Umunyeshure yaguye mu kibuga: Ubushuhe bukomeye (‘Ugukonja mbere, gutwara ubwa kabiri’) n’uguhagarara kw’umutima bukwi na bukwi n’ugufatwa n’indwara¶

Kubona umukinyi w’umupira w’amaguru w’imyaka 15 wo mw’ishure ryisumbuye, umukinyi w’umupira w’amaguru wo mu mashure yisumbuye, umukinyi w’umugwi w’abagendagenda, canke umukinyi w’umupira w’amaguru w’urubyiruko, apfukama bukwi na bukwi canke akagwa ku kibuga mu gihe c’imyimenyerezo yo kwitegura umubiri imisi ibiri mu kwezi kwa Myandagaro, ni kimwe mu bintu bifata umwanya munini cane mu bijanye n’ubuvuzi. Mu mikino y’urubyiruko n’iy’amashure yisumbuye, ibice birenga 90% vy’impfu zose zitunguranye zidaterwa n’ibintu bibabaje ku kibuga ziterwa n’ibintu bitatu gusa bikomeye: Uguhagarara kw’umutima gutunguranye (SCA), Ubushuhe buterwa n'inguvu (EHS), na Ugutera umugera w’inguvu (ES mu bakinyi bafise akaranga k’indwara y’umusonga, HbAS). Naho ivyo bihe vyose bitatu vyihutirwa bishobora gushika mu masegonda makeyi umuntu akoresheje inguvu nyinshi z’umubiri ku musi ushushe, gutera urujijo kimwe ku kindi mu masegonda 180 ya mbere birashobora kwica. Gufata umuntu yafashwe n'indwara y'umutima giturumbuka nk'umuntu "ashushe cane gusa" bitera intege gukuraho umutima birenze idirisha ry'iminota 3 ry'ubuzima; gushiramwo umuntu yafashwe n’ubushuhe bukomeye agororotse inyuma y’imodoka itwara abarwayi yumutse kandi ifise ivyuma bikoresha umuyaga ataco abanje kumubika mu mazi akanye aho hantu (CWI) ice tub irenga ku Ishirahamwe ry'Igihugu ry'Abamenyereza b'Imikino (NATA) n’Ikigo ca Korey Stringer “Igikoko ca mbere, ivy’ugutwara abantu ca kabiri” itegeko ry’inzahabu kandi ryemerera 41.5 °C (106.7 °F) ubushuhe bwo mu mutima kugira ngo batekere ubwonko bwabo n’igitigu cabo mu kiringo c’iminota 20 bagenda mu modoka itwara abarwayi; kandi gusemerera umukinyi afise ingorane y’indwara y’umutima** kugira ngo “ahaguruke akureho ububabare bwo mu maguru” bitera uguhagarara kw’utugingo ngengabuzima dutoduto tw’amaraso, rhabdomyolyse, n’uguhagarara kw’umutima.

Igishimishije, abatoza, abatoza b’abakinnyi (ATCs), abaganga bo mu migwi, n’abavyeyi bo ku ruhande ntibakeneye gupimwa amaraso mu laboratwari kugira ngo bamenye ivyo bintu bitatu vyihutirwa bitandukanye ku vyatsi. Mu kugenzura ibimenyetso bine vy’ubuvuzi vyihuta mu masegonda 30 ya mbere - (1) Ukwishura n’Uguhema (SCA = ntaco yishuye rwose n’uguhema kw’ububabare kutaboneka canke guhema), (2) Umuvuduko wo Gusenyuka (SCA na Heatstroke gutera bukwi na bukwi ata n’umwe abimenyesheje, mu gihe Sickling abakinnyi baragwa hasi bakiri maso kandi bakidoga ko bafise intege nke zo mu mugongo/mu mugongo/mu mugongo), (3) Gukora ku mubiri (Heatstroke na Sickling imitsi yumva iyoroshe canke idakomeye, mu gihe ukuri Heat Cramps n’ugufunga mu bihimba bikomeye nk’urutare, bigaragara ko bifise amapfundo), na (4) Ubushuhe bwo mu Gitereko (Exertional Heatstroke ni ugusobanurwa neza n'ukudakora neza kwa CNS hamwe n'ubushuhe bwo mu nda buri hejuru 40.5 °C / 105 °F, mu gihe Sickling na SCA bishika mu bushuhe busanzwe canke burengeye bukeyi bwo kwinonora imitsi munsi ya 40.0 °C / 104 °F) - ushobora gutera umurongo nyawo wo gukiza ubuzima ubwo nyene.

(Ku bijanye n’intambwe zo gusubiza ubuzima mu mutima n’amahaha, raba CPR na AED. Ku bijanye n’ibintu vyihutirwa vy’ubushuhe muri rusangi, raba Ubushuhe n'urushe n'ubushuhe na Igikomerekezo gikomeye c'amafyigo, rhabdomyolyse, n'ugutoranya amasobe y'umwirabura, kandi tuzigame ivyacu vy’isi yose . inomero z'ivyihutirwa ububiko buboneka ku ruhande.)

