Aortic Dissection ne Yafunu mu Aortic Aneurysm a Apaapae (AAA) Triage¶

Acute aortic dissection ne ruptured abdominal aortic aneurysm (AAA) yɛ koma ne ntini mu nsɛm a egye ntɛmpɛ a egye bere kɛse wɔ nnuruyɛ mu no mu abien, na ebetumi ama mogya a ɛtɔ kɔ nipadua no mu a edi awu anaasɛ akwaa ahorow no di huammɔ wɔ simma kakraa bi mu. Esiane sɛ aorta no ne ntini titiriw a ɛwɔ nhyɛso kɛse a ɛde mogya a oxygen wom fi koma no mu kɔ amemene, nsa, akwaa, ne nan mu tẽẽ nti, ntetew biara a ɛbɛtetew ne mu fasu mu (a wɔatwa) anaasɛ ɛbɛpae afa ɔfã bi a ayɛ mmerɛw (aneurysm a apaapae) no hwehwɛ sɛ wɔyɛ oprehyɛn ntɛm ara. Mmoa a edi kan no twe adwene si frankaa kɔkɔɔ ho sɛnkyerɛnne ahorow a wobehu ntɛmntɛm so, afrɛ nnuruyɛfo a wɔhwɛ ntɛmpɛ so de ntini mu kɔkɔbɔ a ɛda adi pefee, ma onipa no ayɛ dinn koraa na amma mogya mmoroso ankɔ soro, na wɔakwati nnuru te sɛ aspirin a ɛma mogya tu no mu yɛ den.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara na bɔ amanneɛ sɛ "Suspected Acute Aortic Emergency" anaa "Suspected Ruptured Aortic Aneurysm." Brɛ 911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom, anaa hwɛ ne nyinaa nɔma ahorow a egye ntɛmpɛ. Sɛ ɔyarefo no wɔ aortic aneurysm a wonim, Marfan syndrome, bicuspid aortic valve, anaasɛ ne koko, akyi, anaa yafunu mu yaw a ɛtetew mpofirim a ɛma ɔtotɔ piti ka kyerɛ nea ɔde rekɔma no no pefee, sɛnea ɛbɛyɛ a wobetumi asoma ambulance a ɛkɔ anim a ɛboa nkwa na wɔabɔ ayaresabea a wotumi yɛ koma ne ahurututu anaa ntini mu oprehyɛn kɔkɔ.
2. Fa onipa no to n’akyi petee (anaasɛ fa baabi a ɛyɛ fɛ a ɔde ne ho to fam fã bi sɛ ahome tiawa a) na hyɛ nipadua mu ahomegye koraa. Mma onipa no nsɔre, nkɔ aguaree, anaasɛ mfi adi nkɔ ambulance no nkyɛn. Nipadua mu mmɔdenbɔ, nhyɛso, anaa gyinabea mpofirim biara ma koma no bɔ ne mogya mmoroso (adwennwen a ɛma obi twitwa) kɔ soro a ebetumi ama aortic tear anaa retroperitoneal hematoma a ɛwɔ mu no mu apaapae koraa akɔ koko anaa yafunu mu.
3. Gye aduane, nsuo, nsuo, ne nnuru a wɔnom nyinaa, titire aspirin ne nitroglycerin. Ma onipa no nnyɛ hwee koraa wɔ ano (NPO) ɛfiri sɛ ɛbɛhia sɛ wɔde aduru a wɔde kum nipadua no ntɛm ntɛm ara bere a wɔadu ayaresabea no. Mfa aspirin, clopidogrel, anaa nitroglycerin a wɔde petepete kasa ase no mma gye sɛ oduruyɛfo bi a wakyerɛ sɛ aortic yare no nni hɔ pefee.
4. Ma onipa no nyɛ komm, yɛ komm, na ɔnyɛ normothermic bere a woma akanea a ɛhyerɛn no yɛ kusuu na wotew nkate mu ehu so. Ehu ne ɛyaw a emu yɛ den ma adrenaline asorɔkye akɛse (epinephrine ne norepinephrine) kɔ mogya no mu, na ɛma mogya mmoroso a ɛwɔ nipadua no mu ne aortic fasu mu nhyɛso kɔ soro. Fa nne a ɛma awerɛhyem kasa brɛoo, sansan abɔso anaa kɔla a ɛyɛ den, na fa kuntu biako kata onipa no so kakra na amma ne ho anwosow a woremma ne hyew dodo.
5. Hwɛ pulses wɔ wo nsateaa abien no nyinaa mu na hyɛ mmerɛwyɛ biara a ɛwɔ ɔfã biako, ɛyɛ mmerɛw, anaa mogya mmoroso mu nsonsonoe nsow. Sɛ wowɔ ofie mogya mmoroso cuff a, susuw mogya mmoroso wɔ basa nifa ne benkum nyinaa bere a woretwɛn ayarehwɛfo, na kyerɛw nɔma no. Te radial pulse no nka brɛoo wɔ wo nsateaa abien no nyinaa so anaasɛ hwɛ sɛ nan biako ayɛ mmerɛw mpofirim, awɔw wom, anaasɛ abubu, efisɛ aortic dissection taa siw nkorabata a ɛma nsa biako, amemene no, anaa nan no aduan no kwan.
6. Bue apon mu, boaboa aduruyɛ ho kyerɛwtohɔ anaa mfiri nkrataa a wɔde ahyɛ mu ano, na siesie wo ho ma CPR ntɛm ara sɛ onipa no hwe ase a. Ma obi a ɔrehwɛ no mmue anim pon no na mmue ɔkwan bi mma ambulance stretcher no. Sɛ onipa no ntumi nyɛ hwee na ogyae home sɛnea ɛsɛ a, fi ase ntɛm ara CPR a wɔde yɛ adwuma a wɔde mia ne koko a wɔbɔ no mpɛn 100 kosi 120 simma biara.

