Nyob hauv tsab xov xwm, peb yuav txiav txim siab seb kev kho mob xwm txheej ceev hauv kev kho hniav txhais li cas. Tsis yog txhua tus paub tias lub tswvyim no txhais li cas.
Txhua tus kws kho hniav yuav tsum tau nrog tus neeg mob xwm txheej ceev hauv lawv qhov kev xyaum. Cov xwm txheej zoo li no suav nrog kev qaug zog nrog rau kev poob siab anaphylactic, mob hawb pob, qaug dab peg, thiab lwm yam, mus txog rau lub plawv nres. Hauv cov xwm txheej zoo li no, qhov tseem ceeb yog ua txhua yam kom raug thiab sai sai.
Tseem pom zoo yog qhov kev txiav txim ntawm kev saib xyuas xwm txheej ceev hauv kev kho hniav No. 1496n hnub tim 07.12.2011 "Rau kev pom zoo ntawm Txoj Cai rau kev muab kev kho mob rau cov neeg laus thaum muaj kab mob hniav."
Dental first aidkit
Muab qhov xwm txheej ceev uas tuaj yeem tshwm sim hauv kev kho hniav, cov kws kho mob siv cov khoom siv hauv qab no los pab cov neeg mob: tshuaj tiv thaiv kab mob nrog rau cov pa oxygen rau kev ua pa, "Nitroglycerin" hauv daim ntawv ntawm sublingual.tshuaj thiab tshuaj tsuag, tshuaj tua kab mob hawb pob, khoom noj qab zib, Aspirin thiab Benadryl.
Lub luag haujlwm rau kev tshuaj xyuas tsis tu ncua (ib lub lis piam) ntawm cov txheej txheem saum toj no yuav tsum raug xaiv. Nws yog qhov kev ntxhov siab heev uas nrhiav tau lub tog raj kheej tsis ua haujlwm ntawm lub sijhawm thaum tus neeg mob xav tau tiag tiag.
Kev kho mob xwm txheej ceev hauv kev kho hniav raws li SanPiNu
Kev nrawm ntawm cov tshuaj tiv thaiv yog tus yuam sij rau kev ua tiav kev pab cuam ntawm txhua tus neeg mob. Txhawm rau ua txhua yam kom sai li sai tau, koj yuav tsum faib lub luag haujlwm. Txhua tus neeg ua haujlwm ua haujlwm hauv chaw kho hniav yuav tsum paub yuav ua li cas thaum tus neeg mob xav tau kev saib xyuas xwm txheej ceev.
Cov lus qhia tsim nyog rau kev txiav txim thaum muaj xwm txheej ceev hauv kev kho hniav yog tsim ua ntej thiab coj los rau txhua tus neeg ua haujlwm. Cov uas muaj kev kawm kho mob tau koom nrog kev pab thawj zaug. Raws li cov thawj coj ntawm cov chaw kho hniav, lawv hu lub tsheb thauj neeg mob, hu rau tus neeg mob tus kws kho mob, thiab, yog tias tsim nyog, nrog nws cov txheeb ze.
Txoj kev npaj yuav tsum tau ua nyob rau hauv tag nrho cov lus qhia, uas yog, nws tsis tuaj yeem tso siab rau ib qho haujlwm tshwj xeeb rau ib tus neeg nkaus xwb, vim nws tsuas tuaj yeem tsis tuaj ntawm nws qhov chaw ua haujlwm thaum lub sijhawm tseem ceeb tshaj plaws. Qhov tseem ceeb tshaj plaws yog ua txhua yam kom tsis muaj leej twg cuam tshuam nrog leej twg thiab ua qhov yuav tsum tau ua, ua rau lawv tus kheej muaj txiaj ntsig los kho thiab daws qhov teeb meem. Tsis tas li ntawd, nws tsis yog superfluous los cob qhia tag nrho cov neeg ua haujlwm ntawm kev kho hniavtsev kho mob cov hauv paus ntsiab lus ntawm kev saib xyuas xwm txheej ceev.
