Violent penetrating trauma: kupindira mukukuvara kwekupinda

By Cristiano Antonino On Sep 9, 2022

Kushungurudza kunopinda kunoguma nekubatana kwakaoma pakati pemaitiro akasiyana-siyana ekukuvadza. Izvo zvisingatarisirwi chimiro chekukuvara kunoguma kunotungamira kune akawanda akasiyana evarwere mharidzo

Ichi chikamu chinotarisa pane akati wandei zvinhu zvinotamba mumhando dzakasiyana-siyana dzinoonekwa mukukuvara kwekupinda:

Zvinhu zvekukuvara kwakapihwa, hunhu hwezvinhu zvinopinda, kuti izvo zvinoshanda sei kune pfuti / kubayiwa, uye kuongororwa uye manejimendi evarwere vane kukuvara kwechipiri kune chisimba chinopinda.

Kukuvadza kunopinda: Zvinhu zvekukuvadza

Zvinhu zvikuru zvinoumba kukuvara kwehuwandu hunoonekwa nekukuvara kwemukati kupwanya, kutambanudza, uye kukuvara kwecavitating.

Kunyatsobatanidzwa kwezvikamu zvitatu izvi kunotsamira zvakanyanya pachimiro, ukuru, huremu, uye kumhanya kwechinhu chinopinda pamwe chete nerudzi(s) rwetishu chinhu chinoyambuka.

KUPUTSA: Iri ndiro simba rekutanga rinosangana nemuviri: chero chinhu chisati chabaya muviri chinoburitsa simba rinopwanya paganda uye pasi petsandanyama/nhengo.

Iri simba rimwe chete rekupwanya rinoenderera mberi kwechinhu apo chinhu chinopfuura nemuviri.

Izvi zvinotungamirira kune zvinotevera, simba rinotambanudza.

KUTAMBUDZA: Nepo matishu ari padanho rekuita nechinhu achipwanyika, nyama yese yakatenderedza inotambanudzwa. Kungofanana nemasimba anopwanya, masimba anotambanudza anoitika mukati mechinhu chinofamba nenyama.

Nekuda kwehupamhi hwekusvika kwesimba rinotambanudza, rinokonzeresa kukanganisa munzvimbo yakafara yakapoteredza chinhu chaicho chinopinda.

SHANYIRA ZVINZVIMBO ZVASPENCER PAEMERGENCY EXPO

CAVITATION: Cavitation igomba risina chinhu rinosiiwa nechikamu chezvinhu.

Kumhanya kwechinhu chinhu chikuru chinogadzirisa cavitation, sezvo masimba makuru ekutambanudza anokonzerwa ne-high-speed zvinhu anotambanudza nzvimbo huru dzetishu kunze kwekukwanisa kwavo kudzoka nenzira yakarongeka, zvichiita kuti nzvimbo huru dzakaputika uye dzisipo.

Hunhu hweZvinhu Zvinopinza

Hunhu hwakanyanya kukosha hwekufunga nezvechinhu chinopinda maumbirwo, saizi, huremu, velocity, uye mhando yenyama inofambwa nechinhu.

SHAPE/SIZE: Kana ukatariswa pamwe chete zvinhu izvi zvinogadzira "chikamu chemuchinjikwa" chechinhu. Funga izvi se "kupinza" kana "point" yechinhu.

Zvinhu zvakapinza zvakapinza zvinopinza zvakanyanya kudzvanya simba uye kushoma kutambanudza simba, zvichikuvadza matishu munzira yavo yakananga apo ichisiya nzvimbo dzakatenderedza dzisina kukuvadzwa.

Iyo cavitation yekukuvara uku ishoma pane zvakanakisa, zvichipihwa yakaderera kutambanudza simba pane yakapoteredza tishu.

Zvinhu zvakagomara zvine maitiro akapesana ekukuvadzwa, zvichishandisa simba rekupwanya pamusoro penzvimbo hombe apo zvichishandisa masimba makuru ekutambanudza sezvazvinopwanya nepakati nemasimba makuru.

