Inā he haumāna kauka a kumu paha ʻoe e ʻimi nei e hoʻonui i kou ʻike ma nā ʻōnaehana nānā maʻi a i ʻole ka mea hoʻolaha hoihoi e ʻimi nei i ka ʻike e pili ana i nā kumukūʻai a me nā hiʻohiʻona o ka mea nānā maʻi MeCan, manaʻolana mākou e hāʻawi kēia ʻatikala i nā ʻike waiwai. ʻO kā mākou pahuhopu ke kōkua i ka poʻe e hoʻomaopopo maikaʻi i ke koʻikoʻi o ka nānā ʻana i nā hōʻailona koʻikoʻi a me ke koho ʻana i nā mea pono. No nā nīnau hou a i ʻole e aʻo hou e pili ana i kā mākou huahana, e ʻoluʻolu e kelepona iā mākou i kēlā me kēia manawa.
He aha nā mea mālama maʻi？
ʻO ka mea nānā maʻi he mea hana a i ʻole ʻōnaehana i hoʻolālā ʻia e ana a mālama i nā ʻāpana physiological o ka mea maʻi a hiki ke hoʻohālikelike ʻia me kahi waiwai i ʻike ʻia, a hiki ke kani i kahi puʻupuʻu inā ʻoi aku ka nui.
Nā hōʻailona a me ka laulā o ka hoʻohana
1. Nā hōʻailona: Ke loaʻa i ka poʻe maʻi ka maʻi nui o ke kino, ʻoi aku ka puʻuwai a me ka māmā, a pono ka nānā ʻana inā paʻa nā hōʻailona koʻikoʻi.
2. Ka laulā o ka noi: i ka wā o ka ʻoki, ma hope o ka ʻoki ʻana, ka mālama trauma, ka maʻi naʻau coronary, nā maʻi maʻi maʻi, nā keiki hānau hou, nā pēpē premature, Hyperbaric oxygen keʻena, lumi lawe
Hoʻokumu kumu
ʻO ke ʻano kumu o ka nānā ʻana i ka mea maʻi he ʻehā mau ʻāpana: ʻo ka ʻāpana nui, ka monitor, nā ʻike like ʻole a me ka ʻōnaehana pili. Hoʻokomo ʻia ke ʻano nui i ka mīkini holoʻokoʻa a me nā mea pono.
（ MCS0022 ） 12 ʻīniha ka nānā ʻana i nā mea maʻi nānā i nā mea pono
Hoʻokaʻawale i nā mea nānā maʻi？
ʻEhā mau ʻāpana e pili ana i ka hoʻolālā: nā mākaʻikaʻi portable, nā mea nānā plug-in, nā mākaʻikaʻi telemetry, a me nā mea nānā ʻo Holter (24-hola ambulatory ECG) ECG. Wahi a ka hana, ua māhele ʻia i ʻekolu mau ʻāpana: ka nānā ʻana i kahi moe, ka nānā waena, a me ka nānā hoʻokuʻu (telemetry monitor).
He aha ka Multiparameter Monitor?
ʻO nā hana maʻamau o ka Multiparameter-Monitor he electrocardiogram (ECG), Respiratory (RESP), non-invasive blood pressure (NIBP), Pulse Oxygen Saturation (SpO2), Pulse Rate (PR), a me Temperature (TEMP).
I ka manawa like, hiki ke hoʻonohonoho ʻia ke kahe koko invasive (IBP) a me End-tidal carbon dioxide (EtCO2) e like me nā pono lapaʻau.
Ma lalo nei mākou e wehewehe i nā loina o nā ʻāpana kumu i ana ʻia e ka mea nānā maʻi a me nā mea e mālama ai no kā lākou hoʻohana.
Nānā Electrocardiogram (ECG).
