Penetrating Chest Trauma na Pericardial Tamponade Nnabata¶

Obi mmadụ na-akụ n'ime akpa akpụkpọ anụ siri ike, nke nwere eriri, nwere okpukpu abụọ nke a na-akpọ pericardium. N'okpuru ọnọdụ nkịtị, oghere dị n'etiti ime na mpụta nke sac a nwere nanị 15 ruo 50 milliliters (1 ruo 3 tablespoons) nke mmiri na-ekpo ọkụ doro anya, na-ekwe ka ventricles gbasaa na nkwekọrịta n'efu ugboro 100,000 kwa ụbọchị. Mgbe mma agụba, ice pick, screwdriver, mgbo, ma ọ bụ shrapnel ibe n'ime n'ime etiti obi mgbidi ("Cardiac Box") na nicks mgbidi nke obi ma ọ bụ mgbọrọgwụ nke aorta, elu-nrụgide ọbara na-esi n'ime ụlọ na-esi n'ime obi pụta ozugbo n'ime akara nke pericardial sac na-adịghị ahụkebe.

Ebe ọ bụ na pericardium fibrous enweghị ike ịgbatị ngwa ngwa, ọ na-ewe naanị ** 60 ruo 150 milliliters (2 ruo 5 ounces fluid, erughị ọkara iko) nke nnukwu ọbara ** tọrọ n'ime akpa pericardial iji kpachie ọnụ ụlọ obi mechiri n'èzí. Dị ka nrụgide intrapericardial karịrị nrụgide ndochi nke atrium ziri ezi na ventricle aka nri, obi enweghịzi ike ịgbasa n'etiti iti iji were na-alọghachi ọbara venous, na-eme ka mmepụta obi na-adaba na efu n'ime nkeji nkeji (** nnukwu pericardial ma ọ bụ cardiac tamponade**). N'ịmara ka esi edepụta ókèala anatomical nke ** Igbe obi *, ka esi amata ** obi tamponade (Beck's triad) site na ngụgụ dara ada (pneumothorax erughị ala), kedu ihe kpatara na ị gaghị ewepụtụ mma mma a kpọgidere n'osisi ***, yana ihe kpatara na ị ga - ewepụla gauze n'ime oghere obi ** zụta nkeji dị oke ọnụ ahịa achọrọ maka ịwa ahụ mberede thoracotomy ma ọ bụ pericardiocentesis na-azọpụta ndụ.

Mee nke a ugbu a¶

1. Kpọọ nọmba mberede mpaghara gị ozugbo wee rịọ ndị enyemaka ahụike Advanced Life Support (ALS) maka ụgbọ njem n'ọkwa 1 Trauma Center ngwa ngwa. Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, 000 na Australia, ma ọ bụ lelee ndekọ aha nọmba mberede. Kwuo otu ** ọnya na-abanye n'ime igbe etiti (igbe obi)** ka a mara ndị otu ịwa ahụ trauma tupu ụgbọ ihe mberede abịarute.
2. ** Kpuchie igbe ahụ dum, elu afọ, ogwe aka, na azụ ka ịchọta ọnya ọ bụla mbata na ọpụpụ.** Ọbụna obere mkpọmkpọ ice 5-millimeter (0.2-inch) n'elu ọkpụkpụ ara, ahịrị ọnụ ara, ma ọ bụ epigastrium nke elu ("olulu nke afọ") nwere ike ịgbago elu site na diaphragm nke obi nri.
3. **Ewepụla agụba mma, screwdriver, akụ, ma ọ bụ mpio enyo a kpọgidere n'ime obi. ịwepụ ya na-ewepụta oke iyi ọbara na-erugharị n'ime akpa pericardial nke na-ebute tamponade obi na-egbu egbu n'ihe na-erughị 60 sekọnd. Mee ka ihe ahụ guzosie ike site na iji mpịakọta gauze ejima buru ibu.
4. AKWỤKWỌGHỊ KWUKWU gauze ma ọ bụ hemostatic rịbọn N'ime ọnya na-abanye n'ime obi. N'adịghị ka ọnya miri emi dị n'apata ụkwụ, ukwu ukwu, ma ọ bụ ogwe aka, oghere thoracic bụ nnukwu oghere oghere; Iri akwa gauze site na ọgịrịga anaghị mpikota obi obi na-agba ọbara ma ọ bụ akwara mammary dị n'ime, kama ọ na-akwapụ akpa ume n'akụkụ wee zoo ọbara ọgbụgba na-egbu egbu.
5. ** Ọ bụrụ na ọnya obi ahụ na-aṅụ ikuku ma ọ bụ na-agbapụta ọbara pink na-esi ísì ụtọ, tinye Akara Azụmahịa Vented Chest ma ọ bụ Uwe Flutter Sided Atọ.** Ejila bandeeji akụkụ anọ nke agbachiri kpamkpam na ọnya obi ọ bụla, ma dịrị njikere ịpụpụ azụ ("ọkụ") akara ahụ ma ọ bụrụ na iku ume na-akawanye njọ.
6. ** Debe onye ọrịa maara ahụ nke ọma, na-anọdụ ala n'ụzọ ziri ezi (ma ọ bụ n'ọnọdụ nkasi obi ha), NPO siri ike (ọ dịghị ihe ọ bụla n'ọnụ), wee kechie ya na blanket na-ekpo ọkụ. ụda ***, na-esonyere oke enweghị ike yana ** ụda ume nhata n'akụkụ abụọ nke obi.

