Epiglottitis, Croup a Ɛyɛ Den, Stridor, ne Mframa a Ɛwɔ Atifi Mu a Ɛsiw¶

Mframa kwan a ɛwɔ soro a ɛsiw denneennen a ɛnam menewa mu ntini a ɛho ahonhon a ɛde ɔyare mmoawa ba so no yɛ nneɛma a egye ntɛmpɛ a ɛkɔ so ntɛmntɛm sen biara wɔ mmofra ne mpanyimfo nnuruyɛ mu no mu biako. Wɔ simma kosi nnɔnhwerew kakraa bi mu no, mmoawa a wɔde wɔn ho hyɛ epiglottis no mu (acute epiglottitis), ɔyare mmoawa a ɛho ahonhon kɛse wɔ ɛnne ntini no ase (laryngotracheobronchitis anaa croup), anaa mmoawa a wɔde mframa mu yare a emu dɔ (bacterial tracheitis) betumi atew ɔkwan a wɔfa so home no so akodu pinhole. Esiane sɛ abofra mframa kwan no ntwemu bɛyɛ sɛ wɔn nsateaa ketewa no nti, ntini a ɛho ahonhon milimita 1 (nsateakwaa 0.04) mpo wɔ abofra mframa kwan mu no ma baabi a ɔhome a wɔatwa no ntwemu no so tew bɛboro ɔha biara mu nkyem 60 na ɛma mframa a ɛsen no yɛ kɛse mpɛn dunsia.

Sɛ mframa kwan a ɛwɔ soro a ɛho ayɛ hyew no teateaa kɛse a, nea ɔyarefo no tra ase gyina hɔ, de ne ho to n’anim, na ɔkura wɔn kɔn mu pɛpɛɛpɛ a ɛma mframa ketewaa bi bue nkutoo so na onya nkwa. Asiane kɛse biako pɛ a ɛwɔ mmoa a edi kan a wɔde ma ansa na wɔakɔ ayaresabea ne iatrogenic complete airway closure a ogyefo a wɔwɔ adwempa a wɔhyɛ abofra anaa ɔpanyin a ehu aka no ma ɔda n’akyi, bɔ mmɔden sɛ wɔde nsenia anaa kanea bɛhwɛ wɔn ano mu, anaasɛ wɔhyɛ abofra a ɔresu abufuw na ɛkanyan no. Nim a wunim sɛnea wobɛma nsonsonoe ada epiglottitis ho ehu a ɛba mpofirim, ɛyɛ komm, a ɛreworo so no ne kɔbere, seal-bark cough of viral croup, nea enti a ɛsɛ sɛ woma ɔyarefo no yɛ komm wɔ wɔn tripod gyinabea a wɔapaw no mu, ne bere a nsuyiri a ɛyɛ nwini anaa mframa a ɛyɛ nwini boa no betumi ama mframa kwan no abue kosi sɛ nnuruyɛfo kuw a wogye ntɛmpɛ bɛba.

