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Megacode急救決策與處置流程，從「有脈搏嗎」判斷是否進行高品質CPR與選擇可電撃或不可電撃心律，涵蓋去颤電撃、同步整流與循環中的藥物投予。內容以EKG辨識為核心，建立Shock-First與Pump-and-Find序列，並針對VF/pVT、Asystole/PEA、Hyperkalemia等情境給出能量、節律特徵、按壓比例與可逆轉病因(5H5T)的系統化排查框架，強調穩定性導向的決策。",{"@graph":69,"@context":126},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/acls-megacode-ultimate-command-handbook/370410/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/acls-megacode-ultimate-command-handbook/370410.png","ImageObject",300,407,{"name":92,"@type":93},"RuangKosong","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-04","2026-09-23",true,{"@type":102,"interactionType":103,"userInteractionCount":56},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118,122],{"name":109,"@type":110,"acceptedAnswer":111},"面對無脈搏時，Megacode的起點是什麼？","Question",{"text":112,"@type":113},"先判斷是否為急救流程起點：有脈搏嗎、是否需要壓胸。決策會導向高品質CPR以及後續選擇可電撃或不可電撃的心律策略。","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"VF或無脈搏pVT屬於哪一類節律，處置重點是什麼？",{"text":117,"@type":113},"屬於可電撃節律，需採用Shock-First序列進行電撃（去颤電撃）並在後續立即做高品質CPR循環。流程並包含藥物投予的時序與劑量安排。",{"name":119,"@type":110,"acceptedAnswer":120},"Asystole或PEA無法電撃矯正時，處置核心是什麼？",{"text":121,"@type":113},"核心是Pump-and-Find序列：立即高品質CPR、給予Epinephrine並在CPR循環間積極尋找並處理5H5T可逆轉原因。治療基石是CPR與可逆原因的排查，而非電撃。",{"name":123,"@type":110,"acceptedAnswer":124},"高血钾的EKG線索與常見處置重點有哪些？",{"text":125,"@type":113},"文中列出Prominent U wave、ST下降、Peaked T wave、P波變平、QRS變寬等線索，並提到嚴重時可出現正弦波。處置重點包含Calcium gluconate、Sodium bicarbonate、Glucose+Insulin與Albuterol等，並以U波與EKG波形判讀高低血钾。","https://schema.org",{"og:url":83,"og:type":128,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":130,"canonical":83},"index,follow",{"doc_id":132,"site_id":62},370410,1790635588,{"code":4,"msg":5,"data":135},{"doc_id":132,"user_id":136,"nickname":92,"user_avatar":137,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":138,"file_id":139,"file_url":140,"file_type":141,"file_size":142,"view_count":56,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":143,"language":144,"language_code":63,"site_id":62,"html_lang":145,"table_of_contents":146,"faqs":147,"seo_title":148,"seo_description":67,"update_tm":149,"read_time":150},962090883219,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","# ACLS Megacode:終極指揮手册\n\n将混亂轉化為清晰，化知識為本能的實戰指南  \n## 有脈搏嗎?(要壓胸嗎?)\n\n這是急救流程的起點,決定是否動高品質CPR。  \n# Megacode的三大決策核心\n\n## 要電撃嗎?(可電撃心律?)\n\n快速辨識心律，決定使用「去颤」或「同步整流」。  \n●去颤電撃：死人，無脈搏的VT和VF。  \n●同步整流：活人，不穏定的心搏過速。  \n## 給什麽藥?(對應的藥物?)\n\n根據心律舆生命徵象，精準投予適当的急救藥物。  \n核心演算法：可電撃vs.不可電撃心律  \n## EKG辨識\n\n### 1.電撃(Shock)B\n\n可電撃節律：VF/無脈搏VT(pVT)的應對策略  \nVF(心室顫動)  \n特徵：亂,心臓的垂死淨扎。  \n脈搏：一定没有。  \nNote:若VF波形微弱像Asystole,仍當作VF處置。  \nWww~~~~m~~～w  \n處置流程(The \"Shock-First\"Sequence)  \n雙向電撃器：120-200J(建議200J)。單向電撃器：360J  \n### 2.壓胸(CPR)電撃後立即CPR5個循環(約2分鐘)。壓胸中断時間\u003C10秒。\n\npVT(無脈搏心室頻脈)  \n特徵：單形性(Monomorphic)-大而快的QRS波、規則。  \n多形性(Polymorphic)-大而快的QRS波、不規則。  \n脈搏：無。  \n### 3.