Dejinta Jabka Misigta, Isku-xidhka Wareegga, iyo Dhiig-baxa Gudaha¶

Tamarta sareeysa ** jabka giraanta miskaha *** waa mid ka mid ah dhaawacyada ugu halista badan ee daawada dhaawacyada, sidda heerka dhimashada 15 ilaa 50 boqolkiiba marka ay weheliso xasillooni darro hemodynamic. Si ka duwan lafta dheer sida shinka ama cududda, miskaha bani'aadamku waa giraan adag oo lafo ah oo ka samaysan laba lafo oo waaweyn oo aan cidhiidhi ahayn (misigta) oo ku xiran hore ee ** pubic symphysis ** waxayna ku xiran yihiin dhabarka ** sacrum ** by seedaha ugu xoogga badan ee jirka. Marka shil baabuur oo aad u sarreeya, isku dhaca mootada (halka miskaha uu horay ugu sii jiro haanta shidaalka), lugta lugaynta, burburida dhaawaca, ama ka soo dhaca dhererka ayaa jebiya faraantigan laba meelood oo ay jeexjeexaan seedaha sacroiliac ee dambe, miskaha ayaa u furan sida daboolka buuga (** "buug furan" jabka miskaha**).

Marka giraanta miskaha lafta ay furmaan, mugga wareega gudaha ayaa si aad ah u ballaarinaya, abuurista meel bannaan oo dib-u-dhac weyn leh oo liqi karta ** 3,000 ilaa 5,000 millilitir (6 ilaa 10 pints) oo dhiig ah ** (dhammaan mugga dhiigga wareegga dhiigga ee bukaanka) iyada oo aan hal dhibic oo dhiig ahi ka soo bixin maqaarka ka baxsan. Waxaa taa ka sii daran, samatabbixiyeyaal si fiican u macne ah waxay si joogta ah u dilaan dhibbanayaasha dhaawacyada miskaha iyagoo riixaya ama ruxaya sinta sinta si ay "u tijaabiyaan jabka" ama iyagoo bukaanka u galgala dhinacooda, taas oo jebisa xinjirowga dhiigga ee jilicsan. Ogaanshaha sababta ay tahay inaadan waligaa u ruxin miskaha ***, sababta miskaha miskaha ama sariirta la hagaajiyay ay tahay in si adag loogu dhejiyo ** trochanters-ka weyn ee femurs ** (iyo ** waligood *** aan ka sarreyn dhexda ama cirridka iliac), iyo sida loo xiro jilbaha iyo anqawyada wareegga gudaha wuxuu xiraa miskaha nolosha.

Hadda samee tan¶

1. ** Isla markaaba wac nambarkaaga deg-degga ah oo ka codso Advanced Life Support (ALS) kalkaaliyayaasha caafimaadka ee Heerka 1 ee gaadiidka degdega ah. nambarada degdega ah.
2. ** Marnaba "gu'ga," dhagax, riix, ama cadaadin lafaha sinta si aad u hubiso in miskaha jabay iyo in kale.** Hoos u riixida ama gudaha miskaha aan xasiloonayn waxay shiiddaa jajabyada lafaha fiiqan ee xididdada sacral plexus iyo halbowlayaasha iliac gudaha, waxayna meesha ka saaraysaa xinjirowga bilowga ah ee jilicsan ee bukaanka sii nooleynaya. Haddii habka dhaawaca ama calaamadaha ay soo jeediyaan jabka miskaha, ** ka qaad miskaha jabay oo xidh ***.
3. **Weligaa haku-wareejin dhibbanaha jabka miskaha ee looga shakisan yahay dhinacooda ilaa marinka hawadu uu si firfircoon u xidho matag ama dhiig Bukaanka ku dhig mid siman dhabarka (jilibka) oo isticmaal wiish fidsan oo fidsan oo bad-baadiyayaal badan ah ("wiish buundada") ama bareelo qaad haddii dhaqdhaqaaqa laga fursan waayo.
4. ** Codso binderka miskaha ee ganacsiga (SAM Pelvic Sling, T-POD, ama Prometheus) ama xaashida sariirta laalaaban ee udub dhexaad u ah GREATER TROCHANTERS ( kuuskuuska lafaha ee bowdyaha sare ee kore ee miskaha), AAN ka koreynin dhexda ama sinta sare ee sinta. ilaa heerka trochanters-ka weyn iyo symphysis pubic pubic waxay awoodaan madaxyada femur gudaha si ay u xiraan "buuga furan" miskaha.
5. **Si tartiib ah labada lugood gudaha ugu wareeji ("lugo-lugo") oo ku xidh shaxan-sideed faashad ama suuf iyo suunka ku wareegsan jilbaha iyo anqawyada. furan
6. **Bukaanka si adag uga ilaali NPO (wax afka ah) oo madaxa-ilaa-lugo ugu duub buste diirran si aad uga hortagto hypothermia iyo xinjirowga dhiigga. Haddii bukaanku ku qabowsado laamiga, xinjirowga enzymes waa la xiraa oo dhiigbaxa gudaha wuxuu noqdaa mid aan la joojin karin.

