2015 成人 ACLS 要点・心停止後ケア …

1 1 / 9 2015 acls Circulation,Nov3,2015 2015 american Heart association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 7 Adult Advanced Cardiovascular Life Support Part 8 Post-Cardiac Arrest Care 2015 acls 8 CPR 100-120/ 5-6 CO2 10mmHg ROSC 20mmHg ROSC 12 EKG ROSC 32-36 24 targeted temperature management ROSC 100 94 ROSC 4 5 2015 acls 4

2 2015 acls CPR shockable), Vf pulselessVT DC biphasic 120-200J monophasic 360J CPR 30 2 5 2 1 100-120 push hard and fast 5-6 1/3 complete recoil IV IO 2 Vf pulseless VT DC CPR2 30 2 5 1 3 5 advanced airway ( LM ) capnography 20 CO2<10mmHg 20 Hg 2 / 9 2 Vf pulseless VT DC CPR2 advanced airway 6 1 300 bolus 2 150 5H5T Hypovolemia, Hypoxia, Hydrogen(acidosis),Hypo/Hyperkalemia,Hyp othermia Tension pneumothorax,Tamponade,Toxins,Thrombosis ( ),Thrombosis( ) 3 unshockable Asystole PEA CPR 30 2 5 2 IV IO 3 5 advanced airway ( LM )

3 Capnography 10mmHg ROSC 2 Vf pulseless VT 2 Asys PEA CPR2 5H5T ROSC: return of spontaneous circulation ROSC ROSC 40 Hg 12 EKG STEMI Targeted temperature management(TTM) ROSC 32 36 24 3 2015 acls 2010 2010 polymorphic VT (torsades de pointe) Torsades de pointe ponto 3 / 9

4 1170 10 16 13 30 300 800 1-3 4 nonshockable rhythm Asys PEA shockable Vf pulseless VT nonshockable Asys PEA IHCA:In-hospital cardiac arrest ROSC OHCA:Out-of-hospital cardiac arrest 4 / 9 CPR acls BLS CPR CPR 5 1.

5 100 120/ 2. 5 6 / 3. complete recoil 4. 5. advanced airway ( LM ) SGA supraglottic airway: LM lay rescuer Hands-only CPR CPR Class 1 The Lancet 2010 Kitamura et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests, The Lancet,2010:375.

6 1347-1354 Hands-only CPR CO2 10mmHg ROSC 20 ROSC return of spontaneous circulation CO2 ETCO2 waveform capnography arterial relaxation pressure 5 / 9 2010 acls CO2 capnography ER 2015 CO2 100 100 CO LM o PPV.

7 NPV 100 CO2 10mmHg 150 OHCA 20 ETCO2<10mmHg 20 ETCO2 20mmHg CO2 ETCO2 20 10 Hg ROSC ETCO2 10mmHg ETCO2 10mmHg 20mmHg 2010 ACLS20 2015 acls 6 / 9 Part11 BLS CPR35 12 60 CPR 20 CO2 10 CPR monophasic biphasic 200J 85 98 Vf 5 Philip AED biphasic 2 150J-200J-200J Monophasic impedence( ) 360J BTE(biphasic truncated exponential) RLB(rectilinear biphasic)

8 BTE impedence RLB 200J ROSC 12 EKG CAG ROSC return of spontaneous circulation 40mmHg ROSC american What time is it now? ROSC 12 EKG OHCA out-of-hospital cardiac arrest STEMI Class I ST CAG Class IIa CAG intervention 7 / 9 ROSC 3 ROSC ROSC 32-36 24 SO2 100 94 2010 acls ROSC( )

9 32-34 32-36 24 Class 1 TTM targeted temperature management TTM evidence SO2 100 ROSC SO2 94 CO2 30 40mmHg ROSC ROSC 4 5 TTM 72 ROSC 5 Class 1 72 72-120 status myoclonus myoclonus 72 burst suppression 24 72 N20 SSEP (somatosensory evoked potential ) CT GWR gray-white ratio 2 GWR 2-6 MRI diffusion restriction NSE neuron-specific enolase.

10 G/L g/L 8 / 9 S100B NSE S100B donor Class1 8 2015 acls CPR 100-120/ 5-6 CO2 10mmHg ROSC 20 ROSC 12 EKG CAG ROSC 32-36 24 ROSC SO2 100 94 ROSC 4 5 2015 acls CPR DC Vf pulseless VT DC biphasic 120-200J monophasic 360J CPR2 30 2 5 1 100-120 push hard and fast 5-6 1/3 complete recoil IV IO Vf pulseless VT DC CPR2 30 2 5 1 3 5 advanced airway ( LM ) capnography 2