Imisumari Yimbunda-Umuriro Kabiri-Kurasa no Kuzunguza imisumari¶

Imisumari ya pneumatike, ikoreshwa na gaze, kandi idafite umugozi utwara imisumari itwara ** 75 kugeza kuri 90-milimetero (3.0-kugeza kuri 3,5-santimetero) ibyuma bikozwe mu misumari ** ku muvuduko w’umunwa wa metero 30 kugeza kuri 425 ku isegonda (metero 100 kugeza kuri 1,400 ku isegonda) **, bigatanga ingufu za kinetic ugereranije n’intwaro za kalibiri zonyine muri Leta zunze ubumwe za Amerika. (CDC) ** hamwe na ** Ikigo cyigihugu gishinzwe umutekano n’ubuzima (NIOSH) **. Ubushakashatsi bw’akazi ka Epidemiologiya bugaragaza ko ** 65 kugeza 69 ku ijana by’imvune zose z’imisumari ** biterwa nigishushanyo kimwe gishobora gukumirwa: ** Contact-Urugendo ("Bump-Fire" cyangwa "Bottom-Fire") Trigger , yemerera umubaji gufata urutoki rwikubita hasi kandi akanatera umusumari igihe cyose ikintu cyo guhuza umutekano cyizuru hejuru yacyo. Nyuma yo kurasa umusumari wa mbere, pneumatic recoil itera umusumari uremereye wibiro 4 (9 pound) wapanze umusumari hejuru hanyuma uhita usubira hasi ( utabishaka kabiri-umuriro utabishaka **) hejuru yumubaji wenyine ukuboko kwi bumoso kutiganza ufashe sitidiyo 2x4, cyangwa kumatako, ivi, boot, igituza, cyangwa igihanga mugihe basitaye kuntambwe hejuru yinzu. Ikirushijeho kuba kibi, imisumari yo gufatira hamwe ifatanyirizwa hamwe mumigozi cyangwa ibiceri ukoresheje ** umuringa wumuringa wogoswe, umuringa wa plastike ucagaguye, cyangwa amashanyarazi akoreshwa nubushyuhe **. Mugihe pine irasa yometse umusumari kumurongo, ** urwembe rukarishye rwumuringa wumuringa cyangwa amababa ya pulasitike yajimije bikomeza guhuzwa kugeza kumutwe wumusumari ** mugihe igitekerezo kitagaragara cyakubise agacupa ka denim yanduye, reberi yimpu yimpu, cyangwa gants yo gukora cyane mumagufwa hamwe na capsule. Niba umukozi mukorana akuye umusumari winyuma inyuma yukuboko, ivi, ikirenge, igihanga, cyangwa igituza kumurimo wakazi ukoresheje inyundo yomwuma cyangwa pliers, umuringa wumuringa ufata kandi ucagagura ** imitsi ya digitale, imitsi ya flexor, na arteri ** mugihe usize ibice byanduye bya plastike nigitambara byafatiwe mumagufwa kugirango bitere osteomyelitis cyangwa se septique. Niba umusumari winjiye mu mutwe, ijosi, igituza, inda, ijisho, cyangwa ingingo ikomeye, hamagara ako kanya nimero yawe yihutirwa (911 muri Amerika na Kanada, 112 mu bihugu by’Uburayi, 999 mu Bwongereza, 000 muri Ositaraliya, 111 muri Nouvelle-Zélande) cyangwa urebe ububiko bwacu ku isi nimero yihutirwa. Kubijyanye na enterineti byinjira cyane, soma ubuyobozi bwacu kuri imbunda yimisumari na pneumatic yihuta kwinjira no gukomeretsa ricochet, kumanikwa no gushiramo ibintu byamahanga byo gutuza, umutima wa tamponade no kwinjira mu gituza triage triage, na kuva amaraso menshi no gushira amarushanwa.

