Spinal motion restriction uchishandisa refu musana bhodhi uye cervical collar inoshandiswa muzviitiko zvekushungurudzika, kana mamwe maitiro asangana, kubatsira kuderedza mikana yekukuvara kwemusana.

Zviratidzo zvekushandiswa kwe Musipinha motion restriction are a GCS isingasviki 15, humbowo hwekudhakwa, hunyoro kana kurwadziwa pakati peiyo mutsipa kana kumashure, focal neurological zviratidzo uye / kana zviratidzo, anatomical deformity yemuzongoza, uye zvinokanganisa mamiriro kana kukuvara.

Nhanganyaya kune spinal trauma: riini uye nei musana bhodhi inodiwa

Kukuvara kwakaomarara ndiko kunonyanya kukonzera kukuvara kwemusana muUnited States nedzimwe nyika dzakawanda, nezviitiko zvepagore zvingangosvika makumi mashanu nemana pamiriyoni yevagari vemo uye chikamu che54% chevanopinzwa muchipatara nekuda kwekukuvadzwa kwakanyanya.[3]

Kunyange zvazvo kukuvara kwemusana kuchikonzera chikamu chiduku chekukuvara kwekukuvara kwakakomba, ivo vari pakati pevanonyanya kukonzera kurwara nekufa.[2][3]

Nekuda kweizvozvo, muna 1971, American Academy of Orthopedic Surgeons yakaronga kushandiswa kwechirwere ichi. cervical collar uye yakareba spinal board kurambidza kufamba kwepelinha kune varwere vane fungidziro yekukuvadzwa kwemusana, zvichibva pane nzira yekukuvara.

Panguva iyoyo, izvi zvakanga zvakavakirwa pakubvumirana pane uchapupu.[4]

Mumakumi emakore kubvira kurambidzwa kwepinal motion, kushandisa cervical collar uye refu musana bhodhi rave chiyero mukutarisira prehospital.

Inogona kuwanikwa mumirayiridzo yakati wandei, kusanganisira Advanced Trauma Life Support (ATLS) uye Prehospital Trauma Life Support (PHTLS) nhungamiro.

Pasinei nekushandiswa kwavo kwakapararira, kushanda kwemaitiro aya kwakanzi kune mubvunzo.

Mune imwe tsvakurudzo yepasi rose ichienzanisa avo vakawana kurambidzwa kwekufamba kwemusana kune avo vasina, chidzidzo chacho chakawana kuti avo vasina kugamuchira kutarisirwa kwemazuva ose nemusana wekufamba kwekudzivirira vaiva nekukuvara kuduku kweurological nekuremara.

Zvisinei, zvinofanira kucherechedzwa kuti varwere ava havana kufananidzwa nekuoma kwekukuvara.[5]

Ichishandisa vazvipiri vechidiki vane hutano, imwe ongororo yakatarisa lateral spine motion pane refu musana bhodhi kana ichienzaniswa nemetiresi yekutamba uye yakaona kuti refu musana board yakabvumira mukuru lateral kufamba.[6]

Muna 2019, ongororo, yekutarisa, yakawanda-agency prehospital study yakaongorora kana pakanga pasina shanduko mukukuvadzwa kwemusana mushure mekuita EMS protocol iyo inoganhurira kudzivirira kwemusana kune avo chete vane njodzi dzakakura kana bvunzo dzisina kujairika uye vakawana kuti pakanga paine. hapana musiyano mukuitika kwekukuvara kwemusana.[7]

ANOGONESESA MABHODHI AKATSIKIRA? Shanyira iyo SPENCER BOOTH PAKUKOSHA EMPENYU

Parizvino hapana yakakwirira-level randomized control miedzo yekutsigira kana kuramba kushandiswa kwepinal motion restriction.

Hazvigoneki kuti pave nemurwere achazvipira kune chidzidzo chinogona kuguma nekuoma mitezo zvachose kunopesana nezvino zvinotungamirirwa netsika.

Nekuda kweizvi nezvimwe zvidzidzo, mitsva mitsva inotungamira inokurudzira kudzikamisa kushandiswa kwerefu musana board spinal motion restriction kune avo vane nezve nzira yekukuvara kana nezvezviratidzo kana zviratidzo sezvakatsanangurwa gare gare munyaya ino uye kuderedza nguva iyo murwere anoshandisa immobilized. .

