Inoraswa NIBP Dziviriro

Deredza NIBP uye auscultation zvikanganiso nekucherechedza iyo plethysmographic waveform pane pulse oximeter uye nekucherechedza zvinoreva arterial pressure.
"Kana pane kwaunoda kuenda ndinogona kukuendesa ikoko, ndinoziva, ndini mepu. Kana pane kwaunoda kuenda, ndinobheja kuti ndinogona kukuendesa ikoko, uye ndiri mepu. 'Ndiri mepu, ndini mepu, ndini mepu!"- Dora the Explorer
Vazhinji vashandi vezvokurapa vemireniyumu vanogona kuimba pamwe chete nemufaro vachiverenga izvi, nepo vabereki vavo uye vakura vavanoshanda navo vane vana vangave vachiri kushandisa cheese grater pa forebrain kudzima ndangariro.
Usazvidya mwoyo, mwana anofarirwa nemishonga, handisi kuzotanga kuimba rwiyo rwedingindira rekuti "Barney" rinotevera, asi ndinoda kuratidza rudo rushoma kune chinowanzofuratirwa chechiratidzo chakakosha, kureva kumanikidza kweropa (mepu). Tinofanira kuita teerera zvakanyanya kunhamba diki iri mumaparenthesi padivi pekuverenga kweNIBP, sezvo iri imwe yezviyero zvinovimbika zveperfusion zvatinogona kuongorora.
Kudzoka muna 2011, ndakanyora koramu yakanzi "Mazano uye Mazano eEMS Ropa Kuverengera Kuverengera." Iyi koramu, pamwe naMike McEvoy's "Kukanganisa Mashanu Ari Kukonzera Kuverenga Kweropa Kweropa Kwako Kusina Kurongeka," inowanzoitika pasocial media uye EMS mablog. pese apo EMT itsva ichitsvaga rubatsiro rwekuti ungawana sei BP chaiyo uchienda kuamburenzi.
Uye nguva dzose mune idzo tambo dzekutaura, vamwe vakachenjera vekare vanobatsira varwere vanonongedza kuti kuverenga kweNIBP kunozivikanwa kusarongeka uye kuti unofanirwa "kurapa murwere, kwete mucherechedzo". vanofanira kuwana presha yekutanga nemaoko.Ane chokwadi, michina yeNIBP inozivikanwa isina kururama.Kunyange vagadziri vemidziyo vanotaura kudaro.Verengai bhuku remushandisi wemoyo wako uye uvanze disclaimer pane imwe nzvimbo mairi kuti muvarwere vedu vanoda BP yakarurama zvakanyanya - varwere. pamigumo yese yechiyero - iyo NIBP yekuverenga pachiratidziro chako inogona kunge isiri, um, chaiyo yeropa.
Dai ndaiva nedhora reEMT yega yega yakataura nechivimbo kuti BP inopera muna zero (150/90, 120/80, 110/70, nguva dzose) kana BP yaibudisa stethoscope kunzeve yake uye yakandandama. nhamba isinganzwisisike inoverengwa pamita ine kana hashi mucherechedzo ... zvakanaka, ndingadai ndine madhora akawanda. Pamwe haikwani kutenga iyo yefashoni yakapetwa kaviri yandanga ndakatarisa kwenguva yakareba, asi zvinowanzoitika zvekuti Ini ndinodaidza dhizaini yeropa rekutarisa paramedic polygraph.
Dai zvaive nyore kudzoreredza BP, tingadai tisiri kutumira matipi uye mazano ekuti ungazviita sei gore rega rega kana zvakadaro.
Nekudaro, kunyangwe iyo NIBP cuff inoda zvakanyanya overestimate systolic blood pressure mukuvhunduka, inowana yakada kufanana MAP seyakavharisa arterial yekutarisa.
Muchidzidzo chevarwere ve4,957 vakuru veICU munzvimbo yepamusoro yekuchengetedza, zvinopfuura zviuru makumi maviri nezvinomwe zvehuwandu hweBP zvakawanikwa panguva imwe chete neNIBP uye catheter-of-arterial sensors. kupfuura muboka rine arterial systolic blood pressure in the same range (<70 mmHg) .1
Pakufananidza kuwanda kwekukuvara kwetsvo kwakanyanya uye kufa kweICU pakati pearterial MAP uye isingasviki MAP, misiyano yaive midiki, uye vanyori vanotungamira vekudzidza vakagumisa kuti NIBP yakawedzera systolic blood pressure in the state of shock, asi kwete neiyo isingasviki blood pressure cuff.Iwo akawanikwa MAP correlations aive padyo zvakanyanya kune arterial MAP (Figure 1 uye 2).
