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

Ubuchwephesha be-Cervical and spinal immobilization: isishwankathelo

By UCristiano Antonino On Feb 24, 2023

Iindlela zokunyanzeliswa komlomo wesibeleko kunye nomgogodla: abasebenzi beenkonzo zonyango eziphuthumayo (EMS) baqhubeka bengabanyamekeli abaphambili ekulawuleni iimeko eziphuthumayo ngaphandle kwesibhedlele, kubandakanywa neemeko ezibuhlungu.

I-ATLS (i-advanced trauma life support) izikhokelo, eziphuhliswe kwi-1980s, ziyaqhubeka zibe ngumgangatho wegolide wokuvavanya nokubeka phambili ukulawulwa kokulimala okusongela ubomi ngendlela enengqiqo kunye neyobuchule, nangona kukho ixesha elide ingxabano enzulu malunga neendlela. lokusebenzisa olu ncedo.

Ukunyanzeliswa komgogodla kuye kwaba yinxalenye ebalulekileyo yokufundisa, ukongeza kwi-pelvic binders kunye ne-splints ngenxa yokuphuka kwamathambo amade.

Iindidi ezahlukeneyo zonyango izixhobo ziye zaphuhliswa ukwenzela ukuba kube lula ukusebenza kunye nokulula kwesicelo, kunye nokuvumela ukuguquguquka kunye nokufikelela okubalulekileyo ekulawuleni indlela yomoya kunye nezinye iinkqubo.

Isidingo sokumisa umqolo sinqunywe ngumbono kunye novavanyo lwesigulane.

IZOLUHLI, IIBHODWE ZOMHLABA, IZIHLALO ZOKUPHUMEZELA IMIPHUMVU, IZIHLALO ZOKUPHUMA: IIMVELISO ZESPENSER KWI-DOUBLE BOOTH KWI-EXPO EXPO

Cinga ukungasebenzi komqolo xa indlela yokulimala idala isalathisi esiphezulu sokusola intloko, entanyeni okanye ukulimala komqolo

Isimo sengqondo esiphazamisekileyo kunye nokusilela kwe-neurological kukwazalathisi ukuba ukunyanzeliswa komgogodla kufuneka kuthathelwe ingqalelo. [1][2][3][4]

Imfundiso ye-ATLS yendabuko yokunyanzeliswa komgogodla ofanelekileyo wesigulane kwimeko yentlungu enkulu ifakwe kakuhle eqinile. ikhola ngeebhloko kunye ne-tape ukukhusela umqolo wesibeleko, kunye ne-backboard ukukhusela umqolo wonke.

The Isixhobo sokukhupha i-Kendrick ivumela umqolo ukuba ukhuselwe kunye nomntu owenzakeleyo kwindawo ehleliyo ngexesha lokukhutshwa ngokukhawuleza kwisithuthi okanye kwezinye iimeko apho ukufikelela kunqunyelwe ukuvumela ukusetyenziswa kwebhodi egcweleyo.

Nangona kunjalo, esi sixhobo sifuna ukuba abasebenzi bokuhlangula banakekele ukunciphisa ukunyakaza komlomo wesibeleko ngokusebenzisa ukuhlanganiswa kwe-inline kude kube yindibano [5].

Ushicilelo lwe-10 lwezikhokelo ze-ATLS kunye nengxelo yokuvumelana ye-American College of Emergency Physicians (ACEP), i-American College of Surgeons Committee on Trauma (ACS-COT), kunye noMbutho weSizwe weeGqirha ze-EMS (NAEMSP) uthi, imeko ye-trauma yokungena akukho nto ibonisa ukuthintelwa kwentshukumo yomgogodla [6], ngokuhambelana nesifundo esiqhubekayo esivela kwi-American Trauma Database ebonisa inani eliphantsi kakhulu lokulimala okungazinzanga okudinga utyando kumxholo wokulimala okungena ngaphakathi. Uphononongo lukwabonisa ukuba inani lezigulane eziza kunyangwa ukufumana inzuzo enokwenzeka liphezulu kakhulu kunenani lezigulane eziza kunyangwa ukufumana ukulimala, i-1032/66.

Nangona kunjalo, kwimeko yokwenzakala okubonakalayo okubonakalayo, izithintelo ziyaqhubeka ziboniswa kwezi meko zilandelayo:

low I-GCS okanye ubungqina bokunxila kotywala neziyobisi
Ukuthamba komqolo wesibeleko ophakathi okanye ngasemva
Ukukhubazeka okucacileyo komgogodla
Ubukho bezinye izilonda eziphazamisayo

Isindululo sokuthintelwa okusebenzayo siqhubeka singumtya womlomo wesibeleko kunye nokukhuselwa komgudu opheleleyo, omele ususwe ngokukhawuleza.

