Palekana NIBP hiki ke hoopau

Hoʻemi i nā hewa NIBP a me ka auscultation ma ka nānā ʻana i ka nalu plethysmographic ma ka pulse oximeter a me ka ʻike ʻana i ke kaomi arterial mean
"Inā he wahi āu e makemake ai e hele, hiki iaʻu ke lawe iā ʻoe i laila, ʻike wau, ʻo wau ka palapala ʻāina. 'O wau ka palapala 'āina, 'o wau ka palapala 'āina, 'o wau ka palapala 'āina!"- Dora ka Mea Huli
Hiki i nā limahana lapaʻau millennial ke hīmeni ʻoliʻoli i ka heluhelu ʻana i kēia, ʻoiai e hoʻohana mau ana ko lākou mau mākua a me nā hoa hana kahiko me nā keiki i nā graters cheese ma ka forebrain e holoi i nā hoʻomanaʻo.
Mai hopohopo, e nā lāʻau lapaʻau pēpē pēpē, ʻaʻole wau e hoʻomaka e hīmeni i ke mele kumu "Barney" ma hope aʻe, akā makemake wau e hōʻike i ke aloha liʻiliʻi no kahi ʻāpana hōʻailona koʻikoʻi i nānā ʻole ʻia, mean arterial pressure (map). e noʻonoʻo nui i ka helu liʻiliʻi i loko o nā pale e pili ana i ka heluhelu NIBP, no ka mea, ʻo ia kekahi o nā ana ʻoi aku ka hilinaʻi o ka perfusion i hiki iā mākou ke loiloi.
Ma hope o ka makahiki 2011, ua kākau au i kahi kolamu i kapa ʻia ʻo "Tips and Tricks for EMS Blood Pressure Readings." ʻO kēia kolamu, me Mike McEvoy's "Five Mistakes That Are Causing Your Blood Pressure Readings to Be Inaccurate," ʻike pinepine ʻia ma ka media media a me nā blog EMS i kēlā me kēia manawa e ʻimi ai kahi EMT hou i ke kōkua no ka loaʻa ʻana o ke koko pololei i ka wā e neʻe ana i kahi kaʻa kaʻa.
A i nā manawa a pau i loko o kēlā mau manaʻo manaʻo, hōʻike kekahi mau mea lapaʻau kahiko akamai i ka heluheluʻoleʻana o ka NIBP a ponoʻoe e "hana i ka mea maʻi,ʻaʻole ka mea nānā". pono lākou e kiʻi i ke kaomi mua me ka lima. Ua pololei ʻo ia, ua kaulana nā mīkini NIBP ʻaʻole pololei. E ʻōlelo paha nā mea hana. ma nā ʻaoʻao ʻelua o ka pālākiō - ʻo ka heluhelu NIBP ma kāu pale ʻaʻole paha, um, ke koko maoli.
Inā loaʻa iaʻu kahi kālā no kēlā me kēia EMT nāna i haʻi wiwo ʻole i kahi BP e pau ana i ka ʻole (150/90, 120/80, 110/70, i kēlā me kēia manawa) a i ʻole he BP nāna i huki i ka stethoscope mai kona pepeiao a haʻalulu me ke kānalua. Heluhelu ʻē aʻe i heluhelu ʻia ma ka mika me ka hōʻailona hash like... ʻoi aku ka nui o kaʻu mau kālā. Kāhea wau i kahi nānā paʻi koko lima he polygraph paramedic.
Inā he mea maʻalahi ke auscultate i ke koko, ʻaʻole mākou e hoʻouna i nā ʻōlelo aʻoaʻo a me nā hoʻopunipuni e pili ana i ka hana ʻana i kēlā me kēia makahiki a i ʻole.
Eia nō naʻe, ʻoiai ʻo ka NIBP cuff e manaʻo nui e hoʻomāhuahua i ke kahe koko systolic i ka haʻalulu, loaʻa iā ia kahi MAP like me ka nānā ʻana i ka arterial invasive.
Ma kahi noiʻi o 4,957 mau maʻi ICU makua ma kahi kikowaena mālama kula, ʻoi aku ma mua o 27,000 mau kumu kūʻai koko i loaʻa i ka manawa like me ka NIBP a me ka catheter-of-arterial sensors. ma mua o ka hui me ke koko systolic arterial ma ka laulā like (<70 mmHg).1
I ka hoʻohālikelike ʻana i ka maʻi maʻi maʻi maʻi maʻi a me ka make ʻana o ka ICU ma waena o ka MAP arterial a me ka MAP noninvasive, ua liʻiliʻi nā ʻokoʻa, a ua hoʻoholo nā mea kākau alakaʻi i ka NIBP overestimated systolic blood pressure i ka mokuʻāina o ka haʻalulu, akā ʻaʻole ma ka cuff koko noninvasive.Ua kokoke loa nā pilina MAP i loaʻa i ka MAP arterial (Nā Kiʻi 1 a me 2).
