Ntu Ntu Bump-Ọkụ ugboro abụọ na ntu ntu ntu¶

Pneumatic, gas-actuated, na cordless framing nailers na-anya ** 75-to-90-millimeter (3.0-to--3.5-inch) steel Framing mbọ ntu ọsọ ọsọ nke ** 30 ruo 425 mita kwa nkeji (100 ruo 1,400 ụkwụ kwa sekọnd)**, na-ebuga kinetic-ọkụ ọkụ n'elu. ** 37,000 ngalaba mberede na-eleta kwa afọ ** na United States naanị dị ka ** Centers for Disease Control and Prevention (CDC)* na ** National Institute for Safety and Health Ọrụ (NIOSH)** si dị. Nnyocha ebe ọrịa na-efe efe na-egosi na ** 65 ruo 69 pasent nke mmerụ egbe ntu niile na-akpata ya bụ otu ihe eji egbochi ya: **Contact-Trip ("Bump-Fire" ma ọ bụ "Bottom-Fire") na-akpalite *, nke na-enye ohere ka onye ọkwá nkà jide mkpịsị aka ya na-akpalite ala na-aga n'ihu ma gbaa ntu n'oge ọ bụla ihe nchekwa imi na-emetụ n'elu. Mgbe agbachara ntu nke mbụ, mgbake pneumatic na-eme ka onye na-agba agba dị kilogram 4 (paụnd 9) dị arọ na-arịgo elu wee daa azụ ozugbo ( ọkụ ọkụ abụọ na-achọghị onwe ya **) na aka ekpe nke onye ọkwá nkà nke na-enweghị isi na-ejide stud 2x4, ma ọ bụ n'elu apata ụkwụ, akpụkpọ ụkwụ ma ọ bụ ikpere ụkwụ, n'elu ụkwụ, ikpere ụkwụ, ikpere ụkwụ, ikpere ụkwụ, ụkwụ ma ọ bụ ikpere ụkwụ. mkpịsị aka ha dabere na mkpata. Nke ka njọ, a na-ejikọta mbọ ntu ọnụ n'ime ibe ma ọ bụ eriri igwe na-eji ** waya ọla kọpa welded, eriri plastik na-agbaji agbaji, ma ọ bụ gluu resin ọkụ na-arụ ọrụ . Ka ntụtụ ahụ na-akpụ ntu n'okirikiri ahụ, ** Barbs dị nkọ nke waya ọla kọpa ma ọ bụ nku rọba nwere jakị ka na-ejikọta ya na ogwe ntu ahụ ebe ọnụ ọnụ ya na-akụtu plọg nke denim ruru unyi, rọba akpụkpọ anụ, ma ọ bụ mkpuchi ọrụ n'ime ọkpụkpụ na capsule nkwonkwo. Ọ bụrụ na onye ya na ya na-arụkọ ọrụ na-ewepụ ntu ahụ azụ azụ n'aka, ikpere, ụkwụ, okpokoro isi, ma ọ bụ igbe n'ebe a na-arụ ọrụ site na iji hama ma ọ bụ ngwa ngwa, nkochi ọla kọpa na-agbaji ** irighiri akwara dijitalụ, akwara na-agbanwe agbanwe, na akwara ụkwụ ** mgbe ọ na-ahapụ plastik ruru unyi na iberibe akwa dabara n'ime ọkpụkpụ iji mee ka ọkpụkpụ ọkpụkpụ na-agbawa obi. Ọ bụrụ na ntu banye n'isi, olu, obi, afọ, anya, ma ọ bụ nnukwu nkwonkwo, kpọọ nọmba mberede mpaghara gị ozugbo (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, 000 na Australia, 111 na New Zealand) ma ọ bụ lelee akwụkwọ ndekọ aha zuru ụwa ọnụ nke anyị. nọmba mberede. Maka usoro nbanye trauma nwere njikọ chiri anya, gụọ ntuziaka anyị na ya egbe ntu na pneumatic fastener ntinye na mmerụ ahụ ricochet, kpọgidere n'osisi na nkwụsi ike ihe mba ọzọ, tamponade obi na penetrating trauma triage, na nnukwu ọbara ọgbụgba na ngwa nlegharị anya.

