Sudden Racing Heart (SVT), Modified Valsalva Maneuver, le Arrhythmia Red Flags¶

Ha ngoana ea phetseng hantle, mocha, kapa motho e moholo a utloa pelo ea hae e qepha joalo ka switch ea lebone 'me hang-hang a matha ka \(160\text{ho }250\text{ beats per minute}\) ka lebelo le potlakileng, le tloaelehileng la sethunya molaleng, hangata le susumetsoa ke ho inama ho tlama seeta, ho ema ka potlako, ho felloa ke metsi 'meleng, kapa khatello ea maikutlo. Tachycardia (PSVT / SVT) **, loop ea motlakase e khutšoanyane ea motlakase e shebaneng le **atrioventricular (AV) node **. Le hoja SVT e sa rarahanang ho mokuli ea tsitsitseng hangata e ka khutlisetsoa morao ho morethetho o tloaelehileng lapeng ka metsotsoana ea 60 ho sebelisoa letšoao **REVERT Modified Postural Valsalva Maneuver ** (e leng se fetang habeli lebelo la katleho ea khale ea khale ka ho eketsa motho e moholo ea nang le 45-degree), ho phahamisa pelo hang-hang ka mor'a hore motho e moholo a phahamise pelo, ho phahamisa pelo hang-hang lefu, kapa mang kapa mang ea nang le sefubeng, ho hema ka thata, kapa ho akheha (syncope) e ka ba Ventricular Tachycardia (VT) kapa Pre-Excited Atrial Fibrillation (Wolff-Parkinson-White [WPW] syndrome), e ka senyehang ho ba ho tšoaroa ha pelo ho bolaeang ka mor'a metsotso e seng mekae. Ho tseba ho hlahloba botsitso ba hemodynamic pele, etsa se nepahetseng metsotsoana e 15 + 45-second supine leg-lift Modified Valsalva Maneuver, etsa ka mokhoa o sireletsehileng masea a sefahleho ice-pack application, 'me le ka mohla u se ke ua itlotsa methapo ea molala e pholosa bophelo.

