267.2 📚 國考版

267.2.0.1 必背 — Chain of Survival

  1. Early recognition + call 911
  2. Early CPR
  3. Early defibrillation
  4. Early ACLS
  5. Post-arrest integrated care

267.2.0.2 必背 — High-Quality CPR

  • Rate: 100-120/min
  • Depth: ≥ 2 inches (5 cm) adult; 1/3 chest depth pediatric
  • Full chest recoil
  • Minimize interruptions
  • 30:2 compression:ventilation (lay rescuer / before advanced airway)
  • Continuous compressions + asynchronous ventilation after advanced airway

267.2.0.3 必背 — ACLS Shockable Rhythm

  1. Immediate defibrillation (200 J biphasic)
  2. CPR + epinephrine 1 mg IV/IO q3-5 min
  3. Amiodarone 300 mg IV for refractory (after 3rd shock)
  4. Treat reversible causes

267.2.0.4 必背 — ACLS Non-Shockable Rhythm

  • CPR + epinephrine 1 mg IV/IO q3-5 min
  • Treat reversible causes (Hs and Ts)

267.2.0.5 必背 — Reversible Causes (Hs and Ts)

  • Hs: hypoxia, hypovolemia, hydrogen (acidosis), hyper/hypokalemia, hypothermia
  • Ts: tension pneumothorax, tamponade, toxins, thrombosis (PE/MI), trauma

267.2.0.6 必背 — Drugs in ACLS

  • Epinephrine 1 mg IV/IO q3-5 min
  • Amiodarone 300 mg IV bolus for refractory VF/VT (after 3rd shock)
  • Lidocaine alternative (1-1.5 mg/kg)
  • Magnesium for torsades de pointes
  • No vasopressin (removed 2020)
  • No atropine for PEA/asystole (removed 2010)

267.2.0.7 必背 — Post-Cardiac Arrest Care

  • TTM (32-36°C × 24 hr) for comatose post-ROSC
  • TTM2 trial (2021): 33°C vs 36°C equivalent; fever avoidance important
  • Hemodynamic management (MAP > 65)
  • Coronary angiography if suspected ischemic cause
  • Delayed neurologic prognostication (≥ 72 hr)

267.2.0.8 必背 — ECPR

  • VA-ECMO during refractory cardiac arrest
  • Selected patients (younger, witnessed arrest, shockable rhythm initially)
  • ARREST trial 2020: ECPR superior in OHCA refractory
  • Increasing adoption in specialized centers

267.2.0.9 必背 — Special Situations

  • Pregnancy: left uterine displacement + perimortem cesarean within 4-5 min if no ROSC
  • Hypothermia: “not dead until warm and dead”
  • Drug overdose: antidotes (naloxone, glucagon, calcium, bicarb)
  • Massive PE: thrombolysis
  • Trauma: address bleeding + pneumothorax + tamponade

267.2.0.10 必背 — AED

  • Widely deployed in public areas
  • Layperson use acceptable + recommended
  • Voice-guided
  • Improves OHCA outcomes
  • Single shock + immediate CPR resumption

267.2.0.11 必背 — Bystander CPR

  • Hands-only CPR acceptable for laypeople
  • Encouraged via dispatcher
  • Improves OHCA outcomes significantly