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Inkxaso yobomi obusisiseko (BTLS) kunye nenkxaso yobomi obuphambili (ALS) kwisigulane esibuhlungu

By UCristiano Antonino On Ngamana 12, 2022

Inkxaso yesiseko sobomi bomothuko (BTLS): Inkxaso esisiseko yobomi bomothuko (kungoko igama elithi SVT) yinkqubo yokuhlangula esetyenziswa ngokubanzi ngabahlanguli kwaye ijolise kunyango lokuqala lwabantu abonzakeleyo abaye bafumana umonzakalo, okt isiganeko esibangelwa sisixa esikhulu samandla. ukusebenza emzimbeni kubangela umonakalo

Ngoko ke olu hlobo lokuhlangula alujoliswanga kuphela kumaxhoba e-polytrauma athe abandezeleka umz. iingozi zendlela, kodwa kunye namanxeba arhaxwayo, abanjwe ngumbane, atshileyo okanye eembumbulu, kuba kuzo zonke ezi meko ukwenzakala kubangelwa kukuchithwa kwamandla emzimbeni.

I-SVT kunye ne-BTLF: Iyure yegolide, isantya sisindisa ubomi

Umzuzu omnye ngaphezulu okanye ngaphantsi udla ngokuba ngumahluko phakathi kobomi nokufa kwesigulane: oku kuyinyaniso ngakumbi kwimeko yezigulane eziye zafumana ukwenzakala okukhulu: ixesha eliphakathi kwesiganeko somonzakalo kunye nohlangulo libaluleke kakhulu, kuba ngokucacileyo lifutshane. ixesha lokuphumla ukusuka kweso siganeko ukuya kungenelelo, likhulu ithuba lokuba umntu owenzakeleyo uya kusinda okanye ubuncinane afumane umonakalo onokwenzeka.

Ngenxa yesi sizathu, ingcamango yeyure yegolide ibalulekile, egxininisa ukuba ixesha phakathi kwesiganeko kunye nokungenelela kwezonyango akufanele kube ngaphezu kwemizuzu engama-60, umda ngaphaya koko kukho ukwanda okuphawulekayo kwamathuba okungasindisi isigulane. ubomi.

Nangona kunjalo, ibinzana elithi 'iyure yegolide' alibhekiseli kwiyure, koko livakalisa uluvo jikelele lokuba: 'inyathelo langaphambili lithatyathwe, kokukhona liba likhulu ithuba lokusindisa ubomi besigulane'.

Izinto ezingundoqo ze-trauma dynamics

Xa ummi efowunela iNombolo yoNgxamiseko eNye, umqhubi uyambuza imibuzo ethile malunga nokuguquguquka kwesiganeko, esisebenza

vavanya ubuzaza bomothuko
ukuseka ikhowudi ephambili (eluhlaza, etyheli okanye ebomvu);
thumela iqela lokuhlangula njengoko kuyimfuneko.

Kukho izinto eziqikelela ubuqatha obucingelwayo bomothuko: ezi elementi zibizwa ngokuba 'ziinkalo zezinto eziphambili'.

Izinto eziphambili ze-dynamics eziphambili

ubudala besigulane: ubudala obungaphantsi kwe-5 kunye nangaphezulu kwe-55 ngokuqhelekileyo luphawu lobunzima obukhulu;
ubundlobongela bempembelelo: ungquzulwano lwentloko okanye ukukhutshwa komntu kwindawo yabakhweli, umzekelo, imiqondiso yobukhali obukhulu;
ungquzulwano phakathi kwezithuthi ezinobukhulu obuchaseneyo: ibhayisekile/ilori, imoto/abahambi ngeenyawo, imoto/isithuthuthu yimizekelo yobunzima obandileyo;
abantu ababulewe kwisithuthi esinye: oku kuphakamisa inqanaba elicingelwayo lobuzaza;
i-complex extrication (ixesha elilindelekileyo lokukhutshwa elingaphezu kwemizuzu engamashumi amabini): ukuba umntu ubanjiwe umz. phakathi kwamaphepha esinyithi, inqanaba lomxhuzulane elicingelwayo liyaphakanyiswa;
ukuwa ukusuka kwiindawo eziphakamileyo kuneemitha ezi-3: oku kuphakamisa inqanaba lokucinga lobunzima;
uhlobo lwengozi: i-electrocution trauma, ngokubanzi kakhulu okwesibini okanye okwesithathu ukutshisa idigri, ukurhaxwa, amanxeba okudutyulwa, zonke iingozi eziphakamisa inqanaba lokucinga lobunzima;
i-trauma ebanzi: i-polytrauma, i-fractures eveziweyo, i-amputations, zonke iingozi eziphakamisa izinga lobunzima;
ukulahlekelwa yingqondo: ukuba isifundo esinye okanye ngaphezulu silahlekelwe yingqondo okanye i-airway engasebenziyo kunye / okanye ukubanjwa kwenhliziyo kunye / okanye ukubanjwa kwe-pulmonary, inqanaba lobunzima liphakanyiswa kakhulu.

