ʻO nā ʻeha ʻeha i hoʻopaʻa ʻia i ka ea: Embolism, ʻili ʻili, a me ka Trauma Pneumatic.¶

E kūʻai i nā laina ea i hoʻopaʻa ʻia i loko o nā kaʻa kaʻa, nā hale kūʻai hana lāʻau, nā hale kūʻai mīkini, a me nā hale hana maʻamau e hana ma 6.2 a 8.6 bar (90 a 125 paona no ka ʻīniha square, a i ʻole psi), me nā kaʻa kaumaha a me nā laina pneumatic ʻoihana a hiki i 10.3 a 12 bar (150 a 17.5 psi) Ma muli o ka ʻike ʻole ʻia o ka ea i hoʻopaʻa ʻia, ʻaʻohe ʻala, a ʻoluʻolu a maikaʻi ʻole hoʻi mai kahi mamao aku, hoʻohana pinepine nā limahana i nā pū puhi ea i hoʻopau ʻia i ka lepo i ka lepo, nā mea metala, a i ʻole nā ​​​​ʻaʻahu hana, nā lima, a me ka lauoho. ʻO kēlā maʻamau he hewa hiki ke make. Ke hoʻopaʻa ʻia ka nozzle ea i hoʻopaʻa ʻole ʻia i loko o 1 a 2 kenimika (0.4 a 0.8 iniha) o ke kino, a inā hoʻohana ka mea hana i ka manamana lima e ālai ai i ka piko o ka nozzle, e lele maʻalahi ka ea ma luna o 2 bar (30 psi) ma ka lole a me ka ʻili paʻa, a i ʻole ke komo ʻana i loko o nā nicks microscopic, nā maka, nā kui, nā kui. nā ʻiʻo subcutaneous e like me ka baluna a me ka hoʻoikaika ʻana i nā ʻōhū ea i loko o nā veins haehae a me nā capillaries.

I ke komo ʻana o ka ea i hoʻopaʻa ʻia i loko o ke kahe koko, lilo ia i ** vascular gas embolism** e holo ana i loko o kekona i ka ʻaoʻao ʻākau o ka puʻuwai, kahi e hahau ai i loko o ka huʻihuʻi hiki ke hoʻopaʻa i ke kahe o ke koko i loko o ka māmā (loke ea ventricular ʻākau), a i ʻole ke ʻaʻa i loko o ke kahe koko e ālai i nā kīʻaha koko i loko o ka lolo a me ka puʻuwai, e hoʻohālike ana i kahi hahau nui a i ʻole ka cardia. ʻOi aku ka ikaika o ka hoʻokani lio ʻana i ka ea: ke kuhikuhi ʻana i kahi paipu ea hale kūʻai ma ka ʻāʻī a i ʻole ka ʻāʻī o ka hoa hana mai 10 a 15 mau kenimika (4 a 6 ʻīniha) ka mamao, ʻoiai me nā jeans hana denim kaumaha, e puhi pololei i ke kolamu o ke kinoea kiʻekiʻe ma o ka sphincter anal, e hoʻonui a pahū i ke kolone ma lalo o ka hapalua kekona. ʻO ka ʻike i ka hoʻonoho ʻana i ka mea i pepehi ʻia e ka ea ma ka left-lateral decubitus (Durant) kūlana, e hoʻokō i ka 100 pakeneka kahe nui o ka oxygen, e ʻike i ka subcutaneous emphysema ("Rice Krispies" e pohā ana ma lalo o ka ʻili), a mālama i ka ʻeha pneumatic bowel e hoʻopakele i nā ola. E nana helu pilikia, ʻeha ka mea holoi holoi a me nā ʻeha kickback, ʻeha maka, a haʻalulu.

E hana i kēia i kēia manawa¶

1. **Hoʻopaʻa a hoʻopau koke i ka hāʻawi ʻana i ka ea i hoʻopaʻa ʻia a hoʻoneʻe i ka mea i hoʻopaʻa ʻia ma luna o kahi pālahalaha mai nā mīkini hana. komo ke kinoea piʻi kiʻekiʻe ma o ka microscopic pinhole e hoʻopaʻa ana ma hope o ka ea e wehe ana ma nā mokulele ʻiʻo a komo i nā veins.
2. **Inā hoʻopōkole ʻia ka hanu o ka mea i pepehi ʻia, ʻeha ka umauma, ʻūlū, huikau, haʻihaʻi ʻōlelo, lolo, a hāʻule paha ma hope o ka pahū ʻana o ka ea, e hoʻonoho koke iā lākou ma ko lākou ʻaoʻao hema me ko lākou poʻo a me ka umauma palahalaha a i ʻole ke hili iki ʻana i lalo (ke kūlana ʻo Durant / left-lateral Trendelenburg). ke aʻa i waho i hiki ai i ka naʻau ke hoʻomau i ke kahe ʻana i ke koko i ka māmā; ike hahau a ʻeha puʻuwai.
3. **E kelepona i kāu helu pilikia kūloko (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka Hui ʻEulopa, 999 ma United Kingdom) a ʻōlelo maopopo: "Ua manaʻo ʻia ʻo vascular air embolism from high-pressure compressed air injection." nānā helu pilikia.
4. E hoʻokō i ka oxygen kahe nui he 100 pakeneka ma o ka mask non-rebreather ma 15 lita i kēlā me kēia minuke i ka wā e hiki mai ai kahi ʻāpana oxygen kōkua mua a i ʻole ka mea lapaʻau. ʻO ka hanu ʻana he 100 pākēneka o ka oxygen e holoi i ka nitrogen mai ke koko, e hana ana i kahi gradient diffusion e hōʻemi i nā ʻōpū ea i hoʻopaʻa ʻia i ka nitrogen-rich i hoʻopaʻa ʻia i loko o ka moku koko a me ka cardiac.
5. Inā hoʻokuʻu ʻia ka ea i hoʻoemi ʻia ma kahi kokoke i ka ʻāʻī, ka ʻāʻī, a i ʻole ka ʻōpū (ka lio a i ʻole ka hāʻule ʻole ʻana i ka nozzle) a loaʻa koke ka ʻeha o ka ʻōpū a i ʻole ka ʻōpū ʻoʻoleʻa, pehu, e hoʻomoe paʻa, hāʻawi ʻole i kekahi mea ma ka waha, a hoʻomākaukau no ka haʻalulu wikiwiki. pneumoperitoneum), e hoʻopiʻi ana i ka vena cava a me ka diaphragm.
6. Wehe i nā apo a pau, nā wati, a me nā lima lima paʻa mai ka lima a i ʻole ka lima i hoʻopaʻa ʻia e ka ea, a e hoʻokuʻu koke i ka lālā i ka pae o ka puʻuwai. Mai hoʻopili i kahi wīwī paʻa paʻa paʻa a i ʻole pūʻulu hau i kahi lālā i pehu ʻia me ka ea ma lalo o ka ʻili, no ka mea, hoʻomaka koke ka piʻi ʻana o ka ʻiʻo kiʻekiʻe i ka maʻi hoʻoweliweli **; ike ʻeha ʻeha a me ka maʻi compartment.

