Barika dɔgɔyali min bɛ wuli joona, Guillain-Barre Syndrome ani Myasthenic Crisis¶

Farikolo fanga dɔgɔyali teliya la min bɛ wuli ka bɔ senw ni senw na ka taa san fɛ ka taa disi la (paralysie ascendante Guillain-Barre Syndrome, walima GBS) walima ka ɲɛda, dawolo, galaka, kɔ ani ninakili fasaw barika dɔgɔya (Myasthenic Crisis Myasthenia Gravis la) o ye ɲɛnamaya-ko ye neuromuscular kɔrɔtɔko. Ninakilidegun tɛ i n’a fɔ jolida walima dusukun tantanni, a man teli ka kɛ sababu ye ka fiɲɛ bila mɔgɔ la kosɛbɛ walima ka oksizɛni dɔgɔya a daminɛ na; o nɔ na, ​​ɲɛgɛnɛsira ni disi kogo fasaw bɛ fanga dɔgɔya dɔɔni fo a tigi tɛ se ka daji bɔ walima ka gazi ɲuman fiyɛ, o bɛ na ni ninakilidegun barikama ye. Dɛmɛ fɔlɔ sinsinnen bɛ a dɔnni joona kan, ka taa ni anpulu ye joona ka taa dɔgɔtɔrɔso la min bɛ wele ko Intensive Care Unit (ICU), ka a jɔ ka ɲɛ walasa ka dawolo jigin, ka dumuni walima jimafɛnw bali kosɛbɛ, ani ka dilan kɛrɛfɛ Single-Breath Count Test kɛ walasa ka ninakili farikolo yɔrɔw lajɛ sani dɔgɔtɔrɔso baarakɛlaw ka se.

