Imililo, ukuhogela intuthu kanye nokusha: izimpawu, izimpawu, umthetho wesishiyagalolunye

By UCristiano Antonino On Apr 7, 2023

Imililo iyimbangela ebalulekile yokulimala, ukufa kanye nokulimala komnotho. Ukulimala okubangelwa ukuhogela intuthu kuholela ekwenyukeni kakhulu kokushona kwabantu ezigulini ezishile: kulezi zimo, umonakalo wokuhogela intuthu uyengezwa ukuze ushise umonakalo, okuvame ukuholela ekufeni.

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Izimpawu, izimpawu kanye nokuxilongwa kwezisulu zomlilo

Ukwanda kokugula nokufa okuhlobene nokulimala kokuhogela ezigulini ezishile kudinga ukuqashelwa kwazo ngokushesha kanye nokwelashwa.

Ukuhlolwa komtholampilo okusheshayo, i-fibreoptic bronchoscopy, i-X-ray yesifuba, i-hemogasanalysis, i-ECG kanye nokuqapha i-hemodynamic yizinyathelo ezibalulekile enqubweni yokuxilonga.

Ukuqapha ngokucophelela kwesiguli ngalezi zindlela kuvumela ukuthi kuthathwe izinyathelo ezifika ngesikhathi futhi ezifanele uma kunesidingo.

Eminye imininingwane ebalulekile ingase ibe usizo ekuhlolweni nasekuphathweni kokuqala kwezisulu zomlilo ezihogele intuthu.

Umlando omuhle wokuchayeka endaweni evalekile, enentuthu eningi kufanele uholele umuntu ekulimaleni okusolwayo lapho ehogelwa umoya, ngisho noma zingekho izimpawu zomtholampilo ezicacile.

Isimo sokuquleka kufanele senze i-asphyxia kanye/noma i-carbon monoxide (CO) ne-cyanide (RCN) ibe nobuthi kakhulu.

Uphawu lwakudala lombala wesikhumba obomvu we-cherry ezimeni zobuthi be-CO aluthembeki ngokwalo.

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I-Oximetry iyisivivinyo esibalulekile sokuxilongwa kokudakwa kwe-CO, nokho, amazinga aphansi e-Hbco awabandakanyi amathuba okulimala okukhulu kwamaphaphu ezigabeni ezimaphakathi nezakamuva ngemuva kokusha.

I-Pulse oximetry iyipharamitha yesihlanu ebalulekile ekuqapheni iziguli ezibucayi, nokho, i-SpO2 ayikuvezi ngokunembile ukugxila kwe-Hbo ezigulini ezinoshevu we-CO ngoba i-oxyhaemoglobin ne-Hbco zine-spectrum yokumunca ukukhanya efanayo, ngakho-ke, amanani e-SpO2 azokhushulwa ngokungeyikho ezigulini ezinoshevu we-CO. .

I-Pulse oximetry ibonakala iwusizo kuphela ezigulini ezishile ezinamavelu aseduze avamile e-Hbco.

Ukusha kobuso, i-vibrissae eshile, i-buccal kanye ne-laryngeal edema, imfucumfucu eshile emigudwini yomoya kanye nesikhwehlela kusikisela ukulimala kokuhogela, kodwa ukungabi khona kwabo akukukhiphi.

Ukuba khona kwezinhlayiya ezishile esikhwehlela, nakho okubhekwa njengophawu olubucayi kakhulu lokuhogela intuthu, kungase kungabonwa amahora angu-8-24, futhi kwenzeka kuphela cishe ku-40 % wezifundo ezinokulimala kwamaphaphu.

I-Laryngeal stridor, ukuhogela, inkulumo engacacile kanye nokuhlehla kwethoracic kuphakamisa ukuba khona kwesilonda somzila womoya ophezulu kanye nesidingo sokuhlolwa okuphelele kwalokhu.

I-Laryngoscopy kanye ne-fibreoptic bronchoscopy ziwusizo kakhulu kukho kokubili ukusesha kwezilonda eziphezulu zomoya kanye nokususwa kwamathe nemfucumfucu engaphezulu okungenzeka ibe khona.

Ukubonakala kokukhwehlela, i-dyspnoea, i-tachypnoea, i-cyanosis, ukuhayiza, ukushaywa umoya noma i-rhonchi kubonisa ukulimala okubi kakhulu kokuhogela.

I-electrocardiogram (ECG) ngokuvamile ibonisa i-tachycardia futhi ingase ibonise izimpawu zesifo senhliziyo ye-ischemic.

