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Jagora Mai Sauri da Datti don Ciwon Ƙirji

By Cristiano Antonino On Sep 14, 2022

Raunin ƙirji ne ke da alhakin kashi 25% na duk mace-mace masu rauni kowace shekara. Yana da mahimmanci ga duk masu samar da EMS su kasance masu shakka da kuma faɗakarwa lokacin da suka fuskanci mai ciwon kirji.

Raunin Kirji

Raunin ƙirji yana haifar da rauni mai ƙarfi, rauni mai shiga ko duka biyun.

Ana yawan ganin su a:

Hadarin mota
Faɗuwa daga tsayin daka mai yawa (yawanci> 15' a tsaye)
Raunin fashewa (duka na farko da na sakandare)
Muhimman bugun kirji
Raunin datse kirji
Raunin harbin bindiga (GSW)
Raunin wuka/cillawa

Raunin thoracic daban-daban, rauni / rauni, wanda aka rarraba ta wurin sa hannu:

Raunin kwarangwal (Haƙarƙari, Clavicles, Sternum)
Raunin huhu (Trachea, Bronchi, Lungs)
Zuciya/Babban Jirgin ruwa (Myocardium, Aorta, Tasoshin Huhu)

Yana da mahimmanci ga mutum ya sami caja na thoracic mara kyau don samun isasshiyar iskar iska.

Raunin thoracic mara kyau wanda ke haifar da rashin isasshen iska zai iya haifar da hypoxia da hypercarbia da sauri.

Acidosis da gazawar numfashi za su biyo baya idan ba a fara aiwatar da ayyukan gaggawa cikin sauri ba.

Raunukan bangon ƙirji da ba su da ƙarfi sun haɗa da karyewar haƙarƙari daga haƙarƙari ɗaya zuwa ƙirji mai ƙwanƙwasa, da kuma karaya.

Ciwon ƙirji kuma yana iya haifar da hypoxia tare da hypocarbia kamar yadda matsi masu ban sha'awa suka ɓace.

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Game da ciwon ƙirji: Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙwara

Karayar haƙarƙari ita ce mafi yawan raunin ƙirji.

Ko da yake yana da zafi sosai ga majiyyaci, matsala tare da raunin haƙarƙari ba yawanci raguwa ba ne, amma tare da yiwuwar rauni na ciki wanda ke tare da raguwa; kamar:

Pneumothorax
Hemothorax
Raunin zuciya
Lacerations na hanta
Lacerations na splin

Karyewar haƙarƙari 3 na farko ba a saba gani ba; sun fi guntu, ƙanƙara, kuma ana kiyaye su ta clavicle, scapula, da tsokoki na bangon kirji na sama.

Kasancewar raunin haƙarƙari biyu ko fiye a kowane mataki a kan kejin thoracic yana da alaƙa da mafi girma na raunin ciki.

Haƙarƙari 4-9 sune mafi yawan haƙarƙari da suka ji rauni saboda an fallasa su kuma ba su da motsi.

Wadannan haƙarƙari suna haɗe zuwa sternum a gaba da kuma kashin baya a baya.

Haƙarƙari 9-11 fx. suna da alaƙa da babban haɗari na rauni na ciki-ciki, musamman raunin hanta da ƙwayar cuta.

Karyawar jijiyoyi da kuma rabuwar costochondral (rabuwar sternum daga haƙarƙari) galibi ana haifar da su ta hanyar rauni mai ƙarfi na gaba.

Saboda wurin wurin zuciya kai tsaye a baya zuwa sternum, matsalolin zuciya irin su tashin hankali na zuciya na iya faruwa tare da karaya ko ƙaura.

Lura: Yana da wahala a gare mu mu fahimci wurin amma, fasinja da aka hana ya fi fasinja mara takura ya sami karaya.

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Falon Kirji

Kirji mai laushi yana faruwa lokacin da haƙarƙari 3 ko fiye suka karye a wurare biyu ko fiye, suna ƙirƙirar ɓangaren bangon ƙirji mai motsi kyauta zuwa sauran ƙirjin.

Za a iya kasancewa sassan ɓarna a gaba, a baya ko a baya.

Ƙwaƙwalwar ƙwanƙwasa na iya haifar da rauni mai ƙarfi na gaba wanda ke lalata sternum daga duk hakarkarin (rabuwar costochondral).

