Disama dia bingoma bia lupepele: Dibunda dia kapepe, dibuela dia dikoba, ne disama dia tshiadi¶

Milonda ya kapepe kakole mu nzubu ya mashinyi, nzubu ya mabaya, nzubu ya mashinyi, ne nzubu ya midimu idi yenza mudimu ku 6.2 too ne ku 8.6 bar (90 too ne ku 125 pounds ku inch kare, anyi psi), ne mionji ya mashinyi manene ne ya mu midimu ya bianza idi ifika ku **10.3 too ne ku 12 to ne ku 12 bar (1705 too ne ku 17) psi **. Bu mudi lupepele lukole kaluyi lumueneka, kaluyi ne mupuya, ne ludi lumueneka lupepele ne kaluyi ne njiwu padibu balua ku bule, bena mudimu batu misangu ya bungi benza mudimu ne bingoma bia kapepe kakole bidi kabiyi ne nsongo bua kumbusha lupuishi, biamu bia mitaku anyi kukosa bilamba biabu bia mudimu, bianza ne nsuki. Tshibidilu atshi ntshilema tshidi mua kushipa muntu. Padibu bakuate tshiamu tshia kapepe tshidi katshiyi tshilongolola mutantshi wa 1 anyi 2 santimetre (0,4 too ne ku 0,8 inches) wa mubidi, anyi bikala muena mudimu wenza mudimu ne tshianza tshinene bua kukanga nsongo ya tshiamu tshia nzembu, kapepe ka pa mutu pa 2 bar (30 psi) kadi kapatuka bipepele mu bilamba ne mu dikoba dikese, anyi mu bitupa bikese bia mubidi, mu mishiku, mu mishiku matshi, anyi bipese bia mubidi, bidi bipuekesha mifuba ya muinshi mua dikoba bu mudi tshipepele ne bienzeja bipese bia kapepe buludiludi mu mishipa ne mu mishipa ya mashi.

Padi kapepe kakole kabuela mu mashi, kadi kaenza vascular gas embolism kadi kaenda mu masekonde makese too ne ku luseke lua dia balume lua mutshima, muaba udidi kafika mu tshintu tshidi tshipangisha mashi bua kuya mu mikolo (right ventricular air lock), anyi kapitshila mu njila wa mashi bua kukanga mijilu ya mashi mu buongo ne kuimana kua mutshima anyi dia AVC. Tshidi tshitamba kuikala ne tshikisu ntshia se: kuela tshiamu tshia kapepe ka mu tshisalu ku mataku anyi ku tshiadi tshia muena mudimu nende ku 10 too ne ku 15 centimètres (4 too ne ku 6 inches) kule, nansha mu jeans ya mudimu ya denim mikole, udi utuma tshilongo tshia gaz wa pression wa bungi buludiludi mu tshitupa tshia mu tshiadi, uvuija ne ututa colon mu tshitupa tshia sekonde mikese. Kumanya mua kuteka muntu udi ne disama dia luya mu muaba wa kulala ku dia bakaji (Durant), kumupesha 100 pa lukama wa oxygène wa bungi, kumanya disama dia emphysème muinshi mua dikoba ("Rice Krispies" udi ulenga muinshi mua dikoba), ne kuondopa dinyanguka dia mala didi disungila mioyo. Tangila nomba ya tshimpitshimpi, dibueja dia tshiamu tshia kusukula natshi ne tshiamu tshia mudimu tshia nzembu, mputa ya ku mêsu, ne dikema.

Enza nunku mpindieu¶

1. Kima anyi umbusha kapepe kakole diakamue ne uteke muntu udibu bashipe pa muaba mupepele kule ne mashinyi adi enza mudimu. Kulenguludi nansha kakese dibutuka dia kapepe kakole pa dikoba anu bualu kakuena mashi adi apatuka pambelu to; kapepe ka bukole kadi kabuela mu tshina tshia tshiamu tshia mitaku tshidi tshikanga panyima patshi eku lupepele luenda lupita mu mishipa ne lubuela mu mijilu.
2. Bikala muntu udibu bashipe upeta dipanga dia mupuya, disama dia mu tshiadi, disama dia mutu, dipanga dia lungenyi, diakula dibi, disama dia tshiadi, anyi dikuluka kunyima kua dibutuka dia kapepe, umuteke diakamue ku luseke lua dia bakaji ne mutu wende ne tshiadi tshiende bimane anyi bitenteke kakese panshi (Durant / left-lateral Trendelenburg udi uteka pa bule bua kapepe ka ku dia bakaji). ku mutu kua atrium wa ku dia balume ne ventricule wa ku dia balume kule ne njila wa dipatuka dia mashi mu mikolo bua mutshima utungunuke ne kupompa mashi mu mikolo; tangila disama dia avc ne disama dia mutshima.
3. Bikila nimero ya tshimpitshimpi ya muaba unudi (911 mu États-Unis ne Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni) ne uleje patoke ne: "Udi wela meji ne: udi ne disama dia mashi adi afumina ku diela dia kapepe kakole." Umanyishe bantu badi batuma bantu ne: mubedi udi mua kuikala dijinga ne dituma dia lukasa lukasa mu lupitadi ludi ne tshiamu tshia Hoxybary Therapie (THO) nzubu; tangila nomba ya tshimpitshimpi.
4. Ufila 100 pa lukama ya oxygène wa bungi ku diambuluisha dia tshilamba tshidi katshiyi tshipuyakana ku 15 litre ku minite diakamue padi tshiamu tshia oxygène tshia kumpala tshia ku mudimu anyi munganga ufika. Kuela oxygène wa 100 pa lukama kudi kusukula azote mu mashi, kuenza tshitupa tshikole tshia ditangalaka tshidi tshipuekesha luya lua mu mashi mishipa ya mashi ya mu buongo ne ya mutshima.
5. Bikala kapepe kakole kapatuka pabuipi ne mataku, tshiadi, anyi difu (dienza manaya a kabalu anyi dikuluka dia mpukapuka pa tshintu tshia kuela) ne muntu udibu bashipe ne disama dikole dia mu difu anyi difu dikole, diuwule, umulame mulale panshi, kanupeshi tshintu nansha tshimue ku mishiku, ne udilongolole bua kupeta tshipupu tshia lukasa. Kapepe ka bukole bua bungi ka lupepele ludi lunyanguka ne luya lukole ludi luenzeja tshifu ne luya mu tshifu. tshina (tension pneumoperitoneum), tshidi tshifina vena cava ne diaphragm.
6. Umbusha bipese bionso, nsa, ne maboko makole ku tshianza anyi ku diboko didibu bele kapepe diakamue, ne enza bua tshitupa atshi katshiyi tshiendakana mu mutshima. Kuena ne bua kuela tshilamba tshikole anyi tshilamba tshia mashika pa tshitupa tshia mubidi tshidi tshiuwule tente ne kapepe ka muinshi mua dikoba to, bualu disama dia tshitupa tshia mubidi tshidi ne bukole bua bungi didi dijula ​​lukasa **tshitupa tshia tshitupa tshia mubidi tshidi tshisama; mona disama dia tshiadi ne disama dia tshitupa tshia mubidi.

