2016

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2

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22-22
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22-23
PULSLESS VT / VF 22
PEA / ASYSTOLE 26
( )ROSC
22-22

22-33
/ 33-32

33-32
46-47
48-49
COPD 50-51
CPAP 22-22
54-56
22-22
22-63

63-62

63-62
3

()ACS 66-67
68-71
/ 22-22
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26-22
-
22-23
23-23
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332-336
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4

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322
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322-326

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232-233


233


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223-222
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, 226-233

232-232
232-223
223-222

LUCAS II 222-263
Medumat Easy CPR 263-263
Medumat Standart A 262-262
()IN 262-223
5

/ 223-222
222-223
CPAP 222-226
' 222-222
Laryngeal Mask Airway 222-223
Quicktrach 223-222
B.I.G 222-223
TPAK 222-222
222-222

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18

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19

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21

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 22

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 23

.

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.

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ALS , ,'.

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24

BLS "
.BLS
ALS ( )
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- ( , ,
).

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.
!
.
.

33-32
. .23%-22% .
/ ( )
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. .

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( ) . ""
.
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 25

( , ETCO2 ,
, ).
( ,
,').

, .
" .
.
.

( )
/ .
( !!) : 500 cc ,/
20 cc/kg .

.
,
.

26

2016
 27

100-120
. !!
5-6".

( !!).
2.
CPR C-A-B

/ .
(
).

(
,
).
.2:30


?


.

, .

.
10 .
PEA/ASYSTOLE VF/PULSELESS VT

10 mmhg
.

 28

.3 ,
outcome .
.2 32 .
.
.2 (
).

.3 6-2 .
.2 , 5 mg
5 cc.
.2 - , (.)NA
.3 ( )ROSC .

, .

.3 " .
.2 ( 23).

= ( A-B-C , ,).

 29
VT/VF
VT/VF

.IV/IO

:
2 J 200-300-360 LP-12
J 200 Corpuls
()IV/IO

.1 mg = IV
20 cc
.0.9%
3 mg = ET 5 cc
.0.9%
?
IV
= .300 mg
= .150 mg

IV

(.)TDP
2 = .1-2 gr
= 10-20 cc
3-5 D5W .NS
push ( 5-10').

ROSC
".
ETCO2
( .)40 mmHg

?
.
.
.
? ROSC
.
/

IV
.1 meq/kg
(
)60 mg/% .IV 25 gr
2 .NA

IV ROSC


,
.

 31

PEA/ASYSTOLE
ASYSTOLE/PEA

2
.IV/IO
()IV/IO

3-5
1 mg = IV 3-5'.
20
cc .0.9%
3 mg = ET 5 cc
.0.9%

ROSC

? ".
ETCO2
( .)40 mmHg

.

.
? ROSC
.
100%

/
.1 meq/kg IV

.IV 25 gr
2
.NA
"


,
.
ROSC

 31

()ROSC

10.

.94-99%
94-99% .35-40 mmHg = ETCO2
( )
ETCO2


250 cc
0.9%
" .90 mmHg

?
:
= 150 mg 10'.
= . 1 mg/min
= .5-20 mcg/kg/min

:


" NA
? 90 mmHg ( IV
.) 100 mg/%

"
0.9%

.IV 250 cc

STEMI
60
150 ? ?

( ) .IV 250 cc 0.9%
'
.IV
ROSC

 32

( : ) H'S and T'S

.3 , ".
.2 . 23%
.2 / (
) . (
, , ").
.3 .
( ) , , ,
.
.2 ,IV
mg/% 333
.6 (.)NA
.2 , , ".
" = " . 23 mmHg

.3 .
.23-22%
.2 . 33 ,
. 22-33 mmHg ETCO2
.2 :

o "" .
o ,
.

.3 ,100 mg% "

.
.2 "" , IV
2.2-2 mg ".

 33

: /
. 10.
: ,
.
1/3 ( 4
" 5" ).
5-6".

100-120.
!!
: 2
2 ,
.
CPR C-A-B

/ .

.
.
. = 1.

(
).
? 2:30

2:15.


( 10")
.

/.

PEA/ASYSTOLE VF/PULSELESS VT . 10
.
10
mmHg .

 34

(*) ( )
. " .

(*) 60 = !!

(*) . .

.3 = .SIDS
= .
.2 22" - ,
, ,'.

( ) :

.3 = ( .2 + ) 2 X
.2 :
2.5-3 :" .
: 2.2" , 2".
: 3" , 2.2".
: = +2.2 ,3/ = +3.3/
.2 " :
: 6 +
: 2 X

.3
.
.2 , "" .
.2 .
.
.3 63 32-23
.

 35
VT/VF

.IV/IO
VT/VF

:
. 2 J/kg
. 4 J/kg
.4-9 J/kg -
2 10 J/kg .J 200

()IV/IO

3-5.
0.01 mg/kg = IV
10 cc .0.9%
0.1 mg/kg = ET 5 cc

.0.9% 5 .

? IV
= . 5 mg/kg
.
= . 300 mg

IV

(.)TDP
= . 25-50 mg/kg
2 ' = . 2 gr
3-5 = 5-10 cc
D5W .NS
push ( 5-10').

ROSC
".
( ETCO2
.) 40 mmHg
? ROSC 12-
20 .
? ROSC


20 cc/kg "
.
IV 0.5
.gr/kg' . gr 12.5 -
2 = ( % 25 )10%
.
IV
.
ROSC ASYSTOLE/PEA / /
TCA . 1 meq/kg IV

.NA

 36

PEA/ASYSTOLE

ASYSTOLE/PEA


2
.IV/IO
()IV/IO

3-5
3-5.

. 0.01 mg/kg = IV
10 cc .0.9%
0.1 mg/kg = ET
.0.9% 5 5 cc
.

? ROSC
".
( ETCO2
.) 40 mmHg
ROSC
12-20 .

? ROSC

. 20 cc/kg

IV
.0.5 gr/kg' -
. gr 12.5 = 25%
( . )10%
.
.
/
2
TCA /
" ROSC . 1meq/kg IV
.NA

 37
-

()ROSC

94-99% 12-20.
( ) .94-99%
ETCO2 . 35-40 mmHg = ETCO2

.0.9%
"
.

= . 5-20 mcg/kg/min
"
? :



NA
( IV
NaCl 0.9%
.) 80 mg/%
.IV 20 cc/kg

"
?

0.9%

.IV 20 cc/kg NaCl

.IV "
ROS

 38

- ROSC

( : ) H'S and T'S

.3 ( (20 cc/kg ".

.2 ( 23%
.)333%
.2 IV .80 mg%
.3 ( ).
(
, ").
.2 .
, , .
.6 (.)NA
.2 , , ".
" = "
.

"

. 23 mmHg
( + 23 mmHg 33 . )2 X
. 23 mmHg 33

.3 .
.23-22%
.2 . 32-23
, ETCO2 22- mmHg
. 33
.2 "" , IV 0.1
mg/kg " , IV . 2 mg/kg

 39




.1 = 37.
? .2 :
? "".
/ ?
=

() .
.3 = ,
() .

