Nhoroondo uye Nzira Dzakanakisisa dzeZvingangodaro Makuvara Kwepamuviri
Kugadziriswa kwemasana emvura kunoshandiswa kuderedza kushandiswa kwemutsara wepelinha uye kudzivirira, zvakanyanyobvira, rwonzi rwepelinha kubva pakuzvidzwa zvakare shure kwekugona kukuvara kwepamuviri. Izwi iri rave rakapoteredza kubva kuma1980, asi rakashandurwa kureva chimwe chinhu chakasiyana zvakanyanya kupfuura tsanangudzo yaro yepakutanga.
Mukuchengetedzwa kwemazuva ano, pfungwa yekumhanya kwepamuviri ndeyekuchengetedza musana mukutenderera kwepakati maererano nechembera yemurwere.
Kuchengetedza nheyo yepamusoro yevarwere inokosha zvikuru mukudzivirira kwepamuviri. Murwere mumwe nomumwe akasiyana, uye chero kuedza kuendesa murwere kumusana kune izvo zvinoonekwa se "chimiro" chinotyisa chinokonzera njodzi yekuisa kumanikidzwa kune nzvimbo yemurwere musana wakuvadzwa kana kutamisa musana wekukuvara uri kure kwazvo kurongeka kwechinyakare.
Kuti tinzwisise zvakananga zvinyorwa zvekumhanya kwepelinha uye izvo zvatiri kuedza kuita, zvinobatsira kuziva nhoroondo nekushanduka kwehutano hwehutachiona hweporosi.
Kuchinja Kwemwenje Kuchengetedzwa
Pakutanga, paiva nemasipiramu asina kudzivirira. Icho chaiva chimiro chakatarwa chemupi wepamberi wekuchengetedza wepamusoro mune zvekukurumidzira mazano ezvokurapa (EMS) kubata chirwere chakakanganisika chepamuviri. Mumabhuku akawanda ekutanga uye emakambani mapepa, kukuvara kwakanyanya kwaive kunowanzonzi chirwere chepervical injury uye nzira chaiyo yainzi kazhinji inonzi cervical spine (kana c-spine) kusagadzikana.
Kushungurudzwa kwekukuvara kwepamuviri kwakatanga semuenzaniso-based assessment. Izvozvo zvinoreva kuti varwere 'maronda akanga asina kukwanisa kungoita semhinduro kune nzira dzavo dzekukuvara . Panzvimbo pezvo, kugona kwemapapiro kwakashandiswa kuvarwere vane kurwadziwa kwemutsipa mushure mekukuvadzwa kwakanyanya (kureba kwenguva refu kana motokari kukoromoka, somuenzaniso), uchapupu hwekuora mitezo , kana kusaziva .
Pakutanga vatapi vekutanga vakanga vane nzira dzakasiyana-siyana dzavakafunga kuti dzakakosha zvakakwana kuti varatidzire mumasana. Munzvimbo dzakawanda dzenyika, kudzika kwepasi-pasi kwakanga kusingafungidziki zvakakwana nechikonzero chekuita kuti murwere arambe ari musana, kazhinji kunyange pakuvapo kwemarwadzo emutsipa uye uchapupu hwakajeka hwokuti murwere akarova musoro wake.
Muhafu yekupedzisira yema1980, anecdotes yevarwere vane chii chakazozivikanwa se "masvikiro" cervical spine fractures yakaita kuti vanachiremba vanokurumidzira kuti varambe vaine x-ray varwere vanotevera zvinenge zvese zvinokonzerwa nekukuvadzwa nekwanisi yekushungurudzika kusina musoro kumusoro kana kuti nechaplash kushanda (kurova musoro musoro nekudzoka, kuisa kumanikidzi pamutsipa). Varwere vaizoendesa kune dhipatimendi rekukurumidzira kusin'un'una kwemarwadzo emutsipa mushure mokunge vasunungurwa kubva kune imwe nguva yapfuura. Vazhinji vevarwere ava vakanga vaporerwa kuti chii, nenguva iyo, chaifungidzirwa nzira shomanana dzokukuvadzwa nemakonzero maduku. Vamwe vevarwere ava vakawanikwa vane cervical spine fractures pa x-ray mushure mokunge vadzokera kuE ER.