Oku kungenxa yomngcipheko wokonzakala kwamanqanaba amaninzi.

Nangona kunjalo, kubantwana bezingane, umngcipheko wokulimala kwe-multilevel uphantsi kwaye ngoko ke kuphela amanyathelo okukhusela omlomo wesibeleko kwaye kungekhona amanyathelo apheleleyo okukhusela abonakalisiweyo (ngaphandle kokuba iimpawu okanye iimpawu zokulimala komgogodla zikhona).

Ukunyanzeliswa komlomo wesibeleko kunye nekhola eqinile kwisigulane sabantwana

intlungu entanyeni
Ukuguqulwa kwe-neurology yelungu elingachazwanga ngumonzakalo wamalungu
Ukuqaqamba kwemisipha entanyeni (torticollis)
I-GCS ephantsi
Ukwenzakala okusemngciphekweni omkhulu (umzekelo, ingozi yemoto enamandla kakhulu, ukwenzakala okukhulu kwentamo kunye nokwenzakala okubalulekileyo emzimbeni)

Iindawo ezixhalabisayo

Kukho ubungqina obukhulayo kunye nenkxalabo yaloo ntsimi udidi kukhokelele ekusetyenzisweni ngokugqithiseleyo kweendlela zokunyanzeliswa komgogodla kwaye ezinye izigulana zinokuba sengozini [7] [8] [9] [10].

Iingxaki ezinokubakho zokungakwazi ukuhamba komqolo:

Ukuphazamiseka kunye Ndezelo kwisigulana[11].
Ukwandiswa kwexesha langaphambi kwesibhedlele kunye nokulibaziseka okunokwenzeka kophando olubalulekileyo kunye nonyango, kunye nokuphazamisana nolunye ungenelelo[11].
Ukuthintelwa kokuphefumla ngeentambo, kunye nomsebenzi ombi wokuphefumla kwindawo yokulala xa kuthelekiswa nendawo ethe tye. Oku kubaluleke kakhulu kwiimeko ze-thoracic trauma, nokuba i-blunt okanye ingena [12] [13] Ubunzima nge-intubation[14].
Imeko yezigulane ezine-spondylitis e-ankylosing okanye i-spinal deformity ekhoyo ngaphambili, apho umonakalo wangempela unokubangelwa ukunyanzelisa isigulane ukuba sihambelane nesimo esinqunywe kwangaphambili sekhola yomlomo wesibeleko kunye ne-backboard [15].

Uphononongo olutsha lweencwadi zaseScandinavia, oluqhutywe ukuhlola ubungqina obukhoyo bokuthintelwa kwentshukumo yomgogodla [16], inika ingqiqo ebaluleke kakhulu ekuthelekisweni kweendlela zokuzinzisa umgogodla we-prehospital kunye nokuvavanya amandla obungqina.

Ikhola eqinileyo

Ikhola eqinile isetyenziswe ukususela phakathi kwe-1960 njengendlela yokuzinza komgogodla womlomo wesibeleko, kunye nobungqina obuphantsi obuxhasa impembelelo yayo emihle kwisiphumo se-neurological sokulimala komlomo wesibeleko, kunye nemiphumo emibi enokubakho ngenxa yokunyuka okukhulu kwengcinezelo ye-intracranial kunye i-dysphagia [17].

Eli nqaku libonisa ukuba isigulane esilumkileyo kunye nentsebenziswano kunye ne-muscle spasms ebangelwa ukulimala akunakwenzeka ukuba kubekho ukufuduka okuphawulekayo, njengoko kuphawulwe kwizifundo ze-cadaver eziye zazama ukufunda umphumo wokulimala.

Eli nqaku licebisa ukulungelelaniswa kweengozi neengenelo zolu tyando.

Nangona kunjalo, i-American Association of Neurological Surgeons iyaqhubeka nokucebisa ikhola eqinile njengendlela yokuzinzisa umqolo wesibeleko kwimeko yangaphambi kwesibhedlele[18].

Ibhodi eqinileyo: Isetyenziswa nini i-spinal longboard?

I-original longboard ye-spinal longboard yayisetyenziswe kunye nekhola eqinile, iibhloko kunye neentambo zokufezekisa ukungahambi kakuhle komqolo.

Umonakalo onokwenzeka, ngakumbi izilonda zoxinzelelo kwi-sacrum, [19] [20] ngoku zibonakalisiwe, ngakumbi kwimeko yokulimala komgogodla ngaphandle kokuziva ukhuselekile.

I-mattress vacuum ethambileyo inika umphezulu othambileyo okhusela kwimiphumo yoxinzelelo lwezilonda kwaye kwangaxeshanye unikezela ngenkxaso eyaneleyo xa yandiswe ngaphezulu kwenqanaba lentloko[16].

