Flail Chest, Ragewar Haƙarƙari da yawa, da Taimakon Farko na Ƙarji¶

Haƙarƙari na ɗan adam wani keji ne na kasusuwa na roba na haƙarƙari guda goma sha biyu waɗanda aka tsara don kare zuciya, huhu, manyan hanyoyin jini, hanta, da saifa yayin aiki azaman ƙwanƙolin injin da ke jan iska zuwa cikin huhu. Lokacin da ƙarfin ƙarfi mai ƙarfi (kamar tasirin tuƙi, faɗuwa kan tsani ko dogo, bugun doki, ko karon wasanni) ya afka bangon ƙirji, ɗaya ko fiye da hakarkarinsa zai iya fashe. Yayin da karayar haƙarƙari mai sauƙi guda ɗaya yana da zafi mai tsanani, karya ** biyu ko fiye da ke kusa da hakarkarinsa a wurare biyu ko fiye ** (ko cire sternum daga hakarkarin biyu) yana karya wani sashe na bangon kirji gaba daya daga sauran ribcage, yana haifar da gaggawa mai barazana ga rayuwa mai suna ** flail chest **.

A cikin ƙirjin lallausan ƙirji, keɓe tsibiri mai iyo na hakarkarin hakarkari (bangaren flail) ba a sake fitar da haƙarƙarin waje yayin shakar numfashi; a maimakon haka, matsa lamba mara kyau a cikin ƙirji yana tsotse sashin da ya karye ** na ciki lokacin da majiyyaci ya numfasa**, kuma matsi mai kyau yana tura shi ** waje lokacin da majiyyaci ya fitar da numfashi** (** motsin kirjin paradoxical**). Har ma mafi mahimmanci, tasirin tashin hankali da ake buƙata don ɗaukar haƙarƙari da yawa a wurare biyu koyaushe yana ɓarna da yayyage jakunkunan iska na huhu kai tsaye a ƙarƙashin (** rikicewar huhu ***), yana cika huhu da jini da ruwa a cikin sa'o'i 2 zuwa 24 masu zuwa. Sanin dalilin da ya sa dole ne **kada ku taɓa nannade tef ɗin m ko maɗaurin roba a cikin ƙirji ***, yadda ake koyar da ** matashin kai mai laushi **, yadda ake sanya wanda ya mutu a tsaye, da kuma yadda ake kallon huhun ɓoyayye.tashin hankali pneumothorax) ko fashe fashe yana ceton rayuka.

Yi wannan yanzu¶

1. **Kira lambar gaggawa ta gida nan da nan idan wanda aka azabtar yana da motsin ƙirji (wani sashe na hakarkarin da ke tsotsar ciki a cikin numfashi), uku ko fiye da ake zargi da karyewar hakarkarinsu, gajeriyar numfashi, tari jini, ko ciwon kirji mai tsanani bayan rauni mai sauri. lambobin gaggawa.
2. Bare duk kirjin da babu kowa a ciki sannan a kalli haƙarƙarin yana tashi ya faɗi a matakin ido na tsawon daƙiƙa 10 zuwa 15. Ba za ka iya ganin motsin da ba a taɓa gani ba ta jaket ko rigar gumi. Duba a hankali a jikin bangon kirji don gano kowane yanki da ya nutse a ciki yayin wahayi yayin da sauran kirjin ke fadada.
3. **KADA KA KARYA nannade tef, bandeji na roba, belts, ko igiyoyi damtse a kusa da hakarkarin, kuma KAR KA DORA DORA JABUKAN YACI A KIRJI
4. **Tallafa wani yanki na flail ko raunin haƙarƙari mai raɗaɗi a hankali ta hanyar sa majiyyaci mai hankali ya riƙe matashin kai mai laushi, bargo mai naɗewa, ko tawul mai ƙaƙƙarfan a gefen wanda ya ji rauni ("Pillow Splinting").
5. ** Matsayi mai hankali, mara lafiya mai numfashi yana zaune madaidaiciya (Matsayin Fowler a digiri 45 zuwa 60) ko ya karkata kadan zuwa gefen da ya ji rauni (sai dai idan raunin kashin baya yana buƙatar kwance). karkatar da dan kadan zuwa gefen da ya ji rauni yana barin lafiyayyen huhu a saman ya fadada cikin yardar kaina.
6. ** Kula da kowane minti 2 zuwa 5 don alamun haɓakar Tension Pneumothorax, Hemothorax, ko Ragewar Hanta.** Karyewar haƙarƙari suna da kaifi-kaifi kuma akai-akai suna huda huhun da ke ƙasa (wanda ke haifar da ci gaba da tarkowar iska da kumburin wuyansa) ko lacerate splin (ƙarƙashin haƙarƙarin hagu 11) ko 7 zuwa hanta. Rike mai haƙuri dumi da tsananin NPO (babu komai da baki).

