 5 ~ 7 residents. The ratio of the total number of doctors to ICU beds is 1.5 ~ 2: 1. The ratio of the total number of nurses to the number of beds is 3 ~ 4: 1. Under the leadership of the dean, the comprehensive ICU is responsible for the medical teaching, scientific research and administrative management of the ICU. The attending physician leads the resident to manage the patients' medical treatment at different levels. Under the leadership of the director, the head nurse is in charge of nursing work, supervising the completion of nursing work and checking the implementation of ICU rules and regulations.
3. Income and transfer indications of ICU patients
In principle, ICU patients should be all kinds of critical, acute and reversible diseases, that is, patients can get obvious benefits in ICU treatment and are expected to turn the corner. Therefore, patients who have been clearly diagnosed as brain death, paraplegia, advanced tumor and some terminal diseases should not be admitted to ICU to avoid unnecessary waste of medical resources. During the treatment in ICU, the patient's vital signs tend to be stable, and there is no obvious abnormality in all monitoring indexes, and they have been stable for more than 72 hours, so they should be transferred to the general ward in time for further treatment.
4. Intensive care unit monitoring
Monitoring the vital signs and related organ functions of critically ill patients is the primary task of ICU. The monitoring contents of ICU mainly include the following aspects: ① temperature monitoring; ② Monitoring of brain function; ③ Monitoring of circulatory function; ④ Respiratory function monitoring; ⑤ Renal function monitoring; ⑥ Liver function monitoring; ⑦ acid-base balance and electrolyte monitoring; 8 Coagulation function monitoring, etc.
In addition to the above, the monitoring of critically ill patients also includes nutritional status monitoring, immune function monitoring, endocrine and metabolic function monitoring. In clinical practice, the necessary monitoring items should be used selectively according to the actual situation of patients.
Chapter II Pre-hospital Preliminary First Aid
Section 1 Tasks of Pre-hospital First Aid
First, pre-hospital first aid for patients calling for help: this is the main and regular task. There are generally two types of patients who call for help. One type is patients whose lives are in danger in a short time, which are called critical patients or emergency patients, such as asphyxia, shock and myocardial infarction. These patients account for about 10% ~ 15% of patients who call for help, and the proportion of critically ill patients who need on-site cardiopulmonary resuscitation is less than 5%. The other is patients whose condition is urgent but not life-threatening in a short time, such as acute abdomen, asthma, fracture and so on. This kind of patients account for about 85% ~ 90% of patients seeking help. The purpose of pre-hospital first aid for this kind of patients is to stabilize their condition, reduce their pain during transportation and avoid complications.
Second, pre-hospital first aid for the wounded in case of disasters or accidents: In case of catastrophic disasters or major events, pre-hospital first aid personnel should closely cooperate with other professional disaster relief teams and implement relevant rescue plans in light of actual conditions. Responsible for the on-site rescue and classification of the wounded, distinguish between different situations, and achieve reasonable diversion and transshipment.
Emergency network communication: responsible for communication between citizens and 120, emergency centers and sub-centers (stations), ambulances, emergency hospitals, emergency centers, superior leaders, health administrative departments and other disaster relief systems.
Four. Major task rescue duty: refers to the rescue duty of local large-scale gatherings, important meetings, international competitions, foreign heads of state's visits and other activities.
Verb (abbreviation of verb) first aid knowledge popularization: popularize first aid knowledge to the public and citizens through radio, television, newspapers and other media, and carry out on-site rescue and cardiopulmonary resuscitation education. The popularization of first aid knowledge and education is helpful to improve the success rate of first aid service.
The content of pre-hospital first aid in the second quarter
First, medical care.
(a) to maintain the function of the respiratory system;
(2) maintaining the function of the circulatory system;
(3) hemostasis, dressing and fixation of various wounds;
(4) Symptomatic treatments such as spasmolysis, analgesia, antiemesis and hemostasis.
Second, deal with
Safe and stable handling methods should be adopted to transfer the sick and wounded to ambulances or sickbeds as soon as possible. The most commonly used is stretcher handling.
Third, traffic.
Emergency transportation should be fast, stable and safe. In order to avoid possible injuries caused by emergency braking, the position of the sick and wounded and stretchers should be fixed, and medical personnel and accompanying guests should use safety belts or grab handrails. The position of the wounded and sick in the car should be placed according to the condition, such as supine position, sitting position or head high (low) position. Patients with spinal injury should be padded with hard plates, patients with fracture should prevent the pain from aggravating due to the violent bump of vehicles, and patients with coma and vomiting should tilt their heads to one side to prevent respiratory obstruction.
