Mputa ya tshiamu tshia nzembu tshikole idi ifumina ku peinture, mafuta, ne milongo ya hydraulique¶

Nomba ya malu a tshimpitshimpi idi mishilangane bilondeshile ditunga. Dibeji edi didi dienza mudimu ne 911, nomba wa ditunga dia États-Unis ne dia Canada. Matunga makuabu a bungi adi ne nomba wa 112, 999 anyi nomba mukuabu. Keba nomba wa ditunga dienu.

Disama dia tshiamu tshia nzembu tshikole (didibu babikila misangu ya bungi ne: "Kabalu ka Trojan ka dipanda dia bianza") ntshimue tshia ku bilumbu bia dipanda bidi bitamba kushima ne bidi mua kunyangakaja malu a luondapu lua mudimu ne lua nzubu. Padi muena mudimu anyi muena nzubu wela munu wende anyi tshianza tshiende ku mpukapuka ku mushiku wa tshiamu tshia kuela natshi bintu tshidi katshiyi ne luya, tshiamu tshia mafuta tshia mu luya, tshiamu tshia dipatuka dia mafuta a hydraulique, tshiamu tshia kuela natshi mafuta a diesel, anyi tshiamu tshia kusukula natshi mafuta tshia mu tshisalu, tshiamu tshia kusukula natshi bintu tshidi tshienza mudimu ku 104 700+ bar (2,000 to 10,000+ pounds per square inch / PSI) udi ututa buludiludi mu dikoba dia muntu ne lubilu lua pabuipi ne lua mutoyi kayi nansha dijinga ne dikasa.

Bu mudi tshina tshia kubuela natshi tshikale anu bu **tshitupa tshikese tshia 1-to-2-millimetre (tshia bunene bua tshiamu tshia nsongo) tshidi katshiyi tshipatuka mashi ne tshidi tshiumvuika bu tshintu tshidi tshikuata anyi tshikuma mu mêba 1 anyi 3 a kumpala, bantu badibu bakengesha, balombodi, ne nansha bena mudimu ba mu lupitadi badi kabayi ne dimanya dia bungi batu misangu ya bungi bateka tshilamba tshia kulamakaja natshi ku munu ne batuma mubedi kumbelu. Dipanga dia dîba edi ndibi menemene: muinshi mua tshintu tshidi tshimueneka katshiyi ne bualu, peinture wa bukole bua bungi, solvant, mafuta, anyi mafuta a hydraulique mmapuekele too ne mu tshitupa tshia flexor tendon sheath mu bitupa bia muinshi mua tshianza ne tshia tshianza, bienza bua mijilu ya mashi itshibuke diakamue, bintu bia tshimpitshimpi bia mashika, bintu bidi ne muoyo ne bintu bidi ne muoyo gangrene ischémique rapide. Shi dipanda dia mubidi didi dipita mêba 6, bungi bua dikosa dia munu budi buvula kumbukila ku 15 too ne ku 30 pa lukama too ne ku 50 too ne ku 80 pa lukama. Kumanya mua kujingulula mputa ya tshiamu tshia nzembu anyi ya tshiamu tshia nzembu bu Level 1 surgical hand emergency, bua tshinyi kuena ne bua kuela glace nansha kakese ku munu udibu bakuele, ne bua tshinyi kuena ne bua kufina tshina tshia dipanda kudi kusungila tshianza tshia mubedi.

Enza nunku mpindieu¶

Ndaku ku tshibambalu tshia malu a tshimpitshimpi tshia lupitadi ne munganga wa bianza diakamue, anyi ubikile nimero wa malu a tshimpitshimpi wa muaba unudi (911 mu États-Unis ne Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni), dîba didi tshintu tshionso tshidi ne bukole bua bungi anyi tshintu tshidi tshipatuka mâyi tshituta dikoba, nansha mudi tshina tshimueneka tshikese ne katshiyi tshitapa mulombodi wa Chey. nomba ya tshimpitshimpi shi udi wenza ngendu mu matunga makuabu. Ambila munganga wa dipanda diakamue ne: "Etshi ntshipupu tshia dipanda dia bukole bua bungi ku [X] PSI ne [Peinture / Grease / Hydraulic Fluid]; tudi dijinga ne diyukidilangana dia lukasa dia dipanda dia bianza mu tshikondo tshia dipanda dia mêba 6."
Umbusha bipese bionso, nsa, bipese bia ku bianza, ne bifulu bia ku tshianza ne ku tshianza bidi bitapike mu masekonde 60 a kumpala. Mu mêba 2 anyi 4, disama dia tshimpitshimpi ne dikuma dia tshitupa tshia mubidi nebivudije munu too ne ku bunene buende misangu ibidi, nebikudimune mpeta yonso bu tshintu tshia tshiamu tshidi tshikosa munu.
KUENA ne: ice, cold packs, anyi mâyi mashika pa mputa wa injection wa pression wa bungi to. Mashi adibu bateke adi anyanguka kale mishipa ya digitale idi mikanga munda mua tshitupa tshia munu tshikole; kuela mabue a mashika kudi kufikisha ku dipanga dia mashi mu mishipa idi ikosa tshitupa tshia ndekelu tshia mashi tshidi tshilama munu ne muoyo.
KUTEKI nansha kakese bua kufina, kuela mabele, kunua, anyi kukosa mputa wa pinprick bua "kupingaja peinture anyi mafuta pambelu." Mashi avua apuekeshibua mu mifuba ya mishipa ku binunu bia kilo ku inch kare; kufinya munu kakuena mua kuwupatula to, kadi kudi kuenzeja tshintu tshidi ne buanga anyi mafuta bua kuya munda menemene mu tshitupa tshia mishipa mu tshianza ne mu diboko.
Fuka muaba udibu babuele ne tshiamu tshia gauze tshiume tshidi katshiyi ne disama ne ufuke tshianza bitekete bitekete mu muaba udi kauyi ne bualu udi uikisha pa mutu pa mutshima. Kuela bandeji mikole ya dikuma ku munu anyi ku tshianza to.
Lama mubedi bimpe menemene (kakuyi bualu nansha bumue ku mishiku: kakuena mayi, biakudia, anyi manga a ku mishiku) ne ulue ne mukanda wa malu a bukubi (SDS) anyi foto wa telefone wa bianza wa tshibombi tshia peinture, tshiamu tshia dilengeja natshi bintu, tshiamu tshia hydraulique, anyi tshiamu tshia mafuta ku lupitadi. Mubedi neakengedibue anesthésie wa tshimpitshimpi anyi wa tshitupa kampanda mu nzubu wa dipanda ne mêba a dipanda, ne munganga udi ne bua kumanya tshimuma tshijalame viscosité, base de solvant, ne pH wa tshintu tshidibu bele.