Aw bɛ o kɛ sisan¶

1. Aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele joona ni aw senw fanga dɔgɔyali ka taa a fɛ ni ninakili, munumunu, walima kan caman cili bɛ taa ɲɔgɔn fɛ. Aw bɛ 911 wele Ameriki ni Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri, walima aw bɛ o bɛɛ lajɛ kɔrɔtɔko nimɔrɔw. Aw bɛ a fɔ ciden ye k’a jɛya ko: "Banabagatɔ farikolo fanga dɔgɔyali bɛ taa ɲɛ joona [a bɛ siga ko Guillain-Barre syndrome / Myasthenic Crisis] ni ninakilidegun farati bɛ a la." Aw bɛ ɲɛnamaya dɛmɛni anpulu ɲini.
2. Aw bɛ a tigi jɔ ka kɛɲɛ ni degere 45 fo degere 90 ye (aw kana a kɛ a kɔ la abada) fo ni a tɛ a yɛrɛ dɔn. Ni kɔnɔbara basigilen bɛ mɔgɔ min na, o dalen bɛ a kɔ la (a ɲɛda la), kɔnɔbara girinmanw bɛ u gɛrɛ sanfɛ ka ɲɛsin ɲɛgɛnɛsira paralize ma, o bɛ fogonfogon hakɛ dɔgɔya (fogonfogon seko fangama, walima FVC) fo ka se 25 ma fo ka se 25 ma kɛmɛsarada la 50 ani ka sɔgɔsɔgɔninjɛ bila mɔgɔ la joona. Aw bɛ u sigi ka jɔ ka u kunkolo ni u kɔ don.
3. Aw bɛ dilan kɛrɛfɛ Single-Breath Count Test (SBCT) kɛ sisan yɛrɛ ka nimɔrɔ sɛbɛn. Aw bɛ a ɲini a tigi fɛ a ka ninakili jugumanba ta a bɛ se ka min kɛ ani ka jate kɛ ni kanba ye k’a ta \(1\) la ka taa sanfɛ (\(1, 2, 3, 4...\)) ni teliya basigilen ye jateden fila segin kɔnɔ k’a sɔrɔ a ma ninakili filanan ta. Baliku kɛnɛman jate bɛ kɛ \(30\text{ ka se }50\) ma; ni se tɛ ka jate kɛ ka tɛmɛ \(20\) kan ninakili kelen na, o b’a jira ko ninakili fasaw ka dɛsɛ jugumanba don, wa ni jate kɛra \(15\) walima a dɔgɔyalen ye, o b’a jira ko mago bɛ ICU intubation ni masin fiɲɛbɔli la sɔɔni.
4. Aw kana a tigi to foyi la da la (NPO) ani ka a dɛmɛ ka daji dalajɛlenw daji bɔ. Aw kana ji, dumuni, walima furakisɛw di a ma (piridostigmine/Mestinon furakisɛ wɛrɛw fana sen bɛ o la gɛlɛya waati). Galaka ni dawolo fasaw barikantanya (bulbar weakness) bɛ kɛ sababu ye ka jilamaw jigin fiɲɛbɔlan fɛ ka taa fogonfogon la, ani piridostigmine tɛmɛnen bɛ fogonfogon nɔgɔmuguba lase min bɛ fiɲɛbɔyɔrɔ barikama dɔ fa.
5. Aw bɛ dusukun tantanni ni tansiyɔn kɔlɔsi kosɛbɛ ni kungo kɔnɔ jiginni barikama tɛ (Autonomic Dysfunction). Guillain-Barre syndrome la, farikolo tangalan bɛ to ka insulasi bɔ a yɛrɛma nɛrɛw la minnu bɛ dusukun ni joli siraw kɔlɔsi, o bɛ kɛ sababu ye ka dusukun tantanni barikama barikama, tansiyɔn jiginni jugumanba, walima dusukun tantanni barikama ani ka sumaya (bradycardie) ye. Aw kana a to a tigi ka wuli joona.
6. Aw bɛ fura buteliw bɛɛ lajɛlen ni banakisɛw sɔrɔcogo tariku lajɛ dɔgɔtɔrɔso jɛkulu ye. Aw bɛ kɔnɔboli, kɔnɔboli, ninakilibana, walima boloci fɛn o fɛn kɛ dɔgɔkun 1 fo dɔgɔkun 6 tɛmɛnenw kɔnɔ (Guillain-Barre ka bana sababu jɔnjɔnw), ani ka a lajɛ ni Myasthenia Gravis bɛ banabagatɔ min na, o ye banakisɛfagalan walima fura dɔ di a ma kɔsa in na (i n’a fɔ fluoroquinolones, macrolides, aminoglycosides, manje walima beta-blokɛriw).

Kɔrɔtɔko triage ani neuromuscular ninakili latigɛ jiri¶

Aw bɛ baara kɛ ni nin kɛnɛyaso taabolow ye walasa ka danfara don Guillain-Barre ka bana, musoya gɛlɛya, kɔkolo degun, ani farikolojidɛsɛbanakisɛ minnu bɛ jigin (i n’a fɔ botulizi walima wuluwulu), ani ka ninakilidegun min bɛna kɛ, o dɔn joona.

flowchart TD
    Start["Farikolodɛsɛ jugumanba walima min bɛ taa ɲɛ teliya la<br/>Sen/bolo fila bɛɛ la OR Ɲɛkisɛw/Glo/Kɔnɔ fila bɛɛ la"] --> AirwayScreen{"Bulbar & Diaphragme Écran teliya la:<br/>1. Ninakili kelen jate <= 20 (walima <= 15 kɔrɔlen)?<br/>2. Nu kan, kumakan jɛman, walima sɔgɔsɔgɔ ni a munumunu?<br/>3. Kɔ barikama (kunkolo bɛ jigin ɲɛfɛ walima a tɛ se ka wuli ka bɔ barajuru kan)?<br/>4. A tɛ se ka da a la k’a sɔrɔ i ma fiɲɛ bila (Orthopnea)?<br/>5. Kɔnɔbara jigincogo kɔnɔna na fiɲɛ bilali waati (Paradoxical breathing)?"}

