INqanaba eliTshintshiweyo loNgxamiseko lweNgxaki (ALOC): ukwenza ntoni?

By UCristiano Antonino On Jan 18, 2023

Inqanaba elitshintshiweyo lokuqonda (ALOC) yisixhenxe esixhaphakileyo esixhaphakileyo ukuba iingcali ze-EMS ziphendule, zibalelwa phantse i-7% yazo zonke iifowuni ze-EMS.

Inqanaba lokuqonda elitshintshiweyo (ALOC) lithetha ukuba awuphaphanga, uphaphile, okanye awukwazi ukuqonda njengesiqhelo. I-ALOC inokubangelwa kukwenzakala entloko, amayeza, utywala, iziyobisi, ukuphelelwa ngamanzi emzimbeni, kunye nezinye izifo, ezifana nesifo seswekile.

Amanqanaba ahlukeneyo e-ALOC abandakanya:

Ukudideka: Uphazamiseka ngokulula kwaye unokucotha ukuphendula. Usenokungazi ukuba ungubani na okanye uphi okanye ixesha losuku okanye lonyaka.

waphazamiseka: unokubhideka okukhulu kunye nokudideka kwaye unokuba neenkohliso (ukukholelwa kwizinto ezingezizo zokwenyani) okanye ukubona izinto ezingekhoyo (ukuva izinto ezingezizo ezenyani). Iqondo lokubhideka linokuba ngcono okanye libe mbi ngokuhamba kwexesha.

Ndilele: ulele ngaphandle kokuba uvuswa ngumntu okanye into. Ungahlala uthethe kwaye ulandele izikhokelo, kodwa unokuba nengxaki yokuhlala uphaphile.

Uvaleleke okanye utyhafile: udiniwe kwaye awunalwazi kangako okanye awunamdla kangako kwindawo okuyo.

Stupor: usebuthongweni obunzulu ngaphandle kokuba uvuswe yinto engxolayo okanye ebuhlungu. Usenokungakwazi ukuthetha okanye ukulandela izikhokelo kakuhle, kwaye uya kulala kwakhona xa ushiywe wedwa.

Isiqaqa: ulele, kodwa awunakuvuswa konke konke.

I-stupor kunye ne-coma zireyithwa ngokobunzima beempawu.

UQEQESHO: TYELELA I-BOOTH YE-DMC DINAS MEDICAL CONSULTANTS KWI-EXPO EXPO.

INqanaba eliGuquliweyo leNgqondo Inkcazo

Inqanaba lengqondo ngumlinganiselo wokuphendula komntu kwimpembelelo evela kwindalo.

Umgangatho wengqondo otshintshiweyo nguwo nawuphi na umlinganiselo wokuvuselela okanye ukuvuselela ngaphandle kwesiqhelo.

Inqanaba eliphantsi lodandatheko lokuphaphile lisenokuchazwa njengolutyhafileyo, imeko apho umntu anokuthi avukwe ngobunzima obuncinane.

Abantu abangaboniyo banenqanaba lokudakumba ngakumbi kwaye abanakuvuswa ngokupheleleyo.

Abo bangakwaziyo ukuvuswa kwimeko yobuthongo kuthiwa balala.

I-Coma kukungakwazi ukwenza nayiphi na impendulo enenjongo.

Izikali ezifana ne Isikali se-coma saseGlasgow ziyilelwe ukulinganisa inqanaba lokuziva.

I-ALOC inokubangelwa yimiba eyahlukeneyo, kubandakanywa utshintsho kwimichiza yobuchopho (umzekelo, ukuvezwa yityhefu okanye iziyobisi), ioksijini enganelanga okanye ukuhamba kwegazi engqondweni, okanye uxinzelelo olugqithisileyo kwingqondo.

Ukungabikho zingqondweni ixesha elide luphawu lwengxakeko yonyango.

Ukusilela kwinqanaba lokuqonda kunokuthetha ukuba i-cerebral hemispheres okanye inkqubo ye-reticular activating yenzakele.

Ukuncipha komgangatho wokuqonda kuhambelana nokunyuka kokugula (ukugula) kunye nokufa (ukufa). I-ALOC ngumlinganiselo oxabisekileyo wemeko yezonyango neyemithambo-luvo yesigulana.

