Diambuluisha dia kumpala dia dikosa dia mubidi, Tourniquets, ne dilama dia tshitupa tshikosa¶

**Dikosa dia munu, tshianza tshinene, tshianza, diboko, dikasa, anyi dikasa dijima anyi dia tshitupa ku diambuluisha dia tshiamu tshia nzembu, tshiamu tshia mudimu, tshiamu tshia mudimu tshia madimi, tshiamu tshia kukosa natshi bisonsa, dikuluka dia mashinyi anyi dibutuka) didi difila malu abidi adi enzeka musangu umue, adi ne mushinga wa bungi: kusungila muoyo wa mubedi ku tshipupu tshinene ne ku njiwu ya mashi kulama tshitupa tshia mubidi tshidibu bakose bua baminganga ba mishipa mikese bamone mua kutshilamakaja kabidi. Katshia ku dipanda dia kumpala dia tshianza tshia muntu ne dia tshianza tshinene mu bidimu bia 1960, dipanda dia matuku etu aa diakambuluisha bua kusonga mishipa ya mashi idi mikese kupita 1 millimetre (0.04 inches) mu diamètre ne kupingaja mudimu wa dikema ku minu minene, minu, bianza, maboko, dikoba dia mutu, matshi ne mishiku.

Ino, shi munu nansha tshianza tshikosa tshidi mua kupingajibua mu nzubu wa dipanda, bidi bilondeshila mushindu udi bantu badi pabuipi ne badi bambuluisha kumpala benza mudimu ne tshitupa tshidi tshipatuka mashi ne tshitupa tshidibu bakose mu minite 15 ya kumpala muaba udibu bapanda. Bilema bibidi bia kanyinganyinga bidi binyanga kashidi tshitupa tshia mubidi tshidibu bakose kumpala kua kutshifika mu lupitadi ntshia se: kuteka tshitupa tshidibu bakose buludiludi pa neje anyi mu mâyi a neje (tshidi tshienza bua mijilu ya mashi ikale ne mashika ne itshibula, bienza bua iatrogenic frostbite necrosis) ne kuela tshitupa tshidibu bakose mu tshibombi tshia mâyi, anyi tshintu tshidi tshiluisha masama mayi a bungi ne adi anyanga bitupa bia mubidi). Kumanya dîba dia kuela tshilamba tshia windlass tshia mushinga mukole anyi tshia kuela tshilamba tshia nzembu pa tshimuma, mushindu wa kupanda tshitupa ("pabuipi") tshia dikosa kakuyi dikosa dia dikoba diatshi didi dishale, ne mushindu wa kusangisha Two-Bag Moist-Cold Preservation System kudi kusungila mioyo ne bitupa bia mubidi.