Section 3 Basic Techniques of Initial First Aid on Site
First, stop the bleeding
(1) Pressure bandage hemostasis: it is suitable for bleeding of arterioles, small and medium-sized veins or capillaries. The method is as follows: first, cover the wound with sterile dressing, and then wrap it with bandage or triangle cloth under proper pressure.
(2) Acupressure hemostasis: It is suitable for moderate or massive arterial bleeding.
(3) Rubber tourniquet for hemostasis: it is suitable for hemostasis of arteries with large limbs. Methods: Raise the affected limb, put soft fabric on the skin near the heart end of the wound, wrap the affected limb tightly with rubber band for 2-3 times, and press the end of the rubber band under the tightly wrapped rubber band.
Second, dress.
Bandage is a common method of trauma first aid, which has the functions of protecting wound, reducing pollution, fixing dressing, compressing hemostasis and promoting wound healing at an early date.
(A) the scroll bandage method
1. Ring bandaging method: it is suitable for small wounds with the same thickness as limbs, forehead, chest and abdomen, that is, bandaging in a ring overlapping way, and finally cutting the middle of the belt tail into two ends, knotting and fixing.
2, spiral or spiral reverse folding dressing method: this method can be used for the transition part of limb thickness.
3. Figure-8 dressing method: the flexion part of the joint can be used, and each circle covers the upper circle 1/3 ~ 1/2.
(2) triangle bandage method
1, dressing method
The dressing method includes ① hood dressing method; (2) Single and double shoulder bandaging; ③ Single and double chest dressing; ④ Back bandaging; ⑤ Abdominal and hip dressing; ⑥ Upper limb dressing; ⑦ Hand dressing; 8 the dressing method of calf and foot, etc.
2. Precautions of triangle bandage method
① Before dressing, the wound should be simply debrided and covered with sterile gauze; (2) the dressing pressure should be moderate, in order to stop bleeding or preliminary braking; ③ The dressing direction should be from bottom to top, from left to right, and from distal to proximal to help venous blood return. Knots fixed with bandages should be placed on the outside of limbs, not on wounds and bony processes. ④ Fingers or toes should be exposed when the limbs are bandaged, so as to observe the blood supply and feeling around. If any abnormality is found, the limbs should be loosened and bandaged again.
Third, fixed.
Fixation is an emergency measure for fracture. Through fixation, the movement of the fracture site can be limited, thus alleviating the pain of the wounded and avoiding the damage of blood vessels, nerves and important organs caused by friction at the broken end of the fracture. Fixation is also beneficial to prevent shock and facilitate the treatment of the wounded.
The most ideal fixing material is splint. If the splint can't be found at the rescue site for a while, bamboo boards, wooden sticks and pickaxes can be used instead. Gauze or towel, bandage, triangle towel, etc. It is also necessary.
1, fracture temporary fixation method
① Clavicle fracture: put a towel on the front upper part of both axils, fold the triangular scarf into a band shape, and wrap the two ends around the shoulders in an "8" shape, so that the shoulders can be stretched backwards as far as possible, tighten the two ends of the triangular scarf and tie a knot at the back.
② Humeral fracture: place a long splint on the posterolateral side of the upper arm and a short splint on the anterolateral side of the upper arm. The upper and lower ends of the fracture were fixed, and the elbow flexion was 90 degrees. The upper arm is hung with a triangular towel and fixed to the chest.
(3) Forearm fracture: Make the injured elbow bend 90 degrees and thumb up. Put two splints on the inside and outside of the forearm respectively, then fix both ends with bandages, and then hang the forearm on the chest with a triangular towel.
④ Fracture of thigh: Put one long splint on the outside of the injured leg and the other splint on the inside of the injured leg, divide it into 5-6 sections with bandage or triangular towel, and fix the splint firmly.
⑤ Leg fracture: Put two splints on the inside and outside of the injured leg respectively, and fix them with bandages in sections.
⑥ Spinal fracture: Let the wounded lie flat on a hard board, and put a thin pillow on the back and waist to make the spine slightly protrude upward. If necessary, use several straps to fix the wounded on the board to prevent displacement.
2. Preventive measures
① If there is any wound or bleeding before fixing the fracture site, stop bleeding and bandage it first.
