【Osmosis字幕文本-中英文对照】Advanced cardiac life support（高级生命支持）

Advanced cardiac life support or ACLS is a structured way to respond to an unresponsive person with cardiac arrhythmias and cardiac arrest.

高级心脏生命支持或ACLS是的一种标准结构化的方式，可运用于因心律失常和心脏骤停而失意识的患者。

 

ACLS can be done by an individual or by a team that's led by a team leader.

ACLS可以单人或由团队完成。

 

When we suspect a person maybe in need of assistance， the first thing we need to do is determine their level of consciousness.

当我们怀疑某人可能需要帮助时, 我们需要做的第一件事就是判断他们的意识水平。

 

Talk loudly at them，rub their sternum，or apply pressure to their nail beds or earlobeswhile simultaneously checking for absent or abnormal breathing.

大声呼唤他们，摩擦他们胸部，或者对他们的甲床或耳垂施加压力，与此同时检查他们是否存在呼吸暂停或不正常的呼吸运动。

 

If they're not responsive，check the carotid pulse for about 10 seconds.

如果他们对于以上动作没有反应，接着检查颈动脉脉搏大约10秒钟。

 

If there's no pulse first immediately activate the emergency response system to get more help and an AED or defibrillator.

如果颈动脉搏动消失，立即启动应急反应系统，来获得更多帮助并获取AED设备或除颤器。

 

Then move on to the ACLS algorithm.

然后继续ACLS的一些列步骤。

 

The first thing to do is cardiopulmonary resuscitation or CPR，which combines chest compressions and artificial ventilation.

首先要做心肺复苏术，即CPR， 它包括胸外按压和人工通气。

 

The big picture goal of CPR is to maintain blood flow to the brain while a patient is pulseless.

心肺复苏术的总体目标是使病人在无脉搏的情况下，仍能保证大脑的血供。

 

Because the patient's heart is not functioning，the team is mechanically squeezing the heart to ensure blood flows to the brain.

由于患者此时的心脏不能正常工作，抢救人员通过胸外按压机械性的挤压心脏以确保血液流向大脑。

 

In a person over 8 years of age，chest compressions are done by placing the heel of one hand in the center of the chest ，then placing the other hand on top ，interlocking the fingers，and without flexing the elbows，pushing down on the chest.

对于8岁以上的患者，抢救人员在施行胸部按压时，应将一只手的掌跟放在患者胸部的中心，另一只手与之十指相扣放在上面，进行胸外按压时肘部不能弯曲。

 

This should be done to a depth of at least 5 cm or 2 inches which is about the same size as a closed fist is lengthwise.

按压深度应该做到至少5厘米（或2英寸）大致和握紧的拳头的纵向长度相同。

 

Compressions are done at a rate of about 100 compressions per minute【注1】，which you can remember if you do them to the beat of “staying alive” by the Bee Gees.

按压的速度约为100次/分，你可以通过Bee Gees的歌“staying alive”的节奏去做。

【注1】目前的指南已对此观念有更新，目前推荐按压速度不低于100次/分，在100～120次/分为宜。

 

Additionally，the team attempts to artificially ventilate the patient, so oxygen can enter the lungs and carbon dioxide can leave.

此外，团队通过为病人人工通气，这样氧气就可以进入肺部，同时二氧化碳排出。

 

Artificial ventilation includes a variety of ways to assist respiration for a person who isn't breathing or making sufficient respiratory effort on their own.

人工通气包括多种方法来帮助一个没有呼吸或者自己不足以维持足够的呼吸的患者。

 

 

The options for ventilation usually involve a bag valve mask device to push air in.     

辅助通气的选择中，常用的有通球囊通气。

 

A bag valve mask can be applied directly to the person's mouth, or with an oral airway, a supraglottic airway like laryngeal mask airway (LMA), or an endotracheal tube.

球囊呼吸器可以通过面罩直接扣在患者口鼻部，还可以通过口咽途径，或者声门上途径，如使用喉罩通气，又或者也可以通过气管内插管途径。

 

Directly applying the bag valve mask is the simplest option since it's just positioned over the nose and mouth of the patient，creating a tight seal so air does not escape around the sides of the mask.

