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Umukinnyi wabanyeshuri waguye mukibuga: Ubushyuhe bukabije ('Cool Yambere, Ubwikorezi bwa kabiri') vs Ifatwa rya Cardiac Bitunguranye vs Sickling

Imibare yihutirwa itandukanye nigihugu. Uru rupapuro rukoresha 911, umubare kuri Amerika na Kanada. Ibindi bihugu byinshi bikoresha 112, 999, cyangwa undi mubare. Shakisha umubare wigihugu cyawe.

Kurebera umusore wimyaka 15 wumupira wamaguru wumupira wamaguru, umunyeshuri wiruka wambukiranya igihugu, umunyamuryango witsinda ryumukino, cyangwa umukinnyi wumupira wamaguru wumupira wamaguru ukiri muto yikubita hasi apfukamye cyangwa yikubita hasi kuri ruhago mugihe imyitozo yo kwisuzumisha muminsi ibiri kumunsi nimwe mubintu byihutirwa mubuvuzi bwa siporo. Mu rubyiruko rwimikino ngororamubiri, ** hejuru ya 90% yimpfu zose zitunguranye zidahungabana kumikino yo gukiniraho ziterwa nibintu bitatu gusa bikaze **: ** Ifatwa ryumutima ritunguranye (SCA) **, ** Ubushyuhe bukabije (EHS) **, na ** Indwara zidasanzwe (ES mu bakinnyi bitwaje Indwara ya Sickle, HbAS) **. Mugihe ibintu byihutirwa byose uko ari bitatu bishobora kwerekana mumasegonda yo gukora cyane kumubiri kumunsi ushushe, kwitiranya undi mumasegonda ** yambere 180 180 birashobora kwica. Gufata Uwahohotewe Yumutima Bitunguranye nk "ubushyuhe bukabije" bidindiza defibrillation kurenza idirishya ryiminota 3 yo kubaho; gushyira Exertional Heatstroke uwahohotewe ahita asubira inyuma ya ambulance yumye, yumuyaga utabanje kubiroha mukibanza ** kwibiza-amazi akonje (CWI) ice tub ** irenga ku ishyirahamwe ryabatoza ryimikino ngororamubiri ** (NATA) na Korey Stringer Institute "Cool Icya mbere, Ubwikorezi bwa kabiri" manda-zahabu isanzwe manda ** kandi ibemerera 41.5 °C (106.7 °F) ubushyuhe bwibanze bwo guteka ubwonko bwabo numwijima mugihe cyiminota 20 yo gutwara ambulance; no gutaka umukinnyi uhura nikibazo gikomeye ** Indwara idasanzwe yo kurwara ** "guhaguruka no gukomeretsa amaguru" bitera microcasculaire microcasculaire itukura-maraso-selile logjamming, rhabdomyolysis yuzuye, hamwe no gufatwa k'umutima hyperkalemique.

Kubwamahirwe, abatoza, abatoza b'imikino (ATCs), abaganga b'ikipe, n'ababyeyi kuruhande ntibakeneye gupimwa amaraso ya laboratoire kugirango babwire ibi byihutirwa bitatu bitandukanye nibyatsi. Mugenzura ** bane bavangura ivuriro mumasegonda 30 yambere ** - ** (1) Kwitabira no guhumeka (SCA = kutitabira rwose hamwe no guhumeka agonal guhumeka) **, ** (2) Gusenyuka Umuvuduko (SCA na Heatstroke manuka gitunguranye nta nteguza, mugihe Sickling abakinnyi basinziriye hasi mugihe bakiri maso kandi binubira intege nke, ischemic hepfo-inyuma / gluteal / hamstring intege) **, ** (3) Palpation yimitsi (Heatstroke na Sickling imitsi yumva yoroshye cyangwa flaccid, mugihe arukuri Heat Cramps funga muri rock-ikomeye, bigaragara ko ifunze spasms) **, na ** (4) Ubushyuhe bwa Core Rectal ()Exertional Heatstroke isobanuwe neza na CNS idakora neza hiyongereyeho ubushyuhe bwurukiramende hejuru 40.5 °C / 105 °F, mu gihe Sickling na SCA bibaho kubisanzwe cyangwa byoroheje ubushyuhe bwimyitozo ngororamubiri hepfo 40.0 °C / 104 °F) ** - urashobora gukurura protocole nyayo irokora ubuzima ako kanya.

