Disama dia mashika, dibuela mu mayi a luya, ne njiwu ya mashika¶

Disama dia mashika ndisama dikole dia mashika didi dimanyibua ku dienza dia mabue a mashika munda mua selile ne pambelu pa selile. Padi munyinyi wa muntu udi kayi ne tshintu anyi udi kayi ne tshintu tshikumbane udi mu luya lua muinshi mua mashika, mishindu ya dikuba dia mubidi idi ifila dipanga dia mijilu ya ku mpenga. Mu mashika makole, dienda dia mashi ku minu, ku makasa, ku mishiku, ne ku matshi didi dienda dipueka too ne ku tshitupa tshia dienda dia mashi dia pa tshibidilu. Shi luya lua mubidi lufika kuinshi kua -0.55 °C (31.01 °F), mayi adi mu mubidi adi akola, anyangakaja bipese bia selile, anyangakaja miaba idi mishipa ya mashi mikese, ne abanga dinyanguka dia mubidi.

Diambuluisha dia kumpala dia disama dikole dia mashika didi dilomba mikenji mijalame, mijadika kudi baminganga. Buondapi bua bantu budi kabuyi buimpe, bu mudi: kusukula bitupa bia mubidi bidi ne mashika ne neje, kuela kapia ka mu tshikuku tshia nkunyi, anyi kuendakana ku bukole ku makasa adi mafuma ku dinyanguka, bidi binyangula bikole dibutuka dia selile ne bifikisha ku dipanda dia bitupa bia mubidi bidi mua kuepuka. kabidi, kutuadija dilengeja dia lukasa mu miaba ya kule idi mifuba mimane kunyanguka mua kupingana mu mashika padibu bayimbula ntshilema tshinene tshidi tshijadika lufu lua mifuba mijima. Kujingulula tshikondo tshia disama dia mashika, tshilele tshia dibueja dia lukasa mu mayi a kapia, dilama dia kanyinganyinga ka dipingana dia mashika, ne njiwu ya dipingana dia mashika bidi bikuba bitupa bia mubidi ne bilama dienda dia mudimu.

Enza nunku mpindieu¶

1. Ela mubedi muaba wa luya, udi kayi ne lupepele diakamue. Kupatuka mu lupepele ne mu luya kudi kuimanyika dijimija dia luya ne kudi kujadika luya lua mubidi.
2. Tondapa hypothermie systémique kumpala kua kuondopa disama dia frostbite. Muntu kena mua kuondopa mputa ya mashika a ku mpenga padi luya lua mubidi lushala lutekete to; funda mubidi wa mubedi mu bisaka bia bulalu biume, bilamba bia kulala, anyi bilamba bia kapia.
3. Ela meji a nsombelu wa dipatuka kumpala kua kuteta bua kuondopa bitupa bia mubidi bidi ne mashika. Bikala mubedi ne bua kuenda bua kuya muaba wa bukubi, anyi bikalaku mushindu wa se: bitupa bia mubidi bidi bifume bidi mua kuikala kabidi mashika padibu babituma, kutshinyi tshitupa atshi to.
4. Umbusha bilamba bidi ne mayi, bisabata, ne mabwe a mushinga mukole. Umbusha ne budimu buonso mashosette a mayi, magan, ne mpeta mikole kumpala kua tshilamba kukola; kosa bilamba ne tshiseba pikala tshilamba tshikole buludiludi ku dikoba.
5. Longolola tshina tshia mâyi tshikezuke tshidi pankatshi pa 37 °C ne 40 °C (99 °F to 104 °F). Bikala muaba wa tshisokomenu mujalame ne kakuyi mushindu wa kupingaja mashika, ela tshitupa tshidi tshikole mu mâyi adibu balame anu mu tshitupa tshia luya elu munkatshi mua minite 15 too ne ku 30.
6. Lama dikoba didi dikola ne bilamba bidi kabiyi ne disama ne ubibandishe. Uteke pankatshi pa minu anyi minu idi minyanguke ne tshiamu tshia gaze tshidi katshiyi tshinyanguka, wela bilamba bidi kabiyi bikuata, ubandishe tshitupa tshia mubidi pa mutu pa mutshima bua kukepesha edema, ne uya natshi ku lupitadi diakamue.

Biophysique ya mashika a mubidi: mabue a mashika a mu selile ne mashika a mu mishipa¶

Disama dia mashika ki ndikoba dia mashika patupu to; i tshienzedi tshikole, tshia bitupa bibidi tshia disama tshidi tshilomba dinyanguka dia bulongolodi bua selile dilonda kudi disama dia thrombose microvasculaire didi dienda dikola.

flowchart TD
    A["Muinshi mua mashika (-0.55 °C / 31 °F)"] --> B["Disama dikole dia mishipa ya ku mpenga"]
    B --> C["Difuka dia mabue a mashika a pambelu pa selile"]
    C --> D["Dijimija dia mayi: mayi adi ashiya selile"]
    D --> E["Bubi bua electrolyte munda mua selile ne dinyanguka"]
    E --> F{"Mubedi udi mua kufika muaba wa tshisokomenu kayi ne njiwu ya kupingana mu mashika anyi?"}
    F -- No --> G["Ikala mu mashika; Splint & Pad; Kumbuka ku makasa"]
    F -- Yes --> H["Ela mu mayi ku 37 °C too ne ku 40 °C (99 °F too ne ku 104 °F)"]
    H --> I["Kupingaja kapia mu minite 15 too ne ku 30 too ne padiye ujika"]
    I --> J["Tshilamba tshia sterile tshidi katshiyi tshikole pankatshi pa minu; Kubandisha tshianza"]
    J --> K["Diya dia lukasa mu lupitadi bua disama dia mashi / Iloprost"]

Dibutuka dia buludiludi dia nzubu ya selile¶

Padi luya lua mubidi lupueka muinshi mua tshipiminu tshia mashika a mashi a muntu (-0.55 °C / 31.01 °F), tshipepele tshia mashika tshidi tshipatuka:

Dibutuka dia mabue a mashika didi dituadija munda mua miaba ya mâyi a pambelu pa selile mudi bungi bua bintu bidi binyanguka bupuekele.