Ivyo ubikore ubu¶

1. Gukoresha umugambi w'ibikorwa vyihutirwa vy'aho ukorera (EAP) mu masegonda 10 ya mbere: ushireho umuntu umwe ngo ahamagare 911 (canke 112 / 999), umuntu umwe ngo yiruke kugira ngo abone AED yo ku ruhande, n'umuntu umwe ngo yugurure amarembo y'ibarabara kugira ngo imodoka itwara abarwayi. Ntukigere urindira "kubona nimba umukinyi ayizunguruka." Hamagara inomero y’ivyihutirwa yo mu karere kawe (911 muri Amerika na Canada, 112 mu Buraya bwose, 999 mu Bwongereza, canke urabe inomero z'ivyihutirwa) ubwo nyene igihe cose umukinyi uwo ari we wese aguye mu kibuga.
2. Gukuraho Umutima Uhagaze Bukwi na bukwi (SCA) Ubwa mbere (Amasegonda 0 gushika kuri 30): Nimba umukinyi ATASUBIZA kandi adahema neza, tangura CPR y’amaboko gusa maze ushireko AED mu minota 3.
3. Kora ku rutugu rw’uwo mukinyi maze uvugire hejuru izina ryiwe. UMUTEGO WO KU RUHANDE: Nk'50% vy'abakinnyi bari mu gihe c'uguhagarara kw'umutima bukwi na bukwi bagaragaza uguhungabana kw'amaboko/amaguru mu gihe gito nk'ugufatwa n'indwara y'umutima (mu masegonda 10 gushika kuri 20) n'uguhungabana kw'amaboko n'ijwi rirenga "agonal gasps". Ntukigere wihenda ngo guhungabana canke guhema nk'ugufatwa n'indwara y'umusonga, kandi ntiwigere wibaza ko umukinyi yaguye "ashushe cane" gushika wemeje ko ariko arahumeka neza afise umutima ukomeye.
4. Iyo umukinyi ataco yishuye kandi adahema neza: kata umupira wiwe n’ibipfukisho vy’ibitugu (ukoresheje ibikoresho bikomeye vyo gukingira ibikomere bimanuke ku mirongo y’imbere y’igipfukisho c’igikiriza, usige inkofero/inyuma mu kibanza cayo kiretse iyo bikenewe kugira ngo umuntu ashobore gushika mu nzira y’impwemu), tangura Hands-Only CPR (100 to 120 compressions/min, 5 to 6 cm / 2 to 2.4 in deep), hanyuma ushire ibipande vya AED ku gikiriza kitagira ikintu ubwo nyene. Igihe cose ugucererwa kw’amasegonda 60 birenze iminota 3, ubuzima bugabanuka 10%.
5. Nimba umukinyi afise umutima ukomeye kandi ariko arahumeka, suzuma Mental Status (CNS Function) ubwo nyene: ugutahura kwose, inyifato idahuye n’ubwenge, kuvuga nabi, gutsitara canke guhungabana mu gihe c’ubushuhe ni Exertional Heatstroke (EHS) gushika bigaragajwe ko atari vyo.
6. Baza ibibazo bine vy'inyigisho: "Witwa nde? Turi mu murima uwuhe? Ni ukwezi gute? Ni imyimenyerezo iyihe twariko turakora?"
7. NTUKIGEZE wizigira ko umukinyi ariko aravyuka canke atarivyo (anhidrosis), kandi NTUZOKWIGEZE ukoresha ugutwi (tympanic), uruhanga (temporal), canke igipimo c’ubushuhe co mu kanwa. Bitandukanye n’abageze mu zabukuru bashikiwe n’ubushuhe bwa kera, abarenga 90% b’abanyeshure bakina umupira w’amaguru mu ndwara y’ubushuhe bw’inguvu nyinshi bariko baratonyanga ivyutsi vyinshi mu gihe bagwa, kandi ibipimo vy’ubushuhe vyo mu ruhanga/ugutwi bisoma **2 gushika kuri 4 degrees Fahren to **it Cel7s too) urukoba rufise ivyuya, rukonjeshwa n’umuyaga. Gusa igipimo c'ubushuhe bwo mu mutwe gishobora guhinduka (inserted 15 cm / 6 inches past the anal sphincter) ipima neza ubushuhe bwo mu mutima (> 40.5 °C / 105 °F ni ko EHS yemeza).
8. Nimba Ubushuhe buterwa n'Inguvu (EHS) iriho (Core Temp > 40.5 °C / 105 °F CANKE gusenyuka kw'umubiri mu gihe c'ubushuhe bwinshi iyo igipimo c'ubushuhe co mu nda kitaboneka): Shira mu ngiro "COOL FIRST, TRANSPORT SECOND" ubwo nyene.
9. Kura ibikoresho vyose vy’impuzu (inkofero, ibipfukisho vyo ku rutugu, umupira, ipantaro, amasogisi, ibipfukisho vy’imbere) hanyuma ubike uwo mukinyi gushika mw’izosi mu mazi akanye Amalita 190 gushika kuri 570 (amagaloni 50 gushika kuri 150) (CWI) Igikarabiro cuzuye barafu n’amazi ku . 1.7 °C to 15.0 °C (35 °F to 59 °F).
10. Amazi y’urubura aguma azunguruka umubiri n’imitwe y’uwo mukinyi mu gihe afashe umutwe n’ibitugu hejuru y’amazi akoresheje igitambaro co gupfuka munsi y’ibirenge.
11. Nimba ata tub iriho ("TACO Method - Tarp-Assisted Cooling with Oscillation"): Rara uwo mukinyi hagati y’igitambaro co mu kibuga kidashobora guterwa n’amazi, ubwire abo mugenziwe 4 canke 6 baduze imirongo y’ico gitambaro kugira ngo bakore igikarabiro c’abantu, bashire ibikoresho 3 canke 4 bikonjesha vy’urubura n’amazi bica hejuru y’umubiri w’uwo mukinyi, hanyuma uzungurutse igitambaro ugenda ugaruka inyuma udasiba.
12. NTUKEKE ngo ambulance ishire ibintu kandi igende n’umukinyi gushika ubushuhe bwabo bwo mu nda bugabanutse bugera kuri 100. 38.9 °C (102.0 °F) (ivyo bikaba bifata iminota 10 gushika kuri 18 y’ugukomeza kwibika mu mazi y’urubura, bikakonja ku rugero rwa 100). 0.20 °C to 0.26 °C / 0.36 °F to 0.47 °F per minute).
13. Nimba umukinyi ariko aravyuka, urabe maso, ubushuhe bwo mu mutima buri munsi ya 40.0 °C (104 °F), kandi baragwa hasi mu gihe bariko bariruka cane bidoga ko “amaguru n’umugongo bigoyagoya, bipfuye, bisha” bifise imitsi Yoroshe: bafate nk’umugera w’indwara y’umutima (ES) Amagorwa.
14. Kura uwo mukinyi mu rukino ubwo nyene (never order them to run another rep or "walk it off").
15. Bishire mu gitutu, ubihe umwuka w’inyongera w’umwuka (15 Liters/min via Non-Rebreather Mask) iyo biriho ku igare ry’inyuma ry’umumenyereza w’abakinnyi, ukomeze gukurikirana ibimenyetso bihambaye, gukonjesha neza nimba bishushe, no gutwara ubwo nyene n’imodoka itwara abarwayi ya ALS ku kigo c’ivy’ubuvuzi kiri hafi, umenyeshe umuganga wo mu bitaro vy’ubuvuzi ku maradiyo kugira ngo witegurire ububabare bukomeye bw’indwara y’ibicurane, indwara y'amaraso (peaked T-waves on 12-lead ECG).

