Izimo okumelwe zihlangane ngaphambi kokuba kutholakale ukuxilongwa
Kuningi ekulahlekelweni kokwazi kunokungapheli. Ukulala kanye ne-coma, isibonelo, kuhilela ukulahlekelwa kokuqonda futhi ikakhulukazi kuchazwa isikhathi esithatha ukubuyela ekuzileni. Ngisho nomuntu osesimweni sokuphika kwezitshalo (PVS ) unethuba lokuthi, noma ngabe lincane, lokuvuka.
Ukufa kwengqondo kuhlukile. Njengoba leli gama libonisa, ukufa kobuchopho kubonisa ukuthi akukho msebenzi wobuchopho futhi, ngaleyo ndlela, akukho nethemba lokubuyiselwa.
Ukukhuluma ngomqondo, ukufa kobuchopho ukuxilongwa ngokucacile kokufa .
Ukuqonda Ukufa Kwebongo
Ngokungafani nezinye izinhlobo zokulahlekelwa, ukufa kwengqondo kuhilela ukulahlekelwa okuphelele komsebenzi we-brainstem. Lokho kusho ukuthi uhlelo olusebenzayo olusebenzayo -inethiwekhi ehambayo yezinzwa ezixhuma intambo yomgogodla nobuchopho-ibonakaliswe ngokungenakuqondiswa. Liphinde ikhombisa ukuthi izingxenye zobuchopho ezilawula ukuphefumula kanye nomsebenzi wenhliziyo ziye zabhujiswa ngokungenakuqhathaniswa.
Ukufa kwengqondo kungaba umqondo wokuthi abanye abantu bakuthola kunzima ukuwaqonda. Ngoba ngokwemvelo sihlobanisa ukufa ngenhliziyo eyekile ukushaya, ngokuvamile siwaqaphele ukuthi yilophi ubuchopho obunikeza imiqondo "egijima" inhliziyo.
Ngenkathi imishini yokusekela impilo ingasetshenziswa ukugcina ukuphefumula nokusabalalisa, ayikho idivaysi enjalo engagcina ubuchopho bugijima. Ekugcineni, uma ubuchopho bufa, wonke umzimba uzokulandela.
Ukuthola Ukufa Kwebongo
Kunemibandela eminingi okumelwe ihlangane ukuze ukufa komqondo kukhishwe. Nakuba imithetho yombuso noma yendawo ingadinga izenzo ezengeziwe, ukwakha ukuxilongwa kwamukelwe emhlabeni wonke njengokwakheka. Ngamafuphi, ukumemezela umuntu othile ubuchopho-abafile:
- I-coma kumele ingenakuguqulwa ngenye imbangela eyaziwayo noma eseduze.
- Umuntu akumele abe ne-reflexes ye-brainstem.
- Umuntu akanalo umsebenzi wokuphefumula.
Zonke izimo ezintathu kufanele zaneliswe ngokufa kwengqondo okuzokwaziswa.
Ukusungula ukungenakusiza kanye nenhloso yeComa
Ngaphambi kokuba udokotela anganquma ukuthi i-coma ayinakuphika yini, kufanele athole ukuthi kukhona yini indlela yokuyibuyisela emuva. Ukuze wenze kanjalo, ithimba lezokwelapha kumele liqale ukukhomba imbangela (noma imbangela enkulu) ye-coma.
Ngaphezu kwalokho, leli qembu kumele lishiye noma yisiphi isimo esingase silingise ukufa kobuchopho, njenge- hypothermia , ukuxoshwa kwezidakamizwa noma ubuthi, ukungavamile kwezidakamizwa, noma amanxusa e-neuromuscular angabangela "ukufa okufana" nokukhubazeka. Konke lokhu, ngezinga elihlukahluka, kungabuyekezwa.
Ukusungula ukungahambi kahle kwe-coma kudinga ukuthi udokotela alinde isikhathi esifanele-esekelwe imbangela eyaziwayo noma eseduze. Ukuzimisela okumelwe kuhlangabezane namazinga wezokwelapha nezomthetho. Kulo mbono, igama elithi "ukusondela" libonisa ukuthi imbangela kufanele isungulwe ngokwanele futhi isekelwe uma ingaziwa kakade.
Ukusungula ukungabi khona kwe-Brainstem Reflexes
I-Brainstem reflexes yizimpendulo ezizenzakalelayo ezingafani nezezivivinyo zama knee-jerk ezinikezwe ehhovisi likadokotela.
Ziyizenzo zokucabanga ezibonisa ukuthi umsebenzi womuntu womzimba ungojwayelekile, awuvamile noma awukho.
Umuntu ubhekwa njengengqondo-efile uma engakwazi ukuphendula kuzo zonke lezi zinto ezilandelayo:
- Ukuntuleka kwe-pupillary reflex kusho ukuthi abafundi bomuntu abaphenduli nganoma iyiphi indlela lapho ukukhanya kukhanya kubo. Uma lo muntu ephilile, abafundi bangathola amancane.
