I-Endotracheal intubation ezigulini zezingane: amadivayisi emigwaqo yomoya ephezulu
I-Endotracheal intubation (ETI) ezinganeni ayivamile ngokubonga futhi izinga lethu lokuphumelela lokuqala lingakwenza ngokuthuthuka okuthile
Kunzima ukuqhathanisa ukusebenza kwamasu ahlukahlukene wokuthuthuka kwezindiza ezinganeni.
Kunemithelela yokuziphatha, kunjalo, kepha futhi kuphawule umehluko phakathi kweminyaka nasezintweni ezingaba khona zokuboshwa.
Isikhathi esiningi kunesikhathi sokukhuluma nethimba labagula kakhulu bese wenza uhlelo olususelwa kumgudu womoya ongcono waleso simo esinikeziwe.
Ngokufanayo, indawo yokusebenzela, ikhaya labaningi lokulingwa kwe-airway, yindawo ehluke kakhulu.
Sizobheka imigwaqo yomoya esezingeni eliphakeme ezimweni zokuboshwa kwenhliziyo / ukuphefumula.
Khumbula ukuthi kuzohlala kunomehluko ngesikhathi nasekhonweni elibekwe phakathi kokuboshwa kwenhliziyo ngaphandle kwesibhedlela (OHCA) nokuboshwa kwenhliziyo esibhedlela (IHCA).
Kunezifundo ezimbalwa zangempela eziqhathanisa izindlela zokwelashwa ezisezingeni eliphakeme ezisetshenziswa ngesikhathi sokuphathwa kokuboshwa kwenhliziyo ezinganeni.
Kunezifundo ezimbalwa kakhulu ezizungeze ukusetshenziswa kwemigwaqo yomoya ephezulu (SGAs) ezinganeni. Eziningi zalezi zifundo zokuhlola.
I-ILCOR njengamanje incoma i-endotracheal intubation (ETI) njengendlela ekahle yokuphatha indlela yomoya ngesikhathi sokuvuselelwa
Baphinde bathi imigwaqo yomoya yesupraglottic iyindlela eyamukelekayo yokungenisa umoya okujwayelekile kwe-bag-valve-mask (BVM).
Kunokuhlolwa okuncane kakhulu kwemitholampilo ezinganeni lapho lezi zincomo zisuselwa khona (futhi ngokuqinisekile azikho zedizayini eqinile eminyakeni engama-20 edlule).
Ngenxa yalokhu kushoda kobufakazi, bathumele ucwaningo njengengxenye yePediatric Life Support Task Force.
ULavonas et al. (I-2018) yenze ukubuyekeza okuhlelekile nokuhlaziywa kwemeta ekusetshenzisweni kokungenelela okuthuthukile komoya (i-ETI vs SGA), uma kuqhathaniswa ne-BVM iyodwa, yokuvuselela izingane ekuboshweni kwenhliziyo. Kutholwe kuphela izifundo eziyi-14.
I-12 yalezi bekufanele ukufakwa ekuhlaziyweni kwe-meta.
Babegxile kakhulu ku-OHCA. Kwakunobungozi obukhulu bokuchema ngakho-ke ikhwalithi ephelele yobufakazi yayisezingeni eliphansi kuya kweliphansi kakhulu.
Umphumela osemqoka wokulinganisa kwaba ukusinda lapho kukhishwa esibhedlela ngomphumela omuhle wezinzwa.
Ukuhlaziywa kuphakamisa ukuthi womabili ama-ETI ne-SGA abengaphakeme kune-BVM.
Ngakho-ke manje, ake sihlanganise ezinye zezincwadi ngokusetshenziswa kwamadivayisi we-supraglottic airway. Lokhu ikakhulukazi kususelwa ezifundweni zabantu abadala.
