ʻO ka maʻi maʻi maʻi maʻi maʻi maʻi (Bottle-Cap Protocol) a me nā pilikia ulia pōpilikia¶

No ke kanaka e mālama ana i ka hemodialysis no ka hōʻino ʻana o ke kīkī (End-Stage Renal Disease, a i ʻole ESRD), ʻo kona arteriovenous (AV) fistula, AV graft, a i ʻole central venous dialysis catheter ʻo ia ko lākou ola kino, akā ʻo ia hoʻi he ʻauwaʻa puʻuwai kiʻekiʻe e hiki ke hoʻomake i ka exsanguination i loko o 3 mau minuke inā pono ke puhi ʻana. Hoʻopili pololei ʻia kahi fistula AV oʻo i ke aʻa i ke aʻa i loko o ka lima, e lawe ana i ka \(600\text{ a i }2,000\text{ milliliters}\) (\(0.6\text{ to }2.0\text{ liters}\)) o ke koko i hoʻokahe ʻia i kēlā me kēia minuke, ʻoi aku ia ma mua o ka hapakolu o ka puka o ka naʻau holoʻokoʻa o ke kino. I ka manawa like, ʻo ka hala ʻana i hoʻokahi a ʻelua mau kau hemodialysis (i ka wā o ka ʻino, ka pau ʻana o ka mana, a i ʻole ka maʻi) e hoʻoulu ai i ʻelua mau mea pepehi kanaka wikiwiki: ** hyperkalemia weliweli i ke ola (potasiuma koko)** hiki ke hoʻōki i ka puʻuwai me ka ʻole o ka ʻōlelo aʻo ʻana, a me ka ** acute uremic fluid overload (flash pulmonary edema)** e kahe ana i ka māmā. Pono ke kōkua mua i ke akamai i ka Pinpoint One-Finger / Bottle-Cap Pressure (ʻaʻole e ʻōwili i kahi kāwele nunui a puni ka fistula e kahe ana ke koko), e pale ana i ka lima dialysis mai nā kuʻekuʻe koko a i ʻole tourniquets, a me ka ʻike ʻana i ka nāwaliwali o ka hyperkalemia mua ma mua o ka paʻi ʻana o ka naʻau.

E hana i kēia i kēia manawa¶

1. No ka fistula AV e kahe ana a i ʻole ke kālai ʻia: E kaomi i hoʻokahi manamana lima a i ʻole ka pāpale ʻilika maʻemaʻe pololei ma luna o ka puka kiko. E kau i kou manamana nui a i ʻole ka manamana lima kuhikuhi (a i ʻole kahi gauze liʻiliʻi maʻemaʻe a i ʻole ka pāpale ʻōmole plastik) ma luna pono o ka lua o ka nila a i ʻole ka maʻi maʻi maʻi kahi e kahe ana ke koko. E hoʻopili i ke kaomi paʻa i lalo, e lawa pono e hoʻōki i ke kahe ʻana me ka ʻike ʻana i ka haʻalulu ("hauʻoli"**) o ke koko e kahe ana ma ka fistula ma lalo o kou manamana lima, a hoʻopaʻa mau iā ia me ka nānā ʻole ʻana no 15 a 20 mau minuke.
2. E kāhea koke i kāu helu pilikia kūloko ma ke kelepona leo a hoʻokiʻekiʻe i ka lima ma luna o ka pae naʻau. Kāhea i ka 911 ma United States a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom, a i ʻole e ʻike i nā mea āpau helu pilikia. E hoʻomoe i ka mea maʻi ** moe palahalaha ma kona kua** ma ka papahele a i ʻole kahi moe (i ʻole lākou e maule a huki i ko lākou lima mai kou manamana lima) a paʻa i ka lima koko ** i hoʻokiʻekiʻe ʻia ma luna o ke kiʻekiʻe o ko lākou puʻuwai**. ʻOiai inā pau ke kahe koko ma hope o 15 mau minuke ma ka home, pono e loiloi ʻia kēlā me kēia puka ma hope o ka dialysis i ka blow-out a i ʻole scab rupture i loko o kahi Keʻena Emergency, no ka mea, hiki ke poha ka paia aneurysm lahilahi (pseudoaneurysm) i ka wā hiamoe i kekahi mau hola ma hope.
3. Mai hoʻohana i ka tourniquet ke ʻole e make ana ka mea maʻi i ka hemorrhage hiki ʻole ke hoʻopaʻa ʻia a ua hāʻule loa ke kaomi kiko pololei. ʻO ka hoʻopili ʻana i ka tourniquet a i ʻole ke kaomi ʻana i ke koko i kahi maʻi maʻi e hiki ai ke hoʻopaʻa i ka lima a hoʻopau i ke kaula ola o ka mea maʻi. Eia naʻe, "Life Comes Before Limb or Fistula": inā hāmama ākea ka aneurysm fistula degenerated a ʻaʻole hiki i ke kaomi kiko ke hoʻomalu i ke kahe koko weliweli me ka haʻalulu, e hoopili i ka windlass tourniquet luna (kokoke) ka fistula ma ka poohiwi no ka hoopakele ana i ke ola o ka mea mai (e nana kahe koko).
4. No ka Central Venous Dialysis Catheter (Permcath / Vas-Cath ma ka umauma a i ʻole ka ʻāʻī): E hoʻopaʻa i ka paipu a hoʻomoe koke i ka mea maʻi ma ko lākou ʻaoʻao hema. Inā hāʻule ka pāpale mai ka catheter dialysis o ka umauma a i ʻole ka ʻāʻī a hāmama paha ka paipu plastik, hiki ke omo ʻia ka ea i loko o ka puʻuwai (venous embolism) ʻoiai e kahe ana ke koko:
5. ** ʻomi koke i ka paipu catheter e pani me kou manamana lima** (a i ʻole e hoʻopaʻa i ka paʻi paheʻe paheʻe plastik ma ka catheter i pani ʻia, a i ʻole e peʻe a hoʻopaʻa paʻa i ka paipu i ka hapalua).
6. E hoʻomoe i ka mea maʻi palaha ma ko lākou ʻaoʻao HAE me ko lākou poʻo e hili iki i lalo (Durant's / left lateral Trendelenburg position) no ka paʻa ʻana i nā ʻōhū ea me ka palekana ma ka atrium ʻākau mai ka māmā, a kāhea aku iā 911 / 112 / 999.
7. **No ka mea maʻi maʻi maʻi dialysis me ka nāwaliwali o ka wāwae, ʻeha, ka puʻupuʻu lohi, a i ʻole nā ​​hōʻailona o ka umauma: E kelepona iā 911 / 112 / 999 no "Suspected Hyperkalemia." ** Ke piʻi ka potassium ma luna o \(6.5\text{ a i }7.0\text{ mmol/L}\) (\(mEq/L\)) ma hope o ka nalowale ʻana o ka maʻi dialysis, hoʻopau ia i ka ʻiʻo uila a hoʻopau ʻia ka puʻuwai. Mai ʻae i ka mea maʻi e ʻai a inu i kekahi mea, a noi koke i nā paramedics me kahi **12-lead ECG a me intravenous calcium gluconate / calcium chloride **.
8. **No ka mea maʻi maʻi dialysis ʻaʻole e ʻae ana i ka ea me ka nui o ka wai: E hoʻopaʻa pololei iā lākou ma 90 degere me nā wāwae e kau ana i lalo. ʻO ka noho pololei ʻana me nā wāwae e kau ana i lalo, ʻo ia ka nui o ka wai i loko o nā wāwae mai ka māmā aʻo ke kaʻa kaʻa kaʻa e holo wikiwiki ai i ka hemodialysis pilikia.

