Ua ntej, cov neeg mob mob hnyav rau kev saib xyuas yooj yim
⒈ kev txais tos sov so ntawm cov neeg mob, tus neeg mob muab tso rau hauv chav xwm txheej ceev lossis chav saib xyuas mob hnyav, Cov Khoom Siv Kho Mob kom cov cua hauv tsev tshiab, sov thiab av noo tsim nyog;tus neeg mob zoo thiab tsev neeg ntawm lub tsev kho mob (Section) lub hom phiaj.
⒉ Kev soj ntsuam raws sij hawm:
Xws li cov xwm txheej tseem ceeb, cov tsos mob tseem ceeb, cov tsos mob ntawm daim tawv nqaij, kev kuaj xyuas zoo, ntau yam kav dej, kev kho tshuaj thiab lwm yam.
⒊ Kev ntsuas kub ceev: kev tsim kho sai ntawm kev nkag mus rau venous (nyob ntawm qhov xwm txheej thiab cov khoom siv tshuaj los kho tus nqi qis), oxygen (nyob ntawm qhov xwm txheej los kho cov pa oxygen), kev saib xyuas ECG, hauv tsev catheterization, sov, ua ntau yam ntawm kev sau cov qauv, Cov Khoom Siv Kho Mob los pab kev txheeb xyuas, yog tias tsim nyog, kev npaj ua ntej ua haujlwm
⒋ supine thiab nyab xeeb
⑴ raws li tus kab mob kom ua raws li txoj haujlwm tsim nyog.
⑵ txhawm rau tswj txoj hlab pa patency, cov neeg mob coma yuav tsum tau nqus lub qhov ntswg raws sijhawm thiab lub qhov ntswg thiab endotracheal secretions, kom nqus pa oxygen.
⑶ cov hniav kaw, convulsions ntawm tus neeg mob yuav siv tau cov ntaub so ntswg, qhib, tiv thaiv tus nplaig tom, tus nplaig suffix.
⑷ kub taub hau, coma, delirium, chim siab, qaug zog thiab cov me nyuam mos thiab cov me nyuam yaus yuav tsum tau ntxiv laj kab, yog tias tsim nyog, muab lub band, tiv thaiv lub txaj, kom tus neeg mob muaj kev nyab xeeb.
⑸ npaj tag nrho cov khoom siv cawm, tshuaj thiab khoom siv, kev cawm hauv tsev teeb tsa lub xeev standby.
⒌ Kev soj ntsuam ze ntawm tus mob: kev saib xyuas tus kheej, Cov Khoom Siv Kho Mob Tus neeg mob cov cim tseem ceeb, kev nco qab, cov menyuam kawm ntawv, los ntshav, SpO2, CVP, peripheral ncig thiab tso zis thiab lwm yam kev mob ntawm kev soj ntsuam zoo;nrog tus kws kho mob nquag cawm, ua cov ntaub ntawv kho mob.
⒍ Cov tshuaj tau sau tseg, ua raws li tus kws kho mob qhov ncauj cov lus qhia, yuav tsum rov ua dua yam tsis tau tso cai siv.
⒎ khaws ntau cov kav dej kom du, kho kom zoo, qhov chaw nyab xeeb los tiv thaiv tawm, twisted, thaiv;nruj sterile technology los tiv thaiv retrograde kab mob.
⒏ ua kom lub qhov tso quav kom du: tso zis tso zis los siv cov kev pab tso zis;yog tias tsim nyog catheterization;cem quav raws li tus mob rau enema.
⒐ nyob ntawm seb yuav tsum tau noj zaub mov zoo li cas: tswj dej, electrolyte sib npaug thiab ua kom tau raws li qhov xav tau ntawm lub cev khoom noj khoom haus;cov neeg mob yoo mov tuaj yeem yog khoom noj khoom haus peripheral venous.
Kev saib xyuas yooj yim
9, plaub hau, qhov muag, lub cev, qhov ncauj, qhov ntswg, tes, ko taw, perineum, qhov quav, tawv nqaij huv si;tsib mus rau lub txaj: thawj peb, Tshuaj, neeg laus, mov, tshuaj, dej rau tus neeg mob txaj).
⑵ sawv ntxov, yav tsaus ntuj tu 2 zaug ib hnub;urethral qhov ncauj tu 2 zaug ib hnub twg;kev kho mob tracheotomy 2 zaug hauv ib hnub;xyuam xim tiv thaiv qhov muag.
⑶ txhawm rau tswj lub limb muaj nuj nqi, ntxiv dag zog rau kev ua haujlwm tsis zoo ntawm lub cev lossis pab ua haujlwm nquag.
⑷ Kev cob qhia ua pa zoo, txhua 2 teev los pab cov neeg mob tig rov qab, tua rov qab, qhia ua pa tob tob, pab tawm cov kua dej tawm.
⑸ ntxiv dag zog rau kev saib xyuas ntawm daim tawv nqaij, tiv thaiv qhov mob siab.
⒒ Kev saib xyuas kev puas siab puas ntsws: kev saib xyuas raws sijhawm, saib xyuas cov neeg mob, Cov Khoom Siv Kho Mob raws li qhov xwm txheej sib txuas lus nrog lawv tsev neeg, tsim kom muaj kev sib raug zoo ntawm tus kws saib xyuas neeg mob, txhawm rau kom tau txais kev ntseeg siab ntawm cov neeg mob, kev koom tes hauv tsev neeg thiab kev nkag siab.