② In the case of an open fracture, if the bone end pierces the skin, it must not be sent back to the wound to avoid infection. The length of the splint must exceed the upper and lower joints of the fracture, and the upper and lower ends of the fracture site and the upper and lower joints should be fixed firmly.
(3) A cotton pad or other articles should be placed between the splint and the skin, so that all parts are evenly compressed and firmly fixed.
(4) When limb fracture is fixed, the finger (toe) end should be exposed and the peripheral circulation should be observed. If poor blood supply is found, it should be loosened and fixed again.
Fourth, deal with
The purpose of transporting the wounded on site is to transport the wounded to a safe area in time, quickly and safely to prevent them from being injured again. Therefore, using the correct treatment method is an important link in the success of first aid, while the wrong treatment method will cause additional harm. On-site handling is mostly manual, and some handling tools can be used on the premise of safe transportation.
1, stretcher handling of several secret service wounded
① The wounded with prolapse of abdominal organs: A, make the wounded leg bend, relax abdominal muscles and lie on a stretcher; B. Avoid sending internal organs back to abdominal cavity to avoid infection. You can buckle the internal organs with a clean bowl and wrap them with a triangular towel. C after dressing change, keep supine position, bend lower limbs, and keep the abdomen warm before transfer.
② Coma patients or patients at risk of vomiting and suffocation: make the patients lie on the stretcher on their side or prone, with their heads tilted to one side, and transport them on the premise of ensuring unobstructed respiratory tract.
③ The injured person with pelvic injury: wrap the pelvis in a circular way with a triangular towel. When handling, let the injured person lie on his back on a hard wooden board or stretcher, with his knees slightly bent and a cushion under it.
④ Injured spinal column: It is forbidden to carry spinal column injury in a bad luck or flexion position. Three to four people should hold the head, shoulders, back, waist, buttocks and ipsilateral lower limbs of the injured person and lie flat on a hard stretcher or hard board. Cervical spine injury should be pulled by a special person. Pay attention to the consistent movements when handling. The wounded should put a thin pillow on the chest and waist to keep the chest and waist from overstretching.
2, batch treatment of the wounded
When a mass injury accident occurs, the transport order of the wounded should be decided according to the injury classification.
① First-degree injury: shock, asphyxia, severe open injury of chest and abdomen, massive bleeding of limbs, tourniquet and other life-threatening phenomena.
② Grade II injury: There is no danger of delaying the operation for 6-8 hours, such as mild hemopneumothorax, small area burn and spinal cord injury.
③ Grade Ⅲ injury: Delayed operation 18 ~ 24 hours will not be life-threatening, such as soft tissue injury and closed fracture.
The first-level wounded should be transported immediately, the second-level wounded should wait for transport, and the third-level wounded should be transported finally.
Five, mouth-to-mouth artificial respiration
When anyone is found unconscious and stops breathing, mouth-to-mouth artificial respiration must be performed to rebuild breathing, and then other medical assistance and treatment of any other injuries must be carried out, unless suffocation occurs. Mouth-to-mouth resuscitation is suitable for older children and adults, but for infants, the following alternative methods should be adopted.
1, Rehabilitation of Older Children and Adults
① Lie the injured person on his back on a stable hard board, hold his neck and make his head lean back, clean his mouth with his fingers and remove foreign bodies in the airway. ② Hold the nose of the injured person, take a deep breath, open your mouth and seal the victim's mouth, and blow hard for 4 times. Continue to breathe every 5 seconds, move your lips after each blow, listen to the gas leave your lungs and observe the chest ups and downs, and continue artificial respiration until you get medical help or the patient resumes spontaneous breathing.
2. Rehabilitation of infants and young children
Like the first step above, let the child lie on his back and clean his mouth. Later, tilt the child's head backwards, seal the nose and mouth, and blow slightly into the child's lungs. Remove the mouth of the rescuer, observe the fluctuation of the baby's chest when the air leaves the lungs, and repeat blowing every 2 ~ 3 seconds until the medical rescuer arrives or the baby begins to breathe spontaneously.
3, mouth-to-nose resuscitation
If the patient's face is injured, it will hinder mouth-to-mouth artificial respiration. At this point, the patient must lie on his back and quickly clean up the foreign bodies in the mouth and airway. Put the patient's head back (mouth-to-mouth resuscitation for adults ① and ②). Take a deep breath to seal the patient's nose, raise the patient's chin to seal his lips, take a deep breath into the patient's nose, remove the mouth of the rescuer, open the mouth of the injured person with your hands, let the gas out, and breathe every 5 seconds like mouth-to-mouth breathing.