Igiti c'ingingo: Gutoranya itandukaniro ry'inyuma ry'umunyeshure w'umupira w'amaguru yaguye (Amasegonda 180 ya mbere)¶

flowchart TD
    Start["Umunyeshure w'umunyamideri arasenyuka canke aragwa hasi mu gihe c'imyimenyerezo canke umukino"] --> ActivateEAP["Intambwe ya 1 (0-10 Sec): Gukoresha EAP y’aho hantu, Hamagara 911, Gutora AED yo ku ruhande, Gufungura amarembo y’itongo"]

    ActivateEAP --> CheckResp{"Intambwe ya 2 (10-30 Sec): Mbega Umukinyi yoba ashobora kwishura kandi akahumeka neza? (Urabe maso mu gihe gito co gufatwa n’indwara y’umutima)"}

    CheckResp -->|"OYA: Ntaco yishuye kandi Ntahumeka / Guhema gusa"| SCAProtocol["UBURYO BWO GUHAGA UMUTIMA MU GITUBA (SCA) (Ushobora no gukeka ko ufise Commotio Cordis iyo ukubiswe mu gikiriza): Kata igitambaro/ibipande, utangure gukoresha amaboko gusa (100-120/min), ushireko AED mu minota 3"]

    CheckResp -->|"EGO: Guhema n'umutima"| CheckCNS{"Intambwe ya 3: Suzuma uko umuntu ameze mu mutwe (CNS) n’ubushuhe bwo mu mutwe: Mbega umukinyi arazazanirwa, ararwanya, aratera ububabare, aratera ububabare, canke ubushuhe > 40.5 C (105 F)?"}

    CheckCNS -->|"EGO: Ugukora nabi kw'umubiri + ubushuhe bwinshi (ubushuhe bw'umubiri > 40.5 C / 105 F)"| EHSProtocol["AMATEGEKO Y’UBUSHUHE BWO GUKORA (EHS): Gukuraho ibikoresho, Ubibike mu Gitereko c’Amazi y’Ibarafu (1.7-15 C / 35-59 F) canke TACO Tarp ubwo nyene. COOL YA MBERE (kugeza kuri 38.9 C / 102 F), IVYO GUTUNGANYA KABIRI"]

    CheckCNS -->|"OYA: Kuvyuka, Gutahura, Gutahura, Ubushuhe bw'Imbere < 40.0 C (104 F)"| CheckMuscles{"Intambwe ya 4: Umukinyi Yasenyutse Gute, Kandi Imitsi Y’Amaguru/Imugongo Iyumva Gute?"}

    CheckMuscles -->|"Slumped Inyuma y’Imigwi; Imitsi Iyumva Iyoroshe/Idakomeye; Ububabare bw’umugongo/igihimba c’irondoka/amaguru; Tachypnée"| SicklingProtocol["IKIBAZO C'IMYIMENYEREZO (ES): Hagarika imyimenyerezo ubwo nyene, Uhe 15 L/min Oxygène, Ugume uryamye/Ufise amazi, Ubwo nyene ALS Ambulance ija mu bitaro vya Rhabdomyolyse & Hyperkalemia ECG"]