Yɛ eyi mprempren¶

1. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma ntɛm ara sɛ obi wɔ ahomegye a ɛyɛ dede bere a ɔregye n’ahome (stridor), ɔretu nsu a ontumi mene, ne nne a ɛyɛ "ɛmo a ɛyɛ hyew" a ɛyɛ mmerɛw, n'ano gyina hɔ a ɛyɛ tripod, anaasɛ n'ano yɛ bruu a. Bɔ 911 wɔ United States ne Canada, 112 wɔ Europa Aman Nkabom Aman Nkabom no nyinaa mu, 999 wɔ United Kingdom, 000 wɔ Australia, anaa hwɛ directory of nɔma ahorow a egye ntɛmpɛ. Bisa Advanced Life Support (ALS) ambulance na ka no pefee sɛ wususuw sɛ mframa kwan a ɛwɔ soro a ɛho ahonhon denneennen anaasɛ epiglottitis enti nnuruyɛfo a wɔboa nkurɔfo bɛn hɔ komm a siren nbɔ wɔ ɔpon no ano.
2. MONhyɛ obi a ne stridor, drooling, anaa ne menewa mu ahonhon kɛse DA ma ɔnda fam tratraa wɔ n’akyi. Ma ɔyarefo no ntena hɔ tẽẽ koraa wɔ tebea biara a ɛte nka sɛ ɛyɛ mmerɛw sɛ ɔbɛhome, mpɛn pii no ɔde ne ho to n’anim wɔ wɔn nsa so a wɔde wɔn hwene akɔ n’anim kakra (tripod anaa sniffing gyinabea). Wɔ akokoaa anaa abofra ketewa fam no, ma wɔntra ase gyina hɔ a wɔakura wɔn wofo asen ne ne nsa mu brɛoo.
3. MFA tɛkrɛma a wɔde hyɛ ano, nsenia, nsateaa, ɔhyew kyerɛwtohɔ, anaa kanea a wɔde tow ano nhyɛ ano no mu da mfa nhwɛ menewa no. Sɛ wode wo nsa ka tɛkrɛma no akyi anaasɛ wohyɛ anom ma ɛbue wɔ epiglottitis a wosusuw sɛ ɛyɛ no mu a, ɛkanyan vagal laryngospasm ntɛm ara anaasɛ ɛpia epiglottis a ahonhon, cherry-red no kɔ fam te sɛ cork kɔ mframa afiri no mu, na ɛde ntɛm ara na mframa kwan a wɔasiw a wontumi nsakra no.
4. Ma abofra a ehu aka no nyɛ komm na ɔyɛ komm sɛnea wubetumi wɔ wɔn awofo abasa mu. Su, nteɛteɛm, ne ntɔkwaw ma mframa a ɛyɛ basabasa fa menewa a ayɛ teateaa no mu (Bernoulli nkɛntɛnso), a ɛtwe mframa kwan afasu a ahonhon no kɔ mu na ɛma hypoxia yɛ kɛse. Mma abofra no mfi nea ɔhwɛ no no ntam, mmɔ mmɔden sɛ wubeyi ne ntade gye sɛ ɛho hia, na brɛ akanea a ɛhyerɛn anaa dede a ano yɛ den no ase.
5. Ma ɔyarefo no sie NPO katee (ɛnyɛ biribiara wɔ ano). Mfa nsu, nufusu, nsu, popsicles, ɛwo, anaa atiridiinini a wɔde ano aduru (te sɛ paracetamol nsu anaa ibuprofen) mma obiara a ɔretu nsu, ɔrepere sɛ ɔbɛmene, anaasɛ ɔreyɛ stridor nnyigyei a ano yɛ den bere a ɔregye n’ahome. Sɛ wɔbɔ mmɔden sɛ wɔbɛmene nsu atwa epiglottis a ahonhon ho a, ɛma obi memene basabasa na ɛma ahurututu mu ntini mu yare a edi awu.
6. Sɛ abofra no nya classic "barking seal" cough (viral croup) A ONNI nsuo mu, ɔtena ase yie, na ɔwɔ stridor a ɛnyɛ den bere a ɔresu nkutoo a, fa wɔn to anadwo mframa a ɛyɛ nwini anaa aguaree nsuyiri mu bere a worehwɛ no yiye. Sɛ ɔte aguaree a nsuyiri a ɛyɛ nwini wom mu anaasɛ ɔhome abɔnten anadwo mframa a ɛyɛ nwini simma 10 kosi 15 bere a worekyekye abofra no werɛ no taa tew subglottic viral ɔfe a ɛdɔɔso a ɛbɛma croup a ɛnyɛ den no ayɛ mmerɛw, ɛwom sɛ stridor biara a ɛwɔ hɔ bere a abofra no ho adwo no na ɔregye n’ahome no hwehwɛ sɛ wɔyɛ aduruyɛ mu nhwehwɛmu ntɛm ara na wɔkyerɛw corticosteroids a wɔkyerɛw ma no de.

Ntɛmntɛm gyinaesi dua ma acute stridor ne soro mframa kwan a ɛho ahonhon¶

flowchart TD
    Start["Sudden Noisy Breathing (Stridor), Hoarseness, Barking Cough, or Severe Throat Pain"]
    ChokeCheck{"Did this start INSTANTLY (within seconds)<br/>while eating, playing with small toys, or holding an object in the mouth,<br/>with NO fever or prior illness?"}
    ForeignBody["SUSPECTED FOREIGN-BODY CHOKING / AIRWAY OBSTRUCTION<br/>1. If unable to speak, cough, or breathe: Perform Back Blows & Abdominal Thrusts<br/>   (or Back Blows & Chest Thrusts for infants under 1 year)<br/>2. If coughing forcefully or breathing with stridor: Call EMS immediately;<br/>   do NOT perform blind finger sweeps; keep patient upright"]
    AllergyCheck{"Was the patient exposed to a bee sting, peanut/food allergen,<br/>medication, or has a history of hereditary angioedema,<br/>with swollen lips, tongue, or hives?"}
    Anaphylaxis["ANAPHYLACTIC AIRWAY EDEMA / ANGIOEDEMA<br/>1. Inject Epinephrine Auto-Injector into outer mid-thigh immediately<br/>2. Call EMS (911 / 112 / 999) for urgent transport<br/>3. Keep patient sitting upright if airway/tongue is swollen (unless hypotensive)<br/>4. Give second epinephrine dose at 5 to 15 minutes if no improvement"]
    RedFlagCheck{"Are ANY Epiglottitis or Severe Obstruction Red Flags Present?<br/>- Drooling saliva / unable to swallow own spit<br/>- Sitting upright leaning forward (Tripod / Sniffing posture)<br/>- Muffled 'Hot Potato' voice & absence of barking cough<br/>- High-pitched stridor heard even when resting quietly<br/>- Sternal/rib retractions, lethargy, or bluish/pale skin"}
    EpiglottitisProtocol["CRITICAL UPPER AIRWAY EMERGENCY (EPIGLOTTITIS / SEVERE CROUP / TRACHEITIS)<br/>1. Call EMS (911 / 112 / 999) immediately; request quiet ALS approach<br/>2. Keep patient sitting 100% UPRIGHT (child held in parent's lap)<br/>3. DO NOT look in mouth, DO NOT use tongue blade, DO NOT lay flat<br/>4. Keep strictly NPO (no water, no oral fever medicine)<br/>5. Keep child calm; allow parent to hold blow-by oxygen near face if EMS provides it"]
    MildCroup["LIKELY MILD TO MODERATE VIRAL CROUP (LARYNGOTRACHEOBRONCHITIS)<br/>(Barking seal-like cough, hoarse voice, able to swallow, NO drooling,<br/>NO stridor when resting quietly, alert and drinking fluids)<br/>1. Hold child upright and calm them immediately to stop crying<br/>2. Expose to cool outdoor night air (wrapped warmly) or cool-mist humidifier for 15 min<br/>3. Contact physician or urgent care for single-dose oral Dexamethasone<br/>4. Watch continuously for resting stridor or rib retractions"]

