Mulongi uvua mukuluke mu tshipalu: tshipupu tshia luya ('tshia kumpala tshia mashika, tshibidi tshia diendesha') ne disama dia mutshima dia tshimpitshimpi ne disama dia tshiadi¶

Kutangila muana wa bidimu 15 udi wenza manaya a ndundu mu kalasa ka kumpala, munyemi wa mu tshilongelu tshinene, muena mu tshisumbu tshia manaya, anyi muena manaya a ndundu wa nsonga udi upona mu tshimpitshimpi anyi upona pa buloba mu tshikondo tshia dibidija dia mubidi dia matuku abidi mu ngondo wa muanda mukulu ntshimue tshia ku bilumbu bia luondapu bidi bilomba dîba dia bungi mu malu a luondapu lua manaya. Mu manaya a bansonga ne a tulasa tua bikadilu, pa mutu pa 90% ya lufu lua tshimpitshimpi ludi kaluyi lua tshimpitshimpi mu tshipalu lua manaya ludi lufumina anu ku masama asatu a tshimpitshimpi: Dipanga dia mutshima dia tshimpitshimpi (SCA), Tshipupu tshia luya (EHS), ne Exertional Sickling (ES mu bena manaya badi ne ngikadilu wa Sickle Cell, HbAS). Nansha mudi malu onso asatu a tshimpitshimpi mua kuenzeka mu tusekonde tukese tua mudimu mukole wa mubidi mu dituku dia kapia, dikokangana ne dikuabu mu tusekonde 180 tua kumpala kudi mua kushipa muntu. Kuondopa muntu udi ne disama dia muoyo dia tshimpitshimpi bu "udi anu ne kapia kakole" kudi kuenza bua defibrillation ikale panyima pa minite 3 ya kupanduka; kuteka muntu udi ne disama dia Exertional Heatstroke buludiludi kunyima kua mashinyi a ambulance maume adi ne luya lua mashika kuyi muanji kumuela mu mâyi mashika adi pa muaba au (CWI) ice tub** udi unyanga Tshisumbu tshia balongeshi ba manaya a mu ditunga dijima (NATA) ne Korey Stringer Institute "Cool First, Transport Second" gold-standard mandate ne udi witaba 41.5 °C (106.7 °F) luya lua munda bua kulamba buongo ne tshifu tshiabu mu luendu lua minite 20 lua ambulanse; ne kuela mbila kudi muena manaya udi ne disama dia tshimpitshimpi dia Exertional Sickling crisis bua "kujuka ne kukolesha disama dia ku makasa" kudi kufikisha ku dipanga dia selile ya mashi mikunze, disama dia fulminant rhabdomyolyse, ne hyperkalemic cardiac stop.

Diakalenga, balongeshi, balongeshi ba manaya (ATCs), baminganga ba mu tshisumbu, ne baledi badi ku luseke kabena dijinga ne mateta a mashi a mu laboratware bua kumanya malu asatu aa a tshimpitshimpi pa bisonsa to. Pa kutangila bimanyinu binayi bia lukasa bia luondapu mu masekonde 30 a kumpala - (1) Diandamuna ne dipuyakana (SCA = kayi wandamuna nansha kakese ne dipanga anyi dipuekesha dia mupuya), (2) Collapse Velocity (SCA ne Heatstroke upona mu tshimpitshimpi kakuyi didimuija, kadi Sickling Bena manaya batu bapueka panshi padibu batshidi batabale ne badila bua dipanga dia bukole dia mu tshiadi tshia kuinshi/tshia tshiadi/tshia tshiadi), (3) Muscle Palpation (Heatstroke ne Sickling mifuba idi imueneka mitekete anyi mitekete, kadi bulelela Heat Cramps kukanga mu tshitupa tshikole tshia dibue, tshidi tshimueneka tshilamakaja), ne (4) Core Rectal Temperature (Exertional Heatstroke udi umvuija bimpe menemene kudi dipanga dia mudimu wa CNS ne luya lua munda mua tshiadi lua pa mutu 40.5 °C / 105 °F, kadi Sickling ne SCA bienzeka mu luya lua pa tshibidilu anyi lua pa tshibidilu lua dibidija dia mubidi ludi kuinshi kua 40.0 °C / 104 °F) - udi mua kuenza mudimu ne tshilele tshia kusungila muoyo diakamue.

(Bua kumanya malu adi atangila dikolesha dia mutshima ne mikolo, bala Bulombodi bua CPR ne AED. Bua malu a tshimpitshimpi a luya, bala Disama dia luya ne ditshioka dia luya ne Disama dia tshimpitshimpi, rhabdomyolyse, ne dienza dia mashi mafiike, ne kulama buloba buetu nomba ya tshimpitshimpi mukanda udi mua kufika ku luseke.)

