Emergency Live | 10 Steps to perform a Correct Spinal Immobilization of a Trauma Patient image 4 — Emergency drill: kushandiswa kwemusoro immobilizer uye yekervical collar

Cervical uye musana immobilization maitiro: muchidimbu

By Cristiano Antonino On February 24, 2023

Cervical and spinal immobilization techniques: emergency emergency services (EMS) vashandi vanoramba vari ivo vanonyanya kutarisira mukutungamira kweakawanda kunze kwechipatara emergency, kusanganisira mamiriro ekushungurudza.

Iyo ATLS (advanced trauma life support) nhungamiro, yakagadzirwa mu1980s, inoramba iri chiyero chegoridhe chekuongorora uye kuisa pamberi pekutungamira kwekukuvara kwehupenyu munjodzi nenzira inonzwisisika uye inoshanda, kunyangwe paine nguva yakareba gakava rakakomba pamusoro penzira idzi. yekushandisa rubatsiro urwu.

Spinal immobilization yanga iri chikamu chakakosha chekudzidzisa, kuwedzera kune pelvic binders uye splints kune refu mapfupa akatyoka.

Mhando dzakasiyana dzekurapa midziyo dzakagadzirwa kuti dzigone kushanda uye nyore kwekushandisa, pamwe nekubvumira kushanduka uye kuwana kwakakosha kwekutungamira kwemhepo uye mamwe maitiro.

Kudikanwa kwekumisa musana kunotsanangurwa nechiitiko uye kuongororwa kwemurwere.

ZVINHU ZVINHU ZVINHU, MABHADHA AMATAMBUDZIKO, MALUNGU VENTILATORS, MACHEYA EKUBVISA: SPENCER PRODUCTS PADOUBLE BOOTH PAEMERGENCY EXPO

funga spinal immobilisation apo nzira yekukuvara inogadzira yakakwira index yekufungira musoro, mutsipa kana kukuvara kwemusana

Chimiro chepfungwa chakakanganisika uye kushomeka kwetsinga zvakare zviratidzo zvekuti kusafamba kwemusana kunofanirwa kutariswa.[1][2][3][4]

Traditional ATLS dzidziso yekwakakodzera spinal immobilisation yemurwere ari mukushungurudzika kukuru mamiriro akanyatso kukwenenzverwa akasimba. collar nemabhuroko uye tepi kuchengetedza cervical spine, pamwe nebackboard kuchengetedza iyo yese musana.

The Kendrick extrication mudziyo inobvumira musana kuti udzivirirwe nemunhu akakuvadzwa ari panzvimbo yakagara panguva yekukurumidza kubudiswa kubva mumotokari kana mune mamwe mamiriro ezvinhu apo kuwana kunogumira kubvumira kushandiswa kwebhokisi rakazara.

Zvisinei, chigadzirwa ichi chinoda kuti vashandi vekununura vatarisire kuderedza kufamba kwepervical spine nekushandisa inline mobilization kusvikira gungano [5].

The 10th edition yeATLS nhungamiro uye chirevo chekubvumirana cheAmerican College of Emergency Physicians (ACEP), American College of Surgeons Committee on Trauma (ACS-COT), uye National Association of EMS Physicians (NAEMSP) inotaura kuti, mu nyaya yekurwadziwa kwemukati hakuna chiratidzo chekudziviswa kwekufamba kwepelinha [6], maererano nekuongorora kwekare kubva kuAmerican Trauma Database iyo yakaratidza nhamba yakaderera zvikuru yekukuvara kwepelinha kusina kugadzikana kunoda kuvhiyiwa mumamiriro ezvinhu ekurwadziwa kwepakati. Chidzidzo chacho chinoratidzawo kuti nhamba yevarwere vanofanira kurapwa kuti vawane rubatsiro rwakakosha zvikuru kupfuura nhamba yevarwere vanorapwa kuti vawane kukuvara, 1032/66.

Nekudaro, muchiitiko chekukuvara kwakakomba kwakakomba, zvirambidzo zvinoramba zvichiratidzwa mumamiriro anotevera:

Low GCS kana umboo hwekudhakwa nedoro nezvinodhaka
Midline kana posterior cervical spine nyoro
Kuremara kwemusana kuri pachena
Kuvapo kwezvimwe zvipembenene zvinokanganisa

Kurudziro yekudzivirira kunobudirira inoramba iine cervical collar ine yakazara-yakareba kudzivirira musana, iyo inofanira kubviswa nekukurumidza sezvinobvira.

