Emergency Live | 10 Steps to perform a Correct Spinal Immobilization of a Trauma Patient image 5 — Mgbochi nke ndị ọrịa trauma nwere eriri

Ọkpụkpụ azụ nke onye ọrịa: olee mgbe a ga-ewepụ osisi ọkpụkpụ azụ?

By Cristiano Antonino On Aug 29, 2022

Banyere nkwụsị nke ọkpụkpụ azụ: bọọdụ azụ azụ anọwo na-abụ isiokwu nke mkparịta ụka na-ekpo ọkụ mgbe ụfọdụ, ndị a emewokwa ka a mara nke ọma maka ngwaọrụ ahụike, kamakwa iji ya mee ihe ziri ezi. Mkparịta ụka yiri ya na-emetụta olu olu cervical

Ịtụnye onye ọrịa ahụ n'ụzọ na-adịghị mma nwere ike imetụta iku ume na njikwa ụzọ ikuku, mana ohere ndị ahụ hà karịrị ihe ize ndụ nke enweghị ike imegharị ahụ?

A na-eduzi ọmụmụ ihe mbụ a ma ama na mmejuputa azụ azụ na C-collars na 1960s, ma ọtụtụ n'ime ndụmọdụ ndị a dabeere na omenala na echiche nke ihe ọmụma, na ọ bụchaghị eziokwu, ihe akaebe sayensị [1,2,3].

Dịka ọmụmaatụ, mgbe American Association of Neurological Surgeons na Congress of Neurological Surgeons Joint Commission kwadoro ndụmọdụ iji kwadoo ojiji spinal eme ihe (dị ka akọwara dị ka C-olu akwa na backboard), ọtụtụ n'ime ndị ahụ dabere na ọkwa nke ọkwa III [4].

N'ụzọ dị mwute, enwere ntakịrị ihe akaebe maka mmejuputa ya na ịga n'ihu na-eji nkwụsị azụ azụ

Nyochaa Cochrane sitere na 2007 kwuru, dịka ọmụmaatụ, na ọ nweghị otu RCT ga-aga n'ihu na immobilization spinal [5].

Ka ọ dị ugbu a, ọtụtụ n'ime ihe akaebe kwadoro na nchekwa nke ọkpụkpụ azụ na-esite na ọmụmụ ihe ndị na-enyocha ndị ọrịa na-achọ ihe oyiyi tupu ha ewepụ ya.

Ma usoro NEXUS na iwu Canada C-spine kwadoro, ndị American Association of Neurological Surgeons na Congress of Neurological Surgeons Joint Commission kwuru na ndụmọdụ ha na-akwado maka nlekọta nke nnukwu mmerụ ahụ.

Ejiri njirisi NEXUS na iwu Canada C-spine na ntọala ụlọ ọgwụ tupu oge eruo; ndị ga-achọ ihe onyonyo na-etinye n'ime akwa cervical maka nkwụsi ike c-spine.

Otú ọ dị, ọ dịtụbeghị mgbe a na-achịkwa ikpe na ndị ọrịa na-enyocha ma ọ bụrụ na C-collars na-eme ka ọkpụkpụ azụ sie ike.

Enweela ọtụtụ ule na ndị ọrụ afọ ofufo na ụdị, ọtụtụ n'ime ha nwere nsonaazụ na-emegiderịta onwe ya.

Ọ bụ ezie na ụfọdụ ọmụmụ na-egosi na C-collars na-eme ka ahụ sie ike n'olu, ndị ọzọ na-egosi na olu olu nwere ike ịbawanye n'olu olu [6].

Ọ bụ ezie na data iji kwado nkwụsị ọkpụkpụ azụ adịghị ike, enwere ọnụ ọgụgụ na-arịwanye elu nke ihe àmà na-egosi ihe ize ndụ ndị nwere ike ime na ọrịa na-ejikọta ya na nkwụsị nke ọkpụkpụ azụ.

A na-eji immobilization nke ọkpụkpụ azụ mee ihe iji gbochie mmerụ ahụ ọkpụkpụ azụ

Otú ọ dị, n'ime nchọpụta arụmụka nke Hauswald et al mere, ndị ọrịa na-adịghị ahụ anya na Malaysia nwere ihe ndị na-adịghị mma na-eme ka ọ dị mma karịa ndị ọrịa na-emerụ ahụ na-emekọ ihe na New Mexico (OR 2.03) [7].

