ʻO nā ʻeha ʻeha hohonu, hehi ʻana i ke kui, a me ka pale ʻana i ka maʻi maʻi maʻi¶

ʻO ka hehi ʻana i ke kui, ke hou ʻana i ka ʻili me ka uwea paʻa, ka hoʻopaʻa ʻia ʻana e ke kākalai rose a i ʻole ka mamala lāʻau, a i ʻole ka loaʻa ʻana o kahi ʻeha hohonu e hana ai i kahi pilikia olakino hoʻopunipuni. ʻAʻole like me nā ʻoki ākea ākea e kahe wale ana a maʻalahi ke holoi ʻia, hana ʻia kahi mea puncture ololi e like me ka nila hypodermic. Hoʻokuʻu ʻo ia i nā hua bacteria lepo, anaerobic Clostridium tetani spores, a me nā ʻāpana o ka ʻōpala kāmaʻa a i ʻole ka sock lint i loko o ka momona subcutaneous, plantar fascia, capsules hui, a i ʻole periosteum iwi, a laila pani ʻia nā sila ʻili elastic ma hope o ka lau a i ʻole ka lae.

Hāʻawi kēia alakaʻi i nā kaʻina hana ulia pōpilikia e pili ana me nā ʻōlelo aʻoaʻo mai ka World Health Organization (WHO), ka United States Centers for Disease Control and Prevention (CDC), ke UK Health Security Agency (UKHSA), ka American College of Foot and Ankle Surgeons (ACFAS), a me ka Infectious Diseases Society of America (IDSA). E hana koke i ka wai i ka ʻeha me ka hoʻopaʻa ʻole ʻana i ka sila, e hōʻoia ana i kou kūlana hoʻoikaika tetanus 5 makahiki me 10 makahiki, a me ka nānā ʻana i ka Pseudomonas aeruginosa cartilage a i ʻole ka iwi maʻi inā i hou ʻia ke kui ma ka sneaker e pale ai i ke kīnā mau a me ka hoʻoweliweli ola.

E hana i kēia i kēia manawa¶

Inā hehi ʻoe a i ʻole kekahi mea kokoke i ke kui, ke kākalaioa, ka ʻāpana aniani, ka uwea metala, a i ʻole ka ʻeha hohonu:

1. Noho i lalo a nānā inā paʻa mau ka mea: Wehe koke i ke kaumaha a pau mai kahi wāwae ʻeha. Inā pipili māmā kahi kui liʻiliʻi, kaʻi, a i ʻole ke kākalaioa i ka wāwae o kou kāmaʻa a i ʻole ka ʻili pāpaʻu a huki ʻole i waho i kou hāpai ʻana i kou wāwae, e wehe pono i kou kāmaʻa a me ka ʻili. **Aka naʻe, inā i hoʻopaʻa hohonu ʻia ka mākia nui, ke koʻokoʻo, ka ʻāpana aniani, a i ʻole ka lāʻau i loko o ka wāwae, ka lima, a i ʻole ke kino, a i ʻole e hele aʻe ma kahi lālā, mai huki i waho. impalement stabilization alakaʻi) a kelepona i kāu helu ulia pōpilikia kūloko (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom) ma o kā mākou helu pilikia papa kuhikuhi.
2. E hoʻomalu i ke kahe nui ʻana i ka wā e ʻae ana i ka hoʻoheheʻe ʻana o ka capillary pōkole no nā ʻoki liʻiliʻi: Inā e hū aʻe ana ke koko, e hoʻopili i ke kaomi lima pololei me ka lole maʻemaʻe a i ʻole ka paʻi lole maʻemaʻe no 10 mau minuke. hoʻomalu koko ʻino). Inā he mau kulu wale nō o ke koko venous ʻeleʻele ka paʻi ʻana, e hoʻokahe mālie ke koko no 30 a 60 kekona ke neʻe ʻoe i ka poho, no ka mea, kōkua ke kahe o waho e hoʻolei i ka lepo a me ka bacteria mai ka ʻāpana haiki.
3. E holoi a hoʻohāinu ma lalo o ka wai piʻi kaomi no 5 a 10 mau minuke: E hoʻopaʻa pono i ka ʻeha ma lalo o ke kahawai ikaika o ka wai kahe maʻemaʻe a holoi pono i ka ʻili a puni me ke kopa hale maʻemaʻe no 5 a 10 mau minuke. E hohola mālie i nā ʻaoʻao o ka wehe ʻana me nā manamana lima maʻemaʻe i hiki i ka wai kahe ke kahe i loko o ka waha o ka ʻāpana, akā ʻaʻole ʻoe e ʻū i nā pulupulu, nā tweezers, a i ʻole nā ​​nila i loko o ka lua.
4. Nānā i ka mea a me kou kāmaʻa no nā ʻāpana nalowale: E nānā pono i ke kui, ke kākalaioa, a i ʻole ka māmala mea i hōʻeha ʻia a nānā i ka lalo a me loko o kou kāmaʻa a me kou wāwae. Inā ʻoki ka piko o ka māmala lāʻau a i ʻole ke kākalaioa i loko o kou wāwae, a i ʻole ke kuʻi ʻana o ke kui ma ke kapuaʻi ʻōpala o kahi kāmaʻa haʻuki a kāmaʻa hana paha, e haʻi koke i ke kauka nānā.
5. Uuhi me ka lole ʻaʻahu maʻemaʻe (ʻaʻole e hoʻopaʻa i kahi ʻeha maʻi i pani ʻia): E hoʻopili i kahi ʻāpana lahilahi o ka petroleum jelly maʻamau a i ʻole ka ʻaila ʻaila antibiotic a puni ka ʻili a uhi ʻia me kahi paʻi maʻemaʻe a me ke kāʻei māmā. Mai hoʻopaʻa i ka ʻeha ʻeha i pani ʻia me ke kāpili ʻili cyanoacrylate, ka tape butterfly, a i ʻole ke kāʻei wai, e pahele ana i nā spores anaerobic Clostridium tetani i loko o kahi keʻena ʻole o ka oxygen.
6. E ʻimi i ka loiloi lāʻau lapaʻau i ka lā hoʻokahi no ka pale ʻana i ka tetanus a me nā kino haole hohonu: E kipa i ke keʻena mālama koʻikoʻi a i ʻole ke keʻena pilikia i ka lā hoʻokahi inā he lepo a i waho paha ka mea, inā i hele ke kui ma ka kāmaʻa a i ʻole ka sneaker, inā ma ka ami, ka lima, a i ʻole ka wāwae, a inā ʻaʻole ʻoe i loaʻa i ka tetanus booster i loko o 5 mau makahiki i hala.

