Jariri BRUE (Taƙaitaccen Magance Abubuwan da Ba a Bayyana ba): Canjin Launi na Farko, Ragewa, ko Apnea¶

Kallon jaririn da bai kai shekara 1 ba ba zato ba tsammani ya daina numfashi, ya juya shuɗi ko fatalwa, ya yi tagumi kamar ragdoll ko taurin baya, sannan ya murmure cikin daƙiƙa ɗaya na ɗaya daga cikin abubuwan da suka fi ban tsoro da iyaye ko mai kulawa za su iya shaidawa. A cikin maganin gaggawa na yara, lokacin da jaririn da ke ƙasa da watanni 12 ya sami wani abu na kwatsam wanda bai wuce minti 1 ba wanda ya shafi cyanosis ko pallor, rashi ko numfashi mara kyau, canji mai kyau a cikin sautin tsoka, ko canza amsa wanda gaba daya ya dawo zuwa asali ba tare da wani dalili ba, likitocin asibiti suna rarraba shi a matsayin ** Taƙaitaccen Matsala mara Matsala.BRUE)**. Ko da jaririnka ya dubi faɗakarwa 100 bisa 100, ruwan hoda, kuma mai farin ciki a lokacin da ka ɗauki wayar, kowane abin da ba a bayyana ba a cikin jariri a ƙasa da shekara 1 yana buƙatar kimantawar likita nan da nan ta hanyar kiran yankin ku. lambobin gaggawa (911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a Burtaniya) ko kuma kai tsaye zuwa sashen gaggawa na yara. Abin da ya yi kama da tsayawa na daƙiƙa 20 mara lahani na iya zama alamar gargaɗin farko na pertussis na pneic pertussis (tari), ƙwayar cutar syncytial na numfashi (RSV), arrhythmia na zuciya irin su Long QT Syndrome, cututtuka na rayuwa, ko laryngospasm, kuma dole ne ku san yadda ake yin aiki. yara da jarirai CPR da shaƙewa ceto da kuma bambanta jariri BRUE daga jariri sharar numfashi da kuma bugun jarirai ko zazzabi mai zafi na jarirai da zazzaɓi.

Yi wannan yanzu¶

1. Ki sanya jarirai a gefensu akan tsayayyen fili sannan ki duba hanyar iska da numfashi nan da nan. Kada ki rike jaririn da ya rame ko mara amsa a kafadarki, domin a tsaye yana fitar da jini daga cikin kwakwalwar kuma yana ba da kan floppy kan ya runguma zuwa ga kirji, tare da lallausan bututun iska. Kwanta jariri a gefensu (matsayin dawowar jarirai) a kan katifa mai ƙarfi, bene, ko tebur mai canzawa don haka duk madarar da aka sake zubar da ruwa ko ƙoƙon ƙwayar cuta daga baki maimakon shiga cikin huhu.
2. **Ai amfani da kuzari mai ƙarfi na tsawon daƙiƙa 5 zuwa 10 (kada ku taɓa jinjirin).*sternum), lanƙwasa ko taɓa tafin ƙafãfunsu, kuma a busa iska mai sanyi a kuncinsu don tada motsin numfashi na trigeminal. Kar a taɓa girgiza jariri baya da gaba don tada su, kamar yadda girgiza hawaye ke haifar da jijiyoyi masu laushi a cikin kwanyar kuma yana haifar da zubar jini na kwakwalwa.
3. Fara CPR na jarirai ko ceto nan da nan idan jaririn bai numfasawa ba ko amsa a cikin dakika 10. Sanya wayarka akan lasifika don kiran lambar gaggawa ta gida (911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, 999 a Burtaniya). Idan jaririn ya yi shiru kuma ya kasa yin numfashi daidai bayan ya ci abinci ko kuma ya gagare a ruwa mai kauri, sai a sadar da 5 na baya na jarirai (tallafa muƙamuƙi da ƙirji tare da goshinka tare da kai ƙasa da dunƙule) sannan 5 bugun ƙirji mai yatsa biyu; idan jaririn ba shi da amsa ba tare da numfashi na yau da kullum ba kuma babu wani shinge mai maƙarƙashiya, fara ** Jariri CPR a 30 kirjin kirji zuwa 2 laushi mai laushi na iska ** (ko 15: 2 idan masu ceto biyu suna nan), danna 4 centimeters (inci 1.5) zurfi a tsakiyar kirji kusa da layin nono a kimanin minti 1.20 zuwa minti 100.
4. Duba agogon agogon hannu ko agogon wayar ku lura da ainihin tsawon lokacin da cikakkun bayanai na asibiti guda hudu. Likitocin da ke cikin dakin gaggawa sun dogara da abin da idon idonka ya lura don sanya jaririn a matsayin Low-Risk ko High-Risk. BRUE. Kulle cikin hankali ko rubuta: (a) daƙiƙa nawa abin ya faru, (b) ainihin launi na lebe, harshe, da fuska (blue/purple, fatalwa fari/ launin toka, ko ja mai haske), © ko jikin jaririn ya tafi gaba ɗaya ©hypotonia) ko kuma taurin kai (hypertonia), da (d) abin da jaririn ke yi a cikin mintuna 5 kafin taron (barci kwance, zaune a kujerar mota, ciyarwa, tofi, ko kuka).
5. Ki je wurin gaggawar gaggawa ko da a yanzu jaririn ya yi kama da al'ada dari bisa dari. Kar a mayar da jaririn ya kwanta a gida a jira ganawa da likitan yara da safe. A cikin jariran da ke ƙasa da watanni 12 (musamman jarirai a ƙasa da kwanaki 60 ko kuma waɗanda aka haife su da wuri kafin makonni 32), dakatarwar da aka yanke na tsawon daƙiƙa 30 akai-akai shine abin da ya faru na saƙon da ke gaba da na biyu, ya fi tsayi, kamawar cututtukan zuciya da ke barazanar rai sa'o'i daga baya yayin barci mai zurfi.
6. ** Hoton ainihin yanayin barci ko wurin ciyarwa kuma kawo nau'ikan kayan abinci, magunguna, da jerin masu kula da jariri zuwa asibiti.** Kafin barin ko yayin da wani babba ya shirya, ɗauki hoto mai sauri na wayar inda jaririn yake kwance (garin gado, bassinet, mai barci, kujerar mota, ko gadon manya) da kawo duk wani buɗaɗɗen gwangwani, faɗuwar bitamin, maganin sanyi na ganye na iya yin maganin gaggawa na gida, ko kuma cikakken lafiyayyen magunguna na gida. binciken toxicology.

