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ʻO ka hoʻopaʻa ʻana a me ka hoʻopaʻa ʻana i nā mea ʻē aʻe i ke kōkua mua

He ʻokoʻa nā helu ulia pōpilikia ma ka ʻāina. Hoʻohana kēia ʻaoʻao i ka 911, ka helu no ʻAmelika a me Kanada. Nui nā ʻāina ʻē aʻe i hoʻohana i ka 112, 999, a i ʻole ka helu ʻē aʻe. E huli i ka helu no kou ʻāina.

Loaʻa ka ʻeha i ka wā i ʻō ai kekahi mea lōʻihi ʻoʻoleʻa (e like me ka pahi pahi, ke koʻokoʻo kila, ka pā lāʻau, ka lālā lāʻau, ka ʻāʻī aniani, ka pua pua, a i ʻole ka mea hoʻopaʻa nail-gun pneumatic) i ke kino a paʻa i loko o ke ala ʻeha. ʻOiai ʻo ka ʻike maka ʻana o kahi mea i hoʻokuʻu ʻia e hoʻoulu i ka manaʻo ikaika i ka mea i pepehi ʻia a me ka poʻe e kū ana e huki koke iā ia i waho, ** ʻo ka huki ʻana i kahi mea i hoʻopaʻa ʻia ma ke kula ʻo ia kekahi o nā ala wikiwiki loa e hoʻomake koke ai i ka hemorrhage nui**.

I loko o ke kino, hana ke kumu o kahi mea i hoʻokomo ʻia ma ke ʻano he plug mechanical pololei (internal tamponade), e kaomi ana i nā ʻaoʻao i ʻoki ʻia o nā ʻaʻa ʻaʻa kiʻekiʻe, nā veins nui, a i ʻole nā ​​keʻena puʻuwai e kūʻē i ka ʻiʻo a puni. I ka manawa like, e hoʻonui ʻia kēlā me kēia millimeter o ka ʻāwili ʻaoʻao a i ʻole ka rotational torque i hoʻopili ʻia i ka ʻau i waho o ke kino i kahi ākea ākea, ʻoki ʻoki i ka piko hohonu i loko o ka umauma, ka ʻōpū, ka ʻāʻī, a i ʻole ka iwi poʻo. ʻO ka ʻike ʻana i nā lula lapaʻau koʻikoʻi no ka wā e hoʻopā ʻole ʻia ai kahi mea i hoʻopaʻa ʻia, ʻo ke ala ea ola ola ʻelua a me nā ʻokoʻa CPR, a pehea e hana ai i kahi pale nui multi-layer a i ʻole ke apo apo e paʻa ai ka mea me ka neʻe ʻole i ka wā o ka lawe ʻana, ʻo ia ka ʻokoʻa ma waena o ke ola a me ka exsanguination wikiwiki.

E hana i kēia i kēia manawa

  1. E waiho paʻa i ka mea i hoʻopaʻa ʻia a haʻi aku i ka mea i hoʻopaʻa ʻia ʻaʻole e hopu a huki paha. Inā he pahi kīhini ma ka umauma, he ʻāpana aniani ma ka ʻāʻī, he ʻāpana ʻāʻī ma ka ʻūhā, a i ʻole ke kui kui ma ke kuli, ** MAI uhuki i waho** a mai ʻae i ka mea maʻi e huki i waho.
  2. **E kāhea koke i kāu helu ulia pōpilikia a noi i nā mea lapaʻau Advanced Life Support (ALS) a me Heavy Technical Rescue inā paʻa ke kanaka i kahi hale paʻa. helu pilikia. E haʻi i ka mea hoʻouna inā pono nā mea ʻoki hydraulic hoʻopakele ahi e hoʻokuʻu i ka mea i hōʻeha ʻia mai ka pā, ka pahu pahu, a i ʻole nā ​​mīkini.
  3. E hoʻopaʻa paʻa i ka mea e puka ana me ka lima hoʻokahi i ka wā e ʻoki ai i nā lole a puni ka ʻeha komo. Mai huki i ka pālule a i ʻole nā ​​​​palu ma luna o kahi mea i maʻi ʻia, no ka mea, nakinaki ka lole i ke kumu a huki i ka piko o loko ma nā kīʻaha koko. E hoʻohana i nā ʻako trauma a i ʻole nā ​​ʻoki e ʻoki loa i nā lole mai ke kumu o ka mea.
  4. E hoʻopaʻa i ke kahe ʻana o waho ma ke kaomi paʻa ʻana me ka gauze sterile ma ka ʻili a puni ke kumu o ka mea, ʻaʻole e hoʻokuʻu i lalo i ka mea ponoʻī. E kau i nā manamana lima lima lima a me nā pale lole i pelu ʻia ma kēlā ʻaoʻao kēia ʻaoʻao o ka ʻeha komo a hoʻokau mau i ke kaomi i lalo i ka ʻili a puni a me ka moku lalo me ka ʻole o ka hoʻohili ʻana a i ʻole ka hoʻokomo ʻana i ke kumu i hoʻopaʻa ʻia.
  5. Kūkulu i mea hoʻopaʻa paʻa kiʻekiʻe a ʻoʻoleʻa (ke apo donut, ʻōwili lua gauze, a i ʻole ke kīʻaha pale i hoʻopaʻa ʻia) a hiki i ka hapalua o ke kiʻekiʻe o ka mea e puka mai ana. E hoʻopaʻa i nā kāʻei i ʻōwili ʻia, nā ʻaʻahu ʻeha i pelu ʻia, a i ʻole nā ​​kāwele maʻemaʻe ma nā ʻaoʻao a pau o ke kumu, a laila e hoʻopaʻa i ka ʻaoʻao ʻaoʻao i ka ʻaoʻao a puni ka hoe.
  6. E mālama pono i ka mea i hōʻeha ʻia, mehana, a me ka NPO (ʻaʻohe mea ma ka waha) i ka nānā ʻana i ke koko o loko a me ka haʻalulu. Mai hāʻawi i ka wai, ka meaʻai, a me nā lāʻau lapaʻau waha. E mālama i ka lālā ʻeha a i ʻole ka ʻōpū i ka wā e neʻe ai ma luna o ke kaʻa kaʻa, a nānā i ka pulse distal, ka waihoʻoluʻu ʻili, a me ka hanu ʻana i kēlā me kēia 5 mau minuke.

No ke aha ke kumu o ka huki ʻana i ka pahi i hoʻopaʻa ʻia, ke koʻokoʻo, a i ʻole ka ʻāʻī aniani ke kumu o ke koko make koke.

