Flail Chest, Multiple Rib Fractures, le Blunt Chest Trauma First Aid¶

Ribcage ea motho ke mokokotlo oa masapo a mabeli a likhopo tse leshome le metso e 'meli tse etselitsoeng ho sireletsa pelo, matšoafo, methapo e meholo ea mali, sebete le spleen ha e ntse e sebetsa e le mouoane oa mochine o hulelang moea matšoafong. Ha matla a matla a matla (a kang ho thula ha lebili la setere, ho oela lereng kapa ho raha, ho raha ha pere, kapa ho thulana ha lipapali) ho otla lebota la sefuba, khopo e le 'ngoe kapa tse 'maloa li ka peperana. Le hoja ho robeha ha likhopo tse bonolo ho le bohloko haholo, ho robeha ** likhopo tse peli kapa ho feta tse haufi libakeng tse peli kapa ho feta ** (kapa ho tlosa sternum ho tloha likhopo mahlakoreng ka bobeli) ho senya karolo ea lerako la sefuba le hlephileng ka ho feletseng ho tloha karolong e 'ngoe ea likhopo, ho etsa hore ho be le ts'ohanyetso e kotsi ea bophelo e bitsoang flail chest.

Sefubeng se phaphametseng, sehlekehlekeng se phaphametseng sa likhopo (**karolo ea flail **) ha e sa huleloa ka ntle ke leqheka nakong ea ho hema; ho e-na le hoo, khatello e mpe ea vacuum ka hare ho sefuba e monya karolo e robehileng ** ka hare ha mokuli a hema , 'me khatello e ntle e e sutumelletsa ** ka ntle ha mokuli a ntša ** ( paradoxical chest movement **). Habohlokoa le ho feta, tšusumetso e matla e hlokahalang ho tšoara likhopo tse ngata libakeng tse peli e lula e le matetetso le ho tabola mekotla ea moea e sa bonahaleng ea matšoafo ka tlas'a (pulmonary contusion), e tlatsang matšoafo ka mali le mokelikeli nakong ea lihora tse 2 ho isa ho tse 24 tse tlang. Ho tseba hore na ke hobane'ng ha u tlameha **le ka mohla u se ke ua phuthela theipi e khomarelang kapa li-bandage tse thata ho pota-potile sefuba **, mokhoa oa ho ruta **mosamo o bonolo o petsoha **, mokhoa oa ho beha motho ea lemetseng a otlolohile, le ho shebella lets'oafo le ipatileng le oeleng (khatello ea maikutlo pneumothorax) kapa ho phatloha ha spleen ho pholosa bophelo.

