Kamewar zuciya mai rauni
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| Rabe-rabe da ma'adanai da waje | |
| Onset | Acute onset following trauma to the chest |
| Causes | Blunt or penetrating trauma to the chest |
| Diagnosis | ECG, chest x-ray, bedside echocardiogram |
| Similar conditions | Hemorrhagic shock, tension pneumothorax, hemothorax, cardiac tamponade, hypoxia |
| Treatment | Thoracotomy, thoracostomy, fluid resuscitation, decompression, pericardiocentesis |
| Outcome | Poor |
Kamewar zuciya mai rauni ( TCA ) wani yanayi ne wanda zuciya ta daina bugawa saboda baƙar magana ko shiga cikin rauni, kamar rauni mai rauni a yankin thoracic. Yana da kyau yanada likita wanda zai kawo agaji cikin gaggawa wanda koyaushe zai iya mutuwa inba tare da gaggawar kulawar likita ba. Ko da Likita yayi gaggawar shiga tsakani, rayuwa ba tare da likita ba yana da wuya.[1] A cikin 'yan shekarun nan, an ba da shawarar ka'idoji don inganta yawan rayuwa a cikin marasa lafiya da ke fama da ciwon zuciya, kodayake sauye-sauyen abubuwan da ke haifar da wannan yanayin da kuma yawancin raunin da ke tattare da su na iya sa waɗannan ka'idoji suna da wuyar daidaitawa. Kamewar zuciya mai raɗaɗi wani nau'i ne mai rikitarwa na kamun zuciya sau da yawa yana kawar da goyon bayan rayuwa na zuciya na ci gaba a ma'anar cewa dole ne tawagar gaggawa ta fara kafa dalilin kamawar rauni kuma su juya waɗannan illolin, misali hypovolemia da haemorrhagic shock saboda rauni mai shiga.[2]
Makanikai[gyara sashe | gyara masomin]
Kamewar zuciya mai rauni na iya faruwa a cikin marasa lafiya bayan wani mummunan rauni ko rauni a ƙirji. Bayan faruwar lamarin, zuciya zata daina harba jini a jiki. Ba kamar kamun zuciya na likita ba, akwai wasu dalilai masu yuwuwa waɗanda zasu iya haifar da kamewar zuciya a cikin yanayin rauni. Ma'aikatan asibiti za su yi la'akari da sauri don waɗannan dalilai, kuma za a ba da gudummawa da takamaiman dalili.
Yawan Zubar Jini[gyara sashe | gyara masomin]
A cikin ɓoyayyen rauni da mai shiga ciki, zubar jini mai yawa na ciki ko na waje na iya rage yawan jinin da ake samu bugun zuciya zuwa jiki. Ana ɗaukar wannan kame wanda aka dogara da saɓo.[3]
Tashin Hankalin Pneumothorax[gyara sashe | gyara masomin]
Tension pneumothorax yana faruwa lokacin da iska ke iya shiga sararin samaniya tsakanin huhu da bangon ƙirji, amma ba zai iya tserewa ba. Matsakaicin karuwa a cikin rami na kirji yana hana jini daga dawowa daga jiki don shiga zuciya.
Hemothorax[gyara sashe | gyara masomin]
Hemothorax yana faruwa ne a lokacin rauni ga kirji ya haifar da jini a cikin rami na thoracic. Kama ga tashin hankalin pneumothorax, kara matsa lamba hana dawowar daga zagayawa zuwa zuciya.
Tamponade na Zuciya[gyara sashe | gyara masomin]
A cikin yanayin rauni, tamponade na zuciya yana haifar da mummunan zubar jini na pericardial, tarin jini a cikin jakar da ke kewaye da zuciya. Yayin da wannan jakar ta cika da ruwa, sai karfin zuciya ya karu, kuma sassan zuciya ba su iya cika da jini.
Hypoxia[gyara sashe | gyara masomin]
Rashin iya kula da iskar oxygen a cikin marasa lafiya masu rauni na iya zama sakamakon rashin daidaituwar hanyar iska saboda rauni na kirji ko toshewa ko kuma saboda asarar motsin numfashi daga kashin mahaifa ko raunin jijiya na gefe. Wadannan yanayi suna haifar da hypoxia wanda zai iya haifar da kamewar zuciya.
Alamomi da Yanayi[gyara sashe | gyara masomin]
Marasa lafiya za su nuna ƙarancin hawan jini tare da bugun jini waɗanda ba za a iya palpated ba. Marasa lafiya za su ci gaba zuwa asystole idan ba a juya yanayin da ke ciki ba.
Sauran alamun da ba takamaiman alamu ba da ke da alaƙa da kamawar zuciya mai rauni na iya haɗawa da gumi, canza yanayin tunani, saurin numfashi ko jinkirin numfashi, da alamun rauni (ƙwaƙwalwa, laceration , karaya, da sauransu).
Bincike[gyara sashe | gyara masomin]
An fara gano cutar kamun zuciya mai rauni tare da electrocardiogram tare da EMS ko a cikin sashin gaggawa. Likitoci kuma za su yi odar gwajin gano cutar da zai iya haɗawa da x-ray na ƙirji, duban dan tayi na gefen gado da echocardiogram , da matakan iskar gas na jini.
Za a ba da umarnin nau'i da giciye don dacewa da majiyyaci don samun ƙarin jini idan ya cancanta.
