Tshipepele tshikole tshia defibrillateur (ICD) ne tshiamu tshia pacemaker tshidi katshiyi tshienza mudimu bimpe¶

Bantu binunu ne binunu pa buloba bujima badi ne Cardiovascular Implantable Electronic Device (CIED) muinshi mua dikoba dia tshiadi tshia kuulu (anyi difu/ku dia bakaji): anyi Permanent Pacemaker (PPM) udi ukandika mutshima bua kututa bitekete bitekete (bradycardia), IDimplantable (ICD) udi umona ne unyanga lubilu lua lukasa lua lufu (tachycardie ventriculaire anyi ventricular fibrillation), anyi Cardiac Resynchronization Therapy (CRT-P anyi CRT-D) tshiamu tshia biventricular bua dipanga dia mutshima. Padi ICD ufila tshipupu tshia munda tshia tshimpitshimpi tshia nzembu (tshidi babedi bumvuija bu "diumvua bu mudibu batute mu tshiadi kudi kabalu"), anyi padi tshiamu tshia pacemaker katshiyi tshikuata mishipa ya muoyo (pulse udi upueka muinshi mua \(40\text{ beats per minute}\) ne tshiji anyi kujimija lungenyi), anyi padi dikoba dia pa mutu pa tshibombi tshia tshiamu tshilua tshikunze, tshiuwule, anyi tshinyanguke, mumanye "1-Shock vs. 2-or-More-Shocks (Electrical Storm)" mukenji wa disungula, mumanye ne: **kulenga mubedi mu tshikondo tshia tshipupu tshia ICD kudi 100 pa lukama bua bantu badi pabuipi, kumanya mushindu wa kuteka tshiamu tshia nzembu tshidi tshipatuka (AED) pads munyunguluke tshiamu tshidibu bateke mu mubidi udi usungila mioyo.

Enza nunku mpindieu¶

1. Lekela muntu au asombe anyi alale panshi diakamue bua kakuluki ne kukuma mutu wende pikala dikuma dia mutshima dijula tshikuma tshikuabu anyi dijika dia tshitupa tshîpi.
2. Tumikila mukenji wa "1-Shock vs. Multiple-Shocks" Triage Rule (Heart Rhythm Society & AHA Guidelines):
   • BIKILA 911 / 112 / 999 DIAMUE BIkala: Muntu mupeta 2 anyi kupita apu ya ICD mu meba 24; NANSHA mupeta tshipupu tshimue ne udi ne bimanyinu bionso bidi bitungunuka (disama dia mu tshiadi, dipanga dia mupuya, mutu mupepele, dikuma dia muoyo, dipanga dia lungenyi, anyi disama dia mutshima); NANSHA muntu mujimije lungenyi (mujimije lungenyi) kumpala anyi mu tshikondo tshia tshipupu. Ela 911 mu États-Unis ne mu Canada, 112 mu matunga a ku Mputu, 999 mu Royaume-Uni, anyi tangila bionso nomba ya tshimpitshimpi.
   • BIkala MUNTU MUPETE ANYI 1 SINGLE SHOCK ne udiumvua 100% muimpe, mudimuke, ne kayi ne bimanyinu mu tusunsa 60: Umulame mulale anyi musombe mu ditalala kumbelu, umuambile bua kuenza mudimu ne tshiamu tshia ku bianza ku tshiamu tshia ku nzubu tshia ku luseke lua bulalu (anyi ku tshiamu tshia telefone), ne **bikila tshiamu tshiabu tshia luondapu tshia Carnicic/call-call diakamue bua mibelu ya nkonko ya dituku dimue dimue. (Bikalabu batuadija kudiumvua bibi anyi bapeta tshipupu tshibidi, bikila 911 / 112 / 999 diakamue.)
3. Bikala muntu mukuluke ne kayi witaba ne kayi upuyakana bimpe, utuadije kuenza mudimu ne bianza CPR diakamue ne ela AED: KUEKANYI nansha kakese bua buôwa bua se: ICD wabu wa munda mua kukuatshika.
4. Bualu bua bukubi bua muntu udi pabuipi: ICD wa munda udi ufila bu \(30\text{ to }40\text{ Joules}\) munda mua mutshima. Shi udi wenza mudimu wa dikuma dia tshiadi anyi ukuata mubedi mu milisekonde menemene udi ICD wende wa munda utuadija, kuena mua kupeta njiwu to, pa tshibidilu, neumvua tshintu tshidi katshiyi ne bualu, tshidi tshienza buôwa pa dikoba dia tshiadi (wewe muvuale bianza bia buanga bia nitrile, kuakumvua tshintu nansha tshimue).
5. AED Pad Placement Rule Over a Pacemaker/ICD: Tangila ne umvue bua tshiamu tshikole tshidi tshipatuka muinshi mua dikoba kuinshi kua mufuba wa ku dia bakaji anyi wa ku dia balume. Teka tshilamba tshia AED tshidi tshilamakaja mutantshi wa \(2.5\text{ centimètres}\) (\(1\text{ inch}\)) kule ne tshiamu tshidibu bateke (anyi wenze mudimu ne tshiamu tshia kumpala ne tshia panyima), ne lekela AED atangile ne atshioka bimpe.
6. Bikala tshiamu tshia ICD tshienza mudimu misangu ne misangu padi mubedi mubike, mupole, ne wakula bimpe ("Bipupu bia ICD bidi kabiyi biakane" bifumina ku tshiamu tshitshibuka anyi ku disama dia tshiadi tshia lukasa):
7. Lama mubedi mulale mupuwe ne mupole (kudila, buôwa, ne dienda bidi bivudija lubilu lua mutshima mu "tshitupa tshia tshinyangu" tshia ICD, bienza bua bipupu bia bungi kabidi).
8. Bikila 911 / 112 / 999 diakamue ne ambila muena mudimu ne: "Mubedi mmubike bikole ne udi utshioka misangu ne misangu kudi ICD udibu bamuele; tudi dijinga ne baminganga bapiluke badi ne tshiamu tshia 12-lead ECG ne tshiamu tshia magnete tshia tshiamu tshia luondapu."
9. **Umbusha telefone yonso ya bianza, tshiamu tshia kumona natshi dîba, tshiamu tshia nzembu tshidi katshiyi ne nshinga (MagSafe), makanya a ku nzembu/vape, anyi tshiamu tshia nzembu tshia tshiamu tshia nzembu tshia \(15\text{ centimeters}\) (\(6\text{ inches}\)) kule ne tshiadi.
10. Bikala mubedi ne tshiamu tshia Pacemaker (anyi ICD) ne udi ne tshiji tshikole, pabuipi ne kujimija lungenyi, mutshioke bikole, anyi dikuma dia tshianza didi dienda bitekete bitekete muinshi mua \(40\text{ to }50\text{ beats per minute}\) (anyi dikuma dia tshifu/dikuma dia tshiadi misangu yonso):
11. Udi wela meji ne: Pacemaker udi kayi mua kukuata, dipatuka dia plomb, anyi dijimija dia batterie. Teka mubedi panshi ne maulu mabandisha kakese, ubikile 911 / 112 / 999, ne wangate Wallet Pacemaker/ICD Identification Card (udi uleja muenji: Medtronic, Abbott/St. Jude, Boston Scientific, Biotronik, anyi MicroPort, nomba ya modele ne mishindu ya dilongolola).
12. Tangila dikoba didi pa mutu pa tshibombi tshia tshiamu tshia ku tshiadi: Shi dikoba didi pa mutu pa tshiamu tshia mudimu anyi ICD dileja dikala dikunze, difu, luya, butekete, dipatuka dia mayi/mpu, tshipupu tshia violet, anyi tshiamu tshia arjan tshidi tshibuela mu dikoba ditekete (dinyanguka), ndaku ku Tshibambalu tshia malu a mpukapuka dituku adi. Kufinyi, kuela, anyi kuela lushinge mu tshibombi tshia pacemaker tshidi tshiuwule, ne kulekedi nansha kakese luya lua muinshi mu mubedi wa pacemaker/ICD (CIED infective endocarditis).

