Syndrome de compartiment acute, Tight Cast Emergencies, ani 6 Ps Triage¶

Syndrome de compartiment acute (ACS) ye opereli kɔrɔtɔlen ye min bɛ se ka kɛ sababu ye ka farikolo yɔrɔw ni ɲɛnamaya bila farati la, funu walima joli bɔli farikolo yɔrɔ dagalen kɔnɔ, min tɛ wuli, o bɛ joli mikoroskɔpikɛlen bali ka taa kolotugudaw ni farikolo yɔrɔw la. Ni aw bɛ sigasiga ko mɔgɔ dɔ bɛ ka a bolokɔni, a bolo, a sen duguma, walima a sen karilen kɔfɛ, a sɔgɔsɔgɔninjɛ, a bilali sirilen kɔfɛ, walima a opereli kɔfɛ, aw bɛ aw ka sigida wele kɔrɔtɔko nimɔrɔw o yɔrɔnin bɛɛ. Ni aw bɛ bolifɛn kɔrɔtɔlen makɔnɔ, aw bɛ segin ka ɲɛsin joginda bilasirali ma min bɛ tali kɛ o la joginni min bɛ kɛ ni fɛn dɔ ye min bɛ mɔgɔ sɔgɔsɔgɔ ani min bɛ wele ko compartiment syndrome, . kolo karilenw ni kurukuruw, ani da wulilenw karilenw ani farikolojidɛsɛ sɛgɛsɛgɛli.

Ni opereli ma kɛ ni degun tɛ (fasciotomie) walima ni cast tilalen don teliya la lɛri 4 fo lɛri 6 kɔnɔ bana taamasiɲɛw daminɛ kɔfɛ, farikolo yɔrɔw tansiyɔn jiginni bɛ farikolo yɔrɔw tiɲɛ kudayi, ka kɛ sababu ye ka farikolojidɛsɛ bila mɔgɔ la min tɛ se ka segin kɔ, ani ka kɛ sababu ye ka bolokɔniw tiɲɛni banbali kɛ i n’a fɔ nɛgɛbere (Volkmann ischemic contracture) walima ka a tigɛ. O waati kelen na, farikolo min bɛ sa, o bɛ potasiyɔmu ni miyɔglobini bɔ joli la, o bɛ sugunɛbaralabana jugumanba ni dusukun jɔli bagabaga.

Aw bɛ o kɛ sisan¶

1. I ka sigida kɔrɔtɔko nimɔrɔ wele walima ka segin kɔrɔtɔko ɲɛmɔgɔso la joona. I ka 911 wele Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri, 000 Ɔsitarali, walima an ka lisi lajɛ kɔrɔtɔko nimɔrɔw. Aw bɛ a fɔ ka jɛya ciden walima triage infirɛri ye ko dimi jugumanba bɛ banabagatɔ la, min bɛ ka juguya ka taa a fɛ, a karilen kɔfɛ, a joginlen kɔfɛ, walima a bilali kɔfɛ, wa a mago bɛ opereli la joona ka a lajɛ ni a ka kan ka kɛ ni acute compartiment syndrome ye.
2. Aw bɛ lasɔmini taamasiɲɛ fɔlɔ fila sɛgɛsɛgɛ: dimi min tɛ bɛn a hakɛ ma ani dimi min bɛ kɛ ni a ma kɛ ni a ma kɛ. Aw bɛ banabagatɔ bolokɔninw walima a senkɔniw kɔrɔta dɔɔni dɔɔni (aw bɛ u lamaga aw yɛrɛ la ka banabagatɔ lafiya) walasa ka farikolo yɔrɔw lamaga bolokɔni, bolokɔni, misiden walima sen joginlen kɔnɔ. Ni lamaga-lamagali nɔgɔman bɛ dimi jugumanba bila farikolo kɔnɔbara kɔnɔ, ka dimi jugumanba bila mɔgɔ la, aw bɛ bolokɔni in furakɛ i n’a fɔ active compartiment syndrome kɔrɔtɔlen hali ni bolokɔnincininw walima senkɔniw bɛ pinki ani ka sumaya hali bi.
3. Aw bɛ lamini bandiw bɛɛ lajɔ walima ka u tigɛ, ka finimugu sirilenw, ani fini sirilenw bɛɛ lajɔ fo ka se fari jɛlen ma. Aw bɛ bandi sirilenw bɛɛ lajɔ (ACE wraps), ka gaze sirilanw tigɛ minnu tɛ gɛlɛn ye, ka Velcro sirilanw lajɔ o yɔrɔnin bɛɛ. Ni bolokɔni sirilen don ni pilatiri gɛlɛn walima fibreglasi ye, aw bɛ teliya ka cast bivalving ɲini (ka bɔgɔdaga kɛrɛ fila bɛɛ tigɛ ani ka cotton padding jukɔrɔla bɛɛ tigɛ ka jigin fo ka se fari jɛlen ma) ni aw sera dɔgɔtɔrɔso la.
4. Aw bɛ bolokɔni min bananen don, aw bɛ o bila ka ɲɛ ka a kɛ dusukun hakɛ la. Aw bɛ bolokɔni walima sen lafiɲɛ ka a kɛ barajuru walima tabali kan, banabagatɔ disi janya tigitigi. Aw kana bolokɔni kɔrɔta abada ni a bɛ siga ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ ko a bɛ se ka kɛ.
5. Aw bɛ jisumamuguw, nɛnɛ furakɛlilanw, ani nɛnɛmadalanw bɛɛ bɔ senkɔni na joona. Nɛnɛ bɛ kɛ sababu ye ka joli siraw sɔgɔsɔgɔ, o bɛ dɔ bɔ oksizɛni tali la ka taa a fɛ farikolo yɔrɔw la minnu bɛ kɔngɔ la, degunba yɔrɔ kɔnɔ. Aw bɛ senkɔni to a la so funteni hakɛ bɛnnen na.
6. Aw bɛ banabagatɔ to a da la (aw kana dumuni walima minfɛn foyi kɛ). Ikomi furakɛli dafalen bɛ opereli kɔrɔtɔlen kɛ opereli yɔrɔ la ni anesteziba ye walima ni anestezi ye, aw kana dumuni, ji walima daji di banabagatɔ ma ka opereli jateminɛ makɔnɔ.

