Ukuphathwa kwezindiza ezithuthukisiwe kuyisici esiyisisekelo sokunakekelwa kwangaphambi kokubhedlela kwangaphambili. Yiziphi izici eziyinhloko zesinqumo sokwenza intubation?

Ukulandelana okusheshayo okulandelanayo kuyindlela yokulawula ukuhamba kwemimoya nokunciphisa ingozi yokuhlanza nokuhlanza amanzi ukubuyiswa kabusha okuzalwa ku-1970 (Stept | Safar) ukusebenzisa i-Cricoid Pressure ngesikhathi sokuphathwa kwe-Airway (Sellick). Ukulandelana Ngokushesha Okusheshayo kungenye yezindlela ezibaluleke kakhulu kwi-ALS ngoba kufanele igcine ukusebenza kahle komoya. Yinto ebalulekile ye- amakhono kwezobuchwepheshe, ngokusebenza ku esiphuthumayo esandulela esibhedlela. Kodwa kusukela ku-2010, kunemibuzo mayelana Sellick Maneuver ukuthi abacwaningi baphenya.

The Indawo e-Greater Sydney HEMS ungomunye wamathimba anamakhono kakhulu mayelana nezinqubo zangaphambili ze-ALS esibhedlela emhlabeni. Zilandela Ama-protocol a #FOAMED ukuhlinzeka wonke umuntu ngolwazi mayelana nokuhlangenwe nakho kwabo, ikakhulukazi nge-Airway Management. Bayidale I-Airway Registry lokho kubhekwa uphawu olubalulekile lokufunda umkhuba ongcono. Wonke amacala abhalisiwe kwi-Airway Registry axoxwa ngaphandle kokucabangela, angaziwa futhi ahlanganiswe esikhathini esithile ukudweba ndawonye ukuhlanganisa imiyalezo yokuthatha ekhaya.

The Indawo enkulu yaseSydney HEMS e 2010 idale ibhukwana le-Rapid Sequence Intubation. Le manuwali ichaza uhlelo lwe-anesthesia yezimo eziphuthumayo zangaphambi kwesibhedlela. Yincwadi ethakazelisa ngempela kubachwepheshe abasebenza kuzilungiselelo ezinomkhawulo lapho kutholakala khona ithimba imishini nobuchwepheshe bungadingeka ukuthi bunikeze ukuphathwa komgwaqo okuphephile nokuphephe kakhulu okuhamba phambili.

Indawo yase-Greater Sydney Indawo ye-HEMS manual ichaza izinqubo okufanele zilandelwe i-anesthesia ephuthumayo yangaphambi kwesibhedlela. Umqondo wase-Australia ukusekela isu elicwangcisiwe le-laryngoscopy lokuqala ukubheka impumelelo. "Lokhu kugwema imizamo ehlala isikhathi eside futhi eminingi kanye nezinkinga ezilandelanayo. Ihlose ukuqinisekisa a inqubo eqinisekisiwe yokulondoloza i-anesthesia yangaphambi kwesibhedlela ngenkathi zivuma izimo ezahlukahlukene, izimo kanye nama-pathologies ahlangane nawo kulungiselelo lwangaphambi kwesibhedlela. Iseluleko esinikeziwe sivela ekuhlangenwe nakho okuhlangene kwenqwaba yabahlengikazi ekunakekelweni kwabagula kwangaphambi kwesibhedlela futhi kunobufakazi obusekelwe lapho kungenzeka. Le ncwajana ichaza amakhono asemqoka futhi awasebenzisayo ahlolwa ku-Emergency Anesthesia Clinical Currency ”. Njengazo zonke izinqubo, isinqumo sokuqhubeka nesifo esiphuthumayo se-preest hospital kumele sisekelwe ekuhloleni okunolwazi ngengozi yenqubo ngokuphathelene nezinzuzo zomtholampilo. Izinkomba i-anesthesia ephuthumayo yangaphambi kwesibhedlela yilezi:

• Ukungaphumeleli kwe-airway patency
• Ukwehluleka kokuvikelwa kwomoya
• Ukuhluleka kwe-ventilation / oxygenation
• Inkambo yokulinda emtholampilo
• Izizathu zobuntu
• Ukusiza ukuhamba okuphephile

Ukuphathwa kwe-airway okuthuthukisiwe, kufaka phakathi i-anesthesia ephuthumayo, kuyingxenye eyisisekelo yokunakekelwa kwangaphambi kwesibhedlela. Ukuvikeleka kwe-airway patency nokuvikelwa kuyikhono elibalulekile ekunakekeleni isiguli eselimele kakhulu. Ikhulisa i-oxygenation yeziguli ezilimele kakhulu, inika amandla ukuthutha okuphephile ukuya esibhedlela, kusiza i-neuroprotection kanye nokuphenya okusheshayo esibhedlela nokunakekelwa kokuhlinzwa.

Isikhathi esengeziwe esisetshenzisiwe ekutholeni i-airway (ngisho nodokotela abaqeqeshiwe) singenye yezimpikiswano ezinkulu kakhulu ekunakekelweni kwasesibhedlela. Isikhathi esisetshenziselwe ukuphatha umgwaqo womoya sisuswa ngesikhathi esigciniwe ngesikhathi sokuhamba nasesibhedlela sokuphinda uvunyelwe inqobo nje uma kwenziwa ngempumelelo nangokuphepha. Izikhathi zezimo eziphuthumayo zangaphambi kwesibhedlela ze-anesthesia ezingaphansi kwama-20min ziyafinyeleleka futhi kufanele kube yizo ezihlosiwe ngesikhathi sokuqeqeshwa.

I-anesthesia ephuthumayo yangaphambi kwesibhedlela ingase ibe yingozi kune-anesthesia ejwayelekile esibhedlela ngenxa yezinselelo ezinikezwe imvelo yangaphambi kwesibhedlela ngakho-ke yonke imizamo kufanele yenziwe ukuqinisekisa ukuphepha kwenqubo. Izilungiselelo zezindiza nezamasosha ziyamukelwa kahle, ukuthi ukuphakama kwesimo, kuyadingeka kakhulu ukususa okuthandwa yizinqubo ezithile futhi kunesidingo esikhulu sokuhambisana nenqubo ejwayelekile yokusebenza.

Isinqumo sokufaka: uhlu lokucatshangelwa oluvela eSydney HEMS

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