Mutshi wa mapangadika: disama dia tshingoma tshia luya lukole ne disungula dia embolie¶

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    Site -->|"Disama dia mu tshiadi, dipanga dia mupuya, dipanga dia lungenyi, dipanga dia lungenyi, anyi dikuluka"| Embolism["1. KUELA EMBOLISME WA LUPETU LUA VASCULER DIAMUE; 2. Teka muntu udibu bashipe ku luseke lua dia bakaji ne mutu mutekete anyi mupuekele kakese (muaba wa durant); 3. Ufila 100% ya oxygène wa bungi (15 L/min non-rebreather mask); 4. Bikila 911 / 112 / 999 ne lomba tshibambalu tshia Hyperbaric Oxygen (HBOT)"]
    Site -->|"Dikoba dia ku tshianza, ku munu, ku diboko, anyi ku nshingu (dikoba didi dijula anyi dibutuka)"| SkinInject["1. Umbusha bipese bionso, ma-watch, ne bilamba bidi bikuata diakamue; 2. Tangila bimpa bimanyinu bia disama dia mitu anyi dia mupuya; 3. Lama tshitupa tshia mubidi ku tshipiminu tshia mutshima; KUFINYI anyi KUPETA tshitupa tshia mubidi tshidi tshiuwule to; 4. Diya nadi ku tshibambalu tshia malu a mpukapuka bua kukonkonona dipanda dia mubidi"]
    Site -->|"Dibutuka pabuipi ne mataku, perineum, anyi mukana (dinaya dia tubalu / njiwu ya mukana)"| Orifice["1. KUELA MU DITUKU DIA MU MUTU ANYI MU ESOPHAGE NE MU MUTU WA TENSION PNEUMOPERITONEUM; 2. Lala muntu udibu bashipe panshi anyi ku luseke lua dia bakaji ne binu bikese bikese; 3. Kufila tshintu nansha tshimue ku mishiku; kutangila mupuya padi tshifu tshikole tshifina mifuba; 4. Bikila ku 911 / 112 / 999 bua kupeta diakamue disama dia tshiadi"]
    Site -->|"Dibutuka dia kapepe buludiludi mu disu anyi mu matshi"| EyeEar["1. Disu: Buikila ne tshilamba tshikole kakuyi dikuma; Tangila ni orbite udi muvula; 2. Ditshi: KUTEKA matonsi anyi tshilamba tshia butoyi mu tshitupa tshia matshi to; ikala ne ditshi diume; 3. Tangila vertigo, butekete bua mijilu ya ku mpala, anyi kapepe ka munda mua mutu"]
    Embolism --> Monitor["Tuadija CPR shi udi kayi ne tshiadi ne kayi wandamuna; Ikala mumanyishe baminganga bua barotrauma"]
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Malu a fisike a njiwu ya lupepele lukole ne mukenji wa bukubi wa OSHA 2-bar (30-psi)¶

Bua tshinyi kapepe kakole kadi kabuela mu dikoba dia muntu ne mu bitupa bia mubidi¶

Bena mudimu ba bungi batu bela meji ne: bu mudi kapepe kakole kadi kafumina ku lupepele pamutu pa kuikala tshintu tshikole anyi tshintu tshidi ne bukole bua bungi bu mudi tshiamu tshia kusukula natshi bintu anyi tshiamu tshia hydraulique, tshidi anu tshipatuka pa dikoba. Mu bulelela, dikoba dia muntu ne tshitupa tshia muinshi mua dikoba bidi ne bukole bukese bua kukandamena tshipepele tshikole tshia kapepe:

• 0.2 to 0.35 bar (3 to 5 psi): Bukole bukumbane munda mua mukana, mu tshifu, anyi mu tshiadi bua kutshibula tshifu tshia muntu, tshifu anyi mala manene.
• 0.35 to 1.0 bar (5 to 15 psi): Bukole bukumbane bua kutshibula tshitupa tshia matshi tshia muntu (tshiamu tshia ditshi) anyi kupatula dikasa dia dîsu (globe luxation) ne kuenzeja kapepe kunyima kua tshijengu tshia dîsu.
• 0.8 to 2.0 bar (12 to 30 psi): Udi mua kuendesha bukoya, tshiamu tshia mitaku, ne kapepe kupitshila ku dikasa dikese, dibeji dikosa, anyi dikoseka dia minu, dikosolola dia mishiku ya flexor tendon sheaths kumbukila ku nsongo ya munu too ne ku diboko dia kumpala ne ku tshimanu tshia tshiadi mu sekonde umue.
• Pa mutu pa 2.0 bar (30 psi) ne too ne ku 8.6 bar (125 psi): Tshipepele tshia mu tshisalu tshidi katshiyi tshilongolola. Kulamakaja buludiludi ku dikoba dia patupu anyi ku tshilamba tshitekete, tshintu tshia 6-to-8-bar (90-to-120-psi) tshidi tshituta buludiludi mu tshitupa tshia mubidi tshidi katshiyi tshinyanguke, tshipuekesha tshitupa tshia mubidi ne nkama ya mililitre ya kapepe kafiika, tshipatula mishipa ya muinshi mua dikoba, ne tshibueja kapepe buludiludi mu mashi adi enda mu mijilu.

OSHA 29 CFR 1910.242(b) ne mukenji wa pa buloba bujima wa 2-bar (30-psi) udi kayi ne ndekelu¶

Bua kuepuka disama dia luya ne disama dia tshiadi didi dibuela mu dikoba, tshibambalu tshia malu a bukubi ne makanda a mubidi tshia mu États-Unis (OSHA Standard 29 CFR 1910.242(b)), tshibambalu tshia malu a bukola bua mubidi ne bukubi tshia mu UK (HSE), ne mikenji ya malu a bukubi ya pa buloba bujima idi ileja ne: kapepe kakole kadibu benza naku mudimu kadi ne bua kukepeshibua bar (30 psi) gauge pressure, ne anu pashishe ne tshiamu tshia kulama nabi bintu ne bintu bia kudikuba nabi.

Bia mushinga, tshitupa etshi tshia 2-bar (30-psi) tshidi tshitangila dead-end static pressure, mbuena kuamba ne: tshipiminu tshidibu bapima ku nsongo ya tshingoma padibu bafina tshintu tshikole (bu mudi tshianza tshia muena mudimu anyi tshilamba):

1. Bua tshinyi tshingoma tshidi katshiyi tshilongolola tshidi tshibengangana ne mikenji bua kutshisukula: Shi tshiamu tshia kapepe tshia mu tshisalu tshidi ne luya lua 7 bar (100 psi) ne tshienza mudimu ne tshingoma tshia tshiamu tshia mitaku tshidi katshiyi ne tshiamu tshia kukokesha natshi luya anyi bipese bia ku luseke, kufina tshingoma atshi ku dikoba kudi kufila **7 bar (100 psi) mu mulongo wa kapepe mu tshitupa tshia mubidi.
2. Mushindu udi tshingoma tshia bukubi tshidi tshilonda mikenji ya OSHA tshienza mudimu: Tshiamu tshia bukubi tshidi tshilonda mikenji tshidi ne mabue a radial relief anyi nsongo ya Venturi ku luseke lua tshiamu tshia nzembu tshidi muinshi mua 2 bar (30 psi). Shi nsongo ya tshiamu tshia bukubi mifina ku mpukapuka ku dikoba dia muena mudimu, tshibuelelu tshinene tshidi tshikanga, ne njila ya kapepe idi ipatuka ku luseke lua biibi bia radial relief nunku bukole bua dikoba budi kabuyi buenda kabuyi mua kupita 2 bar (30 psi).

Disama dia kapepe ka mu mishipa: padi kapepe ka mu tshisalu kabuela mu mashi¶

Mushindu kayi udi kapepe kakole kafumina ku mputa wa munu anyi wa mu nshingu uya ku mutshima ne ku buongo¶

Padi tshingoma tshia kapepe kakole tshienzeja kapepe mu dikoba dia tshianza, dia tshianza, dia nshingu, anyi dia tshimanu tshia tshiadi, tshibombi tshia kapepe tshidi tshienda tshivula tshidi tshienza bua mashi ikale ne bukole bua bungi kupita bukole bua mashi adi mu mishipa (budi anu 0,005 too ne ku 0,015 bar, anyi 4 too ne ku 12 mmHg). Gaz udi ubuela buludiludi mu mijilu ya muinshi mua dikoba ne wenda mu njila ibidi mishilangane:

1. Embolie wa kapepe ka mu mishipa (Dikanga dia kapepe ka mutshima wa ku dia balume): Mabue a luya adi apita mu mijilu ya ku diboko anyi ya mu nshingu mu vena cava wa ku mutu ne abuela mu atrium wa ku dia balume ne ventricule wa ku dia balume wa mutshima. Bu mudi kapepe kadi mua kufina kadi mashi a mu mayi kaena mua kufina, padi tshitupa tshia ku dia balume tshikoka pabuipi ne tshibombi tshinene tshia kapepe (pa tshibidilu 50 to ne ku 100 millilitres, tshidi tshiamu tshia 7-bar shop hose tshifila mu tshitupa tshia sekonde), mushipa wa mutshima udi anu ufina ne uvudija tshipepele tshia mupuya pamutu pa kupompa mashi mu mushipa wa mu mikolo. Dipatuka dia muoyo didi dipueka too ne ku zero, didi difikisha ku disama dia tshimpitshimpi (dikoba dia bule), dikuluka dia mashi, ne dijika dia mutshima dia pulseless electrical activity (PEA).
2. Disama dia mu mishipa ya mu buongo (Embolie wa mu lungenyi): Bantu batue ku 25 too ne ku 30 pa lukama ba bantu bakole badi ne makanda a mubidi mimpe badi ne tshitupa tshikese tshidi tshienza bu tshilamba tshidi tshiunzuluka pankatshi pa tshitupa tshia muoyo tshia ku dia balume ne tshia ku dia bakaji tshidibu babikila ne: patent foramen ovale (PFO) tshidi pa tshibidilu tshishala tshikanga. Padi bipepele bia mu mishipa bikanga mishipa ya mu mikolo ne bienza bua bukole budi ku luseke lua dia balume lua muoyo bubandile, tshitupa atshi tshidi tshiunzuluka, tshituma bipepele bia mu mishipa mikole buludiludi ku luseke lua dia bakaji lua muoyo, mu aorte, mu mishipa ya mu mikolo (idi ifikisha ku disama dia muoyo dia lukasa), ne mu **mishipa ya mu mikolo ya mu mikolo (idi ifikisha diakamue ku disama dia tshiadi, tshipupu bufofo, anyi koma). Kapepe kadi mua kubuela mu mishipa ya mu mikolo buludiludi pikala bingoma bia mu mikolo bipita bukole ne bitshibula mishipa ya mu mikolo (barotrauma pulmonaire).

