14. 12. 基本救命術及早期去顫:
Figure 1. The Chain of Survival. The Chain of Survival consists of 4 links or actions:
early access, early CPR, early defibrillation, and early advanced care.
19. 找胸部按壓的方法:
教一般民眾時,可用下面之陳述“胸部之正中央,在兩乳頭之間”,使其了解胸部按壓之部
位。
Figure 21. Positioning the rescuer’s hands on the
lower half of the sternum. The rescuer should (A)
locate the margin of the rib using first and second
finger of the hand closer to the victim’s feet, (B) follow
the rib margin to the base of the sternum (xiphoid
process) and place his or her hand above the fingers
(on the lower half of the sternum), and (C) place the
other hand directly over the hand on the sternum.
Figure 22. Position of the
rescuer during compressions
22. Figure 6. Check for unresponsiveness and EMS
activation. The rescuer should tap the victim’s
shoulder and shout "Are you all right?" If the
victim does not respond, the rescuer directs
someone to activate the emergency medical
response system (telephone 911 or appropriate
emergency telephone number).
Figure 7. Obstruction by the tongue and
epiglottis. When a victim is unconscious, the
tongue and epiglottis can block the upper
airway. The head tilt–chin lift opens the airway
by lifting the tongue and epiglottis.
Figure 8. Head tilt–chin lift.
This maneuver lifts the
tongue to relieve airway
obstruction.
23. Figure 9. Jaw thrust without head tilt.
The jaw is lifted without tilting the head.
This is the airway maneuver of choice
for a victim suspected of having
sustained a cervical spine injury.
Figure 10. The recovery position.
1.The victim should be in as near a true lateral position as possible, with the
head dependent to allow free drainage of fluid.
2.The position should be stable.
3.Avoid any pressure on the chest that impairs breathing.
4.It should be possible to turn the victim on his or her side and to return to
the back easily and safely, with concern for a possible cervical spine injury.
5.Good observation of and access to the airway should be possible.
6.The position itself should not cause an injury to the victim.
25. Figure 13. Mouth-to-stoma
rescue breathing. A, Stoma; B,
mouth-to-stoma
Figure 14. Face shield. The shield is placed over
the mouth and nose with the opening at the center
of the shield placed over the victim’s mouth. The
technique of rescue breathing is the same as for
mouth-to-mouth.
26. Figure 15. Mouth-to-mask, cephalic
technique. A, Using thumb and thenar
eminence on the top of the mask. B,
Circling the thumb and first finger
around the top of the mask.
Figure 16. Mouth-to-mask, lateral technique.
The lateral technique allows the rescuer to
perform 1-rescuer CPR from a fixed position
at the side of the victim.
27. Figure 17. Two-rescuer use of the bag
mask. The rescuer at the head uses the
thumb and first finger of each hand to
provide a complete seal around the
edges of the mask. Use the remaining
fingers to lift the mandible and extend the
neck while observing chest rise. The
other rescuer slowly squeezes the bag
(over 2 seconds) until he observes chest
rise
Figure 18. One-rescuer use of the bag
mask. The rescuer circles the top edges of
the mask with her index and first finger and
lifts the jaw with the remaining fingers. The
bag is squeezed while the rescuer observes
chest rise. Mask seal is key to the
successful use of the bag mask.
28. Figure 19. Cricoid pressure (Sellick
maneuver).
Figure 20. Checking the carotid
pulse. A, Locate the trachea. B,
Gently feel for the carotid pulse.
29. Figure 21. Positioning the rescuer’s hands on the lower half of the sternum. The
rescuer should (A) locate the margin of the rib using first and second finger of the
hand closer to the victim’s feet, (B) follow the rib margin to the base of the sternum
(xiphoid process) and place his or her hand above the fingers (on the lower half of
the sternum), and (C) place the other hand directly over the hand on the sternum.
30. How to Read an EKG Strip
EKG paper is a grid where time is
measured along the horizontal axis.
Each small square is 1 mm in
length and represents 0.04 seconds.
Each larger square is 5 mm in
length and represents 0.2 seconds.
Voltage is measured along the vertical axis
10 mm is equal to 1mV in voltage.
The diagram below illustrates the
configuration of EKG graph paper and
where to measure the components of the
EKG wave formHeart rate can be easily calculated
from the EKG strip:
When the rhythm is regular, the heart rate is 300 divided by the number of large squares.
between the QRS complexes
For example, if there are 4 large squares between regular QRS complexes, the heart
rate is 75 (300/4=75).
The second method can be used with an irregular rhythm to estimate the rate. Count the
number of R waves in a 6 second strip and multiply by 10.
For example, if there are 7 R waves in a 6 second strip, the heart rate is 70 (7x10=70).
