Tampon yagumye, Igikombe co mu kwezi gifatanye, n'Ivyihutirwa vy'Umubiri w'Amahanga¶

Kumenya ko igitambaro co mu nda gifise umugozi utariho, igikombe co mu kwezi kinyobwa neza, agakingirizo kanyuze canke ikintu c’amahanga co mu nda bidashobora gukurwamwo bitagoranye, biratuma umuntu agira ubwoba bwinshi kandi akagira isoni. Ukwo gutera isoni kenshi gutuma abantu bakora amakosa ateye akaga mu vy’ubuhinga mu bwogero: gutera cane ku nzira y’igikombe c’imihango gipfungiwe n’ubusa (kikwegera umutwe w’igitereko hasi kigatuma umuntu agira ibikomere bibabaje cane), kwinjiza kichezers,en ptweers, igitsina canke igitsina c’umugore, canke gutevya kwivuza igikoresho co mu nda canke igitsina c’umugore gigumye gushika aho umuntu agira indwara y’ubumara (TSS) canke gutoboka kw’amara kwica. Mu buryo bw’umubiri, umuyoboro w’igitsina ni umufuko w’imitsi wugarijwe, ufise iherezo ry’impumyi (7 to 12 cm / 3 to 5 in deep) irangizwa n'umunwa ukomeye, bisobanura nta kintu na kimwe gishobora kwigera "kizimira imbere mu nda" biciye mu gitereko, kandi ibintu vyinshi vyo mu gitereko bitagira ububabare bishobora gukurwamwo ata nkomanzi muhira hakoreshejwe ugupfukama kure cane n'intoke zibiri zisukuye. Mu buryo butandukanye n’ubwo, igihimba c’irondoka gifunguka kija hejuru kija mu gitereko c’imbere gikomeye kandi gikikujwe n’ibihimba vy’irondoka bikomeye ivyo mu nda n’ivyo hanze, ivyo bikaba bija mu nzira ikomeye nk’urutare maze bikanyonka ibintu bimeze neza bishika hejuru cane mu gitereko c’irondoka. Kugerageza gufata umubiri w’amahanga wo mu nda muhira ukoresheje ibikoresho, canke gufyonda igikombe c’ibirahuri gifise umwobo, bishobora gutuma gutobora uruhome rworoshe rw’urutirigongo rwitwa sigmoïde ruja mu mfuruka y’urutirigongo, bikaba bishobora gutuma umuntu apfa. Huza ukwitwararika kwawe n' indwara y'ubumara (TSS) amabendera atukura, sepsis n'uguhungabana, na kuva amaraso mu nda, hanyuma uhamagare aho uba inomero z'ivyihutirwa (911 muri Leta Zunze Ubumwe za Amerika na Kanada, 112 mu bihugu vyose vy’Ubumwe bw’Uburayi, 999 mu Bwongereza) ubwo nyene iyo habonetse ibendera ry’umutuku ry’ugutoboka canke ry’ugusenyuka kw’ibisebe.

