Kusamalira Odwala Ovuta Kwambiri
Kusamalira odwala ovutika kwambiri ndi njira zingapo zachipatala zokonzedwa bwino, mwachangu, komanso zozikidwa pa umboni kuti zisunge ntchito zofunika kwambiri ndikupewa kuwonongeka kwina kwa ziwalo mwa odwala omwe ali ndi matenda oopsa. Odwala ovutika kwambiri nthawi zambiri amachiritsidwa mu Dipatimenti Yothandizira Zadzidzidzi (ER), chipinda chotsitsimutsa, kapena Chipinda Chosamalira Odwala Ovutika Kwambiri (ICU), ndi kuyang'aniridwa mosamala, chithandizo cha zida, komanso mgwirizano wamagulu osiyanasiyana. Chithandizo chopambana chimadalira kwambiri kuzindikira mavuto mwachangu, kukhazikika koyambirira, chithandizo choyenera, ndi kuyang'aniridwa kosalekeza.
Tanthauzo ndi Makhalidwe a Odwala Ovuta
Wodwala wodwala kwambiri ndi wodwala amene akukumana ndi mavuto aakulu m'thupi limodzi kapena angapo omwe angayambitse imfa kapena chilema chachikulu ngati sanalandire chithandizo mwachangu. Matendawa angayambike chifukwa cha kuvulala kwambiri, sepsis, shock, kulephera kupuma, sitiroko, matenda a mtima, kutuluka magazi ambiri, poizoni, kapena mavuto ena pambuyo pa opaleshoni. Zizindikiro zazikulu za wodwala wodwala kwambiri ndi kusakhazikika kwa hemodynamic, kusokonezeka kwa magazi m'mitsempha, kuchepa kwa chikumbumtima, kusokonezeka kwa mpweya/mpweya, komanso chizolowezi chofooka msanga.
Mfundo Zazikulu Zoyendetsera Ntchito
Mfundo yaikulu yoyendetsera chisamaliro chofunikira ndi "kukhazikitsa bata choyamba, kuzindikira matenda kachiwiri, chithandizo chikupitirira," popanda kuchedwetsa njira zopulumutsira moyo. Njira yokhazikika, monga ABCDE (Airway, Breathing, Circulation, Disability, Exposure), imagwiritsidwa ntchito kuti mavuto omwe ali pachiwopsezo chachikulu athetsedwe kaye. Kulankhulana bwino, kulemba zikalata zoyenera, ndi kugwirizana kwa gulu ndikofunikira kuti chisamaliro chikhale chogwira mtima.
Kuwunika Koyamba: Njira ya ABCDE
1. Njira ya ndege
Cholinga chachikulu ndikuonetsetsa kuti njira yolowera mpweya ndi yotetezeka. Kuwunika kumaphatikizapo kupezeka kwa kutsekeka, phokoso la mpweya wotuluka (gurgling, stridor), chitetezo cha njira yolowera mpweya, komanso chiopsezo cha kutuluka kwa mpweya. Njirazi zingaphatikizepo kukweza chibwano kapena kupondaponda nsagwada, kukoka madzi otuluka, kuyika njira yolowera mpweya m'mphuno/m'mphuno, ndi kulowetsa mpweya m'mimba ngati wodwalayo sangathe kusunga njira yolowera mpweya kapena akusowa chidziwitso. Kuti mwina Nthawi zina, cricothyrotomy ingachitike ngati intubation yalephera ndipo mpweya wokwanira suli wokwanira.
2. Kupuma
Kuwunika kumaphatikizapo kuchuluka kwa kupuma, ntchito yopuma, kuchuluka kwa mpweya, kukula kwa chifuwa mofanana, ndi kukweza mpweya. Kuyang'anira kumaphatikizapo kupereka mpweya ngati pakufunika, kupuma movutikira pogwiritsa ntchito chigoba cha thumba, ndi kupuma movutikira pogwiritsa ntchito makina. Mayeso othandizira monga kusanthula mpweya wa m'magazi (ABG) amathandiza kuwunika mpweya, mpweya, ndi momwe asidi alili. Zomwe zimayambitsa kulephera kupuma, monga tension pneumothorax, pulmonary edema, asthma/COPD exacerbation, kapena chibayo chachikulu, ziyenera kuzindikirika ndikuchiritsidwa mwachangu.
