Zosintha Zadzidzidzi Zadzidzidzi (ALOC): zoyenera kuchita?

By Cristiano Antonino On Jan 18, 2023

Kusintha kwa chidziwitso (ALOC) ndi ngozi yachisanu ndi chiwiri yomwe akatswiri a EMS amayankha, kuwerengera pafupifupi 7% ya mafoni onse a EMS.

Kusintha kwa chidziwitso (ALOC) kumatanthauza kuti simuli maso, ogalamuka, kapena otha kumvetsetsa momwe mumakhalira. ALOC imatha chifukwa chovulala mutu, mankhwala, mowa, mankhwala osokoneza bongo, kutaya madzi m'thupi, komanso matenda ena, monga shuga.

Magawo osiyanasiyana a ALOC akuphatikizapo:

Kusokonezeka: mumasokonezedwa mosavuta ndipo mutha kuchedwa kuyankha. Mwina simukudziwa yemwe kapena komwe muli kapena nthawi ya tsiku kapena chaka.

Delirium: muli ndi chisokonezo chachikulu ndi kusokonezeka maganizo ndipo mukhoza kukhala ndi chinyengo (kukhulupirira zinthu zomwe siziri zenizeni) kapena kuyerekezera zinthu m'maganizo (kuzindikira zinthu zomwe siziri zenizeni). Kuchuluka kwa chisokonezo kumatha kukhala bwino kapena kuipiraipira pakapita nthawi.

Wogona: mukugona pokhapokha wina kapena chinachake chikudzutseni. Nthawi zambiri mumatha kulankhula ndi kutsatira malangizo, koma mungakhale ndi vuto lokhala maso.

Obtunded kapena lethargic: mwatopa komanso simukudziwa kapena kuchita chidwi ndi malo omwe mumakhala.

Stupor: uli m’tulo tofa nato pokhapokha ngati chinachake chaphokoso kapena chowawa sichikudzutsa. Mwina simungathe kulankhula kapena kutsatira malangizo bwino, ndipo mudzagonanso mukasiyidwa nokha.

Koma: inu mukugona, koma inu simungakhoze kudzutsidwa konse.

Chikomokere ndi chikomokere zimayesedwa malinga ndi momwe zizindikirozo zilili.

MAPHUNZIRO: ENDWENI KU BOOTH YA DMC DINAS MEDICAL CONSULTANTS MU EMERGENCY EXPO

Tanthauzo Losinthidwa Lachidziwitso

Mlingo wa chidziwitso ndi muyeso wa kuyankha kwa munthu ku zokopa zochokera ku chilengedwe.

Kusintha kwa chidziwitso ndi mulingo uliwonse wa kudzutsidwa kapena kukondoweza kwina kosiyana ndi kwanthawi zonse.

Kukhala tcheru pang’ono kwa kupsinjika maganizo kungasonyezedwe kukhala kulefuka, mkhalidwe umene munthu angadzuke movutikirapo pang’ono.

Anthu omwe ali otsekeka amakhala ndi malingaliro opsinjika kwambiri ndipo sangathe kudzutsidwa mokwanira.

Anthu omwe satha kudzutsidwa kuchokera ku tulo ngati tulo amati ali ndi chibwibwi.

Coma ndikulephera kuyankha mwadala.

Mamba ngati Glasgow coma scale adapangidwa kuti ayese kuchuluka kwa chidziwitso.

ALOC imatha chifukwa cha zinthu zosiyanasiyana, kuphatikiza kusintha kwa chemistry yaubongo (mwachitsanzo, kukhudzana ndi poyizoni kapena zoledzeretsa), mpweya wosakwanira kapena kutuluka kwa magazi muubongo, kapena kupanikizika kwambiri muubongo.

Kukomoka kwa nthawi yayitali ndi chizindikiro cha ngozi yachipatala.

Kuperewera kwa chidziwitso kungatanthauze kuti cerebral hemispheres kapena reticular activating system yavulazidwa.