Thib ob, cov neeg mob coma saib xyuas niaj hnub
(I) Saib cov ntsiab lus
⒈ Kev soj ntsuam ze ntawm cov cim tseem ceeb (T, P, R, BP), me nyuam kawm ntawv loj, lub teeb teb.
⒉ ntsuam xyuas GLS cuam tshuam ntawm kev nco qab qhov ntsuas thiab qib ntawm cov lus teb kom nkag siab txog qib ntawm coma, pom cov kev hloov pauv tam sim ntawd qhia rau tus kws kho mob.
⒊ soj ntsuam cov neeg mob nrog dej, electrolyte tshuav nyiaj li cas, sau tus nqi ntawm 24 teev, muab kev taw qhia rau lub hauv paus ntawm rehydration.
⒋ Ua tib zoo saib xyuas tus neeg mob cov quav, saib seb puas muaj peev xwm teb tau.
(2) cov ntsiab lus hauv tsev laus
⒈ hu tus neeg mob: kev ua haujlwm, thawj zaug hu nws lub npe, piav qhia lub hom phiaj ntawm kev ua haujlwm thiab kev ceev faj.
⒉ txhawm rau tsim thiab tswj txoj kev ua pa du: nqa sab ntawm lub taub hau mus rau sab, txhua lub sijhawm kom tshem tawm cov tracheal secretions, npaj txhij nqus khoom, txhua lub sijhawm nqus.
⒊ kom tswj tau txoj hlab ntshav: nruj cov ntaub ntawv ntawm cov tshuaj siv.
⒋ txhawm rau tswj lub limb ua haujlwm me ntsis, ua kom lub cev tsis tu ncua thiab zaws kom lub cev, tiv thaiv tes, ko taw thiab contracture, deformation thiab paj hlwb.
⒌ los txhawb lub hlwb kev ua haujlwm rov qab: tsa lub txaj 30 mus rau 45 degrees los yog muab lub cev rov qab los, kev kho mob thiab kev nqus pa.
⒍ kom tswj tau qhov kev tso tawm ib txwm muaj: kev kuaj xyuas cov neeg mob lub zais zis tsis tu ncua, raws sij hawm muab tso rau hauv txaj, pab zaws lub plab hauv plab kom tso zis, catheterization lossis hloov cov hnab tso zis yuav tsum xyuam xim rau aseptic technology.
⒎ kom huv si thiab xis: tshem cov hniav hniav, hairpin, pruning ntiv taw (toe) A;kev tu lub qhov ncauj txhua hnub ob zaug, ua kom lub qhov ncauj huv si thiab noo, tuaj yeem pleev xim rau cov roj paraffin (lipstick) kom tiv thaiv daim di ncauj cleft;tsis tu ncua xuab zeb da dej thiab perineal ntxuav, Hloov cov khaub ncaws huv si.
⒏ xyuam xim rau kev nyab xeeb: kev ntxhov siab yuav tsum yog lub txaj ntxiv, yog tias muaj qhov hnyav heev, tsim nyog rau kev txwv;nco ntsoov nrog kub taub hau convulsions, meningeal irritation, Cov cuab yeej kho mob yuav tsum tau muab cov cua txias kom zoo thiab tso cov ntaub qhwv hniav, kom tsis txhob tom lub plhu;Txhua yam kav dej, kom tsis txhob swb.
⒐ tiv thaiv kab mob ntsws: tsis tu ncua tig rov qab mus tua, txhawb tus neeg mob hnoos, nqus raws sijhawm;ua kom sov, kom tsis txhob txias, siv dej kub thaum dej kub tsis yooj yim rau ntau tshaj 50 degrees, tsis tuaj yeem tiv tauj ncaj qha rau ntawm daim tawv nqaij kom tsis txhob kub hnyiab.
⒑ Kev tiv thaiv kev mob siab: kev siv lub txaj hauv huab cua, cov pob txha protruding ib feem ntawm daim txhuam cev, ua kom lub txaj huv thiab du.Txhua 1 ~ 2 teev sawv ntsug ib zaug.
⒒ Kev saib xyuas qhov muag: tshem cov looj tsom iav kom them nyiaj saib xyuas.Cov neeg mob tsis tuaj yeem kaw daim tawv muag, kev siv cov tshuaj ntsev ib txwm siv los ntxuav lub qhov muag, nrog cov tshuaj pleev qhov muag lossis Vaseline roj xov paj los tiv thaiv lub pob muag, Cov Khoom Kho Mob Kho Mob tiv thaiv lub ntsej muag qhuav thiab mob.
(iii) Kev Kawm Txuj Ci Kev Noj Qab Haus Huv
⒈ tau txais tsev neeg nrog kev taw qhia ntawm cov neeg hauv tsev neeg kom ua raws li cov neeg mob paub txog kev rov pib dua kev cob qhia los pab cov neeg mob uas muaj lub cev tsis muaj zog thiab zaws.
⒉ Kev saib xyuas kev puas siab puas ntsws: saib xyuas txhawb cov neeg mob, Cov Khoom Siv Kho Mob kom cov neeg mob paub txog lawv tus kheej qhov tseem ceeb hauv tsev neeg thiab zej zog kom muaj kev ntseeg siab kom kov yeej tus kab mob.