Iska yaree NIBP iyo khaladaadka auscultation adiga oo eegaya qaabka mawjada plethysmographic ee oximeter-ka garaaca wadnaha oo ogaanaya celceliska cadaadiska halbowlaha
"Haddii ay jirto meel aad rabto inaad tagto, waan ku geyn karaa halkaas, waan ogahay, waxaan ahay khariidad. Haddii ay jirto meel aad u baahan tahay inaad tagto, waxaan sharad ku leeyahay inaan ku geyn karo halkaas, aniguna waxaan ahay khariidad. Anigu waxaan ahay khariidad, waxaan ahay khariidad, waxaan ahay khariidad!- Dora Explorer
Shaqaale caafimaad oo kun sano ah ayaa laga yaabaa inay si farxad leh u heesaan marka ay tan akhrinayaan, halka waalidkood iyo asxaabtooda waaweyn ee carruurta leh ay wali isticmaalayaan jiiska jiiska ee maskaxda hore si ay u tirtiraan xusuusta.
Ha werwerin, dhakhaatiirta kobcinta dhallaanka, ma bilaabi doono heesida heesta mawduuca "Barney" ee xigta, laakiin waxaan rabaa in aan muujiyo jacayl yar oo loogu talagalay calaamad muhiim ah oo inta badan la iska indho-tiray, macnaheedu waa cadaadiska halbowlaha (map). fiiro gaar ah u yeelo tirada yar ee qaws ee ku xigta akhrinta NIBP, maadaama ay tahay mid ka mid ah cabbiraadaha lagu kalsoonaan karo ee dhiig-karka ee aan qiimeyn karno.
Dib ugu noqo 2011, waxaan qoray tiir ciwaankeedu yahay "Talooyinka iyo Khiyaamooyinka loogu talagalay Akhriska Dhiig karka ee EMS." Tiirkan, oo ay weheliso Mike McEvoy's "Shanta Qalad ee Sababaya Akhrinta Cadaadiska Dhiigaaga inay Khaldamaan," ayaa si joogta ah uga muuqda warbaahinta bulshada iyo blogyada EMS mar kasta oo EMT cusub ay raadsato caawimo ku saabsan sida loo helo cadaadis dhiig oo sax ah markaad u guureyso ambalaas.
Had iyo jeerna mawduucyada faallooyinka, qaar ka mid ah dhakhaatiirta hore ee xigmadda leh ayaa tilmaamaya in akhrinta NIBP ay tahay mid aan sax ahayn oo waa inaad "daaweysaa bukaanka, ma aha kormeeraha" . Sida caadiga ah, wuxuu soo jeedinayaa haddii aysan si buuxda uga tagin mashiinka NIBP, Waa inay ugu yaraan cadaadiska ugu horreeya gacanta ku helaan. Waa sax, mashiinnada NIBP waa kuwo aan sax ahayn. Xitaa kuwa sameeya qalabka ayaa sidaas leh. Akhri buug-gacmeedka kormeeraha wadnahaaga oo ku qari meel ka mid ah in bukaannadayada u baahan BP sax ah ay ugu badan yihiin - bukaannada labada daraf ee miisaanka - akhrinta NIBP ee shaashaddaada waxaa laga yaabaa inaanay ahayn, um, cadaadis dhiig oo dhab ah.
Haddii aan hal dollar u lahaa EMT kasta oo si kalsooni leh ugu dhawaaqay BP-ga oo ku dhammaanaya eber (150/90, 120/80, 110/70, mar kasta) ama BP oo dhegta ka soo saaray stethoscope Nambar aan fiicneyn ayaa lagu akhriyay mitir oo leh calaamad xashiishad ah ... si fiican, waxaan lahaan lahaa lacag badan oo dollars ah. Waxaa laga yaabaa in aan ku filnayn si aan u iibsado labanlaabyada casriga ah ee ballaaran ee aan isha ku hayay muddo dheer, laakiin waxay dhacdaa marar badan in Waxaan u wacaa kormeeraha cadaadiska dhiigga ee gacanta ah polygraph paramedic.
Haddii ay sahlanaan lahayd in la aaso cadaadiska dhiigga, ma soo dhajin lahayn talooyin iyo tabaha ku saabsan sida loo sameeyo sannad kasta ama wax ka badan.
Si kastaba ha ahaatee, inkasta oo cufka NIBP uu u janjeero inuu si aad ah u qiimeeyo cadaadiska dhiigga ee systolic ee shoogga, wuxuu ku gaaraa ku dhawaad isla MAP la mid ah kormeerka halbowlaha soo galitaanka.
Daraasad lagu sameeyay 4,957 bukaanada ICU ee qaangaarka ah ee ku jira xarun daryeel heer jaamacadeed ah, in ka badan 27,000 qiimaha cadaadiska dhiigga ayaa la helay si isku mid ah NIBP iyo dareemayaasha xididada xididada. Marka loo eego kooxda leh cadaadiska dhiigga halbowlaha systolic ee isku mid ah (< 70 mmHg).1
Marka la barbardhigo faafitaanka dhaawaca kelyaha ee ba'an iyo dhimashada ICU ee u dhaxaysa halbowlayaasha MAP iyo MAP-ka, kala duwanaanshuhu way yaraayeen, qorayaasha daraasadda hogaanka ah waxay soo gabagabeeyeen in NIBP ay si xad dhaaf ah u qiimeysay cadaadiska dhiigga ee systolic ee xaaladda shoogga, laakiin maaha cadaadiska dhiigga ee aan caadiga ahayn.Xidhiidhka MAP ee la helay ayaa aad ugu dhawaa MAP halbowlaha (Jaantus 1 iyo 2).
