Kunyura' kana kuti 'drowning syndrome' mumushonga zvinoreva chimiro cheacute asphyxia kubva kune chekunze mechanical chikonzero chinokonzerwa nekugarwa kwepulmonary alveolar space nemvura kana imwe mvura inounzwa kuburikidza nepamusoro pemhepo, iyo inonyudzwa zvachose mumvura yakadaro.

Kana asphyxia ikarebeswa kwenguva yakareba, kazhinji maminetsi akati wandei, 'rufu nekunyura' runoitika, kureva kufa nekuda kwekudzipwa nekunyudzwa, kunowanzobatanidzwa neacute hypoxia uye kutadza kusimba kwe ventricle yakarurama yemoyo.

Mune zvimwe zviitiko zvisingaurayiwi, kunyura kunogona kurapwa zvinobudirira nemaitiro ekumutsidzira chaiwo

ZVINOKOSHA: Kana mudikani akambonyura uye usingazive zvekuita, tanga wabata rubatsiro rwechimbichimbi nekukasira nekufonera Single Emergency Number.

Kutanga kurapwa kwevanonyura

Emergency maneuvers inofanirwa kuitwa uye rubatsiro runofanira kuvhurwa nekukasira nekufonera Emergency Number.

Zvichakadaro, muponesi anofanira kunyatsojekesa nzira yemhepo yenyaya yacho uye, kana pasina kuita zvekufema zvega, anotanga kufemeruka pamuromo kusvika murwere awanazve kufema akazvimirira.

Kutsvaga kurova kwemoyo kunofanirwa kuitwa mushure mekunge murwere adzoserwa kumahombekombe kana kusimudzwa pane chinoyangarara chakakura zvakakwana kuti chigare vese vakabatwa nemuponesi.

Chest compression maneuvers anoitwa mumvura haashande zvakakwana kudzoreredza kuyerera.

Kana tsaona yakaitika mumvura inotonhora, zvinokurudzirwa kushandisa mamwe masekonzi mashoma uchitsvaga peripheral pulsations, kuitira kuti udzivise kuvepo kwechiratidzo bradycardia kana kunyanya kushaya simba kwemoyo.

Kukurumidza kuitwa cardiac massage inogona kukonzera ventricular fibrillation uye, kutaura zvazviri, kuwedzera kuwedzera kwecerebral perfusion.

Iyo Heimlich maneuver haifanirwe kuitwa kunze kwekunge kuvharika kwemhepo kunokonzerwa nechimwe chinhu kuripo: vanonyura vanogona kumedza mvura yakawandisa uye iyo HeimIich maneuver inogona kuita kuti vadaro. kurutsa, nechishuvo chinozotevera, chinogona kuwedzera mamiriro acho ezvinhu.

Musoro uye mutsipa haifanirwe kuunganidzwa, kunyanya kana munhu akanyura mushure mekunyura mumvura isina kudzika.

Kana kukuvara kune spinal column zvinofungidzirwa, zvinodikanwa kumisa murwere usati watakurwa kuti udzivise kumwe kukuvadzwa, mune zvimwe zviitiko zvisingachinjiki uye zvinoremadza, senge izvo zvinotungamira mukuoma mitezo.

Nokukurumidza sezvinobvira, murwere anofanira kuendeswa kuchipatara.

Kurapwa muchipatara kwevanhu vanenge vanyura

Vashandi vechipatara vanofanira kugadzirira zvinodiwa midziyo ye intubation (laryngoscope, scalpels akasiyana-siyana, cannulas emhando dzakasiyana-siyana, flexible specils, Magill forceps, majekiseni ekutarisa patency yemaoko uye kuisa mukati mawo, aspirator, plaster kugadzirisa endotracheal cannula, mhepo yakakodzera ye "balloon-valve-" mask').

Iyo arterial haemogasanalysis kit uye zvipfeko zvakakodzera zvinofanirwa kuve zviripo kuti ive nechokwadi chekuchengetedza hutsanana hunodiwa.

Kurapa kwevanonyura kunobva pakukurumidza kwekutanga kuongororwa kwekliniki uye kunotevera kurongwa kwekuoma kwehutano hwemurwere.