    AirwayScreen -->|"ƆWƆ: Mɔgɔ 1 o 1 bɛ yen"| RespEmerg["NEUROMUSCULAR FIANAN ƝƐNABƆLI MIN BƐ SƆRƆ:<br/>1. Aw bɛ telefɔni 911 / 112 / 999 wele joona ka ɲɛsin ALS Anpulu ma<br/>2. Aw bɛ banabagatɔ sigi ka wuli degere 45-90 (aw bɛ kɔ barikama dɛmɛ)<br/>3. Strictly NPO (foyi tɛ da la; aw bɛ daji daji kɛ tasa/bɔrɔsi kɔnɔ)<br/>4. Aw kana piridostigmine (Mestinon) walima hakiliɲagamifura wɛrɛw di a ma"]

    AirwayScreen -->|"AYI: Ninakili ni munumunu bɛ cogo la sisan"| PatternCheck{"barikantanya in farikololabila siratigɛ<br/>ni a cogoya ye mun ye ?"}

    PatternCheck -->|"Yɛlɛli (Jigin-San):<br/>A bɛ daminɛ ni senkɔniw/bolokɔniw sɔgɔsɔgɔli ye -> senw barika dɔgɔyali simetriki<br/>-> jiginni ka se kɔ/bolow ma; senkɔniw bɔnɛ;<br/>dɔgɔkun 1-4 kɔnɔboli walima ninakilibana kɔfɛ"| SuspectGBS["SUSPECTED GUILLAIN-BARRE SYNDROME (GBS):<br/>- Kɔrɔtɔko Kɔrɔtɔko ɲɛmɔgɔso ka jiginni bi<br/>- Aw bɛ segin ninakili kelen jate kan miniti 30-60 o miniti 30-60<br/>- Aw bɛ BP jiginni a yɛrɛma kɔlɔsi ani kɔ/nɛrɛmugu dimi jugumanba"]

    PatternCheck -->|"OCULO-BULBAR FLUCTUATING:<br/>Ɲɛkisɛw bɛ jigin (ptosis), yeli fila bɛ kɛ, dawolo barika ka dɔgɔn/ka sɔgɔsɔgɔ,<br/>nu kan, kɔ bɛ jigin; a ka jugu ni cɛsiri ye walima wula fɛ;<br/>min dɔnna Myasthenia Gravis walima banakisɛfagalan/banakisɛ kura sɔrɔlen kɔsa in na"| SuspectMG["SUSPECTE MYASTENIA GRAVIS EXACERBATION / CRISSE:<br/>- Kɔrɔtɔko Kɔrɔtɔko ɲɛmɔgɔso ka jateminɛ<br/>- Aw bɛ furaw lisɛli lajɛ ni fluoroquinolones, macrolides, beta-blockers<br/>- Aw ye aw labɛn ICU IVIG walima Plasma Exchange (PLEX) kama"]

    PatternCheck -->|"JIGI (Sanfɛ-Jigi) ni ɲɛkisɛ jɔlenw ye :<br/>Yɛlɛma fila, ɲɛkisɛw bɛ bonya, da jalen -> dawolo -> bolow -> senw;<br/>dusukunnataw tɛ sɔgɔsɔgɔ; kɔsa in na dumuni minnu bɛ kɛ so kɔnɔ/min maralen don"| SuspectBot["ƝƐNABƆLI WAALIMA ƝƐNABƆLI MIN BƐ SƆRƆ:<br/>- Aw bɛ kunsigi/kunsigi/farikolo yɔrɔw ɲini ni fɛnɲɛnamafagalan dogolen don<br/>- Aw ye gafe ɲɛ Botulisme & Neurotoxin Guide lajɛ; Aw bɛ telefɔni 911 / 112 / 999 wele"]

