Nail Gun Bump-Fire Double-Phot and Barbed Nail Triage¶

Nailers pneumatic, gas-actuated, a me cordless framing nailers e holo 75-a-90-millimeter (3.0-a-3.5-inihi) na kui hao kila ma ka muzzle velocities o 30 a 425 mau mika no kekona (100 a 1,400 kapuai i kekona), e haawi ana i ka ikehu kinetic ma luna o ka 22-arm like like. 37,000 kipa ʻoihana pilikia i kēlā me kēia makahiki ma ʻAmelika wale nō e like me ka Centers for Disease Control and Prevention (CDC) a me ka National Institute for Occupational Safety and Health (NIOSH). Hōʻike nā haʻawina epidemiological i ka wahi hana he 65 a hiki i ka 69 ka nui o nā ʻeha a pau o ka pū nail ma muli o kahi hoʻolālā mechanical hiki ke pale ʻia: ʻo ka Contact-Trip ("Bump-Fire" a i ʻole "Bottom-Fire") Trigger, e hiki ai i ke kamanā ke hoʻopaʻa i ka manamana lima e ʻomi mau ʻia i lalo a puhi i kahi kui i kēlā me kēia manawa i ka ihu e pili ana i kahi mea palekana. Ma hope o ke kī ʻana i ke kui mua, hoʻihoʻi ʻia ka pneumatic e hoʻolele ai ka naila 4-kilogram (9-pauna) kaumaha i luna a hāʻule koke i lalo (** hoʻihoʻi ahi pālua ʻole ) ma luna o ka lima hema ʻole o ke kamanā e paʻa ana i ka stud 2x4, a i ʻole ma ka ʻūhā, ke kuli, ka ʻūhā, ka pahu, ka umauma, a i ʻole ka manamana lima. hoʻomaka. ʻOi aku ka ʻoi aku ka maikaʻi loa, ua hoʻopaʻa ʻia nā kui kuʻi i loko o nā ʻāpana a i ʻole nā ​​wili me ka hoʻohana ʻana i ka ** uwea keleawe i hoʻopaʻa ʻia ma kahi kiko, nā ʻāpana ʻiliʻili ʻili, a i ʻole ke kāpili resin i hoʻāla ʻia i ka wela. I ka ʻako ʻana o ka pine kī i ke kui mai loko mai o ke kaula, ** mau ʻēheu keleawe a i ʻole nā ​​ʻēheu ʻiʻo i hoʻopaʻa ʻia i ke kumu o ke kui** a ʻo ka ʻaoʻao pōpō e kuʻi ai i kahi plug o ka denim lepo, ka ʻili kāmaʻa ʻili, a i ʻole ka mīkina lima hana i loko o ka iwi a me ka capsule hui. Inā huki ka hoa hana i kēlā kui i hope mai loko mai o ka lima, kuli, wāwae, iwi poʻo, a i ʻole ka umauma ma ka wahi hana e hoʻohana ana i ka hāmare maʻuʻu a i ʻole nā ​​wili, ua ʻoki ʻia nā ʻāʻī o ke keleawe a ʻokiʻoki i ** nā aʻalolo kikohoʻe, nā ʻāʻī flexor, a me nā ʻaʻaʻa** me ka waiho ʻana i nā ʻōpala lepo a me nā ʻāpana lole i paʻa i loko o ka iwi i mea e hōʻeha ai i ka osteomyelitis septic. Inā komo ke kui i ke poʻo, ka ʻāʻī, ka umauma, ka ʻōpū, ka maka, a i ʻole kahi hui nui, e kelepona koke i kāu helu pilikia kūloko (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom, 000 ma Australia, 111 ma New Zealand) a i ʻole e nānā i kā mākou papa kuhikuhi honua. helu pilikia. No nā protocols pili pili i ka trauma, e heluhelu i kā mākou alakaʻi ma ka pū kui a me ka hoʻopaʻa pneumatic hoʻokomo a me nā ʻeha ricochet, ka hoʻopaʻa ʻana a me ka hoʻopaʻa ʻana i nā mea haole, ka tamponade puʻuwai a me ka hoʻāʻo ʻana i ka trauma umauma, a ke koko nui a me ka noi tourniquet.

