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1、临床学院教案及讲稿课程名称Emergency nursing年级授课专业教 师职称授课方式学时 2题目章节SCA and CPCR教材名称Emergency nursing作者Zhou xiuhua出版社People health publishing company版次the first editionOct. 2003教 学 目 的 要 求1:RecallThe definition of Sudden Cardiac Arrest .The clinical symptoms of Sudden Cardiac ArrestThe basic steps of CPR for adult
2、s.2:Application :Show the complete sequence for 1-rescuer CPR.教学难点How to perform all the steps of CPR in order教 学 重 卢How to perform all the steps of CPR in order外语 要求CET- 4学法段 教方手Multimedia参考 资料Guideline 2005 of CPR and ECG教研 室意 见教学组长：教研室主任：年 月曰小结Ok Jets watch a short video to recall the steps to pe
3、rform 1-rescuers CPR1 assess the victim for a response ,if no response ,shout for help2 if you are alone, active the emergency response system and get an AED if available.3 open the victims airway and check breathing 5-10 seconds4 if no adequate breathing ,give 2 breaths5 check the victims pulse 5-1
4、0 seconds6 if you do not definitely feel a pulse ,perform 5 cycles of compression and ventilations (30:2)Now ,this class we just talk about SCA and one of the part of CPCR , BLS or we may call CPR思考 题及 复习Here some questions here ,put 5 students into a group ,when you get the results , Talk out the a
5、nswers loudly or write on the paper and hand in the answers1 A person has chronic disease, at age 89 ,one day , the nurse detect the person in unconciousness ,absent of breathing and pulse ,could we call the person in SCA . and way .2 The most common disease lead to SCA is coronary heart disease ,an
6、d the sings on electrocardiogram is ventricular fibrillation .3 witch parts consist of CPCR4 ABC sequence means A airway B breathing C circulation5 We open the victims airway with jaw thrust ,is it right? Head tile-chin life6 The characters of chest compression is?7 The hand placement on chest durin
7、g chest compression is?8 The ratio of compression and breathing is?教案讲稿质量评价表评估内容权 重A 好1.0-0.9B 较好 0.89-C 一般 0.79-D 差 0.59-01001.编写认真、教学态度端正102.教学目的明确、概念清楚、内容准确203.教学注意系统性及先进性154.重点突出、难点清楚155.教学方法、手段适当106.运用专业外语适当、准确107.理论联系实际、举例恰当108.知识容量密度适宜、时间分配合理10后、见评价得分=（A级=100-90分；B级=89-80分；C级=79-60分；D级=59-0分）
8、评价者：评价时间：SCA and CPCR辅助手段时间分配Play videoGood afternoon everybody, today we are going to discuss the SCA and CPCR ,at first let me introduce myself beginning of the class ,we will watch a short video, please watch it carefully ,there are two questions, What happened and what are they doing?SCA（）DEFINI
9、TIONQuestionBut how do we define SCA Sudden Cardiac Arrest ,we also call SCA ,refers to sudden and unexpected loss of heart function ,cease the blood flow form the heart to the rest of the body , the brain and vital organs lack of blood and oxygen Jf the victim get the propriety medical service imme
10、diately ,survival is possible ,if not ,death occurs .because when SCA happens Joss of heart function ,cease the blood flow from the heart the rest of the body, it causes the brain and the vital organs lack of the blood and oxygen,Sometimes it occurs suddenly ,comes without warning , .it happens unex
11、pected .sometimes it may happened on somebody who is thought in good health situation（二）cuasesMany diseases may lead to SCA ,like as heart disease , The person who has heart disease has the higher chances of SCA.See the picturejf the disease can cause Decreased contractility, Arrhythmia ,Lower cardi
12、ac output Insufficient Coronary perfusion, then it may lead to SCA.The person who has heart disease has the higher chances of SCA .Studies report ,80% SCA were caused by coronary heart disease ,And the typical sings on electrocardiogram, we may see the ventricular fibrillation, and ventricular systo
13、le, the most common SCA are caused by ventricular fibrillation. Approximately 70%.（三）CLINICAL SIGNSSCA comes suddenly and unexpected, but how can we recognize it.There are six signs in our text book1.sudden unconsciousness .You palpate the shoulder ,if no response ,you may say the victim in unconsci
14、ousness.2 . Absence of major artery pulse( carotid or femoral)3 .No breathing .Question4 .Pupillary dilation and no pupillary reflex to light5 .Heart sound is not obtainable6 .Pale and no blood in the face(四)DIAGONOSISDo we need to collect all the evidences to establish the diagonosis?Here if you se
15、e the victim in unconsciousness, you cant palpate the pulse on carotid or femoral ,you can establish the diagnosis SCA .We have discussed that when the victim in SCA , loss of heart function ,cease of blood ,the brain and the vital organs lack of blood and oxygen , What medical service is propriety
16、and can save the lifeCPCRHere are two concepts , CPR and CPCR .CPRCPCRBut what the differences between them , the protection of brain,CPR is results from many years clinical experiences and many medical professionals contributed to it , Peter J Safar , who created mouth to mouth breathing in 1958 ,
