Chitsogozo chachangu komanso chodetsa chokhudza kugwedezeka: kusiyana pakati pa kulipidwa, kubwezeredwa komanso kosasinthika

By Cristiano Antonino On Jun 15, 2022

Nthawi iliyonse wodwala amwalira, kugwedezeka kumachitika. Kugwedezeka ndiko kutayika kwa kayendedwe kake kokwanira kuthandizira ziwalo zofunika. Maziko a mitundu yonse ya mantha ndi hypotension yomwe imabweretsa hypoxia

Hypotension iyi imatha chifukwa cha kulephera kwa gawo lililonse la kayendedwe ka magazi, ndipo kulephera kwake kumatha kugawidwa m'magulu osiyanasiyana malinga ndi kuuma kwake.

Mitundu Yakugwedezeka

Dongosolo la circulatory si kanthu chabe koma kusinthasintha kwamadzimadzi komwe kumayendetsedwa ndi pampu.

Kugwedezeka kumabwera ngati mpope, chubu, kapena madzimadzi awonongeka/atatayika.

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Iliyonse mwa mitundu itatu ya mantha ili ndi zifukwa zosiyanasiyana

Kulephera kwa mpope (mtima) kumadziwika kuti "Cardiogenic Shock" pali njira zambiri zomwe mtima ukhoza kulephera, koma kuwonetsera kofala komanso koyesedwa kwambiri ndi kulephera kwa mtima (CHF).

CHF ndi kuchepa kosalekeza kwa kutulutsa kwa mtima chifukwa cha kuwonongeka kwa maselo a minofu.

Odwala omwe ali ndi mantha a cardiogenic adzakhala ndi khungu lozizira / lammy / lotuwa komanso kutupa m'munsi mwawo ndipo akhoza kukhala ndi mpweya wochepa wa okosijeni ngati matenda awo ndi ovuta.

Kulephera kwa chubu (mitsempha yamagazi) kumatenga mitundu itatu yayikulu:

Anaphylactic shock pamene allergen imayambitsa kuyankha kwakukulu; neurogenic shock pomwe kuwonongeka kwa Msana chingwe chimalepheretsa zizindikiro za mitsempha kuti zifike ku mitsempha ya magazi; ndi sepsis kumene tizilombo toyambitsa matenda m'magazi timayambitsa kuwonjezereka kwa chitetezo cha mthupi.

Kugwedezeka kwa anaphylactic kumachitika maselo oyera a magazi kutulutsa kuchuluka kwa mankhwala omwe amapangitsa kuti mitsempha ya magazi ikhale vasodilate ndikutulutsa madzimadzi m'matenda mosayenera.

Odwalawa adzakhala ndi khungu lotentha / lofiira, lokhala ndi zidzolo, tachycardia, ndipo amatha kutupa kumaso/milomo.

Atha kukhala ndi vuto la kupuma komanso/kapena kusokonezeka kwapanjira chifukwa cha kutupa uku.

Kugwedezeka kwa Neurogenic kumachitika pamene kuvulala kwa msana kumakwera kwambiri khosi amadula thupi ku dongosolo lamanjenje lachifundo, izi zimalepheretsa mitsempha ya magazi ku vasoconstricting ndi mtima kuti usawonjezere kuthamanga kwake.

Odwalawa adzakhala ndi bradycardic kapena kugunda kwa mtima wamba ngakhale ali ndi hypotensive.

Kupuwala kwa thupi kwa miyendo ndi manja kumakhala pafupifupi nthawi zonse.

Sepsis ndi chifukwa chofala kwambiri cha "cholepheretsa chotengera," tizilombo toyambitsa matenda m'magazi timayambitsa kuyankha mwamphamvu kwa chitetezo cha mthupi ndipo ngati alipo ambiri izi zingayambitse kutulutsa kwa mitsempha ya magazi ndi vasodilation mofanana ndi anaphylaxis.

Odwalawa adzakhala ndi khungu lotentha / lofiira ndi tachycardia, nthawi zambiri amakhala ndi zizindikiro monga kuzizira, kutentha thupi, ndi diaphoresis.

Kutaya madzimadzi (mwazi) ndizomwe zimayambitsa mantha, zomwe zimatchedwa "Hypovolemic Shock"

Magazi amatha kutayika m'njira zambiri, kaya chifukwa cha kupwetekedwa mtima kapena kutuluka kwa magazi kosalekeza / kwakukulu m'matumbo kukhala zifukwa zofala kwambiri mu EMS.

Odwalawa nthawi zambiri amakhala ndi khungu lozizira / lotumbululuka / losalala komanso ndi tachycardic.