Bua tshinyi kutangila ni tshianza tshiebe tshia patupu (anyi tshilamba tshia kujingila natshi) bua kumanya ni kudi mâyi adi apatuka mu tshiamu tshia hydraulique anyi tshia peinture sans airless

Bipita pa tshitupa tshia mputa ya mayi a hydraulique ne ya peinture idi yenzeka padi muena mudimu umona lupuishi lukese anyi umvua mutoyi ne wela tshianza tshiende tshidi ne tshianza anyi tshilamba pa tshiamu tshia nzembu bua "kumvua muaba udi tshina tshia pinhole tshipatuka." Ku 200 too ne ku 500 bar (3,000 too ne ku 7,000 PSI), musulu wa mafuta a hydraulique udi kayi umueneka ne mêsu ne udi ukosolola buludiludi mu bianza bia mudimu bia dikoba dikole, bianza bia bena mudimu ba tshiamu tshia caoutchouc, ne bilamba bia mu tshisalu bivuabu bafunde bu ne: bivua bilamba bia mabeji, too ne ku mifuba too ne ku mifuba 10 centimètres (4 inches) ku bule kakuyi tshianza tshilenga tshiamu tshia nzembu. Misangu yonso, ikala upuekesha bukole bua pompe ne wenze mudimu ne tshitupa tshile tshia karton anyi tshia mutshi, nansha tshianza tshiebe, bua kutangila ni mayi adi apatuka mu tshina tshia pinhole.

Mutshi wa mapangadika a tshimpitshimpi bua mputa ya tshiamu tshia nzembu tshikole¶

flowchart TD
    Start["Skin Contact with Pressurized Jet or Pinhole Leak<br/>(Airless Paint Sprayer, Grease Gun, Hydraulic Hose, Diesel Injector,<br/>Pressure Washer, Cement Grout Pump, or Compressed Air Nozzle)"]
    Appearance["DO NOT BE FOOLED BY A TINY 1-2 mm PINPRICK WOUND<br/>(Initial pain is often mild or painless for the first 1 to 4 hours)"]
    RemoveRings["IMMEDIATE FIRST AID STEPS AT THE SCENE (FIRST 60 SECONDS)<br/>1. Shut off equipment and move away from pressurized line<br/>2. Strip off all rings, watches, bracelets, and contaminated gloves immediately<br/>3. Gently blot surface paint/oil off intact skin without squeezing the puncture<br/>4. Cover pinprick loosely with sterile gauze"]
    CriticalDonts["STRICT CONTRAINDICATIONS (WHAT NEVER TO DO)<br/>- NEVER apply ice or cold packs (causes fatal digital artery vasospasm)<br/>- NEVER squeeze, milk, or incise the finger<br/>- NEVER wrap a tight compression bandage<br/>- NEVER let a clinic numb the finger with a 'Digital Ring Block' injection"]
    InfoPrep["PREPARE FOR IMMEDIATE OPERATING ROOM SURGERY<br/>1. Keep patient strictly NPO (nothing by mouth: no water, food, or pills)<br/>2. Photograph or bring the Paint / Hydraulic / Grease container & SDS<br/>3. Note the exact Operating Pressure (PSI / bar) and Time of Injection"]
    TriageED["TRANSPORT IMMEDIATELY TO TRAUMA CENTER WITH HAND SURGERY<br/>(Target: Surgical Wide Decompression & Debridement in < 6 Hours)<br/>Hospital starts IV Broad-Spectrum Antibiotics, Tetanus Prophylaxis,<br/>Plain X-rays (shows radiopaque lead/titanium paint or subcutaneous air),<br/>and Emergent Open Palmar-Digital Fasciotomy & Synovectomy"]

    Start --> Appearance
    Appearance --> RemoveRings
    RemoveRings --> CriticalDonts
    CriticalDonts --> InfoPrep
    InfoPrep --> TriageED

Kufuanyikija bintu bidibu bafila: Bua tshinyi peinture wa mafuta ne turpentine bidi ne njiwu ya 80% ya dikosa dia mubidi eku mâyi anyi kapepe bikale bikese menemene¶

