Transcript 临床医学英语Unit 12

Unit 12
Emergency Medicine
Word Formation
1. re- (again) e.g. resuscitation
2. cardi/o ( heart )
3. pulmon/o ( lung )
4. –graph ( instrument)
e.g. cardiograph/ cardiogram
5. therm/o ( temperature )
6. pre- ( before ) e.g. precordial
Questions to consider:
1. If someone fainted in front of you , what would you do ?
2. Do you have any knowledge about first aid ?
3. What do you know about cardiac resuscitation ?
Cardiopulmonary resuscitation
 Definition
Cardiopulmonary resuscitation (CPR) is a procedure
to support and maintain breathing and circulation for
a person who has stopped breathing (respiratory arrest)
and/or whose heart has stopped (cardiac arrest).
Cardiopulmonary resuscitation, commonly called
CPR, combines rescue breathing (one person breathing
into another person) and chest compression in a
lifesaving procedure performed when a person has
stopped breathing or a person's heart has stopped
beating.
 The medical term for the condition in which a person's
heart has stopped is cardiac arrest (also referred to as
cardiorespiratory arrest). CPR is used on patients in
cardiac arrest in order to oxygenate the blood and
maintain a cardiac output to keep vital organs alive.
 If the patient still has a pulse, but is not breathing,
this is called respiratory arrest and artificial respiration
is more appropriate. However, since people often have
difficulty detecting a pulse, CPR may be used in both
cases, especially when taught as first aid.
Cardiopulmonary resuscitation (CPR) is an emergency
medical procedure for a victim of cardiac arrest or, in
some circumstances, respiratory arrest.
CPR is performed in hospitals, or in the community by
laypersons or by emergency response professionals.
 Description
CPR is part of the emergency cardiac care system
designed to save lives. Many deaths can be prevented
by prompt recognition of the problem and notification
of the emergency medical system (EMS), followed by
early CPR, defibrillation (which delivers a brief electric
shock to the heart in attempt to get the heart to beat
normally), and advanced cardiac life support measures.
 CPR must be performed within four to six minutes
after cessation of breathing so as to prevent brain
damage or death. It is a two-part procedure that
involves rescue breathing and external chest
compressions. To provide oxygen to a person's lungs,
the rescuer administers mouth-to-mouth breaths, then
helps circulate blood through the heart to vital organs
by external chest compressions.
 When performed by a bystander, CPR is designed to
support and maintain breathing and circulation until
emergency medical personnel arrive and take over.
When performed by healthcare personnel, it is used in
conjunction with other basic and advanced life support
measures.
 According to the American Heart Association, early
CPR and defibrillation combined with early advanced
emergency care can increase survival rates for people
with a type of abnormal heart beat called ventricular
fibrillation by as much as 40%. CPR by bystanders
may prolong life during deadly ventricular fibrillation,
giving emergency medical service personnel time to
arrive.
 However, many CPR attempts are not ultimately
successful in restoring a person to a good quality
of life. Often, there is brain damage even if the heart
starts beating again. CPR is therefore not generally
recommended for the chronically or terminally ill or
frail elderly. For these people, it represents a traumatic
and not a peaceful end of life.
 Purpose
When performed quickly enough, CPR can save lives
in such emergencies as loss of consciousness, heart
attacks or heart "arrests," electric shock, drowning,
excessive bleeding, drug overdose, and other conditions
in which there is no breathing or no pulse. The purpose
of CPR is to bring oxygen to the victim's lungs and to
keep blood circulating so oxygen gets to every part of
the body. When a person is deprived of oxygen,
permanent brain damage can begin in as little as four
minutes and death can follow only minutes later.
There are three physical symptoms that indicate a
need for CPR to be performed immediately and for
emergency medical support to be called:
unconsciousness, not breathing, and no pulse detected.
 Unconsciousness
Unconsciousness is when the victim seems to be asleep
but has lost all awareness and is not able to respond to
questions or to touch or gentle shaking. An unconscious
person will not respond to noise or shaking. When
unconscious, a person can not cough or clear the throat,
which can block the windpipe and cause suffocation and
death. People with a major illness or injury or who have
had recent surgery are at risk for losing consciousness.