Bishiyar yanke shawara: Canjin launi na jarirai kwatsam, tsayawar numfashi, ko rame¶

flowchart TD
    A["Jaririn da bai kai watanni 12 ba ba zato ba tsammani ya daina numfashi, ya juya shuɗi/kodi, ko ya yi tauri/tauri."] --> B{"Ka kwanta a gefe + shafa sternum / flick soles na 5 zuwa 10 seconds. Numfashi ya dawo?"}
    B -->|"A'a: Rashin amsawa kuma baya numfashi akai-akai"| C["Kira 911/112/999 akan lasifikar nan take"]
    C --> D{"Shin labarin ya fara ne da matsananciyar shaƙewa/ciƙar madara ko abu?"}
    D -->|"Ee: An toshe hanyar jirgin sama"| E["Yi Jarirai Busa Baya 5 + Ƙirji 5; maimaita har sai hanyar iska ta share ko fara CPR idan ba a amsa ba"]
    D -->|"A'a: Tsayawa ta tsakiya ko rame"| F["Fara Jariri CPR: 30 ƙwaƙwalwar ƙirji (4 cm / 1.5 a zurfi, 100 zuwa 120 / min) + 2 numfashi mai laushi"]
    B -->|"Ee: Jaririn ya murmure a cikin dakika 60 kuma ya dawo kan asali"| G{"Shin jaririn yana da wata alama ta zahiri a yanzu? (Zazzabi, hunhuwa, amai mai maimaitawa, ƙwanƙwasa, gajiya)"}
    G -->|"Ee: Ba a bayyana ba"| H["Ƙimar Sashen Gaggawa na gaggawa don rashin lafiya mai aiki (Sepsis, RSV, Pertussis, Aspiration, Seizure)"]
    G -->|"A'a: Jaririn yana kallon al'ada 100% a asali (Mai yiwuwa BRUE)"| I{"Bincika Ma'aunin BRUE Babban Haɗari AAP (Duk 1 da ake bayarwa?)"}
    I -->|"Shekaru <= Kwanaki 60 KO Wanda bai kai ba <32 wks (< 45 wks gyara) KO Tsawon lokaci>= Minti 1 KO Maimaita abubuwan da suka faru ko Bukatar CPR"| J["KYAUTA MAI KYAU: jigilar Sashen Gaggawa kai tsaye + shigar da marasa lafiya + Ci gaba da oximetry, Pertussis/RSV PCR, ECG mai gubar 12, Sepsis/Allon Metabolic"]
    I -->|"Shekaru> Kwanaki 60 zuwa watanni 12 DA Cikakken lokaci> = 32 wks DA taron Farko < 1 min KUMA Babu CPR da ake buƙata DA jarrabawar al'ada"| K["KARANCIN KYAUTA: Ƙimar Sashen Gaggawa na Gaggawa + 1 zuwa 4 hr ci gaba da bugun jini oximetry, 12-lead ECG, Pertussis Test, Safe-Sleep Audit, and 24-hr pediatrician follow up."]