Ke ʻoki ʻia kekahi mea ʻoi a paʻa paha i loko o kahi kīʻaha koko nui (e like me ke aorta, vena cava, femoral artery, carotid artery, a i ʻole portal vein) a i ʻole ke komo ʻana i ka ʻiʻo o ka puʻuwai, e hoʻopiha ka nui kino o ka mea i ka lua āna i hana ai. Hoʻohui pū ʻia me ka hoʻihoʻi ʻana o ka elastic maoli a me ka spasm o ka pā aʻe o ka ʻiʻo e hoʻopaʻa paʻa ana a puni ke kumu, ʻo kēia ** tamponade i loko ** e kaupalena pinepine i ke koko waho i kahi kahe hoʻopunipuni. I ka manawa e huki ai kekahi i ka mea i waho o ke kahua, nalo ka ipuhao, e hamama ana ka ipu i hookomoia iloko o ka lua hohonu kahi i hiki ole ai ke kaomi manamana lima pololei, a hiki i ka mea i pepehiia ke lilo i ka nui o ke koko holookoa iloko o 60 a 180 kekona. Pono e hoʻoneʻe ʻia nā mea i hoʻopaʻa ʻia i loko o ke keʻena hana o ka haukapila ma hope o ka wehe ʻana o nā mea lapaʻau ʻeha i ka lua a kau i nā pipili vascular ma luna a ma lalo o ka moku ʻeha.

lāʻau hoʻoholo pilikia no ka hoʻopaʻa ʻana a me nā mea i hoʻopili ʻia

flowchart TD
    Start["Victim with Impaled or Embedded Foreign Object"]
    StopPull["CRITICAL RULE: DO NOT PULL OUT THE OBJECT<br/>Manually steady object and call EMS + Fire Technical Rescue"]
    ExceptionCheck{"Does the Object Meet One of the Two Rare Removal Exceptions?<br/>1. Piercing the cheek with catastrophic airway bleeding<br/>2. Directly blocking chest compressions during Cardiac Arrest"}
    ExceptionCare["RARE CLINICAL EXCEPTION PROTOCOL<br/>- Cheek perforation blocking airway: carefully extract ONLY if needed to suction/pack oral bleeding and secure airway<br/>- Blocking CPR in confirmed cardiac arrest: remove or cut flush ONLY if required to perform life-saving chest compressions"]
    PinnedCheck{"Is the Victim Impaled onto a Fixed Immovable Structure?<br/>(Rebar in concrete, iron picket fence, tree trunk, machinery)"}
    TechRescue["PINNED CASUALTY / TECHNICAL EXTRICATION<br/>1. Manually support victim's full body weight so gravity cannot tear wound<br/>2. Wait for Fire Rescue to cut the structure AWAY from the body<br/>3. Cool metal with water and shield victim if saws/torches are used<br/>4. Leave a 10 to 15 cm (4 to 6 in) stub attached to transport into OR"]
    LocationCheck{"Identify Anatomical Region of Free-Standing Impaled Object"}
    EyeGlobe["Eye / Orbit Impalement<br/>1. Zero pressure on eyeball<br/>2. Build tall gauze collar + tape paper cup over object<br/>3. Cover BOTH eyes to stop conjugate eye movement"]
    ChestNeckAbd["Neck, Chest, Abdomen, Pelvis, or Skull<br/>1. Press gauze AROUND base (never on skull fragments)<br/>2. Seal sucking chest wound around shaft with vented dressing<br/>3. Build twin-roll or doughnut stabilizer and monitor for shock"]
    Extremity["Limb / Extremity Impalement<br/>1. Press gauze around base to control bleeding<br/>2. Apply bulky bolster + splint entire limb joint-to-joint<br/>3. Check distal pulse, capillary refill, and nerve function"]

    Start --> StopPull
    StopPull --> ExceptionCheck
    ExceptionCheck -->|Yes: Airway Blocked or CPR Impossible| ExceptionCare
    ExceptionCheck -->|No: All Other Cases (99.9%)| PinnedCheck
    PinnedCheck -->|Yes: Pinned to Fence / Rebar / Post| TechRescue
    PinnedCheck -->|No: Object Mobile with Patient| LocationCheck
    LocationCheck -->|Eye or Orbit| EyeGlobe
    LocationCheck -->|Head, Neck, Chest, or Abdomen| ChestNeckAbd
    LocationCheck -->|Arm, Hand, Leg, or Foot| Extremity

Ka hoʻohālikelike ʻana i nā ʻāpana anatomical impalement a me nā pōʻino hoʻokūpaʻa kikoʻī

ʻO nā hale o loko i hoʻoweliweli ʻia e kahi mea i hoʻopili ʻia a me ke ala pololei āu e hoʻohana ai i ke kaomi hoʻopaʻa ʻana e hilinaʻi nui ʻia i ka ʻāpana anatomical i hou ʻia.