Nws tseem yuav tsum tau xaiv ib tus neeg saib xyuas kom tsis tu ncua ntawm cov khoom siv kho mob uas tau hais dhau los.
Lub algorithm rau kev saib xyuas xwm txheej ceev hauv kev kho hniav yuav raug tham ntxiv hauv qab no.
mob hnyav hauv cov neeg mob - lawv yog dab tsi?
Cov neeg xav tau kev kho hniav xwm txheej:
- Cov uas tshwm sim los ntawm kev ntxhov siab lossis kev ntxhov siab.
- Cov xwm txheej uas cuam tshuam nrog kev siv tshuaj loog, thiab ntxiv rau, nrog kev nyuaj hauv kev ua haujlwm ntawm lub plawv, ua pa lossis vascular system.
Kev tshuaj loog hais txog xwm txheej ceev yog ib qho kev cuam tshuam ntawm kev ua pa. Tus neeg mob tej zaum yuav muaj laryngospasm, hyperventilation, los yog bronchial spasm. Bronchospasm, raws li kws kho hniav, yog qhov nyuaj tshaj plaws ntawm kev saib xyuas xwm txheej ceev. Qhov ua rau ntawm tus mob no yog kev tsis haum tshuaj lossis rhiab rau qee yam khoom, piv txwv li, sulfites thiab lwm yam. Hyperventilation nyob rau hauv cov neeg mob tuaj yeem tshwm sim los ntawm kev ntxhov siab thiab feem ntau pom ntawm cov neeg uas ntshai heev.
Kev kho hniav xwm txheej yog dab tsi?
Yuav kom tswj tau sai sai rau cov xwm txheej zoo li no, nws yog ib qho tsim nyog yuav tsum muaj ntawm tes txhua yam uas yuav tsum tau ua kom sai sai ntawm qhov tshwm sim tsis zoo. Piv txwv li, kom tsis txhob muaj kev cuam tshuam ntawm cov hlab ntsws thaum muaj teeb meem hauv kev ua haujlwm ntawm lub ntsws,koj yuav tsum tau siv daim txhuam cev tshwj xeeb sai sai. Rau cov neeg mob uas muaj kev ntxhov siab provokes hyperventilation, kev siv lub tshuab pa oxygen yuav tsum tau muab tam sim ntawd. Tom ntej no, xav txog yuav ua li cas cov neeg mob tuaj yeem ntsib kev poob siab anaphylactic hauv chaw kho hniav thiab yuav ua li cas tus mob no tuaj yeem ua tau zoo.
Kev saib xyuas xwm txheej ceev yog dab tsi rau anaphylactic shock hauv kev kho hniav?
Anaphylactic shock: nws tshwm sim li cas thiab vim li cas thiaj txaus ntshai?
Tus mob no yog ib qho kev tsis haum tshuaj loj heev uas tshwm sim hauv daim ntawv mob plawv thiab vascular insufficiency thiab adrenal insufficiency. Raws li ib feem ntawm cov kev kho mob tshwm sim ntawm anaphylactic shock, cov neeg mob muaj ib tug lub xeev ntawm tsis xis nyob nrog ib tug indefinite cov tsos mob. Ua ntej tshaj plaws, muaj kev ntshai ntawm kev tuag nrog rau lub xeev ntawm kev tsis sib haum xeeb.
Ntaus, qee zaum ntuav thiab hnoos kuj tshwm sim. Cov neeg mob tuaj yeem yws txog qhov tsis muaj zog txaus nrog rau qhov hnov tsw thiab khaus khaus. Tsis tas li ntawd, thaum muaj xwm txheej tshwm sim, feem ntau muaj kev xav ntawm cov ntshav mus rau lub ntsej muag, ua ke nrog kev xav hnyav tom qab lub sternum lossis compression ntawm lub hauv siab. Feem ntau muaj mob hauv cheeb tsam ntawm lub plawv, nrog rau kev ua pa nyuaj lossis tsis muaj peev xwm ua tsis taus pa, kiv taub hau lossis mob taub hau ntawm kev siv zog tsis tuaj yeem txiav tawm. Cov tsos mob ntawm kev tsis nco qab tuaj yeem cuam tshuam kev hais lus nrog tus neeg mob. Kev tsis txaus siab yuav tshwm sim tam sim tom qab noj tshuaj.
