Hoʻomākaukau no nā pōʻino no nā mea hoʻohana i ka pauma Insulin a me nā maʻi Dialysis: Hoʻololi ʻana i ka Syringe Manual a me ka ʻai pālolo.¶

Ke hāʻule ka makani ʻino, ka waikahe, ka hoʻokuʻu ʻana i ke ahi, a i ʻole nā lā uila uila he nui, ʻo ka poʻe e noho ana me ka maʻi diabetes-pili i ka insulin a i ʻole ka maʻi ʻāʻī hope o ka pae hope e kū koke i ka pōʻino metabolic weliweli i loko o 12 a 72 mau hola. Inā hāhā ka pahū insulin, nalowale ka mana pākaukau, a i ʻole pau ʻole ka hoʻohana ʻana i ka infusion i ka wā o ka haʻalele ʻana, piʻi ka glucose i ke koko i mea make. ketoacidosis diabetic i loko o 4 a 8 mau hola ke ʻole hiki i ka mea maʻi ke hoʻololi koke i nā injection syringe manual me ka hoʻohana ʻana i kahi hoʻolālā hoʻihoʻi i kākau mua ʻia. I ka manawa like, inā pani nā alanui i kahe ʻia a i ʻole ka pau ʻana o ka uila i nā kikowaena hemodialysis ma waho no ʻelua a ʻekolu mau lā, ʻike ʻia ka poʻe maʻi anuric kidney i ka hopu ʻana i ka naʻau mai ka piʻi ʻana o ke koko potassium a i ʻole ka hoʻomake ʻana i ka wai nui ke ʻole lākou e hoʻopaʻa koke i ka meaʻai renal pilikia 3 lā. Ma mua o ka hiki ʻana mai o kahi pilikia, e mālama i kahi ʻeke metabolic i hoʻolaʻa ʻia me kāu nā lāʻau pili wela, hoʻopaʻanaʻau pehea e lawelawe ai dialysis fistula a me ka hyperkalemia ulia pōpilikia, a mālama i kāu wahi helu pilikia (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ʻEulopa, 999 ma United Kingdom) ma kahi kāleka wai.

E hana i kēia i kēia manawa¶

1. E paʻi a laminate i kāu Insulin Pump Basal a me Bolus Settings Card i kēia lā. E wehe i kāu pāpaʻi insulin a i ʻole ka polokalamu kelepona hoʻopuka ʻana i ka insulin (AID) i kēia manawa a e kākau i kāu kikoʻī kikoʻī kikoʻī 24-hola basal rate (mau ʻāpana i kēlā me kēia hola no kēlā me kēia poloka manawa), kāu huina o ka insulin basal i kēlā me kēia lā, kāu insulin-to-carbohydrate ratios (ICR), kou insulin sensitivity a i ʻole ka insulin sensitivity. E hoʻopaʻa i hoʻokahi kope laminated i loko o kāu ʻeke maʻi diabetes a mālama i kahi kope ʻelua i kāu ʻeke.
2. E hoʻopaʻa i ka insulin basal hana lōʻihi, nā syringes insulin U-100, a me nā nila peni i loko o kāu pahu pilikia. Aia i loko o ka paila insulin ka insulin hana wikiwiki wale nō (e like me lispro, aspart, a i ʻole glulisine). E noi i kāu endocrinologist no kahi palapala hoʻihoʻi no ** nā peni insulin basal lōʻihi a i ʻole nā hue ** (e like me ka insulin glargine a i ʻole insulin degludec), ma ka liʻiliʻi loa 30 sterile U-100 insulin syringes (0.3 mL a i ʻole 0.5 mL hiki), a me 4 millimeter a i ʻole 5 millimeter peni nila no laila hiki iā ʻoe ke hoʻololi i Multiple Daily Injections (MDI) i ka manawa e haki ai ka pauma a nalo paha ka mana.
3. E hoʻopaʻa i ka mika koko koko kuʻuna, 100 mau ʻāpana hoʻāʻo, nā ketone, a me ka glucagon mākaukau no ka hoʻohana ʻana. ʻAʻole hiki ke hoʻohana ʻia nā mea ʻike glucose hoʻomau (CGM) ke pau nā mea hoʻolele, make nā kelepona, a i ʻole ka ʻili ʻana i ka ʻili i ka wai kahe a i ʻole ka hou. E hoʻopaʻa mau i ka glucometer kuʻuna manamana lima me nā ʻokoʻa ʻokoʻa ʻē aʻe, ke koko a i ʻole ka mimi ketone test strips, nasal a i ʻole auto-injector glucagon, a me 300 grams o nā papa glucose wikiwiki a i ʻole nā ​​gels.
4. No nā poʻe maʻi hemodialysis: E kau i kāu Hemodialysis "Run Sheet" a me Vascular Access Bleed Kit i loko o kahi ʻeke wai ʻole. E noi aku i kāu kahu keʻena dialysis no kahi kope hou o kāu pepa kuhikuhi lapaʻau e hōʻike ana i kāu **paona maloʻo maloʻo **, kānana kānana dialyzer, kahe kahe koko, dialysate potassium a me ka wai ʻauʻau calcium, a me ka heparin. E hoʻopaʻa i kēia pepa ma ka ʻaoʻao o 3 mau ʻōmole ʻōmole maʻemaʻe, sterile 10 x 10 centimeter (4 x 4 inch) nā paʻi gauze, a me ka hoʻopaʻa ʻana i ka venous catheter.
5. Kūkulu i 3 lā i hoʻolaʻa ʻia i kahi pahu meaʻai hoʻolaʻa haʻahaʻa haʻahaʻa, Low-Sodium, Fluid-Restricted Emergency Food Box. E kūʻai i kahi pahu plastik ʻokoʻa i kapa ʻia ʻo "Dialysis 3-Day Disaster Diet Only" i hoʻopaʻa ʻia me nā meaʻai paʻa paʻa, haʻahaʻa-potassium (pahū paʻakai ʻole, ʻeke raiki keʻokeʻo, kīʻaha kīʻaha, kīʻaha cereal i hoʻokahe ʻia i loko o ka wai i hoʻoheheʻe ʻia ma mua o ka wai. hua manu keʻokeʻo a i ʻole ka tuna haʻahaʻa i holoi ʻia) a me kahi kīʻaha ana liʻiliʻi e hoʻopaʻa i ka nui o ka wai i 500 a 700 milliliters (16 a 24 mau auneke wai) no 24 hola.
6. Nīnau i kāu nephrologist e pili ana i kahi hoʻopaʻa pōʻino o nā ʻeke paʻa pāpaʻa waha. Inā loaʻa iā ʻoe ka hemodialysis mālama ʻana, e nīnau i kāu kauka kīkī inā pono ʻoe e lawe i kahi lako ulia pōpilikia 3 lā o kahi mea hoʻopaʻa pāpaʻi o ka ʻōpū o ka waha hou (e like me sodium zirconium cyclosilicate a i ʻole patiromer) me nā ʻōlelo kuhikuhi i ka wā e hoʻomaka ai ka lawe ʻana i ka maʻi maʻi.

