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

Ukumiswa kwekholomu yomgogodla usebenzisa ibhodi lomgogodla: izinhloso, izinkomba kanye nemikhawulo yokusetshenziswa

By UCristiano Antonino On Kwangathi 29, 2022

Ukuvinjelwa kokunyakaza komgogodla usebenzisa ibhodi elide lomgogodla kanye nekholomu yomlomo wesibeletho kusetshenziswa ezimweni zokuhlukumezeka, lapho izimo ezithile zifinyelelwa, ukusiza ukunciphisa amathuba okulimala komgogodla.

Izinkomba zokusetshenziswa kwe Umgogodla umkhawulo wokunyakaza a I-GCS ngaphansi kwe-15, ubufakazi bokudakwa, ukuzwela noma ubuhlungu emgqeni ophakathi nendawo intamo noma emuva, izimpawu ze-neurological ezigxile kanye/noma izimpawu, ukukhubazeka kwe-anatomical yomgogodla, nezimo eziphazamisayo noma ukulimala.

Isingeniso sokuhlukumezeka komgogodla: nini futhi kungani ibhodi lomgogodla lidingeka

Ukulimala okubuhlungu okubuhlungu kuyimbangela ehamba phambili yokulimala komgogodla e-United States nakwamanye amazwe amaningi, ngesigameko saminyaka yonke samacala angaba ngu-54 esigidini ngasinye futhi cishe u-3% wabo bonke abalaliswa esibhedlela ngenxa yokulimala okubuhlungu.[1]

Nakuba ukulimala komgogodla kubala iphesenti elincane kuphela lokulimala kabuhlungu, kuphakathi kwengxenye enkulu yezifo nokufa.[2][3]

Ngenxa yalokho, ngo-1971, i-American Academy of Orthopedic Surgeons yahlongoza ukusetshenziswa kodokotela. ikhola yomlomo wesibeletho futhi eside ibhodi lomgogodla ukukhawulela ukunyakaza komgogodla ezigulini ezisolwa ngokulimala komgogodla, ngokusekelwe kuphela endleleni yokulimala.

Ngaleso sikhathi, lokhu kwakusekelwe ekuvumelaneni kunobufakazi.[4]

Emashumini eminyaka kusukela ekuvinjweni kokunyakaza komgogodla, ukusebenzisa ikhola yomlomo wesibeletho kanye nebhodi lomgogodla omude kuye kwaba yindinganiso ekunakekelweni kwe-prehospital.

Ingatholakala kuzinkombandlela ezimbalwa, okuhlanganisa imihlahlandlela ye-Advanced Trauma Life Support (ATLS) kanye ne-Prehospital Trauma Life Support (PHTLS).

Naphezu kokusetshenziswa kwazo kabanzi, ukusebenza kahle kwale mikhuba kuye kwangabazeka.

Ocwaningweni olulodwa lwamazwe ngamazwe oluqhathanisa nalabo ababenomkhawulo wokunyakaza komgogodla kulabo abangazange, ucwaningo lwathola ukuthi labo abangazange bathole ukunakekelwa okujwayelekile ngokuvinjelwa kokunyakaza komgogodla babenokulimala okuncane kwe-neurologic ngokukhubazeka.

Nokho, kufanele kuqashelwe ukuthi lezi ziguli zazingafani nobukhulu bokulimala.[5]

Kusetshenziswa amavolontiya amancane anempilo, olunye ucwaningo lwabheka ukunyakaza komgogodla ongemuva ebhodini lomgogodla omude uma kuqhathaniswa nomatilasi we-stretcher futhi lathola ukuthi ibhodi lomgogodla omude livumela ukunyakaza okukhulu kwe-lateral.[6]

Ngo-2019, ucwaningo lwe-retrospective, observational, multi-ejensi prehospital lwahlola ukuthi ngabe lukhona yini ushintsho ekulimaleni komgogodla ngemuva kokusebenzisa umthetho olandelwayo we-EMS okhawula izinyathelo zokuphepha zomgogodla kulabo abasengozini enkulu noma okutholwe ukuhlolwa okungajwayelekile futhi bathola ukuthi kukhona awukho umehluko ezenzakalweni zokulimala komgogodla.[7]

AMABHODI OKUQHUBEKA KAKHULU? VAKASHELA I-SPENCER BOOTH EMBONWENI WEZIPHUTHUMO

Okwamanje azikho izivivinyo zokulawula ezingahleliwe eziphezulu ezingasekela noma zenqabe ukusetshenziswa komkhawulo wokunyakaza komgogodla.