Abanye oogqirha bakugqala ukuba sezingqondweni ngomnye wemiqondiso ebalulekileyo, kunye nobushushu bomzimba, uxinzelelo lwegazi, nokubetha kwentliziyo.

Umgangatho otshintshileyo wengqondo unokuthatha iindlela ezininzi.

Ngokubanzi, iimpawu ze-ALOC zibandakanya xa isigulane singenzi njengesiseko sabo, sibonakala sididekile kwaye sididekile, okanye singenzi ngokuqhelekileyo.

Isigulana sinokubonakala singekho zingqondweni yaye sisenokuba buthathaka, sibe nesiyezi, okanye sibe nesiqaqa.

Isigulana sisenokuba besithetha sodwa okanye besibona izinto ezingekhoyo.

Isigulana sinokubonakala silumkile kakhulu, sikhathazekile, sibhidekile, okanye sididekile.

Irediyo YABAhlanguli Behlabathi? TYELELA I-RADIO EMS BOOTH KWIMBONISO KAXAKEKA

Iimbangela ze-ALOC

I-ALOC inokubangelwa zezi meko zilandelayo:

uhlobo	imizekelo
Usulelo	• Ukukrala kwemiphunga • Usulelo lomjelo womchamo • I-Meningitis okanye i-encephalitis • I-Sepsis
Metabolic/netyhefu	• I-Hypoglycemia • Ukusela utywala • Izinto ezingaqhelekanga ze-Electrolyte • I-Hepatic Encephalopathy • Iziphazamiso zedlala lengqula • Ukuyeka utywala okanye iziyobisi
Ngengqondo	• Istroke okanye uhlaselo lwe-ischemic oludlulayo • Ukuxhuzula okanye imeko yeposi • I-Subarachnoid hemorrhage • Ukopha kwi-Intracranial • Ukonakala kwemithambo-luvo kumbindi • I-hematoma engaphantsi
I-Cardiopulmonary	• Ukungaphumeleli kwentliziyo • Imyocardial infarction • I-Pulmonary embolism • I-Hypoxia okanye i-CO2 narcosis
Okunxulumene neziyobisi	• Amachiza e-Anticholinergic • Ukuyeka utywala okanye iziyobisi • Izithomalalisi-hypnotics • I-narcotic analgesics • I-Polypharmacy

Utsalelwa nini iNombolo kaNgxamiseko ye-ALOC

Ngokutsho kwe-American College of Emergency Physicians, i-ALOC okanye utshintsho kwimeko yengqondo yimpawu ezilumkiso zongxamiseko lwezonyango, kwaye kufuneka ubize iNombolo yoNgxamiseko.

Fowunela iNombolo kaNgxamiseko ukuba ufumana i-ALOC kwaye uwedwa.

Musa ukuziqhubela esibhedlele ukuba uqaqanjelwa kakhulu esifubeni okanye ukopha kakhulu okanye ukuba umbono wakho awuboni kakuhle.

Ukuthatha iigulane ikhuselekile ngakumbi kuba i-paramedics inokunikezela ngononophelo olusindisa ubomi kwindlela eya esibhedlele.

Ukuba omnye umntu ubonisa iimpawu ze-ALOC okanye isimo sengqondo esitshintshileyo, fowunela iNombolo yoNgxamiseko ngoko nangoko.

UKUTSHINTSHWA KWE-CARDIOPULOTE KUNYE NOKUVUSELELWA KWEZIBOPHELELE? NDWENDWELA EMD112 BOOTH KWIMBONAKALO YONXAKEKO NGOKU UKUFUNDA OKUNGAKUMBI

Indlela yokuNyanga i-ALOC

Zonke iziqendu ze-ALOC zifuna ukuqwalaselwa ngononophelo, ngakumbi kwiiyure ezingama-24 zokuqala.

Izigulana ze-ALOC ziya kufuna ukulaliswa esibhedlele ukuze kubekwe iliso, uvavanyo kunye nonyango.

Xa uvavanya isigulana kwisimo sengqondo esitshintshileyo, kubalulekile ukuqokelela imbali yesigulana kangangoko kunokwenzeka kwaye wenze uvavanyo lomzimba olupheleleyo lwentloko ukuya kwinzwane.