No ke aha i pololei loa ai nā mīkini NIBP i ke ana ʻana i ka MAP akā ʻaʻole hiki ke hilinaʻi ʻia i ke ana ʻana i ke koko systolic? ʻO ka pane ʻo ka mea a ka mīkini NIBP e ana maoli ai ʻo ia ʻo MAP. ʻO kā lākou kahe koko helu.
ʻO kēia ke kū'ē pololei o kā mākou hana lima;Auscultate mākou iā Korotkoff no ka hoʻoholo ʻana i ke koko systolic a me ka diastolic, a laila e loaʻa mai i ka makemakika mean arterial pressure mai ka hoohalike aʻe:
Nui ka poʻe o mākou i aʻo i kēia helu ma ke kula kahu hānai a laila poina koke, no ka mea, ʻo ka hapa nui o kā mākou mau ʻāpana lapaʻau e pili ana i ke koko systolic, a no ka mea ʻino mākou i ka makemakika. ʻoi aku ka maikaʻi ma ka makemakika ma mua o mākou.
ʻO ka hapa nui o ka poʻe i noho ma ka noho hope o kahi kaʻa kaʻa no ʻoi aku ma mua o ʻelima mau minuke, ʻike lākou ʻo ke kupuna wahine ʻulaʻula ʻulaʻula nona ke kaumaha he 90 paona a he 84/60 ke koko, ʻaʻole ia e like me ke kanaka nona ke kaumaha he 250 paona a he koko kona. ʻO ke kaumaha o 90./40. No ke kupuna wahine, ʻo ia paha ke kahe koko i kēlā me kēia lā, ʻo kona mau kino koʻikoʻi ua hoʻohuʻi maikaʻi ʻia.
Manaʻo ka hapa nui o ka MAP o 65 mmHg i ka paepae haʻahaʻa no ka hoʻoheheʻe ʻana o ke kino, me ka laulā MAP maʻamau o 70-110 mmHg. ʻOi aku ka maʻalahi o nā puʻupaʻa kanaka i ka hypoperfusion, ʻoiai ua hōʻike ʻia kekahi mau haʻawina holoholona i nā ʻiole koko (ua ʻike anei ʻoe. loaʻa i nā ʻiole ka MAP like me nā kānaka?) hiki ke ʻae i nā MAP ma lalo o 50 mmHg a hiki i nā minuke 90. Hoʻomaka ka hōʻeha ʻeha ʻeha i loko o 20 mau minuke me kahi MAP ma lalo o 60 mmHg.
No laila, i ka manawa aʻe e noʻonoʻo ai ʻoe inā he hapaha haʻahaʻa kou maʻi akā ʻaʻole maikaʻi loa ke kahe koko, e nānā i ka nalu plethysmographic ma kāu oximeter pulse, inā ʻoe e manaʻoʻiʻo nei ʻo NIBP ke koko ma waena o Indecisive ʻaʻole i kūlike me ka ʻO ka hōʻike ʻana o ka maʻi maʻi, a i ʻole ka pepeiao wahaheʻe o kāu hoa, e nānā pono i kēlā helu liʻiliʻi i loko o nā pale e pili ana i kāu heluhelu NIBP. ʻAʻole e alakaʻi ʻo MAP iā ʻoe i ke ala hewa.
Ma ka waiho ʻana i kāu ʻike, ʻae ʻoe i ka mea kūʻai aku i koho ʻia e hoʻopili iā ʻoe a ʻaʻole kau ʻia ka ʻikepili āu e hoʻouna ai i kahi noi "Mai kūʻai aku i kaʻu ʻike pilikino".
ʻO Kelly Grayson, NRP, CCP, he paramedic mālama koʻikoʻi ma Louisiana. No nā makahiki 24 i hala iho nei, ua lawelawe ʻo ia ma ke ʻano he paramedic kahua, mālama koʻikoʻi transport paramedic, luna hoʻomalu a me ka mea hoʻonaʻauao. ʻO ia ka pelekikena o ka Louisiana EMS Educators Association a he lālā papa o ka 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.
Ke hoʻololi nei ka EMS1 i ke ala e ʻike ai ke kaiāulu EMS i nā nūhou kūpono, ʻike i ka ʻike hoʻomaʻamaʻa koʻikoʻi, kamaʻilio me kekahi, a noiʻi i nā kūʻai huahana a me nā mea hoʻolako.