Ƙirjin flail yana shafar numfashi ta hanyoyi 3:

Ayyukan numfashi yana ƙaruwa ta hanyar asarar mutuncin bangon kirji da sakamakon motsi na ɓangaren flail.
Ana raguwar ƙarar tidal ta hanyar juzu'in motsi na ɓangaren flail yana matsawa huhu a gefen da abin ya shafa yayin wahayi. Hakanan yana haifar da rashin son / rashin iya ɗaukar numfashi mai zurfi saboda zafin da ake samu lokacin da sashin flail ya motsa.
Raunin huhu yana tsoma baki tare da numfashi wanda ke haifar da atelectasis da rashin kyawun musayar iskar gas a cikin membrane na alveolar-capillary.

Wadannan abubuwan suna ba da gudummawar haɓaka isasshiyar numfashi da hypoxia.

Raunin huhu

Bugu da ƙari ga bangon ƙirji maras kyau, tsarin tsarin huhu mai aiki da aiki kuma ana buƙatar tabbatar da isasshen iska.

Raunin huhu na yau da kullun sun haɗa da:

Cutar huhu
Sauƙaƙan pneumothorax bude/rufe
Tashin hankali pneumothorax
Hemothorax
Cutar asphyxia mai rauni.

Pneumothorax yana faruwa ne lokacin da iska ta taru a sararin samaniya tsakanin huhu da ciki na bangon kirji.

Yana da rikitarwa na yau da kullun na rauni mara ƙarfi da shiga cikin ƙirji wanda ke wucewa ta cikin parietal da visceral pleura.

Pneumothoraxes an rarraba su kamar:

Sauƙaƙe pneumothorax
Bude pneumothorax
Tashin hankali pneumothorax
Sauƙaƙe Pneumothorax

Sauƙaƙan pneumothorax yana faruwa lokacin da rami a cikin visceral pleura ya ba da damar iska ta tsere daga huhu kuma ta tattara a cikin sararin samaniya.

Mafi sau da yawa pneumothorax yana faruwa lokacin da haƙarƙarin da ya karye ya lakanci pleura.

Yana iya faruwa ba tare da karaya ba lokacin da aka isar da mummunan rauni a cikakkiyar wahayi tare da rufe glottis (riƙe numfashinka).

Wannan yana haifar da karuwa mai ban mamaki a cikin matsa lamba na intra-alveolar kuma fashewar alveolar yana faruwa. Wanda aka fi sani da, ciwo na jakar takarda.

Jiyya: sau da yawa marasa lafiya za su iya kula da nasu hanyar iska da kuma yin iska sosai.

A irin waɗannan lokuta, ba da iskar oxygen ta hanyar NRB @ 12-15 lpm (SpO2 na akalla 94%). Sanya majiyyaci akan na'urar lura da zuciya kuma kafa damar IV.

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Saka idanu EtCO2 idan zai yiwu kuma ya hana kashin baya idan an sami garanti. Marasa lafiya da wuya su buƙaci BVM ko intubation.

Bude Pneumothorax

Buɗaɗɗen pneumothorax yana faruwa lokacin da rami (wanda ya fi girma fiye da nickel) a bangon ƙirji da pleura yana ba da damar iska ta tattara a cikin sararin samaniya.

Iska na iya motsawa da fita daga cikin ramin da ke bangon kirji tare da ilhama, wanda zai haifar da rauni a kirji.

Jiyya : Rufe shigar da ke tare da buɗaɗɗen pneumothorax tare da suturar da ba ta dace ba da aka nannade ta gefe uku.

Wannan yadda ya kamata ya haifar da bawul ɗin hanya ɗaya wanda zai hana iska daga shiga cikin ƙirji ta hanyar shiga yayin wahayi, duk da haka ba da damar iska ta tsere yayin fitar numfashi, hana haɓakar pneumothorax tashin hankali.

Akwai lokutan da suturar ɓoye ba za ta yi aiki da kyau ba, kuma iska za ta taru a cikin thorax.

Idan an yi amfani da suturar ɓoye kuma alamun da alamun tashin hankali pneumothorax sun haɓaka, ɗaga kusurwar suturar don ba da damar ƙirji ya yanke.

Shortan bidiyo mai zuwa yana nuna ingantaccen maganin raunin ƙirjin tsotsa.

Tashin hankali Pneumothorax

Tension pnuemo ta gaggawa ce ta gaskiya; yana faruwa lokacin da rami a cikin huhu yana aiki azaman bawul ɗin hanya ɗaya, yana barin iska ta shiga cikin thorax tare da wahayi amma, iska ba zata iya tserewa tare da numfashi ba.

