บทบาทพยาบาลในการดูแลหญิงตั้งครรภ์ที่ประสบอุบัติเหตุฉุกเฉิน

บทบาทพยาบาลในการดูแลหญิงตั้งครรภ์ที่ประสบอุบัติเหตุฉุกเฉิน

• 1.
  «“√ “√欓∫“≈»“ μ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ªï28 ©∫—∫∑’Ë 1 ¡°√“§¡-‡¡…“¬π 2559 1 ∫∑§«“¡«‘™“°“√ ∫∑∫“∑欓∫“≈„π°“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π ™—™«“≈ «ß§å “√’* ·≈–∏π—πμåπ‘¿“ ¿—§»ÿ¢π‘∏‘«—≤πå** §≥–欓∫“≈»“ μ√å °“≠®π∫ÿ√’ ¡À“«‘∑¬“≈—¬‡« ‡∑‘√åπ ‡≈¢∑’Ë 600 μ. √–≈߇√◊Õ Õ.À⫬°√–‡®“ ®.°“≠®π∫ÿ√’ 71170 ∫∑§—¥¬àÕ Õÿ∫—쑇Àμÿ„π√–À«à“ß°“√μ—Èߧ√√¿å ‡ªì𠓇ÀμÿÕ—π¥—∫·√°¢Õß “‡Àμÿ∑’ˉ¡à‡°’ˬ«¢âÕß°—∫ Ÿμ‘°√√¡∑’Ë∑”„Àâ À≠‘ßμ—Èߧ√√¿å‡ ’¬™’«‘μ À≠‘ßμ—Èߧ√√¿å®–¡’°“√‡ª≈’ˬπ·ª≈ß∑“ß√à“ß°“¬À≈“¬Õ¬à“ß §«“¡‡¢â“„®Õ¬à“ß≈÷°´÷Èß μàÕ°“√‡ª≈’ˬπ·ª≈ߥ—ß°≈à“«π’È®– à߇ √‘¡°“√™à«¬‡À≈◊Õ„Àâ¡’ª√– ‘∑∏‘¿“楒∑’Ë ÿ¥μàÕ¡“√¥“·≈–∑“√°„π§√√¿å °“√™à«¬‡À≈◊ÕÀ≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘πμâÕß∑”ß“π√à«¡°—π‡ªìπ∑’¡ ‚¥¬æ¬“∫“≈μâÕß√Ÿâ®—° ∫∑∫“∑∑’Ëμπ‡Õß “¡“√∂ªØ‘∫—쑉¥â∑—Èß„π∫∑∫“∑Õ‘ √–·≈–°÷ËßÕ‘ √–¿“¬„μâ¢Õ∫‡¢μ°ÆÀ¡“¬·≈–®√√¬“ ∫√√≥«‘™“™’æ°”Àπ¥ ∫∑§«“¡π’È®÷ß¡ÿà߇ πÕ∫∑∫“∑¢Õß欓∫“≈„π°“√®—¥°“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’Ë ª√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π‚¥¬√«¡ 4 ∫∑∫“∑À≈—° ¥—ßπ’È 1) ∫∑∫“∑°“√ª√–‡¡‘π ¿“æ¢ÕßÀ≠‘ßμ—Èߧ√√¿å·≈– ∑“√°„π∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π2)∫∑∫“∑°“√™à«¬‡À≈◊Õ‡∫◊ÈÕßμâπ„πÀ≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π 3) ∫∑∫“∑°“√™à«¬°Ÿâ™’æ„πÀ≠‘ßμ—Èߧ√√¿å∑’ËÀ—«„®À¬ÿ¥‡μâπ„π∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π ·≈– 4) ∫∑∫“∑°“√ ªÑÕß°—π°“√‡°‘¥Õÿ∫—쑇Àμÿ„πÀ≠‘ßμ—Èߧ√√¿å §” ”§—≠: ∫∑∫“∑欓∫“≈/À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ/Õÿ∫—쑇Àμÿ©ÿ°‡©‘π * Õ“®“√¬å  “¢“°“√欓∫“≈ºŸâ„À≠à·≈–ºŸâ ŸßÕ“¬ÿ §≥–欓∫“≈»“ μ√å °“≠®π∫ÿ√’ ¡À“«‘∑¬“≈—¬‡« ‡∑‘√åπ **§≥∫¥’ §≥–欓∫“≈»“ μ√å ∫ÿ√’√—¡¬å ¡À“«‘∑¬“≈—¬‡« ‡∑‘√åπ «“√ “√欓∫“≈»“ μ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ 2559; 28(1): 1-11
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  Journal of NursingScience Chulalongkorn University Vol. 28 No. 1 January-April 20162 ∫∑π” À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ¡’§«“¡‡ ’ˬßμàÕ °“√‡ ’¬™’«‘μ∑—Èß¡“√¥“·≈–∑“√°„π§√√¿å ´÷Ëß°“√ μ—Èߧ√√¿å¡’°“√‡ª≈’ˬπ·ª≈ß ∑—Èß∑“ߥâ“𰓬¿“æ ·≈–∑“ß √’√«‘∑¬“ ‰¡à‡À¡◊Õπ∫ÿ§§≈∑—Ë«‰ª ¥—ßπ—Èπ ®÷ß¡’§«“¡·μ°μà“ß°—π„π°“√ª√–‡¡‘π·≈–°“√®—¥°“√ °“√™à«¬™’«‘μ ªí®®ÿ∫—πÕÿ∫—쑇Àμÿ‡ªì𠓇Àμÿ°“√‡ ’¬ ™’«‘μ¢Õß μ√’μ—Èߧ√√¿å∑’ˉ¡à‰¥â‡°’ˬ«¢âÕß°—∫ Ÿμ‘»“ μ√å∑’Ë æ∫¡“°∑’Ë ÿ¥ («√ÿ≥ ‘√‘ Àß å≈¥“√¡¿å ·≈–‡øóòÕß≈¥“ ∑Õߪ√–‡ √‘∞, 2551; Mendez, Dahlke, & Rouse, 2013) Õÿ∫—쑇Àμÿ„πÀ≠‘ßμ—Èߧ√√¿åæ∫ª√–¡“≥ √âÕ¬≈– 7 ¢Õß°“√μ—Èߧ√√¿å „πμà“ߪ√–‡∑»¡’√“¬ß“π «à“Õÿ∫—쑇Àμÿ‡ªì𠓇Àμÿ°“√쓬¢ÕßÀ≠‘ßμ—Èߧ√√¿å Ÿß ∂÷ß√âÕ¬≈– 46.7-51.4 ¢Õß°“√쓬¢ÕßÀ≠‘ßμ—Èߧ√√¿å ∑—ÈßÀ¡¥ (Jacob, Bloebaum, Shah, & Varner, 1998; Mendez et al., 2013) ª√–‡∑»‰∑¬æ∫¢âÕ¡Ÿ≈°“√‡ ’¬™’«‘μ¢ÕßÀ≠‘ßμ—Èß §√√¿å∑’ˇ°‘¥Õÿ∫—쑇Àμÿ©ÿ°‡©‘π„πªï 2550, 2551 ·≈– 2552 ‡∑à“°—∫ 185, 257 ·≈– 269 §π μ“¡≈”¥—∫ ´÷Ëßæ∫«à“®”π«πÀ≠‘ßμ—Èߧ√√¿å‡ ’¬™’«‘μ®“°Õÿ∫—쑇Àμÿ Ÿß ¢÷ÈπÕ¬à“ßμàÕ‡π◊ËÕß∑ÿ°ªï  à«π„À≠àæ∫„πæ◊Èπ∑’Ë°√ÿ߇∑æ- ¡À“π§√√âÕ¬≈–25-37( ”π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ μ√å,  ”π—° à߇ √‘¡ ÿ¢¿“æ °√¡Õπ“¡—¬, °√–∑√«ß  “∏“√≥ ÿ¢,2552) “‡Àμÿ¢ÕßÕÿ∫—쑇Àμÿ∑’Ëæ∫∫àÕ¬∑’Ë ÿ¥ ‰¥â·°à Õÿ∫—쑇Àμÿ®“°¬“πæ“Àπ– æ∫ª√–¡“≥ 2 „π 3 ¢ÕßÕÿ∫—쑇Àμÿ∑—ÈßÀ¡¥ √Õß≈ß¡“ ‰¥â·°à Õÿ∫—쑇Àμÿ∑’Ë ‡°‘¥®“°§«“¡√ÿπ·√ß¿“¬„π§√Õ∫§√—« °“√∂Ÿ°∑”√⓬ ·≈–°“√À°≈â¡ (Horstmann, Larsen, & Grønborg, 2014) ‡¡◊ËÕÀ≠‘ßμ—Èߧ√√¿åª√– ∫Õÿ∫—쑇Àμÿ∑”„Àâ¡’ ‚Õ°“ ‡°‘¥°“√·∑âß °“√§≈Õ¥°àÕπ°”Àπ¥ ∂ÿßπÈ” §√Ë”·μ°°àÕπ°”Àπ¥ √°≈Õ°μ—«°àÕπ°”Àπ¥ ¡¥≈Ÿ° ·μ° ∑“√°‰¥â√—∫∫“¥‡®Á∫·≈–‡ ’¬™’«‘μ„π§√√¿å ´÷Ëß  “¡“√∂‡°‘¥¢÷Èπ‰¥â„πºŸâ∑’˪√– ∫Õÿ∫—쑇Àμÿ√ÿπ·√ß(∏“√“ß- √—μπå À“≠ª√–‡ √‘∞æß…å, 2550)  √’√«‘∑¬“¢ÕßÀ≠‘ß μ—Èߧ√√¿å¡’§«“¡·μ°μà“ß®“°À≠‘ß∑’ˇ°‘¥Õÿ∫—쑇Àμÿ ∑—Ë«‰ª‡π◊ËÕß®“°°“√‡ª≈’ˬπ·ª≈ß∑“ߌÕ√å‚¡π ¥—ßπ—Èπ °“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ®”‡ªìπμâÕß¡’ ∑’¡ À “¢“«‘™“™’æ√à«¡°—π¥Ÿ·≈ ‡™àπ  Ÿμ‘·æ∑¬å «‘ —≠≠’·æ∑¬å »—≈¬·æ∑¬å ·æ∑¬åª√–®”ÀâÕß©ÿ°‡©‘π 欓∫“≈«‘™“™’æ∑’ˇ™’ˬ«™“≠„π°“√¥Ÿ·≈ºŸâªÉ«¬«‘°ƒμ‘ ·≈–©ÿ°‡©‘π 1. °“√‡ª≈’ˬπ·ª≈ߢÕß√à“ß°“¬∑’Ë —¡æ—π∏å °—∫°“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π À≠‘ßμ—Èߧ√√¿å¡’°“√‡ª≈’ˬπ·ª≈ߢÕß√à“ß°“¬ ·≈–¿“«– ÿ¢¿“æÀ≈“¬¥â“𠇙àπ πÈ”Àπ—°√à“ß°“¬ ‡æ‘Ë¡¢÷Èπ ¢π“¥¢Õß¡¥≈Ÿ°¢¬“¬„À≠à °“√‡ª≈’Ë¬π ·ª≈ߢÕ߇≈◊Õ¥·≈–√–∫∫‰À≈‡«’¬π √–∫∫∑“߇¥‘π À“¬„® √–∫∫∑“߇¥‘πÕ“À“√ √–∫∫°≈â“¡‡π◊ÈÕ·≈– ª√– “∑ πÕ°®“°π’È °“√‡æ‘Ë¡¢÷Èπ¢ÕߌÕ√å‚¡π∑”„Àâ Õ“√¡≥凪≈’ˬπ·ª≈ßßà“¬ „π‰μ√¡“  2-3 ∑“√°„π §√√¿å®–‡®√‘≠‡μ‘∫‚μ¡“°¢÷ÈπμâÕß°“√ “√Õ“À“√¡“° ¢÷Èπ¥â«¬ ‡ªìπμâπ ´÷Ëß°“√‡ª≈’ˬπ·ª≈ß ”§—≠∑’Ë àߺ≈ „À⇰‘¥Õÿ∫—쑇Àμÿ‰¥âßà“¬„πÀ≠‘ßμ—Èߧ√√¿å ( ÿæ√ ·°â«»‘√‘ «√√≥, 2556; ∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å, 2550; Grossman, 2004) ¡’¥—ßπ’È 1.1 °“√‡ª≈’ˬπ·ª≈ß∑“ß°“¬«‘¿“§ °“√ ¢¬“¬¢π“¥¢Õß¡¥≈Ÿ° ‡¡◊ËÕ¡¥≈Ÿ°¡’¢π“¥ª√–¡“≥ √–¥—∫ –¥◊ÕÀ√◊Õ‡∑’¬∫°—∫°“√μ—Èߧ√√¿å 20  —ª¥“Àå ¡¥≈Ÿ°®–¡’¢π“¥„À≠à¡“°‡æ’¬ßæÕ∑’Ë®–°¥À≈Õ¥ ‡≈◊Õ¥¥”„À≠à„π™àÕß∑âÕß ‡¡◊ËÕÀ≠‘ßμ—Èߧ√√¿åÕ¬Ÿà„π∑à“ πÕπ√“∫®–¡’°“√°¥∑—∫¢ÕßÀ≈Õ¥‡≈◊Õ¥¥”„À≠à∑”„Àâ ‡≈◊Õ¥¥”°≈—∫ ŸàÀ—«„®ÀâÕß∫π¢«“≈¥≈ß π”‰ª Ÿà°“√≈¥ ≈ߢÕß stroke volume ∂÷ß√âÕ¬≈– 30 „π∫“ß Õ‘√‘¬“∫∂Õ“®∑”„ÀâÀ≠‘ßμ—Èߧ√√¿å‡°‘¥Õÿ∫—쑇Àμÿ®“°°“√ ‡ª≈’ˬπ·ª≈ßπ’ȉ¥â ¥—ßπ—Èπ °“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’Ë ª√– ∫Õÿ∫—쑇Àμÿ §«√®—¥∑à“ºŸâªÉ«¬„ÀâπÕπμ–·§ß¢â“ß ‰ª∑“ߥâ“π´â“¬ª√–¡“≥ 30 Õß»“ ‡æ◊ËÕ‡æ‘Ë¡°“√‰À≈ ‡«’¬π‚≈À‘쉪 ŸàÕ«—¬«–∑’Ë ”§—≠√«¡∑—Èß¡¥≈Ÿ° 1.2 °“√‡ª≈’ˬπ·ª≈ߢÕß√–∫∫À“¬„® °“√ ‡ª≈’ˬπ·ª≈ߢÕߪ√‘¡“μ√ªÕ¥„πÀ≠‘ßμ—Èߧ√√¿å‡√‘Ë¡
• 3.