.4

= 40-60.
23
' .5
.
?
.6
/ ?
? HR > 100
.
.7 =
1:3 120
?
, .
.8 :

. 0.01-0.03 mg/kg = IV

. 0.05 mg/kg = ET
= .1:10000

63
'

? HR > 100







. ? HR > 60
.

? HR > 60
100%


41

.3 22 ()
.

.3 ( 2' ) . 2
. 6
.
.2 , ,
333.
.2 .
.
.3 ' . ,
.
.2 ' ( )2-33
. (
).

.3 " " ( , ,)
.
.2 23 23 .
.2 / (
, ) . = . 33 cc/kg
.4 ,
( ,)10%
. 60 mg/%
.

 41
/

:

.1 -
.
/.
.
? .
.
" .2 " "
.
/ " .3

,
.
( )

:
3 "

.
?

( 2) :
20 ALS

,

.PEA

Etco2<10 mmhg .


?
" , :


.
.
" ".

.
.
.
/ .
42

. .
. " :
.a .
.b .
/ . .c
.d/.
. " ' ' .
" ".

:
(.)3
= ( )2 .
/ ( )2 .

.3 .
.2 23'
.
.2
. " .
.3 /
.
.2 .
.6 .
.2 " " .
".

43

2016
 44

:
,
,
(

).
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.

:
30
.
(/
).
2
().

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:
" .

!!

,
.

/ :

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(
).
/

5
/" 5
.




/"
.

 45

3-2

( , ,)

/ ,
(
).

 46

,A-B-C , :
.
.
.
.
.

CPAP :



, ,
.94%

" :
100" ? : SL
1-3 ( 1.25 mg )

SL .
IV
IV IV : IV
IV . .1 mg/kg
IV :drip
=
.20 mcg/min
"
=
ACS
.200 mcg/min
IV :push
= 1-2 mg 5-10'.
= 50%
.
"
=
"
.12 mg/hour
5-10'
: IV
=
.5-20 mcg/kg/min

 47

: ( , , ) , , ()3
( volume overload ) , .
: , preload ,afterload ()2
() , ().

( )1 :IV

. .
Drip 2 .
.
- Push 23% . .
- .
( -//) 26 .
" - .
.
. .
( ) :
.100 mmhg
23%
.

( )2:

-
.
.120 mg

: ()3

" , 23 mmHg
.

 48



.94%

, ,
/ = 2.5 mg

.
5 mg =

( ) .
3
20'

.

,
,
( 5 mg
"
/ 5 cc )0.9%
.


+
+
. +.
.
.IV .IV / = 0.5 mg

.IV I.M ..
S.C 0.5 mg =
.IV
, 3 (
).
? ?
?


0.3 mg = S.C .
: : : 0.5 mg = I.M .
.
( IV +.

). . +. 40/ .IHD

I.V
= 2 gr .
"
= 100 cc
5-10'
( 20 cc/min' )500 cc
CPAP D5W 20'.

" "

90 mmHg

49

.3 , (
"" ) ,/ ,
.

.2 :
./ :
- -
.
( 23 ) , (
333) , ,
23% .
. :
. .
- , ,
, , ( 22% ) ,
( 22 ) , ( 333).
. :
/ .
/ , 23% ,
".

.3 :
ICU. .
2 . .
2 " . .
2 . .

 51 COPD
COPD
:

,A-B-C ,

.
. -
.
.

.
.

:

CPAP
.90-94 %


.CO2

+
:
IV
" :
2.5 mg .
:
0.5 mg .

? 2 cc
.

: IV
125 mg .



.

:

"
"
5-10'

 51

- COPD

. 3 CO PD , ,
+ .

. 2 ,
- , .

. 3 , , /
-, ,
.

. 4 :
.
.
.
( ) .

. 5 : C P AP
23%
.
PE E P ( .) 5 cm H 2 O
/ /
.

 52 CPAP

" (
" )


"
,

"

"

.

? CPAP /.
100 "
. mmHg
"
CPAP .

PEEP 5 cm H2O /
.
.
, ,
/ .
/
.

PEEP

"

"

- CPAP
5-10'

PEEP

 53

. 3 ( : ) Acute Respirat ory Failure

2 3% ,
.
. 2 ( : ) Imminent Resp. Failure
.
: CP AP . 2
, /
.

. 3 , , ,
, , , /
, " .
. 2 , ,
, , CP A P P E E P 5 c m H 2 O -
.
. 2 2 - 33 , P E EP
2.5 c m H 2 O . 10 c m H 2 O " "
( CO P D / PE E P = .) 5 c m H 2 O
. 4 , /
.
. 2 - C PA P =
. 15 L PM
. 6 " . CP A P
. 2 , " " , C P A P
, P E E P , 2. 5 c m H 2O - 33 - 32 .

. 3 ( / ) .
. 2 " P E E P / / .
. 2 .
. 3
.

 54

.
/
= IV 0.2-0.3 mg/kg
.
30-60
'.
/ .
/ IV .10

= 0.1 mg/kg
( 3 , ' = 10 mg
) BOUGIE " .

" .mmHg 100

.

? 2.
2.5-5
( mg )
.
.



( = . 2-3 mg/kg
)

0.5 mg/kg

/ .

.
0.5 mg
IV ? /
? .

.

= . 0.6 mg/kg

QuickTrach
" .
55

.3 :
.
.
.
.
.
. ""
/ ( 1-2).

.2 :
. / / .
. , , .
.

:BOUGIE .3
. 6".
. ' .
. ' :
.
.

.4 :
. ( )LMA
. - ,
.
. QUICKTRACH .

.5 :
. .
. .PEEP
. .

56

. ""
(/) + (/) . ""
( ) .IV
*** : ( )
.

.6 :PEEP

PEEP , .

, ARDS ,.

,3-4 cm/H2O .

. ,

.33 cm/H2o

PEEP .

, , , .

- PEEP COPD , .

PEEP " .

 57

, ,

, (
, ).

.94%


IM
0.3-0.5 mg = IM
3
10' .

/
40/ .IHD
1-10 mcg/min = IV

IM
0.1-0.2 mg 5-10.
"


IV
IV 3-5

1 lit/hr .
2-3 lit/hr
4-5 lit/hr


IV = 2.5-5 mg.
3
? ?
20' .

,
,
IM IV ( 5 mg
IV 5 cc )0.9% .

ROSC
/ " .
5-10' . = .5-20 mcg/kg/min
"

 58

.3 , , (,
, , ).
.2 / ,/ , ,
, , , .
.2 , ,
( ,) , , ,.
.3 :
.
/ .
.
" . 23 mmHg

.3 .
.2 .
.2 ()0.5 mg
.

 59

100
/
150.


, . 94%
,
( ) :
.
.

" 90 mmHg/
.
/ .


.
3 .
:
=
/ . 50-100 J
? . 120-200 J = A.FIB
=
.100 J
:
.360 J = LP 12
= .200 J
? /POL VT =
.

= 6 mg .
= 150 mg 10'.
/ = 5000' push..