Idivayisi ekahle yokuphefumula
- … Kulula ukusetha nokufaka noma ngubani ngakho-ke akunandaba ukuthi ukwakheka kweqembu kuyini
- … Iyashesha ukusetha futhi iyashesha ukufaka. Lokhu kunciphisa isikhathi esisuswe kweminye imisebenzi ebalulekile futhi kuvumela lokho 'umkhawulokudonsa' obaluleke kakhulu
- … Ivumela ubungozi obuncane bokufisa
- … Ihlinzeka ngophawu oluqinile lokuvumela ingcindezi ephezulu yomoya uma kudingeka
- … Iqine ngokwanele ukuthi isiguli asikwazi ukuluma ngakho futhi sinqamule ukutholakala kwaso komoya-mpilo
- … Inikeza inketho yokuqeda isisu ngedivayisi efanayo
- … Unengozi encane yokufakwa endaweni engafanele ngephutha noma yokulahleka komoya lapho usufakiwe
Uma lokhu kuzwakala kukuhle kakhulu ukuba kube yiqiniso, kunjalo. Ayikho idivayisi eyodwa ehlanganisa zonke lezi zici ezibalulekile.
Lokhu kusishiya sinquma ukuthi yini efanele isiguli esiphambi kwethu.
Kunzima kakhulu ukuqhathanisa ama-SGA namashubhu endotracheal (ETT).
I-ETT 'iyindlela eqondile yomoya' enikela ukuvikelwa ekufuneni.
Lokhu akusho ukuthi ama-SGA ayindlela 'encane'.
I-SGA iseyindlela 'ehamba phambili yomoya' futhi isebenza kangcono kunokusebenzisa inqubo ye-bag-valve-mask.
Kubalulekile ukukhumbula ukuthi izindiza ezindizayo zinobuhle nobubi bazo.
Ngenkathi bengathuthukisa amathuba eziguli okusinda ngokululama okuhle kwezinzwa, kungahle kube nezinkinga ezihambisanayo.
Isayensi engemuva kwemikhumbi yomoya ephezulu
Ngakho isayensi ithini? Kunokulingwa okumbalwa ezinganeni kepha kube khona amaphepha amaningi wokukhipha akhululwe kumasu athuthukile endiza kubantu abadala. Yize ingahlobene ngqo nezingane, iphakamisa amaphuzu athile athakazelisayo wokuqhathanisa phakathi kwamadivayisi.
Lesi silingo semikhakha eminingi, iqoqo elenziwa ngokungahleliwe, lenziwa ngabezimo eziphuthumayo ezindaweni ezine i-ambulensi izinsizakalo eNgilandi. Iqhathanise amadivayisi we-supraglottic ne-tracheal intubation ezigulini zabantu abadala abane-OHCA ebheka umphumela wazo kumphumela osebenzayo wezinzwa.
Lolu cwaningo lubandakanya kuphela iziguli ezingaphezu kweminyaka engu-18.
Abatholanga mehluko ophawulekayo ngokwezibalo emphumeleni wezinsuku ezingama-30 (isilinganiso somphumela oyinhloko) noma esimeni sokusinda, isilinganiso sokuphindwaphindwa, isifiso noma iROSC (imiphumela yesibili).
Kwakukhona umehluko ophawulekayo ngokwezibalo uma kukhulunywa ngempumelelo yokuqala yokungena komoya.
Izindiza zezindiza zeSupraglottic zidinga imizamo emincane, kepha ukusetshenziswa kwazo kuholela nasemathubeni andayo okulahleka komgwaqo osunguliwe
Ngabe kusho ukuthini lokhu? Ukukhathazeka okuyinhloko okuboshwa lapho kuxoxwa ngama-SGA yingozi enkulu yokufisa. Uma bekungekho mehluko engozini, ngabe lokho kungashintsha umqondo wakho?
Lesi bekuyisilingo semitholampilo ehlukahlukene, eFrance naseBelgium ebheka i-OHCA esikhathini esiyiminyaka emibili. Nakulolu cwaningo kubhaliswe abantu abadala abaneminyaka engaphezu kwengu-2 ubudala.
