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Zewnętrzny uraz krtani to bezpośrednie zagrożenie życia. Jak przebiega ocena urazu i leczenie?

Karolina482 komentarze
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Do zewnętrznego urazu krtani najczęściej dochodzi w wyniku uderzenia z dużą siłą, np. na skutek wypadku komunikacyjnego czy pobicia, a także działania ostrego narzędzia lub broni palnej. Uszkodzenie krtani może grozić życiu pacjenta, dlatego konieczna jest natychmiastowa interwencja medyczna.

Krtań ze względu na położenie między mostkiem a żuchwą jest stosunkowo dobrze chroniona przed urazem zewnętrznym. Z drugiej strony jest jednak umiejscowiona centralnie na szyi i posiada delikatną budowę, co może zwiększać podatność na uszkodzenia.

Urazy zewnętrzne krtani dzieli się na urazy tępe, które najczęściej są konsekwencją wypadków komunikacyjnych, zawodów sportowych, duszenia czy prób samobójczych. Urazy występujące na skutek postrzału lub pchnięcia nożem określa się mianem urazów penetrujących krtani.

Uraz zewnętrzny krtani – objawy

Rodzaj objawu urazu krtani uzależniony jest od czynnika wywołującego uraz. Najczęściej obserwowane objawy to:

  • duszność,
  • ból,
  • zaburzenia głosu,
  • uporczywy kaszel,
  • chrypka,
  • krwioplucie,
  • odma podskórna szyi,
  • ból podczas przełykania pokarmów (odynofagia) lub zaburzenia połykania (dysfagia),
  • ślinotok,
  • obrzęk tkanek szyi,
  • przemieszczenie krtani,
  • wylewy krwawe na przedniej powierzchni szyi,
  • stridor wdechowy (świst, szmer krtaniowy).

Urazom krtani często towarzyszą uszkodzenia gardła, przełyku, naczyń szyi, nerwów czy szyjnego odcinka kręgosłupa. Niebezpiecznymi następstwami urazu krtani są odruchowy skurcz krtani, wstrząs kardiogenny, bradykardia, spadek ciśnienia tętniczego, zatrzymanie krążenia. Z kolei podrażnienie nerwów błędnych i ich gałęzi może prowadzić do spadku ciśnienia tętniczego, zwolnienia rytmu serca, zwężenia naczyń wieńcowych, arytmii, nagłego zatrzymania oddechu, skurczu krtani.

Ocena rozległości urazu krtani

W postępowaniu klinicznym, w przypadku wystąpienia zewnętrznego uraz krtani, podstawowe znaczenie ma wywiad dotyczący okoliczności wystąpienia urazu. Specjalista wykonuje również badanie palpacyjne szyi, laryngoskopię pośrednią i bezpośrednią, fiberoskopię, badania radiologiczne, np. RTG klatki piersiowej, tomografię komputerową, rezonans magnetyczny. Konieczna jest również ocena narządów sąsiadujących z krtanią, które mogły ulec uszkodzeniu.

Rodzaj urazu zewnętrznego krtani oceniany jest za pomocą 5-punktowej skali Schaefera:

I. niewielki krwiak wewnątrz krtani, bez widocznego złamania; postępowanie: ścisła obserwacja, kontrola fiberoskopowa krtani, nawilżanie powietrza, w wybranych przypadkach tomografia komputerowa;

II. obrzęk, krwiak, niewielki uraz błony śluzowej krtani, bez złamania; postępowanie: tracheotomia, laryngoskopia, bronchoskopia, ezofagoskopia, w wybranych przypadkach tomografia komputerowa;

III. masywny obrzęk, rozdarcie błony śluzowej, złamanie chrząstek, unieruchomienie fałdów głosowych; postępowanie: tracheostomia, endoskopia, operacja metodą otwartą;

IV. grupa III + ponad dwie szczeliny złamania lub masywny uraz krtani; postępowanie: jw.;

V. całkowite oderwanie krtani i tchawicy; postępowanie: bronchoskopia, tracheotomia, operacja metodą otwartą.

Postępowanie w przypadku uszkodzenia krtani

W przypadkach urazów krtani zawsze wymagana jest hospitalizacja pacjenta, ze względu na bezpośrednie zagrożenie życia. Najpilniejszym postępowaniem jest udrożnienie dróg oddechowych, a także opanowanie ewentualnego krwawienia, ustabilizowanie odcinka szyjnego kręgosłupa (gdy istnieje podejrzenie jego uszkodzenia), zapobieganie powstania obrzęku krtani. W przypadku rozległych urazów i narastania duszności nie zawsze możliwa jest intubacja dotchawicza, gdyż mogłaby ona powiększyć uraz. Dlatego w takich okolicznościach wykonuje się tracheotomię ze znieczuleniem miejscowym, zabieg polegający na otwarciu przedniej ściany tchawicy i wprowadzeniu rurki do dróg oddechowych.

