ʻO ka hoʻohana ʻana i ka spinal column immobilization me ka papa spine: nā pahuhopu, nā hōʻailona a me nā palena o ka hoʻohana
Hoʻohana ʻia ka hoʻopaʻa ʻana i ka neʻe ʻana o ke kuamoʻo me ka papa spine lōʻihi a me ke kola cervical i nā hihia o ka trauma, ke hoʻokō ʻia kekahi mau koi, e kōkua i ka hōʻemi ʻana i ka manawa o ka hōʻeha spinal cord.
Nā hōʻailona no ka noi ʻana o spinal ʻO ka palena o ka neʻe ʻana he a GCS o ka emi malalo o 15, hoike o ka ona, palupalu a eha paha ma ka laina waena o ka 'ā'ī a i ʻole ke kua, nā hōʻailona neurological focal a/a i ʻole nā hōʻailona, ke ʻano anatomical o ka iwi kuamoʻo, a me nā kūlana hoʻopilikia a i ʻole nā ʻeha.
Introduction to spinal trauma: i ka manawa a me ke kumu e pono ai ka spine board
ʻO nāʻeha ulia pōpilikia ke kumu nui o ka hōʻeha ʻana i ke kuamoʻo ma ʻAmelika Hui Pū ʻIa a me nā ʻāina ʻē aʻe, me ka maʻi o ka makahiki ma kahi o 54 mau hihia ma ka miliona o ka heluna kanaka a ma kahi o 3% o nā komo ʻana i ka haukapila no ka trauma blunt.[1]
ʻOiai ʻo nā ʻeha o ke kuamoʻo he hapa liʻiliʻi wale nō o nā ʻeha trauma blunt, aia lākou i waena o nā mea nui loa i ka maʻi maʻi a me ka make.[2][3]
No laila, i ka makahiki 1971, ua noi ka American Academy of Orthopedic Surgeons e hoʻohana i kahi ka paila pūpū a lōʻihi papa spinal e hoʻopaʻa i ka neʻe ʻana o ke kuamoʻo i nā poʻe maʻi i manaʻo ʻia e ʻeha ʻia ke kuamoʻo, ma muli wale nō o ke ʻano o ka ʻeha.
I kēlā manawa, ua hoʻokumu ʻia kēia ma ka ʻaelike ma mua o ka hōʻike.[4]
I nā makahiki he mau makahiki mai ka hoʻopaʻa ʻana i ka neʻe ʻana o ke kuamoʻo, ua lilo ka hoʻohana ʻana i ke kola cervical a me ka papa spine lōʻihi i mea maʻamau i ka mālama prehospital.
Hiki ke loaʻa iā ia i loko o kekahi mau alakaʻi, me ka Advanced Trauma Life Support (ATLS) a me Prehospital Trauma Life Support (PHTLS) alakaʻi.
ʻOiai kā lākou hoʻohana nui ʻana, ua nīnau ʻia ka pono o kēia mau hana.
I loko o kahi noiʻi honua e hoʻohālikelike ana i ka poʻe i hoʻopaʻa ʻia i ka neʻe ʻana o ka spinal motion i ka poʻe ʻaʻole i loaʻa, ua ʻike ʻia ka poʻe i loaʻa ʻole i ka mālama maʻamau me ka hoʻopaʻa ʻana i ka spinal motion ka liʻiliʻi o nā hōʻeha neurologic me ke kīnā.
Eia naʻe, pono e hoʻomaopopoʻiaʻaʻole i kūlike kēia mau maʻi no ka nui o kaʻeha.[5]
I ka hoʻohana ʻana i nā mea manawaleʻa ʻōpio olakino, ua nānā ʻia kahi noiʻi ʻē aʻe i ka neʻe ʻana o ka spine lateral ma kahi papa spine lōʻihi i hoʻohālikelike ʻia me kahi moena kauā a ʻike ʻia ua ʻae ka papa spine lōʻihi i ka neʻe ʻana i ka ʻaoʻao nui.[6]
I ka makahiki 2019, ua nānā ʻia kahi noiʻi prehospital retrospective, observational, multi-agency inā he hoʻololi a i ʻole ka hoʻololi ʻana i nā ʻeha spinal cord ma hope o ka hoʻokō ʻana i kahi protocol EMS e kaupalena ana i ka mālama ʻana i ka spinal i ka poʻe me nā kumu koʻikoʻi koʻikoʻi a i ʻole nā hōʻike hōʻike maʻamau a ʻike ʻia aia aia. ʻaʻohe ʻokoʻa i ka nui o nā ʻeha o ke kuamoʻo.[7]
NA PAPA NUI KAHI? E HELE I KA PAHU SPENCER MA EMERGENCY EXPO
I kēia manawa ʻaʻohe hoʻāʻo hoʻāʻo hoʻokele randomized kiʻekiʻe e kākoʻo a hōʻole paha i ka hoʻohana ʻana i ke kaohi ʻana o ka spinal motion.
