Emergency Live | 10 Steps to perform a Correct Spinal Immobilization of a Trauma Patient image 4 — Emergency drill/ Ketso ya maemo a tshohanyetso: tshebediso ya sethiba hlooho le molala wa popelo

Ho senyeha ha mokokotlo oa mokokotlo ho sebelisa boto ea mokokotlo: sepheo, matšoao le meeli ea tšebeliso

By Cristiano Antonino On E se eka 29, 2022

Moea oa Ambulense ambulense tlaleho ea nyeoe EMS Lefatšeng pele ho arabela Tlhahlobo pholosa sekwahelo koetliso ea tšitiso

Thibelo ea ho sisinyeha ha mokokotlo ho sebelisa letlapa le lelelele la mokokotlo le mokokotlo oa mokokotlo o kenngoa ts'ebetsong maemong a ts'oaetso, ha mekhoa e itseng e finyelloa, ho thusa ho fokotsa menyetla ea ho lemala ha mokokotlo.

Lipontšo tsa tšebeliso ea Mokokotlo thibelo ea motsamao ke a GCS ea ka tlase ho 15, bopaki ba botahoa, bonolo kapa bohloko bohareng ba molala kapa morao, matšoao a tsepamisitsoeng a methapo ea kutlo le/kapa matšoao, ho holofala ha lesapo la mokokotlo, le maemo a sitisang kapa likotsi.

Kenyelletso ea ho sithabela ha mokokotlo: neng le hobaneng boto ea mokokotlo e hlokahala

Likotsi tse hlabisang lihlong ke sesosa se ka sehloohong sa ho lemala ha lesapo la mokokotlo United States le linaheng tse ling tse ngata, ka ketsahalo ea selemo le selemo ea linyeoe tse ka bang 54 ho baahi ba milione le hoo e ka bang 3% ea bohle ba amoheloang sepetlele bakeng sa ho sithabela ho hoholo.[1]

Le hoja likotsi tsa lesapo la mokokotlo li etsa hore ho be le karolo e nyenyane feela ea likotsi tse mpe tsa ho sithabela maikutlo, ke tse ling tsa tse tlatsetsang haholo ho kula le ho shoa ha batho.[2][3]

Ka lebaka leo, ka 1971, American Academy of Orthopedic Surgeons e ile ea etsa tlhahiso ea hore ho sebelisoe khala ea mokokotlo le bolelele boto ea lesapo la mokokotlo ho thibela ho sisinyeha ha lesapo la mokokotlo ho bakuli ba belaelloang hore ke likotsi tsa mokokotlo oa mokokotlo, ho itšetlehile feela ka mochine oa kotsi.

Ka nako eo, sena se ne se thehiloe tumellanong ho e-na le bopaki.[4]

Lilemong tse mashome ho tloha thibelo ea ho sisinyeha ha lesapo la mokokotlo, ho sebelisa molala oa mokokotlo le boto e telele ea mokokotlo e fetohile tekanyetso ea tlhokomelo ea prehospital.

E ka fumanoa litataisong tse 'maloa, ho kenyelletsa le tataiso ea Advanced Trauma Life Support (ATLS) le Prehospital Trauma Life Support (PHTLS).

Ho sa tsotellehe tšebeliso e atileng, ho sebetsa ha mekhoa ena ho ’nile ha belaelloa.

Phuputsong e 'ngoe ea machaba ha ho bapisoa ba neng ba e-na le thibelo ea ho sisinyeha ha lesapo la mokokotlo ho ba sa kang ba e fumana, phuputso e fumane hore ba sa kang ba fumana tlhokomelo e tloaelehileng ka thibelo ea ho sisinyeha ha lesapo la mokokotlo ba ne ba e-na le likotsi tse fokolang tsa neurologic tse nang le bokooa.