Anatomical Zone Nā Kūlana Kūloko koʻikoʻi i ka pilikia Hemorrhage kiko'ī a me ke kānāwai koʻikoʻi ʻenehana hoʻopaʻa lole Noʻonoʻo Kūikawā a me ka lawe ʻana
** Ka Poʻo, ka Maka, a me ka Vault Cranial** Parenchyma lolo, dural venous sinuses (sagittal sinus), internal carotid artery AOLE e kau i ke kaomi paʻa i lalo ma ka iwi poʻo a puni ka mea inā loaʻa nā haʻi iwi poʻo keʻokeʻo (e pili ana i ka hoʻokomo ʻana i nā ʻāpana iwi i loko o ka lolo) ʻO ke apo apo ʻoluʻolu a i ʻole nā puʻu koʻikoʻi i hoʻopaʻa ʻia e kau ana ma ka iwi paʻa i kahi mamao loa mai ke kahua komo; hoʻokiʻekiʻe ke poʻo 30 degere E makaʻala no ka hāʻule ʻana o ka wai maʻemaʻe/ʻulaʻula ** cerebrospinal fluid (CSF)** mai ka ihu a i ʻole nā ​​pepeiao (ʻaʻole loa e hoʻopaʻa i ka ihu); e manaʻo i ka hopu ʻana a i ʻole ka piʻi ʻana o ke kaomi intracranial
Orbit Maka & Iwi Poʻo honua (sclera, retina, vitreous), aʻalolo optic, cavernous sinus, a me ka mua cranial fossa ** ʻAʻohe kaomi ma ka pōkā maka**; ʻaʻole e hoʻopā a paʻi paha i ka penikala e puka mai ana, ka uwea, a i ʻole ka ʻāpana aniani E hoʻopaʻa i nā donuts mānoanoa a puni ka iwi orbital rim + lipine i kahi ** kīʻaha pepa a i ʻole ka dome plastic kiʻekiʻe** ma luna o ka mea; paʻi pū i ka maka UNINJURED Hoʻopau ka uhi ʻana i ka maka ʻeha ʻole ** nā neʻe ʻana o ka nānā ʻana ** i ʻole e hahau ʻia ka maka i hoʻopaʻa ʻia ʻaoʻao.
Neck (Nā ʻĀpana I, II, a me III) ʻO nā ʻaʻa carotid, nā ʻaʻa ʻāʻī o loko, ka trachea, ka larynx, esophagus, ke kuamoʻo cervical, ke aʻalolo vagus E hoʻopili i ka ** kaomi kikohoʻe i manaʻo ʻia me kahi manamana lima lima lima/gauze pad** ma ka ʻaoʻao o ka ipu koko me ka ʻole o ka ʻumi ʻana i ka paipu makani. E hoʻopaʻa i ka mea me nā ʻōwili gauze nui i hoʻopaʻa ʻia ma ka poʻohiwi a me ka ʻāwae; ʻAʻole e hoʻopaʻa i kahi kāʻei pōʻai a puni ka ʻāʻī E hoʻohana i kahi ʻaʻahu occlusive ma ke kumu no ka pale ʻana i ka ** venous air embolism** i loko o ke aʻa jugular; ka hoʻopaʻa ʻana o ka spine cervical manual
Ka Puʻu (Puka Puka) ʻO ka puʻuwai, pericardium, thoracic aorta, vena cava, nā māmā, nā aʻa intercostal E kaomi a puni ke kumu; ina e omo ana ka ea a pohu paha a puni ke kumu (open pneumothorax), e sila i ka hakahaka a puni ke kumu me ka petroleum gauze a i ole ia he sila pahu puka. ʻO nā ʻōwili lole ʻaʻahu nui ʻelua i kau ʻia ma kēlā ʻaoʻao kēia ʻaoʻao o ka lau, i hoʻopaʻa ʻia i lalo me ka waiho ʻana i hoʻokahi kihi hiki ke hoʻokuʻu i ka ea inā piʻi ka umauma. Mai hoʻopaʻa paʻa loa i ka lole pale ea a puni ka pahu i hoʻopaʻa ʻia e paʻa ai ka ea i ka pneumothorax hoʻopaʻapaʻa; ka lawe noho ʻana a i ʻole ʻaoʻao ʻeha i lalo inā paʻa
Ka ʻōpū, ka ʻaoʻao, a me ka ʻāʻī ʻO ka ʻōpū o ka ʻōpū, ka vena cava haʻahaʻa, ke akepaʻa, ka ʻāʻī, nā kīʻaha mesenteric, nā puʻupaʻa, ka ʻōpū puha. E kaomi a puni ke kumu me nā pad sterile; inā puka mai nā puka lou ma ka ʻaoʻao o ka mea (evisceration), e uhi i ka ʻōpū i ʻike ʻia me ka mau lole i hoʻomaʻemaʻe ʻia i ka wai paʻakai ʻO ka pahu apo donut ākea a i ʻole ka ʻaoʻao ʻehā ʻaoʻao o nā ʻaʻahu ʻeha i hoʻopaʻa paʻa ʻia ma ka paia o ka ʻōpū. Hoʻololi iki i nā kuli o ka mea maʻi (uluna ma lalo o nā kuli) e hoʻomaha ai i ka ʻeha o ka paia o ka ʻōpū; mālama pono NPO
Wāhi ('ūhā, Bipi, Lima, Lima, Wawae) Femoral, popliteal, brachial, radial, and ulnar arteries; nā kumu aʻalolo āpau ʻO ke kaomi pololei paʻa ma kahi kokoke a mamao loa i ka ʻeha komo ma ke axis arterial; e hoʻohana i ka tourniquet kokoke WALE inā ʻaʻole hiki ke hoʻōki ʻia ke kahe koko e hoʻoweliweli i ke ola e ke kaomi kumu ʻO ke kākoʻo nui a puni ka mea PLUS ka māmala ʻoʻoleʻa piha o ka lālā ma luna a ma lalo o nā hui pili ʻOiai inā paʻa ka mea i ka ʻili, ʻo ke kulou ʻana i ke kuli a i ʻole ke kuʻekuʻe e hoʻoneʻe i nā ʻōpū ʻiʻo o loko i ka piko ʻoi; ** māʻai ka lālā holoʻokoʻa **

ʻO ka biomechanics o ka tamponade kūloko a me ka pilikia lever-lima

No ka hoʻomaopopo ʻana i ke kumu o ka hoʻomau ʻia ʻana o ka hoʻopaʻa ʻana i ka prehospital prehospital o kēlā me kēia mea i hoʻopili ʻia, e noʻonoʻo i nā mana mechanical ʻelua e hana ana ma ka piko o ka mea kaua a i ʻole ke koʻokoʻo i loko o ke kino o ka mea maʻi:

1. Taponade Kuloko a me ka Moku Elastic Recoil

I ka wā e hoʻololi ai kekahi puʻupuʻu paʻa (e like me ke koʻokoʻo kila 12-milimeter / 0.5-inihi a i ʻole ka pahi pahi 3-kenimika-ākea) i kahi kīʻaha koko nui a i ʻole nā ​​okano vascular paʻa (e like me ke ake, spleen, a i ʻole ka puʻupaʻa), ʻekolu mau mea e hana i ka manawa like e hoʻolōʻihi i ke koko inā lōʻihi ka mea: * Ke hoʻopili ʻana i ka mīkini: ʻO ke kila paʻa a i ʻole ka lāʻau e noho ana i ka hemahema kea i ka paia o ka moku. * ** ʻO ka ʻiʻo maʻemaʻe maʻemaʻe o ka ʻiʻo:** Aia i loko o nā paia aʻa i ʻoki ʻia a i ʻoki ʻia paha nā ʻiʻo ʻiʻo maʻemaʻe pōʻai e ʻokiʻoki a puni ka lāʻau haole. * Peivascular hematoma kaomi: Ke kahe mua ke koko i loko o ka ʻāpana fascial paʻa a puni ka moku a hoʻopaʻa hope i waho o ka pā o ka moku.

Inā huki ʻia ka mea i waho a wiliwili ʻia paha, e hāʻule koke nā pale pale ʻekolu: nalo ke plug mechanical, hāmama ka moku i haehae ʻia, a haehae ʻia ka ʻōpala pale pale.