    Start --> ChokeCheck
    ChokeCheck -->|Yes: Sudden Onset, No Fever| ForeignBody
    ChokeCheck -->|No: Preceded by Fever, Cold, or Sore Throat| AllergyCheck
    AllergyCheck -->|Yes: Hives, Lip/Tongue Swelling, Allergen| Anaphylaxis
    AllergyCheck -->|No: Infectious / Inflammatory Pattern| RedFlagCheck
    RedFlagCheck -->|Yes: ANY Red Flag Present| EpiglottitisProtocol
    RedFlagCheck -->|No: Barking Cough Only, Calm at Rest| MildCroup

Mframa kwan a ɛwɔ soro a egye ntɛmpɛ a ɛde nkwa to asiane mu a wɔde toto ho¶

Sɛ abofra anaa ɔpanyin bi nya ahome a ɛyɛ dede (stridor) anaasɛ ne menewa mu haw a, ɛsɛ sɛ wɔma nsonsonoe ba tebea atitiriw anum a ɛde ɔyare mmoawa ba ne nea ɛnyɛ ɔyare mmoawa mu ntɛmntɛm. Nea ɛnte sɛ wheezing (nnwom, abɛn nnyigyei a wɔte titiriw bere a wɔrehome fi ahurututu mu ntini a ɛwɔ fam a ɛyɛ teateaa mu wɔ ayamtu mu) no, stridor yɛ nnyigyei a emu yɛ den, ɛyɛ den, ɛyɛ osebɔ anaa saw a wɔte titiriw bere a wɔte home (anaasɛ wɔhome ne mframa a wɔhome nyinaa wɔ subglottic teateaa a emu yɛ den mu) a mframa a ɛyɛ basabasa a ɛfa soro a wɔasiw no fã bi mu na ɛba menewa, nne adaka (larynx), anaa mframa afiri (trachea).

Anatomy ne physics a ɛfa mframa kwan a ɛwɔ soro a wɔasiw ho¶

Nea enti a milimita 1 a ɛhoa no yɛ ɔhaw ma ɔpanyin nanso ɛyɛ asiane wɔ abofra mu¶

Sɛnea ɛbɛyɛ na yɛate nea enti a akokoaa anaa abofra ketewa a ɔwɔ croup anaa epiglottitis betumi asɛe afi ahome a ɛyɛ dede so akosi ɔhome a ɛgyae wɔ simma kakraa bi mu ase no, nnuruyɛfo a wɔhwɛ ntɛmpɛ so de Poiseuille’s Law of Laminar and Turbulent Fluid Flow di dwuma:

1. Ahoɔden a Ɛto so Anan a Ɛko Tia-Radius (\(R \propto \frac{1}{r^4}\)): Sɛ mframa a ɛkɔ no yɛ mmerɛw (laminar) a, mframa kwan no mu ahoɔden a ɛko tia no ne ahoɔden a ɛto so anan a ɛwɔ mframa kwan no mu no hyia wɔ ɔkwan a ɛne no bɔ abira so (na sɛ osu ma mframa no kɔ basabasa a, ahoɔden a ɛko tia no ne tumi a ɛto so anum a ɛwɔ mframa kwan no mu no nsenia).
2. Mmofra vs. Mpanyimfo Mframa kwan Nsusuwii:
3. nkokoaa anaa abofra ketewaa mframa kwan a ɛwɔ ase no a ɛteɛ wɔ cricoid cartilage ring no mu no mu ntwemu yɛ milimita 4 (nsateakwaa 0.16) pɛ (a ne kɛse yɛ mm 2). Sɛ viral croup ma milimita 1 pɛ a ɛyɛ circumferential mucosal swelling ba saa ring a ɛyɛ den no mu a, emu ntwemu no so tew fi mm 4 kosi mm 2 (radius no so tew ɔha biara mu nkyem 50 fi mm 2 kosi mm 1). Esiane sɛ \(2^4 = 16\) nti, sɛ wotwa mframa kwan no mu fã a ɛma baabi a wɔhome no so tew ɔha biara mu nkyem 75 na ɛma adwuma a wɔde home no kɔ soro ɔha biara mu nkyem 1,600 (mpɛn 16).
4. Nea ɛne eyi bɔ abira no, mpanyimfo ahurututu a ɛteɛ no mu ntwemu bɛyɛ milimita 20 (nsateakwaa 0.79) (a ne kɛse yɛ mm 10). Saa ara pɛpɛɛpɛ milimita 1 a ɛyɛ kurukuruwa no ma mpanyimfo no kɛse so tew fi mm 20 kosi mm 18, na ɛma mframa kwan a ɛko tia no yɛ kɛse bɛyɛ ɔha biara mu nkyem 50 pɛ (mpɛn 1.5).
5. Nea Enti a Osu Ma Mframa kwan no Bu (The Dynamic Bernoulli Effect): Wɔ mmofra mu no, ntini a ɛwɔ ntini a ɛboa mframa kwan a ɛwɔ soro ne anom no yɛ mmerɛw na ɛyɛ mmerɛw. Sɛ abofra a ehu aka no teɛteɛm anaa osu na ɔbɔ mmɔden sɛ ɔbɛnom mframa denneennen afa ne menewa a ayɛ teateaa mu a, mframa a ɛde ahoɔhare kɛse tu mmirika twa afasu a ahonhon no ho no ma nhyɛso a enye a emu yɛ den ba mframa kwan no mu (Venturi / Bernoulli nkɛntɛnso). Saa nhyɛso bɔne yi ankasa su abofra no menewa afasu a ɛyɛ mmerɛw na ɛyɛ mmerɛw no kɔ mu bere a ɔrehome, na ɛdan akwanside fã bi ma ɛkame ayɛ sɛ ɛhwe ase koraa. Ɛno nti na abofra a ɔwɔ stridor a wobɛma wayɛ komm na ɔyɛ komm no nyɛ awerɛkyekye ara kwa; ɛyɛ mfiri a ɛho hia a wɔde gye nkwa.

Nsonsonoe a ɛda Supraglottic ne Subglottic swelling ntam wɔ nipadua mu¶

• Supraglottic Obstruction (Epiglottitis): Ɛba atifi ɛnne nhama no mu wɔ ntini a ɛka bom a ɛyɛ mmerɛw na ɛtrɛw mu. Esiane sɛ ntini a ɛkata epiglottis ne aryepiglottic folds no so no abata ho yiye nti, mmoawa nsu ne mogya mu nkwammoaa fitaa no de ballon epiglottis no ntɛmntɛm ma ɛbɛyɛ kurukuruwa kɛse bi a ahonhon a ɛhwe ase wɔ laryngeal inlet no so bere a wɔrehome no. Ɛma komm, brɛoo, ɛnne a ɛba fam inspiratory stridor, muffled "hot potato" nne, ne drooling efisɛ ɔyarefo no ntumi nmene ntwam wɔ mass a ahonhon no ho, nanso no barking cough.
• Subglottic Obstruction (Viral Croup): Ɛba ase ɛnne nhama a ɛwɔ cricoid cartilage mu, ntini biako pɛ a ɛwɔ onipa mframa kwan no nyinaa mu a ɛyɛ signet ring a edi mũ, a ɛyɛ den a ɛyɛ digrii 360. Esiane sɛ cricoid ring no ntumi ntrɛw nkɔ abɔnten bere a lining no ahonhon nti, wɔhyɛ ɔfe no nyinaa kɔ mu kɔ ɔhome afiri no mu, na ɛtrɛw ɛnne nhama no mu wɔ soro na ɛma kɔbere "barking seal" ɔfe a ano yɛ den, nne a ɛyɛ dede, ne ɔsoro, katee a ɛma ɔhome (anaasɛ biphasic) stridor ba.

