Moto, kufema utsi uye kupisa: zvinangwa zvekurapa uye kurapwa
Moto ndicho chikonzero chikuru chekukuvara, kufa uye kukanganisa kwehupfumi. Gore rega rega, pakati pe15 ne25 mamiriyoni emoto anoitika muUnited States, zvichikonzera kukuvara kwe25,000, 5,000 kufa uye $ 7 kusvika $ 9 bhiriyoni mukukuvadza kwehupfumi.
Kukuvadzwa kunokonzerwa nekufema kweutsi kunotungamirira kukuwedzera kunoshamisa kwehuwandu hwekufa kwevarwere vakatsva: mune izvi zviitiko, kukuvara kwekufema kweutsi kunowedzerwa mukupisa kukuvadza, kazhinji nemigumisiro inouraya.
Ichi chinyorwa chakatsaurirwa kurapwa kwekutsva, kunyanya kukuvara kwepulmonary uye systemic muvarwere vakapisa utsi, nepo maronda edermatological achakurukurwa zvakadzama kumwewo.
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Zvinangwa zvekuchengetedza kufema muvarwere vakatsva ndezvekuona
- airway patency,
- kufefetera zvakanaka,
- oxygenation yakakwana,
- kuchengetedza acid-base balance,
- kuchengetedza kwemoyo kugadzikana,
- kurapwa nekukurumidza kwezvirwere.
Mune zvimwe zviitiko, kuita escharotomy kwakakosha kudzivirira chero thoracic scar tishu kubva mukukanganisa kufamba kwechipfuva.
Zvinangwa zvekurapa kwekutsva kweganda zvinosanganisira
- kubviswa kweganda risingaiti
- kushandiswa kwemabhandeji ane medicated ane topical antibiotics,
- kuvharwa kwevanga nezvinotsiva ganda zvenguva pfupi uye kuisirwa ganda kubva munzvimbo dzine hutano kana mafomu akaumbwa kuenda kunzvimbo yakatsva,
- kuderedza kurasikirwa kwemvura uye njodzi yehutachiona.
Nyaya yacho inofanirwa kupihwa yakakwirira kudarika basal caloric quantities kuti ifambise kugadzirisa maronda uye kudzivirira catapolism.
Kurapa varwere vakatsva
Kupisa vanhu vanenge vakuvara zvishoma pamusoro pemhepo, kana kuti vane zviratidzo zvekufema kana kupindira kwemapapu, zvinofanira kunyatsoongororwa.
Oxygen supplementation inofanirwa kupihwa, kuburikidza nenasal cannula, uye murwere anofanirwa kuiswa munzvimbo yepamusoro yeFowler kudzikisa basa rekufema.
Bronchospasm inofanira kurapwa ne-β-agonists muaerosol (yakadai se orciprenaline kana albuterol).
Kana kuvharika kwenzira yemhepo kuchitarisirwa, patency inofanirwa kuvimbiswa ne endotracheal cannula yemhando yakakodzera.
Kazhinji, kutanga kwetracheostomy hakukurudzirwi muvarwere vanopisa, nokuti iyi nzira inosanganiswa nehuwandu hwehutachiona uye kuwedzera kwekufa, kunyange zvazvo zvingave zvakakosha kune nguva refu yekuchengetedza kufema.
Zvakaonekwa kuti kutanga intubation kunogona kukonzera kupera kwepulmonary edema mune vamwe varwere vane kukuvara kwekufema.
Iko kushandiswa kwekuenderera mberi kwakanaka kwe5 kana 10 cm H2O (CPAP) inogona kubatsira kuderedza kutanga kwepulmonary edema, kuchengetedza vhoriyamu yemapapu, kutsigira edemamatous airways, optimize the ventilation/perfusion ratio uye kuderedza kufa kwekutanga.
Kutungamirirwa kwe systemic corticosteroids yekurapa edema hakukurudzirwi nekuda kwekuwedzera kwengozi yehutachiona.
Kurapa kwevarwere vane comatose kunofanira kutungamirirwa kune yakanyanya hypoxia uye CO poisoning uye inobva pakutungamirirwa kweokisijeni.
Kuparadzaniswa uye kubviswa kwecarboxyhaemoglobin kunokwidziridzwa nekutonga kweO2 yekuwedzera.
Vadzidzi vakafemesa utsi, asi vanongowedzera zvishoma muHbco (pasi pe30%) uye vanochengeta zvakajairika cardiopulmonary basa, zvinofanirwa kurapwa ne100% O2 kuburitsa, kuburikidza neyakasunga-yakakodzera, isingadzoke kumeso mask (iyo isingatenderi. mweya uchangobva kubuda kuti ufemerwe zvakare), pamwero wekuyerera we15 litres / miniti, kuchengetedza dhamu rizere.