Akunakwenzeka ukuthi kube khona isiguli esizovolontiya ocwaningweni olungase luphumele ekukhubazekeni unomphela okwephula izinkombandlela zokuziphatha zamanje.

Njengomphumela walezi nezinye izifundo, imihlahlandlela emisha incoma ukukhawulela ukusetshenziswa kwebhodi elide lomgogodla umkhawulo wokunyakaza komgogodla kulabo abanendlela ephathelene nokulimala noma ngokuphathelene nezibonakaliso noma izimpawu njengoba kuchazwe kamuva kulesi sihloko futhi kukhawulelwe isikhathi isiguli esichitha i-immobilized. .

Izinkomba zokusebenzisa ibhodi lomgogodla

Ngombono kaDenis, ukulimala kwamakholomu amabili noma ngaphezulu kuthathwa njengokuphuka okungazinzile ukuze kulimaza umgogodla ongaphakathi kwekholomu yomgogodla.

Inzuzo ehlosiwe yokuvinjelwa kokunyakaza komgogodla ukuthi ngokunciphisa ukunyakaza komgogodla, umuntu anganciphisa amandla okulimala komgogodla wesibili kusuka ezingxenyeni ezingazinzile zokuphuka ngesikhathi sokukhishwa, ukuthutha, nokuhlolwa kweziguli ezihlukumezekile.[9]

Izinkomba zokuvinjelwa kokunyakaza komgogodla zincike kuphrothokholi eyakhiwe abaqondisi benkonzo yezokwelashwa ezimeni eziphuthumayo futhi ingahluka ngokufanele.

Kodwa-ke, i-American College of Surgeons Committee on Trauma (ACS-COT), i-American College of Emergency Physicians (ACEP), kanye ne-National Association of EMS Physicians (NAEMSP) benze isitatimende esihlangene mayelana nokuvinjelwa kokunyakaza komgogodla ezigulini zabantu abadala abahlukumezekile. ngo-2018 futhi ubhale lezi zinkomba ezilandelayo:[10]

Izinga lokuqaphela elishintshile, izimpawu zokudakwa, i-GCS <15
Ubuhlungu be-Midline spine noma ubuhlungu
Izimpawu ze-neurologic ezigxile noma izimpawu ezinjengobuthakathaka bemoto, ukuba ndikindiki
Ukukhubazeka kwe-anatomic komgogodla
Ukulimala noma izimo eziphazamisayo (isb., ukuphuka, ukusha, imizwa Ukucindezeleka, umgoqo wolimi, njll.)

Isitatimende esifanayo esihlanganyelwe siphinde senza izincomo zeziguli ezihlukumezekile zezingane, eziphawula ukuthi iminyaka namandla okuxhumana akufanele kube yisici ekuthathweni kwezinqumo zokunakekelwa komgogodla wangaphambi kwesibhedlela.

Okulandelayo yizinkomba zabo ezinconyiwe:[10]

Isikhalazo sobuhlungu bentamo
I-Torticollis
Ukushoda kwe-Neurologic
Isimo sengqondo esishintshile, okuhlanganisa i-GCS <15, ukudakwa, nezinye izimpawu (ukuyaluza, ukuphelelwa umoya, i-hyopnea, ukuqwasha, njll.)
Ukubandakanyeka engozini enkulu yokushayisana kwemoto, ukulimala kokutshuza okunamandla, noma ukulimala okukhulu komzimba

Contraindications ekusetshenzisweni kwebhodi lomgogodla

Ukuphikisana okuhlobene ezigulini ezinokuhlukumezeka okungena ekhanda, intamo, noma i-torso ngaphandle kokushoda kwe-neurologic noma isikhalazo.[11]

Ngokwezifundo ezishicilelwe kuyi-Eastern Association for the Surgery of Trauma (EAST) kanye ne-Journal of Trauma, iziguli ezine-trauma engena ngaphakathi ezabhekana nokuvinjelwa komgogodla zaziphindwe kabili amathuba okufa kuneziguli ezingazange zife.