Enza nunku mpindieu¶

1. **Enza mudimu ne tshipangu tshia malu a tshimpitshimpi tshia muaba wenu (EAP). Bikila nimero ya njiwu ya muaba unudi (911 mu États-Unis ne mu Canada, 112 mu matunga a ku Mputu, 999 mu Grande-Bretagne, anyi tangila nomba ya tshimpitshimpi) diakamue dîba dionso didi muena manaya nansha umue upona mu tshipalu.
2. Kumbusha disama dia mutshima dia tshimpitshimpi (SCA) Tshia kumpala (Sekonde 0 too ne ku 30): Shi muena manaya kena wandamuna ne kena upuyakana biyampe, utuadije CPR wa bianza nkayawu ne wela AED mu minite 3.
3. Fina pa dikaya dia muena manaya ne wela dina dienda mbila. BUEYI BUA KU MUDIMU: Pabuipi ne 50% ya bena manaya badi ne disama dia mutshima dia tshimpitshimpi badi baleja dikankamika dia maboko/maulu (mu tusunsa 10 too ne ku 20) ne dîyi dikole, dia "agonal gasps". Kuena ne bua kuela meji ne: dikankamika anyi dipuekesha dia mikolo didi difumina ku dipuyakana dia pa tshibidilu to, ne kuedi meji ne: muena manaya udi mukuluke udi "anu ne kapia kakole" too ne paudi ujadika ne: mmubike anyi udi upuyakana bimpe ne mupuya mukole.
4. Bikala muena manaya kayi wandamuna ne kayi upuyakana bimpe: ukose tshilamba tshiende tshia pa makaya ne tshilamba tshia pa makaya (kuenza mudimu ne tshiamu tshia kukosa natshi tshiadi tshikole, kushiya tshifulu/tshiamu tshia panyima pa muaba watshi pa kumbusha padibi bikengela bua kubuela mu njila wa luya), utuadije Hands-Only CPR (100 to 120 compressions/min, 5 to 6 cm / 2 to 2.4 in deep), ne ulamakaja AED pads ku tshiadi tshia patupu diakamue. Dipangadika dionso dia 60-sekonde kupita minite 3 didi dipuekesha muoyo ne 10%.
5. Bikala muena manaya ne tshiadi tshikole ne udi upuyakana, tangila nsombelu wa lungenyi (CNS Function) diakamue: dipanga dia lungenyi, ngikadilu udi kayi ne lungenyi, ngakuilu mubi, dilenduka, anyi koma mu tshikondo tshia mashika bidi Exertional Heatstroke (EHS) too ne padibu baleja ne ki mmuomu to.
6. Ela nkonko inayi ya dilongesha: "Dîna diebe nganyi? Tudi mu budimi kayi? Nku ngondo kayi? Tuvua tuenza mudimu kayi?"
7. KUEYEKI nansha kakese ni muena manaya udi wela tuishi anyi kayi wela tuishi (anhidrosis), ne KUENA mudimu ne ditshi (tympanic), mpala (temporal), anyi tshipiminu tshia luya tshia mukana. Bishilangane ne bantu bakulumpe badi ne disama dia tshipupu tshia luya lua kale, bapite pa 90% ba balongi badi mu tshipupu tshia luya lua mubidi badi bapueka mu tuishi tua bungi dîba didibu bakuluka, ne tshipiminu tshia luya tshia ku mpala anyi tshia ku matshi tshidi tshileja **2 too ne ku 4 degre Celsius (4 too ne ku 7 degre) padiye **mutoke bikole, dikoba dilengeja kudi lupepele. Anu tshiamu tshia luya tshia mu tshiadi tshia thermistor tshidi tshishintuluka (inserted 15 cm / 6 inches past the anal sphincter) udi upima bimpa luya lua munda (> 40.5 °C / 105 °F udi ujadika EHS).
8. Shi Exertional Heatstroke (EHS) udiku (Core Temp > 40.5 °C / 105 °F NANSHA dinyanguka dia CNS didi dimueneka patoke mu kapia kakole padi tshipiminu tshia luya tshia mu tshiadi katshiyiku): Enza "COOL FIRST, TRANSPORT SECOND" diakamue.
9. Umbusha bintu bionso bia mudimu (tshifulu, tshilamba tshia ku maboko, tshilamba, pantalon, masosete, bilamba bia ku makasa) ne ela muena manaya too ne ku nshingu mu tshina tshia mâyi mashika tshia 190-to-570-litre (50-to-150-gallon) tshidibu balongolole kumpala kua dîba (CWI) Tshina tshiuwule tente ne mashika ne mayi ku 1.7 °C to 15.0 °C (35 °F to 59 °F).
10. Tangila mayi a mashika misangu yonso pa mubidi wa muena manaya ne ku mikolo yende eku mukuate mutu ne makaya pa mutu pa mayi ne tshilamba tshia kuowela muinshi mua maboko.
11. Bikalaku kakuyi tshina tshia mâyi tshidiku ("TACO Method - Tarp-Assisted Cooling with Oscillation"): Teka muena manaya munkatshi mua tshilamba tshia mu budimi tshidi katshiyi tshibuela mâyi, lomba balunda bebe 4 anyi 6 bua kubandisha miele ya tshilamba bua kuenza tshibombi tshia muntu, ela bintu 3 anyi 4 bia mashika ne mâyi buludiludi pa mutu pa mubidi wa muena manaya, ne unyungisha tshilamba atshi kumpala ne panyima katupa katupa.
12. KULEKELI mashinyi a lupitadi bua kuela bintu ne kuya ne muena manaya too ne padi luya lua mu tshifu tshiabu lupueka too ne ku 38.9 °C (102.0 °F) (udi wangata minite 10 too ne ku 18 ya dibuela mu mayi a mashika, dilengeja dia 0.20 °C to 0.26 °C / 0.36 °F to 0.47 °F per minute).
13. Bikala muena manaya mubike, mudimuke, luya lua munda ludi kuinshi 40.0 °C (104 °F), ne bakakuluka panshi pavuabu benda lubilu lukole bavua badipisha bua "maulu matekete, mafue, a kapia ne mukolo wa kuinshi" ne mifuba mipepele: wenze bu Acute Exertional Sickling (ES) Tshilumbu.
14. Umbusha muena manaya diakamue (never order them to run another rep or "walk it off").
15. Ubateke mu mundidimbi, ubapeshe oxygène wa bungi (15 Liters/min via Non-Rebreather Mask) shi udiku pa ditempu dia mulongeshi wa manaya, ikala utangila bimanyinu bia mushinga mukole, utekesha bitekete bitekete pikalaku luya, ne umuangate diakamue ne ambulanse wa ALS ku Tshibambalu tshia malu a mpukapuka tshidi pabuipi, udimuija munganga wa ER ku radio bua kudilongolola bua disama dia tshimpitshimpi dia mudimu mukole, disama dia nsukadi dia bungi, disama dia nsukadi dia bungi, disama dia nsukadi ne disama dia lufu lua bungi (peaked T-waves on 12-lead ECG).

