Kunua mputa wa mu tshiadi ne diambuluisha dia kumpala dia mu mikolo¶

Dipuyakana dia muntu dia pa tshibidilu didi dimanyine pa tshintu tshidi katshiyi tshibuela luya, tshidi ne bukole bubi munda mua tshifu. Pankatshi pa tshitupa tshia pambelu tshia mifuba (pleure visceral) ne tshimanu tshia munda tshia tshiadi (pleure pariétal) mudi tshitupa tshia pleure tshia muinshi mua buloba, tshidi tshilama ku bukole bua muinshi mua lupepele bua santimetre mitue ku -4 too ne ku -8 ya mâyi. Padi tshingoma, tshingoma tshia muele, tshitupa tshia tshiamu tshia mitaku, tshiadi tshitshibuka, anyi tshitupa tshia mu mikolo tshidi tshipatuka nkayatshi tshipatuka mu tshina etshi tshikanga, luya ludi lubuela mu tshitupa tshia mu tshiadi ne lumbusha mupuya wa elastic kule ne tshimanu tshia tshiadi, bienza bua mupuya mukuluke (pneumothorax).

Padi tshina tshia pambelu tshidi tshipita mu tshimanu tshia tshiadi tshinene bikumbane (pabuipi ne bitupa bibidi bia bisatu bia bunene bua tshitupa tshia lupepele anyi tshinene), luya ludi luangata njila udi kayi ne bukole bua bungi ne ludi lupita buludiludi mu tshimanu tshia tshiadi pamutu pa kupueka mu tshiadi, bienza mputa wa tshiadi udi unyunguluka (pneumothorax mubulula). Tshidi tshibi menemene ntshia se: bikala kapepe kabuela mu tshifu tshia mupuya wonso anyi kafika muinshi mua tshilamba tshikanga tshijima katshiyi ne mushindu wa kupatuka, bukole budi munda mua tshiadi budi buenda buvula kupita bungi bua mu lupepele, butshibula mifuba yonso ne bunyangakaja mijilu minene idi ipingaja mashi mu mutshima. Tshilumbu etshi tshia lufu, tshidibu babikila ne: tension pneumothorax, tshidi tshikebesha disama dia mutshima didi dipangisha muntu bua kuenza mudimu mu minite mikese pa kumbusha padibu bamumanya ne bamumbusha.

Enza nunku mpindieu¶

1. **Bikila nimero ya njiwu ya muaba unudi diakamue ne lomba baminganga ba Advanced Life Support (ALS) nomba ya tshimpitshimpi. Uleje patoke mputa wa mu tshiadi udi mubuele mu tshiadi anyi udi wela meji ne: udi mukuluke mu tshiadi bua baminganga balue ne biamu bia kukanga nabi tshiadi, biamu bia diondopangana nabi ne oxygène.
2. Leja tshiadi tshijima ne tangila bitekete bitekete nyima ne maboko bua kumona ni kudi mputa wa kupatuka. Kosa anyi bandisha tshilamba tshijima too ne ku nshingu. Dîba dionso diudi upeta mputa wa mu tshiadi kumpala, diakamue udi mua kukunguluka anyi kumvua muinshi mua makaya, ku maboko (ma tshiadi), ne ku nyima bua kupeta tshina tshibidi, ne kuanji kukanga tshina tshinene anyi tshidi tshipatuka bikole.
3. Fuka mputa wa mu tshiadi udi unyunguluka diakamue ne tshianza tshidi ne tshianza padibu bapuekesha luya, pashishe wela tshintu tshia kukanga natshi tshiadi tshia mushinga mukole anyi tshilamba tshia kukanga natshi tshia ku nseke isatu. Kupula mashi ne tuishi pa dikoba bua tshintu tshidi tshilamakaja tshikuate, lomba mubedi bua kupuyakana (kupatula mupuya), ne ela tshiamu tshia kukanga natshi tshiadi tshia mushinga mukole pa mutu pa tshiadi tshidi ne luya. Shi kuena ne tshiamu tshia kukanga natshi luya tshia mushinga, ela tshilamba tshia plastique tshidi katshiyi tshibuela luya, tshiamu tshia nzembu, anyi tshilamba tshia defibrillateur pa nseke isatu patupu, ushiye tshitupa tshia kuinshi katshiyi tshilamakaja bu tshiamu tshia flutter.
4. Kuena ne bua kuela tshilamba tshikole tshia mu tshiadi ne kulekedi tshintu tshidi katshiyi ne luya tshidi katshiyi ne luya lua ku nseke inayi to. Kukanga mputa wa mu tshiadi udi kauyi ne kapepe ku nseke yonso inayi kakuyi tshiamu tshia kupatula natshi kapepe kudi kukanga kapepe kadi kapatuka mu tshiadi tshidi tshitapa munda mua tshiadi, kukudimuna lukasa mputa udi mua kushala ne muoyo mu ** ** tension udi mua kufua.
5. Somba mubedi udi ne lungenyi, udi upuyakana mululame anyi muteke tshitupa (anyi mutenteke kakese ku luseke ludi lutapike) bua kulekela tshiadi tshimpe tshienda tshivula. Kuenzeji mubedi udi ne lungenyi udi uluangana bua kupuyakana ne mputa wa mu tshiadi bua kulala panshi pa mukolo to, anu padibi bikengela kuenza nanku bua kuimanyika mukolo.
6. Lama mupuya kunyima kua sekonde 60 yonso ne "BURP" tshibuikidiji tshia tshiadi diakamue pikala mubedi mupangile mupuya, cyanotic, anyi mujimije radial pulse wende. Bikala mupuya wa mubedi munyanguke mu tshimpitshimpi panyima pa bamane kuela tshibuikidiji tshia tshifu, upuekesha luseke lumue lua tshilamba etshi munkatshi mua sekonde 3 anyi 5 padiye upatula kapepe ka mu tshiadi tshiende, bua kulekela kapepe ka mu tshiadi tshiende kapatuka kumbusha mashi onso adi makanga tshiibi, ne ulengeje kabidi tshibuikidiji tshia tshiibi.

