Te Whakahaere Tūroro Tino Hira
Ko te whakahaere tiaki nui he raupapa o ngā tikanga hauora hanganga, tere, me te ahu mai i ngā taunakitanga hei pupuri i ngā mahi nui me te ārai i ngā kino o ngā okana i roto i ngā tūroro e pāngia ana e ngā mate e morearea ana ki te ora. Ko ngā tūroro tiaki nui e rongoatia ana i te Tari Ohotata (ER), te rūma whakaora, te Wāhanga Tiaki Kaha (ICU) rānei, me te aroturuki tata, te tautoko taputapu, me te mahi tahi a te tīma maha-mātauranga. Ko te angitu o te maimoatanga ka whakatauhia nuitia e te tautuhi tere i te raruraru, te whakatau wawe, te rongoā tika, me te aroturuki tonu.
Te Whakamāramatanga me ngā Āhuatanga o ngā Tūroro Tino Hira
Ko te tūroro tino mate he tūroro e pāngia ana e ngā raruraru nui i roto i tētahi, neke atu rānei o ngā pūnaha okana, ka mate pea, ka whara kino rānei mēnā kāore e rongoatia wawetia. Ka puta pea tēnei āhuatanga mai i te whara nui, te sepsis, te ohorere, te ngoikore o te manawa, te whiu nui, te mate ngakau, te toto nui, te paihana, ngā raruraru rānei i muri i te pokanga. Ko ngā āhuatanga matua o te tūroro tino mate ko te kore pumau o te toto, te ngoikore o te rere o te toto ki roto i te kiko, te heke o te māramatanga, te ngoikore o te manawa/hāora, me te āhua o te tere o te heke.
Ngā Mātāpono Whānui o te Whakahaere
Ko te kaupapa matua o te whakahaere tiaki nui ko te "whakaū i te tuatahi, te tautuhi i te mate tuarua, te haere tonu o te rongoā," me te kore e whakaroa i ngā mahi whakaora ora. Ka whakamahia he huarahi pūnaha, pērā i te ABCDE (Airway, Breathing, Circulation, Disability, Exposure), hei whakarite kia arohia tuatahitia ngā take tino mōrearea. He mea nui te whakawhitiwhiti kōrero whai hua, te tuhi tika, me te mahi tahi a te rōpū mō te tiaki whai hua.
Aromatawai Tuatahi: Te Huarahi ABCDE
1. Ara Rererangi
Ko te whāinga matua kia mārama, kia tiakina hoki te ara manawa. Kei roto i te aromatawai te aroaro o te aukati, ngā oro manawa hou (te haruru, te stridor), ngā urupare ara manawa tiaki, me te mōrearea o te mimiti. Kei roto pea i ngā tikanga ko te hiki i te kauae me te pana i te kauae ki te upoko, te momi i ngā mea huna, te whakauru i te ara manawa oropharyngeal/nasopharyngeal, te whakauru ngongo endotracheal rānei mēnā kāore e taea e te tūroro te pupuri i te ara manawa, kei te ngaro nui rānei te māramatanga. I ētahi wā, ka taea te mahi i te cricothyrotomy mēnā kāore e taea te whakauru ngongo, ā, kāore e ranea te manawa.
2. Te manawa
Kei roto i te aromatawai te tere o te manawa, te mahi manawa, te mākū o te hāora, te ōrite o te whānui o te uma, me te whakarongo. Kei roto i te whakahaere ko te hoatutanga hāora e hiahiatia ana, te whakapūngao i roto i te pēke-takirere-kōpare, me te whakapūngao ā-ringa. Ko ngā whakamātautau tautoko pēnei i te tātari hau toto uaua (ABG) ka āwhina i te aromatawai i te whakapūngao, te whakapūngao, me te āhua waikawa-pūtake. Me tautuhi wawe, me te rongoā i ngā take o te ngoikore o te manawa, pēnei i te tension pneumothorax, te edema pūkahukahu, te whakararuraru o te huango/COPD, te niumōnia kino rānei.