Leczenie urazu krtani uzależnione jest od rozległości uszkodzenia. Urazy z grupy I i II klasyfikacji Schaefera mogą być leczone farmakologicznie. W praktyce klinicznej pacjentom podaje się glikokortykosteroidy i antybiotyki. W niektórych sytuacjach w urazach z grupy II, przy narastaniu duszności, wykonuje się tracheostomię. Leczenie chirurgiczne urazów grupy III i IV polega na wykonaniu tracheostomii z jednoczesną eksploracją szyi i krtani, a także z nastawieniem złamanych i przemieszczonych chrząstek, pokryciem ubytków błony śluzowej przemieszczonymi płatami z sąsiedztwa. W niektórych przypadkach stosuje się stenty wewnątrzkrtaniowe w celu stabilizacji rusztowania chrzęstnego i uniknięcia zrostów. Jak najszybsze wykonanie rekonstrukcji krtani zapobiega trwałym zniekształceniom. W przypadku całkowitego oderwania krtani od tachawicy, zalecana jest operacja, która polega na zespoleniu „koniec do końca”.

Źródła: mp.pl, G. Janczewski, „Otolaryngologia praktyczna. Podręcznik dla studentów i lekarzy”, tom 2, 2005, str. 127-129

 

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  373. проверить свои usdt на чистоту
    Проверка кошельков для хранения криптовалюты за наличие подозрительных средств: Обеспечение безопасности своего электронного портфельчика

    В мире электронных денег становится все значимее важнее гарантировать безопасность своих финансовых активов. Каждый день обманщики и хакеры разрабатывают новые методы обмана и мошенничества и угонов виртуальных средств. Один из ключевых инструментов защиты является анализ бумажников по присутствие подозрительных финансовых средств.

    Почему же именно поэтому важно, чтобы осмотреть личные криптовалютные кошельки?

    В первую очередь, вот этот момент важно для того чтобы охраны своих средств. Многие из участники рынка рискуют потерять потери средств их средств вследствие непорядочных планов или воровства. Проверка кошельков кошельков способствует предотвращению обнаружить в нужный момент непонятные операции и предупредить.

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    Мы предоставляем сервис проверки данных цифровых кошельков и переводов с намерением обнаружения начала средств передвижения и выдачи детального доклада. Наши программа осматривает данные пользователя для определения подозрительных операций и оценить риск для того чтобы личного портфеля. Благодаря нашей службе проверки, вы будете в состоянии предотвратить возможные проблемы с государственными органами и защитить себя от случайной вовлеченности в незаконных действий.

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    Важный запрос: „проверить свои USDT на чистоту”

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  375. Проверка кошельков для хранения криптовалюты за присутствие незаконных денег: Охрана вашего цифрового активов

    В мире электронных денег становится все необходимее гарантировать защиту личных активов. Регулярно мошенники и хакеры создают совершенно новые схемы мошенничества и угонов виртуальных средств. Ключевым инструментом ключевых средств защиты является проверка кошельков бумажников за выявление наличия неправомерных денег.

    Почему именно поэтому важно, чтобы провести проверку собственные криптовалютные бумажники?

    В первую очередь этот момент нужно для того чтобы обеспечения безопасности своих финансовых средств. Многие из пользователи находятся в зоне риска потери их денег вследствие несправедливых подходов или воровства. Анализ кошельков для хранения криптовалюты помогает обнаружить в нужный момент подозрительные операции и предотвратить возможные.

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    Мы предлагаем услугу анализа цифровых кошельков и переводов средств с целью идентификации места происхождения финансовых средств и предоставления полного отчета о результатах. Наши платформа проверяет информацию для определения подозрительных манипуляций и оценить риск для того, чтобы своего портфеля активов. Благодаря нашей службе проверки, вы будете в состоянии избежать с органами контроля и защитить от случайной вовлеченности в незаконных операций.