    CheckMuscles -->|"Gutera imbere mu Mubabaro; Imitsi Ipfungiwe mu Rutare IKOMEYE Iboneka Ifise Amapfundo"| CrampProtocol["UBUSHUHE BWO GUKORA IMYIMENYEREZO: Ukuruhuka mu gitutu, Gukaraba, Gukora Masaje ku Barafu, Gufata Umunyu w’Amajambo (0.5 tsp umunyu mu 500 mL y’ikinyobwa c’imikino)"]

Icigwa ca 1: Imbonerahamwe y’ukugereranya ubuvuzi bw’inzira 4 (SCA n’Indwara y’Ubushuhe n’Indwara y’Inguvu n’Indwara y’Ubushuhe)¶

Mu ndwi ya mbere y’ukwezi kwa munani, abatoza barakunda kwihenda ngo Exertional Sickling ni Imibabaro y’ubushuhe, canke bagafata Umutima uhagaze bukwi na bukwi ngo ni Imibabaro y’ubushuhe. Gufata mu mutwe itandukaniro ry’ubuvuzi riri muri iyi mbonerahamwe birabuza gupima nabi umuntu ku kibuga:

Ivyiyumviro bitandukanye vyo gusenyuka kw’umurongo w’inyuma mu banyeshure bakina umupira w’amaguru (NATA / ACSM / AHA Consensus)¶

Icigwa ca 2: Umutima Uhagarara bukwi na bukwi (SCA) na Commotio Cordis ku kibuga: itegeko ry’iminota 3 AED .¶

Indwara y’umutima ihagarara bukwi na bukwi ni #1 itera urupfu rw’abakinyi batobato, itera nk’umuntu umwe ku bakinyi 50.000 bo mu mashure yisumbuye no muri kaminuza buri mwaka. Mu buryo butandukanye n’indwara z’umutima z’abantu bakuze ziterwa n’imitsi y’umutima ipfutse, SCA y’urubyiruko iterwa n’indwara y’umutima itamenyekanye canke y’umuyagankuba** canke n’ugukubitwa n’inkuba mu gikiriza (Commotio Cordis).

1. Impamvu 5 z’ibanze zituma umutima uhagarara bukwi na bukwi mu bakinyi bakiri bato¶

1. Indwara y'umutima (HCM): Ugukomera kw'imitsi y'umutima y'ibubamfu bitera urupfu Ventricular Fibrillation (VFib) iyo adrenaline ivyuka cane mu gihe c’ugusimbuka.
2. Imitsi y'umutima ivutse (CAA): Umutsi w’umutima uva mu nzira mbi y’umutsi w’umutima urafatanya hagati y’umutsi w’umutima n’umutsi w’amahaha mu gihe c’imyimenyerezo y’umubiri.
3. Indwara z'Iyon-Channelopathies n'Indwara z'Umuyagankuba (Long QT, Brugada, CPVT, na Wolff-Parkinson-White / WPW): Imitima isanzwe mu mibumbe yayo ikora umurongo mutoyi w’umuyagankuba mu gihe c’uguturika kwa adrenaline.
4. Acute Viral Myocarditis: Umururumba ucereje w’imitsi y’umutima mu gihe canke mu ndwi 1 canke 2 inyuma y’indwara y’umugera (Coxsackievirus, Influenza, COVID-19, Adenovirus) igihe umukinyi asubira mu vyo kwinonora imitsi bikomeye mu gihe ariko arakira.
5. Ikibazo ca Cordis (Blunt Chest-Impact Arrest): Bishika mu mutima ufise amagara meza 100% iyo umupira w’amaguru, umupira w’amaguru, umupira w’amaguru, umupira w’amaguru, canke inkofero ikubise uruhome rw’igikiriza rw’ibubamfu (precordium) mu kiringo nyaco c’ugutera kw’umuvuduko wa T (ventricular repolarization)**, gutera umutima mu Mutima w’Imitsi.

2. Kubera iki abatoza badategerezwa kwigera bahendanywa n'"Ivyiyumviro vy'Ivyiyumviro" canke "Ivyiyumviro vy'Ivyiyumviro".¶

Mu biganiro vy’amasanamu y’abakinnyi bo mu mashure yisumbuye no muri kaminuza, imvo #1 yatumye abatoza bacerezwa CPR no kuzana AED ni uko amaboko n’amaguru vy’uwo mukinnyi yari yaguye vyanyiganyiga nk’aho umuntu arwaye igicuri mu masegonda 15, kandi igifu cabo kikaba cari kivyimba n’ijwi rirenga, ry’ugusonza. - Ivyerekeye umubiri: Iyo Ventricular Fibrillation igabanyije amaraso aja mu bwonko, acute hypoxia itera ugufatwa n’indwara y’umutima mu masegonda 10 gushika kuri 20, hanyuma hakaza ubwonko uguhagarika umutima. - Itegeko ryo ku ruhande (Inter-Association Task Force Mandate): Umukinnyi wese aguye ataco akora (canke amaze gukubitwa mu gikiriza) akabura ico akora, aba ari mu Sudden Cardiac Arrest gushika bigaragajwe ko ataco bivuze. Ntugire ico ushira mu kanwa, ntutegereze ko "ugufatwa n'intandara" guhera, kandi ntumare amasegonda 60 uhiga umuvuduko w'umutima. Urungike AED ubwo nyene, ugaragaze igifu, hanyuma utangure gufata igifu. Iyo AED itanga igitero mu minota 1 gushika kuri 3 y’ugusenyuka ku kibuga, ibiharuro vy’abarokoka birarenga 85% gushika kuri 90%.