Kuchepa kwa chidziwitso kumagwirizana ndi kuchuluka kwa matenda (matenda) ndi kufa (imfa). ALOC ndimuyeso wofunikira wamankhwala ndi minyewa ya wodwala.

Madokotala ena amaona kuti kukomoka ndi chimodzi mwa zizindikiro zofunika kwambiri, kuphatikizapo kutentha kwa thupi, kuthamanga kwa magazi, ndi kugunda kwa mtima.

Kusintha kwa chidziwitso kumatha kuchitika m'njira zosiyanasiyana.

Kawirikawiri, zizindikiro za ALOC zimaphatikizapo pamene wodwala sakuchita monga momwe akuyambira, akuwoneka osokonezeka komanso osokonezeka, kapena sakuchita bwino.

Wodwala atha kukhala ndi vuto la kuzindikira ndipo akhoza kukhala wofooka, wopunduka, kapena chikomokere.

Wodwalayo angakhale akudzilankhulira yekha kapena kuyerekezera zinthu m’maganizo.

Wodwalayo angawonekenso wochenjera, wokwiya, wosokonezeka, kapena wosokonezeka.

WADIYO YA OPULUMUTSA DZIKO LAPANSI? ONANI ZOONA ZA RADIO EMS BOOTH PA EMERGENCY EXPO

Zifukwa za ALOC

ALOC ikhoza kuyambitsidwa ndi zinthu zotsatirazi:

Type	zitsanzo
Opatsirana	• Chibayo • Matenda a mkodzo • Meningitis kapena encephalitis • Sepsis
Metabolic / poizoni	• Hypoglycemia • Kumwa mowa • Electrolyte abnormalities • Kutupa kwa chiwindi • Matenda a chithokomiro • Kusiya kumwa mowa kapena mankhwala osokoneza bongo
Neurological	• Stroke kapena kusakhalitsa kwa ischemic • Kugwidwa kapena posttal state • Kutaya magazi kwa Subarachnoid • Kutaya magazi mu ubongo • Kuwonongeka kwakukulu kwa dongosolo la mitsempha • Subdural hematoma
Cardiopulmonary	• Kulephera kwa mtima kwamtima • Myocardial infarction • Kutsekeka kwa m'mapapo • Hypoxia kapena CO2 narcosis
Zokhudzana ndi mankhwala	• Anticholinergic mankhwala • Kusiya kumwa mowa kapena mankhwala osokoneza bongo • Sedatives-hypnotics • Mankhwala osokoneza bongo • Polypharmacy

Nthawi Yoyimba Nambala Yadzidzidzi ya ALOC

Malingana ndi American College of Emergency Physicians, ALOC kapena kusintha kwa maganizo ndi zizindikiro zochenjeza za ngozi yachipatala, ndipo muyenera kuyimbira Nambala Yodzidzimutsa.

Imbani Nambala Yadzidzidzi ngati mukukumana ndi ALOC ndipo muli nokha.

Osadziyendetsa nokha kuchipatala ngati mukumva kupweteka kwambiri pachifuwa kapena kutuluka magazi kwambiri kapena ngati simukuwona bwino.

Kutenga ambulansi ndi otetezeka chifukwa opereka chithandizo amatha kupereka chithandizo chopulumutsa moyo panjira yopita kuchipatala.

Ngati wina awonetsa zizindikiro za ALOC kapena kusintha kwa malingaliro, imbani Nambala Yadzidzidzi nthawi yomweyo.

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

Momwe Mungachitire ndi ALOC

Magawo onse a ALOC amafunika kuyang'anitsitsa, makamaka m'maola 24 oyambirira.

Odwala a ALOC adzafunika kugonekedwa m'chipatala kuti awonedwe, kuyezetsa, komanso kulandira chithandizo.

Poyesa wodwalayo kuti asinthe malingaliro ake, ndikofunikira kuti asonkhanitse mbiri ya wodwalayo momwe angathere ndikuyesa kuyezetsa kwathunthu kwamutu mpaka kumapazi.

