Title: To The Cath Lab - In V Fib


题目：要转到心导管室 – 在心室颤动时
作者：EMedHome.com
Emergency Physicians may be confronted with a case of an awake and alert patient who arrives to the ED with an acute STEMI and then develops refractory ventricular fibrillation.
急诊医师可能会遇见一个因急性STEMI病人，就诊时清醒和警觉，但随后 出现了顽固性室颤。
The typical approach is to continue ACLS protocol in the ED until the V Fib is terminated, and then transfer the patient to the cardiac catheterization laboratory for emergency primary PCI.


典型的做法是在急诊科继续执行ACLS方案，直到室颤终止，然后将病人转移到心导管室行紧急PCI。
However, the EP should be aware that in the setting of persistent V Fib, there is precedent for salvage PCI during ongoing CPR .
然而， 急诊医生应该知道，在持续性室颤情形下，有在进行心肺复苏同时进行挽救PCI的先例。
The interventional cardiologist may be reluctant to take the patient to the cath lab while V Fib is ongoing.
介入心脏医生可能不愿将患者在室颤时送进导管室 。
Since shock-refractory ventricular fibrillation in many such cases is most likely driven by ongoing ischemia and infarction, it is postulated that PCI facilitates termination of the ventricular fibrillation.
由于除颤无反应顽固性室颤在许多情况下是由持续性缺血和梗死造成的，因此PCI有可能会有利于终止室颤。
Advanced airway management, antiarrhythmic agents, and epinephrine or vasopressin can be given while rapidly moving the patient to revascularization in the cath lab.


先进的气道管理，抗心律失常药物，肾上腺素或加压素，都可以在迅速转移病人到导管室做血运重建的同时进行。
It may be incumbent upon the EP to advocate for transfer of the patient to the cath lab in the setting of shock-refractory V Fib, especially in the setting of a patient who arrived to the ED neurologically intact.


提倡转移除颤无反应顽固性室颤病人到导管室可能是急诊医生义不容辞的责任，尤其是在到达急诊科时神经系统无异常的病人 。
Reference 参考文献:

N Engl J Med September 12, 2013; 369:1047-1054.