Iyo cavitation yekukuvara uku inowanzokosha nekuda kwehuwandu hwakawanda hwezvinyama zvakakuvadzwa zvakavakomberedza.

Chimiro nehukuru zvakaoma, nokuti chinhu chine hukuru hwakapiwa uye velocity imwe nzvimbo uye saizi inogona kukonzera kukuvara kunouraya, nepo imwe inogona kukonzera zvishoma kudarika mavanga. (baseball inofamba pa45mph kupesana nebanga rinofamba pa45mph).

MASS: chivakwa ichi chakanyatsosungirirwa kune simba rechinhu chinopinda. Huzhinji huzhinji pane imwe spidhi yakapihwa = simba rakawanda. (kureva, mota inofamba pa60 mph vs. Basketball inofamba pa60 mph

Kana zvinhu zviviri zviri kufamba nekumhanya kwakafanana, iyo yakakura kwazvo inova nesimba rakawanda rekupwanya, kutambanudza, kupinda nekuparadza nyama.

High simba zvinhu zvinowanzokonzera zvakanyanya kupwanya, kutambanudza, uye cavitating kukuvara.

VELOCITY: chechipiri chinogadzirisa simba, mushure mehuwandu. (Funga nezve bara rakandirwa kwauri rinopesana nerimwe rapfurwa nepfuti):

High-velocity zvinhu zvinokonzera kuwedzera kunoshamisa kwekupwanya uye kutambanudza simba; cavitation inonyanya kuuraya mu high-velocity trauma sezvakakurukurwa muchikamu chino pasi pemusoro unoti "maronda ekupfurwa."

TISSUE TYPE TRAVERSED: Tissue ine mazinga akasiyana ekuramba kutambanudza uye kupwanya trauma.

Matishu akasununguka akadai semafuta kana mapapu anoshingirira kupwanya / kutambanudza uye anogona kupukunyuka kushungurudzika nekushomeka cavitation kana kukanganisa.

Neimwe nzira, dense tishu senge tsandanyama / chiropa / pfupa inoparadzwa nyore nyore nemasimba akadaro uye inogona kupa neinoyevedza cavitation.

Pfuti uye Maronda Ekubaya

Mafungiro ari pamusoro anoratidzwa zvakakwana mumaronda anokonzerwa nezvimwe zvombo zvakajairika-pfuti nemapanga (kana chero chinhu chinopinza/ chakanongedza kubaya).

GUNSHOT WOUNDS (GSW): Maronda epfuti ndiwo muenzaniso wekare wechinhu chepamusoro-velocity / low-mass chinokonzera kukuvadzwa kukuru uye kutambanudza kukuvara, pasinei nezvinhu zvishoma uye chimiro chakanongedza.

Izvi zvinokonzerwa necavitation yakakura inokonzerwa nepamusoro-velocity chinhu chinosangana nemvura mumuviri.

Iyo inogadzira yakakura yemukati "kuputika" sezvo kinetic simba rebullet rinotamirwa kune yakatenderedza tishu.

Izvi zvinopwanya uye kutambanudza matishu mune yakafara denderedzwa patani yakatenderedza saiti inokonzeresa, zvichigadzira kushungurudzika zvakanyanya kudarika izvo zvingaratidzwa neronda rekupinda.

Kune rekodhi, ese maGSWs kudumbu anoda kuvhiyiwa kuongororwa, nekuda kwemukana wehutumbu huchaputika.

Kana murwere akagadzikana, kunyange GSW kubhokisi inogona kuonekwa isati yaona chido chekuongorora (kubuda ropa, hypotension = kuongorora). Asi aya ndiwo anotariswa mushure mekusvika. KUDAI KUITA CHINHU: TRANSPORT ZVINOSIMBISA!

MAronda ekubaya: Maronda ekubaya muenzaniso wechinhu chakakwirira-chikuru/chishoma-chinokonzera kushungurudzika kukuru.

