Kurumidza uye Yakasviba Gwara kune Chest Trauma
Kukuvara kwechipfuva ndiko kunokonzera 25% yevose vanofa zvinotyisa gore negore. Izvo zvakakosha kuti vese vanopa EMS vanyumwire uye vakasvinura kana vatarisana nemurwere wechipfuva.
Chest Injuries
Kukuvara kwechifuva kunokonzerwa nekushungurudzika kwechisimba, kupindira kwemukati kana zvose zviri zviviri.
Kazhinji vanoonekwa mu:
- Njodzi dzemotokari
- Inodonha kubva pakakwirira (kazhinji> 15' yakatwasuka)
- Kukuvara kwekuputika (zvese zvekutanga uye zvechipiri)
- Kurova kwakakosha pachipfuva
- Kukuvara kwekumanikidzwa kwechipfuva
- Maronda epfuti (GSW)
- Maronda ekubaya/kurovererwa
Kukuvara kwakasiyana kwe thoracic / kukuvadzwa, kwakarongedzerwa nenzvimbo yekubatanidzwa:
- Kukuvara kweSkeletal (mbabvu, Clavicles, Sternum)
- Kukuvara kwePulmonary (Trachea, Bronchi, Lungs)
- Mwoyo / Midziyo mikuru (Myocardium, Aorta, Pulmonary midziyo)
Zvakakosha kuti munhu ave nekeji yechipfuva isina kusimba kuitira kuti pave nemhepo yakakwana.
Kukuvadzwa kwe thoracic kunokonzera kusakwana kwemhepo kunogona kukurumidza kutungamirira ku hypoxia uye hypercarbia.
Acidosis uye kutadza kufema kuchaitika kana kupindira kwekukurumidzira kusatangwa nekukurumidza.
Kukuvara kwakashata kwemadziro echipfuva kunosanganisira kuputsika kwembabvu kubva kune imwe mbabvu kusvika pachipfuva cheflail, pamwe nekutyoka kwemusana.
Kupinza kukuvara kwechipfuva kunogonawo kukonzera hypoxia ne hypocarbia sekufemerwa kunorasika.
QUALITY AED? SHANYIRA ZOLL BOOTH PAEMERGENCY EXPO
Nezve kurwadziwa kwechipfuva: Rib/Sternal Fracture
Kutyoka mbabvu ndiko kunonyanya kukuvadzwa muchipfuva.
Kunyange zvazvo zvichirwadza zvikuru kumurwere, dambudziko rekuputsika kwembabvu harisi kazhinji kuputsika pachayo, asi nekugona kwekukuvara kwemukati kunofambidzana nekuputsika; zvakaita se:
- Pneumothorax
- Hemothorax
- Kukuvara kwemoyo
- Maronda echiropa
- Maronda espleen
Kutyoka kwembabvu nhatu dzekutanga hazviwanzo; dzakapfupika, dzakaoma, uye dzinodzivirirwa neclavicle, scapula, uye mhasuru dzemadziro epamusoro echipfuva.
Kuvapo kwemaviri kana kupfuura mbabvu dzakaputsika pane imwe nhanho pane thoracic cage inobatanidzwa nehuwandu hwepamusoro hwekukuvara kwemukati.
Mbabvu 4–9 ndidzo mbabvu dzinonyanya kukuvadzwa nekuti dzinobuda pachena uye hadzifambe.
Idzi mbabvu dzakasungirirwa kune sternum anterior uye musana shure.
Mbabvu 9–11 fx. zvinosanganiswa nehuwandu hwekukuvara kwemukati-mudumbu, kunyanya kukuvara kwechiropa uye spleen.
Kutsemuka kwemukati uye kuparadzaniswa kwekostochondral (kuparadzaniswa kwesternum kubva mbabvu) kunowanzokonzerwa neanterior blunt force trauma.
Nekuda kwenzvimbo yemoyo yakananga kumashure kwe sternum, matambudziko emwoyo akadai semyocardial contusion anogona kuitika nekutsemuka kana kubviswa sternum.
Cherechedza: Zvakatiomera kuti tinzwisise panzvimbo asi, mutyairi anodzorwa ane mukana mukuru pane mutyairi asingadzoreki kuti atyoke neshure.
