Kuletsa kusuntha kwa msana pogwiritsa ntchito bolodi lalitali la msana ndi kolala ya khomo lachiberekero kumagwiritsidwa ntchito pakavulala, pamene zofunikira zina zakwaniritsidwa, kuthandiza kuchepetsa mwayi wa kuvulala kwa msana.

Zizindikiro zogwiritsira ntchito Msana zoletsa kuyenda ndi a Mtengo wa GCS zosakwana 15, umboni wa kuledzera, kukoma mtima kapena ululu pakatikati pa khosi kapena kumbuyo, zizindikiro za ubongo ndi / kapena zizindikiro, kuwonongeka kwa anatomical kwa msana, ndi zochitika zododometsa kapena kuvulala.

Chiyambi cha kuvulala kwa msana: nthawi ndi chifukwa chiyani bolodi la msana likufunika

Kuvulala koopsa kwambiri ndizomwe zimayambitsa kuvulala kwa msana ku United States ndi mayiko ena ambiri, ndi zochitika zapachaka za anthu pafupifupi 54 pa anthu milioni imodzi ndi pafupifupi 3% ya onse omwe amagonekedwa m'chipatala chifukwa cha kuvulala koopsa.[1]

Ngakhale kuti kuvulala kwa msana kumapangitsa anthu ochepa chabe kuvulala koopsa, iwo ali m'gulu la zomwe zimayambitsa matenda ndi imfa.[2][3]

Chifukwa chake, mu 1971, American Academy of Orthopaedic Surgeons inakonza zoti agwiritse ntchito khola lachiberekero ndi wautali msana kuletsa kuyenda kwa msana kwa odwala omwe akuganiziridwa kuti kuvulala kwa msana, pogwiritsa ntchito njira yovulaza.

Pa nthawiyo, izi zinali zochokera ku mgwirizano osati umboni.[4]

M'zaka makumi angapo kuyambira kuletsa kwa msana, kugwiritsa ntchito kolala ya khomo lachiberekero ndi bolodi lalitali la msana kwakhala mulingo wa chisamaliro cha prehospital.

Zitha kupezeka mu malangizo angapo, kuphatikizapo malangizo a Advanced Trauma Life Support (ATLS) ndi Prehospital Trauma Life Support (PHTLS).

Ngakhale kuti amagwiritsidwa ntchito mofala, mphamvu za machitidwewa akhala akukayikira.

Pakafukufuku wina wapadziko lonse lapansi poyerekeza ndi omwe adaletsa kusuntha kwa msana ndi omwe sanatero, kafukufukuyu adapeza kuti omwe sanalandire chisamaliro chanthawi zonse ndi zoletsa za msana anali ndi zovulala zochepa zama neurologic ndi olumala.

Komabe, ziyenera kudziwidwa kuti odwalawa sanafanane ndi kukula kwa chovulalacho. [5]

Pogwiritsa ntchito achinyamata odzipereka athanzi, kafukufuku wina adayang'ana kusuntha kwa msana pa bolodi lalitali la msana poyerekeza ndi matiresi amtundu wautali ndipo adapeza kuti bolodi lalitali la msana linalola kusuntha kwakukulu.

Mu 2019, kafukufuku wobwereza, wowonera, wamagulu angapo a prehospital adawona ngati pali kusintha kwa kuvulala kwa msana pambuyo pokhazikitsa ndondomeko ya EMS yomwe imachepetsa chitetezo cha msana kwa iwo okha omwe ali ndi chiopsezo chachikulu kapena zotsatira zachilendo ndipo anapeza kuti panali palibe kusiyana pa zochitika za kuvulala kwa msana.[7]

MITUNDU YABWINO KWAMBIRI? YENDANI SPENCER BOOTH KU EXEREKERANI EXPO

Pakalipano palibe mayesero apamwamba owongolera mwachisawawa kuti athandizire kapena kutsutsa kugwiritsa ntchito kuletsa kwa msana.

Ndizokayikitsa padzakhala wodwala kuti adzipereke ku kafukufuku yemwe angapangitse kuti ziwalo zamuyaya ziphwanye ndondomeko zamakono zamakono.

Chifukwa cha maphunzirowa ndi ena, malangizo atsopano amalimbikitsa kuchepetsa kugwiritsidwa ntchito kwa msana wautali wa msana woletsa kusuntha kwa msana kwa iwo omwe ali ndi vuto la kuvulala kapena zizindikiro kapena zizindikiro monga momwe tafotokozera m'nkhani ino ndikuchepetsa nthawi yomwe wodwalayo amakhala osasunthika. .