3. Kufalikira kwa magazi m'thupi
Yang'anani kwambiri pa kufalikira kwa magazi ndi kuthamanga kwa magazi. Zizindikiro za kugwedezeka ndi monga kutsika kwa magazi, tachycardia, khungu lozizira, kudzaza magazi m'mitsempha kwa nthawi yayitali, oliguria, ndi kusintha kwa maganizo. Njira zoyamba zimaphatikizapo kukhazikitsa njira yolowera m'mitsempha, kutenga zitsanzo za magazi, kupereka madzi otsitsimutsa (monga ma crystalloids), ndi kuikidwa magazi ngati magazi atuluka kwambiri. Ngati kutsika kwa magazi kukupitirira, mankhwala oletsa magazi monga norepinephrine angagwiritsidwe ntchito mosamala. Kuyang'anira ECG ndikofunikira kuti mudziwe arrhythmias kapena myocardial ischemia.
4. Kulemala (Mkhalidwe wa Mitsempha)
Kuwunika mwachangu kumaphatikizapo Glasgow Coma Scale (GCS), kukula kwa mwana ndi reactivity, ndi zizindikiro za focal neurologic deficits. Hypoglycemia iyenera kuchotsedwa ngati chifukwa chosinthika cha kuchepa kwa chidziwitso; kuyezetsa shuga m'magazi a capillary ndiko kofala. Ngati mukugwidwa ndi khunyu, perekani benzodiazepines ngati chithandizo choyamba ndipo ganizirani zopitiliza kugwiritsa ntchito mankhwala oletsa khunyu. Ngati mukukayikira kuti sitiroko, chithandizo chiyenera kutsatira njira zochizira sitiroko, poganizira nthawi yomwe yayamba komanso zizindikiro za thrombolysis kapena endovascular intervention.
5. Kuwonekera (Kuwonekera ndi Kufufuza Kwathunthu)
Wodwalayo amafufuzidwa bwino kuti apeze magwero a mavuto monga kutuluka magazi, ziphuphu, zizindikiro za matenda, kuvulala kobisika, kapena KuwotchaKomabe, kutentha kwa thupi kuyenera kusungidwa kuti tipewe hypothermia, makamaka mwa odwala kuvulala kapena kugwedezeka. Kutenthetsa thupi ndi mabulangete kungathandize kupewa "matenda atatu oopsa" pa zoopsa (hypothermia, acidosis, coagulopathy).
Kuwunika Kwambiri ndi Chithandizo mu ICU
Pambuyo pokhazikika koyamba, odwala omwe ali ndi vuto lalikulu amafunika kuyang'aniridwa mosamala ndi chithandizo chochirikiza nthawi zonse. Zizindikiro zofunika kwambiri zimayang'aniridwa nthawi zonse, kuphatikizapo kuthamanga kwa magazi m'malo ena, kuchuluka kwa mpweya m'thupi, kutuluka kwa mkodzo, momwe madzi alili, komanso magawo a labotale nthawi ndi nthawi (ma electrolytes, lactate, ntchito ya impso, ndi zizindikiro za matenda). Kugwiritsa ntchito zizindikiro monga SOFA kapena APACHE kungathandize kuwona kuopsa ndi nthawi yodziwira matenda, koma sizilowa m'malo mwa chiweruzo chachipatala.
Kuwongolera Mpweya ndi Mpweya wa Makina
Mpweya wopumira wamakina nthawi zambiri umafunika mwa odwala kulephera kupuma kapena kusazindikira bwino. Njira yochepetsera mpweya m'mapapo (makamaka mu ARDS) imathandiza kuchepetsa chiopsezo cha kuvulala kwa mapapo chifukwa cha mpweya wopuma. Zolinga zoperekera mpweya ziyenera kusinthidwa kuti zipewe kutsika kwa mpweya m'mapapo komanso kupewa kukwera kwa mpweya wopuma kwambiri. Kuchepetsa ululu ndi kupumitsa minofu kumachitika molingana ndi muyezo kuti wodwalayo akhale bwino komanso mogwirizana ndi mpweya wopuma, ndipo kuyezetsa kuyamwa kwa mwana tsiku ndi tsiku kumachitika.