Mutshi wa dipangadika dia tshimpitshimpi: disama dia ICD, dipanga dia pacemaker, ne disama dia mu tshibombi¶

Ingidija tshikandakanda etshi mu tusunsa 60 tua kumpala bua kujikija lutatu luonso lua tshiamu tshia muoyo tshidibu bateke mu mubidi.

flowchart TD
    Start["Tshilumbu tshia tshimpitshimpi kudi mubedi udi ne tshiamu tshia mudimu (PPM), tshiamu tshia defibrillateur (ICD), anyi tshiamu tshia CRT"] --> EventType{"Tshilumbu tshia tshiamu tshia kumpala ntshinyi?"}

    EventType -->|"MUBEDI KAYENA WA KUANDAMUNA<br/>& Kena Upuyakana Bimpe"| Arrest["DISHIPA DIA MUOYO (ICD kena mua kukudimuna lubilu):<br/>1. Bikila ku 911 / 112 / 999 ne utuadije kuenza mudimu wa dikuma dia tshiadi mpindieu<br/> (Mbimpe kulenga mubedi nansha mudi ICD wa munda mua kapia)<br/>2. Lamakaja AED: Teka tshilamba >= 2.5 cm (1 inch) kule ne<br/> tshintu tshidi tshipatuka (anyi wenza mudimu ne tshilamba tshia AP tshia kumpala too ne panyima)<br/>3. Londa mibelu ya AED kakuyi lutatu"]

    EventType -->|"ICD DELIVERED SHOCK(S)<br/>(Conscious Patient)"| ShockCount{"Mmalu bungi munyi avua menzeke<br/>& Mubedi udi umvua bishi?"}

    ShockCount -->|"2 NANSHA BIPI BIKUATA mu meba 24<br/>(>= 3 Bipupu = 'ICD ELECTRICAL STORM')<br/>ANYI 1 Tshipupu NE Disama dia mu tshiadi, Dipanga dia luya,<br/>Disama dia mutu, Dijimija dia lungenyi, anyi Dikuma dia mutshima"| StormER["MIMMEDIETE 911 / 112 / 999 EMERGENCY:<br/>1. Lala mubedi panshi ne mupuwe (udi upuekesha adrenaline)<br/>2. Suspect VT/VF Electrical Storm OR Inappropriate Shocks<br/> (from fractured lead / rapid AFib / T-wave oversensing)<br/>3. EMS/ER udi uteka 12-lead ECG; Shi bipupu bidi kabiyi bikumbane pa<br/> tshiamu, munganga udi ufunda Ring Magnet pa ICD bua kupangisha<br/> bipupu eku ulama tshintu tshia pacemaker tshimpe"]