UNODA HERE? KUSHANYIRA ZVINOMIRA MUMUDZIDZI PAKUKANGANISIRA EXPO
Flail Chest
Chipfuva chine flail chinoitika kana mbabvu nhatu kana kupfuura dzakatyoka panzvimbo mbiri kana kupfuura, zvichigadzira chikamu chemahara chinofamba chemadziro echipfuva chichifamba zvinokatyamadza kune yese chipfuva.
Zvikamu zveFlail zvinogona kuwanikwa pamberi, kumashure kana kumashure.
A flail sternum inogona kuguma kubva kune anterior blunt force trauma iyo inoparadzanisa sternum kubva mbabvu dzose (costochondral separation).
Kufema kunobatwa neflail chest munzira nhatu:
- Basa rekufema rinowedzerwa nekurasikirwa kwekutendeseka kwemadziro echipfuva uye zvinokonzeresa paradoxical kufamba kwechikamu cheflail.
- Tidal vhoriyamu inodzikiswa nekufamba kunoshamisa kwechikamu cheflail chinomanikidza mapapu padivi rakakanganiswa panguva yekufemerwa. Izvo zvinokonzerwawo nekusada kwemurwere / kusakwanisa kutora kufema kwakanyanya nekuda kwemarwadzo anogadzirwa kana chikamu cheflail chinofamba.
- Pulmonary contusions inokanganisa kufema kunokonzeresa atelectasis uye kusachinjana kwegasi kwakashata kuyambuka alveolar-capillary membrane.
Izvi zvinhu zvinobatsira pakuvandudza kufema kusina kukwana uye hypoxia.
Kukuvara kwePulmonary
Pamusoro pemadziro echipfuva akasimba, yakasimba uye inoshanda pulmonary system uye inodiwa kuti ive nechokwadi chekufemerwa kwakakwana.
Kukuvara kwakanyanya kwepulmonary kunosanganisira:
- Pulmonary contusion
- Pneumothorax iri nyore yakavhurika/yakavharwa
- Tension pneumothorax
- Hemothorax
- Traumatic asphyxia.
Pneumothorax inoitika apo mweya unoungana munzvimbo yepleural pakati pemapapu uye mukati memadziro echipfuva.
Icho chinowanzoitika chekushungurudza uye kunopinda mukati mechipfuva chinopfuura neparietal uye visceral pleura.
Pneumothorax inoratidzirwa se:
- Zviri nyore pneumothorax
- Vhura pneumothorax
- Tension pneumothorax
- Pneumothorax iri nyore
Pneumothorax iri nyore inoitika apo gomba mu visceral pleura rinobvumira mweya kubuda mumapapu uye kuunganidza munzvimbo yepleural.
Pneumothorax iri nyore inowanzokonzerwa kana mbabvu yakatsemuka ichicheka pleura.
Zvinogona kuitika pasina kutyoka kana blunt trauma inounzwa pakufemerwa kwakazara neglottis yakavharwa (kubata mweya wako).
Izvi zvinoguma neanoshamisa spike mu intra-alveolar pressure uye alveolar kuputika kunoitika. Inowanzozivikanwa se, the paper bag syndrome.
Kurapa: varwere vanowanzokwanisa kuchengetedza nzira yavo yemhepo uye ventilate zvakakwana.
Mumamiriro ezvinhu akadaro, shandisa okisijeni kuburikidza neNRB @ 12-15 lpm (SpO2 yeinenge 94%). Isa murwere pane chekutarisa chemoyo uye gadza IV kuwana.
Monitor EtCO2 kana zvichibvira uye simbisa musana kana zvakakodzera. Varwere havazowanzoda BVM kana intubation.
Vhura Pneumothorax
Pneumothorax yakavhurika inoitika apo buri (kazhinji rakakura kupfuura nickel) mumadziro echipfuva uye pleura inobvumira mweya kuungana munzvimbo yepleural.
Mhepo inogona kufamba ichipinda nekubuda mugomba mumadziro echipfuva nekufemerwa, zvichikonzera ronda remuchipfuva rinoyamwa.
Kurapa : Vhivha kupinda kunoperekedza pneumothorax yakavhurika ine occlusive dressing yakatepwa pamativi matatu.
