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Notfall + Rettungsmedizin -  相似文献   
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Waveforms of external defibrillators: analysis and energy contribution.   总被引:3,自引:0,他引:3  
BACKGROUND AND OBJECTIVE: Defibrillation is the most important therapy for terminating ventricular fibrillation in cardiac arrest patients. In addition to performing defibrillation at the earliest possible time, appropriate pulse energy and optimal waveform seem to be crucial for success. Emergency medical service personnel use different defibrillators and rely on their similarity of energy content. This study examined the true pulse energy content and waveform of 17 commonly used defibrillators. METHODS AND RESULTS: Defibrillation energies were selected to be 30, 200 or 360 J and defibrillators were discharged into test resistors, simulating transthoracic impedances of 25, 50 or 100 Ohms. Pulse energy deviated by up to +23% or -29% from the selected energy. Pulse energy within the initial 8 ms ranged from 90 to 30% of total pulse energy. Fourteen defibrillators utilising damped sinusoidal waveforms produced a monophasic pulse when discharged into resistances of 50 Ohms and 100 Ohms. CONCLUSIONS: Defibrillators used at the same energy settings do not necessarily produce the same defibrillation pulse energy. All but one defibrillator actually use monophasic waveforms, leaving the potential advantage of biphasic waveforms unused. Energy accuracy of defibrillators needs to be improved, and biphasic waveforms should be used more.  相似文献   
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When comparing the well-established model of the functional organization structure with the model of the process-orientated organization structure, problems are perceived in the effective coordination of all system partners. A lack of communication, documentation and feedback, a large number of unnecessary emergency missions with physicians and undue costs in some areas of the system have a negative effect on motivation, efficient teamwork and satisfaction of staff and patients. Therefore, a restructuring of out-of-hospital emergency medicine towards a process-orientated approach to organization is highly recommended in the context of quality management.  相似文献   
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Ende August 2000 haben die American Heart Association und das European Resuscitation Council gemeinsam die internationalen Richtlinien zur kardiopulmonalen Reanimation (CPR) ver?ffentlicht; das Ergebnis sind CPR-Richtlinien, die gleichzeitig ein umfassendes Nachschlagewerk darstellen. Die Diskussion und erste Entwürfe begann in einer Konferenz in Dallas, Texas/USA im M?rz 1999 sowie danach in einer zweiten Konferenz im September 1999 (jeweils ∼250 Teilnehmer), und schlie?lich einer dritten Konferenz im Februar 2000 (∼500 Teilnehmer). Eine genaue Durchsicht der aktuellen Literatur, Diskussionen, und übereinstimmung erfolgten danach per e-mail, Konferenzschaltungen, Facsimile, und pers?nliche Treffen. W?hrend dem gesamten Prozess waren Wissenschaftler und Wiederbelebungsgesellschaften aus aller Welt beteiligt; wobei Teilnehmer aus den USA etwa 60%, und Teilnehmer von au?erhalb der USA etwa 40% ausmachten. Um ein übergewicht eines Landes oder einer Wiederbelebungsgesellschaft zu vermeiden, wurden alle Themen von jeweils zwei Wissenschaftlern aus den USA und von au?erhalb der USA untersucht und bewertet. Auf diese Weise kann man sagen, dass ?nderungen in den neuen CPR Richtlinien anhand dieses “evidence-based” Konzepts durch Experten aus aller Welt getragen werden. Die wichtigsten ?nderungen der Empfehlungen nach Einsch?tzung der Autoren sind die Abschaffung des Pulschecks für Laien, 500 ml statt 800–1.200 ml Beatmungszugvolumina bei der Maskenbeatmung (FiO2 >0,4) eines Patienten mit ungesichertem Luftweg, Verifizierung einer endotrachealen Intubation durch Kapnometrie und einen ?sophagusdetektor, Einsatz mechanischer Hilfsmittel wie interponierter abdominaler Kompressions-CPR, Westen CPR, aktiver-Kompressions-Dekompresions CPR, und der “inspiratory threshold valve” (ITV) CPR als Alternativen bzw. Erg?nzung zur manuellen Thoraxkompression, die Defibrillation mit <200 Joule biphasischen statt mit 200–360 Joule monophasischen Impulsen, Injektion von Vasopressin (40 Einheiten) und Adrenalin (1 mg) als vergleichbar wirksame Medikamente bei Herzkammerflimmern, Amiodaron (300 mg) bei refrakt?rem Kammerflimmern und pulsloser Kammertachykardie, sowie intraven?se Lyse beim Schlaganfall.  相似文献   
