Moto ndiwomwe umayambitsa kuvulala, kufa komanso kuwonongeka kwachuma. Chaka chilichonse, pakati pa 15 ndi 25 miliyoni moto umachitika ku United States, zomwe zimapangitsa kuvulala pafupifupi 25,000, kufa kwa 5,000 ndi $ 7 mpaka $ 9 biliyoni pakuwonongeka kwachuma.

Kuwonongeka kobwera chifukwa cha kutulutsa utsi kumapangitsa kuti chiwerengero cha anthu omwe amafa ndi chiwopsezo chichuluke kwambiri: m'malo awa, kuwonongeka kwa mpweya wa utsi kumawonjezedwa ndikuwotcha, nthawi zambiri kumakhala ndi zotsatirapo zakupha.

Nkhaniyi ikugwiritsidwa ntchito pochiza zilonda zamoto, makamaka ponena za kuwonongeka kwa pulmonary ndi systemic kwa odwala omwe amawotcha utsi, pamene zotupa za dermatological zidzakambidwa mwatsatanetsatane kwina.

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

Zolinga za chisamaliro cha kupuma kwa odwala oyaka ndikuwonetsetsa

• mpweya patency,
• mpweya wabwino,
• mpweya wokwanira,
• kukhazikika kwa acid-base balance,
• kukonza kukhazikika kwa mtima,
• chithandizo chachangu cha matenda.

Nthawi zina, kuchita escharotomy ndikofunikira kuti muteteze minofu iliyonse ya thoracic kuti isalepheretse kuyenda kwa chifuwa.

Zolinga za chithandizo cha kutentha kwa khungu ndizo

• kuchotsa khungu losatheka
• kugwiritsa ntchito mabandeji okhala ndi ma antibayotiki apakhungu,
• kutsekedwa kwa chilonda ndi zoloweza m'malo kwakanthawi ndikuyika khungu kuchokera kumadera athanzi kapena zoyeserera kupita kumalo otenthedwa,
• kuchepetsa kutaya madzimadzi komanso chiopsezo chotenga matenda.

Nkhaniyi iyenera kuperekedwa mochuluka kuposa ma basal caloric quantities kuti athandize kukonza mabala ndikupewa kusokoneza.

KUFUNIKA KWA MAPHUNZIRO PA KUPULUMUTSA: ENDWENI KU BUKHU LA SQUICCIARINI RESCUE BOOTH NDIKUDZIWA MMENE MUNGAKONZEKERE PADZIWAZI.

Chithandizo cha odwala kutentha

Ovulala omwe adawotchedwa ndi kuvulala pang'ono kumtunda kwa mpweya, kapena ndi zizindikiro za kutsekeka kwa kupuma kapena kukhudzidwa kwa mapapo, ayenera kuyang'aniridwa mosamala.

Oxygen supplementation iyenera kuperekedwa, kudzera mu cannula ya m'mphuno, ndipo wodwalayo ayenera kuikidwa pamalo apamwamba a Fowler kuti achepetse ntchito yopuma.

Bronchospasm iyenera kuthandizidwa ndi β-agonists mu aerosol (monga orciprenaline kapena albuterol).

Ngati kutsekeka kwa mayendedwe akuyembekezeredwa, patency iyenera kutsimikiziridwa ndi endotracheal cannula ya calibre yoyenera.

Kawirikawiri, tracheostomy yoyambirira sivomerezedwa kwa odwala oyaka moto, chifukwa njirayi imagwirizanitsidwa ndi chiwerengero chachikulu cha matenda ndi kuwonjezeka kwa imfa, ngakhale kuti zingakhale zofunikira pa chisamaliro cha kupuma kwa nthawi yaitali.

Zawonedwa kuti kulowetsedwa koyambirira kumatha kuyambitsa edema yapam'mapapo kwakanthawi kwa odwala ena omwe amavulazidwa ndi inhalation.

Kugwiritsa ntchito mosalekeza kuthamanga kwabwino kwa 5 kapena 10 cm H2O (CPAP) zingathandize kuchepetsa kutupa koyambirira kwa m'mapapo, kusunga kuchuluka kwa mapapo, kuthandizira mpweya wa edema, kupititsa patsogolo mpweya wabwino/kutulutsa mpweya komanso kuchepetsa kufa msanga.