Osisi mkpebi ihe mberede maka ịbanye trauma obi na tamponade obi¶

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

Ịdepụta "igbe obi" ( Mpaghara Ihe egwu Mediastinal)¶

Ndị dọkịta na-awa trauma na-akọwa mpaghara anatomical akụkụ anọ dị n'ihu (na azụ kwekọrọ) nke anụ ahụ a na-akpọ ** "igbe obi"** (ma ọ bụ * igbe precordial*). Ọnya ọnya, ntapu, ma ọ bụ ntinye/mpụ mgbọ egbe dị n'ime oke anọ ndị a na-ebute ** nnukwu ohere nke mmerụ ahụ kpọmkwem n'obi, pericardial, ma ọ bụ nnukwu ụgbọ mmiri ***:

• ** Oke oke (Kachasị elu):** Ahịrị kwụ ọtọ gafee ** clavicles (ọkpụkpụ ọkpụkpụ)** na ** ọkwa dị elu** n'okpuru olu.
• ** Oke ala (nke dị ala):** Ahịrị kwụ ọtọ gafee usoro xiphoid (n'ọnụ ala nke ọkpụkpụ ara) na akụkụ ọgịrịga ọnụ ala ** dị ala ** (gụnyere n'elu ** epigastric triangle**).
• Oke akụkụ aka ekpe na aka nri (Lateral):** Ahịrị kwụ ọtọ gbadata n'etiti ọkpụkpụ ọkpụkpụ ọ bụla (** ahịrị etiti aka ekpe na aka nri , na-agafe n'akụkụ ** ara n'ime ụmụ nwoke).
• ** Ihe kpatara e ji eti ventricle ziri ezi 50% nke oge: *** N'ihi ụzọ obi mmadụ si agbagharị n'ime obi, ** ventricle aka nri ** na-etolite ihe fọrọ nke nta ka ọ bụrụ akụkụ ihu (anyi) dum nke obi ozugbo n'azụ sternum wee hapụ 3^rd-na-6^th cartilages costal. N'ihi ya, ** ihe karịrị pasent 50 nke mmerụ obi na-abanye n'ime obi na-amapu ventricle aka nri **, ihe dị ka pasent 30 na-amapu oke ** ventricle ekpe **, na pasent 10 ruo 15 na-amapuo atrium aka nri ma ọ bụ aka ekpe ma ọ bụ intrapericardial aorta/vena cava.