Enza nunku mpindieu¶

1. **Bikila nimero ya njiwu ya muaba unudi diakamue ne lomba baminganga ba Advanced Life Support (ALS) nomba ya tshimpitshimpi. Amba patoke ne udi ne dipanda dia mubidi dia kanyinganyinga bua EMS ikale mua kutuma mubedi ku nzubu wa tshinyangu udi ne bukole bua kupingaja mishipa mikese.
2. Uondopa mubedi KUMPALA kua wewe kukeba tshitupa tshidibu bakose: kuanji kukanda mashi adi apatuka pa tshimuma.
3. Bua munu, tshianza tshinene, anyi tshianza: Bandisha tshianza pa mutu pa mutshima ne ufina tshilamba tshinene tshia gaze tshidi katshiyi ne disama tshikole buludiludi pa tshitupa tshidi tshipatuka mashi munkatshi mua minite 5 too ne ku 10 mishindame. (Kuteka nansha kakese tshilamba tshia tshiamu tshia mitaku, tshingoma, anyi tshilamba tshia ku makasa ku munu udi upatuka mashi, bualu biamu bia munu bidi bikuata mashi a mu mishipa, bitshibula mijilu ya ku bianza, ne binyanga tshikokedi.)
4. Bua dikosa dia diboko, diboko dia kumpala, tshiadi, anyi dikasa dia kuinshi (anyi dipatuka dia mashi didi kadiyi dilombodibua): Diakamue ela tshiamu tshia mudimu tshia tourniquet (bu mudi CAT anyi SOFTT-W) **5 to 7 centimètres (2 to 3 inches) pa mutu pa dikosa dia tshikokedi, pa mutu pa mufuba anyi tshianza funda tshingoma too ne padi mashi onso ajika, ne funda dîba dijalame pa tshingoma.
5. Bikala munu anyi tshitupa tshia mubidi tshikosa tshitupa (tshidi anu tshilamakaja kudi tshitupa tshia dikoba, muonji, anyi mifuba), KUTSHIKOLA anyi kutshikoka nansha kakese. Teka tshitupa tshidi tshilenga mu muaba watshi wa tshilelela bua mijilu idi mishale munda mua tshibumba tshia dikoba kayiyi mikoseka anyi minyanguke, ufuke tshilonda ne gazeline wa mupuya muimpe ne mupuya muimpe ela tshitupa tshijima tshia mubidi bimpe.
6. Lama tshitupa tshia mubidi tshikosa tshijima ku diambuluisha dia "Two-Bag Moist-Cold Method" (tshipatshila tshia luya 4 degrés Celsius / 39 degrés Fahrenheit):
7. Tshitupa A (Kusukula bitekete bitekete anu padibi ne bukoya): Shi munu anyi tshianza tshikosa tshikuluka mu bukoya anyi mu tshisuku, utshisukule bitekete bitekete mu tusunsa tukese ne saline normal sterile (0.9% chloride de sodium) anyi mayi a kunua a mu milondo mimpe (kuyisukula nansha kakese, ne kuena ne bua kuenza mudimu ne nsabanga, maluvu, peroxyde anyi idine to).
8. Tshitupa B (Mufuku wa munda): Funda tshitupa tshikosa mu gaze wa tshiamu tshia mitaku mutokesha (mutoke, kayi upueka) ne saline wa pa tshibidilu, teka tshitupa tshidibu bakuate munda mua tshibombi tshikezuke, tshiume, tshidi katshiyi tshibuela mâyi tshibombi tshia plastike tshia zip, upuekesha kapepe kadi kapite bungi, ne utshikanga bimpe.
9. Tshitupa C (Outer Slush Bath): Teka tshibombi tshia plastique tshikanga munda mua tshibombi tshibidi tshia pambelu anyi tshibombi tshiuwule tente ne 50/50 wa mabue a mashika ne mayi a mâyi (tshibombi tshia mâyi a mashika tshidi tshishala anu ku 4 degrés Celsius / 39 degrés Fahrenheit kakuyi mashika).
10. KUTEKA munu anyi tshianza tshikosa buludiludi pa mabue a mashika, KUENA mua kutshibueja mu mabue a mashika, ne KUENA mua kutshiela buludiludi mu mayi anyi mu mâyi a mukele to. Dipetangana buludiludi ne mabue a mashika didi dienza bua selile ya muoyo ikale mikole ne didi dijadika dipanga dia kukuna kabidi.
11. Lama mubedi mulale panshi (anyi musombe ne tshianza tshidi tshitapike tshibandishibue), NPO (kakuyi tshintu tshia ku mishiku), ne mubuikila mu bilamba bia kapia. Ufunde pa tshibombi tshia pambelu dîna dia mubedi ne dîba dilelela dia disama, ne enza bua tshibombi tshikole tshikale munda mua ambulanse ne mubedi.

Mutshi wa mapangadika a tshimpitshimpi bua dikosa dia mubidi dijima ne dia tshitupa¶

