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Polytrauma: ma'anar, gudanarwa, kwanciyar hankali da rashin kwanciyar hankali mara lafiya polytrauma

By Cristiano Antonino On Apr 5, 2023

Tare da "polytrauma" ko "polytraumatized" a cikin magani muna nufin ma'anar majinyacin da ya ji rauni wanda ke gabatar da raunin da ya faru ga sassa biyu ko fiye na jiki (kwanyar kai, kashin baya, thorax, ciki, ƙashin ƙugu, gaɓoɓi) tare da halin yanzu ko rashin lahani na ayyukan. mai mahimmanci (na numfashi da / ko bugun jini)

Polytrauma, dalilin

Dalilin raunin rauni gabaɗaya yana da alaƙa da wani mummunan hatsarin mota amma duk wani nau'in abin da ya faru da ƙarfin da ke da ikon shiga tsakani akan maki da yawa na jiki ɗaya yana iya haifar da ɓarna da yawa.

Mai ciwon polytrauma sau da yawa yana da tsanani ko kuma mai tsanani.

Daga cikin majinyatan da suka mutu sanadiyar polytrauma:

50% na polytraumas sun mutu a cikin dakika ko mintuna na taron, saboda karyewar zuciya ko manyan tasoshin, laceration na kwakwalwar kwakwalwa ko zubar da jini mai tsanani;
30% na polytraumas sun mutu a lokacin sa'a na zinariya, saboda hemopneumothorax, bugun jini, hanta da hanta rupture, hypoxemia, extradural hematoma, maye gurbin jiki tare da mummunan halin da ake ciki na farko ko kuskuren likita;
20% na polytrauma suna mutuwa a cikin kwanaki ko makonni masu zuwa saboda sepsis, matsalolin numfashi, kama zuciya, ko gazawar multiorgan (MOF).

Daidaitacce, daidaitaccen lokaci da tasiri na ƙayyadaddun taimako yana ba da damar haɓaka damar rayuwa na wanda ya ji rauni, rage haɗarin lalacewa na biyu.

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Gudanar da polytrauma

Domin daidaita jerin abubuwan da ƙungiyar da ke gudanar da aikin ceto ta bi, an raba na ƙarshe zuwa matakai daban-daban, wanda ake kira "zobe", kamar haka:

Tsarin shiri da faɗakarwa - A cikin wannan lokaci, ƙungiyoyi suna da alhakin shirya daidaitattun hanyoyin da kayan aikin da suka dace. kayan aiki. Cibiyar ayyuka tana da alhakin, bisa bayanan da ke hannunta, don faɗakar da ƙungiyar da ta fi dacewa da buƙatu.
Ƙimar yanayi da saduwa - Bayan isowa, kowane mai amsawa yana da alhakin kula da aminci da kimanta haɗarin haɗari. Abubuwan wajibcin da doka ta kafa sun haɗa da tantance manajan da ɗaukar kayan kariya na sirri waɗanda dole ne a sa su daidai kuma cikin cikakken tsari na aiki.
Binciken farko da na sakandare - Mahimman ƙima na ayyuka masu mahimmanci koyaushe suna dacewa da ayyukan da aka tsara taimakon farko da ka'idojin farfadowa da faɗakarwar ƙungiyoyin ceto na ci gaba (ALS). Wadannan sarrafawa ana gano su ta mnemonically tare da gajarta A B C D E.
Sadarwa tare da Cibiyar Ayyuka - A wannan lokaci, ban da zaɓi da kuma sanya wurin da ake nufi, an tabbatar da damar yin kira a madadin hanyoyin sufuri ko tsara tafiya tare da ƙungiyar ALS.
Sufuri tare da saka idanu - A wannan lokaci, ban da ci gaba da lura da muhimman ayyuka na marasa lafiya, ana iya ba da sashin asibiti tare da bayanai game da mahimman bayanai da duk waɗanda ke ba da damar tsarin da za a shirya don maraba da kuma kula da mutumin da ya ji rauni mai tsanani.
Kula da lafiya a asibiti.

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Akwai ƙa'ida mai mahimmanci kuma mai sauƙi don tunawa da yadda ake ba da kulawa ga majiyyaci polytrauma, bisa ga ƴan haruffa na farko na haruffa:

Hanyoyin iska: ko "hanyar numfashi", kamar yadda yake sarrafa yanayin sa (watau yuwuwar iska ta ratsa ta) yana wakiltar yanayin farko kuma mafi mahimmanci don tsira ga majiyyaci;
Numfashi: ko "numfashi", wanda aka yi nufin "ingancin numfashi"; yana da alaƙa da abin da ya gabata, an wadatar da shi da mahimmancin asibiti na jijiyoyi, kamar yadda wasu raunukan kwakwalwa ke ba da yanayin yanayin numfashi (watau nawa / yaya / yadda majiyyaci ke yin ayyukan numfashi), kamar misali Cheyne-Stokes numfashi;
Zagawa: ko "zazzagewa", kamar yadda a bayyane yake daidaitaccen aiki na tsarin zuciya (kuma tare da maki biyu na baya na zuciya-huhu) yana da mahimmanci don rayuwa;
Nakasa: ko "nakasa", musamman mahimmanci idan akwai tuhuma kashin baya raunuka ko fiye da gaba ɗaya na tsarin jin tsoro na tsakiya, kamar yadda zai iya faruwa cewa raunuka a cikin wannan gundumomi suna haifar da yanayin girgiza wanda, a farkon matakansa, ba za a iya gano shi ba sai da idon ƙwararru, kuma zai iya "shiru" ya kawo polytraumatized zuwa ga polytraumatized. mutuwa (ba daidaituwa ba ne cewa wani lokaci muna magana game da girgiza kashin baya);
Bayyanawa: ko "bayyana" majiyyaci, cire masa sutura don neman duk wani rauni, yayin da yake kiyaye sirri da zafin jiki (ana iya fassara shi azaman E-muhalli).

Taimakon farko, yadda ake magance polytrauma

Sau ɗaya a cikin ɗakin gaggawa, Mai haƙuri da aka lalatar da shi zai sha duk binciken da ka'idojin rauni ke buƙata.

Yawanci, kimantawa na biyu don rauni, iskar jini, da sinadarai na jini da haɗakar jini ana yin su ta hanyar binciken rediyo, wanda zai dogara da matakin kwanciyar hankali na hemodynamic.

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Stable polytrauma haƙuri

Idan majiyyaci yana da kwanciyar hankali na haemodynamically, ban da ainihin binciken ecoFAST, x-ray na kirji da ƙashin ƙugu, ana kuma iya yin cikakken binciken CT na jiki, duka ba tare da madaidaicin matsakaici ba, wanda zai iya haskaka raunukan jijiyoyin jini da manyan tasoshin.

Binciken bincike na rediyon da aka gudanar a cikin matsanancin polytrauma mai ƙarfi na hemodynamically shine gabaɗaya:

FAST duban dan tayi;
X-ray na kirji;
x-ray na pelvis;
kwanyar CT;
CT na kashin baya;
kirji CT;
Ciki CT.

Za a iya yin ƙarin bincike mai zurfi kamar angiography da resonance na maganadisu; musamman, ana yin MRI akan kashin baya idan ana zargin raunuka na myelic (na kashin baya), tun da CT yana nuna ɓangaren kashi na kashin baya kuma ba bincike mai amfani ba don nazarin kashin baya.

Hakanan za'a iya yin MRI don nazarin fossa na cranial na baya, kuma musamman ga hematomas na dabara, waɗanda ba a bayyana su sosai akan CT ba.

Ana yin X-ray na gaɓoɓin gaba ɗaya a ƙarshen gwaje-gwajen da ke sama.

X-ray na kashin baya na mahaifa ba shi da amfani don nazarin zurfin binciken raunin kashi, saboda ba ya nuna alamar C1 da C2 a fili kuma ba zai isa ya fahimci wurin da aka samu karyewar vertebral ba.

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Mara lafiya polytrauma mara lafiya

Idan polytraumatized majiyyaci ne hemodynamically m, misali saboda aiki na waje ko na ciki (ko duka) zub da jini, wanda bai warware ba bayan gudanar da crystalloids, colloid da / ko sabo daskararre plasma da jini, mai haƙuri ba zai sha CT binciken. amma bincike na asali kuma daga baya za a yi tiyata don magance matsalolin da ke haifar da rashin kwanciyar hankali.

Idan majiyyaci ya isa cikin ED mara ƙarfi amma daga baya ya daidaita ta hanyar taimakon warkewa, ƙungiyar masu rauni na iya yin la'akari da ko za a yi ƙarin zurfin bincike (kamar CT). Musamman, binciken rediyo da aka yi a cikin mara lafiyar polytrauma maras tabbas (wanda ya kasance maras tabbas bayan jiyya) gabaɗaya ya ƙunshi: -ultrasound (wataƙila ba FAST ba) -ray X-ray - pelvis X-ray - cervical spine X-ray Cervical spine X- ray ba koyaushe ake yin ba .

Bayan bincike

A ƙarshen duk binciken bincike, ana ƙididdige buƙatar tiyata a cikin kwanciyar hankali mai haƙuri ko kuma an tsara ayyukan da za a yi na kwanaki masu zuwa.

Ana kai mara lafiyar marar lafiya gabaɗaya zuwa ɗakin tiyata a ƙarshen bincike na asali kuma za a ƙara yin bincike mai zurfi a ƙarshen tiyata da yiwuwar yin tiyata na biyu a cikin kwanaki masu zuwa.

Ana shigar da marasa lafiya na polytrauma a rukunin kulawa mai zurfi, wanda aka sani kawai da “resuscitation” ko rukunin kulawa mai zurfi na neurosurgical.