Etsa sena hona joale¶

1. Letsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang haeba motho ea hlokofalitsoeng a e-na le ho sisinyeha ha sefuba se makatsang (karolo ea likhopo tse monyang ka hare ha a hema), likhopo tse tharo kapa ho feta tseo ho belaelloang hore li robehile, ho hema ka thata, ho khohlela mali, kapa mahlaba a bohloko sefubeng ka mor'a leqeba le matla. Letsetsa 911 United States le Canada, 112 ho pholletsa le European Union, 9900 kapa United Kingdom dinomoro tsa tshohanyetso.
2. Beha sefuba kaofela se hlobotseng 'me u shebelle leqeba le phahama le ho oela boemong ba mahlo ka metsotsoana e 10 ho isa ho e 15. U ke ke ua bona motsamao o makatsang ka baki kapa sekipa. Sheba ka mokhoa o tsitsitseng leboteng la sefuba ho bona karolo leha e le efe e tebang ka hare nakong ea pululelo ha sefuba se ntse se hola.
3. ** LE KA mohla u se ke ua phuthela teipi e khomarelang, mabanta a rekere, mabanta kapa liropo ka thata-thata ho pota-pota likhopo, 'me U SE KE UA beha mekotla e boima ea lehlabathe sefubeng.** Ho tlama kapa ho tlanya selikalikoe sa sefuba ho thibela ho atoloha ha matšoafo* a phetseng hantle, a sa lemalang, ho etsa hore mekotla ea moea e ka tlaase ea matšoafo e theohe (**), ho hloleha ho hema.
4. Tshehetsa karolo ea lepheo kapa likhopo tse bohloko hanyenyane ka ho etsa hore mokuli a tšoare mosamo o bonolo, kobo e menoang, kapa thaole e khōlō lehlakoreng le lemetseng ("Pillow Splinting"). Tšehetso e bonolo e tšoaroang ka letsoho e nang le mosamo o bonolo e kokobetsa likhopo tse bohloko nakong ea ho hema kapa ha u khohlela ntle le ho thibela ho atolosoa.
5. Beha mokuli ea utloang, ea phefumolohang ea lutseng a otlolohile (boemo ba Fowler ho likhato tse 45 ho isa ho tse 60) kapa a sekame hanyenyane lehlakoreng le lemetseng (ntle le haeba leqeba la lesapo la mokokotlo le hloka ho robala fatše). Ho lula u otlolohile ho theola litho tsa mpa ho tloha ho diaphragm 'me ho etsa hore ho phefumoloha ho be bonolo haholoanyane; ho sekamela hanyane lehlakoreng le lemetseng ho etsa hore lets'oafo le phetseng hantle le ka holimo le hole ka bolokolohi.
6. Sheba metsotso e meng le e meng e 2 ho isa ho e 5 bakeng sa matshwao a Tension Pneumothorax, Hemothorax, kapa Spleen/Liver Rupture. Likhopo tse robehileng li na le lehare 'me hangata li phunya lets'oafo le ka tlaase (ho baka hore moea o ntse o hola le ho ruruha ha methapo ea molala) kapa ho phunya karolo e ka letsohong le letšehali ho ea ho le letšehali (9) likhopo 7 ho isa ho 11). Boloka mokuli a futhumetse 'me ka tieo NPO (ho se letho ka molomo).

Sefate sa liqeto tsa tšohanyetso bakeng sa leqeba le lerootho la sefuba le likhopo tse robehileng¶

flowchart TD
    Start["Blunt Impact to the Chest Wall, Ribcage, or Breastbone (Sternum)"]
    Expose["Expose Entire Bare Chest and Look Across Ribcage at Eye Level<br/>Assess breathing rate, depth, skin color, and symmetry"]
    FlailCheck{"Is Paradoxical Chest Movement Present?<br/>(A section of ribs sucks INWARD during inhalation<br/>and bulges OUTWARD during exhalation)"}
    FlailProtocol["FLAIL CHEST & PULMONARY CONTUSION PROTOCOL<br/>1. Call EMS (911 / 112 / 999) immediately for ALS trauma transport<br/>2. DO NOT tape ribs; DO NOT place heavy weights/sandbags on chest<br/>3. Have conscious patient hold a soft pillow or folded blanket gently over flail area<br/>4. Sit patient semi-upright (45 deg) or tilted slightly toward injured side<br/>5. If breathing becomes shallow/failing, assist with gentle positive-pressure breaths"]
    RedFlagRibs{"Are ANY High-Risk Rib Fracture Red Flags Present?<br/>- Shortness of breath, blue lips, or SpO2 < 94%<br/>- Coughing up bright red or frothy pink blood (hemoptysis)<br/>- Subcutaneous emphysema ('Rice Krispies' crackles under skin)<br/>- Fractures of Upper Ribs (1-2), Lower Ribs (9-12), or Sternum<br/>- Patient is > 65 years old, frail, on blood thinners, or has COPD<br/>- 3 or more painful ribs"}
    UrgentEMS["HIGH-RISK BLUNT THORACIC TRAUMA<br/>1. Call EMS (911 / 112 / 999) or go to Emergency Department immediately<br/>2. Sit semi-upright; support ribs with soft pillow when coughing<br/>3. Monitor closely for Tension Pneumothorax or Spleen/Liver bleeding<br/>4. Keep patient strictly NPO (nothing by mouth) and warm"]
    SimpleRib["SUSPECTED SIMPLE ISOLATED RIB FRACTURE OR CHEST WALL BRUISE<br/>(Young healthy adult, low-energy bump, normal breathing, no red flags)<br/>1.Seek medical evaluation to rule out small pneumothorax and get pain plan<br/>2. NEVER wrap or tape the chest<br/>3. Perform 'Pillow-Splinted Deep Breaths & Coughs' every hour while awake<br/>   to prevent post-injury pneumonia"]

