Nkwụghachi ụgwọ, decompensated na irreversible ujo: ihe ha bụ na ihe ha na-ekpebi

By Cristiano Antonino On Nwere ike 22, 2022

Mgbe ụfọdụ, ujo na-esi ike ịmata n'oge mmalite ya na onye ọrịa nwere ike gbanwee n'ụjọ erughị ala tupu ị mata. Mgbe ụfọdụ mgbanwe ahụ na-eme tupu anyị eruo ebe ahụ

N'ọnọdụ ndị a, anyị kwesịrị itinye aka ma tinye aka ngwa ngwa n'ihi na emeghị nke a ga-eme ka onye ọrịa ahụ nwee ọganihu na-ama jijiji na-enweghị mgbagha.

Usoro kacha mma ị ga-eji mgbe a na-akọwa ujo bụ nsị na hypoperfusion.

Mgbe anyị na-esi ísì ụtọ nke ọma, ọ bụghị naanị na anyị na-ebuga oxygen na nri na-edozi ahụ na akụkụ ahụ, mana anyị na-ewepụkwa ihe ndị na-emebi emebi nke metabolism n'ụzọ kwesịrị ekwesị.

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Enwere ụdị ujo asatọ anyị nwere ike ihu:

Hypovolemic - nke a na-ahụkarị
Cardiogenic
Ihe mgbochi
Septan
Neurogenic
Anaphylactic
Psychogenic
Enweghi ike iku ume

Akụkụ atọ nke ujo: Ujo agaghị agbanwe agbanwe, akwụghachi ụgwọ, na mgbakasị ahụ

Nkeji 1 - Ujo akwụ ụgwọ

Ujo akwụ ụgwọ bụ akụkụ ujo nke ahụ ka nwere ike ịkwụ ụgwọ maka mfu mmiri zuru oke ma ọ bụ nke ikwu.

N'ime oge a, onye ọrịa ahụ ka na-enwe ike ịnọgide na-enwe ọbara mgbali elu zuru oke yana ụbụrụ ụbụrụ n'ihi na usoro ụjọ ahụ na-eme ka obi dịkwuo elu na ume iku ume ma na-emechi ọbara na isi nke ahụ site na vasoconstriction nke arịa ọbara na microcirculation, precapillary. sphincters na-egbochi ma na-ebelata ọbara na-eruba n'akụkụ akụkụ ahụ nke nwere oke nnabata maka mbelata nke perfusion, dịka akpụkpọ ahụ.

Usoro a na-abawanye ọbara mgbali na mbido n'ihi na enwere obere ohere n'ime usoro ọbara.

The ihe ịrịba ama na mgbaàmà nke ujo akwụ ụgwọ -agụnye:

Enweghị ezumike, mkpasu iwe na nchekasị - ihe ịrịba ama mbụ nke hypoxia
Pallor na clammy akpụkpọ - nke a na-eme n'ihi microcirculation
Ọgbụgbọ na vomiting - mbelata nrịba ọbara na sistemu GI
akpịrị ịkpọ nkụ
Ndoju nke capillary egbuola oge
Na-ebelata nrụgide pulse

Nkeji 2 - Ujo akwụghị ụgwọ

Ujo na-emezigharị bụ akọwapụtara dị ka "N'ikpeazụ nke ujo nke usoro nkwụghachi ụgwọ nke anụ ahụ (dịka ọnụọgụ obi na-abawanye, vasoconstriction, mmụba iku ume) na-enweghị ike ịnọgide na-enwe perfusion zuru oke na ụbụrụ na akụkụ ahụ dị mkpa."

Ọ na-eme mgbe olu ọbara na-ebelata karịa 30%.

Usoro nkwụghachi ụgwọ onye ọrịa na-ada nke ọma na mmepụta obi na-agbadata nke na-ebute mbelata ma ọbara mgbali elu na ọrụ obi.

Ahụ ga-aga n'ihu na-agbanye ọbara ruo n'isi nke ahụ, ụbụrụ, obi na akụrụ.

Ihe ịrịba ama na mgbaàmà nke ujo decompensated na-apụtawanye ìhè na mmụba nke vasoconstriction na-ebute hypoxia na akụkụ ahụ ndị ọzọ.

N'ihi mbelata nke ikuku oxygen na ụbụrụ onye ọrịa ahụ ga-enwe mgbagwoju anya na mgbagwoju anya.

The mgbaàmà dị nke ujo decompensated gụnyere:

Mgbanwe na ọnọdụ uche
Tachycardia
Tachypnea
Na-eku ume na-arụ ọrụ na oge ọ bụla
Ọkụ mpụta dị n'akụkụ adịghị ike
Mbelata okpomọkụ ahụ
Cyanosis

Mgbe ahụ na-agbalị ime ka ọbara na-eruba na isi ahụ, usoro ụjọ ahụ na-enwe ọmịiko na-akwụsịkwa ịchịkwa sphincters precapillary nke na-enyere aka na microcirculation nke a kpọtụrụ aha na mbụ.

