Kunyura 'mumushonga kunoreva chimiro cheacute asphyxia chinokonzerwa nemuchina chinokonzera kunze kwemuviri, chinounzwa nenyaya yekuti pulmonary alveolar space - inowanzogarwa negasi - inogara ichigarwa nemvura (semuenzaniso mvura yemunyu mune iyo kesi. yekunyura kwegungwa kana mvura ine chlorine kana ichinyura mudziva rekushambira)

Mvura inopinzwa mumapapu kuburikidza nemugwagwa wepamusoro wemhepo, izvo zvinoitika, semuenzaniso, kana munhu apererwa nekuziva zvachose uye anowira pasi pechiyero chemvura, kana kuti paanoziva asi anosairirwa pasi pechiyero chemvura. simba rekunze (semuenzaniso masaisai kana maoko emurwi) uye rinobuda mweya mumapapu nekufemerwa KASATI adzokera pamusoro.

Kunyura - kunogona kuuraya mukati memaminitsi - hakusi nguva dzose kunouraya, zvisinei: mune dzimwe nguva kunogona kubudirira kurapwa nemaitiro akakodzera ekumutsidzira.

Kufa nekunyura kwaishandiswa kare sechirango cherufu kune dzimwe mhosva, semuenzaniso mhosva yekupandukira muMiddle Ages.

ZVINOKOSHA: Kana mudiwa akambonyura uye usingazive zvekuita, tanga wabata rubatsiro rwekukurumidzira nekukurumidza nekufonera Emergency Number.

Kuoma kwekunyura kwakakamurwa kuita 4 madhigirii:

1st degree: munhu akabatwa haana kufema zvinwiwa, ari kufefetera zvakanaka, ane cerebral oxygenation yakanaka, haana nyonganiso yekuziva, anoshuma kugara zvakanaka;

2nd degree: munhu akabatwa akafema zvinwiwa zvishoma, kuputika ma rales uye / kana bronchospasm zvinoonekwa, asi mhepo yekufema yakakwana, kuziva kwakasimba, murwere anoratidza kunetseka;

3rd degree: munhu akabatwa akafema zvinwiwa zvakasiyana, anopa rales, bronchospasm uye mweya wekufema, inovandudza cerebral hypoxia nezviratidzo kubva pakuvhiringidzika kusvika kune chisimba, kusvika kune soporific state, cardiac arrhythmias iripo;

4th degree: munhu akabatwa akafemera mvura yakawandisa kana kuramba ari muhypoxic kusvika kusungwa kwemoyo uye kufa.

ZVINOKOSHA: zviratidzo zvakakomba zvekunyura zvinoitika kana huwandu hwemvura yakafemerwa inopfuura 10 ml pakirogiramu yehuremu hwemuviri, kureva hafu yerita yemvura kumunhu anorema makirogiramu 50 kana 1 litre kana akayera makirogiramu zana: kana huwandu hwemvura. zvishoma, zviratidzo zvinowanzova pakati nepakati uye zvenguva pfupi.

Kunyura kwechipiri

Kunyura kwechipiri kunoreva kutaridzika kwematambudziko mumhepo yekufema nemapapu mushure mechiitiko chekunyura, kunyange mazuva akati wandei mushure mechiitiko, zvichikonzerwa nekuunganidzwa kwemvura yakaiswa mumapapu.

Pakutanga, pulmonary edema haikonzeri chero matambudziko, asi mushure memaawa mashoma kana kunyange mazuva mashoma, inogona kukonzera rufu.

Zvakakosha kuyeuka kuti chlorinated swimming pool mvura ine akawanda emakemikari emakemikari: kana akabatwa uye anoramba ari mumapapu, anokonzera kutsamwa uye kuzvimba, kunyanya mubronchi.

Pakupedzisira, yeuka kuti, kubva pakuona kwe microbiological, kufemesa mvura yakachena kune ngozi zvikuru nekuda kwekukwanisa kupinza mavhairasi, mabhakitiriya uye mamwe utachiona.

Dry kunyura

Dry drowning' kunoreva kuitika kwematambudziko mumhepo yekufema nemapapu mushure mechiitiko chekunyura, kunyange mazuva akawanda mushure mechiitiko, zvichikonzerwa nelaryngospasm.

Muviri nehuropi zvakakanganisa 'kunzwa' kuti mvura yave kuda kupinda nemunzira dzemhepo, saka zvinoita kuti larynx iite spasm kuti ivhare uye kudzivirira kupinda kwekufungidzira kwemvura, izvo zvinoita kuti mweya usapinde mumuviri, dzimwe nguva uchitungamira. kusvika pakufa nekunyura pasina kunyudzwa mumvura.

