Transcription of 2015 成人 ACLS 要点・心停止後ケア、Circulation,Nov3,2015
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
2 Temperature management ROSC 100 94 ROSC 4 5 2015 acls 4 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 )
3 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 ) capnography 10mmHg ROSC 2 Vf pulseless VT 2 Asys PEA CPR2 5H5T ROSC.
4 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
5 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.
6 Out-of-hospital cardiac arrest 4 / 9 CPR acls BLS CPR CPR 5 1. 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.
7 Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests, The Lancet,2010:375:1347-1354 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
8 CO LM o PPV: 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
9 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)
10 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()
