Dabarun immobilization na mahaifa da kashin baya: bayyani
Cervical da fasaho na ciki
Sharuɗɗan ATLS (ci gaba da tallafawa rayuwa ta rauni), waɗanda aka haɓaka a cikin 1980s, sun ci gaba da zama ma'aunin zinare don tantancewa da ba da fifikon kula da raunin da ke barazanar rayuwa cikin ma'ana da inganci, kodayake an daɗe ana muhawara mai tsanani game da hanyoyin. na amfani da wannan taimako.
Rashin motsin kashin baya ya kasance muhimmin sashi na koyarwa, ban da masu ɗaure ƙashin ƙashin ƙashin ƙugu da tsagewar ƙashi na dogon lokaci.
Daban-daban na likitanci kayan aiki an ɓullo da su don ba da damar tasiri da sauƙi na aikace-aikace, da kuma ba da damar sassauci da mahimmanci don gudanar da hanyar iska da sauran hanyoyin.
Bukatar rashin motsin kashin baya an ƙaddara ta wurin wuri da kima na haƙuri.
Ka yi la'akari da rashin motsi na kashin baya lokacin da tsarin rauni ya haifar da babban alamar tuhuma ga kai, wuyansa ko raunin kashin baya
Rashin yanayin tunani da raunin jijiya shima alamu ne da ya kamata a yi la’akari da rashin motsin kashin baya.[1][2][3][4]
Koyarwar ATLS ta al'ada don daidaitawar kashin baya na majiyyaci a cikin babban yanayin rauni shine ingantaccen tsari. abin wuya tare da tubalan da tef don tabbatar da kashin mahaifa, da kuma allon baya don kare sauran kashin baya.
The na'urar cirewa Kendrick yana ba da damar kariyar kashin baya tare da wanda ya ji rauni a cikin wurin zama a yayin da ake fitar da sauri daga abin hawa ko a wasu yanayi inda aka iyakance damar yin amfani da cikakken allon baya.
Koyaya, wannan na'urar tana buƙatar ma'aikatan ceto su kula don iyakance motsin kashin mahaifa ta hanyar amfani da haɗakar layi har zuwa taro [5].
Buga na 10 na jagororin ATLS da sanarwar yarjejeniya ta Kwalejin Likitocin Gaggawa ta Amurka (ACEP), Kwamitin Likitocin Likitoci na Amurka akan Cutar (ACS-COT), da Ƙungiyar Likitocin EMS ta ƙasa (NAEMSP) sun bayyana cewa, a cikin yanayin shiga cikin rauni babu wata alama don ƙuntata motsi na kashin baya [6], daidai da binciken da aka yi na baya-bayan nan daga Cibiyar Nazarin Trauma ta Amurka wanda ya nuna ƙananan ƙananan raunin raunin da ya faru na kashin baya da ke buƙatar tiyata a cikin mahallin shiga cikin rauni. Har ila yau, binciken ya nuna cewa adadin marasa lafiya da za a bi da su don samun damar yin amfani da su ya fi yawan adadin marasa lafiya da za a yi amfani da su don samun rauni, 1032/66.
Duk da haka, a cikin yanayin mummunan rauni mara kyau, ana ci gaba da nuna ƙuntatawa a cikin yanayi masu zuwa:
- low GCS ko shaida na barasa da maye
- Tausayin kashin bayan mahaifa na tsakiya ko na baya
- Bayyanar nakasar kashin baya
- Kasancewar sauran raunuka masu karkarwa
Shawarwari don ƙuntatawa mai tasiri yana ci gaba da zama abin wuya na mahaifa tare da cikakken kariyar kashin baya, wanda ya kamata a cire shi da wuri-wuri.
Wannan shi ne saboda haɗarin raunin da ya faru da yawa.
Duk da haka, a cikin yawan yara na yara, haɗarin raunin da yawa yana da ƙananan kuma sabili da haka kawai ka'idodin kashin baya na mahaifa kuma ba a nuna cikakkiyar kariya ta kashin baya ba (sai dai idan alamun ko alamun wasu cututtuka na kashin baya sun kasance).
