Professional Documents
Culture Documents
16.00-18.00 +
: 14,21, 28
: 4,11,18, 25 (16.00-20.00)
: 2, 8,16, 23,30
: 6, 13 , 20,27
. , . ,
., . &
25 /11 &
20/1/12
27/1/12
653 !!
233
01
.
06
.
09
. , .
08
( )
.
1
;
1
2
&
()
K ;
-
--
: 60-80/min
: 100/min
:100-140/min
12-24/min
: -
---
( )
100+ ( 50)
80
90 + ( 50)
80
. . . . 60 80
. . . . . . 80 100
. . . . . . . 100 140
80% .
40% .
.
36.0-37.8
38.0-38.4
38.1-39.2
39.3-39.9
37.9-38.2
36.5-37.2
39.7-40.7
37.9-41.0
38.3-39.3
39.3-42.2
40.5-41.1
38.6-39.4
37.8-39.3
41.0-41.5
34.0-37.0
25.0-28.0
27.9
39.0-42.0
29.0-35.0
32.7
( )
()
( )
( )
()
( )
&
/ ( )
(.. ,
, )
(..
, )
,
:
. /
.
.
.
100.
(= 10)
.
.
!!!
-
-
- - -
- -
- -
-166 (
).
.
.
-
.
()
O
I
166
2
;
1.
2.
3.
4.
.;
: !
()
.!
80%
:
460.000/ (), 700.000/ ()
60%
40%
>40% ( )
, , ,
, , , ,
Out-of-hospital cardiopulmonary
arrests (21,175) by aetiology.
Aetiology
Number (%)
17451 (82.4%)
1814 (8.6%)
Lung disease
Cerebrovascular disease
Cancer
Gastrointestinal haemorrhage
Obstetric/paediatric
Pulmonary embolism
Epilepsy
Diabetes mellitus
Renal disease
71 (0.3)
50 (0.2)
38 (0.2)
1910 (9.0%)
Trauma
Asphyxia
Drug overdose
Drowning
Other suicide
Other external
Electric shock/lightning
901(4.3)
457 (2.2)
190 (0.9)
36 (0.2)
30 (0.1)
23 (0.1)
657 (3.1)
465 (2.2)
411 (1.9)
105 (0.5)
194 (0.9)
50 (0.2)
28 (0.1)
: 49-66/100.000
/
1.5-3.3/1000
1.5/1000 - (. )
0.5/1000 - ( )
()
=
:
!!! -
!!! -
Dutch fumigator
1767, :
, ,
, tobacco
: Brodie 1811 4 oz
1 1 oz
: ,
34
!!:
( 19
)
Sylvester
1 ()
9
-
Green TA et al, Lancet 1906;2:1708
(II)
>20 min
:
3 the heart begun to beat
forcibly
post-resuscitation
Green TA et al, Lancet 1906;2:1708
LANCET 1906
120 ml 20
ml
4 60 ml ,
60 ml
20
- Defibrillation
166
.,
7-10%/
. 3-4%
/
, .
10-15%
. + 3-5
: 49-75%
: 8
()
: > 15
. 2/3
.
.;
1.
2.
.
;
Resuscitation (2005) 67;S1, S1S181
.
3.. :
( )
,
.
3.. :
(
, head tilt - chin
lift)
Jaw
thrust
:
,
head tilt - chin lift
.
5. .
5. .
,
.
.
()
.!
3
:
1.
2.
3.
4.
ABC ;
Airway
Breathing
C
Circulation
D
E
F
G
H
I
Drugs +
E.K.G
Fibrillation
Gauging
Human mentation
Intensive Care
;;
.;
&
/
(Head-tilt/chinlift).
/
(Headtilt/neck-lift).
(Jaw
lift)
.
.
.
.
.
4. :
:
:
:
gasping
(
)
< 10
: ,
&
.
1, 500 ml
:
&
.
6. .
30
( )
4 5
100/
30:2
.
6. .
(
)
100/
7. .
!
CPR. : A, :
.
B, :
. .
gasping
.
;
:
2
1 :
.. :
100/, 4-5 ,
(
)
. :
2
, 500 ml x 8-10 /
: 1 ( 2)
, - , -
( !)
30:2
..
: =
30:2
X
30
: 1 sec
4
:
1. 15:1
2. 30:2
3. 25:1
4.
&
;
3.2 min Japan AED (NEJM 2010)
12.4 min NYC
16 min Chicago
7.8 min Seattle
15 min !!!
!!
min
7-10%
.
:
5-10% ( )
15%
17%
37% 2007 AED (Per square kilometer of
inhabited area 0.97, Per 100,000 population 69.0)
!!!!
.. !!!
!
1-3
( > 100 mmHg)
!!
/ ;
30:2 15:2 ( :
1 2 , )
1 min
(166)
..
(2 )
(86%)
..
(<30 C )
&
,
,
..
KT
(),
,
..
()
(
, 20
)
( )
5
..
Jaw thrust
..
(Jaw thrust)
(, )
(, )
16.000/ ()
< 1%
24 / (>50%
< 1 )
1.
:
2.
:
3.
.
(finger
sweep) .
-
& Heimlich.
5 +5
-
& Heimlich.
5 +
5
, , , , ,
, , ,
( ,
)
&
- , ,
- -
,
, ,
, (
,
:
;
400.000 /
3%
Chest 1997;111:712
$ 400.000 (344-967.000 $)
8.7 - 18%
16 - 49 % King County, Seattle
<2% (NYC -Chicago)
VF 5.3% NYC
50%
(
)
.
- Ca Karnofsky
- AIDS P.carinii
- Childs C
- MSOF 3
-
= 6 /
80 %
1
2
(,
,
)
, 80%
; ;
:
.,
20 cm
< 10 sec
-
pads
shock
150-360 J 360 J
. 2
,
p <0.0001
98% (53/54)
p < 0.0001
69% (42/61)
59%(36/61)B
Biphasic
Monophasic
1 shock
Biphasic
Monophasic
3 shocks
Schneider T, et al, Circulation 2000;102:1780-1787.
. +
5
1.
2.
3.
4.
5.
AED;
casinos
1 2
AEDs;
OHare
Chicago: 60-90
Second Walk To
An AED
49 AEDs
10
14
9 !!
Caffrey et. al. N Engl J Med 2002;347:1242-7.
>275
AEDs;
/
60% (!!)
25
191 AED
14
6 !!
Page RL et al. N Engl J Med 2000;343:1210-1216
AEDs;
Casinos
<3 minutes
AED ~4.5 minutes
: 59%!
AEDs;
0.746
//
AED
90%
90%
80%
Cardiac
rehabilitation
Chicago airports
70%
64%
60%
50%
59%
Casinos
45%
40%
Rochester, MN
34%
30%
20%
Seattle, WA
10%
7%
0%
US National Average
Survival rate
. ,
,
.
.