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I-Polytrauma: inkcazo, ulawulo, isigulane esine-polytrauma esizinzile nesingazinzile

By UCristiano Antonino On Ngo-Apr 5, 2023

Nge "polytrauma" okanye "polytraumatised" kumayeza sithetha ngenkcazo isigulane esonzakeleyo esibonakalisa ukulimala okuhambelanayo kwiindawo ezimbini okanye ngaphezulu zomzimba (ukakayi, umqolo, ithorax, isisu, i-pelvis, imilenze) kunye nokukhubazeka kwangoku okanye okunokwenzeka kwemisebenzi. kubalulekile (ukuphefumla kunye/okanye ukujikeleza)

Polytrauma, oonobangela

Isizathu sezinto ezininzi ezibuhlungu ngokuqhelekileyo zidibaniswe nengozi enkulu yemoto kodwa naluphi na uhlobo lwesiganeko esibonakaliswe ngamandla okwazi ukungenelela kumanqaku amaninzi omzimba ofanayo luyakwazi ukubangela ukuxhatshazwa okuphindaphindiweyo.

Isigulane se-polytrauma sihlala sinzima okanye sinzima kakhulu.

Phakathi kwezigulana ezibulewe yi-polytrauma:

I-50% ye-polytraumas ifa kwimizuzwana okanye imizuzu yesiganeko, ngenxa yokuphuka kwentliziyo okanye iinqanawa ezinkulu, ukutyunjwa kwe-brainstem okanye i-cerebral hemorrhage enzima;
I-30% ye-polytraumas ifa ngexesha leyure yegolide, ngenxa ye-hemopneumothorax, ukothuka kwe-hemorrhagic, isibindi kunye ne-spleen rupture, i-hypoxemia, i-hematoma ye-extradural, ukufuduka komzimba kunye nokunyuka kwemeko yokuqala okanye ukungenelela kwezonyango okuphosakeleyo;
I-20% ye-polytrauma ifa kwiintsuku okanye iiveki ezilandelayo ngenxa ye-sepsis, iingxaki zokuphefumula, ukubanjwa kwenhliziyo, okanye ukungaphumeleli kwe-multiorgan (MOF).

Ukungenelela okuchanekileyo, ngexesha elifanelekileyo kunye noncedo oluthile luvumela ukwandisa amathuba okusinda komntu owenzakeleyo, ukunciphisa umngcipheko wokulimala kwesibini.

IZOLUHLI, IIBHODI ZOKUGQIBELA, IZIHLALI ZOKUPHUMELA IMIPHUMVU, IZIHLALO ZOKUPHUMA: IIMVELISO ZE-SPENCER KWI-DOUBLE BOOTH KWI-EXPO EXPO.

Ulawulo lwe-polytrauma

Ukuze ulungelelanise ulandelelwano olulandelwa liqela eliqhuba ukuhlangula, le yokugqibela ihlulwe ibe ngamanqanaba ahlukeneyo, abizwa ngokuba yi "rings", ezi zilandelayo:

Isigaba sokulungiselela kunye nesilumkiso - Kweli nqanaba, amaqela anoxanduva lokulungiswa ngokuchanekileyo kweendlela kunye nezibonelelo ezenza izinto eziyimfuneko. izixhobo. Iziko lemisebenzi linoxanduva, ngokwesiseko solwazi olukulo, lokwazisa iqela elifanelene kakhulu neemfuno.
Uvavanyo lwemeko kunye udidi – Ekufikeni, umphenduli ngamnye unoxanduva lokulawula ukhuseleko kunye novavanyo lomngcipheko. Izibophelelo ezisekwe ngumthetho zibandakanya ukuchongwa komphathi kunye nokwamkelwa kwezixhobo zokhuselo lomntu ekufuneka zinxitywe ngokuchanekileyo kwaye zisebenza ngokugqibeleleyo.
Iitshekhi eziphambili kunye nesekondari - Uvavanyo oluyimfuneko lwemisebenzi ebalulekileyo luhlala luhambelana nezenzo ezicetywayo Uncedo yokuqala kunye neeprothokholi zokuvuselela kunye nokulumkisa iiyunithi zokuhlangula eziphuculweyo (ALS). Olu lawulo luchongwa ngokufihlakeleyo nge-akhronimi IABCDE.
Unxibelelwano kunye neZiko lokuSebenza - Ngeli nqanaba, ngaphezu kokukhetha kunye nokwabela indawo ekuya kuyo, ithuba lokubiza ezinye iindlela zothutho okanye ukucwangcisa i-rendezvous kunye neqela le-ALS liqinisekisiwe.
Ukuthutha ngokubeka iliso - Ngeli nqanaba, ngaphezu kokubeka iliso ngokuqhubekayo kwimisebenzi ebalulekileyo yesigulane, iyunithi yesibhedlele inokubonelelwa ngolwazi kwiiparamitha ezibalulekileyo kunye nabo bonke abo bavumela ukuba isakhiwo silungele ukwamkela nokunyanga umntu owenzakele kakhulu.
Unyango lwezempilo esibhedlele.

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Kukho umgaqo obalulekileyo kunye olula wesithupha wokukhumbula indlela yokubonelela ngononophelo kwisigulane se-polytrauma, ngokusekwe kwiileta ezimbalwa zokuqala zealfabhethi:

Iindlela zomoya: okanye “indlela yokuphefumla”, njengokulawula ipatency yayo (okt ukuba nokwenzeka kokudlula komoya kuyo) imele eyona meko yokuqala kunye neyona meko ilindelekileyo yokuphila kwesigulana;
Ukuphefumla: okanye "ukuphefumula", okujoliswe "njengomgangatho wokuphefumula"; ihambelana nenqaku langaphambili, iphuculwe ngokubaluleka kwekliniki ye-neurological, njengoko ezinye izilonda zengqondo zinika iimpawu zeendlela zokuphefumla (okt ukuba ingakanani / kangakanani / indlela isigulane esenza ngayo izenzo zokuphefumla), njengomzekelo wokuphefumla kwe-Cheyne-Stokes;
Ukujikeleza: okanye "ukujikeleza", njengoko ngokucacileyo ukusebenza ngokuchanekileyo kwenkqubo ye-cardiovascular system (kunye namanqaku amabini angaphambili i-cardio-pulmonary) ibalulekile ukuze uphile;
Ukukhubazeka: okanye "ukukhubazeka", kubaluleke ngakumbi ukuba kukho ukukrokrelwa Umgudu isilonda okanye ngaphezulu ngokubanzi kwinkqubo ye-nervous central, njengoko kunokwenzeka ukuba izilonda kwesi sithili zibangele imeko yokothuka, ekuthi, kwizigaba zayo zokuqala, ayinakubonwa ngaphandle kweliso lengcali, kwaye "ithe cwaka" ukuzisa i-polytraumatised. ukufa (ayikho into eyenzekayo ukuba ngamanye amaxesha sithetha ngokutshatyalaliswa komgogodla);
Ukuvezwa: okanye "ukuvezwa" kwesigulane, ukumkhulula ekhangela nakuphi na ukwenzakala, ngelixa ukhusela ubumfihlo kunye nobushushu (inokutolikwa njenge-E-nviroment).

Uncedo lokuqala, indlela yokujongana ne-polytrauma

Kanye kwi Igumbi loncedo olukhawulezayo, isigulane se-polytraumatised siya kujongwa kuzo zonke iitshekhi ezifunwa yimigaqo ye-trauma.

Ngokuqhelekileyo, uvandlakanyo lwesibini lokwenzakala, iigesi zegazi, kunye nekhemistri yegazi kunye neqela legazi lwenziwa lulandelwa luphando lwe-radiological, oluya kuxhomekeka kwiqondo lokuzinza kwe-hemodynamic.

