Izinga Elishintshiwe Lezimo Eziphuthumayo Zokuqaphela (ALOC): yini okufanele uyenze?

By UCristiano Antonino On UJan 18, 2023

Izinga lokuqaphela elishintshiwe (ALOC) yisimo esiphuthumayo sesikhombisa esivame kakhulu ochwepheshe be-EMS abasabela kuso, esibalela cishe u-7% wazo zonke izingcingo ze-EMS.

Izinga lokuqaphela eliguquliwe (ALOC) lisho ukuthi awuphapheme, awuphapheme, noma awukwazi ukuqonda njengoba ujwayele. I-ALOC ingabangelwa ukulimala ekhanda, imithi, utshwala, izidakamizwa, ukuphelelwa amanzi emzimbeni, ngisho nezifo ezithile, ezifana nesifo sikashukela.

Amazinga ahlukene we-ALOC afaka:

Ukudideka: uphazamiseka kalula futhi ungase wephuze ukuphendula. Ungase ungazi ukuthi ungubani noma ukuphi noma isikhathi sosuku noma sonyaka.

I-Delirium: unokudideka okukhulu nokudideka futhi ungase ube nezinkolelo-ze (ukukholelwa ezintweni ezingezona ezangempela) noma ukubona izinto ezingekho (ukuzwa izinto ezingezona ezangempela). Izinga lokudideka lingase libe ngcono noma libe libi kakhulu ngokuhamba kwesikhathi.

Elele: ulele ngaphandle kokuthi kukhona okukuvusayo. Ungakwazi ukukhuluma futhi ulandele izikhombisi-ndlela, kodwa ungase ube nenkinga yokuhlala uphapheme.

I-Obtunded noma i-lethargic: ukhathele futhi uyazi kancane noma awunantshisekelo kangako endaweni okuzungezile.

Stupor: usebuthongweni obujulile ngaphandle kokuthi uvuswe into enomsindo noma ebuhlungu. Ungase ungakwazi ukukhuluma noma ukulandela izikhombisi-ndlela kahle, futhi uzophinde ulale lapho ushiywe wedwa.

Yidla: ulele, kodwa awukwazi ukuvuswa nhlobo.

I-Stupor kanye ne-coma ilinganiswa ngokuya ngokuthi izimpawu zinzima kangakanani.

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Izinga Eliguquliwe Lokuqaphela Incazelo

Izinga lokuqaphela liwukulinganisa kokusabela komuntu ezisusa ezivela endaweni ezungezile.

Izinga lokuqaphela eliguquliwe yinoma isiphi isilinganiso sokuvuka noma ukuvuselela ngaphandle kokujwayelekile.

Izinga lokuphaphama elicindezeleke kancane lingase lifakwe esigabeni sokukhathala, isimo lapho umuntu engase avukwe khona ngobunzima obuncane.

Abantu abayizimpumputhe banezinga lokuqonda elicindezelekile futhi abakwazi ukuvuswa ngokugcwele.

Labo abangakwazi ukuvuswa esimweni esifana nobuthongo kuthiwa banezithukuthuku.

Ikhoma ukungakwazi ukwenza noma iyiphi impendulo enenjongo.

Izikali ezifana ne- Isikali se-Glasgow coma zenzelwe ukukala izinga lokuqaphela.

I-ALOC ingabangelwa izici ezihlukahlukene, okuhlanganisa izinguquko kukhemistri yobuchopho (isb, ukuchayeka ebuchosheni noma ezidakeni), umoya-mpilo onganele noma ukugeleza kwegazi ebuchosheni, noma ukucindezela okukhulu kwengqondo.

Ukuquleka isikhathi eside kuwuphawu lwesimo esiphuthumayo sezokwelapha.

Ukushoda ezingeni lokuqaphela kungasho ukuthi i-cerebral hemispheres noma isistimu yokuvula i-reticular ilimele.

Izinga elinciphile lokuqaphela lihambisana nokwanda kokugula (ukugula) nokufa (ukufa). I-ALOC iyisilinganiso esibalulekile sesimo sesiguli sezokwelapha nezinzwa.

