I-Atropine noma i-Pacing?
Ezingxenyeni eziningi zokwelashwa eziphuthumayo ze-prehospital ezizungezile e-United States, kunezinketho ezimbili zokwelashwa ngokuqondile kwe-bradycardia ephawulekayo etholakalayo kwabalingani bezimo eziphuthumayo : i-transcutaneous pacing (TCP) noma ukuphathwa okunamandla kwe-atropine sulfate. Ezinkambisweni eziningi, kukhona impikiswano mayelana nokuthi iyiphi indlela yokwelashwa ethandwayo. Lesi yisibonelo esihle sokuthi imithi esekelwe ebufakazini igxila kanjani phakathi kwezokwelapha kwezinye izimo ezisekelwe emgqonyeni wedatha eyakha ohlangothini olulodwa lwempikiswano noma enye.
I-Bradycardia yesimangaliso
I-Bradycardia (izinga lentliziyo elincane) livame ukuchazwa njengezinga lokushaywa kwamaphesenti angaphansi kwama-50 ngomzuzu (BPM). Sithola ukukhathazeka lapho isiguli esinama-bradycardia sinezibonakaliso ezingase zibangelwe izinga lokugulisa kancane-noma-isiguli sinempawu ebangelwa into efanayo ebangela i-bradycardia. Noma yikuphi, isiguli kuthiwa sibe ne-bradycardia ephawulekayo. Izimpawu ezihambisana ne-bradycardia futhi zibhekwa njengeziphawulekayo zihlanganisa:
- I-Hypotension (umfutho wegazi ophansi)
- Ubuhlungu besifuba
- Ukuphelelwa umoya
- Isizungu
- I-Syncope
- Ukudideka
Abanye abantu, ikakhulukazi abagijimi bokukhuthazela, bangaba nokuphumula kwamazinga enhliziyo ahamba kancane kunama-BPM angu-50 kanti kuyilapho okwamanje i-bradycardia, ivela ngaphandle kwempawu (engaqondakali).
I-bradycardia engaqiniseki noma eqinile yeSyptomatic
Lezi zimpawu zingahlukaniswa ngezigaba ezimbili: i-hemodynamically unstable versus hemodynamically stable. I-bradycardias engaqinisekisiwe ye-Hemodynam ibhekisela kulabo abaholele ekulahlekelweni kwe-perfusion futhi kuhambisana ne-hypotension noma izimpawu ezibonisa ukuntuleka kwengqondo yokuxoshwa (isizungu, i-syncope, nokudideka).
Ngokuvamile, lezi zimpawu ziwumphumela we-bradycardia, ngakho ukulungisa i-bradycardia kungase kuxazululwe izimpawu.
Ubuhlungu be-chest nokuphefumula okuphefumula kungahambisana ne-bradycardia ehleliwe noma engazinzile. E-bradycardia engaqiniseki, ukungabi khona kwe-perfusion kungabangela imbangela yesifuba noma i-dyspnea.
E-Bradycardia ezinzile, ezinye izimo zenhliziyo zingase ziholele kokubili izimpawu kanye ne-bradycardia. Ezinye izinhlelo zezokwelapha eziphuthumayo zicabangela ukuthi i-bradycardia igxilile uma izimpawu ezihambisana kuphela zibuhlungu besifuba noma ukuphefumula. Ezinye izinhlelo zibheka njengokungaqiniseki. Ama-paramedics kufanele alandele njalo izivumelwano zawo zendawo.
I-Atrioventricular Block (AVB)
Amanye ama-bradycardia angabangelwa ukuqhutshwa okungalungile nge- noode ye - atrioventricular (AV) , okuyinto idlulisela umfutho ukutshela inhliziyo ukuba inkontileka kusuka i- atria (amakamelo amabili aphezulu) kuya kuma- ventricles (amakamelo amabili angaphansi). I-node ye-AV inikeza ikhefu elincinci ekuqhubeni umfutho wokunikeza isikhathi sokuba igazi lifakwe ku-atria bese ligcwalisa ngokuphelele ama-ventricles. Ngemuva kwekhefu, umfutho usuke uthunyelwa ngaphansi kwesigxobo saKhe futhi kuya emagqumeni e-Purkinje , lapho kubangelwa ukuthi ama-ventricles asebenze futhi aqhube igazi e-arteries (the pulse). Ukuvinjwa kwenhliziyo (enye inkulumo ye-AVB) kuza ngamadireji amathathu.