Bishiyar yanke shawara ta gaggawa don raunin ƙirji da karyewar haƙarƙari¶

flowchart TD
    Start["Blunt Impact to the Chest Wall, Ribcage, or Breastbone (Sternum)"]
    Expose["Expose Entire Bare Chest and Look Across Ribcage at Eye Level<br/>Assess breathing rate, depth, skin color, and symmetry"]
    FlailCheck{"Is Paradoxical Chest Movement Present?<br/>(A section of ribs sucks INWARD during inhalation<br/>and bulges OUTWARD during exhalation)"}
    FlailProtocol["FLAIL CHEST & PULMONARY CONTUSION PROTOCOL<br/>1. Call EMS (911 / 112 / 999) immediately for ALS trauma transport<br/>2. DO NOT tape ribs; DO NOT place heavy weights/sandbags on chest<br/>3. Have conscious patient hold a soft pillow or folded blanket gently over flail area<br/>4. Sit patient semi-upright (45 deg) or tilted slightly toward injured side<br/>5. If breathing becomes shallow/failing, assist with gentle positive-pressure breaths"]
    RedFlagRibs{"Are ANY High-Risk Rib Fracture Red Flags Present?<br/>- Shortness of breath, blue lips, or SpO2 < 94%<br/>- Coughing up bright red or frothy pink blood (hemoptysis)<br/>- Subcutaneous emphysema ('Rice Krispies' crackles under skin)<br/>- Fractures of Upper Ribs (1-2), Lower Ribs (9-12), or Sternum<br/>- Patient is > 65 years old, frail, on blood thinners, or has COPD<br/>- 3 or more painful ribs"}
    UrgentEMS["HIGH-RISK BLUNT THORACIC TRAUMA<br/>1. Call EMS (911 / 112 / 999) or go to Emergency Department immediately<br/>2. Sit semi-upright; support ribs with soft pillow when coughing<br/>3. Monitor closely for Tension Pneumothorax or Spleen/Liver bleeding<br/>4. Keep patient strictly NPO (nothing by mouth) and warm"]
    SimpleRib["SUSPECTED SIMPLE ISOLATED RIB FRACTURE OR CHEST WALL BRUISE<br/>(Young healthy adult, low-energy bump, normal breathing, no red flags)<br/>1.Seek medical evaluation to rule out small pneumothorax and get pain plan<br/>2. NEVER wrap or tape the chest<br/>3. Perform 'Pillow-Splinted Deep Breaths & Coughs' every hour while awake<br/>   to prevent post-injury pneumonia"]

    Start --> Expose
    Expose --> FlailCheck
    FlailCheck -->|Yes: Paradoxical Movement| FlailProtocol
    FlailCheck -->|No: Chest Moves Outward Together| RedFlagRibs
    RedFlagRibs -->|Yes: Any Red Flag Present| UrgentEMS
    RedFlagRibs -->|No: Isolated Point Tenderness Only| SimpleRib

Yankunan haɗarin jiki na haƙarƙari: Waɗanne fashe haƙarƙari ke barazanar gabobin ciki¶

Ba duka nau'i-nau'i na haƙarƙari guda goma sha biyu ke ɗaukar haɗari iri ɗaya ba. Likitoci sun raba haƙarƙarin zuwa sassa huɗu daban-daban na jiki domin wurin da aka karye haƙarƙarin yana annabta ɓoyayyen ɓoyayyen ɓoyayyen gaɓoɓin gabobi a ƙasa:

Anatomy da pathophysiology na Flail Chest and Pulmonary Contusion¶

1. Yadda Sashe na Flail ke samuwa da dalilin da yasa yake komawa baya (Motion Paradoxical)¶

Kirar kirji *** yana buƙatar aƙalla ** hakarkarin da ke kusa da su biyu sun karye a wurare biyu ko fiye da haka** a gefe guda (ko rabuwar costochondral na biyu da ke cire sternum). Wannan yana haifar da bangon ƙirji mai yawo kyauta wanda ya rasa ci gaban ƙashin sa tare da sauran kejin thoracic: * Lokacin shakar na al'ada: Diaphragm yana yin kwangilar ƙasa kuma tsokoki na waje suna jan haƙarƙarin da ba daidai ba sama da waje. Wannan yana sauke matsa lamba a cikin ramin ƙirji ƙasa da matsa lamba na yanayi (zuwa kusan -8 \(\rubu{cmH}_2\rubutu{O}\)). Saboda bangaren flail da ke iyo ya kebe daga madaidaicin hakarkarinsa, matsawar yanayi na waje yana tura shi INWARD zuwa cikin kogon kirjin da ba ya da kyau yayin da sauran ribcage din ke fadada waje. * Lokacin fitar da numfashi (ko Tari): Matsi a cikin kirji yana hawa sama da matsa lamba na yanayi, yana tura sashin flail mai iyo DAGA yayin da sauran haƙarƙarin ke nutsewa ciki. * ** Me yasa ake yawan rasa motsin motsin rai a cikin mintuna 30 na farko ("Mashin Muscle-Spasm Mask"):** Nan da nan bayan wani karo, mai hankali, tsokar tsoka da tsokar bangon kirji yana shiga cikin matsananciyar son rai ** kiyaye spasm** a cikin raƙuman haƙarƙari, riƙe ɓangaren flail na ɗan lokaci kaɗan ba za ku gaji da farko ba. Bayan haka, mintuna 20 zuwa 60 bayan haka, yayin da tsokoki na tsaka-tsakin gajiya daga gajiya da hypoxia, tsattsauran tsoka yana fitowa kuma yana ban mamaki ** motsin paradoxical ** yana bayyana kwatsam. Koyaushe sake duba kirjin da babu kowa a kowane minti 5 zuwa 10.

2. Me yasa ciwon huhu (Bruised Lung) shine ainihin kisa a cikin Flail Chest¶

Likitoci na ƙarni na 20 na farko sun yi imanin ƙirjin ƙirji ya kashe marasa lafiya saboda iska ta ja baya da gaba tsakanin huhun biyu (Pendelluft). Binciken ilimin lissafi na zamani ya tabbatar da cewa ainihin cutar cututtukan da ke barazanar rayuwa a cikin ƙirjin ƙirjin ita ce ** Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙirji 1. Alveolar Hemorrhage and Edema: Babban tasiri mai banƙyama wanda ke ɗaukar haƙarƙari da yawa a wurare biyu yana aika da girgiza ta cikin soso mai kama da huhu a ƙasa kai tsaye. Ƙwayoyin ƙananan ƙwayoyin cuta da bangon alveolar sun rushe, suna cika buhunan iska da jini, ruwa mai wadatar furotin, da tarkace mai kumburi. 2. Bam na Lokacin "Blossoming" da aka jinkirta (Sa'o'i 2 zuwa 24): Ciwon huhu yana zama kamar mummunan rauni akan fatar ku: baya kumbura zuwa girmansa a cikin mintuna 5 na farko. Majinyacin da ke da ƙirji mai lanƙwasa ko bugun ƙirji mai tsanani zai iya samun matakan iskar oxygen kusa da na al'ada nan da nan bayan hadarin, amma a cikin sa'o'i 2 zuwa 24 na gaba , ruwa mai tsaka-tsaki da jini yana mamaye huhu da ya lalace a hankali (" furen contusion"). Oxygen ba zai iya ketare buhunan iska da aka ambaliya zuwa cikin jini ba ( shunting intrapulmonary**), yana haifar da ci gaba, mai tsanani hypoxia da Ciwon Ciwon Hankali (ARDS). 3. ** Gargaɗi na Yara (Cutar Huhu BA TARE DA K'ARUWA BA):** A cikin jarirai, yara, da matasa, hakarkarin haƙarƙarin yana kunshe da nakuda mai ƙarfi, mara ƙididdigewa da ƙashi mai raɗaɗi. Yaron da mota ta buge ko aka jefar da shi daga keke yana iya fama da ciwon bugun huhu mai girma mai hatsarin gaske, pneumothorax, ko bugun zuciya ba tare da karya haƙarƙari ɗaya ba.* Kada ku taɓa yin watsi da mummunan rauni na huhu a cikin yaro kawai saboda hakarkarinsa ya yi kama.

