Izenzo Zomlando Nezikhono Ezinhle Zokulimala Komgogodla
Umkhawulo wokunyakaza komgogodla usetshenziselwa ukunciphisa ukuphathwa kwekholomu yomgogodla futhi uvikele, ngangokunokwenzeka, intambo yomgogodla ekuqhubekeni okuqhubekayo ngemva kokulimala komgogodla. Leli gama liye lazungeze kusukela ngawo-1980, kodwa liye laguqukela ukusho into ehluke kakhulu kuncazelo yayo yangempela.
Ekunakekelweni kwangaphambi kwe-prehospital, umqondo wokuvinjelwa kwamagogasi ukuvimbela umgogodla endaweni yokungathathi hlangothi ngokuhambisana nesisekelo sesiguli.
Ukugcina isisekelo sesiguli kuyinto ebaluleke kakhulu ekuvinjeni kokunyakaza komgogodla. Zonke iziguli zihlukile, futhi noma yikuphi ukuzama ukuhambisa umgogodla wesikhala kulokho okubhekwa njengokuthi "okuvamile" isimo se-anatomical kubeka ingozi yokubeka ingcindezi ezindaweni zomgulane weziguli ezingalimala noma ukuhambisa umgogodla olimale kude kakhulu ukulungiswa okuvamile.
Ukuze siqonde ngempela iziqu zokuvimbela ukunyakaza komgogodla nokuthi yini esizama ukuyifeza, kuyasiza ukwazi umlando nokuziphendukela kwemithi yokulimala kwangaphambi kokulimala komzimba.
Ukuguqulwa kokuqapha kwamagciwane
Ekuqaleni, kwakukhona ukukhubazeka komgogodla. Lokho kwakukulindeleke okujwayelekile kwanoma yimuphi umhlinzeki wangaphambi kokubeletha ngezinsizakalo eziphuthumayo zezokwelapha (EMS) ukuphatha ukulimala okusemangcwabeni okusolwa. Ezincwadini eziningi zokuqala kanye nasemaphephandabeni embonini, ukulimala okuqondile kwakubizwa njalo ngokuthi ukulimala kwesibeletho somlomo wesibeletho futhi inqubo yangempela yayivame ukubizwa ngokuthi i-cervical spine (noma c-spine) immobilization.
Ukulimala komgogodla okusolwa kuqalwe njengesivivinyo esekelwe ekunikisweni. Lokhu kusho ukuthi izigulane zeziguli zazingenakulinganiswa nje kuphela njengempendulo yamasu azo okulimala . Esikhundleni salokho, ukukhubazeka komgogodla kwasetshenziselwa iziguli ezinezinhlungu zentamo emva kokulimala okukhulu (ukuwa isikhathi eside noma ukushayisana kwemoto, isibonelo), ubufakazi bokukhubazeka , noma ukungazi .
Abaphenduli bokuqala bokuqala babe nezinqubo ezahlukene ezazibhekwa njengezibalulekile ngokwanele ukuze kuqinisekiswe ukuphothulwa komgogodla. Ezingxenyeni eziningi zezwe, ukuwa kwezinga eliphansi komhlaba akuzange kubhekwe ngokwanele isizathu sokuvimbela umgogodla wesiguli, kaningi ngisho nasebuhlungu bezintamo nobufakazi obucacile bokuthi isiguli sashaya ikhanda lakhe.
Ekhulwini lokugcina lama-1980, ama-anecdotes weziguli ezaziwa kamuva ngokuthi "ukusebenzelana nemimoya" izibeletho zomgogodla wezilwane eziphuthumayo zaholela odokotela bezimo eziphuthumayo eziguli ezilandelanayo ngokulandela cishe noma yikuphi ukulimala okungenzeka kube nokuhlukunyezwa okubangelwa ikhanda noma i- whiplash umphumela (ukushaya ikhanda emuva nangaphandle, ukubeka ingcindezi entanyeni). Iziguli zizoletha umnyango ophuthumayo ukukhononda ubuhlungu bentamo ngemva kokukhishwa ekuhambeni kwangaphambili. Iningi lalezi ziguli liye laphulukiswa ngoba ngaleso sikhathi lalibhekwa njengendlela encane yokulimala nezikhalazo ezincane. Ezinye zalezi ziguli zitholakale zine-cervical spac fractures e-ray ray ngemva kokuba zibuyele ku-ER.