Ntɛmntɛm triage ne nsonsonoe gyinaesi dua¶

Fa ayaresabea nhyehyɛe yi kyerɛ nsonsonoe a ɛda ahurututu mu aortic dissection a emu yɛ den, yafunu mu aortic aneurysm a ɛpaapae, ne koma mu ntini a ɛyɛ mmerɛw anaa akyi ntini a ɛyɛ den a wɔtaa yɛ wɔ simma a edi kan wɔ ɔhaw bi mu no ntam.

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    SuspectAorta --> CallEMS["Frɛ 911 / 112 / 999 Ntɛm ara:<br/>Pae mu ka sɛ ‘Wosusuw sɛ Aortic Dissection anaasɛ Ruptured AAA’<br/>Srɛ sɛ wɔmfa nkɔ Vascular / Cardiothoracic Center"]

    CallEMS --> NoAspirin["NKYERƐKYERƐMU A ƐHO HIA:<br/>1. MMA Aspirin anaa nnuru a ɛma mogya yɛ mmerɛw<br/>2. MMA aduan anaa nsu (Sie NPO ma wɔyɛ oprehyɛn)<br/>3. MMA ɔyarefo no nnyina hɔ, ɔnnantew, anaa ɔmfa ne ho nhyɛ mu"]

    NoAspirin --> LocationCheck{"Ɛhe na ɛyaw titiriw<br/>no wɔ na dɛn ne nsɛnkyerɛnne no?"}

    LocationCheck -->|"Anim koko anaa akyi atifi wɔ mmati ntam<br/>Abasa a ɛbɔ a ɛnyɛ pɛ / BP anaa stroke sɛnkyerɛnne"| DissectionCare["Suspected Thoracic Aortic Dissection (Type A / B):<br/>- Ma wo ho dwo na wo ho yɛ komm (semi-reclined anaa flat)<br/>- Susuw BP wɔ nsa nifa ne benkum ABIEN NO nyinaa mu sɛ cuff wɔ hɔ a<br/>- Hwɛ yiye sɛ ebia stroke, tamponade, anaa mframa kwan no asɛe anaa"]

    LocationCheck -->|"Yafunu mfinimfini, akyi ase, anaa flank/groin<br/>Pale, clammy, dizzy, hypotensive, anaa >60 yrs smoker"| AAACare["Wosusuw sɛ Yafunu mu Aortic Aneurysm a Apaapae (AAA):<br/>- Da fam tratraa wɔ akyi; MMFA yafunu no nhyɛ mu kɔ akyiri<br/>- Fa kuntu ma wo ho nyɛ hyew na amma hypothermia ankɔ<br/>- Siesie wo ho ma hypovolemic shock ne oprehyɛn a wɔde bɛkɔ baabi foforo ntɛmntɛm"]

    RedFlags -->|"DABI: Nhyɛso/ahyɛnsode nkakrankakra koko mu yaw,<br/>basa a ɛbɔ pɛpɛɛpɛ, tetew biara mfi ase"| CheckMI["Hwɛ sɛ Acute Coronary Syndrome / Koma Yareɛ:<br/>Hwɛ Koma Yareɛ Akwankyerɛ ma EMS & aspirin protocol a wɔahyɛ da ayɛ"]

Aortic ntɛmpɛ abien a ɛde nkwa to asiane mu no ntease¶

Ɛwom sɛ tebea abien no nyinaa fa nipadua no ntini kɛse a ɛsen biara no nhyehyɛe mu huammɔdi ho de, nanso acute aortic dissection ne ruptured abdominal aortic aneurysm (AAA) nam mfiri ahorow so nam, ɛbɔ ayarefo no nsɛm a ɛsono emu biara kakra, na ɛhwehwɛ sɛ wɔfa ayaresabea akwan horow a ɛda nsow.

1. Acute Aortic Dissection: Nsu a ɛwɔ mu a ɛyɛ nhyɛso kɛse¶

Aorta a ɛte apɔw no fasu no yɛ nketenkete abiɛsa: emu ade a ɛyɛ tratraa (tunica intima), mfinimfini a ɛyɛ den a ɛyɛ ntini a ɛyɛ den (tunica media), ne akyi nhama a ɛyɛ den (tunica adventitia). Wɔ aortic dissection mu no, tetew mpofirim wɔ intimal lining a ɛwɔ mu no mu, mpɛn pii no wɔ koko (thoracic aorta) mu baabi a mogya fi koma no mu ntɛmntɛm.

Sɛ mogya fa saa mu nusu yi mu wɔ systolic nhyɛso ase pɛ a, ɛpaapae (ɛpaapae) mfinimfini ntini no mu, na ɛyɛ "atoro lumen" (mogya kwan a ɛto so abien a ɛnyɛ ne kwan so) kɔ fam anaa ɛkɔ soro wɔ aorta no tenten mu. Bere a saa atoro kwan yi de mogya tu no, ɛkanyan asiane anan a ɛde nkwa to asiane mu ntɛm ara: - Rupture into the pericardial sac (Cardiac Tamponade): Sɛ dissection no kɔ akyi kɔ koma no mu kɔ pericardial sac a atwa koma no ntini ho ahyia no mu a, mogya hyɛ kotoku no ma na ɛpia koma no kosi sɛ entumi nkɔ pump, na ɛde owu mpofirim ba. - Acute aortic valve regurgitation: Nsuo no tumi yi aortic valve no nhaban no mu, na ɛma mogya hwie kɔ akyi kɔ benkum ventricle no mu na nsuo ahyɛ ahurututu no mu ma (flash pulmonary edema). - Coronary artery occlusion: Dissecting flap no tumi twitwa fa nifa anaa benkum coronary artery no bue mu, na ɛkanyan ankasa bere koro mu komayare. - Branch vessel malperfusion (Stroke, Paraplegia, Visceral Ischemia): Bere a atoro lumen no twitwiw kɔ aorta no ase no, emu flap a ayɛ kɛse no betumi atwitwa carotid ntini a ɛma amemene no aduan no (na ɛde ntɛm ara ba ɔyare a ɛma obi hwe ase).