Kufa nekunyura

Chikonzero chekufa mukunyura ndeye hypoxaemia, iyo inotungamirira ku hypoxia yakaoma inokonzera kukanganisa kushanda kunyanya muuropi uye myocardium nekurasikirwa kwekuziva, kukanganisa kwemoyo wakarurama uye kusungwa kwemwoyo.

Panguva imwe chete, hypercapnia (yakawedzera carbon dioxide concentration muropa) uye metabolic acidosis inoitika.

Hypoxemia inokonzerwa nekupinda kwemvura mumapapu uye / kana laryngospasm (kuvharwa kwe epiglottis, iyo inodzivirira mvura nemhepo kupinda).

waridza

MuItaly, kune zvingangoita 1000 zviitiko zvakakomba zvetsaona dzemvura gore rega rega, nehuwandu hwekufa hunosvika 50%.

Sangano reWorld Health Organisation rinoti vana vanosvika zviuru zvishanu vari pakati pemakore 5,000 kusvika mana vanofa muEurope gore rega rega, uye pasi rose, pane nzufu dzinosvika 1 4 nekuda kwekunyura mumakore gumi nemanomwe ekutanga.

Kufa nekunyura kunofanira kusiyaniswa kubva pakufa kamwe kamwe nekunyudzwa, kunokonzerwa nekushungurudzika, reflex cardiac syncope, kukachidzwa. kurutsa uye kusaenzana kwekupisa

Kufa nekunyura: zviratidzo uye zviratidzo

Kufa nekunyura kunotangirwa nematanho mana:

1) Nhanho yekushamisika: inotora masekonzi mashoma uye inoratidzwa nekukurumidza uye yakadzika sezvinobvira inhalation munhu asati aenda pasi pemvura.

Zvinoitika zvakare:

• tachypnea (kuwedzera kufema chiyero);
• tachycardia;
• arterial hypotension ('low blood pressure');
• cyanosis (bluish ganda);
• miosis (kuderedza dhayamita yemwana weziso).

2) Danho rekudzivirira: rinotora anenge maminetsi maviri uye rinoratidzwa nekutanga apnoea, panguva iyo munhu anodzivirira mvura kuti isapinda mumapapu nekufema uye anonetsekana paanenge achiedza kumuka, kazhinji nekutambanudza maoko avo pamusoro pemusoro wavo akananga kumhepo. pamusoro pemvura.

Muchikamu ichi, zvinotevera zvinoitika zvishoma nezvishoma:

• apnea;
• kutya;
• kukurumidza kufamba mukuedza kumukazve;
• hypercapnia;
• BP;
• kusunungurwa kwakanyanya kweadrenaline mukutenderera;
• tachycardia;
• kukanganisa kwekuziva;
• cerebral hypoxia;
• kugwinha;
• kuderedza motokari reflexes;
• sensory alteration;
• sphincter kusunungurwa (tsvina uye/kana weti inogona kuburitswa zvisina kufanira).

Kana nyaya yacho yapera mweya mumapapu nekufema, mvura inopinda nemunzira dzemhepo ichikonzera apnea inokonzerwa nekuvharwa kwe epiglottis (laryngospasm), kuita kwakagadzirirwa kuchengetedza nzira yekufema kubva mumvura asi iyo zvakare inodzivirira kupfuura kwemhepo.

Hypoxia uye hypercapnia zvinozokurudzira nzvimbo dzetsinga kuti dzitangezve kufema: izvi zvinoita kuti glottis ivhure kamwe kamwe, izvo zvinoguma nekuwanda kwemvura ichipinda mumapapu, kutadzisa kuchinjana kwegasi, kushandura surfactant, kudonha kwealveolar uye kukura kweatelectasis uye shunts.

3) Apnoic kana kuti 'inooneka rufu' nhanho: inotora anenge 2 maminetsi, umo kuedza kumuka, pasina, kunoderedzwa kusvika iyo nyaya inoramba isingafambi.

Iyi nhanho inoratidzwa zvishoma nezvishoma ne:

• kugumisa kufema chaiko
• miosis (pupil constriction);
• kurasikirwa kwekuziva;
• kuzorora kwemhasuru;
• bradycardia yakaoma (inononoka uye isina simba kurova kwemoyo);
• idya.

4) Terminal kana 'gasping' nhanho: inotora inenge 1 miniti uye inoratidzwa ne:

• kuramba uchirasikirwa nekuziva;
• yakanyanya cardiac arrhythmia;
• kusungwa kwemoyo;
• rufu.