Padi mayi a pambelu pa selile akudimuka bu mabue a mashika, mayi adi kaayi mashika adi ashala adi alua hyperosmolar.

Dishintuluka dia osmotic edi didi dikoka mayi a munda mua selile idi pabuipi kupitshila ku membrane ya selile, ne didi difikisha ku dijimija dia mâyi munda mua selile.

Bungi bua electrolyte ne enzyme bidi munda mua selile bidi bivula too ne ku tshipiminu tshia toxique, binyanga metabolisme wa selile, binyanga proteyine, ne binyanga membrane ya mafuta.

Shi dipepula dienda lukasa anyi dikala dia mutantshi mule, mabue a mashika adi akola buludiludi munda mua cytoplasme wa munda mua selile. Bintu ebi bidi ne mishiku, bidi bienda bivula bidi bienza mudimu bu tshiamu tshia tshiamu tshia mitaku, tshidi tshikosolola tshitupa tshia munda tshia selile ne tshikosolola membrane ya selile munda.

Microvascular thrombosis ne disama dia dipingana dia mashi¶

Tshitupa tshibidi tshia disama dia mashika tshidi tshienzeka padi mashi ateta bua kupingana ku tshitupa tshidi tshinyanguke kudi mashika:

Padi tshitupa tshia mubidi tshidi tshikole tshienda tshikola, arterioles ne venules bivua bikanga kumpala bidi bienda bivula. Ino, endothelium wa capillaire udi mubuikila mishipa mikese eyi ukadi munyanguke bikole kudi mashika.

Maselile a endothélium adi manyanguke adi avula, aditapuluka, ne adila mâyi a munda mua mashi mu tshitupa tshia munkatshi mua mashi tshidi tshinyunguluke, bienza edema munene wa muaba au.

Maplakete a mu mashi ne ma erythrocytes adi alamakaja ku collagène udi mupatuke ku bimanu bia mishipa idi mitapa, bienza microvasculaire thrombi (bipese bia mashi).

Ma globules rouges adi mu tshisuku adi akanga lumen wa capillaire, bualu budibu babikila ne: stasis vasculaire. Dienda dia mashi didi dijika, dijimija oxygène ne glucose mu bitupa bia mubidi bidi muinshi mua mâyi nansha mudibu bapingaje tshitupa tshia mubidi mu kapia.

Mu tshikondo tshimue ne dipanga dia mijilu, dipingaja dia mashi mu mashi didi dipatula bintu bia bungi bidi bienza bua mubidi usama: aside arachidonique, thromboxane A2, prostaglandines, ne radicals libres de oxygène reactive toxic. Thromboxane A2 udi wenza bua plakete ikale misangisha bikole ne vasospasme udi utungunuka, udi ufikisha ku dinyanguka dia mashi too ne mu mifuba ne mu mifuba.

Tshikondo tshia luondapu: disama dia tshiadi tshia kumpala too ne ku tshiadi tshinayi tshia lufu¶

Kumanya bimpa bunene bua mashika a mubidi kudi kulomba mushindu wa kufila diambuluisha dia kumpala, malu adibu batekemene ne mushindu wa kupatuka ne lukasa. Buanga bua mu lupitadi budi butapulula mputa ya mashika ku diambuluisha dia tshipimu tshia kale tshia bipimu binayi ne tshilongo tshia bipimu binayi tshia Cauchy tshia matuku etu aa.

Traditional Four-Degree Frostbite Staging:
--------------------------------------------------------------------------------
1st Degree (Frostnip):   Superficial; erythema, numbness; NO blisters or necrosis.
2nd Degree (Superficial): Clear bullae; partial dermal freeze; skin remains pliable.
3rd Degree (Deep):       Hemorrhagic (bloody) bullae; full-thickness dermal death.
4th Degree (Deep):       Muscle/bone frozen; mummification; dry gangrene; autoamputation.

Disama dia mashika dia kumpala (frostnip)¶

Frostnip udi uleja disama dia pa mutu, didi mua kupingajibua dia mashika didi anu ku tshitupa tshia ku mutu:

Lukoba ludi lumueneka lutoke, lua wax, anyi lua erythematous (lukunze), lulondangana ne disama dia muaba kampanda, dia ditapa anyi dia kutapa.

Palpation udi uleja ne tshitupa tshia muinshi mua dikoba tshidi tshishala tshitekete, tshikole, ne tshikole pa mutu pa mufuba.

Mabwe a mashika adi enzeka anu pa mutu pa dikoba anyi munda mua bitupa bia stratum corneum bifue bia pa mutu.

Kakuena bipupu bidi bipatuka, ne kakuena dijimija dia kashidi dia mubidi didi dienzeka to. Padibu bapingaja kapia, muaba au udi ulua hyperemic (mukunze bikole), udi ne kapia, ne udi uvula, udi ujika bionso mu matuku makese ne dinyanguka dia pa mutu didi difuanangane ne dia kapia ka munya.