Kora ubu

  1. ** Kora gahunda y'ibikorwa byihutirwa byaho (EAP) mu masegonda 10 yambere: shyira umuntu umwe guhamagara 911 (cyangwa 112/999), umuntu umwe wo kwiruka kuruhande rwa AED, numuntu umwe gukingura amarembo yumurima kuri ambulance. ** Ntuzigere utegereza ngo "urebe niba umukinnyi ayinyeganyeza." Hamagara nimero yawe yihutirwa (** 911 ** muri Amerika na Kanada, ** 112 ** mu Burayi, ** 999 ** mubwongereza, cyangwa urebe nimero yihutirwa) ako kanya igihe cyose umukinnyi wese aguye mukibuga.
  2. ** Kuraho Ifatwa ry'umutima ritunguranye (SCA) Icyambere (Isegonda 0 kugeza 30): Niba umukinnyi adashubijwe kandi adahumeka bisanzwe, tangira amaboko-gusa CPR hanyuma ushyire AED muminota 3. **
  3. Kanda ku rutugu rw'umukinnyi maze utere hejuru izina ryabo. ** UMutego wo KUNYAZA: ** Hafi ** 50% by'abakinnyi mu ifatwa rya Cardiac Cardenac batunguranye berekana gufata igihe gito nko gufatwa na myoclonic yinyeganyeza amaboko / amaguru (amasegonda 10 kugeza kuri 20) n'ijwi rirenga, ritontoma "gasone gasons" **. Ntuzigere wibeshya gufata nko guhinda umushyitsi cyangwa guhumeka kugirango uhumeke bisanzwe, kandi ** ntuzigere wibwira ko umukinnyi waguye "ashyushye cyane" kugeza igihe wemeje ko bakangutse cyangwa bahumeka bisanzwe hamwe na pulse ikomeye **.
  4. Niba umukinnyi atitabye kandi adahumeka bisanzwe: gabanya imyenda yabo nigitugu (ukoresheje ihahamuka riremereye imbere yimbere yigituza, usige ingofero / umugongo aho bikenewe keretse ukeneye inzira yo guhumeka), tangira ** Amaboko-Yonyine CPR (100 to 120 compressions/min, 5 to 6 cm / 2 to 2.4 in byimbitse) **, hanyuma ushireho ** AED padi ** mugituza cyambaye ako kanya. Buri ** gutinda-amasegonda 60 ** kurenza iminota 3 bigabanuka kubaho kuri ** 10% **.
  5. ** Niba umukinnyi afite impiswi ikomeye kandi ahumeka, reba Imitekerereze (CNS Function) ako kanya: gutandukana kwose, imyitwarire idashyira mu gaciro, kuvuga nabi, gutsitara, cyangwa koma mugihe cyubushyuhe ni Exertional Heatstroke (EHS) kugeza bigaragaye ukundi. **
  6. Baza ibibazo bine byerekezo: * "Witwa nde? Turi mu murima ki? Ukwezi ni uwuhe? Ni uwuhe mwitozo twakoraga gusa?" *
  7. ** NTUKIGERE wishingikiriza niba umukinnyi abira icyuya cyangwa atarimo ((anhidrosis), kandi NTUKIGERE ukoresha ugutwi (tympanic), agahanga (temporal), cyangwa umunwa wa termometero. Gusa ** yoroheje ya thermistor igororotse ya termometero ** (inserted 15 cm / 6 inches past the anal sphincter) gupima neza ubushyuhe bwibanze ((> 40.5 °C / 105 °F yemeza EHS).
  8. ** Niba Ubushyuhe bukabije (EHS) irahari (Core Temp > 40.5 °C / 105 °F CYANGWA bigaragara CNS delirium / gusenyuka mubushyuhe bwinshi mugihe ubushyuhe bwa termometero butabonetse): Kora "COOL BWA MBERE, YOHEREZWA KWA KABIRI". **
  9. Kuramo ibikoresho byose (ingofero, udutugu, ibitugu, jersey, ipantaro, amasogisi, uduce) hanyuma winjize umukinnyi kugeza ku ijosi muri litiro yabanje gutegurwa ** 190-kugeza kuri 570-litiro (50-150-litiro) Imvura ikonje (CWI) Igituba cyuzuyemo urubura n'amazi kuri 1.7 °C to 15.0 °C (35 °F to 59 °F)**.
  10. Kangura amazi ya barafu ubudahwema kuzenguruka umubiri no kumutwe mugihe ufashe umutwe nigitugu hejuru yamazi ukoresheje igitambaro kizungurutse munsi yamaboko.
  11. ** Niba nta tubari ihari ("TACO Method - Tarp-Assisted Cooling with Oscillation").
  12. ** Ntukemere ko ambilansi yikoreza kandi igatwara hamwe na siporo kugeza igihe ubushyuhe bwabo bwibanze bugabanutse 38.9 °C (102.0 °F)** (mubisanzwe bifata ** iminota 10 kugeza kuri 18 ** yo guhora yibiza-amazi, gukonjesha ku gipimo cya 0.20 °C to 0.26 °C / 0.36 °F to 0.47 °F per minute).
  13. ** Niba umukinnyi akangutse, menyesha, ubushyuhe bwibanze buri munsi 40.0 °C (104 °F), kandi barikubise hasi mugihe cyo kwiruka cyane binubira "intege nke, zapfuye, zaka amaguru n'umugongo wo hepfo" n'imitsi ya SOFT: ifata nk'indwara ikaze ()ES) Ikibazo. **
  14. Kuraho umukinnyi mukina ako kanya (never order them to run another rep or "walk it off").
  15. Shyira hasi mu gicucu, utange ** ogisijeni yuzuye yuzuye (15 Liters/min via Non-Rebreather Mask.peaked T-waves on 12-lead ECG) **.

Kuki 'Ubukonje bwa mbere, Ubwikorezi bwa kabiri' bufite igipimo cyo kurokoka 100% kubushyuhe bukabije - Kandi ni ukubera iki gupakira abakinnyi bashyushye neza muri ambulance birabica?

  • ** Iminota 30-ya selile yubushyuhe bwa selile: ** Ubwonko bwubwonko bwabantu, hepatocytes yumwijima, endotelium yimitsi, hamwe ningirangingo zimitsi ya skeletale zitangira gukorerwa proteine ​​yumuriro udasubirwaho na ** Gukwirakwiza Coagulation (DIC) ** iyo ubushyuhe bwibanze bwumubiri bugumye hejuru ya **40.5 °C (105 °F) kuminota irenga 30 **.
  • ** Ikigo cy’ubuvuzi cya Korey Stringer: ** Hafi y’ibihumbi n’ibihumbi byanditse byerekeranye na Exertional Heatstroke muri marathoners, abinjira mu gisirikare, ndetse n’abakinnyi b’umupira wamaguru aho ubushyuhe bwibanze bwageze hejuru nk 42.2 °C to 43.3 °C (108 °F to 110 °F), ** kubaho ni 100% mugihe gikabije umubiri wose Ubukonje-Amazi (CWI) itangirwa kurubuga mu minota 10 yo gusenyuka igakomeza kugeza ubushyuhe bwibanze bugabanutse munsi 38.9 °C (102 °F) mbere yo gutwara EMS itangira **.
  • ** Impamvu Kugenda kwa Ambulance bidashobora gukonjesha umurwayi wa EHS: ** Iyo umukinnyi amaze guhambirirwa ku kabati imbere inyuma ya ambulance igenda, ntibishoboka ko uyibira mumazi ya barafu. Gushyira uduce duto twa chimique dukonje mumaboko yabo no gufungura ambulance AC ikonjesha intoki munsi ya 0.04 °C (0.07 °F) per minute - bivuze ko umukinnyi aguma hejuru yica 40.5 °C (105 °F) selile-apfundikiro yimodoka yose yimodoka yiminota 25 hamwe na ER triage yiminota 20, bikaviramo kunanirwa kwingingo nyinshi. ** Inkeragutabara za EMS hamwe nabatoza b'imikino bagomba guhuza kugirango umukinnyi agume mu rubura rwa rubura rw'iminota 12 kugeza 18 Yambere, hanyuma yinjizwa muri ambulance GUSA nyuma yubushyuhe bwo kugororoka 38.9 °C (102 °F). **

