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Dan Wasan Dalibai Ya Rushe A Filin: Ƙunƙarar Ƙwararrun Ƙwararru ('Cool First, Transport Na Biyu') vs Kwatsam Kame Zuciya vs Sickling

Lambobin gaggawa sun bambanta da ƙasa. Wannan shafin yana amfani da 911, lambar ga Amurka da Kanada. Yawancin ƙasashe suna amfani da 112, 999, ko wata lamba. Nemo lambar don ƙasar ku.

Kallon ɗan wasan ƙwallon ƙafa na makarantar sakandare mai shekaru 15, ɗan tseren ƙetare, memba na ƙungiyar maci, ko ɗan wasan ƙwallon ƙafa na matasa ba zato ba tsammani sun faɗi ƙasa ko kuma sun faɗi a kan turf yayin aikin kwantar da hankali na kwana biyu na Agusta yana ɗaya daga cikin gaggawar gaggawa na likita a cikin likitancin wasanni. A cikin matasa da wasannin motsa jiki, ** sama da kashi 90% na duk mutuwar ba zato ba tsammani a filin wasa ana haifar da mummunan yanayi guda uku kawai : ** kama Cardiac na gaggawa (SCA, Matsalar Zafin Zafi (EHS, da kuma Magungunan motsa jikiES a cikin 'yan wasan da ke ɗauke da Sickle Cell Trait, HbAS). Yayin da duk abubuwan gaggawa guda uku zasu iya nunawa a cikin dakika na matsanancin motsa jiki na jiki a rana mai zafi, rikitar da juna ga wani a farkon 180 seconds na iya zama m. Maganin kama wanda aka kama na zuciya ba zato ba tsammani a matsayin "mai zafi kawai" yana jinkirta jinkirin wucewa ta taga tsira na mintuna 3; sanya wanda aka azabtar da shi kai tsaye a bayan busasshiyar motar asibiti mai kwandishan ba tare da fara nutsar da su a cikin wurin ba ** nutsar da ruwan sanyi (CWI) kankara tub* ya sabawa kungiyar masu horar da 'yan wasa ta kasa (National Art Trainers' Association).NATA) da Korey Stringer Institute "Cool First, Transport Na biyu" zinariya-misali umarni** da ba da damar su 41.5 °C (106.7 °F) ainihin zafin jiki don dafa kwakwalwarsu da hanta yayin tafiyar motar asibiti na minti 20; da kururuwa ga wani ɗan wasa da ke fama da matsananciyar matsalar ciwon sikila ** don "tashi da tsaurin ƙafar ƙafa" yana haifar da bala'i na microvascular ja-jini-cell logjamming, fulminant rhabdomyolysis, da hyperkalemic cardiac arrest.

An yi sa'a, masu horarwa, masu horar da 'yan wasa (ATCs), likitocin ƙungiyar, da kuma iyaye na gefe ba sa buƙatar gwajin jini na dakin gwaje-gwaje don gaya wa waɗannan gaggawa guda uku a kan ciyawa. Ta hanyar duba masu nuna wariya na asibiti guda huɗu a cikin daƙiƙa 30 na farko - (1) Amsa da Numfasawa (SCA = rashin amsa gaba daya tare da rashi ko shakar shakar shaka), **(2) Rushewar Saurin (2)SCA kuma Heatstroke sauke kwatsam ba tare da gargadi ba, alhali Sickling 'yan wasa sun durƙusa a ƙasa yayin da suke farke kuma suna gunaguni na rashin ƙarfi, ƙananan ƙananan baya / gluteal / rauni na hamstring) , ** (3) Palpation Muscle (Heatstroke kuma Sickling tsokoki suna jin taushi ko rashin ƙarfi, alhali gaskiya ne Heat Cramps kulle a cikin dutsen-hard, spasms a bayyane), da (4) Matsakaicin zafin jikiExertional Heatstroke An bayyana ta tabarbarewar CNS tare da zafin jiki na dubura a sama 40.5 °C / 105 °F, alhali kuwa Sickling kuma SCA faruwa a yanayin yanayin motsa jiki na al'ada ko ɗan ƙaramin ƙarfi a ƙasa 40.0 °C / 104 °F - zaku iya jawo ainihin ƙa'idar ceton rai nan da nan.

(Don cikakkun matakan farfado da bugun zuciya, duba CPR da AED jagora. Don matsalolin gaggawa na zafi gabaɗaya, duba Heat bugun jini vs. zafi gajiya kuma Mummunan rauni na koda, rhabdomyolysis, da duhun fitsari, da kuma kiyaye mu duniya lambobin gaggawa littafin adireshi a gefe.)