Disama dia mashika dia tshitupa tshibidi (dikoba dia pa mutu dijima)¶

Disama dia mashika dia mulongo muibidi didi dilomba mashika a tshitupa tshijima tshia mubidi ne bitupa bia kuulu bia tshitupa tshia mubidi:

Muaba udi musama udi umvua mashika, mutekete, ne mukole padibu bawulenga, nansha mudi bitupa bia munda mua bitupa bia mubidi bitshidi anu bienda.

Mu meba 12 to ne ku 24 a dilengeja dia kapia, bipumbishi binene, bikola biuwule tente ne mayi a serose (clear bullae) matoke, a mubidi wa bisonsa bidi bipatuka.

Bintu ebi bidi bimueneka patoke bidi bileja ne: mishindu ya kapila idi muinshi muayi idi anu yenza mudimu ne idi ipatula plasma mu tshitupa tshia muinshi mua dikoba.

Ku nshindamenu kua tshipupu tshitoke tshidi tshimueneka tshitoke, tshitoke, ne tshidi tshilama diumvua dia kulenga. Disama dia mashika dia mulongo muibidi ditu dikola mu mbingu ibidi anyi inayi ne dipanda dikese, nansha mudi babedi misangu ya bungi bapeta disama dia mashika dia matuku a bungi ne disama dia mijilu.

Disama dia mashika dia tshitupa tshisatu (difuisha dia mubidi)¶

Disama dia mashika dia tshitupa tshisatu didi dileja dibutuka dijima dia kikoba ne mafuta a muinshi mua dikoba:

Tshitupa tshia mashika tshidi tshiumvuika bu mutshi, tshikole, ne katshiyi tshinyanguka nansha kakese. Padibu batuadija kunyunguluka, dikoba didi dimueneka bu dia mabala, dia violet mufike anyi dia bleu-griy.

Mu ma nsa 24 to ne ku 48, bipumbishi bifita, bya mashi biuwule tente ne mayi a violet anyi a mashi adi apatuka.

Bipupu bia mashi bidi bipatuka bidi tshimanyishilu tshibi tshia disama tshidi tshileja ne: tshitupa tshia munda tshia dikoba tshidi ne thrombose ne tshipanduluke, tshipatuka mashi mu bitupa bia mubidi bifue.

Nshindamenu wa tshipupu tshia mashi tshidi tshipatuka tshidi tshifiike, tshiume, ne katshiena tshiumvuika nansha kakese bua kuenza mateta a pinprick. Mputa ya tshitupa tshisatu idi ishiya tshitupa tshikole tshifiike (eschar) tshidi tshikola mu mbingu, tshilomba dipanda anyi dipanda dia dikoba.

Disama dia mashika dia tshitupa tshinayi (difua dia mubidi dikole)¶

Disama dia mashika dia mulongo muinayi didi dilomba dikola dia mashika dijima ne disama dia ischémique didi dipita mu dikoba, mu mafuta a muinshi mua dikoba, mu difu dia mifuba, mu mishipa, mu periosteum ne mu mufuba:

Muelelu udi mukola, udi umueneka bu dibue dia mashika, dikole, didi bu dibue didi kadiyi mua kunyunguluka anyi kubuela munda kudi dikuma.

Panyima pa dilengeja kabidi, tshitupa tshia mubidi tshidi tshishala tshikole, katshiyi ne mashi, ne tshidi ne mabala a cyanotic anyi a fioke.

Bipupu bitu bitamba kuikala kabiyiku anyi bikese menemene ne bitu bipatuka mashi ku muelelu wa pabuipi, bualu microcirculation mmunyanguke bikole menemene ne kakuena plasma udi mua kupompa bua kuenza mâyi a bilonda to.

Mu mbingu ya bungi, tshitupa tshia mubidi tshidi tshifue tshidi tshienza mudimu wa dilengeja dia mubidi. Tshitupa tshia mubidi tshidi tshifiike ne tshinyanguke tshidi tshienza tshitupa tshikole tshia mumi tshidi tshitapuluka patoke ne tshitupa tshia mubidi tshidi ne muoyo tshimpe, ndekelu wa bionso tshidi tshienza mudimu wa dipanda anyi tshia dikosa dia mubidi nkayatshi.

Mukenji wa dibuela dia lukasa mu mayi a luya¶

Tshipiminu tshia or tshia kulengeja tshitupa tshia mubidi tshidi tshikuate kudi mashika nkutshiosha lukasa mu tshina tshia mâyi a kapia. Mulongolola ku diambuluisha dia makebulula a bungi a mu lupitadi kudi midimu ya buanga ya basalayi ne kudi Wilderness Medical Society (WMS), protocole eu udi ulama bungi bua bitupa bia mubidi bidi mua kusungidibua.

Dilengeja dia bitekete bitekete (bu mudi kulekela tshitupa tshia mubidi tshinyanguka mu luya lua nzubu) didi divudija tshikondo tshia njiwu mudi mabue a mashika adi munda mua selile anyanguka ne apingana mashika, bivudija bikole dibutuka dia selile. Kuowa mu mayi lukasa kudi kukepesha tshikondo etshi tshia dishintuluka dia malu.

Dilongolola dia luya: 37 °C too ne ku 40 °C (99 °F too ne ku 104 °F)¶

Luya lua mayi mu tshikondo tshia dilengeja ludi ne tshia kulonda ne bujalame bua mu lupitadi:

Tshikondo tshia luondapu tshidi anu 37 °C too ne ku 40 °C (99 °F too ne ku 104 °F). Mu mpata idi kayiyi ne tshiamu tshia kupima natshi luya, mayi adi ne tshia kuikala ne luya padibu balenga tshianza tshidi katshiyi tshitapike, anu bu mayi a kuowa nawu bana.