    Start --> Expose
    Expose --> FlailCheck
    FlailCheck -->|Yes: Paradoxical Movement| FlailProtocol
    FlailCheck -->|No: Chest Moves Outward Together| RedFlagRibs
    RedFlagRibs -->|Yes: Any Red Flag Present| UrgentEMS
    RedFlagRibs -->|No: Isolated Point Tenderness Only| SimpleRib

Anatomical risk zones of the ribcage: Ke likhopo life tse robehileng tse sokelang litho tsa ka hare¶

Ha se lipara tsohle tse leshome le metso e 'meli tsa likhopo tse nang le kotsi e tšoanang. Baoki ba arola ribcage ka libaka tse 'ne tse fapaneng tsa tlhaho hobane sebaka sa ho robeha ha likhopo se bolela esale pele kotsi e ipatileng ea setho se ka tlase:

Anatomy le pathophysiology of Flail Chest le Pulmonary Contusion¶

1. Karolo ea Flail e theha joang le hore na ke hobane'ng ha e khutlela morao (Paradoxical Motion)¶

Sefuba sa flail se hloka bonyane **likhopo tse peli tse bapileng tse robehileng libakeng tse peli kapa ho feta ** ka lehlakoreng le le leng (kapa likarohano tse peli tsa costochondral tse thibelang sternum). Sena se etsa phanele e phaphametseng ea sefuba ea lebota la sefuba le lahlehetsoeng ke ho tsoela pele ha masapo le karolo e 'ngoe ea sefuba sa sefuba: * Nakong ya Tlwaeleho ya Ho Hohelwa: Diaphragm e honyela ho ya tlase mme mesifa ya kantle e hulela leribcage e sa fetoheng ho ya hodimo le kantle. Sena se theola khatello ka har'a sefuba sa sefuba ka tlase ho khatello ea sepakapaka (ho isa ho -8 \(\text{cmH}_2\text{O}\)). Hobane karolo e phaphametseng karohano ea flail e koaletsoe leribeng le thata, khatello e kantle ea sepakapaka e e sutumelletsa INWARD ka har'a sefubeng sa khatello e mpe ha karolo e 'ngoe ea likhopo e ntse e atoloha ho ea kantle. **Nakong ea ho Phahamisoa (kapa ho Khohlela Khatello e ka har'a sefuba e nyolohela ka holim'a khatello ea sepakapaka, e sutumelletsa karolo ea flail e aphametseng ** KA NTLE ** ha likhopo tse ling kaofela li teba ka hare. * Hobaneng Paradoxical Motion e atisa ho hloloheloa nakong ea metsotso e 30 ea pele ("The Muscle-Spasm Mask"): Hang ka mor'a ho oa, mesifa ea mokuli ea nang le letsoalo le mesifa ea lerako la sefuba le ea sefuba e kena ka har'a likhopo tse robehileng, e ts'oereng karolo e hlabang e sa boneng pele. Joale, metsotso e 20 ho isa ho e 60 hamorao, ha mesifa ea intercostal e khathala ka lebaka la mokhathala le hypoxia, mesifa ea mesifa e fana ka 'me e tsotehang ** motsamao o makatsang ** o hlaha ka tšohanyetso. Ka linako tsohle hlahloba sefuba se hlobotseng metsotso e meng le e meng e 5 ho isa ho e 10.