Kunyura, chirongwa chinotevera chinoreva post-kunyura neurological classification yeModel naConn:

A) Chikamu A. Mukai

• Muka, anoziva uye akananga murwere

B) Chikamu B. Dulling

• Kupera simba kwekuziva, murwere ane lethargic asi anogona kumutswa, mhinduro ine chinangwa kune zvinorwadza zvinokurudzira.
• Murwere haakwanisi kumutswa, achipindura zvisina kujairika kune zvinorwadza zvinokurudzira

C) Chikamu C. Comatose

• C1 Decerebrate-mhando kuchinjika kune zvinorwadza zvinokurudzira
• C2 Decerebrate-mhando yekuwedzera kune zvinorwadza zvinokurudzira
• C3 Flaccid kana kusipo mhinduro kune zvinorwadza zvinokurudzira

Kunyura, ngatitarisei zvino pamapoka akasiyana ega

Chikamu A (Mukai)

Varwere ava vari mukuyeverwa uye vane a Glasgow Coma Scale (GCS) ye14, inoratidza kushomeka kwekukuvara kwe hypoxic.

Kunyange zvazvo vanhu vari muchikwata ichi vane hutano hwakanaka, vanofanira kuramba vari muchipatara uye vachiiswa pasi pekutarisa kwemaawa 12-24 kuti vabvumire kupindira kwepakutanga kana pakaitika kuparara kwepulmonary kana neurological function, kuparara kunofanira kugara kuchitarisirwa kunyange mukati. nyaya yenyaya ine hutano hwakakwana.

Iwo mabvunzo anofanira kusanganisira:

• huwandu hweropa,
• kutsunga kweserum electrolytes uye glucose yeropa,
• X-ray yechipfuva,
• kuongororwa kwe arterial gasi reropa,
• bvunzo dze sputum tsika,
• kusarudza nguva ye coagulation.

Drug-toxicological screening inogonawo kudiwa.

Muchiitiko chekufungidzirwa kwekukuvara kwemutsipa, X-ray uye / kana CT scan yemuzongoza inofanira kuitwa.

Panyaya yekukuvara kwemusoro kana kuputsika, kufungidzira kunofanira pachena zvakare kuongorora dehenya uye kuputsika.

Kurapa kwevarwere vanowira muchikamu ichi kunonyanya kuratidza zviratidzo.

Okisijeni inogona kupihwa, kuburikidza necannula kana mask, kuitira kuchengetedza PaO2 pamusoro pe60 mmHg.

Spirometry inogona kubatsira.

Kushuvira kunokwanisika kwemitumbi yekunze kunogona kusimbiswa nechipfuva X-ray kana endoscopy.

Bronchospasm inogona kurapwa ne β2-adrenergic mishonga neaerosol.

Pakupedzisira, zvakakosha kuve nechokwadi chekuwana venous, iyo inobvumira chiyero chehydro-electrolyte kuti chidzorwe uye kupindira nokukurumidza kana chiitiko chekuora kwehutano hwehutano.

Kuipa kwehutano hwetsinga kunogona kutsamira pazvinhu zvakawanda, senge:

• hypoxemia, yechipiri kune kuora kwekushanda kwepulmonary;
• kuwedzera intracranial pressure (ICP), yechipiri kune hypoxia;
• mushonga kana kutora zvinodhaka pamberi penjodzi;
• yapfuura metabolic, kufema, coagulative uye/kana cardiological zvirwere.

Kana chirwere chechipatara chikaramba chakagadzikana uye pasina kuwedzera kwehutano hwepfungwa kana pulmonary mukati meawa 12-24, murwere anogona kazhinji kusunungurwa, kunze kwezviitiko zvisingawanzoitiki.

Kuongororwa kwechiremba mukati memazuva 2-3 kunokurudzirwa zvakasimba.

Chikamu B (Kukotsira)

Varwere ava vari muhurombo, kana semi-consciousness, asi vanogona kumutswa.

Chibodzwa cheGCS chinowanzova pakati pegumi negumi nenhatu, zvichiratidza chiitiko chakanyanya uye chakareba cheasphyxia.

Vanopindura kune zvinorwadza zvinokurudzira nekufamba zvine chinangwa, kuita kwekufema uye pupillary reflexes zvakajairika.

Vanogona kunge vakashatirwa uye vane hasha.

Mushure mekusimudzira uye kuongororwa kwekutanga mudhipatimendi rekukurumidzira, varwere ava vanofanira kubvumirwa kune imwe nzvimbo yekuchengetedza zvakanyanya (ICU), vachinyatsocherechedza kuonekwa kwekuchinja kupi zvako muurological, pulmonary uye / kana cardiovascular function.

Kugara kwavo muchipatara kunowanzoreba kupfuura kwevarwere vechikamu A.

Yese miedzo yekuongorora inofanirwa kuitwa uye marapirwo ese anokurukurwa pamusoro apa muchikamu chechikamu A varwere.

Tsika yezuva nezuva yeropa, sputum uye, kana zvichibvira, weti samples inofanira kuitwa.