Tare da kowane numfashi, matsa lamba a cikin rami na kirji yana ƙaruwa, yana ƙara lalata huhu.

Yayin da matsin lamba ya ci gaba da karuwa, ana tura mediastinum zuwa gefen da ba a shafa ba.

Wannan motsi yana sa vena cava yayi kink, yana rage dawowar venous.

Wannan yana haifar da sarkar ɗaukar nauyi mai nauyi, raguwar ƙarar bugun jini, raguwar fitarwar zuciya kuma, a ƙarshe, rage hawan jini.

Daga ƙarshe zai fara tsoma baki tare da faɗaɗa huhu a gefe guda zuwa rauni, yana rage ƙarar ruwa a cikin huhu mai lafiya.

Matsanancin girgiza da hypoxia sune sakamakon tashin hankali pneumothorax.

Idan pneumothorax tashin hankali ya yi muni, motsi na tsakiya zai faru.

Tachycardia da hypotension za su yi zurfi, sa'an nan kuma rage matakin sani.

Sautunan huhu za su ragu a gefen da ba a shafa ba, kuma JVD zai faru ne sakamakon raguwar dawowar venous zuwa zuciya a cikin rashin hypovolemia concomitant.

Ragewar tracheal, idan EMS ya lura da shi kwata-kwata, alama ce ta marigayi kuma tana faruwa ƙasa kaɗan a cikin wuyansa.

Cyanosis mai lalacewa, rashin sani kuma a ƙarshe mutuwa zai faru.

Jiyya: jiyya don tashin hankali pneumothorax shine raguwar allura, fasaha yawanci samuwa ga masu samar da ALS kawai.

BLS ya kamata masu samarwa su ba da PPV ga waɗannan marasa lafiya yayin da suke tafiya da sauri zuwa sashin gaggawa ko sake komawa tare da sashin ALS.

Yi lalatawar allura lokacin da ake zargin pneumothorax tashin hankali, kafin kowane magani (A tuntuɓi MCP).

Tsari: Ana shigar da catheter 2-3"14 g a cikin sarari na biyu ko na uku a cikin layin tsakiyar clavicular kusa da saman haƙarƙarin.

Yana da mahimmanci a yi amfani da allura mai tsayi mai tsayi.

Bayan shigar da allura a cikin sararin sararin samaniya, saurin iska yana fita ta cikin allura, ɓacin rai na thorax, da sauri da sauri na gyaran jijiyar zuciya na rashin tausayi na pneumothorax.

Ana barin catheter a wurin, yawanci tare da bawul ɗin flutter don ƙyale iska ta tsere daga thorax amma ba don sake shiga ba.

Ana samun kayan aikin allurar thoracostomy na kasuwanci daga masana'antun da yawa, ko kuma ana iya yin kit da su. kayan aiki yawanci ana samuwa akan wani motar asibiti.

Tension Pneumothorax Jiyya Prehospital

Hemothorax

Hemothorax yana faruwa lokacin da jini ya taru a cikin rami na pleural.

Zai iya faruwa tare da raunin ƙirji a fili da mai shiga.

Zubar da jini daga rauni ga parenchyma na huhu shine mafi yawan abin da ke haifar da hemothorax, amma zubar da jini daga irin wannan raunin yakan zama mai iyakancewa saboda yanayin da ke tattare da jini, yawan adadin thromboplastin (protein na jini wanda ke taimakawa wajen coagulation). ) kasancewa a cikin huhu, da ƙananan bugun jini na huhu, duk waɗannan suna taimakawa don sauƙaƙe samuwar jini da kuma dakatar da zubar jini.

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Babban raunin da ya faru ga parenchyma na huhu da arteries da/ko veins na iya zubar da jini da yawa (fiye da lita 1) kuma ya haifar da girgiza hypovolemic.

Zubar da jini daga jijiya intercostal da aka ji rauni na iya zama mai tsanani, yana rassan kai tsaye daga aorta kuma yana ƙarƙashin matsin lamba.

Tara jini yana motsawa kuma yana rushe huhu, yana rage yawan ruwa da kuma lalata iska, yana haifar da hypoxia.

Idan an ba da izinin ci gaba, rikice-rikicen da ba a saba ba da ake kira hemothorax na tashin hankali zai iya tasowa wanda zai gabatar da irin wannan zuwa pneumothorax tashin hankali.