Izvi zvinokonzerwa nenjodzi yekukuvadzwa kwakawanda.

Zvisinei, muhuwandu hwevana, njodzi yekukuvara kwemazinga akawanda yakaderera uye naizvozvo chete cervical spine precautions uye kwete zvizere zvekudzivirira kwepelinha zvinoratidzirwa (kunze kwekuti zviratidzo kana zviratidzo zvezvimwe kukuvara kwepelinha zviripo).

Cervical immobilization uye rigid collar mumurwere wevana

Neck marwadzo
Shanduko yemakumbo neurology isina kutsanangurwa nekukuvara kwemakumbo
Muscle spasm yemutsipa (torticollis)
Low GCS
Kukuvadzwa kwepamusoro-ngozi (semuenzaniso tsaona yemotokari ine simba, hyperextension kukuvara kwemutsipa uye kukuvara kwakanyanya kwepamusoro)

Nzvimbo dzekunetsekana

Kune humwe humbowo huri kukura uye kunetseka nezvemunda iwoyo triage zvaita kuti pave nekunyanya kushandiswa kwespinal immobilisation nzira uye kuti vamwe varwere vanogona kunge vari panjodzi [7] [8] [9] [10].

Zvinetso zvinogona kuitika zvepinal immobilisation:

Kusagadzikana uye pakutambudzika kumurwere[11].
Kurebeswa kwenguva isati yasvika kuchipatara nekugona kunonoka kwekutsvaga kwakakosha uye marapirwo, pamwe nekukanganisa kumwe kupindira[11].
Kudziviswa kufema nemabhandi, pamwe nekushanda kwakaipisisa kwekufema munzvimbo ye supine kana ichienzaniswa nenzvimbo yakatwasuka. Izvi zvinonyanya kukosha mumamiriro ekurwadziwa kwe thoracic, kungave kusina kujeka kana kupinda mukati [12] [13] Kuoma ne intubation[14].
Mhosva yevarwere vane ankylosing spondylitis kana pre-exist spinal deformity, uko kukuvadzwa chaiko kunogona kukonzerwa nekumanikidza murwere kuti aenderane nenzvimbo yakafanotemerwa yemutsipa wekervical collar uye backboard [15].

Ongororo itsva yezvinyorwa zveScandinavia, yakaitwa kuti iongorore uchapupu huripo hwekudziviswa kwekufamba kwepelinha [16], inopa ruzivo rwakakosha zvikuru mukuenzanisa kweprehospital spinal stabilization nzira pamwe nekuongororwa kwesimba reuchapupu.

Rigid collar

Iyo yakaomeswa collar yakashandiswa kubva pakati pe-1960s senzira yecervical spine stabilisation, ine humbowo hwakaderera hunotsigira simba rayo rakanaka pamhedzisiro yeurological yekukuvara kwekervical spine, pamwe nemhedzisiro yakaipa nekuda kwekuwedzera kukuru kwe intracranial pressure uye. dysphagia [17].

Chinyorwa chacho chinoratidzawo kuti murwere akangwarira uye anoshandira pamwe ane mhasuru dzemhasuru dzinokonzerwa nekukuvadzwa hazvibviri kuva nekutama kukuru, sezvakacherechedzwa muzvidzidzo zvecadaver zvakaedza kudzidza mhedzisiro yekukuvara.

Chinyorwa chacho chinopa zano kudzikamisa njodzi uye zvakanakira kuvhiyiwa uku.

Zvisinei, American Association of Neurological Surgeons inoenderera mberi ichikurudzira collar yakaoma senzira yekudzikamisa cervical spine mumamiriro epamberi echipatara[18].

Rigid board: Inini bhodhi refu rinoshandiswa riini?

Iyo yepakutanga spinal longboard yakashandiswa pamwe chete neyakaomarara collar, zvidhinha uye tambo kuti iwane immobilisation yemuzongoza.

Kukuvadza kunogona kuitika, kunyanya maronda ekumanikidzika pa sacrum, [19] [20] zvino aratidzwa, kunyanya panyaya yekukuvara kwemusana pasina kunzwa kwekudzivirirwa.

