Nchekwa NIBP enwere ike ịtụfu

Mbelata NIBP na mmejọ auscultation site na ilele ụdị ebili mmiri nke plethysmograph na pulse oximeter na ịhụ nrịbama akwara.
"Ọ bụrụ na enwere ebe ịchọrọ ịga, enwere m ike ịkpọrọ gị gaa ebe ahụ, amaara m, abụ m map ahụ. Ọ bụrụ na e nwere ebe ị ga-aga, m na-ama na m nwere ike ịkpọrọ gị gaa ebe ahụ, abụ m map ahụ. Abụ m map ahụ, abụ m map ahụ, abụ m map ahụ!"- Dora onye Explorer
Ọtụtụ ndị ọrụ ahụike puku afọ nwere ike iji obi ụtọ na-abụ abụ mgbe ha na-agụ nke a, ebe nne na nna ha na ndị ọrụ ibe ha na ụmụaka nwere ike ka na-eji cheese graters na ụbụrụ ụbụrụ ihichapụ ihe ncheta.
Echegbula onwe gị, baby boomer medics, agaghị m amalite ịbụ abụ isiokwu "Barney" na-esote, ma m chọrọ igosi ntakịrị ịhụnanya maka ihe ịrịba ama dị mkpa nke a na-elegharakarị anya, pụtara nrụgide akwara (map) .We need to lebakwuo anya na ọnụ ọgụgụ dị nta na mpakọ dị n'akụkụ ọgụgụ NIBP, ebe ọ bụ otu n'ime ihe ndị a pụrụ ịdabere na ya nke perfusion nke anyị nwere ike ịlele.
Laa azụ na 2011, edere m otu kọlụm aha ya bụ "Tips and Tricks for EMS Blood Pressure Readings." Kọlụm a, yana Mike McEvoy's "Mmehie ise nke na-eme ka ọgụgụ ọbara mgbali gị bụrụ nke na-ezighị ezi," na-apụta ugboro ugboro na mgbasa ozi mgbasa ozi na blọọgụ EMS. mgbe ọ bụla EMT ọhụrụ na-achọ enyemaka maka otu esi enweta ọbara mgbali elu mgbe ọ na-aga ụgbọ ihe mberede.
Na mgbe niile na ndị na-ekwu threads, ụfọdụ maara ihe ochie paramedics na-arụtụ aka na NIBP agụ bụ nke ọma na-ezighị ezi nakwa na ị kwesịrị "na-emeso onye ọrịa, ọ bụghị ndị nlekota oru." Na-emekarị, ọ ga-atụ aro na ọ bụrụ na ha anaghị agbahapụ kpamkpam NIBP igwe. ha kwesịrị ma ọ dịkarịa ala nweta nrụgide mbụ n'aka ya. O ziri ezi, igwe NIBP bụ ihe a ma ama na-ezighị ezi. Ọbụna ndị na-emepụta ngwaọrụ na-ekwu otú ahụ. Gụọ akwụkwọ ntuziaka onye na-ahụ maka obi gị ma zoo nkwupụta ebe n'ime ya na n'ime ndị ọrịa anyị chọrọ BP ziri ezi bụ ndị ọrịa. na nsọtụ abụọ nke ọnụ ọgụgụ - ọgụgụ NIBP na ihuenyo gị nwere ike ọ gaghị abụ, um, ọbara mgbali elu n'ezie.
Ọ bụrụ na enwere m dollar maka EMT ọ bụla bụ onye ji obi ike kwupụta na BP na-ejedebe na efu (150/90, 120/80, 110/70, oge ọ bụla) ma ọ bụ BP bụ onye wepụrụ stethoscope na ntị ya wee sụọ n'ala azụ na-ejedebe na ihe. ọnụ ọgụgụ na-adịghị mma na-agụ na mita na ọbụna akara hash ... nke ọma, m ga-enwe ọtụtụ dollars. Ma eleghị anya, ezughị ezu ịzụta ihe na-ewu ewu okpukpu abụọ nke m na-ele anya ogologo oge, ma ọ na-eme mgbe mgbe nke ahụ. Ana m akpọ onye nleba anya ọbara mgbali elu polygraph paramedic.
Ọ bụrụ na ọ dị mfe auscultate ọbara mgbali, anyị agaraghị na-ikesa ndụmọdụ na aghụghọ banyere otú e si eme ya kwa afọ ma ọ bụ karịa.
Otú ọ dị, ọ bụ ezie na NIBP cuff na-eme ka ọ̀tụ̀tụ̀ ọbara mgbali elu systolic dị elu karịa n'ụjọ, ọ na-enweta ihe fọrọ nke nta ka ọ bụrụ otu MAP ahụ dị ka nleba anya nleba anya akwara.