Igiti cyemezo: Itandukanyirizo ritandukanye ryumukinnyi wabanyeshuri waguye (Amasegonda 180)

flowchart TD
    Start["Umukinnyi wabanyeshuri arasenyuka cyangwa agwa hasi mugihe cyimyitozo cyangwa umukino"] --> ActivateEAP["Intambwe ya 1 (0-10 Sec): Kora ahazabera EAP, Hamagara 911, Fata umurongo AED, Gufungura amarembo yumurima"]

    ActivateEAP --> CheckResp{"Intambwe ya 2 (10-30 Sec): Ese Umukinnyi Yitabira kandi Guhumeka Mubisanzwe? (Witondere Gufata Muri make Jerks & Agonal Gasps)"}

    CheckResp -->|"OYA: Kutitabira no Guhumeka / Guhumeka gusa"| SCAProtocol["GUFATA CARDIAC SUDDEN (SCA) PROTOCOL (Kandi ukekako Commotio Cordis niba yakubiswe mu gatuza): Kata Jersey / Padi, Tangira amaboko gusa CPR (100-120 / min), Koresha AED muminota 3"]

    CheckResp -->|"YEGO: Guhumeka hamwe na pulse"| CheckCNS{"Intambwe ya 3: Reba Imiterere Yumutwe (CNS) hamwe na Temp Rectal Temp: Umukinnyi Yaba Yitiranya, Kurwanira, Ataxic, Comatose, cyangwa Temp> 40.5 C (105 F)?"}

    CheckCNS -->|"YEGO: Imikorere idahwitse ya CNS + Ubushyuhe bwinshi (Ubushyuhe bwa Core> 40.5 C / 105 F)"| EHSProtocol["GUSHYIRA MU BIKORWA BIKORESHEJWE (EHS) PROTOKOL: Ibikoresho bya Strip, Kwibira mu cyayi-Amazi (1.7-15 C / 35-59 F) cyangwa TACO Tarp ako kanya. GUKORA BWA MBERE (kugeza 38.9 C / 102 F), KUGENDANA KWA KABIRI"]

    CheckCNS -->|"OYA: Kanguka, Lucid, Icyerekezo, Ubushyuhe bwibanze <40.0 C (104 F)"| CheckMuscles{"Intambwe ya 4: Umukinnyi yaguye ate, kandi imitsi y'amaguru / Inyuma yumva ite?"}

    CheckMuscles -->|"Yasinziriye Nyuma ya Sprint; Imitsi Yumva SOFT / Flaccid; Ischemic Yinyuma / Pelvis / Kubabara Ukuguru; Tachypnea"| SicklingProtocol["INDWARA ZIDASANZWE (ES) CRISIS: Hagarika imyitozo ako kanya, Tanga 15 L / min Oxygene, Komeza Supine / Hydrated, AMS Ambulance ihita kuri ER kuri Rhabdomyolysis & Hyperkalemia ECG"]

    CheckMuscles -->|"Hobbling in Agony; Imitsi Ifunze muri ROCK-HARD Biboneka Spasms"| CrampProtocol["BENIGN BIKORESHEJWE BISHYUSHYE: Kuruhuka mu gicucu, kurambura passiyo, Massage ya ice, Umuti wumunyu wa Electrolyte (0,5 tsp umunyu muri 500 mL ikinyobwa cya siporo)"]

Icyiciro cya 1: Imbonerahamwe yuburyo 4 bwo kugereranya ivuriro (SCA na Exertional Heatstroke na Sickling Exertional vs Heat Cramps)

Mugihe cyicyumweru cya mbere Kanama mbere yigihembwe, abatoza bakunze kwibeshya ** Indwara idasanzwe ** kubwiza ** Ubushyuhe bwa **, cyangwa kwibeshya ** Ifatwa ryumutima ritunguranye ** kuri ** Ubushyuhe bwa Syncope **. Gufata mu mutwe itandukaniro ry’amavuriro muri iyi mbonerahamwe birinda kwisuzumisha nabi ku murima:

Gusuzuma Itandukaniro Ryatunguranye Kugwa Kumurongo Wabanyeshuri (()NATA / ACSM / AHA Consensus)