Ọ bụ ezie na a na-eduzi ọmụmụ ihe ndị a na mba dị iche iche, echiche n'ozuzu ya na mmerụ ahụ nke abụọ na ụdọ n'ihi njem dị ụkọ n'ihi na ike ndị a na-eme n'oge njem adịghị ike ma e jiri ya tụnyere nke a chọrọ iji merụọ ọkpụkpụ azụ nwere ike ka na-abụ eziokwu.

Ọmụmụ ihe ndị ọzọ egosila mmụba na-anwụ anwụ (OR 2.06-2.77) na ndị ọrịa na-abanye n'ime trauma na spinal immobilization, dịcha n'ihi na ọ na-ewe oge (ihe dị ka nkeji ise, na kasị mma [8]) iji tinye onye ọrịa n'ime zuru ezu immobilization, nke na-egbu oge resuscitation na ibubata onye ọrịa n'ime ụlọ ịwa ahụ [9,10,11,12].

Ọ bụ ezie na ihe mgbaru ọsọ nke C-collars bụ iji belata mmegharị nke spine cervical ma chebe ọkpụkpụ azụ azụ, nchọpụta ole na ole egosila na ịmanye olu n'ime "ọnọdụ anatomical" nwere ike ime ka ọkpụkpụ azụ azụ, karịsịa na ndị ọrịa nwere ankylosing spondylitis na ndị agadi [13].

Nnyocha e mere na ndị cadavers kwuru na olu mgbapụ na-eme ka ọnụ ọgụgụ dị ukwuu nke nkewa dị n'etiti vertebrae mgbe enwere mmerụ ahụ [14].

Ịtụnye onye ọrịa n'ọkpụkpụ azụ nwere ike imetụta iku ume na njikwa ụgbọ elu

Otu nnyocha e mere na ndị ọrụ afọ ofufo ahụ siri ike gosiri na ịtụkwasị onye ọrịa n'azụ azụ na-egbochi iku ume, na ndị ọrịa meworo agadi nwere oke mmachi [15].

Ọ bụghị ihe siri ike iche n'echiche na mmachi ahụ nwere ike inwe mmetụta dị ukwuu na ndị ọrịa nwere iku ume ma ọ bụ n'ime ndị ọrịa na-arịa ọrịa akpa ume.

Ọkpụkpụ azụ azụ nwekwara ike ime ka njikwa ụgbọ elu sikwuo ike, ebe ọ na-esikarị ike itinye onye ọrịa n'ime C-collar.

Na mgbakwunye, ndị ọrịa na-achọghị njikwa ụgbọ elu nọ n'ihe ize ndụ dị ukwuu nke ọchịchọ sitere na vomiting.

Na nyocha nhazi nke Sparke et al mere, enwere nnyocha ole na ole na-achọpụta mmụba nke nrụgide intracranial na ntinye nke C-collar [16].

N'ime nyocha nke Kolb, mmụba nke ihe fọrọ nke nta ka ọ bụrụ 25 mmHg (dị ka nrụgide LP tụrụ) ka a tụrụ mgbe etinyere C-collars na ndị ọrụ afọ ofufo ahụike [17].

Ihe ize ndụ nke ịba ụba ICP bụ 35.8%, dị ka Dunham mere atụmatụ na nyocha ya tụnyere ICP nke ndị ọrịa na-emerụ ahụ na C-collar na ndị na-enweghị C-collars na ọmụmụ dị iche iche [18].

A na-eche na mmụba nke ICP bụ nke abụọ na nrụgide a na-etinye na vein jugular (na-akpata nkwụsị nke venous); Otú ọ dị, ọ dịghị ezigbo ihe ọmụma banyere etiology nke ụba ICP.

Tụkwasị na nke ahụ, ọnya nrụgide bụ nsogbu na-egbu mgbu site na nkwụsị azụ azụ

Ọnya nrụgide na-amalite ịmalite n'ime nkeji 30 nke enweghị ike imegharị ya [19].

Nke a na-enye nsogbu n'obi ka ọmụmụ ihe ọzọ gosipụtara na nkezi oge onye ọrịa na-etinye na bọọdụ azụ bụ ihe dịka otu awa [20].

E gosipụtara usoro nke immobilization na-eme ka ọnụ ọgụgụ mgbu na-arịwanye elu na ndị ọrụ afọ ofufo dị mma, ya mere, ọbụna ndị na-enweghị mmetụta dị nro n'etiti etiti n'ọhịa nwere ike ịdị nro mgbe ha rutere na ngalaba mberede.