    ShockCount -->|"1 SINGLE SHOCK ONLY<br/>+ Mubedi udi umvua 100% bimpe ne kayi ne bimanyinu<br/>Mu minite umua"| SingleShock["MUSHINDU WA KUDIMUENA / MUDIMU WA LUPILU:<br/>1. Kuikisha musombe/mulale panshi; KUENJI mashinyi<br/>2. Tuma tshiamu tshia mudimu tshia ku nzubu tshia ku bule mpindieu<br/>3. Bikila nimero ya Device Clinic bua kupeta mibelu<br/>4. Shi 2nd shock nansha kiyukeno kyonso kimweka -> Bikila 911"]

    EventType -->|"DITUKU, DIFUKA, NANSHA MUTU < 40-50 BPM<br/>(anyi Rhythmic Diaphragm Hiccups / Pectoral Twitch)"| PacerFail["KUELA NE PACEMAKER MALFUNCTION:<br/>(Dipanga dia kukuata, dibuela dia plomb, anyi dimona dia bungi)<br/>1. Bikila 911 / 112 / 999 diakamue; kuteka mubedi panshi<br/>2. Umbusha telefone yonso/magnete adi mu bule bua 15 cm ku tshiadi<br/>3. Ulue ne karte ka ID ka tshiamu tshia tshibutshilu bua kuela nkonko mu ER"]

    EventType -->|"BIDIMU BIDI BIUMVUA NANSHA BIDI BITUNKA<br/>Kudi Munda mua Tshifu"| BeepAlert["MUTOYI WA DIDIMUIJA DIA MU TSHIMU:<br/>Udi uleja ERI wa batterie, dishintuluka dia impedance wa plomb, anyi mushindu wa Mag.<br/>Bikala mubedi umvua bimpe -> Bikila lupitadi lua tshiamu lelu.<br/>Biwikala ne mutu, mupuya mutekete anyi mutshioke -> Ndaku ku ER LELU."]

    EventType -->|"LUKOBA LUTUKU, LUVUME, LUDI LUPA, ANYI LUDI LUSHINTUKE<br/>Pa mutu pa tshibombi tshia tshiamu (anyi luya ludi kaluyi ne diumvuija)"| PocketInf["CIED POCKET INFECTION / ENDOCARDITIS:<br/>1. Dikonkonona dia tshibambalu tshia malu a tshimpitshimpi dia dituku dimue<br/>2. KUFINYI anyi kupuekesha mu tshibombi nansha kakese<br/>3. Bidi bikengela kuenza mudimu ne mashi, manga a antibiotique, ne diumusha dionso"]

Tshitupa 1: Tshiamu tshia Cardioverter-Defibrillator (ICD) tshidi tshiteka mu mubidi ne "Tshipepele tshikole tshia nzembu"¶

Mushindu udi ICD uondopa disama dia arrhythmie kumpala ne mu tshikondo tshia tshipupu¶

Biamu bia lelu bia Cardioverter-Defibrillators (ICDs), bidi ne transvenous ICDs (ne nshinga idi mibuela mu mutshima) ne subcutaneous ICDs (S-ICDs) (miteka muinshi mua dikoba ku luseke lua tshiadi tshia ku dia bakaji), bidi bushuwa ne bipese bibidi bia luondapu padibi bimueneka ne lukasa: 1. Mulongo 1: Anti-Tachycardia Pacing (ATP, Painless): Padi ICD umona tshiona tshia lukasa tshia pa tshibidilu (monomorphic ventricular tachycardia [VT]), udi uteta bua kutshibula tshijengu kakuyi kanyinganyinga pa kufila tshipupu tshia lukasa tshia 8 too ne ku 10 tshia pacing pulses mikese lubilu kupita arthmie (drive pacing). Babedi kabatu bumvua ATP nansha kakese (anyi bumvua anu tshipupu tshia sekonde 2). 2. Tier 2: High-Voltage Defibrillation Shock (\(30\text{ to }41\text{ Joules}\)): Shi ATP udi kayi ne kanyinganyinga kena mua kuimanyika tshiona, anyi pikala tshiona tshienda tshikola too ne ku Ventricular Fibrillation (VF) anyi VT wa lubilu lua bungi (\(2{\)0}, b tshiamu tshia munda tshia 5 too ne ku 10 sekonde ne tshidi tshifila bukole bua bungi buludiludi mu mishipa ya muoyo. - Bu mudi mubedi misangu ya bungi utshidi anu ne lungenyi mu tshikondo tshia VT (anyi upingana mu lungenyi kunyima kua tusunsa 2 kunyima kua tshipupu), udi umvua tshintu tshia tshimpitshimpi tshidi tshimufofomija mêsu (phosphenes), dikokangana dikole dia misunya ya mu tshiadi ne ya pa makaya, ne diumvua dia dikuma dikole dia mufuba wa tshiadi.