He mea koʻikoʻi ka puʻuwai i loko o ke kaʻa holo kaʻa kanaka. Hiki ke kahe mau ke koko i loko o ka ʻōnaehana pani ma muli o ka rhythmic systolic a me ka hana diastolic mau o ka puʻuwai. Hiki ke alakaʻi ʻia nā au uila liʻiliʻi i ka wā e hauʻoli ai ka ʻiʻo o ka naʻau ma o nā ʻiʻo o ke kino a hiki i ka ʻili o ke kino, e hoʻoulu ai i nā ʻano like ʻole i nā wahi like ʻole o ke kino. ʻO ka electrocardiogram (ECG) e ana i ka hana uila o ka puʻuwai a hōʻike iā ia ma ka nānā maʻi me nā ʻano nalu a me nā waiwai. He wehewehe pōkole kēia o nā ʻanuʻu e loaʻa ai kahi ECG a me nā ʻāpana o ka puʻuwai i ʻike ʻia i kēlā me kēia alakaʻi ECG.
I. Hoʻomākaukau ʻili no ka hoʻopili electrode He mea koʻikoʻi ka hoʻopili ʻana i ka ʻili-i-electrode maikaʻi e hōʻoia i ka hōʻailona ECG maikaʻi no ka mea ʻo ka ʻili kahi alakaʻi maikaʻi ʻole o ka uila. 1. E koho i kahi pūnaewele me ka ʻili paʻa a ʻaʻohe mea ʻino. 2. Inā pono, e kahi i ka lauoho o ke kino o ka wahi e pili ana. 3. Holoi me ke kopa a me ka wai, mai waiho i ke kopa. Mai hoʻohana i ka ether a i ʻole ethanol maʻemaʻe, e hoʻomaloʻo lākou i ka ʻili a hoʻonui i ke kū'ē. 4. Eʻae i kaʻili e maloʻo loa. 5. E kāpī mālie i ka ʻili me ka pepa hoʻomākaukau ʻili ECG no ka wehe ʻana i ka ʻili make a hoʻomaikaʻi i ka conductivity o ka pae electrode paste.
II. Hoʻohui i ke kaula ECG 1. Ma mua o ka hoʻokomo ʻana i nā electrodes, e hoʻokomo i nā clips a i ʻole nā pihi paʻi ma nā electrodes. 2. E kau i nā electrodes ma luna o ka mea maʻi e like me ke ʻano o ke kūlana alakaʻi i koho ʻia (e ʻike i ke kiʻikuhi ma lalo no nā kikoʻī o ke ʻano hoʻopili maʻamau 3-lead a me 5-lead, a e nānā i ka ʻokoʻa o nā kaha kala ma waena o American Standard AAMI a me European Standard IEC cables). 3. Hoʻohui i ke kaula electrode i ke kaula maʻi.
inoa lepili uila
kala uila
AAMI
EASI
IEC
AAMI
IEC
lima ʻākau
I
R
Keʻokeʻo
ʻulaʻula
Lima hema
S
L
ʻeleʻele
Melemele
Wawae hema
A
F
ʻulaʻula
ʻōmaʻomaʻo
RL
N
N
ʻōmaʻomaʻo
ʻeleʻele
V
E
C
Palaunu
Keʻokeʻo
V1
C1
Palaunu/ʻulaʻula
Keʻokeʻo/ʻulaʻula
V2
C2
Palaunu/melemele
Keʻokeʻo/melemele
V3
C3
Palaunu/Omaomao
Keʻokeʻo/'ōmaʻomaʻo
V4
C4
Palaunu/Puliuli
Keʻokeʻo/ʻeleʻele
V5
C5
Palaunu/Alani
Keʻokeʻo/ʻeleʻele
V6
C6
Palaunu/Poni
Keʻokeʻo/ʻulaʻula
III. ʻO nā ʻokoʻa ma waena o ka hui alakaʻi 3 a me ka hui alakaʻi 5 a me nā pūnaewele puʻuwai i hōʻike ʻia e kēlā me kēia alakaʻi 1. E like me ka mea i ʻike ʻia ma ka helu ma luna, hiki iā mākou ke loaʻa iā I, II, a me III alakaʻi ECGs i ka hui 3-lead, ʻoiai hiki i ka hui 5-lead ke loaʻa iā I, II, III, aVL, aVR, aVF, a me V alakaʻi ECG. 2. Hōʻike wau a me aVL i ka paia ʻaoʻao mua o ka ventricle hema o ka puʻuwai; Hōʻike ka II, III a me ka aVF i ka paia hope o ka ventricle; Hōʻike ka aVR i ke keʻena intraventricular; a hōʻike ʻo V i ka ventricle ʻākau, septum a me ka ventricle hema (ma muli o ka mea āu e koi ai e alakaʻi i ke koho).
