Emergency Live | 10 Steps to perform a Correct Spinal Immobilization of a Trauma Patient image 4 — I-Emergency drill: ukusetshenziswa kwe-immobilizer yekhanda kanye nekholomu yomlomo wesibeletho

Amasu okuvimbela umlomo wesibeletho nomgogodla: ukubuka konke

By UCristiano Antonino On Feb 24, 2023

Izindlela zokuvala umlomo wesibeletho kanye nomgogodla: abasebenzi bezinsizakalo zezokwelapha eziphuthumayo (EMS) baqhubeka bengabanakekeli abayinhloko ekuphathweni kwezimo eziphuthumayo eziningi ngaphandle kwesibhedlela, kuhlanganise nezimo ezibuhlungu.

Imihlahlandlela ye-ATLS (advanced trauma life support) eyathuthukiswa ngeminyaka yawo-1980, isaqhubeka iyindinganiso yegolide yokuhlola kanye nokubeka phambili ukulawulwa kokulimala okusongela ukuphila ngendlela enengqondo nephumelelayo, nakuba sekunesikhathi eside kunenkulumompikiswano engathi sína mayelana nezindlela. lokusebenzisa lolu sizo.

Ukuvinjelwa komgogodla kube yingxenye ebalulekile yokufundisa, ngaphezu kokubopha i-pelvic nama-splints amathambo amade aphuka.

Izinhlobo ezahlukene zezokwelapha imishini zenzelwe ukunika amandla ukusebenza kahle nokulula kwesicelo, kanye nokuvumela ukuguquguquka nokufinyelela okubalulekile kokuphathwa komgwaqo womoya nezinye izinqubo.

Isidingo sokumisa umgogodla sinqunywa indawo kanye nokuhlolwa kwesiguli.

IZIDLULI, IZIBHODI ZOMPHINI, IZIHLALO ZOKUPHUMA AMALUNGA: IMIKHIQIZO YE-SPENCER E-DOUBLE BOOTH KU-EXPO EZIPHUTHUMAYO

Cabanga ukukhubazeka komgogodla lapho indlela yokulimala idala inkomba ephezulu yokusola ekhanda, intamo noma ukulimala komgogodla

Isimo sengqondo esikhubazekile kanye nokushoda kwemizwa nakho kuyizinkomba zokuthi ukungakwazi ukuhamba komgogodla kufanele kucatshangelwe.[1][2][3][4]

Imfundiso ye-ATLS yendabuko yokungakwazi ukuhamba kahle komgogodla wesiguli esisesimweni esibucayi kakhulu iqinile eqinile. ikhola ngamabhuloki kanye ne-tape ukuze uvikele umgogodla womlomo wesibeletho, kanye ne-backboard ukuvikela wonke umgogodla.

The Idivayisi yokukhipha i-Kendrick ivumela umgogodla ukuthi uvikeleke nomuntu olimele endaweni ehlezi ngesikhathi sokuphuma ngokushesha emotweni noma kwezinye izimo lapho ukufinyelela kunqunyelwe ukuvumela ukusetshenziswa kwe-backboard egcwele.

Kodwa-ke, le divayisi idinga ukuthi izisebenzi zokuhlenga zinakekele ukukhawulela ukunyakaza komgogodla womlomo wesibeletho ngokusebenzisa ukuhlanganisa umugqa kuze kube yilapho ihlanganiswa [5].

Uhlelo lweshumi lweziqondiso ze-ATLS kanye nesitatimende sokuvumelana se-American College of Emergency Physicians (ACEP), I-American College of Surgeons Committee on Trauma (ACS-COT), kanye ne-National Association of EMS Physicians (NAEMSP) ithi, icala lokuhlukumezeka elingena ngaphakathi asikho isibonakaliso sokuvinjelwa kokunyakaza komgogodla [10], ngokuhambisana nocwaningo olubukwayo oluvela ku-American Trauma Database ebonisa inani eliphansi kakhulu lokulimala komgogodla okungazinzile okudinga ukuhlinzwa esimweni sokuhlukumezeka okungena ngaphakathi. Ucwaningo luphinde lubonise ukuthi isibalo seziguli okufanele zelashwe ukuze zithole inzuzo engaba khona sikhulu kakhulu kunesibalo seziguli okufanele zelashwe ukuze zithole ukulimala, 6/1032.

Kodwa-ke, esimweni sokuhlukumezeka okubonakalayo okubalulekile, imikhawulo iyaqhubeka nokuboniswa kulezi zimo ezilandelayo:

ongaphakeme I-GCS noma ubufakazi botshwala nezidakamizwa
Ubumnene bomgogodla womlomo wesibeletho ophakathi nendawo noma ngemuva
Ukukhubazeka okusobala komgogodla
Ukuba khona kwezinye izilonda eziphazamisayo

Isincomo sokuvinjelwa okuphumelelayo siyaqhubeka nokuba yikhola yomlomo wesibeletho enokuvikela okugcwele komgogodla, okufanele kususwe ngokushesha ngangokunokwenzeka.