Ka hoʻoholo hoʻoholo hoʻoholo ʻana i ka hoʻāʻo ulia pōpilikia a me ka maʻi maʻi maʻi¶

flowchart TD
    Start["ʻEha Hohonu (Nail, Thorn, Splinter, Wire, Glass)"] --> Impaled{"Ua paʻa a paʻa paha ka mea i ka iwi/hui?"}

    Impaled -->|Yes: Deeply Embedded or Through-and-Through| LeaveIt["MAI Wehe i ka mea<br/>E hoʻopaʻa me nā lole nui a puni ka lāʻau<br/>E kelepona iā 911 / 112 / 999 a i ʻole ka lawe ʻana i ka Oihana Emergency"]

    Impaled -->|No: Object came out cleanly| Irrigate["ʻO ka wai kiʻekiʻe koke<br/>E ʻae i ka 30-60s oozing liʻiliʻi, a laila holoi me ke kopa a me<br/>pressurized wai kahe wai no 5 a 10 mau minuke<br/>E uhi ākea me ka gauze sterile; ʻAʻole hoʻopaʻa paʻa"]

    Irrigate --> RiskCheck{"Aia kekahi mau hiʻohiʻona kiʻekiʻe kiʻekiʻe kiʻekiʻe kiʻekiʻe kiʻekiʻe/infectious?"}

    RiskCheck -->|Nail pierced through a rubber-soled sneaker/boot| Sneaker["Loaʻa kiʻekiʻe o Pseudomonas Osteochondritis<br/>Same-day Urgent Care / ED evaluation for surgical coring,<br/> Foreign body removal (sock/foam), and targeted care"]
    RiskCheck -->|Retained wooden splinter, thorn, or glass fragment| Retained["ʻO ka Lapaʻau Lapaʻau a me ka unuhi ʻana i ka lā hoʻokahi<br/>Ultrasound (no ka lāʻau/kākalaioa) a i ʻole X-ray (no ka metala/aniani)<br/>me ka hoʻohemo ʻana i ka maʻi maʻi kūloko kūloko."]
    RiskCheck -->|Clean, shallow puncture without retained material| TetanusEval["E noʻonoʻo i ke kūlana o ka maʻi maʻi tetanus koke"]

    LeaveIt --> TetanusEval
    Sneaker --> TetanusEval
    Retained --> TetanusEval

    TetanusEval --> VaxHist{"Ua hoʻopau ka mea maʻi >= 3 mau kau o ke ola o ka Vaccine Tetanus?"}

    VaxHist -->|No, Unknown, or < 3 Doses (Dirty/Puncture Wound)| FullPEP["Hoʻoponopono i ʻelua ma ka lā 0 (ma nā lālā ʻokoʻa):<br/>1. Hoʻopaʻa Kano Tetanus (Tdap a i ʻole Td)<br/>2. Tetanus Immune Globulin (TIG 250 IU IM)"]
    VaxHist -->|Yes (>= 3 Doses): Last booster >= 5 years ago| FiveYr["Hoʻoponopono i ka Tetanus Booster (Tdap a i ʻole Td) i loko o 48h<br/>(5-Makahiki Rula pili i nā ʻeha lepo/punakea a pau)<br/>ʻAʻole pono ʻo TIG ke ʻole e hoʻopaʻa ʻia i ka immunocompromised."]
    VaxHist -->|Yes (>= 3 Doses): Last booster < 5 years ago| Covered["ʻAʻohe kano a TIG i koi ʻia; nānā no ka maʻi bacteria"]

