Inkokora ya Nursemaid, Limp Acute Toddler Limp, hamwe nabana bato Ibendera ritukura¶

Iyo umwana muto cyangwa umwana muto yanze kwimura ukuboko cyangwa guhagarika gutungurana kuguru, ababyeyi bahura nibibazo byo kwisuzumisha. Kubera ko abana bari munsi yimyaka 4 badashobora gutandukanya neza ububabare bwumugongo, akenshi berekana ukuboko kwabo mugihe inkokora yabo irenze, cyangwa bakerekana ivi ryabo mugihe ikibuno cyabo cyanduye cyangwa cyakomeretse, abarezi b'abana bagomba kwishingikiriza kumyerekano igaragara, uburyo bwo gukomeretsa, hamwe nibendera ritukura rya sisitemu kugirango bahitemo ubuvuzi bwihutirwa no gusura byihutirwa byihutirwa.

Mugice cyo hejuru, inkokora ya ** umuforomo (subaluxation ya radial cyangwa "gukurura inkokora") ** ni imvune ikunze kugaragara cyane kubana bafite hagati yimyaka 1 na 4, iterwa no gukwega imitwe kumaboko arambuye kandi igakira mumasegonda nukugabanuka kworoheje gufunze iyo kuvunika. Mu gice cyo hasi, ** acide toddler acumbagira cyangwa yanze kubyibuha ** bisaba gutandukanya byihuse hagati yumuriro wa virusi nziza (** transient synovitis **), kuvunika kwa tibial spiral tibial (kuvunika umwana muto ), isahani yo gukura yibibuno byanyerera ( SCFE ), hamwe na karitsiye yangiza ikibuno ( bagiteri). Aka gatabo gatanga ibipimo nyabyo bifatika, ** 4-Ingingo ya Kocher Hip Score ** kuvunika hamwe namategeko yo gusuzuma subluxation, hamwe na protocole y'abana orthopedic triage protocole.

