Lokho odokotela nabahlengikazi abalindelayo
Iziguli ezinezifo ze-neurological zihlukile kwezinye izinhlobo zeziguli. Ngenxa yokuthi inkinga yabo ihilela isimiso sabo sezinzwa, zijwayele ukuthuthukisa izinhlobo ezithile zezinkinga. Inzuzo ye-ICU yezinzwa ukuthi odokotela nabahlengikazi banokuqeqeshwa okukhethekile okubenza baqonde kangcono futhi baphathe izinkinga ezinjalo uma bevuka.
Hyponatremia
Izifo ze-neurological zingabangela ukukhululwa kwama-hormone okushintsha ukuhlushwa kwe-sodium egazini, eyaziwa ngokuthi i- hyponatremia . Lokhu kuyinkimbinkimbi kusukela ekugxilweni kwe-sodium engaphansi kwegazi kungabangela uketshezi ukuvuza emathisini obuchopho futhi kuhlase i-edema nokuvuvukala. Kunezindlela ezimbili eziyinhloko ukulimala kobuchopho okuholela ku-hyponatremia: isifo se-hypersecretion engavumelekile ye-hormone (SIADH) kanye nosawoti we-cerebral ukuchitha isifo se-syndrome (CSWS).
I-SIADH ihlobene ngempela namazinga aphezulu asemzimbeni emzimbeni, futhi i-CSWS impela idala amazinga aphansi ngokungavamile we-sodium yomzimba. Ngamanye amazwi, kanti izinkinga ezimbili zingabangela ukubaluleka kwebhu elifanayo, empeleni zihluke kakhulu futhi zidinga ukwelashwa okuhlukile.
I-Deep Vein Thrombosis
Kunezici ezintathu eziyinhloko zokubeka ingozi emathunzini egazi: i-stasis, ukulimala kwamasongo, kanye nokusetshenziswa kwe-hypercoagulability.
Stasis kusho ukuthi awuhambisani kakhulu.
Yingakho izindiza zikhuthaza abagibeli ukuba bavuke njalo ngezikhathi ezindizayo bese behamba bezungeza ikamelo. Ukuhlala ude kakhulu kungabangela ukuthi ama-clots egazi akhiwe emithanjeni yemilenze yakho. Uma lezi zindwangu ziphuka emilenzeni, zikwazi ukuhamba zifike emaphashini bese zidala ukuphazamiseka kokuphazamiseka kwamapulmonasi .
Ukulimala odongeni lwesitsha segazi kungabangela ukuthi ama-clots akha, njengoba kunjalo nangokwenqamuka kwamagciwane . Okokugcina, abanye abantu banegazi elijwayele ukwenza ama-clots futhi, ngenxa yalokho, engozini yokwanda kwe-thrombosis ye-vein ne-embolism ye-pulmonary.
Iziguli ezinama-ICU ezinengqondo zijwayele ukuthuthukisa ama-blood clots. Ngenxa yesifo sabo, abantu abakhubazekile noma abahamba ngamanqamu akuhambanga . Ngaphezu kwalokho, abanye abahlukumezekile babe nesifo sochungechunge lwe-ischemic ngoba banegazi elikwazi ukwenza ama-clots. Izisulu zokuhlukunyezwa kwekhanda kungenzeka zenze umonakalo owengeziwe ezindongeni zegazi.
Ukuqhubeka nokucindezela lolu daba ngumbuzo walokho okufanele ukwenze uma othile evula i-clot yegazi ngenkathi ese-ICU ukuze aphuluke ebuchosheni babo. Isibonelo, ukubola kwesimiso esinqunyiwe kwamanye amazwe kuhlotshaniswe nengozi ephezulu kakhulu ye-thrombosis ejulile ye-vein. Ama-blood clots avame ukuvinjelwa ngokunikeza igazi abanomzimba ofana ne-heparin, kodwa lezi zidakamizwa zingaba zimbi kakhulu. Indlela yokuphatha lezi zingozi ezikhuphisanayo kungaba yisinqumo esinzima.
Ukuphefumula
Lapho ubhekene nesimo esiphuthumayo, odokotela bafundiswa ukugxila kuma-ABC - ukuhamba, ukuphefumula nokuhambisa. Okubaluleke kakhulu kulezi zinto yi-airway.
Ngaphandle kokuba imibhalo esivumela ukuba siphefumule ivulekile, akukho okunye okubalulekile. Ngisho nokushaya kwenhliziyo kaningi kubaluleke kakhulu ngokushesha. Ukufakela into emaphashini angahlosiwe ukuba abe khona eyaziwa njenge- aspiration , futhi ingabeka umuntu phezulu ngezifo ezimbi.
Abaningi bethu benza izinto ezincane njalo njalo ihora ukuqinisekisa ukuthi indlela yethu yokuhamba emoyeni ihlala ivulekile. Isenzo esilula esingenzi lutho sokugwinya umquba, isibonelo, siqinisekisa ukuthi amabhaktheriya emilonyeni yethu ayengena emaphashini ethu futhi aqhube ube yi-pneumonia . Sibubula ngezikhathi ezithile ukugcina izifunda ezincane zamaphaphu ethu zingawa. Uma sizizwa sikhalaza ngemuva komphimbo wethu, sikhohlela.
