Defibrillator etinyere (ICD) Storm Storm yana arụrụ arụrụ arụrụ arụ¶

Ọtụtụ nde mmadụ n'ụwa niile na-ebi na ** Cardiovascular Implantable Electronic Device (CIED)** nke etinyere n'okpuru akpụkpọ anụ nke elu obi (ma ọ bụ afọ / akụkụ aka ekpe): ma ọ bụ ** Permanent Pacemaker (PPM)** nke na-egbochi obi ịkụ aka nwayọ nwayọ (** bradycardia**), (** ventricular tachycardia ma ọ bụ ventricular fibrillation**), ma ọ bụ ** Usoro ọgwụgwọ mmeghari nke obi (CRT-P ma ọ bụ CRT-D) *** ngwaọrụ biventricular maka nkụda obi. Mgbe ICD na-ebunye mkpọmkpọ ọkụ dị n'ime na mberede (nke ndị ọrịa na-akọwa dị ka "ọ na-adị ka ịnyịnya na-agba ya ụkwụ n'obi") ma ọ bụ mgbe onye na-eme ngwa ngwa ejideghị akwara obi ( usu na-adaba n'okpuru $ 40 ederede na-akụ kwa nkeji) $ na dizziness ma ọ bụ na-ada mbà**), ma ọ bụ mgbe akpụkpọ ahụ n'akpa uwe ngwaọrụ na-aghọ ** uhie, fụrụ akpụ, ma ọ bụ mebie ***, ịmara kpọmkwem "1-Shock vs. 2-ma ọ bụ-More-Shocks (Electrical Storm)" iwu triage, ịmara na ** imetụ onye ọrịa aka n'oge ICD ujo bụ 100% nchekwa maka ndị na-ekiri ihe na-eme ihe (ED) pads *** gburugburu ngwaọrụ etinyere na-azọpụta ndụ.

Mee nke a ugbu a¶

1. Mee ka onye ahụ nọdụ ala ma ọ bụ dinara ala ozugbo ka ọ ghara ịdaba na-akụ isi ha ma ọ bụrụ na ụda obi na-akpalite ujo ọzọ ma ọ bụ mgbụsị akwụkwọ.
2. ** Tinye iwu Triage "1-Shock vs. Multiple-Shocks" (Heart Rhythm Society & AHA Guidelines):**
   • ** Kpọọ 911/112/999 ozugbo Ọ BỤRỤ na:** Onye ahụ natara 2 ma ọ bụ karịa ICD shocks n'ime awa 24; MA ọ bụ natara ** 1 ujo ma nwee mgbaàmà ọ bụla na-aga n'ihu ** (mgbu obi, mkpụmkpụ ume, isi ọkụ, obi mgbawa, mgbagwoju anya, ma ọ bụ ọgbụgbọ); MA ọ bụ onye ** dara ada (efu efu)** tupu ma ọ bụ n'oge ujo. Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, ma ọ bụ hụ ihe niile. nọmba mberede.
   • ** Ọ bụrụ na onye ahụ natara naanị otu ujo ma nwee mmetụta 100% nkịtị, anya na enweghị akara n'ime sekọnd 60:** Debe ha ụgha ma ọ bụ nọdụ jụụ n'ụlọ, mee ka ha kpalite nnyefe akwụkwọ ntuziaka na ** bedside home monitor *** (ma ọ bụ ngwa smartphone), yana ** kpọọ Cardiology / Device Clinic Emergency on-Call ozugbo n'otu ụbọchị. (Ọ bụrụ na ha amalite inwe ahụ erughị ala ma ọ bụ nwee ujo nke abụọ n'oge ọ bụla, kpọọ 911/112/999 ozugbo.)
3. Ọ bụrụ na onye ahụ daa ma ọ naghị anabata ume ma ghara iku ume, malite aka ya CPR ozugbo ma tinye AED: Adịla ala azụ n'ihi egwu nke ịbụ onye ICD ime ha na-ama jijiji.
4. Eziokwu Nchekwa nke onye na-ahụ anya: ICD dị n'ime na-ebuga ihe dị ka \(30\ederede{gaa na }40\ederede{ Joules}\) n'ime akwara obi. Ọ bụrụ na ị na-eme mkpakọ obi ma ọ bụ na-ejide onye ọrịa na otu millisecond nke ọkụ ICD dị n'ime ha, ** ị nweghị ike imerụ ahụ **, ma ọ dịkarịa ala, ị ga-enwe mmetụta na-adịghị njọ, dị nro dị nro na akpụkpọ obi ha (ọ bụrụ na ị na-eyi uwe mkpuchi ahụike nitrile, ị gaghị enwe mmetụta ọ bụla).
5. ** Iwu ntinye AED Pacemaker/ICD:** Lee anya ma nwee mmetụta maka mpụta akụkụ anọ nke ọla siri ike n'okpuru akpụkpọ ahụ n'okpuru ọkpụkpụ aka ekpe ma ọ bụ aka nri. Debe mpe mpe akwa AED nke nnyapade ** opekata mpe \(2.5\text{centimeters}\) (\(1\text{ inch}\)) pụọ na ngwaọrụ etinyere** (ma ọ bụ jiri ebe nchekwa ** n'ihu na azụ [anterior-posterior] pad placement **), wee mee ka AED nyochaa na ịma jijiji na-adịkarị.
6. ** Ọ bụrụ na ICD na-agba egbe ugboro ugboro ka onye ọrịa nọ na-eteta ụra, dị jụụ, ma na-ekwukarị okwu ("ICD Shocks na-ekwesịghị ekwesị" site na waya gbajiri agbaji ma ọ bụ ngwa ngwa atrial fibrillation):**
7. Debe onye ọrịa ahụ ka ọ dinara nke ọma ma nọrọ jụụ (ịkwa ákwá, ụjọ na imegharị ahụ na-eme ka ọ̀tụ̀tụ̀ obi ya dị ngwa n'ime “mpaghara ujo” nke ICD, na-akpata ọbụna ihe mgbagwoju anya karị).
8. Kpọọ 911/112/999 ozugbo wee gwa onye na-ezipụ ozi ahụ: "Onye ọrịa ahụ na-amụ anya ma na-awụ akpata oyi n'ahụ ya ugboro ugboro site na ICD ha etinyere; anyị chọrọ ndị na-ahụ maka ahụike na-akwado ndụ dị elu nwere ECG-edu ndú 12 na magnet ngwaọrụ ụlọ ọgwụ."
9. ** Bugharịa ekwentị ọ bụla, smartwatch, chaja ikuku magnetik (MagSafe), e-cigare/vape, ma ọ bụ ihe nkwado magnetik ọ dịkarịa ala \(15\text{centimeters}\) (\(6\text{inch}\)) n'ebe igbe dị.**
10. ** Ọ bụrụ na onye ọrịa nwere ihe na-eme ihe na-eme ihe na-eme ihe na-eme ihe (ma ọ bụ ICD) wee malite nnukwu isi ọwụwa, ike ọgwụgwụ dị nso, oke ike ọgwụgwụ, ma ọ bụ obere mkpịrị aka n'okpuru \(40\text{ga }50\text{ beats per minute}\) (ma ọ bụ hiccuping/obi na-akụ ụda mgbe niile):**
11. Ihe a na-enyo enyo ** Onye na-eme ihe na-eme ihe na-eme ngwa ngwa ejideghị, mwepu isi, ma ọ bụ mmebi batrị ***. Dina onye ọrịa ahụ n'ụkwụ na-ebuli obere elu, kpọọ 911/112/999, wee weghachite Wallet Pacemaker/ICD Identification Card (nke depụtara onye nrụpụta: Medtronic, Abbott/St. Jude, Boston Scientific, Biotronik, ma ọ bụ MicroPort, nọmba nlereanya, na ntọala mmemme).
12. ** Nyochaa akpụkpọ ahụ n'elu akpa ngwaọrụ dị n'ime igbe: ** Ọ bụrụ na akpụkpọ ahụ n'elu ihe na-eme ngwa ngwa ma ọ bụ ICD na-egosi ** ọbara ọbara, ọzịza, ikpo ọkụ, ịdị nro, mmiri mmiri / pus drainage, blister na-acha odo odo, ma ọ bụ ọla ọla ọcha n'akụkụ/ waya na-esi na akpụkpọ ahụ dị gịrịgịrị (erosion)**, gaa na ** Ngalaba Mberede *** n'otu ụbọchị ahụ. Adịla mgbe ọ bụla afanye, kpatụ, ma ọ bụ tinye agịga n'ime akpa pacemaker fụrụ akpụ, elegharala ahụ ọkụ dị obere na onye ọrịa pacemaker/ICD (CIED infective endocarditis).