Yi wannan yanzu

  1. ** Kunna Shirin Ayyukan Gaggawa na wurinku (EAP) a cikin dakika 10 na farko: sanya mutum ɗaya don kiran 911 (ko 112 / 999), mutum ɗaya don yin gudu don AED na gefe, da kuma mutum ɗaya don buɗe ƙofofin filin don motar asibiti.** Kada ku jira don "gani idan dan wasan ya girgiza shi." Kira lambar gaggawa ta gida (911 a cikin Amurka da Kanada, 112 a duk faɗin Turai, 999 a cikin Burtaniya, ko gani lambobin gaggawa) nan take a duk lokacin da wani dan wasa ya fadi a filin wasa.
  2. ** Hukunce Hukunce Hukunce Hukunce Hukunce Hukuncen Kamun ZuciyaSCA) Na farko (Na biyu 0 zuwa 30): Idan dan wasan ba shi da amsa kuma baya numfashi akai-akai, fara Hands-Only CPR kuma yi amfani da AED a cikin mintuna 3.**
  3. Taɓa kafadar ɗan wasan kuma ku yi ihun sunansu. ** TARKO MAI MUHIMMANCI:** Kusan ** 50% na 'yan wasa a cikin kamawar zuciya kwatsam suna nuna ɗan gajeren kamawa-kamar myoclonic jerking na hannaye/ƙafa (na tsawon daƙiƙa 10 zuwa 20) da babbar murya, suna snorting "agonal gasps"**. Kada ku yi kuskuren kamawa-kamar girgiza ko haki don yin numfashi na yau da kullun, kuma **kada ku taɓa ɗauka cewa ɗan wasan da ya ruguje yana "ɗaukar zafi kawai" har sai kun tabbatar sun farka ko suna numfashi kullum tare da bugun jini mai ƙarfi **.
  4. Idan dan wasan bai amsa ba kuma baya numfashi akai-akai: yanke rigunan su da sandunan kafada (ta yin amfani da rauni mai nauyi yana saukowa a gaban kushin kirji, yana barin kwalkwali / farantin baya a wurin sai dai idan an buƙata don samun hanyar iska), fara ** Hannu-kawai CPR (CPR)100 to 120 compressions/min, 5 to 6 cm / 2 to 2.4 in mai zurfi), kuma a haɗa ** AED pads zuwa kirjin da babu shi nan da nan. Kowane jinkiri na daƙiƙa 60** bayan mintuna 3 yana sauke rayuwa da 10%.
  5. Idan ɗan wasan yana da bugun jini mai ƙarfi kuma yana numfashi, duba Matsayin Haihuwa (CNS Functionnan da nan: duk wani rashin fahimta, hali mara hankali, magana mara kyau, tuntuɓe, ko suma a lokacin zafi shine Exertional Heatstroke (EHS) har sai an tabbatar da haka.
  6. Yi tambayoyi guda huɗu: "Mene ne sunanka? Wane filin muke? Wane watan ne? Wane irin rawar jiki muke yi?"
  7. KADA KA dogara akan ko dan wasan yana zufa ko a'a (anhidrosis), kuma KAR KA YI amfani da kunne (tympanic), goshi (temporal), ko ma'aunin zafi na baka. Ba kamar tsofaffi waɗanda ke fama da matsanancin zafi ba, ** sama da kashi 90% na ɗaliban 'yan wasan da ke fama da matsanancin zafin nama suna digowa cikin tsananin gumi a daidai lokacin da suke faɗuwa**, kuma ana karanta ma'aunin zafin jiki na goshi/kunne 2 zuwa 4 digiri Celsius (4 zuwa 7 digiri Fahrenheit) yayi ƙasa sosai akan fatar gumi. Kawai ma'aunin zafi da sanyio mai sassauƙan thermistor rectal** (inserted 15 cm / 6 inches past the anal sphincter) daidai gwargwadon zafin jiki (> 40.5 °C / 105 °F ya tabbatar da EHS).
  8. Idan Ciwon Zafin Motsa Jiki (EHS) akwai (Core Temp > 40.5 °C / 105 °F KO bayyananne CNS delirium/ruduwa cikin zafi mai zafi lokacin da babu ma'aunin zafin jiki na dubura): Yi "COOL FARKO, TRANSPORT NA BIYU" nan take.
  9. Cire duk kayan aikin yunifofi (kwalkwali, fakitin kafada, riga, wando, safa, cleats) sannan a nutsar da ɗan wasan har zuwa wuyansa a cikin riga-kafi ** 190-zuwa-570-lita (50-zuwa-150-gallon) nutsewar ruwan sanyi (CWI) Tub cike da kankara da ruwa a 1.7 °C to 15.0 °C (35 °F to 59 °F)**.
  10. Ci gaba da motsa ruwan kankara a kusa da ƙwanƙarar ɗan wasan yayin da suke riƙe kansu da kafadu sama da ruwa tare da tawul ɗin nadi a ƙarƙashin ƙwanƙwasa.
  11. ** Idan babu tub din ("TACO Method - Tarp-Assisted Cooling with Oscillation"):** A kwantar da dan wasan a tsakiyar filin tafki mai hana ruwa ruwa, a sa ’yan wasa 4 zuwa 6 su daga gefuna na kwalta don su zama kwandon dan Adam, a zubar da masu sanyaya 3 zuwa 4 na kankara da ruwa kai tsaye a jikin dan wasan, sannan a rika murza kwal din gaba da gaba.
  12. KADA KA ƙyale motar motar asibiti tayi lodi kuma ta tafi tare da ɗan wasan har sai ainihin zafin jikin su ya faɗi zuwa 38.9 °C (102.0 °F) (wanda yawanci yana ɗaukar mintuna 10 zuwa 18** na ci gaba da nutsar da ruwan ƙanƙara, sanyaya a cikin adadin 0.20 °C to 0.26 °C / 0.36 °F to 0.47 °F per minute).
  13. Idan dan wasan yana FADA, faɗakarwa, ainihin zafin jiki yana ƙasa 40.0 °C (104 °F), kuma sun slumped ƙasa a lokacin tsananin sprinting gunaguni na "raunana, matattu, kona kafafu da ƙananan baya" tare da SOFT tsokoki: bi a matsayin m Exertional Sickling (ES) Rikici.
  14. Cire ɗan wasan daga wasan nan da nan (never order them to run another rep or "walk it off").
  15. Ajiye su a cikin inuwa, ba da izini ** ƙarin iskar oxygen mai girma (15 Liters/min via Non-Rebreather Mask** idan akwai a kan keken motar mai horar da 'yan wasa, lura da mahimman alamun ci gaba, sanyi a hankali idan dumi, da ** jigilar gaggawa ta ALS motar asibiti zuwa Sashen Gaggawa mafi kusa , faɗakar da likitan ER akan rediyo don shirya don ** rashin lafiya mai ƙarfi, rhabdomyolysis mai ƙarfi, da hyperkalemia mai barazanar rayuwa (peaked T-waves on 12-lead ECG).