Babheke ukungabukelwa phansi kwe-BVM vs ETI maqondana nokusinda ngomphumela omuhle wezinzwa ezinsukwini ezingama-28.
Amaqembu aphendulayo abe nomshayeli we-ambulensi, umhlengikazi nodokotela ophuthumayo.
Izinga le-ROSC lalilikhulu kakhulu eqenjini le-ETI kodwa kwakungekho mehluko ekusindeni ukuze kukhishwe.
Sekukonke, imiphumela yocwaningo ibingacacisi nganoma iyiphi indlela.
Uma ukusinda ekukhipheni kungathinteki, ngabe sonke kufanele sisebenzise isikhathi ukuqeqesha nokugcina amandla noma kufanele i-endotracheal intubation igcinelwe kuphela labo abakwenza njalo emsebenzini wabo wosuku?
Lo mklamo we-cluster-randomized, multiple crossover wenziwa ngabosizo lokuqala / i-EMS kuma-ejensi e-27.
Kubheke iziguli ezindala ezithola i-laryngeal tube noma i-endotracheal intubation nokusinda emahoreni angama-72.
Futhi, bafaka kuphela abantu abadala abangaphezu kweminyaka eyi-18 ngokuboshwa kwenhliziyo okungeyona okwethusayo.
Bathole isilinganiso sokusinda esithuthukisiwe 'esithobekile kepha esibalulekile' eqenjini le-LMA futhi lokhu kuhambisana nezinga eliphakeme le-ROSC.
Ngeshwa, lesi silingo sifaka ukuchema okuningi okungahle kube khona futhi ukwakheka kokutadisha kungenzeka kungabi namandla ngokwanele ukukhuphula izinga lomehluko.
Ngabe inani lokusinda lingachazwa ngempumelelo yokuqala yokupasa nesikhathi esincane esichithwe 'ngaphandle kwesifuba' ngesikhathi sokuvuselelwa kokuqala? Asikho isifundo esiphelele. Zilinganisele njalo ngokuhlolisisa bese ubheka ukuthi imiphumela yokufunda iyasebenza yini kubantu bendawo yakho kanye nokwenza kwakho ngaphambi kokushintsha noma yini.
Imibuzo eminingi kunezimpendulo
Ngemuva kokufunda isayensi (futhi ngicela uye uthathe ukujula ngokujulile kulawo maphepha bese uzihlolela wona), ake siphendule imibuzo ejwayelekile.
Ama-SGA kulula kakhulu ukuthi ungavele uwenze futhi uwenze!
Cha Ukuthola i-SGA kuyisinyathelo sokuqala kuphela. Noma kunjalo, kufanele uqiniseke ukuthi ukhethe usayizi ofanele futhi uhlolwe ukuvuza. Ama-SGA maningi amathuba okuthi akhishwe futhi aholele ekulahlekelweni okungalindelekile komoya. Ngokuvamile, asikhathaleli kangako ngokuwavikela njengoba kufanele sibe njalo. Ngokufanelekile, sebenzisa uthayi weshubhu ukuyivikela endaweni futhi ubheke indawo (maqondana namazinyo). Amanye ama-SGA anomugqa omnyama kushaft okufanele ahambisane ne-incisors (qaphela ukuthi lokhu kungaba khona kuphela ngosayizi abakhulu). Njengama-ETTs, adinga ukuthi ubheke ukungena komoya okwanele nge-auscultation, i-ETCO2 nokulalela ukuvuza okusobala.
