Rage NIBP da kurakurai auscultation ta hanyar lura da nau'in motsi na plethysmographic akan bugun bugun jini da kuma lura da ma'anar matsa lamba
"Idan akwai wurin da kake son zuwa, zan iya kai ka can, na sani, ni ne taswirar. Idan akwai wurin da kake buƙatar zuwa, na yi nasara zan iya kai ka wurin, kuma ni ne taswirar. 'ni taswira, ni ne taswira, ni ne taswirar!"- Dora da Explorer
Yawancin ma'aikatan kiwon lafiya na shekara dubu na iya yin waƙa tare da farin ciki yayin karanta wannan, yayin da iyayensu da tsofaffin abokan aikinsu tare da yara za su iya yin amfani da cuku a kan goshin goshi don shafe abubuwan tunawa.
Kada ku damu, likitocin baby boomer, Ba zan fara rera taken "Barney" na gaba ba, amma ina so in nuna ɗan ƙauna ga ma'aunin alamar mahimmancin sau da yawa da ba a kula da shi ba, yana nufin matsin lamba (taswira) mai da hankali ga ƙananan adadin a cikin baka kusa da karatun NIBP, saboda yana ɗaya daga cikin ma'auni mafi aminci na turare da za mu iya tantancewa.
Komawa a cikin 2011, na rubuta wani shafi mai suna "Nasihu da Dabaru don Karatun Hawan Jini na EMS." Wannan shafi, tare da Mike McEvoy's "Kurakurai guda biyar waɗanda ke haifar da Karatun Hawan jinin ku don zama mara kyau," yana bayyana akai-akai akan kafofin watsa labarun da shafukan EMS. duk lokacin da sabon EMT ya nemi taimako kan yadda ake samun daidaitaccen hawan jini yayin motsi zuwa motar asibiti.
Kuma ko da yaushe a cikin wadannan zaren sharhi, wasu hazikan tsofaffin likitocin sun nuna cewa karatun NIBP ba daidai ba ne kuma ya kamata ku "yi wa marasa lafiya magani, ba mai duba ba". Ya kamata a kalla su sami matsa lamba na farko da hannu. Ya yi daidai, injin NIBP ba daidai ba ne. Har ma masu yin na'ura sun ce haka. Karanta littafin mai kula da zuciyar ku kuma ku ɓoye wani abu a cikinsa cewa a cikin marasa lafiya da ke buƙatar cikakken BP mafi girma - marasa lafiya. a kan bangarorin biyu na sikelin - karatun NIBP akan allonku bazai zama, um, ainihin hawan jini ba.
Idan ina da dala ga kowane EMT wanda da amincewa ya ayyana BP yana ƙarewa a sifili (150/90, 120/80, 110/70, kowane lokaci) ko BP wanda ya zare stethoscope daga kunnensa kuma ya yi tagumi ya ƙare tare da m lamba karanta a kan mita tare da ko da zanta mark... da kyau, Ina da yawa daloli.Wataƙila bai isa saya Trend biyu fadi da Na dade ina kallo, amma yakan faru sau da yawa cewa Ina kiran ma'aunin hawan jini na hannun hannu mai duban aikin likita.
Idan yana da sauƙin auscultate hawan jini, da ba za mu yi posting tukwici da dabaru game da yadda za a yi shi kowace shekara ko makamancin haka.
Duk da haka, ko da yake NIBP cuff yana kula da girman girman hawan jini na systolic a cikin gigice, yana samun kusan MAP ɗaya kamar yadda ake sa ido kan jijiya.
A cikin binciken da aka yi na 4,957 manya ICU marasa lafiya a cibiyar kula da manyan makarantu, fiye da 27,000 dabi'un hawan jini an samu a lokaci daya tare da NIBP da catheter-of-arterial firikwensin. Rashin raunin koda da mace-mace sun kasance mafi girma a cikin systolic NIBP-ma'auni kungiyar. fiye da a cikin rukuni masu hawan jini na systolic arterial a cikin kewayon guda (<70 mmHg).1
Lokacin kwatanta mummunan rauni na koda da kuma mace-mace na ICU tsakanin MAP na arterial da kuma MAP maras nauyi, bambance-bambancen sun kasance ƙananan, kuma masu rubutun binciken binciken sun kammala cewa NIBP ya yi la'akari da hawan jini na systolic a cikin yanayin girgiza, amma ba ta hanyar hawan jini mara kyau ba.Abubuwan da aka samu MAP sun kasance kusa da MAP na jijiya (Figures 1 da 2).
To me yasa na'urorin NIBP suke da daidaito wajen auna MAP amma basu da dogaro wajen auna hawan jini na systolic?