Ịdịiche ihe mberede obi atọ na-egbu egbu: Cardiac Tamponade vs. Tension Pneumothorax vs. Massive Hemothorax¶

Mgbe onye ọrịa nwere ọnya na-abanye n'ime obi na-abata ngwa ngwa, ndị na-ahụ maka ahụike na ndị dọkịta mberede ga-amata ọdịiche dị n'etiti ** Pericardial Tamponade , Pneumothorax erughị ala, na oke hemothorax **. Rịba ama ka mmadụ abụọ n'ime ha na-ebute ** veins olu -agba agba * (** ihe mgbochi mgbochi ***) ebe otu na-ebut veins olu dị larịị *** (* hypovolemic shock ***), yana ka ige ntị ngụgụ si agwa ihe mberede abụọ na-egbochi mmadụ iche:

Anatomi na pathophysiology nke Pericardial Tamponade¶

1. Gịnị kpatara na ọkara iko ọbara na-egbu n'ime nkeji ebe otu lita nke mmiri dị nwayọọ adịghị (The Pericardial Pressure-Volume Curve)¶

Kedu ihe kpatara onye ọrịa ahụike na-arịa ọrịa akụrụ na-adịghị ala ala ma ọ bụ ọrịa kansa ji nwayọọ nwayọọ gbakọta ** 1,000 ruo 1,500 milliliters (1 ruo 1.5 lita)** nke mmiri dị n'obi ha n'ime ọtụtụ izu na-enweghị akpata oyi n'ahụ, ebe onye merụrụ ahụ n'obi na-anwụ n'ime nkeji 5 site na naanị ** 75 ruo 100 milliliters (3 fluid ounces) n'ime ọbara? * A na-akpa akwa oyi akwa nke mpụta nke pericardium (** pericardium fibrous ***) site na eriri collagen na-adịghị agbanwe agbanwe nke nwere ihe fọrọ nke nta ka ọ bụrụ ihe na-agbatị ogologo. * Mgbe mmiri na-agbakọ nwayọọ nwayọọ n'ime izu, eriri collagen ji nwayọọ nwayọọ na-emegharị ma gbatịa iji jide otu liter nke mmiri. * Na ** nnukwu penetrating trauma ***, ọbara na-awụba n'ime oghere pericardial n'ime sekọnd. Ozugbo 30 na 50 milliliters nke oghere oghere dị n'ime akpa ahụ jupụtara, ** ụda nrụgide nke pericardium na-atụgharị kwụ ọtọ **: ịgbakwụnye naanị ** 20 ma ọ bụ 30 milliliters ọbara ọzọ ** na-eme ka nrụgide intrapericardial na-arị elu site na 0 mmHg ruo ** 15 ruo 25 mmHg **. * N'ihi na ihe gbara ọkpụrụkpụ ** atrium aka nri na ventricle aka nri ** na-ejupụta na nrụgide venous dị nro nke naanị ** 2 ruo 8 mmHg **, nrụgide pericardial mpụga nke 20 mmHg na-etipịa atrium aka nri na ventricle aka nri n'oge diastole (akụkụ izu ike nke ndochi obi).

2. Nkwekọrịta nke Ventricular na "Pulsus Paradoxus"¶

N'ime igbe siri ike, nke na-adịghị agbanwe agbanwe nke akpa pericardial, ventricle ekpe na ventricle aka nri ga-asọ mpi maka oghere zuru ezu (** ventricular interpendence ), nke kewapụrụ naanị site na muscular ** interventricular septum : 1. Mgbe ọ bụla onye ọrịa ** kuru ume (na-eku ume), nrụgide na-adịghị mma n'ime obi na-amịpụta ntakịrị ọbara venous n'akụkụ aka nri nke obi. 2. N'ihi na akpa pericardial siri ike, jupụtara n'ọbara n'èzí na-ajụ ikwe ka ventricle aka nri gbasaa * apụta, a na-amanye ventricle aka nri na-agbasa ka gbanye septum interventricular INWARD n'ime ventricle aka ekpe, na-akụda oghere ventricle aka ekpe fọrọ nke nta ka ọ mechie mgbe iku ume. 3. N'ihi nke a, n'oge ** iku ume **, ventricle aka ekpe nwere ike ịpụpụ ọbara ọ bụla n'ime aorta: ọbara mgbali systolic nke onye ọrịa na-agbada karịa ** 10 mmHg ** n'oge iku ume ọ bụla, ya ọ bụrụ na ị na-inye mkpịsị aka gị na radial radial pulse na nkwojiaka, ị nwere ike inwe mmetụta nkwojiaka ma ọ bụ na-eku ume mgbe ọ bụla onye ọrịa na-apụ n'anya. pụta. A na-akpọ akara ngosi anụ ahụ dị ịrịba ama Pulsus Paradoxus.

