Ukwenzakala kombane: Nangona iingozi zombane ezenzeke ngempazamo ekhaya (umzekelo, ukubamba umbane okanye ukothuswa sisixhobo esincinci sombane) azifane zibangele umonzakalo omkhulu okanye ulandelelwano, ukuchanabeka ngengozi kwimisinga yombane ophezulu kubangela ukufa kwabantu abaphantse babe ngama-300 nyaka ngamnye. eunited States

Kukho ngaphezulu kwama-30 000 eengozi zombane ezingabulaliyo/ngonyaka e-US kwaye i-akhawunti yokutsha kombane malunga ne-5% yokwamkelwa kwiiyunithi ezitshileyo e-US.

Ukulimala kombane, i-pathophysiology

Ngokwesiqhelo, kufundiswa ukuba ubukhali bokwenzakala kumbane buxhomekeke kwizinto zeKouwenhoven:

• Uhlobo lwangoku (ngqo [DC] okanye olutshintshanayo [AC])
• I-Voltage kunye ne-amperage (imilinganiselo yamandla angoku)
• Ubude bexesha lokuvezwa (utyhileko ixesha elide kwandisa ubuzaza bokwenzakala)
• Ukumelana nomzimba
• Indlela yangoku (emisela ukuba zeziphi izihlunu ezonakeleyo)

Nangona kunjalo, amandla ombane ombane, ubuninzi obusandul 'ukuqwalaselwa, kubonakala kuxela kwangaphambili ubunzima bokulimala ngokuchanekileyo.

Umbane: Izinto zaseKouwenhoven

Ukutshintsha indlela yangoku rhoqo; luhlobo lwangoku olunikwa amakhaya aseMelika naseYurophu.

Umsinga othe ngqo uhamba rhoqo kwicala elinye; luhlobo lwangoku olunikezelwa ngeebhetri.

Izixhobo ze-defibrillators kunye ne-cardioversion zihambisa ngokuthe ngqo ngoku.

I-DEFIBRILLATORS, UKUBEKWA ESWENI IZIBONAKALISO, IZIXHOBO ZOKUNXINEZELA ISIFUBA: TYELELA I-PROGETTI MEDICAL BOOTH KWI-EXPO EMERGENCY

Indlela ukutshintshwa kwangoku kuwonakalisa ngayo umzimba kuxhomekeke kakhulu kumaza.

I-low-frequency alternating current (50-60 Hertz) isetyenziswa kwiinkqubo zasekhaya kuzo zombini eUnited States (60 Hertz) naseYurophu (50 Hertz).

Ngenxa yokuba i-low-frequency alternating current ibangela ukuqina kwemisipha (tetany), enokuthi itshixe izandla kumthombo wangoku kwaye yandise ukuvezwa kwexesha elide, kunokuba yingozi ngakumbi kune-high-frequency alternating current kwaye i-3 ukuya ku-5 amaxesha ayingozi ngakumbi kunomsinga othe ngqo. umbane ofanayo kunye ne-amperage.

Ukuba sesichengeni kumbane othe ngqo kuthanda ukubangela ukuxhuzula okukodwa ngokulula ngakumbi, okuhlala kuphosa umxholo ngaphandle komthombo wangoku.

DEFIBRILLATORS, NDWENDWELELE E-EMD112 BOOTH KWIMIBONISO ENGXAMISEKILEYO

Ukutsha kombane: impembelelo yombane kunye ne-amperage kubunzima bokulimala

Kuzo zombini ezitshintshayo kunye nombane othe ngqo, ukuphakama kwamandla ombane (V) kunye ne-amperage (A), kokukhona kubangelwa ukulimala kombane (kwi-exposure efanayo).

Umbane wasekhaya e-USA usukela kwi-110 V (izixhobo zombane eziqhelekileyo) ukuya kwi-220 V (esetyenziselwa izixhobo ezinkulu, umzekelo ifriji, isomisi).

I-high-voltage currents (> 500 V) idla ngokubangela ukutshisa okunzulu, ngelixa i-low-voltage currents (110 ukuya kwi-220 V) idla ngokubangela ukuba i-muscle tetany kunye nokungahambi kakuhle kumthombo wangoku.