Kumanya disama dia luya lua mu mishipa pa tshisasa tshia tshisalu¶

Udi mua kuela meji ne: udi ne disama dia luya didi mua kushipa muntu padiye wenza mudimu ne tshingoma tshia luya lukole anyi mupete njiwu ku tshiamu tshia luya lua mu mashi udi upeta tshimanyinu tshionso tshia ku bimanyinu bidi bilonda ebi mu tusunsa tukese too ne ku minite 30:

• Dipanga dia mupuya dia tshimpitshimpi (dipanga dia mupuya), dikokola, anyi diumvua dia tshimpitshimpi
• Disama dikole dia mu tshiadi didi dilondangana ne dipueka dia tshimpitshimpi dia mashi, dikoba ditoke anyi dia bule, ne mutu mupepele bikole
• Malu adi kaayi makane adi afuanangana ne tshiadi: Dipanga dia lungenyi dia tshimpitshimpi, dipanga dia kuakula (aphasie), dinyanguka dia mpala, butekete anyi disama dia tshiadi ku luseke lumue lua mubidi (hemiparesis), dijimija dia tshimpitshimpi dia kumona, anyi disama dia tonic-clonic dia tshimpitshimpi; mona disama dia avc ne bipupu
• Dikuluka dia tshimpitshimpi ne dijimija dia lungenyi

Diondapangana dia lukasa lukasa bua disama dia embolie wa kapepe kakole¶

1. Teka muntu udibu bashipe mu mushindu wa Durant (Decubitus wa ku dia bakaji, mutu mutekete anyi mupuekele kakese):
2. Ela muntu udibu bashipe pa luseke luabu lua dia bakaji diakamue.
3. Bu mudi tshitupa tshia mashi tshidi tshipatuka mu tshitupa tshia muoyo tshia ku dia balume (mushipa wa mu mikolo) tshisombe ku tshitupa tshia kuulu tshia ku dia bakaji tshia nzubu wa mutshima wa ku dia balume, kuela mubedi ku luseke luende lua dia bakaji kudi kuenza bua lupepele ludi luenda luenda luenda lubandila ku mutu kua atrium wa ku dia balume ne ku tshimanu tshia ku luseke lua ventricule wa ku dia balume, biunzulula njila bua mashi apita muinshi mua tshibombi tshia mifuba.
4. Ikala ne mutu ne mubidi bitekete (muinshi/ku dia bakaji), anyi uteke makasa muulu kakese (10 too ne ku 15 degrés Trendelenburg) anu bua tshitupa tshîpi pikalabu bela meji ne: mushipa wa muoyo wa ku dia balume mmukuate ne kakuyi disama dia ku mutu; shi embolie wa mu mishipa ya mu buongo udi kale ukebesha bimanyinu bia AVC, ba munganga ba bungi badi ne disama dia hyperbarie batu basue kuikala mu tshitupa tshia ku dia bakaji anyi tshia mu buongo tshitekete bua tension wa mu mishipa ya mu buongo kayivudije disama dia buongo to. Ku mutu kua bionso, kuena mua kusomba mubedi mululame to.
5. Ufile 100 pa lukama ya oxygène diakamue:
6. Lupepele lua mu tshisalu ludi ne 78 pa lukama lua azote ne 21 pa lukama lua oxygène. Padi muena mudimu upuyakana 100 pa lukama ya oxygène wa luondapu ku diambuluisha dia tshilamba tshikole tshidi katshiyi tshipuyakana ku 15 litres ku minite, azote udi upatuka mu mashi ende a mu mishipa.
7. Azote udi mubuikila munda mua bipese bia luya bidi munda mua mashi udi unyunguluka lukasa mu mashi adi kaayi ne azote ne udi upatuka mu mikolo, ukepesha bunene bua bipese ebi ne 50 pa lukama anyi kupita apu eku ufila oxygène wa mushinga mukole ku tshitupa tshia buongo tshidi ne disama dia ischémie.
8. Wenza CPR wa mushinga mukole pikala muntu udibu bashipe kayi witaba ne kayi upuyakana bimpe:
9. Bikala muntu udibu bashipe mukuluke mu disama dia mutshima bua tshiibi tshia luya lua mu tshiadi tshia balume, umuele panshi pa mukolo pa tshintu tshikole ne utuadije kufina tshiadi ne bukole ku 100 too ne ku 120 ku minite, 5 too ne ku 6 santimetre (2 too ne ku 2,4 inches) mu butshiama diakamue; mona CPR ne AED.
10. Dikuma dia tshiadi dia pambelu dikole didi ditshibula tshibombi tshinene tshia luya lua mu tshiadi tshia balume mu tu-mabue tukese ne ditshienzeja bua kuya kumpala kupitshila mu tshitanda tshia kapilare ka mu mikolo bua mashi kutuadija kabidi.
11. Kulongolola bua kuya diakamue ku nzubu wa luondapu lua oxygène wa hyperbaric (HBOT):
12. Buondapi bua bushuwa bua disama dia mashi adi afumina mu mishipa anyi mu mishipa mikole budi buondapi bua dipingaja dia mashi mu mishipa bikole (pa tshibidilu ku 2,8 atmospheres absolute), budi bushipa bipese bia mashi mu mubidi too ne ku tshia bisatu tshia bunene buabi bilondeshile mikenji ya Boyle ne bupingaja dienda dia mashi mu buongo ne mu mutshima.