E hana i kēia i kēia manawa¶

1. E hoʻokaʻawale i ka paipu ea paʻa (a i ʻole e wehe i ka ʻeke a me ka wahie) mai ka pū kui ma mua koke o ke kōkua ʻana i ka mea i hōʻeha ʻia: Mai hoʻonoho i kahi kui pneumatic ola ma luna o kahi scaffold, kaupaku, a i ʻole ka papahele ke hoʻopili ʻia i ka hose ea. Inā hehi ka mea e kū ana ma luna o ke kumu a hoʻokuʻi paha i ka ihu o kahi naila huakaʻi hoʻopili i ka wā hoʻopakele, e puhi hou ia i kahi kui 90-milimeter.
2. ** ʻAʻole loa e huki i ka nail pneumatic mai loko mai o ka lima, kāmaʻa, kuli, iwi poʻo, a i ʻole ka umauma ma ka wahi hana me ka hāmare a i ʻole nā ​​palaki:** ʻOiai ke wili nei ke poʻo o ke kui 2 kenimika (0.75 iniha) mai ka manamana lima a i ʻole ka pahu hana, e waiho paʻa i ke kui. Lawe ʻia nā kui kuʻikuʻi i hui ʻia i ** nā lāʻau uwea keleawe i hoʻopaʻa ʻia ma kahi kikoʻī a i ʻole nā ​​ʻili i hoʻopili ʻia i ka plastik** ma ko lākou kumu. ʻO ka huki ʻana i ke kui i hope me ka ʻike ʻole ʻia ʻana o ke kaʻi ʻana, ʻoki ʻia nā aʻalolo a me nā kīʻaha koko, wehe i ka ʻili i loko o ka iwi, a wehe i ke koko o loko.
3. **Inā hoʻopaʻa pololei ʻia ka lima o ka mea i pepehi ʻia, ka manamana lima, a i ʻole ka kāmaʻa i ka stud 2x4, ka hale o ka hale, a i ʻole ka ʻili lāʻau, e hoʻohana i ka ʻili a i ʻole ka ʻoki pōʻai e ʻoki i ka lāʻau a puni ka mea i pepehi ʻia (e waiho ana i kahi wahi lāʻau i hoʻopili ʻia i ke kui): E kākoʻo i ka lālā ʻeha i ʻole e piʻo ke kui, ʻike ma ka stud 2x4 15 kenimika (6 ʻīniha) ma kēlā ʻaoʻao kēia ʻaoʻao o ke kui, a lawe i ka mea maʻi me ka poloka pōkole o ka lāʻau a me ke kui i hoʻopaʻa pū ʻia.
4. Inā komo ke kui i ka paia o ka umauma (ma loko o ka "Pahu Pu'uwai" ma waena o nā nipples a me nā iwi iwi po'o) a i 'ole ka iwi po'o, e kelepona koke i ka 911 / 112 / 999 a e mālama pono i ka mea i ho'opa'a 'ia: 'O ke kui kui 90-milimita i kī 'ia i loko o ka sternum e hou pinepine i ka **ventricle akau. ʻO ke kui kila ponoʻī e hoʻokuʻu i ka puka o ka ʻiʻo puʻuwai kuʻi; ʻo ka huki ʻana i waho e hoʻopōʻino i ka cardiac tamponade i loko o 60 kekona. E hoʻopaʻa i ke poʻo kui me ke apo ʻoluʻolu o nā ʻōwili gauze, e hoʻomau i ka mea maʻi, a holo wikiwiki i kahi Papa 1 Trauma Center.
5. Inā komo ka kui i loko o kahi kāma'a hana a kāma'a paha, MAI wehe a huki paha i ka kāma'a mai ka wāwae ma ke kahua: Ke huki nei i kahi kāma'a ili ma luna o ke kui i ho'oku'u 'ia i loko o nā iwi wāwae e ho'oku'u i ke kui i loko o ka wāwae a e huki i nā pahu lepo lepo ma nā a'a a me nā a'a. E waiho i ka kāmaʻa a hiki i ka lawe ʻia ʻana o nā kukui X o ka haukapila.
6. E hoʻololi i nā nail hoʻoheheʻe ʻia o ka wahi hana mai kahi ʻeleʻele "Contact-Trip (Bump-Fire)" Trigger i kahi Gray/Alani "Full-Sequential Trigger": Wahi a NIOSH a me OSHA, e hoʻololi i nā mea hoʻopili-huakaʻi me Full-Sequential Triggers, kahi e koi ʻia ai ka ihu e huki ʻia i ka * manamana lima no ka huki ʻana i ka lāʻau. nā ʻeha pū kui kuʻekuʻe ʻia e ** ʻoi aku ma mua o 50 a 65 pākēneka**.

Ka lāʻau hoʻoholo: ke komo ʻana i ka pū nail pneumatic a me ka triage anatomical zone¶

flowchart TD
    Start["Pneumatic a i ʻole Cordless Nail Gun Penetration"] --> Disconnect["1. E OKE I KA PALAPALA EA A I OLE I KA PALAPALA: Uncouple Ea Hose / Wehe i ka Battery & Gas Cartridge Ma mua o ka pa ana i ka pu a i ka ma'i."]

    Disconnect --> WoodPinned{"2. Ua paa anei ka lima, ka wawae, a me ke kino o ka mea i pepehiia i ka laau?"}

    WoodPinned -->|"ʻAe: Kuʻi pololei ʻia i ka Stud, Joist, a i ʻole Plywood"| SawWood["ʻOki Laʻau ʻAʻole (ʻAʻole ʻOli): 1. Kākoʻo i ka Laʻa o ka mea ʻeha i hiki ʻole ke Kuʻu a wili paha ke kui."]

