I-Endotracheal intubation (ETI) ebantwaneni inqabile ngombulelo kwaye inqanaba lethu lokuqala lokuphumelela ngokuqinisekileyo linokukwenza ngokuphucula

Kunzima ukuthelekisa ukusebenza kweendlela ezahlukeneyo zokuhamba ngomoya kubantwana.

Kukho iimpembelelo zokuziphatha, kunjalo, kodwa ikwaphawula ukungafani kubudala nakwindlela yokubanjwa enokubakho.

Kukho ixesha elininzi lokuthetha neqela lezonyango kwaye wenze isicwangciso esisekwe kweyona ndlela ihamba phambili yomoya kuloo meko inikiweyo.

Kwangokunjalo, indawo yemidlalo yeqonga yokusebenza, ikhaya lolingo oluninzi lomoya, yindawo eyahlukileyo kakhulu.

Siza kujonga kwiindlela zomoya eziphambili kwimeko yokubanjwa kwentliziyo / ukuphefumla.

Khumbula ukuba kuya kuhlala kukho umahluko kumaxesha kunye nobuchule obubekwe phakathi kwesibhedlele sentliziyo esingaphandle kwesibhedlele (OHCA) ukubanjwa kwentliziyo esibhedlele (IHCA).

Zimbalwa izifundo ezikhoyo ezithelekisa unyango lomoya oluqhubele phambili olusetyenziswa ngexesha lolawulo lokubanjwa kwentliziyo ebantwaneni.

Kukho izifundo ezimbalwa ezijikeleze ukusetyenziswa kweendlela zomoya ezihamba phambili (SGAs) ebantwaneni. Uninzi lwezi zezifundo zokujonga.

I-ILCOR ngoku icebisa i-endotracheal intubation (ETI) njengeyona ndlela yokulawula indlela yomoya ngexesha lokuvuselelwa

Bakwatsho ukuba ii-supraglottic airways ziyindlela eyamkelekileyo yokungenisa umoya kwi-bag-valve-mask (BVM).

Zimbalwa kakhulu izilingo zeklinikhi ebantwaneni ekusekwe kuzo ezi ngcebiso (kwaye ngokuqinisekileyo akukho nanye yoyilo olungqongqo kule minyaka ingama-20 idlulileyo).

Ngenxa yokunqongophala kobungqina, bayalela isifundo njengenxalenye yeQeqesho laBantwana leNkxaso yoBomi.

ILavonas okqhubekayo. (2018) yenze uphononongo olucwangcisiweyo kunye nohlalutyo lweemeta ekusetyenzisweni kongenelelo lwendlela ehamba phambili (i-ETI vs SGA), xa kuthelekiswa ne-BVM iyodwa, yokuvuselela abantwana ekubanjweni kwentliziyo. Zizifundo ezili-14 kuphela ezichongiweyo.

I-12 kwezi zilungele ukufakwa kuhlalutyo lweemeta.

Zazijolise ikakhulu kwi-OHCA. Kwakukho umngcipheko omkhulu wokhetho kwaye ke umgangatho wobungqina ngokubanzi wawusezantsi ukuya kuluhlu olusezantsi kakhulu.

Esona siphumo siphambili kukusinda ukukhutshwa esibhedlele ngesiphumo esifanelekileyo se-neurological.

Uhlalutyo lucebisile ukuba zombini i-ETI kunye ne-SGA bebengekho ngaphezulu kwe-BVM.

Ke ngoku, masigubungele olunye uncwadi ngokusetyenziswa kwezixhobo zomoya ezibalaseleyo. Oku ikakhulu kusekwe kwizifundo zabantu abadala.