"

"

IV

 61

.3 ,
( , , ,).
.2 , 323
.
.2 " ,
.

.3 :
23% .
/ .
" .
.2 :
IV 0.2-0.3 mg/kg . IV 2.2-2 mg
.2 :
," mmHg
.23
.
.
, ()WPW
.
.3 :
.
2-33
.
- (.)WPW
.
.2 :
32 , .

 61

,100 QRS>0.12 sec ,

-

? /
150.

:
IV . 6 mg = I
( 12 mg = II/III
).
PUSH +
.20 cc 0.9%
1-2' .

? :


.
IV
:
IV = 150 mg 10
.
.
= .1 mg/min

:

,
(.)TDP
= 1-2 gr 15'.

"
: WPW

WPW


.

 62

,100 QRS<0.12 sec , -

/
150
.

VALSALVA

?


:
. 6 mg = I
( 12 mg = II/III ).
? PSVT PUSH +
.20 cc 0.9%
1-2' .

:

(,
,') /
.
PUSH.
. 2.5 mg = I

? PSVT = . 5 mg
= 10'.
= . 20 mg
" .

IV :

48
.
= 150 mg 10.

.
?
: WPW
IV WPW

.
"
/


IV
?

 63

.3 ( VT : ) SVT ,
, - ( ,)WPW
( ,)TORSADE .
.2 :/ ( ),
SVT , (.)MAT
.2 , 323
.

.3
" .
: WPW .2
( AV-NODE ,
, ,).
.WPW
.3 :
( > 33%
.) EF
,,
'.
333 mmHg ,
.) 3.2-2 gr ( IV
.4 :
PUSH "" , 33-23 cc.
WPW
.
(),
() , .
.5 :
.
2-33 .
.

 64


60
,
, ,".


( )50 94%

:



" 90 mmHg
/


/

:
0.5 mg 3-5'.
= . 3 mg

:
?
.5-20 mcg/kg/min
:

.
:
IV .2-10 mcg/min
"
.

"


.
?
"

.

"
( STBY
type 2 II)

IV

/


"
IV
65

.3 .
.2 .
.
.2 - (: )AVB
( , , ,').
.
(
).

.3 :
( )TYPE II.
.

.2 :

" , 23 mmHg
.

 66
()ACS

ACS


,
, ,".
,
, .
:
.

.
, ,
.94%

:
2 250 cc 0.9%

, ",
?
.
" .90 mmhg

:

:
"
" 160-325 mg.
SL
IV .
:
.5-20 mcg/kg/min

.
IV
: SL
IV 3 1.25 mg
, 3-5.
.
: IV
STEMI LBBB .
?
.

IV
10.
: IV
10 mg PUSH
.

" " : IV
5000 un PUSH".
' . . " .

67

( - )ACS

.3 ACS , , ,/.
.2 // ,.
.2 : , , ,"
.mmHg 23
.3 " ( .) V7-9 ,V4R

.3 :
, ( 2 )
, , ,
.NSAIDS
.
.2 :
" , 333 mmHg 20%
, -
(' -,,) 26 ,
.
" .
.2 : IV
" ,333 mmHg .
2/2 22 .COPD
STEMI .2
0.05 mg/kg PUSH . 5 mg.
1 mcg/kg PUSH . 100 mcg.
.3 :
.
.2 :
, 23 ,
/ , .

 68

:
.
=
.

.
,
, ,

, ,
, ,

.

.

:
.
.

=

.

=
.
=

:
" < 100 mmhg
(
500 NS").
" > 220 mmhg
" > 140 mmhg
/"



/"
(
).

 69

.
/ .
- .

,
,'.
.
.

( ).
/ (
).
/ ( , ,
,').
( , ,').

/
. .
, ,10-15 lit/min

.sat<94%

,
. " (
) .

 71

 71

3.2 .
2 .
, .
' .
" 185 mmhg .110 mmhg
( , ,333,333
, ,').

.
, .
23"
2-33 . 233".
" .
:
" 223" / 333"
.
" 322" / 333"
,
.
:
.
63.
- 2.
.

 72
/
/

,A-B-C ,
=
.
. .
. =
.
.
/ ( ).

:

.94-99 %


? :
. 2.5 mg = IV
. 5 mg = IM
IV/IM/IN
. 10 mg = IN
5-10
' .
" .

.
.
.
.

:

,60 mg% 25 gr( IV

.)25-50%
?

.

"

"
5-10'

73

. 3 2' .
23 = . 6%

. 2 23'
, 2
.

. 2 :
/ .
. 32%
( ) 23% , .
, , ,
.

. 4 .

. 5 :
, , , .
, , .
"" " " aura , .
, , -
, , .

. 6 , ,
, .

. 7 /
( ) ! !!

 74

=
.A-B-C , .
.
=
( .
. .
( ).
. .94-99%
.

60 mg/%
.

? .
'
.

: IV
' PO
= . 25 gr
= . 25-50 %
?

IV 5' .

:
IV/IN =
( ).
( 2 mg = IN
0.4 mg ).

? ( 0.4 mg = IV 10 cc

).

(IN
)IV 5-10
.
".
" .
5-10'.

75

. 3 :
= , , , , , .
.
= , .
,.

. 2 :

, , , " , .

. 3 :

, ( tidal
,) volume , (
) . .
. 2 :
.
( +
).
.

 76
/

6-18

( ) A-B-C"
.

.6

( )
+ .

.20 cc/kg/hr
= 1.

/ :

,,
?
, ,
, ,,

, .

?

(
).
IM/IV .
.
.
.
.

"

" 10" , IM IV
5-10' push ( 3).
2.5-5" ,IM IV
push ( 3).

77

. 3 :
" = 2".
33" . IV

. 2 :
push ,
() , , ( )23
( : )23

, , ,
. ,,
.
( neuroleptic malignant syndrome).
().

. 2 :
' ( ,
, ) ,
.

. 3 ( ) :
- ,
,
,,
, .
- , ,,
.
, , .
, .

78

2016

79

.
( ).
.

( , ,').
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.
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?

? .

.
.
.crowning

:


,

" .
,
.
? .

.
"
.

(
)
( , ,,

').
/

.
.


.

"
 81

!!! .1
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/ . .

. .3
. .2
. .2
" . .3

.3 . !!
.2 ( 3-2' ).
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!!
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.


81

Hands off

" "

:

ALS
"
82

.3 .
.2 . .
.3 !!
.3 .
.2 .
.6 .

83

.3 / .
.
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.
.2 / .
.4 !!
.2
.

 84

.1 "" !!!
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( ).
.
.
.
.2 :
" " ( , , ).

GASKIN Mc'Robberts

 85

:
20

.
:
/.

.I
.
.40
,
,
, .
/ :
? / .
(.)RUQ
.

IV
:
.

" > 140 mmhg/

" > .90 mmhg

/.

:
.
.10 lpm
"
( 160 mmhg/

.)110 mmhg

/"
.

IV/IN
/"


.

86

.
, .
23"
2-33 . 233".
" .
:
" 363" / 333"
-/.
:
.
63.
- 2.
.

