I-UK / Igumbi lezimo eziphuthumayo, intubation yezingane: inqubo nengane esesimweni esibucayi
Intubation emnyangweni wezimo eziphuthumayo zezingane kuyinto esabekayo. Ezinganeni ezigula kakhulu ezidinga intuba, akuvamile ukwenziwa ngaphandle kweyunithi yokunakekelwa okubucayi
Ngokufakwa kwezinsiza endaweni eyodwa ancishisiwe amathuba okuthi lawa makhono asetshenziswe. Labo abasebenza kuma-DGH bangase babe namathuba ambalwa okuprakthiza lawa makhono - futhi uma benza kungase kube sesimweni esiphuthumayo.
Lokhu kungasizwa ngokusebenzisana namathimba aletha izingane anganikeza izeluleko ezikude kulabo abasezindaweni okungezona ezesikhungo semfundo ephakeme kuze kufike ithimba labazolanda. Nokho, abaphathi sebebonke bangase babe seqenjini lendawo.
Isihloko sakamuva sikaKanaris et al. ihlose ukunikeza amathiphu okuthi unganikeza kanjani intubation ephephile, esheshayo ephumelelayo kanye nezinye izingibe ezivamile nokuthi ungazinqoba kanjani (okwenze isisekelo salokhu okuthunyelwe).
Intubation yezingane egumbini lezimo eziphuthumayo: The 3Ps- Planning | Ukulungiselela | Inqubo
Kubalulekile ukuthi ukuhlela okufanele kwenzeke ngisho nasesimweni esiphuthumayo. Izinto eziningi zidinga ukwenzeka ngokushesha.
Isinyathelo sokuqala kufanele sigxile ekuqeqesheni nasekufanisweni kwalezi zinqubo - ngokufanelekile kunoma iyiphi indawo eshiwo ngenhla.
Mayelana ne-intubation yezingane egumbini lezimo eziphuthumayo: vuselela ngaphambi kokufaka intuba
Ukufakela ingane egula kakhulu kuyinqubo eyingozi. Ukungeniswa kunethuba langempela lokubangela ukuboshwa kwenhliziyo ekufakweni.
Lokhu kungenzeka nakakhulu uma ingane ingavuselelwanga ngendlela efanele.
Ukuphathwa koketshezi (10mls/kg aliquots - kufika ku-40-60mls/kg) ezinganeni ezinomfutho wegazi ophakeme kanye ne-tachycardic, noma igazi ezinganeni eziye zalahlekelwa igazi kubalulekile.
Njengokwesiqondiso esisha somkhandlu we-resus olinganiselayo i-isotonic crystalloids, isb, iPlasmalyte, manje isiyinketho yokuqala.
Ukwesekwa kwe-peripheral inotropic kungase kudingeke futhi nge-adrenaline/noradrenaline.
Enganeni ethukile ukuthola ukufinyelela kwe-IV kungenzeka kube luqili - ukufinyelela kwe-IO kungaba enye indlela esheshayo, elula nephumelelayo.
Lokhu kungabonakala 'njengokufinyelela okumaphakathi' kwesikhashana okungaba usizo ikakhulukazi ku-ED resus.
Ukubekwa komugqa omaphakathi kule ndawo kungathatha isikhathi futhi kungase kuphazamise iqembu kwezinye izenzo ezibalulekile.
IMPILO YENGANE: FUNDA KABANZI NGE-MEDICHILD NGOKUVAKASHA I-STAND EMBONWENI WEZIPhuthumayo
Asikhulume Izidakamizwa...
Njengezinto eziningi kwezokwelapha zezingane, awukho umuthi 'ophelele' noma inhlanganisela yezidakamizwa zokubulala izinzwa esimweni esiphuthumayo.
Inhlanganisela ekhuthazwayo futhi ethembele kuyo ngamathimba okunakekelwa okubucayi yi-Ketamine (1-2mg/kg) (+/- Fentanyl 1.5 microgram/kg) kanye ne-Rocuronium (1mg/kg).
Odokotela ababulala izinzwa okungenzeka bajwayelene kakhulu nabantu abadala bangase basetshenziswe ukusebenzisa izidakamizwa ezifana ne-propofol noma i-thiopentone.
