Chimene Chimachitika Panthaŵi ya Intubation ya Opaleshoni
Intubation ndi njira yowonjezera chubu, yotchedwa endotracheal tube (ET), kudzera pakamwa ndikupita panjira. Izi zimachitidwa kuti wodwalayo athe kuikidwa pa mpweya woti athandizidwe kupuma panthawi ya anesthesia , sedation, kapena matenda aakulu. Pambuyo pake chubu imagwirizanitsidwa ndi mpweya wotulutsa mpweya m'mapapo kuti apereke mpweya kwa wodwalayo.
Izi zimachitika chifukwa wodwala sangathe kukhalabe panjira, sangapume yekha popanda thandizo, kapena onse awiri. Izi zikhoza kukhala chifukwa chakuti akupatsidwa anesthesia ndipo sangathe kupuma payekha panthawi ya opaleshoni, kapena akhoza kudwala kapena kuvulala kuti apereke oxygen yokwanira kwa thupi popanda thandizo.
Momwe Matupa Amachitira Kawirikawiri
Asanayambe kumva mthupi wodwalayo amakhala pansi kapena osadziŵa chifukwa cha matenda kapena kuvulala, zomwe zimalola kuti pakamwa ndi pamtunda pakhale mpumulo. Wodwala amakhala wathanzi kumbuyo kwawo ndipo munthu yemwe akuika chubu akuima pamutu pa bedi, akuyang'ana mapazi a wodwalayo. Pakamwa pake pang'onopang'ono imatseguka ndi kugwiritsa ntchito chida chowongolera kuti lilime lisatulukemo komanso kuti azimitse khosi, chubuyo imatsogoleredwa mokhala mmwamba ndikupita panjira.
Pali buluni yaying'ono pafupi ndi chubu yomwe imakhudzidwa kuti igwire chubuyo m'malo ndi kuti mpweya usapulumuke.
Bululi likadakonzedwa, chubuyi imakhala bwino pamsewu ndipo imamangiriridwa pamalo pakamwa.
Kuika malo opindulitsa kumayang'aniridwa koyamba mwa kumvetsera mapapu ndi stethoscope ndipo nthawi zambiri amatsimikiziridwa ndi chifuwa cha x-ray. M'mundawu, monga pamene 911 yatsegulidwa ndipo kupuma kwapadera kumaikidwa ndi othandizira opaleshoni, chipangizo chapadera chimagwiritsidwa ntchito chomwe chimasintha mtundu pamene chubu iikidwa bwino.
Ngozi za Intubation
Ngakhale kuti opaleshoni yambiri ndi yoopsa kwambiri, ndipo vutoli limakhala pangozi yochepa, pali zina zomwe zingathe kuchitika makamaka pamene wodwala ayenera kukhala pa mpweya wabwino kwa nthawi yaitali. Zoopsa zomwe zimakhalapo ndi izi:
- Kusokonezeka kwa mano, pakamwa, lilime, ndi / kapena larynx
- Kuwombera kosayembekezereka m'magazi (chakudya) m'malo mwa trachea (mpweya wabwino)
- Zovuta kwa trachea
- Kusuta
- Kulephera kuyamitsidwa kuchokera ku mpweya wabwino, wofuna tracheostomy.
- Kutulutsa masititi, saliva kapena madzi ena amadzimadzi
- Chibayo, ngati mpweya umapezeka
- Chikhure
- Kusokonezeka
- Kuwonongeka kwa minofu yofewa (ndi kupuma kwa nthawi yaitali)
Gulu la zachipatala lidzayesa ndikuzindikira za ngozi zomwe zingakhalepo, ndipo chitani zomwe angathe kuti athetse.
Kodi Chimachitika Bwanji?
Nthawi zina, ngati pakamwa kapena pakhosi pakagwiritsidwa ntchito kapena kuvulala, pulogalamu ya kupuma imaloledwa kudzera mu mphuno mmalo mwa pakamwa, komwe kumatchedwa kuti minofu. Mankhwala otchedwa nasotracheal tube (NT) amapita m'mphuno, kumbuyo kwa mmero, ndi kumtunda wapamwamba. Izi zimachitidwa kuti pakamwa panu musakhale ndi kanthu ndikulola opaleshoniyo ichitike.
Mtundu woterewu sufala kwambiri, chifukwa nthawi zambiri zimakhala zosavuta kuzigwiritsira ntchito kutsegula pakamwa, komanso chifukwa sizowonjezera njira zambiri.
Kodi Kutsegula Kumakhala Kofunika Kwambiri?
Nthenda imafunika pamene anesthhesia ambiri amaperekedwa. Mankhwala a anesthesia amachititsa kuti thupi likhale lopweteka, kuphatikizapo chithunzithunzi , chomwe chimapangitsa kukhala kosatheka kupuma opanda mpweya wabwino.
Odwala ambiri amatulutsidwa, kutanthauza kuti mpweya wabwino umachotsedwa, mutangotha opaleshoni. Ngati opirira ali odwala kwambiri kapena akuvutika kupuma okha, iwo akhoza kukhala pa mpweya wabwino kwa nthawi yaitali.
Pambuyo pa ndondomeko yambiri, mankhwala amaperekedwa kuti asinthe zotsatira za anesthesia, zomwe zimalola wodwala kuwuka mwamsanga ndikuyamba kupuma yekha.
Kwa njira zina, monga njira yotsegulira mtima, wodwala sapatsidwa mankhwala kuti asinthe mchitidwe wogonana komanso amadzuka pang'onopang'ono. Odwalawa adzafunika kukhalabe pa mpweya wabwino kufikira atadzuka mokwanira kuti ateteze ulendo wawo wautali ndikupuma.