2. ʻO ka Fulcrum a me ka Lever-Arm Effect

Hana ʻia kahi mea i maʻa ʻia e like me ka lever papa mua nona ka fulcrum (pivot point) e noho pono ana ma ka ʻeha komo i ka ʻili: * Inā paha e puka ka lāʻau a pua paha 20 kenimika (8 iniha) ma waho o ka umauma a i ʻole ka ʻōpū a komo i ka 10 kenimika (4 iniha) i loko o ke kino. * Inā kū ka wēlau i waho i ka wā e hoʻouka ai i ka ʻōnaʻi a haʻalulu paha i ka 4 kenimika (1.5 iniha) i loko o ka kaʻa kaʻa, lele ka piko o loko ma kahi 2 kenimika (0.8-ʻīniha) arc i loko o ka puʻuwai, ʻāmāmā, a i ʻole ka ate, e hana ana e like me ka wiper pale makani i hana ʻia me ke kila aʻalolo i ʻeha mau ʻia. * No laila, ʻo ka hoʻopaʻa ʻana i kahi mea i hoʻopaʻa ʻia e pono ** e hoʻopaʻa i ke kumu ma ka liʻiliʻi o ka hapalua o kona lōʻihi e puka mai ana** i hiki ʻole ai ka fulcrum ke pivot ma ka ʻili o ka ʻili.

ʻElua wale nō ʻokoʻa lāʻau lapaʻau kahi e wehe ʻia ai kahi mea i hoʻopaʻa ʻia

Across International Liaison Committee on Resuscitation (ILCOR), American College of Surgeons Advanced Trauma Life Support (ATLS), a me nā alakaʻi alakaʻi Prehospital Trauma Life Support (PHTLS), ʻelua wale nō mau hanana weliweli i ke ola** kahi e ʻae ʻia ai ka mea pane prehospital e wehe a ʻoki i kahi mea i hoʻopaʻa ʻia ma mua o ka hiki ʻana i ka lumi hana:

ʻOkoʻa 1: ʻAha ʻia ka pāpālina e hoʻopilikia ana i ke ala ea

Inā hou kekahi mea i ka paia ʻiʻo palupalu o ka pālina (buccal cavity) i loko o ka waha, e hoʻoheheʻe koke ʻia ke koko i loko o ke kua o ka ʻāʻī ʻaʻole hiki ke hoʻomalu ʻia a hoʻomoʻi ʻia a puni ka mea, a pale pololei i ka mea hoʻopakele mai ka wehe ʻana i ke ala ea (a ʻaʻole ** ** komo ka mea i loko o ka ʻāʻī hope, a i ʻole ke kumu o ke kuamoʻo): * Hiki i ke kauka i aʻo ʻia a mea hoʻopakele paha ke wehe pono i ka mea mai ka pāpālina ** inā pono e hoʻopaʻa i loko a i waho o ka pā papalina me ka gauze a hoʻomaʻemaʻe i ke ala ea** i ʻole e hoʻomake ka mea maʻi i ke koko. * ʻO ka mea ʻē aʻe, inā ** ʻaʻole ** e kahe ikaika ana ka mea maʻi i ke ala ea a hiki i ka mea maʻi ke hanu a kuha a hoʻomoʻi ʻia paha me ka palekana, a i ʻole e hohonu ka mea i loko o ka ʻāʻī paʻa, ka ʻāʻī, a i ʻole ke kumu iwi poʻo, ** waiho ma kahi paʻa** a hoʻopaʻa i waho.

Hoʻokoe 2: ʻO kahi mea e pale pono ai i ka hoʻōla ʻana i ka umauma CPR a i ʻole ke kūlana ala ea i ka hoʻopaʻa ʻia ʻana o ka Cardiac Arrest

  • Hoʻopaʻa ʻia ka umauma mua i ka hopu ʻia ʻana o ka naʻau: Inā ʻaʻohe puʻuwai o ka mea i hōʻeha ʻia a ʻaʻole hanu (ua hōʻoia ʻia ka hopu ʻia ʻana o ka naʻau)** a ʻo kahi mea i hoʻopaʻa pololei ʻia i waenakonu o ka iwi umauma (sternum) he mea hiki ʻole ke kau i nā lima ma ka umauma e hana i ka hoʻōla cardiopulmonary resuscitation (CPR), me ka waiho ʻole ʻana o ka mea i hoʻopaʻa ʻia ʻo ia he 100 pakeneka o ka make. Pono nā mea hoʻopakele e ʻoki koke i ka mea me ka paia o ka umauma a i ʻole, inā ʻaʻole i loaʻa nā mea hana ʻoki, e wehe iā ia i hiki ke hoʻomaka koke ka hoʻopiʻi umauma kiʻekiʻe.
  • Ke hoʻopaʻa ʻia i ke kua a i ʻole ka hoʻopaʻa ʻia ʻana e pale ana i ke ala ea i ka hopu ʻana i ka hanu/naʻau: Inā ua paʻi ʻia ka mea i ʻike ʻole ʻia, ʻaʻa, ʻaʻole i hoʻopaʻa ʻia i lalo i lalo a i ʻole he mea lōʻihi e puka mai ana mai ko lākou kua i luna e pale ai i ka ʻōwili ʻana iā lākou ma ko lākou kua e wehe i ke alaloa a hana i ka CPR, pono nā mea hoʻopakele e hoʻāʻo mua e kau i ʻelua mau moena mānoanoa a i ʻole nā pākeʻe ma luna o ka mea ma waena o ka mea maʻi e kau ana ma waena o ka mea maʻi. moe moe; inā ʻaʻole hiki ʻole a e make ana ka mea maʻi no ke keʻakeʻa ʻana o ke ea a i ʻole ka hopu ʻana i ka naʻau, ʻo ka pōkole a i ʻole ka wehe ʻana i ke keakea e hana i ka hoʻōla hou ʻana ka mea nui.

Mai wehe i ka umauma, ka ʻāʻī, a i ʻole ka ʻōpū i hoʻopaʻa ʻia i loko o ka mea maʻi hanu me ka pulse

Hoʻopili ʻia ka CPR ʻokoʻa ** wale nō ** i ka wā i hoʻopaʻa ʻia ai ka mea i hoʻopaʻa ʻia i ka hopu ʻana i ka naʻau (ka pane ʻole, ʻaʻole hanu maʻamau, ʻaʻohe puʻupuʻu) a hoʻopaʻa kino ka mea i kou mau lima mai ke kaomi ʻana i ka sternum. Inā e hanu ana kekahi kanaka me ka pahi a i ʻole ka lāʻau ma ka umauma a i ʻole he puʻupuʻu paha, mai huki i waho.