2. Hobaneng ha Pulmonary Contusion (Bruised Lung) e le 'molai oa 'nete ho Flail Chest.¶

Lingaka tsa mathoasong a lekholo la bo20 la lilemo li ne li lumela hore sefuba sa flail se bolaea bakuli hobane moea o ne o theoha le ho tloha pakeng tsa matšoafo a mabeli (Pendelluft). Liphuputso tsa sejoale-joale tsa fisioloji li pakile hore lefu la 'nete le behang bophelo kotsing sefubeng sa flail ke ka tlase ho Pulmonary Contusion e kopantsoeng le mahlaba a sefuba sefubeng le ho hloleha ha melumo: 1. Alveolar Hemorrhage and Edema: Tšusumetso e kholo e hlabang e tšoarang likhopo tse ngata libakeng tse peli e etsa hore motho a tšoenyehe ka har'a lesapo la matšoafo le kang seponche le ka tlaase ka ho toba. Li-capillary tse nyenyane haholo le mabota a alveolar lia phatloha, li tlatsa mekotla ea moea ka mali, mokelikeli o nang le protheine e ngata le litšila tse ruruhileng. 2. Bomo ea Nako e Liehisitsoeng ea "Ho Thunya" (Lihora tse 2 ho isa ho tse 24): Lefu la matšoafo le sebetsa joalo ka leqeba le matla letlalong la hau: ha le ruruhe ho fihlela boholo ba lona metsotsong e 5 ea pele. Mokuli ea nang le sefuba se hlabang kapa sefubeng se matla haholo a ka ba le maemo a oksijene haufi le a tloaelehileng hang ka mor'a ho oa, empa nakong e latelang 2 ho ea ho lihora tse 24 , mokelikeli oa interstitial le mali a phalla butle-butle alveoli ea matšoafo ("blossoming of the contusion"). Oxyjene e sitoa ho tšela mekotla ea moea e tletseng metsi ho kena maling (*intrapulmonary shunting ), e bakang hypoxia e tsoelang pele, e matla le Acute Respiratory Distress Syndrome (ARDS). 3. Tlhokomeliso ho Bana (Pulmonary Contusion KA NTLE le Likhopo): Ho masea, bana le bacha, likhopo li entsoe ka lefufuru le sarolohang haholo, le sa baloang le lesapo le qephang. Ngoana ea thutsoeng ke koloi kapa a lahleloa ka baesekele a ka ba le lefu le leholo, le behang bophelo kotsing ea pulmonary, pneumothorax, kapa leqeba la pelo ntle le ho robeha leqeba le le leng **, hobane ribcage ea bona e tenyetsehang e kobeha ho ea ka hare ho pshatla lets'oafo ebe e khutlela hantle sebopehong sa eona se tloaelehileng. Le ka mohla u se ke ua thibela ngoana ho tsoa kotsi e tebileng ea matšoafo ka hare hobane feela likhopo tsa hae li bonahala li tiile.

Thuso ea pele ea mohato ka mohato bakeng sa Flail Chest le Multiple Rib Fractures¶

Mohato oa Pele: pepesa, sheba, 'me u utloe lebota la sefuba ka bonolo¶

1. Etsa hore mokuli a lule kapa a phomole hamonate 'me a tlose kapa a sehe liaparo tse ka holimo ho pepesa sefuba kaofela.
2. Sheba boemo ba mahlo: Khumama pel'a mokuli 'me u shebe ka mose ho sefofane se tšekaletseng sefubeng sa bona metsotsoana e 15 ho bona hore na mahlakore ka bobeli a phahama ka ho lekana le hore na karolo efe kapa efe e teba ka hare ha a hema.
3. Ikutloe ka bonolo bakeng sa Subcutaneous Emphysema le Crepitus: Ka menoana e nang le liatlana tse bataletseng, ama letlalo hanyenyane ho pota-pota lesapo la mokokotlo, molala, le sebaka sa likhopo tse teteaneng:
4. Bony Crepitus: Ho tsikitlanya ha likhopo tse robehileng ho qetella ho hohla hammoho (u seke oa ese ho hatella ka matla hang ha u se u utloile).
5. Subcutaneous Emphysema: Maikutlo a matletle joalo ka ha ho hlaha Bubble Wrap kapa cereal ea Rice Krispies ka tlas'a letlalo. Subcutaneous emphysema ke letlapa le lekgubedu le mahlonoko: e paka hore kgopo e bohale e robehileng e phuntse parietal pleura le lesela la matshwafo ka tlase, e qobella moya hore o tswe letshwafong ho kena lera le mafura le tlasa letlalo, mme e lemosa hore pneumothorax kapa tension pneumothorax e teng ka tlasa kgopo eo.