Etsa sena hona joale¶

1. Etsa hore motho a lule kapa a paqame hang-hang, emisa ho sisinyeha hohle, 'me u hlahlobe Lifolakha tse Khubelu tse 5 tsa Unstable Arrhythmia.
2. Haeba motho a e-na le mahlaba sefubeng, ho hema ka thata, ho akheha/ho akheha, ho ferekana, kapa a na le lefu la pelo (lefu la pelo pele, ho hloleha ha pelo, kapa mesifa ea pelo), ** letsetsa 911/112/999 hona joale** (sheba tsohle dinomoro tsa tshohanyetso). Ho mang kapa mang ea nang le lefu la pelo ea sebopeho, nka hore pelo ea lebelo la tšohanyetso ke Ventricular Tachycardia (VT) ho fihlela ECG e etellang pele 12 e paka ho fapaneng.
3. Sheba ho otla ha pelo letsohong la letsoho (radial artery) metsotsoana e 15 'me u botse hore na ho otla ha pelo ho QILE joang:
4. Phetoho ea hang-hang + morethetho o tsitsitseng oa rock ka \(160\text{ho ea }240\text{bpm}\) + ho otla hoa bonahalang botlaaseng ba molala ("Frog Sign"): Classic Supraventricular Tachycardia (AVNRT kapa AVRT).
5. Ho eketsa lebelo ho feta metsotso e mmalwa + morethetho o tlwaelehileng ho \(110\text{ho }160\text{bpm}\) nakong ya feberu, bohloko, ho felloa ke metsi, kapa ho tshoha: Mohlomong Sinus Tachycardia kapa ho tshoha (motsamao oa vagal o tla liehisa sinus tachycardia hanyane ka metsotsoana e 3 ebe e potlaka ho khutlela morao; ho phekola feberu e teng, ho felloa ke metsi 'meleng, kapa matšoenyeho).
6. Moribo o sa tsitsang ka mokhoa o sa tloaelehang ("ka mokhoa o sa tloaelehang" o qhomang molumo o se nang paterone ho hang): Mohlomong Atrial Fibrillation (AFib) e nang le Rapid Ventricular Response (RVR) (batla tlhahlobo e potlakileng ea bongaka bakeng sa taolo ea sekhahla le thibelo ea stroke).
7. Bakeng sa motho e moholo ea hlokolosi, ea tsitsitseng kapa ngoana e moholo ea nang le SVT e belaelloang (le lifolakha tse khubelu tse sa tsitsang), etsa REVERT Modified Postural Valsalva Maneuver:
8. Mohato oa 1 (Ho lutse Semi-Recumbent 15-Second Strain): Lulisa mokuli a otlolohile ka \(45\text{-degree}\) angle. Etsa hore ba heme ka mokhoa o tloaelehileng 'me ba butsoe ka matla bakeng sa metsotsoana e 15 e tletseng ntlheng ea sekoti se se nang letho \(10\text{mL}\) serinji ea molomo ea polasetiki ba leka ho sutumelletsa moqomo ka ntle (kapa ba koala nko ea bona ebe ba butsoela ka matla khahlanong le melomo e koetsoeng joalokaha eka ba leka ho phunya litsebe tsa bona metsotsoana e 15 e tletseng).
9. Mokhahlelo oa 2 (Immediate Flat Drop + 45-Degree Passive Leg Raise bakeng sa Metsotsoana e 45): Qetellong ea ho otla ha metsotsoana e 15, bolella mokuli hore a khaotse ho phefumoloha le ho hema ka mokhoa o tloaelehileng ha mothusi hang-hang a beha 'mele o ka holimo oa mokuli ka ho feletseng ka mokokotlong oa bona ($ 0 maoto) le maoto a mabeli a otlolohileng{} \(45\text{-degree}\) angle bakeng sa metsotsoana e 45.
10. ** Ke hobane'ng ha Phase ea 2 e le sephiri: ** Ho theoha fatše le ho phahamisa maoto ho lahlela leqhubu la mali a venous ho tloha maotong ho ea ka pelong ka motsotsoana hantle sefuba se phutholoha, ho etsa hore ho be le ho phahama ho hoholo ha khatello ea methapo ea vagus hoo ** ho phunya SVT ho khutlela moretheng o tloaelehileng ho karolo ea 43 lekholong ea bakuli ba lutseng ** (ha ho bapisoa le Vasal ea 17 lekholong feela).
11. Bakeng sa lesea kapa ngoana ea nang le SVT e tsebahalang kapa e belaelloang (tekanyo ea pelo \(220\mongolo{ ho }300\text{bpm}\), palesa/e ferekaneng, phepo e mpe): Kenya mokotla o phuthetsoeng oa metsi a leqhoa holim'a sefahleho se UPPER (phatleng, mahlo, le borokho ba nko) bakeng sa metsotsoana e 15 ho isa ho e 92 ha u ntse u letsa metsotsoana e 15 ho isa ho 92
12. Le ka mohla u se ke ua koahela molomo kapa linko tsa lesea, hape le ka mohla u se ke ua hatella linkhoana tsa lesea. Ho tsosoa ho batang ha makala a methapo ea mahlo / maxillary trigeminal ho pholletsa le phatleng le borokho ba nko ho baka ** mammalian diving reflex **, ho romela ho phatloha ha vagal ho emisang SVT ea bana ka mokhoa o sireletsehileng.
13. Le ka mohla u se ke ua hatella liroboto tsa mahlo (ocular pressure) 'me LE KA mohla u se ke ua lumella motho ea emeng haufi hore a tlotse kapa a sila methapo ea mali ea molala (carotid sinus massage). Ho hatella libalaka tsa mahlo ho ka ntša retina kapa ho senya cornea, ha ho ntse ho hohla mothapo oa carotid molaleng ho ka senya lejoe la k'holeseterole le sa lemoheng 'me ha baka lets'ollosetorouku**.
14. Haeba pelo ea lebelo e sa emise ka mor'a liteko tse peli tse fetotsoeng tsa Valsalva (kapa e nka nako e fetang metsotso e 15 ho isa ho e 20), e-ea Lefapheng la Tšohanyetso. Letsetsa ambulense; le ka mohla u se ke ua khanna u ntse u le ka har'a arrhythmia e sebetsang. Haeba mokuli a e-na le ngaka ea pelo e laetsoeng ** "pilisi-ka-pokothong"** meriana (e kang diltiazem, verapamil, kapa metoprolol), e nke joalokaha e laetsoe 'me u phomole ha u ntse u emetse tlhokomelo ea meriana.

Sefate sa qeto ea maemo a tšohanyetso: Pelo e mathang ka tšohanyetso (Tachyarrhythmia)¶

Sebelisa chate ena ea bongaka ho lekola ho otla ha pelo ka potlako le ho fumana hore na u ka etsa Modified Valsalva Maneuver neng ha u bapisoa le ho tsosa motho ka tšohanyetso.

flowchart TD
    Start["Ho otla ha Pelo ka potlako, ho otla ka matla, kapa ho otla ha pelo"] --> UnstableCheck{"Sheba Lifolakha tse Kgubedu tse 5 tse SA TSAMAEAng:<br/>1. Ho opeloa ke sefuba, khatello, kapa ho tiea<br/>2. Ho hema ka thata / ho hema <br/>3. Ho akheha (syncope), pherekano, kapa ho tsekela ho matla<br/>4. Letlalo le lesehla, le boreleli, le batang (Tšoselo)<br/>5. Histori ea ho hlaseloa ke pelo, ho hloleha ha pelo, kapa VT"}

    UnstableCheck -->|"EE (Lefolakha le Lefubelu le teng)"| Call911["HARAKA 911 / 112 / 999 TŠIRELETSO:<br/>1. Suspect Ventricular Tachycardia (VT), AFib Pre-Excited,<br/> kapa Hemodynamically Unstable SVT<br/>2. Robala fatše (kapa o otlolohile haeba o sa hema); ZERO ho tsamaea<br/>3. Boloka AED e khomaretsoe / e loketse; lokisetsa synchronized<br/> cardioversion kapa defibrillation ha EMS fihla"]