Me yasa 'Cool Farko, Transport Na Biyu' Yana da Matsayin Rayuwa na 100% don Ciwon Zafin Ƙarfafa - Kuma Me yasa Load'an Wasanni Masu Zafi Kai tsaye a cikin motar asibiti ta kashe su

  • Matsakaicin zafin jiki na minti 30:** Neuron kwakwalwar ɗan adam, hepatocytes hanta, endothelium na jijiyoyin jini, da ƙwayoyin tsoka na kwarangwal sun fara juyewar furotin na thermal da ba za a iya jujjuya su ba da kuma ** Yaduwan Coagulation na Intravascular.DIC*** lokacin da ainihin zafin jiki ya kasance a sama 40.5 °C (105 °F) fiye da mintuna 30.
  • ** Cibiyar Korey Stringer Data Clinical:** A cikin dubunnan bayanan da aka rubuta na Exertional Heatstroke a cikin marathoners, ƙwararrun sojoji, da 'yan wasan ƙwallon ƙafa inda ainihin yanayin zafi ya kai har 42.2 °C to 43.3 °C (108 °F to 110 °F), ** Rayuwa kusan 100% ne lokacin da duk jikin jiki ya nutsar da ruwan sanyi (CWI) an ƙaddamar da shi akan wurin cikin mintuna 10 na rushewa kuma ana ci gaba har sai ainihin zafin jiki ya faɗi ƙasa 38.9 °C (102 °F) kafin EMS sufuri ya fara ***.
  • ** Me yasa Motar Ambulans ba zai iya sanyaya mara lafiyar EHS ba:** Da zarar dan wasa ya makale a kan shimfiɗa a bayan motar motar daukar marasa lafiya, ba zai yuwu a jiki a nutsar da su cikin ruwan kankara ba. Saka kananan kayan sanyin sinadarai a hammatansu da kunna motar daukar marasa lafiya AC yana sanyaya zuciyar a kasa da 0.04 °C (0.07 °F) per minute - ma'ana dan wasa ya kasance sama da mai mutuwa 40.5 °C (105 °F) Ƙofar mutuwa ta tantanin halitta don dukan motar motar asibiti na minti 25 da canja wuri na ER na minti 20, yana haifar da gazawar gabobin jiki da yawa. ** Ma'aikatan lafiya na EMS da masu horar da 'yan wasa dole ne su daidaita don haka dan wasan ya zauna a cikin kwanon kankara na gefe na mintuna 12 zuwa 18 FARKO, kuma an ɗora shi a cikin motar asibiti KAWAI bayan zazzabin dubura ya faɗi. 38.9 °C (102 °F).**

Bishiyar yanke shawara: Bambance-bambancen gefe na ɗan wasan ɗalibin da ya ruguje (Daƙiƙa 180 na farko)

flowchart TD
    Start["Dan Wasan Dalibai Ya Rugujewa Ko Ya Rugujewa A Kasa Yayin Fitowa Ko Wasa"] --> ActivateEAP["Mataki na 1 (0-10 Sec): Kunna EAP Wuri, Kira 911, Dauke Sideline AED, Buɗe Ƙofar Filin"]

    ActivateEAP --> CheckResp{"Mataki na 2 (Dakika 10-30): Shin Dan Wasan Yana Amsa Da Numfashi A Kullum? (Hattara Brief Seizure Jerks & Agonal Gasps)"}

    CheckResp -->|"A'a: Rashin amsawa kuma baya Numfasawa / Haki kawai"| SCAProtocol["KAMUN CARDIAC (SCA) ba zato ba tsammani (Haka kuma ana zargin Commotio Cordis idan an buge shi a ƙirji): Yanke Jersey/Pads, Fara Hannu kawai-CPR (100-120/min), Aiwatar AED A cikin Minti 3"]

    CheckResp -->|"Ee: Numfashi Da bugun jini"| CheckCNS{"Step 3: Check Mental Status (CNS) and Core Rectal Temp: Is Athlete Confused, Combative, Ataxic, Comatose, or Temp > 40.5 C (105 F)?"}

    CheckCNS -->|"Ee: Rashin Aikin CNS + Babban Zafi (Tsarin Zazzabi> 40.5 C / 105 F)"| EHSProtocol["TSARIDAR ZAFI NA EXERTIONAL (EHS): Kayan Aikin Tattara, Nitsewa a cikin Tushen Ruwan Kankara (1.7-15 C / 35-59 F) ko TACO Tarp nan da nan. SANYI FARKO (zuwa 38.9 C/102 F), TRANSPORT NA BIYU"]

    CheckCNS -->|"NO: Wayyo, Lucid, Madaidaici, Yanayin zafi <40.0 C (104 F)"| CheckMuscles{"Mataki na 4: Yaya Dan Wasa Ya Ruguje, kuma Yaya Ƙafar Ƙafa/Baya Ke Ji?"}

    CheckMuscles -->|"Rushewa Bayan Gudu; Tsokoki suna jin SOFT/Flaccid; Ƙunƙarar Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙarƙashin Ƙafar Ƙafar Ƙafar; Tachypnea"| SicklingProtocol["RIKICIN CIWON EXERTIONAL (ES): Dakatar da Motsa jiki Nan da nan, Ba da 15 L/min Oxygen, Ci gaba da Jiki / Ruwa, Nan da nan ALS Ambulance zuwa ER don Rhabdomyolysis & Hyperkalemia ECG"]

    CheckMuscles -->|"Hobbling a cikin azaba; An kulle tsokoki a cikin ROCK-HARD A bayyane Knotted Spasms"| CrampProtocol["BENIGN EXERTIONAL HEAT CRAMPS: Huta a cikin Inuwa, Tsaftace Tsayawa, Massage Ice, Maganin Gishiri na Electrolyte na Baka (0.5 tsp gishiri a cikin 500 ml na abin sha na wasanni)"]

Mataki na 1: Teburin kwatancen asibiti na gefe guda 4 (SCA vs. Exertional Heatstroke vs. Exertional Sickling vs. Heat Cramps)

A cikin satin farko na yanayin sanyi na kakar wasanni na watan Agusta, masu horarwa suna yawan yin kuskure Cikin Ciwon Jiki don rashin lafiya Cukan Zafi, ko kuskure Kamuwar Zuciya na Kwatsam don Haɗin Kan Zafi*. Haddar bambance-bambancen asibiti a cikin wannan tebur yana hana mummunan ganewar asali a fagen:

Gano Bambance-bambancen Rushewar Sideline Kwatsam a cikin 'Yan Wasan Dalibai (NATA / ACSM / AHA Consensus)

