Adult cardiopulmonary resuscitation points?

Blow method compared with other artificial respiration method has the following advantages ① do not need to prepare special equipment ② where a person or withdraw any circumstances can be enrolled ⑧ have the effect of alveolar expansion. The operator can use his hands to change the patient's position, so that the airway is open, and then can also touch the pulse and pressure on the upper abdomen to prevent gastric inflation and dilatation. @Woodeners are not easily fatigued. When dibbling for artificial respiration, the results can be determined. Mouth to day ^ Z breathing method; the patient to take the supine position, head tilted back, depressed forehead to make the airway open, with the thumb and forefinger pinch the patient's nostrils, the rescuer deep inhalation, the mouth open tightly cooing around the patient's mouth, blowing the gas into the patient's chest to make the patient's thorax gently bulging. The formation of warm air, and then leave the mouth, so that the gas blown into the natural exhalation, when the operator puts his ear close to the patient's mouth around the anonymous listening to the sound of gas exhaled to determine the effect of artificial respiration. Can also hands in the jaw corner of the lower forehead upward, with their own cheeks blocking the patient's nostrils, for rl to mouth artificial respiration. The first four times to be rapid succussion, blowing force to be too, after 16 to 20 times per minute to note that in the blowing should be dubbed chest Gala Lambi anonymous life congestion care outside the cardiac compression, the general gas blowing and the number of cardiac compression is the ratio of the single CPR, every chest compression l5 times, blowing twice, that is, 15 t 2} double CPR, every chest compression 5 times, after blowing once, that is, 5: mouth to nose Artificial respiration: the patient takes the supine position, tilts the head back, and the operator lifts the patient's jaw with both hands forward and upward. The patient's mouth is closed. The operator then inhales y and then presses the lips of the mouth against the patient's nose, blowing in gas to form the patient's inhalation. When exhaling, open the patient's mouth to exhale gas and observe the effect of artificial respiration according to the method described above. Gas inhalation by means of instruments: artificial respiration by means of a mask, a ventilator tube in the oral cavity and an endotracheal tube inserted into the trachea The operator inhales y and then blows ^gas into the opening of the above instruments to form the patient's inspiratory breath, and then leaves the mouth to form the expiratory breath. The effect of artificial respiration is still observed in the same way as above. C2) Mechanical artificial respiration using simple respirator, anesthesia machine, automatic artificial respirator to assist breathing is called mechanical artificial respiration. ①Simple respirator. Is composed of mask and breathing bag two parts of the airbag is made of sponge rubber, flexible, can be automatically inflated. At the end of the airbag can be connected to the oxygen operator with the left hand to lift the lower jaw, head tilted back to keep the airway open. The mask is connected closely around the patient's mouth and nose, and then squeeze the respiratory capsule with the right hand, the frequency of 15 to 30 times / min ② anesthesia machine: to maintain a clear airway, the mask connected to the airbag, with the thumbs and forefingers of both hands, tightly press the patient's mouth and nose around the mouth and nose, so that it is connected closely, and turn on the carbon dioxide absorber, so that the airbag is inflated, and then the airbag is pressurized, the pressure in the respiratory capsule after the extrusion of the pressure should be relaxed immediately after both hands to Yu Yu to remove the pressure. The frequency of pressurization is controlled at 20-30 times/minute, and the frequency of pressurization is adjusted to l5 times/minute after the condition is stabilized@ Automatic artificial respirator: In case of emergency, tracheal intubation or tracheotomy should be carried out, and the artificial respiration should be carried out by a simple respirator or anesthesia machine. After the condition is stabilized, an automatic artificial respirator should be applied to assist respiration. This allows the operator to carry out other push rescue work. In the application of artificial respirator, according to the state of the patient to mediate the volume of gas exchange, the frequency of exhalation, the concentration of oxygen inhalation, air pressure. So that it can maintain good blood oxygen saturation, carbon dioxide partial pressure and acidity, electrolyte balance, and does not affect the cardiac output and blood pressure, no damage to the lungs feast quality. (- )C (artificial circulation) (1) cardiac compression: cardiac compression is adapted to various causes of cardiac arrest, ventricular fibrillation and high degree of atrioventricular block caused by ventricular arrest clinical manifestations for the peripheral arteriovenous pulsation pulse can not be la and, the disappearance of the heart sounds, can not be measured blood pressure, cyanosis, with the passage of time the pupil fluffy gradually dilated. (2) timing: clinically, if you suspect that the blood circulation stops, you