Ndị sphincters postcapillary na-anọgide na-emechi emechi na nke a na-enye ohere maka ikpokọta ọbara, nke ga-aga n'ihu na-ekesa coagulation intravascular (DIC).

Na mmalite nkebi okwu a ka nwere ike idozi site na ọgwụgwọ ike.

Ọbara nke na-agbakọta ugbu a na-amalite ịgbakọta, mkpụrụ ndụ ndị dị n'ógbè ahụ anaghịzi enweta nri na-edozi ahụ na metabolism anaerobic bụ maka mmepụta nke adenosine triphosphate (ATP).

DIC na-amalite n'oge a ma na-aga n'ihu na-aga n'ihu n'oge ujo na-enweghị ike ịtụgharị.

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Nkeji 3 - Ujo na-enweghị ike ịgbagha

Ujo a na-apụghị ịgbagha agbagha bụ akụkụ njedebe nke ujo ma ozugbo onye ọrịa batara n'ime oge a, ọ bụ ihe agaghị alaghachi azụ n'ihi na usoro obi obi na-emebi ngwa ngwa na usoro nkwụghachi ụgwọ onye ọrịa adaala.

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Onye ọrịa ahụ ga-eweta mbelata siri ike na mmepụta obi, ọbara mgbali elu na nsị anụ ahụ.

N'ime mbọ ikpeazụ a na-eme iji chekwaa isi ọbara, a na-egbochi ya site na akụrụ, imeju na ngụgụ iji nọgide na-enwe perfusion nke ụbụrụ na obi.

Ọgwụgwọ

Akụkụ kachasị mkpa nke ọgwụgwọ bụ ịmara ihe omume ahụ ma na-arụsi ọrụ ike iji gbochie ọganihu nke ujo.

Dịka m kwuru na mbụ, ujo hypovolemic bụ ụdị ujo a na-ahụkarị na ntọala ụlọ ọgwụ.

Nke a bụ ihe ezi uche dị na ya, dịka ihe na-akpatakarị ọnwụ maka ndị nọ n'afọ 1-44 bụ mmerụ ahụ n'amaghị ama.

Ọ bụrụ na onye ọrịa na-agba ọbara n'èzí, anyị maara na anyị kwesịrị itinye aka ozugbo ka anyị nwee ike idowe ọbara dị ukwuu n'ime akpa dị ka o kwere mee.

Ọ bụrụ na onye ọrịa ahụ gosipụtara ihe ịrịba ama nke ọbara ọgbụgba n'ime, anyị kwesịrị ibuga na ebe trauma maka enyemaka ịwa ahụ.

A na-egosipụta ikuku oxygen dị elu, ọ bụrụgodị na onye ọrịa ahụ ka na-eche echiche ma nwee oximetry pulse nke 94% ma ọ bụ karịa.

Anyị maara na n'ọnọdụ ndị a, ọ bụrụ na a na-enyo enyo na hypoxia na-akpata na enwere ike inye oxygen n'agbanyeghị ihe pulse oximetry gosipụtara.

Na-eme ka onye ọrịa gị na-ekpo ọkụ, na-ebelata okpomọkụ nke ahụ, na-emebi ikike nke anụ ahụ iji chịkwaa ọbara ọgbụgba nke abụọ na-arụ ọrụ platelet na-adịghị mma ma na-ebute nkwụsịtụ na-ekwesịghị ekwesị nke mkpụkọ etolitela.

Na n'ikpeazụ, ọgwụgwọ intravenous iji nọgide na-enwe ọnọdụ nke ikike hypotension. Nke a pụtara na ọbara mgbali systolic kwesịrị ịdị n'etiti 80- na 90-mmHG.

Anyị na-adabakarị na 90-mmHg dị ka a na-akụziri anyị na nke ahụ bụ ngbanwe site na nkwụghachi ụgwọ gaa na ujo akwụghị ụgwọ.

Edere ya: Richard Main, MED, NRP

Richard Main, MED, NRP, bụ onye nkuzi EMS. Ọ rụrụ ọrụ na EMS kemgbe 1993 ka ọ nwetasịrị EMT ya na Johnson County Community College. Ọ biri na Kansas, Arizona na Nevada. Mgbe ọ nọ na Arizona, Main rụrụ ọrụ maka Avra Valley Fire District maka afọ 10 wee rụọ ọrụ na EMS nkeonwe na Southern Nevada. Ọ na-arụ ọrụ ugbu a dị ka prọfesọ nke ọrụ nlekọta ahụike mberede na College of Southern Nevada ma bụrụ onye nduzi nduzi maka Distance CME.