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【論文摘要】心房顫動引起心律不整院前救護與院內處置經驗分享
【論文摘要】A Case Study of An Emergency Medical Service for the Treatment of Arrythmia Caused by Atrial Fibrillation
摘要
背景：心房顫動是常見心律不整現象，年長者罹病率高，大部分人罹患多年，因未曾不適而不自知。當心跳忽快忽慢且不規律，心輸出量減少，血壓可能下降；過慢或停頓，可能因腦循環不足而昏厥；過快且不規則時，除心輸出量減少外，長期下心臟功能惡化，致心臟衰竭或易產生血栓，故需以危急個案儘速送醫。個案簡介：男性75歲，主訴胸口不適，心跳忽快忽慢，感覺像發生地震。脈搏在70－170次／分區間跳動，呼吸18次／分，血壓132/78mmHg，SPO 298%，體溫37℃，病史為病竇症候群，有裝心律調節器。車上十二導程心電圖顯示心房顫動及疑似急性ST段上升前側壁梗塞，排除主動脈剝離與用藥禁忌後，給Aspirin 300mg。曾使用NTG造成不適，故未給予，緊急送醫。結果：院內十二導程心電圖為心房顫動併快速心室反應，D-Dimer與心肌酵素正常，患者症狀穩定，先給口服藥物Diltiazem 30mg/tab、建立靜脈注射管路、持續心電圖監測，留觀3小時皆正常後出院。Diltiazem是鈣離子拮抗劑，能有效治療心律不整，亦可能引起緩脈副作用，而患者裝有心律調節器能防止緩脈副作用發生。結論：面對心房顫動者，EMT若因患者無胸痛主訴，僅依一般非創傷流程而未考慮做十二導程心電圖，有可能錯失嚴重的心律不整、STEMI或主動脈剝離。藉此案例學習及反思，跳脫流程框架，以病人為中心處置，讓我們在下次的救護能做到更好。
關鍵字
無資料並列摘要
Background: Atrial fibrillation (Afib) is a common cardiac arrhythmia, especially in the elderly who has a high morbidity rate. Unwarily, most of the people suffer from it for many years due to the reason that they have not experienced any major discomfort. Afib is an irregular, slow and very often rapid heart rhythms (arrhythmia) which can lead to low blood pressure and cardiac arrest. When heartbeat is slow it can cause fainting due to insufficient cerebral circulations, on the other hand faster and irregular heartbeat results in permanent cardiac arrest in addition to low blood pressure. In critical cases, where Afib increases the risk of stroke, heart failure, and blood clot in heart, an immediate medical attention is a necessity. Example: A 75-year-old man required medical care on immediate basis due to chest discomfort and rapid heartbeat. His heart rate is 70-170 bpm, respiration 18 breaths/min, blood pressure (BP) 132/78mmHg, oxygen saturation SPO2 98%, body temperature 37°C, and has medical history of sinus syndrome and equipped with a heart rhythm regulator. On an ambulance he is equipped with a cardiac rhythm regulator is that the twelve-lead electrocardiogram (ECG), which shows Atrial fibrillation and sharp rise into the ST segment. The initial diagnosis for these signals is acute anterolateral infarct and after removal of arterial strips and contraindication of medication an Aspirin 300mg is given. It is not suggested to use NTG (drug) which has been caused patient discomfort and the patient is referred to Doctor immediately. Results and Observations: In Hospital the twelve-lead electrocardiogram (ECG) showed atrial fibrillation with a rapid ventricular response. D-Dimer and myocardial enzymes were normal, and the patient's symptoms were getting stable. First, the oral drug Diltiazem 30mg/tab was given then intravenous injection line was established, in the meantime electrocardiogram was continuously monitored. Diltiazem is a calcium ion antagonist that can effectively treat arrhythmias but it may also cause side effects such as bradycardia. The patient was equipped with a heart rhythm regulator to prevent any symptoms of bradycardia. After 3 hours of observation, when patients started feeling normal, he was discharged. Conclusion: Atrial fibrillation is a complicated heart condition, in the absence of ECG report or using improper treatment the condition for heart disease can get worsen. Conventional method cannot determine the seriousness of the heart condition and patient might suffer from ST-elevation myocardial infarction (STEMI) or aortic dissection. Through this case study we understand the process and different stages of patient treatment. With proper equipment and preparations, we can rescue our patient more efficiently.