Ukutshona okanye 'isifo sokutshona' kwezamayeza kubhekiselele kuhlobo lwe-asphyxia ebukhali evela kwisizathu 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.

Unyango lokuqala lwamaxhoba arhaxwayo

Ulawulo olungxamisekileyo kufuneka lwenziwe kwaye uncedo kufuneka lwenziwe lusebenze ngokukhawuleza ngokufowunela iNombolo yoNgxamiseko.

Okwangoku, umhlanguli kufuneka acacise ngononophelo indlela yomoya yesifundo kwaye, ngokungabikho kokuphefumla okuzenzekelayo, aqalise ukuvuselela umlomo ukuya emlonyeni de isigulane siphinde siphefumle ngokuzimeleyo.

Ukukhangela ukubetha kwentliziyo kufuneka kwenziwe emva kokuba isigulane sibuyiselwe elunxwemeni okanye siphakanyiselwe kwi-float enkulu ngokwaneleyo ukuhlalisa zombini ixhoba kunye nomhlanguli.

Iindlela zokunyanzeliswa kwesifuba ezenziwa emanzini azisebenzi ngokwaneleyo ukubuyisela ukuhamba.

Ukuba ingozi yenzeke kumanzi abandayo, kuyacetyiswa ukuba uchithe imizuzwana embalwa eyongezelelweyo ukukhangela i-pulsations ye-peripheral, ukuze uthintele ubukho be-bradycardia ephawulweyo okanye ngokukodwa umsebenzi wentliziyo obuthathaka.

I-massage ye-cardiac eyenziwa ngokukhawuleza inokubangela i-fibrillation ye-ventricular kwaye, ngokwenene, i-cerebral perfusion ibe mandundu.

I-Heimlich maneuver akufuneki yenziwe ngaphandle kokuba kuthintelwe indlela yomoya ebangelwa yenye into ekhoyo: amaxhoba arhaxwayo angaginya umthamo omkhulu wamanzi kwaye i-HeimIich maneuver ingababangela ukuba batshone. ukugabha, kunye nolangazelelo olulandelayo, olunokuthi lube mbi ngakumbi imeko.

Intloko kunye entanyeni Akufunekanga ahlanganiswe, ngakumbi ukuba umntu uye warhaxwa emva kokuntywila emanzini angekho nzulu.

Ukuba ukwenzakala kwi umqolo womgcini kurhanelwa, kuyimfuneko ukuthintela isigulana phambi kokuba kuthuthwe ukuze kuthintelwe umonakalo ongakumbi onokwenzeka, kwezinye iimeko ezingenakulungiseka kwaye zikhubazeke, ezifana nezo zikhokelela ekukhubazekeni.

Ngokukhawuleza, isigulane kufuneka sihanjiswe esibhedlele.

Unyango lwasesibhedlele lwamaxhoba arhaxwayo

Abasebenzi basesibhedlele kufuneka balungiselele oko kuyimfuneko izixhobo I-intubation (i-laryngoscope, ii-scalpels ezahlukeneyo, ii-cannulas zohlobo olwahlukeneyo, ii-speils eziguquguqukayo, i-Magill forceps, iisirinji ukujonga i-patency yemikhono kunye nokuyifakela, i-aspirator, i-plaster yokulungisa i-endotracheal cannula, i-ventilator efanelekileyo 'yebhaluni-valve- imaski').

Ikhithi ye-arterial haemogasanalysis kunye nempahla efanelekileyo kufuneka ibekhona ukuze kuqinisekiswe amanyathelo ayimfuneko ococeko.

Unyango lwamaxhoba arhaxwayo lusekelwe kuvavanyo olukhawulezayo lokuqala lweklinikhi kunye nokuhlelwa okulandelayo kobunzima bemeko yesigulane.