should immediately perform cardiac compression, dibble the earlier the resuscitation rate is higher, the more complications are also the more Vipro information 1995, No. 2 step. The tolerance of each organ of the human body to hypoxia is different, the brain tissue in the blood circulation stops after 4~6min that serious damage occurs, so that it is impossible to recover. After the heart stops beating for lOm[n, the carrying of the tissues is basically dead. At room temperature. When the heart stops beating for 3s, the patient feels dizzy; 10~20s that is, fainting occurs}40s about convulsions, 30~40s pupils are big}60s after respiratory cessation, urinary and fecal loss; 4~6m[n after the irreversible damage to the brain cells a lot of practice shows that, half of the people who resuscitated in 4rain may be saved I 4~6min resuscitator can be only 1O can be saved, more than 6min survival rate is only 1O can be saved. The survival rate of those who start resuscitation within 4~6min is only 1O can be saved, and those who start resuscitation more than 6min are only 4, and those who start resuscitation more than [Omin] have no possibility to survive. In recent years, China's various sudden cardiac arrest (sudden death) patients have been increasing tendency. Coronary heart pain is the most common cause of sudden cardiac death. Among them, 70 died outside the hospital. 40 died within 1Stain after the onset of the disease. 30 died in the onset of the disease 1Stain to 2h. If the surrounding people or family members can learn the correct resuscitation methods. Can avoid the delay of valuable time in sudden cardiac death most of the momentary serious arrhythmia, not lesions have developed to a fatal degree. As long as the rescue timely, correct, effective, most patients are expected to live. The key is to have a large number of people to learn the correct CPR, every second to put into the rescue. (3) Cardiac compression methods: there are two types: external chest type and open chest type. ① Extrachest cardiac compression: make the patient lie supine on a hard board bed or flat surface, the operator stands on the side of the patient, the root of the palm of the left hand is placed on the lower part of the sternum, the palm of the right hand is placed on the back of the left hand, the fingers of both hands are in the position of crossing each other, and the fingers are lifted up and away from the chest wall. The two forearms were vertical, and the weight of the operator's upper body was pressed down. The sternum was pressed down by 3 to 5 cm, and the pressure was applied in a smooth and regular manner. It should not be intermittent or impacted, and the time of downward and upward relaxation should be equal. Pressure to the lowest point should be obvious pause, vertical force down, do not swing from side to side, relaxation of the palm of the hand does not leave the positioning point of the sternum, but should be as relaxed as possible, to ensure that the sternum is not subjected to any pressure pressure on the pressurization frequency of 80 ~ 100 times / min. The ratio of compression and artificial respiration is le for single person, 2. 5:1 for double person. Common mistakes and complications of extrathoracic cardiac compression: in addition to the root of the palm sticking to the sternum during compression, the fingers are also pressed on the chest wall, which is easy to bow f up rib fracture} Incorrect positioning of the compression, downward fracture of the raphe and rupture of the liver. To the sides of the ribs or rib cartilage fracture, resulting in pneumothorax, hemothorax; pressure is not vertical, so that the pressure is ineffective or rib fracture a relaxation of the chest failed to make the chest sufficiently relaxed, the chest two to bear the pressure. It is difficult for blood to return to the heart. Contraindications to thoracic cardiac compression: pericardial effusion. Acute myocardial infarction complicated by cardiac rupture ② open-chest cardiac compression. Indications: chest cardiac compression is ineffective, suspected acute myocardial infarction combined with cardiac rupture and pericardial tamponade. Obvious deformation of the thorax and spine (funnel chest), 8 to 9 months of pregnancy. After artificial heart valve replacement. To avoid blindly using chest external cardiac compression to arch f up cardiac contusions. Methods: Try to clean and disinfect locally. However, in emergencies, the skin disinfection is not strictly required to cut the skin of the left side of the rib question and intercostal muscles with a scalpel. Then cut the pleura with scissors. If there is a chest opener, install the chest opener to pull open the intercostal muscles and incise the pericardium. Expose the cardiac border. To resuscitate an adult, place the thumb of the right hand in front of the right ventricle. The other four fingers are placed behind the left ventricle, and the heart is squeezed at a frequency of about 8O times per minute, and there should be enough diastole after each squeeze, and the intensity of the squeeze is appropriate to be able to touch the peripheral arterial pulsation. For larger heart borders, place the left hand in front of the heart. Place the right hand behind the heart and squeeze with both hands. When resuscitating a skip child. Because the operator's hand is often not able to enter the chest cavity with the whole hand, only with