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gul-filtvis reanimaciis Tanamedrove midgomebi. giorgi kutubiZe giorgi SaiSmelaSvili 22.03.11 . reanimaciis adreuli mcdelobebi. istoriuli faqtebi - PowerPoint PPT Presentation
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gul-filtvis reanimaciis Tanamedrove midgomebi
giorgi kutubiZe giorgi SaiSmelaSvili
22.03.11
reanimaciis adreuli
mcdelobebi
istoriuli faqtebi1740 parizis mecnierebaTa akademiam oficialurad gaukeTa rekomendacia piriT-pirSi sunTqvis gamoyenebas daxrCobis dros;1767 wyalSi damxrCvalTa gadarCenis sazogadoebas (the Society for the Recovery of Persons Apparently Drowned) hqonda pirveli organizebuli Zalisxmevis mcdelobebi uecari da moulodneli sikvdilis SemTxvevebis samarTavad;1891 Dr. Friedrich Maass-ma ganaxorciela pirveli dokumentirebuli gulmkerdis kompresia adamianebSi;1903 Dr. George Crile-ma aRwera gulmkerdis garegani kompresiis pirveli warmatebuli gamoyeneba; 1904 Dr. George Crile-ma ganaxorciela pirveli gulmkerdis garegani masaJi aSS-Si;. 1954 James Elam-ma daadastura, rom amosunTquli airi sakmarisia oqsigenaciisTvis;1956 Peter Safar-ma da James Elam-ma gamoigones piriT-pirSi reanimacia Tanamedrove saxiT; 1957 aSS-s samxedro uwyebam moaxdina aRniSnuli reanimaciis meTodis adaptireba ugonod myofi dazaralebulebis gacocxlebis mizniT; 1960 ganviTarda gul-filtvis reanimacia (CPR) . amerikis gulis asociaciam daiwyo gacnobiTi xasiaTis treningebis Catareba eqimebisTvis da amavdroulad gaxda lideri gul-filtvis reanimaciis swavlebaSi. 1963 kardiologma Leonard Scherli-ma wamoiwyo amerikis gulis asociaciis CPR-is komiteti. amave wels amerikis gulis asociaciam formalurad miiRo CPR. 1966 amerikis wiTeli jvris da sxva organizaciebis moTxovniT amerikis mecnierebaTa akademiis nacionalurma kvleviTm sabWom Caatara specialuri konferencia gul-filtvis reanimaciis standartebis da misi universaluri swavlebis SesamuSaveblad. 1972 Leonard Cobb-ma Caatara msoflioSi pirvelad gfr-s masobrivi treiningi moqalaqeebisTvis qalaq sietlSi. am treningma pirveli 2 wlis manZilze moicva 100000-ze meti adamiani;1981 aSS- qalaq King County-Si daiwyo programa _ telefoniT instruqciebis miwodeba gfr-s dros. dReisaTvis aSS-Si es servisi standartulad xorcieldeba EMT–s da saxanZro departamentis dispeCerebis meSveobiT.
