Mfundo Zofunikira za Chisamaliro cha Odwala mu Chipinda Chosamalira Odwala Kwambiri
Chipinda Chosamalira Anthu Ambiri (ICU) ndi malo osamalira odwala omwe ali ndi vuto lalikulu, omwe ali osakhazikika, kapena omwe ali pachiwopsezo chachikulu cha kuwonongeka mwachangu. Mu ICU, odwala amafunika kuyang'aniridwa mosamala, thandizo lapamwamba la zida, komanso kuyang'aniridwa mwachangu ndi gulu la akatswiri osiyanasiyana. Chifukwa cha zovuta za mkhalidwe wa wodwalayo, chisamaliro cha ICU sichimangoyang'ana pa kuchiza matenda oyamba komanso kupewa zovuta, kubwezeretsa magwiridwe antchito a ziwalo, komanso chitetezo cha wodwala. Nkhaniyi ikufotokoza mfundo zoyambira za chisamaliro cha odwala m'chipinda chosamalira anthu ambiri ngati chitsogozo chachikulu cha ntchito zachipatala.
1. Kuyesa Koyamba Koyenera ndi Kuyeza Matenda a Mtima
Mfundo yoyamba mu ICU ndikuchita kafukufuku woyambirira mwachangu, mwadongosolo, komanso wokhazikika. Kwa odwala omwe akudwala kwambiri, kuchedwa kupanga zisankho kumatha kupha. Kuwunika nthawi zambiri kumatsatira njira ya ABCDE (Airway, Breathing, Circulation, Disability, Exposure). Njirayi imalola ogwira ntchito zachipatala kuzindikira mwachangu mavuto omwe ali pachiwopsezo chachikulu choyamba.
Kuyeza magazi m'thupi n'kofunika kwambiri podziwa kufunika kwa chisamaliro, kuphatikizapo kufunikira kwa makina opumulira, ma vasopressor, kapena njira zolowerera. Kuphatikiza apo, mfundo zoyambira monga mbiri yachipatala, mankhwala omwe alipo, ziwengo, ndi momwe zimagwirira ntchito kale zimathandiza gulu la ICU kupanga dongosolo lenileni komanso lolunjika la chisamaliro.
2. Kuwunika Kokhwima Komanso Kosalekeza
ICU imadziwika ndi kuyang'anira odwala mosalekeza. Kuyang'anira kumaphatikizapo zizindikiro zofunika kwambiri (kuthamanga kwa magazi, kugunda kwa mtima, kuthamanga kwa mpweya, kutentha, kuchuluka kwa mpweya m'thupi), momwe mitsempha imakhudzira, kutuluka kwa mkodzo, ndi magawo apamwamba a hemodynamic, ngati kuli kofunikira. Cholinga chake ndikuwona kusintha kwa mkhalidwe mwachangu momwe zingathere kuti chithandizo chiyambe mwachangu.
Kuwonjezera pa kuyang'aniridwa kokhazikika, odwala ena amafunika kuyang'aniridwa mosalekeza, monga ma catheter a mitsempha yamagazi kuti ayese kuthamanga kwa magazi nthawi yeniyeni komanso kutengera mpweya m'magazi, ndi ma catheter apakati a mitsempha yamagazi kuti apereke mankhwala ena ndikuwunika momwe madzi alili. Komabe, kugwiritsa ntchito zida zosaloŵerera kuyenera kuganizira za chiopsezo cha matenda ndi zovuta zamakina, kotero zizindikiro ziyenera kukhala zomveka bwino komanso kuwunika pafupipafupi.
3. Sungani Mpweya ndi Chithandizo cha Kupuma
Odwala ambiri a ICU amavutika kupuma chifukwa cha matenda a m'mapapo, sepsis, kuvulala, kulephera kwa mtima, kapena matenda amitsempha. Mfundo yayikulu yosamalira ndikuwonetsetsa kuti mpweya wabwino ukuyenda bwino komanso mpweya wabwino umalowa m'thupi mokwanira. Chithandizo cha kupuma chingaphatikizepo mpweya wa m'mphuno, chigoba, kannula ya m'mphuno yothamanga kwambiri, mpweya wabwino wosalowa m'thupi, komanso makina opumulira mpweya.
Kwa odwala omwe ali ndi makina opumira mpweya, gulu la ICU liyenera kugwiritsa ntchito njira zotetezera mpweya, monga kusintha kuchuluka kwa madzi m'mapapo malinga ndi kulemera koyenera kwa thupi kuti apewe kuvulala kwa mapapo chifukwa cha makina opumira mpweya. Kuyang'anira mpweya wa m'magazi, momwe mpweya umapumira, kuthamanga kwa mpweya, ndi kukonzekera kuyamwa ndi zinthu zofunika kwambiri pa chisamaliro cha tsiku ndi tsiku.