Kulungile uma kunokuvuza ekuqaleni njengoba ijeli lizobumba njengoba lishisa
Cha. Abukho ubufakazi obukhombisa ukwakheka kwama-i-gel (lokhu imvamisa ukuthi odokotela abayimodeli okukhulunywa ngabo kulesi simo) bazobumbela ngaphakathi komphimbo. Abaphenyi bazamile ukufudumeza okubhaliwe futhi alukho ushintsho lwezibalo lapho kuvuza khona. Uma unokuvuza okuphawulekayo, cabanga ukubeka kabusha, ukushintshela usayizi ohlukile noma ukusebenzisa imodeli ehlukile. Ungathola ukuvuza okuncane okunyamalala ngokuhamba kwesikhathi. Ngokuhamba kwesikhathi, indlela yomoya iyazungeza futhi ihlale kangcono.
Kufanele ngaso sonke isikhathi unciphise isisu lapho ufaka i-LMA
Mhlawumbe. Lokhu akutholakali njalo kumihlahlandlela njengoba kubonakala njengenqubo yokulungisa okuhle. Kungathatha isikhathi nezinsizakusebenza kude neminye imisebenzi ebucayi (njengokucindezelwa kwesifuba, ukufinyelela kwe-IV, ukungena komoya okuphelele) kepha uma unezinsizakusebenza zokwenza kanjalo, ngaphandle kokuthinta izisekelo zokunakekelwa okuhle kokuvuselelwa, kuyindlela enhle uma umoya akuyona kahle ngangokunokwenzeka. Lokhu kubaluleke kakhulu ezinganeni. Siyazi ukuthi basengozini enkulu yokuqhekeka ngokwe-diaphragmatic kusuka ekungeneni komoya ngokweqile ngakho ukufakwa kwangaphambi kweshubhu le-nasogastric kungathuthukisa izinto.
I-Laryngoscopy kufanele isetshenziswe ngaphambi kwakho konke ukufakwa kwe-SGA
Mhlawumbe. Ezinye izindawo seziqale ukugunyaza i-laryngoscopy ngoba ilahlekelwe ukuvinjelwa ngumzimba wangaphandle, noma ukuvumela ukuncela okungcono nokwenza ngcono indawo yokufakwa. Kukhona impikiswano yokuthi i-SGA ingahlala kangcono uma ifakwe ngosizo lwe-laryngoscope njengoba, ezimweni eziningi, ingafakwanga ngokujulile ngokwanele. I-Laryngoscopy ikhono eliyinkimbinkimbi, elidinga ukujwayela njalo futhi liza nezinselelo zalo (ukulimala emlonyeni / emazinyweni, isikhathi esengeziwe esithathiwe, isethi yamakhono ephakeme edingekayo)
Uma usufakiwe, ama-SGA angasetshenziswa eceleni kokucindezelwa kwesifuba okuqhubekayo
Mhlawumbe. Lokhu kudinga ukucatshangelwa ngokweqiniso. Ama-SGA angumgudu womoya osezingeni eliphezulu futhi angasetshenziswa ngokucindezela okuqhubekayo kwesifuba ukukhulisa ukucindezelwa kwe-cerebral perfusion. Kukudokotela ngamunye ukuthi aqaphe futhi anqume ukuthi ngabe ukwesekwa komoya abakunikezayo kwenele yini ngesikhathi sokucindezelwa okusebenzayo. Ezimweni lapho ukuboshwa kungokwesibili kwe-hypoxia (njengasekuboshweni okuningi kwezingane) kungaba lula, futhi kube wusizo, ukuqhubeka nokukala okungu-30: 2 noma 15: 2 ukuqinisekisa ukuthi inani lamaza amahle lifinyelela emaphashini. Ezinye izifundo zikhombise umehluko omncane ngokuqhathanisa indlela engama-30: 2 yokungenisa umoya okuqhubekayo.
Funda Futhi:
Umkhuba Wokuphumelela We-Intubation Nge-Succinylcholine Ukuqhathanisa ne-Rocuronium
I-Tracheal Intubation: Nini, Kanjani Futhi Kungani Ungayakha I-Airway Yokwenzela Isiguli