Izvi zvinonyatsogadzira vharuvhu yenzira imwe chete inodzivirira mhepo kupinda muchipfuva kuburikidza nekupinda panguva yekufemerwa, asi ichibvumira mweya kubuda panguva yekufema, kudzivirira kukura kwetension pneumothorax.
Pane dzimwe nguva apo iyo occlusive dressing isingashande zvakanaka, uye mhepo inoungana muchipfuva.
Kana chipfeko chisina kuvharwa chikaiswa uye zviratidzo nezviratidzo zvetension pneumothorax zvichikura, simudza kona yekupfeka kuti chifuva chiome.
Vhidhiyo pfupi inotevera inoratidza kurapwa kwakakodzera kweronda rechipfuva rinoyamwa.
Tension Pneumothorax
Tension pnuemo's idambudziko rechokwadi; kuitika kana buri mumapapu richishanda sevharuvhu yenzira imwe chete, zvichiita kuti mweya upinde muchipfuva nekufemerwa asi, mweya haugone kutiza nekufemerwa.
Nekufema kwega kwega, kumanikidza muchipfuva chechipfuva kunowedzera, kuchiwedzera kusvibisa mapapu.
Sezvo dzvinyiriro ichiramba ichiwedzera, mediastinum inosundirwa kudivi risina kubatwa.
Kuchinja uku kunoita kuti vena cava iite kink, ichideredza kudzoka kwevenous.
Izvi zvinogadzira chain reaction yekudzikira preload, kudzikira sitiroko vhoriyamu, kuderera kwemoyo kubuda uye, pakupedzisira, kuderera kweropa.
Inozopedzisira yatanga kukanganisa kuwedzera kwemapapu kune rumwe rutivi kune kukuvara, kuderera kwehuwandu hwemvura mumapapu ane hutano.
Obstructive shock uye hypoxia mhedzisiro yetension pneumothorax.
Kana tension pneumothorax ikawedzera, kuchinja kwemukati kuchaitika.
Tachycardia uye hypotension ichava yakadzika, inoteverwa nekuderera kwekuziva.
Ruzha rwemapapu ruchadzikira parutivi rwusina kubatwa, uye JVD ichaitika semugumisiro wekuderera kwevenous kudzokera kumoyo kana pasina concomitant hypovolemia.
Kutsauka kweTracheal, kana ikaonekwa neEMS zvachose, chiratidzo chekunonoka uye chinoitika chakaderera mu mutsipa.
Kuwedzera cyanosis, kusaziva uye pakupedzisira kufa kuchaitika.
Kurapa: kurapwa kwetension pneumothorax kuderedzwa kwetsono, hunyanzvi hunowanikwa chete kune vanopa ALS.
BLS vatapi vanofanirwa kupa PPV kuvarwere ava vachikurumidza kutakura kuenda kudhipatimendi rekukurumidzira kana kuonana nechikamu cheALS.
Ita decompression yetsono kana tension pneumothorax ichifungidzirwa, kusati kwaitwa kumwe kurapwa (Bata MCP).
Maitiro: A 2-3" 14 g catheter inopinzwa mune yechipiri kana yechitatu intercostal nzvimbo pamutsetse wepakati nepamusoro pembabvu.
Zvakakosha kushandisa tsono yehurefu hwakakwana.
Mushure mekuisa tsono munzvimbo yepleural mhepo inobuda nepakati petsono, kukurumidza kuora kwe thorax, uye kukurumidza kugadziriswa kwe cardiorespiratory kutuka maitiro etension pneumothorax.
Iyo catheter inosiiwa panzvimbo, kazhinji ine flutter valve kubvumira mweya kutiza muchipfuva asi kwete kupinda zvakare.
Commercial tsono thoracostomy kits inowanikwa kubva kune akati wandei vagadziri, kana kiti inogona kugadzirwa nayo midziyo kazhinji inowanikwa pane amburenzi.
Tension Pneumothorax Kurapa Prehospital
Hemothorax
Hemothorax inoitika apo ropa rinoungana mu pleural cavity.
Zvinogona kuitika nezvose zvakagomara uye zvinopinda mukati mechipfuva.
