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--> 00:02.417\n我们将从任四个。\n\n00:03.302 --> 00:04.703\n方面开始讲解，\n\n00:04.703 --> 00:08.152\n第一个是认我们认识一下什么是上气道的梗阻。\n\n00:08.303 --> 00:10.703\n第二个是急救黄金的4分钟。\n\n00:10.852 --> 00:13.203\n第三个是临床诊断与治疗，\n\n00:13.352 --> 00:15.152\n第四个是预防的策略。\n\n00:19.841 --> 00:22.392\n什么是上呼吸道上气道梗阻呢？\n\n00:24.771 --> 00:27.021\n我们先来看一下它的解剖位置，\n\n00:27.172 --> 00:29.146\n它的精准对位是上气道，\n\n00:29.146 --> 00:33.872\n是指鼻咽部到气管隆突上段约10.13cm。\n\n00:33.972 --> 00:35.646\n梗阻多发生于喉部，\n\n00:35.646 --> 00:42.771\n也就是这个地方声门区散68%和声管上段剑突剑突下两横指，\n\n00:42.922 --> 00:44.497\n这个这个就是剑突，\n\n00:44.497 --> 00:46.247\n剑突下这个就是剑突，\n\n00:46.247 --> 00:49.771\n剑突下的两横指是关键的施救施救点，\n\n00:50.021 --> 00:53.172\n致命的时间窗窗口是完全阻塞，\n\n00:53.172 --> 00:54.972\n4分钟即会发生。\n\n00:55.037 --> 00:58.625\n脑缺氧损伤8分钟的存活率低于10%。\n\n00:58.625 --> 01:03.312\n2023年北京急救中心数据显示，\n\n01:03.312 --> 01:06.788\n91%成功抢救案例均在4分钟内实施急救。\n\n01:07.087 --> 01:08.188\n阻塞的类型，\n\n01:08.288 --> 01:13.337\n它分为急性异物、水肿和慢性肿瘤和狭窄。\n\n01:13.337 --> 01:15.962\n按照部位分为胸腔外梗阻，\n\n01:15.962 --> 01:20.388\n占83%和胸腔内梗阻急救方法存在差异。\n\n01:22.564 --> 01:24.789\n它的高发人群其实就是儿童，\n\n01:24.789 --> 01:31.539\n跟成年成成人对成有鲜明对比，\n\n01:31.539 --> 01:34.039\n对全部儿童多发，\n\n01:34.039 --> 01:35.814\n占病例的70%，\n\n01:35.963 --> 01:37.914\n多以1.3岁为主，\n\n01:37.914 --> 01:40.064\n多因玩具零食误吸，\n\n01:40.263 --> 01:40.963\n成人呢，\n\n01:40.963 --> 01:42.814\n常见于聚聚餐的时候，\n\n01:43.213 --> 01:44.363\n嗯，\n\n01:44.363 --> 01:45.564\n65%肉类嵌顿。\n\n01:46.093 --> 01:49.680\n老年人吞咽功能退化者风险增加3倍，\n\n01:49.680 --> 01:53.343\n特征性的表现是V字V字的手型，\n\n01:53.642 --> 01:53.992\n嗯，\n\n01:53.992 --> 01:56.642\n双手卡喉出现率是92%，\n\n01:56.742 --> 02:00.142\n紫绀多在阻塞后2.3分钟显现。\n\n02:00.292 --> 02:02.843\n2024年上海瑞金医院案例显示，\n\n02:02.892 --> 02:07.742\n花生呛入儿童氧饱和度可在30秒内降至80%。\n\n02:08.192 --> 02:10.143\n还有一个特殊人群的识别，\n\n02:10.542 --> 02:13.393\n孕妇肥胖者出现锁骨上窝的凹陷，\n\n02:13.393 --> 02:16.192\n婴儿表现为无声哭闹伴鼻翼。\n\n02:16.410 --> 02:16.761\n颤动。\n\n02:16.910 --> 02:19.035\n北京儿童医院显示，\n\n02:19.035 --> 02:22.660\n86%的婴儿窒息病例伴有特征明显的三凹症。\n\n02:25.347 --> 02:27.597\n第二个是讲一下急救的四分钟。\n\n02:28.820 --> 02:29.871\n我们，\n\n02:29.871 --> 02:34.371\n其实最常见的是有一个哈姆立克急救法分解。