Ibalẹ àyà ti nwọle ati idanimọ Tamponade Pericardial¶

Okan eniyan n lu inu inu apo lile kan, fibrous, apo-alawọ-alawọ meji ti a npe ni pericardium. Labẹ awọn ipo deede, aaye laarin awọn ipele inu ati ita ti apo yii ni 15 si 50 milimita nikan (1 si 3 tablespoons) ti omi lubricating mimọ, gbigba awọn ventricles lati faagun ati ṣe adehun larọwọto 100,000 igba lojumọ. Nigbati abẹfẹlẹ ọbẹ, yinyin yiyan, screwdriver, ọta ibọn, tabi ajẹkù shrapnel wọ inu ogiri àyà aarin (“Apoti ọkan”) ti o si fa ogiri ọkan tabi gbòngbo aorta, ẹjẹ titẹ ti o ga ti n jade lati iyẹwu ọkan taara sinu edidi, apo pericardial inelastic.

Nitori pericardium fibrous ko le na ni kiakia, o gba ** 60 si 150 milimita (2 si 5 iwon omi omi, o kere ju idaji ago) ti ẹjẹ nla ** idẹkùn inu apo pericardial lati fun awọn iyẹwu ọkan ti o wa ni ita. Bi titẹ intrapericardial ti kọja titẹ kikun ti atrium ọtun ati ventricle ọtun, ọkan ko le faagun laarin awọn lilu lati mu ni ipadabọ ẹjẹ iṣọn, nfa iṣelọpọ ọkan ọkan lati ṣubu si odo laarin awọn iṣẹju (** pericardial pericardial tabi tamponade ọkan ọkan**). Mọ bi o ṣe le ṣe maapu awọn aala anatomical ti ** Apoti ọkan ***, bii o ṣe le ṣe iyatọ ** tamponade ọkan (Beck's triad) *** lati ẹdọfóró ti o ṣubu (ẹdọfu pneumothorax), kilode ti o ko gbọdọ ** fa abẹfẹlẹ ọbẹ ti a kan mọ mọ lailai, ati idi ti o ko gbọdọ ṣe idii gauze ninu iho àyà kan *** ra awọn iṣẹju iyebiye ti o nilo fun fifipamọ igbesi aye thoracotomy iṣẹ abẹ pajawiri tabi pericardiocentesis.

Ṣe eyi ni bayi¶

1. Pe nọmba pajawiri ti agbegbe rẹ lẹsẹkẹsẹ ki o beere fun Advanced Life Support (ALS) paramedics fun amojuto ni Ipele 1 Trauma Center ọkọ. pajawiri awọn nọmba. Jabọ kan ** ọgbẹ ti nwọle ni aarin àyà (Apoti ọkan) nitorinaa ẹgbẹ iṣẹ abẹ ọgbẹ ti wa ni itaniji ṣaaju ki ọkọ alaisan to de.
2. ** Fi gbogbo àyà ti ko nii han, ikun oke, awọn apa, ati sẹhin lati wa gbogbo ọgbẹ ti nwọle ati ijade.** Paapaa yinyin-millimita 5 kekere kan (0.2-inch) puncture yinyin lori egungun igbaya, laini ori ọmu, tabi epigastrium oke (“ọfin ikun”) le ni igun si oke nipasẹ diaphragm sinu ọkan-ọtun.
3. **MASE yọ abẹfẹlẹ ọbẹ, screwdriver, itọka, tabi fifọn gilasi ti a kan mọ àyà. fifaa jade n tu iṣan ẹjẹ ti o ga-giga sinu apo pericardial ti o fa tamponade ọkan apaniyan ni labẹ awọn aaya 60. Ṣe iduroṣinṣin ohun naa ni aye pẹlu awọn yipo gauze ibeji nla.
4. ** MA ṢE di gauze tabi ribbon hemostatic NINU ọgbẹ àyà ti nwọle fifi awọn yaadi gauze nipasẹ awọn iha ko ni fun ọkan ẹjẹ tabi iṣọn-ẹjẹ inu inu, ati dipo ti awọn ẹdọfóró si apakan ki o fi iṣọn-ẹjẹ ti inu ti o le pa mọ.
5. **Ti ọgbẹ àyà ba n mu afẹfẹ tabi ti nyọ eje Pink frothy, lo Igbẹhin Igbẹhin Iṣowo Iṣowo tabi Wíwọ Flutter Apa Mẹta.
6. ** Jeki alaisan ti o ni oye tunu, joko ologbele-iduroṣinṣin (tabi ni ipo itunu wọn), NPO ni muna (ko si ohunkan nipasẹ ẹnu), ati ti a we sinu awọn ibora ti o gbona. awọn ohun ***, ti o tẹle pẹlu ailagbara pupọ ati awọn ohun ẹmi deede ni ẹgbẹ mejeeji ti àyà.

