Njira zochepetsera chiberekero ndi msana: mwachidule
Njira zowonongeka kwa chiberekero ndi msana: ogwira ntchito zachipatala (EMS) ogwira ntchito zachipatala akupitirizabe kukhala otsogolera otsogolera pazochitika zambiri zadzidzidzi kunja kwa chipatala, kuphatikizapo zoopsa.
Malangizo a ATLS (advanced trauma life support) omwe adapangidwa m'ma 1980, akupitilizabe kukhala muyezo wa golide wowunika ndikuyika patsogolo kasamalidwe ka kuvulala kowopsa m'njira yomveka komanso yothandiza, ngakhale kwa nthawi yayitali pakhala pali mkangano waukulu wokhudza njirazi. kugwiritsa ntchito chithandizo ichi.
Kusasunthika kwa msana kwakhala gawo lofunikira pakuphunzitsa, kuwonjezera pa zomangira za m'chiuno ndi ma splints a mafupa aatali.
Mitundu yosiyanasiyana yachipatala zida zapangidwa kuti zitheke kugwiritsa ntchito bwino komanso zosavuta kugwiritsa ntchito, komanso kulola kusinthasintha komanso mwayi wofunikira woyendetsa ndege ndi njira zina.
Kufunika kolepheretsa msana kumatsimikiziridwa ndi zochitika ndi kuwunika kwa odwala.
Taganizirani kusayenda kwa msana pamene njira yovulaza imapanga chiwerengero chachikulu cha kukayikira kwa mutu, khosi kapena kuvulala kwa msana
Kusokonekera kwamalingaliro ndi kuperewera kwa minyewa ndizizindikiro zomwe kusayenda kwa msana kuyenera kuganiziridwa. [1] [2] [3] [4]
Chiphunzitso chachikhalidwe cha ATLS cha kusasunthika koyenera kwa msana kwa wodwala yemwe ali pachiwopsezo chachikulu ndichokhazikika bwino. kolala ndi midadada ndi tepi kuteteza msana khomo lachiberekero, komanso backboard kuteteza msana ena onse.
The Kendrick extrication chipangizo amalola kuti msana utetezedwe ndi munthu wovulalayo ali pamalo omwe akukhala panthawi yothamangitsidwa mofulumira kuchokera ku galimoto kapena muzochitika zina zomwe kupeza kuli kochepa kuti alole kugwiritsa ntchito kumbuyo kwathunthu.
Komabe, chipangizochi chimafuna kuti ogwira ntchito yopulumutsa asamalire kuchepetsa kuyenda kwa msana wa khomo lachiberekero pogwiritsa ntchito kulimbikitsana mpaka kusonkhana [5].
Kusindikiza kwa 10 kwa malangizo a ATLS ndi mawu ogwirizana a American College of Emergency Physicians (ACEP), American College of Surgeons Committee on Trauma (ACS-COT), ndi National Association of EMS Physicians (NAEMSP) akunena kuti, mu vuto la kupwetekedwa mtima kolowera palibe chizindikiro choletsa kusuntha kwa msana [6], mogwirizana ndi kafukufuku wobwerezabwereza kuchokera ku American Trauma Database yomwe inasonyeza chiwerengero chochepa kwambiri cha kuvulala kwa msana kosasunthika komwe kumafuna opaleshoni pazochitika za kupwetekedwa mtima. Kafukufukuyu akuwonetsanso kuti chiwerengero cha odwala omwe akuyenera kulandira chithandizo kuti apindule ndi ochuluka kwambiri kuposa chiwerengero cha odwala omwe ayenera kuchiritsidwa kuti apeze chovulala, 1032/66.
Komabe, pakachitika zoopsa zazikulu, zoletsa zimapitilira kuwonetsedwa muzochitika zotsatirazi:
- Low Mtengo wa GCS kapena umboni wa kuledzera kwa mowa ndi mankhwala osokoneza bongo
- Kukoma kwa msana wapakati kapena wapambuyo pa khomo lachiberekero
- Kupunduka koonekeratu kwa msana
- Kukhalapo kwa zotupa zina zosokoneza
Malangizo oletsa kuletsa bwino akupitiriza kukhala kolala ya chiberekero ndi chitetezo chokwanira cha msana, chomwe chiyenera kuchotsedwa mwamsanga.