    UnstableCheck -->|"HA HO Lifolakha tse Khubelu (Tlhokomeliso ea Mokuli, E tsitsitse, <br/>Ha ho Mahlaba Sefubeng, Ho Phefumoloha ho Tloaelehileng)"| PatternCheck{"Lekola Pulse Rhythm & Started Pattern"}

    PatternCheck -->|"PULUSE E HLAHANG KA TSELA:<br/>Moribo oa ho qhoma o nang le paterone ea lefela"| AFib["TSOELA PELE HO FIHLELA ATRIAL FIBRILLATION (AFib e nang le RVR):<br/>1. Litsamaiso tsa Vagal HA LI TLA fetolela AFib ho morethetho o tloaelehileng <br/>2. Batla Kamore ea Tšohanyetso / Tlhokomelo e potlakileng ea lefu la pelo <br/> bakeng sa ECG e etellang pele 12, taolo ea sekhahla, le anticoagulation ea stroke"]

    PatternCheck -->|"HO PHETHA HAKANE (110 ho isa ho 160 bpm):<br/>E qalile butle ka feberu, ho felloa ke metsi 'meleng, mahlaba,<br/>caffeine/lintho tse susumetsang, kapa ho tšoha haholo."| SinusTach["MELAELOA SINUS TACHYCARDIA:<br/>1. Phekola lintho tse bakang sesosa (ho khutlisetsa metsi ka metsi/electrolyte,<br/> phekola feberu/bohloko, phefumoloha butle ka metsotsoana e 4)<br/>2. Batla tlhokomelo ea bongaka haeba HR e phomotse e lula> 120 bpm"]

    PatternCheck -->|"HO TSAMAYA ha 'LIGHT-SWITCH':<br/>Mohatla o tsitsitseng wa rock ka 160 ho isa ho 250+ bpm<br/>+ Ho phunya molala ('Swat's Frog'):<br/>SUPRAVENTRICULAR TACHYCARDIA (SVT)"| AgeSplit{"Na Mokuli ke Motho e Moholo / Ngoana e Moholo <br/>kapa ke Lesea / Ngoana?"}

    AgeSplit -->|"Ngoana e moholo kapa ea Tšebelisano-'moho"| RevertValsalva["ETSA MOKHOA OA REVERT E FETOTSENG VALSALVA MANEUVER:<br/>1. Lula ka likhato tse 45 'me u butsoe ka matla ka har'a serinji ea 10 mL<br/> (kapa khahlanong le nko e koetsoeng/melomo e koetsoeng) metsotsoana e 15<br/>2. Hang-hang theola 'mele o ka holimo FLAT (0 deg) 'me u phahamise<br/> maoto ka bobeli ho ea ho 45 DEGREES bakeng sa 45 SECONDS<br/>3. Haeba u ntse u matha ka mor'a liteko tsa 2 -> Letsetsa EMS / E-ea ho ER <br/> bakeng sa IV Adenosine kapa Calcium Channel Blocker"]

    AgeSplit -->|"Lesea kapa Ngoana e Monyenyane<br/>(HR 220 ho isa ho 300 bpm)"| InfantIce["CALL 911 / 112 / 999 + INFANT DIving REFLEX:<br/>Kenya mokotla oa metsi a leqhoa o phuthetsoeng ka lesela le tšesaane holim'a<br/>Phatla, MAHLO, & NASAL BRIDGE bakeng sa metsotsoana e 15-20 <br/>(O SE KE UA koahela molomo kapa linko; LE KA mohla u se ke ua hatella libolo tsa mahlo)"]

Pathophysiology: Tsela e khuts'oane ea SVT e sebetsang le kamoo Vagus Nerve e robang loop¶

Pelong e phetseng hantle e phomotse, ho otla ha pelo e 'ngoe le e 'ngoe ho qala ho pacemaker ea tlhaho ka phaposing e ka holimo ka ho le letona (the sinoatrial [SA] node), e haola le likamore tse ka holimo (atria), e khefutsa bakeng sa \(0.1\text{ seconds}\) sebakeng se le seng sa tollbooth sa motlakase bohareng ba pelo (klzzwxh:00 leAV) (ventricles**) \(60\text{ ho }100\text{ beats ka motsotso}\).

