ʻO ka hōʻeha ʻana i ka umauma a me ka ʻike ʻana i ka pericardial Tamponade¶

Paʻi ka puʻuwai kanaka i loko o kahi ʻeke ʻili paʻa paʻa, fibrous, ʻāpana ʻelua ʻili i kapa ʻia ʻo pericardium. Ma lalo o nā kūlana maʻamau, ʻo ka hakahaka ma waena o nā papa o loko a me waho o kēia ʻeke he 15 a 50 milliliters wale nō (1 a 3 punetēpē) o ka wai lubricating maʻemaʻe, e ʻae ana i nā ventricle e hoʻonui a hoʻopaʻa manuahi i 100,000 mau manawa i ka lā. Ke komo ka pahi pahi, ka hau hau, ka screwdriver, ka poka, a i ʻole ka ʻāpana shrapnel i loko o ka paia o ka umauma waena (ka "Pahu Puʻuwai") a haki i ka paia o ka puʻuwai a i ʻole ke kumu o ke aorta, hū koke ke koko kiʻekiʻe mai ke keʻena puʻuwai i loko o ka ʻeke pericardial inelastic i hoʻopaʻa ʻia.

Ma muli o ka hiki ʻole o ka fibrous pericardium ke kikoo koke, ʻo ia wale nō ka 60 a 150 milliliters (2 a 5 mau auneke wai, emi iho ma lalo o ka hapalua kīʻaha) o ke koko koʻikoʻi i hoʻopaʻa ʻia i loko o ka ʻeke pericardial e ʻomi ai i nā keʻena naʻau i pani ʻia mai waho. ʻOiai ʻoi aku ka nui o ke kaomi intrapericardial i ke kaomi hoʻopiha o ka atrium ʻākau a me ka ventricle ʻākau, ʻaʻole hiki i ka puʻuwai ke hoʻonui hou ma waena o nā kuʻi e lawe i ke koko venous hoʻi, e hāʻule ana ka puʻuwai puʻuwai i ka zero i loko o nā minuke (acute pericardial or cardiac tamponade). No ka ʻike ʻana i ka palapala ʻāina i nā palena anatomical o ka Cardiac Box, pehea e hoʻokaʻawale ai i ka cardiac tamponade (Beck's triad) mai kahi māmā hāʻule (nūnē pneumothorax), no ke aha ʻoe e ʻaʻole loa e huki i ka pahi pahi i hoʻopaʻa ʻia, a no ke aha ʻoe e ** ʻaʻole pono e hoʻokomo i ka gauze i loko o ka lua umauma** e kūʻai i nā minuke waiwai e pono ai no ka thoracotomy ulia pōpilikia e ola ai a i ʻole pericardiocentesis.