Ivyo ubikore ubu¶

1. NTUKIGEZE winjiza ivyuma, amapinze, amapense, umukasi, amakoti, canke inzara zisongoye mu gitereko canke mu gitereko. Ibikoresho vyo mu nzu biranyerera ku mubiri utose maze bikaca mu gitereko c’inyuma c’igitsina canke mu ruhome rw’igitsina, bikazana amaraso menshi mu gitereko canke mu gitereko. Koresha intoke zisukuye gusa, zoshe zifise imisumari ishaje kugira ngo ushobore gukura igitsina ata ngorane, kandi ntiwigere ugerageza gukura n’amaboko canke n’igikoresho umubiri w’amahanga wo mu nda uri mu nda canke ushobora gusenyuka.
2. Uce usuzuma ubwo nyene "Icumba c'Ivyihutirwa Ubu" Ibendera Ritukura (Indwara y'Ugutoboka canke y'Uguhungabana kw'Ubumara) hanyuma uhamagare 911 / 112 / 999 canke ugende kuri ER nimba hari UWO ARI WESE ariho:
3. Umuriro mwinshi utunguranye (\(\ge 38.9 degrees C / 102.0 degrees F\)), urukoba rutukura rukwiragiye "rumeze nk'urw'izuba", gukorora, gucibwamwo amazi, kubabara cane mu mitsi, canke gusinzira iyo uhagaze mu gihe tampon, igikombe, canke igiponji co ku ruhande rwa Sho [ITSS]**).
4. Ububabare bukomeye, bukomeye bwo mu nda, inda ikomeye imeze nk’urubaho, ububabare bushika ku rutugu, amaraso atukura cane ava mu nda, canke gusinzira inyuma y’aho umuntu abonye ikintu kitari co mu nda canke mu nda (Bowel or Vaginal Vault Perforation / Peritonitis).
5. Ikintu cose c’ikiyo, itara, ikintu c’ibara ry’agahama/ibara ry’agahama, ikintu gisongoye, canke bateri ivuza imbere mu nzira y’amaraso canke mu gitsina (akaga ko gumenagurika cane no guturika n’imiti: NTUSUNIKE, NTUFYENYE, canke ngo ushireko).
6. Ikintu gifise imoteri kinyiganyiga kigica kiriko kiragenda imbere mu gitereko canke mu gitereko (ugunyiganyiga kw’incuro nyinshi ku nzira y’amabere bitera pressure necrosis n’ugutoboka mu masaha makeyi).
7. Kugira ngo ukureho igikombe c'imihango gifatanye: Uhagarare hasi, ushire hasi buhoro buhoro, hanyuma ushire urutoke rumwe hejuru iruhande y'uruzitiro) kugira ngo umene ikidodo c'ubusa IMBERE yo gukurura hasi. Ntukigere ukura ugororotse hasi ku giti c'i silikoni gitoyi mu gihe igikombe kiriko kirazunguruka. Gukwega uruti ku kidodo c’ubusa kitagiramwo ikibazo bikora nk’igikoresho co gutera ku mutwe w’igitereko cawe.
8. Kugira ngo ubone Tampon (umugozi wazimiye) canke agakingirizo kavuye mu gitereko: Ibuka ko igitsina ari umufuko upfutse. Woze ibiganza vyawe, winjire mu kuguru kw’igikere (canke wicare ku bwiherero ibirenge vyawe biduzwe ku ntebe y’ibirenge nk’aho ufise imitsi y’ibirenge). kwinyiganza (ivyo bikaba bisunika umunwa w’inda n’igitambaro co gupfuka umutwe ku masentimetero 3 gushika ku 5 hafi y’aho bifungukira), ushiremwo intoke zibiri zisukuye zifise amavuta (index and middle) ku ruhome rw’inyuma rw’igitsina gushika ku gice c’inyuma c’igitsina c’umugore kiri inyuma y’umutwe w’igitsina, hanyuma ukubura iyo tampon canke agakingirizo hagati y’intoke zawe zibiri nk’inkoni zo gukubura.
9. Ku mubiri w’amahanga wo mu nda udaca ata ngorane ku bwiherero bwa mbere bwiza: HAGANIKA gukora, guma ukora NPO (ZERO ivyokurya, ZERO amazi, ZERO imiti yo gusohora, ZERO enemas), hanyuma ugende ugororotse ku bitaro vy’ubuvuzi bw’ivyihutirwa. orwahin ashotero-d wedged rectal foreign body yubaka umuvuduko w’amazi uturika imbere mu nzira y’amaraso upfutse uruhome rw’amara.
10. **Iyo agakingirizo kavuye canke kavunitse imbere mu gitereko mu masaha 72 gushika ku 120 aheze: Rondera impanuro z’uburyo bwo kwirinda gutwara inda vyihutirwa n’uburyo bwo kwirinda gutwara inda bwihutirwa (levonorgestrel mu masaha 72 canke **ulipristal aceta,L/UD2) n’Ukwirinda SIDA Inyuma yo Gushikirwa n’Umugera wa SIDA (mu masaha 72 iyo hari ingorane nyinshi) ni ivy’igihe gihambaye inyuma yo gukuraho agakingirizo kagumye.

Igiti c'ingingo: Umubiri w'amahanga wo mu gitsina n'uwo mu nda n'ugutoranya ibintu vyo mu kwezi¶

Koresha iki kigereranyo c’ubuvuzi kugira ngo umenye nimba ikintu gishobora gutorwa muhira ata nkomanzi n’intoke zisukuye canke gikeneye kwitaho vuba n’Igisata c’Ibitaro vy’Ivyihutirwa.

flowchart TD
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    RedFlags -->|"EGO ku Ibendera ryose ry'Umutuku"| GoER["UMUGAMBI WO GUSHIRA MU BITARI VYIHUTIRA (Hamagara 911 / 112 / 999):; 1. NTUKURE, ntufye, canke ngo ushire; 2. Gumana NPO (Zero ivyokurya, amazi, imiti yo gukura amaso, canke enemas); 3. Niba TSS ikekwa & tampon ishobora gushikwako bitagoranye n’urutoke, uyikureho buhoro buhoro; 4. Genda mu bitaro vya ER kugira ngo baguhe imiti irwanya indwara / babaga canke bakuremwo endoscope"]

    RedFlags -->|"NTA mabendera atukura"| Location{"None ico kintu cagumye kiri hehe?"}

    Location -->|"1. Igitsina: Igikombe canke Disiki y'Imihango Ifatanye"| CupSteps["UMUGAMBI WO KUNYUNGA-GUREKURA IKINYOMA C'UMUGAMBI MU MUTEGEKO:; 1. Uruhuke iminota 15 (ubwoba burakomeza imitsi yo mu gitereko); 2. Gukaraba ibiganza; kwinjira mu gupfukama cane mu gukaraba gushushe canke ibirenge ku ntebe; 3. Gutera hasi buhoro buhoro (‘poop push’) kugira ngo ugende igikombe hasi 3-4 cm; 4. PINCH BASE y’igikombe neza (canke ushire urutoke 1 hejuru y’uruzitiro rwo hejuru) kugira ngo wumve/wumve umuyaga uvunika; 5. Urutare uruhande-ku-rundi mu C-fold maze ushire hanze ukomeze guhagarara"]

