I-Violent penetrating trauma: ukungenelela kwingozi yokungena

By UCristiano Antonino On Sep 9, 2022

I-trauma yokungena iphumela kwintsebenziswano eyinkimbinkimbi phakathi kweendlela ezahlukeneyo zokulimala. Ubume obungalindelekanga bokwenzakala okubangelwa kukukhokelela kwiinkcazo ezininzi zezigulane ezizodwa

Eli candelo liza kugxila kwizinto ezininzi ezidlala kwiindidi ezibonwa ekungeneni kokwenzakala:

Izinto zokulimala okunikeziweyo, iimpawu zezinto ezingenayo, indlela ezo zisebenza ngayo kwimipu / ukuhlatywa, kunye novavanyo kunye nokulawulwa kwezigulane ezinokulimala okwesibini kwi-trauma enobudlova.

I-trauma yokungena: Izinto zokulimala

Izinto eziphambili ezenza umonakalo obonwayo kunye nokulimala okungena ngaphakathi kukutyumza, ukolula, kunye nokulimala kwe-cavitating.

Ukudityaniswa ngqo kwala macandelo mathathu kuxhomekeke kakhulu kwimilo, ubungakanani, ubunzima, kunye nesantya sento egqobhozayo kunye nohlobo (ii) lwethishu into enqumlayo.

UKUQHWAZA: La ngamandla okuqala afunyanwa ngumzimba: phambi kokuba nayiphi na into igqobhoze umzimba ikhupha amandla atyumzayo esikhumbeni kunye nezihlunu/amalungu angaphantsi.

La mandla okutyumza afanayo aqhubeka phambi kwento njengoko into inqumla umzimba.

Oku kukhokelela koku kulandelayo, amandla azolula.

UKWANISA: Ngelixa i-tissue kwindawo yempembelelo kunye nento etyunyuziweyo, zonke izicubu ezijikelezileyo zoluliwe. Kanye njengakumandla atyumzayo, amandla azolula ayenzeka kuyo yonke into ejikeleza izicubu.

Ngenxa yokufikelela ngokubanzi kwamandla okunweba, inoxanduva lomonakalo kwindawo ebanzi malunga neyona nto ingena ngaphakathi.

TYELELA IZIMEMO ZIKASPENCER KWIMBONISO KAXAKEKA

I-CAVITATION: I-Cavitation ngumgodi wenxeba ongenanto oshiywe ngumzila wezinto.

Isantya sento sisigqibo esiphambili se-cavitation, njengoko amandla amakhulu okunweba okubangelwa izinto ezikhawulezayo zolula iindawo ezinkulu zezicubu ezingaphaya kwamandla abo okubuyisela ngendlela ehleliweyo, okubangelwa iindawo ezinkulu zezicubu ezinqabileyo kunye nezilahlekileyo.

Iimpawu zezinto eziNgenelelayo

Ezona mpawu zibalulekileyo ekufuneka ziqwalaselwe into egqobhozayo kukumila, ubukhulu, ubunzima, isantya, kunye nohlobo lwethishu etyhutyhayo yiloo nto.

UMLO/UBUKHULU: Xa zijongwa kunye ezi zinto zenza “icandelo elinqamlezayo” lento. Kucinge oku "njengobukhali" okanye "ingongoma" yento.

Izinto ezingenelelayo ezibukhali kakhulu zisebenzisa amandla okutyumza agxininise kakhulu kunye namandla amancinci azolula, wonakalisa izicubu kwindlela yazo ethe ngqo ngelixa zishiya iindawo ezizingqongileyo zingonzakele.

I-cavitation yale nzakala incinci kakhulu, inikwe amandla aphantsi okunweba kwizicubu ezijikelezileyo.

Izinto ezibuthuntu zinepateni echaseneyo yomonzakalo, zisebenzisa amandla atyumzayo kwindawo enkulu ngelixa zisebenzisa amandla amakhulu okuzolula njengoko zityhutyha iithishu ngamandla amakhulu.

I-cavitation yale nzakalo idla ngokubaluleka ngenxa yobuninzi bezicubu ezonakalisiweyo ezibajikelezile.

Imilo kunye nobukhulu buntsokothile, kuba into enobunzima obunikiweyo kunye nesantya esinye isithuba kunye nobukhulu bunokubangela ukwenzakala okubulalayo, ngelixa enye inokubangela ngaphezulu kancinci kunomkrwelo. (i-baseball ehamba nge-45mph ngokuchasene nemela ehamba kwi-45mph).