Ka Paroxysmal Supraventricular Tachycardia (PSVT / SVT), motho o tsoaloa a e-na le tsela ea motlakase e nyenyane e se nang kotsi, ebang ** litsela tse peli tse tšoanang ka har'a node ea AV ka boeona ** (AV Nodal Reentrant Tachycardia [AVNRT], e ikarabellang bakeng sa 60% ea SVT le microscopic ea SVT le mesifa e eketsehileng ea SVT) kapa 60% ea SVT bridge (Atrioventricular Reciprocating Tachycardia [AVRT], e ikarabellang bakeng sa 30% ea SVT, ho akarelletsa le Wolff-Parkinson-White [WPW] syndrome): 1. Kamoo "Leseli le Fetola" le Bulela: Pina e le 'ngoe e tsamaisa motlakase ka potlako empa e khutla butle (tsela e potlakileng), ha pina ea bobeli e tsamaea butle empa e khutla ka potlako (**tsela e butle ). Ha tšubuhlellano, e se nang kotsi matla a atrial pele ho nako (ho tlola beat / PAC) e tuka ka lebelo la millisecond ha pina e le 'ngoe e phomotse 'me e 'ngoe e butsoe, tšusumetso ea motlakase e kena tseleng e bulehileng ebe e pota-pota ka selika-likoe ho \(160\text{ho }250\text{ revolutions ka motsotso}\) circuit (a). 2. **Lebaka Leo ka Lona Bakuli ba Ikutloang ba Ipholla Melala ("The FroSign"): Ho AVNRT, liphaposi tse ka holimo (atria) le tse ka tlase (li-ventricle) li chesa ka belo le lekanang hantle la millisecond. Hobane valve ea tricuspid pakeng tsa atrium e nepahetseng le ventricle e nepahetseng e phunyeletsoa ha konteraka e nepahetseng ea atrium e lumellana, li-canon tsa mali li khutlela morao holimo ho ka hare ho methapo ea molala ea molala **, ho etsa hore ho be le mumo o bonahalang, o nang le morethetho o tlaase oa molala (" "Frog Sign" **) e khethollang matla SVT kapa sinus tachynic. 3. Hobaneng bakuli ba ntša metsi haholo nakong kapa hang ka mor'a SVT:** Hatria e otlolla khahlanong le li-valve tse koetsoeng kaklzzwxh:0018, mesi ea po e ša hmone e bitsoang **AtriaNatriuric Peptide (ANP)**, e bolellang liph hore li lahle metsi a mangata hlakileng (**tachycardia-induced polyuria) kaare ho metsot e 60 ea polyuria. 4. Kamoo Vagal Maneuvers (le IV Adenosine) A Hlōlang Loop: Ka bobeli lupu ea AVNRT le AVRT li tlameha ho feta ho AV node holim'a serope se ng le se seng. Vagus Nerve (Cranial Nerve X) lithapo ka kotloloho ho node ea AV ebe e ntša acetylcholine, e liehisang tsamaiso ka bokhuts'oane ka node ea AV metsotsoana e 2 ho isa ho e 3. Haeba u ka etsa hore ho be le ts'ebetso e matla e lekaneng ea ho thibela mothapo o le mong ka har'a node ea AV, lebelo la motlakase le chitja le thula tsela, la tima hang-hang, 'me mochini o thusang pelo oa tlhaho oa SA node o tla khutla ka \(70\text{ho isa ho }90\text{bpm}\).

Papiso e phethahetseng ea maemo a 5 a matla a sekhahla sa pelo¶

Sebelisa tafole ena ea ho hlahloba ho khetholla benign sinus tachycardia le ho tšoha ho tloha SVT, atrial fibrillation, le tachycardia e behang bophelo kotsing:

Phethahatso ea mohato ka mohato ea REVERT Modified Postural Valsalva Maneuver¶

Ka lilemo tse mashome, thuso ea pele e tloaelehileng e ne e ruta "mokhoa oa khale oa Valsalva" (ho lula o otlolohile le ho inama joalo ka ho ntša mala), e atlehileng ho ** ka tlase ho 15 ho karolo ea 17 lekholong ** ea bakuli ba tšohanyetso, ho qobella bakuli ba fetang 80 ho fumana intravenous ** adenosine ** ka kamoreng ea tšohanyetso.

Ka 2015, lets'oao la REVERT Randomized Controlled Trial e phatlalalitsoeng ho The Lancet (Appelboam et al.) e ile ea fetola litataiso tsa lefu la pelo lefatšeng ka bophara (AHA, ERC, ESC, le UK NICE/Resuscitation Council) ka ho hlahisa Modified Postural Valsalva rates ho tloha ho 1 ho ea ho 1, ho tloha ho 1 ho ea ho 1 43%* e nang le lithethefatsi tse se nang letho le litlamorao tse mpe.

Hobaneng ha Standard Valsalva e hloleha, le Hobaneng ha Phahamiso ea Leoto ea 45-degree e Sebetsa¶