ʻO ka nānā ʻana o ka hanu (Resp) i ka neʻe ʻana o Thoracic i ka wā o ka hanu ʻana e hoʻololi i ke kūpaʻa o ke kino, a ʻo ka pakuhi o nā loli i nā waiwai impedance e wehewehe i ke ʻano nalu ikaika o ka hanu, hiki ke hōʻike i nā ʻāpana o ka hanu. ʻO ka mea maʻamau, e ana nā mākaʻi i ka impedance o ka pā umauma ma waena o nā electrodes ECG ʻelua ma ka umauma o ka mea maʻi e hoʻokō i ka nānā ʻana i ka hanu hanu. Eia kekahi, hiki ke nānā ʻia ka hoʻololi ʻana o ka carbon dioxide i ka manawa o ka hanu e helu pololei i ka nui o ka hanu a i ʻole ka nānā ʻana i ka hoʻololi ʻana o ke kaomi a me ke kahe o ke kahe o ke kaapuni o ka mea maʻi i ka wā mechanical ventilation e helu i ka hana hanu o ka mea maʻi a hōʻike i ka wikiwiki o ka hanu. I. Ke kūlana o nā alakaʻi i ka wā e nānā ai i ka hanu 1. Hana ʻia nā ana hanu me ka hoʻohana ʻana i ka papahana alakaʻi pae uila ECG maʻamau, e like me ka mea i hōʻike ʻia ma ke kiʻi ma luna. II. Nā memo e pili ana i ka nānā ʻana i ka hanu 1. ʻAʻole kūpono ka nānā ʻana i ka hanu no nā poʻe maʻi me ka nui o ka hana, no ka mea hiki ke alakaʻi i nā ala hoʻopunipuni. 2. Pono e pale ʻia ka ʻāpana hepatic a me ka ventricle ma ka laina o nā electrodes respiratory, i hiki ke pale ʻia nā mea hana mai ka uhi ʻana o ka naʻau a i ʻole ke kahe koko pulsatile, he mea nui loa ia no nā neonates.
ʻO ke koko oxygen (SpO2) kiaʻi ʻO ka oxygen koko (SpO2) ʻo ia ka ratio o ka hemoglobin i hoʻokahe ʻia i ka huina o ka hemoglobin i hoʻokaʻawale ʻia me ka hemoglobin ʻole o ka oxygen. ʻO nā ʻano hemoglobin ʻelua i loko o ke koko, oxygenated hemoglobin (HbO2) a me ka hemoglobin emi (Hb), he ʻokoʻa nā mana absorption no ke kukui ʻulaʻula (660 nm) a me ke kukui infrared (910 nm). Hoʻemi ʻia ka hemoglobin (Hb) i ke kukui ʻulaʻula a emi mai ke kukui infrared. He ʻoiaʻiʻo ka mea ʻē aʻe no ka hemoglobin oxygenated (HbO2), ka mea e hoʻomoʻi i ke kukui ʻulaʻula liʻiliʻi a me ke kukui infrared. Ma ka hoʻonohonoho ʻana i ke kukui ʻulaʻula a me ke kukui LED infrared ma kahi like o ka oximeter nail, ke komo ke kukui mai kekahi ʻaoʻao o ka manamana lima a i kekahi ʻaoʻao a loaʻa ʻia e ka photodiode, hiki ke hana ʻia kahi volta proportional like. Ma hope o ka hoʻololi ʻana i ka algorithm, hōʻike ʻia ka hopena hopena ma ka pale LCD, i ʻike ʻia ma ke ʻano he ana e ana i ka helu olakino kanaka. He wehewehe pōkole kēia