Desizɔn jiri : ka bolokɔniw dimi jugumanba jateminɛ, ka sɔgɔsɔgɔninjɛ siri, ani ka 6 Zaburuw¶

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    EarlyCheck -->|"ƆWƆ ka ɲɛsin taamasiɲɛ fɔlɔ ƝƐNABƆLI ma"| Emergency["ACTIVE COMPARTMENT SYNDROME EMERGENCY: Lɛrɛ 4 fo sanga 6 Salvage Window"]

    EarlyCheck -->|"AYI: Dimi dɔɔni dɔrɔn, dimi tɛ kɛ ka a senw kɔrɔta, a bɛ kɛ ni dusukunnata dafalen ye"| Routine["Aw bɛ farikolojidɛsɛ taamasiɲɛw kɔlɔsi miniti 30 fo miniti 60 o miniti 60 ani ka dɔ fara a kan ni dimi juguyara"]

    Emergency --> CallEMS["1. Aw bɛ kɔrɔtɔko baaradaw wele (911 / 112 / 999) walima ka ED Triage lasɔmi joona"]
    CallEMS --> CheckWrap{"2. Yala senkɔni bɛ bandi sɔgɔlen, sɔgɔsɔgɔninjɛ walima bandi elastiki kɔnɔ wa?"}

    CheckWrap -->|"Bandi elastiki, sɔgɔlilan walima gaze sirilan"| CutAll["Aw bɛ finimugu bɛɛ dabɔ ka u tigɛ ani ka u datugu ka jigin fo fari jɛlen (A bɛ degun dɔgɔya 30% fo 55%)"]

    CheckWrap -->|"Plaster gɛlɛn walima fibre de verre cast"| Bivalve["Imediate Cast Bivalving Required: Aw bɛ cast fan fila bɛɛ tila ANI ka cotton padding 100% tigɛ ka kɛ fari jɛlen ye (A bɛ degun dɔgɔya 65% ka se 85%)"]

    CheckWrap -->|"Kɛnɛma dasiri si tɛ yen"| HeartLevel["3. Aw bɛ bolokɔni bila ka kɛ fla ye dusukun hakɛ la: aw kana a kɔrɔta abada ka tɛmɛ dusukun kan ani aw kana jisuma kɛ a la abada"]

    CutAll --> HeartLevel
    Bivalve --> HeartLevel

    HeartLevel --> Hospital["4. Aw bɛ banabagatɔ ka NPO mara opereli yɔrɔ la: Ni Delta tansiyɔn ye milimɛtɛrɛ 30 ye walima ni a ka dɔgɔn walima ni taamasiɲɛw bɛ to sen na, aw bɛ Fasciotomy kɛ teliya la"]

Banakisɛfagalanw : mun na farikolo yɔrɔ datugulenw bɛ sɔgɔsɔgɔ ka bɔ kɔnɔna na¶

Adamaden bolokɔni, bolo, sen duguma ani sen kolotugudaw, olu bɛ fara ɲɔgɔn kan n’u ka dusukunnataw ni u ka farikoloɲɛnajɛw ni joli siraw ye ɲɔgɔn cɛ, minnu bɛ ɲɔgɔn cɛ fɛnɲɛnamafagalan gɛlɛnw kɔnɔ minnu tɛ wuli, n’u bɛ wele ko fascia juguman, minnu bɛ fara kolo gɛlɛnw kan ni kolotugudaw ni ɲɔgɔn cɛ. Ikomi fasa juguman bɛ kɛ ni kolajɛni fiyɛri belebelebaw ye minnu dilannen don walasa ka farikolo sɔgɔsɔgɔli siri, a bɛ se ka kɛ zeru ye, wa a tɛ se ka wuli ni a kɔnɔna yɔrɔ fununen don.

Ni lafiɲɛ cogoya bɛnnen don, farikolo yɔrɔ dɔ kɔnɔ tansiyɔn bɛ kɛ mɛkisikalan milimɛtɛrɛ 0 ni milimɛtɛrɛ 8 cɛ (mmHg). Joli min bɛ ni oksizɛni ye, o bɛ don joli siraba belebelebaw fɛ (sistoliki milimɛtiri 100 fo 120, diastoliki milimɛtɛrɛ 60 fo 80), a bɛ woyo ka tɛmɛ kapilɛri dilan mikoroskɔpikiw fɛ (militiri 25 ka se milimɛtiri 35 ma) walasa ka oksizɛni lase farikolo ni farikolojidɛsɛbanakisɛw ma, ka sɔrɔ ka bɔ ka tɛmɛ joli siraw fɛ minnu kogo ka fin, tansiyɔn dɔgɔyalen don (ni u bɛ se milimɛtiri 10 fo 15 ma mmHg) ye.

Tansiyɔn jiginni joli siraw fɛ ani Delta Pressure sariya¶

Ni kɔnɔna jogin (i n’a fɔ senkɔni walima a cɛmancɛ karilen, farikolo yɔrɔ min tigɛlen don, sa kinni baga bɛ min na, walima joli seginni joli siraw datugulen kɔfɛ) ye joli ni farikolojidɛsɛ bila farikolo yɔrɔ datugulen kɔnɔ, walima ni bandi gɛlɛn walima bandi sirilen dɔ ye senkɔni digi ka bɔ kɛnɛma, o hakɛ latigɛlen kɔnɔna na, farikolo yɔrɔ tansiyɔn bɛ wuli kosɛbɛ.