3. Ịghọta Beck's Triad (na ihe kpatara na ịchọghị stethoscope n'okporo ámá mkpọtụ)¶

N'afọ 1935, dọkịta na-awa cardiothoracic Claude Beck kọwara triad a ma ama nke nnukwu obi tamponade (** Beck's Triad ): 1. Hypotension (Ọbara mgbali akwara na-adaba na nrụgide akwara dị warara): Ọbara systolic na-agbada mgbe nrụgide diastolic na-adị elu (dịka ọmụmaatụ, 85/75 mmHg, obere mgbali pulse 10 mmHg), na-amịpụta adịghị ike, eriri radial pulse nke na-apụ n'anya na iku ume. 2. ** Jugular Venous Distension (JVD):* N'ihi na a na-egbochi ọbara venous n'isi na n'olu ịbanye n'ime atrium aka nri nke ọma, akwara mpụta na nke dị n'ime n'akụkụ olu na-apụta dị ka eriri na-acha anụnụ anụnụ, ọbụlagodi mgbe onye ọrịa nọ ọdụ n'ogo ogo 45. (Rịba ama: N'akụkụ okporo ụzọ na-eme mkpọtụ ebe ị na-enweghị ike ịnụ ụda obi na stethoscope, ** ọnya na-abanye n'ime igbe obi + Shock + Mgbochi olu + Nha nhata ume iku ume ** bụ naanị ihe ịchọrọ iji chee na tamponade obi.) 3. ** Ụda obi akpọchiri akpọchi ma ọ bụ dị anya:** Ọbara gbara obi gburugburu na-egbochi ụda lub-dub acoustic nke valvụ obi dị ka jaket mmiri.

4. Ihe ịrịba ama ịdọ aka ná ntị ndị ọzọ nke Pericardial Tamponade¶

• Akara Kussmaul: Ihe nhụsianya ** ebili (ịgbapụta ọzọ) nke akwara olu n'oge ikuru ume** (na-adịkarị, akwara olu na-adaba ntakịrị mgbe mmadụ na-ekuku ume n'ihi na a na-amịnye ọbara n'ime obi; na tamponade, ọbara enweghị ike ịbanye n'obi gbajiri agbaji, ya mere veins olu na-agbapụta ọbụna karịa n'ike mmụọ nsọ).
• ** Mgbaghara dị oke egwu na "Sense of Impending Dom" (* Angor Animi*):** N'ihi na ụbụrụ ụbụrụ na-ada ngwa ngwa mgbe onye ọrịa ka maara ihe, ndị na-egbu tamponade na-enwekarị ahụ iru ala, na-etipịa ihe, na-alụ ọgụ ịnọdụ ala, na-ekwu na ha na-achọ ịnwụ, ihe ịrịba ama na-emehie mgbe ndị na-eguzo ma ọ bụ ndị uwe ojii na-emehie tupu ha ejide mmanya na-egbu egbu.

Enyemaka mbụ nke nzọụkwụ-site-nzọụkwụ maka Penetrating Ọnya Chest na Tamponade a na-enyo enyo¶

Kwụpụ 1: Triage ozugbo na “Scoop and Run” ebighị¶

1. ** Kpọọ 911 / 112 / 999 ozugbo: ** N'adịghị ka ọnya nsọtụ nke nwere ike ịme ka ọ kwụsie ike n'ọhịa site na iji njem nlegharị anya, ** obi tamponade nwere ike gwọọ naanị site na igbapu akpa pericardial (pericardiocentesis ma ọ bụ mkpịsị aka pericardiotomy) na ịkwa akwa n'ime oghere n'ime akwara obi. Nkeji ọ bụla etinyere na ọnọdụ na-ebelata ndụ nke ọma.
2. ** Kpuchie igbe na azụ:** Wepụ uwe elu ahụ nke ọma wee lelee ma ihu na azụ azụ.

