Ukuphathwa Kweziguli Okubucayi
Ukuphathwa kokunakekelwa okubucayi kuwuchungechunge lwezinqubo zezokwelapha ezihlelekile, ezisheshayo, nezisekelwe ebufakazini zokugcina imisebenzi ebalulekile nokuvimbela ukulimala kwezitho ezigulini ezinezimo ezisongela ukuphila. Iziguli zokunakekelwa okubucayi ngokuvamile zelashwa eMnyangweni Wezimo Eziphuthumayo (ER), egumbini lokuvuselela, noma eYunithi Yokunakekelwa Okujulile (ICU), ngokuqapha okuseduze, ukwesekwa kwemishini, kanye nokubambisana kwethimba elihlukahlukene. Ukwelashwa okuphumelelayo kunqunywa kakhulu ngokuhlonza izinkinga ngokushesha, ukuzinzisa kusenesikhathi, ukwelashwa okufanele, kanye nokuqapha okuqhubekayo.
Incazelo kanye nezici zeziguli ezibucayi
Isiguli esigula kakhulu yisiguli esibhekene nokuphazamiseka okukhulu ohlelweni olulodwa noma ngaphezulu lwesitho esingaholela ekufeni noma ekukhubazekeni okukhulu uma singelashwa ngokushesha. Lesi simo singabangelwa ukulimala okukhulu, i-sepsis, ukushaqeka, ukwehluleka kokuphefumula, isifo sohlangothi esibi, i-myocardial infarction, ukopha okukhulu, ubuthi, noma izinkinga zangemva kokuhlinzwa. Izici ezibalulekile zesiguli esigula kakhulu zifaka phakathi ukungazinzi kwe-hemodynamic, ukungasebenzi kahle kokuhamba kwegazi kwezicubu, ukwehla kokuqwasha, ukungasebenzi kahle komoya/i-oxygen, kanye nokuthambekela kokuwohloka ngokushesha.
Izimiso Ezijwayelekile Zokuphatha
Isimiso esiyinhloko sokuphathwa kokunakekelwa okubucayi "ukuzinza kuqala, ukuxilongwa kwesibili, ukwelashwa kuyaqhubeka," ngaphandle kokulibazisa izinyathelo zokusindisa impilo. Indlela ehlelekile, njenge-ABCDE (Umoya, Ukuphefumula, Ukujikeleza kwegazi, Ukukhubazeka, Ukuvezwa), isetshenziswa ukuqinisekisa ukuthi izinkinga ezisongela kakhulu zixazululwa kuqala. Ukuxhumana okuphumelelayo, ukubhalwa kwemibhalo efanele, kanye nokuxhumana kweqembu kubalulekile ekunakekelweni okuphumelelayo.
Ukuhlolwa Kokuqala: Indlela ye-ABCDE
1. Umgwaqo Wezindiza
Umgomo oyinhloko ukuqinisekisa ukuthi umoya uvikelekile futhi uvikelekile. Ukuhlolwa kuhlanganisa ukuba khona kokuvinjelwa, imisindo yokuphefumula ephumayo (ukugigitheka, i-stridor), ukusabela komoya okuvikelayo, kanye nengozi yokufutha. Izinqubo zingafaka phakathi ukuphakamisa isilevu noma ukusunduza umhlathi ngekhanda, ukumunca uketshezi, ukufaka umoya ongaphakathi/nasopharyngeal, noma ukufakelwa kwe-endotracheal uma isiguli singakwazi ukugcina umoya ongaphakathi noma silahlekelwa kakhulu ingqondo. Kwezinye izimo, i-cricothyrotomy ingenziwa uma ukufakelwa kwe-intubation kwehluleka futhi umoya unganele.
2. Ukuphefumula
Ukuhlola kuhlanganisa izinga lokuphefumula, umsebenzi wokuphefumula, ukugcwala komoya-mpilo, ukulingana kokukhula kwesifuba, kanye nokuxhumanisa imisipha. Ukuphathwa kuhlanganisa ukuphathwa komoya-mpilo njengoba kudingeka, ukuphefumula kwe-bag-valve-mask, kanye nokuphefumula ngomshini. Ukuhlolwa okusekelayo okufana nokuhlaziywa kwegesi yegazi emithanjeni (i-ABG) kusiza ukuhlola ukuphefumula, ukuphefumula, kanye nesimo se-acid-base. Izimbangela zokwehluleka kokuphefumula, njenge-tension pneumothorax, i-pulmonary edema, i-asthma/COPD exacerbation, noma i-pneumonia enzima, kumele zitholakale futhi zelashwe ngokushesha.
