Nheyo dzeKutarisirwa kweVarwere muIntensive Care Unit
Chikamu Chekutarisira Varwere Vakanyanya (ICU) inzvimbo yekutarisirwa kwechipatara yakagadzirirwa varwere vari mumamiriro ezvinhu akaomarara, vasina kugadzikana, kana kuti vari panjodzi huru yekuora nekukurumidza. MuICU, varwere vanoda kutariswa kwakanyatsojeka, rutsigiro rwepamusoro rwemidziyo, uye kutarisirwa nekukurumidza nechikwata chevanhu vane hunyanzvi hwakasiyana-siyana. Nekuda kwekuoma kwemamiriro emurwere, kutarisirwa kweICU hakungotaridzi chete pakurapa chirwere chiripo asiwo pakudzivirira matambudziko, kudzoreredza mashandiro enhengo dzemuviri, uye kuchengetedzeka kwemurwere wese. Chinyorwa chino chinokurukura misimboti yekutanga yekutarisirwa kwevarwere muchikamu chekutarisira vanonyanya kukuvara senzira yakajairika yekurapa.
1. Ongororo Yekutanga Yakakodzera uye Kuongororwa Kwekiriniki
Nheyo yekutanga muICU ndeyekuita ongororo yekutanga nekukurumidza, yakarongeka, uye yakarongeka. Muvarwere vanorwara zvakanyanya, kunonoka kuita sarudzo kunogona kuuraya. Ongororo dzinowanzo tevera nzira yeABCDE (Airway, Breathing, Circulation, Disability, Exposure). Nzira iyi inobvumira vashandi vehutano kuti vakurumidze kuona matambudziko anotyisidzira hupenyu kutanga.
Kuongororwa kwekiriniki kwakakoshawo pakuona kukosha kwekurapwa, kusanganisira kudiwa kwemuchina wekufema, vasopressors, kana nzira dzekurapa dzinopinda mumuviri. Uyezve, ruzivo rwekutanga rwakadai senhoroondo yezvekurapa, mishonga iripo, allergies, uye mamiriro ekushanda kwemuviri anobatsira timu yeICU kugadzira hurongwa hwekutarisira hwakajeka uye hwakanangana.
2. Kutarisa Kwakasimba Uye Kuenderera Mberi
ICU inoratidzwa nekutarisa murwere nguva dzose. Kutarisa kunosanganisira zviratidzo zvinokosha (BP, pulse, kufema, tembiricha, oxygen saturation), mamiriro etsinga, kubuda kweweti, uye parameters dze hemodynamic dzakakwira, kana zvichidikanwa. Chinangwa ndechekuona shanduko mumamiriro ezvinhu nekukurumidza sezvinobvira kuitira kuti kupindira kutange nekukurumidza.
Pamusoro pekutariswa kwakajairika, vamwe varwere vanoda kutariswa kwevanorwara, zvakaita semacatheter eropa kuti vapimwe BP chaiyo uye vatore sampling yegesi yeropa, uye macatheter epakati emutsinga ekupa mimwe mishonga uye kutarisa mamiriro emvura. Zvisinei, kushandiswa kwemidziyo inorwisa kunofanira kufunga nezvenjodzi yehutachiona uye matambudziko emuchina, saka zviratidzo zvinofanira kunge zvakajeka uye zvichiongororwa nguva dzose.
3. Chengetedza Rutsigiro rweNzira Dzekufema uye Rutsigiro rweKufema
Varwere vazhinji veICU vanotambura nekutadza kufema nekuda kwechirwere chemapapu, sepsis, kukuvara, kutadza kushanda kwemoyo, kana matambudziko etsinga. Nheyo huru yekuchengetedza ndeyekuona kuti mhepo inovhurika uye oxygen yakakwana. Rutsigiro rwekufema runogona kusanganisira oxygen yemhino, mask, cannula yemhino inoyerera zvakanyanya, kufefetera kusingapindi muropa, uye kunyange mudziyo wekufema wemakanika.
Muvarwere vari kushandisa michina yekufema, timu yeICU inofanira kushandisa nzira dzakachengeteka dzekufema, dzakadai sekugadzirisa huwandu hwemvura inopinda mumuviri zvichienderana nehuremu hwemuviri hwakakodzera kudzivirira kukuvara kwemapapu kunokonzerwa nemhepo. Kutarisa magasi eropa, maitiro ekufema, kumanikidzwa kwemhepo, uye kugadzirira kurumurwa kwemwana zvikamu zvakakosha pakuchengeta zuva nezuva.