ʻAʻole paha e loaʻa ka mea maʻi e hāʻawi manawaleʻa no kahi noiʻi i hiki ke hopena i ka maʻi lolo mau e uhaʻi i nā alakaʻi koʻikoʻi o kēia manawa.
Ma muli o kēia mau haʻawina a me nā haʻawina ʻē aʻe, ʻōlelo ʻia nā alakaʻi hou e kaupalena ʻia ka hoʻohana ʻana o ka spinal board lōʻihi i ka poʻe e pili ana i ka hana o ka hōʻeha a i ʻole e pili ana i nā hōʻailona a i ʻole nā hōʻailona e like me ka mea i wehewehe ʻia ma hope o kēia ʻatikala a e kaupalena ʻia ka lōʻihi o ka hoʻohana ʻana o ka mea maʻi i ka immobilized. .
Nā hōʻailona no ka hoʻohana ʻana i ka papa spine
Ma ke kumumanaʻo Denis, ua manaʻo ʻia ka hōʻeha ʻana i ʻelua kolamu a ʻoi aku paha he haki paʻa ʻole e hōʻeha i ke kuamoʻo e waiho ana i loko o ke kolamu.
ʻO ka pōmaikaʻi i manaʻo ʻia o ka hoʻopaʻa ʻana i ka spinal motion, ʻo ia ma ka hōʻemi ʻana i ka neʻe ʻana o ka spinal, hiki i kekahi ke hōʻemi i ka hiki ke loaʻa i nā ʻeha o ke kuamoʻo lua mai nā ʻāpana haʻihaʻi paʻa ʻole i ka wā o ka extrication, lawe ʻana, a me ka loiloi o nā maʻi trauma.[9]
ʻO nā hōʻailona no ka hoʻopaʻa ʻana i ka neʻe ʻana o ka spinal e pili ana i ka protocol i hoʻomohala ʻia e nā alakaʻi lawelawe olakino kūloko a hiki ke ʻano like ʻole.
Eia naʻe, ua hoʻomohala ka American College of Surgeons Committee on Trauma (ACS-COT), ka American College of Emergency Physicians (ACEP), a me ka National Association of EMS Physicians (NAEMSP) i kahi ʻōlelo hui e pili ana i ke kaohi ʻana o ka spinal motion i nā poʻe maʻi trauma blunt. i 2018 a ua papa inoa i nā hōʻailona aʻe:[10]
- Hoʻololi ʻia ka pae o ka ʻike, nā hōʻailona o ka ʻona, GCS <15
- ʻO ka ʻeha o ke kuamoʻo waena a i ʻole ka ʻeha
- ʻO nā hōʻailona neurologic focal a i ʻole nā hōʻailona e like me ka nāwaliwali o ka kaʻa, ka helu
- Anatomic deformity o ka iwi kuamoʻo
- Hoʻopilikia i nā ʻeha a i ʻole nā kūlana (e laʻa, haʻihaʻi, wela, naʻau pilikia, pale ʻōlelo, etc.)
ʻO ka ʻōlelo like pū kekahi i hāʻawi i nā ʻōlelo aʻoaʻo no nā maʻi maʻi trauma blunt pediatric, me ka ʻike ʻana ʻaʻole pono ka makahiki a me ka hiki ke kamaʻilio ke kumu i ka hoʻoholo ʻana no ka mālama spinal prehospital.
ʻO kēia nā hōʻailona i manaʻo ʻia:[10]
- ʻO ka hoʻopiʻi o ka ʻeha ʻāʻī
- Hoʻopiʻi
- ʻO ka hemahema neurological
- Hoʻololi ʻia ke kūlana noʻonoʻo, me ka GCS <15, ka ʻona, a me nā hōʻailona ʻē aʻe (agitation, apnea, hypopnea, somnolence, etc.)
- Ke komo ʻana i ka hui ʻana o ke kaʻa kaʻa koʻikoʻi, ʻeha luʻu hopena kiʻekiʻe, a i ʻole he ʻeha kino nui.