Mutshi wa dipangadika: Disungula dia ku luseke dia mulongi uvua mukuluke (Sekonde 180 ya kumpala)¶

flowchart TD
    Start["Mulongi udi wenza manaya udi upona anyi udi upona panshi padiye wenza manaya anyi manaya"] --> ActivateEAP["Tshitupa 1 (0-10 Sec): Enza EAP wa muaba, Bikila 911, Angata AED wa ku luseke, Kangula biibi bia madimi"]

    ActivateEAP --> CheckResp{"Tshitupa 2 (10-30 Sec): Muena manaya udi wandamuna ne upuyakana bimpe anyi? (Ikala mudimuke bua tshipupu tshia tshimpitshimpi ne tshipupu tshia agonal)"}

    CheckResp -->|"TO: Kakuyi wandamuna ne kubenga kupuyakana / Anu kupuyakana"| SCAProtocol["MUSHINDU WA KUIKA MU MUOYO (SCA) (Kabidi, udi mua kuela meji ne: Commotio Cordis udi mukuate mu tshiadi): Kukosa tshilamba/tshiamu, kutuadija CPR anu ku bianza (100-120/min), Ela AED mu minite isatu"]

    CheckResp -->|"EYOWA: Kupuya ne Pulse"| CheckCNS{"Tshitupa 3: Tangila nsombelu wa lungenyi (CNS) ne luya lua munda mua tshifu: Muena manaya udi mubungame, udi uluangana, udi kayi ne disama, udi mu koma anyi luya lua > 40.5 C (105 F) anyi?"}

    CheckCNS -->|"EYOWA: CNS Dysfunction + High Heat (Core Temp > 40.5 C / 105 F)"| EHSProtocol["EXERTIONAL HEATSTROKE (EHS) PROTOCOL: Kumbusha bintu, kubiteka mu tshina tshia mayi a mashika (1.7-15 C / 35-59 F) anyi TACO Tarp diakamue. KUMPALA (too ne ku 38.9 C / 102 F), KUTUA MUIBIDI"]

    CheckCNS -->|"NO: Awake, Lucid, Oriented, Core Temp < 40.0 C (104 F)"| CheckMuscles{"Tshitupa 4: Mmunyi muvua muena manaya mukuluke, ne mmunyi mudi mishipa ya ku makasa/ya mukolo imvua?"}

    CheckMuscles -->|"Kupueka kunyima kua lubilu; Mifuba idi yumvua mipepele/mitekete; Disama dia mukolo/mu tshiadi/mu makasa didi kadiyi dikole; Tachypnea"| SicklingProtocol["EXERTIONAL SICKLING (ES) CRISIS: Stop Exercise Immediatement, Give 15 L/min Oxygen, Keep Supine/Hydrated, Immediate ALS Ambulance to ER for Rhabdomyolysis & Hyperkalemia ECG"]