ʻO ka ʻenehana i kēlā me kēia ʻanuʻu: pehea e kūkulu ai i kahi lole stabilizer nui

Mai ho'āʻo e hoʻopaʻa i kahi mea i hoʻopaʻa ʻia ma ka hoʻomoe wale ʻana i nā ʻāpana lipine paʻa ma luna o ka ʻau e like me ka hale lole; hoʻopaʻa ʻia ka lipine a hiki i ke kumu ke hoʻopaʻa i hope a i waho me kēlā me kēia puʻuwai puʻuwai a me ke ala. Akā, e hoʻohana i hoʻokahi o ʻekolu mau ʻenehana hoʻopaʻa ʻana ma muli o ke ʻano o ka mea.

Ka Papa Hana 1: ʻO ka Twin-Roll Bolster (Ka mea maikaʻi loa no nā ʻili pahi palahalaha, nā ʻāpana aniani, a me nā kumu lōʻihi)

  1. E hāʻawi i ka hoa 1 e hoʻopaʻa i ka mea me ka neʻe ʻole: Hoʻopaʻa mālie ka hoa 1 i ka mea e puka mai ana me nā manamana lima lima e pale aku ai i ka hili ʻana i ka wā e hoʻomākaukau ai ʻo Partner 2 i ka lole.
  2. E hoʻopili i nā pad kumu ʻāʻī a puni ka ʻeha komo ʻana i ka ʻili: E lawe i ʻelua mau ʻaʻahu trauma sterile mānoanoa a i ʻole nā ​​puʻupuʻu o 10-by-10-kenimika (4-by-4-inihi). E hoʻokuʻu i hoʻokahi ahu ma luna o ka ʻili ma ka ʻaoʻao hema o ka lau a me ka ʻaoʻao ʻelua ma ka ʻaoʻao ʻākau no laila e hoʻopaʻa paʻa lākou i ka ʻeha komo a mālama i ke koko.
  3. E hoʻokomo i ʻelua ʻōwili paʻa paʻa ma ka ʻaoʻao o ka lāʻau: E lawe i ʻelua ʻōwili paʻa paʻa ʻole i wehe ʻole ʻia, ʻelua kāwele crepe i ʻōwili ʻia, ʻelua poloka splint foam, a i ʻole ʻelua kāwele lima i ʻōwili paʻa ʻia. E hoʻomoe i hoʻokahi ʻōwili e pili ana i kēlā me kēia ʻaoʻao o ka mea e puka ana (e hoʻomaha ana ma luna o nā papa kumu).
  4. Kūkulu i ke kiʻekiʻe a hiki i ka 50 a hiki i ka 75 ka nui o ka lōʻihi e puka ana: Inā 12 kenimika (5 ʻīniha) ka lāʻau, e hoʻopaʻa i ka papa lua o nā kāʻei i ʻōwili ʻia ma ke kihi 90-degere (ʻano "log cabin") a hiki i ka 6 a 9 mau kenimika (2.5 a 3.5 mau iniha) a hiki i ka pale.
  5. E hoʻopaʻa i ke poʻo me ke kāwele wili a me ka lipine: E hoʻopaʻa paʻa i ka ʻōpala a i ʻole ka pahu elastic a puni ka lālā a i ʻole ka ʻūhā, e hele ** a puni a ma waena o nā ʻōwili nui me ka kaomi ʻole ʻana i lalo ma luna o ka mea i hoʻopaʻa ʻia**. E hoʻopau i ka heleuma ʻana i nā ʻōwili i ka ʻili me nā ʻāpana ākea o ka lipine lāʻau lapaʻau a i ʻole ka duct tape. Aia wale nō i ka paʻa o ke kākoʻo e hoʻokuʻu mālie ʻo Partner 1 i ko lākou lima.

Ka Papa Hana 2: ʻO ka Donut Ring Pad (Ka mea maikaʻi loa no nā ʻōpala pōkole, nā kui, nā kākalaioa, a me nā mea iwi poʻo/maka)

Ke puka ka mea i hoʻokomo ʻia ma kahi o 2 a 6 kenimika wale nō (1 a 2.5 ʻīniha) ma luna o ka ʻili, a i ʻole pono ʻoe e pale i ke kaomi ʻana ma kahi kokoke i kahi iwi poʻo i haʻihaʻi ʻia a i ʻole ka maka, e kūkulu i kahi Doughnut Ring Pad: 1. E lawe i kahi kāwele huikolu haiki i pelu ʻia i loko o ka cravat, ka lōʻihi o ka roller gauze, a i ʻole ke kāwele kīʻaha maʻemaʻe. 2. E wīwī i kekahi wēlau o ke kāʻei ʻelua a ʻekolu manawa a puni nā manamana lima o kou lima ponoʻī e hana i ka loop loop nona ka puka o loko i ʻoi aku ka laulā ma mua o ka mea i hoʻopaʻa ʻia. 3. E hoʻopaʻa pinepine i ka huelo i koe o ke kāʻei ma waena o ka lua waena a puni ka rim, e huki ana i kēlā me kēia ʻōwili paʻa a hiki i ka loaʻa ʻana o kahi fabric torus paʻa (doughnut) 4 a 6 kenimika (1.5 a 2.5 ʻīniha) ka mānoanoa. 4. E hoʻohaʻahaʻa mālie i ka lua waena o ke apo donut ma luna o ka mea e puka mai ana no laila e kau ka pae ʻau i ka ʻili maikaʻi e puni ana i ka ʻeha me ka hoʻo ʻole ʻana i ka mea ponoʻī, a laila e hoʻopiha i kahi āpau ma waena o ke apo i loko a me ke kumu me ka gauze palupalu a hoʻopaʻa paʻa i ka donut.

Kaʻina 3: ʻO ka Pale Pale / Cone Shield (Ka mea maikaʻi loa no nā penikala, nā uea, a i ʻole nā nila i ka maka a i ʻole nā hono)

  1. E hoʻopuni i ke kumu o ka mea me kahi apo donut palupalu e kau ana ma ka ʻaoʻao iwi.
  2. E lawe i ** kīʻaha inu pepa, kīʻaha huʻihuʻi, a i ʻole kīʻaha lāʻau palaki** i lawa ka lōʻihi e hoʻomaʻemaʻe ʻia ka piko o luna o ka mea i maʻa ʻia ma kahi o 2 kenimika (0.8 iniha).
  3. Inā lōʻihi loa ka mea no ke kīʻaha hoʻokahi, e ʻoki i puka liʻiliʻi ma lalo o ke kīʻaha, e hoʻoheheʻe mālie i ke kīʻaha ma luna o ke kumu, e hoʻopaʻa mālie i ka gauze ma waena o ke kīʻaha a me ke kumu e hoʻōki ai i ka haʻalulu, a hoʻopaʻa paʻa i ka ʻaoʻao ākea o ke kīʻaha i ka ʻili a puni.