Ka lāʻau hoʻoholo: ʻAʻole i pau ka pauma insulin a pani ʻia ke keʻena dialysis i ka wā pōʻino¶

E hoʻohana i kēia palapala hoʻoheheʻe hoʻāʻo i ka wā o ka ʻeleʻele, ka haʻalele ʻana, a i ʻole ka ʻino nui e pale ai i ka ketoacidosis diabetic, hypoglycemia koʻikoʻi, ka hopu ʻana i ka naʻau hyperkalemic, a me ka edema pulmonary flash.

flowchart TD
    Start["Nā pōʻino: Pau ka mana, hoʻokuʻu ʻana, a i ʻole pani ʻia ke keʻena"] --> PatientType{"ʻO wai ka hilinaʻi olakino pili?"}

    PatientType -->|"Pum Insulin / CGM Mea hoʻohana"| PumpCheck{"Ua paʻa, hoʻopaʻa ʻia a hoʻokomo ʻia ka pauma insulin me nā ʻāpana ʻokoʻa?"}
    PumpCheck -->|"ʻAe, hana maʻamau"| PumpConserve["1. E hoʻopaʻa i ka pauma rechargeable i loko o ka panakō mana paʻa ma 50% uku; 2. Mālama i nā hue insulin i loko o ka ʻeke evaporative i hoʻoikaika ʻia i ka wai (15C a 30C); 3. ʻO ka hoʻopaʻa ʻana i ka pale CGM; E mālama i ka mīkini lima lima a me nā ʻāpana glucose ma ke kino"]
    PumpCheck -->|"ʻAʻole: ʻAʻe ka pāpaʻi, pulu, pau ʻole ka pākaukau, a i ʻole i waho o nā pūʻulu infusion"| PumpFail["E HOOLOLI I KA MANUAL INJECTION (MDI) PROTOCOL KOKE:; 1. Wehe i ka cannula pump mai ka ʻili e pale i ka huikau; 2. Huki i ka Pump-to-Syringe Conversion Card mai ka ʻeke hele; 3. Loaʻa iā Basal Insulin lōʻihi (Glargine / Degludec)?"]

    PumpFail -->|"ʻAe, loaʻa iā Basal Insulin"| GiveBasal["Inject i kauoha ʻia 24-hour Long-Acting Basal dose ma o ka peni a i ʻole U-100 syringe; + Inject Rapid-Acting insulin ma mua o ka ʻai ʻana a no ka hoʻoponopono ʻana i ka glucose kiʻekiʻe"]
    PumpFail -->|"ʻAʻole loaʻa ka Basal Insulin"| RapidBridge["ALAKAI HANA HANA KUKULU:; Inject i helu ʻia 3-a-4-hola Basal like me ka hoʻohana ʻana i ka insulin Rapid-Acting; ma o U-100 syringe i kēlā me kēia 3 a 4 hola i ke ao a me ka pō + hoʻāʻo i nā ketones"]

    PatientType -->|"Hemodialysis a i ʻole Peritoneal Dialysis maʻi"| DialCheck{"Ua wehe ʻia paha kāu kikowaena dialysis ma waho?"}
    DialCheck -->|"Pani ʻia ka Hale Hōʻikeʻike a i ʻole nā alanui i ka wai"| DialDiet["HANA 3-LA EMERGENCY RENAL SURVIVAL PROTOCOL:; 1. E ho'omaka i ka 'ai i ka manawa 3-Day Low-Potassium (<1,500 mg/day); 2. Kaohi i ka TOTAL inu wai i 500 a 700 mL (16 a 24 oz) no 24 hola; 3. Kāhea i ka laina hoʻokele pōʻino / KCER no ka ʻimi ʻana i kahi ʻāpana hoʻihoʻi wehe; 4. E lawe i ka mea hoʻopaʻa pāpaʻa pilikia i ʻōlelo ʻia inā kauoha ʻia e ka nephrologist"]
    DialDiet --> RedFlags{"He nawaliwali paha ka wāwae, lehelehe kani, lohi ka puʻupuʻu, a i ʻole ke ʻuhū ʻana i ka ea?"}
    RedFlags -->|"ʻAe"| CallEMS["KELE ANA IA 911 / 112 / 999 KOKE:; E haʻi aku i ka 'Maʻi Dialysis me ka Hyperkalemia a i ʻole Pulmonary Edema'; E noho kū pololei ma 90 degere me nā wāwae e kau ana i lalo"]
    RedFlags -->|"ʻAʻole"| MonitorWeight["Kaumaha i kēlā me kēia lā (palena i ka loaʻa i ka 0.5-1.0 kg / lā) a haʻalele i ka wehe ʻana i ka hale maʻi."]