Tshintu tshimuepele tshia mushinga mukole tshidi tshileja ni mubedi udi mua kujimija munu wende kunyima kua disama dia tshiamu tshia nzembu tshikole (pamo ne tshikondo tshia mêba 6 tshia dipanda) ntshia se: mushindu wa tshintu tshidibu bamuele tshiamu. Baminganga ba ku bianza batu bateka bintu bidibu bafila mu bitupa binayi bia bubi:

Bintu bidibu bele mu mashi ne bintu bia mudimu	Bukole bua mudimu bua pa tshibidilu	Bikadilu bia tshimuma ne bia cytotoxique munda mua tshitupa tshia mubidi	Njiu ya dikosa dia mubidi (Nansha padibu bamuondapa)	Bintu bia pa buabi bia ku radiografie (X-Ray) ne bia dipanda
Bintu bidi bilengeja bintu, bintu bidi bipepeja bintu, terpentine, nyuma mutoke, mafuta a mazutu, mafuta a ndeke, ne bintu bia kupenta nabi bidi ne mafuta	140 to 350 bar (2,000 to 5,000 PSI) (Airless paint sprayers & diesel fuel injectors)	EXTREME CYTOTOXICITY: Bintu bidi binyanguka mu mafuta bidi binyanga diakamue membrane ya selile, bivuija mafuta adi muinshi mua dikoba bu mâyi (necrose wa mafuta), bifikisha ku dienza dia thrombose chimique ya mishipa ya digitale, ne bifikisha ku disama dia fulminant necrotising inflammation	50% too ne ku 80% ya dipanda dia mubidi (udi ufika ku > 80% pikala dipanda dipita pa meba 6); njiwu ya bubi bua hydrocarbure/plomb	Mabala a plomb anyi a titanium-dioxide adi amueneka mutoke mutoke (mutoke) pa biamu bia X-ray bia ku bianza, adi aleja ditangalaka dilelela dia mu tshitupa tshia muonji mu tshianza tshia muntu
Latex (Water-Based Acrylic) Paint	140 to 250 bar (2,000 to 3,600 PSI) (Biamu bia ku nzubu ne bia kusumbisha)	Moderate-to-High: Le lipid-dissolvence mikese kupita paint/thinner wa mafuta, kadi udi anu ukebesha disama dikole dia tshitupa tshia mubidi, dikanga dia mishipa mikese, ne granulomas ya mubidi wa bende	6% too ne ku 20% ya dikosa dia mubidi pikalabu bumbusha mu meba 6 (budi buvula bikole pikalabu balekelela)	Misangu ya bungi radiolucent (kayi umueneka ku rayon X pa kumbusha padiye ne bintu bia tshiamu tshikole), nunku rayon X wa pa tshibidilu kena mua kupangisha ditangalaka dia disama to
Mafuta a mashinyi / a midimu ya bianza ne mayi a hydraulique	140 to 700+ bar (2,000 to 10,000+ PSI) (Pneumatic grease guns & excavator/tractor hydraulic hoses)	High Mechanical Pression + Chronic Granulomas: Kupuekesha luya lua tshimpitshimpi kupita tshiamu tshia peinture, nunku munu udi usama mukese mu mêba 6 a kumpala, udi udinga babedi bua kulekela luondapu too ne padi ischémie wa mu tshitupa ushipa tshianza. Mafuta adi mashala adi akebesha oleogranulomas ne fistulas	20% too ne ku 45% ya dikosa dia bitupa bia mubidi	Radiolucent pa rayon X (udi umueneka bu mafuta mafiike makese anyi bipepele bia muinshi mua dikoba); bidi bikengela kuenza mudimu wa dipanda dia mijilu
Mâyi a bukole bua bungi, a mukele, anyi kapepe kakole	100 too ne ku 300 bar (1,500 too ne ku 4,400 PSI) (Biamu bia kuowa nabi mâyi bia mu tshisalu ne biamu bia kusukula nabi luya bia mu tshisalu)	Barotrauma + Polymicrobial Infection: Mâyi anyi lupepele kabiena binyangakaja mafuta to, kadi mayi a mu tshina/a mu pompi adi atuta bactérie ya muaba udibu basombele (Aeromonas, Pseudomonas, Staphylococcus) mu bitupa bia mubidi	Mukese (< 5% too ne ku 10%) pikalaye muondapibua kumpala kua dîba ne manga a IV ne disungula dia dijimija dia makanda a mubidi	Kapepe kakole kadi kafila emphysème wa muinshi mua dikoba (mapuya a kapepe adi apueka muinshi mua dikoba too ne ku diboko too ne ku tshiadi anyi ku dikasa)

Anatomi ne physique: Mushindu kayi udi tshiamu tshia 1-millimetre tshifika ku tshianza mu milisekonde¶

