E noʻonoʻo, ua nalowale koke ka ʻike o kekahi ma mua ou a hāʻule i ka honua. Holo wikiwiki ʻoe a nānā i ko lākou ʻāʻī no ka pulse, akā ʻaʻohe pulse. Me he mea lā ʻaʻole lākou e hanu ana. Manaʻo ʻoe he hopu puʻuwai kēia. Akā, he mea kupanaha, i ka wā i lawe ai lākou iā lākou i ka haukapila, lawe nā kauka i kahi ECG a hōʻike ia i ka hana uila i loko o ka puʻuwai. Aia ka uila, akā ʻaʻole e paʻi ana ka puʻuwai. ʻO kēia kūlana kupanaha a weliweli ka mea a mākou i kapa ai ma ka lāʻau lapaʻau ʻo "Pulseless Electrical Activity". Kapa mākou iā ia he PEA no ka pōkole. He kūlana pilikia loa kēia. No laila, e kamaʻilio maʻalahi kākou e pili ana i kēia.
I ka ʻōlelo maʻalahi, he aha ka PEA?
He ʻano hopu puʻuwai ka PEA. ʻO ka mea e hana ʻia ma ʻaneʻi, ʻoiai aia ka hana uila i loko o ka puʻuwai, ʻaʻole e ʻūlū ka ʻiʻo o ka puʻuwai a hoʻopumu i ke koko e like me kēlā hōʻailona uila. Ua like ia me ke kukui uila ʻaʻole e hoʻā no ka mea ua pau ke kaula uila ʻoiai aia ka uila .
Hiki ke ana ʻia kēia hana uila me kahi ECG (electrocardiogram). Eia nō naʻe, ke nānā ʻoe i kou pulse, ʻaʻole ʻoe e ʻike i kahi pulse no ka mea ʻaʻole e kuʻi ana ka puʻuwai a e pamu ana i ke koko a puni ke kino.
ʻO ka mea nui loa, ʻo ka PEA kahi ʻano mele puʻuwai "nonshockable". ʻO ia hoʻi, ʻaʻole hiki ke hoʻihoʻi ʻia e kahi haʻalulu mai kahi defibrillator, e like me ka mea i hōʻike ʻia ma nā kiʻiʻoniʻoni. No laila, inā ʻaʻole i loaʻa koke ka lāʻau kūpono, hiki ke make i loko o nā minuke.
ʻElua ʻano o ka PEA
Ua hoʻokaʻawale nā kauka i kēia i ʻelua ʻano nui.
1. Pseudo-PEA: Ma kēia, nāwaliwali loa ka ʻiʻo o ka puʻuwai ma muli o ka hana uila o ka puʻuwai. ʻOiai inā e pamu iki ia i ke koko, ʻaʻole ia i ikaika e like me ka puʻuwai maʻamau. No laila, ʻaʻole lawa ke kahe o ke koko e ʻike ai i kahi pulse i loko o ke kino.
2. PEA ʻoiaʻiʻo: Ma kēia, ʻoiai aia ka hana uila i loko o ka puʻuwai, ʻaʻole pane iki ka ʻiʻo o ka puʻuwai. ʻO ia hoʻi, ʻaʻohe koko i pamu ʻia. ʻAʻohe pulse i ʻike ʻia.
He aha ka ʻokoʻa ma waena o ka PEA a me ka Asystole (Flat-lining)?
Ua ʻike paha ʻoe iā ia ma nā kiʻiʻoniʻoni, ke make kekahi kanaka, ʻike ʻia kahi laina pololei ma ka monitor me kahi leo "beep...". ʻO ia ka mea a mākou e kapa nei he `(asystole)` a i ʻole "flat-lining."
- PEA: Aia ka uila i loko o ka puʻuwai, akā ʻaʻole hana ka puʻuwai. (E like me ke TV me ka uila , akā ua haki).
- Asystole: ʻAʻohe uila o ka puʻuwai, a ʻaʻole e kuʻi ka puʻuwai. Ua mālie loa ia. (E like me ke TV i wehe ʻia ke kaula).
