心肺复苏术在74例心搏骤停病人中的应用及护理

回顾性分析74例心搏骤停病人的临床资料,发病时病人均伴有意识丧失、脸色苍白、全身性抽搐、瞳孔放大、颈动脉和股动脉无搏动等症状,在场医护人员迅速对病情做出判断,采用有力胸外按压、人工通气、早除颤、建立静脉通道、迅速脑复苏等急救措施实施及时救治。20例病人经抢救后恢复意识、血压恢复、血液循环恢复,54例病人抢救无效当场死亡。对心搏骤停的病人,及时采取有效的急救措施,加强对病人的有效护理是提高心肺复苏成功的关键。     

重症心肌炎心搏骤停患者应用急诊体外膜肺氧合技术1例的急救与监护

总结1例重症心肌炎心搏骤停患者应用体外膜肺氧合技术的急救与监护体会。急救的重点是快速反应团队在心肺复苏抢救的同时建立体外循环。体外膜肺氧合运行管理中根据患者心脏病理生理状态进行流量管理,联合肾脏替代治疗技术进行精准容量管理,强化抗凝管理,应用超保护机械通气策略,合理镇痛、镇静降低应激,全程综合、全面的血流动力学监测明确循环功能转归。患者心肺脑复苏成功,体外膜肺氧合技术治疗时间183h,ICU住院13d后脑功能恢复良好,转当地医院治疗。     

1例糖尿病肾病突发昏迷及反复心搏骤停的急救护理

随着急诊医疗体系的不断健全,医疗技术的不断提高,医疗设施的不断完备,心肺复苏的成功率有所提高,然而,脑复苏的成功率却不尽人意.我科近期成功抢救了1例突发昏迷反复心搏骤停的糖尿病病人.现将急救护理介绍如下.     

中药配合抢救心搏骤停心肺脑复苏2例

心肺脑复苏是心搏骤停后抢救能否成功的关键.在正确实施心肺脑复苏以及应用有关复苏药物的基础上,我们还采用参麦注射液静脉滴注和以益气固脱为主的中药鼻饲或口服,成功抢救2例心搏骤停患者,未出现心、肺、脑等严重后遗症,报告如下.     

心肺脑复苏护理用于心搏骤停中的效果分析

目的 探讨心肺脑复苏护理对于心搏骤停患者的护理效果.方法 选择2019年3月至2020年10月实施心肺复苏抢救的100例心搏骤停患者为研究对象.按简单随机法就患者分为常规组和探究组,每组各50例.常规组进行常规急救护理,探究组进行心肺脑复苏护理.分析比较两组的不同时间段4～6min、6～10min抢救存活率、抢救效率.结果 探究组不同时间段抢救存活率高于常规组(P<0.05).探究组患者抢救效率(98.00％)高于常规组(86.00％)(P<0.05).结论 心肺脑复苏护理可提高心搏骤停患者存活率,保证抢     

心肺复苏新指南在急诊呼吸心搏骤停病人中的应用

[目的]探讨心肺复苏新指南在急诊呼吸心搏骤停病人中的应用。[方法]回顾性分析2013年3月—2013年12月抢救的73例呼吸心搏骤停病人的临床资料。[结果]73例病人中恢复自主心搏24例,收治EICU 9例,收治重症监护室(ICU)10例,病人家属放弃抢救,自动出院5例,死亡49例;22例院内呼吸心搏骤停病人中恢复自主心搏10例;院外呼吸心搏骤停病人有无院前急救的抢救成功率比较,差异有统计学意义。[结论]对呼吸心搏骤停病人应及时、有效的进行心肺复苏,对非专业人员深入普及心肺复苏知识,加强医护人员急救知识培训及强化心肺复苏技能的训练,才能提高抢救成功率。     

心肺脑复苏动物模型的标准化问题

心搏骤停患者死亡率很高,即使复苏成功也往往出现严重的复苏后心功能不全、神经功能缺陷等后遗症,因而心肺脑复苏研究是目前急救医学研究的重点和难点.临床上心脏骤停发生往往突然、多变,心肺复苏过程中混杂因素也较多,现代心肺复苏研究依靠于合理设计动物心搏骤停模型,以达到模拟人类心搏骤停事件.     