Kora ubu¶

1. ** Itegereze kuruhuka kwingingo yakomeretse mbere yo kuyikoraho **:
2. ** Inkokora ya Elsemaid ya Nursemaid **: Umwana muto afashe ukuboko kwanduye ** ku buryo bworoshye kuruhande rwabo cyangwa hejuru yinda yabo ** akoresheje inkokora ya ** yunamye gato (dogere 15 kugeza kuri 20) ** naho ukuboko kwa ** kuzunguruka intoki-hasi (bivuzwe) **. Umwana arakina kandi agenda yishimye mugihe cyose ntamuntu ukora ku kuboko, ararira gusa iyo asabwe kunama inkokora cyangwa guhindura ikiganza hejuru kugirango agere ku gikinisho.
3. ** Ibihe byihutirwa bya Hip Septic Arthritis (Umwanya "Igikeri-Ukuguru") **: Umwana araryamye aracyanga kwihagararaho, afashe ikibuno kibabaza ** ahindagurika (yunamye), ashimuswe (ahindukirira hanze yumurongo wo hagati), kandi azunguruka hanze ** kuko iyo myanya nyayo igabanya umuvuduko wibibuno byikibuno kandi bikagabanya umuvuduko ukabije uturutse kumitsi ifatanye.
4. ** Erekana ukuboko kuvunika amabendera atukura mbere yo kugenda **: Reba umukoroni (clavicle), urutugu, ukuboko hejuru, inkokora, ukuboko, hamwe nintoki muburyo bugaragara kandi ukoresheje urutoki rumwe. Niba hari ** kubyimba, gukomeretsa, kurakara kugaragara, ubushyuhe, cyangwa niba igikomere cyatewe no kugwa cyangwa gukubitwa mu buryo butaziguye aho gukurura ** guhagarika ukuboko mumugozi woroshye mumwanya wabonetse hanyuma ukajya mubyihutirwa cyangwa ishami ryihutirwa kugirango X-ray; reba amagufwa yamenetse.
5. ** Reba kuzenguruka, kumva, no gutunga urutoki (Kugenzura Neurovasculaire) **: Menya neza ko intoki z'umwana ku gihimba cyakomeretse ari ** zishyushye kandi zijimye ** ko capillary yongeye kugaruka muri ** munsi y'amasegonda 2 ** iyo ukanze urutoki, kandi ko umwana ashobora kuzunguza intoki cyangwa amano bisanzwe. Intoki zijimye, zikonje, ubururu, cyangwa zinanutse byerekana gutandukana kw'amaraso biturutse ku kuvunika inkokora kwimuwe kandi bisaba guhamagara nimero yawe yihutirwa (911 muri Amerika na Kanada, 112 hirya no hino mu muryango w’ubumwe bw’ibihugu by’Uburayi, 999 mu Bwongereza; reba byose nimero yihutirwa) ako kanya.
6. ** Fata ubushyuhe bwumwana ako kanya kugirango amaguru yose acumbagira cyangwa yange kugenda **: Koresha termometero ya digitale kugirango urebe niba umuriro. Koresha ibipimo bya ** Kocher **: niba umwana yanze kubyibuha ku kuguru KANDI afite umuriro uri hejuru ya dogere selisiyusi 38.5 (dogere 101.3 Fahrenheit) ** jya mu bitaro bishinzwe ubutabazi bwihuse (gumana umwana ** NPO / ntakintu na kimwe cyo kurya cyangwa kunywa ** mugihe hagomba kubagwa icyifuzo cyo kubaga cyangwa kuvoma munsi ya anesteziya).
7. ** Kugenzura ukuguru kwambaye ubusa kuva ku kirenge kugera ku ruti rw'umugongo **: Niba umwana muto acumbagira adafite umuriro, kura inkweto, amasogisi, ipantaro, na diaper burundu. Reba ibirenge byikirenge kugirango uhishe ikintu cyihishe, ikirahure cyikirahure, cyangwa umusatsi wogoshe umusatsi uzengurutse ukuguru; kanda witonze igufwa rya shin (tibia) kugirango ubupfumu bwacitse ** umwana muto ; hanyuma urebe uruhu hejuru yamaguru namatako kugirango utagira ibara ryijimye ( Henoch-Schönlein Purpura / IgA vasculitis ) cyangwa impfizi yizengurutsa ijisho ( Lyme arthritis **).
8. ** Shakisha isuzuma ryubuvuzi kugirango ugabanye umutekano ufunze cyangwa amashusho y’amagufwa **: Ku nkokora y’umuforomo w’umuforomo utagoranye, umuganga w’abana, umuganga wihutirwa, cyangwa umuganga wihutirwa ashobora gukora ** Hyperpronation cyangwa Supination-Flexion manuuver ** mu masegonda 3 nta anesteziya cyangwa X-X, bigarura 100% gukoresha amaboko asanzwe mu minota 10 kugeza kuri 15.

Umwigisha w'abana Ukuboko & Ukuguru Kwiyemeza Igiti¶

flowchart TD
    Start["Uruhinja rutunguranye rwanga gukoresha ukuboko <br/> CYANGWA RUGENDE / Yanze kugenda kumaguru"] --> Limb{"Ni izihe ngingo zigira ingaruka?"}

    Limb -->|"UPPER EXTREMITY: <br/> Umwana yanze gukoresha ukuboko kumwe"| ArmHx{"Hoba hariho PULL ya axial (yazamuwe n'intoki, izunguruka, <br/> ikururwa, cyangwa izunguruka ku kuboko gufashwe) <br/> hamwe na ZERO yaguye, kubyimba ZERO, & ubumuga bwa ZERO?"}

    ArmHx -->|"OYA: Kugwa kuva muburebure / kuryama, gukubita, <br/> kubyimba, gukomeretsa, cyangwa clavicle / ukuboko kwamaboko"| ArmFracture["UKOMEZE KUBONA AMAFARANGA <br/> (Supracondylar Humerus, Clavicle, cyangwa Radiyo ya Radiyo ya kure) kubona X-ray kuri Byihutirwa / ER"]

    ArmHx -->|"YEGO: Uburyo bwa kera bwo gukurura + + <br/> Ukuboko gufashe gato & palm-down (byavuzwe);"| Nursemaids["UBURYO BWA CLASSIC NURSEMAID <br/> (Umutwe wa Radial Subluxation)"]

    Limb -->|"KUGARAGAZA GUKURIKIRA: <br/> Umucyo ukabije cyangwa kwanga kwihanganira ibiro"| FeverCheck{"Reba Ubushyuhe & Ibimenyetso bya Sisitemu: <br/> Ese Ubushyuhe> 38.5 C (101.3 F), umwana asa nkuwarwaye / umunebwe, <br/> cyangwa ikibuno gifashwe muburyo buhamye bwibikeri-Ukuguru?"}