Zizindikiro zogwiritsira ntchito bolodi la msana

Mu chiphunzitso cha Denis, kuvulala kwa mizati iwiri kapena kuposerapo kumaonedwa kuti ndi kusweka kosasunthika kuvulaza msana womwe uli mkati mwa msana.

Zomwe zimanenedwa kuti phindu la kuletsa kuyenda kwa msana ndiloti mwa kuchepetsa kusuntha kwa msana, munthu akhoza kuchepetsa kuthekera kwa kuvulala kwachiwiri kwa msana kuchokera ku zidutswa zosasunthika za fracture panthawi ya extrication, zoyendetsa, ndi kuyesa odwala ovulala. [9]

Zizindikiro za kuletsa kuyenda kwa msana zimadalira ndondomeko yopangidwa ndi otsogolera ogwira ntchito zachipatala zadzidzidzi ndipo zikhoza kusiyanasiyana.

Komabe, American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), ndi National Association of EMS Physicians (NAEMSP) apanga mawu ogwirizana oletsa kusuntha kwa msana kwa odwala omwe ali ndi vuto lovulala kwambiri. mu 2018 ndipo adalemba izi:[10]

• Kusintha kwachidziwitso, zizindikiro za kuledzera, GCS <15
• Midline kupweteka kwa msana kapena kupweteka
• Zizindikiro za neurologic zokhazikika kapena zizindikiro monga kufooka kwagalimoto, dzanzi
• Kuwonongeka kwa anatomic kwa msana
• Kuvulala kosokoneza kapena zochitika (mwachitsanzo, kusweka, kutentha, kukhudzidwa nsautso, cholepheretsa chinenero, etc.)

Mawu ophatikizana omwewo adaperekanso malingaliro kwa odwala omwe ali ndi vuto lopwetekedwa mtima, ndikuzindikira kuti zaka komanso kuthekera kolankhulana siziyenera kukhala chinthu chofunikira pakupanga chisankho cha chisamaliro chamsana cha prehospital.

Zotsatirazi ndi zomwe akulimbikitsidwa:[10]

• Kudandaula kwa ululu wa khosi
• Torticollis
• Kuperewera kwa Neurological
• Kusintha kwamaganizidwe, kuphatikiza GCS <15, kuledzera, ndi zizindikilo zina (kugwedezeka, kupuma movutikira, hypopnea, kusomnolence, etc.)
• Kuchita nawo ngozi yagalimoto yowopsa kwambiri, kuvulala kwambiri pamadzi, kapena kuvulala kwambiri

Contraindications kugwiritsa ntchito bolodi la msana

Kusagwirizana kwachibale kwa odwala omwe ali ndi vuto lolowera kumutu, khosi, kapena torso popanda kuperewera kwa ubongo kapena kudandaula.[11]

Malinga ndi kafukufuku wofalitsidwa ku Eastern Association for the Surgery of Trauma (EAST) ndi The Journal of Trauma, odwala omwe ali ndi vuto lolowera mkati omwe adakumana ndi vuto la msana anali okhoza kufa kawiri kuposa odwala omwe sanatero.

Kusayenda bwino kwa wodwala ndi njira yotengera nthawi, pakati pa 2 mpaka 5 mphindi, zomwe sizimangochedwetsa zoyendera kuti zikapezeke chisamaliro chotsimikizika komanso zimachedwetsanso chithandizo china cha prehospital popeza iyi ndi njira ya anthu awiri.[12][13]

WADIYO YA OPULUMUTSA PADZIKO LONSE? ENDWENI KU EMS RADIO BOOTH PA EMERGENCY EXPO

Zida zofunika kuti msana usasunthike: kolala, bolodi lalitali komanso lalifupi la msana

The zida zofunikira pakuletsa kwa msana kumafuna bolodi la msana (kaya lalitali kapena lalifupi) ndi kolala ya khomo lachiberekero.

matabwa a msana wautali

Mapulani aatali a msana anayamba kugwiritsidwa ntchito, mogwirizana ndi kolala ya khomo lachiberekero, kuti asamayendetse msana monga momwe ankaganizira kuti kusagwira bwino m'munda kungayambitse kapena kuonjezera kuvulala kwa msana.

