Imbali kunye neZenzo eziMnandi kwiNgxaki yokuNgcwaba
Isithintelo sokunyakaza kwesithambiso sisetyenziselwa ukunciphisa ukusetyenziswa kwekholam yomgcini kunye nokukhusela, kangangoko kunokwenzeka, intambo yomgogodla ekuqhubekeni kokuhlaselwa emva kokulimala komgudu. Ixesha liye lajikeleza ukususela ngowe-1980, kodwa liye laguqukela ukuba lithetha into ehluke kakhulu kunokuba ichazwe kwintsusa.
Kwiinkathalo zangaphambili zangaphambili, imbono yesithintelo sokunyanyiswa kwempompo kukugcina umgudu kwindawo engathathi hlangothi ngokubhekiselele kwisiseko somguli.
Ukugcina isigxina sesigulane kubaluleke kakhulu ekuthintekeni kwemfudu. Zonke izigulane zihlukileyo, kwaye nayiphi na inzame yokuhambisa isigulane somgudu kwizinto ezithathwa ngokuba "ziqhelekileyo" zibeka umngcipheko wokubeka uxinzelelo kwiindawo zesigulane somlwelwana ongenakunobungozi okanye ukuhambisa umlenze owonzakeleyo kude kude ulungelelwaniso oluqhelekileyo.
Ukuqonda ngokucacileyo izicwangciso zesithintelo sokunyakaza kompompo kunye nento esizama ukuyifeza, kuyakunceda ukwazi imbali kunye nokuziphendukela kwempilo yezilwanyana zokulimala.
Ukuguqulwa kwezilwanyana zokuLondoloza
Ekuqaleni, kwakukho ukuchithwa kwempundu. Yilo lindelo elindelekileyo yiphina imbopheleleko ye-prehospital kwiinkonzo zonyango eziphuthumayo (EMS) ukuphatha unyango olusesikweni lokulonda. Kwiintlobo ezininzi zeencwadi zokuqala kunye namaphephancwadi zorhwebo, ukulimala okuthe ngqo kwakusoloko kuthethwa ngokuba yingozi yentsholongwane yesibeleko kunye nenkqubo eyona nto yayibizwa ngokuba ngumlomo wesibeleko (okanye u-c-spine).
Ukuxhatshazwa komnxeba kuqalwe njengoluvavanyo olusekelwe kumboniso. Oko kuthetha ukuba izigulane zezigulane azizange zithintele nje ngokusabela kwiindlela zabo zokulimala . Esikhundleni saloo nto, ukunyanzelisa umthambo kwasetyenziswa kwizigulane zentlungu emva kwentlungu eyingozi (ukuwa kwexesha elide okanye ukushayisana kwemoto, umzekelo), ubungqina bokukhubazeka , okanye ukungazi .
Abaphenduli bokuqala bokuqala babe neendlela ezahlukeneyo abazibonayo ezibalulekileyo ngokwaneleyo ukuba bavumele ukunyanzelisa umthambo. Kwiindawo ezininzi zelizwe, ukuwa kwamanqanaba aphantsi komhlaba akuzange kuthathwa njengento efanelekileyo yokukhupha umgudu wesigulane, ngokuphindaphindiweyo nokuba kukho intlungu yentamo kunye nobungqina obucacileyo bokuthi isigulane samshaya intloko.
Kwisiqingatha sokugqibela sama-1980, i-anecdotes yezigulane eziye zaziwa ngokuba "ukusebenzelana nemimoya" zentsholongwane zentsholongwane zentsholongwane ziqhube amayeza angxamisekileyo kwizigulane ze -x-ray ngokulandela phantse naziphi na iindlela zokulimala ezinokubangela ukuphazamiseka kwentloko okanye i- whiplash isiphumo (ukubetha intloko emva nangaphandle, ukubeka uxinzelelo entanyeni). Izigulana ziza kufaka kwiSebe eliphuthumayo likhalaza intlungu emva kokuba ikhutshwe kwintlanganiso yangaphambili. Ininzi yezi zi gulane ziye zaphathwa ngokuba yintoni, ngelo xesha, yayiqwalaselwa njengendlela encinci yokulimala kunye nezikhalazo ezincinane. Ezinye zezi zi gulane zafunyanwa zineentambo zentambo yomlomo wesiqhelo kwi-ray ray emva kokuba zibuyele kwi-ER.
