除颤仪的正确使用教学教材.ppt

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,心脏电复律,心内二科：孙悦,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,概述；,心脏电复律也称心脏电除颤，指在严重快速型,心律失常,时，用额定短暂高压强电流通过心脏，使全部或大部分,心肌细胞,在瞬间同时除极，造成心脏短暂的电活动停止，然后由最高自律性的,起搏点,（通常为,窦房结,）重新主导,心脏,节律的治疗过程。同时非同步电复律也分为胸内除颤和胸外除颤。,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,同步与非同步电复律,一、同步电复律：病人为意识清醒状态，即同步触发装置能利用病人心电图中R波来触发放电，使电流仅在,心动周期,的绝对不应期中发放，避免诱发,心室颤动,，可用于转复心室颤动以外的各类,异位性,快速,心律失常,，称为同步电复律。术前复查心电图并利用心电图,示波器,检测电复律器的同步性。缓慢静注安定03一05mg/kg或,氯胺酮,o51mg/kg麻醉，直至病人睫毛反射开始消失，痛觉消失后开始电复律。,二、非同步电复律：非同步触发装置则可在任何时间放电，用于转复,心室颤动,，称为非同步电复律。可分为胸外电复律和胸内电复律，此时病人情况危急，神志丧失，抢救应争分,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,除颤仪的使用,主讲人：李红秋,4,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,除颤仪的使用,双向波除颤仪,单向波除颤仪,5,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,单向波与双向波比较,单向波,能量较高，360,对心肌损伤大,不随经胸阻抗变化,双向波,能量较小，,200,对心肌损伤小,随经胸阻抗变化,6,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,7,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,目录,外观构造,自检,功能,除颤原理,适应证、禁忌证、并发症,操作步骤,注意事项,8,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,外观构造,1.电极板,2.主机面,3.心电图导联线,9,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,1.电极板,成人电极板,成人电极板,胸骨,APEX：心尖,STERNUM：胸骨,放电键按钮,儿童电极板锁扣,接触指示器,儿童电极板,10,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,2.主机面,11,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.主机面按键（一）,12,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,主机面按键（二）,HR ALARM：心率报警键,LEAD SELECT：（导联选择键）,SYNC：同步键,2键：充电键,3键：,放电键(,只适用于AED,),100/30,、,PADDLES四个,140/60,160/90,200/120,13,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,主机面按键（三）,标志对异常心电图做记号,条图心电图打印键,摘要记录开机监护状态下8小时内或50条异常心电图，关机2分钟后重新记录,心电波,高低调节,14,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,3.导连线,RA,LA,LL,15,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,装卸打印纸,16,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,自检,1.检查除颤仪外观是否清洁，有无破损，防压防水，检查有无备用电极片、心电图纸及导电膏，电极板是否放入支架座，机器是否处于充电状态（每天充电10小时以上）2.自检步骤：,3.时间调节：,17,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,自检步骤,拔掉电源,语音提示后，双手同时按放电键,按充电键,一手按条图，一手开机,检查心电图纸打印是否顺畅，查看打印的墨迹是否清晰，查看时间是否准确，如不符合，则需调整.,自检单打印,18,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,查看墨迹和时间,19,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,时间调节,通电源，转动,“,能量选择,”,旋钮到,“,OFF（断）位置；同时按下软键4与5转动,“,能量选择,”,旋钮到,“,AED ON,”,（AED通）位置；选择General Settings，进行时间调节.,20,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,调节时间操作图,21,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,功能,1.除颤,2.心电监护,3.起搏功能,22,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,除颤原理,用高压强电流短时间内通过心脏（经胸壁或直接与心脏接触），使心肌组织瞬间同时除极，消除异位心律，阻断折返激动，终止快速性心律失常，恢复窦性心律。分同步和非同步除颤。,23,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,同步除颤,由心电图R波触发复律放电，使电击脉冲落在R波降支，也就是在心室绝对不应期放电。,24,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,非同步除颤,电击脉冲的发放与R波无关，也就是复律器放电发生在心动周期的任何时期。,25,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应证,同步除颤：房颤、房扑、室上速、有脉搏的室速,非同步除颤：室颤、室扑、无脉搏的室速,26,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应症,同步除颤心电图,P波消失、代之以大小不等、形状不同、间隔不均的f波（频率350 600次分）,RR间期绝对不等，心室率极不规则,QRS波群形态正常,心房颤动,27,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应症,同步除颤心电图,P波消失，可见频率为250350次/分的F波,QRS波群形态正常,F波与QRS波比例固定，则RR间期相等；不 固定，则RR间期不等,心房扑动,28,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应症,同步除颤心电图,三个或三个以上连续出现的室上性早搏,心率150250次/分，节律规则,QRS波正常（差异传导时例外）,P波不易辨认,阵发性室上性心动过速,29,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应症,同步除颤心电图,三个或三个以上连续出现的室性早搏,心室率140220次/min，节律可稍不规则,QRS波群形态畸形，宽度0.12s,未见P波或P波与 QRS波无关,有时可见心室夺获和心室融合波,单形性,多形性,阵发性室性心动过速,30,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,同步电复律治疗的要求,室上速和室速：当患者同时伴有血流动力学障碍时，如心绞痛、休克、心功能不全等时应立即行电复律治疗。