Ezikhathini zakudala zasendulo, imihlaba eyimpicabadala yezokwelapha nokuphulukisa yayivame ukuhlotshaniswa nemfihlakalo nengokomoya. Ukwembula lo mdwebo othakazelisayo kusithatha ohambweni olubuyela emuva ezinsukwini lapho igama elithi 'coma' laliyimfihlakalo, futhi umkhakha wezokwelapha wawusakhula. Kodwa benzani ngalabo abalahleka ezindaweni ezifiphele zokuquleka, labo ababanjwe ukuquleka, phakathi nalezi zikhathi zasendulo?
Lo mbuzo oshukumisa ingqondo usimema ukuba singene ezimpikiswaneni ezithakazelisayo zezindlela zokwelapha zasendulo, lapho amakhambi ayesukela kwemvelo kuye kwenamandla angaphezu kwawemvelo, futhi umugqa phakathi kokuphila nokufa wawuvame ukufiphala. Ngakho-ke, njengoba sidabula izihlabathi zesikhathi, singakhanyisa izindlela ezikhangayo nezivame ukushaqisa okhokho bethu ababebhekana nazo ngeziguli zokuquleka.
Umsuka wegama elithi “coma”
Abantu ezikhathini zasendulo babekwazi kahle ukuthi i-coma iyini. Eqinisweni, igama lesiGreki κῶμα ( kôma ), okusho ukuthi “ubuthongo obukhulu, obungenakunqamuka” lisetshenziswe emibhalweni yeHippocratic Corpus ( Epidemica ), iqoqo lemibhalo yezokwelapha ehlukahlukene yamaGreki, eyokuqala yayo esukela cishe ekhulwini lesihlanu leminyaka BC; futhi kamuva yasetshenziswa uGalen ngekhulu lesibili AD. Kamuva, ayizange isetshenziswe ezincwadini ezaziwa kuze kube maphakathi nekhulu le-17.
Leli gama litholakala futhi ku-Thomas Willis' (1621-1675) enethonya ethi De anima brutorum (1672), lapho ukukhathala (ukulala kwe-pathological), 'coma' (ubuthongo obunzima), i-carus (ukuntuleka kwezinzwa) kanye ne-apoplexy (lapho i-carus engase ajike futhi lapho ebeka khona odabeni olumhlophe) kuyashiwo. Igama elithi carus liphinde lisuselwe esiGrekini, lapho lingatholakala khona ezimpandeni zamagama amaningana asho i-soporific noma ukulala. Isengatholakala kumsuka wegama elithi 'carotid'. UThomas Sydenham (1624-1689) ukhulume ngegama elithi 'coma' ezimweni eziningi zomkhuhlane (Sydenham, 1685).
Ezikhathini zasendulo, yiziphi izindlela ezazisetshenziswa ukuze kubhekwane nabantu abasesimweni sokuquleka? Ingabe bangcwatshwa bephila noma kwakukhona enye indlela?
Ngakho-ke abantu basemandulo bazi kahle kamhlophe ukuthi abantu abakwi-coma babengafile futhi babengangcwatshwa bephila.
Inkinga iwukuthi abantu abaningi ezikhathini zasendulo abangene kwi-coma cishe abazange basinde kuleso simo isikhathi eside, njengoba abantu abaningi abangena esimweni sokuquleka balahlekelwa i-reflex yabo yokugwinya, okusho ukuthi, ngisho noma benabantu ababanakekelayo, ukubapha ukudla, nokubanikeza amanzi okuphuza, mhlawumbe babengeke babe namandla okugwinya.
Kuthatha cishe izinsuku ezintathu kuya kweziyisikhombisa ukuthi ukuphelelwa amanzi emzimbeni kubulale umuntu, okusho ukuthi uma umuntu equlekile, wangakwazi ukugwinya, futhi wayengavuki zingakapheli izinsuku eziyisikhombisa, wayefa ngenxa yokuphelelwa amanzi emzimbeni. Abantu abakwikhoma namuhla ngokuvamile bangasinda kuphela ngenxa yokudla okunomsoco amashubhu wokudla kanye nama-IV.
Namuhla izimbangela eziyinhloko zokufa kwabantu abane-comatose yizinto ezifana ne-aspiration pneumonia.
Iyini i-aspiration pneumonia?
I-Aspiration pneumonia yenzeka lapho ukudla noma uketshezi (amathe noma amafinyila) kuphefumulelwa emoyeni noma emaphashini, esikhundleni sokugwinywa.
Umminzo wakho kanye noqhoqhoqho womabili amagatsha asuka phansi komphimbo wakho, kodwa umminzo wakho uvalwe ngokuzenzakalelayo futhi indlela yakho yokuphefumula/uqhoqhoqho ivuleke kakhulu, njengoba kusobala ukuthi kufanele uphefumule. Ukugwinya kuwuchungechunge oluyinkimbinkimbi lwemicimbi eklanyelwe ukuthola izinto emphinjeni futhi zehlele esiswini sakho kunokuba zehlele emaphashini akho.