    WoodPinned -->|"ʻAʻole: Hoʻokomo wale ʻia ke kui i loko o ke kino o ka mea ʻeha"| ZoneCheck{"3. ʻO ka ʻāpana anatomical hea i komo ai ke kui?"}
    SawWood --> ZoneCheck

    ZoneCheck -->|"1. PU'UWAI, MAKA, MAKA, A'I"| HeadNeck["INTRACRANIAL / NECK / OCULAR PROTOCOL: 1. E kelepona iā 911 / 112 / 999 koke (Level 1 Trauma / Neurosurgery Center) 2. Mai Huki a hoʻopā paha i ke Poʻo Nail Protruding."]

    ZoneCheck -->|"2. KA PAHA ('PUA PUʻAI'), KUA, A I OLE OPU"| TorsoBox["CARDIAC TAMPONADE & TORSO PROTOCOL: 1. E kelepona iā 911 / 112 / 999 koke (Alert Dispatch: Penetrating Cardiac/Thoracic Nail) 2. MAI Huki i ka Nail Out (Nail Plugs Right Ventricle / Aorta Hole) 3. E kiaʻi no Beck's Triad (Muffle Heart Distend) Ka lawe ʻana o Thoracotomy"]

    ZoneCheck -->|"3. LIMA, PUMIMA, KULI KULI, A I OLE WAWAI / PUA HANA"| ExtremityCare["BARBED-NAIL EXTREMITY & JOINT PROTOCOL: 1. E waiho paʻa i ka Nail ma kahi (E pale aku i ke keleawe/plastic barbs mai ka haehae ʻana i nā aʻalolo a me nā moku) 2. inā ma o kahi kāmaʻa hana: ʻaʻole e huki i ka wāwae i ka wāwae 3. e nānā i ka distal capillary refill a me ka manaʻo ma nā manamana lima a me nā manamana wāwae. X-Ray a me ka hoʻopaʻapaʻa ʻana"]

Luʻu hohonu 1: Hoʻokaʻaʻike-Hīkaʻi ("Bump-Fire") vs. Full-Sequential Trigger mechanics¶

No ke aha la e pana ai ka poe kamana ma ka lima, ke kuli, a me ka umauma i na tausani manawa o ka makahiki i ka manawa aole i manao ke kamana e huki i ke kumu no ka lua o ka manawa?

1. Pehea ka hana ʻana o ka Mechanism Palekana ʻElua a ka Nail Gun¶

ʻO kēlā me kēia pu kui pneumatic a i ʻole cordless nail hou he ʻelua mau hoʻololi mechanical kaʻawale e pono e hoʻohaʻahaʻa ʻia ma mua o ka ea paʻa (\(5.5\text{ a }8.3\text{ bar} / 80\text{ to }120\text{ PSI}\)) e hoʻokuʻu i ka piston kūloko e hoʻokuʻu i ke kui: 1. Ka Finger Trigger ma ka pu panapana. 2. Ka Mea Hoʻopili Mea Hana (Safety Nosepiece / Yoke) ma ka piko o ka barela, pono e hoʻokuʻu ʻia i hope i ka lāʻau ma kahi o 6 a 10 millimeters.

ʻO ka ʻokoʻa ma waena o kahi pū nail palekana a me kahi pū pōʻino e hele mai i lalo i inā mālama ʻia ka valve ea o loko NA KE kauoha e kaomi ʻia kēlā mau hoʻololi ʻelua:

====================================================================================
    CONTACT-TRIP ("BUMP-FIRE") vs. FULL-SEQUENTIAL TRIGGER MECHANICS (NIOSH/OSHA)
====================================================================================

 [A] CONTACT-TRIP / BUMP-FIRE TRIGGER       [B] FULL-SEQUENTIAL TRIGGER (SAFE)
     (Black Trigger; 65-69% of Injuries)        (Gray/Orange Trigger; ANSI SNT-101)

  * Order Does NOT Matter:                   * STRICT 1-THEN-2 SEQUENCE REQUIRED:
    Operator holds Finger Trigger squeezed     [Step 1] Press Nosepiece firmly
    down continuously.                                  against wood FIRST.
                ||                             [Step 2] Pull Finger Trigger SECOND
                vv                                      to fire 1 single nail.
    [Shot 1] Nose touches stud -> FIRES                    ||
                ||                                         vv
    [Recoil] Gun bounces up 5 cm and           If gun bounces after Shot 1 while
             drops back down onto stud         finger holds trigger down:
             or onto LEFT HAND holding wood                ||
                ||                                         vv
    [Shot 2] Nose touches hand -> FIRES        GUN WILL NOT FIRE A SECOND NAIL
             90 mm NAIL THROUGH HAND           (Must release finger trigger first)
====================================================================================