  «“√ “√欓∫“≈»“ μ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ªï28 ©∫—∫∑’Ë 1 ¡°√“§¡-‡¡…“¬π 2559 3 μ—Èß·μàÕ“¬ÿ§√√¿åª√–¡“≥ 20  —ª¥“Àå æ∫«à“æ◊Èπ∑’Ë ª√‘¡“μ√°“√·≈°‡ª≈’ˬπÕ“°“»®–≈¥≈ß ∑”„ÀâÀ≠‘ß μ—Èߧ√√¿åÀ“¬„®‡√Á«¢÷Èπ·≈–‡°‘¥¿“«–‡≈◊Õ¥‡ªìπ°√¥ √à“ß°“¬®–ª√—∫ ¡¥ÿ≈¥â«¬¥à“ß®“°°“√‡º“º≈“≠ ∑”„Àâ ‡°‘¥°“√≈¥μË”≈ߢÕß√–¥—∫§“√å∫Õπ‰¥ÕÕ°‰´¥å·≈– √–¥—∫¢Õ߉∫§“√å∫Õπ‡πμ„π°√–· ‡≈◊Õ¥ °“√ ‡ª≈’ˬπ·ª≈ߥ—ß°≈à“«¡’º≈„À⧫“¡¥—π‚≈À‘μ≈¥μË”≈ß ®÷ßπ”¡“ Ÿà°“√‡°‘¥Õÿ∫—쑇Àμÿ‰¥â(Cunningham,Leveno, & Bloom, 2005; Marshall, Lindheimer, Sandra, & Cunningham, 2009) 1.3 °“√‡ª≈’ˬπ·ª≈ߢÕß√–∫∫À—«„®·≈– °“√‰À≈‡«’¬π‚≈À‘μ Õ—μ√“°“√‡μâπ¢ÕßÀ—«„®„πÀ≠‘ß μ—Èߧ√√¿å‡æ‘Ë¡¢÷Èπª√–¡“≥√âÕ¬≈– 17 ‚¥¬°“√‡ª≈’Ë¬π ·ª≈ߥ—ß°≈à“«‡√‘Ë¡μ—Èß·μà‰μ√¡“ ·√°¢Õß°“√μ—Èߧ√√¿å „π¢≥–∑’˧«“¡¥—π‚≈À‘μ„πÀ≠‘ßμ—Èߧ√√¿å®–≈¥≈ß ‡π◊ËÕß®“°°“√≈¥≈ߢÕß·√ßμâ“π‡≈◊Õ¥¢ÕßÀ≈Õ¥ ‡≈◊Õ¥ à«πª≈“¬ ‚¥¬§à“§«“¡¥—π‚≈À‘μ systolic ®– ≈¥≈߇©≈’ˬ 5-15 ¡‘≈≈‘‡¡μ√ª√Õ∑ §à“§«“¡¥—π‚≈À‘μ diastolic ®–≈¥≈߇©≈’ˬ 5-15 ¡‘≈≈‘‡¡μ√ª√Õ∑ À≈Õ¥‡≈◊Õ¥ à«πª≈“¬ ‚¥¬§à“§«“¡¥—π‚≈À‘μ systolic ®–≈¥≈߇©≈’ˬ 5-15 ¡¡.ª√Õ∑ §à“§«“¡¥—π‚≈À‘μ diastolic ®–≈¥≈߇©≈’ˬ 5-15 ¡‘≈≈‘‡¡μ√ª√Õ∑ ®÷ß π”¡“ Ÿà°“√‡°‘¥§«“¡¥—π‚≈À‘μμË”„π¢≥–‡ª≈’ˬπ∑à“ ‰¥âßà“¬ 1.4 °“√‡ª≈’ˬπ·ª≈ߢÕß√–∫∫‚≈À‘μ«‘∑¬“ À≠‘ßμ—Èߧ√√¿å¡’°“√‡æ‘Ë¡¢÷Èπ¢Õߪ√‘¡“μ√‡≈◊Õ¥ª√–¡“≥ √âÕ¬≈– 40-45 ¢Õߪ√‘¡“≥‡≈◊Õ¥„πÀ≠‘ß∑’ˉ¡à‰¥âμ—Èß §√√¿å ‡√‘Ë¡μ—Èß·μàÕ“¬ÿ§√√¿å 6-8  —ª¥“Àå °“√‡æ‘Ë¡¢÷Èπ ¢Õߪ√‘¡“≥¥—ß°≈à“«‡ªìπ —¥ à«π∑’Ë¡“°°«à“°“√‡æ‘Ë¡ ª√‘¡“μ√¢Õ߇¡Á¥‡≈◊Õ¥ ∑”„Àâ§à“§«“¡‡¢â¡¢âπ‡≈◊Õ¥ ¢ÕßÀ≠‘ßμ—Èߧ√√¿å®–≈¥≈ß„π™à«ß‰μ√¡“ ∑’Ë 2 ¢Õß °“√μ—Èߧ√√¿å (Cunningham et al., 2005) ª√‘¡“≥ ‡¡Á¥‡≈◊Õ¥¢“«Õ“®‡æ‘Ë¡¢÷Èπ‰¥â‚¥¬¡’§à“‡©≈’ˬª√–¡“≥ 5,000-25,000 μàÕ≈Ÿ°∫“»°å¡‘≈≈‘≈‘μ√ ‚¥¬‡©æ“–„π ‰μ√¡“ ∑’Ë “¡¢Õß°“√μ—Èߧ√√¿å „πÀ≠‘ßμ—Èߧ√√¿å®–¡’ °“√‡æ‘Ë¡¢÷Èπ¢Õß√–¥—∫ fibrinogen clotting factor II VII VIII IX X ·≈–¡’°“√≈¥≈ߢÕß√–¥—∫ plasminogen activator ∑”„ÀâÀ≠‘ßμ—Èߧ√√¿å¡’§«“¡‡ ’ˬß∑’Ë®–‡°‘¥ °“√·¢Áßμ—«¢Õ߇≈◊Õ¥„πÀ≈Õ¥‡≈◊Õ¥¥” °“√¥Ÿ·≈À≠‘ß μ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ·≈–μâÕßπÕππ‘Ëß∫π‡μ’¬ß π“πÊ ®÷ßμâÕß√–¡—¥√–«—ß°“√‡°‘¥≈‘Ë¡‡≈◊Õ¥Õÿ¥μ—π (Sugrue & Connor, 2004) 1.5 °“√‡ª≈’ˬπ·ª≈ߢÕß√–∫∫ª√– “∑ ·≈–°≈â“¡‡π◊ÈÕ º≈®“°°“√°¥∑—∫À≈Õ¥‡≈◊Õ¥¥”„À≠à inferior vena cava ¢Õß¡¥≈Ÿ°∑”„Àâ‡≈◊Õ¥‰À≈°≈—∫ ‡¢â“À—«„®‰¡à –¥«° ®÷ßμâÕ߉À≈ºà“π‰ª∑“ßÀ≈Õ¥ ‡≈◊Õ¥¥” paravertebral ´÷Ëß®–∑”„ÀâÀ≈Õ¥‡≈◊Õ¥¥” ¥—ß°≈à“«¢¬“¬ ∑”„Àâ epidural space ·≈– spinal canal ·§∫≈ß√à«¡°—∫°“√¬◊¥Àà“ßÕÕ°¢ÕߢâÕμàÕ ∫√‘‡«≥ symphysis pubis ·≈– sacroiliac joint „π‰μ√¡“ ∑’Ë 2 ®π∂÷ß√–¬–§≈Õ¥∑”„Àâ°“√‡¥‘π·≈– °“√∑√ßμ—«¢ÕßÀ≠‘ßμ—Èߧ√√¿åº‘¥‰ª®“°∑à“∑’ˇ§¬‡¥‘𠉥âμ“¡ª°μ‘ À“°‡°‘¥°“√‡§≈◊ËÕπ‰À«√à“ß°“¬·∫∫‰¡à √–«—ßÀ≠‘ßμ—Èߧ√√¿å®–¡’‚Õ°“ ‡°‘¥Õÿ∫—쑇Àμÿ®“°°“√ À°≈⡉¥â¡“° (∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å, 2550) 2. ≈—°…≥–°“√‡°‘¥Õÿ∫—쑇Àμÿ©ÿ°‡©‘π„πÀ≠‘ß μ—Èߧ√√¿å °“√ª√– ∫Õÿ∫—쑇Àμÿ∑’ˇ°‘¥¢÷Èπ°–∑—πÀ—π·≈–¡’ º≈°√–∑∫μàÕ™’«‘μ¢ÕßÀ≠‘ßμ—Èߧ√√¿å·≈–∑“√°„π §√√¿å∑’Ëæ∫∫àÕ¬Ê ¡’ 2 ≈—°…≥– ¥—ßπ’È 2.1 Õÿ∫—쑇Àμÿ™π‘¥¡’°“√°√–·∑°∫√‘‡«≥∑âÕß  “‡Àμÿ∑’Ë∑”„À⇰‘¥Õÿ∫—쑇Àμÿ™π‘¥°√–·∑°∑’Ëæ∫∫àÕ¬∑’Ë ÿ¥ §◊Õ Õÿ∫—쑇Àμÿ®“°°“√¢—∫¢’ˬ“πæ“Àπ– √Õß≈ß¡“ §◊Õ °“√∂Ÿ°∑”√⓬ °“√À°≈â¡ μ“¡≈”¥—∫ ªí®®—¬∑’Ëæ∫«à“  —¡æ—π∏å°—∫°“√쓬¢Õß∑“√°„π§√√¿å·≈–À≠‘ß μ—Èߧ√√¿å®“°°“√¢—∫¢’ˬ“πæ“Àπ– ‰¥â·°à °“√‰¡à§“¥ ‡¢Á¡¢—¥π‘√¿—¬ ·≈–°“√°√–‡¥ÁπÀ≈ÿ¥ÕÕ°®“°¬“π æ“Àπ–¢≥–‡°‘¥Õÿ∫—쑇Àμÿ (Grossman, 2004) „π ∑“ß°“¬¿“æºπ—ßÀπâ“∑âÕß¡¥≈Ÿ°·≈–πÈ”§√Ë”®–™à«¬ ≈¥·√ß°√–·∑°‰ª Ÿà∑“√°„π§√√¿å ·μà∑“√°Õ“®‰¥â
• 4.
