Bimanyinu bikunze bia panyima pa dipanda, mashi adi apatuka munda ne masama¶

Midimu mipite pa 65 pa lukama ya dipanda pa buloba bujima idi yenzeka mpindieu mu njila wa kuendakana (wa pambelu) anyi ku dipatuka dia lukasa, mbuena kuamba ne: babedi miliyo ya bungi batu bapola ku diambuluisha dia anesthesie wa tshibungi, dia dikuba dia mukolo, dia laparoscopie, dia dibuela dia mijilu, ne dia dipanda dia mifuba anyi dia difu mu nzubu yabu mu mêba makese panyima pa bamane kupatuka mu nzubu wa dipanda. Nansha mudi kanyinganyinga ka bungi ka panyima pa dipanda, disama dia mutshima dikese, ne mputa mikese bijika bimpa, matuku 14 a kumpala kunyima kua dipanda adi ne ntatu mikole ya dipatuka dia mashi munda disokoka, divulangana dia mashi mu mishipa ya luya, hyperthermie malignant retardée, **difua dia mputa mu tshifu, dipanga dia tshifu dipatuka dia mala dia anastomotic, embolie pulmonaire, ne sepsis wa panyima pa dipanda.

Malu audi ne bua kuenza diakamue paudi ulama mubedi udibu bapatule matuku mashale aa udi wenda unyanguka kumbelu nkusunguluja diondapibua didibu batekemene ku dipanda ne dia njiwu ya dipanda idi mua kunyanga muoyo, kubikila bena mudimu ba lupitadi lua lukasa kumpala kua tshipupu tshikale katshiyi mua kupingana, kulama tshifu tshia mubedi tshiyi tshiyi ne tshintu (kakuena bualu nansha bumue ku mishiku) padibi bikengela kupingana mu nzubu wa dipanda ne lukasa, bidi bikengela kukuba tshitupa tshia mubidi tshidi tshipatuka anyi tshia mu njila wa luya, ne kufila mushindu mulelela wa dipanda ne mikanda ya dipatuka kudi baminganga.

Enza nunku mpindieu¶

1. Bikila bena mudimu ba lupitadi lua lukasa lukasa bua kupeta tshimanyishilu tshionso tshia panyima pa dipanda: Bikila nimero wa lukasa lukasa wa muaba unudi (911 mu États-Unis ne mu Canada, 112 mu Union européenne mujima, 999 mu Royaume-Uni, 000 mu Australie) anyi tangila mukanda wetu wa nomba ya tshimpitshimpi Shi mubedi upeta lutatu lua mupuya, disama dia mu tshiadi, dipanga dia lungenyi, disama dia tshiadi padiye usomba, mashi makunze adi apita mu bilamba, nshingu udi uvula lukasa kunyima kua dipanda dia tshiadi anyi dia tshiadi, mifuba mikole ne luya ludi luenda luvula, anyi tshitupa tshia mu difu tshidi tshipatuka.
2. Kuenzeja NPO mikole (kakuyi tshintu tshia ku mishiku) diakamue: Kupeshi mubedi mayi, bipese bia mashika, biakudia, anyi manga a kanyinganyinga ka mukana padibu bela meji ne: udi ne lutatu lua dipanda. Shi mubedi udi ne tshia kupingajibua lukasa mu dipanda bua kuimanyika mashi adi apatuka munda anyi kulongolola dipatuka dia mashi mu mala, kuikala ne mayi anyi biakudia mu tshifu kudi mua kufikisha muntu ku lufu mu tshikondo tshia dienza dia anesthesie wa tshimpitshimpi.
3. Lala mubedi panshi bua kuela meji ne: mashi adi apatuka munda anyi tshipupu: Bikala mubedi mutoke, mashika, mutshima, tshiji, anyi disama dia mutshima (mutshima udi ututa kupita 100 ku minite padiye uikisha), ulala panshi pa mukolo ne ubandishe maulu ende 15 too ne ku 30 santimetre (6 too ne ku 12 inches) pa kumbusha dibandisha dia maulu anyi dia tshifu kanyinganyinga.
4. Ela tshienzedi tshikole pa mashi adi apatuka pambelu pa dipanda (pa kumbusha pa tshiadi tshia luya): Shi mashi makunze adi apita mu tshilamba tshia dipanda pa tshiadi, pa tshiadi, pa tshiadi, anyi pa difu, kupudi tshilamba tshia kuinshi tshia gaze to; Ela bilamba bikezuke, biume bia kuowela nabi anyi gaze buludiludi pa mutu ne ufina panshi bikole ne bianza bionso bibidi.
5. Fuka bitupa bia mu difu bidi biunzuluke (dehiscence) ne tshilamba tshia mâyi tshidi katshiyi ne disama: Bikala tusonji tua dipanda anyi biamu bia kukanga nabi bintu bipatuka ne mâyi a rose anyi bipese bia mala bimueneka mu mputa, kupinganyi nansha kakese bitupa bia mubidi munda to. Buikila mputa udi mubulula bimpe ne tshilamba tshikezuke anyi gaze mutoke mu mâyi a mukele anyi mâyi a mu pompi a kapia, ne inama binu bia mubedi kakese pa tshilamba tshia kulala bua kumbusha lutatu lua tshimanu tshia difu.
6. Usangishe mukanda wa dipatuka dia mu lupitadi ne mukanda wa anesthésie: Pesha baminganga mukanda wa dipatuka dia mu lupitadi, nimero ya telefone ya munganga wa mpukapuka wa mêba 24, karte ka tshiamu tshia dipanda natshi (bikalabu bateka tshiamu anyi tshiamu tshia nzembu), ne manga onso adibu bakufundile bua kujikija mashi ne bua kujikija kanyinganyinga.

