Drowning: hōʻailona, hōʻailona, loiloi mua, ʻike, ʻeha. Ka pili o ka helu Orlowski

By Cristiano Antonino On E 17, 2023

ʻO ka Drowning a i ʻole 'Drowning Syndrome' i loko o ka lāʻau lapaʻau e pili ana i kahi ʻano o ka asphyxia ma muli o kahi kumu mechanical waho i hoʻokumu ʻia e ka noho ʻana o ka pulmonary alveolar space e ka wai a i ʻole nā wai ʻē aʻe i hoʻokomo ʻia ma nā ala o luna, i hoʻopiha piha ʻia i loko o ia wai.

Inā hoʻolōʻihi ʻia ka asphyxia no ka manawa lōʻihi, ʻo ka maʻamau he mau minuke, hiki mai ka 'make ma ka luʻu ʻana', ʻo ia hoʻi ka make ma muli o ka ʻumeke ʻana ma ka hoʻokomo ʻia ʻana, pili maʻamau i ka hypoxia a me ka hemahema o ka ventricle ʻākau o ka puʻuwai.

I kekahi mau hihia make ʻole, hiki ke mālama maikaʻi ʻia ke kau ʻana me nā hana hoʻōla kikoʻī.

NUI: Inā ua make ka mea aloha i ka make ʻana a ʻaʻole ʻoe maopopo i ka mea e hana ai, e hoʻopili mua i nā lawelawe pilikia ma ke kelepona ʻana i ka Helu Hoʻokahi Emergency.

ʻO kēia a me nā ʻatikala ʻē aʻe i manaʻo ʻia e hoʻonui i kahi kumuhana, a e ʻike i ka mea e ʻōlelo aku ai i kahi mea hoʻokele helu Emergency Number Center.

Nā hiʻohiʻona maʻi o ke kau ʻana

ʻO ka loiloi mua o ka poʻe i make i ka wai e like me ka wikiwiki a me ka manaʻo e hoʻoholo i ke kūlana o ka ʻike, nā hiʻohiʻona pulse a me ka wikiwiki o ka hanu.

Hiki ke kōkua nui ʻia nā ʻike i hōʻiliʻili ʻia mai nā mea ʻike maka i ka loiloi ʻana i ke koʻikoʻi o ke kūlana o ka mea maʻi.

Inā hiki, pono e hoʻoholo i kekahi mau ʻike, e like me:

pehea ka lōʻihi o ka hoʻokomo ʻia ʻana o ka mea maʻi i loko o ka wai,
nā hiʻohiʻona o ka wai i loaʻa ai ka pōʻino (ka paʻakai a i ʻole ka wai hou, wela a i ʻole ke anu, a me nā mea ʻē aʻe).
ka hiki mai o nā hōʻailona koʻikoʻi i ka manawa o kōkua mua,
ua hala ka manawa ma mua o ka hoʻomaka ʻana o ka hoʻōla ʻana i ka cardiopulmonary resuscitation (CPR), a inā i hana ʻia kēia mau hana ma hope koke o ka huki ʻia ʻana o ka mea maʻi mai ka wai.
pehea ka lōʻihi o ka hoʻomau ʻana o ka CPR ma mua o ka puka hou ʻana o nā hōʻailona koʻikoʻi,
inā hiki i ka wela kūpono o ka wai,
ka makahiki o ke kumuhana a me ke kūlana maʻamau ma mua o ka ulia pōpilikia (e laʻa, ua loaʻa paha ke kumuhana i ka ʻāmāmā a i ʻole ka maʻi puʻuwai?)
nā kūlana ʻē aʻe e pili ana i ka hanana (e laʻa i ka pōʻino i ka luʻu ʻana a i ʻole nā mea ʻē aʻe, ka ʻai ʻana i ka waiʻona a i ʻole nā lāʻau lapaʻau, etc.).

ʻO ka luʻu: pono e wikiwiki loa ka anamnesis a me ka hoʻāʻo ʻana

ʻO nā hōʻailona koʻikoʻi o ka poʻe i make i ka wai e hiki ke loli, ʻo ia ke kumu e pili ai ka ʻike ma ka papa inoa ma luna.

Hiki i nā maʻi ke hōʻike i ka hopu ʻana i ka naʻau a i ʻole me ka hana hanu a me ka pulse peripheral i loko o nā palena maʻamau.

He ʻokoʻa ka mahana o ke kino a pili i ka wela o ka wai i loaʻa ai ka pōʻino, ka ʻili o ke kino o ke kumuhana a me ka lōʻihi o ka luʻu ʻana.

He mea maʻamau ka Hypothermia i ka wā i noho ai ka mea maʻi i ka wai anuanu a hiki ke hoʻomaikaʻi i ke ola.

I ia mau hihia, pono e hana ʻia me ka akahele.

ʻO nā hopena puʻuwai o ka hāʻule ʻole ʻana i ka wai ʻana, ʻo ia ka bradycardia, a ma muli paha o ka asystole.