Sezvo varwere vakawanda vakaisa mapepa mumutambo we-ray-ray, zvakanyanya kuputsika zvakawanikwa. Mafungiro akaitwa kuti zvakanga zviri nyore kuputsa vertebrae kupfuura pakutanga zvaifunga zvichibvira.
Zvichiendeswa kune dzimwe nguva nekutywa kwemhosva dzisina kukodzera, mazhenje epakukurumidzira akawedzera maitiro emucheto wenguva refu-mahara kusvikira vasati vawanikwa mune zvose kubva pasi-level inowira pfuti.
Kudzidziswa kwepamberi yepamusoro kunowedzera kujekesa kuti chero ipi zvayo inogona kuisa mhirizhonga pamutsipa yakaratidza kudikanwa kwepamuviri. EMT uye varapi vakagadziriswa vakadzidziswa kutora musana wechipfupa kune umwe muchengeti akadonha uye akawira pasi seimwe nzira yekukuvadza kune mumwe murwere uyo akambotaura seasingazivi.
Iro izwi remusana rekugadzirisa maruva raiita nzira yekuchengetedzwa kwemagunha sezvo kurapa kwakava kwakafanana seyakisijeni.
Mvura yepasipo yakaonekwa sokuti yakaenzana netsoka nechekudzivirira kwemhepo uye kuchenesa ropa mudambudziko rinotambudza.
Kuderedza X-ray Kunotungamirira Kuchinja
Zvose izvo-x-rays zvaidhura uye zvinogona kubudisa pachena varwere kune miviri isina kufanira. Mapoka maviri akazvimiririra echiremba akatanga matanho ekuongorora mazano ekubatsira vanachiremba vanokurumidzira kuziva varwere vainyatsoda kuva nemitsipa x-rayed. Mutemo we NEXUS uye mutemo weCanada C-Spine zvakangoerekana zvichishanda mumatare ekukurumidzira akapoteredza US uye Canada.
Paramedics yakaramba ichifungira kuti ER docs ichibvarura mapiritsi emudzimai yavo uye inoshandura misoro yevarwere kubva kune rumwe rutivi. Imwe nguva tsika yacho yakawana kushandiswa kwose kwose, vatsigiri vezvematongerwo enyika vakatanga kubvunza kuti nei murwere achifanira kuiswa mumagadzirirwo epamumunda mumunda kungova nevanokurumidzira vanachireji kubvisa zvigadzirwa muE ER panzira.
Nenguva isipi, zvidzidzo zvakaitwa kuti zviongorore kushandiswa kwezvishandiso sekufananidzira kwokuti varwere vanoda kuve vasina kukwanisika munzvimbo yekutanga. Paramedics vakaedzwa kuti vaone kana tikakwanisa kuziva varwere pamwe neE ER docs. Pakati pemakore gumi ekutanga ezana remakore rino, masangano eEEM anotenderera kuUnited States aive akadai seasinga "kujekesa" cervical spines mu prehospital setting.
Kubvunza Mamiriro Ekuti Quo
Sezvo chiedza chikavhenekera pamusana pemusana wepeminha kana mavara emumumvuri, vamwe vanopa prehospital uye vanachiremba vakatanga kubvunza tsika yacho zvachose. Kushandiswa kwemashure mabheji kwakanyanya kuipa, zvichiita kumarwadzo ekumanikidza uye kurwadziwa kune varwere vaifanira kurara pamapuranga muEER mahara kwemaawa.
Cervical spine collars (inozivikanwawo sekudziridzwa kwemakorani kana kuti c-collars) inotarisirwa kuchengetedza chirwere chepervical uye kurega kufamba kwemusoro mushure mekugona kweropa remusana. Inowanzoshandiswa zvisina kunaka kana kuti kusimba zvisina kururama uye kune humwe humwe humwe hunoratidza kuti vanogona kuwedzerwa kudzvinyirira kusinganzwisisiki kune varwere vane kukuvadzwa kwemusoro .
