Kutarisirwa Kwevarwere Vakakosha
Kutarisirwa kwekuchengetedzwa kwevarwere vane chirwere chakakomba inzira dzakasiyana-siyana dzekurapa dzakarongeka, dzinokurumidza, uye dzine humbowo hwekuchengetedza mashandiro akakosha uye kudzivirira kukuvara kwenhengo dzemuviri muvarwere vane mamiriro ezvinhu anotyisidzira hupenyu. Varwere vane chirwere chakakomba vanowanzo rapwa muEmergency Department (ER), mukamuri rekudzorera varwere kuvarwere, kana muIntensive Care Unit (ICU), nekutarisa kwakanyatsojeka, rutsigiro rwemidziyo, uye kushanda pamwe chete nechikwata chevanhu vakawanda. Kurapa kunobudirira kunonyanya kukonzerwa nekuonekwa kwedambudziko nekukurumidza, kugadzikana kwekutanga, kurapwa kwakakodzera, uye kutariswa kuri kuitwa.
Tsanangudzo uye Hunhu hweVarwere Vakakosha
Murwere anorwara zvakanyanya murwere ari kusangana nematambudziko akakomba mune imwe nhengo kana kupfuura izvo zvinogona kukonzera rufu kana kuremara kwakanyanya kana zvikasarapwa nekukasika. Dambudziko iri rinogona kubva mukukuvadzwa kwakanyanya, sepsis, shock, kutadza kufema, sitiroko yakanyanya, myocardial infarction, kubuda ropa zvakanyanya, chepfu, kana matambudziko mushure mekuvhiyiwa. Hunhu hukuru hwemurwere anorwara zvakanyanya hunosanganisira kusagadzikana kwehemodynamic, kusashanda zvakanaka kwemafuta mumuviri, kudzikira kwekuziva, kusashanda zvakanaka kwemhepo/oxygen, uye katsika kekukurumidza kuipa.
Nheyo Dzakajairika dzeKutungamira
Nheyo huru yekutarisira varwere vane chirwere chakakomba ndeyekuti "kutanga kugadzirisa chirwere, kuongorora chirwere kechipiri, kurapwa kunoenderera mberi," pasina kunonoka matanho ekuponesa hupenyu. Nzira yakarongeka, yakaita seABCDE (Airway, Breathing, Circulation, Disability, Exposure), inoshandiswa kuona kuti matambudziko anonyanya kutyisidzira agadziriswa kutanga. Kutaurirana kwakanaka, magwaro akakodzera, uye kubatana kwechikwata zvakakosha kuti pave nerubatsiro runoshanda.
Kuongorora Kwekutanga: Nzira yeABCDE
1. Nzira yemuchadenga
Chinangwa chikuru ndechekuona kuti nzira yekufema yakachengeteka uye yakachengeteka. Kuongorora kunosanganisira kuvapo kwekuvharika, ruzha rwekufema rwunobva mudumbu (gurgling, stridor), kudzivirira mweya, uye njodzi yekusvuta. Maitiro anogona kusanganisira kusimudza chirebvu chakarereka kana kukanda shaya, kusveta tsvina, kuisa nzira yekufema yemudumbu/mudumbu, kana kupinza mweya mudumbu kana murwere asingakwanise kuchengetedza nzira yekufema kana kuti ari kurasikirwa nepfungwa. Muzviitiko zvimwe, cricothyrotomy inogona kuitwa kana nzira yekufema ikasashanda uye mhepo isina kufefetera yakakwana.
2. Kufema
Kuongororwa kunosanganisira mwero wekufema, kushanda kwekufema, oxygen saturation, symmetry yekuwedzera kwechipfuva, uye auscultation. Kutarisirwa kunosanganisira kupa okisijeni sezvinodiwa, kufefetera kwebag-valve-mask, uye kufefetera kwemuchina. Miedzo inotsigira yakadai sekuongorora gasi reropa muropa (ABG) inobatsira kuongorora kufefetera, kufefetera, uye mamiriro eacid-base. Zvikonzero zvekutadza kufema, zvakaita se tension pneumothorax, pulmonary edema, asthma/COPD exacerbation, kana pneumonia yakanyanya, zvinofanirwa kuzivikanwa uye kurapwa nekukasika.