Sauran aikin da aka yi amfani da shi a cikin ganewar asali na mai rauni na iya haɗawa da e-FAST , jarrabawar RUSH, CBC , X-ray na pelvic, da CT na kai, wuyansa, kirji, ciki, da ƙashin ƙugu.
Magani[gyara sashe | gyara masomin]
Maganin kama ciwon zuciya mai rauni yana jagorancin jagororin tallafi na rayuwa masu rauni. Daidaitaccen jagororin tallafin rayuwa na ci gaba na zuciya bai dace ba don amfani da su a cikin kamawar zuciya mai rauni, saboda ana jagorantar su da farko wajen magance cututtukan cututtukan da suka samo asali a cikin zuciyar kanta.[4] Yayin da likitocin suka fara shiga tsakani, za su nemi musabbabin kamawa a lokaci guda. Gudanarwa yana farawa ta hanyar kafa maki da yawa na samun damar IV da kimanta hanyar iska da numfashin mara lafiya. Sauran ayyukan na iya haɗawa da thoracostomy da thoracotomy, da kuma maganin dalilin kamawa.
Taimakon Rayuwa na asali[gyara sashe | gyara masomin]
Masu kallo da masu amsawa na farko ne ke farawa na asali na tallafi, amma ba a san rawar da tallafin rayuwa take takawa a cikin kamewar zuciya mai rauni. Taimakon rayuwa na asali an yi niyya ne don kula da iskar oxygen wanda ke zagayawa a cikin jiki, wanda zai iya zama ceton rai a ga Likita a lokutan kame zuciya, amma baya magance yawan adadin yawan asarar jini akai-akai a lokuta da yawa na kamewar bugun zuciya.
Motsawar Kirji[gyara sashe | gyara masomin]
Ana ɗaukar matsawar ƙirji a matsayin mafi mahimmancin shiga tsakani na farko a lokutan da aka kamu da bugun zuciya, duk da haka binciken da ke kimanta ingancinsu ya keɓe marasa lafiya da ke fama da ciwon zuciya. Ƙirjin yana aiki don maye gurbin aikin zuciya na zubar da jini a ko'ina cikin jiki, duk da haka lokuta inda zuciya ba ta iya cika da jini ko jimlar adadin jinin ya ƙare, wannan saƙon na iya zama mara amfani. Bugu da ƙari, yayin da yawancin ayyukan da aka yi niyya akan takamaiman dalilan kama suna dogara ne akan hanyoyin da aka yi a kusa da ƙirjin, kai, da wuyan majiyyaci, matsawa na iya tsoma baki tare da ingantaccen gudanarwa.[5]
Gudanar da abubuwan da zasu iya juyawa[gyara sashe | gyara masomin]
Hanyar Gaba[gyara sashe | gyara masomin]
Sharuɗɗan na yanzu waɗanda aka keɓance don magance takamaiman abubuwan da ke haifar da kamun zuciya mai rauni sun inganta sakamako ga marasa lafiya, duk da haka waɗannan jagororin na iya zama da wahala a yi amfani da su ta daidaitacciyar hanya saboda bambance-bambance a cikin kulawar asibiti da kuma nau'ikan abubuwan da ke haifar da kama bugun zuciya idan aka kwatanta dasu ciwon zuciya na likita. Algorithms masu haɓakawa ana ba da umarnin gano abubuwan da suka faru na kama zuciya tare da wani tushe mai rauni da kuma shiga tsakani cikin sauri don magance abubuwan da za su iya juyawa.[6]
Manazarta[gyara sashe | gyara masomin]
- ↑ Hunt PA, Greaves I, Owens WA (January 2006). "Emergency thoracotomy in thoracic trauma-a review". Injury. 37 (1): 1–19. doi:10.1016/j.injury.2005.02.014. PMID 16410079.
- ↑ Gräsner JT, Wnent J, Seewald S, et al. (2011). "Cardiopulmonary resuscitation traumatic cardiac arrest--there are survivors. An analysis of two national emergency registries". Critical Care. 15 (6): R276. doi:10.1186/cc10558. PMC 3388703. PMID 22108048.
- ↑ "Traumatic Cardiac Arrest". emDOCs.net - Emergency Medicine Education (in Turanci). 2015-12-10. Retrieved 2021-11-17.
- ↑ Smith, Jason E; Rickard, Annette; Wise, David (January 2015). "Traumatic cardiac arrest". Journal of the Royal Society of Medicine (in Turanci). 108 (1): 11–16. doi:10.1177/0141076814560837. ISSN 0141-0768. PMC 4291327. PMID 25572990.
- ↑ Zwingmann, Jörn; Mehlhorn, Alexander T; Hammer, Thorsten; Bayer, Jörg; Südkamp, Norbert P; Strohm, Peter C (2012). "Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review". Critical Care (in Turanci). 16 (4): R117. doi:10.1186/cc11410. ISSN 1364-8535. PMC 3580693. PMID 22770439.
- ↑ Lockey, David J.; Lyon, Richard M.; Davies, Gareth E. (June 2013). "Development of a simple algorithm to guide the effective management of traumatic cardiac arrest". Resuscitation (in Turanci). 84 (6): 738–742. doi:10.1016/j.resuscitation.2012.12.003. PMID 23228555.