E hana i kēia i kēia manawa¶

1. **E kāhea koke i kāu helu ulia pōpilikia a noi i nā mea lapaʻau Advanced Life Support (ALS) no ka lawe wikiwiki ʻana i ka Level 1 Trauma Center. helu pilikia. E hōʻike i kahi ʻeha komo i loko o ka umauma waena (Pahu Puka) no laila e makaʻala ʻia ka hui ʻokiʻoki trauma ma mua o ka hiki ʻana mai o ke kaʻa kaʻa.
2. E hōʻike i ka umauma ʻole holoʻokoʻa, ka ʻōpū luna, nā ʻāʻī, a me ke kua e ʻimi ai i kēlā me kēia ʻeha komo a puka i waho. ʻOiai he 5-milimeter (0.2-inihi) pahu koho hau liʻiliʻi ma luna o ka iwi umauma, laina nipple, a i ʻole epigastrium luna ("ka lua o ka ʻōpū") hiki ke piʻi i luna ma o ka diaphragm i loko o ka ventricle ʻākau o ka puʻuwai.
3. ** ʻAʻole loa e wehe i ka pahi pahi, screwdriver, pua, a i ʻole ʻāpana aniani i hoʻopaʻa ʻia ma ka umauma. ʻO ka huki ʻana i waho e hoʻokuʻu i ke kahe koko kiʻekiʻe i loko o ka ʻeke pericardial e hoʻoulu ai i ka tamponade cardiac make ma lalo o 60 kekona. E hoʻopaʻa i ka mea ma kahi me nā ʻōwili gauze māhoe nui.
4. **ʻAʻole loa e hoʻokomo i ka gauze a i ʻole lipine hemostatic ILOKO o ka ʻeha o ka umauma. ʻAʻole hiki ke hoʻopaʻa ʻia nā iwilei o ka gauze ma nā iwi ʻaoʻao i ka puʻuwai kahe a i ʻole ke aʻaʻa mammary o loko, akā e hoʻolei i ka māmā a hūnā i ka hemorrhage o loko.
5. Inā e omo ana ka ʻeha o ka umauma i ka ea a i ʻole ke kahe ʻana o ke koko ʻulaʻula ʻulaʻula, e hoʻopili i ka Commercial Vented Chest Seal a i ʻole Three-Sided Flutter Dressing. Mai hoʻopili i kahi kāʻei ʻehā ʻaoʻao i hoʻopaʻa ʻia a hoʻopaʻa ʻole ʻia i kekahi ʻeha umauma, a mākaukau e ʻili hope ("burp") ke sila inā ʻoi aku ka ʻino o ka hanu.
6. E mālama i ka mea maʻi e noho mālie, e noho pololei (a i ʻole ma ko lākou kūlana o ka hōʻoluʻolu), NPO pono (ʻaʻohe mea ma ka waha), a ʻōwili ʻia i nā pākeke mahana. E nānā mau i ka Beck's Triad of Cardiac Tamponade: bulging neck veins (jugular venous distension), ** hāʻule koke ke koko / nalo ʻana o ka puʻuwai puʻuwai, ** puʻuwai puʻuwai ** hele pū ʻia me ka hoʻomaha loa a me ka ** kani hanu like ma nā ʻaoʻao ʻelua o ka umauma**.

ʻO ka lāʻau hoʻoholo pilikia no ke komo ʻana i ka ʻeha umauma a me ka tamponade naʻau¶

flowchart TD
    Start["Penetrating Trauma (Knife, Gunshot, Ice Pick, Shrapnel)<br/>to the Chest, Back, Axilla, or Upper Epigastrium"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Expose entire bare chest, upper abdomen, armpits, and back"]
    ImpaleCheck{"Is a Knife, Screwdriver, or Object Still Impaled in the Chest?"}
    ImpaleCare["IMPALED CHEST OBJECT PROTOCOL<br/>1. NEVER pull out or wiggle the impaled object<br/>   (It may be plugging a hole in the right ventricle or aorta)<br/>2. Seal any sucking air gap around base of blade on 3 sides<br/>3. Stabilize with bulky twin-roll pads so blade does not move with heartbeat"]
    SuckingCheck{"Is the Wound Sucking Air or Bubbling Frothy Blood?"}
    SealStep["APPLY VENTED CHEST SEAL OR 3-SIDED DRESSING<br/>1. Wipe skin dry and apply Vented Chest Seal at end-exhalation<br/>2. NEVER pack gauze inside the chest cavity<br/>3. Control external skin-edge bleeding with flat surface pressure only"]
    BoxCheck{"Is the Wound Inside the 'CARDIAC BOX' (Thoracoabdominal Box)?<br/>- Superior: Clavicles (Collarbones) / Sternal Notch<br/>- Inferior: Costal Margin / Xiphoid / Upper Epigastrium<br/>- Lateral: Mid-Clavicular (Nipple) Lines on Left and Right<br/>(Or any gunshot/stab trajectory crossing the mediastinum)"}
    TamponadeCheck{"Assess for Obstructive Shock:<br/>Bulging Neck Veins (JVD) + Weak/Absent Wrist Pulse + Agitation/Cyanosis?"}
    DiffLung{"Compare Breath Sounds & Percussion on Both Sides of Chest:<br/>Are Breath Sounds Absent on One Side OR Equal on Both Sides?"}
    TensionPath["ABSENT BREATH SOUNDS ON ONE SIDE + HYPERRESONANT<br/>= SUSPECTED TENSION PNEUMOTHORAX<br/>1. Immediately BURP or lift chest seal for 3-5 seconds<br/>2. ALS Paramedic performs immediate Needle Decompression"]
    TamponadePath["EQUAL BREATH SOUNDS ON BOTH SIDES + MUFFLED HEART SOUNDS<br/>= SUSPECTED PERICARDIAL (CARDIAC) TAMPONADE<br/>1. Priority 1 Rapid Transport ('Load and Go') to Trauma Surgeon<br/>2. Keep patient calm, warm, semi-upright (avoid laying flat if dyspneic)<br/>3. ALS gives cautious IV fluid bolus to boost venous filling pressure<br/>   & prepares for Pericardiocentesis / Resuscitative Thoracotomy"]
    MonitorAll["Monitor Pulse, Breathing, and Neck Veins Every 60 Seconds<br/>Keep patient warm and strictly NPO until hospital arrival"]