4. Kukhazikika kwa Kuyenda kwa Mthupi ndi Kusamalira Kuyenda kwa Magazi
Matenda a magazi monga kugwedezeka (septic, hemorrhagic, cardiogenic) ndi ofala kwambiri mu ICU. Mfundo yake ndi kuonetsetsa kuti magazi akuyenda bwino m'ziwalo kudzera mu kuphatikiza madzi, kuikidwa magazi, ngati kuli kofunikira, komanso kugwiritsa ntchito mankhwala oletsa kuthamanga kwa magazi kapena mankhwala oletsa kutentha. Kuyang'anira kuthamanga kwa magazi, kugunda kwa mtima, lactate, ndi kutuluka kwa mkodzo kumathandiza kuwunika kukwanira kwa magazi kuyenda bwino.
Kusamalira madzimadzi kuyenera kukhala koyenera. Kusowa kwa madzimadzi kungapangitse kuti impso zisamagwire bwino ntchito, pomwe kuchuluka kwa madzimadzi kumawonjezera chiopsezo cha kutupa m'mapapo ndikuwonjezera kudalira mpweya wopumira. Chifukwa chake, kuwunika momwe madzi alili komanso zolinga zochiritsira ziyenera kukonzedwa kuti zigwirizane ndi thanzi la wodwalayo, makamaka kwa odwala omwe ali ndi vuto la mtima kapena impso.
5. Kuletsa Matenda ndi Kupewa Sepsis
ICU ndi malo omwe ali pachiwopsezo chachikulu cha matenda opatsirana m'maso chifukwa chogwiritsa ntchito zida zowononga komanso chitetezo cha mthupi cha wodwalayo chofooka. Mfundo zazikulu zopewera ndi ukhondo wa manja, njira yopewera matenda, komanso kusamalira bwino zida monga ma ventilator, ma catheter a mkodzo, ndi ma catheter a m'mitsempha motsatira ndondomeko.
Ngati mukukayikira kuti matenda a sepsis achitika, chithandizo chiyenera kuchitika mwachangu: kusonkhanitsa mbewu, kupereka mankhwala opha tizilombo toyambitsa matenda moyenera, komanso kuwongolera komwe kwayambitsa matenda (monga kutulutsa madzi m'thupi kapena kusintha katheta wogwidwa ndi matendawa). Kuyankha kwa mankhwala kuyenera kuyesedwa nthawi ndi nthawi kuti maantibayotiki athe kusinthidwa kutengera zotsatira za mbewu komanso momwe matendawo alili, potero kuchepetsa kukana kwa maantibayotiki.
6. Kuwongolera Ululu, Kupumula, ndi Kusokonezeka Maganizo
Odwala a ICU nthawi zambiri amamva ululu chifukwa cha matenda, opaleshoni, kapena kulephera kuyenda. Kuchepetsa ululu sikuti kumangokhala chitonthozo chokha komanso kuchepetsa kupsinjika kwa thupi komwe kungawonjezere vutoli. Mfundo yaikulu ndikuwunika ululu molondola ndikupereka mankhwala ochepetsa ululu ngati pakufunika.
Kupumitsa thupi nthawi zambiri kumafunika kwa odwala omwe ali ndi mpweya wokwanira, koma kupumitsa thupi kwambiri kumatha kutalikitsa mpweya ndikuwonjezera chiopsezo cha misala. Chifukwa chake, njira zamakono zimagwiritsa ntchito kupumitsa thupi kochepa komanso kotetezeka, ndi kuwunika tsiku ndi tsiku kuti awone zomwe akufunikira pakupumitsa thupi komanso mapulani osiya kuyamwa.
Kusokonezeka maganizo ndi vuto lofala kwambiri mu ICU, lomwe limadziwika ndi kusokonezeka kwambiri, kusokonezeka maganizo, kapena kusinthasintha kwa chidziwitso. Kupewa kumaphatikizapo kuyang'anira nthawi zonse, kuyang'anira kugona, kufulumira msanga, komanso kuchepetsa kugwiritsa ntchito mankhwala ena ochepetsa ululu ngati n'kotheka.
7. Thandizo la Zakudya ndi Kagayidwe kachakudya
Odwala omwe ali ndi vuto lalikulu ali mu mkhalidwe wa catabolic, zomwe zimawonjezera mphamvu zawo ndi mapuloteni. Mfundo ya zakudya mu ICU ndikuyamba chithandizo cha zakudya mwachangu momwe zingathere ngati palibe zotsutsana, makamaka kudzera mu enteral (kudzera mu m'mimba), chifukwa ndi ya thupi komanso imachepetsa chiopsezo cha matenda poyerekeza ndi zakudya za parenteral.