Zviratidzo zvekushandisa musana bhodhi

Muchidzidzo cheDenis, kukuvadzwa kwemakoramu maviri kana anopfuura kunoonekwa sekutsemuka kusingagadzike kukuvadza musana uri mukati memutsara.

Izvo zvinonzi kubatsirwa kwepinal motion restriction ndeyokuti nekuderedza kufamba kwemusana, munhu anogona kuderedza mukana wekukuvadzwa kwechipiri chepamusoro kubva kune zvimedu zvekuputsika zvisina kugadzikana panguva yekubudiswa, kutakura, uye kuongororwa kwevarwere vanoshungurudzika.[9]

Zviratidzo zvepinal motion restriction zvinoenderana neprotocol yakagadzirwa nevatungamiriri vebasa rekurapa rekukurumidzira uye inogona kusiyana zvichienderana.

Nekudaro, iyo American College of Surgeons Committee on Trauma (ACS-COT), iyo American College yeEmergency Physicians (ACEP), uye National Association of EMS Varapi (NAEMSP) vakagadzira chirevo chakabatana pamusoro pepinal motion kudziviswa muvarwere vakuru vakakuvara. muna 2018 uye akanyora zvinotevera zviratidzo:[10]

• Yakashandurwa nhanho yekuziva, zviratidzo zvekudhakwa, GCS <15
• Midline musana unyoro kana kurwadziwa
• Focal neurologic zviratidzo kana zviratidzo senge mota kushaya simba, chiveve
• Anatomic deformity yemuzongoza
• Kukuvadza kunokanganisa kana mamiriro ezvinhu (semuenzaniso, kuputsika, kutsva, manzwiro pakutambudzika, chipingamupinyi chemutauro, nezvimwewo)

Chirevo chimwechete chakabatana chakaitawo kurudziro yevarwere vepachipatara vanoshungurudza varwere, vachiona kuti zera uye kugona kutaura hazvifanirwe kuve chinhu mukuita sarudzo ye prehospital spinal care.

Izvi zvinotevera zviratidzo zvavanokurudzirwa:[10]

• Kunyunyuta kwemarwadzo emutsipa
• Torticollis
• Neurologic deficit
• Chimiro chepfungwa chakachinjika, kusanganisira GCS <15, kudhakwa, uye zvimwe zviratidzo (kushushikana, apnea, hypopnea, somnolence, nezvimwewo)
• Kubatanidzwa mukudhumhana kwemotokari ine njodzi, kukuvara kwakanyanya kwe diving, kana kukuvara kwakakura kwemuviri.

Contraindications mukushandiswa kwemuzongoza board

A hama contraindication kune varwere vane kupindira kunorwadza kumusoro, mutsipa, kana torso pasina neurologic kushomeka kana kunyunyuta.[11]

Maererano nezvidzidzo zvakaburitswa muEastern Association for the Surgery of Trauma (EAST) uye The Journal of Trauma, varwere vane mhirizhonga inopinda mukati avo vakasangana nemusana wekusagadzikana vaiva nemukana wekufa kaviri sevarwere vasina.

Kusafambisa murwere inzira inopedza nguva, pakati pe2 kusvika kumaminitsi e5, iyo haingononotse kutakurwa kwekuchengetedzwa kwechokwadi asiwo kunonotsa kumwe kurapwa kweprehospital sezvo iyi iri nzira yevanhu vaviri.[12][13]

RAHIYO YEVANHUVIRI MUNYIKA YOSE? SHANYIRA EMS RADIO BOOTH PAEMERGENCY EXPO

Inodiwa midziyo yepinal immobilisation: iyo collar, iyo refu uye pfupi musana bhodhi

The midziyo inodiwa pakurambidzwa kwekufamba kwemusana kunoda bhodhi remusana (ringava refu kana pfupi) uye cervical spine collar.

Long Spine Boards

Mapuranga emuzongoza marefu akatanga kushandiswa, pamwe chete necollar yekervical, kuti asafambisa musana sezvaifungidzirwa kuti kubata kusina kunaka mumunda kunogona kukonzera kana kuwedzera kukuvara kwepelinha.