Siffar Clinical 1. Kamewar zuciya kwatsam (SCA / Commotio Cordis) 2. Zafin motsa jiki (EHS) 3. Mugun Ciwon Motsa jikiES - HbAS Hali) 4. Mutuwar zafi mai laushi
Lokaci Na Musamman & Hatsawa Duk wani batu a aikace ko wasa; ko dai na bazata (HCM, anomalous coronary artery, Long QT) ko a cikin daƙiƙa 3 na bugun ƙirji mai ƙwanƙwasa (Commotio Cordis). Yawancin lokaci bayan ** 45+ mintuna ** na ci gaba da aiki mai ƙarfi a cikin babban zafi / danshi (WBGT > 27.8 °C / 82 °F), sau da yawa akan ** Kwanaki 1 zuwa 5 ** na pre-season kafin haɓakar zafi. Sau da yawa a cikin ** minti 10 zuwa 30 na farko ** na aiki yayin ** ci gaba mai dorewa (sprinting).gassers, suicides, timed 800-to-1600m conditioning runs, stadium stairs*** tare da gajeriyar tazara. A ƙarshen dogon lokaci, aikin gumi ko rabi na biyu na wasa bayan asarar sodium mai nauyi da asarar gumi.
Yadda Dan Wasa Ya Sauka ** Nan take "digo-kamar-dutse" rushewa** (non-contact ko dama bayan tasirin kirji); idanu suna juya baya; **50% suna da daƙiƙa 10-20 na girgiza kamar girgiza hannu. Wanda ya rigaye shi da tuntuɓe, ƙaƙƙarfan aikin ƙafa (ataxia), rashin ayyukan yi, bacin rai, ihu mara dalili, ko rugujewa cikin hayyaci. Sluck a hankali zuwa turf: Dan wasan ya daina gudu, ya sa hannu a gwiwa, ya ruguje ko ya kwanta saboda kafafuwansu da na baya ba zato ba tsammani sun ji "matattu, rubbery, da rashin ƙarfi." Dan wasa ya yi tsalle ko ya fado kasa yana rike da maraƙi guda, hamstring, ko quad yayin da yake kururuwa ko baƙin ciki daga ciwon tsoka mai raɗaɗi.
Matakin HankaliCNS) Ban amsa gaba ɗaya a cikin daƙiƙa na rugujewa. ** Babban Rashin Aiki na CNS (100% diagnostic hallmark):** Rashin fahimtar juna, faɗa, magana mara kyau, kallon gilashi, tashin hankali, ko suma. Da farko Wayarka, Faɗakarwa, da Lucid: Zan iya gaya muku sunan su kuma ya bayyana ciwon su sarai, kodayake suna saurin gajiya da damuwa (can progress to shock/coma if forced to keep running). 100% Wayyo, Faɗakarwa, da Daidaitawa.
** Numfashi & Buga *** ** bugun jini babu**; rashin nunfashi ko a hankali, hayaniya hasken agonal/nasha. Tachycardia mai sauri (tachycardia)140 to 180+ bpm), saurin numfashi (tachypnea), ƙananan hawan jini na diastolic. Mai sauri, numfashi mara zurfi (feeling "winded" / unable to catch breathtare da bugun jini mai sauri wanda zai iya lalacewa da sauri zuwa ** hyperkalemic arrhythmias (VFib / PEA)**. Numfashi na al'ada da bugun jini (wanda aka ɗaukaka kawai daga motsa jiki na baya-bayan nan da zafi).
** Sautin tsoka & Ingantacciyar Ciwo** Flaccid (bayan ɗan gajeren lokaci na farko na myoclonic jerking). Rashin ƙarfi ko gamammiyar tauri idan kamawa. SUNA JI SAUKI CIKAKKIYAR TSARO: Ciwo mai zurfi ne, mara nauyi, ciwon ischemic mai kona* a cikin ** ƙananan baya, gindi.gluteals), ƙashin ƙashin ƙugu, da ƙwanƙwasa** (ba kulli mai tauri ba). KWANKWASO SUNA ROCK-HARD & KNOT KYAUTA: Kuna iya gani kuma ku ji gastrocnemius ko hamstring ɗin ya taru kamar ƙwallon ƙwallon ƙwallon ƙafa a ƙarƙashin fata.
Fata & Matsakaicin Zazzabi Yanayin motsa jiki na al'ada (37.5 °C to 39.5 °C / 99.5 °F to 103.1 °F); fata da sauri tana juya kodadde ko cyanotic. ** Matsakaicin zafin jiki > 40.5 °C (105.0 °F)** (often 41.0 to 43.0 °C / 106 to 109 °F); Fata tana da zafi kuma yawanci tana diga da gumi. ** Matsakaicin zafin jiki < 40.0 °C (104.0 °F)**; fata na iya zama gumi ko al'ada. Core Rectal Temp < 40.0 °C (104.0 °F); fata tana tsananin gumi da gishiri (white salt crust on jersey).
Aikin Ceton Rai Nan take ** Hannu-kawai CPR + Sideline AED Shock a ciki < 3 minutes** + 911 ALS sufuri. "Cool Na Farko, Sufuri Na Biyu": Nan take ** Nutsar da Ruwan Kankara1.7-15 °C / 35-59 °F*** a kan wurin har sai zafin dubura ya kai 38.9 °C (102 °F), SANNAN sufuri. ** Tsaya kai tsaye + 15 L/min Oxygen + Hutu na bacci + Kai tsaye 911 ALS Transport zuwa ER** (IV normal saline + stat ECG for hyperkalemia). Huta a cikin inuwa, a hankali miƙewa, tausa kankara, abin sha mai gishiri na baka.

Mataki na 2: Kame Zuciya kwatsam (SCA) da Commotio Cordis a filin wasa: dokar AED na minti 3

Kamewar zuciya ba zato ba tsammani shine # 1 sanadin likita na mutuwa a cikin matasa 'yan wasa, yana kashe kusan 1 cikin 50,000 na makarantar sakandare da 'yan wasan kwaleji kowace shekara. Ba kamar ciwon zuciya na manya da ke haifar da toshewar arteries na jijiyoyin jini ba, SCA na matasa na motsa jiki yana haifar da ko dai ta hanyar yanayin tsarin da ba a gano ba ko na lantarki ** ko kuma ta hanyar bugun ƙirji ()Commotio Cordis).

