Ukuhamba nge-Transcutaneous kunzima kunokuba kubonakale.
Enye yezimangalo ezinkulu kakhulu ekwelapheni okuphuthumayo kwe- bradycardia ephawulekayo yi-propensity yokudumala ukuphathwa kwe-atropine futhi igxume ngqo ku-pacing yangaphandle. Kuyinto ejwayelekile phakathi kwezimo eziphuthumayo . Ukucabanga ukuthi i-atropine idala ukwanda okwe-oksijeni okunjalo ukuthi kubeka ukucindezeleka okungadingekile emzimbeni wenhliziyo futhi kungaholela ekutheni i- myocardial infarction .
Esikhundleni salokho, ukucabanga kuhamba, sebenzisa i-transcutaneous pacing ukwandisa isilinganiso senhliziyo ngaphandle kwemiphumela emibi ye-atropine.
Ngaphandle kokungena engxoxweni mayelana nokuthi lokho kuyisinqumo esifanele noma cha, kubalulekile ukuqaphela izingibe zokusebenzisa ngaphandle kwe-transcutaneous pacing. Kukude nokuhlukana. Kuyinto inqubo ephezulu-acuity, low-frequency inqubo engaphezulu kwesabelo sayo sokudideka esimweni esiphuthumayo. Ukuze uhambisane kahle nesiguli esivela ku-bradycardia ephawulekayo, umuntu kufanele aqiniseke ukuthi uyaqonda ngokugcwele imishini kanye nokusetshenziswa komtholampilo we-pacemaker yangaphandle ye-transcutaneous.
Umlando we-Pacing
Okokuqala, abahamba nge-pacemakers bebelokhu bekhona nxa nje inhliziyo yenhliziyo iseduze. Kuza nama- pacemaker awo angokwemvelo-futhi , zonke izinsizwa ze-cardiac cell zingakwazi ukufeza le ndima uma kunesidingo-kodwa ukusetshenziswa kukagesi okubangela ukuvinjelwa kwenhliziyo kuye kwaba khona kusukela ngasekupheleni kuka-1700s, nakuba kungama-frogs.
Izikhukhula zezokwelapha zithinta isitholampilo phakathi neminyaka ye-1900 futhi sezilokhu zithola ezincane futhi zihlakaniphile kusukela ngaleso sikhathi. Kukhona ama- pacemakers asetshenziselwa ukusetshenziselwa iziguli ezine-arrhythmias ezingapheli zengqondo. Ukusetshenziswa kwama-pacemakers wangaphandle okusebenzisa ama-electrode afakwe emaceleni okunamathisela asetshenzisiwe naphandle esibhedlela kusukela ngo-1985.
Umshini
Kunezinhlobo eziningana namamodeli ama-pacemakers zangaphandle, kodwa bonke balandela umklamo ofanayo oyisisekelo. Umlindi wezinhliziyo okwazi okungenani i- electrocardiogram ( Basic) eqhubekayo, eqhubekayo, ebonakalayo eyodwa (ECG) ihlanganiswe ne-pacemaker eza ne-electrodes amabili. Ama-electrode avame ukungena ekusetshenzisweni okukodwa, amaphuzu okunamathisela ngaphambili. Ezinhlobonhlobo eziningi zanamuhla, ingxenye ye-pacemaker kanye nama-pads kabili njenge- defibrillator .
Iningi lalawo liza nephrinta ukurekhoda isigqi se-ECG sesiguli kanye nanoma yikuphi ukuzama ukuhamba noma ukuyibeka phansi. Amadivaysi amaningi angakwazi ukuqapha okuphawulekayo, njengokungapheli komfutho wegazi (NIBP), i- pulse oximetry , i-end-tidal capnography, njll Kunamanye amaqhinga esingakwenza ngokusebenzisa lezi ezinye izibonakaliso ezibalulekile ukusiza ukukhomba ukuhamba kahle. Okuningi okunye kamuva.
Ama-pacemaker anesigqebhezana anokuguquguquka okubili umnakekeli okufanele alawule: amandla okugesi kagesi kanye nesilinganiso semisindo ngomzuzu. Ukukala kuhle kakhulu okuchazayo. Lokhu kuyindlela yokwelashwa kwe-bradycardia ephawulekayo, ngakho-ke izinga lokulinganisa kufanele libe ngesivinini kune-arrhythmia yesiguli. Ngokujwayelekile, sidubula inombolo engaba ngu-80 ngomzuzu. Lokhu kuyahluka ngendawo, ngakho-ke qiniseka ukuthi uhlole umqondisi wakho wezezokwelapha ukuze uthole isiqondiso mayelana nesilinganiso esifanele sokuhamba phambili.