ʻOiai ʻo nā hihia ʻelua o ka hopu ʻia ʻana o ka puʻuwai, hiki ke ʻike ʻia ka ʻokoʻa ma muli o ke ʻano o ka ECG.
He aha nā kumu nui o ka PEA?
Nui nā kumu e hiki ai ke hoʻoulu i ka PEA. I mea e maʻalahi ai ka hoʻomanaʻo ʻana i kēia mau mea, hoʻohana nā kauka i kahi ʻōnaehana pōkole i kapa ʻia ʻo "H's and T's." E nānā kākou i ke ʻano o lākou.
| Māhele Kumu | He wehewehe maʻalahi |
|---|---|
| Ka emi ʻana o ka nui o ke koko (Hypovolemia) | Ka emi ʻana o ke koko i loko o ke kino ma muli o kekahi kumu e like me ke kahe nui ʻana o ke koko mai kahi ulia nui a i ʻole ka maloʻo nui ʻana o ka wai. |
| Hoʻemi ʻia nā pae oxygen (Hypoxia) | ʻAʻohe o ka oxygen i ke kino ma muli o ka pilikia o ka hanu ʻana a me ke piholo ʻana. |
| Nā loli i ke kaulike waikawa/paʻakai o ke kino (Hydrogen ion - Acidosis) | Hoʻonui ʻia ka waikawa i loko o ke kino ma muli o nā kumu e like me ka hāʻule ʻana o nā puʻupaʻa. Nā loli koʻikoʻi i nā pae electrolyte e like me ka potassium. |
| Ka emi ʻana o ka mahana o ke kino (Hypothermia) | Ke hāʻule nei ka mahana o ke kino i kahi haʻahaʻa loa. |
| Ka ʻai ʻana i nā mea ʻawahia | ʻO ka nui o kekahi mau lāʻau lapaʻau, nā lāʻau lapaʻau, a i ʻole nā mea ʻawaʻawa ʻē aʻe. |
| Ka hōʻiliʻili ʻana o ka wai a puni ka puʻuwai (Tamponade - cardiac) | Hoʻopiha ʻia ka lua a puni ka puʻuwai me ke koko a i ʻole kekahi wai ʻē aʻe, e hoʻoulu ai i ke kaomi ma luna o ka puʻuwai. Pale kēia i ka puʻuwai mai ke kuʻi manuahi ʻana. |
| ʻO ka pneumothorax haunaele | Pahū kahi māmā, e hoʻopiha ana i ka lua o ka umauma me ka ea, e ʻomi ana i ka puʻuwai a me nā kīʻaha koko. |
| Nā ʻūpā koko (Thrombosis) | ʻO kahi kūlana e like me ka hāʻule puʻuwai (`myocardial infarction`) a i ʻole kahi ʻaʻa koko i loko o nā māmā (`pulmonary embolism`). |
| Nā ʻeha kino (Trauma) | Ka pōʻino o ka puʻuwai ma muli o kahi ulia nui i ka umauma. |
Pehea e mālama ʻia ai kēia?
Ke loaʻa i kekahi ka PEA, hiki ke paʻakikī ke ʻike ma waho o ka haukapila, no ka mea, ʻaʻole hiki ke ʻike me ka ʻole o ka ECG. ʻO ka mea pōmaikaʻi, ʻo ka mea mua a me ka mea nui e hana ai i kekahi hihia o ka hopu ʻana o ka puʻuwai he mea hoʻokahi: CPR (Cardiopulmonary Resuscitation).
1. E hoʻomaka koke i ka CPR: Inā ʻike ʻole kekahi, ʻaʻohe pulse a hanu paha, e kāhea koke i kahi ambulance a hoʻomau i ke kaomi ʻana i ka umauma a hiki i ko lākou hōʻea ʻana. ʻO kēia ka manawa kūpono loa e hoʻopakele ai i ke ola. Inā ʻaʻole ʻoe ʻike pehea e hana ai i ka CPR, hiki i nā lawelawe ulia pōpilikia ke aʻo iā ʻoe pehea e hana ai.