Njengoko iintsimbi zamagulane ezongezelelweyo zazifakwe kwisebe le-ray-ray, kwafunyanwa ezinye iintambo. Iingcamango zenziwe ukuba kulula ukuphula i-vertebrae kunokuba ingcamango yokuqala ingenzeka.
Eqhutywe kwezinye iimeko ngenxa yokwesaba ukuxhatshazwa kwamatyala, iinkqubo zengxamiseko zonyango zanda ukwanda kwe-collar x-rays kuze kube yinto ebonakalayo kuyo yonke into esuka kumgangatho wehlabathi uhlaselwa ngamanxeba.
Ukuqeqeshwa kwe-Prehospital kwandiswe ukucacisa ukuba nayiphi na indlela eyenza ukubeka uxinzelelo entanyeni ibonise isidingo sokukhulelwa komgudu. I-EMT kunye nee-paramedics zafundiswa ukuba zithinte ukulimala komgudu kumntu nawuphi na isigulane owawa waza wawa njengendlela yokulimala nasiphi na isigulane esasifakile singenalo.
Ixesha lokugungqiswa komgogodla liye lenza iindlela zokulondoloza umgudu njengoko unyango lwaba lufana ne-oxygen.
Ukutsalwa kwe-spinal immobili kwakucatshangelwa ukuba kunamanqanaba alinganayo nokulawulwa kwendlela yokuhamba kunye nokulawulwa kwegazi kwisigulane esibuhlungu.
Ukunciphisa ii-X-ray zikhokelela ekutshintsheni
Zonke ezo x-ray zazingabizi kwaye izigulana zangezibonakaliso zangezibonelelo ezingekho mfuneko. Amaqela amabini azimeleyo oogqirha aphuhlise amathuluzi okuhlola ukunceda amayeza angxamisekileyo ukuba abone izigulane ezazifuna ukuba neentamo zazo zitshathwe. Ulawulo lwe-NEXUS kunye nolawulo lweCanada C-Spine lusetshenziswe ngokungazelelwe kwiinkonzo eziphuthumayo malunga ne-US neCanada.
Iiparamedics zakhula zikhunjulwa ii-docs ze-ER zikhupha iikholeji zentsholongwane yazo kwaye ziphazamise iintloko zezigulane ukusuka ecaleni. Emva kokuba lo mkhuba ufumene ukusetyenziswa ngokubanzi, ama-paramedics aqala ukubuza ukuba kungani isigulane sifanele sibekwe emagqabini emilenze kwintsimi kuphela ukuba amayeza angxamisekileyo asuse izixhobo kwi-ER hall.
Kungekudala, uphando lwaqhutyelwa ukuphonononga ukusetyenziswa kwezixhobo njengengqikelela yokuba izigulane zifuna ukuba zingenakukhutshwa kwindawo yokuqala. Iiparamedics zavavanywa ukuba zibone ukuba ngaba singakwazi ukubona izigulane kunye nee-docs ze-ER. KwiMidway kwiminyaka yokuqala yokuqala yale nkulungwane, ii-EMS iinkqubo ngeenxa zonke zase-US zazingenakwenzeka ukuba "zingacacisi" iintsiba zomlomo wesibeleko kwi-prehospital setting.
Ukubuza i-Status Quo
Njengoko ukukhanya kwakhanya ngakumbi ekusebenziseni ukunyanzeliswa komgudu okanye ukukhusela umgudu, abanye ababonelela nge-prehospital kunye namagqirha baqala ukubuza umbuzo ngokupheleleyo. Ukusetyenziswa kweebhodi zangemuva kunzima, okukhokelela kwizilonda zengxinzelelo kunye neentlungu kwizigulana ezazimele zilale kwiibhodi kwi-ER zokuhlala iiyure.