Ukunganyakazi kwesiguli kuyinqubo edla isikhathi, phakathi kwemizuzu emi-2 kuya kwemi-5, engabambezeli nje kuphela ezokuthutha ukuze uthole ukunakekelwa okuqondile kodwa futhi ibambezeleka ezinye izindlela zokwelapha ngaphambi kokuya esibhedlela njengoba lokhu kuyinqubo yabantu ababili.[12][13]

UMSAKAZO WABAHLELI EMHLABENI WONKE? VAKASHELA I-EMS RADIO BOOTH KU-EXPO EZIPHUTHUMAYO

Imishini edingekayo yokungakwazi ukunyakaziswa komgogodla: ikhola, ibhodi lomgogodla omude nelifushane

The imishini okudingekayo ekuvinjweni kokunyakaza komgogodla kudinga ibhodi lomgogodla (kungaba isikhathi eside noma esifushane) kanye nekholomu yomgogodla wesibeletho.

Amabhodi Omgogodla Omude

Amabhodi omgogodla omude aqale ukusetshenziswa, ngokuhambisana nekhola yomlomo wesibeletho, ukuze angakwazi ukuhamba umgogodla njengoba kwakucatshangwa ukuthi ukuphatha okungalungile ensimini kungabangela noma kukhulise ukulimala komgogodla.

Ibhodi elide lomgogodla nalo lalishibhile futhi lisebenza njengendlela ekahle yokuthutha iziguli eziqulekile, ukunciphisa ukunyakaza okungafunwa, nokuvala indawo engalingani.[14]

Amabhodi Omgogodla Omfushane

Amabhodi omgogodla omfishane, aziwa nangokuthi amadivayisi okukhipha esiteji esimaphakathi, avamise ukuba mancane kakhulu kunozakwabo abade.

Ubude bazo obufushane buvumela ukusetshenziswa kwazo ezindaweni ezivaliwe noma ezivalekile, ezivamise ukushayisana kwezimoto.

Ibhodi elifushane lomgogodla lisekela umgogodla we-thoracic nomlomo wesibeletho kuze kube yilapho isiguli singafakwa ebhodini lomgogodla omude.

Uhlobo oluvamile lwebhodi elifushane lomgogodla yi- Idivayisi ye-Kendrick Extrication, ehlukile ebhodini lomgogodla elifushane lakudala ngoba liqinile futhi linwebeka ngokusemaceleni ukuze lihlanganise izinhlangothi nekhanda.

Ngokufanayo namabhodi omgogodla omude, lezi zibuye zisetshenziswe ngokuhambisana namakholomu omlomo wesibeletho.

I-Cervical Collars: I-"C Collar"

Amakholomu omlomo wesibeletho (noma i-C Collar) angahlukaniswa ngezigaba ezimbili ezibanzi: ezithambile noma eziqinile.

Ezilungiselelweni zokuhlukumezeka, amakholomu omlomo wesibeletho aqinile ayizinqamuleli zokuzikhethela njengoba enikeza imikhawulo ephakeme yomlomo wesibeletho.[15]

Amakholomu omlomo wesibeletho ngokuvamile aklanyelwe ukuba abe nesiqephu sangemuva esisebenzisa imisipha ye-trapezius njengesakhiwo sokusekela kanye nesiqephu sangaphambili esisekela i-mandible futhi isebenzisa i-sternum ne-clavicles njengesakhiwo sokusekela.

Amakholomu omlomo wesibeletho ngokwawo awanikezi ukuvinjelwa komlomo wesibeletho okwanele futhi adinga izakhiwo ezengeziwe zokusekela ezingemuva, ngokuvamile ngendlela yamaphedi egwebu e-Velcro atholakala kumabhodi omude womgogodla.