1. Venular collapse and outflow babstruction: Ni tansiyɔn kɔnɔna bɛ wuli ka tɛmɛ 15 fo 20 mmHg kan, a bɛ tɛmɛ venules microscopiques kogo finmanw kɔnɔna tansiyɔn kan. Jibolisiraw bɛ sɔgɔsɔgɔ ka kɛ, ka joli minɛ yɔrɔ kɔnɔ ka sɔrɔ tansiyɔnba joli siraw bɛ taa a fɛ ka joli caman don a kɔnɔ.
2. Kapilari dabila ani 30 mmHg Delta Pressure threshold: Ni ji bɛ lajɛ fascial sleeve kɔnɔ min tɛ wuli, tansiyɔn kɔnɔna bɛ wuli ka tɛmɛ 30 mmHg kan. Kolotugudaw ni joginda operelikɛlaw bɛ yɔrɔ tansiyɔn jateminɛ ka kɛɲɛ ni banabagatɔ yɛrɛ ka tansiyɔn diastolic ye ni Delta Pressure (Delta P) formula: 1. .
3. Delta Tansiyɔn = Tansiyɔn diastolic minus Tansiyɔn kɔnɔna na
4. Tuma o tuma ni Delta tansiyɔn jiginna ka se milimɛtiri 30 ma walima ka dɔgɔn o ma (misali la, banabagatɔ min ka tansiyɔn bɛ se milimɛtiri 70 ma, ni tansiyɔn jiginni bɛ se milimɛtiri 40 ma, walima banabagatɔ min ka tansiyɔn jiginni bɛ se milimɛtiri 50 ma, ni tansiyɔn jiginni bɛ se milimɛtɛrɛ 22 dɔrɔn ma), kapilɛri perfusion bɛ bin pewu.
5. Oksizɛni dɔgɔyali selilɛriw la ani sɔgɔsɔgɔninjɛ jugumanba: Kɔngɔ fɛ oksizɛni na, farikolojidɛsɛbanakisɛw bɛ wuli ka taa farikoloɲɛnajɛ la min tɛ fiɲɛ bila mɔgɔ la, ka asidi laktiki dalajɛ ani ka se ka selilɛriw ka sodium-potassium pɔnpew mara. Ji bɛ boli ka don farikolokisɛw kɔnɔ ka sɔrɔ joli-sira-funu-kogo minnu tɛ oksizɛni na, olu bɛ joli bɔn ka don selilu kɔkan, o bɛ kɛ sababu ye ka yɔrɔ tansiyɔn bila ka taa a fɛ ka tɛmɛ fɔlɔ kan fo ni a kɛra ko a sɔgɔlen, a sirilan walima a fascia tigɛra ka da.

Lɛrɛ 4 fo lɛri 6 farikolo yɔrɔw ka ɲɛnamaya waati bolodacogo¶

Fɛnɲɛnɛmafagalanw ni kolotugudaw la minnu bɛ kɛ ni jiribolo ye, olu dan ka gɛlɛn biologiki la walasa ka kisi ischemie sumalen ma:

• Miniti 30 fo miniti 60 kɔnɔ: Senfagabana misɛnnin minnu bɛ boli ka tɛmɛ yɔrɔ la, olu bɛ daminɛ ka baara kɛ ka ɲɛ, o bɛ kɛ sababu ye ka pinɛw ni nɛgɛw sɔgɔsɔgɔ joona ani ka dimi taamasiɲɛw caya.
• Lɛrɛ 2 fo lɛri 4 kɔnɔ: Kolotugudaw bɛ tiɲɛni kɛ joli-sira-funu fɛ min bɛ se ka segin kɔ, ani farikolojidɛsɛ bɛ sumaya kosɛbɛ. Ni bɔgɔdaga tilalen don walima ni opereli kɛra o finɛtiri kɔnɔ, bolokɔniw baara kɛmɛsarada la, a bɛ se ka kɛ ko a bɛ kɛnɛya.
• Lɛrɛ 4 fo lɛri 6 kɔnɔ: Miyonɛkɔrɔsi min tɛ se ka segin kɔ (fasa selilɛriw ka saya) ani axonal nerve degeneration bɛ daminɛ.
• Lɛrɛ 6 fo lɛri 8 kɔfɛ: Farikolo fagali bɛ kɛ yɔrɔ bɛɛ la, o bɛ to senna. Farikolo salenw bɛ ji kɛ ka miyɔglobini ni potasiyɔmu bɔ farikolo la, o bɛ kɛ sababu ye ka... rabdomyolyse ani sugunɛ joginni jugumanba. Dɔgɔkun nataw la, farikolojidɛsɛ bɛ bila a nɔ na ni sɔgɔsɔgɔninjɛ ye min ka bon, min ka dɔgɔn, o bɛ kolotugudaw sama ka kɛ fɛn ye min bɛ to senna, min bɛ kɛ nɛnɛ ye, min bɛ i n’a fɔ nɛgɛbere, min bɛ wele ko Volkmann ischemic contracture.

The 6 Ps triage: mun na taamasiɲɛ fɔlɔw bɛ farikolo yɔrɔw kisi ani taamasiɲɛ labanw kɔrɔ ye farikolo yɔrɔw saya ye¶

Ni i ye kalan gafe taamasiyɛn wɔɔrɔ bɛɛ minɛ ("the 6 Ps") i n'a fɔ u bɛ bɛn ɲɔgɔn ma, o bɛ na ni balawu ye. Aw ka kan ka P 6 tila Kɛwale fɔlɔ taamasiɲɛw (ni bolokɔni bɛ se ka kisi hali bi kɛmɛsarada la) ani Taamasiyɛn juguman labanw (o b’a jira ko farikolo ni farikolo saya min tɛ se ka wuli, o bɛ sen na kaban).