Imobilization na mahaifa da ƙwanƙwasa mai ƙarfi a cikin majinyacin yara
- Neck zafi
- Canje-canjen ilimin jijiya na hannu ba a bayyana shi ta hanyar raunin hannu ba
- Muscle spasm na wuyansa (torticollis)
- Farashin GCS
- Babban haɗari mai haɗari (misali haɗarin mota mai ƙarfi, rauni mai ƙarfi na wuyansa da babban rauni na sama)
Yankunan damuwa
Akwai tarin shaida da damuwa da wannan filin saduwa ya haifar da wuce gona da iri na hanyoyin kawar da kashin baya da kuma cewa wasu marasa lafiya na iya fuskantar haɗari[7] [8] [9] [10].
Matsaloli masu yuwuwar rashin motsin kashin baya:
- Rashin jin daɗi da wuya ga majiyyaci[11].
- Tsawaita lokacin kafin zuwa asibiti tare da yuwuwar jinkiri na mahimman bincike da jiyya, da kuma tsoma baki tare da wasu ayyukan[11].
- Ƙuntatawar numfashi ta madauri, da kuma mummunan aikin numfashi a cikin matsayi na baya idan aka kwatanta da matsayi na tsaye. Wannan yana da mahimmanci musamman a lokuta na rauni na thoracic, ko mara kyau ko shiga[12][13] Wahala tare da intubation[14].
- Batun marasa lafiya tare da ankylosing spondylitis ko nakasar kashin baya da ta kasance a baya, inda za a iya haifar da cutarwa ta ainihi ta hanyar tilasta majiyyaci ya dace da matsayi da aka ƙayyade na ƙwanƙwasa na mahaifa da allon baya[15].
Wani sabon bita na wallafe-wallafen Scandinavian, wanda aka gudanar don nazarin shaidun da ke samuwa don ƙuntatawa na motsi na kashin baya [16], yana ba da basira mai mahimmanci game da kwatanta hanyoyin kwantar da hankali na prehospital tare da kimanta ƙarfin shaida.
M abin wuya
An yi amfani da ƙwanƙarar ƙaƙƙarfan tun daga tsakiyar 1960s a matsayin hanyar kwantar da hankali na mahaifa, tare da ƙananan shaida na tabbatar da tasiri mai kyau akan sakamakon ciwon daji na ciwon ƙwayar cuta na mahaifa, tare da mummunan sakamako masu tasiri saboda karuwa mai yawa a cikin matsa lamba na intracranial kuma. dysphagia [17].
Har ila yau labarin ya nuna cewa mai faɗakarwa da haɗin gwiwa tare da ƙwayar tsoka da ke haifar da raunin da ya faru ba zai yiwu a sami babban ƙaura ba, kamar yadda aka lura a cikin binciken cadaver wanda ya yi ƙoƙarin yin nazarin sakamakon rauni.
Labarin yana ba da shawarar daidaita haɗari da fa'idodin wannan tiyata.
Duk da haka, ƙungiyar likitocin likitocin neurological na kwastomomi na kwayar cutar sankara a matsayin hanyar inganta kashin mahaifa a cikin yanayin Pre-asibiti [18].
Tsayayyen allo: Yaushe ake amfani da dogon allo na kashin baya?
An yi amfani da dogon allo na asali na kashin baya tare da tsayayyen abin wuya, tubalan da madauri don cimma rashin motsi na kashin baya.
Lalacewa mai yuwuwa, musamman matsi na matsa lamba akan sacrum, [19] [20] yanzu an nuna su, musamman a yanayin raunin kashin baya ba tare da jin kariya ba.