3. Te tohanga
Arotahi ki te rere o te toto me te toto toto tiketike. Ko ngā tohu o te ohorere ko te whakaheke toto, te tachycardia, te kiri mātao, te whakakī roa o te capillary, te oliguria, me te āhua hinengaro rerekē. Ko ngā mahi tuatahi ko te whakatū urunga uaua nui, te tiki tauira toto, te hoatu wai whakaora (hei tauira, crystalloids), me te whakawhiti toto mena he nui te toto. Mena ka mau tonu te whakaheke toto, ka taea te whakamahi i ngā vasopressors pēnei i te norepinephrine me te aroturuki tata. Me aroturuki te ECG hei kite i ngā arrhythmias, i te myocardial ischemia rānei.
4. Hauātanga (Tūnga Io)
Kei roto i te aromatawai tere te Glasgow Coma Scale (GCS), te rahi me te tauhohenga o te whatu, me ngā tohu o ngā ngoikoretanga io. Me whakakore te hypoglycemia hei take whakahurihuri o te hekenga o te māramatanga; ko te whakamātautau huka toto capillary te paerewa. Mēnā he mate hopuhopu, hoatu he benzodiazepines hei maimoatanga tuatahi, ā, whakaarohia te haere tonu o ngā rongoā antiepileptic. Mēnā e whakapaetia ana he whiu, me whai te maimoatanga i ngā tikanga whiu, me te whakaaro ki te wā tīmatanga me ngā tohu mō te thrombolysis, te wawaotanga endovascular rānei.
5. Te Whakaaturanga (Te Whakaaturanga me te Whakamātautau Whānui)
Ka tirotirohia te tūroro mō ngā raruraru huna pēnei i te toto, te ponana, ngā tohu o te mate, te whara huna, te wera rānei. Heoi anō, me pupuri tonu te pāmahana o te tinana hei ārai i te hypothermia, inā koa mō ngā tūroro e whara ana, e ohorere ana rānei. Mā te whakamahana anō me ngā paraikete ka āwhina i te ārai i te "toru whakamate" o te whara (hypothermia, acidosis, me te coagulopathy).
Te Aroturukitanga me te Whakaora Matatau i roto i te ICU
I muri i te pumautanga tuatahi, me aro turuki tata ngā tūroro tino mate me te rongoā tautoko tonu. Ka aro turuki tonutia ngā tohu ora, tae atu ki te toto totoka whakaeke i roto i ētahi kēhi, te mākū o te hāora, te putanga mimi, te āhua o te wai, me ngā tawhā taiwhanga ā-wā (ngā irahiko, te lactate, te mahi whatukuhu, me ngā tohu o te mate). Mā te whakamahi i ngā kaute pēnei i te SOFA, i te APACHE rānei ka āwhina i te aromatawai i te kaha me te matapae, engari kāore e whakakapi i te whakatau haumanu.
Te Whakahaere Whakahauora Ā-Mīhini me te Hāora
He mea nui te whakamahi i te hauhautanga ā-ringa mō ngā tūroro e ngoikore ana te manawa, e ngoikore ana rānei te hinengaro. Mā te rautaki hauhautanga tiaki-pūkahukahu me te iti o te rahinga tidal (ina koa i roto i te ARDS) ka āwhina i te whakaiti i te mōrearea o te whara o ngā pūkahukahu i puta mai i te hauhautanga. Me whakarerekē ngā whāinga hāora hei karo i te hypoxemia engari hei ārai hoki i te nui rawa o te hyperoxia. Ka tukuna te whakangāwari me te whakangāwari i roto i te tikanga ine hei whakarite i te whakamarie o te tūroro me te tukutahi ki te hauhautanga, ā, ka mahia ngā aromatawai o ia rā mō te whakamutu i te kai.