. .
2 32-23 .
100 cc D5W .
:
(/ /
).
:
" , .
/ /
, ( 3' )
.
23"
.

 87

2016

= .
= .
= ( , ).
 88

:
,94%

.
?
?

:
.

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

:
.
.
?
/ .

:
= 0.25-0.5 mg/kg
= 5 mg

( 5 cc
?
).

"

10'

 89

. 3 :

- ( . ) CR O U P

. 2 :

/ .

. 2 :

() .

 91

.94%

, ,
= 0.15 mg/kg.
5 mg =
.
( ) 3
20' .
,
,
( 2.5 mg 2 cc )0.9%
.

"
/

:
.0.25 mg = 20 kg

0.5 mg = 20 kg
+
+ / = ..
. +.
.
.IV 3 =
.IV
I.M ( ).
.IV
S.C
IV
= 2 mg/kg .
? = . 125 mg
? ?



: : 0.01 mg/kg = S.C/IM
:
. . = . 0.4 mg
( IV
+.
). . +.

I.V
= ( 50 mg/kg' .)2 gr
= (
D5W )
" ,20% 20'.
5-10'
( 20 cc/kg' )500 cc "

"

.

 91

.3 , (
"" ) ,/ ,
.

.2 :
/ : .
- ,
-
.
, ,
, 23%
.
: .
( ,
, ) , , .
,
, ,,
, ,
( 22% ) , , .
: .
/ .
( /
/) , 23% ,
" ,.

.3 :
ICU. .
2 . .
2 " . .
2 . .

 92 -

/ = . 0.1 mg/kg
' = 10 mg
" .

"
/ .
/ IV
.

3 2.
( - (
) BOUGIE )
.

. 2 mg/kg = IV

? . 0.5 mg/kg
. 5 mg/kg = IM

.


.

( 0.02 mg/kg 0.1
,mg )0.5 mg
/ .



? = IV 0.2-0.3 mg/kg
IV
.
30-60'.
.
.10

= 0.6 mg/kg
"

.

93

- -

.3 :
.
.
" .
.
.
( 3-2 2-33 ,IV .
)IM .
.

.2 :
. / .
, , . .

: BOUGIE .3
. 6".
' .
.
' : .
.
.

.4 :
. - .23%
( .)LMA .
: .
33-22" .Quictrach 2 mm
22" .QuickTrach 4 mm

.5 :
. .
( = 23") . .
 94

"" .
(/) + (/) .
"" ( )
.IV
*** : ( )
.

 95

, ,

, (

, ).
IM
/
.90%

. 0.01 mg/kg = IM

/ = . 0.5 mg
3
10' .

IM 0.1-1 mcg/kg/min =IV

" .1:10000
IV
' 10 mcg/min
IV

. 0.9%
.0.9% ((0.01/0.03/0.05 mg/kg
. 0.9% 3-5
.


? ?
0.15 mg/kg =

. = 5
.mg
IM
IV 3
20' .

ROSC 2.5-5 mg
/ "
5-10' )0.9% ( 5 cc
" .

 96

- -

.3
( ,.)CNS ,GI ,
.2 , , (,
, , ).
.2 / ,/ , ,
, , , , ,.
.3 , ,
( ,) , , ,.
.2 :

.
.
.
" .

.3 .
.2 .
.2 :
/ : MAITENANCE" :

4 cc/kg/hr 33"

50 cc/hr 33-23"

1 cc/kg + 60 cc)/hr "

23"
)23

/ : 20 cc/kg 32-23.

 97





94%

,
.
, " .
/ .

.
220
/ 180 .
P P-R.
R-R.

2 .

.
?
= 0.5-1 J/kg

= . 2 J/kg
=
.

"
?
= 5 mg/kg 20
'.
(25-50 mg/kg = )TDP

10' . = 2 gr
? 0.09 >QRS

( ,)

?

/
IV
IV "

98

.3 ,
( , , ,,
').
.2 :
2' = 233 .
2' = 323 .
33 = 333 .
333 = 33 .
.2 :
. 23 mmHg
( + 23 mmHg 33 . )2 X
. 23 mmHg 33
.3 " ,
.

.3 :

23% .
/ .
" .

.2 :

.0.1 mg/kg IV .5 mg -
.0.2-0.3 mg/kg IV .10

.2 :

WPW.
2 33 .
.

 99

QRS > 0.09 sec

:
. 0.1 mg/kg = I
= 6 mg
( 0.2 mg/kg = II
) . = . 12 mg
PUSH
5 cc.
? 1-2' .
WPW
.


IV .

:
= 5 mg/kg 20-30
. ".
= . 300 mg

?
.

:
IV = POLYMORPHIC
.VT

= 25-50 mg/kg 20
. . 2 gr

2 .
.
= 0.5-1 J/kg
" = . 2 J/kg
/

 111



QRS<0.09 sec
PSVT
( ,
, ).
220
180 .
P/.
R-R.

( )6
? .

.

:
( ,)
0.1 mg/kg = I =
. 6 mg
( 0.2 mg/kg = II/III ).
= . 12 mg
? PUSH
5 cc.
1-2' .
WPW.

IV
.

:
20-30
= 5 mg/kg
".
.
. 300 mg
=

?
.


2 .
" .
/ = . 0.5-1 J/kg
IV = . 2 J/kg

 111




"
,


-

:
= . 0.01 mg/kg
3-5.
/ ET .0.1 mg/kg

:
= . 0.02 mg/kg
60
' = 0.1'.

? ' = 0.5'.

ET 0.05 mg/kg

(
) 2 :

.

IV
60
(' 5 mg 0.1-0.2 mg/kg
?
).

"

IV
/
IV
"


 112

.3 .
.
.2 / ".

( /
) .
= 333
= 3/2 ( 3" 2" ).
= 23:2 32:2 ,

IV = . 3 mg
ET = . 2.2 mg

 113 /

/
=
.

,A-B-C , :
.

.
. .94-99 %
.
.
:
. 0.1-0.2 mg/kg = IV
= ( 5 mg
)6 ( 10 mg
.)6
. 0.2 mg/kg = IM

? 6 mg
. 0.2 mg/kg = IN
. 10 mg
5'
IV 10' IM
IV/IM/IN .
" .

.20 cc/kg

:
.
. ,60 mg% IV
. ( 0.2-0.5 gr/kg =
(12.5 gr 25%
( = .)10%
5-

" 10 .
"
5-10' .

114

. 3 2' .
23 = . 6%
. 2 :
6' 2 2-2% .
. '
22 . -.
/ ,
, ,
.
. 2 23' ,
2 .
. 3 :
/
. 3-6%
( ) 23% , ,
, ,.
. 5 :
, , , ,
, .
"" , ,
" " aura , , ,
- , ,
.
. 6 , ,
, .
. 7
( .) ongoing

/ (
) ! !!

 115

= .

.A-B-C , .94-99%
.

( )
. 60 mg/% .
( ).
. .
.
'
. 6 .
6 .

? : IV
= . 0.2-0.5 gr/kg' -
. 12.5 gr

= ( 25 % )10%
' PO
.
?
2-3'.
5'
IV
.

