Emergency Live | 10 Steps to perform a Correct Spinal Immobilization of a Trauma Patient image 4 — I-Emergency drill: ukusetyenziswa kwentloko ye-immobilizer kunye nekhola yomlomo wesibeleko

Ukunyanzeliswa kwekholamu yomgogodla usebenzisa ibhodi yomqolo: iinjongo, izibonakaliso kunye nokunciphisa ukusetyenziswa

By UCristiano Antonino On Ngamana 29, 2022

Isithintelo sokunyakaza komgogodla usebenzisa ibhodi elide lomqolo kunye nekhola yomlomo wesibeleko iphunyezwa kwiimeko zokulimala, xa imilinganiselo ethile idibene, ukunceda ukunciphisa amathuba okulimala komgogodla.

Iimpawu zokusetyenziswa kwe Umgudu Izithintelo zesindululo a I-GCS ngaphantsi kwe-15, ubungqina bokunxila, ukuthamba okanye intlungu kumbindi we- entanyeni okanye emva, iimpawu ze-neurological focal kunye / okanye iimpawu, ukukhubazeka kwe-anatomical yomqolo, kunye neemeko eziphazamisayo okanye ukulimala.

Intshayelelo kwi-spinal trauma: nini kwaye kutheni ibhodi yomgogodla ifunekayo

Ukwenzakala okubuhlungu okubuhlungu ngoyena nobangela uphambili wokwenzakala komnqonqo eUnited States nakwamanye amazwe amaninzi, kukho izehlo zonyaka ezimalunga nama-54 kwisigidi sabemi kunye ne-3% yabo bonke abalaliswa esibhedlele ngenxa yokwenzakala okubuhlungu.[1]

Nangona ukwenzakala komnqonqo kubangelwa kuphela ipesenti encinci yokonzakala okubuhlungu, baphakathi kweyona galelo likhulu ekuguleni kunye nokufa.[2][3]

Ngenxa yoko, ngowe-1971, iAmerican Academy of Orthopedic Surgeons yacebisa ukuba kusetyenziswe amayeza. ikhola yomlomo wesibeleko kunye nexesha elide ibhodi yomgogodla ukukhawulela intshukumo yomgogodla kwizigulane ezinokulimala okukrokrelwayo, ngokusekelwe kuphela kwindlela yokulimala.

Ngelo xesha, oku kwakusekelwe kwimvumelwano kunokuba kubungqina.[4]

Kwiminyaka emashumi ukususela ekuthintelweni kwentshukumo yomgogodla, ukusebenzisa ikhola yomlomo wesibeleko kunye nebhodi elide lomqolo libe ngumgangatho wokunakekelwa kwe-prehospital.

Inokufumaneka kwizikhokelo ezininzi, kuquka i-Advanced Trauma Life Support (ATLS) kunye nezikhokelo ze-Prehospital Trauma Life Support (PHTLS).

Phezu kwako nje ukusetyenziswa kwazo okuxhaphakileyo, ukusebenza kwezi nkqubo kuye kwathandatyuzwa.

Kolunye uphononongo lwamazwe ngamazwe ngokuthelekisa abo baye bafumana ukunyanzeliswa komgogodla kwabo bangazange bafumane ukunakekelwa kwesiqhelo kunye nokunciphisa umlenze we-spinal motion benokulimala okumbalwa kwe-neurologic kunye nokukhubazeka.

Nangona kunjalo, kufuneka kuqatshelwe ukuba ezi zigulana azizange zihambelane nobunzima bokwenzakala.[5]

Ukusebenzisa amavolontiya aselula asempilweni, olunye uphononongo lujonge ukushukuma komqolo osecaleni kwibhodi yomnqonqo omde xa kuthelekiswa ne-stretcher matrasi kwaye kwafumanisa ukuba ibhodi yomqolo ende ivumela intshukumo enkulu yecala.[6]

Ngo-2019, i-retrospective, i-observational, i-prehospital ye-arhente yophando yavavanya ukuba ngaba kukho utshintsho okanye akukho tshintsho kumonzakalo we-spinal cord emva kokuphumeza iprotocol ye-EMS ethintele izilumkiso zomgogodla kuphela kwabo banemingcipheko ebalulekileyo okanye iziphumo ezingaqhelekanga zovavanyo kwaye bafumanisa ukuba kukho. akukho mahluko kwizehlo zokwenzakala komqolo.[7]

EZONA BHODI ZESIPILI ZIBALASELE? NDWENDWELA KWI-SPENCER BOOTH KWIMiboniso ENGXAMISEKILEYO

Okwangoku akukho zilingo zolawulo olungenamkhethe olukwinqanaba eliphezulu lokuxhasa okanye ukuchasa ukusetyenziswa kwesithintelo sokushukuma komgogodla.