Ka mālama ʻana i kahi mea i hoʻopaʻa ʻia i kahi hale paʻa (Rebar, Fences, Trees)

Hiki mai kekahi o nā pilikia ulia pōpilikia ma mua o ka haukapila ke hāʻule ka mea hana hale ma luna o ka ka hoʻoikaika paʻa paʻa (rebar), ke keiki a i ʻole ka mea hele wāwae e hāʻule ma luna o ka **pa piket hao i hoʻopaʻa ʻia, a i ʻole ka mea hoʻokele i hoʻopaʻa ʻia e kahi lāʻau.

No ke aha ka ʻumekaumaha ka ʻenemi koke

Ke hoʻopaʻa ʻia ke kanaka ma ka pou paʻa a i ʻole ke koʻokoʻo paʻa kūpaʻa, huki koke ka umekaumaha i ke kaumaha o ko lākou kino i lalo ma ka lāʻau, e haehae nui aʻe ai i ka ʻeha o loko i kēlā me kēia kekona a lākou e kau ai a hāʻule paha.

  1. E kākoʻo koke i ke kaumaha o ke kino holoʻokoʻa o ka mea i pepehi ʻia: E hoʻokomo koke i ʻelua a ʻekolu mau mea e kū ana a i ʻole mea hoʻopakele a hoʻopaʻa i ka ʻōpū o ke kanaka, pūhaka, a me nā wāwae i ke kiʻekiʻe a me ke kihi o ka hoʻopaʻa ʻia ʻana no laila ** ʻaʻohe kaumaha o ke kino e kau ʻia ma ke koʻokoʻo i maʻi ʻia**. E hoʻoneʻe i nā poloka cribbing lāʻau, kahi noho paʻa, kahi alapiʻi, a i ʻole nā ​​​​papa i hoʻopaʻa ʻia ma lalo o ka mea i hōʻeha ʻia e wehe i ke koʻikoʻi mai nā lima o ka poʻe hoʻopakele i ke kali ʻana no ka hoʻopakele ahi.
  2. Mai hoʻokiʻekiʻe i ka mea i hōʻeha ʻia i luna a i waho o ka pā a i ʻole ka pā: ʻOiai he maʻalahi ke koʻokoʻo a i ʻole ke ʻano pōkole o ka pā, ʻo ka hoʻokuʻu ʻana i ka mea i hōʻeha ʻia mai ka spike i loko o ke kula, ua like ka hana me ka huki ʻana i ka pahi mai ke kino a e hoʻomaka ana ka hemorrhage kūloko.
  3. E ʻoki i ka hale mai ka mea i pepehi ʻia, e waiho ana he 10 a 15 kenimika (4 a 6 ʻīniha): E ʻoki pono nā hui hoʻopakele ahi a me ka ʻenehana i ka pou pā, ka lālā lāʻau, a i ʻole ke koʻokoʻo paʻa ma waho o ka hale makua i hiki ke hāpai ʻia ka mea maʻi ma luna o ke kau ʻana ** me ka ʻāpana i hoʻopaʻa ʻia i loko o ko lākou kino**.

Nā lula koʻikoʻi i ka wā e ʻoki ai i ka ʻūhā metala a i ʻole ka pā hao ma kahi kokoke i kahi mea i hōʻeha ʻia

Inā pono e ʻoki ʻia ke koʻokoʻo metala a i ʻole ke kaola lāʻau i hoʻopaʻa ʻia i kahi mea hoʻopakele ahi a i ʻole nā mea pane ʻoihana, pono e mālama ʻia nā pōʻino kino ʻehā:

Mea ʻoki ʻoki Poino Nui i ka Mea i Hoopaa ia Pono e hoʻomalu palekana
** Nā ʻokiʻoki Hydraulic ("Jaws of Life" / Rebar Cutters)** ** ʻO ka "whip" mechanical a me ka torque** i ka manawa e paʻi ai ke kila paʻakikī, e hoʻopiʻi ana i ka piko o loko i loko o nā ʻōpū o ka mea maʻi. Mea hana maʻamau gula ke kākoʻo ʻia: pono ʻelua mau mea hoʻopakele e hoʻopaʻa i nā wili paʻa (Vise-Grips) a i ʻole e paʻa paʻa i ke koʻokoʻo ma waena o nā ʻāʻī ʻoki a me ka ʻili o ka mea maʻi e komo i ka haʻalulu paʻa.
Rotary Abrasive Cutoff Saw (K12 / Angle Grinder) a i ʻole Reciprocating Saw (Sawzall) Kuhi alapine kiʻekiʻe e ʻōniʻoniʻo ana i ka piko o loko PLUS hoʻololi wela hoʻokele ma ke koʻokoʻo kila a me ka ua o nā ʻālohilohi wela. E wīwī i ** kāwele mānoanoa mānoanoa i hoʻopiha ʻia me ka hau a i ʻole e ninini i ke kahe mau o ka wai anuanu** ma luna o ke koʻokoʻo metala ma waena o ka ʻili a me ka ʻili o ka mea i hoʻopaʻa ʻia e hoʻopau i ke ahi wela i loko o ka ʻeha; pale i ka mea maʻi me ke ahi-pale hoʻopakele tarp
Manual Hacksaw Huki a hoʻokuke i ke koʻokoʻo i loko o ke ala ʻeha E hoʻohana wale i ka alumini lahilahi, fiberglass, a i ʻole ka lāʻau ke loaʻa ʻole nā ​​mea ʻoki hydraulic mana; e hoʻopaʻa paʻa i ka lāʻau e pili ana i ka ʻili me nā wili paʻa i paʻa e kekahi mea hoʻopakele lua
Oxy-Acetylene Oki Laka a i ʻole Plasma ʻoki ʻoki KALAPALA LOA: lawe ke kila i ka wela 1,000+ degere Celsius i loko o nā ʻōpū o loko o ka mea i pepehi ʻia i loko o kekona a hoʻā i ka lole/oxygen. E hōʻalo i ka wā e loaʻa ai nā mea ʻoki hydraulic a i ʻole nā ​​​​mea ʻoki mīkini. Inā hoʻohana ʻia ma ke ʻano he hopena hope loa ma ke kila kila kaumaha, ʻoki mamao loa mai ke kino me ka hoʻoinu mau ʻana i ke kumu waena me kahi paipu ahi.