Mokhoa oa Valsalva o sebetsa ka mekhahlelo e mene ea fisioloji: - Nakong Mokhahlelo oa I le oa Bobeli (ho otla ha metsotsoana e 15), khatello e phahameng ka har'a sefuba e pepeta vena cava e koala, **e thibela mali a venous ho khutlela pelong . Hobane mali a fokolang a kena ka pelong, khatello ea mali e theoha hanyenyane, 'me' mele o hlile o retelehela ON adrenaline (molumo o nang le kutloelo-bohloko) ha o ntse o tima Ho tima vagus nerve. (SVT e batla e HLOKA E emisa ha o ntse o foka.) - Boselamose bo etsahala Mokhahlelong oa III le oa IV (metsotsoaneng e 5 ho isa ho e 20 KA MOR’A hore u khaotse ho phefumoloha): Ha u tlohela ho tsitlella ’me u hema ka tsela e tloaelehileng, khatello ea sefuba e theohela ho lefela ’me mali a venous-up a khutlela ka pelong. Ho phahama hoo ha mali ka tšohanyetso ho otlolla li-sensor tsa khatello (baroreceptors **) ka har'a aortic arch le methapo ea carotid, e leng se etng hore ho be le rebound e kholo **Vagus Nerve bking reflex (Pse IV vagal ovshoot) ** e emisang SVT. - Hobaneng Valsalva e Tloaelehileng e Ile ea Fana: Haeba u lula u lutse hantle ha u emisa ho phefumoloha, matla a khoheli a koalla mali maotong a hao, kahoo khutlela feela lets'oao le lenyenyane pelo ea hau (ho etsa karolo fokolang ea Phase IV vagal reflex - **Haneng Phetoho ea REVERT e Atleha Hararo:** Ka ho etsa hore mokuli **a butse ha a lutse \(45\text{ degrees}\)**, ebe **hang-hang a theola' torso flat (klzxh:0043) ha a ntse a phahamisa maoto ka bobeli ho \(45\text{ degrees}\) motsotsong o le mong feela ba emisa ho foka* ho ea ho \(30} milliliters}\) ea mali a leoto a kopantsoeng ka ho toba ka atrium e nepahetseng nakong ea Phase III, e phahamisa sekhahla sa Phase IV baroreceptor surge le ho emisa SVT nakong ea metsotsoana e 10 ho isa ho e 30.

Hantle-ntle Lethathamo la Mehato e 4 ho Etsa ReVERT e Fetoletsoeng ea Valsalva Maneuver¶

   PHASE 1: SEATED STRAIN (15 SECONDS)          PHASE 2: SUPINE + LEG LIFT (45 SECONDS)
        \                                                                   /  /
         \  45 deg   [Blow hard into 10 mL                                 /  /  45 deg
          \______     syringe for 15 sec]        \________________________/  /   Leg Lift
                 \                                 0 deg Flat Back

1. Peakanyo ya Boemo le Thepa:
2. Lulisa motho a otlolohile \(45\text{-degree}\) semi-recumbent angle holim'a bethe, sofeng kapa mokatong o nang le k'hapete moo ho nang le sebaka ka mor'a hlooho ea hae ho mo robatsa ka motsotsoana o le mong, 'me mothusi (kapa setuloana sa maoto/lebota) o se a le maotleng a bona ho phahamisa maoto.
3. Mokhoa oa ho etsa \(40\text{mmHg}\) e hlileng e leng khatello ea moea:
   • Gold Standard (The \(10\text{ mL}\) Syringe Method): Fa motho \(10\text{ mL}\) e hloekileng, e se nang letho{mL}$ (\(2\text{ teaspoon}\)) serinji ea molomo oa polasetiki ea molomo (mofuta o kenyellelitsoeng mabokoseng a mokelikeli a ibuprofen/acetaminophen). Ba kope hore ba kenye ntlha e nyane lipakeng tsa molomo oa bona 'me ba bulule ka matla ho leka ho sutumelletsa plunger morao. (Lithuto tsa boenjineri ba biomedical li paka hore ho butsoela ka \(10\text{mL}\) syringe plunger ho hlahisa \(40\text{ mmHg}\) ea khatello ea methapo ea mali, khatello e nepahetseng bakeng sa Valsalva reflex.)
   • Mokgwa o Mongwe wa Sesebediswa: E re motho o koale nko ka ho feletseng ka letsoho le le leng, a koale molomo oa hae ka thata ho pota-pota monoana oa hae o motona (joaloka ho letsa terompeta e sa lumelleng moea leha e le ofe ho tsoa), ’me a letse ka matla ka mesifa ea hae ea sefuba le ea mala joalokaha eka o leka ho phunya litsebe sefofaneng kapa ho letsa balune e ncha e thata.
4. Etsa mofuta o tsoelang pele oa Metsotsoana e 15:
5. Etsa hore motho a heme moea o tloaelehileng 'me a butsoe butle le ka matla ka metsotsoana e 15 e felletseng (bala ka lentsoe le phahameng: "Sekete-kete, tse peli-sekete-kete... ho fihla ho leshome le metso e mehlano").
6. Sheba ho tiisa ho bonahalang ha molala le mesifa ea mpa le ho phalla hanyenyane ha sefahleho. Se lumelle moea ho tsoa ka nko kapa molomong.
7. Etsa ho theoha ha Hang-hang ka Postural + 45-Degree Leg Lift (Metsotsoana e 45):
8. Ho matšoao a nepahetseng a metsotsoana e 15, bolella motho eo: "Khaotsa ho phefumoloha, liha matsoho, 'me u heme ka mokhoa o tloaelehileng."
9. Ka nako e le 'ngoe (nakong ea metsotsoana e 1 ho isa ho e 2 ka mor'a ho emisa ho otla), rola hlooho ea motho le torso e bataletse ka ho feletseng mokokotlong oa bona ($ 0\text{ degrees}$, tlosa mesamo) le phahamisa maoto a bona a mabeli a otlolohileng ho ea ho \(45\text{-degree}\) angle, ba tšoere maqaqailana a bona holimo (kapa ba phomotse setulong sa molamu o phahameng ** 4 chair* e tletseng)
10. Bolella motho hore a lule a phutholohile 'me a heme ka mokhoa o tloaelehileng ha maoto a hae a phahame. Ha tsamaiso e sebetsa, hangata ba tla utloa ho otla ha letsoho ho matla kapa khefu e khutšoane ea motsotsoana o le 1 lipakeng tsa 10 le metsotsoana e 25 ha ba phahamisa leoto, 'me ho lateloe ho otla ha pelo ho khutsitseng hang hang.
11. Khutlela sebakeng sa Semi-Recumbent 'me u hlahlobe Pulse hape:
12. Ka mor'a metsotsoana e 45 ka maoto a phahamisitsoeng, theola maoto 'me u khutlisetse motho sebakeng se phutholohileng sa \(45\text{-degree}\) a lutse sebakeng sa motsotso o le mong, ebe u hlahloba ho otla ha letsoho.
13. Haeba pelo e ntse e matha ka \(160\text{ to }240\text{bpm}\)' me mokuli a ntse a tsitsitse, ema metsotso e 2 'me u etse teko ea bobeli ea Modified Valsalva Maneuver. Haeba liteko tse peli tse entsoeng hantle li sa fetole morethetho, letsetsa EMS kapa u ee lefapheng la tšohanyetso.