Mutshi wa mapangadika a tshimpitshimpi bua mputa ya mu tshiadi ne mifuba mikuluke¶

flowchart TD
    Start["Penetrating Chest Trauma, Blunt Rib Impact, or Sudden Sharp Pleuritic Chest Pain"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Expose entire anterior chest, armpits, and posterior back"]
    ImpaleCheck{"Is a Knife, Rod, or Shard Still Impaled in the Chest?"}
    ImpaleChest["IMPALED CHEST OBJECT PROTOCOL<br/>1. DO NOT pull out the impaled object<br/>2. Seal sucking gap around base of blade with petroleum gauze/plastic<br/>3. Leave one corner unsealed to vent air<br/>4. Stabilize blade with twin bulky gauze rolls"]
    OpenCheck{"Is There an Open Wound in the Chest Wall?<br/>(Hissing/sucking sound, frothy pink blood bubbles, chest wall defect)"}
    ClosedPneumo["CLOSED PNEUMOTHORAX / HEMOTHORAX / FLAIL CHEST<br/>1. Do NOT apply chest seal if skin is intact<br/>2. Sit patient upright or semi-reclined (Fowler's position)<br/>3. Calm patient to slow rapid breathing<br/>4. Watch continuously for Tension Pneumothorax signs"]
    SealChoice{"Do You Have a Commercial Vented Chest Seal?<br/>(HyFin Vent, SAM Chest Seal, Asherman, Russell, Halo Vent)"}
    CommercialSeal["Apply Commercial Vented Chest Seal<br/>1. Wipe blood and sweat dry around wound<br/>2. Center one-way valve/channels directly over hole at end-exhalation<br/>3. Seal second hole on back if exit wound exists"]
    ThreeSided["Build Improvised Three-Sided Flutter-Valve Dressing<br/>1. Cut airtight plastic square 5 cm (2 in) wider than wound<br/>2. Tape TOP, LEFT, and RIGHT edges airtight to dry skin<br/>3. Leave BOTTOM corner completely UNTAPED to drain blood & vent air"]
    MonitorTension{"Monitor Every 60 Seconds: Worsening Dyspnea, Agitation,<br/>Absent Breath Sounds, Hypotension, or Neck Vein Distension?"}
    BurpSeal["TENSION PNEUMOTHORAX DEVELOPING: BURP THE SEAL NOW<br/>1. Peel back one side of chest seal for 3 to 5 seconds<br/>2. Listen/feel for rush of trapped air and blood escaping<br/>3. Wipe clotted blood off wound and re-apply vented seal<br/>4. ALS Paramedic performs Needle Decompression / Finger Thoracostomy"]
    StableTransport["Continue Monitoring & Reassuring Patient<br/>Position upright or tilted toward injured side until ALS arrival"]

