Disposable NIBP Protector

Txo NIBP thiab auscultation yuam kev los ntawm kev soj ntsuam cov plethysmographic waveform ntawm lub pulse oximeter thiab sau tseg qhov nruab nrab arterial siab
"Yog tias muaj ib qho chaw koj xav mus, kuv tuaj yeem coj koj mus rau qhov ntawd, kuv paub, kuv yog daim ntawv qhia, yog tias muaj ib qho chaw koj xav mus, kuv twv kuv tuaj yeem coj koj mus rau ntawd, thiab kuv yog daim ntawv qhia. Kuv yog daim ntawv qhia, kuv yog daim ntawv qhia, kuv yog daim ntawv qhia!- Dora tus Explorer
Ntau txhiab xyoo cov neeg ua haujlwm kho mob yuav zoo siab hu nkauj nrog thaum nyeem qhov no, thaum lawv niam lawv txiv thiab cov npoj yaig laus nrog cov menyuam yaus tseem yuav siv cov cheese graters rau ntawm lub hauv siab kom tshem tawm qhov nco.
Tsis txhob txhawj, tus me nyuam boomer cov kws kho mob, Kuv yuav tsis pib hu nkauj "Barney" lub ntsiab lus tom ntej, tab sis kuv xav qhia me ntsis kev hlub rau qhov feem ntau saib xyuas qhov tseem ceeb ntawm cov cim ntsuas, txhais tau tias lub siab siab (daim duab qhia). them nyiaj ntau dua rau tus lej me me hauv kab lus ntawm ib sab ntawm NIBP kev nyeem ntawv, vim nws yog ib qho ntawm cov kev ntsuas kev ntseeg siab dua ntawm perfusion uas peb tuaj yeem ntsuas.
Rov qab rau xyoo 2011, kuv tau sau ib kab ntawv hu ua "Cov Lus Qhia thiab Tricks rau EMS Ntshav Siab Nyeem." Kab lus no, nrog rau Mike McEvoy's "Tsib Yug Uas Ua Rau Koj Cov Ntshav Siab Nyeem Ntawv Tsis Muaj Tseeb," tshwm sim ntau zaus hauv kev tshaj xov xwm thiab EMS blogs. thaum twg EMT tshiab nrhiav kev pab yuav ua li cas kom tau cov ntshav siab kom raug thaum tsiv mus rau lub tsheb thauj neeg mob.
Thiab ib txwm nyob rau hauv cov lus hais, qee cov kws kho mob laus tau taw qhia tias NIBP kev nyeem ntawv tsis muaj npe tsis raug thiab koj yuav tsum "kho tus neeg mob, tsis yog tus saib". Lawv yuav tsum tsawg kawg tau txais thawj lub siab manually.Nws yog, NIBP cov cav tov tsis muaj npe tsis raug.Txawm tias cov cuab yeej siv tau hais tias yog li ntawd.Nyeem koj lub plawv saib tus neeg teb xov tooj phau ntawv thiab zais qhov tsis lees paub qhov chaw hauv nws tias hauv peb cov neeg mob uas xav tau BP qhov tseeb tshaj plaws - cov neeg mob ntawm ob qhov kawg ntawm qhov ntsuas - NIBP nyeem ntawv ntawm koj lub vijtsam yuav tsis yog, um, ntshav siab.
Yog tias kuv muaj nyiaj duas las rau txhua tus EMT uas ntseeg siab tshaj tawm BP xaus rau xoom (150/90, 120/80, 110/70, txhua zaus) lossis BP uas rub lub stethoscope tawm ntawm nws pob ntseg thiab stuttered hesitantly xaus nrog ib qho khib tus lej nyeem ntawm ib lub 'meter' nrog tus cim hash... zoo, kuv yuav tau nyiaj ntau heev.Tej zaum tsis txaus los yuav qhov trendy ob chav dav kuv tau pom ntev, tab sis nws tshwm sim ntau zaus. Kuv hu rau phau ntawv ntshav siab saib xyuas tus kws kho mob polygraph.
Yog tias nws yooj yim rau auscultate ntshav siab, peb yuav tsis tshaj tawm cov lus qhia thiab cov lus qhia txog yuav ua li cas txhua xyoo los yog li ntawd.
Txawm li cas los xij, txawm hais tias NIBP cuff zoo li ua rau muaj kev ntsuas ntau tshaj systolic ntshav siab hauv kev poob siab, nws ua tiav yuav luag tib yam MAP raws li kev saib xyuas cov hlab ntsha.