Intubation imathandizanso kuti kupuma kusalephereke. Pali zifukwa zambiri zomwe wodwalayo angadwale kwambiri kuti asapume bwinobwino. Iwo akhoza kuvulazidwa m'mapapu, akhoza kukhala ndi chibayo chachikulu, kapena vuto lopuma monga COPD. Ngati wodwalayo sangathe kutenga mpweya wabwino wokha, mpweya wabwino ukhoza kukhala wofunikira kufikira atakhala ndi mphamvu yokwanira yopuma popanda thandizo.
Matenda ndi Mafupa
Ndondomekoyi ndi yofanana ndi akulu ndi ana, kupatula kukula kwa zipangizo zomwe zimagwiritsidwa ntchito panthawiyi. Mwana wamng'ono amafunika chubu yaying'ono kwambiri kuposa wamkulu, ndipo kuika chubu kungakhale kofunika kwambiri chifukwa ndegeyo ndi yaying'ono kwambiri. Nthawi zina, fiber optic scope, chida chimene amalola munthu kuyika chubu chopuma kuti ayang'ane ndondomekoyi, amagwiritsidwa ntchito kupanga zosavuta mosavuta.
Ngakhale njira yeniyeni yopangira chubuyo ndi yofanana, kukonzekera mwana kwa opaleshoni ndi kosiyana kwambiri ndi anthu akuluakulu. Ngakhale munthu wamkulu angakhale ndi mafunso okhudza inshuwalansi, zoopsa, phindu ndi nthawi zobwezeretsa, mwanayo amafunikanso kufotokozera za njira yomwe idzachitike. Chilimbikitso ndi chofunikira, ndipo kukonzekera maganizo kwa opaleshoni kumasiyana malinga ndi msinkhu wa wodwalayo.
Kudyetsa Panthawi Yopweteka
Wodwala amene ali pamphepete mwa mpweya ndikuwongolera pamene ntchitoyo yatsirizidwa sikufuna kudyetsa, koma akhoza kulandira madzi kudzera mwa IV. Ngati wodwala akuyembekezeredwa kukhala wodalira mpweya kwa masiku awiri kapena kuposerapo, kudyetsa kumayambira tsiku limodzi kapena awiri mutalowa.
Sizingatheke kutenga chakudya kapena madzi ammadzi pakamwa pang'onopang'ono, osati mofanana ndi momwe amachitira ndi kuluma, kutafuna, ndikumeza.
Pofuna kuteteza chakudya, mankhwala ndi madzi pamakamwa, chubu imayikidwa mmero ndi mmimba. Thubuyi imatchedwa orogastric (OG) pamene imayikidwa m'kamwa, kapena thumba la nasogastric (NG) likayikidwa m'mphuno mpaka kummero. Mankhwala, madzi, ndi tizilombo toyambitsa matenda amatha kuponyedwa mu chubu ndi m'mimba pogwiritsa ntchito sitiroko yaikulu kapena mpope.
Kwa odwala ena, chakudya, madzi, ndi mankhwala ayenera kuperekedwa mwachangu. Zakudya zowonjezera, zomwe zimatchedwa TPA kapena chakudya chonse cha amayi, zimapereka zakudya zabwino ndi zopatsa mphamvu m'magazi mumadzi. Kudyetsa kotereku kumapewa kupatula ngati kuli kofunika kwambiri, monga chakudya chimapangidwira kudzera m'matumbo.
Kuchotsa Tube ya Breathing
Thumba ndi losavuta kuchotsa kusiyana ndi malo. Nthawi ikatha kuti chubu chichotsedwe. maubwenzi kapena tepi yomwe imaigwiritsira ntchito pamalo yoyamba iyenera kuchotsedwa. Kenaka baluni yomwe imagwira chubu pamtunda ndi yotetezedwa kuti chubu ikhale yosungidwa bwino. Thupi likatha, wodwalayo ayenera kugwira ntchito yopuma yekha.
Musalowetsetu / Osayambiranso
Odwala ena amadziwitsa zofuna zawo pogwiritsa ntchito malangizo apamwamba, chikalata chomwe chimasonyeza bwino zofuna zawo zaumoyo. Odwala ena amasankha "osalowetsa" njira, zomwe zikutanthauza kuti safuna kuikidwa pamphepete kuti apitirize moyo wawo. Musabwererenso kumatanthauza kuti wodwala amasankha kuti asakhale ndi CPR.
Wodwala ali ndi ulamuliro pa chisankho ichi, kotero iwo angasankhe kusinthira kanthawi kokha chisankho ichi kuti apite opaleshoni yomwe imafuna mpweya wabwino, koma iyi ndilo lamulo lovomerezeka lomwe silingasinthidwe ndi ena pansi pa chikhalidwe.
Mawu Ochokera
Kufunika kokhala ndi malo otsekemera ndi kosavuta kumakhala ndi anesthesia wambiri, kutanthauza kuti opaleshoni yambiri idzafuna mtundu uwu wa chisamaliro. Ngakhale pakuwopsya kuganizira kuti muli ndi mpweya wabwino, odwala opaleshoni ambiri akupuma okha mkati mwakumapeto kwa opaleshoni. Ngati mukudandaula kuti muli ndi mpweya wochitira opaleshoni, onetsetsani kuti mukukambirana zakukhosi kwanu ndi dokotala wanu opaleshoni kapena munthu amene mumapereka mankhwalawa.
> Chitsime:
> Endotracheal Intubation. Medline Plus. https://medlineplus.gov/ency/article/003449.htm