IHemothorax

I-Hemothorax iqoqo legazi esikhaleni esiphakathi kodonga lwesifuba kanye nephaphu (umgudu wokuncenga).

Isizathu esivame kakhulu se-hemothorax ukuhlukunyezwa kwesifuba. I-Hemothorax nayo ingenzeka kubantu abane:

• Isici sokuvala igazi
• Isifuba (thoracic) noma ukuhlinzwa kwenhliziyo
• Ukufa kwezicubu zamaphaphu (i-infarction yamaphaphu)
• Umdlavuza we-Lung noma we-pleural - oyinhloko noma wesibili (metastatic, noma kusuka kwenye indawo)
• Ukudabuka esitsheni segazi lapho ubeka ipayipi eliyinhloko le-venous noma lapho kuhlotshaniswa nomfutho wegazi ophezulu
• Isifo sofuba

Izimpawu zifaka:

• Ukuphelelwa umoya
• Kuyashesha, ukuphefumula okungajulile
• Ubuhlungu besifuba
• Umfutho wegazi ophansi (ukushaqeka)
• Isikhumba esipholile nesipholile
• Ukushaya kwenhliziyo okusheshayo
• Ukungahlaliseki
• Ukukhathazeka

Umhlinzeki wakho wezokunakekelwa kwempilo angabona imisindo yokuphefumula eyehlile noma engekho ohlangothini oluthintekile. Izimpawu noma ukutholakala kwe-hemothorax kungabonakala kulezi zivivinyo ezilandelayo:

• I-x-ray yesifuba
• Iskena se-CT
• I-Thoracentesis (amanzi e-pleural fluid ngokusebenzisa inaliti noma ipayipi)
• I-Thoracostomy (amanzi e-pleural fluid ngokusebenzisa ishubhu lesifuba)

Inhloso yokwelashwa ukwenza umuntu azinze, ayeke ukopha, futhi asuse igazi nomoya esikhaleni sokuncenga.

• Kufakwa ishubhu lesifuba odongeni lwesifuba phakathi kwezimbambo ukukhipha igazi nomoya.
• Kushiywe endaweni futhi kunamathiselwe ukuncela izinsuku ezimbalwa ukukhulisa iphaphu kabusha.

Uma ishubhu lesifuba lilodwa lingakulawuli ukopha, kungadingeka ukuhlinzwa (i-thoracotomy) ukunqanda ukopha.

Kuzolashwa nembangela ye-hemothorax. Iphaphu elingaphansi kungenzeka liwile. Lokhu kungaholela ebunzimeni bokuphefumula. Kubantu abalimele, i-chest tube drainage ingaba yiyo yonke into edingekayo. Ukuhlinzwa kungenzeka kungadingeki.

LOKHO ONGAKULINDELA EMNYANGWENI WEZIPhuthumayo

Umhlinzeki uzolinganisa futhi aqaphe izimpawu zomuntu ezibalulekile, kufaka phakathi i-oxygen saturation, i-pulse, isilinganiso sokuphefumula, kanye nomfutho wegazi. Izimpawu zizophathwa lapho kudingeka. Umuntu angathola:

• Ukwesekwa kokuphefumula - Lokhu kungafaka umoya oksijini, ukwesekwa kwengcindezi yomoya ongafaki umoya njenge-BIPAP, noma i-endotracheal intubation (ukubekwa kweshubhu lokuphefumula ngomlomo noma ngamakhala emoyeni) nokubekwa kumshini wokuphefumula (umshini wokuphefumula osekela impilo)
• Ukuhlolwa kwegazi nokufakwa kwegazi okungenzeka
• Ishubhu lesifuba (ishubhu ngesikhumba nemisipha ephakathi kwezimbambo iye esikhaleni esizungeze amaphaphu) uma kukhona ukuwa kwamaphaphu
• Iskena se-CT
• Ukuhlaziywa kwe-pleural fluid, Electrocardiogram (ECG)
• Uketshezi olunikezwa ngomthambo (IV)
• Imithi yokwelapha izimpawu
• Ama-X-ray esifubeni nasesiswini noma ezinye izitho zomzimba uma kukhona ukulimala okwengeziwe

Umphumela uncike embangela ye-hemothorax, inani lokulahleka kwegazi nokuthi unikezwa ngokushesha kangakanani ukwelashwa.

Endabeni yokuhlukumezeka okukhulu, umphumela uzophinde uncike ebucayi bokulimala nasezingeni lokopha.

Izinkinga zingafaka:

• Iphaphu eliwile, noma i-pneumothorax, okuholela ekuhlulekeni kokuphefumula (ukungakwazi ukuphefumula kahle)
• I-Fibrosis noma isikhumba sezingxenyeni ze-pleural nezicubu zamaphaphu ezingaphansi
• Ukutheleleka kwe-pleural fluid (empyema)
• Ukushaqeka nokufa ezimweni ezinzima

Shayela ku-911 noma inombolo ephuthumayo yendawo uma une:

• Noma yikuphi ukulimala okungaba kubi kakhulu esifubeni
• Ubuhlungu besifuba
• Ubuhlungu obukhulu bomhlathi, intamo, ihlombe noma ingalo
• Ukuphefumula kanzima noma ukuphefumula okuncane

Iya egumbini labezimo eziphuthumayo noma ushayele inombolo yendawo ephuthumayo (efana ne-911) uma une:

• Isiyezi, ikhanda elikhanyayo, umkhuhlane nokukhwehlela, noma umuzwa wobunzima esifubeni sakho

Sebenzisa izindlela zokuphepha (njengamabhande esihlalo) ukugwema ukulimala. Ngokuya ngesizathu, i-hemothorax kungenzeka ingavinjelwa.

• Ukuqhuma kwe-aorta - i-x-ray yesifuba
• Uhlelo lokuphefumula
• Ukufaka ishubhu esifubeni - uchungechunge

Ukukhanya RW, Lee YCG. I-Pneumothorax, i-chylothorax, i-hemothorax ne-fibrothorax. Ku: Broaddus VC, Mason RJ, Ernst JD, et al, abakwa-eds. Incwadi kaMurray neNadel Yemithi Yokuphefumula. Umhlaka 6. IPhiladelphia, PA: Elsevier Saunders; 2016: isahluko 81.

URaja AS. Ukuhlukumezeka Thoracic. Ku: Walls RM, Hockberger RS, Gausche-Hill M, ama-eds. Imithi Ephuthumayo yaseRosen: Imiqondo kanye Nokuzijwayeza Komtholampilo. Umhlaka 9. IPhiladelphia, PA: Elsevier; 2018: isahluko 38.

USmon G, uMcCarthy M. Udonga lwesifuba, i-pneumothorax, ne-hemothorax. Ku: UCameron AM, uCameron JL, ama-eds. Ukwelashwa Kwamanje. Umhlaka 13. IPhiladelphia, PA: Elsevier; 2020: 1146-1150.