Bolodi lalitali la msana linalinso lotsika mtengo ndipo linkagwiritsidwa ntchito ngati njira yabwino yonyamulira odwala omwe akomoka, kuchepetsa kuyenda kosafunikira, ndi kuphimba malo osagwirizana.[14]

Short Spine Boards

Ma board afupi a msana, omwe amadziwikanso kuti zida zapakatikati, amakhala opapatiza kwambiri kuposa omwe amatalikirapo.

Kutalika kwawo kwaufupi kumawalola kugwiritsidwa ntchito m'malo otsekedwa kapena otsekeka, nthawi zambiri pakugundana kwa magalimoto.

Gulu lalifupi la msana limathandizira msana wa thoracic ndi khomo lachiberekero mpaka wodwalayo atha kuikidwa pa bolodi lalitali la msana.

Mtundu wodziwika wa bolodi lalifupi la msana ndi Kendrick Extrication Chipangizo, yomwe imasiyana ndi bolodi lalifupi la msana chifukwa ndi lolimba kwambiri ndipo limatambasula mozungulira kuti likhale m'mbali ndi mutu.

Mofanana ndi matabwa a msana wautali, izi zimagwiritsidwanso ntchito pamodzi ndi makola a khomo lachiberekero.

Mitsempha Yachiberekero: "C Collar"

Makolala a khomo lachiberekero (kapena C Collar) akhoza kugawidwa m'magulu awiri akuluakulu: ofewa kapena okhwima.

M'malo opwetekedwa mtima, makolala olimba a khomo lachiberekero ndi omwe amachititsa kuti chiberekero chisamayende bwino. [15]

Makola a khomo lachiberekero nthawi zambiri amapangidwa kuti akhale ndi kachidutswa kakang'ono kamene kamagwiritsa ntchito minofu ya trapezius monga chithandizo chothandizira ndi kachidutswa kakang'ono kamene kamathandizira mandible ndikugwiritsa ntchito sternum ndi clavicles monga chothandizira.

Makolala a khomo lachiberekero paokha samapereka mphamvu yokwanira ya khomo lachiberekero ndipo amafunikira zida zowonjezera zothandizira, nthawi zambiri zimakhala ngati mapepala a thovu a Velcro omwe amapezeka pamatabwa a msana wautali.

MAPHUNZIRO WOYAMBA WOYAMBA? ENDWENI KU DMC DINAS MEDICAL CONSULTANTS BOOTH PA EMERGENCY EXPO

njira

Njira zingapo zilipo zoyika munthu mumsana woletsa kuyenda, imodzi mwazofala kwambiri ndi njira ya supine log-roll yomwe ili pansipa ndipo imachitidwa, moyenera, ndi gulu la anthu a 5, koma osachepera, gulu la anayi.[16] ]

Kwa Team ya Asanu

Asanapumitse, muuzeni wodwalayo kuwoloka manja ake pachifuwa.

Mtsogoleri wa gulu ayenera kuperekedwa kwa mutu wa wodwalayo yemwe adzachita zokhazikika pamanja pogwira mapewa a wodwalayo ndi zala zawo kumbuyo kwa trapezius ndi chala chachikulu cham'mwamba kumbuyo kwake ndi manja ake akukanikizidwa mwamphamvu motsutsana ndi mbali za lateral. mutu wa wodwalayo kuchepetsa kuyenda ndi kukhazikika kwa khomo lachiberekero msana.

Ngati zilipo, kolala yachiberekero iyenera kuikidwa panthawiyi popanda kukweza mutu wa wodwalayo pansi. Ngati imodzi palibe, sungani kukhazikika uku panthawi yolemba chipika.

Membala wa gulu awiri ayenera kuikidwa pa thorax, membala wa gulu atatu m'chiuno, ndipo membala wa gulu anayi pamiyendo ndi manja awo kumbali yakutali ya wodwalayo.

Membala wa gulu asanu ayenera kukhala wokonzeka kusuntha bolodi lalitali la msana pansi pa wodwalayo atakulungidwa.

Pa lamulo la membala wa gulu 1 (makamaka pa chiwerengero cha atatu), mamembala a gulu 1 mpaka 4 amagudubuza wodwalayo, panthawi yomwe membala wa gulu asanu adzalowetsa bolodi lalitali la msana pansi pa wodwalayo.

Apanso, pa lamulo la membala wa gulu, wodwalayo amakulungidwa pa bolodi lalitali la msana.

Pakani wodwalayo pa bolodi ndikuteteza torso ndi zingwe zotsatiridwa ndi pelvis ndi miyendo yakumtunda.