Kupita 40 °C (104 °F). Tshitupa tshia mubidi tshidi tshikuate kudi mashika tshidi tshinyanguka bikole ne katshiena mua kumvua muditshi tshiosha to. Kuteka tshianza anyi dikasa dikole mu mayi adi ne luya lua bungi kupita 40 °C kudi kufikisha ku kapia kakole ne kuosha proteyine ya mashika pa mutu pa mputa wa mashika.

Kuena ne bua kupingaja mashika mu mayi adi ne mashika mapite pa 37 °C (99 °F), bualu mashika adi kaayi mua kuondopa adi akolesha dikala dia mabue a mashika ne adi alepesha dipingana dia mashi mu mishipa mikese.

+-----------------------------------------------------------+
|             WATER BATH REWARMING SPECIFICATIONS           |
|                                                           |
|  [.] TARGET TEMPERATURE: 37 °C to 40 °C (99 °F to 104 °F) |
|  [.] DURATION: 15 to 30 minutes continuous immersion      |
|  [.] ADD WARM WATER CONTINUOUSLY to maintain target range |
|  [.] AGITATE GENTLY; never rub tissue against basin walls |
|                                                           |
|  STOP IMMERSION WHEN:                                     |
|  - Distal skin turns soft and pliable to touch            |
|  - Red or purple flushing appears at tips of digits       |
+-----------------------------------------------------------+

Kuenza mudimu wa diowa mâyi ku kakese ku kakese¶

Londa malu aa paudi wenza mudimu wa diowa mâyi a kapia:

1. Lama tshintu tshia bunene bukumbane. Ingidija tshibombi tshikezuke, tshilongo, anyi tshibombi tshinene tshikumbane bua kuambula tshitupa tshia mashika kakuyi dikoba dilenga ku nseke anyi kuinshi kua tshintu.
2. Sangila mayi ku tshipimu tshia luya. Sangila mayi a kapia ne a mashika too ne padi tshipiminu tshia luya tshijadika luya lua 38 °C (100.4 °F). Shi udiku, weja nsabanga wa antiseptique anyi solution wa chlorhexidine mu mayi bua kukepesha bungi bua bactérie mu mputa.
3. Umbusha mabwe a mushinga mukole ne bilamba bionso. Umbusha bitekete bitekete bipese bionso bidi bishale, bipese bia ku bianza anyi mashosette. Divula didi dituadija diakamue padibu bapingaja kapia; bipese bia tshiamu bidibu bashiye pa minu nebikale bu biamu bia mudimu bikole, nebikebeshe gangrène wa digitale.
4. Ela tshitupa tshidi tshikole mu mayi. Ela tshitupa tshia mubidi tshidi tshisama tshijima mu mayi. enza bua minu anyi minu ikale pa mâyi bimpe ne kayena mishindame pa tshiamu tshikole anyi pa plastique wa kuinshi kua tshilongo to.
5. Ikala utangila ne ukumbaja luya lua mayi. Tshitupa tshia munyinyi tshikole tshidi tshikuata kapia lukasa, tshienza mashika mu tshina tshia mayi. Tangila luya lua mayi kunyima kua minite itanu yonso. Ela ndambu wa mayi a kapia mu tshibombi kule ne dikoba dia mubedi, wenda unyunguluka mayi bitekete bitekete bua kulama luya lua muomumue pankatshi pa 37 °C ne 40 °C.
6. Upingaje mu minite 15 to ne ku 30. Tungunuka ne kuela mu mayi too ne padi nsongo ya bianza milue mitekete, mipepele, ne ileja bimanyinu bia erythema (dikala dikunze anyi dia violet). Kokipeshi tshikondo tshia kuowa mâyi pikala tshitupa tshia mubidi tshishala tshikole ne tshitoke.
7. Umbusha bitekete bitekete ne umume mu lupepele. Umbusha tshitupa tshia mubidi mu tshina tshia mâyi ne budimu bua bungi. Kusukudi anyi kukosa dikoba ne tshilamba nansha kakese. Lekela tshitupa tshia mubidi tshiume mu lupepele anyi tshipuekeshe mâyi bitekete bitekete ne bilamba bia gauze bidi kabiyi bikuata.

Njiwu ya dibutuka dia mashika: bua tshinyi makasa mashika adi enda, makasa mashika adi afua¶

Umue wa ku malu adi kaayi malelela ne a mushinga mukole a luondapu lua lukasa lua mashika udi ukandika dilengeja dia madimi padibi mua kuenzeka bua kupingaja mashika.

Bena mudimu ba dikeba ne dipandisha ne baminganga ba mu tshipela batu misangu ne misangu batuilangana ne nsombelu ya kanyinganyinga idi bantu badi ne meji mimpe bapingaja makasa a mashika munda mua ntenta anyi muaba wa tshisokomenu, anu bua kujingulula ne: mubedi kena mua kuenda kabidi to, tshisumbu katshiena mua kupatuka mu ndeke wa helikoptere bua malu a mu tshikondo tshia mashika to, ne makasa a mashika adi kabidi ajika mu tshikondo tshia luendu ludi lulonda.

Biophysique wa tshipupu tshia dilengeja dia mashika¶

Kupingaja mashika mu mashika kudi ne njiwu ya pa buloba bujima:

Mu tshikondo tshia mashika a ntuadijilu, mabue a mashika adi enzeka nangananga mu miaba idi pambelu pa selile. Imue selile itu ishala ne muoyo, ne bujalame bua tshiamu tshia kapila budi bushala anu bumue.