Nā mea i hoʻokomo ʻia i ka alapine kiʻekiʻe: Fishhooks, Nail Guns, a me Taser Darts

ʻAʻole kēlā me kēia mea i hoʻopili ʻia he koʻokoʻo rebar nui; ʻIke pinepine nā kauka lapaʻau a me ka poʻe pane wao nahele i nā makau iʻa, nā kui pneumatic framing, a me nā mea hoʻoheheʻe uila (Taser).

1. Nā makau iʻa

He māwae piko ko ka makau i'a e pau ana i kahi kiko oi a me ka barb i ho'i hope i hana 'ia e hopu i ka 'i'o ke huki 'ia i hope.

  • I ka wā ʻaʻole pono ʻoe e wehe i kahi makau iʻa ma ke kula:
  • Hoʻokomo ʻia ka makau i loko a i ʻole kokoke i ka ** maka maka, lihilihi, a i ʻole nā ​​iwi iwi** (pale me ke kīʻaha pepa a hele koke i ke kauka ophthalmologist).
  • Hoʻokomo ʻia ka makau ma luna o kahi ke aʻa nui a i ʻole ke aʻalolo (neck, radial/ulnar wrist, groin, antecubital fossa), i loko o ka ** finger joint capsule or flexor tendon sheath**, a i ʻole ma lalo o kahi kui.
  • ʻO ia ka treble hook ʻano nui me ka ʻoi aku ma mua o hoʻokahi kiko i kanu ʻia a i ʻole ke kowali kokoke ʻana i ka ʻili i ka wā e hoʻoponopono ʻia ai.
  • Pehea ka wehe ʻana o nā kauka i kahi makau ʻili maʻalahi maʻalahi:
  • Ke ʻano o ka Advance-and-Cut (ʻoi loa ka palekana no nā makau hohonu a mānoanoa paha): Ma hope o ka hoʻomaʻemaʻe ʻana i ka ʻili a me ka hoʻomaʻemaʻe ʻana me ka antiseptic, ua hoʻokuʻu ʻia ka lae a me ka ʻili o ka makau ** i mua ma ka ʻaoʻao maoli o ka makau** a hiki i ka puka ʻana o ka piko o ka ʻili ma ka ʻili; ʻoki ʻia nā mea ʻoki uea i ka piko o ka ʻāʻī, a hoʻihoʻi ʻia ka lāʻau maʻemaʻe i waho o ka puka komo.
  • Ke ʻano String-Yank (no nā makau pāpaʻu i loko o ka ʻili ʻiʻo): Hoʻopili ʻia kahi loop o ke aho lawaiʻa ikaika a i ʻole ka lipine umbilical i ka waena waena o ka piko ʻāwili o ka makau i ka wā e kaomi ai ka mea hoʻopakele i ka maka/māwae o ka makau i lalo i ka ʻili (e wehe ana i ka ʻili mai ka dermis), a ukali ʻia e hoʻokahi axis brisk ma ka ʻaoʻao.

2. Pneumatic Nail-Gun Eha

ʻO nā kui pneumatic a me ka cordless framing nail hou e puhi ana i nā kui 5 a 9 kenimika (2 a 3.5 iniha) ma ka wikiwiki a hiki i 400 mika i kekona (1,300 kapuaʻi i kekona). ʻO ka mea koʻikoʻi, ʻo nā kui i hana pinepine ʻia ** i hoʻopaʻa ʻia i ke apo (i hoʻopaʻa ʻia i ka makahiki)** a i ʻole ** i hoʻopaʻa ʻia me nā paʻi paʻi kiʻi/wiea (nā kui i hui ʻia)** a i uhi ʻia i nā mea hoʻopili resin e hoʻoheheʻe ʻia i ka hopena a hoʻopili i ke kui i loko o ka iwi.

  • Protokona kōkua mua no nā ʻeha nail-gun:
  • Mai huki i waho i ka mea hoʻopaʻa pū kui me nā wili a i ʻole ka hāmare maʻuʻu ma kahi o ka hana: ʻO ka huki ʻana i ke kui i hoʻopaʻa ʻia a i ʻole ke apo lima i hope e moku ai nā aʻalolo, nā aʻa, a me nā aʻa koko a waiho ʻia nā ʻili uwea lepo a me nā ʻāpana resin i uhi ʻia i ke keleawe i loko o ka iwi a i ʻole ka ʻāpana hui.
  • E mālama i kēlā me kēia ʻeha o ka pū kui i ka umauma, ke poʻo, ka ʻāʻī, a i ʻole ka ʻōpū ma ke ʻano he pōʻino like me ka pū hoʻoweliweli: ʻOi aku ma mua o 25 pakeneka o nā ʻeha nail-gun cardiac e hele mua a kamaʻilio paha ma mua o ka hoʻomohala ʻana i ka ** cardiac tamponade **. E kelepona iā 911/112/999 koke.
  • No nā kī kui lima, manamana lima, kuli, a wāwae paha: E waiho ʻole i ke kui, e hana i kahi kāwele liʻiliʻi a i ʻole ka lua-roll bolster a puni ke poʻo kui e puka mai ana, e kuʻi i ka lima a i ʻole ke kuli ma ke kūlana i loaʻa, a hele i kahi keʻena pilikia no ʻelua nānā ʻana i nā radiographs (e nānā i ka hoʻololi ʻana i ka iwi, ka hoʻoulu ʻana o ka iwi, ka hoʻoulu ʻana o ka iwi, ka hoʻoulu ʻana o ka iwi, ka hoʻoulu ʻana i ke kino, a me ka hoʻoulu ʻana i ka iwi, a me ka hoʻoikaika kino kino), a me ka hoʻoulu ʻana o ka iwi. uhi.

3. Hoʻohana ʻia i nā mea kaua uila (CEW / Taser) ʻO nā Probes Barbed

Hoʻokomo ʻia nā ʻimi Taser e hoʻokō i ke kānāwai me kahi puʻupuʻu dart metala i hoʻopaʻa ʻia me kahi lāʻau i hoʻopololei ʻia he 9-a-12-milimeter (0.35-a-0.47-iniha). Pono e hoʻopaʻa ʻia nā mea ʻimi i hoʻokomo ʻia i loko o ka maka, maka, ʻāʻī, ʻāʻī, ka umauma wahine, ka ʻāʻī/genitalia, a i ʻole i loko o ka iwi a i ʻole nā ​​pūpū neurovascular ma kahi a wehe ʻia i ka haukapila.