Mohato oa 2: Sebelisa "Pillow Splinting" e Bonolo (Le ka mohla u se ke ua Tape kapa Li-Sandbags)¶

1. Nka mosamo oa bethe o bonolo, kobo ea boea e mennweng ka botenya, jase e mennweng, kapa thaole e kgolo ya ho hlapa mme o e behe ka bonolo hodima karolo ya flail kapa dikgopo tse robehileng.
2. Haeba mokuli a elelloa 'me a falimehile: E-re mokuli a tšoare mosamo o bonolo likhopong tsa hae tse lemetseng ka letsoho le letsoho. Ka tlhaho ba khona ho fetola ts'ehetso e bonolo ea ka hare ho fokotsa ho sisinyeha ha likhopo ha ba hema kapa ba khohlela ntle le ho thibela matšoafo a bona a matle.
3. Haeba u tlameha ho lokolla matsoho a mokuli nakong ea lipalangoang: U ka sebelisa letjeketjane le sephara la kgutlotharo le loose swathe e tšoereng letsoho le kobehileng la mokuli le lepheo le bonolo ka lehlakoreng la sefuba le lemetseng, le ka mohla le sa ka la huloa ka thata ho lekana ho hatella likhopo kapa ho thibela lehlakore le sa tsoa kotsi.

Mohato oa 3: Maemo a nepahetseng bakeng sa ho phefumoloha¶

• Mokuli ea utloang KA NTLE le kotsi ea mokokotlo e belaelloang:
• Lulisa mokuli ka ** semi-Fowler's kapa boemo bo otlolohileng (45 ho 60 likhato)**, a itšetlehile hanyenyane ** ka lehlakoreng le lemetseng ** a tšehetsoeng ke mesamo.
• Ke hobane'ng ha u sekamela hanyenyane lehlakoreng le lemetseng? Ho itšetleha hanyenyane holim'a mosamo o bonolo ka lehlakoreng le robehileng ho sebelisa boima ba 'mele bo bonolo ho tsitsisa likhopo tsa flail ha u ntse u lumella ** lets'oafo le sa lemalang lehlakoreng le phahameng ** ho hola ho fihlela bophahamo ba lona bo phahameng ntle le thibelo.
• Mokuli ea belaelloang molala kapa mokokotlo (mokokotlo) kotsi:
• Boloka lesapo la mokokotlo le sa nke lehlakore sebakeng se bataletseng kapa scoop stretcher, beha thaole e mennoeng e bonolo kapa mosamo ka holim'a karolo ea flail (e tšoaroang hanyenyane ke letsoho la mopholosi ntle le ho sutumelletsa fatše), 'me u hlokomele phefumoloho e sa khaotse.
• Mokuli ea sa tsebeng ho hema (Ha ho kotsi ea mokokotlo):
• Beha sebakeng sa ho hlaphoheloa ka morao ** ka lehlakore le HLOKOMENG HO TLA TLA HO TSAMAEA khahlanong le fatše / padding ** le ** HEALTHY lung UP ** e le hore matšoafo a matle a ka atoloha ka bolokolohi ntle le ho hatelloa ke boima ba 'mele.

Mohato oa 4: Ho thoe'ng haeba mokuli ea nang le Flail Chest a khaotsa ho hema ka ho lekaneng? (Ho tsitsisa ka hare ho Pneumatic)¶

• Hobane ho sisinyeha ha sefuba ho nka boiteko bo matla ba mesifa le matšoafo a ka tlas'a lets'oafo ha a khone ho monya oksijene hantle, mahlatsipa a nang le likarolo tse kholo tsa flail a ka khathala ka potlako: phefumoloho ea bona e fetoha ka potlako le e sa tebang (> 30 breaths / min) ebe e lieha ka kotsi (< 8 ho 10 breaths / min) ka melomo e putsoa.
• **Ho fapana le phefumoloho e tlwaelehileng e itlelang feela (e itshetlehileng hodima kgatello e mpe ya vacuum e monyang karolo ya flail kahare), **moya o bonolo o nang le kgatello ** (ka mask a pokothong, bag-valve-mask, kapa phefumoloho ya pholoso) e bululela ka tlasa kgatello e kenang le matšoafong ka tsela e ts'oanang le karolo e 'ngoe ea ribcage ** ("internal pneumatic stabilization").
• Tlhokomeliso ea Bohlokoa ka ho Phefumoloha ha Khatello e Ntle Sefubeng: Hobane likhopo tse robehileng hangata li phuntse lets'oafo le ka tlase, ho phefumoloha ha moea o matla le o matla matšoafong ho ka qobella moea hore o tsoe ka lets'oafo ho ea sefubeng, ka potlako ho baka tension pneumothorax. Fana ka phefumoloho ** ka bonolo, butle, le ho lekana ho bona sefuba se tloaelehileng se phahama **.