Kora ubu¶

1. ** Hagarika amashanyarazi yugarije (cyangwa ukureho bateri na selile ya lisansi) mumisumari ako kanya mbere yo gufasha uwahohotewe: ** Ntuzigere ushyira umusumari wa pneumatike nzima kumutwe, hejuru yinzu, cyangwa hasi mugihe uhujwe numuyaga. Niba umuntu uhagaze akandagiye kuri trigger cyangwa agasunika izuru ryumuhuza uhuza-urugendo-umusumari mugihe cyo gutabara, bizarasa undi musumari wa milimetero 90.
2. ** NTUKIGERE ukuramo umusumari wa pneumatike mu ntoki, inkweto, ivi, igihanga, cyangwa igituza ku kazi hamwe n'inyundo cyangwa isahani: ** Nubwo umutwe w’umusumari waba ufite santimetero 2 (santimetero 0,75) mu rutoki cyangwa inkweto z'akazi, usige umusumari neza. Imisumari ikusanyirijwe hamwe itwara ** ityaye neza-isudira insinga z'umuringa cyangwa ibyuma bya pulasitike byegeranye ** kuruhande rwabyo. Gukuramo umusumari inyuma utabanje kubagwa bikuraho imitsi n'imitsi y'amaraso, bikuramo plastike / insinga zometse imbere mu magufwa, kandi bikavamo amaraso imbere.
3. ** Niba ikiganza cy'uwahohotewe, urutoki, cyangwa inkweto byatewe imisumari kuri sitidiyo ya 2x4, igisenge cy'igisenge, cyangwa urupapuro rwa pani, koresha icyuma gisubiza inyuma cyangwa uruziga kugira ngo GUCA UBUNTU ku buntu uwahohotewe (usige agace gato k'ibiti bifatanye n'umusumari): ** Ntukigere ushyira ukuboko cyangwa ikirenge ku musumari. Shyigikira ingingo yakomeretse kugirango umusumari utunama, wabonye unyuze muri sitidiyo ya 2x4 santimetero 15 (santimetero 6) ku mpande zombi z'umusumari, hanyuma utware umurwayi ufite igiti gito cy'ibiti n'umusumari bihamye hamwe.
4. ** Niba umusumari winjiye mu rukuta rw'igituza (cyane cyane imbere muri "Agasanduku k'umutima" hagati yonsa na collarbone) cyangwa igihanga, hamagara 911/112/999 ako kanya hanyuma ugumane uwahohotewe rwose: ** Umusumari wa milimetero 90 ushushanya umusumari urasa mu nda akenshi ucengera ** iburyo bwumutima **. Umusumari wicyuma ubwacyo ucomeka umwobo mumitsi yumutima utera; kuyikuramo itera impfu ** yumutima tamponade ** mumasegonda 60. Komeza umutwe wumusumari hamwe nimpeta irekuye ya gaze ya gaze, komeza umurwayi, kandi wihutire kujya mukigo cya 1 cy’ihungabana.
5. ** Niba umusumari winjiye muri boot cyangwa inkweto zakazi, NTIBIFUNGURE cyangwa ngo ukure inkweto kumaguru mumurima: ** Gukuramo inkweto zuruhu hejuru yumusumari utwarwa na rubber mu magufa yamaguru yunamye umusumari wogosha imbere yikirenge hanyuma ugakurura ibyuma byanduye byanduye mumitsi ya arteri na arteri. Kureka boot kugeza igihe ibitaro X-bifashwe.
6. ** Hindura imirimo yose ikora imisumari uhereye kumwirabura "Twandikire-Urugendo (Bump-Fire)" Trigger to Gray / Orange "Trigger-Full-Sequential Trigger": ** Dukurikije ** NIOSH na OSHA **, usimbuza imbarutso-y'urugendo na ** Full-Sequential Triggers **, bisaba ko izuru ryakanda ku nkoni * mbere yo gukomeretsa imisumari kuri 60.

Igiti cyemezo: pneumatic nail imbunda yinjira na anatomical zone triage¶

flowchart TD
    Start["Pneumatic cyangwa Cordless Nail Imbunda Yinjira"] --> Disconnect["1"]

    Disconnect --> WoodPinned{"2. Ese ukuboko, ukuguru, cyangwa umubiri wahohotewe byometse ku giti?"}

    WoodPinned -->|"YEGO: Yometse ku buryo butaziguye Kwiga, Joist, cyangwa Plywood"| SawWood["Gabanya UMUBARE KUBUNTU (NTUGASIMBURE): 1. Shigikira ingingo yuwahohotewe kugirango Nail idashobora kunama cyangwa kugoreka 2."]

