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人工呼吸中の患者さんに電気ショックを行う時、回路は外すべきか? [CPRの基礎]

 心肺蘇生の講習会では、電気ショックを行う時に、安全確認を十分するように指導されます。特に高濃度酸素が流れていたために引火したと言う報告があったようで、酸素が流れている物は遠ざけると言う事が指導されます。ガイドライン的には1m以上離せばいいようですが、バッグバルブマスクなどを「背中に回して3m以上下がってください!」と言わないと不合格になると言う講習会もあるとかないとか。

 気管挿管されていて、気管挿管チューブと人工呼吸器の回路がなかなか外れない時があります。そういう時にはどうしたらいいのでしょうか???

 ヨーロッパ蘇生協議会のガイドライン2015のP.114に書かれています。

「Safe use of oxygen during defibrillation」
 In an oxygen-enriched atmosphere, sparking from poorly applied defibrillator paddles can cause a fire and significant burns to a patient. The absence of case reports of fires caused by sparking where defibrillation was delivered using self-adhesive defibrillation pads suggests that the latter minimise the risk of electrical arcing and should always be used when possible.
 The risk of fire during attempted defibrillation can be minimised by taking the following precautions:
 Take off any oxygen mask or nasal cannulae and place them at least 1m away from the patient's chest.
 Leave the ventilation bag connected to the tracheal tube or supraglottic airway, ensuring that there is no residual PEEP remaining in the circuit.
 If the patient is connected to a ventilator, for example in the operating room or critical care unit, leave the ventilator tubing (breathing circuit) connected to the tracheal tube unless chest compressions prevent the ventilator from delivering adequate tidal volumes. In this case, the ventilator is usually substituted by a ventilation bag, which can itself be left connected. If not in use, switch off the ventilator to prevent venting large volumes of oxygen into the room or alternatively connect it to a test lung. During normal use, when connected to a tracheal tube, oxygen from a ventilator in the critical care unit will be vented from the main ventilator housing well away from the defibrillation zone. Patients in the critical care unit may be dependent on positive end expiratory pressure (PEEP) to maintain adequate oxygenation; during cardioversion, when the spontaneous circulation potentially enables blood to remain well oxygenated, it is particularly appropriate to leave the critically ill patient connected to the ventilator during shock delivery.

日本語がいい方はこちらを。


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