Ho Laola Likhopo Tse Bonolo: Hobaneng ha Batho ba Hlileng ba Tobana le Pneumonia le Joang "Ho Khohlela ho Splinted" ho Pholosang Bophelo¶

Le hoja baatlelete ba bacha ba nang le khopo e le 'ngoe e robehileng hangata ba fola hantle, ho robeha likhopo ho batho ba baholo ba baholo (ba lilemo li 65 ho ea holimo) kapa bakuli ba nang le lefu le sa foleng la matšoafo (COPD) ke kotsi e kholo ea bophelo: * Lingoliloeng tsa lits'oants'o tsa kliniki li bonts'a hore bakeng sa likhopo tse ling tse eketsehileng tse robehileng ho mokuli ea fetang lilemo tse 65, kotsi ea ho ba le **pneumonia ea baktheria e eketseha ka liperesente tse 27 **, mme mafu a eketseha ka liperesente tse 19.

The Vicious Cycle of Rib Pain -> Atelectasis -> Pneumonia¶

Hobaneng ha likhopo tse phatlohileng li baka pneumonia e bolaeang matsatsi a 3 ho isa ho a 5 hamorao? 1. Ho nka phefumoloho e tebileng e tloaelehileng kapa ho khohlela ho otlolla mesifa ea intercostal le ho phunya likhopo tse robehileng ho qetella hammoho, ho baka bohloko bo hlabang. 2. Ho qoba bohloko boo bo bohale, mokuli o nka phefumoloho e nyane, e sa tebang (**hypoventilation / splinting **) mme o hana ho khohlela. 3. Ntle le ho feheloa le ho khohlela nako le nako, moea o monyane botebong ba matšoafo ka lehlakoreng le lemetseng o oa oa joalo ka libalune tse senyehileng (atelectasis) ebe o tlala mucus e emeng. 4. Libaktheria li ikatisa ka har'a letamo leo le futhumetseng la mucus e qabeletsoe, 'me li hlahisa post-traumatic lobar pneumonia le ho hema ka thata nakong ea lihora tse 48 ho isa ho tse 96.

Mokhoa oa ho senya potoloho: Multimodal Analgesia le Hourly "Pillow-Splinted Coughing"¶

Ka mor'a hore ngaka e hlahlobe mokuli ('me e fane ka pneumothorax kapa ho tsoa mali ka hare): 1. Le ka mohla u se ke ua thatela kapa ua tlama sefuba: Lahla mabanta a khale a likhopo kapa masela a sefubeng. 2. Itloaetse "Mosamo-Splinted Deep Breathing and Huff Coughing" lihora tse ling le tse ling tse 1 ho isa ho tse 2 ha u falimehile: * Etsa hore mokuli a lule a otlolohile setulong ’me a haka mosamo o tiileng oa bethe ka makhethe khahlanong le likhopo tse bohloko ka matsoho a mabeli. * Ha u ntse u hatella mosamo ka hare ka har'a likhopo tse bohloko ho e tsitsisa, nka ** 5 ho 10 butle, phefumoloho e tebileng ho pholletsa le **, u tšoere phefumoloho e 'ngoe le e' ngoe bakeng sa metsotsoana ea 3 holimo ho bula mekotla ea moea e oeleng (ho sebelisa spirometer ea khothatso haeba e fanoe ke sepetlele). * Latela ka 2 e bonolo, e tšehelitsoeng ka mosamo "huff khohlela" ho tlosa phlegm efe kapa efe matšoafong a tlase. 3. Latela leano la ngaka le reriloeng la ho laola bohloko: Ho fapana le maqeba a maqaqailaneng moo moriana oa maqaqailana e leng feela bakeng sa matšeliso, ho imolla bohloko bo lekaneng ha ho robeha likhopo ke phekolo ea meriana e pholosang bophelo hobane e nolofalletsa mokuli ho hema haholo le ho khohlela. Lipetlele, bakuli ba nang le likhopo tse ngata tse robehileng hangata ba fumana methapo ea methapo ea libaka e lebisitsoeng (e kang ** serratus anterior plane block, erector spinae block, kapa thoracic epidural **) e le hore ba ka phefumoloha ka ho teba ntle le sedation ea opioid. 4. ** Kenya liphutheloana tsa leqhoa tse phuthetsoeng ka thaole metsotso e 15 ho isa ho e 20 ka nako ** holim'a likhopo tse bonolo nakong ea lihora tse 48 tsa pele ho fokotsa ho ruruha ha periosteal ea sebakeng seo.