Ayaresafo de Stanford Classification System a ɛkyerɛ sɛnea wɔhwɛ wɔn ntɛm ara ma wonya nkwa no na ɛkyekyɛ aortic dissections mu: - Stanford Type A Dissection: Ɛfa ascending aorta (ɔfã a edi kan a ɛsɔre fi koma no mu tẽẽ) ne/anaasɛ aortic arch no ho, ɛmfa ho sɛnea ɛkɔ fam kodu. Type A dissections yɛ oprehyɛn a egye ntɛmpɛ a nnipa a wowuwu no kɔ soro bɛyɛ ɔha biara mu nkyem 1 kosi 2 wɔ dɔnhwerew biara mu wɔtwentwɛn oprehyɛn a wosiesie no ase wɔ nnɔnhwerew 48 a edi kan no mu. - Stanford Type B Dissection: Efi ase wɔ descending thoracic aorta (a ɛboro benkum subclavian artery a ɛma benkum nsa no aduan) na ɛkɔ fam kɔ ​​yafunu no mu. Wɔde mogya mmoroso a wɔde fa ntini mu denneennen ne koma bɔ a wɔhwɛ so ("anti-impulse therapy") di Type B dissections ho dwuma mfiase no, ne endovascular stent-graft repair (TEVAR) sɛ mogya kɔm de akwaa ahorow anaasɛ ɔfasu no hunahuna sɛ ɛbɛpae a.

2. Ruptured Abdominal Aortic Aneurysm (AAA): Ɔfasu a ɛpaee no ayɛ mmerɛw¶

aneurysm yɛ ntini no fasu no fã abiɛsa no nyinaa a ɛtrɛw (ballooning) a ɛtra hɔ daa, a ɛnam nhama a ɛyɛ den ne collagen a ɛsɛe bere tenten nti. Bere a ntini a ɛyɛ mmerɛw betumi aba wɔ koko mu (thoracic aortic aneurysm) no, ɛtaa ba yafunu a ɛwɔ fam a ɛwɔ asaabo ntini no ase (infrarenal abdominal aortic aneurysm, anaa AAA), baabi a mpanyimfo aorta a ɛteɛ no kɛse bɛyɛ sentimita 2.0 (nsateakwaa 0.8). Sɛ saa fã no trɛw boro sentimita 3.0 (nsateakwaa 1.2) a, wɔkyerɛ ase sɛ ntini a ɛma mogya tu; sɛ ɛboro sentimita 5.0 kosi 5.5 (nsateakwaa 2.0 kosi 2.2) pɛ a, asiane a ɛwɔ hɔ sɛ ɔfasu no bɛpaapae ara kwa no kɔ soro kɛse.

Yafunu mu aortic aneurysms dodow no ara nyin komm mfe pii a ɛmma sɛnkyerɛnne biako mpo mma kosi sɛ ɛbɛtrɛw mpofirim anaasɛ ɛbɛtetew (AAA a apaapae). Sɛ AAA pae a, mogya fi aorta no mu kɔ mmeae abien no mu biako: - Free Intraperitoneal Rupture: Aneurysm no anim fasu no pae tẽẽ kɔ yafunu no mu a abue no mu. Mogya a ɛtɔ kɛse no ba wɔ simma kakraa bi mu, na mpɛn pii no ɛma koma no gyaw ntɛm ara ansa na ambulance no aba. - Contained Retroperitoneal Rupture (The Golden Triage Window): Wɔ ayarefo dodow no ara a wɔtra ase kyɛ sɛnea ɛbɛyɛ a wobedu ayaresabea no, ntini a ɛma mogya tu no tetew kɔ retroperitoneal space a ɛyɛ den no mu wɔ yafunu no akyi (a ɛbɛn akyi berɛmo ne psoas ntini ahorow no). Ntini a atwa ho ahyia ne mogya mmoroso a ɛrekɔ fam no siw nsu a ɛretu no ano (plug) bere tiaa bi simma 30 kosi nnɔnhwerew pii. Nanso, sɛ ɔyarefo no bɔ ne ho mmɔden, ɔhyɛ no den, anaasɛ onya nsu a ɛboro so a wɔde fa ntini mu ma ɛma ne mogya mmoroso kɔ soro dodo a, saa akyi berɛmo mu ntini a ɛyɛ mmerɛw yi bɔ, na ɛdan mogya a ɛtwetwe a ɛwɔ mu a ebetumi atra ase no ma ɛbɛyɛ mogya a ekum a enni mu.

