Imililo, ukuphefumla umsi kunye nokutshisa: iimpawu, iimpawu, umgaqo wesithoba

By UCristiano Antonino On Ngo-Apr 7, 2023

Imililo yimbangela ebalulekileyo yokulimala, ukufa kunye nomonakalo wezoqoqosho. Umonakalo obangelwa kukuphefumla umsi ukhokelela ekunyukeni okumangalisayo kokusweleka kwezigulana ezitshayo: kwezi meko, umonakalo wokuphefumla umsi wongezwa kumonakalo otshayo, kunye neziphumo ezihlala zibulala.

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Iimpawu, iimpawu kunye nokuxilongwa kumaxhoba omlilo

Ukwanda kokugula kunye nokufa okuhambelana nokulimala kokuphefumla kwizigulana ezitshileyo kufuna ukuba ziqatshelwe ngokukhawuleza kunye nonyango.

Uvavanyo lweklinikhi olukhawulezileyo, i-fibreoptic bronchoscopy, i-X-reyi yesifuba, i-haemogasanalysis, i-ECG kunye nokujongwa kwe-haemodynamic ngamanyathelo aphambili kwinkqubo yokuxilongwa.

Ukujongwa ngokucokisekileyo kwesigulane ngezi ndlela kuvumela ukuba kuthathwe amanyathelo afanelekileyo ngexesha elifanelekileyo xa kuyimfuneko.

Ezinye iinkcukacha ezibalulekileyo zinokuba luncedo kuvavanyo kunye nonyango lokuqala lwamaxhoba omlilo athe aphefumla umsi.

Imbali encumisayo yokuvezwa kwindawo evalelweyo, enomsi omninzi kufuneka ikhokelele umntu ekurhaneleni ukwenzakala ekusezeleni umoya, nangona zingekho iimpawu ezicacileyo zeklinikhi.

Isimo sokungazi kakuhle kufuneka senze i-asphyxia kunye / okanye i-carbon monoxide (CO) kunye ne-cyanide (RCN) ityhefu ngakumbi.

Uphawu lweklasi yombala we-cherry-obomvu wesikhumba kwiimeko zetyhefu ye-CO ayithembekanga ngokwayo.

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I-Oximetry luvavanyo olubalulekileyo lokuxilongwa kwe-CO yokuxiliswa, nangona kunjalo, amanqanaba aphantsi e-Hbco awabandakanyi ukuba nokwenzeka komonakalo omkhulu wamaphaphu kumanqanaba aphakathi kunye nasemva kwexesha emva kokutshiswa.

I-Pulse oximetry yiparameter yesihlanu ebalulekileyo ekubekeni iliso kwizigulane ezinzima, nangona kunjalo, i-SpO2 ayibonakali ngokuchanekileyo ukugxilwa kwe-Hbo kwizigulane ezinetyhefu ye-CO ngenxa yokuba i-oxyhaemoglobin kunye ne-Hbco zine-spectrum yokufunxa ukukhanya okufanayo, ngoko ke, ixabiso le-SpO2 liya kuphakanyiswa ngobuxoki kwizigulane ezinetyhefu ye-CO. .

I-Pulse oximetry ibonakalisa ukuba luncedo kuphela kwizigulane ezitshileyo ezinemilinganiselo ekufutshane neqhelekileyo ye-Hbco.

Ukutshisa ebusweni, i-vibrissae etshiswayo, i-buccal kunye ne-laryngeal edema, i-debris etshisiweyo kwi-airways kunye ne-sputum ibonisa ukwenzakala kokuphefumla, kodwa ukungabikho kwabo akukhupheli ngaphandle.

Ubukho bamasuntswana atshayo kwisikhohlela, esikwathathwa njengophawu olubuthathaka kakhulu lokuphefumla umsi, akunakufunyaniswa iiyure eziyi-8-24, kwaye kwenzeka kuphela malunga ne-40% yezifundo ezinokulimala kwemiphunga.

I-Laryngeal stridor, i-hoarseness, intetho engacacanga kunye ne-thoracic retractions iphakamisa ubukho besilonda somoya ophezulu kunye nesidingo sokuphononongwa ngokucokisekileyo koku.

I-Laryngoscopy kunye ne-fibreoptic bronchoscopy ziluncedo kakhulu kuzo zombini ukukhangela izilonda zomoya ophezulu kunye nokususwa kwamathe amaninzi kunye ne-debris enokuthi ibe khona.

Inkangeleko yokukhohlela, i-dyspnea, i-tachypnoea, i-cyanosis, i-hising, i-wheezing okanye i-rhonchi ibonisa ukwenzakala okubi ngakumbi kokuphefumla.

I-electrocardiogram (ECG) ihlala ibonisa i-tachycardia kwaye inokubonisa iimpawu ze-ischemic heart disease.