直接使球囊面罩呼吸器最简单办法，它只需要将面罩叩在患者的口鼻上方，使用时注意贴合密闭，这样气体就不会从面罩边缘漏出。

 

If the bag valve mask is ineffective or difficult to perform，like in the case of an air leak because of an abnormally large face, then a supraglottic airway can be placed blindly into the airway through the mouth by pushing towards the throat.

如果球囊面罩使用效果不佳，例如在脸部比较大的患者可能由于面罩贴合困难而导致气体漏出，此时可以将辅助通气设备从患者口部向喉部推进，盲插入气道从而建立声门上气道。

 

This is generally preferred over endotracheal tube intubation because it's faster to perform and minimizes the interruption of chest compressions.【注2】

这种方法通常优于气管插管，因为它操作起来更迅速，可以最大程度减少胸外按压的中断时间。

【注2】此处观点目前已有一些变化，我的老师Dr. Tian在与西雅图学者的交流中得知他们目前已接受的观念是即便是使用气管插管，也可以做到不间断的胸外按压，甚至在胸外按压的过程中更有助于气管插管的进行，因为在胸外按压时气体从肺部被挤出，声门开放，可顺势插入气管插管；所以目前已有学者认为并经过实践证实可以在不中断胸外按压的情况下进行气管插管，熟练地掌握并运用这项技能或可大大提高救治成功率。

 

Time and time again, researchers have shown that the most important part of ACLS is high quality uninterrupted chest compressions followed by defibrillation in those who need it, that's why intubation is done only if the patient can't be ventilated by other means.【注3】

在一次次的尝试中，研究发现成功的ACLS中最重要的是保持不间断的高质量胸外按压，并按需除颤。这就是为什么只有在患者采用其他通气方式均失效时才选用气管内插管。

【注3】此处观念变化同【注2】

 

Continuous capnography should be performed in addition to clinical assessment for both confirming and monitoring correct tracheal tube placement and for monitoring the quality of CPR and return of spontaneous circulation.

应进行持续的CO2监测以及临床评估，来确认并保证气管导管的位置放置正确，同时也有助于监测CPR的实行质量以及自主循环的恢复。

 

Capnography is a recording of the amount of expired carbon dioxide coming out of the tube。

CO2描记图是经过管道呼出的CO2的量的记录。

 

When ventilating a patient in cardiac arrest，100% oxygen should be used.

当为心脏骤停的患者进行通气时，应使用100%的氧气。

 

In a person over 8 years of age，the rate of compressions and breath should be 30 to 2 for both single and two person CPR.

在对大于8岁的患者施行心肺复苏时，按压与通气的比例应该为30：2，无论是单人或是双人的CPR都是如此。

 

Finally，it's important to have access with an Intravenous (IV) line or Intraosseous(IO) line in place as soon as possible so that it's ready in case you need to start giving medications.

最后一点，尽可能快速建立静脉通道（IV）或骨髓腔输液通道（IO）也同样重要，这样可以随时按需给药。

 

Compressions and ventilation are started immediately on patient without a pulse, however as soon as an AED or cardiac monitor or defibrillator is available，using it becomes the most important step.

对于无脉的患者，应第一时间进行胸外按压以及人工通气，但是当AED、心脏监护仪、或除颤仪送到时，使用这些仪器则成为了最重要的事。 

 

The ACLS team needs to troubleshoot the non-functioning heart by diagnosing the cardiac rhythm and defibrillating if indicated.

ACLS团队需要对患者心脏的节律进行分析并按需除颤，来治疗患者不能工作的心脏。

 

Chest compressions should be paused briefly to apply and use the AED or cardiac monitor，this allows accurate assessment of the rhythm on the ECG and determines whether it's a shockable rhythm like ventricular fibrillation（ VFib ）and pulseless ventricular tachycardia（VT）, as well as a non-shockable rhythm like asystole and pulseless electrical activity(PEA) 

胸外按压可短暂中断以使用AED或心电监护仪，这样一来就可以通过心电图准确地获取患者心脏的节律，看是否是可除颤心律如室颤和无脉性室性心动过速，或是不可除颤节律如心脏停搏或无脉性电活动。

 

In ACLS, ECG interpretation is guided by 3 questions：

Is the rhythm fast or slow？

Are the QRS complex is wider or narrow？

And is the rhythm regular or irregular？

在施行ACLS的过程中，心电图的解读需要从以下三个方面入手：节律是快还是慢？

 

Rhythms where a defibrillator can be used to shock a patient,

---shockable rhythms are ones that are fast and have a wide QRS complex, after that VT is a regular rhythm whereas VFib is an irregular rhythm, if either VT or VFib is found ，defibrillation should be done as soon as possible.

