Tikanga Whakahaere
(I) Te Whakangote
Ka whakamahia te aukati i te plexus brachial mō ngā waewae o runga, ka whakamahia te aukati epidural, te aukati subarachnoid rānei mō ngā waewae o raro, ā, ka taea hoki te whakamahi i te mate whakamoe whānui, te mate whakamoe ā-rohe rānei inā tika.
(II) Tūnga
Ngā waewae o runga: takoto tahanga, piko te tuke, ringa ki mua i te uma.
Ngā waewae o raro: takoto tāne, piko hope, kahaki, piko turi me te hononga pona i te tūnga toronga tuara 90 nekehanga.
(III) Te raupapatanga o te mahi
Ko te raupapa mahi motuhake o te whakatikatika o waho he taupatupatu o te tautuhi anō, te miro me te whakatikatika.
[Tukanga]
Arā, ka hurihia te tūranga o te whati i te tuatahi (kia whakatikatikahia ngā āhua hurihuri me ngā āhua taupatupatu), kātahi ka werohia ki ngā pine i tawhiti atu i te rārangi whati, ā, ka whakatūturutia i te tuatahi, kātahi ka hurihia anō, ka werohia ki ngā pine i te taha tata ki te rārangi whati, ā, i te mutunga ka hurihia kia rite ki te hiahia o te whati, kātahi ka whakatikahia katoatia. I ētahi wā motuhake, ka taea hoki te whakatika i te whati mā te wero tika, ā, ki te pai te āhua, ka taea te huri, te whakatikatika, me te whakatika anō i te whati.
[Whakaiti i te whati]
He wāhanga nui o te maimoatanga whati te whakaiti i te whati. He pānga tika ki te kounga o te whakaora whati te whakaiti pai i te whati. Ka taea te kati i te whati, te tirotiro tika rānei, kia rite ki te āhuatanga motuhake. Ka taea hoki te whakarite kia rite ki te kiriata hihi-X i muri i te tohu mata o te tinana. Ko ngā tikanga motuhake e whai ake nei.
1. I raro i te tirohanga tika: Mō ngā whati tuwhera me ngā pito whati e kitea ana, ka taea te tautuhi anō i te whati i raro i te tirohanga tika i muri i te tango i te kiri pakaru. Mēnā kāore e taea te whakahaere i te whati kati, ka taea hoki te whakaiti, te wero me te whakatika i te whati i raro i te tirohanga tika i muri i te tapahi iti o te 3~5cm.
2. Tikanga whakaiti kati: tuatahi, me tautuhi anō te whati, kātahi ka mahi kia rite ki te raupapatanga, ka taea te whakamahi i te pine maitai e tata ana ki te rārangi whati, ā, ka whakamahia te tikanga hiki me te kume hei āwhina i te whati kia tautuhi anō kia ea rā anō, kātahi ka whakatika. Ka taea hoki te whakarite i ngā whakatikatika tika mō te nekehanga iti, te koki rānei e ai ki te hihi-X i muri i te whakaiti me te whakau tata i runga i te mata o te tinana, i ngā tohu wheua rānei. Ko ngā whakaritenga mō te whakaiti whati, ko te tikanga, ko te whakaiti hanganga, engari he whati pakaru nui, he maha ngā wā kāore e ngāwari ki te whakahoki i te āhua hanganga taketake, i tēnei wā me pai ake te hononga o te whati ki waenganui i te poraka whati, me te pupuri i te raina kaha pai.
[Te whakapiri]
Ko te whakapiripiri te tikanga matua o te whakapiripiri wheua o waho, ā, ko te tikanga whakapiripiri pai, kino rānei, ehara i te mea ka pā ki te pumau o te whakapiripiri whati anake, engari e pā ana hoki ki te nui, te iti rānei o te maha o ngā mate tāpiri. Nō reira, me tino whai i ēnei tikanga mahi ina whakapiripirihia te ngira.
1. Ārai i ngā kino tāpiri: Kia mārama ki te hanganga o te wāhi i werohia ai, kia kore ai hoki e whara ngā uaua toto me ngā io matua.
2. Me whakamahi i te tikanga werohanga ārai-mate, me waiho te ngira kia 2~3cm ki waho o te wāhi whara kua pangia.
3. Ngā tikanga tino kore-whakaeke: ina mau ana i te ngira haurua me te ngira matotoru, me tapahi te putanga o te ngira maitai ki te maripi koi, kia 0.5~1cm te roa o te kiri i te tomokanga me te putanga; ina mau ana i te ngira haurua, whakamahia he kuku haemostatic hei wehe i te uaua, kātahi ka whakanoho i te cannula, kātahi ka pokaia ngā kōhao. Kaua e whakamahi i te poka tere-tere ina pokaia, ina miro tika rānei i te ngira. I muri i te miro i te ngira, me neke ngā hononga hei tirotiro mēnā he pēhanga kei roto i te kiri i te ngira, ā, mēnā he pēhanga, me tapahi te kiri, me tuitui.