Taimakon farko na mataki-mataki don Ƙirji na Flail da Karan Haƙarƙari da yawa¶

Mataki 1: Bayyana, duba, kuma a hankali ka ji bangon kirji¶

1. Ka sa majiyyaci ya zauna ko ya huta cikin jin daɗi kuma ya cire ko yanke tufafi na sama don fallasa dukan ƙirjin.
2. Duba matakin ido: Ku durkusa kusa da majiyyaci kuma ku duba saman saman kirjin nasu na tsawon dakika 15 don duba ko bangarorin biyu sun tashi daidai da ko wani bangare ya nutse a ciki yayin shakar numfashi.
3. Ji a hankali don Emphysema na Subcutaneous da Crepitus: Tare da yatsun safofin hannu masu lebur, a ɗan taɓa fata a kusa da ƙasusuwan ƙugiya, wuya, da yankin haƙarƙari.
4. Crepitus Bony: Wani rashi mai raɗaɗi na karyewar haƙarƙari yana ƙare shafa tare (kada a danna ** da ƙarfi sau ɗaya ji).
5. Subcutaneous Emphysema: Wani abin sha'awa kamar bubbuga ƙaramin kumfa ko Rice Krispies hatsi a ƙarƙashin fata. Subcutaneous emphysema yana da mahimmancin jan tuta: yana tabbatar da cewa haƙarƙari mai kaifi ya huda ƙwayar huhu da ƙwayar huhu a ƙarƙashinsa, yana tilasta iska daga cikin huhu zuwa cikin kitse a ƙarƙashin fata, kuma yayi kashedin cewa ** pneumothorax ko tashin hankali pneumothorax ** yana ƙarƙashin wannan haƙarƙarin.

Mataki na 2: Aiwatar da "Pillow Splinting" mai laushi (Kada Tape ko Jakar Yashi)¶

1. Dauki matashin gado mai laushi, bargon ulu mai naɗewa mai kauri, riga mai naɗewa, ko tawul ɗin wanka mai ƙaƙƙarfan tawul ɗin wanka sai a sanya shi a hankali a kan ɓangaren flail ɗin ko haƙarƙarin da ya karye.
2. Idan majiyyaci ya sane kuma yana faɗakarwa: Ka sa majiyyaci ya riƙe matashin kai mai laushi a hankali a kan haƙarƙarin da suka ji rauni da hannu da hannunsa. Za su iya daidaita a hankali goyon bayan ciki don rage zafin haƙarƙari lokacin shakar ko tari ba tare da tauye huhun su mai kyau ba.
3. Idan dole ne ku 'yantar da hannayen majiyyaci yayin jigilar kaya: Kuna iya amfani da majajjawar bandeji mai faɗi mai faɗin triangular da ** sako-sako** mai riƙe da hannun marar lafiyan lankwasa da tausasawa a hankali a gefen ƙirjin da aka ji rauni, kar a taɓa ja da ƙarfi don danne haƙarƙarin ko kuma taƙaitaccen gefen da ba a samu rauni ba.

Mataki na 3: Mafi kyawun Matsayi don Numfasawa¶

• Majiyyaci mai hankali ba tare da wanda ake zargi da rauni na kashin baya ba:
• Zama majiyyaci a ** Semi-Fowler's ko madaidaiciya (digiri 45 zuwa 60)**, jingina kaɗan zuwa gefen da aka ji rauni wanda matashin kai ke goyan bayansa.
• Me yasa karka karkata kadan zuwa bangaren da aka ji rauni? Jingila kadan kan matashin kai mai laushi a gefen da ya karye yana amfani da nauyin jiki mai laushi don daidaita haƙarƙari yayin da yake barin ** huhun da ba ya rauni a mafi girma gefen** ya faɗaɗa zuwa iyakar girmansa ba tare da ƙuntatawa ba.
• Mai lafiya da ake zargi da wuya ko baya (kashin baya) rauni:
• Ajiye kashin baya cikin tsaka mai tsaka-tsaki na layi akan shimfida mai lebur ko shimfida shimfidar wuri, sanya tawul mai laushi ko matashin kai a hankali akan sashin flail (hannun mai ceto yana riƙe da sauƙi ba tare da turawa ƙasa ba), da kuma lura da numfashi akai-akai.
• Majiyyacin numfashin da bai sani ba (Babu raunin spinal):
• Sanya wuri a matsayin farfadowa na gefe ** tare da gefen RAUNIYA KASA a kan ƙasa / padding ** da ** HUhun LAFIYA *** don haka huhu mai kyau zai iya faɗaɗa cikin 'yanci ba tare da an murkushe shi da nauyin jikin ba.

