未命名.JPG 

1.緊急適應症:

1. Slow heart rates (bradycardias) that produce
   unstable hemodynamics (e.g. low BP, stroke
   volume, SvO2).
2. Slow heart rates (particularly escape rhythms)
   that do not respond to drug therapy.
3. Any condition as a temporary measure in
   preparation for a transvenous pacemaker.
4. Non emergent indications.
   a. Overdrive pacing (when drugs and electrical
   cardioversion have failed).
   b. Heart blocks in the presence of myocardial
   infarction.

2.模式:

需求模式(同步):Demand (synchronous) Mode is the preferred means of
pacing as it paces only when the patient's heart rate falls below a
level set by the clinician. This avoids problems such as a pacer
impulse landing on a T-wave and possibly causing a ventricular
dysrhythmia.
固定模式(非同步):Fixed (asynchronous) Mode paces at the rate set by the
clinician regardless of the patient's heart rate. This mode is not the
preferred means of pacing and is usually reserved for when 1) the
pacer cannot sense the heart rate or 2) when motion artifact
prevents the pacer from sensing the heart rate.

3.位置:

未命名.JPG 

 

4.心電圖波型:

正確波型--QRS複合波寬,QRS波前有一尖峰,形狀大部分像是VPC或脫逸性節律~~~

Increase the Output (mA) until the pacer spike is seen in
front of the QRS complex.The amount of mA used
varies per patient. Increasingthe output (mA) slightly above
where capture is obtained may help prevent the loss of
capture.The QRS from the pacemaker
will appear wide (much like a PVC or ectopic beat). This is
normal for a TC pacemaker.

未命名.JPG 

注意事項:

The muscle under the pads will contract as the
pacemaker discharges.However, this muscle
contraction does not mean the pacemaker is producing
good cardiac output.
Effective capture of the cardiac muscle is seen by
improving hemodynamics.

錯誤波型:

如果QRS複合波前無一尖峰(spike),也許存在下列問題之一

1.捕獲失敗(failure to capture):

Failure to obtain capture occurs in demand and fixed
mode. Increasing the Output(mA) may obtain capture. Be
sure the pads have good skin contact. Check for correct pad
placement.

未命名.JPG 

2.感應失敗(failure to sense):

This problem occurs in Demand Mode only and is
seen when the pacemaker discharges immediately after
the patient's own QRS complex (the discharge occurs
in the refractory period of the heart). In this case, the pads
are not sensing the patient's heartbeat. Select a different
monitoring lead or reposition the pads. Fixed pacing may be
indicated.

6.皮膚應注意事項:

1.Educate patient about possible discomfort with pacing.
2.Instruct patient and family that muscles will
   twitch with each pacemaker beat.

3.If sedation is needed (a normal occurrence),
   be prepared to initiate when pacemaker is
   activated.

4.Discomfort may not be noticed until higher
   mAs are used.

5.Sedation should be for a targeted level
(e.g. Ramsey of 2-4).

6.Prepare skin for pad placement (cleaning,
shaving if necessary).                             

7.Be sure to avoid breaking the skin while shaving.
8.Check skin routinely to avoid severe skin
   irritation.
9.Move pad placement (if patient condition
    allows) as necessary to protect skin.

7.護理問題:

1.Evaluate pads for comfort.Pads should be checked
often. Normally they are checked every 30 minutes
(to avoid severe skin irritation).

2.They should not be left in the same place for more than a few hours.
3.Ensure there is a pulse with each QRS complex.Otherwise,
   electromechanical dissociation may exist.

4.Routinely ensure that the pacemaker is capturing the
heart rate with each discharge (check for a
pulse with each pacer spike).
5.Identify the length of time the pacemaker is to be
used. Keep in mind TC pacing is only temporary,
usually less than a few hours.

8.節律器調整:

 開機-->貼貼片 換接插座-->ON-->調MODE

 

 DEMAND (PRN)  或  FIX(一直PACING)-->

START-->調 RATE p/min    60p/min開始-->調輸出 mA (output)

     

DEMAND (輕微的):從最低調起,如無效再往上慢慢調,直到可以的mA再加10%

      ex:20mA-->30-->......-->60(有效)再加60*10%--->最後應為66mA

     

FIX: 從最高往下調,直到無效的時候回到上一個有效的量,再加其10%

      ex: 200mA-->190mA-->......-->160mA(有效)-->150(無效)-->最後應160+160*10%--->176mA

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  • 威派VPN
  • 玩遊戲會LAG嗎?

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  • GREENFDA
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  • 德瑞寶推薦新書:護肝抗癌的黃金植物苧麻
  • SHARON
  • 可以給看tcp影片密碼嗎
  • 抱歉太晚寄給你囉

    msicu1 於 2010/05/12 00:17 回覆

  • 瑛瑛
  • TCP

    你好,我是小醫院急診的護士,因為今天差點讓我碰上TCP,雖然沒有操作到,但還是想看看有沒有影片可以參考,所以,請問可以給我TCP影片的密碼嗎?感謝你!!!
  • 抱歉太晚寄給你囉

    msicu1 於 2010/05/12 00:17 回覆

  • Luna
  • 可以給TCP影片的密碼嗎??
  • 抱歉太晚寄給你囉

    msicu1 於 2010/05/12 00:15 回覆

  • 婉婉
  • 我可以要tcp的影片嗎?
    我只是個學生 我想多學學
  • beryl
  • 您好~可以和你要TCP的影片嗎?謝謝^^
  • 累累
  • 可否給我TCP,IABP及PICO的密碼十分感謝
  • n3147
  • 需要密碼及影片,感恩…
  • 悄悄話
  • 丁丁
  • 可以給我密碼看影片嗎!?

    感激~
  • I WANNA LEARN MORE. WOULD U PLEASE SEND ME A PASSWORD FOR TCP AND IABP?
    THANK U
  • 悄悄話
  • Nu
  • 不好意思~可以給我TCP的影片密碼嗎?
    我想了解如何操作!!
    謝謝
    Kindkins1213@yahoo.com.tw
  • 悄悄話
  • 悄悄話
  • 訪客
  • 您好我想要了解TCP的操作
    能否給予密碼
    謝謝你
    u101001067@kmu.edu.tw
  • 訪客
  • 版主你好我想要了解TCP的操作 可以給予密碼嗎
    感謝您

    sa1220346@gmail.com
  • 奇異果
  • 您好,我剛好要報有關TCP,想要影片密碼
    s703072004@yahoo.com.tw
  • 悄悄話
  • 悄悄話
  • 悄悄話
  • 悄悄話
  • Lily
  • 可以給看tcp影片密碼嗎?
  • Lily Jhang
  • 可以給看tcp影片密碼嗎?
  • 悄悄話
  • 悄悄話
  • 欣
  • 請問可以寄tcp的影片密碼給我嗎?感謝您!!
  • 悄悄話
  • 悄悄話