    PatternCheck -->|"SHARP SENSORY LEVEL + BLADDER RETENTION:<br/>Disi/cɛya kɛrɛnkɛrɛnnen dɔ jukɔrɔla sɔgɔsɔgɔ + kɔdimi juguman<br/>+ koli sebaliya walima sɔgɔsɔgɔninjɛ"| SuspectCord["SUSPECTED ACUTE SPINAL CORD COMPRESSION / CAUDA EQUINA:<br/>- Aw ye Cauda Equina & Spinal Cord Compression Guide lajɛ<br/>- Aw bɛ 911 / 112 / 999 wele walasa ka kɔkolo MRI kɔrɔtɔlen kɛ"]

Farikoloɲɛnajɛ fɔlɔ fila faamuyali¶

1. Guillain-Barre Syndrome (GBS): O ye farikolojidɛsɛ jugumanba ye min bɛ wuli¶

Guillain-Barre Syndrome (GBS) (a bɛ fɔ fana ko Acute Inflammatory Demyelinating Polyradiculoneuropathy, walima AIDP, ka fara axonal variants kan AMAN ani AMSAN) ye farikolo tangalanw ka binkanni jugumanba ye min bɛ kɛ farikolo laminiw ni farikolojidɛsɛ juw kan minnu bɛ bɔ kɔkolo la. - A bɛ daminɛ cogo min na ("Molecular Mimicry"): Banabagatɔ kɛmɛsarada la 70 ɲɔgɔn na, GBS bɛ daminɛ dɔgɔkun 1 fo dɔgɔkun 4 banakisɛ gansan dɔ kɔfɛ, a tɔgɔ bɔra kosɛbɛ kɔnɔboli dumuni fɛ min bɛ sɔrɔ Campylobacter jejuni fɛ (a ka ca a la a bɛ bɔ kɔnɔ tobilen na), walima ninakilibanaw i n’a fɔ kunfilanitu, sitomegalovirusi (CMV), Epstein-Barr banakisɛ (EBV), Mycoplasma pneumoniae, Zika banakisɛ, walima SARS-CoV-2. Banakisɛfagalan minnu bɛ bɔ farikolo tangalanw fɛ walasa ka banakisɛ kɛlɛ, olu bɛ ɲɔgɔn sɔrɔ bala la ni ganglioside lipids ye hadamadenw ka farikolo yɔrɔw la, ka miyɛlini fɛnɲɛnamafagalan bɔ (i n’a fɔ ka lastikuw bɔ kuran fiyɛli la) walima ka farikolo yɔrɔw tiɲɛ k’a ɲɛsin u yɛrɛ ma. - GBS bɛ taa ɲɛ cogo min na: 1. Early Sensory & Pain Phase (Hours to Days): Banabagatɔ fanba bɛ fɔlɔ ka symmetrical "pins and needles" (paresthesias) walima sɔgɔsɔgɔninjɛ senkɔniw ni bolokɔniw na, a ka ca a la dimi jugumanba, dimi, kirinni bɛ kɛ kɔ duguma, kɔkili, ani cɛmancɛ la (o bɛ sɔrɔ kɔkolo funu fɛ, o min bɛ to ka sɛgɛsɛgɛ cogo jugu la ko sɔgɔsɔgɔninjɛ walima disiki sɔgɔlen). 2. Ascending Motor Paralysis (Tile 2 fo dɔgɔkun 4): Barika dɔgɔyali bɛ daminɛ sen fila bɛɛ la (ka senna-tɛgɛrɛ kɛ siraba kan, ka gɛlɛya ka jiginni kɛ ɛrɛzɛnsunw kan walima ka wuli ka bɔ ɲɛgɛn na) ka wuli ka taa san fɛ ka taa a fɛ lɛrɛ caman kɔnɔ fo ka se tile damadɔ ma ka don cɛya la, kɔkolo la, bolokɔniw na, ɲɛda nɛrɛmugumaw la (a ka ca a la o bɛ kɛ sababu ye ka ** ɲɛda paralizi fan fila ** lase a tigi tɛ se yɔrɔ min na aw bɛ nisɔndiya walima ka ɲɛ fila bɛɛ datugu), ka farikolo yɔrɔw munumunu, ka laban ka kɔkolo ni ɲɛdawolo ni ɲɛdawolo. 3. Tɔgɔtɔgɔnin jugumanba (Areflexia) bɔnɛni): Ni dɔgɔtɔrɔ ye gɛnɛgɛnɛ walima senkɔni sɔgɔsɔgɔninjɛ gosi ni reflex hammer ye, o reflexes tɛ yen walima a bɛ dɔgɔya kosɛbɛ. 4. Autonomic Nervous System Instability: GBS banabagatɔ tilancɛ fila bɛ se ka kɛ sababu ye ka farikolojidɛsɛ faratilen sɔrɔ u yɛrɛ sago la, o bɛ kɛ sababu ye ka tansiyɔn jiginni jugumanba bila mɔgɔ la, ka dusukun tantanni teliya barikama (bradycardia/asystole), sugunɛbilenni, walima paralytic ileus (banakɔtaa jɔli). - Miller Fisher Syndrome (MFS) Variant: GBS suguya kɛrɛnkɛrɛnnen dɔ min bɛ taa sanfɛ ka jigin sanni ka taa duguma ka taa sanfɛ, o bɛ dɔn ni klasiki saba ye min ye ɲɛdimi (ɲɛ lamagacogo paralizi min bɛ kɛ sababu ye ka yeli fila jugumanba bila mɔgɔ la), ataxia (basigibaliya jugumanba ani jɛɲɔgɔnya bɔnɛ), ani areflexia (reflexes absent).