Izi zimachitika chifukwa cha chiopsezo cha kuvulala kosiyanasiyana.
Komabe, m'magulu a ana, chiopsezo cha kuvulala kwamagulu ambiri ndi chochepa ndipo chifukwa chake kutetezedwa kwa msana wa khomo lachiberekero komanso osati chitetezo chokwanira cha msana kumasonyezedwa (pokhapokha ngati zizindikiro kapena zizindikiro za kuvulala kwa msana zilipo).
Cervical immobilization ndi kolala yolimba mwa wodwala wodwala
- kupweteka khosi
- Kusintha kwa mitsempha ya mitsempha sikunafotokozedwe ndi kuvulala kwa miyendo
- Kuphulika kwa minofu ya khosi (torticollis)
- Mtengo wapatali wa magawo GCS
- Kuvulala koopsa (monga ngozi yagalimoto yamphamvu kwambiri, kuvulala kwapakhosi komanso kuvulala kwakukulu kwa thupi)
Madera ofunikira
Pali umboni wochulukirachulukira komanso wodetsa nkhawa za nkhaniyi kuyendera zapangitsa kugwiritsa ntchito mopitirira muyeso njira zolepheretsa msana komanso kuti odwala ena ali pachiwopsezo [7] [8] [9] [10].
Mavuto omwe angakhalepo a spinal immobilisation:
- Kusokonezeka komanso nsautso kwa wodwala[11].
- Kutalikitsa nthawi yopita kuchipatala ndi kuchedwa kwa kafukufuku wofunikira ndi chithandizo, komanso kusokoneza njira zina [11].
- Kuletsa kupuma ndi zomangira, komanso kupuma koyipa komwe kumagwirira ntchito pamtunda poyerekeza ndi malo owongoka. Izi ndizofunikira makamaka pakavulala kwa thoracic, kaya momveka bwino kapena kulowa mkati [12] [13] Kuvuta ndi intubation[14].
- Nkhani ya odwala omwe ali ndi ankylosing spondylitis kapena kuwonongeka kwa msana komwe kunalipo kale, kumene kuvulazidwa kwenikweni kungayambitsidwe ndi kukakamiza wodwalayo kuti agwirizane ndi malo okonzedweratu a kolala yolimba ya khola ndi kumbuyo [15].
Ndemanga yatsopano ya mabuku a Scandinavia, yomwe inachitidwa kuti ifufuze umboni womwe ulipo woletsa kusuntha kwa msana [16], umapereka chidziwitso chamtengo wapatali kwambiri poyerekeza ndi njira za prehospital kukhazikika kwa msana ndi kuyesa mphamvu ya umboni.
Kolala yolimba
Kolala yolimba yakhala ikugwiritsidwa ntchito kuyambira pakati pa zaka za m'ma 1960 monga njira yokhazikika ya msana wa khomo lachiberekero, ndi umboni wochepa wotsimikizira kuti zotsatira zake zimakhala zabwino pa zotsatira za ubongo za kuvulala kwa msana wa khomo lachiberekero, zomwe zingakhale ndi zotsatira zoipa chifukwa cha kuwonjezeka kwakukulu kwa intracranial pressure ndi dysphagia [17].
Nkhaniyi imasonyezanso kuti wodwala tcheru ndi wogwirizana ndi mitsempha ya minofu chifukwa cha kuvulala sikungatheke kukhala ndi kusamuka kwakukulu, monga momwe taonera mu maphunziro a cadaver omwe ayesa kufufuza zotsatira za kuvulala.
Nkhaniyi ikusonyeza kulinganiza kuopsa ndi ubwino wa opaleshoni imeneyi.