Igi ipinnu pajawiri fun ibalokan àyà ati tamponade ọkan ọkan¶

flowchart TD
    Start["Penetrating Trauma (Knife, Gunshot, Ice Pick, Shrapnel)<br/>to the Chest, Back, Axilla, or Upper Epigastrium"]
    CallEMS["Call Emergency Medical Services (ALS Paramedics) Immediately<br/>Expose entire bare chest, upper abdomen, armpits, and back"]
    ImpaleCheck{"Is a Knife, Screwdriver, or Object Still Impaled in the Chest?"}
    ImpaleCare["IMPALED CHEST OBJECT PROTOCOL<br/>1. NEVER pull out or wiggle the impaled object<br/>   (It may be plugging a hole in the right ventricle or aorta)<br/>2. Seal any sucking air gap around base of blade on 3 sides<br/>3. Stabilize with bulky twin-roll pads so blade does not move with heartbeat"]
    SuckingCheck{"Is the Wound Sucking Air or Bubbling Frothy Blood?"}
    SealStep["APPLY VENTED CHEST SEAL OR 3-SIDED DRESSING<br/>1. Wipe skin dry and apply Vented Chest Seal at end-exhalation<br/>2. NEVER pack gauze inside the chest cavity<br/>3. Control external skin-edge bleeding with flat surface pressure only"]
    BoxCheck{"Is the Wound Inside the 'CARDIAC BOX' (Thoracoabdominal Box)?<br/>- Superior: Clavicles (Collarbones) / Sternal Notch<br/>- Inferior: Costal Margin / Xiphoid / Upper Epigastrium<br/>- Lateral: Mid-Clavicular (Nipple) Lines on Left and Right<br/>(Or any gunshot/stab trajectory crossing the mediastinum)"}
    TamponadeCheck{"Assess for Obstructive Shock:<br/>Bulging Neck Veins (JVD) + Weak/Absent Wrist Pulse + Agitation/Cyanosis?"}
    DiffLung{"Compare Breath Sounds & Percussion on Both Sides of Chest:<br/>Are Breath Sounds Absent on One Side OR Equal on Both Sides?"}
    TensionPath["ABSENT BREATH SOUNDS ON ONE SIDE + HYPERRESONANT<br/>= SUSPECTED TENSION PNEUMOTHORAX<br/>1. Immediately BURP or lift chest seal for 3-5 seconds<br/>2. ALS Paramedic performs immediate Needle Decompression"]
    TamponadePath["EQUAL BREATH SOUNDS ON BOTH SIDES + MUFFLED HEART SOUNDS<br/>= SUSPECTED PERICARDIAL (CARDIAC) TAMPONADE<br/>1. Priority 1 Rapid Transport ('Load and Go') to Trauma Surgeon<br/>2. Keep patient calm, warm, semi-upright (avoid laying flat if dyspneic)<br/>3. ALS gives cautious IV fluid bolus to boost venous filling pressure<br/>   & prepares for Pericardiocentesis / Resuscitative Thoracotomy"]
    MonitorAll["Monitor Pulse, Breathing, and Neck Veins Every 60 Seconds<br/>Keep patient warm and strictly NPO until hospital arrival"]