Akunakwenzeka ukuba kubekho isigulane sokuvolontiya kwisifundo esinokubangela ukukhubazeka okusisigxina kwaphula izikhokelo zokuziphatha zangoku.

Ngenxa yezi zifundo kunye nezinye izifundo, izikhokelo ezitsha zincoma ukunciphisa ukusetyenziswa kwebhodi elide lomgudu we-spinal motion restriction kwabo banendlela yokulimala okanye malunga neempawu okanye iimpawu njengoko kuchazwe kamva kweli nqaku kunye nokunciphisa ixesha isigulane esichitha i-immobilized. .

Iimpawu zokusebenzisa ibhodi yomqolo

Kwithiyori kaDenis, ukwenzakala kwiintsika ezimbini okanye ngaphezulu kuthathwa njengokuqhekeka okungazinzanga ukulimaza intambo yomqolo engaphakathi kwikholamu yomqolo.

Inzuzo ecetywayo yokuthintelwa kwentshukumo yomgogodla kukuba ngokunciphisa ukunyakaza komgogodla, umntu unokunciphisa amathuba okulimala kwesibini somgogodla ukusuka kwiqhekeza elingazinzanga ngexesha lokukhutshwa, ukuthuthwa, kunye novavanyo lwezigulane ezixinzelelekileyo.[9]

Izibonakaliso zokuthintelwa kwentshukumo yomgogodla zixhomekeke kwiprotocol ephuhliswe ngabalawuli benkonzo yonyango oluphuthumayo kwaye inokwahluka ngokufanelekileyo.

Nangona kunjalo, i-American College of Surgeons Committee on Trauma (ACS-COT), i-American College of Emergency Physicians (ACEP), kunye noMbutho weSizwe weeGqirha ze-EMS (NAEMSP) baye baphuhlisa inkcazo edibeneyo malunga nokunyanzeliswa kwentshukumo yomgogodla kwizigulana zabantu abadala. ngo-2018 kwaye udwelise ezi zalathiso zilandelayo:[10]

Inqanaba elitshintshileyo lokuziva, iimpawu zokunxila, i-GCS <15
Ubunzima bomqolo ophakathi okanye intlungu
Iimpawu ezigxile kwi-neurologic okanye iimpawu ezinjengobuthathaka bemoto, ukuba ndindisholo
Ukukhubazeka kwe-anatomic yomqolo
Ukonzakala okuphazamisayo okanye iimeko (umzekelo, ukwaphuka, ukutsha, iimvakalelo Ndezelo, umqobo wolwimi, njl.)

Inkcazo edibeneyo efanayo yenza iingcebiso kwizigulane ezibuhlungu ezibuhlungu zabantwana, ziphawula ukuba ubudala kunye nokukwazi ukunxibelelana akufanele kube yinto yokwenza izigqibo zokunakekelwa kwe-prehospital spinal.

Oku kulandelayo yizalathisi ezicetyiswayo:[10]

Isikhalazo seentlungu zentamo
Torticollis
Ukusilela kweNeurologic
Isimo sengqondo esitshintshileyo, kubandakanywa i-GCS <15, ukunxila, kunye nezinye iimpawu (ukuphazamiseka, ukuphelelwa umoya, i-hyopnea, i-somnolence, njl.
Ukubandakanyeka kwingozi enkulu yokungqubana kwemoto, umonzakalo wokuntywila, okanye ukwenzakala kakhulu emzimbeni.

