2010新版ACLS简介
1 國軍松山總醫院家庭醫學科 總住院醫師
2 國軍松山總醫院家庭醫學科 主治醫師 : ACLS, CPR, 2010
[4 ] 2 [5 ])
1? 2 2005 AHA CPR ECC
3.
4.
5.
( ) 30:2 ( 100 / )
6 8
( 8 10 )
新版BLS (basic life support)流程步驟：叫叫C-A-B-D
BLS A-B-C C-A-B(C C h e s t compressions A Airway B Breathing )
2010 ACLS
1 2前言
2005 (American
Heart Association, AHA) (CPR) (ECC)
2010
AHA CPR ECC
CPR
2010 CPR ACLS
CPR
新版ACLS強調高品質CPR的重要性
1. 100 / (
100 / )
2. 2 ( 5
)
( 1.5
醫學新
知
(VF) (pulseless VT) BLS (D:Defibrillation ) A-B-C
30 2 100 2 5 ( CPR )
新版BLS將施救者區分為經訓練(專業)者與非經訓練者
BLS - -C - - AED/ C- C P R (Hands-Only CPR) AED ( BLS 1)
BLS - -C-A-B - 1 BLS
資料來源：參考資料1
( ) - AED/ C-10 ( 30 100 5 ) A- B- 2 6-8 ( 8-10 ) ( ) ( BLS 1)
醫學新
知
電擊治療
2010 AHA CPR ECC CPR
(A E D ) 1. AED 2. ( )
1 BLS
*
縮寫：AED (Automated External Defibrillator，自動體外去顫器)；AP (anterior-posterior，前方-後方)；CPR (cardiopulmonary resuscitation，心肺復甦)；HCP (healthcare provider，醫護人員)*除新生兒之外，此類嬰兒的心臟停止病因幾乎全為窒息性。資料來源：參考資料1
醫學新
知
AED 3. AED ( 3 ) 4. AED 5. 1 CPR 3 6. 120-200 ( ) 360 7. 2 / 4 / 10 / or 8. - - - - pacemaker pacemaker
2
高級心臟救命術(ACLS)重要問題和主要更動摘要(ACLS環行流程如圖2)
1.
(partial pressure of end-tidal CO2, PETCO2) CPR (ROSC) CO2 ROSC ( ) PETCO2 ROSC PETCO2 ROSC PETCO2 ( 3A 3B)
2. 3-5 epinephrine IV/IO 1mg vasopressin IV/IO 40
2
資料來源：參考資料2
醫學新
知
epinephrine amiodarone IV/IO 300mg 150mg atropine (PEA)/ ACLS
3. (P E A ) 5H 5T 5H (hypovolemia) (hypoxia) ( )(h y d r o g e n i o n /acid osis) (h yp er-/
hypokalemia) (hypothermia)CPR品質
? ( 2 [5 ]) ( 100 / ) ? ?
? 2
? 30:2 ?
– PETCO2 10 CPR ?
– ( ) 20 CPR
自發性循環恢復 (ROSC)?
? PETCO2 ( 40mmHg)? 電擊能量
? (120-200 )
? 360 藥物治療
? Epinephrine IV/IO 3-5 1mg
? Vasopressin IV/IO 40
? Amiodarone IV/IO 300mg 150mg 高級呼吸道
?
? ? 8-10 可逆因素
– – – – – ( ) – – / – –
–
2 ACLS
資料來源：參考資料1
IWIO
3-5 VF/VT
醫學新
知
5T (t e n s i o n pneumothorax) (tamponade, c a r d i a c) (t o x i n s) (thrombosis, pulmonary) (thrombosis, coronary) 2005 (hypoglycemia) (trauma)
4. CPR 5
100 /
2
30:2 CPR
(partial pressure of end-tidal CO2, PETCO2) 10mmH g (D B P) 20mmHg CPR 5. (r e t u r n
of spontaneous circulation, ROSC (VF)/ (asystole) SBP>60mmHg
20 )
2010
AHA CPR ECC
3
醫學新
知
( [PCI] ) ( ) 6. (ROSC) (FiO2) (SaO2) 94-99%
ACLS對急性冠狀動脈症候群(acute coronary syndrome, ACS)的處理建議
1. S T (ST-segment elevation myocardial
infarction, STEMI) EMS(Emergency Medical Service) ACS(acute coronary syndrome) EMS ACS
2. 12 (ECG) EMS ( )
3.
(p e r c u t a n e o u s c o r o n a r y interventions, PCI)
4. STEMI(ST-segment elevation myocardial infarction) ACS
5. ( ) 1. (SaO2) 94% 2. N T G S T E M I STEMI(unstable angina/NSTEMI) 結語
AHA ECC CPR ( C-A-B) 1. 2. CPR 3. 4. 5.
2010 ACLS CPR( ) AED ACLS Mega code ( Mega Code
醫學新
知
ACLS ) A C L S
參考資料
1. Field JM, Hazinski MF, Sayre M, et al: Executive Summary of 2010 AHA Guidelines for CPR and ECC. Circulation. In press.
2. Hazinski MF, Nolan JP, Billi JE, et al: Executive Summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. In press.
3. Kouwenhoven WB, Jude JR, Knickerbocker GG: Closed-chest cardiac massage. JAMA 1960; 173: 1064-7.
4. Kilgannon JH, Jones AE, Shapiro NI, et al: Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 2010; 303: 2165-71.