,房颤：初发房颤（发作时间48小时至7天）应早复律。因房颤时间越长，心房肌有效不应期会明显缩短，发生“电重构”，使电复律难度增加。反复发作的阵发性和持续性房颤如无禁忌症可选择电复律治疗（复律前应服用华法林等抗凝药2-3周，防栓塞发生）以改善心功能，防左房血栓的形成等。,清醒患者做好心理护理，必要时使用镇静药。,31,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应症,非同步除颤心电图,呈正弦波图形，波幅大、规则,频率150-300次/分,心室扑动,32,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,适应症,非同步除颤心电图,无法区分QRS波群、ST段与T波,波形、振幅和频率均极不规则,心室颤动,33,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,禁忌症,1.缓慢心律失常，包括病态窦房结综合症。,2.洋地黄过量引起的心律失常（除室颤外）。,3.伴有高度或完全性传导阻滞的房颤、房扑等。,4.严重的低血钾暂不宜作电复律。,5.左房巨大，心房颤动持续一年以上，长期心室率不快者。,34,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,并发症,发生率4%-6%,1.低血压,2.局部皮肤灼伤及心肌损伤,3.心律失常,4.栓塞,35,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,影响胸壁阻力的因素,1.释放的能量,2.电极板的大小,3.除颤的次数和间隔,4.电极板的压力,5.通气阶段,36,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,相关知识,导联优点:P波和QRS波都是直立的，方向一致，比较清晰易辨别。,PADDLES：快速查看,粗颤与细颤：,在1毫伏的标准电压下，波幅0.5毫伏称粗波型室颤，波幅 0.5毫伏称细波型室颤。,除颤时选,粗颤的优点,：胸壁阻力小，心肌收缩力强，到达心肌的能量大，除颤效果好,同步除颤为何在R波的降支上：使电流在心动周期的绝对不应期发放，避免诱发室颤。,37,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,操作流程,接通电源,按Sync On/Off（限同步）,选择能量150J,涂导电膏,按Charge（充电）,正确位置紧贴胸壁,双手按Shoch（放电）,手动除颤,38,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,操作步骤,确认患者出现室颤，立即予胸外心脏按压，呼叫医生，取除颤仪。,接上电源，打开开关。,去除金属物品，充分暴露胸壁，去除胸壁上异物，贴电极片（来不及时选Paddles导联快速查看心率）；,将导电膏涂在电极板上。,正确选择能量（150或200J）；儿童首次2J/kg，后续电击的能量为4J/kg。,按压充电键，等待监视屏上显示达到所需值。,将电击板分别置于胸骨右缘第二肋间及左腋前线第五肋间。,再次观察心电波，确认需除颤。,嘱周围抢救人员离开病床及病人，确认没有接触床边。,电极板紧贴皮肤并施加10-12重的压力，电极板上的指示器显示绿色，双手同时按压放电键。,39,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,1.评估,无,无反应，发绀,快来人,抢救!,暴露胸部,40,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,2.取除颤仪后开机,41,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,3.贴电极或快速查看,PADDLES,快速查看,42,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,4.涂导电膏,“C”字型涂导电膏,十字交叉转至对齐,43,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,5,.,选择能量,同步除颤能量：单向波100-200J；双向波50-100J,非同步除颤能量：单向波300-360J；双向波150-200J,儿童首次2J/kg，后续电击的能量为4J/kg,44,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,6,.,充电,按压充电键,45,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,7.放置电极板,左腋前线第五肋间,胸骨右缘第二肋间,胸骨,心尖,两电极板间距约10-15cm,46,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,8.再次确定心率,避免盲目除颤！,47,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,9.清场,嘱周围抢救人员离开病床及病人，确认没有接触床边。,48,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,10.放电,只适用于AED,施加10-12公斤重的压力,同时按动两个手柄上的橙色按钮,绿色,49,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,11.评估效果（一）,继续CPR，,必要时再除颤,50,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,11.评估效果（二）,自主呼吸,有,无,高级生命支持,51,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,瑞安人民医院急诊科李红秋,11.整理,（抢救成功）用纱布擦拭病人身上的导电膏，整理床单位，协助患者取舒适体位。,用清洁干纱布将除颤仪电极板擦干净，再将其放回原地并插上插头。,物品分类放置，洗手，做好记录。,52,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,注意事项,1.如心室颤动为细颤,除颤前遵医嘱给予肾上腺素,使之转为粗颤,再进行除颤。,2.前次除颤后，继续胸外按压五个循环后再判断是否恢复窦性心律，若未恢复再次除颤。,3.电击时，任何人不得接触病人及病床，以免触电。,4.除颤成功后，继续心电监护，严密观察心电图、生命体征及病情变化，必要时送入CCU或ICU进一步观察治疗。,5.放置电极板前，须评估患者胸前皮肤是否完整，同时避开伤口敷料、起搏器等。,53,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,除颤监护仪保养,54,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,机器日常清洁,可以用以下清洁液来清洁机器外表面、电极和电池,异丙醇（水中为70%）,中性肥皂水,氯漂白粉（水中为3%）,四价氨化合物，例如Lysol（水中为10%）,清洁时，不要让液体倾倒在设备上，不允许液体透过设备表面进入设备。清洁显示屏时要使用软布，避免擦伤表面。,注意：机器不能用高压锅消毒，不能用超声法清洗，也不能浸泡。不要使用摩擦性清洁剂或强溶剂，例如丙酮或丙酮基的清洁剂。,55,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,谢谢聆听,56,Evaluation only.,Created with Aspose.Slides for.NET 3.5 Client Profile 5.2.0.0.,Copyright 2004-2011 Aspose Pty Ltd.,