Yakabhadharwa, yakaderedzwa uye isingadzokeri kuvhunduka: zvavari uye zvavanosarudza

By Cristiano Antonino On Dai 22, 2022

Dzimwe nguva, kuvhunduka kwakaoma kuziva muzvikamu zvaro zvekutanga uye murwere anogona kushandura mukuvhunduka kwakadzikira usati waziva. Dzimwe nguva shanduko iyoyo inoitika isu tisati tasvika panzvimbo

Muzviitiko izvi, tinofanira kupindira nekukasira kupindira nekuti kutadza kuita izvi kunozoita kuti murwere aenderere mberi nekuvhunduka kusingadzokerike.

Matemu ari nani ekushandisa pakutsanangura kuvhunduka kufefeterwa uye hypoperfusion.

Kana isu tiri kunhuhwirira zvakaringana hatisi chete kuendesa okisijeni uye chikafu kune nhengo dzemuviri, asi isu tiri kubvisa zvakare tsvina yemetabolism pamwero wakakodzera zvakare.

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

Pane mhando sere dzekuvhunduka dzatingasangana nadzo:

Hypovolemic - inonyanya kusangana
Cardiogenic
Zvinodzivisa
Septic
Neurogenic
Anaphylactic
Psychogenic
Kufema kusakwana

Iwo matanho matatu ekuvhundutsa: Kusadzorereka, kubhadharwa, uye kukanganiswa kuvhunduka

Phase 1 - Yakabhadharwa kuvhunduka

Compensated shock ichikamu chekuvhunduka umo muviri uchiri kukwanisa kutsiva zvachose kana kuti hama yekurasikirwa kwemvura.

Muchikamu ichi murwere anenge achiri kukwanisa kuchengetedza BP yakakwana pamwe nekupfapfaidza kwehuropi nekuti tsinga dzinonzwira tsitsi dzinowedzera moyo nekufema uye kuvharira ropa kupakati pemuviri kuburikidza ne vasoconstriction yemidziyo yeropa uye microcirculation, iyo precapillary. sphincters inomanikidza uye inoderedza kuyerera kweropa kunzvimbo dzinoenda kunzvimbo dzemuviri dzine kushivirira kwakanyanya kwekudzikira kwemvura, semuenzaniso ganda.

Kuita uku kunowedzera BP pakutanga nokuti pane nzvimbo shoma mukati megadziriro yeropa.

The zviratidzo uye zviratidzo zvekutsiva kuvhunduka dzinosanganisira:

Kusagadzikana, kusagadzikana uye kusagadzikana - zviratidzo zvekutanga zve hypoxia
Pallor uye clammy ganda - izvi zvinoitika nekuda kwe microcirculation
Nausea uye kurutsa - kuderera kwekuyerera kweropa kune GI system
nyota
Kunonoka kuzara kwecapillary
Kuderedza pulse pressure

Chikamu chechipiri - Decompensated shock

Decompensated shock ndizvo zvinotsanangurwa se “chikamu chokupedzisira chokuvhunduka umo nzira dzokutsiva dzomuviri (dzakadai sokuwedzera kurova kwemwoyo, vasoconstriction, kuwedzera kurova kwekufema) hadzikwanisi kuramba dzichiyerera zvakakwana kuuropi nenhengo dzinokosha.”

Zvinoitika kana huwandu hweropa hunoderera neanopfuura 30%.

Nzira dzekuripa dzemurwere dziri kutadza kushanda nesimba uye kubuda kwemoyo kuri kudonha zvichikonzera kudzikira kweropa uye kushanda kwemoyo.

Muviri ucharamba uchivharira ropa kupakati pemuviri, uropi, moyo neitsvo.

Zviratidzo nezviratidzo zvedecompensated shock zviri kuwedzera kuoneka uye kuwedzera kwevasoconstriction kunoguma ne hypoxia kune dzimwe nhengo dzemuviri.

Nekuda kwekuderera kweokisijeni kuuropi murwere anovhiringika uye kuvhiringidzika.

The zviratidzo uye zviratidzo ye decompensated shock inosanganisira:

Kuchinja kwechimiro chepfungwa
Tachycardia
Tachypnea
Kufemereka uye kutadza kufema
Simba rekushaya simba rekushaya peripheral pulses
Kuderera kwekushisa kwemuviri
Cyanosis

Panguva iyo muviri uri kuyedza kuwedzera kuyerera kweropa kusvika pakati pemuviri iyo inonzwira tsitsi sisitimu inorasikirwa nekutonga kweiyo precapillary sphincters inobatsira mune microcirculation yambotaurwa.

