Kev nruj kev tsiv ntawm kev raug mob: cuam tshuam hauv kev raug mob

By Cristiano Antonino On Sep 9, 2022

Nkag mus rau kev raug mob ua rau muaj kev sib cuam tshuam ntawm ntau yam kev raug mob. Qhov xwm txheej tsis tuaj yeem tshwm sim ntawm kev raug mob ua rau muaj ntau yam kev nthuav qhia tus neeg mob tshwj xeeb

Tshooj lus no yuav tsom mus rau ntau yam uas ua rau muaj ntau yam pom hauv kev raug mob:

Cov ntsiab lus ntawm kev raug mob, cov yam ntxwv ntawm kev nkag mus rau cov khoom, yuav ua li cas rau cov phom / stabbings, thiab kev ntsuam xyuas thiab kev tswj cov neeg mob uas raug mob thib ob rau kev ua phem rau kev raug mob.

Penetrating trauma: Elements of Injury

Cov ntsiab lus tseem ceeb uas ua rau cov nyiaj raug mob pom nrog kev raug mob yog crushing, ncab, thiab cavitating raug mob.

Qhov sib xyaw ua ke ntawm peb lub ntsiab lus yog nyob ntawm qhov loj, qhov loj, qhov loj, thiab qhov nrawm ntawm cov khoom nkag mus nrog rau hom (s) ntawm cov ntaub so ntswg ntawm cov khoom traverses.

CRUSHING: Qhov no yog thawj lub zog ntawm lub cev: ua ntej txhua yam khoom pierces lub cev nws siv lub zog crushing rau ntawm daim tawv nqaij thiab hauv qab cov leeg nqaij / cov kabmob.

Tib lub zog crushing no txuas ntxiv mus rau pem hauv ntej ntawm cov khoom thaum cov khoom hla mus rau hauv lub cev.

Qhov no ua rau cov nram qab no, ib tug stretching quab yuam.

STRETCHING: Thaum cov ntaub so ntswg ntawm qhov cuam tshuam nrog ib qho khoom raug crushed, tag nrho cov ntaub so ntswg yog stretched. Ib yam li nrog crushing rog, stretching rog tshwm sim thoob plaws hauv cov khoom traversal ntawm cov ntaub so ntswg.

Vim qhov dav ncav cuag ntawm lub zog stretching, nws yog lub luag haujlwm rau kev puas tsuaj nyob rau hauv ib qho chaw dav dav nyob ib ncig ntawm cov khoom tiag tiag.

Mus ntsib SPENCER's sawv ntawm Emergency EXPO

CAVITATION: Cavitation yog qhov khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob khoob.

Qhov ceev ntawm ib yam khoom yog ib qho kev txiav txim loj ntawm cavitation, raws li loj stretching rog tshwm sim los ntawm high-ceev khoom stretches loj cheeb tsam ntawm cov ntaub so ntswg tshaj lawv muaj peev xwm mus recoil nyob rau hauv ib tug txheej txheem, uas ua rau loj cheeb tsam ntawm shredded thiab ploj ntaub so ntswg.

Cov yam ntxwv ntawm Penetrating Objects

Cov yam ntxwv tseem ceeb tshaj plaws los xav txog cov khoom nkag mus yog cov duab, qhov loj, qhov loj, qhov nrawm, thiab cov ntaub so ntswg uas hla los ntawm cov khoom.

SHAPE/SIZE: Thaum xav txog ua ke cov khoom no tsim "hloov seem" ntawm cov khoom. Xav txog qhov no yog "ntse" lossis "point" ntawm ib qho khoom.

Cov khoom ntse ntse heev ua rau lub zog loj heev ntawm kev sib tsoo thiab kev quab yuam tsawg tsawg, ua rau cov ntaub so ntswg hauv lawv txoj kev ncaj nraim thaum tawm hauv thaj chaw ib puag ncig tsis muaj kev puas tsuaj.

Lub cavitation ntawm cov kev raug mob no tsawg kawg yog qhov zoo tshaj plaws, muab qhov qis qis zog ntawm cov ntaub so ntswg.

Blunt cov khoom muaj qhov sib txawv ntawm kev raug mob, ua rau lub zog crushing nyob rau hauv ib cheeb tsam loj dua thaum lub zog stretching loj heev thaum lawv tsoo los ntawm cov ntaub so ntswg nrog rau lub zog loj heev.

Lub cavitation ntawm cov kev raug mob no feem ntau tseem ceeb vim yog qhov loj ntawm cov ntaub so ntswg puas nyob ib puag ncig lawv.