flowchart TD
    Start["Complete or Partial Traumatic Amputation<br/>(Finger, Thumb, Hand, Arm, Toe, Foot, Leg, Ear, Nose, or Scalp)"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Priority 1: Treat the Patient and Control Stump Hemorrhage First"]
    PartialCheck{"Is the Body Part COMPLETELY Detached<br/>or PARTIALLY Attached by a Skin/Tissue Bridge?"}
    PartialCare["PARTIAL ('NEAR') AMPUTATION PROTOCOL<br/>1. NEVER cut or sever the remaining skin/tendon bridge<br/>2. Control bleeding with firm direct pressure (or proximal tourniquet if arterial)<br/>3. Gently untwist/align part into natural anatomical position<br/>4. Cover wound with sterile saline-moistened gauze + bulky pad<br/>5. Splint limb securely; if part is completely cold/white, place cool pack<br/>   OUTSIDE a thick dry towel barrier distal to wound without freezing"]
    StumpLevel{"COMPLETE AMPUTATION: What Level of the Limb is Severed?"}
    MajorStump["MAJOR LIMB AMPUTATION (Hand, Wrist, Forearm, Upper Arm, Foot, Leg, Thigh)<br/>1. Apply Commercial Windlass Tourniquet 5-7 cm (2-3 in) ABOVE stump<br/>   (Even if arterial spasm temporarily hides spurting)<br/>2. Tighten until all bleeding stops and record exact time<br/>3. Cover raw stump end with sterile saline-moistened gauze + dry bulky dressing"]
    DigitStump["DIGIT OR FACIAL AMPUTATION (Finger, Thumb, Toe, Ear, Nose)<br/>1. Elevate hand/foot above heart level<br/>2. Apply firm direct pressure to stump with thick sterile gauze for 5-10 min<br/>3. Wrap snug pressure bandage around hand/stump<br/>4. NEVER put a rubber band or string tourniquet around the base of a finger"]
    PartCare["TWO-BAG MOIST-COLD PRESERVATION OF SEVERED PART<br/>1. Gently rinse off gross dirt with sterile saline (DO NOT scrub or use soap)<br/>2. Wrap part in sterile gauze lightly dampened with sterile normal saline<br/>3. Seal wrapped part inside a dry, watertight plastic bag (Bag 1)<br/>4. Place Bag 1 into a mixture of Crushed Ice + Water (4 deg C / 39 deg F) (Bag 2)<br/>5. NEVER touch part directly to ice; NEVER use dry ice; NEVER soak in liquid"]
    Transport["Keep Patient Warm, Calm, and Strictly NPO (Nothing by Mouth)<br/>Send labeled cooled part in the SAME ambulance with the patient"]

    Start --> CallEMS
    CallEMS --> PartialCheck
    PartialCheck -->|Partially Attached| PartialCare
    PartialCheck -->|Completely Detached| StumpLevel
    StumpLevel -->|Major Limb / Uncontrolled Arterial| MajorStump
    StumpLevel -->|Finger, Thumb, Toe, Ear, Nose| DigitStump
    MajorStump --> PartCare
    DigitStump --> PartCare
    PartialCare --> Transport
    PartCare --> Transport

Tshikondo tshia ischémie tshia luya ne tshia mashika Madidishi a dîba: Bua tshinyi dilengeja dia munu ne dia diboko dia kumpala didi dishintulula dîba¶

Tshitupa tshia mubidi tshidibu bakose tshidi mua kushala ne muoyo matuku bungi munyi kayi ne mashi kumpala kua bitupa biatshi kufua kashidi (ischémique necrose)? Diandamuna didi dimanyine pa bualu bua mushinga mukole bua mubidi: bikala tshitupa tshia mubidi tshidibu bakose tshidi ne mifuba ya mifuba.

• Mushipa wa mifuba (udi uwuja diboko dia kumpala, diboko dia kuulu, tshiadi, dikasa dia kuinshi, ne tshianza tshia ku tshianza) udi ne dijinga dia oxygène dia bungi. Pa luya lua mu nzubu (ischémie chaud), mifuba mikosolola idi ituadija kufua selile kayiyi mua kupingana ne ipatula potassium ne myoglobine bidi ne buôwa kunyima kua mêba 4 anyi 6.
• Minu ne tshianza tshinene (bimanyinu), mu dishilangana, bidi ne mifuba ya ZERO. Misunyi idi yenza mudimu ne minu yebe idi bushuwa misombe mu diboko diebe ne mu tshianza tshiebe, ikoka minu yebe ku diambuluisha dia mionji mile mitoke (tendons). Bu mudi munu muikale anu ne mifuba, mionji, mijilu, mishipa ya mashi, mafuta, ne kikoba (bionso ebi bidi ne dijinga dikese dia oxygène), munu anyi tshianza tshinene tshidi tshilengeja bimpe tshidi mua kupingajibua bimpe too ne mêba 12 kunyima kua disama dia ischémie, anyi too ne mêba 24 (ne mu bilumbu bidibu bafunde) padibu batshikuma mêba 30 + pa 4 Celsius (39 degrees Fahrenheit).

