Wuta, shakar hayaki, da konewa: manufofin jiyya da magani

By Cristiano Antonino On Apr 8, 2023

Lalacewar da hayaki ke haifarwa yana tabbatar da muni mai girma na mace-macen masu fama da ƙonewa: a cikin waɗannan lokuta lahanin da ke fitowa daga shakar hayaki ya haɗa da na ƙonewa, sau da yawa tare da sakamako mai muni.

An sadaukar da wannan labarin don ƙona hanyoyin kwantar da hankali, tare da yin la'akari da lahani na huhu da na tsarin jiki a cikin abubuwan da suka ƙone da suka sha hayaki, yayin da za a bincika raunuka na dermatological a wani wuri.

Shakar hayaki da konewa, makasudin jiyya

Manufar taimakon numfashi a cikin masu ƙonawa shine tabbatar da:

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

A wasu lokuta, yin excartomy yana da mahimmanci don hana duk wani tabon ƙirji daga hana motsin ƙirji.

Manufofin maganin kunar fata sune:

kawar da fata mara mahimmanci,
aikace-aikacen bandages na magani tare da maganin rigakafi,
raunin rauni 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.

Dole ne a ba da adadin adadin kuzari fiye da basal, don sauƙaƙe gyaran raunuka da kuma guje wa catapolism.

Maganin ƙona marasa lafiya tare da shakar hayaki mai guba

Kone wadanda ke fama da ƙananan raunuka da ke shafar manyan hanyoyin iska, ko tare da alamun toshewar numfashi ko, a kowane hali, shigar da huhu, dole ne a sa ido sosai.

Wajibi ne don samar da ƙarin iskar oxygen, ta hanyar cannula na hanci, kuma don sa mai haƙuri ya ɗauka babban matsayi Fowler, domin rage aikin numfashi.

Bronchospasm Ana bi da su tare da β-agonists mai aerosolized (kamar orciprenaline ko albuterol).

Idan ana tsammanin toshewar hanyar iska, ya kamata a kiyaye shi da bututun endotracheal mai girman da ya dace.

Early tracheostomy Gabaɗaya ba a ba da shawarar ga waɗanda ke fama da ƙonawa ba saboda wannan hanya tana da alaƙa da haɓakar kamuwa da cuta da haɓaka mace-mace, kodayake yana iya zama dole don tallafin numfashi na dogon lokaci.

An ba da rahoton shigar da farko don haifar da edema na huhu na wucin gadi a wasu marasa lafiya da ke da rauni na numfashi.

Aikace-aikacen 5 ko 10 cm H2O ci gaba da ingantaccen matsi na iska (CPAP) zai iya taimakawa wajen rage yawan kumburin huhu da wuri, adana ƙarar huhu, tallafawa hanyoyin iska, inganta iskar iska/perfusion, da rage mace-mace da wuri.

Ba a ba da shawarar tsarin kula da cortisone don maganin edema ba, la'akari da haɗarin kamuwa da cuta.

Jiyya na comatose marasa lafiya ana karkata zuwa ga mai tsanani hypoxia daga shakar hayaki da CO guba kuma yana dogara ne akan gudanar da iskar oxygen.

Rarrabawa da kawar da carboxyhemoglobin suna haɓaka ta hanyar sarrafa abubuwan da ke cikin iskar oxygen.

Abubuwan da suka sha hayaki, amma suna da ƙaramin haɓaka a Hbco (kasa da 30%) kuma suna kula da aikin zuciya na yau da kullun, yakamata a kula da su tare da isar da iskar oxygen 100% ta hanyar abin rufe fuska mai dacewa, kamar "rashin numfashi" ( wanda ba ya ba ka damar shakar iskar da ka sake fitar da shi), tare da kwararar lita 15/minti, tare da kiyaye tankin ajiyar ya cika.

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

Mask CPAP tare da isar da iskar oxygen 100% na iya zama maganin da ya dace ga marasa lafiya da ke fama da cutar hypoxemia kuma babu ko kawai raunin zafi na fuska da manyan hanyoyin iska.