Geedka go'aanka degdega ah ee la tuhunsan yahay jabka giraanta miskaha¶

flowchart TD
    Start["High-Energy Blunt Trauma: Motor Vehicle Crash, Motorcycle Impact,<br/>Pedestrian Struck, Fall > 3 m (10 ft), Horse Trampling, or Crush Injury"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Keep patient strictly flat (supine); DO NOT log-roll onto side;<br/>DO NOT push or rock the hips ('No Pelvic Springing')"]
    AssessSigns{"Are Pelvic Fracture Criteria or Visual Signs Present?<br/>- Severe hip, groin, lower back, or sacroiliac pain<br/>- Unexplained tachycardia / shock after blunt trauma<br/>- One or both legs flopped outward (external rotation) or one leg shorter<br/>- Bruising over scrotum/labia, perineum, flanks, or blood at urethra"}
    NoPelvic["NO PELVIC FRACTURE SUSPECTED<br/>Continue standard trauma assessment, spinal precautions,<br/>and shock warming until EMS arrival"]
    PrepBinder["PREPARE FOR CIRCUMFERENTIAL PELVIC STABILIZATION<br/>1. Empty trouser pockets (remove keys, wallet, phone, belt)<br/>2. Select Commercial Pelvic Binder (SAM Sling / T-POD)<br/>   OR fold a strong cotton bedsheet smoothly to 15-20 cm (6-8 in) width"]
    SlideSheet["SLIDE BINDER UNDER PATIENT WITHOUT LIFTING OR LOG-ROLLING<br/>1. Pass binder under the natural hollow beneath the KNEES<br/>2. Use a smooth 'seesaw' sawing motion to slide sheet up beneath lower thighs/buttocks<br/>3. Center strictly over the GREATER TROCHANTERS & PUBIC SYMPHYSIS<br/>   (NOT high up over the iliac crests / waist)"]
    TightenLeg["CLOSE THE PELVIC RING & INTERNAL-ROTATE LEGS<br/>1. Have assistant gently bring legs together and rotate feet INWARD ('pigeon-toed')<br/>2. Pull binder straps/sheet ends firmly across front of greater trochanters<br/>3. Lock commercial buckle OR twist/clamp/tie sheet ends securely in front<br/>4. Pad between knees/ankles and tie figure-of-eight strap around ankles & knees"]
    ShockCare["PREVENT LETHAL TRAUMA TRIAD & MONITOR<br/>1. Wrap patient in warm blankets / thermal foil<br/>2. Keep strictly NPO (nothing by mouth)<br/>3. Do NOT remove or loosen pelvic binder until inside Trauma Resuscitation Bay"]

    Start --> CallEMS
    CallEMS --> AssessSigns
    AssessSigns -->|No| NoPelvic
    AssessSigns -->|Yes: Any Criterion Present| PrepBinder
    PrepBinder --> SlideSheet
    SlideSheet --> TightenLeg
    TightenLeg --> ShockCare

Isbarbardhigga afarta nooc ee Young-Burgess ee jabka giraanta miskaha¶

Dhakhaatiirta qalliinka lafaha lafaha waxay u kala saaraan jabka giraanta miskaha jihada xoogga burburinta (** Kala-saarista-Young-Burgess**). Fahamka sida miskaha u jabo wuxuu sharxayaa sababta "buug-furan" jabka uu keeno lugaha inay dibadda u soo baxaan iyo sababta dhiig-baxa gudeedku u yahay mid cabsi leh.