    Start --> CallEMS
    CallEMS --> ImpaleCheck
    ImpaleCheck -->|Yes: Object Impaled| ImpaleCare
    ImpaleCheck -->|No: No Object Present| SuckingCheck
    SuckingCheck -->|Yes: Sucking / Bubbling| SealStep
    SuckingCheck -->|No: Non-Sucking Hole| BoxCheck
    ImpaleCare --> BoxCheck
    SealStep --> BoxCheck
    BoxCheck -->|Yes: Inside Cardiac Box| TamponadeCheck
    BoxCheck -->|No: Lateral Chest Only| TamponadeCheck
    TamponadeCheck -->|Yes: Shock + Bulging Neck Veins| DiffLung
    TamponadeCheck -->|No: Stable Vitals| MonitorAll
    DiffLung -->|Absent Unilateral Breath Sounds| TensionPath
    DiffLung -->|Equal Bilateral Breath Sounds| TamponadePath

Ṣiṣe aworan aworan “Apoti ọkan” (Agbegbe Ewu Mediastinal)¶

Awọn oniṣẹ abẹ ibalokanjẹ ṣalaye agbegbe anatomical onigun mẹrin ni iwaju (ati ẹhin ti o baamu) ti torso ti a pe ni ** “Apoti ọkan” *** (tabi * apoti precordial *). Ọgbẹ ọgbẹ eyikeyi, puncture, tabi titẹsi ibọn / ijade ti o wa laarin awọn aala mẹrin wọnyi ni ** iṣeeṣe giga ti ọkan taara, pericardial, tabi ipalara ọkọ nla ***:

• ** Oke Aala (Superior): *** Laini petele kọja awọn ** clavicles (egungun) ** ati ogbontarigi giga julọ ** ni ipilẹ ọrun.
• ** Aala Isalẹ (Irẹlẹ):** Laini petele kọja ilana ilana xiphoid** (isalẹ ti egungun igbaya) ati awọn ala kekere iye owo kekere ** (pẹlu oke ** triangle epigastric **).
• ** Awọn aala apa osi ati ọtun (Lateral):** Awọn laini inaro ti a fa taara si isalẹ laarin aarin egungun kola kọọkan (** awọn laini aarin clavicular osi ati ọtun **, ni aijọju ti n kọja nipasẹ awọn ọmu *** ninu awọn ọkunrin).
• ** Kilode ti a fi lu ventricle Ọtun ni 50% ti akoko naa: ** Nitori ọna ti ọkan eniyan ṣe n yi pada si inu àyà, ** ventricle ọtun ** fẹrẹ jẹ gbogbo iwaju iwaju (iwaju) ti okan taara lẹhin sternum ati osi 3^rd-si-6^th cartilages costal. Nitoribẹẹ, ** ju 50 ida ọgọrun ti awọn ọgbẹ ọkan ti o wọ inu ventricle ọtun ***, ni aijọju 30 ogorun gun nipon ** ventricle osi **, ati 10 si 15 ogorun gun atrium sọtun tabi osi tabi intrapericardial aorta/vena cava.

Iyatọ Awọn pajawiri Aya Apaniyan Mẹta: Tamponade Cardiac vs. Tension Pneumothorax vs. Massive Hemothorax¶

Nigbati alaisan kan ti o ni ọgbẹ àyà ti nwọle ni iyara lọ sinu iyalẹnu, awọn alamọdaju ati awọn dokita pajawiri gbọdọ ṣe iyatọ lẹsẹkẹsẹ laarin ** Pericardial Tamponade **, Pneumothorax ẹdọfu, ati Gbígbà Hemothorax ***. Ṣe akiyesi bi meji ninu wọn ṣe fa ** awọn iṣ ọrun bulging * (** mọnamọna obstructive **) lakoko ti ọkan nfa *awọn iṣọn ọrun alapin *** ( mọnamọna hypovolemic **), ati bii gbigbọ ẹdọforo ṣe sọ fun awọn pajawiri idena idena meji lọtọ:

Anatomi ati pathophysiology ti Pericardial Tamponade¶

1. Kini idi ti idaji ife ẹjẹ npa ni awọn iṣẹju nigba ti lita kan ti omi ti o lọra ko (The Pericardial Pressure-Volume Curve)¶

Kilode ti alaisan kan ti o ni ikuna kidirin onibaje tabi akàn le ṣajọpọ laiyara ** 1,000 si 1,500 milimita (1 si 1.5 liters)** ti omi ni ayika ọkan wọn fun ọsẹ pupọ laisi lilọ sinu mọnamọna, lakoko ti olufaragba ti o gun ninu àyà yoo ku ni iṣẹju 5 lati iṣẹju 75 si 100 milimita (3ricardium 3) ninu ẹjẹ? * Layer ita ti pericardium (** pericardium fibrous ***) jẹ hun lati ipon, awọn okun kolaginni ti ko ni rirọ ti o fẹrẹ fẹẹrẹ na isan. * Nigbati omi ba n ṣajọpọ laiyara fun awọn ọsẹ, awọn okun collagen maa ṣe atunṣe diẹdiẹ ati ki o na lati di lita ti ito kan. * Ni ** ibalokanjẹ ti nwọle nla ***, ẹjẹ n ṣàn sinu aaye pericardial ni iṣẹju-aaya. Ni kete ti ibẹrẹ 30 si 50 milimita ti aaye ọlẹ inu apo ti kun, ** titẹ-iwọn iwọn didun ti pericardium yipada ni inaro **: fifi kun kan ** 20 tabi 30 milimita ẹjẹ diẹ sii ** fa titẹ intrapericardial si ọrun lati 0 mmHg si ** 15 si 25 mmHg ***. * Nitori tinrin-olodi ** atrium ọtun ati ventricle ọtun ** deede fọwọsi ni titẹ iṣọn iṣọn ti onírẹlẹ ti nikan ** 2 si 8 mmHg **, titẹ pericardial ita ti 20 mmHg n fọ atrium ọtun ati alapin ventricle ọtun lakoko diastole (ilana kikun isinmi ti lilu ọkan).

2. Igbẹkẹle Ventricular ati "Pulsus Paradoxus"¶

Ninu inu rigidi, apoti aiduro ti apo pericardial, ventricle osi ati ventricle ọtun gbọdọ dije fun aaye lapapọ ti o wa titi (** Igbẹkẹle ventricular ***), ti o yapa nipasẹ iṣan nikan ** septum interventricular : 1. Ni gbogbo igba ti alaisan ** ifasimu (simi sinu), titẹ odi inu àyà ma fa ẹjẹ iṣọn kekere kan si apa ọtun ti ọkan. 2. Nitoripe apo pericardial ti o ni lile, ti o kun ẹjẹ ti o wa ni ita kọ lati jẹ ki ventricle ọtun faagun * ita, ventricle ọtun ti o gbooro yoo fi agbara mu lati **bulge septum interventricular INWARD sinu ventricle osi **, fifọ iho ventricle osi ti o fẹrẹẹ ku lakoko ifasimu. 3. Nitoribẹẹ, lakoko ** ifasimu **, ventricle osi le fa ẹjẹ eyikeyi sinu aorta: titẹ ẹjẹ systolic alaisan lọ silẹ nipasẹ diẹ sii ju ** 10 mmHg nigba gbogbo ẹmi kan ninu, ati ** ti o ba fi ika rẹ si pulse radial alsan ni ọwọ ọwọ, le ni ikunsinu ọrun-ọwọ tabi simi ni gbogbo igba ti alaisan naa ba lọ kuro patapata jade ***. Ami ti ara iyalẹnu yii ni a pe ni Pulsus Paradoxus.