Kuwongolera kwa systemic corticosteroids pochiza edema sikuvomerezeka chifukwa chakuwonjezeka kwa matenda.

Chithandizo cha odwala chikomokere ayenera mwachindunji hypoxia kwambiri ndi CO poizoni ndipo zachokera makonzedwe a mpweya.

Kupatukana ndi kuchotsedwa kwa carboxyhaemoglobin kumachulukitsidwa ndi makonzedwe a O2 owonjezera.

Odwala omwe adakoka utsi, koma amangowonjezera pang'ono Hbco (ochepera 30%) ndikusunga magwiridwe antchito amtima, amayenera kuthandizidwa ndi 100% O2 yobereka, pogwiritsa ntchito chigoba chakumaso cholimba, chosapumira (chomwe sichilola mpweya wotuluka kumene kuti utulutsidwenso), pamlingo wothamanga wa 15 malita / mphindi, kusunga nkhokwe yodzaza.

Chithandizo cha okosijeni chiyenera kupitilira mpaka milingo ya Hbco itsike pansi pa 10%.

Chigoba cha CPAP, chokhala ndi 100% O2 makonzedwe, chikhoza kukhala chithandizo choyenera kwa odwala omwe ali ndi vuto la hypoxaemia ndipo palibe kapena kuvulala pang'ono chabe kumaso ndi kumtunda kwa mpweya.

Odwala omwe ali ndi refractory hypoxaemia kapena kuvulala kwa inhalation komwe kumakhudzana ndi coma kapena cardiopulmonary instability amafuna intubation ndi thandizo la kupuma ndi 100% O2 ndipo ayenera kutumizidwa mofulumira kwa hyperbaric oxygen therapy.

Chithandizo chotsirizirachi chimathandizira kuyendetsa bwino kwa oxygen ndikufulumizitsa njira yochotsa CO m'magazi.

Odwala omwe ali ndi edema yoyambirira ya pulmonary, ARDS, kapena chibayo nthawi zambiri chimafuna thandizo la kupuma ndi mphamvu yopuma yopuma (PEEP) pamaso pa haemogasanalysis yosonyeza kulephera kupuma (PaO2 pansi pa 60 mmHg, ndi/kapena PaCO2 pamwamba pa 50 mmHg, ndi pH pansi pa 7.25).

PEEP ikuwonetsedwa ngati PaO2 ili pansi pa 60 mmHg ndipo kufunika kwa FiO2 kupitirira 0.60

Thandizo la mpweya wabwino liyenera kukulitsidwa nthawi zambiri, chifukwa anthu omwe amawotchedwa amakhala ndi metabolism yofulumira, zomwe zimapangitsa kuti pakhale kufunikira kowonjezera mpweya wopuma pamphindi kuti muwonetsetse kuti homeostasis ikusungidwa.

The zida ogwiritsidwa ntchito ayenera kukhala okhoza kupereka voliyumu / mphindi imodzi (mpaka malita 50) pokhalabe ndi kuthamanga kwapamwamba kwambiri (mpaka 100 cm H2O) ndi chiŵerengero chokhazikika cha kupuma / mpweya (I: E), ngakhale pakufunika kuwonjezereka. zikhalidwe zokakamiza.

Refractory hypoxaemia imatha kuyankha mpweya wodalira mphamvu ndi chiŵerengero cholowera

Ukhondo wokwanira wa m'mapapo ndi wofunikira kuti mpweya ukhale wopanda sputum.

Physiotherapy yopumira yopumira imathandizira kulimbikitsa katulutsidwe ndikuletsa kutsekeka kwa mpweya ndi atelectasis.

Zomera zaposachedwa zapakhungu sizilola kugwedezeka ndi kugwedezeka pachifuwa.

Thandizo la fibrobronchoscopy lingakhale lofunikira kuti mutsegule njira yodutsa mpweya kuchokera kumadzi ochulukirapo.

Kusamalira bwino kwa madzi ndikofunikira kuti muchepetse chiopsezo cha kugwedezeka, kulephera kwaimpso ndi edema ya m'mapapo.

