Transcutaneous pacing yakaoma kupfuura iyo inoratidzika.
Chimwe chezvinhu zvisingadikanwi mukurapa kwekukurumidzira kwechirwerecardia chechirwere ndiko kukanganisa kudarika atropine administration uye kuramba zvakananga kune kunze pacing. Icho chisarudzo chakakurumbira pakati pevashandi vezvematongerwo enyika . Kufunga ndechokuti atropine inokonzera oksijeni yakawanda inoda kuti iise kudzvinyirira zvisina kukodzera pamutsipa wemwoyo uye inogona kutungamirira kune myocardial infarction .
Pane kudaro, kufunga kunofamba, shandisa nzira yekutengesa kuwedzera kukura kwemwoyo kunze kwekukanganisa kweatropine.
Pasina kupinda mune nharo pamusoro pekuti icho ndicho chisarudzo chakanaka here kana kwete, zvakakosha kuziva zvikwereti zvekushandisa kunze kwekutengesa kwekutengesa. Icho chiri kure nekaceaaa. Iko-high-acuity, pasi-frequency process inounza kupfuura chikamu chayo chekuvhiringidzika kune dambudziko. Kuti tifambe zvakanaka nemurwere ane chirwere chechirdycardia, munhu anofanirwa kuve nechokwadi kuti anonzwisisa zvakakwana ma mechanics uye kushandiswa kwekliniki yekunze transcutaneous pacemaker.
Nhoroondo yePacing
Chokutanga pane zvose, vanyengeri vanga varipo zvakaperera chero bedzi mwoyo wemunhu wakanga uripo. Iyo inouya neyoyo chaiyo yega pacemakers- yekuti, mutsara wose wemasikirini emwoyo unogona kuzadzisa basa iri kana zvichidiwa-asi kushandiswa kwemagetsi kunokonzera kukanganisa kwemoyo kwakave kwakapoteredza kubva kuma1900 ekupedzisira, kunyangwe pamatatya.
Therapeutic pacemakers yakakonzera chiitiko chechipatara mukatikati ma1900 uye yave ichingova duku uye yakanaka kubva ipapo. Iko kune mishonga inogadziriswa inogadziriswa iyo inoshandiswa kuvarwere vane chirwere chisingagoneki arrhythmias. Kushandiswa kwetsika dzakasununguka dzomukati dzemagetsi dzinoshandisa electrode dzakaputirwa mumatepa ekunamatira dzakashandiswa mukati uye kunze kwechipatara kubva muna 1985.
The Machine
Pane marongerwo emhando uye mienzaniso yekutenderera kwekunze kwekunze, asi vose vanotevera zvakafanana zvakagadzirwa. Mucherechedzo wemwoyo unogona kunge unokosha, unoenderera mberi, unonzi-single- electrocardiogram (ECG) unotenderedzwa ne pacemaker inouya nemagetsi maviri. Mafuta emagetsi anowanzobatanidzwa muusina-kushandiswa, pre-gellic adhesive pads. Mune mienzaniso yakawanda yemazuva ano, mugove we pacemaker nemapadhi zvakapetwa kaviri semudziri wechipfigrillator .
Zvizhinji zvezvo zvinouyawo ne printer kuti inyore chirwere cheEGG murwere uye chero ipi zvayo kuedza kukurumidza kana kuideredza. Zvinhu zvizhinji zvinokwanisa kuita zvimwe zviratidzo zvakakosha, zvakadai sokusava nechisimba kwezvinokonzerwa neropa (NIBP), kuputika oximetry , kuguma-kugadzirisa mazita, etc. Kune mamwe matanho atingaita kushandisa idzi zvimwe zviratidzo zvinokosha kuti tibatsire kuziva zvakakodzera kufamba. Zvimwe pane izvozvo gare gare.
Transcutaneous pacemakers ine zvinyorwa zviviri izvo mutarisiri anofanira kutarisa: simba remagetsi emagetsi uye chiyero chemafungiro paminiti. Nhamba yacho yakajeka chaizvo. Uyu ndiwo mushonga weBardycardia inoratidzika, saka muyero wakatarwa unofanirwa kunge uri kukurumidza kupfuura chirongwa chemurwere. Kazhinji, tinopfura nhamba dzinenge makumi mapfumbamwe neminomwe paminiti. Izvi zvinoparadzaniswa nenharaunda, saka iva nechokwadi chekutarisa nemutungamiriri wako wezvechiremba kuti utungamirire pahutano hwakanaka hwekutengesa.
