Ukutshona: iimpawu, iimpawu, uvavanyo lokuqala, ukuxilongwa, ubunzima. Ukufaneleka kwenqaku le-Orlowski

By UCristiano Antonino On Ngamana 17, 2023

Ukutshona okanye 'isifo sokutshona' kwezamayeza kubhekisa kuhlobo lwe-acute asphyxia ngenxa yesizathu sangaphandle somatshini esibangelwa kukuhlala kwesithuba se-pulmonary alveolar ngamanzi okanye olunye ulwelo olungeniswa kwimizila yomoya ephezulu, ethi intywiliselwe ngokupheleleyo kulwelo olunjalo.

Ukuba i-asphyxia ithatha ixesha elide, ngokuqhelekileyo imizuzu eliqela, 'ukufa ngokurhaxwa' kwenzeka, oko kukuthi, ukufa ngenxa yokufuthaniselwa ngokuntywiliselwa, okunxulunyaniswa ngokubanzi ne-acute hypoxia kunye nokusilela okubukhali kwe-ventricle yasekunene yentliziyo.

Kwezinye iimeko ezingabulaliyo, ukurhaxwa kwamanzi kunokunyangwa ngempumelelo ngeendlela ezithile zokuvuselela umoya.

KUBALULEKILEYO: Ukuba umntu omthandayo ube lixhoba lokutshona kwaye ungazi ukuba wenze ntoni, qale uqhagamshelane neenkonzo ezingxamisekileyo ngokukhawuleza ngokubiza iNombolo yoNgxamiseko eNye.

La manqaku kunye namanye ahloselwe ukwenza nzulu isihloko, kwaye ukwazi ukuba ungathini kuMsebenzi weZiko leNombolo eNgxamisekileyo.

Imiba yeklinikhi yokurhaxwa

Uvavanyo lokuqala lwamaxhoba okuntywila kufuneka lukhawuleze ngokusemandleni kwaye lujolise ekunqumeni imeko yokuqonda, iimpawu ze-pulse kunye nezinga lokuphefumula.

Inkcazelo eqokelelwe kumangqina okuzibonela isenokuba luncedo kakhulu ekuhloleni ubunzulu bemeko yomguli.

Ukuba kunokwenzeka, iinyani ezithile kufuneka zimiselwe, kubandakanywa:

ixesha elingakanani, malunga, isigulane santywiliselwa kulwelo,
iimpawu zolwelo ekwenzeke kulo ingozi (ityuwa okanye amanzi amatsha, ashushu okanye abandayo, njl.njl.),
ubukho obunokwenzeka beempawu ezibalulekileyo ngexesha Uncedo yokuqala,
ixesha eliqikelelweyo lidlulile ngaphambi kokuba kuqaliswe i-cardiopulmonary resuscitation (CPR), kwaye ingaba ezi ziqhutywe ngokukhawuleza emva kokuba isigulane sikhutshwe emanzini.
ixesha elingakanani i-CPR kufuneka iqhutyelwe ngaphambi kokuba iimpawu ezibalulekileyo ziphinde zivele,
ukuba kunokwenzeka ubushushu obuchanekileyo bamanzi,
iminyaka yomfundi kunye nemeko jikelele phambi kwengozi (umzekelo, ingaba umba lowo uphethwe sisifo semiphunga okanye sentliziyo?)
naziphi na ezinye iimeko ezinokunxulumana nesehlo (umzekelo, ingozi xa untywila okanye enye, ukusela utywala okanye iziyobisi, njl. njl.).

Ukutshona: i-anamnesis kunye novavanyo lwenjongo kufuneka lukhawuleze kakhulu

Iimpawu ezibalulekileyo zamaxhoba okurhaxwa ziyakwazi ukuguquguquka kakhulu, yingakho ulwazi oluluhlu olungentla lufanelekile.

Izigulane zinokubonisa ukubanjwa kwentliziyo epheleleyo okanye ngomsebenzi wokuphefumula kunye ne-peripheral pulse ngaphakathi kwemida eqhelekileyo.

Ubushushu bomzimba buyaguquguquka kwaye buxhomekeke kubushushu bamanzi ekwenzeke kuwo ingozi, umphezulu womzimba womntu kunye nobude bexesha lokuntywila.

I-Hypothermia ixhaphakile xa isigulana sisemanzini abandayo kwaye sinokuphucula ukusinda.

Kwiimeko ezinjalo, ukufudumala kufuneka kwenziwe ngononophelo.

Iziphumo zentliziyo zokutshona okungaphumeleliyo zibandakanya ibradycardia, ekusenokwenzeka ukuba ilandelwe yi-asystole.

Umonakalo we-neurological obangelwa yi-hypoxia kunye neziyobisi ezilawulwa ngexesha lokuvuselela zikhokelela kwi-mydriasis, kunye nokudandatheka okanye ukungabikho kwe-pupillary reflex ekukhanyeni.

