How to evaluate various indicators of the monitor

How to evaluate various indicators of the monitor

I am a Meilun doctor in the emergency department. Now, it is a hospital with a ECG monitor, the model, the manufacturer is different, generally including heart rate, blood pressure, blood oxygen, breathing times, some temperature and invasive monitoring, now only the most common four items.

Often there is a nurse shouting: a doctor, a doctor, 1 beds of blood pressure 85/50, 2 bed oxygen more than 80, 3 bed heart rate 180, get you a surprise at first Chad, quick past, many times are not so, often have the instrument setting and other problems, let the nurse wrong judgment, in fact, not only a nurse, but also the doctor is often watching prison. A doctor's order to make jokes.

The nurse is good to say, if the patient's family is in the side, more is sick, often have family panic to find you, say the patient's blood pressure is only 20, the result you look, God clear language, no abnormality, let you be surprised, nothing to say, if the alarm is not appropriate to sound, and you would not say, and you would not say more, and The time explained by family members is much longer than the time you spent treating patients.

So, how should we evaluate all kinds of data of monitor and how to make use of these data to serve us better?

The monitor manufacturer asks everybody to discuss together, find some problems of the monitor, some problems that can easily cause misunderstandings, of course, more experience, because guardianship can help us find the risk of the patient, early intervention, and very beneficial to the patient.

Throw a brick, say a personal view first.

1. blood oxygen: often someone calls me because of the very low oxygen. In fact, according to the measuring principle of the monitor, the peripheral circulation of the patient, and the use of nail polish, and the local hygienic condition will affect the judgment. However, it is usually caused by the decline, rarely raised, if the patient's value is very low, The patient's situation should be observed, especially the local condition, the conditional machine should observe the curve, the very regular Qu Xiancai has the reference value, prevents the error judgment.

2. blood pressure: very troublesome index, because the relation of measurement principle, according to the result of my checking book, is often too low estimate low value, overestimate high value, that is to say, if the patient is true blood pressure 180/100, it may give you measure into 190/110, if the patient is 70/40, may measure the value is 60/30, should say it is my individual Feeling, general machine measurement, low pressure value is low, so the simple low pressure is very low performance, you can not pay special attention, generally do not have life risk.

3. the number of breaths is the most unreliable index, because there are too many influencing factors.

4. heart rate: the person thinks it is the most useful indicator in the monitor, because it can automatically measure heart rate, and heart rate is a barometer of many diseases critical degree. In addition, for serious diseases such as myocardial infarction, arrhythmia is judged by heart rate waveform.

The trouble of heart rate wave: if there is a premature beat, the number of messages will change regularly, and the nurse, especially the family members, often come to you. Sometimes, because it is a simulation lead, QRS and T waves may be very close, the instrument will take them all as heart rate, then the heart rate will double, cause panic, a specialist in a specialist hospitalization let me, must put the patient's 230 "horror" heart rate immediately down, really speechless.

In fact, the most important thing is that the monitor has abnormal indicators. The best way is to see the patient, the state and condition of the patient, and the monitor. This is the most important thing, rather than being far away from the machine.

I think it's like dealing with all kinds of electrical appliances at home. There are many kinds of monitors for Cory. There are various models, including HP, PHILPS, ZOLL, and the same brand. Some monitors have not even been eliminated for more than 10 years, but the things that early Americans bought for us were still solid. Most of the new monitors are intelligent, touch-screen and keyed. But it's almost the same.

However, some details, such as HP MP1000 monitor ECG's monitoring, diagnosis and automatic mode, show the ECG effect is often very large. After being disturbed, the waveforms also vary greatly, which often affect the diagnosis. Therefore, the emergency doctor must be proficient in the use of the monitor, portable ventilator, AED and other first aid equipment, and the adjustment of the parameters, so the nurse can not wait for the nurse to do it.

The basic knowledge of first aid doctors is very important, for example, the location, requirement and width of upper cuff will affect blood pressure tracing. Some monitors are "silly" and tend to elevate the ST segment as a heart rate, causing the illusion of tachycardia. Some monitors have poor oxygen saturation connection, and often cause "finger tip blood oxygen" not to be detected, causing false alarm. Some of the first aid patients groaned with pain, but they did not breathe quickly, but the number of monitors showed more than 30 times. Just like electrical appliances at home, these Dongdong also need regular maintenance and quality check and proofreading. For a long time, it is inevitable that there are some minor problems. More funny is, once, the monitor in an emergency patient monitoring an emergency patient, the nurse carelessly, did not connect the monitor power supply, the monitor battery after the use of the monitor stopped operation, the monitor center ceaselessly sent out of the alarm signal, but in English, the old doctor did not understand, so a half day to check to check.