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1、Unit 12,Emergency Medicine,Questions to consider:,1.If someone fainted in front of you,what would you do?2.Do you have any knowledge about first aid?3.What do you know about cardiac resuscitation?,Cardiopulmonary resuscitation,Definition Cardiopulmonary resuscitation(CPR)is a procedure to support an
2、d maintain breathing and circulation for a person who has stopped breathing(respiratory arrest)and/or whose heart has stopped(cardiac arrest).Cardiopulmonary resuscitation,commonly called CPR,combines rescue breathing(one person breathing into another person)and chest compression in a lifesaving pro
3、cedure performed when a person has stopped breathing or a persons heart has stopped beating.,The medical term for the condition in which a persons heart has stopped is cardiac arrest(also referred to as cardiorespiratory arrest).CPR is used on patients in cardiac arrest in order to oxygenate the blo
4、od and maintain a cardiac output to keep vital organs alive.If the patient still has a pulse,but is not breathing,this is called respiratory arrest and artificial respiration is more appropriate.However,since people often have difficulty detecting a pulse,CPR may be used in both cases,especially whe
5、n taught as first aid.,Cardiopulmonary resuscitation(CPR)is an emergency medical procedure for a victim of cardiac arrest or,in some circumstances,respiratory arrest.CPR is performed in hospitals,or in the community by laypersons or by emergency response professionals.,Description CPR is part of the
6、 emergency cardiac care system designed to save lives.Many deaths can be prevented by prompt recognition of the problem and notification of the emergency medical system(EMS),followed by early CPR,defibrillation(which delivers a brief electric shock to the heart in attempt to get the heart to beat no
7、rmally),and advanced cardiac life support measures.,CPR must be performed within four to six minutes after cessation of breathing so as to prevent brain damage or death.It is a two-part procedure that involves rescue breathing and external chest compressions.To provide oxygen to a persons lungs,the
8、rescuer administers mouth-to-mouth breaths,then helps circulate blood through the heart to vital organs by external chest compressions.,When performed by a bystander,CPR is designed to support and maintain breathing and circulation until emergency medical personnel arrive and take over.When performe
9、d by healthcare personnel,it is used in conjunction with other basic and advanced life support measures.,According to the American Heart Association,early CPR and defibrillation combined with early advanced emergency care can increase survival rates for people with a type of abnormal heart beat call
10、ed ventricular fibrillation by as much as 40%.CPR by bystanders may prolong life during deadly ventricular fibrillation,giving emergency medical service personnel time to arrive.,However,many CPR attempts are not ultimately successful in restoring a person to a good quality of life.Often,there is br
11、ain damage even if the heart starts beating again.CPR is therefore not generally recommended for the chronically or terminally ill or frail elderly.For these people,it represents a traumatic and not a peaceful end of life.,Purpose When performed quickly enough,CPR can save lives in such emergencies
12、as loss of consciousness,heart attacks or heart arrests,electric shock,drowning,excessive bleeding,drug overdose,and other conditions in which there is no breathing or no pulse.The purpose of CPR is to bring oxygen to the victims lungs and to keep blood circulating so oxygen gets to every part of th
13、e body.When a person is deprived of oxygen,permanent brain damage can begin in as little as four minutes and death can follow only minutes later.,There are three physical symptoms that indicate a need for CPR to be performed immediately and for emergency medical support to be called:unconsciousness,