可以使用除颤器进行除颤的心律---即可除颤心律，表现为快速的心率，并且有宽大的QRS波群，其中室性心动过速心律规则，而室颤心律不规则。如果患者出现了室性心动过速或者室颤，应尽快电除颤。

 

Defibrillation with a synchronized shock is given when there's a regular rhythm like in VT, whereas an unsynchronized shock is given when there's no regular rhythm like in VFib.

电除颤时，同步电击适用于心律规则的情况如室性心动过速，而非同步电击适用于心律不规则的情况如室颤。

 

The initial dose of energy that the defibrillator delivers typically ranges between 120 to 200 jewels, but a maximum dose can always be used even on the first attempt, immediately after delivering the shock chest compressions must be resumed right away without reassessing the rhythm.

除颤最开始使用的能量通常在120~200J，不过在第一次除颤时就可以使用最大能量。在放电后，第一时间应该做的是继续胸外按压，而不是重新评估心律。

 

After 2 minutes of chest compressions, there's a new evaluation of the rhythm through ECG，if the rhythm is still shockable, a second shock is given using the maximum available dose of energy.

在2分钟的胸外按压之后，应通过心电图重新评估患者心脏节律，如果仍然是可除颤心律，应使用最大能量进行第二次电除颤。

 

In addition，1 mg of epinephrine is given using the IV line，all medication should be followed by a saline flush or by raising the patient's arm to guarantee that the medication travels all the way to the heart

除此以外，静脉注射1mg肾上腺素，所有注射的药物都行继之以盐水冲洗，或者通过抬高患者的手臂保证药物到达心脏。

 

Once we start using epinephrine, it's continuously given every 3 to 5 minutes, while chest compressions are being performed.

当开始使用肾上腺素后，应在胸外按压的过程中，每3~5分钟持续给药。

 

After 2 minutes of chest compressions or when there's a rotation of the person doing CPR，the rhythm is checked again.

在完成2分钟的胸外按压后，或是完成一轮的CPR后，要重新评估患者的心律。

 

The rhythm is still shockable after a third defibrillation attempt, 300 mg of amiodarone may be administered intravenously as well, with a repeat dose of 150 mg IV as indicated, if amiodarone is unavailable, it may be replaced by 1 to 1.5 milligrams per kilogram of lidocaine given every 5 to 10 minutes.

如果经过三次电除颤后患者仍然表现为可除颤心律，可静脉注射300mg胺碘酮，并在有适应症的情况下重复使用150mg静脉注射。如果没有胺碘酮，可以使用利多卡因替代，剂量为1~1.5mg/kg，每5~10分钟使用一次。

 

Additionally，2 grams of magnesium sulfate followed by a maintenance infusion of 1 to 2 grams per hour may be used in case of polymorphic ventricular tachycardia consistent with torsade de pointes, but it's not recommended for routine use in ACLS.

除此以外，2g的硫酸镁以1~2g/hr的速度持续滴注可以防止多形性室性心动过速如尖端扭转型室速，但是并不推荐在常规的ACLS过程中使用。

 

This whole process is repeated for however long it's needed, there's no absolute standard. 

这整个过程只要需要就可以不断重复，并没有绝对的停止标准。

 

Generally，it's interrupted if there's a clinical change in the patient like breathing or regaining consciousness.

通常来说，当患者临床表现出现变化，如出现自主呼吸或意识恢复，此时可以停止。

 

Alternatively, it may be stopped if it looks like a patient won't survive, like after 30 minutes of unsuccessful resuscitative effort or in patients with an end-tidal CO2 below 10 millimeters of mercury(mmHg).

另一方面，当患者以没有生存希望时也是可以停止的情况，比如

That’s because a low end-tidal CO2 following prolonged resuscitation (over 20 minutes) is a sign of absence circulation and a strong predictor of death.

因为在长时间的复苏过程中（一般大于20分钟），如果呼气末CO2分压一直很低，这通常标志着患者缺乏自主循环并且死亡率很高。

 

End-tidal CO2 values are a function of carbon dioxide production and venous return to the right heart and pulmonary circulation. This is evaluated through capnography.