flowchart TD
    Start["Mubedi wa panyima pa dipanda udi wenda unyanguka kumbelu (Mêba too ne matuku 14 kunyima kua dipatuka)"] --> Triage{"1. Umanye tshilejelu tshia njiwu tshia kumpala"}
    Triage -->|Shortness of Breath, Chest Pain, or Neck Swelling| AirwayPE["Disama dia mu mishipa: Bikila ku 911/112/999, ikala mululame, tangila ni disama dia mu nshingu didi divula anyi disama dia mu mikolo"]
    Triage -->|Pale, Sweaty, Dizzy, Heart Rate Over 100, or Expanding Belly/Thigh| Bleed["Dipatuka dia mashi a munda anyi a pambelu: Bikila 911/112/999, Lala panshi, Fina bikole pa mashi adi apatuka pambelu, Lama NPO"]
    Triage -->|Jaw/Muscle Stiffness, Rapid Fever Over 38.8 C, Dark Urine Within 24 Hours| MH["Muntu udi wela meji ne: udi ne disama dia hyperthermie malignant: Bikila 911/112/999, umbusha bilamba, lupuishi ne dikoba dia ventilateur, ice packs too ne ku tshiadi anyi ku nshingu"]
    Triage -->|Pink Salmon Fluid Gush from Belly Incision or Bowel Visible| Dehisce["Dibutuka dia mputa / Dipatuka dia munda: Bikila 911/112/999, Ubuikile ne tshilamba tshikezuke tshia kapia, Inama binu pa mutu pa tshilamba tshia kulala"]
    Triage -->|Fever, Confusion, Shivering Chills, or Worsening Belly Pain Day 3 to 10| Sepsis["Wewe wela meji ne disama dia tshiadi anyi dia sepsis: Bikila 911/112/999 anyi munganga diakamue, kuena ne bualu nansha bumue ku mishiku to"]
    AirwayPE --> NPO["2. Kuenzeja NPO mikole (Kakuyi mayi, biakudia, anyi manga a kunua) mu tshilumbu tshia dipanda dia lukasa"]
    Bleed --> NPO
    MH --> NPO
    Dehisce --> NPO
    Sepsis --> NPO
    NPO --> Docs["3. Sangisha tshikoso tshia dipatuka dia mu lupitadi, mukanda wa anesthesie, ne milondo yonso ya manga bua EMS"]

Tshikondo tshia ntatu ya panyima pa dipanda: padi ntatu misunguluke ilua¶

Bilumbu bia dipanda bidi bilonda bikondo bia mubidi bidi mua kumanyibua bilondeshela hemostase, metabolism wa anesthesie, bukole bua mputa, ne divulangana dia bactérie. Kujingulula dituku didi mubedi ("Dituku dia panyima pa dipanda 0" ndituku dia dipanda) kudi kuambuluisha balami bua kumanya tshidi tshinyanguka munda mua mubidi.

Mashi adi apatuka munda adi masokoka ne tshipupu tshia mashi tshidi tshipatuka panyima pa dipanda¶

Bishilangane na mashi a pambelu adi afumina ku ditapa dia dikoba, mashi a munda a panyima pa dipanda adi enzeka mu musokoko munda mua bitupa bia mubidi bikanga, mu tshina tshia munda (mu difu), mu tshitupa tshia panyima pa mifuba (panyima pa mifuba ne tshia mu tshiadi), muaba wa pleural (tshifu), tshitupa tshia mubidi tshidi tshinyunguluke mutshima), anyi mu bitupa bia muinshi mua tshiadi ne tshia tshiadi. Mubedi udi mua kujimija 1.5 too ne ku 2.5 litre (3 to ne ku 5 pints) ya mashi mu difu diende kunyima kua diumusha dia tshiadi tshia mu tshifu, diumusha dia tshifu, dilongolola dia tshifu, anyi diumusha dia tshiadi, anyi mu tshiadi tshiende kunyima kua dipingaja dia tshiadi, kakuyi nansha ditoba dimue dia mashi didi dimueneka pa tshilamba tshia pambelu tshia dikoba.