Katifa mai laushi mai laushi yana ba da ƙasa mai laushi wanda ke ba da kariya daga tasirin matsi kuma a lokaci guda yana ba da isasshen tallafi lokacin da aka shimfida sama da matakin kai[16].
tubalan
Tubalan wani ɓangare ne na dabarun tattara layi don daidaita kashin baya kuma suna bayyana suna da tasiri yayin ɗaure mara lafiya zuwa kashin baya. hukumar don cimma wani mataki na rashin motsi, ba tare da ƙarin fa'idar yin amfani da ƙwanƙarar abin wuya a haɗa [21].
Vacuum katifa
Kwatanta katifa mai katifa tare da tsayayyen allo kaɗai, katifar tana ba da ƙarin sarrafawa da ƙarancin motsi yayin aikace-aikace da ɗagawa fiye da ƙaƙƙarfan allo [22].
Yin la'akari da haɗarin matsa lamba, katifa yana da alama yana ba da mafi kyawun zaɓi don jigilar marasa lafiya.
Yantar da kashin baya: daidaitawa na kashin baya da na mahaifa
Ma'auni na NEXUS: faɗakarwa, mutumin da ba ya maye ba tare da raunin da ya faru ba yana da ƙananan yuwuwar raunin rauni a cikin rashin tashin hankali na tsakiya da rashi na jijiyoyi.
Wannan ya bayyana azaman kayan aiki mai mahimmanci tare da azanci na 99% da ƙimar tsinkaya mara kyau na 99.8%[23].
Duk da haka, wasu nazarin binciken sun nuna cewa mai faɗakarwa mai faɗakarwa tare da raunin kashin baya na mahaifa zai yi ƙoƙari ya daidaita kashin baya kuma cewa kasancewar raunuka masu banƙyama (ban da thorax) ba zai shafi sakamakon gwajin gwaji na asibiti na mahaifa ba kuma saboda haka Za a iya share kashin baya a asibiti ba tare da ƙarin hoto ba[24]. Sauran nazarin sun ba da shawarar sakamako iri ɗaya don kashin thoracolumbar [25] [24].
RADIYO Ceto MA'aikata A DUNIYA? ZIYARAR BOTH RADIO EMS A EXPO Gaggawa
Hanyar na asibiti
Ko da yake an riga an yi aikin kashin baya na asibiti tun shekaru da yawa, bayanai na yanzu sun nuna cewa ba duk marasa lafiya ba ne ke buƙatar a daina motsi.
Yanzu Ƙungiyar Ƙwararrun Likitocin Gaggawa ta Ƙasar Amirka da Kwamitin Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru.
Waɗannan ƙa'idodin na baya-bayan nan sun nuna cewa adadin majinyata da za su iya cin gajiyar rashin motsa jiki kaɗan ne
Kwamitin ya ci gaba da bayyana cewa, ya kamata a yi amfani da hankali wajen hana kashin baya a lokacin safara, domin a wasu lokuta hadarin da ke tattare da su ya fi amfaninsu.
Bugu da ƙari kuma, a cikin marasa lafiya waɗanda suka sami rauni mai raɗaɗi kuma ba su da ƙarancin ƙarancin jijiya, ba a ba da shawarar yin amfani da kashin baya ba.
A cikin Amurka dole ne ma'aikacin EMS yayi amfani da ilimin asibiti kafin ya yanke shawarar amfani da allon kashin baya.[26]
A ƙarshe, rashin motsi na kashin baya yana da alaƙa da ciwon baya, ciwon wuyan wuyansa kuma yana da wuya a yi wasu hanyoyin, ciki har da hoto.
An kuma danganta rashin motsin kashin baya da wahalar numfashi, musamman idan aka shafa manyan madauri a kirji.
Kodayake ƙungiyoyin EMS da yawa a cikin Amurka sun karɓi waɗannan sabbin jagororin kan rashin motsi na kashin baya, wannan ba na duniya bane.
Wasu tsarin EMS suna tsoron shari'a idan ba su motsa marasa lafiya ba.
