01/10/2021

This needs to puncture the artery,Direct measuring arterial blood pressure。After punctured to the artery,Insert a puncture needle in the arterial,Pressing the tail of the tail、Catheter, etc.,Directly connected to the head of the ECG monitor,Adjustment mode,You can directly measure the blood pressure of the patient.,Every heartbeat will have a blood pressure。This is called continuous artery blood pressure monitoring。

Have a patient’s blood pressure,USICUDoctors have a number in their hearts.。Otherwise, I haven’t seen blood pressure for a few minutes.,Will make people feel uncomfortable。data,data,Very important。
Directed to the artery and place the left needle,It is necessary to take blood in the future、What is the arterial blood?,There is no need for frequent needles.,Directly from here。It’s okay.。To reduce pain,Sometimes nurses make some local anesthetics in the puncture site。
Nine、Thoracic puncture
If the patient has pneumonia、Lung cancer、tuberculosis,Or heart failure, etc.,Causes can cause pleural effusion。So-called pleural effusion,It is accumulated in the chest.。Under normal circumstances,There should be no lots of liquids in the chest.,Only a little liquid is。But under the condition,Such as lung cancer,There are many exudated liquids.,These liquids will fall into the chest,Causes pleural effusion,Bloody。
Presence of pleural effusion,Will affect pulmonary inflation,Affect ventilation,Patients will feel hypoxia、Not enough。In order to solve this problem,We need a thoracic puncture,Puminate the liquid inside。at the same time,Can take the liquid to test,Understand the nature of liquid,It is to speculate that the cause of a pleural effusion。Aiming to the etiology。
The process of chest puncture is relatively simple,It is in the needle between the two ribs,Directly into the chest,If there is liquid,That said that the name is went to the place.。Fast cases,May wear blood vessels,Big bleeding。It is also possible to wear a lung,Take the lung or abdominal surgery(Such as gallbladder、pancreas、Stomach、Knot
Engraving changes in the condition。
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NS301chapter
forICUPatient,Such an indignant needle is not enough。First of all,Ordinary venous indwelling needles are not fast enough,For patients who need rescue,The speed of replenishment is critical。Second,Ordinary table light retire needles is best not to use some vascular active drugs(Such as boosting medicine),I thought once the drug leaked,May cause local tissue necrosis。2
Based on the above two reasons,ICUPatients usually need to make a relatively deep venous(Deep vein puncture),For example, put intravenous、Obseric vein、Negior vein, etc.,These venous positions are relatively deep,And more rough,Very good for rescue medication。
To puncture these positions deep veins,Need still need a certain technique,This is alsoICUAnd anesthesiologist’s stunt。Because it is blind,Doctors first experience to find a probably venous position,Then in this part into the puncture needle。With medical progress,You can now use ultrasound to assist in puncture.,Ultrasound can find veins,Looking at the vein。
In order to reduce the pain of patients,Doctors will definitely have local anesthesia,Even the whole body calm,Do patients with full relaxation。In order to reduce puncture infection,Doctors will fully disinfect、Spread towel。
Established this deep venous pathway,It is only possible to use adrenaline when you are rescued.、Dopamine、Evascular active drug such as adrenaline,It is only possible20Quick drop in minutes500lEven more liquids。It is possible to save the endangered life of the patient.!
six、Continuous renal replacement treatment
If the patient is infected,Or it has a renal function,This disease is likely to cause new hits to the kidneys,Acute renal failure,No urine,Internal environment disorder。At this time, you need to do kidneys.(CRRT)。
So-called continuous kidney replacement treatment,Need to use a machine(Bedside blood filter)。The doctor will first puncture a deep vein to the patient.,Place a diameter in the vein4Left and right catheter,This catheter will connect to the blood filter line,Open blood filter machine,Blood filter takes blood through the catheter,Filter clean(Simulated kidney function)After returning to the body,This process is called kidney replacement treatment,Sometimes this treatment can also clear the inflammatory media in the blood,So some people use this treatment called blood purification treatment。
(This is a hundred-special blood filter machine)
ICUThis type of blood filter with kidney medicine dialysis machine,The principle is almost,It is replacing the kidneys.。butICUSpecial,It is the slow bleeding speed.,Work speed is also slow,Often24Hourly uninterrupted。The advantage of this is to reduce the impact on blood pressure on critically ill patients.。
And dialyzing machine in nephrology,Is a week3Second-rate,Every time you do4-5Hours,Go home after finishing。This dialysis speed is very fast,Ordinary patients can bear。But critically ill patients do not have to bear。I have tried many critically ills of patients with heartbeat.,very dangerous。
seven、ECMO(extrarporeal brane oxygenation)
When a severe respiratory failure,Patients such as acute respiratory distress syndrome,It is no longer able to meet the patient’s basic oxygen demand through the ventilator.,Then you must further support。OnlyECMONS(In vitro fluidoxide,Simple understanding as artificial lungs)。ECMOIs the ultimate means of lung support,The principle is to lead the patient’s blood to the machine,Oxygen in the machine,Oxygen enters red blood cells,Re-return。The entire oxygenation process no longer rely on the lungs。
Ventilator,Can only be said to be a ventilator。The ventilator is only responsible for implying oxygen into the airway、lung,If there is also a function of lung,So the ventilator can still play。If the lungs are completely destroyed,The ventilator is not used by the gas.。At this time, you can only use it.ECMONS。
ECMOLet many people continue to continue,Wait until the basic disease is improved,Take off againECMO,Reuse retreat machine。But if it is some patients in the end,Not recommended for useECMO。BecauseECMONot treating means,Just support means。If the disease cannot be removed,Patient should always useECMONS?Unrealistic。
(ECMOSchematic diagram)
knowledgeECMOIs the fee??Boot fee6Ten thousand,Every day in the future2Ten thousand,Almost this number,And medical insurance is not reimbursed。If it is an acute condition,Have hope reversed,For a few daysECMOTransition transition is ok。If it is a final stage,That is no need.。
After allE,It is also the artery that needs to puncture the patient.、Vein。These are traumatic,Although it is minimally invasive。
Eight、Artery puncture
Conditional patient,We need to measure blood pressure。If it is ordinary sleeve bag non-invasive blood pressure,Can only be measured for a few minutes or minutes,And there may be error,No way to reflect the patient’s condition in time。To know,ICUPatient,The degree of life is sometimes in seconds、Minute,So we need to see the patient’s real-time blood pressure at all times.。
This needs to puncture the artery,Direct measuring arterial blood pressure。After punctured to the artery,Insert a puncture needle in the arterial,Pressing the tail of the tail、Catheter, etc.,Directly connected to the head of the ECG monitor,Adjustment mode,You can directly measure the blood pressure of the patient.,Every heartbeat will have a blood pressure。This is called continuous artery blood pressure monitoring。
Have a patient’s blood pressure,USICUDoctors have a number in their hearts.。Otherwise, I haven’t seen blood pressure for a few minutes.,Will make people feel uncomfortable。data,data,Very important。
Directed to the artery and place the left needle,It is necessary to take blood in the future、What is the arterial blood?,There is no need for frequent needles.,Directly from here。It’s okay.。To reduce pain,Sometimes nurses make some local anesthetics in the puncture site。

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