Kutaura varwere avo vanoda kuve intubated, tinogona kufunga zvakasiyana zvinhu zvinokurudzira vanachiremba uye vanamukoti kuti vape mamwe maitiro panzvimbo pevamwe. Ko cricoid kudzvinyirira mu ER nekukurumidza kutevedzera intubation inonyatsoita here?

Imwe yeiyi ndiyo cricoid pressure application, iyo inonziwo Sellick maneuver; muitiro unofanirwa kudzivisa kudzoka kwezvokudya zvemuviri mukati me pharynx uye zvinotevera zvinopinda mumuti wemapurmonary. Izvozvo zvinofanira, zvechokwadi. Mumakore ekupedzisira, tsika iyi yakave yakabvunzwa zvikuru.

Vazhinji vakadzidza vakaratidzira kuti kumanikidza kunogona kunonoka kana kukanganisa chikoreo cheti mudziyo mumhepo. Nezve nyaya iyi. Ntombifuthi Jennet Ngiba, mumwe mukoti wechiremba ari kushanda paGreytown Hospital, kuKwazulu-Natal, province yeSouth Africa, akanyora a tsanangudzo yesayenzi rakabudiswa musi DENOSA (Democratic Nursing Organization of South Africa).

VERENGA ZVAKO:

“Pane shanduko iri kuramba ichiitika mukati mevanamukoti vetsitsi nekuda kwekuwedzera kwekutsvaga munzvimbo iyi. Miitiro yakagara ichigamuchirwa seyakajairwa, asi zvichizotevera pakuongorora zvakare kwakaratidza kuti hakubatsiri uye kune njodzi kune murwere (Moore & Lexington, 2012). Kutsvagisa kwakapinza mumubvunzo maitiro kana maitiro senge iko kuiswa kwecricoid kumanikidza panguva yekukurumidza kuteedzana tracheal intubation. Iyi tsika yakange yakakwenenzverwa pakudzivirira kudzokororwa kweiyo gastric zvemukati mune iyo pharynx uye inotevera tarisiro mukati memapurmoni muti, asi ikozvino wabvunzwa.

Cricoid kudzvinyirira: iyo Sellick maitiro

Cricoid pressure yakatsanangurwa muchidimbu Sellick in 1961 senzira inoshandiswa kuti kuderedze njodzi yekutsvaga panguva yekugadzirisa chikamu cheaneshesia. Sellick`s maitiro aive ekushandisa kumashure kumanikidza kune cricoid shwashwa, kumanikidza esophagus kupokana nepasi pe vertebral muviri (Ellis, Harris & Zideman 2007; Priebe 2005). Mukushandisa uku kwe kudzvinyirira oesophageal lumen is occluded, kudzivirira kutenderera kwe regurgitated gastric content in the pharynx uye zvinotevera zvinopinda mumuti wemapurmonary (Stewart et al, 2014).

Iyo inosanganisirwa iyo yakazara nzira yekudzikisa mikana yekuda kuburikidza nekukurumidza kutevedzana kuiswa kweanesthesia (Ellis et al., 2007; Priebe 2005). Kwemakore nekukurumidza kutevedzana kupindira kwakagadziriswa nachiremba ekukurumidzira kuti vabvumidze kupenya kwemhepo sekudikanwa kwekudzivirira hypoxia uye yakazonzi "nekukurumidza kutevedzana tracheal intubation". Rapid sequence tracheal intubation (RSTI) ikozvino ndiyo nzira inonyanya kushandiswa yeiyo tracheal intubation mudhipatimendi rechimbichimbi (ED) uye cricoid kudzvinyirira kunodzidziswa sechinhu chakajairwa che emergency emergencywayway management (Ellis et al., 2007).