3. Loye Beck's Triad (ati idi ti o ko nilo stethoscope ni opopona alariwo)¶

Ni ọdun 1935, oniṣẹ abẹ cardiothoracic Claude Beck ṣe apejuwe triad Ayebaye ti tamponade cardiac cardiac (** Beck's Triad *): 1. Hypotension (Iwọn titẹ ẹjẹ ti iṣan ti n ṣubu & Titẹ Pulse Di dín): Sisitoliki titẹ ẹjẹ silẹ lakoko ti titẹ diastolic duro ga soke (fun apẹẹrẹ, 85/75 mmHg, titẹ pulse 10 mmHg kekere kan), ti n ṣe alailagbara, radial radial thready ti o padanu lori ifasimu. 2. * Jugular Venous Distension (JVD): Nitori ipadabọ ẹjẹ iṣọn lati ori ati ọrun ti ni idinamọ lati wọ inu atrium ọtun ti a tẹ, ita ati awọn iṣọn jugular ti inu ni awọn ẹgbẹ ti ọrun nyọ jade bi awọn okun buluu ti o nipọn, paapaa nigbati alaisan ba joko ni igun 45-degree. (Akiyesi: Ni opopona alariwo nibiti o ko le gbọ awọn ohun ọkan pẹlu stethoscope kan, ** ọgbẹ ti nwọle ninu Apoti ọkan + Ibanujẹ + Awọn iṣọn Ọrun bulging + Awọn ohun Imi Agbedemeji dọgba *** ni gbogbo ohun ti o nilo lati fura si tamponade ọkan ọkan.) 3. ** Awọn ohun inu ọkan ti o ṣokunkun tabi ti o jinna: ** Ẹjẹ ti o yika ọkan ṣe idabo ohun acoustic lub-dub ti awọn falifu ọkan bi jaketi omi.

4. Awọn ami ikilọ miiran ti Pericardial Tamponade¶

• Ami Kussmaul: Aparadoxical dide (fifun siwaju sii) awọn iṣọn ọrun nigba ifasimu (ni deede, iṣọn ọrun kan di pẹlẹbẹ diẹ nigbati eniyan ba fa simi nitori ẹjẹ ti fa sinu àyà; ni tamponade, ẹjẹ ko le wọ inu ọkan ti o fun pọ, nitorina awọn iṣọn ọrun n dagba paapaa ni imisi).
• ** Ibanujẹ nla ati “Oye ti iparun ti n bọ” (* Angor Animi*):** Nitori pe iṣọn-ẹjẹ ọpọlọ n lọ silẹ ni iyara lakoko ti alaisan tun wa ni mimọ, awọn olufaragba tamponade nigbagbogbo di aisimi pupọ, ipaya, ija lati joko, ati sisọ pe wọn fẹrẹ ku, ami kan nigbagbogbo n ṣe aṣiṣe nipasẹ awọn aladuro tabi ọlọpa fun imuni mu ọti-lile lojiji.

Iranlọwọ akọkọ ni Igbesẹ-igbesẹ fun Awọn ọgbẹ Aya ati Ti fura Tamponade¶

Igbesẹ 1: Iyatọ Lẹsẹkẹsẹ ati “Scoop and Run” Muu ṣiṣẹ¶

1. Ipe 911/112/999 lẹsẹkẹsẹ: Ko dabi awọn ọgbẹ opin ti o le jẹ iduroṣinṣin ni aaye pẹlu irin-ajo irin-ajo, **tamponade ọkan ọkan le ṣe arowoto nikan nipasẹ gbigbe apo pericardial (pericardiocentesis tabi ika pericardiotomy) ati sisọ iho inu iṣan aarin ọkan. Gbogbo iseju ti o lo lori iṣẹlẹ n ge iwalaaye ni kiakia.
2. ** Fi àyà ati ẹhin han: *** Ge seeti naa ṣii patapata ki o ṣayẹwo mejeeji iwaju ati ẹhin torso.