Tshipepele tshikole tshia nzembu tshia bushuwa "tshikumbane" ne tshipepele tshikole tshia ICD "tshidi katshiyi tshikumbane"¶

Padi mubedi upeta bipupu bia bungi mu mulongo (ICD Electrical Storm, udi umvuija bu \(\ge 3\text{ bikondo bia sustained VT/VF anyi ICD shocks mu tshikondo tshia mêba 24}\)), baminganga ne baminganga ba malu a mpukapuka batu benza mudimu ne tshiamu tshia ECG tshia 12 bua kumanya malu abidi mashilangane:

Mushindu udi biamu bia tshiamu tshia mitaku bienza mudimu pa biamu bia mudimu ne ICDs (mukenji wa mushinga mukole wa luondapu)¶

Babedi ba bungi nansha bamue bena mudimu ba mu lupitadi badi mu dielakana bua tshidi tshienzeka padi magnete wa tshiamu tshia mitaku (anyi magnete wa neodymium wa muena mudimu mu telefone/vape) ulenga tshiadi pa tshiamu tshia muoyo tshidibu bateka. Magnete udi wenza bualu budi bushilangane menemene ne Pacemaker ne ICD:

1. Tshienzedi tshia tshiamu tshia nzembu pa tshiamu tshia defibrillateur (ICD):
2. Kuteka tshiamu tshia nzembu buludiludi pa ICD KUDI KUJIMA BIDIMU BIONSO BIA TACHYARRHYTHMIE NE BIDIMU BIDI BIKUATA MU MUSHINDU MUNENE (bua ICD **kakutshinyisha mutshima padi tshiamu tshia nzembu tshikuate ku tshiadi), padiye ushiya mudimu wa tshiamu tshia nzembu wa muoyo wa ICD-100% KAKUENA MUSHINGA.
3. Dîba diudi umbusha tshiamu tshia nzembu ku tshiadi, tshiamu tshia ICD tshidi tshipingaja diakamue tshiamu tshiatshi tshia bukubi ku tshipupu.
4. Bua tshinyi biamu bia nzembu (MagSafe iPhones, Smartwatches, Magnetic Vape Pens, CPAP Magnetic Clips) bidi ne njiwu mu tshibombi tshia tshilamba: Shi mubedi wa ICD muteka tshiamu tshia nzembu tshidi ne tshiamu tshia nzembu tshia tshiamu tshia nzembu (bu mudi Apple MagSafe), makanya/vape wa nzembu udi ne tshibuikidiji tshia nzembu, anyi tshilamba tshia nzembu mu tshibombi tshiabu mu tshibombi munda mua \(15\text{ centimeters}\) (\(6\text{ inches}\)) wa ICD wabu, anyi ulala ne telefone wende muteke pa tshiadi, tshiamu tshidi tshipangisha tshiamu tshiabu tshia defibrillateur tshidi tshisungila muoyo paditshi tshiikishamu. Ikala anu ne telefone ya bianza, tshiamu tshia nzembu tshia meji, biamu bia ku matshi bidi kabiyi ne nshinga, ne biamu bia magnete bidi kabiyi ne nshinga \(15\text{ cm}\) (\(6\text{ inches}\)) kule ne tshiamu tshia pacemaker anyi ICD (\(30\text{ cm}\) [\(12\text{ inches}\)] bua tshiamu tshia bukole bua bungi).
5. Tshienzedi tshia tshiamu tshia nzembu pa tshiamu tshia mudimu tshia kashidi (PPM):
6. Kuteka tshiamu tshia nzembu pa tshiamu tshia nzembu kakuena kujima tshiamu tshia nzembu to, kadi kudi kushintulula tshiamu tshia nzembu mu "Asynchronous Pacing Mode" (mode DOO anyi VOO), mudi tshiamu tshia nzembu tshilengulula dikuma dia mutshima wa mubedi ne tshienza mudimu ne tshipiminu tshisunguluke (pa tshibidilu \(85\xt {000} to bpm}\)). (Anu baminganga bapiluke badi mu tshiamu tshia ECG ke badi ne tshia kuela tshiamu tshia tshiamu tshia mitaku anyi ICD.)

Tshitupa 2: Kuenza CPR ne kuenza mudimu ne AED kudi mubedi udi ne Pacemaker anyi ICD¶

Shi muntu udi na tshiamu tshia pacemaker anyi ICD mukuluke, kayi wenza mudimu, ne kayi upuyakana bimpe (anyi udi anu upuyakana), tshiamu tshidibu bamuele mu mubidi katshiena mua kumusungila to (nansha bualu bua rythme udi kayi mua kutshioka PEA/asystole, muscle wa mutshima udi ne ischemic wa bungi bua kuandamuna, anyi batterie/lead mmupangile). Muntu udi utangila diakamue CPR ne tshiamu tshia pambelu tshidi tshienza mudimu nkayatshi (AED) ke mushindu umuepele udibu mua kupanduka.

Londa Mikenji isatu ya AHA / ERC ya dilengeja dia mubidi eyi bua babedi badi ne biamu bia mudimu:

1. Kulekedi dikuma dia tshiadi nansha dimo: Teka bianza biebe muaba udibi bikengela, munkatshi mua tshiadi ku tshitupa tshia kuinshi tshia mufuba wa tshiadi (mu tshiadi), ne utute bikole ne lukasa (\(100\text{ to }120\text{ compressions per minute}\), \(5\text{ to }6cm\text{ to }\)xt{t\t\xt{to }2.4\text{ inches}$] deep). Bu mudi pacemaker ne ICD generators biteka muinshi mua mufuba wa ku dia bakaji anyi wa ku dia balume (clavicle) (anyi muinshi mua tshiadi tshia dia bakaji bua ICD wa muinshi mua dikoba), bianza biebe bidi munkatshi mua mufuba wa tshiadi kabiena pabuipi ne kazubu ka tshiamu to.
2. Ntshinyi tshienzeka pikala ICD wa munda mua kukuma padi bianza bianyi pa tshiadi?
3. Tungunuka ne kuenza CPR: Nansha biobi bikala ICD wa munda mua kuenza tshipupu tshia \(35\text{-Joule}\) padi bianza biebe bia patupu bikuma pa tshiadi, mudilu udi ushala munda mua tshiadi pankatshi pa tshiamu tshia mutshima tshia munda ne tshibombi tshia titanium. Muinshi mua 1 volt udi ufika pa mutu pa dikoba. Kuakuenzela bibi to.
4. (Dimanya: Wewe mumone tshifu tshia mubedi tshinyunguluka mu tshimpitshimpi bua tshipupu tshia munda tshia ICD mu tshikondo tshia CPR, lekela anu sekonde 1 anyi 2 bua tshipupu tshijike ne utungunuke ne dikonkonona dia CPR/AED.)
5. Muaba wa kulamakaja bintu bia pambelu bia AED:
6. Paudi upatula tshifu, keba \(3\text{ to }5\text{ cm}\) tshilonda tshia dipanda ne tshitupa tshikole tshia tshijengu tshidi tshipatuka muinshi mua dikoba kuinshi kua tshiadi tshia balume anyi tshia bakaji (anyi ku luseke lua mifuba ya ku dia bakaji bua S-ICD).
7. Kuena mua kulamakaja tshiamu tshia AED pa mutu pa tshiamu tshia pacemaker/ICD to: Tshiamu tshidi muinshi mua dikoba tshidi tshipangisha AED wa pambelu bua kufika mu mutshima ne tshinyanga tshiamu tshia mudimu.
8. Teka tshiamu tshia AED nansha \(2.5\text{ centimetres}\) (\(1\text{ inch}\)) ku luseke anyi kuinshi kua tshiamu tshidibu bateke mu mubidi (anyi teka tshiamu etshi mu Anterior-Posterior [Front-and-Back] position: tshiamu tshimue tshidi ku tshiadi tshia kumpala pankatshi pa tshiadi, tshikuabu pankatshi pa tshiadi ne tshia panyima bipese bia makaya).

Tshitupa 3: Kujingulula mudimu mubi wa tshiamu tshia nzembu ne ntatu idi ifumina ku diteka tshiamu tshia nzembu¶

Bimanyinu 5 bia tshimpitshimpi bia Pacemaker anyi Lead udi kayi wenza mudimu bimpe¶

Shi muntu udi na tshiamu tshia pacemaker anyi ICD mupeta tshimue tshia ku bimanyinu bidi bilonda ebi, umuambula diakamue ku tshibambalu tshia malu a mpukapuka:

1. Bradycardie symptomatique ("Dipanga dia kukuata" anyi "Dipanga dia kupatula"):
2. Muntu udi umvua tshiji, mutu mupepele, mutekete, mupuya mutekete, mubungame, anyi mupuya (syncope), ne kutangila dikuma dia mutshima wende ku tshianza anyi ku nshingu kudi kuleja ne muoyo wende udi wenda bitekete bitekete kupita tshipiminu tshia pacemaker tshidibu balongolole (pacemaker yonso idi milongolola bua kubenga kulekela mutshima upueka muinshi mua \(5** anyi }60\text{ beats per minute}\)**).
3. Tshiamu tshia mushinga tshia Pulse Oximeter / Smartwatch Didimuija: Kueyemenyi anu tshiamu tshia ECG nkayatshi pikala mubedi umvua mutshioke. Mu "Dipanga dia kukuata", tshiamu tshia pacemaker tshidi anu tshituma tu-malunji tukese tua nzembu tudi tshiamu tshia kumona natshi muoyo mua kubala bu \(70\text{ bpm}\), kadi mushipa wa muoyo kawena ufinya to, nunku tshipiminu tshia bushuwa tshia ku tshianza anyi tshia munu tshidi anu \(30\text{bpm}\). Ikala umvua misangu yonso pulse wa radial anyi wa carotid ne minu yebe.
4. Kukankamika anyi kunyunguluka kua misunya ya mu tshiadi anyi ya mu tshifu (dipatuka dia plomb anyi dibutuka):
5. Bikala mubedi mutuadije kuikala ne bipupu bia pa tshibidilu bia metronome (\(60\text{ to }80\text{ misangu mu minite}\), bikumbanangana ne dikuma dia mutshima wabu menemene) anyi dikankamika dia muscle wa tshiadi tshiabu ku dikuma dionso, tshiamu tshia pacemaker/ICD tshidi tshipatula muaba wa kuulu (kusaka Phrenic Nerve udi ukokesha diaphragme) anyi mubuele mu tshimanu tshitekete tshia ventricule wa dia balume, udi mua kuikala mu njiwu disama dia tshiadi anyi disama dia mutshima.
6. Divula dia tshimpitshimpi, dishintuluka dia dikala dia violet, anyi dikola dia mijilu mu diboko dimue (Thrombose wa mijilu ya muinshi mua diboko):
7. Bu mudi pacemaker ne ICD bipita mu mishipa ya muinshi mua tshiadi ne ya tshiadi muinshi mua mufuba wa tshiadi, tshipupu tshia mashi (tshiamu tshia mu mishipa tshia ku mutu) tshidi mua kuikala tshinyunguluke mionji, tshienza bua diboko dia balume anyi dia balume, tshianza, ne luseke lua nshingu bikale bivula, bisama, ne bilue bikunze.
8. Disama dia Pacemaker ne Disama dia Twiddler:
9. Shi mubedi udi unyunguluka, unyunguluka, anyi unaya ne kazubu ka pacemaker mu dikoba diende kayi mumanye (Twiddler's Syndrome), mionji idi inyanguka bu tshiamu tshia kuloba natshi ne ipatuka anu mu tshimanu tshia mutshima. Kuena ne bua kunyunguluka anyi kufina kazubu ka tshiamu muinshi mua dikoba to.
10. Malu adi umvuika, mbila, anyi mbila ya munda mua tshiadi:
11. Biamu bia lelu bia ICD ne bia CRT (Medtronic, Boston Scientific, Abbott, Biotronik) bidi ne tshiamu tshia kuakula natshi anyi tshiamu tshia dikankamika tshidi tshipatula mutoyi wa tshiona tshikole (bu mudi tshisanji tshia dîba anyi tshia ambulanse) anyi dikankamika dikole mu bikondo bisungula dituku dionso padi tshiamu etshi tshimona tshiona tshikole: Dipingaja dia dîyi dia E Tshimanyishilu (ERI)**, dipanga dia tshiamu tshia plomb tshidi katshiyi tshiakane (tshiamu tshitshibuka), anyi dipanga dia tshiadi dia bungi.
12. Shi mubedi umvua tshiadi tshienda tshikuma anyi mumvue tshienda tshinyunguluka: Shi udi umvua bimpa, ubikile nzubu wende wa lupitadi dituku adi; bobu ne disama dia tshiadi, dipanga dia mupuya, anyi bipupu, ndaku diakamue ku tshibambalu tshia malu a mpukapuka.