Iikholeji zentambo yomlomo wesibeleko (eyaziwa nangokuthi i-collar extlaration okanye i-col-collars) zenzelwe ukukhusela umlenze wesibeleko kunye nokunqanda intloko yentloko emva kokulimala komgudu. Zivame ukusetyenziswa kakubi okanye ubuncinci kwaye kukho ubungqina obubonisa ukuba banokunyusa uxinzelelo lwe-intracranial kwizigulane ezinokulimala kwentloko .
Ukulala kwi-backboard ekhuni kunye nentloko egcinwe kwisixhobo, nangona xa isibini sisilungele ngokuqinisekileyo, sisinikeza intshukumo ebalulekileyo ngexesha lokuthunyelwa esibhedlele. I-physics elula igxininisa ukuba ukusabalalisa ubunzima kunye nesimo somzimba wesigulane kuya kuvumela ukuba isibini sakhe sitshintshe ngaphezu kwekhanda lakhe, ukubeka amandla emlonyeni wesibeleko emva kwesikhashana kunye nokucindezela nokuphazamisa i-vertebrae.
Ukungabikho kwezilingo ezingaphendulwanga, ezilawulwayo ngokusetyenziswa kwamagqabha emilenze elukhuni kunye neengcongolo zentambo yomlomo zenze ukuba ezinye iinkqubo ze-EMS zinciphise kakhulu ukusetyenziswa kwezi ndlela ezimbini. I-San Joaquin County, eCalifornia yinkqubo yokuqala ye-EMS kweli lizwe ukwenqaba ukuvumela ii-EMT kunye nee-paramedics ukuba zisebenzise okanye zithwale iibhodi zangaphambili kwii-ambulensi nonke.
UkuLungiswa kweMihla yangoku
Njengamabhobho akhuselekileyo athola ubomi obutsha njengama-surfboards kunye ne-snowboards, ukunyanzeliswa komgogodla kulandele indlela efanayo, ukusukela ekubeni lukhuni kwaye luhlelwe kube yinto echazwe ngokucacileyo kwaye nzima ukulinganisa. Enyanisweni, abaninzi abancedisi be-paramedics bakuthola kunzima ukucwangcisa ngokuchanekileyo iinkqubo ezisetyenziselwa "ukukhawulela" ukunyuswa, okungaquka into elula njengokukhumbuza isigulane ukuba angadlulisi intloko.
Iindlela ezilungileyo ziquka ukusetyenziswa kwamagcisa okuhlola afana ne-NEXUS okanye i-Canadian C-Spine Rule. Isigulane sibuzwa ukuba sibone intlungu evulekileyo. Ukuba isiguli asinayo intlungu okanye intlungu ebonakalayo i-lateral kwi-midline ukwenzela ukuba ibonise ukuba ayikho kwindawo esondele ngqo kwikholamu yomgudu, i-paramedic ikhala kwikholamu yomgcini. Ukuba akukho festile okanye ukukhubazeka kufumaneka, i-paramedic iya kukhokela isigulane ngokusebenzisa uchungechunge lwezithuba kunye nokwandisa, ukujikeleza kunye nokunyakaza kwentsimbi yentamo. Ukuba, ngexesha le ntshukumo, isigulane asikhalazi ngesantya esitsha okanye sokwanda kwe-midline, isithintelo sokunyakaza kwesibhakabhaka siya kushiywa.
Uvavanyo olwaneleyo nolungqinisisekileyo lusekelwe kwikhono lomguli lokuthetha nomnakekeli. Ukuba isigulane singaphantsi kwefuthe lotywala okanye iziyobisi, i-paramedic kufuneka igcine kwaye iphakame kakhulu ukukhankanyiswa ngenxa yokulimala komgudu. Nangona kunjalo, nangona kunjalo, i-paramedic ayinakukhetha ukusebenzisa i-backboard kunye ne-col-collar eqinile yokunakekelwa kweminwe.