Likotsi tse ling tse bolaeang tse mahlonoko tsa sefuba tse ka bonoang tšimong¶

Ha matla a matla a phahameng a otla lebota la sefuba kapa sternum, ho ka hlaha likotsi tse ling tse tharo tse patehileng tsa pelo le methapo ea mali hammoho le ho robeha ha likhopo:

1. Commotio Cordis (Tšoaro ea Tšoaro ea Ka tšohanyetso ea Ventricular Fibrillation)¶

Commotio cordis ke ho tšoaroa ha pelo ka tšohanyetso, ho bolaeang ho bakoang ke ho otla ho matla, hoo e batlang e le matla a fokolang ka ho toba leboteng le letšehali la sefuba (hantle-ntle holim'a silhouette ea pelo) ha ho na ho se na tšenyo ea sebopeho likhopong kapa mesifa ea pelo ho hang . * Maemo a Tloaelehileng: Ngoana, mocha, kapa motho e moholo e monyenyane ea pakeng tsa lilemo tse 5 le 25 o otloa sefubeng se ka letsohong le letšehali ke projectile e thata (baseball, lacrosse ball, hockey puck, cricket ball, martial arts kick, kapa setsoe). Moatlelete a ka ’na a nka mohato o le mong kapa tse peli tse khoptjoang ebe joale oa oela ka ho feletseng, a sa arabele, a koaleha moea ’me a felloa ke matla. * The Electrophysiological Mechanism: Haeba projectile e otla lebota la sefuba ka nako e moqotetsane haholo 15-to-30-millisecond fensetere sebakeng se ka holimo sa T-wave (ha li-ventricle tsa pelo li fetoha 'me li kotsing ea motlakase), lets'oho la mochini le bula ho ts'oaroa ha mesifa ea pelo le methapo ea pelo e otlolohileng. (VF) ho tšoaroa ha pelo. * Immediate First Aid: Motsotsoana o mong le o mong oa bohlokoa. ** Qala ho hatella sefuba sa boleng bo holimo (CPR) hang-hang 'me u kopanye le Automated External Defibrillator (AED) nakong ea metsotso ea 3. Ho pholoha ho tloha commotio cordis ho feta **70 lekholong ** haeba CPR le ts'oaetso ea AED li fanoa ka hare ho metsotso ea 3, empa e theoha ka tlase ho karolo ea 10 haeba e lieha ho feta metsotso ea 5.

2. Kotsi e Ntle ea Pelo (Myocardial Contusion) le Maqheka a Sternal¶

Ha lesapo la sefuba la mokhanni (sternum) le thula lebili la setere kapa lebanta le tiileng la setulo ka lebelo la 'mila o moholo, ventricle e nepahetseng ea pelo (e lutseng hang-hang ka mor'a sternum) e pshatleha pakeng tsa lesapo la sefuba le ka pele le mokokotlo oa sefuba ka morao. * Matšoao a Temoso: Ho hatelloa ke mahlaba a sefubeng a bohareng a sa imolloeng ke ho phomola, ho ba le matetetso kapa bofokoli bo tsoang bohareng ba lesapo la letsoele (ho robeha ha lesea), ho otla ka tsela e sa tloaelehang, ho tlōla-tlōla kapa ho matha ka lebelo (**sinus tachycardia, ho holofala ha ventricular pele ho nako, kapa ho ferekana ha ventricular pele ho nako, kapa ho tsieleha ho tlase ha atrial*ogenic), khatello ea mali e tlase**ogenic le atrial*ogenic fibrillation). * ** Thuso ea Pele: ** Boloka mokuli a lutse a khutsitse a otlolohile, thibela boiteko leha e le bofe ba 'mele, ho shebella ho otla ha pelo ho sa khaotse bakeng sa ho tšoaroa ha pelo ka tšohanyetso,' me u hlophise lipalangoang tsa hang-hang tsa ambulense ea ALS bakeng sa ho hlahloba 12-lead ECG le tlhahlobo ea pelo ea troponin.