UMASIPALA: le propati ibotshelelwe ngokusondeleyo kumandla ento egqobhozayo. Ubunzima obuninzi ngesantya esinikiweyo = amandla amaninzi. (oko kukuthi, imoto ehamba nge-60 mph vs. ibhola yomnyazi ehamba nge-60 mph

Ukuba izinto ezimbini zihamba ngesantya esifanayo, kokukhona inkulu iya kuba namandla angakumbi okutyumza, ukolula, ukungena nokutshabalalisa izicubu.

Izinto zamandla aphezulu zidla ngokubangela ukutyumza ngakumbi, ukolula, kunye nokulimala kwe-cavitating.

I-VELOCITY: isithako sesibini samandla, emva kobunzima. (Qwalasela imbumbulu ephoswe kuwe xa ithelekiswa nenye edutyulwe kumpu):

Izinto ezihamba ngesantya esiphezulu zibangela ukunyuka okukhulu kokutyumza kunye nokwelula amandla; i-cavitation ibulala kakhulu kwi-high-velocity trauma njengoko kuxoxwe ngayo kweli candelo phantsi kwesihloko esithi "amanxeba okudutyulwa."

UHLOBO LWEZIQINISEKISO: Izicubu zinamanqanaba ahlukeneyo okuxhathisa ukolula nokutyumza umonzakalo.

Izicubu ezikhululekileyo ezifana namafutha okanye imiphunga zixhathisa kakhulu ukutyumza / ukunweba kwaye zinokubaleka ukwenzakala nge-cavitation encinci okanye ukuphazamiseka.

Ngenye indlela, izicubu ezixineneyo ezifana ne-muscle / isibindi / ithambo litshatyalaliswa lula yimikhosi enjalo kwaye inokubonisa nge-cavitation ekhangayo.

Iimbumbulu kunye namanxeba okuhlatywa

Ezi ngqikelelo zingasentla zibonakaliswe ngokugqibeleleyo kumanxeba enziwa zizixhobo eziqhelekileyo-imipu neemela (okanye nasiphi na isixhobo esihlabayo esibukhali/esitsolo).

I-GUNSHOT WUNDS (GSW): Izilonda zezibhamu ngumzekelo weklasi wento ephezulu yesantya / ephantsi-ubuninzi obubangelwa ukutyunyuzwa okuphawulekayo kunye nokulimala okunwebekayo, nangona izinto eziphantsi kunye nemilo ecacileyo.

Oku kungenxa ye-cavitation enkulu eyenziwa yinto yesantya esiphezulu edibana namanzi emzimbeni.

Yenza "ukuqhuma" okukhulu kwangaphakathi njengoko amandla e-kinetic yebhulethi idluliselwa kwizicubu ezijikelezileyo.

Oku kutyumza kwaye kwandise izicubu kwipatheni ebanzi ejikelezayo ejikeleze indawo yempembelelo, kudala umonzakalo ogqithise ngaphezu koko kunokucetyiswa linxeba lokungena.

Kwirekhodi, zonke ii-GSWs kwisisu zifuna ukuphononongwa ngotyando, ngenxa yokuba kunokwenzeka ukuba amathumbu agqitywe.

Ukuba isigulane sizinzile, nokuba i-GSW kwisifuba ingabonwa ngaphambi kokumisela imfuno yokuhlola (i-anemia eguqukayo, i-hypotension = ukuhlola). Kodwa ezi ziingcamango zasemva kokufika. ISIBIZELO SENZO: UKUTHUTHWA NGOKUXHAKAZAYO!

AMAnxeba okuhlatywa ngumzekelo wento enobunzima obuphezulu/isantya esisezantsi esidala umonzakalo omkhulu.

Ipateni yokulimala kwenxeba elihlatywayo liphuma kumlinganiselo olinganiselwe wamandla ogxininiswe kwinqanaba lomzuzu, okuvumela ukugxininiswa kwamanye amandla okutyumza okuncinci kwindawo encinci, ukutyhala ngokulula kwizicubu kunye nokonakalisa zonke izakhiwo ezifika kuzo.

Amanxeba emela ayingozi kakhulu ngenxa yokungakwazi komzimba ukuxhathisa amandla agqithisileyo kwincam yemela.