    FeverCheck -->|"YEGO (Umuriro cyangwa ububabare bukabije kuri Hip Motion)"| SepticER["BYIHUTIRWA BIKORESHEJWE: SHAKA INGINGO ZIKURIKIRA <br/> CYANGWA OSTEOMYELITIS (Amanota Kocher)"]

    FeverCheck -->|"OYA umuriro; Umwana asa nkumukino kandi neza"| LegExam{"Suzuma Imyaka & Byibanze Byibanze"}

    LegExam -->|"Imyaka 9 mo kugeza 3 yrs: Ikirenge cyahinduwe mubitereko, <br/> yamanutse kumurongo ku bibero byumuntu mukuru, cyangwa yikandagiye;"| ToddlersFx["UKOMEZE KUBONA URUBUGA RWA <br/>"]

    LegExam -->|"Imyaka 3 kugeza 8 yrs: Ubukonje bworoheje bwa virusi 1 kugeza 2 wks ishize;"| Synovitis["LIKELY SYNOVITIS YIMBERE ('Ikibuno kidasanzwe') ikiruhuko + NSAIDs; garuka ako kanya niba umuriro utangiye"]

    LegExam -->|"Imyaka 9 kugeza 15 yrs (Mbere yumwangavu / Umwangavu): <br/> Ikibuno, igituba, cyangwa ububabare BUMENYEKANA; <br/> ikirenge gihinduka hanze iyo ugenda"| SCFE["SHAKA GUKURIKIRA CAPITAL FEMORAL EPIPHYSIS (SCFE)"]

Igice cya 1: Inkokora y'abaforomo (Subialxation ya Radial)¶

1.¶

Ku nkokora y'inkokora, hejuru yizengurutswe hejuru yamagufa yimbere yimbere (** umutwe wa radial **) azunguruka imbere yimpeta yumuzingi ya ligamente yitwa ** annular ligament ** ihambira radiyo kuri ulna. - ** Impamvu abana bato (bafite imyaka 1 kugeza 4) bafite intege nke zidasanzwe **: Mubana bato, ligament ya annular iroroshye kandi ifatanye neza na periosteum yijosi rya radiyo, na nubu ikaba ikunze kuba karitsiye yoroshye. - ** Inzira nyayo yo gukurura **: Iyo umuntu mukuru akwegeye hejuru hejuru yumwana muto, ** uvugwa (palm-down) ** ukuboko, umutwe wa radiyo uranyerera igice kiva mumuzingo wa ligamente ya annular, hanyuma impera yimbere yumurongo wa ** urambuye uhuza (hagati) n'umutwe wa radiyo na capitellum ya humerus **. - ** Ibintu bitanu bisanzwe bisanzwe buri munsi **: 1. Gufata umwana muto watsitaye mukuboko cyangwa kuboko kugirango batagwa kumuhanda. 2. Gukurura umwana muto udashaka hejuru ukuboko kumwe iyo baguye hasi mububiko. 3. ** Kuzunguza umwana muto mu ruziga cyangwa kubazamura mu kirere n'amaboko yabo cyangwa amaboko **. 4. Gukurura ukuboko k'umwana muto byihuse ukoresheje ikote ryoroshye cyangwa swater. 5. Uruhinja (rufite amezi 6 kugeza 12) ruzunguruka mu gitanda cyabo mugihe ukuboko kwabo gufashwe munsi yumubiri wabo. - ** Impamvu abana barusha imyaka 5 kugeza 6 **: Mugihe cyimyaka 5, imigozi ya fibrocartilage ya ligament ya annular irabyimbye kandi ikabara neza ku ijosi rya radiyo, kandi umutwe wa radiyo ukura mugari kandi ukaka cyane kuruta ijosi, bigatuma subluxation idasanzwe muburyo budasanzwe nyuma yishuri.