Ubuninzi be-amperage obunokubangela ukucutshungulwa kwemisipha ye-arm flexor, kodwa uvumele umbandela ukuba ukhulule isandla sawo kumthombo wangoku, ubizwa ngokuba yi-let-go current.

I-let-go yangoku iyahluka ngokobunzima bomzimba kunye nobunzima bemisipha.

Kwi-avareji ye-70 kg indoda, i-let-go current imalunga nama-75 milliampere (mA) kumbane othe ngqo kwaye malunga ne-15 mA yokutshintshana kwangoku.

I-low-voltage ye-60 Hz ehamba ngokutshintshana ngoku edlula esifubeni nakwiqhekeza lesibini inokubangela i-fibrillation ye-ventricular, nakwi-amperages ephantsi njenge-60-100 mA; ngoku ngqo okwangoku, malunga ne-300-500 mA iyadingeka.

Ukuba i-current ifikelela entliziyweni ngokuthe ngqo (umzekelo nge-catheter yenhliziyo okanye i-electrodes ye-pacemaker), nokuba i-amperage ye-< 1 mA inokubangela i-fibrillation (kuzo zombini i-alternating kunye ne-direct current).

Umonakalo wezicubu ngenxa yokuvezwa kombane ubangelwa ikakhulu kukuguqulwa kwamandla ombane kubushushu, okubangela umonakalo wobushushu.

Ubungakanani bobushushu obuchithwayo bulingana ne-amperage2 × ukumelana × ixesha; ngoko, kwixesha elinikiweyo kunye nobude, ithishu enoxhathiso oluphezulu ithande ukonakaliswa kakhulu. Ukuchasana nomzimba (kulinganiswa kwi-ohms / cm2) kubonelelwa ngokukodwa ngesikhumba, kuba zonke izicubu zangaphakathi (ngaphandle kwethambo) zinokumelana nokungakhathali.

Ubunzima besikhumba kunye nokoma kwandisa ukuchasana; Isikhumba esomileyo, esine-keratinized kunye ne-intact sinamaxabiso aphakathi kwama-20 000-30 000 ohm/cm2.

Isundu, isundu okanye isityalo esinabileyo sinokuchasana ne-2-3 yezigidi ze-ohms / cm2; ngokuchaseneyo, ulusu olubhityileyo, olufumileyo lunokuxhathisa malunga ne-500 ohms/cm2.

Ukunganyangeki kwesikhumba esonzakeleyo (umzekelo, amanxeba, amanxeba, iinkuni yenaliti) okanye imifinya efumileyo (umz. umlomo, umngxuma welungu lobufazi) unokuba ngaphantsi ukuya kuma-200-300 ohms/cm2.

Ukuba ukuchasana kwesikhumba kuphezulu, amandla amaninzi ombane angachithwa ngesikhumba, okubangela ukutshisa okukhulu kwesikhumba, kodwa kuncinci ukulimala kwangaphakathi.

Ukuba ukuchasana kwesikhumba kuphantsi, ukutshisa kwesikhumba kuncinci okanye akukho nto, kwaye amandla ombane amaninzi adluliselwa kwizakhiwo zangaphakathi.

Ngaloo ndlela, ukungabikho kokutshisa kwangaphandle akubonisi ukungabikho kokulimala kombane, kwaye ubunzima bokutshisa kwangaphandle abubonisi ubunzima bomonakalo wombane.

Ukonakaliswa kwezicubu zangaphakathi kuxhomekeke ekuchaseni kwabo kunye nokuxinana kwangoku (okwangoku kwiyunithi yendawo; amandla agxininiswe ngakumbi xa ukuqina okufanayo kwangoku kudlula kwindawo encinci).

Umzekelo, xa amandla ombane edlula engalweni (ngokukodwa kwizihlunu ezisezantsi, umz., imisipha, iinqanawa, imithambo-luvo), ukuxinana kwangoku kuyanda kumalungu ngenxa yokuba ipesenti enkulu yendawo enqamlezayo yejoyinti iqulunqwe phezulu. izicubu zokumelana (umzekelo, amathambo, ii-tendon), ezinciphisa indawo ephantsi yokumelana nezicubu; ngoko, umonakalo kwiithishu ezisezantsi zokuxhathisa zithande ukuba nzima ngakumbi kumalungu.

Indlela yangoku ngomzimba inquma ukuba zeziphi izakhiwo eziza konakaliswa.