Mee nke a ugbu a¶

1. ** Kwụpụ eriri ikuku abịakọrọ (ma ọ bụ wepụ batrị na mmanụ mmanụ) na egbe ntu ozugbo tupu ị nyere onye ahụ aka:** Ekwela ka ọ dị ndụ na-agbada n'elu ihe mkpuchi, elu ụlọ, ma ọ bụ ala mgbe ejikọtara ya na eriri ikuku. Ọ bụrụ na onye na-ege ntị zọọ ụkwụ n'ihe mkpalite ma ọ bụ kụrie n'imi nke nkuta njem ejikọtara ọnụ n'oge nnapụta, ọ ga-agba ntu milimita 90 ọzọ.
2. EJIGHỊ ịdọpụ ntu pneumatic n'aka, akpụkpọ ụkwụ, ikpere, okpokoro isi, ma ọ bụ igbe n'ebe a na-arụ ọrụ na hama ma ọ bụ ngwa ngwa: Ọ bụrụgodị na isi ntu ahụ na-arapara 2 centimeters (0.75 sentimita) na mkpịsị aka ma ọ bụ akpụkpọ ụkwụ ọrụ, hapụ ntu ahụ nke ọma. Ntu ntu agbakọkọtara na-ebu ** barbs ọla kọpa nwere ntụpọ gbadoro anya ma ọ bụ ntù ngwu rọba nwere eriri** n'akụkụ ogwe ha. Ịdọghachi ntu ahụ azụ na-enweghị ikpughe ịwa ahụ na-adọka irighiri akwara na arịa ọbara, na-ewepụ plastik/ waya gbachiri n'ime ọkpụkpụ, na-ewepụkwa ọbara ọgbụgba n'ime.
3. ** Ọ bụrụ na a kpọgidere aka, mkpịsị aka, ma ọ bụ buut nke onye ahụ merụrụ ahụ ozugbo na stud 2x4, truss ụlọ, ma ọ bụ plywood mpempe akwụkwọ, jiri nhịahụ na-emegharịgharị ma ọ bụ mkpirisi okirikiri gbutuo osisi ahụ n'efu gburugburu onye ahụ (na-ahapụ obere osisi nke etinyere na ntu):** Ya adịla mgbe ọ bụla dọpụ aka ma ọ bụ ụkwụ a kpọtu n'osisi mgbidi. Kwado akụkụ ahụ merụrụ ahụ ka ntu ahụ ghara ehulata, hụ site na stud 2x4 15 centimeters (6 inch) n'akụkụ ọ bụla nke ntu ahụ, ma buru obere osisi na ntu ahụ kwụsie ike ọnụ.
4. ** Ọ bụrụ na ntu abanye n'ime mgbidi igbe (karịsịa n'ime "igbe obi" n'etiti nipples na collarbones) ma ọ bụ okpokoro isi, kpọọ 911 / 112 / 999 ozugbo ma mee ka onye ahụ na-ata ahụhụ kwụsị kpamkpam:* Ntu nchara n'onwe ya na-agbanye oghere na akwara obi na-eti ihe; ịdọpụ ya na-ebute ọnwụ ** obi tamponade ** n'ime sekọnd 60. Mee ka isi ntu guzosie ike site na iji mgbanaka gauze na-adịghị mma, mee ka onye ọrịa nọrọ jụụ, wee gbaga n'ọkwa trauma nke ọkwa 1.
5. ** Ọ bụrụ na ntu banye n'ime akpụkpọ ụkwụ ma ọ bụ akpụkpọ ụkwụ ọrụ, Atọpụla ma ọ bụ dọpụ akpụkpọ ụkwụ n'ụkwụ n'ọhịa:** Ịwepụ akpụkpọ ụkwụ akpụkpọ anụ n'elu ntu a na-etinye n'ọkpụkpụ rọba n'ime ọkpụkpụ ụkwụ na-ehulata ntu ahụ n'ime ụkwụ ma dọkpụrụ rọba ruru unyi gafee akwara osisi na akwara. Hapụ akpụkpọ ụkwụ ahụ ruo mgbe ewere X-ray ụlọ ọgwụ.
6. ** Gbanwee ọrụ niile na-emepụta nailers site na Black "Contact-Trip (Bump-Fire)" na-akpalite na isi awọ / oroma "Full-Sequential Trigger":** Dị ka ** NIOSH na OSHA **, dochie kọntaktị-njem na-akpalite na ** Full-Sequential mkpịsị aka na-akpalite osisi a na-achọ ka a na-adọkpụ ya megide ***. ntu ọ bụla, na-ebipụ mmerụ ahụ egbe ntu mberede site na ** karịa pasent 50 ruo 65 **.

Osisi mkpebi: mbanye egbe ntu pneumatic na mpaghara anatomical triage¶

flowchart TD
    Start["Mmerụ ahụ ntu ntu ma ọ bụ enweghị eriri"] --> Disconnect["1. Kwụpụ ikuku ikuku ma ọ bụ batrị ozugbo: Uncouple Air Hose / Wepu Batrị & Gas Cartridge tupu imetụ egbe ma ọ bụ onye ọrịa aka."]

