Mtetezi wa NIBP Wotayika

Chepetsani zolakwika za NIBP ndi auscultation powona mawonekedwe a plethysmographic pa pulse oximeter ndikuzindikira kupsinjika kwapakati.
"Ngati pali malo omwe mukufuna kupita, ndikhoza kukutengerani kumeneko, ndikudziwa, ndine mapu. Ngati pali malo omwe muyenera kupita, ndikukutengerani kumeneko, ndipo ndine mapu. Ndine mapu, ndine mapu, ndine mapu!"- Dora Wofufuza
Ambiri ogwira ntchito zachipatala a zaka chikwi akhoza kuimba nawo mosangalala pamene akuwerenga izi, pamene makolo awo ndi anzawo akuluakulu omwe ali ndi ana angakhale akugwiritsabe ntchito cheese graters pa forebrain kuti athetse kukumbukira.
Osadandaula, azachipatala akhanda, sindiyamba kuyimba nyimbo yamutu wa "Barney", koma ndikufuna kusonyeza chikondi chaching'ono kwa chizindikiro chofunikira chomwe chimanyalanyazidwa, kutanthauza kuthamanga kwa magazi (mapu) . tcherani khutu ku chiwerengero chochepa chomwe chili m'makolo pafupi ndi kuwerenga kwa NIBP, chifukwa ndi imodzi mwa miyeso yodalirika ya kutsekemera yomwe tingayese.
Kubwerera ku 2011, ndidalemba gawo lotchedwa "Malangizo ndi Malangizo a EMS Blood Pressure Readings." Ndime iyi, pamodzi ndi Mike McEvoy's "Zolakwa Zisanu Zomwe Zimapangitsa Kuwerenga Kwamagazi Anu Kukhala Osalondola," zimawonekera pafupipafupi pama media azachuma ndi mabulogu a EMS. nthawi iliyonse EMT yatsopano ikufuna thandizo la momwe angapezere kuthamanga kwa magazi kolondola pamene akusamukira ku ambulansi.
Ndipo nthawi zonse muzolemba za ndemanga, othandizira ena akale anzeru amanena kuti kuwerengera kwa NIBP sikudziwika bwino ndipo kuti muyenera "kuchitira wodwalayo, osati kuyang'anira". Ayenera kupeza mphamvu yoyamba pamanja.Iye akulondola, makina a NIBP amadziwika kuti ndi olakwika.Ngakhale opanga zipangizo amanena choncho.Werengani bukhu la opareta wa mtima wanu ndipo mubise chodzikanira kwinakwake kuti odwala athu omwe amafunikira BP yolondola kwambiri - odwala. pa malekezero onse a sikelo - kuwerenga kwa NIBP pazenera lanu sikungakhale, um, kuthamanga kwenikweni kwa magazi.
Ndikadakhala ndi dola pa EMT iliyonse yomwe idalengeza molimba mtima kuti BP imathera ziro (150/90, 120/80, 110/70, nthawi iliyonse) kapena BP yemwe adatulutsa stethoscope m'khutu lake ndikuchita chibwibwi monyinyirika. nambala yosamvetseka yowerengedwa pa mita yokhala ndi chizindikiro chofananira ... chabwino, ndikanakhala ndi madola ambiri.Mwina zosakwanira kugula zowoneka bwino zomwe ndakhala ndikuziyang'ana kwa nthawi yayitali, koma zimachitika nthawi zambiri. Ndimatcha wowunikira kuthamanga kwa magazi kukhala paramedic polygraph.
Zikanakhala zophweka kuti tichepetse kuthamanga kwa magazi, sitikanatumiza malangizo ndi zidule za momwe tingachitire chaka chilichonse.
Komabe, ngakhale cuff ya NIBP imakonda kuchulukirachulukira kwambiri kuthamanga kwa magazi kwa systolic modzidzimutsa, imakwaniritsa pafupifupi MAP yofanana ndi kuwunika kowopsa kwa mitsempha.
Pakufufuza kwa odwala 4,957 akuluakulu a ICU m'malo osamalira maphunziro apamwamba, kuchuluka kwa kuthamanga kwa magazi kwa 27,000 kunapezedwa nthawi imodzi ndi NIBP ndi ma catheter-of-arterial sensors. kuposa gulu lomwe lili ndi kuthamanga kwa magazi kwa systolic mumtundu womwewo (<70 mmHg) .1
Poyerekeza kuchuluka kwa kuvulala kwaimpso komanso kufa kwa ICU pakati pa MAP yamtundu wa MAP ndi MAP yosasokoneza, kusiyana kunali kochepa, ndipo olemba maphunziro otsogolera adatsimikiza kuti NIBP inkayerekezera kuthamanga kwa magazi kwa systolic mu mkhalidwe woopsya, koma osati chifukwa cha kuthamanga kwa magazi kosasunthika.Malumikizidwe a MAP omwe adapezedwa anali pafupi kwambiri ndi arterial MAP (Zithunzi 1 ndi 2).