Cov duab thiab qhov loj me yog qhov nyuaj, rau ib yam khoom uas muab huab hwm coj thiab tshaj tawm ib qho chaw thiab qhov loj me tuaj yeem ua rau raug mob tuag taus, thaum lwm qhov yuav ua rau me ntsis ntau dua qhov nqaij tawv. (ib pob baseball txav ntawm 45mph piv rau riam txav ntawm 45mph).

MASS: Cov cuab yeej no txuas nrog lub zog ntawm cov khoom nkag. Ntau pawg ntawm qhov muab ceev = ntau zog. (piv txwv li, lub tsheb txav ntawm 60 mph vs. basketball txav ntawm 60 mph

Yog tias ob yam khoom txav mus rau tib lub nrawm, qhov loj dua ib qho yuav muaj zog ntau dua los tsoo, ncab, nkag mus thiab tom qab ntawd rhuav tshem cov ntaub so ntswg.

Cov khoom siv hluav taws xob siab yuav ua rau muaj kev sib tsoo ntau dua, ncab, thiab cavitating raug mob.

VELOCITY: qhov thib ob determinant ntawm lub zog, tom qab loj. (Xav txog ib lub mos txwv uas tau muab pov rau ntawm koj thiab ib qho uas raug tua los ntawm rab phom):

Cov khoom siv ceev ceev ua rau muaj kev sib tsoo thiab ncab quab yuam ntau heev; cavitation yog tshwj xeeb tshaj yog tuag taus nyob rau hauv high-ceev kev raug mob raws li tau tham nyob rau hauv nqe lus no nyob rau hauv lub npe "qhov txhab phom."

TISSUE HOM TRAVERSED: Cov ntaub so ntswg muaj qhov sib txawv ntawm kev tiv thaiv kev ncab thiab kev puas tsuaj.

Cov ntaub so ntswg xws li cov rog lossis lub ntsws muaj zog heev rau kev sib tsoo / ncab thiab tuaj yeem khiav tawm kev raug mob nrog cov cavitation tsawg lossis cuam tshuam.

Hloov pauv, cov ntaub so ntswg tuab xws li cov leeg / siab / pob txha tau yooj yim puas los ntawm cov rog thiab tuaj yeem nthuav tawm nrog cov cavitation zoo.

Phom phom thiab Stab Wounds

Cov ntsiab lus saum toj no tau piav qhia zoo kawg nkaus hauv qhov txhab raug mob los ntawm qee yam riam phom-phom thiab riam (los yog ib qho ntse / taw tes stabbing siv).

GUNSHOT WOUNDS (GSW): Cov phom phom yog cov piv txwv classic ntawm cov khoom siv siab / qis uas ua rau muaj kev cuam tshuam loj thiab ncab kev raug mob, txawm tias cov khoom me me thiab taw tes.

Qhov no yog vim qhov loj heev cavitation induced los ntawm ib tug high-ceev khoom uas ntsib cov dej nyob rau hauv lub cev.

Nws tsim ib qho loj heev sab hauv "tawg" raws li lub zog kinetic ntawm cov mos txwv yog pauv mus rau cov ntaub so ntswg ib puag ncig.

Qhov no crushes thiab stretches cov ntaub so ntswg nyob rau hauv ib tug dav ncig qauv nyob ib ncig ntawm qhov chaw cuam tshuam, tsim kev raug mob nyob deb tshaj li qhov nkag qhov txhab yuav qhia.

Rau cov ntaub ntawv, tag nrho cov GSWs mus rau lub plab yuav tsum tau phais kev tshawb fawb, vim hais tias lub plab hnyuv perforated.

Yog tias tus neeg mob nyob ruaj khov, txawm tias GSW rau hauv siab tuaj yeem pom ua ntej txiav txim siab xav tau kev tshawb nrhiav (evolving anemia, hypotension = kev tshawb nrhiav). Tab sis cov no yog kev txiav txim siab tom qab tuaj txog. HU RAU DAIM NTAWV: TRANSPORT EMERGENTLY!

STAB WOUNDS: Cov kab mob stab yog ib qho piv txwv ntawm cov khoom loj / qis tshaj tawm ua rau muaj kev raug mob loj heev.

Cov qauv raug mob ntawm lub qhov txhab stabbing tshwm sim los ntawm qhov nruab nrab ntawm lub zog muaj zog ntawm ib feeb taw tes, tso cai rau cov concentration ntawm lwm yam me me crushing rog mus rau hauv ib cheeb tsam microscopic, yooj yim thawb los ntawm cov ntaub so ntswg thiab puas tag nrho cov qauv nws tuaj.