N'ikpeazụ, ozugbo ndị ọrịa na-apụ apụ, ọ ga-abụrịrị na ha ga-eme ihe ngosi iji kpochapụ C-spine ha. N'ime nnyocha nke Leonard et al., Ụmụaka ndị e debere na C-collar nwere ike ịme ihe ngosi iji kpochapụ c-spine (56.6 vs. 13.4%) ma nwee ike ịbanye n'ụlọ ọgwụ (41.6 vs. 14.3%). 21 vs. XNUMX%) [XNUMX].

Nsonaazụ ndị a emere ọbụna mgbe emezigharịrị maka ndị nwere mmerụ ahụ azụ.

Nke a nwere mmetụta siri ike na ogologo ọnụnọ yana ọnụ ahịa ma onye ọrịa ma ụlọ ọgwụ.

Ọ bụ ezie na ihe akaebe na-akwado nkwụsị nke ọkpụkpụ azụ dị ntakịrị, karịsịa na ndị ọrịa na-amụ anya ma na-enweghị ihe mgbaàmà nke neurologic, ihe echekwabara nke na-eme ka ọkpụkpụ ọkpụkpụ ọzọ dịkwuo njọ nke na-enweghị usoro, nchọpụta a na-achịkwa na isiokwu a dị ụkọ ma sie ike ime.

Otú ọ dị, a na-enwewanye ihe àmà nke nwere ike imerụ ahụ site na nkwụsị nke ọkpụkpụ azụ zuru ezu.

Na nzaghachi na nyocha ahụ, St. Louis Fire Department-Emergency Medical Services Division, American Medical Response/Abbott EMS, na Clayton Fire Department wepụrụ backboards na protocol ha na September 2014, ọ bụ ezie na C-collar na C-spine stabilization ka na-anọgide a. akụkụ nke nlekọta ha tupu ụlọ ọgwụ.

Mgbochi ọkpụkpụ azụ, ndụmọdụ ndị bụ isi:

Jiri bọọdụ ogologo maka ebumnuche mkpochapụ naanị, ọ bụghị maka njem. Ogologo bọọdụ abụghị usoro mara mma. Ihe akaebe ruo taa egosighi na bọọdụ ogologo na-ebelata mmegharị nke ọkpụkpụ azụ ma ọ bụ kpachie nsogbu akwara ozi. Kama nke ahụ, ihe akaebe na-egosi na ojiji dị otú ahụ na-abawanye ọnwụ, karịsịa n'ime trauma, yana ịkpata ihe isi ike dị ukwuu na ikuku ikuku, mgbu, na ọnya nrụgide.
Jiri C-collars na C-spine immobilization site na njirisi NEXUS. Agbanyeghị, ka a na-ebipụta ọmụmụ ihe ọhụrụ, nke a nwere ike ịgbanwe.

Nchịkọta nke NEXUS Criteria na Imaging Spinal Cord Mmerụ ahụ

Enweghị onyonyo adịghị mkpa ma ọ bụrụ na ihe ndị a niile dị:

Enweghị nro dị n'etiti etiti azụ cervical
Ọkwa nke ịmụrụ anya
Enweghị ihe akaebe nke ịṅụbiga mmanya ókè
Enweghị nchọpụta neurologic na-adịghị mma
Enweghị mmerụ ahụ na-adọpụ uche na-egbu mgbu

References:

1. Farrington JD. Mwepụ nke ndị merụrụ ahụ- Ụkpụrụ ịwa ahụ. Akwụkwọ akụkọ Trauma. 1968;8 (4):493-512 .
2. Kossuth LC. Mwepụ nke ndị merụrụ ahụ n'ụgbọ ala mebiri emebi. Akwụkwọ akụkọ Trauma. 1965; 5 (6): 703-708 .
3. Farrington JD. Ọnwụ n'olulu. Amer Coll nke ndị dọkịta na-awa ahụ. 1967 Juun; 52 (3): 121-130 .
4. Walters BC, Hadley MN, Hurlbert RJ, Aarabi B, Dhall SS, Gelb DE, Harrigan MR, Rozelle CJ, Ryken TC, Theodore N; Òtù Na-ahụ Maka Ndị dọkịta na-awa ahụ nke America; Congress of Neurological Surgeons. Ntuziaka maka nlekọta nke nnukwu ọkpụkpụ cervical na ọkpụkpụ azụ: 2013 melite. Ịwa ahụ akwara. 2013 Ọgọst; 60 Nkwado 1:82-91 .
5. Kwan I, Bunn F, Roberts I. Spinal immobilisation maka ndị ọrịa trauma. Cochrane Database Syst Mkpu. 2001; (2): CD002803.
6. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K. Prehospital Use of Cervical Collars in Trauma Patients: A Critical Review. J Neurotrauma. 2014 Mar 15;31 (6): 531-40 .
7. Hauswald M, Ong G, Tandberg D, Omar Z. Ọpụpụ n'ụlọ ọgwụ na-apụ apụ: mmetụta ya na mmerụ ahụ neurologic. Acad Emerg Med. 1998 Mar; 5 (3): 214-9 .
8. Stuke LC, Pons PT, Guy JS, Chapleau WP, Butler FK, McSwain N. Prehospital Spine Immobilization for Penetrating Trauma- Review na Aro sitere na Prehospital Trauma Life Support Executive Committee. Akwụkwọ akụkọ Trauma. 2011 Septemba; 71 (3): 763-770.
9. Lance s, Pons P, Guy J, Chapleu W, Butler F, McSwain N. Prehospital Spine Immobilization for Penetrating Trauma- Review and Aro Site na Prehospital Trauma Life Support Committee Executive. J trauma. 2011 Septemba 71 (3): 763-770.
10. Vanderlan W, Tew B, McSwain N, Mmụba ihe ize ndụ nke ọnwụ site na nkwụsị nke cervical spine na-abanye n'ime trauma cervical. Mmerụ ahụ. 2009;40:880-883 .
11. Brown JB, Bankey PE, Sangosanya AT, Cheng JD, Stassen NA, Gestring ML. Mgbochi azụ azụ n'ihu ụlọọgwụ adịghị ka ọ bara uru ma nwee ike ịkpagide nlekọta na-esochi mmerụ egbe n'ọsọ ahụ. J trauma. 2009 Ọkt; 67 (4): 774-8 .
12. Haut ER, Balish BT, EfronDT, et al. Ịkwụsị ọkpụkpụ azụ na-abanye n'ime trauma: ihe ọjọọ karịa mma? J trauma. 2010;68:115-121 .
13. Papadopoulos MC, Chakraborty A, Waldron G, Bell BA. Ihe nkuzi nke izu: ime ka mmerụ ahụ dị n'ọkpụkpụ cervical dị njọ site n'itinye olu olu siri ike. BMJ. 1999 Jul 17;319 (7203): 171-2 .
14. Ben-Galim P, Dreiangel N, Mattox KL, Reitman CA, Kalantar SB, Hipp JA. Mkpokọta mkpochapụ nwere ike ịkpata nkewa na-adịghị mma n'etiti vertebrae na ọnụnọ nke dissociative mmerụ ahụ. J trauma. 2010 Ọgọst; 69 (2): 447-50 .
15. Totten VY, Sugarman DB. Mmetụta iku ume nke ọkpụkpụ azụ azụ. Nlekọta Prehosp Emerg.1999 Ọkt-Dec;3(4):347-52.
16. Sparke A, Voss S, Benger J. Ntụle nke nrụgide interface anụ ahụ na mgbanwe nke jugular venous parameters jikọtara ya na cervical immobilisation ngwaọrụ: nyochaa usoro. Scand J Trauma Resusc Emerg Med. 2013 Dec 3;21:81 .
17. Kolb JC, Summers RL, Galli RL. Mgbanwe nke olu olu cervical na nrụgide intracranial. Am J Emerg Med. 1999 Maachị; 17 (2): 135-7 .
18. Dunham CM, Brocker BP, Collier BD, Gemmel DJ. Ihe ize ndụ ndị metụtara onyonyo resonance magnetik na olu akwa cervical na comatose, ndị na-arịa ọrịa trauma na-adịghị mma nwere ngụkọ akwara cervical na-adịghị mma na enweghị ụkọ ọkpụkpụ pụtara ìhè. Nlekọta Crit. 2008;12(4):R89 .
19. Sparke A, Voss S, Benger J. Ntụle nke nrụgide interface anụ ahụ na mgbanwe nke jugular venous parameters jikọtara ya na cervical immobilisation ngwaọrụ: nyochaa usoro. Scand J Trauma Resusc Emerg Med. 2013 Dec 3;21:81 .
20. Cooney DR, Wallus H, Asaly M, Wojcik S. Backboard oge maka ndị ọrịa na-anata immobliziation spinal site na ọrụ ahụike mberede. Int J Emerg Med. 2013 Jun 20;6 (1):17 .
21. Leonard J, Mao J, Jaffe DM. Mmetụta ọjọọ nwere ike ime ka ọkpụkpụ azụ azụ n'ime ụmụaka. Prehosp. Emepụta Nlekọta. 2012 Ọkt-Dec; 16 (4): 513-8 .