\n\n02:36.802 --> 02:37.628\n我们标准化的，\n\n02:37.628 --> 02:39.753\n我们来讲一下它的标准化的操作。\n\n02:39.902 --> 02:43.253\n它是第一个步骤是施救者呈弓步站位，\n\n02:43.302 --> 02:44.902\n环抱患者的腰部，\n\n02:45.102 --> 02:47.203\n定在脐上两横指，\n\n02:47.203 --> 02:48.427\n脐上脐上，\n\n02:48.427 --> 02:53.052\n这个脐上的两横指用拳眼快速向上冲击，\n\n02:53.102 --> 02:54.552\n45°冲，\n\n02:54.552 --> 02:55.652\n45°冲击，\n\n02:55.902 --> 03:00.003\n每次冲击发生400到六百能源的力量，\n\n03:00.302 --> 03:02.302\n精准定位是剑突。\n\n03:03.147 --> 03:03.347\n嗯，\n\n03:03.347 --> 03:05.347\n这个剑突与肚脐连线，\n\n03:05.347 --> 03:07.046\n肚脐连线的中点，\n\n03:07.097 --> 03:09.621\n也就是脐上的5.8cm，\n\n03:09.621 --> 03:10.746\n为冲击靶点。\n\n03:10.796 --> 03:15.647\n错误定位可告造成肋骨骨折和内脏损伤等并发症。\n\n03:15.897 --> 03:18.097\n动态评估效果是，\n\n03:18.097 --> 03:20.972\n每次冲击后观察口腔内有没有异物，\n\n03:20.972 --> 03:22.046\n可以有排出。\n\n03:22.197 --> 03:24.447\n5次冲击为一周期。\n\n03:27.552 --> 03:31.052\n无效时应立即启动心肺复苏的流程。\n\n03:32.591 --> 03:35.240\n关于婴儿急救差异处理。\n\n03:36.529 --> 03:38.279\n俯卧位拍击技术。\n\n03:39.617 --> 03:47.867\n前臂托举在婴儿形成15°头低脚、15°头低脚高位，\n\n03:47.966 --> 03:52.266\n掌根在胸肩胛骨连线中点连续叩击5次，\n\n03:52.417 --> 03:55.466\n冲击力叩击在3.5kg范围内。\n\n03:55.567 --> 03:59.817\n俯卧冲击位的要点是要将婴儿俯卧于前臂，\n\n03:59.867 --> 04:01.766\n头低脚高约15°，\n\n04:01.867 --> 04:04.617\n两指快速冲击胸骨下半部，\n\n04:04.716 --> 04:07.716\n连续5次力度控制在1.3kg。\n\n04:09.869 --> 04:11.970\n婴幼儿上气道梗阻的急救技术，\n\n04:12.070 --> 04:14.270\n它有它的拍击的技术要点，\n\n04:14.570 --> 04:17.970\n是针对婴幼儿上气道梗阻的一种急救方法，\n\n04:18.019 --> 04:21.170\n要求操作者将婴儿置于俯卧位，\n\n04:21.170 --> 04:25.019\n用掌根部对其肩胛骨进行连续拍击，\n\n04:25.119 --> 04:28.619\n目的是通过震动使异物松动并排出。\n\n04:29.268 --> 04:31.417\n仰卧位冲击技术的要点的话，\n\n04:31.667 --> 04:33.768\n是适用于婴幼儿头部。\n\n04:34.118 --> 04:34.467\n嗯，\n\n04:34.467 --> 04:38.067\n婴幼儿部分气道梗阻或俯卧位拍击无效时，\n\n04:38.217 --> 04:44.118\n操作者需将婴儿仰卧用手指并拢胸骨下1/3进行快速冲气，\n\n04:44.317 --> 04:47.368\n以帮除且清除气道异物。\n\n04:48.238 --> 04:50.763\n特殊人群的急救方方案，\n\n04:50.763 --> 04:52.738\n首先我们针对孕妇。\n\n04:52.937 --> 04:53.738\n孕妇的话，\n\n04:53.738 --> 04:56.562\n我们是采用胸部环抱法，\n\n04:56.562 --> 05:02.638\n定位在胸骨柄中段距离胸骨角两二横指垂直方向实施冲击，\n\n05:02.787 --> 05:03.738\n避免压迫。