Ukutshona, esi sikimu silandelayo sibhekisa kuhlelo lwemithambo-luvo lwasemva kokutshona kweModell kunye neConn:

A) Udidi A. Vukani

• Vuka, unolwazi kunye nesigulana esiqhelanisiweyo

B) Udidi B. Dulling

• Ukuncipha kwengqondo, isigulana sityhafile kodwa sinokuvuswa, impendulo enenjongo kwisivuseleli esibuhlungu.
• Isigulana asinakuvuswa, siphendule ngokungaqhelekanga kwi-stimuli ebuhlungu

C) 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

Ukutshona, ngoku makhe sijonge iindidi ezahlukeneyo ngokwahlukeneyo

Udidi A (Vuka)

Ezi zigulana zikwimeko ephaphileyo kwaye zine- Glasgow Coma Scale (GCS) ye-14, ebonisa umonakalo omncinci we-hypoxic.

Nangona amaxhoba akweli nqanaba esempilweni, kufuneka alaliswe esibhedlele kwaye abekwe phantsi koqwalaselo oluqhubekayo kwiiyure ze-12-24 ukuvumela ukungenelela kwangethuba xa kwenzeka ukuwohloka ngequbuliso kwe-pulmonary okanye umsebenzi we-neurological, ukuwohloka okufuneka kuhlale kulindelwe nakwixesha elizayo. imeko yesifundo esibonakala sisempilweni ngokupheleleyo.

Iimviwo mazibandakanye:

• ubalo olupheleleyo lwegazi,
• ukuzimisela kwe-serum electrolytes kunye neglucose yegazi,
• X-ray esifubeni,
• uhlalutyo lwegesi yegazi,
• iimvavanyo zokukhuliswa kwesikhohlela,
• ukuzimisela amaxesha coagulation.

Ukuhlolwa kweziyobisi kusenokuba yimfuneko.

Kwimeko yokuxhatshazwa kwentamo ekrokrelwayo, i-X-ray kunye / okanye i-CT scan yomqolo kufuneka yenziwe.

Kwimeko yokulimala kwentloko okanye ukwaphuka, ukucinga kufuneka ngokucacileyo kuphande ukhakhayi kunye nokwaphuka.

Unyango lwezigulane eziwela kolu didi luyimpawu.

Ioksijeni inokulawulwa, nge-cannula okanye imaski, ukuze kugcinwe i-PaO2 ngaphezu kwe-60 mmHg.

I-Spirometry inokuba luncedo.

Ukulangazelela okunokwenzeka kwemizimba yangaphandle kunokuqinisekiswa nge-X-reyi yesifuba okanye i-endoscopy.

I-Bronchospasm inokunyangwa ngamachiza e-β2-adrenergic nge-aerosol.

Ekugqibeleni, kubalulekile ukuqinisekisa ukufikelela kwe-venous, okuvumela ukuba ibhalansi ye-hydro-electrolyte ilawulwe kwaye ingenelele ngokukhawuleza xa kwenzeka ukuwohloka kwimeko yeklinikhi.

Ubunzima bemeko ye-neurological inokuxhomekeka kwizinto ezininzi, ezinje:

• i-hypoxemia, okwesibini ukuwohloka komsebenzi we-pulmonary;
• ukwanda koxinzelelo lwe-intracranial (ICP), okwesibini kwi-hypoxia;
• amayeza okanye ukuthatha iziyobisi phambi kwengozi;
• yangaphambili metabolic, ukuphefumla, coagulative kunye/okanye izifo sentliziyo.

Ukuba imeko yeklinikhi ihlala izinzile kwaye akukho kuphazamiseka kwe-neurological or pulmonary function ngaphakathi kweeyure ze-12-24, isigulane sinokukhutshwa ngokubanzi, ngaphandle kweemeko ezinqabileyo.

Ukuhlolwa kwezonyango ngaphakathi kweentsuku ezi-2-3 kucetyiswa ngamandla.

Udidi B (Ukozela)

Ezi zigulana zikwimeko yobuthuntu, okanye i-semi-consciousness, kodwa zinokuvuswa.