Ikiranga ivuriro 1. Ifatwa ry'umutima ritunguranye (SCA / Commotio Cordis) 2. Ubushuhe budasanzwe (EHS) 3. Indwara ikabije yo kurwara (ES - HbAS Ikiranga) 4. Benign Ubushyuhe bukabije
** Igihe gisanzwe & Imyitozo ** Ingingo iyo ari yo yose mu myitozo cyangwa umukino; byizana (HCM, anomalous coronary artery, Long QT) cyangwa mu masegonda 3 yikubita mu gatuza (Commotio Cordis). Mubisanzwe nyuma ya ** 45 + iminota ** yubukomezi bukabije bwimbaraga nyinshi mubushyuhe bwinshi / ubuhehere (WBGT > 27.8 °C / 82 °F), akenshi kuri ** Iminsi 1 kugeza 5 ** ya pre-season mbere yubushyuhe. Akenshi muri ** iminota 10 kugeza 30 yambere ** imyitozo mugihe ** byose-bikomeza kwiruka (gassers, suicides, timed 800-to-1600m conditioning runs, stadium stairs) ** hamwe nigihe gito cyo kuruhuka. Gutinda mu myitozo ndende, ibyuya cyangwa igice cya kabiri cyumukino nyuma ya sodium iremereye hamwe no gutakaza ibyuya byamazi.
** Ukuntu Umukinnyi Yamanutse ** ** Ako kanya "igitonyanga-kimeze-ibuye" gusenyuka ** (non-contact cyangwa iburyo nyuma yigituza); amaso asubira inyuma; ** 50% bafite amasegonda 10-20 yo gufatwa nkigice cyo kunyeganyega **. Byabanjirijwe no gutsitara, gukora ibirenge (ataxia), kubura umukoro, kurakara, gutaka bidafite ishingiro, cyangwa kugwa gitunguranye muri delirium / stupor. ** Buhoro buhoro gusinzira kuri ruhago: ** Umukinnyi areka kwiruka, ashyira amaboko ku mavi, arasinzira cyangwa aryamye kuko amaguru n'umugongo wo hepfo yumva gitunguranye ** "yapfuye, rubberi, kandi idafite imbaraga." ** Umukinnyi atera hejuru cyangwa agwa hasi afashe inyana imwe, hamstring, cyangwa quad mugihe ataka cyangwa yinubira imitsi ibabaza.
** Urwego rwumutimanama (CNS) ** ** Kutitabira Byuzuye ** mumasegonda yo gusenyuka. ** Imikorere idahwitse ya CNS (100% diagnostic hallmark): ** Kudahuza, kurwana, kuvuga nabi, kureba ibirahuri, gufatwa, cyangwa koma. ** Mubanze Kanguka, Alert, na Lucid: ** Irashobora kukubwira izina ryabo no gusobanura ububabare bwabo neza, nubwo umunaniro wihuse kandi uhangayitse (can progress to shock/coma if forced to keep running). ** Kanguka 100%, Kumenyesha, no kwerekera. **
** Guhumeka & Pulse ** ** Impanuka idahari **; guhumeka bidahari cyangwa gahoro, urusaku ** agonal gasps / gutontoma **. Tachycardia yihuta, ihuza140 to 180+ bpm), guhumeka vuba (tachypnea), umuvuduko ukabije w'amaraso wa diastolique. Guhumeka byihuse, bidahwitse (feeling "winded" / unable to catch breath) hamwe na pulse yihuse ishobora kwangirika gitunguranye muri ** hyperkalemic arththmias (VFib / PEA) **. Guhumeka bisanzwe no guhumeka (bizamurwa gusa mumyitozo ya vuba nububabare).
** Ijwi ryimitsi & Ububabare Bwiza ** Flaccid (nyuma yigihe gito cya myoclonic jerking). Flaccid cyangwa rusange muri rusange niba ifata. ** UMUZIKI WUMVISE CYANE CYANE / FLACCID KUGEZA: ** Ububabare ni ** bwimbitse, butuje, butwika ischemic ache ** mumyanya ** yinyuma yinyuma yinyuma, ikibuno (gluteals), igituba, na hamstrings ** (ntabwo ari ipfundo rikomeye). ** MUSCLES NI ROKOKA-HARD & BIGARAGARA KUMENYA: ** Urashobora kubona kandi ukumva gastrocnemius cyangwa hamstring ifatanye nka baseball munsi yuruhu.
** Ubushyuhe & Core Ubushyuhe Buringaniye ** Imyitozo isanzwe temp (37.5 °C to 39.5 °C / 99.5 °F to 103.1 °F); uruhu ruhinduka vuba cyangwa cyanotic. ** Ubushuhe bwibanze > 40.5 °C (105.0 °F)** (often 41.0 to 43.0 °C / 106 to 109 °F); ** uruhu rurashyushye kandi mubisanzwe KUNYUKA N'UBWOROZI **. ** Ubushuhe bwibanze < 40.0 °C (104.0 °F)**; uruhu rushobora kubira ibyuya cyangwa bisanzwe. Ikigereranyo Cyibanze < 40.0 °C (104.0 °F); uruhu rufite ibyuya byinshi kandi birimo umunyu (white salt crust on jersey).
** Igikorwa cyo Kurokora ubuzima ako kanya ** ** Amaboko-Gusa CPR + Sideline AED Shock imbere < 3 minutes** + 911 Ubwikorezi. ** "Ubukonje Bwa mbere, Ubwikorezi Bwa kabiri": ** Ako kanya ** Kwibiza Amazi-Amazi Amazi (1.7-15 °C / 35-59 °F) ** kurubuga kugeza temp rectal igeze 38.9 °C (102 °F), HANYUMA ubwikorezi. ** Guhagarika ako kanya + 15 L / min Oxygene + Ikiruhuko cyiza + Ako kanya 911 ALS Gutwara ER ** (IV normal saline + stat ECG for hyperkalemia). Kuruhukira mu gicucu, kurambura byoroheje kurambura, massage ya ice, ibinyobwa bya siporo byumunyu.

Icyiciro cya 2: Ifatwa ry'umutima ritunguranye (SCA) na Commotio Cordis kumurima: itegeko ryiminota 3 AED

Ifatwa ry'umutima ritunguranye ni ** # 1 itera ubuvuzi mu bakinnyi bakiri bato , ikubita hafi 1 kuri 50.000 bo mu mashuri yisumbuye na za kaminuza buri mwaka. Bitandukanye n'indwara z'umutima zikuze ziterwa n'imitsi ifunze imitsi, siporo y'urubyiruko SCA iterwa na ** imiterere itamenyekanye cyangwa imiterere y'umutima w'amashanyarazi ** cyangwa no gukubitwa mu gatuza (Commotio Cordis**).

