taƙaitawa
Majalisar Resulciation ta Turai (ERC) da kuma al'ummar Casterungiyar Turai ta Cinikin Turai (ESICM) sun hada gwiwa don bunkasa jagororin kulawa da su na farko, a cikin layi tare da yarjejeniyar International da lura da CPR. Maudu'ai sun rufe hada-hadar Cardiac, Cutar Cardiac da ke haifar da kamuwa da Cardiac, Juyin Jiki, Jagora, Jigilar Hemwars, Gaba ɗaya babban aiki, Jagora, Gaba gudummawar kwastomomi.
Kalmomi: Keywords
Gabatarwa da Iyalai
A cikin 2015, Majalisar Resultations Turai (ERC) da kuma al'adar Turai ta hada kai don samar da jagororin kulawa ta farko ta farko-revication, waɗanda aka buga a cikin sake farfadowa da magani na kulawa. Wadannan tsare-tsaren kula da kulawar da aka gabatar dasu a shekarar 2020 da hada Kimiyya da aka buga tun 2017. Jagoran Masarautar zazzabi, Kulawa, Kulawa, Kulawa, Tsinkaya, Gwaji, da Sakamako na dogon lokaci (Hoto 1).
Takaitaccen bayani na canje-canje
Kulawa da Batun-tsaye:
• Jiyya-Rearation Jiyya yana farawa nan da nan nan da nan bayan rosc (dawo da yaduwar zuciya), ba tare da la'akari da wurin (Hoto 1).
Don kamawa na Cardiac na Foritic, la'akari da ɗaukar cibiyar kama zuciya. Gano dalilin kamuwar zuciya.
• Idan akwai asibiti (misali, hemodynamic rashin ƙarfi) ko shaidar ECG na ischemia, ana yin maganin cututtukan zuciya na farko. Idan matabbi na jijiyoyin jiki baya gano raunin causation, CT ENVEPLOLIGLIG DA / ko CT UVungiyar Angolography ana yin su.
• Farkon ganowar numfashi ko rikice-rikice na asali da kwakwalwa za a iya yi ta hanyar samar da kwakwalwa da kirji yayin asibiti, kafin ko bayan tashin hankali na jijiya (duba magungunan jijiyoyin jiki).
• Yi CT na kwakwalwa da / ko Angiography na huhu idan akwai alamu ko bayyanar cututtuka, ko gajeriyar numfashi, ko rashin numfashi, ko kuma karancin numfashi, ko hypoxemia a cikin marasa lafiya da sanannen yanayin numfashi).
1. Jirgin sama da numfashi
Gudanar da Airway bayan an dawo da yiwuwar tattarawa
• Ya kamata a ci gaba da goyan bayan Hanyoyi da Ingilatory bayan murmurewa daga baya na rarraba ba da kariya (ROSC).
• Marasa lafiya wadanda suka sami kamawar zuciya, komawa zuwa aikin kwakwalwa na yau da kullun, amma ya kamata a ba da iskar oxyogen ta hanyar fuska da 94%.
• Ya kamata a aikata yanayin rashin daidaituwa a cikin marasa lafiya waɗanda suka kasance a bayan rosc, ko ga marasa lafiya da keɓaɓɓe na Clination, idan ba a yin saƙar ciki yayin CPR.
• Dole ne a aiwatar da yanayin wasan kwaikwayo ta hanyar gogewa ta kwarewa tare da babban nasara.
• Daidaitaccen wuri na bututun mai bayyana dole ne a tabbatar da shi ta hanyar ɗaukar hoto.
• Idan babu gogaggen intubators na wasan kwaikwayo, yana da ma'ana don saka wani yanki na jirgin sama (sga) ko kula da jirgin sama ta amfani da fasahar asali har sai da ƙwararren mai ƙanshi yana samuwa.
Sarrafa oxygen
• Bayan Rosc, 100% (ko maximally akwai) oxygen ana amfani da oxygen har sai an iya amfani da matsin oxygen na artengen ko matsi na iskar oxygen za'a iya lissafa shi.
• Da zarar an iya samun daidaitawa ta hanyar iskar oxygen ko ƙimar iskar gas, to an sami iskar gas don cimma matsayar oxygen mai iskar oxygen (pao2) na 10 zuwa 13 KPA ko 75 zuwa 100 mmhg (Hoto na 2).
• 避免 Rosc 后 的 低氧血症 (pao2 <8 KPHG).