Zombili lezi zinemiphumela ephawulekayo ye-vasodilatory futhi kufanele ngempela zibekelwe izingane kuphela NGAPHANDLE kwanoma yiziphi izimpawu zokushaqeka.
Ozakwethu abadala bangase babe sekhaya kakhulu ngokusebenzisa i-suxamethonium kune-rocuronium.
I-Suxamethonium isebenza ngokushesha ihlinzeka ngokukhubazeka ngemizuzwana engama-30-60.
Isebenza ngokushesha kodwa ayihlali isikhathi eside (2-6mins), ingabangela futhi i-bradycardia nokukhululwa kwe-potassium.
I-Rocuronium, uma isetshenziswe kumthamo olungile, ingaba nokuqala kwesenzo esifanayo (imizuzwana engu-40-60) ngaphandle kwemiphumela emibi engadingeki.
I-Rocuronium nayo ingahlehliswa uma idingeka nge-sugammadex uma kudingeka.
Indawo, indawo, indawo
Ukuthutha ukusuka ku-ED ukuya kumatiyetha ukuze kuqhutshekwe ne-intubation kungaba yinto esabekayo.
Lokhu kungase kube kuhle ngenxa yokujwayelana nakho imishini kanye nesikhala sethimba le-intubating, indawo engaba namandla engeziwe, kanye nekhono lokusebenzisa amagesi okubulala izinzwa esimweni somzila womoya onzima.
Ezinye izisetshenziswa isb. i-laryngoscope yevidiyo ingase itholakale kalula e-CCU/Itiyetha.
Kodwa-ke, kuhlale kunengozi yokuwohloka okungenzeka ohambweni olusuka ku-resus luye kwenye indawo.
Njengoba ubambeke ku-lift nengane engazinzile kakhulu, akusona isikhundla esifiselekayo ukuba ube kuso.
Uma, njengeqembu, kwenziwa isinqumo sokudlulisa isiguli, ukuhlela ngokucophelela mayelana nokuthi ubani nokuthi yini ongase uyidinge ngokuya ngabasebenzi nemishini kubalulekile.
Ukuqinisekisa ukuqapha: i-pulse oximetry, i-ECG, ukuhamba ngebhayisikili i-NIBP futhi vele njengokusho kwe-capnography yomkhandlu omusha we-resus ekhona ngaphambi kokunyakaza kubalulekile.
Isisebenzi esimpofu sigxeka amathuluzi abo… Kodwa udinga ukwenza isiqiniseko sokuthi unawo afanele.
Esimeni esiphuthumayo esibucayi ngesikhathi, neqembu elisanda kuhlanganiswa, ukuba nezinto ezifanele kubalulekile.
Uhlu lokuhlola lwe-intubation luvumela abantu ukuthi baqoqe okokusebenza okufanele ngaphandle kokuthi umuntu adinge ukukuthatha njengomthwalo wokuqonda.
Kunezibonelo eziningi zohlu lokuhlola lwemishini ye-intubation. Bheka izikhombo ukuze uthole izibonelo ezithile.
Ngaphezu kokuba nohlu lokuhlola lwe-intubation, kuwumqondo omuhle ukuba nohlu lokuhlola olusebenza njengohlobo lweshidi lokungena/lokuphuma le-WHO elingase lihlanganise impahla edingekayo.
Ama-cuffs angakanani?
Amashubhu afakwe ama-cuffed ayindinganiso yegolide ezinganeni ezingaphilile kahle > 3kg.
I-intubation yezingane egumbini lezimo eziphuthumayo: I-oxygenation, i-oxygenation kanye ne-oxygenation eyengeziwe
Uma kukhulunywa ngokufaka umoya-mpilo isiguli ngaphambi noma phakathi kwemizamo yokufaka intubation, isikhwama esijwayelekile se-valve-mask noma isifunda sokubulala izinzwa singasetshenziswa.
Okuthile okufanele kucatshangelwe kungase kube ukubeka ingane kumoya-mpilo omswakama ogelezayo ophezulu (100%) nge-HFNC ukuze kuthuthukiswe umoya-mpilo ngaphambi naphakathi kwemizamo.
