Kulawa ta gaggawa don cutar sikila

Hyma na hyperglycemic coma wani rikitarwa ne na "mummunan rashin lafiya" na mawuyacin yanayi, tare da yawan adadin sukari na jini gaba ɗaya na cikakkiyar cuta (tare da cutar cuta ta 1) ko dangi (nau'in 2) karancin insulin. Ana la'akari da yanayin mai mahimmanci kuma yana buƙatar asibiti da gaggawa da kuma sa hannun kwararru. Algorithm na kulawa ta gaggawa don rikicewar hyperglycemic coma ya kamata ya zama sananne ga duk wanda ke da ciwon sukari ko kuma yana da masaniyar rashin lafiya, dangi.

Bambancin Coma

Tunda akwai nau'ikan nau'ikan cututtukan shaye-shaye guda uku, taimakon da aka bayar a matakin likita ya bambanta da kowannensu:

• cocin ketoacidotic;
• ƙwayar cuta na hyperosmolar;
• lactic acidosis.

Ketoacidosis yana da alaƙa da samuwar sassan jikin ketone (acetone) kuma yana haɓakawa daga tushen ƙwayar sukari mai dogaro da mellitus. Hankalin hyperosmolar yana faruwa tare da cutar ta 2, jikin ketone ba ya nan, amma marasa lafiya suna fama da matsanancin sukari da kuma tsananin ƙonewa.

Lactic acidosis yana da halin matsakaici a hankali idan aka kwatanta shi da abubuwa biyu na farko, yana tasowa a cikin cututtukan da basu da insulin-insulin kuma ana nuna shi ta tara yawan acid ɗin lactic acid a cikin jini.

Asibitin

Bayyanar cututtuka na ketoacidosis da coperosmolar coma iri daya ne. Hoto na asibiti yana girma a hankali. Jin ƙishirwa, yawan fitar fitsari, yawan tashin zuciya da amai, raɗaɗin bayyana.

Bugu da kari, a gida, zaku iya fayyace matakin sukari (tare da hyperosmolar coma zai iya isa 40 mmol / L da mafi girma, tare da ketoacidosis - 15-20 mmol / L) kuma ƙayyade kasancewar jikin acetone a cikin fitsari ta amfani da gwajin kwalliyar gwaji.

Ayyade matakin acetone a cikin fitsari yana ɗayan sharuɗɗan don bambance nau'in ƙwayar hyperglycemic

Jin ƙishirwa da polyuria ba halayen lactic acidosis bane; babu jikin ketone a cikin fitsari. A gida, kusan ba zai yiwu ba a gano cutar.

Taimako na farko

Don kowane nau'in cutar sihiri ta mahaifa, yakamata a kira kwararru na motar asibiti nan da nan kuma ya kamata a aiwatar da jerin matakai kafin shigowar su. Taimako na farko kamar haka:

Hypoglycemia a cikin ciwon sukari

• Sanya mai haƙuri a cikin kwance a kwance.
• Bayar da iska mai kyau, buɗe ko cire sutura. Idan ya cancanta, cire taye, bel.
• Sanya kai na mara lafiya a gefe don kada a sami wani abin da ya faru na amayar da mutum to bai sha kan amayar.
• Saka idanu wurin da harshe. Yana da mahimmanci cewa babu koma baya.
• Bayyana ko mai haƙuri yana kan maganin insulin. Idan amsar ita ce ee, ƙirƙiri yanayin da ake buƙata don ya yi allura da kansa ko taimaka masa ya sarrafa jijiyoyin cikin sigar da ake buƙata.
• Saka idanu karfin jini da karfin zuciya. Idan za ta yiwu, yi rikodin alamun domin sanar da kwararrun motar asibiti game da su.
• Idan mara lafiyar yana "matsoraci", yi masa ɗumi ta hanyar rufewa da bargo ko samar da abin ɗamara mai dumin dumama.
• Sha ya isa.
• Game da kamawar zuciya ko kamawa na numfashi, sake tayar da jiki ya zama dole.

Siffofin sake maidowa

Dole ne a fara tayar da hankali a cikin manya da yara, ba tare da jiran isowar kwararrun motar asibiti ba, tare da farawar alamu: karancin bugun jini a cikin jijiyoyin carotid, rashin numfashi, fatar ta zama launin toka-kuli, ɗaliban sun yi haske kuma ba sa amsa ga haske.

