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Thandizo loyambira la moyo (BTLS) ndi chithandizo chapamwamba cha moyo (ALS) kwa wodwala wovulalayo

By Cristiano Antonino On Mwina 12, 2022

Basic trauma life support (BTLS): Basic trauma life support (motero SVT acronym) ndi njira yopulumutsira yomwe imagwiritsidwa ntchito ndi opulumutsa ndipo cholinga chake ndi chithandizo choyamba cha anthu ovulala omwe avulala, mwachitsanzo, chochitika chomwe chimachitika chifukwa cha mphamvu zambiri. kuchita pa thupi kuwononga

Kupulumutsira koteroko sikungoyang'ana anthu okhudzidwa ndi polytrauma omwe adakumana nawo mwachitsanzo ngozi zapamsewu, komanso mabala omira, ogwidwa ndi magetsi, otenthedwa kapena owombera, chifukwa muzochitika zonsezi kuvulala kumachitika chifukwa cha kutaya mphamvu pa thupi.

SVT ndi BTLF: Ola lagolide, kuthamanga kumapulumutsa moyo

Mphindi imodzi yochulukirapo kapena yocheperapo nthawi zambiri imakhala kusiyana pakati pa moyo ndi imfa kwa wodwala: izi ndizowona makamaka kwa odwala omwe avulala kwambiri: nthawi yomwe ili pakati pa chochitika chopwetekedwa mtima ndi kupulumutsidwa ndi chofunikira kwambiri, chifukwa mwachiwonekere chofupikitsa. kutha kwa nthawi kuchokera pazochitikazo kupita kukuchitapo kanthu, mpata waukulu woti munthu wovulalayo apulumuke kapena kuonongeka pang'ono.

Pachifukwa ichi, lingaliro la ola la golidi ndilofunika, lomwe limatsindika kuti nthawi pakati pa chochitikacho ndi chithandizo chamankhwala sichiyenera kupitirira mphindi 60, malire omwe ali ndi kuwonjezeka kwakukulu kwa mwayi wosapulumutsa wodwalayo. moyo.

Komabe, mawu oti 'golden hour' samangotanthauza ola, koma amafotokoza mfundo yakuti: 'kachitidwe koyambirira kachitidwe, mpata wopulumutsa moyo wa wodwalayo umakhala waukulu'.

Zinthu zamphamvu zazikulu zowopsa

Nzika ikayimba Nambala Yadzidzidzi Imodzi, wogwiritsa ntchitoyo amamufunsa mafunso okhudza momwe chochitikacho chikuyendera, chomwe chimathandiza

yesani kuopsa kwa zoopsazo
kukhazikitsa malamulo oyambirira (wobiriwira, achikasu kapena ofiira);
tumizani gulu lopulumutsa ngati kuli kofunikira.

Pali zinthu zomwe zimaneneratu kuopsa kwa kuvulala: zinthuzi zimatchedwa 'maelements of major dynamics'.

Mfundo zazikuluzikulu zazikuluzikulu ndizo

zaka za wodwala: zaka zosakwana 5 ndi kupitirira 55 nthawi zambiri zimasonyeza kuopsa kwakukulu;
chiwawa cha zochitikazo: kugundana kwapang'onopang'ono kapena kutulutsa munthu m'chipinda chokwerapo, mwachitsanzo, zizindikiro za kuopsa kwambiri;
kugundana pakati pa magalimoto osiyana kukula kwake: njinga/mathiraki, galimoto/oyenda pansi, galimoto/njinga yamoto ndi zitsanzo za kuopsa kochuluka;
anthu ophedwa m'galimoto imodzi: izi zimakweza mlingo wongopeka wa kuopsa;
zovuta extrication (kuyembekezeredwa extrication nthawi yoposa mphindi makumi awiri): ngati munthu atsekeredwa mwachitsanzo pakati pa zitsulo mapepala, zongopeka mphamvu yokoka mlingo amaukitsidwa;
kugwa kuchokera pamalo okwera kuposa mamita atatu: izi zimakweza mulingo wongoyerekeza wa kuuma;
mtundu wa ngozi: kuwonongeka kwa electrocution, kutentha kwakukulu kwachiwiri kapena kwachitatu, kumira, mabala owombera mfuti, ndi ngozi zonse zomwe zimakweza mlingo wongopeka wa kuopsa;
kuvulala kwakukulu: polytrauma, fractures yowonekera, kudulidwa, ndi zovulala zonse zomwe zimakweza msinkhu wovuta;
kutayika kwa chidziwitso: ngati munthu mmodzi kapena angapo ataya chidziwitso kapena njira yosagwira ntchito ya mpweya ndi / kapena kumangidwa kwa mtima ndi / kapena kumangidwa kwa pulmonary, mlingo wa kuuma umakwezedwa kwambiri.