Ma'anar asibiti: Abin da ke bayyana BRUE da dalilin da ya sa ya maye gurbin ALTE¶

Shekaru talatin kafin 2016, likitocin yara sunyi amfani da babban laima acronym ALTE (Bayan Lamarin Barazana Rayuwa) don bayyana duk wani lamari mai ban tsoro a cikin jariri wanda ya sa mai kulawa ya ji tsoron jaririn na mutuwa. Binciken asibiti daga baya ya tabbatar da hakan ALTE Ba daidai ba ne mai haɗari: ta tattara jariran da har yanzu ke fama da rashin lafiya a cikin dakin gaggawa tare da jariran da suka murmure gaba ɗaya, kuma ya dogara ga matakin firgita na mai kulawa maimakon ainihin alamomin ilimin lissafi. A cikin 2016 (kuma an ƙarfafa shi a cikin ƙa'idodin kula da yara na duniya na gaba), ** Cibiyar Nazarin Ilimin Yara na Amurka (AAP)** yayi ritaya wa'adin ALTE kuma ya kafa tabbataccen, ainihin ganewar asali na BRUE (Taƙaice Magance Lamarin da Ba a Fahimce shi ba).

ginshiƙai na wajibi guda 4 na BRUE ganewar asali¶

Likita zai rarraba lamarin jariri a matsayin BRUE kawai idan yaron ya kasance ** kasa da watanni 12 (shekaru 1)** kuma lamarin ya gamsar da duk hudu na wadannan ginshikan bincike:

1. Taƙaitaccen (Lokacin ƙasa da daƙiƙa 60): Gabaɗayan abin da ba a saba gani ba ya ƙare ** ƙasa da minti 1** (mafi gaskiya BRUE sassan suna wucewa tsakanin 10 da 45 seconds). Idan lamarin ya dade ** minti 1 (60 dakika 60) ko ya fi tsayi**, ya zarce gajeriyar ƙofa kuma ana daidaita shi ta atomatik zuwa hanyar binciken Babban Haɗari.
2. An warware (kashi 100 na komawa zuwa asali): A lokacin da jariri ya zo don auna lafiyarsa, jaririn ya dawo gaba daya zuwa yanayin lafiyarsu na yau da kullun. Yawan zuciyar su, yawan numfashi, jikewar iskar oxygen, zafin jiki, turaren fata, sautin tsoka, da saduwa da ido dole ne ya zama na al'ada. Idan jaririn ya kasance cikin barci, gajiya, tachypneic (numfashi da sauri), zazzaɓi, ko fushi, al'amarin ba a warware ba. BRUE, Yana da gaggawar gaggawa na likita da ke buƙatar farfadowa da gaggawa da kuma aikin da aka yi niyya.
3. ** An siffanta shi da aƙalla 1 cikin 4 takamaiman canje-canje na haƙiƙa:**
4. Cyanosis na tsakiya ko pallor: Tsararren shuɗi, shuɗi, duhu duhu, ko canza launin fatalwa/ashen launin fata wanda ya haɗa da ** leɓuna, harshe, gumi, fuska, ko gangar jikin tsakiya**. (Hnnuna da ƙafafu marasa lahani lokacin sanyi, wanda aka sani da acrocyanosis, ko jajayen ɗan lokaci a kusa da baki yayin kuka ko wucewar stool baya ** BRUE).
5. Rashi, ragewa, ko numfashi mara ka'ida: Dakatawar numfashi na gaske (apnea), haki marar zurfi, ko shaƙewa kwatsam don neman iska. (Jarirai na yau da kullun numfashin lokaci, inda jaririn da ke barci ya ɗauki numfashi da sauri da sauri sannan a dakata na tsawon daƙiƙa 5 zuwa 10 yayin da yake zama ruwan hoda gabaɗaya, ilimin halittar jiki ne na yau da kullun ba wai BRUE).
6. ** Canjin alama a cikin sautin tsoka (hypotonia ko hypertonia):** Jaririn ba zato ba tsammani ya tafi gabaɗaya kuma Ragdoll-floppy (hypotonia) ko kuma ba zato ba tsammani ya taurare tare da tsattsauran ra'ayi da ruɗaɗɗen baya (hypertonia ko opisthotonos).
7. Canjin matakin amsawa: Jariri ya zama ba zato ba tsammani ya kasa jin murya da tabawa, yana kallo babu komai da idanu masu gilashi, ko ya rasa hayyacinsa.
8. Ba a bayyana ba bayan tarihi da duba lafiyar jiki: Da zarar likitan gaggawa ya ɗauki cikakken tarihin kuma ya bincika jariri daga kai zuwa ƙafafu, babu wani dalili na gaggawa. Misali, idan jaririn da zazzabin 39.2 digiri Celsius (102.6 digiri Fahrenheit) da matsananciyar retracts na kirji ya dakatar da numfashi, ganewar asali shine kwayar cutar bronchiolitis ko sepsis, ba wanda ba a bayyana ba. BRUE.