Uninzi lweendlela zomonzakalo ziya kuyigcina imithambo yegazi eyomeleleyo/imithambo-luvo, kodwa umonzakalo wokuhlatywa unqumla ngokulula ezi zakhiwo.

Ngandlel’ ithile ngendlela engaqondakaliyo, ngelixa izihlunu eziqinileyo ezifana nesibindi, izintso, kunye nodonga lomzimba kunokwenzeka ukuba zonakaliswe kakhulu ukuba zilele kwindlela yeemela, izibilini ezidadayo ezikhululekileyo azinakwenzakala kangako kunembumbulu, njengoko ezi “ ezidadayo ezikhululekileyo” zikholisa ukutyhala okanye “zijije” endleleni.

ISIBIZELO SENZO: UKUTHUTHWA NGOKUXHAKAZAYO!

Awunakukwazi ukuba yintoni eza kwenzeka ngokukhawuleza ngenxa yokuba awukwazi ukubona okwenzekayo “ezantsi komphakamo wolwandle,” oko kukuthi, ngaphantsi kolusu, ngaphandle kokuba uyifumene ngokungangqalanga ngemiqondiso ebalulekileyo.

Uvavanyo noLawulo: ABC(DE)s

Njengoko kuninzi lweendlela zokwenzakala okukhulu, ulawulo lomonzakalo olungeneyo lugxile kulawulo lwe ABC's (indlela yomoya, ukuphefumla, ukujikeleza) kodwa ikwanwenwela ku-D kunye no-E (ukukhubazeka kunye nokuvezwa) ngenxa yendalo entsonkothileyo kunye ne-multifactorial yokonzakala okwesibini ukuya kumonzakalo wobundlobongela.

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I-AIRWAY: Umonzakalo wokungena entloko kunye/okanye entanyeni unomngcipheko omkhulu wokuphazamiseka kwendlela yomoya ngenxa yomonakalo othe ngqo wesakhiwo kunye "nemiphumo yobuninzi," ukwandisa ukuqokelelwa kwegazi / ulwelo olucinezela iipaseji zomoya.

Ukuvula indlela yomoya ngokusebenzisa i-jaw-thrust eguqulwayo kunokuba yimfuneko njengoko i-C-spine trauma ixhaphake kumandla aphezulu okungena kwingozi entloko nasentanyeni.

Ukuguqulwa komgca womhlathi owenza ukuba uguqulwe kukuseka umgca wokuzinza kwentloko kunye nentamo ukuhambisa umhlathi phambili kunye nokwandiswa kwentloko encinci.

Ukwenzakala kwesisu esingena esiswini, ukuzinza kwe-C-spine akuzange kubonise nzuzo ngaphandle kokuba ukusilela okucacileyo kwe-neurological (iimpawu ze Umgudu ukulimala) zikhona.

Njalo qwalasela ukusetyenziswa kweendlela zomoya zomatshini (i-nasopharyngeal / oropharyngeal, i-suction ephathekayo, kunye ne-endotracheal) njengoko igunya lakho livumela. Ukukhumbula ukuba ii-airways ze-nasopharyngeal zichasene nokulimala kobuso.

UKUPHEFUMLA: Kanye kunye nomgudu wokuphefumula, ukuphefumla kufuneka kuhlolwe njengoko uvula / uvavanya izigulane zomoya: izinga, umgangatho, ubunzulu, kunye nokusetyenziswa kwemisipha ye-accessory zizinto eziphambili zokuphefumla.

I-Palpation ye-thorax kunye ne-auscultation yezandi zemiphunga kwimiphunga yomibini nasemqaleni kubalulekile ukuveza nayiphi na inzakalo efihliweyo okanye i-pneumothorax kwizigulane ezine-trauma yokungena. I-100% i-oksijini kwi-12-15 L / min ngokusebenzisa i-non-rebreather yindlela yokungenelela yokuphefumula okusemgangathweni kwi-trauma enzulu yokungena.

I-Positive pressure ventilation nge-Bag-Valve-Mask inokuba yimfuneko ngokuxhomekeke kumonzakalo wesigulane.

I-CIRCULATION: Uvavanyo olukhawulezayo lwee-peripheral kunye ne-central pulses lunokubonelela ngoqikelelo oluqinileyo lwe-perfusion yezigulane kunye noxinzelelo lwegazi ngelixa unika ulwazi olongezelelweyo malunga nesantya se-pulse, rhoqo, kunye nomgangatho.