Kubwezeretsanso madzi a wodwalayo, pogwiritsa ntchito njira ya Parkland (4 ml isotonic solution pa kilogalamu iliyonse ya malo oyaka pakhungu, kwa maola 24) ndikusunga diuresis pakati pa 30 ndi 50 ml / ola ndi kuthamanga kwapakati kwa venous pakati pa 2 ndi 6. mmHg, imateteza kukhazikika kwa haemodynamic.

Odwala omwe avulala pokoka mpweya, kuchuluka kwa capillary kumawonjezeka, komanso kuyang'anira kuthamanga kwa m'mapapo mwanga ndi chitsogozo chothandiza pakubwezeretsanso kwamadzimadzi, kuphatikiza pakuwongolera diuresis.

Ozunzidwa ndi moto, electrolyte ndi acid-base balance iyenera kuyang'aniridwa

Mkhalidwe wa hypermetabolic wa wodwala wowotcha umafunikira kuwunika mosamalitsa kadyedwe koyenera, pofuna kupewa catabolism ya minofu ya minofu.

Njira zolosera zam'tsogolo (monga za Harris-Benedict ndi Curreri) zakhala zikugwiritsidwa ntchito kuyerekeza kukula kwa metabolism mwa odwalawa.

Pakalipano, zowunikira zonyamula katundu zilipo malonda omwe amalola kuti miyeso ya calorimetry yosadziwika bwino, yomwe yasonyezedwa kuti ikupereka kuyerekezera kolondola kwa zakudya zoyenera.

Odwala omwe amayaka kwambiri (oposa 50% ya khungu) nthawi zambiri amapatsidwa zakudya zomwe ma caloric amadya ndi 150% ya mphamvu zawo zopuma kuti athetse machiritso ndi kupewa catabolism.

Pamene kuyaka kuchira, kudya kwa zakudya kumachepetsedwa pang'onopang'ono mpaka 130% ya basal metabolism.

Pankhani ya circumferential burns pachifuwa, minofu ya chipsera ikhoza kulepheretsa kuyenda kwa khoma la chifuwa.

Escharotomy (kuchotsa opareshoni yakhungu yowotchedwa) imapangidwa popanga magawo awiri ozungulira pamzere wakumbuyo kwa axillary, kuyambira ma centimita awiri pansi pa clavicle mpaka XNUMX mpaka XNUMX intercostal space, ndi zina ziwiri zopingasa zotambasulidwa pakati pa malekezero oyamba, kuti agawane lalikulu.

Opaleshoniyi iyenera kupititsa patsogolo kukhazikika kwa khoma la pachifuwa ndikuletsa kupsinjika kwa minofu yachilonda.

Kuchiza kwa chiwopsezo kumaphatikizapo kuchotsa khungu lomwe silingagwire ntchito, kugwiritsa ntchito mabandeji opangidwa ndi maantibayotiki apakhungu, kutsekeka kwa chilondacho ndi zolowa m'malo mwakhungu kwakanthawi komanso kuyika khungu kuchokera kumalo athanzi kapena zofananira zomwe zidawotchedwa.

Izi zimachepetsa kutaya madzimadzi komanso chiopsezo chotenga matenda.

Matendawa nthawi zambiri amayamba chifukwa cha coagulase-positive Staphylococcus aureus ndi mabakiteriya opanda gramu monga Klebsiella, Enterobacter, Escherichia coli ndi Pseudomonas.

Njira yoyenera yodzipatula, kukakamiza chilengedwe komanso kusefera kwa mpweya ndiye maziko achitetezo ku matenda.

Kusankhidwa kwa maantibayotiki kumatengera zotsatira za zikhalidwe zosawerengeka zomwe zimatengedwa pabala, komanso magazi, mkodzo ndi sputum.

Maantibayotiki sayenera kuperekedwa prophylactically odwala amenewa, chifukwa chomasuka ndi kugonjetsedwa mitundu akhoza kusankhidwa, udindo matenda refractory mankhwala.

Kwa anthu omwe amakhala nthawi yayitali, heparin prophylaxis ingathandize kuchepetsa chiopsezo cha pulmonary embolism, ndipo chidwi chapadera chiyenera kuperekedwa kuti apewe kukula kwa pulmonary embolism. kuthamanga zilonda.

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