2. Gutandukanya inkokora y'abaforomo n'inkokora, ukuboko, cyangwa kuvunika kwa Collarbone¶

Kuberako abimuwe ** supracondylar humerus yamenetse ** cyangwa ** icyatsi kibisi / buckle intera ya radiyo yamenetse ** bisaba ubudahangarwa na X-imirasire, kandi bigomba ** kutigera ** bigoreka, burigihe ugenzura ibintu 6 byose biri muri iyi matriki yubuvuzi:

3. Gusobanukirwa Uburyo bubiri bwo Kugabanya Amavuriro (Hyperpronation vs. Supination-Flexion)¶

Mu ivuriro ryihutirwa, ku biro by’umuganga w’abana, cyangwa mu cyumba cyihutirwa (cyangwa ku buyobozi bwa telehealth itangwa na muganga iyo uhagaze mu gace ka kure nyuma yo gukuramo amabendera atukura yose yamenetse), abaganga bakoresha imwe mu nzira ebyiri zihuta, amasegonda 3 kugira ngo basubize inyuma buri mwaka hejuru y’umutwe wa radiyo:

flowchart TD
    Prep["1. Kugenzura Umutekano Mbere yo Kugabanya <br/> Emeza imyaka 6 mo kugeza 5 yrs, gukurura uburyo (nta kugwa),"] --> Sit["."]

    Sit --> Method{"3. Hitamo uburyo bwo kugabanya ivuriro"}

    Method -->|"IKORANABUHANGA A: HYPERPRONATION <br/> (Umurongo wa mbere: 85% kugeza 95% igipimo cyambere cyo gutsinda; <br/> ntibibabaza umwana muto)"| Hyper["Fata ukuboko kwa kure kwumwana / ukuboko ukoresheje ukundi kuboko <br/> Kuzunguza ukuboko kwumwana gushikamye URUNDI PALM-HANUKA <br/> (hyperpronate) muburyo bumwe bworoshye kugeza byoroshye <br/> byoroshye KANDA / POP byunvikana munsi yintoki kumutwe wa radiyo"]

    Method -->|"IKORANABUHANGA B: SUPINATION-FLEXION <br/> (Tekiniki isanzwe isimburana niba Technique A yananiwe)"| SupFlex["Koresha igitutu cyoroheje hejuru yumutwe wa radiyo <br/> 1. Kuzenguruka ukuboko kwumwana byuzuye PALM-UP (supinate) <br/> 2. Byoroheje kandi byuzuye BUGENDE (flex) inkokora <br/> izana ikiganza cyumwana hejuru yigitugu <br/> kugeza igihe KANDA yumvikana kumutwe wa radiyo"]

    Hyper --> Reassess["4. -Iminota 15-Nyuma yo Kugabanuka Nyuma yo Kugabanuka <br/> Sohoka mucyumba cy'iminota 10 kugeza kuri 15"]
    SupFlex --> Reassess

• ** Impamvu Ibigeragezo Byemewe Bikunda Hyperpronation Yambere **: Isubiramo ryinshi rya Cochrane hamwe nibigeragezo byihutirwa byabana ugereranije nuburyo bubiri byerekana ko tekinike ya Hyperpronation ** igera kuri ** igeragezwa ryambere ryambere rya 85 kugeza 95% ** (ugereranije na 68 kugeza 77% kubireba Supination-Flexion) kandi bitera kutoroherwa mukuboko kwabana bato.
• ** Bigenda bite nyuma ya "kanda"? **: Mugihe ligamente yumwaka isubira inyuma yumutwe wa radiyo, umuganga yumva pop yihariye, ntoya ** cyangwa ukande ** munsi yintoki zabo ku nkokora yinyuma, kandi umwana muto ararira mugihe gito amasegonda 30 kugeza kuri 60 uhereye kubitekerezo bitangaje. Muri ** iminota 10 kugeza kuri 15 ** umwana muto yibagirwa ukuboko kwigeze kubabaza kandi akagera hejuru yumutwe wabo gufata igikinisho. ** Nta shitingi cyangwa umukinnyi ukenewe ** nyuma yo kugabanuka kwibanze, nubwo ababyeyi bagomba kuburira abarezi bose, abavandimwe, ndetse nabakozi bashinzwe kurera abana ** kutazigera bakurura cyangwa kuzamura umwana mumaboko cyangwa kuboko ** kuko inkokora yumuforomo ifite igipimo cya ** 20 kugeza 35% byisubiramo ** kugeza igihe ligament ikomera kumyaka 5.

Igice cya 2: Acute Toddler Limp na Lower-Extremite ihuriweho Ibendera ritukura¶

Iyo uruhinja, umwana muto, cyangwa umwana mukuru atangiye gucumbagira (** antalgic gait ** kumara umwanya muto kumaguru ababara) cyangwa yanze guhagarara no kugenda rwose, isoko yububabare irashobora kuryama ahantu hose kuva kumugongo kugeza kumano.

