”Life and death”, recognize the “golden five minutes” 10 seconds after cardiac arrest, blackout, loss of consciousness, sudden collapse, pale and then obscure 15 seconds, convulsions, sigh-like breathing Peng Ning’an, Beijing Beijing Coal Group General Hospital, Intensive Care Unit 30 seconds, respiratory arrest 1- 2 minutes, pupil fixation 5 minutes, ATP depletion and complete cessation of energy metabolism in the brain 6 minutes, irreversible neuronal damage. 2 minutes Pupil fixation 4 minutes Glucose anaerobic metabolism stops 5 minutes ATP depletion in the brain, energy metabolism stops completely 6 minutes Irreversible neuronal damage If a previously awake patient suddenly suffers a cardiac arrest, the performance may be very prominent, he will suddenly fall to the ground, in a comatose state, pale and then obscure in about ten seconds, this situation is easier to attract the attention of family members and doctors. However, if a patient who is already in a coma has sudden cardiac arrest, the performance is often not so obvious, and may only show mild agitation and convulsions, followed by pallor and loss of aortic pulsation. Therefore, for all critically ill patients, it is best to perform ECG monitoring and not to wait until after cardiac arrest to come on monitoring, which obviously delays the golden five minutes and makes the time of electric defibrillation delayed. The time to defibrillation in patients with ventricular fibrillation after cardiac arrest is the most important determinant of successful CPR. Second, we need to distinguish between cardiac arrest and respiratory arrest. The important difference between the two is the two key factors of successful CPR: continuous effective chest compressions and early electrical defibrillation when it is time to defibrillate. Above we have seen the process of change after cardiac arrest, so what if breathing alone stops first? Usually in respiratory arrest, our primary concern is to take effective ventilation measures “in time”. There are two points here: the first is timely, and the second is effective. The concept of “timely” varies greatly for each patient. In critical patients, respiratory arrest may cause immediate cardiac arrest because the body’s compensation for hypoxia has reached its limit. The key is whether we can detect respiratory arrest in time within a few minutes, and we know that respiratory arrest is not as significant as cardiac arrest, because most of the patients with respiratory arrest are patients with very critical underlying diseases, and most of them are in coma, and we also know that We also know that respiratory monitoring is not as accurate and sensitive as ECG monitoring, and our observation of respiration with the naked eye is more variable. Therefore, it is still difficult to achieve “timely”, and it mainly depends on the careful observation of the medical staff at the bedside. After respiratory arrest, we have to start effective ventilation support immediately at the time of detection, and the smaller the interval between the time of detection and the time of respiratory arrest, the better, because in addition to the severe respiratory acidosis caused immediately after respiratory arrest, the ratio of ventilation to blood flow is severely abnormal, which also leads to metabolic acidosis due to severe hypoxia, and the heart is at great risk of cardiac arrest at any time within a few minutes. Therefore, effective ventilation should be performed as early as possible before cardiac arrest. Before tracheal intubation, mouth-to-mouth manual ventilation or manual ventilation with a respiratory bag can be performed in a single person, while in-hospital tracheal intubation with ventilator mechanical ventilation is preferred. ”Effective” ventilation means that you have to find a way to ensure that the ventilation is effective as soon as possible, so you have to ensure that the airway is open, clean the oral cavity and airway secretions, and undress to ensure that the chest breathing is not restricted by pressure. Establish tracheal intubation and mechanical ventilation as soon as possible, which is the most effective way to ventilate. However, it should be noted that in case of severe interstitial lung disease sometimes mechanical ventilation is also difficult to resolve. In critically ill patients, respiratory arrest and cardiac arrest are closely related and causal. Both can manifest as sudden loss of consciousness and darkening of the face, and both require immediate establishment of effective ventilation. The main differences between the two are: 1. Early respiratory arrest does not require cardiothoracic compressions, the key is to establish effective ventilation 2. Early respiratory arrest does not require consideration of electrical defibrillation.