    CheckMuscles -->|"Kuteketa mu kanyinganyinga; Mifuba Mikanga mu ROCK-HARD Visibly Knoted Spasms"| CrampProtocol["BIDIMU BIDI BIFUMINA KU MUDIMU: Dikisha mu mundidimbi, ditantamana dia patupu, dilengeja dia mashika, dilengeja dia mukana dia electrolyte (0.5 tsp wa mukele mu 500 mL ya maluvu a manaya)"]

Tshitupa 1: Tshiamu tshia 4-way sideline clinical comparison table (SCA vs. Exertional Heatstroke vs. Exertional Sickling vs. Heat Cramps)¶

Mu lumingu lua kumpala lua ngondo wa muanda mukulu, balongeshi batu batamba kuela meji ne: Exertional Sickling ne: Heat Cramps, anyi batu bafuanyikija ne: Sudden Cardiac Arrest ne: Heat Syncope. Kuvuluka dishilangana dia malu a luondapu mu tshibambalu etshi kudi kupangisha dipanga dia disama dia lufu mu budimi:

Dishilangana dia dimanya dia dikuluka dia tshimpitshimpi dia ku luseke kudi balongi ba manaya (NATA / ACSM / AHA Consensus)¶

Tshitupa 2: Dijika dia mutshima dia tshimpitshimpi (SCA) ne Commotio Cordis pa tshipalu: mukenji wa AED wa minite 3¶

Disama dia mutshima dia tshimpitshimpi ke tshintu tshia kumpala tshidi tshikebesha lufu lua bana batekete, tshidi tshikuata muntu umue pa 50,000 wa banayi ba mu tulasa tua bikadilu ne tua iniversite tshidimu tshionso. Bishilangane na misongo ya mutshima ya bantu bakole idi ifumina ku dikanga dia mishipa ya mioyo, SCA wa bansonga udi ufumina ku disama dia mutshima didi kadiyi dimanyike anyi dia ku nzembu anyi ku dikuma dia tshiadi (Commotio Cordis).

1. Bintu 5 binene bidi bifikisha ku disama dia mutshima dia tshimpitshimpi kudi bansonga badi benza manaya¶

1. Hypertrophic Cardiomyopathie (HCM): Dikola dia mubidi wa mutshima wa ku dia bakaji didi difikisha ku lufu lua Ventricular Fibrillation (VFib) padi adrenaline ubanda mu tshikondo tshia lubilu.
2. Malu adi kaayi makane a mu mishipa ya mu mashi (CAA): Mushipa wa mutshima udi ufuma ku sinus wa aorte mubi udi ufika pankatshi pa aorta ne mushipa wa mu mikolo mu tshikondo tshia dibidija dia mubidi.
3. Disama dia ion-channelopathies ne dia nzembu (Long QT, Brugada, CPVT, ne Wolff-Parkinson-White / WPW): Mitshima idi milongolola bimpe idi yenza circuit muipi wa nzembu muinshi mua dibutuka dia adrenaline.
4. Myocardite Viral Acute: Disama dia mutshima didi kadiyi diumvuika mu mbingu 1 anyi 2 kunyima kua disama dia virus (Coxsackievirus, Influenza, COVID-19, Adenovirus) padi muena manaya upingana ku dibidija dia mubidi padiye wenda ukola.
5. Commotio Cordis (Blunt Chest-Impact Arrest): Bidi bienzeka mu mutshima muimpe 100% padi baseball, mupimbu wa lacrosse, hockey puck, softball, anyi tshifulu tshituta tshimanu tshia tshiadi tshia ku dia bakaji (precordium) mu tshikondo tshia 20-to-40-millisecond ya dibandila dia T-wave (ventricular repolarization), wela mutshima mu tshipupu tshia mu tshiadi.

2. Bua tshinyi balongeshi kabena ne bua kuikala bashima kudi "Seizure Jerks" anyi "Agonal Gasping"¶

Mu tshikebelu tshia video tshia disama dia muoyo dia mu tulasa tua bikadilu ne tua iniversite, bualu bua kumpala buvua bufikishe balongeshi ku dilekela CPR ne kuangata AED buvua ne: maboko ne maulu a muena manaya uvua mukuluke avua anyunguluka bu tshipupu tshia tshimpitshimpi munkatshi mua masekonde 15, ne tshiadi tshiabu tshivua tshienda tshikola ne mupuya mukole. - Mubidi: Padi tshipupu tshia mu tshiadi tshipangisha mashi bua kuya mu buongo, dipanga dia oxygène didi dijula ​​10-to-20-second myoclonic seizure, dilonda kudi brainstem agonal gasping reflexes. - Mukenji wa ku luseke (Inter-Association Task Force Mandate): Muena manaya yense udi upona kayi ne kanyinganyinga (anyi kunyima kua dikuma dia mu tshiadi) ne kayi wenza bualu udi mu disama dia mutshima dia tshimpitshimpi too ne padibu baleja ne: ki mmuomu to. Kokuteka tshintu nansha tshimue mukana muende to, kuindidi bua "tshipupu" tshijike, ne kupitshishi sekonde 60 ukeba tshiadi tshia mutshima to. Tuma AED diakamue, uleje tshifu, ne utuadije kufina tshifu. Padi AED wenza tshipupu mu minite 1 anyi 3 ya dikuluka mu budimi, bungi bua bantu badi bapanduka budi bupita 85% too ne ku 90%.

