LOGO室颤的识别与急救VentricularFibrillation＆EmergencyManagement11病例导入CaseStudy一位60岁的女性患者，因“胸痛三天”诊断为急性广泛前壁心肌梗死收住CCU，护士巡视病房时突然间病人两眼上翻、呼之无反应，心电监护显示如图60y,Female,Maincomplain:chestpainforthreedays.Diagnosis:AcuteMyocardialInfarction.Thepatientsuddenlyloseherconsciousnessduringthenurse'sroundcheck，ECGmonitorshowasbellow:22学习目标LearningObjectives识别室颤的心电图DistinguishECGofVF1掌握室颤的急救处理MasterEmergencyManagementofVF2掌握除颤技术MasterDefibrillationTechnique333概念Definition最严重的心律失常之一(mostseverearrhythmia)心室丧失有效的整体收缩能力(uncoordinatedcontractionofventricle)心肌快而不协调的颤动(rapidanddisorganizedfibrillation)室颤441室颤概念临床表现ClinicalManifestation551室颤概念2心电图表现3临床表现1.面色苍白或青紫Cyanosis2.意识丧失Lossofconsciousness3.全身抽搐Convulsion4.阿斯综合症Adams-StokesSyndrome5.呼吸循环骤停SuddenarrestofRespirationandCirculation心电图ECGManifestation1.P和QRS波群，ST段及T波消失2.代之以波形、振幅及频率极不规则的细颤波3.频率达到250-500次/分661室颤概念2心电图表现InVF,thereisnoclearPandQRSwaves,thewaveformamplitudeandfrequencyaredisorganized,frequencycouldbe250-500beatsperminute.室颤急救处理EmergencyManagement病人呼之不应，无心跳及呼吸，心电监护示室颤即刻胸外心脏按压，以C-A-B顺序开始CPR同时呼叫医生让另一护士去取除颤仪立即电击除颤床边没有除颤仪有除颤仪电击:单向波360J双相波200J马上进行5个CPR循环评估节律，必要时再次电击771室颤概念2心电图表现3临床表现4急救处理早期除颤EarlyDefibrillation不及时救治，室颤在几分钟内导致猝死除颤是终止室颤最为有效的方法除颤成功的可能性随时间推移而下降从室颤发作到给予电击的时间不应超过3分钟881室颤概念2心电图表现3临床表现4急救处理除颤Defibrillation对心脏的电击electricshock消除原有的异位心律letrandomactiontostop使心脏转复为窦性心律Converthearttonormalsinusrhythm除颤除颤995除颤概念2心电图表现3临床表现4急救处理1室颤概念除颤适应症Indications1心室颤动VentricularFibrillation2心室扑动VentricularFlutter3无脉性室速PulselessVT10106除颤适...