Mishindu ya kukosa: Bua tshinyi Guillotine Cut mmupepele bua kukuna kabidi kupita Avulsion anyi Crush¶

Baminganga bakese badi bakonkonona mushindu uvuabu bakose tshitupa atshi bualu tshiamu etshi ke tshidi tshileja bungi bua santimetre ya mushipa udi munyanguke udibu ne bua kukosa anyi kupingaja ne tshiamu tshia mushipa:

1. Dipanda dia mutshima ("Guillotine"): Difumina ku tshingoma tshia mufidi wa biakudia, tshiamu tshia mitaku, tshiamu tshia kukosa natshi mabeji tshia guillotine, tshiamu tshia dikalashi, anyi tshingoma. Dikoba, mufuba, mishipa, mijilu, ne mishipa ya mashi bidi bikosolola bimpe mu tshitupa tshimue tshikese ne mputa mikese ku luseke luonso. Udi ne tshitupa tshinene tshia dikumbana dia dipingaja dia mitshi (85% too ne ku 92%).
2. Local Crush Amputation: Difumina ku tshiamu tshikole, tshiamu tshia mitshi, tshiibi tshia mashinyi, anyi tshiamu tshia hydraulique tshidi tshikuluka pa munu anyi pa tshianza. Mishipa ya mashi idi mitshibuka pa tshitupa tshia 1-to-3-centimetre (0.5-to-1.2-inch), bidi bikengela kupanda mishipa ne kukepesha mifuba anyi mishipa ya munda.
3. Avulsion (Pull-Off) anyi "Ring Avulsion" Amputation: Didi dienzeka padi tshitupa tshia mubidi tshikuata mu tshiamu tshia auger tshidi tshinyunguluka, mu nkamba, mu tshiamu tshia PTO, anyi padi tshilamba tshia dibaka tshikuata pa tshibandilu, pa lupangu anyi pa bulalu bua mashinyi padi muntu utuluka panshi, tshipatula dikoba, mijilu, ne mionji mile idi mibumbakane ya mu mishipa ya digitale bu mudi dikoka dia minu tshianza. Nansha mudi mufuba mua kuikala anu mujima munda mua tshitupa tshia "degloved" ring avulsion, tshitupa tshia munda tshia mu mishipa (tunica intima) tshia mu mishipa tshidi tshitambakane ne tshipanda santimetre ya bungi too ne ku tshianza (tshimanyinu tshia "Red Ribbon" ku luseke lua mushipa), tshidi tshikengela dipanda dia mishipa mikese.

Mushindu wa kuenza malu ku kakese ku kakese: Kutabalela mubedi ne tshimuma¶

Tshitupa 1: Kukanda mashi adi apatuka pa tshimuma (Direct Pressure vs. Windlass Tourniquet)¶