3. Kuyerera kweropa
Tarisa pakuyerera kweropa uye kukwira kweropa. Zviratidzo zvekuvhunduka zvinosanganisira hypotension, tachycardia, ganda rinotonhorera, kuzara kwecapillary kwenguva refu, oliguria, uye mamiriro epfungwa akachinja. Matanho ekutanga anosanganisira kuona kupinda kweropa mutsinga, kutora sampuro dzeropa, kupa mvura yekudzorera ropa (semuenzaniso, crystalloids), uye kuwedzerwa ropa kana ropa rakawanda. Kana hypotension ikaramba iripo, mishonga yekuderedza ropa yakaita se norepinephrine inogona kushandiswa nekutarisa kwakanyatsojeka. Kutarisa ECG kunodiwa kuti uone arrhythmias kana myocardial ischemia.
4. Kuremara (Chimiro chetsinga)
Ongororo yekukurumidza inosanganisira Glasgow Coma Scale (GCS), saizi yemudzidzi uye reactivity, uye zviratidzo zve focal neurologic deficits. Hypoglycemia inofanira kubviswa sechikonzero chinodzokororwa chekusaziva; kuongororwa kweglucose muropa re capillary ndiko kwakajairika. Kana paine pfari, tora benzodiazepines sekurapa kwekutanga uye funga nezve antiepileptics dzinoramba dziripo. Kana paine fungidziro yekuti sitiroko, kurapwa kunofanira kutevedzera maitiro esitiroko, tichifunga nezvenguva yekutanga kwayo uye zviratidzo zve thrombolysis kana endovascular intervention.
5. Kuratidzwa (Kuratidzwa Kwakazara uye Kuongorora)
Murwere anoongororwa zvakakwana kuti aone kana paine matambudziko akadai sekubuda ropa, mapundu, zviratidzo zvehutachiona, kukuvara kwakavanzika, kana kutsva. Zvisinei, tembiricha yemuviri inofanira kuchengetedzwa kudzivirira hypothermia, kunyanya kune varwere vane kukuvara kana kuvhunduka. Kudziya muviri uye magumbeze zvinogona kubatsira kudzivirira "triad inouraya" yekukuvara (hypothermia, acidosis, uye coagulopathy).
Kutarisa Kwepamusoro uye Kurapa muICU
Mushure mekugadzikana kwekutanga, varwere vanorwara zvakanyanya vanoda kutariswa zvakanyanya uye kurapwa kunoramba kuchienderera mberi. Zviratidzo zvakakosha zvinogara zvichitariswa, kusanganisira BP inopararira muzviitiko zvakasarudzwa, oxygen saturation, weti inobuda, mamiriro emvura, uye paramita dzemarabhoritari (electrolytes, lactate, itsvo, uye zviratidzo zvehutachiona). Kushandisa mamakisi akadai seSOFA kana APACHE kunogona kubatsira kuongorora kuomarara uye fungidziro, asi hazvitsivi kutonga kwekiriniki.
Kutungamirirwa kweKufefetera kweMichina uye Kugadzira Okisijeni
Kufefetedza nemagetsi kunowanzo dikanwa kuvarwere vane kutadza kufema kana kuti vane dambudziko rekuziva. Nzira yekudzivirira mapapu ine huwandu hushoma hwemvura (kunyanya muARDS) inobatsira kuderedza njodzi yekukuvara kwemapapu kunokonzerwa nemhepo. Chinangwa chekuisa mweya mumapapu chinofanira kugadziriswa kudzivirira kushaya oksijeni yakawanda asiwo kudzivirira kushaya oksijeni yakawanda. Kunyaradza nekuderedza marwadzo zvinopihwa nenzira yakayerwa kuti murwere anyarare uye ashande pamwe chete nemuchina wekufema, uye kuongororwa kwezuva nezuva kunoitwa kuti mwana arege kufema.