Iyo anoxia, acidosis uye electrolyte uye haemodynamic kusaenzana kunokonzerwa neasphyxia zvinotungamira mukukanganisika mutinhimira kusvika pakusungwa kwemoyo uye kufa.

Munhu anokurumidza kufa sei?

Nguva iyo rufu inoitika inosiyana zvakanyanya nekuda kwezvinhu zvakasiyana-siyana sezera, mamiriro ehutano, mamiriro ehutano uye maitiro easphyxia.

Munhu akwegura, ane chirwere cheshuga, hypertension uye pulmonary emphysema, muchiitiko chekunyura uye kutadza kufema, anogona kurasikirwa nekuziva uye kufa munguva isingasviki miniti, sezvinoita mwana ane chirwere chebronchial asthma.

Munhu mukuru, akakodzera munhu akajaira kurovedza muviri kwenguva refu (funga nezvemutambi ane hunyanzvi kana scuba diver) muchiitiko chekudzipwa anogona, kune rumwe rutivi, kutora maminetsi akati wandei kutadza kuziva uye kufa (kunyangwe anopfuura maminitsi matanhatu), asi mu ruzhinji rwezviitiko rufu runoitika munguva inosiyana kubva pamaminitsi matatu kusvika ku6 muhuwandu, umo zvikamu zvina zvakatsanangurwa mundima yapfuura zvinochinjana.

Kazhinji, munhu wacho anoramba achiziva ari muapnea kweanenge maminetsi maviri, obva atadza kuziva uye anoramba asingazivi kwemamwe maminitsi matatu kusvika ku2 asati afa.

Kunyura mumvura yakachena, munyu kana chlorinated mvura

Kune kunyanya marudzi matatu emvura umo kunyura kunoitika: yakachena, munyu kana chlorinated.

Rudzi rumwe norumwe rwemvura runokonzeresa kuita kwakasiyana mumuviri.

Kunyura mumvura ine munyu

Mvura yemunyu inowanzoitika munzvimbo dzegungwa uye ine 4 nguva yeosmotic pressure yeplasma; iyi hypertonicity inobatanidzwa nekuvapo kwemamineral salts akadai sodium, chlorine, potasium uye magnesium.

Kuti udzorere zvakajairika homeostasis, kufamba kwemvura kubva kucapillary kuenda kupulmonary alveolus kunogadzirwa, zvichiita kuti hemoconcentration, hypernatriemia uye hyperchloremia.

Nenzira iyi, kune kudzikira kwekutenderera kweropa uye, mumapapu, alveoli yakazara nemvura inokonzera diffuse pulmonary edema.

Local hypoxia inokurudzirawo pulmonary vasoconstriction nekuwedzera pulmonary vascular pressures, kushandura mhepo yemhepo / perfusion ratio uye kuderedza kutevedza kwemapapu uye kusara kwekuita basa;

Kunyura mumvura yakachena:

Mvura yakachena inofanana nenzvimbo dzenzizi nenyanza uye ine osmotic pressure hafu yeropa.

Nekuda kweiyo hypotonicity, inokwanisa kuyambuka alveolus-capillary barriers uye nekudaro ichipfuura mupulmonary venous circulation ichikonzera hypervolaemia, haemodilution uye hyponatriemia.

Izvi zvinogona kukonzera kupetwa kwevhoriyamu inotenderera.

Izvi zvinotungamirira kukuderera kweosmotic blood pressure, zvichiita kuti erythrocyte haemolysis uye hyperkalemia.

Zvose izvi zvinokanganisa zvinogona kunge zvakakomba kumuviri: nepo kuwedzera kwekutenderera kwe potassium kunogona kutungamirira kune yakaipa cardiac arrhythmias (ventricular fibrillation), haemoglobinuria inokonzerwa nehemolysis inogona kutungamirira kukukundikana kwetsvo.

Mvura yakachena zvakare inokuvadza rudzi rwechipiri pneumocytes uye denatures surfactant, kukurudzira kuparara kwealveolar uye kuumbwa kwepulmonary atelectasis.

Iyi nzira inokurumidza kutungamira mukupfachukira kwemvura mumapapu, zvichikonzera kutanga kwepulmonary edema nekuderera kwekuteerera kwemapapu, kuwedzera intrapulmonary shunt uye kuchinjwa kweventilation / perfusion ratio.

Kubva pakuona kwe microbiological, rudzi urwu rwekufema zvakare rune ngozi zvakanyanya, nekuda kwekugona kukuru kwekupinza mavhairasi, mabhakitiriya uye mamwe hutachiona;

Kunyura mumvura ine chlorine:

Mvura ine chlorine inofananidzwa nemadziva ekushambira uye ine ngozi zvikuru nekuda kwemigumisiro yezvigadziko zvakasimba (chlorates) inoshandiswa kuchenesa mvura uye nzvimbo.