Mahele 1: ʻO ka paila insulin a me ka hoʻomākaukau ʻana i ka pōʻino CGM (The Pump-Failure Survival Kit)¶

ʻOi aku ma mua o ka hapalua o ka poʻe me ka maʻi maʻi type 1 a me ka nui me ka maʻi maʻi type type 2 pili i ka insulin e hilinaʻi nei i ** hoʻomau i ka hoʻokomo ʻana o ka insulin subcutaneous (CSII)** ma o nā paʻi paʻa i hoʻopaʻa ʻia a i ʻole nā paʻi paʻi paʻa ʻole, i hui pū ʻia me kahi Continuous Glucose Monitor (CGM) i loko o kahi ʻōnaehana hoʻopaʻa ʻia ʻo Automated Insulin Delivery (AID). ʻOiai hāʻawi kēia mau mea hana i ka mana kūʻokoʻa i kēlā me kēia lā, hoʻolauna lākou i ʻehā mau wahi palupalu o ka hāʻule ʻole i ka wā o kahi pōʻino:

1. Ka Uila a me ka Pa'a Pa'a: E holo ana ka hapa nui o na pauma paipu hou a me na mea hooponopono pauma ma na paani lithium-ion hiki ke hookui hou ia (a i ole na paani lithium AA kūikawā) e make ana iloko o 2 a 5 mau la me ka mana ole.
2. ** Lako Pahu Infusion Pono:** ʻAʻole hiki iā ʻoe ke huki i ka insulin mai loko mai o ka pahu pahū i hoʻopiha mua ʻia a hoʻokomo ʻia paha i loko o kou kino ke ʻole ʻoe he U-100 insulin syringes maʻamau (a i ʻole nā ​​nila peni no nā peni insulin). Inā hoʻokomo kāu infusion plastic hope loa ma ke kāʻei kāʻei i ka wā e hoʻouka ana i kahi kaʻa hoʻokuʻu ʻana, lilo kāu pamu i mea palaka ʻole.
3. Ka ʻAʻole o Subcutaneous Basal Depot: No ka mea, hoʻokomo wale nā ​​pumps i nā analog insulin wikiwiki (insulin lispro, insulin aspart, a i ʻole insulin glulisine) e piʻi ana i loko o 60 a 90 mau minuke a pau i 3 a 5 mau hola, ʻo ka hoʻōki ʻana i ka lawe ʻana i ka pauma e waiho i ke kino me ka ʻole o ka insulin hope i loko o 2 a 3 mau hola.
4. Cloud and Smartphone Lockout: He nui nā mea hoʻohana e mālama i kā lākou helu basal, ratio carb, a me sensitivity factor wale nō i loko o ka papa kuhikuhi o kā lākou pamu a i ʻole ka puka ao. I ka wā e haki ai ka pale pāpaʻi a make paha ke kelepona kelepona, ʻaʻole ʻike ka mea maʻi a i ʻole ke kauka hoʻomalu pilikia i ka pono o ka insulin o kēlā me kēia lā.

Kaʻanuʻu-a-ʻanuʻu: Hoʻomākaukau i kāu Kāleka Hoʻololi Pump-to-Syringe¶

Pono kēlā me kēia mea hoʻohana i ka pauma insulin e noho i lalo me kā lākou endocrinologist a i ʻole Certified Diabetes Care and Education Specialist (CDCES) i hoʻokahi manawa i ka makahiki e hoʻopiha ai i kahi kino a wai ʻole Emergency Pump Failure Conversion Card. Mai kuhi i ka nui o ka insulin i ka wā pilikia. Pono kāu kāleka e hoʻopaʻa pono i kēia mau helu ʻeono:

Pehea e hoʻololi ai mai ka pauma insulin i hāʻule ʻole i ka hoʻokele lima (ʻElua Scenarios)¶

Ke hāʻule ka pauma, komo i loko o ka wai kahe, a i ʻole ka pau ʻana o ka infusion set, ** wehe a ʻili a wehe koke i ka cannula infusion pump kahiko a i ʻole patch pod ** no laila maopopo ʻoe ʻaʻole e kahe ana ka insulin i manaʻo ʻole ʻia, a laila e hahai i ke ʻano i kūpono i kāu lako:

Hōʻike A: Loaʻa iā ʻoe ka Insulin Basal Long-Acting (Glargine, Detemir, a i ʻole Degludec) A me ka Insulin Hana wikiwiki.¶