    Disconnect --> WoodPinned{"2. Aka, ụkwụ, ma ọ bụ ahụ onye ahụ a tara ahụhụ ọ na-atụnye ya n'ibe osisi?"}

    WoodPinned -->|"EE: Akpọgidere ya ozugbo na Stud, Joist, ma ọ bụ Plywood"| SawWood["CUT Lumber FREE (AKWỤKWỤKWỌ): 1. Kwado akụkụ aka nke onye ihe merụrụ ahụ ka ntu enweghị ike ịgbagọ ma ọ bụ tụgharịa 2. Jiri Reciprocating / Aka Hụrụ osisi 15 cm (6 n'ime) n'akụkụ abụọ nke ntu 3. Kwado obere ihe mgbochi osisi + ọnụ ọnụ dị ka otu nkeji maka ụgbọ njem."]

    WoodPinned -->|"Mba: A na-etinye ntu naanị n'ime ahụ onye ihe merụrụ ahụ"| ZoneCheck{"3. Kedu mpaghara anatomical ka ntu batara?"}
    SawWood --> ZoneCheck

    ZoneCheck -->|"1. Okpokoro Isi, Anya, Ihu, ma ọ bụ olu"| HeadNeck["Usoro INTRACRANIAL / N'olu / OCULAR: 1. Kpọọ 911 / 112 / 999 ozugbo (Ọkwa 1 Trauma / Neurosurgery Center) 2. Ọ dịghị mgbe ịdọrọ ma ọ bụ metụ isi ntu na-apụta 3. teepu nnukwu mgbanaka gauze / mpempe akwụkwọ ọta Gburugburu isi & Nail 3. Mee ka ọkpụkpụ cervical ghara imegharị ahụ"]

    ZoneCheck -->|"2. OBI ('igbe obi'), azụ, ma ọ bụ afọ"| TorsoBox["CARDIAC TAMPONADE & TORSO PROTOCOL: 1. Kpọọ 911 / 112 / 999 ozugbo (Alert Dispatch: Penetrating Cardiac/Thoracic Nail) 2. AKWỤKWỌ Ntu (Ntukọ Ntu Right Ventricle / Aorta Hole) 3's Watch for Diins Beins (Ntube Ntu). Ụda obi akpọchiri akpọchi) -> Ụgbọ njem Thoracotomy ngwa ngwa"]

    ZoneCheck -->|"3. AKWỤKWỌ, KWESỊRỊ, MKỌKỌKWU, MA Ọ BỤ Ụkwụ / BỤTA ỌRỤ."| ExtremityCare["BARBED-NAIL EXTREMITY & JINT PROTOCOL: 1. Hapụ ntu nke ọma n'ebe (na-egbochi ọla kọpa/plastic barbs ịdọka akwara na ụgbọ mmiri) 2. Ọ bụrụ na site na akpụkpọ ụkwụ ọrụ: Akwụsịla buut n'ụkwụ 3. Lelee Distal Capillary Refill & Ganders / Sensation Rolls, Split Joint Still, na Transport for X-Ray & Debridement nke ịwa ahụ"]

Mikpuo mmiri miri emi 1: Njem kọntaktị ("Bump-Fire") vs. Usoro ihe na-akpalite usoro zuru oke¶

Gịnị mere ndị na-akpụ nku na-eku ume na-eji agba ndị ọkwá nkà n'aka, ikpere, ma ọ bụ n'obi ọtụtụ puku ugboro kwa afọ mgbe onye ọkwá nkà na-ebughị n'obi dọpụta ihe ahụ ugboro abụọ?

1. Otu esi arụ ọrụ nchekwa abụọ na-eme ntu ntu¶

Igwe ikuku pneumatic ọ bụla ma ọ bụ eriri ntu na-enweghị eriri nwere ** igwe ọkụ abụọ dị iche iche *** nke ga-abụ nke dara mbà n'obi tupu ikuku abịakọrọ ($ 5.5 ederede { ka } 8.3 ederede {bar} / 80 ederede { ka } 120 ederede { PSI} $ ) na-ahapụ piston dị n'ime iji kwọọ ntu: 1. ** Mkpịsị aka na-akpata *** na njide egbe. 2. ** Ihe Kọntaktị Ọrụ (Safety Nosepiece / Yoke)** n'ọnụ ọnụ gbọmgbọm ahụ, nke a ga-atụgharị azụ n'osisi site na 6 ruo 10 millimeters.

