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更新重點提要
照護系統與持續的品質改善
2015 AHA CPR & ECC 更新重點提要
使用社群媒體呼叫急救者
社區可採用社群媒體技術,呼叫
在發生疑似 OHCA 患者附近,
願意且能夠進行 CPR 的急救者
成人基本救命術與 CPR 品質:
非專業施救者 CPR
重大更新
施救者不須離開患者身旁(使用行動電話)
即可啟動緊急應變
高品質 CPR:以適當速率和深度按壓胸部、
每次按壓後確保胸部完全回彈、盡量減少
按壓中斷、避免過度通氣
胸部按壓速率為每分鐘 100 到 120 次
胸部按壓深度至少 5 公分但不超過 6 公分
成人基本救命術與CPR 品質:
醫療專業施救者 BLS
重大更新
 目擊成人心臟停止且可立即使用 AED 時,應
儘速使用去顫器。若成人在無人目擊時發生
心臟停止或無法立即使用 AED,先開始 CPR,
若適合去顫,應在AED就緒時儘速進行
 目擊發生的 OHCA 若具有可電擊心律,應使
用最多 3 個循環的 200 次連續按壓加上被動
氧氣吹入和呼吸道輔助用具,延後正壓通氣
(PPV)
 CPR 進行中且放置高級呼吸道裝置的病患,
施予每 6 秒鐘1 次人工呼吸(每分鐘 10 次人
工呼吸)
2015 AHA CPR & ECC 更新重點提要
2015 AHA CPR & ECC 更新重點提要
CPR 的替代技術與輔助裝置
體外技術和侵入式灌流裝置
心臟停止且病因疑為可逆之病患,可考慮
使用 ECPR 替代傳統 CPR
成人高級心臟救命術
重大更新
 Vasopressin 已從成人心臟停止流程中移除
 不可電擊心律的心臟停止,應儘早使用
epinephrine
 VF/pVT 的心臟停止在 ROSC 後,可考慮立即
開始或繼續 lidocaine
 插管病患 CPR 20 分鐘後,潮氣末二氧化碳
(ETCO2) < 10 mmHg,與極低的復甦可能性
相關,但不應單獨使用
 ECPR 對初期傳統 CPR 無反應的可逆疾病心臟
停止病患,在能夠快速實行的情境下,可考慮
進行
復甦後照護
冠狀動脈血管攝影術
心臟停止疑似為心臟病因且 ECG 顯示ST 段
升高的 OHCA 病患,應緊急進行冠狀動脈
血管攝影術(而非住院後才進行或完全不
進行)
OHCA 後昏迷但 ECG 顯示 ST 段未升高,
疑似心臟病因的特定成人病患(電氣或血
液動力學不穩定),進行緊急冠狀動脈血
管攝影術應為合理
目標體溫管理 TTM (Targeted
Temperature Management)
所有昏迷心臟停止後 ROSC 的成人病患應
進行 TTM,達成 32 °C 至 36 °C 的目標溫
度,維持至少 24 小時
在 TTM 後積極防止昏迷病患發燒
復甦後的血液動力學目標
復甦後照護期間,避免並立即修正低血壓
(收縮壓低於 90 mmHg,平均動脈壓低
於 65 mmHg)
急性冠心症
到院前 ECG 取得和判讀
到院前 ECG 發現 STEMI 的所有病患,應在
到院前通知接收醫院及/或到院前啟動心
導管室
再灌流
若 STEMI 照護系統可提供到院前血栓溶解,
且可直接送到 PCI 中心的情況下,到院前
檢傷分類及直接送到 PCI 中心可能較佳
STEMI 成人病患到未提供 PCI 的醫院急診,
建議不進行血栓溶解,立即從原醫院轉診
到 PCI 中心
STEMI 病患到未提供 PCI 醫院打血栓溶解
治療時,應可合理將所有血栓溶解病患在
前 3 到6 小時及至多 24 小時內,轉診施行
早期例行血管攝影
用 Troponin 辨識可
急診安全出院的病患
 在 0 和 2 小時(未進行 clinical risk stratification)
測量的 high-sensitivity troponin,不得單獨用於排
除 ACS 診斷,但在 0 和 2 小時測得 hs troponin 小
於第 99 百分位,併用 low-risk stratification (TIMI
score of 0 or 1, or low risk per Vancouver rule) ,
30 天內預期重大心臟不良事件機率 (MACE) 小於 1%
 第 0 小時和第 3 和 6 小時之間 troponin negative,
併用 very low-risk stratification (TIMI score of 0,
low risk score per Vancouver rule, North
American Chest Pain score of 0 and age < 50
years, or low-risk HEART score), 30 天預期 MACE
機率小於 1%
特殊復甦情況
2015 AHA CPR & ECC 更新重點提要
急救
重大更新
在照護無反應、可正常呼吸、無重大創傷,
例如脊椎或骨盆損傷的病患時,讓病患採
側臥位可能可改善呼吸道功能
不建議急救人員使用頸圈。對於符合脊椎
損傷高風險標準的傷患,在等候高級醫療
照護人員抵達時,急救人員協助固定以防
移動的理想方式仍有待進一步研究證實,
但可使用口頭提醒和徒手固定。
2015 AHA CPR & ECC 更新重點提要

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2015 AHA CPR & ECC 更新重點提要