ʻO kēia ke ala palekana palekana maʻamau maʻamau gula i ʻōlelo ʻia e ka American Diabetes Association (ADA), Diabetes UK, a me ka Diabetes Disaster Response Coalition (DDRC): 1. E hoʻokele i kāu Long-Acting Basal Insulin ma o ka peni a i ʻole U-100 syringe: E nānā i kāu kāleka hoʻololi i kākau ʻia no ka helu ʻana o kāu kauka i hoʻokahi manawa i kēlā me kēia lā (a ʻelua paha i kēlā me kēia lā). Ma muli o ka lōʻihi o ka insulin basal e lawe i ka 2 a 4 hola e loaʻa ai ka hopena piha ma hope o ka hoʻokō mua ʻana, hiki i kāu hoʻolālā hoʻololi kākau ke aʻo iā ʻoe e hāʻawi i kahi pānaʻi liʻiliʻi liʻiliʻi 1-a-2-hola i ka manawa pono e hemo ai ʻoe i ka pamu inā ua piʻi ke kō koko. 2. E hoemi i ka insulin basal ma ka 10% a i ka 20% ina e hana ana i na hana poino nui a i ole e hookahua ana i ka mea ai: O ka lawe ana i na eke one, ka hele ana ma kahi loihi e haalele ai, a i ole ka ai ana i na mea ai pilikia liilii e hoonui loa i ka ike o ka insulin. E kūkākūkā i kahi "Disaster Activity Basal Reduction" (pinepine 80% o ka basal maʻamau) ma kāu kāleka kākau ma mua. 3. ** Hāʻawi i ka Insulin Rapid-Acting ma mua o ka ʻai ʻana a no ka hoʻoponopono ʻana i ka glucose kiʻekiʻe:** E hoʻohana i kāu palapala ICR a me ISF me kahi peni wikiwiki a i ʻole kahi syringe U-100 i unuhi ʻia mai ka hue hana wikiwiki o kāu pamu. E kali ma kahi o 3 a 4 mau hola ma waena o nā hoʻoponopono hoʻoponopono e pale aku i ka "hoʻopaʻa ʻana o ka insulin" (ke hoʻopaʻa ʻana i ka lua o ka hoʻoponopono ʻana ma mua o ka pau ʻana o ka hana ʻana o ka pana wikiwiki mua, ke kumu o ka hoʻopaneʻe nui o ka hypoglycemia).

Ka Manaʻo B: Ua haki kāu pauma a loaʻa iā ʻoe wale kāu vial/cartridge o Rapid-Acting Insulin (No Long-Acting Basal Insulin)¶

Inā ʻoe i haʻalele me kāu pamu wale nō a me kāna hue o ka insulin hana wikiwiki (lispro, aspart, a i ʻole glulisine) a ʻaʻohe insulin basal hana lōʻihi: 1. Hiki iā ʻoe ke huki pololei i ka insulin hana wikiwiki mai loko mai o ka hue aniani, kahi pahu paʻa paʻa, a i ʻole ka septum rubber ma ka piko o ka peni insulin e hoʻohana ana i ka syringe insulin U-100. 2. Mai hoʻopaʻa ʻia i 24 mau hola basal me ka hoʻohana ʻana i ka insulin wikiwiki: ʻO ka hoʻokomo ʻana i 20+ mau ʻāpana o ka insulin hana wikiwiki i ka manawa hoʻokahi e hōʻeha i ka hypoglycemia make i loko o 90 mau minuke. 3. E hahai i ka 3-a-4-Hour Rapid-Acting Micro-Basal Schedule: No ka mea, he 3 a 4 mau hola wale nō ka hana ʻana o ka insulin ma lalo o ka ʻili, pono ʻoe e hoʻonoho i kahi puʻupuʻu a hoʻokomo i kahi 3-hola a i ʻole 4-hola hapa o kāu pānaʻi basal i kēlā me kēia 3 a 4 mau hola, 24 mau hola i ka lā (me ke ala ʻana, ʻelua mau hola i ka pō a i ʻole kou hiki ʻana i ka pō) hale hoʻomalu pilikia me ka insulin lōʻihi. - Ka laʻana mai kāu kāleka i kākau ʻia: Inā hoʻokomo maʻamau kāu pamu 0.8 units/hour i ka pō, he \(0.8 \times 4 = 3.2\text{ units}\) (hoʻopuni ʻia i lalo conservatively e like me nā ʻōlelo a kāu kauka e 3 units ma kahi syringe U-100) i hoʻokomo ʻia i kēlā me kēia 4 hola.

ʻO 14 mau lā Diabetes & CGM Disaster Go-Bag Checklist¶

E hoʻopaʻa i kēia mau lako i loko o kahi ʻeke hopu a me ka wai i mālama ʻia ma ka ʻaoʻao o kou puka mua:

• Kaleka Hoʻololi i kākau ʻia i ka Pump-to-MDI Laminated a me kahi lako o nā lāʻau lapaʻau waha he 14 mau lā.
• Rapid-Acting Insulin + Long-Acting Basal Insulin Backup i mālama ʻia i loko o kahi ʻeke maʻalahi e hopu i loko o ka pahu hau, a me kahi puke hoʻoheheʻe evaporative i hoʻōla ʻia i ka wai e mālama ai i ka insulin ma waena o \(15 degere\text{C a me }30 degere C\) (\(59 degere\text{F a }86 degere F\)) no nā lā a hiki i ka uila. E nana ka mālama ʻana i ka insulin a me nā lāʻau lapaʻau i ka wā e pau ai ka mana.
• 30 a hiki i 50 mau pūkini insulin U-100 sterile (0.3 mL a i ʻole 0.5 mL ka nui) A me 30 mau kola peni 4 mm o ke ao holoʻokoʻa.
• 5 a 7 mau pūʻulu hoʻoheheʻe pauma kaʻawale, nā waihona, a i ʻole nā ​​​​pods adhesive, me ka holoi ʻana i ka ʻili a me ka lipine lāʻau lapaʻau.
• 2 a 3 mau mea ʻike CGM a me uwea transmitter, a me ka 20,000 mAh USB mana panaka me ke kaula hoʻouka i koi ʻia e kāu pama a me ka mea hoʻokipa (me nā ʻeke lithium AA ʻokoʻa inā pili).
• ** Kuʻuna Fingerstick Blood Glucose Meter, mea hoʻopaʻa ʻana, nā ʻeke kālā ʻokoʻa (CR2032), a me 100 mau pahu ho'āʻo** i loko o kā lākou hue i hoʻopaʻa ʻia.
• Blood Beta-Ketone Test Strips a i ʻole Urine Ketone Strips no ka nānā ʻana i ka maʻi maʻi maʻi Ketoacidosis i ka wā i ʻoi aku ai ka glucose i ka \(13.9\text{ mmol/L}\) (\(250\text{ mg/dL}\)) a i ʻole i ka wā maʻi.
• ** ʻElua mau pahu hoʻopakele ʻo Glucagon i hoʻopau ʻole ʻia** (nasal spray or liquid auto-injector) a me 300+ grams o nā haʻahā maʻalahi wikiwiki (papa glucose, ʻeke glucose gel, a i ʻole ʻeke meli).
• **Pūnaewele Hoʻopaʻa Kaʻahele Hiki ** (a i ʻole he ʻōmole holoi holoi pā mānoanoa i kapa ʻia ʻo "BIOHAZARD SHARPS").