Lokhu kungenxa yengozi yokulimala kwezingqimba eziningi.

Kodwa-ke, kubantu bezingane, ingozi yokulimala kwe-multilevel iphansi futhi ngakho-ke kuphela izinyathelo zokuphepha zomgogodla womlomo wesibeletho futhi hhayi izinyathelo zokuphepha ezigcwele zomgogodla ezibonisiwe (ngaphandle uma izimpawu noma izimpawu zokulimala komgogodla zikhona).

Ukunganyakazi komlomo wesibeletho kanye nekhola eqinile esigulini sezingane

ubuhlungu Neck
Ukuguqulwa kwe-neurology yemilenze engachazwanga ukuhlukumezeka kwamalungu
Imisipha yentamo (torticollis)
Inani eliphakeme kakhulu lama-GCS
Ukuhlukumezeka okunobungozi obukhulu (isb. ingozi yemoto enamandla amakhulu, ukulimala kwentamo nokulimala okukhulu komzimba ophezulu)

Izindawo ezikhathazayo

Kunobufakazi obukhulayo nokukhathazeka kwalowo mkhakha ukulinganisa kuholele ekusetshenzisweni ngokweqile kwezindlela zokuvimbela umgogodla nokuthi ezinye iziguli zisengozini enkulu[7][8][9][10].

Izinkinga ezingaba khona ze-spinal immobilisation:

Ukungakhululeki kanye Ukucindezeleka okwesiguli[11].
Ukwelulwa kwesikhathi sangaphambi kwesibhedlela ngokubambezeleka okungenzeka kophenyo nokwelashwa okubalulekile, kanye nokuphazamisa okunye ukungenelela[11].
Ukuvinjelwa kokuphefumula ngamabhande, kanye nokusebenza okubi kakhulu kokuphefumula endaweni ephansi uma kuqhathaniswa nendawo eqondile. Lokhu kubaluleke kakhulu ezimeni zokuhlukumezeka kwesifuba, kungakhathaliseki ukuthi kushubile noma ukungena [12] [13] Ubunzima be-intubation[14].
Icala leziguli ezine-ankylosing spondylitis noma ukukhubazeka komgogodla okukhona ngaphambili, lapho ukulimala kwangempela kungabangelwa ukuphoqelela isiguli ukuba sihambisane nesimo esinqunyiwe sekholomu yomlomo wesibeletho eqinile kanye ne-backboard[15].

Ukubuyekezwa okusha kwezincwadi zaseScandinavia, okwenziwa ukuhlola ubufakazi obutholakalayo bokuvinjelwa kokunyakaza komgogodla [16], kunikeza ukuqonda okubaluleke kakhulu ekuqhathaniseni izindlela zokuqiniswa komgogodla we-prehospital nokuhlolwa kwamandla obufakazi.

Ikhola eqinile

I-collar eqinile isetshenziswe kusukela phakathi no-1960 njengendlela yokuqina komgogodla womlomo wesibeletho, nobufakazi obuphansi bekhwalithi obusekela ithonya layo elihle kumphumela we-neurological wokulimala komgogodla wesibeletho, nemiphumela emibi engaba khona ngenxa yokwanda okukhulu kwengcindezi ye-intracranial kanye i-dysphagia [17].

Lesi sihloko siphinde siphakamise ukuthi isiguli esiqaphile futhi esibambisanayo esinama-muscle spasms okubangelwa ukulimala akunakwenzeka ukuthi sibe nokuhamba okuphawulekayo, njengoba kuphawulwe ezifundweni ze-cadaver eziye zazama ukutadisha umphumela wokulimala.

Lesi sihloko sisikisela ukulinganisa izingozi nezinzuzo zalokhu kuhlinzwa.

Nokho, i-American Association of Neurological Surgeons iyaqhubeka nokuphakamisa ikhola eqinile njengendlela yokusimamisa umgogodla womlomo wesibeletho esimweni sangaphambi kwesibhedlela[18].

Ibhodi eliqinile: Isetshenziswa nini i-spinal longboard?

Ibhodi elide lomgogodla langempela lalisetshenziswa kanye nekholomu eqinile, amabhlogo namabhande ukuze kuzuzwe ukungakwazi ukuhamba komgogodla.

Ukulimala okungenzeka, ikakhulukazi izilonda zokucindezela ku-sacrum,[19][20] manje sekubonisiwe, ikakhulukazi esimweni sokulimala komgogodla ngaphandle komzwelo wokuvikeleka.

Umatilasi we-vacuum othambile unikeza indawo ethambile evikela emiphumeleni yezilonda zokucindezela futhi ngesikhathi esifanayo inikeza ukusekelwa okwanele uma kunwetshwa ngaphezu kwezinga lekhanda[16].