Osisi mkpebi ihe mberede: ihe egwu ICD, ọdịda pacemaker, & ọrịa akpa¶

Jiri eserese ụlọ ọgwụ a n'ime sekọnd 60 mbụ iji jikwaa ihe mberede ngwaọrụ obi etinyere.

flowchart TD
    Start["Mberede na onye ọrịa nwere ihe etinyere ya<br/>Pacemaker (PPM), Defibrillator (ICD), ma ọ bụ ngwaọrụ CRT"] --> EventType{"Kedu ihe bụ isi <br/> Nsogbu ngwaọrụ?"}

    EventType -->|"NDỊ NDI anabataghị<br/>& Ọ naghị eku ume"| Arrest["MJIDE OBI (ICD adịghị atụgharị n'ụda): <br/>1. Kpọọ 911 / 112 / 999 & Malite Mgbakọ Obi UGBUA <br/> (Ọ dị mma imetụ onye ọrịa aka ọbụlagodi ma ọ bụrụ na ICD dị n'ime na-agba ọkụ) <br/>2. Jikọọ AED: Ebe mpe mpe akwa>= 2.5 cm (1 inch) pụọ na <br/> mgbaka ngwaọrụ (ma ọ bụ jiri ndowe oghere AP ihu na azụ) <br/>3. Soro AED kpaliri n'egbughị oge"]

    EventType -->|"ICD DELIVERED SHOCK(S)<br/>(Onye ọrịa nwere uche)"| ShockCount{"Ujo ole mere<br/>& kedu ka ọ dị onye ọrịa?"}

    ShockCount -->|"2 MA Ọ BỤRỤ Ụjọ n'ime awa iri abụọ na anọ<br/>(>= 3 Shocks = 'ICD ELECTRICAL Storm')<br/>MA ọ bụ 1 Ujo n'ime obi mgbu, dyspnea, <br/>Ahụhụ, nkụda mmụọ, ma ọ bụ palpitations."| StormER["Ngwa ngwa 911 / 112 / 999 Mberede:<br/>1. Dina onye ọrịa ala & kpamkpam (na-ebelata adrenaline)<br/>2. A na-enyo enyo VT/VF Eletriki Storm ma ọ bụ ihe egwu na-ekwesịghị ekwesị<br/> (sitere na-agbaji ụzọ / ngwa ngwa AFib / T-wave oversensing) <br/>3. EMS/ER ebe 12-edu ECG; ma ọ bụrụ na ihe egwu na-ekwesịghị ekwesị na<br/> nyochaa, dọkịta na-ahụ maka ụlọ ọgwụ Ring Magnet over ICD iji gbochie <br/> ihe mgbagwoju anya mgbe ị na-edebe pacemaker ndabere emebibeghị."]