Tshitupa 3: Tshipupu tshia luya (EHS): dienza dia "Cool First, Transport Second"¶

Tshipupu tshia luya (EHS) udi ubanda bikole mu mu ngondo wa 7 ne wa 8 wa kumpala kua tshikondo tshia manaya a ndundu, a dinaya dia ndundu, ne a manaya a ndundu padi Wet-Bulb Globe Temperature (WBGT) udi upita 27.8 °C to 32.2 °C (82 °F to 90 °F).

1. Bua tshinyi udi ne tshia kuenza mudimu ne tshipiminu tshia luya lua mu tshiadi (Ne bua tshinyi kuela tuishi kakuena kupangisha muntu bua kuikala ne luya to)¶

Miyuki ibidi idi anu ijimija mioyo ya balongi ba manaya mu ngondo wa muanda mukulu: - Myth #1 ("Bikalabu batshidi anu batua tuishi, mbua ditshioka dia luya, ki mbua luya to"): DISHIMI. Dikoba diume (anhidrosis) udi wenzeka mu tshipupu tshia luya tshia kale kudi babedi bakulumpe mu matuku a bungi. Mu Exertional Heatstroke, nsongalume muena manaya udi upatula 1,000+ watts ya luya munda mua biamu bia mudimu udi ubandisha luya luende lua munda mua 37 °C (98.6 °F) ku 41.5 °C (106.7 °F) mu minite 45 eku utshidi anu utua tuishi tua bungi. - Lungenyi #2 ("Wenza mudimu ne tshiamu tshia mpala tshia infra-rouge anyi tshiamu tshia kupima natshi luya lua mu matshi"): DI DISHIMI. Malonga a Korey Stringer Institute adi aleja ne: mpala, ditshi (tympanic), ne biamu bia kupima nabi luya bia mukana bidi bibala 36.5 °C to 38.0 °C (97.7 °F to 100.4 °F) pa muena manaya udi ne luya lua munda mua tshifu ludi lua lufu 41.8 °C (107.2 °F), bualu dibutuka dia tuishi didi dilengeja kikoba. - Netuambe tshinyi pikala tshilongelu tshieba katshiyi ne tshiamu tshia kupima natshi luya lua mu tshiadi mu tshipalu? Eyemena pa Mukenji wa diela meji dia mu lupitadi: Muena manaya yonso udi wenza manaya mu nsombelu wa luya udi ne tshitupa tshia mubidi tshidi katshiyi tshinyanguka (CNS) dipanga dia mudimu (dipanga dia lungenyi, dipanga dia lungenyi, tshikisu, dikuluka, dikuluka, anyi koma kunyima kua dibenga SCA) BIDI ne tshia kuondopibua diakamue ne dibueja dia mubidi mujima mu mayi mashika bu mudibu bela meji ne: ndisama dia luya lua mubidi.

2. Mua kuenza mudimu ne dibuela mu mayi mashika (CWI) Tub anyi TACO Tarp protocole ku luseke¶

1. Kulongolola tshiamu tshia kuowela mâyi kumpala kua kudibidija WBGT > 25 °C (77 °F): Uwuje 380-to-570-litre (100-to-150-gallon) tshina tshia Rubbermaid pabuipi ne ntenta wa dilongesha udi ne mundidimbi ne mayi (10 °C to 15 °C / 50 °F to 59 °F].
2. Umbusha bintu mu tusunsa 60: Umbusha tshifulu, bilamba bia pa makaya, tshilamba, pantalo, bilamba bia ku makasa, ne masosete (wet uniforms trap heat).
3. Ela mu nshingu too ne mu nshingu ne unyunguluka misangu yonso: Ubandishe muena manaya mu tshina tshia mâyi bua mubidi wende, tshiadi tshiende, bikono biende ne maboko ende bikale mu 1.7 °C to 15.0 °C (35 °F to 59 °F) mayi a mashika. Ela tshilamba tshia kuowela muinshi mua maboko onso abidi tshikuate kudi bantu babidi bua kulama njila wa luya pa mutu pa mayi. Utekesha mayi bikole kunyima kua masekonde 30 bua tshitupa tshia ku muelelu tshia kapia katshiyi mua kuenza pa dikoba to.
4. Kulombola tshinyangu tshia mvita: Dikolesha dia buongo ditu misangu ya bungi divuija muena manaya muena mvita. Enza bua bantu 4 bakuate bitekete bitekete makaya ne binu bia muena manaya munda mua tshina tshia mâyi (anyi wenze mudimu ne TACO mushindu wa tarp pa bisonsa). Mu minite 3 to ne ku 5 ya dibuela mu mayi a mashika, dipanga dia lungenyi didi dijika padi mashi a mu buongo apueka.
5. Luya lua diumusha dia tshipatshila (38.9 °C / 102.0 °F): Umbusha muena manaya mu tshina tshia mashika ne umuteke mu tshibandilu tshia ambulanse tshidi tshiindila padi tshiamu tshia rectal tshibala 38.9 °C (102.0 °F) (prevents afterdrop hypothermia). Paudi kuyi ne tshipiminu tshia luya lua mu tshifu, ela mu mâyi munkatshi mua minite 12 too ne ku 15 (anyi too ne padi dikankamika ne lungenyi lutoke bipingana) kumpala kua kubueja mu ambulanse.