Ntotoe a edi mũ: Aortic Dissection vs. Ruptured AAA vs. Koma mu Yare¶

Esiane sɛ koko, akyi, ne yafunu mu yaw yɛ anwiinwii a ɛtaa ba nti, wɔn a wɔde nneɛma a egye ntɛmpɛ kɔ ne wɔn a wɔhwɛ no taa bu aortic asiane ahorow no mu wɔ ɔkwan a ɛnteɛ so sɛ komayare, asaabo mu abo, anaa sciatica. Hwɛ ntotoho pon yi mu na woahu agyiraehyɛde ahorow a ɛda nsow:

Frɛko kɔkɔɔ ho sɛnkyerɛnne ahorow a wobehu no kɔ akyiri¶

Nsɛnkyerɛnne a ɛyɛ tete ne nea ɛnyɛ nea wɔtaa hu a ɛkyerɛ sɛ Acute Aortic Dissection¶

Sɛnea International Registry of Acute Aortic Dissection (IRAD) ne ACC/AHA akwankyerɛ ahorow kyerɛ no, ayarefo a wɔatwa wɔn aortic a emu yɛ den no mu bɛboro ɔha biara mu 90 te ɛyaw mpofirim, nanso mfiase no wohu sɛ ɛyɛ ɔha biara mu nkyem 30 wɔ ɔkwan a ɛnteɛ so. Hwɛ saa ayaresabea akuw yi:

1. Ɛyaw a ɛba mpofirim, a ɛsen biara bere a efi ase "tetew" anaasɛ "ɛpaapae": Nea ɛnte sɛ komayare a ɛkɔ soro nkakrankakra wɔ simma pii mu no, ɛyaw a ɛba wɔ aortic dissection mu no du kɛse wɔ sekan a edi kan no mu bere a intimal layer no mu tetew no. Ayarefo ka ho asɛm sɛ ɛte sɛ nea "te sɛ biribi a atetew me moma so" anaasɛ "te sɛ nea wɔde sekan abɔ me mmati ntam."
2. Ɛyaw kwan a ɛkɔ baabi foforo: Bere a dissection no tetew aorta no mu kɔ akyiri fi koko no mu kɔ yafunu no mu no, ɛyaw no betumi afi ase wɔ anim koko anaa menewa mu, akɔ mmati no ntam simma 10 akyi, na afei ahyew wɔ akyi anaa asen no ase.
3. "Pain Plus One" (Chest/Back Pain Combined with Neurological or Limb Symptoms): Bere biara a koko anaa akyi yaw bɛba a ntini mu yare anaa akwaa a ɛyɛ nwini no, susuw ho aortic dissection kan:
4. Koko/akyi yaw + Stroke sɛnkyerɛnne: Sɛ wɔtrɛw kɔ carotid ntini mu a, ɛma ɔfã biako yɛ mmerɛw mpofirim, n’anim hwe ase, anaasɛ ɔkasa hwere. (Ayaresabea kɔkɔbɔ a ɛho hia: Ɛkame ayɛ sɛ nnuru a ɛma mogya tu te sɛ tPA/tenecteplase a wɔde fa ntini mu ma ɔyarefo a ɔyare a ɔyare a ɔyare a ɔyare a ɛma mogya tu a ɛnam Type A aortic dissection a ahintaw mu na ɛde ba no yɛ owuyare wɔ amansan nyinaa mu.)
5. Koko/akyi yaw + Paraplegia (Paralyzed Legs): Sɛ wɔtwitwa akyi berɛmo mu ntini (titiriw Adamkiewicz ntini) a, ɛma anan abien no nyinaa yɛ mmerɛw mpofirim na ɛyɛ mmerɛw.
6. Akoko/akyi yaw + Acute Limb Ischemia: Subclavian anaa iliac artery a esiw no ma nsa anaa nan biako yɛ fitaa a awu, awɔw yɛ nsukyenee, enni koma, na ɛyɛ yaw.
7. Painless Syncope (Fainting) wɔ ɔha biara mu nkyem 5 kosi 10 mu: Bɛyɛ ayarefo 10 biara mu 1 a wɔayɛ wɔn Type A dissection no totɔ piti a wɔmmɔ amanneɛ sɛ wɔn koko mu yaw kakraa bi anaasɛ wonni bi koraa, mpɛn pii no esiane sɛ mogya akɔhyɛ koma no akyi (cardiac tamponade) anaasɛ wɔatwa carotid mogya a ɛkɔ no mu bere tiaa bi nti.

Classic triad ne "masquerades" a ɛkyerɛ sɛnea Yafunu mu Aortic Aneurysm a Apaapae (AAA) .¶

Adesua nhoma abiɛsa a wɔtaa de di dwuma ma AAA a apaapae no yɛ yafunu/akyi/akyi ɛyaw a ɛba mpofirim, hypotension anaasɛ syncope, ne yafunu mu a ɛyɛ pulsatile mass. Nanso nhwehwɛmu ahorow a efi UK National Institute for Health and Care Excellence (NICE) ne Society for Vascular Surgery (SVS) hɔ kyerɛ sɛ nneɛma abiɛsa no nyinaa bom ba wɔ AAA ayarefo a wɔapaapae no mu nea ennu ɔha biara mu nkyem 50 mu. Mmom no, hwɛ clinical masquerades abiɛsa a abu so sen biara no:

Hena na ɔwɔ asiane kɛse mu: awosu mu nneɛma, aduruyɛ, ne asetra kwan¶

Asiane ho abakɔsɛm a wɔde bɛkyɛ 911 / 112 / 999 dispatcher ne ntɛmpɛ dan mu triage ɔyarehwɛfo no yɛ akwan a ɛyɛ ntɛm sen biara a wɔfa so kanyan mpa ho ultrasound anaa CT angiogram ntɛm ara no mu biako.

Mmoa a edi kan a wɔde ma anammɔn anammɔn ne ɔhwɛ a wɔde ma ansa na wɔakɔ ayaresabea bere a wɔretwɛn EMS no¶

Sɛ worehwɛ obi a wosusuw sɛ watwa aortic dissection anaasɛ abdominal aortic aneurysm a apaapae ansa na nnuruyɛfo a wɔboa no aba a, wɔayɛ adeyɛ biara sɛ bɛtew aortic wall shear stress so na akora clot a ɛwɔ mu so.