Anatomy iyo pathophysiology: Waa maxay sababta miskaha jabay uu u dhiigi karo 5 litir oo dhiig gudaha ah¶

1. Joometri ee Sphere: Waa maxay sababta furitaanka miskaha 5 sentimitir u abuurto kayd dhiig oo weyn¶

Gudaha miskaha qaangaarka ah ee aan fiicneyn, giraanta lafta waxay ku xirtaa weel yar oo hemispherical ah oo qiyaastii ah 1.5 litir (3 pints), oo si adag ay uga buuxaan peritoneum parietal iyo fascia. Haddii xidid yar oo dhiig ah uu ka dillaaco gudaha miskaha * aan fiicneyn, dhiiggu si dhakhso ah ayuu u buuxiyaa booskaas yar ee cidhiidhiga ah ilaa cadaadiska dhiigga ku xayiran uu la mid yahay cadaadiska gudaha xididdada, si dabiici ah ayuu u xiraa dheecaanka (self-tamponade).

Si kastaba ha ahaatee, gudaha buug furan (APC) ama jabka miskaha ee xiirid toosan, symphysis-ka cambarku wuxuu ka dillaacaa xagga hore, seedaha sacroiliac ayaa dhabarka ka dillaacay, iyo sagxada miskaha adag ee fascia ayaa kala jeexjeexa: * Marka loo eego sharciga xisaabta ee mugga goobka (\(V = \ frac{4}{3}\pi r^3\)), koror kasta oo yar oo ku yimaada radius (\(r\)) ee giraanta miskaha wuxuu kordhiyaa mugga gudaha ee cube of radius. * Haddii dhanka hore ee miskaha uu furmo kaliya 5 sentimitir (2 inji), mugga gudaha ee daloolka miskaha ayaa ka boodaya in ka badan 400 boqolkiiba. * Xitaa waxaa ka sii daran, mar haddii sagxada fasiirka ee miskaha jeexjeexo, dhiiggu kuma eka miskaha: wuxuu si xor ah kor ugu socdaa xuubka caloosha ilaa xidda ballaaran ee retroperitoneal *** ilaa kelyaha iyo diaphragm. Retroperitoneum-ku wuxuu hayn karaa ** 4,000 ilaa 5,000 millilitir (8 ilaa 10 pints) oo dhiig ah ka hor inta uusan cadaadisku dhismin si uu u yareeyo dhiig-baxa, taasoo la macno ah qof weyn ayaa dhiigi doona ilaa uu dhinto muddo dheer ka hor intaysan is-tamboonidu dhicin.

2. Saddexda Ilaha ee Dhiigbaxa Misigta (iyo sababta xidhuhu u joojiyo laba ka mid ah)¶

Halkee dhiigaas oo dhami ka imaanayaa gudaha miskaha jabay? 1. Plexus Presacral iyo Prevesical Venous Plexus (80% ilaa 85%) Marka sacrum ama lafta cambarku dilaacdo, boqolaal ka mid ah xididadaas ayaa isku mar la gooyaa. 2. ** Dusha sare ee Dhuuxa Lafta Isbuunyada: Baalasha iliac ee fidsan iyo xinjirowga waxaa ka buuxa dhuuxa cas ee xididdada dhiigga; Oogada lafaha cayriin ee jaban ayaa si degdeg ah u daaqaya sida isbuunyo qoyan. 3. ** Laamaha Halbowlaha Iliac Gudaha (10% ilaa 15% kiisaska):** Ilmada halbowlayaasha cadaadiska sare leh (inta badan ** halbowlaha gluteal-ka sare ** halkaasoo ay ku xirto hareeraha cirifka weyn ee sciatic, ama ** gudaha gudaha pudendal iyo xididada obturator**). * ** Sida uu u shaqeeyo miskaha miskaha:** Isku-dubbarid wareeg ah oo adag oo ku wareegsan ** trochanters-ka weyn ** waxay si farsamaysan u xidhaa giraanta miskaha ee kala go'a oo dib ugu soo celisa raadiskeeda yar ee caadiga ah (dib u soo celinta qaybta ** retroperitoneal tamponade ***), waxay si toos ah u cadaadisaa lafaha dhiigbaxa cayriin ee midba midka kale si ay u joojiyaan soobaxa dhuuxa. gaadiidka ambalaaska.