Tetezani mutu poyika matawulo okulungidwa mbali zonse kapena chipangizo chomwe chilipo malonda ndikuyika tepi pamphumi ndikumangirira m'mphepete mwa bolodi lalitali la msana.

Kwa Team ya Anayi

Apanso, mtsogoleri wa gulu ayenera kuperekedwa kwa mutu wa wodwalayo ndikutsatira njira yomweyi yomwe tafotokozera pamwambapa.

Mamembala awiri a gulu ayenera kuikidwa pa thorax ndi dzanja limodzi paphewa lakutali ndi lina pa chiuno chakutali.

Wothandizira gulu atatu ayenera kuikidwa pamiyendo, ndi dzanja limodzi kumtunda wa mchiuno ndi wina kumbali yakutali.

Zindikirani kuti akulimbikitsidwa kuti manja a mamembala a gululo awoloke pa chiuno.

Mamembala a gulu anayi amalowetsa bolodi lalitali la msana pansi pa wodwalayo, ndipo njira yonseyo imatsatiridwa monga tafotokozera pamwambapa.

Zovuta zogwiritsa ntchito bolodi la msana mu spinal immobilisation

Kuvulala Kwambiri

Vuto lomwe lingakhalepo mwa omwe akukhala ndi nthawi yayitali ya msana ndi kuletsa kwa khomo lachiberekero ndi zilonda zam'mimba, zomwe zimanenedwa kuti ndi 30.6%.[17]

Malinga ndi National Pressure Ulcer Advisory Panel, zilonda zopatsirana tsopano zasinthidwa kukhala kuvulala kokakamiza.

Amabwera chifukwa cha kukakamizidwa, nthawi zambiri chifukwa cha kutchuka kwa mafupa, kwa nthawi yayitali zomwe zimapangitsa kuti khungu liwonongeke komanso minyewa yofewa.

Kumayambiriro kwa khungu, khungu limakhalabe bwinobwino koma kenako limakula n’kukhala chilonda.[18]

Kuchuluka kwa nthawi yomwe imatengera kuti munthu avulale chifukwa chovulala amasiyanasiyana, koma kafukufuku wina adawonetsa kuti kuvulala kwa minofu kumatha kungoyambira mphindi 30 mwa anthu odzipereka athanzi. [19]

Panthawiyi, nthawi yomwe imakhala yosasunthika pamtunda wautali wa msana ndi pafupi maminiti 54 mpaka 77, pafupifupi mphindi 21 zomwe zimachulukana mu ED pambuyo pa zoyendera.[20][21]

Poganizira izi, onse opereka chithandizo ayenera kuyesetsa kuchepetsa nthawi yomwe odwala amathera osasunthika pamagulu okhwima a msana kapena ndi makola a khomo lachiberekero chifukwa zonsezi zingayambitse kuvulala.

Kulephera kwa kupuma

Kafukufuku wambiri wasonyeza kuchepa kwa ntchito ya kupuma chifukwa cha zingwe zomwe zimagwiritsidwa ntchito pamapulani aatali a msana.

Athanzi achinyamata odzipereka, ntchito yaitali msana zomangira gulu pachifuwa zinachititsa kuchepa kwa magawo angapo m'mapapo mwanga, kuphatikizapo anakakamizika kofunika mphamvu, kukakamizidwa expiratory voliyumu, ndi kukakamizidwa m'ma expiratory otaya chifukwa choletsa kwenikweni.[22]

Pakafukufuku wokhudza ana, mphamvu yokakamizika yokakamizika idachepetsedwa kufika pa 80% ya zoyambira. [23] Mu kafukufuku winanso, matiresi olimba a bolodi ndi vacuum anapezeka kuti amalepheretsa kupuma ndi pafupifupi 17% mwa anthu odzipereka athanzi.[24]

Chisamaliro chiyenera kuperekedwa pamene odwala akulephera kusuntha, makamaka kwa omwe ali ndi matenda a m'mapapo omwe analipo kale komanso ana ndi okalamba.

ululu

Vuto lodziwika bwino, lodziwika bwino la kuletsa kwa msana kwakutali ndi kupweteka, zomwe zimapangitsa kuti pakhale mphindi 30 zokha.

Ululu umawonekera kwambiri ndi mutu, kupweteka kwa msana, ndi kupweteka kwa mandible.[25]

Apanso, ndipo pakali pano mutu wobwerezabwereza, nthawi yogwiritsidwa ntchito pa bolodi lolimba la msana wautali liyenera kuchepetsedwa kuchepetsa ululu.