UKUQEQESHWA KOSIZO LOKUQALA? VAKASHELA I-DMC DINAS MEDICAL CONSULTANTS BOOTH EMBUMBENI OPHUTHUMAYO

Technique

Amasu amaningana ayatholakala okubeka umuntu ekuvinjweni kokunyakaza komgogodla, enye yezinto ezivame kakhulu inqubo yokugoqa ilogi echazwe ngezansi futhi yenziwa, ngokufanelekile, neqembu labantu aba-5, kodwa okungenani, iqembu labane.[16] ]

Okweqembu labahlanu

Ngaphambi kokuba isiguli sinqande izingalo zaso phezu kwesifuba saso.

Umholi weqembu kufanele anikezwe inhloko yesiguli esizokwenza ukuzinza kwezandla okusemgqeni ngokubamba amahlombe esiguli ngeminwe endaweni engemuva ye-trapezius kanye nesithupha saso esicini sangaphambili ngezingalo ezicindezelwe ngokuqinile ngokumelene nezici ze-lateral. ikhanda lesiguli ukuze linciphise ukunyakaza futhi lizinzise umgogodla womlomo wesibeletho.

Uma ikhona, ikhola yomlomo wesibeletho kufanele ibekwe ngalesi sikhathi ngaphandle kokuphakamisa ikhanda lesiguli phansi. Uma eyodwa ingatholakali, gcina lokhu kuzinzisa ngesikhathi sokuqoqwa kwelogi.

Ilungu leqembu ezimbili kufanele libekwe ku-thorax, ilungu leqembu lesithathu ezinqulwini, futhi ilungu leqembu elinesine emilenzeni izandla zalo zibekwe ohlangothini olude lwesiguli.

Ilungu leqembu lesihlanu kufanele lilungele ukuslayida ibhodi lomgogodla omude ngaphansi kwesiguli ngemva kokuba ligoqiwe.

Emyalweni welungu leqembu 1 (imvamisa ekubaleni kokuthathu), amalungu eqembu 1 kuya ku-4 azogingqa isiguli, ngaleso sikhathi ilungu leqembu lesihlanu liyoslayida ibhodi lomgogodla elide ngaphansi kwesiguli.

Nakulokhu, ngokomyalo welungu leqembu, isiguli sizogingqika ebhodini lomgogodla omude.

Beka isiguli ebhodini futhi uvikele i-torso ngezintambo ezilandelwa i-pelvis nemilenze engaphezulu.

Vikela ikhanda ngokubeka amathawula agoqiwe nhlangothi zombili noma idivayisi etholakalayo ethengiswayo bese ubeka itheyiphu ebunzini futhi uvikelekile emaphethelweni ebhodi lomgogodla omude.

Okweqembu laBane

Futhi, umholi weqembu kufanele anikezwe ikhanda lesiguli futhi alandele inqubo efanayo eshiwo ngenhla.

Ilungu leqembu ezimbili kufanele libekwe endaweni ye-thorax ngesandla esisodwa ehlombe elikude kanti elinye libe senqulwini ekude.

Ilungu leqembu lesithathu kufanele libekwe emilenzeni, isandla esisodwa sibekwe okhalweni olude futhi esinye emlenzeni ode.

Qaphela ukuthi kunconywa ukuthi izingalo zamalungu eqembu ziwela omunye komunye enqulwini.

Ilungu leqembu lesine lizoslayida ibhodi lomgogodla elide ngaphansi kwesiguli, futhi yonke inqubo ilandelwa njengoba kuchazwe ngenhla.

Izinkinga zokusebenzisa ibhodi lomgogodla ku-spinal immobilisation

Ukulimala Kokucindezela

Inkinga engaba khona kulabo abangaphansi kwebhodi lomgogodla omude kanye nokuvinjelwa kokunyakaza komgogodla womlomo wesibeletho izilonda zokucindezela, okubikwa ukuthi kubikwe ukuthi kufike ku-30.6%.[17]

Ngokwe-National Pressure Ulcer Advisory Panel, izilonda zengcindezi manje seziphinde zahlelwa njengokulimala komfutho.

Zibangelwa ingcindezi, ngokuvamile ngenxa yokugqama kwamathambo, isikhathi eside okuholela ekulimaleni kwendawo esikhumbeni nasezicutshini ezithambile.

