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Ukusekelwa kwempilo okuyisisekelo (BTLS) kanye nokwesekwa kwempilo okuthuthukisiwe (ALS) esigulini esihlukumezekile

By UCristiano Antonino On Kwangathi 12, 2022

Ukusekelwa kwempilo ye-trauma eyisisekelo (BTLS): ukusekelwa kwempilo ye-trauma eyisisekelo (yingakho igama elithi SVT) liyi-protocol yokuhlenga ngokuvamile esetshenziswa abatakuli futhi ehloswe ekwelashweni kokuqala kwabantu abalimele abaye bahlukumezeka, okungukuthi umcimbi obangelwa inani elikhulu lamandla. ukusebenza emzimbeni kubangela ukulimala

Ngakho-ke lolu hlobo lokuhlenga aluhloselwe kuphela izisulu ze-polytrauma eziye zahlupheka isib.

I-SVT ne-BTLF: Ihora legolide, isivinini sisindisa impilo

Umzuzu owodwa ngaphezulu noma ngaphansi ngokuvamile umehluko phakathi kokuphila nokufa kwesiguli: lokhu kuyiqiniso nakakhulu endabeni yeziguli eziye zahlukumezeka kakhulu: isikhathi phakathi kwesigameko sokuhlukumezeka nokuhlenga sibaluleke kakhulu, njengoba kusobala ukuthi esifushane isikhawu sesikhathi kusukela kumcimbi kuya ekungeneleleni, makhulu amathuba okuthi umuntu ohlukumezekile asinde noma okungenani abhekane nomonakalo omncane ongenzeka.

Ngenxa yalesi sizathu, umqondo wehora legolide ubalulekile, okugcizelela ukuthi isikhathi phakathi komcimbi kanye nokungenelela kwezokwelapha akufanele kube ngaphezu kwemizuzu engu-60, umkhawulo ongaphezu kwalokho kukhona ukwanda okuphawulekayo kwamathuba okungasindisi isiguli. ukuphila.

Nokho, inkulumo ethi 'ihora legolide' ayisho ngempela ihora, kodwa iveza umqondo ovamile wokuthi: 'isenzo sangaphambili sithathwa, makhulu amathuba okusindisa impilo yesiguli'.

Izakhi ze-trauma Dynamics ezinkulu

Uma isakhamuzi sishayela Inombolo Yezimo Eziphuthumayo Eyodwa, umqhubi uyasibuza imibuzo ethile mayelana nokuguquguquka komcimbi, okusebenza

hlola ubukhulu bokuhlukumezeka
sungula ikhodi yokuqala (eluhlaza, ephuzi noma ebomvu);
thumela ithimba labatakuli njengoba kudingeka.

Kunezici ezibikezela ukuqina okukhulu okucatshangwayo kokuhlukumezeka: lezi zakhi zibizwa ngokuthi 'izakhi ze-dynamics ezinkulu'.

Izakhi eziyinhloko zama-dynamics amakhulu ziyi

iminyaka yesiguli: iminyaka engaphansi kwe-5 nangaphezulu kwama-55 ngokuvamile iyinkomba yokuqina okukhulu;
udlame lomthelela: ukungqubuzana okuqondile noma ukukhishwa komuntu endaweni yabagibeli, isibonelo, izinkomba zobunzima obukhulu;
ukungqubuzana phakathi kwezimoto ezinobukhulu obuhlukile: ibhayisikili/iloli, imoto/abahamba ngezinyawo, imoto/isithuthuthu yizibonelo zobunzima obukhulayo;
abantu ababulawa emotweni eyodwa: lokhu kuphakamisa izinga lokucatshangelwa lobunzima;
i-extrication eyinkimbinkimbi (isikhathi sokukhipha esilindelekile esingaphezu kwemizuzu engamashumi amabili): uma umuntu evaleleke isb phakathi kwamashidi ensimbi, izinga lokucabanga lokudonsela phansi liyakhuphuka;
ukuwa kusuka ezindaweni eziphakeme ezingaphezu kwamamitha angu-3: lokhu kuphakamisa izinga lokucatshangelwa lobunzima;
uhlobo lwengozi: ukuhlukumezeka ngogesi, ukusha okukhulu kwedigri lesibili noma lesithathu, ukuminza, amanxeba okudutshulwa, zonke izingozi eziphakamisa izinga lokucatshangelwa lobunzima;
ukuhlukumezeka okukhulu: i-polytrauma, ukuphuka okuveziwe, ukunqunywa, konke ukulimala okuphakamisa izinga lobunzima;
ukulahlekelwa ukwazi: uma isifundo esisodwa noma ngaphezulu belahlekelwa ukwazi noma indlela yomoya engasebenzi kanye/noma ukuboshwa kwenhliziyo kanye/noma ukuboshwa kwamaphaphu, izinga lokuqina liyakhuphuka kakhulu.