Abanye odokotela babheka izinga lokuphaphama njengesinye sezimpawu ezibalulekile, kanye nezinga lokushisa lomzimba, umfutho wegazi, nokushaya kwenhliziyo.

Izinga lokuqaphela elishintshile lingathatha izinhlobo eziningi.

Ngokuvamile, izimpawu ze-ALOC zihlanganisa lapho isiguli singenzi njengesisekelo saso, sibonakala sididekile futhi sididekile, noma singenzi ngendlela evamile.

Isiguli singathula izinga lokuphaphatheka elikhubazekile futhi singase sibe buthakathaka, sibe nokuquleka, noma siquleke.

Kungenzeka ukuthi isiguli besizikhulumela sodwa noma sibe nemibono engemihle.

Isiguli singase futhi sibonakale siqaphile kakhulu, sikhungathekile, sididekile, noma sididekile.

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Izinkinga ze-ALOC

I-ALOC ingabangelwa yizimo ezilandelayo:

Uhlobo	Izibonelo
Kuyathathelana	• Inyumoniya • Ukutheleleka ngomgudu womchamo • I-Meningitis noma i-encephalitis • I-Sepsis
I-Metabolic/toxic	• I-Hypoglycemia • Ukuphuza utshwala • Ukungajwayelekile kwe-Electrolyte • I-Hepatic encephalopathy • Ukuphazamiseka kwe-thyroid • Ukuyeka utshwala noma izidakamizwa
I-Neurologic	• Ukushaywa unhlangothi noma ukuhlasela kwe-ischemic kwesikhashana • Ukubanjwa noma isimo sokuposa • Ukopha kwe-Subarachnoid • Ukopha ngaphakathi enhliziyweni • Ukulimala kwesistimu yezinzwa emaphakathi • I-hematoma engaphansi
I-Cardiopulmonary	• Ukuhluleka kwenhliziyo eqinile • I-myocardial infarction • I-Pulmonary embolism • I-Hypoxia noma i-CO2 narcosis
Okuhlobene nezidakamizwa	• Izidakamizwa ze-Anticholinergic • Ukuyeka utshwala noma izidakamizwa • Ama-sedative-hypnotics • Ama-analgesics ezidakamizwa • I-Polypharmacy

Nini Yokushayela Inombolo Yezimo Eziphuthumayo ye-ALOC

Ngokusho kwe-American College of Emergency Physicians, i-ALOC noma izinguquko esimweni sengqondo yizimpawu eziyisixwayiso zesimo esiphuthumayo sezokwelapha, futhi kufanele ushayele Inombolo Yezimo Eziphuthumayo.

Shayela Inombolo Yezimo Eziphuthumayo uma uhlangabezana ne-ALOC futhi uwedwa.

Ungazishayeli uye esibhedlela uma unobuhlungu obukhulu esifubeni noma wopha kakhulu noma uma ungaboni kahle.

Ukuthatha i-ambulensi iphephe kakhudlwana ngoba abezimo eziphuthumayo bangaletha usizo olusindisa ukuphila endleleni eya esibhedlela.

Uma omunye umuntu ebonisa izimpawu ze-ALOC noma isimo sengqondo esishintshile, shayela Inombolo Yezimo Eziphuthumayo ngokushesha.

I-cardioPROTECTION KANYE NE-CARDIOPULMONARY RESUSCITATION? VAKASHELA I-EMD112 BOOTH EMPILWENI YESIMO ESIPHUTHUMAYO MANJE UKUFUNDA KABANZI

Ungayiphatha kanjani i-ALOC

Zonke iziqephu ze-ALOC zidinga ukubhekwa ngokucophelela, ikakhulukazi emahoreni angama-24 okuqala.

Iziguli ze-ALOC zizodinga ukulaliswa esibhedlela ukuze ziqashwe, zihlolwe, futhi zelashwe.

Lapho uhlola isiguli isimo sengqondo esishintshile, kubalulekile ukuqoqa umlando wesiguli omningi ngangokunokwenzeka futhi wenze ukuhlolwa okuphelele komzimba kwekhanda kuya ozwaneni.