Igbesẹ 2: Ṣiṣakoṣo Abẹfẹ Kan tabi Ohun kan ninu Apoti Ẹdun ọkan¶

Ti ọbẹ, yinyin gbe, rebar, tabi shard gilasi ṣi n duro jade kuro ninu àyà tabi epigastric oke: 1. MASE fa jade, maṣe gbiyanju lati tọ tabi kuru. 2. ** Wo fun "Pulsatile Blade Motion":** Nigbagbogbo, abẹfẹlẹ ọbẹ ti itọ rẹ wa ninu ogiri ti ventricle ọtun yoo han gbangba ** bob tabi twitch ni rhythm pẹlu gbogbo ọkan ọkan lu ọkan . 3. ** Didi ati muduro laisi ihamọ išipopada lilu ọkan: * Ti afẹfẹ ba n mu ni ayika ipilẹ ti abẹfẹlẹ, gbe awọn ila ti gauze epo tabi ṣiṣu ṣiṣu ni ayika ẹnu-ọna awọ ara (nlọ igun kan ti a ko fi idi silẹ lati yọ afẹfẹ). * Gbe awọn yipo nla meji ti gauze tabi awọn aṣọ inura ti a ṣe pọ si ẹgbẹ mejeeji ti abẹfẹlẹ lati daabobo rẹ lati jija tabi titari jinle lakoko gbigbe ọkọ alaisan, ṣugbọn **maṣe fa abẹfẹlẹ naa si isalẹ ni lile ti ọkan lilu fa omije funrararẹ lodi si imọran irin ti ko le gbe **.

Igbesẹ 3: Ṣiṣakoṣo Ọgbẹ Sisun Ṣii Laisi Nkankan Ti a Kan Kan¶

1. Maṣe gbe gauze sinu iho àyà: Ma ṣe Titari gauze ija tabi bandages laarin awọn egungun sinu àyà.
2. ** Waye Igbẹhin àyà Vented (tabi Wíwọ Occlusive Apa Mẹta):** Paapaa fun ọgbẹ kekere kan lori sternum tabi àyà osi, nu ẹjẹ ati lagun gbẹ ki o lo edidi àyà vented ti iṣowo ni opin exhalation ki afẹfẹ ko le mu sinu aaye pleural tabi mediastinum.
3. Ti ẹjẹ pupa didan ba njade lati ogiri àyà funrararẹ?
4. Awọn iṣọn-alọ nla meji, awọn iṣọn inu mammary ti inu (ti abẹnu thoracic) **, ṣiṣe ni inaro si isalẹ inu ti ribcage iwaju ni o kan ** 1 si 2 centimeters (0.5 inches) si apa osi ati ọtun ti eti egungun igbaya (sternum) **, ati ** intercostal artery ** nṣiṣẹ lẹba isalẹ groove ti gbogbo igun.
5. Ti ọgbẹ ọgbẹ kan ba ge intercostal tabi iṣọn mammary ti inu ati ẹjẹ ti n ṣan jade lati awọn egbegbe awọ ara, lo ** titẹ taara alapin duro pẹlu paadi gauze ti ko ni ifo taara lori ọgbẹ ita ** (tabi lori edidi àyà ti a ti tu silẹ lakoko abojuto ni pẹkipẹki fun pneumothorax ẹdọfu).