\n\n05:04.850 --> 05:09.299\n膨隆子宫还有肥胖者的适配技术是腋下环抱，\n\n05:09.500 --> 05:12.049\n他需调整手臂角度为30°，\n\n05:12.049 --> 05:16.049\n冲击点选择在胸骨中下1/3交界处，\n\n05:16.100 --> 05:18.049\n确保力量传至纵膈区，\n\n05:18.399 --> 05:19.950\n体位代偿策略，\n\n05:20.000 --> 05:22.100\n对于没有办法站立的患者，\n\n05:22.250 --> 05:25.174\n采用俯位位冲击，\n\n05:25.174 --> 05:27.250\n仰俯仰卧位冲击法。\n\n05:27.299 --> 05:28.500\n施救者跨。\n\n05:30.055 --> 05:31.355\n位于患者髋部，\n\n05:31.355 --> 05:32.256\n双手叠加，\n\n05:32.256 --> 05:33.656\n此时向上推挤。\n\n05:36.132 --> 05:36.382\n第三，\n\n05:36.382 --> 05:39.333\n我们来看一下它的临床诊断与治疗。\n\n05:40.854 --> 05:42.778\n首先是影像学的检查，\n\n05:42.778 --> 05:46.428\n也就是拍片子或者做CTCT的话，\n\n05:46.428 --> 05:48.653\n可以建CT重建技术的话，\n\n05:48.903 --> 05:50.954\n可立体呈现气道结构，\n\n05:51.053 --> 05:58.028\n对肿瘤压迫气道狭窄准确率诊断准确率要高达92%。\n\n05:58.028 --> 06:00.954\n其实就是我们做CT就可以完全明，\n\n06:00.954 --> 06:02.854\n大概率就是22%，\n\n06:02.854 --> 06:05.854\n能够明确它是识别这个异物，\n\n06:06.003 --> 06:08.604\n最小可识别3mm的异物。\n\n06:08.753 --> 06:11.053\n这是北京协和医院2024年。\n\n06:11.145 --> 06:11.746\n的数据，\n\n06:11.946 --> 06:16.996\n还有就是纤维支气管镜适用于活体组织取样及异物取出。\n\n06:17.196 --> 06:21.096\n对声门下病变诊断敏感度达85%。\n\n06:21.096 --> 06:23.596\n检查前需要评估血氧饱和度，\n\n06:23.596 --> 06:28.496\n要大于90%才能实施检查手段选择原则，\n\n06:28.746 --> 06:31.270\n急性梗阻首选床边超声，\n\n06:31.270 --> 06:33.045\n敏感性是78%，\n\n06:33.196 --> 06:36.295\n稳定性稳定期推荐增强CT，\n\n06:36.446 --> 06:37.770\n疑似血管压迫，\n\n06:37.770 --> 06:41.096\n结合CTA婴幼儿检查辐射量应控制。\n\n06:41.147 --> 06:44.046\n是在两毫S以下。\n\n06:45.561 --> 06:45.960\n阶梯，\n\n06:46.161 --> 06:48.036\n我们对于上气道梗阻的话，\n\n06:48.036 --> 06:49.661\n有一个阶梯的治疗方案。\n\n06:50.311 --> 06:50.885\n第一，\n\n06:50.885 --> 06:52.561\n第一是一级急救处理，\n\n06:52.610 --> 06:53.960\n实施海姆立克法，\n\n06:54.010 --> 06:56.210\n氧饱和小于50%，\n\n06:56.210 --> 07:01.811\n应该行环甲膜穿刺黄金抢救时间窗为4分钟内建立气道。\n\n07:01.911 --> 07:04.610\n这是2023年国际版的指南。\n\n07:04.811 --> 07:08.210\n二级药物是肾上腺素喷雾，\n\n07:08.210 --> 07:09.561\n0.5mg每公斤体重，\n\n07:09.661 --> 07:12.010\n联合地塞米松静脉注射，\n\n07:12.161 --> 07:15.411\n对过敏性水肿有效率达91%。\n\n07:15.800 --> 07:18.401\n30分钟内重复给药不超过两次，\n\n07:18.800 --> 07:20.200\n三级手术治疗，\n\n07:20.300 --> 07:23.075\n经喉罩通气后行急诊，\n\n07:23.075 --> 07:23.950\n气管切开，\n\n07:24.050 --> 07:27.050\n恶性肿瘤患者优先选入金属支架，\n\n07:27.050 --> 07:29.550\n植入直径16.20。