Isixhobo esifanelekileyo sokuphefumla umoya

• … Kulula ukuyilungisa kwaye uyifake nangubani na ke oko akunamsebenzi nokuba ithini na imo yokwenziwa kweqela
• … Iyakhawuleza ukuseta kwaye iyakhawuleza ukufaka. Oku kunciphisa ixesha elisuswe kweminye imisebenzi ebalulekileyo kunye nokuvumela loo nto ibaluleke kakhulu 'kwi-bandwidth'
• … Ivumela umngcipheko omncinci wokufuna
• … Inikezela itywina eliqinileyo ukuvumela uxinzelelo oluphezulu lokuhamba ngomoya xa kufuneka njalo
• … Yomelele ngokwaneleyo ukuba isigulana singakwazi ukuluma ngayo kwaye sinqumle ukuhanjiswa kweoksijini
• … Inikeza ukhetho lokudibanisa isisu ngesixhobo esinye
• … Unobungozi obuncinci bokuphoswa ngempazamo ngengozi okanye ilahleko yomoya emva kokuba ifakwe

Ukuba oku kuvakala kulungile kakhulu ukuba kuyinyani, kunjalo. Akukho sixhobo sidibanisa zonke ezi zinto zibalulekileyo.

Oku kusishiya sithatha isigqibo sokuba yeyiphi eyona ifanelekileyo kwisigulana esiphambi kwethu.

Kunzima kakhulu ukuthelekisa ii-SGAs kunye neetyhubhu ze-endotracheal (ETT).

I-ETT 'yindlela yomoya ecacileyo' ebonelela ngokhuseleko kwiminqweno.

Oku akuthethi ukuba ii-SGAs zikhetho 'oluncinci'.

I-SGA iseyi 'ndlela yomoya ehambele phambili' kwaye isebenza ngakumbi kunokusebenzisa ubuchule be-valve-valve-mask.

Kubalulekile ukuba ukhumbule ukuba iindlela zomoya ohamba phambili zinezinto ezilungileyo nezingalunganga.

Ngelixa banokuphucula amathuba okuba isigulana siphile ngokufumana kwakhona kakuhle kwe-neurological, kunokubakho iingxaki ezinxulumene noko.

Inzululwazi isemva komoya ophakamileyo

Ithini inzululwazi? Zimbalwa izilingo ebantwaneni kodwa kuye kwakho amaphepha amaninzi okugqibela akhutshwa kubuchwephesha bendlela ehamba phambili kubantu abadala. Ngelixa linganxibelelananga ngokuthe ngqo nabantwana, bayaphakamisa amanqaku anomdla wokuthelekisa phakathi kwezixhobo.

Le multicentre, ulingo olungenamkhethe olulingwayo, lwaluqhutywa zii-paramedics kuzo zone iigulane iinkonzo eNgilani. Ithelekise izixhobo ze-supraglottic ukuya kwi-tracheal intubation kwizigulana zabantu abadala abane-OHCA ejonge kwiziphumo zazo kwisiphumo se-neurological.

Olu phononongo lubandakanya kuphela abaguli abangaphezulu kweminyaka ye-18.

Abafumananga mahluko ubalulekileyo kwisiphumo seentsuku ezingama-30 (esona siphumo sokuqala) okanye kwimeko yokusinda, inqanaba lokuphinda ubuye, umnqweno okanye iROSC (iziphumo zesibini).

Kwakukho umahluko obalulekileyo ngokweenkcukacha manani xa kufikwa kwimpumelelo yokuqala yomoya.

Iindlela zomoya zeSupraglottic zifuna iinzame ezimbalwa, kodwa ukusetyenziswa kwazo kukhokelela ekwandeni kokulahleka komgaqo womoya omiselweyo

Ithetha ntoni ke le nto? Eyona nkxalabo iphambili ejikelezayo xa kuxoxwa ngee-SGA ngowona mngcipheko mkhulu wokulangazelela. Ukuba kwakungekho mahluko emngciphekweni, ngaba loo nto ingayitshintsha ingqondo yakho?

Le yayiyinkqubo yeemvavanyo ezininzi zeklinikhi eFrance naseBelgium ejonge i-OHCA ngaphezulu kweminyaka emi-2. Kwakhona olu phando lubhalise abantu abadala ngaphezulu kweminyaka eli-18 ubudala.

Bajonge ukungathobeli kwe-BVM vs ETI ngokubhekisele ekusindeni kwisiphumo esifanelekileyo se-neurological kwiintsuku ezingama-28.

