Kwimothuko ye-neurogenic, i-vasodilation iyenzeka ngenxa yokulahleka kwebhalansi phakathi kwe-parasympathetic kunye novelwano lokuvuselela.

Yintoni iNeurogenic Shock?

Ukutshatyalaliswa kwe-Neurogenic luhlobo olusasazayo lokutshatyalaliswa.

Kwi-neurogenic shock, i-vasodilation iyenzeka ngenxa yokulahleka kokulinganisela phakathi kwe-parasympathetic kunye nokuvuselela imfesane.

Luhlobo lokuphazamiseka (imeko yonyango esongela ubomi apho kungabikho ukuhamba kwegazi okwaneleyo kuwo wonke umzimba) okubangelwa ukulahlekelwa ngokukhawuleza kweempawu ezivela kwinkqubo ye-nervous system enovelwano egcina ithoni ye-muscle eqhelekileyo kwiindonga zemithambo yegazi.

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

Isigulana sifumana oku kulandelayo okukhokelela kumothuko we-neurogenic:

• Ukuvuselela. Ukuvuselela ngovelwano kubangela ukuba i-vascular smooth muscle ixinzelele, kwaye i-parasympathetic stimulation ibangela ukuba i-vascular smooth muscle ikhululeke okanye ivule.
• I-Vasodilation. Isigulane sifumana i-parasympathetic stimulation eyona nto ibangela ukuba i-vasodilation ihlale ixesha elide, ekhokelela kwisihlobo se-hypovolemic state.
• Uxinzelelo lwegazi. Umthamo wegazi ufanelekile, kuba i-vasculature iyancipha; umthamo wegazi uyafuduswa, uvelisa imeko ye-hypotensive (i-BP ephantsi).
• Utshintsho lwentliziyo. I-parasympathetic stimulation engaphezulu eyenzeka nge-neurogenic shock ibangela ukwehla okukhulu kwi-systemic vascular resistance yesigulane kunye ne-bradycardia.
• Ukuthambisa okungonelanga. Ukungonelanga kwe-BP kubangela ukunyanzeliswa okwaneleyo kwezicubu kunye neeseli eziqhelekileyo kuzo zonke iimeko zokothuka.

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

Umothuko weNeurogenic unokubangelwa zezi zilandelayo:

• Umqolo ukwenzakala kwentambo. Ukulimala komgogodla (SCI) kubonwa ukuba kubangele i-hypotension kunye ne-bradycardia (i-neurogenic shock).
• I-anesthesia yomqolo. I-anesthesia yomgogodla-i-injection ye-anesthetic kwindawo ejikeleze intambo yomgogodla-okanye ukuqhawulwa kwentambo yomgogodla kubangela ukuhla koxinzelelo lwegazi ngenxa yokuhlanjululwa kwemithambo yegazi kwindawo esezantsi yomzimba kunye nokunciphisa ukubuya kwe-venous. intliziyo.
• Isenzo soxinzelelo lwamayeza. Isenzo soxinzelelo samayeza kunye nokungabikho kweglucose kunokubangela ukothuka kwe-neurogenic.

Ukubonakaliswa kweklinikhi ye-neurogenic shock yimpawu zokuvuselela i-parasympathetic

• Ulusu olomileyo, olushushu. Esikhundleni sesikhumba esipholileyo, esimanzi, isigulane sifumana isikhumba esomileyo, esifudumeleyo ngenxa ye-vasodilation kunye nokungakwazi ukuvalelwa kwe-vasoconstrict.
• Uxinzelelo lwegazi. I-Hypotension yenzeke ngenxa yokunyuka ngokukhawuleza, okukhulu.
• I-Bradycardia. Esikhundleni sokufumana i-tachycardic, isigulane sifumana i-bradycardia.
• Ukuphefumla kwe-diaphragmatic. Ukuba ukulimala kungaphantsi kwe-5th vertebra yomlomo wesibeleko, isigulane siya kubonisa ukuphefumla kwe-diaphragmatic ngenxa yokulahlekelwa yi-nervous control of the intercostal muscles (efunekayo ekuphefumuleni kwethoracic).
• Ukubanjwa ngokuphefumla. Ukuba ukulimala kungaphezulu kwe-3rd vertebra yomlomo wesibeleko, isigulane siya kungena ekubanjweni kokuphefumula ngokukhawuleza emva kokulimala, ngenxa yokulahlekelwa yi-nervous control of diaphragm.

