{"id":11385531,"date":"2010-10-15T00:00:00","date_gmt":"2010-10-14T22:00:00","guid":{"rendered":"https:\/\/alertdiver.eu\/uncategorized-cs_cz\/chemicka-vyroba-kysliku-vyhodnoceni-teto-moznosti\/"},"modified":"2010-10-15T00:00:00","modified_gmt":"2010-10-14T22:00:00","slug":"chemicka-vyroba-kysliku-vyhodnoceni-teto-moznosti","status":"publish","type":"post","link":"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/chemicka-vyroba-kysliku-vyhodnoceni-teto-moznosti\/","title":{"rendered":"CHEMICK\u00c1 V\u00ddROBA KYSL\u00cdKU: VYHODNOCEN\u00cd T\u00c9TO MO\u017dNOSTI"},"content":{"rendered":"

Kysl\u00edk je z\u00e1kladn\u00edm prost\u0159edkem prvn\u00ed pomoci pro zvl\u00e1dnut\u00ed dekompresn\u00ed nemoci po pot\u00e1p\u011bn\u00ed se stla\u010den\u00fdm plynem.1 Zaji\u0161t\u011bn\u00ed jeho dostate\u010dn\u00fdch dod\u00e1vek v odlehl\u00fdch lokalit\u00e1ch m\u016f\u017ee b\u00fdt problematick\u00e9 vzhledem k z\u00e1kazu p\u0159epravy tlakov\u00fdch lahv\u00ed v b\u011b\u017en\u00fdch letadlech a kv\u016fli obt\u00ed\u017e\u00edm i vysok\u00fdm n\u00e1klad\u016fm p\u0159i jejich doprav\u011b pozemn\u00ed.<\/p>\n

Alternativn\u00edm \u0159e\u0161en\u00edm ke zdroj\u016fm stla\u010den\u00fdch plyn\u016f jsou, mimo jin\u00e9, kysl\u00edkov\u00e9 koncentr\u00e1tory a chemick\u00e1 za\u0159\u00edzen\u00ed na v\u00fdrobu (uvol\u0148ov\u00e1n\u00ed) kysl\u00edku.
Kysl\u00edkov\u00e9 koncentr\u00e1tory jsou z\u00e1visl\u00e9 na elektrick\u00e9 energii – ze s\u00edt\u011b nebo z baterie. Chemick\u00e9 uvol\u0148ov\u00e1n\u00ed kysl\u00edku nevy\u017eaduje \u017e\u00e1dnou energii z vn\u011bj\u0161ku. O syst\u00e9mu na chemick\u00e9 uvol\u0148ov\u00e1n\u00ed kysl\u00edku jsme psali ji\u017e d\u0159\u00edve, ten v\u0161ak nezaji\u0161\u0165oval dostate\u010dn\u00fd objem dod\u00e1vek pro vyu\u017eit\u00ed p\u0159\u00edmo v ter\u00e9nu.2 Tento \u010dl\u00e1nek je zam\u011b\u0159en na vyhodnocen\u00ed nov\u011bj\u0161\u00edho za\u0159\u00edzen\u00ed pro chemick\u00e9 uvol\u0148ov\u00e1n\u00ed kysl\u00edku. Podrobn\u011bj\u0161\u00ed informace na toto t\u00e9ma jsou k dispozici v ji\u017e zve\u0159ejn\u011bn\u00e9 zpr\u00e1v\u011b.<\/p>\n

Popis syst\u00e9mu a z\u00e1kladn\u00ed provoz <\/strong>
Za\u0159\u00edzen\u00ed emOx pro v\u00fdrobu kysl\u00edku pro nal\u00e9hav\u00e9 (emergency) p\u0159\u00edpady je p\u0159enosn\u00fd netlakov\u00fd p\u0159\u00edstroj vyvinut\u00fd a vyr\u00e1b\u011bn\u00fd spole\u010dnost\u00ed Green Dot Systems, Inc. (Ji\u017en\u00ed Afrika). Tato jednotka se nab\u00edz\u00ed na trhu jako za\u0159\u00edzen\u00ed vhodn\u00e9 pro pou\u017eit\u00ed p\u0159i prvn\u00ed pomoci do doby, ne\u017e se posti\u017een\u00e9 osob\u011b dostane profesion\u00e1ln\u00ed zdravotn\u00ed pomoci. V reklam\u011b se zd\u016fraz\u0148uj\u00ed n\u00e1sleduj\u00edc\u00ed v\u00fdhody: neexistence tlakov\u00e9 n\u00e1doby, vysok\u00e1 \u010distota dod\u00e1van\u00e9ho kysl\u00edku, pr\u016fb\u011b\u017en\u00e1 v\u00fdroba kysl\u00edku a\u017e do \u00fapln\u00e9ho vy\u010derp\u00e1n\u00ed reaguj\u00edc\u00edch slo\u017eek a dlouhodob\u00e1 skladovatelnost zm\u00edn\u011bn\u00fdch reaguj\u00edc\u00edch slo\u017eek. <\/p>\n