Leha ho le joalo, ho lokela ho hlokomeloa hore bakuli bana ba ne ba sa bapisoa le ho teba ha kotsi.[5]

Ho sebelisa baithaopi ba bacha ba phetseng hantle, phuputso e 'ngoe e ile ea sheba ts'ebetso ea mokokotlo oa mokokotlo holim'a letlapa le lelelele la mokokotlo ha le bapisoa le materase a lesela le ho fumana hore letlapa le lelelele la mokokotlo le ile la lumella motsamao o moholo oa lateral.[6]

Ka 2019, phuputso ea morao-rao, ea tlhokomelo, ea mekhatlo e mengata ea li-prehospital e ile ea hlahloba hore na ho bile le phetoho ea likotsi tsa mokokotlo kapa che ka mor'a ho kenya ts'ebetsong protocol ea EMS e neng e fokotsa mehato ea ho itšireletsa ho ba nang le mabaka a mangata a kotsi kapa liphuputso tse sa tloaelehang 'me ba fumana hore ho na le. ha ho na phapang ketsahalong ea likotsi tsa lesapo la mokokotlo.[7]

LITLHAKU TSE KHABANE TSA MOKOLO? Etela SPENCER BOOTH HO Expo Emergency

Hajoale ha ho na liteko tse phahameng tsa taolo e sa reroang ho tšehetsa kapa ho hana tšebeliso ea thibelo ea ho sisinyeha ha mokokotlo.

Ho ke ke ha etsahala hore ho be le mokuli ea ka ithaopelang ho etsa boithuto bo ka fellang ka ho holofala ka ho sa feleng ho tlōla melao ea boitšoaro ea hona joale.

Ka lebaka la lithuto tsena le tse ling, litataiso tse ncha li khothalletsa ho fokotsa tšebeliso ea thibelo ea nako e telele ea mokokotlo oa mokokotlo ho ba nang le mokhoa o amanang le kotsi kapa matšoao kapa matšoao a hlalositsoeng hamorao sehloohong sena le ho fokotsa nako eo mokuli a e qetang a sa khone ho tsamaea. .

Lipontšo tsa ho sebelisa boto ea mokokotlo

Khopolong ea Denis, ho lematsa litšiea tse peli kapa ho feta ho nkoa e le ho robeha ho sa tsitsang ho lematsa lesapo la mokokotlo le ka har'a mokokotlo oa mokokotlo.

Molemo o reriloeng oa thibelo ea ho sisinyeha ha lesapo la mokokotlo ke hore ka ho fokotsa ho sisinyeha ha mokokotlo, motho a ka fokotsa monyetla oa ho tsoa likotsi tsa mokokotlo oa mokokotlo ho tloha likhechana tse sa tsitsang tsa fracture nakong ea extrication, lipalangoang le tlhahlobo ea bakuli ba tšoenyehileng.[9]

Lipontšo tsa thibelo ea ho sisinyeha ha mokokotlo li itšetlehile ka protocol e entsoeng ke batsamaisi ba litšebeletso tsa meriana ea tšohanyetso ea sebakeng seo 'me e ka fapana ho ea ka eona.

Leha ho le joalo, American College of Surgeons Committee on Trauma (ACS-COT), American College of Emergency Physicians (ACEP), le National Association of EMS Physicians (NAEMSP) ba thehile polelo e kopanetsoeng mabapi le thibelo ea ho sisinyeha ha lesapo la mokokotlo ho bakuli ba batho ba baholo ba sithabetseng maikutlo. ka 2018 mme e thathamisitse matšoao a latelang:[10]

Boemo bo fetotsoeng ba kelello, matšoao a botahoa, GCS <15
Bonolo kapa bohloko ba mokokotlo o bohareng
Matšoao a tsepamisitsoeng a methapo ea kutlo kapa matšoao a joalo ka bofokoli ba 'mele, ho tsieleha
Ho holofala ha lesapo la mokokotlo
Likotsi kapa maemo a sitisang (mohlala, ho robeha, ho chesa, maikutlo Mahlomola, mokoallo oa puo, joalo-joalo)

Polelo e tšoanang e kopanetsoeng e ile ea boela ea fana ka likhothaletso bakeng sa bakuli ba nang le bokooa bo bobe ba bana, ba hlokomela hore lilemo le bokhoni ba ho buisana ha lia lokela ho ba sesosa sa ho etsa liqeto bakeng sa tlhokomelo ea mokokotlo oa prehospital.