Iyo refu yemuzongoza board yakanga yakachipa uye yakashanda senzira iri nyore yekutakura varwere vanenge vasingazivi, kuderedza kufamba kusingadiwi, uye kuvhara nzvimbo isina kuenzana.[14]

Short Spine Boards

Short spine boards, inozivikanwawo seyepakati-nhanho yekubvisa zvigadziriso, anowanzo kutetepa kupfuura mamwe awo akareba.

Hurefu hwavo hupfupi hunobvumira kushandiswa kwavo munzvimbo dzakavharwa kana dzakavharirwa, kazhinji mukudhumhana kwemotokari.

Iyo pfupi musana bhodhi inotsigira thoracic uye cervical spine kusvikira murwere achigona kuiswa pane refu musana bhodhi.

Rudzi rwakajairika rweshort spine board ndiyo Kendrick Extrication Chishandiso, iyo inosiyana neyakare diki musana bhodhi pakuti ine semi-yakaomarara uye inotambanukira nechemberi kutenderedza mativi nemusoro.

Zvakafanana nemapuranga emusana akareba, aya anoshandiswawo pamwe chete nekervical collars.

Cervical Collars: iyo "C Collar"

Cervical collars (kana C Collar) inogona kuiswa mumapoka maviri akafara: akapfava kana akaoma.

Muzvirongwa zvekushungurudzika, makora akaomarara ekervical ndiwo anogadzirisa sarudzo sezvo achipa cervical restriction yepamusoro.[15]

Cervical collars inowanzogadzirirwa kuti ive nechidimbu chemashure chinoshandisa trapezius muscle sechigadziro chekutsigira uye chidimbu chepamberi chinotsigira mandible uye chinoshandisa sternum uye clavicles sechimiro chekutsigira.

Cervical makora ega haapi cervical immobilization yakakwana uye inoda mamwe lateral anotsigira zvimiro, kazhinji muchimiro cheVelcro foam pads inowanikwa pamapuranga emusana.

KUDZIDZWA KWERUBATSIRO RWEKUTANGA? SHANYIRA DMC DINAS MEDICAL CONSULTANTS BOOTH PAEMERGENCY EXPO

chidobi

Nzira dzinoverengeka dziripo dzekuisa mumwe munhu mumusana wekufamba kurambidzwa, imwe yeanonyanya kuzivikanwa ndeye supine log-roll nzira inotsanangurwa pazasi uye inoitwa, zvakanaka, nechikwata chevanhu 5, asi zvishoma, chikwata chevana.[16] ]

KuChikwata Chevashanu

Usati watadza kufamba, ita kuti murwere ayambuke maoko ake pachipfuva.

Mutungamiri wechikwata anofanirwa kupihwa mukuru wemurwere achaita inline manual kudzikamisa nekubata mapendekete emurwere neminwe yavo kumashure kweiyo trapezius uye chigunwe chavo pane anterior aspect nemaoko akatsikirirwa zvakasimba kune lateral aspects. musoro wemurwere kuderedza kufamba uye kudzikamisa cervical spine.

Kana iripo, cervical collar inofanira kuiswa panguva ino pasina kusimudza musoro wemurwere kubva pasi. Kana imwe isipo, chengetedza iyi kudzikamisa panguva yelogi roll tekinoroji.

Nhengo yeboka mbiri inofanira kuiswa pa thorax, nhengo yeboka katatu pahudyu, uye nhengo yeboka ina pamakumbo maoko avo akaiswa kune rumwe rutivi rwomurwere.

Nhengo yechikwata shanu inofanirwa kunge yakagadzirira kutsvedza iyo refu musana bhodhi pasi pemurwere mushure mekunge vakungurutswa.

Pamurairo wenhengo yechikwata 1 (kazhinji pakuverenga vatatu), nhengo dzechikwata 1 kusvika 4 dzinokungurutsa murwere, panguva iyo nhengo yechikwata shanu inotsveta bhodhi refu remuzongoza pasi pemurwere.

Zvakare, pamurairo wenhengo yechikwata, murwere anokungurutswa pabhodhi refu remuzongoza.

Isai murwere pabhodhi uye chengetedza torso nemabhandi anoteverwa nechiuno nemakumbo epamusoro.

Chengetedza musoro nekuisa matauro akamonerwa kumativi ese kana mudziyo unotengeswa uye woisa tepi pahuma uye wakachengetedzwa kumicheto yerefu musana board.