2. Miyastɛni gɛlɛya : Dɛsɛ bɛ sɔrɔ farikolo yɔrɔw la¶

Myasthenia Gravis (MG) ye farikolo tangalan bana ye min na farikolo tangalanw (a ka ca a la anti-acetylcholine receptor [AChR] anticorps walima anti-MuSK antibodies) bɛ mikroskɔpi kemikoro minɛbagaw bali farikolo yɔrɔw kan, farikolojidɛsɛbanakisɛw bɛ acetylcholine bɔ yɔrɔ minnu na. - Hallmark fatigable weakness: Ikomi farikolo ka baarakɛminɛnw ka dɔgɔ kojugu, farikolojidɛsɛ fɔlɔw bɛ se ka kɛ i n’a fɔ a bɛ ɲini ka kɛ cogo la, nka ni a kɛra siɲɛ caman, o bɛ ɲɔgɔndan dɔgɔya joona (sɛgɛn). A taamasiɲɛw ka nɔgɔn sɔgɔma lafiɲɛbɔ kɔfɛ, wa u bɛ juguya tile kɔfɛ walima kuma basigilen, ɲimi walima sanfɛla lajɛ waati. - Miasthenic Crisis ye mun ye: myasthenic crisis ye bana juguya ye min bɛ mɔgɔ ka ɲɛnamaya bila farati la, fanga dɔgɔya bɛ jɛnsɛn bulbar muscles (dawolo, kan, dawolo, dawolo) ani ninakili fasaw (diaphragme ani disi kogo) la kosɛbɛ fo ka se ka fiɲɛbɔyɔrɔw lakanani bila farati la walima ka fiɲɛbɔli masin kɛ. Miyastɛni Gravis banabagatɔ kɛmɛsarada la, 15 fo 20 ɲɔgɔn bɛ miyastɛni gɛlɛya kelen sɔrɔ a dɔgɔyalenba la, wa banabagatɔ dɔw fɛ, gɛlɛya ye u ka Miyastɛni Gravis sɔrɔli siɲɛ fɔlɔ ye. - Miasthenic Crise (Myasthenic Crise) sababu minnu ka teli ka sɔrɔ: - Ninakili walima sugunɛbaralabana jugumanba ani sumaya. - Opereli, dusukunnataw ta fan fɛ, kɔnɔmaya walima den sɔrɔli. - Kɔritikositɛri tata hakɛ caman daminɛni (pɛrɛdinizɔni bɛ se ka kɛ sababu ye ka MG barikantanya juguya waati kunkurunnin kɔnɔ tile 5 fo tile 14 fɔlɔ kɔnɔ). - Fura minnu tɛ se ka furakɛ minnu bɛ farikolojidɛsɛ bali (aw ye furaw farati jatebɔ sɛbɛn lajɛ jukɔrɔ).