    WoodPinned -->|"OYA: Umusumari washyizwe gusa mumubiri wuwahohotewe"| ZoneCheck{"3. Ni uwuhe mwanya wa anatomique umusumari winjiye?"}
    SawWood --> ZoneCheck

    ZoneCheck -->|"1. SKULL, IJISHO, AMASO, CYANGWA NINKOKO"| HeadNeck["INTRACRANIAL / NECK / OCULAR PROTOCOL: 1. Hamagara 911/112/999 Ako kanya (Urwego rwa 1 Ihahamuka / Ikigo cya Neurosurgie Centre) 2. NTUKIGERE UGUKURIKIRA CYANGWA KORA UMUKONO W'IMISOZI 3. Tape nini ya Gauze Impeta / Impapuro z'igikombe Shield kuzengurutse umusumari hejuru."]

    ZoneCheck -->|"2. CYIZA ('CARDIAC BOX'), INYUMA, CYANGWA INYUMA"| TorsoBox["CARDIAC TAMPONADE & TORSO PROTOCOL: 1. Hamagara 911/112/999 Ako kanya (Kohereza Alert: Kwinjira mu mutima wa Cardiac / Thoracic Nail) 2."]

    ZoneCheck -->|"3. UKUBOKO, WANDIKE, UFATANYIJE, CYANGWA UMUPIRA / AKAZI K'AKAZI"| ExtremityCare["BARBED-NAIL KUGARAGAZA & PROTOCOL YIFATANYIJE: 1. Kureka imisumari mu mwanya wawe (Irinda Umuringa / Umuringa wa Plastike gutanyagura imitsi & Vessel) 2. Niba unyuze muri bote y'akazi: NTIBIKURIKIZE INKINGI ZIKURIKIRA. X-Ray & Surgical Debridement"]

Kwibira cyane 1: Guhuza-Urugendo ("Bump-Fire") hamwe nubukanishi bwuzuye-bukurikirana¶

Ni ukubera iki imisumari ya pneumatike irasa ababaji mu ntoki, ivi, cyangwa igituza inshuro ibihumbi mu mwaka mugihe umubaji atigeze ashaka gukurura imbarutso ubugira kabiri?

1¶

Buri mbunda ya kijyambere ya pneumatike cyangwa idafite umugozi ifite ** ibyuma bibiri bitandukanye bya mashini ** bigomba kuba byombi mbere yo guhumeka mbere ($ 5.5 inyandiko {kugeza} 8.3 inyandiko {bar} / 80 inyandiko {kugeza} 120 inyandiko {PSI} $) irekura piston y'imbere kugirango itware umusumari: 1. ** Urutoki Trigger ** kuri pistolet. 2. ** Igikorwa cyo Guhuza Ibikorwa (Umutekano Nosepiece / Yoke) ** hejuru yigitereko, bigomba gusubizwa inyuma ku giti hafi ya milimetero 6 kugeza 10.

Itandukaniro riri hagati yimbunda yimisumari itekanye nimbogamizi iramanuka rwose kuri ** niba indege yimbere yimbere yitaye NIKI ITEGEKO izo switch zombi zikanda **:

====================================================================================
    CONTACT-TRIP ("BUMP-FIRE") vs. FULL-SEQUENTIAL TRIGGER MECHANICS (NIOSH/OSHA)
====================================================================================

 [A] CONTACT-TRIP / BUMP-FIRE TRIGGER       [B] FULL-SEQUENTIAL TRIGGER (SAFE)
     (Black Trigger; 65-69% of Injuries)        (Gray/Orange Trigger; ANSI SNT-101)

  * Order Does NOT Matter:                   * STRICT 1-THEN-2 SEQUENCE REQUIRED:
    Operator holds Finger Trigger squeezed     [Step 1] Press Nosepiece firmly
    down continuously.                                  against wood FIRST.
                ||                             [Step 2] Pull Finger Trigger SECOND
                vv                                      to fire 1 single nail.
    [Shot 1] Nose touches stud -> FIRES                    ||
                ||                                         vv
    [Recoil] Gun bounces up 5 cm and           If gun bounces after Shot 1 while
             drops back down onto stud         finger holds trigger down:
             or onto LEFT HAND holding wood                ||
                ||                                         vv
    [Shot 2] Nose touches hand -> FIRES        GUN WILL NOT FIRE A SECOND NAIL
             90 mm NAIL THROUGH HAND           (Must release finger trigger first)
====================================================================================