Amandla okugulisa amandla kagesi alinganiselwa ku-milliamperes (ama- milliamp for those in know). Kuthatha isilinganiso esincane samandla ukuphulula umlenze wesiguli ukuze udale ukuchotshozwa. Leyo mingcele ihlukile kuzo zonke iziguli futhi iphutha elivame kakhulu ekusebenziseni i-pacemaker ye-transcutaneous ehluleka ukugoqa amandla phezulu ngokwanele. Ukwenza izinto zibe nzima nakakhulu, kunemibundu ehlukene yokuhamba kwenhliziyo nenhliziyo yangempela, okusho ukuthi kungenzeka ukuthi i-ECG ibonakale sengathi i-pacemaker isebenza, kodwa imisipha yenhliziyo ayiphenduli ngempela.
Ukuhlanganisa idivayisi
Imodeli ngayinye ihlukile futhi kubaluleke kakhulu ukuthi umnakekeli ngamunye uzinike isikhathi sokuzijwayeza ngedivayisi azoyisebenzisa ensimini. Lokho okushiwo, izinqubo zifana kakhulu kuwo wonke ama-brand.
Ama-per pads kufanele afakwe kanye nama-electrode wokuqapha. Lapho ama-pacemakers e-transcutaneous nama-defibrillator ayehlukene, ama-pacer pads ayefanele akhishwe endleleni ye-defibrillator paddles uma ukuboshwa kwe-cardiac, ukukhathazeka okusemthethweni lapho udlala nge-system's conduction system. Manje ukuthi ama-pacemakers amaningi ashintshaniswa kabili njengama-defibrillators, ama-patches ngokuvamile afakwa okufanayo kokubili kokusetshenziswa. Futhi, landela izikhombisi-ndlela zomkhiqizi.
Isiguli kufanele sixhunywe kumlindo wezinhliziyo. Lokhu kubalulekile. Kulabo abajwayele indlela yokusebenza kakhulu ye-cardiac defibrillators esebenzayo, kuyiphutha elivamile ukucabanga ukuthi i-pacemaker electrodes (i-pacer pads) izokwazi futhi ukuqapha isigqi senhliziyo yesiguli. Yile ndlela abasebenza ngayo i-defibrillators, kodwa ama-defibrillators akhipha ukwethuka okukodwa, bese ubuyela emuva ekuqapheliseni isigqi. I-pacemaker ye-transcutaneous iqhubeka ihambisa impulses futhi ayinayo ngempela ithuba lokuqapha noma yini ngokusebenzisa amapadpad we-pacer.
Qinisekisa ukuthi i-monitor ye-ECG isethelwe ukuhola ukuhola ngokusebenzisa ama-electrode wokuqapha hhayi nge-pip pads. Ngenxa yokuthi i-defibrillator / pacemaker yenhlanganisela isebenzisa ama-patches afanayo kokubili ukwelashwa kagesi, kulula kakhulu ukusetha lokhu ngokungalungile. Uma usetshenziselwe ukufundwa ngokusebenzisa amaphuzu, amadivayisi amaningi ngeke asebenze lapho ukuzama ukuzamazama.
Phakamisa isiguli
Uma idivayisi isetshenziswa ngendlela efanele futhi isebenze, bheka ama-spikes we-pacer ekulandeleni kwe-ECG. Uma sesinakho, yisikhathi sokuhamba nesiguli:
- Hlela izinga kuma-beats oyifunayo ngomzuzu. Amadivayisi amaningi ahluleka ukukala phakathi kuka 70-80, kodwa izinga lilungiswa ngumnakekeli.
- Ukwandisa izinga lamandla kuze kube yilapho impuls iqala inkimbinkimbi ye-QRS, eyaziwa ngokuthi iyabanjwa . Umqapha we-ECG uzobonisa i-spike eqinile ngayinye futhi lapho i-spike ngayinye ilandelwa ngokushesha nge-complex QRS, ukuthunjwa kufinyelelwa (bheka isithombe ngenhla).
- Zizwa ngomfutho we-radial. Kumelwe kube nokushayela kwe- radial kwenkimbinkimbi ngayinye ye-QRS, noma le nto ayikusizi. Uma isiguli singenzi umonakalo we-radial pulse, ukucindezelwa kwegazi kusekuphansi kakhulu ukusimamisa.
- Bump up the energy 10 milliamps esedlule iphuzu lokuthunjwa. Lokhu kunciphisa amathuba okulahlekelwa ukubanjwa esikhathini esizayo.
Uma i-pacemaker isebenza futhi isimo sesiguli siyathuthuka, cabanga nge-sedation. Le nto iyabuhlungu njengengqondo. Kuzobe kuningi lwe-squelette muscle contraction of the wall esifubeni ngesisindo ngasinye. Isiguli singakwazi ukubekezelela imizuzu embalwa, kodwa hhayi isikhathi eside. Uma lokhu kusetshenziselwa ensimini, isiguli sisadingeka sithunyelwe esibhedlela ngaphambi kokunye okungahlaselwa (futhi okubuhlungu kakhulu) kungashintsha i-pacemaker ye-transcutaneous.