Contraindications i ka hoʻohana ʻana i ka papa spine
ʻO kahi contraindication pili i nā poʻe maʻi me ka ʻehaʻeha i ke poʻo, ka ʻāʻī, a i ʻole ka ʻōpū me ka ʻole o ka neurologic deficit a i ʻole ka hoʻopiʻi.[11]
Wahi a nā haʻawina i paʻi ʻia ma ka Eastern Association for the Surgery of Trauma (EAST) a me The Journal of Trauma, ʻo ka poʻe maʻi me ka trauma penetrating i loaʻa i ka spinal immobilization ʻelua ʻelua o ka make e like me ka poʻe maʻi ʻaʻole.
ʻO ka hoʻokuʻu ʻana i ka mea maʻi he kaʻina hana manawa, ma waena o 2 a 5 mau minuke, ʻaʻole ia e hoʻopaneʻe wale i ka lawe ʻana no ka mālama pono akā hoʻopaneʻe pū kekahi i nā maʻi prehospital ʻē aʻe no ka mea he ʻelua kanaka kēia.[12][13]
KA LEKIO O KA POE HOPE A puni ka honua? E KIPA I KA HALE ELEI O EMS MA EMERGENCY EXPO
ʻO nā mea pono no ka immobilization spinal: ke kola, ka papa spine lōʻihi a pōkole
ka pono pono no ka kaohi ana i ke kuamoo e pono ai ka papa kuamoo (he loihi a he pokole paha) a me ke kola iwi kuamoo.
Na Papa Hukupae loloa
Ua hoʻokō mua ʻia nā papa spine lōʻihi, i hui pū ʻia me ke kola cervical, e hoʻokuʻu i ka iwi kuamoʻo no ka mea i manaʻo ʻia ʻo ka lawelawe pono ʻole ʻana i ke kula e hiki ke hōʻeha a hoʻonui paha i nā ʻeha o ke kuamoʻo.
He ʻuʻuku nō hoʻi ka papa kuamoʻo lōʻihi a lawelawe ʻia ma ke ʻano he ala kūpono no ka lawe ʻana i nā poʻe maʻi ʻike ʻole, hoʻemi i ka neʻe makemake ʻole, a uhi i ka ʻāina like ʻole.[14]
Na Papa iwi kuamoo pokole
ʻO nā papa spine pōkole, ʻike ʻia hoʻi ʻo nā mea hoʻopau pae waena, ʻoi aku ka haiki ma mua o ko lākou mau hoa lōʻihi.
ʻO ko lākou lōʻihi pōkole e hiki ai ke hoʻohana i nā wahi i pani ʻia a paʻa paha, ka mea maʻamau i ka hui ʻana o nā kaʻa.
Kākoʻo ka papa spine pōkole i ke kuamoʻo a me ka spine cervical a hiki i ka hiki ke kau ʻia ka mea maʻi ma luna o ka papa spine lōʻihi.
ʻO kahi ʻano maʻamau o ka papa spine pōkole ka Kendrick Extrication Device, ʻokoʻa ia mai ka papa kuamoʻo pōkole maʻamau no ka mea he semi-ʻoʻoleʻa a hoʻonui ʻia ma hope e hoʻopuni i nā ʻaoʻao a me ke poʻo.
E like me nā papa spine lōʻihi, hoʻohana pū ʻia kēia me nā kola cervical.
ʻO nā Collars Cervical: ka "C Collar"
Hiki ke hoʻokaʻawale ʻia nā kola cervical (a i ʻole C Collar) i ʻelua mau ʻāpana ākea: palupalu a ʻoʻoleʻa paha.
I loko o nā hoʻonohonoho trauma, ʻo nā kola cervical paʻa ka immobilizer o ke koho ʻana no ka mea e hāʻawi lākou i ka palena ʻoi aku o ka cervical.[15]
Hoʻolālā ʻia nā kola ʻāʻī e loaʻa kahi ʻāpana hope e hoʻohana ana i nā ʻiʻo trapezius ma ke ʻano he kākoʻo a me kahi ʻāpana mua e kākoʻo ana i ka mandible a hoʻohana i ka sternum a me nā clavicles i mea kākoʻo.
ʻAʻole hāʻawi ʻia nā kola cervical i ka immobilization kūpono a koi i nā hale kākoʻo ʻaoʻao hou aʻe, ma ke ʻano he Velcro foam pad i loaʻa ma nā papa spine lōʻihi.