Simba rekugadzirisa magetsi rinotaridzwa mu milliamperes ( milliamps yeavo vanoziva). Zvinotora huwandu huwandu hwesimba kuti hupinde nepakati pemurwere wepakati kuti utange kuvhara. Chikumbaridzo ichocho chakasiyana kune varwere vose uye kukanganisa kwakajairika pakushandisa transcutaneous pacemaker kunokundikana kukonzera simba rakakwana zvakakwana. Kuita kuti zvinhu zviwedzere kuoma, kune misiyano yakasiyana yemakwara ekufambisa emwoyo uye chaiyo mutsara wemwoyo, izvo zvinoreva kuti zvinoita kuti ECG itaridzike seyo pacemaker iri kushanda, asi mitsipa yemwoyo haisi kunyatsopindura.
Kubatanidza Chigadzirwa
Muenzaniso wega woga wakasiyana uye zvakakosha kuti mutarisiri wega wega anotora nguva yekuzviziva nemhando yaanenge achishandisa mumunda. Izvo zvichitaurirwa, mitemo yacho yakafanana zvakanyanya pamitambo yakawanda.
Ipaper pads inofanira kusanganiswa pamwe chete nemagetsi ekuongorora. Apo transcutaneous pacemakers ne-defibrillator vakange vari zvakasiyana-siyana zvakagadziriswa, pacer pads vaifanira kubudiswa kunze kwenzira yezvigadziriswa zvepfibrillator kana chikafu chekusungwa kwemwoyo, chikonzero chakanaka paunenge uchitamba-svetuka nemutano wemoyo wemurwere. Ikozvino iyo yakawanda yekutengesa inokonzeresa yakaita sedhijidhiyo, zvisikwa zvinowanzoiswa zvakafanana kune zvose zvinoshandiswa. Zvakare, tevera mazano ekugadzira.
Murwere anofanira kunge akabatanidzwa kumeso emwoyo. Izvi zvinokosha. Kune avo vanoziva nzira iyo inonyanya kushandiswa nayo yemoyo inonzi defibrillators inoshanda, inowanzokanganisa kufungidzira kuti motokari yemagetsi ye pacemaker (pacer pads) ichakwanisawo kutarisa mwoyo wemurwere rhythm. Ndiyo nzira iyo defibrillators inoshanda, asi zvinokonzera zvinokonzera zvinokonzera kushungurudza kumwe chete, uye zvino dzoka zvakare kuongorora rhythm. A transcutaneous pacemaker iri kuramba ichibudisa mafungiro uye haina chaizvo mukana wekutarisa chero chinhu kuburikidza ne pacer pads.
Iva nechokwadi chekuona kweEECG yakagadzirirwa kuverenga mutungamiri kuburikidza nekuongorora magetsi uye kwete kuburikidza ne pacer pads. Nokuti musanganiswa defibrillator / pacemaker anoshandisa maitiro akafanana emishonga yemagetsi ose, zviri nyore kwazvo kuisa izvi zvisina kururama. Kana yakagadzirirwa kuverengwa kuburikidza nemapadhi, maitiro mazhinji haazoshandisi kana kufamba kwekuedza kuchiedzwa.
Pacing a Patient
Kana imwechete iyo yakashandiswa zvakakodzera uye yakashandiswa, tsvaga mapikicha epakati mukutengesa kweEECG. Pane imwe nguva tine izvozvo, inguva yekufambisa murwere:
- Isa chiyero kune zvidiro zvinoda paminiti. Zvose zvinowanzosvika pari pakati pe 70-80, asi chiyero chinogadziriswa nemutarisiri.
- Wedzera simba remhepo kusvikira mafungiro atanga QRS complex, iyo inozivikanwa sekutorwa . Mucherechedzo weEGG ucharatidza hutete hwakasimba pamusungo mumwe nomumwe uye apo imwe nyoka inoteverwa pakarepo ne QRS yakaoma, kubatwa kunowanikwa (ona mufananidzo uri pamusoro).
- Inzwa nokuda kwekupisa kwemhepo. Panofanira kuva nemhepo inokonzerwa nehuwandu hwe QRS, kana chinhu ichi hachibatsiri. Kana murwere asingakonzeri kupisa kwemazuva, ropa redu rinoramba richiderera kuti rive rakasimba.
- Bump up energy 10 milliamps kupfuura iyo yekubatwa. Izvi zvinoderedza mikana yekurasikirwa kubatwa munguva yemberi.
Kana imwe nguva pacemaker iri kushanda uye mamiriro ezvinhu emuurwere ari kuvandudza, funga kuti sedation. Chinhu ichi chinoshungurudza semapenzi. Pachave nehuwandu hwemapapu echinyorwa chechifukidzo chechifukidzo chechifukidzo nemhemberero imwe neimwe. Murwere anokwanisa kuzvitsungirira kwemaminitsi mashomanana, asi kwete kwenguva refu. Kana izvi zvichishandiswa mumunda, murwere achiri kuendeswa kuchipatara chimwe chinhu chisingazovhiringidzi (uye zvishoma zvinorwadza) chinogona kutora mutambo wekutengesa pacemaker.