1. Dalilai 5 na Farko da ke Kame Kwatsam ga Matasa 'Yan Wasa

  1. ** Hypertrophic Cardiomyopathy (HCM:** Ƙaƙƙarwar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cutaVFib*** lokacin da adrenaline spikes a lokacin sprints.
  2. Rashin ciwon Jijiya na Haihuwa (CAA: Jiji na jijiyoyin jini wanda ya samo asali daga sinus na aortic da ba daidai ba yana samun matsawa tsakanin jijiya da huhu a lokacin fitowar motsa jiki.
  3. Genetic Ion-Channelopathies & Electrical SyndromesLong QT, Brugada, CPVT, kuma Wolff-Parkinson-White / WPW): Tsarin zukata na yau da kullun waɗanda ke kewayawa ta hanyar lantarki a ƙarƙashin adrenaline suna fashe.
  4. Myocarditis mai saurin kamuwa da cuta: Kumburi na tsokar zuciya shiru lokacin ko tsakanin makonni 1 zuwa 2 bayan rashin lafiyan hoto.Coxsackievirus, Influenza, COVID-19, Adenovirus) lokacin da dan wasa ya dawo cikin yanayin damuwa yayin da yake murmurewa.
  5. ** Commotio Cordis (Blunt Chest-Impact Arrest*** Yana faruwa a cikin zuciya mai lafiya 100%.precordium) lokacin daidai ** 20-zuwa-40-milli na daƙiƙa na daƙiƙa na T-wave (ventricular repolarization***, jefa zuciya cikin Fibrillation na ventricular.

2. Me Yasa Kociyoyin Ba Za Su Taba Wautar da "Seizure Jerks" ko "Agonal Gasping"

A cikin bita na bidiyo na kama bugun zuciya na makarantar sakandare da koleji, dalilin # 1 dalilin da masu horar da 'yan wasan suka jinkirta CPR da kuma dauko AED shine hannun 'yan wasan da suka ruguje da kafafun su sun yi murzawa kamar ciwon farfadiya na tsawon dakika 15, kirjinsu ya yi zafi da karfi, yana huci. - ** Ilimin Halittar Halitta:** Lokacin da Fibrillation Ventricular ya yanke kwararar jini zuwa kwakwalwa, matsanancin hypoxia yana haifar da bugun jini na miyoclonic ** 10 zuwa 20 na biyu**, sannan sai kwakwalwar kwakwalwar agonal gasping reflexes. - ** Dokokin Sideline (Inter-Association Task Force Mandate):Duk dan wasan da ya fadi ba tare da jin rauni ba (ko bayan bugun kirji) kuma bai amsa ba, to yana cikin kamawar zuciya ta gaggawa har sai an tabbatar da hakan. Kada a sanya komai a bakinsu, kar a jira “kamewa” ya kare, kuma kada ya kwashe dakika 60 yana farautar bugun jini. ** Aika don AED nan da nan, fallasa ƙirji, kuma fara damfara ƙirji.* Lokacin da AED ya ba da mamaki a cikin minti 1 zuwa 3** na rushewa a filin wasa, ƙimar rayuwa ta wuce ** 85% zuwa 90%**.

Mataki na 3: Gwajin ZafiEHS): aiwatar da mataki-mataki na "Cool First, Transport Na biyu"

Ƙunƙarar Zafi (EHS) kololuwa sosai a lokacin wasan ƙwallon ƙafa na farkon kakar Yuli da Agusta, ƙetare, da ayyukan ƙwallon ƙafa ** lokacin da ** Wet-Bulb Globe Temperature (WBGT*** ya wuce 27.8 °C to 32.2 °C (82 °F to 90 °F).

1. Me Yasa Dolene Kayi Amfani da Thermometer (kuma Me yasa gumi baya kawar da bugun jini)

Tatsuniyoyi biyu har yanzu suna kashe ƴan wasa ɗalibi a duk watan Agusta: - Tatsuniyar #1 ("Idan har gumi ke ci gaba da yin gumi, zafi ne kawai, ba zafin zafi ba"): ** KARYA. bushewar fata (anhidrosis) yana faruwa a classic m heatstroke a cikin tsofaffi marasa lafiya a cikin kwanaki da yawa. A cikin Exertional Heatstroke, matashin ɗan wasa wanda ke samar da watts 1,000+ na zafi na rayuwa a cikin pads yana fitar da ainihin zafin su daga 37 °C (98.6 °F) ku 41.5 °C (106.7 °F) a cikin mintuna 45 yayin da har yanzu gumi ke ta faman yi. - Tatsuniyar #2 ("Yi amfani da na'urar daukar hoto ta infrared na goshi ko kuma ma'aunin zafin jiki na kunne"): KARYA. Nazarin Cibiyar Korey Stringer ta nuna cewa goshi, kunne (tympanic), kuma ana karanta ma'aunin zafin jiki na baka 36.5 °C to 38.0 °C (97.7 °F to 100.4 °F) akan dan wasa wanda zafinsa na ciki ya zama mai kisa 41.8 °C (107.2 °F),domin zubar gumi yana sanyaya fata. - Mene ne Idan Makaranta Bata da Ma'aunin Ma'aunin zafi da sanyio (Rectal Thermometer) akan Filin? Dogara da Dokar zato na asibiti: Duk wani dan wasa da ke motsa jiki a yanayin zafi wanda ke nuna Tsarin Jijiya ta Tsakiya mara fahimta (CNS) rashin aiki (rikitarwa, rashin fahimta, tashin hankali, tuntuɓe, rugujewa, ko rashin lafiya bayan kawar da SCA) DOLE a bi da shi nan da nan tare da Cikakkiyar Ruwan Sanyi mai cikakken jiki a matsayin zazzafan zafin da ake ɗauka.

