Nthawi zina, kugwedezeka kumakhala kovuta kuzindikira kumayambiriro kwake ndipo wodwalayo amatha kusintha ndikugwedezeka musanazindikire. Nthawi zina kusintha kumeneku kumachitika tisanafike pamalopo

Zikatere, tiyenera kulowererapo ndi kulowererapo mwachangu chifukwa kulephera kutero kumapangitsa kuti wodwalayo ayambe kugwedezeka kwambiri.

Mawu abwino oti agwiritse ntchito pofotokoza kugwedezeka ndi perfusion ndi hypoperfusion.

Tikamanunkhira mokwanira sikuti tikungopereka mpweya ndi zakudya ku ziwalo za thupi, komanso timachotsa zowonongeka za metabolism pamlingo woyenera.

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Pali mitundu isanu ndi itatu ya mantha yomwe tingakumane nayo:

• Hypovolemic - nthawi zambiri amakumana
• Cardiogenic
• Zolepheretsa
• Chisamba
• Neurogenic
• Anaphylactic
• Psychogenic
• Kulephera kupuma

Magawo atatu akunjenjemera: Kugwedezeka kosasinthika, kulipidwa, komanso kuwonongeka

Gawo 1 - Kubwezeredwa kugwedezeka

Kugwedezeka kolipiridwa ndi gawo la kugwedezeka komwe thupi limatha kubwezera kutayika kwathunthu kapena wachibale.

Panthawi imeneyi, wodwalayo amatha kukhalabe ndi kuthamanga kwa magazi kokwanira komanso kutulutsa muubongo chifukwa dongosolo lamanjenje lachifundo limawonjezera kugunda kwa mtima ndi kupuma komanso kuthamangitsa magazi pakati pathupi kudzera mu vasoconstriction ya mitsempha yamagazi ndi microcirculation, precapillary. sphincters constricter ndi kuchepetsa magazi kumadera kumadera a thupi ndi mkulu kulolerana amachepetsa perfusions, mwachitsanzo khungu.

Kuchita zimenezi kumawonjezera kuthamanga kwa magazi poyamba chifukwa chakuti m’kati mwake muli malo ocheperapo.

The zizindikiro ndi zizindikiro za kubwezeredwa mantha monga:

• Kusakhazikika, kukwiya komanso nkhawa - zizindikiro zoyambirira za hypoxia
• Pallor ndi clammy khungu - izi zimachitika chifukwa cha microcirculation
• Nausea ndi kusanza - kuchepa kwa magazi kupita ku dongosolo la GI
• ludzu
• Kuchedwetsedwanso kwa capillary
• Kuchepetsa kuthamanga kwa pulse

Gawo 2 - Kugwedezeka kwapang'onopang'ono

Decompensated mantha ndi kutanthauzidwa monga “Kumapeto kwa kunjenjemera kumene njira zolipirira thupi (monga kuwonjezereka kwa kugunda kwa mtima, kugunda kwa mtima, kugunda kwa mtima, kupuma kwamphamvu) zimalephera kutulutsa mpweya wokwanira ku ubongo ndi ziwalo zofunika kwambiri.”

Zimachitika pamene kuchuluka kwa magazi kumachepetsa ndi 30%.

Njira zolipirira za wodwalayo zikulephereka mwachangu ndipo mtima ukutuluka ukutsika zomwe zimapangitsa kuchepa kwa kuthamanga kwa magazi komanso ntchito yamtima.

Thupi lidzapitirizabe kutsekereza magazi mpaka pakati pa thupi, ubongo, mtima ndi impso.

Zizindikiro ndi zizindikiro za kugwedezeka kwa decompensated zikuwonekera kwambiri ndipo kuwonjezeka kwa vasoconstriction kumabweretsa hypoxia ku ziwalo zina za thupi.

Chifukwa cha kuchepa kwa oxygen ku ubongo wodwalayo amasokonezeka ndi kusokonezeka.