14、not breathing,and no pulse detected.,Unconsciousness Unconsciousness is when the victim seems to be asleep but has lost all awareness and is not able to respond to questions or to touch or gentle shaking.An unconscious person will not respond to noise or shaking.When unconscious,a person can not cou
15、gh or clear the throat,which can block the windpipe and cause suffocation and death.People with a major illness or injury or who have had recent surgery are at risk for losing consciousness.,If the person has fainted,which is brief unconsciousness,the cause may be dehydration(lack of body fluids),lo
16、w blood pressure,or low blood sugar.This is a temporary condition.If the victim is known to have diabetes,a bit of fruit juice may revive the person once they have regained consciousness.,Not Breathing Not breathing,which is also called apnea,is the lack of spontaneous breathing.It requires immediat
17、e medical attention.The victim may become limp and lifeless,have a seizure,or turn blue.Prolonged apnea is called respiratory arrest.In children,this can lead quickly to cardiac arrest in which the heart stops beating.In adults,cardiac arrest usually happens first and then respiratory arrest.,The co
18、mmon causes of apnea in adults are obstructive sleep apnea(something blocks the airway during sleep),choking,drug overdose,near-drowning,head injury,heart irregularities(arrhythmia,fibrillation)or cardiac arrest,nervous system disorders,or metabolic disorders.In children the causes may be different,
19、such as prematurity,bronchial disturbances or pneumonia,airway blockage or choking on a foreign object,holding the breath,seizures,meningitis,regurgitating food,or asthma attacks.,No Pulse Detected If the rescuer is unable to detect a pulse or has difficulty in feeling a pulse it can be an indicatio
20、n of the use of improper technique by the rescuer,or shock or cardiac arrest in the victim.If a sudden,severe decrease occurs in pulse quality(such as pulse weakness)or pulse rate(how many beats in a minute)when other symptoms are also present,life-threatening shock is suspected.,The rescuer may nee
21、d to explain to a doctor or medical professional where on the victims body the pulse was measured,if the pulse is weak or absent altogether,and what other symptoms are present.Medical help and CPR are needed immediately if any of these symptoms is found.,Time is critical.A local emergency number sho
22、uld be called immediately.If more than one person is available to help,one can call a local emergency medical service,while the other person begins CPR.Ideally,someone CPR certified performs the procedure.If a critically ill patient or post-operative patient is being cared for at home,it is a good i
23、dea for a family member to take a CPR course to be better prepared to help in case of an emergency.,CPR in Basic Life Support Figure A:The victim should be flat on his back and his mouth should be checked for debris.Figure B:If the victim is unconscious,open airway,lift neck,and tilt head back.Figur
24、e C:If victim is not breathing,begin artificial breathing with four quick full breaths.Figure D:Check for carotid pulse.Figure E:If pulse is absent,begin artificial circulation by depressing sternum.Figure F:Mouth-to-mouth resuscitation of an infant.,Understanding the Text,Para.1cardiac arrest-心跳骤停
25、ischemic cardiovascular disease-缺血性心血管疾病 lethal-fatalventricular fibrillation-心室纤颤 infarcted myocardium-心肌梗塞 primary electrical disturbance-原发性心肌电活动紊乱,Para.2emergency-medical-services system-急症医疗服务体系 code team-a specially trained and equipped team of physicians,nurses,and technicians that is availab
