Sodobna imobilizacija hrbtenice v predbolnišničnem okolju : diplomsko delo

Rismondo Mlakar, Klemen (avtor), Thaler, Darja (mentor), Posavec, Anton (komentor)

Uvod: Zaradi hitrega tempa življenja je veliko ljudi odvisnih od prevoznih sredstev, ki so vodilni povzročitelj poškodb hrbtenice ob nesrečah. Za možnost zdravljenja poškodovanca je potrebna pravilna obravnava, ki ohrani trenutno stanje in prepreči nadaljnje poškodbe. Imobilizacija je ena izmed temeljnih prvin kakovostne oskrbe poškodovanca, ki poškodovancu lahko zagotovi boljšo prognozo. Namen: Namen diplomskega dela je predstaviti celovito imobilizacijo v predbolnišničnem okolju ter pokazati prednosti in slabosti imobilizacije ter s tem zmanjšati število sekundarnih poškodb, ki se pojavijo zaradi nepravilnega ravnanja s poškodovancem. Metode: V diplomskem delu je bila uporabljena deskriptivna metoda. Uporabljeni so bili članki v časovnem obdobju od leta 2005 do 2018. Literatura je bila iskana v slovenskem in angleškem jeziku s ključnimi besedami: spinal cord injury, cervical spine injury, immobilization, scoop stretcher, cervical collar, prehospital spine injury, spinal motion restriction v podatkovnih bazah CINAHL, Medline, Science Direct ter COBISS.SI. V analizo je bilo vključenih 43 člankov. Članki so bili ovrednoteni glede na moč dokazov. Rezultati: Imobilizacija je ključnega pomena za preprečitev sekundarnih poškodb, saj se ocenjuje, da se pojavi do 25 % sekundarnih poškodb med transportom ali v začetni oskrbi na terenu in bolnišnici. Kljub vsem koristim prinaša tudi pomanjkljivosti, na katere je treba biti pozoren. Ohranjanje življenja je pomembnejše od ohranjanja hrbtenice v nevtralnem položaju. Med hujše zaplete spada zavlačevanje pomembnejših ukrepov, kot so ustavljanje krvavitev, zagotovitev dihanja ter proste dihalne poti. Pri penetrantnih poškodbah, kjer niso prisotne nevrološke motnje, se imobilizacija ne priporoča, saj povzroča zakasnitev potencialne reanimacije oz. pomembnejših ukrepov, kar doprinaša k večji smrtnosti pri imobiliziranih poškodovancih. Razprava in zaključek: Učinkovitost imobilizacije je neposredno težko dokazljiva, saj so vse raziskave, ki bi ugotavljale, kakšni premiki povzročajo poškodbo hrbtenjače oz. razliko med imobiliziranim poškodovancem ter neimobiliziranim, etično sporne. Imobilizacija lahko privede do zapletov, kot so otežkočeno dihanje, poškodbe zaradi pritiska, lahko je neudobna ter podaljša čas obravnave poškodovanca in poveča stroške. Zato so kriteriji, po katerih se reševalec odloči za imobilizacijo, pomembni. Potrebna je strokovna usposobljenost, s katero lahko reševalec ugotovi potencialno poškodbo hrbtenice in potrebo po imobilizaciji, saj nepotrebne imobilizacije povzročajo nepotrebne bolečine in nelagodje poškodovanca.

• Jezik: Slovenski jezik
• Ključne besede: imobilizacija, poškodba hrbtenice na terenu, zajemalna nosila, obračanje v osi
• Vrsta gradiva: Diplomsko delo/naloga
• Organizacija: ZF - Zdravstvena fakulteta
• Leto izida: 2018
• PID: 20.500.12556/RUL-105480
• COBISS.SI-ID: 5542251
• Datum objave v RUL: 01.12.2018

Sekundarni jezik

• Jezik: Angleški jezik
• Naslov: Modern spine immobilization in prehospital setting : diploma work

Izvleček

Introduction: Due to the rapid pace of life many people are dependent on means of transport which are the leading cause of spinal cord injuries when accidents occur. Proper treatment is crucial for preserving current state and preventing further injuries. Immobilization is one of the basic elements of quality care for injured persons and can provide better prognosis of the injury. Purpose: This bachelor thesis aims to present comprehensive immobilization in a pre-hospital environment and demonstrate its advantages and disadvantages, thereby reducing total number of secondary injuries that occur due to improper handling. Methods: In the thesis descriptive method was used. Papers cited date to the time period of 2005 to 2018. References were searched for in Slovenian and English by key words comprising cervical spine injury, immobilization, scoop stretcher, cervical collar, prehospital spine injury, spinal motion restriction in databases of CINAHL, Medline, Science Direct and COBISS.SI. 43 scientific papers were included in the analysis. The articles were evaluated according to the power of evidence. Results: Immobilization is crucial for preventing secondary injuries, as it is estimated that up to 25% of secondary injuries occur during transportation or initial pre-hospital and hospital care. In spite of all the benefits, it also brings deficiencies that require further attention. Preserving life is more important than retaining the spine in a neutral position. One of the more serious complications is delay in important measures such as stopping of bleeding, ensuring free airway and enabling breathing. In case of penetrant injuries where no neurological disorders are present, immobilization is not recommended as it causes delayed reanimation or holds up important measures, which contributes to higher mortality rate for immobilized injured patients. Discussion and conclusion: It is challenging to demonstrate the effectiveness of immobilisation directly, as studies for determination of difference between immobilized and non-immobilized injury are ethically controversial. As of now it is not known how much movement is required to cause secondary injuries. Immobilization contributes to complications such as difficulty in breathing, possibility of ulcer due to discomfort while also prolong the time and costs of treatment of the victim, so the criteria with which the rescuer (paramedic) decides to immobilize are important. Professional qualifications are needed to identify potential injuries of spine cord and the need for immobilization, as unnecessary immobilization causes unnecessary pain and discomfort to the injured person.

• Ključne besede: immobilization, spinal cord injury, scoop stretcher, log-roll