Riam qhov txhab yog qhov mob hnyav heev vim lub cev tsis muaj peev xwm tiv thaiv lub zog loj ntawm qhov kawg ntawm rab riam.

Feem ntau cov ntaub ntawv ntawm kev raug mob yuav tseg cov hlab ntsha / cov hlab ntsha, tab sis stabbing raug mob yooj yim transects cov qauv.

Me ntsis unintuitively, thaum cov ntaub so ntswg ruaj xws li daim siab, ob lub raum, thiab lub cev phab ntsa muaj feem yuav raug puas ntsoog yog hais tias lawv pw nyob rau hauv lub riam trajectory, lub free-floating plob tsis so tswj yuav raug mob tsawg dua nrog ib tug mos txwv, raws li cov " free-floaters" nyiam raug thawb lossis "twist" tawm ntawm txoj kev.

HU RAU DAIM NTAWV: TRANSPORT EMERGENTLY!

Koj tsis tuaj yeem txiav txim siab seb yuav tshwm sim dab tsi tshwm sim vim tias koj tsis tuaj yeem pom qhov tshwm sim "hauv qab dej hiav txwv," uas yog, hauv qab ntawm daim tawv nqaij, tsuas yog txiav nws ncaj qha nrog cov cim tseem ceeb.

Kev Ntsuam Xyuas thiab Kev Tswj Xyuas: ABC(DE)s

Raws li nrog rau feem ntau cov ntaub ntawv ntawm kev raug mob hnyav, kev tswj kev nkag mus rau kev raug mob yog tsom rau kev tswj hwm ntawm cov ABC's (airway, ua tsis taus pa, ncig) tab sis kuj txuas mus rau D thiab E (kev tsis taus thiab raug) vim qhov complex thiab multifactorial xwm ntawm kev raug mob thib ob mus rau qhov hnyav nkag mus.

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AIRWAY: Nkag mus rau lub taub hau thiab / lossis lub caj dab muaj kev pheej hmoo siab ntawm kev cuam tshuam ntawm txoj hlab ntsws vim kev puas tsuaj ncaj qha thiab "kev cuam tshuam loj," nthuav tawm cov ntshav / kua dej uas ua rau cov cua nkag.

Qhib txoj hauv kev los ntawm kev hloov lub puab tsaig-thrust tej zaum yuav tsim nyog raws li C-spinal trauma yog muaj nyob rau hauv siab zog nkag mus rau lub taub hau thiab caj dab.

Kev hloov kho ntawm lub puab tsaig thrust uas ua rau nws hloov kho yog tsim kom muaj nyob rau hauv-kab stabilization ntawm lub taub hau thiab caj dab kom txav lub puab tsaig rau pem hauv ntej nrog qhov tsawg kawg nkaus lub taub hau extension.

Rau kev raug mob plab nkag mus, C-spinal stabilization tsis tau pom muaj txiaj ntsig tshwj tsis yog tias pom tseeb ntawm cov hlab ntsha tsis txaus (cov cim qhia ntawm tus hlwb raug mob) muaj.

Nco ntsoov xav txog kev siv cov tshuab ua pa (nasopharyngeal / oropharyngeal, nqus nqus, thiab endotracheal) raws li koj txoj cai tso cai. Nco ntsoov tias txoj hlab pas nasopharyngeal yog contraindicated nyob rau hauv lub ntsej muag raug mob.

Ua pa: Nrog rau kev siv zog ua pa, kev ua pa yuav tsum raug ntsuas thaum koj qhib / ntsuas tus neeg mob txoj hlab cua: tus nqi, qhov zoo, qhov tob, thiab kev siv cov leeg nqaij yog cov ntsiab lus tseem ceeb ntawm kev ua pa.

Palpation ntawm lub thorax thiab auscultation rau lub ntsws suab nyob rau hauv ob lub ntsws thiab nyob rau hauv lub caj dab yog ib qho tseem ceeb los qhia ib tug zais kev raug mob los yog pneumothorax nyob rau hauv cov neeg mob uas nkag mus rau trauma. 100% oxygen ntawm 12-15 L / min ntawm non-rebreather yog tus qauv ua pa cuam tshuam hauv kev raug mob hnyav.

Kev ua pa zoo ntawm lub hnab-Valve-Mask yuav tsim nyog nyob ntawm tus neeg mob qhov kev raug mob.

CIRCULATION: Kev ntsuam xyuas sai ntawm ob qho tib si peripheral thiab hauv nruab nrab pulses tuaj yeem muab kev kwv yees ntawm tus neeg mob lub perfusion thiab ntshav siab thaum muab cov ntaub ntawv ntxiv ntawm cov mem tes, qhov tsis tu ncua, thiab zoo.