Igbesẹ 4: Ipo, Itọju Gbona, ati Isọji¶

1. ** Ipo ipo: ** Gba laaye mimọ, alaisan mimi lati duro si ipo itunu wọn (ni deede ** ologbele-iduroṣinṣin ni iwọn 30 si 45 ** tabi gbigbe ara diẹ siwaju, eyiti o gba titẹ diẹ diẹ si atrium ọtun). Ti titẹ ẹjẹ wọn ba lọ silẹ ni itara ati pe wọn lero rẹwẹsi, sọ ori ti stretcher silẹ si alapin/lẹhin lakoko ti wọn nwo mimi ni pẹkipẹki.
2. ** Jẹ ki alaisan naa balẹ ki o si duro jẹ: *** Ijakadi ti ara tabi dide duro ni alekun ibeere atẹgun ọkan ati jijẹ titẹ ventricular systolic, ti o mu ẹjẹ diẹ sii jade nipasẹ yiya myocardial sinu apo pericardial.
3. • Dena hypothermia: *** Fi ipari si alaisan ni awọn ibora ti o gbona ki o tọju wọn ni deede NPO (ko si nkankan nipasẹ ẹnu).
4. Kini ti alaisan ba padanu aiji ti o lọ sinu Imuduro Ẹdun ọkan ti o buruju (Iṣẹ Itanna Ailopin Pulseless / PEA) ṣaaju ki EMS to de?
5. Ninu tamponade ọkan ọkan, oluṣeto itanna ọkan n tọju awọn ifihan agbara deede lori atẹle ECG lakoko ti o ti fa ẹjẹ odo (** Iṣẹ Itanna Ailopin tabi PEA**).
6. ** Bẹrẹ boṣewa CPR lẹsẹkẹsẹ *** nigba ti paramedics wa lori ọna. Lakoko ti awọn ifunmọ àyà ti ita ko ni imunadoko nigbati apo pericardial ti kun fun ẹjẹ ju ni ikọlu ọkan ti iṣoogun, CPR n ṣetọju iṣọn-ẹjẹ iṣọn-alọ ọkan ati perfusion cerebral titi ti ALS paramedics tabi awọn oniṣẹ abẹ ọgbẹ ti de lati ṣe ** thoracotomy resuscitative pajawiri ** tabi ** pericardiocentesis itọ-ultrasound ** 0 milimita paapaa nilo 5 milimita. lati inu apo pericardial le mu pulse kan pada lesekese).

Awọn oju iṣẹlẹ ile-iwosan pataki ni ibalokan ọgbẹ ẹgun¶

1. Awọn ipalara Trajectory Thoracoabdominal (Ni isalẹ 4^th Intercostal Space / Laini Ọmu)¶

Ọ̀pọ̀ àwọn olùdáǹdè ni kò mọ̀ pé ibi ìdọ̀tí inú ẹ̀jẹ̀ náà ti ga tó nínú egungun ìhà nígbà tí ènìyàn bá ń mí jáde. Lakoko isunmi deede, dome ọtun ti diaphragm dide ni gbogbo ọna titi de aaye intercostal ** 4^th (ipele ti ọmu) *** ni iwaju, igun 6^th ** ni ẹgbẹ, ati egungun 8^th (isalẹ ti abẹfẹlẹ ejika)** ni ẹhin. * Nitoribẹẹ, ọgbẹ ọgbẹ eyikeyi tabi ibọn ti o wa ni isalẹ laini ori ọmu ni iwaju tabi isalẹ abẹfẹlẹ ejika ni ẹhin ni iṣeeṣe giga ti wọ inu BOTH iho àyà (pleura/pericardium) ATI iho inu (diaphragm, ẹdọ, Ọlọ, ikun, tabi oluṣafihan). * Nigbagbogbo tọju alaisan kan pẹlu ọgbẹ àyà isalẹ ni muna NPO (ko si nkankan nipasẹ ẹnu) ki o ṣayẹwo ikun wọn fun iṣọ, rigidity, tabi tọka irora ejika.

2. Awọn ọgbẹ Ibọn Ikọja Ikọja (Awọn ọta ibọn Nkọja Ile-iṣẹ ti àyà)¶

Nigbakugba ti ọta ibọn ba wọ ẹgbẹ kan ti àyà ti o si jade ni apa idakeji (tabi awọn ibugbe ni apa idakeji ti ọpa ẹhin), itọpa rẹ ti kọja ** mediastinum **, ọdẹdẹ aarin ti n gbe ọkan lọ si ọkan, aorta ti n gòke ati ti o sọkalẹ, awọn iṣọn ẹdọforo, trachea, ati esophagus. * Ju 50 ida ọgọrun ti awọn alaisan ti o ni ọgbẹ ibọn transmediastinal ti o wa ninu ijaya nla lati tamponade ọkan tabi hemothorax nla, lakoko ti awọn alaisan ti o ku ti o han ni iduroṣinṣin igba diẹ nilo CT angiography ni iyara, esophagoscopy, ati bronchoscopy lati ṣe akoso jade ninu aortic tabi awọn perforations esophageal.