    Location -->|"2. Igitsina: Tampon yagumye (Umugozi wazimiye) canke agakingirizo kanyereye"| TamponSteps["GUKUBURA MU GIHUGU BIRI MU NTOKE ZIBIRI (Anatomie y’Isaho Ifunze):; 1. Gupfukama cane no kwikorera hasi buhoro buhoro kugira ngo ushire hasi umunwa w’inda; 2. Siga amavuta meza ku ntoke z’urutoke n’izo hagati n’amavuta akoreshwa mu mazi; 3. Gushika ku ruhome rw’inyuma mu gice c’inyuma c’umubiri (inyuma y’umutwe w’igitereko); 4. Gufata tampon/agakingirizo hagati y’intoke zibiri hanyuma ukayinyerera hanze; 5. Raba ubuvuzi mu masaha 24h nimba udashobora gushika canke nimba amazi asohoka aguma asohoka"]

    Location -->|"3. Rectum: Umubiri wose wo mu mahanga ufatanye hejuru y’umutsi w’umubiri"| RectalSteps["UMUGAMBI WO GUKURAMWO IVYITURWA MU BITARO:; 1. NTUKIGEZE winjiza ibikoresho, intoke, enema canke imiti igabanya ububabare; 2. Gukomeza gukora NPO (Nta vyo kurya canke ivyo kunywa iyo bikenewe guterwa umuti wo gutera umutwe); 3. Injira utuje & ubwire umuforoma w’ivy’ugupima ‘Umubiri w’amahanga wo mu nda’; 4. ER ikora X-ray yo mu nda + gukuraho umutsi w'umubiri udatera ububabare"]

Igice ca 1: Ukuri kw'Imibiri: Igituma Igitsina ari Cul-de-Sac Yugarijwe, Rectum na yo ikaba ari Igipfukisho c'Ubusa¶

Gutahura neza neza uko igihimba c’irondoka c’umugore giteye n’igihimba c’irondoka bikuraho 90% vy’ubwoba bukikuje ibintu vyo mu nda mu gihe umuntu asigura igituma ibintu vyo mu nda bisaba kwitaho mu bitaro:

Igice ca 2: Intambwe ku yindi: Uko wokuraho igikombe c'imihango "Cifatanye" canke giteye hejuru (Guca ikidodo c'ubusa)¶

Igikombe c’imihango c’i silikoni canke TPE gikora mu gukora ikidodo co kunyonga c’umuvuduko mubi kidashobora gushikamwo umwuka ku mpome zo hejuru z’igitsina kiri munsi gato y’umutwe w’igitereko (bitandukanye n’igikombe c’imihango** gisanzwe, kikaba cicara gipfutse inyuma y’igufa ry’igitsina ataco kinyota). Iyo ufashe uruti rworoshe rwo hasi rw’igikombe c’imihango kinyobwa maze ukagikwega kigororotse, ico kidodo kidashobora gushikamwo umwuka gikora nk’igikombe co kunyobwa gifatanye n’ibirahuri, kigakwegera ku mutwe wawe w’igitereko no ku gitereko c’igitsina, kigatuma ugira ububabare bukomeye, kandi kikanka guhungabana.

Kurikiza iyi nzira y’ubuvuzi y’intambwe 5 kugira ngo urekure igikombe c’imihango kiri hejuru canke gipfutse cane ata kubabara:

1. Intambwe ya mbere: Hagarika gukurura maze ufate akaruhuko k'iminota 15 nimba igihimba c'irondoka cawe gifatanye:
2. Igikombe co mu kwezi gishobora kuguma imbere ata nkomanzi gushika amasaha 12, rero nta nkeka ko kwihuta mu gahinda. Iyo ucitse intege inyuma y’iminota 5 wimba, imitsi yawe yo mu gitereko irafata hasi nk’ikiganza, igasunika igikombe mbere kikaja hejuru cane. Haguruke, woge canke woge mu mazi asusurutse, hanyuma uhumeke buhoro buhoro mu nda iminota 15.
3. Intambwe ya 2: Injira mu Squat Ikomeye maze Ushire Hasi Mu Muziki ("Genda Igikombe Hasi"):
4. Ntugerageze gukuraho igikombe kirekire mu gihe uhagaze ukuguru kumwe gushize hejuru canke wicaye uhagaze neza. Upfukame gushika hasi mu gikarabiro (canke wicare ku bwiherero amavi yawe aduzwe hejuru ku ntebe yo mu bwogero).
5. Fata impwemu ushire hasi n’imitsi yawe yo hasi yo mu nda n’iyo mu gitereko (ukwo nyene gusunika hasi mu buryo buyoroshe gukoreshwa mu gusohoka canke gusunika umwana). Gutwara hasi bigabanya umuyoboro w’igitsina sentimetero 3 gushika kuri 5 (1,2 gushika kuri 2 inches) kandi bisunika hasi y’igikombe gushika hasi cane yerekeza ku bwinjiriro bw’igitsina.
6. Kora 3 gushika kuri 5 rhythmic pushes, ufate neza umutwe w’uruti n’intoke zawe gusa kugira ngo igikombe ntikisubire hejuru iyo uhumekera (ntukikure uruti).
7. Intambwe ya 3: Ushire Ishingiro neza CANKE Ushire Urutoke Rumwe rw'Index Gushika ku Rubavu kugira ngo Umene Ikidodo co Kunyota:
8. Uburyo A (The Two-Finger Base Pinch): Igihe umaze gutera hasi, ushire urutoke rwo hasi rw’igikombe aho ushobora kugishikako, ushire urukumu rwawe n’urutoke rw’ikigereranyo hejuru urenga uruti maze ushire umubiri wo hasi/urutoke rw’igikombe hamwe neza kugira ngo ushiremwo urutoke rwo hasi rw’igikombe. Kenshi uzokwiyumva canke wumve aka pop canke squelch gatoyi uko umuyaga wiruka urenga uruzitiro ukamenagura ubusa.
9. Uburyo B (Urutoke Rumwe rw’Igikombe ku Bakoresha Urutoke Rurengeye): Nimba gufata urutoke rwo hasi biguma bitavuna ikidodo gikomeye gikikuje urutoke rumanitse hasi, n’ushire urutoke rumwe rw’urutoke rusukuye gushika hejuru ku ruhande rw’igikombe gushika urutoke rwawe rushitse ku **urutoke rwo hejuru, hagati y’igikombe kugira ngo umwuka winjire.
10. Intambwe ya 4: Ushire mu "C-Shape" Idasanzwe maze Uyiterere ku ruhande ku rundi ("The Shimmy"):
11. Gukomeza gufatanya urutoke hagati y’urukumu rwawe n’urutoke rw’ikigereranyo (canke ukazipfunyariza gatoyi n’urutoke rwawe rwo hagati mu buryo buke C igishushanyo), uzunguze igikombe ku ruhande ku rundi (left-to-right canke front-to-back) uko uyiyobora hasi no hanze mu mfuruka gatoyi y’inyuma-hanyuma-imbere, ukayigumiza igororotse kugira ngo ibirimwo bimeneke mu bwiherero canke mu nzira y’amazi yo mu bwogero.
12. Intambwe ya 5: Uko wofungura Disiki y'Ukwezi (Nta Kunyota Bikenewe):
13. Niba ukoresha idisiki y’imihango ifise uruzitiro aho gukoresha igikombe gifise ishusho y’inkengeri, wibuke ko ata kidodo co kunyonga co gupfukamira: wikubita hasi cane, ushire hasi cane kugira ngo ushire uruzitiro rw’imbere uvuye inyuma y’inyuma y’igiti c’amagufa y’igitsina cawe**, ushire urutoke rumwe rw’urutoke munsi (canke hejuru) y’uruzitiro rw’imbere maze urushire hanze, hanyuma ushire urudodo rugororotse.

Igice ca 3: Gukuraho Tampon yibagiwe / yagumye, umugozi wazimiye, canke agakingirizo kanyereye¶

Kimwe mu bihe vyihutirwa vy’abaganga b’abagore bikunze kubaho ni iyo umuntu yinjije igitambaro gishasha mu mpera z’imihango yiwe atazi ko igitambaro ca kera kikiri imbere, canke iyo umugozi w’igitambaro ucitsemwo canke wihishije imbere mu gihe co gusohora canke co gukora imibonano mpuzabitsina.

1. Kumenya Ibimenyetso vya kera vy’Igikoresho co Gukingira Igikoko Cibagiwe¶

Iyo tampon igumye imbere mu gitsina amasaha arenga 24 gushika kuri 72+ (rimwe na rimwe imara indwi canke irenga umuntu atazi igituma afise ibimenyetso), imigera y’igitsina isusurutse iragwira ningoga imbere mu nsinga za rayon/cotton zitobowe n’amaraso: - Impumuro y'Igitsina idashobora kwihenda, Iboze, canke "Inyama Iboze / Ifi" itera bukwi na bukwi mu masaha 24 gushika kuri 48. - Ibiva mu nda vy'amazi vy'inzobe, vy'umuhondo mwiza, vy'imvi, canke vy'ibisebe (bisa n'ibisebe) biva mu nda. - Ukwuzura kw’igihimba c’irondoka canke umuvuduko mutoyi (kenshi n’ubushuhe busanzwe rwose n’ububabare butagiramwo ububabare iyo bitagoye, canke biherekejwe n’umuriro mwinshi utunguranye n’ibisebe iyo bigenda biratera imbere gushika ku Toxic Shock Syndrome).