V\u00fdkonnost a \u00fa\u010dinnost syst\u00e9mu emOx jsme hodnotili v laboratorn\u00edch podm\u00ednk\u00e1ch. P\u0159\u00edstroj emOx se podob\u00e1 asi 40 cm vysok\u00e9 termosce o pr\u016fm\u011bru 13 cm. (Obr. 1<\/a>). Pru\u017en\u00e1 p\u0159\u00edvodn\u00ed hadice vych\u00e1z\u00ed z horn\u00ed \u010d\u00e1sti za\u0159\u00edzen\u00ed a vede do jednoduch\u00e9 masky pro pacienta. Jednor\u00e1zov\u00e9 d\u00e1vky (bal\u00ed\u010dky) obsahuj\u00edc\u00ed dv\u011b chemik\u00e1lie se sm\u00edchaj\u00ed s vodou ve velk\u00e9 komo\u0159e a jednotliv\u00e9 sou\u010d\u00e1sti se sestav\u00ed dohromady. Za\u010dne prob\u00edhat chcemick\u00e1 reakce, p\u0159i kter\u00e9 se uvol\u0148uje teplo a kysl\u00edk. Kysl\u00edk proud\u00ed tak dlouho, dokud jsou vid\u011bt bubliny pr\u016fhledn\u00fdm uz\u00e1v\u011brem. Jinou variantou balen\u00ed reaguj\u00edc\u00edch slo\u017eek jsou v\u00edcen\u00e1sobn\u00e9 bal\u00ed\u010dky pro opakovan\u00e9 pou\u017eit\u00ed.<\/p>\n

Metody<\/strong>
Provedli jsme celkem sedm test\u016f (ne na lidech) za stabiln\u00edch a standardn\u00edch laboratorn\u00edch podm\u00ednek. P\u0159\u00edstroj jsme pou\u017eili p\u0159esn\u011b podle n\u00e1vodu od v\u00fdrobce. Jednoduchou obli\u010dejovou masku nahradilo monitorovac\u00ed za\u0159\u00edzen\u00ed pro m\u011b\u0159en\u00ed v\u00fdkonu.
M\u011b\u0159en\u00ed prob\u00edhala b\u011bhem v\u0161ech f\u00e1z\u00ed testu a pro ka\u017ed\u00fd dal\u0161\u00ed test se provedla aktivace za\u0159\u00edzen\u00ed stejn\u00fdm zp\u016fsobem znovu od za\u010d\u00e1tku. V\u00fdsledky testu se zachycovaly a ukl\u00e1daly syst\u00e9mem po\u010d\u00edta\u010dov\u00e9ho z\u00edsk\u00e1v\u00e1n\u00ed a zpracov\u00e1v\u00e1n\u00ed dat. Pr\u016fb\u011b\u017en\u011b se m\u011b\u0159il tok plynu a ka\u017ed\u00fdch 60 vte\u0159in se vypo\u010d\u00edt\u00e1vala jeho pr\u016fm\u011brn\u00e1 hodnota, dokud tok neklesl a\u017e na nulu. <\/p>\n

Z \u00fadaj\u016f o pr\u016fm\u011brn\u00fdch pr\u016ftoc\u00edch nam\u011b\u0159en\u00fdch v jednominutov\u00fdch odstupech se vypo\u010detl celkov\u00fd objem vyroben\u00e9ho plynu. Na vn\u011bj\u0161\u00ed st\u011bn\u011b reak\u010dn\u00ed komory se m\u011b\u0159ila teplota. Z proudu plynu se v poloze p\u0159ibli\u017en\u011b u pacientovy masky odeb\u00edraly vzorky pro zji\u0161\u0165ov\u00e1n\u00ed teploty a vlhkosti dod\u00e1van\u00e9ho plynu. Z\u00edskan\u00e9 hodnoty se uv\u00e1d\u011bly jako st\u0159edn\u00ed ± standardn\u00ed odchylka s mezn\u00edmi hodnotami uveden\u00fdmi v z\u00e1vork\u00e1ch.<\/p>\n