  Journal of NursingScience Chulalongkorn University Vol. 28 No. 1 January-April 20164 √—∫º≈°√–∑∫®“°√°≈Õ°μ—«°àÕπ°”Àπ¥ °“√§“¥ ‡¢Á¡¢—¥π‘√¿—¬∑—È߉À≈à·≈– –‚氙૬≈¥Õ—πμ√“¬μàÕ À≠‘ßμ—Èߧ√√¿å·≈–∑“√°„π§√√¿å ‰¡à„ÀâÀ≠‘ßμ—Èߧ√√¿å æÿàßÕÕ°πÕ°√∂®π‡ªìπÕ—πμ√“¬ ·μà°“√§“¥‡¢Á¡¢—¥„π μ”·Àπàß –‚æ°∑’Ë Ÿß‡°‘π‰ªÕ“®°¥√—¥®π¡¥≈Ÿ°©’° ¢“¥‰¥â À√◊Õ°“√§“¥‡©æ“–‡Õ«°ÁÕ“®°¥√—¥¡¥≈Ÿ° ‚¥¬μ√ß®π∑”„Àâ¡¥≈Ÿ°©’°¢“¥À√◊Õ√°≈Õ°μ—«‰¥â (Rush, 2009) 2.2 °“√‡°‘¥Õÿ∫—쑇Àμÿ™π‘¥¡’°“√·∑ߢÕß «—μ∂ÿ‡¢â“„π√à“ß°“¬ ¢≥–μ—Èߧ√√¿å¡¥≈Ÿ°∑’Ë¢¬“¬ ¢π“¥‡¢â“„π™àÕß∑âÕß®–¥—π≈”‰ â¢÷Èπ‡Àπ◊Õ¡¥≈Ÿ° ¥—ßπ—Èπ °“√‡°‘¥Õÿ∫—쑇Àμÿ∑’Ë¡’°“√·∑ߢÕß«—μ∂ÿ‡¢â“ ∫√‘‡«≥¥â“π∫π¢Õß™àÕß∑âÕ߉¡à«à“®–‡ªìπ°“√·∑ß ¥â«¬¡’¥À√◊Õ°“√∂Ÿ°¬‘ߥ⫬ªóπ ¡—°®– —¡æ—π∏å°—∫°“√ ∫“¥‡®Á∫¢ÕßÕ«—¬«–√–∫∫∑“߇¥‘πÕ“À“√À≈“¬μ”·Àπàß „π‰μ√¡“  ÿ¥∑⓬¢Õß°“√μ—Èߧ√√¿å °“√‡°‘¥ Õÿ∫—쑇Àμÿ≈—°…≥–π’È∑’Ë∫√‘‡«≥™àÕß∑âÕߥâ“π≈à“ß¡¥≈Ÿ° ®–‡ªìπÕ«—¬«–∑’˪ÑÕß°—π°“√∫“¥‡®Á∫μàÕÕ«—¬«–Õ◊Ëπ ·μà °“√∫“¥‡®Á∫¢Õß¡¥≈Ÿ°®–¡’Õ—μ√“°“√쓬¢Õß¡“√¥“ ª√–¡“≥√âÕ¬≈– 7-9 ∑”„À⇰‘¥°“√∫“¥‡®Á∫¢Õß ∑“√°„π§√√¿å‰¥â Ÿß∂÷ß√âÕ¬≈– 60-90 ‚¥¬Õ—μ√“°“√ 쓬¢Õß∑“√°π’È®–¡“°¢÷Èπ∂â“Õ“¬ÿ§√√¿å¢≥–‡°‘¥ Õÿ∫—쑇ÀμÿπâÕ¬°«à“ 37  —ª¥“Àå ®”‡ªìπμâÕß∑”§≈Õ¥ „ÀâÀ≠‘ßμ—Èߧ√√¿å„π‰μ√¡“ ∑’Ë “¡∑’ˉ¥â√—∫Õÿ∫—쑇Àμÿ ™π‘¥π’ȉ¥â§≈Õ¥∑—π∑’ (∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å, 2550; Petrone et al., 2011) °“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ§«√ ∑”‡ªìπ¢—ÈπμÕπ √Õ∫§Õ∫ √«¥‡√Á« ·≈–¡’°“√ª√÷°…“ °—πÕ¬à“߇À¡“– ¡√–À«à“ß∑’¡·æ∑¬åºŸâ‡™’ˬ«™“≠„π  “¢“μà“ßÊ ‡æ◊ËÕ„À≥â¢âÕ¡Ÿ≈§√∫∂â«π·≈–‡À¡“– ¡ π”¡“´÷Ëß°“√¥Ÿ·≈ºŸâªÉ«¬Õ¬à“ß¡’ª√– ‘∑∏‘¿“æ ©–π—Èπ 欓∫“≈«‘™“™’æ∑’Ë„Àâ∫√‘°“√°Ÿâ™’æ©ÿ°‡©‘πÀ√◊ÕÕÕ°„Àâ ∫√‘°“√À≠‘ßμ—Èߧ√√¿å ≥ ®ÿ¥‡°‘¥‡Àμÿ ®÷ßμâÕß¡’§«“¡√Ÿâ ‡°’ˬ«°—∫°“√‡ª≈’ˬπ·ª≈ß„π√–∫∫μà“ßÊ ¢Õß√à“ß°“¬ „πÀ≠‘ßμ—Èߧ√√¿å ‡æ◊ËÕ„Àâ°“√ à߇ √‘¡¿“«– ÿ¢¿“æ ªÑÕß°—π°“√‡°‘¥Õÿ∫—쑇Àμÿ √«¡∑—Èߪ√–‡¡‘π·≈–®—¥°“√ ¥Ÿ·≈‰¥âμ“¡∫∑∫“∑¢Õßμπ‡¡◊ËÕμâÕߥŸ·≈À≠‘ßμ—Èߧ√√¿å ∑’Ë®ÿ¥‡°‘¥Õÿ∫—쑇Àμÿ„π°√≥’μà“ßÊ 3. ∫∑∫“∑欓∫“≈„π°“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å ∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π 欓∫“≈«‘™“™’æ∑’Ë∑”ß“π°—∫√∂°Ÿâ™’æ©ÿ°‡©‘π ∑”ß“π„π·ºπ°©ÿ°‡©‘π·≈–ÀÕºŸâªÉ«¬Àπ—° À√◊Õ æ¬“∫“≈«‘™“™’æ∑—Ë«‰ª∑’Ë¡’‚Õ°“ æ∫À≠‘ßμ—Èߧ√√¿å ª√– ∫Õÿ∫—쑇Àμÿ®”‡ªìπμâÕß„Àâ°“√™à«¬‡À≈◊Õ‡√àߥà«π ∂Ÿ°μâÕßμ“¡À≈—°°“√·æ∑¬å¿“¬„μâ∫∑∫“∑欓∫“≈ ´÷Ëß∫∑∫“∑欓∫“≈„π°“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’Ë ª√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π·∫àßÕÕ°‡ªìπ 4 ∫∑∫“∑À≈—° §√Õ∫§≈ÿ¡∑—Èß°“√ª√–‡¡‘π ¿“æ °“√√à«¡¥Ÿ·≈√—°…“ °“√™à«¬™’«‘μ·≈–°“√ªÑÕß°—π°“√‡°‘¥Õÿ∫—쑇Àμÿ ¥—ßπ’È 3.1 ∫∑∫“∑°“√ª√–‡¡‘π ¿“æ¢ÕßÀ≠‘ßμ—Èß- §√√¿å·≈–∑“√°„π§√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π ‡¡◊ËÕ æ¬“∫“≈«‘™“™’懪ìπºŸâ™à«¬‡À≈◊ÕÀ≠‘ßμ—Èߧ√√¿å∑’Ë ª√– ∫‡Àμÿ®”‡ªìπμâÕß√ŸâÀ≈—°°“√ª√–‡¡‘π ¿“æÀ≠‘ß μ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ ´÷Ë߇ªìπ∫∑∫“∑∑’ˇªìπ ∫∑∫“∑Õ‘ √–·≈–°÷ËßÕ‘ √–·∫à߇ªìπ 2 ¢—ÈπμÕπ (Õÿ∫≈ ¬’ˇŒß, 2552) ¥—ßπ’È 1) Primary survey ‡ªìπ∫∑∫“∑∑’ËÕ‘ √–´÷Ëß °“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ„π‡∫◊ÈÕßμâπ ‰¡à·μ°μà“ß®“°°“√¥Ÿ·≈ºŸâªÉ«¬∑’˪√– ∫Õÿ∫—쑇ÀμÿÕ◊Ëπ ´÷ËßμâÕߪ√–‡¡‘π®“°Õ“°“√∑’˪√“°Øæ√âÕ¡„Àâ°“√™à«¬ ‡À≈◊ÕÕ¬à“ß√«¥‡√Á« ¥—ßπ’È A: Airway/cervical spine control ‡ªìπ°“√ ª√–‡¡‘π∑“߇¥‘πÀ“¬„® À“°æ∫Õ“°“√º‘¥ª°μ‘ ‡™àπ À¬ÿ¥À“¬„® À√◊ÕÀ“¬„®μ‘¥¢—¥ §«√™à«¬À“¬„®„Àâ·°à À≠‘ßμ—Èߧ√√¿å°àÕπ‡æ√“–¡“√¥“¡’‚Õ°“  Ÿ¥ ”≈—° Õ“À“√‡¢â“ªÕ¥‰¥âßà“¬ Õ—π‡π◊ËÕß®“°ÀŸ√Ÿ¥¢Õß À≈Õ¥Õ“À“√À≈«¡·≈–°√–‡æ“–Õ“À“√¬àÕ¬‰¥â™â“ ®π∑”„Àâ¡’Õ“À“√§â“ßÕ¬Ÿà„π°√–‡æ“–‰¥âπ“π „π¢—ÈπμÕππ’È §«√√–«—ß°“√‡§≈◊ËÕπÀ√◊Õ°“√∫“¥‡®Á∫‡æ‘Ë¡¢Õß °√–¥Ÿ°μâπ§Õ (C-spine injury)