Bua tshinyi disama dia difu didi tshimanyishilu tshia panyima ne orthostatic vitals ntshimanyinu tshia kumpala¶

Muaba wa tshifu wa muntu mukole udi mua kudiunda bua kukuata litre ya bungi ya mashi ne divulangana dikese dia tshijengu tshia mu tshiadi. Kabidi, bansonga badi ne makanda a mubidi mimpe ne bakulumpe ba bidimu bia pankatshi batu bakanga mijilu yabu ya mashi bua kulama tension wabu wa mashi padibu balala bimpe too ne padibu bajimija 30 pa lukama ya bungi bua mashi abu onso. Keba pa muaba wa bimanyinu bikunze bia difutu dia kumpala ebi:

• Tachycardie wa dikisha udi kauyi umvuika (Mutshima udi ukuma kupita 100 too ne ku 110 mu minite): Panyima pa dibala dia kanyinganyinga, tshipiminu tshia mutshima tshidi tshienda tshivula tshitu misangu ya bungi tshimanyishilu tshia kumpala tshia dipatuka dia mashi munda anyi dia dipatukila dia mubidi.
• Disama dia mutu anyi dipanga dia lungenyi (dijimija dia lungenyi padiye wimana anyi usomba): Mubedi udi umvua bimpe padiye mulale panshi pa bulalu, kadi dîba didiye musombe ku muelelu wa matela anyi uya mu tshina tshia kuowa mâyi, tshimuenenu tshiende tshidi tshinyanguka anyi tshilua tshifiike, matshi ende adi alenga, adi apatuka ne tuishi tua mashika, ne adi akuluka.
• Disama dia mu tshiadi dia tshiadi (tshimanyinu tshia Kehr): Nansha mudi disama dia dikaya ditekete mu mêba 24 a kumpala kunyima kua dipanda dia tshiamu tshia laparoscopie ditamba kufumina ku gaz wa dioxide de carbone udi kayi ne njiwu, disama dipiadipia, dikole anyi didi dienda dikola ku mutu kua dikasa dia bakaji anyi dia balume didi dilondangana ne butekete, butoke anyi mashi adi amueneka muinshi mua mutu diaphragme ne dibungamija dia phrenic nerve.
• Alarme ya dipatuka dia tshina tshia dipanda: Bikalabu batume mubedi kumbelu ne tshiamu tshia kupanda natshi (bu mudi tshiamu tshia Jackson-Pratt anyi tshia Blake) ne tshipepele tshiuwuja diakamue ne mashi makunze, a kapia adi mapite pa 100 millilitre ku dîba (anyi mapite pa 200 200 millilitres mu mêba manene anyi a arterieux) mushipa udi upatuka mashi.
• Femoral catheterization / groin puncture site hematoma: Panyima pa dipanda dia mutshima, diteka dia stent mu mutshima, anyi dipanda dia munda mua tshiadi ku diambuluisha dia tshiadi (mushipa wa tshiadi) anyi tshianza (mushipa wa tshiadi), tshitupa tshidi tshienda tshivula lukasa, tshikole bu dibue, tshidi tshituta muinshi mua dikoba dia tshiadi, anyi disama dikole dia tshimpitshimpi dia muinshi mua tshiadi ne dia mashi ne tension wa mu tshiadi (introneal ** dipatukila dia mashi**), i disama dia lukasa dia mashi didi mua kunyanga muoyo.

Diambuluisha dia lukasa dia mashi adi apatuka panyima pa dipanda¶

1. Teka maulu panshi ne ubandishe: Teka mubedi panshi pa bulalu anyi panshi ne uteke maulu ende muulu 15 too ne ku 30 santimetre (6 too ne ku 12 inches) bua kupingaja mashi a mu mishipa mu mutshima. Kuena ne tshia kuendesha mubedi udi ne tshiji tshia panyima pa dipanda too ne ku mashinyi to; bikila ambulanse bua baminganga batuadije kuela mishipa minene panshi mu nzubu wa bulalu.
2. Dienzeja dia buludiludi pa mutu pa tshitupa tshia mu tshiadi anyi pa miaba idibu bashipe mishipa ya ku mpenga: Bikala mashi makunze apatuka anyi avula ku muaba udibu bapanda mishipa ya mu tshiadi mu tshiadi, uvuala bilamba bia ku bianza, teka muvungu munene wa gaze anyi tshilamba tshikezuke buludiludi **1 anyi 2 santimetre (0,5 too ne ku 0,8 inches) pa mutu pa dikoba (anyi) bua kuela tshimanyinu pa dikoba. mushipa udi ubuela mu tshimanu tshia mushipa munda menemene), ne ufina bululame panshi too ne ku mufuba wa tshiadi ne bujitu bua mubidi webe mujima wenza mudimu ne bianza bionso bibidi bikuate pamue too ne padi baminganga bangata mudimu.
3. Kulekedi anyi kumbusha tshintu tshia kupatula natshi mâyi tshia kupanda natshi bantu to anu padi munganga ukuambila, ne kuena ne bua kupatula tshintu tshia kupatula natshi mâyi tshia kupanda natshi to.
4. Lama mubedi mu luya ne bilamba biume: Hypothermie udi upangisha enzyme idi ikolesha mashi (tshitupa tshisatu tshia lufu tshia disama dia mubidi ne dipatuka dia mashi padibu bamupanda). Buikila mubedi ne bilamba bia kapia paudi muindile ambulanse.

