Yuav Ua Li Cas Zaws Carotid: 12 Kauj Ruam (nrog Duab)

Cov txheej txheem:

Yuav Ua Li Cas Zaws Carotid: 12 Kauj Ruam (nrog Duab)
Yuav Ua Li Cas Zaws Carotid: 12 Kauj Ruam (nrog Duab)

Video: Yuav Ua Li Cas Zaws Carotid: 12 Kauj Ruam (nrog Duab)

Video: Yuav Ua Li Cas Zaws Carotid: 12 Kauj Ruam (nrog Duab)
Video: Ntshaw nkauj hmoob nplog thiaj tau noj mij. 10/4/2017 2024, Lub peb hlis ntuj
Anonim

Kev zaws carotid, feem ntau hu ua carotid sinus massage lossis CSM, yog kev kho mob siv los ua kom lub plawv dhia nrawm nrawm txaus ntshai hauv cov neeg mob lossis kuaj qee yam kev mob plawv plawv. Cov kws kho mob tseem tuaj yeem siv CSM txhawm rau tshuaj xyuas tus neeg mob ntshav siab tsis sib xws, thiab lwm yam mob hnyav. Txhawm rau ua zaws carotid, koj yuav tsum zaws thaj chaw ntawm lub hauv paus ntawm tus neeg mob lub caj dab, qhov twg cov hlab ntsha carotid nkag mus rau hauv taub hau. Cov hlab ntsha carotid nqa ntshav mus rau lub hlwb, thiab ua tsis raug CSM tuaj yeem ua rau muaj kev phom sij loj rau kev noj qab haus huv, tshwj xeeb yog cov neeg laus. Tsis txhob ua qhov kev txav no ntawm koj tus kheej lossis lwm tus neeg tshwj tsis yog koj yog kws kho mob.

Cov kauj ruam

Ntu 1 ntawm 3: Npaj Tus Neeg Mob

Ua Carotid Massage Kauj Ruam 1
Ua Carotid Massage Kauj Ruam 1

Kauj Ruam 1. Hais kom tus neeg mob pw ntawm lawv nraub qaum

Rau lub hom phiaj kev nyab xeeb, CSM yuav tsum tau ua thawj lub taub hau (tiaj tus nraub qaum) thiab tom qab ntawd zaum nrog tsawg kawg 5 feeb so ntawm nruab nrab. Tom qab ua qhov kev tswj hwm ntawm ob txoj haujlwm no tus neeg mob yuav tsum raug saib xyuas li 10 feeb thaum nyob hauv qhov chaw supine. Yog tias koj tab tom ua CSM ntawm ib tus neeg lub tsev, hais kom tus neeg mob pw ntawm lub rooj zaum lossis txaj.

Nws yog ib qho tseem ceeb uas tus neeg mob pw, yog tias lawv tau ntsib teeb meem me me lossis tsis nco qab los ntawm CSM

Ua Carotid Massage Kauj Ruam 2
Ua Carotid Massage Kauj Ruam 2

Kauj Ruam 2. Muab lub tshuab electrocardiograph (ECG) rau tus neeg mob

Cov cuab yeej kho mob no yuav saib xyuas cov hluav taws xob ua haujlwm ntawm tus neeg mob lub plawv thaum CSM raug tswj hwm. Txij li CSM feem ntau yog ntsuas ntsuas, ECG muaj txiaj ntsig zoo hauv kev saib xyuas lub plawv thaum tus txheej txheem. Yog tias ECG qhia asystole (lub plawv nres ntaus) ntau dua 3 vib nas this CSM yuav tsum tau txiav tam sim ntawd. ECG kuj tseem tuaj yeem pab kuaj mob ntawm carotid sinus syndrome.

Txawm hais tias koj tab tom ua CSM txhawm rau txo tus neeg mob lub plawv dhia nrawm (supraventricular tachycardia, lossis SVT), koj tseem yuav tsum saib xyuas lub plawv kev ua haujlwm hluav taws xob ntawm ECG. Siv ECG txhua lub sijhawm ua CSM

Ua Carotid Massage Kauj Ruam 3
Ua Carotid Massage Kauj Ruam 3

Kauj Ruam 3. Saib xyuas tus neeg mob ntshav siab ua ntej, thaum thiab tom qab txheej txheem siv cov ntshav siab tas mus li thiab ntsuas lub plawv dhia

Cov ntaub ntawv no tuaj yeem muab cov ntaub ntawv hais txog qhov ua rau muaj qhov txawv txav ntawm lub suab. Kev saib xyuas ntshav siab kuj tseem ua tiav rau kev nyab xeeb.