IV/IN
:
=
( ).

? / '.
= IN' ( 2 mg

.) 0.4 mg
( IV .0.1 mg/kg = )20 kg
' ( 2 mg 10 cc
).
( IV ( 2 mg = )20 kg
10 cc ).
(IN
".
)IV 5-10
" .
5-10'. .

116

, , , (),
/ , , .

. 3 :
= , , ,, .
,.
: .
= , , , , ,
.
= ,
,.
. 2 :

, , , " , .

. 3 :
, ( .
,) tidal volume , (
) .
.
. 2 :
. .
( + .
).
. .

117

2016
 118

0
''
/
( ) :
/ ,
.
(
/. 30
' . 8
)90% ,
.
.
(,
, , ,)
.

.
, " , . (
,
- A (//). , /
).
- B ( , ,).

C ( , ). ( ,
/ , ) ,
.

,
.

30' ?
'' :
.3 33.

+ .2

( 2) :
( ).
! .


! .90 mmhg-
333

: :


: IV

IO/ 2( 1 gr -) 100 -
cc 33.


( 15 mg/kg -' 2)

" 50 cc - 33.
"

119

.3 " .
.2 , ,
, , , ".
.2 / , / ,.
.3 ( , ,').

.3 :

.
, " (
).

.2 :

( ).
( - ,
, ").

.2 , " :

.AVPU
" .
( - ,
).

.3 :

(.)jaw thrust
, .
.
2 ( ) .
.

.2 :

111

( 2 ) 2-33
.
( 23 ) .
, ,/ .

.6 :

( , ).
.TCPA
.

( )
.3 (.)A-W
.2 " ( , ).
.2 ( , ) . IO/
. .
.3 ( ).
.2 ( ).
.6 ( ," , ).

( )
.3 ,GCS.
( IO/ ) . ( .2
, . 250 cc - 20 cc/kg , )
, " 100 mmhg
. 3-2 .
.2 ..
.3 ( ," ,.)ETCO2 ,
.2 .
.6 ,
.

( TBI ):
.3 .23%
.2 ( ) ETCO2=35-45 mmhg -
111

.2 " 333".

.3 " !!
.2 ( )A,B,C .
.2 .
.3 .

.3 ( )IV/IO = .2-3 mg/kg ( )IV/IO = 1-2

. mg/kg
.2 - .
3/2 .
.2 ( )IM = .5 mg/kg 2-2.
.3 ( ,2.5-5 mg - 0.1-0.2
)mg/kg
.2 ( 0.02 mg/kg IV .)0.1 mg

112

) Traumatic Cardiopulmonary Arrest ) TCPA

:
.3 ( ALS )
:
o , .
o (.)RIGOR MORTIS
o .
o (.)LIVOR MORTIS
.2
( " ) ,
" .
.2 (") ,
- .TCPA
.3 ALS
,
PEA . 33 -
.2 ,
, :


( ) PEA
.
.
.6 " . "
32 - ,
( , * ,) -
. ,
( ) - .
.2 ,ALS , TCPA
-:

113

( VT .) VF
( ).
( .) NA
( "
) .
.2 " 32 -
( ) .
33 . TCPA
.2 ALS
.
.33 :
.
( 22
).
" .

/ .

.11 :

.
(*) ,
( 33).

 114

()TCPA '

( ,
, ).


.
.

PEA 40 ?

" .
(.)VT/VF

? .
.
(.)NA

?
:

.
.
.

, , ,
.

15 ?

/


.6
?

 115


"

".

?
,


? ?
? .


"
.

.
"

" :
.
/ ? .
"
? "
? .
.
()
.

? :
"


( ).
/
("
,
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, ,').
? /
?
.
.


" " .
.

 116

.1 :
: .
.3 (.)GCS<15
.2 (.)TBI
( , , .2
).
.3 //.
.2 "" ( , ,').
.6 ( ,').
.
.
(/ , , , .
,)
" .

.2
:
. .
. .
. .
. .
. .

.3 :

 117

(/)
.
.

A-B-C "
/.
/ =

.
= .1-3

= .4-6
= .7-10

= .500-1000 mg
= .15 mg/kg' .250 mg -

= .500-1000 mg
= ( 20 mg/kg'500 -
.) mg

/ / / = .50-100 mg
PO PO .
IV .14


IN/IM
= .0.05 - 0. 1 mg/kg
= . 10 mg

?
/ ?
IM/IV
= .1-2 mcg/kg
' = . 200 mcg

IN
= 1.5 mcg/kg
IV ' = . 100 mcg

IV
/ 10-15.
"

5-10' = .0.2 mg/kg
5-10.


= .1-2.5 mg
= .0.05 mg/kg' 2.5
.mg
.

 118

!!!

.3 . .
.2 :
.G6PD
.
( ) (
).

.1 .14
.2 .
.2 : .

(/)

.3 2-33 ( ).
.2 22 2/2( COPD).
.2 .
.3 = ( 3-2').
.5 :
.
.
.

.3 .
.2 .
.2 ().
.4 :
.
( 323).

( ) .

 119

"

/ "

.

A-B-C "

.
94%
( 4 .
).

/ ( ( IV
) . 250 cc
, 20 cc/kg).
/ ( ).
/ .
.

/. , ,

/.

( ).
?

.

(
).
/ /
"
(

10' ).
"

121

.3 /.
.2 .
.2 ( ) , .
.3 .

.3 .
.2 ( , ).
.2 ( , , ).
.3 ( , , , ,).
.2 ( ,) .
.6 / .
" " (.)compartment synd.
.2 / .

.3 ('
) .
.2 ( ) .
, , .

 121

(//)

:
, , .
.

? / ( !!).

.



:

""

, ,'.

? A/B

( , ,

.
,') ,
" .CO
.
(
" ") .
.

.
/
"
.

/ .

" / ( )

( ) .10%

/" 20 cc/kg
.

122

" " :

.
/ (
).
"" .

- 33% ( ).
- 33% .
.

( ) . .
32'
.
"
.

().
() .
.
,
.

123

"
" ( ) . !!
" ,
, ,
. 2332"
" ( ).
" .32
- 2332" .

, " . 2332",
, , , " ,.

.1 :
" .
( A-B-C ,
, , " ,
, ).
.
, :
(
/).
( 23% /
).
/ ,
( / ).
( ) 23
( ).
.ALS
.
" . , "

 124

, 33
.
( = : )32 .
/ ,
.
33% .
33% .
"" ( , , ,
).
.

.2 :
" , .
, ,
( ,
/ , ,
, , ).
, . .
( ,) ,
, , , .
.
.
( .
) ,
" .

 125

, , II
,
, - III
' ' .

III II I

 126 "/

"/

.
.

.

,.

, ,,
() ,
), ,QT ( "
, ,
.

(
) , ,
IV
, ,
IV
( ) ,
,.



IM/IV/IO
1-2 mg ,
.
2-4 mg .
?
0.02-0.05 mg/kg

.
5

(
).