2. ʻEkolu Classic Contact-Trip ("Bump-Fire") Nā Hōʻike ulia pōpilikia¶

1. Ka Hoʻi ʻAi ʻAi Pālua i loko o ka lima ʻAʻole Manaʻo (Maʻamau):
2. ʻOiai ke kālai ʻana i ka paia a i ʻole ke kuʻi wāwae i ke kui ma kahi kihi ʻinoʻino, paʻa ke kamanā i ka pahu 2x4 me ko lākou lima hema he 15 kenimika (6 ʻīniha) ka mamao mai ka hui ʻana a puhi i kahi kui hoʻopili me kona lima ʻākau.
3. Ma muli o ka paʻa ʻana o ka manamana lima ʻākau o ke kamanā ma ke kumu, hoʻolei ka pneumatic recoil i ka ihu mai ka lāʻau a hoʻokuʻu iho i lalo i 5 kenimika (2 iniha) i ka hema, a pā paha i ka lihi o ka stud a pae pololei paha ma ke kua o ko lākou manamana lima hema/lima kuhikuhi lima, e kī pololei ana i ka 839-mill.
4. Ka Ladder, Roof Truss, a i ʻole Scaffold Stumble (Knee, Thigh, Chest, and Skull):
5. ʻO ka mea hana paʻi kiʻi e hele ana ma luna o nā ʻauamo o ka hale a i ʻole e piʻi ana i kahi alapiʻi e lawe ana i ke kui pneumatic kaumaha ma ko lākou ʻaoʻao me ko lākou manamana lima i ʻōwili ʻia a puni ke kumu no ke kākoʻo ʻana i ke kaumaha o ka mea hana.
6. Inā pahee ka mea hana a nele paha i ke kaulike, e ku'i ka ihu o ka pu i kona 'ūhā, piko kuli (patella), ka umauma, a i 'ole ka auwae, a i 'ole e pa i ke po'o o kekahi hoa hana ma lalo o ia mau mea, e ho'oku'u koke ana i ke kui kui i loko o ke kino ko'iko'i.
7. Ka Puhi ʻana a me ka Hoʻopaʻa ʻana a me ka Hoʻopaʻa ʻana:
8. I ke kui ʻana i ka lāʻau lāʻau lahilahi a i ʻole ke kui ʻana i ke kui, inā hala ke kamanā i ke kua o ke kua ma ka 5 millimeters a i ʻole ke kuʻi ʻana i kahi puʻupuʻu ʻōpoʻo/paʻa kila, e pā pololei ka kui ma ka ʻaoʻao o ka lāʻau i kahi e paʻa ai ka lima hema o ke kamanā i ke kumu. (Rule: E mālama mau i kou lima paʻa ʻole ma kahi liʻiliʻi 30 kenimika [12 ʻīniha] mamao mai ke kiko kui, ʻaʻole ma hope pono o ka papa e kui ʻia ai).

Luʻu hohonu 2: ʻO ka hoʻoheheʻe ʻana i nā mea hao (nā kaula uwea, nā ʻili plastik, ke kāpili resin) a me ka wehe ʻana.¶

No ke aha e koi mau ai nā kauka orthopedic a me nā kauka lima e lawe i nā kukui X ma mua o ka hoʻopā ʻana i kahi ʻeha o ka pū kui, a no ke aha lākou e pahu pinepine ai i ke kui ** i mua** a ʻoki paha i ke poʻo ma mua o ka huki pololei ʻana i hope?

1. ʻO ke Anatomy o nā Nails Framing Collated (15, 21, 28, a me 30 a 34 Degree Strips)¶

ʻO ka hana ʻana i nā pū kui e hānai i nā kui i ʻoki ʻia i loko o nā ʻāpana a i ʻole nā ʻōwili i paʻa pū ʻia e nā mea hōʻiliʻili ʻehā, e hana ana kēlā me kēia i kahi pōʻino ʻokoʻa i loko o ke kino kanaka:

1. 15-Degere Uea-Weld Coil Nails (Copper-Hoated Steel Wire Barbs):
2. Hoʻopili ʻia ʻelua mau uea kila keleawe lahilahi i hoʻopaʻa ʻia ma kahi o nā kumu o 200 a 300 mau kui i loko o kahi wili.
3. I ka wā e kuʻi ai ka maka o ka mea hoʻokele i ke kui mua, ʻoki ka uwea, a waiho ʻia ** ʻelua ʻāpana uea ʻoʻoleʻa 2-4-milimita i wili ʻia i ke kumu o ke kui, e pio i hope e like me nā ʻaoʻao makau iʻa**.
4. Radiographic Visibility: He radiopaque kēia mau kaula uwea (ʻike ʻia ma nā X-ray), e ʻae ana i ke kauka lapaʻau lima e ʻike i ke ala e kuhikuhi ai nā ʻala ma mua o ka wehe ʻana i ke kui.
5. 20-a-22-Degere Nails-Strip Nails (Radiolucent Polycarbonate Wings):
6. Hoʻoheheʻe ʻia nā kui kuʻikuʻi poʻo poʻo piha i loko o kahi ʻāpana polikarbonate plastic. Ke kī ʻia, pili nā ʻēheu liʻiliʻi liʻiliʻi liʻiliʻi liʻiliʻi o ka ʻilika ʻoiʻi** i ka mākia kui i loko o ke ala ʻeha.
7. Ka Huna X-Ray Huna: ʻAʻole like me nā ʻili uwea metala, he radiolucent nā ʻāpana hōʻiliʻili palaki (ʻaʻole ʻike ʻia ma nā hihi X maʻamau), ʻoiai hiki ke ʻike ʻia ma ka ultrasound. Inā huki ka mea hana i kahi kui 21-degere i ho'uluulu 'ia i waho ma kahi e hana ai, wehe ka iwi i ka pe'a pa'i mai ke kumu kui i loko o ka hui a i 'ole ka iwi.
8. 28-Degree Wire-Strip a me 30-to-34-Degree Paper-Tape Nails (Thermoplastic Resin Glue):
9. Hoʻopaʻa pū ʻia me ka lipine pepa a me ka thermoplastic adhesive resin me ka ring-shank a i ʻole screw-shank threads e nakinaki pono i ka iwi cortical.