Iinjongo zomsebenzisi wefowuni

Iinjongo zomsebenzisi wefowuni ziya kuba kuku

ukutolika inkcazo yesiganeko kunye neempawu zeklinikhi, ezihlala zibonakaliswa ngokungachanekanga ngumfowuni, ngokucacileyo akayi kuhlala enemvelaphi yezonyango;
baqonde ubunzulu bemeko ngokukhawuleza kangangoko kunokwenzeka
thumela olona ncedo lufanelekileyo (i-ambulensi enye? ezimbini ii-ambulensi? Thumela ugqirha omnye okanye ngaphezulu? Kwakhona thumela i-fire brigade, i-carabinieri okanye amapolisa?);
mqinisekise ummi kwaye umcacisele ekude into anokuyenza ngelixa elindele uncedo.

Ezi njongo kulula ukuzithetha, kodwa zintsonkothe kakhulu xa kujongwa imincili neemvakalelo zomfowunelwa, osoloko ejongene neziganeko ezihlasimlis’ umnxeba okanye naye ebekhe wabandakanyeka kuzo ngoko ke ingcaciso yakhe yoko kwenzekileyo isenokuba ngamaqhekeza kwaye iguqulwe (umz. kwimeko yokuphazamiseka, okanye ukusetyenziswa kotywala okanye iziyobisi).

I-SVT kunye ne-BTLF: ukulimala okuphambili kunye nesekondari

Kolu hlobo lwesiganeko, umonakalo unokwahlulwa kumonakalo osisiseko kunye nowesibini:

umonakalo ophambili: lo ngumonakalo (okanye umonakalo) obangelwa ngokuthe ngqo kwi-trauma; umzekelo, kwingozi yenqwelo-mafutha, owona monakalo uphambili anokuvela kuwo umntu usenokuba kukuqhekeka okanye ukunqunyulwa kwamalungu;
umonakalo wesibini: lo ngumonakalo isigulane esibandezeleka ngenxa yokwenzakala; enyanisweni, amandla okwenzakala (i-kinetic, i-thermal, njl.) Iphinde isebenze kwizitho zangaphakathi kwaye inokubangela umonakalo omkhulu okanye ongaphantsi. Umonakalo wesibini oqhelekileyo unokuba yi-hypoxia (ukungabikho kwe-oksijini), i-hypotension (ukunciphisa uxinzelelo lwegazi ngenxa yokuqala kwemeko yokuphazamiseka), i-hypercapnia (ukwanda kwe-carbon dioxide egazini) kunye ne-hypothermia (ukunciphisa ubushushu bomzimba).

Iiprotokholi ze-SVT kunye ne-BTLF: Ikhonkco lokuSinda kwi-Trauma

Kwimeko yomothuko, kukho inkqubo yokulungelelanisa izenzo zokuhlangula, ebizwa ngokuba yikhonkco labasindileyo kwi-trauma, eyahlulwe yangamanyathelo amahlanu aphambili.

umnxeba ongxamisekileyo: isilumkiso sangethuba ngenombolo yonxunguphalo (e-Italy yiNombolo yoNgxamiseko eNye 112);
udidi kwenziwe ukuvavanya ubungqongqo besiganeko kunye nenani labantu ababandakanyekayo;
ekuqaleni inkxaso yobomi;
ukufakwa kwindawo yokuqala kwiZiko leTrauma (ngaphakathi kweyure yegolide);
ukusebenza kwenkxaso yobomi obuphambili (jonga kumhlathi wokugqibela).

Onke amakhonkco kule khonkco abaluleke ngokulinganayo kungenelelo oluyimpumelelo.