2. Ibintu bitatu bya kera byitumanaho-Urugendo ("Bump-Fire") Ibihe Byimpanuka¶

1. ** Kongera umuriro-kabiri mu kuboko kutiganje (Bikunze kugaragara): **
2. Mugihe arimo gukora urukuta cyangwa gutera imisumari kuri sitidiyo ku buryo butameze neza, umubaji afashe sitidiyo ya 2x4 n'ukuboko kwabo kw'ibumoso santimetero 15 (santimetero 6) uvuye ku rugingo maze arasa umusumari w'urugendo-ukuboko kw'iburyo.
3. Kubera ko urutoki rw'iburyo rw'umubaji ruguma rusunitswe ku mbarutso, pneumatic recoil yikubita izuru ku giti hanyuma ikayimanura ikamanuka kuri santimetero 5 (santimetero 2) ibumoso, haba gukubita ku nkombe ya sitidiyo cyangwa kugwa ku mugongo w'urutoki rw'ibumoso / urutoki rwa kabiri, ikarasa umusumari wa milimetero 89 (santimetero 3,5).
4. ** Urwego, Igisenge cy'igisenge, cyangwa Igitsitaza (Amavi, Ikibero, Isanduku, na Gihanga): **
5. Umuntu ugenda hejuru yinzu hejuru yinzu cyangwa kuzamuka urwego atwara umusumari uremereye wa pneumatike kuruhande rwabo urutoki rwabo rwerekanwe ruzengurutse imbarutso kugirango rushyigikire uburemere bwigikoresho.
6. Niba umukozi anyerera cyangwa agatakaza uburimbane, izuru ryimbunda ryikubita hejuru yibibero byabo **, ikibero cyamavi (patella), igituza, cyangwa umunwa **, cyangwa agakubita umutwe wumukozi bakorana munsi yabo, ahita asohora umusumari wateguwe mumubiri ukomeye.
7. ** Binyuze-na-Binyuze muri Blowout na Knot Ricochet: **
8. Iyo utera imisumari ya pisine yoroheje cyangwa imisumari yomutwe, niba umubaji abuze sitidiyo yinyuma ya milimetero 5 cyangwa agakubita isahani yuzuye ipfundo / icyuma cya truss, umusumari uhita uhita unyura inyuma yinkwi aho ukuboko kwi bumoso k'umubaji gufatiye kuri sitidiyo. .

Kwibira cyane 2: Gukusanya metallurgie (insinga z'insinga, amababi ya plastike, resin glue) no kuvanaho kubaga¶

Ni ukubera iki abaganga b'amagufwa n'abaganga bashimangira gufata X-ray mbere yo gukora ku gikomere cy'imbunda, kandi ni ukubera iki basunika umusumari ** imbere ** cyangwa bagaca umutwe aho kuwukurura inyuma?

1. Anatomy yimisumari ikusanyirijwe hamwe (15, 21, 28, na 30 kugeza 34 Impamyabumenyi)¶

Imbunda yimisumari igaburira imisumari ifatanye mumirongo cyangwa ibifuniko bifatanyirijwe hamwe nibikoresho bine byakusanyirijwe hamwe, kimwekimwe cyose kikaba cyateje akaga kihariye ko kubaga imbere mubice byabantu:

1. ** 15-Impamyabumenyi Yumudozi-Weld Coil Nail (Umuringa usize umuringa wicyuma): **
2. Insinga ebyiri zoroshye zometseho umuringa zometseho uruzitiro hejuru yumutwe wimisumari 200 kugeza 300 muri coil.
3. Iyo umushoferi wumusumari yakubise umusumari wimbere, insinga zirakata, hasigara ** ibice bibiri bya milimetero 2 kugeza kuri 4 za milimetero z'insinga zikomeye zasuditswe ku rufunzo rw'umusumari, zunamye inyuma nk'ibiti by'amafi **.
4. ** Kugaragara kwa Radiografiya: ** Izi nsinga ni ** radiopaque ** (igaragara kuri X-imirasire), ituma umuganga ubaga intoki abona icyerekezo cyerekezo mbere yo gukuraho umusumari.
5. ** 20-kuri-22-Impamyabumenyi ya Plastike-Yanditseho imisumari (amababa ya Radiolucent Polycarbonate): **
6. Imisumari yuzuye-yuzuye imitwe ibumbabumbwe imbere yumutwe ucagaguye wa plastiki ya polikarubone. Iyo wirukanwe, amababa mato ** ya shark-fin ya plastike ityaye ** yiziritse kumutwe wumusumari imbere yinzira.
7. ** Umutego Wihishe X-Ray: ** Bitandukanye ninsinga zicyuma, ** ibice byo gukusanya plastike ni radiolucent (itagaragara kuri X-ray isanzwe) **, nubwo igaragara kuri ultrasound. Niba umukozi yankiye imisumari ya dogere 21 yegeranijwe ku kazi, igufwa ryambura uduce twa plastike ku musumari w’imisumari imbere y’urugingo cyangwa ururenda.
8. ** 28-Impamyabumenyi ya Wire-Strip na 30-kuri-34-Impapuro Impapuro-Imisumari (Thermoplastic Resin Glue): **
9. Bifatanije hamwe na kaseti hamwe na ** thermoplastique adhesive resin ** wongeyeho ** impeta-shank cyangwa imigozi ya screw-shank ** ihuza cyane n'amagufwa ya cortique.