Te Whakahaere i te Sepsis me te Septic Shock
Ko te Sepsis tētahi o ngā tino take o te mate i roto i te ICU. Ko ngā mātāpono matua ko te kitenga wawe, te whakahaere tere i ngā paturopi whānui-whānui i muri i ngā ahurea, te whakaora wai kua tohua, me ngā vasopressors ina hiahiatia. Me whakahaere te pūtake o te mate mā roto i ngā mahi pēnei i te tango i te wai i roto i te puku, te tango rānei i ngā catheter kua pangia. Mā te aroturuki i te lactate me te urupare haumanu ka āwhina i te aromatawai i te whai huatanga o te whakaora.
Tautoko Okana me te Whakaora Tāpiri
He maha ngā wā ka pāngia ngā tūroro tino mate e te ngoikore o ngā okana maha. Ko te tautoko whatukuhu ka uru pea ki te rongoā whakakapinga whatukuhu (dialysis) i roto i ngā take o te ngoikore whatukuhu whakapeka me ngā tohu motuhake. He mea nui te tautoko kai hei ārai i te catabolism; he pai ake te kai enteral mēnā kei te mahi te ara gastrointestinal. Ka whakaarohia te ārai i te thromboembolism uaua me te ārai i te mate pukupuku ahotea i runga i te mōrearea. He mea nui te whakahaere tupato i te huka toto, nā te mea he morearea hoki te hypoglycemia.
Te Haumaru o te Tūroro me te Ārai i ngā Whakararuraru
He mōrearea ngā raruraru pēnei i ngā mate pāwera i roto i te whare hauora, te niumōnia e pā ana ki te manawa, te pōrangi, ngā mate pēhanga, me te ngoikore o ngā uaua nā te kore e taea te neke. He mea nui te whakatinana i tētahi paihere ārai, te akuaku ringa, te tikanga ārai mate, te nekeneke wawe, me te aromatawai pōrangi auau. Hei tāpiri, ko te aromatawai i ia rā i ngā hiahia mō te katitere me te manawa ka āwhina i te tere ake o te tango i ngā taputapu kāore e hiahiatia ana.
Te Tūranga o te Rōpū Maha-mātauranga me te Whakawhitiwhiti Kōrero a te Whānau
Ko te whakahaere i ngā tūroro tino mate me mahi tahi i waenga i ngā tākuta tiaki nui, ngā nēhi ICU, ngā tohunga whakamoe, ngā tohunga kai, ngā kaiwhakaora rongoā haumanu, ngā kaiwhakaora tinana, me ngā kaimahi hapori. Mā tēnei mahi tahi ka tere ake te whakatau kaupapa, ka whakapai ake hoki i te kounga o te tiaki. He mea nui anō hoki te whakawhitiwhiti kōrero ki te whānau, inā koa mō ngā whanaketanga o te āhua, ngā mahere maimoatanga, ngā mōrearea, me ngā tumanakohanga pono. I ētahi wā, me matapakihia ngā whakataunga matatika pēnei i te whakawhāiti i te rongoā tautoko-ora me te ngaio, me te aroha, me te rite ki ngā ture me ngā uara o te tūroro.
Whakamutunga
Ko te whakahaere tiaki nui me whai huarahi pūnaha, urupare tere, me te aroturuki tonu. Ka tīmata mā te whakaū i te ABCDE, ā, muri iho ka whai i te whakahaere motuhake i te take, te tautoko okana, me te aukati i ngā raruraru i te wā tiaki nui. Ko te angitu o te maimoatanga e whakatauhia ana ehara i te mea ko te hangarau me ngā rongoā anake, engari ko te mahi tahi a te tīma, te haumaru tikanga, me te whakawhitiwhiti kōrero whai hua ki te whānau. Mā te whakamahi i ngā mātāpono e ahu mai ana i ngā taunakitanga me te tiaki whānui, ka taea te whakapai ake i ngā tupono o te ora o ngā tūroro tino mate me te whakatutuki i te kounga pai ake o te oranga.