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    Основной запрос: „проверить свои USDT на чистоту”

    Если вас интересует убедиться надежности своих кошельков USDT, наши эксперты предоставляет возможность бесплатной проверки первых 5 кошельков. Просто введите свой кошелек в соответствующее поле на нашем сайте проверки, и мы передадим вам детальный отчет о состоянии вашего счета.

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    קנאביס מדריך: המדריכים השלם לרכישת פרחי קנאביס על ידי הטלגרמה

    שרף הוראות היה אתר מידע ומדריכי להשקיה פרחי קנאביס דרך האפליקציה הניידת הפופולארית המשלוח.

    האתר האינטרנט הוצע את כל הקישורים לאתרים והמסמכים העדכני לקבוצות וערוצים מומלצות לסחר ב שרף בטלגרם במדינת ישראל.

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  441. Player線上娛樂城遊戲指南與評測

    台灣最佳線上娛樂城遊戲的終極指南！我們提供專業評測，分析熱門老虎機、百家樂、棋牌及其他賭博遊戲。從遊戲規則、策略到選擇最佳娛樂城，我們全方位覆蓋，協助您更安全的遊玩。

    Player如何評測：公正與專業的評分標準
    在【Player娛樂城遊戲評測網】我們致力於為玩家提供最公正、最專業的娛樂城評測。我們的評測過程涵蓋多個關鍵領域，旨在確保玩家獲得可靠且全面的信息。以下是我們評測娛樂城的主要步驟：

    娛樂城是什麼？

    娛樂城是什麼?娛樂城是台灣對於線上賭場的特別稱呼，線上賭場分為幾種：現金版、信用版、手機娛樂城(娛樂城APP)，一般來說，台灣人在稱娛樂城時，是指現金版線上賭場。

    線上賭場在別的國家也有別的名稱，美國 – Casino, Gambling、中國 – 线上赌场,娱乐城、日本 – オンラインカジノ、越南 – Nhà cái。

    娛樂城會被抓嗎？

    在台灣，根據刑法第266條，不論是實體或線上賭博，參與賭博的行為可處最高5萬元罰金。而根據刑法第268條，為賭博提供場所並意圖營利的行為，可能面臨3年以下有期徒刑及最高9萬元罰金。一般賭客若被抓到，通常被視為輕微罪行，原則上不會被判處監禁。

    信用版娛樂城是什麼？

    信用版娛樂城是一種線上賭博平台，其中的賭博活動不是直接以現金進行交易，而是基於信用系統。在這種模式下，玩家在進行賭博時使用虛擬的信用點數或籌碼，這些點數或籌碼代表了一定的貨幣價值，但實際的金錢交易會在賭博活動結束後進行結算。

    現金版娛樂城是什麼？

    現金版娛樂城是一種線上博弈平台，其中玩家使用實際的金錢進行賭博活動。玩家需要先存入真實貨幣，這些資金轉化為平台上的遊戲籌碼或信用，用於參與各種賭場遊戲。當玩家贏得賭局時，他們可以將這些籌碼或信用兌換回現金。

    娛樂城體驗金是什麼？

    娛樂城體驗金是娛樂場所為新客戶提供的一種免費遊玩資金，允許玩家在不需要自己投入任何資金的情況下，可以進行各類遊戲的娛樂城試玩。這種體驗金的數額一般介於100元到1,000元之間，且對於如何使用這些體驗金以達到提款條件，各家娛樂城設有不同的規則。

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  442. слив сид фраз
    Слив засеянных фраз (seed phrases) является одной из наиболее распространенных способов утечки персональной информации в мире криптовалют. В этой статье мы разберем, что такое сид фразы, почему они важны и как можно защититься от их утечки.

    Что такое сид фразы?
    Сид фразы, или мнемонические фразы, составляют комбинацию слов, которая используется для составления или восстановления кошелька криптовалюты. Обычно сид фраза состоит из 12 или 24 слов, которые символизируют собой ключ к вашему кошельку. Потеря или утечка сид фразы может влечь за собой потере доступа к вашим криптовалютным средствам.

    Почему важно защищать сид фразы?
    Сид фразы представляют собой ключевым элементом для безопасного хранения криптовалюты. Если злоумышленники получат доступ к вашей сид фразе, они могут получить доступ к вашему кошельку и украсть все средства.

    Как защититься от утечки сид фраз?

