单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,Company Logo,LOGO,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,单击此处编辑母版标题样式,*,Company Logo,室颤的识别与急救,Ventricular Fibrillation,Emergency Management,1,病例导入,Case Study,一位60岁的女性患者，因,“,胸痛三天,”,诊断为急性广泛前壁心肌梗死,收住CCU，护士巡视病房时,突然间,病人两眼上翻、,呼之无反应，心电监护,显示如图,60y,Female,Main complain:chest pain for three days.,Diagnosis:Acute Myocardial Infarction.,The patient suddenly lose her consciousness during the nurses round check,，,ECG monitor show as bellow:,病人发生了什么情况？该如何处理？,2,学习目标,Learning Objectives,识别室颤的心电图,Distinguish ECG of VF,1,掌握室颤的急救处理,Master Emergency Management of VF,2,掌握除颤技术,Master Defibrillation Technique,3,3,概念,Definition,最严重的心律失常之一,(,most severe arrhythmia,),心室丧失有效的整体收缩能力,(uncoordinated contraction,of ventricle),心肌快而不协调的颤动,(rapid and disorganized,fibrillation),室颤,4,1,室颤,概念,临床表现,Clinical Manifestation,5,1,室颤概念,2,心电图表现,3,临床表现,1.,面色苍白或青紫,Cyanosis,2.,意识丧失,Loss of consciousness,3.,全身抽搐,Convulsion,4.,阿斯综合症,Adams-Stokes Syndrome,5.,呼吸循环骤停,Sudden arrest of Respiration and Circulation,心电图,ECG Manifestation,1.P,和,QRS,波群，,ST,段及,T,波消失,2.,代之以波形、振幅及频率极不规则的,细颤波,3.,频率达到,250-500,次,/,分,6,1,室颤概念,2,心电图表现,In VF,there is no clear P and QRS waves,the waveform amplitude and frequency are disorganized,frequency could be 250-500 beats per minute.,室颤急救处理,Emergency Management,病人呼之不应，,无心跳及呼吸，,心电监护示室颤,即刻,胸外心脏按压，,以,C-A-B,顺序开始,CPR,同时呼叫医生,让另一护士去取除颤仪,立即电击,除颤,床边没有除颤仪,有除颤仪,电击,:,单向波,360J,双相波,200J,马上进行,5,个,CPR,循环,评估节律，必要时再次电击,7,1,室颤概念,2,心电图表现,3,临床表现,4,急救处理,早期除颤,Early Defibrillation,不及时救治，室颤在几分钟内导致猝死,除颤,是终止室颤最为有效的方法,除颤成功的可能性随时间推移而下降,从室颤发作到给予电击的时间,不应超过,3,分钟,8,1,室颤概念,2,心电图表现,3,临床表现,4,急救处理,除颤,Defibrillation,对心脏的电击,electric shock,消除原有的异位心律,let,random action to stop,使心脏转复为窦性心律,Convert heart to,normal sinus rhythm,除颤,9,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,除颤适应症,Indications,1,心室颤动,Ventricular Fibrillation,2,心室扑动,Ventricular,Flutter,3,无脉性室速,Pulseless VT,10,6,除颤适应症,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,除颤三步,3 Main Steps,充 电,charge,选择能量,energy select,放 电,shock,第一步,第二步,第三步,11,7,除颤操作,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,6,除颤适应症,除颤操作,Basic Operation Steps,1.,打开电源,12,7,除颤操作,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,6,除颤适应症,3.,充电,2.,选择合适的能量,4.,生理盐水纱布置于病人胸壁,除颤操作,Basic Operation Steps,13,7,.,提醒大家离床,8.,同时按下放电键,7,除颤操作,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,6,除颤适应症,5.,放置电极板,6.,心电图确认为室颤,电极板位置,Position of Paddles,心尖,部：,Apex,放于左,腋前线,第四肋,间,心底部：,Sternum,放于胸骨右缘第二肋间,两电极板位置距离,10cm,以上,除颤时避开皮肤破溃处，永久,起搏器植入,部位,放电时按压力量：,10kg,心尖部,心底部,14,7,除颤操作,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,6,除颤适应症,除颤后处理,After Defibrillation,恢复窦性心律,-,成功！,心脏一直线：,1.,心脏按压,2.,肾上腺素,1mgiv,3-5min,重复一次,仍为,室颤,1.,继续胸外心脏按压，再次除颤,2.,遵医嘱给药，胺碘酮或利多卡因,15,7,除颤操作,5,除颤概念,2,心电图表现,3,临床表现,4,急救处理,1,室颤概念,6,除颤适应症,8,除颤后处理,总结,Conclusion,Yur Text,Your Text,YourText,室颤心电图,室颤急救处理,除颤技术,P,和,QRS波群,消失，代之以,波形、振幅及频率极不规则,的,细颤波,频率达到250-500次/分,立即以,C-A-B,顺序开始,CPR,，呼叫医生，另一名护士去取除颤仪，除颤仪到位后,立即除颤,1.,选择能量,单相波,360J,双相波,200J,2.,充电,3.,放电,16,课后循证作业,特殊情况下除颤电极板放置部位,？,18,谢谢大家！,Thank you,