Ukuxhatshazwa kwesifuba: iimpawu, ukuxilongwa kunye nokulawulwa kwesigulane esinokulimala okukhulu kwesifuba

By UCristiano Antonino On Mar 31, 2023

Umntu uya kufunyaniswa ukuba unokwenzakala esifubeni xa enokwenzakala kakhulu esifubeni

Ikwabizwa ngokuba yi-chest trauma, le meko iya kubangela ukukhubazeka kwaye ukufa kungenzeka njengesiphumo; ingowesithathu unobangela wokufa ngenxa yokwenzakala emzimbeni.

Ukuxhatshazwa kwesifuba kunokuthi kwenzeke ngenxa yeentlobo ezahlukeneyo zokulimala; phakathi kwezona zizathu zixhaphakileyo zokwenzakala kwesifuba ziingozi zendlela.

Ukwenzakala ngengozi okanye okunonya kunokubangela ukwenzakala kwethoracic

Ukulimala kwesifuba kubandakanya amanxeba okudutyulwa, kunokwenzeka kwakhona ngenxa yokuwa, emva kokuhlatywa, ukubethwa okanye ukubethwa.

Ukuxilongwa kunokwenziwa ngugqirha, ngokuqhelekileyo ngeX-reyi.

Ngokuqinisekileyo, i-thoracic trauma yenye yezona zihloko ezinzima kakhulu, kwaye kumanqaku anzulu kuya kukwazi ukufunda ngezinye iinkalo ezikhethekileyo: akunakwenzeka ukushwankathela isifundo kwisicatshulwa esinye.

Ukwenzakala kwesifuba kunokohlulwa kube ziindidi ezimbini:

Ixinzelelo, eyenzeka xa ixhoba lenzakala ngokwaphuka ulusu, njengemela esifubeni okanye inxeba lokudutyulwa;
Umonzakalo wokugruzuka kuya kubangela ukukrazuka okuthile kolusu, ukukrazuka ayingonobangela wokwenzakala ngokwawo kwaye umonakalo udla ngokuba ngaphantsi kwendawo. Ukukhatywa sisilwanyana esikhulu okanye ukuba kwi ingozi yemoto kunokubangela ukwenzakala okubuhlungu.

I-akhawunti ye-trauma ye-Blunt kwi-25% yabo bonke abafayo ngenxa yeemeko eziphuthumayo zonyango.

Ukuxhatshazwa kwesifuba kuya kubonisa iimpawu ezininzi, ezona ziqhelekileyo ziya kuba yintlungu enzima kunye nobunzima bokuphefumla.

Ezinye iimpawu ziya kubandakanya ukopha, ukothuka, ukuphefumla kancinci, ukopha, ukugruzuka kunye nokulahlekelwa zingqondo, okuya kwenzeka ngokuxhomekeke kunobangela wokwenzakala kwesifuba.

Ukuqhekeka kwamathambo kunokuthi kwenzeke ngenxa yokulimala kwethoracic.

Ukwenzakala kwesifuba kuya kunyangwa ngokuxhomekeke kunobangela

Kusenokufuneka ungenelelo lokucoca umgaqo womoya, kokubini kwimeko yokuwa kwemiphunga kunye nokuthintela umonzakalo ukuba ubangele umonakalo ombi kwaye ngaloo ndlela ubangele usulelo.

Ukwenzakala esifubeni kunokubangela iintlobo ezahlukeneyo zokwenzakala kwentliziyo, njengokungena emzimbeni wasemzini, ukugqabhuka, tamponade, i-laceration kunye ne-occlusion ye-coronary arteries, i-myocardial contusion, i-pericardial effusion, i-septal defects, izilonda ze-valvular, kunye nokuphuka kweenqanawa ezinkulu.

Ezi nzakala zidla ngokubulala.

Ukwenzakala kwentliziyo okugqobhozayo kudla ngokubangelwa zizixhobo ezibuthuntu okanye imipu kwaye kukhokelela kwinqanaba lokufa eliphakathi kwama-50% kunye nama-85%.

Uxinzelelo oluvaliweyo luhlala lunxulunyaniswa nokuqhekeka kwentliziyo, kunye ne-ventricle elungileyo ichaphazeleka ngokuphindaphindiweyo kunekhohlo, kwaye ikhokelela kwizinga lokufa elimalunga ne-50% kwizigulane ezifika kwi-ventricle. Igumbi loncedo olukhawulezayo uyaphila.

Ukulandela ukuphulwa kwegumbi lentliziyo okanye ukukrazula kwimibhobho ye-coronary okanye iinqanawa ezinkulu, igazi lizalisa ngokukhawuleza i-sac ye-pericardial kwaye ibangele i-tamponade ye-cardiac.

Nokuba nje i-60-100 ml yegazi inokubangela i-tamponade ye-cardiac kunye ne-cardiogenic shock, ngenxa yokunciphisa ukuzaliswa kwe-diastolic.

Amanxeba okugqobhoza agqobhoza kwingxowa ye-pericardial kwaye ngaphakathi entliziyweni abangela ukopha okukhawulezileyo, okulawula umfanekiso wekliniki.

I-cardiac tamponade elandela inxeba lokudutyulwa entliziyweni inyanyaniswa nokonyuka kokusinda ngenxa ye-systemic hypotension kunye noxinzelelo olwandayo kwindawo ye-pericardial, enceda ukunciphisa ukopha.

I-tamponade ye-cardiac isoloko ihambelana neempawu zekliniki ze-Beck's triad (i-jugular venous distension, i-hypotension kunye nokunciphisa iitoni zenhliziyo).

Esi sibini sisenokungabikho kwizigulana eziye zane-hypovolaemic ngenxa yokopha.

Ubungqina be-radiographic bokwandiswa kwesithunzi se-mediastinal sinokubonisa ukukhutshwa kwe-mediastinum kunye / okanye i-tamonade.

Ukuqinisekiswa kwe-pericardial effusion kunokubonelelwa nge-echocardiography.

I-thoracotomy yokuhlola ngokukhawuleza, kunye ne-cardiopulmonary bypass kunye nokulungiswa kokuhlinzwa, kunye nokumpontshelwa njengoko kufunwa yimeko yeklinikhi kuya kwenziwa.

Utshintsho lwe-anatomopathological yentliziyo ephazamisekileyo lubandakanya ukopha kwe-intramyocardial, i-myocardial edema, i-coronary occlusion, i-myofibrillar degeneration kunye ne-necrosis ye-myocardiocytes.

Ezi zilonda zikhokelela kwi-arrhythmias kunye nokungazinzi kwe-haemodynamic ezifana nezo zibonwa emva kwe-myocardial infarction.

Ukongezelela, i-intubation, i-ventilation okanye ezinye iindlela ze-oxygenation zingadingeka, kunye nokuhlinzwa, unyango lweziyobisi, ukuphumla ngokupheleleyo kwaye kwezinye iimeko unyango lomzimba.

Ngenxa yobunzima beentlungu, i-anesthetics yendawo iya kusetyenziswa ukunciphisa ubungakanani bentlungu.

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