Te

1
(No Transcript)
2
?????? Te??????

• ??a?s??s???????
• ???

3
??µ?d??aµ??? monitoring

• ECG ?a? ST monitoring
• CVP

4
ECG

• S????t?ta
• ???µ???t?ta a????µ?a
• QRS µ??f?????a
• ST
• T

5
??e?? apa?????
RED (Right)
YELLOW
GREEN
6
??e?? apa?????

• ??????? ?? ??? ???? ? de?te?? µes?p?e????
  d??st?µa de??? t?? st?????
• ??t???? ?? ??? ???? ? de?te?? µes?p?e????
  d??st?µa a??ste?? t?? st?????
• ???s??? (? µa???) ?? ??t? ???? ? st?? pe????? t??
  ????f?? t?? ?a?d???

7
??e?? apa?????

• ? apa???? ?? ??e? ?a??te?? ape?????s? t?? ? ?a?
  ???t??e? t? ?at?te?? t????µa t?? ?a?d???

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
???te apa?????
12
(No Transcript)
13
???te apa?????

• ? ?? ?a? ? V5 s??d?asµ??e? ????? d??at?t?ta
  a?a?????s?? 80 ?s?a?µ???? epe?s?d???

14
?????µ?e?

• S????t?ta
• P
• S??s? P ?a? QRS
• ???f?????a QRS
• ABC a??????µ?? a????µ???

15
QT
16
QT
17
QT
QTc v
RR
(sec)
F? ???e? 0,39 T??? 0,41
18
?????s? ST
19
ACC/AHA 2007 Guidelines on Perioperative
Cardiovascular Evaluation and Care for Noncardiac
Surgery 11/10/2007
20
CLASS IIa Intraoperative and postoperative ST
segment monitoring can be useful to monitor
patients with known CAD or those undergoing
vascular surgery, with computerized ST segments
analysis, when available, used to detect .
myocardial ischemia during the perioperative
period. (Level of evidence B)
CLASS IIb Intraoperative and postoperative ST
segment monitoring may be considered in patients
with single or multiple risk factors for CAD who
are undergoing noncardiac surgery (Level of
evidence B)
21
Computerized ST segment trending is superior to
visual interpretation in the identification of ST
segment changes
No studies have addressed the issue of the effect
on outcome when therapy is based on the results
of ST segment monitoring. However general
consensus is that early treatment such as control
of tachycardia could lead to reduction in cardiac
morbidity
22
??G ?????s? ST d?ast?µat??
23
(No Transcript)
24
(No Transcript)
25
(No Transcript)
26
(No Transcript)
27
(No Transcript)
28
(No Transcript)
29
(No Transcript)
30
(No Transcript)
31
??t?a ?at?spas?? ST

• ?s?a?µ?a
• ?p??e?µ?a
• ?p??
• ta???a?d?a
• ?pe?d????d?? ???
• ?at?pt???? a??spas? ST
• ?????a?? ?pe?t??f?a
• desµ???? ap???e?sµ??
• da?t???t?da

32
?at?spas? ST

• pa??d???
• ?at???sa ? ??????t?a se s??s? µe t? J

??????? ?S?????? !!!!!!

• a????sa
• ?S?????? ??????

??ast??f? ?? p??a?? ?pe?t??f?a ?? ?????a?
33
(No Transcript)
34
?at?spas? ST

• se desµ??? ap???e?sµ? (LBBB)
• µe???? p?at? R ?at??? ST p?? ?ata???e? se
  a?est?aµµ??? ?
• ßa?? , p?at? S a???? ST, p?? ?ata???e? se ???? ?
  

35
?at?spas? ST

• da?t???t?da ?p?a ?at?spas? lt1mm
• ?p??e?µ?a - p???ap??? apa????? pa??tas? PR, QT
• ?p?? p???ap??? apa????? pa??tas? PR, ß?????s? ST

36
(No Transcript)
37
??t?a a??spas?? ST

• ???
• a??e??s?spast??? st??????
• pe???a?d?t?da
• p???µ? epa?ap???s?