Komabe, bungwe la American Association of Neurological Surgeons likupitiriza kusonyeza kolala yolimba ngati njira yokhazikitsira msana wa khomo lachiberekero muzochitika zachipatala [18].
Rigid board: Kodi bolodi lalitali la msana limagwiritsidwa ntchito liti?
Dongosolo loyambirira la msana lidagwiritsidwa ntchito limodzi ndi kolala yolimba, midadada ndi zomangira kuti msana ukhale wosasunthika.
Zowonongeka zomwe zingatheke, makamaka zilonda zopanikizika pa sacrum, [19] [20] tsopano zasonyezedwa, makamaka pankhani ya kuvulala kwa msana popanda kumva chitetezo.
Matiresi ofewa a vacuum amapereka malo ochepetsetsa omwe amateteza ku zotsatira za zilonda zopanikizika ndipo nthawi yomweyo amapereka chithandizo chokwanira akatalikitsidwa pamwamba pa mutu [16].
Zolemba
Mizinga ndi gawo la njira yolimbikitsira msana kuti ikhazikike ndipo imawoneka yothandiza pomangirira wodwalayo ku msana. bolodi kuti mukwaniritse kusasunthika pang'ono, popanda kupindula kogwiritsa ntchito kolala yolimba kuphatikiza [21].
Vuto matiresi
Poyerekeza matiresi a vacuum ndi bolodi lolimba lokha, matiresi amapereka mphamvu zambiri komanso kuyenda kochepa panthawi yogwiritsira ntchito ndikukweza kuposa bolodi lolimba [22].
Poganizira za chiopsezo cha zilonda zopanikizika, matiresi akuwoneka kuti amapereka njira yabwinoko yoyendetsera odwala.
Kumasula msana: kusinthasintha kwa msana ndi khomo lachiberekero immobilization
Njira ya NEXUS: munthu watcheru, wosaledzeretsa wopanda kuvulala kosokoneza amakhala ndi mwayi wochepa kwambiri wovulazidwa popanda kusokonezeka kwapakati komanso kuchepa kwa mitsempha.
Izi zikuwoneka ngati chida chowunikira chowunikira chomwe chili ndi chidwi cha 99% komanso mtengo wolosera woyipa wa 99.8% [23].
Komabe, maphunziro ena owonetsetsa awonetsa kuti wodwala tcheru yemwe ali ndi vuto la msana wa khomo lachiberekero adzayesa kukhazikika kwa msana komanso kuti kukhalapo kwa zilonda zosokoneza (kupatulapo thorax) sikumakhudza zotsatira za mayesero a zachipatala a msana wa khomo lachiberekero ndipo chifukwa chake msana ukhoza kuyeretsedwa popanda kulingalira kwina[24]. Kafukufuku wina amasonyeza zotsatira zomwezo za msana wa thoracolumbar [25][24].
WASIYO WA ONSE ONSE NTCHITO PADZIKO LAPANSI? ENDWENI KU EMS RADIO BOOTH PA EMERGENCY EXPO
Kufunika kwamankhwala
Ngakhale kuti pre-hospital immobilisation immobilisation yakhala ikuchitika kwa zaka zambiri, deta yamakono imasonyeza kuti si odwala onse omwe ayenera kukhala osasunthika.
Tsopano bungwe la National Association of Emergency Physicians USA ndi Komiti ya American College of Surgeons Committee on Trauma akusonyeza kuti kugwiritsa ntchito pang'ono kwa msana kusayenda bwino.
Malangizo atsopanowa amasonyeza kuti chiwerengero cha odwala omwe angapindule ndi immobilization ndi chochepa kwambiri
Komitiyo inapitiriza kunena kuti kugwiritsa ntchito mwamphamvu zoletsa msana panthawi yoyendetsa galimoto kuyenera kugwiritsidwa ntchito mosamala, chifukwa nthawi zina zoopsa zomwe zingakhalepo zimaposa phindu lawo.
Komanso, kwa odwala omwe adakumana ndi vuto lolowera mkati ndipo alibe vuto lodziwika bwino la mitsempha, kugwiritsa ntchito zoletsa za msana sikuvomerezeka.