3. Ukugeleza kwegazi
Gxila ekugelezeni kwegazi kanye nomfutho wegazi. Izimpawu zokushaqeka zifaka phakathi ukwehla komfutho wegazi, i-tachycardia, isikhumba esipholile, ukugcwalisa kabusha ama-capillary isikhathi eside, i-oliguria, kanye nesimo sengqondo esishintshile. Izinyathelo zokuqala zifaka phakathi ukusungula ukufinyelela kwe-large-bore ngemithambo yegazi, ukuthola amasampula egazi, ukunikeza uketshezi lokuvuselela (isb., ama-crystalloids), kanye nokumpontshelwa igazi uma ukopha kukubi kakhulu. Uma ukwehla komfutho wegazi kuqhubeka, ama-vasopressor anjenge-norepinephrine angasetshenziswa ngokuqapha okuseduze. Ukuqapha kwe-ECG kuyadingeka ukuthola ama-arrhythmia noma i-myocardial ischemia.
4. Ukukhubazeka (Isimo Sezinzwa)
Ukuhlolwa okusheshayo kufaka phakathi i-Glasgow Coma Scale (GCS), usayizi womfundi kanye nokusabela komzimba, kanye nezimpawu zokuntuleka kwe-focal neurologic. I-Hypoglycemia kumele ikhishwe njengembangela eguquguqukayo yokuncipha kokuqwasha; ukuhlolwa kwe-glucose egazini le-capillary kuyinto ejwayelekile. Ezimweni zokuxhuzula, nikeza ama-benzodiazepines njengokwelashwa kokuqala futhi ucabangele ukuqhubeka nemithi yokulwa nesifo sokuxhuzula. Uma kusolwa ukuthi isifo sokuxhuzula, ukwelashwa kufanele kulandele izindlela zokwelashwa kwesifo sokuxhuzula, kucatshangelwa isikhathi sokuqala kanye nezinkomba zokungenelela kwe-thrombolysis noma i-endovascular.
5. Ukuchayeka (Ukuchayeka kanye nokuhlolwa okuphelele)
Isiguli sihlolwa ngokucophelela ukuze sibone noma yiziphi izinkinga eziyisisekelo njengokuphuma kwegazi, ukuqubuka, izimpawu zokutheleleka, ukulimala okufihliwe, noma ukusha. Kodwa-ke, izinga lokushisa lomzimba kumele ligcinwe ukuze kuvinjelwe ukwehla kokushisa komzimba, ikakhulukazi ezigulini ezihlukunyezwe noma ezishaqekile. Ukuvuselela umzimba kabusha kanye nezingubo zokulala kungasiza ekuvimbeleni "ukulimala okubulalayo" (ukwehla kokushisa komzimba, i-acidosis, kanye ne-coagulopathy).
Ukuqapha Okuthuthukisiwe Nokwelashwa E-ICU
Ngemva kokuzinza kokuqala, iziguli ezigula kakhulu zidinga ukubhekwa eduze kanye nokwelashwa okuqhubekayo okusekelayo. Izimpawu ezibalulekile ziqashwa njalo, okuhlanganisa umfutho wegazi ongenayo ezimweni ezithile, ukugcwala komoya-mpilo, ukuphuma komchamo, isimo soketshezi, kanye nemingcele yelebhu ephindaphindwayo (ama-electrolyte, i-lactate, ukusebenza kwezinso, kanye nezimpawu zokutheleleka). Ukusetshenziswa kwezibalo ezifana ne-SOFA noma i-APACHE kungasiza ekuhloleni ubukhali kanye nokubikezela, kodwa azithathi indawo yokwahlulela kwezokwelapha.
Ukuphathwa Komoya Ongenisa Umoya kanye Nokuphathwa Komoya-mpilo
Ukuphefumula ngomshini kuvame ukudingeka ezigulini ezinenkinga yokuphefumula noma ezingakwazi ukuqonda kahle. Isu lokuphefumula elivikela amaphaphu elinomthamo ophansi womoya (ikakhulukazi ku-ARDS) lisiza ukunciphisa ingozi yokulimala kwamaphaphu okubangelwa umoya. Izinhloso zokufaka umoya-mpilo kudingeka zilungiswe ukuze kugwenywe ukuntuleka komoya-mpilo kodwa futhi kuvinjelwe ukucindezeleka ngokweqile. Ukupholisa kanye nokunciphisa ubuhlungu kunikezwa ngendlela elinganisiwe ukuqinisekisa induduzo yesiguli kanye nokuhambisana nomshini wokuphefumula, futhi ukuhlolwa kwansuku zonke kwenziwa ukuze kukhishwe umntwana.