Intloko kunye entanyeni kufuneka ihlolwe ngononophelo ukukhangela iimpawu zomothuko, okukhokelela, umzekelo, ukutshona kumanzi angekho nzulu.

Ukuba kukrokreleka ukulimala komnqonqo, kuyimfuneko ukuphazamisa isigulane ngaphambi kokuba uthuthwe ukuze ugweme umonakalo ongakumbi, kwezinye iimeko ezingenakuguqulwa kwaye zikhubazeke, ezifana nezo zikhokelela ekukhubazekeni.

I-Auscultation ye-thorax ingabonisa ubukho be-wheezes, ngenxa ye-bronchospasm okanye i-aspiration yezinto zangaphandle kunye / okanye i-tele-expiratory rales, ehambelana ne-atelectasis okanye i-pulmonary edema.

Ukufunyaniswa kwengxolo ye-accessory emiphunga (efana ne-coarse ralesalesales) iphakamisa umnqweno wezinto zangaphandle kunye nomngcipheko we-pneumonia kunye i-ARDS.

Iziphelo zezi zigulana zihlala zibanda kwi-thermoprinting, ngenxa ye-hypothermia kunye ne-peripheral vessel constriction.

Ukucotha kokujikeleza kwe-peripheral kukhokelela ekwandiseni ixesha lokuphindaphinda kwe-capillary.

Uhlalutyo lwe-Arterial haemogas (ABG) luhlala lubonisa i-hypoxaemia, ngakumbi ukuba ukulangazelela kwenzeke, kunye ne-metabolic acidosis.

Ubuzaza be-metabolic acidosis ngokuqhelekileyo buhambelana nobunzulu be-tissue hypoxia.

I-Hemoglobin kunye ne-serum electrolyte concentrations kunye namaxabiso e-hematocrit anokuncipha ukuba amanzi amaninzi ahlambulukileyo aginyiwe okanye anqwenelekayo, adlula kwi-circulation kwaye abangele ukuhlanjululwa kwegazi.

Uvavanyo lokuqala kunye ne-prognosis kwiimeko zokurhaxwa

Iinkqubo ezininzi zamanqaku ziye zaphuhliswa ukuze kuhlolwe amaxhoba arhaxwayo, kodwa akukho namnye kubo onokuqikelela ukuxilongwa kweklinikhi ngokuchaneka kwe-100%.

Iinkqubo ezintathu eziqhelekileyo ezisetyenziswayo zezi:

le Glasgow Coma Scale (GCS),
amanqaku e-Orlowski,
i-post-submission neurological classification ye-Model kunye ne-Conn.

Glasgow Coma Scale

I-Glasgow Coma Scale ineeparamitha ezintathu, nganye apho impendulo engcono yesigulane inqunywe kwaye inikwe ixabiso lamanani (jonga itafile engezantsi).

Ukuvulwa kwamehlo:

ndingekhoyo
Ukuphendula kwi-stimuli ebuhlungu
Ukuphendula kwi-stimuli yomlomo
Ngokukhawuleza

Eyona mpendulo yomlomo:

nanye
Ayinakuqondakala
Ayifanelekanga
Udidekile
Ikhokelwe

Eyona mpendulo yemoto

nanye
Ulwandiso (lwahlisiwe)
I-Flexion (ehonjisiweyo)
Ukwakhiwa kwendawo ye-stimulus ebuhlungu
Umyalelo impendulo

Inqaku lesikali seGlasgow limiselwa ngokuvavanya eyona mpendulo ilungileyo yesigulana kwicandelo ngalinye.

Amanani amanani eendlela zokuziphatha eziqatshelweyo zongezwa kunye kwaye zibonelela ngamanqaku apheleleyo.

Inqaku elipheleleyo le-3 lilelona liphantsi kwaye libonisa eyona meko imbi kakhulu; inqaku le-7 okanye ngaphantsi libonisa ukuba isigulane sikwi-coma kunye namanqaku e-14 ukugcinwa kwengqondo epheleleyo.

I-prognosis isekelwe kwixabiso le-GCS elifunyenwe ngexesha lovavanyo lokuqala lweklinikhi.

Amaxhoba arhaxwayo anamanqaku okuqala e-GCS esi-4 okanye ngaphantsi aneepesenti ezingama-80 zokufa okanye umonakalo osisigxina wemithambo-luvo.

Izigulana ezinenqaku le-GCS le-6 okanye ngaphezulu, kwelinye icala, zisemngciphekweni ophantsi wokufa okanye wokwenzakala okusisigxina kwi-neurological.