Popeza odwala nthawi zambiri sangathe kupereka mbiri yawo chifukwa cha kusintha kwawo, mbiri iyenera kupezedwa kuchokera kwa wachibale kapena kuchipatala kuti adziwe momwe alili m'maganizo.

Muyenera kuwonanso mbiri yamankhwala a wodwalayo mu mbiri yachipatala yamagetsi (EMR) kapena itanani ku pharmacy.

Odwala a ALOC aziyang'aniridwa mosalekeza ndikuwunika pafupipafupi zizindikiro zotsatirazi:

Kuthamanga kwa mtima, kuthamanga kwa magazi, ndi kutentha
Mulingo wa okosijeni wamagazi
Mphamvu, kusuntha kosiyanasiyana, komanso kuthekera komva ululu

Kuyesa kwa ALOC kungaphatikizepo:

Kuyezetsa magazi kuti awone shuga, kuchuluka kwa okosijeni, kutaya madzi m'thupi, matenda, mankhwala osokoneza bongo, kapena mowa
Magazi, mkodzo, ndi mayesero ena kuti ayang'ane ntchito ya ziwalo zosiyanasiyana
Kuwunika kwa Neurologic kuti muwone mphamvu, kumverera, kulingalira, kulingalira, ndi kukumbukira
Computed tomography (CT) scan kuti muwone kuvulala kwa ubongo kapena matenda a ubongo
Imaging resonance imaging (MRI) kuti muwone kuvulala kwaubongo kapena matenda a ubongo
X-ray pachifuwa kuti awone ngati pali vuto la mapapo

Chithandizo cha ALOC chimatengera zomwe zimayambitsa, zizindikiro, thanzi la wodwalayo, komanso zovuta zilizonse. Odwala a ALOC angayembekezere:

Katheta wa IV wolowetsedwa mumtsempha m'manja kapena mkono wawo
Chubu cha okosijeni choyikidwa pansi pa mphuno zawo kapena chigoba cha okosijeni chomwe chimayikidwa pankhope zawo
Mankhwala: a) Kuchiza kapena kupewa matenda b) Kuchepetsa kutupa mkati ndi kuzungulira ubongo ndi Msana chingwe c) Kuwongolera kuchuluka kwa shuga m'magazi

Kodi mungathandize bwanji munthu yemwe ali ndi ALOC?

Othandizira azaumoyo ayenera kudziwa mbiri yaumoyo wa wodwala wa ALOC.

Ngati wodwalayo sangathe kupereka chidziwitsochi, wosamalira wodziwa bwino ayenera kukhalapo.

Uzani gulu lazachipatala chilichonse mwa izi:

Kukomoka kapena kukomoka
Kutuluka magazi m'makutu kapena mphuno
Kulankhulidwa
Vuto ndi kayendedwe ka minofu, monga kumeza, kusuntha manja ndi miyendo
chizungulire
chisokonezo
Kusintha kwa masomphenya, monga kuwona pawiri, kusawona bwino, kapena kusawona ndi diso limodzi kapena onse awiri
m'chikaiko chowakaikitsa
Kukhumudwa
Kuvuta kukhala maso kapena tcheru
kusanza
Mutu umene sudzatha pambuyo pa chithandizo
kutopa
Kusokonekera kapena kusamvana
Kulephera kukumbukira
Khalidwe losazolowereka

Momwe EMTs & Paramedics Amachitira ALOC

Pazidzidzi zonse zachipatala, sitepe yoyamba ndikuwunika mofulumira komanso mwadongosolo kwa wodwalayo.

Pakuwunika uku, ambiri opereka EMS adzagwiritsa ntchito Mtengo wa ABCDE yandikira.

Njira ya ABCDE (Ndege, Kupuma, Kuzungulira, Kulemala, Kuwonekera) imagwira ntchito pazochitika zonse zadzidzidzi kuti zifufuze mwamsanga ndi kulandira chithandizo. Itha kugwiritsidwa ntchito mumsewu kapena popanda chilichonse zida.