Safe vs. Dangerous Vagal Maneuvers: Seo u ka se Sebelisang le Seo u ka se Qobang¶

Tsepamiso e Khethehileng: Ho lemoha SVT ho Masea le Bana ba banyenyane¶

Ho masea a ka tlase ho selemo se 1, Supraventricular Tachycardia (SVT) ke matšoao a atileng haholo a ho otla ha pelo, 'me ho otla ha pelo ho pakeng tsa \(220\text{ le }300\text{ beats per minute}\) (ha ho bapisoa le ho otla ha pelo ho tloaelehileng ho $110\60} ho ea ho $111pm kapa ho ea ho $111pm ho ea ho $110\60 \(190\text{ bpm}\) ha o lla ka feberu e matla). - Ke Hobane'ng ha SVT ea Lesea ho le Bonolo ho Feta ka Lihora tse 24: Lesea le ke ke la re, "Pelo ea ka e matha ka lebelo." Lesea la SVT ka \(260\text{ bpm}\) le ka shebahala le khutsitse ka mokhoa o makatsang lihora tsa pele tse 6 ho isa ho tse 12, ho fihlela mesifa ea pelo ea hae e qala ho khathala (tachycardia-e bakiloeng ke ho hloleha ha pelo). - Matšoao a SVT ho Lesea: - Ho hana ka tšohanyetso ho anyesa kapa ho nka botlolo (kapa ho fufuleloa le ho feheloa ha u leka ho anya). - Ho ferekana ho sa tloaelehang, ho teneha, ho fokola, kapa letlalo le boputsoa bo boputsoa. - Ho phefumoloha ka potlako, ho sa tebang (tachypnea) le ho phaphasela ka potlako ha lebota la sefuba kapa liaparo tsa lesea holim'a sternum. - Oache e bohlale, pulse oximeter, kapa stethoscope ka holim'a sefuba se letšehali se bala ho otla ha pelo ho tsitsitseng ka holimo ho \(220\text{ beats per minute}\) e sa khoehliseng ha lesea le khobile matšoafo. - Seo U Lokelang ho se Etsa Hang-hang Bakeng sa Lesea le belaelloang ho SVT: 1. ** Letsetsa 911 / 112 / 999 hang-hang ** (masea a ka senyeha ka potlako ho cardiogenic shock). 2. Haeba lesea le elelloa le ho phefumoloha (kapa le laetsoe ke li-dispatchers / cardiologist ea bana), tlatsa mokotla oa polasetiki ka ** leqhoa le pshatlehileng le metsi a batang *, le phuthe ka lesela le le leng le le leng le le leng le mongobo le mongobo, 'me le le behe ka bonolo ho pholletsa le ** halofo e ka holimo ea sefahleho sa lesea (ho koahela phatleng, mahlo a koalehileng, le borokho ba nko bakeng sa ** LS5 feela le ho tloha molomong oa bobeli **5) 100% e senotsoe ebile e bonahala **. 3. Le ka mohla u se ke ua tšoara lesea le le lebisitse fatše le **le ka mohla u se ke ua hatella mahlo a lesea kapa karolo ea mokokotlo **.

Ho Etsahala'ng Lefapheng la Ambulense le Boemo ba Tšohanyetso: "Adenosine Moment"¶