Ukuphathwa kwe-Sepsis kanye ne-Septic Shock
I-Sepsis iyimbangela ehamba phambili yokufa e-ICU. Izimiso ezibalulekile zifaka phakathi ukutholakala kusenesikhathi, ukunikezwa ngokushesha kwama-antibiotic empiric spectrum ngemuva kokukhuliswa, ukuvuselelwa koketshezi okuqondiwe, kanye nama-vasopressor uma kudingeka. Umthombo wokutheleleka kufanele ulawulwe ngezinyathelo ezifana nokukhipha amathumba noma ukususa ama-catheter athelelekile. Ukuqapha i-lactate kanye nempendulo yezokwelapha kusiza ukuhlola ukusebenza kahle kokuvuselelwa.
Ukusekelwa Kwezitho kanye Nokwelashwa Okungeziwe
Iziguli ezigula kakhulu zivame ukubhekana nokwehluleka kwezitho eziningi. Ukusekelwa kwezinso kungafaka phakathi ukwelashwa kokushintsha kwezinso (i-dialysis) ezimweni zokwehluleka kwezinso okukhulu ngezinkomba ezithile. Ukusekelwa kokudla okunempilo kubalulekile ukuvimbela i-catabolism; ukudla okunempilo kuyathandwa uma umgudu wokugaya ukudla usebenza. Ukuvimbela i-venous thromboembolism kanye nokuvimbela izilonda zokucindezeleka kucatshangelwa ngokuya ngengozi. Ukulawulwa kwe-glucose ngokucophelela kubalulekile, njengoba i-hypoglycemia nayo iyingozi.
Ukuphepha Kwesiguli Nokuvimbela Izinkinga
Ukunakekelwa okujulile kuthwala ingozi yezinkinga ezifana nokutheleleka kwe-nosocomial, i-pneumonia ehlobene nokuphefumula, i-delirium, izilonda zokucindezeleka, kanye nobuthakathaka bemisipha ngenxa yokungakwazi ukuhamba. Ukusebenzisa i-bundle yokuvimbela, ukuhlanzeka kwezandla, indlela yokuvimbela ukutheleleka, ukunyakaza kwasekuqaleni, kanye nokuhlolwa kwe-delirium okuvamile kubalulekile. Ngaphezu kwalokho, ukuhlolwa kwansuku zonke kwezidingo ze-catheter kanye ne-ventilator kusiza ukusheshisa ukususwa kwamadivayisi angasadingeki.
Indima Yethimba Elihlanganisa Izifundo Ezihlukahlukene Nokuxhumana Komndeni
Ukuphatha iziguli ezigula kakhulu kudinga ukubambisana phakathi kodokotela abanakekela kakhulu, abahlengikazi be-ICU, odokotela ababulala izinzwa, ochwepheshe bezokudla, osokhemisi bezokwelapha, ochwepheshe be-physiotherapists, kanye nabasebenzi bezenhlalakahle. Lokhu kubambisana kusheshisa ukwenziwa kwezinqumo futhi kuthuthukise ikhwalithi yokunakekelwa. Ukuxhumana nomndeni nakho kubalulekile, ikakhulukazi maqondana nokuthuthukiswa kwesimo, izinhlelo zokwelapha, izingozi, kanye nokulindela okungokoqobo. Ezimweni ezithile, izinqumo zokuziphatha ezifana nokunciphisa ukwelashwa okusekela impilo kumele kuxoxwe ngazo ngobuchwepheshe, ngozwela, nangokuhambisana nemithethonqubo kanye nezindinganiso zesiguli.
Isiphetho
Ukuphathwa kokunakekelwa okubucayi kudinga indlela ehlelekile, impendulo esheshayo, kanye nokuqapha okuqhubekayo. Kuqala ngokuzinzisa i-ABCDE, kulandelwe ukuphathwa kwezimbangela ezithile, ukwesekwa kwezitho zomzimba, kanye nokuvimbela izinkinga ngesikhathi sokunakekelwa okujulile. Ukwelashwa okuphumelelayo akunqunywa nje kuphela ubuchwepheshe kanye nemithi, kodwa futhi nokuxhumana kweqembu, ukuphepha kwenqubo, kanye nokuxhumana okuphumelelayo nomndeni. Ngokusebenzisa izimiso ezisekelwe ebufakazini kanye nokunakekelwa okuphelele, amathuba eziguli ezigula kakhulu okululama nokufeza izinga lempilo elingcono angathuthukiswa kakhulu.