Wannan shi ne ainihin akasin yadda muke yin shi da hannu;Mun gwada Korotkoff don ƙayyade systolic da diastolic hawan jini, sa'an nan kuma ta hanyar lissafi za mu sami ma'anar bugun jini daga ma'auni mai zuwa:
Da yawa daga cikinmu sun koyi wannan lissafin ne a makarantar koyon aikin jinya, sannan suka manta da sauri, saboda yawancin sigogin maganin mu suna da alaƙa da hawan jini na systolic, kuma saboda muna ƙin lissafi. ya fi mu kyau a lissafi fiye da mu.
Yawancin mutanen da suka kasance a cikin kujerar motar motar asibiti fiye da minti biyar sun gane cewa murmushi, kaka mai ruwan hoda mai nauyin kilo 90 kuma yana da hawan jini na 84/60 ba kome ba ne kamar mutumin da ya auna nauyin 250 kuma yana da jini. matsa lamba na 90./40. Ga kakarta, yana iya zama hawan jininta na yau da kullun, kayan aikinta masu mahimmanci sun cika sosai. Ga direban babbar mota mai launin toka, mai gumi, duk da hawan jini na systolic, ba ya da turare.
Yawancin tushe sunyi la'akari da MAP na 65 mmHg a matsayin mafi ƙanƙanci don zubar da jini mai mahimmanci, tare da nauyin MAP na yau da kullum na 70-110 mmHg. Kodan ɗan adam sun fi damuwa da hypoperfusion, ko da yake wasu nazarin dabbobi sun nuna cewa berayen na zubar da jini (shin kun sani). berayen suna da MAP iri ɗaya da ɗan adam?) Za su iya jure wa MAPs ƙasa da 50 mmHg har zuwa mintuna 90. Mummunan raunin koda yana farawa a cikin mintuna 20 tare da MAP ƙasa da 60 mmHg.
Don haka a gaba ne da kuke mamakin idan mai haƙuri ya kasance kwata-kwata ƙasa ne amma karfin jini, idan kuna yin imani da ƙwayar ƙwayar jini a tsakani da gaske gabatarwar asibiti na majiyyaci, ko kunnen abokin ku na kwance, ku mai da hankali kan wannan ɗan ƙaramin lamba a cikin baƙaƙe kusa da karatun NIBP ɗin ku.MAP ba zai kai ku ga hanya mara kyau ba.
Ta hanyar ƙaddamar da bayanan ku, kun yarda da zaɓin mai siyar da ke tuntuɓar ku kuma bayanan da kuka ƙaddamar ba su ƙarƙashin buƙatun "Kada ku Siyar da Bayanin Keɓaɓɓen Nawa".Duba Sharuɗɗan Sabis ɗinmu da Manufar Sirri.
Kelly Grayson, NRP, CCP, wani ma'aikacin jinya ne mai mahimmanci a Louisiana.A cikin shekaru 24 da suka gabata, ya yi aiki a matsayin mai kula da lafiyar jiki, mai kula da lafiyar lafiyar jiki, mai kula da filin da kuma ilmantarwa.Shi ne shugaban kungiyar EMS ta Louisiana da kuma malamai. memba na kwamitin EMT na Los Angeles National Registered EMT Association.
He holds an associate degree in general studies from Nunez Community College, Louisiana State University Eunice.Kelly was recognized as the 2016 Louisiana Paramedic of the Year, the 2002 Louisiana EMS Instructor of the Year, and the 2002 Louisiana AHA District Teacher of the Year, and was the recipient of the 2012 Best Regular Featured Web Column/Industry Maggie Award and 2014 Best Online Column at the Annual Folio Eddie Awards.He is a frequent speaker at EMS conferences, has contributed to various EMS training materials, and is the author of the popular blog A Day In a Day In a Ambulance Driver, "En Route: A Paramedic's Stories of Life, Death and Everything Inbetween" and "Live: More Stories About Life, Death, and What's In Between".You can follow him on Twitter (@AmboDriver), Facebook, LinkedIn, or email kelly@ambulancedriverfiles.com.Kelly is a member of the EMS1 Editorial Advisory Board.
EMS1 yana jujjuya yadda al'ummar EMS ke samun labarai masu dacewa, gano mahimman bayanan horo, sadarwa tare da juna, da kuma yin bincike kan siyayyar samfur da masu ba da kaya.Ya zama mafi mahimmanci kuma amintaccen makoma ta kan layi don sabis na asibiti na asibiti da gaggawa.
Lokacin aikawa: Jul-05-2022