Ku USA woyendetsa EMS ayenera kugwiritsa ntchito luso lachipatala asanasankhe kugwiritsa ntchito bolodi la msana.[26]
Potsirizira pake, kusasunthika kwa msana kwagwirizanitsidwa ndi ululu wammbuyo, kupweteka kwa khosi ndipo kumakhala kovuta kwambiri kuchita njira zina, kuphatikizapo kujambula.
Kusasunthika kwa msana kwagwirizanitsidwanso ndi vuto la kupuma, makamaka pamene zingwe zazikulu zimagwiritsidwa ntchito pachifuwa.
Ngakhale mabungwe ambiri a EMS ku US atengera malangizo atsopanowa pa kusasunthika kwa msana, izi sizichitika konsekonse.
Machitidwe ena a EMS amawopa milandu ngati sakulepheretsa odwala.
Odwala omwe ayenera kukhala osasunthika pamsana ndi awa:
- mwakayakaya yosamveka
- kupweteka kwa msana
- odwala omwe ali ndi chidziwitso chosinthika
- kuperewera kwa minyewa
- zoonekeratu anatomical chilema cha msana
- Kupweteka kwakukulu kwa wodwala woledzera ndi mankhwala osokoneza bongo, mowa.
Maumboni a m'Baibulo
[1] Hostler D, Colburn D, Seitz SR, Kuyerekeza kwa zida zitatu zolepheretsa khomo lachiberekero. Prehospital chisamaliro chadzidzidzi : magazini yovomerezeka ya National Association of EMS Physicians ndi National Association of State EMS Directors. 2009 Apr-Jun; [Yolembedwa ndi PMID: 19291567]
[2] Joyce SM, Moser CS, Kuunika kwa chipangizo chatsopano cha khomo lachiberekero chotsekereza/kutulutsa. Mankhwala a Prehospital ndi tsoka. 1992 Jan-Mar; [Yolembedwa ndi PMID: 10171177]
[3] McCarroll RE,Beadle BM,Fullen D,Balter PA,Followill DS,Stingo FC,Yang J, Khothi LE, Kuchulukirachulukira kwa kukhazikitsidwa kwa odwala pampando wokhala pachipatala: Chithandizo chatsopano. mpando kupanga. Journal of Applied Clinical Medical Physics. 2017 Jan; [Yolembedwa ndi PMID: 28291911]
[4] Lacey CM, Finkelstein M, Thygeson MV, Mphamvu ya kuyika pamantha pa nthawi ya katemera: supine motsutsana ndi kukhala pamwamba. Journal of Pediatric Nursing. 2008 Jun; [Yolembedwa ndi PMID: 18492548]
[5] Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS, Kuyenda kwa msana wa khomo pachibelekeropo. Journal of Emergency Medicine. 2013 Jan [Yolembedwa ndi PMID: 23079144]
[6] Fischer PE,Perina DG,Delbridge TR,Fallat ME,Salomone JP,Dodd J,Bulger EM,Gestring ML,Kuletsa kwa Spinal Motion mu Odwala Ovulala - Chidziwitso Chogwirizana. Prehospital chisamaliro chadzidzidzi : magazini yovomerezeka ya National Association of EMS Physicians ndi National Association of State EMS Directors. 2018 Nov-Dec [Yolembedwa ndi PMID: 30091939]
[7] Purvis TA, Carlin B, Driscoll P, Zowopsa zotsimikizika ndi zokayikitsa za liberal pre-hospital spinal immobilisation. The American Journal of Emergency Medicine. 2017 Jun; [Yolembedwa ndi PMID: 28169039]