Kusamalira Sepsis ndi Septic Shock
Sepsis ndi chifukwa chachikulu cha imfa mu ICU. Mfundo zazikulu ndi monga kuzindikira msanga, kupereka mankhwala opha tizilombo toyambitsa matenda a broad-spectrum empiric pambuyo pochiza matenda, kubwezeretsa madzi m'thupi, ndi kutsekereza mitsempha yamagazi ngati pakufunika kutero. Gwero la matendawa liyenera kulamulidwa pogwiritsa ntchito njira monga kutulutsa madzi m'thupi kapena kuchotsa ma catheter omwe ali ndi kachilomboka. Kuyang'anira lactate ndi momwe wodwalayo akuyankhira kuchipatala kumathandiza kuwunika momwe kubwezeretsa thupi kumagwirira ntchito.
Chithandizo cha Ziwalo ndi Chithandizo Chowonjezera
Odwala omwe ali ndi matenda oopsa nthawi zambiri amakumana ndi kulephera kwa ziwalo zambiri. Chithandizo cha impso chingakhale mu njira yosinthira impso (dialysis) ngati izi zitachitika. kulephera kwa impso mwachangu ndi zizindikiro zinazake. Thandizo la zakudya ndilofunika kwambiri popewa kusokonekera kwa kagayidwe kachakudya m'thupi; zakudya zoyenera m'mimba zimakondedwa ngati njira ya m'mimba ikugwira ntchito. Kuteteza ku thromboembolism ya venous ndipo kupewa zilonda za kupsinjika maganizo kumaganiziridwa malinga ndi chiopsezoKulamulira shuga m'magazi kumachitika mosamala chifukwa hypoglycemia nayonso ndi yoopsa.
Chitetezo cha Odwala ndi Kupewa Mavuto
Kusamalira kwambiri kumakhala ndi chiopsezo cha mavuto monga matenda a nosocomial, chibayo chokhudzana ndi mpweya wopuma, delirium, zilonda zamagazi, ndi kufooka kwa minofu chifukwa cha kulephera kuyenda. Kugwiritsa ntchito njira yodzitetezera, ukhondo wa manja, njira yopewera matenda, kuyendetsa msanga, komanso kuwunika nthawi zonse delirium ndikofunikira. Kuphatikiza apo, kuwunika tsiku ndi tsiku kwa catheter ndi zofunikira za mpweya kumathandiza kuti zichotsedwe mwachangu zida zomwe sizikufunikanso.
Udindo wa Gulu la Maphunziro Amitundu Yosiyanasiyana ndi Kulankhulana kwa Banja
Kusamalira odwala omwe ali ndi vuto lalikulu kumafuna mgwirizano pakati pa madokotala osamalira odwala kwambiri, anamwino a ICU, akatswiri ogonetsa odwala, akatswiri azakudya, akatswiri a zamankhwala, akatswiri ochiritsa thupi, ndi ogwira ntchito zachitukuko. Kugwirizana kumeneku kumathandizira kupanga zisankho mwachangu ndikukweza mtundu wa chisamaliro. Kulankhulana ndi banja ndikofunikiranso, makamaka pankhani ya chitukuko cha matenda, mapulani a chithandizo, zoopsa, ndi ziyembekezo zenizeni. Nthawi zina, zisankho zamakhalidwe abwino monga kuchepetsa chithandizo chothandizira moyo ziyenera kukambidwa mwaukadaulo, mwachifundo, komanso mogwirizana ndi malamulo ndi mfundo za wodwalayo.
Mapeto
Kusamalira odwala pa nthawi yovuta kumafuna njira yokhazikika, kuyankha mwachangu, ndi kuyang'anira nthawi zonse. Kumayamba ndi kukhazikika kwa ABCDE, kutsatiridwa ndi kuyang'anira chifukwa chake, kuthandizira ziwalo, ndi kupewa mavuto panthawi ya chisamaliro chamankhwala. Chithandizo chopambana sichimatsimikiziridwa ndi ukadaulo ndi mankhwala okha, komanso ndi mgwirizano wamagulu, chitetezo cha machitidwe, komanso kulankhulana bwino ndi banja. Pogwiritsa ntchito mfundo zozikidwa pa umboni ndi chisamaliro chathunthu, mwayi wa odwala omwe ali ndi vuto lalikulu lochira ndikukhala ndi moyo wabwino ukhoza kuwonjezeka kwambiri.