If the person has fainted, which is brief unconsciousness,
the cause may be dehydration (lack of body fluids), low
blood pressure, or low blood sugar. This is a temporary
condition. If the victim is known to have diabetes, a bit
of fruit juice may revive the person once they have
regained consciousness.
 Not Breathing
Not breathing, which is also called apnea, is the lack of
spontaneous breathing. It requires immediate medical
attention. The victim may become limp and lifeless, have
a seizure, or turn blue. Prolonged apnea is called
respiratory arrest. In children, this can lead quickly to
cardiac arrest in which the heart stops beating. In adults,
cardiac arrest usually happens first and then respiratory
arrest.
The common causes of apnea in adults are obstructive
sleep apnea (something blocks the airway during sleep),
choking, drug overdose, near-drowning, head injury,
heart irregularities (arrhythmia, fibrillation) or cardiac
arrest, nervous system disorders, or metabolic disorders.
In children the causes may be different, such as
prematurity, bronchial disturbances or pneumonia,
airway blockage or choking on a foreign object, holding
the breath, seizures, meningitis, regurgitating food, or
asthma attacks.
 No Pulse Detected
If the rescuer is unable to detect a pulse or has difficulty
in feeling a pulse it can be an indication of the use of
improper technique by the rescuer, or shock or cardiac
arrest in the victim. If a sudden, severe decrease occurs
in pulse quality (such as pulse weakness) or pulse rate
(how many beats in a minute) when other symptoms are
also present, life-threatening shock is suspected.
The rescuer may need to explain to a doctor or medical
professional where on the victim's body the pulse was
measured, if the pulse is weak or absent altogether, and
what other symptoms are present. Medical help and
CPR are needed immediately if any of these symptoms
is found.
Time is critical. A local emergency number should be
called immediately. If more than one person is available
to help, one can call a local emergency medical service,
while the other person begins CPR. Ideally, someone
CPR certified performs the procedure. If a critically ill
patient or post-operative patient is being cared for at
home, it is a good idea for a family member to take a
CPR course to be better prepared to help in case of an
emergency.
CPR in Basic Life Support
Figure A: The victim should be flat on his back and his
mouth should be checked for debris.
Figure B: If the victim is unconscious, open airway, lift
neck, and tilt head back.
Figure C: If victim is not breathing, begin artificial
breathing with four quick full breaths.
Figure D: Check for carotid pulse.
Figure E: If pulse is absent, begin artificial circulation
by depressing sternum.
Figure F: Mouth-to-mouth resuscitation of an infant.
Understanding the Text
Para. 1
cardiac arrest----心跳骤停
ischemic cardiovascular disease----缺血性心血管疾病
lethal----fatal
ventricular fibrillation----心室纤颤
infarcted myocardium----心肌梗塞
primary electrical disturbance----原发性心肌电活动紊乱
Question:
1. What are the causes of cardiac arrest ?
Para. 2
emergency-medical-services system
----急症医疗服务体系
code team----a specially trained and equipped team of
physicians, nurses, and technicians that is available to
provide advanced cardiac life support when summoned
by an emergency code set by the institution. A code team
usually includes a physician, registered nurse, respiratory
therapist, and pharmacist. 急救医疗小组
advanced help----further aid 进一步的救助
chance----possibility
range from----vary from
variously----ranging from
在美国，尚没有医院外心室纤颤存活的全国性统计数
据，社区报告存活率为4-33%不等，能够快速提供救
助的社区中存活率较高。对于住院患者心脏骤停，
存活率为0-29%不等。
Question:
2. How do you understand the chain of survival ?
Explain.
Para. 3
rhythm----心律
collapse (witnessed/unwitnessed)---other than----except
Question:
3. As a medical student, would you offer your first
aid to a stranger who collapsed suddenly? And
how ?
Para. 4
a collapsed person---encounter----meet
unresponsive----无反应
summon----call
agonal respirations
----临终前呼吸
Question:
4. In what condition is a person
whose heart suddenly stops
beating ?