Ukuchasana ekusebenziseni ibhodi yomqolo

Ukuchasana okuhambelanayo kwizigulane ezinokulimala okungena entloko, intamo, okanye i-torso ngaphandle kwe-neurologic deficit okanye isikhalazo.[11]

Ngokutsho kwezifundo ezipapashwe kwi-Eastern Association for the Surgery of Trauma (EAST) kunye ne-Journal ye-Trauma, izigulane ezine-trauma yokungena ephantsi kwe-spinal immobilization zaziphindwe kabini ukuba zife njengezigulane ezingazange.

Ukunyanzeliswa kwesigulane yinkqubo echitha ixesha, phakathi kwe-2 ukuya kwi-5 imizuzu, ukuba ayilibazisi kuphela ukuthutha ukhathalelo oluqinisekileyo kodwa iphinde ilibazise ezinye unyango lwangaphambi kwesibhedlele njengoko le yinkqubo yabantu ababini.[12][13]

Irediyo yabahlanguli EMHLABENI WONKE? TYELELA I-EMS RADIO BOOTH KWIMBONISO KAXAKEKA

Izixhobo eziyimfuneko zokunyanzeliswa komgogodla: ikhola, ibhodi yomqolo ende kunye nemfutshane

The izixhobo iyimfuneko ekuthinteleni intshukumo yomgogodla ifuna ibhodi yomqolo (ide okanye imfutshane) kunye nekhola yomqolo wesibeleko.

Iibhodi zoMnqongo omude

Iibhodi zomgudu ezide zaqala ukuphunyezwa, ngokubambisana nekhola yomlomo wesibeleko, ukuphazamisa umqolo njengoko kwakucatshangelwa ukuba ukuphathwa ngendlela engafanelekanga kwintsimi kunokubangela okanye kwandise ukulimala kwentambo yomgogodla.

Ibhodi yomqolo ende yayinexabiso eliphantsi kwaye yasebenza njengendlela efanelekileyo yokuthutha abaguli abangekho zingqondweni, ukunciphisa intshukumo engafunwayo, kunye nokugubungela umhlaba ongalinganiyo.[14]

Iibhodi zoMnqongo oMfutshane

Iibhodi ezimfutshane zomnqonqo, ezaziwa ngokuba zizixhobo zokuxhwila zenqanaba eliphakathi, zihlala zimxinwa ngakumbi kunezinye zazo ezinde.

Ubude bazo obufutshane buvumela ukusetyenziswa kwabo kwiindawo ezivaliweyo okanye ezivaliweyo, ngokuqhelekileyo kwiingozi zemoto.

Ibhodi emfutshane yomqolo isekela i-thoracic kunye ne-cervical spine de kube isigulane sinokufakwa kwibhodi elide lomqolo.

Uhlobo oluqhelekileyo lwebhodi emfutshane yomqolo yi Kendrick Extrication isixhobo, eyahluke kwi-classic short spine board kuba i-semi-rigid kwaye iqhubela phambili ijikeleze i-flanks kunye nentloko.

Ngokufana neebhodi zomgudu omude, ezi nazo zisetyenziselwa kunye neekhola zomlomo wesibeleko.

IiKhola zesibeleko: "iKhola yeC"

Iikhola zomlomo wesibeleko (okanye i-C Collar) zingahlelwa kwiindidi ezimbini ezibanzi: ezithambileyo okanye eziqinileyo.

Kwiimeko zonxunguphalo, iikhola zomlomo wesibeleko eziqinileyo ziyi-immobilizer yokuzikhethela njengoko zibonelela ngokuthintelwa okuphezulu komlomo wesibeleko.[15]

Iikholeji zomlomo wesibeleko ngokuqhelekileyo zenzelwe ukuba zibe nesiqwenga sangasemva esisebenzisa imisipha ye-trapezius njengenkxaso yenkxaso kunye neqhekeza langaphambili elixhasa i-mandible kwaye lisebenzise i-sternum kunye ne-clavicles njengenkxaso yenkxaso.

Iikhola zomlomo wesibeleko ngokwazo azinikezeli ngokwaneleyo ukunyanzeliswa komlomo wesibeleko kwaye zifuna izakhiwo zenkxaso ezongezelelweyo zecala, ngokuphindaphindiweyo kwifom ye-Velcro foam pads efunyenwe kwiibhodi ezinde zomqolo.