4. Kugadzikana kweropa uye Kutarisirwa kweHemodynamics
Zvirwere zveropa zvakaita se shock (septic, hemorrhagic, cardiogenic) zvakajairika muICU. Nheyo yacho ndeyekuona kuti ropa rinoyerera zvakakwana munhengo kuburikidza nekusanganisa mvura inobuda mumuviri, kuwedzerwa ropa, kana zvichidikanwa, uye kushandisa mishonga inodzvinyirira ropa kana mishonga inotropic. Kutarisa BP, pulse, lactate, uye weti inobuda kunobatsira kuona kuti ropa rinoyerera zvakakwana here.
Kutarisirwa kwemvura kunofanira kuenzana. Kushomeka kwemvura kunogona kuwedzera kurohwa nehana uye kutadza kushanda kweitsvo, nepo kuwanda kwemvura kuchiwedzera njodzi yekuzvimba kwemapapu uye kunowedzera nguva yekuvimba neventilator. Nokudaro, kuongororwa kwemamiriro emvura uye zvinangwa zvekurapa zvinofanirwa kugadziriswa zvinoenderana nemamiriro emurwere, kunyanya kune varwere vane chirwere chemwoyo kana chirwere cheitsvo.
5. Kudzora Kutapukirwa uye Kudzivirira Sepsis
ICU inzvimbo ine njodzi huru yezvirwere zvemudumbu nekuda kwekushandisa michina inorwisa utachiona uye kushaya simba kwemuviri wemurwere. Nheyo huru dzekudzivirira kuchena kwemaoko, nzira yekusauraya utachiona, uye kutarisirwa kwakakodzera kwemidziyo yakaita semafenzi ekufema, macatheter emuweti, uye macatheter emutsinga zvichienderana nemutemo.
Kana paine chinofungidzirwa kuti chirwere che sepsis, kurapwa kunofanira kuitwa nekukurumidza: kuunganidzwa kwemishonga inorwisa utachiona, kupa mishonga inorwisa utachiona yakakodzera, uye kudzora kwakabva hutachiona (semuenzaniso, kubuda kwemvura mudumbu kana kutsiva catheter ine utachiona). Mhinduro yekurapa inofanira kuongororwa nguva nenguva kuitira kuti mishonga inorwisa utachiona igone kugadziriswa zvichienderana nemigumisiro yemishonga inorwisa utachiona uye mamiriro ekurapa, nokudaro zvichideredza kuramba kwemishonga inorwisa utachiona.
6. Kudzora Marwadzo, Kunyaradza, uye Kuora Mwoyo
Varwere veICU vanowanzo nzwa kurwadziwa nekuda kwekurwara, kuvhiyiwa, kana kutadza kufamba. Kudzora marwadzo hakusi kwekungonyaradzwa chete asiwo kuderedza kushushikana kwemuviri kunogona kuita kuti mamiriro acho awedzere kuipa. Nheyo yacho ndeyekuongorora marwadzo nemazvo uye kupa mushonga wekurwadziwa sezvinodiwa.
Kunyaradza kunowanzodiwa kuvarwere vane mweya unofefetera, asi kunyaradza kwakanyanya kunogona kuwedzera nguva yekufema uye kuwedzera njodzi yekuvhiringidzika mupfungwa. Nokudaro, nzira dzemazuva ano dzinowanzo shandisa kunyaradza kushoma uye kwakachengeteka, nekuongorora kwezuva nezuva kuti vaone zvinodiwa pakunyaradza uye zvirongwa zvekurega kurumurwa.
Dambudziko rekusagadzikana mupfungwa (delirium) rinowanzoitika muICU, rinoratidzwa nekuvhiringidzika kwakanyanya, kusagadzikana, kana kuchinja-chinja kweruzivo. Kudzivirira kunosanganisira kuronga nguva dzose, kuronga nguva yekurara, kufamba nekukurumidza, uye kuderedza kushandiswa kwemimwe mishonga yekunyaradza kana zvichibvira.
7. Rutsigiro rwezvekudya uye metabolic
Varwere vane chirwere chakanyanya vari mumamiriro ezvinhu akaomarara, zvichiwedzera simba ravo uye mapuroteni. Nheyo yekudya kunovaka muviri muICU ndeyekutanga rutsigiro rwezvekudya nekukurumidza kana pasina zvinorambidzwa, zviri nani kuburikidza nenzira yemukati (nemudumbu), sezvo iri yemuviri uye inoderedza njodzi yehutachiona kana tichienzanisa nekudya kunovaka muviri.