    Start --> CallEMS
    CallEMS --> ImpaleCheck
    ImpaleCheck -->|Yes: Object Impaled| ImpaleChest
    ImpaleCheck -->|No: No Object Present| OpenCheck
    OpenCheck -->|No: Closed Skin| ClosedPneumo
    OpenCheck -->|Yes: Open Chest Wound| SealChoice
    SealChoice -->|Yes| CommercialSeal
    SealChoice -->|No| ThreeSided
    ImpaleChest --> MonitorTension
    CommercialSeal --> MonitorTension
    ThreeSided --> MonitorTension
    ClosedPneumo --> MonitorTension
    MonitorTension -->|Yes: Tension Signs Present| BurpSeal
    MonitorTension -->|No: Breathing Stable| StableTransport
    BurpSeal --> MonitorTension

Kufuanyikija malu a tshimpitshimpi adi mua kunyanga muoyo¶

Disama dia mu tshiadi ne dipatuka dia kapepe ka mu tshiadi didi dipatuisha masama atanu mashilangane. Kutapulula tshifu tshidi tshikuluke ne mputa wa mu tshiadi udi unyunguluka, pneumothorax wa tension, hemothorax munene, anyi tshifu tshidi tshinyanguka bidi bileja muaba wa lukasa ne dijimija dia muoyo didi mua kusungila muoyo.

Disama dia mputa wa mu tshiadi (Open Pneumothorax)¶

Mu nsombelu muimpe wa mubidi, padi diaphragme webe udikoka panshi ne misunyi yebe ya munkatshi mua tshiadi ikoka tshiadi tshiebe pambelu, bukole bua munda mua tshiadi budi bupueka kakese kuinshi kua bukole bua pambelu (kubangila ku -4 too ne ku -8 \(\text{cmH}_2\text{O}\)). Bu mudi tshimanu tshia tshiadi tshikanga bimpe, njila umuepele udi kapepe mua kubuela mu tshiadi udi kupitshila ku mishiku, ku tshiadi, ne ku mikolo, ne kupuekesha mifuba yonso ibidi kakuyi lutatu.

"Bitupa bibidi bia bisatu bia diametre wa trachée" tshipiminu¶

Tshiamu tshia muntu mukole tshidi ne diamètre wa munda wa 18 too ne ku 24 millimètres (0.7 to ne ku 0.95 inches). Shi tshingoma tshia mvita, bingoma bia lubilu lukole, tshingoma tshia mvita, anyi tshingoma tshia lupangu tshienza tshina tshiunzuluke mu tshimanu tshia tshiadi tshidi ne bunene bua tshitupa tshia **bitupa bibidi bia bisatu bia tshitupa tshia mu tshiadi (pabuipi ne milimetre 12 too ne ku 15 / 0,5 too ne ku 0,6 inch) anyi bunene, ** mikenji ya dishintuluka dia mâyi idi ishintulula malu lupepele ludi lulonda njila wa ditantamana dikese:

1. Bu mudi tshina tshipi tshidi tshipita mu tshiadi tshifila dikanda dikese dia njila wa lupepele kupita mutshi mule udi ne matamba, dîba dionso didi muntu udibu bashipe uteta bua kuela luya, luya lua pambelu ludi lunyema buludiludi mu tshina tshia mu tshimanu tshia tshiadi mu tshitupa tshia tshiadi pamutu pa kupueka mu tshina tshia lupepele mu mikolo.
2. Bu mudi kapepe ka mu nzubu kawuja muaba wa pleure ku luseke ludi lutapa, tshifu tshia ku luseke alu tshidi tshikuluka tshishiki ne katshiena mua kushintulula oxygène to.
3. Tshidi tshibi menemene ntshia se: padi muntu udibu bashipe upuyakana ne upatula mupuya, kapepe ka kale kadi ne dioxide de carbone kadi kapingana kakuyi bualu pankatshi pa tshiadi tshidi tshinyanguke ne tshiadi tshimpe (Pendelluft anyi "pendulum air"), eku mediastinum (udi ne mutshima ne vena cava) wenda unyunguluka ku luseke ne ku luseke (**mediastinal flutter), wenza bua mubedi ikale ne kanyinganyinga kakole ne lukasa ne hypercapnia.