Haeba Modified Valsalva Maneuver e sa emise SVT mme o ea lefapheng la tšohanyetso, ho tseba seo u ka se lebellang ho tlosa tšabo: 1. 12-Lead ECG Recording: Pele ba fana ka meriana leha e le efe, baoki kapa baoki ba ER ba tlaleha ECG e etellang pele 12 nakong ea morethetho o potlakileng (le ho boloka morethetho o tsoelang pele o ntse o sebetsa nakong ea phekolo) e le hore setsebi sa lefu la pelo se bone mofuta o nepahetseng oa SVT le ho hlahloba ** Wolff-Parkinson-White . 2. Intravenous Adenosine (\(6\text{mg}\) ebe \(12\text{mg}\)Rapid IV Push): - Bakeng sa SVT e tloaelehileng e rarahaneng, lingaka li beha IV mothapong o moholo haufi le ho kobeha ha setsoe (antecubital fossa) 'me e ente adenosine e lateloa hang-hang ke \(20\text{mL}\) saline flush e potlakileng. - Kamoo Adenosine e Utloang Kateng (Tiiso ea Bohlokoa): Adenosine ke molek'hule ea tlhaho ea purine e nang le halofo ea bophelo e khuts'oane ea ka tlase ho metsotsoana e 10. Ha e otla pelo, e thibela ka ho feletseng node ea AV bakeng sa **3 ho metsotsoana e 6 ** ho tsosolosa tsamaiso ea motlakase ea pelo. Bakeng sa **5 ho metsotsoana ea 10 **, mokuli o tla utloa mocheso o boima oa tšohanyetso sefubeng le sefahlehong, boikutlo bo khutšoanyane ba ho felloa ke moea, le maikutlo a makatsang ao pelo ea bona e ileng ea emisa, 'me joale **metsotsoana e 10 hamorao sethethefatsi se tlohile' meleng oa 100 lekholong ** 'me pelo e otla ka khutso ho \(80\text{ bpm}\). - (Khetho e 'ngoe e bonolo ea sepetlele: Liteko tsa morao-rao tsa bongaka li bontša hore li-blocker tsa calcium channel tse kenang ka methapong tse kang diltiazem kapa verapamil tse fanoang e le tšelo ea metsotso e 20 ea IV e fetola SVT ho >90% ea bakuli ba tsitsitseng ntle le khefu ea metsotsoana e 6 ea adenosine.) 3. Kalafo ea Nako e Telele (Catheter Ablation): Ka mor'a ketsahalo ea SVT, ho fetisetsoa ho cardiac electrophysiologist (EP) ho lumella phekolo e fokolang ea bakuli ba ka ntle e bitsoang **catheter ablation **, e phekolang ka ho sa feleng AVNRT le AVRT/WPW ka **95 ho karolo ea 98 lekholong ea pelo ea bophelo bohle.

Mongolo o nepahetseng oa puisano bakeng sa 911/112/999 le tlhahlobo ea sepetlele¶

Sebelisa mangolo ana a hlakileng a kliniki ha u letsetsa batho ba ts'ohanyetso kapa u fihla sepetlele:

• Bakeng sa Pelo e sa tsitsang ea Peiso (Bohloko ba Sefubeng, Ho Phefumoloha Ka Bokhuts'oane, Ho a akheha, kapa Lefu la Pelo la Pele):

  "Ke hloka ambulense ea tšohanyetso e nang le mochine oa pelo / defibrillator ho [Aterese e Nepahetseng]. Mokuli ke [Lilemo] ea nang le ho otla ha pelo ka tšohanyetso hoo e ka bang [Palo] ho otla ka motsotso ho tsamaisana le [bohloko ba sefuba / ho hema ka thata / molichaba / ho akheha / histori ea lefu la pelo pele kapa lefu la pelo]. ke phomotse ka ho feletseng.”

• Bakeng sa SVT e belaelloang e tsitsitseng (Ha u ea ER Ka mor'a Valsalva e Fetoletsoeng):

  *"Ke maemong a tšohanyetso le mokuli ea lilemo li [Age] ea ileng a hlahisa tachycardia ea tšohanyetso ea 'light-switch' ka nako e ka bang [180 ho ea ho 220] beats ka motsotso ho qala ka [Nako]. Mokuli o falimehile a se na bohloko ba sefuba, 'me liteko tse peli tsa REVERT Modified Postural Valsalva Maneuver-diadm CG ha lia ka tsa fetola ECG. ha arrhythmia e ntse e sebetsa le tlhahlobo bakeng sa phetoho ea SVT."

• Bakeng sa Lesea le Nang le Seo ho belaelloang SVT (\(>220\text{ bpm}\)):

  "Ke hloka ambulense ea bana ba tšohanyetso ho [Aterese e Nepahetseng]. Lesea la ka la [Lilemo]-khoeli le lerootho, le hana lijo, 'me pelo ea hae e otla ka mokhoa o tsitsitseng ho feta [220 ho ea ho 280] ka motsotso ho se feberu. Re belaela hore Infant Supraventricular Tachycardia (SVT)."

Lipotso tse botsoang khafetsa¶

Ke hobane'ng ha ho phahamisetsa maoto a ka ho likhato tse 45 hang ka mor'a ho foka (REVERT Modified Valsalva) e sebetsa ho feta habeli hammoho le ho inamela fatše ha u ntse u lutse?¶

Ho letsa ka matla metsotsoana e 15 ho haha ​​khatello e phahameng sefubeng sa hao e thibelang mali ka nakoana ho khutlela pelong ea hau; ho phahama ha methapo ea 'nete ea vagus e emisang SVT ho etsahala metsotsoana e 5 ho isa ho e 20 KA MOR'A hore u khaotse ho foka, ha mali a khutlela ka pelong 'me a otlolla li-sensor tsa khatello ea aorta. Haeba u lula u otlolohile ha u khaotsa ho phefumoloha, matla a khoheli a tšoasa mali ao ho theosa maotong a hao; ka ho beha mokokotlo oa hao hang-hang 'me u phahamise maoto a hao ho likhato tse 45 motsotsoana ha u khaotsa ho foka, matla a khoheli a tšollela leqhubu le leholo la mali a maoto ka ho toba sefubeng sa hao, e leng se etsang hore ho be le methapo e matla ea vagus reflex e emisang SVT ho karolo ea 43 lekholong ea batho.