Disama dia muinshi mua dikoba ne dipanda dia dikoba dia bukole dia ku tshianza ne ku diboko¶

Bua tshinyi disama dia munu didi kadiyi ne mashi didi difumina ku luya lukole didi bualu bua tshimpitshimpi tshia dipanda¶

Padi muenji wa mashinyi anyi muenji wa mashinyi wela tshingoma tshia 7-bar (100-psi) ku tshianza, ku tshianza, ku tshianza anyi ku diboko, nangananga padiku tshitupa tshikese tshia mafuta, mputa wa tshitupa, anyi dikasa, lupepele ludi lutobola tshitupa tshia mubidi ne luvula muaba udi muinshi mua dikoba ne tshitupa tshia muinshi mua dikoba.

Mu masekonde 2 to ne ku 5, muena mudimu udi upeta:

• Divula dia tshimpitshimpi dia bu tshintu tshia muulu didi difumina ku munu too ne ku tshianza, ku diboko dia kumpala, ku diboko dia kuulu, ku dikaya, ku nshingu, ne too ne ku mpala ne ku tshimanu tshia tshiadi.
• Tactile crepitus ("Rice Krispies" crackling under the skin): Paudi ulenga bitekete bitekete diboko anyi nshingu udi mujuke, udi umvua ne umvua tshintu tshidi tshituta, tshituta anyi tshituta padi binunu bia tu-mabue tukese tua luya tudi tuenda tuenda tuenda muinshi mua minu yebe (emphysème subcutanée).
• Disama dikole dia tshisumi, dikala dia mpala, ne dipanga dia lungenyi: Shi kapepe ka tshisumi ka bungi kabuela mu bitupa bia tshianza anyi bia ku tshianza bidi bikole, luya lua mubidi ludi lubandila kupita luya lua mashi adi apita mu mifuba, bipangisha mashi bua kuya mu mifuba ne mu mijilu (tshitupa tshia mu mifuba). Kabidi, lupepele lua mu tshisalu kaluena lunyanguka nansha kakese; udi ne bukoya bua bungi ne lupuishi lua mafuta a tshiamu tshia mashinyi, mayi a bukoya, lupuishi lua tshiamu tshia mitaku, ne lupuishi lua mu tshisalu, bidi bifikisha ku disama dia cellulite dikole ne masama a mu tshibuashibuashi adi afua; mona dibueja dia tshiamu tshia kusukula natshi ne tshiamu tshia mudimu tshia nzembu.

Diambuluisha dia kumpala dia diela dia kapepe ka muinshi mua dikoba¶

1. Umbusha bipese bionso, nsa, bipese bia ku bianza, ne bipese bia tshilamba tshikole mu masekonde 60 a kumpala: Divulangana dia luya lua muinshi mua dikoba didi dienda dikola lukasa kupita disama dia mputa dia pa tshibidilu; tshifulu tshia or anyi tshia tshiamu tshia mitaku netshikuate munu mu minite ibidi.
2. Tangila nshingu ne njila wa kapepe pikala kapepe kapite pa dikaya: Padi kapepe kafiika mu tshianza anyi mu diboko dikosolola mu tshitupa tshia ku tshianza mu mediastinum (munkatshi mua tshiadi) ne mu nshingu (pneumomediastinum), nshingu wa muntu udibu bashipe udi mua kuvula bikole ne dîyi diende didi mua kuangata mishiku mikole, " Duck" anyi hoarse quality ("hamman's crunch" udi mua kumvuika pa mutshima). Tangila bimpe mushindu udibu bapuyakana ne ubalame batabale.
3. Fuka tshitupa tshikese tshia tshibuelelu ne tshilamba tshia gaze tshiume tshidi katshiyi ne disama ne ikala ne tshianza tshikole pa mutu pa mutshima: Kubandishi tshianza mulu pa mutu (tshidi tshipuekesha bukole bua mijilu ne tshikankamija luya bua kubuela mu mijilu) ne kulekedi tshilengeja panshi to.
4. Kulomba bua kuenza tshikebelu tshia lukasa tshia lupitadi ne kuenza rayon X: Nansha mudi muntu udibu bashipe udiumvua bimpe, muntu yonso udi ne disama dia crepitus muinshi mua dikoba didi difumina ku tshiamu tshia kapepe tshia mu tshisalu udi dijinga ne radiografi ya lukasa (bua kuleja kapepe mu bitupa bia mubidi ne mu tshiadi), dikuba dia disama dia tetanus, manga a antibiotique a mu mishipa (a mu mayi ne a mu mashi), ne bua kulonda bactérie disama dia tshitupa anyi disama dia peinture/mafuta.

Luya lua kabalu lukole ne dibutuka dia tshifu¶

Bua tshinyi kuleja tshiamu tshia kapepe ku mataku a muena mudimu netu kudi kushipa¶

Mu miyuki ya bukubi bua midimu, umue wa ku malu mabi adi enzeka misangu ne misangu ne adi atamba kuenzeka mu nzubu ya dipanyishila bintu udi "dinaya dia tubalu tua kapepe kakole": muena mudimu udi utua anyi upatula tshingoma tshia kapepe kakole pabuipi ne mataku anyi tshiadi tshia muena mudimu nende padiye unama pa tshibasa tshia mudimu, anyi wenza mudimu ne tshiamu tshia kapepe bua kumbusha lupuishi ku tshibasa tshia pantalo yende.