Bimanyinu bia kale bia mputa wa mu tshiadi udi unyunguluka¶

• Mutoyi wa kunua, wa kuela mbila, anyi wa kuela mbila udi ufuma ku tshiadi anyi ku mputa wa mu nyima dîba dionso didi muntu udi mutapike wela luya.
• Mashi a butoke, a rose anyi a tshitoke adi apatuka anyi apatuka mu mputa padibu bapuekesha luya anyi padibu bakokola (bishilangane ne mashi adi apatuka mu mishipa mikunzubile anyi adi afumina ku mputa wa ku diboko, mashi adi ne butoke adi aleja ne: kapepe ka mu njila wa kupuyakana anyi ka mu tshiadi kadi kasambakena ne mashi).
• Emphysème wa muinshi mua dikoba: Lupepele ludi luenzeja muinshi mua dikoba dia tshimanu tshia tshiadi ne tshia nshingu ludi luenza tshintu tshia dikema, tshidi tshienza bu "Bubble Wrap" anyi "Rice Krispies" (crepitus) paudi ufina minu yebe kakese pa dikoba didi dinyunguluke mufuba wa tshiadi anyi mifuba.

Mushindu wa kuenza malu ku kakese ku kakese: Kuela tshilamba tshia ku tshiadi tshidi ne luya anyi tshilamba tshia ku nseke isatu¶

Tshipatshila tshia lukasa tshia diambuluisha dia kumpala bua mputa wa mu tshiadi tshiunzulula ntshia kukudimuna pneumothorax mubulula mu pneumothorax mupepele: kupangisha kapepe ka pambelu bua kubuela padibu bapuekesha luya eku ulekela kapepe ka munda ne mashi bipatuke padibu bapuekesha luya.

Mushindu A: Tshiamu tshia tshifu tshia mushinga mukole (Mukenji wa or: CoTCCC & Mikenji ya diambuluisha dia kumpala)¶

Biamu bia mudimu bia matuku etu aa bidi ne Vented Chest Seals (bu mudi HyFin Vent, SAM Chest Seal, Russell Chest Seal, Halo Vent, anyi Bolin/Asherman seal). Bino bidi na tshiamu tshia hydrogel tshia buanga tshikole tshidi ne tshiamu tshia dome tshidi tshibandishibue anyi njila ya bungi ya laminar-flow vent idi ilekela kapepe ne mashi bipatuka pambelu eku bikanga bimpe ku dikoba padi mubedi upuyakana.

1. Leja mputa ne tangila kunyima: Kosa tshilamba tshijima. Tangila misangu yonso nyima ne maboko bua kumona ni kudi mputa wa kupatuka; Shi kudi mabulu abidi (muaba wa kubuela ne wa kupatukila), teka tshibuikidiji tshia tshiadi tshidi ne luya mu tshina tshia kumpala tshia kunua ne tshibuikidiji tshibidi (tshidi ne luya pikalaku) ku tshina tshia kupatuka.
2. Kupula kikoba tshidi pabuipi ne mputa tshiume: Etshi ke tshidi basungidi ba bungi bapua muoyo padibu ne tunyinganyinga. Nansha tshintu tshimpe tshia kulamakaja natshi tshia hydrogel tshidi mua kupatuka diakamue pa dikoba didi dibuikila ne mashi, tuishi, bitotshi anyi mayi a mvula. Ingidija tshilamba tshiume tshidi munda mua tshibombi tshia tshifu bua kusukula lukasa tshitupa tshia 10-centimetre (4-inch) tshia tshijengu tshia dikoba tshidi tshinyunguluke tshina tshiume.
3. Ukosolola tshilamba tshia panyima ne utshiele ku ndekelu kua dipuekesha dia luya: Bikala mubedi mumanye, umulombe bua apatule mupuya (upatule mupuya) ne wimane bua sekonde umue (dipatula luya ludi lupatula kapepe ka bungi mu tshitupa tshia mu tshiadi kumpala kua wewe kutshikanga). Teka tshintu tshia njila umua anyi njila ya dipatuila luya lua laminar buludiludi pa mutu pa tshina ne ufina tshintu tshia kulamakaja natshi bikole kumbukila munkatshi too ne pambelu bua kumbusha milonda.

