Indlela yokuPhatha iWide and Narrow Tarsydia eMdeni
I-Tachycardia (ixabiso lentliziyo ekhawulezayo) ngenye yezinto ezinzima kakhulu ukunyanga ngenxa yokuba kuninzi kunye neemeko ezininzi. Eli nqaku lijolise kunyango lwe-tachycardia engaxhamliyo yintliziyo kwimeko yongxamiseko ngabaqeqeshi be-prehospital.
Ngokuqhelekileyo, ukhetho lwezonyango kwintsimi luncinci ludityaniswa neSebe lexakeka.
Ngezakhono ezifanelekileyo zokuvavanya, nangona kunjalo, uninzi lwama-paramedics lunakho konke okufunekayo ukuzinzisa izigulane kwaye zibenokufumana unyango oluchanekileyo esibhedlele.
Iipulse okanye Akukho Pulses
Eli nqaku lichaza ngqo kwi-tachycardia kwizigulane ezine-pulse. Izigulane ezingenazo iimpompo ezingenakunyaka okanye ngaphandle kwempawu yokuhambisa (ukuphefumula, ukunyakaza okufanelekileyo) kufuneka kuthathelwe ingqalelo ekubanjweni kwenhliziyo kunye nokuphathwa, ngokuqala ngeCPR .
Ukukhawuleza Kukukhawuleza Kangakanani?
I-Tachycardia ngokuqhelekileyo ichazwa njengento nxamnye ne-100 beats ngomzuzu (bpm) xa uphumla, kodwa akusiyo yonke i-tachycardias ephawulekayo kwiklinikhi. Ngaphandle koqwalaselo lwe-ECG, umgaqo omhle wesithupha ufanele ukhathazeke ukuba isigulane sinomyinge we-pulse ngaphezu kwe-140 bpm, okanye ukuba ukutshitshiswa kwe-radial akungaqhelekanga, kubuthathaka okanye kungabikho.
Kukho izizathu ezininzi zezinga lentliziyo elikhawulezayo elingahambelani nentliziyo engasebenzi. Ngamaqondo entliziyo phakathi kwe-100-140 bpm, amathuba ayenayo inxulumene nenhliziyo.
Ngokukhawuleza kunama-140 bpm, kubalulekile ukuqwalasela izizathu zesifo kunye neemeko ezingekho komzimba. Ngelishwa, oku akuwona umthetho okhuni kunye wokukhawuleza, ngoko ungawunaki iimbangela zomzimba ngenxa yokuba izinga lentliziyo lincinci.
Ukubaluleka kwintsholongwane yenani lentliziyo litshintsha kuxhomekeke kuhlobo lwe-tachycardia.
Ububanzi beli nqaku abukwazi ukugubungela ingcaciso ye-ECG , kodwa amandla okunyamekela ukutolika iinqununu ze-ECG zicingwa. Ngezantsi, siza kuxubusha ingxube-nxu lumene ne-tachycardia ephangaleleyo, kodwa ngoku, yazi nje ukuba i-tachycardia enobubanzi ibuhlungu xa ihamba ngaphezu kwe-140 bpm. I-tachycardia encinci ingancinci, ingaba ihamba ngokukhawuleza, kodwa yicinge malunga nokuba i-160 bpm.
Unstable okanye Stable Tachycardia
Ukuchonga ukuzinza kweekliniki kuxhomekeke kwi-tachycardia. Abanye bathi iimpawu ezinxulumene nenhliziyo (ubuhlungu besifuba, ukuphefumula okufutshane, njl.) Zizibonakaliso ezibalulekileyo ze-tachycardia engaqinisekanga. Oku kunyanisekileyo kwisimo esibhedlele kunasendle, ngenxa yeendlela ezahlukeneyo zokonyango.
Ngaphandle kwesibhedlele, gxininisa ikhono lentliziyo yokuqhubeka nokupompa igazi ngeengcinezelo ezaneleyo ukuze ufike kwingqondo. Oku kuthiwa ukuzinza kwe-hemodynamic . I-tachycardia engaqinisekanga nge-Hemodynamini ayinikeli amagumbi entliziyo kwanele ixesha lokuzalisa igazi phakathi kokuphambana.