YHyperemia, pallor, cyanosis
Raws li cov tsos mob ntxiv hauv kev poob siab anaphylactic, hyperemia ntawm daim tawv nqaij tshwm sim nrog pallor thiab cyanosis, ntau yam exanthemas, o ntawm daim tawv muag lossis lub ntsej muag thiab tawm hws ntau. Nyob rau hauv feem ntau cov neeg mob, cramps ntawm caj npab yog feem ntau sau tseg nyob rau hauv ua ke nrog nrog rau ncua convulsive qaug dab peg, lub cev muaj zog nyob tsis tswm, involuntary excretion ntawm cov zis, gases thiab quav. Cov menyuam kawm ntawv yuav dilate thiab tsis teb rau lub teeb. Nyob rau tib lub sijhawm, cov mem tes yog nquag, thready, tachycardia thiab arrhythmia tau sau tseg.
Kev saib xyuas xwm txheej kub ntxhov rau anaphylactic poob siab hauv kev kho hniav yuav tsum tau muab kev txawj ntse. Tus neeg mob lub neej nyob ntawm nws.
Tib neeg ntshav siab poob sai. Hauv cov xwm txheej hnyav, lub siab diastolic nyuaj rau txiav txim siab. Tom qab ntawd, muaj ib daim duab kho mob ntawm pulmonary edema. Ib hom kev poob siab anaphylactic yog qhov ua txhaum ntawm cov ntshav ncig, kev nco qab thiab ua pa ua haujlwm.
Algorithm rau kev saib xyuas xwm txheej ceev rau kev poob siab anaphylactic hauv kev kho hniav
Cov ntsiab cai ntawm kev tshem tawm ntawm anaphylactic shock yog raws li hauv qab no:
- Cov kws kho mob nrhiav kev kho mob ntawm cov hlab plawv thiab ua pa tsis ua haujlwm.
- Txoj kev them nyiaj rau tus neeg mob lub adrenococoid insufficiency.
- Inhibition thiab neutralization ntawm biologically active Cheebtsam nyob rau hauv cov ntshav.
- Kev txwv tsis pub nkag ntawm cov tshuaj tsis haum rau hauv cov hlab ntsha.
- Kev txhawb nqa lub luag haujlwm tseem ceeb ntawm tus neeg mob lub cev lossis rov ua haujlwm thaum muaj xwm txheej hnyavmob lossis kev hem thawj ntawm kev kho mob tuag.
Tam sim no xav txog yuav ua li cas los ntawm kws kho mob thaum muaj kev kho hniav xwm txheej ceev:
- Tsi txhob txhaj tshuaj uas ua rau mob hnyav.
- Tus neeg mob muab tso rau hauv txoj kab rov tav nrog ob txhais ceg tsa.
- Yog tias muaj ib qho mob me me ntawm kev poob siab anaphylactic, ces nws muaj peev xwm tswj tau adrenaline (0.1%) intramuscularly, nrog rau cov hlab ntsha. 0.5-1 ml ntawm cov tshuaj nquag yog diluted hauv 5 ml ntawm saline. Qhov chaw txhaj tshuaj ntawm qhov tsis haum yog txiav tawm nrog 0.1% kev daws ntawm adrenaline, uas yog diluted hauv 5-10 ml ntawm saline. Yog tias ntshav siab tseem poob qis, txhaj tshuaj epinephrine 0.5-1 ml tso rau hauv txhua peb mus rau tsib feeb kom txog thaum ntshav siab stabilizes.