Mushindu B: Dilengeja dia nzembu isatu dia tshibuikidiji tshia Flutter-Valve¶

Shi kuena ne tshiamu tshia kukanga natshi tshiadi tshia mushinga mukole mu tshibombi tshieba tshia diambuluisha dia kumpala, udi ne tshia kuenza Three-Sided Occlusive Dressing:

1. Keba tshintu tshidi katshiyi tshibuela luya, tshidi katshiyi ne mputa: Bipese bia tshiamu tshia mitaku kabiena bienza mudimu nkayabi to, bualu luya ludi lupita anu mu tshiseba tshiluka. Wenza mudimu ne tshimue tshia ku bintu bidi bilonda ebi:
2. Tshilamba tshia munda tshikezuke anyi tshilamba tshia plastique tshia tshilamba tshia gaze tshidi katshiyi ne disama anyi tshilamba tshia defibrillateur tshia AED.
3. Tshintu tshikosa mu tshibombi tshia plastike tshikole, tshibombi tshia bianza tshia nitrile, anyi tshilamba tshia plastike tshikezuke.
4. Petrolatum (Vaseline) gauze mubuikila ne tshilamba tshia pa mabeji anyi tshia plastique.
5. Mu masekonde 10 a kumpala kumpala kua bintu kuikalabi bilongolola: Ela tshianza tshiebe tshidi ne bianza buludiludi pa tshina tshia kunua paudi upatula luya, ubandishe tshikasa tshia tshianza tshiebe kakese padi mubedi upatula luya bua kupatula kapepe, ne utshikanga padiye upuyakana.
6. Kukosa tshitupa tshia plastique tshia bule bua santimetre 5 (2 inches) kupita tshilonda ku nseke yonso: Bikala plastique mukese menemene, dipuekesha dia luya nedikoke tshitupa tshijima tshia plastique mu tshina tshia mputa.
7. Kupula kikoba tshidi tshinyunguluke tshiume ne uteke tshilamba pa tshilonda padi mubedi upatula mupuya.
8. Tape ku nseke isatu kayiyi mua kubuela luya, kushiya tshitupa tshia kuinshi anyi luseke luinayi kaluyi luela:
9. Ela tshilamba tshia buanga tshinene anyi tshilamba tshia kuela natshi bintu tshidi tshibuikila muelelu wa kuulu, muelelu wa ku dia bakaji, ne muelelu wa ku dia balume wa tshitupa tshia plastique bua kapepe kakupatuka muinshi mua nseke isatu ayi to.
10. Lekela muelelu wa kuinshi (anyi ditumba dia kuinshi didi dilondeshila ku bukole budi bukokela bintu panshi) kayi ne tshilamba nansha tshimue.
11. Mushindu udi tshiamu tshia flutter tshienza mudimu: Padi mubedi upuyakana, tshienzedi tshibi tshidi munda mua tshiadi tshidi tshikoka tshilamba tshia plastique tshidi katshiyi tshienda ne tshidi tshitokesha ku dikoba, tshikanga tshina tshidi katshiyi tshibuela luya bua luya lua pambelu kaluyi mua kubuela to. Padi mubedi upatula mupuya anyi ukokola, bukole buimpe budi munda mua tshiadi budi bupatuisha kapepe ne mashi adi makuate muinshi mua tshitupa tshia kuinshi tshidi katshiyi tshilamakaja bu mudi tshiamu tshia kukanga natshi tshia njila umue.

Kumanya ne kuondopa Pneumothorax ("Kuela tshitampi")¶

Pneumothorax wa tension i tshipupu tshia lufu tshia lukasa tshidi mua kufumina ku ditshibuka dia tshiadi tshikanga / ditshibuka dia mu mikolo anyi padi dibuikila dia mputa wa mu tshiadi diunzuluke dilua dikanga anyi dikanga ku nseke yonso inayi.