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

Uvavanyo kunye neziphumo zokuxilonga

Ukuxilongwa kwe-neurogenic shock kunokwenzeka ngezi mvavanyo zilandelayo:

• I-Computerized tomography (CT) scan. I-CT scan inokubonelela ngojongo olungcono kwizinto ezingaqhelekanga ezibonwa kwi-X-reyi.
• IiXreyi. Abasebenzi bezonyango badla ngokuyalela olu mvavanyo kubantu ekurhaneleka ukuba banomonzakalo womqolo emva kokwenzakala.
• Umfanekiso wemagnetic resonance imaging (MRI). I-MRI isebenzisa imagnethi eyomeleleyo kunye namaza kanomathotholo ukuvelisa imifanekiso eveliswa yikhompyutha.

Ulawulo lwezonyango

Unyango lwe-neurogenic shock lubandakanya:

• Ukubuyisela ithoni yovelwano. Kuya kuba ngokuzinziswa kokulimala komgogodla okanye, kwimeko ye-anesthesia yomgogodla, ngokubeka isigulane ngokufanelekileyo.
• Ukungasebenzi. Ukuba isigulane sinecala elikrokrelwayo lokulimala kwentambo yomgogodla, i-traction ingadingeka ukuzinzisa umqolo ukuzisa ukulungelelaniswa okufanelekileyo.
• IV ulwelo. Ukulawulwa kwe-IV fluids kwenziwa ukuzinzisa uxinzelelo lwegazi lwesigulane.

Pharmacologic Therapy

Amachiza anikwa isigulane esothuswa yi-neurogenic shock ngala:

• Iiarhente ze-Inotropic. Iiarhente ze-Inotropic ezifana ne-dopamine zinokufakelwa ukuvuselela ulwelo.
• Atropine. I-Atropine inikezelwa nge-intravenously ukulawula i-bradycardia enzima.
• Iisteroids. Isigulane esine-neurological deficit ebonakalayo sinokunikwa i-IV steroids, njenge-methylprednisolone kwi-dose ephezulu, kwiiyure ze-8 zokuqalisa ukutshatyalaliswa kwe-neurogenic.
• IHeparin. Ukulawulwa kwe-heparin okanye i-heparin ephantsi ye-molecular-weight njengoko kumiselweyo kunokuthintela ukubunjwa kwe-thrombus.

Ulawulo lobunesi kwisigulana esinomothuko we-neurogenic lubandakanya:

Uvavanyo lokonga

Uvavanyo lwesigulana esinomothuko we-neurogenic kufuneka lubandakanye:

• ABC uvavanyo. Umboneleli we-prehospital kufuneka alandele isiseko somoya, ukuphefumla, ukujikeleza kwindlela yesigulane esibuhlungu ngelixa ukhusela umqolo kuyo nayiphi na intshukumo eyongezelelweyo.
• Uvavanyo lwe-Neurologic. Iintsilelo ze-Neurologic kunye nenqanaba eliqhelekileyo apho izinto ezingaqhelekanga zaqala khona kufuneka zichongwe.

Ukuchonga ubuhlengikazi

Ngokusekwe kwidatha yovavanyo, uxilongo lokonga kwisigulana esinomothuko we-neurogenic zezi:

• Umngcipheko wepateni yokuphefumla ephazamisekileyo enxulumene nokonakala kwe-diaphragm (izilonda okanye ngaphezulu kwe-C-5).
• Umngcipheko wokwenzakala okunxulumene nobuthathaka bexeshana/ukungazinzi kwe umqolo womgcini.
• Ukungahambi kakuhle komzimba okunxulumene nokuphazamiseka kwe-neuromuscular.
• Ukuphazamiseka kombono woluvo olunxulumene nokutshatyalaliswa kwamaphecana eenzwa kunye nokuguqulwa kolwamkelo lweemvakalelo, ukuhanjiswa kunye nokudibanisa.
• Iintlungu ezibuhlungu ezinxulumene nokudityaniswa kwegazi okwesibini ukuya kwi-thrombus.

UCwangciso lweNkathalelo lokonga kunye neenjongo

Iinjongo eziphambili zesigulana ziquka:

• Gcina umoya owaneleyo njengoko kungqinwa ngokungabikho uxinzelelo lokuphefumla kunye nee-ABGs ngaphakathi kwemida eyamkelekileyo
• Bonisa ukuziphatha okufanelekileyo ukuxhasa umzamo wokuphefumla.
• Gcina ulungelelwaniso olufanelekileyo lomqolo ngaphandle komonakalo ongakumbi womgogodla.
• Gcina isikhundla somsebenzi njengoko kubonakaliswe ukungabikho kwekhontrakthi, ukuhla kweenyawo.
• Ukwandisa amandla amalungu omzimba angachaphazelekiyo/ahlawulayo.
• Bonisa ubuchule/indlela yokuziphatha evumela ukuqalisa kwakhona komsebenzi.
• Ukuqaphela ukuphazamiseka kweemvakalelo.
• Chonga iindlela zokuziphatha ukuhlawula iintsilelo.
• Ukuvakalisa ulwazi ngeemfuno zeemvakalelo kunye nokubanakho ukuvinjwa / ukugqithiswa.