Iyo yakapfava vacuum mattress inopa nzvimbo yakapfava inodzivirira kubva kune zvinokonzeresa maronda uye panguva imwechete inopa rubatsiro rwakakwana kana yawedzerwa pamusoro pemusoro [16].

Blocks

Mabhuroki chikamu cheiyo inline yekuunganidza zano rekudzikamisa musana uye inoita senge inoshanda pakusungirira murwere kumusana. bhodhi kuti uwane imwe dhigirii yekusamira, pasina iyo yakawedzerwa bhenefiti yekushandisa yakasimba collar musanganiswa [21].

Vacuum metiresi

Kuenzanisa mattress yevacuum nebhodhi rakasimba roga, metiresi inopa kutonga kwakawanda uye kushoma kufamba panguva yekunyorera uye kusimudza kupfuura bhodhi rakaoma [22].

Tichifunga nezve njodzi yemaronda ekumanikidza, metiresi inoita kunge inopa sarudzo iri nani yekutakura varwere.

Kusunungura musana: modulation yemusana uye cervical immobilization

Nzira yeNEXUS: munhu akangwarira, asina kudhakwa asina kukuvadzwa kunovhiringidza ane mukana wakaderera zvikuru wekukuvara mukusavapo kwekunetseka kwepakati uye kukanganisa kwetsinga.

Izvi zvinoratidzika sechinhu chinotarisa chekuongorora chinoshandiswa nekunzwa kwe99% uye kusakosha kwekufungidzira kukosha kwe99.8% [23].

Zvisinei, zvimwe zvidzidzo zvekucherechedza zvakaratidza kuti murwere akangwarira ane chirwere chepervical spine achaedza kudzikamisa musana uye kuti kuvapo kwezvipembenene zvinokanganisa (kunze kwe thorax) hazvikanganisi migumisiro yekliniki yekuongorora kwepervical spine uye naizvozvo musana unogona kucheneswa pasina imwe fungidziro[24]. Zvimwe zvidzidzo zvinoratidza mhedzisiro imwechete ye thoracolumbar spine [25][24].

RESCUE WORKERS' RADIO MUNYIKA? SHANYIRA EMS RADIO BOOTH PAEMERGENCY EXPO

Clinical significance

Kunyange zvazvo pre-hospital spinal immobilisation yakaitwa kwemakumi emakore, data yemazuva ano inoratidza kuti havasi varwere vose vanoda kuvharwa.

Iye zvino National Association of Emergency Physicians USA uye American College of Surgeons Committee yeTrauma inoratidza kushandiswa kushoma kwepinal immobilisation.

Iyi miitiro yazvino inoratidza kuti nhamba yevarwere vanogona kubatsirwa nekusafamba ishoma

Dare racho rakaenderera mberi richitaura kuti kushandiswa kwemasimba ekudzivirira kwemusana panguva yekufambisa kunofanira kushandiswa nekuchenjerera, sezvo mune dzimwe nguva njodzi dzinogona kuitika dzinopfuura zvikomborero zvavo.

Uyezve, kune varwere vakatambura nekushungurudzika kunopinda uye vasina pachena kukanganiswa kwetsinga, kushandiswa kwekudzivirira kwemusana hakukurudzirwi.

MuU.SA mushandisi weEMS anofanira kushandisa ruzivo rwekiriniki asati afunga kushandisa spinal board.[26]

Pakupedzisira, kusagadzikana kwepelinha kwakabatanidzwa nemarwadzo ekudzokera shure, kurwadziwa kwemutsipa uye kunoita kuti zvive zvakaoma zvikuru kuita mamwe maitiro, kusanganisira kufungidzira.

Spinal immobilisation yakabatanidzwawo nekunetseka kwekufema, kunyanya kana tambo dzakakura dzichiiswa pachipfuva.

Kunyange zvazvo masangano akawanda eEMS muU.

Mamwe masisitimu eEMS anotya kutongerwa mhosva kana akasamisa varwere.

Varwere vanofanirwa kunge vasina kusimba pamuzongoza vanosanganisira zvinotevera:

Capnography mune yekufemesa kudzidzira: nei tichida…

24 Sea, 2023

Nzira yekusarudza uye kushandisa pulse oximeter?