2. Uko wogarura neza Tampon canke agakingirizo ukoresheje intoke zisukuye¶

Niba ufise ibimenyetso vy’indwara ya Toxic Shock Syndrome (nta muriro, nta n’ibisebe, nta n’ugusinzira), gerageza iyi minota 3 yo gusubira muhira rimwe imbere y’uko uja ku kigo c’ubuvuzi bwihutirwa: 1. Woze neza ibiganza vyawe n'amazi n'isabune kandi urabe ko inzara zawe zigufi kandi ziryoshe. Siga itosi ry’ubuntu ry’amavuta y’amazi (canke amazi asusurutse asukuye) ku intoke zawe z’urutoke n’izo hagati. 2. Assume the Deep Frog-Leg Squat: Upfukame hasi amavi yawe atandukanye cane, ibirenge vyawe bibe hasi, hanyuma wikore hasi buhoro buhoro nk’aho woba uriko urasunika amaso. 3. Gukubura igihimba c'inyuma (Inyuma y'umunwa w'inda): - Injiza urutoke rwawe rw’urutoke n’urwo hagati gushika hejuru y’igitsina (7 to 10 cm / 3 to 4 inches). - Uzokwiyumva igihimba c’umubiri citwa cervix yawe giteye neza, gikomeye, kizunguruka (kimeze nk’isonga ry’izuru). - Ushike mu mufuko ugoramye ushitse INYUMA y’umutwe w’igitereko kandi munsi gatoyi y’umutwe w’igitereko (fornix posterior) hanyuma ukure mu nziga y’ubugwaneza ukikuje impande z’umutwe w’igitereko (lateral fornices). Akenshi igitambaro gishaje gipfutse kimeze nk’igipande c’ipampa gitose kandi gikomeye gipfutse ku ruhande inyuma y’umutwe w’igitereko, mu gihe agakingirizo kanyuze kimeze nk’impeta y’umupira yoroshe kandi inyerera. - Fyonda tampon canke agakingirizo hagati y’ibipande vy’urutoke rwawe rw’urutoke n’urwo hagati (nk’inkoni) canke ushire urutoke rumwe inyuma yarwo maze urushire hanze buhoro buhoro. 4. Ntukigere Ukora Douche Inyuma yo Gukuraho Tampon ya Kera: - Iyo umuntu amaze gukuraho tampon igumye ifise umunuko mubi, umunuko n’ibisohoka bica bivaho mu masaha 24 gushika kuri 48 uko ibimera vy’amagara y’igitsina Lactobacillus bisukura umugende. Ntukigere ukoresha amazi yo gukaraba igitsina, amazi yo gukaraba inkari, canke isabune imbere mu gitereko, kuko gukaraba bituma imigera yo hejuru ija hejuru biciye mu munwa w’igitereko ikaja mu gitereko (bigatuma umuntu arwara indwara y’umururumba wo mu gitereko) kandi bikakuraho ibimera vy’aside bikingira. - Igihe co kubonana n’umuganga canke ivuriro: Niba udashobora kwumva canke gukuraho iyo tampon inyuma y’ukugerageza incuro 2 canke 3, nimba utazi neza 100% nimba hari igice ca kabiri gisigaye imbere, canke nimba amazi asohoka, ububabare bwo mu gitereko, canke umuriro ugumaho amasaha 24 inyuma yo gukuraho, genda ku muganga w’abagore canke umuganga w’abagore yihutirwa Gukuraho igipimo c’amasegonda 30.

Igice ca 4: Ivyihutirwa vy’umubiri w’amahanga wo mu nda (Igituma gukura mu bitaro bikiza ubuzima bwawe)¶

Ibisata vy’ubuvuzi bw’ivyihutirwa kw’isi yose biravura abarwayi ibihumbi n’ibihumbi buri mwaka kubera ibihimba vy’umubiri biva hanze bigumye (kuva ku bikinisho vy’abantu bakuze bitagira ishingiro rihagije ry’umuriro, inkoni zo gutera imitsi, n’ibikoresho vyo gutera umuti w’amaraso gushika ku macupa, ibibindi vy’imiti yo gukurako umunuko, imboga, n’ibikoresho vy’ibirahuri).

1. Kubera iki udakwiye kwigera wumva isoni zo kwinjira mu bitaro vy’abarwayi bikomeye ubwo nyene¶

Ikintu kimwe gusa cica abantu mu gihe umuntu afise umubiri w’amahanga mu nda ni ugucererwa amasaha 12 gushika kuri 48 muhira bitewe n’isoni, bifatanijwe n’ukugerageza gusenyura gucukura ico kintu hakoreshejwe ibikoresho. - Uko abaganga n’abaforomo b’ibihe vyihutirwa bavyifatamwo mu vy’ukuri: Ku muganga wo mu cumba c’ivyihutirwa n’umuforomo w’ivy’ugutoranya, umubiri w’amahanga ufatanye n’umubiri ni uburyo busanzwe, busanzwe, nta ntandukaniro itandukanye mu vy’ubuvuzi n’ugukuraho igiti c’ibitoke mu muyoboro w’ugutwi canke kugabanya urutugu rwacitse. Ukingiwe n’amategeko akomeye agenga ivy’ubuzima bwite bw’ubuvuzi (HIPAA / GDPR / Ibanga rya NHS). - Ivyo wovuga kuri ER Triage Desk: Ntukeneye gutanga ijambo rirerire mu cumba co kurindiriramwo cuzuye abantu. Gusa n’uhe umuforomakazi w’ivy’ugutoranya aka gatabo kuri telefone yawe canke uvuge mu gacerere uti:

"Mfise umubiri w'amahanga wo mu nda wagumye winjiye imbere [X] amasaha aheze. Ukozwe muri [silicone / plastique / ikirahuri / ivyuma], kandi nagumye ndi NPO (ntaco ndya canke nnywa)."