Anatomique compartiment guide : aw bɛ se ka sɛgɛsɛgɛli kɛ cogo min na tigitigi pasif stretch ni nerve tests¶

Fɛnɲɛnɛma yɔrɔ bɛɛ la, fasa yɔrɔ danfaralenw bɛ yen. Ikomi yɔrɔ kelen bɛ se ka degun fagalen sɔrɔ ka sɔrɔ yɔrɔ kɛrɛfɛtaw tora ka nɔgɔya, n’i y’a dɔn cogo min na i bɛ se ka farikolo yɔrɔ kɛrɛnkɛrɛnnenw ni nɛrɛmuguma sɛgɛsɛgɛ bolokɔni, bolo, sen duguma ani senna la, o b’a to i bɛ farati yɔrɔ tigitigi dɔn.

1. Bolo ɲɛfɛla (yɔrɔ 3) ani bolo (yɔrɔ 10) .¶

Bolo ɲɛfɛla karilenw bɛ tugu distal radius fractures kɔ balikuw la, supracondylar humerus fractures walima both-both-bone forearm forearm fractures denmisɛnw na, sɔgɔsɔgɔninjɛ sirilen, IV extravasation, ani bolokɔniw degunni kuntaalajan ("found down"). Bolo la, yɔrɔ fitinin 10 danfaralen don (kɔfɛla naani, bolokɔni saba, thenar, hypothenar ani adductor pollicis) minnu bɛ funu sɔgɔsɔgɔli joginw kɔfɛ, senkɔniw karilen kɔfɛ, sa kinni kɔfɛ, jeninida kɔfɛ, ani pikiri kɛli ni tansiyɔnba ye, ka bolo sama ka don "intrinsic minus" posture la (kɔnɔnatumuw bɛ janya kɔfɛ, bolokɔnincininw bɛ kuru ka taa kɔnɔna na).

2. Sen duguma (dakun 4) ani sen (dakun 9) .¶

Sen duguma bɛ kɛ sababu ye ka banaw bɛɛ lajɛlen kɛmɛsarada la 40 ni kɔ sɔrɔ, minnu ka teli ka sɔrɔ tibial shaft fractures, tibial plateau fractures, blunt calf trauma in sport, tight casts, ani vascular reperfusion. Sen na, yɔrɔ 9 danfaralenw bɛ sen na (cɛmancɛ, sanfɛla cɛmancɛ, kɛrɛfɛ, adductor/calcaneal, interossei naani, ani kɔkolo) ani a ka teli ka kɛ senkɔniw na senkɔni (senkɔni kolo) karilenw, Lisfranc sen cɛmancɛ kari-bɔli, ani roll-over crush joginw kɔfɛ.

Tight cast emergencies: mun na casts bɛ farikolo yɔrɔw sɔgɔsɔgɔ ani cast splitting (bivalving) bɛ baara kɛ cogo min na¶

Ni den walima baliku ye bolo, bolokɔni, senkɔni walima sen kari, kolo joginlen ni a lamini farikolo yɔrɔ nɔgɔlenw bɛ to ka funu fo lɛrɛ 24 fo lɛri 72. Ni kurun gɛlɛn lamininen (Pari ka plastiki walima fibre de verre sintetiki min sirilen don ni degere 360 ​​ye farikolo yɔrɔ la) kɛra a la dɔɔni karilen manipule walima opereli kɔfɛ, o bɔgɔlan bɛ kɛ kɛnɛma silinda ye min tɛ wuli. Ni sɔgɔsɔgɔninjɛ kɔfɛta bɛ bonya senkɔni kɔnɔ, fari bɛ digidigi kosɛbɛ sɔgɔsɔgɔninjɛ kɔnɔna kogo gɛlɛn na, o bɛ kɛ i n’a fɔ kɛnɛma enveloppe zeru-compliance min bɛ degunw bila yɔrɔ kɔnɔ ka tɛmɛ milimɛtiri 30 kan lɛrɛ damadɔ kɔnɔ.

Faratiw sɛgɛsɛgɛli sɛbɛn ani teliya walew¶

Mɔgɔ o mɔgɔ cilen don so ni bɔgɔdaga walima sɔgɔlan ye, o tigi ka kan ka a bolokɔnincininw walima a senkɔniw lajɛ lɛri 1 fo lɛri 2 o lɛri 48 fɔlɔ kɔnɔ, ka segin joona kɛnɛyaso la ni darapo bilenman dɔw bɔra:

• Dimi min bɛ bonya sɔgɔsɔgɔninjɛ kɔnɔ min bɛ banabagatɔ kunun walima min tɛ ɲɛ miniti 30 kɔnɔ, a kɛlen kɔ ka senkɔni kɛ fla ye dusukun hakɛ la.
• Dimi bɛ kɛ ni aw bɛ bolokɔniw walima senkɔniw lamaga nɔgɔya la walima ka u kɔrɔta.
• Pinɛ-ni-minɛn kura bɛ sɔgɔsɔgɔ, ka jeni, ka sɔgɔsɔgɔ, walima ka "yɔrɔ funteni" jeni yɔrɔ dɔ la kolo ɲɛnama dɔ kan (senkɔni, senkɔni, bolokɔni, walima kɔkili).
• Bolo walima senkɔniw minnu bɛ funu kosɛbɛ i n’a fɔ sosiso, u bɛ kɛ jɛman ye walima u ɲɛ ye bulama ye, walima u tɛ lamaga kɛcogo ɲuman bɔ ("bolokɔniw kɔrɔtalen", "OK" taamasiɲɛ, walima senkɔniw kɔrɔta).
• Denmisɛn na kasi, jɔrɔ, walima dimimadafura mago min tɛ mɔgɔ dusu saalo.

Ni aw bɛ taa dɔgɔtɔrɔso la, aw bɛ ACE bandi elastiki min bɛ se ka bɔ, aw bɛ o siri joona sɔgɔlan kan. Ni aw bɛ fɛnɲɛnamafagalan gɛlɛn dɔ sɔrɔ, aw bɛ a fɔ dɔgɔtɔrɔso triage infirɛri ye o yɔrɔnin bɛɛ aw selen: "Cast emergency: suspected acute compartment syndrome, needs immediate cast bivalving." Aw kana coat hangers walima pens siri abada cast kɔnɔ, o min bɛ padding bunches into pressure wads.