    Start --> CallEMS
    CallEMS --> ImpaleCheck
    ImpaleCheck -->|Yes: Object Impaled| ImpaleCare
    ImpaleCheck -->|No: No Object Present| SuckingCheck
    SuckingCheck -->|Yes: Sucking / Bubbling| SealStep
    SuckingCheck -->|No: Non-Sucking Hole| BoxCheck
    ImpaleCare --> BoxCheck
    SealStep --> BoxCheck
    BoxCheck -->|Yes: Inside Cardiac Box| TamponadeCheck
    BoxCheck -->|No: Lateral Chest Only| TamponadeCheck
    TamponadeCheck -->|Yes: Shock + Bulging Neck Veins| DiffLung
    TamponadeCheck -->|No: Stable Vitals| MonitorAll
    DiffLung -->|Absent Unilateral Breath Sounds| TensionPath
    DiffLung -->|Equal Bilateral Breath Sounds| TamponadePath

Ka palapala 'āina i ka "Pahu Pu'uwai" (The Mediastinal Danger Zone)¶

Hoʻomaopopo ka poʻe kauā ʻeha i kahi ʻāpana anatomical rectangular ma ke alo (a me ke kua i hope) o ka ʻōpū i kapa ʻia ʻo ka "Pahu Puka" (a i ʻole pahu precordial). ʻO kēlā me kēia ʻeha ʻeha, ʻeha, a i ʻole ke komo ʻana i ka pū i loko o kēia mau palena ʻehā e loaʻa kahi ** kiʻekiʻe o ka hōʻeha o ka naʻau pololei, pericardial, a i ʻole ka ʻeha moku nui**:

• Ka palena kiʻekiʻe (ʻoi aku): He laina ʻāpae ma waena o ka clavicles (collarbones) a me ka suprasternal notch ma ke kumu o ka ʻāʻī.
• Ka palena o lalo (Inferior): He laina hoʻopaʻa ma waena o ka xiphoid process (ka piko lalo o ka iwi umauma) a me ka ʻaoʻao ʻaoʻao kumu kūʻai haʻahaʻa (me ka epigastric triangle o luna).
• Ka palena ʻaoʻao hema a me ka ʻaoʻao ʻākau (Lateral): Kahakiʻi pololei ʻia nā laina kū pololei i lalo ma waena o kēlā me kēia iwi ʻāʻī (** nā laina waena hema a me ka ʻākau**, e hele ana ma waena o nā nipples i nā kāne).
• ** No ke aha i hahau ʻia ai ka Ventricle ʻĀkau he 50% o ka manawa:** Ma muli o ke ʻano o ka ʻōwili ʻia ʻana o ka naʻau o ke kanaka i loko o ka umauma, ua hana ka ventricle ʻākau i ka ʻili holoʻokoʻa o mua (mua) o ka puʻuwai ma hope pono o ka sternum a haʻalele i nā cartilages costal 3 a hiki i 6. No laila, ** ʻoi aku ma mua o 50 pākēneka o nā ʻeha puʻuwai komo i ʻō i ka ventricle ʻākau**, ma kahi o 30 pākēneka e hou i ka mānoanoa ** ventricle hema** ʻoi aku ka mānoanoa, a ʻo 10 a 15 pākēneka e hou i ka atrium ʻākau a hema a i ʻole intrapericardial aorta/vena cava.