Teburin kwatance: Ƙananan-Haɗari BRUE vs. Babban Haɗari BRUE vs. Mimics marasa BRUE¶

Fahimtar ko jaririnku ya faɗi cikin Rashin Hadari BRUE ko ** Babban Haɗari BRUE** Rukuni yana gaya muku ainihin gwaje-gwaje da lura da asibiti da ƙungiyar gaggawa za ta yi. Idan jariri ya rasa ko da ɗaya na ƙa'idodin ƙarancin haɗari, ana rarraba su da ** Babban Haɗari BRUE**.

Abubuwan da ke haifar da barazanar rayuwa an bincika su a cikin Babban Haɗari BRUE¶

Me yasa likitocin gaggawa suka dage akan shigar da Babban Haɗari BRUE jarirai (kamar duk wani jariri da bai wuce kwanaki 60 ba ko duk wani jariri da ya yi sihiri na biyu) zuwa asibiti ko da jaririn yana murmushi yana shan kwalba a cikin dakin gaggawa? Domin a cikin yara ƙanana waɗanda ba su balaga ba tsarin juyayi na kai tsaye, yanayi bakwai masu barazanar rai akai-akai suna kasancewa tare da ** shiru, keɓancewar buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗa a matsayin farkon alamar su** kafin alamu na yau da kullun kamar zazzabi ko tari ya taɓa bayyana.

1. Laryngospasm da Laryngeal ChemoreflexLCRdaga reflux¶

A cikin manyan yara da manya, idan digo na acid na ciki ko miya ya taɓa igiyoyin murya (larynx), kwakwalwar kwakwalwa tana haifar da tari mai tsanani don share hanyar iska. A cikin jarirai da jarirai a ƙarƙashin watanni 4 zuwa 6, duk da haka, mafi girman jijiyar laryngeal yana haifar da tsarin rayuwa na ɗan tayi wanda ake kira ** Laryngeal Chemoreflex.LCR)** (wanda aka ƙera don dakatar da tayin shakar ruwan amniotic cikin mahaifa). Lokacin da ƙaramin digo na madara mai raɗaɗi ko acid ɗin ciki a hankali ya isa bayan makogwaron jariri, igiyoyin muryar suna manne da ƙarfi a cikin *cikakkiyar laryngospasm, tsakiyar kwakwalwar numfashi yana tsayawa, kuma jijiyar vagus yana rage saurin bugun zuciya.bradycardia).

• Abin da iyaye ke gani a lokacin wani LCR Sihiri: Lamarin yakan faru ne yayin da jaririn ke kwance a bayansa ** Minti 15 zuwa 60 bayan an ci abinci** (ko kuma bayan jika). Ba zato ba tsammani sai jaririn ya tashi ya dafe, ya rufa bayansa, ya bude idanunsu a firgice, ya yi shiru baki ko motsin kirji da zero sauti, sai ya zama jajayen launin ja sannan ya zagaya lebbansa, sannan ya saki wani tsawa mai tsauri.inspiratory stridor) bayan dakika 20 zuwa 45 yayin da igiyoyin murya suka shakata.
• Shiga kan gadon gaggawa: Juya jarirai a gefen su ** ko kuma ka riƙe su a tsaye a kusurwar digiri 45 a kan ƙirjinka, a hankali tsotsa madarar da ake gani daga hanci da sirinji mai laushi (saboda jariran da ba su kai watanni 4 ba suna wajabta numfashin hanci**), sannan ka busa iska mai sanyi a kunci. Karka taba tilasta yatsa cikin makogwaro.

2.Apneic pertussis (whooping tari) da RSV bronchiolitis¶

Iyaye suna tsammanin jariri tare da pertussis (Bordetella pertussis) ko ** Virus syncytial na numfashi (RSV*** a yi tari mai ƙarfi, tari ko zazzaɓi. A jarirai ** kasa da watanni 3, wannan zato na iya zama m:

• Apnea kafin tari: A cikin kashi 50 cikin 100 na jarirai da jarirai da ba su wuce sati 8 ba RSV ko pertussis daga babban ɗan'uwa ko babba mai ɗanɗano "sanyi mai ban haushi," ** gaggawa ta tsakiya (tsayawa da numfashi na tsawon daƙiƙa 20 zuwa 60 da juya shuɗi) ita ce alamar asibiti ta farko **, tana faruwa ** 24 zuwa 48 hours kafin duk wani tari, cunkoso, ko zazzabi ya tashi **.
• Rashin "kullun": Yaran jarirai ba su da ƙarfin bangon ƙirji don ƙirƙirar sautin tari mai ƙirƙira. Maimakon haka, suna yin shiru a kan ƙuƙumma na iska, suna gajiyawa, dakatar da numfashi, kuma suna haɓaka bradycardia mai zurfi. Domin jariri mai fama da ciwon huhu da wuri ko RSV zai iya zama kamar na yau da kullun tsakanin farkon tsafi sannan kuma ya daina numfashi na dindindin yayin barci mai zurfi bayan sa'o'i 6, sassan gaggawa suna yin nasopharyngeal PCR swabs ga Pertussis da RSV da kuma kiyaye yara ƙanana a kan ci gaba da bugun bugun jini da na'urori masu auna bugun zuciya.

