New progress of cardiopulmonary resuscitation

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Cardiopulmonary resuscitation (resuscitation science) is a science that studies the epidemiology, pathophysiology, pathogenesis, and first a


Cardiopulmonary resuscitation (resuscitation science) is a science that studies the epidemiology, pathophysiology, pathogenesis, and first aid treatment of the pathological state of the sudden cessation or cessation of oxygen transport in the body. The pathological state of heart, lung and brain, which is an important subject in the field of critical illness, especially emphasizes the mechanism and the experimental and clinical study of systemic hypoxia. This clinical condition is usually not an omen, the impact of the population from the baby to the elderly, with high morbidity, high mortality and low acceptance of family characteristics [1]. It is reported that the incidence of sudden cardiac death outside the hospital, 100 thousand people were 36~128, of whom 34%~86% patients received cardiopulmonary resuscitation (CPR), restore the autonomous cycle and served the hospital accounted for 17%~49%. In the patients who were hospitalized after resuscitation, the patients who survived and had good neurological function only accounted for 11%~48%[2]. How to improve the success rate of out patient care is a severe challenge. Emergency cardiovascular care is a measure to deal with emergencies of cardiovascular, cerebrovascular and respiratory systems. The ultimate goal is to achieve the best outcomes for all patients.

Keywords cardiopulmonary resuscitation new development

1 judgment should be based on Jane, early start EMSS, emphasis on emergency life chain

Rapid and accurate determination of respiratory and cardiac arrest, the rapid implementation of CPR, plays a decisive role in the success of resuscitation. The main criteria for determining whether there is breathing and consciousness, carotid pulse only for professionals. Methods: to judge whether or not to sense by shaking the shoulder and calling; using the "three L" (Look) - to see if the chest had any ups and downs; listen - to listen to the sound of breathing gas; feel - to feel the breath stream) to determine whether or not to breathe. Resuscitation should be performed if the patient is unconscious, respiratory, and carotid pulse disappears. EMSS quick start, fast help, fast CPR, fast rapid defibrillation, senior cardiac resuscitation (ACLS). These 4 links chain chain, lack of first aid and survival opportunities. According to reports, the implementation of 4min in CPR, 8min implementation of ACLS, the survival rate was 43%; if 8~12min was CPR, 8~16min do ACLS, the survival rate was 6%; over the above time, the survival rate was [3].

2 correct selection of several artificial ventilation methods

Mouth to mouth resuscitation is the first choice for the rescue of unarmed, such as the use of breathing equipment as soon as possible, in order to strengthen self-protection, to ensure ventilation and oxygen supply.

2.1 "S" type of oropharyngeal blow pipe use

2.2 bag mask positive pressure breathing

Methods 2.3 artificial ventilation endotracheal intubation mechanical ventilation in hospital [4] is the fastest, most effective and reliable, once found in patients with respiratory and cardiac arrest, or patients with weak breathing was nodding like breathing, tracheal intubation should act decisively. Tracheal intubation is not only an important step of CPR, but also an important link to improve the survival rate of [5] (CPR). To ensure ventilation and inhalation of high concentrations of oxygen, convenient suction, delivery from the trachea way in the channel has not been established, which can accurately control the amount of moisture, prevent aspiration pneumonia [6].

2.4 laryngeal mask (LMA) using [7] in the treatment of difficult airway is superior to mask and tracheal intubation, especially for neck too short, body weight, cervical spine injuries, ankylosing spondylitis.

2.5 on the airway foreign body obstruction (FBAO) treated by [8] artificial airway and breathing, still not seen in patients with pulmonary or thoracic expansion of ups and downs, they are considered FBAO, can adopt the supine abdominal impact method (Heimlich method), the diaphragm elevation, airway pressure suddenly increased, the gas discharged from the lungs, the the pressure is to produce the artificial cough the foreign body rushed out from the trachea. Methods: the patients were supine position, kneeling in the patients who take one side or ride on the hip, one hand clenched on patients with abdomen umbilical line above the xiphoid, the other hand on the hand, hands and force in the abdomen fast stamping, stamping direction cephalad, continuous exact.

3 external chest compression maintenance cycle

3.1 CPR press to fast and powerful effect, therefore, rhythm and continuous chest compressions effectively is crucial, with a frequency of 100 beats / min. Chest compressions and artificial ventilation can be used to provide oxygenated blood to the brain and vital organs. The pressure / ventilation ratio is 30/2[9] and 5/1[3,8].

3.2 ACD/ITD CPR was superior to standard CPR[2] in improving the status of low perfusion during resuscitation and improving short-term survival rate. ACD-CPR is the use of a special sucker with the heart of the pump, when the pressure is relaxed, the suction cup can take the initiative to extract the chest wall, reducing intrathoracic pressure to increase venous return. ITD is an air suction valve device to prevent inhalation of air flow in the lifting phase, in order to increase the negative pressure generated by chest wall reduction, enhance the effect of CPR. ITD can be installed in the breathing circuit, located between the mask or endotracheal intubation and gas; indicator lights to guide the rescue when given ventilation helps prevent hyperventilation.

3.3 chest compressions and chest compressions may have an effect on the recovery, so chest compressions can improve survival. The experiment proved that chest compressions 15 times 2 blowing mouth, can cause hyperventilation, and hyperventilation can cause nervous system damage, the chest is not completely relaxed, the recovery of adverse. In order to reduce the excessive ventilation, don't interrupt chest compressions, through the discussion of the 2005 International cardiopulmonary resuscitation and emergency cardiovascular care guidelines meeting of experts agreed that in CPR when the chest compression and ventilation than from the past 15:2 to 30:2, while the baby is 15:2[10].