ʻO ka pathophysiology o nā ʻeha ʻeha: no ke aha nā puka liʻiliʻi e hoʻoulu ai i nā maʻi koʻikoʻi¶

Ke ʻoki ʻoe i kou manamana lima me ka pahi kīhini maʻemaʻe, wehe ʻia ka ʻoki ma ka laina laina, kahe ke koko, hōʻike i ke kino i ka oxygen ea, a hiki i ke kopa a me ka wai e hiki i lalo o ka ʻeha. ʻO ka ʻeha ʻeha hohonu ke ʻano like me ka mechanical a me ke ʻano biological.

ʻO ka mīkini pahele anaerobic¶

1. Hoʻohuki piston hohonu: Ke komo ka ʻili i ka ʻili ma lalo o ke kaumaha o ke kino o kahi mea ʻoi ʻoi e like me ke kui, awl, pitchfork tine, a i ʻole ke kākalaioa. ʻImi ʻo ia i ka stratum corneum o waho a hoʻokuʻu i ka maʻi bacteria o ka ʻili o ka ʻili (Staphylococcus aureus a me Streptococcus pyogenes), nā spores lepo (Clostridium tetani), a me nā puʻupuʻu microscopic o ka ʻiʻo epidermal, sock lint, a me ka pahu kāmaʻa 10 a 30 millimeters (0.2 inches) hohonu hohonu (0.4 inches to vascular). fascia, tendons, a iwi paha.
2. Hoʻopaʻa ka ʻili elastika i ka ʻili: ʻO ka manawa e huki ʻia ai ke kui, e hoʻihoʻi hou ʻia nā ʻili kolagen elastic o nā dermis a me ka ʻili kanu mānoanoa o ke kapuaʻi e like me ke kīpē hoʻopaʻa paʻa ponoʻī. I loko o nā minuke, hoʻopaʻa ʻia kahi puʻupuʻu fibrin liʻiliʻi i ka puka ʻili he 2-milimita.
3. Oxygen depletion and necrotic hematoma: I loko o ka ʻāpana subcutaneous i hoʻopaʻa ʻia, ua hoʻoheheʻe ʻia nā moena capillary i ʻoki ʻia i kahi ʻeke liʻiliʻi o ke koko ʻaʻa (micro-hematoma) ma ka ʻaoʻao o nā cell devitalized a me nā fibers haole. ʻAi ʻia nā hua bacteria aerobic (e like me Staphylococcus) i ka nui liʻiliʻi o ka oxygen i hoʻoheheʻe ʻia i waiho ʻia i loko o ka ʻeke, e hoʻemi ana i ka hiki ke hoʻemi ʻokiʻoki ʻia (redox) i kahi kokoke i ʻole.
4. Ka hoʻoulu ʻana o nā anaerobes obligate: ʻAʻole hiki i nā endospora moe Clostridium tetani ke hoʻopuʻu i loko o ka ʻiʻo olakino maikaʻi-oxygenated. Eia naʻe, i ka wā e paʻa ai i loko o kēia ʻeke pōʻeleʻele, mahana, hoʻopau ʻia ka oxygen, hoʻoneʻe ʻia, e ulu ana nā spores i loko o nā hua bacteria vegetative ikaika a hoʻomaka e huna tetanospasmin, kekahi o nā neurotoxins ola kino loa i ʻike ʻia e ka ʻepekema.

CDC a me WHO Tetanus Prophylaxis Matrix: nā lula 5-makahiki vs. 10-makahiki¶

No ka mea, lawe ka ma'i tetanus mai 3 a 21 mau la (ma ka awelika 7 a hiki i ka 10 mau la) e ulu a hoopuka i ke kino, e loaa koke ana i ka ma'i ma hope o ka wehe 'ana i ka ma'i. Hoʻoholo ka poʻe kauka inā pono ʻoe i ka lāʻau lapaʻau maʻi tetanus wale nō, a i ʻole ** he kano maʻi tetanus a me Tetanus Immune Globulin (TIG)**, ma ke kuhikuhi ʻana i ʻelua kumu: ka hoʻokaʻawale ʻana i nā ʻeha a me kau moʻolelo o ka lāʻau lapaʻau i ke ola a pau.