The fourth quarter heart, brain and lung resuscitation
If cardiac arrest is not rescued in time, it will cause irreversible damage to the brain and other important organs and tissues after 4 ~ 6 minutes, so cardiopulmonary resuscitation (CPR) must be carried out immediately on the spot. Traditional cardiopulmonary resuscitation (CPR) is usually divided into three stages: basic life support, further life support and extended life support. In view of the more emphasis on the importance of brain protection and brain resuscitation in recent 20 years, it later developed into cardiopulmonary-cerebral resuscitation (CPCR).
First, basic life support
Basic life support (BLS), also known as initial first aid or on-site first aid, aims to rescue the heart, brain and important organs of the whole body by hand immediately after cardiac arrest, so as to obtain the minimum emergency oxygen supply (usually routine training can provide 25% ~ 30% of normal blood supply). BLS sequence includes: determination of cardiac arrest, airway (a) opening, breathing (b) reconstruction, circulation (c) reconstruction and transportation, which are ABC steps of cardiopulmonary resuscitation.
Early diagnosis of cardiac arrest
Consciousness disappears, breathing behavior stops, and the pulse of aorta (carotid artery and femoral artery) cannot be felt. Electrocardiogram showed: cardiac arrest, ventricular fibrillation, electromechanical separation.
(2) Placement of resuscitation position
The correct resuscitation position is supine position. Carefully lie the patient on his back on a solid and flat ground. When rotating, one hand holds the patient's neck and the other hand holds his shoulder, so that the patient can turn to supine position along the longitudinal axis of his body.
(3) Open the airway (A)
Open the airway to keep it unobstructed, you can use chin-lifting method, neck-lifting method (not suitable for people with cervical spine injury) or chin-holding with both hands.
(4) judging whether there is spontaneous breathing.
Use the method of "looking, hearing and feeling" to judge whether the patient has spontaneous breathing, that is, to observe whether the patient's chest has ups and downs; Put your ears and face close to the patient's nose and mouth, and listen to and feel whether there is airflow and exhalation in the patient's respiratory tract. If there is no breathing, mouth-to-mouth artificial respiration should be performed immediately.
(5) reestablishing breathing (b)
Mouth-to-mouth artificial respiration passively blows gas into alveoli with the help of the rescuer's forced exhalation, and maintains alveolar ventilation and oxygenation through intermittent expansion of the lungs, thus reducing the body's hypoxia and carbon dioxide retention. The method is: (see the previous section).
(6) Reconstruction period (c)
Touch the carotid artery. If there is no pulse, start chest compressions immediately. Pressing position: 4-5 cm above xiphoid process; Compression frequency: 80 ~ 100 times/minute, and artificial respiration after every 5 heart compressions; The depth is 3.8 ~ 5.0 cm; When pressing, the elbows should be straight, the force should be vertical downward, and the extrusion should be appropriate to prevent hemopneumothorax and pericardial effusion.
(seven) single or double recycling.
1. Single-person operation: the same rescuer completes mouth-to-mouth artificial respiration and chest compressions in turn, and the number of artificial respiration and chest compressions is 2∶ 15.
2. Two-person operation: one person carries out mouth-to-mouth artificial respiration twice and the other person carries out chest compressions five times, so the number of artificial respiration and chest compressions is 1∶5, and so on. In addition to keeping the patient's respiratory tract unobstructed during the operation, ventilation cannot be carried out while pressing. When two people rotate the rescue position, they can do it in the interval after completing a round of ventilation and compression, and the rescue time shall not be interrupted for more than 5 seconds.
(8) Precardiac pulsation
Precardiac impact is mainly used to witness cardiac arrest or ventricular fibrillation during 1 min. If it doesn't work, you can repeat 1 times or perform ABC steps immediately.
(nine) the effective index of cardiopulmonary resuscitation and the standard of terminating rescue.
1, effective index of cardiopulmonary resuscitation
(1) can feel the aortic pulse; ② The patient's lips and face turned red; ③ Pupil reflex recovery; ④ Spontaneous breathing began to appear.