Abantu abonakalise izinzwa ezilawula udonga lwaso esifubeni, imfucuza, ulimi noma umphimbo kungase kube nenkinga yokwenza lezi zenzo ezilula, ezingaziwa. Umuntu othile ku-coma angeke enze noma iyiphi yalezi zinto noma. Enyunithi yokunakekelwa okujulile, lezi zinto zenzelwe ochwepheshe nabahlengikazi abanamasu afana nokuluthwa, ukwelapha ukuphefumula, nokukhwehlela kokufakelwa.
Ukutheleleka
Amayunithi okunakekelwa okujulile yilapho abantu abagulayo abagulayo banakekelwa khona. Lokhu kusho nokuthi ama-ICU avame ukutholakala lapho amabhaktheriya anzima kakhulu futhi ayingozi kakhulu atholakala khona. Ngenxa yokusetshenziswa kaningi kwama-antibiotic aqinile kuma-ICU, amanye alawa ma- bacterium aguqukile ukulwa namagciwane , okwenza kube nzima kakhulu ukwelashwa.
Abasebenzi bezokwelapha baqeqeshwe ukusebenzisa zonke izinyathelo zokugwema ukusabalalisa ukutheleleka, kubandakanya ukugeza izandla kanye nezinye izingubo kanye namaski kanye. Kodwa-ke, akukho ukunqanda okusebenza ngamaphesenti angu-100 esikhathi, kanti ngezinye izikhathi izifo zithwala naphezu kwalokhu okuqapha. Ngenxa yalesi sizathu, abasebenzi bezokwelapha babheka iziguli eduze nezibonakaliso zokutheleleka. Ngaphezu kwalokho, kwenziwa imizamo yokuhambisa isiguli endaweni engavamile, njengesitezi esibhedlela esivamile, ngokushesha nje ngangokunokwenzeka.
State Acoustic Confusional
Isimo esiyinkimbinkimbi esiyinkimbinkimbi, esaziwa nangokuthi i- delirium noma i-encephalopathy, ingenye yezinto eziphazamisa kakhulu iziguli noma abathandekayo babo abathola esibhedlela. Ngeshwa, nenye yezinto ezivame kakhulu. Amaphesenti angama-80 weziguli eziphuthumayo kuma-ICU ahlangabezana nalesi simo. Umuntu udidekile mayelana nokuthi ukhona, ukuthi ukuphi isikhathi, nokuthi kwenzekani. Bangase bangaboni abangane noma umndeni. Bangase bahlenge, noma babe yi-paranoid. Ngezinye izikhathi lokhu kuholela emizamweni yokubalekela esibhedlela noma ukukhipha ama-tubes nama-IV okudingeka agcine isiguli siphila.
Ukwelashwa kwesimo esibucayi se-confusional kungaba cishe njengokucindezela njengoba kunenkinga ngoba kungabandakanya ukunikeza imithi yokwehlisa noma ngisho nokuvimbela ngokomzimba isiguli. Kodwa-ke, kunezinyathelo eziningi ezinzima kakhulu ezingathathwa ukuphatha ukudideka ngaphambi kokuthi ziphume.
Isimo esincane se-Epilepticus
Lapho abantu abaningi becabanga ngokuthunjwa, bacabanga ukuthi othile uthuthumela ngamandla. Kunezinhlobo eziningi ezingenangqondo zokuthunjwa, noma kunjalo, lapho umuntu engabonakali enza okuningi kunoma yini, noma kungenzeka avele edidekile.
Noma kunjalo, laba bantu bangazuza ngemithi efanele. Ucwaningo olunye luphakamisa ukuthi abantu abangaba ngu-10% kuma-ICU bangase babe nokuhlukunyezwa okuvame ukungaqondakali, futhi lokhu kukhula cishe kuphakeme kwiziguli ezinezinkinga zezinzwa.
I-Dysautonomia
Isistimu ye-neon autonomic ayinamazwi futhi ngokuvamile ayakwaziswa. Le yingxenye yesimiso sezinzwa esilawula izinga lenhliziyo, ukuphefumula, ukucindezeleka kwegazi, nokuningi. Njengoba nje izifo ze-neurological zingashintsha imisebenzi esivame ukucabanga ngayo, njengokunyakaza nokukhuluma, ezinye iziphazamiso zingathinta isimiso sezinzwa ze-autonomic.
Izinkinga ezibalwe ngenhla zivame ukutholakala ezinhlobonhlobo zezifo ezehlukene ezenza umuntu abe ne- ICU yezinzwa . Nakuba zingatholakala kwamanye amayunithi okunakekelwa okujulile, abanye ochwepheshe bangase bangajwayele ukukhomba nokulawula lezi zinkinga. Ngenxa yalesi sizathu, i-neuro-ICUs iboniswe ukuthi iyigugu ekwelapheni abantu abanesifo esibucayi sezinzwa.
Imithombo:
U - Allan H. Ropper, uDaryl R. Gress, uMichael .UDiringer, uDeborah M. Green, uStephan A. Mayer, uThomas P. Bleck, Ukunakekelwa Kwezinzwa Neurosurgical Intensive, I-Fourth Edition, uLippincott Williams & Wilkins, 2004
I-Braunwald E, Fauci ES, et al. Izimiso zikaHarrison zeMithi yangaphakathi. 16th ed. 2005.