17、he proposed the A-BC (airway, breathing, circulation) sequence of resuscitation, including the technique of mouth-to-mouth rescue breathing/1 So he is known as the father of CPR .CPR save many life ,but the persons who was survival from SCA , but Approximately 10-40% of them suffered obvious non-rev
18、erseable brain damage More and more medical professionals pay more attention to the protection of brain function.The becomes CPCR , so the most important difference between CPR andCPCR ,is the protection of brain .The modern Resuscitation CPR consist of three main elements: Mouth to mouth breathing
19、Chest compression DefibrillationThe present standard of CPR is guidelines CPR and ECC 2005.And it was pubulished on the journal Circulation Nov. 2005 we call it guidelines 2005. Completely CPCR includes thiee partsBasic life supportBLSBdvanced cardiac life supportACLSProlonged life supportPLS一 BLSTh
20、e main aim of BLS is to deliver oxygen to muscles of the heart and all of the important organsBLS Consists of 4 partsA airwayB breathingC circulationD defibrillationBut today ,we just discuss the ABC sequence ,the step D place on the next class , Now we know , SCA is the life and death disease , let
21、s watch the statistics here The relationship of the starting CPR and the ratio of survival .If the victim get the CPR Within 4min50% Within 4-6min10% More than 6min4% More than 1 Omin0%This picture shows the chain of survival .it consists of 4 links ,Early acces ,early CPR ,early defibrillation and
22、early advance care .Early access refers to recognize and activate the emergency medical system early ,and early CPR ,we just talked about the relationship of starting CPR and the ratio of survival ,and we know early CPR increase the ratio of survival ,early defibrillation also increase the ratio of
23、survival ,the reason is (question),ok ,the most common SCA were caused by ventricular fibrillation .and early advanced care refers to bring equipment to support ventilation and establish the intravenous access and stabilized the victim to transfer . the chain of survival summarize the present unders
24、tanding of the best approach to the treatment the person in SCA.1 ：positionWhen you meet a person in SCA , at first ,put him or her on back on a firm plant surface. Put the hand beside the body naturally . 2: assessShout for the victim ,and palpate the victims shoulder .if no response ,call 120 and
25、active the EMS.3: opening airwayThen take the steps of ABC sequenceThe A of the ABC sequence is airwaythen opening the airway ,The common cause of the airway obstruction in the unresponsive victim is the tongue block the upper airway.At the same time clear the foreign objective in the airway .There
26、are two postures to open the airwayHead tilt-chin liftjaw thrustThe most common posture we use is head tilt-chin lift,1 .Put one hand on the victim s forehead and push with you palm to tilt the head back.2,place the fingers of the other hand under the bony part of the lower jaw near the chin.3.Lift
27、the jaw to bring the chin forward .Please note .you just need to put the fingers on the bony part of the lower jaw, dont put on the soft tissue , it would obstruct the airway .But when you suspect the victim has cervical spine injure ,you must open airway with the manuvaur jaw thrust, After opening
28、the airway ,take the rescuer breathing4：B breathingAt first,assess the breathingAssess the breathing by looking, listening feeling .Put you face close to the victims mouth and noseLOOK for the chest to rise and fallLISTEN for air escaping during exhalationFEEL for the flow of air against your cheekT
29、he time you must take at least 5 seconds but no more than 10 seconds .If you cant look for the chest to rise and fall ,you cant listen for air escaping during exhalation ,and you cant feel for the flow of air against your cheekThen the victim has no breathing .The healthcare provider must delivery r
30、escuer breathing to the victim.Mouth to mouth breathing is a quick ,effective way to provide oxygen to the victim ,the rescuers exhaled air contains approximately 17%and 4%carbon dioxide ,This is enough oxygen to supply the victims needs. Hold the victims airway open with a head tilt-chin lift. Pinc
31、h the nose closed with your thumb and index finger (using the hand on the forehead.) Take a regular (not deep )breath and seal your lips around the victims mouth, creating an airtight seal.2分钟 Give 1 breath (blow for 1 second). Watch for the chest to rise as you give the breath. If the chest does no
32、t rise, repeat the head tilt-chin lift. Give a second breath (blow for 1 second). Watch for the chest to rise Please note:Take 1 second to deliver each breathDeliver enough air to make the victims chest rise.If you give breaths too quickly or with too much force ,air is likely to enter the stomach r