Tshitupa 4: Disama dia mu tshibombi tshia tshiamu, dinyanguka dia kikoba, ne CIED Endocarditis¶

Bua tshinyi tshilonda tshikese, tshitupa tshia mubidi anyi tshiamu tshia nzembu tshidi tshimueneka pa mutu pa tshiamu tshia pacemaker ntshilumbu tshia lukasa tshia dipanda¶

Bishilangane na disama dia kikoba ku diboko anyi ku dikasa didi mua kuondopibua ne mulondo wa manga a antibiotique a matuku 7, disama dionso dia bactérie didi dilenga tshiamu tshia pacemaker anyi tshibombi tshia ICD anyi nshinga yende didi disama dia mutshima didi mua kunyanga muoyo: - Bactérie (nangananga Staphylococcus aureus ne Staphylococcus epidermidis) badi benza tshilamba tshia bukubi (biofilm) pa tshiamu tshia plastike ne tshiamu tshia pacemaker tshidi tshifikisha manga a antibiotique ku dibuela. - Bu mudi bintu ebi bienda bipueka mu mijilu ne bibuela munda mua atrium wa ku dia balume, tshia tricuspid valve, ne tshia ventricle wa ku dia balume, disama dia mu tshibombi didi dimueneka bu dikese didi dilonda buludiludi mu mionji mu mishipa ya muoyo ne mu mashi, difikisha ku CIED Infective Endocarditis ne Sepsis (udi ne tshitupa tshia lufu tshia 20 too ne ku 30 pa lukama pikala dipatula dia tshiamu tshienzeja).

Mukanda wa dibendele dikunze bua disama dia mu tshibombi tshia tshiamu ne dinyanguka dia tshiamu (Ndaku ku ER / Cardiology lelu)¶

Tangila dikoba dia tshiadi pa tshiamu tshia pacemaker anyi ICD mu butoke bua bungi: - [ ] Dikala dikunze (rythema), luya, disama, anyi disama dipiadipia pa mutu pa tshibombi tshia tshiamu (nansha mbingu 2 kunyima kua dipanda anyi bidimu 5 pashishe). - [ ] Disangisha dia mayi (dishintuluka), pus, tshitupa tshia jaune, anyi dipatuka dia mashi mutoke adi apatuka mu tshilonda tshia dipanda. - [ ] Pre-erosion anyi Frank Skin Erosion: Dikoba didi pa mutu pa ditumba dia tshiamu tshia tshiamu anyi tshiamu tshia mitaku didi dilua ditekete bu dibeji, dikenkesha, dikole, ne dikunze dia violet (dilamakaja ku tshiamu tshidi muinshi), anyi tshitupa tshia tshiamu tshia arjan anyi tshiamu tshitoke/tshitoke tshidi tshipatuka mu tshina tshikese tshidi mu dikoba. (MUYUKI WA MUSHINDU: Nansha mudiku kakuyi tshipupu ne kanyinganyinga, bikala tshitupa kampanda tshia tshiamu tshia tshiamu anyi tshia nshinga tshipatuka mu luya lua pambelu kupitshila ku dikoba, tshiamu tshijima ne nshinga yonso ya muoyo bidi ne disama dia bactérie 100% ne bidi ne bua kupatuka mu lupitadi lua pa bualu. Utshibuikile bimpe ne gauge wa sterile, kuteta bua kuela muinshi mua tshiamu panyima dikoba, ne uya ku lupitadi lelu.) - [ ] Luya ludi kaluyi lumvuija, mashika, anyi tuishi tua butuku mu mubedi yonso udi ne tshiamu tshia kuenza natshi mudimu anyi ICD: Nansha mudi dikoba dia mu tshiadi dimueneka bimpe 100 pa lukama, luya luonso ludi kaluyi lumvuija (\(>38^\circ\text{C}\) [\(100.4^\circ\text){\)100.4^\circ\text){F}$ anyi tshipiminu tshia mashi katshiena dijinga ne disama dia lukasa ne mashi transesophageal echocardiogram (TEE) bua kutangila ni bikunyibua bidi pa njila ya mutshima.