4. Kōwhiria tika te wāhi me te koki o te ngira: kaua te ngira e tika kia paku noa te haere mā roto i te uaua, kaua hoki te ngira e whakaurua ki roto i te āputa uaua: ina whakaurua te ngira ki te papa kotahi, kaua te tawhiti i waenga i ngā ngira i roto i te wāhanga whati e iti iho i te 6 cm; ina whakaurua te ngira ki ngā papa maha, me nui rawa te tawhiti i waenga i ngā ngira i roto i te wāhanga whati. Kaua te tawhiti i waenga i ngā pine me te rārangi whati, te mata hononga rānei e iti iho i te 2 cm. Ko te koki whakawhiti o ngā pine i roto i te weronga ngira maha-papa kia 25°~80° mō ngā pine katoa, me te 60°~80° mō ngā pine haurua me ngā pine katoa.
5. Kōwhiria tika te momo me te whānui o te ngira maitai.
6. Tākaihia te kōhao ngira kia papatahi ki te tauera waipiro me te tauera parakore.
Te tūranga o te ngira wero o te humerus distal e pā ana ki te paihere io toto o te ringa o runga (Ko te wāhanga e whakaaturia ana i te whakaahua ko te rohe haumaru mō te wero i te ngira.)
[Te whakamau me te whakau]
I te nuinga o te wā, ka mahia te whakaiti whati, te whakapiri me te whakapiri i runga i te taurite, ā, ka oti te whakapiri i runga i te hiahia ina werohia ngā pine maitai kua whakaritea. Ka whakapirihia ngā whati pumau ki te pēhitanga (engari kaua te kaha o te pēhitanga e tino nui rawa, ki te kore ka puta he koki piko), ka whakapirihia ngā whati pakaru ki te tūranga kūpapa, ā, ka whakapirihia ngā hapa wheua ki te tūranga whakararuraru.
Ko te tikanga o te aro nui ki te tirohanga whānui me aro ki ēnei take e whai ake nei: 1.
1. Whakamātauria te pumau o te whakapiringa: ko te tikanga he nekeneke i te hononga, te kume roa, te pana taha rānei i te pito whati; kaua te pito whati pumau e mahi, kaua hoki e iti noa te kaha o te ngohe. Mena kāore i te rawaka te pumau, ka taea te mahi i ngā mahi tika hei whakanui ake i te pakari whānui.
2. Te tawhiti mai i te taputapu whakapiri wheua ki te kiri: 2~3cm mō te peka o runga, 3~5cm mō te peka o raro, hei ārai i te pēhanga kiri me te whakahaere i te rongoā whara. Mēnā he nui te pupuhi, he nui rānei te whara, ka taea te waiho kia nui ake te tawhiti i te wā tōmua, ā, ka taea te whakaiti i te tawhiti i muri i te mimiti o te pupuhi, me te whakatika i te whara.
3. Mēnā ka haere tahi mai me te whara nui o ngā kiko ngohengohe, ka taea te tāpiri i ētahi wāhanga hei whakairi, hei whakarunga rānei i te peka kua whara, hei whakahaere i te pupuhi o te peka, hei ārai hoki i te whara pēhanga.
4. Kaua te mea whakau wheua o waho o te anga wheua e pā ki te mahi a ngā hononga, me ngāwari te hikoi o te waewae o raro i raro i te taumaha, ā, me ngāwari te waewae o runga mō ngā mahi o ia rā me te tiaki i a ia anō.
5. Ka taea te whakaatu i te pito o te ngira maitai ki te topenga whakapiri ngira maitai mō te 1cm pea, ā, me tapahi te hiku roa rawa o te ngira. Takaia te pito o te ngira ki te hiri kirihou, ki te rīpene rānei, kia kore ai e werohia te kiri, e motu rānei te kiri.
[Ngā mahi hei mahi i ngā take motuhake]
Mō ngā tūroro he maha ngā whara, nā ngā whara kino, ngā whara morearea rānei i te wā whakaora, tae atu ki ngā āhuatanga ohorere pērā i te āwhina tuatahi i te mara, ngā whara puranga rānei, ka taea te wero i te ngira me te whakamau i te tuatahi, kātahi ka whakatikahia anō, ka whakatikatikaina, ka whakamauhia i te wā tika.
[Ngā raruraru noa]
1. Te mate pūwero; me
2. Te pirau o te kiri; me
3. Te whara o te pūnaha io
4. Te whakaroa o te whakaora, te kore rānei e ora o te whati.
5. Ngā pine whati
6. Te whati o te ara titi
7. Te ngoikore o te hononga
(IV) Te maimoatanga i muri i te pokanga
Ka pā tika te maimoatanga tika i muri i te pokanga ki te whai huatanga o te maimoatanga, ki te kore ka puta he raruraru pēnei i te mate pūwero me te kore e honoa te whati. Nō reira, me aro nui ki tēnei.