Mushindu udi tension pneumothorax ushipa (Obstructive Shock)¶

Ku luya luonso, 50 too ne ku 100 millilitres ya kapepe idi ipatuka mu tshiadi tshidi tshinyanguke mu tshitupa tshia mu tshiadi tshidi tshikuate ne kayena mua kupatuka kabidi mu tshiadi anyi kupitshila mu tshimanu tshia tshiadi to: 1. Bukole munda mua tshitupa tshia tshiadi tshidi tshitapa budi buvula kumbukila ku tshibi (-5 \(\text{cmH}_2\text{O}\)) too ne ku tshimpe tshikole (+15 too ne ku +30 \(\text{cmH}_2\text{O}\)). 2. Lufu ludi lutapike ludi lunyanguka mu tshitupa tshikese tshia kapepe ku hilum, eku diaphragme udi ku luseke alu wenda upuekeshibua panshi mu difu. 3. Tshibombi tshia kapepe kakole tshidi tshienda tshivula tshidi tshituta mediastinum mujima (mutshima, aorte, vena cava supérieure, vena cava inférieur, ne trachée) ku luseke mu luseke lua tshiadi ludi kaluyi lutapike, tshifina tshitupa tshimpe tshia tshiadi tshidi tshishale. 4. Tshitupa tshia lufu: Bualu vena cava wa kuulu ne wa kuinshi udi ne bimanu bitekete udi upingaja mashi adi kaayi ne oxygène ku luseke lua dia balume lua mutshima ku tension mukese menemene wa mu mishipa (anu 2 too ne ku 8 mmHg), dishintuluka dia mu tshitupa tshia munkatshi didi dikosa mishipa minene yonso ibidi bu mudi tshiamu tshia mu budimi tshikosa. Mashi kaena kabidi mua kubuela mu mutshima to (preload udi upueka too ne ku zero), dipatukila dia muoyo didi dipueka, ne mubedi udi ukenga ne Pulseless Electrical Activity (PEA) cardiac arrest bua tshipupu tshia tshiamu tshia nzembu.

Bimanyinu 7 bia disama dia Tension Pneumothorax¶

Tangila mubedi yonso udi ne disama dia mu tshiadi bu nyunyi wa nkutshi bua bimanyinu bidi bilonda ebi bia dikola dia tension wa mu tshiadi:

Tshitupa ku tshitupa: Mushindu kayi wa "BURP" tshimanyishilu tshia tshiadi diakamue¶

Shi muntu udi ne disama uvua muvuale tshilamba tshia ku tshiadi tshia mushinga anyi tshilamba tshia plastique tshia nseke isatu tshileja tshimanyinu tshimue tshia kudimuija tshidi kulu eku (nzala ya luya idi yenda ikola, dibungama, mishiku mitoke, anyi diteketa dia tshiadi):

1. Kuata ditumba dimue dia tshilamba tshia ku tshiadi anyi tshia tshilamba tshia plastique ne minu idi ne bianza ne utshipatule pa dikoba bua kuleja tshina tshia mputa tshijima.
2. Fina bitekete bitekete pa dikoba didi ku luseke lua mputa anyi windile padi mubedi upatula mupuya munkatshi mua masekonde 3 anyi 5: Padi disama dia pneumothorax dilelela dikaleku, neuteleje anyi neumvue diakamue mutoyi mukole anyi mutoyi wa kapepe kadibu bakuate ne mashi adi apatuka mu tshilonda, pashishe mu tusunsa tukese mubedi neapuekeshe mupuya mukole ne dilengeja dia dikala diende ne dipuekesha dia mashi.
3. Kupula tshintu tshidi tshibuikila mashi: Enza mudimu ne tshiamu tshia gauze tshidi katshiyi ne disama bua kusukula mashi onso adi makole adi bu jelly avua mabuikile njila wa mputa anyi tshiamu tshia kukanga natshi tshiadi tshia njila umue.
4. Ulengeja kabidi tshibuikidiji tshia tshiadi tshidi ne luya (anyi wela tshikuabu tshikezuke) ku ndekelu kua dipuekesha dia luya: Bikala tshibuikidiji tshia tshifuka tshiuwule tente ne mashi ne kuena ne tshibuikidiji tshia tshiadi tshidi katshiyi ne luya, shiya ditumba kadiyi dibuikila anyi shiya tshilonda tshibuikila anu ne tshiamu tshia gauze tshidi katshiyi tshibuela mu luya padi mashi apatuka.