KOKUA MUA? E KIPA I KA DMC DINAS MEDICAL CONSULTANTS BOOTH MA EMERGENCY EXPO
ʻano hana
Loaʻa kekahi mau ʻenehana no ka hoʻokomo ʻana i kekahi i loko o ke kaohi ʻana o ke kuamoʻo, ʻo kekahi o ka mea maʻamau ʻo ka supine log-roll technique i hōʻike ʻia ma lalo nei a hana ʻia, kūpono, me kahi hui 5-kanaka, akā ma ka liʻiliʻi, he hui ʻehā.[16 ]
No ka Hui Elima
Ma mua o ka hoʻokuʻu ʻana, e kau ka mea maʻi i ko lākou mau lima ma luna o ko lākou umauma.
Pono e hāʻawi ʻia kahi alakaʻi o ka hui i ke poʻo o ka mea maʻi nāna e hana i ka hoʻopaʻa ʻana i ka manual inline ma ka hopu ʻana i nā poʻohiwi o ka mea maʻi me ko lākou manamana lima ma ka ʻaoʻao hope o ka trapezius a me ko lākou manamana lima ma ka ʻaoʻao mua me ka paʻa paʻa ʻana o nā lima i nā ʻaoʻao ʻaoʻao. ke poʻo o ka mea maʻi e kaupalena i ka neʻe ʻana a hoʻopaʻa i ka spine cervical.
Inā loaʻa, pono e kau ʻia kahi kola cervical i kēia manawa me ka ʻole e hoʻokiʻekiʻe i ke poʻo o ka mea maʻi mai ka honua. Inā ʻaʻole loaʻa kekahi, e mālama i kēia hoʻopaʻa ʻana i ka wā o ka ʻenehana log roll.
Pono e hoʻonoho ʻia ka lālā ʻelua ma ka ʻāʻī, ʻekolu ma ka pūhaka, a ʻo ka lālā o ka hui ʻehā ma nā wāwae me ko lākou mau lima ma ka ʻaoʻao loa o ka mea maʻi.
Pono nā lālā ʻelima e hoʻoheheʻe i ka papa spine lōʻihi ma lalo o ka mea maʻi ma hope o ka ʻōwili ʻia ʻana.
Ma ke kauoha a ka lālā o ka hui 1 (ma ka helu ʻekolu), e ʻōwili nā lālā o ka hui 1 a 4 i ka mea maʻi, a i ia manawa e hoʻoheheʻe ka lālā o ka hui ʻelima i ka papa spine lōʻihi ma lalo o ka mea maʻi.
Eia hou, ma ke kauoha a ka lālā o ka hui, e ʻōwili ʻia ka mea maʻi ma luna o ka papa spine lōʻihi.
E hoʻokuʻu i ka mea maʻi ma ka papa a hoʻopaʻa i ke kino me nā kaula i ukali ʻia e ke pelvis a me nā wāwae o luna.
E hoʻopaʻa i ke poʻo ma ke kau ʻana i nā kāwele i ʻōwili ʻia ma kēlā ʻaoʻao kēia ʻaoʻao a i ʻole kahi mea kūʻai kūʻai aku a laila kau i ka lipine ma ka lae a hoʻopaʻa ʻia ma nā kihi o ka papa spine lōʻihi.
No ka Hui ʻEhā
Eia hou, pono e hāʻawi ʻia kahi alakaʻi hui i ke poʻo o ka mea maʻi a hahai i ka ʻenehana like i hōʻike ʻia ma luna.
Pono e hoʻonoho ʻia nā lālā ʻelua ma ka ʻokiʻoki me kekahi lima ma ka poʻohiwi lōʻihi a ʻo kekahi ma ka ʻūhā lōʻihi.
Pono e hoʻonoho ʻia ka lālā o ka hui ʻekolu ma nā wāwae, hoʻokahi lima ma ka ʻūhā lōʻihi a ʻo kekahi ma ka wāwae lōʻihi.
E hoʻomanaʻo e ʻōlelo ʻia e kau nā lima o nā lālā o ka hui ma luna o kekahi ma ka ʻūhā.
ʻO ka lālā o ka hui ʻehā e hoʻoheheʻe i ka papa spine lōʻihi ma lalo o ka mea maʻi, a hahai ʻia ke koena o ka ʻenehana e like me ka mea i hōʻike ʻia ma luna.