3. Cardiac channelopathies (Long QT Syndrome, WPW, da ductal-dogara lahani)¶

Wani lamari na kwatsam inda jariri ya juya ** fatalwa, launin toka, ko ashen (pallor*** kuma ya rame kamar ragdoll akai-akai na zuciya ko vagal maimakon numfashi. Kowane jariri an kimanta don a BRUE (Dukansu Ƙananan-Haɗari da Babban Haɗari) yakamata su karɓi na'urar lantarki mai gubar ** 12.ECG***:

• ** Ciwon QT mai Haihuwa (LQTS) da Ciwon Brugada:** Lalacewar ion-tashar kwayoyin halitta a cikin tsarin wutar lantarki na zuciya na iya haifar da gajeriyar guduwar tachycardia na ventricular polymorphic (torsades de pointes). A lokacin gudu na 20 na daƙiƙa na arrhythmia, fitarwar zuciya ya ragu zuwa sifili, yana juya jaririn kodadde da rame; idan rhythm ɗin ya koma cikin ruɗar sinus na yau da kullun, jaririn ya tashi yana da kyau, har sai gudu na gaba ya haifar da kama bugun zuciya.SIDS).
• ** Wolff-Parkinson-White (WPWSupraventricular tachycardia da kuma tachycardia.SVT:** Jarirai masu hanyar lantarki a cikin zuciya suna iya tsalle ba zato ba tsammani zuwa bugun zuciya na 240 zuwa 300 a cikin minti daya, suna haifar da pallor kwatsam, busasshen fata, rashin cin abinci, ko ɗan gajeren lokaci.
• Cutar cututtukan zuciya da ke faruwa a ƙarshen zamani ko ALCAPA: Sharuɗɗa irin su coarctation na aorta ko anomalous hagu na jijiyoyin jini daga jijiyoyin huhu (ALCAPA) na iya haifar da kuka kwatsam, gumi, pallor, da rame yayin ƙoƙarin ciyarwa.

4. Ƙwararrun jarirai da ƙananan yara (ciki har da spasms na jarirai)¶

Ba kamar manyan yaran da ke da jujjuyawar girgiza ba, jariran da ke ƙasa da watanni 6 ba su da cikakkar ƙumburi na hanyoyin su na cortex. Sakamakon haka, ciwon farfaɗo da ke farawa a cikin yanki na ɗan lokaci ko na kwakwalwa sau da yawa yana nunawa kamar ** kawai mai cin gashin kansa ko abin mamaki na mota ***:

• Apneic seizures: Ba zato ba tsammani jaririn ya daina numfashi, yana kallon gefe ɗaya da idanu masu gilashi, yana yin bugun leɓe, bugun harshe, ko motsi na ƙafafu, kuma ya zama shuɗi mai duhu na 30 zuwa 60 seconds.
• ** Farawa yawanci tsakanin watanni 3 zuwa 8 ***, yawanci daidai lokacin da jaririn ya tashi ko ya yi barci, jaririn yana da ɗan gajeren lokaci, kwatsam 1-zuwa-2 na biyu na jackknife flexing ko tsawo na wuyansa, akwati, da makamai, sau da yawa yana faruwa a cikin 5 don yin kuskure a kowane sakan 5. cramps" ko farar fata. Rikodin bidiyo na farko na iyaye da na gaggawa na ƙwayoyin jijiya na yara na electroencephalogram (EEG) suna da mahimmanci don hana ci gaban ci gaba na dindindin.

5. Kurakurai na haihuwa na metabolism da hypoglycemia¶

Cututtukan da ba a taɓa samun haihuwa ba (irin su Matsakaici-Chain Acyl-CoA Dehydrogenase Deficiency [MCADD], lahani na fatty acid oxidation, urea cycle disorders, da Organic acidemias) suna hana jariri canza kitsen da aka adana zuwa glucose lokacin azumi tsakanin abinci. Idan jariri ya ɗan yi barci kaɗan fiye da yadda aka saba ko kuma yana ciyarwa mara kyau, glucose na jininsu yana raguwa ko ammoniya mai guba ya taru, yana haifar da gajiya kwatsam, rame, apnea, ko kodadde rashin amsawa. Duban gaɓoɓin gado mai sauri ** glucose jini na jini **, iskar jini, electrolytes, da lactate a cikin sashin gaggawa yana gano rikice-rikice na rayuwa.

6. Occult bacteremia, meningitis, yoyon fitsari, da botulism na jarirai¶

A jarirai ‘yan kasa da kwanaki 60, kamuwa da cuta mai tsanani (kamar ciwon fitsari, farkon rukunin B Streptococcus ko E. coli bacteremia, ko farkon sankarau) yana haifar da hypothermia (zazzabi na dubura ƙasa da digiri 36.0 Celsius / 96.8 digiri Fahrenheit) ko kuma zazzaɓi kwatsam ba tare da wani zazzabi ba. Hakazalika, da wuri jarirai botulism daga hadiye kurar muhalli yana haifar da rauni na jijiyar wuya, rashin jin daɗin gag, haɗa baki, da kuma buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗen buɗaɗɗa.