4 - early cardioversion defibrillation

4.1 although the gold order in CPR is A-B-C-D, the cause of most of the sudden death of non trauma in adults is ventricular fibrillation, which should be D in the first place. Has confirmed that each delayed defibrillation recovery 1min, the success rate of decline of 7%~10%[11]. According to Zhang Xiaoxue and Zheng Hua [12] Research Report in the implementation of CPR short-term expert ED, its 10min, 30min, more than 30min rescue success rate was 29.2%, 17.6%, 6.5%, which fully demonstrates the importance of early ED.

4.2 precordial percussion cardioversion, defibrillation equipment or ventricular fibrillation and fall witnessed the scene, can knock 1 times. Methods: Patients with left hand on the press position, the right hand fist 25cm knock down of the left back.

4.3 external defibrillation in pre hospital emergency first time success rate is up to 94% 1min AED in the process of using, if ECG monitoring identified as sustained rapid ventricular fibrillation or ventricular tachycardia, immediate defibrillation. Because of improper CPR may delay the time to defibrillation loss of chance, reduce the success rate of CPR. With the defibrillation success rate, the effect was better than the original single wave defibrillation, 3 consecutive defibrillation spend 100s time stop continuous compressions, the 2005 International Conference experts strongly recommend 3 consecutive single defibrillation to only 1 dual phase wave shocks, with the energy, adult ventricular fibrillation than epinephrine effect, VP constricts blood vessels, increase coronary perfusion pressure, increase cerebral oxygen supply and oxygen consumption did not increase [16] myocardial, VP is considered to be the substitute of [17] epinephrine. Sodium bicarbonate only after effective ventilation was established as the case application (severe acid, generation cycle stop time >10 minutes). As a result of stress hyperglycemia may occur in the recovery, the vein does not give sugar containing liquid.

7 choice of route of administration

The routes of administration in CPR include intravenous administration and endotracheal administration. It is safe, convenient and quick to use, and the superior vena cava system is [18]. First of all, the central vein or external jugular vein, followed by the elbow joint or above vein, should not use the dorsal hand dorsal vein. In special cases, such as upper limb injury or burns to choose the lower limb vein, should be elevated to the body of the drug, the rapid return of favorable drugs. In order to control the rate of infusion or incompatibility of some drugs, it is best to set up more than 2 venous passages. Tracheal delivery in the absence of appropriate channels when it is advisable to use the dosage is 2~2.5 times the intravenous drug [19], commonly used drugs for epinephrine, atropine, lidocaine, etc.. The drug should be diluted to 10ml, by the endotracheal tube immediately into the breathing sac or breathing machine, so that the drug as soon as possible to reach the alveolar pulmonary circulation.

8 interval of vasoactive drugs

We have previously accepted the recommended interval from the American Heart Association for 5 minutes. According to the determination of the circulating time of human chest cardiac compression in recent years, it is reasonable to find that the interval of vasoactive drugs should be shortened to 2~3 minutes ([20]).

9 after cardiopulmonary resuscitation treatment

9.1 first of all, we should check whether there is any complications caused by chest compressions, and give timely treatment.

9.2 to further understand and identify the cause or cause of cardiac arrest.

9.3 to deal with the common problems of recovery syndrome, arrhythmia, hypotension, shock, cerebral hypoxia and acid-base balance, electrolyte imbalance and other [21].

9.4 intensive care for the purpose of brain resuscitation. Stop breathing for clinical cardiac arrest and death, but death is not equal to the clinical biological death, advanced national death ended life to do the brain, and the situation of our country is not a simple copy, must do a thorough and meticulous work.

9.5 open the ureter catheter, observe the change of urine volume, record the amount of 24 hours. Pay attention to whether there is renal insufficiency, and maintain water, electrolyte and acid-base balance, generally based on hemodynamic and blood gas analysis data in a timely manner to adjust.

10 to prevent iatrogenic infection before hospital [22]

CPR treatment in patients with invasive ductal more, such as tracheal intubation, venous catheter, catheter, central venous catheter, drainage tube, suction, low temperature treatment, in patients with critical illness, their resistance and protection ability, can occur at any time the risk of infection, it will make the condition worse, bring great difficulties to the treatment and nursing work. Therefore. The operation must be strictly aseptic operation, to strengthen the prevention of infection, cut off all means of transmission.

In the extensive use of CPR30 after more than a year to review its efficacy, although both the survival rate or the quality of life of its effect on a small number of people, but can save the patient's life is understandable. With the development of emergency medicine and the emergence of new technology and equipment, the traditional CPR processing methods are constantly updated. The cardiac arrest patients need for effective rescue of the "golden opportunity", we should constantly update their knowledge, training quality, training ability, able to do instant judgment for cardiac arrest patients, not rigidly adhere to a fixed rescue way, due to people due to injury and appropriate, comprehensive analysis, decisive decision-making, selection of different CPR schemes in different situations. A person with the right technology and concept, the treatment of cardiac arrest patients have a great impact, bold use of new methods can successfully improve the survival rate of CPR treatment. Cardiopulmonary resuscitation was performed in patients with standardized procedures and high frequency chest compressions, as well as shortening the interval.


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