Māhele 2: Hemodialysis a me peritoneal dialysis ka hoʻomākaukau ʻana no ka pōʻino¶

ʻO nā poʻe maʻi me ka maʻi maʻi ʻāʻī maʻamau o ka pae 5 (End-Stage Renal Disease, a i ʻole ESRD) e hilinaʻi nei i ʻekolu pule i kēlā me kēia pule in-center hemodialysis, home hemodialysis, a i ʻole peritoneal dialysis (PD) i kēlā me kēia lā i waena o ka poʻe pilikia loa i ka lāʻau lapaʻau i kekahi pōʻino kūlohelohe. Pono ka manawa hemodialysis he 4 hola ma kahi o 120 a 160 lita (32 a 42 mau galani) o ka wai i mālama ʻia he ultra-pure reverse-osmosis a me ka mana uila mau ʻekolu. Ke hoʻokuʻu ʻia nā ʻino, nā ʻōlaʻi, ka hoʻoilo, a i ʻole nā ​​waikahe i ke kaomi wai o ke kūlanakauhale a i ʻole nā ​​​​substations uila, hiki ke pani ʻia nā keʻena dialysis ma waho o ka ʻāina holoʻokoʻa no 48 a 96 mau hola.

Rula 1: E lawe i ka "Early Surge" Pre-Disaster Dialysis Session¶

I kēlā me kēia manawa e wānana ʻia ka makani ʻino, ka makani nui, a i ʻole ka waikahe nui he 48 a 72 mau hola ma mua, e hoʻāla ka poʻe lawelawe maʻi maʻi maʻi maʻi ma waho "Early Dialysis Surge Schedules" (e holo ana i nā hoʻololi 24-hola e hoʻopaʻa i kēlā me kēia maʻi *ma mua o ka pae ʻana o ka ʻino). - Mai hoʻokuʻu i kahi kau dialysis ma mua o ka ʻino e hoʻopaʻa a haʻalele ʻole me ka haʻi ʻole ʻia: ʻO ka hoʻopaʻa ʻana ma mua o ka ʻino e hāʻawi iā ʻoe i kahi pahu maʻemaʻe 48-a-72-hola me ka haʻahaʻa potassium a me ka wai ʻole. - Inā haʻalele ʻoe i kekahi kūlanakauhale ʻē aʻe, e lawe i kāu Hemodialysis Run Sheet: ʻO kēlā me kēia "guest" dialysis center a i ʻole ke keʻena pilikia o ka haukapila ma kāu wahi hoʻokuʻu e pono ai kāu pono Papa Paona Māloʻo (kilograms/paona), ʻano komo ʻana o ke kino, heparin anticoagulation protocol, a me dialysate potassium concentration ($1\text{K}}}},\text to text{K}}},\text to text{K}}} e hoʻokaʻawale koke iā ʻoe me ka ʻole o ka arrhythmias a i ʻole hypotension.

Rula 2: Hoʻopaʻa i lalo i ka 3-Day Emergency Low-Potassium, Low-Fluid Renal Diet i ka manawa i loaʻa ai kahi pōʻino.¶

Inā he ōlaʻi hikiwawe, kahe ʻana, a ʻeleʻele paha e pale iā ʻoe mai ka hele ʻana i ka dialysis, ** ʻo ka mea āu i hoʻokomo ai i loko o kou waha i nā hola he 72 e hiki mai ana e hoʻoholo inā ola ʻoe**. Me ka ʻole o ka kānana ʻana, ʻelua mea e pepehi koke i ka poʻe maʻi i hala-dialysis: 1. Papaʻai meaʻai (K+): Hoʻonui i ka pāpaʻa koko ma luna o \(6.0\text{ a i }7.0\text{ mmol/L}\), e piʻi ana i ka maʻi wāwae a me ka hopu koke ʻana i ka maʻi maʻi (ventricular fibrillation a i ʻole asystole). 2. Ka wai a me ka Sodium (Na+): ʻO kēlā me kēia mililita o ka wai āu e inu ai e noho pololei ana i loko o kou mau kīʻaha koko, e hoʻokiʻekiʻe ana i ke koko i nā pae pilikia a hoʻopiha i kou mau māmā me ka wai (acute flash pulmonary edema).

