Hemothorax

Hemothorax ndi magazi m'magulu pakati pa khoma lachifuwa ndi mapapo (pakhosi).

Chifukwa chachikulu cha hemothorax ndichopweteka pachifuwa. Hemothorax amathanso kupezeka mwa anthu omwe ali ndi:

• Cholimba chotseka magazi
• Chifuwa (thoracic) kapena opaleshoni ya mtima
• Imfa ya minofu yamapapu (infarction yamapapu)
• Khansa kapena khansa yam'mapapo - yoyamba kapena yachiwiri (metastatic, kapena tsamba lina)
• Kugwetsa mumtsuko wamagazi mukamaika catheter yapakati ya venous kapena mukamayenderana ndi kuthamanga kwambiri kwa magazi
• Matenda a chifuwa chachikulu

Zizindikiro zake ndi izi:

• Kupuma pang'ono
• Mofulumira, kupuma pang'ono
• Kupweteka pachifuwa
• Kuthamanga kwa magazi (mantha)
• Wotuwa, wozizira komanso wonyezimira khungu
• Kuthamanga kwa mtima mwachangu
• Kusakhazikika
• Nkhawa

Wothandizira zaumoyo wanu amatha kuzindikira kuchepa kwa mpweya kapena kuchepa kwa mpweya kumbali yomwe yakhudzidwa. Zizindikiro kapena zotsatira za hemothorax zitha kuwoneka pamayeso otsatirawa:

• X-ray pachifuwa
• Kujambula kwa CT
• Thoracentesis (ngalande yamadzi yamadzimadzi kudzera mu singano kapena catheter)
• Thoracostomy (ngalande yamadzi yamadzimadzi kudzera mu chubu pachifuwa)

Cholinga cha chithandizo ndikuti munthuyo akhale wolimba, kuimitsa magazi, ndikuchotsa magazi ndi mpweya pamalo opembedzera.

• Thumba lachifuwa limalowetsedwa kudzera pachifuwa pakati pa nthiti kukhetsa magazi ndi mpweya.
• Amasiyidwa m'malo mwake ndikumangirizidwa kwa kuyamwa kwa masiku angapo kuti akukulitsenso mapapo.

Ngati chubu pachifuwa pakokha silingaletse kutuluka kwa magazi, pamafunika opaleshoni (thoracotomy) kuti magazi asiye kutuluka.

Chifukwa cha hemothorax chidzathandizidwanso. Mapapu oyambira atha. Izi zitha kubweretsa kupuma movutikira. Mwa anthu omwe avulala, ma chubu pachifuwa atha kukhala zonse zofunika. Kuchita opaleshoni sikungakhale kofunikira.

ZIMENE MUYENETSE KU Dipatimenti Yoopsa

Woperekayo amayesa ndikuwunika zizindikilo zofunika za munthuyo, kuphatikiza kukhathamira kwa oxygen, kugunda, kupuma, komanso kuthamanga kwa magazi. Zizindikiro zidzathandizidwa pakufunika. Munthuyo akhoza kulandira:

• Kupumira kothandizirana - Izi zitha kuphatikizira mpweya, mpweya wosagwira ntchito wampweya monga BIPAP, kapena endotracheal intubation (kuyikika kwa chubu lopumira mkamwa kapena mphuno kulowa mlengalenga) ndikuyikapo makina opumira (makina othandizira kupuma)
• Kuyezetsa magazi komanso kutengera magazi
• Thumba la chifuwa (chubu kudzera pakhungu ndi minofu pakati pa nthitiyo ndikulowa m'malo ozungulira mapapo) ngati mapapo agwa
• Kujambula kwa CT
• Kufufuza kwa madzi am'mapapo, Electrocardiogram (ECG)
• Madzi operekedwa kudzera mumtsempha (IV)
• Mankhwala ochizira matenda
• X-ray ya pachifuwa ndi pamimba kapena mbali zina za thupi ngati pali kuvulala kowonjezera

Zotsatira zake zimadalira chifukwa cha hemothorax, kuchuluka kwa kutaya magazi komanso momwe mankhwala amaperekera mwachangu.

Pakakhala zoopsa zazikulu, zotsatira zake zimadaliranso kukula kwa kuvulala komanso kuchuluka kwa magazi.

Zovuta zingaphatikizepo:

• Mapapu atagwa, kapena pneumothorax, zomwe zimapangitsa kupuma bwino (kulephera kupuma bwino)
• Fibrosis kapena mabala am'mimbamo yam'mimba komanso minofu yam'mapapo
• Matenda am'madzi am'mimba (empyema)
• Shock ndi imfa pamavuto akulu

Imbani 911 kapena nambala yadzidzidzi yakomweko ngati muli:

• Kuvulaza kulikonse pachifuwa
• Kupweteka pachifuwa
• Nsagwada zazikulu, khosi, phewa kapena mkono
• Kuvuta kupuma kapena kupuma movutikira

Pitani kuchipinda chodzidzimutsa kapena itanani nambala yadzidzidzi yakomweko (monga 911) ngati muli ndi:

• Chizungulire, mutu wopepuka, malungo ndi chifuwa, kapena kumva kulemera pachifuwa

Gwiritsani ntchito njira zachitetezo (monga malamba ampando) kuti musavulaze. Kutengera ndi chomwe chimayambitsa, hemothorax sangakhale yotetezedwa.

• Kuphulika kwa aortic - x-ray pachifuwa
• Dongosolo kupuma
• Kuyika chubu pachifuwa - mndandanda

Kuwala RW, Lee YCG. Pneumothorax, chylothorax, hemothorax, ndi fibrothorax. Mu: Broaddus VC, Mason RJ, Ernst JD, et al, olemba. Buku la Murray & Nadel la Mankhwala Opuma. Lachisanu ndi chimodzi. Philadelphia, PA: Elsevier Saunders; 2016: chap 81.

Raja AS. Zoopsa Thoracic. Mu: Makoma RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018: mutu 38.

Semon G, McCarthy M. Khoma pachifuwa, pneumothorax, ndi hemothorax. Mu: Cameron AM, Cameron JL, olemba., Eds. Chithandizo Chamakono Cha Opaleshoni. Wolemba 13. Philadelphia, PA: Elsevier; 2020: 1146-1150.