1. Impamvu 5 zibanze zitera gutungurwa kumutima gitunguranye kubakinnyi bato

  1. ** Indwara ya Hypertrophique Cardiomyopathie (HCM).VFib) ** iyo adrenaline itera mugihe cyo kwiruka.
  2. ** Ivuka rya Coronary Artery Anomalies (CAA(**)
  3. ** Irondakoko Ion-Umuyoboro & Syndromes z'amashanyarazi (Long QT, Brugada, CPVT, na Wolff-Parkinson-White / WPW): ** Muburyo bwimitima isanzwe imitima igufi-amashanyarazi munsi ya adrenaline iturika.
  4. ** Indwara ikaze ya virusi Myocarditis: ** Gutwika bucece imitsi yumutima mugihe cyangwa mugihe cyicyumweru 1 kugeza 2 nyuma yuburwayi bwa virusi (Coxsackievirus, Influenza, COVID-19, Adenovirus) iyo umukinnyi agarutse kumiterere ikomeye mugihe akira.
  5. ** Commotio Cordis (Blunt Chest-Impact Arrest).precordium) mugihe nyacyo ** 20 kugeza kuri 40-milisegonda hejuru ya T-wave (ventricular repolarization) **, guta umutima muri Ventricular Fibrillation.

2. Impamvu abatoza batagomba na rimwe gushukwa na "Ifatira rya Jerks" cyangwa "Agonal Gasping"

Mu mashusho yerekana amashusho y’ifatwa ry’umutima w’ishuri ryisumbuye na kaminuza, # 1 impamvu abatoza batinze CPR bakazana AED ni uko ** amaboko n'amaguru by'umukinnyi waguye byanyeganyega nk'igicuri cya epileptic mu masegonda 15, kandi igituza cyabo cyuzuyemo amajwi menshi, asakuza **. - ** Physiology: ** Iyo Fibrillation ya Ventricular igabanya umuvuduko wamaraso mu bwonko, hypoxia ikaze itera ** myoklonic ya ** 10 kugeza kuri 20-isegonda **, igakurikirwa nubwonko ** agonal gasping reflexes **. - ** Amategeko yo ku ruhande (Inter-Association Task Force Mandate). ** Ohereza kuri AED ako kanya, shyira ahagaragara igituza, hanyuma utangire kwikuramo igituza. ** Iyo AED itanga ihungabana muminota ** 1 kugeza kuri 3 ** yo kugwa kumurima, ibipimo byo kubaho birenga ** 85% kugeza 90% **.

Icyiciro cya 3: Ubushyuhe bukabije (EHS): intambwe ku yindi irangizwa rya "Cool Mbere, Ubwikorezi bwa kabiri"

Ubushyuhe bukabije (EHS) impinga cyane mugihe cya ** Nyakanga na Kanama umupira wamaguru mbere yigihembwe, kwambukiranya igihugu, hamwe numupira wamaguru ** mugihe Ubushyuhe bwa ** Wet-Bulb Globe (WBGT) ** irenga 27.8 °C to 32.2 °C (82 °F to 90 °F).

1.

Ibinyoma bibiri biracyahitana ubuzima bwabanyeshuri buri Kanama: - ** Ikinyoma # 1 ("Niba bakibira icyuya, ni umunaniro mwinshi, ntabwo ari ubushyuhe"): ** ** IKINYOMA. ** Uruhu rwumye (anhidrosis) bibaho muri * classique passive hotstroke * kubarwayi bageze mu zabukuru muminsi myinshi. Muri * Exational Heatstroke *, umukinnyi ukiri muto utanga 1.000+ watt yubushyuhe bwa metabolike imbere muri padi atwara ubushyuhe bwibanze kuva 37 °C (98.6 °F) Kuri 41.5 °C (106.7 °F) mu minota 45 mugihe ukiri icyuya cyane. - ** Ikinyoma # 2 ("Koresha uruhanga rwo mu ruhanga rwa scaneri cyangwa amatwi ya termometero"): ** ** IKINYOMA. ** Ubushakashatsi bwakozwe n'ikigo cya Korey Stringer bwerekana ko agahanga, ugutwi (tympanic), hamwe na termometero umunwa soma 36.5 °C to 38.0 °C (97.7 °F to 100.4 °F) kumukinnyi ufite ubushyuhe bwimbere bwurukiramende rwica 41.8 °C (107.2 °F), kubera ko ibyuya byo kubira ibyuya bikonjesha uruhu. - ** Byagenda bite niba Ishuri ryanyu ridafite ubushuhe bwa termometero mu murima? ** Wishingikirize ku mategeko ya ** Clinical Presumption ** **CNS) kudakora neza (urujijo, gutandukana, gukaza umurego, gutsitara, gusenyuka, cyangwa koma nyuma yo kwanga SCA) BIGOMBA guhita bivurwa hamwe numubiri wuzuye Cold-Water Immersion nkuwitwa ko ari Ubushyuhe bukabije. **