E hahai i ka Kidney Community Emergency Response (KCER), National Kidney Foundation (NKF), a me CDC 3-Day Emergency Renal Diet a hiki i kou hoʻi ʻana i ka mīkini dialysis:

Nā lula kūikawā no nā maʻi maʻi maʻi maʻi maʻi maʻi (Hoʻoponopono i nā kūlana ʻelua)¶

Ma kahi o 40% a 50% o nā maʻi dialysis i loaʻa pū kekahi i ka maʻi diabetes. I loko o kahi pōʻino, ʻelua mau hana maʻamau e paio weliweli: 1. ** MAI hoʻohana i ka wai ʻalani, maiʻa, kokoleka, a i ʻole waiu no ka mālama ʻana i ke kō koko haʻahaʻa (hypoglycemia) inā aia ʻoe ma ka maʻi maʻi maʻi:** Aia i kahi kīʻaha wai ʻalani he \(240\text{mL}\) (\(8\text{ oz}\)) kokoke i \(500\text{ mg}\) o ka potassium a me ke kīʻaha wai piha. Akā, mālama i ka hypoglycemia (<3.9 mmol/L a i ʻole <70 mg/dL) wale nō me papa glucose maʻemaʻe, nā paipu glucose gel, nā lole kopaʻa paʻa, ka meli, a i ʻole ke kō papaʻaina i hoʻoheheʻe ʻia i loko o 1 punetune wai, aia i loko o ka zero potassium a me ka wai haʻahaʻa. 2. E hōʻalo i ka Hard-Candy/Sugar Calorie Boosters i helu ʻia ma ka papaʻai maʻamau no ka maʻi maʻi maʻamau ke ʻole ʻoe e mālama ikaika ana i ke kō koko haʻahaʻa a i ʻole e uhi ana i nā ʻakika me ka insulin. Akā, e hoʻohana i ka ʻaila ʻoliva, ʻaila canola, pata paʻakai ʻole, a i ʻole kaʻaila kirīmi paʻakai ʻole ma ka pahū sodium haʻahaʻa a me ka laiki keʻokeʻo e loaʻa ai nā calorie koʻikoʻi me ka ʻole o ke koko koko a i ʻole ka pāpaʻi koko.

Māhele 3: Ka pale ʻana i kou komo ʻana i ke kīpē a me ka hoʻonohonoho ʻana i ka home peritoneal dialysis i loko o kahi pilikia¶

1. ʻO ka Arm AV Fistula / Graft and Central Catheter Emergency Kit¶

E like me ka kikoʻī ma kā mākou dialysis fistula koko a hala ka dialysis alakaʻi kōkua mua, Pono kēlā me kēia maʻi hemodialysis e hoʻopaʻa i kahi pahu pale e hoʻopaʻa ʻia i kā lākou ʻeke hele: - Pinpoint Bleed Control Supplies: Pūʻulu 3 mau ʻōmole ʻōmole wili ʻili maʻemaʻe, sterile 10 x 10 cm (4 x 4 in) nā ʻāpana gauze, a me kahi pā lole hemostatic. Inā naha ka ʻōpala o ka nila fistula i ka wā e hoʻokuʻu ʻia ai, ʻaʻole e ʻōwili i kahi kāwele ʻauʻau nui a puni ka lima; E kaomi pono i hoʻokahi manamana lima a i ʻole ka pāpale omole maʻemaʻe ma ka puka kiko no 15 a 20 mau minuke mau ʻoiai e hoʻokiʻekiʻe ana i ka lima ma luna o ka puʻuwai a kāhea aku i nā lawelawe pilikia. - ** ʻIke Kiʻekiʻe "NO BP / NO IV / DIALYSIS ACCESS ARM" Pūlima Alert Lapaʻau:** I ka hoʻāʻo ʻana a i ʻole hoʻopakele ʻana i kahi malu, e hoʻokomo i kahi pūʻulu ʻulaʻula ʻulaʻula ʻulaʻula ma kou lima fistula no laila ʻaʻole e hoʻokomo ka poʻe lapaʻau i kahi kīʻaha koko a i ʻole e hoʻokomo i kahi laina IV i loko o kāu laina ola. - Central Venous Catheter (Permcath) Clamp and Waterproof Dressing: Inā ʻoe e hoʻopaʻa inoa ma ka umauma a i ʻole ka ʻāʻī o ka ʻāʻī, e hoʻokomo i kahi pulu maʻemaʻe maʻemaʻe ʻāʻī, nā lole alohilohi wai (Tegaderm), a me nā pāpale sterile. Mai ʻae i ka wai kahe a i ʻole ka wai paipu ʻole e hoʻopā i kahi kahua puka catheter; inā nahā ka paipu catheter a hāʻule paha ka pāpale, paʻi a kiki koke i ka paipu ma waena o ka haʻi a me kou umauma a moe ma kou ʻaoʻao hema me kou poʻo haʻahaʻa i mea e pale ai i ka ea embolism.