[8] Lerner EB, Billittier AJ 4th, Moscati RM, Zotsatira za kusalowerera ndale komanso popanda zophimba pamitsempha ya msana ya anthu athanzi. Prehospital chisamaliro chadzidzidzi : magazini yovomerezeka ya National Association of EMS Physicians ndi National Association of State EMS Directors. 1998 Apr-Jun; [Yolembedwa ndi PMID: 9709329]
[9] Hauswald M, Ong G, Tandberg D, Omar Z, Kutuluka kwa chipatala kwa msana: zotsatira zake pa kuvulala kwa ubongo. Mankhwala odzidzimutsa amaphunziro : magazini yovomerezeka ya Society for Academic Emergency Medicine. 1998 Marichi; [Yolembedwa ndi PMID: 9523928]
[10] Haut ER,Kalish BT,Efron DT,Haider AH,Stevens KA,Kieninger AN,Cornwell EE 3rd,Chang DC, Kusasunthika kwa msana pakuvulala kolowera: zovulaza kuposa zabwino? Journal of Trauma. 2010 Jan; [Yolembedwa ndi PMID: 20065766]
[11] Freauf M,Puckerridge N, KUKWERA KAPENA KUSAKWEDWERA: UMBONI WA UMBONI WA PREHOSPITAL SPINAL IMMOBILIZATION. JEMS : magazini ya chithandizo chamankhwala mwadzidzidzi. 2015 Nov [Yolembedwa ndi PMID: 26721114]
[12] Kwan I, Bunn F, Zotsatira za prehospital spinal immobilization: kuwunika mwadongosolo mayesero osasinthika pamitu yathanzi. Mankhwala a Prehospital ndi tsoka. 2005 Jan-Feb [Yolembedwa ndi PMID: 15748015]
[13] Rasal Carnicer M,Juguera Rodríguez L,Vela de Oro N,García Pérez AB,Pérez Alonso N,Pardo Ríos M, Kusiyana kwa mapapu akugwira ntchito pambuyo pogwiritsira ntchito machitidwe a 2 extrication: kuyesa kosasintha kosasintha. Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias. 2018 Abr [Yolembedwa ndi PMID: 29547234]
[14] Nemunaitis G, Roach MJ, Hefzy MS, Mejia M, Kukonzanso kwa gulu la msana: Umboni wa kuwunika kwamalingaliro. Tekinoloje yothandizira: magazini yovomerezeka ya RESNA. 2016 Kugwa [Yolembedwa ndi PMID: 26852872]
[15] Kornhall; Scandinavia Journal of Trauma, Resuscitation and Emergency Medicine. Januware 2017, 5 [Yolembedwa ndi PMID: 28057029]
[16] Maschmann C. Scandinavia Journal of Trauma, Resuscitation and Emergency Medicine. 2019 Aug 19 [Yolembedwa ndi PMID: 31426850]
[17] Hood N, Considine J, Spinal immobilisaton mu pre-hospital ndi chisamaliro chadzidzidzi: Kuwunika mwadongosolo mabuku. Magazini ya unamwino yadzidzidzi yaku Australasia: AENJ. 2015 Aug [Yolembedwa ndi PMID: 26051883]
[18] Sukulu ya zamankhwala ndi anthu ozungulira: zokambirana., Zimmerman HM, Bulletin of the New York Academy of Medicine, 1977 Jun [Yolembedwa ndi PMID: 23417176]
[19] Main PW, Lovell ME, Ndemanga ya malo asanu ndi awiri othandizira ndikugogomezera chitetezo chawo cha ovulala msana. Journal of accident & emergency medicine. 1996 Jan [Yolembedwa ndi PMID: 8821224]
[20]KOSIAK M, Etiology ya zilonda za decubitus. Zosungidwa zakale zamankhwala amthupi ndi kukonzanso. 1961 Jan [Yolembedwa ndi PMID: 13753341]
[21] Holla M, Mtengo wa kolala yolimba kuwonjezera pa midadada yamutu: umboni wa phunziro la mfundo. Magazini ya Emergency Medicine: EMJ. 2012 Feb [Yolembedwa ndi PMID: 21335583]