2. Uburyo bwo Gukoresha Imvura ikonje (Amazi)CWI) Igituba cyangwa TACO Tarp Protocole kumurongo

  1. ** Mbere yo Gutegura Igituba Mbere yo Kwitoza Iyo WBGT > 25 °C (77 °F).10 °C to 15 °C / 50 °F to 59 °F), hamwe na firime 3 kugeza kuri 4 za barafu yajanjaguwe yicaye iruhande rwigituba yiteguye kujugunya.
  2. ** Ibikoresho bya Strip munsi yamasegonda 60: ** Kuraho ingofero, amakariso yigitugu, jersey, ipantaro, imyenda, namasogisi (wet uniforms trap heat).
  3. ** Shira ijosi-Byimbitse kandi Ukangure Gukomeza: ** Zamura umukinnyi mukibindi kugirango imitiba yabo, pelvis, ibibero, n'amaboko byarohamye muri 1.7 °C to 15.0 °C (35 °F to 59 °F) amazi ya barafu. Shyira igitambaro kizungurutse munsi yamaboko yombi gifashwe na sisitemu ebyiri kugirango umwuka uhumeka hejuru y'amazi. ** Koresha amazi cyane buri masegonda 30 ** kugirango umupaka ushyushye ntushobora gukora kuruhu.
  4. ** Gucunga Delirium Combative: ** Ubushyuhe bukabije bwubwonko akenshi butuma umukinnyi arwana. Saba utumenyetso 4 ufate witonze ibitugu byumukinnyi hamwe namavi imbere yigituba (cyangwa ukoreshe **TACO uburyo bwa tarp ** ku byatsi). Mugihe cya ** iminota 3 kugeza kuri 5 ** yo kwibiza mu mazi-amazi, delirium irwanya kugabanuka uko amaraso akonje.
  5. ** Gukuraho Intego Ubushyuhe ((38.9 °C / 102.0 °F): ** Kura umukinnyi mukibarafu hanyuma ubohereze kumurambararo wa ambulance utegereje ** mugihe iperereza ryukuri 38.9 °C (102.0 °F)** (prevents afterdrop hypothermia). Hatariho tometrometero igororotse, shyira kuri ** iminota 12 kugeza kuri 15 ** (cyangwa kugeza igihe uhinda umushyitsi no kumvikana neza mumutwe) mbere yo gupakira muri ambulance.

Icyiciro cya 4: Indwara zidasanzwe (HbAS) ikibazo: kuki gutaka "Gusunika unyuze" bitera hyperkalemia yica

Hafi ya ** 1 kuri 12 Abirabura b'Abanyamerika (8%) *HbAS) ** - bivuze ko barazwe gene imwe isanzwe ya hemoglobine (HbA) n'umuhoro umwe hemoglobine gene (HbS). Mubuzima busanzwe bwa buri munsi, abantu bafite Akagari ka Sickle bafite ubuzima bwiza rwose kandi ntibafite uburwayi bwindwara (HbSS).

Ariko, mugihe ** gikabije, cyakomeje anaerobic imbaraga ** - byumwihariko ** gusubiramo ibihe byagenwe (gassers, suicides, mat drills). 1. ** Hypoxia Tissue Ikabije ** (ogisijeni itonyanga imbere muri quadriceps ikora / hamstrings); 2. ** Acide Acide Lactique ** (imitsi pH igabanuka hepfo 7.0); 3. ** Dehydrasi ya selile ** (hyperosmolality imbere mumitsi ya capillaries); na 4. ** Ubushyuhe bwo hejuru bwimitsi **.

Iyi tetrad itera uturemangingo tw'amaraso atukura y'umukinnyi guhita atangira kuva kuri disiki yoroshye, yoroheje muri ** igoye, ifatanye ukwezi "umuhoro" **. Mu minota 2 kugeza kuri 5, utugingo ngengabuzima dutukura twumuhoro ** logjam hanyuma ugashyiramo capillaries ya microscopique igaburira imitsi minini yigituba, pelvis, ikibero, ninyuma yo hepfo (acute ischemic rhabdomyolysis) **. Inzara yamaraso na ogisijeni, ingirangingo z'imitsi ya skeletale ziraturika ari nyinshi, zijugunya ubwinshi bwimitsi idasanzwe ** Potasiyumu (K+) ** na ** Myoglobin ** igororotse mumaraso. Niba umutoza ahatira umukinnyi urwaye gusubira kumurongo agakoresha irindi siganwa, ** serum potassium skyrockets yashize 7.0 to 9.0 mEq/L, gutera hyperkalemic yica umutima wumutima (sine-wave ventricular fibrillation or PEA) ku murima **.

Nigute Wabwira Indwara Zidasanzwe Zivuye Mubushuhe mumasegonda 10

  • ** Ubushyuhe bukabije: ** Umukinnyi yikinira mu kibuga avuza induru, afata inyana ya ** ikomeye, inyana ifunze neza cyangwa imitsi ya hamstring **; kurambura bifasha buhoro buhoro.
  • ** Indwara idasanzwe: ** Umukinnyi ** asinziriye kuri turf ** asa nkunaniwe kandi afite ubwoba, yinubira intege nke, gutwika intege zinyuma hejuru ya ** yinyuma yinyuma, ikibuno, n'amatako yombi **, kandi iyo ukandagiye ibibero cyangwa inyana n'amaboko yawe, ** imitsi yumva yoroshye rwose kandi nibisanzwe **. Ntuzigere urambura cyangwa gukanda imitsi irwaye, kandi ** ntuzigere ubwira umukinnyi urwaye guhaguruka ukarangiza imyitozo **.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo

Igihugu / Akarere Kohereza byihutirwa Ubushyuhe bwa Athletic, Cardiac & Indwara ziyobora Ibikoresho Byateganijwe Byateganijwe & Amategeko ya Aclimatisation
** Amerika ** ** 911 ** ** Ishyirahamwe ryabatoza ryimikino ngororamubiri (NATA) ** + ** Ikigo cya Korey Stringer (KSI, UConn) ** + ** Ikigo cy'ubumenyi cya siporo cya NCAA ** + ** NFHS (National Federation of State High School Associations) ** ** NCAA Gupima Indwara Yumudugudu Kugerageza / Politiki yo Kwemeza **; amashuri yisumbuye ya leta ** WBGT Amategeko yo Kwishyushya Ubushyuhe ** (urugero: * Itegeko rya Zach Martin * muri FL, * Jordan McNair * amabwiriza muri MD, Jeworujiya GHSA WBGT amategeko) ategeka kurubuga ** Ibibabi bikonje-Amazi ** na ** AEDs mu minota 1-3 **.
** Kanada ** ** 911 ** ** Komite Ngishwanama ku buvuzi bwa siporo (SMAC) ** + ** Ishyirahamwe ryimikino ngororamubiri muri Kanada (CATA) ** + ** Fondasiyo Yumutima & Indwara ya Kanada ** Ubushyuhe bwo mu Ntara / WBGT imbonerahamwe yo guhindura (OFSAA muri Ontario, BC School Sports) n'ahantu hateganijwe AED kwinjira protocole.
** Ubwongereza ** ** 999 ** cyangwa ** 112 ** ** Ikigo cy'imikino cyo mu Bwongereza (UKSI) ** + ** Inama ishinzwe kuzura UK ** + ** Ishami rya siporo nubuvuzi bwimyitozo ngororamubiri (FSEM) ** + ** Ingaruka z'umutima mu rubyiruko (CRY) ** FA (Football Association) na RFU Pitchside Kwitaho Byihuse (PHICIS) amabwiriza ategeka guhita defibrillation ya pitchside hamwe no gukonjesha gukora neza.
** Umuryango w’ubumwe bw’ibihugu by’i Burayi ** ** 112 ** ** Inama ishinzwe gutabara iburayi (ERC) ** + ** Umuryango w’uburayi w’umutima ()ESC Igice kijyanye na siporo yumutima) ** + ** Amabwiriza yubuvuzi ya UEFA ** Mbere yo kwitabira 12-bayobora ECG yo kwerekana protocole (urugero, amategeko yo kugenzura siporo yemewe n'amategeko mubutaliyani) hamwe na stade ikibuga cya AED / gukonjesha sitasiyo.
** Australiya & Nouvelle-Zélande ** ** 000 ** (AU) / ** 111 ** (NZ) ** Ubuvuzi bwa siporo Australiya (SMA Politiki y'Ubushyuhe bukabije) ** + ** Akanama gashinzwe gutabara muri Ositaraliya (ARC) ** + ** NZ Inama ishinzwe ubutabazi ** ** SMA Siporo Yihariye Yubushyuhe Bwubushyuhe ** (ibidukikije temp va kugabanya ubukonje bugereranije) hamwe no gutegekwa kwibiza mumazi akonje yiteguye kwihangana / ibyabaye mumirima.
** Ubuhinde & Aziya-Pasifika ** ** 112 ** (Ubuhinde) / ** 119 ** (Ubuyapani / Koreya) / ** 995 ** (SG) ** Ikigo gishinzwe siporo mu Buhinde (SAI) ** + ** Ishyirahamwe ry'imikino mu Buyapani (JSPO Amabwiriza ya WBGT) ** + ** Ikigo cyimikino cya Singapore ** Ibiteganijwe ** Gukurikirana metero ya WBGT ** kumikino ngororamubiri y'ishuri (halting all strenuous youth outdoor exercise at WBGT >= 31 °C / 87.8 °F mu Buyapani).

Ibibazo bikunze kubazwa

Bite ho mugihe inkeragutabara za EMS zahageze mukibuga hanyuma zigatsimbarara ku gupakira umukinnyi wa Exertional Heatstroke muri ambulance ako kanya mbere yuko ubushyuhe bwabo bukonja?

Buri shuri ryemewe ryumutoza wimikino ngororamubiri (ATC) hamwe numuganga witsinda bagomba gushyiraho amasezerano yanditse mbere yigihembwe n’umuyobozi w’ubuvuzi wa Fire / EMS waho. Muri iki gihe Ishyirahamwe ry’Abaganga ba EMS (NAEMSP), Ishuri Rikuru ry’Abaganga Bihutirwa (ACEP), hamwe n’amasezerano ahuriweho n’ubwumvikane bwa NATA, inkeragutabara zirasabwa ** gufasha mu gukonjesha igituba Cold-Water Immersion (CWI) gukonjesha igituba (mugihe utangiye umurongo wa IV na monitor yumutima kuruhande rwigituba) kugeza kuri dogere 38.92. ambulance **. Niba ubuvuzi bwa EMS bwaho butegeka ubwikorezi bwihuse mbere yuko igituba cyitegurwa, koresha uburyo bwa ** TACO (gupfunyika ibishishwa bitose, bipfunyika urubura / imipira ikikije umukinnyi wambaye ubusa) ** hanyuma umenyeshe ishami ryihutirwa ryakira kugira ubwogero bwo kwibiza mu mazi butegereje kumuryango wa ambulance.

Ni ukubera iki iminsi 5 yambere yumupira wamaguru cyangwa kwambukiranya igihugu ikora idirishya ryica kuri Heatstroke na Sickling Exertional?

Kurenga ** 75% yishuri ryisumbuye hamwe na koleji Impanuka zishyushye hamwe nindwara zindwara zindwara zibaho mugihe cyiminsi 4 yambere yo gutangira ibihe **. Mu buryo bwa physiologique, umubiri wumuntu urasaba ** iminsi 10 kugeza 14 yikurikiranya yubushyuhe burangije ("Heat Acclimatisation") ** kugirango yongere ubwinshi bwamaraso ya plasma 12% kugeza kuri 15%, kugabanya ubushyuhe bwibanze bwibanze aho ibyuya bitangirira, kongera umuvuduko wibyuya, no kubika sodium ibyuya. Iyo umunyeshuri udafite ibyangombwa asohotse munzu yumuyaga kumunsi wa 1 hanyuma akorerwa imyitozo yamasaha 3 mumashanyarazi yuzuye cyangwa igihe cyagenwe ("serial gassers"), sisitemu yimitsi yumutima ntishobora gukwirakwiza ubushyuhe cyangwa gukomeza umwuka wa ogisijeni. Niyo mpamvu amategeko ya NATA na NFHS abuza imyitozo ibiri-kumunsi iminsi ikurikiranye, ikabuza ibikoresho byose birinda kumunsi wa 1 kugeza 5, kandi ikabuza ibizamini byateganijwe igihe cyose kumunsi wa 1.