Ka lāʻau hoʻoholo: ʻeha pū puhi ʻea a me ka hoʻāʻo embolism¶

flowchart TD
    Start["ʻO ka puʻu ea i hoʻopaʻa ʻia a i ʻole ke kiʻekiʻe o ka Pneumatic Exposure"] --> Site{"Ma hea i hahau ai ka ea compressed i ke kino?"}
    Site -->|"ʻO ka ʻeha o ka umauma, pōkole o ka hanu, huikau, maʻi lolo, a i ʻole hāʻule"| Embolism["1. E PONO KOKE ANA I KA WAEWA ANA; 2. E kau i ka mea pepehi ma ka aoao hema me ke poo palahalaha a ilalo iki paha (Durant position); 3. Hoʻoponopono i ka 100% oxygen kahe kiʻekiʻe (15 L / min non-rebreather mask); 4. E kelepona iā 911 / 112 / 999 a noi i ke kikowaena Hyperbaric Oxygen (HBOT)"]
    Site -->|"ʻImi ʻili lima, manamana lima, lima, a i ʻole ʻāʻī (Pehu / ʻili ʻāʻī)"| SkinInject["1. Wehe koke i na apo a pau, wati, a me ke kapa komo; 2. E nānā pono i nā hōʻailona neurological a respiratory embolism; 3. E mālama i ka lālā ma ka pae pu'uwai; Mai ʻomi a ihe i ka ʻiʻo pehu; 4. E lawe i ka 'Oihana Ho'opi'i no ka loiloi decompression o ke ka'ina"]
    Site -->|"Pahū ma kahi kokoke i ka ʻāʻī, perineum, a i ʻole waha (Horseplay / Nozzle Accident)"| Orifice["1. HOʻOPIʻO COLONIC OR ESOPHAGEAL RUPTURE AND TENSION PNEUMOPERITONEUM; 2. E hoʻomoe i ka mea pepehi kanaka palahalaha a i ʻole ma ka ʻaoʻao hema me nā kuli i ʻoni iki; 3. Mai haawi ma ka waha; e nānā i ka hanu ʻana e like me ka hoʻopaʻa ʻana o ka ʻōpū i nā māmā; 4. E kelepona iā 911 / 112 / 999 no ka lawe ʻana i ka ʻeha ʻeha."]
    Site -->|"E hoʻokuʻu i ka ea i loko o ke kahawai Maka a i ʻole ka pepeiao"| EyeEar["1. Maka: E uhi me ka pale ʻoʻoleʻa me ke kaomi ʻole; e nānā i ka pehu orbital; 2. Pepepeiao: Mai hookomo i na kulu a pulupulu paha ma ke kahawai pepeiao; maloʻo ka pepeiao; 3. E nānā no ka vertigo, nāwaliwali o ke aʻalolo, a i ʻole ea intracranial"]
    Embolism --> Monitor["E hoʻomaka i ka CPR inā pulseless a pane ʻole; e hoʻomaopopo i ka barotrauma"]
    SkinInject --> Monitor
    Orifice --> Monitor
    EyeEar --> Monitor

ʻO ka physics o ka ʻeha hau i hoʻopaʻa ʻia a me ke kānāwai palekana OSHA 2-bar (30-psi).¶

No ke aha ke komo ʻana o ka ea compressed i ka ʻili a me ka ʻiʻo kanaka¶

Manaʻo ka poʻe he nui no ka mea he kinoea ka ea i hoʻopaʻa ʻia ma mua o ka projectile paʻa a i ʻole ke kahawai wai kaomi kiʻekiʻe e like me ka mea holoi kaomi a i ʻole ka hose hydraulic, lele wale ia mai ka ʻili. ʻO ka ʻoiaʻiʻo, hāʻawi ka ʻili kanaka a me ka subcutaneous fascia i ke kūʻē liʻiliʻi i kahi jet concentrated o ke kinoea i hoʻopaʻa ʻia:

• 0.2 a hiki i ka 0.35 bar (3 a 5 psi): Ua lawa ke kaomi ʻana i loko o ka waha, pharynx, a i ʻole rectum e uhaʻi ai i ka esophagus, ʻōpū, a i ʻole ka ʻōpū nui.
• 0.35 a hiki i ka 1.0 bar (5 a hiki i ka 15 psi): Ua lawa ke kaomi ʻana no ka uhaʻi ʻana i ka pahu pepeiao o ke kanaka (tympanic membrane) a i ʻole e hoʻoneʻe i ka ʻōpoʻo maka (globe luxation) a hoʻoikaika i ka ea ma hope o ka orbit o ka maka.
• 0.8 a hiki i ka 2.0 bar (12 a 30 psi): Hiki ke hoʻokuʻu i ka lepo, ka ʻili metala, a me ka ea ma kahi kui liʻiliʻi, ʻoki pepa, a ʻoki ʻia paha ma nā manamana lima, e ʻoki ana ma nā ʻūhā flexor tendon mai ka manamana lima a hiki i ka lima a me ka paia o ka umauma i hoʻokahi kekona.
• Ma luna o 2.0 bar (30 psi) a hiki i 8.6 bar (125 psi): ʻO ke kaomi ea hale kūʻai i hoʻoponopono ʻole ʻia. Paʻa pono i ka ʻili ʻole a i ʻole ka lole lahilahi, he 6-a-8-bar (90-a-120-psi) ea nozzle blasts pololei ma o ka epidermis paʻa, hoʻonui i ka lālā me nā haneli milliliters o ka ea paʻa, wehe i nā waimaka ma lalo o ke kino, a hoʻokomo pololei i ke kinoea i loko o ke kahe koko.

ʻO ka OSHA 29 CFR 1910.242(b) a me ka lula make-end 2-bar (30-psi) honua¶

No ka pale ʻana i nā embolisms ea make a me ke komo ʻana i ka ʻili barotrauma, ke kauoha ikaika nei ka United States Occupational Safety and Health Administration (OSHA Standard 29 CFR 1910.242(b)), ke UK Health and Safety Executive (HSE), a me nā kānāwai palekana honua like ʻole e kauoha pono ʻia e ** pono e hoʻemi ʻia ka ea i hoʻohana ʻia no ka hoʻomaʻemaʻe ʻana i ka gaue wale nō i 30**, a laila pono e hoʻemi ʻia ka pahu ma lalo o 30**. kiaʻi a me nā lako pale pilikino.

ʻO ka mea koʻikoʻi, pili kēia palena 2-bar (30-psi) i ke kaomi static dead-end, ʻo ia hoʻi ke ana ʻana ma ka wēlau o ka pū puhi i ka wā e kaomi paʻa ai ka nozzle i kahi ʻili paʻa (e like me ka poho lima a i ʻole ka lole o ka mea hana):

1. No ke aha e hoʻomaʻemaʻe ʻole ai ka pū puhi maʻamau i hoʻoponopono ʻole ʻia: Inā holo ka laina ea hale kūʻai ma 7 bar (100 psi) a hoʻohana i ka nozzle puhi keleawe maʻamau me ka ʻole o ka mea hoʻoponopono kaomi a i ʻole nā ​​puka hoʻomaha ʻaoʻao, kaomi ʻana i kēlā nozzle i ka ʻili e hoʻopuka i ka piha 7 bar (100 psi) o ke kaomi laina i loko o ke kiko.
2. Pehea ka hana ʻana o kahi pū hoʻopaʻa palekana OSHA: Ua hoʻopaʻa ʻia ka nozzle palekana kūpono i nā lua hoʻomaha radial a i ʻole kekahi kihi Venturi ma ka ʻaoʻao o kahi mea hoʻoponopono kaomi inline i hoʻonohonoho ʻia ma lalo o 2 bar (30 psi). Inā paʻa ʻole ka piko o ka nozzle palekana i ka ʻili o ka mea hana, ua ālai ʻia ka puka nui, a puka ka ea ma waho o nā awa hoʻomaha radial no laila ʻaʻole hiki ke piʻi i ke kaomi ʻili make ma mua o 2 bar (30 psi).

Vascular air embolism: ke komo ka ea hale kūʻai i ke kahe koko¶

Pehea ka holo ʻana o ka ea paʻa mai ka manamana lima a i ʻole ka ʻāʻī i ka puʻuwai a me ka lolo¶

Ke hoʻoikaika ʻia ke kinoea ma ka ʻili o ka lima, ka forearm, ka ʻāʻī, a i ʻole ka pā o ka umauma, ʻo ka ʻeke kinoea e hoʻonui ana e hana i nā kaomi kino i ʻoi aku ka kiʻekiʻe ma mua o ke koko venous maʻamau (ʻo ia wale nō ka 0.005 a 0.015 bar, a i ʻole 4 a 12 mmHg). Hoʻokuʻu pololei ʻia ke kinoea i loko o nā aʻa subcutaneous sheared a hele ma nā ala ʻokoʻa ʻelua:

1. Venous Air Embolism (Right-Heart Air Lock): Ke kahe nei nā ʻea kinoea i nā aʻa o ka lima a i ʻole ka ʻāʻī i loko o ka vena cava kiʻekiʻe a komo i ka atrium ʻākau a me ka ventricle ʻākau o ka puʻuwai. Ma muli o ka hiki ke hoʻopaʻa ʻia ka ea a ʻaʻole hiki ke hoʻopili ʻia ke koko wai, i ka wā e ʻaelike ai ka ventricle ʻākau a puni kahi ʻeke nui o ka ea (maʻamau 50 a 100 milliliters, i hāʻawi ʻia e kahi paipu hale kūʻai 7-bar ma kahi hapa o ke kekona), ʻomi wale ka ʻiʻo o ka puʻuwai a hoʻonui i ka huʻa ma mua o ka puhi ʻana i ke koko i mua i loko o ke aʻa pulmonary. Hāʻule ka puʻuwai puʻuwai i ka ʻole, ke kumu o ka cyanosis hikiwawe (ʻili ʻulaʻula), hāʻule ke koko, a me ka hana uila pulseless (PEA) hopu puʻuwai.
2. Arterial / Cerebral Air Embolism (Paradoxical Embolism): Ma kahi o 25 a 30 ka nui o ka poʻe makua olakino he wahi puka liʻiliʻi e like me ka peʻa ma waena o ka atria ʻākau a hema o ka puʻuwai i kapa ʻia he patent foramen ovale (PFO) e paʻa mau. I ka wa e paa ai ka ea venous ea i na aa pulmonary a e hookiekie i ke kaomi ma ka aoao akau o ka puuwai, e hamama ana kela pepa, e hoolele pololei ana i ka ea i hookomoia ma ka aoao hema o ka puuwai, ke aorta, ka coronary arteries (no ka hiki koke mai o ka myocardial infarction), a me ka cerebral arteries (causing, blindness immedia). Hiki nō hoʻi i ka ea ke komo pololei i loko o nā aʻaʻaʻa puʻupuʻu inā paʻa ka pū i loko o ka waha a ʻāhaʻi i ka alveoli māmā (pulmonary barotrauma).