====================================================================================
    WHY PULLING A COLLATED NAIL BACKWARD RIPS NERVES & LEAVES BARBS IN BONE
====================================================================================

            Nail Head Outside Skin
                 +---------+
                 |=========|
     ============+   | |   +============ <-- SKIN ENTRY WOUND
                     | |
       Digital Nerve | | <-- Spot-Welded Copper Wire Barbs (15 deg)
       & Artery ---> |/|     OR Jagged Plastic Fin Collar (21 deg)
                    /| |\    (Pointing UPWARD toward the nail head)
                     | |
     ----------------+ +---------------- <-- CORTICAL BONE / JOINT CAPSULE
                     | |
                     \ / <-- Blunt Tip Carries Plug of Denim, Boot Rubber,
                      v      Resin Glue & Pseudomonas Bacteria Into Bone

  * JOBSITE ERROR (Pulling Upward with Pliers): Barbs hook the digital nerve/artery
    and bone edge strips the plastic/wire barbs OFF inside the wound cavity.
  * SURGICAL METHOD (In OR): Surgeon clips the nail head off with sterile bolt
    cutters and pulls the nail FORWARD in the direction of the barbs, OR opens the
    tract to shield the neurovascular bundle while debriding the bacterial plug.
====================================================================================

2. Pehea e wehe ʻia ai e nā poʻe ʻoki ʻoki lima a me nā Orthopedic i kahi kui i hui ʻia i loko o ke keʻena hana¶

Ke waiho ʻole ʻoe i ke kui a hiki i ke keʻena pilikia: 1. Nā X-Nā Nānā ʻElua (AP a me Lateral) + Ultrasound: Lawe ke kauka i nā kukui X orthogonal MAMUA o ka hoʻopā ʻana i ke kui no ka nānā ʻana i kahi haʻi hāmama, komo ʻana i ka hui, a me ** mau kaula uwea wahi-welded**. 2. Nerve Block: Ua helu ʻia ka wahi no laila ʻaʻole ʻeha ka mea maʻi. 3. Ke ʻano "Cut-the-Head-and-Pull-Forward" (No Through-and-Through Limb Nails): Inā ʻo ke poʻo a me ka piko o ke kui e puka mai ana ma ka manamana lima a i ʻole ka lima a hōʻike ʻia e nā kukui X i hope-kuhikuhi i hope, e hoʻomaʻemaʻe ke kauka lapaʻau i ka ** poʻo kui** i puka mai, e hoʻohana i ka ʻokiʻoki ʻoki ʻana i ke poʻo maʻemaʻe. MUA i waho ma ka ʻaoʻao puka ma ka ʻaoʻao kūlohelohe o nā ʻāʻī, a ukali ʻia e ka hoʻoinu piha ʻana a me ka debridement.

Luʻu hohonu 3: Ke komo ʻana i nā pū kui e hoʻoweliweli ana i ke ola (Cardiac, Intracranial, Ocular, a me Joint Capsule)¶

ʻOiai he 65 pakeneka o nā ʻeha pū kui e hahau ana i ka lima a me nā manamana lima, ʻo ke koena 35 pakeneka e komo pū ana me nā wahi anatomical weliweli a i ʻole nā lālā.