2. Home Peritoneal Dialysis (PD) i ka wā o ka pau ʻana o ka mana¶

Hiki i nā poʻe maʻi e hoʻohana ana i ka mīkini kaʻa kaʻa (APD / CCPD) i ka pō ma ka home ke ola i ka pau ʻana o ka uila i nā lā he nui inā hoʻomākaukau lākou ma mua: - E mālama i 7 a 14 mau lā o Manual Twin-Bag CAPD Supplies (Y-sets and drain bags) i ka waiho ʻana: Ke pau ka uila a pau ka hana ʻana o kāu mea hoʻokele pō pō, e hoʻololi koke i manual gravity exchanges (Continuous Ambulatory Peritoneal Dialysis, or CAPD). E kau i ka ʻeke hoʻonā ma luna o ke kiʻekiʻe o ka poʻohiwi a kau i ka ʻeke hoʻokahe palahalaha ma ka papahele no laila e kahe ka gravity a hoʻopiha i kou ʻōpū me ka ʻole o ka uila. - Pehea e hoʻomaʻamaʻa pono ai i nā ʻeke hoʻonā PD me ka ʻole o ka uila a i ʻole ka microwave: Mai hoʻokomo i ka wai PD anu anuanu, a ʻaʻole loa e wela i kahi ʻeke PD i loko o ka microwave a i ʻole e hoʻoheheʻe i nā awa plastik i loko o ka wai lepo (no ka mea e make ai ka peritonitis). Akā, e wahī i ka ʻeke waho maloʻo i hoʻopaʻa ʻia i loko o kahi ** kāwele maloʻo maʻemaʻe ma ka ʻaoʻao o nā mea hoʻomehana lima kemika a i ʻole nā ​​hue wai wela** (e mālama i ka makū a pau mai nā awa), a i ʻole e paʻa i ka ʻeke i kou kino ma lalo o kahi pākeʻe a hiki i ka wela o ke kino (\(37 degere C / 98.6 degere F\)). - Waterless Hand Antisepsis: Inā aia ka wai paipu ma lalo o kahi hoʻolaha wai hoʻolapalapa a pani ʻia paha, holoi i kou mau lima no 60 kekona me 60% a 80% hoʻomaʻemaʻe lima me ka waiʻona, e hoʻokomo i ka pale maka, a hoʻopau i nā mea pā ma mua o ka hoʻohui ʻana i kāu set hoʻololi PD.

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

I ka wā o ka pōʻino kūloko, hoʻolaʻa nā ʻoihana dialysis a me nā hui maʻi maʻi diabetes i nā hotline hoʻolaʻa manuahi manuahi e ala i nā poʻe maʻi i haʻalele ʻia e wehe i nā keʻena keʻena, nā huna huna insulin pilikia, a me nā hale lapaʻau:

• ** ʻAmelika Hui Pū ʻIa:**
• Pūkia Lapaʻau: Kāhea iā 911.
• Kidney Community Emergency Response (KCER) Hotline: Kāhea iā 1-866-901-3773 no ka huli ʻana i nā keʻena dialysis backup.
• Laina Kokua no ka National Kidney Foundation (NKF): Kāhea 1-855-NKF-CARES (1-855-653-2273) (DaVita Emergency Hotline: 1-800-400-8331; Fresenius Disaster Line: 1-800-626-1297).
• Diabetes Disaster Response Coalition (DDRC) & ADA: E kelepona iā 1-800-DIABETES (1-800-342-2383) a i ʻole e nānā iā Healthcare Ready (RxOpen.org) no nā lāʻau lapaʻau hāmama.
• Kanada:
• Nā Hana ulia pōpilikia: Kāhea iā 911. Hoʻokaʻaʻike i kāu pūnaewele renal kalana (Kidney Foundation of Canada: 1-800-361-7494) a me Diabetes Canada (1-800-BANTING).
• Aupuni Mōʻī Hui Pū ʻia:
• Nā Hana Kūikawā: Kāhea iā 999 (a i ʻole 112), a i ʻole NHS 111 no ka hoʻopaʻa ʻana i ka insulin a i ʻole ka hui pū ʻana o ka renal. E hoʻopaʻa inoa ma mua ma kāu hui pono 'Priority Services Register (PSR) no ka mana hoʻihoʻi mua a me ka lawe wai.
• Uni ʻEulopa:
• Nā Hana ulia pōpilikia: Kāhea iā 112. E lawe i ka European Renal Association (ERA) kāleka pōʻino a me kāu European Health Insurance Card (EHIC) me kāu pepa holo dialysis i paʻi ʻia.
• Australia a me Aotearoa:
• Lau Hana ulia pōpilikia: Kāhea iā 000 ma Australia a i ʻole 111 ma New Zealand. E kelepona iā Kidney Health Australia (1800 454 363) a i ʻole ** Kidney Health New Zealand** (0800 543 639), a e hoʻopaʻa inoa ma ke ʻano he Life Support Customer me kāu mau pono uila a me ka wai.
• India a me Asia-Pākīpika:
• Lau Hana ulia pōpilikia: Kāhea iā 112 ma India, 119 ma Iapana, 995 ma Singapore, a i ʻole 999 ma Malaysia a me Hong Kong. E mālama i kope kino o kāu palapala kauoha dialysis, Hepatitis B, Hepatitis C, a me HIV nā hualoaʻa hou, a me ka papa kuhikuhi insulin.

Nīnau pinepine¶

No ke aha e hiki ʻole ai i ka mea hoʻohana i ka pauma insulin ke kali wale mai 12 a 24 mau hola no ka hiki ʻana mai o ka uila a i ʻole ka pauma pani?¶

Hoʻokomo ka pahū insulin i ka insulin hana wikiwiki wale nō, e hemo ana mai ke kahe koko i loko o 3 a 5 mau hola. Ma muli o ka loaʻa ʻole o ka insulin basal lōʻihi i mālama ʻia ma lalo o ka ʻili, ʻo ka hoʻōki ʻana i ka lawe ʻana i ka pauma ke kumu o ka hemahema o ka insulin i loko o 2 a 3 mau hola. Me ka ʻole o ka insulin hope, hoʻokahe ka ate i ka glucose a me nā ketone acidic i loko o ke koko, e hoʻoulu ai i ke ola maʻi Ketoacidosis (DKA) i loko o 4 a 8 mau hola. Pono nā mea hoʻohana pauma e lawe i ka insulin basal lōʻihi, nā syringes U-100, a me kahi kāleka hoʻololi i kākau ʻia e hoʻololi koke i ka wā e pau ai ka pamu.