Nigute dukoresha Ubushuhe bwa Wet-Bulb Globe Ubushyuhe (WBGT) metero kuruhande, kandi ni ukubera iki aruta porogaramu ya telefone igendanwa ya "Heat Index"?

Igipimo "Ubushyuhe Bwiza" kuri porogaramu yikirere kibarwa ukeka ko wicaye mu gicucu cya ** 100% n'umuyaga woroheje ** - birengagiza ** imirasire y'izuba itaziguye ishyushya umwijima w'icuraburindi ** na ** guhagarika umuyaga wa stade yaho **. Ikiganza ** Ubushuhe-Ubushyuhe bw'isi Ubushyuhe (`WBGT`) metero ** ihuza ibyuma bitatu bitandukanye: ** (1) Ubushyuhe bwumye-Amatara ** (`10%`), ** (2) Ubushyuhe busanzwe-Ubushyuhe ()`70%`) ** gupima ubushobozi bwo gukonjesha ibyuya bikonjesha hejuru yubushyuhe n'umuyaga, na ** (3) Ubushyuhe bwa Black-Globe (`20%`) ** gupima ubushyuhe buturuka ku mirasire y'izuba kuri turf. Iyo kuruhande `WBGT` igera kuri **`27.8 °C to 30.0 °C (82 °F to 86 °F)`**, itegeko ryo gukonjesha iminota 15 rigomba kubaho buri saha; ryari `WBGT` irenga **`32.2 °C (90.0 °F)`**.

Niba umunyeshuri wumunyeshuri azi ko afite Indwara Yumudugudu (HbAS), babujijwe gukina siporo itandukanye?

Oya - ** nta mukinnyi ufite Indwara ya Sickle (`HbAS`) burigihe ntiyemewe muri siporo iyo ari yo yose **. Ibihumbi n'ibihumbi bya NCAA hamwe nabakinnyi babigize umwuga barushanwe neza na Sickle Cell Trait buri munsi. Ahubwo, kumenya umukinnyi `HbAS` imiterere ituma abatoza nabatoza ba siporo bashyira mubikorwa ** Kwirinda Akagari ka Sickle Cell ** ** ** (2) ** Kuruhuka kabiri kuruhuka no gukira hagati yisubiramo; ** (3) ** Kubabarira umukinnyi kwiruka igihe cyose cyarangiye mubushyuhe bwinshi cyangwa murwego rwo hejuru (`above 1,500 meters / 5,000 feet`); ** (4) ** Kugenzura neza amazi meza; na ** (5) ** Guha imbaraga umukinnyi kuva mumyitozo iyo ari yo yose ako kanya bumva ukuguru kudasanzwe, ikibuno, cyangwa intege-zinyuma zo hasi badatinya igihano.

Tugomba gukuramo ingofero yumupira wamaguru cyangwa lacrosse mukibuga mugihe cyo gufatwa gitunguranye kumutima cyangwa Heatstroke idasanzwe?

Yego. Muri ** Ubushyuhe bukabije (`EHS`. Muri ** Ifatwa ry'umutima ritunguranye (`SCA`:)`or helmet/pads`) kumuyaga uhumeka watanze ** ntizigera idindiza gutangira kwikuramo igituza cyangwa gutanga AED ihungabana **.

.NFHS Learn), no kwitoza aho bazabera ** Gahunda y'ibikorwa byihutirwa (EAP) ** hamwe nisaha yo guhagarara mbere yimyitozo yambere ya buri gihembwe.

Kuyobora

Inkomoko nubuyobozi

  • ** Ishyirahamwe ryabatoza ryimikino ngororamubiri (NATA, Reta zunzubumwe zamerika) **: * Itangazo ryumwanya: Indwara zidasanzwe zishyushye (Rectal Thermometry Standard and on-site Cold-Water Immersion "Cool First, Transport Second" Mandate) * na * Itangazo ryumvikanyweho: Imicungire ikaze yimikino yakomeretse cyangwa Yaguye *, SCA, SCA,
  • ** Ikigo cya Korey Stringer (KSI, Kaminuza ya Connecticut) & Ishuri Rikuru ry’Ubuvuzi rya Siporo ry’Abanyamerika (ACSM) **: * Itangazo ryumvikanyweho ku bijyanye no kwita ku bitaro by’ubuvuzi bw’indwara zidasanzwe, Ubuvuzi bwa Tarp bufashijwe na Oscillation (TACO), hamwe n’Amashuri yisumbuye ya Leta Wet-Bulb Globe Temperature (WBGT) Politiki yo Kwakira *.
  • ** Itsinda rishinzwe amashyirahamwe yo gukumira urupfu rutunguranye mu mashuri yisumbuye & Amashuri Yisumbuye ya Koleji (NCAA / NATA / NSCA / Ishyirahamwe ry’umutima w’Abanyamerika) **: * Ibyifuzo byo kumenya no gucunga ifatwa ryumutima ritunguranye (3-minota AED Intego, Gufata Myoclonic / Agonal Gasping Recognition) (HbAS) *.
  • ** Ishuri Rikuru ry’abaganga byihutirwa (ACEP) & Ishyirahamwe ry’abaganga ba EMS (NAEMSP) **: * Impapuro zihuriweho na Politiki hamwe n’uburezi: Ubuyobozi bw’ibitaro by’ubushyuhe bukabije (Kurangiza Kwibiza mu mazi akonje mbere y’ubwikorezi bwa EMS) *.
  • ** Ibigo bishinzwe kurwanya no gukumira indwara (CDC, Amerika) **: * Uburwayi bushyushye mu bakinnyi bo mu mashuri yisumbuye hamwe n’imiterere y’akagari ka Sickle (HbAS) Kwirinda Imyitozo Yizewe *.