Ngenxa yokuba ukutshintshanisa kwangoku kuthe gqolo ukubuyisela umva isalathiso, amagama adla ngokusetyenziswa 'yegalelo' kunye 'nemveliso' akafanelekanga; 'umthombo' kunye 'nomhlaba' zichaneke ngakumbi.

Isandla yeyona ndawo ixhaphakileyo yomthombo, ilandelwa yintloko.

Unyawo yeyona ndawo ixhaphakileyo emhlabeni. Ukuhamba okukhoyo ngoku phakathi kweengalo okanye phakathi kwengalo nonyawo kunokwenzeka ukuba kudlule entliziyweni, oko kunokubangela i-arrhythmia.

Lo msinga uthande ukuba yingozi ngakumbi kunohambo lwangoku ukusuka kolunye unyawo ukuya kolunye.

Okwangoku iqondiswe entloko inokonakalisa inkqubo ye-nervous central.

Amandla ombane ombane

Amandla ombane kukuqina kombane kuwo wonke ummandla osetyenziswa kuwo.

Kunye nezinto zeKouwenhoven, ikwamisela iqondo lokwenzakala kwethishu.

Umzekelo, i-20 000 volts (20 kV) isasazwa emzimbeni wendoda malunga ne-2 m ubude iphumela kumandla omhlaba malunga ne-10 kV/m.

Ngokufanayo, i-volts ye-110, xa isetyenziswe kwi-1 cm kuphela (umzekelo, umlomo womntwana), iphumela kumandla afanayo entsimi ye-11 kV / m; Lo mlinganiselo uchaza ukuba kutheni umonakalo onjalo wombane ophantsi unokubangela umonakalo kwithishu yobunzima obufanayo nomonakalo othile wombane ophezulu osetyenziswa kwiindawo ezinkulu.

Ngokwahlukileyo, xa kuqwalaselwa amandla ombane endaweni yamandla ebala lombane, ukonzakala okuncinci okanye okungabalulekanga kombane kunokwahlulwa ngokobuchwephesha njengombane ophezulu.

Umzekelo, umothuko owufumanayo xa urhubuluza iinyawo zakho kwikhaphethi ebusika ubandakanya amawaka eevolthi, kodwa ubangela ukonzakala okungenamsebenzi kwaphela.

Umphumo wentsimi yombane unokubangela umonakalo kwi-membrane yeseli (i-electroporation) nangona amandla anganelanga ukwenza umonakalo we-thermal.

Ukulimala kombane: i-pathological anatomy

Ukusetyenziswa kombane okwiqondo eliphantsi kakhulu kubangela ukuziva ungemnandanga ngoko nangoko ('umothuko'), kodwa akufane kubangele ukwenzakala okumandundu okanye okusisigxina.

Ukusetyenziswa kwentsimi yombane ephezulu kubangela umonakalo oshushu okanye we-electrochemical kwizicubu zangaphakathi.

Umonakalo unokubandakanya

• I-Haemolysis
• Ukudibanisa iiprotheni
• I-coagulation necrosis yezihlunu kunye nezinye izihlunu
• Thrombosis
• emzimbeni
• Ukuxhatshazwa kwemisipha kunye neentambo

Umonakalo ovela kwintsimi yombane ephezulu unokubangela i-edema ebalulekileyo, ethi, njengoko igazi lithintela kwimithambo kunye nezihlunu, kubangela i-compartment syndrome.

I-edema ephawulekayo inokubangela i-hypovolaemia kunye ne-hypotension.

Ukutshatyalaliswa kwemisipha kunokukhokelela kwi-rhabdomyolysis kunye ne-myoglobinuria, kunye nokungalingani kwe-electrolyte.

I-Myoglobinuria, i-hypovolaemia kunye ne-hypotension yonyusa umngcipheko womonakalo omkhulu wezintso.

Iziphumo zokungasebenzi kakuhle kwelungu azihlali zinxulumana nomthamo wezicubu ezitshatyalalisiwe (umzekelo, i-fibrillation ye-ventricular ingenzeka ngokutshatyalaliswa kwezicubu ezincinci).

I-Symptomatology

Ukutshisa kunokwahlulwa ngokucacileyo eluswini nangona ikhoyo ngoku ingena ngokungaqhelekanga kwizicubu ezinzulu.