Izinjongo zomqhubi wefoni

Izinjongo zomqhubi wefoni kuzoba uku

ahumushe incazelo yesigameko kanye nezimpawu zomtholampilo, ezivame ukwethulwa ngokungalungile ngumuntu oshaye ucingo, okusobala ukuthi ngeke ahlale enesizinda sezempilo;
baqonde ubucayi besimo ngokushesha ngangokunokwenzeka
thumela usizo olufanele kakhulu (i-ambulensi eyodwa? ezimbili ama-ambulensi? Thumela udokotela oyedwa noma ngaphezulu? Futhi thumela izicishamlilo, i-carabinieri noma amaphoyisa?);
aqinise isakhamuzi asichazele ukude ukuthi yini angayenza esalinde usizo.

Lezi zinhloso kulula ukuzisho, kodwa ziyinkimbinkimbi kakhulu uma kubhekwa isasasa kanye nemizwelo yomuntu ofonayo, ovame ukubhekana nezigameko ezibuhlungu noma naye oke wabandakanyeka kuzo ngakho-ke incazelo yakhe yalokho okwenzekile ingase ibe yizicucu futhi iguqulwe (isb. esimweni sokuquleka, noma ukusetshenziswa kotshwala noma izidakamizwa).

I-SVT ne-BTLF: ukulimala okuyisisekelo nesesibili

Kulolu hlobo lomcimbi, umonakalo ungahlukaniswa kube umonakalo oyinhloko nowesibili:

umonakalo oyinhloko: lona umonakalo (noma umonakalo) obangelwa ngokuqondile ukuhlukumezeka; isibonelo, engozini yemoto, umonakalo oyinhloko umuntu angase awuphathe ungase ube ukuphuka noma ukunqunywa kwezitho;
umonakalo wesibili: lona umonakalo isiguli esiwuthola ngenxa yokulimala; empeleni, amandla okuhlukumezeka (kinetic, thermal, njll.) nawo asebenza ezithweni zangaphakathi futhi angabangela ukulimala okukhulu noma okuncane kakhulu. Ukulimala kwesibili okuvame kakhulu kungase kube i-hypoxia (ukuntuleka komoya-mpilo), i-hypotension (ukwehla komfutho wegazi ngenxa yokuqala kwesimo sokushaqeka), i-hypercapnia (ukwanda kwe-carbon dioxide egazini) kanye ne-hypothermia (ukwehla kokushisa komzimba).

Izivumelwano ze-SVT ne-BTLF: i-Trauma Survival Chain

Uma kwenzeka kuhlukumezeka, kunenqubo yokuxhumanisa izenzo zokuhlenga, ebizwa ngokuthi i-trauma survivor chain, ehlukaniswe ngezinyathelo ezinhlanu eziyinhloko.

ucingo oluphuthumayo: isexwayiso sangaphambi kwesikhathi ngenombolo yezimo eziphuthumayo (e-Italy yiNombolo Yezimo Eziphuthumayo Eyodwa 112);
ukulinganisa kwenziwe ukuhlola ubucayi bomcimbi kanye nenani labantu abahililekile;
ekuqaleni ukwesekwa kokuphila okuyisisekelo;
ukufakwa endaweni eyodwa kwangaphambi kwesikhathi esikhungweni se-Trauma (ngaphakathi kwehora legolide);
ukwenza kusebenze ukwesekwa kwempilo okuthuthukile kusenesikhathi (bheka isigaba sokugcina).

Zonke izixhumanisi kulolu chungechunge zibaluleke ngokulinganayo ekungeneleleni okuyimpumelelo.