Iibhloko

Iibhloko ziyinxalenye yesicwangciso sokuhlanganiswa kwe-inline sokuzinzisa umqolo kwaye zibonakala zisebenza kakuhle xa zibophelela isigulana kumqolo. ibhodi ukufezekisa iqondo elithile lokungashukumi, ngaphandle kwenzuzo eyongezelelweyo yokusebenzisa ikhola eqinile ngokudibeneyo [21].

Vacuum umatrasi

Ukuthelekisa i-vacuum umatrasi kunye nebhodi eqinile yodwa, i-mattress inikezela ngolawulo ngakumbi kunye nokunyakaza okuncinci ngexesha lokufaka isicelo kunye nokuphakamisa kunebhodi eqinile [22].

Ukuqwalasela umngcipheko wezilonda zoxinzelelo, i-mattress ibonakala inika ukhetho olungcono lokuthuthwa kwesigulane.

Ukukhulula umqolo: ukumodareyithwa kwe-spinal and cervical immobilization

Iikhrayitheriya ze-NEXUS: umntu ophaphileyo, onganxiliyo ngaphandle kokulimala okuphazamisayo unomngcipheko ophantsi kakhulu wokulimala ngokungabikho koxinzelelo lwe-midline kunye ne-neurological deficit.

Oku kubonakala ngathi sisixhobo sokuhlola esibucayi esinovakalelo lwe-99% kunye nexabiso elibi lokuxela kwangaphambili kwe-99.8% [23].

Nangona kunjalo, ezinye izifundo zokuqwalasela ziye zacebisa ukuba isigulane esilumkileyo esinokulimala komgogodla womlomo wesibeleko siya kuzama ukuzinzisa umqolo kwaye ubukho bezilonda eziphazamisayo (ngaphandle kwe-thorax) azichaphazeli iziphumo zovavanyo lweklinikhi yomlomo wesibeleko kwaye ngoko ke umqolo unokucocwa ngokonyango ngaphandle kokucinga ngakumbi[24]. Olunye uphando lucebisa iziphumo ezifanayo kwi-thoracolumbar spine [25][24].

UKUHLANGULA Irediyo YABASEBENZI EHLABATHINI? TYELELA I-EMS RADIO BOOTH KWIMBONISO KAXAKEKA

Ukubaluleka kweklinikhi

Nangona i-pre-hospital immobilisation ye-spinal immobilisation yenziwe amashumi eminyaka, idatha yangoku ibonisa ukuba ayizizo zonke izigulane ezifuna ukuba zingasebenzi.

Ngoku i-National Association of Emergency Physicians USA kunye ne-American College of Surgeons Committee kwi-Trauma iphakamisa isicelo esilinganiselweyo sokunyanzeliswa komgogodla.

Ezi zikhokelo zamva nje zibonisa ukuba inani lezigulane ezinokuxhamla kwi-immobilization lincinci kakhulu

Ikomiti yaqhubeka yachaza ukuba ukusetyenziswa ngokusemthethweni kwezithintelo zomgogodla ngexesha lothutho kufuneka kusetyenziswe ngononophelo, njengoko kwezinye iimeko iingozi zabo ezinokuthi zibe ngaphezu kweenzuzo zabo.

Ngaphezu koko, kwizigulane eziye zabandezeleka ngenxa yengozi yokungena kwaye azikho iintsilelo ezicacileyo ze-neurological, ukusetyenziswa kwezithintelo zomgogodla akukhuthazwa.

E-USA umsebenzisi we-EMS kufuneka asebenzise i-accumen yekliniki ngaphambi kokuba enze isigqibo sokusebenzisa ibhodi yomgogodla.[26]

Ekugqibeleni, ukunyanzeliswa komgogodla kuye kwadibaniswa neentlungu zangasemva, iintlungu zentamo kwaye kwenza kube nzima kakhulu ukwenza iinkqubo ezithile, kuquka ukucinga.

Ukunyanzeliswa komgogodla kuye kwadibaniswa nobunzima bokuphefumla, ngakumbi xa iintambo ezinkulu zifakwe esifubeni.

Nangona imibutho emininzi ye-EMS e-US iye yamkele ezi zikhokelo ezitsha kwi-spinal immobilisation, oku akusiyo yonke indawo.

Ezinye iinkqubo ze-EMS zoyika ukumangalelwa ukuba aziyikhuseli izigulane.

Izigulana ekufuneka zingashukumi kumqolo zibandakanya oku kulandelayo:

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Ukwenzakala okubuhlungu
intlungu yomqolo
izigulana ezinomgangatho wokuqonda otshintshileyo
ukusilela kwemithambo-luvo
ukukhubazeka okucacileyo kwe-anatomical yekholamu yomgogodla
Uxinzelelo oluphezulu kwisigulane esinxiliswe ngamachiza, utywala.

Iimbekiselo zeBibliographic

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