• Guji hyperxemia bayan rosc.
Iko
• Sami gas na jini da amfani da saka idanu na CO2 a cikin marasa lafiya na injin da ke cikin injin da ke ventilated.
• Don marasa lafiya suna buƙatar iska ta yau da kullun bayan Rosc, daidaita iska mai ƙarfi na carbon dioxide (Paco2) na 4.5 zuwa 6.0 zuwa 35 zuwa 45 mmhg.
• Paco2 ana iya sa ido akai-akai a cikin marasa lafiya da aka bi da aikin zazzabi (ttm) saboda don gudanar da rayada ta rayuka.
• Dabi'un gas ana kimanta ta amfani da zazzabi ko hanyoyin zazzabi yayin ttm da ƙananan yanayin zafi.
• Kulawa da dabarar iska mai kariya ta huhu don cimma girman mataki na 6 - 8 ml / kilogiram na nauyin jiki.
2. Canc jiki mai rikicewa
Sake rubutawa
• Madorin marasa lafiya na manya tare da RosC na fuskantar tuhuma da haɓakar St-kashi ya kamata a yi nan da nan idan aka nuna).
• Ya kamata a ɗauki kimantawa game da kimantawa game da cututtukan cardiate a cikin marasa lafiya da ROSC waɗanda ke da haɓaka a asibiti na ECG da kuma waɗanda aka kiyasta suna da babban yiwuwar cutar cututtukan zuciya na ƙasa (misali, haemynamic da / ko marasa tausayi marasa amfani).
Kulawa na Hemodynamic Kulawa da Gudanarwa
• Cigaba da sa ido kan karfin jini ta hanyar dunƙule Arterioosus ya kamata a yi a dukkan marasa lafiya, da kuma saka idanu a zuciya yana da ma'ana a cikin marasa lafiya m marasa lafiya.
• Yi ECOCOCARDOORORAM kamar wuri (da wuri-wuri) a cikin dukkan marasa lafiya su gano kowane yanayi na zuciya da kuma amfani da yanayin rashin daidaituwa.
• Guji hypotinsi (<65 mmhg). Target yana nufin matsin lamba na Arerial (Map) don cimma isasshen kayan fitsari (> 0.5 ml / kg * h da kuma raguwar lactate (Hoto na 2).
• Za a iya barin BradyCard da ba a kula da shi ba yayin ttm a 33 ° C Idan karfin jini, lacto, SCVO2, ko SVO2 sun isa. Idan ba haka ba, yi la'akari da ƙara yawan zafin jiki, amma ba ya fi girma 36 ° C.
• Gyar da matuka da ruwa, noreppherine, da / ko dobutamine dangane da girman m, vasoconstriction, ko kuma ƙanƙantar tsoka a cikin mai haƙuri.
• Guji sankara, wanda yake hade da arrhythmias ventricular.
• Idan maimaitawar tsoka, ƙanƙantar karaya ba ta isa ba, na'urori na hanzari (misali, na Arlioous na taimaka wajan shafewar haushi. Isar da iska. Na'urorin Ventricular na hagu ko kuma mentrogporeal Endgencular ya kamata kuma a yi la'akari da oxygencular tare da cututtukan cututtukan zuciya (VT) ko kuma abubuwan da ke cikin vef (vf), duk da zaɓin magani.
3
Kulawa da Kulawa
• Muna bada shawara ga amfani da eltroMoma don gano elecospasmas a cikin marasa lafiya da na asibiti da hankali kuma don saka idanu da martani.
• Don magance satizures bayan kamawar zuciya, muna ba da shawarar levetiracetam ko ƙwayoyin sodium kamar magungunan farko na-farko.
• Muna ba da shawarar yin amfani da hayaniyar yau da kullun a cikin marasa lafiya masu zuwa da kama Cardiac.
Sarrafa zazzabi
• Ga manya waɗanda ba sa amsa wa OHCA ko Cikin Cardica Cardiac (kowane Zuciyar Zuciyar Zuciya), muna ba da shawarar gudanar da zazzabi (ttm).
• Raba yawan zafin jiki a cikin darajar kullun tsakanin 32 zuwa 36 ° C na akalla awanni 24.
• Ga marasa lafiya waɗanda suka rage, su guji zazzabi (> 37.7 ° C) aƙalla awanni 72 bayan rosc.
• Kada kayi amfani da maganin sanyi na prehospital ta hanyar zazzabin jiki. Gudanar da kulawa mai zurfi - amfani da gajeru-mawuyacin hali da kuma opiiiids.