Divulangana dia mashi a mu nshingu ne disama dia post-thyroïde / carotid¶

Dipanda dia mu nshingu, bu mudi dipanda dia tshiadi, dipanda dia parathyroïde, dipanda dia tshitupa tshia mu nshingu, dipanda dia tshiadi tshia kumpala ne disangisha dia nshingu (ACDF), ne dipanda dia nshingu, didi ne njiwu ya pa buayi, mikole menemene mu mêba 6 too ne ku 24 a kumpala kunyima kua dipanda: divulangana dia mashi mu tshiadi.

Bu mudi bitupa bia munda bia mu nshingu bienza tshilamba tshikole tshidi katshiyi tshikola tshidi tshinyunguluka tshiadi (tshiamu tshia lupepele), nansha disangisha dikese dia mashi a mililitre 50 too ne ku 100 munda mua bulalu bua dipanda didi divudija lubilu lua tshitupa tshia mubidi. Kumpala kua hematoma kuikalaye munene bikumbane bua kutshibula bipese bia mu tshiadi bia mu tshiadi, tshienzedi etshi tshidi tshipangisha dipatuka dia mashi ne dia mashi adi afumina mu tshiadi (kazubu ka dîyi), ne tshidi tshikebesha edema wa mu tshiadi tshinene tshia lukasa tshidi tshikanga njila wa luya mu minite mikese.

Bimanyinu bikunze bia disama dia mu nshingu didi dienda divula (Bikila bena mudimu ba lukasa lukasa)¶

• Diumvua dia dibutuka didi dilua ne dipanga dia dikisha: Mubedi udi usomba mu tshimpitshimpi, udi ukuata ku tshilamba tshia ku nshingu anyi ku tshilamba tshia ku nshingu tshidibu bamupanda, ne udi wamba ne: "Tshiena mua kupuyakana to" anyi "Nshingu wanyi udi umvua bu udi mufuishe."
• Divulangana, dikolesha, anyi diuwule muinshi mua tshitupa tshia mu nshingu: Kumpala anyi ku luseke lua nshingu ludi luenda lupatuka pambelu, ludi lumueneka lukole anyi lukole bu mutshi, ne ludi lujimija tshitupa tshidi pa mutu pa mufuba wa tshiadi (tshitupa tshia pa mutu).
• Dishintuluka dia dîyi ne dipanga dia tshiakudia: Dîyi dia mubedi didi dilua ditekete, dikola, anyi dikola, ne kabena mua kumina mate abu nkayabu to (drooling).
• Inspiratory stridor (a late, pre-arrest sign): Mutoyi mukole, wa tshiona, anyi wa tshiona udi umvua padi mubedi upuyakana mu. Padi stridor umueneka, diamètre wa njila wa luya udi mupuekele ne bia pa lukama 70 too ne ku 80, ne dipuekesha dia luya didi mua kuenzeka mu minite mikese.

Diambuluisha dia kumpala dia lukasa bua disama dia nshingu dia panyima pa dipanda¶

1. Lama mubedi musombe mululame (muaba wa Fowler mubandile): Kulala nansha kakese mubedi udi ne disama dia mu nshingu anyi stridor pa mukolo to; bukole budi bukokela bintu pa buloba ne dibutuka dia mijilu ya mu tshiadi nebikanga diakamue njila wa luya udi mushale. Lekelayi basombe balulame bashindame kakese kumpala.
2. Sula anyi ukose tshilamba tshia pambelu tshia mu nshingu diakamue: Bikala tshilamba tshia gaze, bande, anyi tshilamba tshia mu nshingu tshidi tshifina bikole ku nshingu udi mujuke, udi mua kukosa anyi kumbusha tshilamba tshia pambelu tshidi tshikuata nshingu bua kujikija lutatu lua pambelu (pa kumbusha paditshi tshilamba tshikole tshia mu nshingu panyima pa dipanda dia nshingu didi kadiyi mua kuenzeka, mu tshilumbu etshi, udi ne bua kunzulula dididishi dia kubuela mu tracheostomy pikalabi bilomba kudi tshibambalu tshia lukasa).
3. Ikala ku tshiamu tshia kuakula natshi ne muena mudimu wa tshimpitshimpi ne munganga udi wenza mudimu: Mu bilumbu bikole mudi mubedi ujimija lungenyi ne ulua bule bua dikanga dia njila wa luya bua disama dia tshiadi tshia panyima pa dipanda dia tshiadi kumpala kua baminganga kufikabu, dilama dia malu a tshimpitshimpi didi mua kulombola muntu udi mulonge bua kuandamuna ku diambuluisha dia tshimpitshimpi ( UK Airway Society Airway Sufficulty SCOOP protocol: Dileja dia kikoba, Dikosa dia milonda, Dikoba diunzulula, Mifuba miunzulula, mputa wa pack), udi ujikija dikanga dia mijilu bikumbane bua kupingaja mupuya. Bua balami ba tshianana, dituma dia lukasa dia ambulanse ne miendu ne sirene ("expansion post-thyroïdectomy hematoma with stridor") didi didimuija baminganga bua kulongolola bintu bia mudimu wa tshimpitshimpi.