Tshitupa 4: Exertional Sickling (HbAS) tshilumbu: bua tshinyi kuela mbila ne: "Push Through the Cramps" kudi kufikisha ku lufu lua hyperkalemia¶

Pabuipi ne 1 pa 12 wa bena Amerike bafike (8%), 1 pa 100 bena Amerika ba mu Hispanique, ne binunu bia banayi ba mu Mediterane, Moyen Orient, Inde, ne Caraïbes badi ne Sickle Cell Trait (HbAS) - mbuena kuamba ne: bavua bapiane gene umue wa hémoglobine (HbA) ne tshintu tshimue tshia hemoglobine (HbS). Mu nsombelu wa ku dituku ne ku dituku, bantu badi ne disama dia Sickle Cell badi ne makanda a mubidi mimpe ne kabena ne disama dia Sickle Cell (HbSS).

Ino, mu tshikondo tshia dienzeja dia bungi, dia tshimpitshimpi dia anaerobe - nangananga dienza dia lubilu lua bungi (gassers, suicides, mat drills), mateta a 1-mile/2-mile a dituku dia kumpala dia makanda a mubidi, anyi dilongolola dia mubidi dia pa mutu kakuyi dikisha - bintu binayi bidi bijula mubidi bidi bisangisha munda mua misunyi ya dikasa ne ya mukolo idi yenza mudimu wa muena manaya: 1. Dipanga dia oxygène mu bitupa bia mubidi (dikuma dia oxygène munda mua quadriceps/hamstrings idi yenza mudimu); 2. Acidose lactique mikole (pH wa mifuba udi upueka kuinshi 7.0); 3. Dipanga dia mayi mu selile (hyperosmolality munda mua mifuba); ne 4. Luya lua mubidi lua bungi.

Tetrad eu udi wenza bua globules rouges ya muena manaya apatuke mu tshimpitshimpi kumbukila ku diske dimpe ne dipepele bua kulua "sickles" mikole ne milamakaja. Mu minite 2 to ne ku 5, globules rouges eyi logjam ne occlude capillaires microscopiques idi idisha mishipa minene ya mu nshingu, ya mu nshingu, ya mu nshingu, ne ya ku nshingu (acute ischemic rhabdomyolysis). Bu mudibu kabayi ne mashi ne oxygène, selile ya mifuba idi ipasuka mu tshibungi, ipatula bungi bua bungi bua Potassium (K+) ne Myoglobin buludiludi mu mashi. Shi mulongeshi wenzeja muena manaya udi kayi ne bukole bua kupingana pa mulongo ne kunyema lubilu lukuabu, serum potassium udi upita 7.0 to 9.0 mEq/L, udi ufila disama dia mutshima didi dishipa bantu (sine-wave ventricular fibrillation or PEA) pa budimi.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

Nkonko itubu bela misangu ya bungi¶

Netuambe tshinyi pikala bena mudimu ba EMS bafika mu tshipalu ne balomba bua kuela muena manaya wetu wa Exertional Heatstroke mu mashinyi a lupitadi diakamue kumpala kua luya luende lua munda lupueka?¶

Mulongeshi wa manaya wa tulasa tuonso (ATC) ne munganga wa tshisumbu badi ne tshia kuenza tshipungidi tshifunda kumpala kua tshikondo tshia manaya ne mulombodi wa malu a luondapu wa muaba udibu basombele. Muinshi mwa meyi a tshisumbu tshia ba munganga tshia mu ditunga dia EMS (NAEMSP), a American College of Emergency Physicians (ACEP), ne a NATA, badi bambila baminganga bua **kuambuluisha ne dilengeja dia tshina tshia mâyi mashika (CWI) (padibu batuadija tshiamu tshia IV ne tshiamu tshia kutangila natshi muoyo ku luseke lua tshina tshia mashika) too ne padi luya lupueka 38.9 degre Celsius (102.0 degre Fahrenheit) KUMPALA kua kubueja mubedi mu ambulanse**. Shi ba munganga ba EMS ba muaba utudi balomba bua kuya nabu diakamue kumpala kua tshina tshia mâyi kuikalatshi tshilongolola, enza mudimu ne mushindu wa **TACO (kubuikila mabeji a mashika/mashinyi adi ne mabue a mashika pa muena manaya udi butaka)** ne manyisha tshibambalu tshia malu a mpukapuka tshidi tshipeta tshina tshia mâyi a mashika tshidi tshiindila ku tshiibi tshia nzubu wa ambulanse.