\n\n07:30.605 --> 07:33.055\n毫米术后48小时，\n\n07:33.506 --> 07:36.455\n纤支镜清除率需达100%。\n\n07:36.756 --> 07:39.305\n我们有一个决策的关键指标，\n\n07:39.455 --> 07:42.455\n决策机CS评分选择干预方式，\n\n07:42.656 --> 07:46.105\n大于12分尝试保守治疗，\n\n07:46.105 --> 07:47.855\n8.12分准备插管，\n\n07:48.006 --> 07:50.006\n小于8分直接手术。\n\n07:50.205 --> 07:53.756\n这是AHA 2025急救流程。\n\n07:56.981 --> 07:59.481\n最后我们讲一下它的预防策略。\n\n08:04.552 --> 08:06.752\n第一个是环境的安全管理。\n\n08:10.015 --> 08:11.865\n也就是说我们对于婴幼儿的话，\n\n08:12.115 --> 08:12.515\n嗯。\n\n08:14.634 --> 08:18.183\n要防止他有避免接触到物品误吸，\n\n08:18.933 --> 08:19.334\n嗯，\n\n08:19.334 --> 08:20.533\n误吸物品，\n\n08:20.734 --> 08:26.433\n比如说直径小于3.7cm物品均处于误吸的风险。\n\n08:26.683 --> 08:28.533\n它包括一些小孩子的玩具，\n\n08:28.533 --> 08:29.734\n比如说磁力珠，\n\n08:29.834 --> 08:31.433\n还有包括我们的硬币，\n\n08:31.683 --> 08:32.883\n还有纽扣电池。\n\n08:33.283 --> 08:36.833\n这个2025年北京儿童医院数据显示，\n\n08:36.984 --> 08:39.434\n占儿童误吸的76%。\n\n08:40.080 --> 08:45.729\n第二个就是我们的食品高温险高风险食物警示，\n\n08:45.979 --> 08:48.080\n一个是坚果、花生啊，\n\n08:48.080 --> 08:49.030\n腰果啊，\n\n08:49.080 --> 08:50.268\n还有胶冻类，\n\n08:50.268 --> 08:54.429\n比如说果丁布、冬布、果冻布丁，\n\n08:54.729 --> 08:55.905\n粘性的食物，\n\n08:55.905 --> 08:57.280\n比如年糕、汤圆。\n\n08:58.922 --> 08:59.372\n还有虚。\n\n09:02.385 --> 09:03.835\n需标注红色警示。\n\n09:03.984 --> 09:05.385\n建议3岁以下。\n\n09:07.078 --> 09:07.278\n嗯，\n\n09:07.328 --> 09:07.927\n儿童。\n\n09:09.557 --> 09:13.557\n不用使用安全收纳的三原则物品，\n\n09:13.807 --> 09:14.557\n小物件，\n\n09:14.656 --> 09:18.406\n物品应存放高度应该是大于1.2米。\n\n09:19.007 --> 09:21.757\n药品使用安全使用，\n\n09:21.757 --> 09:23.007\n儿童安全瓶盖，\n\n09:23.307 --> 09:27.757\n玩具零玩具零件配备防脱落测检测，\n\n09:28.307 --> 09:30.606\n还有我们监护人的责任规范，\n\n09:30.706 --> 09:32.156\n建立三查制度，\n\n09:32.257 --> 09:34.656\n进食前要检查食物的形态，\n\n09:34.906 --> 09:39.656\n玩耍后要检查零件的玩是否玩玩具是否有零件。\n\n09:39.885 --> 09:42.784\n完整就诊前应该检查床铺。\n\n09:43.034 --> 09:47.684\n这是我们2025年婴幼儿伤害预防白皮书的建议。\n\n09:49.515 --> 09:50.116\n谢谢大家。\n\n09:54.265 --> 09:54.664\n继续念。\n\n09:56.010 --> 09:59.909\n那其实我们在除了环境安全方面的话。\n\n10:00.862 --> 10:03.312\n我们还有其他的。