1. "7-Bar (100-PSI) Skin Penetration Threshold"¶

Mu mateta a mushinga mukole a biomekanike, bakebuludi bajadike ne dikoba dia muntu didi dinyanguka kudi tshipepele tshia mayi diakamue padi tshipepele tshia mu tshibombi tshipita anu 7 bar (100 pounds per square inch / PSI). * Mpindieu fuanyikija tshipiminu tshia 100-PSI ne bintu bia mudimu ne bia ku nzubu bia ku dituku ne ku dituku: * Tshiamu tshia kuela natshi bintu tshia ku nzubu/tshia mushinga: 2,000 too ne ku 5,000 PSI (140 too ne ku 350 bar), misangu 30 too ne ku 50 ya bukole budi bukengedibua bua kutobola dikoba. * Mushimi wa mayi wa bintu binene (tshiamu tshia kumbula natshi bintu, tshiamu tshia nzembu, tshiamu tshia dibandisha natshi bintu, tshiamu tshia kukosolola mitshi): 2,500 to 6,000 PSI (170 to 410 bar). * Pneumatic / Battery Grease Gun: 3,000 to 10,000+ PSI (200 to 700+ bar). * Common-Rail Diesel Fuel Injector: 4,000 to 30,000+ PSI (275 to 2,000+ bar). * Padi ndeke udi upatuka lubilu lua 150 too ne ku 300 metre ku sekonde (335 too ne ku 670 mph) ututa tshitupa tshia munu wa tshianza (muaba umuepele udibu batamba kutapa, pa tshibidilu ku tshianza tshidi katshiyi tshikokesha), udi utapa tshina tshia 1-millimetre mu dikoba dikole ne ututa **5 too ne ku 30 militre mu tshitupa tshia mâyi muibidi.

2. "Flexor Tendon Sheath Superhighway" ku tshianza ne ku diboko¶

Ntshinyi tshidi tshienzekela tshintu atshi tshia peinture, mafuta anyi mafuta a hydraulique paditshi tshipita mu dikoba dia munu anyi dia tshianza? 1. Shi jet ututa tshitupa tshia mubidi tshia ku mutu kua munu anyi ku luseke lua mufuba, udi ututa mufuba wa phalanx udi kayi unyema, udi unyunguluka ku luseke, ne udi unyunguluka bionso digital neurovascular bundles (mijilu ibidi mikese ne mijilu idi ilama munu ne muoyo). 2. Shi jet ututa pa mutu pa bipese bia munu mudi tshilamba tshia muonji wa flexor tshitekete (bishilangane ne bipese bia nshinga bidi pankatshi pa bipese), tshipepele tshikole tshidi tshituta buludiludi munda mua tshitupa tshia synovial tshia munda mua tshianza tshia muonji wa flexor. 3. Padibu bafika munda mua tshina tshia synovial tshidi tshilengeja, mâyi adi ne bukole adi apetangana ne ditantamena dia zero ne adi apueka buludiludi ku munu mu miaba ya muinshi mua tshianza (midpalmar ne thenar spaces), mu muaba wa tshianza tshia tshianza, ne mu muaba wa Parona mu diboko dia kuinshi. * Tshidi tshitamba kuikala ne njiwu: kudi bantu ba bungi, mishipa ya flexor tendon sheaths ya tshianza tshinene (radial bursa) ne munu mukese (ulnar bursa) idi ilamakaja buludiludi ku tshianza ne misangu ya bungi idi iyukila munkatshi muabu mu "horseshoe abscess/injection pathway," mbuena kuamba ne: peinture udibu bele mu tshianza tshinene udi mua kupueka mu tshianza tshikese ne kupingana mu tshianza tshikese mu masekonde makese.

3. Mushindu inayi wa dibutula dia mifuba¶

Bua tshinyi munu udibu bele tshiamu udi ufua lukasa pikalabu kabayi bawubulule mu mêba 6? 1. Immediate Mechanical Barotrauma & Compartment Tamponade: Munu wa muntu udi tshintu tshikole, tshidi katshiyi tshishintuluka tshikolesha kudi septa wa mionji (Cleland's ne Grayson's ligaments). Kuenzeja nansha mililitre 2 anyi 5 ya peinture anyi mafuta mu munu kudi kubandisha bukole bua munda mua tshitupa tshia mubidi kupita bukole bua mashi a mu mashi (acute digital disama dia tshitupa), kukuma mijilu ne mishipa ya mashika. 2. Disama dikole dia mijilu ne dinyanguka dia mashi: Tshipupu tshia lubilu lua bungi ne disama dia tshimpitshimpi bidi bijula tshipupu tshikole ne dibuela dia mashi munda mua mijilu yonso ibidi ya tshiadi. 3. Difua dia bintu bia mu mashi: Hydrocarbures, xylène, toluène, minerale spirits, ne alkyd resins bidi binyangakaja membrane ya selile ya mafuta ne bienza bua proteine ikale mikole padibu bapetangana, bikudimuna mafuta a muoyo, mionji ne mijilu ya mubidi mu buloba bua lufu. 4. Disama dibidi dia bactérie polymicrobienne: Bu mudi tshitupa tshia munda mua munu mpindieu tshifue, tshinyanguke, ne katshiyi ne oxygène anyi globules blanc, bactérie idibu babueja ku tshiamu tshia nzembu idi ivulangana lukasa mu tshitupa tshia mubidi tshidi tshifue.

