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ÖLÇÜM PARAMETRELERİ

ÖLÇÜM PARAMETRELERİ. MASIMO RAD57cm. SpO2 Oksijen Satürasyonu BPM Nabız hızı SpCO Karboksihemoglobin SpMet Methemoglobin Perfüzyon. ÖLÇÜM PARAMETRELERİ. MASIMO RAD-87. SpO2, Nabız, SpHb, SpMet, SpCO, SpHct, Perfüzyon, PVI. ÖLÇÜM PARAMETRELERİ. SpMet Methemoglobin.

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ÖLÇÜM PARAMETRELERİ

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  1. ÖLÇÜM PARAMETRELERİ MASIMO RAD57cm • SpO2 Oksijen Satürasyonu • BPM Nabız hızı • SpCO Karboksihemoglobin • SpMet Methemoglobin • Perfüzyon

  2. ÖLÇÜM PARAMETRELERİ MASIMO RAD-87 SpO2, Nabız, SpHb, SpMet, SpCO, SpHct, Perfüzyon, PVI

  3. ÖLÇÜM PARAMETRELERİ SpMet Methemoglobin SpCO Karboksihemoglobin SpO2 Oksijen Saturasyonu SpHb Total Hemoglobin Oksijen Miktarı O2/dl Nabız Hızı Perfüzyon İndeksi PVI MASIMO Radical 7 blue

  4. SpO2 Oksijen Satürasyonu Ölçüm Hassasiyeti

  5. SpCO Karboksihemoglobin Ölçüm Hassasiyeti

  6. Karbon Monoksit Zehirlenmesi • Renksiz, kokusuz, irritasyon yapmayan bir gaz • ABD’de zehirlenmelere bağlı morbidite ve mortalitenin en sık sebebi • Yılda en az 2100 zehirlenme • Morbidite • Yılda ~10000 hastane başvurusu • En az 1 gün normal aktivite kaybı • En ciddi komplikasyon • Akut veya gecikmiş nörolojik disfonksiyon • Tanı almayan CO zehirlenmeleri???

  7. Reusable Problar Erişkin Pediatrik

  8. Disposable (Tek hasta) Problar Erişkin Pediatrik Hasta Ara Kablosu Yenidoğan Infant

  9. SpHb Total HemoglobinÖlçüm Hassasiyeti N=492 data points collected on adults using reusable sensors

  10. ÖLÇÜM PARAMETRELERİ SpMet Methemoglobin SpCO Karboksihemoglobin SpO2 Oksijen Saturasyonu SpHb Total Hemoglobin Oksijen Miktarı O2/dl Nabız Hızı Perfüzyon İndeksi PVI MASIMO Radical 7 color

  11. Invaziv Hb Metodu Pulse CO-Oximetry Çalışma Prensibi Spektrofotometrik Spektrofotometrik Analiz için kullanılan madde Evet Küvet Evet Evet Evet Kan Hayır Tehlikeli/Riskli Kan Evet Parmak Hayır Hayır Hayır Hayır Hayır Numune Şekli Enfeksiyona açık Potansiyel Anemi Sebebi İstenmeyen İğne Saplanmaları Tıbbi Atık Komple İşlem Süresi Dakikalar/Saatler Saniyeler Özel Eğitim Gereksinimi Sürekli Monitörizasyon Total Hemoglobin Ölçümü

  12. MASIMO Radical 7Non-invaziv /Düşük Maliyet ve Hızlı Sonuç /Sürekli Gözlem

  13. Geleneksel Yöntem Invaziv /Maliyetli ve Uzun İşlem Süresi /Sürekli Gözlem Yok

  14. Arterial blood Arterial blood Venous blood Venous blood Tissues Bones Tissues Bones Sensor Sensor Diastole Systole • Be careful that those absorption phenomena are not modified by other non physiological elements like: • Nail polish or artificial nails • Haematoma under the nail or the skin

  15. Konvansiyonel Pulse Oksimetreler 2 dalga boyu ile çalışır 10000 Oxyhaemoglobin 1000 Deoxyhaemoglobin Extinction Coefficient 100 658 nm 905 Nm (Infra red) 700 800 900 600 Wavelength (nm)

