Atropine okanye iPacing?
Kwiinkqubo ezininzi zokuncedisa unyango lwe-emergency prehospital e-United States, kukho iindlela ezimbini zokwenza unyango oluchanekileyo lwe-bradycardia ebonakalayo efumanekayo kwiimpawu zengqondo: i-transcutaneous pacing (TCP) okanye ukuphathwa kwe-atropine sulfate. Kwiinkqubo ezininzi, kukho impikiswano malunga nendlela yokwenza imodyulo yonyango ithandwa. Lo ngumzekelo omhle wendlela unyango olusiseko lobungqina obunikela phakathi kwonyango kwezinye iimeko ezisekelwe kwinqanaba leenkcukacha ezakhayo kwicala elinye.
Symptomatic Bradycardia
I-Bradycardia (izinga lentliziyo elincinci) lichazwe ngokuqhelekileyo njengezinga lokutshiza kwe-50 beats ngomzuzu (BPM). Siyaxhalabisa xa isigulane esine-bradycardia sinempawu ezinokubangelwa lizinga lokutsala-okanye-isigulane sinempawu ebangelwa yinto enye ebangela i bradycardia. Ngandlela-thile, isigulane sitsho ukuba sibe ne-bradycardia ephawulekayo. Iimpawu ezihamba nebhadycardia kwaye zibhekwa njengento ebalulekileyo ziquka:
- I-Hypotension (uxinzelelo lwegazi oluphantsi)
- Iintlungu zesifuba
- Ukuqhawukelwa ngumphefumlo
- Utywala
- Syncope
- Ukudideka
Abanye abantu, ngokukodwa abadlali abanokunyamezela, banokuphumla kweenqanaba zentliziyo eziphantsi kwe-BPM engama-50 kwaye ngelixa i-bradycardia yezobuchwepheshe, ivela ngaphandle kweempawu (ezingabonakaliyo).
Unstable okanye Stable Symptomatic Bradycardia
Ezi zimpawu zinokuhlulwa zibe ngamacandelo amabini: i-hemodynamically instable ngokumelene nokuzinza kwesigxina. I-bradycardias engaqinisekanga nge-Hemodynam ibhekiselele kulabo abakhokelela ekulahlekelweni kwe-perfusion kwaye ihamba kunye ne-hypotension okanye iimpawu ezibonisa ukungabikho kwengqondo yengqiqo (ukuxakeka, ukudibanisa, nokudideka).
Ngokuqhelekileyo, ezi zimpawu zibangelwa yi-bradycardia, ngoko ukulungisa i-bradycardia kunokusombulula iimpawu.
Intlungu yesifuba kunye nokuphefumula okuphefumlelweyo kungahamba kunye ne-bradycardia engazinziyo okanye i-bradycardia engaqinisekanga. Kwi-bradycardia engaqinisekanga, ukungabi nciphiso kungabangela intlungu yesifuba okanye i-dyspnea.
Kwi-Bradycardia enesimo, ezinye iimeko zentliziyo zingakhokelela kuzo zombini iimpawu kunye ne-bradycardia. Ezinye iinkqubo zeenkonzo zonyango zongxamisekileyo zijonga ukuba i-bradycardia isigxina ukuba iimpawu ezihambayo kuphela zibuhlungu besifuba okanye ukuphefumula okufutshane. Ezinye iinkqubo zijonga ukuba zizinzile. Iiparamedics kufuneka zilandele rhoqo iinkqubo zazo zendawo.
I-Atrioventricular Block (AVB)
Elinye i-bradycardia ingaba ngumphumo wokuqhutyelwa kobuhlwempu kwi- nrioventricular (AV) nodode , eguqulela umtsalane ukuxelela intliziyo ukuba ivumelane ne- atria (amacandelo aphezulu aphezulu) ukuya kuma- ventricles (amacandelo angaphantsi amabini). I-AV node inikeza ikhefu elincinci ekuqhutyweni kwempembelelo yokunika ixesha lokuba igazi lifakwe kwi-atria kwaye lizalise ngokupheleleyo i-ventricles. Emva kwekhefu, i-impulse ithunyelwa phantsi kwiNgxowa yaYakhe kwaye iya kwiifayili zePurkinje , apho ibangela ukuba i-ventricles ivumelane kwaye iqhube igazi kwimibhobho (i-pulse). Iibhloko zentliziyo (enye inqaku kwi-AVB) ziza kwiidridi ezintathu.
I-grade ye-AVB yokuqala iyakwandisa ikhefu lezendalo ukuba i-AV node ifanele idale. I-grade ye-AVB ayinayo eninzi, ukuba ikhona, ifuthe kwisantya senhliziyo. Isilinganiso kulo mzekelo sisasetyenziswe kwinqanaba le-sinus elisecaleni lokushiya.
Uninzi lweebhloko zokuqala zeerandi zibhekwa njengengozi.