2. Criteria for terminating rescue: On-site cardiopulmonary resuscitation should be carried out continuously, and it is not easy to make a decision to stop resuscitation. If the following conditions are met, the on-site rescuers may consider terminating the recovery:
① The patient's breathing and circulation have been effectively restored.
② No heartbeat, spontaneous breathing, cardiopulmonary resuscitation lasting more than 30 minutes at room temperature, and the presence of a doctor confirmed that the patient had died.
(3) specialists take over the resuscitation or other personnel take over the rescue.
Second, further life support.
Advanced life support (ALS), also known as second-stage resuscitation or advanced life maintenance, mainly applies instruments and drugs on the basis of BLS to establish and maintain effective ventilation and circulation, identify and control arrhythmia, asynchronous defibrillation with direct current, establish effective venous access and treat primary diseases.
(1) Respiratory management
1, tracheal intubation: If possible, do tracheal intubation as soon as possible, because tracheal intubation is the best way of artificial ventilation.
2. Puncture of cricothyroid membrane: For patients with severe asphyxia caused by emergency laryngeal obstruction, it is feasible to puncture cricothyroid membrane urgently when tracheotomy is not available immediately.
3. Tracheotomy: Tracheotomy can keep the airway unobstructed for a long time, prevent or quickly remove airway obstruction, remove airway secretions, reduce airway resistance and dissect invalid cavities, increase effective ventilation, and facilitate sputum aspiration, pressurized oxygen supply and intratracheal drug dripping. Tracheotomy is often used for patients with oral, facial and neck trauma who cannot be intubated.
(2) Respiratory support
It is very important to establish artificial airway and respiratory support in time. In order to improve the arterial oxygen partial pressure, it is generally advocated to inhale pure oxygen first. Oxygen can be inhaled through various masks and artificial airways, and tracheal intubation and mechanical ventilation (ventilator) are the most effective.
(3) Intrathoracic cardiac compression
Open chest cardiac compression can produce higher arterial pressure and blood flow, and the cardiac output can be increased by 2 ~ 3 times compared with external chest cardiac compression.
(d) defibrillation of cardiac shock
Defibrillation by electric shock is the most effective way to terminate ventricular fibrillation, and defibrillation should be done as soon as possible. After the diagnosis of cardiac arrest, the defibrillator can be used for "blind" defibrillation 1 time, and the electric energy is 300 ~ 400 J. If it is ineffective, press again. If ECG monitoring proves ventricular fibrillation, intravenous medication should be given before electric shock. Intrathoracic defibrillation energy is 50 ~100 J.
(5) Resuscitation drug therapy
1. Administration route: ① Administration via great veins (internal jugular vein and subclavian vein); ② Intratracheal administration; ③ Intracardiac injection.
2, commonly used drugs for resuscitation: ① drugs that stimulate heartbeat: adrenaline, atropine, isoproterenol; ② acidosis: NaHCO3, etc.
Third, extend life support.
Prolonged Life Support (PLS) is mainly used for cerebral resuscitation.
(A) the principle of brain resuscitation
Prevent or alleviate the development of brain edema.
(b) Brain resuscitation measures
1. Dehydration therapy is used to reduce the body fluid load of the whole body (mainly the brain). Generally, osmotic diuresis is the main method, and rapid diuresis can also be used as an auxiliary measure.
2. Reduce body temperature and oxygen demand.
3. Use a large dose of corticosteroids to relieve the development of edema.
4. Systemic support therapy provides a good foundation for brain resuscitation.
Four. Treatment and referral after resuscitation
(1) Treatment after rehabilitation
1, maintain circulatory function and treat hypotension.
2. Maintenance of respiratory function, sputum aspiration and application of antibiotics.
3, infusion, supplement K+, limited intake in the first three days.
4. Maintenance of renal function.
5. Treatment of primary disease.
(2) Referral after resuscitation
When unconditionally maintaining continuous treatment, referral must be made on the premise that vital signs are relatively stable, and the following matters should be noted:
1, before referral, be sure to contact the relevant hospital, let the other party prepare for meeting, and briefly state the introduction of referral, including cardiac arrest time, rescue process, medication time, fluid inflow and outflow, and changes in vital signs.
2. On the smooth and fast way, the patient's head should be opposite to the direction of the vehicle to ensure the blood supply to the brain.
3, the car must be ready to rescue drugs and necessary equipment, including oxygen facilities, etc.
4, before referral should explain the necessity of referral to the patient's family, and explain the condition and possible accidents.