I-degree ye-AVB yokuqala iyakwandisa ukuma kancane kwemvelo ukuthi i-AV node kufanele idale. I-degree yokuqala AVB ayinayo iningi, uma likhona, umphumela esilinganisweni senhliziyo. Izinga kulolu cala lisalokhu lihlelwe yinothi le-sinus elise-atrium kwesokunxele.
Ama-blocks amaningi okuqala ayibhekwa njengengozi.
Kunezinhlobo ezimbili ze-secondary degree AVB:
- I-Second degree Type I (eyaziwa nangokuthi i- Wenckebach ) ihamba kancane kancane ekuqhutshweni nge-AV node kuze kube yilapho umfutho ungawenzile ukusuka e-atria kuya kwi-ventricles. Uma kwenzeka lokho, ukuqhutshwa kokuqala kuqala ngokushesha futhi bese kuqhubeka kancane kancane. Uma izimpembezo ezilahlekile zenzeka njalo, zinganciphisa i-BPM ibe ngaphansi kuka-50. Isibonelo, uma isiguli sinehlobo lwesigamu esingu-1 se-AVB futhi zonke izintambo zenhliziyo yesithathu azikwenzeki kodwa i-node yesus isithumela impulse engu-70 ngomzuzu, isilinganiso se-pulse esiphumela sizoba ngu-46 ngomzuzu.
- I-Second degree Type II ayiqhubeki njengohlobo lwe-Type I, kodwa kusengabangela izimpendulo ezithile ezingenziwanga ngokusebenzisa i-AV node kanye nokushaya okungabanjwanga. Izintambo ezingabanjwanga zingenzeka kuphethini noma ngendlela engahleliwe. Noma ngabe yikuphi, ukulahlekelwa kwezibhamu ngokwanele ngomzuzu kungabangela ukushaywa kwe-pulp ukuba ibe ngaphansi kwe-BPM engu-50 futhi kungabhekwa njenge-bradycardia.
I-third degree i-AVB (ebizwa nangokuthi i- AVB ephelele noma i-block ephelele ye-heart ) yenzeka uma impingqa ingabonakali ukuyenza ngokusebenzisa i-AV node nhlobo. Kulesi simo, i-atria izoshaywa ngodugodla we-sinus kodwa ama-ventricles azokwenza into yawo siqu. I-ventricles, engenayo i-pacemaker esheshayo okumele ilandele, izoshaya endaweni ephakathi kuka-20-40 BPM, okuncane okwanele ukubhekwa njenge-bradycardia. Naphezu kokubizwa ngokuthi i-block ephelele, ngesikhathi se-AVB yesithathu kungase kube khona ukuqhuba okuthile ngokusebenzisa i-AV node. Uma ukuqhuba kuhamba kancane, ama-ventricles ngeke alinde ukubona ukuthi kukhona okuzayo futhi kuzoziphatha ngendlela efanayo uma ngabe ukuqhuba kuvinjelwe ngokuphelele. Lokhu kubaluleka kubaluleke kakhulu uma uphikisana noma ungazami yini i-atropine nhlobo ukuthola amabhulogi enhliziyo ephelele.
Ukwelashwa kweBydycardia yeSymptomatic
I-bradycardia eqinile iqondiswa ngokuphatha imbangela eyimbangela ye-bradycardia. Uma ihlobene ne-infarction ye-myocardial acute (AMI), ukuphatha i-AMI kufanele ibe nomthelela omuhle ebradycardia. Uma kuhlobene nemithi, ukususa noma ukulungisa imithi kufanele kusize.
