2015 ACLS流程圖 (公告)
2015 ACLS流程圖 (公告)
2015 ACLS流程圖 (公告)
&
&
A1-A9
1
&
(AHA 2015)
ICU
ED ICU
2
&
AHA Highlights (A2)
BLS CPR (AHA 2015)
1
10
10
AED CPR
2 CPR
AED
AED CPR
CPR AED
AED
1
30:2
1 2
2
30:2
15:2
100-120 /
6 1 10 /
100-120 /
2 5cm*
3
AED(Automated External Defibrillator)CPR(cardiopulmonary resuscitation)
*
&
2
5
AED
5-6
10-12 /
3 2
4
()
2
10 ?
CPR
CPR
Naloxone
6 AED
CPR
30 2
AED
7
AED
8
9 10
1
CPR 2
CPR 2
AED
AED
ALS
ALS
4
&
(AHA 2015)
/ CPR
(5-6 )
100-120 /min
CPR
/
2
30:2
VT/pVF Asystole/PEA
- PETCO <10mmHg
2
Torsa de CPR
-<20mmHg
CPR
CPR 2
IV/IO 2 (120-200J)
360J
Epinephrine 3-5 1mg IV/IO
Amiodarone IV/IO
6 (
10 )
ROSC
CPR 2
CPR 2 PETCO (40mmHg)
Amiodarone 2
()
check pulse
pulse: Hypovolemia
pulse: Hypoxia
Hydrogen ion(acidosis)
/ Hypo-/Hyperkalemia Gas
Hypothermia
5 7
ROSC 10 11 Tension pneumothorax
Tamponade, cardiac
ROSC Toxins
Thrombosis, pulmonary
5
Thrombosis, coronary
*
synchonize(R)
Rate
volume &
Tachycardia
()
ABCDE
12
* 1. 3.
3
2. 4.
Amiodarone 300mg IV
10-20
QRS (<0.12 )
Amiodarone 900mg
24
QRS QRS
QRS
12mg
12mg Beta
>48
()
QRS Amiodarone 300mg IV
20-60
( torsade de pointes- 900mg 24
12 ( beta )
adenosine
QRS
6
&
ERC 24 (A6)
1
()
ABCDE
12
1. 3.
2. 4.
(Atropine) 0.5mg IV
*
Aminophylline
Dopamine
Glucagon ( beta
)
Glycopyrrolate
atropine
7
&
3 5
ST
>0.1mV
/0.2mV
LBBB
6 7
c troponin c troponin
= ST =
4 8
ST ST
ST
/
TIMI, GRACE
8
&
(ERC 2015)
1
2
>90mmHg 3-5
3
150-300
4 7
ST ST
5 6 8 9
enoxaparin enoxaparin
bivalirudin bivalirudin
fondaparinux
enoxaparin enoxaparin
Ticagrelorclopidogrel
bivalirudin Ticagrelorclopidogrel
Ticagrelor fondaparinux streptoainase
9
&
(ERC 2015)
ERC 30 (A9)
1
94-98%
2
12
>100mmHg
()-
3
32C-36C
6 7
8 9
10 11
12
32C-36C24 72
(ScvO2CO/CI)
()
72
13
14
10
ICD
&
A10-A20
11
&
ERC 6 (A10)
(ERC 2015)
12
&
ERC 7 (A11)
CPR 30:2
AED
13
&
ERC 15 (A12)
(ERC 2015)
4 3 9
?
5 10
ABCDE
6
CPR 30:2
11
7
/
12
8
14
&
ERC 18 (A13)
CPR 30:2
/
(VF/Pulseless VT) (PEA/Asystole)
CPR 2 CPR2
ABCDE
SaO2 94-98%
PaCO2
12
Hypoxia Tension pneumothorax
Hypovolaemia Tamponade (cardiac)
CPR / Hyper-/Hypokalemia, metabolic
CPR / Hypothermia/hyperthermia
- Thrombosis-coronary or pulmonary
Toxins
(IV/IO)
3-5 adrenaline
3 amiodarone
CPR(ECPR)
15
&
ERC 25 (A14)
(Airway)(Breathing)(Circulation)
(Disability)(Exposure)
(A) / (B) / (C) 1
()
16
&
ERC 26 (A15)
/
?