Tse latelang ke litšupiso tsa bona tse khothaletsoang:[10]

Ho tletleba ka bohloko ba molala
Torticollis
Khaello ea Neurologic
Boemo bo fetotsoeng ba kelello, ho kenyelletsa le GCS <15, botahoa, le matšoao a mang (ho ferekana, ho koaleha moea ka nakoana, hypopnea, somnolence, jj.)
Ho kenya letsoho kotsing e kholo ea ho thulana ha koloi, kotsi e matla ea ho qoela, kapa ho ba le kotsi e kholo ea 'mele.

Contraindications ts'ebelisong ea boto ea mokokotlo

A contraindication e lekanyelitsoeng ho bakuli ba nang le ts'oaetso e phunyeletsang hloohong, molala, kapa torso ntle le khaello ea neurologic kapa tletlebo.[11]

Ho ea ka liphuputso tse hatisitsoeng ho Eastern Association for the Surgery of Trauma (EAST) le The Journal of Trauma, bakuli ba nang le ts'oaetso e phunyeletsang ba ileng ba e-ba le mokokotlo oa mokokotlo ba ne ba e-na le menyetla ea ho shoa habeli ho feta bakuli ba sa kang ba e etsa.

Ho etsa hore mokuli a se ke a tsamaea ke mokhoa o nkang nako, pakeng tsa metsotso e 2 ho isa ho e 5, e seng feela ho liehisa lipalangoang bakeng sa tlhokomelo e tiileng empa hape ho liehisa liphekolo tse ling tsa prehospital kaha ona ke mokhoa oa batho ba babeli.[12][13]

SEAMOSO SEAEA-SEO SA BAPHOLOSI LEFATŠENG KATENG? ETELA EMS RADIO BOOTH AT EXPO EXPO

Lisebelisoa tse hlokahalang bakeng sa ho se sebetse ha lesapo la mokokotlo: molaleng, nako e telele le e khutšoanyane ea mokokotlo oa mokokotlo

The thepa e hlokahalang bakeng sa thibelo ea ho sisinyeha ha mokokotlo e hloka letlapa la mokokotlo (ebang ke nako e telele kapa e khutšoanyane) le mokokotlo oa mokokotlo oa mokokotlo.

Liboto tsa Mokokotlo o Motelele

Mapolanka a nako e telele a mokokotlo a qalile ho kenngoa ts'ebetsong, hammoho le molaleng oa mokokotlo, ho thibela mokokotlo oa mokokotlo kaha ho ne ho nahanoa hore ho se sebetse hantle tšimong ho ka baka kapa ho mpefatsa likotsi tsa mokokotlo.

Boto e telele ea mokokotlo e ne e boetse e le theko e tlaase 'me e sebelisoa e le mokhoa o loketseng oa ho tsamaisa bakuli ba akhehileng, ho fokotsa motsamao o sa batleheng, le ho koahela sebaka se sa lekaneng.[14]

Liboto tse Khutšoane tsa Mokokotlo

Liboto tsa mokokotlo tse khuts'oane, tse tsejoang hape e le lisebelisoa tsa ho ntša methati e bohareng, hangata li tšesaane ho feta tse ling tsa tsona tse telele.

Bolelele ba tsona bo khuts'oane bo li lumella ho sebelisoa libakeng tse koetsoeng kapa tse koaletsoeng, hangata ho thulang likoloi.

Letlapa le lekhutšoanyane la mokokotlo le tšehetsa mokokotlo oa sefuba le mokokotlo oa mokokotlo ho fihlela mokuli a ka behoa holim'a letlapa le lelelele la mokokotlo.

Mofuta o tloaelehileng oa boto ea mokokotlo o mokhuts'oane ke Sesebelisoa sa Kendrick Extrication, e fapaneng le boto ea khale ea mokokotlo e khuts'oane ka hore e thata-thata 'me e atoloha ka thōko ho pota-pota mahlakore le hlooho.

Ho tšoana le mapolanka a nako e telele a mokokotlo, tsena li boetse li sebelisoa hammoho le li-collar tsa cervical.

Li-Cervical Collars: "C Collar"

Li-collar tsa cervical (kapa C Collar) li ka aroloa ka mekhahlelo e 'meli e pharaletseng: e bonolo kapa e thata.

Libakeng tsa ts'oaetso, li-collar tse thata tsa popelo ke tsona tse thibelang ho ikhethela kaha li fana ka thibelo e phahameng ea molomo oa popelo.[15]

Hangata li-collars tsa cervical li etselitsoe ho ba le karolo e ka morao e sebelisang mesifa ea trapezius e le mohaho oa ts'ehetso le karolo e ka pele e tšehetsang mokokotlo le ho sebelisa sternum le clavicles e le mohaho oa tšehetso.

