Hoʻopaʻi ʻia, decompensated a hiki ʻole ke hoʻihoʻi ʻia: he aha lākou a he aha lākou e hoʻoholo ai
I kekahi manawa, paʻakikī ke ʻike i ka haʻalulu i kona wā mua a hiki i ka mea maʻi ke hoʻololi i ka haʻalulu decompensated ma mua o kou ʻike ʻana. I kekahi manawa, hiki mai kēlā hoʻololi ma mua o ko mākou hōʻea ʻana i ke kahua
I kēia mau manawa, pono mākou e komo a hoʻopaʻa koke no ka mea ʻaʻole e hana pēlā e hopena ka mea maʻi i ka holomua ʻana i ka haʻalulu hiki ʻole.
ʻO nā huaʻōlelo maikaʻi e hoʻohana ai i ka wehewehe ʻana i ka haʻalulu ʻo ka perfusion a me ka hypoperfusion.
Ke hoʻomaʻamaʻa maikaʻi nei mākou ʻaʻole wale mākou e hāʻawi i ka oxygen a me nā meaʻai i nā kino o ke kino, akā ke hoʻoneʻe pū nei mākou i nā huahana ʻōpala o ka metabolism ma kahi kūpono kūpono pū kekahi.
AʻO I KE KOKUA MUA? E KIPA I KA DMC DINAS MEDICAL CONSULTANTS BOOTH MA EMERGENCY EXPO
ʻEwalu ʻano haʻalulu i hiki iā mākou ke hālāwai:
- Hypovolemic - ka mea i ʻike pinepine ʻia
- Cardiogenic
- Keakea
- Septic
- Neurogenic
- Anaphylactic
- ʻĀpikopa
- Ka lawa ʻole o ka hanu ʻana
ʻO nā ʻāpana ʻekolu o ka haʻalulu: Hiki ʻole ke hoʻihoʻi ʻia, uku ʻia, a me ka haʻalulu decompsated
Māhele 1 - Hoʻopaʻi haʻalulu
ʻO ka haʻalulu i hoʻopaʻi ʻia, ʻo ia ka māhele o ka haʻalulu i hiki ai i ke kino ke hoʻopaʻi no ka pau ʻana o ka wai.
I loko o kēia māhele, hiki i ka mea maʻi ke mālama i ke kahe koko kūpono a me ka hoʻoheheʻe ʻana o ka lolo no ka mea ke hoʻonui nei ka ʻōnaehana nerve aloha i ka puʻuwai a me ka hanu a hoʻokuʻu i ke koko i ke kumu o ke kino ma o ka vasoconstriction o nā kīʻaha koko a me ka microcirculation, ka precapillary. ʻO nā sphincters e hoʻopaʻa a hoʻemi i ke kahe o ke koko i nā wahi o ke kino me ka hoʻomanawanui kiʻekiʻe no ka emi ʻana o ka perfusion, e laʻa me ka ʻili.
ʻO kēia kaʻina hana e hoʻonui i ke kahe koko ma mua no ka mea he liʻiliʻi ka lumi i loko o ka ʻōnaehana circulatory.
ka nā hōʻailona a me nā hōʻailona o ka haʻalulu i uku ʻia puke:
- ʻO ka hoʻomaha, ka huhū a me ka hopohopo - nā hōʻailona mua loa o ka hypoxia
- ʻO ka ʻili ʻulaʻula a me ka ʻili - ma muli o ka microcirculation
- Nausea a luaʻi - ka emi ʻana o ke kahe koko i ka ʻōnaehana GI
- makewai
- Hoʻopiha hou ʻia ka capillary
- Hoʻemi ʻana i ke kaomi pulse
Māhele 2 - Haʻalulu decompensated
ʻO ka haʻalulu decompensated ho'ākāka 'ia ma "ʻO ka hopena hope o ka haʻalulu i hiki ʻole ai i nā mīkini uku o ke kino (e like me ka piʻi ʻana o ka puʻuwai puʻuwai, vasoconstriction, piʻi ʻana o ka hanu) hiki ʻole ke mālama pono i ka perfusion i ka lolo a me nā ʻāpana koʻikoʻi."
Hiki ia i ka wā e emi ai ka nui o ke koko ma mua o 30%.
Ke hāʻule nei nā hana uku o ka mea maʻi a ke hāʻule nei ka puʻuwai puʻuwai ma muli o ka emi ʻana o ke koko a me ka hana naʻau.
E hoʻomau ke kino i ke kahe ʻana i ke koko i ke kumu o ke kino, ka lolo, ka puʻuwai a me nā puʻupaʻa.
ʻO nā hōʻailona a me nā hōʻailona o ka haʻalulu decompensated e ʻike ʻia a ʻo ka piʻi ʻana o ka vasoconstriction ka hopena i ka hypoxia i nā ʻāpana ʻē aʻe o ke kino.