ʻO ka hoʻokaʻawale ʻana i nā pilikia ulia pōpilikia ʻekolu: Cardiac Tamponade vs. Tension Pneumothorax vs. Massive Hemothorax¶

Ke haʻalulu koke ka mea maʻi me ka ʻeha o ka umauma, pono e hoʻokaʻawale koke nā paramedic a me nā kauka pilikia ma waena o Pericardial Tamponade, Pneumothorax hoʻopaʻapaʻa, a me Massive Hemothorax. E hoʻomaopopo i ke kumu o nā ʻaʻa ʻāʻī ʻelua ** (** haʻalulu ʻāʻī**) a ʻo kekahi e hoʻoulu ai i ** veins ʻāʻī paʻa** (** hoʻopūhoihoi hypovolemic**), a pehea ka hoʻolohe ʻana i ka māmā e haʻi i nā pilikia pilikia ʻelua:

Anatomy a me ka pathophysiology o Pericardial Tamponade¶

1. No ke aha e make ai ka hapalua kīʻaha koko i loko o nā minuke ʻoiai ʻaʻole e make ka lita o ka wai lohi (The Pericardial Pressure-Volume Curve)¶

No ke aha e hiki ai i ka mea maʻi me ka maʻi hōʻino ʻole a i ʻole ka maʻi kanesa ke hōʻiliʻili lohi i ka 1,000 a i ka 1,500 milliliters (1 a 1.5 lita) o ka wai a puni ko lākou puʻuwai i kekahi mau pule me ka ʻole o ka haʻalulu, aʻo ka mea i hōʻeha ʻia ma ka umauma make i loko o 5 mau minuke mai ka 75 a 100 milliliters (3 auneke wai) o ke koko i loko o ka pericardium? * ʻO ka papa waho o ka pericardium (ka fibrous pericardium) ua ulana ʻia mai nā pulupulu kolagen paʻa, ʻaʻole elastic i ʻaneʻane ʻaneʻane ʻaʻohe kikoʻī. * Ke hōʻiliʻili mālie ka wai i nā pule, e hoʻoponopono hou ʻia nā fibers collagen a hoʻopaʻa i hoʻokahi lita o ka wai. * I ka ʻehaʻeha komo nui, kahe ke koko i loko o ke kikowaena pericardial i kekona. Ke hoʻopiha ʻia ka 30 a i ka 50 milliliters mua o ka manawa hoʻomaha i loko o ka ʻeke, ** huli ka pihi kaomi-nui o ka pericardium i ke kūpaʻa**: ʻo ka hoʻohui ʻana i ka 20 a i ʻole 30 mililita hou aku i ke koko e piʻi nui ai ke kaomi intrapericardial mai 0 mmHg a i > 15 a i 25 mmHg. * Ma muli o ka hoʻopiha maʻamau o ka ** atrium ʻākau a me ka ventricle ʻākau** i ka pā lahilahi i kahi kaomi venous haʻahaʻa o 2 a i ka 8 mmHg wale nō, ʻo ke kaomi pericardial waho o 20 mmHg e paʻi i ka atrium ʻākau a me ka ventricle ʻākau i palahalaha i ka wā diastole (ka manawa hoʻopiha hoʻomaha o ka puʻuwai puʻuwai).

2. Ventricular Interdependence a me "Pulsus Paradoxus"¶

I loko o ka pahu paʻa paʻa ʻole o ka ʻeke pericardial, pono e hoʻokūkū ka ventricle hema a me ka ventricle ʻākau no kahi ākea paʻa (ventricular interdependence), i hoʻokaʻawale ʻia e ka muscular interventricular septum: 1. I kēlā me kēia manawa o ka mea maʻi ** e hanu (hanu i loko)**, ʻo ke kaomi kino ʻole i loko o ka umauma e omo ana i kahi kahe liʻiliʻi o ke koko venous i ka ʻaoʻao ʻākau o ka puʻuwai. 2. Ma muli o ka hōʻole ʻana o ka ʻeke pericardial i piha i ke koko i waho e hoʻonui i ka ventricle ʻākau * i waho *, ua koi ʻia ka ventricle ʻākau e hoʻonui nei i ** hoʻoulu i ka septum interventricular INWARD i loko o ka ventricle hema , e ʻoki ana i ka lua o ka ventricle hema a kokoke e pani ʻia i ka wā inhalation. 3. ʻO ka hopena, i ka ** inhalation, hiki ʻole i ka ventricle hema ke pana i ke koko i waho o ke aorta: hāʻule ke koko systolic o ka mea maʻi ma mua o 10 mmHg i kēlā me kēia hanu i loko, a inā mālama ʻoe iou mau manamana lima ma ka puʻupuʻu radial o ka mea maʻi, hiki iā ʻoe ke ʻike maoli i ka pau ʻana o ka puʻupuʻu lima a nalowale loa i ka hanu, a laila hoʻi mai ka hanu o ka mea maʻi. Ua kapa ʻia kēia hōʻailona kino kupaianaha ʻo Pulsus Paradoxus.