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Uvavanyo lweX-reyi lwesifuba lusoloko lungabonakalisi zimpawu zokwenzakala ngokuphefumla

Uphononongo lwe-scintigraphic olwenziwa emva kokutofa nge-intravenous ye-xenon-133 lubonisa ukwenzakala okuncinci kwendlela yomoya ukuba ukupheliswa ngokupheleleyo kwe-isotope akwenzeki kwimizuzwana engama-90.

Ngelishwa, akwenzeki ukwenza olu vavanyo kwisigaba sokuqala sonyango.

I-Spirometry ibonakalise ukuba luncedo ekuboneni indlela encinci yomoya kunye nezilonda zomoya ophezulu.

Zombini ukuhamba okugqithiseleyo kokuphelelwa umoya kunye nezinga lokuphelelwa ngamandla kwi-50% yomthamo obalulekileyo onyanzelekileyo ziyancipha ngokuphawulekayo.

Ukusetyenziswa kwale ndlela, nangona kunjalo, kukhawulelwe kwezo zigulana ezinokuthi zenze imiyalelo yomhloli kwaye zenze umgudu wokuphefumula owaneleyo.

Uhlalutyo lwegesi yegazi ye-Arterial (ABG) luluncedo kakhulu ekuhloleni ubukhali kunye nokuqhubela phambili kokulimala kwemiphunga.

Ukunciphisa i-PaO2 kunye nokunyuka kwe-P (Aa) i-O2 (inkulu kune-300), okanye ukunciphisa umlinganiselo we-PaO2 / FiO2 (ngaphantsi kwe-350), zizibonakaliso ezisebenzayo kunye nezibuhlungu zokuphazamiseka kokuphefumla.

Ialkalosis yokuphefumla ixhaphakile kwithuba elikhawulezayo emva kokutshiswa kwaye ihlala iqhubeka nenqanaba le-hypermetabolic.

I-acidosis yokuphefumla ibonakalisa ukoyisakala kokuphefumla kwaye idla ngokunxulunyaniswa ne-hypoxaemia emandla.

I-asphyxiation, amanqanaba aphezulu e-Hbco (ngaphezu kwama-40), ubuthi be-HCN kunye nokukhutshwa kwentliziyo ephantsi zizo zonke izinto ezinokukhokelela kwi-acidosis enzima ye-metabolic.

I-Electrocardiogram (ECG) kunye ne-haemodynamic monitoring zibalulekile kwizigulane ezineqondo lesithathu lokutshisa okungaphezulu kweepesenti ze-10 zomphezulu womzimba, nokuba zihambelana okanye azihambelani nokulimala kokuphefumla.

Kwiindawo ezitshisa kakhulu, ngokukodwa ezo zinzima ngenxa yokulimala kwe-inhalation, uxinzelelo lwe-pulmonary arterial, i-cardiac output kunye nezinye izinto eziguquguqukayo ze-haemodynamic zinokujongwa ukuze kulungiswe ukunyuswa kwamanzi ngexesha lokuvuselela, ukuphepha i-hypotension, ukungaphumeleli kwezintso kunye nokugqithisa kwamanzi.

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Umlilo uyatsha, umthetho wesithoba

Uvavanyo lokulimala kwesikhumba lwenziwa ngokuhlolwa komzimba, ukuvavanywa kobunzima bomzimba (ukulandela umlinganiselo wamanzi) kunye nokuzimisela kobungakanani bomzimba otshisiweyo.

Lo mva unokubalwa ngokukhawuleza, usebenzisa okubizwa ngokuba ngumgaqo wesithoba, emva kokumisela iqondo lokubandakanyeka kwentloko, ngaphambili nangasemva kwesiqu kunye nemilenze.

Kumthetho wesithoba, kumntu omdala, indawo nganye ye-anatomical imele malunga ne-4.5% okanye i-9% okanye i-18% yendawo yonke yomzimba.

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Ubunzulu bomtshiso buvavanywa ngesiseko sembonakalo yeklinikhi, uhlala ugcina olu lwazi lufutshane engqondweni:

Ukutshisa iqondo lokuqala: Ukutshisa kwi-epithelium, ebonakalisa njenge-erythema kunye nentlungu;
Ukutshiswa kwenqanaba lesibini: Ukutshiswa kwe-epidermis kunye nedermis, ebonakalisa nge-erythema, ukugqabhuka kunye neentlungu.
Ukutshisa okwesithathu: Ukutshisa okutshabalalisa ulusu ukuya kwi-hypodermis okanye ngaphakathi kwe-hypodermis kwaye kubonakaliswe ngokugqithiswa kwebala okanye greyish-brownish ebusweni obuchaphazelekayo, obungebuhlungu, ngenxa yokutshatyalaliswa ngokupheleleyo kwazo zonke izitho zoluvo ulusu.