Anamɔn 1: Positioning ma hemodynamic gyina pintinn¶

• Wɔsusu sɛ Thoracic Aortic Dissection (akyi/akyi atifi yaw, mpɛn pii no mogya mmoroso): Boa wɔn ma wɔda gyinabea a ɛmma ɛyaw kakraa bi na ɛma wɔhome, mpɛn pii no supine (ɛyɛ tratraa wɔ akyi) anaa semi-Fowler’s (ti ne mmati a wɔde gyina hɔ brɛoo wɔ 30-degree angle). Mma nhyɛ ɔyarefo a ɔrepere sɛ ɔbɛhome da sɛ ɔnda fam koraa.
• Wɔsusu sɛ Ruptured AAA anaasɛ nsɛnkyerɛnne a ɛkyerɛ sɛ ahodwiriw (pale, cold, clammy, dizzy, faint): Fa wɔn to wɔn akyi tratraa koraa. MMFA nan no so denneennen sɛ ɛma yafunu mu yɛ wo yaw a, na mma ɛntra hɔ tẽẽ anaasɛ ennyina hɔ da, efisɛ sɛ wotra soro a, ɛma mogya a aka no fi amemene ne koma no ho.
• Onnim anaasɛ ɔde nnam fe: Bobɔw wɔn brɛoo kɔ wɔn nkyɛn kɔ lateral recovery position sɛ unit biako (log-roll style, a wonkyinkyim torso) sɛnea ɛbɛyɛ a ɔfe ntumi nkɔ ahurututu no mu.

Anamɔn 2: MMFA wo nsa nka anaa mia yafunu a ɛrebɔ denneennen no so kɛse¶

Sɛ wuhu anaa wususuw sɛ biribi a ɛrebɔ wɔ onipa no yafunu mfinimfini a, mmia wɔn yafunu so kɛse mfa nhwɛ, na mma wɔn a wɔwɔ adwempa npia ne yafunu. Nsa nhyɛso a emu dɔ wɔ yafunu mu aortic aneurysm a ɛwɔ ɔfasu teateaa a ɛretu so no betumi de mfiri asɛe akyi berɛmo mu ntini a ɛyɛ mmerɛw no na ama apaapae ntɛm ara.

Anamɔn 3: Sɛnea wɔde nsa abien yɛ mogya mmoroso ne koma a ɛbɔ ho nhwehwɛmu¶

Sɛ dijitaal ofie mogya mmoroso kyerɛwtohɔ bɛn hɔ na ɛde di dwuma a ɛrentwentwɛn so sɛ wɔbɛfrɛ wɔn a wɔhwɛ ntɛmpɛ so anaasɛ ɛrenhaw ɔyarefo no: 1. Sua na kyerɛw mogya mmoroso ne koma bɔ wɔ basa nifa atifi. 2. Ntɛm ara fa cuff no kɔ benkum atifi nsa na susuw mogya mmoroso wɔ hɔ. 3. Nea akontaahyɛde no kyerɛ: Wɔ obi a ɔwɔ apɔwmuden mu no, mogya mmoroso a ɛkɔ nipadua no mu wɔ nsa nifa ne benkum ntam no yɛ soronko a ennu \(10\text{ mmHg}\). systolic mogya mmoroso nsonsonoe a ɛboro \(20\text{ mmHg}\) wɔ nsa nifa ne benkum ntam (a wɔde abɔ mu ne koko anaa akyi yaw a emu yɛ den) kyerɛ sɛ ebia aortic dissection flap resiw subclavian ntini no biako kwan. Fa nɔma abien no nyinaa ho amanneɛ pɛpɛɛpɛ kyerɛ nnuruyɛfo a wɔboa wɔn no bere a wɔadu hɔ ara pɛ.

Anamɔn 4: Nipadua mu kommyɛ ("Verbal Beta-Blockade") .¶

Wɔ ayaresabea dwumadibea a wɔhwɛ ntɛmpɛ so no, aduruyɛ a edi kan a wɔde sa aortic dissection ne beta-blockers a wɔde fa ntini mu (te sɛ esmolol anaa labetalol) a ɛma koma no bɔ ba fam sen \(60\text{ beats per minute}\) ne systolic mogya mmoroso wɔ \(100\text{ ne }120\text{ mmHg}\) ntam, na ɛtew tumi a koma biara bɔ wɔ aortic fasu a ɛtete no so no so. Wɔ fie no, ansa na IV nnuru bɛba no, ehu ne ɛyaw ne ɔtamfo: - Yi nnipadɔm a ehu aka wɔn no fi dan no mu na tete ɔyarefo no ma ɔhome brɛoo na ɔhome brɛoo, kwati katee sɛ ɔbɛkura wɔn home mu anaasɛ ɔbɛbrɛ ase (kwati Valsalva maneuver, a ɛma aortic nhyɛso kɔ soro). - Ma nneɛma a atwa yɛn ho ahyia no nyɛ komm na ma wɔn awerɛhyem sɛ mmoa yɛ simma kakraa bi.

Anamɔn 5: Ɔhyew ahobammɔ a wɔhwɛ so (Preventing the Lethal Triad) .¶

Wɔ ɔyarefo a ne AAA apaapae a mogya retu no wɔ ne mu fam no, nipadua mu hyew so tew ntɛmntɛm. Hypothermia (nipadua mu hyew a ɛba fam sen \(35^\circ\text{C}\) anaa \(95^\circ\text{F}\)) ma mogya no mu enzymes ne mogya nkwammoaa a ɛma mogya tu no nyɛ adwuma, na ɛma mogya a ɛba nipadua no mu no yɛ kɛse. Fa ntama anaa ntade a ɛyɛ nwunu kata ɔyarefo no so fi ne nsateaa so kosi ne nansoaa so, na sɛ wɔda fam a awɔw wom a, fa ntama to wɔn ase.