[Maimoatanga whānui]
I muri i te pokanga, me whakaara ake te waewae whara, me tirotiro hoki te rere o te toto me te pupuhi o te waewae whara; ina pēhia te kiri e ngā wāhanga o te whakapūmau wheua o waho nā te tūnga, te pupuhi rānei o te waewae, me whakatika wawe. Me whakakīkī ngā tīwiri wetekina i te wā tika.
[Te ārai me te rongoā i ngā mate urutā]
Mō te whakapiri wheua o waho, kāore e hiahiatia he paturopi hei ārai i te mate pūwero. Heoi, me rongoā tonu te whati me te patunga ki ngā paturopi e tika ana. Mō ngā whati tuwhera, ahakoa kua horoia rawatia te patunga, me whakamahi paturopi mō ngā rā e 3 ki te 7, ā, me hoatu he paturopi ki ngā whati kua pangia mō te wā roa atu e tika ana.
[Te tiaki i te kōhao titi]
Me nui ake te mahi i muri i te whakapiringa wheua o waho hei tiaki i ngā kōhao i ia wā, i ia wā. Ka hua ake te mate i roto i ngā kōhao mēnā kāore i te tika te tiaki.
1. Ko te tikanga ka whakawhitia te takai i te rā tuatoru i muri i te pokanga, ā, me whakawhiti te takai i ia rā ina puta he turuturu mai i te kōhao iti.
2. Mō ngā rā 10 pea, ka takaihia te kiri o te kōhao titi ki te muka, me te pupuri i te kiri kia ma, kia maroke hoki. Ia rā 1-2, ka taea te tāpiri i te 75% waipiro, te waikura iodine fluoride rānei ki te kiri kōhao titi.
3. Mēnā he pēhanga kei te kiri i te kōhao titi, me tapahi te taha pēhanga i te wā tika hei whakaiti i te pēhanga.
4. Kia tūpato ki te mahi ārai mate i te wā e whakarerekē ana i te taputapu whakatikatika wheua o waho, e whakarerekē ana rānei i te whirihoranga, ā, me horoi te kiri huri noa i te kōhao titi me te ngira maitai i ia wā.
5. Āraia te pangia whakawhiti i te wā e tiaki ana i te kōhao titi.
6. Kia pā mai te mate pūwero, me whakahaere te pokanga tika i te wā tika, ā, me whakaara ake te peka kua whara kia okioki ai, me te whakamahi i ngā rongoā paturopi e tika ana.
[Whakangungu mahi]
Ko te whakakori tinana mahi tika me te wā tika, ehara i te mea he āwhina anake ki te whakaora i te mahi a te hononga, engari he āwhina anō hoki ki te hanga anō i te haemodynamics me te whakaohooho i te ahotea hei whakatairanga i te tukanga whakaora whati. I te nuinga o te wā, ka taea te mahi i te whakaheke uaua me ngā mahi hononga i runga i te moenga i roto i ngā rā e 7 i muri i te pokanga. Ka taea e ngā waewae o runga te mahi i te pītiti me te pupuri i ngā ringaringa me ngā nekehanga motuhake o ngā hononga o te ringaringa me te tuke, ā, ka taea te tīmata i ngā mahi hurihuri i te 1 wiki i muri mai; ka taea e ngā waewae o raro te wehe atu i te moenga me te awhina o ngā tokotoko i muri i te 1 wiki, i muri rānei i te ora o te patunga, kātahi ka tīmata haere me te pikau taumaha katoa i muri i te 3 wiki. He rerekē te wā me te momo whakakori tinana mahi i ia tangata, i runga i ngā āhuatanga ā-rohe me ngā āhuatanga pūnaha. I roto i te tukanga whakakori tinana, ki te puta te kōhao iti ki te whero, te pupuhi, te mamae me ētahi atu tohu mumura, me mutu te mahi, me whakaara ake te waewae e pāngia ana ki te moenga.
[Te tango i te taputapu whakatikatika wheua o waho]
Me tango te whitiki whakapiri o waho ina eke te whati ki ngā paearu haumanu mō te whakaora whati. Ina tangohia te whitiki whakapiri wheua o waho, me whakatau tika te kaha whakaora o te whati, ā, kaua e tangohia wawe te whitiki whakapiri wheua o waho me te kore e tino mōhiotia te kaha whakaora o te wheua me ngā raruraru kitea o te whitiki whakapiri wheua o waho, inā koa ka rongoatia ngā āhuatanga pēnei i te whati tawhito, te whati pakaru, me te kore hononga wheua.
Wā tuku: 29 o Ākuhata-2024