ʻO ka lāʻau hoʻoholo pilikia pilikia a me ka dialysis¶

E hoʻohana i kēia palapala hoʻokahe lapaʻau no ka pane ʻana i kekahi pilikia pilikia a i ʻole pilikia metabolic i loko o kahi maʻi hemodialysis a peritoneal dialysis.

flowchart TD
    Start["ʻO ka ulia pōpilikia i loko o kahi maʻi dialysis<br/>(Hemodialysis AV Fistula, Graft, Catheter,<br/>a i ʻole Session Dialysis i hala)"] --> CrisisType{"He aha ka pilikia nui i kēia manawa?"}

    CrisisType -->|"1. Ke koko mai ka Arm AV Fistula a i ʻole Graft"| FistulaBleed["HEMODIALYSIS ACCESS HEMORRHAGE PROTOCOL:<br/>1. E kaomi pololei i KE ONE FINGER a i ʻole BOTTLE CAP ma ka puka kikoʻī<br/> (ʻAʻole loa e kāwele i ke kāwele ʻauʻau nui a puni ka lima)<br/>2. E hoomoe i ka ma'i palahalaha; e hoʻokiʻekiʻe i ka lima ma luna o ka pae puʻuwai<br/>3. Kāhea iā 911 / 112 / 999 ma ke kelepona leo<br/>4. E hoʻopaʻa i ke kaomi haʻihaʻi ʻole 15-20 mins (NO PEEKING)<br/>5. E hele i ER no ka nānā ʻana i ka ʻauʻau ʻana i ke koko inā pau ke koko"]

    CrisisType -->|"2. Wehe, māwae, a i ʻole ke koko ʻāʻī"| CathEmerg["CENTRAL DIALYSIS CATHETER EMERGENCY:<br/>(Risk of Venous Air Embolism & Hemorrhage)<br/>1. Hoʻopaʻa paʻa paʻa paʻi kiʻi paheʻe a i ʻole kink/pinch tube <br/> (Pili ma waena o ka māwae/hope hāmama a me ka umauma o ka mea maʻi)<br/>2. E uhi i ka pahu me ka gauze sterile; Mai hoʻohana i nā ʻoki kokoke i ka paipu<br/>3. E hoʻomoe i ka mea maʻi ma ka ʻaoʻao hema me ke poʻo haʻahaʻa inā e omo ʻia ka ea<br/>4. E kelepona iā 911 / 112 / 999 koke"]

    CrisisType -->|"3. Haʻalele 'ia ka Dialysis + Kaumaha/Nawaliwali Wawae, <br/>Tingling lehelehe/Manamana, lohi/Iregular Pulse"| HyperK["HIPERKALEMIA HOPE OLA (Potassium Kiʻekiʻe):<br/>1. Kāhea iā 911 / 112 / 999: Hōʻike 'ia ka maʻi maʻi me Hyperkalemia'<br/>2. Noi i ka Ambulance ALS no 12-Lead ECG + IV Calcium Rescue<br/>3. NPO ikaika (Zero food/wai); e lawe i ka Emergency Resin Binder WALE<br/> inā ala a kuhikuhi ʻia ma ka Disaster Action Plan"]