Isigulane esingenayo imbonakalo ecacileyo yokungazinzi kwegazi ( uxinzelelo lwegazi oluphantsi , ukutshintsha okanye ukutshatyalaliswa kwamandla omzimba, utshintsho lwangaphambili , njl njl.) Mhlawumbi luya kuthunyelwa esibhedlele ngaphandle kokuzama ukuphatha i-tachycardia.
Ngaphezu koko, izigulane ezingenayo impawu yokungazinzi kwe-hemodynamic ziqhele ukuphathwa ngokukhuselekileyo kwezinye iimpawu ezinxulumene nenhliziyo.
Izigulane ezingaqinisekiyo ze-tachycardia ngokukhawuleza kunama-140-160 bpm zinokuzuza ekubeni neqondo lentliziyo lilungiswe ngokuqhelekileyo. Zizo ezo zigulane esizijolise kulo nqaku.
Nqamle okanye iWide
I-tachycardia ephawulekayo emzimbeni iwela kwiindidi ezibini ezibalulekileyo: ezincinci okanye ezibanzi. Oku kubhekisela kwiinkcukacha zeQRS kwi-ECG yokulandelela. Xa i-QRS imncinci kunama-millisecond angama-120 (amabhokisi amancinci amathathu kumgca we-ECG) ibonisa ukuba i- heart's impulse yamandla ivela kwi-atria kwaye yehla nge-nrioventricular (AV) node kwiimpahla ze-HIS kunye ne-Purkinje fibers, zifumaneka kwii-ventricles.
Le yindlela eqhelekileyo yokuqhubela phambili, kwaye indlela yodwa i-QRS ingancinci ukuba i-imprusi ihamba ngokufanelekileyo. Ngenxa yokuba umgudu kufuneka uqale ngaphaya kwee-ventricle kwi-tachycardia encomekayo, iyaziwa ngokuba yi-tachycardia yesibini (SVT).
I-QRS eyinkimbinkimbi ebanzi ngaphezu kwe-120 milisecond isoloko ihambelana ne-ventricular tachycardia (VT) -yatsho umtsalane ovela kwii-ventricles, ngaphantsi kwesodi ye-atrioventricular node. Akunjalo ngaso sonke isikhathi, nangona kunjalo. Ukuba ilula, kufuneka ibe yi-SVT. Ukuba ibubanzi, ingaba yi-VT okanye ingaba isisiseko esivela ngaphezu kwee-ventricle asiqhutyelwa kwi-AV node. Iphuma kwikhosi kwaye ilandele indlela yayo, eyenza ityeke. Oku kudla ngokubhekwa njengebhokisi lentliziyo, ibloko le-AV, okanye ibloko legatsha, kuxhomekeke kwindawo apho ibhloko livela khona.
Ukutsala impela kwaye ukuchonga i-tachycardia idinga i-ECG ye-12 ekhokelela ekuboneni i-ECG. Kwezinye izicwangciso ngaphandle kwesibhedlele, i-ECG ekhokelayo ye-12 ayikho. Esinye isizathu sokuba singaphathi i-tachycardia ngaphandle kokuba kungenakunqandwa kwegazi ngenxa yendlela yokunyanga i-tachycardia eninzi njenge-tachycardia ye-ventric xa kungenjalo. Ukuthatha elo thuba xa isigulane sisengozini enkulu yokubanjwa komzimba kuyamkeleka. Ukuphatha ngokugqithisileyo i-tachycardia enobubanzi xa isigulane sisigxininxu se-hemodynamically asifanelekanga ingozi.
Ummandla wentliziyo apho igalelo elivela khona liyaziwa ngokuba yi-pacemaker kuba nayiphi na indawo eyenza igalelo libuye libeke isantya seentliziyo. I-node ye sinus ikhona kwi-atrium ekhohlo. Kuyi-pacemaker evamile. I-node yesusus isebenza ngokuphakathi kwe-60-100 bpm. Njengoko sihamba phantsi entliziyweni, amaxabiso athile ahamba ngokukhawuleza. Imiphumo evela kwi-node ye-AV ihamba malunga ne-40-60 bpm. Kwi-ventricles, i-20-40 bpm. Yingakho i-tachycardia ebanzi iyinkqantosi ebalulekileyo kwizinga elincinci.