Radial pulse muaj qhov qhia tias kwv yees systolic BP tsawg kawg yog 80 mmHg.

Femoral mem tes muaj feem cuam tshuam nrog systolic BP tsawg kawg yog 70 mmHg.

Carotid mem tes yog txuam nrog systolic BP tsawg kawg yog 60 mmHg.

Vim hais tias nws yog cov mem tes palpable thaum peripheral pulses tsis tuaj (< 70 mmHg), carotid yog qhov chaw zoo tshaj plaws los kuaj xyuas cov mem tes hauv cov neeg laus uas tsis nco qab txog kev raug mob.

Daim tawv nqaij: tus neeg mob daim tawv nqaij kuj tuaj yeem yog qhov qhia tau zoo ntawm cov xwm txheej hauv lub cev: Cov tawv nqaij uas sov, qhuav, thiab liab dawb yog qhov qhia tau tias muaj kev sib haum xeeb txaus.

Txias, daj ntseg, ashen, thiab / los yog daim tawv nqaij ntub yog txawv txav. Capillary refill lub sij hawm hauv qab 2 vib nas this kuj sib cav kom txaus perfusion.

HAIV NEEG: Kev kuaj lub cev thiab lub hlwb sai txaus los ntsuas qhov muaj qhov tsis taus loj.

Lub cev, qhov kev ntsuas nrawm yuav suav nrog kev ntsuas tus neeg mob tuav thiab muaj peev xwm ua kom dorsal / plantar flex tus taw rau kev ntsuam xyuas ntawm kev txav mus los thiab kev xav.

Kev poob ntawm kev hnov qab thiab / lossis tuag tes tuag taw yog qhov kev ceeb toom tshaj plaws uas qhia txog kev cuam tshuam ntawm cov hlab ntsha.

Kev ntsuam xyuas dua kuj tseem ceeb, vim tias kev hloov pauv ntawm kev tshawb pom nyob rau lub sijhawm yuav tsum tau sau tseg.

Cov kev tsis taus uas tshwm sim los ntawm kev raug mob mus rau lub hauv nruab nrab lub paj hlwb (tshwj xeeb tshaj yog lub taub hau) yuav tsum tau soj ntsuam siv cov AVPU los yog GSC nplai.

AVPU nplai yog qhov ua tau zoo dua hauv cov xwm txheej muaj kev ntxhov siab.

AVPU scale yog raws li nram no: Puas yog tus neeg mob ceeb toom thiab sib tham, teb rau cov lus stimuli nkaus xwb, teb rau Painful stimuli nkaus xwb, los yog tag nrho Unresponsive? Cov GCS yuav tsum tau siv los ntsuas qhov tseeb dua qhov muaj peev xwm ntawm kev xiam oob qhab thaum lub sijhawm tso cai.

EXPOSURE (thiab kev ntsuam xyuas theem nrab): Kev ua tiav ntawm txhua tus neeg mob uas muaj kev puas tsuaj yog qhov tseem ceeb. Undress tus neeg mob rau kev ntsuam xyuas ntawm txhua qhov chaw ntawm daim tawv nqaij, qhov no yog qhov tseem ceeb kom tsis txhob muaj kev raug mob uas tsis yog ib feem ntawm qhov kev nthuav qhia thawj. Yog tias txiav tawm cov khaub ncaws, txiav cov seams kom tsis txhob rhuav tshem cov pov thawj pov thawj (cov mos txwv qhov, thiab lwm yam).

DCAPBLTS kev ntsuam xyuas (Deformity, Contusions, Abrasions, Penetrations, Bruising, Tenderness, Lacerations, thiab o) yog ib qho lus luv luv ua haujlwm dhau los ntawm kev ntsuam xyuas theem nrab thiab ceeb toom seb ib tus neeg yuav xav pom dab tsi hauv kev raug mob nkag mus.

CEEB TOOM: Yog hais tias qhov txhab raug mob los ntawm kev sib ntsib tsausmuag. Nws yog ib qho tseem ceeb kom khaws cov pov thawj, cov ntaub ntawv ntxaws ntxaws ntawm txhua qhov kev raug mob yog qhov tseem ceeb, thiab yuav tsum tau ceev faj khaws cov khaub ncaws ntawm cov neeg raug tsim txom.

Yog tias ua tau txiav cov seams thiab tso cov khaub ncaws hauv lub hnab yas rau tub ceev xwm. Tsis txhob muab pov tseg ib qho khaub ncaws, cia nrog cov tub ceev xwm ntawm qhov chaw lossis nqa nrog tus neeg mob mus rau ER.