E hoʻomanaʻo e uhi i nā maka ʻelua ke kau ʻia kekahi mea ma ka maka hoʻokahi

Inā he penikala, uwea, dart, a ʻāpana aniani paha i hoʻopaʻa ʻia ma ka maka ʻākau o ke keiki a mea hana paha, ʻo ke kūkulu ʻana i ka pale kīʻaha pepa pale ma luna o ka maka ʻākau ʻeha he hapalua wale nō ka hana. Ma muli o ka hoʻopili ʻana o ka lolo kanaka i nā maka ʻelua ma conjugate gaze, i kēlā me kēia manawa e lele ka maka hema ʻole i ka hema, ʻākau, i luna, a i lalo paha e nānā i nā mea lapaʻau, ʻo ka ʻōpoʻo maka ʻākau ʻeha i ka manawa like me ka huina hoʻokahi, e wili ana i ka retina a me ka iris e kūʻē i ka lāʻau impaled stationary. E uhi mālie i ka maka i ʻeha ʻole me kahi pāpaʻi palupalu a i ʻole ka lole oiai e kamaʻilio mālie e hōʻoluʻolu i ka mea maʻi.

ʻO ka hoʻopaʻa ʻana i ke kōkua mua e pale i ka impalement mai ka lilo ʻana i mea make ma mua o ka hōʻea ʻana o nā paramedics, akā ʻo ka hana trauma lima lima e hana i kēia mau mākau ma lalo o ke kaomi. E noʻonoʻo e hoʻopau i kahi kōkua mua i hōʻoia ʻia, Stop the Bleed, a i ʻole ka papa trauma wao nahele 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

Why is it so dangerous to pull out a knife, glass shard, or piece of rebar that is stuck in someone?

Inside the body, the solid shaft of an impaled knife, rod, or glass shard acts like a cork in a pressurized bottle, physically plugging the holes it just cut in major arteries, veins, or organs (a physiological effect called internal tamponade). At the same time, the muscular walls of injured blood vessels spasm tightly around the shaft to slow down bleeding. If you pull the object out outside of an operating room, two deadly things happen at once: the sharp edges slice through additional blood vessels and nerves on the way out, and the plugged arteries suddenly spring wide open deep inside the body where no one can reach them with finger pressure, causing fatal internal bleeding within minutes.

Are there ANY situations where you are supposed to pull out an impaled object before the ambulance arrives?

In emergency medicine guidelines worldwide, there are only two extremely rare exceptions. First, if an object pierces through the soft fleshy wall of the cheek into the mouth and causes uncontrollable bleeding directly into the throat that blocks the airway and prevents breathing, it may be carefully removed only if necessary to pack both sides of the cheek and keep the person from choking to death on blood. Second, if a victim is in confirmed cardiac arrest (unresponsive, not breathing, no pulse) and an object impaled in the center of the chest or back physically blocks rescuers from performing life-saving CPR chest compressions, the object must be cut flush or removed so CPR can begin immediately. In all other cases, leave the object strictly in place.

How do I stop severe bleeding from a wound when there is a knife or rod sticking right out of the middle of it?

Never push down on top of the impaled object itself. Instead, put on gloves, take two thick folded sterile gauze pads or clean cloths, and place them flat against the skin on either side of the object right where it enters the body (or wrap a split gauze pad around the base like a keyhole). Press firmly downward with your fingers on the skin and soft tissue immediately surrounding the shaft to compress the bleeding blood vessels against the underlying bone or muscle, while using your other hand to make sure the protruding object does not tilt or wobble.

Why do I have to cover BOTH of the victim's eyes if a pencil or shard of glass is only stuck in one eye?

Human eyes are neurologically wired in the brainstem to move together as a pair (a reflex called conjugate gaze). It is physically impossible for a person to look left or right with their good eye while keeping their injured eye still. If you shield only the injured eye and leave the uninjured eye uncovered, every time the frightened patient looks around at rescuers, their injured eyeball pivots underneath the shield, dragging delicate internal eye structures across the sharp tip of the impaled object. Covering the uninjured eye as well (while holding the patient's hand and explaining everything you are doing so they do not panic) keeps both eyeballs completely still.

What should we do if someone falls onto an iron fence or construction rebar and is pinned in place?

First, have bystanders immediately step in and support the person's full body weight with their hands, chairs, or wooden blocks so gravity does not pull their body further down the spike and tear internal organs. Never try to lift the person up and off the fence or rebar. Call your emergency number immediately and tell the dispatcher to send both an ambulance and Fire Technical Rescue with hydraulic cutters. Firefighters will stabilize the shaft, cool the metal if saws are used, and cut the fence post or rebar rod off at the base, leaving a short 10 to 15 centimeter (4 to 6 inch) section inside the patient to be removed safely by trauma surgeons in the operating room.

Can I just pull out a nail-gun nail from my hand or knee with pliers at the job site?

No, never pull out a pneumatic nail-gun fastener with pliers or a hammer at work. Framing nailers fire nails coated in heat-activated resin glue, and most collated nails have tiny barbed wire fragments attached to the shaft or ring-shanked threads that act like fishhooks inside tissue and bone. Pulling a nail out backward can rip nerves, tendons, and arteries or leave dirty wire pieces inside a joint space, causing septic arthritis. Stabilize the protruding nail head with a gauze doughnut pad, splint the joint, and go to an emergency department for X-rays and sterile surgical removal.

Nānā ʻia nā kumu

  • American College of Surgeons (ACS, United States): Advanced Trauma Life Support (ATLS) Student Course Manual: Penetrating Trauma, Impalement Injuries, and Hemorrhage Control.
  • National Association of Emergency Medical Technicians (NAEMT, United States): *Prehospital Trauma Life Support (PHTLS): Hoʻoponopono i nā mea i hoʻopaʻa ʻia a me ka hoʻopau ʻenehana *.
  • Ke Kōmike Kūkākūkā o ka Honua no ka Hoʻōla hou ʻana (ILCOR, International) & Keʻa ʻulaʻula ʻAmelika: Nā Kokua Mua a me nā Kūlana Hoʻōla: Severe Bleeding and Impaled Foreign Objects.
  • Lau Hana Ola Lahui (NHS, United Kingdom) & St John Ambulance (United Kingdom): First Aid Manual: Embedded Objects, Amputations, and Severe External Bleeding.
  • ** Nā kikowaena no ka hoʻopaʻa ʻana a me ka pale ʻana i ka maʻi (CDC / NIOSH, ʻAmelika Hui Pū ʻIa): ** Pale ʻana i ka Nail-Gun a me ka mālama ʻana i nā maʻi maʻi o nā ʻeha Pneumatic Fastener High-Velocity.
  • Faculty of Pre-Hospital Care, Royal College of Surgeons of Edinburgh (United Kingdom): Consensus Guidance on Prehospital Management of Thoracic and Abdominal Impalement.

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