Kwụpụ 2: Ijikwa agụba ma ọ bụ ihe akpọgidere n'igbe obi¶

Ọ bụrụ na mma, ice pick, rebar, ma ọ bụ ugegbe shard ka na-apụta n'ime obi ma ọ bụ n'elu epigastrium: 1. AKWỤKWỌ KWESỊRỊ ya, agbalịkwala ịgbatị ma ọ bụ mkpụbelata ya. 2. ** Lelee maka "Pulsatile Blade Motion":** Ọtụtụ mgbe, mma mma nke ọnụ ya dabara n'ime mgbidi nke ventricle aka nri ga-apụta n'ihu ** bob ma ọ bụ tụgharị n'ụda n'otu egwu ọ bụla. 3. ** Mechie ma kwụsie ike na-enweghị igbochi mmegharị obi:** * Ọ bụrụ na ikuku na-amị n'akụkụ ala nke agụba ahụ, dọba ibe mmanụ gauze ma ọ bụ kechie plastik n'akụkụ ọnụ ụzọ akpụkpọ ahụ (na-ahapụ otu akụkụ ka etinyeghị ya ka ikuku pụta). * Tinye akwa gauze abụọ buru ibu ma ọ bụ akwa akwa apịaji n'akụkụ ọ bụla nke agụba ahụ iji chebe ya ka ọ ghara ịkụda ya ma ọ bụ ịkwanye ya n'ime oge njem ụgbọ ihe mberede, mana ** Ejila eriri ahụ n'ala nke ọma nke na obi na-eti mkpu na-adọwa onwe ya n'ọnụ igwe na-enweghị ike ibugharị **.

Kwụpụ 3: Ijikwa Ọnya Penetrating mepere emepe na-enweghị ihe akpọgidere¶

1. Akwanyela gauze n'ime oghere obi: Atụnyela gauze ọgụ ma ọ bụ bandeeji n'etiti ọgịrịga n'ime obi.
2. ** Tinye Akara Chest Vented (ma ọ bụ akwa mkpuchi mkpuchi akụkụ atọ):** Ọbụlagodi maka obere ọnya n'elu sternum ma ọ bụ igbe aka ekpe, hichaa ọbara na ọsụsọ kpọrọ nkụ ma tinye akara mkpuchi mkpuchi azụmahịa na njedebe nke iku ume ka ikuku ghara ịbanye n'ime oghere pleural ma ọ bụ mediastinum.
3. ** Gịnị ma ọ bụrụ na ọbara na-acha uhie uhie na-esi na mgbidi igbe n'onwe ya pụta?**
4. Nnukwu akwara abụọ, akwara mammary dị n'ime (internal thoracic) **, na-agbada n'ụzọ kwụ ọtọ n'ime ime ọgịrịga n'ihu naanị ** 1 ruo 2 centimeters (0.5 sentimita) n'aka ekpe na aka nri nke nsọtụ ọkpụkpụ ara (sternum) ***, yana ** intercostal artery ** na-aga n'akụkụ oghere nke ọgịrịga ọ bụla.
5. Ọ bụrụ na ọnya mgbo na-egbutu akwara intercostal ma ọ bụ nke ime mammary ma ọbara na-awụpụ n'akụkụ akpụkpọ ahụ, tinye ** nrụgide kwụ ọtọ na pad gauze na-adịghị mma ozugbo n'elu ọnya mpụta ** (ma ọ bụ n'elu akara mkpuchi ventilashị mgbe ị na-eleba anya maka pneumothorax erughị ala).