Zolinga za woyendetsa mafoni

Zolinga za wogwiritsa ntchito mafoni zidzakhala

tanthauzirani kufotokozera kwa zochitikazo ndi zizindikiro zachipatala, zomwe nthawi zambiri zimaperekedwa molakwika ndi woyitanayo, yemwe mwachiwonekere sadzakhala ndi chithandizo chamankhwala nthawi zonse;
kumvetsetsa kuopsa kwa mkhalidwewo mwamsanga
tumizani chithandizo choyenera kwambiri (ambulansi imodzi? awiri ambulansi? Tumizani dokotala mmodzi kapena angapo? Komanso tumizani ozimitsa moto, carabinieri kapena apolisi?);
limbikitsani nzikayo ndikumufotokozera patali zimene angachite poyembekezera thandizo.

Zolinga izi nzosavuta kunena, koma zovuta kwambiri poganizira chisangalalo ndi kukhudzidwa kwa woyimbirayo, yemwe nthawi zambiri amakumana ndi zokhumudwitsa kapena nayenso adakhalapo nazo ndipo chifukwa chake kufotokozera kwake zomwe zidachitika kumatha kukhala kwapang'onopang'ono komanso kusinthidwa (mwachitsanzo. pakakhala kukomoka, kapena kumwa mowa kapena kugwiritsa ntchito mankhwala osokoneza bongo).

SVT ndi BTLF: kuvulala koyambirira ndi kwachiwiri

Muzochitika zamtunduwu, zowonongeka zimatha kugawidwa muzowonongeka zoyambirira ndi zachiwiri:

kuwonongeka kwakukulu: izi ndizowonongeka (kapena zowonongeka) zomwe zimayambitsidwa mwachindunji ndi zoopsa; mwachitsanzo, pangozi ya galimoto, kuwonongeka kwakukulu kumene munthu angakumane nako kungakhale kuthyoka kapena kudula miyendo;
kuwonongeka kwachiwiri: izi ndizowonongeka zomwe wodwalayo amamva chifukwa cha zoopsa; kwenikweni, mphamvu ya zoopsa (kinetic, thermal, etc.) imagwiranso ntchito pa ziwalo zamkati ndipo zimatha kuwononga kwambiri. Kuwonongeka kwachiwiri kwachiwiri kungakhale hypoxia (kusowa mpweya), hypotension (kutsika kwa magazi chifukwa cha kuyambika kwa mantha), hypercapnia (kuwonjezeka kwa carbon dioxide m'magazi) ndi hypothermia (kutsika kwa kutentha kwa thupi).

Ma protocol a SVT ndi BTLF: The Trauma Survival Chain

Pakachitika zoopsa, pali njira yolumikizira zopulumutsira, yotchedwa trauma survivor chain, yomwe imagawidwa m'magawo asanu akuluakulu.

kuyimba kwadzidzidzi: chenjezo loyambirira kudzera pa nambala yadzidzidzi (ku Italy ndi Nambala Yodzidzidzi Yokha 112);
kuyendera kuchitidwa kuti awone kuopsa kwa chochitikacho ndi kuchuluka kwa anthu omwe akukhudzidwa;
oyambirira chithandizo chamoyo chofunikira;
kukhazikitsidwa koyambirira ku Trauma Center (mkati mwa ola lagolide);
kuyambitsa chithandizo chamoyo choyambirira (onani ndime yotsiriza).

Maulalo onse mu unyolo uwu ndiwofunikira chimodzimodzi kuti achitepo kanthu bwino.