• Ana kiyaye amfani da magungunan yau da kullun a cikin marasa lafiya da ttm, amma ana iya ɗauka a lokuta na matsanancin sanyi a lokacin ttm.
• Juyin hankali prophylaxis ana bayar da shi a kai tsaye ga marasa lafiya da ake kama zuciya.
• Yin rigakafin zurfin jijiya.
• 如果需要, 使用胰岛素输注将血糖定位为 7.8-10 MMOL / L (140- 180 MG / DL), 避免低血糖 (<4.0 MGL / L (<70 MG / DL).
• Fara ciyarwar mai ɗorewa (ciyar da abinci) yayin ttm da kuma ƙara bayan sake dawowa idan an buƙata. Idan an yi amfani da ttm na 36 ° C azaman manufa zazzabi, ƙimar ciyarwar ciyar na iya karuwa a baya a lokacin TTM.
• Ba mu bada shawarar amfani da maganin rigakafi ba.
4. Tsohon yasan al'ada
Janar Janar
• Ba mu bayar da shawarar maganin rigakafi na pomphicriccs na marasa lafiya ba saboda rashin nutsuwa bayan kamewar zuciya, da kuma don yin tunani, da kebuloans, duka don sanar da asibitoci da aka yiwa bijimi bisa ga mai haƙuri damar samun nasarar dawo da hankali (Hoto na 3).
• Babu wani annabta mai hangen nesa 100% daidai ne. Sabili da haka, muna ba da shawarar dabarun hangen nesa na ƙwayar cuta.
• Lokacin da aka tsinkaya sakamakon neurologological sakamakon, ana buƙatar takamaiman bayani da daidaito da daidaito don kauce wa tsinkayar ƙarya na ƙarya.
• Binciken neurological na ilimi yana da mahimmanci don hangen nesa. Don nisantar tsinkayar tsinkayar cututtukan fata, asibiti ya kamata mu gujewa yiwuwar fitina sakamakon sakamakon gwajin da zai iya rikita shi ta hanyar magani da sauran magunguna.
• An bayar da shawarar yau da kullun lokacin da ake bi da marasa lafiya tare da ttm, amma ya kamata a yi kimantawa na ƙarshe na ƙarshe bayan sake biya.
• Ma'aikata dole ne su san hadarin annabci da nuna kai, wanda ya faru lokacin da sakamakon gwajin alamomi ana amfani da su a kan yanke shawara na lura, musamman dangane da magungunan rayuwa.
• Dalilin gwajin inuroprognogisos shine don tantance tsananin rauni na raunin hypoxic. Neuropronosis yana daya daga cikin bangarori da dama don la'akari idan an tattauna yiwuwar murmurewa.
Da yawa
• Fara tantancewa tare da cikakken bincike na asibiti, an yi shi ne kawai bayan manyan abubuwan da ke haifar da abubuwan da suka faru (misali 4) an cire (Hoto na 4)
• Idan babu masu shirya shirye-shirye, marasa lafiya suna tare da Rosc ≥3 a cikin sa'o'i 72 na yau da kullun suna da ƙarancin sakamako a ≥ 72 H, Cikakkun abubuwan da ke cikin ≥ 72 H, Cikakkun abubuwa masu faɗi suna halarta 24 h, babban-aji EEG> 24 h da kuma / or, Mypoxic CT, MRI da raunin hypoxic. Yawancin waɗannan alamu za a iya yin rikodin kafin 72 h na rosc; Koyaya, sakamakonsu za'a kimanta shi a lokacin kimantawa a asibiti.
Gano Clinical
• Binciken Clinical yana da saukin tsoma baki zuwa tsangwama daga siltiative, opiiiids, ko tsoka. Yiwuwar fitina ta saura ya kamata koyaushe a yi la'akari da shi.
• Don marasa lafiya da suka ci gaba da kasancewa a cikin sa'o'i 72 ko daga baya bayan Rosc, gwaje-gwajen da ke gaba na iya hasashen hangen nesa na kwarewa.