Tshikondo tshia malu asatu tshia dishima: Bua tshinyi kuindila kanyinganyinga kudi kulomba munu¶

Muena mudimu yense, mufundi wa DIY, muenji wa mashinyi, ne munganga wa disungula badi ne tshia kuvuluka bitupa bisatu bia disama dia mputa wa tshiamu tshia nzembu tshia bungi bua kabakuluki mu buteyi bua tshitupa tshia kumpala budi kabuyi ne kanyinganyinga:

Tshitupa 1: Tshitupa tshia "Silent / Pinprick" tshia dishima (Mu minite 0 too ne ku Dîba 2 too ne ku 4)¶

Mudibi bimueneka: Katupa kakese ka 1-to-2-millimetre ka munu wa tshianza, tshianza tshinene, anyi tshianza, imue misangu ne ditontolola dikese dia peinture anyi dia mafuta ku tshibuelelu. Misangu ya bungi kakuena dipatuka dia mashi nansha dikese.
Mushindu udibi biumvuika: Disuma dia tshitupa tshîpi anyi dia dikuma dia tshianza pa dîba dia dikuma, dilonda kudi dikumbana dikese, dipanga dia lungenyi, anyi disama nansha dikese. Mubedi udi mua kuenza mudimu ne munu wende ne misangu ya bungi udi upingana diakamue ku dipenta anyi kulongolola traktere.
Bua tshinyi edi ndididishi dia or: Mu tshitupa tshia kumpala, bitupa bia mubidi kabiena bianji kupitshila mu dinyanguka dia bintu bidi kabiyi mua kupingana to. Kuya ku tshibambalu tshia malu a mpukapuka mu tshitupa tshia kumpala, padi munu utshidi anu umvua "bimpe," ke tshidi tshisungila munu.

Tshitupa 2: Tshitupa tshia disama dia nsukadi ne dia tshitupa tshia mubidi (mêba 2 too ne ku 4 too ne ku mêba 12 too ne ku 24)¶

Mushindu udibi bimueneka: Munu anyi tshianza tshidi tshivula mu tshintu tshikole, tshikole, tshienza bu tshijengu ("tshidi tshifuanangane ne sosise"). Dikoba didi dilua ditoke, ditoke bu wax, anyi ditoke, pashishe dikala dikunze ne dikola kunyima kua tshianza ne tshianza (lymphangitis chimique ne tenosynovitis).
Mudibi biumvuika: Dituadija dia tshimpitshimpi dia disama dikole, didi kadiyi dijika, didi dikola didi kadiyi diandamuna nansha kakese ku manga a dijikija nawu kanyinganyinga anyi mene a morphine wa mu mishipa. Kuteta bua kululamija munu mukosa bitekete bitekete kudi kufikisha ku kanyinganyinga kakole (Bimanyinu bia Kanavel bia flexor tenosynovitis).
Bimanyinu bia mubidi: Kapia kakese, bungi bua globules blancs buvule, mutshima udi ututa lukasa, ne mashika, munu udi kayi wenza mudimu.

Tshitupa 3: Tshitupa tshia lufu lua mashi ne tshia gangrene (kupita pa meba 24)¶

Mushindu udibi bimueneka: Dikoba dia pa mutu pa munu didi dipatuka bipumbishi, dinyanguka, ne dipatula mayi a lufu adi ne mupuya mubi musambakaja ne pente anyi mafuta. Nsongo ya munu ne distal phalanx bidi bilua violaceous violet, pashishe makala ne mufike (gangrène muume anyi mutoke).
Tshipeta: Dipanda dia munu didi kadiyi mua kuepuka, dipanda dia tshianza, anyi dipanda dia bungi dia tshianza tshidi tshishala tshikole ne katshiyi ne lungenyi.

Mikenji mikole ya diambuluisha dia kumpala ne malu adibu mua kuenza mu lupitadi¶

1. Bua tshinyi mabue a mashika mmakandika bikole¶

Padi munu utuadija kukuma ne kuvula mu tshitupa 2, lungenyi lua muntu ludi lua kujingila tshianza ne tshibombi tshia neje anyi kutshiela mu mayi a neje. * Kuteka neje anyi mayi mashika pa mputa wa tshiamu tshia nzembu tshikole to. * Bua tshinyi? Dipanduka dia munu didi dilengeja ku tshingoma pa tshintu tshionso tshikese tshia mashi tshidi mua kupitshila mu mishipa ya tshiamu tshia mitaku. Kuela mashika kudi kujula diakamue dikosa dia mijilu ya luse, kukanga mishipa ya mashika idi mipuekele ne kuenza bua gangrene ikale ne lukasa. Lama tshianza mu luya lua nzubu ne tshikuate bitekete bitekete mu tshitupa tshia mutshima.

2. Bua tshinyi baminganga ba mu lupitadi kabena ne bua kuenza "Digital Nerve Ring Block" ku munu to¶

Wewe muye ne mubedi ku lupitadi lua lukasa anyi ku tshibambalu tshia malu a lukasa, manya mukenji wa mushinga wa buanga eu: * Kulekedi muntu nansha umo bua kuela tshintu tshia kuondopa natshi (lidocaine/bupivacaine) mu tshianza tshia munu udi mutapike ("digital ring block"). * Ku nshindamenu kua munu kudi kale kuvula too ne ku bukole ne peinture anyi mafuta adibu bele muinshi mua bukole bua bungi; kuela 3 to ne ku 5 millilitres ya anesthesie wa mu mayi mu nshindamenu wa tshiamu tshikole tshidi tshienza bu tshintu tshia mayi tshidi tshijikija difila dia mashi a ku Enternete. Dikanda dia kanyinganyinga ne diondapangana dia mubidi didi ne tshia kuenzeka ku diambuluisha dia diondapangana dia mu mishipa, dia proximal brachial plexus / wrist nerve block, anyi dia anesthésie générale.