the right hand 2 to 5 fingers behind the left ventricle, the heart is pressed toward the sternum. Perform cardiac compression. When cardiac compression is effective and bleeding occurs at the site of the bow-f up planing injury, bleeding should be stopped and, if necessary, transfused. Hemostasis and, if necessary, blood transfusion should be performed. If sinus rhythm is restored, place a bow-flow tube and close the chest cavity. Postoperatively, attention should be paid to the observation of cardiac rhythm, pulse rate, blood pressure, urine output, and at the same time given oxygen, application of antibiotics to prevent infection. Correct acidosis, water-electrolyte imbalance and so on. In addition to continuous cardiac extrusion, but also with endotracheal and intravenous injection of drugs, electric shock resuscitation, pacing and other methods of cardiac resuscitation. Anterior cardiac area boxing method: this method can be used at the beginning of cardiac arrest. The mechanical energy generated by boxing the precordial area to the heart can produce 3 ~ 5 watt seconds of electrical energy, when the heart is in ventricular flutter, can be terminated boxing once, such as the heart does not resumption of beating should be changed to the chest cardiac compression (5) skip young JL, O-lung resuscitation points t in cardiopulmonary resuscitation, less than 1 year of age of the pediatric child as a skip child. 1 ~ 3 years of age for the young children, the cardiopulmonary resuscitation treatment of the basic same as the adults, but there are the following points of special. The following are some of the special features of CPR. ① Shoveling consciousness. Skip children can not respond to the language, you can use your hands to slap the heel. Or pinch the points of the house. If it can sob in the beams, it is conscious. Artificial belching. Tilt your head and lift your forehead to clear the airway. Mouth to nose artificial respiration. Because of the ligamentous muscle relaxation of young children, the head should not be tilted back too much. Therefore, the head should not be excessively tilted back, so as not to pressure the trachea, affecting the airway, can also be used with one hand to support the neck, in order to maintain a straight airway. Check the brachial artery. The carotid artery is not easily palpable. If the carotid artery is not easily accessible, the cerebral artery can be examined. The site and method of chest compressions. The site of chest compressions for a skip child is one transverse finger below the junction of the two nipple lines and the midline of the sternum. Compression is mostly done by the ring method (also known as the posterior support method). Both thumbs overlap and press down. ⑤Chest compression frequency and artificial respiration ratio of a skip child chest compression frequency should be ~ & gt; 10o times / minute. Because of the infant can be a person at the same time for riding outside the pressure and artificial belching, so and adult two-person resuscitation of one ocean, the ratio of the guillotine is 5 l. Artificial cardiac compression and electrode - resuscitation for cardiopulmonary resuscitation for cardiac arrest to restore the circulation (circulation restor~), to maintain the important organ life of important measures. Artificial cardiac compression is the scene of cardiac arrest rescue must immediately carry out the most basic first manufacturing method 'in the medical unit with electric Yu- equipment. If cardiac (field) monitoring confirmed cardiac arrest caused by ventricular. Should be the first to immediately perform electrical capsule - reset, if it can not be confirmed whether the ventricular caused by the feasibility of blind electrical removal -, due to cardiac arrest caused by the ventricular accounted for 80 ~ 90. First, artificial cardiac compression artificial chest cardiac compression should be carried out in conjunction with artificial respiration, generally in artificial respiration 2 times, immediately after the judgment of cardiac arrest, the blood with oxygen through the heart and arteries to the body's main borders of the effective chest cardiac awareness of the compression of the equivalent of drying the amount of normal cardiac 25 ~ 5O, cerebral blood flow of about 30 of the normal in individual patients may also be eliminated in the ventricular - (recently our department in the Chest compressions under electrocardiographic monitoring have restored sinus rhythm in two patients with acute myocardial infarction with ventricular -). Thoracic cardiac compression is ineffective and deemed worthy of continued resuscitation, or the presence of an indication for intrathoracic cardiac compression can be open-chest cardiac compression. 