,

,
.


1 2011 5 08
1 2011 5 18

4-139(1991. 6. 24)

(110-717) 112-1 BD 6
Tel. (02) 762-9194/5 Fax. (02) 764-0209
Tel. (053) 428-2748
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2011, () /
.
.
www.koonja.co.kr
* .
* .
ISBN 978-89-6278-???-?
??,000

2011.

3.

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xi

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10

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2.

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11

12

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,
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.

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9)
worksheet
.
,
.

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.

(2)

.

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.

2)
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, /
.

(2)
,
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13

14

(3)
, ,
(public access defibrillation) .

(4)

.
, .

6.
1)
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.

. 2007
, .
119
.

2)
, , ,
. 2006
.

.

PART 1.

///
1. . . . 2005 2
2. . . 2008.
3. Cho BK, Kim SC, Kim H, et al. Prospective multi-center evaluation and outcome of cardiopulmonary
resuscitation for victims of out-of-hospital cardiac arrest in Seoul. J Korean Soc Emerg Med 2009;20:355-64.
4. Eisenberg MS, Copass MK, Hallstrom AP, et al. Treatment of out-of-hospital cardiac arrest with rapid
defibrillation by emergency medical technicians. N Engl J Med 1980;302:1379-1383.
5. Field JM, Hazinski MF, Sayre MR, et al. Part 1: Executive summary: 2010 American Heart Association
Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010;122:S640S656.
6. Guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiac care (ECC). JAMA 1992;286:2135302.
7. Hazinski MF, Nolan JP, Billi JE, et al. Part 1: Executive summary: 2010 International consensus on
cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations.
Circulation 2010;122:S250-S275.
8. Hwang SO, Ahn ME, Kim YS, et al. Outcome of resuscitation in victims of prehospital cardiac arrest. J Korean
Soc Emerg Med 1992;3:27-36.
9. Hwang SO, Lee BS, Kim YS, et al. Survival and factors influencing restoration of spontaneous circulation after
cardiopulmonary resuscitation. J Korean Soc Emerg Med 1993;4:15-25
10. Hwang SO, Lim KS, Kim YS, et al. Outcome of resuscitation attempts in victims with non-traumatic out-ofhospital cardiac arrest in Korea. Korean Circulation J 1994;24:861-9
11. International Liaison Committee on Resuscitation. 2005 International Consensus on Cardiopulmonary
Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation
2005;112:III-1-III-136.
12. Kim JK, Choi MS, Seo KS, et al. Clinical analysis of resuscitation in victims of out-of-hospital cardiac arrest. J
Korean Soc Emerg Med 2002;13:5-11.
13. Larsen MP, Eisenberg MS, Cummins RO, et al. Predicting survival from out-of-hospital cardiac arrest: a graphic
model. Ann Emerg Med 1993;22:1652-1658.
14. Nolan JP, Soar J, Zideman DA, et al. European Resuscitation Council Guidelines for Resuscitation 2010 Section
1. Executive summary. Resuscitation 2010;81:1219-76.
15. Park KN, Jung KY, Lee K, et al. The outcome of the out-of-hospital cardiac arrest -A collaborative research of
three hospitals-. J Korean Soc Emerg Med 1999:9:370-378.
16. Ryoo JH, Heo T, Min YI, et al. Analysis of cardiopulmonary resuscitation in ward of tertiary hospital. J Korean
Soc Emerg Med 2001;12:369-378.
17. Stults KR, Brown DD, Schug VL, et al. Prehospital defibrillation performed by emergency medical technicians
in rural communities. N Engl J Med 1984:310;219-223.
18. Yoon HD, Park JK, Min YI. Clinical analysis of non-traumatic prehospital cardiac Arrest for two years. J Korean
Soc Emerg Med 1997;8:341-6
19. Yun SH, Lee KM, Kim JH, et al. Outcome of perdiatric out-of-hospital cardiac arrest. J Korean Soc Emerg Med
2007;18:202-10.
20. Zipes DP, Libby P, Bonow RO, et al. Braunwalds heart disease. A textbook of cardiovascular medicine. 7th
ed. Philadelphia: Elsevier Saunders; 2005. p. 865-908.

15

16

17

Part II

18

19

20

1.

. ,

.
50
. (
) .
, , , .
, 100,000 40-60
. 80% ,
50% .
.
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300,000-350,000 .
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, ,
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1.
.

. , ,
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.

.

. 4-5 10 .
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21

22

PART II.

) .
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23

24

PART II.

, .

2)

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.
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,
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.

3)
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.
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syndrome) .

1.

. , ,
,
.

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2011 2006
. 2011

. 2011 ,

. , ,
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.

1)
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- -(C-A-B) . A-B-C
.
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A-B-C . C-A-B
,
.

2) (hands only CPR)

.

.
.
.

25

26

PART II.

. 2011 ,

. , ,
.
, ,
.
--
.


.

3)

.
.

.
. ( : agonal gasps)
.
,
. ,
,
.
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,
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) . 2011
( )
,
.