复发性多软骨炎并发呼吸道塌陷致窒息继发心搏骤停的急救护理

总结1例复发性多软骨炎并发呼吸道塌陷致窒息继发心搏骤停的急救护理经验。护理要点包括使用双人加压通气手法开放气道,关闭呼吸皮囊减压阀实现有效通气,选择气管切开联合气管插管建立人工气道,落实精细化人工气道管理,心搏骤停时给予团队高质量心肺复苏。患者经上述急救护理后成功建立人工气道,实现有效通气并在心搏骤停后获得自主循环,住院对症支持康复治疗149 d后顺利出院。     

叠加通气模式联合心肺复苏机对心肺脑复苏的影响

心搏骤停(cardiac arrest,CA)是严重的心脏急症,无论心源性还是非心源性,病死率都极高.如何在心肺脑复苏(cardiopulmonary-cerebral resuscita-tion,CPCR)救治过程中提高成功率,成为当今急救医学研究的热点.本研究在CPCR过程中应用Thumper 1007型心肺复苏机(美国密执安仪器公司生产)和PB 760型呼吸机(美国邝公司生产)采用叠加通气模式和Thumper心肺复苏机联用,并与VCV通气模式和徒手标准复苏进行分析比较,现报道如下.     

骨髓腔穿刺建立循环对心搏骤停患者自主循环恢复的影响

在心搏骤停患者的抢救治疗中,快速建立静脉通路并尽早给予复苏药物治疗与患者的复苏成功率密切相关,而且直接影响心肺脑复苏的效果.为了提高抢救的效果,国内外学者在心肺复苏(CPR)的流程、技术方面进行了大量研究.本研究中采用EZ-IO骨髓腔内注射系统经骨髓腔建立静脉通路,观察其对呼吸、心搏骤停患者的复苏效果,并与经锁骨下静脉和外周静脉输液通路复苏进行比较.     

Cardiac arrest – cardiopulmonary resuscitation

ObjectiveTo investigate application of cardiopulmonary resuscitation (CPR) measures within the golden minutes in Europe.MethodsThe material was taken from the University Clinical Center of Kosovo – Emergency Centre in Pristina, during the two (2) year period (2010–2011). The collected date belong to the patients with cardiac arrest have been recorded in the patients' log book protocol at the emergency clinic.ResultsDuring the 2010 to 2011 in the emergency center of the CUCK in Pristina have been treated a total of 269 patients with cardiac arrest, of whom 159 or 59.1% have been treated in 2010, and 110 patients or 40.9% in 2011. Of the 269 patients treated in the emergency centre, 93 or 34.6% have exited lethally in the emergency centre, and 176 or 65.4% have been transferred to other clinics. In the total number of patients with cardiac arrest, males have dominated with 186 cases, or 69.1%. The average age of patients included in the survey was 56.7 year old SD ± 16.0 years. Of the 269 patients with cardiac arrest, defibrillation has been applied for 93 or 34.6% of patients. In the outpatient settings defibrillation has been applied for 3 or 3.2% of patients. Patients were defibrillated with application of one to four shocks. Of 27 cases with who have survived cardiac arrest, none of them have suffered cardiac arrest at home, 3 or 11.1% of them have suffered cardiac arrest on the street, and 24 or 88.9% of them have suffered cardiac arrest in the hospital. 5 out of 27 patients survived have ended with neurological impairment. Cardiac arrest cases were present during all days of the week, but frequently most reported cases have been on Monday with 32.0% of cases, and on Friday with 24.5% of cases.ConclusionsAll survivors from cardiac arrest have received appropriate medical assistance within 10 min from attack, which implies that if cardiac arrest occurs near an institution health care (with an opportunity to provide the emergent health care) the rate of survival is higher.     