1. Bua dikosa dia munu, tshianza tshinene, anyi dia makasa:
2. Lekela mubedi asombe anyi alale panshi ne abandishe tshianza anyi dikasa didi ditapa pa mutu pa mutshima.
3. Teka tshibumba tshinene tshia gaze tshidi katshiyi ne disama buludiludi pa mutu pa tshimuma tshidi tshipatuka mashi ne fina bikole ne minu yebe idi ne bianza munkatshi mua minite 5 anyi 10 kuyi utangila.
4. Padi tshipupu tshienda tshijika, udi mua kuela tshilamba tshimpe (tshidi katshiyi tshikosa) pa tshimuma ne tshianza.
5. Bua tshinyi kuena ne bua kusuika tshilamba tshia tshiamu tshia mitaku, tshingoma, tshilamba tshia nsuki, anyi tshiamu tshia kukanga natshi pa munu udi upatuka mashi: Mushipa wonso wa mu tshiadi udi wenda ku luseke ne ku luseke ne mushipa wa tshiadi mu tshitupa tshikese tshia mijilu tshidi ne butshiama bua muinshi mua 2 millimètres. Kukanga tshintu tshidi tshipangisha mashi bua kupatuka mu munu anyi kusuika tshilamba tshikole ku munu kudi kutshibula tshitupa tshia munu tshia mubidi ne tshitupa tshia mashi tshidi munganga udi ne bua kusonga munu, ne kudi mua kufikisha ku disama dia gangrene ku tshitupa tshia munu tshidi tshishale. Dikuma dia buludiludi ne dibandisha dia bintu nebilombole 99 pa lukama ya dikosa dia mubidi.
6. Bua dikosa dia bitupa binene bia mubidi (tshianza, tshianza, diboko, diboko, dikasa, dikasa, tshitalu):
7. Diakamue, ela tourniquet wa windlass wa mushinga (CAT, SOFTT-W, anyi SAM XT) 5 too ne ku 7 santimetre (2 too ne ku 3 inches) pabuipi (pa mutu) pa mputa wa dikosa buludiludi pa dikoba dia tshianana pikalaku mushindu.
8. Kuteka tshilamba pa tshiadi anyi pa dikasa (muaba udi mifuba ibidi ya ku diboko anyi ya kuinshi kua dikasa ikuba mishipa idi pankatshi pa mifuba bua kuyikuma); Shi dikosa didi anu kuinshi kua tshiadi anyi tshianza, teka tshilamba tshia ku tshianza anyi tshianza pa tshiadi tshimue anyi tshia kuulu.
9. Ikala ne tshiamu tshia windlass too ne padi mashi onso a tshitoke ajika, ela tshiamu etshi mu tshiamu tshia kukanga natshi, ne funda dîba dijalame dia ditshiela pa tshimanyinu tshia tourniquet ne pa mpala wa mubedi.
10. Buikila ndekelu wa tshikokedi ne tshilamba tshia tshiamu tshia mitaku tshitokesha ne saline wa pa tshibidilu, pa mutu pa tshilamba tshiume tshia mputa ne tshibuikila bimpe bua kukuba mifuba ne nsongo ya mijilu idi mipatuke ku luya.

Tshitupa 2: Kulombola dikosa dia tshitupa ("pabuipi" anyi kadiyi dijika)¶

Padi tshiamu tshia kukosa nabi mitshi, tshiamu tshia kukosa natshi bisonsa, anyi tshipupu tshishiya munu, tshianza anyi dikasa bilengeja ku tshibumba tshia dikoba, tshia mifuba anyi tshia muonji: 1. Kujikije dikosa dia mubidi nansha kakese: Nansha tshitupa tshia dikoba tshia 1-centimetre (0.4-inch) tshidi katshiyi tshinyanguke kunyima kua munu tshitu misangu ya bungi ne mishipa ya panyima ne mishipa ya mashi idi ikengedibua bua kupatula mashi mu munu panyima pa munganga mumane kulongolola mushipa wa ku tshianza. Kukosa tshibumba tshia dikoba kudi kunyanga njila wa mashi ne kudi mua kunyanga munu. 2. Ubulule bitekete bitekete ne ulongolole: Shi tshianza, dikasa, anyi munu udi mukosolola ndambu 90 anyi 180 anyi mupingajibue panyima, umubandishe bitekete bitekete ne umukuatshishe bua kupingana mu dilongolola dia mubidi dia pa tshibidilu bua mishipa ya mashi idi munda mua tshibumba tshia dikoba kayiyi mikoseka. 3. Tshilamba ne tshilamba: Buikila tshitupa tshidi tshiunzuluke ne mufuba udi mupatuke ne gauze wa saline sterile, ulengeje bimpe ku tshianza anyi ku tshitupa tshia mubidi ne tshilamba tshiume tshia sterile, ne uteke tshianza tshijima/tshianza anyi dikasa/tshianza pa dibaya didibu balengeje anyi tshilamba tshidi tshilengeja bua katshiyi mua kunyunguluka anyi kunyunguluka padibu bambula. 4. Mmunyi muudi mua kutokesha tshitupa tshidibu bakose tshitupa tshidi katshiyi ne mashi? Bikala tshianza anyi munu udi mulamakaja tshitupa tshidi pambelu pa muaba udibu bakose muikale mutoke, mashika, ne kayi ne tshipupu (tshidi tshiumvuija ne: mushipa mmukose ne anu dikoba/mushipa udi mushale), funda tshitupa tshidibu bakose mu **tshilamba tshikole tshia **tool **tool, ne tshia kumpala tshiteke pambelu pa tshibuikidiji tshinene tshia tshilamba ku luseke lua tshitupa tshia ischémie bua tshikale tshikole bitekete bitekete kakuyi mashika nansha tshitupa anyi tshibumba tshia dikoba tshidi ne muoyo.