Kutungamirirwa kwevhitamini K kunogona kuvandudza nguva yekuvhara.

Kurapa kweAntibiotic kunofanirwa kupihwa chete pamberi peiyo yakanaka tsika bvunzo dzepathogenic bacterial flora.

Mamiriro ehutano hwemurwere anogonawo kuchinja nokukurumidza, uye tsika yenguva dzose yevarwere vane kukuvara kwemusoro inofanira kuonekwa.

Kuonekwa kwepulmonary edema kana intractable metabolic acidosis, uye kudiwa kwekuwedzera nguva yekudzorerazve (kunze kwevarwere vakabviswa mumvura inotonhora zvikuru) zvinowanzoratidza hypoxia yakaoma.

Hypoxemia inogona kuramba ichiwedzera kuwedzera kweokisijeni mumhepo yakafuridzirwa.

Kuti uchengetedze PaO2 pamusoro pe60 mmHg, kuenderera mberi kwakanaka kudzvinyirira ventilation (CPAP) uchishandisa mask kana michina yemagetsi inogona kudiwa.

Dzimwe nguva zvakakosha kuderedza kunwa kwemvura, asi iyo plasma osmolality haifanire kudarika 320 mOsm/litre.

Chikamu C (Coma)

Mamiriro etsinga evarwere ava vakanyanya kuoma ndezvekuti havagone kumutswa.

Mucherechedzo weGCS uri pasi pe7.

Kurapa kunofanirwa kunangana nekuchengetedza yakajairika oxygenation, kufefetedza, perfusion, blood pressure, glycemia uye serum electrolytes.

Zvidzidzo zvidiki zvemhuka nezve cerebral resuscitation zvakasimudza tariro nyowani yekupora kwevarwere vane comatose vakatambura nekutukwa kwakanyanya anoxic.

Chinangwa checerebral resuscitation maneuvers ndechekudzivirira kuwedzera kweICP uye kuchengetedza yakakosha asi isiri-inoshanda neurons.

Kurapa kunogona kusanganisira hypothermia, hyperventilation, calcium channel blockers, barbiturates, kuzorora kwetsandanyama kana kuoma mitezo, etomidate, fluorocarbon infusion.

Nehurombo, mhedzisiro yecerebral resuscitation maneuvers ine patchy, uye zvichiri kupokana kuti ndeipi kurapa inofarirwa.

Dambudziko rehutsika rakakomba rine chekuita nekusahadzika kuti cerebral resuscitation haina kuvandudza hupenyu hwevarwere, asi inongononoka kufa kwavo nekuwedzera huwandu hwevanhu vari kuramba vachidyara.

Ndima dzinotevera dzinobva pane zvakakurudzirwa naConn pamusoro pekumutsiridza uropi.

Muchirevo chechinyorwa chino chivakashure chekuti 'HYPER' chinoshandiswa zvisina tsarukano, sezvo varwere vane kukuvara kwakanyanya muuropi vanowanzo.

• hyperhydrated,
• hyperpyretic,
• hyperexcitable,
• hyperrigid,
• hyperventilated.

Hyperhydration 

Hyperhydration inogona kukonzera kuwedzera kweICP uye kutanga kwepulmonary edema.

Mukuedza kudzivirira izvi, ma diuretics anowanzo kupihwa.

Hemodynamic monitoring inoitwa kudzivirira kuwandisa kwemvura, izvo zvinogona kukonzera kutadza kwetsvo.

Zviduku zviduku zve dopamine (zvisingasviki 5 μg/kg/min) zvinokurudzira renal dopamine receptors, kuwedzera kuperesa kwerenal uye zvinogona kuita kuti weti iitwe.

Diuresis, zvisinei, haifaniri kumanikidzwa kusvikira serum osmolarity inopfuura 320 mOsm/litre.

Kuita invasive haemodynamic monitoring kunoda kuiswa kwepulmonary artery catheter, iyo inobvumira central venous pressure, pulmonary artery pressure uye pulmonary wedge pressure inyorwe.

Kana iyo arterial pressure isina kugadzikana, kana kana akawanda maABG akaitwa, kuiswa kwe arterial catheter kungave kuri madikanwa.

Muma1980, ICP yaiitwa zvakanyanya kuitira kudzivirira kana kudzora kutanga kweiyo intracranial hypertension.

Parizvino, nzira iyi inonyanya kushandiswa kune varwere vanowira muzvikamu A uye B uye vanoratidza zviratidzo zvekuora kwepfungwa uye neurological.

Zvinotarisirwa kuti hyperventilation uye kushandiswa kweosmotic diuretics uye thiopental zvinogona kudzorera cerebral edema yechipiri kune ischaemia.