ʻO ka ʻike ʻana i ka embolism vascular air ma ka papahele hale kūʻai¶

E kānalua i kahi embolism weliweli i ke ola inā loaʻa ka mea hana i hoʻohana i ka pū puhi ea i hoʻopaʻa ʻia a i ʻole ka ʻeha pneumatic hose e hoʻomohala ** kekahi ** o kēia mau hōʻailona i loko o kekona a 30 mau minuke:

• Hōpuʻu koke o ka hanu (dyspnea), ʻaʻo, a i ʻole ka ʻāʻī ʻana
• Ka ʻeha ʻeha o ka umauma ma lalo o ka ʻaoʻao me ka hāʻule koke ʻana o ke kahe koko, ka ʻili ʻeleʻele a polū paha, a me ke poʻo māmā loa.
• Nā hemahema ʻino e like me ka hahau ʻana: Piʻoloke hikiwawe, hiki ʻole ke kamaʻilio (aphasia), hāʻule ka maka, nāwaliwali a lolo paha ma kekahi ʻaoʻao o ke kino (hemiparesis), nalo koke ka ʻike, a i ʻole nā maʻi tonic-clonic maʻamau; ike hahau a hopu ʻana
• Holo koke a nalowale ka ʻike

ʻO ka mālama ulia pōpilikia ʻanuʻu no ka mea i manaʻo ʻia i ka embolism compressed-air¶

1. E hoʻonoho i ka mea i pepehi ʻia ma ka Durant maneuver (Left-Lateral Decubitus, Head Flat or Slightly Down):
2. E ʻōwili koke i ka mea i pepehi ʻia ma ko lākou **ʻaoʻao hema.
3. No ka mea e noho ana ke kahe o ka ventricle akau (ka pulmonary artery) ma ka ʻaoʻao hema hema o ke keʻena puʻuwai ʻākau, ʻo ka ʻōwili ʻana i ka mea maʻi ma ko lākou ʻaoʻao hema e lana ai ka huʻi ea i luna i ka piko o ka atrium ʻākau a me ka paia ʻaoʻao o ka ventricle ʻākau, e hoʻomaʻemaʻe ana i ke ala no ke kahe ʻana o ke koko wai ma lalo o ka ʻōpū.
4. E mālama i ke poʻo a me ka lama ** paʻa (hoʻomoe/hema-ʻaoʻao)**, a i ʻole e hoʻokuʻu iki i nā wāwae i luna (10 a 15 degere Trendelenburg) ** pōkole wale nō ** inā kānalua ʻia ka laka ʻana o ka ea puʻuwai akau a ʻaʻohe ʻeha poʻo; inā ke hōʻike mua nei ka embolism arterial cerebral i nā hōʻailona stroke, makemake nui nā kauka hyperbaric i ka ** hoʻonohonoho ʻaoʻao hema a palahalaha paha ** no laila ʻaʻole e piʻi ka pehu o ka lolo. Ma luna o nā mea a pau, mai noho pololei i ka mea maʻi.
5. Hoʻouna koke i ka oxygen 100%:
6. ʻO ka ea hale kūʻai paʻa he 78 pākēneka nitrogen a me 21 pākēneka oxygen. Ke hanu ka mea hana i ka 100 pakeneka o ka oxygen olakino ma o ka mask non-rebreather paʻa i 15 lita i kēlā me kēia minuke, ua hoʻopau ʻia ka nitrogen mai ko lākou koko koko.
7. ʻO ka Nitrogen i paʻa i loko o nā ʻōpū ea intravascular e hoʻopuehu koke i waho i loko o ke koko ʻole nitrogen a hoʻokuʻu ʻia e ka māmā, e emi ana ka nui o ka ʻōpū e **50 pakeneka a ʻoi aku paha ** ʻoiai e hāʻawi ana i ka oxygen koʻikoʻi i ka ʻiʻo o ka lolo ischemic.
8. Hana i ka CPR kiʻekiʻe inā pane ʻole ka mea i hoʻopaʻa ʻia a ʻaʻole hanu maʻamau:
9. Inā hāʻule ka mea i hoʻopaʻa ʻia i loko o ka hopu ʻana i ka naʻau mai kahi laka ea akau, e ʻōwili iā ia ma luna o ko lākou kua ma kahi ʻili paʻa a hoʻomaka i ka ** hoʻoemi ʻana i ka umauma ma 100 a 120 kaomi i kēlā me kēia minuke, 5 a 6 kenimika (2 a 2.4 iniha) hohonu** koke; ike CPR a me AED.
10. ʻO ka hoʻopiʻi ikaika ʻana o ka umauma waho e wāwahi kino i kahi ʻeke paʻa ea-akau-akau i loko o nā microbubbles liʻiliʻi a hoʻoikaika iā lākou i mua ma o ka moena capillary pulmonary i hiki ke hoʻomaka ke kaʻa.
11. Hoʻonohonoho i ka lawe koke ʻana i kahi hale hana Hyperbaric Oxygen Therapy (HBOT):
12. ʻO ka lāʻau lapaʻau paʻa no ka embolism kinoea venous a koʻikoʻi ʻo hyperbaric recompression therapy (maʻamau ma 2.8 atmospheres absolute), nāna e hōʻeha kino i nā ʻōhū kinoea ma lalo o ka hapakolu o ko lākou leo e like me ke kānāwai o Boyle a hoʻihoʻi i ke kahe koko i ka lolo a me ka puʻuwai.