Bena mudimu badi bela meji ne: jeans ya denim anyi bilamba bia pa mutu bidi bikanga kapepe, anyi ne: tshintu tshidi tshibueja kapepe tshidi ne bua kubuejibua mu tshifu bua kuenza bibi. Malu onso abidi adi malelela:

1. Tshipeta tshia tshiamu tshia nzembu: Tshipepele tshikole tshidi tshipatuka mu tshibombi tshia 5 too ne ku 9 bar (70 too ne ku 130 psi) tshidi tshienza tshilongo tshia gaz tshidi tshienza mudimu bimpe. Nansha ku bule bua 5 too ne ku 20 santimetre (2 too ne ku 8 inches), tshitupa tshia kapepe etshi tshidi tshipita kakuyi lutatu mu mionji miluka ya pantalon ya mudimu, tshibuela pankatshi pa milonda ya tshiadi, ne tshienza bua tshitupa tshia mu tshifu tshiunzuluke mu milisekonde mikese.
2. Dibutuka dia tshifu dia lukasa: Tshifu tshia muntu tshidi ne bukole bua dibutuka dia 0.16 too ne ku 0.27 bar (2.3 too ne ku 4.0 psi, anyi 120 too ne ku 200 mmHg). Tshiamu tshia kapepe tshia mu tshisalu tshidi tshifila misangu 25 too ne ku 40 ya bukole bua munda mua muntu, tshipompa 20 too ne ku 40 litre ya kapepe ku sekonde mu tshifu. Mu tusunsa tukese tua 0.5, tshitupa tshia rectosigmoid anyi cecum tshidi tshituta bu tshibombi tshia mabeji tshipite bungi.
3. Tension pneumoperitoneum: Lupepele lua bungi lua mu nzubu wa tshilala benyi ludi lupita mu tshimanu tshia mala tshidi tshinyanguke mu tshina tshia munda tshikanga. Difu dia muntu udibu bashipe didi dipatuka pambelu bua kulua dikole bu ngoma mu tusekonde tukese. Tshipepele tshikole etshi tshidi munda mua difu (tension pneumoperitoneum) tshidi tshisaka diaphragme bikole muulu mu tshiadi, tshitshibula mifuba bua muntu udibu bakengesha katshinyi mua kuela mupuya, ne tshinyangakaja vena cava wa muinshi bua mashi kaayi mua kupingana mu mutshima, eku musangu umue wenzeja bactérie ya mu tshifu bua kubuela mu peritoneum ne mu mishipa ya mashi.

Diandamuna dia tshimpitshimpi bua dinyanguka dia mala ne disama dia pneumoperitoneum¶

1. Bikila 911 / 112 / 999 diakamue ne umanyishe "Disama dia luya lua bungi lua mu tshiadi/mu tshiadi ne disama dia mu mala ne dia mu tshifu." Minite yonso udi ne mushinga; lufu ludi lupita 40 pa lukama kakuyi dilengeja dia lukasa ne dilongolola dia mubidi.
2. Teka muntu udibu bashipe mu muaba wa ku dia bakaji anyi wa panshi ne maboko makosa kakese: Kumuenzeji bua kulala panshi pikala difu didi diunzuluke dimupangisha bua kupuyakana, ne kuena ne bua kumuteka mululame nansha kakese. Kubakuatshisha ku luseke luabu lua dia bakaji kudi kuambuluisha bua kukepesha njiwu ya disama dia kapepe ka mu mishipa musangu umue padi baminganga bambuluisha.
3. Kufila tshintu nansha tshimue ku mishiku (kuyi ne mayi, manga a kanyinganyinga, anyi manga adi ajikija lutetuku): Mubedi udi dijinga ne dipanda dia lukasa dia tshimpitshimpi ne dilongolola dia mala muinshi mua anesthésie générale.
4. Kuambuluisha bua kuela kapepe ne kudilongolola bua kujikija luya lua munganga: Bikala tshifu tshiuwule tente ne kapepe kakole menemene ne muntu udibu bashipe udi ulua bule (cyanotic) ne kayi mua kunyungisha tshimanu tshia tshiadi bua kupuyakana, baminganga ba diambuluisha dia muoyo anyi baminganga ba malu a njiwu badi mua kuenza dipanda dia luya lua tshimpitshimpi lua lukasa lua mu tshifu; mona dikema.

Barotrauma ya dîsu, ya matshi ne ya mukana idi ifumina ku kapepe kakole¶

Dibueja dia kapepe mu mêsu ne mu tshitupa tshia mubidi (Orbital Emphysema)¶

Padi tshiamu tshia kapepe tshikole tshipatuka pabuipi ne mpala, anyi padi bipese bia mabaya bidi bienza mudimu ne bingoma bia 7-bar (100-psi) bikuma dîsu, kapepe kadi mua kutapa conjunctiva (tshitupa tshitekete tshidi tshibuikila dîsu ditoke) kakuyi ditapa tshitupa tshia dîsu nkayatshi, tshivuija tshilamba tshia dîsu ne mifuba mikole idi panyima pa dîsu lupepele (emphysème orbital):