Mushindu wa kuenza malu ku kakese ku kakese: "Two-Bag Moist-Cold Method" bua bitupa bikosolola¶

Muntu yense udi pa muaba wa bualu ebu udi ne tshia kumanya mua kuela munu, tshianza tshinene, tshianza, ditshi, muulu, dikoba dia mutu, anyi tshitupa tshia dinu/mufuba tshikosa tshijima bua tshifike ku lupitadi mu nsombelu muimpe:

Tshitupa 1: Keba ne wenze tshitupa tshikosa bitekete bitekete¶

• Teka muntu udi utangila bua kukeba bitupa bionso bidibu bakose (bikala minu ya bungi mikosa ne tshiamu tshia kukosa natshi, tangila munda mua bianza bia mudimu, pa mesa a tshiamu tshia kukosa natshi, anyi mu bilamba: nansha munu munyanguke bikole udi kauyi mua kupingajibua udi ne mushinga wa bungi kudi munganga udi ne mushinga wa bungi kudi munganga udi ne mushinga wa bungi kudi munganga udi ne mushinga wa bungi kudi munganga udi ne mushinga wa bungi kudi munganga udi ne mushinga wa bungi kudi munganga udi ne mushinga wa bungi kudi munganga udi wenza mudimu wa dipanda bu **"bitupa bia pa mutu **" bidi bikuata mijilu, mijilu, mijilu idi ipetangana dikoba, anyi mifuba miela bua kusungila tshianza tshinene tshia mubedi anyi minu mikuabu).
• Angata tshitupa etshi ne bianza bia luondapu bikezuke. Kuena mua kukoka anyi kukoka mishipa ya mashi idi milengeja anyi mionji ya mijilu idi ifumina ku ndekelu kua tshitupa tshidibu bakose to.

Tshitupa 2: Sukula bitekete bitekete ANYI pikalabi ne bukoya bua bungi (Kusukula nansha kakese)¶

• Bikala tshitupa atshi tshikezuke, kutshisukudi to.
• Shi udi mubuikila kudi buloba, bisonsa, anyi nkunde, umukuate bitekete bitekete ne upongolole saline 0.9% normal (anyi mayi a kunua a mu milondo mimpe pikala saline kayiku) pa mutu pawu bua kumbusha bintu bidi binyanguke.
• Kusukudi, kusukula, nansha kusukula tshitupa tshikosa, ne kulenga tshitupa tshikosa ne nsabanga, maluvu a kukosa, peroxyde wa hydrogène, povidone-iodine (Betadine), chlorhexidine, anyi mayi a kuowa mu pompi. Bintu bidi bishipa masama bidi bishipa ne bishipa selile ya endothélium idi mibuikila mijilu mikese.

Tshitupa 3: Buikila mu tshilamba tshitoke (katshiyi tshitoka) tshidi katshiyi tshinyanguka¶

• Angata tshilamba tshia gaze tshikezuke anyi tshilamba tshikezuke tshidi katshiyi ne nsuki ne utshitokeshe ne saline normal sterile (anyi mâyi mimpe a kunua), pashishe upatule mâyi adi mapite bungi bua gaze ikale mutoke kakese, kayi mutoke to.
• Udi mua kuela tshilamba tshitoke pa munu anyi tshitupa tshia mubidi tshidibu bakose. Tshitupa etshi tshia mayi tshidi tshipangisha kapepe bua kuyuma eku tshienza mudimu bu tshilamba tshidi tshikuba munda mua tshibombi.