Izibhamu ze-Transcutaneous Pacing
Amagama amathathu: Thatha! Thatha! Thatha! Iphutha elivame kakhulu engiliboné ohlelweni lokusebenza lwangaphandle lwe-transcutaneous pacemaker ukuhluleka ukuthatha. Isizathu esikhulu kakhulu ukungafundi kahle i-ECG nokukholelwa ukuthi ukuthunjwa kwenzekile.
Uma ama-spikes e-pacer ebonakala eshaya ngqo ngaphambi kokuba i-QRS idideke, kungabonakala ukuthi idivayisi iyasiza (bona isithombe esingenhla). Kunezinkomba ezimbalwa zokusiza ukugwema leli phutha:
- Qhathanisa isigqi esilandelayo nalokho umnakekeli akholelwa ukuthi yisigqi "sokuhamba". Ukuthunjwa kweqiniso kuzobonisa ukwakheka okuhlukile kwenkimbinkimbi ye-QRS ngoba iphuzu eligxile le-impulse livela endaweni ehlukile (i-giant patch esifubeni esinkulu njengenhliziyo esikhundleni salokho ukukhomba indawo endaweni yokuziphatha komzimba). Uma ukubunjwa kwe-QRS kungashintshi, ukuthunjwa akunakwenzeka kakhulu.
- Uma i-pacer ikhipha ngaphezulu kwezingqinamba ze-QRS, asizange sithole ukuthunyelwa okwamanje. Emfanekisweni ngenhla, kunezinhloli ezintathu, kodwa kuphela ezimbili ze-QRS eziyinkimbinkimbi engxenyeni yomhlu ngaphandle kokuthunjwa.
- Uma ama-spikes e-pacer asezindaweni ezihlukahlukene ukusuka ku-QRS complexes, akukho ukuthunjwa.
- Uma amandla angaphansi kwezigidi ezingama-40 zesiguli esingumdala, akunakwenzeka ukuthi ukuthunjwa kungenzeka. Iningi leziguli zinomngcele ngaphezu kwalesi sizinga. Vula ithokheni. Amadivayisi amaningi akhulisa amandla ezinkolweni ezinhlanu noma eziyishumi-milliamp.
I-QRS ye-spike ngayinye; eureka! Sithathiwe!
Akusilo msinya kangaka ... sine-pulse naleyo? Ukwakheka kagesi kubonakala ku-ECG, kodwa ukuthunjwa ngokomzimba kuhlolwa ngezibonakaliso ezibalulekile. Iphutha lesibini elivame kakhulu engibona ukuhluleka ukuqinisekisa ukuthunjwa komzimba. Funa lezi zimpawu:
- I-pulsal radial ye-QRS ngayinye yikhombisi engcono kakhulu. Lokhu kumtshela umnakekeli ukuthi ukuvinjelwa komzimba ngamunye kufezekisa ukucindezeleka kwegazi okungenani 80-90 mmHg.
- I-hack for iziguli ezinzima ukubuka isimo se-pulse oximetry waveform. Uma ngabe isimo se-wave sifana nesilinganiso se-QRS- okumele sibe isilinganiso esisedivayisini, noma asibambe ngempela -ke siyazi ukuthi inhliziyo iyavumelana ne-QRS ngayinye. Thatha umfutho wegazi ukuze ubone ukuthi ingcindezi isimeme yini. Uma iphansi, i-bolus yomthamo ingasiza ukulungisa inkinga. Qiniseka ukubonisana nesiqondiso sezokwelapha.
Gwema ukusebenzisa i-carotid pulse njengombonakaliso wokuthunjwa ngokomzimba. Ama-muscle contraction contractions eze nge-transcutaneous pacing enza kube nzima ukuthola izimpucu ze-carotid. Zilapho, kodwa mhlawumbe hhayi ngokushesha njengoba i-pacer, okuyisona sizathu sokuhlola ukushayela endaweni yokuqala.
Okokugcina, phatha ubuhlungu. Kukhona okungenani isibonelo esisodwa sesiguli esisekela ukushisa kusuka kuma-pacer pads kanye neziguli cishe emhlabeni wonke ukukhononda ngobuhlungu obuvela emzimbeni we-muscle stimulation nge-transcutaneous pacing.
> Imithombo:
> Bocka, J. (1989). Ama-pacemakers wangaphandle. Annals Of Medicine Emergency , 18 (12), 1280-1286. i-doi: 10.1016 / s0196-0644 (89) 80259-8
> Muschart, X. (2014). Ukushisa ukuba kuphile: ukuxilongwa kokugqugquzela inhliziyo kwe-transcutaneous. Ukunakekelwa Okubalulekile , 18 (6). i-doi: 10.1186 / s13054-014-0622-x