2. Kubera iki gukura umuntu mu bitaro bikora iyo igerageza ryo mu rugo ridashobora¶

Muhira, imitsi y’igihimba c’irondoka irafungana n’ububabare bubabaje (hypertonia) kandi igihimba c’umubiri citwa sigmoïde kiri hejuru y’ico kintu kigatuma haba urufunguzo rwo kunyonga. Mu gisata c’Ivyihutirwa, abaganga barafise ivyiza bine bihambaye cane: 1. Imishwarara y’inda n’iy’igihimba c’irondoka: Imbere y’uko umuntu akora ku nzira y’umubiri, umuganga ategeka ko umuntu akora imishwarara y’umubiri yihuta kugira ngo asuzume uburebure nyabwo, aho ihagaze, n’ubutungane bw’ico kintu (na canecane kugira ngo asuzume ko ibirahuri bitasadutse kandi ko hari zero free air [ diaphrapneumoperitoneum], ivyo bikaba vyoba ari ikimenyetso c’uko amara yatobotse). 2. Ugutera umutsi mu mutsi + Guhagarika umutsi wo mu mutsi wo mu karere: Mu gutanga umuti wo gutera ububabare/ugutera umutsi wo mu mutsi no gutera ububabare mu mutsi w’imbere mu mubiri n’imiti yitwa lidocaine/bupivacaine yo mu mutsi, imitsi y’umutsi w’imbere mu mubiri igumye iraruhuka rwose ata kubabara. 3. Gumenagura neza ikidodo c’ubusa c’ibara ry’umubiri: Nka kurya kw’igikombe c’imihango gifatanye, ikintu kinini gisenye mu nzitiramibu gifatwa mu kibanza caco n’umuvuduko mubi wo kunyota mu nzitiramibu iri hejuru yaco. Mu ER canke endoscopy suite, abaganga baraca mu bugwaneza catheter y’amasobe ya Foley y’umupira woroshe hejuru baciye ku ruhande rw’ikintu c’amahanga, bagafuha umupira woroshe uri hejuru yaco, bagaca batera umuyaga biciye mu nzira y’amasobe mu gitereko kiri hejuru y’ico kintu, **baca bamenagura buhoro buhoro mu gihe bamenagura ikidodo c’ubusa. 4. Igikoresho co gupima amabere canke gukama mu cumba co kubagiramwo (ata guca inda): Iyo ico kintu cimukiye hejuru cane mu gitereko c’amaraso, umuganga w’amaraso canke umuganga w’amaraso akoresha kamera ishobora guhinduka ifise imitego yihariye, canke akora ubuhinga bwo gukama amata (general external s*king abdominal manipulation) ikintu gisohoka biciye mu nzira y’igitsina ataco gikeneye guca mu nda mu bice birenga 85% gushika kuri 90%.

3. Ibintu bidasanzwe vyo mu nda bifise ingorane nyinshi bisaba ko umuntu atagira umukazo wo ku mubiri¶

• Icupa ry'ibirahuri ry'imyobo, ibirahuri vyo kunywa, canke amatara (Afunguye-Iherezo Hejuru canke Hasi):
• Iyo hashizwemwo igikombe canke igikombe c’ibirahuri gifise umwobo akanwa kafunguye karaba hejuru, umubiri w’umubiri w’umubiri uranyobwa imbere mu rubavu rwuguruye nk’ikiyo c’ibirahuri, kandi gufyonda ikirahuri n’ibikoresho vy’icuma birashobora kugimenagura imbere mu gitereko. Abaganga bakoresha ubuhinga bwihariye bwo kuvyara bufise ivyuma, ubuhinga bwa Foley air-insufflation canke ubuhinga bwo gutera umuyagankuba mu gihe bariko baratera umuti wo gutera umutima kugira ngo bakuremwo ibirahuri bitagiramwo ikintu.
• Ivyuma binyiganyiga bikoreshwa n'imoteri bikiriko birakora:
• Tambuka witonze wicare ku musego woroshe wishingikirije ku rubavu rumwe mu nzira ija mu bitaro; ntufyonde hasi ku nda yawe yo hasi, kuko gukanda umutwe uvuga ku ruhome rw’imbere rw’umubiri canke ku ruhome rw’umubiri rwitwa sigmoïde bituma umubiri wihuta gusenyuka.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

Niwaba ubona ibimenyetso vy’Toxic Shock Syndrome, ugutoboka kw’amara (ububabare bukomeye mu nda, umuriro, kuva amaraso mu nda, canke gusinzira), canke umubiri w’amahanga ugumye mu nda, uce urondera ubuvuzi mu bitaro ubwo nyene:

• Leta Zunze Ubumwe za Amerika:
• Indwara y’ibicurane / Gutobora / Ikintu c’ikiyo: Hamagara 911 canke ugende uhereye ku Igisata c’Ibitaro vy’Ivyihutirwa kiri hafi (nti ugende ku kigo c’ubuvuzi c’ubudandaji canke mu kigo c’ubuvuzi bwihutirwa buto buto ku bijanye n’umubiri w’amahanga wo mu nda, kuko badafise abdo-up, X-ray canke abdo).
• Igikoresho co gukingira inda (Nta muriro canke amabendera atukura): Ikigo cose co kwitwararika vyihutirwa, Ubuvyeyi butegekanijwe (1-800-230-PLAN), ibiro vya OB/GYN, canke Igisata c’Ivyihutirwa birashobora gukuraho tampon canke igikombe cagumye mu minota 2.
• Kanada:
• Ibikorwa vy’Ivyihutirwa: Hamagara 911 canke uje ku Bitaro vy’Ivyihutirwa biri hafi. Hamagara HealthLine 811 y’intara kugira ngo ubone ubuyobozi butahutirwa ku bijanye n’ibikoresho vyo mu nda vyagumye be n’uburyo bwo kwirinda gutwara inda vyihutirwa.
• Ubwami bw'Ubwongereza:
• Ibikorwa vy’Ivyihutirwa: Hamagara 999 ku ndwara y’ubumara canke ububabare bukomeye bwo mu nda/amaraso, canke ugende ushitse ku Igisata c’Ibitaro vy’Impanuka n’Ivyihutirwa (A&E) ku kintu cose c’amahanga co mu nda.
• Tampon / Kandomu + Uburyo bwo kwirinda gutwara inda vyihutirwa: Hamagara NHS 111, ugendere Ivuriro ry’ubuzima bw’imibonano mpuzabitsina / ubuvuzi bw’amasobe (GUM) ryo mu karere kawe, Ikigo c’ubuvuzi bwihutirwa ca NHS (UTC), canke umuganga wawe kugira ngo ukoreshe umuganga wawe w’umubiri kugira ngo ubone gusubira gutwara inda vyihutirwa ku musi umwe.
• Ubumwe bw'Uburaya:
• Ibikorwa vy’ubutabazi: Hamagara 112 canke ugende ku bitaro biri hafi vy’ubutabazi bw’ubutabazi n’abakomeretse babazwe.
• Ostraliya na Nouvelle-Zélande:
• Ibikorwa vy’ubutabazi bwihutirwa: Hamagara kuri 000 muri Australiya canke 111 muri Nouvelle-Zélande, canke hamagara kuri Ubuzima buziguye muri Australiya (1800 022 222) / Umurongo w’ubuzima wo muri NZ (0800 611 116).
• Ubuhindi na Aziya-Pasifike:
• Ibikorwa vy’ubutabazi: Hamagara 112 mu Buhindi, 119 mu Buyapani, 995 muri Singapore, canke 999 muri Maleziya na Hong Kong. Gutera imbere mu bitaro bikora vyose bifise amasaha 24 yo kubagwa vyihutirwa n’ubuvuzi bw’abavyeyi/abagore.

Ibibazo bikunda kubazwa¶

Mbega tampon, igikombe co mu kwezi canke agakingirizo vyoshobora kuzimira imbere mu mubiri wanje bikaja mu nda canke mu nda?¶

Oya, ivyo ntibishoboka mu buryo bw’umubiri. Umuyoboro w’igitsina ni umuyoboro w’imitsi upfutse, ufise impera zipfutse, ufise uburebure bwa santimetero 7 gushika kuri 12 gusa. Hejuru cane y’igitsina c’umugore ni ho hari umunwa w’igitereko ukomeye, ukaba ufise urufunguruzo rutoyi cane hagati (ubwaguke bwa milimetero 1 gushika kuri 3) ruto cane ku buryo tampon, agakingirizo canke igikombe co mu kwezi bishobora kwigera biciramwo. Iyo tampon canke agakingirizo yumvise "kazimiye", bica bishirwa gusa mu buryo buringaniye imbere mu gice c'inyuma c'umubiri, umufuko usanzwe winjira inyuma cane y'isonga ry'umutwe w'igitereko, aho ushobora kubishikako mu kwipfukama cane, ukavyikorera hasi buhoro buhoro, no kubikubura n'intoke zibiri zisukuye.

Ni kuki gukurura uruti rw’igikombe canje co mu kwezi bibabaza cane kandi bikanka guhungabana?¶

Igikombe co mu kwezi kiguma mu kibanza caco mu gukora ikidodo co kunyonga c’umuyaga kidashobora gushika ku mpome zo hejuru z’igitsina zikikuje umunwa wawe w’igitereko. Iyo ukuruye ugororotse hasi ku giti co hasi utabanje guca ico kidodo kizibira umwuka, uba uriko ukwegeranya igikombe co kunyonga ugororotse ku mutwe w’igitereko cawe no ku nyama z’igitsina. Imisi yose ushire hasi cane, ushire hasi buhoro buhoro n’imitsi yawe y’igihimba c’irondoka kugira ngo usunikire igikombe hasi amasentimetero 3 gushika kuri 4, hanyuma ushire umutwe wo hasi w’igikombe ushikamye hagati y’urukumu rwawe n’urutoke rw’ikigereranyo (canke ushire urutoke rumwe hejuru kugira ngo ukande uruhande rwo hejuru imbere) kugira ngo umwuka winjire kandi urekure ukunyota imbere y’uko sli.