21 Sea, 2023

Midziyo yekurapa: Maverengero eKuverenga Akakosha Zviratidzo Monitor

18 Sea, 2023

Ventilators, zvese zvaunoda kuziva: mutsauko pakati…

18 Sea, 2023

gomara kunotevera
kurwadziwa kwemusana
varwere vane mwero wakachinja wekuziva
Neurological deficits
pachena anatomical deformity pamusoro musana mbiru
High-intensity trauma mumurwere akadhakwa nezvinodhaka, doro.

Zvinyorwa zveBhaibheri

[1] Hostler D, Colburn D, Seitz SR, Kuenzaniswa kwemidziyo mitatu yecervical immobilization. Prehospital emergency care: gwaro repamutemo reNational Association of EMS Physicians uye National Association of State EMS Directors. 2009 Apr-Jun; [PubMed PMID: 19291567]

[2] Joyce SM, Moser CS, Kuongororwa kwechigadzirwa chitsva chekumisa/kubvisa chibereko. Prehospital uye mishonga yenjodzi. 1992 Jan-Mar; [PubMed PMID: 10171177]

[3] McCarroll RE,Beadle BM,Fullen D,Balter PA,Followill DS,Stingo FC,Yang J, Dare LE, Kuberekwazve kwekugadzika kwemurwere munzvimbo yakagara yekurapa: Mushonga mutsva. cheya design. Journal of Applied Clinical Medical Fizikisi. 2017 Jan; [PubMed PMID: 28291911]

[4] Lacey CM, Finkelstein M, Thygeson MV, Mhedzisiro yekumira pakutya panguva yekubaiwa: supine maringe nekugara. Journal of Pediatric Nursing. 2008 Jun; [PubMed PMID: 18492548]

[5] Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS, Cervical spine kufamba panguva yekubvisa. The Journal of emergency medicine. 2013 Jan [PubMed PMID: 23079144]

[6] Fischer PE,Perina DG,Delbridge TR,Fallat ME,Salomone JP,Dodd J,Bulger EM,Gestring ML,Spinal Motion Restriction muTrauma Patient – A Joint Position Statement. Prehospital emergency care: gwaro repamutemo reNational Association of EMS Physicians uye National Association of State EMS Directors. 2018 Nov-Dec [PubMed PMID: 30091939]

[7] Purvis TA, Carlin B, Driscoll P, Njodzi chaidzo uye mabhenefiti asina mubvunzo ekusununguka pre-chipatara spinal immobilisation. The American Journal of Emergency Medicine. 2017 Jun; [PubMed PMID: 28169039]

[8] Lerner EB, Billittier AJ 4th, Moscati RM, Mhedzisiro yekumira isina kwayakarerekera uye uye isina padding pamuzongoza immobilization yezvidzidzo zvine hutano. Prehospital emergency care: gwaro repamutemo reNational Association of EMS Physicians uye National Association of State EMS Directors. 1998 Apr-Jun; [PubMed PMID: 9709329]

[9] Hauswald M, Ong G, Tandberg D, Omar Z, Kunze-kwechipatara spinal immobilization: maitiro ayo pakukuvara kweurological. Mushonga wemudzidzi wekukurumidzira: chinyorwa chepamutemo cheSosaiti yeAcademic Emergency Medicine. 1998 Mar; [PubMed PMID: 9523928]

[10] Haut ER,Kalish BT,Efron DT,Haider AH,Stevens KA,Kieninger AN,Cornwell EE 3rd,Chang DC,Spine immobilization mukukuvadzwa kunopinda mukati: kukuvadza kupfuura kunaka? The Journal of Trauma. 2010 Jan; [PubMed PMID: 20065766]

[11] Freauf M,Puckerridge N, KUBOORA KANA KUSA BHARA: AN EVIDENCE Wongororo yePREHOSPITAL SPINAL IMMOBILIZATION. JEMS: bhuku re emergency emergency services. 2015 Nov [PubMed PMID: 26721114]

[12] Kwan I, Bunn F, Migumisiro yeprehospital spinal immobilization: kuongorora kwakarongeka kwemiedzo yakarongeka pane zvidzidzo zvine utano. Prehospital uye mishonga yenjodzi. 2005 Jan-Feb [PubMed PMID: 15748015]