Li-collar tsa cervical ka botsona ha li fane ka ts'ebetso e lekaneng ea mokokotlo oa mokokotlo 'me li hloka mekhoa e eketsehileng ea tšehetso ea lateral, hangata e le ka mokhoa oa Velcro foam pads e fumanoang libotong tse telele tsa mokokotlo.

THUTO YA THUSO YA PELE? ETELA DMC DINAS MEDICAL CONSULTANTS BOOTH AT EMERGENCY EXPO

Lewa

Mekhoa e mengata e teng bakeng sa ho beha motho thibelong ea ho sisinyeha ha lesapo la mokokotlo, e 'ngoe ea tse atileng haholo ke mokhoa oa supine log-roll o boletsoeng ka tlase mme o etsoa, ka nepo, ka sehlopha sa batho ba 5, empa bonyane, sehlopha sa ba bane.[16] ]

Bakeng sa Sehlopha sa Bahlano

Pele mokuli a sa khone ho tsamaea, a tšele matsoho holim'a sefuba sa hae.

Moeta-pele oa sehlopha o lokela ho abeloa hlooho ea mokuli ea tla etsa inline manual stabilization ka ho tšoara mahetla a mokuli ka menoana ea hae karolong e ka morao ea trapezius le monoana oa bona o motona karolong e ka pele ea matsoho a hatelloa ka thata khahlanong le likarolo tsa lateral tsa. hlooho ea mokuli ho fokotsa ho sisinyeha le ho tsitsisa mokokotlo oa mokokotlo.

Haeba e le teng, molala oa molomo oa popelo o lokela ho behoa nakong ena ntle le ho phahamisa hlooho ea mokuli fatše. Haeba e le 'ngoe e sa fumanehe, boloka botsitso bona nakong ea mokhoa oa ho roala log.

Setho sa sehlopha sa lihlopha tse peli se lokela ho behoa sefubeng, setho sa sehlopha se tharo lethekeng, 'me setho sa sehlopha sa bone se be maotong ka matsoho a bona a behiloe lehlakoreng le hōle la mokuli.

Setho sa sehlopha sa bohlano se lokela ho itokisetsa ho slide boto e telele ea mokokotlo tlas'a mokuli ka mor'a hore e phuthoe.

Ka taelo ea setho sa sehlopha sa 1 (hangata palo ea tse tharo), litho tsa sehlopha 1 ho isa ho 4 li tla theola mokuli, ka nako eo setho sa sehlopha sa bohlano se tla thellela boto e telele ea mokokotlo tlas'a mokuli.

Hape, ka taelo ea setho sa sehlopha, mokuli o tla phutholloa holim'a letlapa le lelelele la mokokotlo.

Beha mokuli holim'a boto 'me u sireletse torso ka likhoele tse lateloang ke pelvis le maoto a ka holimo.

Sireletsa hlooho ka ho beha lithaole tse phuthoang ka mahlakoreng a mabeli kapa sesebelisoa se fumanehang khoebong ebe u beha tepi ho pholletsa le phatleng 'me u tiisetsoe ho ea lipheletsong tsa letlapa le lelelele la mokokotlo.

Bakeng sa Sehlopha sa Bane

Hape, moetapele oa sehlopha o lokela ho abeloa hlooho ea mokuli mme a latele mokhoa o tšoanang o boletsoeng ka holimo.

Setho sa sehlopha sa lihlopha tse peli se lokela ho behoa sefubeng ka letsoho le le leng lehetleng le hōle le le leng ka lethekeng le hōle.

Setho sa sehlopha sa boraro se lokela ho behoa maotong, letsoho le leng le behiloe lethekeng le hole le le leng leoto le hole.

Hlokomela hore ho khothaletsoa hore matsoho a litho tsa sehlopha a fetele lethekeng.

Setho sa sehlopha sa bone se tla thellela boto e telele ea mokokotlo tlas'a mokuli, 'me mokhoa o mong o lateloa joalokaha o hlalositsoe ka holimo.