Gulu lopulumutsa anthu

Gulu lomwe likuchita SVT liyenera kukhala ndi anthu osachepera atatu: Mtsogoleri wa Gulu, Woyankha Woyamba ndi Woyendetsa Wopulumutsa.

Chithunzi chotsatirachi ndi chabwino kwambiri, chifukwa ogwira ntchito amatha kusiyanasiyana malinga ndi bungwe, lamulo lopulumutsa anthu m'madera ndi mtundu wadzidzidzi.

Mtsogoleri wa gulu nthawi zambiri amakhala wodziwa zambiri kapena wopulumutsa wamkulu ndipo amayang'anira ndikuwongolera zomwe zikuyenera kuchitika panthawi yantchito. Mtsogoleri wa gulu ndiyenso amayesa mayeso onse. Pagulu lomwe namwino kapena dotolo 112 alipo, udindo wa mtsogoleri wa gulu umangopita kwa iwo.

The Rescue Driver, kuwonjezera pa kuyendetsa galimoto yopulumutsa, amasamalira chitetezo cha zochitikazo ndikuthandizira opulumutsa ena ndi kudzikhuthula machitidwe[2]

Woyankha Woyamba (wotchedwanso mtsogoleri woyendetsa) amaima pamutu pa wodwala wovulalayo ndipo amasokoneza mutu, ndikuugwira mopanda ndale mpaka kusasunthika pa Msana bolodi chatsirizidwa. Zikachitika kuti wodwalayo wavala chisoti, wopulumutsa woyamba ndi mnzake amagwira ntchito yochotsa, kusunga mutu ngati n'kotheka.

Khalani & kusewera kapena scout & kuthamanga

Pali njira ziwiri zofikira wodwala ndipo ziyenera kusankhidwa molingana ndi momwe wodwalayo alili komanso momwe chithandizo chachipatala chilili:

scoop & run strategy: njirayi iyenera kugwiritsidwa ntchito kwa odwala omwe akudwala kwambiri omwe sangapindule ndi malo omwe akupezekapo, ngakhale ndi Advanced Life Support (ALS), koma amafunikira kuchipatala mwamsanga komanso chithandizo chamankhwala. Zomwe zimafunikira Scoop & Run ndi monga mabala olowera ku thunthu (chifuwa, pamimba), mizu ya nthambi ndi khosi, mwachitsanzo, malo a anatomical omwe mabala awo sangatsindike bwino;
khalani & kusewera njira: Njirayi imasonyezedwa kwa odwala omwe amafunikira kukhazikika mu situ asananyamutsidwe (zili choncho ndi kutayika kwakukulu kwa magazi kapena kuopsa kwambiri kuposa momwe zimakhalira mwamsanga).

BLS, chithandizo chamoyo wovulala: zowunika ziwirizi

Thandizo loyambira la moyo kwa munthu wopwetekedwa mtima limayambira pa mfundo zomwezo monga BLS wamba.

BLS kwa munthu wopwetekedwa mtima imaphatikizapo kuyesa kuwiri: choyambirira ndi chachiwiri.

Kuwunika kwachangu kwa chidziwitso cha wovulalayo ndikofunikira; ngati izi palibe, protocol ya BLS iyenera kugwiritsidwa ntchito nthawi yomweyo.

Pankhani ya wovulala womangidwa, kuunika kofulumira kwa Basic Life Functions (ABC) ndikofunikira, ndipo ndikofunikira kutsogolera gulu lopulumutsa kuti litulutse mwachangu (ngati wakomoka kapena kuwonongeka kwa imodzi mwa ma VF) kapena kutulutsa wamba pogwiritsa ntchito KED chipangizo extrication.

Kuwunika koyambirira: lamulo la ABCDE

Pambuyo pakuwunika kofulumira komanso kutulutsa ngati kuli kofunikira, kuwunika koyambirira kumachitika, komwe kumagawidwa m'magawo asanu: A, B, C, D ndi E.