Ọdịiche dị n'etiti egbe ntu dị mma na nke dị ize ndụ na-agbadata kpamkpam ** ma ọ bụrụ na valvụ ikuku dị n'ime na-elekọta nke ka etinyere ọkụ abụọ ahụ ***:

====================================================================================
    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. Njem Kọntaktị Omuma Atọ Atọ ("Bump-Fire") Ihe ndapụta ihe mberede¶

1. ** Ọkụ na-agbaghachi ugboro abụọ n'ime aka na-adịghị achị (nke a na-ahụkarị):**
2. Mgbe onye ọkwá nkà na-eji aka ekpe ya na-akpụ mgbidi ma ọ bụ mkpịsị ụkwụ ntu stud n'akụkụ aka ekpe ya 2x4 n'ebe dị anya site na nkwonkwo wee jiri aka nri ya gbanye onye na-ahụ maka njem kọntaktị.
3. N'ihi na mkpịsị aka aka nri nke ọkwa ọkwa na-anọ na mkpalite ahụ, mgbake pneumatic ahụ na-agbapụta imi imi n'osisi wee tụda ya azụ ala 5 centimeters (2 sentimita asatọ) n'aka ekpe, ma ọ bụ na-akụtu nsọtụ nke stud ma ọ bụ na-agbada ozugbo na azụ mkpịsị aka ekpe ha / mkpịsị aka aka ekpe, na-agbapụ aka nke abụọ 89-millimita.
4. ** Ubube, Roof Truss, ma ọ bụ Scaffold Stumble (ikpere, apata ụkwụ, obi na okpokoro isi):**
5. Onye na-ese ihe na-aga n'elu trusses ụlọ ma ọ bụ na-arịgo n'elu ubube na-ebu nnukwu pneumatic ntu n'akụkụ ha na mkpịsị aka mkpịsị aka ha na-agbanye gburugburu ihe mkpalite iji kwado ibu ngwá ọrụ ahụ.
6. Ọ bụrụ na onye ọrụ ahụ adalata ma ọ bụ tụfuo nguzozi, imi imi nke egbe ahụ na-adaba n'apata ụkwụ ya, okpu ikpere (patella), obi, ma ọ bụ agba**, ma ọ bụ tie isi onye ọrụ ibe ya n'okpuru ha, na-agbanye ntu ntu ozugbo n'ime akụkụ dị mkpa.
7. Site na-site na Blowout na Knot Ricochet:
8. Mgbe a na-akụtu ihe mkpuchi plywood dị mkpa ma ọ bụ mkpịsị ụkwụ na-akụ stud, ọ bụrụ na onye ọkwá nkà na-atụfu stud n'azụ site na milimita 5 ma ọ bụ kụrie eriri eriri/ígwè truss nwere nnukwu eriri, ntu ahụ na-esi n'azụ azụ osisi ahụ ebe aka ekpe onye ọkwá nkà na-ejide stud ahụ. (** Iwu:** Na-ejide aka gị na-adịghị achị mgbe niile ma ọ dịkarịa ala ** 30 centimeters (12 sentimita) pụọ ** site na ntu ntu, ọ dịghị mgbe a na-akpọ ya ozugbo n'azụ osisi ahụ).

Ndakpu miri 2: mkpokọta metallurgy (waya barbs, ngwu plastik, resin gluu) na mwepụ ịwa ahụ¶

Kedu ihe kpatara ndị dọkịta na-awa ahụ na aka na-esi ọnwụ ka ha were X-ray tupu ha emetụ ọnya egbe ntu aka, gịnịkwa kpatara na ha na-agbanye ntu ahụ ugboro ugboro ** n'ihu ** ma ọ bụ bepụ isi kama ịdọrọ ya azụ ozugbo?

1. Anatomi nke agbakọta mbọ mbọ (15, 21, 28, na 30 ruo 34 Degree Strips)¶

Egbe ntu na-akpụ akpụ na-enye nri ntu n'akụkụ n'iberibe ma ọ bụ eriri igwe ejiri ihe anọ jikọtara ọnụ, nke ọ bụla na-emepụta ihe egwu ịwa ahụ pụrụ iche n'ime anụ ahụ mmadụ:

1. ** 15-Degree Wire-Weld Coil Ntu (Ogwe igwe ejiri mkpuchi ọla kọpa):**
2. A na-ejikọta waya ọla kọpa abụọ dị gịrịgịrị abụọ nke e ji ọla kọpa mee n'ofe ntu nke 200 ruo 300 n'ime eriri igwe.
3. Mgbe agụba onye ntu ahụ kụpụrụ ntu n'ihu, waya na-akpụ, na-ahapụ ** waya siri ike abụọ dị mita 2 ruo 4 gbadoro n'ogwe ntu ahụ, na-ehulata azụ dị ka ogwe azụ azụ**.
4. ** Visibility redio:** Barbs waya ndị a bụ ** rediopaque ** (nke a na-ahụ anya na ụzarị X), na-enye onye dọkịta na-awa aka hụ ebe ntụzịaka barbs na-atụ aka tupu iwepu ntu ahụ.
5. ** 20 ruo 22-Degree Plastic-Strip mbọ (Radiocent Polycarbonate Wings):**
6. A na-akpụ mbọ ntu agba gburugburu n'ime eriri rọba polycarbonate na-emebi emebi. Mgbe agbapụrụ, obere ** shark-fin nku rọba dị nkọ ** na-arapara na ntu ntu n'ime egwu ọnya ahụ.
7. ** Ọnyà X-Ray zoro ezo:** N'adịghị ka barbs waya igwe, ** mpempe akwụkwọ plastik bụ radiolucent (anaghị ahụ anya na X-ray ọkọlọtọ)**, n'agbanyeghị na a na-achọpụta ya na ultrasound. Ọ bụrụ na onye ọrụ na-ewepụ ntu nke nwere plastik dị ogo 21 n'ebe a na-arụ ọrụ, ọkpụkpụ ahụ na-ewepụ ntu rọba na ntu ntu n'ime nkwonkwo ma ọ bụ n'ọbọ akwara.
8. ** 28-Degree Wire-strip na 30-na-34-Degree Paper-Tepe mbọ (Thermoplastic Resin Glue):**
9. Ejikọta ya na teepu mpempe akwụkwọ na thermoplastic nrapado resin gbakwunyere ** mgbanaka-shank ma ọ bụ screw-shank eri na-ejikọta ya na ọkpụkpụ 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. Olee otú ndị dọkịta na-awa aka na ọkpụkpụ ọkpụkpụ si ewepụ ntu agbakọtara n'ime ime ụlọ ọrụ¶

Mgbe ị hapụrụ ntu ahụ emetụghị aka wee rute na ngalaba mberede: 1. Elele X-ray abụọ (AP na Lateral) + Ultrasound: Dọkịta ahụ na-ewere X-ray orthogonal TUPU imetụ ntu aka ileba anya maka mgbaji gbajiri agbaji**, ntinye nkwonkwo, yana ** barbs waya welded ntụpọ**. 2. ** Mgbochi akwara mpaghara:** A gụchara mpaghara ahụ kpamkpam ka onye ọrịa wee nwee ahụ mgbu efu. 3. ** Usoro "Cut-the-Head-and-Pull-Forward" (For through-and-through Limb Nails):** Ọ bụrụ na isi na ọnụ ntu ahụ na-esi na mkpịsị aka ma ọ bụ aka na-apụta, X-ray na-egosikwa eriri waya na-atụ azụ azụ, onye dọkịta na-awa ahụ na-agbapụ isi ahụ na-apụta ** ntu isi surgi na-eji ** , na-eji ** ntu isi ntu na-apụ apụ. ntu**, ma na-adọkpụrụ osisi dị nro ** GAO n'ihu site n'akụkụ ụzọ ọpụpụ ** n'ụzọ ebumpụta ụwa nke barbs, na-esochi nke ọma ogbugba mmiri n'ubi na debridement.

Ime miri 3: Ntinye egbe ntu na-eyi ndụ egwu (obi, Intracranial, Ocular, and Joint Capsule)¶

Ọ bụ ezie na pasent 65 nke mmerụ egbe ntu na-eti aka na mkpịsị aka, pasent 35 fọdụrụnụ na-agụnye mpaghara anatomical na-eyi ndụ egwu ma ọ bụ ihe egwu:

1. Mmerụ ahụ ntu ntu obi na-abanye n'ime obi ("igbe obi")¶

Ndị na-emepụta ntu si n'elu si n'elu pụta ma ọ bụ kpalite n'oge ọdịda ugboro ugboro ntu 75-na-90-millimita n'ime mgbidi azụ azụ n'ime ** Igbe obi ** (nke dị elu site na clavicles, nke dị ala site na oke ọnụ ala, na n'azụ site na ahịrị midclavicular): - ** Ihe kpatara ndị ihe metụtara na mbụ ji ele anya na-eteta wee na-ejegharị gburugburu:** N'adịghị ka ọnya egbe na-agbawa ọwara cavitation sara mbara, ntu nchara dị mita 3.3 na-amapu sternum na ** na-etinye oghere nke ya na mgbidi ** ventricle aka nri, ventricle ekpe, ma ọ bụ akwara pulmonary. Ihe ruru pasenti 50 nke ndị ọrịa obi ntu na-amabu ma na-ekwu okwu maka nkeji 10 ruo 30 nke mbụ, mgbe ụfọdụ a na-ahụghị isi ntu ahụ ma ọ bụ lie ya n'okpuru akpụkpọ ahụ pectoral (leba anya ma ọ bụrụ na isi ntu ahụ bụ bobbing rhythmically n'oge na-enwe nkụja obi). - ** Mkpesa mberede (Pericardial Tamponade):** Ọ bụrụ na onye ọ bụla na-adọpụ ntu ahụ, ma ọ bụ ka ọbara ji nwayọọ nwayọọ na-adaba n'akụkụ ntu ahụ n'ime fibrous siri ike ** pericardial sac ** gbara gburugburu obi, nrụgide mmiri dị n'ime akpa ahụ na-egwepịa ụlọ obi nke mere na ha enweghị ike imeju ọbara (** obi tamponade**). Chee maka **Beck's Triad ***: (1) ọbara mgbali elu na-ada ada / radial pulse na-adịghị ike, (2) veins jugular gbawara agbawa n'olu, na (3) ụda obi gbawara agbawa, na-esonyere mkpasu iwe, ịcha ọbara ọbara na-acha uhie uhie, na njide obi mberede. - Ihe mberede mberede: Emetụla aka ma ọ bụ dọpụta ntu obi. Kpọọ 911/112/999 maka ibuga ozugbo gaa na Level 1 Trauma/Cardiothoracic Surgery Center maka mberede etiti sternotomy ma ọ bụ anterolateral thoracotomy.

