Umkhuseli we-NIBP olahlayo

Ukunciphisa i-NIBP kunye neempazamo ze-auscultation ngokujonga i-plethysmographic waveform kwi-pulse oximeter kunye nokuqaphela uxinzelelo lwe-arterial.
"Ukuba kukho indawo ofuna ukuya kuyo, ndingakusa apho, ndiyazi, ndiyimephu. Ukuba kukho indawo ekufuneka uye kuyo, ndikubheja ndingakusa khona, kwaye ndiyimephu. 'Ndiyimephu, ndiyimephu, ndiyimephu!"-Dora uMhloli
Uninzi lwabasebenzi bezonyango lweminyaka eliwaka banokucula ngovuyo ngelixa befunda oku, ngelixa abazali babo kunye nabalingane abadala kunye nabantwana basenokusebenzisa i-cheese graters kwi-forebrain ukucima iinkumbulo.
Sukuba nexhala, mamedics osana, andisayi kuqalisa ukucula ingoma yomxholo ethi "Barney" ngokulandelayo, kodwa ndifuna ukubonisa uthando oluncinane lweparameter yophawu olubalulekileyo olusoloko lungahoywa, luthetha uxinzelelo lwemithambo (imephu). nikela ingqalelo ngakumbi kwinani elincinane kwizibiyeli ecaleni kofundo lwe-NIBP, njengoko ingomnye wemilinganiselo ethembekileyo yokuxutywa esinokuyivavanya.
Emuva kwi-2011, ndabhala ikholamu enesihloko esithi "Iingcebiso kunye namaqhinga okufunda ngoxinzelelo lwegazi lwe-EMS." Le kholamu, kunye noMike McEvoy "Iimpazamo eziHlanu ezibangela ukuba ufundo lwegazi lakho luchaneke," luvela rhoqo kumajelo asekuhlaleni kunye neeblogi ze-EMS. nanini na i-EMT entsha ifuna uncedo malunga nendlela yokufumana uxinzelelo lwegazi oluchanekileyo ngelixa ufudukela kwi-ambulensi.
Kwaye rhoqo kuloo misonto yezimvo, ezinye ii-paramedics ezindala ezilumkileyo zibonisa ukuba ukufundwa kwe-NIBP ayaziwa ngokungachanekanga kwaye kufuneka "uphathe isigulana, kungekhona imonitha". kufuneka ubuncinane bafumane uxinzelelo lokuqala ngesandla.Unyanisile, oomatshini beNIBP badume ngokungachanekanga.Nabenzi besixhobo batsho njalo.Funda incwadi yesikhokelo yemonitha yentliziyo yakho kwaye ufihle inkcazo kwindawo ethile kuyo ukuba kwizigulana zethu ezifuna iBP echanekileyo kakhulu - izigulane. kuzo zombini iziphelo zesikali - ukufundwa kwe-NIBP kwiscreen sakho kusenokungabi, um, uxinzelelo lwegazi lokwenyani.
Ukuba bendinedola kuyo yonke i-EMT eyabhengeza ngokuzithemba i-BP ephela ngo-zero (150/90, 120/80, 110/70, ngalo lonke ixesha) okanye iBP eyakhupha i-stethoscope endlebeni yaza yathintitha ngokuthandabuza inani elingumnqakathi lifundeka kwiimitha ezinophawu olulinganayo lwehashi... ke, ndingafumana iidola ezininzi. Mhlawumbi ayanelanga ukuthenga ubuxhakaxhaka obuphindwe kabini bendibujongile ixesha elide, kodwa kuyenzeka rhoqo ukuba Ndibiza i-monitor ye-blood pressure monitor i-paramedic polygraph.
Ukuba bekulula ukwenza uxinzelelo lwegazi, ngekhe sithumele iingcebiso kunye namaqhinga malunga nendlela yokwenza njalo ngonyaka okanye njalo.
Nangona kunjalo, nangona i-cuff ye-NIBP ithande ukugqithisela kakhulu uxinzelelo lwegazi lwe-systolic kukothuka, ifezekisa phantse i-MAP efanayo nokujongwa kwe-arterial ehlaselayo.
Kuphononongo lwabaguli be-ICU abadala abangama-4,957 kwiziko lokhathalelo lwenqanaba lesithathu, ngaphezulu kwe-27,000 yoxinzelelo lwegazi yafunyanwa ngaxeshanye ne-NIBP kunye ne-catheter-of-arterial sensors. kuneqela elinoxinzelelo lwegazi lwe-systolic kuluhlu olufanayo (<70 mmHg) .1
Xa kuthelekiswa ukuxhaphaka kokulimala kwezintso kunye nokufa kwe-ICU phakathi kwe-arterial MAP kunye ne-MAP engabonakaliyo, ulwahlulo lwaluncinci, kwaye ababhali besifundo abakhokelayo bagqiba ukuba i-NIBP igqithise uxinzelelo lwegazi lwe-systolic kwimeko yomothuko, kodwa kungekhona nge-cuff ye-blood pressure cuff.Ulungelelwaniso lwe-MAP olufunyenweyo lwalusondele kakhulu kwi-MAP ye-arterial (Amanani 1 kunye ne-2).