KaʻAnuʻu Hana 1: Hoʻokaʻawale i ka ʻeha (Clean/Minor vs. Dirty/Tetanus-Prone)¶

Hoʻokaʻawale nā keʻena olakino olakino (CDC, WHO, UKHSA) i nā ʻeha āpau i ʻelua ʻāpana:

• ** ʻEha Maʻemaʻe a Liʻiliʻi **: ʻOki maʻemaʻe, ʻoki laina a ʻoki ʻia paha i loko o ka hale me kahi mea maʻemaʻe (e like me ka pahi kīhini maʻemaʻe a ʻoki pepa paha), ma lalo o 6 mau hola, me nā ʻaoʻao maʻemaʻe, ʻaʻohe ʻiʻo i ʻoki ʻia, a ʻaʻole pili me ka lepo, lepo alanui, kohu, a me nā feces.
• ** ʻO nā ʻeha ʻē aʻe a pau (Nā ʻeleʻele a i ʻole Tetanus-Prone Wounds)**: Aneʻe nā ʻeha ʻeha a pau o waho e hāʻule i loko o kēia ʻāpana. Aia kēia me nā ʻeha i haumia i ka lepo, lepo, lepo o ke alanui, ʻōpala, feces, a i ʻole kohu (me ka nahu holoholona a me ke kanaka); ʻeha ʻeha hohonu (ka hehi ʻana i ke kui, ke kākalaioa, ka māmala, a i ʻole ka nila); avulsions; ʻeha ʻeha; kuni; hau hau; projectiles; a i ʻole kekahi ʻeha i loaʻa i nā ʻiʻo devitalised a i ʻole nā ​​​​kino ʻē.

KaʻAnuʻu Hana 2: E hoʻopili i ka pākaukau ʻo CDC/WHO Tetanus Immunization Table¶

Ka hoʻomaopopo ʻana iā Tdap vs. Td a me Tetanus Immune Globulin (TIG)¶

1. No ke aha "Ua loaʻa iaʻu kahi kī tetanus 7 mau makahiki i hala aku nei" ʻAʻole lawa no ke kui kui: Hoʻomanaʻo ka nui o nā poʻe mākua i ka lohe ʻana ua mau ka pana tetanus no 10 mau makahiki. ʻOiai ua lawa ka wā lōʻihi he 10 makahiki no nā ʻoki ʻoki liʻiliʻi i loko o ka hale, e emi mālie ana ka nui o ka antitoxin antibody ma waena o nā makahiki 5 a me 10. No kahi ** ʻeha ʻeha a hohonu paha ** (e like me ke hehi ʻana i kahi kui a i ʻole mea hana māla), hoʻokō nā alakaʻi lapaʻau i ka ** kānāwai 5-makahiki**: inā he 5 a ʻoi aʻe kāu mea hoʻoikaika hope i 5 mau makahiki i hala aku nei, pono ʻoe i kahi mea hoʻoikaika kino kiʻekiʻe.
2. ** ʻO wai ka lāʻau lapaʻau i hāʻawi ʻia (DTaP vs. Tdap vs. Td)**:
3. Nā keiki ma lalo o 7 makahiki: Loaʻa iā DTaP (ka lāʻau lapaʻau maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi maʻi acellular pertussis).
4. Nā ʻōpio a me nā mākua (11 mau makahiki a ʻoi aku): Loaʻa iā Tdap (tetanus, reduced diphtheria, acellular pertussis) inā ʻaʻole lākou i loaʻa mua i ka Tdap ma ke ʻano he kanaka makua, a inā hāpai lākou (e hāʻawi i nā antibodies pertussis i ka pēpē), a i ʻole Td (tetanus a me diphtheria). Hāʻawi ʻo Tdap a i ʻole Td i ka pale like a piha i ka tetanus.
5. Ke koi ʻia ʻo Tetanus Immune Globulin (TIG): Hoʻoikaika ka pana ʻana i ka maʻi tetanus i kou ʻōnaehana pale ponoʻī e kūkulu i nā antibodies, e lawe ana i kekahi mau lā i kahi mea i hoʻopau mua i kā lākou wā kamaliʻi 3-dose series, a lawe i nā hebedoma i ka mea ʻaʻole i hoʻopaʻa ʻia. No laila, inā loaʻa i kahi kanaka me ka ** mōʻaukala kano ʻike ʻole ʻia a i ʻole ka liʻiliʻi ma mua o 3 mau puʻupuʻu ola** i ʻeha ʻia i ka ʻeha kui a i ʻole ka ʻeha lepo, ʻaʻole hiki i ka lāʻau lapaʻau ke hana wikiwiki. Pono ka haukapila e hoʻokomo i ka 250 International Units (IU) o Human Tetanus Immune Globulin (TIG) intramuscularly ma kahi kahua anatomical kaʻawale no ka hoʻolako koke ʻana i ka antitoxin neutralization i ka wā e hoʻomaka ai ke kano.
6. ** ʻEhia koke ma hope o ka ʻeha ʻana e loaʻa iā ʻoe ke kī tetanus?: ʻO ke kūpono ** i loko o 24 a 48 hola o ka ʻeha. Eia nō naʻe, inā ua hoʻopaneʻe ʻoe i ka ʻimi mālama ʻana no kekahi mau lā a i ʻole he pule ma hope o ka hehi ʻana i ke kui, pono ʻoe e kiʻi koke i kāu mea hoʻoikaika tetanus a i ʻole TIG, no ka mea hiki ke hoʻonui ʻia ka manawa incubation o ka tetanus a hiki i 21 lā a ʻoi aku paha.