Marasa lafiya waɗanda yakamata a daina motsa su a kashin baya sun haɗa da:
- m rauni
- ciwon kashin baya
- marasa lafiya tare da canjin matakin sani
- raunin jijiya
- bayyanannen nakasar jikin mutum na kashin baya
- Babban ciwo mai tsanani a cikin majiyyaci mai maye da kwayoyi, barasa.
Bayanan Littafi Mai Tsarki
[1] Hostler D,Colburn D,Seitz SR, Kwatanta na'urorin hana motsin mahaifa guda uku. Kulawar gaggawa na asibiti : Jaridar hukuma ta Ƙungiyar Likitocin EMS ta Ƙasa da Ƙungiyar Ƙungiyar Ƙungiyar EMS ta Jiha. 2009 Afrilu-Yuni; [PubMed PMID: 19291567]
[2] Joyce SM,Moser CS, Ƙididdigar sabuwar na'urar hanawa ko cirewar mahaifa. Maganin asibiti da bala'i. 1992 Jan-Mar; [PubMed PMID: 10171177]
[3] McCarroll RE,Beadle BM,Fullen D,Balter PA,Followill DS,Stingo FCYang J, Kotun LE, Maimaita tsarin saitin haƙuri a cikin wurin zama na jiyya: Wani sabon magani kujera zane. Jaridar amfani da ilimin kimiyyar likitanci na asibiti. 2017 Janairu; [PubMed PMID: 28291911]
[4] Lacey CM, Finkelstein M, Thygeson MV, Tasirin sanyawa kan tsoro yayin rigakafi: nama da zaune. Jaridar jinya na yara. 2008 Juni; [PubMed PMID: 18492548]
[5] Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS, Motsin kashin baya na Cervical yayin cirewa. Jaridar maganin gaggawa. 2013 Jan [PubMed PMID: 23079144]
[6] Fischer PE, Perina DG, Delbridge TR, Fallat ME, Salomone JP, Dodd J, Bulger EM, Gestring ML, Ƙuntataccen Motsi na Spinal a cikin Marasa lafiya - Bayanin Matsayin Haɗin gwiwa. Kulawar gaggawa na asibiti : Jaridar hukuma ta Ƙungiyar Likitocin EMS ta Ƙasa da Ƙungiyar Ƙungiyar Ƙungiyar EMS ta Jiha. 2018 Nov-Dec [PubMed PMID: 30091939]
[7] Purvis TA, Carlin B, Driscoll P, Tabbatattun hatsarori da fa'idodin da ake tambaya na rashin motsa jiki kafin asibiti. Mujallar Amirka na maganin gaggawa. 2017 Juni; [PubMed PMID: 28169039]
[8] Lerner EB,Billittier AJ 4th,Moscati RM, Tasirin matsayi na tsaka-tsaki tare da kuma ba tare da padding akan kashin baya na batutuwa masu lafiya ba. Kulawar gaggawa na asibiti : Jaridar hukuma ta Ƙungiyar Likitocin EMS ta Ƙasa da Ƙungiyar Ƙungiyar Ƙungiyar EMS ta Jiha. 1998 Afrilu-Yuni; [PubMed PMID: 9709329]
[9] Hauswald M.Ong G Magungunan gaggawa na ilimi: Jaridar hukuma na Society for Academic Emergency Medicine. 1998 Mar; [PubMed PMID: 9523928]
[10] Haut ER,Kalish BT,Efron DT,Haider AH,Stevens KA,Kieninger AN,Cornwell EE 3rd,Chang DC,Spine immobilization a shiga cikin rauni: mafi cutarwa fiye da kyau? Jaridar rauni. 2010 Janairu; [PubMed PMID: 20065766]
[11] Freauf M, Puckeridge N, ZUWA GUDA KO BA ZUWA BA: HUJJAR HUJJAR CIWON CIWON KAYANCI. JEMS : mujallar sabis na kiwon lafiya na gaggawa. 2015 Nov [PubMed PMID: 26721114]
[12] Kwan I,Bunn F, Tasirin rashin lafiyar kashin baya na asibiti: nazari na yau da kullun na gwajin bazuwar akan batutuwa masu lafiya. Maganin asibiti da bala'i. 2005 Jan-Fabrairu [PubMed PMID: 15748015]
[13] Rasal Carnicer M, Juguera Rodríguez L, Vela de Oro N, García Pérez AB, Pérez Alonso N, Pardo Ríos M, Bambance-bambance a cikin aikin huhu bayan amfani da tsarin cirewa na 2: gwajin gwagwarmayar bazuwar. Gaggawa : revista de la Sociedad Espanola de Medicina de Emergencias. 2018 Abr [PubMed PMID: 29547234]
[14] Nemunaitis G, Roach MJ, Hefzy MS,Mejia M, Sake ƙerawa na allon kashin baya: Tabbacin kimanta ra'ayi. Fasahar Taimako: Mujallar hukuma ta RESNA. 2016 Faduwa [PubMed PMID: 26852872]
[15] Kornhall DK, Jørgensen JJ, Brommeland T, Hyldmo PK, Asbjørnsen H, Dolven T, Hansen T, Jeppesen E Jaridar Scandinavian na rauni, farfadowa da magungunan gaggawa. 2017 Jan 5 [PubMed PMID: 28057029]
[16] Maschmann C, Jeppesen E, Rubin MA, Barfod C, Sabbin ka'idojin asibiti game da daidaitawar kashin baya na marasa lafiya masu rauni - yarjejeniya da tushen shaida. Jaridar Scandinavian na rauni, farfadowa da magungunan gaggawa. 2019 ga Agusta 19 [PubMed PMID: 31426850]
[17] Hood N, Considine J, Spinal immobilisaton a cikin asibiti na farko da kulawar gaggawa: nazari na yau da kullum na wallafe-wallafe. Jaridar jinya ta gaggawa ta Australiya: AENJ. 2015 Agusta [PubMed PMID: 26051883]
[18] Makarantar likitanci da al'ummar da ke kewaye: tattaunawa., Zimmerman HM, Bulletin na New York Academy of Medicine, 1977 Jun [PubMed PMID: 23417176]
[19] Babban PW,Lovell ME, Bita na saman tallafi guda bakwai tare da mai da hankali kan kariyar su na rauni na kashin baya. Jaridar hatsari & maganin gaggawa. 1996 Jan [PubMed PMID: 8821224]
[20]KOSIAK M, Etiology na decubitus ulcers. Taskokin magungunan jiki da gyaran jiki. 1961 Jan [PubMed PMID: 13753341]
[21] Holla M, Ƙimar ƙwanƙwalwar ƙwanƙwasa ban da tubalan kai: hujja na nazarin ƙa'ida. Mujallar maganin gaggawa: EMJ. 2012 Feb [PubMed PMID: 21335583]
[22]Prasarn ML,Hyldmo PK,Zdziarski LA,Loewy E,Dubose D,Horodyski M,Rechtine GR, Kwatankwacin Matsalolin Vacuum tare da Kashin Kashin Kashin Kashin Lafiyar Mara Lafiyar Ciwon Ciki: Nazari na Cadaveric na Biomechanical. Kashin baya. Dec 2017, 15 [PubMed PMID: 28591075]
[23] Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI, Ingancin tsarin ma'auni na asibiti don kawar da rauni ga kashin mahaifa a cikin marasa lafiya tare da rauni mara kyau. Ƙungiyar Nazarin Amfani da Radiyon Gaggawa ta Ƙasa. Jaridar New England Journal of Medicine. 2000 ga Yuli 13 [PubMed PMID: 10891516]
[24] Konstantinidis A.Plurad D,Barmparas G,Inaba K,Lam L,Bukur M,Branco BC,Demetriades D karatu. Jaridar rauni. 2011 Sep [PubMed PMID: 21248650]
[25] Don haka kuna son mallakar ginin haƙoran ku!, Sarner H,, CAL [mujallar] Certified Akers Laboratories, 1977 Apr [PubMed PMID: 26491795]
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