Bua tshinyi matuku 5 a kumpala a mu ngondo wa muanda mukulu a manaya a ndundu anyi a dinaya dia ntanta mile adi matuku a bungi a lufu bua Heatstroke ne Exertional Sickling?¶

Pa mutu pa **75% ya bantu badi bafua mu tulasa tua bikadilu ne mu tulasa tua bikadilu tudi tufua mu matuku 4 a kumpala a dibidija dia mubidi kumpala kua tshikondo tshia mudimu**. Mu mubidi, mubidi wa muntu udi dijinga ne **matuku 10 too ne ku 14 adi alondangana a kuikala ne luya lua bungi ("Heat Acclimatization")** bua kubandisha bungi bua mashi a mu plasma ku 12% too ne ku 15%, kukepesha tshipiminu tshia luya tshidi tshituadija kuela tuishi, kuvudija bungi bua tuishi tudi tupatuka, ne kulama sodium wa tuishi. Padi mulongi udi kayi mumanye mua kupatuka mu nzubu udi ne tshiamu tshia mashika mu dituku dia kumpala ne wenza manaya a mêba 3 mu bilamba bionso anyi mu manaya a mashika ("serial gassers"), tshitupa tshiabu tshia muoyo katshiena mua kumbusha kapia anyi kulama oxygène wa mu mifuba to. Ke bualu kayi mikenji ya NATA ne ya NFHS idi ikandika dienza dia manaya abidi ku dituku mu matuku adi alondangana, ikandika bilamba bia kudikuba nabi bionso mu matuku 1 too ne ku 5, ne ikandika mateta a dibidija dia mubidi mu dituku dia 1.

Mmunyi mutudi mua kuenza mudimu ne Wet-Bulb Globe Temperature (WBGT) metre ku luseke, ne bua tshinyi udi muimpe kupita "Heat Index" wa tshiamu tshia ordinatere tshia malu a mvula?¶

"Tshimanyinu tshia luya" tshia pa tshiamu tshia mvula tshidi tshibala pa kuela meji ne: udi musombe mu mundidimbi wa **100% ne lupepele lutekete** - tshidi tshilengulula **mutoyi wa dîba udi ufila kapia ka mu tshisuku tshia mîdima** ne **dikanga dia lupepele lua tshipalu tshia muaba udibu basombele**. Tshintu tshia ku bianza tshia **Wet-Bulb Globe Temperature (`WBGT`) metre** udi ne bintu bisatu bishilangane: **(1) Temperature wa Bulb muume** (`10%`), **(2) Luya lua bule bua bule (`70%`)** kupima bukole bua mashika adi afumina ku luya ne lubilu lua lupepele, ne **(3) Luya lua Black-Globe (`20%`)** kupima luya lua dîba ludi lupatuka pa buloba. Padibu ku luseke `WBGT` udi ufika ku **`27.8 °C to 30.0 °C (82 °F to 86 °F)`**, dikisha dia minite 15 dia mashika didi ne tshia kuenzeka dîba dionso; dîba kayi `WBGT` udi upita **`32.2 °C (90.0 °F)`** (anyi kuinshi mu miaba ya mashika ya ku nord), bionso bia kuenza pambelu ne dilengeja dia mubidi bikole bidi ne tshia kuimanyika anyi kubueja mu nzubu.

Shi mulongi udi wenza manaya mumanye ne udi ne ngikadilu wa Sickle Cell (HbAS), mbabakandike bua kunaya manaya a tulasa tua bikadilu anyi?¶

Tòo - **kakuena muena manaya udi ne ngikadilu wa Sickle Cell (`HbAS`) udi anu mupangile mu manaya onso**. Binunu ne binunu bia NCAA ne bena manaya bapiluke batu baluangana bimpe ne Sickle Cell Trait dituku dionso. Pamutu pa nanku, kumanya muena manaya `HbAS` nsombelu udi ufila bukenji kudi balongeshi ne balongeshi ba manaya bua kuenza mudimu ne **Sickle Cell Trait Precautions**: **(1)** Kuanyishila muena manaya bua kuibaka dibidija dia mubidi ku kakese ku kakese pamutu pa kuenza mateta a dituku dia kumpala dia mile/gasser; **(2)** Kuvudija bikondo bia dikisha ne bia dikisha pankatshi pa dipingaja dia lubilu; **(3)** Kulekelela muena manaya bua kunyema lubilu mu tshikondo tshia luya lua bungi anyi muaba mule (`above 1,500 meters / 5,000 feet`); **(4)** Kujadika dilama dia mayi; ne **(5)** Kupesha muena manaya bukole bua kupatuka mu manaya onso dîba didiye umvua butekete bua pa buabu bua dikasa, tshiadi anyi tshia muinshi mua tshiadi kayi utshina dinyoka.