Maitiro ekukuvadzwa kweronda rekubaya anokonzerwa nechiyero chepakati chesimba chakanangidzirwa pane imwe miniti point, zvichibvumira kusungirirwa kwezvimwe zvinyoro zvekupwanya masimba munzvimbo ine microscopic, kusunda nyore nyore kuburikidza nematishu uye kukuvadza ese maumbirwo aanouya nawo.

Maronda ebanga akakomba zvakanyanya nekuda kwekutadza kwemuviri kurwisa masimba akanyanya pamuromo webanga.

Mazhinji maitiro ekukuvadzwa anochengetedza tsinga / tsinga dzakaomarara, asi kubaya kwekukuvara kunopfuudza zvimiro izvi zviri nyore.

Zvimwe zvisinganzwisisiki, nepo matishu akasimba akasimba senge chiropa, itsvo, uye madziro emuviri anogona kukuvara zvakanyanya kana akarara mugwara remapanga, ura hunoyangarara husina mukana wekukuvadzwa kupfuura nebara, seizvi " mafree-floaters” anowanzoita kusundirwa kana “kumonyoroka” kubva munzira.

KUDAI KUITA CHINHU: TRANSPORT ZVINOSIMBISA!

Iwe haugone kuziva zvichaitika nekukurumidza nekuti haugone kuona zviri kuitika "pasi pegungwa," kureva, pazasi peganda, kunze kwekuzviburitsa zvisina kunanga nezviratidzo zvakakosha.

Kuongorora uye Kutungamira: ABC (DE) s

Sezvinei nemhando dzakawanda dzekushungurudzika kwakanyanya, manejimendi ekupinda mukati anotarisa kune manejimendi e ABC's (nzira yemhepo, kufema, kutenderera) asi zvakare inoenderera kuD uye E (kuremara uye kuratidzwa) nekuda kwekuoma uye kwakasiyana-siyana maitiro ekukuvadzwa kwechipiri kune chisimba chinopinda kukuvara.

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AIRWAY: Kupindira kunorwadza mumusoro uye/kana mutsipa ine njodzi huru yekukanganiswa kwenzira yemhepo nekuda kwekukuvadzwa kwemaitiro uye "zvizhinji zvinokonzeresa," kuwedzera kuunganidzwa kweropa / mvura inomanikidza nzira dzemhepo.

Kuvhura nzira yemhepo kuburikidza neyakagadziriswa jaw-thrust inogona kudikanwa sezvo C-spine trauma inowanzoitika mukukuvara kwepamusoro kunopinda mumusoro nemutsipa.

Kugadziriswa kweshaya yekushaya iyo inoita kuti igadziriswe kumisa in-line kugadzikana kwemusoro nemutsipa kufambisa shaya mberi nekuwedzera kwemusoro.

Nekukuvadzwa kwemudumbu kunopinda, C-spine kugadzikana haina kuratidza kubatsirwa kunze kwekunge kwakajeka kuperevedza kwetsinga (zviratidzo zve Musipinha injury) varipo.

Nguva dzose funga nezvekushandiswa kwema mechanical airways (nasopharyngeal/oropharyngeal, portable suction, uye endotracheal) sezvo simba rako rinobvumira. Kuyeuka kuti nasopharyngeal airways inopesana mukushungurudzika kwechiso.

KUFUMIRA: Pamwe chete nekuedza kwekufema, kufema kunofanira kuongororwa paunenge uchivhura / kuongorora varwere vemhepo: chiyero, kunaka, kudzika, uye kushandiswa kwemasumbu ekushandisa zvinhu zvinokosha zvekufema.

Palpation ye thorax uye auscultation yemapapu inonzwika mumapapu ose uye mumutsipa kwakakosha kuratidza chero kukuvara kwakavanzika kana pneumothorax kune varwere vane kukuvara kunopinda. 100% okisijeni pa12-15 L/min kuburikidza ne-non-rebreather ndiyo yakajairwa kupindira kwekufema mukukuvara kwakanyanya kunopinda.

Positive pressure ventilation kuburikidza neBag-Valve-Mask inogona kudiwa zvichienderana nekukuvara kwemurwere.