Ambulance ne ayaresabea adwene ho ntease: Permissive Hypotension ne Impulse Control¶

Sɛ abusua no nim nea nnuruyɛfo a wɔboa nkurɔfo ne nnuruyɛfo a wɔhwɛ ntɛmpɛ bɛyɛ a, ɛboa ma wodi nkitaho pefee bere a aortic haw bi wɔ hɔ no:

1. Nea enti a nnuruyɛfo a wɔboa nkurɔfo no yɛ "Permissive Hypotension" wɔ Ruptured AAA mu¶

Wɔ aduruyɛ mu ntɛmpɛ dodow no ara a ɛfa mogya mmoroso a ɛba fam ho mu no, nnuruyɛfo a wɔboa nkurɔfo de nkyene a wɔde fa ntini mu nkotoku akɛse gu mu ntɛmntɛm na ama mogya mmoroso asan aba \(120/80\text{ mmHg}\). Wɔ yafunu mu aortic aneurysm a apaapae anaasɛ mogya a ɛretu aortic dissection mu no, IV nsu pii a wɔde ma na ama mogya mmoroso ayɛ nea ɛfata ansa na oprehyɛnfo no abɔ aorta no mu no yɛ asiane. - Sɛ wɔde nkyene mogya mmoroso kɔ soro boro \(90\text{ kosi }100\text{ mmHg}\) a, ɛma abɔde mu nneɛma a ɛma mogya no yɛ nwini no yɛ mmerɛw, ɛma mogya no yɛ nwini, na ɛde nsu bɔ bere tiaa mu mogya a ɛtɔ ("popping the clot") a ɛma ɔyarefo no tra ase no. - Enti, amanaman ntam akwankyerɛ ahorow (NICE NG156 a ɛwɔ United Kingdom, Society for Vascular Surgery wɔ United States, ne European Society for Vascular Surgery) kyerɛ nnuruyɛfo a wɔboa nkurɔfo sɛ wɔnyɛ permissive hypotension: bere tenten a ɔyarefo no ani da hɔ, ɔrekasa, na wakura mogya mmoroso a ɛyɛ mmerɛw mu bɛyɛ \(70\text{ kosi }90\text{ mmHg}\) no, wɔbara nsu bere a ɔwɔ ambulance no de kar kɔ baabi a wɔyɛ oprehyɛn wɔ ntini mu oprehyɛn mu tẽẽ.

2. Nea enti a ayaresabea kwan a wɔfa so kɔ Aortic Center no gye nnipa nkwa¶

Ɛnyɛ mpɔtam hɔ ayaresabea biara na ɔwɔ koma ne ahurututu mu oprehyɛn (ma Type A aortic dissection) anaa ntini mu oprehyɛn a ɔwɔ endovascular hybrid oprehyɛn suite (ma AAA a apaapae) a ɔfrɛ no nnɔnhwerew 24 da biara. Sɛ woka pefee sɛ "Suspected Aortic Dissection" anaa "Known Abdominal Aortic Aneurysm with Sudden Pain and Syncope" wɔ wo frɛ a edi kan a ɛfa ntɛmpɛ ho no mu a, ɔmantam EMS nhyehyɛe ahorow betumi ama Direct-to-OR "Code Rupture" anaa "Code Aorta" kwan ayɛ adwuma, atwa ayaresabea nketewa ho ahyia de ɔyarefo no akɔ oprehyɛn beae tẽẽ.

Nkitahodi nkyerɛwee pɔtee ma 911 / 112 / 999 ne ayaresabea triage¶

Sɛ wo ne ɔyarehwɛfo a ɔde nneɛma kɔma ntɛm anaa ɔyarehwɛfo a ɔhwɛ nneɛma mu rekasa a, fa ayaresabea kasa pɔtee yi di dwuma:

• Sɛ Wosusuw sɛ Wɔatwa Aortic Dissection:

  "Mehia ambulance a egye ntɛmpɛ wɔ [Address Pɛpɛɛpɛ]. Ɔyarefo no yɛ [Mfe]-afe [ɔbarima/ɔbea] a onyaa ɛyaw ntɛm ara, 10-wɔ-10 mu tetew [koko / akyi atifi] wɔ [Bere]. [Ɔno/Ɔno] nso wɔ [mogya mmoroso nsonsonoe a ɛyɛ X mmHg wɔ nsa nifa ne benkum ntam / nan a ɛyɛ mmerɛw mpofirim / Marfan syndrome / a bicuspid aortic valve].Yɛsusu sɛ yɛayɛ Acute Aortic Dissection.YƐMMA aspirin."

• Ma AAA a Wosusuw sɛ Apaapae:

  "Mehia ambulance a egye ntɛmpɛ wɔ [Address Pɛpɛɛpɛ]. Ɔyarefo no yɛ [Mfe]-afe [ɔbarima/ɔbea] a ɔwɔ [Abdominal Aortic Aneurysm a wonim no / abakɔsɛm a ɛfa sigaretnom ne mogya mmoroso ho] a mpofirim ara onyaa ɛyaw a emu yɛ den [yafunu / akyi / n'afã] na [ɔtotɔ piti / ne ho yɛ fitaa, ne ho fifiri, na ne ti yɛɛ no yaw]. Yesusuw sɛ Ruptured Abdominal Aortic Aneurysm Yɛrema [no] ada fam na wayɛ dinn."