Kuwongolera kwa Airway ndi Spine (kukhazikika kwa mpweya ndi khomo lachiberekero)

Woyankha Woyamba amadziyika yekha pamutu ndikukhazikika pamanja pomwe Mtsogoleri wa Gulu akugwiritsa ntchito khola lachiberekero. Mtsogoleri wa gulu amawunika mkhalidwe wa chidziwitso pomuyitana munthuyo ndikukhazikitsa kukhudzana, mwachitsanzo, pogwira mapewa awo; ngati chikhalidwe cha chidziwitso chasinthidwa ndikofunikira kudziwitsa 112 mwachangu.

Komanso panthawiyi, mtsogoleri wa gulu amavundukula chifuwa cha wodwalayo ndikuyang'ana njira ya mpweya, ndikuyika oro-pharyngeal cannula ngati wodwalayo sakudziwa.

Ndikofunikira nthawi zonse kupereka okosijeni pakuyenda kwambiri (12-15 malita / mphindi) kwa wovulalayo, chifukwa nthawi zonse amawonedwa kuti ali ndi vuto la hypovolemic.

B - kupuma

Ngati wodwalayo alibe chidziwitso, atatha kuchenjeza 112, mtsogoleri wa gulu amapita ndi njira ya GAS (Tawonani, Mverani, Mverani), yomwe imagwiritsidwa ntchito poyesa ngati munthuyo akupuma.

Ngati palibe kupuma, BLS yachikale imachitika potulutsa mpweya wabwino (mwina ndikulumikiza botolo lodzikulitsa lokha ku silinda ya okosijeni, ndikupangitsa kuti iperekedwe mwachangu), kenako ndikupitilira gawo C.

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Ngati kupuma kulipo kapena ngati wodwalayo akudziwa, chigobacho chimayikidwa, mpweya umayendetsedwa ndipo OPACS (Observe, Palpate, Listen, Count, Saturimeter) ikuchitika.

Ndi kayendetsedwe kameneka, mtsogoleri wa gulu amayesa magawo osiyanasiyana a wodwalayo: kwenikweni, amawona ndi palpate pachifuwa kuti ayang'ane kuti palibe mabowo kapena zolakwika, amamvetsera mpweya akuyang'ana kuti palibe phokoso kapena phokoso, amawerengera kupuma ndi kupuma. amagwiritsa ntchito saturimeter kuti ayese mpweya wabwino m'magazi.

C - Kuzungulira

Mu gawo ili, amawunikiridwa ngati wodwalayo wakhala ndi kutaya magazi kwakukulu komwe kumafuna kutaya magazi msanga.

Ngati magazi akutuluka magazi kwambiri, kapena atapangidwa tamponaded, magawo osiyanasiyana okhudzana ndi kuthamanga kwa magazi, kugunda kwa mtima, khungu ndi kutentha zimawunikidwa.

Ngati wodwala mu gawo B alibe chidziwitso ndipo sakupuma - atapanga mpweya wabwino - timapita ku gawo la C, lomwe limaphatikizapo kufufuza kupezeka kwa carotid pulse mwa kuika zala ziwiri pamtsempha wa carotid ndikuwerengera mpaka masekondi a 10.

Ngati palibe kugunda timapita ku cardiopulmonary resuscitation yochitidwa mu BLS pochita kutikita minofu ya mtima.

Ngati pali kugunda komanso kulibe mpweya, kupuma kumathandizidwa ndikuchita pafupifupi 12 insufflation pa mphindi imodzi ndi baluni yodzikulitsa yokha yolumikizidwa ndi silinda ya okosijeni yomwe imapereka kuthamanga kwambiri.

Ngati kugunda kwa carotid kulibe, kuyesa koyambirira kumayima panthawiyi. Wodwala wozindikira amathandizidwa mosiyana.

Kuthamanga kwa magazi kumayesedwa pogwiritsa ntchito sphygmomanometer ndi radial pulse: ngati chotsiriziracho palibe, kuthamanga kwa magazi (systolic) kumakhala kosakwana 80 mmHg.

Kuyambira 2008, magawo B ndi C aphatikizidwa kukhala njira imodzi, kotero kuti kutsimikizira kukhalapo kwa kugunda kwa carotid kumakhala nthawi imodzi ndi mpweya.