Amanqaku e-Orlowski

Umlinganiselo we-Orlowski usekelwe kubukho bezinto ezingathandekiyo ze-prognostic ngokumalunga nokubuyiselwa kwesigulane.

Izinto ezingathandekiyo zokuqikelela amanqaku e-Orlowski

ubudala obulingana okanye ngaphantsi kweminyaka emi-3;
ixesha lokuntywila eliqikelelweyo ngaphezu kwemizuzu emi-5;
ii-resuscitation maneuvers ezingenziwanga kwimizuzu yokuqala ye-10;
isigulana sifike kwisebe likaxakeka sikwimeko yokuqhawuka;
i-pH yemithambo elingana okanye ngaphantsi kwe-7.10 kwi-haemogasanalysis.

Inqaku le-Orlowski linikezelwa ngokwenani lezinto ezingathandekiyo ze-prognostic, ezidweliswe apha, ezifunyenwe kwixhoba lokutshona.

Amanqaku asezantsi anxulunyaniswa ne-prognosis engcono.

Abo banemibini okanye ngaphantsi kwezi zinto banamathuba angama-90 ekhulwini okuba baphinde baphile ngokupheleleyo ngelixa, kwabo banesithathu okanye ngaphezulu, oku kunokwenzeka kungaphantsi kwe-5 ekhulwini.

IModeli kunye ne-Conn's post-submmergence neurological classification

Kwi-1980, uConn noModel kunye nabasebenzisana nabo bapapasha ngokuzimeleyo i-postresuscitation ye-neurological classification esekelwe kwinqanaba lokuqala lokuqonda kwesigulane. Conn et al., ngokungafaniyo noModell, wenze isindululo sokwahlulwa okungaphaya kwiqela 'lokukoma'.

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Udidi A. Vukani

Vuka, unolwazi kunye nesigulana esiqhelanisiweyo

Udidi B. Dulling

Ukuncipha kwengqondo, isigulana sityhafile kodwa sinokuvuswa, impendulo enenjongo kwisivuseleli esibuhlungu.

Isigulana asinakuvuswa, siphendule ngokungaqhelekanga kwi-stimuli ebuhlungu.

Udidi C. Comatose

C1 Yandisa uhlobo lwe-flexion kwi-stimuli ebuhlungu

C2 Ukwandiswa kohlobo lwe-Decerebrate kwi-stimuli ebuhlungu

I-C3 I-Flaccid okanye impendulo engekhoyo kwi-stimuli ebuhlungu

I-prognosis imiselwa ngokodidi, kwaye igqwesile kwizigulana ezikudidi A no-B.

Kudidi C, ukuxilonga kuya kuba mandundu njengoko isiqaqa sisiba nzulu.

Kuphononongo lokubuyela emva, zonke izigulane ezabelwa ekungenisweni kudidi A zasinda ngaphandle kweengxaki.

I-90% yezigulane ezikudidi B ziye zasinda ngaphandle kokulandelelana, kodwa i-10% yafa.

Kwizigulane ezikudidi C, ama-55% achacha ngokupheleleyo, kodwa ama-34% asweleke kwaye i-10% yafumana umonzakalo osisigxina we-neurological.

Ubuzaza bokurhaxwa bahlulwe ngokwamaqondo amane

IBakala 1: ixhoba alizange lifake i-fluid, i-ventilates kakuhle, i-oxygenation ye-cerebral enhle, ayinakho ukuphazamiseka kwengqondo, ibika inhlalakahle;

I-2nd degree: ixhoba liye laphefumla i-liquids ukuya kwinqanaba elincinci, ii-rales eziqhekezayo kunye / okanye i-bronchospasm ziyabonakala, kodwa umoya ophefumulayo wanele, ukuqonda kuhambelana, isigulane sibonisa ukuxhalaba;

I-3rd degree: ixhoba liye laphefumla izixa ezicacileyo zolwelo, libonisa i-rales, i-bronchospasm kunye noxinzelelo lokuphefumula, iphuhlisa i-cerebral hypoxia kunye neempawu ezivela kwi-disorientation ukuya kwi-aggression, ukuya kwimeko ye-soporific, i-arrhythmias yentliziyo ikhona;

Isidanga se-4: ixhoba liphefumle ulwelo oluninzi okanye lahlala likwimeko ye-hypoxic de kwabanjwa intliziyo kunye nokufa.

KUBALULEKILEYO: ezona mpawu zinzima zokurhaxwa ziyenzeka xa ubungakanani bamanzi arhogelweyo budlula i-10 ml ngekhilogram nganye yobunzima bomzimba, oko kukuthi isiqingatha ilitha yamanzi kumntu onobunzima obuziikhilogram ezingama-50 okanye ilitha enye ukuba unobunzima beekhilogram ezili-1: ukuba ubungakanani bamanzi incinci, iimpawu ziphakathi kwaye zidlula.