1.

4)
2011 2006
. ,

.
.
2011 5cm (5-6 cm),
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.

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2011
.
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. 65 mm
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.
, , .
,
.

27

28

PART II.

///
1. . . 2008.
2. Becker L, Eisenberg M, Fahrenbruch C, et al. Public location of cardiac arrest: implications for public access
defibrillation. Circulation 1998;97:2106-2109.
3. Bernard SA, Gray TW, Buitst MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with
induced hypothermia. N Engl J Med 2002;346:557-63.
4. Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational
study. Lancet 2007;369:920-6.
5. Kitamura T, Iwami T, Kawamura T, et al. Conventional and chest-compression-only cardiopulmonary
resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide,
population-based cohort study. Lancet 2010;375:1347-54.
6. Kobayashi M, Fujiwara A, Morita H, et al. A manikin-based observational study on cardiopulmonary
resuscitation skills at the Osaka Senri medical rally. Resuscitation 2008;78:333-9.
7. Kouwenhoven WB, Jude JR, Knickerbocker GG. Closed-chest cardiac massage. JAMA 1960;173:1064-1067.
8. Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death: epidemiology, transient risk, and intervention
assessment. Ann Intern Med 1993;119:1187-97.
9. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital
cardiac arrest among children and adults. JAMA 2006;295:50-7.
10. Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome: epidemiology, pathophysiology, treatment,
and prognostication. A consensus statement from the International Liaison Committee on Resuscitation
(American Heart Association, Australian and New Zealand Council on Resuscitation, European Resuscitation
Council, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of
Asia, and the Resuscitation Council of Southern Africa); the American Heart Association Emergency
Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on
Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; and the Stroke Council.
Circulation 2008;118:2452-83.
11. Sayre MR, Berg RA, Cave DM, et al. Hands-only (compression-only) cardiopulmonary resuscitation: a call to
action for bystander response to adults who experience out-of-hospital sudden cardiac arrest: a science
advisory for the public from the American Heart Association Emergency Cardiovascular Care Committee.
Circulation 2008;117(16):2162-7.
12. Travers AH, Rea TD, Bobrow BJ, et al. Part 4: CPR Overview: 2010 American Heart Association Guidelines for
Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010;122:S676-84.
13. Weisfeldt ML. A three phase temporal model for cardiopulmonary resuscitation following cardiac arrest. Trans
Am Clin Climatol Assoc 2004;115:115-22

29

30

2.

1.
1)
.
.
3 .
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.
,
.
,
.

2)
25%
.
, .
,
.
.

2.
.

.
.
. ,
.

31

32

PART II.

3.
, ,
. .

.
. .





,

4.

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Resuscitation)

1)

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.

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33

34

PART II.

3)

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.

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35

1
2
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36

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39

40

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41

42

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44

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45

46

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.

47

48

3.

2)

.
. 2006
,
. ,
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2.

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.
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.
.
2011
(hands-only CPR) .
(asphyxia arrest),
. 119
.
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2 .

49

2011
.
.
.
, .

1.
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-
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,
.
.
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.
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.
.
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,
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2. :
2006 .
.
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.
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.
.
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51

52

3.

. 25%~33% , /
.
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.
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.
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,
.

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.

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(reservoir) . 30 L ,

53

54

3.

.
, ,
.

(2) -
-
. - 2
.
. .
500~600 ml (1~2 L) .
, 1 L 2/3 2 L
1/3 . 30
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.

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.

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3.

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55

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. .

1.
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.
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4.

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.

57

58

3.

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.

.
.

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100 . , ,
.
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.
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.

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4.

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.

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.
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7.
.
(13~97%) (1~43%) , , ,
, , , , .
(gasping)
. .

.
2% 12% .

.

59

(hands-only CPR)
.
,
. .
,
.
.
.

.
.
,
.

.
( )
.
.
,
, .

5.

.
.
,
.
.

.
.

.
,
.

.
(non-cardiogenic)
. ,

.

61

1.
,
(electrical defibrillation). 1 7~10%
, .

, .
,
.
, , , , 20 ,
( 47 2) .

2. (public access defibrillation, PAD)

(, ,
, , ) ,
(public access defibrillation, PAD) .


. ,

6.

.

, , 2
. ,
.

3.
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.
. 2
, 16 50 250
. 5
.
,
.
, .
, ,
- .

. (non-perfusing
rhythm) .

.

. 50%
, 34% .

. ,
,
. , ,
.

63

64

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66

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69

70

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.

///
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8
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106

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108

4.

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109

110

4.

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111

112

4.

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12.

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133

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///
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141

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///
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163

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183

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185

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187

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16.

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///
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205

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206

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///
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Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment
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14. Richard HR. Manual of simulation in healthcare, 2008. Oxford Uni. Press. 287-8.
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Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment
Recommendations. Resuscitation 2010;81 Suppl 1:e288-330.

245

246

247

248

1.
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.
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.
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.

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.

250

. ,
94% .

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.
12 .
, ST
.