    Никогда не передавайте свою сид фразу любому, даже если вам кажется, что это привилегированное лицо или сервис.
    Храните свою сид фразу в секурном и секурном месте. Рекомендуется использовать аппаратные кошельки или специальные программы для хранения сид фразы.
    Используйте дополнительные методы защиты, такие как двухфакторная аутентификация (2FA), для усиления безопасности вашего кошелька.
    Регулярно делайте резервные копии своей сид фразы и храните их в других безопасных местах.
    Заключение
    Слив сид фраз является важной угрозой для безопасности владельцев криптовалют. Понимание важности защиты сид фразы и принятие соответствующих мер безопасности помогут вам избежать потери ваших криптовалютных средств. Будьте бдительны и обеспечивайте надежную защиту своей сид фразы

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  448. هنا النص مع استخدام السبينتاكس:

    „هيكل الروابط الخلفية

    بعد التحديثات العديدة لمحرك البحث G، تحتاج إلى تنفيذ خيارات ترتيب مختلفة.

    هناك طريقة لجذب انتباه محركات البحث إلى موقعك على الويب باستخدام الروابط الخلفية.

    الروابط الخلفية ليست فقط أداة فعالة للترويج، ولكن لديها أيضًا حركة مرور عضوية، والمبيعات المباشرة من هذه الموارد على الأرجح قد لا تكون كذلك، ولكن الانتقالات ستكون، وهي حركة المرور التي نحصل عليها أيضًا.

    ما سوف نحصل عليه في النهاية في النهاية في الإخراج:

    نعرض الموقع لمحركات البحث من خلال الروابط الخلفية.
    2- نحصل على تبديلات عضوية إلى الموقع، وهي أيضًا إشارة لمحركات البحث أن المورد يستخدمه الناس.

    كيف نظهر لمحركات البحث أن الموقع سائل:
    1 يتم عمل صلة خلفي للصفحة الرئيسية حيث المعلومات الرئيسية

    نقوم بعمل روابط خلفية من خلال عمليات إعادة توجيه المواقع الموثوقة
    الأهم من ذلك أننا نضع الموقع على أداة منفصلة من أساليب تحليل المواقع، ويدخل الموقع في ذاكرة التخزين المؤقت لهذه المحللات، ثم الروابط المستلمة التي نضعها كتحويل على المدونات والمنتديات والتعليقات.
    هذا العملية المهم يُظهر لمحركات البحث خريطة الموقع، حيث تعرض أدوات تحليل المواقع جميع المعلومات عن المواقع مع جميع الكلمات الرئيسية والعناوين وهو أمر جيد جداً
    جميع المعلومات عن خدماتنا على الموقع!

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  472. Rikvip Club: Trung Tâm Giải Trí Trực Tuyến Hàng Đầu tại Việt Nam

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  474. UEFA Euro 2024 Sân Chơi Bóng Đá Hấp Dẫn Nhất Của Châu Âu

    Euro 2024 là sự kiện bóng đá lớn nhất của châu Âu, không chỉ là một giải đấu mà còn là một cơ hội để các quốc gia thể hiện tài năng, sự đoàn kết và tinh thần cạnh tranh.

    Euro 2024 hứa hẹn sẽ mang lại những trận cầu đỉnh cao và kịch tính cho người hâm mộ trên khắp thế giới. Cùng tìm hiểu các thêm thông tin hấp dẫn về giải đấu này tại bài viết dưới đây, gồm:

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    Đội tuyển tham dự
    Thể thức thi đấu
    Thời gian diễn ra
    Sân vận động

    Euro 2024 sẽ được tổ chức tại Đức, một quốc gia có truyền thống vàng của bóng đá châu Âu.

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    Euro 2024 sẽ quy tụ 24 đội tuyển hàng đầu từ châu Âu. Các đội tuyển này sẽ là những đại diện cho sự đa dạng văn hóa và phong cách chơi bóng đá trên khắp châu lục.

    Các đội tuyển hàng đầu như Đức, Pháp, Tây Ban Nha, Bỉ, Italy, Anh và Hà Lan sẽ là những ứng viên nặng ký cho chức vô địch.

    Trong khi đó, các đội tuyển nhỏ hơn như Iceland, Wales hay Áo cũng sẽ mang đến những bất ngờ và thách thức cho các đối thủ.

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    Bảng B: Tây Ban Nha, Croatia, Ý và Albania
    Bảng C: Slovenia, Đan Mạch, Serbia và Anh
    Bảng D: Ba Lan, Hà Lan, Áo và Pháp
    Bảng E: Bỉ, Slovakia, Romania và Ukraina
    Bảng F: Thổ Nhĩ Kỳ, Gruzia, Bồ Đào Nha và Cộng hoà Séc

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