• Njiwu ya disama dia tshiadi tshia mêsu: Lupepele ludi lulamakaja kunyima kua tshitupa tshia dîsu munda mua tshitupa tshia dîsu tshidi ne mifuba mikole ludi lusaka tshitupa tshia dîsu kumpala (proptose) ne lufina tshitupa tshia dîsu ne tshiadi tshia munkatshi mua dîsu, bidi mua kufikisha muntu ku difua dia kashidi mu minite 60 too ne ku 90.
• Dilama dia lukasa:
• Ambila muntu udibu bashipe ne: KAKUFUMI mu mishiku anyi kuela mishiku ne mukana mukanga (tshidi tshienzeja kapepe ka bungi ka mu mishiku bua kubuela mu njila).
• KUENA kufina pa bipese bia mêsu bidi biuwule to; ela tshilamba tshikole tshia bukubi anyi tshilamba tshia dikopo tshia dibeji pa mutu pa muelelu wa mifuba ya mu tshina tshia dîsu; mona mputa ya ku mêsu.
• Udi mua kuya diakamue ku tshibambalu tshia malu a mpukapuka bua diondopangana dia mêsu.

Dibutuka dia tshina tshia matshi ne ditshibuka dia tshitupa tshia matshi¶

Kuenza mudimu ne tshiamu tshia kapepe bua kupatula lupuishi mu nsuki anyi mu bilamba bidi pabuipi ne ditshi kudi kututa tshiamu tshia ku matshi (tshiamu tshia matshi) ne tshiona tshia dîyi (tshidi tshipita 120 too ne ku 135 decibels) ne tshipepele tshikole:

• Bimanyinu: Disama dikole dia ku matshi, dikuma dia dîyi dikole (tinnitus), dipanga dia kumvua, dipatuka dia mashi anyi mâyi matoke adi apatuka mu tshina tshia matshi, ne disama dia mutu didi dienda dinyanguka (barotrauma vertigo) pikala mifuba ya munkatshi mua ditshi mibueja mu dididishi dia munda dia ditshi dia ovale.
• Dilama dia lukasa: Lama ditshi diume. Kuteka mafuta a ku matshi, mayi, anyi tshilamba tshia butoke munda mua tshina tshia matshi to. Teka tshilamba tshia gaze tshidi katshiyi ne disama pa mutu pa ditshi dia pambelu ne kuambuluisha muntu udi ne tshiji bua kulala bimpe.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

Paudi ubikila bena mudimu ba tshimpitshimpi bua diela dia kapepe kakole, embolie, anyi disama dia mu difu, ambila muntu udi ukutuma patoke ne: line pressure in psi anyi bar ne ulombe **Advanced Life Support (ALS) baminganga badi ne oxygène wa bungi ne dienza mudimu pamue ne Hyperbaric OxyTherapy Therapy Therapy (HT) anyi BOT Level ** Center. Tangila nomba ya tshimpitshimpi bua nomba ya dibuela dia pa buloba bujima.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi OSHA udi uteka mikalu ya bingoma bia kapepe ka 30 psi (2 bar) padibu babienza nabi mudimu bua kusukula, ne 30 psi udi mua kukuenzela bibi anyi?¶

OSHA Standard 29 CFR 1910.242(b) udi ukandika kapepe kakole kadibu benza nawu mudimu bua kusukula ku tshipepele tshikole tshia 2 bar (30 psi) bualu mateta adi aleja ne: kapepe ka mu tshisalu kadi kayi kalongolola pa mutu pa 2 bar (30 psi) kadibu balame pabuipi ne mubidi kadi mua kupatuka buludiludi mu dikoba dia muntu ne kuenzeja bimuma bia muitu ne mu mishipa ya lufu. Ino, 2 bar (30 psi) i tshipiminu tshia tshiamu tshia kusukula natshi, ki mmushindu wa kuela kapepe pa mubidi webe to: nansha ku 0.35 to 1 bar (5 to 15 psi), kapepe kakole kadi mua kutshibula tshitupa tshia matshi, kupuekesha bitupa bia tshiamu mu tshitupa tshia mêsu, anyi kutshibula mala manene pikalabu balombola pabuipi ne mubidi anyi bintu bikuabu. Kapepe kakole kadi ne bukole kayi buonso kadiena ne tshia kuenza mudimu bua kumbusha lupuishi lua bilamba, dikoba anyi nsuki to.

Mmunyi mudi kapepe kakole mua kubuela mu mashi pikalaku kakuyi mashi adi amueneka pa dikoba?¶

Padi tshiamu tshia kapepe tshikole tshia 6 too ne ku 8 bar (90 too ne ku 120 psi) tshikuma ku tshianza, ku tshianza anyi ku nshingu, luya lua mutoyi ludi mua kubuela mu tshitupa tshikese tshia dikoba, bu mudi: dikoba dikese, dikoba diume, anyi dikosa dia tshiamu tshia mitaku, anyi dibunda dia tshitupa tshia dikoba tshidi katshiyi tshinyanguke. Bu mudi kapepe ka bukole kakole kavula diakamue tshitupa tshia muinshi mua dikoba ne kafina tshina tshikese tshia munda, mashi kaena apatukila pambelu to. Mu tshikondo atshi, tshibombi tshidi tshienda tshivula tshia gaz wa bukole bua bungi munda mua tshitupa tshia mubidi tshidi tshiunzulula mishipa ya muinshi mua dikoba idi ne bimanu bikese ne tshienzeja bipupu bia kapepe bua kubuela buludiludi mu mishipa idi ipita mu mutshima.

