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Rehabilitation after stroke (a)


, Wrist, knuckles stretched on a pillow, hip, knee flexion nature, the level of a comfortable pillow is appropriate. Contralateral limb natural place. This position can be avoided Chinese Community Doctors Yang 4,[link widoczny dla zalogowanych], 2008 (Volume 24 of total 346) 45 lay health education promotion and information Jian extensor cream CHINESECOMMUNITYDOCTORS tense when lying, prevent cramps, but also to respiratory secretions drainage, but the loss of the normal side of the self-activity. ③ the affected side lying: lying ipsilateral to the affected arm should reach, after forearm rotation, the patient's shoulder out, to prevent compression and retraction. Suffering from leg should be placed in a comfortable position, knee flexion forward, placed in front of body support pillow. The advantage of this position is to increase the hemiplegic side of the sensory input, is conducive to the recovery of neurological function, and so unaffected free town, the drawback is not very comfortable. 3 lying above advantages and disadvantages, different situations should be based on the patient chose not to ask the prone position. More importantly, in order to avoid the occurrence of pressure sores should be timely transfer of position. In vital signs were stable and that the case of the airway, should be transferred every 2 to 3 hours 1 position. However, when the following conditions can not be transferred position: ① head bent light appears mydriasis: ② ipsilateral dilated pupils, light reflex; ③ irregular breathing: ④ frequent vomiting; ⑤ frequent convulsions; ⑥ lower blood pressure, systolic blood pressure less than 90himHg: ⑦ bilateral flaccid paralysis: ⑧ tonic seizures Cortical; ⑨ within 1 hour after onset of coma. Passive motion: If a patient asks for too long coma, or other reasons (serious complications) still can not start in a few days after the training initiative to bed, you need to carry out passive range of motion. The sequence of activities by the large joints to the small joints, step by step, should not rude. Passive movement should do the opposite with the spasm of activities, such as shoulder abduction, external rotation,[link widoczny dla zalogowanych], forearm rotation after ankle dorsiflexion, wrist extension activities of finger joints. Occupational Therapy: ① to encourage as scanning, encourage patients to turn his head, scanning the environment to adapt to visual field defects. ② a static splint to keep your hands in the relatively open position, so help to relieve muscle tension, and not let the hand ball or gauze patients, because patients with cerebrovascular disease is often first on the extensor flexor rehabilitation, so will increase the risk of flexion contracture. ③ In the upright position when the hold up with the appropriate method of upper limb, to prevent sagging and shoulder dislocation, you can groove to the forearm with the forearm resting on a pallet in front of wheelchair, you can also hold up the forearm with a sling, but this controversial, some people think that it can neither reduce the incidence of shoulder dislocation, is not conducive to prevent flexion contracture. ④ encourage more use of the injured arm. (Continued from page 44) direct current cardioversion. AF-way wave for the first time 100 ~ 200J,[link widoczny dla zalogowanych], two-way wave 100 d. Pre-excitation syndrome, atrial fibrillation, some or all of the ventricles by the accessory pathway downstream. Heart rate> 200bpm, hemodynamic instability, immediate direct current cardioversion, the energy above; heart rate> 200bpm, hemodynamic stability, the choice of intravenous amiodarone or propafenone. Note: Pre-excitation syndrome, atrial fibrillation disabled cedilanid, verapamil, B receptor antagonist, adenosine and so on. ① bradyarrhythmia asymptomatic sinus bradycardia, heart rate ≥ 45bpm, without treatment. ② once and second degree AV block type I can be observed, to find and correct the cause, generally do not need emergency treatment. ③ Type II second and third degree atrioventricular block, sick sinus syndrome with syncope or cardiogenic shock, should be urgently addressed. Have a clear cause or incentives should be corrected simultaneously. Measures are as follows: a. Intravenous atropine 0.5mg to try, repeated every 3 to 5 minutes 1 second,[link widoczny dla zalogowanych], the total 3mg. b. Timely grant temporary artificial heart pacing. C. Waiting for pacing or pacing fails, consider the infusion of epinephrine (2--10g/min) or the infusion of dopamine 2 ~ 10g / (Kg · min). Emergency procedures shown in Figure 1, Figure 2,[link widoczny dla zalogowanych], Figure 3, Figure 4. Palm hemodynamically stable hemodynamic instability Figure 3 Atrial flutter, atrial fibrillation, 46 Chinese Community Doctors first aid procedures 4, 2008 (Volume 24 of total 346) (critically ill patients dealing with special treatment and operation), the slow rhythm disorders (heart rate <60bt ~ 1) l transfer considerations. Condition improved or improved. Required pacing, electrical cardioversion should be transferred to hospital for treatment as soon as possible. Oxygen, keep the airway open. To maintain intravenous access patency. Patients with a high degree of tension on the absence of contraindications, to give sedatives. Good way center power monitoring (on the ventricular fibrillation may occur by, monitoring the implementation of AED): in vitro arrhythmias were pacing shock. Figure 4 bradyarrhythmia aid procedures
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