Ukuphathwa kweTashycardia ye-Wide-Complex
Ngeenjongo zonyango oluphuthumayo lwesigulane esingenasigxina esisemgangathweni, qwalasela zonke iziganeko ze-tachycardia ezinokubanzi njenge-VT. Ukuba isigulane sibonisa iimpawu zengozi yangoku (iscinezelo segazi se-systolic ngaphantsi kwe-90 mm / Hg, ukulahlekelwa kwengqondo, ukudideka, okanye ukukwazi ukufumana ukutshatyalaliswa kwe-carotid), i-cardioversion ehambelanayo iboniswe. Ixabiso eliphakanyisiweyo lidla ngokuba ngama-50 Joules.
Ukuba naliphi na ixesha isigulane silahlekelwa ingqondo kwaye siyeka ukuphefumula, okanye akunakwenzeka ukufumana ukutshatyalaliswa kwe-carotid, ukuchithwa kwe-defibrillation (ukungatshatshatshintshiswanga okungahambelaniyo) kuboniswa kwi-200 Joules ukuqala. Emva kokufakela i-defibrillation (okanye ukuba i-defibrillator ayitholakali) qalisa i-CPR, ngokuqala ngokuchotshozwa kwesifuba.
Ukuphatha iTachycardia
I-tachycardias edibeneyo yinkimbinkimbi yinkimbinkimbi kunokuba i-arrhythmias edibeneyo. Kule meko, ukulungelelaniswa kwe-arrhythmia kubalulekile. Kuba i-arrhythmias esincinci esingazinziyo (ingcinezelo yegazi ye-systolic engaphantsi kwe-90 mm / Hg, ukulahleka kwengqondo, ukudideka, okanye ukukwazi ukufumana i-carotid pulse), i-cardioversion echanekileyo iboniswe kwi-100 Joules.
Izigulane ezingenawo uxinzelelo lwegazi oluphantsi-kodwa zinezinye iimpawu (utywala, iintliziyo zepiliti) -nokuphathwa ngamanzi okanye iziyobisi, ngokuyinhloko i-adenosine. I-Fluid yinqanaba lokuqala lokuqala le-tachycardia xa imeko yokudalwa kwamanzi iyona nto.
I-Adenosine kufuneka inikezwe ngokukhawuleza kwe-IV. Inqanaba lokuqala li-6 mg, kodwa ukuba oko kungasebenzi, i-dose yokulandelelana ye-12 mg ingazama. I-Adenosine isebenza ngokufanayo kwi-cardioversion yamandla kagesi, ekhokelela ekugqibeleni i-heart muscle kunye nokuvumela i-sinus node ukuba isetyenziswe kwakhona.
Ukuba i-adenosine ayisebenzi, into enokwenzeka ukuba i-tachycardia ayinxaxha, ezinye iindidi ezimbini zamachiza zinokuzama. I-calcium channel blockers iyancipha ukunyakaza kwekhalsiyamu ngaphaya kweentliziyo ze-muscle cell membranes. Yenza ukuba umjikelezo wonke uphuze. Iibet blockers zithintela indlela i-epinephrine isebenza ngayo kwi-heart muscle.
Ukwelapha i-tachycardia encomekayo encomekayo kwintsimi akufanele yenziwe ngaphandle kwemimiselo emileyo okanye ukubonisana ngongcali ngokusebenzisa ulawulo lwezonyango lwe-intanethi kunye nomlawuli ochaphazelekayo wezonyango.
> Imithombo:
> Abarbanell NR, Marcotte MA, Schaible BA, Aldinger GE. Ukuphathwa kwe-Prehospital ye-fibrillation ye-atrial ngokukhawuleza: iingcebiso malunga neenkqubo zonyango. NguJim Emerg Med . 2001 Jan; 19 (1): 6-9. i-doi: 10.1053 / ajem.2001.18124
> Garner, JB., & M Miller, J. (2013). I-Complex Wide Compact Tachycardia - i-Ventricular Tachycardia okanye i-Tachycardia engekho eVetywayo, Ehlalayo Ngombuzo. I-Arrhythmia & Electrophysiology Review , 2 (1), 23-29. http://doi.org/10.15420/aer.2013.2.1.23
Page, R., Joglar, J., Caldwell, M., Calkins, H., Conti, J., & Deal, B. et al. (2015). Isikhokelo se-ACC / i-AHA / HRS yoLawulo lwabaguli abadala abaneTrasydia. Ukuhamba , 133 (14), e506-e574. i-doi: 10.1161 / i-cir.0000000000000311