3. Ka hoʻomaopopo ʻana i ka Beck's Triad (a no ke aha ʻoe e pono ʻole ai i kahi stethoscope ma ke alanui walaʻau)¶

I ka makahiki 1935, ua wehewehe ke kauka lapaau cardiothoracic Claude Beck i ka triad maʻamau o ka acute cardiac tamponade (Beck's Triad): 1. Hypotension (Falling Arterial Blood Pressure & Narrowed Pulse Pressure): Hoʻoemi ke koko systolic i ka wā e piʻi ana ke kaomi diastolic (no ka laʻana, 85/75 mmHg, kahi puʻupuʻu puʻupuʻu liʻiliʻi he 10 mmHg), e hana ana i kahi puʻupuʻu radial nāwaliwali a nalo i ka inhalation. 2. Jugular Venous Distension (JVD): Ma muli o ka hoʻihoʻi ʻana mai o ke koko venous mai ke poʻo a me ka ʻāʻī ua ālai ʻia mai ke komo ʻana i ka atrium ʻākau i kaomi ʻia, ʻo nā ʻaʻa ʻāʻī waho a me loko ma nā ʻaoʻao o ka ʻāʻī e hū aʻe e like me nā kaula uliuli mānoanoa, ʻoiai ke noho ka mea maʻi ma kahi kihi 45-degere. *(E hoʻomaopopo: Ma ka ʻaoʻao o ke alanui ʻaʻole hiki iā ʻoe ke lohe i ke kani ʻana o ka puʻuwai me kahi stethoscope, *he ʻeha ʻeha i loko o ka Puʻuwai Puʻuwai + Haʻalulu + Puʻupuʻu ʻāʻī + Leo Hanu Kūlike Kūlike ** ʻo ia wale nō ka mea e manaʻo ai ʻoe i ka tamponade cardiac.) 3. Ke kani ʻana o ka puʻuwai i ʻole: ʻO ke koko e hoʻopuni ana i ka puʻuwai e hoʻokaʻawale i ka leo lub-dub acoustic o nā puʻuwai puʻuwai e like me ke kapa wai.

4. Nā hōʻailona ʻē aʻe o Pericardial Tamponade¶

• Ka hōʻailona o Kussmaul: ʻO ka piʻi ʻana o nā ʻaʻa ʻāʻī i ka wā e inhalation ai (ʻo ka mea maʻamau, palahalaha iki nā ʻāʻī ʻāʻī i ka hanu ʻana o ke kanaka no ka mea omo ʻia ke koko i loko o ka umauma; i ka tamponade, ʻaʻole hiki i ke koko ke komo i loko o ka puʻuwai i ʻoki ʻia, no laila, ʻoi aku ka nui o ka ʻāʻī o ka ʻāʻī i ka hoʻoulu ʻana).
• Ka Huhū Nui a me ka "Sense of Impending Doom" (Angor Animi): Ma muli o ka hāʻule koke ʻana o ka pahū cerebral i ka wā e ʻike mau ana ka mea maʻi, ʻo ka poʻe i make i ka tamponade e hoʻomaha pinepine ʻole ai, e hahau ana, e hakakā ana e noho i luna, a me ka ʻōlelo ʻana ua kokoke lākou e make, he hōʻailona pinepine i kuhi hewa ʻia e ka poʻe e kū pono ana a i ʻole ka hopu ʻana i ka ʻona.

ʻO ke kōkua mua ʻanuʻu no ke komo ʻana i nā ʻeha o ka umauma a me ka Tamponade i manaʻo ʻia¶

KaʻAnuʻu Hana 1: Hoʻomaka koke a me ka "Scoop and Run" ho'āla¶

1. E kelepona iā 911 / 112 / 999 koke: ʻAʻole e like me nā ʻeha hope i hiki ke hoʻopaʻa paʻa ʻia ma ke kula me kahi tourniquet, ** hiki ke hoʻōla ʻia ka tamponade naʻau ma ka hoʻokahe ʻana i ka ʻeke pericardial (pericardiocentesis a i ʻole ka manamana lima pericardiotomy) a humuhumu i ka lua o ka ʻiʻo puʻuwai i pani ʻia i loko o kahi kikowaena trauma**. ʻO kēlā me kēia minuke i hoʻohana ʻia ma ke kahua e ʻoki loa i ke ola.
2. E hōʻike i ka umauma a me ke kua: E ʻoki i ka pālule a hāmama loa a nānā i mua a me hope o ka ʻōpū.