Hiki iaʻu ke huki i ka insulin mai loko mai o ka peni insulin a i ʻole ka pahu pahu e hoʻohana ana i ka syringe maʻamau U-100 inā haki ka peni a i ʻole ka pauma?¶

ʻAe, inā ʻo ka insulin i loko o ka peni a i ʻole ka pahu pahu he U-100 maʻamau (100 mau ʻāpana no ka milliliter). Inā paʻa ka peni insulin a haki ʻole ka pamu a ʻaʻohe ou kola peni a i ʻole hoʻonohonoho infusion, e kāpī i ka septum rubber ma ka piko o ka peni U-100 a i ʻole pahu pahu me ka waiʻona, e hoʻokomo i ka nila U-100 insulin syringe maʻamau i loko o ka membrane, a huki i kāu ʻāpana kikoʻī. Mai huki i nā insulins concentrated (U-200, U-300, a i ʻole U-500) i loko o kahi syringe U-100 me ka ʻole o nā ʻōlelo kuhikuhi hoʻololi o ke kauka.

No ke aha i make ai nā pani paʻakai paʻakai (e like me NoSalt a i ʻole Lite Salt) no ka poʻe maʻi dialysis i ka wā o ka pōʻino?¶

He nui nā mea hoʻonani "haʻahaʻa-sodium" pāʻoihana e pani i ka sodium chloride me ka potassium chloride maʻemaʻe. Aia i loko o kahi puna puna hoʻokahi o ka paʻakai pākēneka pākēneka he 2,500 a i ka 2,800 milligrams o ka pāhare, kokoke pālua i ka palena pōʻino āpau o 1,500-miligram i kēlā me kēia lā no kahi maʻi hemodialysis anuric. ʻO ka ʻai ʻana i nā pani paʻakai pāpaʻa i ka wā e lohi ai ka dialysis hiki ke piʻi i ka serum potassium ma luna o 6.5 mmol/L i loko o nā hola a hiki i ka hopu koke ʻana i ka naʻau.

Pehea e mālama ai ke kanaka me ka maʻi maʻi a me ka hōʻino ʻole ʻana ma ka dialysis i ke kō koko haʻahaʻa (hypoglycemia)?¶

Mai hoʻohana i ka wai ʻalani, ka maiʻa, ka waiū, a i ʻole ke kokoleka no ka mālama ʻana i ka hypoglycemia inā ʻoe ma ka maʻi dialysis, no ka mea, ua piha ka wai ʻalani a me ka maiʻa i ka nui o ka potassium a me ka wai. Akā, e hahai i ka "Rule of 15" me ka hoʻohana ʻana i 15 grams o ka waiʻaʻaʻaʻai maʻemaʻe me ka potassium-free: e nau i 3 a 4 mau papa glucose maʻemaʻe, e ʻomi i 1 paipu o ka glucose gel, e ʻai i 1 punetēpē o ka meli a i ʻole ke kō, a i ʻole e omo i nā lole kō paʻakikī, a laila e nānā hou i kou glucose koko i loko o 15 mau minuke.

He aha nā palapala e koi ai nā keʻena dialysis malihini ma mua o ka mālama ʻana i kahi maʻi dialysis i haʻalele ʻia?¶

Pono nā kikowaena dialysis backup pilikia i kāu Pepa Lapaʻau Hemodialysis i paʻi ʻia ("Run Sheet") e kikoʻī ana i kāu paona maloʻo i manaʻo ʻia, ke kumu hoʻohālike dialyzer, ke kahe o ke koko a me ka dialysate, potassium a me ka wai ʻauʻau calcium, ka nui o ka heparin, ka papa inoa o nā lāʻau lapaʻau o kēia manawa, a me nā hopena lab Hepatitis B, Hepatitis C, a me HIV. ʻO ka mālama ʻana i kahi kope laminated i loko o kāu ʻeke hele e pale i ka hoʻopaneʻe ʻana.

Nā alakaʻi pili¶

• Ka mālama ʻana i ka insulin a me nā lāʻau e pili ana i ka wela i ka wā o ka pau ʻana o ka uila
• ʻO ka dialysis fistula bleed (bottle-cap protocol) a me ka dialysis hyperkalemia ulia pōpilikia
• Ketoacidosis maʻi maʻi (DKA) a me ke kūlana hyperglycemic hyperosmolar
• Hoʻomākaukau hoʻomākaukau no ka poʻe me ke kino kīnā a me nā pono olakino

Nā kumu a me ke alakaʻi kūhelu¶

• Kidney Community Emergency Response (KCER) & Centers for Disease Control and Prevention (CDC, United States): Hoʻomākaukau no nā pilikia: He alakaʻi no ka poʻe ma ka Dialysis (CMS Pub. No. 10150, 3-Day Emergency Renal Diet and Run Sheet Protocol).
• National Kidney Foundation (NKF, United States) & UK Kidney Association (UKKA): Planning for Emergencyencies: Chronic Kidney Disease and Hemodialysis Access Control.
• ** ʻAhahui ʻAi ʻAi ʻAi Maʻi ʻAi Maʻi Diabetes (DDRC), American Diabetes Association (ADA), & Endocrine Society:** Ka Hoʻolālā Hoʻomaʻamaʻa Hoʻomaʻamaʻa Maʻi Diabetes a me ka hoʻololi ʻana mai ka Pump Insulin i Multiple Daily Injections (MDI).
• ** ʻAmelika Hui Pū ʻIa a me nā lāʻau lapaʻau (FDA):** Insulin Pump and Continuous Glucose Monitor Safety during Disasters.
• Ka Hui Kaiapuni no ka Dialysis Peritoneal (ISPD): Nā Kuhikuhi ISPD no ka Kāohi ʻana i nā maʻi maʻi maʻi Peritoneal a me nā hoʻololi pōʻino.