Mathata a ho sebelisa lesapo la mokokotlo mokokotlong oa mokokotlo

Likotsi Tsa Khatello

Bothata bo ka bang teng ho ba fetang nako e telele ea lesapo la mokokotlo le thibelo ea ho sisinyeha ha mokokotlo oa mokokotlo oa mokokotlo ke liso tsa khatello, 'me ketsahalo e tlalehiloeng e fihla ho 30.6%. [17]

Ho ea ka National Pressure Ulcer Advisory Panel, liso tsa khatello joale li se li arotsoe e le likotsi tsa khatello.

Li bakoa ke khatello, hangata ka lebaka la ho hlahella ha masapo, ka nako e telele e bakang tšenyo ea sebaka sa letlalo le lisele tse bonolo.

Mehatong ea pele, letlalo le lula le tiile empa le ka 'na la tsoela pele ho ba seso ka mor'a nako.[18]

Nako ea nako eo motho a e nkang ho hlahisa kotsi ea khatello e ea fapana, empa bonyane thuto e le 'ngoe e bontšitse hore kotsi ea lisele e ka qala ka mor'a metsotso e 30 ho baithaopi ba phetseng hantle.[19]

Ho sa le joalo, nako e tloaelehileng e sebelisoang e sa sisinyehe ka boto e telele ea mokokotlo e ka bang metsotso e 54 ho isa ho e 77, hoo e ka bang metsotso e 21 e fumanoang ED ka mor'a lipalangoang.[20][21]

Re nahanne ka sena, bafani bohle ba tlameha ho leka ho fokotsa nako eo bakuli ba e qetang ba sa khone ho tsamaea ebang ke mapolanka a thata a lesapo la mokokotlo kapa ka li-collar tsa cervical kaha ka bobeli li ka lebisa likotsing tsa khatello.

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Ho Sekisetsa ho Phefumolohang

Liphuputso tse ngata li bontšitse ho fokotseha ha mosebetsi oa phefumoloho ka lebaka la marapo a sebelisoang libotong tse telele tsa mokokotlo.

Ho baithaopi ba bacha ba phetseng hantle, tšebeliso ea marapo a nako e telele ea mokokotlo holim'a sefuba e ile ea fella ka ho fokotseha ha likarolo tse 'maloa tsa pulmonary, ho kenyelletsa le matla a bohlokoa a qobelloang, molumo oa ho felloa ke matla o qobelloang, le phallo ea bohareng ba ho felloa ke matla e fellang ka phello e thibelang.[22]

Phuputsong e amang bana, ho bile le phokotseho ea matla a qobelloang ho fihla ho 80% ea motheo.[23] Phuputsong e 'ngoe hape, boto e thata le materase a vacuum a fumanoe a thibela ho hema ka karolelano ea 17% ho baithaopi ba phetseng hantle.[24]

Tlhokomelo e hlokolosi e tlameha ho lefshoa ha bakuli ba sa khone ho tsamaea, haholo-holo ho ba nang le lefu la matšoafo le neng le le teng pele hammoho le bana le maqheku.

Bohloko

Bothata bo tloaelehileng ka ho fetisisa, bo ngotsoeng hantle ba thibelo e telele ea mokokotlo oa mokokotlo oa mokokotlo ke bohloko, bo bakang metsotso e ka bang 30 feela.

Hangata bohloko bo bonahala ka ho opa ha hlooho, bohloko ba mokokotlo le bohloko ba mandible.[25]

Hape, 'me hona joale e le sehlooho se pheta-phetoang, nako e sebelisoang holim'a letlapa le thata la mokokotlo le lelelele le lokela ho fokotsoa ho fokotsa bohloko.

Bohlokoa ba kliniki ea kotsi ea mokokotlo oa mokokotlo: karolo ea molala le mokokotlo oa mokokotlo

Tlhekefetso e matla e ka bakang kotsi ea mokokotlo oa mokokotlo, ka lebaka leo, tšenyo ea mokokotlo e ka bakang mafu a tebileng le lefu.

Lilemong tsa bo-1960 le bo-1970, thibelo ea ho sisinyeha ha lesapo la mokokotlo e ne e sebelisoa ho fokotsa kapa ho thibela sequelae ea methapo e nahanoang hore ke ea bobeli ho likotsi tsa mokokotlo oa mokokotlo.