ʻO ka "Sneaker Nail" Emergency: Pseudomonas aeruginosa osteochondritis¶

ʻO kekahi o nā momi orthopedic koʻikoʻi i ka lāʻau lapaʻau pilikia, ʻo ia ka ** hehi ʻana i ke kui e kuʻi ana ma ka wāwae o kahi sneaker, kāmaʻa tennis, a i ʻole kāmaʻa hana hoʻoheheʻe ʻia** ma mua o ka hehi ʻana i ke kui me ka wāwae ʻole.

No ke aha i ʻoi aku ka pōʻino o ke kui ma o ka sneaker ma mua o ke kuʻi wāwae ʻole¶

ʻOiai ʻo ke kui kuʻe wāwae ʻaʻole e hoʻolauna mua i nā meaola lepo a me nā pua ʻili (Staphylococcus a me Streptococcus), kahi kui e kuʻi ana i lalo o kahi sneaker e hele i loko o ka ** polyurethane i hoʻomoʻa ʻia i ka wela a i ʻole EVA foam midsole** o ka kāmaʻa.

• ** ʻO ka huʻa kāmaʻa he incubator no Pseudomonas aeruginosa**: Hōʻike nā haʻawina microbiological ʻo ka ʻūhā a me ka porous ʻāʻī o loko o nā kāmaʻa haʻuki a me nā kāmaʻa hana i hoʻopaʻa ʻia e Pseudomonas aeruginosa, kahi hua bacteria Gram-negative ikaika.
• Hoʻopololei pololei ʻia i loko o ka cartilage wāwae a me ka iwi: I ka wā e hou ai ke kui i ka kāmaʻa a komo i loko o ka kapuwai o ka wāwae, ʻokiʻoki kona wēlau ʻākala i nā ʻāpana microscopic o Pseudomonas-hoʻopiha ʻia i ka huʻa sneaker a me nā pulu sock, e hoʻokomo pololei iā lākou i loko o ka fascia plantar, nā ami liʻiliʻi o nā manamana wāwae (iwi metatarsophalangeal).
• Makemake ʻo Pseudomonas i ka cartilage: He pilina ko Pseudomonas aeruginosa* no ka cartilage hyaline avascular a me ka iwi periosteum. Ma loko o 2 a 7 mau lā ma hope o ka puncture sneaker, hoʻomohala ka poʻe maʻi i ka Pseudomonas osteochondritis a i ʻole osteomyelitis: he iwi hohonu, luku a me ka maʻi hui e hoʻopau ai i nā hono o ka wāwae inā ʻaʻole i hoʻopau ʻia a mālama ʻia me nā lāʻau anti-pseudomonal antibiotic.

Ka hoʻohālikelike ʻana i nā hiʻohiʻona ʻeha ʻeha a me nā pahuhopu microbial¶

Ke kōkua mua i kēlā me kēia ʻanuʻu no nā ʻeha a me nā mamala¶

ʻO ka mālama ʻana i nā ʻeha mechanical kūpono i nā minuke 30 mua e wehe i ka hapa nui o nā mea haumia ma mua o ka sila ʻana o ka ʻili iā lākou i loko.