Nthawi zambiri amakhala ndi mbiri yakukha magazi kapena kuvulala koopsa posachedwa.

Magulu a Shock

Zowopsa zamtundu uliwonse zitha kuyikidwa m'gulu limodzi mwamagulu atatu, kulipidwa, kubwezeredwa, kapena kosasinthika kutengera zizindikiro ndi zizindikiro zomwe wodwala akukumana nazo.

Kugwedezeka kolipiridwa kumachitika pamene kukanika kwa mtima, mitsempha ya magazi, kapena kuchuluka kwa magazi kungathe kutsekedwa ndi machitidwe ena.

Mtima umachita izi poonjezera mlingo umene umapopa magazi ndipo mitsempha ya magazi imatha kuchepetsa (vasoconstriction) ndikuwonjezera kuchuluka kwa kuthamanga komwe kumafika ku ziwalo.

KUKHUDZITSA MTIMA NDI KUKHUDZITSA KWAMBIRI KWA MITU YA NKHANI? YENDANI EMD112 BOOTH PATSOGOLO LAPANSI KUTI MUPHUNZITSE ZAMBIRI

Zizindikiro za kugwedezeka kolipidwa ndi kugunda kwa mtima kwakukulu, kuthamanga kwa magazi kwa systolic kupitirira 90, ndi maganizo abwino.

Kugwedezeka kolipidwa sikungakhale ndi zizindikiro, odwala ena amatha kumva kugunda kwa mtima, kupuma movutikira, kutopa, kapena zizindikiro zina zosadziwika bwino.

Kugwedezeka kowonongeka kumachitika pamene machitidwe ena a thupi sangathenso kuphimba kwathunthu dongosolo lowonongeka, izi zimachitika pang'onopang'ono pamene dongosolo lowonongeka limasiya kugwira ntchito pang'onopang'ono kapena dongosolo lomwe limaphimba dongosolo lowonongeka likuyamba "kutha."

Hypotension ndiye chizindikiro chachikulu cha kugwedezeka kowonongeka, kugwedezeka sikungatheke mpaka hypotension kapena kusokonezeka kwa chiwalo kulipo, mu EMS kusintha kwa malingaliro ndi chizindikiro chabwino kwambiri cha kusokonezeka kwa chiwalo.

Zizindikiro za kugwedezeka kwamphamvu ndi chisokonezo, kutuluka thukuta, kuzizira, kusintha kwa masomphenya, kugona kwambiri / kutopa.

Kugwedezeka kosasinthika kumachitika pamene imfa ili pafupi, wodwalayo nthawi zambiri amakhala chikomokere, hypotension ingakhale yoopsa, ndipo kugunda kwa mtima kungayambe kuchepa ngati tachycardia inalipo kale.

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Chithandizo cha Shock

Chithandizo cha EMT chamitundu yonse / magulu akunjenjemera chimangoyang'ana ma ABC.

Njira yodutsa mpweya nthawi zambiri imasokonekera pakapita nthawi yodzidzimutsa pamene amachepetsera ndikukulitsa malingaliro osinthika, izi zingayambitsenso kupuma movutikira ndipo odwalawa angafunike mpweya wabwino komanso njira yolumikizira mpweya.

Kugwedezeka kwa Neurogenic ndizochitika zosowa pamene kusagwirizana kwa Kupuma kumatha kuyamba chifukwa cha ziwalo za kupuma kwa minofu.

Chithandizo cha kuzunguliridwa kosokonekera chimakhala chapakati pakunjenjemera, odwala ambiri omwe ali ndi mantha amafunikira madzi a IV kuti achedwetse kapena kuwalepheretsa kupita patsogolo mpaka kugwedezeka kosasinthika.

Septic shock ndi hypovolemic shock nthawi zonse zimafunikira madzi a IV, kugwedezeka kwa neurogenic ndi anaphylactic nthawi zina kumafuna madzi a IV, ndipo odwala omwe ali ndi vuto la mtima sayenera kupatsidwa madzi a IV.

Anaphylactic ndi neurogenic shock ali ndi chithandizo chapadera chomwe chilipo; anaphylaxis imayendetsedwa ndi epinephrine, "Epi-Pen" ndi mlingo wa 0.3mg wa 1mg / ml epinephrine ndipo ndi mankhwala odziwika bwino a EMS a anaphylaxis, odwalawa angafunikire kubwereza mlingo wa epinephrine ngati akupitirizabe kuwononga.

Neurogenic shock imayendetsedwanso ndi epinephrine kuphatikiza madzi a IV ngati hypotension ilipo.