7. Non-accidental trauma (Abusive Head Trauma) and inadvertent poisoning¶

Nazarin asibiti da aka duba AAP nuna cewa tsakanin kashi 1 zuwa 3 na jarirai da ke gabatar da Babban Haɗari ko maimaituwa BRUE suna da ciwon kai abusive head trauma (shaken baby Syndrome) tare da occult subdural hematomas wanda ke haifar da bugun zuciya na tsakiya, koda lokacin da babu kururuwar waje a fatar kai. Don haka likitoci suna yin gwajin fata a hankali, kai-da-ƙafa, duba fontanelle na gaba (tabo mai laushi) don kumbura, duba cikin lebe na sama don tsagewar labial frenulum, da allo don bayyanar da haɗari ga magungunan kwantar da hankali (kamar manya masu sanyin sanyi, diphenhydramine, Topical lidocaine/benzocainemo hakori gels medicaine, ko rashin lafiyan opioid).

Safe-barci da duban asphyxiation na matsayi bayan BRUE¶

Yawancin dakatarwar numfashin jarirai da kuma sifofin cyanotic suna haifar da su ta hanyar matsayin toshewar asphyxiation, wanda ke faruwa lokacin da babban kan jariri ya karkata gaba (neck flexion) don haka haƙarsu ta danna cikin ƙirjinsu, suna kunna bututun iska mai laushi.trachea) rufe, ko kuma lokacin da tarkon gado mai laushi ya fitar da carbon dioxide a kusa da hancinsu. Yayin jiran jigilar gaggawa ko dama bayan dawowa gida daga asibiti, yi wannan cikakken ** Safe-Sleep and Positional Airway Audit ***:

• ** Audit Kujerun Mota, Masu Yaki, Bouncers, da Swings na Jarirai:** Kada ku taɓa barin jariri ya kasance yana barci a kujerar mota da zarar an ɗauke shi daga cikin abin hawa, kuma kada ku taɓa yin amfani da wurin zama na bouncy, lilo, ko matashin jinya a matsayin wurin barci na yau da kullun. Lokacin da aka danna kujerar mota a cikin madaidaicin gindinta a cikin mota, tana zaune a wani kusurwa mai aminci; lokacin da aka saita shi akan falon falo mai lebur, wurin zama yana gaba, yana haifar da kan jariri mai barci ya faɗi gaɓoɓi zuwa ƙirji kuma yayi shiru ya rufe hanyar iska (positional asphyxia).
• ** Audit Baby Slings da Soft Fabric Wraps:** A cikin jarirai 'yan ƙasa da watanni 4 waɗanda ake ɗauka a cikin majajjawa ko nannade, koyaushe bi T.I.C.K.S. ka'ida: kiyaye mai ɗaukar kaya Tight, In kallo a kowane lokaci (kada ku taɓa rufe fuskar jariri da masana'anta), Crasa isa ya sumbaci saman kan jaririn, a ajiye haƙar jaririn ** K************ suka cire ƙirjinsu (aƙalla babban girman yatsa na sarari a ƙarƙashin haɓɓaka), sannan a ajiye bayan jaririn **S.
• ** Audit Crib ko Bassinet (ABCs na Safe Sleep):** Duk lokacin bacci (naptime da na dare) dole ne ya kasance ** A** kaɗai, sanya shi a kwance akan ** B** ack (supine), a kan m, lebur **C *** haƙarƙari ko katifa na bassinet rufe kawai da wani madaidaicin takarda. Cire duk matashin kai, ƙwanƙolin bumpers, buhunan barci masu nauyi, DockATot mai faffadar falo, cushe dabbobi, da barguna mara kyau.
• ** Zazzabi na dakin dubawa da kuma yawan zafafawa:** Yin zafi yana lumshewar tunanin jariri a lokacin tashin hankali. A kiyaye ɗakin kwana tsakanin 20 zuwa 22.2 digiri Celsius (68 da 72 digiri Fahrenheit) da kuma sanya wa jariri a mafi yawan sirara sirara fiye da yadda babba zai sawa cikin kwanciyar hankali (kamar auduga mai numfashi a cikin buhun barci mara nauyi, tare da buɗe kansa).
• Audit Household Secondhand Smoke and Vape Aerosol Exposure: Exposure to nicotine, cigarette smoke, or vaping aerosols on caregiver clothing damages infant autonomic brainstem chemoreceptors, severely impairing a baby's ability to gasp and wake up when oxygen drops (auto-resuscitation).

