Yintoni eyenzekayo ngexesha le-Intubation yoBucholo
Intubation yinkqubo yokufaka ityhubhu, ebizwa ngokuba yi- tube endotracheal (ET), ngokusebenzisa umlomo ize ihambe ngendlela. Oku kwenziwa ukwenzela ukuba isigulane sinokufakwa kwindawo yokuphucula umoya ukuncedisa ngokuphefumla ngexesha le- anesthesia , sedation okanye ugula olubi. Itheyibhu iyaxhunywa kwi-ventilator, ephosa umoya kumaphaphu ukuhambisa umoya kumguli.
Le nqubo yenziwa ngenxa yokuba isiguli asikwazi ukugcina indlela yaso, ayikwazi ukuphefumula ngokwabo ngaphandle kokuncediswa, okanye zombini. Oku kunokuba kuba banikwa i-aneshesia kwaye abayi kukwazi ukuphefumula ngokwabo ngexesha lotyando, okanye banokugula okanye benzakele kakhulu ukubonelela oksijini okwaneleyo emzimbeni ngaphandle koncediso.
Indlela i-Intubation isenziwa ngayo ngokuqhelekileyo
Ngaphambi kokuba intubation isigulane sitshatyalaliswe okanye singayiqapheli ngenxa yokugula okanye ukulimala, okuvumela umlomo kunye nomoya womoya ukuba uphumule. Isigulane sisigxina kwisantya sawo kwaye umntu ofake ityhubhu eme ekhanda lombhede, ejonge iinyawo zakhe. Umlomo wesigulane uvule kakuhle kwaye usebenzise ithuluzi elikhanyayo ukugcina ulwimi luphuma endleleni kunye nokukhanyisa umqala, ityhubhu iboniswa ngenyameko emqaleni kwaye iqhutywe phambili.
Kukho ibhaluni elincinci elijikeleze ityhubhu ehlonyelwe ukuba ibambe ityhubhu kwindawo kwaye igcine umoya ubaleke.
Emva kokuba ibhaluni ihlonyelwe, ityhubhu iboniswe ngokukhuselekileyo kwindlela ehamba ngayo kwaye iboshwe okanye ifakwe kwindawo emlonyeni.
Ukubekwa ngokuphumelelayo kuhlolwe kuqala ngokuphulaphula imiphunga kunye ne-stethoscope kwaye kaninzi kuqinisekiswa nge-x-ray esifubeni. Kwintsimi, njengokuba i-911 isebenze kwaye ibhubhu yokuphefumula ifakwe ngabagadi bee-paramedics, kusetyenziswe isichobo esikhethekileyo esitshintsha umbala xa ityhubhu ifakwe ngokuchanekileyo.
Iingozi ze-Intubation
Nangona uphando oluninzi luyingcipheko ephantsi kakhulu, kwaye intubation ingengozi ephantsi kakhulu, kukho iimeko ezinokuthi zivele ngokukodwa xa isiguli sifanele sihlale kwisiphephelo sexesha elide. Iingozi eziqhelekileyo ziquka:
- Uthukuzo lwamazinyo, umlomo, ulwimi, kunye / okanye i-larynx
- Intubation engxamisekileyo kwindawo yokutya (ityhubhu yokutya) esikhundleni se-trachea (ityhubhu yomoya)
- Inkathazo kwi-trachea
- Ukuhlamba
- Ukungakwazi ukuxiliswa kwi-ventilator, efuna i-tracheostomy.
- Ukuhlambalaza (inhaling) ukuhlanza, u-saliva okanye omnye umbane xa utyhulwa
- I-pneumonia, ukuba isifiso sivela
- Umqala obuhkungu
- Ukuthuka
- Ukutyalwa kweethambo ezifutshane (kunye neengongoma ezinde)
Iqela lezonyango liza kuhlola kwaye liqonde ezi ngozi, kwaye zenze okusemandleni abo ukulungisa.
Yintoni i-Nasal Intubation?