31. normal sinus rhythm
oeach P wave is followed by a QRS
oP waves normal for the subject
oP wave rate 60 - 100 bpm with <10% variation
rate <60 = sinus bradycardia
rate >100 = sinus tachycardia
variation >10% = sinus arrhythmia
normal QRS axis
normal P waves
oheight < 2.5 mm in lead II
owidth < 0.11 s in lead II
for abnormal P waves see right atrial hypertrophy, left atrial hypertrophy, atrial premature beat, hyperkalaemia
normal PR interval
o0.12 to 0.20 s (3 - 5 small squares)
for short PR segment consider Wolff-Parkinson-White syndrome or Lown-Ganong-Levine syndrome (other causes - Duchenne
muscular dystrophy, type II glycogen storage disease (Pompe's), HOCM)
for long PR interval see first degree heart block and 'trifasicular' block
normal QRS complex
o< 0.12 s duration (3 small squares)
for abnormally wide QRS consider right or left bundle branch block, ventricular rhythm, hyperkalaemia, etc.
ono pathological Q waves
ono evidence of left or right ventricular hypertrophy
normal QT interval
oCalculate the corrected QT interval (QTc) by dividing the QT interval by the square root of the preceeding R - R interval. Normal = 0.42
s.
oCauses of long QT interval
myocardial infarction, myocarditis, diffuse myocardial disease
hypocalcaemia, hypothyrodism
subarachnoid haemorrhage, intracerebral haemorrhage
drugs (e.g. sotalol, amiodarone)
hereditary
Romano Ward syndrome (autosomal dominant)
32. Jervill + Lange Nielson syndrome (autosomal recessive) associated with
sensorineural deafness
normal ST segment
ono elevation or depression
causes of elevation include acute MI (e.g. anterior, inferior), left bundle branch block,
normal variants (e.g. athletic heart, Edeiken pattern, high-take off), acute pericarditis
causes of depression include myocardial ischaemia, digoxin effect, ventricular
hypertrophy, acute posterior MI, pulmonary embolus, left bundle branch block
normal T wave
causes of tall T waves include hyperkalaemia, hyperacute myocardial infarction and
left bundle branch block
causes of small, flattened or inverted T waves are numerous and include ischaemia,
age, race, hyperventilation, anxiety, drinking iced water, LVH, drugs (e.g. digoxin),
pericarditis, PE, intraventricular conduction delay (e.g. RBBB)and electrolyte
disturbance.
normal U wave
33. 無脈性VT/VF
無脈性心律___PEA
心跳停止無收縮__Asystole
心搏過慢
心搏過速—總論
Atrial fibrillation or flutter
Stable narrow-complex SVT
穩定型心搏過速
Wide complex tachycardia, type unknown, stable
同步心臟整流__ Synchronized Cardioversion
急性胸痛
Acute coronary syndrome
Non-Q MI and Unstable Angina
急性肺水腫、低血壓、休克
Hypothermia
Submersion Injuries
Stroke
34.
35. Different energy to use
Adult Defibrillation
Biphase (150j-150j-150j)
Monophase(200j-300j-360j)
Cardioversion of Atrial Fibrillation
Biphase(100j-150j-200j-200j)
Monophase(100j-150j-200j-360j)
Pediatric Defibrillation
Biphase (2~4j/kgw)
Monophase(4j/kgw)
40. Atrial rate = 250-350 bpm; ventricular response usually ~ 75, 150, or 300 bpm
• Atrial beats are regular.
• Ventricular beats are also usually regular but you may see a variable block, beca
the junctional area blocks some beats.
41. • PSVT rhythms start and stop suddenly in comparison to sinus
tachycardia, which begins and ends gradually.
• PSVT is also differentiated from sinus tachycardia by altered
configuration of the P waves.
• PSVT is supported by either an AV nodal reentry circuit (AV nodal
reentry tachycardia — AVNRT) or an AV reentry circuit using the
AV node and an accessory pathway (circus movement
tachycardia — CMT). Rate 170-250 bpm.
• A supraventricular rhythm resulting from a focus in or near the
AV junction.
• Rate ranges from 60 to 100 bpm.
• An abnormal rhythm that can result from digitalis toxicity,
particularly when it occurs in combination with atrial fibrillation.
• Can also result from physiologic stress and other causes of
increased sympathetic nervous system tone.
42. Due to increased automaticity of the SA node.
Rate is 100-180 beats per minute (bpm). Differs from NSR only in that
the rate is >100 bpm.
(Some books say > 90 bpm = tachycardia.)
Rhythm regular.
PR interval normal.
One QRS for each P.
Onset and termination of the rhythm is gradual and regular, but may
vary from minute to minute.
Not paroxysmal; it doesn't start and stop abruptly except for a rare
type called sinus nodal reentrant tachycardia.
Almost always a secondary arrhythmia so the underlying cause should
be determined and treated if necessary
43. Different energy to use
Adult Defibrillation
Biphase (150j-150j-150j)
Monophase(200j-300j-360j)
Cardioversion of Atrial Fibrillation
Biphase(100j-150j-200j-200j)
Monophase(100j-150j-200j-360j)
Pediatric Defibrillation
Biphase (2~4j/kgw)
Monophase(4j/kgw)