Amaqela aphendulayo aquka umqhubi we-ambulensi, umongikazi kunye nogqirha ongxamisekileyo.

Izinga le-ROSC lalilikhulu kakhulu kwiqela le-ETI kodwa kwakungekho mahluko ekusindeni ukuze kuphume.

Ngokubanzi, iziphumo zophando bezingachananga nangayiphi na indlela.

Ukuba ukusinda ekukhupheleni ngaphandle kokuchaphazeleka, ngaba sonke kufuneka sichithe ixesha loqeqesho kunye nokugcina ubuchule okanye ngaba i-endotracheal intubation igcinwa kuphela kwabo bayenza rhoqo kwimisebenzi yabo yosuku?

Olu qulunqo olwenziwe ngokungafaniyo, luyilo oluninzi olwenziwe ngama-paramedics / EMS kwii-arhente ezingama-27.

Kwajongwa kwizigulana zabantu abadala ezifumana ityhubhu yelaryngeal okanye i-endotracheal intubation kunye nokusinda kwiiyure ezingama-72.

Kwakhona, babandakanya abantu abadala abangaphezu kwe-18 kunye nokubanjwa okungabangeli ntlungu.

Bafumene 'ukuthozama kodwa okubalulekileyo' okuphuculweyo kwenqanaba lokusinda kwiqela le-LMA kwaye oku kudityaniswa nenqanaba eliphezulu le-ROSC.

Ngelishwa, eli tyala libandakanya uninzi lokhetho olunokubakho kwaye uyilo lokufunda alunakuba namandla ngokwaneleyo ukubuyisela inqanaba lokwahluka.

Ngaba inqanaba lokusinda linokuchazwa yimpumelelo yokupasa yokuqala kunye nexesha elincinci elichithwe 'ngaphandle kwesifuba' ngexesha lokuvuselelwa kokuqala? Akukho sifundo sigqibeleleyo. Soloko uzibeka emxholweni uzivavanye kwaye ujonge ukuba ngaba iziphumo zokufunda ziyasebenza kubemi bendawo yakho kunye nokwenza kwakho ngaphambi kokutshintsha nantoni na.

Imibuzo engaphezulu kuneempendulo

Emva kokufunda isayensi (kwaye nceda uhambe uye kungena nzulu kula maphepha kwaye uzivelele ngokwakho), makhe siphendule imibuzo eqhelekileyo.

Ii-SGAs zilula ngokulula ungazifaka kwaye uzenze!

Hayi Ukufumana iSGA linyathelo lokuqala kuphela. Nokuba kunjalo, kuya kufuneka uqiniseke ukuba ukhethe ubungakanani obufanelekileyo kwaye wavavanya ukuvuza. Ii-SGAs kunokwenzeka ngakumbi ukuba zikhutshwe kwaye zikhokelele kwilahleko engalindelekanga yendlela yomoya. Ngokubanzi, asiqinisekanga ngokubakhusela njengoko kufanelekile. Ngokufanelekileyo, sebenzisa ityhubhu yokubopha ukuyikhusela endaweni kwaye ujonge indawo (ngokunxulumene namazinyo). Ezinye ii-SGA zinomgca omnyama kwi-shaft ekufuneka ihambelane ne-incisors (lumka oku kunokuba khona kubungakanani obukhulu). Njengee-ETT, zifuna ukuba ujonge ukungena komoya okwaneleyo ngokusebenzisa i-auscultation, i-ETCO2 kunye nokumamela ukuvuza okucacileyo.

Kulungile ukuba kukho ukuvuza ekuqaleni njengoko ijeli iya kubumba njengoko ishushu

Akunabungqina obucebisa ukumila kwee-igels (oku kuhlala kungumzekelo wabezonyango ekubhekiswa kubo kulo mzekelo) kuya kubumba kungaphakathi kwingqula. Abaphandi bazamile ukufudumeza izinto kwaye akukho lutshintsho manani ekuvuza. Ukuba unendawo evuzayo, cinga ukuphinda ubeke indawo, utshintshele kubungakanani obahlukileyo okanye usebenzisa imodeli eyahlukileyo. Unokufumana ukuvuza okuncinci okunyamalala ngokuhamba kwexesha. Ixesha elingaphezulu, indlela yomoya iyajikeleza kwaye ihlala ngcono.