Haddaba maxay tahay sababta mashiinnada NIBP ay aad ugu saxsan yihiin cabbirka MAP balse aan la isku hallayn karin marka la cabbirayo cadaadiska dhiigga ee systolic?
Tani waa lidka saxda ah ee sida aan gacanta ugu qabanno;Waxaan tijaabineynaa Korotkoff si loo go'aamiyo cadaadiska dhiigga ee systolic iyo diastolic, ka dibna xisaab ahaan waxaan ka soo saareynaa cadaadiska halbowlaha ee isla'egta soo socota:
Qaar badan oo naga mid ah ayaa xisaabintan ku barannay dugsiga kalkaalinta ka dibna si dhakhso ah ayaan u iloobin, sababtoo ah inta badan xuduudaha daawayntayadu waxay la xiriiraan cadaadiska dhiigga ee systolic, iyo sababtoo ah waxaan necbahay xisaabta. Waxaa soo baxday in mashiinnada NIBP ee ka soo jeeda cadaadiska dhiigga ee MAP iyo heerka garaaca wadnaha aysan ahayn aad uga fiican xisaabta inta aan nahay.
Inta badan dadka ku jiray kursiga dambe ee ambalaasta in ka badan shan daqiiqo waxay ogaadaan in ayeeyo dhoola cadeynaysa, casaan ah oo miisaankeedu yahay 90 rodol oo uu leeyahay cadaadiska dhiigga 84/60 ma aha wax la mid ah nin miisaankiisu yahay 250 rodol oo uu leeyahay dhiig. Cadaadiska 90./40. Ayeeyo, waxay noqon kartaa dhiig karka maalinlaha ah, xubnaheeda muhiimka ah ayaa si fiican u daaran. Darawalka weyn, maqaar-cawlan, dhididka ah darawalka xamuulka, inkasta oo uu sareeyo cadaadiska dhiigga ee systolic, wuu ka hooseeyaa.
Ilaha intooda badani waxay tixgeliyaan MAP ee 65 mmHg inay tahay marinka ugu hooseeya ee dhiig-karka xubnaha muhiimka ah, oo leh qiyaasta caadiga ah ee MAP ee 70-110 mmHg. Kelyaha bini'aadamka ayaa aad ugu nugul hypoperfusion, inkastoo qaar ka mid ah daraasadaha xayawaanka ay muujiyeen in dhiig-baxa jiirka (ma ogtahay. Jiirku waxay leeyihiin MAP la mid ah tan bini'aadamka?
Markaa marka xigta ee aad la yaaban tahay haddii bukaan-socodkaagu uu rubuc hooseeya laakiin cadaadiska dhiiggu aanu ahayn mid xun, fiirso qaabka loo yaqaan 'plethysmographic waveform' ee oximeter-ka garaaca wadnahaaga, haddii aad rumaysan tahay in cadaadiska dhiigga ee NIBP uu u dhexeeya Indecisive uusan dhab ahaantii u dhigmin soo jeedinta bukaan-socodka, ama dhegta beenta ee lammaanahaaga, aad u fiirso lambarkaas yar ee qawlka ku xiga NIBP-ga akhriskaaga. MAP kuma horseedi doonto jiho khaldan.
Markaad soo gudbiso macluumaadkaaga, waxaad ogolaatay iibiyaha la doortay inuu kula soo xidhiidho xogta aad soo gudbisona kuma xidhna codsiga "Ha Iibiin Macluumaadkayga Gaarka ah".Arag Shuruudaha Adeegga iyo Siyaasaddayada Gaarka ah.
Kelly Grayson, NRP, CCP, waa kalkaaliye caafimaad oo muhiim ah oo ku yaal Louisiana.Sannadihii 24 ee la soo dhaafay, wuxuu u adeegay sidii kalkaalisada caafimaadka, kalkaalisada gaadiidka daryeelka muhiimka ah, kormeeraha goobta iyo baraha.Waa madaxweynaha Ururka Barayaasha Louisiana EMS iyo xubin guddiga ee Ururka EMT ee Diiwaangashan Qaranka ee Los Angeles.
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 waxa ay isbedelaysaa habka ay bulshada EMS u hesho wararka la xidhiidha, aqoonsata macluumaadka tababarka muhiimka ah, la xidhiidho midba midka kale, iyo cilmi baadhista wax iibsiga iyo alaab-qeybiyeyaasha.Waxay noqotay meesha ugu dhammaystiran oo la aamini karo goobta internetka ee isbitaalka kahor iyo adeegyada caafimaadka degdegga ah.
Waqtiga boostada: Jul-05-2022