38
??t?a a??spas?? ST

• ???
• a??e??s?spast??? st??????
• pe???a?d?t?da
• se ??e? t?? apa?????
• p???µ? epa?ap???s?

39
??t?a a??spas?? ST

• ???
• a??e??s?spast??? st??????
• pe???a?d?t?da
• p???µ? epa?ap???s?
• a????s? J ?ea?? ?t?µa

40
(No Transcript)
41
(No Transcript)
42
Monitoring mode f??t?? p?? a?a??????e? 0,5 40
Hz
ST segment mode f??t?? p?? a?a??????e? 0,05
60 ? 100 Hz
43
(No Transcript)
44
CVP
45
??de??e?? ?a?et???asµ??

• monitoring p?es?? p????se?? ?? ???p??
• ??????s? fa?µ???? (???t??pa, e?e??st???, ?????a,
  ??µe???e?ape?a)
• ta?e?a ??????s? ?????
• a?a???f?s? eµß???? a??a
• a?epa???? pe??fe???? f?eß??? p??sßas?

46
?p?p????? ?a?et???asµ??

• t??s? a?t???a? (?a??t?da, ?p???e?d???, µ???a?a)
• a?µ?t?µa
• a?µ????a?a?
• ???????a?a?
• µes????a???? ? p?e???t??? s??????
• p?e?µ????a?a?
• ß??ß? ?e????
• ß?a?????? p???µa ?a? aste??e?d?? ???????
• eµß??? a??a ? teµa???? ?a?et??a
• t??s? ?a?d???
• a????µ?e? ap???e?sµ??
• ???µß?eµß????? epe?s?d??
• ???µ??e?? (s???, e?d??a?d?t?da)

47
CVP

• µet??µe p??se??, ??? ????
• ? a?a???? se ???? p???p???te? sta?e??
  e?e?d?t?t?ta
• ? a?a???? se te??d?ast????? ???? ?? ?????a?
  p???p???te? f?s???????? gradient ??? ?????? ???
  ?? ?????a
• trends ?a? ??? ap???t? t?µ?
• µe???? s?µas?a ? s?st? t?p???t?s? ?a? µ?de??sµ??
  t?? transducer (p??s??? st?? µeta????se??)
• ep??e??eta? ap? a?ap?e?st??? ????? ?a? PEEP
• µet??ste te??e?p?e?st???
• ??????ste ???? ??? µ????? ????? (300ml) a?eß?se?
  ?a?a?t???st??? t?? CVP 3-5mmHg (ATLS)

48
(No Transcript)
49
S?µe?a pa?a???t?s??

• ?. ?s? sfa??t?da
• p??ß????µ? a?at?µ??? ??s?
• ???af?t? ?d??? s?µe?a
• ß?a?e?a, e??e?a, ????? ßa?ß?de? p??e?a st?? ???
  ?????
• e????a p??spe??s?µ? ap? t?? ??s? t??
  a?a?s??s???????
• ?. ??? sfa??t?da
• p??a??? ßa?ß?de?
• d?s???? p?????s? p??? ??? ?????
• e????a ?atast??feta?

50
S?µe?a pa?a???t?s??

• G. ?p???e?d???
• e????a a?e?t? ap? as?e?? ?? ??s?
• µe?a??te?e? p??a??t?te? a?µ?-, p?e?µ????a?a
• ?. ????a?a
• e????? µ????s?
• d?s???? p??sßas? ap? a?a?s??s??????

51
v t???? s?st???? y d?ast???
a s?st??? ???p?? c ?s????? s?st??? ??????? x
e????s?
52
a s?st??? ???p?? c ?s????? s?st??? ??????? x
e????s?
v t???? s?st???? y d?ast???
??ep???e?a t???????????, ???? s?st????? cv, e?af.
x
53
Cannon waves
54
Cannon waves
55
Pericardial constriction
56
Cardiac tamponade
57
?p?d?as? a?ap?e?st???? ??????
58
(No Transcript)