====================================================================================
    WHY PULLING A COLLATED NAIL BACKWARD RIPS NERVES & LEAVES BARBS IN BONE
====================================================================================

            Nail Head Outside Skin
                 +---------+
                 |=========|
     ============+   | |   +============ <-- SKIN ENTRY WOUND
                     | |
       Digital Nerve | | <-- Spot-Welded Copper Wire Barbs (15 deg)
       & Artery ---> |/|     OR Jagged Plastic Fin Collar (21 deg)
                    /| |\    (Pointing UPWARD toward the nail head)
                     | |
     ----------------+ +---------------- <-- CORTICAL BONE / JOINT CAPSULE
                     | |
                     \ / <-- Blunt Tip Carries Plug of Denim, Boot Rubber,
                      v      Resin Glue & Pseudomonas Bacteria Into Bone

  * JOBSITE ERROR (Pulling Upward with Pliers): Barbs hook the digital nerve/artery
    and bone edge strips the plastic/wire barbs OFF inside the wound cavity.
  * SURGICAL METHOD (In OR): Surgeon clips the nail head off with sterile bolt
    cutters and pulls the nail FORWARD in the direction of the barbs, OR opens the
    tract to shield the neurovascular bundle while debriding the bacterial plug.
====================================================================================

2¶

Iyo usize umusumari udakoraho ukagera ku ishami ryihutirwa: 1. ** Kureba-X-Imirasire ibiri (AP na Lateral) + Ultrasound: ** Muganga afata X-imirasire ya orthogonal MBERE YUKO akora ku musumari kugirango arebe niba ** yacitse **, kwinjira hamwe, hamwe na ** insinga zometseho **. 2. ** Agace k'imitsi yo mu karere: ** Agace karumiwe rwose kuburyo umurwayi yumva ububabare bwa zeru. 3. ** Tekinike ya "Gukata-Umutwe-na-Gukurura-Imbere" (Kubinyujije mu-na-Binyuze mu nzara zo mu gihimba): ** Niba umutwe n'umutwe wumusumari byombi biva mu rutoki cyangwa mu ntoki kandi X-imirasire yerekana insinga zerekeza inyuma, umuganga ubaga akuramo umusumari wa ** imisumari ya **. hanze unyuze kuruhande rwo gusohoka ** mubyerekezo bisanzwe byibyatsi, bikurikirwa no kuhira neza no kuvomerera.

Kwibira cyane 3: Kwinjira mu mbunda zangiza imisumari (Cardiac, Intracranial, Ocular, na Capsule)¶

Mugihe 65 ku ijana by'imvune z’imisumari zikubita ukuboko n'intoki, 35 ku ijana bisigaye birimo guhita byangiza ubuzima cyangwa byangiza amaguru:

1. Kwinjira mu nkomere z'umutima w'umutima ("Agasanduku k'umutima")¶

Imisumari yimanitse yamanutse hejuru cyangwa ikururwa mugihe cyo kugwa akenshi irasa umusumari wa milimetero 75 kugeza kuri 90 murukuta rwimbere rwimbere imbere muri ** Cardiac Box ** (ihambiriwe cyane na clavicles, munsi yumurongo uhenze, hanyuma ikaza kumurongo wa midclavicular): - ** Impamvu abahohotewe babanje kureba maso kandi bakagenda hirya no hino: ** Bitandukanye nigikomere cyamasasu giturika umuyoboro mugari wa cavitation, umusumari wa milimetero 3.3 wacumise umurambararo hanyuma ** ucomeka umwobo wacyo ** murukuta rwa ** umuyaga wiburyo, ibumoso, cyangwa imiyoboro yimitsi **. Abagera kuri 50 ku ijana by'abarwayi bafite imisumari-mbunda babanje kumenya no kuvuga mu minota 10 kugeza 30, rimwe na rimwe n'umutwe w'imisumari ugaragara cyane cyangwa ugashyingurwa munsi y'uruhu rw'amatora (reba niba umutwe w'imisumari urimo ** urimo urigata mu gihe gikwiye hamwe n'umutima utera ). - ** Indishyi zitunguranye (Pericardial Tamponade): ** Niba umuntu akuyemo uwo musumari, cyangwa mugihe amaraso yamenetse buhoro buhoro mumisumari muri fibrous ** pericardial sac ** ikikije umutima, umuvuduko wamazi mumasaho ujanjagura ibyumba byumutima kuburyo badashobora kuzura amaraso ( cardiac tamponade **). Reba kuri Triad ** ya **: - ** Igikorwa cyihutirwa: ** ** NTUKIGERE UKORA cyangwa gukurura umusumari wigituza.

2. Intracranial (Igihanga / Ubwonko) Imisumari yinjira¶

Iyo imbunda yimisumari ricochets kumutwe wumutwe, irasa hepfo yumutwe hejuru, cyangwa isohoka mugihe cyo kugwa, umuvuduko mwinshi utwara umusumari wicyuma unyuze muri ** calvarium (igufwa ryigihanga) **, orbit, cyangwa umunwa ukomeye mubwonko bwa parenchyma: - Abarwayi benshi bafite imisumari imwe ya milimetero 90 bajugunywe mumbere cyangwa parietal baguma ** bumva bafite igipimo gisanzwe cya Glasgow Coma (GCS 15) ** hamwe no kuva amaraso make yo hanze kuko igufwa rya gihanga rifata umusumari cyane kandi umusumari wa tamponade watanyaguye imitsi ya cortical. - ** Umutego wa Hemrarhage Umutego: ** Gukuramo umusumari wimbere hanze yicyumba cyo gukoreramo cya neurosurgie gitera ako kanya ** subdural, subarachnoid, cyangwa intraparenchymal hemorhage ** cyangwa irira sinus nini ikomeye. Komeza umutwe wumurwayi uzamuke kuri dogere 30 30 **, wirinde kuruka cyangwa kunanirwa, guhagarika umusumari usohoka utabikandagiye, no gutwara kuri ** CT angiography (CTA) ** na neurosurgical craniotomy.

3. Synovial Joint Capsule Kwinjira (Amavi, Wrist, Amaguru, hamwe na Knuckle) hamwe na Bote Yakazi¶

• ** Arthritis ya Septique Mu masaha 24 kugeza 48: ** Iyo imbunda y'imisumari irasa mu ivi rya ** mugihe umutegarugori apfukamye ku igorofa yo hasi **, imisumari ya milimetero 90 ikubita fibre yanduye yanduye mu buryo bwa ** tibiofemoral synovial space **. Amazi ya synovial imbere ahuriweho akora nk'isahani ya petri ishyushye ya bagiteri. Nubwo ikivi cyangwa ivi ryakomerekeje imisumari yabanje kuva amaraso, ** buri musumari winjira hafi yingingo bisaba ko byihutirwa kwisuzumisha mubitaro kugirango habeho kubagwa hamwe na antibiotike zinjira mu maraso mu masaha make kugirango birinde kwangirika burundu.
• ** Gutobora ibihingwa binyuze muri Rubber-Soled Boots Akazi (* Pseudomonas aeruginosa * Osteomyelitis): ** Insole zuzuye ibyuya byuzuye ibyuya imbere yinkweto zakazi zikoronizwa na bagiteri *** Pseudomonas aeruginosa ***. Iyo umusumari uciye mu kayunguruzo ka rubber mu magufa y'agatsinsino cyangwa metatarsal, itera * Pseudomonas * mu ndiba y'amagufwa, bisaba kuvurwa no kubaga antibiyotike yo kurwanya pseudomonal (hiyongereyeho ** tetanus toxoid booster **).