Iqela labahlanguli

Iqela elisebenza kwi-SVT kufuneka ubuncinane libe ngabantu abathathu: iNkokeli yeQela, uMphenduli wokuQala kunye noMqhubi wokuHlangula.

Lo mzobo ulandelayo ufanelekile, njengoko abasebenzi basesenokwahluka ngokuxhomekeke kumbutho, umthetho wokuhlangula wengingqi kunye nohlobo lwemeko kaxakeka.

Inkokeli yeqela ngokuqhelekileyo ngoyena unamava okanye umhlanguli ophezulu kwaye ulawula kwaye ulungelelanise imisebenzi eyenziwa ngexesha lenkonzo. Inkokeli yeqela ikwanguye owenza zonke iimvavanyo. Kwiqela apho umongikazi we-112 okanye ugqirha ekhoyo, indima yenkokeli yeqela idlula ngokuzenzekelayo kubo.

I-Rescue Driver, ngaphezu kokuqhuba isithuthi sokuhlangula, inyamekela ukhuseleko lwemeko kwaye inceda abanye abahlanguli nge ukungasebenzi ubuchule [2]

UMphenduli wokuQala (okwabizwa ngokuba yinkokeli yokuqhuba) umi entloko yesigulane esonzakeleyo kwaye ayishukumisi intloko, ayibambe kwindawo engathathi hlangothi de kube kukungashukumi Umgudu ibhodi igqityiwe. Kwimeko apho isigulane sigqoke i-helmet, umhlanguli wokuqala kunye nomlingane osebenza naye baphatha ukususwa, ukugcina intloko ngokusemandleni.

Hlala & udlale okanye ukhuphe kwaye ubaleke

Kukho izicwangciso ezibini zokusondela kwisigulana kwaye kufuneka zikhethwe ngokweempawu zesigulana kunye nemeko yezempilo yendawo:

i-scoop & run strategy: esi sicwangciso kufuneka sisetyenziswe kwizigulane ezigula kakhulu ezingayi kuxhamla kwi-site intervention, nangona i-Advanced Life Support (ALS), kodwa ifuna ukulaliswa esibhedlele ngokukhawuleza kunye nonyango lwesigulane. Iimeko ezifuna i-Scoop & Run ziquka amanxeba angena esiqwini (isifuba, isisu), ingcambu yelungu kunye entanyeni, oko kukuthi iziza ze-anatomical ezinamanxeba angenako ukunyanzeliswa ngokufanelekileyo;
ukuhlala & isicwangciso sokudlala: esi sicwangciso sibonakaliswe kwezo zigulana zifuna ukuzinziswa kwindawo ngaphambi kokuba zihanjiswe (oku kunjalo nge-hemorrhages enkulu ecinezelayo okanye enzima kakhulu kuneemeko eziphuthumayo).

I-BLS, inkxaso yobomi bokwenzakala: iimvavanyo ezimbini

Inkxaso yobomi obusisiseko kumntu oxhwalekileyo iqala kwimigaqo efanayo ne-BLS eqhelekileyo.

I-BLS kumntu oxhwalekileyo ibandakanya iimvavanyo ezimbini: eziphambili kunye nesekondari.

Uvavanyo olukhawulezileyo lwengqondo yexhoba lokwenzakala lubalulekile; ukuba oku akukho, iprotocol ye-BLS kufuneka isetyenziswe ngokukhawuleza.

Kwimeko yokwenzakala okuvalelweyo, uvavanyo olukhawulezileyo lweMisebenzi yoBomi obuSisiseko (ABC) ibalulekile, kwaye iyimfuneko ukwalathisa iqela lohlangulo mhlawumbi ekukhutshweni ngokukhawuleza (kwimeko yokungabi nazingqondweni okanye ukonakala kwenye yee-VFs) okanye ukukhutshwa okuqhelekileyo kusetyenziswa IKED isixhobo sokukhupha.

Uvavanyo oluphambili: umthetho we-ABCDE

Emva kovavanyo olukhawulezayo kunye nokukhutshwa xa kuyimfuneko, uvavanyo oluphambili lwenziwa, olwahlulwe ngamanqaku amahlanu: A, B, C, D kunye no-E.