Kwezinye iimeko, ukuba umlomo okanye umhobho uqhutyelwa okanye wenzakele, ityhubhu yokuphefumula ifakwe kwimpumlo endaweni yengomlomo, ebizwa ngokuba yi-intubation yangasese. I-tubot nascheraal (NT) iyangena empumleni, iphantsi komqolo, kwaye ingena ephezulu. Oku kwenziwa ukugcina umlomo ungenanto kwaye uvumele ukuba utyando lwenziwe.
Olu hlobo lwentetho aluqhelekanga, kuba kulula ukuyivula ngokusebenzisa umlomo omkhulu, kwaye ngenxa yokuba ayimfuneko kwiinkqubo ezininzi.
Xa i-Intubation iyadingeka?
Intubation iyadingeka xa kunikwa i- anesthesia jikelele . Izidakamizwa ze- anesthesia ziphazamisa izidumbu zomzimba, kubandakanywa isithsaba , okwenza kube nzima ukuphefumula ngaphandle kwefenisi.
Uninzi lwezigulane zigqityiweyo, oku kuthetha ukuba ithubhu yokuphefumula isuswe, kwangoko emva kokuhlinzwa. Ukuba abagulane bagula kakhulu okanye banokuphefumula ngokwabo, banokuhlala kwi-ventilator ixesha elide.
Emva kwenkqubo eninzi, iyeza linikezelwa ukuguqula umphumo we-anesthesia, evumela isiguli ukuba siphume ngokukhawuleza kwaye siqale ukuphefumula.
Kweminye inkqubo, njengenkqubo evulekileyo yentliziyo, isigulane asinikwe iyeza ukuba iguqule i-anesthesia kwaye iza kuvuka kancane. Ezi zi gulane ziza kufuneka zihlale kwi-ventilator ade zivuke ngokwaneleyo ukukhusela indlela yabo yokuhamba kunye nokuziphefumlela.
Intubation yenzelwa ukuhluleka ukuphefumula. Zininzi izizathu zokuba isigulane sinokugula kangako ukuba siphefumle ngokwaneleyo ngokwabo. Basenokulimala kwimiphunga, banokuba ne-pneumonia enamandla, okanye ingxaki yokuphefumula njengeCOPD. Ukuba isigulane asikwazi ukuthatha oksijini ngokwaneleyo, i-ventilator ingafuneka ukuba ibe yomelele ngokwaneleyo yokuphefumula ngaphandle koncediso.
Izifo kunye ne-Intubation
Inkqubo ye-intubation iyafana nabantu abadala nabantwana, ngaphandle kobukhulu bezixhobo ezisetyenziswe ngexesha leenkqubo. Umntwana omncinci ufuna i-tube encinci kakhulu kunomntu omdala, kwaye ukubeka ityhubhu kungadinga ukuchaneka okuphezulu kuba uhambo luhamba lukhulu kakhulu. Kwezinye iimeko, i-fiber optic indawo, isixhobo esivumela umntu ukuba abeke ityhubhu yokuphefumula ukuze abukele inkqubo kwi-monitor, isetyenziselwa ukwenza intubation lula.
Nangona inkqubo eyona nto yokubeka ityhubhu iyafana ngokufanayo, ukulungiselela umntwana ukuhlinzwa kuyehluka kakhulu kunabantu abadala. Nangona umntu omdala enokuba nemibuzo malunga ne-inshurensi yokukhawuleza, ingozi, iingeniso kunye namaxesha okuphucula, umntwana uya kufuna inkcazelo eyahlukileyo yenkqubo eya kuyenzeka. Ukuqinisekiswa kuyimfuneko, kwaye ukulungiswa ngokomzwelo kwindlela yokuhlinzwa kuyahluka kuye kuxhomekeke kwiminyaka yesigulane.