\n\n10:05.054 --> 10:07.155\n比如说那些高风险食物的警示，\n\n10:07.354 --> 10:09.854\n其实这个是小朋友，\n\n10:09.905 --> 10:12.354\n还还有就是大人常见的，\n\n10:12.505 --> 10:12.854\n嗯，\n\n10:12.854 --> 10:13.705\n在那个。\n\n10:15.674 --> 10:18.375\n花生和坚果这一类的话，\n\n10:18.674 --> 10:19.075\n嗯，\n\n10:20.075 --> 10:24.099\n我们尽量不要让小朋友接触这些东西，\n\n10:24.099 --> 10:25.474\n或者吃这些东西，\n\n10:25.575 --> 10:32.224\n尤其是在玩耍什么时候应该尽量的避免他们吃花生、腰果，\n\n10:32.375 --> 10:37.375\n还有其他像杏仁啊、开心果啊、松子这些坚果类的东西。\n\n10:37.625 --> 10:38.625\n胶冻类的话，\n\n10:38.625 --> 10:40.950\n我们不像果冻啊，\n\n10:40.950 --> 10:44.750\n布丁这些要是要要进食的话，\n\n10:44.750 --> 10:45.825\n就是要需要。\n\n10:45.986 --> 10:49.986\n在大人的监护下才能够食用，\n\n10:49.986 --> 10:51.385\n对于老年人来说，\n\n10:51.486 --> 10:53.935\n粘性的食物年糕汤圆。\n\n10:54.185 --> 10:55.885\n每年在过年的时候，\n\n10:56.036 --> 10:56.385\n嗯，\n\n10:56.385 --> 10:58.536\n可能急诊都会接触到一些，\n\n10:58.736 --> 11:02.835\n因为年糕汤圆梗阻的急，\n\n11:03.236 --> 11:08.286\n在急诊都能碰到老年人有这种年糕汤圆梗阻的病例。\n\n11:08.736 --> 11:11.286\n我们在这些病例上需要标示，\n\n11:11.435 --> 11:11.835\n嗯，\n\n11:12.036 --> 11:13.786\n标志红色警示。\n\n11:13.986 --> 11:17.161\n而且在三岁以下的小朋友的话，\n\n11:17.161 --> 11:19.935\n尽量不要让他们接触这些东西。\n\n11:20.620 --> 11:21.721\n还有就是要我们，\n\n11:21.820 --> 11:22.221\n嗯。\n\n11:24.052 --> 11:24.877\n对于小朋友的话，\n\n11:24.877 --> 11:29.302\n我们监护人的责任其实是很重大的，\n\n11:29.353 --> 11:34.853\n因为我们有一句话就是3岁不离手，\n\n11:35.203 --> 11:36.552\n8岁不离眼，\n\n11:36.603 --> 11:39.453\n所以我们在那个作为监护人，\n\n11:39.603 --> 11:40.603\n我们要。\n\n11:42.879 --> 11:43.528\n对于小孩子，\n\n11:43.528 --> 11:45.229\n平常的玩具啊，\n\n11:45.429 --> 11:46.479\n食物啊，\n\n11:46.479 --> 11:48.278\n都要进行检查，\n\n11:48.578 --> 11:48.979\n嗯。\n\n11:50.846 --> 11:56.896\n然后玩耍或者进食以后也要检查小朋友的状态，\n\n11:57.096 --> 12:00.546\n还有检查玩具的零完整性。\n\n12:00.846 --> 12:01.546\n就是，\n\n12:01.546 --> 12:03.796\n还有在小朋友睡觉之前的话，\n\n12:03.846 --> 12:06.396\n我们也应该多加照顾小朋友。\n\n12:06.497 --> 12:11.346\n嗯看看他床铺上面有没有自己拿的这些小的玩具，\n\n12:11.447 --> 12:11.796\n嗯，\n\n12:11.796 --> 12:12.971\n小的这种，\n\n12:12.971 --> 12:14.846\n特别像这种磁力珠啊，\n\n12:14.947 --> 12:19.346\n还有现在有很多这种像那个我们小朋友去。\n\n12:20.359 --> 12:21.385\n淘乐，\n\n12:21.385 --> 12:22.710\n淘气堡玩的话，\n\n12:22.710 --> 12:26.909\n会有那种小沙子那种小颗粒会携带，\n\n12:26.909 --> 12:27.210\n嗯，\n\n12:27.210 --> 12:29.835\n会钻到小朋友的那个裤子啊，\n\n12:29.835 --> 12:31.159\n衣服的口袋里面。