KuChikwata cheVana

Zvakare, mutungamiri wechikwata anofanirwa kupihwa musoro wemurwere uye kutevedzera nzira imwechete yatsanangurwa pamusoro.

Nhengo yeboka mbiri inofanira kuiswa pachifuva neruoko rumwe pafudzi riri kure uye imwe pahudyu iri kure.

Nhengo yechikwata chetatu inofanira kuiswa pamakumbo, neruoko rumwe rwakaiswa pahudyu iri kure uye imwe pagumbo riri kure.

Cherechedza kuti zvinokurudzirwa kuti maoko enhengo dzechikwata ayambuke pamusoro pehudyu.

Nhengo yechikwata ina inotsvedza iyo refu musana bhodhi pasi pemurwere, uye iyo yese nzira inoteverwa sezvakatsanangurwa pamusoro.

Matambudziko ekushandisa musana bhodhi mumusana immobilisation

Kushungurudza Kukuvara

Dambudziko rinogona kuitika kune avo varikurebesa musana bhodhi uye cervical spine motion restriction maronda ekumanikidzika, ane chiitiko chinoshumwa chakakwira se30.6%.[17]

Sekureva kweNational Pressure Ulcer Advisory Panel, maronda ekumanikidza ave kudzokororwa sekukuvara kwekumanikidzwa.

Zvinobva mukudzvinyirirwa, kazhinji pamusoro pehukuru hwemabhonzo, kwenguva yakareba zvichikonzera kukuvara kwenzvimbo kune ganda uye matishu akapfava.

Mumatanho ekutanga, ganda rinoramba rakasimba asi rinogona kufambira mberi kusvika pakuva ronda munguva inotevera.[18]

Nguva inotora kukudziridza kukuvara kwedzvinyiriro inosiyana, asi chidzidzo chimwechete chakaratidza kuti kukuvara kwenyama kunogona kutanga mukati memaminitsi 30 mune vanozvipira vane hutano.[19]

Zvichakadaro, avhareji yenguva inopedzwa isina kufambiswa pane refu musana board inotenderedza 54 kusvika 77 maminetsi, angangoita 21 maminetsi ayo anounganidzwa muED mushure mekufambisa.[20][21]

Uine izvi mupfungwa, vese vanopa vanofanirwa kuedza kudzikisa nguva iyo varwere vanopedza vasingafambisirwe ingave yakaomeswa mizongoza mabhodhi kana nemakora ekervical sezvo ese ari maviri anogona kutungamirira mukumanikidzwa kukuvara.

Kupindirana kwekufema

Zvidzidzo zvakawanda zvakaratidza kuderedzwa kwekushanda kwekufema nekuda kwetambo dzinoshandiswa pamapuranga emusana.

Muvazvipiri vechidiki vane hutano, kushandiswa kwetambo refu yemuzongoza pamusoro pechipfuva kwakaguma nekudzikira kwemapurmonary paramita akati wandei, kusanganisira kumanikidzwa kwakakosha simba, kumanikidzwa kupera simba, uye kumanikidzwa kwepakati-kuyerera kwekupera zvichikonzera kudzora maitiro.[22]

Mutsvakurudzo yaisanganisira vana, pakava nekudzikiswa kwesimba rekumanikidzwa kusvika pa80% yepakutanga.[23] Mune imwezve ongororo, zvese zvakaomarara bhodhi nemametiresi evacuum zvakawanikwa zvichiganhurira kufema neavhareji ye17% muvazvipiri vane hutano.[24]

Kuchenjerera kunofanirwa kubhadharwa kana varwere vasingagone, kunyanya kune avo vane pre-existing pulmonary chirwere pamwe nevana nevakwegura.

Pain

Iyo inonyanya kuzivikanwa, yakanyatso kunyorwa complication yerefu musana board spinal motion restriction kurwadziwa, zvichikonzera zvishoma se30 maminetsi.

Marwadzo anonyanya kuratidzwa nekutemwa nemusoro, musana, uye kurwadziwa mandible.[25]

Zvakare, uye pari zvino dingindira rinodzokororwa, nguva inopedzwa pane yakaoma refu musana bhodhi inofanira kuderedzwa kuderedza marwadzo.