2. Intracranial (okpokoro isi / ụbụrụ) ntu egbe ntu¶

Mgbe egbe ntu na-apụ apụ n'osisi nkụnye eji isi mee, na-agbapụ ala site na ihe mkpuchi dị n'elu, ma ọ bụ na-agbapụta n'oge ọdịda, oke ọsọ na-ebugharị ntu nchara n'ụzọ ziri ezi site na calvarium (ọkpụkpụ okpokoro isi), orbit, ma ọ bụ palate siri ike banye n'ụbụrụ parenchyma: - Ọtụtụ ndị ọrịa nwere otu ntu 90-millimiter nke a chụpụrụ n'ihu ma ọ bụ parietal lobe na-anọgide ** maara na Glasgow Coma Scale (GCS 15) na obere ọbara ọgbụgba n'èzí n'ihi na ọkpụkpụ okpokoro isi na-ejide ntu ahụ nke ọma na ogwe ntu tamponades dọwara arịa cortical. - ** Ọnyà hemorrhage intracranial:** Ịwepụ ntu intracranial n'èzí ụlọ ịwa ahụ na-akpata ozugbo ** subdural, subarachnoid, ma ọ bụ ọbara ọgbụgba intraparenchymal ** ma ọ bụ na-adọwa nnukwu venous sinus. Mee ka isi onye ọrịa dị elu na ** 30 degrees **, gbochie ọgbụgbọ ma ọ bụ nhụsianya, mee ka ntu na-apụtaghị ìhè na-enweghị ịpị ya, na ibuga maka CT angiography (CTA) na neurosurgical craniotomy.

3. Synovial Joint Capsule Penetration (Knee, Wrist, Angle, and Knuckle Joints) na akpụkpọ ụkwụ ọrụ.¶

• ** Septic Arthritis N'ime awa 24 ruo 48: ** Mgbe egbe ntu na-agba ọkụ n'ime ** ikpere mgbe onye na-ese ihe na-egbu ikpere n'ala n'elu ala ụlọ **, ntu 90-millimeter na-atụba eriri denim ruru unyi ozugbo n'ime oghere nkwonkwo synovial tibiofemoral **. Mmiri Synovial n'ime nkwonkwo na-eme ka efere petri na-ekpo ọkụ maka nje bacteria. Ọbụlagodi na ọnya ikpere ntu ma ọ bụ ntu na-agbapụta obere ọbara na mbụ, ** Ntinye ntu ọ bụla dị nso na nkwonkwo chọrọ nyocha ụlọ ọgwụ ngwa ngwa maka ịsacha nkwonkwo ịwa ahụ na ọgwụ nje na-egbu egbu n'ime awa n'ime awa iji gbochie mbibi cartilage na-adịgide adịgide.
• Mkpịsị osisi site na akpụkpọ ụkwụ na-arụ ọrụ rọba ( Pseudomonas aeruginosa Osteomyelitis): *** Pseudomonas aeruginosa na-achịkwa n'ime akpụkpọ ụkwụ na-arụ ọrụ n'ime akpụkpọ ụkwụ. Mgbe ntu na-akụtu naanị akpụkpọ ụkwụ rọba n'ime ọkpụkpụ ikiri ụkwụ ma ọ bụ metatarsals, ọ na-abanye * Pseudomonas* n'ime ọkpụkpụ ọkpụkpụ, na-achọ nkwụsị ịwa ahụ na ọgwụgwọ ọgwụ nje pseudomonal ezubere iche (gbakwunyere ** tetanus toxoid booster**).