Para. 5
fundamentals----(pl.) basic facts or principles
基本事实或原则
chest compression----胸部按压
intrathoracic pressure----胸廓内压
viability (viable)----存活;活力;生机
e.g. 1) The viability of the fetus before the 22nd week is
doubtful.
2) A fetus is viable by about the 28th week of pregnancy.
contract----(心脏)收缩
cardiac output----心输出量
Question:
5. What are the basic principles of
cardiopulmonary resuscitation ? Explain.
Para. 6
definitive----conclusive 果断的; 明确的
pulseless ventricular tachycardia----无脉性室性心动过速
take/have precedence over 先于…;比…重要
---- come before, appear more important than
Question:
6. What comes first , cardiopulmonary resuscitation or
rapid defibrillation ? Why ?
Para. 7
airway control----(文中指气管插管)
intravenous access----(文中指静脉点滴)
constitute----make up; form
sustain a perfusing rhythm----维持灌注节律
perfusion----passing of a liquid through vessels or an
organ or tissue, especially the flow of blood
into lung tissue 灌注
Question:
7. What procedures are involved in advanced care ?
Para. 8
administer----vt.
observational study---interpret the form and amplitude of---(未来的除颤器可能能够诠释心电图的形状和振幅，
能建议直接除颤或先实施一段时间的心肺复苏。)
envision----v. imagine
biosensors----生物传感器
end-tidal carbon dioxide monitors
----呼气末二氧化碳监测器
adequacy----sufficiency
Question:
8. What are the new changes in future first aid
procedures according to this paragraph ?
Para. 9
placebo-controlled studies----安慰剂对照研究
setting----condition; situation
intravenous----(静脉内注射胺碘酮 )
optimal----the best, most desirable
have/has yet to----肯定句中用 yet 表示”还没…”,
或表示”到目前为止”
e.g. 1) I have yet to hear your explanation.
2) That is the largest sapphire(蓝宝石) yet discovered.
refractory ----unresponsive: applied to a condition that
fails to respond satisfactorily to a given
treatment. 难治性的, 治疗无效的(指治疗
未获得满意疗效的状况)
Question:
9. What does this paragraph mainly talk about ?
Para. 10
hypoxic brain damage----缺氧性脑损伤
induce/induction---(目前的研究正致力于诱导体温下降以及以降低脑损伤
为目标的药物干预。)
Question:
10. What procedures are helpful in dealing with brain
damage ?
Para. 11
precordial thump----胸前区击打(能产生一定能量 )
for a monitored arrest---Question:
11. What is the function of precordial thump ?
Para. 12
mechanical vests----机械充气背心
compress/decompress----主动式胸外按压-减压复苏）
randomized studies----随机抽样研究
equivocal----indefinite
interposed abdominal compression cardiopulmonary
resuscitation----插入式腹部按压心肺复苏术技术
alternate ( with )----交替(进行胸部和腹部按压)
equivalent----as good as
superior----better than
Question:
12. How to improve cardiopulmonary resuscitation
according to this paragraph ? Give your advice.
Para. 13
automated external defibrillators----全自动体外除颤器
interpret----detect
shock----电击
Question:
13. What can automated external defibrillators do ?
Para. 14
prolong/prolonged/prolongation---be compounded by---(除非患者心跳停止的同时还有以下情况，患者体温降
低、浸在冷水中、用药过量、其它可确定也可治疗的疾
病或间歇性心室纤颤或室性心动过速)
intermittent ---间歇性的
community setting----社区环境
in preference to---Question:
14. At what time cardiac resuscitation is to stop ?
Para. 15
strike down----(illnesses) have a disastrous or disabling
effect upon
使受到摧残;使一蹶不振;使倒下
e.g. be struck down with a serious illness 重病不起
be struck down by heart disease 患心脏病倒下
prime----n. (sing.) the time when sb. is strongest, most
beautiful, most successful ,etc.
壮年, 盛年; 最美好的岁月; 颠峰时期
e.g. 1) He is past his prime as a tennis player.