3. Bua tshinyi ba munganga kabena ne tshia kuenza mudimu ne "Esmarch Squeeze Bandage" kumpala kua kupanda¶

Mu tshikondo tshia dipanda dia tshianza tshia lukasa, baminganga batu batamba kuela tshilamba tshikole tshia tshiamu tshia caoutchouc (tshia Esmarch bandage) kumbukila ku nsongo ya minu too ne ku diboko bua kupatula mashi mu tshianza kumpala kua kuela tshiamu tshia pneumatique tshia ku diboko dia kuulu. * Mu mputa ya tshiamu tshia nzembu tshikole, kuela tshilamba tshia Esmarch kubangila ku minu too ne kuulu ki nkukandika to, bualu kufina tshianza kudi kupingaja peinture, solvant anyi mafuta a hydraulique kunyima mu tshitupa tshia tendon sheaths too ne ku diboko dia kumpala. Pamutu pa nanku, baminganga badi anu babandisha diboko mu minite 2 ne bapuekesha tshianza tshia kuulu kabayi bafina tshianza.

4. Tshidi tshienzeka mu nzubu wa dipanda (ne bua tshinyi bidi bikengela kuenza mudimu wa dipanda misangu ya bungi)¶

Babedi ne mêku abu badi ne tshia kumvua tshidi dipanda dia tshianza dia lukasa dilomba bua bobu kuikala badilongolole bua dilonga dia mu lupitadi: * Wide Open Brunner (Zigzag) Incisions: Muinshi mua anesthesie general anyi brachial plexus, munganga wa tshianza udi wenza bipese binene, bia zigzag kumbukila ku nsongo ya munu too ne ku tshianza ne ku tshianza tshia ku tshianza (digital-palmar fasciotomy ne flexor tenosynovectomy) bua kupatula diakamue tshienzedi tshia bukole. * Diumusha dia peinture anyi dia mafuta ku diambuluisha dia dipanda dikese: Ku diambuluisha dia biamu bia kupanda nabi anyi tshiamu tshia kupanda natshi bantu, munganga udi upanda ne muoyo mujima bipese bia peinture bikole, bia résine anyi bia hydraulique bia mu mishipa ne mu mijilu, pashishe udi wenza mudimu ne mâyi a bungi a mukele adi kaayi ne luya lua bungi (** ku diambuluisha dia tshiamu tshia nzembu bua kusukula kupatula peinture munda mua tshianza tshidi ne muoyo**, bu mudi bintu bidi bishipa bitupa bia mubidi bidi bishala). * Dipanda dia mputa ne dipanda dia "Ditangila dibidi" mu meba 24 too ne ku 48: Bu mudi tutoyi tukese tua mafuta anyi tua peinture tusokoma mu bitupa bia mafuta, baminganga batu misangu ya bungi bashiya mputa miunzulula anyi pa mutu pa milonda idi kayiyi ne tshintu ne bapingana mu nzubu wa dipanda kunyima kua mêba 24 too ne ku 48 bua kuondopa musangu muibidi, ne kulonda kudi mubedi wa tshianza tshikole diondapangana dia mubidi bua kuepuka mputa ya kashidi ya mu mifuba.

5. Tshia kulua natshi ku tshibambalu tshia malu a tshimpitshimpi (SDS & Pressure Checklist)¶

Padi muntu umua udilongolola bua kuya ne mubedi (ulama mubedi mu NPO kayi ne tshia kudia anyi tshia kunua), lomba muena mudimu nebe anyi muena mu dîku diebe bua kusangisha anyi kukuata foto ya bintu bitanu ebi ku telefone: * [ ]. * [ ]. * [ ]. * [ ]. * [ ] Bikala dikuba dia mubedi dia disama dia tetanus didi dikumbane (mu bidimu 5 bishale ebi bua mputa ya bukoya/mikole).

Bintu bia pa buabi bidi ne bukole bua bungi ne njiwu ya buanga bua mubidi¶

1. Tshiamu tshia diesel ne tshia Common-Rail Automotive Engine Injections¶

Ma motere a lelu a diesel a common-rail adi enza mudimu ne bukole bua bungi budi pankatshi pa 1500 ne 3000 bar (22000 too ne ku 44000 PSI), bukole bua bungi bua misangu dikumi ya tshiamu tshia dilengeja natshi bintu tshidi katshiyi ne luya. * Padi muenji wa mashinyi uteta tshiamu tshia diesel tshidi tshienza mudimu pambelu pa mutu wa cylindre anyi ulekela tshiamu tshia esanse tshidi ne bukole bua bungi padi nshinga utshidi anu ne bukole, tshiamu tshia diesel tshidi tshibuela munda menemene mu tshianza, mu diboko dia kumpala, anyi mene mu dîsu ne mu mpala. * Diesel ne petrole i hydrocarbures aliphatique ne aromatique idi inyangakaja mafuta a muinshi mua dikoba ne mifuba padiyi ipetangana, idi ifikisha ku disama dia fulminant chimique cellulite, fièvre systémique severe, leucocytose, ne necrose rapide des tissues dans les heures 2 ou 4. Dibueja dia mafuta a diesel didi ne tshitupa tshinene tshia dikosa dia mubidi dia mputa yonso ya pression wa bungi ne didi dilomba dikonkonona dia lukasa mu nzubu wa dipanda mu mêba 3 anyi 6.