Mukanda wa dimanyishangana wa 911 / 112 / 999 ne disungula dia lupitadi¶

Misangu yonso ikala ne Pacemaker / ICD Wallet Identification Card (anyi ulame tshimfuanyi tshimpe tshia kumpala ne tshia panyima pa karte mu tshibuelelu tshia ID wa luondapu tshia telefone webe wa bianza). Wenza mudimu ne script eyi mu tshikondo tshia njiwu:

• Bua bipupu bia bungi bia ICD ("Tshipepele tshikole tshia nzembu") anyi tshipupu tshimue tshidi ne bimanyinu:

  "Ndi dijinga ne mashinyi a diambuluisha dia lukasa lukasa ku [Adrese mulelela]. Mubedi udi ne bidimu [Bidimu] ne tshiamu tshia [Muenji: Medtronic / Boston Scientific / Abbott / Biotronik] Defibrillator (ICD) tshidibu bateke [Muenji: Medtronic / Boston Scientific / Abbott / Biotronik] Defibrillator (ICD) udi mupete [Number] shocks mu bikondo bishale [nunutes [//ziz] ne disama dia tshiadi / dipanga dia mupuya]. Tudi ne mubedi mulale panshi ne mupuwe, ne tudi dijinga ne dikonkonona dia lukasa dia 12-lead ECG ne dimufikisha ku lupitadi ludi ne tshiamu tshia muoyo tshidi ne bukole bua kukonka nkonko."

• Bua Pacemaker udi wela meji ne udi kayi wenza mudimu bimpe (udi wenda bitekete bitekete, udi ujimija lungenyi, anyi udi unyunguluka dia diaphragme):

  "Disungula dia tshimpitshimpi: mubedi eu udi ne [Muenji] Pacemaker muela munda ne udi ne disama dia tshiadi dikole/pabuipi ne dijimija dia lungenyi ne dikuma dia tshianza dia tshiamu tshia [Number] dia bikuma pa minite [anyi diaphragme udi wenda ukola ku 70 bpm]. Tudi tuela meji ne: Pacemaker udi unyanguka bikole anyi udi ne dipanga dia dipanga dia mutshima/dipanga dia dipanga dia tshianza anyi dipanga dia dipanga dia bukole anyi dipanga dia dipanga dia tshiadi. ne udi dijinga ne diakamue ECG wa 12-lead, X-ray wa mu tshiadi, ne dikonkonona dia tshiamu tshia stat."

• Bua disama dia mu tshibombi tshia tshiamu anyi dinyanguka dia kikoba:

  "Mubedi udi ne tshiamu tshia muoyo tshidibu bateke mu tshiadi tshia [ku dia bakaji/ku dia balume] ne mmulue [dikala dikunze ne disama dia mu tshibombi / dipatuka dia mâyi / tshiamu anyi tshiamu tshidi tshienda tshinyanguka mu dikoba / kapepe kadiyi diumvuija]. Bilondeshile mikenji ya Heart Rhythm Society, katuena bafina anyi batute mu tshibombi ne katuena balame mubedi mashi bua tshintu nansha tshimue (PON) bilele ne dikonkonona dia malu a muoyo."

Nkonko itubu bela misangu ya bungi¶

Ndi mua kupeta nzembu meme mukuate muena mu dîku dianyi anyi ngenza CPR kudiye padi ICD wende wa munda umutonda anyi?¶

Tòo, kuena mua kutapa anyi kupeta nzembu wewe ulenga muntu padi tshiamu tshiende tshia munda tshia Cardioverter-Defibrillateur (ICD) tshienza mudimu to. Bu mudi tshipupu tshidi tshifidibua munda menemene mua tshiadi pankatshi pa tshiamu tshia mutshima ne tshibombi tshia tshiamu (pabuipi ne 30 too ne ku 40 Joules munda, misangu dikumi mikese kupita tshipupu tshia pambelu tshia lupitadi), pabuipi ne bukole buonso bua nzembu budi bushala munda mua mubidi wabu; pa tshibidilu, muntu udi utangila udi ulenga dikoba diabu didi kadiyi ne tshintu neumvue dikankamika dia misunya anyi dikankamika dia mubidi didi kadiyi ne bualu, ne kuvuala bianza bia luondapu kudi kupangisha nansha diumvua edi bimpe menemene.

Bua tshinyi ndi ne tshia kuya mu nzubu wa lupitadi bua kupeta 2 ICD shocks mu meba 24, padi 1 shock imue misangu ulomba anu kubikila munganga wanyi wa mutshima?¶

Shi ICD webe mufila 1 single shock ne udi umvua diakamue bimpe 100 pa lukama kuyi ne kanyinganyinga ka mu tshiadi, tshiji, anyi dipanga dia mupuya, bidi biumvuija ne ICD mmujikije bimpe tshikondo tshimue tshia arrhythmie ne mutshima webe mmupingane mu tshipiminu tshimpe (bidi bikengela kubikila diakamue ku telefone ne kutuma ku lupitadi luebe lua muoyo ku bule). Ino, kupeta bipupu 2 nansha kupita apu mu ma nsa 24 (nansha bipupu 3+, bibikila ne "Tshipepele tshikole tshia nzembu") bidi biumvuija ne: muoyo udi ushipa udi utungunuka ne kupingana diakamue bua disama dia mutshima dipiadipia, dipanga dia potassium, anyi dipanga dia muoyo, anyi bua tshiamu tshitshibuka tshidi tshikutshinyisha mu mushindu udi kauyi muakanyine, bionso bibidi ebi bidi bilomba diambuluisha dia lukasa dia lukasa.

