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Gobara, shakar hayaki da konewa: manufofin jiyya da jiyya

By Cristiano Antonino On Bari 18, 2023

Gobara dai ita ce babbar sanadin rauni, mutuwa da barnar tattalin arziki. Kowace shekara, tsakanin 15 zuwa 25 miliyan gobara na faruwa a Amurka, wanda ya haifar da raunata kusan 25,000, mutuwar 5,000 da dala biliyan 7 zuwa dala biliyan 9 na tattalin arziki.

Lalacewar da shakar hayaki ta haifar yana haifar da muni mai ban mamaki na yawan mace-mace na masu ƙonawa: a cikin waɗannan lokuta, ana ƙara lalacewar shakar hayaki don ƙonewa, sau da yawa tare da sakamako mai mutuwa.

Wannan labarin ya keɓe don maganin konewa, tare da la'akari da lalacewar huhu da tsarin jiki a cikin ƙona marasa lafiya waɗanda suka sha hayaki, yayin da raunuka na dermatological za a tattauna dalla-dalla a wasu wurare.

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Manufofin kulawa na numfashi a cikin masu ƙonawa shine tabbatarwa

patency airway,
ingantacciyar iska,
isasshen oxygenation,
kula da ma'aunin acid-base,
kula da kwanciyar hankali na zuciya,
gaggawar maganin cututtuka.

A wasu lokuta, yin escharotomy yana da mahimmanci don hana duk wani tabo na thoracic daga hana motsin kirji.

Manufofin maganin kunar fata sun ƙunshi

kawar da fata mara amfani
aikace-aikacen bandages na magani tare da maganin rigakafi,
rufe raunin tare da maye gurbin fata na wucin gadi da dasa fata daga wurare masu lafiya ko samfuran cloned zuwa wurin da aka ƙone,
rage asarar ruwa da haɗarin kamuwa da cuta.

Ya kamata a ba da batun mafi girma fiye da adadin caloric na basal don sauƙaƙe gyaran raunuka da kuma guje wa catapolism.

MUHIMMANCIN KOYARWA A CIKIN Ceto: ZIYARAR KWANA CETO SQUICCIARINI KUMA KA GANO YADDA AKE SHIRYA DON GAGGAWA.

Maganin masu ciwon kuna

Ya kamata a sa ido sosai ga wadanda suka ƙone da ƙananan raunuka na sama, ko tare da alamun toshewar numfashi ko shigar huhu.

Ya kamata a samar da ƙarin iskar oxygen, ta hanyar cannula na hanci, kuma ya kamata a sanya mai haƙuri a cikin babban matsayi na Fowler don rage aikin numfashi.

Ya kamata a bi da bronchospasm tare da β-agonists a cikin aerosol (kamar orciprenaline ko albuterol).

Idan ana tsammanin toshewar hanyar iska, ya kamata a tabbatar da patency tare da cannula na endotracheal wanda ya dace.

Gabaɗaya, ba a ba da shawarar farkon tracheostomy a cikin ƙona marasa lafiya ba, saboda wannan hanya tana da alaƙa da haɓakar kamuwa da cuta da haɓaka mace-mace, kodayake yana iya zama dole don kulawar numfashi na dogon lokaci.

An lura cewa shigar da wuri da wuri zai iya haifar da edema na huhu na wucin gadi a wasu marasa lafiya tare da rauni na numfashi.

Aikace-aikace na ci gaba da matsa lamba mai kyau na 5 ko 10 cm H2O (CPAP) na iya taimakawa rage yawan kumburin huhu da wuri, adana ƙarar huhu, tallafawa hanyoyin iska, inganta yanayin iskar iska da rage mace-mace da wuri.

Gudanar da tsarin corticosteroids don maganin edema ba a ba da shawarar ba saboda yawan haɗarin kamuwa da cuta.

Maganin marasa lafiya ya kamata a ba da umarni ga hypoxia mai tsanani da guba na CO kuma yana dogara ne akan gudanar da iskar oxygen.

Rarrabawa da kawar da carboxyhaemoglobin suna haɓaka ta hanyar sarrafa abubuwan O2.

Abubuwan da suka sha hayaki, amma kawai suna da ɗan ƙaruwa a cikin Hbco (kasa da 30%) kuma suna riƙe da aikin zuciya na yau da kullun, yakamata a bi da su tare da isar da 100% O2, ta hanyar madaidaicin fuska, abin rufe fuska mara numfashi (wanda baya ba da izini) iskar da aka fitar da za a sake shakar da ita), a gudun lita 15/minti, ta cika tafki.

Ya kamata a ci gaba da maganin oxygen har sai matakan Hbco sun faɗi ƙasa da 10%.

Mashin CPAP, tare da 100% O2 gwamnati, na iya zama maganin da ya dace ga marasa lafiya da ke fama da cutar hypoxaemia kuma babu ko kawai rauni mai zafi a fuska da babbar hanyar iska.

Marasa lafiya da hypoxaemia refractory ko inhalation rauni hade da coma ko na zuciya da jijiyoyin jini rashin zaman lafiya na bukatar intubation da numfashi taimako tare da 100% O2 kuma ya kamata a sauri koma ga hyperbaric oxygen far.

Magani na ƙarshe yana haɓaka jigilar iskar oxygen da sauri kuma yana hanzarta aiwatar da cire CO daga jini.

Marasa lafiya waɗanda ke tasowa farkon oedema na huhu, ARDS, ko ciwon huhu sau da yawa yana buƙatar taimako na numfashi tare da matsi na ƙarshe na ƙarshe (PEEP) a gaban hemogasanalysis mai nuna gazawar numfashi (PaO2 da ke ƙasa 60 mmHg, da / ko PaCO2 sama da 50 mmHg, tare da pH a ƙasa 7.25).