    CrisisType -->|"4. Nalo ʻia ka Dialysis + ʻAhu no ka Ea,<br/>ʻAi ʻAka ʻAka Huhu, ʻAʻole hiki ke moe palahalaha"| FluidOverload["FLASH PULMONARY EDEMA (Hoʻonui Wai Koʻikoʻi):<br/>1. E kelepona iā 911 / 112 / 999 koke<br/>2. E noho ma'i BOLT UPRIGHT (90 degere) me nā wāwae e lele ana i lalo<br/>3. Hāʻawi i ka oxygen kahe nui / sublingual nitroglycerin inā kauoha ʻia"]

    CrisisType -->|"5. ʻO ke kuni/ʻaʻahu + ʻulaʻula ʻula a i ʻole<br/>Cloudy Peritoneal Dialysis Drain Bag + ʻEha ʻōpū"| DialSepsis["CATHETER SEPSIS A I ʻole PD PERITONITIS:<br/>Keʻena Kūikawā i kēia manawa no nā moʻomeheu wai koko/PD<br/>a me nā lāʻau Antibiotic Intravenous a Intraperitoneal koke."]

Māhele 1: Hoʻopau i kahi AV Fistula Pohō i ke ola a i ʻole Graft Bleed (Pinpoint Finger & Bottle-Cap Protocol)¶

No ke aha i kahe nui ai ke koko o ka dialysis fistulas (a no ke aha he mau pana manawa ka scabs shiny)¶

I loko o ka hemodialysis ʻekolu manawa o ka pule, ua hoʻokomo ʻia ʻelua mau nila nui \(14\text{- a i }16\text{-gauge}\) i loko o ka maʻi ʻokiʻoki arteriovenous (AV) fistula (he aʻa maoli i humuhumu pololei ʻia i kahi vein ma ka pulima lima a i ʻole ka lima kiʻekiʻe) a i ʻole AV graft (he mea maʻi i hoʻohui ʻia he ʻaʻa PTFE) hoʻoheheʻe koko heparin no laila ʻaʻole e paʻa ko lākou koko i ka mīkini dialysis.

ʻElua ʻano ʻokoʻa o ka fistula bleeding ma waho o ke keʻena: 1. Mahope o ka Dialysis Needle-Site Re-Bleed (First 1 to 6 Hours Home): Ma hope o ka haʻalele ʻana i ke kikowaena dialysis, hemo ka palaka platelet hou e hoʻopaʻa ana i kekahi o nā lua o ka nila ʻelua i ka wā e hāpai ai ka mea maʻi i nā mea kūʻai, kukuli i kona lima, ʻū, a i ʻole ke kuʻi hewa ʻana i ka lipine, ʻoiai e kahe ana ka heparin i ke koko. 2. Late Spontaneous Aneurysm / Pseudoaneurysm Rupture (The "Shiny Black Scab" Emergency): I nā mahina a i ʻole mau makahiki o ka hoʻopaʻa pinepine ʻana ma ka wahi hoʻokahi, hiki i ka paia o ka fistula a i ʻole ke kālai ʻia ke kikoo aku i loko o kahi aneurysm a i ʻole pseudoaneurysm. Inā lilo ka ʻili ma luna o kēlā puʻupuʻu i ** ʻiʻikiʻi pepa, paʻa, ʻālohilohi, depigmented, ʻulaʻula, a i ʻole e ulu ana i kahi ʻeleʻele ʻeleʻele (eschar) ʻaʻole hoʻōla no nā pule**, ua ʻā maoli ka paia o ka moku arterialized ma ka ʻili. Inā hāʻule kēlā pehu ʻeleʻele i loko o ka ʻauʻau a i ʻole i ka wā e hiamoe ai, e lele ana kahi kolamu koko kiʻekiʻe ma waena o ka lumi.

Kaʻanuʻu-a-Kaʻina: ʻO ke ʻano Pinpoint One-Finger and Bottle-Cap Method¶

E hahai i ka protocol vascular access hemorrhage official i aʻo ʻia e ka National Kidney Foundation (NKF), Kidney Care UK / UK Kidney Association, a me ka Vascular Access Society:

