Umvikeli we-NIBP olahlwayo

Nciphisa amaphutha e-NIBP namaphutha e-auscultation ngokubheka i-plethysmographic waveform ku-pulse oximeter futhi uphawule ingcindezi ye-arterial emaphakathi
"Uma kunendawo ofuna ukuya kuyo ngingakuyisa khona, ngiyazi, yimina imephu. Uma kukhona lapho okumele uye khona, ngikubheja ngingakuyisa khona, futhi yimina imephu. 'Ngiyimephu, ngiyimephu, ngiyimephu!"- Dora Umhloli
Izisebenzi eziningi zezokwelapha zeminyaka eyinkulungwane zingase zicule ngenjabulo ngenkathi zifunda lokhu, kuyilapho abazali babo nozakwabo abadala abanezingane kungenzeka basasebenzisa ama-cheese grater ku-forebrain ukuze basule izinkumbulo.
Ungakhathazeki, odokotela bezingane, ngeke ngiqale ukucula ingoma yetimu ethi "Barney" ngokulandelayo, kodwa ngifuna ukubonisa uthando oluncane ngohlaka olubalulekile oluvame ukunganakwa, okusho umfutho wegazi (imephu). qaphela kakhulu inombolo encane kubakaki eduze kokufundwa kwe-NIBP, njengoba kungenye yezilinganiso ezinokwethenjelwa kakhulu zokufafaza esingakwazi ukuzihlola.
Emuva ngo-2011, ngabhala ikholomu enesihloko esithi "Amathiphu Namasu Okufundwa Komfutho Wegazi we-EMS."Le kholamu, kanye nekaMike McEvoy ethi "Amaphutha Amahlanu Adala Ukufundwa Komfutho Wegazi Lakho Kungabi Nembi," ivela kaningi ezinkundleni zokuxhumana kanye namabhulogi e-EMS. noma nini lapho i-EMT entsha ifuna usizo mayelana nendlela yokuthola umfutho wegazi onembile ngenkathi uthuthela ku-ambulensi.
Futhi njalo kuleyo micu yokuphawula, abanye abezimo eziphuthumayo abadala abahlakaniphile baveza ukuthi ukufundwa kwe-NIBP kwaziwa ngokungalungile nokuthi kufanele "uphathe isiguli, hhayi umqaphi". Ngokuvamile, angasikisela ukuthi uma bengawushiyi ngokuphelele umshini we-NIBP, kufanele okungenani bathole ingcindezi yokuqala mathupha.Uqinisile, imishini ye-NIBP idume ngokungalungile.Ngisho nabenzi bemishini basho njalo.Funda imanuwali ye-opharetha yenhliziyo yakho bese ufihla incwadi ephikisayo endaweni ethile lapho yokuthi ezigulini zethu ezidinga i-BP enembile kakhulu - iziguli. kuzo zombili iziphetho zesikali - ukufundwa kwe-NIBP esikrinini sakho kungase kungabi, um, umfutho wegazi wangempela.
Ukube nginedola kuyo yonke i-EMT eyamemezela ngokuzethemba i-BP egcina ngoziro (150/90, 120/80, 110/70, njalo) noma i-BP ekhipha i-stethoscope endlebeni yakhe futhi yangingiza ngokungabaza inombolo eyinqaba efundwa imitha enophawu olulinganayo lwe-hashi... kuhle, ngingaba namadola amaningi. Mhlawumbe akwanele ukuthenga imfashini enobubanzi obuphindwe kabili kade ngayibuka isikhathi eside, kodwa kwenzeka kaningi ukuthi Ngibiza imonitha yomfutho wegazi owenziwe ngesandla nge-polygraph yezimo eziphuthumayo.
Ukube bekulula ukwehlisa umfutho wegazi, besingeke sithumele amathiphu namasu okuthi ungakwenza kanjani unyaka nonyaka.
Kodwa-ke, nakuba inkomishi ye-NIBP ijwayele ukweqisa umfutho wegazi we-systolic ngokushaqeka, ifinyelela cishe i-MAP efanayo nokuqapha kwe-arterial ehlaselayo.
Ocwaningweni lweziguli ezingama-ICU zabantu abadala ezingama-4,957 esikhungweni sokunakekelwa kwemfundo ephakeme, kutholwe amanani womfutho wegazi angaphezu kuka-27,000 kanye nezinzwa ze-NIBP kanye ne-catheter-of-arterial. kunaseqenjini elinomfutho wegazi we-arterial systolic ebangeni elifanayo (<70 mmHg) .1
Lapho kuqhathaniswa ukwanda kokulimala kwezinso okukhulu nokufa kwe-ICU phakathi kwe-arterial MAP kanye ne-MAP engavamile, umehluko wawumncane, futhi abalobi bocwaningo abaholayo baphetha ngokuthi i-NIBP ilinganisela ngokweqile umfutho wegazi we-systolic esimweni sokushaqeka, kodwa hhayi nge-cuff ye-blood pressure engavamile.Ukuxhumana kwe-MAP okutholiwe bekuseduze kakhulu ne-arterial MAP (Amanani 1 kanye no-2).