Thaum tus neeg mob tau poob qis, thiab koj tau thov ECG thiab pib saib xyuas ntshav siab, tos tsib feeb ua ntej pib txheej txheem. Qhov no yuav tso cai rau tus neeg mob lub plawv kom qeeb mus rau qhov so kom koj thiaj li tuaj yeem ntsuas qhov ntsuas qhov tseeb ntawm cov ntshav siab thiab lub plawv dhia

Ntu 2 ntawm 3: Ua Zaws

Ua Carotid Massage Kauj Ruam 4
Ua Carotid Massage Kauj Ruam 4

Kauj Ruam 1. Nrhiav lub ntsiab lus zaws carotid sinus

Muaj ob qhov carotid sinuses, thiab koj yuav tsum tau ua CSM ntawm txhua tus. Carotid sinus nyob ntawm tus neeg mob lub caj dab. Nrhiav pem hauv ntej ib nrab ntawm tus neeg mob lub caj dab (ze lawv Adas lub kua), thiab txheeb xyuas lub kaum sab xis ntawm tus neeg mob lub puab tsaig. Tom qab ntawd taug koj cov ntiv tes ncig ntawm tus neeg mob lub caj dab, kom txog thaum nws ncaj qha hauv qab lub kaum ntawm lawv lub puab tsaig. Koj tus ntiv tes yuav tsum tau so ntawm tus neeg mob lub carotid sinus.

  • Lub kaum ntawm lub puab tsaig yuav tsum yog qhov chaw uas lawv lub puab tsaig khoov, li 4 ntiv tes (10 centimeters) rov qab los ntawm qhov kawg ntawm lawv lub puab tsaig.
  • Qhov thib ob carotid sinus yuav nyob hauv qhov chaw zoo ib yam ntawm lwm sab ntawm tus neeg mob lub caj dab.
Ua Carotid Massage Kauj Ruam 5
Ua Carotid Massage Kauj Ruam 5

Kauj Ruam 2. Zaws txoj cai carotid sinus rau 5-10 feeb

CSM feem ntau yog ua thawj zaug ntawm sab xis ntawm tus neeg mob lub caj dab. Nias khov kho ntawm tus neeg mob lub carotid sinus zaws taw tes. Siv cov lus tsa suab, rub thiab zaws lub carotid sinus rau lub sijhawm 5-10 feeb.

Tsis txhob nias nyuaj dhau, lossis koj tuaj yeem pheej hmoo txo qis cov pa oxygen mus rau tus neeg mob lub hlwb. Raws li txoj cai ntawm tus ntiv tes xoo, siv tus nqi siab uas koj yuav xav tau rau hauv qhov chaw ntawm pob ntaus pob tesniv

Ua Carotid Massage Kauj Ruam 6
Ua Carotid Massage Kauj Ruam 6

Kauj Ruam 3. Zaws tus neeg mob sab laug carotid sinus

Tom qab ua qhov kev zaws carotid ntawm sab xis ntawm tus neeg mob lub caj dab, rov ua zaws ntawm tus neeg mob sab laug carotid sinus. Zaws hauv cov lus tsa suab rau 5-10 feeb.

Ua Carotid Massage Kauj Ruam 7
Ua Carotid Massage Kauj Ruam 7

Kauj Ruam 4. Qhia tus neeg mob kom pw twj ywm li 10 feeb

Tom qab ua tiav CSM, tus neeg mob yuav ntsib qee qhov mob taub hau lossis yuav hnov mob taub hau me ntsis. Nug lawv kom mus pw saum txaj ntxiv 10 feeb. Qhov no yuav tso cai rau lawv lub plawv dhia rov zoo li qub (yog tias nws txawv txav tsis zoo pib nrog) thiab yuav tso cai kom cov pa oxygen rov qab los rau lawv lub hlwb.

Ntu 3 ntawm 3: Txiav Qhov Zaws

Ua Carotid Massage Kauj Ruam 8
Ua Carotid Massage Kauj Ruam 8

Kauj Ruam 1. Tsis txhob ua CSM yog tias ECG qhia asystole

Asystole yog daim ntawv hnyav ntawm lub plawv nres uas yuav tshwm sim los ntawm CSM. Yog tias ECG saib pom qhov tsis muaj hluav taws xob ua haujlwm thiab lub ntsws qis dua li 3 vib nas this, tsis txhob ua qhov kev txav tam sim ntawd.