Kuzvifema, kutaura zvazviri, kunokonzeresa kushatirwa kwakanyanya kwekemikari yemapapu alveoli nekuvharika kunokonzeresa mukugadzirwa kweiyo surfactant inodiwa kuti mapapu apinde mhepo.

Izvi zvinotungamira kudzikisira kwakanyanya munzvimbo dzekuchinjana mapapu, zvichikonzera kudonha kwemapapu uye atelectasis.

Kubva pakuona kwekufungidzira, rudzi urwu rwekufema ndirwo rwakaipisisa, rwunotungamirira kurufu mune nhamba yepamusoro yezviitiko.

Chinhu chinozivikanwa pamarudzi ese matatu emvura (kunyangwe isingawanzo wanzo mumadziva ekushambira) ndechekuti kunyura kazhinji kunosanganisira kuve mumvura pane tembiricha yakaderera, nekudaro kunobatsira kukura kwe hypothermia, iyo inofarirwa muvana, kunyanya kana vakaonda zvakanyanya. kuderedza subcutaneous mafuta.

Apo kupisa kwepakati kunosvika kuhutano huri pasi pe30 ° C, hupenyu hunopisa pathophysiological kuratidzwa kunoitika: kurova kwemwoyo, ropa uye kushandiswa kwemagetsi emuviri kunoderera zvishoma nezvishoma nekutanga kweasystole kana ventricular fibrillation;

Kunyura: kuita sei?

Rubatsiro rwekutanga inopesvedzerwa nezvinhu zvakasiyana-siyana uye, muzviitiko zvakakomba zvikurusa, zvamazvirokwazvo inomirira mharadzano chaiyoiyo pakati pokupukunyuka norufu rwomunhu akanyura.

Muponesi anofanira:

• ita nekukurumidza;
• dzosa munhu wacho uye umubvise kubva mumvura (chenjerera nokuti munhu anonyura mumvura, mukuedza kurarama, anogona kusundira muponesi pasi pemvura)
• ita ongororo yemamiriro enyaya yekuziva, kutarisa patency yemhepo (zvinogoneka kuvapo kwemucus, algae, jecha), kuvepo kwekufema uye kuvapo kwekurova kwemoyo;
• kana zvichidiwa, tanga kudzorerwa kwemwoyo;
• chenjerera paunenge uchifambisa munhu akabatwa: kana usina chokwadi, Musipinha kushungurudzika kunofanira kugara kuchifungidzirwa;
• chengetedza mhepo yakakwana, zvichiita kuti vanomira vafambe;
• chengetedza tembiricha yakakwana yemunhu anenge abatwa, achiomesa munhu wacho kana achiri kunyorova;
• takura munhu wacho kuchipatara.

Emergency Number inofanira kudanwa nekukurumidza sezvinobvira, ichizivisa mushandisi nezvekuipa kwemamiriro acho ezvinhu.

Kurapa kwemunhu anenge anyura kunoitirwa ku:

• tsigira uye kutarisa mabasa anokosha
• kururamisa organic alterations;
• kudzivirira matambudziko ekutanga nekunonoka.

Izvi zvinotevera zvakakosha kune chinangwa ichi

• kuchengetedzwa kwekutsinhana kwegasi kuburikidza nerubatsiro rwekufema nemhepo yakanaka yemhepo;
• iyo haemodynamic optimization kuburikidza nekugadziriswa kwevolaemia nekutonga kwemvura, plasma expanders, plasma, albumin, ropa uye, kana zvichiratidzwa, cardiokinetics;
• kugadziriswa kwe hypothermia, kana iripo.

Kugadzirisa matambudziko ekutanga, zvinotevera zvakakosha

• kubviswa kwemvura iri mudumbu;
• kudzivirira kweacute tubular necrosis muhupo hwehemolysis;
• antibiotic prophylaxis;
• kurapwa kwehydro-electrolyte uye acid-base kusaenzana;
• kurapwa kwekukuvara (s) (semuenzaniso maronda kana kuputsika kwebhonzo).

Matambudziko anogona kuitika mushure mekunyura ndeaya:

• aspiration pneumonia;
• kuputika kwemapapu;
• myoglobinuria uye hemoglobin;
• itsvo kutadza;
• kufema kunetseka syndrome (ARDS);
• ischaemic-anoxic encephalopathy (kukuvadzwa kwehuropi kubva pakushayikwa kweropa / oxygen kupa);
• coagulopathies;
• sepsis.

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Source:

Medicina Online