Dipatuka dia mashi panyima pa dipanda dia tonsille (matuku 5 to ne 14)¶

Bana ne bantu bakole badi benza tonsillectomy badi benza bilonda binene bia nsongo (eschar) pa mutu pa bitupa bia tonsil munda mua nyima kua nshingu. Munkatshi mua Dituku dia 5 ne dia 10 dia panyima pa dipanda, padi dikoba dipiadipia dia mubidi dikola muinshi, bilonda ebi bidi bipatuka. Mu 2 to ne ku 5 pa lukama ya babedi, tshilonda tshidi tshipatuka kumpala kua dîba ne tshiunzulula ditamba dia muinshi mua mushipa wa carotide wa pambelu.

• Diambuluisha dia kumpala mu tshikondo tshia dipanda dia mashi:
• Bikila nimero ya njiwu ya muaba unudi diakamue.
• Lama muana anyi muntu mukulumpe musombe mululame ne muinamine kumpala pa mutu pa dilongo anyi pa tshina tshia mâyi bua bobu kupatula mashi onso mukana muabu. Bakankamije bua kubenga kumina mashi, bualu mashi adibu bamina adi asokoka bungi bulelela bua mashi adibu bajimije ne adi asaka muntu bua kuela nsukadi mikole idi ipatula bitupa bia mashi.
• Shi mubedi udi mutabale ne udi witaba, kumulomba bua kuela mbila ne kuela mayi mashika a mashika anyi kunua tshitupa tshia mashika (anu padiye mubike ne kayi ufua) eku mukuate tshilamba tshia mashika tshibuikila ku pambelu ne ku nseke ya nshingu bidi biambuluisha bua kukanga mijilu ya mashi ya mu nshingu too ne padi baminganga balua.
• Shi mubedi udi ulala tulu anyi ujimija lungenyi, umukudimune diakamue ku luseke luabu mu muaba wa kuondopibua ne mutu mutangile panshi kakese bua mashi apatuke ku ditama panshi pamutu pa kubuela mu tshina tshia luya.

Disama dia hyperthermie malignant ne toxicite systemique wa anesthesie wa pa muaba (LAST)¶

Nansha mudi malu a bungi a tshimpitshimpi adi atangila dienza dia anestezi enzeka munda mua nzubu wa luondapu, dipatuka dia lukasa dia mu lupitadi didi diumvuija ne: balami badi ne bua kumanya malu abidi adi mua kuenzeka panyima pa dienza dia anestezi adi mua kuenzeka kumbelu mu mêba 12 anyi 24 a kumpala.

1. Disama dia luya lua bungi (MH) dia panyima pa dienza dia anesthesie¶

Malignant hyperthermie (MH) i disama dia pharmacogenetic dia mu mifuba ya mifuba (misangu ya bungi gene wa RYR1). Padi muntu udi ne disama dia MH mupeta biamu bia kuondopa nabi mupuya (sevoflurane, desflurane, isoflurane) anyi tshintu tshidi tshipangisha misunyi bua kujikija lutetuku succinylcholine, calcium udi ubuela mu tshitupa tshia mubidi tshidi katshiyi tshikokeshibua. Mifuba idi ilamakaja mu dikokangana ditungunuka, idi idia oxygène, ipatula bungi bua bungi bua dioxide de carbone ne acide lactique, ne ibandisha luya lua mubidi ku tshipiminu tshia 1 degré Celsius (1,8 degré Fahrenheit) ku minite yonso 5.

Nansha mudi 90 pa lukama ya bilumbu bia MH bituadija mu tshikondo tshia dipanda anyi mu dîba dimue dia dilekela dia anesthesie, MH wa panyima pa dipanda udi mua kujuka mêba makese panyima pa mubedi mumane kupingana kumbelu kunyima kua dipanda dia pambelu, anyi mubedi uvua ne disama dikese, didi kadiyi dimanyike mu dipanda udi mua kupeta rhabdomyolysisfulminant dilolo adi.

• Bimanyinu bikunze bia disama dia luya lubi lua panyima pa dienza dia anesthésie:
• dikolesha dia tshiadi (masseter spasm) didi kadiyi diumvuija anyi dikolesha dia dibue ne disama dikole mu bitupa bia ngombe, mu bitupa bia mubidi, mu difu ne mu nyima kunyima kua dienza dia anesthesie mujima.
• Kupuya lubilu, mukola (tachypnea) ne dikuma dia mutshima padi mubidi uteta bua kumbusha kapepe ka karbone ka bungi.
• Lukoba ludi lumueneka bu mutoke (mutoke ne bule-mutoke), lutoke, ne ludi lupatula kapia kakole, ne luya ludi luenda luvula lupita pa 38,8 too ne ku 40,0 degre Celsius (101,8 too ne 104,0 degre Fahrenheit).
• Nzubu mufike, mukunze, anyi wa cola udi ufumina ku dinyanguka dia proteyine wa mu mifuba (myoglobine).
• Tshienzedi tshia lukasa: Bikila nimero wa lupitadi lua muaba unudi diakamue ne umuambile patoke ne: "Mubedi uvua ne anesthesie wa tshimpitshimpi lelu ne udi ne bimanyinu bia hyperthermie mubi, tudi dijinga ne kuya nende ku lupitadi ne dantrolene mu mushipa." Umbusha bilamba bionso, ulengeje dikoba ne mâyi mashika, wenzeja ne luya lukole, wela tshilamba tshibuikila mu nshingu, mu nshingu, ne mu nshingu ne mu nshingu kupeshi acetaminophen anyi ibuprofen nansha kakese. Ubwanya kabidi kulomba bena mudimu ba mu lupitadi bua kubikila Malignant Hyperthermia Association of the United States (MHAUS) 24-hour hotline ku 1-800-644-9737 (anyi +1-209-417-3722 pa buloba bujima).