2. Yadda Ake Gudu da Nitsewar Ruwan Sanyi (CWI) Tuba ko TACO Yarjejeniyar Tarp akan Sideline

  1. ** Pre-Mataki na Tub Kafin Aiki Lokacin WBGT > 25 °C (77 °F): ** Cika ** 380-zuwa-570-lita (gallon 100-zuwa-150-gallon) Rubbermaid tank tank ** kusa da tantin horo na inuwa da ruwa (10 °C to 15 °C / 50 °F to 59 °F), tare da masu sanyaya 3 zuwa 4 na niƙaƙƙen ƙanƙara zaune kusa da baho a shirye don zubar da ciki.
  2. ** Kayayyakin Tafi a Ƙasa da Daƙiƙa 60:** Cire kwalkwali, pad ɗin kafaɗa, riga, wando, sutura, da safa (wet uniforms trap heat).
  3. ** Zurfafa Zurfi da Ci gaba:** ɗaga ɗan wasan a cikin baho don gangar jikinsu, ƙashin ƙugu, cinyoyinsu, da hannaye su narke cikin 1.7 °C to 15.0 °C (35 °F to 59 °F) ruwan kankara. Zare tawul ɗin birgima a ƙarƙashin hammata biyu waɗanda masu tabo biyu ke riƙe don kiyaye hanyar iska sama da ruwa. Haɗa ruwa da ƙarfi kowane daƙiƙa 30 don haka ɗumi mai iyaka ba zai iya samuwa da fata ba.
  4. ** Sarrafa Haɓaka Haɓaka:** Yawan zafi na ƙwaƙwalwa yana sa ɗan wasa yaƙar yaƙi. Yi masu tabo guda 4 a hankali suna riƙe kafadu da gwiwoyi a cikin baho (ko amfani da **TACO Hanyar tarp ** akan ciyawa). A cikin 3 zuwa mintuna 5 na nutsewar ruwan kankara, ɓacin rai yana raguwa yayin da jinin kwakwalwa ke yin sanyi.
  5. ** Zazzabi Mai Cire Makasudin (38.9 °C / 102.0 °F):** Cire ɗan wasan daga cikin bahon ƙanƙara sannan a tura su zuwa madaidaicin motar asibiti mai jiran gado ** lokacin da binciken dubura ya karanta. 38.9 °C (102.0 °F)** (prevents afterdrop hypothermia). Ba tare da ma'aunin zafi da sanyio na dubura ba, a nutsar da shi na tsawon mintuna 12 zuwa 15** (ko har sai rawar jiki da tsayuwar tunani ta dawo) kafin lodawa cikin motar asibiti.

Mataki na 4: Ciwon Motsa Jiki (HbAS) rikicin: me yasa kururuwar "Tusawa Ta Ciki" yana haifar da hyperkalemia mai mutuwa

Kusan 1 cikin Baƙar fata Amurkawa 12 (8%* 1 a cikin 100 Hispanic Amurkawa , da kuma dubban 'yan wasa na Rum, Gabas ta Tsakiya, Indiyawa, da Caribbean al'adun gargajiya suna ɗauke da ** Sickle Cell Trait (HbAS - ma'ana sun gaji haemoglobin guda daya na al'ada (HbAda sickle haemoglobin gene (sickle)HbS). Ƙarƙashin rayuwar yau da kullum, mutanen da ke da Halin Sikila suna da cikakkiyar lafiya kuma ba su da Cutar Sikila (HbSS).

Koyaya, a lokacin ** matsananci, ci gaba da aikin anaerobic ** - musamman ** maimaituwar lokaci (sprints).gassers, suicides, mat drills), lokaci 1-mile / 2-mile gwaje-gwajen motsa jiki na ranar farko, ko kwanciyar hankali na lokaci-lokaci ba tare da hutu ba *** - abubuwan motsa jiki guda huɗu sun haɗu a cikin ƙafar mai aiki da tsokoki na baya: 1. Mummunan Nama Hypoxia (oxygen yana sauka a cikin quadriceps masu aiki); 2. ** Mummunan Lactic Acidosis *** (tsawon pH na tsoka yana raguwa a ƙasa 7.0); 3. ** Rashin ruwa na salula *** (hyperosmolality a cikin capillaries na tsoka); kuma 4. Hawan zafin tsokar tsoka.

Wannan tetrad yana haifar da ƙwayoyin jajayen jini na ɗan wasa su yi tsalle da sauri daga santsi, fayafai masu sassauƙa zuwa ** stiff, m jinjirin ''sickles''. A cikin mintuna 2 zuwa 5, waɗannan ƙwayoyin jajayen jini marasa lafiya ** logjam kuma suna ɓoye ƙananan ƙwayoyin cuta waɗanda ke ciyar da manyan tsokoki na gindi, ƙashin ƙugu, cinya, da ƙananan baya (acute ischemic rhabdomyolysis). Yunwar jini da iskar oxygen, ƙwayoyin tsoka na kwarangwal sun karye gaba ɗaya, suna zubar da adadi mai yawa na intracellular ** Potassium (K+** da Myoglobin kai tsaye zuwa cikin jini. Idan koci ya tilasta wa ɗan wasa mara lafiya ya dawo kan layi kuma ya sake gudu guda ɗaya, ** sinadarin potassium ya wuce sama. 7.0 to 9.0 mEq/L, yana haifar da kamun zuciya mai kisa (hyperkalemic)sine-wave ventricular fibrillation or PEA) a filin**.

Yadda Ake Gane Ciwon Motsa Jiki Daga Zafi A Cikin Dakika 10

  • Ciwon zafi: Dan wasan ya fashe daga filin wasa yana kururuwa, yana kama wani ** dutse mai wuya, maraƙi mai dunƙule a bayyane ko tsokar hamma*; mikewa yana taimakawa a hankali.
  • Masu ciwon motsa jiki: Dan wasa ** ya dunguma zuwa turf** yana kallon kasala da firgita, yana korafin rashin jin dadi, konewar rauni a fadin *kasa bayansu, gindi, da cinyoyinsu guda biyu, sannan idan kun matse cinyoyinsu ko marukansu da hannayenki, tsokar tana ji gaba daya tayi laushi da al'ada. Kar a taba mewa ko tausa tsokar da ba ta da lafiya, kuma kada a ce ma dan wasa mara lafiya ya tashi ya gama rawar jiki.