2. Dikuba dia nyama ne dia madimi dia bukole bua bungi ("Oil-Adjuvant Vaccine Finger")¶

Babidime, bena mudimu ba nyunyi, bena mudimu ba mu madimi a mishipa, ne baminganga ba nyama batu misangu ya bungi bapeta disama dia malu a nyama mu minu anyi mu bianza biabu padi nyama unyema mu tshimpitshimpi. * Bua tshinyi tuishi tua nyama tudi ne mafuta tudi ne lutatu lua lukasa lua dipanda: Bishilangane ne tuishi tudi tuenza ne mâyi a bantu, tuishi tua bungi tua bimuna, ngulube, ngombe ne saumon tudi tuteka mu mafuta a minerale anyi emulsion wa diambuluisha dia Freund muenza bua kujula dikuba dia mubidi dia matuku a bungi ne dikole mu nyama. * Padibu babueja mu tshibombi tshia munu wa muntu, bintu bia diambuluisha nabi bia mafuta a minerale bidi bienza anu bu mafuta a mu midimu anyi bu tshintu tshidi tshilengeja bintu bia kupenta nabi: bidi bijula disama dikole dia granulomatose, disama dia tshitupa tshia mubidi tshidi katshiyi ne disama, ne disama dia lufu lukole. Ulue ne mulondo wa tshiamu tshia dikuba natshi nyama ku tshibambalu tshia malu a mpukapuka tshia lupitadi diakamue bua baminganga ba ku bianza bamone ni tshidi ne tshintu tshia diambuluisha tshia mafuta tshidi tshikengela kusukula lukasa.

3. Pompe ya tshiamu tshia simente, biamu bia kuela nabi plaster, ne biamu bia kuela nabi plastique¶

Pressurized Ciment and Mortar Grout: Pa kumbusha barotrauma wa tshiamu, ciment wa Portland mutoke udi ne pH wa alkaline wa 12 too ne ku 13 (calcium hydroxyde), udi ukumbaja alkaline liquefactive burn munda mua nzubu ya bianza.
High-Ppression Heated Industrial Extruders (Hot-Melt Adhesives, Bitumen, and Molten Plastics): Sangila dibueja dia tshiamu tshia nzembu ne diosha dia munda dia munda padi polymère mufuba wenda ukola pabuipi ne mijilu ne mijilu. Kutetshi nansha kakese bua kumbusha plastike mukole anyi goudron pa kikoba pa muaba wa bualu ebu to; ulengeja pa mutu pa tshitupa tshîpi ne mâyi a mukele adi kaayi ne luya lua mu nzubu anu padiwu atema kapia, pashishe uleke dilengeja bua kulama mashi adi enda bimpe ne kuambula diakamue.

4. Disama dia mubidi didi difumina ku bintu bia kuela nabi bintu bia kupenta nabi, bintu bia kulengeja nabi ne bintu bia kuela nabi mayi¶

Nansha mudi dilama dia bianza dia muaba udibu basombele dikale bualu bua kumpala, baminganga badi kabidi balonda **dikuata dia bintu bidi ne buanga bidi bifumina mu bitupa bia muinshi mua tshianza mu mashi: * Lead-Based Industrial Marine and Anti-Corrosive Primers: Chromate de plomb anyi globules ya peinture rouge mu tshianza idi mua kufikisha ku poison wa plomb (plumbisme) pikalabu kabayi bawumbusha bimpe. **Halogenated Hydrocarbons (Methylene Chloride / Paint Strippers Absorbed methyne chloride udi ushintuluka kudi tshifu mu carbon monoxide**, udi ukebesha dipanga d carboxyhemoglobinemia ne ischemia wa mutshima. * Systemic Corticosteroids in the Hospital: Pa kumbusha manga a antibiotique a mu mishipa (pa tshibidilu cephalosporin wa tshipungu tshisatu anyi beta-lactam/beta-lactamase inhibitor) ne dikuba dia tetanus, baminganga ba ku bianza batu misangu ya bungi bafila **dose mikole ya mu mishipa anyi dexasolo anyi panyima pa yeye mumane kupanda muntu diumusha bua kujikija tshipepele tshikole tshia cytokine tshidi tshifumina ku bintu bidibu bele ne mafuta.

Mulongo wa malu a kuepuka mudimu muimpe: kuimanyika diela dia tshiamu tshia nzembu kumpala kua bualu ebu kuenzeka

[ ].
Misangu yonso ikala ne tshiibi tshia bukubi tshia tshiamu tshia mvita ne umbusha bukole budi bushala: Kujima motere wa tshiamu tshia peinture udi kayi ne luya kakuena kupuekesha bukole bua tshiamu tshia nzembu to: tshiamu tshia nzembu tshidi tshishala ne bukole bua 3000 PSI too ne paudi ushintulula tshiamu tshia prime/pressure-relief ne ukoka tshiamu tshia nzembu mu tshibombi tshia tshiamu tshia mitaku tshidi panshi.
[ ].

Kuenza mudimu ne tshintu tshionso tshidi ne bukole bua bungi anyi tshintu tshionso tshidi ne tshiamu tshia pinhole bu bualu bua lukasa bua mêba asambombo, nansha padi dikoba dileja anu tshintu tshidi katshiyi tshisama, ke bualu bumuepele bua mushinga mukole bua kusungila tshianza tshia muena mudimu ne nsombelu wende. Ela meji bua kulonga tulasa tua diambuluisha dia kumpala ne bukubi bua mudimu kupitshila ku tshisumbu tshia ditunga tshiebe tshia Croix-Rouge anyi tshia Croix-Rouge, St John Ambulance, anyi tshisumbu tshia bukubi bua mudimu tshia ditunga diebe.