Njengoba iziguli ngokuvamile zingakwazi ukunikeza umlando wazo ngenxa yesimo sazo esishintshile, irekhodi kufanele litholwe elungeni lomndeni noma esikhungweni sezokwelapha ukuze kutholwe isimo sazo sengqondo esiyisisekelo.

Kufanele ubuyekeze umlando wemithi yesiguli kwirekhodi lezokwelapha likagesi (EMR) noma ushayele ikhemisi.

Iziguli ze-ALOC zizobhekwa njalo futhi zihlolwe njalo ngezimpawu ezilandelayo:

Izinga lokushaya kwenhliziyo, umfutho wegazi, nezinga lokushisa
Izinga le-oxygen yegazi
Amandla, ububanzi bokunyakaza, kanye nekhono lokuzwa ubuhlungu

Ukuhlolwa kwe-ALOC kungafaka:

Ukuhlolwa kwegazi ukuhlola ushukela wegazi, izinga le-oxygen, ukuphelelwa amanzi emzimbeni, izifo, izidakamizwa, noma utshwala
Igazi, umchamo, nokunye ukuhlola ukuqapha ukusebenza kwezitho ezihlukahlukene
Ukuhlolwa kwe-Neurologic ukuhlola amandla, ukuzwa, ibhalansi, i-reflexes, nenkumbulo
I-Computed tomography (CT) scan ukuhlola ukulimala kobuchopho noma izifo zobuchopho
I-Magnetic resonance imaging (MRI) ukuhlola ukulimala kobuchopho noma izifo zobuchopho
Ama-X-ray esifubeni ukuhlola izinkinga zamaphaphu

Ukwelashwa kwe-ALOC kuncike kumbangela yayo, izimpawu, impilo yesiguli iyonke, nanoma yiziphi izinkinga. Iziguli ze-ALOC zingalindela:

I-IV catheter efakwe emthanjeni esandleni noma engalweni yabo
Ishubhu le-oxygen elibekwe ngaphansi kwekhala labo noma imaski yomoya-mpilo ebekwe phezu kobuso babo
Umuthi kadokotela: a) Ukwelapha noma ukuvikela isifo b) Yehlisa ukuvuvukala ngaphakathi naseduze kobuchopho kanye Umgogodla intambo c) Lawula izinga likashukela egazini

Ungamsiza kanjani umuntu one-ALOC?

Abahlinzeki bezempilo bazodinga ukwazi ngomlando wezempilo wesiguli se-ALOC.

Uma isiguli singakwazi ukunikeza lolu lwazi, umnakekeli onolwazi kufanele abe khona.

Tshela ithimba lezokunakekelwa kwempilo nganoma yisiphi kulezi zimo ezilandelayo:

Ukuquleka noma ukudlikizela
Ukopha ezindlebeni noma emakhaleni
Inkulumo emisiwe
Inkinga ngokunyakaza kwemisipha, njengokugwinya, izingalo ezihambayo nemilenze
isiyezi
Ukudideka
Ukushintsha embonweni, njengokubona kabili, ukungaboni kahle, noma inkinga yokubona ngelinye iso noma womabili
Ukuphumula
Ukuthukuthela
Inkinga ngokuhlala uphapheme noma uqaphile
Ukuvota
Ikhanda elibuhlungu elingeke liphele ngemva kokwelashwa
Ukukhathala
Ukulahlekelwa ibhalansi noma ukuxhumanisa
Ukulahleka kwenkumbulo
Ukuziphatha okungajwayelekile

I-EMTs & Nezimo Eziphuthumayo Ziyiphatha Kanjani I-ALOC

Kuzo zonke izimo eziphuthumayo zomtholampilo, isinyathelo sokuqala ukuhlola okusheshayo nokuhlelekile kwesiguli.

Kulokhu kuhlola, abahlinzeki abaningi be-EMS bazosebenzisa i A B C D E sondela.

Indlela ye-ABCDE (Umoya, Ukuphefumula, Ukujikeleza, Ukukhubazeka, Ukuchayeka) iyasebenza kuzo zonke izimo eziphuthumayo zomtholampilo ukuze zihlolwe ngokushesha futhi zelashwe. Ingasetshenziswa emgwaqeni noma ngaphandle kwayo imishini.