KaʻAnuʻu Hana 2: Ka mālama ʻana i kahi lāʻau i hoʻopaʻa ʻia a i ʻole mea i loko o ka pahu cardiac¶

Inā ʻo ka pahi, ka ʻohi hau, ka ʻāʻī, a i ʻole ka ʻāpana aniani e pipili mau ana i waho o ka umauma a i ʻole ka epigastrium luna: 1. ** MAI uhuki i waho, mai ho'āʻo e hoʻopololei a pōkole paha.** 2. E nānā no "Pulsatile Blade Motion": I ka manawa pinepine, ʻo ka pahi pahi nona ka piko e waiho ana i loko o ka paia o ka ventricle ʻākau e ʻike ʻia ʻo bob a i ʻole ʻāwīwī i ke kani me kēlā me kēia puʻuwai puʻuwai. 3. Hoʻopaʻa a hoʻopaʻa me ka ʻole kaohi ʻana i ka neʻe ʻana o ka puʻuwai: * Ina e omo ana ka ea a puni ke kumu o ka lau, e kau i na kaula o ka petroleum gauze a i ole ia e uhi i ka ilikai a puni ka ipuka o ka ili (e waiho ana i kekahi kihi i wehe ole ia e puka i ka ea). * E kau i ʻelua ʻōwili gauze a i ʻole nā ​​kāwele i pelu ʻia ma kēlā ʻaoʻao kēia ʻaoʻao o ka maka i mea e pale aku ai i ka hoʻopaʻa ʻia ʻana a i ʻole ka hoʻokuʻu ʻia ʻana i ka wā o ka lawe kaʻa kaʻa, akā ** ʻaʻole e nakinaki i ka maka i lalo e haʻihaʻi ka puʻuwai iā ia iho i kahi kihi metala hiki ʻole ke hoʻoneʻe ʻia**.

KaʻAnuʻu Hana 3: Ka mālama ʻana i kahi ʻeha e wehe ʻia me ka ʻole o kahi mea i hoʻopaʻa ʻia¶

1. Mai hoʻokomo i ka gauze i loko o ka lua o ka umauma: Mai hoʻokuʻi i ka gauze hakakā a i ʻole nā ​​pepa ma waena o nā iwi ʻaoʻao i ka umauma.
2. E hoʻopili i kahi Sila Puʻu Puʻu (a i ʻole ʻAʻahu ʻAi ʻEkolu ʻaoʻao): ʻOiai no ka ʻeha liʻiliʻi ma luna o ka sternum a i ʻole ka umauma hema, holoi i ke koko a me ka hou a maloʻo a kau i kahi sila pahu pahu kalepa ma ka hopena o ka hoʻohu ʻana i hiki ʻole i ka ea ke omo i loko o ka pleural space a i ʻole mediastinum.
3. Pehea inā e puka mai ana ke koko ʻulaʻula mai loko mai o ka paia o ka umauma?
4. ʻElua mau aʻaʻaʻa nui, ʻo ** nā ʻaʻaʻa mammary (internal thoracic), e holo kū pololei i lalo i loko o ka iwi ʻaoʻao mua 1 a 2 kenimika wale nō (0.5 ʻīniha) ma ka hema a me ka ʻākau o ka ʻaoʻao o ka iwi umauma (sternum), a ʻo kahi ** aʻa intercostal e holo ana ma ka ʻaoʻao lalo o kēlā me kēia iwi ʻaoʻao.
5. Inā ʻoki ka ʻeha i kahi aʻa mammary intercostal a i loko a e kahe ana ke koko mai loko mai o nā ʻaoʻao o ka ʻili, e hoʻopili ** paʻa paʻa paʻa pololei me kahi pā lole maʻemaʻe ma luna pono o ka ʻeha waho** (a i ʻole ma luna o ka sila i hoʻoheheʻe ʻia me ka nānā pono ʻana no ka pneumothorax keu).