Deep dive: Acute Epiglottitis wɔ mmofra ne mpanyimfo mu¶

Epiglottitis anim a ɛresakra: Nea enti a mprempren mpanyimfo wɔ asiane kɛse mu¶

Ansa na wɔde Haemophilus influenzae type b (Hib) conjugate vaccine reba daa wɔ 1980 ne 1990 mfe no awiei no, na epiglottitis a emu yɛ den titiriw yɛ mmofra yare a ɛka mmofra a wɔadi mfe 2 kosi 7. Ɛnnɛ, ɛsɛ sɛ abusua biara ne nea odi kan yɛ ho biribi te ɔyaredɔm ho nokwasɛm abien a ɛho hia ase: 1. Mmofra Epiglottitis Da so ara Ba: Ɛbɔ mmofra a wɔmfa nnuru a wɔde bɔ wɔn ho ban anaasɛ wɔmfa nnuru a ekum Hib nni dwuma yiye, mmofra a wɔwɔ mmeae a wɔmfa amansan Hib nnuru a wɔde bɔ wɔn ho ban nni dwuma, ne mmofra a wɔde mmoawa a wɔde bɔ wɔn ho ban koraa mpo bere a mmoawa afoforo te sɛ Streptococcus pneumoniae, Kuw A beta-hemolytic Streptococcus, anaa Stalococcus na ɛde ba aureus, anaasɛ ɛnam ɔhyew mu opira so (nsu a ɛyɛ hyew a wɔnom anaasɛ nsu a ɛyɛ hyew a wɔhome). 2. Mpanyimfo Supraglottitis / Epiglottitis Rekɔ soro: Epiglottitis a ɛba aman a wɔde vaccine ama wɔn no mu dodow no ara mprempren wɔ mpanyimfo a wɔadi mfe 20 kosi 65 mu. Wɔtaa hu mpanyimfo epiglottitis wɔ ɔkwan a ɛnteɛ so mfiase no sɛ "strep menewa ho asɛmmɔne" efisɛ mpanyimfo menewa no te sɛ nea ɛteɛ wɔ nnaadaa kwan so bere a oduruyɛfo de kanea hwɛ tonsils no (esiane sɛ epiglottis no te fam, a wontumi nhu no tẽẽ nti).

"D Anan" a ɛwɔ Acute Epiglottitis ho¶

Ayaresayɛfo kyerɛkyerɛ Four Ds a wɔtaa de di dwuma no ma wohu epiglottitis ntɛm ara wɔ animtiaabu mu a ɛnka ɔyarefo no da: 1. Drooling (Sialorrhea): Nnompe kɔ so tɔ fi abɔgyesɛ no mu efisɛ sɛ obi mene a, ɛkanyan menewa mu yaw a ɛyɛ yaw na ɛyɛ hu sɛ ɛbɛma mframa kwan no amene. 2. Dysphagia ne Severe Odynophagia: Nsu anaa aduan a ɛyɛ den a wontumi mene koraa. Wɔ mpanyimfo mu no, epiglottitis agyiraehyɛde #1 ne menewa mu yaw a emu yɛ den, a ɛyɛ yaw ("ɛyaw 10 biara mu 10") a ɛne ano a ɛwɔ anom ne anom a ɛte sɛ nea ɛte sɛ nea ɛfata no nhyia koraa. 3. Dysphonia ("Hot Potato" Voice): Ɛnne no te sɛ nea ɛyɛ den, ɛyɛ mmerɛw, na ɛyɛ tokuru, te sɛ nea onipa no rebɔ mmɔden sɛ ɔbɛkasa bere a okura ɛmo a ɛyɛ hyew a ɛyɛ hyew wɔ wɔn menewa akyi. 4. Ahoyeraw (Inspiratory Stridor ne Tripod Posture): Ɔyarefo no tra ase a onhinhim, ɔde ne ho to n’anim a ɔde ne nsa ahyɛ ne nkotodwe so (tripod position), ne kɔn atrɛw akɔ n’anim na ɔde ne hwene akɔ soro (sniffing position), ɔhome brɛoo na ɔde ahwɛyiye home sɛnea ɛbɛyɛ a ɔremma mframa a ɛyɛ basabasa a ɛnom epiglottis a ahonhon no nto mu.

