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Polytrauma: wehewehe, hoʻokele, paʻa a paʻa ʻole ka maʻi polytrauma

By Cristiano Antonino On Apr 5, 2023

Me ka "polytrauma" a i ʻole "polytraumatized" i ka lāʻau lapaʻau ke manaʻo nei mākou ma ka wehewehe ʻana i kahi mea maʻi ʻeha e hōʻike ana i nā ʻeha pili i ʻelua a ʻoi aku paha mau ʻāpana o ke kino (ka poʻo, spine, thorax, ʻōpū, pelvis, nā lālā) me ka pōʻino o nā hana i kēia manawa. mea koʻikoʻi (ka hanu a/a i ʻole ke kahe ʻana)

Polytrauma, nā kumu

Hoʻopili pinepine ʻia ke kumu o nā ʻeha he nui i kahi ulia kaʻa koʻikoʻi akā ʻo kēlā me kēia ʻano hanana i hōʻike ʻia e ka ikaika hiki ke komo i nā wahi he nui o ke kino hoʻokahi hiki ke hopena i nā traumas lehulehu.

ʻO ka maʻi maʻi polytrauma pinepine a koʻikoʻi loa.

Ma waena o nā maʻi i make i ka polytrauma:

ʻO 50% o nā polytraumas make i loko o kekona a i ʻole mau minuke o ka hanana, ma muli o ka haki ʻana o ka puʻuwai a i ʻole nā moku nui, ka ʻoki ʻana o ka lolo a i ʻole ka hemorrhage cerebral nui;
ʻO 30% o nā polytraumas make i ka hola gula, ma muli o ka hemopneumothorax, hemorrhagic shock, ate a me ka spleen rupture, hypoxemia, extradural hematoma, hoʻoneʻe kino me ka piʻi ʻana o ke kūlana mua a i ʻole nā hana lapaʻau hewa;
20% o ka polytrauma make i nā lā a i ʻole nā pule e hiki mai ana ma muli o ka maʻi maʻi, nā pilikia hanu, ka hopu ʻana i ka naʻau, a i ʻole ka hemahema multiorgan nui (MOF).

ʻO ka hana kūpono, ka manawa a me ka maikaʻi o ke kōkua kūikawā e hiki ai ke hoʻonui i ka manawa o ke ola o ka mea ʻeha, e hōʻemi ana i ka hopena o ka pōʻino lua.

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Ka mālama ʻana i ka polytrauma

I mea e hoʻohālikelike ai i nā kaʻina i ukali ʻia e ka hui e hoʻokō nei i ka hoʻopakele, ua māhele ʻia ka hope i nā ʻano like ʻole, i kapa ʻia ʻo "rings", penei:

Māhele hoʻomākaukau a me ka ʻōlelo aʻo - Ma kēia ʻāpana, kuleana nā hui no ka hoʻomākaukau pono ʻana i nā ala a me nā mea e pono ai. pono. ʻO ke kikowaena hana ke kuleana, ma ke kumu o ka ʻike i loaʻa iā ia, no ka makaʻala ʻana i ka hui kūpono loa i nā pono.
Hoʻolālā kūlana a me ke hele - I ka hōʻea ʻana, kuleana kēlā me kēia pane no ka hoʻokele palekana a me ka loiloi pilikia. ʻO nā kuleana i hoʻokumu ʻia e ke kānāwai, ʻo ia ka ʻike ʻana o kahi luna a me ka hoʻopaʻa ʻana i nā lako pale pilikino pono e ʻaʻahu pono ʻia a ma ke ʻano hana kūpono.
Nā loiloi mua a me ke kula kiʻekiʻe - ʻO nā loiloi kūpono o nā hana koʻikoʻi e pili mau i nā hana i manaʻo ʻia e ka kōkua mua a me nā protocol resuscitation a me ka makaʻala ʻana o nā hui hoʻopakele holomua (ALS). Hoʻomaopopo ʻia kēia mau mana me ka acronym A B C D E.
Kūkākūkā me ka Operations Center - Ma kēia māhele, ma waho aʻe o ke koho ʻana a me ka hāʻawi ʻana i ka wahi e hele ai, ua hōʻoia ʻia ka manawa e kelepona ai i nā ala kaʻa ʻē aʻe a i ʻole e hoʻolālā i kahi hui me kahi hui ALS.
ʻO ka lawe ʻana me ka nānā ʻana - Ma kēia māhele, ma waho aʻe o ka nānā mau ʻana i nā hana koʻikoʻi o ka mea maʻi, hiki ke hāʻawi ʻia i ka hale haukapila me ka ʻike e pili ana i nā ʻāpana koʻikoʻi a me nā mea āpau e hiki ai i ka hale ke hoʻomākaukau e hoʻokipa a mālama i kahi kanaka ʻeha nui.
Ka mālama ola kino ma ka haukapila.