Ekubeni izigulane zihlala zingakwazi ukubonelela ngembali yazo ngenxa yemeko yazo etshintshileyo, irekhodi kufuneka lifunyanwe kwilungu lentsapho okanye kwiziko lonyango ukuze libone imeko yabo yengqondo esisiseko.

Kufuneka uphonononge imbali yeyeza lomguli kwirekhodi yonyango ye-elektroniki (EMR) okanye ubize ikhemesti.

Izigulana ze-ALOC ziya kujongwa rhoqo kwaye zijongwe rhoqo ngezi mpawu zilandelayo:

Ukubetha kwentliziyo, uxinzelelo lwegazi, kunye nobushushu
Inqanaba le-oxygen yegazi
Amandla, uluhlu lwentshukumo, kunye nokukwazi ukuva intlungu

Uvavanyo lwe-ALOC lunokubandakanya:

Uvavanyo lwegazi ukujonga iswekile yegazi, inqanaba le-oxygen, ukuphelelwa ngamanzi emzimbeni, usulelo, iziyobisi, okanye utywala
Igazi, umchamo, kunye nezinye iimvavanyo ukujonga umsebenzi wamalungu ahlukeneyo
Uvavanyo lwe-Neurologic ukujonga amandla, imvakalelo, ibhalansi, i-reflexes kunye nememori
I-Computed tomography (CT) scan ukujonga ukwenzakala kwengqondo okanye izifo zengqondo
I-Magnetic resonance imaging (MRI) ukujonga ukwenzakala kwengqondo okanye izifo zengqondo
X-reyi zesifuba ukujonga iingxaki zemiphunga

Unyango lwe-ALOC luxhomekeke kunobangela walo, iimpawu, impilo yonke yesigulane, kunye nazo naziphi na iingxaki. Izigulana ze-ALOC zinokulindela:

I-IV catheter efakwe kwi-vein esandleni okanye engalweni yabo
Ityhubhu yeoksijini ebekwe phantsi kweempumlo zabo okanye imaski yeoksijini ebekwe phezu kobuso babo
Amayeza amiselweyo: a) Ukunyanga okanye ukuthintela usulelo b) Ukunciphisa ukudumba ngaphakathi nangaphakathi kwengqondo kunye Umgudu intambo c) Lawula izinga leswekile egazini

Ungamnceda njani umntu one-ALOC?

Ababoneleli ngezempilo baya kufuna ukwazi malunga nembali yempilo yesigulana se-ALOC.

Ukuba isigulane asikwazi ukubonelela ngolu lwazi, umkhathaleli onolwazi kufuneka abekho.

Xelela iqela lezempilo ngayo nayiphi na kwezi meko zilandelayo:

Ukuxhuzula okanye ukuxhuzula
Ukopha ngeendlebe okanye impumlo
Intetho edibeneyo
Inkathazo ngokunyakaza kwemisipha, njengokugwinya, ukuhamba kweengalo kunye nemilenze
Utywala
Ukudideka
Utshintsho embonweni, njengokubona kabini, ukubona luzizi, okanye ingxaki yokubona ngeliso elinye okanye omabini
Ukungabi naso
Ukutshatyalaliswa
Ingxaki yokuhlala uthe qwa okanye uthe qwa
Ukuvutha
Intloko engayi kuhamba emva konyango
Ukukhathala
Ukulahleka kwebhalansi okanye ulungelelwaniso
Ukuphulukana nenkumbulo
Ukuziphatha okungaqhelekanga

Ii-EMTs kunye neeParamedics ziyiphatha njani i-ALOC

Kuzo zonke iimeko ezingxamisekileyo zeklinikhi, isinyathelo sokuqala luvavanyo olukhawulezayo nolucwangcisiweyo lwesigulane.

Kolu vavanyo, uninzi lwababoneleli be-EMS baya kusebenzisa i IABCDE indlela.

Indlela ye-ABCDE (i-Airway, ukuphefumla, ukujikeleza, ukukhubazeka, ukuvezwa) iyasebenza kuzo zonke iimeko eziphuthumayo zeklinikhi ukuze kuhlolwe ngokukhawuleza kunye nonyango. Ingasetyenziswa esitratweni kunye okanye ngaphandle kwayo nayiphi na izixhobo.