• 5.
  «“√ “√欓∫“≈»“ μ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ªï28 ©∫—∫∑’Ë 1 ¡°√“§¡-‡¡…“¬π 2559 5 B: Breathing ‡ªìπ°“√ª√–‡¡‘π°“√À“¬„® ´÷ËßÀ≠‘ßμ—Èߧ√√¿å¡’‚Õ°“ ‡°‘¥¿“«–¢“¥ÕÕ°´‘‡®π‰¥âßà“¬ ∑—Èßπ’È ‡æ√“–¢≥–μ—Èߧ√√¿å¡¥≈Ÿ°®–‚μ®π¡“‡∫’¬¥∫—ß ‡π◊ÈÕªÕ¥∑’Ë„™â„π°“√·≈°‡ª≈’ˬπÕÕ°´‘‡®π (functional residual capacity) „Àâ≈¥≈ß Õ’°∑—ÈßÀ≠‘ßμ—Èߧ√√¿å¡—° ¡’§«“¡μâÕß°“√„™âÕÕ°´‘‡®π Ÿß‡æ◊ËÕ √â“ßæ≈—ßß“π„Àâ ·°àμπ‡Õß·≈–∑“√°„π§√√¿åÕ’°¥â«¬ À“°ª√–‡¡‘π ·≈â«æ∫«à“À≠‘ßμ—Èߧ√√¿å¡’Õ“°“√À“¬„®ÀÕ∫À√◊Õ ª≈“¬¡◊Õª≈“¬‡∑Ⓡ¢’¬« §«√„ÀâÕÕ°´‘‡®π∫”∫—¥ ‡ªìπ°“√¥à«π C: Circulation, contraction (uterine) ‡ªìπ °“√ª√–‡¡‘π™’æ®√‡æ◊ËÕ‡ªìπ°“√∑”π“¬√–¥—∫§«“¡¥—π‚≈À‘μ ≥ ®ÿ¥‡°‘¥‡Àμÿ À“°§≈”‰¡àæ∫™’æ®√§«√‡√‘Ë¡μâπ™à«¬ øóôπ§◊π™’æ æ√âÕ¡√à«¡°—∫·æ∑¬å„π°“√™à«¬‡æ‘Ë¡§«“¡ ¥—π‚≈À‘μ¥â«¬°“√„™â¬“ Vasopressor agents ‡™àπ epinephrine, vasopressin ·≈– dopamine ¡—° ∑”„Àâ≈¥ª√‘¡“≥‡≈◊Õ¥‰ª Ÿà¡¥≈Ÿ° ‡æ◊ËÕπ”‡≈◊Õ¥‰ª ‡≈’ȬßÕ«—¬«– ”§—≠¢ÕßÀ≠‘ßμ—Èߧ√√¿å‡ªìπÀ≈—° 欓∫“≈μâÕߪ√–‡¡‘πÀ“ “‡Àμÿ·≈–„Àâ°“√·°â‰¢√à«¡ °—∫·æ∑¬åμ“¡À≈—° 5T6H ¥—ßπ’È 5T ‰¥â·°à Toxins, Tamponade, Tension pneumothorax, Trauma, Thrombosis ·≈– 6H ‰¥â·°à Hypovolemia, Hypoxia, Hydrogen ion, Hypo/hyperkalemia, Hypoglycemia, Hypothermia ‡æ◊ËÕ∑’Ë®–‰¥â·°â‰¢ ‰¥âμ√ß “‡Àμÿ (√æ’æ√ ‚√®π巠߇√◊Õß, ¡.ª.æ.) „π ¢—ÈπμÕππ’ÈÀ“°¡’μ”·ÀπàߢÕ߇≈◊Õ¥Õհ欓∫“≈μâÕß ™à«¬Àâ“¡‡≈◊Õ¥Õ¬à“߇√àߥà«π¥â«¬ D: Disability ‡ªìπ°“√ª√–‡¡‘π°“√μÕ∫ πÕß ¢Õß√–∫∫ª√– “∑ „π√–¬–·√°®–μ√«®‡æ’¬ß§«“¡ √Ÿâ ÷° ·≈–√Ÿ¡à“π쓇∑à“π—Èπ‚¥¬„™â AVPU method (A : alert, V : vocal stimuli, P : pain stimuli, U : unresponsive) ¡“ª√–‡¡‘πÀ≠‘ßμ—Èߧ√√¿å∑’˪√– ∫ Õÿ∫—쑇Àμÿ©ÿ°‡©‘π ·μà∂â“Õ“°“√‰¡à©ÿ°‡©‘π¡“§«√ ª√–‡¡‘πÕ¬à“ß≈–‡Õ’¬¥‚¥¬„™â Glasgow coma score °“√√—°…“À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ´÷Ëß ‡ªìπ∫∑∫“∑∑’ËμâÕß∑”ß“π¿“¬„μâ·ºπ°“√√—°…“¢Õß ·æ∑¬åÕ¬à“߇√àߥà«π 欓∫“≈μâÕߧ”π÷ß∂÷ߧ«“¡ ª≈Õ¥¿—¬¢Õß™’«‘μ¡“√¥“‡ªì𠔧—≠ ´÷Ë߬÷¥À≈—°°“√ ∑’Ë«à“„Àâ™à«¬‡À≈◊Õ™’«‘μÀ≠‘ßμ—Èߧ√√¿å„Àâª≈Õ¥¿—¬°àÕπ ·≈â«√’∫™à«¬‡À≈◊Õ∑“√°„π§√√¿å‡ªìπ≈”¥—∫∂—¥‰ª (∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å, 2550) 欓∫“≈ μâÕߪ√–‡¡‘π°“√∫“¥‡®Á∫®“°»’√…–®√¥‡∑â“Õ¬à“ß √«¥‡√Á«·≈–„Àâ°“√™à«¬‡À≈◊Õ¥Ÿ·≈¡ÿàß√—°…“™’«‘쇪ìπ  ”§—≠ æ√âÕ¡μ√«®°“√À¥√—¥μ—«¢Õß¡¥≈Ÿ° ª√–‡¡‘π °“√¡’‡≈◊Õ¥ÕÕ°∑“ß™àÕߧ≈Õ¥·≈–øí߇ ’¬ßÀ—«„® ∑“√°„π§√√¿å√à«¡¥â«¬‡ ¡Õ·≈–„Àâ°“√‡§≈◊ËÕπ¬â“¬ À≠‘ßμ—Èߧ√√¿åÕ¬à“ß∂Ÿ°«‘∏’ π” àß‚√ß欓∫“≈Õ¬à“߇√àß ¥à«π·≈–ª≈Õ¥¿—¬ 2) Secondary survey À≈—ß®“°°“√¥Ÿ·≈ ‡∫◊ÈÕßμâπ·≈–π” àß‚√ß欓∫“≈·≈â« °“√¥Ÿ·≈μàÕ¡“ ª√–°Õ∫¥â«¬°“√´—°ª√–«—쑇°’ˬ«°—∫°≈‰°°“√‡°‘¥ Õÿ∫—쑇ÀμÿÕ¬à“ß≈–‡Õ’¬¥ °“√´—°ª√–«—쑇°’ˬ«°—∫°“√ μ—Èߧ√√¿å °“√μ√«®√à“ß°“¬Õ¬à“ß≈–‡Õ’¬¥ °“√μ√«® ª√–‡¡‘π ÿ¢¿“æ∑“√°„π§√√¿åÕ¬à“ß≈–‡Õ’¬¥ „π ¢—ÈπμÕππ’È欓∫“≈μâÕß∑”ß“π¿“¬„μ⧔ —Ëß°“√√—°…“ ¢Õß·æ∑¬å√à«¡¥â«¬ °≈à“«‚¥¬√«¡∫∑∫“∑¢Õß æ¬“∫“≈„π¢—ÈπμÕππ’È §◊Õ °“√‡μ√’¬¡À≠‘ßμ—Èߧ√√¿å  ”À√—∫°“√μ√«®√à“ß°“¬·≈–°“√μ√«®‡©æ“–∑’ˇ°’ˬ« ¢âÕß ‡™àπ °“√μ√«®Õ—≈μ√â“´“«πå °“√μ√«®∑“ß√—ß ’ °“√μ√«®∑“ßÀâÕߪؑ∫—μ‘°“√ °“√„Àâ¬“μ“¡·ºπ°“√ √—°…“¢Õß·æ∑¬å ‡ªìπμâπ ¢≥–‡¥’¬«°—π∫∑∫“∑Õ‘ √– ∑’Ë欓∫“≈μâÕߪؑ∫—μ‘ ‰¥â·°à °“√«—¥ —≠≠“≥™’æ °“√ª√–‡¡‘π ¿“æ∑“√°„π§√√¿å·≈–°“√À¥√—¥μ—« ¢Õß¡¥≈Ÿ° °“√¥Ÿ·≈ ¿“æ®‘μ„® ‡ªìπμâπ 3.2 ∫∑∫“∑°“√™à«¬‡À≈◊Õ‡∫◊ÈÕßμâπ„πÀ≠‘ß μ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ©ÿ°‡©‘π °“√„Àâ°“√¥Ÿ·≈ ®”‡æ“–‡ªìπ摇»…„πÀ≠‘ßμ—Èߧ√√¿å∑’˪√– ∫Õÿ∫—쑇Àμÿ∑’Ë ·μ°μà“ß®“°ºŸâªÉ«¬Õ◊Ëπ (∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å, 2550; ¡“≈’ ‡°◊ÈÕπæ°ÿ≈, ¡.ª.æ.) ¡’¥—ßπ’È 1) °“√„ÀâÕÕ°´‘‡®π∑¥·∑π ‡æ◊ËÕªÑÕß°—π°“√
• 6.
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• 7.
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• 8.
  Journal of NursingScience Chulalongkorn University Vol. 28 No. 1 January-April 20168 √Ÿª∑’Ë 3 °“√º“¬ªÕ¥¥â«¬«‘∏’ Mouth to Mouth ∑’Ë¡“ http://www.fire2fight.com/articles. D: Defibrillation ¬—߉¡à¡’À≈—°∞“π«à“ °√–·  ‰ø®“°‡§√◊ËÕß defibrillator „π°“√™ÁÕ°‰øøÑ“‡æ◊ËÕ°Ÿâ™’æ ·°àÀ≠‘ßμ—Èߧ√√¿å∑’Ë¡’¿“«–À—«„®À¬ÿ¥‡μâπ®–¡’º≈ °√–∑∫„¥Ê μàÕ∑“√°„π§√√¿å ¥—ßπ—Èπ ·π«∑“ß°“√ °Ÿâ™’æμ“¡ ¡“§¡·æ∑¬å‚√§À—«„®¢Õߪ√–‡∑» Õ‡¡√‘°“„πªï §.». 2005 ‰¥â·π–π”„Àâ∑”°“√™ÁÕ° ‰øøÑ“‰¥â„π°√≥’∑’Ë®”‡ªìπ Õ¬à“߉√°Áμ“¡ °àÕπ∑”°“√ ™ÁÕ°‰øøÑ“π—Èπ°Á§«√∂Õ¥‡§√◊ËÕ߇ΩÑ“μ‘¥μ“¡ —≠≠“≥ ™’æ∑—ÈߢÕß¡“√¥“·≈–∑“√°„π§√√¿åÕÕ°°àÕπ‡æ◊ËÕ ªÑÕß°—π‡§√◊ËÕß¡◊Õ‡À≈à“π—Èπ‰¥â√—∫§«“¡‡ ’¬À“¬®“° °“√™ÁÕ°‰øøÑ“∫∑∫“∑π’ȇªìπ∫∑∫“∑°÷ËßÕ‘ √–欓∫“≈ μâÕß∑”μ“¡§” —ËߢÕß·æ∑¬å‡∑à“π—Èπ À≈—ß∑”°“√™à«¬øóôπ§◊π™’æÀ≠‘ßμ—Èߧ√√¿å‰¥â ”‡√Á® 欓∫“≈μâÕ߇ΩÑ“¥Ÿ·≈Õ“°“√¢ÕßÀ≠‘ßμ—Èߧ√√¿å„πÀÕ ºŸâªÉ«¬Àπ—°À√◊ÕÀÕºŸâªÉ«¬«‘°ƒμÕ¬à“ßμàÕ‡π◊ËÕß ‚¥¬ μâÕߪ√–‡¡‘π ¿“æÀ≠‘ßμ—Èߧ√√¿å·≈–∑“√°„π§√√¿å μ≈Õ¥‡«≈“®π°«à“®–¡—Ëπ„®«à“ª≈Õ¥¿—¬∑—ÈßÀ≠‘ßμ—Èߧ√√¿å ·≈–∑“√°„π§√√¿å ´÷Ëß„π√–¬–π’ÈμâÕߪؑ∫—μ‘μ“¡ ·ºπ°“√√—°…“¢Õß·æ∑¬åÕ¬à“߇§√àߧ√—¥ √“¬ß“π Õ“°“√º‘¥ª°μ‘ ‡™àπ ¡’‡≈◊Õ¥ÕÕ°∑“ß™àÕߧ≈Õ¥ À√◊Õ ¡¥≈Ÿ°À¥√—¥μ—«¡“° À√◊Õ∑“√°„π§√√¿å¥‘ÈππâÕ¬≈ß À√◊Õ°“√‡ª≈’ˬπ·ª≈ßÕ◊ËπÊ ∑’Ë ◊ËÕ∂÷ß«à“®–‡°‘¥Õ—πμ√“¬ °—∫À≠‘ßμ—Èߧ√√¿å·≈–∑“√°„π§√√¿å 欓∫“≈μâÕß √“¬ß“π„Àâ·æ∑¬å∑√“∫æ√âÕ¡„Àâ°“√®—¥°“√Õ“°“√ μ“¡·ºπ°“√√—°…“Õ¬à“ß∑—π∑à«ß∑’ 3.4 ∫∑∫“∑°“√ªÑÕß°—π°“√‡°‘¥Õÿ∫—쑇Àμÿ„π À≠‘ßμ—Èߧ√√¿å „π°√≥’°“√¢—∫¢’Ë√∂¬πμå °“√π—Ëß √∂¬πμå (Hyde, Cook, & Olson, 2003) 欓∫“≈ §«√·π–π”À≠‘ßμ—Èߧ√√¿å∑ÿ°√“¬„À⧓¥‡¢Á¡¢—¥π‘√¿—¬ ∑ÿ°§√—Èß∑’Ë„™â¬“πæ“Àπ– ‡π◊ËÕß®“°¡’À≈—°∞“πÕ¬à“ß ™—¥‡®π«à“°“√§“¥‡¢Á¡¢—¥π‘√¿—¬ “¡“√∂≈¥Õ—πμ√“¬ §«“¡√ÿπ·√ßμàÕ∑—Èß¡“√¥“·≈–∑“√°„π§√√¿å °“√ §“¥‡¢Á¡¢—¥π‘√¿—¬∑’ˇÀ¡“– ¡ §◊Õ·∫∫ three points ‚¥¬ “¬‡¢Á¡¢—¥‡ âπ≈à“ß«“ß≈à“ßμàÕÀπâ“∑âÕß  “¬ ‡¢Á¡¢—¥‡ âπ∫π«“ß√–À«à“߇μâ“π¡∑—Èß Õߢâ“ß ·≈– «“߇Àπ◊Õ°÷Ëß°≈“ߢÕß°√–¥Ÿ°‰Àª≈“√â“ °“√«“ß “¬ ‡¢Á¡¢—¥‰«â∫π¡¥≈Ÿ°®–‡ªìπÕ—πμ√“¬μàÕ∑“√°„π§√√¿å‰¥â ·≈–æ÷߇¢â“„®«à“∂ÿ߬“ßπ‘√¿—¬∑’ËæÕßÕÕ°¢≥–√∂‡°‘¥ Õÿ∫—쑇Àμÿ‡æ◊ËÕ°—π°√–·∑√°π—Èπ®–‰¡à™à«¬„π°“√°—π °√–·∑√°„πÀ≠‘ßμ—Èߧ√√¿å √Ÿª∑’Ë 4 «‘∏’°“√§“¥‡¢Á¡¢—¥π‘√¿—¬„πÀ≠‘ßμ—Èߧ√√¿å ∑’Ë¡“ ∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å, 2550 „π°√≥’°“√∫“¥‡®Á∫∑’ˇ°‘¥®“°°“√∂Ÿ°·∑ß·≈– °“√∂Ÿ°¬‘ß∑’ˇ°‘¥®“°°“√‡®μπ“∑”√⓬√à“ß°“¬À≠‘ß μ—Èߧ√√¿å ‡ªìπ‡Àμÿ∑’ˇ°‘π°«à“®–ªÑÕß°—π‰¥â欓∫“≈μâÕß ∑”Àπâ“∑’ˇ¢â“∂÷ß∑’ˇ°‘¥‡ÀμÿÕ¬à“ß√«¥‡√Á«·≈–„Àâ°“√ ™à«¬‡À≈◊Õμ“¡À≈—°°“√¢â“ßμâπÕ¬à“߇√àߥà«π ‚¥¬ ª√– “πß“π°—∫∑’¡ À “¢“«‘™“™’æ‡æ◊ËÕ√à«¡¡◊Õ°—π ∑”ß“π‡ ¡Õ Õπ÷Ëß°“√‡°‘¥Õÿ∫—쑇Àμÿ©ÿ°‡©‘π¿“¬„π∫â“πæ—°¢Õß À≠‘ßμ—Èߧ√√¿å‡ªìπ ‘Ëß∑’˪ÑÕß°—π‰¥â ‚¥¬°“√·π–π” æƒμ‘°√√¡∑’ˇÀ¡“– ¡„π°“√¥”‡π‘π™’«‘μª√–®”«—π„Àâ