1. ʻEha Pu Nail Puʻuwai ("The Cardiac Box")¶

Hoʻokuʻu ʻia nā kui kui mai luna mai a i hoʻoulu ʻia i ka wā hāʻule e puhi pinepine i kahi kui 75-a-90-millimeter i loko o ka paia o ka umauma mua i loko o ka Cardiac Box (i hoʻopaʻa ʻia ma luna o nā clavicle, haʻahaʻa e ka palena kumu kūʻai, a ma hope e nā laina midclavicular): - No ke aha e nana mua ai ka poʻe maʻi i ke ala a me ka hele ʻana a puni: ʻAʻole like me ka ʻeha o ka pū e pahū ana i kahi awāwa ākea ākea, ʻo ke kui kila 3.3-milimita i ka sternum a pii i kona puka ponoʻī i ka paia o ka ventricle ʻākau, ventricle hema, a i ʻole aʻa pulmonary. A hiki i ka 50 pakeneka o ka poe ma'i nail-gun cardiac i ike mua a kama'ilio no na minuke 10 a 30 mua, i kekahi manawa me ka ike ole a kanuia ke poo o ke kui ma lalo o ka ili pectoral (e nana ina ke poo o ke kui e bobbing rhythmically in time with the heartbeat). - The Sudden Decompensation (Pericardial Tamponade): Inā huki kekahi i kēlā kui i waho, a i ʻole ke kahe mālie ʻana o ke koko a puni ka kui i loko o ka fibrous pericardial sac paʻakikī e hoʻopuni ana i ka puʻuwai, ʻo ke kaomi ʻana o ka wai i loko o ka ʻeke e paʻi i nā keʻena naʻau i hiki ʻole iā lākou ke hoʻopiha i ke koko (cardiac tamponade). E nānā iā Beck's Triad: (1) hāʻule ke koko / nāwaliwali radial pulse, (2) nā aʻa jugular distended ma ka ʻāʻī, a me (3) kani puʻuwai puʻuwai, i hui pū ʻia me ka haʻalulu, haʻiʻo ka ʻili hou a me ka hopu koke ʻana. - Ka Hana Kūikawā: ʻAʻole loa e hoʻopā a huki i kahi kui o ka umauma. E kelepona iā 911 / 112 / 999 no ka lawe koke ʻana i kahi Kōnaewele 1 Trauma / Cardiothoracic Surgery Center no ka sternotomy median a i ʻole anterolateral thoracotomy.

2. Intracranial (Skull / Brain) Nail Gun Penetration¶

Ke hoʻokuʻu ʻia ka pū kui ma luna o ke kaola poʻo, e ʻā ana i lalo mai kahi scaffold ma luna, a i ʻole e hoʻokuʻu ʻia i ka wā hāʻule, ʻo ka wikiwiki kiʻekiʻe e hoʻokuʻu pololei i ke kui kila ma o ka calvarium (iwi iwi poʻo), orbit, a i ʻole ka palaka paʻa i loko o ka parenchyma lolo: - Nui nā poʻe maʻi me kahi kui 90-milimita hoʻokahi i hoʻokuʻu ʻia i loko o ka lobe mua a i ʻole parietal lobe e noho ** ʻike me ka Glasgow Coma Scale maʻamau (GCS 15)** a me ka liʻiliʻi o ke koko waho no ka paʻa ʻana o ka iwi iwi poʻo i ke kui a hoʻopaʻa ke kumu kui i nā moku cortical haehae. - Ka Intracranial Hemorrhage Trap: ʻO ka huki ʻana i kahi kui intracranial i waho o kahi lumi hoʻopaʻa neurosurgical e hoʻoulu koke i ka subdural, subarachnoid, a i ʻole intraparenchymal hemorrhage a i ʻole ka waimaka i kahi sinus venous sinus nui. E hoʻokiʻekiʻe i ke poʻo o ka mea maʻi ma 30 degere, e pale i ka luaʻi ʻana a i ʻole ka hoʻopaʻapaʻa ʻana, e hoʻopaʻa i ke kui e puka mai ana me ka ʻole o ke kaomi ʻana, a lawe aku no CT angiography (CTA) a me ka neurosurgical craniotomy.

3. Synovial Joint Capsule Penetration (Knee, Wrist, Ankle, and Knuckle Joints) a me na Kamaa Hana.¶

• Septic Arthritis I loko o 24 a i 48 Hola: Ke kī ʻia ka pū kui i loko o ka kuli i ka wā e kukuli ana ka mea hana ma luna o ka papahele lalo, e kuʻi pololei ka nail 90-milimita i nā fiber denim lepo i loko o ka tibiofemoral synovial joint space. ʻO ka wai synovial i loko o kahi hui e like me kahi ipu petri mahana no ka bacteria. ʻOiai inā ʻaʻole i kahe ke koko i ka wā mua, ** ʻo kēlā me kēia komo ʻana o nā kui ma kahi kokoke i kahi hui e pono ai ka loiloi wikiwiki ʻana i ka haukapila no ka holoi ʻana i nā hui a me nā lāʻau antibiotic intravenous** i loko o nā hola e pale ai i ka luku mau ʻana o ka cartilage.
• Plantar Puncture Ma o ka Rubber-Soled Work Boots (Pseudomonas aeruginosa Osteomyelitis): Hoʻopili ʻia nā insoles i hoʻomoʻa ʻia i ka houhu i loko o nā kāmaʻa hana e ka hua bacteria Pseudomonas aeruginosa. Ke kuʻi ka kui ma ka wāwae kāmaʻa i loko o ka iwi kuʻekuʻe wāwae a i ʻole nā ​​metatarsals, hoʻokomo ʻo ia i ka Pseudomonas hohonu i loko o ka iwi iwi, e koi ana i ka hoʻomaʻamaʻa ʻana a me ka lāʻau anti-pseudomonal antibiotic therapy (me ka tetanus toxoid booster).