1. E hōʻike i ka lua pololei (E wehe i nā kāwele i hoʻoheheʻe ʻia i ke koko):
2. ʻAʻole hiki iā ʻoe ke hoʻōki i kahi jet pinpoint kiʻekiʻe inā e kaomi makapō ʻoe i kahi puʻu lole pulu. E nānā pono i ka ʻili o ka fistula e ʻike i ka puka pololei \(1\text{- a }3\text{-millimeter}\) kahi e kahe ana ke koko.
3. E hoʻopili i ke kaomi ʻo Pinpoint me hoʻokahi manamana lima, manamana lima, a i ʻole kahi pāpale omole maʻemaʻe:
4. Kō koho A (Hoʻolima / Puni lima): E ʻoluʻolu i kahi ʻāpana liʻiliʻi o ka gauze sterile (a i ʻole e hoʻohana i kou manamana lima maʻemaʻe / manamana lima kuhikuhi inā ʻaʻohe gauze hiki ke hiki) a kaomi i ka ** pololei i lalo ma luna pono o ka lua kiko**.
5. Kō koho B (Ka ʻĀpana Puka Puka Puka Maʻemaʻe): Hāʻawi ka nui o nā ʻāpana dialysis i nā poʻe maʻi me ka Fistula Clamp a i ʻole ke aʻo ʻana i ka Clean Plastic Bottle-Cap Method (me ka hoʻohana ʻana i kahi pāpale wili maʻemaʻe maʻemaʻe mai ka wai a i ʻole ka ʻōmole soda, a i ʻole kahi pilikia * HemCon / Celox* hemostatic pad):
   • ʻO ke kaomi pono ʻana i kahi pāpale ʻōmole maʻemaʻe ma luna o kahi pā liʻiliʻi ma ka wahi o ka puncture e paʻa ai ka paʻa ʻana o ke kaomi ʻana i ke apo o \(2\text{-centimeter}\) me ka ʻole o ka haki ʻana i ka laula holoʻokoʻa o ka lima, a e hōʻemi ana i ka luhi manamana lima i ke kali ʻana i 15 mau minuke no ke kaʻa kaʻa.
   • (E hoʻomanaʻo: E noho mau me ka mea maʻi a paʻa mau i ka pāpale omole a i ʻole ka manamana lima ma ka lima; mai hoʻopaʻa paʻa i kahi pāpale ʻoʻoleʻa a puni ka pōʻai o ka lima a hele aku, no ka mea, hiki i ke koko ke hahai ma ka ʻaoʻao ma lalo o ka ʻili i loko o kahi hematoma nui inā paʻa ka pāpale ma waena.)
6. E hoʻopololei i kou kaomi ("Stop the Bleed, Keep the Thrill"):
7. E kaomi ikaika a hiki i ka ** ʻaʻohe koko e kahe mai lalo o kou manamana lima**.
8. Inā hiki, e kaomi ikaika e sila ai i ka puka ma ka paia o luna o ka fistula me ka ʻole o ka hoʻopaʻa ʻana i ka paia o lalo: pono ʻoe e ʻike i ka haʻalulu haʻahaʻa (ka hauʻoli) ma lalo o kou manamana lima. Eia naʻe, inā hoʻomau ke kahe ʻana o ke koko, e kaomi ikaika a hiki i ka pau ʻana o ke koko, no ka mea, ʻo ka hoʻōki ʻana i ke koko mau ka mua.
9. E hoʻonoho i ka maʻi ma luna o ko lākou kua a hoʻokiʻekiʻe i ka lima:
10. E hoʻomoe koke i ka mea maʻi ma ka papahele a i ʻole ka sofa. ʻO ka lilo koke o ke koko ke kumu e maule koke ai (vasovagal a hemorrhagic syncope); inā e kū ana ka mea maʻi ma kahi lua ʻauʻau i ka wā e maule ai, e haehae lākou i ko lākou lima mai kou lima a paʻi i ko lākou poʻo.
11. E hoʻokiʻekiʻe i ka lima dialysis ma luna o ke kiʻekiʻe o ka puʻuwai e hōʻemi i ke kaomi venous a me ka hydrostatic i loko o ka fistula.
12. Hoʻopaʻa i ke kaomi ʻole no 15 a 20 mau minuke piha (ʻaʻole e nānā mua):
13. Nānā i ka uaki. E hoʻopaʻa i kou manamana lima no ka liʻiliʻi loa 15 a 20 mau minuke mau a hiki i ka poʻe lapaʻau e hōʻea a lawe i luna.
14. Mandatory Hospital Loiloi ʻOiai inā pau ke koko:
15. Mai hoʻopau i ke kaʻa kaʻa a noho i ka home ma hope o ka pau ʻana o ke koko fistula. Inā he pseudoaneurysm pā lahilahi a i ʻole ka maʻi i hoʻopili ʻia i ke koko, ʻo ka ʻōpala palupalu i hana ʻia ma lalo o kou manamana lima e puhi pinepine ʻia i 2 mau hola ma hope me ka hemorrhage make. Pono ke kauka lapaʻau vascular e loiloi i ke komo koke ʻana no ka hoʻoponopono hou ʻana, kahi hoʻokomo stent-graft, a i ʻole ligation.

ʻO nā hōʻailona hōʻailona o ka Fistula Rupture e hiki mai ana (I ka manawa e hele ai i ka ER ma mua o ke koko)¶

E nānā i ka dialysis AV fistula a i ʻole graft i kēlā me kēia lā. E hele i ke Keʻena ʻĀkau a i ʻole e kelepona i kāu Vascular Access Surgeon i ka lā hoʻokahi (ma mua o ka hū ʻana) inā ʻike ʻoe i kekahi o kēia mau "Pre-Rupture Red Flags":