Nkonko itubu bela misangu ya bungi¶

I accidentally nicked my index finger with an airless paint sprayer 20 minutes ago; there's only a tiny dot of paint and it barely hurts. Can I wait and see how it looks tomorrow morning?

No: waiting until tomorrow morning is the exact mistake that causes up to 80 percent of patients with oil-based paint or solvent injection injuries to lose their finger to amputation. High-pressure sprayers operate at 2,000 to 5,000 PSI, which blasts paint through a microscopic hole in the skin without causing much pain at first. For the first 1 to 3 hours, the finger often feels completely fine or just slightly numb or full. However, hidden beneath that tiny dot, the paint has traveled down the tendon tunnel into your finger and palm, where it is right now cutting off blood flow and chemically dissolving the tissues. By the time throbbing pain starts 4 to 6 hours later, irreversible tissue death is already underway. Take off all rings immediately, eat and drink nothing (stay NPO for anesthesia), take a photo of the paint can label, and go straight to a hospital emergency department right now so a hand surgeon can open and wash out the finger within the critical 6-hour window.

Why can't I put an ice pack on a finger that is throbbing after a grease gun or hydraulic fluid injection?

Although ice is helpful for an ordinary bruised knuckle or sprained ankle, putting ice on a high-pressure injection injury is extremely dangerous. Inside the injected finger, the trapped grease, hydraulic oil, or paint has already swollen the tight finger compartments and squeezed the two tiny digital arteries almost completely shut. Putting ice or cold water on the finger triggers a strong cold-reflex spasm (vasoconstriction) in those already-crushed blood vessels, cutting off the last remaining trickle of oxygen to the fingertip and speeding up gangrene. Keep the hand at normal room temperature, loosely covered with sterile gauze and supported at chest/heart level.

How can a leaking hydraulic hose inject oil into my hand through thick leather work gloves without my hand even touching the hose?

Industrial and agricultural hydraulic lines operate at 2,500 to 6,000 PSI (170 to 410 bar). When a tiny pinhole wear-spot forms in a braided hydraulic hose, oil shoots out of that microscopic pinhole in a needle-thin stream moving at over 150 meters per second (more than 330 miles per hour), faster than a pellet gun and often invisible as a fine mist. Because it takes only 100 PSI to penetrate human skin, a 3,000-PSI pinhole jet easily slices straight through heavy leather work gloves, mechanics' gloves, or a shop rag and blasts hydraulic fluid deep into your palm or fingers from several inches away. Never use your bare or gloved hand to feel for a hydraulic or compressed-air leak; always shut down and bleed the pump pressure, or pass a long piece of cardboard or wood along the hose from a safe distance.

What if I was hit by a high-pressure water washer or a compressed air nozzle with no paint or oil, do I still need to go to the emergency room?

Yes. Even though clean water or compressed air does not chemically dissolve fat the way paint thinner or diesel fuel does, a commercial pressure washer (1,500 to 4,000 PSI) or a high-pressure air nozzle pressed against the skin still blasts water, dirt, skin bacteria, and air bubbles deep into the closed compartments and tendon sheaths of the hand. High-pressure water injections carry a high risk of severe deep-space bacterial infections (including aggressive waterborne bacteria) and compartment swelling, while compressed air injections dissect under the skin up the forearm (subcutaneous emphysema) and in rare cases can force air bubbles into torn veins. Always have any high-pressure water or air injection evaluated promptly in an emergency department for X-rays, tetanus prophylaxis, intravenous antibiotics, and compartment pressure monitoring.

Miaba mifumina¶

Société américaine pour la chirurgie de la main (ASSH, États-Unis): Dilombola dia mudimu wa luondapu: mputa ya dipanda dia tshianza ne ya tshitupa tshia kuulu (Dididishi dia 6-Hour Surgical Decompression Window).
Mulombodi wa malu a bukola bua mubidi ne bukubi (HSE, Royaume-Uni) ne Société britannique wa dipanda dia bianza (BSSH): Didimuija dia bukubi ne mikenji ya dipanda: Mashi a mu mayi, tshingoma tshia mafuta, ne mputa ya dipanda dia bintu bidi kabiyi ne luya.
Occupational Safety and Health Administration (OSHA) & National Institute for Occupational Safety and Health (NIOSH, United States): Dimanya dia njiwu ne disungula dia tshimpitshimpi bua dibueja dia mayi a bukole bua bungi ne dipatuka dia mayi mu tshina.
Bulongolodi bua matunga a ku Mputu bua dipanda dia bianza (FESSH, ku Mputu): Dilama dia njiwu ya dipanda dia tshianza tshia bukole bua bungi: tshinyangu tshia tshintu tshidibu bapanda ne dîba dia dipanda.
Tshilongelu tshia baminganga ba mu Amerike (ACS, États-Unis): Diambuluisha dia mu nsombelu wa njiwu mikole (ATLS): Disama dia mu bitupa bia mubidi ne mputa ya mu bitupa bia mubidi bidi bibuela mu bitupa bia mubidi bidi ne bukole bua bungi.