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Ukuhlolwa kwe-X-ray yesifuba ngokuvamile akubonisi zimpawu zokulimala ngokuhogela

Ucwaningo lwe-scintigraphic olwenziwa ngemva komjovo womjovo we-xenon-133 lubonisa ukulimala okuncane kwendlela yomoya uma ukuqedwa ngokuphelele kwe-isotope kungenzeki phakathi nemizuzwana engu-90.

Ngeshwa, akusebenzi ukwenza lokhu kuhlolwa esigabeni sokuqala sokwelashwa.

I-Spirometry ibonakale iwusizo ekutholeni izilonda zomzila womoya omncane kanye nephezulu.

Kokubili ukugeleza okuphezulu kokuphelelwa yisikhathi kanye nezinga lokuphelelwa yisikhathi eliphoqelelwe ku-50% womthamo obalulekile ophoqelekile kwehliswe ngokuphawulekayo.

Ukusebenza kwale ndlela, nokho, kukhawulelwe kulezo ziguli ezikwazi ukwenza imiyalo yomhloli futhi zenze umzamo wokuphefumula owanele.

I-Arterial blood gas analysis (ABG) iwusizo kakhulu ekuhloleni ubukhali nokuqhubeka kokulimala kwamaphaphu.

Ukuncipha kwe-PaO2 kanye nokwenyuka kwe-P(Aa)O2 (ngaphezulu kuka-300), noma ukuncipha kwesilinganiso se-PaO2/FiO2 (ngaphansi kuka-350), kuyizinkomba ezingokoqobo nezizwelayo zokungasebenzi kahle kokuphefumula.

I-alkalosis yokuphefumula ivamile esikhathini esilandela ukusha futhi ngokuvamile iqhubeka nesigaba se-hypermetabolic.

I-acidosis yokuphefumula iyinkomba yokwehluleka ukuphefumula futhi ngokuvamile ihlotshaniswa ne-hypoxaemia enzima.

Ukuphelelwa umoya, amazinga e-Hbco aphakeme (ngaphezu kwama-40), ubuthi be-HCN kanye nokuphuma kancane kwenhliziyo yizici ezingase ziholele ku-acidosis enzima ye-metabolic.

I-Electrocardiogram (ECG) kanye nokuqapha i-haemodynamic kubalulekile ezigulini ezinezinga lesithathu zokusha ezidlulela ngaphezu kwamaphesenti angu-10 ebusweni bomzimba, kungakhathaliseki ukuthi kuhlotshaniswa noma kungahlobene nokulimala kokuhogela.

Ekushiseni okukhulu, ikakhulukazi lokho okuyinkimbinkimbi ngenxa yokulimala kokuhogela, umfutho wegazi wamaphaphu, ukuphuma kwenhliziyo nokunye okuguquguqukayo kwe-haemodynamic kungaqashwa ukuze kuthuthukiswe ukumnika koketshezi ngesikhathi sokuvuselela, ukugwema i-hypotension, ukwehluleka kwezinso kanye nokugcwala koketshezi.

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Umlilo uyasha, umthetho wesishiyagalolunye

Ukuhlolwa kokulimala kwesikhumba kwenziwa ngokuhlolwa ngokomzimba, ukuhlolwa kwesisindo somzimba (ukulandela ibhalansi yamanzi) nokunqunywa kobukhulu bomzimba oshile.

Lesi sakamuva singabalelwa cishe, sisebenzise lokho okubizwa ngokuthi umthetho wesishiyagalolunye, ngemuva kokunquma izinga lokubandakanyeka kwekhanda, ngaphambili nangemuva kwesiqu kanye nezitho.

Emthethweni wesishiyagalolunye, kumuntu omdala, indawo ngayinye ye-anatomical imelela cishe u-4.5% noma u-9% noma u-18% wesamba somzimba wonke.

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Ukujula kokusha kuhlolwa ngesisekelo sokubukeka kwayo emtholampilo, kuhlale kukhunjulwa lolu lwazi olufushane:

Ukushiswa kwezinga lokuqala: Ukushiswa ku-epithelium, okubonisa njenge-erythema nobuhlungu;
Ukushiswa kwezinga lesibili: Ukushiswa kwe-epidermis nedermis, okubonakala nge-erythema, amabhamuza nobuhlungu.
ukushiswa kwezinga lesithathu: Ukusha okucekela phansi isikhumba kuze kufike ku-hypodermis noma ngaphakathi kwe-hypodermis futhi kubonakale ngokushintshashintsha kombala okuphaphathekile noma okumpunga okunsundu kwendawo ethintekile, okungebuhlungu, ngenxa yokucekelwa phansi ngokuphelele kwazo zonke izitho zezinzwa isikhumba.