Ngoko kutheni oomatshini be-NIBP bechaneke kangaka ekulinganiseni i-MAP kodwa bengathembekanga ekulinganiseni uxinzelelo lwegazi lwe-systolic?
Oku kuchasene ngqo nendlela esiyenza ngayo ngesandla;senza i-auscultate Korotkoff ukumisela uxinzelelo lwegazi lwe-systolic kunye ne-diastolic, kwaye ngokwezibalo sifumana uxinzelelo lwe-arterial ukusuka kule nxaki ilandelayo:
Abaninzi bethu bafunda esi sibalo kwisikolo sabahlengikazi kwaye bakhohlwa ngokukhawuleza, kuba uninzi lweeparamitha zethu zonyango zihambelana noxinzelelo lwegazi lwe-systolic, kwaye ngenxa yokuba sizonda izibalo.Kuvela ukuba oomatshini be-NIBP abafumana uxinzelelo lwegazi kwi-MAP kunye nesantya se-pulse asiyiyo. ngcono kakhulu kwizibalo kunathi.
Uninzi lwabantu abaye bahlala kwisihlalo sangasemva se-ambulensi ngaphezu kwemizuzu emihlanu bayaqonda ukuba ugogo omomothekayo, opinki onobunzima be-90 pounds kunye noxinzelelo lwegazi lwe-84 / 60 ayikho into efana nendoda enobunzima be-250 pounds kwaye inegazi. uxinzelelo lwe-90./40.Kumakhulu, inokuba luxinzelelo lwegazi lwakhe lwemihla ngemihla, izitho zakhe ezibalulekileyo zixutywe kakuhle.Kumqhubi weloli onesithukuthezi, onebala elingwevu, obilayo, nangona uxinzelelo lwegazi oluphezulu lwe-systolic, wayephantsi-perfused.
Uninzi lwemithombo luqwalasela i-MAP ye-65 mmHg ukuba ibe yinto ephantsi kakhulu kwi-perfusion yelungu elibalulekileyo, kunye ne-MAP eqhelekileyo ye-70-110 mmHg. iigundane zine-MAP efanayo nabantu?) Unokunyamezela ii-MAP eziphantsi kwe-50 mmHg ukuya kwimizuzu ye-90. Ukulimala kwezintso ezibukhali kuqala kwimizuzu ye-20 kunye ne-MAP engaphantsi kwe-60 mmHg.
Ke kwixesha elizayo xa uzibuza ukuba isigulana sakho sisezantsi na kodwa uxinzelelo lwegazi alubi kangako, jonga i-plethysmographic waveform kwi-pulse oximeter yakho, ukuba uyakholelwa kwi-NIBP blood pressure phakathi kwe-Indecisive ayihambelani ncam. unikezelo lwekliniki yesigulana, okanye indlebe elele iqabane lakho, nikela ingqalelo ngakumbi kwelo nani lincinane kwizibiyeli ecaleni kokufunda kwakho kwe-NIBP.MAP akayi kukukhokelela kwicala elingalunganga.
Ngokuthumela ulwazi lwakho, uvumela umthengisi okhethiweyo ukuba aqhagamshelane nawe kwaye idatha oyithumelayo ayixhomekekanga kwisicelo esithi "Musa ukuthengisa iiNkcukacha zam zoBuqu".Jonga iMigqaliselo yethu yeNkonzo kunye noMgaqo-nkqubo waBucala.
U-Kelly Grayson, i-NRP, i-CCP, i-paramedic ebaluleke kakhulu e-Louisiana.Kwiminyaka eyi-24 edlulileyo, uye wasebenza njenge-paramedic yentsimi, i-paramedic yokunyamekela ukunyamekela, umphathi wentsimi kunye nomfundisi-ntsapho.Ungumongameli we-Louisiana EMS Educators Association kunye ilungu lebhodi 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.
I-EMS1 iguqula indlela uluntu lwe-EMS lufumana ngayo iindaba ezifanelekileyo, luchonga ulwazi olubalulekileyo loqeqesho, lunxibelelana omnye nomnye, kwaye luphanda ukuthengwa kwemveliso kunye nabaxhasi.Ibe yeyona ndawo ibanzi kwaye ithembekileyo ye-intanethi ye-intanethi ye-pre-hospital kunye neenkonzo zonyango ezingxamisekileyo.