Kubuda ropa kubva mukukuvadzwa kuenda kumapapu parenchyma ndiyo inonyanya kukonzera hemothorax, asi kubuda kweropa kubva mukukuvadzwa kwakadaro kunowanzoita kuzvidzikisira nekuda kwekumanikidzika kweropa riri kuungana, kuwanda kwe thromboplastin (protein yeropa inobatsira mukubatana. ) iripo mumapapu, uye yakaderera pulmonary arterial pressure, zvese izvi zvinobatsira kufambisa kuumbwa kwegwamba uye kumisa kubuda ropa.
Kukuvara kwakakura kumapapu parenchyma uye kune tsinga uye/kana tsinga dzinogona kubuda ropa zvakanyanya (kupfuura 1 litre) uye zvinotungamira ku hypovolemic shock.
Kubuda ropa kubva kune yakakuvara intercostal artery inogona kuva yakaoma, iyo matavi zvakananga kubva kune aorta uye iri pasi pekumanikidzwa kukuru.
Kuwanda kweropa kunodzinga uye kunodonha mapapu, kudzikisa huwandu hwemvura uye kukanganisa mhepo, zvichitungamira ku hypoxia.
Kana ikabvumirwa kufambira mberi, dambudziko risingajairike rinonzi tension hemothorax rinogona kukura rinouya zvakafanana netension pneumothorax.
Murwere ane hemothorax achauya nekunetseka kufema, kuderera kana kusavapo kwemapapu kudivi rinenge rabatwa, uye chipfuva chinenge chakagomara pakurova. Mukuwedzera, zviratidzo zvekuvhunduka zvichave zviripo, kusanganisira tachycardia; tachypnea; ganda rinotonhorera, rakachenuruka, diaphoretic; uye hypotension.
Kurapa: Kutungamirirwa kwehemothorax kunotanga neoxygenation uye IV kuwana pamwe chete nekutonga kwekubuda ropa kunze.
Bvumira hypotension inobvumira, sezvo kutsiva kwehuwandu hwemvura hukasha kunogona kuderedza ropa rasara uye zvikonzero zvaro zvekugwamba, zvese zvinogona kukanganisa kuedza kwemuviri pakuumbwa kwegwamba, kudzora kubuda ropa uye hemostasis.
Traumatic Asphyxia
Traumatic asphyxia inoitika apo kamwe-kamwe uye kwakakomba kupwanya masimba pachipfuva kunokonzeresa kuyerera kweropa kubva kurudyi rwemoyo kuburikidza nepamusoro vena cava uye mutsinga huru dzemutsipa nemusoro.
Ongororo yekiriniki yemurwere ane traumatic asphyxia icharatidza kumusoro-extremity cyanosis, bilateral sub-conjunctival hemorrhage, edema, kupenya kwakatsvuka kumeso, uye rurimi rwakazvimba.
Kukanganiswa kweropa kuyerera kunogona kukonzera kushomeka kweneurologic, kuchinjika chimiro chepfungwa, kuchinjika mwero wekuziva kana kubatwa.
Kurapa: prehospital treatment ye traumatic asphyxia inonyanya kutsigira.
Pasinei nekuonekwa kunoshamisa, mamiriro acho pachawo anowanzova asina kunaka mukushayikwa kwekukuvara kwe intrathoracic kana intra-abdominal.
Tipei Musipinha immobilization kana iyo nzira yekukuvara inoratidza mukana weiyo spinal column kana kukuvara kwetambo, uye kupa oxygen kana intrathoracic kukuvara kuchifungidzirwa kana hypoxia iripo.
Tanga kupindira kweALS kwakadai seO2, IV, kutarisa kwemwoyo uye kudzorerwa kwemvura yemvura kana zviratidzo zvekuvhunduka zviripo.
Cardiovascular Injuries mukurwadziwa kwechipfuva
Kukuvara kune intrathoracic components of the cardiovascular system inowanzova nemigumisiro yakaipa uye pakarepo inotyisidzira upenyu.
Kukuvara kwakajairika kunosanganisira pericardial tamponade, blunt cardiac trauma, uye blunt aortic kukuvara.
Pericardial Tamponade
A pericardial tamponade kuunganidzwa kweropa mu pericardium, zvichikonzera kudzvanywa kwemoyo, kukanganisa kuzadza moyo uye kuderedza kubuda kwemoyo.
Acute pericardial tamponade inowanzoitika kune varwere vane kukuvara kwemukati kusvika pachipfuva nekumusoro kwedumbu, uye haiwanzo kubatanidzwa nekukuvadza kwechisimba.