Le hoja li amohetsoe ka ho pharaletseng e le mokhoa oa tlhokomelo, lingoliloeng ha li na boleng leha e le bofe bo phahameng, lipatlisiso tse thehiloeng bopaking tse batlisisang hore na thibelo ea ho tsamaea ha mokokotlo e na le phello efe kapa efe liphellong tsa boko.[26]

Ho phaella moo, lilemong tsa morao tjena ho 'nile ha e-ba le bopaki bo ntseng bo eketseha bo totobatsang mathata a ka bang teng a thibelo ea ho sisinyeha ha mokokotlo. [17] [22] [25] [20]

Ka lebaka leo, litataiso tse ncha li khothalelitse hore thibelo ea ho sisinyeha ha lesapo la mokokotlo e sebelisoe ka masene ho batho ba itseng ba bakuli.[10]

Le hoja thibelo ea mokokotlo oa mokokotlo e ka ba molemo maemong a mang, mofani o hloka ho tloaelana le tataiso le mathata a ka 'nang a e-ba teng bakeng sa bafani hore ba hlomeletsoe hamolemo ho sebelisa mekhoa ena le ho ntlafatsa liphello tsa mokuli.

Ntlafatso ea Litholoana tsa Sehlopha sa Tlhokomelo ea Bophelo

Bakuli ba 'nileng ba ameha ho tsietsing ea matla a maholo ba ka hlahisa matšoao a mangata.

Ke habohlokoa ho litsebi tsa tlhokomelo ea bophelo tse ikarabellang bakeng sa tlhahlobo ea pele ea bakuli bana ho tloaelana le matšoao, li-contraindications, mathata a ka 'nang a e-ba teng, le mokhoa o nepahetseng oa ho kenya ts'ebetsong thibelo ea mokokotlo oa mokokotlo.

Litaelo tse 'maloa li ka ba teng ho thusa ho tseba hore na ke bakuli bafe ba finyellang litekanyetso tsa thibelo ea mokokotlo oa mokokotlo.

Mohlomong tataiso e tsebahalang ka ho fetisisa le e amohelehang ka ho fetisisa ke ea polelo ea boemo bo kopanetsoeng ke American College of Surgeons Committee on Trauma (ACS-COT), Mokhatlo oa Sechaba oa Lingaka tsa EMS (NAEMSP), le American College of Emergency Physicians (ACEP). ).[10] Leha tsena e le litataiso le likhothaletso tsa hajoale, ha ho na liteko tsa taolo e sa reroang tsa boleng bo holimo ho fihlela joale, ka likhothaletso tse thehiloeng lithutong tsa tlhokomeliso, li-cohorts tsa morao-rao, le lithuto tsa linyeoe.[26]

Ntle le ho tloaelana le matšoao le li-contraindications bakeng sa thibelo ea ho sisinyeha ha mokokotlo, ke habohlokoa hape hore litsebi tsa tlhokomelo ea bophelo li tsebe mathata a ka 'nang a e-ba teng a kang bohloko, liso tsa khatello, le ho sekisetsa ho phefumoloha.

Ha ho sebelisoa thibelo ea mokokotlo oa mokokotlo, litho tsohle tsa setsebi sa bophelo bo botle sa interprofessional li tlameha ho tloaelana le mokhoa oo li o ratang le ho sebelisa puisano e ntle ho phethahatsa mokhoa ona hantle le ho fokotsa ho sisinyeha ho feteletseng ha mokokotlo. Litsebi tsa tlhokomelo ea bophelo bo botle le tsona li lokela ho hlokomela hore nako e sebelisoang ka boto e telele ea mokokotlo e lokela ho fokotsoa ho fokotsa mathata.

Ha o fetisetsa tlhokomelo, sehlopha sa EMS se lokela ho buisana ka nako eohle e sebelisitsoeng ka nako e telele ea mokokotlo oa mokokotlo.

Ho sebelisa litataiso tsa morao-rao, ho tloaelana le mathata a tsebahalang, ho fokotsa nako e sebelisitsoeng setulong se selelele sa mokokotlo, le ho sebelisa liphetho tse ntle tsa puisano ea li-interprofessional bakeng sa bakuli bana li ka ntlafatsoa. [Boemo ba 3]

References:

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