Padi tshitupa tshia mubidi tshinyanguka, edema munene udi uwuja bitupa bia mubidi. Miaba ya pambelu pa selile idi idiunda ne bintu bidi bipatuka mu mashi, ne mishipa mikese idi idiunda.

Shi tshitupa tshia mubidi tshidi tshikola musangu muibidi, bungi bua mayi adi munda mua bitupa bia mubidi bidi bivula budi buenza mabue a mashika manene adi ne misongo. Bintu ebi bidi bienda bivula bidi bipanda tshitupa tshionso tshia selile, bitshibula mijilu mipiamipia idi miunzulula, ne bitshibula mijilu ya mubidi.

Dipingaja dia mashika didi difikisha ku disama dia thrombose microvasculaire dijima didi kadiyi mua kupingana. Bimanyinu bia mu lupitadi bidi bijadika ne: tshitupa tshia mubidi tshidibu bafila mu tshikondo tshia dilengeja dia mubidi tshidi ne disama dia 100 pa lukama dia bunene buonso, tshidi tshikengela bua kutshikosa bikole.

Initial Freeze: Extracellular ice forms; partial tissue survival possible.
      |
Rapid Thawing:  Tissues flood with fluid; capillaries reopen; massive edema.
      |
REFREEZING:     Massive ice shards shred engorged cells and crush microvessels.
      |
Result:         100% Full-Thickness Gangrene; Amputation Guaranteed.

Mukenji wa kuenda pa makasa mashika¶

Shi muntu udi na maulu a mashika mushikile mu tshipela tshia kule, ne bantu badi basungidibue kabayi mua kufika muaba udi bualu ebu buenzekele:

Muntu udi mua kuenda pa makasa makole munkatshi mua mêba a bungi anyi mene matuku a bungi bua kufika muaba wa bukubi. Nansha mudi kuenda pa makasa makole kudi mua kufikisha ku bipupu bikese ne ku njiwu ya pa mutu, dijimija dia mifuba yonso didi dikese menemene kupita dibutuka dinene didi difumina ku tshijengu tshia dinyanguka dia mashika.

Kupatudi bisabata bia mubedi to. Tshilamba tshia mashika tshidi tshienza mudimu bu tshilamba tshikole, tshikuba dikasa dia mashika ku dikuma dia mashika.

Kuela bintu bia kapia anyi mayi a kapia to. Lama dikasa mu mashika too ne padi mubedi mu mashinyi adi ne kapia, mu lupitadi, anyi mu nzubu wa tshisokomenu wa pa mukuna mudibu mua kuikala ne luya lua kashidi.

Ela tshilamba tshia pambelu pa bisabata bua kuepuka dikokangana dia mashinyi, enza bua mubedi ikale mushindame ne mitshi ya kuendesha nayi, ne enda bitekete bitekete batangile ku njila udi pabuipi anyi muaba udibu bumbusha bintu.

Padi mubedi ufika muaba wa tshisokomenu udi ne luya lukole, enza diakamue tshilele tshia dibueja dia lukasa mu mayi a luya.

Dipingaja dia mashi mu mashi ne dilama dia bipumbishi¶

Kulengeja mputa mikole ya mashika i bualu budi buenza kanyinganyinga kakole. Padi mashi apingana mu mijilu ne mu bitupa bia mubidi bidi kabiyi ne mashi, babedi badi bumvua dikuma dikole, diosha, ne diumvua dia nzembu didibu batamba kuamba ne: didi dibungamija.

Dilama dia kanyinganyinga dimpe ne dilama dia bipumbishi bidi bintu bia mushinga mukole bia dilama dia panyima pa dilengeja.

Dikanda dia kanyinganyinga ka manga¶

Bafidi ba diambuluisha dia kumpala ne baminganga badi ne tshia kudianjila kumona kanyinganyinga kakole ne kutuadija manga a dijikija kanyinganyinga kumpala kua dîba:

Maluvu adi kaayi a steroïde adi ambuluisha bua kujikija disama dia nsukadi (NSAIDs) ke manga a kumpala adi ambuluisha bua kuondopa disama dia mashika. Ibuprofen udi mutambe buimpe bualu udi wenza mudimu bu tshintu tshikole tshidi tshipangisha njila wa cyclooxygenase:

Ibuprofen udi ukandika dienza dia thromboxane A2 ne prostaglandines, bintu bidi bienza bua plakete ikale mikole, dibueja dia mashi mu mishipa mikese ne dipangisha dia mijilu.

Udi mua kufila ibuprofen (pa tshibidilu 400 mg too ne ku 800 mg ku mishiku kunyima kua mêba 8 kudi bantu bakole, bilondeshile mikenji ya luondapu ya muaba udibu basombele ne mushindu udi mubedi mua kuitaba).

Acetaminophen (paracetamol) udi mua kusakidila bua kuenza mudimu pamue ne ibuprofen.

Mu nzubu ya lupitadi, manga a opioïde (morphine, fentanyl, anyi hydromorphone) adi misangu ya bungi akengedibua bua kujikija kanyinganyinga kakole ka dipingana dia mashi mu tshikondo tshia dilengeja dia mayi.

Mikenji ya lelu ya dilama dia bipupu¶

Bipupu bidi bimueneka mu meba 6 to ne ku 24 kunyima kua dilengeja dia kabidi, bidi bimueneka bu bullae mitoke anyi bu bullae hemorrhagic mifiike. Kulama bimpe bipumbishi ebi kudi kupangisha masama a mputa adi mua kubuela:

Lekela bipumbishi bitoka kabiyi binyanguke padiku mushindu. Tshisasa tshia bipupu tshidi ne tshitupa tshifue tshia stratum corneum tshidi tshienza tshilamba tshia kuosha tshidi katshiyi ne disama. Mashi a bipupu adi ne bintu bidi bikolesha dikola dia mubidi bidi bikolesha dikola dia mubidi.