Sida loo garto jabka miskaha adoon waligeed ruxin miskaha¶

Waa maxay sababta "Maskaxda Guga/ Ruxida" si adag loo mamnuucay¶

Muddo tobanaan sano ah, buugaagtii gargaarka degdegga ah ee hore ayaa baray samatabbixiyeyaasha inay gacmahooda saaraan labada sinta sita oo ay si xoog ah hoos iyo hoos ugu riixaan ("ruxitaanka miskaha") si ay u dareemaan jajabinta lafaha (** crepitus**) ama xasillooni darro. ** Tilmaamaha dhaawacyada casriga ah (ATLS, PHTLS, CoTCCC, NICE, JRCALC) waxay si adag u mamnuucayaan guga miskaha:** * Gacanta oo la kala fogeeyo giraanta miskaha ee aan xasilloonayn waxay leedahay dareen ka hooseeya 60 boqolkiiba, waxay keentaa xanuun aad u daran, iyo ** si firfircoon u dila bukaannada iyadoo ka soo baxaysa xinjiro dhiig oo fibrin ah oo dhowaan sameeyay oo daboolaya jeexjeexa xididdada sacral plexus ***. * Xataa gudaha qolka dhaawacyada ee isbitaalka, haddii kalkaaliye caafimaad uu horey u dhigay xiraha miskaha ee ku saleysan habka shilka, dhakhaatiirta qalliinka dhaawacyada ayaa ka tagaya xiraha xirmada ilaa CT scan ama raajada miskaha laga qaado.

Lix calaamadood oo badbaado leh, gacmaha laga saaray oo tilmaamaya jabka miskaha¶

1. ** Farsamaynta tamarta sare + naxdin aan la garanayn:** Dhibbanaha shil baabuur oo aad u sarreeya, shil mootada, shaqo joojin dadka lugaynaya, shil faras, dhaawac burburay, ama ka soo dhacay> 3 mitir (10 cagood) kaasoo leh garaaca wadnaha degdega ah
2. Meesha Xanuunka (Bukaanada miyirka qaba): Xanuun lama filaan ah ** sinta, gumaarka, aagga cawska, dhabarka hoose (sacrum), ama badhida ***, ama awood la'aanta in labada lugood dhulka laga qaado.
3. ** Wareegid dibadda ah ama Gaabinta Cidhifyada Hoose:** Hoos u eeg cagaha dhibbanaha marka ay dhabarka u jiifaan. Jajabka miskaha ee buug-furan, hal ama labada lugood ayaa dibadda u soo baxay si cirifka sare ee cagtu ugu timaaddo dhulka (** wareegtada dibadda**). Jabka xiiran ee toosan (ama kala-baxa miskaha ee dambe), hal lug ayaa u muuqda **2 ilaa 5 sentimitir (1 ilaa 2 inji) ka gaaban kan kale.
4. Calamadaha kaadi mareenka iyo xubinta taranka (50% jabka miskaha ee daran waxay dhaawacaan kaadiheysta ama kaadi mareenka):
5. Dhibic dhiig guduudan oo dhalaalaya oo ku yaal caarada guska ama daloolka kaadi mareenka
6. Nabaro guduudan oo madow iyo barar ** xiniinyaha, faruuryaha faruuryaha, ama perineum** (** Calamada Destot**).
7. Dhiig-baxa xubinta taranka ama malawadka (taasoo tilmaamaysa ** jabka miskaha furan** halkaasoo jeex fiiqan oo lafta cambarku uu dalooliyay xubinta taranka ama malawadka, isagoo wata khatar masiibo ah oo ah in la is-goysiiyo iyo sepsis-ka miskaha ee polymicrobial).
8. ** Burburka dhabarka dhabarka:** Nabaro buluug-buluug ah oo ka soo baxaya garbaha (Calaamadda Grey Turner) ama ka sarreeya seedaha inguinal (** Calamada Fox**).
9. ** Qalbi-Taabasho-Taabasho ah oo fudud (Kaliya haddii miyir-qabka iyo ogaanshaha aan la hubin) at the trochanters, WALIGAA dibadda iyo hoos ha u riixin ***.