Kukho ezimbini iindidi zesibini ze-AVB:
- Udidi lwesibini I-I (eyaziwa nangokuthi i- Wenckebach ) kukuphuculwa kokunyuka kokuqhutyelwa kwe-AV node kuze kube yimpembelelo ayifumananga ukusuka kwi-atria ukuya kuma-ventricles. Xa oko kwenzeka, ukuqhubela phambili kuqala ngokukhawuleza kwaye ngokukhawuleza kuphuculwa kwakhona. Ukuba iimpembelelo zehlile zenzeke rhoqo, zinganciphisa i-BPM ibe ngaphantsi kwama-50. Ngokomzekelo, ukuba isigulane senza uhlobo lwesibini se-AVB kwaye intlungu yesithathu ayiyi kwenzeka kodwa i-node ye-sinus ithumela iimpembelelo ezingama-70 ngomzuzu, Umyinge we-pulse umphumo uza kuba ngu-46 ngomzuzu.
- Udidi lwesibini Udidi lwesi II aluhambelani njengohlobo lwe-I, kodwa luya kuba nemiphumo ethile engenziwanga ngokusebenzisa i-AV node kunye nentsimbi ephosakeleyo. Iinqwelo eziphosiweyo zingenzeka kwipatheni okanye ngendlela engafanelekanga. Ngandlela-thile, ukulahlekelwa kwintsimbi eyaneleyo ngomzuzu kungabangela ukuba i-pulse ibe ngaphantsi kwe-BPM engama-50 kwaye iza kuthathwa njenge-bradycardia.
Isiqendu sesithathu i-AVB (ebizwa ngokuba yi- AVB epheleleyo okanye ibhloko epheleleyo yentliziyo ) iyenzeka xa iziphumo zingabonakali ukuba zenze i-AV node nonke. Kule meko, i-atria iya kutshitshiswa kwisigubhu se-node ye-sinus kodwa i-ventricles iya kwenza into yayo. Ama-ventricles, abangenayo i-pacemaker ngokukhawuleza ukuba bayilandele, baya kutshitshisa phakathi kwe-20-40 ye-BPM, ukutya okwaneleyo okwaneleyo ukubhekwa njenge-bradycardia. Nangona kuthiwa yi-block epheleleyo, ngexesha le-grade ye-AVB, kusenokwenzeka ukuba kusekho ukuqhuba okuthile nge-AV node. Ukuba ukuqhuba kuyanciphisa, ama-ventricles akayi kukulinda ukubona ukuba kukho into ezayo kwaye iya kwenza ngendlela efanayo ukuba ingaba ukuqhutyelwa komsebenzi kuvalwe ngokupheleleyo. Oku kubaluleke kakhulu xa kuxubusha ukuba okanye ungazami ukuhlaselwa i-atropine nantoni zonke kwiibhloko zentliziyo epheleleyo.
Ukwelashwa kweSymptomatic Bradycardia
I-bradycardia ethembekileyo ijongiswa ngokuphatha imbangela ebangela ibradycardia. Ukuba ihambelana ne-infyoction ye-myocardial infirction (AMI), ukunyanga i-AMI kufuneka ibe nefuthe elihle kwi-bradycardia. Ukuba ngaba unxulumene neyeza, ukususa okanye ukulungiswa kwamachiza kufuneka kuncede.
I bradycardia engaqinisekanga kufuneka iphathwe ngqo. I-bradycardia engaphendulwanga engaphendulwanga, ingabikho ukulawula-ukungabikho komngcipheko kungaphaya kwefuthe legazi legazi. Ukunciphisa okwehla kwintliziyo kungakhokelela ekubetheni, ukuxakeka okanye ukudideka.
Kukho iindlela ezintathu zokuphatha i-bradycardia engabonakaliyo yonyango: ukwandisa uxinzelelo lwegazi (kunye nokunyuswa kwamanzi) ngokunyusa umthamo womthamo kwisimo senhliziyo, ukubethelela imithwalo yegazi kwimizila yegazi, ukunyusa igazi kwizitho ezibalulekileyo okanye ukunyuka kwenhliziyo. Unonophelo oluninzi lwonyango lusebenzisa inhlanganisela yazo zonke ezintathu.
I-bolus ye-IV i-fluid engenayo ingakunceda ukwandisa uxinzelelo lwegazi kunye nokuphucula ukucoceka. Izidakamizwa ze-Sympathomimetic, ezifana ne-dopamine, zinokukunceda ukupheka igazi kude nommandla kwaye ugxininise ingcinezelo engundoqo, ngakumbi ingqondo nentliziyo. Iziyobisi ze-sympathomimetic zinokukunceda ukwandisa izinga lentliziyo, eyona yonyango oluthe ngqo. Kwiimeko ezininzi, ukunyuka okuphezulu kwintliziyo yeza kuvela kuphela okanye ukulawula i-atropine sulfate okanye i-pacing treatment.
Kwaye ngoku, ingxoxo.
Atropine okanye iTranscutaneous Pacing
I-American Heart Association ikhuthaza i-atropine sulfate njengowona wokuqala umgca wonyango kwi-bradycardia ephawulekayo, kungakhathaliseki ukuba kungenxa ye-AVB okanye ayikho. Le yilapho kubonakala khona iinjongo zeentliziyo ezipheleleyo. Ngokuqhelekileyo kucingelwa ukuba ngelixa i-atropine iphucula ukuqhuba nge-node ye-AV, ayiyi kwenza nantoni na inqobo yebhokisi yenhliziyo epheleleyo.