Shi tshipupu tshinene tshitoke tshidi mu lutatu lukole ne tshidi mua kupatuka padibu batshimbula, baminganga badi mua kupuekesha mâyi mu nsombelu mikole ya aseptique ku diambuluisha dia lushinge ludi kaluyi ne disama, bashiya dikoba dia tshimpumpu dikala pa muaba wa tshilonda.

Kuena ne bua kumbusha anyi kumbusha bipumbishi bia mashi mu budimi to. Bitupa bia mashi bidi bileja necrose dermique wa bunene bujima. Kumbusha tshisasa tshia bipupu kudi kuleja tshitupa tshia mubidi tshidi katshiyi ne makanda, tshidi ne disama dia ischémie buludiludi ku dinyanguka dia bactérie, tshidi tshikudimuna tshilonda tshiume tshia ischémie tshilue gangrène wa mashika.

Ela gel wa aloe vera pa mutu pikalaku. Aloe vera mukezuke i tshintu tshimpe tshidi tshiluisha thromboxane. Kuela aloe vera pa dikoba dilengeja, kadiyi dinyanguka kunyima kua meba 6 kudi kukepesha disama dia tshiadi ne kulengeja mushindu wa kusungila mifuba.

Udi mua kuela tshitupa tshia ku mutu bimpe mu bilamba binene bidi kabiyi ne disama. Teka bipese bia gaze biume bidi kabiyi ne disama pankatshi pa munu anyi dikasa dionso bua kuepuka dienza dia maceration, funda dikasa dijima anyi tshianza mu gaze wa roller udi ne bufuke, ne enza bua tshitupa tshia mubidi tshikale tshienda ne tshiamu tshipepele.

Mikenji ya diondapangana dia mashika ne ngondapilu ya mu lupitadi¶

Buondapi bua disama dia mashika dikole budi buenda bukola bikole mu bidimu makumi abidi bishale ebi. Bibambalu bia pa buabi bia bantu badi ne mputa ne mashika bidi mpindieu bienza mudimu ne mishindu ya bungi ya diondopangana idi isungila bitupa bia mubidi bivuabu ne bua kukosa kumpala.

Dikuatshisha dia mu lupitadi dia kumpala: thrombolytics ne prostacyclin analogues¶

Padi mubedi udi ne disama dikole dia mashika difika mu lupitadi lua pa bualu mu mêba 24 too ne ku 72 a disama, badi batuadija luondapu lua kumpala:

Tshiamu tshia plasminogène (tPA) tshidibu bafila mu mishipa anyi mu mishipa. Shi angiography nansha multi-spectral laser Doppler imaging ijadika kakuena mashi adi apita mu mishipa ya mashi idi kule, baminganga badi bafila tPA mulombola kudi catheter buludiludi mu mishipa ya mashi idi ne thrombose. tPA udi unyangakaja mashi adi mu mishipa mikese, upingaja dibuela dia mashi mu mishipa ya mashi ku minu idi kayiyi ne mashi ne ukepesha bikole bungi bua bantu badibu bapanda.

Prostacyclin analogs (Iloprost). Iloprost udi wenza mudimu bikole mu Mputu ne mu Canada, ne muanyishibue kudi FDA mu États-Unis, udi tshintu tshia prostacyclin tshidibu bafila ku diambuluisha dia dibueja dia mashi mu mijilu. Bidi bifikisha ku divulangana dia mashi, bipangisha disangisha dia plakete, ne bilongolola bimanu bia selile ya endothélium binyanguke, bilama mishiku too ne ku meba 72 kunyima kua dilengeja dia kabidi.

Hyperbaric oxygen therapy (HBOT). Mu nzubu kampanda ya luondapu, babedi badi bapeta 100 pa lukama ya oxygène munda mua nzubu wa hyperbarique mu 2.0 too ne ku 2.5 atmosphères. HBOT udi uwuja bitupa bia mubidi bidi kabiyi ne mashi ne oxygène munyanguke, udi wenza bua mputa ikale ne lukasa, ne udi ukepesha edema wa reperfusion.

Dikosa dia mubidi dia panyima pa matuku (dîyi dia kuindila). Dipanda dia mashika dia matuku etu aa didi dilonda mukenji mukole: "Disama dia mashika mu ngondo wa kumpala, dipanda dia mubidi mu ngondo wa muanda mutekete." Eschar mufue, mufiike udi ulekela bua kuuma, kuikala mumi, ne kuikala ne mikalu ya pa tshibidilu munkatshi mua ngondo ibidi anyi isambombo. Dipanda dia mubidi dia kumpala kua dîba didi dikosa tshitupa tshia mubidi tshidi tshimueneka tshifue pa mutu kadi tshidi ne mishipa idi mua kuikala ne muoyo, idi ipingana mu bitupa bia mubidi bidi muinshi mua buloba.

Dipatuka mu budimi, diendesha, ne dishilangana dia mputa ya mashika adi kaayi a mashika¶

Diendesha dia bintu mu bukubi difumina mu miaba idi mashika didi dilomba kuikala ne budimu bua kuluisha malu adi anyanga muaba udibu basombele.