Zvinoitika kakawanda nemaronda ekubaya kupfuura nemaronda epfuti.
Mushure mekutambudzika kwekutanga kunopinda, pericardium inovhara gomba. Kuramba kubuda kweropa kubva kune yakakuvara myocardium inozadza nzvimbo yepericardial.
Iyo pericardium inenge inelastic, uye kuiswa kwemavhoriyamu madiki (60-100 mL) eropa kwenguva pfupi kuchaita tamponade.
Kuwedzera kudzvinyirirwa mu pericardium kunoparidzirwa kumwoyo, kuchimanikidza uye kudzivirira kuzadza kwakakwana kwe ventricular panguva ye diastole.
Izvi zvinoderedza preload, sitiroko vhoriyamu uye kubuda kwemoyo.
Drastic hypotension inokurumidza kuitika.
Mhedzisiro yekumanikidzwa kwemoyo ndeyekuwedzera diastolic pressure.
Kudzikira kwepulse kunowedzera sekunge systolic pressure inodonha nekudzikira kwemoyo kubuda asi diastolic pressure inoramba yakakwira nekuda kwekutsikirirwa kwemoyo.
JVD inogona kukura yechipiri kune yakaderera venous kudzoka kurudyi rwemoyo.
Kuwedzera kune yakaderedzwa yemoyo kubuda, cardiac tamponade inoderedza myocardial perfusion kuburikidza nekumanikidza kweiyo coronary arteries, ichideredza myocardial oxygen supply.
Zvakawanikwa zvekare zvine chekuita necardiac tamponade zvinosanganisira hypotension, JVD uye muffled heart tones, matatu ezviratidzo anozivikanwa pamwe chete seBeck's triad.
Iyi triad yakaoma kuziva munzvimbo yeprehospital, sezvo kunzwisiswa kwemanzwi emwoyo kunogona kuratidza kuoma muma ambulensi ane ruzha.
Sezvo tamponade inoshanduka, hypotension uye tachycardia zvichave zviripo, sezvichaita kuderera kwepulse pressure uye zvichida pulsus paradoxus (kudonha mu systolic blood pressure inopfuura 10 mmHg panguva yekufemerwa).
Kurapa: Kutarisira pericardial tamponade nzvimbo pakudzora kwemhepo, oxygenation, uye kutsigirwa kwemhepo uye kutenderera.
Zviratidzo nezviratidzo zve pericardial tamponade zvinogona kutevedzera izvo zvetension pneumothorax, kunyangwe kuvepo kwekunzwika kwemapapu emativi maviri kunogona kuita kunze kwekupedzisira.
Varwere vane hypotensive, kukurumidza kuwedzera vhoriyamu ne isotonic crystalloid kuchawedzera venous kumanikidzwa, zvichikonzera kuwedzera kwekuwedzera uye kuwedzera kwemoyo kuburitsa, kusimudza systolic kumanikidzwa.
Blunt Cardiac Trauma
Blunt cardiac trauma ishoko rinomiririra huwandu hwekukuvara kwemyocardial kunosanganisira:
- Myocardial concussion inotsanangura chimiro chekushungurudzika kwemoyo kwakaoma kusingakonzeri kukuvara kwakananga kune myocardium.
- Myocardial contusion inoitika apo myocardium yakakuvadzwa, kazhinji nechisimba chisina simba.
- Myocardial rupture ndeye acute traumatic rupture yeatrial kana ventricular wall.
Myocardial contusion inowanzoitika kubva kublunt force trauma kune sternal area inomanikidza moyo pakati pe sternum ne spinal column, zvichikonzera kukuvara kune myocardium.
Kukuvara kwemyocardial kunogona kusanganisira kubuda ropa mukati memyocardium, edema, ischemia uye necrosis, zvose zvinoguma nekushaya simba kwemwoyo.
Kuputika kwemyocardial kunoitika apo kushungurudzwa kwechisimba kusina simba kunoguma nekuwedzera kwe intraventricular kana intra-arterial pressure yakakosha zvakakwana kuti iparadze rusvingo rwemyocardial. Kazhinji kazhinji inokonzerwa nekuparara kwemotokari yepamusoro-soro; inenge nguva dzose inouraya pakarepo.