Njengoba izintuthwane eziningi zabaguli zifakwe emnyangweni we-x-ray, kutholakala ukuhlukana okuningi. Kwacatshangelwa ukuthi kwakulula ukuhlukumeza ama-vertebrae kunalokho okucatshangwa ekuqaleni.
Njengoba kuqhutshwa kwezinye izimo ngenxa yokwesaba ukuhlukunyezwa kwamacala okuhlukumezeka, ama-docs ophuthumayo akhulisa umvuthwandaba we-collar x-rays kuze kube yilapho ebonakala khona kuyo yonke into esuka emhlabathini-phansi ahlaselwa amanxeba.
Ukuqeqeshwa kwe-prehospital kwacaca ukuthi noma yikuphi indlela engakwazi ukubeka ingcindezi entanyeni yabonisa isidingo sokumisa imfucuza. Ama-EMT kanye nezimo eziphuthumayo bafundiswa ukuthatha ukulimala komgogodla kunoma yisiphi isiguli esawela futhi sokuwa njengendlela yokulimala kunoma yisiphi isiguli esasikhulume ngokungenalutho.
Igama elithi immobilization yokugaya umgogodla lenze indlela yokugwema umgogodla njengoba ukwelashwa kwafana ne-oxygen.
Ukugxila komgogodla kubhekwa ukuthi kunezinyawo ezilinganayo nokulawulwa kwamanzi kanye nokulawulwa kwegazi kulesi siguli esibuhlungu.
Ukunciphisa ama-X-ray kuholela ekushintsheni
Zonke lezo x-ray zazibiza kakhulu futhi zingase ziveze iziguli emisebeni engadingekile. Amaqembu amabili azimele odokotela athuthukise amathuluzi okuhlola ukusiza odokotela abaphuthumayo ukuthi babone iziguli ezidinga ngempela ukuba nezintamo zazo zixakwe. Ukubusa kwe-NEXUS kanye nokubusa kweCanada C-Spine kwamanye amazwe basebenza ngokungazelelwe eminyangweni ephuthumayo e-US naseCanada.
Ama-paramedics akhula asola ukuthi ama-ER amacillard avela amakhola abo omlomo wesibeletho futhi aphikisana nezinhloko zeziguli. Lapho lo mkhuba uthola ukusetshenziswa okubanzi, izimo eziphuthumayo zaqala ukungabaza ukuthi kungani isiguli kufanele sibekwe ekuqapheleni komgogodla ensimini nje ukuze kube nezidakamizwa eziphuthumayo zisuse imishini emgwaqweni we-ER.
Ngokushesha, kwenziwa ucwaningo ukuze kuhlolwe ukusetshenziswa kwamathuluzi njengendlela yokubikezela ukuthi iziphi iziguli ezidingekayo ukuba zingenakwenzeka endaweni yokuqala. Ama-paramedics ahlolwe ukuhlola ukuthi singakwazi yini ukubona iziguli kanye nama-ER amarekhodi. Phakathi neminyaka eyishumi yokuqala yalekhulu leminyaka, izinhlelo ze-EMS ezungeze i-US zazingenakwenzeka njengokuthi "zingacacisi" izikhala zomlomo wesibeletho esimweni sokuqala.
Ukubuza isimo Isimo Quo
Njengoba ukukhanya kukhanya kakhudlwana emzimbeni wokugwinya komgogodla noma izigwegwe zomgogodla, abahlinzeki abathile be-prehospital kanye nodokotela baqala ukuyibuza lo mkhuba ngokuphelele. Ukusetshenziswa kwama-backbard okunzima kwakubi kakhulu, okuholela ezilonda ezicindezelayo kanye nobuhlungu ezigulini ezazimele zilale emabhokisini ase-ER emihoreni yamahora.
Amakholeji womlomo wesibeletho (owaziwa nangokuthi i-collar collars noma i-col-collars) ahloswe ukuvikela umgogodla womlomo wesibeletho futhi avimbele ukuhamba kwekhanda ngemva kokulimala komgogodla. Zivame ukusetshenziswa ngendlela engalungile noma ngobukhulu futhi kunobunye ubufakazi obusikisela ukuthi bangakhuphula ukucindezelwa kokungena emzimbeni ezigulini ezilimale ikhanda elivaliwe .