Farsamo tillaabo-tallaabo ah: Dalbashada xidhidhka miskaha ee ganacsiga ama xidhidhka xaashida sariirta oo la hagaajiyay¶

Tallaabada 1: U diyaari bukaanka oo faaruqi dhammaan jeebadaha¶

1. Bukaanku si buuxda ha u jiifsado ** dhabarka ha si fidsan (dhabarka)**.
2. Dhammaan jeebadaha iska saar oo ka saar suunnada: Kahor intaadan si adag wax ugu duubin miskaha, isticmaal xiirimaha dhaawacyada si aad u gooyso ama u faaruqiso wax kasta oo ku jira jeebabka hore, dhinaca iyo dambe ee surwaalka (telefoonnada casriga ah, furayaasha, boorsooyinka qaro weyn, qadaadiicda, guntimaha suunka, ama qalabka). Adkeynta isku xidhka miskaha ee furayaasha ama taleefoonka jeebka ku jira waxay ku wadi doontaa shayga birta maqaarka lafta dushiisa, taasoo keenta boog cadaadis necrotic ah oo buuxa 60 daqiiqo gudahood.

Tallaabada 2: Soo hel calaamadda anatomical ee saxda ah: The Greater Trochanters¶

Si aad u hesho ** trochanters-ka weyn ** bukaan kasta: 1. ha dareemin dhexda ama cidhifka ugu sarreeya ee lafta sinta (taas oo ah jiifka iliac, kaas oo ah 10 ilaa 15 sentimitir / 4 ilaa 6 inji aad u sarreeya). 2. Taa baddalkeeda, gacmahaaga galoofisyada hoos ugu dhig bannaanka bowdyaha sare ee bukaanka ilaa heerka lafta cambarka (lafta) ee hore iyo qaybta ugu ballaaran ee barida xagga dambe. Waxaad dareemi doontaa caannimo adag oo lafaha gariiradda ah oo dhanka dibadda ah ee femur kasta oo sare: taas oo ah trochanter ka weyn **. 3. Xariiqda dhexe ee xiraha miskahaaga ama xaashida laalaabka leh ** waa in ay si toos ah u dhex martaa trochanters-ka waaweyn iyo guud ahn sambabada cambarka.

Talaabada 3A: Codsiga xidhidhka miskaha ganacsiga (SAM Pelvic Sling II, T-POD, ama Prometheus)¶

1. **Marka hore silbaadi jilbaha hoostooda (Farsamo-qaadis-la'aan)
2. ** Kor u eeg:** Ku hay hal cidhif oo binderka dhinac kasta oo bukaanka ah, adeegso dhaqdhaqaaq miinshaar dhinac-ilaa-dhince ah si aad si habsami leh ugu dhejiso xidhaha ilaa bowdada hoose iyo badhida hoose ilaa ay si toos ah ugu dul foorarsato ** trochanters ka weyn **.
3. Gudaha u rog lugaha: Samatabbixiye labaad ha qabto anqawga bukaanka oo si tartiib ah isu keeno lugaha inta uu lugaha gudaha u roganayo
4. Jiid oo quful:
5. ** SAM Pelvic Sling *** , si adag u jiid suunka madow adigoo u soo jiidaya xajinta ka soo horjeeda jihada ka soo horjeedda ilaa xayndaabku gujiyo iyo labada bir ee birta ah waxay ku xiraan daloolada (loogu talagalay in si toos ah loogu xiro ** 150 Newtons / 33 rodol oo wareeg ah ** si aadan u xakameyn karin), ka dibna cadaadiska hoos u dhig.
6. ** T-POD ***, jar suunka adigoo ka tagaya 15-ilaa-20-sintimitir (6-ilaa-8-inch) faraq ah xagga hore ee miskaha, ku dheji habka jilitaanka farsamada ee farqiga u dhexeeya, oo jiid xadhigga ilaa farqiga u cidhiidhiyo miskahana uu jilicsan yahay, ka dibna xidh xadhigga.

Talaabada 3B: Codsashada xaashida sariirta ee la hagaajiyay ee miskaha (Marka aan qalab ganacsi la heli karin)¶