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

Nīnau pinepine¶

He aha ka ʻokoʻa ma waena o ka "contact-trip (bump-fire)" a me ka "full-sequential" trigger ma kahi pū kui?¶

ʻO ka **contact-trip (bump-fire) ** hiki i ka mea hoʻohana ke ʻomi a hoʻopaʻa mau i ka manamana lima i ke ahi i kēlā me kēia manawa e kuʻi ka ihu i kekahi ʻili; inā hoʻihoʻi ka pū ma hope o ka pana mua ʻana a lele ma ka lima hema a i ʻole ka wāwae o ka mea hoʻohana, ua kī ʻo ia i ka lua o ke kui me ka manaʻo ʻole (** ʻo ia ka 65 a 69 ka nui o nā ʻeha a pau o ka pū kui**). Pono ka ** hoʻomaka holo kaʻina holoʻokoʻa ** i ʻelua ʻanuʻu ʻokoʻa no kēlā me kēia kui: **(1) kaomi mua i ka piko o ka ihu i ka lāʻau, a (2) huki i ka pahu manamana lima lua**. Inā hoʻihoʻi ka pū i ka wā e paʻa ana ka manamana lima o ka mea hoʻohana i ke kumu i lalo, ʻaʻole hiki i kahi nail kaʻina holoʻokoʻa ** ke kī i kahi kui lua**.

No ke aha ʻaʻole pono iaʻu e huki i kahi kui mai koʻu manamana lima, lima, a kuli paha ma ka wahi hana me ka hāmare a i ʻole ka wili?¶

ʻAʻole like me ke kui i hoʻohenehene ʻia e ka lima, hoʻopaʻa pū ʻia nā kui i kī ʻia mai ka pū nail framing i loko o nā ʻāpana a i ʻole nā ​​wili me ka hoʻohana ʻana i ** uea keleawe i hoʻopaʻa ʻia ma kahi kiko (15-degree coils), polycarbonate plastic strips (21-degree strips), a i ʻole ke kāpili resin adhesive**. Ke puhi ka pū i ke kui mai loko mai o ke kaula, ** mau kaula uwea keleawe koʻikoʻi a i ʻole nā ​​ʻili iʻa i hoʻopaʻa ʻia ma nā ʻaoʻao o ke kumu kui**, e kuhikuhi ana i hope i ke poʻo kui e like me nā makau iʻa. Inā huki ʻoe i ke kui i hope mai ka manamana lima a i ʻole ka hui pū me nā pli, ʻo ka makau a uhae ** nā aʻalolo kikohoʻe, nā aʻa, a me nā ʻiʻo**, ʻoiai e wehe ka iwi i nā ʻili plastik lepo a hoʻopaʻa ʻia ka lole mai ke kumu i loko o ka ʻeha. E waiho i ke kui me ka hoʻopā ʻole ʻia no ka wehe ʻana.

Pehea e wehe ai ka poʻe kauā i ke kui kui me ka uhae ʻole i nā aʻalolo a me nā aʻalolo?¶

Ma ka haukapila, lawe ke kauka i **ʻelua-nānā X-nānā** no ka ʻike inā ua haki ka iwi a inā paha e ʻō mai ana nā kaula uwea i hoʻopaʻa ʻia ma waho o ke kumu kui. Ma hope o ka pau ʻana o ka lima a i ʻole ka wāwae me ka poloka aʻalolo, inā ua hele loa ke kui ma ka manamana lima a i ʻole ka lima, e holoi ke kauka lapaʻau a hoʻomaʻemaʻe i ka **poʻo kui e puka mai ana**, e hoʻohana i nā ʻoki ʻoki ʻoki kino e ʻoki ai i ke poʻo palaha mai ka nail**, a huki i ke kui **MUA i waho ma ka ʻaoʻao puka** ma ke ala o ka ʻiʻo ʻaʻole e hoʻi i hope i ka ʻau.

He aha kaʻu e hana ai inā paʻi pololei ʻia ka lima o ka hoa hana a i ʻole ka kāmaʻa i ka pā pōhaku 2x4 a i ʻole ke kumu hale?¶

**Mai hoʻāʻo e ʻoki i ka lima o ke kanaka a i ʻole e kāʻei i ka stud 2x4**, e pelu ai ke kui i loko o ko lākou mau iwi a e uhae ai i nā aʻa a me nā aʻalolo. Akā: (1) E hoʻokaʻawale koke i ka paipu ea a i ʻole ka pila mai ka pū kui; (2) e kākoʻo i hoʻokahi kanaka i ka lima a i ʻole ka wāwae o ka mea hana i ʻeha i ʻole e kau ke kaumaha ma ke kui; (3) e hoʻohana i ka ** ʻike maka, ʻike pōʻai, a ʻike lima paha e ʻoki ai i ka pahu 2x4 15 kenimika (6 ʻīniha) ma nā ʻaoʻao ʻelua o ke kui**; a (4) lawe aku i ka mea hana i ke keena pilikia me ka pauku laau i okiia i ke kui.