Kutarisirwa kweSepsis neSeptic Shock
Sepsis ndiyo inonyanya kukonzera kufa kwevanhu muICU. Nheyo huru dzinosanganisira kuonekwa nekukurumidza, kupiwa mishonga inorwisa mabhakitiriya inorwisa mabhakitiriya mushure mekuchekwa kwemasero, kudzorerwa kwemvura mumuviri, uye kudzvanywa kweropa kana zvichidikanwa. Kwakabva hutachiona kunofanira kudzorwa kuburikidza nematanho akadai sekubuda kwemvura mudumbu kana kubviswa kwecatheters dzine utachiona. Kuongororwa kwelactate uye kupindura kwekiriniki kunobatsira kuongorora kushanda kwekudzoka kwemuviri.
Kutsigira Nhengo uye Kurapa Kwekuwedzera
Varwere vane chirwere chakakomba vanowanzosangana nekutadza kushanda kwenhengo dzakawanda dzemuviri. Kutsigirwa kweitsvo kunogona kusanganisira kurapwa kwetsvo (dialysis) kana paine kutadza kushanda kweitsvo zvine zviratidzo zvakati. Kutsigirwa kwezvekudya kwakakosha kudzivirira catabolism; kudya kunovaka muviri kunodiwa kana nzira yekugaya iri kushanda. Kudzivirira venous thromboembolism uye kudzivirira maronda ekushushikana zvinofungwa zvichienderana nenjodzi. Kudzora shuga nekungwarira kwakakosha, sezvo hypoglycemia iriwo njodzi.
Kuchengetedzeka kweMurwere uye Kudzivirira Matambudziko
Kutarisirwa kwakanyanya kune njodzi yezvinetso zvakaita sehutachiona hwemudumbu, pneumonia inokonzerwa neventilator, delirium, maronda ekumanikidzwa, uye kushaya simba kwetsandanyama nekuda kwekusagona kufamba. Kushandisa mushonga wekudzivirira, kushambidzika kwemaoko, nzira yekusauraya utachiona, kufamba nekukurumidza, uye kuongorora delirium nguva dzose zvakakosha. Uyezve, kuongororwa kwezuva nezuva kwezvinodiwa necatheter neventilator kunobatsira kukurumidzisa kubviswa kwemidziyo isingachadiwi.
Basa reChikwata cheVanodzidzisa Nyanzvi Dzakawanda uye Kutaurirana Kwemhuri
Kutarisira varwere vanorwara zvakanyanya kunoda kushandira pamwe pakati pevanachiremba vanorwara zvakanyanya, vanamukoti veICU, vanachiremba vanoraramisa varwere, nyanzvi dzezvekudya, vanachiremba vemishonga, vanachiremba vephysiotherapists, nevashandi vemagariro evanhu. Kushandira pamwe uku kunoita kuti pave nesarudzo dzinokurumidzira uye kunovandudza mhando yekurapwa. Kutaurirana nemhuri kwakakoshawo, kunyanya maererano nekukura kwechirwere, zvirongwa zvekurapa, njodzi, uye zvinotarisirwa zvechokwadi. Mune zvimwe zviitiko, sarudzo dzetsika dzakadai sekuganhurira kurapwa kunochengetedza hupenyu dzinofanira kukurukurwa nehunyanzvi, netsitsi, uye zvichienderana nemitemo netsika dzemurwere.
Mhedziso
Kutarisirwa kwevarwere vane chirwere chakakomba kunoda nzira yakarongeka, mhinduro nekukurumidza, uye kutariswa nguva dzose. Kunotanga nekugadzikana kweABCDE, kunoteverwa nekutarisira zvikonzero zvakanangana, rutsigiro rwemitezo, uye kudzivirira matambudziko panguva yekurapwa kwakanyanya. Kurapa kunobudirira hakungoonekwi chete nehunyanzvi nemishonga, asiwo nekubatana kwechikwata, kuchengetedzeka kwemaitiro, uye kutaurirana kwakanaka nemhuri. Nekushandisa misimboti yakavakirwa pauchapupu uye kutarisirwa kwakazara, mikana yevarwere vanorwara zvakanyanya yekupora uye kuwana hupenyu hwakanaka inogona kuvandudzwa zvakanyanya.