2. Bubi bua mubidi (LAST) budi bufumina ku mapompe a kanyinganyinga a ku nzubu anyi ku bipumbishi bia mijilu¶

Babedi ba mifuba ne ba mu tshifu batu batamba kupatuka kumbelu ne bimanyinu bia mijilu ya ku mpenga bidi bienza mudimu mutantshi mule (bu mudi liposomal bupivacaine anyi ropivacaine) anyi pompe wa disama dia anesthesie local élastomérique (tshintu tshidi tshienza bu mupimbu tshidi tshilamakaja ne tshiamu tshikese tshidibu bateka pabuipi ne mijilu anyi mu mputa wa dipanda). Shi tshiamu tshia kuela natshi mashi tshibuela mu mushipa wa mashi anyi tshibuela lukasa, anesthesie wa pa muaba udi ubanda too ne ku tshipiminu tshia toxique mu buongo ne mu mutshima (LAST):

• Bimanyinu bia kumpala bia disama dia mitu: Tshimpitshimpi dipanga dia lungenyi ne disama dia mishiku ne ludimi (perioral paresthesia), mutoyi wa tshiamu mukana, mutoyi mu matshi (tinnitus), dimona dibi, ngakuilu mubi, anyi dikankamika dia mifuba.
• Bimanyinu bikole bia ndekelu: Disama dia tshimpitshimpi, dijimija dia lungenyi, dikuma dia mutshima bitekete bitekete, anyi dijika dia mutshima dia tshimpitshimpi.
• Tshia kuenza diakamue: Diakamue kanga tshiamu tshia pompe wa disama dia ku nzubu ku diambuluisha dia tshiamu tshia plastique tshidi tshilamakaja (kukoki catheter mu dikoba to, anu padibu bakuambila), bikila nimero wa lupitadi lua muaba unudi, ambila muntu udi utuma bantu "Suspect local anesthetic systemic systemic toxicity from a home nerve block, the pompe needs need 20 percent of lipide mu mushipa buanga," ne kukuba mubedi mu muaba wa kuondopibua pikala tshipupu tshituadija.

Dibutuka dia mputa ya mu difu ("difu ditshibuka") ne dipatuka dia munda¶

Munkatshi mua Dituku dia 4 dia panyima pa dipanda ne dia 10 kunyima kua dipanda dia mu difu (laparotomie, C-section, dilongolola dia hernie, anyi dipanda dia mala), tshitupa tshia mubidi tshidi tshilamakaja tshimanu tshia difu pamue (line alba anyi rectus fascia) tshidi tshishindamene anu pa dipanda dia mu tshifu kumpala kua collature mupiamupia. Shi milonda mikoka mu tshitupa tshia mubidi tshidi tshipatuka, misangu ya bungi diakamue kunyima kua mubedi mumane kukokola, kuela nseku, kuela nsukadi, anyi kuela mbila mu tshina tshia mâyi, tshitupa tshia munda tshia tshitupa tshia mubidi tshidi tshitapuluka (dibutuka dia mputa).

Tshimanyinu tshia kale tshia didimuija: "dipatuka dia mâyi a mushipa wa saumon-pink"¶

Mêba makese kumpala kua dikoba dia pambelu anyi biamu bia kukanga nabi dikoba kupatuka, babedi badi ne disama dia tshiadi tshikole batu misangu yonso bumvua tshipepele tshikole tshia mashi makese a mubidi wa rose-orange (adibu babikila ku kale ne: mashi a mu tshifu tshia "salmon-colored") adi apita mu tshimpitshimpi mu tshilamba tshiabu ne mu tshilamba tshiabu. Babedi ba bungi batu kabidi bamba mudibu bumvua anyi bumvua "pop" anyi diumvua dia binsonji munda mua difu diabu padibu bakokola.

Shi tshitupa tshia pambelu tshia dikoba tshidi kabidi tshilekela ne tshitupa tshia mala tshidi tshikenkesha anyi tshia mafuta a jaune tshidi tshipatuka mu tshibuelelu, lutatu ludi luenda luvula too ne ku diumusha dia mputa ya dipanda.