Tudiku mua kumbusha tshifulu tshia muena manaya a ndundu anyi a lacrosse mu tshipalu padiye ne disama dia mutshima dia tshimpitshimpi anyi dia tshimpitshimpi anyi?¶

Eyowa. Mu **Exertional Heatstroke (`EHS`)**, kakuena disama dia mu tshiadi to, ne tshifulu ne bilamba bia ku makaya bidi bikuata kapia: **umbusha tshifulu ne bia ku makaya diakamue** kumpala kua kupuekesha muena manaya mu tshina tshia mâyi mashika. Mu **Dijika dia mutshima dia tshimpitshimpi (`SCA`)**, pikala muena manaya mukuluke kayi ne disama dia mu nshingu anyi ku mutu, **kosa tshilamba ne mionji ya kumpala ya bilamba bia ku makaya diakamue bua kuleja tshifu tshidi katshiyi ne tshintu bua kuteka tshilamba tshia CPR ne tshia AED**, ne umbusha tshilamba tshia ku mpala (`or helmet/pads`) bua dipepula dia mu njila wa luya pikala **kayi ulengulula nansha kakese bua kutuadija dikuma dia tshiadi anyi difila dia tshipupu tshia AED**.

Dilongesha didibu balomba: Nsonga yonso, mulongeshi wa tulasa tua bikadilu, ne mulongeshi wa tulasa tua bikadilu, arbitre, ne muledi udi ku luseke badi ne bua kujikija CPR, AED, ne tulasa tua diambuluisha dia kumpala dia manaya ku diambuluisha dia Croix-Rouge wa mu Amerike, Association wa muoyo wa mu Amerike, Ambulance wa St John, anyi National Federation of State High School Associations (NFHS Learn), ne kulonga Mulongo wa malu a tshimpitshimpi (EAP) ne tshiamu tshia kubandila kumpala kua dibidija dia kumpala dia tshikondo tshionso.

Malu adi apetangana¶

• Bulombodi bua CPR ne AED
• Disama dia luya ne ditshioka dia luya
• Disama dia tshimpitshimpi, rhabdomyolyse, ne dienza dia mashi mafiike
• Disama dia ku mutu ne disama dia mutshima diambuluisha dia kumpala
• Nomba ya tshimpitshimpi ne dituma dia matunga makuabu

Miaba ne buludiki bua mbulamatadi¶

• National Athletic Trainers' Association (NATA, United States): Position Statement: Exertional Heat Illnesses (Rectal Thermometry Standard and On-Site Cold-Water Immersion "Cool First, Transport Second" Mandate) and Consensus Statement: Acute Management of the Injured Illnessed Ill-Illed Athletes (NATA, United States, AHSC, ne Exertional Sickling Triage).
• Korey Stringer Institute (KSI, University of Connecticut) & American College of Sports Medicine (ACSM): Mêyi a buobumue pa bidi bitangila dilama dia luya lua mubidi kumpala kua lupitadi, dienza dia mashika dia diambuluisha dia tshiamu tshia nzembu (TACO), ne mikenji ya dilengeja dia luya lua mu tshilongelu tshinene tshia ditunga (WBGT).
• Kasumbu ka bena mudimu ba mu bisumbu bua kuepuka lufu lua tshimpitshimpi mu tulasa tua bikadilu ne mu tulasa tua bikadilu (NCAA / NATA / NSCA / American Heart Association): Malu adibu bafila bua kumanya ne kulama disama dia mutshima dia tshimpitshimpi (3-Minute AED Target, Myoclonic Seal Seal Gaser/Agon Recognitional Recognitional Gation) ne Rhabdomyolysis / Sickling in Athletes with Sickle Cell Trait (HbAS).
• Tshilongelu tshia baminganga ba mu tshimpitshimpi tshia mu Amerike (ACEP) ne tshisumbu tshia baminganga ba mu tshimpitshimpi (NAEMSP): Mukanda wa malu a mikenji ne wa dilongesha: Dilama dia tshipupu tshia luya kumpala kua lupitadi (Kujikija dibuela mu mayi mashika kumpala kua kuya ne mashinyi a lupitadi lua EMS).
• Bibambalu bia diluisha ne dikuba dia masama (CDC, États-Unis): Disama dia luya munkatshi mua banayi ba mu tulasa tua bikadilu ne ngikadilu wa Sickle Cell Trait (HbAS) Dikuba dia mubidi.