Inokusetyenziswa nakwifomu ephucukileyo apho iinkonzo zonyango ezingxamisekileyo zifumaneka, kubandakanywa amagumbi angxamisekileyo, izibhedlele, okanye amaziko onyango olungxamisekileyo.

IZOLUHLI, IZIXHOBO ZEMIPHUMVA, IZIHLALO ZOKUPHUMA: IIMVELISO ZESPENSER KWI-DOUBLE BOOTH KWI-EXPO EXPO.

IziKhokelo zoNyango kunye neZibonelelo zabaFundi bokuqala boNyango

Izikhokelo zonyango kwizinga eliguquliweyo lokuqonda zifumaneka kwiphepha le-66 le-National Model EMS Guidelines Clinical yi-National Association of State EMT Official (NASEMSO).

I-NASEMSO igcina ezi zikhokelo ukuququzelela inkqubo ye-EMS ye-EMS yelizwe kunye nezikhokelo zeklinikhi, iiprothokholi, kunye neenkqubo zokusebenza.

Ezi zikhokelo mhlawumbi zisekelwe kubungqina okanye zisekelwe kwimvumelwano kwaye zenziwe ukuba zisetyenziswe ngabasebenzi be-EMS.

Izikhokelo ziquka olu nyango lulandelayo kunye nongenelelo:

Khangela izizathu ezinyangekayo zesimo sengqondo esitshintshileyo:

Indlela yomoya – Qinisekisa ukuba indlela yomoya ihlala ikwi patent; beka kwakhona isigulana njengoko kuyimfuneko
Ukuphefumla - Khangela ukudakumba kokuphefumula; khangela i-SPO2, i-ETCO2, kunye nokufundwa kwe-CO detector
Ukujikeleza – Jonga iimpawu zomothuko
Amanqaku eGlasgow Coma kunye/okanye I-AVPU
Abafundi
Neck ubulukhuni okanye intlungu enoluhlu lwentshukumo
Isixhobo se-Stroke
Inqanaba leglucose yegazi
I-EKG – iArrhythmia iyanqanda ukuthululwa kwamanzi
Ivumba lokuphefumula - Ukuvumba okungaqhelekanga okunokwenzeka kubandakanya utywala, i-acidosis, i-ammonia
Isifuba / Isisu-I-Intra-thoracic hardware, izixhobo zokuncedisa, intlungu yesisu okanye ukuxhatshazwa
Iziphelo / ulusu-Amanqaku okulandelela, ukufakwa kwamanzi, i-edema, i-dialysis shunt, ubushushu bokubamba (okanye ukuba unako, sebenzisa i-thermometer)
Okusingqongileyo – Uvavanyo lweepilisi, izinto eziluncedo, ubushushu bendawo

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IProtocol ye-EMS yeeNgxaki ze-ALOC

Iiprotokholi zonyango lwangaphambi kwesibhedlele lwenqanaba elitshintshileyo lokuqonda ziyahluka ngumnikezeli we-EMS kwaye zinokuxhomekeka kwiimpawu zesigulane okanye kwimbali yonyango.

Vavanya imeko ngengozi enokwenzeka okanye yokwenyani. Ukuba indawo leyo/imeko ayikhuselekanga, buyela kwindawo ekhuselekileyo, yenza indawo ekhuselekileyo, kwaye ufumane uncedo olongezelelweyo kwi-arhente yamapolisa. Izigulana eziphazamiseke ngokwasemoyeni kufuneka kucingelwe ukuba zinemeko yonyango esisiseko okanye ebuhlungu ebangela ukuguqulwa kwesimo sengqondo. Zonke izoyikiso zokuzibulala okanye zobundlobongela okanye izijekulo kufuneka zithathelwe ingqalelo. Ezi zigulana kufuneka zibe selugcinweni lwamapolisa ukuba zibeka ingozi kuzo okanye kwabanye. Ukuba isigulana sibeka ingozi kuso kunye/okanye kwabanye, fowunela amapolisa afumane uncedo.

2) Yenza uvavanyo oluphambili. Qinisekisa ukuba umzila womoya wesigulana uvulekile kwaye ukuphefumla nokuhamba kwegazi ngokwaneleyo. Ukufunxa njengoko kuyimfuneko.