Izihlunu ezinzima ezizenzekelayo, ukuxhatshazwa, i-fibrillation ye-ventricular okanye ukubanjwa kokuphefumula kunokuthi kwenzeke ngenxa yomonakalo kwinkqubo ye-nervous central okanye imisipha.

Ukonakala kwengqondo, Umgudu Intambo okanye i-peripheral nerves inokubangela ukusilela kwe-neurological eyahlukeneyo.

Ukubanjwa kwentliziyo kunokwenzeka xa kungekho ukutsha, njengakwimeko yeengozi kwigumbi lokuhlambela (xa umntu omanzi [odibene nomgangatho] efumana i-110 V yangoku, umz. kwisixhobo esomisa iinwele okanye unomathotholo).

Abantwana abalumayo okanye abafunxa iintambo zombane basenokutshiswa emlonyeni nasemilebeni.

Ukutshisa okunjalo kunokubangela ukukhubazeka kwe-cosmetic kwaye kuphazamise ukukhula kwamazinyo, umhlathi kunye nemihlathi.

I-Labial artery haemorrhage, ephumela ekuweni kwe-eschar kwiintsuku ezi-5-10 emva kokwenzakala, kwenzeka ukuya kutsho kwi-10% yaba bantwana.

Ukutshatyalaliswa kombane kunokubangela ukunyanzeliswa kwemisipha enamandla okanye ukuwa (umzekelo ukusuka kwinqanaba okanye uphahla), okubangelwa ukuchithwa (ukutshatyalaliswa kombane ngenye yezinto ezimbalwa ezibangela ukuchithwa kwegxala elingasemva), i-vertebral okanye ezinye iifractures zamathambo, ukulimala kwizitho zangaphakathi kunye nezinye iimpembelelo. ukwenzakala.

Ubuncinci okanye obungachazwanga kakuhle ngokwasemzimbeni, ngokwengqondo kunye ne-neurological sequelae inokuphuhlisa iminyaka eyi-1-5 emva kokulimala kwaye ibangele ukugula okukhulu.

Ukutsha kombane: Ukuxilongwa

• Gqibezela uvavanyo lwezonyango
• Ngamanye amaxesha i-ECG, i-titration ye-enzyme yenhliziyo kunye nohlalutyo lomchamo

Emva kokuba isigulane sisusiwe okwangoku, ukubanjwa kwentliziyo kunye nokubanjwa kokuphefumula kuhlolwa.

Ukuvuselelwa okuyimfuneko kuyenziwa.

Emva kokuvuselelwa kokuqala, izigulane zihlolwe ukusuka entloko ukuya kwinzwane ngenxa yokulimala okubuhlungu, ngakumbi ukuba isigulane siwile okanye siphonswa.

Izigulana ezingakhulelwanga, azinaziphazamiso zentliziyo ezaziwayo, kwaye eziye zavezwa nje kancinci kwimizi yangoku zihlala zingenalo ukwenzakala okukhulu kwangaphakathi okanye kwangaphandle, kwaye akukho mfuneko yovavanyo olongezelelweyo okanye iliso.

Kwezinye izigulane, i-ECG, i-CBC enefomula, i-titration ye-enzyme ye-cardiac kunye ne-urinalysis (ukukhangela i-myoglobin) kufuneka ithathelwe ingqalelo. Izigulane ezilahlekelwa yingqondo zingafuna i-CT scan okanye i-MRI.

impatho

• Ukucima umbane
• Ukuvuselela
• Uhlaziyo
• Ngamanye amaxesha ukubeka iliso kwintliziyo ye-6-12 h
• Ukhathalelo lwenxeba

Unyango lwangaphambi kwesibhedlele

Into ephambili yokuqala kukuqhawula uqhagamshelwano phakathi kwesigulane kunye nomthombo wamandla ngokucima umbane (umz. ngokukhubekisa isaphuli sesekethe okanye ukucima iswitshi, okanye ukuqhawula isixhobo kwindawo yombane).

Imigca ye-voltage ephezulu kunye ne-low-voltage ayisoloko ibonakala lula, ngakumbi ngaphandle.

ISILUMKISO: Ukuba imigca ye-voltage ephezulu ikrokrelwa, ukuphepha ukumangalisa umhlanguli, akukho nzame kufuneka yenziwe ukukhulula isigulane de amandla aphelile.