Lambobin gaggawa na yanki da ka'idojin hukumar

Ƙasa / Yanki Aiko Gaggawa Zafin motsa jiki, Zuciya & Ka'idodin Mulki na Marasa lafiya Kayayyakin Sideline na Tilas & Dokokin Haɗawa
Amurka *911 Ƙungiyar Masu Horas da Ƙwallon Ƙwallon Ƙwallon Ƙasa ta ƘasaNATA* + ** Cibiyar Korey Stringer (KSI, UConn)** + ** Cibiyar Kimiyyar Wasanni ta NCAA** + NFHS (National Federation of State High School Associations) ** Gwajin Halin Sikila na Tilas NCAA/Tabbatar da Manufa**; makarantar sakandare ta jihar ** WBGT Dokokin Haɓakar Heat *** (misali, * Zach Martin Act* a cikin FL, * Jordan McNair * jagororin MD, Dokokin Georgia GHSA WBGT) waɗanda ke ba da umarni akan rukunin yanar gizon ** Tubs na Ruwa na Sanyi ** da ** Sideline AEDs cikin mintuna 1-3 ***.
Kanada *911 ** Kwamitin Ba da Shawarar Magungunan Wasanni (SMAC*** + ** Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararru ta Kanada (CATA*** Gidauniyar Zuciya & Shanyewar Jiki ta Kanada** Jadawalin gyare-gyaren zafi/WBGT na lardiOFSAA in Ontario, BC School Sports) da kuma ƙa'idodin samun damar AED na wajibi.
United Kingdom 999**** 112** ** Cibiyar Wasanni ta Burtaniya (UKSI** + Majalisar Farfadowa UK + Faculty of Sport and Exercise Medicine (FSEM* Hadarin zuciya a cikin Matasa (CRY)** FA (Football Association) da RFU Pitchside Kula da gaggawa (PHICIS) jagororin da ke ba da umarnin defibrillation na fili da kuma sanyaya aiki mai aiki.
Ƙungiyar Tarayyar Turai 112 ** Majalisar Farfadowa ta Turai (ERC*** Ƙungiyar Ƙwararrun Ƙwararrun Ƙwararru ta Turai (ESC Sashe akan Ilimin Zuciya na Wasanni)** + Dokokin Likitanci na UEFA Shirye-shiryen nunin ECG masu jagora 12 kafin shiga (misali, dokar nuna wasannin motsa jiki ta Italiyanci) da filin filin wasa AED/tashar sanyaya.
** Ostiraliya & New Zealand *** 000* (AU) / 111 (NZ) ** Magungunan Wasanni Ostiraliya (SMA Manufofin Zafi Mai Tsanani)** + ** Majalisar Resuscitation ta Australiya (ARC*** + ** Majalisar Tattaunawar NZ *** SMA Sport-Takamaiman Charts Haɗarin Zazzabi (na yanayi na yanayi vs. Yanke yanayin zafi) da shirye-shiryen nutsewar ruwan sanyi na wajibi don juriya/ abubuwan filin.
Indiya & Asiya-Pacific 112 (Indiya) / 119 (Japan/Koriya) / 995 (SG) Hukumar Wasanni ta Indiya (SAI* + ** Ƙungiyar Wasannin Japan (JSPO Ka'idojin WBGT)** + ** Cibiyar Wasanni ta Singapore** Wajibi ** Kula da mitar WBGT** akan filayen wasannin makaranta (halting all strenuous youth outdoor exercise at WBGT >= 31 °C / 87.8 °F a Japan).

Tambayoyin da ake yawan yi

Me zai faru idan ma'aikatan lafiya na EMS na gida sun isa filin kuma suka dage kan lodin ɗan wasan mu na Heatstroke a cikin motar asibiti nan da nan kafin a kwantar da yanayin zafin su?

Kowane Ma'aikacin Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Makaranta (ATC) da Likitan Ƙungiya ya kamata su kafa yarjejeniya ta kafin kakar wasa tare da Daraktan Kiwon Lafiya na Wuta/EMS na gida. Under current National Association of EMS Physicians (NAEMSP), American College of Emergency Physicians (ACEP), and NATA joint consensus statements, paramedics are instructed to **assist with on-site Cold-Water Immersion (CWI) tub cooling (while starting an IV line and cardiac monitor beside the tub) until the athlete's core rectal temperature drops to 38.9 degrees Celsius (102.0 digiri Fahrenheit) KAFIN motsa mara lafiya cikin motar asibiti **. Idan kulawar likitancin EMS na gida ya ba da umarnin kai kai tsaye kafin baho ya shirya, yi amfani da hanyar **TACO (nannade rigar, zanen gadon kankara / tarps a kusa da dan wasa tsirara)** kuma sanar da Ma'aikatar Gaggawa don samun wanka mai nutsewa ruwan kankara yana jira a ƙofar motar asibiti.

Me yasa kwanakin 5 na farko na wasan ƙwallon ƙafa na watan Agusta ko ƙetare ke yin tagar mafi muni ga duka ciwon zafi da ciwon motsa jiki?

Fiye da **75% na duk makarantar sakandare da kwalejin motsa jiki na motsa jiki da cututtukan motsa jiki suna faruwa a cikin kwanaki 4 na farko na yanayin yanayin kakar wasa**. A ilimin halittar jiki, jikin mutum yana buƙatar ** 10 zuwa kwanaki 14 a jere na bayyanar zafi na digiri ("Heat Acclimatization")** don faɗaɗa ƙarar jinin plasma da kashi 12% zuwa 15%, rage ƙimar zafin jiki na ainihin abin da gumi ya fara, ƙara yawan fitowar gumi, da kiyaye sodium gumi. Lokacin da ɗalibin da ba a yarda da shi ba ya fita daga gidan mai kwandishan a ranar 1 kuma yana yin aikin sa'o'i 3 a cikin cikakken pads ko kuma lokacin da aka tsara lokaci ("serial gasers"), tsarin su na zuciya da jijiyoyin jini ba zai iya watsar da zafi ko kula da iskar oxygenation na tsoka ba. Wannan shine dalilin da ya sa dokokin NATA da NFHS sun haramta ayyukan kwana biyu a jere a jere, sun hana cikakken kayan kariya a cikin Ranaku 1 zuwa 5, da kuma hana gwaje-gwajen kwantar da tarzoma a ranar 1.

Yaya ake amfani da Wet-Bulb Globe Temperature (WBGT) mita a gefe, kuma me ya sa ya fi na'urorin yanayin yanayi na wayoyin salula na "Heat Index"?