I-3) Ukulawula i-oksijeni ephezulu yoxinzelelo. Ebantwaneni, i-oxygen e-humidified ikhethwa.

4) Fumana kwaye urekhode iimpawu ezibalulekileyo zesigulana, kubandakanywa nokumisela inqanaba lokuqonda kwesigulane. Vavanya kwaye ubeke iliso kwi-Glasgow Coma Scale.

Ukuba isigulane asiphenduli okanye siphendule kuphela kwi-stimuli ebuhlungu, lungiselela ukuthutha ngelixa uqhubeka nokunyamekela.
Ukuba isigulane sinomlando owaziwayo wesifo sikashukela esilawulwa ngamayeza, uyazi, unokusela ngaphandle koncedo, unikeze isisombululo se-glucose yomlomo, i-juice yesithelo, okanye i-soda engeyiyo yokutya ngomlomo, ngoko ukuthutha, ukugcina isigulane sifudumele. Ukuba kuvunywe ngokwengingqi ukufumana amanqanaba eglucose egazini usebenzisa iglucometer, landela iprotocol yakho evunyiweyo kwingingqi.
Ukuba isigulana sikrokrelwa ukuba sigqithise i-opioid:

a) Ukuba isigulane asiphenduli kwi-stimuli yomlomo, kodwa mhlawumbi iphendule kwi-stimuli ebuhlungu okanye ayiphenduli; kwaye

b) Ukuphefumla ngaphantsi kwe-10 / umzuzu kunye neempawu zokungaphumeleli kokuphefumula okanye ukubanjwa kokuphefumula, bhekisa kwiprotocol efanelekileyo yokuphefumula.

c) Ukuba ummandla uvunyiwe kwaye uyafumaneka, fumana inqanaba leglucose yegazi (BG) yesigulana.

Ukuba i-BG ingaphantsi kwama-60, kubantu abadala kunye nezigulane zabantwana, landela i-IV ngasentla.
Ukuba i-BG ingaphezulu kwama-60 kubantu abadala kunye nezigulane zabantwana, qhubela phambili kwisinyathelo esilandelayo.

d) Lawula i-naloxone (Narcan®) ngesixhobo se-atomizer ye-mucosal (MAD).

Izithintelo ezinxulumeneyo:

Ukubanjwa kweCardiopulmonary
Umsebenzi wokubamba ngexesha lesi siganeko
Ubungqina bokwenzakala ngeempumlo, ukuvaleka kweempumlo kunye/okanye ne-epistaxis

Faka i-MAD kwimpumlo yasekhohlo yesigulana kunye ne:

OMDALA: tofa i-1mg/1ml
PEDIATRIC: tofa i-0.5mg/05ml

Faka i-MAD kwimpumlo yasekunene yesigulana kunye ne:

OMDALA: tofa i-1mg/1ml
PEDIATRIC: tofa i-0.5mg/05ml

e) Qalisa ezothutho. Emva kwemizuzu ye-5, ukuba izinga lokuphefumula kwesigulane alikho ngaphezu kwe-10 ukuphefumula / umzuzu, lawula umthamo wesibini we-naloxone ngokulandela inkqubo efanayo nalapha ngasentla kwaye uqhagamshelane nolawulo lwezonyango.

f) Ukuba imeko yezonyango okanye eyonzakeleyo ebangela ukuguqulwa kwesimo sengqondo ayibonakali, isigulana sinolwazi olupheleleyo, sithe qwa, kwaye siyakwazi ukunxibelelana; kunye nokuphazamiseka kweemvakalelo kurhanelwa, qhubela phambili kwi-protocol ye-Behavioral Emergency protocol.

g) Uthutho oluya kwesona sakhiwo sikufutshane nesifanelekileyo ngelixa kuhlolwa kwakhona iimpawu ezibalulekileyo rhoqo ngemizuzu emi-5 kwaye kuphononongwe kwakhona njengoko kuyimfuneko.

h) Bhala zonke iinkcukacha zokhathalelo lwesigulane, kubandakanywa nembali yonyango yesigulane kunye nalo lonke unyango olunikeziweyo, kwiNgxelo ye-Prehospital Care Report (PCR).