Mataki na 4: Idan majiyyaci mai Flail Chest ya daina numfashi yadda ya kamata? (Tsarin huhu na Ciki)¶

• Saboda motsin ƙirjin ƙirjin yana ɗaukar ƙoƙari na tsoka mai yawa kuma huhu mai rauni ba zai iya ɗaukar iskar oxygen da kyau ba, waɗanda suka mutu tare da manyan ɓangarori na iya yin gajiya da sauri: numfashin su ya zama da sauri kuma mara ƙarfi (> 30 numfashi / min) sannan kuma cikin haɗari (< 8 zuwa 10 numfashi / min) tare da leɓuna masu launin shuɗi.
• Yadda ingantacciyar numfashin ceto ke aiki azaman "Splint na ciki": Ba kamar numfashi na yau da kullun ba (wanda ya dogara da matsa lamba mara kyau wanda ke tsotse sashin flail * ciki*), ** iska mai kyau-matsi mai laushi ** (ta hanyar abin rufe fuska, jakar-bawul-mask, ko numfashin ceto) yana hura iska a ƙarƙashin matsi mai fa'ida. a cikin wannan shugabanci kamar sauran ribcage ** ("tsarin huhu na ciki").
• Muhimmiyar Tsanaki tare da Numfashin Matsi mai Kyau a Cikin Ƙirji: Saboda karyewar haƙarƙari ya sau da yawa ya huda huhun da ke ƙarƙashinsa, yana busawa mai ƙarfi, numfashi mai ƙarfi a cikin huhu zai iya tilasta iska ta fita ta tsagewar huhu zuwa cikin ramin ƙirji, da sauri haifar da ** tashin hankali pneumothorax . Isar da numfashin ceto ** a hankali, a hankali, kuma kawai don ganin tashin ƙirji na yau da kullun.

Sarrafa Sauƙaƙan Karancin Haƙarƙari: Dalilin da yasa Manya Manya ke Fuskantar Ciwon huhu da Yadda "Ciwon Tari" ke Ceto Rayuka¶

Yayin da matasan 'yan wasa da ke da haƙarƙari guda ɗaya kusan kullum suna farfadowa lafiya, ** raunin haƙarƙari a cikin tsofaffi (shekaru 65 da haihuwa) ko marasa lafiya da ke fama da cutar huhu (COPD) babbar barazana ce ta rayuwa : * Rijistar cututtuka na asibiti sun nuna cewa ga kowane ƙarin karyar haƙarƙari guda ɗaya a cikin majiyyaci sama da shekaru 65, haɗarin kamuwa da cutar ciwon huhu yana ƙaruwa da kashi 27 cikin ɗari, kuma ** mace-macen yana ƙaruwa da kashi 19 cikin ɗari*.

Mummunan Zagayowar Ciwon Haƙarƙari -> Atelectasis -> Cutar huhu¶

Me yasa haƙarƙari mai sauƙi ke haifar da ciwon huhu na huhu bayan kwanaki 3 zuwa 5? 1. Shan numfashi na al'ada ko tari yana shimfiɗa tsokoki na intercostal kuma yana shafa haƙarƙarin da ya karye ya ƙare tare, yana haifar da ciwo mai rauni. 2. Don guje wa wannan kaifi zafi, majiyyaci a cikin sane yana ɗaukar ɗan ƙaramin numfashi (hypoventilation/ splinting) kuma ya ƙi tari. 3. Ba tare da nishi mai zurfi da tari na lokaci-lokaci ba, ƙananan jakunkunan iska a kasan huhu a gefen da suka ji rauni sun ruguje kamar balloons (atelectasis) kuma suna cika da tsumma. 4. Kwayoyin cuta suna haɓaka a cikin wannan tafkin dumin ƙwayar cuta, suna haifar da matsananciyar ** ciwon huhu na lobar bayan rauni ** da gazawar numfashi cikin sa'o'i 48 zuwa 96.