Nā pilikia o ka hoʻohana ʻana i ka spine board i ka immobilization spinal
Nā hanaʻeha
ʻO ka hoʻopiʻi ʻana i ka poʻe e loaʻa ana i ka papa spine lōʻihi lōʻihi a me ka hoʻopaʻa ʻana i ka neʻe ʻana o ka spine cervical he mau maʻi maʻi puʻuwai, me kahi maʻi i hōʻike ʻia he 30.6%.[17]
Wahi a ka National Pressure Ulcer Advisory Panel, ua helu hou ʻia nā maʻi ʻeha ma ke ʻano he ʻeha puʻuwai.
Ma muli o ke kaomi, maʻamau ma luna o nā iwi koʻikoʻi, no ka manawa lōʻihi e hopena i ka pōʻino kūloko o ka ʻili a me ka ʻiʻo palupalu.
I ka wā mua, paʻa mau ka ʻili akā hiki ke piʻi i ka maʻi maʻi ma hope.[18]
ʻOkoʻa ka nui o ka manawa e hoʻomohala ai i kahi ʻeha puʻupuʻu, akā ma ka liʻiliʻi o hoʻokahi haʻawina i hōʻike ʻia e hoʻomaka paha ka ʻeha ʻiʻo i loko o 30 mau minuke i nā mea manawaleʻa olakino.[19]
I kēia manawa, ʻo ka manawa maʻamau i hoʻopau ʻia ma ka papa spine lōʻihi ma kahi o 54 a 77 mau minuke, ma kahi o 21 mau minuke i loaʻa i ka ED ma hope o ka lawe ʻana.[20][21]
Me kēia noʻonoʻo, pono e hoʻāʻo nā mea hoʻolako āpau e hōʻemi i ka manawa o ka poʻe maʻi e hoʻohana ʻole ʻia ma nā papa spine lōʻihi a i ʻole me nā kola cervical no ka mea e alakaʻi ʻia nā mea ʻelua i nā hōʻeha ʻeha.
Hoʻopaʻa hanu
Ua hōʻike nā haʻawina lehulehu i ka emi ʻana o ka hana hanu ma muli o nā kaula i hoʻohana ʻia ma nā papa spine lōʻihi.
I loko o nā poʻe manawaleʻa ʻōpio olakino, ʻo ka hoʻohana ʻana i nā kaula papa spine lōʻihi ma luna o ka umauma i hopena i ka emi ʻana o nā ʻāpana pulmonary, me ka ikaika ikaika, ka nui o ka expiratory ikaika, a me ke kahe ʻana o ka waena waena e hopena i kahi hopena paʻa.[22]
I loko o kahi noiʻi e pili ana i nā keiki, ua hoʻemi ʻia ka mana koʻikoʻi ikaika i 80% o ka baseline.[23] Ma kekahi noiʻi ʻē aʻe, ua ʻike ʻia nā moena paʻa paʻa a me nā moena maloʻo e hoʻopaʻa i ka hanu ma ka awelika o 17% i nā mea manawaleʻa olakino.[24]
Pono e mālama pono i ka wā e hoʻopaʻa ʻia ai nā mea maʻi, ʻoi aku ka poʻe me ka maʻi pulmonary mua a me nā keiki a me nā ʻelemakule.
Pain
ʻO ka hoʻopiʻi maʻamau, i kākau maikaʻi ʻia o ka hoʻopaʻa ʻana i ka neʻe ʻana o ke kuamoʻo lōʻihi, ʻo ia ka ʻeha, a hiki i ka 30 mau minuke.
Hōʻike pinepine ʻia ka ʻeha me ke poʻo, ka ʻeha kua, a me ka ʻeha maʻa.[25]
Eia hou, a i kēia manawa he kumuhana hou, pono e hoʻemi ʻia ka manawa i hoʻohana ʻia ma ka papa spine lōʻihi e hōʻemi i ka ʻeha.
ʻO ke koʻikoʻi o ke kino o ka ʻeha spinal cord: kuleana o ke kola a me ka papa spine
Hiki ke hōʻeha i ka ʻeha o ke kuamoʻo a, no laila, ka pōʻino o ke kuamoʻo i hiki ke hopena i ka maʻi maʻi a me ka make.
I nā makahiki 1960 a me 1970, ua hoʻohana ʻia ka ʻae ʻana i ka neʻe ʻana o ke kuamoʻo no ka hōʻemi a pale ʻana paha i nā sequelae neurological i manaʻo ʻia he lua ia i nā ʻeha kolamu.