Nka tseba joang phapang pakeng tsa tlhaselo ea tšabo (sinus tachycardia) le Supraventricular Tachycardia (SVT)?¶

Le hoja ka bobeli li baka pelo e otlang, ho fufuleloa le maikutlo a ho tšoha, SVT e ntse e otla hang-hang ka ho otla ha pelo e le 'ngoe (hangata ha e khumama kapa e sisinyeha ka tšohanyetso) ebe e otla ka matla a 160 ho ea ho 250 ka motsotso ka ho otla ho bonahalang botlaaseng ba molala ("Frog Sign"), ebe e tima hang ka nako e le 'ngoe. Ho hlaseloa ke tšabo (sinus tachycardia) ho nyoloha butle-butle ka metsotso e 'maloa, ka seoelo ho feta ho otla ha 150 ho isa ho 160 ka motsotso ho batho ba baholo,' me ho fokotseha butle-butle ka metsotso e 10 ho isa ho e 30 ha u ntse u khutsitse.

Ke hobane'ng ha ho le kotsi hore setho sa lelapa se ntšitse molala ( carotid sinus massage ) kapa ho hatella mahlo a ka ho emisa pelo e mathang?¶

Ho pikitla mothapo oa carotid molaleng ho ka bula letlapa le sa tsejoeng la k’holeseterole ka har’a lebota la mothapo oa mali ’me ha thunya leqeba la mali ka ho toba bokong, ho baka setorouku se holofatsang hang-hang, se holofatsang ka ho sa feleng. Ho hatella mahlo a mahlo (oculocardiac reflex) ho ka tabola kapa ha thiba retina 'me ha senya leihlo; ha ho na mokhoa o mong o lokelang ho etsoa ka ntle ho sepetlele, haholo-holo ha mokhoa o sireletsehileng oa REVERT Modified Valsalva Maneuver o sebetsa hantle haholo.

Ke hobane'ng ha ke tlameha ho ntša metsi hakaale hang ka mor'a ketsahalo ea SVT kapa atrial fibrillation?¶

Ha likarolo tse ka holimo tsa pelo ea hau (atria) li otla khahlanong le li-valve tsa pelo tse koetsoeng ka ho otla ha 180 ho isa ho 220 ka motsotso, marako a atrial a otlolohileng a ntša hormone ea tlhaho e bitsoang Atrial Natriuretic Peptide (ANP) maling a hao. ANP e laela liphio tsa hau hore li ntše sodium le metsi ka potlako ho theola molumo oa mali, e leng se bakang moroallo o se nang kotsi oa ho ntša metsi nakong ea metsotso e 30 kapa ka mor'a ketsahalo ea pelo ea peiso.

Mehloli e hlahlobiloe¶

• The Lancet (REVERT Randomized Controlled Trial, United Kingdom): Postural Modification to the Standard Valsalva Maneuver for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomized Controlled Trial (Appelboam et al., The Lancet 2015) the Lancet* 2015; thea the Lancet* 2015 mm} thea con $15; ho \(45^\circ\) e lateloang ke 45-metsotsoana supine \(0^\circ\) + \(45^\circ\) leg raise protocol).
• American Heart Association (AHA), American College of Cardiology (ACC), le Heart Rhythm Society (HRS, United States): Taelo bakeng sa Tsamaiso ea Bakuli ba Batho ba Baholo ba nang le Supraventricular Tachycardia le AHA Adult & Pediatric Advanced Life Support (ACLS / PALS) Tachyarrhythmia Algorithms.
• ** European Society of Cardiology (ESC) le European Resuscitation Council (ERC): ** * Litaelo tsa ESC bakeng sa Tsamaiso ea Bakuli ba nang le Supraventricular Tachycardia * (Khothatso ea Sehlopha sa I bakeng sa Mokhoa oa Modified Postural Valsalva Maneuver le ho qoba khatello ea mahlo).
• ** Resuscitation Council UK le National Institute for Health and Care Excellence (NICE, United Kingdom):** Peri-Arrest Tachycardia Guidelines le Pediatric SVT Facial Ice Application.

Litataiso tse amanang¶

• Leholiotsoana le kentsoeng la defibrillator (ICD) le ho se sebetse hantle ha pacemaker
• Acute myocarditis, pericarditis, le boemo ba ho opeloa ha sefuba
• Ho lemoha lefu la pelo le thuso ea pele
• Ho akheha (syncope) thuso ea pele le lifolakha tse khubelu tsa pelo
• Litlhaselo tsa tšabo le mekhoa ea motheo ea hyperventilation