1. Cardiopulmonary Resuscitation Chai-yanfen Department of Emergency Medicine, Tianjin Medical University General Hospital

10. History of CPR

11. History of CPR

21. Causes of cardiac arrest cardiac extracardiac Primary lesion of cardiac muscle leading to the progressive decline of contractility, conductivity disorders, mechanical factors all cases accompanied with hypoxia Death concepts

26. Part Ⅰ

28. Early Access Early CPR Early Defibrillation Early Advanced Care Part Ⅰ

31. A victim's chances of survival are reduced by 7 to 10 percent with every minute that passes without defibrillation.

42. Adult Basic Life Support Check responsiveness Call for help Correctly place and open airway Check breathing breathe Assess 10 second only Pulse present Continue rescue breathing No pulse Compress chest Shake and shout Head tilt/chin lift Look,listen and feel 2 effective breatha Signs of a circulation 100per minute 30:2 BLS

48. Positioning the patient supine on a flat, firm surface with arms along the sides of the body, Always be aware of head and spinal cord injuries stabilize the cervical spine by maintaining the head ,neck, and trunk in a straight line

49. 2.A – airway control BLS Part Ⅱ Ensure open airway by preventing the falling back of tongue, tracheal intubation if possible

57. mouth to mouth or mouth to nose respiration ventilation by a face mask and a self-inflating bag with oxygen 2 initial subsequent breaths wait for the end of expiration 10-12 breaths per minute with a volume of app. 800 ml, each breath should take 1,5-2 seconds Algorithm for artificial ventilation Control over the ventilation check chest movements during ventilation check the air return

62. BLS Part Ⅱ ④ Mouth-to-Mask

64. 4.C -Circulation BLS Part Ⅱ Restore the circulation, that is start external cardiac compression-ECC

68. mechanisms explaining the restoration of circulation by external cardiac massage Cardiac pump Thoracic pump

69. Cardiac pump during the cardiac massage Blood pumping is assured by the compression of heart between sternum and spine Between compressions thoracic cage is expanding and heart is filled with blood

72. WRONG 1

73. WRONG 2

87. ALS Part Ⅱ defibrillator

92. Antero-apical position: one paddle is placed to the right of the sternum just below the clavicle.another paddle is placed to the normal cardiac apex . Antero-posterior position : the anterior paddle placed over the apex,and the posterior paddle on the back in the left or right infrascapular （ 肩胛下的 ） region. Proper position of the paddles There two widely accepted positions for the paddles that optimize current delivery to the heart:

93. ALS Part Ⅱ ⑺ Clear the area ,no contact with anyone other than the victim. ⑻ Recheck the ECG ⑼ Activate the firing button. ⑽ If no skeletal muscle twitch or spasm has occurred ， you should check the equipment ， contacts ， and synchronizer switch Procedure of Electrical defibrillation ⑾ The rhythm should be assessed after each countershock and the patient should be checked for a pulse at appropriate time. ⑿ If unsuccessful,,repeat steps 4~11.

96. 5. Venous access ALS Part Ⅱ To establish a reliable intravenous route is an essential part of ALS ， this allow administration of necessary drugs and fluids during the CPR .

98. Peripherial veins

107. ① Epinephrine ALS Part Ⅱ . Actions: Epinephrine can stimulate peripheral α-adrenergic receptor and cardial β adrenergic receptor ， increases resistance in non-cerebral and non-coronary arteries,result in decreased blood flow to non-cerebral and non coronary vessels.in creased aortic blood pressure and increased perfusion of heart and brain vessel .

115. Actions: Magnesiun is an essential electrolyte that may be depleted by duretics,severe diarrhoae and alcohol abuse.Hypomagnesaemia may cause cardiac dysrhythmias . Indication ： Magnesium may be considered in refractory VF/VT,particularly hypokalaemia is present,and is an agent of choice in torsaded de pointes. Dose: The initial dose is 5mmol given over1 minute, which may be repeated if indicated and followed by an infusion of 20 mmol over 4 hours . ⑤ Magnesium Sulfate

127. ● Complication of defibrillaton Skin burns (common) Skeletal muscle injury or thoracic vertebral fractures (uncommon) Myocadial injury and post-defibrillation dysrhythmias (high-energy shocks) The rescuer can receve electrical injures(due to electrical contact with the patients during defbrillation The complication of CPR

130. Part Ⅳ Monitoring during CPR