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The new CPR guidelines are based on a scientific consensus which was reached by 281 international experts. Chest compressions (100/min, 4–5 cm deep) should be performed in a ratio of 30:2 with ventilation (tidal volume 500 ml, Ti 1 s, FIO2 if possible 1.0). After a single defibrillation attempt (initially biphasic 150–200 J, monophasic 360 J, subsequently with the respective highest energy), chest compressions are initiated again immediately for 2 min. Endotracheal intubation is the gold standard; other airway devices may be employed as well depending on individual skills. Drug administration routes for adults and children: first choice IV, second choice intraosseous, third choice endobronchial [epinephrine dose 2–3× (adults) or 10× (pediatric patients) higher than IV]. Vasopressors: 1 mg epinephrine every 3–5 min IV. After the third unsuccessful defibrillation attempt amiodarone IV (300 mg); repetition (150 mg) possible. Sodium bicarbonate (1 ml/kg 8.4%) only in excessive hyperkalemia, metabolic acidosis, or intoxication with tricyclic antidepressants. Consider atropine (3 mg) and aminophylline (5 mg/kg). Thrombolysis during spontaneous circulation only in myocardial infarction or massive pulmonary embolism; during CPR only during massive pulmonary embolism. Cardiopulmonary bypass only after cardiac surgery, hypothermia or intoxication. Pediatrics: best improvement in outcome by preventing cardiocirculatory collapse. Alternate chest thumps and chest compression (infants), or abdominal compressions (>1-year-old) in foreign body airway obstruction. Initially five breaths, followed by chest compressions (100/min; ~1/3 of chest diameter): ventilation ratio 15:2. Treatment of potentially reversible causes (4 “Hs”, “HITS”: hypoxia, hypovolemia, hypo- and hyperkaliemia, hypothermia, cardiac tamponade, intoxication, thrombo-embolism, tension pneumothorax). Epinephrine 10 µg/kg IV or intraosseously, or 100 µg (endobronchially) every 3–5 min. Defibrillation (4 J/kg; monophasic oder biphasic) followed by 2 min CPR, then ECG and pulse check. Newborns: inflate the lungs with bag-valve mask ventilation. If heart rate <60/min chest compressions:ventilation ratio 3:1 (120 chest compressions/min). Postresuscitation phase: initiate mild hypothermia [32–34°C for 12–24 h; slow rewarming (<0.5°C/h)]. Prediction of CPR outcome is not possible at the scene; determining neurological outcome within 72 h after cardiac arrest with evoked potentials, biochemical tests and physical examination. Even during low suspicion for an acute coronary syndrome, record a prehospital 12-lead ECG. In parallel to pain therapy, aspirin (160–325 mg PO or IV) and in addition clopidogrel (300 mg PO). As antithrombin, heparin (60 IU/kg, max. 4000 IU) or enoxaparine. In ST-segment elevation myocardial infarction, define reperfusion strategy depending on duration of symptoms until PCI (prevent delay >90 min until PCI). Stroke is an emergency and needs to be treated in a stroke unit. A CT scan is the most important evaluation, MRT may replace a CT scan. After hemorrhage exclusion, thrombolysis within 3 h of symptom onset (0.9 mg/kg rt-PA IV; max 90 mg within 60 min, 10% of the entire dosage as initial bolus, no aspirin, no heparin within the first 24 h). In severe hemorrhagic shock, definite control of bleeding is the most important goal. For successful CPR of trauma patients, a minimal intravascular volume status and management of hypoxia are essential. Aggressive fluid resuscitation, hyperventilation, and excessive ventilation pressure may impair outcome in severe hemorrhagic shock. Despite bad prognosis, CPR in trauma patients may be successful in select cases. Any CPR training is better than nothing; simplification of contents and processes remains important.  相似文献   
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