Icigwa ca 3: Ubushuhe buterwa n’inguvu (EHS): intambwe ku yindi gushirwa mu ngiro kwa "Cool Mbere, Transport Ubwa Kabiri".¶

Ubushuhe buterwa n'inguvu (EHS) ishika ku rwego rwo hejuru cane mu kiringo c’imyimenyerezo y’umupira w’amaguru, y’uguca mu gihugu, n’iy’umupira w’amaguru** mu kwezi kwa Nyakanga no muri Myandagaro** igihe Ubushuhe bw’Isi (WBGT) birenze 27.8 °C to 32.2 °C (82 °F to 90 °F).

1. Kubera iki Utegerezwa Gukoresha Igipimo c’Ubushuhe bwo mu Gitereko (Kandi Kubera Iki Gutera Icuya BITAKURUKA Ugufatwa n’Ubushuhe)¶

Inkuru z’imigani zibiri ziracariho zituma abanyeshure b’abakinnyi b’umupira w’amaguru batakaza ubuzima bwabo buri kwezi kwa Myandagaro: - Ikinyoma #1 ("Nimba bakiriko baravyuka, ni urushe rw'ubushuhe gusa, si ubushuhe"): IKINYOMA. Urukoba rwumye (anhidrosis) bishika muri ubushuhe budakora neza ku barwayi bageze mu zabukuru mu misi myinshi. Mu Exertional Heatstroke, umukinyi akiri muto atanga ubushuhe burengeye ama watts 1.000+ mu bipfukisho vy’umubiri, atuma ubushuhe bwiwe bw’umubiri buva ku 37 °C (98.6 °F) ku 41.5 °C (106.7 °F) mu minota 45 mu gihe akiriko aravyuka cane. - Ikinyoma #2 ("Koresha igikoresho co gupima ubushuhe bwo mu ruhanga canke igikoresho co gupima ubushuhe bwo mu gutwi"): IKINYOMA. Ivyigwa vyakozwe n'ishirahamwe Korey Stringer Institute vyerekana ko uruhanga, ugutwi (tympanic), n’ibipimo vy’ubushuhe vyo mu kanwa bisoma ** .36.5 °C to 38.0 °C (97.7 °F to 100.4 °F)** ku mukinnyi afise ubushuhe bwo mu mubiri bwiwe bwo mu nda bushobora kwica 41.8 °C (107.2 °F), kuko uguhinduka kw’icuya gukonjesha urukoba. - Bimeze gute iyo ishure ryawe ridafise igipimo c’ubushuhe bwo mu nda ku kibuga? Wizigire Itegeko ry’Ivyiyumviro vy’Ubuvuzi: Umukinyi wese akora imyimenyerezo mu bihe vy’ubushuhe yerekana ubushuhe budashobora kwihenda (CNS) ukudakora neza (ugutera urujijo, ukutamenya iyo uja, ubukazi, gutsitara, gusenyuka, canke guhungabana inyuma yo gukuraho SCA) BITEGEREZWA kuvurwa ubwo nyene hakoreshejwe umubiri wose wo kwibiza mu mazi akanye nk’aho umuntu yiyumviriye ko ari ubushuhe buterwa n’inguvu.

2. Uko wokora igikorwa co kwibiza mu mazi akanye (CWI) Tub canke TACO Amasezerano ya Tarp ku ruhande¶

1. Imbere y'Igikarabiro Imbere y'Imyimenyerezo Igihe WBGT > 25 °C (77 °F): Uzuza amazi **itangi ry’amazi ry’amalita 380 gushika kuri 570 (amagaloni 100 gushika kuri 150) hafi y’ihema ry’imyimenyerezo ry’igitutu (10 °C to 15 °C / 50 °F to 59 °F), harimwo ibikoresho 3 canke 4 vy’ugukonjesha vy’urubura rwajanjaguritse vyicaye iruhande y’ico kinogo biteguye guterwamwo.
2. Kura ibikoresho mu masegonda atarenga 60: Kura inkofero, ibipfukisho vyo ku rutugu, umupira, amapantaro, amaboko, n’amasoseti (wet uniforms trap heat).
3. Ubike mu mazi gushika mu ijosi ryose kandi ukomeze gutera imbere: Terura umukinyi mu gitereko kugira ngo umubiri wiwe, igihimba c’irondoka, amatako, n’amaboko bibe mu mazi 1.7 °C to 15.0 °C (35 °F to 59 °F) amazi y’urubura. Ushire urudodo rw’igitambaro co gupfuka munsi y’ibirenge vyose bibiri bifashwe n’abapoteri babiri kugira ngo inzira y’impwemu igume hejuru y’amazi. Uvungure amazi cane buri masegonda 30 kugira ngo urubibi rushushe ntirushobore gusenyuka ku rukoba.
4. Gucungera Delirium y’Intambara: Ubwonko bushushe cane kenshi bituma umukinyi w’umupira w’amaguru arwana. Ha aba spotters 4 bafate buhoro buhoro intugu n’amavi vy’umukinyi imbere mu gitereko (canke bakoreshe TACO uburyo bwa tarp ku vyatsi). Mu minota 3 gushika kuri 5 umuntu yibiye mu mazi y’urubura, ububabare bwo mu bwonko burahera uko amaraso yo mu bwonko akonjera.
5. Ubushuhe bwo gukuraho intumbero (38.9 °C / 102.0 °F): Kura umukinyi mu gitereko c'urubura maze umushire ku gitereko c'imodoka itwara abarwayi irindiriye igihe igipimo c'umubiri gisoma 38.9 °C (102.0 °F) (prevents afterdrop hypothermia). Ata gipimo c’ubushuhe bwo mu nda, ushire mu mazi iminota 12 gushika kuri 15 (canke gushika uguhinda umushyitsi n’ugusobanukirwa mu mutwe bigarutse) imbere y’uko ubishira mu modoka itwara abarwayi.