Triage ahosiesie checklist bere a ambulance no rekɔ so no¶

• Wɔakyerɛw bere pɔtee a ɛyaw no fii ase: Ɛsɛ sɛ nnuruyɛfo a wɔyɛ oprehyɛn no hu simma pɔtee a ɛyaw a ɛtetew anaasɛ ɔtotɔe no bae.
• Wɔakyerɛw abasa abien no nyinaa mogya mmoroso (sɛ wɔsusuw a): Kyerɛw Right Arm BP ne Left Arm BP wɔ krataa bi so.
• Aortic mfoninitwa anaa oprehyɛn nkrataa a wɔadi kan ayɛ a ɛwɔ hɔ: Fa nsuo a ɛfiri mu no ho nsɛm tiawa biara a ɛkyerɛ aneurysm kɛseɛ a atwam (e.g., "4.8 cm infrarenal AAA"), stent-graft implant cards, anaa koma valve cards.
• Nnuru a ɛma mogya yɛ mmerɛw a wɔahu no din a edi mũ: Sɛ ɔyarefo no nom warfarin, apixaban, rivaroxaban, dabigatran, edoxaban, clopidogrel, anaa da biara da aspirin a, ka kyerɛ nnuruyɛfo a wɔboa wɔn ntɛm ara, sɛnea ɛbɛyɛ a ayaresabea no betumi asiesie nnuru a wɔde dannan no ntɛm (te sɛ 4-factor prothrombin complex concentrate [PCC], idarucizumab, anaa andexanet alfa) ansa na wɔreyɛ no oprehyɛn.
• Biribiara nni hɔ a wɔde ano si so dua: Ka bere a ɔyarefo no bedidi anaa wanom nea etwa to no kyerɛ nnuruyɛfo a wɔboa no ma wɔayɛ nhyehyɛe a ahobammɔ wom wɔ aduru a wɔde kum nipadua no mu.

Siw a wosiw ano ne nhwehwɛmu: Ntini mu ntini a ɛkyere ansa na apaapae¶

Esiane sɛ wobetumi apaw aortic aneurysm a enni dɛm no a wɔpaw sɛ wobenya nkwa ɔha biara mu nkyem 95 kosi 98, bere a aneurysm a apaapae no de owu dodow a ɛyɛ ɔha biara mu nkyem 70 kosi 80 ba nti, ultrasound screening ne mogya mmoroso a wɔhwɛ so no gye nkwa:

1. Yafunu mu Ultrasound Nhwehwɛmu a Wɔyɛ no Pɛnkoro:
2. Wɔ United States (USPSTF & SVS Akwankyerɛ): Wɔkamfo kyerɛ sɛ wɔnyɛ yafunu mu ultrasound pɛnkoro mma mmarima a wɔadi mfe 65 kosi 75 a wɔanom sigaret pɛn nyinaa, na wɔpaw mmarima ne mmea a wɔadi mfe 65 kosi 75 a wɔwɔ abusua abakɔsɛm a edi kan a ɛkyerɛ sɛ wɔwɔ AAA.
3. Wɔ United Kingdom (NHS AAA Screening Programme): Wɔto nsa frɛ mmarima nyinaa sɛ wɔnyɛ ultrasound screening a wontua hwee wɔ afe a wɔadi mfeɛ 65 mu, na obiara a wadi boro mfeɛ 65 a wɔanhwɛ no no bɛtumi ahwɛ ne ho.
4. Awosu ne Echocardiographic Nhwehwɛmu a Wɔde Hwɛ Thoracic Aneurysms:
5. Ɛsɛ sɛ obiara a ɔwɔ ahurututu mu aortic dissection a emu yɛ den anaasɛ ɔwɔ bicuspid aortic valve abusuafo a wodi kan (awofo, anuanom, ne mmofra) kɔ awosu mu afotu ne mfiase echocardiography anaa CT/MR angiography de susuw wɔn aortic ntini kɛse.
6. Da Dabiara Asetra mu Ahobammɔ ma Ayarefo a Wonim Wɔn a Wɔyɛ Ntini Mu Ntini:
7. Gyae sigaretnom koraa (ɛtew mogya mu ntini a ɛtrɛw no so fã) na kɔ so yɛ mogya mmoroso a wode gye w’ahome no nkɔ fam nsen \(130/80\text{ mmHg}\).
8. Kwati Valsalva a ɛyɛ den kɛse: Ɛsɛ sɛ nnipa a wonim sɛ wɔwɔ aortic aneurysms no kwati isometric weightlifting a emu yɛ duru (baabi a wokura wo home mu na woyɛ den a ɛbɛn tumi a ɛsen biara), a ebetumi ama mogya mmoroso a ɛwɔ aortic no mu akɔ soro aboro \(300\text{ mmHg}\). Wɔtaa hyɛ apɔw-mu-teɛteɛ a ɛkɔ fam ho nkuran; hwɛ ntini pɔtee bi ho ɔbenfo a ɔyɛ mu duru anohyeto ahorow ho adanse.

Nsɛm a wɔtaa bisa¶

Dɛn nti na aspirin a wɔbɛwe no yɛ asiane bere a wɔretwa aortic bere a wɔkamfo kyerɛ sɛ wɔmfa mma komayare no?¶

Mogya a ɛtwetwe a esiw koma mu ntini bi ano na ɛde komayare ba, enti sɛ obi we aspirin a, ɛma saa akisikuru no ntumi nyin. Nea ɛne eyi bɔ abira no, aortic dissection anaa aneurysm a ɛpaapae yɛ mfiri a ɛtetew aorta no fasu mu; aspirin a wɔde ma no ma mogya nkwammoaa a ɛwɔ nipadua no mu no nyɛ adwuma yiye, esiw mogya a ɛbɔ ho ban no ano, na ɛma mogya tu kɔ koko, yafunu, anaa koma no akyi kotoku a edi awu mu.