Kuyang'anira shuga m'magazi n'kofunika kwambiri chifukwa kupsinjika maganizo chifukwa cha matenda kungayambitse hyperglycemia, ngakhale kwa odwala omwe alibe matenda a shuga. Kuwongolera shuga m'magazi kuyenera kuyang'aniridwa mosamala kuti apewe hypoglycemia. Kuphatikiza apo, ma electrolyte monga sodium, potaziyamu, calcium, ndi magnesium ayenera kuyang'aniridwa nthawi zonse, chifukwa kusalinganika kungayambitse matenda a arrhythmias kapena matenda amitsempha.
8. Kupewa Mavuto Okhudza Kusayenda Bwino
Odwala a ICU nthawi zambiri amakhala ndi vuto losayenda bwino. Kulephera kuyenda kumawonjezera chiopsezo cha zilonda za m'mimba, kutsekeka kwa mitsempha yakuya, chibayo, ndi kufooka kwa minofu. Mfundo zofunika pa chisamaliro zimaphatikizapo kusintha malo pafupipafupi, kugwiritsa ntchito matiresi apadera ngati pakufunika kutero, kusamalira khungu, ndi physiotherapy komanso kusuntha msanga monga momwe wodwalayo amalolera.
Kupewa matenda a thrombosis kumachitika kudzera mu kunyamula zinthu, kupondereza masokisi, kapena kuteteza magazi kuundana ngati palibe zotsutsana ndi izi monga kutuluka magazi nthawi zonse. Kupewa chibayo chokhudzana ndi mpweya kumaphatikizaponso kukweza mutu wa bedi, kusamalira pakamwa, komanso kuwunika zosowa za mpweya tsiku ndi tsiku.
9. Kulankhulana ndi Gulu la Maphunziro Osiyanasiyana ndi Chitetezo cha Odwala
Chisamaliro cha ICU chimaphatikizapo madokotala osamalira odwala kwambiri, akatswiri ena ofanana nawo, anamwino a ICU, akatswiri a mankhwala, akatswiri azakudya, akatswiri ochiritsa thupi, ndi antchito ena. Mfundo zazikulu ndi kulankhulana bwino, kuphatikizapo zochitika za tsiku ndi tsiku, zolinga zomveka bwino zochiritsira, ndi zolemba zolondola.
Chitetezo cha wodwala chimaphatikizapo kupewa zolakwika pa mankhwala, kuwunika momwe wodwalayo alili, ndikugwiritsa ntchito mndandanda wazinthu zomwe ziyenera kutsatiridwa. Pazochitika zovuta, mgwirizano wogwirizana bwino ungafulumizitse kuchitapo kanthu ndikuchepetsa chiopsezo cha zovuta.
10. Njira Yaumunthu ndi Kutenga nawo Mbali kwa Banja
Ngakhale kuti pali ICU yochuluka muukadaulo, odwala amafunikirabe njira yothandiza anthu. Zachinsinsi, ulemu, ndi chitonthozo ziyenera kusungidwa. Mabanja nawonso amatenga gawo lofunika kwambiri monga magwero a chidziwitso, chithandizo chamaganizo, komanso opanga zisankho ngati wodwala sakutha kuchita bwino.
Kulankhulana ndi banja kuyenera kukhala koona mtima, komvera chisoni, komanso komveka bwino. Mafotokozedwe okhudza matenda, dongosolo la chithandizo, zoopsa, ndi zotsatira zomwe zingatheke ziyenera kuperekedwa nthawi zonse. Nthawi zina, kukambirana za malire a chithandizo, chisamaliro chochepetsa ululu, kapena zisankho za kumapeto kwa moyo ndi gawo la chisamaliro chapamwamba cholemekezeka.
Mapeto
Mfundo zazikulu zosamalira odwala mu ICU zikuphatikizapo kuwunika mwachangu komanso kokhazikika, kuyang'anira mosamala, kuthandizira kupuma ndi kuyenda kwa magazi, kupewa ndi kulamulira matenda, kupweteka, kugona, ndi kuyang'anira misala, kuthandizira zakudya, kupewa mavuto olepheretsa kuyenda, kugwira ntchito limodzi ndi anthu osiyanasiyana, komanso njira yothandiza anthu yokhudza banja. ICU si malo ongosamalira "zipangizo," koma ndi malo ovuta omwe amafuna kulondola kwachipatala, kusamala kwambiri, komanso kudera nkhawa za thupi ndi maganizo a wodwalayo. Pogwiritsa ntchito mfundozi nthawi zonse, mwayi wa wodwalayo wochira komanso kubwerera ku moyo wabwino ukhoza kuwonjezeka kwambiri.