Ukutya ngexesha le-Intubation
Isigulane esiya kuba se-ventilator kwinkqubo kwaye ikhutshwe xa inkqubo igqityiweyo ayifuni ukufumana isondlo, kodwa angayifumana i-fluids ngokusebenzisa i-IV. Ukuba isigulane kulindeleke ukuba sibe yintsholongwane yentsholongwane kwiintsuku ezimbini okanye ngaphezulu, ukondla kuya kuqalwa ngokutsha ngosuku okanye ezimbini emva kokungena.
Akunakwenzeka ukuthatha ukutya okanye ukusetyenziswa kwamanzi ngomlomo ngelixa likhutshwe, ubuncinane ngendlela engenziwa ngokubamba, ukuhlafuna, ukugwinya.
Ukwenza kube lula ukufumana ukutya, amachiza kunye namanzi ngomlomo, ityhubhu ifakwe emqaleni kwaye iphantsi kwisisu. Le bhubhu ibizwa ngokuthi i-orogastric (OG) xa ifakwe emlonyeni, okanye i-nasogastric tube (NG) xa ifakwe kwimpumlo ize iphantsi emqaleni. Amachiza, ama-fluids, kunye nokutya kwe-tube ithoxiswa kwi-tube kunye nasesisu usebenzisa i-syringe enkulu okanye ipompo.
Kwezinye izigulane, ukutya, amayeza, kunye neyeza kufuneka zinikezwe kwangaphakathi. I-IV feedings, ebizwa ngokuthi yi-TPA okanye isondlo esipheleleyo se-parenteral, inikeza ukutya kunye neekhalori ngokuthe ngqo kwigazi kwiifomu zamanzi. Olu hlobo lwesondlo luya kugwenywa ngaphandle kokuba luyimfuneko, njengoko ukutya kulunge kakhulu kumathumbu.
Ukususa iTreat Breathing
Ityhubhu kulula kakhulu ukususa kunokubeka indawo. Xa lixesha lokuba ityhubhu isuswe. izibophelelo okanye itheyiphi ebambelela kuyo kufuneka isuswe kuqala. Emva koko ibhaluni ephethe ityhubhu kwindlela yokuhamba yomoya iyahlanjululwa ukwenzela ukuba ityhubhu ingacinywa ngokunyanisekileyo. Emva kokuba ityhubhu iphume, isiguli siya kufuneka senze umsebenzi wokuphefumula ngokwabo.
Musa ukufaka i-Intubate / Musa ukuvuselela
Ezinye izigulane zenza izifiso zabo ziyaziwa ngokusebenzisa umyalelo ohambileyo, umqulu obonisa ngokucacileyo umnqweno wokunakekelwa kwezempilo. Ezinye izigulane zikhetha "ukungenayo intubate", oko kuthetha ukuba abafuni ukufakwa kwindawo yokucima umoya ukuze balinde ubomi babo. Musa ukuhlaziya kuthetha isigulane sikhetha ukungabi neCPR.
Isigulane sinolawulo lwolu khetho, ngoko banokukhetha ukutshintsha okwethutyana olu khetho ukuze babe notyando oludinga i-ventilator, kodwa lo luxwebhu oluyimbopheleleko lomthetho olungenakuguqulwa ngabanye phantsi kweemeko eziqhelekileyo.
ILizwi
Isidingo sokungenwa kwaye sibeke kwi-ventilator siqhelekileyo nge-anesthesia jikelele, oko kuthetha ukuba uphando olubanzi luya kufuna olu hlobo lonyango. Nangona kukhwankqisa ukucinga ukuba usemvini, ezininzi izigulane zonyango ziphefumula ngokwawo ngaphakathi kwemizuzu yokuphela kokuhlinzwa. Ukuba unenkxalabo malunga nokuba nomoya wokuqhubela umoya, qiniseka ukuba uxoxe ngezinto ozikhathazayo kunye nodokotela wakho ohlinzayo okanye umntu onika i-anesthesia yakho.
> Umthombo:
> Endotracheal Intubation. Medline Plus. https://medlineplus.gov/ency/article/003449.htm