CPR

Due to some temporary causes, the heart suddenly stops beating or ventricular fibrillation, so that blood circulation cannot be maintained, especially the blood supply to the central nervous system. Correct and positive resuscitation should be performed immediately, otherwise the patient will be in the short term due to the whole body. Death due to lack of oxygen. Treating diseases: heart disease Indication Due to some temporary causes, the heart suddenly stops beating or ventricular fibrillation, so that blood circulation cannot be maintained, especially the blood supply to the central nervous system. Correct and positive resuscitation should be performed immediately, otherwise the patient will be in the short term due to the whole body. Death due to lack of oxygen. Surgical procedure Cardiopulmonary resuscitation: After the heartbeat and breathing stop, artificial respiration and heart compression must begin immediately. The simplest artificial respiration is a rhythmic blow from mouth to mouth. When blowing, you can use your hand to pinch the nostrils. If you have the conditions, while maintaining the mouth-to-mouth insufflation, quickly prepare the endotracheal tube and connect it to the anesthesia machine or ventilator to enable inhalation of oxygen and carbon dioxide. Cardiac compression is divided into chest compression and chest compression. In the past, more chest compressions were performed. In recent years, most of the chest compressions were first used. Only open chest compressions should be used when the chest compressions do not improve. In the case of severe trauma to the chest, in the event of cardiac arrest, chest compressions should be performed to relieve possible intrathoracic injuries. In the case of cardiac arrest during a thoracotomy, intrathoracic compression can be performed immediately. When a stroke occurs during an open surgery, the transverse diaphragm is immediately cut for intrathoracic heart compression. First, chest compressions: Place the patient on the hard bed or on the ground, the head should not be higher than the heart level, in order to increase the blood flow in the brain when pressing, and raise the lower limbs by 15°, which is beneficial to the venous return of the lower extremities to increase the blood output of the heart. The first-aider is standing on the left side of the patient. The right hand and the middle finger are close together and the right rib edge touches the junction with the sternum. The longitudinal axis of the left palm is parallel to the sternum body in the lower half of the sternum, and the right hand is pressed on the left hand. The first-aid person straightens his arm and uses the upper body strength to press the lower part of the sternum in a rhythmic manner toward the spine. This action can make the sternum collapse down 3.8 ~ 5.0cm, so that the heart receives pressure, venting the blood inside the hollow. When the compression is relaxed, the sternum is restored to the original position by the elasticity of the ribs and costal cartilage on both sides, and the heart is simultaneously relieved, and the negative pressure in the chest is increased, and the venous blood can be returned to the atrium to fill the ventricle. The number of extrusions should be maintained at 80 to 100 times per minute, and the ratio to artificial respiration is 5:1. When the squeezing is too fast, the venous blood is too late to fill the heart and is squeezed out, but the effect of maintaining the circulation is not achieved. Children's chest wall is soft and the activity is greater. The crushing force should be appropriately reduced. Only one palm or even a few fingers can be used, but the number of extrusions per minute can be increased to 100 times. When the compression is effective, the carotid or femoral artery should be able to touch the pulsation when squeezed, the patient's face is improved, the pupil is narrowed, the blood pressure is heard again, and even spontaneous breathing is resumed. As long as the compression is effective, the chest compression should be continued and the intracardiac drug injection (see open chest compression). If there is ventricular fibrillation, it can be removed with a defibrillator (referred to as defibrillation). After the two electrode plates are coated with conductive paste (or saline gauze wrap), they are pressed tightly in the anterior region of the anterior and posterior thoracic regions, and defibrillated with a DC shock of 100-360 watts (Joules). The posterior chest plate can sometimes be placed on the upper part of the sternum. (2) The electrode is placed at the apex and upper sternum: If you can feel the heart beat, it means that the heart has re-jumped, you can stop pressing; if you do not see the effect, you should use the open chest heart compression in time. Second, open chest heart compression: The patient is lying on his back. In order to gain time, the skin can be simply disinfected or not disinfected, and then refilled and sterilized after the heart has jumped. From the left edge of the sternum to the anterior line of the iliac crest, the chest wall is cut into the chest along the fifth intercostal space (because the heart has stopped, the blood vessel is not bleeding, and there is no need to stop bleeding), immediately put the hand into the incision for cardiac compression; Automatic hook to open the incision. If the exposure is poor, the fifth costal cartilage can be cut and the incision can be enlarged. There are three ways to press: 1. One-handed presses stand on the left side of the patient, the right hand holds the heart, the thumb and big fish are placed on the front side of the right ventricle, and the other 4 fingers are placed flat on the back side of the left ventricle. Note that the contact surface between the finger and the heart should be as large as possible, avoiding the use of fingertips to squeeze, to reduce damage to the heart muscle, and even perforation. The heart should be twisted when squeezed, the force should be uniform and rhythmic, and the frequency is 60-80 times per minute. The squeezing action should be slower and should be fast when relaxing to facilitate blood filling. The left hand can be used when the right hand is tired. 