Mushindu kayi udi baminganga ne baminganga ba ALS bondopa Pneumothorax wa tension mukanga¶

Shi mubedi upeta disama dia pneumothorax didi kadiyi ne tshina tshia pambelu mu tshimanu tshia tshiadi** (tshilejilu, kunyima kua dikuma dia volant, dikuluka dia moto, anyi dinyanguka dia tshifu), kakuena tshintu tshia kukanga tshiadi tshia kuela to. Ba munganga ba mu lupitadi lua Advanced Life Support (ALS) ne baminganga ba malu a njiwu badi benza diakamue Needle Thoracostomy Decompression: * Kubueja tshiamu tshile, tshinene (10-to-14-gauge, 8.25-centimetre / 3.25-inch) pa mutu pa muelelu wa ku mutu kua tshiadi tshia kuinshi (bua kuepuka mushipa wa intercostal, mushipa, ne tshiadi tshidi tshienda mu tshitupa tshia kuinshi kua **muelelu wa kuinshi kua tshiadi) 5 ku luseke luonso tshitupa tshia pankatshi pa tshiadi mu mulongo wa kumpala/wa munkatshi mua tshiadi (tshitupa tshia matuku etu aa tshia ATLS 10^th Edition tshidibu basue kudi bantu bakole) anyi muaba wa pankatshi pa tshiadi mu mulongo wa munkatshi mua tshiadi, udi upatula kapepe ka mu tshiadi diakamue too ne padibu bateka tube wa tshiadi (tube thoracostomy).

Diteka dia babedi bimpe ne dilama dia Flail Chest¶

Mushindu kayi wa kuteka mubedi udi ne mputa mu tshiadi¶

• Kumanya ne kupuyakana: Lekela mubedi asombe muimane anyi mupuwe mu tshitupa tshia 45-to-60-degree (muaba wa Fowler), anyi muinamine kakese kumpala pa binu biende (muaba wa tshiamu tshia makasa asatu). Kusomba mululame kudi kuenza mudimu ne bukole budi bukoka bintu bua kukoka bitupa bia mu difu panshi ku diaphragme ne kulama mashi a mu tshifu (hemothorax) kuinshi kua tshifu bua bitupa bia kuulu bia mu mikolo bikale anu mua kupuyakana.
• Kutenteka ku luseke ludi lutapike (padibi bikengela): Bikala mubedi ne mputa wa mu tshiadi tshikanga anyi mifuba mityumuke ku luseke lumue ne musue kuinama, kumutenteka kakese ku luseke ludi lutapike kudi kukosa mifuba idi ne kanyinganyinga ku tshilamba anyi ku tshilamba tshia ku mutu ne kulekela mupuya wa ku mutu udi kayi mutapike upatula mashi onso anyi kayi upatula mashi onso carina mu tshiadi tshimpe.
• Kayi ne lungenyi ne udi upuyakana (kayi ne disama dia mukolo): Teka mubedi mu muaba wa kuondopibua ku luseke ne luseke ludi lutapike panshi (mupuya muimpe kuulu). Kuteka luseke ludi lutapike panshi kudi kupangisha mashi adi apatuka munda mua tshifu tshidi tshinyanguke bua kubenga kupatuka mu tshiadi tshinene ne kunyanga tshifu tshimpe, eku tshilekela tshifu tshimpe tshia kuulu tshienda tshitangalaka.

Diambuluisha dia kumpala dia tshiadi tshia Flail (Mifuba ya bungi mitshibuka ne tshienzedi tshia dipanga dia lungenyi)¶