Nehurombo, kunyangwe kutonga kunoshanda kweICP hakuvimbisi kupona pasina sequelae.

Hyperventilation

Varwere vanoda mechanical ventilation vanofanira kunge vari hyperventilated, kuchengetedza paC02 pakati pe25 ne30 mmHg.

Cerebral vascular resistance inodzorwa nearteriolar tone, iyo inogadziriswa nekuchinja kwepH.

Sezvo pH inopesvedzerwa nePaCO2 kukosha, hyperventilation induces vasoconstriction uye inoderedza ICP maitiro.

Huwandu hwemvura hunogona kusetwa kubva pagumi kusvika pagumi nemashanu ml/kg, pamwero wekufema unodiwa kuti uderedze kuderedzwa kwePaCO10.

Tissue oxygenation chinangwa chakakosha mukurapa kwevarwere vane hurema hwakanyanya hwemapapu.

Zvingava zvakanaka, asi zvisingaiti nguva dzose, kuchengetedza arterial oxygen saturation (SaO2) inenge 96% (PaO2 ye100 mmHg).

Kushandiswa kwemaitiro akanaka ekupedzisira-expiratory pressure (PEEP) inzira inobatsira yekuvimbisa kukwana oxygenation (PaO2 pamusoro pe60 mmHg).

Muvanhu vakuru nevana vakwegura, maitiro ePEEP anofanirwa kuwedzerwa ne 5 cm H2O panguva imwe chete kusvikira okisijeni yakakwana yawanikwa.

Muvarwere vaduku, kuwedzera kunotevera kunofanira kuva kuduku.

Hyperpyrexia

Iko induction ye hypothermia (tembiricha yemuviri ye30± 1 ° C kana yakaderera) yakarongedzerwa kune vakakuvara uropi uye varwere vane comatose nekuti inogona kuderedza metabolic zvinodiwa zvehuropi uye ICP.

Hypothermia, inokonzeresa pamberi pecerebral ischaemia, inozivikanwa kuita inodzivirira pahuropi.

Pasinei neizvi, nzira iyi haina kuvandudza mamiriro eurological yevarwere vakange vatoita cerebral hypoxia uye vanogona, pane kudaro, kukonzera matambudziko, akadai sekudzvinyirirwa kwemaitiro ekudzivirira ekudzivirira muviri, kushanduka kwekuruboshwe mune hemoglobin dissociation curve, uye cardiac arrhythmias. .

Kana kutonhora kwemuviri kwakakwirira, normothermia inofanira kudzorerwa, nekutonga kwe antipyretics uye kushandiswa kwemattresses anotonhorera, sezvo fivha inokonzera kuwedzera kwekushandiswa kweokisijeni.

Hyper-excitability

Barbiturates inotendwa inoderedza ICP nekuita vasoconstriction, kudzvanyirira kugwinha kuita, uye kunonotsa cerebral metabolism.

Thiopental ingangove ndiyo yega barbiturate inokwanisa kubvisa oxygen isina radicals.

The induction of a pharmacological coma ne barbiturates haina kuratidzwa kuvandudza kupona kana kushanduka kwehutano hwepfungwa mukunyura vakakuvadzwa nehuropi hwakanyanya uye zvinogona, pane zvinopesana, kusimbisa kusagadzikana kwemoyo.

Nokuda kwezvikonzero izvi, kutungamirirwa kwebarbiturates haisisiri chikamu chekurapa kunokurudzirwa; pachinzvimbo, mishonga iyi inoshandiswa kudzora convulsive pfari.

Kutungamirirwa kwesteroids kwave kurongwa, mumamiriro ezvinhu ekukundikana kunyura, mune tariro yekuderedza ICP, asi zvidzidzo zvakatevera zvakaratidza kuti hazvina maturo.

Mukuwedzera, mishonga iyi inogona kukanganisa maitiro ekudzivirira zvirwere kune zvirwere zvebhakitiriya, zvichiita kuti pave nehuwandu hwehutachiona hwehutachiona.

Hyperrigidity

Decerebrate uye decorticated postural rigidity chiratidzo che intracranial hypertension.

Kuwedzera ICP inogona kunge iri yechipiri kune cerebral edema kubva ku hypoxia, mechanical ventilation uye PEEP, kukosora, Trendelemburg chinzvimbo.

Aspiration maneuvers inogona kukonzera kuwedzera kweICP kusvika kumaminetsi makumi matatu.

ICP inogona kuderedzwa muvarwere vanoda mechanical ventilation nekutonga kwe sedatives uye paralyzing agents.

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Source:

Medicina Online