Sariirta suufka ah ee xooggan, xaashida dheesha ballaaran, ama buste si habsami leh u laalaabtay ayaa bukaan-socod ahaan la caddeeyey si loo yareeyo mugga miskaha si la mid ah sida xiraha ganacsiga haddii lagu dabaqo trochanters: 1. ** Laab xaashida si habsami leh:** Laabi xaashi fidsan dherer ahaan ilaa ay ka samaynayso xadhig siman, laalaab la'aan qiyaastii 15 ilaa 20 sentimitir (6 ilaa 8 inji) ballac ah. 2. ** Lasobo jilbaha hoostooda oo arag ilaa Trochanters-ka Wayn:** Mar xaashi laalaabka hoostooda godan jilbaha oo si taxadir leh ugu sibx ilaa barida hoosteeda ilaa ay dhexda ka noqoto Tirochanters-ka wayn iyo cambarka cambarka. 3. Iskugu lugee lugaha wareegtada gudaha 4. ** Gudub, si adag u jiid, oo sugo: * Ka gudub labada daraf ee dhaadheer ee xaashida xagga hore ee sammaynta caamka ah. * Mid samatabbixiye ah oo bidixda ah midna midig, ** dib u tiirso oo labada daraf ee xaashida si habsami leh oo adag u jiid jihooyin iska soo horjeeda** ilaa inta caajisnimada laga soo qaadayo oo xaashidu ay si adag u habsato trochantors. * ** Xaji xaashida adoon lumin xiisadda:** Ama labada daraf ee isdhaafsan isku rogo dhanka hore ee miskaha oo ku dheji xirmo dhaawac culus leh (ama ul gaaban/ul gaaban oo usha ku dheji, ama guntin fidsan) ku xidh tuwaal laalaaban si guntidu ayan u qodin).

Tallaabo 4: Ku xidh jilbaha iyo anqawyada wareegga gudaha ("Jaantuska-Siddeed Lugood")¶

Xataa iyada oo xadhigga ku wareegsan miskaha, miisaanka culus ee labada lugood ee miyir la'aanta ah ee dibadda u soo baxaya waxay u dhaqmaan sidii kabaal farsamaysan oo isku dayaya inuu dib u furo symphysis cufan. 1. Dhig shukumaan laalaaban, jaakad, ama suuf xumbo ah ** inta u dhaxaysa jilbaha bukaanka iyo inta u dhaxaysa anqawgooda** si looga hortago nabarada cadaadiska maqaarka ee lafaha ka soo baxa. 2. Ku duub faashad saddex-xagal ah, faashad rullaluistemadka ah, ama suunka ballaaran ee labada jilba, oo ku duub ** tiro-sideed faashad ah oo ku wareegsan anqawyada iyo cagaha** si aad u qabato lugaha si raaxo leh oo gudaha u wareegaya.

Talaabada 5: Qaadista Badbaadada leh, Diirinta, iyo Xeerarka Gaadiidka¶

1. Weligaa ha gashan bukaanka jabka miskaha: Marka ay dhakhaatiirta caafimaadku yimaadaan si ay bukaanka ugu raraan bareelo, waxay isticmaali doonaan lafo-bareed ** bareelo qaada** (kaas oo u kala baxa dherer ahaan kala badh oo ku dul simbiraar dhinaca bidix iyo midig hoostiisa oo dhaqdhaqaaq yar leh) ama 4-ilaa-6-qof ** wiish buundada** ah oo toosan.
2. Weligaa ha ka bixin ama ha furfurin xadhkaha miskaha si degdeg ah: Marka miskaha miskaha la mariyo, ** way ku xidhan tahay meesheeda** ilaa bukaanku ku jiro gudaha xarunta dhaawacyada ee isbitaalka oo dhiig lagu shubayo ay socdaan oo ay diyaar yihiin kooxaha shucaaca lafaha/ dhex galka. Dejinta xiraha miskaha ee gudaha garoonka si loo "u eego maqaarka" waxay u ogolaataa giraanta miskaha inay dib u furto oo ay kiciso dib-u-bax degdeg ah.
3. ** kululaynta gardarada leh:** Ku dabool bukaanka bustayaal diirran iyo xayndaab dahaar ah oo hoostooda ah si aad uga hortagto Triad Trauma Lehalhypothermia, acidosis, iyo xinjirowga dhiigga.