Mikenji ya diendesha ne ya dipangisha¶

Padibu baya nende ku nzubu wa luondapu, mubedi udi ne tshia kuikala ne bupole bua bungi:

Bandisha bitupa bia mubidi bidi binyanguke pa mutu pa tshipiminu tshia mutshima. Edema wa panyima pa difuka udi ufika ku tshibungubungu tshia mêba 24 too ne ku 48. Kubandisha tshitupa tshia mubidi kudi kukepesha bukole bua mashika adi pankatshi pa mifuba, kukepesha difu, ne kukepesha dikuma dia kanyinganyinga.

Tangila tshitupa tshia mubidi tshitekete. Wenza mudimu ne tshiamu tshia SAM anyi tshiamu tshia nshinga tshikole bua kupangisha tshianza anyi tshikasa bua kuenda. Ebi bidi bipangisha dikoseka dia patupu anyi dikuma dia mpukapuka padibu bambula pa buloba bubi.

Lama mubedi ne luya ne mâyi. Udi mua kufila mâyi a mukana adi ne luya, adi ne sukadi pikala mubedi mumanye bimpe, mudimuke, ne mua kumina kayi ufua. Epuka kafeine, udi wenza bua mijilu ikale mikole.

Kulama ku mashika a luya mu mashinyi a lupitadi ne mu ndeke. Kapepe kadi munda mua ndeke ya dipatuila bantu anyi mashinyi a diendesha adi mua kuenza bua mubidi udibu bapingaje kapia ikale mashika. enza bua mubedi ikale mubuikila munda mua tshibombi tshia dikuata dia kapia.

Post-Thaw Care Checklist:
- [ ] Extremity elevated strictly above heart level.
- [ ] Dry sterile gauze placed between each individual toe or finger.
- [ ] Bulky, loose outer dressing applied; NO tight circumferential tape.
- [ ] Limb immobilized with a padded splint to prevent movement trauma.
- [ ] Patient receiving oral ibuprofen for thromboxane inhibition.
- [ ] Whole-body warmth maintained; patient shielded from vehicle drafts.

Kutapulula disama dia mashika ne disama dia mashika didi kadiyi dia mashika¶

Bafidi ba diambuluisha dia kumpala batu misangu ya bungi bafuanyikija disama dia mashika ne disama dia mashika adi kaayi a mashika (NFCI), bu mudi: dikasa dia mu tshina (dikasa dia mu mâyi) ne disama dia mashika (pernio):

Disama dia mashika didi dilomba luya lua muinshi mua mashika (muinshi mua 0 °C / 32 °F) ne didi dilomba dienza dia mabue a mashika mu mubidi.

Trench foot utu wenzeka mu luya lukole, kaluyi ne mashika adi afumina ku 0 °C too ne ku 15 °C (32 °F too ne ku 59 °F) bua dibenga kuendakana mu bisabata bia mashika munkatshi mua mêba 12 anyi matuku a bungi. Kakuena mabue a mashika adi afumina to; disama edi didi difumina ku dikanga dia kapila, dipanga dia oxygène wa endothélium, ne dinyanguka dia mishipa ya mu mikolo.

Chilblains (pernio) udi uleja mputa ya dikoba idi ifila disama dia vasospastic idi yenzeka kunyima kua dikala dia mashika, kapepe ka mashika adi pa mutu pa mashika, idi imueneka bu disama dikole, disama dia papules mikunzubile anyi ya violet ku minu anyi ku minu.

Kuondapa dikasa dia mu tshina ne mâyi a kapia a 40 °C (104 °F) ki nkuimpe to, bualu diowa dia lukasa didi divudija kanyinganyinga kakole ka mu mishipa ne divudija dinyanguka dia mifuba. Bilonda bia mashika adi kaayi a mashika bidi ne tshia kupingajibua bitekete bitekete ku luya lua nzubu, kusukula bitekete bitekete ne tshintu tshidi tshishipa masama, ne kuumisha bimpe menemene.

Nkonko itubu bela misangu ya bungi¶

Ndi ne tshia kuela neje pa minu idi ne mashika bua kuyikolesha anyi?¶

Tòo. Kuela dikoba dia mashika ne neje mbualu bua njiwu mikole bualu neje itu ikosa ne mashika makole. Kukosa tshitupa tshia mubidi tshidi katshiyi tshienza mudimu kudi kuenza bua mabue a mashika apatuke mu bitupa bia selile ne kumbusha bitupa bia dikoba bidi bikuba. Kukosa, kukosa, nansha kukuma dikoba didi ne mashika nansha kakese. Udi mua kuenza mudimu ne tshitupa tshia mubidi ne bupole bua bungi ne kutshiosha anu mu mâyi a kapia adibu bakokesha.

Ntshinyi tshindi mua kuenza pikala muntu udi ne mashika ne bua kuenda bua kufika muaba udibu mua kumusungila?¶

Shi muntu udi na maulu a mashika udi ne tshia kuenda bua kuya muaba wa bukubi, kuteketshi bua kupepeja maulu ende to. Kuenda pa makasa adi mashika kudi kusama ne kudi kufikisha ku kanyinganyinga kakese, kadi kuenda ku makasa adi mashika kudi kutshibula mishipa idi mijuke, kudi kufikisha ku kanyinganyinga kakole, ne kufikisha ku dibutula dia bitupa bia mubidi bidi mua kufua pikala makasa afika ku mashika mu tshikondo tshia luendu. Ikala ne bisabata, patuka mu mashika, ne utuadije kuenza mudimu ne mâyi a kapia anu padibu bafika muaba wa tshisokomenu wa mu nzubu.