1. Pehea e hoʻoinu pono ai i kahi kui hou a i ʻole uea puncture¶

1. E holoi mua i kou mau lima ponoʻī: Holoi i kou mau lima me ke kopa a me ka wai a kau i nā mīkina lima lapaʻau maʻemaʻe inā e mālama i kekahi.
2. E paipai i ka 30 a i ka 60 kekona o ka venous oozing (inā he liʻiliʻi ke koko): Inā ʻaʻole e hū a kahe nui paha ke koko, e hoʻoheheʻe maoli ka puka o ka venous no ka hapalua minuke ke hoʻā ʻoe i ka faucet. Mai ʻomi ikaika a ʻokiʻoki paha i ka ʻiʻo a puni ka ʻeha ʻeha, no ka mea, hiki i ka ʻomi ʻana ke hoʻokuʻu i ka bacteria i loko o nā moena capillary a puni.
3. E hoʻohāinu ma lalo o ka wai piʻi kaomi no 5 a 10 mau minuke: E kau pono i ka wāwae a i ʻole ka lima ma lalo o kahi kahawai ikaika o ka wai kahe maʻemaʻe. E holoi pono i ka ʻili a puni me ke kopa maʻemaʻe a me ka wai e hoʻomaʻemaʻe i ka lepo, nā ʻōpala, a me nā ʻōpala kāmaʻa mai ka puka ʻeha.
4. Mai hoʻomoʻu i kahi ʻeha i loko o kahi kīʻaha paʻa a i ʻole ʻauʻau paʻakai Epsom: ʻO ka hewa maʻamau o ka home ʻo ka hoʻoinu ʻana i ka wāwae i ʻoki ʻia i loko o ka pahu a i ʻole ke kīʻaha wai mehana a me nā paʻakai Epsom ma hope koke o ka ʻeha. ʻO ka ʻū ʻana i loko o ka wai ʻūlū e hoʻohuli i ke kīʻaha i sopa bacteria mehana i hana ʻia mai ka lepo ma ke koena o kou wāwae, a laila e hū wale i loko o ka ʻāpana puncture. E hoʻohana mau i ka wai kahe e holoi ana i nā mea haumia ma lalo o ke kahawai.
5. E hōʻalo i nā kemika cytotoxic koʻikoʻi i loko o ka poka: Mai ninini ʻole i ka hydrogen peroxide, ** ʻānai waiʻona**, a i ʻole bleach i loko o kahi ʻeha hohonu. Huhū nui ka hydrogen peroxide i ka hoʻopili ʻana me ka catalase koko, he mea kupanaha ka nānā ʻana akā hoʻopau maoli i nā keʻokeʻo keʻokeʻo olakino (neutrophils) a me nā fibroblasts i ka wā e hana ana i nā ʻiʻo make microscopic e makemake ana i ka ulu anaerobic Clostridium tetani. ʻO ka wai kahe maʻemaʻe a me ka kopa maʻemaʻe (a i ʻole ka paʻakai maʻamau a me ka wai hoʻoheheʻe povidone-iodine) ʻoi aku ka palekana a ʻoi aku ka maikaʻi.
6. E hoʻopili i ka lole hanu, ʻaʻole hoʻoheheʻe ʻia: E paʻi i ka ʻili e hoʻomaloʻo me ka gauze sterile, e kau i ka lole māmā o ka petroleum jelly a i ʻole ka ʻaila ʻaila triple-antibiotic e mālama i ka wehe ʻana o ka ʻili mai ka pani ʻana i ka wā mua, a uhi ʻia me kahi pā lole sterile i hoʻopaʻa ʻia me ka lipine pepa a i ʻole ke kāʻei ʻōwili. E hoʻololi i ka ʻaʻahu i kēlā me kēia lā a hoʻokiʻekiʻe ka wāwae i ka wā e noho ana e hōʻemi i ka edema throbbing.

2. I ka manawa a pehea e wehe ai i ka mamala lāʻau a i ʻole ke kākalaioa ma ka hale¶

Pono ʻoe e wehe wale i kahi maʻa a i ʻole ma ka home inā he ** liʻiliʻi, pāpaʻu, e noho ana ma lalo o nā ʻili o luna o ka ʻili (epidermis/superficial dermis), a he hopena huelo ʻike ʻia hiki iā ʻoe ke hopu maʻalahi**.

• E hoʻomaʻemaʻe i kāu mau mea hana: E hoʻomaʻemaʻe i ʻelua mau tweezers kikoʻī maikaʻi a me kahi nila humuhumu me ka 70% isopropyl alcohol. E holoi i ka ʻili a puni ka māmala me ke kopa a me ka wai.
• Huki ma ka ʻaoʻao pololei o ke komo ʻana: E hoʻopaʻa i ka wēlau o ka māmala me nā tweezers e pili kokoke ana i ka ʻili o ka ʻili a hoʻoheheʻe maikaʻi ʻia ** ma ka huina like i komo ai**. ʻO ka huki pololei ʻana i luna ma kahi kihi 90-degere e paʻi i ka lāʻau palupalu a i ʻole nā ​​kākalaioa rose i ka hapalua, e waiho ana i ka piko e kanu hohonu i ka dermis.
• Inā ʻaʻole uhi ʻia ka piko e ka ʻili lahilahi o ka ʻili make: E hoʻohana i ka nila i hoʻomaʻemaʻe ʻia i ka waiʻona e hoʻokiʻekiʻe mālie i ka hale ʻālohilohi lahilahi o ka epidermis make ma luna o ka hope o ka mamala a hiki i nā tweezers ke hopu i ke kumu lāʻau.
• I ka wa e hooki ai a hele i ke kauka no ka mamala: Mai eli i ka i'o koko ma ka hale ina:
• ʻO ka māmala he hohonu, kū pololei, a i ʻole kanu ʻia paha ma lalo o ka ʻili paʻa.
• Aia ka māmala ma lalo o ka manamana lima a i ʻole ka manamana wāwae (subungual)** a ua ʻoki ʻia ka ʻili.
• Aia ka mamala kokoke i ka maka, ma kahi ami manamana, a i ole hohonu o ka wawae.
• ʻO ka mea he barbed (e like me ka makau iʻa a cactus glochid) a i ʻole ** aniani palupalu**.
• No ke aha e hoʻohana ai nā kauka i ka Ultrasound ma mua o nā kukui X no ka lāʻau a me nā kākalaioa: Hōʻike ʻia nā kui metala a me ka hapa nui o nā ʻāpana aniani i nā kukui X maʻamau (radiopaque). Eia naʻe, ʻaʻole ʻike ʻia ka ** nā māmala lāʻau, nā kākalaioa mea kanu, nā spines cactus, a me ka plastic ma nā kukui X maʻamau (radiolucent)** ma kahi o 85 pakeneka o nā hihia. Hoʻohana nā kauka lapaʻau wikiwiki a me nā pilikia pilikia i ka ʻaoʻao moe ** ʻo ka ultrasound point-of-care kiʻekiʻe (POCUS)** no ka nānā ʻana i nā mamala lāʻau i kanu ʻia a hiki i ka 1 millimeter, hoʻopiʻi i ka wāwae a i ʻole ka lima me kahi poloka nerve kūloko, a wehe i ka ʻāpana holoʻokoʻa me ka ʻole o ka ʻeli makapō.