Xaalado caafimaad oo gaar ah oo ku saabsan dhaawaca miskaha¶

1. Fur jabka Misigta iyo Jeexitaanka xubinta taranka / malawadka / siilka¶

Qiyaastii 5 boqolkiiba jabka giraanta miskaha waa ** jabka miskaha furan *, kaas oo jajab fiiqan oo ka mid ah rami ama xaleef ischium ee maqaarka gumaarka, perineum, barida, siilka, ama malawadka. Jabka miskaha ee furan waxa ay qaadaan heerka dhimashada oo ku soo dhowaanaya 40 ilaa 50 boqolkiiba sababtoo ah tamponade maqaarka dibadda ayaa lumay bakteeriyada saxarada ayaa wasakhaysa hematoma retroperitoneal: **Weligaa ha kala jiidin lugaha ama miska si aad u baarto nabarka xubinta taranka haddii ay la macno tahay furitaanka giraanta miskaha. * **Contr external groin or perineal bleeding with firm direct pressure and hemostatic gauze wound packing (or a junctional inguinal compression device if available then apply the circumferential pelvic binder over the greater trochanters** right over the packed wound dressing. * **ligaa ha galin tuubada kaadi mareenka, heerkulbeegga malawadka, ama xirmada xubinta taranka ee siilka haddii dhiiga uu ka muuqdo xuubka kaadi mareenka ama perineum, sababtoo ah kaadi mareenka ama malawadka ayaa laga yaabaa inay qayb ka gudbaan.

2. Pelvic Fractures in Pregnancy and in Children¶

• During Pregnancy: In the second and third trimesters, the gravid uterus rises out of the bony pelvis into the abdomen, and maternal uterine blood flow reaches 600 to 800 milliliters per minute. You can and should still apply a pelvic binder to an unstable pelvic fracture in a pregnant patient because the binder sits low over the greater trochanters and pubic symphysis (below the main fundus of the uterus). After applying the trochanteric binder, manually displace the pregnant uterus 15 to 20 degrees to the LEFT (or tilt the rigid scoop stretcher 15 to 30 degrees to the left) so the heavy uterus does not crush the maternal inferior vena cava (supine hypotensive syndrome).
• Carruurta: Lafaha miskaha carruurtu waa dabacsan yihiin oo waxaa lagu dahaadhay carjawda qaro weyn, sidaas darteed waxay u baahan tahay tamar firfircoon oo xad dhaaf ah (sida in baabuur lagu dul maro) si loo jebiyo giraanta miskaha ilmaha. Laabi xaashi yar ama xiraha carruurta si aad ugu dhigma ballaadhka trochanters ubadka oo si dhow ula soco beeryarada ama dhiigbaxa beerka.

3. Prehospital Handoff Checklist for EMS and Trauma Resuscitation¶

• ** Habka dhaawaca:** Shil xawaare sare leh, saamaynta haanta shidaalka mootada, dhererka dhicista, ama burburin miisaanka.
• Exact time and anatomical level of binder placement: Confirm the binder is centered over the greater trochanters and that pockets were emptied before tightening.
• Distal neurovascular (PMS) status in both feet: Dorsalis pedis and posterior tibial pulses, skin warmth, and foot movement before and after binding.
• Urogenital signs observed: Presence of blood at the urethral tip, scrotal/labial hematoma, or perineal lacerations.

Knowing how to recognize a hidden pelvic fracture and apply a trochanteric binder turns an otherwise fatal internal bleed into a survivable injury. Consider taking a certified first aid, Stop the Bleed, or prehospital trauma course through your national Red Cross or Red Crescent society, St John Ambulance, or the National Association of Emergency Medical Technicians (NAEMT).

Su'aalaha soo noqnoqda¶

Ilaha la hubiyay¶

• American College of Surgeons (ACS, United States): Advanced Trauma Life Support (ATLS) Student Course Manual: Abdominal and Pelvic Trauma, Circumferential Pelvic Compression, and Hemorrhagic Shock.
• Committee on Tactical Combat Casualty Care (CoTCCC / Joint Trauma System, United States): TCCC Guidelines for Medical Personnel: Pelvic Binder Indications and Trochanteric Placement.
• National Institute for Health and Care Excellence (NICE, United Kingdom): Guideline NG37: Major Trauma and Complex Fractures, Prehospital Application of Pelvic Binders, and Non-Log-Roll Handling.
• Joint Royal Colleges Ambulance Liaison Committee (JRCALC, United Kingdom): Clinical Practice Guidelines: Pelvic Trauma Assessment ("No Springing" Rule) and Pelvic Splinting.
• World Society of Emergency Surgery (WSES, International): Pelvic Trauma Classification and Management Guidelines.

Tilmaamaha la xidhiidha¶

• Aqoonsiga naxdinta leh iyo daryeelka degdegga ah
• Dhaawacyada laf dhabarta iyo dhaqdhaqaaq la'aanta
• Furan (isku dhafan) jabka iyo kabidda
• Caloosha oo ka soo baxda iyo daryeelka boogaha caloosha ee furan
• Dhaawaca burburka iyo aqoonsiga cilladda qaybta
• Nambarada degdega ah iyo diritaanka caalamiga ah