Ithimba labatakuli

Ithimba elisebenza ku-SVT kufanele okungenani libe nabantu abathathu: Umholi Wethimba, Umphenduli Wokuqala kanye Nomshayeli Wokuhlenga.

Umdwebo olandelayo ulungile, njengoba izisebenzi zingahluka kuye ngenhlangano, umthetho wokuhlenga wesifunda kanye nohlobo lwesimo esiphuthumayo.

Umholi weqembu ngokuvamile ungumhlengi onolwazi kakhulu noma umkhulu futhi uphatha futhi aqondise imisebenzi okufanele yenziwe phakathi nesevisi. Umholi weqembu nguyena futhi owenza zonke izivivinyo. Eqenjini lapho kukhona unesi noma udokotela abangu-112, indima yomholi weqembu idlulela kubo ngokuzenzakalelayo.

I-Rescue Driver, ngaphezu kokushayela imoto yokuhlenga, inakekela ukuphepha kwesimo futhi isiza abanye abatakuli nge ukungasebenzi amacebo.[2]

Umphenduli WokuQala (obuye abizwe ngokuthi umholi we-maneuver) uma ekhanda lesiguli esihlukumezekile bese enyakazisa ikhanda, alibambe lingathathi hlangothi kuze kube yilapho isiguli singakwazi ukuhamba. Umgogodla ibhodi kuqediwe. Uma kwenzeka isiguli sigqoke isigqoko sokuzivikela, umhlengi wokuqala kanye nozakwenu baphatha ukususwa, begcina ikhanda linganyakazi ngangokunokwenzeka.

Hlala, udlale noma uqoqe futhi ugijime

Kunamasu amabili okuya esigulini futhi kufanele akhethwe ngokuya nezici zesiguli kanye nesimo sokunakekelwa kwezempilo sendawo:

i-scoop & run strategy: leli su kufanele lisetshenziswe ezigulini ezigula kakhulu ezingeke zizuze ekungeneleleni endaweni, ngisho ne-Advanced Life Support (ALS), kodwa zidinga ukulaliswa esibhedlela ngokushesha kanye nokwelashwa okungaphakathi kwesiguli. Izimo ezidinga i-Scoop & Run zihlanganisa amanxeba angena esiqwini (isifuba, isisu), impande yesitho kanye intamo, okungukuthi izindawo ze-anatomical amanxeba azo angeke acindezelwe ngokuphumelelayo;
hlala & udlale isu: leli su likhonjiswe lezo ziguli ezidinga ukuqiniswa endaweni ngaphambi kokuba zihanjiswe (lokhu kuyinkinga yokopha okukhulu okucindezelayo noma okubi kakhulu kunezimo eziphuthumayo).

I-BLS, ukwesekwa kwempilo yokuhlukumezeka: ukuhlolwa okubili

Ukwesekwa okuyisisekelo kwempilo kumuntu ohlukumezekile kuqala ezimisweni ezifanayo njenge-BLS evamile.

I-BLS kumuntu ohlukumezekile ibandakanya ukuhlolwa okubili: okuyisisekelo nokwesibili.

Ukuhlolwa ngokushesha kokwazi komuntu ohlukumezekile kubalulekile; uma lokhu kungekho, umthetho olandelwayo we-BLS kufanele usetshenziswe ngokushesha.

Esimeni somuntu olimele oboshiwe, ukuhlolwa okusheshayo kwe-Basic Life Functions (ABC) kubalulekile, futhi kuyadingeka ukuqondisa ithimba labatakuli ekukhishweni ngokushesha (uma kwenzeka uqulekile noma ukonakala kwenye yama-VFs) noma ekukhishweni okuvamile kusetshenziswa i- IKEDI idivayisi yokukhipha.

Ukuhlola okuyinhloko: umthetho we-ABCDE

Ngemuva kokuhlolwa okusheshayo kanye nokukhipha uma kunesidingo, ukuhlolwa okuyinhloko kuyenziwa, okuhlukaniswe ngamaphoyinti amahlanu: A, B, C, D kanye no-E.