Ubukho be-Radial pulse bubonisa i-systolic BP emalunga ne-80 mmHg ubuncinane.

Ubukho be-Femoral pulse budibene ne-systolic BP ubuncinane be-70 mmHg.

I-Carotid pulse ihambelana ne-systolic BP ubuncinane ubuncinane be-60 mmHg.

Ngenxa yokuba i-pulse palpable xa i-peripheral pulses ingekho (< 70 mmHg), i-carotid yeyona ndawo ifanelekileyo yokukhangela i-pulse kwisigulane esingenangqondo esinokwenzakala.

Ulusu: Ulusu lwesigulana lunokuba luphawu olulungileyo lwemeko yokujikeleza kwegazi: Ulusu olushushu, olomileyo, kunye nepinki lubonisa ukudumba okwaneleyo.

Ulusu olupholileyo, oluluthuthu, oluluthuthu, kunye/okanye olufumileyo aluqhelekanga. Ixesha lokuzalisa i-Capillary ngaphantsi kwemizuzwana ye-2 liphinda lixoxe ngokugqithisa okwaneleyo.

UKUKHUBAZEKA: Uvavanyo olukhawulezayo lomzimba kunye nolwengqondo lwemithambo-luvo lwanele ukuvavanya ubukho bokukhubazeka okubalulekileyo.

Ngokomzimba, uvavanyo olukhawulezayo lunokubandakanya ukuvavanya ukubamba kwesigulane kunye nokukwazi ukuguqula i-dorsal / plantar flex iinyawo zokuvavanya ukunyakaza kwesigxina kunye nokuziva.

Ukulahlekelwa yimvakalelo kunye / okanye ukukhubazeka kweyona nto ifunyenweyo ebonisa ukuphazamiseka kwemizwa.

Ukuhlola kwakhona kubalulekile, njengoko utshintsho kwiziphumo ekuhambeni kwexesha kufuneka luqatshelwe.

Ukukhubazeka okunokubakho okuvela kumothuko ukuya kwinkqubo yemithambo-luvo (ingakumbi intloko) kufuneka kuhlolwe kusetyenziswa I-AVPU okanye izikali ze-GSC.

Isikali se-AVPU sisebenza ngakumbi kwiimeko ezinokuthi zibe nesiphithiphithi somothuko.

Isikali se-AVPU simi ngolu hlobo lulandelayo: Ngaba isigulane Isilumko kunye nencoko, siphendula kwi-Verbal stimuli kuphela, siphendule kwi-Painful stimuli kuphela, okanye ngokupheleleyo Ukungaphenduli? I I-GCS kufuneka isetyenziswe ukuvavanya ngokuchanekileyo ngakumbi ukuba nokwenzeka kokukhubazeka xa ixesha livuma.

I-EXPOSURE (kunye novavanyo lwesibini): I-exposure epheleleyo yaso nasiphi na isigulane esinobuhlungu obungena ngaphakathi kubalulekile. Khulula isigulana kuphononongo lwazo zonke iindawo zolusu, oku kubalulekile ukunqanda ukuphoswa nakuphi na ukwenzakala okungeyonxalenye yenkcazo-ntetho yokuqala. Ukuba usika iimpahla, usike imithungo ukwenzela ukuba ungaphazamisi ubungqina benkundla (imingxuma yeembumbulu, njl. njl.).

Uvavanyo lwe-DCAPBLTS (i-Deformity, i-Contusions, i-Abrasions, i-Penetrations, i-Bruising, i-Tenderness, i-Lacerations, kunye ne-Swelling) isifinyezo esiqhelekileyo sokusebenza ngexesha lovavanyo lwesibini kunye nesikhumbuzo sokuba umntu unokulindela ntoni ukufumana ukulimala okuqhelekileyo okungenayo.

QAPHELA: Ukuba kwimeko yamanxeba afunyenwe kwindibano enobundlobongela. kubalulekile ukugcina ubungqina, amaxwebhu apheleleyo awonzakeleyo ayimfuneko, kwaye ukugcinwa ngenyameko kwempahla yamaxhoba kuyafuneka.

Ukuba kuyenzeka, sika imithungo kwaye ubeke iimpahla engxoweni yeplastiki ukwenzela amapolisa. Ungaze ulahle nayiphi na impahla, yishiye kunye namagosa kwindawo okanye uyithuthe kunye nesigulana ukuya kwi-ER.