Amanqaku e-GCS aqhele ukuba phakathi kwe-10 kunye ne-13, nto leyo ebonisa isiqephu esiqatha kakhulu kunye nexesha elide le-asphyxia.

Basabela kwi-stimuli ebuhlungu kunye nokunyakaza okunenjongo, umsebenzi wokuphefumula kunye ne-pupillary reflexes ziqhelekileyo.

Basenokuba nomsindo kwaye babe ndlongondlongo.

Emva kokuvuselela kunye novavanyo lokuqala kwisebe elingxamisekileyo, ezi zigulana kufuneka zingeniswe kwiyunithi yokunyamekela kakhulu (ICU), ibeke iliso ngokucokisekileyo ukubonakala kwayo nayiphi na inguqu kwi-neurological, pulmonary and / or cardiovascular function.

Ukuhlala kwabo esibhedlele kulixesha elide kunezigulane zodidi A.

Zonke iimvavanyo zokuxilonga kufuneka zenziwe kwaye zonke iindlela zonyango zixoxwe ngasentla kwicandelo lezigulane zodidi A.

Inkcubeko yemihla ngemihla yegazi, isikhohlela kwaye, ukuba kunokwenzeka, iisampulu zomchamo kufuneka zenziwe.

Ukulawulwa kwevithamin K kunokuphucula amaxesha okujika.

Unyango lwe-Antibiotics kufuneka luqhutywe kuphela xa kukho iimvavanyo zenkcubeko efanelekileyo kwi-pathogenic bacterial flora.

Imeko ye-neurological yesigulane inokutshintsha ngokukhawuleza, kwaye inkqubo eqhelekileyo yezigulane ezinokulimala kwentloko kufuneka ibonwe.

Ukubonakala kwe-pulmonary edema okanye i-acidosis enganyangekiyo ye-metabolic, kunye nesidingo sokwandisa ixesha lokuvuselela ukuvuselela (ngaphandle kwezigulane ezithathwe kumanzi abandayo kakhulu) ngokuqhelekileyo kubonisa i-hypoxia enzima.

I-Hypoxemia inokuba yinto echaseneyo ekwandiseni ukugxila kweoksijini kumoya ophefumlelweyo.

Ukuze kugcinwe i-PaO2 ngaphezu kwe-60 mmHg, i-continuous positive pressure ventilation (CPAP) usebenzisa imaski okanye izixhobo zomatshini zingafuneka.

Ngamanye amaxesha kuyimfuneko ukunciphisa umthamo wolwelo, kodwa i-plasma osmolality mayingadluli kwi-320 mOsm/litre.

Udidi C (Coma)

Imeko yemithambo-luvo yezi zigulana zibaluleke kakhulu kukuba azikwazi ukuvuswa.

Amanqaku e-GCS angaphantsi kwesi-7.

Unyango kufuneka lujoliswe ekugcineni ioksijini eqhelekileyo, ukungena komoya, ukuphefumla, uxinzelelo lwegazi, i-glycemia kunye ne-serum electrolytes.

Izifundo zezilwanyana ezincinci malunga nokuvuselelwa kwengqondo ziye zaphakamisa amathemba amatsha okubuyisela izigulana eziye zafumana isithuko esiqatha.

Injongo ye-cerebral resuscitation maneuvers kukuthintela ukwanda kwe-ICP kunye nokugcina i-neurons ebalulekileyo kodwa ingasebenzi.

Unyango lunokubandakanya i-hypothermia, i-hyperventilation, i-calcium channel blockers, i-barbiturates, ukuphumla kwemisipha okanye ukukhubazeka, i-etomidate, i-fluorocarbon infusion.

Ngelishwa, iziphumo ze-cerebral resuscitation maneuvers zinamabala, kwaye kusaphikiswana ukuba loluphi unyango olukhethwayo.