- Ukuntuleka kwe-refletic corneal kusho ukuthi lo muntu akaxhumi futhi abe nempendulo lapho udokotela ethinta iso nge-swab yekotini noma ukudonsa kwamanzi.
- Ukuntuleka kwe-reflex oculocephalic (eyaziwa nangokuthi i-"doll's eye" reflex) kusho ukuthi amehlo omuntu ngeke akwazi ukulungisa ubuso bomhloli lapho ikhanda lakhe lisuswa khona .
- Ukuntuleka kwe-gag reflex kusho ukuthi lo muntu ngeke agwebe, akhonce noma asebenze lapho emuva komphimbo uthintwa nge-swab yekotini noma idivayisi yokuxubha.
- Ukungabi nampendulo ekuhlolweni kwe-caloric okubandayo kusho ukuthi umuntu ngeke aphendule lapho amanzi e-ice agxila ezindlebeni. Uma lo muntu ephilile, le nkinga ingabangela ukuba amehlo omuntu ahambe ngendlela ehlukile njengoba "enza kahle" indlebe yangaphakathi ekucabangeni ukuthi umuntu uphahla.
Ukusungula ukungabikho komsebenzi wokuphefumula
Isinyathelo sokugcina ekuqaliseni ukufa kobuchopho ukuhlolwa kwe-apnea. I-apnea yigama lezokwelapha lokumiswa kokuphefumula futhi lisetshenziswe kulokhu ukuze kuqinisekiswe ukuthi ukumiswa kungunaphakade.
Ukuze enze ukuhlolwa kwe-apnea, udokotela wayezothatha izinyathelo ezilandelayo:
- Umuntu onomoya we-ventilator uzoxhunyaniswa ne-oximeter ye-pulse . Lona idivaysi esetshenziselwa ukukala ukugcwala kwe-oxygen egazini.
- I-ventilator iyakunqanyulwa futhi ithubhu ingeniswa emthonjeni womuntu ukuletha amaphesenti angu-100 oksijini emaphashini. Lokhu kuqinisekisa ukuthi umuntu akasoze atholakale umoya-mpilo uma ephendula.
- Ukuhlolwa kwegazi kwakungenziwa ngokushesha ukukala amagesi asezingeni eliphansi.
- Udokotela uzobe esalinde imizuzu eyisishiyagalombili kuya kweyishumi ukuze abone ukuthi kukhona yini impendulo evela esigulini.
- Emva kwemizuzu eyisishiyagalombili kuya kweyishumi, amagesi egazi aphinde ahlolwe.
Uma kungekho ukunyakaza kokuphefumula kanti i- PaCO2 (ukucindezelwa kwe-carbon dioxide emithanjeni) iye yanda ngaphezu kuka-60-okusho ukuthi akuzange kube khona ukushintshaniswa kwe-oxygen ne-carbon dioxide emaphashini-lowo muntu uzobikwa ukuthi ubuchopho-bufile.
Uma ngakolunye uhlangothi, ukunyakaza kokuphefumula kuyabonakala, khona-ke lowo muntu akakwazi ukubhekwa njengengqondo-efile. Uphenyo olwengeziwe luyobe selwenziwa ukuze kubone ukuthi yini, uma kukhona, engenziwa ukuze iguqule lesi simo.
Izivivinyo ezengeziwe
Uma kuhlolwa okuphelele komtholampilo (kubandakanya ukuhlolwa kwe-brainstem reflexes nokuhlolwa kwe-apnea) nokufa kwengqondo kukhishwa, akudingeki ukuhlolwa okwengeziwe. Ngalokho kuthiwa, ngenxa yobungcwaba obunjalo, izibhedlela eziningi namuhla zidinga ukuthi ukuhlolwa okuqinisekisiwe kwenziwa ngudokotela oqeqeshiwe ohlukile emva kwesikhathi esabelwe ngaso.
Kwezinye izimo, ukuhlolwa okwengeziwe kungenziwa uma ukulimala ebusweni, ukulimala komgogodla, noma ezinye izici kwenza kube nzima ukuqeda ukuhlolwa okujwayelekile. Lezi zivivinyo ezengeziwe zinganikeza amalungu omndeni ngesinye isiqiniseko sokuthi ukuxilongwa okulungile kwenziwe.
> Umthombo:
> Wijdiks, V .; UVarela, uP .; Gronseth, G. et al. "Isibuyekezo esisekelwe ekuqondiseni iziqondiso: Ukunqunywa kokufa kobuchopho kubantu abadala - Umbiko weKomidi Lezilinganiso Zezilinganiso ze-American Academy of Neurology." I-Neurology. 2010; 74 (23). I-DOI: 10.1212 / WNL.0b013e3181e242a8.