Icigwa ca 4: Gutera indwara ziterwa n’inguvu (HbAS) ingorane: kuki gusemerera ngo "Sunika mu bihimba vy'umubiri" bitera hyperkalemie yica¶

Nk’1 ku Banyamerika b’Abirabura 12 (8%), Umuntu umwe ku 100 b’Abanyamerika b’Abahisipaniya, n’abakinnyi ibihumbi n’ibihumbi bo mu bihugu vyo mu kiyaga Mediterane, mu Buseruko bwo Hagati, mu Buhindi no mu bihugu vya Karayibe bafise Ikaranga k’Ikigobe (HbAS) - bisobanura ko barazwe uruvyaro rumwe rusanzwe rwitwa hemoglobine (HbA) be n’uruvyaro rumwe rw’umugera wa hemoglobine (HbS). Mu buzima busanzwe bwa misi yose, abantu bafise akaranga k’indwara y’ibicurane barafise amagara meza kandi ntibagira indwara y’ibicurane (HbSS).

Ariko rero, mu gihe c’inguvu nyinshi cane, zidakora cane** - canecane ugusubiramwo igihe co kwiruka (gassers, suicides, mat drills), ibipimo vy’umubiri vy’umusi wa mbere vy’ibilometero ½, canke gutera imbere ata n’umwe aruhuka - ibintu bine bitera umubiri bifatanya imbere mu mitsi y’umukinyi ikora ukuguru n’umugongo: 1. Hypoxia y’imitsi ikomeye (amatonyanga y’umwuka w’ikirere imbere mu mitsi y’ibirenge ikora); 2. Acidose Lactique ikaze cane (pH y'imitsi igabanuka munsi 7.0); 3. Ugutakaza amazi mu ngingo (hyperosmolalité imbere mu mitsi y’imitsi); na 4. Ubushuhe bw'imitsi burengeye.

Iryo tetrade rituma utugingo ngengabuzima dutukura tw'umukinyi duhinduka bukwi na bukwi tukava ku bihimba vy'umubiri bimeze neza kandi bishobora guhinduka bikaja mu bice bikomeye kandi bifatanye vy'ukwezi. Mu minota 2 canke 5, utwo tugingo ngengabuzima dutukura dufise umuhoro tura logjam maze tugafunga utugingo ngengabuzima dutoduto tugaburira imitsi minini minini yo mu matako, mu gitereko, mu matako no mu mugongo (acute ischemic rhabdomyolysis). Kubera ko utugingo ngengabuzima tw’imitsi y’amagufa dushonje amaraso n’umwuka w’ikirere, turasaduka cane, tugasuka Potassium (K+) na Myoglobine bica bishika mu maraso. Iyo umumenyereza ahatije umukinyi w’umupira w’amaguru gusubira ku murongo maze yiruke urugendo rumwe, serum potassium iraduga cane ikarenga 7.0 to 9.0 mEq/L, bigatuma umutima uhagarara cane (sine-wave ventricular fibrillation or PEA) ku kibuga.

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

Ibibazo bikunda kubazwa¶

Bimeze gute iyo abaganga bo mu karere ka EMS bashitse ku kibuga bagashimika ku gushiramwo umukinyi wacu w’umupira w’amaguru w’ubushuhe bukomeye mu modoka itwara abarwayi ubwo nyene imbere y’uko ubushuhe bwabo bukonja?¶

Umumenyereza w’imikino ngororamubiri (ATC) n’umuganga w’umugwi w’ishure ryose bakwiye gushinga amasezerano yanditse imbere y’igihe c’umwaka n’umuyobozi w’ubuvuzi w’umuriro/EMS wo mu karere. Mu gihe c’ubu, Ishirahamwe ry’Igihugu ry’Abaganga ba EMS (NAEMSP), Ishure ry’Abaganga b’Ivyihutirwa ryo muri Amerika (ACEP), n’amajambo y’ubumwe ya NATA, abaganga bategetswe **gufasha mu gukonjesha amazi akanye (CWI) mu gukonjesha (mu gihe batangura gukoresha umurongo w’amaraso no kugenzura ubushuhe bw’umutima n’ubushuhe bushika ku bushuhe bwa degre 38,9 (102,0 degre Fahrenheit) IMBERE yo kwimurira umurwayi mu modoka itwara abarwayi**. Niba ubugenzuzi bw’ubuvuzi bwo mu karere ka EMS butegetse ko umuntu ahita atwara igikarabiro imbere y’uko igikarabiro gitegurwa, koresha uburyo bwa **TACO (guzingira amabarafu atose, yuzuye urubura/amabarafu akikuje umukinyi ari gusa)** maze umenyeshe Igisata c’Ivyihutirwa cakira ko hariho igikarabiro co kwibiza mu mazi y’urubura kirindiriye ku kigo c’abarwayi.