Ingxaki enzulu yeenqobo ezisesikweni inxulumene nokuthandabuza ukuba ukuvuselelwa kwengqondo akuphuculi umgangatho wobomi bezigulana, kodwa kulibazisa nje ukufa kwazo ngokwandisa inani labantu abakwimeko yezityalo ezizingileyo.

Le mihlathi ilandelayo isekelwe kwiingcebiso zikaConn malunga nokuvuselela ingqondo.

Kulo mongo isimaphambili 'HYPER' sisetyenziswa ngokungaqhelekanga, njengoko izigulana ezonzakele kakhulu ebuchotsheni zihlala rhoqo.

• i-hyperhydrated,
• hyperpyretic,
• ukuxhalaba kakhulu,
• hyperrigid,
• i-hyperventilated.

Ukungabikho kwamanzi emzimbeni 

I-Hyperhydration inokufaka isandla ekwandeni kwe-ICP kunye nokuqala kwe-pulmonary edema.

Kwiinzame zokuthintela oku, i-diuretics idla ngokusetyenziswa.

Ujongo lwe-Haemodynamic lwenziwa ukunqanda ukuthintelwa kolwelo olugqithisileyo, olunokubangela ukusilela kwezintso.

Idosi encinci ye-dopamine (ngaphantsi kwe-5 μg/kg/min) ivuselela i-renal dopamine receptors, inyusa ukunyibilika kwezintso kwaye inokukhuthaza ukumila komchamo.

I-Diuresis, nangona kunjalo, akufanele inyanzeliswe de i-serum osmolarity ibe ngaphezu kwe-320 mOsm/litre.

Ukwenza uhlolo lwe-haemodynamic olungenelelayo kufuna ukufakelwa kwe-catheter ye-pulmonary artery catheter, evumela uxinzelelo lwe-venous osembindini, uxinzelelo lomthambo we-pulmonary kunye noxinzelelo lwe-pulmonary wedge ukuba irekhodishwe.

Ukuba uxinzelelo lwe-arterial aluzinzile, okanye ukuba kukho ii-ABG ezininzi, ukufakwa kwe-catheter ye-arterial kunokufuneka.

Kwiminyaka ye-1980, i-ICP yayisetyenziswa ngokubanzi ukwenzela ukukhusela okanye ukulawula ukuqala kwe-hypertension ye-intracranial.

Okwangoku, le nkqubo isetyenziswa rhoqo kwizigulane eziwela kwiindidi A kunye no-B kwaye zibonisa iimpawu zokuwohloka kwengqondo kunye ne-neurological.

Kuyathenjwa ukuba i-hyperventilation kunye nokusetyenziswa kwe-osmotic diuretics kunye ne-thiopental inokubuyisela i-cerebral edema yesibini kwi-ischemia.

Ngelishwa, nolawulo olusebenzayo lwe-ICP aluqinisekisi ukusinda ngaphandle kokulandelelana.

Ukuphefumla ngamandla

Izigulane ezifuna umoya wokuphefumula ngomatshini kufuneka zibe ne-hyperventilated, zigcina i-paC02 phakathi kwe-25 kunye ne-30 mmHg.

Ukuxhatshazwa kwe-Cerebral vascular kulawulwa yithoni ye-arteriolar, eguqulwa ngotshintsho kwi-pH.

Ekubeni i-pH ithonywa ngamaxabiso e-PaCO2, i-hyperventilation ibangela i-vasoconstriction kwaye inciphisa ixabiso le-ICP.

Umthamo we-tidal ungamiselwa ukusuka kwi-10 ukuya kwi-15 ml / kg, kwinqanaba le-ventilatory elifunekayo ukubangela ukunciphisa okufunwayo kwePaCO2.

I-oxygenation ye-tissue yinjongo ebalulekileyo kunyango lwezigulane ezinokukhubazeka okukhulu kwemiphunga.

Kuya kuba yinto efanelekileyo, kodwa akunakwenzeka njalo, ukugcina i-arterial oxygen saturation (SaO2) malunga ne-96% (PaO2 ye-100 mmHg).