1. Ibipimo 4-Ingingo ya Kocher Ibipimo: Gukuraho Arthrite ya Septique ya Hip Yambere¶

Impamvu imwe iteye akaga cyane itera ubumuga bukabije bwabana ni ** acute bacterial septic arthritis ** (bikunze guterwa na * Staphylococcus aureus *, * Kingella kingae * kubana bato bari munsi yimyaka 4, cyangwa * Streptococcus pyogenes *). Iyo bagiteri itera imbuto ya sinoviya imbere muri capsule ifatanye yikibuno cyangwa ivi, selile yamaraso irekura imisemburo ya proteolyique itangira ** igogora bidasubirwaho karitsiye yumutima mugihe cyamasaha 8 kugeza 24 ** mugihe umuvuduko ukabije wimbere wumuvuduko wamaraso wumutwe wamaraso ugaburira umutwe wigitsina gore (bitera ** nécrosis ya avasula ** no kurimbuka ubuzima bwose).

Gutandukanya kubaga ** septique arthritis ** na virusi nziza ya sinovitis yinzibacyuho ("ikibuno kirakara") ** abaganga babaga amagufwa n'abaganga byihutirwa bakoresha ibipimo byemewe ** Kocher **:

• Isaro rya Clinical on Toddlers (Amezi 6 Amezi 4) Kubwibyo, ** ingingo zose zisa nkizabyimbye, zishyushye, umutuku, cyangwa ntizishobora kwimurwa muburyo bworoshye bwo kugenda nta bubabare bukabije bisaba guhita bisuzumwa mubitaro ** nubwo umuriro uri munsi ya 38.5 ° C.

2¶

Intambwe ku yindi Urugo Ikizamini Inyandiko: Nigute Kugenzura Umwana Ucumbagira witonze¶

Mbere yo guhamagara umuganga wawe wabana cyangwa kwerekeza mubitaro, kora uku gutuza, iminota 2 kumutwe kugeza kumutwe kandi ugenzure neza mugihe umwana wawe yicaye mukibero cyababyeyi:

1. ** Ibuka Itegeko rya Zahabu ryububabare bwo mu kibuno ("Ububabare bw'amavi = Reba ikibuno") **: Umutima wa ** obturator nerv ** na ** nerval femorale ** winjizamo capsule yibibuno hamwe no hagati yivi. Abagera kuri ** 30 ku ijana by'abana bafite uburwayi bukomeye bwo mu kibuno (harimo na Septic Arthritis, Indwara ya Perthes, na Slipped Capital Femoral Epiphysis) ** binubira ** kubabara ivi gusa ** kandi bafite ikizamini gisanzwe rwose. Umwana wese ufite ububabare bwivi budasobanutse agomba gusuzumwa ikibuno.
2. ** Tangirira Hasi (Amano n'amaguru) **:
3. Kugenzura amano 10 yose kuri ** umusatsi wogusura ** (umugozi utagaragara hafi wumusatsi ukata mumurongo wamano yabyimbye).
4. Koresha urutoki rwawe witonze hejuru y'agatsinsino n'umupira w'amaguru mugihe urabagirana amatara ya terefone yawe kuruhande rwuruhu kugirango ubone igicucu cy'akabuto gato k'ikirahure cyangwa ibiti.
5. ** Shyira amaguru hamwe na Shin (Kugaragaza kuvunika k'umwana) **:
6. Gereranya amaguru n'amavi byombi kuruhande kugirango ubyibushye cyangwa ubushyuhe (shyira inyuma y'intoki zawe kumutwe wiburyo wiburyo, hanyuma ikivi cyibumoso;
7. Kanda buhoro buhoro uburebure bwa ** tibia (igufwa rya shin) ** kuva kumavi ukageza ku kaguru, hanyuma ufate ivi witonze mugihe uzunguruka ikirenge imbere n'inyuma. Niba umwana wimyaka 1 kugeza kuri 3 atsinze cyangwa agasubiza ukuguru mugihe ukanze igice cya gatatu cyo hepfo ya shin, ukekako kuvunika kwa ** Umwana muto **.
8. ** Kora Umugwaneza Supine "Log-Roll" Ikizamini cya Hip **:
9. Saba umwana kuryama ku mugongo cyangwa ku buriri n'amaguru yombi yorohewe kandi agororotse.
10. Shira amaboko yawe witonze ku kibero cy'inyana n'inyana hanyuma ** uzunguruze ukuguru kwose witonze imbere n'inyuma nka pin izunguruka kumeza (dogere 10 kugeza kuri 15 zo kuzunguruka) **.
11. Kuberako kuzunguza ukuguru kuburiri ntabwo byunamye ivi cyangwa amaguru, bipima ** gusa umupira-na-sock ikibuno **:
    • Niba kuzunguruka ukuguru witonze imbere n'inyuma bitera ** ububabare bwa zeru ** umuvuduko ukabije wa septique hip effusion ntabwo bishoboka.
    • Niba umwana arinze ukuguru kandi agatakamba ndetse na ** 5-10-10 ya dogere ** ya flux cyangwa pus arimo kwagura ikibuno, jya mu ishami ryihutirwa.