Mmoa a edi kan a wɔde ma anammɔn biara ma obi a wosusuw sɛ ɔwɔ Epiglottitis¶

1. Frɛ 911 / 112 / 999 ntɛm ara na bisa ALS ayarehwɛfo adwumayɛfo. Ka kyerɛ nea ɔde kɔma no sɛ: "Mewɔ abofra/ɔpanyin bi a wosusuw sɛ ɔwɔ epiglottitis a ɔretu nsu, ɔte tripod gyinabea, na ɔrepere sɛ ɔbɛhome."
2. Fa "Hands-Off, Calm-Environment" protocol a ɛyɛ katee tom:
3. Fa akanea a ano yɛ den a ɛwɔ soro no yɛ kusuu na dum television a ano yɛ den anaa afieboa a wɔrebobom.
4. Sɛ ɔyarefo no yɛ abofra a, gyaw wɔn wɔ wɔn wofo anaa nea ɔhwɛ no nsam. Mmɔ mmɔden da sɛ wobɛtwe abofra ketewa bi a ɔretu mmirika a ne ho yeraw no afi ne maame anaa ne papa nkyɛn akɔhwehwɛ wɔn mu.
5. Ma ɔyarefo no nkura mpopaho anaa kuruwa bi wɔ ne hwene ho na ama watumi agye nsu sɛnea ɛbɛyɛ a ɔrente nka sɛ ɔpɛ sɛ ɔbɛmene.
6. Mfa ɔyarefo no nna fam da na nhwɛ n'ano da: Mma nsrɛ ɔyarefo no sɛ "bue kɛse na ɔka ahh." Mma telefon kanea nhyerɛn nkɔ wɔn menewam.
7. Sɛ ɔyarefo no ntumi nhu na ogyae home koraa ansa na nnuruyɛfo a wɔboa no aba a:
8. Sɛ mframa kwan no to mu koraa na ɔyarefo no ntumi nyɛ hwee, ɔyɛ cyanotic, na ontumi nkɔ mframa mu a, fa wɔn to fam brɛoo na fi ase CPR a wɔde yɛ adwuma (anaasɛ mmofra ho CPR).
9. Nkwagye Hom Mmara wɔ Epiglottitis Arrest a Edi Mu: Sɛ mpo epiglottis a ahonhon no siw ɔhome a ɛba ara kwa ano a, ahome a ɛyɛ den na ɛyɛ brɛoo a wɔde gye nkwa (anom kɔ ano anaa oduruyɛfo a ɔboa nkurɔfo bag-valve-mask) taa tumi hyɛ mframa nketenkete a ɛgye nkwa twam wɔ ahurututu mu ntini a ahonhon no mu kɔ ahurututu no mu bere a koko mu nhyɛso di akɔneaba no oxygen kosi sɛ nnuruyɛfo a wɔboa nkurɔfo bɛba abɛyɛ mframa kwan a wɔyɛ no oprehyɛn ntɛm ara.

Nsu mu a ɛkɔ akyiri: Viral Croup (Laryngotracheobronchitis) ne Spasmodic Croup¶

Croup anadwo fã nkyerɛkyerɛmu a wɔtaa yɛ no a wohu¶

Nea ɛnte sɛ epiglottitis no, viral croup na ɛde stridor a emu yɛ den a ɛba mmofra a wɔadi fi asram 6 kosi mfe 3 mu dodow no ara ba. * Nea enti a Croup tow hyɛ so wɔ 11:00 PM ne 4:00 AM ntam: Abofra ketewaa taa nya hwene mu nsu a ɛyɛ mmerɛw, ne hwene mu yɛ den kakra, na ne ho yɛ hyew a ɛba fam awiabere. Anadwo fã no, abofra no nyane a ɔrehome a ɔde seal-bark cough a ɛyɛ den, ɛyɛ dade, ne nnyigyei a ɛyɛ raspy, a ɛrebɔ ose bere a ɔrehome (inspiratory stridor). Croup kɔ soro anadwo efisɛ endogenous cortisol (nipadua no abɔde mu hormone a ɛko tia ɔyare mmoawa) kɔ fam kodu ne circadian trough a ɛba fam sen biara wɔ anadwo fã ne 4:00 AM ntam, bere a sɛ obi da mpa so a, ɛma ntini mu mogya a ɛboaboa ano wɔ subglottic lining no mu no yɛ kɛse. * Spasmodic Croup: Ɔkwan a ɛne no bɔ abira kɛse a abofra kɔda apɔwmuden a onni atiridii biara na ɔsɔre 2:00 AM a ɔfe a ɛyɛ hu ne stridor a efi subglottic mucosal edema a ɛba mpofirim mu ba.

Croup mu denden a wɔde toto ho: Westley Croup Severity Guide ma awofo ne wɔn a wɔyɛ ho biribi¶

Sɛ́ wobehu sɛ ebia wobetumi de mframa a ɛyɛ nwini akyekye abofra a ɔfe a ɛrebobom no werɛ na wɔde akɔ oduruyɛfo nkyɛn, anaasɛ ɛho hia sɛ wɔde ambulance kɔ ntɛm ara 911 / 112 / 999 no gyina sɛ ebia stridor ne ne koko a ɛtwetwe no wɔ hɔ bere a abofra no ho adwo no na ɔregye n’ahome:

Mmoa a edi kan a wɔde ma wɔ fie ne ansa na wɔakɔ ayaresabea a ahobammɔ wom ma Viral Croup¶