Ma muli o ka emi ʻana o ka oxygen i ka lolo e huikau ka mea maʻi a me ka ʻole.
ka na hoailona a me na Ōuli ʻO ka haʻalulu decompensated pū kekahi:
- Hoʻololi i ke kūlana noʻonoʻo
- Kāleka Kāleka
- ʻO ka paʻi ʻana
- ʻO ka hanu ʻana a me ka hana ʻole
- Nawaliwali i ka hele ʻole ʻana i nā pulse peripheral
- ʻO ka emi ʻana o ka wela o ke kino
- ʻO Cyanosis
ʻOiai ke hoʻāʻo nei ke kino e hoʻonui i ke kahe o ke koko i ke kumu o ke kino, nalowale ka ʻōnaehana sympathetic i nā sphincters precapillary e kōkua i ka microcirculation i ʻōlelo ʻia ma mua.
Paʻa mau nā sphincters postcapillary a hiki i kēia ke hoʻokaʻawale i ke koko, e holomua ana i ka hoʻolaha intravascular coagulation (DIC).
I ka wā mua, hiki ke hoʻoponopono ʻia kēia pilikia me ka mālama koʻikoʻi.
Ke hoʻomaka nei ke koko e ʻauʻau nei i ka coagulate, ʻaʻole e loaʻa hou nā meaʻai i nā sela o ia wahi a ʻo ka metabolism anaerobic ke kuleana no ka hana ʻana o adenosine triphosphate (ATP).
Hoʻomaka ʻo DIC i kēia kaʻina a hoʻomau i ka holomua i ka wā haʻalulu hiki ʻole ke hoʻohuli.
HOOLAHA LEKIO I KE AO NEI? E KIPA I KA HALE ELEI O EMS MA EMERGENCY EXPO
Māhele 3 - Hoʻihoʻi ʻole ʻia
ʻO ka haʻalulu ʻaʻole hiki ke hoʻihoʻi ʻia ka pae hope o ka haʻalulu a ke hele ka mea maʻi i kēia kaʻina ʻo ia ke kumu o ka hoʻi ʻole ʻana no ka mea aia ka wikiwiki o ka ʻōnaehana cardiovascular a ua hāʻule nā hana uku o ka mea maʻi.
E hōʻike ana ka mea maʻi me ka emi nui o ka puka ʻana o ka naʻau, ke koko a me ka perfusion o nā kiko.
I ka ho'āʻo hope loa e hoʻopakele i ke kumu o ke kino, hoʻokaʻawale ʻia ke koko mai nā puʻupaʻa, ate a me nā māmā e mālama i ka perfusion o ka lolo a me ka puʻuwai.
lapaʻau
ʻO ka ʻāpana koʻikoʻi o ka lāʻau lapaʻau ʻo ka ʻike ʻana i ka hanana a me ka hana proactively e pale i ka holomua o ka haʻalulu.
E like me kaʻu i ʻōlelo ai ma mua, ʻo ka haʻalulu hypovolemic ka mea i ʻike pinepine ʻia i ka haʻalulu i ka hoʻonohonoho prehospital.
Maikaʻi kēia, no ka mea, ʻo ke kumu maʻamau o ka make no ka poʻe makahiki 1-44 he mau ʻeha i manaʻo ʻole ʻia.
Inā he koko ka mea maʻi ma waho, ʻike mākou pono mākou e komo koke i hiki iā mākou ke mālama i ke koko i loko o ka ipu e like me ka hiki.
Inā hōʻike ka mea maʻi i nā hōʻailona o ke koko i loko, pono mākou e lawe i kahi kikowaena trauma no nā hana ʻoki.
Hōʻike ʻia ka oxygen kahe kiʻekiʻe, ʻoiai inā e noʻonoʻo mau ana ka mea maʻi a loaʻa iā ia ka pulse oximetry o 94% a ʻoi paha.
ʻIke mākou i kēia mau manawa inā he kānalua ka hypoxia i lalo e hiki ke lawelawe ʻia ka oxygen me ka nānā ʻole i ka mea i hōʻike ʻia e ka pulse oximetry.
E hoʻomaʻamaʻa i kou maʻi, hoʻemi i ka wela o ke kino e hoʻopilikia i ka hiki o ke kino ke hoʻomalu i ke koko lua i ka hana platelet ʻino a hopena i ka haki ʻana o nā clots i hana ʻia.
A ʻo ka mea hope loa, ʻo ka intravenous therapy e mālama i kahi kūlana o ka hypotension ʻae. ʻO ia ke ʻano o ke kahe koko systolic ma waena o 80- a me 90-mmHG.
He mea maʻamau mākou i ka 90-mmHg e like me kā mākou aʻo ʻia ʻo ia ka hoʻololi ʻana mai ka uku i ka haʻalulu decompensated.
Kākau ʻia e: Richard Main, MEd, NRP
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