KaʻAnuʻu Hana 4: Hoʻonohonoho, mālama wela, a me ka ho'ōla hou¶

1. Ke kūlana: E ʻae i ka mea maʻi hanu e noho ma ko lākou kūlana ʻoluʻolu (maʻamau ** semi-kū pololei ma 30 a 45 degere** a i ʻole e hilinaʻi iki i mua, e emi iki ke kaomi ma ka atrium ʻākau). Inā hāʻule nui ko lākou koko a maule lākou, e hoʻohaʻahaʻa i ke poʻo o ke kau ʻana i palahalaha a i ʻole e nānā pono ana i ko lākou hanu ʻana.
2. E mālama i ka mea maʻi me ka mālie: ʻO ka hakakā ʻana a i ʻole ke kū ʻana i luna e hoʻonui i ka koi o ka oxygen o ka naʻau a hoʻonui i ke kaomi systolic ventricular, e koi ana i ke koko hou aʻe ma ka haʻihaʻi o ka myocardial i loko o ka ʻeke pericardial.
3. E pale i ka hypothermia: E uhi i ka mea maʻi i loko o nā pākeʻe wela a mālama pono iā NPO (ʻaʻohe mea ma ka waha).
4. Pehea inā nalo ka mea maʻi i ka ʻike a komo i ka Traumatic Cardiac Arrest (Pulseless Electrical Activity / PEA) ma mua o ka hiki ʻana mai o EMS?
5. Ma ka tamponade puʻuwai, hoʻomau ka pacemaker uila o ka puʻuwai i nā hōʻailona maʻamau ma ka nānā ʻana i ka ECG i ka wā e puhi ʻia ai ke koko ʻole (Pulseless Electrical Activity or PEA).
6. ** Hoʻomaka maʻamau CPR koke** oiai na poe lapaau e hele ana. ʻOiai ʻaʻole ʻoi aku ka maikaʻi o ka hoʻopaʻa ʻana o ka umauma waho i ka wā i piha ai ka ʻeke pericardial i ke koko ma mua o ka hōʻeha ʻana i ka naʻau, mālama ʻo CPR i kahi kahe o ke coronary a me ka cerebral perfusion a hiki i ka hōʻea ʻana o nā paramedics ALS a i ʻole nā ​​kauka trauma e hana emergency resuscitative thoracotomy or ultrasound-guided pericardiocentesis (kahi e wehe ai i ke koko mai **15 a hiki i ka 3 milliliters o ke koko. e hoʻihoʻi koke i kahi pulse kuʻuna).

ʻO nā hiʻohiʻona kūikawā kūikawā i ke komo ʻana i ka trauma thoracic¶

1. Nā ʻeha o ka Thoracoabdominal Trajectory (Ma lalo o ka 4^th Intercostal Space / Nipple Line)¶

ʻAʻole ʻike ka nui o nā mea hoʻopakele i ke kiʻekiʻe o ka piʻi ʻana o ka dome o ka diaphragm i loko o ka iwi ʻaoʻao ke hoʻopuka ke kanaka. I ka manawa maʻamau, piʻi ka dome ʻākau o ka diaphragm a hiki i ka 4^th intercostal space (ke kiʻekiʻe o ka nipple) i mua, ka 6^th iwi ma ka ʻaoʻao, a me ka 8^th iwi (ka piko lalo o ka poʻohiwi) ma hope. * No laila, ** ʻo ka ʻeha hou a i ʻole ka pū i loaʻa ma lalo o ka laina nipple i mua a ma lalo paha o ka ʻāʻī poʻohiwi ma hope, hiki ke komo i loko o ka lua o ka umauma (pleura/pericardium) A me ka ʻōpū o ka ʻōpū (diaphragm, ate, spleen, ʻōpū, a i ʻole kolone)**. * E mālama mau i ka mea maʻi me ka ʻeha o ka umauma haʻahaʻa me ka NPO (ʻaʻohe mea ma ka waha) a nānā i ko lākou ʻōpū no ke kiaʻi, ʻoʻoleʻa, a i ʻole ka ʻeha poʻohiwi.