呼气末CO2分压可以体现CO2的排出功能、静脉血的回心功能以及肺循环功能。呼气末CO2分压可以由CO2描记图得到。

 

Now，moving on to non-shockable rhythms, the most frequent one is asystole, which is where there's a complete absence of electrical and mechanical cardiac activity，the other one is pulseless electrical activity (PEA)which is a mix of electrocardiographic rhythms which result in insufficient mechanical contraction of the heart to produce a palpable pulse or measurable blood pressure.

现在，让我们来看不可除颤心律，最常见的是心脏停搏，即心脏的电活动以及机械活动完全停止了，另一种是无脉电活动（PEA），即患者有心电活动但是不足以使心脏产生足够的机械收缩，使得患者脉搏无法触及或血压无法测得。

 

PEA can be associated with any electrocardiographic rhythm, and actually sinus rhythm is the most frequent type of PEA.

PEA可以出现在任何心电节律的情况中，事实上最常见的是窦性心律。

 

Once a non-shockable rhythm is diagnosed, 1mg of epinephrine is given right away, and then given every 3 to 5 minutes while CPR is performed.

一旦诊断了不可电击心律，应立即给予1mg肾上腺素，并在CPR的 过程中每3~5分钟给予一次。

 

After 2 minutes of CPR the cardiac rhythm is reassessed，if it becomes shockable，defibrillation may be done, otherwise CPR must be resumed for 2 minutes and then the rhythm is reassessed，this is repeated for however long it's needed.

在2分钟的CPR之后，重新评估心脏节律，如果转变为可除颤心律，则进行电除颤；如果没有转变，则继续2分钟的CPR新一轮循环，然后再重新评估心律。这一过程可以不断重复。

 

If a patient improves with ACLS, the immediate post cardiac arrest treatment includes an assessment using the ABCD approach.

当心脏骤停的患者经过ACLS之后出现好转，接着要做的就是用“ABCDE”方法进行评估。

 

That stands for 

Airways -checking if they're clear

Breathing -looking for signs of respiratory distress

Circulation-evaluating tissue perfusion and signs of bleeding

Disability-using the Glasgow Coma Scale

Exposure or examination-by doing a head to toe assessment in getting the clinical history

ABCD方法如下：

A气道-检查气道是否通畅

B呼吸-检查是否存在呼吸困难

C循环-检查组织的灌注情况以及出血情况

D功能-通过GCS量表

E检查-收集病史，从头到脚对患者进行评估

 

Any additional treatable underlying causes should be identified and managed as quickly as possible.

任何可以治疗的潜在的病因都应该快速的识别并治疗。

 

These include hypoxia, metabolic disorders, poisoning, hypovolemia, hypothermia, tension pneumothorax, cardiac tamponade and cardiac or pulmonary thrombosis.

包括低氧，代谢紊乱，中毒，低血容量，低体温，张力性气胸，心包填塞，体循环或肺循环栓塞。

 

All right，as a quick recap，in an unconscious patient，first you check for a pulse. In a pulseless patient，you try to see if the patient speaks or moves, then you check breathing. 

现在快速的小结：对于一个失去意识的患者，首先要做的是检查脉搏。对于脉搏无法触及的患者，检查患者是否能说话或活动，然后检查呼吸。

 

ACLS begins in patients that are unresponsive and not breathing normally. 

当患者没有反应且呼吸不正常时，开始进行ACLS。

 

Resuscitation begins with chest compressions, attaching the defibrillator, placing monitors and IV lines and obtaining the ECG.

复苏过程以胸外按压开始，还包括取来除颤仪，进行心电监护，建立静脉通道，检查心电图。

 

The ECG analysis will show either a shockable rhythm, like ventricular fibrillation and pulseless ventricular tachycardia,

or non-shockable rhythm like asystole and pulseless electrical activity.

通过心电图可以看患者是处于可除颤心律（如室颤、室性心动过速），还是不可除颤心律（如心脏停搏或无脉性电活动）

 

A shockable rhythm should get defibrillated as soon as possible with IV medications given each round.

患者若为可除颤心律，应立即进行电除颤，并在每一轮操作中静脉给药。

 

In a non-shockable rhythm epinephrine is given right away while CPR is performed.

对于不可除颤心律，应立即给予肾上腺素，同时进行CPR。

 

ACLS is repeated for however long it's needed.

ACLS的流程只要需要就可以不断重复。

翻译：star

校正：Dr.Tian