\n\n12:31.159 --> 12:31.909\n这些的话，\n\n12:31.909 --> 12:33.359\n我们也要在那个。\n\n12:35.098 --> 12:35.299\n嗯，\n\n12:35.749 --> 12:37.749\n小朋友玩耍结束以后，\n\n12:37.749 --> 12:40.098\n检查一下他口袋里，\n\n12:40.098 --> 12:41.148\n或者。\n\n12:42.689 --> 12:44.689\n小朋友口袋里是不是有这种东西？\n\n12:44.789 --> 12:46.838\n其实小朋友他有的时候不太清楚，\n\n12:46.838 --> 12:48.989\n他只是觉得这种东西就比较好玩，\n\n12:48.989 --> 12:51.189\n然后他就放到嘴巴里面，\n\n12:51.388 --> 12:53.114\n嗯尝尝尝味道。\n\n12:53.114 --> 12:59.539\n因为很因为小朋友他对他的那个触觉味觉都是在发展的过程，\n\n12:59.539 --> 13:01.614\n发展的过程中对这些东西，\n\n13:01.614 --> 13:03.388\n他们可能还是非常的。\n\n13:04.585 --> 13:05.635\n有好奇心，\n\n13:05.786 --> 13:08.411\n然后所以我们家作为家长的话，\n\n13:08.411 --> 13:10.635\n家长或者监护人的话要。\n\n13:12.257 --> 13:14.956\n检查小朋友是否有这些东西，\n\n13:15.057 --> 13:16.656\n尽量的话在。\n\n13:18.552 --> 13:22.127\n尽量能够把这些东西都，\n\n13:22.127 --> 13:27.203\n避免在小朋友的那个就寝之前全部把它整理好。\n\n13:27.997 --> 13:28.848\n然后，\n\n13:28.898 --> 13:30.848\n就寝就起床，\n\n13:30.848 --> 13:33.172\n就寝的时候也睡着了，\n\n13:33.172 --> 13:38.098\n也要检也也检查一下小朋友的其他的杂物有没有摆好。\n\n13:43.463 --> 13:45.663\n其实我们最主要的一点的话，\n\n13:46.163 --> 13:46.562\n嗯，\n\n13:46.862 --> 13:48.913\n在上气道梗阻，\n\n13:49.062 --> 13:55.713\n大家最最最最能够急救和运用的方法就是一个海姆克利法。\n\n13:58.880 --> 14:01.031\n我们再讲一下海姆克利法，\n\n14:01.031 --> 14:07.281\n它的施救者就是其实施救者就是站在患者的身后，\n\n14:07.380 --> 14:08.580\n弓步站位，\n\n14:08.931 --> 14:11.080\n环抱住患者的腰部。\n\n14:11.380 --> 14:12.156\n定位呢，\n\n14:12.156 --> 14:14.731\n是在脐上的肚脐上，\n\n14:14.731 --> 14:19.531\n两横指用拳快速向上45°冲击。\n\n14:19.880 --> 14:22.906\n每次冲击它其实要有一定的力度的，\n\n14:22.906 --> 14:24.681\n如果它的力度太轻的话，\n\n14:24.681 --> 14:28.580\n它就没有办法把这个东西把气道里的东西。\n\n14:29.137 --> 14:31.361\n攻击就是弄出弄出来，\n\n14:31.361 --> 14:33.161\n他还是需要有一定的力量，\n\n14:33.161 --> 14:33.986\n然后就是。\n\n14:35.452 --> 14:37.502\n你把它弄把它就是敲击出来。\n\n14:39.226 --> 14:39.702\n还有就是，\n\n14:39.702 --> 14:43.577\n我们定位也非常的重要。\n\n14:43.726 --> 14:45.377\n如果你定位错误的话，\n\n14:45.427 --> 14:48.427\n我们可能会造成肋骨的骨折。