歐洲版的最新BLS / ACLS指引

歐洲版的最新BLS / ACLS指引 - 2010

A summary of changes in the European Resuscitation Guidelines 2010
【下載】http://tinyurl.com/2eegkns

Full version of the 2010 European Resuscitation Guidelines
【下載】http://tinyurl.com/2eyxlql

The Resuscitation Guidelines 2010 - Resuscitation Council (UK)
【下載】http://www.resus.org.uk/pages/GL2010.pdf

ERC 的官方網站：


完全免費，比 AHA 版的好唸了。
PS：期待台灣版的急救指引會在不久的將來問世。

超音波診斷肺栓塞：McConnell sign

McConnell's sign is a distinct echocardiographic finding described in patients with acute PE. There is a distinct regional pattern of right ventricular dysfunction, with akinesia of the mid free wall but normal motion at the apex.

Three mechanisms have been proposed that may explain these findings.

• First, in acute PE, the tethering of the right ventricular apex to a contracting and often hyperdynamic left ventricle may account for the preserved wall motion at the apex.
• Second, the right ventricle may be assuming a more spherical shape to equalize regional wall stress when subjected to an abrupt increase in afterload.Third, there may be localized ischemia of the right ventricular free wall as a result of increased wall stress.
  

Another case of submassive PE:


Overall, echocardiography has a low sensitivity for diagnosing PE; however, the accuracy is much higher in the diagnosis of massive PE.

Echocardiography may be useful in cases of massive PE in which a rapid presumptive diagnosis is required to justify the use of thrombolytic therapy. Regional wall motion abnormalities sparing the right ventricular apex (McConnell’s sign) are particularly suggestive of PE.

來源：
http://circ.ahajournals.org/cgi/content/full/118/15/e517

Non-invasive monitor：用echo取代CVP

IVC Ultrasound for Fluid Responsiveness

When treating severe sepsis, we need to adequately fluid load the patient prior to starting vasopressors. But how do you know how much fluid to give? CVP is not the greatest measure. Use IVC ultrasound instead. This video will show you how to examine the IVC in a spont. breathing patient.



參考：
http://www.ncbi.nlm.nih.gov/pubmed/19556029
http://blog.emcrit.org/podcasts/non-invasive-sepsis/

很精簡的整理：2010 ACLS 新指引

【點選】下載 2010 ACLS 新指引的 MP3
【點選】文字檔的全文

精讀以上兩個檔案後，保證讓您短時間內功力大增！

WPW Syndrome

Wolff-Parkinson-White syndrome (WPW) is a syndrome of pre-excitation of ventricles of the heart due to an accessory pathway known as the bundle of Kent. This accessory pathway is an abnormal electrical communication from the atria to the ventricles, in addition to the AV node. This accessory pathway does not share the rate-slowing properties of the AV node, and may conduct electrical activity at a significantly higher rate than the AV node.


WPW syndrome is commonly diagnosed on the basis of the surface ECG in an asymptomatic individual. In this case it is manifested as a delta wave, which is a slurred upstroke in the QRS complex that is associated with a short PR interval. The short PR interval and slurring of the QRS complex is actually the impulse making it through to the ventricles prematurely (across the accessory pathway) without the usual delay experienced in the AV node.


When an individual is in normal sinus rhythm, the ECG characteristics of WPW syndrome are a short PR interval, widened QRS complex (greater than 120 ms in length) with slurred upstroke of the QRS complex, and secondary repolarization changes reflected in ST segment-T wave changes.

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If the patient experiences episodes of atrial fibrillation, the ECG will show a rapid polymorphic wide-complex tachycardia (without torsades de pointes). This combination of atrial fibrillation and WPW is considered dangerous, and most antiarrhythmic drugs are contraindicated.

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下圖是：WPW + PSVT 的樣子


以上所有圖片皆來自網路上各教學網站，僅供教學使用。
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急診同仁不能不知道的 WPW syndrome！
重點：如果WPW+Af，不要誤判為Torsades de pointes，也不能給 A-V nodal blocking agents〔如 Adenosine, Isoptin, Digoxin...〕