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Ibibazo bikunze kubazwa¶

Ni irihe tandukaniro riri hagati ya "guhuza-urugendo (bump-fire)" imbarutso na "byuzuye-bikurikiranye" ku mbunda y'imisumari?¶

A ** guhuza-urugendo (bump-fire) imbarutso ** yemerera uyikoresha gukanda no gufata urutoki hasi hasi kuburyo umusumari urasa burigihe burigihe izuru ryikubita hejuru yubuso; niba imbunda isubiye inyuma nyuma yo kurasa bwa mbere hanyuma igahita yerekeza ku kuboko kw’ibumoso cyangwa ku kuguru, irasa umusumari wa kabiri utabishaka (** bingana na 65 kugeza kuri 69 ku ijana by’imvune zose z’imisumari **). A ** yuzuye-ikurikiranye imbarutso ** isaba intambwe ikaze yintambwe ebyiri kuri buri musumari: ** (1) kanda igitereko cya nosepiece hejuru yinkwi, hanyuma (2) gukurura urutoki rwa kabiri **. Niba imbunda isubiye inyuma mugihe urutoki rwumukoresha rufashe imbarutso hasi, umusumari wuzuye ukurikirana ** ntishobora kurasa umusumari wa kabiri **.

Kuki ntagomba na rimwe gukuramo umusumari w'imbunda mu rutoki, mu kuboko, cyangwa ku ivi ku kazi nkoresheje inyundo cyangwa icyuma?¶

Bitandukanye n'umusumari utwarwa neza n'intoki, imisumari yarashwe mu mbunda ikozwe mu musumari ifatirwa hamwe mu mipira cyangwa mu biceri ukoresheje ** umuringa w’umuringa usudira (umuringa wa dogere 15), imirongo ya pulasitike ya polikarubone (imirongo ya dogere 21), cyangwa kashe ya kole **. Iyo imbunda irasa umusumari muri kariya gace, ** urwembe rukarishye rwumuringa wumuringa cyangwa udusimba twa pulasitike twa pulasitike biguma bifatanye kumpande yumutwe wumusumari **, werekeza inyuma werekeza kumutwe wumusumari nkibiti byamafi. Niba ukuyemo umusumari inyuma y'urutoki cyangwa ugafatanya na pliers, ibibari bifata kandi bigashwanyaguza ** imitsi ya digitale, arteriire, na tendon **, mugihe igufwa ryambura amababi ya plastiki yanduye hamwe nigitambara cyacometse kumutwe imbere y igikomere. Kureka umusumari udakorwa kugirango ukureho.

Nigute abaganga bakuramo imisumari yimisumari yimbunda batiriwe batanyagura imitsi nimitsi?¶

Mu bitaro, umuganga afata ** kureba X-imirasire ibiri ** kugira ngo arebe niba igufwa ryaravunitse kandi niba insinga zometseho insinga zisohoka mu musumari. Nyuma yo kuniga ikiganza cyangwa ikirenge hamwe nigitereko cyumutima, niba umusumari wanyuze munzira cyangwa urutoki, umuganga ubaga arasuzumisha kandi akanahindura ** umutwe wumusumari wa ** usohoka **, akoresha ** sterile yo kubaga ya bolteri kugirango akureho umutwe uringaniye ku musumari **, hanyuma akuramo umusumari ** FORWARD hanze yinyuma yinyuma kugirango yerekane ibibari bityo ntago bigenda bikurura.

Nakora iki niba ikiganza cyumukozi cyangwa boot byatewe imisumari kuri sitidiyo ya 2x4 cyangwa hejuru yinzu?¶

** Ntukigere ugerageza guterura ukuboko k'umuntu cyangwa gukuramo sitidiyo ya 2x4 **, yunama umusumari mumagufwa yabo kandi amarira aritsiye. Ahubwo: (1) Hagarika amashanyarazi cyangwa batiri mumasumari ako kanya; (2) saba umuntu umwe ushyigikire ukuboko cyangwa ukuguru kwabakozi bakomeretse kuburyo nta buremere bumanika ku musumari; . no (4) gutwara umukozi mu ishami ryihutirwa hamwe n'uduce duto duto duto twometse ku musumari.

Ni ukubera iki gukomeretsa imisumari binyuze munsi yumurimo wa reberi ibyuya bitera boot orthopedic byihutirwa nubwo biva amaraso?¶

Iyo imisumari ikozwe mu kayunguruzo hamwe na fumu insole ya boot yakazi yambaraga ikirenge, isonga ryumusumari rikora nkigikonjo-gikata, gutwara icyuma cyibanze cya ** reberi, fibre sock, resin resin, na bagiteri zikunda ibyuya byitwa * Pseudomonas aeruginosa *** byimbitse mumagufwa y'agatsinsino cyangwa metatarsal. Nubwo umwobo wacitse utemba amaraso, * Pseudomonas * bagiteri zafatiwe mu magufa zitera ** osteomyelitis (kwandura amagufwa) cyangwa se septique arthritis ** mu minsi mike keretse ikirenge cyerekanwe X, kibagwa, kandi kivurwa na antibiyotike zirwanya pseudomonal na tetanus.