Tshitupa 4: Kanga munda mua tshibombi tshidi katshiyi tshibuela mâyi #1 (tshibuikidiji tshia munda tshiume)¶

• Teka tshitupa tshia mubidi tshibuikila ne gaze munda mua tshibombi tshikezuke tshidi katshiyi tshibuela mâyi tshibombi tshia plastique tshidi ne zip (anyi dikopo/tshibombi tshia tshilejelu tshidi katshiyi ne disama bua kuela ku munu, ku ditshi anyi ku muulu; anyi tshibombi tshia plastique tshikezuke tshia mudimu mukole bua kuela ku diboko anyi ku dikasa).
• Fina bitekete bitekete kapepe kadi kapita ne kanga tshibombi bimpe menemene bua mayi adi afumina pambelu kaayi mua kubuela ne kuela tshilamba.

Tshitupa 5: Ela tshibombi #1 mu tshibombi #2 tshidi ne 50/50 wa mashika ne mayi¶

• Angata tshibombi tshibidi tshinene tshia plastique, tshibombi, anyi tshiamu tshia mashika ne utshiwuje ne bitupa bia muomumue bia neje mitshibule/mikosa ne mâyi mashika a mu pompi (mayi a glace a kuowa mâyi a mashika).
• Teka Mufuku #1 mukanga munda mua Mufuku #2 bua ikale mu tshibuelelu tshia mayi a mashika.

Tshitupa 6: Kufunda ne kuambula pamue¶

• Funda dîna dijima dia mubedi, tshitupa tshia mubidi, ne dîba dijalame dia dikosa pa tshitupa tshia bande tshidi pambelu pa tshibombi #2.
• Lama mubedi mu luya (mubuikila mu bilamba bua kuepuka disama dia hypothermie ne dia vasospasme), NPO (kakuyi tshintu tshia ku mishiku) bua anesthesie wa lukasa kutuadijaye diakamue, ne tuma tshitupa tshidi tshikosa mu ambulanse umue ne mubedi.

Malu a pa buawu a dikosa dia mubidi: Dikoba dia mutu, ditshi, mulu, nsongo ya minu ya bana, ne bua tshinyi tudi ne bua kuepuka nicotine/caffeine¶

1. Dikoba dia mutu, matshi, mishiku, ne mishiku mikosa¶

Padi nsuki mile mikuate mu mashinyi a midimu anyi padi mbua mulume anyi mukuluke udi ukosa ditshi, muulu anyi mushiku: * Dikoba dia mutu: Dikoba dia mutu didi ne umue wa ku mishipa ya bungi mu mubidi ne didi dipatuka mashi a bungi. Lama mashi adi afumina ku mutu ne dikuma dikole ne tshilamba tshia ku mutu tshimpe, ne ulama tshitupa tshijima tshia mutu tshidi tshinyanguke (kusangisha ne nsuki) ku diambuluisha dia mushindu wa muomumue wa Two-Bag Moist-Cold Method. Baminganga bakese badi mua kusangisha kabidi mushipa umue wa pa mutu ne mushipa bua kupingaja dikoba dijima dia ku mutu didi ne nsuki. * Matshi, mishiku, ne mishiku: Lama tshitupa tshionso tshia mubidi ne tshia dikoba tshidi tshipatuke ku diambuluisha dia mushindu wa Two-Bag Moist-Cold. Nansha biobi kabiyi mua kuenzeka bua kuenza anastomose microvasculaire wa mushipa mukese wa mu matshi, baminganga ba plastique batu benza mudimu ne tshiamu tshia cartilage tshidibu balame bua kulongolola tshiakabidi.