Hauv kev tshawb fawb ntawm 4,957 tus neeg laus ICU cov neeg mob hauv tsev kho mob tertiary, ntau dua 27,000 qhov ntsuas ntshav siab tau txais ib txhij nrog NIBP thiab catheter-of-arterial sensors.Acute raum raug mob thiab kev tuag tau siab dua hauv pawg systolic NIBP- ntsuas. tshaj nyob rau hauv cov pab pawg neeg nrog arterial systolic ntshav siab nyob rau hauv tib yam ntau yam (<70 mmHg).1
Thaum muab piv rau mob raum raug mob hnyav thiab ICU kev tuag ntawm arterial MAP thiab noninvasive MAP, qhov sib txawv me me, thiab cov kws sau ntawv tshawb fawb tau txiav txim siab tias NIBP overestimated systolic ntshav siab nyob rau hauv lub xeev ntawm poob siab, tab sis tsis yog los ntawm cov ntshav siab cuff.Cov kev sib raug zoo ntawm MAP tau nyob ze heev rau arterial MAP (Daim duab 1 thiab 2).
Yog li vim li cas NIBP cov tshuab yog qhov tseeb ntawm kev ntsuas MAP tab sis tsis muaj kev ntseeg siab ntawm kev ntsuas cov ntshav siab?Cov lus teb yog tias lub tshuab NIBP ua tau ntsuas yog MAP.Lawv ntsuas ntshav siab.
Qhov no yog qhov txawv ntawm qhov peb ua li cas manually;Peb auscultate Korotkoff los txiav txim siab systolic thiab diastolic ntshav siab, thiab tom qab ntawd ua lej muab txhais cov hlab ntsha siab los ntawm cov kab zauv hauv qab no:
Ntau tus ntawm peb tau kawm qhov kev suav no hauv tsev laus thiab tom qab ntawd tsis nco qab sai, vim tias feem ntau ntawm peb cov kev kho mob tsis muaj feem cuam tshuam rau cov ntshav siab, thiab vim peb ntxub lej.Nws hloov tawm tias NIBP cov tshuab uas muab ntshav siab los ntawm MAP thiab mem tes tus nqi tsis yog. ua lej zoo dua peb.
Cov neeg feem coob uas tau nyob tom qab lub tsheb thauj neeg mob ntau tshaj tsib feeb paub tias tus luag nyav, pog liab uas hnyav 90 phaus thiab ntshav siab 84/60 tsis muaj dab tsi zoo li tus txiv neej uas hnyav 250 phaus thiab muaj ntshav. Lub siab ntawm 90./40.Rau pog, nws tuaj yeem yog nws cov ntshav siab txhua hnub, nws lub cev tseem ceeb tau zoo perfused.Rau tus burly, grey-skinned, hws tus neeg tsav tsheb thauj khoom, txawm tias nws cov ntshav siab, nws tsis muaj zog.
Feem ntau cov peev txheej xav txog MAP ntawm 65 mmHg yog qhov qis tshaj plaws rau qhov tseem ceeb ntawm lub cev perfusion, nrog rau ib txwm MAP ntau ntawm 70-110 mmHg.Tub neeg lub raum muaj kev nkag siab ntau dua rau hypoperfusion, txawm hais tias qee qhov kev tshawb fawb tsiaj tau pom tias cov nas los ntshav (koj puas paub. nas muaj MAP tib yam li tib neeg?) tuaj yeem tiv taus MAP tsawg li 50 mmHg txog li 90 feeb. mob raum mob pib li ntawm 20 feeb nrog MAP qis dua 60 mmHg.
Yog li lub sij hawm tom ntej koj xav paub yog tias koj tus neeg mob yog quart qis tab sis ntshav siab tsis yog qhov phem, saib plethysmographic waveform ntawm koj lub pulse oximeter, yog tias koj ntseeg tias NIBP ntshav siab nyob rau hauv nruab nrab ntawm Indecisive tsis tiag tiag match. Tus neeg mob qhov kev nthuav qhia kev kho mob, lossis koj tus khub lub pob ntseg dag, ua tib zoo saib rau tus lej me me hauv kab lus ntawm ib sab ntawm koj qhov kev nyeem NIBP.MAP yuav tsis coj koj mus rau qhov tsis ncaj ncees lawm.
Los ntawm kev xa koj cov ntaub ntawv, koj tso cai rau tus neeg muag khoom xaiv hu rau koj thiab cov ntaub ntawv koj xa yuav tsis raug raws li "Tsis Txhob Muag Kuv Cov Ntaub Ntawv Tus Kheej" thov.Saib peb Cov Cai Kev Pabcuam thiab Txoj Cai Tswjfwm Ntiag Tug.
Kelly Grayson, NRP, CCP, yog ib tus kws kho mob tseem ceeb hauv Louisiana.Rau 24 xyoo dhau los, nws tau ua tus kws kho mob, kws kho mob loj thauj neeg mob, tus saib xyuas teb thiab kws qhia ntawv.Nws yog tus thawj tswj hwm ntawm Louisiana EMS Educators Association thiab ib tug tswv cuab ntawm 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 tab tom hloov pauv txoj hauv kev hauv zej zog EMS pom cov xov xwm cuam tshuam, txheeb xyuas cov ntaub ntawv tseem ceeb ntawm kev cob qhia, sib txuas lus nrog ib leeg, thiab tshawb nrhiav cov khoom lag luam thiab cov neeg muag khoom.