Lambobin gaggawa na yanki da ka'idojin hukumar¶

Idan jaririn naku yana da ɗan hutun da ba a bayyana ba, canjin launi, ko ɓacin rai, kira sabis ɗin gaggawa na gaggawa na ƙasa nan da nan kuma sanar da mai aikawa ainihin shekarun jaririn a cikin makonni ko watanni:

• Amurka da Kanada: Kira 911 nan take don sabis na likita na gaggawa (EMS) kai zuwa sashin gaggawar gaggawa mai iya lafiyar yara. Bambance-bambancen asibiti ya bi ** Kwalejin Ilimin Ilimin Yara na Amurka (AAP*** da ** Ƙungiyar Kula da Lafiyar Yara ta Kanada (CPS)** BRUE jagororin aikin likita. Idan kuna zargin shigar da wani abu na gida ko magani na bazata, kuma a kira ** Ikon Guba a 1-800-222-1222** (US) ko 1-844-764-7669 (Kanada).
• United Kingdom: Kira 999 nan take domin neman agajin gaggawa na gaggawa idan jaririn ya daina numfashi, ya zama shudi ko kodadde, ko ya rame, sannan a kai jaririn zuwa wuri mafi kusa Hatsarin Yara da Gaggawa.A&E* sashen. Kima na asibiti yana biye da ** Cibiyar Kula da Lafiya da Ƙwararrun Kulawa ta ƙasa (NICE** da ** Royal College of Paediatrics and Child Health (RCPCH*** rugujewar haihuwa ba zato ba tsammani (SUPC) kuma BRUE jagororin. Don tambayoyi masu biyo baya bayan fitarwa, kira NHS 111.
• ** Tarayyar Turai:** Kira 112 a duk ƙasashe membobin EU don aika motar asibiti na gaggawa na yara. Ka'idojin asibiti suna bin ** Majalisar Resuscitation Council (European Resuscitation Council)ERC*** jagororin tallafin rayuwa na yara na yara (wanda ke ƙayyade ** 5 numfashin ceto na farko *** kafin fara damfara ƙirji a wani rabo na 15: 2 ** don masu ba da horo) da kuma likitan yara na ƙasa BRUE ma'auni.
• ** Ostiraliya da New Zealand:** Kira 000 a Ostiraliya ko 111 a New Zealand don amsar motar asibiti nan take. Sassan gaggawa na yara suna bin ** Bincike na Yara a cikin Sashen Gaggawa na Haɗin Kai na Duniya (PREDICT** da ** Royal Children's Hospital (RCH) Melbourne *** jagororin aikin likita don BRUE.
• Indiya da Asiya-Pacific: Kira 112 (Lambar gaggawa ta Indiya), 995 (Singapore), 119 (Japan da Koriya ta Kudu), ko lambar gaggawa ta gida (duba duk). lambobin gaggawa) and proceed to a tertiary hospital with a Neonatal or Pediatric Intensive Care Unit (NICU/PICU).

Tambayoyin da ake yawan yi¶

Me yasa fuskar jaririna ta yi haske kuma ta dakata da numfashi na tsawon dakika 10 yayin da take gunaguni don wuce hanji? Wannan BRUE ne?¶

A'a. Lokacin da lafiyayyen jarirai ke damuwa don wucewa stool ko iskar gas (wani yanayi mara kyau da ake kira dyschezia na jarirai), suna jurewa a rufaffiyar hanyar iska (mafiyar Valsalva), wanda akai-akai yana juya fuskar su ja ko ja kuma a ɗan ɗan dakata numfashin su na daƙiƙa 5 zuwa 10 yayin da ƙafafu suka ɗaga sama. Domin dalilin shine yunƙuri na ɓacin rai na al'ada na al'ada kuma tsakiyar leɓun jariri da harshen ba su taɓa zama shuɗi ko fari ba, Cibiyar Nazarin Ilimin Ilimin Ilimin Yara ta Amurka ta keɓe jajayen kukan al'ada da ɗimbin stool daga ma'anar BRUE.

Hannun jariraina da ƙafafu sun ɗan yi ja yayin da na kwance ƙullun su, duk da cewa suna numfashi kamar yadda aka saba. Zan kira motar asibiti?¶

Launi mai launin shuɗi ya iyakance ga hannaye, yatsu, ƙafafu, da yatsu a cikin jariri ko ƙaramin jariri ana kiransa acrocyanosis, kuma mara lahani ne, yanayin jijiyoyin jini na al'ada ga iska mai sanyaya yayin da ƙananan tasoshin jini ke takurawa don kiyaye ainihin jaririn. Koyaushe bincika ɓangarorin ɓacin rai na jariri: kalli lebe, harshe, gumi, da ƙirji na tsakiya ƙarƙashin haske mai kyau. Idan harshe da lebe suna da dumi da ruwan hoda mai haske kuma jaririn yana numfashi cikin kwanciyar hankali da faɗakarwa, ba shi da acrocyanosis mara lahani; idan leɓuna, harshe, ko fuska sun zama shuɗi, shuɗi, dusky, ko fari fari, cyanosis ce ta tsakiya kuma tana buƙatar kiran gaggawa nan take.

