ʻO ke kahuehu ʻo ka hōʻeha nui loa e mālama ʻia no nā kumu like ʻole. Ma keʻano kūikawā, ua hoʻokumu ʻia ka ʻāʻī i nā hapa nui loa. Eia kekahi, ʻike paha nā mea maʻi me ka hōʻeha o ka ʻāʻī a paʻa wale nō ma hope o ka hōʻeha e hōʻeha i nā pilikia a me nā hoʻopiʻi.

ʻO kēia ke kumu he mea nui e maopopo maopopo i ka 'ā'ī, pehea e hana ʻia ai, nā mea hōʻailona e pono ai iā mākou e hopohopo i ka trauma ʻāʻī, ʻo ia nā wahi e mālama ai e like me ka maʻi o ka mea maʻi, a pēlā aku. No laila, he aha nā mea nui e pono ai e lawelawe i ka prehospital operator e ʻike a i ʻole a e mālama i ka hōʻeha ʻāʻī.

_______________________________________________________

Mea kākau: Amaan Siddiqi, MD (Senior EM Resident, Brooklyn Hospital Center)

Hoʻoponoponoʻia e: Alex Koyfman, MD (@EMHighAK) a me Justin Bright, MD

Nā kumuhana o ka'ākau mau
Ka ʻāʻī he wahi pahele ka loiloi a me ka mālama ʻana i ka mea maʻi trauma, ʻo ia ka wahi no ka nui o nā hana koʻikoʻi. E hopohopo no vascular, neurologic, digestive tract a me nā ʻeha hōʻino he mea koʻikoʻi nui ia i ka loiloiʻana i kēia mau maʻi, no ka mea, hiki i nā mea a pau ke hoʻoweliweli. ʻO ka manawa pinepine, ka hoʻomanawanui o ka'ā'ī hiki ke kū i kahi pale, akā, ua hoʻolāʻihi i ka maʻi i loaʻa ma hope aku, hoʻonuiʻia ka pōʻino a me ka makeʻana. Hiki ke hoʻokaʻawaleʻia ka trauma i loko o kaʻehaʻeha a me nāʻehaʻeha.

Ua mahele ʻia ka ʻāʻī i 3 zona, e lilo i mea nui i ka loiloi a mālama ʻana i kēia mau mea maʻi, ʻoi aku hoʻi i nā ʻano hana i kūkulu ʻia i loko o kēlā me kēia māhele.

Hana I (kumu o ka ʻāʻī) - ma lalo o ka cartilage cricoid (i ka notch sternal): nā kūkulu mediastinal, a me ke dacchic duct, proximal carotid artery, vertebral / subclavian artery, trachea, lung, esophagus
Hana II (mid-neck) - mai ka cartilage cricoid a i ka ʻaoʻao o ka mandible: carotid / vertebral artery, larynx, trachea, esophagus, jugular vein, vagus a me nā laryngeal nerves hou.
Zone III (ʻāpana luna) - ma luna o ke kihi o ka mandible: distal carotid artery, vertebral artery, distal jugular vein, salivary / parotid glands, CNs 9-12.

ʻO ka hakakā me ka'ā'ī neckuma e kau ana ma nāʻaoʻao likeʻole o ka'ā'ī. Hiki i nā wahi I a me III ke paʻakikī e komo a mālama i loko o ke keʻena hoʻolālā, me nāʻaoʻaoʻeha i loaʻa iaʻu ma nā mea nui loa. ʻO ka Mokuna IIʻo ia kaʻaoʻao iʻikeʻoleʻia, a no laila, uaʻeha ka mea. Akā naʻe, Hanaʻia ka hopena II kahi loaʻa i ka hōʻailona maikaʻi loa no ka mea, aia nā wahi nui o ka hōʻike, e ʻae ana i ka hoʻomālamalama maʻalahi.

ʻO ka ulu ʻana o ke komo trauma 0.55-5% o nāʻehaʻeha. ʻO ka mea nui ʻO GSW ia mau hana, e hōʻeha i nāʻeha, a me nā pale. ʻO nā maʻiʻeha a me ka liʻiliʻi loa GSW ke kumu o ka hoʻonuiʻana i ka 50% haʻahaʻa liʻiliʻi.

Uaʻoi aku kaʻokoʻaʻole o ka trauma neck neck ma mua o kaʻeha o ka'ākau. ʻO ka hapa nui o ka ulua pōʻino o ka'ā'ī mai MVC mai, a me ka hōʻeha a me kaʻumiʻana. ʻO ʻO ka hihia nui me ka maʻi o ka'ā'ī i loko o ka hōʻailonaʻikeʻole a lōʻihi paha.

Pono e hoʻonuiʻia nā māmā maʻamau no ka Nā hōʻailona "paʻakikī" a me nā "māmā". Hōʻike nā "māmā" i ka pono no ka hoʻolālāʻana, 'o ia hoʻi ka lawelawe' ana a me ka hana 'ana. Hōʻike nā "pale" i ka nānāʻana a me ka loiloi hou, akā naʻe,ʻaʻole hiki ke kaukau i ka hana.

Nā Hōʻailona Hiʻona

• Hemoptysis a he hematemesis paha
• ʻO ke koko o ka hemoʻole
• ʻO Dyspena
• ʻO Dysphonia a iʻole dysphagia
• Ke ea ma lalo iho o ka ea a iʻole ka'enele
• Hoʻolāʻia nā ea lele
• ʻAʻohe hua'ōlelo hematoma
• ʻO nā hāʻiliʻili neurologic

Nā Hōʻaiʻe Paʻe

• Hoʻonui i ka hematoma
• Kaheʻana o ka hanu nui
• Mai pīhoihoi i ka paneʻana i nā wai
• Ho'ēmi a haʻalele paha i ka pulial radial
• ʻO ka hopena a me ka hopena
• Ke kālepa Cerebral
• Ka wehewehe o Airway

Management
E hoʻomaka me kāu ABC ma muli o nā alakaʻi o ka ATLS, e like me ka hopena o ka hopena, me kahiʻoihana pili i ka moe. E noʻonoʻo mākou i nāʻeha kūpono iʻikeʻia ma ka'ā'ī o ka'ā'ī a me nā mea iʻike pinepineʻia, e like me nā mea i'aleʻaʻoleʻia.

Hawaiian Airlines + Breathing
ʻO nāʻenehana kūpono e hoʻopili koke i ka mālamaʻana i ka ea stridor, pilikia hanu, haʻalulu, a i ʻole ka hoʻonui wikiwiki ʻana o ka hematoma. Ma nā mea pili i kahi kokoke a me nā mea iʻokiʻia, ponoʻoe e mālama i kahi paepae haʻahaʻa no ka ulia. Eia kekahi, ua loaʻa i kēia mau maʻi ke kūpono o ka hanaʻana i ka edema pulmonary a me ka ARDS.

KEEP ON KA HOPE HERE