Ingasetshenziswa futhi ngendlela ethuthuke kakhulu lapho izinsiza zezokwelapha eziphuthumayo zitholakala khona, okuhlanganisa amagumbi ezimo eziphuthumayo, izibhedlela, noma izikhungo zabagula kakhulu.

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Imihlahlandlela Yokwelashwa Nezinsiza Zabaphenduli Bokuqala Bezokwelapha

Imihlahlandlela yokwelapha yezinga elishintshile lokuqaphela ingatholakala ekhasini 66 le-National Model EMS Clinical Guidelines by the National Association of State EMT Officials (NASEMSO).

I-NASEMSO igcina lezi ziqondiso ukuze kube lula imihlahlandlela yomtholampilo yesifunda neyendawo ye-EMS, izivumelwano, nezinqubo zokusebenza.

Le mihlahlandlela isekelwe ebufakazini noma isekelwe ekuvumelaneni futhi ifomethwe ukuze isetshenziswe ochwepheshe be-EMS.

Imihlahlandlela ihlanganisa ukwelashwa nokungenelela okulandelayo:

Bheka izimbangela ezilaphekayo zesimo somqondo esishintshile:

I-Airway - Qinisekisa ukuthi indlela yomoya ihlala inegunya lobunikazi; beka kabusha isiguli njengoba kudingeka
Ukuphefumula - Bheka ukucindezeleka kokuphefumula; hlola ukufundwa komtshina we-SPO2, ETCO2, kanye ne-CO
Ukujikeleza - Bheka izimpawu zokushaqeka
I-Glasgow Coma Score kanye/noma I-AVPU
Abafundi
Neck ubulukhuni noma ubuhlungu obuhambisana nokunyakaza okuhlukahlukene
Ithuluzi lokushaywa unhlangothi
Izinga le-glucose yegazi
I-EKG - I-Arrhythmia ekhawulela ukugcwala
Iphunga lokuphefumula - Iphunga elingavamile elingaba khona lihlanganisa utshwala, i-acidosis, i-ammonia
Isifuba/Isisu - I-Intra-thoracic hardware, amadivaysi okusiza, ubuhlungu besisu noma ukungezwani
Imilenze/isikhumba – Izimpawu zokulandela umkhondo, ukufakwa kwamanzi emzimbeni, ukuqunjelwa, i-dialysis shunt, izinga lokushisa okufanele ulithinte (noma uma ukwazi, sebenzisa ithemometha)
Imvelo - Inhlolovo yamaphilisi, izinto ezisetshenziswayo, izinga lokushisa lendawo

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Ithemba Nokuqanjwa Okusha Ekulweni Nomdlavuza We-Pancreatic

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Iphrothokholi ye-EMS Yezimo Eziphuthumayo ze-ALOC

Imithethonqubo yokwelashwa kwangaphambi kwesibhedlela kwezinga lokuqaphela elishintshile iyahlukahluka kubahlinzeki be-EMS futhi ingancika nezimpawu zesiguli noma umlando wezokwelapha.

Hlola isimo ngengozi engaba khona noma yangempela. Uma indawo/isimo singaphephile, buyela endaweni ephephile, dala indawo ephephile, futhi uthole usizo olwengeziwe esikhungweni samaphoyisa. Iziguli eziphazamiseke ngokomzwelo kufanele kucatshangwe ukuthi zinesimo esicashile sezokwelapha noma esibuhlungu esibangela ukuguqulwa kwesimo sengqondo. Zonke izinsongo zokuzibulala noma udlame noma ukuthinta kufanele kuthathwe ngokungathi sína. Lezi ziguli kufanele zigcinwe esitokisini samaphoyisa uma zibeka ingozi kuzo noma kwabanye. Uma isiguli sibeka ingozi kuso kanye/noma kwabanye, shayela amaphoyisa ukuze uthole usizo.