Kuya kufuneka usoloko usixinanisa isisu xa ufaka i-LMA

Kusenokwenzeka. Oku akufumaneki rhoqo kwizikhokelo njengoko kubonakala njengenkqubo yokulungisa kakuhle. Ingathatha ixesha kunye nezixhobo kude neminye imisebenzi ebalulekileyo (njengokucinezelwa kwesifuba, ukufikelela kwe-IV, umoya opholileyo) kodwa ukuba unazo izixhobo zokwenza njalo, ngaphandle kokuchaphazela iziseko zononophelo olulungileyo, kuyindlela elungileyo ukuba umoya ayilunganga ngokugqibeleleyo njengoko kunokuba njalo. Oku kubaluleke ngakumbi ebantwaneni. Siyazi ukuba basemngciphekweni omkhulu wokuqhekeka komoya ovuthuzayo ngenxa yokungenisa umoya ngokugqithileyo ukuze ukufakwa kwangoko kwetyhubhu ye-nasogastric kungaziphucula ngokwenene izinto.

I-Laryngoscopy kufuneka isetyenziswe ngaphambi kokufakwa kwe-SGA nganye

Kusenokwenzeka. Ezinye iindawo ziye zaqala ukugunyazisa i-laryngoscopy ngenxa yokuba baphose ukuphazanyiswa ngumzimba welinye ilizwe, okanye ukuvumela ukutsala okungcono kunye nokuphucula indlela yokufakwa. Kukho impikiswano yokuba i-SGA inokuhlala ngcono ukuba ifakwe ngoncedo lwe-laryngoscope njengoko, kwiimeko ezininzi, ayifakwanga ngokwaneleyo ngokwaneleyo. I-Laryngoscopy sisakhono esintsonkothileyo, esenza uqeqesho rhoqo kwaye iza nemiceli mngeni yayo (ukonzakala emlonyeni / emazinyweni, ixesha elongeziweyo elithathiweyo, iseti ephezulu yezakhono ezifunekayo).

Nje ukuba ifakwe, ii-SGAs zinokusetyenziswa ecaleni kokucinezelwa kwesifuba okuqhubekayo

Kusenokwenzeka. Ngokwenyani oku kufuneka kuthathelwe ingqalelo kwimeko-nge-meko. Ii-SGA yindlela ehamba phambili yomoya kwaye inokusetyenziswa ngokucinezelwa kwesifuba okuqhubekayo ukunyusa uxinzelelo lwe-cerebral perfusion. Kuxhomekeke kugqirha ngamnye ukuba abeke esweni kwaye athathe isigqibo sokuba ngaba inkxaso ye-ventilatory abayinikelayo yanele na ngexesha loxinzelelo olusebenzayo. Kwiimeko apho ukubanjwa kungokwesibini kwi-hypoxia (njengokubanjwa kwabantwana) kunokuba lula, kwaye kuluncedo ngakumbi, ukuqhubeka nge-30: 2 okanye i-15: umlinganiso we-2 wokuqinisekisa ukuba umthamo olungileyo ufikelela emiphungeni. Olunye uphononongo lubonakalise umohluko omncinci ngokuthelekisa indlela engama-30: 2 yomoya oqhubekayo.

Funda kwakhona:

Ukuziqhelanisa ne-Intubation yokuziqhelanisa ne-Succinylcholine ngokuchasene neRocuronium

I-Tracheostomy ngexesha le-Intubation kwi-COVID-19 yezigulana: Uphando ngokuziqhelanisa neKlinikhi yangoku

I-Tracheal Intubation: Nini, njani kwaye kutheni uyenza i-Airway yomoya engeyiyo eyomonde

umthombo:

NguJessica Rogers- Ungalibali amaqamza