Oxygen therapy inofanira kuenderera mberi kusvikira mazinga eHbco awira pasi pe10%.
A mask CPAP, ine 100% O2 kutonga, inogona kunge iri kurapa kwakakodzera kune varwere vane kuwedzera hypoxaemia uye kwete kana chete kunyoro kukuvara kwekupisa kumeso uye kumusoro kwemhepo.
Varwere vane refractory hypoxaemia kana kukuvara kwekufema kunobatanidza ne coma kana cardiopulmonary instability inoda intubation uye rubatsiro rwekufema ne 100% O2 uye inofanira kukurumidza kuendeswa kune hyperbaric oxygen therapy.
Kurapa kwekupedzisira kunokurumidza kunatsiridza kutakurwa kweokisijeni uye kunomhanyisa nzira yekubvisa CO kubva muropa.
Varwere vanotanga kutanga pulmonary edema, ARDS, kana mabayo anowanzoda rubatsiro rwekufema neine positive end-expiratory pressure (PEEP) pamberi pehemogasanalysis inoratidza kutadza kufema (PaO2 iri pasi pe60 mmHg, uye/kana PaCO2 pamusoro pe50 mmHg, ine pH iri pasi pe7.25).
PEEP inoratidzwa kana PaO2 inowira pasi pe60 mmHg uye FiO2 inoda inodarika 0.60
Rubatsiro rwekufefetera runofanira kugara rwakareba, nekuti vanopiswa vanowanzove nekukasira metabolism, izvo zvinoita kuti zvive zvakakosha kuwedzera vhoriyamu yekufema paminiti kuti ive nechokwadi chekuti homeostasis inochengetwa.
The midziyo inoshandiswa inofanira kunge ichikwanisa kuendesa yakakwira vhoriyamu/miniti (kusvika ku50 litres) uchichengeta yakakwira peak airway pressure (kusvika 100 cm H2O) uye yakagadzikana yekufemerwa/kufema (I:E) reshiyo, kunyangwe pazvinenge zvakakodzera kuwedzera. pressure values.
Refractory hypoxaemia inogona kupindura kumhepo-inotsamira kufefetedza ine inverted ratio
Utsanana hwakakwana hwemapapu hunodiwa kuchengetedza nzira dzemhepo dzisina sputum.
Passive kufema physiotherapy inobatsira kuunganidza zvakavanzika uye kudzivirira kuvharika kwemhepo uye atelectasis.
Recent ganda grafts haibvumiri percussion uye vibration kuchipfuva.
Therapeutic fibrobronchoscopy ingave yakakosha kuvhura nzira yemhepo kubva kune yakakora yakavanzika.
Kunyatsochengetedza chiyero chemvura kunodiwa kuti uderedze njodzi yekuvhunduka, kutadza kwerenal uye pulmonary edema.
Kudzoreredza chiyero chemvura yemurwere, uchishandisa nzira yeParkland (4 ml isotonic solution pakg pachikamu chimwe nechimwe chenzvimbo yakatsva yeganda, kwemaawa makumi maviri nemana) uye kuchengetedza diuresis iri pakati pe24 ne30 ml/awa uye pakati pepakati venous pressure pakati pe50 ne2. mmHg, inochengetedza kugadzikana kwehemodynamic.
Mune varwere vane kukuvara kwekufema, capillary permeability inowedzera, uye kutarisa pulmonary arterial pressure igwara rinobatsira rekuzadzazve mvura, mukuwedzera kune diuresis control.
Vanopisa moto, electrolyte uye acid-base balance inofanirwa kuongororwa
Iyo hypermetabolic mamiriro emurwere anopisa anoda kunyatsoongororwa kwehutano hwekudya, hune chinangwa chekudzivirira catabolism yemhasuru tishu.
Mafungiro ekufungidzira (akadai seaHarris-Benedict uye Curreri) akashandiswa kufungidzira kusimba kwemasabolism muvarwere ava.
Parizvino, ma analyzer anotakurika anowanikwa mune zvekutengesa anobvumira zvakakomba zvisina kunanga calorimetry zviyero, izvo zvakaratidzwa kuti zvinopa zvakanyanya fungidziro yezvinodiwa zvekudya.
Varwere vane kupisa kwakanyanya (kupfuura 50% yeganda repamusoro) vanowanzotarirwa kudya kune caloric kudya i150% yekuzorora kwesimba ravo rekuzorora kuitira kuti maronda apore uye kudzivirira catabolism.
Sezvo kupisa kunopora, kudya kunovaka muviri kunodzikiswa zvishoma nezvishoma kusvika 130% yebasal metabolism.
Muchiitiko chekutsva kwechitenderedzwa chechipfuva, ganda remavanga rinogona kudzora kufamba kwemadziro echipfuva.
