Canjin Matsayin Gaggawa na Hankali (ALOC): menene abin yi?

By Cristiano Antonino On Jan 18, 2023

Canjin matakin sani (ALOC) shine gaggawa ta bakwai mafi yawan gama gari waɗanda kwararrun EMS ke amsawa, suna lissafin kusan 7% na duk kiran EMS.

Canjin matakin sani (ALOC) yana nufin cewa ba ku da farke, faɗakarwa, ko iya fahimta kamar yadda kuka saba. ALOC na iya haifar da rauni a kai, magunguna, barasa, kwayoyi, bushewa, har ma da wasu cututtuka, irin su ciwon sukari.

Daban-daban matakan ALOC sun haɗa da:

Rikici: Kuna da sauƙin shagala kuma kuna iya jinkirin amsawa. Wataƙila ba za ku san ko wanene ko inda kuke ba ko lokacin rana ko shekara ba.

delirium: kina da rudani mai tsanani da tawaya kuma kuna iya samun rudu (imani da abubuwan da ba na gaske ba) ko hasashe (hankalin abubuwan da ba na gaske ba). Matsayin rudani na iya yin kyau ko muni cikin lokaci.

Barci: kana barci sai dai in wani ko wani abu ya tashe ka. Yawancin lokaci kuna iya magana da bin kwatance, amma kuna iya samun matsala kasancewa a faɗake.

Ƙunƙara ko kasala: kun gaji kuma ba ku da masaniya ko rashin sha'awar kewayen ku.

Mai ƙarfi: kana cikin barci mai zurfi sai dai idan wani abu mai ƙarfi ko mai zafi ya tashe ka. Wataƙila ba za ku iya yin magana ko bin kwatance da kyau ba, kuma za ku sake yin barci idan aka bar ku kaɗai.

Koma: kuna barci, amma ba za a iya tada ku kwata-kwata.

Stupor da coma ana ƙididdige su gwargwadon girman girman alamun.

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Canza Matsayin Ma'anar Hankali

Matsayin hankali shine ma'auni na jin daɗin mutum ga abubuwan motsa jiki daga muhalli.

Canjin matakin wayewa shine kowane ma'auni na tashin hankali ko kuzari banda al'ada.

Za a iya rarraba matakin faɗakarwa mai sauƙi a matsayin rashin hankali, yanayin da mutum zai iya tashi da ɗan wahala.

Mutanen da aka toshe suna da ƙarancin hankali kuma ba za a iya tashe su gabaɗaya ba.

Waɗanda ba za a iya tada su daga yanayin barci ba, an ce sun yi wauta.

Coma shine rashin iya yin kowane amsa mai ma'ana.

Sikeli irin su Glasgow coma ma'auni an tsara su don auna matakin sani.

ALOC na iya haifar da abubuwa daban-daban, gami da canje-canje a cikin sinadarai na kwakwalwa (misali, fallasa guba ko abubuwan maye), rashin isashshen iskar oxygen ko kwararar jini a cikin kwakwalwa, ko matsananciyar matsananciyar kwakwalwa.

Tsawon rashin sani alama ce ta gaggawar likita.

Rauni a cikin matakin sani na iya nufin cewa an ji rauni a cikin kwakwalwar kwakwalwa ko tsarin kunnawa.

Ragewar matakin sani yana da alaƙa da haɓakar cututtuka (cututtuka) da mace-mace (mutuwa). ALOC wani ma'auni ne mai mahimmanci na yanayin lafiyar majiyyaci da jijiyoyi.

Wasu likitoci suna ɗaukar matakin wayewa a matsayin ɗaya daga cikin mahimman alamun, tare da zafin jiki, hawan jini, da bugun zuciya.

Canjin matakin sani na iya ɗaukar nau'i da yawa.

Gabaɗaya, alamun ALOC sun haɗa da lokacin da majiyyaci ba ya aiki kamar tushen su, da alama rikicewa da rashin fahimta, ko kuma baya yin aiki akai-akai.

Majiyyaci na iya gabatarwa tare da raunin hankali kuma yana iya zama mai rauni, m, ko suma.

Mai yiwuwa majiyyacin ya yi magana da kansu ko kuma yana hallata.

Hakanan majiyyaci na iya zama kamar mai faɗakarwa, tashin hankali, ruɗe, ko rashin fahimta.

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Dalilan ALOC

Ana iya haifar da ALOC ta hanyoyi masu zuwa:

type	misalan
Mai cutar	• Namoniya • Ciwon fitsari • Cutar sankarau ko ciwon hauka • Sepsis
Metabolic/mai guba	• Hypoglycemia • Ciwon barasa • Rashin al'ada na lantarki • ciwon hanta • Cututtukan thyroid • Cire barasa ko ƙwayoyi
Kwayoyin cuta	• bugun jini ko harin ischemic na wucin gadi • Kamewa ko yanayin baya • Subarachnoid hemorrhage • zubar jini na ciki • Tsararrun tsarin juyayi na tsakiya • Subdural hematoma
Ciwon zuciya	• Rashin ciwon zuciya • Ciwon zuciya • kumburin huhu • Hypoxia ko CO2 narcosis
Abubuwan da ke da alaƙa da ƙwayoyi	• Magungunan Anticholinergic • Cire barasa ko ƙwayoyi • Magungunan kwantar da hankali-hypnotics • Narcotic analgesics • Wurin sayar da magunguna

Lokacin Kira Lambar Gaggawa don ALOC

A cewar Kwalejin Likitocin Gaggawa na Amurka, ALOC ko canje-canje a yanayin tunani alamun gargaɗi ne na gaggawar likita, kuma ya kamata ku kira Lambar Gaggawa.

Kira Lambar Gaggawa idan kuna fuskantar ALOC kuma kuna kaɗai.

Kada ku tuƙi kanku zuwa asibiti idan kuna fama da ciwon ƙirji mai tsanani ko zubar jini mai tsanani ko kuma idan hangen nesa ya yi rauni.

Shan wani motar asibiti ya fi aminci saboda masu aikin jinya na iya ba da kulawar ceton rai akan hanyar zuwa asibiti.

Idan wani ya nuna alamun ALOC ko yanayin tunani, kira lambar gaggawa nan take.

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Yadda Ake Magance ALOC

Duk abubuwan da ke faruwa na ALOC suna buƙatar lura sosai, musamman a cikin sa'o'i 24 na farko.

Marasa lafiya ALOC za su buƙaci asibiti don kulawa, gwaji, da magani.

Lokacin kimanta majiyyaci don canjin yanayin tunani, yana da mahimmanci a tattara yawancin tarihin majiyyaci gwargwadon yuwuwa kuma a yi cikakken gwajin jiki daga kai zuwa ƙafa.

Tun da sau da yawa marasa lafiya ba za su iya ba da tarihin su ba saboda yanayin da suka canza, ya kamata a sami rikodin daga wani dangi ko wurin likita don sanin matsayin tunaninsu na asali.

Ya kamata ku sake duba tarihin magani na majiyyaci a cikin rikodin likitancin lantarki (EMR) ko kiran kantin magani.

Za a kula da marasa lafiya na ALOC akai-akai kuma a duba su akai-akai don alamun masu zuwa:

Yawan bugun zuciya, hawan jini, da zazzabi
Matsayin oxygen na jini
Ƙarfi, kewayon motsi, da ikon jin zafi

Gwajin ALOC na iya haɗawa da:

Gwajin jini don bincika sukarin jini, matakin iskar oxygen, rashin ruwa, cututtuka, magunguna, ko barasa
Jini, fitsari, da sauran gwaje-gwaje don lura da aikin gabobin daban-daban
Binciken Neurologic don bincika ƙarfi, jin daɗi, daidaito, reflexes, da ƙwaƙwalwa
Hoton hoto na kwamfuta (CT) don bincika raunin kwakwalwa ko cututtuka na kwakwalwa
Hoto na maganadisu na maganadisu (MRI) don bincika raunin kwakwalwa ko cututtuka na kwakwalwa
X-ray na kirji don bincika matsalolin huhu

Jiyya ga ALOC ya dogara da sanadin sa, alamu, lafiyar majiyyaci gabaɗaya, da duk wani rikitarwa. Marasa lafiya ALOC na iya tsammanin:

An saka catheter IV a cikin jijiya a hannunsu ko hannu
Bututun iskar oxygen da aka sanya a ƙarƙashin hancinsu ko abin rufe fuska da aka sanya a fuskarsu
Magungunan magani don: a) Magance ko hana kamuwa da cuta b) Rage kumburi a ciki da wajen kwakwalwa da kashin baya igiya c) Sarrafa matakin sukarin jini

Ta yaya za ku iya taimaka wa wani tare da ALOC?

Masu ba da lafiya za su buƙaci sanin tarihin lafiyar majinyacin ALOC.

Idan majiyyaci ba zai iya ba da wannan bayanin ba, ya kamata ma'aikacin da aka sani ya kasance a hannu.

Faɗa wa ƙungiyar kiwon lafiya kowane ɗayan waɗannan sharuɗɗan:

Kamawa ko girgizawar jiki
Jini daga kunnuwa ko hanci
Maganar zance
Matsala tare da motsin tsoka, kamar haɗiye, motsin hannu da ƙafafu
Dizziness
Rikici
Canji a cikin hangen nesa, kamar hangen nesa biyu, hangen nesa, ko matsalar ganin ido ɗaya ko duka biyu
Ƙaruwa
Madaba
Matsalar kasancewa a faɗake ko faɗakarwa
Vomiting
Ciwon kai wanda ba zai tafi ba bayan magani
Gajiya
Rashin daidaituwa ko daidaitawa
Rashin ƙwaƙwalwar ajiya
Halin da ba a saba gani ba

Yadda EMTs & Ma'aikatan Lafiya ke Kula da ALOC

Ga duk abubuwan gaggawa na asibiti, mataki na farko shine ƙima mai sauri da tsari na mai haƙuri.

Don wannan ƙima, yawancin masu samar da EMS za su yi amfani da A B C D E kusanci.

Hanyar ABCDE (Hanyar Jirgin Sama, Numfashi, Zagayawa, Nakasa, Bayyanawa) yana da amfani a cikin duk abubuwan gaggawa na asibiti don kimantawa da magani nan da nan. Ana iya amfani dashi a titi tare da ko ba tare da wani ba kayan aiki.

Hakanan za'a iya amfani dashi a cikin sigar ci gaba inda ake samun sabis na likita na gaggawa, gami da dakunan gaggawa, asibitoci, ko rukunin kulawa mai zurfi.

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Jagororin Jiyya & Albarkatun Masu Amsa Na Farko na Likita

Za'a iya samun jagororin jiyya don canjin matakin sani akan shafi na 66 na Tsarin Ka'idodin Clinical EMS na Ƙasa ta Ƙungiyar Ƙungiyar Jami'an EMT ta Jiha (NASEMSO).

NASEMSO tana kiyaye waɗannan jagororin don sauƙaƙe jagororin tsarin EMS na jaha da na gida, ƙa'idodi, da hanyoyin aiki.

Waɗannan jagororin ko dai tushen shaida ne ko tushen yarjejeniya kuma an tsara su don amfani da kwararrun EMS.

Sharuɗɗan sun haɗa da jiyya da sa baki masu zuwa:

Nemo abubuwan da za a iya magance su na canjin yanayin tunani:

Hanyar Jirgin Sama - Tabbatar cewa hanyar iska ta kasance ta haƙƙin mallaka; mayar da majiyyaci kamar yadda ake bukata
Numfashi - Nemo bakin ciki na numfashi; duba SPO2, ETCO2, da kuma karatun masu gano CO
Zagayawa - Nemo alamun girgiza
Glasgow Coma Score da/ko AVPU
Yara
Neck rigidity ko zafi tare da kewayon motsi
Kayan aikin bugun jini
Matsayin glucose na jini
EKG - Arrhythmia yana iyakance perfusion
Warin numfashi - Mahimman abubuwan ban mamaki sun haɗa da barasa, acidosis, ammonia
Kirji/Cikin Ciki - Kayan aiki na ciki-thoracic, na'urori masu taimakawa, ciwon ciki ko damuwa
Extremities/fata - Alamomin waƙa, hydration, edema, dialysis shunt, zafin jiki don taɓawa (ko idan zai yiwu, yi amfani da ma'aunin zafi da sanyio)
Muhalli - Binciken kwaya, kayan aiki, zafin yanayi

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EMS Protocol don Gaggawa na ALOC

Sharuɗɗa don maganin kafin asibiti na matakin wayewar da aka canza sun bambanta ta mai bada EMS kuma suna iya dogara da alamun mara lafiya ko tarihin likita.

Yi la'akari da halin da ake ciki don yiwuwar haɗari ko ainihin haɗari. Idan wurin/yanayin ba shi da aminci, koma baya zuwa wuri mai aminci, ƙirƙirar yanki mai aminci, kuma sami ƙarin taimako daga hukumar 'yan sanda. Dole ne a ɗaukan majinyatan da ke damun zuciya cewa suna da ƙwaƙƙwaran likita ko yanayin rauni wanda ke haifar da canjin yanayin tunani. Dole ne a ɗauki duk wani barazanar kashe kansa ko tashin hankali ko motsi da mahimmanci. Ya kamata waɗannan marasa lafiya su kasance a hannun 'yan sanda idan sun haifar da haɗari ga kansu ko wasu. Idan mai haƙuri ya haifar da haɗari ga kansu da/ko wasu, kira 'yan sanda don taimako.

2) Yin kima na farko. Tabbatar cewa hanyar iska ta majiyyaci a buɗe take kuma numfashi da zagayawa sun isa. tsotsa kamar yadda ya cancanta.

3) Sarrafa babban taro oxygen. A cikin yara, an fi son oxygen humidified.

4) Sami da yin rikodin mahimman alamun majiyyaci, gami da tantance matakin sanin mara lafiya. Yi ƙima da saka idanu kan Sikelin Coma na Glasgow.

Idan mai haƙuri ba shi da amsa ko amsa kawai ga abubuwan motsa jiki masu raɗaɗi, shirya don sufuri yayin ci gaba da kulawa.
Idan mai haƙuri yana da sanannen tarihin ciwon sukari da aka sarrafa ta hanyar magani, yana da hankali, zai iya sha ba tare da taimako ba, yana ba da maganin glucose na baki, ruwan 'ya'yan itace, ko soda mara abinci da baki, sannan jigilar kaya, kiyaye mai haƙuri dumi. Idan an amince da yanki don samun matakan glucose na jini ta amfani da glucometer, bi ƙa'idar da aka amince da yankin ku.
Idan majiyyaci yana da abin da ake zargi da wuce gona da iri na opioid:

a) Idan majiyyaci bai amsa maganganun maganganu ba, amma ko dai ya amsa raɗaɗi mai raɗaɗi ko kuma ba shi da amsa; kuma

b) Numfashi kasa da 10/minti da alamun gazawar numfashi ko kama numfashi, koma ga ka'idar numfashi da ta dace.

c) Idan an yarda da shi a yanki kuma akwai, sami matakin glucose na jini na majiyyaci (BG).

Idan BG bai wuce 60 ba, a cikin manya da marasa lafiya na yara, bi IV a sama.
Idan BG ya fi 60 a cikin manya da marasa lafiya na yara, ci gaba zuwa mataki na gaba.

d) Gudanar da naloxone (Narcan®) ta na'urar atomizer na mucosal (MAD).

Abubuwan da ke da alaƙa:

Kamewar zuciya
Ayyukan kamawa yayin wannan lamarin
Shaida na raunin hanci, toshewar hanci da/ko epistaxis

Saka MAD a cikin hancin hagu na majiyyaci kuma don:

BABBAR: allura 1mg/1ml
LARABA: allura 0.5mg/05ml

Saka MAD a cikin hancin dama na majiyyaci kuma don:

BABBAR: allura 1mg/1ml
LARABA: allura 0.5mg/05ml

e) Fara sufuri. Bayan minti 5, idan yawan numfashi na majiyyaci bai fi numfashi 10 / minti ba, ba da kashi na biyu na naloxone bin hanya ɗaya kamar na sama kuma tuntuɓi kulawar likita.

f) Idan rashin lafiya ko yanayin rauni da ke haifar da canjin yanayin tunani bai bayyana ba, mai haƙuri yana da cikakkiyar masaniya, faɗakarwa, kuma yana iya sadarwa; kuma ana zargin tashin hankali, ci gaba zuwa ka'idar Halayyar Gaggawa.

g) Yi jigilar kaya zuwa wurin da ya dace mafi kusa yayin da ake sake kimanta mahimman alamun kowane minti 5 da sake tantancewa idan ya cancanta.

h) Yi rikodin duk bayanan kula da majiyyaci, gami da tarihin likitancin majiyyaci da duk jiyya da aka bayar, akan Rahoton Kula da Asibiti (PCR).