Ni ryari indwara y’ubumara (TSS) iterwa n’igitambaro co kwibagirwa, kandi ni ibimenyetso ibihe biyigabisha?¶

Abantu benshi basigaye mu mpanuka igitambaro co gukingira umubiri mu misi 1 canke 3, baca bagira gusa amazi atari meza cane, agira umunuko mubi w’inzobe canke y’umweru, akava mu masaha 24 canke 48 inyuma y’aho igitambaro co mu nda gikuweko. Ariko rero, iyo imigera ya Staphylococcus aureus canke Streptococcus pyogenes ivyara ubumara buva hanze, indwara y’ubumara bwo mu gihe c’imihango (TSS) irashobora gutera ningoga. Hamagara 911 / 112 / 999 canke ugende mu gisata c’ivyihutirwa ubwo nyene iyo umuntu akoresha tampon/cup ubu canke aherutse gukoresha afise umuriro mwinshi butunguranye (38,9 degrees Celsius / 102 degrees Fahrenheit canke irenga), akaruha, akagira ububabare bw’amazi iyo afise imitsi itukura, akagira ububabare bw’amazi, amaso, canke igisebe gitukura gisongoye kimeze nk’aho izuba ryaturitse.

Ni kuki ntashobora gufata umuti wo gukura umubiri canke gukoresha enema kugira ngo nsunike umubiri w’amahanga ufatanye mu mubiri i muhira?¶

Iyo ikintu c’amahanga gipfutse hejuru y’urutugu canke mu rubavu rwo hasi rwitwa sigmoïde, gikora nk’igipfukisho gipfutse amara. Gufata imiti igabanya ububabare mu kanwa canke gufyonda enema mu nzira y’amaraso inyuma y’ikintu gipfutse bituma imitsi y’amara igira ububabare bukomeye kandi bikaba vyubaka umuvuduko mwinshi w’amazi n’umuyagankuba imbere mu nzira y’amaraso y’uruhome rworoshe, ivyo bikaba bishobora gutuma uruhome rw’amaraso rwuguruka (rutobora) mu nda yawe. Gumana inda yawe ubusa (ntaco urya canke unywa, nta n’imiti igabanya ububabare, nta n’imiti igabanya ububabare) hanyuma ugende ugororotse mu kigo c’ibitaro vy’ibiza vyihutirwa.

Noba nzokenera kubagwa cane mu nda kugira ngo nkuremwo ikintu c’amahanga co mu nda mu bitaro?¶

Mu bice 85% gushika kuri 90%, nta guca mu nda bikenewe, igihe cose uja mu gisata c’Ivyihutirwa ataco uhinduye aho gusunika ico kintu gushika kure cane ukoresheje ibikoresho vyo mu nzu i muhira. Mu ER, abaganga barafata X-ray yihuta, bakaguha umuti wo gutera umunezero mu mutsi n’ikintu co gutera ububabare bwo mu mutsi kugira ngo umutsi wawe wo mu nda uruhuke rwose ata kubabara, bagaca ku kintu kugira ngo bamene igipfukisho c’ubusa n’umuyaga, hanyuma bagasohora ico kintu buhoro buhoro biciye mu nzira isanzwe.

Inyobora zifitaniye isano¶

• Indwara y'ubumara (TSS): igitambaro co mu mazuru, n'amabendera atukura y'ibikomere
• Sepsis na septic shock kwemera n'ugusubiza vyihutirwa
• Ubuzibuzi bw'amara, ububabare bw'umubiri, n'ibimenyetso vyihutirwa vy'ububabare bw'umubiri
• Amaraso ava mu nda, guruka amaraso, na melena .
• Inomero z'ivyihutirwa

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe ry'Isi ry'Ivy'Ukubaga Ivyihutirwa (WSES) & Ishirahamwe ry'Abanyamerika ry'Ivy'Ukubaga Ivyihutirwa (AAST): Ivyihutirwa vy'Ivyihutirwa: Amabwirizwa ya WSES-AAST ku Gupima, Gushikiriza, no Gukuraho Ibintu vy'Inyamahanga Bigumye mu Gitereko.
• Ishure ry’abaganga b’abavyeyi n’abagore ryo muri Amerika (ACOG) & Ishure ry’abaganga b’abavyeyi n’abagore ry’Ubwami (RCOG, UK): Impanuro z’ubuvuzi ku bijanye n’imibiri y’amahanga igumye mu nda, gukuraho igikombe c’imihango ata nkomanzi, no kwirinda indwara y’ubumara bw’imihango.
• Ibigo bijejwe kugenzura no kwirinda indwara (CDC, Leta Zunze Ubumwe za Amerika): Indwara y’ubumara (Staphylococcal na Streptococcal) Insobanuro y’ikibazo, Ibintu bishobora gutuma umuntu agira ingorane, n’ingene yovyifatamwo mu gihe c’ivyihutirwa na Ingingo ngenderwako za CDC zijanye n’ugukingira inda vyihutirwa na nPEP.
• Ikigo c'igihugu c'ubuzima (NHS, Ubwongereza): Impanuro z'ubuvuzi za NHS: Ico wokora iyo Tampon, igikombe co mu kwezi, canke agakingirizo bifashe imbere mu gitereko.
• Ishirahamwe ry'abaganga babaga amafyigo n'amafyigo ryo muri Amerika (ASCRS): Ivyiyumviro vy'ubuvuzi vyo gucungera imibiri y'amahanga y'amafyigo no kwirinda gutoboka kw'amafyigo.