Kufunika kwachipatala kwa kuvulala kwa msana: udindo wa kolala ndi bolodi la msana

Kuvulala kwapang'onopang'ono kungayambitse kuvulala kwa msana ndipo, motero, kuwonongeka kwa msana komwe kungayambitse matenda aakulu ndi imfa.

M'zaka za m'ma 1960 ndi 1970, kuletsa kwa msana kunagwiritsidwa ntchito kuchepetsa kapena kulepheretsa zotsatira za ubongo zomwe zimaganiziridwa kuti ndizo zachiwiri kuvulala kwa msana.

Ngakhale kuti ambiri amavomerezedwa ngati muyezo wa chisamaliro, mabuku alibe khalidwe lapamwamba, kafukufuku wozikidwa pa umboni womwe umafufuza ngati kuletsa kwa msana kumakhudza zotsatira za ubongo.[26]

Kuonjezera apo, m'zaka zaposachedwa pakhala pali umboni wochuluka wosonyeza zovuta zomwe zingatheke chifukwa cha kuletsa kwa msana.

Chifukwa chake, malangizo atsopano alimbikitsa kuti kuletsa kwa msana kugwiritsidwe ntchito mwanzeru pamagulu enaake odwala.[10]

Ngakhale kuletsa kuyenda kwa msana kungakhale kopindulitsa pazochitika zina, wothandizira ayenera kudziwa bwino malangizo onse ndi zovuta zomwe zingakhalepo kuti opereka chithandizo akhale okonzeka kugwiritsa ntchito njirazi ndikuwongolera zotsatira za odwala.

Kupititsa patsogolo Zotsatira Zamagulu a Zaumoyo

Odwala omwe ali ndi vuto lachiwopsezo champhamvu amatha kuwonetsa zizindikiro zambiri.

Ndikofunika kuti akatswiri a zaumoyo omwe ali ndi udindo wowunika koyambirira kwa odwalawa adziwe zizindikiro, zotsutsana, zovuta zomwe zingatheke, komanso njira yoyenera yogwiritsira ntchito zoletsa za msana.

Malangizo angapo angakhalepo kuti athandize kudziwa omwe ali ndi odwala omwe ali ndi ndondomeko yoletsa kusuntha kwa msana.

Mwina malangizo odziwika bwino komanso ovomerezeka kwambiri ndi omwe alembedwa ndi American College of Surgeons Committee on Trauma (ACS-COT), National Association of EMS Physicians (NAEMSP), ndi American College of Emergency Physicians (ACEP). [10] Ngakhale awa ndi malangizo ndi malingaliro omwe alipo pano, palibe mayesero apamwamba owongolera osasinthika mpaka pano, ndi malingaliro ozikidwa pa kafukufuku wowonera, magulu owonera zakale, ndi kafukufuku wamilandu.[26]

Kuphatikiza pa kudziŵa bwino zizindikiro ndi zotsutsana ndi zoletsa zoletsa kuyenda kwa msana, ndikofunikanso kuti akatswiri a zaumoyo adziwe zovuta zomwe zingakhalepo monga ululu, zilonda zam'mimba, ndi kupuma movutikira.

Pokhazikitsa zoletsa za msana, mamembala onse a interprofessional health care professionalsteam ayenera kudziwa bwino njira zomwe amakonda komanso kulankhulana bwino kuti agwiritse ntchito njirayi moyenera komanso kuchepetsa kuyendayenda kwa msana. Ogwira ntchito zachipatala ayeneranso kuzindikira kuti nthawi yomwe imagwiritsidwa ntchito pamtunda wautali wa msana iyenera kuchepetsedwa kuchepetsa mavuto.

Posamutsa chisamaliro, gulu la EMS liyenera kufotokozera nthawi yonse yomwe yagwiritsidwa ntchito pa bolodi lalitali la msana.

Kugwiritsa ntchito malangizo aposachedwa, kudziwa zovuta zomwe zimadziwika bwino, kuchepetsa nthawi yogwiritsidwa ntchito pagulu lalitali la msana, komanso kugwiritsa ntchito njira zabwino zolumikizirana ndi odwalawa zitha kukonzedwa. [Chigawo 3]

Zothandizira:

 

[2]Chen Y,Tang Y,Vogel LC,Devivo MJ, Zomwe Zimayambitsa kuvulala kwa msana. Mitu yakukonzanso kuvulala kwa msana. 2013 Zima;     [Yolembedwa ndi PMID: 23678280]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Source:

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