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ubuchule

Ubuchule bukhona bokubeka umntu kwisithintelo sokushukuma komqolo, enye yezona zinto zixhaphakileyo yinkqubo yelog-roll yasemva echazwe ngezantsi kwaye yenziwa, ngokufanelekileyo, kunye neqela labantu aba-5, kodwa ubuncinci, iqela labane.[16] ]

Iqela labahlanu

Ngaphambi kokuba ungasebenzi, cela isigulana ukuba sinqamle iingalo zaso phezu kwesifuba.

Inkokeli yeqela kufuneka inikwe intloko yesigulane esiza kwenza ukuzinza kwe-inline manual ngokubamba amahlombe esigulane ngeminwe yabo kwi-posterior ye-trapezius kunye nesithupha sabo kwi-anterior aspect kunye ne-forearm ecinezelwe ngokuqinileyo kwi-lateral aspects. intloko yesigulane ukunciphisa ukunyakaza kunye nokuzinzisa umqolo wesibeleko.

Ukuba ikhona, ikhola yomlomo wesibeleko kufuneka ibekwe ngeli xesha ngaphandle kokuphakamisa intloko yesigulane emhlabeni. Ukuba umntu akafumaneki, gcina oku kuzinziswa ngexesha lobuchule belog roll.

Ilungu leqela lesibini kufuneka libekwe kwi-thorax, ilungu leqela lesithathu kwi-hip, kunye nelungu leqela elinesine emilenzeni kunye nezandla zabo zibekwe kwicala elikude lesigulane.

Ilungu leqela lesihlanu kufuneka lilungele ukutyibilika ibhodi yomqolo ende phantsi kwesigulana emva kokuba iqengqeleke.

Kumyalelo welungu leqela loku-1 (ngokwesiqhelo kwinani lesithathu), amalungu eqela 1 ukuya kwisi-4 aya kuqengqeleka isigulana, ngelo xesha ilungu leqela lesihlanu liya kutyibilika ibhodi yomqolo ende phantsi kwesigulane.

Kwakhona, ngokomyalelo welungu leqela, isigulana siya kuqengqeleka kwibhodi yomqolo ende.

Iziko isigulane ebhodini kwaye ukhusele i-torso kunye neentambo ezilandelwa yi-pelvis kunye nemilenze ephezulu.

Khusela intloko ngokubeka iitawuli eziqengqelekayo macala omabini okanye isixhobo esifumanekayo ngokorhwebo kwaye emva koko ubeke iteyiphu ebunzi kwaye ukhuselwe emaphethelweni ebhodi emide yomqolo.

KwiQela laBane

Kwakhona, inkokeli yeqela kufuneka inikwe intloko yesigulane kwaye ilandele indlela efanayo echazwe ngasentla.

Ilungu leqela ezimbini kufuneka libekwe kwi-thorax ngesandla esinye ehlombe elikude kunye nelinye kwi-hip ekude.

Ilungu leqela lesithathu kufuneka libekwe emilenzeni, esinye isandla sibekwe kwi-hip ekude kunye nesinye emlenzeni ode.

Qaphela ukuba kucetyiswa ukuba iingalo zamalungu eqela ziwela omnye komnye kwi-hip.

Ilungu leqela lesine liya kutyibilika ibhodi yomqolo ende phantsi kwesigulana, kwaye yonke inkqubo ilandelwa njengoko kuchaziwe ngasentla.

Iingxaki zokusebenzisa ibhodi yomqolo kwi-spinal immobilisation

Ukulimala kweengcinezelo

Ingxaki enokubakho kwabo baphantsi kwebhodi emide yomqolo kunye nothintelo lokushukuma komqolo wesibeleko zizilonda zoxinzelelo, izehlo ezixelwe phezulu njenge-30.6%.[17]

Ngokutsho kwePhaneli yeeNgcebiso zeSizwe zoxinzelelo lweUlcer, izilonda zoxinzelelo ngoku ziphinde zahlelwa njengomonzakalo woxinzelelo.

Zibangelwa kuxinzelelo, ngokuqhelekileyo phezu kokubaluleka kwamathambo, ixesha elide elikhokelela kumonakalo wendawo eluswini kunye nezicubu ezithambileyo.

