'D' rau cov tuag, 'C' rau cardioversion! - Defibrillation thiab fibrillation rau cov neeg mob cov menyuam yaus
Defibrillation yog ib qho kev xyaum cawm txoj sia. Tab sis, koj puas tau xav tias kev defibrillation yog kev xyaum rau cov neeg tuag?
Nws zoo li tsis muaj tseeb, txawm li cas los xij, nws yog li ntawd! Qhov Tsis Muag Khoom: koj defibrillate ib tug neeg uas raug tuag lawm. Tsis muaj pa, tsis muaj mem tes… lub neej yuav ya mus. Yog li, raws li Pedi-Ed-Trics cov lus ceeb toom, lub website tau tsim los ntawm tus kws ntsuam mob kws kho mob Scott DeBoer, nyob rau hauv nws Peds Pearls:Defibrillation pib nrog "D" thiab qhov ntawd rau cov neeg tuag ... tsis yog peb nyiam qhov xwm txheej. ” (kev txuas tom kawg ntawm tsab xov xwm).
'C' los ua ntej 'D': kev xyaum ua kom tsis txhob muaj zog
Tshwj xeeb, qhov teeb meem uas Dr DeBoer tseem ceeb yog tias peb tus neeg mob yuav xav tau lwm xyaum ua ntej lub defibrillation.
Dr DeBoer tshaj tawm tias nws yooj yim heev thaum koj tus neeg mob nyob hauv ventricular fibrillation (V-fib). Thiab thaum peb xav txog lub tshuab tshwj xeeb ntawd thiab siv hluav taws xob, peb yuav tsum nco ntsoov tias 'C', zoo li hauv cardioversion, los ua ntej Tus D nyob rau hauv cov niam ntawv Yog li, koj ua dab tsi yog tias koj tus neeg mob tsis nyob hauv V-fib, tab sis yog nyob rau hauv supraventricular tachycardia (SVT) nrog tus nqi uas qhia meej meej nrawm dhau?
Yog tias lawv paub meej thiab muaj peev xwm hais tau tias, 'Thov tsis txhob muab cov paddles tso rau hauv kuv lub hauv siab,' tej zaum lawv tsis tas yuav muab cov paddles tso rau ntawm lawv lub hauv siab. Ua li ntawd, nws yuav zoo tsim nyog los xav txog lwm yam 'D' hauv peb cov lus txhais ... tshuaj (adenosine, diltiazem, thiab lwm yam). Thiab txawm hais tias koj tus neeg mob tsis ruaj khov, tab sis tseem nyob rau txhua qhov nco qab, cov tshuaj rau kev ua kom loog yuav tsum tau txais kev txiav txim siab ua ntej cardioversion. Kev tua hluav taws xob los ntawm lub hauv siab tiag tiag tsis yog qhov kev ua kom zoo nkauj!
'C' los ua ntej 'D': cardioversion
Lub ntsiab lus yog: yog tias ib tus neeg zoo li nyob rau hauv kev sib tsoo pem lub taub hau koj, tab sis tseem muaj sia nyob nrog mem tes thiab lub siab, synchronized cardioversion yog qhia.
Cardioversion pib nrog tus "C" thiab nws yog rau cov neeg mob uas yog "C" rashing. Yog tias koj tus neeg mob tsis tuag, tiam sis tsuas yog "ib nrab hnub tuag," lub zog rau kev mob plawv yog ib nrab ntawm qhov defib koob tshuaj (2j / kg) thiab uas txhais tau hais tias 1j / kg.
Defibrillation VS Cov Tshuaj? Raws li Dr DeBoer, qee kis ntawm kev mob plawv rau menyuam yaus, ib txwm tau siv cov koob tshuaj uas tsis tshua muaj qab los ntawm 0.25-0.5j / kg. Txawm li cas los xij, hauv ER, ib nrab koob tuag tus neeg yog qhov yooj yim dua kom nco qab.
Hauv tus menyuam tseem me, nws yog qhov txawv tias koj yuav tsis tuaj yeem hu nrog qhov "meej tseeb" rau ib qho twg defibrillation lossis cardioversionCov. Koj yuav poob ntawm cov lej ntawm lub hu. Yog tias kev xaiv hu yog 15j thiab 20j, tab sis koj xav tau 18j, mus rau loj (20j) lossis mus tsev! Nco ntsoov tias koj mus dhau es tsis nyob hauv qab.
Nws zoo li thim rov qab 'Nqe yog Txoj Cai' qhov uas koj xav tau kom ze tshaj plaws, tsis tas yuav mus hauv qab, tus nqi mis.
Kev xyaum ntawm cardioversion yog rau tus neeg mob uas tseem muaj qhov ua kom zoo txaus thiab thaum twg koj xav kom hluav taws xob tuaj yeem nqa ntawm qhov chaw ntawm lub plawv mob kom tsis txhob poob siab rau hauv V-fib.
Nws tseem ceeb heev uas yuav tsum nco ntsoov ntaus tus 'Sync ' khawm ua ntej txhua qhov kev sib tw cardioversion los xyuas kom meej tias cardioversion, tsis yog defibrillation, yog ua li cas. Koj tus neeg mob tau muaj mem tes, atherosclerosis, thiab QRS txoj; nws tsuas yog sai tiag tiag.
Defibrillating SVT tuaj yeem cuam tshuam txog QRS ntau ceg thiab ua rau muaj kev txhom tag nrho. Qhov no yuav saib qhov phem tiag tiag (thiab yog cov ntaub ntawv ntau dhau).