3. Awọn ipalara Igi Tracheobronchial ati Emphysema Subcutaneous ti o tobi¶

Nigbati abẹfẹlẹ ti nwọle tabi ọta ibọn ege trachea intrathoracic tabi bronchus akọkọ: * Awọn iwọn nla ti afẹfẹ tú sinu mediastinum (** pneumomediastinum ) ki o si pin ni kiakia labẹ awọ ara ọrun, oju, ati odi àyà ( emphysema subcutaneous nla ), nfa ọrun alaisan ati awọn ipenpeju lati fa soke bi balloon kan pẹlu sisanra "Rice Krispies" ti ẹjẹ pupa ti o wa labẹ Ikọaláìdúró. ( heoptysis*). * Jeki awọn alaisan wọnyi joko ni titọ, lo edidi àyà ti o ti tu si eyikeyi ọgbẹ mimu ita, ki o si ṣọra fun awọn alamọdaju ALS lẹsẹkẹsẹ.

Idanimọ iyara ti ipalara Apoti ọkan ati Beck's triad ṣe idaniloju pe awọn alamọdaju fori awọn ile-iwosan agbegbe ati ere-ije taara si ile-iṣẹ ibalokanjẹ abẹ kan. Gbiyanju lati mu iranlọwọ akọkọ ti ifọwọsi, Duro Ẹjẹ naa, tabi Ẹkọ Atilẹyin Igbesi aye Itọju Ẹjẹ nipasẹ Red Cross ti orilẹ-ede tabi Red Crescent awujọ, Ile-ẹkọ giga ti Amẹrika ti Awọn oniṣẹ abẹ, tabi St John Ambulance.

Awọn ibeere ti a beere nigbagbogbo¶

Awọn orisun ṣayẹwo¶

• ** Ile-ẹkọ giga ti Ilu Amẹrika ti Awọn oniṣẹ abẹ (ACS, United States):** * Atilẹyin Igbesi aye Ilọsi Ilọsiwaju (ATLS) Iwe Afọwọkọ Ikẹkọ ọmọ ile-iwe: Ibanujẹ Ẹjẹ, Ipalara ọkan inu ọkan, Pericardial Tamponade, ati Resuscitative Thoracotomy*.
• Ẹgbẹ Ila-oorun fun Iṣẹ abẹ ti Ibalokanjẹ (EAST) & Ẹgbẹ Ibanujẹ Oorun (WTA, United States): * Awọn Itọsọna Iṣakoso Iwa fun Tilalu Ọgbẹ Tọrọ ati “Apoti ọkan”*.
• ** Igbimo lori Itọju Ijakadi Ijakadi (CoTCCC / Eto Ibanujẹ Ijọpọ, Amẹrika):** * Awọn Itọsọna TCCC: Isakoso ti Ibanujẹ Ọgbẹ Aiya ati Itọkasi pipe si Iṣakojọpọ Ọgbẹ inu-Thoracic *.
• ** Igbimọ Imudaniloju European (ERC) & Igbimọ Imudaniloju UK: *** * Awọn Itọsọna fun Imudani Ẹdun Ẹdun Arun (TCA): Awọn okunfa iyipada (4 Hs ati 4 Ts, Cardiac Tamponade, ati Tension Pneumothorax)*.
• ** Ẹgbẹ ti Orilẹ-ede ti Awọn Onimọ-ẹrọ Iṣoogun pajawiri (NAEMT, Orilẹ Amẹrika):** * Atilẹyin Igbesi aye Ibanujẹ Prehospital (PHTLS): Shock Obstructive, Beck's Triad, ati Pulsus Paradoxus*.

Jẹmọ awọn itọsọna¶

• Mimu ọgbẹ àyà ati iranlọwọ akọkọ ti ẹdọfóró
• Àyà ọ̀fọ̀, ọ̀pọ̀ dida egungun ìhà, ati ibalokanjẹ àyà ṣoki
• Imuduro ati imuduro ohun ajeji ajeji
• Idanimọ mọnamọna ati itọju pajawiri
• Agba CPR ati igbala mimi
• Awọn nọmba pajawiri ati fifiranṣẹ ilu okeere