I-Airway and Spine Control (indlela yomoya kanye nokuzinza komgogodla wesibeletho)

Umphenduli WokuQala uzibeka yena ekhanda eliqinisa mathupha ngenkathi Umholi Wethimba esebenzisa isicelo ikhola yomlomo wesibeletho. Umholi weqembu uhlola isimo sokwazi ngokubiza umuntu nokuthola ukuthintana ngokomzimba, isb, ngokuthinta amahlombe akhe; uma isimo sokwazi sishintshile kubalulekile ukwazisa 112 ngokushesha.

Futhi kulesi sigaba, umholi weqembu uvula isifuba sesiguli futhi ahlole indlela yokuphefumula, abeke i-oro-pharyngeal cannula uma isiguli siqulekile.

Kubalulekile njalo ukunikeza i-oksijini ekugelezeni okuphezulu (amalitha angu-12-15/ngomzuzu) kumuntu olimele, njengoba ehlala ebhekwa njengokwethuka kwe-hypovolaemic.

B - Ukuphefumula

Uma isiguli siqulekile, ngemva kokuxwayisa i-112, umholi weqembu uqhubeka ne-GAS (Bheka, Lalela, Zizwe), esetshenziselwa ukuhlola ukuthi umuntu uyaphefumula yini.

Uma kungenakuphefumula, i-BLS yakudala yenziwa ngokufaka umoya omncane (okungenzeka ngokuxhuma iflaski ezinwebayo kusilinda komoyampilo, iyenze ilethwe ngamanani okugeleza okuphezulu), bese idlulela esigabeni C.

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Uma ukuphefumula kukhona noma uma isiguli siyazi, imaski ibekwe, i-oxygen ilawulwa futhi i-OPAS (Qaphela, i-Palpate, Lalela, Bala, i-Saturimeter) yenziwa.

Ngaleli qhinga, umholi weqembu uhlola imingcele ehlukahlukene yesiguli: empeleni, ubheka futhi ashaye izandla isifuba ebheka ukuthi azikho yini izimbobo noma izinto ezingavamile, ulalela umoya ehlola ukuthi akukho yini ukubhodla noma imisindo, ubala izinga lokuphefumula futhi isebenzisa i-saturimeter ukuhlola umoya-mpilo egazini.

C – Ukujikeleza

Kulesi sigaba, kuyabhekwa ukuthi isiguli asinakho yini ukopha okukhulu okudinga ukopha ngokushesha.

Uma kungekho ukopha okukhulu kakhulu, noma okungenani ngemva kokuba etholwe nge-tampon, imingcele eyahlukene mayelana nokujikeleza kwegazi, ukushaya kwenhliziyo nombala wesikhumba nezinga lokushisa liyahlolwa.

Uma isiguli esisesigabeni B siqulekile futhi singaphefumuli - ngemva kokwenza umoya wokungenisa umoya kabili - sidlulela esigabeni C, esihlanganisa ukuhlola ukuba khona kwe-carotid pulse ngokubeka iminwe emibili emthanjeni we-carotid nokubala kuya kumasekhondi angu-10.

Uma kungekho ukushaya kwenhliziyo sidlulela ekuvuselelweni kwenhliziyo okwenziwa ku-BLS ngokwenza massage yenhliziyo.

Uma kukhona ukushaya kwenhliziyo futhi kungenakuphefumula, ukuphefumula kusizwa ukwenza ama-insufflation angaba ngu-12 ngomzuzu ngebhaluni elizikhulisayo elixhunywe kusilinda komoyampilo esiletha ukugeleza okuphezulu.

Uma i-carotid pulse ingekho ukuhlolwa okuyinhloko kuyama kuleli phuzu. Isiguli esinolwazi siphathwa ngendlela ehlukile.

Umfutho wegazi uhlolwa kusetshenziswa i-sphygmomanometer kanye ne-radial pulse: uma lesi sakamuva singekho, umfutho wegazi ophezulu (systolic) ungaphansi kuka-80 mmHg.

Kusukela ngo-2008, izigaba B no-C zihlanganiswe ukuze kwenziwe indlela eyodwa, ukuze ukuqinisekiswa kokuba khona kwe-carotid pulse kufane kanye nalokho kuphefumula.