CIRCULATION: Kukurumidza kuongorora kwese kwese kwese kwepakati uye kwepakati pulses kunogona kupa fungidziro yakasimba yevarwere' perfusion uye blood pressure apo ichipa rumwe ruzivo nezve pulse rate, kugara, uye kunaka.

Radial pulse kuvapo kunoratidza inenge systolic BP inosvika 80 mmHg.

Kuvapo kwefemoral pulse kunobatanidzwa nesystolic BP ye70 mmHg.

Carotid pulse inobatanidzwa ne systolic BP yeinenge 60 mmHg.

Nemhaka yokuti ndiyo pulse palpable kana peripheral pulses isipo (<70 mmHg), iyo carotid ndiyo nzvimbo yakanakisisa yekutarisa kuputika mumurwere mukuru asingazivi.

Ganda: ganda remurwere rinogonawo kuva chiratidzo chakanaka chekutenderera kweropa: Ganda rinodziya, rakaoma, uye pink rinoratidza kupfava kwakakwana.

Kutonhorera, kucheneruka, madota, uye/kana ganda rakanyorova harina kujairika. Capillary refill time pazasi 2 seconds inopokanawo neperfusion yakakwana.

KUREMERA: Kukurumidza muviri uye mupfungwa tsinga bvunzo yakakwana kuongorora kuvepo kwekuremara kwakakosha.

Panyama, kukurumidza kuongorora kunogona kusanganisira kuedza kubata kwemurwere uye kukwanisa dorsal / plantar kushandura tsoka dzekuongorora kwekupedzisira kwekufamba uye kunzwa.

Kurasikirwa kwekunzwa uye / kana kuoma mitezo ndiyo inonyanya kutyisa inowanikwa inoratidza kukanganisa kwetsinga.

Kuongorora zvakare kwakakosha, sezvo shanduko mune zvakawanikwa nekufamba kwenguva inofanirwa kucherechedzwa.

Hurema hunogona kuitika hunobva mukukuvadzwa kuenda kucentral nervous system (kunyanya musoro) hunofanira kuongororwa uchishandisa AVPU kana zvikero zveGSC.

Chiyero cheAVPU chinoshanda zvakanyanya mumamiriro angangoita mhirizhonga.

Chiyero cheAVPU ndeichi: Murwere Alert uye anotaurirana, anoteerera kune Verbal stimuli chete, anopindura Zvinorwadza zvinokurudzira chete, kana zvachose Kusapindura? The GCS inofanira kushandiswa kunyatsoongorora mukana wekuremara kana nguva ichibvumidza.

EXPOSURE (uye chechipiri kuongorora): Kuratidzwa kwakakwana kwemurwere chero upi zvake ane mhirizhonga inopinda kunokosha. Bvisa murwere kuti aongororwe mativi ese eganda, izvi zvakakosha kuti usapotsa kukuvara kupi kusiri chikamu chemharidzo yekutanga. Kana ukacheka zvipfeko, cheka pamwe chete nemisungo kuitira kuti usaparadza humbowo hwehuchapupu (bullet maburi, nezvimwewo).

Iyo DCAPBLTS ongororo (Deformity, Contusions, Abrasions, Penetrations, Bruising, Tenderness, Lacerations, uye Kuzvimba) idimikira rinowanzo shandiswa panguva yekuongororwa kwechipiri uye chiyeuchidzo izvo munhu angatarisira kuwana mune zvakafanana kukuvara kwekupinda.

CHERECHEDZA: Kuti mune maronda akatsigirwa kubva mukusangana kwechisimba. zvakakosha kuchengetedza humbowo, zvinyorwa zvakakwana zvekukuvadzwa kwese kwakakosha, uye kuchengetedzwa kwekungwarira kwevakabatwa zvipfeko zvinodiwa.

Kana zvichiita cheka nemisono woisa mbatya mubhegi repurasitiki kumapurisa. Usambofa wakarasa chero zvipfeko, zvisiye nevakuru pachiitiko kana kutakura nemurwere kuenda kuER.