Marasa lafiya tare da hypoxemia refractory ko raunin sha'awar da ke hade da coma ko rashin kwanciyar hankali na zuciya yana buƙatar intubation da taimakon numfashi tare da 100% oxygen kuma ana kiran su da sauri don maganin oxygen hyperbaric.

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

Marasa lafiya waɗanda ke haɓaka edema na huhu da wuri, ARDS, ko ciwon huhu yakan buƙaci tabbataccen matsi na ƙarewa (SAURARA) goyon bayan numfashi a gaban ABGs mai nuna gazawar numfashi (PaO2 kasa da 60 mmHg, da / ko PaCO2 sama da 50 mmHg, tare da pH ƙasa da 7.25).

SAURARA Ana nuna 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 haɓaka metabolism, wanda ke buƙatar haɓaka ƙarar mintuna na numfashi don tabbatar da 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 / karewa (I: E), ko da lokacin da hawan jini ya buƙaci. a ƙara.

Hypoxemia mai jujjuyawa na iya amsawa ga dogaro da matsa lamba, juye juye-juye.

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 hanyar iska da atelectasis.

Sabbin fata na baya-bayan nan ba sa jurewa bugun ƙirji da rawar jiki.

Fibrobronchoscopy na warkewa na iya zama dole don buɗe hanyoyin iska daga tarin abubuwan ɓoye masu kauri.

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

Maido da ma'aunin ruwa na mai haƙuri, ta amfani da tsarin Parkland (4 ml na maganin isotonic a kowace kg ga kowane kashi na saman fata mai ƙonewa, don awanni 24) da kuma kiyaye diuresis a ƙimar tsakanin 30 da 50 ml / hour da tsakiyar venous. matsa lamba tsakanin 2 da 6 mmHg, yana taimakawa kiyaye kwanciyar hankali na hemodynamic.

A cikin marasa lafiya da ke da rauni na buri, haɓakar capillary yana ƙaruwa, kuma saka idanu kan matsa lamba na huhu shine jagora mai amfani don maye gurbin ruwa, baya ga sarrafa fitar da fitsari.

Wajibi ne don saka idanu da hoton electrolyte da ma'aunin acid-base.

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 nauyi a kasuwa waɗanda ke ba da damar yin ma'aunin calorimetry na kaikaice, 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 kashe kuzarin hutu, don sauƙaƙe warkar da rauni da hana catabolism.

Tare da warkar da konewa, cin abinci mai gina jiki yana ci gaba da raguwa zuwa kashi 130 cikin dari na basal na rayuwa.

A cikin ƙirji mai kewaye yana konewa, tabo na iya hana motsin bangon ƙirji

Ana aiwatar da escharotomy ( tiyatar cire fatar da ta ƙone) ta hanyar yin incisions na gefe guda biyu tare da layin axillary na gaba, farawa daga santimita biyu a ƙasa da clavicle har zuwa sararin intercostal na tara da goma, da wasu incisions guda biyu da aka shimfiɗa a tsakanin ƙarshen ƙarshen. na farko, don ayyana murabba'i.

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

Maganin kuna ya haɗa da cire fatar da ba ta da mahimmanci, yin amfani da suturar magunguna tare da maganin rigakafi, rufe raunuka tare da maye gurbin fata na wucin gadi, da dasa fata daga wurare masu lafiya ko samfurori zuwa wurin da aka kone. cloned.

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.

Kyakkyawan dabarar keɓancewa, matsa lamba na yanayi, tacewa na iska, yana wakiltar ginshiƙan kariyar kariya daga cututtuka.

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Zaɓin maganin rigakafi ya dogara ne akan sakamakon jerin al'adun abu daga rauni, da jini, fitsari, da samfuran sputum.

Bai kamata a yi amfani da maganin rigakafi na rigakafi ga waɗannan marasa lafiya ba, saboda sauƙin da za a iya zaɓar nau'in juriya, wanda ke da alhakin cututtukan cututtuka da ke hana farfadowa.

A cikin batutuwan da suka kasance marasa motsi na tsawon lokaci, maganin heparin na iya taimakawa wajen rage haɗarin cututtukan huhu, kuma dole ne a ba da kulawa ta musamman don hana ci gaban ciwon ciki.