Itha kugwiritsidwanso ntchito m'mawonekedwe apamwamba kwambiri komwe chithandizo chamankhwala chadzidzidzi chilipo, kuphatikiza zipinda zachangu, zipatala, kapena zipinda zachipatala.

MA STRETCHERS, OPULULIRA MABUKU, MIPANDE YOTSATIRA: SPENCER PRODUCTS PA DOUBLE BOOTH PA EXPO EMERGENCY

Malangizo a Chithandizo & Zothandizira kwa Oyankha Oyamba Kuchipatala

Malangizo a chithandizo cha kusintha kwa chidziwitso angapezeke pa tsamba 66 la National Model EMS Clinical Guidelines by the National Association of State EMT Officials (NASEMSO).

NASEMSO imasunga malangizowa kuti atsogolere malangizo achipatala a EMS a boma ndi am'deralo, ndondomeko, ndi njira zogwirira ntchito.

Malangizowa ndi ozikidwa paumboni kapena ogwirizana ndipo adapangidwa kuti agwiritsidwe ntchito ndi akatswiri a EMS.

Malangizowa akuphatikiza chithandizo ndi njira zotsatirazi:

Yang'anani zomwe zimayambitsa kusintha kwamaganizo:

Airway - Onetsetsani kuti airway imakhalabe yovomerezeka; sinthani wodwalayo ngati pakufunika
Kupuma - Yang'anani kupsinjika kwa kupuma; onani zowerengera za SPO2, ETCO2, ndi CO detector
Kuzungulira - Yang'anani zizindikiro za mantha
Glasgow Coma Score ndi/kapena Kutumiza
Ophunzira
Khosi kuuma kapena kuwawa kosiyanasiyana
Chida cha sitiroko
Mlingo wa glucose m'magazi
EKG - Arrhythmia yochepetsera kutulutsa
Kununkhira kwa mpweya - fungo lachilendo lomwe lingakhalepo ndi mowa, acidosis, ammonia
Chifuwa / Pamimba - Zida zamkati zamkati, zida zothandizira, kupweteka m'mimba kapena kutsika
Kumayambiriro / Khungu - Zizindikiro, hydration, edema, dialysis shunt, kutentha kuti mugwire (kapena ngati mungathe, gwiritsani ntchito thermometer)
Chilengedwe - Kafukufuku wa mapiritsi, zida, kutentha kwapakati

Apr 11, 2024

Aviary Alert: Pakati pa Virus Evolution ndi Human Risks

Apr 4, 2024

Tsiku lachikasu motsutsana ndi endometriosis

Mar 28, 2024

Chiyembekezo ndi Zatsopano Polimbana ndi Khansa ya Pancreatic

Mar 27, 2024

EMS Protocol ya ALOC Emergency

Ndondomeko za chithandizo chamankhwala chisanakhale chipatala cha kusintha kwa chidziwitso chimasiyana ndi wothandizira EMS ndipo zingadalirenso zizindikiro za wodwalayo kapena mbiri yachipatala.

Yang'anani momwe zinthu zilili kuti muwone zoopsa zomwe zingatheke kapena zenizeni. Ngati malo/zochitika sizili bwino, bwererani pamalo otetezeka, pangani malo otetezeka, ndikupeza thandizo lina kuchokera ku polisi. Odwala omwe ali ndi vuto la m'maganizo ayenera kuganiziridwa kuti ali ndi vuto linalake lachipatala kapena zoopsa zomwe zimapangitsa kuti maganizo asinthe. Ziwopsezo zonse zofuna kudzipha kapena zachiwawa ziyenera kuonedwa mozama. Odwalawa akuyenera kukhala m'manja mwa apolisi ngati ali pachiwopsezo kwa iwo eni kapena kwa ena. Ngati wodwalayo adziika pachiwopsezo kwa iwo eni komanso/kapena ena, itanani apolisi kuti amuthandize.