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Aia kekahi lula koʻikoʻi a maʻalahi no ka hoʻomanaʻo ʻana i ka mālama ʻana i kahi maʻi polytrauma, e pili ana i nā leka mua o ka alphabet:

ʻO nā ala ea: a i ʻole "kahi ʻāpana hanu", ʻoiai ʻo ka hoʻomalu ʻana i kona patency (ʻo ia hoʻi ka hiki ʻana o ka ea ma loko ona) ke hōʻike nei i ke kūlana mua a ʻoi loa ka hopena no ke ola ʻana o ka mea maʻi;
ʻO ka hanu: a i ʻole "hanu", i manaʻo ʻia he "maikaʻi o ka hanu"; Hoʻopili ʻia me ka helu mua, ua hoʻonui ʻia me ke koʻikoʻi o ke kino neurological, no ka mea, hāʻawi kekahi mau ʻeha lolo i nā hiʻohiʻona hanu (ʻo ia ka nui/pehea/pehea ka hana ʻana o ka mea maʻi i nā hana hanu), e like me ka Cheyne-Stokes hanu;
Ka'apuni: a i 'ole ka "circulation", no ka mea, he mea nui ka hana pololei o ka pu'uwai na'au (a me na helu elua ma mua o ka cardio-pulmonary) no ke ola;
Disability: a i ʻole “disability”, ʻoi aku ka nui inā he kānalua spinal ʻeha a ʻoi aku paha ma ke ʻano maʻamau o ka ʻōnaehana nūnū waena, no ka mea hiki i nā ʻeha ma kēia ʻāpana ke hoʻoulu i kahi kūlana haʻalulu i kona wā mua, ʻaʻole hiki ke ʻike ʻia ke ʻike ʻole ʻia e ka maka akamai, a hiki ke "hamu" e lawe i ka polytraumatized i make (ʻaʻole ia he coincidence i kekahi manawa ke kamaʻilio nei mākou no ka haʻalulu o ke kuamoʻo);
Hōʻike: a i ʻole "hōʻike" o ka mea maʻi, wehe iā ia i ke kapa no ka ʻimi ʻana i nā ʻeha, ʻoiai e mālama ana i ka pilikino a me ka mahana (hiki ke unuhi ʻia ʻo E-nviroment).

ʻO ke kōkua mua, pehea e hana ai me ka polytrauma

Once i ka ka lumi kūikawā, E hoʻopaʻa ʻia ka mea maʻi polytraumatized i nā loiloi āpau e koi ʻia e nā alakaʻi no ka trauma.

ʻO ka mea maʻamau, hana ʻia nā loiloi lua no ka trauma, nā kinoea koko, a me ke kemika koko a me ka hui ʻana i ke koko e ukali ʻia e nā noiʻi radiological, e hilinaʻi ʻia i ke kiʻekiʻe o ka hemodynamic stability.

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Ka maʻi polytrauma kūpaʻa

Inā he hemodynamically paʻa ka mea maʻi, ma waho aʻe o nā noiʻi ecoFAST kumu, nā x-ray o ka umauma a me ke pelvis, hiki ke hana ʻia nā noiʻi CT kino holoʻokoʻa, me ka ʻole a me ke ʻano like ʻole, hiki ke hōʻike i nā ʻeha neurological a me nā moku nui.