Ezigabeni zokuqala, isikhumba sihlala siqinile kodwa singase sithuthukele esilonda ngemva kwezigaba.[18]

Isikhathi esisithathayo ukuthuthukisa ukulimala komfutho siyahlukahluka, kodwa okungenani ucwaningo olulodwa lwabonisa ukuthi ukulimala kwezicubu kungase kuqale emizuzwini nje engama-30 kumavolontiya anempilo.[19]

Ngaleso sikhathi, isilinganiso sesikhathi esichithwe kunganyakazi ebhodini elide lomgogodla cishe imizuzu engama-54 kuya kwengama-77, cishe imizuzu engama-21 enqwabelana ku-ED ngemva kokuthutha.[20][21]

Unalokhu engqondweni, bonke abahlinzeki kufanele bazame ukunciphisa isikhathi iziguli ezisichitha zinganyakazi noma kumabhodi omgogodla omude aqinile noma ngamakholomu omlomo wesibeletho njengoba kokubili kungase kuholele ekulimaleni kwengcindezi.

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Ukuphazamiseka Kokuphefumula

Ucwaningo oluningi luye lwabonisa ukunciphisa umsebenzi wokuphefumula ngenxa yezintambo ezisetshenziswa emabhodini omude omgogodla.

Kumavolontiya amancane anempilo, ukusetshenziswa kwezintambo zebhodi lomgogodla omude phezu kwesifuba kubangele ukuncipha kwemingcele embalwa yamaphaphu, okuhlanganisa umthamo obalulekile ophoqelelwe, umthamo wokuphelelwa umoya ophoqelelwe, kanye nokugeleza okuphoqelekile kokuphelelwa yisikhathi okuholela kumphumela ovimbelayo.[22]

Ocwaningweni olubandakanya izingane, kube nokuncipha kwamandla okubalulekile okuphoqelekile ukuya ku-80% wesisekelo.[23] Kolunye ucwaningo futhi, kokubili ibhodi eliqinile nomatilasi be-vacuum kutholwe ukuthi kukhawulela ukuphefumula ngesilinganiso esingu-17% kumavolontiya anempilo.[24]

Kufanele kuqashelwe ngokucophelela lapho iziguli zingakwazi ukuhamba, ikakhulukazi lezo ezinesifo samaphaphu esivele sikhona kanye nezingane kanye nabantu asebekhulile.

Ubuhlungu

Inkinga evame kakhulu, ebhalwe kahle yokuvinjelwa kokunyakaza komgogodla ubuhlungu, okuholela emizuzwini emincane engama-30.

Ubuhlungu bubonakala kakhulu ngokuphathwa yikhanda, iqolo, nobuhlungu bomzimba.[25]

Futhi, futhi manje isihloko esiphindaphindiwe, isikhathi esichithwa ebhodini lomgogodla omude oqinile kufanele sincishiswe ukuze kuncishiswe ubuhlungu.

Ukubaluleka komtholampilo kokulimala komgogodla: indima yekhola kanye nebhodi lomgogodla

Ukuhlukumezeka okunamandla kungabangela ukulimala kwekholomu yomgogodla futhi, ngenxa yalokho, ukulimala komgogodla okungaholela ekuguleni okubi kakhulu nokufa.

Ngama-1960s kanye nama-1970s, ukuvinjelwa kokunyakaza komgogodla kwasetshenziswa ukunciphisa noma ukuvimbela i-sequelae ye-neurological ecatshangwa ukuthi ingeyesibili yokulimala kwekholomu yomgogodla.