ʻO ka "ʻekolu mau lula" no ka pale ʻana i kahi lima komo dialysis¶

No ka mālama ʻana i ka fistula mai ʻoki ʻia a i ʻole ke koʻokoʻo ʻana i ka wā o kekahi kūlana olakino a kōkua mua paha: - ** ʻAʻole loa e lawe i ka heluhelu ʻana i ke koko** ma ka lima me ka fistula AV a i ʻole ke kāpili ʻana (a ʻaʻole loa e lawe i ka BP ma kahi lima kahi i hoʻolālā ʻia ai kahi fistula e hiki mai ana). - ʻAʻole e huki koko a hoʻomaka i kahi laina intravenous (IV) ma ka lima e hiki ai i ka dialysis. - ** MAI ʻae i nā ʻeke kiaʻi paʻa, nā lima lima lohi, nā ʻeke, nā ʻeke kūʻai, a i ʻole e moe me ke poʻo e kau ana ma kēlā lima.**

Mahele 2: ʻAʻole i loaʻa i nā pilikia pilikia: Hyperkalemia a me Flash Pulmonary Edema¶

Kānā nā puʻupaʻa olakino 150 a 180 lita o ke koko i kēlā me kēia lā, e hoʻokuʻu ana i ka meaʻai nui ** potasium (\(K^+\)), wai, sodium, ʻakika, a me nā meaʻala uremic. ʻO ka mea maʻi hemodialysis e hana ana i ka mimi liʻiliʻi a i ʻole ʻole (anuric) e hilinaʻi piha ʻia i kā lākou mau manawa dialysis 4-hola ʻekolu manawa o ka pule (Poʻakahi/Poʻakolu/Pāʻalima a i ʻole Pōʻalua/Poaha/Pāʻaʻa). Ke hala ka mea maʻi i hoʻokahi a ʻelua mau kau dialysis (a i ʻole i ka manawa lōʻihi he 72 hola ma waena o ka Pōʻalima/Pāʻaono a me ka Pōʻakahi/Poalua), ʻelua mau hanana pilikia e ulu wikiwiki ana:

1. ʻO ka Hyperkalemia Hoʻoweliweli (High Blood Potassium, ka "Silent Heart Stopper")¶

Hoʻopaʻa paʻa ʻia ka pāpaʻa koko maʻamau ma waena o \(3.5\text{ a me }5.0\text{ mmol/L}\) (\(mEq/L\)). Ke piʻi ka potassium ma luna o \(6.0\text{ a i }6.5\text{ mmol/L}\) ma hope o ka hala ʻana o ka manawa dialysis (a i ʻole ma hope o ka ʻai ʻana i nā meaʻai kiʻekiʻe-potassium, nā ʻeha ʻeha o ka ʻiʻo, ke kahe ʻana o ka ʻōpū, a i ʻole ka lawe ʻana i ka ACE inhibitors/spironolactone/NSAIDs), hoʻoneʻe ia i ka hoʻomaha ʻana o ka uila uila (** nā cell cardioomyo).

No ke aha e pilikia ai ka Hyperkalemia: ʻAʻole like me ka hapa nui o nā maʻi, ** hiki i ka hyperkalemia ke hoʻopiʻi i ka maʻi puʻuwai make hikiwawe (sine-wave ventricular fibrillation or asystole) me ka ʻaneʻane ʻaʻohe ʻōlelo aʻo mua**, a i ʻole hiki ke hoʻohālike i kahi pilikia neurological e like me Guillain-Barre syndrome: - Nā hōʻailona ʻāpala Neuromuscular (Holo pinepine): - Ke kani ʻana a i ʻole "nā pine a me nā nila" (paresthesias) a puni nā lehelehe, ke alelo, nā lima, a me nā wāwae. - Ke piʻi wikiwiki nei ka nawaliwali o ka wāwae (Hyperkalemic Flaccid Paralysis): Manaʻo koke ka mea maʻi ua "hana ʻia ko lākou mau wāwae i ke kēpau," ʻaʻole hiki ke kū i luna mai kahi noho a moe paha, a piʻi ka nāwaliwali i ke kumu a me nā lima. - ʻO ka nausea nui, ka luaʻi, a i ʻole ka ʻōpū o ka ʻōpū. - Nā hōʻailona hōʻailona puʻuwai: - Ka lohi ʻana o ka naʻau (bradycardia), lele i ka puʻuwai, palpitations, poni, a maule paha. - Ma ka 12-lead ECG a ka mea lapaʻau, ʻo ka piʻi ʻana o ka potassium e hoʻokumu i kahi holomua maʻamau: ** kiʻekiʻe, "nā hawewe T kiʻekiʻe" ** \(\'ākau\) palahalaha/ʻaʻole nā ​​hawewe P a lōʻihi ka manawa PR \(\rightarrow\) ākea QRS complex \(\rightarrow\) he mea make "ʻo ka hawewe kino ma mua o ka" kumu