Kugenzura Urutonde: Kurinda Inkokora Namagufwa¶

• ** Ntuzigere Uzamura, Kuzunguruka, cyangwa Gukurura Umwana uri munsi yimyaka 5 ukoresheje amaboko, amaboko, cyangwa amaboko **: Buri gihe uzamure impinja nabana bato ushyira amaboko yombi ** munsi yintoki zabo (axillae) ** uzengurutse urubavu rwabo. Igisha barumuna bawe, abarezi, na basogokuru ko gukina "indege" cyangwa kuzunguza umwana muto hagati yabantu bakuru bombi bafatanye amaboko niyo mpamvu ya mbere itera inkokora y'abaforomo.
• ** Ntuzigere Ujya Kumwanya wo gukinisha Ufashe umwana muto ku bibero byawe **: Kwiyandikisha kw'ihungabana rya orthopedic byerekana ko ** kunyerera ari imwe mu mpamvu zingenzi zitera kuvunika kw'abana bato bato (kuvunika tibia spiral) **: iyo umwana muto yicaye ku bibero by'umuntu mukuru amanuka kuri slide, inkweto ya reberi y'urukweto rwa 70-ifata uruzitiro rwa 70-rufata uruhande rwa plastike-uruhande rwa 90-rufata uruhande rwa plastike-uruhande rwa 90. . Reka abana bato banyerera gusa kumyaka ikwiranye nuduce duto bonyine mugihe ubabonye hasi.
• ** Reba Pajamas Yasaze hamwe namasogisi Imbere-Hanze yo kumesa **: Imisatsi irekuye yimisatsi miremire ikuze ikunze kwizirika mumasogisi yimpinja hamwe nabasinzira ibirenge mumashini imesa, bigatera syndrome yintoki cyangwa urutoki-tourniquet.

Ibibazo bikunze kubazwa¶

Inkomoko yagenzuwe¶

• Ishuri Rikuru ry’Abanyamerika ry’Abaganga babaga amagufwa (AAOS) hamwe n’umuryango w’amagufwa y’abana bo muri Amerika ya Ruguru (POSNA, Amerika):
• Cochrane Ububikoshingiro Bwisuzuma Ryuzuye: * Ibikorwa bya Manipulative byo kugabanya inkokora yakuwe mubana bato (Hyperpronation vs. Supination-Flexion Meta-Analyse) *.
• Ishuri Rikuru ry’Abanyamerika ryita ku bana (AAP): * Isuzuma ry’umwana wacumbagira hamwe n’indwara zikaze zitwa Musculoskeletal Indwara z’abana *.
• Ikigo cy'igihugu gishinzwe ubuzima no kwita ku ndashyikirwa (NICE) na Serivisi ishinzwe ubuzima (NHS, Ubwongereza): * Isuzuma rya Limp Acute mu bana no gucunga inkokora *.
• Ibitaro byabana byumwami Melbourne (Ositaraliya): * Amabwiriza yubuvuzi: Gukuramo inkokora, Limp Acute, na Hipritable Hip na Septic Arthritis Triage *.

Kuyobora¶

• Amagufa yamenetse kandi atera ubufasha bwambere
• Igitugu cyimuwe, ivi, hamwe na immobilisation
• Umwana ufite umuriro mwinshi hamwe no gufatwa na febrile
• Sepsis hamwe na septike yo kumenyekana
• Gukomeretsa mumutwe no guhungabana ubufasha bwambere
• Ububiko bwihutirwa