V\u00fdsledky<\/strong>
Celkov\u00e1 v\u00e1ha za\u0159\u00edzen\u00ed s jednou n\u00e1pln\u00ed reaguj\u00edc\u00edch slo\u017eek (v\u010detn\u011b vody) \u010dinila 2,65 kg. Ka\u017ed\u00e1 dal\u0161\u00ed n\u00e1pl\u0148 reaguj\u00edc\u00edch slo\u017eek znamenala p\u0159ibli\u017en\u011b 0,9 kg. Pr\u016fm\u011brn\u00e1 rychlost pr\u016ftoku (m\u011b\u0159en\u00e1 k posledn\u00edmu minutov\u00e9mu pr\u016fm\u011bru p\u0159ed kone\u010dnou nulou) byla 1,75±1,58 (0,05-6,75) L•min-1<\/sup> <\/font>(za okoln\u00ed teploty a tlaku p\u0159i saturaci vodn\u00ed parou = vyj\u00e1d\u0159eno zkratkou ATPS) (Obr. 2). Kysl\u00edk se uvol\u0148oval 23±6 (18-35) minut. \u010cas pot\u0159ebn\u00fd k p\u0159ekro\u010den\u00ed rychlosti pr\u016ftoku byl 2,0 L•min-1<\/sup> byl 15,7±6,4 (11-29) minut.
Rychlost pr\u016ftoku z\u016fstala nad 2,0 L•min-1<\/sup> <\/font>ATPS pouze po dobu 6,4±1,0 (5-8) minut (p\u0159echodn\u011b dosahuj\u00edc\u00ed a\u017e 5,93±0,56 (5.23-6.75) L•min-1<\/sup> <\/font>ATPS, ne\u017e rychle klesala a\u017e na nulu). Celkov\u00fd zisk kysl\u00edku byl 40,4±2,6 (37.7-44.4) litr\u016f.
Teplota vn\u011bj\u0161\u00ed st\u011bny reak\u010dn\u00ed n\u00e1doby dosahovala 54,7±7,4 (46,4-64,9) ºC. Teplota plynu nam\u011b\u0159en\u00e1 v poloze p\u0159ibli\u017en\u011b u pacientovy masky se v kter\u00e9koliv f\u00e1zi reak\u010dn\u00edho cyklu jen velmi m\u00e1lo li\u0161ila od okoln\u00ed teploty.<\/p>\n

Diskuse<\/strong>
Syst\u00e9my dod\u00e1vaj\u00edc\u00ed kysl\u00edk pro prvn\u00ed pomoc mus\u00ed b\u00fdt spolehliv\u00e9, snadno ovladateln\u00e9, snadno p\u0159epravovateln\u00e9 a mus\u00ed poskytovat dod\u00e1vky dostate\u010dn\u00e9ho objemu plynu o pr\u016ftokov\u00e9 rychlosti odpov\u00eddaj\u00edc\u00ed podm\u00ednk\u00e1m z\u00e1chrana\u0159sk\u00e9ho z\u00e1sahu.
Nomin\u00e1ln\u00ed pr\u016ftokov\u00e9 rychlosti doporu\u010dovan\u00e9 pro l\u00e9\u010dbu (z\u00e1sah) pomoci kontinu\u00e1ln\u00edch pr\u016ftokov\u00fdch syst\u00e9m\u016f se pohybuj\u00ed v rozsahu 10-15 L•min-1<\/sup>.
Rychle dostupn\u00e9, ale rozsahem omezen\u00e9 dod\u00e1vky kysl\u00edku, se mohou hodit pro n\u011bkter\u00e9 m\u011bstsk\u00e9 nebo p\u0159\u00edm\u011bstsk\u00e9 oblasti, kde lze pom\u011brn\u011b brzy zajistit profesion\u00e1ln\u00ed zdravotn\u00ed z\u00e1chranou slu\u017ebu. Vzd\u00e1len\u00e9 lokality nebo situace, kde se nelze spolehnout na brzkou zdravotn\u00ed z\u00e1chranou slu\u017ebu, v\u0161ak vy\u017eaduj\u00ed v\u011bt\u0161\u00ed zdroje kysl\u00edku. <\/p>\n