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

Ajụjụ a na-ajụkarị¶

Kedu ihe dị iche n'etiti "njem kọntaktị (bump-fire)" na-akpalite na "usoro zuru ezu" na-akpalite na egbe ntu?¶

Njem kọntaktị (bump-fire) na-akpalite *** na-enye onye ọrụ aka ịpịa ma jide mkpịsị aka aka n'ala mgbe niile ka ntu na-agba ọkụ oge ọ bụla imi imi na-adaba n'elu ọ bụla; Ọ bụrụ na égbè ahụ alaghachi mgbe agbachara nke mbụ wee banye n'aka ekpe ma ọ bụ ụkwụ onye ọrụ, ọ na-agba ntu nke abụọ n'amaghị ama (** na-agụta pasent 65 ruo 69 nke mmerụ egbe ntu niile**). Ihe mkpalite ** n'usoro zuru oke chọrọ usoro nzọụkwụ abụọ siri ike maka ntu ọ bụla: ** (1) buru ụzọ pịa n'ọnụ imi imi n'osisi ahụ, na (2) dọpụta mkpịsị aka nke abụọ **. Ọ bụrụ na egbe ahụ alaghachite mgbe mkpịsị aka onye ọrụ na-ejide ihe mkpalite ahụ, onye ntu zuru oke ** enweghị ike ịgba ntu nke abụọ.

Kedu ihe kpatara na m na-agaghị eji hama ma ọ bụ ngwa ntu wepụ ntu ntu n'aka m, aka ma ọ bụ ikpere m n'ebe a na-arụ ọrụ?¶

N'adịghị ka ntu ejiri aka na-akwọ mụrụmụrụ, ntu agbapụrụ na egbe ntu na-agbakọ ọnụ na ibe ma ọ bụ eriri igwe na-eji ** waya ọla kọpa welded (coils 15-degree coils), polycarbonate plastic strips (21-degree strips), ma ọ bụ nrapado resin gluu **. Mgbe egbe ahụ gbapụrụ ntu n'okirikiri ahụ, ** barbs ọla kọpa dị nkọ ma ọ bụ nku rọba nwere ogologo na-anọkọ n'akụkụ ogwe ntu ahụ **, na-atụ aka azụ n'isi ntu ahụ dị ka nko azụ. Ọ bụrụ na i ji mkpịsị aka ma ọ bụ nkpọkọ dọpụta ntu ahụ azụ azụ, nko na dọkasịa ntu ahụ ** irighiri akwara dijitalụ, akwara na akwara ***, ebe ọkpụkpụ na-ewepụ nku rọba ruru unyi na akwa na-apụ n'ogwe n'ime ọnya ahụ. Hapụ ntu ahụ emetụghị ya maka iwepụ ịwa ahụ.

Kedu ka ndị dọkịta na-awa si ewepụ ntu ntu egbe na-adọkasịghị akwara na akwara?¶

N'ụlọọgwụ, dọkịta na-ewere ** x-ray nlele abụọ ** ka ọ mara ma ọkpụkpụ agbajiri agbaji yana ma barbs waya nwere ntụpọ na-apụ apụ na ntu ntu. Ọ bụrụ na ntu esila mkpịsị aka ma ọ bụ aka mebie aka ma ọ bụ ụkwụ, dọkịta na-awa ahụ ga-ehichapụ isi ahụ ** na-apụta ntu isi **, na-eji ** sterile surgical bolt cutters na-ewepụ isi ahụ dị larịị na ntu ahụ, wee dọpụta ntu ahụ ** GAO n'ihu site n'akụkụ ụzọ ọpụpụ ahụ agaghị eweghachi azụ azụ.

Kedu ihe m ga-eme ma ọ bụrụ na akpọgidere aka ma ọ bụ buut onye ọrụ ibe ozugbo na stud mgbidi 2x4 ma ọ bụ truss ụlọ?¶

**Agbalịla ịrapụ onye ahụ aka ma ọ bụ buut stud 2x4 ***, nke na-ehuda ntu n'ime ọkpụkpụ ha na-adọwa akwara na irighiri akwara. Kama: (1) Kwupu eriri ikuku ma ọ bụ batrị na egbe ntu ozugbo; (2) mee ka otu onye na-akwado ogwe aka ma ọ bụ ụkwụ onye ọrụ merụrụ ahụ ka ọ ghara ịdị arọ na ntu; (3) jiri ihe nkwọgharị **, nkwọ okirikiri, ma ọ bụ ihe aka aka were bechapụ stud 2x4 dị centimita 15 (inch 6) n'akụkụ abụọ nke ntu*; na (4) buru onye ọrụ ahụ gaa na ngalaba mberede nke nwere obere osisi a kpụrụ akpụ ka na-etinye na ntu.