• A cikin marasa lafiya da suka kasance suna ɗaukar sa'o'i 72 ko daga baya bayan rosc, gwaje-gwajen da ke gaba na iya yin hasashen sakamako na kwayar halitta:
- babu wani yanki mai daidaitaccen ma'auni na yau da kullun
- adadi mai karantarwa
- asarar corneal reflex a garesu
- MonoClonus a cikin awanni 96, musamman jihar Myoclonus a cikin sa'o'i 72
Muna ba da shawarar yin rikodin wani EEG a gaban Tics na Myogonic don gano alamun eEG ko don amsa alamun eEG ko ci gaba, ba da shawarar yiwuwar murmurewa na kwayar halitta.
M
• An yi EEG (Eldungiyar Eleyconephalagrogram) a cikin marasa lafiya da suka rasa sani bayan kamuwa da zuciya.
• Hanyoyin mawuyacin hali sun haɗa da rashin halaye masu lalacewa tare da ko ba tare da fitsari na lokaci ba kuma ya fashe da rushewa. Muna ba da shawarar amfani da waɗannan alamu na eeg a matsayin mai nuna alamun talauci bayan ƙarshen TTM da bayan Cedmation.
• Kasancewar Seizures akan EEG a cikin awanni 72 na farko bayan rosc alama ce mai nuna talauci na hango.
• Rashin amsa na asali akan EEG alama ce ta tasirin hangen nesa bayan kama zuciya.
• Satomatoss na Satomatik-da ke haifar da ɓarna na cortical N20 shine mai nuna alama na tsinkayar cuta bayan kama zuciya.
Sakamakon sakamakon EEG da Satitosensory na sanannun menu (ssep) ana daukar su a cikin mahallin jarrabawar asibiti da sauran gwaje-gwaje. Dole ne a ɗauki ƙwanƙolin Neuromuscular lokacin da ake yin la'akari da Ssep.
Biomarkers
• Yi amfani da ma'aunin nse a hade tare da sauran hanyoyin don yin hasashen sakamako bayan kama da Kindiac. Haɗin ƙimar da ake da shi a sa'o'i 24 zuwa 48 ko sa'o'i 72, haɗe da manyan dabi'u a 48 zuwa 72, nuna wani mummunan rikici.
Buri
• Yi amfani da karatun tunanin kwakwalwa don hango ko hasashen rashin daidaituwa game da kamuwa da ƙwaƙwalwar ƙwaƙwalwa a hade tare da wasu annabta da ƙwarewar bincike mai dacewa.
• Kasancewar ci gaban birnin edema, raguwar ragi a cikin kwakwalwa / farwada al'amari akan kwakwalwar kwakwalwa, ko yayyafa bambance bambance bambance na kwayar cuta.
• Ana bincika binciken na hangen nesa a hade tare da sauran hanyoyin don hango kan hangen nesa na neurological.
5. Dakatar da jiyya mai aminci
• Rarraba tattaunawar ƙwayoyin cuta game da karbuwar janyewar da ke jawo hankali na rayuwa mai dorewa. Yanke shawarar WLS ya kamata la'akari da fannoni ban da raunin kwakwalwa, kamar shekaru, comorbidity, aikin aikin, da zaɓi na haƙuri, da zaɓin haƙuri, da zaɓi na haƙuri.
Ware isasshen lokaci don sadarwa, hangen nesa na dogon lokaci bayan kama zuciya
Matsayin magani a cikin ƙungiyar yana ƙera da kuma • Gudanar da kimantawa na zahiri da kuma dangi. Gwajin da aka fara nufi da abubuwan da aka gyara don rashin ƙarfi na jiki kafin fitarwa da samar da ayyukan sake farfadowa lokacin da ake buƙata. (Hoto na 5).
• Shirya ziyarar bibiyar ga duk wadanda suka tsira da tsarewar zuciya a cikin watanni 3 na fitarwa, gami da masu zuwa:
- 1. Allo don tsananin matsaloli.
2. Screenctionwara don matsalolin yanayi da gajiya.
3. Bayar da bayani da tallafi ga waɗanda suka tsira.
6. Gudummawar kwayoyin
• Dukkanin yanke shawara game da gudummawar kwastomomi dole ne ya cika buƙatun shari'a da ɗabi'a.
• Ya kamata a yi la'akari da gudummawar kwayoyin halitta ga waɗanda suka haɗu da Rosc da haɗuwa da ƙa'idodi ga masu ilimin neurological (Hoto na 6).
• A cikin marasa lafiya marasa lafiya da ba su cika sharuddan da ba su da matsala a lokacin da ake zargi da su a lokacin da aka yanke don fara aikin ƙarshen-rayuwa da kuma dakatar da tallafin rayuwa.
Lokaci: Jul-26-2024