ʻO ka emphysema subcutaneous a me ka ʻili kiʻekiʻe o ka ʻili o ka lima a me ka lima¶

No ke aha he ʻeha ʻoki ʻoki ʻia ka ʻeha manamana lima "koko ʻole".¶

Ke hoʻomaka ʻole ka mīkini a i ʻole ka mīkini i ka pū 7-bar (100-psi) e kūʻē i kahi pā manamana lima, pāma, lima lima, a i ʻole ka lima, ʻoi aku ka nui inā loaʻa kahi māwae momona liʻiliʻi, ʻeha maʻi maʻi, a i ʻole hangnail, ʻo ka lele ea i ka dermis a hoʻonui i ka hakahaka o lalo a me nā mokulele fascial hohonu.

I loko o 2 a 5 kekona, ʻike ka mea hana:

• Pehu ʻano baluna e like me ka baluna e heihei ana mai ka manamana lima a hiki i ka lima, ka lima, ka lima luna, ka poʻohiwi, ka ʻāʻī, a ma ka ʻaoʻao o ka maka a me ka paia o ka umauma.
• Tactile crepitus ("Rice Krispies" pohā ma lalo o ka ʻili): Ke hoʻopā mālie ʻoe i ka lima pehu a i ʻole ka ʻāʻī, ʻike ʻoe a lohe ʻoe i ke kani ʻana, popping, a i ʻole ke kani ʻana o ke kani ʻana i ka wā e neʻe ai nā tausani o nā ea liʻiliʻi i paʻa ma lalo o kou manamana lima (subcutaneous emphysema).
• Ka ʻeha puʻupuʻu ikaika, ʻeleʻele, a me ka helu ʻana: Inā lawa ka ea kaomi kiʻekiʻe i loko o nā ʻāpana fascial paʻa ʻole o ka lima a i ʻole ka poʻo, piʻi ka piʻi ʻana o ka ʻiʻo ma luna o ke kaomi capillary perfusion, e ʻoki ana i ke kahe o ke koko i nā ʻiʻo a me nā aʻalolo (pneumatic compartment syndrome). Eia kekahi, ʻaʻole maʻemaʻe ka ea i hoʻopaʻa ʻia ma ka hale kūʻai; ua haumia loa ia me ka ** ʻaila ʻaila compressor crankcase, wai condensation lepo, unahi ʻōpala mai nā pahu pahu kila, a me ka lepo hale kūʻai**, kahi e hoʻoulu ai i ka cellulitis kemika nui a me ka necrotizing deep-space maʻi; ike ʻeha ka mea holoi holoi a me nā ʻeha kickback.

ʻO ke kōkua mua no ka hoʻoheheʻe ʻia ʻana o ka ea ma lalo o ka ʻili¶

1. E wehe i nā apo a pau, nā wati, nā kūpeʻe lima, a me nā puʻupuʻu pālule paʻa i loko o 60 kekona mua: ʻOi aku ka wikiwiki o ka pehu ʻana o ka ea ma mua o ka edema ʻeha maʻamau; ʻO ke apo gula a kila paha e hoʻopaʻa i ka manamana lima i loko o ʻelua mau minuke.
2. E nānā i ka ʻāʻī a me ke alaloa inā ua hele ka ea ma mua o ka poʻohiwi: Ke hoʻoheheʻe ʻia ka ea i loko o ka lima a i ʻole ka poʻe lima ma ka ʻaoʻao o ka brachial fascia i loko o ka mediastinum (ke kikowaena o ka umauma) a me ka ʻāʻī (pneumomediastinum), e pehu aʻe ka ʻāʻī o ka mea i pepehi ʻia a ʻike ʻia ko lākou leo i ke kani kiʻekiʻe, Duck. ("ʻo ka hamman's crunch" ke lohe ʻia ma luna o ka puʻuwai). E nānā pono i ko lākou hanu ʻana a mālama pono iā lākou.
3. E uhi i ka wahi punu liʻiliʻi me ka paʻa maloʻo maloʻo a hoʻopaʻa ʻole i ka lima ma ka pae puʻuwai: Mai hoʻokiʻekiʻe i ka lima ma luna o ke poʻo (e hoʻohaʻahaʻa i ke kaomi venous a paipai i ke komo ʻana o ka ea i loko o nā veins) a mai hoʻokuʻu iā ia e kau i lalo.
4. E koi i ka loiloi halemai pilikia a me nā kukui X: ʻOiai inā maikaʻi ka manaʻo o ka mea i hōʻeha ʻia, ʻo kēlā me kēia me ka crepitus subcutaneous mai ka hale kūʻai ea paipu e koi i nā radiographs koʻikoʻi (e palapala i ke kinoea i loko o nā ʻāpana fascial a me ka umauma), prophylaxis tetanus, broad-spectrum intravenous antibiotics (e kūʻē i ka wai a me ka hui ʻana o ka ʻaila.

ʻO ka hoʻokani lio ʻana i ka ea pahū a me ka haki ʻana o ka colonic¶

No ke aha e make ai ke kuhikuhi ʻana i ka paipu ea ma ka ʻāʻī o ka hoa hana¶

I loko o ka mōʻaukala palekana ʻoihana, ʻo kekahi o nā pōʻino ma ka papahele o ka hale kūʻai he "compressed air horseplay": hoʻohenehene ka mea hana a hoʻokuʻu paha i kahi pū puhi ea kokoke i ka ʻāʻī a i ʻole ka ʻāʻī o kekahi hoa hana i ko lākou kūlou ʻana ma luna o kahi papa hana, a hoʻohana paha i ka nozzle ea e lepo mai ka noho o ko lākou pūlule.