2) Yenza ukuhlola okuyisisekelo. Qinisekisa ukuthi indlela yokuphefumula yesiguli ivulekile nokuthi ukuphefumula nokujikeleza kwegazi kwanele. Ukumunca njengoba kudingeka.

I-3) Phatha i-oksijeni ephezulu. Ezinganeni, i-oxygen enomswakama ikhethwa kakhulu.

4) Thola futhi urekhode izimpawu ezibalulekile zesiguli, okuhlanganisa nokunquma izinga lokuqaphela kwesiguli. Hlola futhi uqaphe I-Glasgow Coma Scale.

Uma isiguli singaphenduli noma siphendula kuphela ekushukunyisweni okubuhlungu, lungiselela ukuthutha ngenkathi uqhubeka nokunakekelwa.
Uma isiguli sinomlando owaziwayo wesifo sikashukela esilawulwa ngemithi, siyazi, singaphuza ngaphandle kosizo, sinikeze isisombululo se-glucose ngomlomo, ijusi yezithelo, noma i-soda engeyona yokudla ngomlomo, bese siyathutha, sigcine isiguli sifudumele. Uma kugunyazwe esifundeni ukuthola amazinga kashukela kusetshenziswa i-glucometer, landela umthetho ogunyazwe yisifunda.
Uma isiguli sine-overdose ye-opioid okusolakala ukuthi:

a) Uma isiguli singaphenduli ekushukunyisweni ngamazwi, kodwa sisabela ekushukunyisweni okubuhlungu noma singaphenduli; futhi

b) Ukuphefumula okungaphansi kwe-10/ngomzuzu kanye nezimpawu zokwehluleka ukuphefumula noma ukuboshwa kokuphefumula, bhekisela kunqubo yokuphefumula efanele.

c) Uma kugunyazwe ngokwesifunda futhi kutholakala, thola izinga likashukela wegazi wesiguli (BG).

Uma i-BG ingaphansi kwama-60, ezigulini zabantu abadala nasezinganeni, landela i-IV ngenhla.
Uma i-BG ingaphezu kwama-60 ezigulini ezikhulile nezezingane, qhubekela esinyathelweni esilandelayo.

d) Lawula i-naloxone (Narcan®) ngedivayisi ye-atomizer ye-mucosal (MAD).

I-contraindication ehlobene:

Ukuboshwa kwe-Cardiopulmonary
Umsebenzi wokuthunjwa phakathi nalesi sigameko
Ubufakazi bokuhlukumezeka kwamakhala, ukuvinjwa kwamakhala kanye/noma i-epistaxis

Faka i-MAD ekhaleni lesobunxele lesiguli futhi wenze lokhu:

OMDALA:jova 1mg/1ml
PEDIATRIC: faka i-0.5mg/05ml

Faka i-MAD ekhaleni langakwesokudla lesiguli futhi wenze lokhu:

OMDALA:jova 1mg/1ml
PEDIATRIC: faka i-0.5mg/05ml

e) Qalisa ezokuthutha. Ngemuva kwemizuzu engu-5, uma izinga lokuphefumula kwesiguli lingekho ngaphezu kokuphefumula kwe-10 / iminithi, phatha umthamo wesibili we-naloxone ngokulandela inqubo efanayo nangenhla futhi uxhumane nokulawula kwezokwelapha.

f) Uma isimo sezempilo esiyisisekelo noma esibuhlungu esidala ukushintshwa kwesimo sengqondo singabonakali, isiguli siphaphama ngokugcwele, siqaphile, futhi siyakwazi ukuxhumana; futhi kusolwa ukuphazamiseka kwemizwelo, qhubekela kuphrothokholi Yezimo Eziphuthumayo Zokuziphatha.

g) Ukuthutha ukuya endaweni eseduze efanele ngesikhathi kuhlolwa kabusha izimpawu ezibalulekile njalo ngemizuzu emi-5 bese kuhlolwa kabusha njengoba kudingeka.

h) Qopha lonke ulwazi lokunakekelwa kwesiguli, okuhlanganisa umlando wezokwelapha wesiguli nakho konke ukwelashwa okunikezwayo, kuMbiko Wokunakekelwa Kwangaphambi Kwasesibhedlela (PCR).