33、ather than the lungs .This can cause gastric inflation The risk of infection from CPR is very low but if you meet the victim in the workplace when there is any exposure to blood or bodily fluids .Standard precautions include using barrier device such as a face mask or a bag mask device when giving b
34、reaths. Some masks have an oxygen inlet that allows you to administer supplementary oxygen.Mouth to mask breathing has two obvious advantagesPlay videoPrevent the infection and can administer the supplementary oxygen ,Now ,we have just talk about the A B steps of ABC sequence .lets watch a short vid
35、eo to recall the contents.Ok, from the video ,we know after delivery 2 rescuer breathing ,the next step is5: C circulationWe have known, the person in SCA loss the function of the heart,cease the blood flow .the easy mean to assess the person if he or she loss the heart function , Assess the pulse o
36、n major artery. Like carotid or femoral.Maintain a head tilt, Locate the trachea , Slide these 2 or 3 fingers between the trachea and the muscles at the side of the neck, check the carotid pulse .Palpate the artery at least 5 seconds but no more than 10 secondsIf you can find the definite pulse ,Giv
37、e 1 breath every 5 to 6 secondsRecheck pulse every 2 minutes.If you are not sure whether the victim has a pulse ,you should start the steps of CPR with chest compression , chest compression refers to compress the chest to build circulation again, create blood circulation increase coronary perfusioni
38、ncrease the blood supplying for brainthere are two theory to support chest compression has the functions we talked above,heart pump .as we know ,the heart between chest and spine, when push chest down to spine ,the pressure on the heart ,grasp the heart , like the heart muscle contract ,push the blo
39、od from the heart to the rest of the body ,and when recoil the chest , the pressure away from the heart ,the heart recover Jike the heart in diastole ,then the blood from the rest of the body back to the heart !then the chest compression created circulation, chest pumpthe heart in the chest cavity ,
40、when push down the chest,reduce the space of chest cavity ,the pressure within it increase ,this pressure push the blood out of the heart ,and when recoil the chest ,the pressure within chest cavity decrease ,then blood back to heart,but through this simple action to establish circulation ,you must
41、do it correctly .otherwise you cant supply adequate blood to meet the needs of the vital organs.first ,make sure the victim is lying on his back on a firm ,flat surface .if the victim is lying facedown ,carefully roll him onto his back .if the victim on a soft place Jike in the bed ,put a board betw
42、een the back and bed, position yourself beside the victim, move or remove all of the clothing of the victim and you are able to see the skin of the chest, locate the hand placement, one , the breastbone between the nipples the second, at the lower of half sternum.You can find this part like this way
43、, grapes your fingers alone from the lower rib to the base of the sternum, then put the heel of the other hand above the fingers ,relieve the fingers from the chest wall , the other hand on the top of the hand,You just put the heel of one hand on the chest ,and all of the fingers must keep away from
44、 the chest ,Straighten your arms and position your shoulders directly over your hands. Make sure the strength from your shoulder upright to the victims chest.Push hard and deepPush fast compress at a rate of 100 times per minute,Rescuers should allow the chest to recoil completely after each compres
45、sion. Rescuers should not interrupt chest compression often or for long.Push hard means press down 4-5 CM with each compression, for each chest compression, make sure you push straight down on the victims breastone .If not, shallow chest compression may not produce adequate blood flow. Push fast, pr
46、ess at a rate of 100 times per minute. Complete chest recoil maximizes refilling of the heart, this is necessary for effective blood flow during chest compression, incomplete chest recoil will reduce the blood flow created by chest compression.Minimize the interruption because when you are not compr
47、essing the chest, blood does not flow.Those are the characters of the chest compression, but,during compressing ,there are some details you must pay more attention ,You just need to put the heel of your hand on the chest ,and the fingers must keep away from the chest ,dont move hand away from the location on the chest during compression.After compression, 2 breathing, so the ratio of compression and breathing is 30 :2.