Ndiye n'chifukwa chiyani makina a NIBP ali olondola poyesa MAP koma osadalirika poyeza kuthamanga kwa magazi kwa systolic?Yankho ndiloti zomwe makina a NIBP amayesa kwenikweni ndi MAP.Kuthamanga kwawo kwa magazi.
Izi ndizosiyana kwambiri ndi momwe timachitira pamanja;Timagwiritsa ntchito Korotkoff kuti tidziwe kuthamanga kwa magazi kwa systolic ndi diastolic, ndiyeno masamu timapeza kuti kuthamanga kwa magazi kumachokera ku equation yotsatirayi:
Ambiri aife tinaphunzira kuwerengera uku ku sukulu ya unamwino ndipo kenako tinaiwala mwamsanga, chifukwa zambiri za mankhwala athu zimagwirizana ndi kuthamanga kwa magazi kwa systolic, komanso chifukwa timadana ndi masamu. bwino kwambiri masamu kuposa ife.
Anthu ambiri omwe akhala pampando wakumbuyo wa ambulansi kwa mphindi zoposa zisanu amazindikira kuti agogo akumwetulira, pinki omwe amalemera mapaundi 90 ndipo ali ndi kuthamanga kwa magazi kwa 84/60 sali ngati munthu yemwe amalemera mapaundi 250 ndipo ali ndi magazi. Kuthamanga kwa 90./40.Kwa agogo aakazi, akhoza kukhala kuthamanga kwa magazi tsiku ndi tsiku, ziwalo zake zofunika zimakhala zomveka bwino.Kwa woyendetsa galimoto ya burly, wakhungu la imvi, thukuta, mosasamala kanthu za kuthamanga kwa magazi kwa systolic, iye anali wosakwanira.
Magwero ambiri amawona MAP ya 65 mmHg kukhala malo otsika kwambiri a kutsekemera kwa ziwalo zofunika kwambiri, ndi MAP yachibadwa ya 70-110 mmHg.Impso zaumunthu zimakhudzidwa kwambiri ndi hypoperfusion, ngakhale kuti maphunziro ena a zinyama asonyeza kuti makoswe akutuluka magazi (kodi mumadziwa? makoswe ali ndi MAP yofanana ndi anthu?) Angathe kulekerera MAP mpaka 50 mmHg mpaka maminiti a 90. Kuvulala koopsa kwa impso kumayamba mkati mwa mphindi 20 ndi MAP pansi pa 60 mmHg.
Chifukwa chake nthawi ina mukamadzifunsa ngati wodwala wanu akutsika kotala koma kuthamanga kwa magazi sikuli koyipa, yang'anani mawonekedwe a plethysmographic pa pulse oximeter yanu, ngati mukukhulupirira kuthamanga kwa magazi kwa NIBP pakati pa Indecisive sikufanana kwenikweni ndi chipatala cha odwala, kapena khutu lakunama la mnzanu, tcherani khutu ku nambala yaing'onoyo m'mabulano pafupi ndi kuwerenga kwanu kwa NIBP.MAP sikudzakutsogolerani njira yolakwika.
Potumiza zambiri zanu, mumavomereza wogulitsa yemwe wasankhidwa kuti akutumizireni ndipo data yomwe mwatumizayo siyikukhudzidwa ndi pempho la "Musagulitse Zomwe Ndikudziwa Payekha".Onani Migwirizano Yantchito ndi Mfundo Zazinsinsi.
Kelly Grayson, NRP, CCP, ndi wothandizira odwala ku Louisiana.Kwa zaka zapitazi za 24, wakhala akuthandiza anthu odwala matenda opatsirana pogonana, oyendetsa galimoto, woyang'anira minda ndi mphunzitsi.Iye ndi pulezidenti wa Louisiana EMS Educators Association ndi membala wa board wa 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 ikusintha momwe gulu la EMS limapezera nkhani zofunikira, limazindikira zambiri zophunzitsira, kulumikizana wina ndi mnzake, ndikufufuza zogula ndi ogulitsa.