o nā ʻanuʻu e loaʻa ai ka oxygen koko (SpO2), a me nā mea e pili ana i ka nānā ʻana i ka oxygen koko. I. E hoʻohana i ka mea ʻike 1. Wehe i ka poli kui kala mai ka wahi e ʻaʻahu ai. 2. E kau i ka sensor SpO2 ma ka mea maʻi. 3. E hōʻoia i ka hoʻolikelike ʻana o ka paipu ʻālohilohi a me ka mea hoʻokipa māmā i kekahi i kekahi e hōʻoia i ka hele ʻana o nā kukui a pau mai ka paipu kukui i loko o nā ʻiʻo o ka mea maʻi. II. Nā mea e pili ana i ka nānā ʻana i ka oxygen koko 1. ʻAʻole i kau ke kūlana sensor a i ʻole ke neʻe ikaika ka mea maʻi. 2. ipsilateral arm ke koko koko a ipsilateral lateral lying compression. 3. E pale i ke keakea o ka hoailona e ka malamalama malamalama. 4. Poor peripheral circulation: e like me ka haʻalulu, haʻahaʻa manamana lima. 5. Nā manamana lima: nā kui kui, nā calluses mānoanoa, nā manamana lima haki, a me nā kui lōʻihi loa e pili ana i ka lawe māmā ʻana. 6. Hoʻokomo i loko o nā lāʻau kala. 7. ʻAʻole hiki ke nānā i ka pūnaewele like no ka manawa lōʻihi.
ʻO ka nānā ʻana i ke koko non-invasive (NIBP) ʻo ke kaomi ʻana o ke koko ke kaomi ʻaoʻao o kēlā me kēia ʻāpana i loko o kahi kīʻaha koko ma muli o ke kahe ʻana o ke koko. He mea maʻamau ke ana ʻia i nā millimeters o ka mercury (mmHg). Hana ʻia ka nānā ʻana i ke koko noninvasive e ke ʻano kani kani Koch (manual) a me ke ʻano haʻalulu, e hoʻohana ana i ke kaomi arterial mean (MP) e helu i nā kaomi systolic (SP) a me diastolic (DP). I. Hoʻomaʻamaʻa 1. E koho i ke ʻano maʻi kūpono. 2. E mālama i ka puʻuwai me ka puʻuwai. 3. E hoʻohana i ka puʻupuʻu nui kūpono a nakinaki i ka 'INDEX LINE' i loko o ka laina 'RANGE'. 4. ʻAʻole pono e paʻa a ʻoluʻolu paha ka puʻupuʻu, a nakinaki ʻia i hiki ke hoʻokomo ʻia kekahi manamana lima. 5. Pono ka hoailona φ o ka cuff e ku pono i ke a'a brachial. 6. ʻAʻole pono e pōkole ka manawa o ke ana ʻakomi. II. ʻAʻole hiki ke hoʻoneʻe i ke koko 1. ʻO ke kiʻekiʻe kiʻekiʻe: ʻoi aku ke koko systolic ma mua o 250 mmHg, ʻaʻole hiki ke hoʻopaʻa ʻia ke kahe o ke koko, hiki ke hoʻonui mau ʻia ka cuff a ʻaʻole hiki ke ana ʻia ke koko. 2. ʻO ka hypotension koʻikoʻi: ʻoi aku ke kahe o ke koko systolic ma mua o 50-60mmHg, haʻahaʻa loa ke koko e hōʻike mau i nā loli koke o ke koko, a hiki ke hoʻonui pinepine ʻia.
Makemake e pili ana i ka nānā ʻana i ka maʻi? E kelepona mai iā mākou i kēia lā e aʻo hou a kūʻai aku!
