Emergency Live | Airway Management Guidelines could change quickly — Ulawulo lwendlela yomoya lusondele kwinqanaba elitsha kwikamva

Izibonelelo kunye neeNgozi zoLawulo lweNdlela yoMoya eNceda kwiZiyobisi ze-Prehospital (DAAM)

By UCristiano Antonino On Dec 28, 2022

Malunga ne-DAAM: Ulawulo lwe-Airway lungenelelo oluyimfuneko kwiingxaki ezininzi zesigulane - ukusuka kwi-compromise ye-airway ukuya ekuphefumuleni kunye nokubanjwa kwentliziyo.

Nangona kunjalo, kuxhomekeke kwindlela enzima ngayo imeko yesigulane, kunye nokungenelela kokungenelela, ulawulo lwendlela yomoya luhlala lubangela imiphumo emibi kwimpilo yengqondo nengokwenyama yezigulane.

Kwiimeko ezithile ze-prehospital, izigulana ngamanye amaxesha zixhamla kuLawulo lwe-Drug Assisted Airway (DAAM), enokubonelela nge-laryngoscopy ephuculweyo kubaboneleli kunye nokufakwa lula kweetyhubhu ze-endotracheal kunye ne-supraglottic airways ngexesha lokungena.

Ukubonelela ngonyango olusebenzayo kunye nolukhuselekileyo olunokwenzeka kwizigulane, ababoneleli be-EMS kufuneka baqaphele iinzuzo ze-DAAM kunye nendlela yokwenza ngokufanelekileyo, kunye neengozi ezibalulekileyo ezinxulumene nayo.

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Yintoni iDAAM?

Ngokoxwebhu lwemithombo evela kuMbutho weSizwe weeGqirha ze-EMS (i-USA), i-Drug Assisted Airway Management (DAAM) ibhekisela ekulawuleni i-sedatives yodwa, okanye ngokudibanisa ne-neuromuscular blockers, ukuqalisa ukufakwa kwe-airway ephezulu kwizigulane ezine-airways eziphazamisekileyo okanye ezizayo. Ukungaphumeleli kokuphefumla, onokuthi ahlupheke kwisimo sengqondo esitshintshileyo, ukuphazamiseka okanye ukhuseleko olululo lwendlela yomoya.

Iinguqu zangoku ze-DAAM ezisetyenziswa ngokuqhelekileyo kwizicwangciso zekliniki ze-prehospital ziquka i-sedation-assisted intubation (SAI), ukulibaziseka kokulandelelana kwe-intubation (DSI) kunye ne-intubation yokulandelelana ngokukhawuleza (RSI).

I-RSI, eyona nto ixhaphakileyo kwezi zintathu, ibandakanya ukulawulwa kwe-sedative kunye ne-paralytic ye-endotracheal intubation kwizigulane.

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Iimeko apho i-DAAM inokuqinisekiswa

Ezinye iimeko ezingxamisekileyo ezinokufuna i-DAAM ziquka i-stroke, ukulimala kwengqondo (TBI) kunye nokungaphumeleli kokuphefumula kwi-pulmonary okanye isifo senhliziyo.

I-DAAM kufuneka yenziwe kuphela kwiindawo ezifanelekileyo apho izibonelelo ezifanelekileyo kunye nezikhokelo zikhona, kwaye uqeqesho olwaneleyo kunye nokulawulwa kogqirha we-EMS kuyafumaneka.

Ababoneleli kufuneka balinganise ngononophelo iinzuzo zeklinikhi ezinokuthi zibe nobungozi obunobungozi be-DAAM

Nangona imeko yesigulane, ngaphambi kokwenza i-DAAM, ii-arhente ze-EMS kufuneka ziqinisekise ukuba ababoneleli baye bafumana uqeqesho olufanelekileyo oluyimfuneko ukulawula izigulane kwiimeko eziphazamisayo, kubandakanywa ngexesha nangemva kokungaphumeleli kwe-DAAM, kwaye banakho okufunekayo. izixhobo esandleni ukulawula iyeza kunye ne-intubate ngokukhuselekileyo nangempumelelo kangangoko.

Ezinye zezixhobo kunye neendlela eziyimfuneko ukwenza i-DAAM ziquka i-bag mask ventilation, izixhobo zomoya we-supraglottic kunye neendlela zotyando zomoya.

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Ukwazi iingozi

Inqanaba lomngcipheko ohambelana nokwenza i-DAAM kuxhomekeke kwizinto ezininzi ezinxulumene neprofayili yesigulane, imeko kunye neemfuno, kunye nenqanaba lamava kunye nokulungela kwicala lababoneleli.

Ngaphambi kokufakwa kwe-intubation, kubalulekile ukuba ababoneleli baqhube uvavanyo lomzimba wesigulana ukuze baqonde kakuhle umngcipheko / umlinganiselo wenzuzo yokwenza i-DAAM, ngokuchasene nolandelelwano olukhawulezayo lwe-intubation okanye ezinye iindlela zokungenisa umoya ezingenayo invasive.

Ngexesha lovavanyo, ababoneleli kufuneka bajonge naziphi na iimpawu ezibonisa ukuba kunokwenzeka ukuba kubekho intubation enzima, njengobukho bamazinyo angaphambili angaphezulu, imbali ye-intubation enzima, nayiphi na inqaku le-Mallampati eyahlukileyo ukusuka kwelinye okanye elilingana nezine, kunye nokuvula umlomo ngaphantsi kwe-4 iisentimitha.

Imingcipheko ephezulu ikwanxulunyaniswa neempawu ezinzima zendlela yomoya yesigulana, ezinje ngokugqithisileyo kobukhulu bendlela yomoya, entanyeni ukungashukumi, ukuvuleka komlomo okuthintelweyo, umoya omdaka kunye nokopha.

Ukongezelela, ukuba yenziwe ngokungalunganga, i-DAAM inokubangela imingeni eyongezelelweyo yokufakwa kwendlela yomoya ngenxa yokulahleka ngokukhawuleza kunye nokupheleleyo kwee-reflexes zokukhusela umoya kunye nokuqhuba ukuphefumula, kunye nokubanakho amayeza ukuba abe mandundu ukungahambi kakuhle kwe-physiologic ekhoyo yezigulane.

Ukwenza isigqibo esinolwazi

Ngelixa kukho iimeko ezahlukeneyo zokhathalelo lwe-prehospital ezinokuqinisekisa ukusetyenziswa kwe-DAAM, njengeemeko apho izigulana zifumana iimeko zengqondo ezibuthathaka okanye zithwaxwa ziingxaki zonyango ezinokubangela ukungaphumeleli kokuphefumla, i-DAAM nayo ibeka imingcipheko ebalulekileyo kwizigulana.

Kubalulekile ukuba ababoneleli be-EMS bazazi ezi ngozi kunye nendlela eyahluke ngayo kwisigulana ukuya kwisigulana, kwaye baxhotyiswe ngoqeqesho olufanelekileyo kunye nezixhobo zokunciphisa imingcipheko kangangoko xa kunyangwa izigulana.