Dokar Tara, wanda aka fi sani da Wallace's Rule of Nine, kayan aiki ne da aka yi amfani da shi a cikin rauni da kuma maganin gaggawa don tantance yawan yanayin jiki (TBSA) da ke cikin ƙona marasa lafiya.

Yin hulɗa da yanayin gaggawa wanda ya haɗa da yiwuwar ƙonawa mai tsanani yana haifar da wani saurin kima.

Don haka yana da mahimmanci ga mai ceto ya kasance da kayan masarufi na asali waɗanda za su ba shi/ta damar tsara wanda ya kone daidai.

Ƙimar wuri na farko na ƙonawa yana da mahimmanci don ƙididdige buƙatun farfadowa na ruwa tun lokacin da marasa lafiya da ke da ƙonawa mai tsanani za su fuskanci asarar ruwa mai yawa saboda kawar da shingen fata.

Ana amfani da wannan kayan aiki ne kawai don ƙonewa na biyu da na uku (wanda ake magana da shi azaman ɓangaren kauri da ƙonawa cikakke) kuma yana taimaka wa mai badawa a cikin ƙima mai sauri don ƙayyade tsananin da buƙatun ruwa.

Ana iya yin gyare-gyare ga Dokokin tara bisa ga ma'aunin jiki (BMI) da shekaru

Ka'idar Tara ta tabbatar da zama algorithm mafi yawan lokuta da likitoci da ma'aikatan aikin jinya ke karantawa don ƙididdige wuri mai ƙonewa a cikin binciken da yawa.[1][2][3]

Ƙa'idar Ƙimar Tara ta ƙwanƙwasa filin jiki ya dogara ne akan sanya kashi zuwa sassa daban-daban na jiki.

An kiyasta dukkan kai a 9% (4.5% na gaba da baya).

An kiyasta gaba dayan gangar jikin a kashi 36% kuma ana iya kara raba kashi 18% na gaba da kashi 18 na baya.

Za a iya ƙara ɓangaren gaba na gangar jikin zuwa kashi (9%) da ciki (9%).

Na sama duka duka 18% sannan 9% na kowane babba. Ana iya ƙara rarraba kowane ɓangaren babba zuwa gaba (4.5%) da na baya (4.5%).

An kiyasta ƙananan gaɓoɓin a kashi 36%, 18% na kowane ƙananan ƙafafu.

Hakanan za'a iya raba wannan zuwa kashi 9% na gaba da kashi 9% na gaba.

An kiyasta makwancin gwal a 1%.[4][5]

Ayyukan Dokar Tara

Ka'idar Tara tana aiki azaman kayan aiki don tantance ma'aunin yanayin jiki na biyu da na uku (TBSA) a cikin ƙona marasa lafiya.

Da zarar an ƙayyade TBSA kuma an daidaita majiyyaci, farfaɗowar ruwa na iya farawa sau da yawa tare da amfani da dabara.

Ana yawan amfani da dabarar Parkland.

Ana ƙididdige shi azaman 4 ml na ruwa na cikin jini (IV) a kowace kilogiram na madaidaicin nauyin jikin kowane kashi TBSA (an bayyana a matsayin ƙima) sama da awanni 24.

Saboda rahotanni na farfadowa da yawa, an gabatar da wasu hanyoyin kamar tsarin Brooke da aka gyara, wanda ya rage ruwan IV zuwa 2 ml maimakon 4 ml.

Bayan tabbatar da jimlar yawan farfadowa tare da ruwa mai ciki na tsawon sa'o'i 24 na farko, ana gudanar da rabin farko na ƙarar a cikin sa'o'i 8 na farko kuma ana gudanar da sauran rabin a cikin sa'o'i 16 masu zuwa (an canza wannan zuwa sa'a daya ta hanyar rarrabawa. rabin jimlar jimlar 8 da 16).

Lokacin ƙarar sa'o'i 24 yana farawa a lokacin kuna.

Idan mai haƙuri ya gabatar da sa'o'i 2 bayan ƙonawa da farfadowa na ruwa ba a fara ba, ya kamata a gudanar da rabi na farko na ƙarar a cikin sa'o'i 6 tare da sauran rabin ruwan da aka gudanar kamar yadda aka tsara.

Farfaɗowar ruwa yana da matukar mahimmanci a farkon gudanarwa na ƙonawa na biyu da na uku wanda ya ƙunshi fiye da kashi 20 na TBSA kamar yadda rikice-rikice na gazawar koda, myoglobinuria, haemoglobinuria da gazawar gabobin jiki da yawa na iya faruwa idan ba a bi da su da ƙarfi da wuri ba.

An nuna cewa mace-mace ta fi girma a cikin marasa lafiya tare da TBSA yana ƙonewa fiye da 20% waɗanda ba su sami farfadowar ruwa mai dacewa ba nan da nan bayan rauni.[6][7][8].

Akwai damuwa tsakanin likitoci game da daidaiton Dokokin tara don yawan kiba da yawan yara

Za a iya amfani da Dokar Tara mafi kyau ga marasa lafiya masu nauyin fiye da kilo 10 da ƙasa da kilo 80 idan BMI ta ayyana a matsayin ƙasa da kiba.

Ga jarirai da marasa lafiya masu kiba, ya kamata a ba da kulawa ta musamman ga masu zuwa:

Marasa lafiya masu kiba

Marasa lafiya da BMI ta ayyana a matsayin kiba suna da manyan kututtukan da ba daidai ba idan aka kwatanta da takwarorinsu marasa kiba.

Marasa lafiya masu kiba suna da kusan 50% TBSA na gangar jikin, 15% TBSA na kowace kafa, 7% TBSA na kowane hannu da 6% TBSA na kai.

Marasa lafiya masu siffar Android, wanda aka ayyana azaman fifikon rarraba gangar jikin jiki da nama mai adipose na jiki (ciki, kirji, kafadu da wuyansa), sami akwati wanda ya fi kusa da 53% TBSA.

Marasa lafiya da siffar gynoid, wanda aka bayyana a matsayin fifikon rarraba nama na adipose a cikin ƙananan jiki (ƙananan ciki, ƙashin ƙugu da cinya), suna da gangar jikin da ke kusa da 48% TBSA.

Yayin da ƙimar kiba ta ƙaru, ƙimar rashin ƙima na shigar TBSA na gangar jikin da ƙafafu yana ƙaruwa lokacin da ake bin Dokokin tara.

Jariri

Jarirai suna da kawuna masu girma daidai gwargwado waɗanda ke canza gudummawar saman sauran manyan sassan jiki.

Dokar 'Dokar Takwas' ita ce mafi kyau ga jarirai masu nauyin kasa da 10 kg.

Wannan doka ta sanya kusan kashi 32% na TBSA ga gangar jikin majiyyaci, 20% TBSA na kai, 16% TBSA na kowace ƙafa da 8% TBSA ga kowane hannu.

Duk da ingancin Dokar Tara da shiga cikin ƙwararrun likitancin tiyata da gaggawa, bincike ya nuna cewa a 25% TBSA, 30% TBSA da 35% TBSA, yawan TBSA ya wuce kima da 20% idan aka kwatanta da aikace-aikacen kwamfuta.

Yin kima da TBSA da aka kone zai iya haifar da farfadowa da yawa tare da ruwa mai ciki, yana ba da yiwuwar hawan girma da kuma kumburi na huhu tare da karuwar bukatar zuciya.

Marasa lafiya tare da cututtukan da suka rigaya sun kasance suna cikin haɗarin kamuwa da cututtukan zuciya da nakasawar numfashi kuma yakamata a kula da su a cikin sashin kulawa mai zurfi (ICU) a lokacin tashin hankali na farfaɗowar ruwa, zai fi dacewa a cikin cibiyar ƙonewa.[9] [10]

Ka'idar Tara shine kayan aiki mai sauri da sauƙi da aka yi amfani da shi don gudanar da farko na farfadowa a cikin ƙonawa marasa lafiya

Bincike ya gano cewa bayan bincikar majinyacin da ba a yi masa sutura ba, za a iya ƙayyade adadin TBSA ta Dokar Tara a cikin mintuna.

Yawancin bincike da aka samu a cikin nazarin wallafe-wallafen sun bayyana cewa dabino mai haƙuri, ban da yatsunsu, ya kai kimanin kashi 0.5 na TBSA kuma an gano tabbaci tare da aikace-aikacen kwamfuta.

Haɗin yatsu a cikin dabino ya kai kusan 0.8% TBSA.

Yin amfani da dabino, wanda shine tushen da aka kafa Dokar Tara, ana ganin ya fi dacewa don ƙananan ƙananan digiri na biyu da na uku.

An lura cewa yawan horar da ƙwararrun ƙwararru, raguwar ƙima, musamman akan ƙananan ƙonewa.

Sauran matsaloli

Saboda yanayin da ke tattare da kuskure a kimar kunar ɗan adam ko da a tsarin tsarin mulki, ana samar da aikace-aikacen da aka yi amfani da su na kwamfuta don wayoyin hannu don rage ƙima da ƙima na ƙimar TBSA.

Aikace-aikacen suna amfani da daidaitattun masu girma dabam na ƙanana, matsakaici da ƙiba na maza da mata.

Aikace-aikace kuma suna motsawa zuwa ma'aunin jarirai.

Waɗannan aikace-aikacen kwamfuta suna fuskantar sauye-sauye a cikin rahoton ƙimar TBSA na sama da kashi 60 cikin ɗari fiye da kima na saman da ya ƙone har zuwa kashi 70 cikin ɗari.

Farfaɗowar ruwa ta cikin jijiya wanda Dokar Tara ta jagoranta yana aiki ne kawai ga marasa lafiya tare da kashi TBSA sama da 20% kuma ya kamata a kai waɗannan marasa lafiya zuwa cibiyar rauni mafi kusa.

Ban da wurare na musamman, irin su fuska, al'aura da hannaye, waɗanda dole ne ƙwararrun su gani, canja wurin zuwa manyan cibiyoyin raunin rauni ya zama dole kawai don ƙonewa fiye da 20% na TBSA.

Ƙungiyar Ƙwararrun Ƙwararrun Amirka (ABA) ta kuma ƙayyade ma'auni don abin da ya kamata a canza marasa lafiya zuwa cibiyar ƙonewa.

Da zarar an fara farfaɗowar ruwa, yana da mahimmanci a gano ko ana iya yin tari mai dacewa, hydration da aikin koda.

Farfadowa da aka samo daga Dokar tara da dabarar ruwa ta ciki (Parkland, Brooke modified, da sauransu) yakamata a kula da su da kyau kuma a daidaita su kamar yadda waɗannan ƙimar farko jagorori ne.

Gudanar da ƙonawa mai tsanani shine tsarin ruwa wanda ke buƙatar kulawa akai-akai da gyare-gyare.

Rashin kula da dalla-dalla na iya haifar da haɓakar cututtuka da mace-mace kamar yadda waɗannan marasa lafiya ke fama da rashin lafiya.

Dokar Tara, wanda aka fi sani da Wallace's Rule of Nine, kayan aiki ne da masu sana'a na kiwon lafiya ke amfani da su don tantance yawan yanayin jiki (TBSA) da ke cikin ƙona marasa lafiya.

Ma'auni na wuri na farko na ƙonawa ta ƙungiyar kiwon lafiya yana da mahimmanci don kimanta buƙatun farfadowa na ruwa saboda marasa lafiya da ƙonawa mai tsanani suna da asarar ruwa mai yawa saboda kawar da shingen fata.

Ayyukan yana sabunta ƙungiyoyin kiwon lafiya akan amfani da Dokokin tara a cikin waɗanda ke fama da ƙonawa wanda zai haifar da kyakkyawan sakamako ga marasa lafiya. [Mataki na V].

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