IN/IM/IV/IO
5 mg .
5'
" .0.1 mg/kg
5-10'
" . 0.1 mg/kg
5.

 127

.3 (
32-23) , , , ,'.
.2 (
+ +) .
.2 QT WCT .torsade de pointe

.3 "/ .
( / ).
.2 " (
,500 cc .)20 cc/kg
.2 torsade de pointe
( 2' 20 cc D5W 33-
32 , 50 mg/kg 10 cc .)D5W

 128

:

.

.
,,
/. . PO

:
( 40)
(,
"
) , /
/
.
"

" ( , ,).

"
.

/
:

/
.

:


0.9% (

),

.
:
. 1 L/h
.20 cc/kg/h -
"
5-10' :
" .0.5 L/h
.10 cc/kg/h -

129

.third space

( ) . .

.
.

T , ,PR ,ST .QRS

, , , ,.

( ) :

: 22 gr 233 cc .2%

() /
, .
- 23 mEq 3333 cc.

/
.
3 mg/kg - .

/ .
5 mg.

".
( )10 cc ,10%
( 3-2).

 131

:

.
,
.

:

.
32C 35C -
28C 32C -
- 28C

:

.
.
.

-
(
500 NS").
:

2

.
.5-20 mcg/kg/min -

/"


/"

 131

.
' , , , , ,
.
( ) , (
) , .

, , " (
).
, , .
,.

/
' 22 .
' 23 .

 132

, ,
, ,

, ,,
.

,
,
, ,
? .

()

" / .




22-33 ,
(

2% ).

,
' .
-' 40
.

.
. -
!!!
(
. ( ) ) , ,
. . /. - IV

.
. .
500 cc .
20
.cc/kg

" , .94-99%
.
" " ".

.

 133

(: )HEAT CRAMPS
.
,
.
+ = .
( " " ) . "
, .

(: (Dehydration
/ - 33% . ,
, , , , , , ,
, . - ,
/ , .
33% .
/ , , , ,
. - ( ,)A-B-C
( ,)94-99% , ,
".

(: )Heat Exhaustion
22-33 , , , . .
+ .

(: )HEAT STROKE
40 , ,
( , , ,') , , ,
( ).
- , / ,
- ( ) , ,
,') , ()
, ( ) . ' 40
!!

!!
.

 134

.


( ) A-B-C" .

.

.

.

?
,
, .

( )

IV .
IV .
/ "
90" (
).

,
IV
(
).
: IV
12.5 gr 33
" .
" ( 400 mg/kg' )12.5 gr
33.
5-10'
: IV
5 gr 32
.
( 70 mg/kg' )5 gr
32.
 135

. 3 :


( , CO , , ' ) .

: . .3
: .2
.
: ' . .2
, ,
, , , . - .
: , , PCO 2 , .3
.
: .5
, , , . .
, .
.
, .
: ,
/ . . .
/ " 2 3" ( ) .

" :

. 1 :
, .
" , ,
.
. 2 :
, -
.
" , , .

 136

.

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

:

? .
.
.

.

:

.

0.5-1 liter.
CPAP
/
.20 cc/kg
/ .

:

I.V PUSH 1 mg/kg

( )
:
:

IV
/
10 mg

2.5-5" ,IM IV
push ( 3).

 137

()Submersion Injury

( )submersion injury ,
, .
, ,
, /
.
,
.

( )submersion injury
:

, . .
- , , .
.
. . .
( 22 ) - .
, , ,
.
IV , PUSH 1 mg/kg . .
/ - .IV 10 mg .
. / .
.

138

2016
139

.
. Class A

.
.3 ,
.
Class B
.2 ,
.

.
.3 ,
. Class C
.2 .

.
Class D
.

! , ,
. Class X

N/A

141

Adenosine

,AV node .reentry

,P1 . ,
CAMP
.(Coupled G Proteins) G
, 33
,Sick Sinus Syndrome ,

. .
,flushing , , , ,

I.V
"
: ,6 mg 12 mg
: ( 0.1 mg/kg ,) 6 mg
( 0.2 mg/kg ) 12 mg
Class C

:


, ,

, ,

141

, Epinephrine, Adrenalin -

() renes ad
() " " ,
.
epi nephros
.
. ,

.
,
. 3
, " , .
2
, .
,
, , ,
- .

Tyrosine DOPA Dopamin norepinephrine Epinephrine

2 ( 2-33 ,)IV ( .)SC

2 ( ,)IV 23 ( .)SC
2-33 ( 23-23 ,)IV (.)SC
()IHD ,
, , , ,

, , ,
/ , ,,

,
:
,VF/Pulseless VT 1 mg : PEA

2-2 ()I.V,I.O
3 mg : E.T 5 cc
 142

,2-10 mcg/min :
1mg/100cc = 10 mcg/cc
0.3 mg : .S.C
1mg : 33
3cc
:
, I.M 0.3-0.5 mg
2 33
.
I.V 1-10 mcg/min :
1mg/100cc = 10 mcg/cc :
: I.V .
:
,PEA ,VF/Pulseless VT
( 0.01 mg/kg : )1mg
0.1 mg/kg : E.T 3-5 cc
2-2.
:
/( I.M 0.01mg/kg :' 0.5
)mg
.iv 0.1-1 mcg/kg/min :
' 10 mcg/min
:" .
.S.C 0.01 mg/kg :' 0.4 mg
() :
.0.25-0.5 mg/kg' .5 mg
.5 cc
IV,IO,ET,IM, SC, Inh "
Class C
: .
- .
,VF/Pulseless VT ,PEA,
, , ,

, .

143

Dipyrone or Metamizole sodium

,
.
,
( )adenylate cyclase ,/
.
3222
3222
(
) . 2333

,
" .
: . 63 23 : ,
3-6 : , 3-2 :
.
, ( G6PD ).
, , ,
,
) 1 Tab = 1ml=25drops=500 mg ( 500 1000 mg :

( 20 mg/kg : )500 mg
P.O Tabs , Sol
"
Class X
:

 144

Etomidate,


( .)Rapid Sequence Intubation
,
( ,)ICP
. ,
. ,
.
,
" GABAA
"" .
( ) ,
(" 33
) .

,
.

. ,
"
2-33 . ,
." ,

( ).
23-63 : . : .

2-2 : . : 22.
, , ( 10

).
( ).


( )
.

 145

.
"
.
Opsoclonus
.
.

I.V.
"
0.2-0.3 mg/kg
Class C

: .
(
)
,
( ,)10 ,

146

Atropine -
( )

.Atropa belladonna
, ,
. , , ,,
, .
, , (
).
-Atropa" Atropa belladonna .
Atropos
( ) Belladonna .

.

- .
, SA Node- AV Node

. - " -
. ,
.
, 2-3 ( ,)IV 2-2


, , 2
, , .

,VF ,VT , , ,
,.