Ngakho-ke kungani imishini ye-NIBP inembe kangaka ekulinganiseni i-MAP kodwa ingathembeki ekulinganiseni umfutho wegazi we-systolic?Impendulo iwukuthi lokho umshini we-NIBP olinganisa ngempela i-MAP.Umfutho wabo wegazi obaliwe.
Lokhu kuphambene ncamashi nendlela esikwenza ngayo mathupha;siqinisa i-Korotkoff ukuze sinqume umfutho wegazi we-systolic ne-diastolic, bese ngokwezibalo sithola umfutho we-arterial omaphakathi kusukela ku-equation elandelayo:
Abaningi bethu bafunde lesi sibalo esikoleni sabahlengikazi base bekhohlwa ngokushesha, ngoba imingcele yethu eminingi yokwelashwa ihlobene nomfutho wegazi we-systolic, futhi ngenxa yokuthi sizonda izibalo.Kuvela ukuthi imishini ye-NIBP ethola umfutho wegazi ku-MAP kanye nesilinganiso sokushaya kwenhliziyo kangcono kakhulu ezibalweni kunathi.
Iningi labantu elihlale esihlalweni esingemuva se-ambulensi isikhathi esingaphezu kwemizuzu emihlanu liyaqaphela ukuthi ugogo omomothekayo, obomvana onesisindo esingamakhilogremu angu-90 futhi onomfutho wegazi ongu-84/60 akafani nendoda enesisindo esingamakhilogremu angu-250 futhi enegazi. umfutho wegazi ongama-90./40.Kugogo, kungaba umfutho wegazi wakhe wansuku zonke, izitho zakhe ezibalulekile zinephunga elimnandi.Kumshayeli weloli oyisidlakela, onebala elimpunga, ojulukile, naphezu komfutho wegazi ophakeme we-systolic, wayengenawo amakha.
Imithombo eminingi ibheka i-MAP engu-65 mmHg njengomkhawulo ophansi kakhulu wokukhipha isitho esibalulekile, enobubanzi obujwayelekile be-MAP obungu-70-110 mmHg.Izinso zomuntu zizwela kakhulu ku-hypoperfusion, nakuba ezinye izifundo zezilwane zibonise ukuthi amagundane ophayo (ingabe bewazi amagundane ane-MAP efanayo nabantu?) Angakwazi ukubekezelela ama-MAP aphansi njenge-50 mmHg kuze kufike kumaminithi we-90. Ukulimala kwezinso ezinzima kuqala phakathi nemizuzu ye-20 nge-MAP engaphansi kwe-60 mmHg.
Ngakho-ke ngesikhathi esilandelayo lapho uzibuza ukuthi ingabe isiguli sakho siphansi ngekwata kodwa umfutho wegazi awumubi kangako, bukela i-waveform ye-plethysmographic ku-pulse oximeter yakho, uma ukholelwa ukuthi umfutho wegazi we-NIBP phakathi kwe-Indecisive awuhambisani ngempela isethulo somtholampilo sesiguli, noma indlebe elele yozakwenu, naka kakhulu leyo nombolo encane kubakaki eduze kokufunda kwakho kwe-NIBP.I-MAP ngeke ikuholele endleleni engafanele.
Ngokuthumela imininingwane yakho, uvumela umdayisi okhethiwe ukuthi axhumane nawe futhi idatha oyithumelayo ayikho ngaphansi kwesicelo esithi "Ungadayisi Ulwazi Lwami Lomuntu Siqu".Buka Imigomo Yesevisi yethu kanye Nenqubomgomo Yobumfihlo.
U-Kelly Grayson, i-NRP, i-CCP, uyizimo eziphuthumayo zokunakekelwa okubucayi e-Louisiana.Kule minyaka engu-24 edlule, usebenze njenge-paramedic yasensimini, ukunakekelwa okubucayi kwezokuthutha, umqondisi wensimu kanye nothisha.Ungumongameli we-Louisiana EMS Educators Association futhi ilungu lebhodi le-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.
I-EMS1 ishintsha indlela umphakathi wakwa-EMS othola ngayo izindaba ezifanele, ihlonza ulwazi olubalulekile lokuqeqeshwa, ukuxhumana nabanye, futhi icwaninga ukuthengwa kwemikhiqizo nabahlinzeki.Ibe yindawo yokufinyelela ku-inthanethi ebanzi kakhulu nethembekile yezinsizakalo zezokwelapha zangaphambi kwesibhedlela nezimo eziphuthumayo.