D – Ukukhubazeka

Ngokungafani nokuhlola kokuqala lapho isimo sokuqaphela sihlolwa kusetshenziswa i I-AVPU isikali (abahlengikazi nodokotela basebenzisa i- I-Glasgow Coma Scale), kulesi sigaba isimo somuntu sezinzwa siyahlolwa.

Umhlengi ubuza isiguli imibuzo elula esihlolayo

inkumbulo: uyabuza ukuthi uyakhumbula yini okwenzeka;
i-spatio-temporal orientation: isiguli sibuzwa ukuthi unyaka ongakanani nokuthi uyazi ukuthi ukuphi;
ukulimala kwemizwa: bahlola kusetshenziswa isikali seCincinnati.

E – Exposure

Kulesi sigaba kuyahlolwa ukuthi isiguli sike salimala kakhulu yini.

Umholi weqembu ukhumula isiguli (ukusika izingubo uma kunesidingo) bese ehlola kusukela ekhanda kuye ozwaneni, ahlole noma yikuphi ukulimala noma ukopha.

Imithetho yomthetho ibiza ukuthi kubhekwe nezitho zangasese, kodwa ngokuvamile lokhu akwenzeki ngenxa yezifiso zesiguli noma ngenxa yokuthi kulula ukubuza isiguli ukuthi siyazizwa yini izinhlungu ngokwaso.

Okufanayo kuya engxenyeni lapho izingubo kufanele zinqunywe khona; kungase kwenzeke ukuthi isiguli simelane nalokhu, futhi ngezinye izikhathi abatakuli ngokwabo banquma ukungenzi uma isiguli sibika ukuthi akukho buhlungu, sinyakazisa izitho zaso kahle futhi siqinisekise ukuthi asizange sihlaselwe noma yikuphi ukushaya endaweni ethile yomzimba waso.

Ukulandela isheke lezinyawo zekhanda, isiguli simbozwe ngendwangu yokushisa ukuvimbela i-hypothermia engenzeka (kulokhu, ukunyuka kwezinga lokushisa kufanele kube kancane kancane).

Ekupheleni kwalesi sigaba, uma isiguli besilokhu siqaphile, umholi weqembu uxhumana nayo yonke imingcele ye-ABCDE esikhungweni sokuhlinza se-112, esizomtshela ukuthi enzeni nokuthi yisiphi isibhedlela azosiyisa isiguli. Noma nini lapho kuba nezinguquko ezinkulu kumapharamitha esiguli, umholi weqembu kufanele azise i-112 ngokushesha.

Ukuhlola kwesibili

Linganisa:

ukuguquguquka komcimbi;
indlela yokuhlukumezeka;
umlando wesiguli. Ngemva kokuphothula ukuhlolwa okuyinhloko kanye nokuxwayisa Inombolo Yezimo Eziphuthumayo yalesi simo, isikhungo sokusebenza sinquma ukuthi isiguli sithuthelwe esibhedlela noma sithumele enye imoto yokuhlenga, njenge-ambulensi.

Ngokusho kwe-PTC protocol, ukulayisha kukholomu yomgogodla kufanele kwenziwe nge-spoon stretcher; abanye abakhiqizi bezincwadi kanye nohlaka, nokho, bathi ukunyakaza okuncane ngangokunokwenzeka kufanele kwenziwe ngakho-ke ukulayisha kukholomu yomgogodla kufanele kwenziwe nge-Log roll (bopha izinyawo ndawonye kuqala), ukuze ingemuva libuye lihlolwe.

Usekelo lwempilo oluthuthukisiwe (ALS)

I-Advanced Life Support (ALS) iphrothokholi esetshenziswa abasebenzi bezokwelapha nabahlengikazi njengesandiso, hhayi esikhundleni se-basic life support (BLS).

Inhloso yalesi simiso ukuqapha nokusimamisa isiguli, nangokuphathwa kwezidakamizwa kanye nokuqaliswa kwezindlela ezihlaselayo, kuze kube sekufikeni esibhedlela.

E-Italy, le protocol ibekelwe odokotela nabahlengikazi, kanti kwezinye izifundazwe, ingasetshenziswa nabasebenzi abaziwa ngokuthi 'izimo eziphuthumayo', umuntu ochwepheshe ongekho e-Italy.