  16. Parmakta Işık Absorpsiyonu • ACPulsatile arteriyel kan akışındaki değişken ışık absorpsiyonu (hacimsel değişiklik) • DCNon-pulsatil arteriyel kan akışındaki sabit ışık absorpsiyonu • DCVenöz kan hacmindeki sabit ışık absorpsiyonu • DCDoku ve kemikteki sabit ışık absorpsiyonu • Absorpsiyon • Zaman

  17. Advantages of the non invasive measurement of Methaemoglobin • MetHb elevation appears by the use of many drugs used allover the hsopital: • Local / topical anaesthetic agents (Benzocaïne, Lidocaïne, Cetacaïne, etc) • Vasodilatators such as NO, sodium nitroprusside & nitroglycerine • Antiseptics (like Dapsone) commonly used for pneumonia and with AIDS patients • A quick detection allow a fast response… which means less neurologic dammages and/or death. • We may see in the future, MetHb being used as a marker of the onset of sepsis.

  18. SpMet Methemoglobin Ölçüm Hassasiyeti

  19. Methemoglobin Ölçüm Prensibi Methemoglobin’ in 2 absorpsiyontepe noktası vardır

  20. Study on “Acquired Methaemoglobinemia”Johns Hopkins, September 2004 Where can we find Methaemoglobinemia ? • OR • ICU • Ped • Wards • ER • Cath Lab • Bronchoscopy Lab • Endoscopy Lab • Clinics (rhumatology, VIH, dermatology, oncology)

  21. Acquired methaemoglobinemia This is from far, the most common cause. Within the hospital • Use or overdose of some specific drugs • Dapsone and sulfates • Inhaled Nitric Oxide (iNO) • Nitrates/Nitrites (Nitroglycerine, Trinitrine®…) • Local / topical anaesthetics benzocaine prylocaine xylocaine EMLA • …… • Other factors • Dehydratation (specially in Peds and Neonates) • Sepsis can increase the potential for toxicity (due to release of NO in the body) • Malnutrition can reduce the albumin which binds benzocaine thereby leading to increased risk of MetHb formation. • Drug abuse (amyl nitrate) Out of the hospital • Contaminated food • Industrial products • Drug abuse (poppers)

  22. Methemoglobinemia semptomları

  23. MetHb on healthy patient • In healthy patient, a small fraction of haemoglobin is continuously transformed in methaemoglobin, in the red blood cells. • This normal biological reaction is continuously compensated by MetHb reduction into Hb. • Normally, this keeps the MetHb levels low. Normal values Expressed as a percentage of total haemoglobin. Normal value: < 1 % for an adult 1,5 % for a new born 2% for a pre-term baby

  24. Rainbow sensors Reusable SpCO/SpMet/SpO2 sensors for infants • Rainbow DCIP-dc3 or DCIP-dc12 Reusable SpCO/SpMet/SpO2 sensors for adults • Rainbow DCI-dc3 or DCI-dc12 Caution, these sensors are equipped with a thermistor which prevent its operation below a specific temperature (-18°C), in this situation, SEN blinks on the display. Disposable SpCO/SpMet/SpO2 sensors for adults • R25-L • R-25 Disposable SpCO/SpMet/SpO2 sensors for infants • R20-L • R20 Disposable SpCO/SpMet/SpO2 sensors for neonates • R25-L

  25. Karboksihemoglobin Ölçüm Hassasiyeti

  26. MASIMO Rainbow Teknolojisi12 dalga boyu ile çalışır Karboksihemoglobin , Methemoglobin ve Total Hemoglobin ölçümü için farklı dalga boyları kullanılmaktadır, kan veya dokularda bulunan değişik element veya hemoglobinin farklı formları kullanılmamaktadır.

  27. Why is carbon monoxide dangerous ? Odourless and colourless gas, it has the same density than air and mix up perfectly. CO is dangerous because of the affinity to the haemoglobin molecule for this gas which is 200 to 250 times higher compare to the one for oxygen. It means that if there is CO and oxygen available to bind to haemoglobin, Hb will combine preferentially to CO; that the CO-Hb link will be very strong, and therefore, haemoglobin will be not available anymore to carry oxygen. Presence of CO reduce the oxygen transportation capacity of the blood. CO bind also with some proteins (myoglobin) and some enzymes. (80 % with haemoglobin; 20 % with myoglobin and 1 % with cytochroms and catalases). CO  CO2

  28. SpCOKarbonmonoksit Zehirlenme Semptomları

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