ʻOiai ua hoʻohana nui ʻia e like me ke ʻano o ka mālama ʻana, ʻaʻole i loaʻa i ka palapala kahi kiʻekiʻe kiʻekiʻe, ka noiʻi e pili ana i nā hōʻike e noiʻi ana inā loaʻa ka hopena o ke kaohi ʻana o ka spinal i nā hopena neurological.[26]
Eia kekahi, i nā makahiki i hala iho nei, ua ulu nui nā hōʻike hōʻike e hōʻike ana i nā pilikia e hiki mai ana o ke kaohi ʻana o ka spinal motion.[17][22][25][20]
No laila, ua ʻōlelo ʻia nā alakaʻi hou e hoʻohana pono ʻia ka palena o ka neʻe ʻana o ke kuamoʻo i nā heluna maʻi kūikawā.[10]
ʻOiai he mea maikaʻi ke kaohi ʻana o ka spinal motion i kekahi mau kūlana, pono ka mea hoʻolako e kamaʻāina i nā alakaʻi a me nā pilikia e hiki ai i nā mea hoʻolako ke mākaukau e hoʻohana i kēia mau ʻenehana a hoʻomaikaʻi i nā hopena maʻi.
Hoʻonui i nā hopena o ka hui mālama ola
Hiki i nā poʻe maʻi i loaʻa i ka ʻeha ʻeha puʻupuʻu me nā hōʻailona he nui.
He mea nui i nā limahana mālama ola kino ke kuleana no ka loiloi mua ʻana o kēia mau maʻi e kamaʻāina i nā hōʻailona, contraindications, complications hiki, a me ke ʻano kūpono o ka hoʻokō ʻana i ke kaohi o ka spinal motion.
Hiki ke loaʻa kekahi mau alakaʻi e kōkua i ka hoʻoholo ʻana i ka poʻe maʻi e hoʻokō i nā pae hoʻohālike no ka hoʻopaʻa ʻana i ka neʻe spinal.
Malia paha ʻo nā alakaʻi i ʻike nui ʻia a ʻae ʻia ʻo ia ka ʻōlelo a ka American College of Surgeons Committee on Trauma (ACS-COT), ka National Association of EMS Physicians (NAEMSP), a me ka American College of Emergency Physicians (ACEP). ).[10] ʻOiai ʻo kēia nā alakaʻi a me nā ʻōlelo aʻoaʻo o kēia manawa, ʻaʻohe kiʻekiʻe kiʻekiʻe o ka randomized control trials a hiki i kēia lā, me nā manaʻo e pili ana i nā noiʻi nānā ʻana, nā cohorts retrospective, a me nā noiʻi hihia.[26]
Ma waho aʻe o ka ʻike ʻana i nā hōʻailona a me nā contraindications no ka hoʻopaʻa ʻana i ka neʻe ʻana o ka spinal motion, he mea nui nō hoʻi i ka poʻe ʻoihana mālama ola ke kamaʻāina i nā pilikia e like me ka ʻeha, ka ʻeha ʻeha, a me ka hoʻololi ʻana i ka hanu.
I ka hoʻokō ʻana i ke kaohi ʻana o ka spinal motion, pono nā lālā a pau o ka interprofessional health care professionalsteam e kamaʻāina i kā lākou ʻenehana makemake a hoʻohana i ke kamaʻilio maikaʻi e hoʻokō pono i ke ʻano hana a hōʻemi i ka neʻe ʻana o ke kuamoʻo. Pono e hoʻomaopopo ka poʻe ʻoihana mālama ola e hoʻemi ʻia ka manawa i hoʻohana ʻia ma ka papa spine lōʻihi e hōʻemi i nā pilikia.
I ka hoʻololi ʻana i ka mālama, pono e kamaʻilio ka hui EMS i ka manawa holoʻokoʻa i hoʻohana ʻia ma ka papa spine lōʻihi.
Ke hoʻohana nei i nā alakaʻi hou loa, ka kamaʻāina i nā pilikia i ʻike ʻia, ka palena ʻana i ka manawa i hoʻohana ʻia ma ka papa spine lōʻihi, a me ka hoʻohana ʻana i nā hopena kamaʻilio interprofessional maikaʻi loa no kēia mau maʻi hiki ke hoʻonui ʻia. [Papa 3]
E hoʻomaopopo ':
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