    ShockCount -->|"1 SINLE SHOCK ONLY<br/>+ Onye ọrịa na-eche 100% Nkịtị & Ahụghị ihe mgbaàmà<br/>N'ime nkeji 1"| SingleShock["Kpọtụrụ ndị ọrịa obi / ngwaọrụ: <br/>1. Nọdụ ala / dinara ala; agbala ụgbọala<br/>2. Zipu akwụkwọ ntuziaka Remote Home Monitor ugbu a<br/>3. Kpọọ ụlọ ọgwụ ngwaọrụ na nọmba oku maka ntuziaka<br/>4. Ọ bụrụ na ujo nke abụọ ma ọ bụ akara ngosi ọ bụla pụtara -> Kpọọ 911"]

    EventType -->|"Ụjọ, nkụda mmụọ, ma ọ bụ usu <40-50 BPM<br/>(ma ọ bụ Rhythmic Diaphragm Hiccups / Pectoral Twitch)"| PacerFail["AKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỊKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWASỊ' 1.1. Kpọọ 911/112/999 ozugbo; dina onye ọrịa flat<br/>2. Wepu ekwentị/magnetị ọ bụla n'ime 15 cm nke igbe <br/>3. Weta kaadị ID ngwaọrụ Wallet maka ajụjụ ER"]

    EventType -->|"Ịnụ Ụnụ ma ọ bụ ịma jijiji <br/>Site n'ime igbe"| BeepAlert["INTERNAL DVICE ALERT TONE:<br/>Na-egosi batrị ERI, Mgbanwe Mgbanwe, ma ọ bụ Mag Mode.<br/>Ọ bụrụ na ahụ dị onye ọrịa ahụ nke ọma -> Kpọọ Cliniclọ Ọgwụ ngwaọrụ taa."]

    EventType -->|"AKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWASỊKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWASỊAKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWỤKWASỊWA'Over'Over-Pocket'"| PocketInf["CIED POCKET INFECTION / ENDOCARDITIS:<br/>1. Ntụle ngalaba ihe mberede nke otu ụbọchị<br/>2. Adịla apịpịa ma ọ bụ agịga mee akpa ahụ<br/>3. Achọrọ omenala ọbara, ọgwụ nje IV, na mkpokọta mkpokọta"]

Nkebi 1: Cardioverter-Defibrillator (ICD) Shocks na "Electric Storm"¶

Otu ICD si emeso arrhythmias tupu na n'oge ujo¶

Cardioverter-Defibrillators nke oge a (ICDs), gụnyere ** transvenous ICDs ** (nke ejiri eriri na-agbanye n'ime akwara n'ime obi) na ** ICDs subcutaneous (S-ICDs)** (etinye n'okpuru akpụkpọ ahụ n'akụkụ eriri aka ekpe), n'ezie nwere ** ọkwa abụọ nke ọgwụgwọ ** mgbe ha chọpụtara ngwa ngwa dị egwu. 1. ** Tier 1: Anti-Tachycardia Pacing (ATP, Painless):** Mgbe ICD na-achọpụta ngwa ngwa ventricular rhythm (** monomorphic ventricular tachycardia [VT]), ọ na-ebu ụzọ gbajie sekit ahụ n'enweghị ihe mgbu site n'iwepụta mgbawa ngwa ngwa nke 8 ruo 10 obere pacing pulse. ** Ndị ọrịa anaghị enwe mmetụta ATP ma ọlị *** (ma ọ bụ na-enwe mmetụta naanị ụda nke abụọ nke abụọ). 2. Tier 2: High-Voltage Defibrillation Shock (\(30\text{to }41\text{ Joules}\)): Ọ bụrụ na ATP na-enweghị mgbu anaghị akwụsị ụda ahụ, ma ọ bụ ọ bụrụ na ụda ahụ na-abawanye n'ime ** Ventricular Fibrillation (VF)** ma ọ bụ VT ngwa ngwa, ($> 200pm) n'ime ya. maka ** 5 ruo 10 sekọnd *** ma na-ebuga ujo dị elu ozugbo n'ofe akwara obi. - N'ihi na onye ọrịa ahụ ka na-amakarị n'oge VT (ma ọ bụ na-enwetaghachi uche 2 sekọnd mgbe ujo ahụ gasịrị), ha na-enweta ọkụ mberede, na-ekpuchi anya n'ọhụụ ha (phosphenes), mgbakasị obi ike nke akwara obi na ubu ha, na mmetụta nke ihe ọkụkụ dị arọ na ọkpụkpụ ara.