Pehea nā Paramedics a me nā Halemai e mālama ai i kahi maʻi Hyperkalemic i nā minuke: Ke haʻi aku ʻoe i ka mea hoʻouna 911/112/999 * "ʻO ka mea maʻi maʻi dialysis i hala ʻole i ka mālama ʻana me ka nāwaliwali o ka wāwae a me ka hyperkalemia i manaʻo ʻia," * hana nā paramedics a me nā kauka pilikia i kahi kaʻina hoʻopakele ola ʻekolu. 1. Hoʻopaʻa i ka ʻiʻo o ka naʻau i loko o 1 a 3 mau minuke: Intravenous Calcium Gluconate (\(10\%\), \(10\text{ to }30\text{ mL}\)) a i ʻole Calcium Chloride ʻaʻole ia e hoʻohaʻahaʻa i ka potassium i loko o ke koko, akā ** pale koke i ka ʻiʻo o ka naʻau. 2. Hoʻololi i ka pāpaʻa i loko o 15 a 30 mau minuke: Insulin maʻamau (\(10\text{ units}\)) i hoʻopaʻa ʻia me ka dextrose intravenous (glucose)**, nebulized nui i ka nui **albuterol (salbutamol, \(10\text{ a i }20\text{ mg}\)) ** hoʻi ke kahe koko i loko o ke kino no kekahi manawa. 3. Hoʻoneʻe mau i ka pāpaʻa mai ke kino: ʻO nā mea hoʻopaʻa pāpaʻa o ka ʻōpū o ka waha (sodium zirconium cyclosilicate [Lokelma], patiromer [Veltassa], a i ʻole sodium polystyrene sulfonate [Kayexalate]) a me emergent hemodialysis (ka lāʻau paʻa).

2. Acute Fluid Overload (Flash Pulmonary Edema) a me Uremic Pericarditis¶

Me ka loaʻa ʻole o ka mimi kīkī, ʻo kēlā me kēia kīʻaha wai, sopa, hau, a i ʻole nā huaʻai e ʻai ai ka mea maʻi dialysis e noho pololei i loko o ko lākou kahe koko a me nā ʻiʻo. Ma hope o ka hala ʻana o 1 a 2 mau lāʻau dialysis, hiki i 3 a 6 mau lita o ka wai nui ke hoʻi hou i loko o ka māmā (acute cardiogenic/volume pulmonary edema) a puni ka puʻuwai (uremic pericarditis / cardiac tamponade): - Nā hōʻailona o ka Flash Pulmonary Edema: - ʻO ka pōkole loa o ka hanu e hiki ʻole ai ke moe palahalaha ma kahi moe (orthopnea). - ʻO ka ʻūhū ʻana i ka ea, ka uwē ʻana (" hānō naʻau "), ka ʻūhū ʻana a i ʻole ke kani ʻana o ka hanu, a me ka keʻe ʻana i ka ʻulaʻula, ka huʻihuʻi o ka huʻa. - ʻO ka pehu nui (edema) ma nā kuʻekuʻe wāwae, nā wāwae, ke kua lalo, a puni nā maka, i hui pū ʻia me ka piʻi ʻana o ke koko ma mua o \(180/110\text{ mmHg}\). - Nā hōʻailona o ka Uremic Pericarditis: - ʻOi aku ka ʻeha o ka umauma ma hope o ka iwi umauma e ʻoi aʻe ka ʻino i ka moe ʻana ma ke kua a e hoʻomaikaʻi i ka wā e noho ai a kūlou i mua. - Hoʻonoho koke i ke kōkua mua no ka hoʻonui ʻana i ka wai: - E noho pololei ka mea maʻi ma kahi kihi 90-degere me nā wāwae ʻelua e kau ana i lalo ma ka ʻaoʻao o ka moena a i ʻole ka noho. Paʻa ʻo Gravity ma kahi o \(500\text{ a }800\text{ milliliters}\) o ke koko venous ma nā wāwae haʻahaʻa ma mua o ka hoʻokuʻu ʻana i ke kahe ʻana i loko o nā māmā paʻa. - Mai hoʻokiʻekiʻe i nā wāwae o ka mea maʻi maʻi dialysis i hoʻopiha ʻia i ka wai, a ʻauʻa i nā wai waha āpau i ke kali ʻana i ke kaʻa kaʻa.

Ke ola pōʻino: ʻO ka "3-Day Low-Potassium, Fluid-Restricted Emergency Diet"¶

I ka wā o nā makani pāhili, nā waikahe, nā hau, a me nā ʻeleʻele mana ke pani ʻia nā keʻena dialysis no 48 a 72 mau hola, ma hope o ka National Kidney Foundation (NKF) a me Centers for Disease Control and Prevention (CDC) "3-Day Emergency Renal Diet" mālama i ka wai pālolo a me ka māmā i nā pae ola a hiki i ka hoʻomaka ʻana o ka dialysis:

