野外でのCPR

野外での心配蘇生は、救助者にとっても究極的な状況です。何ができて、何ができないのか?リーダーの正しい判断が、メンバーの命を繋ぐ。


心肺蘇生(Cardiopulmonary Resuscitation: CPR)と、心脳蘇生(Cardiocerebrial Resuscitation: CCR)は、応急処置の技術として重要であり、全ての人が身につけるべきである。ただしその効果は、野外状況では限界がある。いずれの技術も、脳死を遅らせ、蘇生の可能性を伸ばすが、CPRは、胸骨圧迫と人工呼吸を合わせて行うのに対し、CCRは、胸骨圧迫のみを行う。血液循環を開始するための十分な胸腔内圧を得るためには、おおよそ10-12回の胸骨圧迫が必要である。血液循環のための胸腔内圧は、少量の新鮮な空気と酸素の供給にもなる。もし肺に空気と酸素が残っている場合(例えば心筋梗塞による心停止など)、胸骨圧迫だけの方が、人工呼吸と組み合わせた場合よりも、胸腔内圧を維持しているために、脳死を遅らせることができる。それに対し、CPRは、呼吸停止や酸欠により心停止した傷病者(例えば溺れ、落雷、雪崩など)には、CCRより有効である。いずれの技術も、時間とともにその効果は下がり、20分以上拍動が再開しなければ蘇生の可能性はない。保守的に考え、30分で蘇生しなければCPRを中止する。また、↑ICP、肺損傷、ボリュームショックなどの外傷により心停止した傷病者は、CPR、CCRとも効果がない。

CPR、CCRが効果的に行われるためには、主要3器官系に損傷がなく、体温が32度以上である必要がある。胸骨圧迫は、胸骨の下3分の1の場所に、救助者の体重を乗せ、正確に早く(100回/分)行われなければならない。圧迫の間に、完全に胸骨が反動で戻るように、圧を解放する。圧迫を反動は圧迫と同じくらい重要である。人工呼吸は、傷病者の胸部が上がるまでしっかり吹き込む。吹き込みすぎると、胃に空気が入り、吐瀉物の可能性を高める。これらの技術を正確に行わなければ、蘇生は困難となる。

心室細動、二次救命処置が必要、病院への緊急搬送が不可能、多くの心停止者がいる場合、蘇生は不可能である。救助者は、CPR、CCRの限界を理解し、いつ開始し、いつ止めるかを心得る。

より詳しい情報はデジタルハンドブックを参照し、正しい技術を身につけるためにはWFA/WFRコースに参加し、評価と処置をSOAPノートに記録する。

Author: Paul Nicolazzo/ Translator: Taito Okamura

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