Diambuluisha dia kumpala dia tshitupa ku tshitupa bua diunzulula ne dipatuka dia munda¶

1. Bikila bena mudimu ba lupitadi lua lukasa lukasa ne ulame mubedi anu NPO (kakuyi bualu nansha bumue ku mishiku).
2. Muaba mu muaba wa Fowler flexed-knee position: Leja mubedi alala pa mukolo ne mutu wende ne makaya ende bibandishibue kakese (15 too ne ku 20 degrés) ne teka bipese bibidi binene muinshi mua binu biende bimane. Kuinama maboko ne tshifu kudi kupepeja mishipa ya rectus abdominis ne kupangisha mputa bua kukoka kule.
3. Kupinganyi nansha kakese mala anyi tshitupa tshia mubidi tshidi tshipatuka munda mua difu: Kupingaja bitupa bia mubidi bidi ne bukoya munda kudi kubueja bactérie ya dikoba buludiludi mu tshina tshia mu tshifu ne kudi mua kunyangakaja anyi kunyangakaja mashi adi afumina mu mala.
4. Ela tshilamba tshia kapia, tshia sterile: Ela tshilamba tshia sterile tshia mputa, pads sterile sterile miunzulula, anyi tshilamba tshia kuowa natshi tshia coton tshidi tshilengeja tshidi tshipatuka mu saline normal sterile (mu mulondo wa diowa dia mêsu dia diambuluisha dia kumpala) anyi mayi a kapia a mu pompi adibu balengeje ne mashika bua kufika ku mashika a mubidi. Teka tshilamba tshitoke pa mputa udi mubuluke anyi pa mala adi mapatuke, pashishe ufuke tshilamba tshitoke ne tshilamba tshia tshilamba tshia biakudia tshia plastique tshikezuke anyi tshilamba tshikezuke tshiume bua kulama mâyi ne kapia. (Bikala tshilamba tshiume tshishiya pa mala adi kaayi malelela, tshitupa tshia serosal tshidi tshiuma, tshifua, ne tshilamakaja ku tshilamba).
5. Kukokola tshifu pikala ukokola: Ulombe mubedi bua kubenga kukokola anyi kutshioka; Shi kabena mua kukanda tshifu, ikala ne tshianza tshitekete pa mutu pa tshilamba tshibuikila ne bianza bitekete.

Dipatuka dia mala, disama dia muaba wa dipanda, ne disama dia sepsis dia panyima pa dipanda¶

Shi mubedi muenza mudimu wa dipanda ne disangisha dia tshitupa kampanda tshia tshitupa tshia tshiadi (anastomose), bu mudi dipanda dia tshifu, dipanda dia tshifu, dipanda dia tshiadi, dipanda dia tshiadi, dienza dia Whipple, anyi dilongolola dia mala makese, tshitupa tshipiatshipia tshidibu basuike anyi basonga tshidi tshitekete pankatshi pa Dituku dia 3 ne dia 7. Shi nansha dipatuka dia tshina (dipatuka dia anastomotic), aside, bile, anyi bintu bia munda bidi ne bactérie bidi bibuela mu tshifu tshidi katshiyi ne disama, bienza bua peritonite wa tshimpitshimpi ne ** lukasatshipupu tshia septic**.

Mushindu kayi wa kusunguluja diondapangana dia tshilonda ne disama dia njiwu anyi dipatuka dia munda¶

• Diondapibua dia pa tshibidilu didibu batekemene: Dikala dia rose ditekete didi difika muinshi mua 5 millimeters (0.2 inches) pabuipi ne mulongo wa tshiseba anyi wa disonga, luya lukese, luya lukese anyi lua jaune mutoke mu mêba 48 a kumpala, ne disama didi dienda dilengejibua dituku dionso.
• Disama dia pa mutu pa muaba wa dipanda (Bikila munganga lelu): Dikala dikunze (erythema) didi ditangalaka kupita santimetre 1 to ne ku 2 ku muaba udibu bapanda, difu, kapia kakole, ne mupuya mukole, wa jaune, wa vert anyi wa mupuya mubi udi upatuka pankatshi pa tusonji (tuetu tuetu matuku 4 too ne ku 10). Ufunde mulongo ku muelelu wa pambelu wa tshitoke ne tshiamu tshia kufunda natshi ne ufunde dîba bua baminganga bamone muditshi tshienda tshivula lukasa.
• Disama dia mubidi mutekete (Bikila 911 / 112 / 999 diakamue): Didi dimueneka anu 24 too ne ku 72 meba kunyima kua dipanda. Mubedi udi umvua **disama dikole, kadiyi dijika didi kadiyi dipetangana ne mushindu udi dikoba dimueneka; dikoba didi mua kulua dikunze, kupatula bipumbishi biuwule tente ne mayi (bullae), kumvua bu mabaya, anyi kutshibula bu tshibuikidiji padibu batshilenga (subcutaneous crepitus wa bactérie idi ipatula kapepe), pamue ne kapia kakole, disama dia tshiadi, ne dipanga dia lungenyi.
• Dipatuka dia munda dia mubidi / Disama dia munda (Bikila 911 / 112 / 999 diakamue): Misangu ya bungi tshitupa tshia pambelu tshia dikoba tshidi tshimueneka tshikezuke ne tshiume, kadi pankatshi pa dituku 3 ne dituku 8 mubedi udi upeta:
• Mutshima udi wenda ututa misangu 100 too ne ku 110 ku minite (misangu ya bungi udi ulua kumpala kua kapia mu mêba 12 too ne ku 24).
• Disama dia mu difu didi dienda dikola didi dienda dikola padibu batuta bulalu anyi padibu bakokola (disama dia mu difu didi dikola / didilama).
• Dibungama dia kashidi, disama dia mutshima, dipanga dia mushindu wa kupitshisha kapepe, anyi disama dia bile dia vert/brown.
• Dipanga dia lungenyi dipiadipia, tulu, ngakuilu mubi, mashika adi ateketa (malu makole), dikoba didi ne mabala, anyi dipanga dia mashi mu mêba 12 (bimanyinu bia tshipupu tshia septic).