0.5 mg : 2-2 3
.mg

.0.02 mg/kg : ,0.1 mg
.0.5 mg
147

" ( ) TA
,3-2 : ( 0.5 mg : ) , 2 :

2-33 : ,63 ( 1 mg : ) , 2 :

,33-63 : ( 2 mg : ) , 2 :

)I.V , E.T, I.M (auto injector
"
Class C

:
, ,

 148

Isosorbide Dinitrate-

:

( .)Pre-Load
-
( ,)After-Load .
,

33%-23% .22%
. ( , first
)pass effect ( 2
{ }23% 2 { .)}23%
, 2
2.
3-2 ( 23 ,)SL,IV ( .)transdermal
2-33 ( .)SL,IV 23-23 (2- ,)SL
6 ( .)transdermal,IV 63.
" 333" , 23%
, , 26

- , ,
.
, , ,

)I.V, S.L(spray
"
( 3-2 : )SL .
( : )IV , 20 mcg/min
23 2-33 , 200 mcg/min

( 6mg /100cc = 60 mcg/1cc : )1drop = 3 mcg
23% I.V PUSH 1-2mg 33
.
Class C
: .
.
, ,

,

 149

Verapamil -
,

.

( ) .
.
sinus
. AV-node
,"
.

, ,
.

(. )cluster headache
,
2.2-2.2 . First
.pass effect
,Severe LV dysfunction ,Sick Sinus Syndrome ,
Lown-Ganong-Levine ,WPW ,
,Syndrome .
, , , ,

( ,)Ecchymosis , , .
I.V "
2.5 mg :

5 mg : 33 20 mg
Class C
: .


.
, ,

151

Ipratropium Bromide

, .
.
-
.CGMP
,
. ,
, .,
B.B.B
.CNS
33% 3.2% ,
. 3.2-2 . 3-6 .
3.2-2
( )narrow angle


, , ,
" ,
COPD ,

Inhalation
"
. Inhal 0.5 mg : 2 ( ).

.inhal 0.25 mg : 2 ( ).
Class B

:
, COPD ,

 151

Amiodarone -
()class III

, ( 3
) " ,
.
- ,SA node
, ,reentry
,QT ,QRS ,PR ,
.
, 33% 23-32
, , ,
, WPW
, " , , ,
,QT VT

I.V
"
:
300 mg :VF/Pulseless VT ,D5W 20cc 150
mg
,ROSC , *-
150 mg/10 min : ,D5W 100 cc
1mg/min :
* 32

2cc=100mg : 100cc D5W
:
5 mg/kg :VF/Pulseless VT D5W 5cc
/ 5 mg/kg : 23-23

Class D
:
.

 152

" " ( )
.
"" ( ) ROSC ,
.

 153

Acetylsalicylic acid -
, ( ,)NSAIDS ,


,
( )Spiraea .
.

.

33,333 .
COX (
,)NSAID"
, .
A2
,
A2 .
- .
2-23 , 32
, 3-3 , 2-32
( ).
, , .
.NSAID

Reye's syndrome
.
, ,- ,
, , ,
160 325 mg

"
Class C Class D .

: .

154

acetaminophen -
,
.
, ,
.
(Non-Steroidal Anti
) NSAID Inflammatory Drugs

. 23
CNS (Central ) COX3 (Cyclooxygenase 3
) Nervous System .
COX1 ( COX2 ) NSAID
.
, 3-2,
2-3 , 3-2 .
.

, .

, ,
,
.15 mg/kg : 250 mg -

500-1000 mg :

"
Class B

:

 155

Dopamine -
,
.

. ( )2-5 mcg/kg/min
.

.
( 5-10
)mcg/kg/min ,
. ( 10-20
)mcg/kg/min ,"
.

Tyrosine DOPA Dopamin

2 . 33.

2.
( ),

() , .
() ,VT ,VF ,

, , .
"
5-20 mcg/kg/min
400mg(10cc)/500cc OR :
80mg(2cc)/100cc = 800 mcg/cc
I.V "
Class C
:
.
, , ROSC ,

156

Midazolam -
() ,
()
, ,
.
GABA GABAA .
GABAA
: , , , ,
, .
2-2 ( 6-33 ,)IV ( .)IM/IN
23-63 . .
3-3
" , ,
, , , ,


, ,

I.V, I.M. I.N
"
( ) :
IV 0.1 mg/kg .10 mg
( ) :
( I.V 2.5 -5 mg ).
,I.V 2.5 -5 mg :
2-2 .
/ 5 ( I.M
) mg .) 10 mg ( I.N
:
.IV 3.3-3.2 mg/kg = ( 2 mg )6
( 33 mg .)6
.IM/IN 3.2 mg/kg . 6 mg = IM
.10 mg = IN

( 2' IV 33' .)IM
( Class D ) (
157

).

.
: .
.
,

, , , ,

.

 158

Dextrose - 50%
( )
. () .
( )
( )ketone (.)ATP

( ) (
)NADH ,FADH2 ,GTP .
ATP

. ,
() .
.,

.



, .
-.

)I.V (glucose 50%), P.O (glucogel 15gr
"
22 :' 22-23% .
. 0.2-0.5 gr/kg : ( .22%
.)33% . 32.2'.
.
' : .15gr .

Class C
:
,

 159

()Cyanokit
, B12
( B12
, ) .
" .

.

"
. "
,
. ,
.
. ,

.
, , , , ,
, (
) , .

.

' .
line
.

( .I.V )
"
5 gr 32.
( 70 mg/kg' )5 gr 32.
211"
.Class C : .

.

, , ,

, .

161

Haloperidol -
.

.Dopamine inverse agonist ,
( ,) D2
. ,
H1 ,M1
.
.
' , 33-23 ,

33-23.
, ,.
, , , , ,
,.
.QT
-
.
,
.

. , .
,22 " /
.,
.
,

.QT
,
. .

I.M
"
, I.M 2.5 mg : 23-23
161

: 36
22 .
Class C

: , .
, .

() , ,

"" .

.

 162

Heparin -

.
.
.
,
.
.
, .
( )mast .


.
.
( )XA
.
3333 .
, 63

63 .
,
Heparin Induced Thrombocytopenia

.

. ,
I.V "
5000 I.U
Class C

:
, (

) , .

,ROSC ,

 163

Tranexamic acid -

,
( , ,
) . .
-
.
: . 2 : .

:

, , , .
( )1 ml/min
.

,I.V.
"

3 -' 100 cc , 33
,
( 15 mg/kg' 3' = 2) 50 cc
, 33' , .
,

Class B :
:
)3
: ,. 23" , 333
, ,
.
)2 ,
, ( , ,')
.
:
( , ).

164

Salbutamol -

,2
. " .
3
2-32 , 3-3.2 ,

2-6 , 2.

, , , ,

, , , , ,.

Inhalation , E.T.
"
:
5 mg : 2.5mg , / (
)
,2.5-5mg :
23.
2.5 -5 mg : 5cc
:
0.15 mg/kg' 5 mg :

Class C

:


, , ,

165

Tramal -

" GmbH 23
.
-opioid receptor agonist, serotonin
.releasing agent & norepinephrine reuptake inhibitor

,
.
.O-desmethyltramadol 233
6 .

.
( ) .
: , 3.2-2 , ,
2-2.
( MAO Inhibitors
) , 33
, , , , , ,,
.
)P.O (Drops, Flashtabs
!! "
)50 mg = 20 drops or 1 Flashtab( 50 100 mg
Class C
: .