ALS
Hypoxia
Tension
ALS
Tamponade ()
/
Hypovolemia
1.
2.
3.
4.
5.
(proximal aortic compression)
6.
(thoracotomy)
17
&
ERC 27 (A16)
5 /
30:2
AED
18
&
ERC 29 (A17)
CPR
60min (30)
ALS
2
1
()
>60min (<30)
5
CPR
Asystole
8mmol/L
6
(ECLS)
>8mmol/L
CPR
1.
2.
()
3.
1
4.
<28
5.
CPR
6.
19
&
ERC 34 (A18)
(ERC 2015)
1 2
3 4 5
6
SSEP
-NSE
7
72 M=1 2
8 9
1.
2. N20 SSEP <5%
35
10
24
11
48
12
NSE
/
13
14
20
&
ABCDE
6.5mmol
21
&
(AHA 2015)
1
119 AED Naloxone
2
CPR
CPR*
2 CPR
119 Naloxone AED
3
Naloxone
Naloxone
2 0.4
4
4 5
?
CPR Naloxone
6
CPR AED
* CPR *
22
&
B1-B4
23
&
2
5
3-5
4 12-20 /
3 60
()
2
()
10 ?
2
CPR
CPR
6 7
(
?
) AED/
8
CPR
30 2
15:2 )
AED
9
2
AED
10
AED
11 12
1
CPR 2
CPR 2
AED
AED
ALS
ALS
24
&
2
5
AED
3-5
3 12-20 /
4 60
2
()
10 ?
2
CPR
CPR
6
CPR
CPR
30:2
15:2
AED
7
AED
8 9
1 CPR 2
CPR 2 AED
AED ALS
ALS
25
&
(AHA 2015)
CPR
CPR (
)(
100-120 )
/
15:2
VF/pVT Asystole/PEA
CPR Epinephrine IO/IV
IO/IV 0.01mg(0.1ml/kg
110000) 3~5
IO/IV
0.1mg(0.1ml/kg
11000)
Amiodaronec IO/IV
5mg
VF/pVT
2
Lidocaine IO/IV
1mg
20-50mcg
CPR CPR (>15
3-5 Epinephrine IO/IV 1mg )
3-5 Epinephrine
6
( 10 )
ROSC
CPR
CPR
Amiodarone lidocaine
Hypovolemia
Hypoxia
Hydrogen ion (acidosis)
Hypoglycemia
/ Hypo-/Hyperkalemia
Hypothermia
5 7
Asystole/PEA 10 11 Tamponade,cardiac
Toxins
(ROSC) Thrombosis,pulmonary
Thrombosis,coronary
*
26
&
(AHA2015)
100
PPV()
CPAP
LMA
1 60~65%
2 65~70%
3 70~75%
4 75~80%
5 80~85%
PPV() 10 85~95%
100%
Epinephrine
60
*
27
&
B5-B9
28
&
(ERC2015)
15
2
15
1 CPR
29
&
(ERC2015)
()
5
5
5
( ()
CPR
1 )
30
&
(ERC2015)
CPR
( 5 : 15:2)
/
(VF/Pulseless VT) (PEA/Asystole)
CPR2
CPR 2
3 5 ABCDE
pVT/VF
aminodarone
CPR Hypoxia
CPR: Hypovolemia
/
Hyper-/Hypokalemia, metabolic
(IV/IO) Hypothermia
()
3-5 adrenaline
Thrombosis(coronary or pulmonary)
Tension pneumothorax
Tamponade (cardiac)
Toxins/
Therapeutic disturbances
31
&
32
&
(ERC2015)
ERC 250 (B9)
()
() 60
5
SPO2
2 60%
3 70%
5 4 80%
5 85%
10 90%
?
( 60 )
(3:1)
30
( 60 )
)
33