ʻO ka pōʻino neurological ma muli o ka hypoxia a me nā lāʻau lapaʻau i mālama ʻia i ka wā hoʻōla e alakaʻi i ka mydriasis, me ke kaumaha a i ʻole ka pupillary reflex i ka mālamalama.

ʻO ke poʻo a me 'ā'ī pono e nānā pono ʻia no nā hōʻailona o ka ʻeha, ʻo ka hopena, no ka laʻana, mai ka luʻu ʻana i ka wai pāpaʻu.

Inā manaʻo ʻia kahi hōʻeha i ka iwi kuamoʻo, pono ia e hoʻokaʻawale i ka mea maʻi ma mua o ka lawe ʻana e pale aku i ka pōʻino hou aʻe, i kekahi mau mea hiki ʻole ke hoʻololi a hoʻopau ʻia, e like me ke alakaʻi ʻana i ka lolo.

Hiki ke hōʻike ʻia ke ʻano o ka ʻokiʻoki i ka hele ʻana o ka wheezes, ma muli o ka bronchospasm a i ʻole ka manaʻo o nā mea ʻē a me / a i ʻole tele-expiratory rales, pili me ka atelectasis a i ʻole pulmonary edema.

ʻO ka loaʻa ʻana o nā leo puʻupuʻu ʻokoʻa (e like me ka coarse ralesalesales) hōʻike i ka manaʻo o nā mea ʻē aʻe a me ka pilikia o ka pneumonia a ARII.

ʻO nā ʻaoʻao o kēia poʻe maʻi ke anuanu pinepine i ka thermoprinting, ma muli o ka hypothermia a me ka paʻa ʻana o nā moku peripheral.

ʻO ka hoʻolōʻihi ʻana o ka holo ʻana o ka peripheral e hoʻolōʻihi i ka manawa o ka reperfusion capillary.

Hōʻike pinepine ʻia ka hōʻike ʻana o nā haemogas arterial (ABG) i ka hypoxemia, ʻoi aku ka nui inā loaʻa ka aspiration, a me ka metabolic acidosis.

ʻO ka paʻakikī o ka metabolic acidosis e pili pū me ka paʻakikī o ka hypoxia kiko.

Hiki ke emi iho ka helu o ka Hemoglobin a me ka serum electrolyte a me ka helu hematocrit inā e ale ʻia ka wai hou a i ʻole ka aspirated, e komo ana i loko o ke kahe a hoʻoulu i ka hoʻoheheʻe koko.

ʻO ka loiloi mua a me ka wānana i nā hihia o ka make ʻana

Ua kūkulu ʻia kekahi mau ʻōnaehana helu no ka loiloi ʻana i ka poʻe i make, akā ʻaʻole hiki i kekahi o lākou ke wānana i ka prognosis maʻi me ka 100% pololei.

ʻEkolu mau ʻōnaehana hoʻohana maʻamau:

ka ʻO Glasgow Coma Scale (GCS),
ka helu Orlowski,
ka hoʻohui neurological post-submission o Modell a me Conn.

ʻO Glasgow Coma Scale

ʻO ka Glasgow Coma Scale he ʻekolu mau palena, no kēlā me kēia o ka pane maikaʻi loa o ka mea maʻi i hoʻoholo ʻia a hāʻawi ʻia i kahi waiwai helu (e nānā i ka papa ma lalo).

wehe maka:

kahi e
I ka paneʻana i nā hoʻouluʻeha
I ka pane ʻana i nā hoʻoulu waha
Loaʻa

ʻO ka pane waha maikaʻi loa:

None
Maopopo ʻole
Kūpono ʻole
pioloke
Kuhikuhi

ʻO ka pane kaʻa maikaʻi loa

None
Hoʻonui (decerebrated)
Hoʻololi (hoʻonani ʻia)
Localization o ka hoʻoulu ʻeha
pane kauoha

Hoʻoholo ʻia ka helu pālākiō Glasgow ma ka loiloi ʻana i ka pane maikaʻi loa o ka mea maʻi ma kēlā me kēia ʻāpana.

Hoʻohui pū ʻia nā waiwai helu no nā ʻano i ʻike ʻia a hāʻawi i ka helu holoʻokoʻa.

ʻO ka helu holoʻokoʻa o 3 ka haʻahaʻa haʻahaʻa loa a hōʻike i ke kūlana ʻino loa; ʻO ka helu o 7 a i ʻole ka liʻiliʻi e hōʻike ana aia ka mea maʻi i kahi coma a me ka helu o 14 ka mālama ʻana i ka ʻike piha.

Hoʻokumu ʻia ka wānana ma ka waiwai GCS i loaʻa i ka manawa o ka hoʻokolohua mua.

ʻO ka poʻe i make me ka helu GCS mua o 4 a i ʻole ka liʻiliʻi he 80 pākēneka o ka make a i ʻole ka pōʻino neurological mau loa.

ʻO nā maʻi me ka helu GCS o 6 a i ʻole ke kiʻekiʻe, ma ka ʻaoʻao ʻē aʻe, he haʻahaʻa haʻahaʻa o ka make a i ʻole ka hōʻeha neurological mau.

helu ʻo Orlowski

Hoʻokumu ʻia ka helu Orlowski ma ke alo o nā mea prognostic maikaʻi ʻole e pili ana i ka hoʻihoʻi ʻana o ka mea maʻi.