I-bradycardia engazinzile kufanele iphathwe ngokuqondile. I-bradycardia engaphenduliwe engaphenduliwe ingakwazi ukuphuma ekulawuleni-ukungabi namaphutha kungaphinde kuphazamise ukugeleza kwegazi lomzimba. Ukunciphisa ukungcola ebuchosheni kungabangela ukushaywa, isizungu, noma ukudideka.
Kunezindlela ezintathu zokwelapha i-bradycardia engaqinisekisiwe yesifo: ukwandisa umfutho wegazi (futhi ngaleyo ndlela ukhiqiza) ngokwandisa ivolumu yomswakama ohlelweni lwezinhliziyo, ukuvimbela imithwalo yegazi yomsindo ukushaya igazi ezigodini ezibalulekile, noma ukukhula kwenhliziyo. Ukwelashwa okunempumelelo kakhulu kusebenzisa inhlanganisela yazo zonke ezintathu.
I-bolus ye-fluid ye-IV ingakusiza ingasiza ukwandisa umfutho wegazi futhi uthuthukise umfutho we-perfusion. Imithi ye-sympathomimetic, efana ne-dopamine, ingasiza ukuvimba igazi ngaphandle komgogodla bese ugxila ingcindezi yengqalasizinda, ikakhulukazi ebuchosheni nasenhliziyweni. Izidakamizwa ze-Sympathomimetic zingasiza futhi ukwandisa isilinganiso senhliziyo, okuyinto yokwelashwa okuqondile kakhulu okungenzeka. Ezimweni eziningi, ukunyuka okukhulu kwenhliziyo kuyothola kuphela ngokuphatha i-atropine sulfate noma i-pacing the pacing.
Futhi manje, ingxabano.
I-Atropine noma i-Transcutaneous Pacing
I-American Heart Association itusa i-atropine sulfate njengendlela yokuqala yokwelashwa kwe-bradycardia ephawulekayo, kungakhathaliseki ukuthi ingenxa ye-AVB noma cha. Yilapho i-nuance yama-block blocks ephelele efika. Ngokuvamile kucatshangwa ukuthi ngenkathi i-atropine ithuthukisa ukuqhuba nge-node ye-AV, ngeke yenze noma yini ebhodini lezinhliziyo eliphelele eliphelele.
Ngesikhathi esifanele ukuthi i-transcutaneous pacing (ikhono lokusebenzisa i-pacemaker kagesi ngaphandle kwesikhashana besebenzisa ama-adhesive patches esifubeni kanye / noma emuva) yatholakala kulabo abaphuthumayo emkhakheni, ukusetshenziswa kwe-atropine kwaqala ukuba yinselele. Kunezizathu eziningana ezinikeziwe. Isizathu esivame kakhulu ukuthi i-atropine ikhulisa ukusetshenziswa kwe-oksijini ensikeni senhliziyo, okungaba yingozi kakhulu kwe-AMI. Isizathu sesibili esivame ukunikezwa ukuthi i-atropine ayithinti ama-block blocks ephelele.
Kodwa-ke noma yiziphi izizathu ezithinta ukuhlola, noma kunjalo. Ayikho ubufakazi obushicilelwe ukuthi i-atropine, uma isetshenziselwa i-bradycardia ephawulekayo, ibuhlungu ukudluliswa kwe-myocardial infarction. Futhi, i-AVB ephelele yisimo esingavamile kakhulu esibonakala kalula nge-ECG. Ngisho noma i-AVB yesithathu yesithathu ingekho emthethweni noma ingacacile futhi i-atropine ilawulwa, ngokubi nakakhulu ngeke kube khona ushintsho enqenqenqenqenqenqenqenqenqenqwenqenqenqenqwenqwenqwenqwenqwenqwenqwenqwenqwenhliziyo, nakakhulu, kube khona ukuthuthukiswa.