Mai haƙuri tare da hemothorax zai gabatar da wahalar numfashi, raguwa ko rashi sautunan huhu a gefen da abin ya shafa, da kuma kirjin da ba shi da kullun don bugawa. Bugu da ƙari, alamun girgiza za su kasance, ciki har da tachycardia; tachypnea; sanyi, kodadde, fata diaphoretic; da hypotension.

Jiyya: Gudanar da hemothorax yana farawa tare da oxygenation da damar IV tare da kula da zubar da jini na waje.

Bada izinin hawan jini mai ƙyalli, saboda maye gurbin ƙarar ruwa mai ƙarfi zai iya tsoma ragowar jini da abubuwan da ke damun sa, duka biyun suna iya tsoma baki tare da yunƙurin jiki na samuwar gudan jini, sarrafa zubar jini da hemostasis.

Cutar Asphyxia

Ciwon asphyxia mai rauni yana faruwa ne lokacin da ƙarfin murkushe ƙirji kwatsam kuma ya haifar da jujjuyawar jini daga gefen dama na zuciya ta mafi girman vena cava zuwa cikin manyan jijiyoyi na wuya da kai.

Jarabawar asibiti na mai haƙuri tare da asphyxia mai rauni zai bayyana cyanosis na sama-extremity, zubar da jini na yanki na biyu, edema, fuska mai haske, da harshe mai kumbura.

Rashin kwararar jini na kwakwalwa na iya haifar da gazawar neurologic, canza yanayin tunani, canjin matakin sani ko kamawa.

Jiyya: Maganin asphyxia na gaba da asibiti yana da tallafi musamman.

Duk da bayyanar ban mamaki, yanayin kansa sau da yawa yana da kyau idan babu raunin intrathoracic ko na ciki.

Samar da kashin baya immobilization idan tsarin rauni ya nuna yiwuwar yiwuwar kashin baya ko raunin igiya, kuma ba da iskar oxygen idan ana zargin raunin intrathoracic ko hypoxia.

Fara ayyukan ALS kamar O2, IV, lura da zuciya da farfaɗowar ƙarar ruwa idan alamun girgiza sun kasance.

Raunin zuciya a cikin ciwon kirji

Raunin da ke tattare da sassan intrathoracic na tsarin zuciya da jijiyoyin jini sau da yawa yana da mummunar lalacewa kuma nan da nan yana haifar da barazanar rayuwa.

Raunuka na yau da kullun sun haɗa da tamponade na pericardial, raunin zuciya mara kyau, da rauni mara kyau.

Tamponade na Pericardial

A pericardial tamponade shine tarin jini a cikin pericardium, wanda ke haifar da matsewar zuciya, rashin cikar zuciya da rage fitar da zuciya.

M pericardial tamponade ya fi zama ruwan dare a cikin marasa lafiya masu shiga cikin rauni ga ƙirji da na sama na ciki, kuma ba a cika haɗuwa da rauni mai ƙarfi ba.

Yana faruwa sau da yawa tare da raunukan wuka fiye da raunin harbin bindiga.

Bayan raunin shiga na farko, pericardium ya rufe ramin. Ci gaba da zubar jini daga myocardium da aka ji rauni ya cika sarari na pericardial.

Pericardium yana da ƙarancin ƙarancin ƙarfi, kuma gabatarwar ko da ƙananan ƙananan (60-100 ml) na jini akan ɗan gajeren lokaci zai haifar da tamponade.

Ƙarar matsa lamba a cikin pericardium ana watsa shi zuwa zuciya, matsawa ta da kuma hana isasshen cikawar ventricular yayin diastole.

Wannan kuma yana rage ɗaukar nauyi, ƙarar bugun jini da fitarwar zuciya.

Rashin hawan jini mai tsanani yana faruwa da sauri.

Sakamakon matsawar zuciya shine ƙara yawan matsa lamba na diastolic.

Ƙunƙarar bugun bugun jini zai haɓaka yayin da matsa lamba na systolic ya faɗi tare da raguwar fitarwar zuciya amma matsa lamba diastolic ya kasance mai girma saboda matsawar zuciya.

JVD na iya haɓaka na biyu zuwa raguwar dawowar jijiyoyi zuwa gefen dama na zuciya.

Baya ga raguwar fitarwar zuciya, tamponade na zuciya yana rage bugun zuciya ta hanyar matsewar jijiyoyin jini, yana rage wadatar iskar oxygen ta zuciya.

Abubuwan da aka gano na al'ada da ke da alaƙa da tamponade na zuciya sun haɗa da hauhawar jini, JVD da sautunan zuciya da aka ruɗe, alamomin uku da aka sani tare da Beck's triad.

