I-Chest trauma, isishwankathelo sesithathu esibangela unobangela wokufa ngenxa yokwenzakala emzimbeni

By UCristiano Antonino On Ngo-Apr 21, 2023

Ukwenzakala kwesifuba yenye yezona meko zixhaphakileyo zoncedo lokuqala kunye nabasebenzi be-ambulensi yongenelelo lwezonyango: kufuneka kwaziwe ngokuchanekileyo, ke ngoko.

Umntu uyakufunyaniswa ukuba unokwenzakala esifubeni xa wonzakele kakhulu esifubeni, kwaye kufuneka kufunyaniswe ngokuchanekileyo, kuba ngunobangela wesithathu wokusweleka ngenxa yokwenzakala emzimbeni kumazwe aseNtshona.

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

Ukuxilongwa kunokwenziwa ngugqirha, ngokuqhelekileyo ngeX-reyi.

Ukwenzakala kwesifuba kunokohlulwa kube ziindidi ezimbini:

Ukwenzakala okugqobhozayo okwenzeka xa ixhoba lifumana ukwenzakala okwaphuka 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 kwingozi yemoto kunokubangela ukwenzakala okubuhlungu.

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

Ukwenzakala kwesifuba kuya kubonisa iimpawu ezininzi, eyona ixhaphakileyo yintlungu engathethekiyo kunye nobunzima bokuphefumla

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

Amathambo aphukileyo anokuthi avele ngenxa yokulimala kwethoracic.

Ukwenzakala kwesifuba kuya kunyangwa ngokuxhomekeke kunobangela; ungenelelo lunokufuneka ukuze kucinywe umgaqo womoya, nokuba kukwimeko yokuwa kwemiphunga okanye ukuthintela umonzakalo ukuba ubangele umonakalo ombi kakhulu kwaye oko kubangele usulelo.

Ukuxhatshazwa kwesifuba kunokubangela iintlobo ezahlukeneyo zokulimala kwentliziyo, njengokungenwa komzimba wangaphandle, ukugqabhuka, i-tamonade, i-laceration kunye nokuvalwa kwe-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 eembumbulu angena kwingxowa ye-pericardial kwaye ngaphakathi entliziyweni akhokelela ukopha okukhawulezayo, 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.

Intubation, i-ventilation okanye ezinye iindlela ze-oxygenation nazo zingafuneka; utyando, unyango lweziyobisi, ukuphumla ngokupheleleyo kwaye kwezinye iimeko unyango lomzimba lunokuba yimfuneko.

Ngenxa yobunzima beentlungu, i-anesthetics yendawo iya kusetyenziswa ukunciphisa ubungakanani bentlungu. I-analgesics iya kulawulwa yi-epidural.

Izigulana ezingapheliyo okanye ezingenakuphulukiswa zinokubonelelwa nge-self-control infusion ukuze zisetyenziswe kwimfuno yokulawula intlungu.