ʻO ka ʻike ʻana i nā maʻi Tetanus ("Lockjaw") a me nā maʻi ʻeha hohonu¶

Ma muli o ka hoʻopaʻa koke ʻana o nā ʻeha ʻeha ma luna, ʻike pinepine lākou i ka hoʻōla piha ʻana ma ka ʻili i loko o 48 mau hola i ka wā e hū mai ana kahi maʻi koʻikoʻi ma lalo, a i ʻole i ka wā e paʻa ana ka toxin tetanus i ka ʻōnaehana nerve.

Nā hae ʻulaʻula o ka ʻeha bacteria a i ʻole ka iwi iwi (Nā lā 1 a 7)¶

E hoʻi koke i kahi keʻena pilikia a i ʻole ke keʻena mālama koʻikoʻi inā ʻike ʻoe i kekahi o kēia mau hōʻailona kūloko ma hope o ka ʻeha ʻana:

1. ** ʻO ka hōʻailona "Day 3 to Day 5 Rebound Pain"**: Pono e hoʻomaikaʻi maikaʻi ʻia ka ʻeha mai ka ʻeha mechanical o kahi kui i nā hola 48 mua. Inā ʻoi aku ka maikaʻi o ka ʻeha i ka lā 1 a me ka lā 2, a laila e ulu koke ka ** ʻeha, ʻeha hohonu, wela, a pehu paha i ka lā 3, 4, a i ʻole 5 ** (ʻoiai inā ʻaʻole hiki iā ʻoe ke amo i ke kaumaha ma ka pōleʻa a i ʻole kuʻekuʻe wāwae o kou wāwae), manaʻo ʻoe he abscess hohonu plantar space a i ʻole Pseudomonas osteochondritis.
2. E hohola ana i ka erythema (ʻulaʻula) a i ʻole nā ​​ʻano ʻulaʻula: E hoʻonui ana ka ʻulaʻula i waho ma mua o 1 a 2 kenimika (0.4 a 0.8 ʻīniha) mai ka lua puncture, a i ʻole nā ​​laina ʻulaʻula e ʻimi ana i ka wāwae, kuʻekuʻe wāwae, a i ʻole ka poʻe lima e pili ana i nā puna lymph (piʻi lymphangitis).
3. Ka wai ʻawaʻawa a i ʻole ʻala ʻino: Puka mānoanoa melemele, ʻōmaʻomaʻo, a hina ʻeleʻele paha mai ka ʻōpala i ka wā e kaomi ʻia ai, a i ʻole he ʻala ʻino i hui pū ʻia me nā ʻeha ma lalo o ka ʻili (subcutaneous crepitus, he lāʻau ulia pōpilikia e hōʻike ana iā Clostridial myonecrosis / gas gangrene).
4. Nā hōʻailona o Kanavel o ka maʻi ʻāʻī o ka manamana lima: Inā i ʻō ʻia ka ʻaoʻao pāma o ka manamana lima i kahi kākalaioa, uea, a i ʻole ke kui a pehu like ka manamana lima e like me ka sausage, hoʻomaha ma kahi kūlana piʻo iki, ʻoluʻolu ma ka ʻaoʻao o ka pāma o ka ʻāʻī, a hōʻeha ʻoe i ka ʻeha nui ke hoʻāʻo ʻoe e hoʻopololei i ka manamana lima me ka hala ʻole.

Ka ʻike ʻana i nā hōʻailona neurological o Generalized Tetanus (La 3 a 21)¶

ʻAʻole ** ʻike ʻia ʻo Tetanus he ʻulaʻula a i ʻole ka maʻi pus ma ka wahi ʻeha; ʻoiaʻiʻo, he liʻiliʻi a hoʻōla ʻia ka ʻeha kumu mua i ka wā e hoʻomaka ai ka tetanus. Ke hele nei ka neurotoxin Tetanospasmin i hope me nā aʻalolo kaʻa a hiki i ke kuamoʻo a me ka lolo, kahi e ālai mau ai i ka hoʻokuʻu ʻana o nā neurotransmitters inhibitory (glycine a me GABA). Me ka ʻole o nā "brakes" hoʻopaʻa ʻia, ke ahi ʻole nā ​​neurons kaʻa, e hoʻopaʻa ana i nā ʻiʻo iwi i loko o ka ʻehaʻeha a me ka hoʻomau mau ʻana:

• Trismus ("Lockjaw"): ʻO ka hōʻailona mua loa ma luna o 75 pakeneka o nā maʻi. E ʻeha a ʻeha ka ʻiʻo masseter o ka ʻāʻī, a he mea paʻakikī a hiki ʻole paha ke wehe piha i ka waha a i ʻole nahu i ka meaʻai.
• Risus sardonicus: Hoʻomau ʻia ka spasm involuntary o nā ʻiʻo maka e huki ana i nā kihi o ka waha i waho i loko o kahi ʻāʻī paʻa a paʻa me nā kuʻemaka piʻi.
• Dysphagia a me ka ʻāʻī ʻoʻoleʻa: ʻO ka ʻoʻoleʻa holomua o ka ʻāʻī, ka ʻāʻī, a me ka ʻai ʻana i nā ʻiʻo, e hana ana i kahi pilikia kiʻekiʻe o ke keʻakeʻa ʻana o ke ea a me ka manaʻo.
• Opisthotonus a me ka ma'i tetanic ma'amau: Ka 'o'ole'a 'eha'eha o ka paia o ka 'ōpū (e like me ka papa) a me nā 'i'o hope e pio ai ka iwi kuamo'o i hope i ke kakaka 'o'ole'a (opisthotonus). Hoʻomau ka mea maʻi ** ʻike a makaʻala loa ** i loko o kēia mau ʻōpū o ke kino holoʻokoʻa, hiki ke hoʻoulu ʻia e nā mea hoʻoulu liʻiliʻi e like me ke kukui ʻālohilohi, ka leo hikiwawe, a i ʻole ka hoʻopā ʻana, a ua lawa ka ikaika e haʻi ai i ka vertebrae a i ʻole nā ​​ʻāʻī waimaka.
• Hōʻole ka hanu a me ka hoʻopaʻapaʻa autonomic: ʻAʻole nā ​​spasms o nā kaula leo (laryngospasm) a me ka diaphragm e pale i ka hanu ʻana, ʻoiai ʻo ka piʻi ʻana o ke koko a me ka puʻuwai puʻuwai ke kumu o ka hopu ʻana i ka naʻau. ** ʻO kēlā me kēia ʻoʻoleʻa o ka ʻāʻī, ka ʻāʻī, a i ʻole ka ʻai ʻana i nā ʻiʻo ma hope o ka ʻeha ʻana, pono e lawe koke i ka 911 / 112 / 999 i kahi ʻoihana mālama kino.**

Nīnau pinepine¶

• ʻO kēia alakaʻi no ka ʻike ʻike a ʻaʻole ia e pani i ka loiloi lapaʻau ʻoihana a i ʻole ka hoʻomaʻamaʻa lima. Paipai mākou i ka lawe ʻana i kahi kōkua mua i ʻae ʻia a me ka papa CPR ma o ka International Federation of Red Cross and Red Crescent Societies (IFRC), kāu hui Red Cross National, St John Ambulance, a i ʻole kahi mea hoʻolako hoʻomaʻamaʻa kūloko.*

Nānā ʻia nā kumu¶

• Nā Centers for Disease Control and Prevention (CDC, United States): Alakaʻi Kauka no ka mālama ʻana i nā ʻeha no ka pale ʻana i ka maʻi maʻi maʻi * a me * ka maʻi maʻi maʻi a me ka pale ʻana i nā maʻi maʻi hiki ke pale ʻia (The Pink Book: Tetanus).
• World Health Organization (WHO): Tetanus Vaccines: WHO Position Paper a me *Kaohi a me ka mālama ʻana i ka maʻi maʻi maʻi maʻi maʻi ma ka mālama pilikia.
• UK Health Security Agency (UKHSA, United Kingdom): Immunization Against Infectious Disease (The Green Book, Mokuna 30: Tetanus: Hooponopono i na Eha Tetanus-Prone).
• ʻAmelika Hui Pū ʻIa o ʻAmelika Hui Pū ʻIa (ACFAS, ʻAmelika Hui Pū ʻIa): * ʻŌlelo Kūkākūkā Clinical: ʻO ka ʻike a me ka mālama ʻana i nā ʻeha Puncture Plantar a me Pseudomonas Osteochondritis *.
• Infectious Diseases Society of America (IDSA, United States): Nā Kūlana Hoʻomaʻamaʻa no ka ʻike ʻana a me ka mālama ʻana i nā maʻi ʻili a me nā ʻiʻo palupalu.

Nā alakaʻi pili¶

• Hoʻopaʻa ʻia a hoʻopaʻa ʻia i nā mea haole
• ʻOki, ʻoki, a me ka mālama ʻeha liʻiliʻi
• Nahu holoholona: nahu ʻīlio, nahu pōpoki, a mālama i nā maʻi ʻeha
• Ka hoʻomalu ʻana i ke koko koʻikoʻi a me nā tourniquets
• ʻO Sepsis a me ka ʻike haʻalulu septic
• Nā helu pilikia ma ka ʻāina