166

Labetalol -


, 3 .
(
) . =
.
: , 2 , 2
.
, 63
, , , .

I.V bolus
"
,20 mg , 2-33 ,
.
= 300 mg
Class A
: .
(" )



, ()

 167

Magnesium Sulfate -

, , ( MgSO3
) .
. ,

.
, .
- " .
23
, ,
, ,CNS/ ,
( ) , ,

( ) , ( , )TDP.
I.V "

:
( Pulseless VT 1-2 gr : )TDP
: 10-20 cc D5W .NS 2-
33'.
( WCT 2 gr : )TDP
. 2-3 gr :
() . 5 gr :
: D5W 100cc .
32-23'.

:
( Pulseless VT ( 25-50 mg/kg : )TDP' 2
').
: 5-10 cc D5W .NS 2-33
'.
( WCT )TDP 25-50 mg/kg :
( .' 2').
: 33-23% D5W
.NS 2-33'.

 168

Class A
:
.

, ,VF/Pulseless VT

- , , ,/.

169

morphine


.Morpheus .
/
.

. ,
, .
: , ,
.
,CNS
.
.K
, 323
. ,
.
, .
, , , , ,

I.V
"
0.05 mg/kg : .5mg
33.
,0.05 0.1 mg/kg, : ,10 mg
2-33.
Class C
:

,
, ,

 171

Naloxone -
-

.CNS ,
.
) ,Thebaine (paramorphine (
) , .
( oxymorphone
) (N-
) methyl ( ) allyl N-allyl -
and oxymorphone
2 . 2-2 .

23 . 63-23
.
, , , , ,

I.V , I.N
"
0.4 - 2 mg :IV 10cc.
: IV
23" = 0.1 mg/kg 10cc
2 mg.
23" = 2 mg.
.
2.
.
. 2 mg = IN
( IV 2-33 )IN
.
Class C


. :
.

 171

Sugammadex -

""
," -
.
, ""
( ) .
, .
,
( ) .
( )
2-2 .IV



I.V
16 mg/Kg .
= 3233'.
Class C
:

can't intubate can't ventilate .

 172

Sodium bicarbonate -

.

, ,
.
. pH
- . ()Na+
( )HCO3-
( )H+
( .)H2CO2

. .
,
, "
.
3-2

, ,CHF, Hyperosmolar ,
syndrome

I.V
"
1 mEq/Kg
Class C
:
, , ,
( ) ,

, VF/Pulseless VT VF/Pulseless VT , ,
PEA

173

Sodium thiosulfate ,

,
, .

.
,

.

, , .
,
.

.

.
, ,

I.V.
"
12.5 gr 11.

( 400 mg/kg' )12.5 gr 11.
Class C

:
.

, , ,

, .

174

Methylprednisolone -
-
,
. ,
" ().
2.2-2.2

, , , .

" .
/ , .
" .

I.V
"
:
, I.V 125 mg :

:
, I.V 2 mg/kg :
Class C

.
.


, , ,

 175

Furosemide



.
" .
.
( ) Na+ ( )Cl- ,
.

, .
.
( ) , pre-load
" " .
2-33 . 23-63 .

6 . 23 .
, ," ,80 mmhg -

()hepatic coma
,-" , , ,

.
, , nephrotic syndrome ,
, I.V 1 mg/kg
. ( .) = 120
.mg
I.V
"
Class C

.
: .
.

176

Fentanyl ,


. ,-opioid
333 .
.CNS
,
, ,
, , .
,
.
'23 "
-
. ,
.

.
3222
. 2332
''
.
, 2-3 ,

23-63.


.
, , ,,
, , , ,.

IN/IM/IV
"
.1-2 mcg/kg

' = ( 200 mcg .)100 mcg IN
 177

2-33
.
- IN 33-32
.
( 22)
( 2/2 )
Class C

: .




ACS ,

 178

Metoclopramide
, ()Gastrokinetic
,
.
, :
, , , ,
. ,
. ,
,
.

,D2 CNS Chemoreceptor Trigger
) . Zone (CTZ ,
. ,
,,
.
.
3-2 ( ,)IV
, 2-6.
.6

. .
,
: , , .
, , , (
) , .

( I.V. push 2)
"
10 mg :
(2.5 5 mg : )6-33
Class B
: .

179

.
,

.
.

 181

ketamine
,

)N-methyl d-aspartate( NMDA

(keto-
.)amine ,3262
(" ;PCP ") .
,

- . , "
"
. ,
"" ( K-
.)Hole
, .
,
.
"" .
. ,""
.
.
. ,
32 23-.

"
.
(
) : , , , ,
. : ,

.

NMDA .

181

HCN1 "
( )hyperpolarization-activated cyclic nucleotide
. " NMDA
.
23
( 2-3 ) .
32-22 . 2.2-2.
( )
, , , , (

),

I.V , I.M
"
:
2 mg/kg I.V 0.5 mg/kg

5 mg/kg I.M
,0.2 mg/kg - I.V : .
Class C
: - . , 33
, .
, , .

, , ,

182

Calcium gluconate -


.
, .
, ,
.
.
, ( ATP )
. ,
( )Ca++ .
,
, (.)Tetany

,VF , ,
,IV--" , , ,-
, ,
,
1.5-3 gr 2
I.V
"
Class C
:
/ (
)

 183

Rocuronium
nondepolarizing
()
. motor end-plate
.
( 23-33) .
(
, ,') ,
, .
3-2 , 23-33

, ,

I.V
"
- 0.6 mg/kg

1 mg/kg - RSI
Class C

:
( 23-33)

*** : ( )
.

184

2016
 185

. 3 " " .
. 2 , ,
"" .
. 2
,

.
. 3 " ,
, ALS BLS
( )
.

. 3 ( =
, ).
. 2 /
( , ,
,') .
.
. 2 "" .

. 3
. ,
.
. 2
( ) .
BLS .
. 2 -
. "
.

 186

. 3
( ) .
.
. 2 ,
.

.
. 6 ,
, ALS
. BLS
.

. 3 , "
(
).
. 2 23.
. 2 23
.
.
. 3 (
) .
. 2 = .

. 3
.
. 2 BLS
. ALS
. 2 , BLS ,
( ) ,
.

 187

. 3 ,

. ALS
. 2 (
) " ALS.
. 6 /
( ).

 188

. 3 " "" (
/ ).
. 2 :
.
.
/ .
.
. 2
" . "
.
, ALS . 3
// " ( ALS
).
. 2 BLS ,
// " ( ALS
).
. 6
( , , ) , ( )
".
. 2 .

" ( ) " .3
, "
.
" , .2
"
( .) ALS
/ .2
.
.

 189

( ) .3
/ " ."
, .

. 5 :
" : .
) a "
? ?
) b
?
.
.
.
( ) " .
, /
,
.
' ' .
, .

.

" " , " .3

2.
.2
, , .
/ , .2
,
.
. , .3

.

 191

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 283

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 284

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285

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