2. Nā ʻEha Puʻupuʻu Transmediastinal¶

Ke komo ka poka ma kekahi ʻaoʻao o ka umauma a puka i waho ma ka ʻaoʻao ʻē aʻe (a i ʻole moe ma ka ʻaoʻao ʻaoʻao o ka iwi kuamoʻo), ua hele kona alahele i ka mediastinum, ke ala waena e noho ai ka puʻuwai, ka ʻaoʻao piʻi a me ka iho ʻana, nā ʻaʻa pulmonary, ka trachea, a me ka esophagus. * Ma luna o 50 pakeneka o nā mea maʻi me kahi ʻeha pu transmediastinal i loaʻa i ka haʻalulu nui mai ka cardiac tamponade a i ʻole hemothorax nui, aʻo nā mea maʻi i koe i ʻike ʻia i ka manawa paʻa e koi koke i ka CT angiography, esophagoscopy, a me bronchoscopy e hoʻokuʻu ʻia i loko o nā aortic a i ʻole esophageal perforations.

3. Nā ʻEha Laʻau Tracheobronchial a me ka Emphysema Subcutaneous Nui¶

I ka wā e ʻoki ai ka maka a i ʻole ka pōkā i ka trachea intrathoracic a i ʻole ka bronchus kumu nui: * E kahe nui ka ea i loko o ka mediastinum (pneumomediastinum) a wehe koke ma lalo o ka ʻili o ka ʻāʻī, ka maka, a me ka paia o ka umauma (massive subcutaneous emphysema), e hoʻohūhū ai ka ʻāʻī o ka mea maʻi a me nā lihilihi o ka mea maʻi e like me ka baluna me ka puʻupuʻu "Rice Krispies" crepitus ma lalo o nā manamana lima, cocroopsis ʻulaʻula** ke koko. * E mālama pono i kēia poʻe maʻi, e hoʻopili i ka sila umauma i hoʻoheheʻe ʻia i waho, a e makaʻala koke i nā mea lapaʻau ALS.

ʻO ka ʻike wikiwiki ʻana i kahi hōʻeha Cardiac Box a me Beck's triad e hōʻoiaʻiʻo i ka poʻe paramedic e kāpae i nā keʻena olakino kūloko a holo pololei i kahi kikowaena trauma hōʻoki. E noʻonoʻo e lawe i kahi kōkua mua i hōʻoia ʻia, Stop the Bleed, a i ʻole ka papahana Prehospital Trauma Life Support ma o kāu hui Red Cross a i ʻole Red Crescent, ke Kulanui o ʻAmelika Hui Pū ʻIa, a i ʻole St John Ambulance.

Nīnau pinepine¶

Nānā ʻia nā kumu¶

• ** Ke Kula Nui o ʻAmelika Hui Pū ʻIa (ACS, ʻAmelika Hui Pū ʻIa):** Advanced Trauma Life Support (ATLS) Papa Haʻawina Haumana: Thoracic Trauma, Penetrating Cardiac Injury, Pericardial Tamponade, and Resuscitative Thoracotomy.
• ** ʻAhahui Hikina no ka ʻoki ʻana o ka Trauma (EAST) & Western Trauma Association (WTA, ʻAmelika Hui Pū ʻIa):** Nā Kūlana Hoʻomaʻamaʻa Hoʻomaʻamaʻa no ka Penetrating Thoracic Trauma a me ka "Cardiac Box".
• Komite no ka Tactical Combat Casualty Care (CoTCCC / Joint Trauma System, United States): TCCC Guidelines: Management of Penetrating Chest Trauma and Absolute Contraindication to Intra-Thoracic Wound Packing.
• European Resuscitation Council (ERC) & UK Resuscitation Council: Alakaʻi no ka Traumatic Cardiac Arrest (TCA): Reversible Causes (4 Hs and 4 Ts, Cardiac Tamponade, and Tension Pneumothorax).
• National Association of Emergency Medical Technicians (NAEMT, United States): Prehospital Trauma Life Support (PHTLS): Obstructive Shock, Beck's Triad, and Pulsus Paradoxus.

Nā alakaʻi pili¶

• ʻOmo ʻana i ka ʻeha o ka umauma a me ke kōkua mua o ka māmā
• ʻO ka umauma flail, nā ʻaoʻao ʻaoʻao he nui, a me ka ʻeha ʻeha o ka umauma
• Hoʻopaʻa ʻia a hoʻopaʻa ʻia i nā mea haole
• ʻIke haʻalulu a me ka mālama pilikia
• ʻO CPR makua a me ka hanu hoʻopakele
• Nā helu pilikia a me ka hoʻouna honua