2) to be in the prime of life 正值盛年/壮年
productive---e.g. ～ land/discussion/cough/lives
avert----vt. to prevent something unpleasant; to avoid 避免
e.g. The accident could have been averted.
preclude----vt. 排除, 消除
e.g. ～ all doubts 排除一切疑虑
regardless of---Question:
15. How do you understand the phrase
“hearts too good to die” in this paragraph ?
Para. 16
prolongation----delay
address----vt.
terminal ---- fatal, advanced
in the event of----(formal) if something happens
e.g. In the event of fire, leave the building as quickly as
possible.
premises (pl.)----房屋及其产权范围空地; 宅邸内
e.g. The thief was still on the premises.
Keep off the premises. 禁止入内
crews----staff members
honor----vt. respect
Question:
16. How do you understand the phrase
“hearts to bad to live” in this paragraph ?
Para.17
Question:
17. What is the author’s opinion about the effect
of cardiac resuscitation ?
Do you agree ?
 Do-Not-Resuscitate (DNR) Orders
A do-not-resuscitate (DNR) order placed in a person's
medical record by a doctor informs the medical staff
that cardiopulmonary resuscitation should not be
performed. This order has been useful in preventing
unnecessary and unwanted invasive treatment at the
end of life.
 Doctors discuss with patients the possibility of
cardiopulmonary arrest (when the heart stops and
breathing ceases), describe CPR procedures, and ask
patients about treatment preferences. If a person is
incapable of making a decision about CPR, a surrogate
may make the decision based on the person's
previously expressed preferences or, if such
preferences are unknown, in accordance with the
person's best interests.
 A DNR order does not mean "do not treat." Rather,
it means only that CPR will not be performed. Other
treatments (for example, antibiotic therapy,
transfusions, dialysis, or use of a ventilator) that may
prolong life can still be provided. Treatment that keeps
the person free of pain and comfortable (called
palliative care) should always be given.
 Most states also provide for special do-not-resuscitate
orders that are effective outside of hospitals, wherever
the person may be in the community. These are called
out-of-hospital DNR orders, Comfort Care orders, No
CPR orders, or other terms. Generally, they require the
signature of the physician and patient (or patient's
surrogate), and they provide the patient with a visually
distinct quick identification form or bracelet or necklace
that emergency medical services personnel can identify
and comply with.
 These orders are especially important for terminally ill
people living in the community who want only comfort
care and no resuscitation if their heart or breathing
stops. Living wills and durable powers of attorney for
health care are not generally effective in emergency
situations.
Medical Terms Related to Life-Sustaining Treatment
 Cardiopulmonary resuscitation (CPR):
An action taken to revive a person whose
heart stops (cardiac arrest), whose breathing
stops(respiratory arrest), or whose heart and
breathing stop (cardiopulmonary arrest).
 Code: The summoning of professionals
trained in CPR to revive a person in cardiac,
respiratory, or cardiopulmonary arrest.
 No code: An order signed by a patient's
doctor stating that CPR should not be
performed. (Also called a do-not-resuscitate
[DNR] order.)
 Irreversible coma: A coma or persistent
vegetative state from which the person will
not recover.
 Terminally ill: The medical state of being
near death where there is no hope of cure.
 Life-sustaining treatment: Any treatment
given to postpone the death of a terminally ill
person.
 Palliative care: Measures taken to keep a
terminally ill person as comfortable as possible.
Phrases in the Text
1. cardiac resuscitation / arrest
2. ischemic cardiovascular disease
3. ventricular fibrillation
4. infarcted myocardium
5. cardiopulmonary resuscitation
6. agonal respirations
7. chest / abdominal compression
8. intrathoracic pressure
9. cardiac output
10. pulseless ventricular tachycardia
11. endotracheal intubation
12. pharmacologic therapy / intervention
13. end-tidal carbon dioxide monitor
14. placebo-controlled studies
15. antiarrhythmic medications
16. hypoxic brain damage
17. precordial thump
18. automated external defibrillators
19. cardiac rhythm
20. terminal diseases