Shin fuskantar ƙarancin haɗarin BRUE yana nufin jaririna zai mutu da SIDS (Ciwon Mutuwar Jarirai)?¶

Manya-manyan nazarin yara na yara da yawa sun nuna cewa jariran da suka cika dukkan sharuɗɗa don Ƙananan Hadarin BRUE (fiye da kwanaki 60, an haife su a cikin makonni 32 na ciki ko kuma daga baya, taƙaitaccen taƙaitaccen abu a ƙarƙashin minti 1, babu CPR da ake buƙata, da jarrabawar jiki ta al'ada da ECG) suna da ƙananan haɗari na mutuwar kwatsam wanda ya dace da ainihin yawan jarirai. Aiwatar da tsayayyen halayen barci mai aminci (kaɗai, a baya, a cikin ƙaƙƙarfan gado) yana da mahimmanci ga kowane jariri.

Me yasa likitan dakin gaggawa ya ba da shawarar hana odar gwaje-gwajen jini, bugun kashin baya, da duban kwakwalwa ga jaririna mai ƙarancin haɗari?¶

When an infant over 60 days old strictly satisfies every single Low-Risk BRUE criterion and has a completely normal physical exam, extensive clinical trials involving thousands of infants prove that invasive blood draws, lumbar punctures, chest X-rays, and brain CT scans have a diagnostic yield of well under 1 percent while exposing the infant to radiation, pain, false-positive results, and hospital-acquired infections. Madadin haka, jagororin AAP na hukuma suna ba da shawarar awanni 1 zuwa 4 na ci gaba da lura da bugun jini, ECG mai cutarwa 12 mai cutarwa, swab na nasopharyngeal idan ana zargin pertussis, da kuma bibiya tare da likitan yara a cikin sa'o'i 24.

Shin zan sayi mabukaci mai wayo-sock ko faifan faifan bidiyo na numfashi bayan jaririna yana da BRUE?¶

Cibiyar Nazarin Ilimin Yara ta Amurka da Cibiyar Abinci da Magunguna ta Amurka ta shawarci iyaye kada su dogara ga mabukaci mai wayo-socks, tabarma na kyamara, ko shirye-shiryen diaper don hana SIDS ko saka idanu ga jariri bayan BRUE, saboda na'urorin mabukaci akai-akai suna rasa hypoxemia yayin haifar da ƙararrawa na ƙarya. Idan an gano jaririnka da Babban Haɗari BRUE, matsananciyar rashin haihuwa, ko ciwon zuciya/na iska da ke buƙatar sa ido a gida, ƙwararren ku zai rubuta na'urar duba lafiyar zuciya ta FDA tare da horarwar iyaye na CPR.

Menene bambanci tsakanin BRUE a cikin ɗan wata 2 da sihiri mai riƙe numfashi a cikin ɗan wata 14?¶

A BRUE occurs strictly in infants under 12 months of age and is unexplained, often happening during sleep, rest, or feeding. In contrast, a breath-holding spell typically occurs in toddlers aged 6 months to 6 years right after a clear trigger: either crying from frustration (cyanotic blue spell) or a sudden minor bump or fright (pallid white spell). Both require medical evaluation on their first occurrence, including an ECG for pale spells.

Jagora masu alaƙa¶

• Breath-holding spells (blue vs. pale syncope) and infant apnea triage
• Yara da jarirai CPR da shaƙewa
• botulism na jarirai, shan zuma mai ɗanɗano, ciwon jariri na floppy, da maƙarƙashiya
• Jaundice na jarirai, kernicterus, lethargy, da rigar diper dehydration ƙidaya
• Lambobin gaggawa

Tushen da jagorar hukuma¶

• ** Kwalejin Ilimin Yara na Amurka (AAP, Amurka):** *Jagorar Ayyukan Kula da Lafiya: Taƙaitaccen Magance Abubuwan da Ba a Fahimci Ba (BRUE) (Abubuwan da Suka Shafi Barazana Rayuwa) da kuma Ƙimar Ƙarfafa Jarirai * (Tieder et al., * Likitan Yara *) da Task Force on Kwatsam Mutuwar Jarirai Shawarwari Safe Barci.
• Canadian Paediatric Society (CPS, Canada): Acute Care Committee Practice Point: Managing the Low-Risk Brief Resolved Unexplained Event (BRUE) in Infants.
• National Institute for Health and Care Excellence (NICE) and Royal College of Paediatrics and Child Health (RCPCH, United Kingdom): Guidelines for the Investigation of Sudden Unexpected Postnatal Collapse (SUPC) and Apparent Life-Threatening Events in Infancy.
• Centers for Disease Control and Prevention (CDC, United States): Clinical Features of Pertussis (Whooping Cough) and RSV Apnea in Infants Under 6 Months.
• World Health Organization (WHO) and International Liaison Committee on Resuscitation (ILCOR): Tallafin Rayuwar Yara Na Farko (PBLS) Ijma'i akan Kimiyya tare da Shawarwari na Jiyya.