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ST
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)
.
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.
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.

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,

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mV (1 mm) . , J-point V2 V3 0.15 mV (1.5 mm)
, 0.1 mV (1 mm) .

/ST
/ST ST 0.5 mm
T . ST
0.5 mm 20 . ST
, V2 V3 J-point 0.05 mV (-0.5 mm)
-0.1 mV (-1 mm) .

( ST-T)
ST 0.5 mm (0.0 5mV) , T
0.2 mV . ST T
.
.

2)
(cardiac biomarker)
. creatinine kinase isoenzyme (CK-MB)
. , .
ST
. 4-6
. .
6 , 6-12 .

251

252

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ST
. ST ,
.
.

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ST . /ST

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ST- T . ST
.
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. /ST
.
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,
.
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.

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.

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.

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ST . , , ,
.

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, .
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. phosphodiesterase inhibitor(sildenafil 24 , tadalafil 48
) .

4)
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.

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90% . , ,

253

254

.
.
.
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.
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.

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.
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.
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75 ,
.
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, 0.25%, 3
2.5% .

8)
ST
. door-to-balloon time 90
. .

9)
12 . ST

1.

. ST
.

4.
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ST ST
, (loading dose)
. 75 ST ST 300-600 mg
75 ST , ,
300 mg .

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Glycoprotein IIb/IIIa inhibitors
.

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.
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, 60 , 100 mm Hg
, , 2 3
.

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ST

255

256

5)
.

6)

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.
.

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.

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.
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10 56.5. 2,
1 . ,
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Delivery():
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Data():
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1.
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1) (119 ) , 2) ,

258

3) , 4) , ,
.

2.
(recombinant tissue plasminogen
activator(rtPA)
.

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. (Cincinnati Prehospital Stroke Scale:
CPSS)(1) (Los Angeles Prehospital Stroke Screen: LAPSS)
. CPSS
3 ( , , ) . CPSS
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, , ) . LAPSS
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CPSS LAPSS
.

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.


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) .
. ,

259

260

( 90mm Hg ) .

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.
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2.

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1a. Level of Consciousness

0:
1:
2:
3:

1b. LOC questions

0=
1=
2=

1c. LOC commands

0=
1=
2=

2. Best Gaze

0=Normal
1=Partial gaze palsy
2=Forced deviation

3. Visual

0=No visual loss

1=Partial hemianopsia
2=Complete hemianopsia
3=Bilateral hemianopsia

4. Facial Palsy

0=Normal symmetrical movements

1=Minor paralysis
2=Partial paralysis
3=Complete paralysis

5. Motor Arm

0=No drift
1=Drift
2=Some effort against gravity
3=No effort against gravity
4=No movement

6. Motor Leg

0=No drift
1=Drift
2=Some effort against gravity
3=No effort against gravity
4=No movement

7. Limb ataxia

0=Absent
1=Present in one limb
2=Present in two limb
Un=Amputation or joint fusion, explain

8. Sensory

0=Normal
1=Mild-to-moderate sensory loss
2=Severe to total sensory loss

9. Best Language

0=No aphagia
1=Mild-to-moderate aphasia
2=Severe aphasia

10. Dysarthria

0=Normal
1=Mild-to-moderate dysarthria
2=Severe dysarthriaUn=Intubated

11. Extinction and Inattention

0=No abnormality
1=Visual, tactile, auditory, spatial, or personal inattention
2=Profound hemi-inattention or extinction to more than one modality

261

262

NIHSS)( 1).

. .
185/110mm Hg
. 220/120mm Hg
, , 15%~25% .

3)
25 45 .

,
.
. rtPA .
.
.
.

4)
(
2).
, 5-6% .
.
. ,
, .
rtPA rtPA . rtPA 0.9 mg/
( 90 mg) 60 , 10% .
rtPA 3 .
2~2.5 ,
. rtPA 3-4.5
. 3-4.5
rtPA ( 3).

6 .

2.

2. 3 rtPA


3

3

7

(185/110 mm Hg )


< 100000/mm3
48 , aPTT
INR > 1.7 PT > 15
50mg/dL

( rtPA )


14
21
3

3. 3~4.5 rtPA


3~4.5

80
(NIHSS > 25)

rtPA 3

263

264

5)
rtPA ,
. ,
.

.

(1)

( 4).
75-100 /h .

(2)
, 185 mg/dL
. 185 mg/dL .

(3)

. .

(4)
.

4.
185/110 mm Hg
Labetalol 10-20 mg 1-2
Nicardipine 5 mg/hr, 5-15 2.5 mg/hr , 15 mg/hr, 3 mg/hr
.
185/110 mm Hg rtPA .
rtPA
rPA 2 15 ; 6 30 , 16

180~230 mm Hg 105~120 mm Hg
Labetalol 10 mg 2-8 mg/min
Nicardipine 5 mg/h, 5~15 2.5 mg/hr , 15 mg/h
140 mg sodium nitroprusside

2.

, .

(5)
.
.

///
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