Mmushindu kayi menemene wa luya bua kupingaja mashika mu mayi?¶

Tshina tshia mayi tshidi ne tshia kuikala pankatshi pa 37 °C ne 40 °C (99 °F too ne ku 104 °F). Mâyi a luya lupite pa 40 °C adi mua kuosha ne kuosha tshitupa tshia mubidi tshidi katshiyi tshienza mudimu, kadi mayi adi ne mashika mapite pa 37 °C kaakulengeja tshitupa tshia mubidi lukasa bua kuimanyika dinyanguka dia mabue a mashika a mu selile to. Tangila mayi misangu yonso ne tshiamu tshia kupima natshi luya, wela ndambu wa mayi a luya bua kulama luya luakane munkatshi mua minite 15 too ne ku 30.

Ndi ne tshia kupatula bipumbishi binene biuwule tente ne mayi bidi bipatuka kunyima kua dilengeja anyi?¶

Tòo. Kupuekeshi, kupuekeshi, anyi kupuekeshi bipumbishi bia mashika mu budimi to. Bitupa bia mputa bidi kabiyi binyanguke bidi bienza mudimu bu bande ya bioloji idi kayiyi ne disama idi ilama tshitupa tshia mubidi tshidi katshiyi tshinyanguka ne tshidi tshipingana tshiakabidi tshidi muinshi. Bitupa bifiike anyi bia mashi bidi bileja dinyanguka dia mubidi ne kabiena ne bua kukangula nansha kakese, bualu kubitshibula kudi kuenza bua tuishi tua tshikisu tubuele mu bitupa bia mubidi bidi kabiyi ne makanda ne kufikisha ku masama makole a mubidi.

Bua tshinyi ibuprofen udi mulomba bua kuondopa disama dia mashika?¶

Ibuprofen udi muimpe bualu udi buanga budi kabuyi ne steroïde budi bupangisha disama dia thromboxane A2 ne prostaglandins. Bintu ebi bidi bienza bua mishipa ya mashi ikale mikole ne mashi adi anyanguka mu bitupa bia mubidi bidi bipiabipia. Kunua manga a ibuprofen kumpala kua dîba kudi kukepesha dibuela dia mashi mu mishipa mikese, kukepesha kanyinganyinga kakole ka dipingana dia mashi, ne kuambuluisha bua kusungila minu ne minu idi kayiyi ne bukole.

Dianyisha dia diambuluisha dia kumpala¶

Kulama ntatu mikole ya mashika a muaba udibu basombele kudi kulomba dilongesha dia mudimu, didi dimanyine pa bijadiki didi dipita kule ne kule dimanya dia malu a nshindamenu. Kujingulula dishintuluka dia patupu dia frostnip wa pa mutu too ne ku dikala dia mashika makole, kulonga mua kuowa mâyi lukasa, ne kuenza mudimu muimpe wa dipanda dia mu budimi kudi mua kumvuija dishilangana pankatshi pa diondopangana dia tshitupa tshia mubidi tshidi tshienza mudimu bimpe ne dikosa dia bitupa bia mubidi bidi mua kushintulula nsombelu.

Tudi tukankamija bikole bantu bonso badi banange kuendakana pambelu, bantu badi benza ngendu mu muvu wa mashika, ne badi babanda mikuna bua kujikija tulasa tua diambuluisha dia kumpala mu tshipela (WFA) anyi diambuluisha dia kumpala dia pa tshibidilu ne dia dikolesha dia mioyo ne mikolo (CPR). Bantu badi bamanyike bu mudi: Croix-Rouge wa mu Amerike, Croix-Rouge wa mu Canada, St John Ambulance, ne Croix-Rouge wa mu Grande-Bretagne badi bafila dilongesha dia pa buadi dia malu a tshipela ne a muaba udibu basombele. Dianyisha didi dijadika ne udi ne mamanya a mudimu, ditalala dia mu lungenyi, ne dimanya dia malu a luondapu didi dikengedibua bua kulombola malu a tshimpitshimpi a mashika bimpe.

Miaba mifumina¶

• Wilderness Medical Society (WMS, United States): Mikenji ya mudimu wa luondapu bua kuepuka ne kuondopa disama dia mashika.
• Tshisumbu tshia bena Amerike tshia kuosha (ABA, mu États-Unis): Mikenji ya dilama dia mputa ya mashika mu nzubu ya pa buayi ya kuosha.
• Tshisumbu tshia baminganga ba mu Canada (CAEP, Canada): Dilombola dia disama dia mashika dikole mu tshibambalu tshia malu a mpukapuka.
• Tshipangu tshia bena Grande-Bretagne tshia dibandila mikuna (BMC, Royaume-Uni): Mikenji ya luondapu lua Frostbite, Dianyisha, ne Dilombola dia Mu budimi.
• Tshibambalu tshia buloba bujima tshia malu a luondapu lua lukasa lua ku mikuna (ICAR-MEDCOM): Diondapa dia pa muaba wa disama dia mashika mu dipandisha dia ku mikuna.
• Tshisumbu tshia baminganga ba mu mpata ya ku Mputu (UE): Dilombola dia mputa ya mashika ya mpukapuka ne mikenji ya dipingaja dia mashi mu bitupa bia mubidi.

Malu adi apetangana¶

• Buondapi bua tshimpitshimpi bua luya lukole ne mashika
• Dijingulula dia tshipupu ne dilombola dia tshipupu
• Bipupu bia mu muvu wa mashika ne mishindu ya kupanduka ku bipupu bia mashika
• Diambuluisha dia kumpala dia nzembu ne kapia ka nzembu
• Nomba ya njiwu bilondeshile ditunga