No ke aha i ʻeha ʻia ai ka ʻeha o ka pū kui ma ka lalo o kahi kāmaʻa hana hoʻoheheʻe ʻana i ka ulia pōpilikia inā ʻaʻole kahe ke koko?¶

I ka wā e kuʻi ai ke kui kuʻi i loko o ke kapuaʻi a me ka ʻūhā o ka kāmaʻa hana ʻeleʻele i loko o ka wāwae, hana ka piko o ke kui e like me ke kuʻi ʻoki kuki, e hoʻokuʻu ana i kahi pahu kumu o ka **ruba, sock fibers, glue resin, a me nā bacteria aloha hou i kapa ʻia ʻo *Pseudomonas aeruginosa*** i loko o ka iwi kuʻekuʻe wāwae a i ʻole metatarsal iwi. ʻOiai inā ʻaʻole kahe ke koko o ka lua, ʻo ka bacteria *Pseudomonas* i hoʻopaʻa ʻia i loko o ka iwi e hoʻopōʻino i ka **osteomyelitis (ka maʻi iwi) a i ʻole ka maʻi o ka maʻi septic** i loko o nā lā ke ʻole ka wāwae i X-ray, hoʻomaʻemaʻe ʻia, a mālama ʻia me nā lāʻau anti-pseudomonal antibiotic a me kahi hoʻoikaika tetanus.

No ke aha e hiki ai i ka mea i pana ʻia ma ka umauma me ka pū kui ke hele a kamaʻilio maʻamau i ka wā mua, a laila hāʻule i 15 mau minuke ma hope?¶

Ke komo ka kui kui 90-milimeter (3.5-inihi) i waenakonu o ka umauma (**ka Pahu Puuwai**), e hou pinepine ia ma ka iwi umauma i ka **ventricle akau o ka puuwai**. Ma muli o ka paʻa ʻana o ke kui kila paʻa i loko o ka ʻiʻo o ka puʻuwai, hoʻopili ia i kona puka ponoʻī no kekahi manawa. Eia nō naʻe, inā huki kekahi i ke kui, a i ʻole ke kahe ʻana o ke koko a puni ke kui i loko o ka ** pericardial sac ** e hoʻopuni ana i ka puʻuwai, ʻo ke koko i paʻa ʻia e kaomi i ka puʻuwai a hiki ʻole iā ia ke pā (**cardiac tamponade**). Mai hoopa aku i ke kui umauma; E hoʻomau i ka mea i hoʻopilikia ʻia a kelepona iā 911 / 112 / 999 no ka lawe koke ʻana i kahi Papa 1 Trauma Center. ʻO ka lawe ʻana i kahi kōkua mua i hōʻoia ʻia a me ka papa CPR mai ke Keʻa ʻulaʻula, St John Ambulance, a i ʻole kahi mea lawelawe kūloko e hoʻomākaukau iā ʻoe no nā pilikia ulia pōpilikia.

Nā alakaʻi pili¶

• ʻO ka pū nail a me ka pneumatic fastener penetration a me nā ʻeha ricochet
• Hoʻopaʻa ʻia a hoʻopaʻa ʻia i nā mea haole
• ʻO ka tamponade puʻuwai a me ka hoʻāʻo ʻana i ka trauma umauma
• Ka hoʻohana ʻana i ke koko a me ka windlass tourniquet
• ʻO nā ʻeha o ka maka, ka paʻipaʻi kemika, a me ka ʻeha poʻo honua

Nā kumu a me ke alakaʻi kūhelu¶

• National Institute for Occupational Safety and Health (NIOSH) and Occupational Safety and Health Administration (OSHA, United States): *Nail Gun Safety: A Guide for Construction Contractors (DHHS/NIOSH Publication No. 2011-202 / OSHA 3459-8-11, Contact-Trip vs. Full-Sequential Trigger and Prevention Injury)
• Na Center for Disease Control and Prevention (CDC, United States): MMWR Surveillance of Nail-Gun-Related Injuries Treated in Emergency Departments and Trigger Mechanism Risk Factors (Lipscomb et al. Residential Carpentry Studies).
• American National Standards Institute (ANSI) a me International Staple, Nail and Tool Association (ISANTA): ANSI SNT-101-2015 Nā Koina Palekana no ka Portable, Compressed-Air-Actuated, Fastener Driving Tools a me EN ISO 11148-13.
• Ka Hui ʻAmelika no ka ʻoki ʻana o ka lima (ASSH) a me ka American Academy of Orthopedic Surgeons (AAOS): *Hoʻoponopono ʻana i nā ʻeha kiʻekiʻe kiʻekiʻe Pneumatic Nail Gun: Radiographic Detection of Wire Barbs, Radiolucent Plastic Collation Fragments, Antegrade Extraction After Nail-Head Clipping, and Pseudomye Ostemonas Bootom.
• Komite ʻAmelika Hui Pū ʻIa o ʻAmelika Hui Pū ʻIa (ACS) no ka Trauma: Nā Kūkākūkā Ola Ola Loa Loaʻa (ATLS) no ka Penetrating Cardiac Box Trauma (Pericardial Tamponade / Beck's Triad) a me Penetrating Intracranial Non-Missile Nail Injuries.