Kukosha kwekliniki yekukuvara kwepelinha: basa rekororo uye musana bhodhi

Blunt force trauma inogona kukonzera musana wekukuvara uye, nekudaro, kukuvara kwemusana kunogona kukonzera kurwara kwakanyanya uye kufa.

Muma1960 nema1970, kurambidzwa kwepelinha kwekufamba kwakashandiswa kuderedza kana kudzivirira neurological sequelae inofungidzirwa kuti ndeyechipiri kune kukuvara kwepinini.

Kunyange zvazvo yakagamuchirwa zvakanyanya seyero yekutarisira, zvinyorwa hazvina chero mhando yepamusoro, humbowo-hwakavakirwa tsvagiridzo inoongorora kana kwete musana wekufamba kurambidzwa kune chero kukanganisa pamhedzisiro yetsinga.[26]

Uyezve, mumakore achangopfuura kwave kune humbowo huri kukura hunoratidza zvingangoitika zvepinal motion restriction.[17][22][25][20]

Nekuda kweizvozvo, mitsva nhungamiro yakakurudzira kuti kurambidzwa kwemuzongoza kushandiswe zvine hungwaru muhuwandu hwevarwere.[10]

Kunyange zvazvo kudziviswa kwekufamba kwemusana kungave kunobatsira mune mamwe mamiriro ezvinhu, mupi wacho anofanira kujairana nezvose zvinotungamirira uye zvinogona kunetsa kune vanopa kuti vave vakashongedzerwa zviri nani kushandisa nzira idzi nekuvandudza migumisiro yevarwere.

Kuvandudza Healthcare Team Outcomes

Varwere vanga vachibatanidzwa mukushungurudzika kwechisimba vanogona kupa nezviuru zvezviratidzo.

Zvakakosha kune vashandi vehutano vane basa rekutanga kuongororwa kwevarwere ava kuti vazive zviratidzo, zvinopesana, zvinogona kuoma, uye nzira yakakodzera yekushandisa kurambidzwa kwepelinha.

Nhungamiro dzinoverengeka dzinogona kuvapo kubatsira kuona kuti ndevapi varwere vanosangana nemaitiro ekurambidzwa kwepelinha kufamba.

Zvichida nhungamiro inonyanya kuzivikanwa uye inogamuchirwa zvakanyanya ndeyeiyo yenzvimbo yakabatana chirevo neAmerican College of Surgeons Committee on Trauma (ACS-COT), National Association of EMS Physicians (NAEMSP), uye American College of Emergency Physicians (ACEP). [10] Kunyangwe izvi zviri izvo zvinotungamira uye zvinokurudzirwa, hapana yemhando yepamusoro-randomized control miedzo kusvika parizvino, nekurudziro iri kubva paongororo yekuongorora, retrospective cohorts, uye nyaya dzenyaya.[26]

Pamusoro pekujairana nezviratidziro uye contraindications yepinal motion restriction, zvakakoshawo kuti varapi vehutano vazive zvinogona kunetsa sekurwadziwa, maronda ekumanikidza, uye kufema kukanganiswa.

Paunenge uchiita spinal motion restriction, nhengo dzese dze interprofessional health care professionalsteam dzinofanirwa kunge dzichiziva nzira yadzinoda uye kushandisa kutaurirana kwakanaka kuita hunyanzvi nemazvo uye kuderedza kuwandisa kwemusana kufamba. Vashandi vehutano vanofanirawo kuziva kuti nguva inoshandiswa pane yakareba musana bhodhi inofanira kuderedzwa kuderedza matambudziko.

Paunenge uchiendesa kutarisirwa, timu yeEMS inofanirwa kutaurirana iyo yakazara nguva yakashandiswa pane refu musana bhodhi.

Kushandisa mirairo yazvino, kujairana nematambudziko anozivikanwa, kuderedza nguva inoshandiswa pane refu musana board, uye kushandisa yakanakisa interprofessional kutaurirana mhedzisiro yevarwere ava inogona kuvandudzwa. [Chikamu 3]

References:

 

[2]Chen Y,Tang Y,Vogel LC,Devivo MJ Zvikonzero zvekukuvara kwemusana. Misoro mukugadziriswa kwekukuvara kwemusana. 2013 Chando;     [PubMed PMID: 23678280]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Source:

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