\n\n14:48.476 --> 14:50.677\n因为你上面一点其实它就是肋骨，\n\n14:50.677 --> 14:52.052\n还有里面，\n\n14:52.052 --> 14:53.026\n如果你定位不好，\n\n14:53.026 --> 14:55.177\n旁边就是肝脏还有脾脏，\n\n14:55.276 --> 14:56.851\n会造成脾损伤啊，\n\n14:56.851 --> 14:58.327\n肝损伤这种的。\n\n14:58.476 --> 15:00.202\n我们的精准定位的话，\n\n15:00.202 --> 15:01.726\n是在剑突下，\n\n15:01.776 --> 15:06.127\n剑突其实就是在那个两个胸骨下端，\n\n15:06.226 --> 15:07.177\n还有肚脐。\n\n15:07.177 --> 15:08.901\n肚脐大家都知道的，\n\n15:08.901 --> 15:09.276\n在。\n\n15:09.559 --> 15:13.010\n线突下与肚脐连线的中点，\n\n15:13.409 --> 15:13.760\n嗯，\n\n15:13.760 --> 15:15.085\n如果你不太清楚的话，\n\n15:15.085 --> 15:18.809\n也可以就是作为脐上的5.8cm。\n\n15:18.809 --> 15:21.484\n五五其实五五到八米的话，\n\n15:21.484 --> 15:24.409\n也可能就是大家这样一个手掌的这个大小，\n\n15:24.760 --> 15:25.159\n嗯，\n\n15:25.159 --> 15:26.659\n是是5cm，\n\n15:26.659 --> 15:27.784\n然后再多一点，\n\n15:27.784 --> 15:28.585\n再加一个，\n\n15:28.585 --> 15:32.510\n这个就是手掌应该是一手掌差不多5到八厘米。\n\n15:32.609 --> 15:32.984\n嗯，\n\n15:32.984 --> 15:37.010\n在肚脐上面5到八厘米这个点作为一个冲击的靶点，\n\n15:37.409 --> 15:38.210\n那我们。\n\n15:39.932 --> 15:42.382\n每一次冲击以后。\n\n15:43.565 --> 15:44.914\n最好的结果就是，\n\n15:44.914 --> 15:49.715\n观能够观察到患者的口腔中有异物的排出。\n\n15:49.965 --> 15:52.515\n那有看到如果有异物排出的话，\n\n15:52.565 --> 15:54.164\n那证明就是，\n\n15:54.315 --> 15:56.565\n这个梗阻就已经解除。\n\n15:56.914 --> 15:58.215\n如果是没有的话，\n\n15:58.315 --> 16:01.765\n是5次作为一个冲击的周期，\n\n16:02.114 --> 16:02.715\n对吧？\n\n16:02.715 --> 16:03.315\n然后，\n\n16:03.614 --> 16:05.914\n如果5次作为还没有。\n\n16:06.721 --> 16:07.072\n嗯，\n\n16:07.372 --> 16:08.521\n有异物排出，\n\n16:08.521 --> 16:09.771\n它还是处于梗阻，\n\n16:09.921 --> 16:13.247\n那么他这个时候就是要肯定是有缺血，\n\n16:13.247 --> 16:15.671\n就是缺氧的那个情况发生。\n\n16:15.921 --> 16:17.072\n这个无效时，\n\n16:17.221 --> 16:21.072\n我们需要立即启动一个心肺复苏的流程。\n\n16:21.822 --> 16:23.997\n心肺复心肺复苏呢，\n\n16:23.997 --> 16:25.471\n我们也知道就是。\n\n16:27.487 --> 16:31.437\n先是先是那个胸外按压什么好，\n\n16:31.487 --> 16:32.987\n今天就接到这里，\n\n16:32.987 --> 16:33.838\n谢谢大家。\n\n","v0247cg10004d76c2gqljht6lhl8o3cg",998,705,"2026-01-26 11:55:17"," \"高效会议策略与技巧 - meeting_01.mp4 内容解析\"  "," \"会议管理, 高效会议技巧, 团队协作, 会议记录, 商务会议, meeting_01.mp4\"  "," \"通过 meeting_01.mp4 学习如何组织高效会议，掌握时间管理、议程设置和团队沟通的关键技巧，提升您的会议效率和决策质量。\"","2026-06-10 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