Ezi "E Kwesịrị Ekwesị" Igwe ọkụ eletrik vs. "Ekwesighi" ICD Shocks¶

Mgbe onye ọrịa na-enweta ọtụtụ ihe akpata oyi n'ahụ n'usoro (** ICD Electric Storm ***, akọwapụtara nke ọma dị ka \(\ge 3\text{nhụhụhụhụhụhụhụhụhụhụhụanya VT/VF ma ọ bụ ICD n'ime oge awa 24}\)), ndị na-ahụ maka ahụike na ndị dibịa mberede na-eji nyocha ECG nke 12 na-eduga ozugbo ịmata ihe abụọ dị iche iche:

Kedu ka Magnets Mgbanaka Clinical si arụ ọrụ na ndị na-eme ihe ike vs. ICD (Iwu ahụike dị mkpa)¶

Ọtụtụ ndị ọrịa na ọbụna ụfọdụ ndị ọrụ ahụike na-enwe mgbagwoju anya maka ihe na-eme mgbe magnetik ** mgbanaka ụlọ ọgwụ ** (ma ọ bụ magnet neodymium na ekwentị / vape) metụrụ igbe n'elu ngwaọrụ obi etinyere. ** Ihe ndọta na-eme ihe na-emegide ndị na-eme ihe ike na ICD:**

1. *Mmetụta nke Igwe Ọdụdọ na Defibrillator (ICD):
2. Ịtụkwasị magnetik ozugbo n'elu ICD ** SUSPENDS / gbanyụọ Nchọpụta TACHYARRHYTHMIA NIILE NA HIGH-VOLTAGE SHOCKS ** (ya mere ICD agaghị eme ka ọ maa jijiji mgbe magnet na-ejide n'obi), ** ka ị na-ahapụ ICD's ji nwayọọ nwayọọ-obere nkwado ndabere na-eme ihe na-arụ ọrụ 100% .
3. Ozugbo i buliri magnetik n'obi, ICD na-atụgharị nchedo ujo ozugbo ozugbo.
4. ** Gịnị kpatara Magnets ndị ahịa (MagSafe iPhones, Smartwatches, Magnetic Vape Pens, CPAP Magnetic Clips) dị ize ndụ na akpa uwe: ** Ọ bụrụ na onye ọrịa ICD tinye ekwentị nwere igwe chaja ikuku magnetik (dị ka Apple MagSafe), sịga / vape eletrọnịkị nwere okpu magnetik, ma ọ bụ ihe mkpuchi $ 5 n'ime CPAP magnetik. centimeters}$ (\(6\text{inch}\))** nke ICD ha, ma ọ bụ daa n'ụra ka ekwentị ha dabere n'obi ha, ** magnet na-agbanyụ ihe nhụsianya nke na-azọpụta ndụ ha mgbe ọ na-ezu ike mgbe ọ na-ezu ike. ICD (\(30\text{cm}\) [\(12\text{inch}\)] maka akụrụngwa nwere nnukwu ike).
5. Mmetụta Igwe Ọdụdọ na Onye Na-eme Ihe Na-adịgide adịgide (PPM):
6. Ịtụkwasị magnet n'elu ọkọlọtọ pacemaker ** anaghị atụgharị ihe ngwa ngwa ngwa ngwa ** kama ọ na-atụgharị onye na-eme ngwa ngwa n'ime "Asynchronous Pacing Mode" (DOO ma ọ bụ VOO mode), ebe onye na-eme ngwa ngwa na-eleghara obi obi onye ọrịa anya wee gbaa ọkụ n'ogo nke edobere (na-emekarị $85\text{ruo 1pm). * (Ọ bụ naanị ndị ụlọọgwụ mberede zụrụ azụ na nlebanya ECG dị ndụ kwesịrị itinye magnetị ụlọ ọgwụ na onye na-eme ngwa ngwa ma ọ bụ ICD.)*

Nkebi 2: Ime CPR na iji AED na onye ọrịa nwere ihe eji eme ihe ma ọ bụ ICD¶

Ọ bụrụ na onye nwere pacemaker ma ọ bụ ICD daa, ọ naghị anabata ya, ọ naghịkwa eku ume (ma ọ bụ na-eku ume naanị), ** ngwaọrụ ha etinyere adịghị echekwa ha ** (ma ọ bụ n'ihi na ụda ahụ abụghị PEA / asystole na-adịghị atụ egwu, akwara obi na-esikwa ike ịzaghachi, ma ọ bụ batrị / ndu dara). ** Onye guzo ozugbo CPR na mpụga Automated External Defibrillator (AED) bụ naanị ohere ha nwere ịlanarị.

Soro ndị a ** 3 Official AHA / ERC Resuscitation Iwu ** maka ndị ọrịa nwere ngwaọrụ etinyere:

1. Egbula oge mkpakọ obi: Tinye aka gị n'otu ebe ọkọlọtọ, ** etiti igbe dị na ọkara nke ọkpụkpụ ara (sternum), wee kwagide ngwa ngwa (\(100\text{to }120\text{ compressions per minute}\), \(5\text{ to }6\)text{ cm}$ to }text{ cm}$ [$2}text. N'ihi na a na-akụnye ndị na-eme ihe ngwa ngwa na ndị na-emepụta ICD n'okpuru ọkpụkpụ aka ekpe ma ọ bụ aka nri (clavicle) (ma ọ bụ n'okpuru ogwe aka ekpe maka ICD subcutaneous), aka gị na etiti ọkpụkpụ ara adịghị ebe ọ bụla nso igbe ígwè.
2. ** Gịnị ma ọ bụrụ na ICD ime ime na-awụ akpata oyi n'ahụ mgbe aka m dị na igbe?**
3. ** Nọgide na-eme CPR: ** Ọ bụrụgodị na ICD dị n'ime na-agba ọkụ $ 35 ederede {-Joule}$ ujo mgbe aka gị na-agbanye n'ime obi, ọkụ eletrik na-anọ n'ime oghere obi n'etiti eriri obi na titanium nwere ike. Ihe na-erughị 1 volt na-eru n'elu akpụkpọ ahụ. Agaghị emerụ gị ahụ.
4. • (Rịba ama: Ọ bụrụ na ị hụ obi onye ọrịa na-agbapụta na mberede site na ujo ICD dị n'ime n'oge CPR, hapụ naanị 1 ruo 2 sekọnd maka ujo ahụ ka gwụchaa wee gaa n'ihu nyocha CPR/AED.)*
5. ** Ebe ị ga-arapara na mpempe AED mpụga: ***
6. Mgbe i buri igbe ahụ, chọọ \(3\text{ga }5\text{cm}\) àpà ịwa ahụ na mpụta akụkụ anọ siri ike n'okpuru akpụkpọ ahụ n'okpuru ọkpụkpụ aka nri ma ọ bụ aka ekpe (ma ọ bụ n'akụkụ ọgịrịga aka ekpe maka S-ICD).
7. ** Ekwela ka ịrapara AED pad ozugbo n'elu igwe pacemaker/ICD mgbịrịgba:** Ihe mkpuchi ọla n'okpuru akpụkpọ ahụ na-egbochi ujo AED dị n'èzí iru n'obi wee bibie sekit ngwaọrụ.
8. ** Tinye AED pad opekata mpe \(2.5\text{ centimeters}\) (\(1\text{ inch}\)) n'akụkụ ma ọ bụ n'okpuru ngwaọrụ etinyere nfụkasị ** (ma ọ bụ tinye pads ahụ n'ọnọdu ** Anterior-Posterior [Front-na-Back] **: otu mpe mpe akwa dị n'ihu etiti aka ekpe na azụ n'akụkụ nke ọzọ n'ubu n'azụ ngwaọrụ).

Nkebi nke 3: Ịghọta arụrụ arụrụ arụrụ arụrụ arụrụ arụrụ arụ na ihe mgbakwụnye etinyere¶

Ihe ịrịba ama mberede 5 nke onye na-eme ihe ngwa ngwa ma ọ bụ ụzọ adịghị arụ ọrụ¶

Ọ bụrụ na onye nwere pacemaker ma ọ bụ ICD na-etolite nke ọ bụla n'ime mgbaàmà ndị a, buru ya gaa na ngalaba mberede ozugbo:

1. Symptomatic Bradycardia ("Ọdịda ijide" ma ọ bụ "ọdịghị mmepụta"):
2. Onye ahụ na-enwe nkụda mmụọ, isi ọwụwa, adịghị ike, mkpụmkpụ ume, mgbagwoju anya, ma ọ bụ ịda mbà (** syncope**), na ịlele pulse ha na nkwojiaka ma ọ bụ n'olu na-egosi ọnụọgụ obi ** ji nwayọọ nwayọọ karịa usoro ihe na-eme ngwa ngwa ha na-eme ka ọnụ ọgụgụ dị ala dị ala** (ihe fọrọ nke nta ka ọ bụrụ ndị na-eme ngwa ngwa niile ka edobere ka ọ ghara ikwe ka obi daa n'okpuru **$50 60minti kwa nkeji).
3. Mkpa Pulse Oximeter / Smartwatch ịdọ aka ná ntị: Ekwela ** atụkwasịla obi na ihuenyo ECG naanị ma ọ bụrụ na ike gwụrụ onye ọrịa. Na "Enweghị iweghara", onye na-eme ihe ngwa ngwa ka na-ezipụ obere spikes eletriki nke onye na-ahụ maka obi obi nwere ike ịgụta dị ka \(70\text{bpm}\), ** mana akwara obi anaghị agbakọ n'ezie **, yabụ ezigbo mkpụkọ akwara na nkwojiaka ma ọ bụ oximeter mkpịsị aka bụ naanị \(30 ederede {bpm}\). Jiri mkpịsị aka gị na-enwe mmetụta ahụ n'ezie ** radial ma ọ bụ carotid pulse **.
4. ** Mkpịsị aka ma ọ bụ mkpọtụ nke akwara obi / afọ (mkpọsa ndu ma ọ bụ mmesa):**
5. Ọ bụrụ na onye ọrịa ahụ na-amalite na mberede na-enwe ** na-aga n'ihu, metronome-oge niile hiccups ($ 60\text{to } 80\text{time a minute}$, dakọtara kpọmkwem obi ha na-akụ)** ma ọ bụ rhythmic mkpọtụ nke akwara pectoral obi ha na ihe ọ bụla, onye na-eme ihe ike / ICD nwere ma ọ bụrụ na ọ na-apụ n'ime ebe dị elu. nke na-achịkwa diaphragm) ma ọ bụ ** gbapụrụ site na mgbidi dị mkpa nke ventricle aka nri **, na-etinye ihe egwu pericarditis ma ọ bụ obi tamponade .
6. ** Ọzịza mberede, mgbawa na-acha odo odo, ma ọ bụ akwara na-agbapụta n'otu ogwe aka (Subclavian vein Thrombosis):**
7. N'ihi na onye na-eme ngwa ngwa na ICD na-eduga na-agafe ** subclavian na axillary veins ** n'okpuru ọkpụkpụ ọkpụkpụ, mkpụkọ ọbara (** elu-extremity deep vein thrombosis ***) nwere ike ịmalite gburugburu wires, na-eme ka ** aka ekpe ma ọ bụ aka nri, aka, na akụkụ olu na-aza elu, mgbu, ma gbanwee ọbara ọbara-acha odo odo.
8. ** Ọrịa Pacemaker & Ọrịa Twiddler:**
9. Ọ bụrụ na onye ọrịa n'amaghị ama tụgharịa, tụgharịa, ma ọ bụ jiri igbe ihe na-eme ngwa ngwa gwuo egwu site na akpụkpọ ahụ ya (Twiddler's Syndrome), wires na-efego dị ka igwe azụ wee dọpụta ozugbo na mgbidi obi. Adịla mgbe ọ bụla gbagọrọ agbagọ ma ọ bụ tinye na igbe ngwaọrụ n'okpuru akpụkpọ ahụ.
10. *Mkpu, mkpu, ma ọ bụ ịma jijiji site n'ime igbe:
11. Ngwa ICD na ngwaọrụ CRT nke oge a (Medtronic, Boston Scientific, Abbott, Biotronik) nwere igwe na-ekwu okwu ma ọ bụ igwe na-ama jijiji nke na-ewepụta ụda ụda ụda dị elu (dị ka mkpu elekere ma ọ bụ ụgbọ ihe mberede) ma ọ bụ ịma jijiji siri ike ** n'oge a kara aka kwa ụbọchị mgbe ngwaọrụ ahụ na-achọpụta ọkwa dị oke egwu: ** Batrị na-erute Elective Replacement In** (waya gbajiri agbaji)**, ma ọ bụ ** arrhythmia dị elu ogologo oge.
12. Ọ bụrụ na onye ọrịa anụ ụda obi ha ma ọ bụ nwee mmetụta na ọ na-ama jijiji: Ọ bụrụ na ahụ ahụ dị ha mma, kpọọ ụlọ ọgwụ ngwaọrụ ha n'otu ụbọchị ahụ; ọ bụrụ na ha nwere isi ọwụwa, mkpụmkpụ ume, ma ọ bụ ihe ịma jijiji, gaa na Ngalaba Mberede ozugbo.