- "Dexamethasone" 20-24 mg intravenously lossis intramuscularly, lossis "Prednisolone" 150-300 mg (3-5 mg / kg ntawm lub cev hnyav).
- "Dimedrol" 1% raws li cov koob tshuaj: cov neeg laus - 1.0 mg / kg, menyuam yaus - 0.5 mg / kg ntawm lub cev hnyav, "Suprastin" lossis "Tavegil" 2 mg / kg ntawm lub cev hnyav, yog tias tsis muaj cov tshuaj no., ces koj tuaj yeem siv "Pipolfen" 2.5%, 1-2 ml intravenously lossis intramuscularly.
- Yog tias anaphylaxis tshwm sim raws li hom asphyxial thiab bronchial, ces eufillin 2, 4% 10 ml yog muab tso rau hauv txoj hlab ntshav.
Kev saib xyuas xwm txheej kub ntxhov kuj muaj nyob rau hauv kev kho hniav rau menyuam yaus.
Yog vim li cas rau kev kho hniav xwm txheej ceev rau menyuam yaus
Qhov khoom ntawm kev kho hniav menyuam yaus yogtshwj xeeb yog cov menyuam yaus hnub nyoog qis dua kaum tsib xyoos. Lub sijhawm no yog ncaj qha ntsig txog cov yam ntxwv ntawm kev tsim lub cev ntawm cov hniav, puab tsaig, qhov ncauj mucosa, periodontal, thiab ntxiv rau, nrog rau kev tiv thaiv kab mob. Qhov sib txawv ntawm cov menyuam yaus lub siab nyiam, ua ke nrog lawv qhov tsis muaj zog tiv thaiv qhov mob, coj nws tus yam ntxwv rau qhov tshwj xeeb ntawm kev saib xyuas xwm txheej ceev. Cov txheej txheem pathological uas nyob rau hauv cov menyuam yaus yog vim li cas rau kev kho mob xwm txheej ceev hauv kev kho hniav tau muab faib ua peb pawg:
- Taumatic raug mob: pob txha ntawm lub puab tsaig, raug mob rau daim di ncauj, lub puab tsaig thiab lwm yam kev raug mob ntawm cov hniav.
- Tau txais cov kab mob carious hauv daim ntawv ntawm pulpitis lossis periodontitis.
- Qhov tshwm sim ntawm cov txheej txheem mob hauv qhov ncauj mucosa nyob rau hauv daim ntawv ntawm o ntawm cov pos hniav tiv thaiv keeb kwm yav dhau los ntawm kev tawg ntawm ib ntus incisors, aphthous herpetic stomatitis lossis ulcerative gingivitis.
Kev kho hniav kub ceev rau menyuam yaus
Nyob rau hauv lub xub ntiag ntawm ib qho kev raug mob rau cov hniav, nws yog ib qhov tsim nyog los qhia meej txog cov xwm txheej ntawm cov pob txha paradental thiab cov cuam tshuam incisor los ntawm X-ray txoj kev. Tom qab ntawd, koj yuav tsum txiav txim siab txog kev khaws cia lossis tshem tawm cov hniav. Cov hniav uas tau tawg cov hauv paus hniav raug tshem tawm, vim tsis muaj txoj hauv kev rau lawv cov kev kho kom rov zoo rau hnub tim. Kev tshem tawm, tshwj xeeb tshaj yog nyob rau hauv cov menyuam yaus, yuav tsum tau ncua mus txog rau thaum cov txheej txheem kev puas tsuaj loj zuj zus, tshwj tsis yog rau cov xwm txheej uas lawv cov seem cuam tshuam nrog cov txheej txheem ntawm kev kho lub puab tsaig pob txha.