Blocks

Amabhulokhi ayingxenye yesu lokuhlanganisa elingaphakathi komugqa lokuzinzisa umgogodla futhi abonakale esebenza kahle lapho ebophela isiguli emgogodleni. ibhodi ukufeza izinga elithile lokunganyakazi, ngaphandle kwenzuzo eyengeziwe yokusebenzisa ikhola eqinile ngokuhlanganisa [21].

Vacuum umatilasi

Uma uqhathanisa umatilasi we-vacuum nebhodi eliqinile lodwa, umatilasi unikeza ukulawula okwengeziwe nokunyakaza okuncane ngesikhathi sokufaka isicelo nokuphakamisa kunebhodi eliqinile [22].

Ngokucabangela ubungozi bezilonda zokucindezela, umatilasi ubonakala unikeza inketho engcono yokuthutha isiguli.

Ukukhulula umgogodla: ukuguqulwa komgogodla kanye ne-cervical immobilization

Indlela ye-NEXUS: umuntu oqaphile, ongadakiwe ngaphandle kokulimala okuphazamisayo unethuba eliphansi kakhulu lokulimala lapho kungabikho ukungezwani kwe-midline kanye nokushoda kwezinzwa.

Lokhu kubonakala kuyithuluzi lokuhlola elibucayi elinozwela lwe-99% kanye nenani lokubikezela elibi lika-99.8%[23].

Kodwa-ke, ezinye izifundo zokubheka ziye zaphakamisa ukuthi isiguli esiqaphile esinokulimala komgogodla womlomo wesibeletho sizozama ukuzinzisa umgogodla nokuthi ukutholakala kwezilonda eziphazamisayo (ngaphandle kwe-thorax) akuphazamisi imiphumela yokuhlolwa komtholampilo komgogodla womlomo wesibeletho ngakho-ke umgogodla ungasulwa ngokomtholampilo ngaphandle kokucabanga okwengeziwe[24]. Ezinye izifundo ziphakamisa imiphumela efanayo yomgogodla we-thoracolumbar [25][24].

KHULULA UMSAKAZO WABASEBENZI EMHLABENI? VAKASHELA I-EMS RADIO BOOTH KU-EXPO EZIPHUTHUMAYO

Ukubaluleka komtholampilo

Nakuba i-pre-hospital immobilisation yomgogodla yenziwe amashumi eminyaka, idatha yamanje ibonisa ukuthi akuzona zonke iziguli ezidinga ukungakwazi ukuhamba.

Manje i-National Association of Emergency Physicians USA kanye ne-American College of Surgeons Committee on Trauma iphakamisa ukusetshenziswa okulinganiselwe kokungakwazi ukuhamba komgogodla.

Le mihlahlandlela yakamuva ikhombisa ukuthi isibalo seziguli ezingazuza ekuvinjweni sincane kakhulu

Ikomidi laqhubeka nokusho ukuthi ukusetshenziswa okunamandla kwezivimbelo zomgogodla ngesikhathi sokuthutha kufanele kusetshenziswe ngokuqapha, njengoba kwezinye izimo ubungozi babo obungaba khona budlula izinzuzo zabo.

Ngaphezu kwalokho, ezigulini eziye zabhekana nokuhlukunyezwa okungenayo futhi azikho ukulahlekelwa okusobala kwe-neurological, ukusetshenziswa kwezivimbelo zomgogodla akukhuthazwa.

E-USA umqhubi we-EMS kufanele asebenzise ikhono lomtholampilo ngaphambi kokuthatha isinqumo sokusebenzisa ibhodi lomgogodla.[26]

Okokugcina, ukukhubazeka komgogodla kuye kwahlotshaniswa nobuhlungu bokubuyela emuva, ubuhlungu bentamo futhi kwenza kube nzima kakhulu ukwenza izinqubo ezithile, kuhlanganise ne-imaging.

Ukunganyakazi komgogodla nakho kuye kwahlotshaniswa nobunzima bokuphefumula, ikakhulukazi lapho kufakwa izintambo ezinkulu esifubeni.

Nakuba izinhlangano eziningi ze-EMS e-US zamukele lezi ziqondiso ezintsha mayelana nokungahambi kahle komgogodla, lokhu akuyona yonke indawo.

Ezinye izinhlelo ze-EMS zesaba ukuqulwa amacala uma zingavimbeli iziguli.

Iziguli okufanele zingakwazi ukuhamba emgogodleni zihlanganisa okulandelayo:

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Ukuhlukumezeka okubuhlungu
ubuhlungu bomgogodla
iziguli ezinezinga elishintshile lokuqaphela
ukuntuleka kwe-neurological
ukukhubazeka okusobala kwe-anatomical yekholomu yomgogodla
Ukuhlukumezeka okuphezulu esigulini esidakwe izidakamizwa, utshwala.

Izikhombo ze-Bibliographic

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