1. Fa abofra no na fa wɔn mu gyina hɔ ntɛm ara: Sɛ wotena hɔ gyina hɔ a, ɛtew mogya a ɛkɔ subglottic mucosa a ahonhon no mu no so na ɛde tumi a ɛtwe ade ba fam no boa diaphragm no.
2. Fa awerɛhyem a ɛyɛ komm ma abofra no dwo na ma ne bo dwo: To dwom brɛoo, kenkan nhoma bi a w’ani gye ho, anaa fa video a ɛyɛ komm to hɔ bere a wokura abofra no wɔ wo kɔn mu no. Sɛ wogyae abofra no su ntɛm ara a, ɛdannan mframa a ɛyɛ basabasa no san kɔ laminar mframa a ɛyɛ mmerɛw, na ɛtaa twa wɔn mmɔdenbɔ a wɔde home no mu fã wɔ simma 2 mu.
3. Fa Cool Night Air anaa Cool-Mist Bathroom Protocol (simma 10 kosi 15) no di dwuma:
4. Option A (Cool Outdoor Night Air or Open Freezer Door): Fa kuntu kyekyere abofra no ho hyew na fa wɔn gyina hɔ tẽẽ kɔ abrannaa so, wɔ mfɛnsere a wɔabue mu, anaa frigye/freezer pon a wɔabue anim na ama woatumi ahome anadwo mframa a ɛyɛ nwini na ɛyɛ nwini simma 10 kosi 15. Mframa a ɛyɛ nwini ma mogya ntini a atrɛw wɔ subglottic lining no mu no twetwe, na ɛda adi sɛ ɛtew ɔfe no so na ɛma ɔfe a ɛrebobom no brɛ ase.
5. Option B (Cool-Mist Humidifier anaa Bathroom Mist): Fa cool-mist humidifier a ɛho tew tu mmirika wɔ abofra no nkyɛn pɛɛ, anaasɛ wo ne abofra no tena hɔ tẽẽ wɔ aguaree a wɔato mu bere a woretu mmirika wɔ shower no mu na ama nsuyiri a ɛyɛ nwini aba.
6. CRITICAL BURN WARNING: Nkura abofra bi da wɔ kukuo a nsuo a ɛrefɔw, fononoo a ɛyɛ hyeɛ, anaa steam vaporizer a ɛyɛ hyeɛ so. Nsu a ɛyɛ hyew a wɔde yɛ nsu a ɛyɛ hyew ne nkuku a nsu a ɛrefɔw wom ma anim ne mframa kwan mu hyew a ɛyɛ hu ɔhyew wɔ mmofra nkumaa a wɔrehuruhuruw mu, na nsu a ɛyɛ hyew betumi ama mogya a ɛkɔ ntini no mu no ayɛ kɛse ankasa na ama mframa kwan mu akisikuru no ayɛ kɛse.
7. Nea enti a ɛsɛ sɛ oduruyɛfo bi hwehwɛ abofra biara a ɔwɔ croup mu hwɛ sɛ ɔwɔ corticosteroids:
8. Sɛ mpo anadwo mframa a ɛyɛ nwini gyae croup ntua a ɛnyɛ den wɔ 2:00 AM a, viral subglottic inflammation di nnafua 3 kosi 5 na ɛtaa san ba anadwo a edi hɔ no.
9. Mprempren amanaman ntam mmofra ayaresa akwankyerɛ ahorow (American Academy of Pediatrics, UK NICE, Canadian Pediatric Society, WHO) kamfo kyerɛ sɛ mmofra a wɔwɔ croup (croup a emu nyɛ den mpo) nyinaa nnya corticosteroid (a mpɛn pii no Dexamethasone) dodow biako a wɔakyerɛw ama wɔn mfi oduruyɛfo anaa ayaresabea a wɔhwɛ wɔn ntɛm so. Dexamethasone a wɔde ma pɛnkoro no fi ase ma mframa kwan a ɛho ahonhon no so tew wɔ nnɔnhwerew 2 kosi 4 mu, ɛtra hɔ nnɔnhwerew 72, na ɛtew dwumadibea a wɔhwɛ ntɛmpɛ so sankɔhwɛ ne ayaresabea a wɔde wɔn kɔ no so bɛboro ɔha biara mu nkyem 50.