ʻO nā noiʻi diagnostic radiological i hana ʻia ma kahi polytrauma hemodynamically stable koʻikoʻi ka maʻamau:

ʻO ka ultrasound wikiwiki;
X-ray o ka umauma;
pelvis x-ray;
iwi poʻo CT;
iwi kuamoʻo CT;
umauma CT;
CT ʻōpū.

Hiki ke hana ʻia nā noiʻi hohonu e like me ka angiography a me ka resonance magnetic; ʻO ka mea nui, hana ʻia ʻo MRI ma ka iwi kuamoʻo inā kānalua ʻia ka myelic lesions (o ka spinal cord), no ka mea, hōʻike ʻo CT i ka ʻāpana iwi iwi maʻemaʻe o ka iwi kuamoʻo a ʻaʻole ia he noiʻi kūpono no ke aʻo ʻana i ke kuamoʻo.

Hiki ke hana ʻia ʻo MRI no ke aʻo ʻana i ka fossa cranial posterior, a no nā hematoma maʻalahi, ʻaʻole i hōʻike maikaʻi ʻia ma CT.

Hoʻomaʻamaʻa pinepine ʻia nā X-ray o nā lālā i ka hopena o nā hoʻokolohua ma luna.

ʻAʻole pono ka x-ray o ke kuamoʻo cervical no ka noiʻi hohonu ʻana i nā ʻeha iwi, no ka mea, ʻaʻole ia e hōʻike pono i ka vertebrae C1 a me C2 a ʻaʻole lawa e hoʻomaopopo i kahi o ka haʻihaʻi vertebral.

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Ka maʻi polytrauma paʻa ʻole

Inā he hemodynamically paʻa ka maʻi polytraumatized, no ka laʻana ma muli o ke kahe o waho a i loko (a i ʻole nā mea ʻelua), ʻaʻole i hoʻoholo ʻia ma hope o ka hoʻohana ʻana i nā crystalloids, colloids a me / a i ʻole ka plasma hau hou a me ke koko, ʻaʻole e hana ka mea maʻi i nā noiʻi CT. akā, e hoʻopaʻa ʻia nā noiʻi maʻamau a ma hope o ke kaʻina ʻana no ka hoʻoponopono ʻana i nā pilikia e hoʻopilikia ai.

Inā hōʻea ka mea maʻi i ka ED me ka paʻa ʻole akā ua hoʻopaʻa ʻia ma o nā kōkua lapaʻau, hiki i ka hui trauma ke noʻonoʻo inā e hana hou i nā noiʻi hohonu (e like me CT). ʻO ka mea nui, ʻo nā noiʻi radiological i hana ʻia i kahi maʻi polytrauma paʻa ʻole (ʻo ia ka mea paʻa ʻole ma hope o ka lāʻau lapaʻau) ʻo ia ka: -ultrasound (ʻaʻole paha FAST) -X-ray umauma -pelvis X-ray -cervical spine X-ray Cervical spine X- ʻAʻole hana ʻia ka ray i nā manawa a pau .

Ma hope o ka hoʻokolokolo ʻana

I ka pau ʻana o nā noiʻi diagnostic āpau, ʻike ʻia ka pono no ka ʻoki ʻana i ka mea maʻi paʻa a i ʻole nā hana hiki ke hoʻonohonoho ʻia no nā lā aʻe.

Lawe ʻia ka mea maʻi paʻa ʻole i ke keʻena hana ma ka hopena o nā noiʻi kumu a e hoʻokau ʻia i nā noiʻi hohonu hou aʻe ma ka hopena o ke ʻoki ʻana a i nā hana ʻoki lua paha i nā lā aʻe.

Hoʻokomo pinepine ʻia ka poʻe maʻi Polytrauma i nā keʻena mālama koʻikoʻi, i ʻike ʻia ʻo "resuscitation" a i ʻole nā ʻāpana mālama kino neurosurgical.