Nkebi 4: Ọrịa akpa akpa ngwaọrụ, mmebi akpụkpọ ahụ, na CIED Endocarditis¶

Kedu ihe kpatara obere ọzịza, eriri, ma ọ bụ waya na-egosi n'elu ihe na-eme ngwa ngwa bụ ihe mberede ịwa ahụ¶

N'adịghị ka ọrịa akpụkpọ anụ na ogwe aka ma ọ bụ ụkwụ nke enwere ike iji karama ọgwụ nje ọgwụ ụbọchị 7 gwọọ ya, ** ọrịa nje ọ bụla na-emetụ ihe na-eme ngwa ngwa ma ọ bụ akpa ICD ma ọ bụ waya ya bụ ihe mberede obi na-eyi ndụ egwu ***: - Bacteria (karịsịa Staphylococcus aureus na Staphylococcus epidermidis) na-etolite ọta nchebe na-adịghị ahụkebe (biofilm) na mkpuchi plastik na metal nke onye na-eme ngwa ngwa na-eduga na ọgwụ nje enweghị ike ịbanye. - N'ihi na ndị na-edu ndú na-aga ozugbo site na veins wee banye n'ime ime atrium aka nri, valvụ tricuspid, na ventricle aka nri, ọrịa obere akpa na-ele anya na-agbadata wires ozugbo n'ime lvụ obi na ọbara , na-akpata ** CIED Infective Endocarditis na Sepsis (nke na-ebu ọnụ ọgụgụ ọnwụ pasent 20 ruo 30 ma ọ bụrụ na ewepụla mmịpụta ngwaọrụ).

Ndepụta ọkọlọtọ uhie maka ọrịa n'akpa uwe ngwaọrụ & nzepu (Gaa na ER / Cardiology Taa)¶

Nyochaa akpụkpọ obi n'elu ihe na-eme ngwa ngwa ma ọ bụ ICD n'ìhè na-egbuke egbuke: - [ ] ** Acha ọbara ọbara (erythema), ikpo ọkụ, ọzịza, ma ọ bụ ịdị nro ọhụrụ na-eme mkpọtụ ** n'ime akpa ngwaọrụ (ma izu abụọ ka a wachara ya ahụ ma ọ bụ afọ ise ka e mesịrị). - [ ] Mmụba mmiri (mgbanwe), pus, crusting odo, ma ọ bụ nke doro anya/mmisa ọbara na-agbapụta site na ọnya ịwa ahụ. - [ ] ** Mgbochi tupu eruo ma ọ bụ Frank Skin Erosion:** Akpụkpọ ahụ dị n'akụkụ akụkụ nke ngwaọrụ igwe ma ọ bụ waya na-aghọ ** akwụkwọ dị nro, na-egbu maramara, taut, na-acha uhie uhie (na-agbaso ígwè dị n'okpuru), ma ọ bụ ** otu mpempe ọla ọcha ma ọ bụ mkpuchi waya ọcha na-apụta na-apụta site na obere oghere n'ime akpụkpọ ahụ. * (IWU OKWU: Ọ bụrụgodị na ọ bụ efu efu na efu efu, ** ma ọ bụrụ na akụkụ ọ bụla nke ngwaọrụ ma ọ bụ waya na-ekpuchi ikuku dị n'èzí site na akpụkpọ ahụ, ngwaọrụ dum na eriri obi niile na-ebute nje bacteria 100% ma bụrụ nke a ga-ewepụ ya na ụlọ ọgwụ pụrụ iche ** kpuchie ya n'enweghị ihe mgbochi na akwa gauze na-adịghị ahụkebe n'okpuru akpụkpọ ahụ, mee ka ígwè ahụ laghachi azụ taa, mee ka ígwè ahụ laghachi azụ. - [ ] ** Ahụ ọkụ na-akọwaghị, oyi, ma ọ bụ ọsụsọ abalị na onye ọrịa ọ bụla nwere onye na-eme ihe na-eme ihe ma ọ bụ ICD: Ọ bụrụgodị na akpa akpa akpụkpọ ahụ dị ka pasent 100 nkịtị, ahụ ọkụ ọ bụla a na-akọwaghị (\(> 38 ^ circ\text{C}\) [$ 100.4^\circ\text{F}$]) maka ahịhịa ndụ na obi na-edu.