Ukulala emgodini oqinile ngemuva kwekhanda elivikelekile kudivayisi, ngisho nalapho i-torso ivinjiwe ngokuqinile, isebenza ngokunyakaza okukhulu ngesikhathi sokuthutha esibhedlela. I-physics elula igcizelela ukuthi ukusatshalaliswa kwesisindo nokuma komzimba wesiguli kuzokuvumela ukuba i-torso yakhe iguqule okuningi kunenhloko yayo, ibeke amandla emgodleni wesibeletho ngemuva kwesikhathi kanye nokucindezela futhi ihlukanise ama-vertebrae.
Ukuntuleka kokuhlolwa okungahleliwe, okulawulwa ukusetshenziselwa ama-backboards ezinzima kanye namakholeji womlomo wesibeletho kuye kwaholela ezinye izinhlelo ze-EMS ukunciphisa kakhulu ukusetshenziswa kwalezi zimiso ezimbili. I-San Joaquin County, California yayisistimu yokuqala ye-EMS ezweni ukwenqaba ukuvumela ama-EMT kanye nezimo eziphuthumayo ukuthi basebenzise noma baphathe amabhodi emabulensi nhlobo.
Ukunciphisa ukunyakaza kwama-spinal yanamuhla
Njengoba amabhodi abheke kanzima athole izimpilo ezintsha njengama-surfboards kanye nama-toboggans weqhwa, ukupholisa ukugwinya komgogodla kulandela indlela efanayo, okushiya ekubeni eqinile futhi kuhlelwe kube yinto echazwe ngokukhululekile futhi eyinkimbinkimbi yokulinganisa. Ngempela, abaningi abahlinzeka ngezimo eziphuthumayo bakuthola kunzima ukuloba ngokunembile izinqubo ezisetshenziselwa "ukuvimbela" ukunyakaza, okungafaka into elula njengokukhumbuza isiguli ukuba angadluliseli ikhanda.
Izindlela ezinhle kakhulu zihlanganisa ukusetshenziswa kwamasu okuhlola afana ne-NEXUS noma iCanada C-Spine Rule. Isiguli sibuzwa ukucacisa ubuhlungu obuvulekile. Uma isiguli singenabuhlungu noma ubuhlungu obubonakala bubekwe eceleni kwe-midline ukuze kuboniswe ukuthi akusikho eduze ngqo kwikholomu yomgogodla, imithi ye-paramedic ihlanganisa ikholomu yomgogodla. Uma kungabikho ububele noma ukukhubazeka okutholakala, umuthi wezokwelapha uzoqondisa isiguli ngokusebenzisa uchungechunge lwe-flexion nokwandisa, ukujikeleza, nokunyakaza okuqhubekayo entanyeni. Uma, phakathi nalokhu ukunyakaza, isiguli asikhononda ngobuhlungu obusha noma obuningi be-mediline, ukuvinjelwa komgogodla cishe kuyoshiywa.
Ukuhlola okwanele nokunembile kuncike ekwenzeni isiguli ukuxhumana nomnakekeli. Uma isiguli singaphansi kotshwala noma izidakamizwa, losizo lwezempilo kumele lugcine futhi lube nokusola okukhulu ngokulimala komgogodla. Ngisho nakuleso senzakalo, noma kunjalo, losizo lwezokwelapha lungase lungakhethi ukusebenzisa i-backboard ne-collar eqinile yokunakekela umgogodla.
I-tenet yokumisa umgogodla kunokuvimbela umgogodla ukukwazi ukuguqula umgogodla we-collar. Esikhundleni sokuqamba amanga futhi uboshwe ngokuphepha kwi-backboard, iziguli zivame ukuhlala zihlezi phezu kwe-gurney kanye nekhola elithambile libekwe ngaphezulu isikhumbuzi sokungahambisani kunoma yikuphi ukuvinjelwa okuphawulekayo kokunyakaza.
Iziguli ezingakwazi ukulandela imiyalo futhi ezinokusola okuphezulu ngenxa yokuhlukana komgogodla ongazange zizuze kusuka kudivayisi eyaziwa ngokuthi i-split splint. Ukugcoba ukugoqa kuvumelana nemigomo yomzimba wesiguli futhi kungenza imithwalo ibe yimpumelelo ngaphandle kwemithelela engafanele yama-backboards.
Ukusetshenziswa komkhawulo wokunyakaza komgogodla kunokuba ukukhulelwa komgogodla kuyisinyathelo esifanele ekunakekelweni kokulimala komgogodla.
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