Hemothorax

ʻO Hemothorax kahi hōʻiliʻili o ke koko i ka hakahaka ma waena o ka paia o ka umauma a me ka akemāmā (ka lua pleura).

ʻO ke kumu maʻamau o ka hemothorax ka trauma o ka umauma. Hiki pū kekahi ʻo Hemothorax i ka poʻe i loaʻa:

• He kīnā pili koko
• Chest (thoracic) a i ʻole ʻoki puʻuwai puʻuwai
• Ka make ʻana o kaʻiʻo māmā (infarction pulmonary)
• Lung a pleura cancer paha - kumu mua a kula kiʻekiʻe paha (metastatic, a mai kekahi pūnaewele ʻē aʻe)
• ʻO kahi waimaka i loko o kahi kīʻaha koko ke waiho ana i kahi catheter venous kikowaena a i ʻole ke pili ʻia me ke koko kiʻekiʻe
• Maʻi puʻu

ʻO nā hōʻailona me:

• Pokole o ka hanu
• Hanu wikiwiki, pāpaʻu
• ʻEha ʻeha
• Ke koko haʻahaʻa (haʻalulu)
• ʻO kaʻili pale, anuanu a paʻakikī
• Helu puʻuwai wikiwiki
• Hoʻomaha ʻole
• Hopohopo

Hoʻomaopopo paha kāu mea mālama ola i ka hoʻemi a me ke kani ʻole o ka hanu ma ka ʻaoʻao i hoʻopilikia ʻia. E ʻike ʻia nā hōʻailona a i ʻole nā ​​hopena o ka hemothorax ma nā hōʻike aʻe:

• Pākuʻi x-ray
• CT scan
• Thoracentesis (kahawai o ka wai pleura ma o kahi nila a catheter paha)
• Thoracostomy (kahena o ka wai pleura ma o ka pahu pahu)

ʻO ka pahuhopu o ka mālama ʻana e hoʻopaʻa i ke kanaka, kū i ke kahe o ke kahe, a hemo i ke koko a me ka lewa i kahi ākea.

• Hoʻokomo ʻia kahi pahu umauma ma o ka paia o ka umauma ma waena o nā iwi ʻaoʻao e hoʻokahe i ke koko a me ka ea.
• Waiho ʻia i kahi a hoʻopili ʻia i ka omo no kekahi mau lā e hoʻonui hou ai i ka māmā.

Inā ʻaʻole kaohi kahi umauma umauma i ke kahe ʻana, pono paha ke ʻoki (thoracotomy) e hōʻoki i ke kahe.

E mālama pū ʻia ke kumu o ka hemothorax. Ua hāʻule paha ka māmā paʻa. Hiki i kēia ke alakaʻi i ka paʻakikī hanu. I ka poʻe i loaʻa kahi ʻeha, ʻo ka hoʻowahāwahā ʻana o ka pahu umauma wale nō ka mea e pono ai. ʻAʻole pono ka ʻoki ʻana.

HEAHA KA MEA E NOHO AI MA KA OIHANA EMERGENCY

E ana a mālama ka mea hāʻawi i nā ʻōuli nui o ke kanaka, e like me ka māʻona o ka oxygen, ka lāʻau ikiʻai, ka hanu ʻana, a me ke kahe o ke koko. E mālama ʻia nā ʻōuli e pono ai. E loaʻa paha i ke kanaka:

• Kākoʻo hanu - Hiki i kēia ke komo pū me ka oxygen, ke kākoʻo o ke kaomi ʻino ʻole invasive e like me BIPAP, a i ʻole ka endotracheal intubation (ke kau ʻana o kahi pahu hanu ma o ka waha a i ʻole ka ihu i loko o ke alaloa) a kau ʻia ma luna o ka mea hoʻoweliweli (mīkini hanu kākoʻo ola)
• Nā hoʻāʻo ʻana i ke koko a hiki ke kōkuʻi ʻia o ke koko
• Tube pahu (paipu ma o ka ʻili a me nā mākala ma waena o nā iwi ʻaoʻao i ke ākea a puni nā akemāmā) inā he hāhā o ka hāhā
• CT scan
• Ka Ikepili o ka wai pleura, Electrocardiogram (ECG)
• Nā Fluids i hāʻawi ʻia ma o ka aa (IV)
• Nā lāʻau lapaʻau e mālama ai i nā ʻōuli
• X-kukuna o ka umauma a me ka ʻōpū a i ʻole nā ​​ʻāpana ʻē aʻe o ke kino inā he mau hōʻeha hou aʻe

Pili ka hopena i ke kumu o ka hemothorax, ka nui o ke kahe o ke koko a me ka wikiwiki e hāʻawi ʻia ai ka lāʻau.

I ke kumu o ka ulia nui, e pili ka hopena i ka nui o ka ʻeha a me ka nui o ke kahe.

Komo pū nā pilikia:

• Haki nahu, a i ʻole pneumothorax, e alakaʻi ana i ka hanu ʻole (hiki ʻole ke hanu kūpono)
• ʻO Fibrosis a i ʻole scarring o nā membrane pleura a me nā aʻa o nā māmā
• ʻO ka maʻi o ka wai pleura (empyema)
• ʻO ka haʻalulu a me ka make i nā kūlana koʻikoʻi

Kāhea iā 911 a i ʻole ka helu pilikia kūloko inā loaʻa iā ʻoe:

• ʻO nā hōʻeha koʻikoʻi i ka umauma
• ʻEha ʻeha
• ʻEha ʻeha, ʻāʻī, ʻiwi a ʻehaʻeha lima
• Ka hanu paʻakikī ʻana a i ʻole ka liʻiliʻi o ka hanu

E hele i ka lumi pilikia a kāhea paha i ka helu pilikia kūloko (e like me 911) inā loaʻa iā ʻoe:

• Ka paupauaho, ʻālohilohi, ahulau a me ka puʻu, a i ʻole ke ʻano kaumaha i kou umauma

E hoʻohana i nā hana palekana (e like me nā kāʻei noho) e hōʻalo ai i ka hōʻeha. Aia i ke kumu, ʻaʻole hiki ke pale ʻia kahi hemothorax.

• Haki ʻaʻa - pahu x-ray
• ʻŌnaehana hanu
• Hoʻokomo ʻana o ka pahu umauma - series

ʻO RW māmā, ʻo Lee YCG. ʻO Pneumothorax, chylothorax, hemothorax, a me fibrothorax. I: Broaddus VC, Mason RJ, Ernst JD, et al, eds. ʻO Murray & Nadel's Textbook of Respiratory Medicine. ʻElua huaʻōlelo Piladelapia, PA: Elsevier Saunders; 2016: chap 81.

Raja AS. Hōʻeha Thoracic. I: Nā paia RM, Hockberger RS, Gausche-Hill M, nā ʻaoʻao. ʻO Rosen's Emergency Medicine: Nā Manaʻo Manaʻo a me ka hana lapaʻau. 9th ed. Piladelapia, PA: Elsevier; 2018: chap 38.

ʻO Semon G, ʻo McCarthy M. Pā paia, pneumothorax, a me hemothorax. I: Cameron AM, Cameron JL, eds. ʻO ke kaʻoki lāʻau lapaʻau o kēia manawa. 13th ed. Piladelapia, PA: Elsevier; 2020: 1146-1150.