D - Chilema

Mosiyana ndi kuwunika koyambirira komwe mkhalidwe wa chidziwitso umayesedwa pogwiritsa ntchito Kutumiza mlingo (anamwino ndi madokotala amagwiritsa ntchito Glasgow Coma Scale), mu gawo ili mkhalidwe wa minyewa wa munthu umawunikidwa.

Wopulumutsa amafunsa wodwala mafunso osavuta akuwunika

kukumbukira: amafunsa ngati akukumbukira zomwe zinachitika;
spatio-temporal orientation: wodwalayo amafunsidwa kuti ndi chaka chanji komanso ngati akudziwa komwe ali;
kuwonongeka kwa mitsempha: amayesa kugwiritsa ntchito sikelo ya Cincinnati.

E - Kuwonekera

Mu gawoli amawunikidwa ngati wodwalayo wavulala kwambiri kapena zochepa.

Mtsogoleri wa gulu amavula wodwala (kudula zovala ngati kuli kofunikira) ndikuwunika kuyambira kumutu mpaka kumapazi, kuyang'ana ngati pali kuvulala kapena kutuluka magazi.

Malamulo amafuna kuti afufuzenso maliseche, koma nthawi zambiri sizitheka chifukwa cha zofuna za wodwala kapena chifukwa chakuti n'zosavuta kufunsa wodwala ngati akumva ululu uliwonse.

Momwemonso ndi gawo lomwe zovala ziyenera kudulidwa; zikhoza kuchitika kuti wodwalayo akutsutsana ndi izi, ndipo nthawi zina opulumutsawo amasankha kuti asachite ngati wodwalayo anena kuti palibe ululu, amasuntha miyendo yake bwino ndikuonetsetsa kuti sanavutikepo m'dera linalake la thupi lake.

Pambuyo poyang'ana pamutu pamutu, wodwalayo amaphimbidwa ndi nsalu yotentha kuti ateteze hypothermia (panthawiyi, kukwera kwa kutentha kuyenera kuchitika pang'onopang'ono).

Kumapeto kwa gawoli, ngati wodwalayo wakhala akuzindikira nthawi zonse, mtsogoleri wa gulu amalankhulana ndi magawo onse a ABCDE ku malo opangira opaleshoni a 112, omwe angamuuze zoyenera kuchita komanso chipatala chomwe anganyamulire wodwalayo. Nthawi zonse pakakhala kusintha kwakukulu pazigawo za wodwala, mtsogoleri wa gulu adziwitse 112 nthawi yomweyo.

Kuwunika kwachiwiri

Unikani:

mphamvu za zochitika;
ndondomeko ya zoopsa;
mbiri ya odwala. Pambuyo pomaliza kuwunika koyambirira ndi kuchenjeza Nambala ya Emergency ya chikhalidwecho, malo ogwirira ntchito amasankha ngati wodwalayo atengedwera kuchipatala kapena kutumiza galimoto ina yopulumutsa, monga ambulansi.

Malinga ndi protocol ya PTC, kutsitsa pamsana kuyenera kuchitidwa ndi machira a spoon; mabuku ena ndi opanga machira, komabe, amanena kuti kuyenda pang'ono momwe kungathekere kuyenera kuchitidwa ndipo motero kukweza pamsana wa msana kuyenera kuchitidwa ndi Log roll (kumangirirani mapazi pamodzi poyamba), kotero kuti kumbuyo kukhozanso kuyang'aniridwa.

Thandizo la moyo wapamwamba (ALS)

Advanced Life Support (ALS) ndi ndondomeko yogwiritsidwa ntchito ndi ogwira ntchito zachipatala ndi anamwino monga chowonjezera, osati cholowa m'malo mwa, Basic Life Support (BLS).

Cholinga cha ndondomekoyi ndi kuyang'anira ndi kukhazikika kwa wodwalayo, komanso kupyolera mu kayendetsedwe ka mankhwala ndi kukhazikitsa njira zowonongeka, mpaka kufika kuchipatala.

Ku Italy, protocol iyi imasungidwa kwa madotolo ndi anamwino, pomwe m'maiko ena, itha kugwiritsidwanso ntchito ndi anthu omwe amadziwika kuti 'achipatala', katswiri yemwe kulibe ku Italy.