Kubuyekezwe, kuhlawulelwe kunye nomothuko ongenakuguqulwa: into abayiyo kunye nento abayigqibayo
Ngamanye amaxesha, ukothuka kunzima ukuchonga kumanqanaba okuqala kwaye isigulana sinokutshintshela kumothuko othotyiweyo ngaphambi kokuba uqonde. Ngamanye amaxesha olo tshintsho lwenzeka ngaphambi kokuba sifike kwindawo
Kwezi meko, kufuneka singenelele kwaye singenelele ngokukhawuleza kuba ukusilela ukwenza oko kuya kubangela ukuba isigulana siqhubele phambili kumothuko ongenakuguquleka.
Amagama angcono okusetyenziswa xa kuchazwa umothuko kukutyhala kunye ne-hypoperfusion.
Xa siqhola ngokwanelisayo asipheleli nje ekuhambiseni ioksijini kunye nezondlo kumalungu omzimba, kodwa sikwasusa nenkunkuma yemetabolism ngesantya esifanelekileyo ngokunjalo.
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Kukho iindidi ezisibhozo zomothuko esinokudibana nazo:
- I-Hypovolemic - eyona nto ixhaphakileyo ukudibana nayo
- I-Cardiogenic
- Ukuthintela
- Isicatshulwa
- I-Neurogenic
- I-Anaphylactic
- I-Psychogenic
- Ukungoneliseki kokuphefumla
Izigaba ezithathu zomothuko: Ayinakuguqulwa, ibuyekezwe, kunye nomothuko obolileyo
Inqanaba loku-1 – Imbuyekezo yomothuko
Umothuko ohlawulelwayo sisigaba somothuko apho umzimba usenakho ukubuyisela ulwelo olupheleleyo okanye olunxulumeneyo.
Ngesi sigaba isigulana sisakwazi ukugcina uxinzelelo lwegazi olwaneleyo kunye nokuphazamiseka kwengqondo kuba inkqubo ye-nervous enovelwano inyusa izinga lentliziyo kunye nenqanaba lokuphefumla kwaye ikhuphe igazi kumbindi womzimba nge-vasoconstriction yemithambo yegazi kunye ne-microcirculation, i-precapillary. I-sphincters iyakuxinzelela kwaye icuthe ukuhamba kwegazi kwiindawo eziya kwiindawo zomzimba ezikwaziyo ukunyamezela ukuncipha kokuxutywa, umzekelo, ulusu.
Le nkqubo eneneni yonyusa uxinzelelo lwegazi ekuqaleni kuba kukho indawo encinci ngaphakathi kwinkqubo yokujikeleza kwegazi.
The iimpawu kunye neempawu zomothuko ohlawulelwayo ziquka:
- Ukungazinzi, ukuphazamiseka kunye nokuxhalaba - iimpawu zokuqala ze-hypoxia
- I-Pallor kunye ne-clammy isikhumba - oku kwenzeka ngenxa ye-microcirculation
- Isicaphucaphu kunye ukuhlanza -ukunciphisa ukuhamba kwegazi kwinkqubo ye-GI
- Okwesithathu
- Ukuzaliswa kwakhona kwe-capillary kulibazisekile
- Ukunciphisa uxinzelelo lwe-pulse
Inqanaba lesi-2 – Umothuko othotyiweyo
Umothuko othotyiweyo ichazwe njenge “Inqanaba lamva lokothuka apho iinkqubo zomzimba zokuhlawulela (ezifana nokubetha kwentliziyo eyonyukayo, ivasoconstriction, ukunyuka kwesantya sokuphefumla) zingakwazi ukugcina umchamo owaneleyo engqondweni nakumalungu abalulekileyo.”
Kwenzeka xa umthamo wegazi uyancipha ngaphezu kwe-30%.
Iindlela zembuyekezo zesigulane ziyasilela kwaye ukukhutshwa kwentliziyo kuyehla okukhokelela ekunciphiseni kokubili uxinzelelo lwegazi kunye nokusebenza kwentliziyo.
Umzimba uya kuqhubeka nokugxotha igazi ukuya kumbindi womzimba, ingqondo, intliziyo kunye nezintso.
Iimpawu kunye neempawu zomothuko othotyiweyo ziya zicaca ngakumbi kwaye ukwanda kwe-vasoconstriction kubangela i-hypoxia kwamanye amalungu omzimba.