Ke manaʻo nui nei ka poʻe hana ʻo nā jeans denim koʻikoʻi a i ʻole nā ​​uhi uhi e hoʻopaʻa i ka lewa, a i ʻole e hoʻokomo kino ʻia ka nozzle ea i loko o ka ʻāʻī i mea e pōʻino ai. He hewa nā manaʻo ʻelua:

1. Ka hopena o ka hipa kāne pneumatic: E puka ana ka ea ea koʻikoʻi i waho o ka nozzle ma 5 a 9 bar (70 a 130 psi) e hana i ke kolamu kinoea hui pū. Mai ka 5 a hiki i ka 20 kenimika (2 a 8 iniha) ka mamao, e hele koke ana ke kolamu o ka ea ma o na kaula i ulana ia o na palule hana, na hoolele ma waena o ka gluteal folds, a hooikaika i ka anal sphincter e hamama i na milliseconds.
2. Pahū ʻākoʻo koke: Loaʻa i ka ʻāʻī o ke kanaka ke kaomi physiological burst o 0.16 a 0.27 bar wale nō (2.3 a 4.0 psi, a i ʻole 120 a 200 mmHg). Hāʻawi ka laina ea hale kūʻai i 25 a 40 mau manawa o ka pahū ʻana o ka ʻōpū o ke kanaka, e puhi ana 20 a 40 lita o ka ea i kēlā me kēia kekona i loko o ka rectum. Ma lalo o 0.5 kekona, pahū ka hui rectosigmoid a i ʻole cecum e like me ka ʻeke pepa i hoʻonui ʻia.
3. Tension pneumoperitoneum: He nui ka ea o ka hale kūʻai paʻa kiʻekiʻe e ninini ʻia ma ka paia o ka ʻōpū i haehae ʻia i loko o ka lua ʻōpū i hoʻopaʻa ʻia. ʻO ka ʻōpū o ka mea i pepehi ʻia i waho e lilo i paʻakikī e like me ka pahu i loko o kekona. ʻO kēia kaomi kinoea nui loa i loko o ka ʻōpū (tension pneumoperitoneum) e hoʻokuke ikaika i ka diaphragm i luna i loko o ka umauma, e uhaʻi ana i ka māmā i hiki ʻole ai i ka mea i hōʻeha ke hanu, a e hoʻohiolo i ka vena cava haʻahaʻa no laila ʻaʻole hiki ke hoʻi ke koko i ka puʻuwai, ʻoiai e koi ana i ka fecal bacteria i loko o ka peritoneum a me nā kīʻaha koko.

ʻO ka pane ulia pōpilikia no ka haki ʻana o ka ʻōpū pneumatic a me ka pneumoperitoneum haʻalulu¶

1. E kelepona iā 911 / 112 / 999 koke a hōʻike i kahi "ʻeha ʻeha ʻeha i hoʻopaʻa ʻia i ka ʻōpū me ka ʻeha o ka ʻōpū a me ka pneumoperitoneum i manaʻo ʻia." He helu kēlā me kēia minuke; ʻoi aku ka make ma mua o 40 pakeneka me ka ʻole o ka decompression wikiwiki a me ka hoʻoponopono ʻana.
2. E hoʻonoho i ka mea i pepehi ʻia ma ka ʻaoʻao hema a i ʻole ka ʻaoʻao ʻaoʻao me nā kuli e kūlou iki: Mai koi iā lākou e moe palahalaha inā ʻae ka ʻōpū i ka hanu ʻana, ʻaʻole hoʻi e hoʻokau pololei iā lākou. ʻO ke kākoʻo ʻana iā lākou ma ko lākou ** ʻaoʻao hema ** e kōkua i ka hōʻemi ʻana i ka pilikia o ka embolism venous ea i ka manawa e pane mai ai nā paramedic.
3. ** ʻAʻole hāʻawi i kekahi mea ma ka waha (ʻaʻohe wai, nā lāʻau ʻeha, a i ʻole nā ​​​​antacids): ** Pono ka mea maʻi e hoʻomaʻamaʻa koke i ka laparotomy a me ka hoʻoponopono ʻana i ka ʻōpū ma lalo o ka anesthesia āpau.
4. ** Kākoʻo i ka ea a me ka hoʻomākaukau ʻana no ka hoʻopau ʻana i ka nila paramedic:** Inā paʻa loa ka ʻōpū me ka ea paʻa e huli aʻe ka polū (cyanotic) a ʻaʻole hiki ke hoʻoneʻe i ko lākou pā umauma e hanu, hiki i nā poʻe lapaʻau ola ola kiʻekiʻe a i ʻole nā ​​​​kauka trauma ke hana i ka hoʻoemi pilikia o ka lua peritoneal me ka lawe wikiwiki; ike haʻalulu.

ʻO ka barotrauma ka maka, ka pepeiao, a me ka waha mai ka ea paʻa¶

ʻO ka maka a me ka ea orbital injection (Orbital Emphysema)¶

Ke hoʻoheheʻe ʻia ka nozzle ea i hoʻopaʻa ʻia ma kahi kokoke i ka maka, a i ʻole i ka wā e paʻi ʻia ai nā ʻāpana lāʻau e ka pū puhi 7-bar (100-psi) i ka maka, hiki i ke kahawai ea ke haehae i ka conjunctiva (ka membrane lahilahi e uhi ana i ka keʻokeʻo o ka maka) me ka ʻole o ka hou ʻana i ka ʻōpoʻo maka ponoʻī, e hoʻonui ana i ka lihilihi a me ka iwi iwi ma hope o ka maka (**

• ** ʻO ka pōʻino o ka neuropathy optic compressive:** ʻO ka ea i paʻa ma hope o ka ʻōpoʻo maka i loko o ke kumu iwi iwi ʻoʻoleʻa e hoʻokuke i ka ʻōpoʻe maka i mua (proptosis) a hoʻopaʻa i ke aʻalolo optic a me ke aʻaʻa retinal waena, hiki ke hoʻomaka ka makapō mau i loko o 60 a 90 mau minuke.
• Mālama koke:
• E haʻi aku i ka mea i pepehi ʻia ** ʻAʻole e puhi i ka ihu a i ʻole ke kihe ʻana me ka pani ʻana o ka waha** (ʻo ia ka mea e koi ai i ka ea sinus i loko o ka orbit).
• Mai AOLE kaomi ma ka pehu o na lihilihi; e hoʻopaʻa i kahi pale pale ʻoʻoleʻa a i ʻole ke kīʻaha kīʻaha pepa ma luna o ka ʻāpana iwi o ka maka; ike ʻeha maka.
• E lawe koke i kahi keʻena pilikia no ka decompression ophthalmology.