Kumanqanaba okuqala, ulusu luhlala lunjalo kodwa lusenokuqhubela phambili lube sisilonda kumanqanaba amva.[18]

Ubungakanani bexesha elithathwayo ukuphuhlisa ukulimala koxinzelelo liyahluka, kodwa ubuncinane uphando oluthile lubonise ukuba ukwenzakala kwezicubu kunokuqala kwimizuzu engama-30 kumavolontiya anempilo.[19]

Ngeli xesha, umndilili wexesha elichithwe lingashukumi kwibhodi yomqolo ende lijikeleze i-54 ukuya kwimizuzu engama-77, malunga nemizuzu engama-21 eqokelelwa kwi-ED emva kothutho.[20][21]

Ngale nto engqondweni, bonke ababoneleli kufuneka bazame ukunciphisa ixesha izigulane ezichitha i-immobilizeki kwiibhodi eziqinileyo zomnqonqo okanye ngeekhola zomlomo wesibeleko njengoko zombini kunokukhokelela kumonzakalo woxinzelelo.

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Ukuthomalalisa ukuphefumla

Izifundo ezininzi zibonise ukunciphisa umsebenzi wokuphefumula ngenxa yeentambo ezisetyenziselwa kwiibhodi ezide zomqolo.

Kumavolontiya aselula asempilweni, ukusetyenziswa kwemitya emide yomqolo phezu kwesifuba kubangele ukuhla kweeparamitha ezininzi zepulmonary, kubandakanywa umthamo obalulekileyo onyanzelekileyo, umthamo wokuphefumla ngenkani, kunye nokuhamba okunyanzeliswayo kokuphelelwa umoya okukhokelela kwisiphumo esithintelweyo.[22]

Kuphononongo olubandakanya abantwana, bekukho ukunyanzeliswa kwamandla okunyanzeliswa ukuya kwi-80% yesiseko.[23] Kolunye uphononongo, zombini ibhodi eqinileyo kunye noomatrasi bevacuum bafunyenwe banqanda ukuphefumla ngomyinge we-17% kumavolontiya asempilweni.[24]

Kufuneka kuqwalaselwe ngononophelo xa kunyanzeliswa izigulana, ngakumbi abo banesifo semiphunga esele sikhona kunye nabantwana kunye nabantu abadala.

Ubuhlungu

Eyona ngxaki ixhaphakileyo, ebhalwe kakuhle yothintelo lwentshukumo yomgogodla ende yintlungu, ekhokelela kwimizuzu engama-30.

Iintlungu zidla ngokubonakaliswa ngokuqaqanjelwa yintloko, umqolo, kunye neentlungu zentloko.[25]

Kwakhona, kwaye ngoku umxholo ophindaphindiweyo, ixesha elichithwe kwibhodi eqinile yomqolo ende kufuneka lincitshiswe ukunciphisa intlungu.

Ukubaluleka kweklinikhi yokulimala kwentambo yomgogodla: indima yekhola kunye nebhodi yomgogodla

I-blunt force trauma ingabangela ukulimala kwekholomu yomgogodla kwaye, ngenxa yoko, umonakalo wentambo yomgogodla onokubangela ukugula okunzulu kunye nokufa.

Kwiminyaka ye-1960 kunye ne-1970, ukunyanzeliswa kwentshukumo yomgogodla kwakusetyenziselwe ukunciphisa okanye ukuthintela i-neurological sequelae ecingelwa ukuba yinto yesibini kukulimala komgogodla.

Nangona yamkelwa ngokubanzi njengomgangatho wokhathalelo, uncwadi alunawo nawuphi na umgangatho ophezulu, uphando olusekwe kubungqina obuphanda ukuba isithintelo sokushukuma somgogodla sinempembelelo kwiziphumo ze-neurological [26].

Ukongezelela, kwiminyaka yakutshanje kukho ubungqina obukhulayo obubonisa iingxaki ezinokuthi zithintele ukunyanzeliswa kwe-spinal motion.