[22]Prasarn ML,Hyldmo PK,Zdziarski LA,Loewy E,Dubose D,Horodyski M,Rechtine GR, Kuyerekeza kwa Vacuum Mattress motsutsana ndi Spine Board Alone for Immobilization of Cervical Spine Ovulala Wodwala: Phunziro la Biomechanical Cadaveric. Msana. Dec 2017, 15 [Yolembedwa ndi PMID: 28591075]
[23] Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI, Kuvomerezeka kwa ndondomeko yachipatala kuti athetse kuvulala kwa msana wa khomo lachiberekero kwa odwala omwe ali ndi vuto lopweteka kwambiri. Gulu la National Emergency X-Radiography Utilization Study Group. The New England Journal of Medicine. 2000 Jul 13 [Yolembedwa ndi PMID: 10891516]
[24] Konstantinidis A, Plurad D, Barmparas G, Inaba K, Lam L, Bukur M, Branco BC, Demetriades D, Kukhalapo kwa kuvulala kosasunthika kosasunthika sikumakhudza kuwunika koyambirira kwa msana wa khomo pachibelekeropo mwa odwala omwe ali ndi vuto lopwetekedwa mtima kwambiri: chiwonetsero choyembekezeredwa. kuphunzira. Journal of Trauma. 2011 Sep [Yolembedwa ndi PMID: 21248650]
[25] Chifukwa chake mukufuna kukhala ndi nyumba yanu yamano!, Sarner H,, CAL [magazini] Certified Akers Laboratories, 1977 Apr [Yolembedwa ndi PMID: 26491795]
[26] Shank CD, Walters BC, Hadley MN, Mitu Yamakono mu Management of Acute Traumatic Spinal Cord Injury. chisamaliro cha neurocritical. 2018 Apr 12 [Yolembedwa ndi PMID: 29651626]
Werengani Ndiponso
Msana Immobilization: Chithandizo Kapena Kuvulala?
Masitepe 10 Ochita Kukhazikika Kwamsana Kwa Wodwala Wopwetekedwa
Kuvulala Kwazitsulo Zam'mimba, Kufunika Kwa Rock Pin / Rock Pin Max Spine Board
Kusasunthika Kwa Msana, Imodzi Mwa Njira Zomwe Wopulumutsa Ayenera Kudziwa
Kuvulala Kwamagetsi: Momwe Mungawunikire, Zoyenera Kuchita
Chithandizo cha RICE Kwa Zovulala Zofewa
Momwe Mungagwiritsire Ntchito Kafukufuku Woyamba Pogwiritsa Ntchito DRABC Mu Thandizo Loyamba
Heimlich Maneuver: Dziwani Zomwe Ili ndi Momwe Mungachitire
Zomwe Ziyenera Kukhala Mu Kiti Yothandizira Ana
Poizoni wa Mushroom Poizoni: Zoyenera Kuchita? Kodi Poizoni Imadziwonetsera Bwanji?
Kodi Poizoni wa Mtovu N'chiyani?
Poizoni wa Hydrocarbon: Zizindikiro, Matenda ndi Chithandizo
Thandizo Loyamba: Zoyenera Kuchita Mukameza Kapena Kutayira Bleach Pa Khungu Lanu
Zizindikiro ndi Zizindikiro Zakugwedezeka: Momwe Mungachitire Ndi Liti
Wasp Sting And Anaphylactic Shock: Zoyenera Kuchita Ambulansi Isanafike?
UK / Chipinda Chadzidzidzi, Kulowetsa kwa Ana: Njira Yokhala ndi Mwana Wovuta Kwambiri
Endotracheal Intubation Mwa Odwala Aana: Zida Za Supraglottic Airways
Kuchepa Kwamasamba Kukulitsa Mliri Ku Brazil: Mankhwala Ochizira Odwala Ndi Covid-19 Akusowa
Sedation ndi Analgesia: Mankhwala Othandizira Kulowetsa
Intubation: Zowopsa, Anaesthesia, Resuscitation, Kupweteka kwapakhosi
Kusasunthika Kwa Msana Kwa Wodwala: Kodi Bungwe la Spine Liyenera Kuyikidwa Pambali Liti?