Yadda za a karya sake zagayowar: Multimodal Analgesia da Sa'a "Pillow-Splinted Coughing"¶

Bayan likita ya bincika majiyyaci (kuma ya kawar da pneumothorax ko jini na ciki): 1. Kada a naɗe ko ɗaure ƙirji: Jefa bel ɗin haƙarƙari na tsofaffi ko nannatin ƙirji. 2. Kwantar da "Shafin Numfashi Mai Rarraba Matashi da Tari" kowane awa 1 zuwa 2 yayin farke: * Ka sa majiyyaci ya zauna a miƙe a kujera kuma ya rungumi matashin gado mai ƙaƙƙarfan matashin kai ga haƙarƙari mai raɗaɗi da hannuwa biyu. * Yayin da ake danna matashin kai a hankali a cikin haƙarƙarin don daidaita shi, ɗauki ** 5 zuwa 10 a hankali, numfashi mai zurfi har zuwa **, riƙe kowane numfashi na tsawon daƙiƙa 3 a saman don buɗe buhunan iska da suka ruɗe (ta yin amfani da spirometer mai ƙarfafawa idan asibiti ya samar). * Bi tare da tausasawa 2, matashin kai mai goyan bayan "huff tari" don share duk wani ƙuri'a daga ƙananan huhu. 3. Bi tsarin da likita ya tsara na magance ciwon kai: Ba kamar ciwon ƙafar ƙafar ƙafa ba inda maganin ciwon ya zama don jin daɗi kawai, isassun ciwon raɗaɗi a karyewar haƙarƙari magani ne na ceton rai *** domin yana bawa mayyaci damar ɗaukar numfashi mai zurfi da tari. A asibitoci, marasa lafiya masu karyewar haƙarƙari sukan karɓi tubalan jijiyoyi na yanki (kamar ** serratus na baya na jirgin sama, toshewar spinae block, ko thoracic epidural ***) don haka suna iya yin numfashi sosai ba tare da kwantar da hankali na opioid ba. 4. A shafa fakitin kankara a nannade cikin tawul na tsawon mintuna 15 zuwa 20 a lokaci guda akan haƙarƙari mai taushi a cikin sa'o'i 48 na farko don rage kumburin periosteal na gida.

Sauran raunukan ƙwanƙwasa masu kisa don gane su a cikin filin¶

Lokacin da ƙarfi mai ƙarfi mai ƙarfi ya bugi bangon ƙirji ko sternum, ƙarin ƙarin ɓoyayyun cututtukan zuciya da bugun jini guda uku na iya faruwa tare da karyewar haƙarƙari:

1. Commotio Cordis (Kamuwar Fibrillation na Kwatsam)¶

Commotio cordis kwatsam ne, bugun zuciya mai saurin kisa wanda ya haifar da kaifi, mai karancin kuzari kai tsaye akan bangon kirji na hagu (daidai a kan silhouette na zuciya) lokacin da babu wata lahani ga hakarkari ko tsokar zuciya kwata-kwata**. * ** Halin da aka saba:** Yaro, matashi, ko matashin da ke tsakanin shekaru 5 zuwa 25 an buge shi daidai a cikin kirjin hagu ta wani abu mai wuya (wallon kwando, ƙwallon lacrosse, wasan hockey, ƙwallon cricket, bugun fanti, ko gwiwar hannu). Mai wasan na iya ɗaukar matakai guda ɗaya ko biyu na tuntuɓe sannan ya faɗi gaba ɗaya ba ya jin motsin rai, rashin jin daɗi, da bugun zuciya. * ** The Electrophysiological Mechanism:** Idan projectile ya buga bangon ƙirji yayin kunkuntar tagar ** 15-zuwa-30-millisecond taga akan saman T-wave** (lokacin da ventricles na zuciya ke jujjuyawa kuma suna da rauni ta lantarki), motsin injin yana buɗewa tashoshi mai kunnawa na zuciya da bugun zuciya. (VF)** kamewar zuciya. * Taimakon Farko: Kowane daƙiƙa yana ƙidaya. Fara matsawar ƙirji mai inganci (CPR) nan da nan kuma haɗa na'urar Defibrillator na Automated (AED) a cikin mintuna 3. Tsira daga commotio cordis ya zarce ** 70 bisa dari ** idan CPR da girgizar AED an ba da su cikin mintuna 3, amma ya faɗi ƙasa da kashi 10 idan an jinkirta bayan mintuna 5.