Indlela yoMoya kunye noLawulo loMnqonqo (umoya kunye nokuzinza komqolo wesibeleko)

UMphenduli wokuQala uzimisa entloko eyizinzisa ngesandla ngelixa iNkokeli yeQela isenza isicelo ikhola yomlomo wesibeleko. Inkokeli yeqela ihlola imeko yengqondo ngokubiza umntu kunye nokuseka ukudibana komzimba, umz. ngokubamba amagxa; ukuba imeko yengqondo itshintshile kubalulekile ukwazisa u-112 ngokukhawuleza.

Kwakhona kweli nqanaba, inkokeli yeqela ityhila isifuba sesigulane kwaye ihlolisise indlela yomoya, ibeka i-oro-pharyngeal cannula ukuba isigulane singekho zingqondweni.

Kubalulekile ukuba uhlale ulawula i-oksijini ekuhambeni okuphezulu (i-12-15 ilitha / umzuzu) kumntu osweleyo, njengoko uhlala ebonwa njenge-hypovolaemic shock.

B – Ukuphefumla

Ukuba isigulane asikwazi, emva kokulumkisa i-112, inkokeli yeqela iqhubela phambili ne-GAS (Khangela, Mamela, Zive) i-manuvre, esetyenziselwa ukuvavanya ukuba umntu uyaphefumla.

Ukuba akukho kuphefumla, i-BLS yakudala yenziwa ngokukhupha umoya kabini (mhlawumbi ngokudibanisa iflaski ezandisayo kwicylinder yeoksijini, iyenze ihambise ngesantya esiphezulu sokuhamba), ize idlulele kwisigaba C.

Ukuba ukuphefumla kukho okanye ukuba isigulane siyazi, imaski ibekwe, i-oksijini ilawulwa kwaye i-OPCS (Qaphela, i-Palpate, Mamela, Bala, i-Saturimeter) yenziwa.

Ngolu buchule, inkokeli yeqela ivavanya iiparitha ezahlukeneyo zesigulana: enyanisweni, ijonga kwaye ibambe isifuba ijonga ukuba akukho migongxo okanye into engaqhelekanga, imamele umoya ejonga ukuba akukho gurgles okanye ingxolo, ibala izinga lokuphefumla kwaye isebenzisa i-saturimeter ukuvavanya i-oksijini egazini.

C – Ukujikeleza

Kwesi sigaba, kuyajongwa ukuba ngaba isigulana sinaso na ukopha okukhulu okudinga ukopha ngoko nangoko.

Ukuba akukho ukopha okukhulu, okanye emva kokuba benziwe tamponaded, iiparamitha ezahlukeneyo malunga nokuhamba kwegazi, ukubetha kwentliziyo kunye nombala wolusu kunye nobushushu ziyahlolwa.

Ukuba isigulane kwisigaba B singenangqondo kwaye singaphefumli - emva kokwenza i-ventilations ezimbini - siqhubela phambili kwisigaba C, esibandakanya ukujonga ubukho be-carotid pulse ngokubeka iminwe emibini kwi-carotid artery kunye nokubala ukuya kwi-10 imizuzwana.

Ukuba akukho pulse siqhubela phambili kwi-cardiopulmonary resuscitation eyenziwa kwi-BLS ngokwenza i-massage ye-cardiac.

Ukuba kukho i-pulse kwaye akukho kuphefumula, ukuphefumla kuncediswa ngokwenza malunga ne-12 insufflation ngomzuzu kunye nebhaluni yokwandisa i-self-expanding cylinder ye-oksijini ehambisa ukuhamba okuphezulu.

Ukuba i-carotid pulse ayikho, uvavanyo oluphambili luyayeka kweli nqanaba. Isigulana esinolwazi siphathwa ngendlela eyahlukileyo.

Uxinzelelo lwegazi luvavanywa ngokusebenzisa i-sphygmomanometer kunye ne-radial pulse: ukuba okokugqibela akukho, ubuninzi (systolic) uxinzelelo lwegazi lungaphantsi kwe-80 mmHg.

Ukususela ngo-2008, izigaba ze-B kunye ne-C ziye zadityaniswa kwi-maneuvre eyodwa, ukwenzela ukuba ukuqinisekiswa kobukho be-carotid pulse ngexesha elifanayo kunye nokuphefumula.