Ana nuna PEEP idan PaO2 ya faɗi ƙasa da 60 mmHg kuma buƙatar FiO2 ya wuce 0.60

Dole ne a tsawaita taimako na numfashi sau da yawa, saboda masu ƙonawa gabaɗaya suna da haɓakar haɓakar metabolism, wanda ke sa ya zama dole a ƙara ƙarar numfashi a cikin minti ɗaya don tabbatar da cewa ana kiyaye homeostasis.

The kayan aiki Dole ne a yi amfani da shi ya zama mai iya isar da ƙarar ƙarar / minti (har zuwa lita 50) yayin da yake riƙe da matsananciyar hawan iska (har zuwa 100 cm H2O) da kwanciyar hankali / numfashi (I: E), ko da lokacin da ya zama dole don ƙarawa. darajar matsa lamba.

Hypoxaemia mai jujjuyawa na iya amsa iskar da ta dogara da matsa lamba tare da jujjuyawar rabo

isassun tsaftar huhu ya zama dole don kiyaye hanyoyin iska daga sputum.

Motsa jiki physiotherapy na numfashi yana taimakawa wajen tattara abubuwan ɓoye da hana toshewar iska da kuma atelectasis.

Sabbin fata na baya-bayan nan ba sa jure wa bugun kirji da rawar jiki.

Fibrobronchoscopy na warkewa na iya zama dole don buɗe hanyar iska daga ɓoye mai kauri.

Kula da ma'aunin ruwa a hankali ya zama dole don rage haɗarin girgiza, gazawar koda da kumburin huhu.

Mayar da ma'auni na ruwa na majiyyaci, ta amfani da tsarin Parkland (4 ml isotonic bayani a kowace kg ga kowane kashi na yanki na fata mai ƙonewa, na tsawon sa'o'i 24) da kiyaye diuresis tsakanin 30 zuwa 50 ml / hour da kuma matsa lamba na tsakiya tsakanin 2 da 6 mmHg, yana kiyaye kwanciyar hankali na haemodynamic.

A cikin marasa lafiya tare da raunin numfashi, haɓakawar capillary yana ƙaruwa, kuma saka idanu akan matsa lamba na huhu shine jagora mai amfani ga sake cika ruwa, ban da sarrafa diuresis.

Dole ne a kula da ma'aunin gobara, electrolyte da ma'auni na tushen acid

Halin hypermetabolic na mai ƙonawa yana buƙatar yin nazari a hankali game da ma'aunin abinci mai gina jiki, da nufin guje wa catabolism na ƙwayar tsoka.

An yi amfani da dabarar tsinkaya (kamar na Harris-Benedict da Curreri) don ƙididdige ƙarfin ƙwayar cuta a cikin waɗannan marasa lafiya.

A halin yanzu, ana samun na'urori masu ɗaukar hoto na kasuwanci waɗanda ke ba da izinin ma'aunin calorimetry na kai tsaye, waɗanda aka nuna don samar da ingantattun ƙididdiga na buƙatun abinci mai gina jiki.

Marasa lafiya tare da ƙonawa mai yawa (fiye da 50% na saman fata) galibi ana wajabta abinci waɗanda abincin caloric shine 150% na abincin hutun su don sauƙaƙe raunin rauni da hana catabolism.

Yayin da yake warkar da konewa, ana rage cin abinci mai gina jiki a hankali zuwa 130% na basal metabolism.

A cikin yanayin konewar ƙirji, tabo na iya hana motsi bangon kirji.

Ana yin escharotomy (tsohon fiɗar fata mai ƙonewa) ta hanyar yin ɓangarorin gefe guda biyu tare da layin axillary na baya, farawa santimita biyu a ƙasa da clavicle zuwa sararin intercostal na tara zuwa goma, da wasu incisions guda biyu waɗanda aka shimfiɗa a tsakanin ƙarshen tsohon. don iyakance murabba'i.

Wannan aiki ya kamata ya inganta elasticity na bangon kirji kuma ya hana tasirin matsa lamba na ja da baya.

Jiyya na kuna ya haɗa da cirewar fata maras amfani, aikace-aikacen bandeji da aka yi amfani da su tare da maganin rigakafi, rufe rauni tare da maye gurbin fata na wucin gadi da dasa fata daga wurare masu lafiya ko kuma samfurori na cloned akan wurin da aka ƙone.

Wannan yana rage asarar ruwa da haɗarin kamuwa da cuta.

Kwayoyin cututtuka suna yawanci saboda coagulase-tabbatacce Staphylococcus aureus da gram-korau kwayoyin cuta kamar Klebsiella, Enterobacter, Escherichia coli da Pseudomonas.

Dabarar keɓewa da ta dace, matsa lamba na yanayi da tacewa iska sune ginshiƙan kariya daga kamuwa da cuta.

Zaɓin maganin rigakafi ya dogara ne akan sakamakon jerin al'adun da aka yi akan kayan da aka ɗauka daga rauni, da jini, fitsari da samfurori na sputum.

Kada a gudanar da maganin rigakafi ta hanyar rigakafi a cikin waɗannan marasa lafiya, saboda sauƙi wanda za'a iya zaɓar nau'in nau'i mai juriya, da alhakin cututtuka da ke hana farfadowa.

A cikin mutanen da ba su motsa jiki na tsawon lokaci, prophylaxis na heparin na iya taimakawa wajen rage haɗarin ciwon huhu, kuma ya kamata a ba da kulawa ta musamman don hana ci gaban ciwon daji. matsa lamba.