2. Raunin Zuciya Mai Kaya (Myocardial Contusion) da Karaya¶

Lokacin da kashin jijiyar direba (sternum) ya dunkule cikin sitiyari ko bel ɗin kujera a cikin saurin babbar hanya, ** ventricle na dama ** na zuciya (wanda ke zaune a bayan kashin bayan mahaifa) yana murƙushewa tsakanin ƙashin nono a gaba da kuma kashin bayan thoracic a baya. * Alamomin Gargaɗi: Murƙushe ciwon ƙirji na tsakiya wanda ba a sauƙaƙawa ta wurin hutawa, rauni ko nakasar da ta tashi a kan tsakiyar ƙashin ƙirjin (** karaya ta sternal**), rashin daidaituwa, tsalle-tsalle, ko bugun bugun jini (** sinus tachycardia, ƙanƙancewar ventricular, ko bugun jini da ba a taɓa gani ba), da rashin ƙarfi na jini (***) * Taimako na Farko: Rike majiyyaci yana zaune a nitse mai miƙewa tsaye, hana duk wani motsa jiki, saka idanu akan bugun jini gabaɗaya don kama bugun zuciya na kwatsam, kuma shirya jigilar motar asibiti na ALS nan take don saka idanu ECG mai jagora 12 da gwajin troponin na zuciya.

3. Raunin Ciwon Jiji (Rauni)¶

A cikin hatsarin mota a kan gaba a> 60 km / h (40 mph) ko faɗuwa daga> mita 6 (ƙafa 20), buɗaɗɗen wayar hannu na aorta yana jujjuyawa a gaba yayin da ƙwanƙwaran thoracic mai saukowa ya kasance yana haɗuwa da kashin baya ta ** ligamentum arteriosum , yana tsage bangon aorta. Yayin da kashi 80 cikin 100 na tsattsauran ra'ayi suna mutuwa a wurin, ** kashi 20 cikin 100 na marasa lafiya suna rayuwa da farko saboda tauri mai ƙarfi na aorta (** adventitia**) na ɗan lokaci yana riƙe da jini a ciki kamar kumburin kumburi (** mai ɗauke da pseudoaneurysm**). * Kiyaye duk wani babban abin da ya faru da hatsarin gaggawa mai sauri da kwanciyar hankali kuma har yanzu yayin sufuri; firgita kwatsam, kokawa, ko zafi yana ƙara hawan jini kuma yana iya fashe hawayen da ke ƙunshe kafin a gyara stent graft tiyata.

Fahimtar injiniyoyin ƙirjin ƙirji, ƙwanƙwasa huhu, da ƙwanƙwasa haƙarƙarin kula da numfashi yana hana hypoxia kwatsam da jinkirin ciwon huhu. Yi la'akari da ɗaukar ƙwararrun taimako na farko ko kwas na ba da agajin gaggawa ta Red Cross ko Red Crescent jama'a, St John Ambulance, ko Ƙungiyar Zuciya ta Amurka.

Tambayoyin da ake yawan yi¶

An duba tushe¶

• Kwalejin Likitan Likitan Amurka (ACS, Amurka): Taimakon Rayuwa na Cigaba (ATLS) Jagoran Koyarwar Dalibai: Trauma Thoracic, Flail Chest, Ciwon Jiki, da Rarrabuwar Haƙarƙari.
• Ƙungiyar Gabashin Gabas don Tiyatar Cutar (EAST, Amurka): Sharuɗɗan Gudanar da Ayyuka don Ciwon Jiki - Flail Chest da Blunt Thoracic Trauma a Manya Manya.
• National Institute for Health and Care Excellence (NICE, United Kingdom) & NHS: Major Trauma Clinical Guidelines: Chest Trauma Management and Rib Fracture Analgesia/Physiotherapy.
• National Association of Emergency Medical Technicians (NAEMT, United States): Prehospital Trauma Life Support (PHTLS): Blunt Thoracic Trauma and Internal Pneumatic Stabilization.
• ** Ƙungiyar Ƙungiyar Red Cross da Red Crescent ta Duniya (IFRC, Ƙasashen Duniya):** Taimakon Farko na Duniya, Farfaɗo, da Ka'idodin Ilimi: Raunin ƙirji da Ragewar Haƙarƙari.

Jagora masu alaƙa¶

• Ciwon kirji da rugujewar agajin gaggawa na huhu
• Ciwon ƙirji da kuma tamponade na pericardial
• Karyewar kasusuwa, karaya, da sprains taimakon farko
• Raunin kashin baya da rashin motsi
• Ganewar girgiza da kulawar gaggawa
• Lambobin gaggawa da aika aika ƙasashen waje