N'ime nnyocha nke 4,957 okenye ICU ndị ọrịa na ụlọ ọrụ nlekọta ụlọ akwụkwọ, ihe karịrị 27,000 ọbara mgbali elu nwetara n'otu oge na NIBP na catheter-of-arterial sensọ. nnukwu mmerụ ahụ na ọnwụ nke akụrụ dị elu na systolic NIBP-measured group. karịa na otu ndị nwere ọbara mgbali elu systolic arterial n'otu oke (<70 mmHg).1
Mgbe atụnyere nnukwu mmerụ ahụ akụrụ na oke ọnwụ ICU n'etiti MAP arterial na MAP na-adịghị emerụ ahụ, ndịiche dị ntakịrị, ndị na-eduzi ọmụmụ akwụkwọ kwubiri na NIBP karịrị ọbara mgbali systolic n'ọnọdụ ujo, ma ọ bụghị site n'ọkpụkpụ ọbara na-adịghị ahụ anya.Mmekọrịta MAP enwetara dị ezigbo nso na MAP akwara (Figure 1 na 2).
Yabụ kedu ihe kpatara igwe NIBP ji zie ezi n'ịleta MAP mana enweghị ntụkwasị obi n'ịleta ọbara mgbali systolic? Azịza ya bụ na ihe igwe NIBP na-atụ n'ezie bụ MAP. Ha gbakọrọ ọbara mgbali.
Nke a bụ kpọmkwem ihe megidere otú anyị si eji aka eme ya;Anyị auscultate Korotkoff iji chọpụta systolic na diastolic ọbara mgbali, na mgbe ahụ mgbakọ na mwepụ na-enweta pụtara ọbara mgbali site na ndị na-esonụ:
Ọtụtụ n'ime anyị mụtara ngụkọ a na ụlọ akwụkwọ nọọsụ wee chefuo ngwa ngwa, n'ihi na ọtụtụ n'ime usoro ọgwụgwọ anyị metụtara ọbara mgbali systolic, yana n'ihi na anyị kpọrọ mgbakọ na mwepụ asị. mma na mgbakọ na mwepụ karịa anyị.
Ọtụtụ ndị mmadụ nọ n'azụ oche ụgbọ ihe mberede ihe karịrị nkeji ise na-aghọta na nne nne na-amụmụ ọnụ ọchị, pink nke na-eru 90 pound ma nwee ọbara mgbali elu nke 84/60 abụghị ihe dịka nwoke nke ruru 250 pound ma nwee ọbara. nrụgide nke 90./40. Maka nne nne, ọ nwere ike ịbụ ọbara mgbali elu ya kwa ụbọchị, akụkụ ahụ ya dị mkpa na-agbaze nke ọma. Maka onye na-agba agba, onye isi awọ, onye na-anya ụgbọ ala ọsụsọ, n'agbanyeghị ọbara mgbali elu ya dị elu, ọ na-esi ísì ụtọ.
Ọtụtụ ebe na-atụle MAP nke 65 mmHg ka ọ bụrụ ọnụ ụzọ kacha ala maka ịmịnye akụkụ ahụ dị mkpa, yana usoro MAP nkịtị nke 70-110 mmHg. Akụrụ mmadụ na-enwe mmetụta nke ọma na hypoperfusion, ọ bụ ezie na ụfọdụ ọmụmụ anụmanụ egosila na oke na-agba ọbara (ị maara oke nwere otu MAP dị ka ụmụ mmadụ?) nwere ike ịnagide MAP dị ala dị ka 50 mmHg ruo nkeji 90. Mmerụ akụrụ na-adịghị mma na-amalite n'ime nkeji 20 na MAP n'okpuru 60 mmHg.
Ya mere, oge ọzọ ị na-eche ma onye ọrịa gị ọ dị obere quart mana ọbara mgbali elu adịghị njọ, lelee plethysmographic waveform na pulse oximeter gị, ma ọ bụrụ na ị na-ekwere NIBP ọbara mgbali n'etiti Indecisive adabaghị n'ezie. Ngosipụta ụlọ ọgwụ nke onye ọrịa, ma ọ bụ ntị ịgha ụgha nke onye gị na ya na-akpakọrịta, ṅaa ntị nke ọma na ọnụ ọgụgụ dị nta ahụ dị na akara aka n'akụkụ ọgụgụ NIBP gị. MAP agaghị eduga gị n'ụzọ na-ezighị ezi.
Site n'itinye ozi gị, ị kwenyere na onye na-ere ahịa ahọpụtara na-akpọtụrụ gị yana data ị nyefere adabereghị na arịrịọ "Erela Ozi Nkeonwe M". Lelee Usoro Ọrụ na Amụma Nzuzo anyị.
Kelly Grayson, NRP, CCP, bụ onye nlekọta ahụike dị egwu na Louisiana.N'ime afọ 24 gara aga, ọ na-eje ozi dị ka onye nlekọta ahụike ubi, nlekọta nlekọta ahụike na-ahụ maka nlekọta ahụike, onye nlekọta ubi na onye nkụzi.Ọ bụ onyeisi oche nke Louisiana EMS Educators Association na onye otu bọọdụ nke 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 na-agbanwe ka ndị obodo EMS si achọta ozi dị mkpa, na-achọpụta ozi ọzụzụ dị mkpa, na-ekwurịta okwu n'etiti onwe ha, na nyocha ngwaahịa ịzụrụ na ndị na-ebubata ya. Ọ ghọwo ebe kachasị zuru oke na ntụkwasị obi n'ịntanetị maka ụlọ ọgwụ tupu ụlọ ọgwụ na ọrụ ahụike mberede.