1. Sanya mai haƙuri a ƙasa ko wata wahala, har ma da farfajiya.
2. Hawaye ko yanke sutura don samar da isowa ga kirji.
3. Ja da baya na mai haƙuri har zuwa dama, ka sanya hannun a goshin, kuma ka sanya bebeyen mara lafiya gaba da sauran. Wannan dabara tana ba da izinin jirgin sama.
4. Tabbatar cewa babu wasu sassan jikin baƙi a cikin bakin da makogwaro, idan ya cancanta, cire gamsai tare da motsi mai sauri.

Yarda da ka'idodi na sake rayuwa mataki ne don cimma nasarar sa

Motsa zuwa bakin numfashi. An sanya adiko na goge goge, ko zaren ledo ko kayan leƙo a leɓen mai haƙuri. Ana ɗaukar numfashi mai zurfi, an matsa lebe a bakin mai haƙuri. Sannan ana yin kuzari mai karfi (na tsawon sakanni 2-3), yayin rufe hanci ga mutum. Za'a iya ganin tasirin iska mai kazanta ta hanyar ɗaga kirji. Mitar numfashi sau 16-18 ne a minti daya.

Madaidaiciyar zuciya mai tausa. An sanya hannayen biyu a ƙananan baya na sternum (kusan a tsakiyar kirji), suna zama a gefen hagu na mutum. Ana yin rawar jiki mai ƙarfi zuwa ga kashin kashin, yana juyawa saman kirji ta hanyar 3-5 cm a cikin manya, 1.5-2 cm a cikin yara. Matsakaicin akafi zuwa sau 50-60 a minti daya.

Tare da haɗarin numfashi-baki-baki da kuma tausayawa zuciya, kazalika da ayyukan-mutum-mutum guda ɗaya, ya kamata a maye gurbin inhalation ɗaya tare da matsin lambar 4-5 akan kirji. Ana aiwatar da farfadowa kafin isowar kwararrun motar asibiti ko har sai alamun rayuwar mutum sun bayyana.

Matakin likita

Bayan isowar kwararru, yanayin mai haƙuri an daidaita shi, yana ƙarƙashin asibiti a cikin sashin kulawa mai zurfi. Kulawa ta gaggawa don cutar sikari na hyperglycemic a matakin likita ya dogara da nau'in yanayin da ya bunkasa a cikin mai haƙuri da ciwon sukari.

Asibiti na mara lafiya shine abin da ake bukata, ko da kuwa batun al'ada a gida

Cutar Ketoacidotic

Da ake bukata shine gabatarwar insulin. Na farko, allura ce ta jirgin ruwa, sannan za ta narke a cikin glucose 5% don hana farawar yanayin haila. An wanke mai haƙuri tare da ciki kuma ya tsabtace hanji tare da maganin bicarbonate 4%. An nuna gudanarwar sarrafa ruwan injin na ciki, maganin Ringer don dawo da matakin ruwa a jiki da sinadarin bodizate sodium don mayar da batirin electrolytes ya nuna.

Don tallafawa aikin zuciya da jijiyoyin jini, ana amfani da glycosides, ana amfani da cocarboxylase, ana gudanar da aikin oxygen (jijiyar oxygen na jikin).

Hyperosmolar jihar

Kulawar gaggawa tare da wannan coma yana da wasu bambance-bambance:

• ana amfani da mahimmancin shirye-shiryen jiko (kowace rana har zuwa lita 20) don dawo da matakin ruwa a jikin (saline na ilimin halayyar, maganin Ringer);
• An kara insulin a cikin ilimin halittar jiki kuma a karkatar da shi ta hanyar hanya, wanda ya sa matakin sukari ya ragu a hankali;
• lokacin da aka kai darajar glucose 14 mmol / l, an riga an gudanar da insulin akan 5% glucose;
• Ba a amfani da bicarbonates, tunda babu acidosis.

Harkokin haɓakawa shine muhimmin mataki na aikin likita na gaggawa

Lactic acidosis

Siffofin taimako na lactic acidosis coma sune kamar haka:

• methylene blue an allura a cikin jijiya, yana ba da damar ɗaure ions hydrogen;
• gudanarwar Trisamine;
• peritoneal dialysis ko hemodialysis don tsarkakewar jini;
• ruwa mai narkewa na sodium bicarbonate;
• ƙananan allurai na insulin akan 5% na glucose a matsayin kariya ga raguwar abubuwa masu yawa a cikin alamomin glucose a cikin jini.

Fahimtar yadda ake bayar da agaji na farko a yanayin rashin lafiya, da kuma samun ƙwarewar sake rayuwa, na iya ceton ran wani. Irin wannan ilimin yana da mahimmanci ba kawai ga marasa lafiya da ciwon sukari ba, har ma ga dangi da abokai.