Kedu ihe kpatara mmerụ ahụ ntu ntu site na ala nke akpụkpọ ụkwụ rọba na-arụ ọrụ ọsụsọ ji bụrụ ihe mberede orthopedic ọbụlagodi na ọ na-agbapụta obere ọbara?¶

Mgbe ntu na-akpụ akpụ na-adaba n'ọkpụ rọba na ụfụfụ nke akpụkpọ ụkwụ arụrụ arụ ọrụ n'ụkwụ, ọnụ ntu ahụ na-adịghị mma na-eme ka ntụ ntụ kuki, na-ebu isi plọg nke ** rọba, eriri sock, gluu resin, na nje bacteria na-ahụ n'anya nke a na-akpọ * Pseudomonas aeruginosa *** ma ọ bụ n'ime ọkpụkpụ ọkpụkpụ. Ọbụlagodi na oghere ntanye ahụ na-agbapụta obere ọbara, nje bacteria * Pseudomonas* tọrọ n'ime ọkpụkpụ na-akpata mbibi ** osteomyelitis (ọrịa ọkpụkpụ) ma ọ bụ ọrịa ogbu na nkwonkwo** n'ime ụbọchị ole na ole ọ gwụla ma a na-eme ya x-ray n'ụkwụ, jiri ịwa ahụ mebie, ma were ọgwụ mgbochi pseudomonal na tetanus booster gwọọ ya.

Gịnị mere onye e ji égbè ntu gbagburu n'obi ga-eji na-eje ije na-ekwu okwu nke ọma na mbụ, wee daa mgbe nkeji iri na ise gachara?¶

Mgbe ntu na-akpụ akpụ nke 90-millimita (3.5-inch) na-abanye n'etiti obi (** Igbe obi obi ***), ọ na-esikarị n'ọkpụkpụ obi na-aba n'ime akụkụ aka nri nke obi **. N'ihi na ntu ígwè siri ike na-anọ n'ime akwara obi, ọ na-agbanye oghere nke ya ruo nwa oge. Otú ọ dị, ọ bụrụ na onye ọ bụla adọpụ ntu ahụ, ma ọ bụ ka ọbara na-adaba n'akụkụ ntu ahụ n'ime fibrous ** pericardial sac ** gburugburu obi, ọbara ahụ tọrọ atọ na-amanye obi ruo mgbe ọ nweghịzi ike ịgbapụta (**cardiac tamponade**). Emetụla ntu obi aka mgbe ọ bụla; Debe onye ihe ahụ metụtara wee kpọọ 911/112/999 maka ibuga ngwa ngwa gaa na Center Trauma Level 1. Inweta enyemaka enyemaka izizi na nkuzi CPR sitere na Red Cross, St John Ambulance, ma ọ bụ onye na-eweta mpaghara na-akwado gị maka ihe mberede ebe ọrụ.

Ntuziaka emetụtara¶

• Ntu egbe na pneumatic fastener ntinye na mmerụ ahụ ricochet
• Mkpọgide na agbakwunyere nkwụsi ike ihe mba ọzọ
• Tamponade obi na penetrating trauma nke obi
• Ọbara siri ike na ngwa njem nlegharị anya ikuku
• Mmerụ anya anya, kemịkalụ mwụsa, na trauma na-abanye n'ụwa

Isi mmalite na nduzi ọchịchị¶

• ** National Institute for Safety and Health Care (NIOSH) na Ọrụ Safety and Health Administration (OSHA, United States):** *Nchekwa egbe egbe: Ntuziaka maka ndị na-arụ ọrụ ụlọ (DHHS/NIOSH Publication No. 2011-202 / OSHA 3459-8-11, Contact-Trip and Full-Sejunti)
• ** Centers for Disease Control and Prevention (CDC, United States):** Nleba anya MMWR nke mmerụ ahụ metụtara ntu-egbe a na-emeso na ngalaba mberede na ihe na-akpata ihe ize ndụ nke Mechanism (Lipscomb et al. Residential Carpentry Studies).
• ** American National Standards Institute (ANSI) na International Staple, Nail and Tool Association (ISANTA): *** ANSI SNT-101-2015 chọrọ nchekwa maka ibugharị, arụnyere ikuku-arụ ọrụ, ngwa ịkwọ ụgbọ ala na EN ISO 11148-13*.
• ** American Society for Surgery of Hand (ASSH) na American Academy of Orthopedic Surgeons (AAOS):** * Nlekọta ịwa ahụ nke mmerụ ahụ dị elu nke pneumatic ntu egbe: nchọpụta redio nke Wire Barbs, Ihe nchịkọta ihe mkpuchi nke Radiolucent Plastic, Extraction After Nail-Head Clipping, and Boot-Pseudomonasitis.
• ** American College of Surgeons (ACS) Kọmiti na Trauma:** * Advanced Trauma Life Support (ATLS) Ntuziaka maka ịbanye n'ime igbe obi obi trauma (Pericardial Tamponade / Beck's Triad) na Penetrating Intracranial Non-Missile Nail Injuries*.