Ederede nzikọrịta ozi maka 911/112/999 yana nchikota ụlọ ọgwụ¶

Na-ebu kaadị njirimara * Pacemaker / ICD gị mgbe niile (ma ọ bụ chekwaa foto doro anya nke ihu na azụ kaadị n'ihuenyo NJ ahụike ama ama gị). Jiri kpọmkwem scripts ndị a n'oge ihe mberede:

• ** Maka otutu ICD Shocks ("Electrical Storm") ma ọ bụ 1 Shock nwere akara ngosi:**

  • "Achọrọ m ihe mberede Advanced Life Support ụgbọ ihe mberede na [Adreesị ziri ezi]. Onye ọrịa bụ [Age]-afọ nke etinyere ya [Onye nrụpụta: Medtronic / Boston Scientific / Abbott / Biotronik] Defibrillator (ICD) onye natara [Number] na-awụ akpata oyi n'ahụ n'oge gara aga [nkeji / awa mkpirisi obi / dizziness]. dị larịị ma dịkwa kpamkpam, ma chọọ nlekọta ECG nke ndu iri na abụọ ozugbo na ibuga n'ụlọ ọgwụ nwere ikike ajụjụ gbasara akụrụngwa obi."*

• Maka onye a na-enyo enyo na-eme ihe na-eme ihe na-eme ihe na-adịghị mma (Ọkụkụ na-adịghị ngwa ngwa, ịda mbà n'obi, ma ọ bụ mkpọda diaphragm):

  • "Mgbapụta mberede: onye ọrịa a nwere onye na-emepụta ihe na-arụ ọrụ na-arụ ọrụ ma na-enwe nnukwu dizziness/na-ada mbà na nkwojiaka nkwojiaka nke naanị [Number] na-akụ kwa nkeji [ma ọ bụ na-aga n'ihu rhythmic diaphragm hiccuping na 70 bpm. 12-lead ECG, X-ray obi, na ajụjụ ngwaọrụ stat."*

• Maka ọrịa akpa akpa ma ọ bụ mmebi akpụkpọ ahụ:

  • "Onye ọrịa ahụ nwere ngwaọrụ obi etinyere n'ime igbe [aka ekpe / aka nri] wee mepụta [oke akpa uhie na ọzịza / mmiri na-agbapụta mmiri / metal ekpughere ma ọ bụ waya na-emebi akpụkpọ ahụ / ahụ ọkụ na-akọwaghị]. Dị ka ntụziaka Heart Rhythm Society si kwuo, anyị ejighị ma ọ bụ kpachie akpa ahụ ma debe onye ọrịa ahụ ọ dịghị ihe ọ bụla site n'ọnụ omenala (NPO) maka ọbara ọgbụgba. "*

Ajụjụ a na-ajụkarị¶

M ga-enweta ọkụ eletrik ma ọ bụrụ na m na-ejide onye ezinụlọ m ma ọ bụ na-eme CPR na ha mgbe ICD dị n'ime ha na-amaja ha?¶

Mba, enweghị ike imerụ gị ahụ ma ọ bụ ọkụ eletrik ma ọ bụrụ na ị na-emetụ mmadụ aka mgbe Cardioverter-Defibrillator (ICD) dị n'ime ha na-agba ọkụ. N'ihi na a na-ebunye ujo ahụ n'ime obi n'etiti waya obi na mkpuchi ngwaọrụ (ihe dị ka 30 ruo 40 Joules n'ime, ugboro iri dị ntakịrị karịa ihe mgbagwoju anya ụlọ ọgwụ dị n'èzí), ihe fọrọ nke nta ka ọ bụrụ ike eletrik niile na-anọ n'ime ahụ ha; na kacha, onye na-eguzo na-emetụ ha iferi akpụkpọ ga-enwe a adịghị emerụ ahụ dị nwayọọ muscle twitch ma ọ bụ static tingle, na iyi ọgwụ gloves blocks ọbụna na mmetụta kpamkpam.