Mun na aw ka kan ka senkɔni to dusukun na (ani mun na a kɔrɔtalen ni jikuruw ye farati ye) .¶

Danfara nafama dɔ min bɛ dɛmɛ fɔlɔ kɛcogo kɔrɔlenw ni ɲɔgɔn cɛ ka ɲɛsin sɔgɔsɔgɔninjɛ nɔgɔman ma ani kɔrɔtɔko ladonni ni siga bɛ a la ko bana jugumanba bɛ u la, o ye bolow jɔcogo ni u funteni ye:

1. Mun na farikolo yɔrɔ kɔrɔtalen bɛ dusukun Sanfɛ, o ye farati ye: Ni yɔrɔ kɔnɔ tansiyɔn wulila ka taa milimɛtɛrɛ 30 la fasa yɔrɔ datugulen kɔnɔ, yɔrɔ kɔnɔ jolisiraw bɛ pinɛ kaban ka datugu ni farikolo yɔrɔw tansiyɔn ye, o la kɔrɔta tɛ se ka yɔrɔ ji min sirilen don, o bɔ. O nɔ na, ​​ni aw ye senkɔni kɔrɔta dusukun sanfɛ, o bɛ sigida joli siraw tansiyɔn jigin min bɛ don senkɔni na ka a sababu kɛ girinya ye (jilama tansiyɔn bɛ jigin ni 0,78 mmHg ye santimɛtɛrɛ 1 o santimɛtɛrɛ 1, walima 2 mmHg santimɛtɛrɛ kelen kelen o kelen na. Misali la, ni banabagatɔ dɔ ka tansiyɔn diastolic ye milimɛtɛrɛ 65 ye ani ni misiden ka tansiyɔn ye milimɛtɛrɛ 32 ye (Delta Pressure of 33 mmHg at heart level), ka o sen jɔ barajuru kan santimɛtɛrɛ 30 (santimɛtɛrɛ 12) dusukun sanfɛ bɛ sigida joli sira tansiyɔn jigin ni milimɛtɛrɛ 23 ye ka jigin fo milimɛtɛrɛ 42 ka sɔrɔ a yɔrɔ tansiyɔn bɛ to milimɛtɛrɛ 32 la, ka Delta Pressure gosi ka se 10 mmHg ma ani ka kapilɛriw sɔgɔ ka u datugu. Aw bɛ senkɔni lafiɲɛ tuma bɛɛ a kɛ fla ye ka ɲɛ dusukun hakɛ la (a kana kɔrɔta dusukun sanfɛ, wa a man kan ka jɛngɛ a jukɔrɔ).
2. Mun na jisuma pakew ni kiriyɔterapi mansinw dagalen don kosɛbɛ: Ni aw ye jisuma walima ji nɛnɛ furakɛli bolokɔniw kɛ farikolo yɔrɔ la min ka yɔrɔ tansiyɔn bɛ ka bonya, o bɛ kɛ sababu ye ka reflexe jugumanba bila sen kan arteriolar vasoconstriction, ka kɔngɔ bila farikolojidɛsɛbanakisɛw ni oksizɛni nɛrɛw la ka taa a fɛ ka sɔrɔ ka farikolo sanfɛla nɛrɛw sɔgɔsɔgɔ ani ka lasɔmini joona paresthesias datugu. Aw bɛ jisuma bɛɛ bɔ joona ani ka senkɔni to so funteni na min ka ɲi.

Denmisɛnw ka farati kɛrɛnkɛrɛnnen: kɔkiliw karilenw ani "3 As".¶

Denmisɛn minnu si bɛ san 3 la ka se san 10 ma, bolokɔni ni bolokɔniw ka bana sababu ka teli ka kɛ supracondylar humerus fracture (kɔkili sanfɛ dɔrɔn) walima bolokɔni ɲɛfɛla kari. Ikomi tuma caman na denmisɛnnin fitininw tɛ se ka jɛ ka baara kɛ ni dusukunnataw sɛgɛsɛgɛli ye, denmisɛnw ka kolotugudaw operelikɛlaw bɛ denmisɛnw ka **"3 As" kalan, o min bɛ bɔ lɛrɛ caman na ka kɔn balikukalan taamasiɲɛ kɔrɔw ɲɛ:

1. Jɔrɔ bɛ ka caya: Denmisɛn min hakili sigilen don a daminɛ na a sirilen kɔfɛ walima a sɔgɔlen kɔfɛ, o bɛ barika sɔrɔ, a tɛ lafiya, wa a tɛ se ka sigi.
2. Ka dɔ fara mɔgɔw ka jɔrɔnanko kan: Ka kasi, ka bugɔ, walima ka se ka bangebagaw walima tulonkɛfɛnw hakili ɲagami min tɛ mɔgɔ dusu saalo.
3. Dimimadafura wajibiyalen caya: Dimi min bɛ kari ka tɛmɛ ibuporofɛni, asetaminofɛni, walima mɔrifini hakɛ bɛnnenw kan minnu bɛ tali kɛ a girinya la, o bɛ dimimadafura ta ka caya lɛrɛ o lɛrɛ.

Ni den y’a bolokɔnincininw minɛ ka u kuru dɔɔni ani ka pɛrɛn tuma o tuma ni aw y’a ɲini ka a bolokɔnincinin walima a bolokɔnincinin tilennen kɛ nɔgɔya la (passive extension stretch), walima ni a tɛ se ka taamasiɲɛ kɛ "OK" (min bɛ a bolokɔnincininw tigɛ ka taa a bila a ɲɛfɛla la), aw bɛ segin joona kɛnɛyaso la.

Dɔgɔtɔrɔso bana sɛgɛsɛgɛli ani opereli kɔrɔtɔlen fasciotomie¶

Ni aw sera kɛnɛyaso la ni aw bɛ siga la ko bana jugumanba bɛ aw la, waati min bɛ kɛ ka taa opereli yɔrɔ la, o de ye farikolo yɔrɔw ka ɲɛnamaya dantigɛlan fɔlɔ ye.