Txoj kab uas hla tas mus li nrog cov yas tawg tau tso rau cov menyuam yaus lawm. Yog hais tias lub pulp tsis tau raug cuam tshuam, ces koj yuav tsum tau tos tag nrhoob peb lub lis piam rau qhov kev txiav txim tom ntej ntawm nws txoj kev vam meej. Nyob rau hauv cov xwm txheej uas nws puas lawm, tus kws kho hniav txiav txim seb puas yuav kho cov hniav nrog rau tom ntej preservation ntawm cov ntaub so ntswg nyob los yog tseem devitalize nws.
Koj yuav tsum paub tias cov tawv nqaij ntawm cov incisors tas mus li thaum yau muaj peev xwm kho tau zoo. Thaum tus kws kho hniav txiav txim siab tso nws tseg, kev kho mob pib tam sim ntawd. Nws yog qhov zoo tshaj plaws thaum qhov no ua tiav hauv ib qho kev sib tham nrog kev kaw ntawm qhov chaw puas nrog Calxil los yog muab tshuaj txhuam npaj los ntawm kev daws ntawm novocaine thiab calcium oxide. Lub paste yuav tsum tau npog lub pulp nrog ib txheej nyias. Tsis tas li ntawd, tsis muaj nias, phosphate cement yog siv thiab qhov tawg ntawm qhov incisor crown yog rov qab los. Txoj kev no muab cov nyhuv zoo nkauj zoo nkauj nrog rau kev kho kom ruaj khov ntawm cov hniav yas.
Yog tias tus kws kho hniav tsis muaj cov kev xaiv rov zoo li qub nyob rau hauv ib teev tom ntej, kev pab thawj zaug hauv kev kho hniav tuaj yeem muab los ntawm cov ntaub qhwv ib ntus nrog sulfidine hmoov, cov tshuaj lom neeg uas tau hais los saum no, lossis, hauv qhov xwm txheej hnyav, paj rwb. swab, uas yuav tsum xub muab tso rau hauv chlorophenol camphor. Nws yuav zoo dua los npog cov ntaub ntawv no nrog phosphate cement, uas, nyob rau hauv lem, yuav tsum tau ntes cov phab ntsa noj qab haus huv ntawm incisor crown.
Thaum lub kaus hniav ntawm tus hniav ib ntus yog tawg thiab xav txog qhov kev txiav txim siab txog kev rho tawm lossis tshem tawm, tus kws kho hniav yuav tsum xav txoglub physiological tus nqi ntawm incisors nrog rau kev muaj peev xwm ntawm lawv cov kev kho mob mus sij hawm ntev thiab qhov xwm ntawm qhov raug mob. Nrog cov hniav dislocation tom qab raug mob, nws yuav tsum tau immobilized. Yog hais tias tus hniav me ntsis dislocated, thiab tsis muaj pov thawj ntawm lub xub ntiag ntawm pob txha alveolar puas ncaj qha rau ntawm lub xov tooj cua, tus neeg mob tau qhia kom tsis txhob muaj kev ntxhov siab ntawm cov hniav uas muaj kab mob.
Kev pab thawj zaug hauv kev kho hniav rau cov mob comatose
Cov xeev Coma tau muab cais ua ib pab pawg, txij li lawv qhov tshwm sim tau pom feem ntau hauv cov neeg mob uas muaj qee yam kab mob sib kis, uas lawv ib txwm yuav tsum ceeb toom lawv tus kws kho hniav txog. Coma yog lub xeev ntawm ntse inhibition ntawm lub paj hlwb, uas yog nrog los ntawm kev tsis nco qab thiab tsis ua hauj lwm ntawm tag nrho cov analyzers. Rau tus kws kho mob yuav tsum paub qhov txawv ntawm stupor, thaum ib tug neeg lub ntsiab nyob rau hauv lub siab yog khaws cia thiab cov tshuaj tiv thaiv rau lub teeb muaj zog thiab suab stimuli raug sau tseg.
Kev kho hniav xwm txheej ceev yog dab tsi?