給藥(Drugs)\n\n第一劑：Epinephrine 1mg IV/IO push,每3-5分筵一次。  \n第三次電攀後:Amiodarone 300mg IV/IO push。替代藥物：Lidocaine 1.5mg/kg。  \n## 不可電撃節律：Asystole/PEA的處置核心\n\n核心概念  \nAsystole(心搏停止)  \n心臓完全没有電氟活動。  \n### PEA(無脈搏電氣活動)\n\nEKG有波形，但摸不到脈搏。  \n嗣鍵原則:這些心律無法透過電撃來矯正。治療的基石是高品質CPR舆找出可逆轉的原因。  \n### 處置流程(The \"Pump-and-Find\"Sequence)\n\n#### 1壓胸(CPR):\n\n確認心律後立即開始高品質CPR。CCF(胸部按壓比例)>80%。  \n#### 2給藥(Drug):\n\n唯一選擇:Epinephrine 1mg IV/IO push,盡快給予，之後每3-5分鐘一次，無劑量上限。  \n#### 3診断(Diagnose):\n\n在CPR循環間,積極尋找並處理5H5T(可逆轉的原因)。這是PEA/Asystole最常考的重點。  \n5H5T:找出並排除可逆轉的驟停原因  \n5H  \nHypovolemia(低血容)  \n線索：心跳快、窄QRS、低血壓  \nHypoxia(缺氧)  \n線索：發紺、心跳慢、測SpO2  \nHydrogen ion(酸中毒)  \n線索：抽血測gas、糖尿病/臂衰竭病史、EKG QRS變小  \nHypo-/Hyperkalemia(高/低血钾)  \n線索：抽血、EKG燮化(高T波vs.U波)  \nHypothermia(低體温)線索：測量核心體温  \n5T  \nTension pneumothorax(張力性氣胸)  \n線索：呼吸音消失、氣管偏移、頸靜脈怒張  \nTamponade,cardiac(心包填塞)線索：頸静脈怒張  \nToxins(毒藥物)線索：病史、EKG prolonged QT  \nThrombosis,pulmonary(肺栓塞)線索：發紺、咳血、DVT病史  \nThrombosis,coronary(冠状動脈栓塞)  \n線索：盗汗、皮膚濕冷、EKG變化  \n## 高血钾(Hyperkalemia)\n\n### 小明顯U波(Prominent U wave)\n\n·ST段下降(ST depression)  \n### 人高聳T波(Peaked T wave)\n\n·P波變平(Flat P wave)  \n·QRS波變寬(Wide QRS)  \n### 處置重點\n\nCalcium gluconate(穩定心肌细胞膜)Sodium bicarbonateGlucose+InsulinAlbuterol  \nU波  \nEKG線索：判讀高低血钾的關鍵波形低血钾(Hypokalemia)  \n·QT間期延長(Prolonged QT)  \n·T波變小(Small T wave)  \n·PR間期延長(Prolonged PR)  \n●嚴重時呈正弦波(Sine wave)  \n## 核心演算法：穩定性是首要決策關鍵\n\n寶性心携過速(Sinus Tachycardia)通常是穏定狀態,重點在於找出心臓以外的根本原因(如：發焼、脱水、甲亢),而非直接降速。  \n## 不穩定心搏過速：同步整流的時機輿能量選擇\n\n目的：抓到QRS的R波頂點後放電,將心律重置。  \n對象：有脈搏、心跳快，且出現不穩定徵象的病人。  \n\n| EKG類型   | 描述   | 建議能量   |\n| --- | --- | --- |\n| 規則+窄QRS   | SVT,Atrial Flutter   | 100J(SVT),200J(AF)   |\n| 規則+寬QRS   | Monomorphic VT   | 100 J   |\n| 不規則+窄QRS   | Atrial Fibrillation   | 200J   |\n| 不規則+寬QRS   | Polymorphic VT   | 使用去颤模式(Defibrillation)200 J  \u003Cbr>(因R波難以捕捉)   |\n\n\n| 血栓風險:發生超過48小時的Af(心房顫動)或AF(心房撲動)不應貿然整流，可能打出腦血栓。  \u003Cbr>應先考慮藥物降速。  \u003Cbr>Torsades de Pointes:若為此種多形性VT,可考慮給予MgSO4。   |\n| --- |\n\n穩定心搏過速：根據EKG 選擇藥物","cbCaiuv7je2SWZhE","https://ap.wps.com/l/cbCaiuv7je2SWZhE","pdf",18693323,21,"Chinese","en","# 有脈搏嗎？（要壓胸嗎？）\n# Megacode的三大決策核心\n## 要電撃嗎？（可電撃心律？）\n## 給什麽藥？（對應的藥物？）\n## EKG辨識\n## 不可電撃節律：Asystole/PEA的處置核心\n# 高血钾（Hyperkalemia）\n# 核心演算法：穩定性是首要決策關鍵\n# 不穩定心搏過速：同步整流的時機與能量選擇\n# 穩定心搏過速：根據EKG選擇藥物","[{\"question\":\"面對無脈搏時，Megacode的起點是什麼？\",\"answer\":\"先判斷是否為急救流程起點：有脈搏嗎、是否需要壓胸。決策會導向高品質CPR以及後續選擇可電撃或不可電撃的心律策略。\"},{\"question\":\"VF或無脈搏pVT屬於哪一類節律，處置重點是什麼？\",\"answer\":\"屬於可電撃節律，需採用Shock-First序列進行電撃（去颤電撃）並在後續立即做高品質CPR循環。流程並包含藥物投予的時序與劑量安排。\"},{\"question\":\"Asystole或PEA無法電撃矯正時，處置核心是什麼？\",\"answer\":\"核心是Pump-and-Find序列：立即高品質CPR、給予Epinephrine並在CPR循環間積極尋找並處理5H5T可逆轉原因。治療基石是CPR與可逆原因的排查，而非電撃。\"},{\"question\":\"高血钾的EKG線索與常見處置重點有哪些？\",\"answer\":\"文中列出Prominent U wave、ST下降、Peaked T wave、P波變平、QRS變寬等線索，並提到嚴重時可出現正弦波。處置重點包含Calcium gluconate、Sodium bicarbonate、Glucose+Insulin與Albuterol等，並以U波與EKG波形判讀高低血钾。\"}]","ACLS Megacode:終極指揮手册 | PDF",1790188379,53]