2. Ka mālama ʻana ma ka haukapila: Ma hope o ke komo ʻana i ka Emergency Treatment Unit (ETU) o ka haukapila, e hoʻomau nā kauka i ka hana CPR a hoʻomaka i nā lāʻau ʻē aʻe.
- Epinephrine: Ua kapa ʻia kēia he adrenaline. Hāʻawi ʻia kēia lāʻau lapaʻau e hoʻihoʻi i ka puʻuwai i kahi mele maʻamau.
- Ke mālama ʻana i ke kumu: He mea nui e ʻike koke i ke kumu o ka PEA (kekahi o nā kumu ma ka papa ma luna) a mālama iā ia. No ka laʻana, inā he kahe koko, e hāʻawi i ke koko, inā ʻaʻohe lawa o ka oxygen, e hāʻawi i ka oxygen, inā he koko a puni ka puʻuwai, e wehe me ka syringe.
E hoʻomanaʻo, he mele "nonshockable" ka PEA. ʻO ke ʻano kēia, ʻaʻole e kōkua ka haʻalulu mai kahi defibrillator. Eia nō naʻe, me ka CPR maikaʻi, i kekahi manawa hiki ke loli ke mele o ka puʻuwai i kahi mele hiki ke haʻalulu (e.g., 'ventricular fibrillation'). I kēlā manawa, hāʻawi ka haʻalulu mai kahi defibrillator i ka puʻuwai i kahi manawa e hoʻomaka hou ai. ʻO ia ke kumu he mea nui loa ka CPR.
He aha kā mākou e hana ai i ka wā pilikia?
He pilikia olakino mau ka hopu ʻana o ka puʻuwai, no laila he mea nui ka hana koke.
Kekahi kanaka i mua ou:
- Inā nalowale koke kou ʻike a hāʻule,
- Inā ʻaʻole hiki iā ʻoe ke manaʻo i kahi pulse ma kou ʻāʻī a i ʻole ka pulima lima,
- Inā pau ka hanu ʻana a i ʻole lilo i mea paʻakikī loa,
E kāhea koke aku i kahi ambulance. A laila, e hoʻomaka i ka CPR i ka hikiwawe loa. He mea nui kēlā me kēia kekona.
ʻOiai he maʻi koʻikoʻi loa ka PEA, ua piʻi nui ko mākou ʻike no ia mea me ka holomua o ka lāʻau lapaʻau hou. Eia nō naʻe, ʻoi aku ka koʻikoʻi o nā minuke mua ma mua o kēlā mau mea a pau. No laila, inā ʻike ʻoe i kekahi e ʻike nei i kēia, mai hopohopo, e hoʻomaka koke i ka CPR, a e kiʻi koke i ke kōkua lapaʻau, kahi e hiki ai ke hoʻonui i ka hiki ke hoʻopakele i ke ola.
Leka Lawe-Home
- He pilikia olakino koʻikoʻi loa ka PEA kahi e hana ai ka puʻuwai i ka uila akā ʻaʻohe pulse.
- Inā hāʻule koke kekahi i ka ʻike ʻole, e nānā koke i ko lākou pulse a me ka hanu ʻana.
- Inā ʻaʻohe pulse a i ʻole ka hanu ʻana, e kāhea koke aku i kahi ambulance a hoʻomaka koke i ka CPR (nā kaomi ʻana i ka umauma).
- ʻOiai ʻaʻole holomua ka mālama ʻana i ka haʻalulu (defibrillation) no PEA, hiki i ka CPR hoʻomau ke hoʻololi i ka puʻuwai i kahi mele haʻalulu.
- ʻO ka pahuhopu nui o ka mālama ʻana ma ka haukapila, ʻo ia ka ʻimi a me ka mālama ʻana i ke kumu nui o ka PEA i ka wā e hana ana i ka CPR.
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