Ni kuki imisi 5 ya mbere y’ukwezi kwa munani umupira w’amaguru canke imyimenyerezo yo guca mu gihugu ari yo idirisha ryica cane ku ndwara y’ubushuhe n’indwara y’umutima?¶

Ivyiyumviro birenga **75% vy’abantu bose bapfa mu mashure yisumbuye no mu mashure yisumbuye biva ku ndwara y’ubushuhe n’indwara y’umusonga bishika mu misi 4 ya mbere y’ugutegura umubiri imbere y’igihe c’umwaka**. Mu vy'umubiri, umubiri w'umuntu usaba **imisi 10 gushika kuri 14 ikurikiranye y'ubushuhe bugenda burahinduka ("Heat Acclimatization")** kugira ngo wongere umubare w'amaraso yo mu maraso ku rugero rwa 12% gushika kuri 15%, ugabanye ubushuhe bw'umubiri aho ivyutsi bitangura, wongere igitigiri c'icuya gisohoka, n'icuya gisohoka. Iyo umunyeshure atamenyereye ikirere asohotse mu nzu ifise ivyuma bikoresha umuyaga ku musi wa mbere, akagira imyimenyerezo y’amasaha 3 mu bikoresho vy’ugukoresha ivyuma vy’umuyaga ("serial gassers"), umutima wabo ntushobora gukuraho ubushuhe canke ngo ugume ufise umwuka w’ikirere mu mitsi. Ni co gituma amategeko ya NATA na NFHS abuza gukora ibikorwa bibiri ku musi ku musi ukurikiranye, akabuza gukoresha ibikoresho vyo kwikingira ku musi wa mbere gushika ku wa gatanu, kandi akabuza gukora ibipimo vy’umubiri ku musi wa mbere.

Ni gute dukoresha ubushuhe bw'umubumbe w'amazi (WBGT) metre ku ruhande, kandi ni kuki ari nziza kuruta "Heat Index" y'iporogarama y'ikirere yo kuri telefone ngendanwa?¶

"Index y'ubushuhe" iri kuri app y'ikirere ibarurwa wiyumvira ko wicaye mu gitutu **100% n'umuyaga muto** - ntiyirengagiza **imishwarara y'izuba itaziguye ishushanya ivyatsi vy'umwiza** na **umuyaga wo mu kibuga**. Igikoresho co mu minwe **Ubushuhe bw'Isi y'Itara ry'Itose (`WBGT`) metre** ihuriza hamwe ibimenyetso bitatu bitandukanye: **(1) Ubushuhe bw'Itara ryumye** (`10%`), **(2) Ubushuhe bw’Itara ry’Igitonyanga (`70%`)** gupima ubushobozi bwo gukonjesha ivyutsi bivuye mu mwuka mu gihe c’ubukonje no mu muvuduko w’umuyaga, na **(3) Ubushuhe bw’Umubumbe w’Umwirabura (`20%`)** gupima ubushuhe bw’izuba butaziguye ku butaka. Igihe umurongo wo ku ruhande `WBGT` ashika kuri **`27.8 °C to 30.0 °C (82 °F to 86 °F)`**, amaruhuko y’ugukonja y’iminota 15 ategekanijwe ategerezwa kubaho isaha yose; igihe `WBGT` birenze **`32.2 °C (90.0 °F)`** (canke hasi mu bihe vy’uburaruko bikonje cane), imigenzo yose yo hanze yo gutera ivyatsi n’ugutegura cane bitegerezwa gukurwaho canke kwimurirwa mu nzu.

Iyo umunyeshure w’umunyamideri azi ko afise akaranga k’indwara y’ibicurane (HbAS), boba babujijwe gukina imikino ya varsity?¶

Oya - **nta mukinnyi afise akaranga k'indwara y'ibicurane (`HbAS`) yigera akurwa mu mukino uwo ari wo wose**. Ibihumbi vy’abakinnyi ba NCAA n’abahinga mu vy’umupira w’amaguru barahiganwa ata nkomanzi n’umugera wa Sickle Cell Trait buri musi. Ahubwo, kumenya umukinyi w’umupira w’amaguru . `HbAS` status iremesha abatoza n’abamenyereza b’abakinnyi gushitsa **Ivyitonderwa ku mico y’indwara y’ibicurane**: **(1)** Kwemerera umukinyi kwubaka umubiri buhoro buhoro aho kwiruka ibipimo vy’imirongo y’umupira w’amaguru vy’umusi wa mbere; **(2)** Gutera kabiri ibihe vyo kuruhuka no gusubirana hagati y’ugusubiramwo urugendo rw’amaguru; **(3)** Gusaba imbabazi umukinyi kubera igihe co kwiruka vyose mu gihe c’ubushuhe bwinshi canke mu kirere kinini (`above 1,500 meters / 5,000 feet`); **(4)** Gutuma umuntu aguma afise amazi; na **(5)** Guha ubushobozi umukinyi wo kuva mu myimenyerezo iyo ari yo yose mu gihe yumva ubugoyagoye budasanzwe bw’ukuguru, amatako canke umugongo wo hasi ata bwoba bw’igihano.