Kuvata pamusoro wakaoma mushure uye musoro wakachengetedzwa kuchigadzirwa, kunyange kana torso yakachengetedzwa zvakasimba, ichiripo inopa hurumende huru panguva yekuendesa kuchipatara. Nyanzvi yepafiziki inofunga kuti kugoverwa kwehuremu uye chimiro chemuviri wevarwere kuchaita kuti muto wake ushandure zvakawanda kupfuura musoro wake, kuisa simba pamushonga worudzi rwechibereko mushure mekunge uye kuomesa uye kuparadzanisa vertebrae.
Kushayikwa kwemiedzo yakagadziriswa, yakarongerwa kushandiswa kwemashure mabheji akaoma uye kervical spine collars yakatungamirira dzimwe sangano re EMS kuderedza kushandiswa kwezvinhu zviviri izvi. San Joaquin County, California ndiyo yaiva yekutanga EMS system munyika kuti arambe kubvumira EMT uye varapi vakagadzirisa kushandisa kana kutakura mabhodhi kumabhulani zvachose.
Mazuva ano Mazhenjero Okugadziriswa
Sezvakaoma kare mabhodhi anowana hupenyu hutsva sefrebbhoards uye yechando, avo vanoita zvepagina vakatevera nzira yakafanana, vachibva pakusimbiswa uye kurongeka kuti chimwe chinhu chisina kutsanangurwa uye chakaoma kuenzanisa. Zvechokwadi, vazhinji varapi vezvematongerwo enyika vari kuwana zvakaoma kunyora zvakarurama nzira dzinoshandiswa ku "kurega" kufamba, izvo zvingasanganisira chimwe chinhu chakajeka sekuyeuchidza murwere kuti asafambisa musoro wake.
Nzira dzakanakisisa dzinosanganisira kushandisa maitiro okuongorora akafanana neaya NEXUS kana eCanada C-Spine Rule. Murwere anobvunzurudzwa kuti aone kurwadziwa kunonoka. Kana murwere asina marwadzo kana kurwadziwa kunoonekwa kunge kwepakati pekatikati kuitira kuti aratidze kuti haisi munzvimbo yakananga pedyo nemutsara wepelinha, chirongwa chepachirwere chinoshandisa muromo wemusana. Kana kusina unyoro kana kuora kunowanikwa, chirwere chepachirwere chinotungamirira murwere kuburikidza nehuwandu hwekuyerera nekuwedzerwa, kutenderera, uye kufambisa kufanana kwemutsipa. Kana, panguva ino kufamba, murwere haagunun'uni nezvemutsva kana kuwedzerwa kwepakati pemvura, kuvharwa kwepamuviri kunenge kusina kubviswa.
Kudzidza kwakakwana uye kwakarurama kunoenderana nekukwanisa kwomurwere kutaura nemutarisiri. Kana murwere ari pasi pekudhakwa nedoro kana zvinodhaka, chirwere chepachirwere chinofanira kuchengetedza uye kuwedzerwa kwekufungidzirwa kwepakuvara kwepamuviri. Kunyange zvakadaro, zvakadaro, varapi vemapurisa vanga vasasarudza kushandisa reboardboard uye yakaoma c-collar nekuda kwepamuviri.
Chimwe chikwata chemugodhi chinomira panzvimbo pekuputika kwepaginal ndiko kukwanisa murwere kuti azvidzivirire musangano wepervical spine movement. Panzvimbo pokunyengera pasi uye kusungirirwa zvakachengeteka kumushure, varwere vanowanzosiyiwa vakagara pasi pa gurney uye kora yakanyorova inowanikwa zvimwe chiyeuchidzo chekusatama kupfuura chero chero kupi zvayo kunorambidzwa kwekufamba.
Varwere vasina kukwanisa kutevera mirairo uye avo vane kukanganisika kwepamusoro kwekusagadzikana kwepinja yekuputika kunobatsira kubva pane chigamu chinonzi vacuum splint. Kubvisa zvipfeko zvinopindirana nemitezo yomuviri wevarwere uye zvinogona kukanganisa zvakanyanya pasina kuipa kwemashure mabheji.
Kushandiswa kwekudzivirira kwemupopi panzvimbo pekuputika kwepaginal ishanho iri munzira yakarurama yekuchengetwa kwepamuviri.
> Sources:
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