Mashi a kunyima kua dipanda (DVT ne PE) ne tshikebelu tshia hematoma wa mukolo¶

Bikonkononu bibidi bia ndekelu bia panyima pa dipatuka mu lupitadi bidi ne tshia kuenzeka dituku dionso mu mbingu ibidi ya kumpala kumbelu:

1. Disama dia mishipa ya munda (DVT) ne disama dia tshiadi tshia mu mikolo (PE): Dipanda didi dijula ​​hypercoagulabilité (mashi adi alamakaja) eku diondapangana dikepesha dienda. Fuanyikija bana ba ngombe ne maboko dituku dionso: pikala dikasa dimue divula, dikole, dikale ne luya, dikunze anyi ditekete mu muana wa ngombe, kutshinyi dikasa to (dilengeja didi mua kutshibula tshitupa tshia mashi). Shi mubedi upeta dipanga dia mupuya mu dikisha, disama dikole mu tshiadi padiye upuyakana, ukokola mashi, dipuekesha dia mashi, anyi dijimija dia lungenyi, bikila nimero wa lupitadi lua muaba unudi diakamue bua kuela meji ne: udi ne disama dia embolie pulmonaire.
2. Spinal anyi Epidural Hematoma (Panyima pa anesthésie spinal, epidural analgesia, anyi dipanda dia spinal): Padi tshitupa tshia spinal anyi tshia epidural tshijika (mu mêba 4 anyi 6), bukole buonso ne diumvua mu maulu onso abidi ne dilombola dia tshiadi didi ne bua kupingana ne kushala bimpe. Shi mubedi udi kumbelu upeta disama dikole dia mukolo dilondangana ne disama dipiadipia anyi disama dia mu tshiadi ("saddle anesthesia"), diteketa anyi bujitu mu maulu, anyi dipanga dia kuela manyi / dipanga dia kulama mashi, mashi adi afina mukolo wa mukolo (**cauda equina compression). Bikila bena mudimu ba tshimpitshimpi diakamue; dipanda dia mubidi didi ne tshia kuenzeka mu mêba 6 anyi 8 bua kuepuka disama dia tshiadi tshia kashidi.

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• Tshilongelu tshia baminganga ba mu Amerike (ACS, États-Unis): Biamu bia mudimu bimpe bia dipanda ne bukubi, Mikenji ya dilama dia ku nzubu panyima pa dipanda, ne Mikenji ya dipangisha mashi bua kupatuka.
• Bulongolodi bua malu a bukola bua mubidi pa buloba bujima (OMS, International): Mibelu ya buloba bujima idi itangila dikuba dia disama dia muaba udibu bapanda ne Mikenji ya OMS ya malu a bukubi bua dipanda dia panyima pa dipanda.
• Tshisumbu tshia bantu badi ne disama dia luya lua bungi tshia mu États-Unis (MHAUS) ne tshisumbu tshia bantu badi ne disama dia luya lukole lua ku Mputu (EMHG): Dimanya dia mu lupitadi ne diondapa dia lukasa dia disama dia luya lua bungi dia panyima pa dipanda.
• Société américaine de l'anesthésie régionale et de la médecine du douleur (ASRA, États-Unis): Liste de contrôle pour le traitement de la toxicité systémique d'anesthésie locale (LAST) ne Mikenji ya dilama dia hematoma ya mu tshiadi/ya mu tshiadi.
• Difficult Airway Society (DAS), British Association of Endocrine and Thyroid Surgeons (BAETS), and National Institute for Health and Care Excellence (NICE, United Kingdom): Multidisciplinary Guidelines for the Management of Post-Operative Hemorrhage After Thyroid Surgery (SCOOP) and Regnition* (NG51)*.

Malu adi apetangana¶

• Dipatula dia munda ne dilama dia mputa ya mu tshifu
• Dimanya dia sepsis ne dia septic shock ne diambuluisha dia kumpala
• Embolie pulmonaire ne thrombose veine profonde (DVT) triage
• Dipatuka dia mashi dikole ne dilama dia dipatuka dia mashi
• Diambuluisha dia kumpala dia tshipupu ne dinyanguka dia mashi
• Nomba ya njiwu bilondeshile ditunga