Twoba dukwiye kwigera dukuraho inkofero y’umukinyi w’umupira w’amaguru canke wa lacrosse mu kibuga mu gihe umutima uhagaze bukwi na bukwi canke iyo afise ubushuhe butunguranye?¶

Egome. Mu **Ubushuhe buterwa n'inguvu (`EHS`)**, nta nkovu y’umugongo w’intanga, kandi inkofero n’ibipfukisho vy’ibitugu bifata ubushuhe bujana ubushuhe: **ukureho inkofero n’ibipfukisho vy’ibitugu vyose ubwo nyene** imbere y’uko umanura umukinyi mu gitereko co kwibizamwo amazi akanye. Mu **Umutima uhagaze bukwi na bukwi (`SCA`)**, iyo umukinyi aguye hasi ataco akomeretse mw’izosi/umutwe, **uce ufungura umupira n’imigozi y’imbere y’ibipfukisho vy’ibitugu ubwo nyene kugira ngo ugaragaze igifu kitagira ikintu kugira ngo ushireho ibipfukisho vya CPR na AED**, hanyuma ukureho igipfukisho co mu maso (`or helmet/pads`) ku bijanye n’ugusohora umwuka mu nzira y’impwemu igihe cose **ntizokwigera zicerezwa gutangura gufata igifu canke gutanga igitero ca AED**.

Ivyigwa vyiza: Urubyiruko rwose, umutoza w’amashure yisumbuye, n’umutoza w’amashure yisumbuye, umusifuzi, n’umuvyeyi wo ku ruhande akwiye kurangiza inyigisho y’ibikorwa vy’amaboko Ivyigwa vy’ugutanga icemezo c’ubuhinga bwa CPR, AED, n’ubutabazi bwa mbere bw’imikino biciye ku Musaraba Mutukura w’Amerika, Ishirahamwe ry’Umutima ry’Amerika, St John Ambulance, canke Ishirahamwe ry’Igihugu ry’Amashirahamwe y’Amashure yisumbuye y’Igihugu (NFHS Learn), kandi bakimenyereza Itegeko ry’Ibikorwa vyihutirwa (EAP) n’isaha y’uguhagarara imbere y’imyimenyerezo ya mbere y’umwaka wose.

Inyobora zifitaniye isano¶

• CPR na AED intambwe ku yindi
• Ubushuhe n'urushe n'ubushuhe
• Igikomerekezo gikomeye c'amafyigo, rhabdomyolyse, n'ugutoranya amasobe y'umwirabura
• Ibikomere vyo mu mutwe n'uguhungabana kw'umutima
• Inomero z'ivyihutirwa n'ugurungika mpuzamakungu

Amasoko n'ubuyobozi buzwi¶

• Ishirahamwe ry'igihugu ry'abamenyereza b'imikino ngororamubiri (NATA, Leta Zunze Ubumwe za Amerika): Itangazo ry'Iciyumviro: Ingwara z'ubushuhe buterwa n'Ibikorwa (Itegeko ry'Ugupima Ubushuhe bwo mu Gitereko n'Itegeko ry'Ukwibika mu Mazi Akanye "Itegeko ry'Ugukonja Ubwa mbere, Ugutwara Ubwa kabiri") na Itangazo ry'Uguhurizako: Uburongozi bukomeye bw'Indwara z'Imitsi, ESCColl Ivy’ugutoranya indwara ziterwa n’inguvu).
• Ikigo ca Korey Stringer (KSI, Kaminuza ya Connecticut) & Ishure ryisumbuye ry’ubuvuzi ry’imikino ryo muri Amerika (ACSM): *Itangazo ry’ubumwe ku bijanye no kwitwararika abarwaye ubushuhe bukomeye imbere y’uko aja mu bitaro, gukonjesha bifashijwe n’uguhungabana (TACO), n’ugupima ubushuhe bw’isi bukoresheje amatara y’amazi (WBGT)
• Ishirahamwe ry’abakozi ryo gukingira urupfu rw’igihe gito mu mashure yisumbuye n’amashure yisumbuye (NCAA / NATA / NSCA / Ishirahamwe ry’umutima ryo muri Amerika): Impanuro zo kumenya no gucungera uguhagarara kw’umutima gutunguranye (Iciyumviro c’iminota 3 AED, Myoclonic Gagnier Seure/ Rhabdomyolyse / Indwara y’umusonga mu bakinyi bafise akaranga k’indwara y’umusonga (HbAS).
• Ishure ry’Abaganga b’Ivyihutirwa ryo muri Amerika (ACEP) & Ishirahamwe ry’Igihugu ry’Abaganga b’Ivyihutirwa (NAEMSP): Impapuro z’Ivy’Itegeko n’Inyigisho: Uburyo bwo Gucungera Indwara y’Ubushuhe buterwa n’Ibikorwa vy’Ivyihutirwa imbere y’Ibitaro (Guheza Kwibika mu Mazi Akanye ku Kibanza Imbere y’Ugutwara EMS Ambulance).
• Ibigo bijejwe kugenzura no kwirinda indwara (CDC, Leta Zunze Ubumwe za Amerika): Indwara y’ubushuhe mu bakinyi bo mu mashure yisumbuye n’Ingingo zo kwirinda gukora imyimenyerezo y’umubiri (HbAS).