ʻO ka pahū ʻana o ka pepeiao a me ka haki ʻana o ka membrane tympanic¶

ʻO ka hoʻohana ʻana i ka hose ea e puhi ai i ka lepo mai ka lauoho a i ʻole nā kola ma kahi kokoke i ka pepeiao e pahū ai ka ** tympanic membrane (pepeiao)** me ka haʻalulu leo (ʻoi aku ka nui o 120 a hiki i ka 135 decibels) a me ka pneumatic overpressure:

• Nā hōʻailona: ʻEha pepeiao ʻoi, kani leo nui (tinnitus), nalo ka lohe ʻana, ke kahe ʻana o ke koko a i ʻole ka wai maʻemaʻe e kahe ana mai ke kahawai pepeiao, a me ka milo liʻiliʻi (barotrauma vertigo) inā hoʻolei ʻia nā ossicle o ka pepeiao waena i loko o ka puka aniani oval.
• Mālama koke: E maloʻo ka pepeiao. Mai hoʻokomo i nā kulu pepeiao, ka wai, a i ʻole ka pulupulu pulupulu i loko o ke kahawai pepeiao. E kau i kahi paʻi lole maʻemaʻe ma luna o ka pepeiao o waho a kōkua i ka mea ʻeha ʻeha e moe mālie.

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

Ke kāhea aku nei i nā lawelawe pilikia no ka hoʻokomo ʻia ʻana o ka ea, embolism, a i ʻole ka ʻeha o ka ʻōpū o ka ʻōpū, e haʻi pololei i ka mea hoʻouna i ka ** kaomi laina ma ka psi a i ʻole ka pā ** a noi i ** Advanced Life Support (ALS) paramedics me ka oxygen kahe kiʻekiʻe a me ka hui pū ʻana me kahi Hyperbaric Oxygen Therapy (HBOT) a i ʻole Level 1 Trauma Center**. E nana helu pilikia no nā helu komo honua.

Nīnau pinepine¶

No ke aha e kaupalena ai ka OSHA i nā pū puhi ea i 30 psi (2 bar) ke hoʻohana ʻia no ka hoʻomaʻemaʻe ʻana, a hiki i ka 30 psi ke hōʻeha iā ʻoe?¶

ʻO ka OSHA Standard 29 CFR 1910.242(b) ka ea i hoʻopaʻa ʻia no ka hoʻomaʻemaʻe ʻana i ke kaomi ʻana o ka 2 bar (30 psi) no ka mea e hōʻike ana nā hoʻokolohua ʻo ka ea hale kūʻai ʻole i hoʻoponopono ʻia ma luna o 2 bar (30 psi) i hoʻopaʻa ʻia ma kahi kokoke i ke kino hiki ke pahū pololei ma ka ʻili kanaka a hoʻoikaika i nā ʻea kinoea make i loko o nā veins a me nā aʻa. Eia naʻe, ʻo 2 bar (30 psi) he palena hoʻomaʻemaʻe ʻāpana mīkini, ʻaʻole ia he laikini e puhi i ka ea ma kou kino: ʻoiai ma ka 0.35 a i ka 1 bar (5 a 15 psi), hiki i kahi kahawai ea kōmihi ke naha i ka pahu pepeiao, puhi i nā kohu metala i loko o ka cornea, a i ʻole nahā ka ʻōpū nui inā kuhikuhi ʻia ma kahi o nā puka o ke kino. ʻAʻole pono e hoʻohana ʻia ka ea i hoʻopaʻa ʻia i ka lepo i ka lole, ka ʻili, a me ka lauoho.

Pehea ke komo ʻana o ka ea kōmi i ke kahe koko inā ʻaʻole ʻike ʻia ke koko ma ka ʻili?¶

I ka wā e paʻi ai ka nozzle ea i hoʻopaʻa ʻia ma 6 a 8 bar (90 a 120 psi) i ka lima, lima, a i ʻole ka ʻāʻī, hiki i ke kahawai kinoea supersonic ke komo i loko o ka ʻili liʻiliʻi, e like me kahi liʻiliʻi liʻiliʻi, māwae ʻili maloʻo, a i ʻole ʻōpala metala, a i ʻole ke kuʻi i kahi puka kiko ma ka epidermis paʻa. Ma muli o ka hoʻoulu koke ʻana o ka ea kiʻekiʻe i ka ʻiʻo subcutaneous a hoʻopaʻa i ka puka komo liʻiliʻi mai loko mai, ʻaneʻane ʻaʻohe koko e puka i waho. I kēia manawa, hoʻomāhuahua ka ʻeke o ke kinoea piʻi kiʻekiʻe i loko o ka lālā e wehe ai i nā venules subcutaneous me ka paia lahilahi a hoʻoneʻe pololei i nā ʻōhū ea i loko o ke kahe ʻana i ka puʻuwai.