1. Aw bɛ teliya ka dilan kɛrɛfɛ cast bivalving ni needle manometry¶

Ni bolokɔni bɛ sɔgɔsɔgɔninjɛ walima finimugu kɔnɔ, dɔgɔtɔrɔ walima kolotugudaw dɔnbaga bɛ o yɔrɔnin bɛɛ ka sɔgɔsɔgɔninjɛ kɛ bivalve fila ye ka padding bɛɛ tigɛ ka jigin fo ka se fari jɛlen ma. Aw bɛ bolokɔni bila dusukun hakɛ la ka segin ka a lajɛ miniti 15 fo miniti 30 kɔnɔ. Ni bana taamasiɲɛw bɛ to sen na hali ni a bɔra a la pewu, kɔnɔnatumu lakika bɛ yen.

Baliku walima denmisɛn kɔrɔba min kununna, min kɔrɔtɔlen don, ni kɛnɛyaso ka sɔrɔ kɔrɔlenw bɛ a la, banakisɛ min bɛ wele ko acute compartiment syndrome, o ye kɛnɛyaso sɛgɛsɛgɛli ye, wa operelikɛlaw bɛ taa opereli yɔrɔ la k’a sɔrɔ u ma mɛn ka pikirijikɛlan sɛgɛsɛgɛli kɛ. Ni banabagatɔ hakili tɛ a la, ni a bɛ fiɲɛ bila a la, ni a hakili sigilen don, ni a ka dɔgɔ kosɛbɛ, walima ni a ye fɛn dɔw sɔrɔ minnu tɛ kelen ye, ni a ye a sɔrɔ a ma kɛ ni hakiliɲagami ye, dɔgɔtɔrɔ bɛ baara kɛ ni bolola tansiyɔn jateminɛlan ye min tɛ se ka furakɛ (i n’a fɔ Stryker intracompartmental pressure monitor) walasa ka tansiyɔn tigitigi suman senkɔni kɔnɔ yɔrɔ kelen-kelen bɛɛ kɔnɔ, santimɛtɛrɛ 5 kɔnɔ ka bɔ a kariyɔrɔ la. Fasciotomi kɔrɔtɔlen bɛ jira tuma o tuma ni Delta Pressure (Diastolic BP minus Compartment Pressure) ye milimɛtɛrɛ 30 ye walima a ka dɔgɔn.

2. Opereli decompressive fasciotomy bɛ bolokɔni kisi cogo min na¶

fasitomi kɔrɔtɔlen waati la, operelikɛla bɛ fari tigɛ janya janw kɛ ani ka sɔgɔsɔgɔninjɛ kɛ ka fasɛri jugumanba sirilenw da wuli yɔrɔ bɛɛ la, yɔrɔ min bananen don:

• Sen duguma (Two-incision, four-compartment fasciotomy): Anterolateral incision bɛ ɲɛfɛla ni kɔfɛla yɔrɔw da wuli (a bɛ ɲɛda sanfɛla nɛrɛ lakana), ka sɔrɔ kɔfɛla cɛmancɛ tigɛ bɛ senkɔni kɔfɛ, o bɛ kɔfɛla sanfɛla ni juguman da wuli.
• Bolo ɲɛfɛla ni bolokɔni: Volar tigɛcogo jan min bɛ kɛ ni kurukuru ye, o bɛ volar sanfɛla ni duguma yɔrɔ da wuli ka taa bolokɔni fan bɛɛ fɛ walasa ka carpal tunnel bɔ, ka fara kɔkolo tigɛ tilennen kan ni kɔkolo yɔrɔ tora ka tension.
• Bolo (yɔrɔ 10) ani Sen (yɔrɔ 9): Kɔnɔbara janya tigɛcogo fila minnu bɛ kɛ kɔkiliw walima senkɔniw kan, olu bɛ kolotugudaw labɔ, ka fara ɲɔgɔn kan ni tigɛda kɛrɛnkɛrɛnnenw ye walasa ka ɲɛgɛnɛsira, sɔgɔsɔgɔninjɛ, adductor ani calcaneal yɔrɔw da wuli.

Ikomi farikolo fununnen bɛ wuli ka taa kɛnɛma santimɛtɛrɛ caman kɔnɔ ni a bɔra a la, fasoci joginda bɛ da wuli ni laɲini ye ka da wulilen to sirilan ɲiginnenw kɔrɔ walima joginda fɛnɲɛnamafagalanw kɔrɔ minnu bɛ tansiyɔn juguman kɛ fo lɛri 48 fo lɛri 72 fo ka se funu ka ban, o kɔfɛ, u bɛ datugu filanan na walima ka u datugu ni farikolojidɛsɛbanakisɛ ye min janya tilalen don.

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

Syndrome de compartiment acute bɛ dɔgɔtɔrɔso opereli seko de wajibiya joona (kolo opereli, joginda opereli, walima bolo opereli). Baara kɛ ni nin marabolo kɔrɔtɔlenw ka ɲɔgɔnyew ni triage sariyaw ye:

• Amerika ni Kanada: Aw bɛ 911 wele. Aw bɛ taa ni a ɲini ka taa Trauma Center la min latigɛra walima dɔgɔtɔrɔso kɔrɔtɔko yɔrɔ la min bɛ baara dafalen kɛ ni kolotugudaw opereli ye min bɛ kɛ aw kan (aw kana taa kɛnɛyaso la min bɛ taa teliya la, barisa kɛnɛyaso kɔrɔtɔlenw tɛ se ka opereli fasciotomies kɛ).
• Royaume-Uni: Aw bɛ 999 wele walasa ka anpulu kɔrɔtɔlen sɔrɔ walima aw bɛ taa joona dɔgɔtɔrɔso suguya 1 Kɔrɔtɔko ɲɛmɔgɔso (A&E) la min ka surun aw la ni kolotugudaw ye. BOAST (British Orthopaedic Association Standards for Trauma and Orthopaedics) ani NICE ka laadilikanw kɔnɔ, banabagatɔ o banabagatɔ bɛ segin ni dimi jugumanba ye walima ni farikolojidɛsɛ caman yeli ye, a ka kan ka a ka sɔgɔsɔgɔninjɛ tila ka jigin ka kɛ fari jɛlen ye o yɔrɔnin bɛɛ la, a sɛgɛsɛgɛli senfɛ.
• Erɔpu tɔnba: Aw bɛ 112 wele UE jamanaw bɛɛ kɔnɔ. Aw k’a fɔ ka jɛya ko banabagatɔ sigalen don bana jugumanba la (syndrome des loges faransikan na, Kompartmentsyndrom Alemaɲikan na, sindrome compartimental agudo Ɛsipaɲɔlikan na) ka tugu joginda walima cast immobilisation kɔfɛ.
• Ɔsitarali ani Zelande kura: Aw bɛ 000 wele Ɔsitarali walima 111 Nuwɛlika. Aw bɛ ANZCOR joginda sariyaw labato ni aw ye senkɔni to dusukun hakɛ la, ka bandi minnu bɛ sɔgɔsɔgɔ, ka taa ni u ye mara dɔgɔtɔrɔsoba dɔ la.
• Endi ni Azi Pasifiki: I bɛ 112 (walima 108 Ɛndujamana na), 995 Singapuri, 119 Zapɔn ni Kore Dugu, walima 999 Mali ni Hong Kong. Aw bɛ taa dɔgɔtɔrɔso sabanan dɔ la, min kɔnɔ, kolotugudaw ni opereli yɔrɔw bɛ baara kɛ sanga 24 kɔnɔ.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Mun na mɔgɔ dɔ bɛ se ka kɛ ni dusukun tantanni barikama ye hali bi a bolokɔni walima a senkɔni na, ni a bɛ kɛ ni banakɔtaa jugumanba ye?¶

Farikolo yɔrɔ dɔ kɔnɔ, joli-sira-funu misɛnninw ni joli-sira-funu misɛnninw bɛ bin ni kɔnɔnatumuw tansiyɔn sera milimɛtiri 30 ɲɔgɔn ma (walima tansiyɔn diastoliki milimɛtiri 30 kɔnɔ), o bɛ oksizɛni tali tigɛ pewu farikolo ni nɛrɛmuguma la o yɔrɔ kɔnɔ. Nka, joli siraba belebele minnu bɛ tɛmɛ senkɔni fɛ, olu bɛ tansiyɔn sistoli ta min bɛ se milimɛtɛrɛ 100 fo 120 ma walima ka tɛmɛ o kan, o la joli bɛ taa a fɛ ka tɛmɛ joli siraba fɛ yɛrɛ ka don bolokɔnincininw walima senkɔniw na kabini waati jan lamini farikolo yɔrɔw sɔgɔsɔgɔlen kɔfɛ ka sa. Aw kana a jira abada ko dusukun tantanni ka tunun sani aw ka furakɛli kɔrɔtɔlen ɲini.

Farikoloɲɛnajɛ taamasiɲɛ fɔlɔ jumɛn bɛ yen min bɛ wele ko syndrome de compartiment acute?¶

Dɔgɔtɔrɔso lasɔmini taamasiɲɛ fɔlɔ fila minnu bɛ se ka da u kan, olu ye dimi jugumanba ye, dimi min bɛ wuli ka tɛmɛ joginni kan (o bɛ juguya dɔɔni dɔɔni, wa a tɛ jaabi di mɔgɔ ma min tɛ se ka lamaga walima dimifura barikamaw) ani dimi jugumanba min bɛ sɔrɔ ni bolokɔnincininw walima senkɔniw kɔrɔtalen don dɔɔni dɔɔni ka kɛ fɛn ye min tɛ kɛ (ka nimɔrɔw lamaga walasa ka senkɔniw lamaga minnu bɛ tɛmɛ funu fɛ farikolo yɔrɔ dɔ). Farikolo kɔnɔbara fununi gɛlɛn, i n’a fɔ jiri ani pinɛw ni pikirijikɛlanw sɔgɔsɔgɔninjɛ (paresthésie) digitiw la, o bɛ tugu o kɔ dɔɔni o kɔfɛ.

Mun na ne man kan ka bolokɔni walima sen kɔrɔta dusukun sanfɛ ni ne bɛ sigasiga ko compartiment syndrome?¶

Hali ni senkɔni dɔ kɔrɔta bɛ dɛmɛ ka jolisiraji bɔ sɔgɔsɔgɔninjɛ nɔgɔman kɔfɛ, ni yɔrɔ sindimɛ daminɛna dɔrɔn, jolisira minnu bɛ fasabolo sirilen kɔnɔ, olu bɛ datugu kaban ni kɔnɔnatumuw degun ye, o la kɔrɔta tɛ se ka yɔrɔ in bɔ. O nɔ na, ​​ni aw ye senkɔni kɔrɔta ka tɛmɛ dusukun hakɛ kan, o bɛ dɔ bɔ tansiyɔn ji la min bɛ don senkɔni na ni milimɛtiri 0,78 ye santimɛtɛrɛ kelen o kelen kɔrɔtalen na, o bɛ joli bɔli hakɛ dɔgɔya (Delta Pressure) ani ka kɛ sababu ye ka joli siraw bin joona yɛrɛ. Aw bɛ senkɔni lafiɲɛ tuma bɛɛ ka a flakɛ ka ɲɛ dusukun hakɛ la.