Ukwehluleka ukusebenzisa i-atropine kwenziwa kubi kakhulu ngokukholelwa ukuthi ukuhamba nge-transcutaneous kulula ukuyisebenzisa esimweni sokulungiselela kwangaphambili futhi ukuthi kuyindlela yokwelashwa enobungozi nemiphumela emibi embalwa. Ngokwenza njalo, i-TCP ivame ukusetshenziswa ngendlela engalungile yizimo eziphuthumayo kanye neziguli ezingenayo imiphumela emihle ngisho nangabe isimo se-paramedic sikholelwa ukuthi i-pacemaker "iyabamba" (okuholela ekuqotheni kwe-ventricular kanye ne-pulse yonke imfucu yokuhamba). Ukusebenzisa i-TCP iyikhono eliphakeme kakhulu lekhwalithi eliphansi, elinamandla okusebenza okungalungile.
Ngaphansi: Imithi Ngaphambi kuka-Edison
Emkhakheni osindayo wezinsizakalo zezokwelapha eziphuthumayo, le mpikiswano ivame ukumbozwa njengokuthi usebenzise u-Edison (ugesi) noma imithi (atropine) ekwelapheni i-bradycardia engaqiniseki. Ingxoxo efanayo-ngaphandle kwengxabano ekhona-ikhona ukuthi ingasebenzisa u-Edison noma umuthi we-tachycardia engaqiniseki.
Into engcono ukuyikhumbula ukulandela i-American Heart Association futhi unike i-atropine ukuzama. Ubufakazi bubonisa ukuthi ngeke bulimaze isiguli. Uma i-atropine izosebenza, ivame ukusebenza eminithini yokuphatha. Uma, amanani amabili nemizuzu emibili kamuva, i-atropine ayizange iqambe, ngakho sekuyisikhathi sokuqhubekela phambili ku-TCP.
> Imithombo:
> Brady WJ Jr, uHarrigan RA. Ukuxilongwa nokuphathwa kwe-bradycardia kanye ne-atrioventricular block ehlobene ne-ischemia ephawulekayo ye-coronary ischemia. Emerg Med Clin North Am . 2001 Meyi; 19 (2): 371-84, xi-xii. Buyekeza.
> Brady WJ, Swart G, DeBehnke DJ, Ma OJ, Aufderheide TP. Ukuphumelela kwe-atropine ekwelapheni i-bradycardia engaqinisekisiwe ye-hemodynamically kanye ne-atrioventricular block: izingqinamba ze-prehospital kanye nezimo eziphuthumayo. Ukuvuselelwa . 1999 Jun; 41 (1): 47-55.
> UMorrison LJ, Long J, Vermeulen M, Schwartz B, Sawadsky B, Frank J, Cameron B, Burgess R, Shield J, Bagley P, Mausz V, Brewer JE, Dorian P. Isivivinyo sokulawulwa kwamandla okulawulwa ngokungahleliwe ngokuqhathanisa ukuphepha nokusebenza I-prehospital pacing ngokuhambisana nokwelashwa okuvamile: 'PrePACE'. Ukuvuselelwa . 2008 Mar; 76 (3): 341-9. Epub 2007 Oct 22.
> USherbino J, uVerbeek PR, iMacDonald RD, iSawadsky BV, uMcDonald AC, uMorrison LJ. I-Prehospital inhliziyo ye-transcutaneous yokuhamba nge-bradycardia ephawulekayo noma ukuboshwa kwe-bradyasystolic inhliziyo: ukubuyekezwa okuhlelekile. Ukuvuselelwa . 2006 Aug; 70 (2): 193-200. Epub 2006 Juni 30. Buyekeza.
> Swart G, Brady WJ Jr, DeBehnke DJ, MA OJ, Aufderheide TP. I-infarction e-myocardial eyinkimbinkimbi icindezelekile yi-bradyarrhythmia engazinzile ye-hemodynamically: ukwelashwa kwe-prehospital no-ED nge-atropine. Am J Emerg Med . 1999 Nov; 17 (7): 647-52.