Ukuvuselela

Izigulane zivuselelwa kwaye kwangaxeshanye zivavanywe.

Umothuko, onokuthi ube ngumphumela wokwenzakala okanye ukutsha okukhulu kakhulu, uyanyangwa.

Iifomyula zokubala ulwelo oluza kufakelwa ukuvuselela ukutsha kweklasikhi, esekelwe kubungakanani bokutsha kwesikhumba, inokungazijongeli phantsi iimfuno zolwelo zokutsha kombane; ke, ezi fomula azisetyenziswa.

Kunoko, i-fluid i-titrated ukugcina i-diuresis eyaneleyo (malunga ne-100 mL / h kubantu abadala kunye ne-1.5 mL / kg / h kubantwana).

Kwiimeko ze-myoglobinuria, ukugcinwa kwe-diuresis eyaneleyo kubaluleke kakhulu, ngelixa i-alkanisation yomchamo inceda ukunciphisa umngcipheko wokungaphumeleli kwezintso.

Ukutshatyalaliswa kotyando lwezixa ezikhulu zezicubu ze-muscle kunokunceda ekunciphiseni ukungaphumeleli kwezintso ze-myoglobinuric.

Iintlungu ezibuhlungu ezivela ekutshisweni kombane kufuneka ziphathwe ngokusetyenziswa ngobuchule kwee-opioids ze-EV.

UKUNYANGWA KWEEMTSHINTSHO KWIMISEBENZI YOKUHLANGULA: TYELELA I-SKINNEUTRALL BOOTH KUMBONISO KAXAKEKA

Iingozi zombane: amanye amanyathelo

Izigulana ezingakhulelwanga, azinazo iziphazamiso zentliziyo ezaziwayo, kwaye eziye zachanabeka nje kancinci kumbane wasekhaya zihlala zingenalo ukwenzakala okubukhali kwangaphakathi okanye kwangaphandle okudinga ukulaliswa esibhedlele kwaye banokukhutshwa.

Ukujongwa kwentliziyo ye-6-12 h kuboniswa kwizigulane ezineemeko ezilandelayo:

• Arrhythmias
• Iintlungu zesifuba
• Umonakalo wentliziyo orhanelwayo
• Ukukhulelwa okunokwenzeka
• Nakuphi na ukuphazamiseka kwentliziyo okwaziwayo

I-tetanus prophylaxis efanelekileyo kunye nonyango lwasekhaya lwenxeba lokutsha luyafuneka.

Iintlungu ziphathwa nge-NSAID okanye ezinye ii-analgesics.

Zonke izigulana ezinokutsha kakhulu kufuneka zithunyelwe kwiziko leengcali zokutsha.

Abantwana abatshisa imilebe kufuneka bathunyelwe kwingcali kwi-orthodontics yabantwana okanye ugqirha we-maxillofacial onamava kwezi nzakala.

uthintelo

Izixhobo zombane ezichukumisayo okanye ezinokuthi zichukunyiswe ngumzimba kufuneka zifakwe ngokufanelekileyo, zifakwe emhlabeni kwaye zifakwe kwiisekethe eziqulethe izixhobo zokukhusela iisekethe zokukhusela.

Ii-circuit breakers ezisindisa ubomi, ezihamba ukuba ukuvuza kwangoku kwe-5 milliamperes (mA) kufunyenwe, ziyasebenza kwaye zifumaneka ngokulula.

Amaqweqwe okhuseleko anciphisa umngcipheko kumakhaya anabantwana abancinci.

Ukuze ugweme ukulimala ngokuxhuma ngoku (ukulimala kwe-arc), izibonda kunye neeleli akufanele zisetyenziswe kufuphi neentambo zamandla aphezulu.

Funda kwakhona:

UPatrick Hardison, Ibali loBuso obuTshintshiweyo kuMcimi-mlilo ngokuTshisa

Ukusikwa kunye namanxeba: Uyifowunela nini iAmbulensi okanye uye kwigumbi likaxakeka?

I-Oxygen ye-Hyperbaric kwiNkqubo yokuPhilisa inxeba

Ukhawuleza njani nangokuchanekileyo ukufumanisa ukuba umntu unesifo esibuhlungu sokuhlaselwa sisifo sentambo?

umthombo:

MSD