Ngokufanelekileyo malunga nexesha lokuhamba nge-transcutaneous pacing (ukukwazi ukusebenzisa okwesikhashana i-pacemaker yombane ngaphandle ngaphandle kokusebenzisa i-adhesive patches kwi-esifubeni kunye / okanye ngasemva) yafumaneka kumayeza asemgangathweni, ukusetyenziswa kwe-atropine kwaqala ukujongelwa. Kukho izizathu ezininzi. Isizathu esona siqhelo kukuba i-atropine yandisa i-oksijeni kwisistim senhliziyo, enokudambisa i-AMI. Isizathu sesibini esiqhelekileyo esinikezelwa kukuba i-atropine ayichaphazeli iibhloko zentliziyo epheleleyo.
Akukho kwezi zizathu zibambe ukuhlolisisa, nangona kunjalo. Akukho bubungqina obupapashiweyo bokuthi i-atropine, xa ilawulwa i-bradycardia yesifo, ibangela ukuba i-myocardial infarction ibuhlungu. Kwakhona, gcwalisa i-AVB yimeko engavumelekanga kakhulu elula ukuyiqonda nge-ECG. Nangona i-grade ye-AVB yesithathu engaziwayo okanye engacacile kwaye i-atropin ilawulwa, kwimeko embi ayiyi kuba yintshintsho kwizinga lentliziyo kwaye kulungile, kuya kuba nophuculo.
Ukungafuni ukusebenzisa i-atropine kwenziwa kakubi ngentsholongwane yokuba i-transcutaneous pacing ilula ukuyifaka kwi-prehospital setting kwaye ukuba yinkqubo yobunzima kunye neempembelelo ezimbalwa. Ngokwenza oko, i-TCP idla ngokusetyenziswa ngokungalunganga ngama-paramedics kunye nezigulane azikho iziphumo ezintle nangona i-paramedic ikholelwa ukuba i-pacemaker "iyifake" (kubangelwa ukuphambana kwamagama kunye ne-pulse kuyo yonke imiphumo ehamba phambili). Ukusebenzisa i-TCP yi-high-acuity, ubuchule obuphantsi bekhredithi kunye nekhono elikhulu lokwenza isicelo esifanelekileyo.
Ngaphantsi: Imithi phambi kweEdison
Kwiinkalo ezinzima zeenkonzo zonyango zongxamisekileyo, le mpikiswano ihlala idibene njengokuba usebenzisa i-Edison (ugesi) okanye iyeza (atropine) kunyango lwe-bradycardia engaqinisekanga. Ingxoxo efanayo-ngaphandle kwengxoxo-inxaxheba-ikhona nokuba usebenzisa i-Edison okanye iyeza kwi-tachycardia engaqinisekanga.
Into engcono ukuyikhumbula kukulandela i-American Heart Association kwaye unike i-atropine. Ubungqina bubonisa ukuba ayiyi kulimaza isigulane. Ukuba i-atropine iya kusebenza, ihlala isebenza kwiminithi yokuphatha. Ukuba, amayeza amabini kunye nemizuzu emibini kamva, i-atropine ayizange ikhohlise, ngoko lixesha lokuqhubela phambili kwi-TCP.
> Imithombo:
> UBrady WJ Jr, uHarrigan RA. Ukuxilongwa kunye nokulawulwa kwe-bradycardia kunye ne-atrioventricular block edibene ne-coronary ischemia. Emerg Med Clin North Am . 2001 ngoMeyi; 19 (2): 371-84, xi-xii. Uhlolo.
> Brady WJ, Swart G, DeBehnke DJ, Ma OJ, Aufderheide TP. Ukusebenza kwe-atropine kwonyango ye-bradycardia engaqinisekiyo kunye ne-atrioventricular block: iingqwalasela ze-prehospital kunye ne-urgence. Ukuvuselela . 1999 Juni; 41 (1): 47-55.
> Morrison 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. Uvavanyo olunokulawulwa ngokungaqhelekanga olulinganisa ukhuseleko kunye nokusebenza I-prehospital pacing ngokubhekiselele kwonyango oluqhelekileyo: 'UKUPHUMA'. Ukuvuselela . 2008 Mar; 76 (3): 341-9. Epub 2007 Oktobha 22.
> USherbino J, uVerbeek PR, iMacDonald RD, iSawadsky BV, iMcdonald AC, iMorrison LJ. I-Prehospital cardiac pacing ye-bradycardia okanye uphawu lokubanjwa kwenhliziyo: ukuhlolwa ngokufanelekileyo. Ukuvuselela . 2006 Aug; 70 (2): 193-200. Epub 2006 Juni 30. Ukuphonononga.
> Swart G, Brady WJ Jr, DeBehnke DJ, MA OJ, Aufderheide TP. I-infyoction ye-myocardial ehambelana ne-bradyarrhythmia engaqinisekiyo ye-hemodynamically: i-prehospital kunye ne-ED yonyango nge-atropine. NguJim Emerg Med . Ngo-1999 Nov; 17 (7): 647-52.