Kuki umuntu warashwe mu gatuza akoresheje imbunda y'imisumari ashobora kugenda akavuga bisanzwe, hanyuma agasenyuka nyuma yiminota 15?¶

Iyo milimetero 90 (santimetero 3,5) zometseho umusumari winjiye hagati yigituza (** Agasanduku k'umutima **), ikunze gucengera mu ibere ryinjira muri ** iburyo bwumutima **. Kuberako umusumari ukomeye wicyuma uguma wiziritse mumitsi yumutima, ucomeka umwobo wigihe gito. Ariko, nihagira umuntu ukuramo umusumari, cyangwa mugihe amaraso yamenetse hafi yumusumari muri fibrous ** pericardial sac ** ikikije umutima, amaraso yafashwe asunika umutima kugeza igihe atagishoboye kuvoma (** cardiac tamponade **). Ntuzigere ukora ku musumari w'igituza; komeza uwahohotewe hanyuma uhamagare 911/112/999 kugirango uhite utwara ikigo cya 1 cy’ihungabana. Gufata ibyemezo byambere byemewe hamwe na CPR muri Croix-Rouge, Ambulance ya St John, cyangwa umutanga waho aragutegurira ibihe byihutirwa byakazi.

Kuyobora¶

• Imbunda yimisumari hamwe na pneumatike yihuta kwinjira no gukomeretsa ricochet
• Kumanika no gushiramo ibintu byo mumahanga bihamye
• Cardiac tamponade no gucengera mu gituza triage
• Amaraso akomeye hamwe na windlass tourniquet
• Gukomeretsa kw'amaso, kumeneka imiti, no guhahamuka kwisi

Inkomoko nubuyobozi¶

• ** Ikigo cy’igihugu gishinzwe umutekano n’ubuzima (NIOSH) n’ubuyobozi bushinzwe umutekano n’ubuzima bw’akazi (OSHA, Amerika): ** * Umutekano w’imbunda: Imfashanyigisho y’abashoramari bubaka (DHHS / NIOSH Igitabo No 2011-202 / OSHA 3459-8-11, Guhuza-Urugendo na Byuzuye-bikurikirana bikomeretsa Epidemiologiya no gukumira) *.
• ** Ibigo bishinzwe kurwanya no gukumira indwara (CDC, Amerika): ** * Igenzura rya MMWR ry’imvune ziterwa n’imisumari n’imbunda zavuwe mu mashami yihutirwa hamwe n’impamvu zishobora guteza impanuka (Lipscomb et al. Residential Carpentry Studies) *.
• ** Ikigo cy’igihugu cy’ubuziranenge cy’Abanyamerika (ANSI) hamwe n’umuryango mpuzamahanga w’ibikoresho, imisumari n’ibikoresho (ISANTA): ** * ANSI SNT-101-2015 Ibisabwa by’umutekano ku byerekanwa byoroshye, bikomeretsa-bikoreshwa mu kirere, ibikoresho byo gutwara byihuta na EN ISO 11148-13 *.
• ** Sosiyete y'Abanyamerika ishinzwe kubaga ikiganza (ASSH) hamwe n’ishuri ry’abanyamerika ry’abaganga babaga amagufwa (AAOS): ** * Ubuyobozi bwo kubaga uburyo bwo gukomeretsa cyane bw’umuvuduko ukabije w’imisumari: Imirasire ya radiografiya y’ibice, Gukuramo ibice bya Radiolucent, Gukuramo Antegrade nyuma yo gukuramo imisumari-Umutwe.
• ** Komite y'Abanyamerika ishinzwe kubaga (ACS) komite ishinzwe ihungabana: ** * Amabwiriza Yambere yo Gufasha Ubuzima Bw’Ihahamuka (ATLS) Amabwiriza yo Kwinjira mu Isanduku Y’umutima (Pericardial Tamponade / Triad ya Beck) no Kwinjira mu Nkomere zo mu bwoko bwa misile zidafite misile *.