Uma lokhu kuthatha isikhathi eside kakhulu noma izisetshenziswa zamakhala zithinta uphawu lwemaski yobuso, ungakwenzi.
Inhloso iwukuba imizuzu emi-3 yokukhipha umoya-mpilo wangaphambili ngaphambi kokufaka umoya-mpilo ezinganeni ezincane/ezigulayo kakhulu ithuba lokuphuma kwe-apnoeic desaturation liphezulu njengoba zintweza eweni elibucayi lejika le-oxygen-hemoglobin dissociation curve.
Kubalulekile ukuba ne-NGT engashiselwa njalo kubalulekile ukunciphisa isisu esigcwele (okungaba okuqukethwe yisisu noma umoya) futhi kuvimbele ukuhlukana kwe-diaphragm, kanye nokunciphisa ingozi yokufisa.
Khumbula njalo umgomo oyinhloko - ukufaka umoya-mpilo esigulini. Thatha isinyathelo emuva, uma kunesidingo ukuze uzikhumbuze wena neqembu ngomgomo omkhulu.
Ungakwazi ukufaka i-oxygen ngokusebenzisa izindlela ezilula futhi ngaleyo ndlela ugweme imizamo eminingi yokufaka i-intubation.
'Isu le-Vortex' lingaba usizo njengensiza ebonakalayo ukukhumbuza iqembu ukuthi lihlehle.
Ungakwazi ukunakekela indlela yokuphefumula enezixhumi futhi ukupakisha isiguli kungenziwa kuze kufike usizo olwengeziwe.
Ukubambisana kwenza iphupho lisebenze
Ukuba neqembu elibhola kahle nelinekhono kuyiphupho. Eqinisweni, siyazi ukuthi lokhu kungase kungabi njalo.
Izingeniso ezimfishane ezicacisa izindima kanye nohlelo olufushane lokwenza (okuhlanganisa uhlelo B, C ngisho no-D) uma izinto zingahambi ngendlela ehleliwe ziwusizo.
Kwenze kucace ukuthi ubani oholayo futhi adlulisele ubuholi kafushane ngesikhathi sokufakwa ngaphakathi uma kudingeka.
Nikeza ilungu leqembu ukuthi libheke iwashi ngesikhathi sokufakwa ngaphakathi.
Lokhu kungavimbela i-intubator ekubeni 'igxile emsebenzini' kakhulu.
Futhi 'i-oxygenation', hhayi 'i-intubation' inhloso enkulu lapha.
Njenganoma iyiphi inqubo enobungozi obukhulu, ukulingisa kubalulekile, kuhlanganiswe nengxoxo ngemuva kokuthi umcimbi ngokwawo wenzeke ukuze kubonakale ukuthi yiziphi izingcezu ezisebenze kahle nokuthi yimaphi amaphuzu okufunda angenziwa.
Funda Futhi:
I-Endotracheal Intubation Ezigulini Zezingane: Amadivayisi E-Supraglottic Airways
Umthombo:
Izithenjwa ezikhethiwe
Ezinye izinsiza zamahhala Zohlu Lokuhlola Intubation zimi kanje. Sibonga umphakathi we-DFTB ngokusayina lezi zinhla zokuhlola eziwusizo:
https://kids.bwc.nhs.uk/wp-content/uploads/2021/02/Pre-Intubation-Checklist-V25Final.pdf
Amathuluzi okuvuselela izingane | Ukunakekelwa Kwezimo Eziphuthumayo Kwezingane zase-Queensland (health.qld.gov.au)
I-Airway Plan & Kit Dump - KI Doc (kidocs.org)
U-Anandi Singh, uJilly Boden noVicki Currie. 2021 Umkhandlu Wokuvuselela Umhlahlandlela wase-UK: Yini entsha kudokotela wezingane?, Ungakhohlwa Amabhamuza, 2021. Itholakala e-: https://doi.org/10.31440/DFTB.33450
Indlela ye-Vortex: http://vortexapproach.org/downloads– Ulwazi oluningi oluwusizo ngempela/ okuphrintiwe okungasetshenziswa ku-resus trolley!