Ana ƙididdige ma'auni "Fihirisar Zafi" akan aikace-aikacen yanayi idan kuna zaune a ** 100% inuwa tare da iska mai haske ** - yana watsi da ** hasken rana mai haskaka hasken rana kai tsaye yana dumama turf wucin gadi mai duhu ** da ** toshewar iskar filin wasan gida **. Na hannu ** Zazzabi mai ɗorewa (Wet-Bulb Globe).`WBGT`Mitar** tana haɗa na'urori masu auna firikwensin guda uku: ** (1) Zazzabi mai bushewa** (`10%`), **(2) Yanayin Zazzabi na Jika-Bulb na Halitta (`70%`** Aunawa iyawar sanyin gumi da zafi da saurin iska, da **(3) Zazzabi Black-Globe (`20%`)** auna zafin rana kai tsaye akan turf. Lokacin gefe `WBGT` ya kai **`27.8 °C to 30.0 °C (82 °F to 86 °F)`**, dole ne hutun kwantar da hankali na mintuna 15 ya faru kowace awa; yaushe `WBGT` ya wuce **`32.2 °C (90.0 °F)`** (ko žasa a cikin yanayin sanyi na arewa), duk ayyukan da aka rufe na waje da matsananciyar yanayin dole ne a soke ko matsar da su cikin gida.

Idan ɗan wasa ɗalibi ya san suna da Sickle Cell Trait (HbAS), an hana su buga wasannin varsity?

A'a - ** babu dan wasa mai Sickle Cell Trait (`HbAS`) an hana shi shiga kowane wasa**. Dubban NCAA da ƙwararrun 'yan wasa suna gasa lafiya tare da Sickle Cell Trait kowace rana. Maimakon haka, sanin ɗan wasa `HbAS` Matsayi yana ba masu horarwa da masu horar da 'yan wasa damar aiwatar da niyya **Tsarin Halayen Sikila**: **(1)** Bayar da ɗan wasa damar gina yanayin motsa jiki a hankali maimakon gudanar da gwaje-gwajen Mile/Gasser Day-1; **(2)** Hutu sau biyu da tazarar dawowa tsakanin maimaita gudu; **(3)** Yin uzuri ga dan wasa daga lokacin da ya dace yana gudana cikin zafi mai zafi ko tsayi mai tsayi (`above 1,500 meters / 5,000 feet`); **(4)** Tabbatar da ruwa mai ɗorewa; da **(5)** Karfafawa 'yan wasa damar fita daga kowane irin rawar jiki a take a lokacin da suke jin raunin kafa, gindi, ko kasawar baya ba tare da tsoron hukunci ba.

Shin ya kamata mu taɓa cire kwalkwali na ƙwallon ƙafa ko ɗan wasan lacrosse a filin wasa yayin kamawar zuciya na gaggawa ko bugun jini?

Ee. A cikin **Motsa Jiki (Exertional Heatstroke)`EHS`**, babu raunin kashin bayan mahaifa, kuma kwalkwali da kafada suna kama da zafi mai zafi: ** cire kwalkwali da pad ɗin kafada nan da nan** kafin saukar da ɗan wasan cikin baho mai nutsewa mai sanyi. A cikin ** Kame Zuciyar Kwatsam (`SCA`**, idan dan wasan ya fadi ba tare da wuyansa / kai ba, ** bude rigar rigar da laces na gaban kafada nan da nan don fallasa kirjin da ba a so don CPR da AED pad placement **, kuma cire abin rufe fuska (`or helmet/pads`) don samun iskar iska ya ba shi ** ba zai taɓa jinkirin fara damun ƙirji ba ko isar da gigin AED**.

** Koyarwar da aka Shawarar: *** Kowane matashi, makarantar sakandare, da kocin kwaleji, alƙali, da iyaye na gefe ya kamata su kammala aikin ba da takardar shaida ** CPR, AED, da Wasannin Taimakon Taimakon Farko ** ta hanyar Red Cross ta Amurka, Ƙungiyar Zuciya ta Amurka, St John Ambulance, ko Ƙungiyar Ƙungiyoyin Makarantun Sakandare ta Ƙasa (Ƙasa).NFHS Learn), da kuma maimaita wurin su ** Shirin Ayyukan Gaggawa (Tsarin Ayyukan Gaggawa).EAP*** tare da agogon gudu kafin fara aikin kowane yanayi.

Jagora masu alaƙa

Tushen da jagorar hukuma

  • Ƙungiyar Masu Horar da Wasan Wasan Kwallon Kafa (NATA, Amurka): *Bayanin Matsayi: Cututtukan Zafin Ƙarfafawa (Ma'aunin Ma'aunin zafin jiki na Rectal da Immersion Ruwan Sanyi na Farko "Wajibi na Farko, Sufuri na Biyu") * da * Bayanin Yardajewa: Babban Gudanar da Rauni ko Marasa Lafiya, Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararren Ƙwararwa ne na SC.
  • ** Cibiyar Korey Stringer (KSI, Jami'ar Connecticut) & Kwalejin Ilimin Wasannin Wasannin Amirka (ACSM): * Bayanin Yarjejeniya kan Kula da Kulawa da Ciwon Zafin Jiki, Taimakon Taimakawa Ciwon Sanyi tare da Oscillation (TACO), da Babban Makarantar Wet-Bulb Globe Temperature (WBGT) Manufofin Acclimatization*.
  • Inter-Association Task Force for Preventing Sudden Death in Secondary School & Collegiate Conditioning Sessions (NCAA / NATA / NSCA / American Heart Association): Recommendations for Recognizing and Managing Sudden Cardiac Arrest (3-Minute AED Target, Myoclonic Seizure/Agonal Gasping Recognition) and Acute Exertional Rhabdomyolysis / Marasa lafiya a cikin 'Yan wasa masu Sickle Cell Trait (HbAS).
  • American College of Emergency Physicians (ACEP) & National Association of EMS Physicians (NAEMSP): Joint Policy Resource and Education Paper: Prehospital Management of Exertional Heat Stroke (Completing On-Site Cold-Water Immersion Prior to EMS Ambulance Transport).
  • Cibiyoyin Kula da Cututtuka da Rigakafin Cututtuka (CDC, Amurka): Ciwon Zafi Tsakanin 'Yan Wasan Sakandare da Halin Sickle Cell (HbAS) Tsare Tsarkakewa.