Pasinei kushaya sarudzo kuongorora sengozi uye kubatsirwa kwecricoid pressure inogamuchirwa sechinhu chakakosha chekukurumidza kutevedzana intubation muEDs. Hapana miyedzo inodzorwa yakaratidza chero bhenefiti yekushandiswa kwayo panguva yekukurumidza kutevedzana intubation (Trethewy, Burrows, Clausen & Doherty, 2012). Uyezve, kushandiswa kwecricoid pressure inogona kubatanidzwa nekuwedzera kwengozi kune murwere zvakadai sekudzivirira kufambisa kwemhepo, kuwedzera nguva yekudzivirira nekuvanza kuona kwelaryngeal, kukonzera kusvotwa/kurutsa uye kuputika kweophageal nesimba rakawandisa (Ellis et al., 2007; Priebe 2005; Trethewy, et al, 2012).

Zvinoshamisa kuti inogona kusimudzira kusimudzira nekuzorodza chikamu chepazasi chesophagus (Ellis et al., 2007). Dzimwe nyaya dzinotaura kuti tracheal intubation yakakanganiswa necricoid kudzvinyirira uye kubiridzira yakaitika kunyangwe ichishandiswa, pamwe nekuda kwekushandisa kwayo zvisiri izvo (Trechasy, et al, 2012). Maererano naBhatia, Bhagat uye Sen (2014) kushandiswa kweiyo cricoid kudzvinyirira kunowedzera huwandu hwekubva kwekudzingwa kweesophagus kubva ku53% kusvika pa91%.

ER miedzo

Nekudaro zvisinei neuchapupu uhu uye nemhedzisiro yeTrewwy's (2012) RCT maitiro ekutonga anoita sekutungamirwa mukutonga kwayo nemaitiro akare. Mutongi kuUK akatongesa anaesthesiologist nekutadza kushandisa cricoid kudzvinyirira kumurwere ane irreucible hernia uyo akanyoresa uye achida. Mutongi akataura kuti "Hatigone kutaura kuti kudzvanyirira hakuna kushanda kudzamara miedzo yaitwa, kunyanya sezvo ichi chikamu chehunyanzvi hwekugadzira huturu hwakabatana nehuremu hwevacheche kubva pakufenda kubva kuma1960" (Bhatia et al . Naizvozvo mumwe angati kunyangwe cricoid kudzvinyirira ichipinda muchipatara maitiro pane mashoma humbowo uye inotsigirwa neyakajairwa, neimwe nzira inoramba iri tsika yekusarudza (Bhatia et al., 2014).

Nokudaro ndeye nguva vanachiremba uye vanachiremba vanogamuchira uchapupu-based practice mukati mebazi rekukurumidzira uye kurega kuenda kune tsika dzetsika dzinoratidzwa kuti dzinokuvadza kupfuura kunaka. Icho chichiri chido chakakura chekuwedzera humwe uchapupu-based practice mukati mebazi rekukurumidzira, kuti uongorore kubvumirana kwechirevo chokuti cricoid pressure inodzivisa kudzokerazve. "

References

Bhatia N, Bhagat H & Sen I. (2014). Kumanikidzwa kweCricoid: Timire papi? J Anaesthesiol Clin Pharmacol, Vol 30 mapeji 3 - 6.

Ellis DY, Harris T & Zideman D. (2007). Kumanikidzwa kweCricoid mubazi rekukurumidzira kuteedzana kwekuteedzera tracheal intubations. American College yevanokurumidzira varapi Vol. 50, mapeji 653 - 665.

Moore K & Lexington KY (2012). Uchapupu-hwakavakirwa tsika nhungamiro yekutambudzika kwekutambudzika. Zvinyorwa zveukoti hwekukurumidzira. Vol 38, mapeji 401-402.

Priebe HJ, (2005). Cricoid pressure: mamwe maonero. Elsevier. Jerimani.

Stewart JC, Bhananker S, & Ramaiah R. (2014). Kukurumidza-kuteedzana intubation uye cricoid kumanikidza. J Crit Illn Inj Sci, Vol 4, mapeji 42 - 49.

Trethewy CE, Burrows JM, Clausen D & Doherty SR (2012). Kubudirira kwecricoid kumanikidza mukudzivirira gastric aspiration panguva yekukurumidza kuteedzana intubation mubazi rekukurumidzira: kudzidza protocol yemaitiro akasarudzika anotongwa. BioMedCentral. Ositireriya. Yakadzorerwa 04 Nyamavhuvhu 2016: http://www.trialsjournal.com/content/13/1/17

 

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