Saka sei michina yeNIBP yakarurama pakuyera MAP asi isingavimbike pakuyera systolic blood pressure?Mhinduro ndeyokuti zvinopimwa nemuchina weNIBP iMAP.Kumhanya kweropa kwakaverengerwa.
Izvi zvinonyatsopesana nemaitirwo atinoita nemaoko;Isu tinosimudzira Korotkoff kuti titarise systolic uye diastolic blood pressure, uyezve masvomhu tinowana zvinoreva arterial pressure kubva kune inotevera equation:
Vazhinji vedu takadzidza kuverenga uku muchikoro cheukoti uye takakurumidza kukanganwa, nekuti mazhinji ekurapa kwedu paramita ane hukama ne systolic blood pressure, uye nekuti tinovenga math.Zvinoitika kuti NIBP michina inotora ropa kubva kuMAP uye pulse rate haisi. zviri nani pasvomhu kupfuura zvatiri.
Vanhu vazhinji vanga vari kumashure kweamburenzi kweanopfuura maminitsi mashanu vanoona kuti mbuya vanonyemwerera, pink vanorema makirogiramu makumi mapfumbamwe uye vane BP ye84/60 havana kufanana nemurume anorema mapaundi 250 uye ane ropa. Kutsikirira kwe90./40.Kuna ambuya, kungava BP yavo yezuva nezuva, nhengo dzavo dzinokosha dzakanyatso nhuhwira.Kumutyairi werori akaremara, ane ganda grey, anodikitira, pasinei nekukwira kweropa resystolic, akanga asina kunyanyisa.
Nzvimbo dzakawanda dzinofunga kuti MAP ye 65 mmHg ndiyo yakaderera pachikumbaridzo chekuwedzera kwenhengo inokosha, ine MAP yakasiyana-siyana ye70-110 mmHg. Tsvo dzevanhu dzinonyanya kunetseka kune hypoperfusion, kunyange zvazvo dzimwe dzidzo dzemhuka dzakaratidza kuti ropa rats (waiziva here? makonzo ane MAP yakafanana nevanhu?) Inogona kushivirira MAPs zvakaderera se50 mmHg kusvika kumaminitsi 90. Kukuvara kwakanyanya kwetsvo kunotanga mukati memaminitsi e20 neMAP pasi pe60 mmHg.
Saka nguva inotevera yaunenge uchinetseka kana murwere wako ari quart yakaderera asi BP haina kushata, tarisa iyo plethysmographic waveform pane yako pulse oximeter, kana uchitenda NIBP blood pressure iri pakati peIndecisive haina kunyatsoenderana. kuratidzwa kwekiriniki kwemurwere, kana nzeve yokunyepa yomumwe wako, nyatsoteerera kune nhamba diki iyoyo mumaparenthesi padyo nekuverenga kwako kweNIBP.MAP haizokutungamiriri munzira isiri iyo.
Nekutumira ruzivo rwako, unobvumirana nemutengesi wakasarudzwa kuti ataure newe uye data yaunotumira haisi pasi pechikumbiro che "Usatengese Ruzivo Rwangu Pachako". Wona Mitemo Yebasa uye Yakavanzika Policy.
Kelly Grayson, NRP, CCP, inyanzvi yekuchengetedza varwere muLouisiana. Kwemakore makumi maviri nemana apfuura, akashanda semubatsiri wemumunda, anonyanya kutarisira kutakura paramedic, mutariri wemunda uye mudzidzisi.Ndiye mutungamiri weLouisana EMS Educators Association uye nhengo yebhodhi yeLos 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 iri kushandura nzira iyo nharaunda yeEMS inowana nayo nhau dzakakodzera, inozivisa ruzivo rwakakosha rwekudzidziswa, kutaurirana, uye inotsvagisa kutengwa kwechigadzirwa uye vatengesi.Yave iyo yakazara uye inovimbika yepamhepo kuenda kune pre-chipatara uye emergency emergency mabasa.