Spol\u00e9h\u00e1n\u00ed se na tradi\u010dn\u00ed tlakov\u00e9 zdroje kysl\u00edku mohou p\u016fsobit pot\u00ed\u017ee kv\u016fli doprav\u011b. Koncepce chemick\u00e9 v\u00fdroby kysl\u00edku je zaj\u00edmav\u00e1 i p\u0159ita\u017eliv\u00e1, nebo\u0165 p\u0159i n\u00ed nen\u00ed zapot\u0159eb\u00ed tlakov\u00fdch n\u00e1dob, ani energetick\u00fdch zdroj\u016f. Stabiln\u00ed a bezpe\u010dn\u00e9 reaguj\u00edc\u00ed slo\u017eky dok\u00e1\u017e\u00ed vyrobit velmi \u010dist\u00fd kysl\u00edk. Jedin\u00fdmi probl\u00e9my zde z\u016fst\u00e1vaj\u00ed omezen\u00e1 pr\u016ftokov\u00e1 rychlost kysl\u00edku a jeho celkov\u00fd vyroben\u00fd objem.
P\u0159enosn\u00fd netlakov\u00fd syst\u00e9m emOx na v\u00fdrobu kysl\u00edku je kompaktn\u00ed, pevn\u00fd a snadno pou\u017eiteln\u00fd p\u0159\u00edstroj, pokud jsou k dispozici v\u0161echny t\u0159i reaguj\u00edc\u00ed slo\u017eky. Celkov\u00fd objem vyroben\u00e9ho kysl\u00edku z jedn\u00e9 d\u00e1vky reaguj\u00edc\u00edch slo\u017eek je v\u0161ak velmi omezen\u00fd – p\u0159ibli\u017en\u011b 10% ve srovn\u00e1n\u00ed s jednou kysl\u00edkovou lahv\u00ed velikosti “D”. <\/p>\n

Tato velice omezen\u00e1 kapacita by byla pravd\u011bpodobn\u011b nedosta\u010duj\u00edc\u00ed p\u0159i v\u011bt\u0161in\u011b zdravotn\u00edch z\u00e1sah\u016f. Nav\u00edc pomal\u00fd a nepravideln\u011b se zrychluj\u00edc\u00ed pr\u016fb\u011bh v\u00fdroby kysl\u00edku (navzdory pe\u010dliv\u011b dodr\u017een\u00e9mu postupu p\u0159i aktivaci) vyvol\u00e1v\u00e1 pochyby o mo\u017enosti \u00fa\u010dinn\u00e9ho a rychl\u00e9ho pou\u017eit\u00ed tohoto za\u0159\u00edzen\u00ed p\u0159ed p\u0159\u00edjezdem zdravotn\u00ed z\u00e1chrann\u00e9 slu\u017eby. A kone\u010dn\u011b – \u010das str\u00e1ven\u00fd aktivac\u00ed a obsluhou tohoto p\u0159\u00edstroje a nev\u011bnovan\u00fd dal\u0161\u00edm pot\u0159eb\u00e1m pacienta neodpov\u00edd\u00e1 omezen\u00fdm v\u00fdhod\u00e1m, kter\u00e9 m\u016f\u017ee toto za\u0159\u00edzen\u00ed nab\u00eddnout.
Na z\u00e1v\u011br je t\u0159eba je\u0161t\u011b dodat, \u017ee dod\u00e1van\u00fd plyn nebyl oh\u0159\u00e1t\u00fd dostata\u010dn\u011b vysoko nad okoln\u00ed teplotu – v rozporu s prohl\u00e1\u0161en\u00edm od v\u00fdrobce. Navzdory velmi vysok\u00fdm teplot\u00e1m v reak\u010dn\u00ed komo\u0159e, doprava standardn\u00ed trubic\u00ed t\u00e9m\u011b\u0159 vyrovnala teplotu dopravovan\u00e9ho plynu s teplotou okoln\u00ed. T\u00edm se vylu\u010duje jak\u00e1koliv mo\u017enost\/v\u00fdhoda l\u00e9\u010dby pomoci oh\u0159\u00e1t\u00e9ho plynu.<\/p>\n