• 9.
  «“√ “√欓∫“≈»“ μ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ªï28 ©∫—∫∑’Ë 1 ¡°√“§¡-‡¡…“¬π 2559 9 À≠‘ßμ—Èߧ√√¿å∑√“∫·≈–·π–π”°“√®—¥ ‘Ëß·«¥≈âÕ¡ ‡æ◊ËÕ √â“ߧ«“¡ª≈Õ¥¿—¬ ‡æ◊ËÕ≈¥°“√‡°‘¥Õÿ∫—쑇Àμÿ Õ¬à“ßμàÕ‡π◊ËÕß æ¬“∫“≈μâÕßμ√–Àπ—°„π∫∑∫“∑π’È ‚¥¬„À⧔·π–π”Õ¬à“ß√Õ∫§Õ∫  √ÿª·≈–¢âÕ‡ πÕ·π– À≠‘ßμ—Èߧ√√¿å¡’°“√‡ª≈’ˬπ·ª≈ß∑—Èß√à“ß°“¬ ®‘μ„® Õ“√¡≥å ·≈–§«“¡μâÕß°“√‡≈◊Õ¥·≈– “√ Õ“À“√∑’ˇæ‘Ë¡¡“°¢÷Èπ¢Õß∑“√° ∑—ÈßÀ¡¥≈â«π à߇ √‘¡ „À⇰‘¥Õÿ∫—쑇Àμÿ¢÷Èπ°—∫À≠‘ßμ—Èߧ√√¿å ≈—°…≥–¢Õß Õÿ∫—쑇Àμÿ©ÿ°‡©‘π∑’Ëæ∫∫àÕ¬„πÀ≠‘ßμ—Èߧ√√¿å ¡’ 2 ™π‘¥ §◊Õ Õÿ∫—쑇Àμÿ™π‘¥¡’°“√°√–·∑°∫√‘‡«≥∑âÕß ·≈– °“√‡°‘¥Õÿ∫—쑇Àμÿ™π‘¥¡’°“√·∑ߢÕß«—μ∂ÿ‡¢â“„π√à“ß°“¬ º≈°√–∑∫∑’Ë√ÿπ·√ß®“°Õÿ∫—쑇Àμÿ©ÿ°‡©‘π∑’ËÀ≠‘ßμ—Èߧ√√¿å ‰¥â√—∫ §◊Õ √°≈Õ°μ—«°àÕπ°”Àπ¥´÷Ëßπ”¡“ Ÿà°“√‡ ’¬ ™’«‘μ¢Õß∑“√° °“√∫“¥‡®Á∫¢Õß¡¥≈Ÿ° À√◊Õ°“√∫“¥ ‡®Á∫√–∫∫Õ◊Ëπ∑’Ë√ÿπ·√ßπ”¡“ Ÿà°“√‡ ’¬™’«‘μ∑—Èß¡“√¥“ ·≈–∑“√°„π§√√¿å °“√¥Ÿ·≈À≠‘ßμ—Èߧ√√¿å∑’˪√– ∫ Õÿ∫—쑇Àμÿ§«√∑”‡ªìπ¢—ÈπμÕπ √Õ∫§Õ∫ √«¥‡√Á« ·≈– ¡’°“√ª√÷°…“°—πÕ¬à“߇À¡“– ¡√–À«à“ß∑’¡·æ∑¬å ºŸâ‡™’ˬ«™“≠„π “¢“μà“ßÊ ‡æ◊ËÕ„À≥â¢âÕ¡Ÿ≈§√∫∂â«π ·≈–‡À¡“– ¡π”¡“´÷Ëß°“√¥Ÿ·≈ºŸâªÉ«¬Õ¬à“ß¡’ ª√– ‘∑∏‘¿“æ ©–π—Èπ 欓∫“≈«‘™“™’æ∑’Ë„Àâ∫√‘°“√°Ÿâ™’æ ©ÿ°‡©‘πÀ√◊ÕÕÕ°„Àâ∫√‘°“√À≠‘ßμ—Èߧ√√¿å ≥ ®ÿ¥ ‡°‘¥‡Àμÿ ®÷ßμâÕß¡’§«“¡√Ÿâ‡°’ˬ«°—∫°“√‡ª≈’ˬπ·ª≈ß √–∫∫μà“ßÊ ¢Õß√à“ß°“¬„πÀ≠‘ßμ—Èߧ√√¿å ‡æ◊ËÕ„Àâ°“√  à߇ √‘¡¿“«– ÿ¢¿“æ ªÑÕß°—π°“√‡°‘¥Õÿ∫—쑇Àμÿ√«¡ ∑—Èߪ√–‡¡‘π·≈–®—¥°“√¥Ÿ·≈‰¥âμ“¡∫∑∫“∑¢Õßμπ ‡¡◊ËÕμâÕߥŸ·≈À≠‘ßμ—Èߧ√√¿å∑’Ë®ÿ¥‡°‘¥Õÿ∫—쑇Àμÿ„π°√≥’ μà“ßÊ ‚¥¬¡ÿàßÀ«—ß„Àâ¡“√¥“·≈–∑“√°ª≈Õ¥¿—¬§◊Õ ‡ªÑ“À¡“¬ Ÿß ÿ¥ ‡Õ° “√Õâ“ßÕ‘ß ¿“…“‰∑¬ ∏“√“ß√—μπå À“≠ª√–‡ √‘∞æß…å. (2550). Õÿ∫—쑇Àμÿ„π À≠‘ßμ—Èߧ√√¿å.  ß¢≈“π§√‘π∑√凫™ “√, 25 (5), 437-445. ¡“≈’ ‡°◊ÈÕπæ°ÿ≈. (¡.ª.æ.). ‡Õ° “√ª√–°Õ∫°“√ Õπ: °“√欓∫“≈¡“√¥“μ—Èߧ√√¿å„π¿“«–©ÿ°‡©‘π. ¿“§«‘™“°“√欓∫“≈¡“√¥“∑“√°·≈–°“√ º¥ÿߧ√√¿å «‘∑¬“≈—¬æ¬“∫“≈∫√¡√“™™ππ’ °√ÿ߇∑æ. (Õ—¥ ”‡π“). √æ’æ√ ‚√®π巠߇√◊Õß. (¡.ª.æ.). ‡Õ° “√ª√–°Õ∫ °“√ Õπ: °“√°Ÿâ™’æ„πÀ≠‘ßμ—Èߧ√√¿å. ¿“§«‘™“ ‡«™»“ μ√å©ÿ°‡©‘π §≥–·æ∑¬»“ μ√å ‚√ß æ¬“∫“≈√“¡“∏‘∫¥’. (Õ—¥ ”‡π“). «√ÿ≥ ‘√‘ Àß å≈¥“√¡¿å ·≈–‡øóòÕß≈¥“ ∑Õߪ√–‡ √‘∞. (2556). Trauma in pregnancy. ¿“§«‘™“ Ÿμ‘- »“ μ√å·≈–π√’‡«™«‘∑¬“ §≥–·æ∑¬»“ μ√å ¡À“«‘∑¬“≈—¬‡™’¬ß„À¡à. ◊∫§âπ‡¡◊ËÕ«—π∑’Ë 25 惻®‘°“¬π2558http://www.med.cmu.ac.th/ dept/obgyn.  ÿæ√ ·°â«»‘√‘«√√≥. (2556). °“√欓∫“≈„π√–¬– μ—Èߧ√√¿å.  ”π—°æ‘¡æå·Ààß®ÿÓ≈ß°√≥å- ¡À“«‘∑¬“≈—¬.  ”π—°π‚¬∫“¬·≈–¬ÿ∑∏»“ μ√å ·≈– ”π—° à߇ √‘¡  ÿ¢¿“æ °√¡Õπ“¡—¬ °√–∑√«ß “∏“√≥ ÿ¢. (2552). Õ—μ√“°“√쓬¢Õß¡“√¥“.  ◊∫§âπ‡¡◊ËÕ «—π∑’Ë 25 惻®‘°“¬π 2558. ®“° http:// healthdata.moph.go.th/mdg/report. Õÿ∫≈ ¬’ˇŒß. (2552). °“√ª√–‡¡‘πºŸâªÉ«¬‡®Á∫ ≥ ®ÿ¥ ‡°‘¥‡Àμÿ. ‡Õ° “√ª√–°Õ∫°“√∫√√¬“¬æ‘‡»…∑’Ë ‚√߇√’¬π欓∫“≈ °Õß°“√»÷°…“ °√¡·æ∑¬å ∑À“√‡√◊Õ. (Õ—¥ ”‡π“). .........................
• 10.