1. Bow outside the heart Ju compression (1) mechanism; hundred before that chest heart compression. To restore blood circulation is not the result of direct pressure on the heart, but the pressure of the bow l up the intrathoracic pressure Puchu sacrifice increase, promote blood flow to the dynamic amidine, relaxation of the intrathoracic pressure drop, promote the venous blood hidden to the right heart, in order to choose to maintain the purpose of the effective blood circulation. Rudokof believes that the anterior rather than posterior blood collection produced during compression is related to the following factors t ① the presence of venous valves in the venous system l ② the arteries are more resistant to blood lee pouches than the veins, leading to atrophy of the veins at the thoracic outlets when the intrathoracic pressure is increased; the volume of the arterial cellar is less than that of the veins, implying that an equal volume of blood produces a greater pressure in the arterial system. (2) compression procedure t ① patient position t immediately put the patient on a hard board bed or on the ground, if the spring bed, should be in the back of the pad a length and width of a large enough hard board, in order to ensure that the patient's body does not move up and down, left and right after pressing the sternum, but not to delay the time of compression due to the search for a pad; @ to determine the site of the press: the correct site of the press in the sternum of the upper z / 3 and the lower 1 / 3 junction of the main star ink decoction of the anonymous pads at the place of checking, the operator With a palm root placed in the flattering part, the other palm longitudinal cross overlap on the back of the palm of this hand} @ compression method: in accordance with the 1988 American Heart Association (AHA) published artificial cardiac resuscitation standard program, the frequency of receiving pressure 80 ~ 100 times / minute. The first 2 ~ 3 minutes up to 100 times / min, so that the blood pressure in a short period of time to rise judge 60 ~ 70mmHg (8.O ~ 9.33kPa), and may enable the heartbeat to recover I compression and relaxation time is equal to each accounted for 50, at this time the heart ejection of blood is the most; cardiac compression and the number of times of artificial belching proportion of 15-2 (single person cardiopulmonary resuscitation) or 5-1 (two-person) The ratio of cardiac compression to manual belching is 15-2 (single cardiopulmonary resuscitation) or 5-1 (two-person cardiopulmonary resuscitation)}The sternal exploration of the compression is 4-5era for adults, and 2era for young children. (3) Compression site and method for the child: the compression site is at the intersection point of the nipple line and the sternum midline, and the cross-finger is below the intersection point, and the method of two-handed embracing is mostly adopted, and the thumbs overlap the downward compression (the newborn can be used as a single hand.). Pressure frequency of 100 times / min). (4) press notes: ① pressure should be smooth, regular and different intermittently, until the restoration of sinus camphor; ② pressure position is not only ineffective but also dangerous, the position is too low (such as the subxiphoid process) damage to abdominal organs or cause gastric cellar reflux, the position of the big high, can be harmed by the arm of the blood. Position is not in the center line, can cause rib fractures, and even pneumothorax, hemothorax} ③ operator pressure shoulders, elbows should be soaring straight. Shoulders in the patient's sternum above the center, the use of upper body weight and shoulder and arm muscle strength vertical downward pressure, do not shake left and right; ④ do not eye-impact pressure, its effect is poor, easy to fracture, relaxation of the palm root do not leave the sternum positioning point, so as not to cause the next pressing site of the error, but should try to relax, make sure the sternum is not subjected to any pressure is conducive to the venous return to the right heart I ⑤ compression should not be because of the auscultation of the heart, Do not stop cardiac compression because of auscultation of the heart, tracing the electrocardiographic field, electric shock, gas bud insertion arm and other necessary treatments should be performed by an experienced physician, the compression between ji not more than 10s (maximum lSs); @ each time the compression is effective, can feel a carotid artery pulsation. If there is still a pulse when pressure is stopped, the patient's heartbeat is restored. It means that the patient's heartbeat is restored. 2. In-bow cardiac compression (1) Indications: ① Due to sternal or spinal deformity, the carotid artery cannot be felt by extrathoracic cardiac compression, and it is estimated that it is difficult to be effective; @Cardiac pathology, such as cardiac arrest with cardiac machine damage, ventricular wall tumors, severe mitral stenosis, C,-packet tamponade, pulmonary artery embolism}@Tension pneumothorax; 4) Intractable ventricular - the heart is still in the state of asystole after several times of electric re-bar and resuscitation drug treatment. Experiments have proved that when the external chest cardiac compression is invalid, it is changed to internal chest compression, which can make the resuscitation rate rise from 0 to 75; if the time of external chest compression is greater than 25 minutes, masonry open-chest compression gain saddle small. (2) compression method: after simple disinfection of the skin, quickly along the left 4th rib asked the edge of the sternum to the anterior axillary line as an arc-shaped incision into the chest, open the intercostal exposure of the heart, cut the pericardial cavity, if necessary, will be the right hand into the chest cavity, the thumb in the heart in front of the four fingers placed in the back of the heart, will be the right hand into the chest cavity, the thumb in front of the heart. The fourth finger is placed behind the heart, and the heart is placed straight in the palm of the hand.