Iyo postcapillary sphincters inoramba yakavharwa uye izvi zvinobvumira kubatanidzwa kweropa, izvo zvichafambira mberi kusvika pakuparadzira intravascular coagulation (DIC).

Mumatanho ekutanga nyaya iyi ichiri kugadziriswa nekurapwa kwehasha.

Ropa rava kuungana rinotanga kugwamba, masero ari munzvimbo iyi haasisiri kugamuchira chikafu uye anaerobic metabolism ndiyo inokonzera kugadzirwa kweadenosine triphosphate (ATP).

DIC inotanga panguva iyi uye inoramba ichifambira mberi panguva yekuvhunduka kusingadzoreki.

KUnunura RADIO MUNYIKA? SHANYIRA EMS RADIO BOOTH PAEMERGENCY EXPO

Phase 3 - Irreversible Shock

Kuvhundutsa kusingadzoreki ndiyo danho rekupedzisira rekuvhunduka uye kana murwere achinge apinda muchikamu ichi ndicho chikonzero chekusadzoka nekuti pane kuparara kunokurumidza kwehurongwa hwemoyo uye nzira dzekubhadhara dzemurwere dzakundikana.

Murwere achauya nekudzikira kwakanyanya mukubuda kwemoyo, BP uye kuputika kwematishu.

Mukuedza kwekupedzisira kuponesa moyo weropa rinodzingirwa kure neitsvo, chiropa nemapapu kuchengetedza kupfachukira kwehuropi nemoyo.

mabatiro

Chikamu chakakosha chekurapa kucherechedzwa kwechiitiko uye kushanda nesimba kudzivirira kufambira mberi kwekuvhunduka.

Sezvandambotaura, hypovolemic shock ndiyo inowanzo sangana yekuvhunduka munzvimbo yeprehospital.

Izvi zvine musoro, sezvo chikonzero chinowanzoitika chekufa kwevanhu vane makore 1-44 kukuvara kusingatarisirwi.

Kana murwere ari kubuda ropa kunze, tinoziva kuti tinofanira kupindira nokukurumidza kuitira kuti tigone kuchengetedza ropa rakawanda mumudziyo sezvinobvira.

Kana murwere achiratidza zviratidzo zvekubuda ropa mukati, tinoda kutakura kuenda kune imwe nzvimbo yekutambudzika kune kupindira kwekuvhiya.

High-flow oxygen inoratidzwa, kunyange kana murwere achiri kutaura uye ane pulse oximetry ye94% kana kupfuura.

Tinoziva kuti mumamiriro ezvinhu aya kana pane fungidziro yepasi pe hypoxia iyo okisijeni inogona kupihwa zvisinei nekuti iyo pulse oximetry inoratidza.

Chengetedza murwere wako achidziya, kuderera kwekushisa kwemuviri kunokanganisa kukwanisa kwemuviri kudzora kubuda ropa kwechipiri kune kusakanganiswa kweplatelet kushanda uye kunoguma nekuparara kusina kufanira kwemagwamba anenge aumba.

Uye chekupedzisira, intravenous therapy kuchengetedza mamiriro ekubvumidza hypotension. Izvi zvinoreva kuti systolic blood pressure inofanira kuva pakati pe80- ne90-mmHG.

Isu tinowanzo kusarudzika ku90-mmHg sezvatinodzidziswa kuti ndiyo shanduko kubva mukubhadharwa kuenda kune decompensated shock.

Yakanyorwa na: Richard Main, Med, NRP

Richard Main, Med, NRP, murairidzi weEMS. Akashanda muEMS kubvira 1993 mushure mekuwana EMT yake kubva kuJohnson County Community College. Akagara muKansas, Arizona neNevada. Ndichiri kuArizona, Main akashandira Avra Valley Fire District kwemakore gumi uye akashanda munzvimbo dzakazvimiririra EMS muSouthern Nevada. Parizvino anoshanda sapurofesa we emergency emergency services paCollege of Southern Nevada uye ari murairidzi anotungamira weDistance CME.