Kuongororwa kweshuga muropa kwakakoshawo nekuti kushushikana kwechirwere kunogona kukonzera hyperglycemia, kunyangwe kune varwere vasina chirwere cheshuga. Kudzorwa kweshuga muropa kunofanirwa kuongororwa nekungwarira kudzivirira hypoglycemia. Uyezve, ma electrolyte akadai se sodium, potassium, calcium, uye magnesium anofanira kuongororwa nguva nenguva, sezvo kusawirirana kunogona kukonzera kusagadzikana kwepfungwa kana matambudziko etsinga.
8. Kudzivirira Matambudziko Ekusagona Kufamba Nesimba
Varwere veICU vanowanzo shomeka pakufamba. Kusagona kufamba kunowedzera njodzi yemaronda ekumanikidzwa, deep vein thrombosis, pneumonia, uye kushaya simba kwetsandanyama. Nheyo dzekutarisira dzinosanganisira kuchinja nzvimbo nguva nenguva, kushandisa matiresi chaiwo kana zvichidikanwa, kutarisirwa kweganda, uye physiotherapy uye kufamba nekukurumidza sezvinobvumirwa nemurwere.
Kudzivirira thrombosis kunowanikwa kuburikidza nekushandisa midziyo yekudzivirira ropa, masokisi ekumanikidza, kana kudzivirira ropa kuti risaungane kana pasina zvinorambidzwa zvakaita sekubuda ropa. Kudzivirira pneumonia inokonzerwa nekufema kunosanganisirawo kusimudza musoro wemubhedha, kurapwa nemuromo, uye kuongorora zvinodiwa nekufema zuva nezuva.
9. Kutaurirana kweChikwata cheVanoongorora Zvinhu Zvakasiyana-siyana uye Kuchengetedzwa kweVarwere
Kutarisirwa kweICU kunosanganisira vanachiremba vanorwara zvakanyanya, nyanzvi dzine chekuita nazvo, vanamukoti veICU, varapi vemishonga, nyanzvi dzezvekudya, varapi vemuviri, nevamwe vashandi. Nheyo huru kutaurirana kunobudirira, kusanganisira mazuva ese, zvinangwa zvakajeka zvekurapa, uye magwaro akarurama.
Kuchengetedzeka kwemurwere kunosanganisira kudzivirira zvikanganiso zvemishonga, kuongorora kuzivikanwa kwemurwere, uye kushandisa zvinhu zvekutarisa maitiro. Mumamiriro ezvinhu akaoma, kushanda pamwe chete zvakanaka kunogona kukurumidzisa matanho uye kuderedza njodzi yezviitiko zvakaipa.
10. Maitiro Evanhu uye Kubatanidzwa Kwemhuri
Kunyangwe paine ICU yakawanda mu tekinoroji, varwere vachiri kuda nzira yekuratidza hunhu. Kuvanzika, rukudzo, uye nyaradzo zvinofanirwa kuchengetedzwa. Mhuri dzinoitawo basa rakakosha senzvimbo dzeruzivo, rutsigiro rwemanzwiro, uye vanoita sarudzo kana murwere akatadza kuita basa rake.
Kutaurirana nemhuri kunofanira kuva kwakavimbika, kunzwira tsitsi, uye kunonzwisisika. Tsananguro pamusoro pekuongororwa kwechirwere, hurongwa hwekurapa, njodzi, uye mhedzisiro inogona kuitika dzinofanira kupiwa nguva dzose. Mune zvimwe zviitiko, hurukuro pamusoro pemiganhu yekurapa, kurapwa kwemarwadzo, kana sarudzo dzekupedzisira kwehupenyu chikamu chekurapa kwakasimba kune ruremekedzo.
Mhedziso
Nheyo huru dzekutarisira varwere muICU dzinosanganisira kuongororwa nekukurumidza uye kwakajairika, kutarisisa zvakanyanya, rutsigiro rwekufema neropa, kudzivirira nekudzivirira hutachiona, marwadzo, kunyaradza, uye kugadzirisa kupenga, rutsigiro rwekudya, kudzivirira matambudziko ekusagona kufamba, kushanda pamwe chete mumapoka akasiyana-siyana, uye nzira yekubatsira mhuri. ICU haisi nzvimbo yekungochengetedzwa kwemidziyo chete, asi inzvimbo yakaoma inoda kunyatsoongorora murwere, kungwarira kwakanyanya, uye hanya nezvinhu zvemuviri nepfungwa zvemurwere. Nekushandisa misimboti iyi nguva dzose, mikana yemurwere yekupora uye kudzokera kuhupenyu hwakanaka inogona kuvandudzwa zvakanyanya.