ʻO nā kumu prognostic maikaʻi ʻole o ka helu Orlowski

makahiki like a emi mai paha 3 makahiki;
ʻoi aku ka nui o ka manawa luʻu ma mua o 5 mau minuke;
ʻaʻole i hana ʻia nā hana hoʻōla i loko o nā minuke 10 mua;
ua hōʻea ka mea maʻi i loko o ke keʻena pilikia ma kahi kūlana comatose;
ʻO ka pH arterial i like a i ʻole ma lalo o 7.10 ma ka hemogasanalysis.

Hāʻawi ʻia ka helu Orlowski e like me ka helu o nā kumu prognostic maikaʻi ʻole, i helu ʻia ma ʻaneʻi, i loaʻa i ka mea make.

Hoʻopili ʻia nā helu haʻahaʻa me kahi prognosis maikaʻi aʻe.

ʻO ka poʻe me ʻelua a ʻoi aʻe paha o kēia mau mea he 90 pākēneka o ka hiki ke hoʻōla piha ʻoiai, i ka poʻe me ʻekolu a ʻoi aku paha, ʻoi aku ka liʻiliʻi ma mua o 5 pākēneka.

Modell a me Conn's post-submergence neurological classification

I ka makahiki 1980, ua paʻi kūʻokoʻa ʻo Conn lāua ʻo Modell a me kā lāua mau hoa hana i kahi hoʻohālikelike neurological postresuscitation e pili ana i ka pae mua o ka ʻike. ʻO Conn et al., ʻaʻole like me Modell, ua manaʻo e hoʻokaʻawale hou i loko o ka hui 'coma'.

Māhele A. Ala

E ala, hoʻomanawanui a hoʻonaʻauao

Māhele B. Dulling

ʻO ka hoʻohaʻahaʻa ʻana o ka ʻike, lethargic ka mea maʻi akā hiki ke hoʻāla ʻia, pane kumu i nā hoʻoulu ʻeha.

ʻAʻole hiki ke hoʻāla ʻia ka maʻi, pane ʻole i nā mea hoʻoulu ʻeha.

Māhele C. Comatose

C1 ʻO ka hoʻololi ʻana i ke ʻano derebrate i nā hoʻoulu ʻeha

C2 Decerebrate-type hoʻonui i nā hoʻoulu ʻeha

C3 Paʻa ʻole a pane ʻole paha i nā mea hoʻoulu ʻeha

Hoʻoholo ʻia ka wānana e like me ka ʻāpana, a maikaʻi loa ia no nā maʻi ma nā ʻāpana A a me B.

I loko o ka māhele C, ʻoi aku ka ʻino o ka wānana i ka hohonu o ka coma.

Ma kahi noiʻi retrospective, ua ola nā maʻi āpau i hoʻonohonoho ʻia i ke komo ʻana i ka māhele A me ka ʻole o ka pilikia.

ʻO 90% o nā maʻi ma ka māhele B i ola me ka ʻole o nā hopena, akā 10% i make.

ʻO ka poʻe maʻi i ka māhele C, 55% i hoʻōla loa, akā 34% i make a 10% i loaʻa i nā ʻeha neurological mau loa.

Ua māhele ʻia ka paʻakikī o ka make ʻana i ʻehā degere

Papa 1: ʻaʻole i hoʻomoʻa ka mea i hōʻeha ʻia i ka wai, ventilates maikaʻi, loaʻa ka oxygenation cerebral maikaʻi, ʻaʻohe pilikia o ka ʻike, hōʻike i ka maikaʻi;

Degere 2: ua hanu ka mea i make i ka wai ma kahi liʻiliʻi, hiki ke ʻike ʻia nā ʻōpala a me / a i ʻole bronchospasm, akā ua lawa ka ventila, paʻa ka ʻike, hōʻike ka mea maʻi i ka hopohopo;

Degere 3: ua komo ka mea i hoʻopaʻa ʻia i ka nui o nā wai, hōʻike i nā rales, bronchospasm a me ka ʻeha hanu, hoʻomohala i ka cerebral hypoxia me nā hōʻailona mai ka disorientation a i ka huhū, i kahi kūlana soporific, aia nā arrhythmias cardiac;

Degere 4: ua hanu ka mea i hōʻeha ʻia i ka wai nui a i ʻole noho i loko o kahi kūlana hypoxic a hiki i ka hopu ʻana i ka naʻau a make.

NUI: ʻo nā hōʻailona koʻikoʻi loa o ka make ʻana ke hiki ke ʻoi aku ka nui o ka wai i hoʻomoʻa ʻia ma mua o 10 ml no ke kilo o ke kaumaha o ke kino, ʻo ia hoʻi ka hapalua lita o ka wai no ke kanaka he 50 kilograms a i ʻole 1 lita inā he 100 kilokani kona kaumaha: inā ka nui o ka wai. ʻoi aku ka liʻiliʻi, ʻoi aku ka liʻiliʻi o nā hōʻailona.