piter safari mkvlevarTa jgufTan da moxaliseebTan erTad
1. kompresiebis Catarebis xarisxi saWiroebs Semdgom gaumjobesebas
2. arasamedicino dawesebulebebSi gulis gaCerebis SemTxvevaSi gadarCenis xarisxi mniSvnelovnad damokidebulia im personalze vinc atarebs gul-filtvis reanimacias
3. arasamedicino dawesebulebaSi gulis uecari gaCerebis SemTxvevaSi dazaralebuli droulad ver Rebulobs saTanado daxmarebas (ar utardeba gul-filtvis reanimacia)
gadarCenis maCvenebeli (%) da misi Sefardeba gulmkerdis kompresiebis Soris
pauzis xangrZlivobasTan, fibrilaciis SemTxvevaSi
3 sec 10 sec 15 sec 20 sec0
20
40
60
80
100
Yu - Circulation 106:368 2002
gadarCenis maCveneblebi Cveulebrivi gul-filtvis reanimaciisa (CPR) da mxolod gulmkerdze zewolebis (CCR) dros
CPR CCR0
10
20
30
40
1997-1999
9%28/314
Terry Valenzuela MD AHA Resuscitation Science Symposium 2006 . Tucson, Arizona
2003-2006
25%34/136
spontanuri cirkulaciis aRdgena prehospitalur etapze
CPR CCR0
20
40
60
80
100
Bobrow and SHARE study group. Kansas City
15%52%
gamosavali intaqturi nevrologiiT Cveulebrivi gul-filtvis reanimaciisa (CPR) da mxolod
gulmkerdze zewolebis (CCR) dros
CPR CCR0
10
20
30
40
50
15%
40%
Bobrow and SHARE study group , Wisconsin data
aris Tu ara CasunTqvebi aucilebeli?ABG aRebulia reanimaciis dawyebidan (VF gamo) 7 wuTSi
SaO2 PCO2 pH
CPR 92 ±1 25 ±2 7.49 ±0.02
CCR 76 ±6 37 ±5 7.41 ±0.3
Berg. Circulation 1997
Series1
gfr
15 %
68 %
mxolod zewolebi
(CCP)
Locke et al. University of Arizona CPR Research Group; Arch Intern Med 1995; 155:938-943
CautarebdiT Tu ara ucnobs reanimacias?
reanimaciis arCatarebis mizezebi
• saWiro unarebis ararseboba
• manipulaciis SedarebiTi sirTule (sasunTqi gzebis gaxsna, piriT pirSi Caberva)
• raime daavadebis SiSi
• raimes gafuWebis, dazianebis SiSi
Weisfeldt ML, Becker LB. JAMA 2002: 288:3035-8
reanimaciis samfaziani modeli
0 2 4 6 8 10 12 14 16 18 20dro gulis gaCerebidan (wT.)
1 2
3
0
100%miokardiumis ATP 1. eleqtruli faza
2. cirkulaciuri faza3. metaboluri faza
avtomaturi gareganidefibrilatorebi (AED)sazogadoebriviTavSeyris adgilebSi
avtomaturi garegani defibrilatori (AED)
ABC (Airway Breathing Circulation) Tanmimdevrobis cvlileba CAB-Ti
• ABC sicocxlis gadarCenis algoriTmi Seicvalos CAB-Ti yvela asakobriv jgyfSi (garda axalSobilebisa)
• gulis gaCerebis mqone pacientebis sicocxlis SenarCunebisTvis mniSvnelovania gul-mkerdze zewolebi da drouli defibrilacia.
• ABC Tanmimdevrobis gamoyenebisas zewolebi uxSiresad gviandeba.
• CAB Tanmimdevrobisas gulmkerdze zewolebi iwyeba naadrevad, xolo xelovnuri sunTqva tardeba minimaluri dayovnebiT.
• CAB algoriTmis SemTxvevaSi prioriteti eniWeba C–s (Circulation).
• mocemuli CAB algoriTmi sruldeba TanmimdevrobiT roca reanimacias atarebs erTi adamiani, Tumca ramdenime reanimatoris arsebobis SemTxvevaSi maT SeuZliaT funqciebi gadainawilon
dazaralebuli ugonodaa, ar sunTqavs an sunTqavs araadekvaturad
gamoiZaxedaxmareba
moiZie defibrila-tori
daiwye gfr
Seamowme ritmi, saWiroa Tu ara eleqtroSoki. Tu ki gaimeore yovel 2 wuTSi
Zlieri da swrafi
zewolebi
mozrdilTa reanimaciis gamartivebuli
algoriTmi
• gulis gaCerebis adreuli diagnostireba da daxmarebis drouli gamoZaxeba
• adreuli gul-filtvis reanimacia, ZiriTadi aqcentiT kompresiebze
• swrafi defibrilacia
• sicocxlis gadarCenis daxvewili algoriTmis efeqturad Catareba
• gulis gaCerebis Semdgomi RonisZiebebi
yoveli wuTi gulmkerdiskompresiis gareSe
sasikvdiloa !!!
gmadlobT yuradRebisaTvis
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