26、le to provide advanced cardiac life support when summoned by an emergency code set by the institution.A code team usually includes a physician,registered nurse,respiratory therapist,and pharmacist.急救医疗小组,advanced help-further aid 进一步的救助 chance-possibilityrange from-vary fromvariously-ranging from 在美
27、国，尚没有医院外心室纤颤存活的全国性统计数 据，社区报告存活率为4-33%不等，能够快速提供救 助的社区中存活率较高。对于住院患者心脏骤停，存活率为0-29%不等。,Para.3rhythm-心律collapse(witnessed/unwitnessed)-other than-except,Para.4a collapsed person-encounter-meetunresponsive-无反应 summon-callagonal respirations-临终前呼吸,Para.5fundamentals-(pl.)basic facts or principles 基本事实或原则ch
28、est compression-胸部按压 intrathoracic pressure-胸廓内压 viability(viable)-存活;活力;生机e.g.1)The viability of the fetus before the 22nd week is doubtful.2)A fetus is viable by about the 28th week of pregnancy.contract-(心脏)收缩 cardiac output-心输出量,Para.6definitive-conclusive 果断的;明确的pulseless ventricular tachycardi
29、a-无脉性室性心动过速take/have precedence over 先于;比重要-come before,appear more important than,Para.7airway control-(文中指气管插管)intravenous access-(文中指静脉点滴)constitute-make up;formsustain a perfusing rhythm-维持灌注节律perfusion-passing of a liquid through vessels or an organ or tissue,especially the flow of blood into l
30、ung tissue 灌注,Para.8administer-vt.observational study-interpret the form and amplitude of-(未来的除颤器可能能够诠释心电图的形状和振幅，能建议直接除颤或先实施一段时间的心肺复苏。)envision-v.imaginebiosensors-生物传感器 end-tidal carbon dioxide monitors-呼气末二氧化碳监测器 adequacy-sufficiency,Para.9placebo-controlled studies-安慰剂对照研究 setting-condition;situa
31、tionintravenous-(静脉内注射胺碘酮)optimal-the best,most desirablehave/has yet to-肯定句中用 yet 表示”还没”,或表示”到目前为止”e.g.1)I have yet to hear your explanation.2)That is the largest sapphire(蓝宝石)yet discovered.,refractory-unresponsive:applied to a condition that fails to respond satisfactorily to a given treatment.难治
32、性的,治疗无效的(指治疗 未获得满意疗效的状况)Para.10hypoxic brain damage-缺氧性脑损伤 induce/induction-(目前的研究正致力于诱导体温下降以及以降低脑损伤为目标的药物干预。),Para.11precordial thump-胸前区击打(能产生一定能量)for a monitored arrest-,Para.12mechanical vests-机械充气背心 compress/decompress-主动式胸外按压-减压复苏）randomized studies-随机抽样研究 equivocal-indefiniteinterposed abdomi
33、nal compression cardiopulmonary resuscitation-插入式腹部按压心肺复苏术技术 alternate(with)-交替(进行胸部和腹部按压)equivalent-as good assuperior-better than,Para.13automated external defibrillators-全自动体外除颤器 interpret-detectshock-电击,Para.14prolong/prolonged/prolongation-be compounded by-(除非患者心跳停止的同时还有以下情况，患者体温降低、浸在冷水中、用药过量、其
34、它可确定也可治疗的疾病或间歇性心室纤颤或室性心动过速)intermittent-间歇性的community setting-社区环境 in preference to-,Para.15strike down-(illnesses)have a disastrous or disabling effect upon 使受到摧残;使一蹶不振;使倒下e.g.be struck down with a serious illness 重病不起 be struck down by heart disease 患心脏病倒下prime-n.(sing.)the time when sb.is stronge
35、st,most beautiful,most successful,etc.壮年,盛年;最美好的岁月;颠峰时期e.g.1)He is past his prime as a tennis player.2)to be in the prime of life 正值盛年/壮年,productive-e.g.land/discussion/cough/livesavert-vt.to prevent something unpleasant;to avoid 避免e.g.The accident could have been averted.preclude-vt.排除,消除e.g.all do
36、ubts 排除一切疑虑regardless of-,Para.16-17prolongation-delayaddress-vt.terminal-fatal,advancedin the event of-(formal)if something happense.g.In the event of fire,leave the building as quickly as possible.premises(pl.)-房屋及其产权范围空地;宅邸内e.g.The thief was still on the premises.Keep off the premises.禁止入内crews-s
37、taff membershonor-vt.respect,Phrases the Text,1.cardiac resuscitation/arrest2.ischemic cardiovascular disease3.ventricular fibrillation4.infarcted myocardium5.cardiopulmonary resuscitation6.agonal respirations7.chest/abdominal compression8.intrathoracic pressure9.cardiac output,10.pulseless ventricular tachycardia11.endotracheal intubation12.pharmacologic therapy/intervention13.end-tidal carbon dioxide monitor14.placebo-controlled studies15.antiarrhythmic medications16.hypoxic brain damage17.precordial thump18.automated external defibrillators19.cardiac rhythm20.terminal diseases,