The Zizindikiro za decompensated shock ndi:

• Kusintha kwamaganizidwe
• Tachycardia
• Tachypnea
• Kupuma movutikira komanso kosakhazikika
• Kugunda kwapang'onopang'ono kulibe mphamvu
• Kuchepa kwa kutentha kwa thupi
• Cyanosis

Pamene thupi likuyesera kuonjezera kutuluka kwa magazi pakatikati pa thupi dongosolo lamanjenje lachifundo limataya mphamvu za precapillary sphincters zomwe zimathandiza mu microcirculation yomwe tatchula kale.

Ma postcapillary sphincters amakhalabe otsekedwa ndipo izi zimapangitsa kuti magazi azigwirizana, zomwe zidzapitirire ku disseminated intravascular coagulation (DIC).

Mu magawo oyambirira nkhaniyi akadali chololeka ndi aukali mankhwala.

Magazi omwe tsopano akuphatikizana amayamba kunyezimira, maselo a m'derali sakulandiranso zakudya komanso kagayidwe ka anaerobic kamene kamayambitsa kupanga adenosine triphosphate (ATP).

DIC imayamba panthawiyi ndipo ikupitirizabe kupita patsogolo panthawi yachisokonezo chosasinthika.

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Gawo 3 - Kugwedezeka Kosasinthika

Kugwedezeka kosasinthika ndi gawo lomaliza la mantha ndipo pamene wodwalayo apita patsogolo mu gawoli ndiye kuti palibe kubwerera chifukwa pali kuwonongeka kofulumira kwa dongosolo la mtima ndipo njira zolipirira wodwalayo zalephera.

Wodwala adzawonetsa kuchepa kwakukulu kwa mtima, kuthamanga kwa magazi ndi kutsekemera kwa minofu.

Pomaliza kuyesa kupulumutsa pachimake cha thupi magazi amathamangitsidwa kutali ndi impso, chiwindi ndi mapapo kuti asunge kutulutsa kwa ubongo ndi mtima.

chithandizo

Mbali yofunika kwambiri ya chithandizo ndikuzindikira zomwe zachitika ndikugwira ntchito mwachangu kuti mupewe kugwedezeka.

Monga ndidanenera kale, kugwedezeka kwa hypovolemic ndi njira yomwe anthu amakumana nayo nthawi zambiri mu prehospital.

Izi ndizomveka, chifukwa chomwe chimayambitsa imfa kwa anthu azaka zapakati pa 1-44 ndi kuvulala mwangozi.

Ngati wodwalayo akutuluka magazi kunja, timadziwa kuti tifunika kuchitapo kanthu mwamsanga kuti tithe kusunga magazi ochuluka mumtsuko momwe tingathere.

Ngati wodwalayo akuwonetsa zizindikiro zakutuluka magazi mkati, tiyenera kupita ku malo ovulala kuti akachitepo opaleshoni.

Mpweya wothamanga kwambiri umasonyezedwa, ngakhale wodwalayo akadali kuganiza ndipo ali ndi pulse oximetry ya 94% kapena kuposa.

Tikudziwa kuti muzochitika izi ngati pali kukayikira kwa hypoxia yapansi kuti mpweya ukhoza kuperekedwa mosasamala kanthu za zomwe pulse oximetry ikuwonetsera.

Pitirizani kutentha kwa wodwala wanu, kuchepetsa kutentha kwa thupi kumasokoneza mphamvu ya thupi yolamulira kutuluka kwa magazi kachiwiri ndi kusokonezeka kwa mapulateleti ndipo kumabweretsa kuwonongeka kosayenera kwa ziwiya zomwe zapanga.

Ndipo potsiriza, mtsempha wa magazi mankhwala kukhalabe ndi permissive hypotension. Izi zikutanthauza kuti kuthamanga kwa magazi kwa systolic kuyenera kukhala pakati pa 80- ndi 90-mmHG.

Nthawi zambiri timakhala osasintha mpaka 90-mmHg pamene timaphunzitsidwa kuti ndiko kusintha kuchokera ku kulipidwa kupita ku kugwedezeka kowonongeka.

Yolembedwa ndi: Richard Main, Med, NRP

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Source:

Distance CME