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

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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

 

Przeczytaj także: Najczęstsze powikłania po tracheostomii

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    Если вы хотите убедиться чистоте своих кошельков USDT, наши специалисты предоставляет возможность провести бесплатный анализ первых пяти кошельков. Достаточно просто адрес своего кошелька в указанное место на нашем сайте проверки, и мы предоставим вам подробный отчет о его статусе.

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  76. 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.

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    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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    Наши фирма-разработчик работает с крупными аудиторскими агентствами, как например Kudelsky Security, с тем чтобы обеспечить гарантированность и точность наших проверок. Мы применяем новейшие и подходы анализа данных для идентификации небезопасных операций. Личные данные наших граждан обрабатываются и хранятся в базе в соответствии с положениями высокими стандартами безопасности и конфиденциальности.

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  85. 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。

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    娛樂城會被抓嗎?

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  86. 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.

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    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.

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    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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  88. 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.

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  91. 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:

    Nước chủ nhà
    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.

    Đức là một đất nước giàu có lịch sử bóng đá với nhiều thành công quốc tế và trong những năm gần đây, họ đã thể hiện sức mạnh của mình ở cả mặt trận quốc tế và câu lạc bộ.

    Việc tổ chức Euro 2024 tại Đức không chỉ là một cơ hội để thể hiện năng lực tổ chức tuyệt vời mà còn là một dịp để giới thiệu văn hóa và sức mạnh thể thao của quốc gia này.

    Đội tuyển tham dự giải đấu Euro 2024

    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.

    Các đội tuyển tham dự được chia thành 6 bảng đấu, gồm:

    Bảng A: Đức, Scotland, Hungary và Thuỵ Sĩ
    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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