Bua tshinyi muntu udibu bela meji ne: udi ne disama dia luya lukole udi ne bua kuikala muteka ku luseke lua dia bakaji (muaba wa Durant) pamutu pa kusomba?¶

Padi bipese bia kapepe bibuela mu mushipa bifumina ku mputa wa ku diboko anyi ku nshingu, bidi bienda mu atrium wa ku dia balume ne mu ventricule wa ku dia balume wa mutshima, muaba udibi mua kuenza bubble wa foam udi ukandika mashi bua kubuela mu mushipa wa pulmonaire bua kufika mu mikolo (tshiamu tshia ku dia balume tshia ventricule). Bu mudi tshipapu tshia mushipa wa mu mikolo tshisombe ku luseke lua kuulu lua dia bakaji lua tshiadi tshia balume, kuela muntu udibu bashipe ku luseke luabu lua dia bakaji ne mubidi wende mutekete kudi kuenza bua tshibombi tshia kapepe tshidi tshienda tshibandile ku tshimanu tshia dia balume ne ku mutu kua nzubu wa mutshima, kule ne tshiamu tshia kupatuka natshi, bienza bua mashi a mâyi apita muinshi mua bubble mu mikolo. Kusomba mubedi mululame kudi kuenza bua bipupu bia kapepe bibandile mu mishipa ya buongo anyi kukanga njila wa dipatuka dia kapepe ka mu mikolo.

Ntshinyi tshidi tshikebesha diumvua dia "Rice Krispies" muinshi mua dikoba kunyima kua njiwu ya luya, ne bidi ne njiwu anyi?¶

Dikuma, dibutuka, anyi dikuma didi diumvuika muinshi mua dikoba padibu badilenga didi dibikila ne: crepitus wa muinshi mua dikoba (anyi emphysème wa muinshi mua dikoba), didi difumina ku binunu ne binunu bia mifuba ya kapepe kakoleshibue mu mafuta ne mu bitupa bia mubidi bidi muinshi mua dikoba. Nansha mudi kapepe kakese ka muinshi mua dikoba mua kuikala kafika kudi mubidi, disama dia kapepe ka muinshi mua dikoba didi difumina ku tshiamu tshia kapepe tshia mu tshisalu ntshilumbu tshia lukasa tshia luondapu bua malu asatu: tshia kumpala, tshidi tshileja ne: kapepe kakole kavua kashipe tshibuelelu tshia dikoba ne kadi ne njiwu ya disama dia kapepe ka mu mishipa; tshibidi, kapepe kadi mu bianza anyi mu diboko didi mua kupangisha dienda dia mashi ne kufikisha ku disama dia tshitupa tshia mubidi; ne tshia busatu, kapepe ka mu tshisalu kadi kabueja lupuishi lua mafuta a compresseur, tshisuku, ne bactérie munda mua mifuba, bilomba dikonkonona dia lukasa dia lupitadi ne manga a lufu.

Mmunyi mudi kuela tshiamu tshia kapepe kakole mu tshilamba tshia muntu mua kuenza bua tshifu tshipatuke kakuyi dilenga dikoba diende?¶

Mulongo wa kapepe ka mu tshisalu udi ne bukole bua 6 too ne ku 8,6 bar (90 too ne ku 125 psi) udi upatula lupepele lua lubilu lukole ludi lupita buludiludi mu tshilamba tshia jeans anyi tshilamba tshia ku mutu. Shi tshiamu tshia nzembu tshitangile ku tshiadi anyi ku tshiadi tshia muena mudimu nende ku bule bua santimetre 10 too ne ku 15 (4 too ne ku 6 inches), tshitupa tshia kapepe tshidi tshibuela mu tshina tshia mu tshifu, tshitshimuna tshitupa tshia mu tshifu diakamue, ne tshipuekesha tshifu misangu 25 too ne ku 40 tshia bukole buatshi bua dibutuka dia 20 (34), tshidi tshituta tshimanu tshia mala. mu tshitupa tshia sekonde mikese ne kuwuja tshina tshia munda ne kapepe kakole ne bikunyibua.

Mukanda ewu udi ufila diambuluisha dia kumpala dia ku mudimu ne mikenji ya disungula dia lukasa bua mputa ya mu lupepele ne ya luya lukole ne kayena ipingana pa muaba wa diambuluisha dia baminganga bapiluke to. Ela meji bua kulonga diambuluisha dia kumpala dia ku mudimu, CPR, ne difila dia oxygène ku diambuluisha dia Croix-Rouge, dia St John Ambulance, anyi dia mufidi wa malu a bukubi ku mudimu.

Malu adi apetangana¶

• Dibueja dia tshiamu tshia kusukula natshi bintu ne mputa ya tshiamu tshia nzembu
• Mulondo wa nzembu, dibutuka dia tshibombi tshia tshiamu tshia luya, ne dibutuka dia nkata ya tshiamu tshia nzembu
• Tshingoma tshia misonso ne tshiamu tshia kukanga natshi tshia nzembu tshidi tshibuela ne mputa ya ricochet
• Mputa ya ku mêsu
• Disama dia mutshima ne disama dia tshitupa tshia mubidi

Miaba ne buludiki bua mbulamatadi¶

• Tshibambalu tshia malu a bukubi ne makanda a mubidi (OSHA, mu États-Unis): 29 CFR 1910.242(b) Lupepele lukole ludibu benza nalu mudimu bua kusukula
• Mulombodi wa malu a bukola bua mubidi ne bukubi (HSE, Royaume-Uni): Bukubi bua kapepe kakole (PUWER Guidance)
• Tshibambalu tshia mudimu tshia mu Canada tshia malu a bukola bua mubidi ne bukubi (CCOHS, Canada): Mabeji a malu a bukubi bua kapepe kakole bua kusukula ne biamu bia mudimu bia luya
• Undersea and Hyperbaric Medical Society (UHMS, International) & Divers Alert Network (DAN): Clinical Management for Arterial and Venous Gas Embolism
• Société américaine pour la chirurgie de la main (ASSH, États-Unis): Bipupu bia ku tshianza tshia kuulu tshia dipanda dia pression wa bungi