[13] Rasal Carnicer M,Juguera Rodríguez L,Vela de Oro N,García Pérez AB,Pérez Alonso N,Pardo Ríos M, Kusiyana mukushanda kwemapapu mushure mekushandiswa kwe2 extrication systems: a randomized crossover trial. Emergencias : revista de la Sociedad Espanola de Medicina de Emergencias. 2018 Abr [PubMed PMID: 29547234]

[14] Nemunaitis G,Roach MJ,Hefzy MS,Mejia M,Kugadziridzwa patsva kwebhodhi remusana: Humbowo hwekuongorora pfungwa. Assistive tekinoroji: iyo yepamutemo magazini yeRESNA. 2016 Fall [PubMed PMID: 26852872]

[15] Kornhall DK,Jørgensen JJ,Brommeland T,Hyldmo PK,Asbjørnsen H,Dolven T,Hansen T,Jeppesen E, Mirayiridzo yeNorway yehutungamiri hweprehospital yevarwere vakuru vanoshungurudza vanogona kukuvara kwemusana. Scandinavian Journal of Trauma, Resuscitation uye Emergency Medicine. 2017 Jan 5 [PubMed PMID: 28057029]

[16] Maschmann C. Scandinavian Journal of Trauma, Resuscitation uye Emergency Medicine. 2019 Aug 19 [PubMed PMID: 31426850]

[17] Hood N, Considine J, Spinal immobilisaton mu pre-chipatara uye kuchengetedzwa kwekukurumidzira: Ongororo yakarongeka yezvinyorwa. Australasian emergency nursing magazine: AENJ. 2015 Aug [PubMed PMID: 26051883]

[18] Chikoro chekurapa uye nharaunda yakapoteredza: hurukuro., Zimmerman HM, Bulletin yeNew York Academy of Medicine, 1977 Jun. [PubMed PMID: 23417176]

[19] Main PW, Lovell ME, Ongororo yenzvimbo nomwe dzekutsigira nekusimbisa pakudzivirira kwavo kwevakakuvara musana. Journal of tsaona & emergency mushonga. 1996 Jan [PubMed PMID: 8821224]

[20]KOSIAK M, Etiology ye decubitus maronda. Zvinyorwa zvemishonga yepanyama uye kugadzirisa. 1961 Jan [PubMed PMID: 13753341]

[21] Holla M, Kukosha kwekororo yakasimba mukuwedzera kune mabhuroko emusoro: humbowo hwemusimboti kudzidza. Emergency medicine magazine: EMJ. 2012 Feb [PubMed PMID: 21335583]

[22]Prasarn ML,Hyldmo PK,Zdziarski LA,Loewy E,Dubose D,Horodyski M,Rechtine GR,Kuenzaniswa kweVacuum Mattress versus Spine Board Yega yeImmobilization yeCervical Spine Akakuvara Murwere: A Biomechanical Cadaveric Study. Muzongoza. 2017 Zvita 15 [PubMed PMID: 28591075]

[23] Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI, Kutendeseka kwegadziriro yehutano hwekliniki yekudzivirira kunze kwekukuvadzwa kumusana wekervical kune varwere vane kushungurudzika kwakanyanya. National Emergency X-Radiography Utilization Study Group. The New England Journal of Medicine. 2000 Jul 13 [PubMed PMID: 10891516]

[24] Konstantinidis A, Plurad D, Barmparas G, Inaba K, Lam L, Bukur M, Branco BC, Demetriades D, Kuvapo kwekukuvara kwe-nonthoracic kunokanganisa hakukanganisa kuongororwa kwekiriniki kwechirwere chepervical spine mukuongororwa kwevarwere vanoshungurudzika: anotarisirwa kutarisa. kudzidza. The Journal of Trauma. 2011 Sep [PubMed PMID: 21248650]

[25] Saka iwe unoda kuve neyako chivakwa chemazino!, Sarner H,, CAL [magazini] Certified Akers Laboratories, 1977 Kubvumbi. [PubMed PMID: 26491795]

[26] Shank CD, Walters BC, Hadley MN, Nyaya Dzazvino Mukutungamira kweAcute Traumatic Spinal Cord Injury. Neurocritical care. 2018 Kubvumbi 12 [PubMed PMID: 29651626]