Dambudziko reTranscanally Pacing
Mashoko matatu: Capture! Capture! Capture! Chikanganiso chinonyanya kuwanda chandakaona kunze kwe-chipatara transcutaneous pacemaker chekushandisa kukundikana kutora. Chikonzero chakakosha ndechokusaverenga maEGG nekutenda kuti kubatwa kwaitika.
Apo mafikes anopinda anoita seanorova zvakanaka pamberi pe QRS, zvinogona kuonekwa kuti chigadzirwa chiri kubatsira (ona mufananidzo uri pamusoro). Kune zvikwangwani zvishomanana zvinobatsira kuti urege kudzikanganisa:
- Enzanisa chirevo chekutanga chisati chafamba nezvinodiwa nemutarisiri ndeye "paced" rhythm. Kutora kwechokwadi kucharatidza zvakasiyana-siyana zve QRS yakaoma nokuti chinangwa chekufungidzira chiri kuuya kubva kune imwe nzvimbo (giant patch pachifukidzo chakakura semwoyo panzvimbo yevamwe vanofungidzira nzvimbo pamwe nemafambisiro emwoyo). Kana kuumbwa kweQRS kusina kushanduka, kutora hakunakwanisi.
- Kana iyo inofamba ichinyanya kupfuura QRS complexes, hatina kubudirira kutora zvakare. Mumufananidzo wepamusoro, kune ma spikes matatu, asi chete maQRS maviri akaoma mune chikamu chechidimbu asina kutorwa.
- Kana iyo spikes inofamba iri pamakiromita akasiyana kubva kuQRS complexes, hapana kubatwa.
- Kana simba riri pasi pemamilimita makumi mana emurwere mukuru, hazvigoneki kuti kubatwa kunogona kuitika. Vakawanda varwere vane chikumbaridzo pamusoro peizvi. Dzorera kadhi. Zvose zvinowedzera simba muzvikamu zvishanu kana gumi-milliamp.
QRS imwe neimwe nyoka; eureka! Takabata!
Kwete nekukurumidzira ... tine hurumende here? Kugadziriswa kwemagetsi kunoonekwa paEECG, asi kutora muviri kunongororwa kuburikidza nezviratidzo zvinokosha. Chikanganiso chechipiri chinowanzoonekwa ndechokukundikana kusimbisa kutorwa kwenyama. Tarisa zviratidzo izvi:
- Kushanda kwemajeri kweQRS imwe neimwe chiratidzo chinonyanya kukosha. Izvi zvinoudza muchengeti kuti kushanda kwemweya kwega kwega kwega kuchiwana systolic ropa rinosvika 80-90 mmHg.
- Kakawanda kwevarwere vakaoma ndeyekutarisa hutachiona oximetry waveform. Kana iyo mamiriro ekufananidza ichienderana neQRS-iyo iyo inofanira kunge iri muyero wakaiswa pachigadzirwa, kana isu hatina kutora chaizvo-zvino tinoziva mwoyo inobvumirana ne QRS imwe neimwe. Tora mutoro weropa kuti uone kana kukanganiswa kuri kwakasimba. Kana ichinge ichiderera, hoodid fluus inogona kubatsira kugadzirisa dambudziko racho. Iva nechokwadi chekutsvaga mazano ekurapa.
Dzivisa kushandisa chirwere checarotid sechiratidzo chekubata muviri. Iko musapfupa musumbu zvinopesana izvo zvinouya ne-transcutaneous pacing zvinoita kuti zvive zvakaoma kuziva zvirwere zvecarotid. Varipo, asi zvichida kwete nekukurumidza sezvinoitwa pachip, iyo ndiyo chikonzero chose chekutarisa kupisa munzvimbo yekutanga.
Pakupedzisira, tora marwadzo. Pano pane muenzaniso mumwe wemurwere unotsigira kupisa kubva pacer pads uye varwere vanenge vari pasi rose vanonyunyuta kurwadziwa kubva mumasumbu ekusimudzira musikana ne transcutaneous pacing.
> Sources:
> Bocka, J. (1989). External transcutaneous pacemakers. Annals Of Emergency Medicine , 18 (12), 1280-1286. doi: 10.1016 / s0196-0644 (89) 80259-8
> Muschart, X. (2014). Zvinopisa kuti zvive zvipenyu: chinetso chekutenderera kwemwoyo kunotyisa. Kutarisira kwakakosha , 18 (6). doi: 10.1186 / s13054-014-0622-x