2) Chitani kafukufuku woyamba. Tsimikizirani kuti njira ya mpweya ya wodwalayo ili yotseguka komanso kuti kupuma ndi kuzungulira kwake kuli kokwanira. Kuyamwa ngati kuli kofunikira.

3) Perekani mpweya wambiri wa ndende. Kwa ana, mpweya wonyezimira ndi wabwino.

4) Pezani ndi kulemba zizindikiro zofunika za wodwalayo, kuphatikizapo kudziwa mlingo wa chidziwitso cha wodwalayo. Onani ndikuyang'anira Glasgow Coma Scale.

Ngati wodwalayo sakuyankha kapena amangoyankha zowawa zowawa, konzekerani zoyendera pamene mukupitirizabe kusamalira.
Ngati wodwala ali ndi mbiri yodziwika ya matenda a shuga omwe amalamulidwa ndi mankhwala, amadziwa, amatha kumwa popanda kuthandizidwa, kupereka yankho la glucose pakamwa, madzi a zipatso, kapena soda yopanda zakudya pakamwa, ndiye kunyamula, kusunga wodwalayo. Ngati chigawochi chikuvomerezedwa kuti mupeze kuchuluka kwa shuga m'magazi pogwiritsa ntchito glucometer, tsatirani ndondomeko yanu yovomerezeka m'deralo.
Ngati wodwalayo ali ndi vuto la opioid overdose:

a) Ngati wodwalayo sakuyankha zolimbikitsa zapakamwa, koma amayankha zowawa kapena osayankha; ndi

b) Kupuma kosakwana 10/mphindi ndi zizindikiro za kulephera kupuma kapena kupuma, tchulani njira yoyenera kupuma.

c) Ngati chigawo chavomerezedwa ndi kupezeka, pezani mulingo wa glucose (BG) wa wodwalayo.

Ngati BG ili yochepera 60, mwa akulu ndi odwala odwala, tsatirani IV pamwambapa.
Ngati BG ndi yoposa 60 mwa odwala akuluakulu ndi ana, pitani ku sitepe yotsatira.

d) Yambitsani naloxone (Narcan®) kudzera mucosal atomizer device (MAD).

Contraindications ofanana:

Cardiopulmonary kumangidwa
Kugwira ntchito pazochitika izi
Umboni wa kuvulala kwa mphuno, kutsekeka kwa mphuno ndi/kapena epistaxis

Ikani MAD mumphuno yakumanzere ya wodwala ndi:

WAMKULU: jekeseni 1mg/1ml
ANATRIC: jekeseni 0.5mg/05ml

Ikani MAD mumphuno yakumanja kwa wodwala ndi:

WAMKULU: jekeseni 1mg/1ml
ANATRIC: jekeseni 0.5mg/05ml

e) Kuyambitsa zoyendera. Pambuyo pa mphindi za 5, ngati kupuma kwa wodwalayo sikuli kwakukulu kuposa kupuma kwa 10 / mphindi, perekani mlingo wachiwiri wa naloxone potsatira ndondomeko yomweyi pamwambapa ndikulumikizana ndi chithandizo chamankhwala.

f) Ngati vuto lalikulu lachipatala kapena lopweteketsa mtima lomwe limayambitsa kusintha kwa malingaliro silikuwonekera, wodwalayo akudziwa bwino, ali tcheru, ndipo amatha kulankhula; ndipo kusokonezeka kwamalingaliro kumaganiziridwa, pitani ku protocol ya Behavioral Emergency protocol.

g) Yendetsani kupita ku malo oyandikira kwambiri kwinaku mukuwunikanso zizindikiro zofunika mphindi zisanu zilizonse ndikuwunikanso ngati kuli kofunikira.

h) Lembani zonse zokhudza chisamaliro cha odwala, kuphatikizapo mbiri yachipatala ya wodwalayo ndi chithandizo chonse choperekedwa, pa Prehospital Care Report (PCR).