Mɛyɛ dɛn ahu nsonsonoe a ɛda yafunu mu aortic aneurysm a apaapae ne asaabo mu ɔbo a ɛwɔ ɔpanyin a ne mfe akɔ anim mu ntam?¶

N’abien nyinaa betumi ama ɔfã biako ayɛ ɛyaw mpofirim a ɛhyerɛn kɔ asen no mu efisɛ mogya a ɛwɔ akyi no hyɛ ntini ne nsu a ɛkɔ nsu mu no abufuw te sɛ ɔbo no. Nanso, ɛsɛ sɛ ɔpanyin biara a wadi boro mfe 55 (titiriw obi a ɔnom sigaret anaa mogya mmoroso) a onya asaabo mu abo a ɛyɛ yaw nea edi kan a ɛyɛ no yaw, ne honam ani yɛ mmerɛw, ne ho totɔ piti, anaasɛ mogya mmoroso a ɛba fam no yɛ no sɛ aortic aneurysm a apaapae kosi sɛ ultrasound anaa CT scan bɛma ayɛ nea enni mu.

Dɛn na nsonsonoe a ɛda mogya mmoroso a ɛwɔ nsa benkum ne nifa ntam no kyerɛ bere a koko mu yɛ no yaw?¶

Wɔ ɔpanyin a ɔwɔ apɔwmuden mu no, mogya mmoroso a ɛkɔ so wɔ nsa nifa ne benkum ntam no yɛ soronko wɔ mercury (mmHg) a ennu milimita 10 mu. Sɛ obi a ne koko anaa n’akyi yɛ no yaw kɛse mpofirim no wɔ mogya mmoroso mu nsonsonoe a ɛboro mmHg 20 wɔ ne nsa ntam (anaasɛ ne nsateaa a ɛyɛ mmerɛw wɔ ɔfã biako) a, ɛda adi sɛ aortic dissection flap a emu yɛ den resiw subclavian artery a ɛde saa abasa no ma no kwan.

Sɛ obi a n’akyi anaa ne yafunu mu yɛ no yaw mpofirim totɔ piti na afei ɔsɔre a ne ho tɔ no kɛse wɔ fam a, so ntɛmpɛ no aba awiei?¶

Dabi, bere tiaa mu ahoɔden a obi nya bere a watotɔ piti akyi no yɛ sɛnkyerɛnne a wɔtaa hu a ɛkyerɛ sɛ yafunu mu aortic aneurysm a ɛwɔ akyi no mu apaapae anaasɛ ahurututu mu ntini a ɛretu. Sɛ mogya mmoroso so tew bere a ɔyarefo no da fam na ɔyarefo no da fam a, akyi berɛmo mu ntini no siw nsu a ɛretu no ano bere tiaa bi; sɛ wɔsɔre anaasɛ wɔtwentwɛn wɔn nan ase sɛ wɔbɛfrɛ wɔn a wɔhwɛ ntɛmpɛ so a, saa mogya a ɛyɛ mmerɛw no taa pae ma ɛyɛ mogyatɔw a edi awu wɔ simma kosi nnɔnhwerew kakraa bi mu.

Sources a wɔhwɛɛ mu¶

• Amerika Koma Ho Adesua Sukuu (ACC) ne Amerika Koma Fekuw (AHA, United States): 2022 ACC/AHA Akwankyerɛ a ɛfa Aortic Yare a Wohu ne Nea Wodi Ho (Circulation / Journal of the American College of Cardiology).
• Ɔman Asoɛe a Ɛhwɛ Akwahosan ne Ɔhwɛ a Ɛyɛ Paara So (NICE, United Kingdom): Yafunu mu Aortic Aneurysm: Diagnosis and Management (NICE Akwankyerɛ NG156, a ntɛmpɛ a wɔde kɔ baabi foforo ne mogya mmoroso ho nhyehyɛe a wɔma ho kwan ka ho).
• Fakuw a Ɛhwɛ Ntini Oprehyɛn So (SVS, United States) ne Europa Fekuw a Ɛhwɛ Ntini Oprehyɛn So (ESVS): Ayaresa mu Adeyɛ Akwankyerɛ a Ɛfa Ayarefo a Wɔn Yafunu Mu Aortic Aneurysm Hwɛ Ho (Chaikof ne afoforo, Journal of Vascular Surgery; Wanhainen ne afoforo, European Journal of Vascular and Endovascular Surgery, 2024 na ɔkyerɛwee).
• European Society of Cardiology (ESC): ESC Akwankyerɛ a ɛfa Peripheral Arterial ne Aortic Diseases ho dwumadie ho (2024 update a ɛfa acute thoracic aortic syndromes, Stanford Type A ne Type B triage, ne mogya mmorosoɔ botaeɛ ho).
• Amanaman Ntam Nkyerɛwde a Ɛhwɛ Acute Aortic Dissection (IRAD) & Marfan Foundation / John Ritter Foundation for Aortic Health (United States): Ritter Mmara a ɛfa Triage ne Ntɛmntɛm a Wogye Toracic Aortic Dissection Ho.

Akwankyerɛ ahorow a ɛfa ho¶

• Komayare a wohu ne mmoa a edi kan a wɔde ma ntɛm ara
• Shock recognition ne mmoa a edi kan a wɔhwɛ so
• Stroke recognition (FAST) ne ntɛmpɛ ho mmuae
• Koma ne ahurututu mu nkwaadɔm (CPR) ne AED akwankyerɛ
• Cauda equina syndrome ne akyi berɛmo mu nhyɛso a emu yɛ den frankaa kɔkɔɔ