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Isigulane se-polytrauma ezinzileyo

Ukuba isigulana sinozinzo lwe-haemodynamically, ukongeza kuphando olusisiseko lwe-ecoFAST, ii-x-reyi zesifuba kunye ne-pelvis, uphando lwe-CT yomzimba wonke lunokwenziwa, zombini ngaphandle kunye ne medium medium, enokuthi iqaqambise izilonda ze-neurological kunye nemikhumbi emikhulu.

Uphando lokuxilonga ngeradiyoloji olwenziwa kwipolytrauma eqinileyo ene-hemodynamically stable ngokubanzi:

I-FAST ultrasound;
X-reyi yesifuba;
x-reyi ye-pelvis;
ukhakhayi CT;
umqolo wesibeleko CT;
isifuba CT;
I-CT yesisu.

Uphando olunzulu ngakumbi olufana ne-angiographies kunye ne-magnetic resonance lunokwenziwa; ngokukodwa, i-MRI yenziwa kumqolo ukuba izilonda ze-myelic (ze-spinal cord) zikrokrelwa, ekubeni i-CT ibonisa i-bony inxalenye yomqolo kwaye ayilophando oluluncedo lokufunda intambo yomgogodla.

I-MRI inokwenziwa kwakhona kwisifundo se-fossa ye-cranial yangasemva, kwaye ngokukodwa kwi-hematomas efihlakeleyo, engagxininiswanga ngokwanelisayo kwi-CT.

Ii-X-reyi zamalungu zidla ngokuqhutywa ekupheleni kwezi mvavanyo zingasentla.

I-x-ray yomqolo wesibeleko ayiloncedo kwisifundo esinzulu sezilonda zethambo, njengoko ingagqamisi ngokucacileyo i-C1 kunye ne-C2 vertebrae kwaye ayiyi kukwanela ukuqonda indawo ye-vertebral fracture.

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Isigulane se-polytrauma engazinzanga

Ukuba isigulana esine-polytraumatised hemodynamically azinzanga, umzekelo ngenxa yokopha okusebenzayo kwangaphandle okanye kwangaphakathi (okanye zombini), okungakhange kusonjululwe emva kokusetyenziswa kweekristale, iicolloids kunye/okanye iplasma engumkhenkce negazi elitsha, isigulana asiyi kuphanda ngeCT, kodwa uphando olusisiseko kwaye emva koko luya kwenziwa utyando ukusombulula iingxaki ezibangela ukungazinzi.

Ukuba isigulane sifika kwi-ED singazinzile kodwa emva koko izinzile ngokusebenzisa izixhobo zonyango, iqela le-trauma linokuqwalasela ukuba lenze uphando olunzulu (njenge-CT). Ngokukodwa, uphando lwe-radiological olwenziwa kwisigulane esine-polytrauma engazinzanga (ehlala ingazinzile emva konyango) ngokubanzi iquka: -ultrasound (mhlawumbi i-FAST) -isifuba i-X-ray -i-pelvis X-ray -i-cervical spine X-ray I-Cervical spine X- ray ayisoloko yenziwa .

Emva kophando

Ekupheleni kwalo lonke uphando lokuxilonga, isidingo sotyando sivavanywa kwisigulane esizinzileyo okanye imisebenzi enokwenzeka icwangciselwe iintsuku ezilandelayo.

Isigulane esingazinzanga sithathwa ngokubanzi sisiwe kwigumbi lotyando ekupheleni kophando olusisiseko kwaye siya kwenziwa uphando olunzulu ekupheleni kotyando kwaye mhlawumbi kuqhaqho lwesibini kwiintsuku ezilandelayo.

Izigulana zePolytrauma zihlala zimkelwa kwiiyunithi zokhathalelo olumandla, ezaziwa nje ngokuba “lukuvuselela” okanye iiyunithi zokhathalelo olunzulu lwe-neurosurgical.