Yala ka fɛn dɔ tigɛ min sirilen don, o fan kelen bɛ se ka kɛ ka yɔrɔ degun nɔgɔya wa?¶

Ayi, kolotugudaw ka biyomekaniki sɛgɛsɛgɛliw y’a jira ko ni aw ye bɔgɔmugu gɛlɛn fan kelen dɔrɔn tigɛ (univalving) o bɛ dɔ bɔ kɔnɔna tansiyɔn na ni kɛmɛsarada la 30 ɲɔgɔn dɔrɔn ye, ani ka bɔgɔ gɛlɛn fan fila bɛɛ tigɛ (bivalving) ka sɔrɔ ka cotton padding to a cogo la, o bɛ degun dɔgɔya ni kɛmɛsarada la 40 fo 50 dɔrɔn ye barisa cotton padding ni stockinette min bɛ joli walima sumaya fɛ, olu bɛ baara kɛ i n’a fɔ tourniquet min tɛ wuli. Walasa ka degun dɔgɔyali dafalen sɔrɔ kɛmɛsarada la 65 fo 85, a ka kan ka kɛ ni bɔgɔdaga fila ye a fan fila bɛɛ la ani ka a jukɔrɔla cotton padding ni stockinette kɛmɛsarada la 100 tigɛ ka janya fo fari jɛlen ka ye ka bɔ a laban na ka taa a laban na.

Volkmann ka ischemic contracture ye mun ye?¶

Volkmann ischemic contracture ye bolokɔni, bolokɔni, ani bolokɔni (walima sen duguma ni sen) tiɲɛni banbali ye, min bɛ mɔgɔ farikolo tiɲɛ, o min bɛ sɔrɔ ni acute compartiment syndrome ma furakɛ ka tɛmɛ lɛri 6 kan. Ni oksizɛni kɔngɔ bɛ volar bolokɔni kɔnɔ, olu bɛ sa, dɔgɔkun caman kɔnɔ, u bɛ bila u nɔ na ni sɔgɔsɔgɔninjɛ ye min bɛ dɔgɔya, min ka gɛlɛn i n’a fɔ farakurun, min bɛ bolokɔni ni bolokɔnincininw sama ka kɛ nɛgɛ jɔcogo ye min bɛ to senna, min bɛ kɛ nɛnɛ ye, ka fara farikoloɲɛnajɛ dimi basigilen kan ani dusukunnataw bɔnɛni kan.

Yala acute compartiment syndrome bɛ se ka kɛ ni kolo karilen tɛ walima ni sɔgɔsɔgɔninjɛ tɛ a la wa?¶

Awɔ. Sindrom acute compartiment (banakisɛfagalan jugumanba) kɛmɛsarada la, 30 ɲɔgɔn bɛ sɔrɔ k’a sɔrɔ u ma kari fewu. Fɛn minnu tɛ kari sababu ye, olu ye farikolojidɛsɛ ye min bɛ bɔ farikoloɲɛnajɛ walima mobili gosi la, joginniw mugumugu walima ka siri duguma lɛrɛ caman kɔnɔ fura tata hakɛ cayalenba walima kirinni waati ("a sɔrɔla duguma"), sa baga bɛ mɔgɔ min na, jeninida sabanan lamini na, penti walima tulu pikiri joginni ni tansiyɔnba ye, joli pikiri minnu bɛ bɔ joli la, joli bɔli farikolo la k’a sɔrɔ joli-sira-funu-minɛnw tali, ani farikoloɲɛnajɛ kɛcogo segin-segin kojugu.

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Amerika ka koloci furakɛli kalanso (AAOS, Etazuni): Management of Acute Compartment Syndrome Clinical Practice Guideline (Delta Pressure threshold of 30 mmHg, passive stretch assessment early, and multi-compartment fasciotomy standards).
• British Orthopaedic Association (BOA) ani British Society for Surgery of the Hand (BSSH, Angletɛri): BOAST Ladilikan: Ɲɛgɛnɛsiraw ka banaw sɛgɛsɛgɛli ni u furakɛcogo (o yɔrɔnin bɛɛ la, a bɛ tigɛ ka jigin fo ka se fari jɛlen ma ani senw degunni min bɛ kɛ yɔrɔ naani ye ni tigɛ fila ye).
• Amerika ka operelikɛlaw ka kalanso (ACS, Etazuni): Advanced Trauma Life Support (ATLS) Student Course Manual, 10^th Edition (Dɔgɔtɔrɔso jugumanba, farikolojidɛsɛ sɛgɛsɛgɛli, rabdomyolyse, ani ischemic limb survival windows).
• Royal Children’s Hospital Melbourne (Australie) & Pediatric Orthopaedic Society of North America (POSNA): Dɔgɔtɔrɔso baarakɛcogo laadilikanw: Supracondylar Fracture of the Humerus and Pediatric Compartment Syndrome ("The 3 As": Anxiety, Agitation, Analgesia).
• Jamana ka kɛnɛyako ni ladonniko ɲɛtaa baarada (NICE, Angletɛri): Kariw (Complex): Jateminɛ ni ɲɛnabɔli (NG37) (kɔlɔsili ni ɲɛnabɔli ka ɲɛsin compartiment syndrome ma).
• Duniɲa ka Croix Rouge ni kalo bilenman tɔnw ka tɔnba (IFRC) & Ɔsitarali ni Nuwɛlika Lakununni jɛkulu (ANZCOR): Dɛmɛ fɔlɔw ka laadilikanw ka ɲɛsin joginw, karilenw, ani sɔgɔsɔgɔninjɛ ma.

Gafe minnu bɛ tali kɛ o ko la¶

• Crush jogin, crush syndrome ani compartiment syndrome dɛmɛ fɔlɔ
• Kolow karilen, kari, ani kurukuruw dɛmɛ fɔlɔ
• Kari dafalenw, kolotugudaw bɔli ɲɔgɔn na, ani farikolojidɛsɛ sɛgɛsɛgɛli
• Farikolo farigan barikama min tɛ ni dusukun tantanni ye ani joli siraw datugucogo jugumanba sɛgɛsɛgɛli
• Farikoloɲɛnajɛ la, sugunɛ joginni jugumanba, ani sugunɛ dibi la