Kwụpụ 4: Ndokwa, Nlekọta okpomọkụ, na Mweghachi¶

1. ** Nkwadebe: *** Kwe ka onye nwere uche, na-eku ume ka ọ nọrọ n'ọnọdụ nkasi obi ha (nke a bụ ** ọkara kwụ ọtọ na 30 ruo 45 degrees ** ma ọ bụ na-adabere ntakịrị n'ihu, nke na-ewe obere nrụgide na atrium aka nri). Ọ bụrụ na ọbara mgbali elu ha dara nke ukwuu ma ọ na-adị ha ka ike gwụ ha, wetuo isi nke ihe ndina ahụ ka ọ daa n'elu ala ka ị na-elekwa iku ume ha anya.
2. ** Mee ka onye ọrịa ahụ dajụọ ma gbadaa:** mgba mgba ma ọ bụ iguzo ọtọ na-abawanye agụụ oxygen nke obi ma na-ebuli mgbali systolic ventricular, na-amanye ọbara karịa site na anya mmiri myocardial n'ime akpa pericardial.
3. ** Gbochie hypothermia: *** Kechie onye ọrịa na blanketị ọkụ ma debe ya nke ọma NPO (ọ dịghị ihe ọ bụla n'ọnụ).
4. ** Gịnị ma ọ bụrụ na onye ọrịa ahụ tụfuru uche wee banye n'ime traumatic Cardiac Arrest (Pulseless Electric Activity / PEA) tupu EMS abịarute?**
5. N'ime tamponade obi, onye na-ahụ maka eletriki nke obi na-aga n'ihu na-agba akara ngosi nkịtị na ihe nleba anya ECG ebe ọbara efu na-agbapụta (Pulseless Electric Activity or PEA).
6. **Malite ọkọlọtọ CPR ozugbo *** ka ndị ọrụ ahụike na-aga. Ọ bụ ezie na mkpakọ obi dị n'èzí na-adịchaghị irè mgbe akpa pericardial jupụtara n'ọbara karịa na nkụchi obi na-agwọ ọrịa, CPR na-anọgide na-enwe mgbagwoju anya nke ọrịa obi na ụbụrụ ụbụrụ ruo mgbe ALS paramedics ma ọ bụ ndị dọkịta na-awa ahụ na-abịarute iji mee ** ihe mberede resuscitative thoracotomy ** ma ọ bụ ** pericardiocentesis nke ultrasound na-eduzi ** 0 milliters ọbụna chọrọ 5 milliliters. site na akpa pericardial nwere ike iweghachite ụbụrụ ozugbo).

Ihe ngosi ụlọ ọgwụ pụrụ iche na ntinye trauma thoracic¶

1. Ọrịa Trajectory Thoracoabdominal (N'okpuru 4^th Intercostal Space / Nipple Line)¶

Ọtụtụ ndị nnapụta adịghị aghọta otú elu dome nke diaphragm si ebili n'ime ọgịrịga mgbe mmadụ kupụrụ ume. N'oge iku ume nkịtị, dome ziri ezi nke diaphragm na-ebili n'ụzọ niile ruo oghere intercostal ** nke anọ (ọkwa nke ara)** n'ihu, ọgịrịga ** 6 n'akụkụ, yana ọgịrịga ** 8 (n'ọnụ ala nke ubu)** n'azụ. * N'ihi ya, ** ọnya mma ma ọ bụ mgbọ egbe ọ bụla dị n'okpuru ahịrị ọnụ ara n'ihu ma ọ bụ n'okpuru ubu na azụ nwere nnukwu ohere ịbanye ma oghere obi (pleura/pericardium) na oghere afọ (diaphragm, imeju, splin, afo, ma ọ bụ colon)**. * Debe onye ọrịa nwere ọnya obi dị ala mgbe niile NPO (ọ dịghị ihe ọ bụla site n'ọnụ) wee lelee afọ ha maka nchekwa, isi ike, ma ọ bụ mgbu ubu zoro ezo.

2. Mgbo Mgbo Na-agafe Ebe Obibi¶

Mgbe ọ bụla mgbọ na-abanye n'otu akụkụ nke igbe wee pụọ n'akụkụ nke ọzọ (ma ọ bụ ebe obibi n'akụkụ nke ọzọ nke spain), trajectory ya agafewo ** mediastinum **, etiti etiti etiti na-edobe obi, aorta na-arịgo na nke na-agbada, akwara pulmonary, trachea, na esophagus. * Ihe karịrị pasenti 50 nke ndị ọrịa nwere ọnya ogbunigwe transmediastinal dị na oke ujo site na tamponade obi ma ọ bụ nnukwu hemothorax, ebe ndị ọrịa fọdụrụnụ nke pụtara kwụsiri ike nwa oge chọrọ CT angiography ngwa ngwa, esophagoscopy, na bronchoscopy iji chịkwaa oghere aortic ma ọ bụ esophageal nwere.