移动ICU院内急救模式在呼吸心搏骤停患者抢救中的应用

目的探讨移动ICU院内急救模式在呼吸心搏骤停患者抢救中的应用效果。方法设立移动ICU,基本设施包括必要的抢救设备及足量的抢救药物,并在此基础上提供有急救技术准入的医护人力支援。对临床科室抢救的22例呼吸心搏骤停患者,启动移动ICU协助救治。分析其应用效果。结果移动ICU在（2.5±0.5）min到达急救现场并建立抢救团队。22例患者中,死亡4例（18.18%）,抢救成功12例（54.55%）,转入ICU继续救治6例（27.27%）。未发生一例医疗纠纷。结论移动ICU院内急救模式的建立,提高了住院患者呼吸心搏骤停的救治水平,提高了救治成功率,最大限度地挽救了患者的生命。     

Year in review 2013: Critical Care – out-of-hospital cardiac arrest,traumatic injury,and other emergency care conditions

In this review, we discuss articles published in 2013 contributing to the existing literature on the management of out-of-hospital cardiac arrest and the evaluation and management of several other emergency conditions, including traumatic injury. The utility of intravenous medications, including epinephrine and amiodarone, in the management of cardiac arrest is questioned, as are cardiac arrest termination-of-resuscitation rules. Articles discussing mode of transportation in trauma are evaluated, and novel strategies for outcome prediction in traumatic injury are proposed. Diagnostic strategies, including computerized tomography scan for the diagnosis of smoke inhalation injury and serum biomarkers for the diagnosis of post-cardiac arrest syndrome and acute aortic dissection, are also explored. Although many of the articles discussed raise more questions than they answer, they nevertheless provide ample opportunity for further investigation.     

Year in review 2013: <Emphasis Type="Italic">Critical Care</Emphasis>– out-of-hospital cardiac arrest,traumatic injury,and other emergency care conditions

In this review, we discuss articles published in 2013 contributing to the existing literature on the management of out-of-hospital cardiac arrest and the evaluation and management of several other emergency conditions, including traumatic injury. The utility of intravenous medications, including epinephrine and amiodarone, in the management of cardiac arrest is questioned, as are cardiac arrest termination-of-resuscitation rules. Articles discussing mode of transportation in trauma are evaluated, and novel strategies for outcome prediction in traumatic injury are proposed. Diagnostic strategies, including computerized tomography scan for the diagnosis of smoke inhalation injury and serum biomarkers for the diagnosis of post-cardiac arrest syndrome and acute aortic dissection, are also explored. Although many of the articles discussed raise more questions than they answer, they nevertheless provide ample opportunity for further investigation.     

Acute-onset dysrhythmia heralding fulminant myocarditis and refractory cardiac arrest treated with ED cardiopulmonary bypass and extracorporeal membrane oxygenation

BACKGROUND: The outcome of refractory cardiac arrest is poor. The purpose of this report is to describe two cases presenting with fulminant myocarditis and refractory cardiac arrest treated with emergency department cardiopulmonary bypass (CPB) and extracorporeal membrane oxygenation (ECMO), with subsequent recovery. METHODS: Report of two cases. RESULTS: Two patients presented with a new onset dysrhythmia heralding fulminant myocarditis and cardiac arrest refractory to advanced life support measures. Chest compressions and positive pressure ventilation maintained oxygenation and perfusion until CPB could be initiated in the ED followed by ECMO. Spontaneous cardiac recovery followed, associated with normal neurocognitive function. CONCLUSION: While CPB and ECMO initiation in the ED is a rare event, this could provide patients with cardiac arrest presentations suggestive of myocarditis, additional time for recovery to occur. Clinical factors suggesting a good outcome are witnessed cardiac arrest in a previously healthy child with immediate initiation of effective CPR and good brain perfusion and function as evidence by substantial bodily movement during CPR. Significant dysrhythmias in a previously healthy child may herald substantial deterioration and cardiac arrest.     

A successful emergency thoracotomy performed in the field

An emergency thoracotomy (ET) is a surgical procedure rarely practiced outside a hospital. However, it can be the only way to resuscitate a patient who has suffered cardiac arrest due to penetrating chest trauma. SAMUR-Protección Civil is a two-tier Emergency Medical Service of Madrid, with Advance Life Support teams led by Emergency Physicians, Emergency Nurses and Paramedics. Over the last 3 years, medical teams from SAMUR have performed ET in six cases, after a short period of cardiac arrest, restoring cardiac output in two cases, and one patient with a normal neurological outcome. The following SAMUR protocol describes these emergency situations and details the case of the patient who was treated and discharged from hospital without any repercussions.     