UKUBALULEKA KOQEQESHO LOKUHLANGULA: TYELELA IBHATHI LOKUHLALA I-SQUICCIARINI KWAYE UFUMANE INDLELA YOKULUNGISELELA NGEXESHA LIKAXAKEKA.

Amanyathelo abongikazi

• Ukungenelela kwabongikazi kujoliswe ekuxhaseni umsebenzi we-cardiovascular and neurologic de isiqendu esiqhelekileyo se-neurogenic shock sisombulule.
• Phakamisa intloko ebhedini. Ukuphakama kwentloko kunceda ukukhusela ukusasazeka kwe-anesthetic agent up the spinal cord xa isigulane sifumana i-spinal or epidural anesthesia.
• Amanyathelo okungenelela asezantsi. Ukufaka iikawusi ezichasene ne-embolism kunye nokuphakamisa unyawo lwebhedi kunokunceda ukunciphisa ukudityaniswa kwegazi emilenzeni kunye nokuthintela ukwakheka kwe-thrombus.
• Yenza umthambo. Uluhlu lwe-Passive of motion of immobile extremities lunceda ukukhuthaza ukujikeleza.
• Airway patency. Gcina i-patent airway: gcina intloko kwindawo engathathi hlangothi, phakamisa intloko yebhedi kancinane ukuba unyamezele, sebenzisa izincedisi zomoya njengoko kubonisiwe.
• Ioksijini. Lawula ioksijini ngendlela efanelekileyo (iimpumlo zempumlo, imaski, intubation, i-ventilator).
• Imisebenzi. Cwangcisa imisebenzi yokubonelela ngamaxesha angaphazamisekiyo okuphumla kunye nokukhuthaza ukubandakanyeka phakathi kokunyamezela kunye nokukwazi komntu.
• Ukujongwa kweBP. Ukulinganisa kunye nokubeka iliso kwi-BP ngaphambi nangemva komsebenzi kwizigaba ezinzima okanye kude kube nokuzinza.
• Nciphisa ixhala. Ncedisa isigulana ukuba siqaphele kwaye ubuyekeze utshintsho kwimvakalelo.

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

Evaluation

Iziphumo ezilindelekileyo zesigulana zezi:

• Kugcinwe ukungena komoya okwaneleyo.
• Ubonise ukuziphatha okufanelekileyo ukuxhasa umzamo wokuphefumla.
• Ukugcina ulungelelwaniso olufanelekileyo lomqolo ngaphandle komonakalo ongakumbi womgogodla.
• Isikhundla esigciniweyo somsebenzi.
• Ukonyuka kwamandla kwamalungu omzimba angachaphazelekiyo/ahlawulayo.
• Ukubonisa ubuchule/ukuziphatha okwenza ukuba uqalise umsebenzi.
• Izithintelo zeemvakalelo eziqatshelweyo.
• Iindlela zokuziphatha ezichongiweyo ukubuyisela iintsilelo.
• Ukwaziswa ngomlomo ngeemfuno zeemvakalelo kunye nokubanakho ukuvinjwa / ukugqithiswa.

Izikhokelo zoxwebhu

Ugxininiso lwamaxwebhu lu:

• Imbali efanelekileyo yengxaki.
• Ipateni yokuphefumla, izandi zokuphefumula, ukusetyenziswa kwezihlunu ezincedisayo.
• Amaxabiso eLebhu.
• Imbali yamandulo kunye yakutshanje yokulimala, ukuqaphela iimfuno zokhuseleko.
• Ukusetyenziswa kokhuseleko izixhobo okanye iinkqubo.
• Iinkxalabo zokusingqongileyo, imiba yokhuseleko.
• Inqanaba lomsebenzi, ukukwazi ukuthatha inxaxheba kwimisebenzi ethile okanye efunwayo.
• Inkcazo yempendulo yoMthengi kwiintlungu, iinkcukacha zoluhlu lweentlungu, ukulindela ukuphathwa kweentlungu, kunye nenqanaba elamkelekileyo lentlungu.
• Ukusetyenziswa kwamayeza kwangaphambili.
• Isicwangciso sokhathalelo, ungenelelo oluthile, kwaye ngubani obandakanyekayo kucwangciso.
• Isicwangciso sokufundisa.
• Ukuphendula kungenelelo, ukufundisa, izenzo ezenziweyo, kunye nerejimeni yonyango.
• Ukufikeleleka okanye inkqubela phambili kwiziphumo ezinqwenelekayo.
• Uhlengahlengiso kwisicwangciso sokhathalelo.

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