Blunt Aortic Injury inotsanangura kuwanda kwekukuvara kunotangira kubva pamisodzi midiki muaortic intima (yemukati-kati yetsinga) kupedzisa transection yeaorta, iyo inogara ichiuraya.
Kusvikira ku90% yevarwere vane kukuvara kwakakomba kweaortic vanofira panzvimbo yetsaona kana mukati memaawa ekubvumirwa kuchipatara.
Pese painowira pa spectrum, blunt aortic kukuvara kukuvara kwehupenyu, uye kazhinji kacho mhedzisiro yekusadzora kudhumhana kwepamberi kana chisimba che lateral blunt kukanganisa kuchipfuva.
Kuveura kunoguma nekubvarura masimba kunoisa kushushikana paaorta pa ligamentum arteriosum, uye kubvarura kunogona kuitika.
Nhamba yepamusoro yekufungira, inobva pakunzwisisa kwekukurumidza-kuderedza nzira yekukuvara uye zviratidzo nezviratidzo zvekuvhunduka, inofanira kuratidza mukana wekuita blunt aortic trauma.
Kurapa kwekukuvadza kweaortic kunosanganisira kutungamira kwemhepo, oxygenation uye ventilation, uye fluid volume replacement muvarwere vane hypotension yakadzika yechipiri kune vanofungidzirwa aortic transection.
Usaita hutsinye hwehuwandu hwehuwandu hwehutungamiri kune varwere vasiri hypovolemic, sezvo kuwedzera kwemukati wevascular volume kunogona kukonzera hukuru hweshear pane vakakuvara vasculature uye kuwedzera kwekukuvara.
Sezvimwe nezvimwe zvese zvinoshungurudza, kukurumidza kutakura kuenda kunzvimbo yekushungurudzika kwakakosha.
Chest trauma chinhu chakadzama uye chakakosha chetrauma care.
Verenga Uyewo:
Pathophysiology yeThoracic Trauma: Kukuvara Kumoyo, Midziyo Yakakura uye Diaphragm.
Cardiopulmonary Resuscitation Manoeuvres: Kutungamira kweLUCAS Chest Compressor
Chest Trauma: Clinical Aspects, Therapy, Airway uye Ventilatory Assistance
Precordial Chest Punch: Zvinoreva, Nguva Yekuzviita, Mirayiridzo
Ambu Bag, Ruponeso Kune Varwere Nekushaya Kufema
Blind Insertion Airway Devices (BIAD's)
UK / Emergency Kamuri, Pediatric Intubation: Maitiro NeMwana Ari Mamiriro Akakomba
Tracheal Intubation: Rini, Sei Uye Sei Kugadzira Yakagadzirwa YeMhepo YeMurwere
Endotracheal Intubation: Chii chinonzi VAP, Ventilator-Yakabatana Pneumonia
Sedation uye Analgesia: Mishonga Yekufambisa Intubation
AMBU: Mhedzisiro YeMechanical Ventilation PaKushanda KweCPR
Manual Ventilation, 5 Zvinhu Kuti Uchengete Mupfungwa
FDA Inotendera Recarbio Kurapa Chipatara-Chakawana Uye Ventilator-Yakabatana Bacterial Pneumonia
Pulmonary Ventilation Mune Maamburenzi: Kuwedzera Murwere Kugara Nguva, Zvakakosha Kunaka Mhinduro
Kusvibiswa kweMicrobial Pamusoro peAmbulance Surfaces: Yakabudiswa Dhata Uye Zvidzidzo
Ambu Bag: Hunhu Uye Mashandisiro Anoita Iyo Inozviwedzera Balloon
Anxiolytics Uye Sedatives: Basa, Basa uye manejimendi neIntubation uye Mechanical Ventilation.
Bronchitis uye Pneumonia: Vanogona Kusiyaniswa Sei?
Intubation: Njodzi, Anaesthesia, Resuscitation, Huro Pain
Chii chinonzi Intubation uye nei ichiitwa?
Chii chinonzi Intubation uye nei ichidikanwa? Kuiswa kweTube Kudzivirira Iyo Airway
Endotracheal Intubation: Nzira dzekuisa, Zviratidzo uye Contraindications
Airway Management: Mazano Ekubudirira Intubation