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Polytrauma: tanthauzo, kasamalidwe, wodwala wokhazikika komanso wosakhazikika wa polytrauma

By Cristiano Antonino Kusintha komaliza Apr 5, 2023

Ndi "polytrauma" kapena "polytraumatised" mu zamankhwala timatanthawuza ndi tanthawuzo la wodwala wovulala yemwe amapereka kuvulala kogwirizana ndi magawo awiri kapena angapo a thupi (chigaza, msana, thorax, mimba, pelvis, miyendo) ndi kuwonongeka kwaposachedwa kapena komwe kungachitike. zofunika (kupuma ndi/kapena kuzungulira)

Polytrauma, zoyambitsa

Chifukwa cha zoopsa zambiri nthawi zambiri zimagwirizanitsidwa ndi ngozi yaikulu ya galimoto koma mtundu uliwonse wa zochitika zomwe zimadziwika ndi mphamvu zomwe zimatha kulowererapo pazigawo zambiri za thupi lomwelo zimatha kubweretsa zovuta zambiri.

Wodwala polytrauma nthawi zambiri amakhala wovuta kapena wovuta kwambiri.

Mwa odwala omwe anamwalira ndi polytrauma:

50% ya polytraumas amafa mkati mwa masekondi kapena mphindi za chochitikacho, chifukwa cha kusweka kwa mtima kapena ziwiya zazikulu, kuphulika kwa ubongo kapena kutayika kwakukulu kwa ubongo;
30% ya polytraumas amafa pa ola lagolide, chifukwa cha hemopneumothorax, hemorrhagic shock, chiwindi ndi ndulu, hypoxemia, extradural hematoma, kusamuka kwa thupi ndi kuipiraipira kwa vuto loyambirira kapena njira zolakwika zachipatala;
20% ya polytrauma imamwalira m'masiku kapena masabata otsatirawa chifukwa cha sepsis, vuto la kupuma, kumangidwa kwa mtima, kapena kulephera kwamagulu ambiri (MOF).

Kuchitapo kanthu kolondola, panthawi yake komanso kothandiza kwa chithandizo chapadera kumathandizira kuonjezera mwayi wokhala ndi moyo wa munthu wovulalayo, kuchepetsa chiopsezo cha kuwonongeka kwachiwiri.

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Kuwongolera kwa polytrauma

Kuti akhazikitse machitidwe omwe amatsatiridwa ndi gulu lomwe likugwira ntchito yopulumutsa, omalizawa amagawidwa m'magawo osiyanasiyana, otchedwa "mphete", omwe ali motere:

Gawo lokonzekera ndi chenjezo - Mu gawo ili, maguluwa ali ndi udindo wokonzekera bwino njira ndi zipangizo zomwe zimapanga zofunikira. zida. Malo ogwirira ntchito ali ndi udindo, malinga ndi chidziwitso chomwe chili nacho, kuchenjeza gulu lomwe likuyenera kuthana ndi zosowa.
Kuwunika kwa zochitika ndi kuyendera - Atafika, woyankha aliyense ali ndi udindo woyang'anira chitetezo ndi kuwunika zoopsa. Zofunikira zomwe zakhazikitsidwa ndi lamulo ndi monga kuzindikiritsa manejala komanso kutengera zida zodzitetezera zomwe ziyenera kuvala moyenera komanso mwadongosolo logwirira ntchito.
Macheke a pulayimale ndi achiwiri - Kuwunika kofunikira kwa ntchito zofunika nthawi zonse kumagwirizana ndi zomwe akuyembekezeredwa chithandizo choyambira ndi ndondomeko zotsitsimula komanso kuchenjeza kwa magulu opulumutsira apamwamba (ALS). Zowongolera izi zimazindikirika mwamnemonically ndi mawu achidule Mtengo wa ABCDE.
Kuyankhulana ndi Operations Center - Pachigawo ichi, kuwonjezera pa kusankha ndi kugawa kopita, mwayi woyitana njira zina zoyendera kapena kukonzekera ulendo wopita ku gulu la ALS umatsimikiziridwa.
Kuyendera ndi kuyang'anira - Panthawiyi, kuphatikizapo kuyang'anira kosalekeza kwa ntchito zofunika za wodwalayo, chipatala chachipatala chikhoza kuperekedwa ndi chidziwitso pa magawo ofunikira ndi onse omwe amalola kuti dongosololi likhale lokonzekera kulandira ndi kuchiza munthu wovulala kwambiri.
Chithandizo chamankhwala kuchipatala.

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Pali lamulo lofunikira komanso losavuta la chala chachikulu kukumbukira momwe mungasamalire wodwala polytrauma, kutengera zilembo zoyambirira za zilembo:

Njira zoyendera ndege: kapena “mathirakiti opumira”, monga kuwongolera mphamvu yake (mwachitsanzo, kuthekera kwa mpweya kudutsamo) imayimira chikhalidwe choyambirira komanso chovuta kwambiri kuti wodwalayo akhale ndi moyo;
Kupuma: kapena "mpweya", womwe umapangidwira ngati "mpweya wabwino"; zogwirizana ndi mfundo yapitayi, imalemeretsedwa ndi chidziwitso chachipatala cha mitsempha, monga momwe zotupa zina zaubongo zimapereka mawonekedwe a kupuma (ie kuchuluka / momwe / momwe wodwalayo amachitira kupuma), monga mwachitsanzo kupuma kwa Cheyne-Stokes;
Kuzungulira: kapena "kuzungulira", monga mwachiwonekere kugwira ntchito kolondola kwa dongosolo la mtima (komanso ndi mfundo ziwiri zam'mbuyo za cardio-pulmonary) ndizofunikira kuti munthu apulumuke;
Lumala: kapena "chilema", makamaka ngati pali kukayikira Msana chotupa kapena zambiri za dongosolo lapakati lamanjenje, chifukwa zitha kuchitika kuti zotupa m'chigawo chino zimabweretsa kugwedezeka komwe, koyambirira kwake, sikungathe kudziwika pokhapokha ndi diso la akatswiri, ndipo "chete" kubweretsa polytraumatised. imfa (si mwangozi kuti nthawi zina timalankhula za kugwedezeka kwa msana);
Kuwonekera: kapena "kuwonekera" kwa wodwalayo, kumuvula pofunafuna kuvulala kulikonse, ndikuteteza zachinsinsi ndi kutentha (kungathenso kutanthauziridwa kuti E-nviroment).

Thandizo loyamba, momwe mungachitire ndi polytrauma

Kamodzi mu chipinda changozi, wodwala polytraumatized adzayang'ana macheke onse omwe malangizo okhudza zoopsa amafunikira.

Kawirikawiri, kuwunika kwachiwiri kwa zoopsa, mpweya wamagazi, ndi chemistry ya magazi ndi magulu a magazi amatsatiridwa ndi kufufuza kwa radiological, zomwe zidzadalira kuchuluka kwa kukhazikika kwa hemodynamic.

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Wokhazikika wa polytrauma wodwala

Ngati wodwala ali ndi hemodynamically stable, kuwonjezera pa kufufuza kofunikira kwa ecoFAST, x-ray ya chifuwa ndi pelvis, kufufuza kwathunthu kwa thupi la CT kungathenso kuchitidwa, popanda komanso mosiyana ndi sing'anga, zomwe zingasonyeze zilonda zam'mitsempha ndi zotengera zazikulu.

Kufufuza kwa radiology komwe kumachitika mu polytrauma yolimba kwambiri ya hemodynamically stable nthawi zambiri ndi:

FAST ultrasound;
X-ray pachifuwa;
x-ray ya m'chiuno;
chigaza CT;
CT msana;
chifuwa CT;
M'mimba CT.

Kufufuza mozama monga angiographies ndi maginito resonance mwina kuchitidwa; makamaka, MRI imachitidwa pa msana ngati zilonda za myeli (za msana) zikuganiziridwa, popeza CT imasonyeza mbali ya fupa la msana ndipo si kufufuza kothandiza pophunzira za msana.

MRI ingathenso kuchitidwa pophunzira za posterior cranial fossa, makamaka kwa hematomas wochenjera, omwe sawonetsedwa bwino pa CT.

Ma X-ray a miyendo nthawi zambiri amachitidwa kumapeto kwa mayesero omwe ali pamwambawa.

X-ray ya msana wa khomo lachiberekero siwothandiza pofufuza mozama za zilonda za fupa, chifukwa sizimawonetsa bwino C1 ndi C2 vertebrae ndipo sizingakhale zokwanira kumvetsetsa malo a vertebral fracture.

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Wodwala wa polytrauma wosakhazikika

Ngati wodwala wa polytraumatised ali ndi magazi osakhazikika, mwachitsanzo chifukwa cha kutuluka kwa magazi kunja kapena mkati (kapena zonse ziwiri), zomwe sizinathe pambuyo popereka ma crystalloids, colloids ndi/kapena madzi a m'magazi ndi magazi atsopano oundana, wodwalayo sangayesedwe ndi kafukufuku wa CT, koma kufufuza kofunikira ndipo pambuyo pake adzachitidwa opaleshoni kuti athetse zovuta zomwe zimayambitsa kusakhazikika.

Ngati wodwala afika ku ED wosakhazikika koma kenako akukhazikika kudzera mu zothandizira zothandizira, gulu lopwetekedwa mtima likhoza kulingalira ngati lingayese kufufuza mozama (monga CT). Makamaka, kufufuza kwa radiological komwe kumachitidwa ndi wodwala wosakhazikika wa polytrauma (yemwe amakhalabe wosakhazikika pambuyo pa chithandizo) nthawi zambiri amakhala: -ultrasound (mwina osati FAST) - chifuwa X-ray - pelvis X-ray - khomo lachiberekero X-ray Khomo lachiberekero X- ray sichimachitidwa nthawi zonse.

Pambuyo pofufuza

Pamapeto pa kufufuza konse kwa matenda, kufunikira kwa opaleshoni kumayesedwa mu wodwalayo wokhazikika kapena ntchito zomwe zingatheke zimakonzedweratu masiku otsatirawa.

Wodwala wosakhazikika nthawi zambiri amatengedwera ku chipinda chopangira opaleshoni kumapeto kwa kufufuza kofunikira ndipo adzafufuzidwa mozama kumapeto kwa opaleshoniyo ndipo mwina kuchitidwa opaleshoni yachiwiri m'masiku otsatirawa.

Odwala a polytrauma nthawi zambiri amaloledwa kumalo osamalira odwala kwambiri, omwe amadziwika kuti "kutsitsimutsa" kapena mayunitsi osamalira odwala kwambiri.