Isithintelo sokunyanzeliswa kwesiphambano kunokuba umthamo wokugungqa umgudu unamandla okwenza isigulane sithintele intshukumo yakhe. Esikhundleni sokuqamba amacandelo okulala kunye nokucocwa ngokukhuselekileyo kwi-backboard, izigulane zihlala zihleli kwi-gurney kunye nekholeji ezithambileyo zibekwe ngaphezulu ukuze zikhumbuze ukuba zingadluli kunokuba nayiphi na isithintelo esibalulekileyo sokunyuswa.
Izigulane ezingenakukwazi ukulandela imiyalelo kwaye abanokusola okuphezulu kwizifo zomgogodla ezingaqinisekanga ziya kuxhamla kwisixhobo esaziwa njenge-vacuum splint. Ukucoca iiflethi zihambelana nemida yomzimba wesigulane kwaye iyakwazi ukukhupheka ngokuthe ngempumelelo ngaphandle kweempembelelo ezingekho emacaleni.
Ukusetyenziswa kwesithintelo sokunyakaza kwempompo kunokuba umthamo wokugungqa umgudu unyathelo elifanelekileyo kwicandelo lokunakekelwa kwemilenze.
> Imithombo:
> Hoffman JR, Umbane WR, Wolfson AB, Todd KH, Zucker MI. Ukuqinisekiswa kweteti yemigaqo yekliniki yokulawula ukulimala kwintsimi yomlomo kwizigulane ezinokukhathazeka ngokukhawuleza. Isizwe soPhulo lweSizwe soPhulo lweSizwe soPhuculo lweSizwe. N Engl J Med . 2000 Julayi 13; 343 (2): 94-9. INGXELO: 10.1056 / NEJM200007133430203. I-Erratum ku: N Engl J Med 2001 Feb 8; 344 (6): 464
> Karason, S., Reynisson, K., Sigvaldason, K., & Sigurdsson, G. (2014). Ukuphononongwa kwenkqubo yokusebenza kweekliniki kunye nokukhuselwa kweekholeji zentsholongwane yesibeleko: ukungafani nokungafihli, ukuchaphazela ukunyanzeliswa kweengcambu kunye nokunyamezela kwesigulane. I-Scandinavia Journal Of Trauma, Ukuvuselelwa kunye Nonyango oluPhezulu , 22 (1), 37.
> Michaleff, Z., Maher, C., Verhagen, A., Rebbeck, T., & Lin, C. (2012). Ukuchaneka kolawulo lwe-Canada C-spine kunye ne-NEXUS ukuya kwisikrini ukwenzela ukuba ukhatyelwa kogqithiso lwentliziyo yesibondlo kubangelwa izigulane ezilandelayo: I-Canadian Medical Association Journal , 184 (16), E867-E876.
> Morrissey JF, Kusel ER, uMncedisi KA. Isithintelo sentshukumo yesithintelo: inkqubo yokufundisa nokuphunyezwa ukuhlaziya kwakhona ukuhlolwa komgogodla kunye nokunyamekela. Prehosp Care Emner . 2014 Julayi-Sep; 18 (3): 429-32. Epub 2014 Feb 18.
> Vaillancourt C, Stiell IG, Beaudoin T, Maloney J, Anton AR, Bradford P, uKayin E, i-Travers A, i-Stempien M, i-Lees M, i-Munkley D, i-Battram E, iBanek J, i-Wells GA. Ukuqinisekiswa kwangaphandle kwesibhedlele kwe-Canada C-Spine Rule ngabagadi bee-paramedics. Ann Emerg Med . 2009 Nov; 54 (5): 663-671.e1. Epub 2009 Apreli 24. I-Erratum ku: Ann Emerg Med. NgoJan 2010; 55 (1): 22.