35 40mmHg PaCO2 40mmHg 35mmHg CO2 PETCO2 CO2 CO2 10mmHg CPR CO2 10mmHg ROSC() CO mmHg ROSC return of spontaneous circulation ROSC 17mmHg ROSC 20

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1 2010 ACLS Circulation Nov.2, American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care p640-p BLS 2010ACLS BLS Circulation, Nov American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care p640 p786 5 AHA ACLS advanced airway ROSC: return of spontaneous circulation CPR CPR 2010ACLS CPR cmcomplete recoil CPR CPR 2010ACLS capnography capnography ROSCreturn of spontaneous circulation capnography

2 35 40mmHg PaCO2 40mmHg 35mmHg CO2 PETCO2 CO2 CO2 10mmHg CPR CO2 10mmHg ROSC() CO mmHg ROSC return of spontaneous circulation ROSC 17mmHg ROSC 20mmHg CPR surrogate VfVT ROSC Vf ROSC breakthrough 500ml 30ml/kg ER

3 VfVT vasopressor VfVT vasopressor QT torsades de point 2005ACLS PEA Asystole PEA Asys CPR BLS CPRAED3 3 ACLS CPR 20 ACLS 2010ACLS ACLS 1VfVT 2 2 2PEAAsys 3 CPR cm 4PaCO2 1mmHg Hands-Only CPR Hands-Only CPR 7 CPR 8BVM 9LM 10 10

4 11 12 CO2 100% 100% 13advanced airway advanced airway ROSC15 CPR CO2 16 Hs and Ts5 H 5 T 17H Hypoxia,Hypovolemia,Hydrogen(acidosis),Hypo/hyperkalemia,Hypothermia 18T Toxins,Tamponade,Tension pneumothorax,thrombosis()thrombosis() 19AED J 200J 21Vasopressor 22Vasopressor AED 23VfVT 24 QT torsades de pointes 25PEAAsys mg 27PEAAsys mmHg 29 CO2 10mmHg ROSC 30 CO mmHg ROSC 31CPP15mmHg 17mmHg ROSC 32 20mmHg CPR33 30 ROSC 34 72h 35BLS CPR 3 36ACLS 20 ACLS 37ROSC 12 ACS 38Vf ROSC cooling blanket, 500ml 30ml/kg 40

5 ACLS H American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care p640-p767 Circulation Nov.2,2010 VfVTPEAAsystole ACLS BLS CPR ROSC: return of spontaneous circulation advanced airway ACLS VfVT CPR AED VfVT CPR2 VfVT CPR2 3 5 Advanced airwaycapnography VfVT CPR2 ROSC post-cardiac arrest care ACLS AsystolePEA CPR AED AsystolePEA CPR2 3 5 Advanced airway capnography VfVT CPR 2 ROSC post-cardiac arrest care

6 2005ACLS 2010ACLS continuous quantitative waveform capnography CPR PEA asystole CPR ROSC: return of spontaneous circulation chronotropic drug stable undifferentiated regular wide-complex tachycardia 2. a. CPR a lone rescuer CPR 100FiO EMS) BVM ACLS provider CPR b. Bag-Valve Mask 1 BVM 2 BVM provider1l 2L ml 6 7ml/kg 30 2

7 c. cricoid pressure BVM supraglottic airway( d. Advanced airway Advanced airway supraglottic airway( ECG Advanced airway continuous waveform capnography Supraglottic airway( CPR ROSC advanced airway Supraglottic airway( Advanced airway

8 advanced airway Supraglottic airway(lm essential BVM e. BVM BVM CPR 10 Supraglottic airway(lm 10 supraglottic airway(lm f. waveform capnography EDDesophageal detector device

9 EDD(Esophageal Detector Device) EDD EDD collapse X BVMbag-valve mask g. X Vf VT pulseless electrical activity(pea) asystole

10 ACLS CPR Vf Vf CPR ACLS advanced airway ROSC:return of spontaneous circulation CPR advanced airway CPR PETCO2 relaxation phasescvo2 Advanced airway Advanced airway CPR Vf pulseless VT ACLS ROSC advanced airway The Hs and Ts5 H 5 T The Hs and Ts Hypoxia Hypovolemia Hydrogen ion(adidosis) Hypo/hyperkalemia Hypothermia Toxins Tamponade(cardiac) Tension pneumothorax Thrombosis(pulmonary) Thrombosis(coronary)

11 a. AED --- organized rhythm b. VfVT AED Vf VT clear1 CPR 2 2 CPR 100 /5cm complete recoil PETCO2 relaxation phasescvo2 120J 200J 360J Vf ATP ATP c. Vfpulseless VT Vf pulseless VT CPR ROSC vasopressor Vasopressor IV IO 2 vasopressor Vasopressor 1mg 3 5