Yog tias tus neeg mob lub plawv nres txuas ntxiv mus thaum koj tau tso tseg kev tswj hwm CSM, koj yuav xav tau pib ua qhov ntsuas kev cawm neeg, xws li cuam tshuam ncaj qha (lub hauv siab tshuab). Tsis txhob defibrillate tshwj tsis yog ECG qhia pom lub plawv dhia tsis txaus ntseeg xws li ventricular fibrillation lossis ventricular tachycardia. Asystole tsis yog qhov ua rau poob siab

Ua Carotid Massage Kauj Ruam 9
Ua Carotid Massage Kauj Ruam 9

Kauj Ruam 2. Nres CSM yog tias tus neeg mob qaug zog

Yog tias tus neeg mob tsis nco qab hauv txhua txoj kev thaum koj tab tom ua CSM-txawm tias nws tsuas yog rau lub sijhawm luv luv-nres tswj qhov zaws. Koj lossis tus kws pab kho mob yuav tsum sau tseg tias tus neeg mob tau ntsib syncope (tsis nco qab) lossis ua ntej syncope (kiv taub hau lossis tsis pom kev tam sim tam sim ua ntej tsis nco qab).

Yog tias koj tab tom ua CSM rau lub hom phiaj kuaj mob, nug tus neeg mob yog tias mob taub hau lossis tsaus muag uas lawv nyuam qhuav ntsib zoo ib yam li lwm cov tsos mob uas lawv ib txwm muaj

Ua Carotid Massage Kauj Ruam 10
Ua Carotid Massage Kauj Ruam 10

Kauj Ruam 3. Tsis txhob ua CSM yog tias muaj teeb meem txog paj hlwb, xws li mob hlab ntsha tawg, tshwm sim

Thaum muaj mob hlab ntsha tawg, yuav tsum tau muab tshuaj aspirin (yog tias tsis yog contraindicated) thiab tus neeg mob yuav tsum tau ua tib zoo saib.

Ua Carotid Massage Kauj Ruam 11
Ua Carotid Massage Kauj Ruam 11

Kauj Ruam 4. Tsis txhob ua CSM rau cov neeg mob uas muaj carotid sinus hypersensitivity

Cov neeg mob uas muaj carotid sinus hypersensitivity, lossis CSH, mob siab rau siab rau lawv cov carotid sinus. Qhov xwm txheej no feem ntau cuam tshuam rau txiv neej laus dua 50, txawm hais tias poj niam dhau 50 tuaj yeem ntsib CSH ib yam. Kev tswj hwm CSM rau tus neeg mob nrog CSH tuaj yeem ua rau lub plawv nres lossis lwm yam mob plawv thiab ntshav siab.

Nug koj tus neeg mob yog tias tus kws kho mob tau kuaj pom lawv nrog CSH, lossis yog tias lawv puas tau muaj qhov tsis zoo rau-lossis tsis nco qab thaum lub sijhawm-carotid sinus zaws

Ua Carotid Massage Kauj Ruam 12
Ua Carotid Massage Kauj Ruam 12

Kauj Ruam 5. Tsis tas li ntawd, tsis txhob ua CSM rau cov neeg mob uas muaj cov xwm txheej hauv qab no:

  • Myocardial infarction
  • Transient Ischemic Attack hauv 3 lub hlis dhau los
  • Kev raug mob ntawm cerebrovascular tsis pub dhau 3 lub hlis dhau los
  • Keeb kwm ntawm Ventricular Fibrillation
  • Keeb kwm ntawm Ventricular Tachycardia
  • Carotid Artery Occlusion
  • Cov kev tsis zoo yav dhau los rau CSM
  • Yog tias tus neeg mob muaj carotid bruit, carotid ultrasound yuav tsum tau ua ua ntej txhawm rau kuaj xyuas tus mob stenosis.

Lub tswv yim

Carotid Artery Massage yog ib qho ntawm cov txheej txheem kho mob hu ua "Vagal maneuvers." Vagal maneuvers txhawb lub vagus paj (nyob ntawm ib sab ntawm lub taub hau) thiab hais kom nws tso cov tshuaj uas ua rau tus neeg mob lub plawv dhia qeeb

Lus ceeb toom

  • Tsis txhob ua CSM hauv chav kho mob xub thawj, tshwj tsis yog lub chaw haujlwm muaj cov chaw pab cawm neeg tag nrho.
  • Tsis txhob ua CSM ntawm ob qho carotids tib lub sijhawm.
  • Ib txwm lees paub tias muaj ACLS lub laub sib tsoo (nrog lub tshuab defibrillator) thiab ntsuas cov cuab yeej (ECG thiab ntshav siab thiab lub plawv dhia).
  • Kev zaws tuaj yeem ua rau mob hlab ntsha tawg hauv cov neeg laus (vim tsis muaj oxygen rau lub hlwb). Yog li ntawd, CSM yuav tsum tsuas yog ua hauv chaw kho mob nrog cov chaw pab cawm neeg.

Pom zoo: