Neurogenic shock: abin da yake, yadda za a gane shi da kuma yadda za a bi da haƙuri
A cikin damuwa na neurogenic, vasodilation yana faruwa a sakamakon asarar ma'auni tsakanin parasympathetic da tausayi.
Menene Neurogenic Shock?
Neurogenic shock wani nau'in girgiza ne mai rarrabawa.
A cikin damuwa na neurogenic, vasodilation yana faruwa a sakamakon asarar ma'auni tsakanin parasympathetic da tausayi.
Wani nau'i ne na girgiza (wani yanayin likita mai barazana ga rayuwa wanda babu isasshen jini a cikin jiki) wanda ke haifar da asarar sigina kwatsam daga tsarin juyayi mai tausayi wanda ke kula da ƙwayar tsoka na yau da kullum a cikin ganuwar jini.
Mai haƙuri yana fuskantar abubuwan da ke biyo baya wanda ke haifar da girgiza neurogenic:
- Karfafawa. Ƙarfafawa na tausayi yana haifar da ƙwayar tsoka mai santsi don takurawa, kuma motsa jiki na parasympathetic yana haifar da santsin tsoka don shakatawa ko fadada.
- Vasodilation. Mai haƙuri yana jin daɗin motsa jiki mai mahimmanci wanda ke haifar da vasodilation na dindindin na dogon lokaci, yana haifar da yanayin yanayin hypovolemic dangi.
- Hypotension. Ƙarar jini ya isa, saboda vasculature yana fadada; ƙarar jini yana ƙaura, yana haifar da yanayin hypotensive (ƙananan BP).
- Canje-canje na zuciya da jijiyoyin jini. Maɗaukakiyar haɓakar parasympathetic da ke faruwa tare da girgiza neurogenic yana haifar da raguwa mai ƙarfi a cikin juriya na jijiyoyin bugun jini da bradycardia na mai haƙuri.
- Rashin isashshen iska. Rashin isassun BP yana haifar da rashin isasshen zubar da kyallen takarda da sel waɗanda suka zama ruwan dare ga duk jihohin girgiza.
RADIO NA MASU Ceto DUNIYA? ZIYARAR RADIO EMS BOOTH A EXPO Gaggawa
Neurogenic shock zai iya haifar da wadannan:
- Spinal raunin igiya. An gane raunin kashin baya (SCI) don haifar da hypotension da bradycardia (neurogenic shock).
- maganin maganin kashin baya. Maganin ciwon baya - allurar maganin sa barci a cikin sararin samaniya da ke kewaye da kashin baya - ko yanke kashin baya yana haifar da faduwa a cikin karfin jini saboda fadadawar jijiyoyin jini a cikin ƙananan sassan jiki da kuma sakamakon raguwar dawowar venous zuwa. zuciya.
- Depressant mataki na magunguna. Ayyukan ɓacin rai na magunguna da rashin glucose kuma na iya haifar da girgiza neurogenic.
Bayyanar cututtuka na damuwa na neurogenic alamu ne na motsa jiki na parasympathetic
- bushewa, dumin fata. Maimakon sanyi, fata mai laushi, mai haƙuri yana jin bushewa, fata mai dumi saboda vasodilation da rashin iyawa zuwa vasoconstrict.
- Hypotension. Hypotension yana faruwa saboda kwatsam, babban dilation.
- Bradycardia. Maimakon samun tachycardia, mai haƙuri yana samun bradycardia.
- Diaphragmatic numfashi. Idan raunin ya kasance a ƙasa da 5th vertebra na mahaifa, mai haƙuri zai nuna numfashi na diaphragmatic saboda asarar kulawar jijiya na tsokoki na intercostal (wanda ake buƙata don numfashi na thoracic).
- Kamewar numfashi. Idan raunin ya kasance sama da 3rd vertebra na mahaifa, mai haƙuri zai shiga cikin kama numfashi nan da nan bayan raunin da ya faru, saboda asarar kulawar jijiya na diaphragm.
TARBIYYA: ZIYARAR BOOTH NA DMC DINAS CONTSULTANAN LIVE A EXPO GAGGAWA.
Ƙimar da Binciken Bincike
Ana iya gano alamun girgiza neurogenic ta hanyar gwaje-gwaje masu zuwa:
- Na'urar daukar hoto ta kwamfuta (CT). CT scan na iya samar da mafi kyawun kallon rashin daidaituwa da aka gani akan X-ray.
- Xrays. Ma'aikatan lafiya yawanci suna yin odar waɗannan gwaje-gwaje akan mutanen da ake zargin suna da raunin kashin baya bayan rauni.
- Hoto na Magnetic Resonance Hoto (MRI). MRI yana amfani da filin maganadisu mai ƙarfi da raƙuman rediyo don samar da hotuna da aka samar da kwamfuta.
Gudanar da Lafiya
Jiyya na damuwa neurogenic ya haɗa da:
- Maido da sautin tausayi. Zai kasance ko dai ta hanyar daidaitawar raunin kashin baya ko kuma, a cikin misalin maganin sa barci, ta hanyar sanya majiyyaci daidai.
- Rashin hankali. Idan majiyyaci yana da wani abin da ake zargi da cutar ta kashin baya, ana iya buƙatar motsi don daidaita kashin baya don kawo shi daidai.
- Ruwan IV. Ana gudanar da shaye-shaye na IV don daidaita hawan jini na majiyyaci.
Magungunan Magunguna
Magungunan da aka yi wa majiyyaci da ke fama da ciwon neurogenic sune:
- Inotropic jamiái. Ana iya shigar da ma'aikatan inotropic irin su dopamine don farfado da ruwa.
- Atropine. Ana ba da Atropine ta cikin jini don sarrafa bradycardia mai tsanani.
- Steroids. Marasa lafiya tare da ƙarancin ƙarancin jijiya na zahiri ana iya ba da steroids na IV, irin su methylprednisolone a cikin babban kashi, a cikin sa'o'i 8 na farawa na girgiza neurogenic.
- Heparin. Gudanar da heparin ko ƙananan ƙwayoyin heparin kamar yadda aka tsara na iya hana samuwar thrombus.
Gudanar da aikin jinya na majiyyaci tare da girgiza neurogenic ya haɗa da:
Ƙimar jinya
Ƙimar majiyyaci tare da girgiza neurogenic ya kamata ya ƙunshi:
- ABC kima. Mai ba da asibiti ya kamata ya bi hanyar iska ta asali, numfashi, tsarin wurare dabam dabam ga mai rauni yayin da yake kare kashin baya daga duk wani motsi.
- Kiwon Lafiyar Jiki. Ya kamata a gano gazawar neurologic da babban matakin da aka fara rashin daidaituwa.
Maganin jinya
Dangane da bayanan kima, binciken jinya ga mai haƙuri tare da girgiza neurogenic sune:
- Haɗari don ƙarancin yanayin numfashi mai alaƙa da lahani na innervation na diaphragm (launi a ko sama da C-5).
- Haɗari don rauni mai alaƙa da rauni na ɗan lokaci / rashin kwanciyar hankali na kashin baya.
- Rashin motsin jiki da ke da alaƙa da raunin neuromuscular.
- Hankali mai ruɗani da ke da alaƙa da lalata hanyoyin jijiyoyi tare da canza liyafar azanci, watsawa, da haɗin kai.
- Mummunan ciwo mai alaƙa da haɗuwar jini na biyu zuwa samuwar thrombus.
Tsare-tsaren Kula da Ma'aikatan Jiyya & Maƙasudai
Manyan manufofin majiyyaci sun hada da:
- Kula da isassun iska kamar yadda aka tabbatar ta rashin matsalar numfashi da ABGs a cikin iyakoki masu karbuwa
- Nuna halayen da suka dace don tallafawa ƙoƙarin numfashi.
- Kula da daidaitaccen daidaitawar kashin baya ba tare da ƙarin lalacewar kashin baya ba.
- Kula da matsayi na aiki kamar yadda shaida ta rashin kwangila, saukar ƙafa.
- Ƙarfafa ƙarfin sassan jikin da ba a shafa/ ramawa ba.
- Nuna dabaru/halayen da ke ba da damar sake dawowa aiki.
- Gane nakasar azanci.
- Gano halaye don rama gaira.
- Fahimtar sanin buƙatun azanci da yuwuwar rashi/yawanci.
Ma'aikatan jinya
- Ayyukan jinya ana jagorantar su zuwa tallafawa aikin zuciya da jijiyoyin jini da aikin jijiya har sai abin da ya faru na wucin gadi na girgiza neurogenic ya warware.
- Daukaka kan gado. Hawan kai yana taimakawa hana yaduwar maganin sa barci sama da kashin baya lokacin da majiyyaci ya karɓi maganin saƙar kashin baya ko epidural.
- Ƙarƙashin Ƙarfafawa. Yin amfani da safa na anti-embolism da ɗaga ƙafar gado na iya taimakawa rage haɗuwar jini a ƙafafu da hana samuwar thrombus.
- Motsa jiki. Kewayon motsin motsi na ɓangarorin marasa motsi yana taimakawa haɓaka wurare dabam dabam.
- Jirgin iska. Riƙe hanyar iska ta haƙƙin mallaka: kiyaye kai a cikin tsaka tsaki, ɗaga kan gado kaɗan idan an jure, yi amfani da haɗin kan hanyar iska kamar yadda aka nuna.
- Oxygen Gudanar da iskar oxygen ta hanyar da ta dace (hanyoyin hanci, abin rufe fuska, intubation, injin iska).
- Ayyuka. Shirya ayyukan don samar da lokutan hutu mara yankewa da ƙarfafa shiga cikin haƙuri da iyawar mutum.
- Kulawar BP. Auna da saka idanu BP kafin da kuma bayan aiki a cikin matakai masu tsanani ko har sai barga.
- Rage damuwa. Taimakawa majiyyaci don ganewa da rama don sauye-sauye a cikin abin mamaki.
MASU TSIRA, HUKUNCI, KUJERAR KAURI: SPENCER KAYAN AKAN BOOTH BIYU A EXPO na Gaggawa
Evaluation
Sakamakon majiyyatan da ake tsammanin su ne:
- Kula da isassun iska.
- An nuna halayen da suka dace don tallafawa ƙoƙarin numfashi.
- Kula da daidaitaccen daidaitawar kashin baya ba tare da ƙarin lalacewar kashin baya ba.
- Matsayin da aka kiyaye.
- Ƙarfafa ƙarfin sassan jikin da ba ya shafa/ ramawa.
- Dabaru/dabi'un da aka nuna waɗanda ke ba da damar sake dawowa aiki.
- Gane nakasar azanci.
- Halayen da aka gano don rama gaira.
- Fahimtar faɗakarwa game da buƙatun azanci da yuwuwar rashi/yawanci.
Jagororin Rubutun
Abubuwan da aka fi mayar da hankali kan takaddun sune:
- Tarihin matsala mai dacewa.
- Tsarin numfashi, sautunan numfashi, amfani da tsokoki masu haɗi.
- Ƙimar dakin gwaje-gwaje.
- Tarihin baya da na baya-bayan nan na raunin da ya faru, sanin bukatun aminci.
- Amfani da aminci kayan aiki ko hanyoyin.
- Damuwar muhalli, batutuwan tsaro.
- Matsayin aiki, ikon shiga takamaiman ko ayyukan da ake so.
- Bayanin abokin ciniki game da amsawa ga ciwo, ƙayyadaddun ƙayyadaddun ƙididdiga na ciwo, tsammanin kulawa da ciwo, da kuma yarda da jin zafi.
- Kafin amfani da magani.
- Shirin kulawa, ƙayyadaddun shiga tsakani, da wanda ke da hannu a cikin shirin.
- Shirin koyarwa.
- Martani ga shiga tsakani, koyarwa, ayyukan da aka yi, da tsarin kulawa.
- Samun ko ci gaba zuwa sakamakon da ake so.
- Canje-canje ga tsarin kulawa.
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