Padi tshipupu tshia bukole bua bungi tshitshibula mifuba ibidi anyi mipite apu idi pabuipi mu miaba ibidi anyi mipite apu, tshitupa tshia mufuba tshidi tshienza bu tshijengu tshidi tshijimija dipetangana diatshi dia mifuba ne tshimanu tshikuabu tshia tshiadi. * Mushindu udibi bimueneka (Paradoxical Breathing): Padi muntu wela mupuya MU, tshienzedi tshibi tshidi munda mua tshiadi tshidi tshinua tshitupa tshia mukolo tshidi tshienda tshitshibuka INWARD eku tshitupa tshikuabu tshia tshiadi tshienda tshipatuka pambelu; padibu bapuyakana PAmbelu, tshitupa tshitshibuka tshidi tshipuyakana PAMPALA. * Bua tshinyi katuena kabidi tuela mifuba anyi tuteka mifuku ya nsenga mikole pa tshifuba tshia nsongo to: Kukadi makumi a bidimu, basungidi bavua basuikila mifuba yonso ne bande ya elastic anyi bateka tshibombi tshia nsenga tshikole pa tshitupa tshia nsenga. Mateta a mu lupitadi adi aleja ne: kukanga tshimanu tshia tshiadi anyi kutshipesha bujitu ne mifuba ya nsenga kudi kupangisha tshiadi bua kuikala ne makanda a mubidi mimpe, kudi kunyanga atelectasis (dikuluka dia alveole), ne kudi kufikisha lukasa ku dipanga dia mupuya. * Dilama dia tshifu tshia Flail didi dimanyine pa bijadiki bia matuku etu aa: 1. Kuena ne bua kuela tshilamba tshia tshijengu anyi bande ya elastik ku tshiadi nansha kakese. 2. Wenza mudimu ne "Self-Splinting" ne tshilamba tshia kulala: Somba mubedi udi mumanye malu muimane tshitupa ne umupeshe tshilamba tshia bulalu tshimpe, tshilamba tshia kulala tshidi tshibuikila, anyi jacket wa tshisuku bua kukuata bitekete bitekete ku mifuba idi mitapike ne diboko diabu nkayabu, nangananga padibu bakokola anyi bendela pa bipumbishi. 3. Dilongolola bua kuambuluisha bua kupuyakana: Bualu njiwu ya bushuwa ya lufu mu tshifu tshidi tshinyanguka idi disama dia mu mikolo (tshitupa tshia mu mikolo tshidi ne mputa, tshiuwule tente ne mâyi) tshidi muinshi mua mifuba mitshibuka, babedi batu batshioka misangu ya bungi ne badi dijinga ne dikuatshisha dia mupuya wa positive-pressure bag-valve-mask (BVM) ne dia mu lupitadi.

Dikuatshisha dia kumpala dia tshilonda tshia mu tshiadi tshidi tshimue tshia ku bilejilu bidi bimueneka patoke mudi tshienzedi tshipepele mu minite ibidi ya kumpala tshipangisha buludiludi dijika dia mutshima. Ela meji bua kuangata diambuluisha dia kumpala, kuimanyika mashi, anyi tulasa tua diambuluisha dia lukasa lukasa kupitshila ku tshisumbu tshia ditunga tshiebe tshia Croix-Rouge anyi tshia Crescent-Rouge, tshia mu tshilongelu tshia baminganga tshia mu Amerike, anyi tshia St John Ambulance bua kuenza mudimu ne tshimanyishilu tshia tshiadi ne mulongeshi.

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• Kasumbu ka Tactical Combat Casualty Care (CoTCCC / Joint Trauma System, United States): TCCC Guidelines for Medical Personnel: Management of Open Pneumothorax (Vented Chest Seals), Burping, and Tension Pneumothorax Decompression.
• American College of Surgeons (ACS, United States): Advanced Trauma Life Support (ATLS) Student Course Manual (10^th Edition): Thoracic Trauma, Open Pneumothorax, Flail Chest, and Massive Hemothorax.
• Komite wa malanda a pa buloba bujima udi utangila dilengeja dia bantu (ILCOR, International) & American Heart Association / American Red Croix: Diumvuangana pa malu a sianse ne mibelu ya luondapu (CoSTR) bua diambuluisha dia kumpala dia mputa ya mu tshiadi.
• Tshilongelu tshia ditunga tshia malu a bukola bua mubidi ne a dilama dia bantu (NICE) & NHS (Royaume-Uni): Disama dinene: Dikonkonona ne dilama dia kumpala dia disama dia mu tshiadi kumpala kua lupitadi ne mu lupitadi (NG39).
• British Thoracic Society (BTS, United Kingdom): Mukenji wa disama dia mu tshiadi: Dilama dia Pneumothorax wa tshimpitshimpi ne wa kanyinganyinga.
• European Resuscitation Council (ERC, Europe): Mikenji ya diambuluisha dia kumpala ne disama dia mutshima dia tshimpitshimpi (malu adi mua kupingana: Pneumothorax wa tension).

Malu adi apetangana¶

• Impalement ne embedded foreign object stabilization
• Dikanda dia mashi makole ne tourniquets
• Dipatula dia munda ne dilama dia mputa ya mu difu
• CPR ne dikolesha dia mutshima
• Dijingulula dia tshipupu ne diambuluisha dia lukasa
• Nomba ya tshimpitshimpi ne dituma dia matunga makuabu