Tshiamu tshia iPhone (MagSafe), tshiamu tshia kuela natshi dîba, anyi tshiamu tshia nzembu tshidi mua kujima tshiamu tshia defibrillateur (ICD) anyi?¶

Eyowa, tshiamu tshionso tshia Cardioverter-Defibrillator tshidi ne tshiamu tshia magnétique anyi tshiamu tshia Hall-effect tshienza bua baminganga ba mu lupitadi bateke tshiamu tshia magnétique tshikole pa tshiadi bua kuimanyika bipupu bua tshitupa tshîpi. Telefone ya lelu idi ne bipese bia tshiamu tshia nzembu (bu mudi Apple MagSafe), biamu bia nzembu bia tshiamu tshia nzembu, makanya a ku Enternete/ma vape adi ne bifulu bia tshiamu tshia nzembu, ne biamu bia nzembu bia CPAP bidi ne biamu bia nzembu bia bukole bia neodymium bidi mua kuenza mudimu ne tshintu atshi pikalabu babiteke mutantshi wa 15 centimètres (6 inches) ne tshiadi tshiebe (mu tshibombi tshidi katshiyi tshienza mudimu), bu mudi tshibombi tshidi katshiyi tshienza mudimu kupangisha bukole bua ICD webe bua kukuma tshiona tshia lufu too ne padibu bumbusha tshiamu tshia nzembu.

Bua tshinyi munganga kena mua kufunda anu manga a antibiotique anyi kuela mu tshibombi tshia pacemaker tshidi tshiuwule ne tshidi ne disama bu mudi dikoba dia pa tshibidilu?¶

Padi bactérie babuela mu tshibombi tshidi tshinyunguluke tshiamu tshia pacemaker anyi ICD, anyi pikala dikoba dienda dikepela nunku nansha milimetre umue wa tshiamu tshia mitaku udi umueneka mu dikoba, bactérie idi yenza tshintu tshidi katshiyi mua kubutuka pa tshiamu tshia plastique ne tshia tshiamu tshidi tshifikisha buludiludi mu mijilu yebe munda mua mutshima webe. Kuena ne tshia kuela mu tshibombi tshia pacemaker nansha kakese, ne kueyemenyi anu manga a ku mishiku to: bua kuondopa disama dia tshiamu didi dijadikibue bidi bikengela kuela manga a antibiotique mu mushipa ne kumbusha tshiamu tshia nzembu ne mionji ku diambuluisha dia dipanda bua disama edi kadifiki ku disama dia endocardite dia valve wa mutshima to.

Miaba mifumina¶

• Tshisumbu tshia malu a mutshima (HRS, États-Unis), Tshisumbu tshia malu a mutshima tshia ku Mputu (EHRA), ne Société wa malu a muoyo wa mu Asia Pacific (APHRS): HRS/EHRA/APHRS Dimanyisha dia bamanyi pa bidi bitangila dimanya ne dilama dia disama dia muoyo (Electrical Storm Management ne IHRS) Dimanyisha dia buobumue pa bidi bitangila dilama ne dipatula dia plomb mu tshiamu tshia nzembu tshia muoyo (CIED)* (malu adi atangila disama dia mu tshibombi ne dinyanguka dia bintu).
• American Heart Association (AHA, United States): Clinical Management of Patients with Implantable Cardioverter-Defibrillators (1-Shock vs. Multiple-Shock Patient Action Plan), AHA Adult Basic and Advanced Life Support Guidelines (AED Pad Placement in Pacements with Patients/IC) wa American Heart Association (JAHA) udi ufila didimuija pa bidi bitangila biamu bia mudimu bia bungi (MagSafe / Electronic Cigarettes) ne CIED Interference*.
• Société européenne de cardiologie (ESC) et conseil européenne de resuscitation (ERC): ESC Guidelines on Cardiac Pacing and Cardiac Resnchronization Therapy ne Manage of Infective Endocarditis.
• Tshibambalu tshia malu a bukola bua mubidi tshia ditunga (NHS, Royaume-Uni) ne Tshibambalu tshia muoyo tshia mu Grande-Bretagne (BHF, Royaume-Uni): Tshiamu tshia diondopangana tshia mutshima (ICD) Tshia kuenza panyima pa disama dia mutshima ne buludiki bua bukubi bua mutshima.

Malu adi apetangana¶

• Mukanda wa CPR ne wa AED wa bantu bakole ne bana
• Mutshima udi unyunguluka mu tshimpitshimpi (SVT), tshienzedi tshia Valsalva tshishintulula, ne disama dia arrhythmie
• Dimanya dia disama dia mutshima ne diambuluisha dia kumpala
• Diambuluisha dia kumpala dia dijimija lungenyi (syncope) ne bimanyinu bia mutshima
• Disama dia sepsis ne dia septic shock