Nā pilikia kūikawā i nā maʻi Peritoneal Dialysis (PD): Cloudy Bag Peritonitis¶

ʻO nā poʻe maʻi e hana nei Peritoneal Dialysis (PD) ma ka home me ka hoʻohana ʻana i ka catheter silicone palupalu i loko o ko lākou ʻōpū (Tenckhoff catheter) ke alo i kahi pilikia kū hoʻokahi i kapa ʻia ʻo PD Peritonitis: - Pehea e ʻike koke ai: E nānā i loko o ka ʻeke hoʻoheheʻe paʻakai maʻemaʻe ma hope o kēlā me kēia hoʻololi. ʻO ka maʻamau, ʻike maopopo ʻia ka wai dialysis peritoneal (efluent) e like me ka mimi melemele ʻeleʻele (pono ʻoe e heluhelu pono i ka paʻi nūpepa ma o ka ʻeke piha). Inā ʻeleʻele ka wai i hoʻokahe ʻia, he waiu, ʻeleʻele, a ʻulaʻula paha, A i ʻole inā loaʻa ka mea maʻi i ka ʻeha o ka ʻōpū, palupalu, nausea, a i ʻole ke kuni, e noʻonoʻo i ka Acute Bacterial Peritonitis. - Hana koke: 1. E mālama i ka ʻeke hoʻoheheʻe wai ʻōhuhi (paʻi a lawe pū me ʻoe i ka haukapila a i ʻole ke keʻena PD i hiki i nā kahu hānai ke huki pololei i ka wai mai ka ʻeke no ka helu cell a me ka moʻomeheu bacteria). 2. Kāhea i kāu 24-hola Peritoneal Dialysis Nurse / On-Call Nephrologist a i ʻole e hele koke i ke Keʻena Emergency no intraperitoneal (IP) a i ʻole nā ​​​​antibiotic intravenous. 3. Inā ʻoki ʻia ka catheter PD a hemo ʻole ka hoʻonohonoho hoʻoili ʻana ma ka maʻemaʻe a i ʻole i ka lepo: E hoʻopaʻa koke i ka plastik keʻokeʻo Beta-Clamp (a i ʻole e kuʻi i ka paipu catheter palupalu ma waena o ka haʻi a me ka ʻili o kou ʻōpū), e uhi i ka welau me ka gauze sterile, ʻaʻole e ninini i ka wai i loko o ka paipu hāmama, a hele koke i kāu PD/transfer set a me ka lumi hoʻololi pilikia. nā lāʻau lapaʻau prophylactic.

ʻO ka palapala kamaʻilio pololei no 911 / 112 / 999 a me ka Hospital Triage¶

• No ka AV Fistula a i ʻole Graft Bleed:

  • "Makemake au i kahi kaʻa kaʻa pilikia ma [Exact Address]. ʻO ka mea maʻi he maʻi hemodialysis nona ka lima AV [fistula / graft] i haki a kahe nui ke koko. Ke paʻa nei au i ke kaomi pololei ʻana o ka manamana lima ma ke kahua o ka nila, ua kau i ka mea maʻi i pālahalaha, a hoʻokiʻekiʻe i ka lima ma luna o ka puʻuwai.

• No ka mea maʻi i hala ʻole ʻia me ka maʻi i manaʻo ʻia i ka Hyperkalemia a i ʻole ka nui o ka wai:

  "Makemake au i kahi kaʻa kaʻa pilikia ma [Exact Address] no ka mea maʻi hemodialysis nona ka manawa dialysis hope loa i [X] mau lā i hala aku nei ma [La. a hāʻawi koke aku i ka calcium gluconate i loko o ke koko."

Ka papa helu hoʻopaʻa ʻeke hele ulia pōpilikia maʻi dialysis¶

• Nā kope o kāu Pepa Lapaʻau Hemodialysis hou loa ("Run Sheet"): Hōʻike i kāu ** Kaumaha maloʻo (kaumaha i hoʻopaʻa ʻia)**, ka nui kānana dialyzer, ka holo kahe o ke koko, ka ʻauʻau ʻauʻau dialysate potassium, a me ka nui o ka heparin i hiki i nā halemai pilikia ke hoʻopaʻa palekana iā ʻoe.
• ** 2 a 3 mau pāpale ʻōmole maʻemaʻe maʻemaʻe, \(4\times4\) pad gauze, a me kahi pad hemostatic pāʻoihana (ChitoGauze / Celox)** i loko o kāu ʻeke a ʻeke i nā manawa a pau.
• He mea hoʻopaʻa paʻa paʻakiki maʻemaʻe (catheter clamp) inā he umauma a i ʻole kou ʻāʻī Permcath, a i ʻole he Beta-Clamp keʻokeʻo inā aia ʻoe ma ka Peritoneal Dialysis.
• ** ʻO nā ʻeke hoʻopaʻa hoʻohaʻahaʻa hoʻohaʻahaʻa potassium i kuhikuhi ʻia no 3 lā no ka pilikia ** (sodium zirconium cyclosilicate [Lokelma] a i ʻole patiromer [Veltassa]) a me nā mea hoʻopaʻa phosphate.

Nīnau pinepine¶

No ke aha e hiki ai i ka poʻe maʻi ke kahe koko a make?¶

ʻO ka fistula arteriovenous (AV) lawe i ke koko ʻaʻa ma lalo o ke kaomi kiʻekiʻe ma 600 a 2,000 milliliters i kēlā me kēia minuke ma o kahi puka liʻiliʻi 1-a-2-milimita o ka ʻili. ʻO ke kāwele ʻana i kahi kāwele ʻauʻau mānoanoa a puni ka lima e hūnā i ka wahi kahe mai ka ʻike ʻana a hoʻolaha nāwaliwali i ke kaomi ma kahi ākea ma mua o ka hoʻopaʻa ʻana i ka lua liʻiliʻi. I loko o 3 a 5 mau minuke, hiki i ka mea maʻi ke lilo i ka hapalua o ko lākou koko i loko o ke kāwele a loaʻa i ka hopu ʻana i ka naʻau. E nānā mau i ka ʻeha a pēhi i KEKAHI manamana lima, manamana lima, a i ʻole ka pāpale ʻili maʻemaʻe pololei ma ka lua pololei no 15 a 20 mau minuke mau.

