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Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

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Nội dung chi tiết: Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2t, cardiopulmonary resuscitation (CPR), can be performed without extra equipment. However, not even MaeGyvcr would really be willing to try cardiovers

ion without a defibrillator, and the most basic treatments used for cardiovascular care require at least certain medications and equipment.DLVGNOSIS: Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

ELECTROCARDIOGRAMNo CalipersTo measure electrocardiogram (ECG) intervals without calipers, mark a card or piece of paper with vertical lines: 1)1111-

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

The marks can be spaced to match the lop of the R or the p waves, depending on what you arc looking for. Move the marks to another part of the ECG to

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2 lay a patient down, do the ECG with the patient in a standing position (lig. 10-1). I he resulting ECG is just as interpretable as one done in a supi

ne position.Attaching Heclwcardiagrant ỉ.eadsIf an I CG or a cardiac monitor is available, but the way of attaching the leads to the patient is missin Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

g, several methods work well, fhe key is to pull off any device hiding the bare metal leads (that usually are covered by devices that attach to rape l

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

eads on Western ECG machines). After removal, place the leads directly on small alcohol or saline pads or a lubricant (oil. K-Y jelly)FIG. 10-1. Stand

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2d methods.between the skin and the lead, but that is not essential to obtain a good ECG reading. Affix them in the normal locations using phlebotomy t

ourniquets. If chest leads arc needed, place these on The skill ill the same manner. using tape to temporarily secure them. If they must be kept on fo Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

r some lime or if the patient has injuries (e.g.. bums) precluding the use of tape, insert small-gauge needles just beneath the epidermis and use alli

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

gator clips to make a connection (Fig. 10-2)."ì2-ỈẨì-ad "Electrocardiogram Lsing 3 LeadsNormal 12-lead ECG machines may not be available when addition

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2the information provided by a 12-lcad ECG. To do this, do a tracing with the ECG pads placed in the normal 3-lead positions:White = light chest just b

elow the clavicleBlack left chest just below the clavicleRed left lower abdomen just above the umbilicusI hen, do four more tracings, each time moving Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

the red (left leg) lead to the VI, V2, V3, or V6 positions (Fig. 10-3)? Many monitors can also show leads n. Ill, aVL. aVR. and aVF by moving a dial

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

on the machine w ilh the leads kept in their normal position.hnprow ECG Diagnostic AccuracyStandard ECG machines run at 25 mtn-second. Doubling the pa

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2alize this is to think about stretching the l.CG tracing like a rubber band. One group of physicians improved their diagnostic accuracy from 63% at th

e standard rate to 71% with the faster tracings. Also, inappropriate use of adenosine decreased from 18% to 13%. Everything, including the QRS complex Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

and intervals, gets wider.-Measure Central \E11OUS PressureBoth the catheters and the manometers used for central venous pressure (CVP) monitoring ar

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

e disposable, but. if necessary, they can be boiled (disinfected) and reused. I he danger in reusing catheters is that particulate matter may remain w

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2TIG. 10-3. A normal TUG (I. VI. V2, \3. \b)done using only the three leads from a monitor. The additional limb lead tracings taken by changing setting

s on the monitorarc not shown. The‘ho rm al" tracing is lead L although on most machines it also can do tracings of the other limb leads.For measuring Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

cvp. attach a manometer to either a rliree-way stopcock or a sterile "Y” rube. Construct a manometer from another intravenous set taped over or besid

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

e an upright ruler or cardboard marked in centimeter increments. I ill the manometer from the intravenous bottle and then connect it via a central lin

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2rmal reading is 5-10 cm 11.0.)To be accurate, the zero (“0”) mark on the CVP manometer must be level with the supine patient’s mid-axillary line. Use

a long piece of wood with a level taped on top, so you can check that it is parallel with the floor. Place one end of the wood at (he patient's mid-ax Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

illary line and. while watching the level, attach the CVP manometer to an intravenous (IV) pole so that the zero (“()’’) is even with the wood's other

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

end. An alternative is to use a piece of IV tubing that has been half-tilled with colored water and then formed into a loop by connecting the two end

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2s how to use such a lube to adjust the manometer height.5Pulmonary Embolism Diagnosisliven if you cannot calculate the probability of a patient having

a pulmonary embolus (PI.) using one of the standard clinical decision rules (Wells and revised Geneva scores), your gestalt assessment will be suffic Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

ient. In tact, physicians' gestalt assessment is better at selecting patients with a low or high probability of PE than arc the scoring systems.'TREAT

Ebook Improvised medicine providing care in extreme environments, (2nd edition): Part 2

MENTParoxysmal Supraventricular TachycardiaI he simplest and most available method to convert paroxysmal supraventricular tachycardia l ì ic tn 11CP v

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

10 I Circulation/CardiovascularTew improvised methods are available for diagnosing and treating cardiovascular abnormalities. The most basic treatment

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