Kedu ihe kpatara m ga-eji gaa ụlọ mberede maka 2 ICD shocks n'ime awa 24, mgbe 1 ujo mgbe ụfọdụ na-achọ naanị ịkpọ ọkà mmụta obi m?¶

Ọ bụrụ na ICD gị na-ebunye otu ujo ma ị na-enwe mmetụta ozugbo 100% dị mma na mgbu obi efu, dizziness, ma ọ bụ mkpụmkpụ nke ume, ọ pụtara na ICD kwụsịrị otu ihe omume arrhythmia nke ọma na obi gị alaghachila n'ụda siri ike (chọrọ oku ekwentị ozugbo na ibugo n'ebe dị anya na ụlọ ọgwụ gị). Otú ọ dị, ịnweta 2 ma ọ bụ karịa ihe mgbagwoju anya n'ime awa 24 (ma ọ bụ 3+ shocks, nke a na-akpọ "Electric Storm") pụtara ma ọnyà obi na-egbu egbu na-abịaghachi ozugbo n'ihi nkụchi obi ọhụrụ, obere potassium, ma ọ bụ obi mgbawa, ma ọ bụ waya gbajiri agbaji na-awụ gị akpata oyi n'ụzọ na-ekwesịghị ekwesị, nke abụọ bụ ihe mberede na-eyi ndụ egwu chọrọ ụgbọ ihe mberede ozugbo.

IPhone (MagSafe), chaja smartwatch, ma ọ bụ pen magnetik nwere ike gbanyụọ defibrillator etinyere (ICD) n'ezie?¶

Ee, Cardioverter-Defibrillator ọ bụla a na-akụnye nwere ihe ndọta ndọta ma ọ bụ ihe mgba ọkụ nke e mere ka ndị dọkịta nọ n'ụlọ ọgwụ nwee ike tinye magnet mgbanaka siri ike n'elu igbe iji kwụsịtụ ihe egwu. Igwe igwe ọgbara ọhụrụ nwere mgbanaka nchaji magnetik (dị ka Apple MagSafe), chaja magnetik smartwatch, e-cigare/vapes nwere mkpuchi magnetik, yana ihe nkpuchi magnetik CPAP nwere magnetik neodymium dị ike nke nwere ike rụọ ọrụ ngbanwe ahụ ma ọ bụrụ na etinye ya n'ime 15 centimeters (6 sentimita asatọ) nke igbe gị (dị ka n'akpa ara), CD na-eme ka ike gwụ gị ruo mgbe ị na-eme ka ike gwụ gị. pụọ.

Kedu ihe kpatara na dọkịta na-enweghị ike ịnye naanị ọgwụ nje na-eri ọnụ ma ọ bụ lance ka akpa ihe na-eme ihe na-eme ihe na-adịghị ahụ ọkụ nke nwere ahụ zara aza dị ka etuto anụ ahụ mgbe niile?¶

Ozugbo nje bacteria na-abanye n'akpa ahụ gburugburu ihe na-eme ngwa ngwa ma ọ bụ ICD, ma ọ bụ ọ bụrụ na akpụkpọ ahụ na-esiwanye ike ọbụna otu millimita nke ngwaọrụ ígwè na-egosi site na akpụkpọ ahụ, nje bacteria na-etolite biofilm na-adịghị emebi emebi na plastik na metal wires nke na-eduga ozugbo site na veins gị banye n'ime obi gị. Adịla lance ma ọ bụ agịga tuo akpa ihe na-eme ihe ngwa ngwa, adaberekwala naanị na ọgwụ ọnụ: ịgwọ ọrịa ngwaọrụ enwetara chọrọ ọgwụ nje na-agba n'ime ụlọ ọgwụ na mwepụ nke generator na wires zuru oke ka ọrịa ahụ wee ghara ibute ọrịa obi-valve endocarditis na-egbu egbu.

enyochara isi mmalite¶

• ** Heart Rhythm Society (HRS, United States), European Heart Rhythm Association (EHRA), na Asia Pacific Heart Rhythm Society (APHRS): ** HRS / EHRA / APHRS Nkwupụta nkwenye ọkachamara na nchọpụta na njikwa nke ventricular Arrhythmias (Electrical Storm Management and ICD Shock Electronic Consensus) (CIED) Njikwa ndu na mmịpụta* (njedebe akpa na iwu mbuze).
• ** American Heart Association (AHA, United States):** * Nlekọta ahụike nke ndị ọrịa nwere Cardioverter-Defibrillators (1-Shock vs. Multiple-Shock Patient Action Plan), * AHA Adult Basic and Advanced Life Support Guide (AED Pad Placement in Patients with Pacemakers/ICDs) na American Associationur (JAHA) Igwe Ọdụdọ ndị ahịa (MagSafe / sịga eletrọnịkị) yana nnyonye anya CIED.
• ** European Society of Cardiology (ESC) na European Resuscitation Council (ERC):** * Ntuziaka ESC na Cardiac Pacing na Cardiac Resynchronization Therapy * na * Njikwa Endocarditis na-efe efe *.
• ** Ọrụ Ahụike Mba (NHS, United Kingdom) na British Heart Foundation (BHF, United Kingdom):**

Ntuziaka emetụtara¶

• Ndị okenye na ụmụaka CPR na AED ndu
• Obi ịgba ọsọ mberede (SVT), Valsalva maneuver emegharịrị, yana ọkọlọtọ ọbara ọbara arrhythmia.
• Mmata nkụchi obi na enyemaka mbụ
• Ịda mbà (syncope) enyemaka mbụ na ọkọlọtọ ọbara ọbara obi
• Sepsis na nchọpụta ujo septic