12 1 2A Vasopressin 20U/ml40U Amiodarone 1 Vf pulseless VT ROSC VfVT CPR vasopressor Amiodarone( 150mg/3ml/1A) 300mg bolus 2 150mg ROSC magnesium sulfateqt torsades de pointes The Hs and Ts Vf pulselessvt ACS ROSCpost-cardiac arrest care STEMI f. PEAAsystole AED PEAAsystole CPR2 an organized rhythm post-cardiac arrest care Asystole PEA CPR2 provider 2 Vasopressor( Vasopressin) PEAAsystole h. Hs and Ts

13 advanced airway PEA crystalloid ROSC indicator CPR CPR 100 /5cm6 8 1 ECG PETCO2 CPPcornary perfusion pressurescvo2() 3 3 CPR ROSC ROSC ROSC a. pulse health care provider b. capnography 35 40mmHg CO2 PETCO2

14 CPR PETCO2 PETCO2 CPR ROSC Vasopressor vasopressor CPR PETCO2 10mmHg ROSC supraglottic airway() BVM PETCO2 PETCO2 10 CPR PETCO mmHg ROSC c. CPP(coronary perfusion pressure) Arterial relaxation pressure CPPcoronary perfusion pressure Aortic diastolic pressure right atrial diastolic pressure ROSC CPP 15mmHg 17mmHg ROSC 20 CPR d. SCVO2 : central venous oxygen saturation SCVO2 SCVO2 30 ROSC SCVO2 30 CPR SCVO2 ROSC CPR bolus 20ml IV fluid

15 ACLS IO CPR CPR IV IO IV dose ml 10 ml Advanced airway CPR advanced airway CPR BLS CPR ROSC ACLS CPR BLS 3 CPR AED 3 ROSC AED National Association of EMS Physician ACLS 20

16 EMS ACLS CPR ACLS ROSC AED Vasopressor vasopressor a. Epinephrine CPR Epinephrine coronary perfusion pressure IV IO 1mg 3 5 IV IO 25ml 10ml b. Vasopressin 40 12mg Precordial thump a. Amiodarone Vf pulseless VT CPRvasopressor 300mg 5mg/kg 300mg 150mg IV IO

17 b. Lidocaine Vf pulseless VT mg/kg IV c. Magnesium Sulfate Magnesium sulfate torsades de poitnes QT Vf VT magnesium sulfate ml d. Atropine PEA Asystole atropine e. sodium bicarbonate f. Precordial thump Vf VT precordial thump VT VT Vf asystole CPR Post-Cardiac Arrest Care MOF

18 a. Overview of Post-Cardiac Arrest Care ACLS critical 24 supraglottic airway() 30 VAP capnography pulse oxymetry 94 ROSC ICU IV 90 bolus ROSC PCI PCI the Hs and Ts

19 a. Hypothermia ROSC ROSC ml 30ml/kg Vf ROSC shivering rewarming ACS 12 ST b. Hyperthermia 37.6 poor survival

20 c. PaO2/FiO2 300 ALIacute lung injury200 ARDS X FiO PaO mmHg 94 FiO2 PH PaCO2 1mmHg 2.5 ARDS 10 /ARDS TV 6 8ml/kg 30cm atelectasis PEEP CO2 permissive hypercapnea d. ROSC 12 ST ACS PCI AMI PCI e

21 f. thiopental diazepammagnesium ROSC24 SSEPsomatosensory evoked potential vestibulo-ocular reflex 72 GCS 5 generalized suppressiongeneralized epileptic activity burst suppression patternflat diffuse periodic compolexes 24 SSEP N20 cortical response

Editor Mary Fran Hazinski, RN, MSN Associate Editors Leon Chameides, MD Robin Hemphill, MD, MPH Ricardo A. Samson, MD Stephen M. Schexnayder, MD Eliza

Editor Mary Fran Hazinski, RN, MSN Associate Editors Leon Chameides, MD Robin Hemphill, MD, MPH Ricardo A. Samson, MD Stephen M. Schexnayder, MD Eliza アメリカ心臓協会心肺蘇生と救急心血管治療のためのガイドライン 2010 2010 American Heart Association Guidelines for CPR and ECC のハイライト目次全救助者に共通の主要な問題 1 市民救助者による成人への CPR 3 ヘルスケアプロバイダーによる BLS 5 電気的治療 9 心肺蘇生手技と器具 12 二次救命処置 13 急性冠症候群