Z\u00e1v\u011bry<\/strong>
Roz\u0161\u00ed\u0159en\u00ed mo\u017enost\u00ed \u00fa\u010dinn\u00fdch dod\u00e1vek kysl\u00edku pro prvn\u00ed pomoc jako alternativn\u00edho \u0159e\u0161en\u00ed oproti dod\u00e1vk\u00e1m z tlakov\u00fdch zdroj\u016f je velmi \u017e\u00e1douc\u00ed. Na\u0161e testy syst\u00e9mu emOx bohu\u017eel prok\u00e1zaly velice omezenou pr\u016fm\u011brnou pr\u016ftokovou rychlost kysl\u00edku, velmi omezen\u00fd celkov\u00fd objem jeho v\u00fdroby a tak\u00e9 nepravideln\u00fd \u010dasov\u00fd pr\u016fb\u011bh jeho uvol\u0148ov\u00e1n\u00ed. Na z\u00e1klad\u011b dosa\u017een\u00fdch v\u00fdsledk\u016f jsme dosp\u011bli k z\u00e1v\u011bru, \u017ee p\u0159\u00edstroj emOx nen\u00ed adekv\u00e1tn\u00edm zdrojem kysl\u00edku pot\u0159ebn\u00e9ho p\u0159i prvn\u00ed pomoci. Na\u0161e zku\u0161enosti n\u00e1s p\u0159im\u011bly konstatovat, \u017ee praktick\u00e9 v\u00fdhody kysl\u00edku vyroben\u00e9ho chemickou reakc\u00ed z pr\u00e1\u0161kov\u00fdch reaguj\u00edc\u00edch slo\u017eek mohou b\u00fdt p\u0159i z\u00e1saz\u00edch prvn\u00ed pomoci pouze margin\u00e1ln\u00ed povahy. Domn\u00edv\u00e1me se, \u017ee dal\u0161\u00ed snahy nahradit zdroje stla\u010den\u00e9ho plynu by m\u011bly v\u011bt\u0161\u00ed nad\u011bji na \u00fasp\u011bch, pokud by se zam\u011b\u0159ovaly na zdokonalov\u00e1n\u00ed technologie kysl\u00edkov\u00e9ho koncentr\u00e1toru<\/p>\n

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Fig. 1<\/a><\/td>\nFig. 2<\/a><\/td>\n<\/tr>\n
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O autorovi<\/strong>
 <\/p>\n

Neal W. Pollock, Ph.D., je \u0159editelem v\u00fdzkumu u DAN a dlouholet\u00fdm \u010dlenem v\u00fdzkumn\u00e9ho t\u00fdmu ve St\u0159edisku pro hyperbarickou medic\u00ednu a environment\u00e1ln\u00ed fyziologii Zdravotn\u00edho centra Univerzity Duke ve m\u011bst\u011b Durham ve st\u00e1t\u011b Severn\u00ed Karol\u00edna.<\/p>\n","protected":false},"excerpt":{"rendered":"

Kysl\u00edk je z\u00e1kladn\u00edm prost\u0159edkem prvn\u00ed pomoci pro zvl\u00e1dnut\u00ed dekompresn\u00ed nemoci po pot\u00e1p\u011bn\u00ed se stla\u010den\u00fdm plynem.1 Zaji\u0161t\u011bn\u00ed jeho dostate\u010dn\u00fdch dod\u00e1vek v odlehl\u00fdch lokalit\u00e1ch m\u016f\u017ee b\u00fdt problematick\u00e9…<\/p>\n","protected":false},"author":1,"featured_media":11373851,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[384],"tags":[],"authors":[1521],"class_list":["post-11385531","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-clanky","authors-neal-pollock-ph-d-cs_cz"],"acf":[],"yoast_head":"\nCHEMICK\u00c1 V\u00ddROBA KYSL\u00cdKU: VYHODNOCEN\u00cd T\u00c9TO MO\u017dNOSTI - Alert Diver<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/alertdiver.eu\/cs_CZ\/clanky\/chemicka-vyroba-kysliku-vyhodnoceni-teto-moznosti\/\" \/>\n<meta property=\"og:locale\" content=\"cs_CZ\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CHEMICK\u00c1 V\u00ddROBA KYSL\u00cdKU: VYHODNOCEN\u00cd T\u00c9TO MO\u017dNOSTI - 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