Ngenxa yoko, izikhokelo ezitsha ziye zacebisa ukuba uthintelo lwentshukumo yomgogodla lusetyenziswe ngobuchule kubantu abathile bezigulane.[10]

Nangona ukuvinjelwa kwentshukumo yomgogodla kunokuba luncedo kwezinye iimeko, umboneleli kufuneka aqhelane nazo zombini izikhokelo kunye neengxaki ezinokubakho kubaboneleli ukuba baxhotyiswe ngcono ukusebenzisa ezi ndlela kunye nokuphucula iziphumo zesigulane.

Ukuphucula iziphumo zeQela lezeMpilo

Izigulana eziye zabandakanyeka kumonzakalo wamandla angacacanga zinokubonisa intlaninge yeempawu.

Kubalulekile ukuba abaqeqeshi bezempilo abajongene nokuvavanywa kokuqala kwezi zi gulane baqhelane nezibonakaliso, ukuchasana, iingxaki ezinokuthi zibe khona, kunye nobuchule obufanelekileyo bokuphumeza umqathango wokuhamba komgogodla.

Izikhokelo ezininzi zinokubakho ukunceda ukufumanisa ukuba zeziphi izigulana ezihlangabezana nemilinganiselo yokuthintelwa kwentshukumo yomgogodla.

Mhlawumbi izikhokelo ezaziwa kakhulu kwaye zamkelwe ngokubanzi yileyo yengxelo yesikhundla esidibeneyo yi-American College of Surgeons Committee kwi-Trauma (ACS-COT), i-National Association of EMS Physicians (NAEMSP), kunye ne-American College of Emergency Physicians (ACEP) [10] Nangona ezi zizikhokelo zangoku kunye neengcebiso, akukho lulingo oluphezulu lolawulo olungenamkhethe ukuza kuthi ga ngoku, kunye neengcebiso ezisekelwe kwizifundo zokuqwalasela, amaqela okubuyisela emva, kunye nezifundo zecala.[26]

Ukongezelela ekuqhelaneni nezibonakaliso kunye nokuchasana nokunyanzeliswa kwe-spinal motion restriction, kubalulekile ukuba abaqeqeshi bezempilo baqhelane neengxaki ezinokuthi zibe nentlungu, izilonda zoxinzelelo kunye nokuphefumula kokuphefumula.

Xa kuphunyezwa uthintelo lokushukuma komgogodla, onke amalungu e-interprofessional health care professionalsteam kufuneka aqhelane neendlela ezikhethwayo kwaye asebenzise unxibelelwano olulungileyo ukwenza ubuchule ngokufanelekileyo kunye nokunciphisa ukunyakaza okugqithisileyo komgogodla. Abaqeqeshi bezempilo kufuneka baqonde ukuba ixesha elichithwe kwibhodi elide lomqolo kufuneka lincitshiswe ukunciphisa iingxaki.

Xa udlulisela ukhathalelo, iqela le-EMS kufuneka linxibelelane ixesha elipheleleyo elichithwe kwibhodi yomqolo ende.

Ukusebenzisa izikhokelo zamva nje, ukuqhelana neengxaki ezaziwayo, ukunciphisa ixesha elichithwe kwibhodi yomqolo ende, kunye nokusebenzisa iziphumo ezigqwesileyo zonxibelelwano lwe-interprofessional kwezi zigulana zinokuphuculwa. [Inqanaba lesi-3]

Iingxelo:

[1]Kwan I, Bunn F, Iziphumo ze-prehospital spinal immobilization: ukuphononongwa okucwangcisiweyo kwezilingo ezingahleliwe kwizifundo eziphilileyo. I-Prehospital kunye neyeza lentlekele. 2005 Jan-Feb; [I-PMID epapashiweyo: 15748015]

[2]I-Chen Y, iTang Y, iVogel LC, iDevivo MJ, Iimbangela zokulimala komnqonqo. Izihloko ekubuyiseleni ukulimala kwentambo yomgogodla. 2013 Ubusika; [I-PMID epapashiweyo: 23678280]

[3] Jain NB,Ayers GD,Peterson EN,Harris MB,Morse L,O'Connor KC,Garshick E, Umonzakalo woMnqonqo eUnited States, 1993-2012. JAMA. 2015 Jun 9; [I-PMID epapashiweyo: 26057284]

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