3. Blunt Traumatic Aortic Injury (Deceleration Tear)¶

Kotsing ea koloi e tsamaeang ka hlooho ho > 60 km/h (40 mph) kapa ho oa ho tloha > 6 metres (20 feet), the mobile arch of the aorta swing ho ea pele ha aorta ea thoracic e theoha e ntse e khomaretsoe ka thata ho ea mokokotlong ke **ligamentum arteriosum **, e qhaqha lebota la aorta. Le hoja karolo ea 80 lekholong ea ho phatloha ho feletseng ha aortic e bolaea sebakeng seo, ** karolo ea 20 lekholong ea bakuli ba phela qalong ** hobane lesela le thata la ka ntle la aorta (**the adventitia ) le tšoara mali ka nakoana ka hare joaloka blister e phunyehang ( e nang le pseudoaneurysm **). * Boloka lehlatsipa leha e le lefe la kotsi ea ho theoha ka lebelo le phahameng le khutsitse ka ho feletseng 'me le ntse le le teng nakong ea lipalangoang; Ho tšoha ka tšohanyetso, ho sokola, kapa ho opeloa ho eketsa khatello ea mali 'me ho ka phatloha ho phatloha ha aortic pele ho ts'ebetso ea ho lokisa stent-graft.

Ho utloisisa mekhoa ea sefuba sa flail, pulmonary contusion, le ho robeha likhopo tlhokomelo ea ho phefumoloha ho thibela hypoxia ea tšohanyetso le pneumonia e liehang. Nahana ka ho nka thuso ea pele e tiisitsoeng kapa thupelo ea ba arabelang maemong a tšohanyetso ka sechaba sa hau sa Red Cross kapa Red Crescent, St John Ambulance, kapa American Heart Association.

Lipotso tse botsoang khafetsa¶

Mehloli e hlahlobiloe¶

• American College of Surgeons (ACS, United States): Advanced Trauma Life Support (ATLS) Bukana ea Thupelo ea Seithuti: Thoracic Trauma, Flail Chest, Pulmonary Contusion, le Rib Fracture Triage.
• Mokhatlo oa Bochabela bakeng sa Opereishene ea Tlhekefetso (EAST, United States): Litaelo tsa Tsamaiso ea Boitloaelo bakeng sa Tšoaetso ea Pulmonary - Flail Chest le Blunt Thoracic Trauma ho Batho ba Hōlileng.
• Setsi sa Sechaba sa Bophelo bo Botle ba Bophelo bo Botle le Tlhokomelo (NICE, United Kingdom) & NHS: *Tlhahiso e kholo ea Tleliniki ea Tlhekefetso: Tsamaiso ea Sefuba sa Sefuba le Likhopo Analgesia / Physiotherapy *.
• Mokhatlo oa Sechaba oa Litsebi tsa Meriana ea Tšohanyetso (NAEMT, United States): Tshehetso ea Bophelo ba Prehospital Trauma Life (PHTLS): Tlhekefetso e Blunt Thoracic le Internal Pneumatic Stabilization.
• ** Mekhatlo ea Machaba ea Mokhatlo oa Sefapano se Sefubelu le Mekhatlo e Sefubelu (IFRC, International): ** Thuso ea Machaba ea Thuso ea Pele, Ho Tsosolosa, le Litaelo tsa Thuto: Likotsi Tsa Sefubeng le Likhopo Tsa Likhopo.

Litataiso tse amanang¶

• Ho anya leqeba la sefuba le thuso ea pele ea ho putlama matšoafong
• Sefuba se phunyeletsang le tamponade ea pericardial
• Thuso ea pele e robehileng, ho robeha, le sprains
• Likotsi tsa mokokotlo le ho se tsitse
• Tlhokomeliso e tšosang le tlhokomelo ea tšohanyetso
• Linomoro tsa maemo a tšohanyetso le thomello ea machaba