2. Dikosa dia minu ya bana (Biibi bia mashinyi ne bikunyibua)¶

Bana bakese batu misangu ya bungi bapeta disama dia dikosa dia minu padi tshiibi tshinene tshikuma ku munu wabu: * Bana badi ne bukole bua pa buabu bua kupingaja bukole ne bua kuondopa mu mishipa mikese. Nansha tshilamba tshikese tshia munu tshidibu bakose kunyima kua dikasa dia ndekelu (distal phalanx) mu muana tshidi mua kuikala tshipingajibua bu tshintu tshia kuenza natshi mudimu anyi bu tshintu tshia kuenza natshi mudimu tshia microsurgical bikalabu batshilengeje bimpe mu tshiamu tshia gaze tshitoke munda mua tshibombi tshikanga pa mâyi a mashika.

3. Dikandika dionso dia kunua makanya, nicotine, vaping, ne kafeine¶

Mu tshikondo tshia kumpala kua lupitadi ne mu mbingu mikese kunyima kua dipanda dia tshiakabidi, mubedi udi ne tshia kuikala mulongibue bikole ne: kakuyi makanya, kubenga kunua makanya anyi mifuba ya nicotine, ne kubenga kunua kafeine: * Nicotine i umo wa ku bintu bia bukole bidi bipangisha mishipa ya mu mishipa. Kunua nansha dipembu dimue dia makanya anyi dia vape kudi kuenza bua mijilu ya 0.8-millimetre milongolola ikale ne tshiji tshikole, kukepesha dienda dia mashi mu munu udibu bapingaje ne bia pa lukama 80 ne kuenza bua tshitupa tshidibu bapingaje tshikale ne disama dia thrombose ne lufu lua lukasa. * Bua bualu bua muomumue, lama mubidi wa mubedi ne bilamba mu ambulanse; dikankamika ne mashika bidi mua kufikisha ku dipanga dia mijilu mu bianza ne mu makasa.

Ditalala, dilongolola dia mashika ne dilama dia mashika dia mifuku ibidi didi dipesha baminganga ba microsurgeon mushindu muimpe wa kupingaja tshianza anyi tshitupa tshia mubidi tshia muntu. Ela meji bua kuangata kalasa ka diambuluisha dia kumpala ne ka kuimanyika mashi ku diambuluisha dia tshisumbu tshia ditunga tshiebe tshia Croix-Rouge anyi tshia Crescent-Rouge, tshia American College of Surgeons, anyi tshia St John Ambulance.

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• Société américaine pour la chirurgie de la main (ASSH, États-Unis): Mibelu ya luondapu idi itangila dilama dia lukasa dia bianza, bianza ne bitupa bia mubidi bidibu bakose (The Two-Bag Preservation Protocol and Replantation Indications).
• Tshisumbu tshia bena Grande-Bretagne tshia dipanda dia bianza (BSSH) & Tshisumbu tshia bena Grande-Bretagne tshia baminganga ba dilengeja dia bianza (BAPRAS, Royaume-Uni): Mikenji ya dilama dia disama dia tshiadi tshia ku mutu ne dipanda dia tshianza.
• Tshilongelu tshia baminganga ba mu Amerike (ACS, États-Unis): Kuimanyika mashi ne diambuluisha dia ntatu mikole (ATLS): Dilama dia mashi mu bitupa bia mubidi, Windlass Tourniquets, ne Traumatic Amputation Triage.
• Kasumbu ka Tactic Combat Casualty Care (CoTCCC / Joint Trauma System, United States): TCCC Guidelines: Application Tourniquet for Traumatic Amputations.
• Bulongolodi bua matunga masanga bua Croix-Rouge ne Croix-Rouge (IFRC, International): Malu a diambuluisha dia kumpala, a dikolesha dia mubidi ne a dilongesha: Dipanda dia bitupa bia mubidi ne dipatuka dia mashi makole.

Malu adi apetangana¶

• Dikanda dia mashi makole ne tourniquets
• Bitupa biunzulula (bisangisha) ne dipanda
• Disama dia mputa ne disama dia tshitupa tshia mubidi
• Dijingulula dia tshipupu ne diambuluisha dia lukasa
• Malu a tshimpitshimpi a meno ne dinu dikoseka
• Nomba ya tshimpitshimpi ne dituma dia matunga makuabu