No ke aha e kau ʻia ai ka mea i hoʻopiʻi ʻia i ka embolism compressed-air ma ko lākou ʻaoʻao hema (Durant position) ma mua o ka noho ʻana i luna?¶

Ke komo nā ʻōhū ea i loko o kahi vein mai ka ʻeha lima a i ʻole ka ʻāʻī, hele lākou i ka atrium ʻākau a me ka ventricle ʻākau o ka puʻuwai, kahi e hiki ai iā lākou ke hana i ka huʻihuʻu compressible e ālai i ke koko mai ke komo ʻana i ke aʻa pulmonary a hiki i ka māmā (he laka ea ʻākau). No ka mea e noho ana ka puka o ke aʻa pulmonary ma ka ʻaoʻao hema hema o ka ventricle ʻākau, ʻo ka ʻōwili ʻana i ka mea i hōʻeha ʻia ma ko lākou ʻaoʻao hema me ko lākou puʻupuʻu palahalaha e lana ai ka ʻeke ea i luna a hiki i ka paia ʻākau a me ka piko o ke keʻena puʻuwai, ma kahi mamao mai ka puka puka, e hiki ai i ke koko wai ke kahe ma lalo o ka ʻōpū i loko o ka māmā. ʻO ka noho pololei ʻana o ka mea maʻi e hiki ai i nā ʻōhū ea ke lana i luna i loko o nā ʻaʻa o ka lolo a i ʻole ke kāohi pono ʻana i ka ʻāpana puka o ka pulmonary.

He aha ke kumu o ka ʻeha ʻana o ka "Rice Krispies" ma lalo o ka ʻili ma hope o kahi ulia pōpilikia, a he pōʻino paha?¶

ʻO ke kani ʻana, popping, a i ʻole ke kani ʻana i lalo o ka ʻili ke hoʻopā ʻia, ua kapa ʻia ʻo subcutaneous crepitus (a i ʻole subcutaneous emphysema), i hana ʻia e nā tausani o nā ʻeke o ka ea i hoʻopaʻa ʻia i loko o ka momona a me nā papa fascial ma lalo o ka dermis. ʻOiai hiki ke hoʻopili ʻia nā ea liʻiliʻi e ke kino, ʻo ka emphysema subcutaneous mai kahi hale kūʻai ea he pilikia olakino no nā kumu ʻekolu: ʻo ka mea mua, hōʻike ʻo ia i ka haʻihaʻi ʻana o ke kinoea kiʻekiʻe i ka pale ʻili a lawe i ka pilikia o ka embolism vascular; ʻO ka lua, hiki i ka ea paʻa i ka lima paʻa a i ʻole ka forearm ke ʻoki i ke kaʻa a hoʻoulu i ka maʻi compartment; a ʻo ke kolu, hoʻokomo ka ea hale kūʻai i ka noe ʻaila compressor, ka ʻōpala, a me ka bacteria ma ka hohonu o nā pū ʻāʻī, e koi ana i ka loiloi wikiwiki a me nā lāʻau antibiotic.

Pehea e hiki ai i ke kuhikuhi ʻana i kahi paipu ea i hoʻopaʻa ʻia i ka pants o kekahi ke kumu i ka ʻeha o ka ʻōpū me ka hoʻo ʻole ʻana i ko lākou ʻili?¶

ʻO ka laina ea hale kūʻai maʻamau ma 6 a 8.6 bar (90 a 125 psi) e hoʻokuʻu i kahi kolamu kiʻekiʻe kiʻekiʻe o ke kinoea e hele pololei i ka ulana ʻana o nā jeans denim a i ʻole nā ​​uhi. Inā kuhikuhi ʻia ka nozzle i ka ʻāʻī o ka hoa hana a i ʻole ka perineum mai ka 10 a 15 mau kenimika (4 a 6 iniha) ka mamao, e lele ke kolamu ea i loko o ke kahawai anal, e lanakila koke i ka sphincter anal, a hoʻonui i ke kolone me 25 a 40 mau manawa o kona puʻe ʻana o ka pā o ka 0.2 kekona (3 ʻoi aʻe ma mua o ka hapalua o ka ʻōpū). a me ka hoʻopiha ʻana i ka ʻōpū o ka ʻōpū me ka ea kiʻekiʻe a me ka bacteria.

Ke hāʻawi nei kēia alakaʻi i ke kōkua mua a me nā kuʻina hoʻāʻo pilikia no nā ʻeha pneumatic a me ka ea i hoʻopaʻa ʻia a ʻaʻole e pani i ka mālama olakino ʻoihana. E noʻonoʻo e lawe i kahi hana kōkua mua i hōʻoia ʻia, CPR, a me ka papa hoʻokele oxygen ma o ke Keʻa ʻulaʻula, St John Ambulance, a i ʻole kāu mea lawelawe palekana hana.

Nā alakaʻi pili¶

• ʻO ka hoʻoheheʻe ʻana i ka mīkini holoi a me nā ʻeha kickback
• ʻO ka moku paʻi, nahā ka pahu pahu kōmike ea, a me ka pahū ʻana o nā kaʻa
• ʻO ka pū nail a me ka pneumatic fastener penetration a me nā ʻeha ricochet
• Nā ʻeha maka
• ʻeha ʻeha a me ka maʻi compartment

Nā kumu a me ke alakaʻi kūhelu¶

• Ka Hoʻoponopono Hana Ola a me ka Ola (OSHA, ʻAmelika Hui Pū ʻIa): *29 CFR 1910.242(b) Hoʻohana ʻia no ka hoʻomaʻemaʻe ʻana.
• Luna Hoʻokele Ola a me ka Maluhia (HSE, United Kingdom): Paleʻaleʻa Kūʻai ʻia (Alakaʻi PUWER)
• Ke Kikowaena Kanaka no ke Ola Ola a me ka Maluhia o ka Hana (CCOHS, Kanada): Ea Komi no ka Hoomaemae a me na Mea Hana Pneumatic Pepa Paahana
• Undersea and Hyperbaric Medical Society (UHMS, International) & Divers Alert Network (DAN): Clinical Management for Arterial and Venous Gas Embolism
• American Society for Surgery of the Hand (ASSH, United States): Ke Kiekie-Pressure Injection Injuries of the Upper Extremity