Umuntu ovamile, ophile kahle ugwinya amathe kanye noma kabili ngomzuzu, njalo. Njengoba abantu abaqulekile bengagwinyi, amathe abo ageleza futhi aconse kuqhoqhoqho futhi ehlele emaphashini, okubangela inyumoniya.
Amathe abantu abangadli/abaphuza njalo (isb, abantu abakwi-coma) kungenzeka kakhulu ukuthi abange inyumoniya. Njengoba kungekho ukudla noma isiphuzo esishukumisa izindlala zamathe, ulwelwesi lomlomo nomphimbo luyoma futhi lunamathele futhi lugcine amagciwane ayingozi kakhulu, abese engena emaphashini ngamathe njengoba kuchazwe ngenhla.
Okwengeza le nkinga, ngokuvamile kunzima kakhulu ukuhlanza umlomo womuntu oqulekile ngenxa yokuthi akakwazi ukubambisana ukuze avule umlomo wakhe.
Kukusiphi isimo lapho kokubili ishubhu lokuncelisa kanye ne-IV kungenzeki khona?
I-Hypothermia or i-hypovolemy yomibili ingabangela ukuthi imithambo ye-peripheral ifinyele. Lokhu kwenza imithambo kube nzima ngempela ukuyibona noma ukuyishaya kancane.
Ukuhlukumezeka okuhlukene kungenza ukufakwa kweshubhu noma i-cannula kungenzeki. Uma i-cannula ye-IV ingakwazi ukufakwa, emithini yesimanje kungenzeka ukusebenzisa i-intraosseous infusions. Nakuba lokhu kuyivelakancane.
Amagciwane, ukuvuvukala, ukuhlinzwa noma izimo zesikhumba endaweni yokubhoboza nazo ziyi-contraindication. I-tube yokudla ye-nasogastric ine-contraindication encane. Enye yezinto eziphikisana kakhulu ne-nasogastrical feeding tube ikholoni evinjiwe noma ukubhobozwa kommizo noma ikholoni.
Umculo wawusetshenziselwa ukwelapha iziguli ze-coma eNdiya yasendulo, ngokusho kocwaningo olusha
Ukwelashwa komculo kwakusetshenziselwa ukwelapha iziguli zokuquleka by ISushruta (ngekhulu lesi-8 BC) kanye Charaka (ngekhulu lokuqala CE), ngokusho mhlawumbe kobufakazi bokuqala obunjalo obuvundululwe emibhalweni yasendulo yamaNdiya ngabacwaningi baseNyuvesi yaseHyderabad.
Ucwaningo luye lwabonisa ukuthi u-Sushruta (uyise wokuhlinzwa eNdiya) anqume kanjani ukwelashwa komculo ukuze kukhishwe iziguli e-coma, kuyilapho uCharaka (obambe iqhaza oyinhloko ku-Ayurveda) esebenzisa umculo ezigulini ezaziphume i-coma ukuze zihlanze ingqondo yazo.
Umculo wawusetshenziswa futhi eNdiya yasendulo ukwelapha izifo eziningi njengokungazali kanye nesifo sofuba.
Ucwaningo lushicilelwe kwesibili umqulu wama-57 we-Indian Journal of History of Science (IJHS), incwadi yesayensi kaSpringer, eNetherlands.
Abacwaningi bacaphune izenzakalo ezivela kuma-comendiums amathathu abaluleke kakhulu e-Ayurveda lapho i-vaidyas (odokotela basendulo) bephakamisa umculo njengenye indlela yokwelapha. Ngokusho kwabo, ama-vaidyas asendulo atusa kuwo ukuvuvukala kwe-pitta, igumbi labasebenzi, ubudoda, isifo sofuba, ukudakwa, ukuhlanzwa kokwelapha kanye ne-emesis, kanye ne-coma.
Endabeni yokwelashwa kwe-coma, kube nomehluko omkhulu phakathi kwezinhlelo zokwelapha ze-Charaka ne-Sushruta, kusho abacwaningi. Baphinde bathi ukukhuluma kukaCharaka ngabaculi njengabasebenzi esibhedlela kwaletha izinguquko ezikhathini zakudala.
“UCharaka wayalela isiguli esibuye saphaphama umculo ukuze sivikele ingqondo edidekile. Kodwa-ke, u-Sushruta uchaze umculo wokwephula i-coma. "
Amazwi wokugcina
Ubuchopho bomuntu buye baba umthombo wokuthakazelisa impucuko yasendulo izinkulungwane zeminyaka. Kusukela kuHippocrates eGrisi lasendulo kuya kwabaseGibhithe, abantu bebelokhu bezama ukuqonda izimfihlakalo zomqondo. Ifuna ukwelashwa, imiphakathi yasendulo yenza izinto eziningi ukuze iziguli ziquleke, kuhlanganise nemikhuba eyinqaba nengavamile. Ukusuka ekusebenziseni amakhambi, ukwelashwa komculo kanye namakhambi emvelo kuye kuzinyathelo eziqinile ezifana ukubhoboza izimbobo kugebhezi. Futhi noma kunjalo, kule nkathi yesimanje, sizama ukuletha ukwelashwa kwayo ngokuphelele ngaphakathi kwethu.