Aetiology of unsuccessful prehospital witnessed cardiac arrest of unclear origin.

OBJECTIVES: To determine, by means of autopsy, the cause of death following unsuccessful cardiopulmonary resuscitation of patients with a witnessed prehospital cardiac arrest of unclear origin. METHOD: Observational study of all prehospital-witnessed cardiac arrest of unclear origin over a period of 19 months in the emergency medical service region of a tertiary care hospital. RESULTS: During the study period, 211 prehospital cardiopulmonary resuscitation attempts were recorded. In 144 study participants, cardiopulmonary resuscitation was not successful: there was no return of spontaneous circulation. Cardiac arrest of traumatic or other clear origin was not considered, nor were paediatric cases. Thirty out of the 114 remaining patients underwent an autopsy (26.3%). The main aetiology of cardiac arrest in this selected population was ischaemic heart disease in 16 out of 30 patients (53.3%) followed by pulmonary embolism in four patients (13.3%) and vascular disease other than coronary disease in two patients (6.7%). Other causes consisted of hypertrophic obstructive cardiomyopathy (one patient) (3.3%) and poisoning (one patient) (3.3%). The cause of death could not be identified in six cardiac arrest victims (20%). CONCLUSIONS: Ischaemic heart disease and pulmonary embolism account for 66.6% of all witnessed cardiac arrest with no return of spontaneous circulation.     

Emergent pediatric thoracotomy following traumatic arrest

Objectives

Emergent thoracotomy is a potentially life-saving procedure following traumatic cardiac arrest. The procedure has been studied extensively in adults, but its role in pediatric traumatic cardiac arrest remains unclear. We aimed to determine the prevalence of survival following emergent resuscitative thoracotomy in children.

Methods

This was a retrospective cohort study that included consecutive patients < 18 years old who underwent emergent thoracotomy following traumatic cardiac arrest over a 15-year period. Factors previously associated with survival following thoracotomy in adults were measured.

Results

During the study period, 29 patients underwent emergent thoracotomy. Of these, 3 (10%, 95% confidence interval [CI]: 2–27%) survived to hospital discharge. All survivors sustained penetrating trauma to the heart and had signs of life on arrival of emergency medical services. Of the 13 patients who sustained blunt trauma, 0 (0%, 95% CI: 0–25%) survived, despite 69% (9/13) demonstrating signs of life on arrival of emergency medical services and 38% (5/13) having temporary return of spontaneous circulation.

Conclusions

Emergent thoracotomy is a potentially life-saving procedure for children following traumatic cardiac arrest. It appears most successful in children suffering penetrating trauma to the heart with signs of life on arrival of emergency medical services. Larger studies are needed to determine the factors associated with this survival benefit for emergent thoracotomy in children.     

环状钢丝电极补救性经胸壁紧急心脏起搏的临床应用

目的 探索一种补救性紧急心脏起搏的有效方法,并评价其临床应用情况.方法 18例住院期间发生心搏骤停或缓慢心率患者,在常规经锁骨下或颈内静脉途径紧急心内膜起搏,但因穿刺静脉未成功或起搏电极未进入右心室,而采取补救性经胸壁环状钢丝紧急心内膜心脏起搏.结果 5例心室起搏未夺获心室;其余13例均可起搏夺获心室,未发生心脏压塞的严重并发症.11例患者有效起搏心脏并抢救成功,其中心脏静止3例,心室纤颤经电击除颤后心脏停搏2例,室性心动过速同步电复律后心脏停搏1例,Ⅱ度或高度房室传导阻滞伴极缓慢交界性逸博4例,高血钾伴极缓慢室性心率1例.8例成功夺获心室者心脏停搏至心脏穿刺时间较5例起搏未成功夺获心室者明显缩短[(17.6±4.6)min比(26.4±5.4)min,P＜0.05].结论 环状钢丝电极经胸壁紧急心内膜心脏起搏是一种安全可靠的心脏紧急起搏方法;有助于迅速建立有效的紧急心脏起搏.当常规经静脉途径心脏起搏不成功时,应果断改用经胸壁钢丝电极紧急心内膜心脏起搏,以提高抢救成功率.