Cov ntaub ntawv tseem ceeb rau kev ntsuam xyuas coma feem ntau yog cov tsos mob ntawm tus neeg mob ua ib feem ntawm kev kuaj xyuas thiab kev txiav txim siab ntawm nws tus mob. Lub xub ntiag ntawm cyanosis thiab cov qauv ntawm cov kab mob venous ntawm lub plab qhia tau hais tias cirrhosis ntawm daim siab, uas yog, kev loj hlob ntawm hepatic coma. Cov tawv nqaij qhuav kub hauv tib neeg tshwm sim nrog sepsis, thiab ntxiv rau, tawm tsam keeb kwm ntawm kev kis mob hnyav thiab lub cev qhuav dej. Convulsions nyob rau hauv ua ke nrog txhav caj dab paub meej tias coma vim nce intracranial siab vim raug mob, thrombosis,qog nqaij hlav thiab lwm yam.
Kev ntsuas cov pa tsw qab yog qhov tseem ceeb heev hauv kev kuaj mob tus mob no. Piv txwv li, hauv ntshav qab zib acidosis, feem ntau tsis hnov tsw ntawm acetone los ntawm lub qhov ncauj. Cov tsos mob ntawm tus ntxhiab tsw qhia tias muaj lub siab tsis nco qab nyob rau hauv tus neeg mob, thiab cov ntxhiab tsw ntawm cov zis qhia txog lub raum pathology. Nyob rau hauv cov ntaub ntawv ntawm cawv intoxication, qhov tsis hnov tsw yuav raug. Thaum lub coma ntawm qhov tsis paub etiology tshwm sim, nws yuav tsum tau tshuaj xyuas cov ntsiab lus qab zib.
Kev kho mob xwm txheej kub ntxhov hauv kev kho hniav thaum muaj tus mob coma muaj nyob rau hauv qhov yuav tsum tau hu xov tooj sai ntawm pab pawg resuscitation. Nws yog ib qho tsim nyog yuav tau pib nrog oxygenation thiab kev siv cov kev pab cuam ntawm kev ua haujlwm tsis zoo (nws yuav tsum ua kom ua pa, ntshav ncig thiab lub plawv ua haujlwm). Hauv particular, nyob rau hauv lub xub ntiag ntawm ib tug hypoglycemic coma, nws yuav tsum tam sim ntawd txhaj tus neeg mob intravenously nrog 60 milliliters ntawm ib plaub caug feem pua qabzib tov, txij li thaum tus mob no tshwm sim yuav luag tam sim ntawd nyob rau hauv sib piv nrog rau lwm yam tshwm sim thiab yog txaus ntshai nyob rau hauv nws cov txim. Lub tswv yim ntawm kev kho mob nyob rau hauv lub xub ntiag ntawm coma yog zoo ib yam li cov hauv paus ntsiab lus ntawm ABC resuscitation.
Zoo kawg
Yog li, ua ib feem ntawm kev kho mob, txhua tus kws kho mob yuav tsum tau npaj rau qhov tseeb tias nws tus neeg mob yuav ntsib kev kub ntxhov hauv kev kho hniav thiab nws yuav xav tau kev pab thawj zaug. Tam sim ntawd ua ntej pib kev phais lossis kev kho kom zoo, tus neeg mob yuav tsum ceeb toom rau nws tus kws kho hniav tiasNws muaj mob lossis mob ntev npaum li cas, ua xua rau qee yam tshuaj, thiab lwm yam.
Ntxiv rau, cov neeg mob yuav tsum qhia rau kws kho hniav txog kev noj tshuaj tam sim no thiab lawv qhov ntau npaum li cas. Yog tias tus neeg mob muaj kev pheej hmoo, nws txoj kev kho mob yuav tsum tau ua raws li kev saib xyuas nruj thiab ceev faj kom tsis txhob muaj teeb meem loj. Kev kho mob tsis tu ncua feem ntau ua rau muaj qhov tshwm sim loj heev nyob rau hauv daim ntawv ntawm kev puas tsuaj pathological hauv lub cev.
Peb them cov xwm txheej kho hniav thiab kev pab thawj zaug.