2. One-handed pressing to the sternum man's right thumb is firmly fixed in front of the incision, ie on the sternum, and the remaining 4 fingers are placed behind the left ventricle, pressing the heart against the mediastinum of the sternum and pushing it rhythmically. When pressed, the conduction of force is the right palm finger left ventricular wall ventricular septum right ventricular wall sternum. The force equivalent to the two faces is evenly pressed against the interventricular septum. The frequency of compression is 60 to 80 times per minute for adults. Be careful not to press the atrium when pressing, do not shift the heart to reverse, and do not apply force to the point of the heart. Every time you press it, you should quickly relax and let the vena cava blood flow back into the atrium and ventricle. 3. Press your hands with your right hand behind your heart, your left hand in front of your heart, and press and relax with your hands rhythmically. This method is suitable for pressing a larger heart. Do not cut the happy bag when the heart is pressed, which is beneficial to gain time and reduce the damage of the myocardium; however, the mediastinal pleura can be separated on the anterior side of the heart to make the compression more effective. If the external compression of the pericardium does not cause the heart to re-jump, or if there is ventricular fibrillation, if the defibrillation fails, the heart should be cut in front of the sacral nerve and directly press the heart. If the compression is effective, the myocardial tension is gradually enhanced, and the soft, enlarged heart becomes harder and smaller, and the color of the myocardium changes from dark red to bright red. In the case of ventricular fibrillation, the fine vibration of the muscle fibers can be gradually thickened, and finally the heartbeat is automatically restored. In addition, as with chest compressions, the complexion is improved, the pupils are reduced, the breathing is restored, and the aorta is struck and the blood pressure is heard. If ventricular fibrillation does not recapture on its own, it should be defibrillated by electric shock. Before defibrillation, it should be pressed first to improve myocardial hypoxia, strengthen myocardial tension, and make the tremor wave change from fine tremor to thick tremor. Apply defibrillation if necessary. First, the adrenaline 1mg intravenous bolus method was used to make the tremor wave from fine to thick, and then defibrillated with 2% lidocaine 1~2mg/kg intravenous bolus. If lidocaine is not effective, bromobenzylamine and an appropriate amount of 5% sodium bicarbonate can be used. At present, it is considered that the main route of administration is safe and reliable, and the drug is the first choice. The vein above the diaphragm is preferred, and the intratracheal administration is the second choice. Immediately after intratracheal administration, positive pressure ventilation is performed to allow the drug to diffuse to the bronchus on both sides, and the capillaries of the bronchial mucosa are absorbed into the left heart. Intracardiac injection pathway is easy to cause myocardial and endocardial damage. In recent years, experimental studies have suggested that the optimal dose of adrenaline in cardiac resuscitation is 2.1 to 14.0 mg, which can significantly increase the perfusion blood flow of coronary arteries. However, it should be noted that such a large dose is also a dose of adrenaline toxic reaction, which may cause myocardial cell contraction and necrosis, damage the heart muscle and blood vessels, and produce chest and abdominal pain, transient hypertension and pulmonary edema after resuscitation. It can also inject 10% calcium gluconate or 3 to 5% calcium chloride 10ml to increase myocardial tension. Two pieces of electrode plates moistened with saline (or wrapped in saline gauze) were then placed against the left and right ventricular walls, respectively, and defibrillated with a 5 to 90 watt-second (Joule) DC electric shock [Fig. 4]. When an electric shock is ineffective, continue to press, and repeatedly inject the adrenaline-like drugs, and then shock and defibrillation again. Increase the voltage if necessary. After defibrillation is successful, the heartbeat is automatically restored, or after a heart press. When the repeated electric shock is invalid, 5% sodium bicarbonate 200-300ml, or 11.2% sodium lactate 100-200ml should be added to correct the acidosis after hypoxia, and repeated injection if necessary. At the same time, intramuscular injection of 1% procaine 5ml, or lidocaine 100mg, or procainamide 100 ~ 200mg, to reduce myocardial stress. In addition, attention should be paid to whether the amount of circulation is sufficient, consider accelerating blood transfusion, or even arterial blood transfusion, and can inject blood directly through the aorta to infuse the coronary artery. As long as the myocardium responds to various treatments, it should be persisted and cannot be easily abandoned. After the heartbeat recovers and the blood pressure gradually stabilizes, the chest wall and the pericardial incision begin to bleed. The ligation should be carefully performed to stop bleeding and flush the pericardial cavity and chest cavity. The pericardial drainage incision was made on the posterior side of the radial nerve, and the pericardium was sutured After the thoracic cannula drainage was performed on the posterior line of the eighth intercostal space, the chest wall was sutured in layers.

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