Wannan triad yana da wuyar ganewa a cikin yanayin asibiti, saboda yawan sautin zuciya na iya tabbatar da wahala a cikin motar asibiti mai hayaniya.

Yayin da tamponade ke tasowa, hypotension da tachycardia za su kasance, kamar yadda za a rage matsa lamba na bugun jini da yiwuwar pulsus paradoxus (digo a cikin karfin jini na systolic fiye da 10 mmHg yayin wahayi).

Jiyya: Gudanar da cibiyoyin tamponade na pericardial akan kulawar iska, iskar oxygen, da goyan bayan samun iska da wurare dabam dabam.

Alamu da alamun tamponade na pericardial na iya kwaikwayi na pneumothorax tashin hankali, kodayake kasancewar sautunan huhu na biyu na iya kawar da na ƙarshe.

Marasa lafiya waɗanda ke da hauhawar jini, saurin haɓaka ƙarar girma tare da crystalloid isotonic zai haɓaka matsi na venous, yana haifar da haɓaka haɓakawa da haɓakar fitarwa na zuciya, haɓaka matsi na systolic.

Ciwon Zuciya Mai Raɗaɗi

Ƙunƙarar ciwon zuciya kalma ce da ke wakiltar nau'in raunin raunin zuciya wanda ya haɗa da:

Ciwon zuciya na zuciya yana bayyana wani nau'i na raunin zuciya mara kyau wanda baya haifar da rauni kai tsaye ga myocardium.
Tashin hankali na zuciya yana faruwa lokacin da myocardium ya yi rauni, galibi ta hanyar rauni mai ƙarfi.
Rushewar bugun zuciya shine mummunan rauni mai rauni na bangon atrial ko ventricular.

Raunin zuciya yakan haifar da rauni mai ƙarfi zuwa yankin sternal wanda ke danne zuciya tsakanin kashin kashin baya da na kashin baya, yana haifar da rauni ga myocardium.

Raunin ciwon zuciya na iya haɗawa da zubar jini a cikin myocardium, edema, ischemia da necrosis, duk yana haifar da rashin aiki na zuciya.

Rushewar bugun zuciya yana faruwa a lokacin da raunin ƙarfi da ƙarfi ya haifar da haɓakar matsa lamba na intraventricular ko intra-jijiya mai mahimmanci don tsage bangon zuciya. Mafi sau da yawa yakan faru ne sakamakon hadurran ababen hawa masu sauri; kusan ko da yaushe yana mutuwa nan da nan.

Blunt Aortic Raunin yana bayyana nau'in rauni wanda ke fitowa daga ƙananan hawaye a cikin intima na aortic (mafi girma na ciki na jijiya) don kammala jigilar aorta, wanda kusan kullum yana mutuwa.

Har zuwa kashi 90 cikin dari na marasa lafiya da ke fama da rauni aortic suna mutuwa a wurin da hatsarin ya faru ko a cikin sa'o'i na shigar da asibiti.

A duk inda ya faɗi akan bakan, raunin da ba a iya gani ba rauni ne mai barazanar rai, kuma yawanci yakan faru ne sakamakon karon gaba marar karewa ko wani mummunan tasiri ga ƙirji.

Sakamakon raguwa da tsagewar sojojin sun sanya damuwa a kan aorta a ligamentum arteriosum, kuma tsagewa na iya faruwa.

Babban ƙididdiga na zato, dangane da fahimtar tsarin saurin raguwa na raunin da ya faru da alamu da alamun girgiza, ya kamata ya ba da shawarar yiwuwar mummunan rauni na aortic.

Jiyya na rauni mai rauni mai rauni ya haɗa da sarrafa hanyar iska, iskar oxygenation da samun iska, da maye gurbin ƙarar ruwa a cikin marasa lafiya tare da matsanancin hauhawar jini na biyu zuwa abin da ake zargi da jigilar aortic.

Kada ku aiwatar da ƙarar ƙarar ruwa mai ƙarfi a cikin marasa lafiya waɗanda ba su da hypovolemic, saboda ƙarar ƙarar intravascular zai iya haifar da ƙarin ƙarfi a kan vasculature da aka ji rauni da rauni na rauni.

Kamar yadda yake tare da duk wani rauni, jigilar gaggawa zuwa cibiyar rauni shine mafi mahimmanci.

Raunin ƙirji wani abu ne mai zurfi kuma mai mahimmanci na kula da rauni.