Iyo escharotomy (kuvhiya kubviswa kweganda rakatsva) inoitwa nekuita maviri lateral incision pamwe neanterior axillary line, kutanga masendimita maviri pazasi pe clavicle kusvika kune yepfumbamwe kusvika kune yegumi intercostal space, uye mamwe maviri akachinjika incision akatambanudzwa pakati pemigumo yekare, kuitira kuganhura mativi mana.
Kuvhiya uku kunofanirwa kuvandudza elasticity yemadziro echipfuva uye kudzivirira kudzvanya kwemaitiro ekudzoreredza mavanga.
Kurapa kwekutsva kunosanganisira kubviswa kweganda risingashande, kuiswa kwemabhandeji ane mishonga inorwisa mabhakitiriya, kuvharwa kweronda nezvinotsiva ganda renguva pfupi uye kuisirwa ganda kubva munzvimbo dzine hutano kana kuti dzakaumbwa dzakagadzirwa panzvimbo yakatsva.
Izvi zvinoderedza kurasikirwa kwemvura uye njodzi yehutachiona.
Utachiona hunowanzokonzerwa necoagulase-positive Staphylococcus aureus uye gram-negative mabhakitiriya akadai seKlebsiella, Enterobacter, Escherichia coli uye Pseudomonas.
Nzira yakakodzera yekuzviparadzanisa nevamwe, kudzvanya kwezvakatipoteredza uye kusefa kwemhepo ndiwo makona ekudzivirira kubva kuhutachiona.
Sarudzo yemishonga inorwisa mabhakitiriya inobva pamigumisiro yetsika dzakatevedzana dzakaitwa pane zvinhu zvakatorwa kubva paronda, pamwe chete neropa, weti uye sputum samples.
Mishonga inorwisa mabhakitiriya haifanirwe kupihwa prophylactically muvarwere ava, nekuda kwekureruka uko kusingachinjiki kusarudzwa, kukonzeresa kutapukira kunopesana nekurapa.
Muvanhu vasina kusimba kwenguva yakareba, heparin prophylaxis inogona kubatsira kuderedza njodzi yepulmonary embolism, uye kutarisisa kunofanirwa kubhadharwa kudzivirira kukura kwe pressure maronda.
Verenga zvakare
Moto, Kufema Utsi uye Kupisa: Zviratidzo, Zviratidzo, Mutemo Wezvipfumbamwe
Kuverenga Nzvimbo Yepamusoro Yekutsva: Mutemo we9 Muvacheche, Vana uye Vakuru.
First Aid, Kuziva Kusvirwa Kwakanyanya
Kemikari Kupisa: Kutanga Rubatsiro Kurapa Uye Kudzivirira Mazano
Kupisa Kwemagetsi: First Aid Treatment And Prevention Tips
6 Chokwadi Nezvekutsva Kwekutsva Iyo Vanamukoti Vanoshungurudza Vanofanira Kuziva
Kukuvara Kwekuputika: Maitiro Ekupindira Pakushungurudzika Kwemurwere
Chii Chinofanira Kuve MuChidiki Chekutanga Chekubatsira Kit
Kutsiviwa, Kuderedzwa uye Kusingadzoreki Kuvhunduka: Zvavari Uye Zvavanosarudza
Kusvirwa, First Aid: Kupindira Sei, Zvekuita
First Aid, Kurapwa Kwekusvirwa Nemakwasha
Zvirwere Zvemaronda: Chii Chinovakonzeresa, Ndezvipi Zvirwere Zvavanobatanidzwa Nazvo
Ngatikurukurei Nezve Kufefetedza: Ndeupi Musiyano Pakati peNIV, CPAP neBIBAP?
Basic Airway Assessment: An Overview
Kufema Kushungurudzika Emergency: Patient Management uye Kudzikamisa
Respiratory Distress Syndrome (ARDS): Kurapa, Mechanical Ventilation, Monitoring
Neonatal Respiratory Distress: Zvinhu Zvokufunga nezvazvo
Zviratidzo Zvekufema Kunetseka Muvana: Nheyo dzeVabereki, Nannies uye Vadzidzisi
Matatu Emazuva ese Maitiro Kuchengeta Varwere Vako Ventilator Vakachengeteka
Mabhenefiti uye Njodzi dzePrehospital Drug Assisted Airway Management (DAAM)
Kliniki Ongororo: Acute Respiratory Distress Syndrome
Kushushikana uye Kushushikana Panguva Yepamuviri: Maitiro Ekudzivirira Vese Amai NeMwana
Kushungurudzika Kwekufema: Ndezvipi Zviratidzo Zvekufema Kunetseka Muvana Vachangozvarwa?
Acute Respiratory Distress Syndrome (ARDS): Mirayiridzo Yekutarisira Murwere uye Kurapwa
Pathological Anatomy Uye Pathophysiology: Neurological uye Pulmonary Kukuvadza Kubva Kunyura