Inā ho'ōki ke koko ma hope o 15 mau minuke o ke kaomi manamana lima ma ka home, no ke aha e pono ai au e hele i ke keʻena pilikia?¶

ʻO ke kahe ʻana o ke koko mai kahi fistula dialysis a i ʻole ka hoʻoheheʻe ʻana ma waho o ke keʻena keʻokeʻo pinepine ʻia ma muli o ka lahilahi a me ka ʻai ʻana o kahi paia aneurysm lalo a i ʻole kahi maʻi moku huna. ʻOiai i ka wā e hoʻopaʻa ai ka ʻāʻī liʻiliʻi i ka puka kiko ma lalo o kou manamana lima, ʻo ke kaomi ʻana o ke aʻa kiʻekiʻe i loko o ka fistula e paʻi pinepine i waho i kekahi mau hola ma hope, pinepine i ka wā e hiamoe ana ka mea maʻi ma kahi moe. Pono e nānā koke ʻia ke koko fistula home a pau i loko o ke keʻena ulia pōpilikia e kekahi loea vascular.

Pehea e hiki ai iaʻu ke haʻi aku inā loaʻa i ka poʻe i hala ʻole ke kau maʻi maʻi maʻi pāpaʻi (hyperkalemia)?¶

Hoʻopau ka potassium i ke koko kiʻekiʻe i ka excitability uila o nā aʻalolo a me nā ʻiʻo ma mua o ka pau ʻana o ka naʻau. E makaʻala no ka nawaliwali koke o nā wāwae ʻelua (paʻakikī ke kū i luna a i ʻole ka hele ʻana), ka ʻūlū a i ʻole ke kani ʻana a puni nā lehelehe, ke alelo, nā lima, a i ʻole nā ​​wāwae, ka nausea i wehewehe ʻole ʻia, a i ʻole ka puʻuwai lohi a i ʻole ka maʻamau. No ka mea hiki i ka hyperkalemia ke hoʻopio koke i ka naʻau i kēlā me kēia manawa, e kāhea koke iā 911/112/999 i hiki i nā mea lapaʻau ke hana i kahi ECG a lawelawe i ka calcium intravenous intravenous.

He aha kaʻu e hana ai inā puka mai ka ʻeleʻele ʻeleʻele ma luna o kahi puʻupuʻu ma kahi fistula dialysis?¶

ʻO ka pehu ʻeleʻele ʻeleʻele (eschar), ka ʻili ʻili pepa ʻālohilohi, ʻulaʻula, a i ʻole kulu liʻiliʻi o ke koko e kahe ana a puni ka pehu kahiko ma luna o kahi fistula AV puʻupuʻu a i ʻole grafft he hōʻailona hōʻailona hōʻailona e hiki mai ana i ka pōʻino. Mai ʻohi, ʻohi, a holoi ʻino paha i ka pehu, mai ʻae i kekahi e hoʻokomo i ka nila dialysis ma loko a kokoke paha i kēlā pehu, e mālama i kahi pāpale ʻōmole maʻemaʻe a me ka gauze ma kou lima, a hele pololei i ke keʻena pilikia a i ʻole kāu kauka lapaʻau i ka lā hoʻokahi i hiki ke hoʻoponopono ʻia ka pā ma mua o ka naha ʻana.

Nānā ʻia nā kumu¶

• National Kidney Foundation (NKF, United States): KDOQI Clinical Practice Guideline for Vascular Access: 2019 Update (Lok et al., American Journal of Kidney Diseases, hooponopono ulia pōpilikia o AV fistula/graft hemorrhage, pseudoaneurysms, a me ka pahu-cap / pinpoint Chronic Guide no ka hoʻolālā ʻana no ka *NKF pressure technique) ʻO ka maʻi ʻāʻī *.
• ** ʻAhahui Kidney UK (UKKA), Vascular Society of Great Britain and Ireland (VSGBI), a me British Society of Interventional Radiology (BSIR):** Life-Threatening Haemorrhage from Arteriovenous Vascular Access: Bottle-Cap / Pinpoint Pressure Patient Safety Alert and Clinical Guidelines.
• European Resuscitation Council (ERC) and American Heart Association (AHA): Alakaʻi no ka Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: Electrolyte Abnormalities and Life-Threatening Hyperkalemia in Dialysis Patients.
• Ka Hui Kaiapuni no ka Peritoneal Dialysis (ISPD): *Nā Manaʻo Alakaʻi ISPD Peritonitis: 2022 Hōʻano hou no ka Kāohi ʻana a me ka Lapaʻau * (Li et al., Peritoneal Dialysis International).
• Na Center for Disease Control and Prevention (CDC, United States) & Kidney Community Emergency Response (KCER): Emergency Prepared and 3-Day Renal Disaster Diet for Hemodialysis ma'i.

Nā alakaʻi pili¶

• Ka hoʻomalu ʻana i ke koko, hoʻopaʻa ʻeha, a me nā tourniquets
• ʻO ka ʻeha puʻupaʻa koʻikoʻi, rhabdomyolysis, a me ka hoʻāʻo ʻana o ka mimi ʻeleʻele
• ʻO Sepsis a me ka ʻike haʻalulu septic a me ka pane ulia pōpilikia
• Ka ʻike haʻalulu a me ka mālama ʻana i ke kōkua mua
• ʻO ka hoʻōla ʻana o ka puʻuwai puʻuwai (CPR) a me ke alakaʻi AED