D – Isiphene

Ngokungafaniyo novavanyo lokuqala apho imeko yengqondo ivavanywa kusetyenziswa I-AVPU isikali (abahlengikazi kunye noogqirha basebenzisa i Glasgow Coma Scale), kwesi sigaba isimo se-neurological somntu siyavavanywa.

Umhlanguli ubuza isigulana imibuzo elula evavanyayo

inkumbulo: uyabuza ukuba uyayikhumbula na into eyenzekayo;
i-spatio-temporal orientation: isigulane sibuzwa ukuba nguwuphi unyaka kwaye ingaba siyazi apho sikhoyo;
umonakalo we-neurological: bavavanya usebenzisa isikali seCincinnati.

E – Ukutyhileka

Kwesi sigaba kuhlolwa ukuba ngaba isigulane siye safumana ukwenzakala kakhulu okanye ngaphantsi.

Inkokeli yeqela ikhulula isigulana (ukusika iimpahla ukuba kuyimfuneko) kwaye yenza uhlolo ukusuka entloko ukuya ezinzwaneni, ukujonga nayiphi na inxeba okanye ukopha.

Umgaqo-nkqubo ufuna kujongwe amalungu esini nawo, kodwa oku kudla ngokungenzeki ngenxa yeminqweno yomguli okanye kuba kulula ukubuza umguli enoba uziva naziphi na iintlungu ngokwakhe.

Kukwanjalo nakwindawo apho iimpahla kufuneka zinqunyulwe; kunokwenzeka ukuba isigulane sichasene nale nto, kwaye ngamanye amaxesha abahlanguli ngokwabo banquma ukuba bangenzi ukuba isigulane sichaza intlungu, sihambisa amalungu akhe kakuhle kwaye siqinisekise ukuba akazange ahlupheke nakuphi na ukubethelwa kwindawo ethile yomzimba wakhe.

Ukulandela ukutshekishwa kwentloko yonyawo, isigulane sigqunywe ngelaphu lobushushu ukukhusela i-hypothermia enokwenzeka (kule meko, ukunyuka kweqondo lokushisa kufuneka kube ngokuthe ngcembe).

Ekupheleni kwesi sigaba, ukuba isigulane besisoloko sisazi, inkokeli yeqela inxibelelana nazo zonke iiparamitha ze-ABCDE kwiziko lokusebenza le-112, eliya kumxelela ukuba enze ntoni kunye nesiphi isibhedlele esithutha isigulane. Nanini na kukho utshintsho olukhulu kwiiparamitha zesigulane, inkokeli yeqela mayazise u-112 ngoko nangoko.

Uvandlakanyo lwesibini

Vavanya:

iintshukumo zomsitho;
indlela yokwenzakala;
imbali yesigulane. Emva kokugqiba uvavanyo oluphambili kunye nokulumkisa iNombolo eNgxamisekileyo yemeko, iziko lokusebenza lithatha isigqibo sokuba ngaba isigulane sithunyelwa esibhedlele okanye sithumele esinye isithuthi sokuhlangula, njenge-ambulensi.

Ngokwe-protocol ye-PTC, ukulayisha kwikholamu yomgogodla kufuneka kwenziwe nge-spoon stretcher; ezinye iincwadi kunye nabavelisi be-stretcher, nangona kunjalo, bachaza ukuba ukunyakaza okuncinci kunokwenzeka kwaye ngoko ke ukulayisha kwikholamu yomgogodla kufuneka kwenziwe nge-Log roll (zibophe iinyawo kunye kuqala), ukwenzela ukuba umva uphinde uhlolwe.

Inkxaso yobomi obuphezulu (ALS)

Inkxaso yobomi obuphezulu (ALS) yiprotocol esetyenziswa ngabasebenzi bezonyango kunye nabongikazi njengokwandiswa, kungekhona ukutshintshwa, inkxaso yobomi obusisiseko (BLS).

Injongo yale protocol kukubeka iliso kunye nokuzinzisa isigulane, kwakhona ngolawulo lwamachiza kunye nokuphunyezwa kweendlela ezihlaselayo, de kube sekufikeni esibhedlele.

E-Italiya, le ndlela yomthetho igcinelwe oogqirha kunye nabongikazi, ngelixa kwamanye amazwe, inokusetyenziswa ngabasebenzi abaziwa ngokuba 'ziiparamedics', umntu ochwepheshile ongekhoyo e-Itali.