Nakuba zamukelwe kabanzi njengezinga lokunakekelwa, izincwadi azinayo ikhwalithi ephezulu, ucwaningo olusekelwe ebufakazini oluphenya ukuthi ukuvinjelwa kokunyakaza komgogodla kunawo yini umthelela emiphumeleni yezinzwa.[26]

Ukwengeza, eminyakeni yamuva nje kuye kwaba nendikimba ekhulayo yobufakazi obuqokomisa izinkinga ezingaba khona zokuvinjelwa kokunyakaza komgogodla.[17][22][25][20]

Ngenxa yalokho, imihlahlandlela emisha iye yancoma ukuthi ukuvinjelwa kokunyakaza komgogodla kusetshenziswe ngobuhlakani emiphakathini ethile yeziguli.[10]

Nakuba ukuvinjelwa kokunyakaza komgogodla kungase kube nenzuzo kwezinye izimo, umhlinzeki udinga ukujwayelana kokubili imihlahlandlela kanye nezinkinga ezingase zibe khona ukuze abahlinzeki bahlomele kangcono ukusebenzisa lezi zindlela futhi bathuthukise imiphumela yesiguli.

Ukuthuthukisa Ithimba Lokunakekelwa Kwezempilo

Iziguli eziye zahileleka ekuhlukumezekeni okungaqondakali zingase zibe nenqwaba yezimpawu.

Kubalulekile ochwepheshe bezokunakekelwa kwezempilo abanomthwalo wemfanelo wokuhlola kokuqala kwalezi ziguli ukuthi bajwayele izinkomba, ukuphikisana, izinkinga ezingase zibe khona, kanye nezindlela ezifanele zokusebenzisa ukuvinjelwa kokunyakaza komgogodla.

Imihlahlandlela eminingana ingaba khona ukusiza ukunquma ukuthi yiziphi iziguli ezihlangabezana nemibandela yokuvinjelwa kokunyakaza komgogodla.

Mhlawumbe imihlahlandlela eyaziwa kakhulu neyamukelwa kabanzi yileyo yesitatimende sesikhundla esihlanganyelwe yi-American College of Surgeons Committee on Trauma (ACS-COT), iNational Association of EMS Physicians (NAEMSP), kanye ne-American College of Emergency Physicians (ACEP). [10] Nakuba lezi kuyiziqondiso zamanje kanye nezincomo, azikho izivivinyo zokulawula okungahleliwe zekhwalithi ephezulu kuze kube manje, nezincomo ezisekelwe ocwaningweni lokubheka, amaqoqo e-retrospective, kanye nezifundo eziyisibonelo.[26]

Ngaphandle kokujwayelana nezinkomba kanye nokuphikisana nokuvinjelwa kokunyakaza komgogodla, kubalulekile futhi ukuthi ochwepheshe bezokunakekelwa kwezempilo bajwayele izinkinga ezingase zibe khona njengobuhlungu, izilonda zengcindezi, nokuyekethisa kokuphefumula.

Lapho usebenzisa ukuvinjelwa kokunyakaza komgogodla, wonke amalungu e-interprofessional health care professionalsteam kumele ajwayele amasu akhethiwe futhi asebenzise ukuxhumana okuhle ukuze enze le nqubo ngendlela efanele futhi anciphise ukunyakaza komgogodla ngokweqile. Ochwepheshe bezempilo kufanele futhi baqaphele ukuthi isikhathi esichithwa ebhodini lomgogodla omude kufanele sincishiswe ukuze kuncishiswe izinkinga.

Lapho udlulisela ukunakekelwa, ithimba le-EMS kufanele likhulume nesikhathi esiphelele esichithwa ebhodini lomgogodla omude.

Ukusebenzisa imihlahlandlela yakamuva, ukujwayelana nezinkinga ezaziwayo, ukukhawulela isikhathi esichithwa ebhodini lomgogodla omude, nokusebenzisa imiphumela emihle kakhulu yokuxhumana phakathi kwalezi ziguli kungenziwa ngcono. [Izinga 3]

References:

[1]Kwan I, Bunn F, Imiphumela ye-prehospital immobilization yomgogodla: ukubuyekezwa okuhlelekile kokuhlolwa okungahleliwe ngezihloko ezinempilo. Umuthi we-Prehospital kanye nezinhlekelele. 2005 Jan-Feb; [I-PMID eshicilelwe: 15748015]

[2]I-Chen Y, i-Tang Y, i-Vogel LC, i-Devivo MJ, Izimbangela zokulimala komgogodla. Izihloko ekuvuselelweni kokulimala komgogodla. 2013 Ubusika; [I-PMID eshicilelwe: 23678280]

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