Mfomso ahorow asia a edi awu a ɛsɛ sɛ wɔkwati wɔ mframa kwan a ɛwɔ soro a egye ntɛmpɛ mu¶

1. Mfomso 1: Mmɔden a wobɛbɔ sɛ wode nsenia, nsateaa, anaa kanea a wɔde tow bɛhwɛ menewa no mu. Mmia tɛkrɛma no so da anaasɛ nka nkyerɛ ɔyarefo a ɔretu nsu a ɔwɔ stridor sɛ onbue kɛse. Wɔ epiglottitis mu no, mfiri a wɔde kanyan ahurututu no kakraa bi no ma mframa kwan no to mu koraa na ɛma vagal bradycardic gyae.
2. Mfomso 2: Nsu a wɔnom, ɛwo, anaa atiridii aduru a wɔde ma ɔyarefo a ɔwɔ home stridor anaasɛ nsu a ɛtɔ. Sɛ wode biribiara ma ɔyarefo a mframa kwan a ɛwɔ soro no asiw no a, ɛde asiane ba sɛ ɔbɛtwetwe, ɔfe a ɛyɛ den, ne laryngospasm.
3. Mistake 3: Performing abdominal thrusts (Heimlich maneuver) on a child with infectious croup or epiglottitis. Abdominal thrusts are designed exclusively to expel a solid mechanical foreign body. In epiglottitis or croup, the obstruction is swollen living tissue; abdominal thrusts cannot expel swollen tissue and only panic the child and collapse the airway faster.
4. Mistake 4: Giving over-the-counter cough suppressants, antihistamines, or sedatives. Sedating a child or adult who is working hard to breathe through a narrowed airway removes their conscious respiratory drive and relaxes the pharyngeal muscles holding their throat open, precipitating rapid respiratory arrest. Antihistamines also dry out and thicken airway secretions in viral croup and bacterial tracheitis, causing thick mucus plugs to crust over the narrow windpipe.
5. Mfomsoɔ 5: Abofra a ɔde stridor a emu yɛ den, nsuo a ɛretu, anaasɛ ɔretwe ne ho akɔ ayaresabea wɔ ankorankoro kar akyi nkongua so. Bere nyinaa frɛ 911 / 112 / 999 ma ALS ambulance bere a resting stridor, drooling, anaa retractions wɔ hɔ.
6. Mfomso 6: Mframa a ɛwɔ soro no stridor a ɛyɛ basaa ne ayamtu ntua na wɔhyɛ inhaler ma ɛkɔ abofra ketewa a ɔresu anom. Asthma ma expiratory wheezing (ɛyɛ den sɛ wobɛpia mframa fi ahurututu a ɛwɔ fam no mu), bere a croup ne epiglottitis ma inspiratory stridor (ɛyɛ den sɛ wobɛtwe mframa kɔ atwa me menewa a ɛwɔ soro no ho). Salbutamol bruu anaa albuterol ayamtu a wɔde home a wɔtaa de di dwuma no ma ahurututu mu ntini a ɛyɛ mmerɛw a ɛwɔ ahurututu no ase no dwo; wɔwɔ zero effect wɔ cartilage lining a ahonhon wɔ menewa a ɛwɔ soro no so na ebetumi ama koma no bɔ ne basabasayɛ akɔ soro.

Mframa kwan a ɛwɔ soro a egye ntɛmpɛ hwehwɛ sɛ wɔyɛ ade brɛoo na wohu bere a ɛsɛ sɛ wɔma ɔyarefo bi nhaw no. Susuw ho sɛ wobɛfa wo man Red Cross anaa Red Crescent fekuw, Amerika Koma Fekuw, anaa St John Ambulance so akɔ mmoa a edi kan ho adesua a wɔagye atom.

Nsɛm a wɔtaa bisa¶

Sources a wɔhwɛɛ mu¶

• American Academy of Pediatrics (AAP, United States) & Pediatric Advanced Life Support (PALS / AHA): Recognition and Management of Upper Airway Obstruction, Viral Croup, Epiglottitis, and Bacterial Tracheitis.
• National Institute for Health and Care Excellence (NICE, United Kingdom) & NHS: Clinical Knowledge Summary: Croup, Acute Epiglottitis, and Stridor Assessment in Children and Adults.
• Canadian Paediatric Society (CPS, Canada): Acute Management of Croup in the Emergency Department and Prehospital Setting.
• Wiase Akwahosan Ahyehyɛde (WHO, Amanaman Ntam): Kotoku mu Nhoma a Ɛfa Ayaresabea Hwɛ a Wɔde Ma Mmofra: Stridor, Croup, ne Epiglottitis.
• Ahemfie Mmofra Ayaresabea Melbourne (RCH, Australia): Ayaresabea Adeyɛ Akwankyerɛ: Mframa a Ɛwɔ Atifi Asiw a Ɛyɛ Hu ne Croup.

Akwankyerɛ ahorow a ɛfa ho¶

• Mmofra ne nkokoaa CPR ne wɔn a wɔmene wɔn
• Mmoa a edi kan a wɔde ma mpanyimfo ne mmofra a wɔde menewa di dwuma
• Nneɛma a ɛma obi ho yɛ no hyew ne anaphylaxis mmoa a edi kan
• Asthma ntua a wɔde hwɛ ntɛmpɛ
• Mpanyimfo CPR ne nkwagye ahomegye
• Nnɔmba a egye ntɛmpɛ ne amanaman ntam nneɛma a wɔde mena