  Journal of NursingScience Chulalongkorn University Vol. 28 No. 1 January-April 201610 ¿“…“Õ—ß°ƒ… American Heart Association Emergency Cardiovascular Care Committee. (2015). Cardiac arrest in pregnancy: A scientific statement from the American Heart Association. CINAHL Plus. Cunningham, F.G., Leveno, K.L., & Bloom, S.L. (2005). Williams Obstetrics, (22nd ed.). New York: McGraw-Hill. Grossman, N.B. (2004). Blunt trauma in pregnancy. Am Fam Physician, 70(7), 1303-1310. Horstmann, P., Larsen, C.F., & Grønborg, H. (2014). Adherence to protocol in pregnant trauma patients? A 12-year retrospective study. Eur J Trauma Emerg Surg, 40, 561›566. Hyde, L.K., Cook, L.J., & Olson, L.M. (2003). Effect of motor vehicle crashes on adverse fetal outcomes. Obstet Gynecol, 102, 279-286. Jacob, S.,†Bloebaum, L.,†Shah, G., &†Varner, M.W. (1998). Mortality in Utah. Obstet Gynecol, 91, 187-191. Marshall, D., Lindheimer, S.J.T. & Cunningham, F.G. (2009). ASH position paper: Hyper- tension in pregnancy. The Journal of Clinical Hypertension, 11(4), 214-225. Mendez-Figueroa, H., Dahlke, J.D., & Rouse, D.J. (2013). Trauma in pregnancy: An updated systematic review. Inc. Mosby. Pak, K.M., & Hardasmalani, M. (2015). A Multidisciplinary obstetric trauma resuscitation using In Situ High-Fidelity Simulation. CINAHL Plus. Petrone, P., Talving, P.,†Browder, T.,†Teixeira, P.G.,†Fisher, O.,†Lozornio, A.,†& Chan, L.S. (2011). Abdominal injuries†in†pregnancy: A 155-month study at two level 1 trauma centers. Division of Acute Care Surgery. CINAHL Plus. Rush, C. (2009). Book review:†Advanced† trauma†life†support†for†doctors: ATLS student course manual, (8th ed.). Spring, 32(1), 14. Sugrue, M.E., & Connor, M.C.D. (2004). Amours S. trauma during pregnancy. J ADF Health, (5), 24-28.
• 11.
  «“√ “√欓∫“≈»“ μ√å ®ÿÓ≈ß°√≥å¡À“«‘∑¬“≈—¬ ªï28 ©∫—∫∑’Ë 1 ¡°√“§¡-‡¡…“¬π 2559 11 Abstract Accidental trauma is the most common cause of non obstetric death among pregnant women. Many physiologic changes have occurred during pregnancy, therefore, a comprehen- sive understanding of these changes is important in pregnant trauma care because it enables the best outcome for both mother and fetus. Helping pregnant women who have an emer- gency accident requires team work. The nurse must recognize their roles in both independent and semi- independent roles under the ethics and nursing law. This article aimed at describing nursesû roles in caring for pregnant women with emergency accident. These roles are: First, assessment of pregnant women and fetus. Second, first aid for emergency accident pregnant women. Third, cardiac arrest resuscitation. Fourth, accidental prevention. Keywords: Nursesû role/Trauma pregnant women/Emergency accident. Nurseûs Role in Caring for Pregnant Women with Emergency Accident Chutchavarn Wongsaree* and Thanannipha Phuksuknithiwat** * Instructor Faculty of Nursing Western University, 600 Salongrua, Huai Krachao, Kanchanaburi 71170 Thailand. Email: [email protected] **Dean Faculty of Nursing Western University, 123 Liangmaung Rd., Maung, Burirum 31000, Thailand. Journal of Nursing Science Chulalongkorn University 2016; 28(1): 1-11