Ukusetyenziswa koxinzelelo olulungileyo lokuphelelwa umoya (PEEP) yindlela efanelekileyo yokuqinisekisa i-oksijeni eyaneleyo (i-PaO2 ngaphezu kwe-60 mmHg).

Kubantu abadala kunye nabantwana abadala, ixabiso le-PEEP kufuneka linyuswe nge-5 cm H2O ngexesha kuze kufike i-oxygenation eyaneleyo.

Kwizigulane ezincinci, ukunyuka okulandelayo kufuneka kube kuncinci.

Hyperpyrexia

Ukungeniswa kwe-hypothermia (ubushushu bomzimba obuyi-30 ± 1 ° C okanye ngaphantsi) kucetywayo kwizigulane ezinokulimala kwengqondo kunye ne-commatose kuba kunokunciphisa iimfuno ze-metabolic zengqondo kunye ne-ICP.

I-Hypothermia, eyenziwa ngaphambi kwe-cerebral ischaemia, yaziwa ngokuba negalelo elikhuselayo kwingqondo.

Nangona kunjalo, le nkqubo ayizange iphucule imeko ye-neurological yezigulane esele zifumene i-cerebral hypoxia kwaye, ngokuchaseneyo, zingabangela iingxaki, ezifana nokunyanzeliswa kwempendulo ye-immune ye-immune, ukutshintshela ngasekhohlo kwijika le-hemoglobin dissociation, kunye ne-cardiac arrhythmias. .

Ukuba izinga lokushisa lomzimba liphezulu, i-normothermia kufuneka ibuyiselwe, kunye nokulawulwa kwe-antipyretics kunye nokusetyenziswa kweematrasi zokupholisa, njengoko umkhuhlane ubangela ukwanda kokusetyenziswa kwe-oxygen.

I-hyper-excitability

IiBarbiturates zikholelwa ukuba zinciphisa i-ICP ngokubangela i-vasoconstriction, ukucinezela umsebenzi wokuxhuzula, kunye nokunciphisa imetabolism ye-cerebral.

I-Thiopental mhlawumbi yeyona barbiturate kuphela ekwaziyo ukususa i-oxygen free radicals.

Ukufakwa kwe-coma ye-pharmacological kunye ne-barbiturates akuzange kuboniswe ukuphucula ukusinda okanye ukuguquka kweemeko ze-neurological kumaxhoba arhaxwayo ngomonakalo omkhulu wobuchopho kwaye, ngokuchaseneyo, kugxininisa ukungazinzi kwentliziyo.

Ngenxa yezi zizathu, ukulawulwa kwe-barbiturates akuseyonxalenye yonyango olucetyiswayo; endaweni yoko, la machiza asetyenziselwa ukulawula ukuxhuzula.

Ukulawulwa kwe-steroids kucetywayo, kwiimeko zokungaphumeleli ukutshona, ngethemba lokunciphisa i-ICP, kodwa uphando olulandelayo lubonise ukuba alusebenzi.

Ukongezelela, la machiza anokuphazamisa impendulo yokuzivikela kwintsholongwane yebhaktheriya, ekhokelela kwisiganeko esiphezulu se-sepsis.

Hyperrigidity

I-Decerebrate and decorticated postural rigidity luphawu lwe-intracranial hypertension.

Ukwandiswa kwe-ICP kunokuba yisibini kwi-cerebral edema evela kwi-hypoxia, umoya wokungenisa umoya kunye ne-PEEP, ukukhwehlela, isikhundla seTrendelemburg.

Ukulawula umnqweno kunokukhokelela ekonyukeni kwe-ICP ukuya kuthi ga kwimizuzu engama-30.

I-ICP inokwehliswa kwizigulane ezifuna umoya wokuphefumula ngoomatshini ngokulawula i-sedative kunye ne-paralyzing agents.

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