3. Ọrịa Tracheobronchial Tree na oke Subcutaneous Emphysema¶

Mgbe agụba ma ọ bụ mgbọ na-egbutu trachea intrathoracic ma ọ bụ nnukwu bronchus: * Ikuku buru ibu na-abanye n'ime mediastinum (** pneumomediastinum**) wee kesaa ngwa ngwa n'okpuru akpụkpọ olu, ihu, na mgbidi obi (* nnukwu subcutaneous emphysema ), na-eme ka olu onye ọrịa na nku anya na-afụli elu dị ka balloon nwere mgbawa "Rice Krispies" na-acha uhie uhie na-acha ọbara ọbara n'okpuru ụkwara. ( hemoptysis** * Debe ndị ọrịa a ka ha nọ ọdụ kwụ ọtọ, tinye akara obi ventilashị n'ọnya ọ bụla na-aṅụ na mpụga, ma mee ka ndị na-ahụ maka ahụike ALS mara ozugbo.

Nkwenye ngwa ngwa maka mmerụ ahụ igbe obi obi yana triad Beck na-eme ka a mara na ndị na-ahụ maka ahụike na-agafe ụlọọgwụ mpaghara ma na-agba ọsọ ozugbo gaa na ebe ịwa ahụ. Tụlee ịnara enyemaka mbụ agbaara agbazi, Kwụsị Ọbara, ma ọ bụ Prehospital Trauma Life Nkwado site na Red Cross mba gị ma ọ bụ Red Crescent obodo, American College of Surgeons, ma ọ bụ St John Ambulance.

Ajụjụ a na-ajụkarị¶

enyochara isi mmalite¶

• ** Kọleji nke Ndị dọkịta na-awa ndị America (ACS, United States):** * Akwụkwọ ntuziaka nkuzi nkuzi nke Advanced Trauma Life Support (ATLS): Ọkụkụ Thoracic, Mmerụ Obi Obi Penetrating, Pericardial Tamponade, na Resuscitative Thoracotomy*.
• ** Òtù Ọwụwa Anyanwụ maka ịwa ahụ nke trauma (EAST) & Western Trauma Association (WTA, United States):** * Ntuziaka nchịkwa omume maka ịbanye n'ọgba aghara Thoracic na "igbe obi"*.
• ** Kọmiti na Nlekọta Ọgụ Ọgụ (CoTCCC / Sistemụ Njikọ Trauma, United States): *** Ntuziaka TCCC: Njikwa Penetrating Chest Trauma na Mgbochi zuru oke na Mbukota Ọnya Intra-thoracic*.
• ** European Resuscitation Council (ERC) & UK Resuscitation Council: *** Ntuziaka maka njide obi mgbawa (TCA): Ihe kpatara mgbanwe (4 Hs na 4 Ts, Cardiac Tamponade, na Tension Pneumothorax)*.
• ** Òtù Na-ahụ Maka Ndị Na-ahụ Maka Ọgwụ Ahụike Mberede (NAEMT, United States):** * Nkwado Ndụ Ọhụụ Na-ahụ Maka Ụlọ Ọgwụ (PHTLS): Ihe mgbochi mgbochi, Beck's Triad, na Pulsus Paradoxus*.

Ntuziaka emetụtara¶

• Ọnya obi na-aṅụ ọnya na ngụgụ dara ada enyemaka mbụ
• Obi mgbawa, ọtụtụ ọgịrịga mgbaji, na obi mgbawa na-adịghị mma
• Mkpọgide na agbakwunyere nkwụsi ike ihe mba ọzọ
• Nchọpụta ujo na nlekọta mberede
• Ndị okenye CPR na iku ume nnapụta
• Nọmba mberede na izipu mba ofesi