Ngenxa yokuncipha kweoksijini ebuchotsheni isigulane siya kubhideka kwaye siphazamiseke.
The iimpawu kunye neempawu ukothuka okuthotyiweyo kubandakanya:
- Utshintsho kwisimo sengqondo
- Tachycardia
- I-Tachypnea
- Ukuphefumla nzima nokungaqhelekanga
- I-pulses ye-peripheral ibuthathaka ukuya kukungabikho
- Ukuncipha kobushushu bomzimba
- ICyanosis
Ngelixa umzimba uzama ukonyusa ukuhamba kwegazi ukuya kumbindi womzimba inkqubo ye-nervous enovelwano iphulukana nolawulo lwe-precapillary sphincters encedisa kwi-microcirculation ekhankanywe ngaphambili.
I-postcapillary sphincters ihlala ivaliwe kwaye oku kuvumela ukuxutywa kwegazi, okuya kuqhubela phambili kwi-disseminated intravascular coagulation (DIC).
Kwinqanaba lokuqala lo mbandela usalungiswa ngonyango oluqatha.
Igazi ngoku elidityanisiweyo liqala ukujiya, iiseli ezikuloo ndawo azisafumani izondlo kwaye i-anaerobic metabolism inoxanduva lokuvelisa i-adenosine triphosphate (ATP).
I-DIC iqala ngeli nqanaba kwaye iqhubeleka phambili ngexesha lomothuko ongenakulungiseka.
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Inqanaba lesi-3 – Umothuko ongenakuguquleka
Umothuko ongenakukwazi ukuguqulwa sisigaba sokuphela somothuko kwaye emva kokuba isigulane siqhubela phambili kwesi sigaba siyindawo yokungabuyi ngenxa yokuba kukho ukuwohloka ngokukhawuleza kwenkqubo ye-cardiovascular system kunye neendlela zokuhlawula isigulane asiphumelelanga.
Isigulana siya kubakho ngokuncipha okukhulu kwimveliso yenhliziyo, uxinzelelo lwegazi kunye nokuchithwa kwezicubu.
Kumzamo wokugqibela wokusindisa undoqo womzimba wegazi ukhutshelwa kude nezintso, isibindi kunye nemiphunga ukugcina i-perfusion yengqondo kunye nentliziyo.
impatho
Elona candelo libalulekileyo lonyango kukuqondwa kwesiganeko kunye nokusebenza ngokuqhubekayo ukuthintela ukuqhubeka komothuko.
Njengoko benditshilo ngaphambili, ukothuka kwe-hypovolemic yeyona ndlela ixhaphakileyo yokufumana ukothuka kwimeko yangaphambi kwesibhedlele.
Oku kunengqiqo, njengoko unobangela oqhelekileyo wokufa kwabantu abaneminyaka eyi-1-44 kukulimala okungenanjongo.
Ukuba isigulana sopha ngaphandle, siyazi ukuba kufuneka singenelele ngokukhawuleza ukuze sikwazi ukugcina igazi elininzi kwisitya kangangoko kunokwenzeka.
Ukuba isigulane sibonisa iimpawu zokuphuma kwegazi kwangaphakathi, kufuneka sithuthe kwiziko leentlungu zokungenelela ngokuhlinzwa.
I-oksijeni ephezulu ibonakaliswe, nangona isigulane sisathetha kwaye sine-pulse oximetry ye-94% okanye ngaphezulu.
Siyazi ukuba kule mizekelo ukuba kukho ukukrokra kwe-hypoxia engaphantsi kokuba i-oksijeni inokulawulwa kungakhathaliseki ukuba yintoni i-pulse oximetry ibonisa.
Gcina isigulana sakho sifudumele, ukwehla kobushushu bomzimba kuphazamisa amandla omzimba okulawula ukopha okwesibini ukuya kukungasebenzi kakuhle kweplatelet kwaye kukhokelela ekuqhekekeni okungafanelekanga kwamahlwili athe avela.
Kwaye okokugqibela, unyango lwe-intravenous ukugcina imeko ye-hypotension evumelayo. Oku kuthetha ukuba uxinzelelo lwegazi lwe-systolic kufuneka lube phakathi kwe-80- kunye ne-90-mmHG.
Siqhele ukusilela ukuya kuma-90-mmHg njengoko sifundiswa ukuba lutshintsho olusuka kwimbuyekezo ukuya kumothuko othotyiweyo.
Ibhalwe ngu: Richard Main, Med, NRP
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