Aw ye ɲɔgɔn sanga kosɛbɛ: Guillain-Barre Syndrome ni Myasthenic Crisis ni Botulisme ni kɔkolo degun¶

Ikomi barikantanya jugumanba bɛ se ka bɔ kɔkolo la, farikolo yɔrɔw la, walima farikolo yɔrɔw la, dɔgɔtɔrɔw bɛ baara kɛ ni nin dilan kɛrɛfɛ taamasiɲɛw ye minnu bɛ danfara don u ni ɲɔgɔn cɛ:

Ninakilidegun makunnen yecogo so kɔnɔ (Sanni oksimɛtiri ka jigin) .¶

Sɔgɔsɔgɔninjɛ walima sɔgɔsɔgɔninjɛ bɛ mɔgɔ min na, ninakilidegun bɛ ye ka jɛya: a bɛ sɔgɔsɔgɔ, ka sɔgɔsɔgɔ ni kanba ye, wa a ka oksizɛni hakɛ bɛ dɔgɔya. Guillain-Barre syndrome walima Myasthenia Gravis bɛ mɔgɔ min na, fasa minnu bɛ fiɲɛ bila walima ka sɔgɔsɔgɔba lawuli, olu ye farikolo yɛrɛ de ye minnu bɛ kɛ paralize ye. Aw ye nin taamasiɲɛ fɔlɔ duuru kɛrɛnkɛrɛnnenw kɔlɔsi bulbar ni diaphragmatic failure:

1. Dilan kɛrɛfɛ ninakili kelen jatebɔ sɛgɛsɛgɛli (SBCT): Proxy validé pour la capacité de fogonfogon (FVC) .¶

Dɔgɔtɔrɔso ICU la, dɔgɔtɔrɔw bɛ Fogonfogon seko fangama (FVC) ni Fanga jugumanba (NIF) suman ni bolola spirometer ye (ka "20/30/40 Sariya" kɛ: intubation ka kan ka kɛ ni fogonfogon seko fanga dɔgɔyara \(20\text{ mL/kg}\) duguma, Maximal Inspiratory Pressure ka dɔgɔn ka tɛmɛ \(-30\text{ cmH}_2\text{O}\), walima Fiɲɛ bilali tansiyɔn maksimali bɛ \(40\text{ cmH}_2\text{O}\) duguma). So kɔnɔ, Fiɲɛ kelen jate sɛgɛsɛgɛli bɛ tali kɛ ɲɔgɔn na ni Fogonfogon seko fangama ye (jateden kelen-kelen bɛɛ jate bɛ bɛn fogonfogon seko ma \(100\text{ fo ka se }115\text{ mililitiri}\) ma): - A kɛcogo: Aw bɛ a tigi bila ka sigi, ka ninakili kosɛbɛ, ka jate kɛ ni kanba ye (\(1, 2, 3, 4, 5...\)) ni teliya ye jateden 2 segin kɔnɔ (ka bɛn watɛsi bolo filanan ma) fo a ka kan ka ninakili wɛrɛ ta. - Sɔrɔdasi kɔrɔfɔcogo: - Jate \(> 30\): Ninakili fasaw maracogo ɲuman (aw bɛ to ka segin ka a lajɛ lɛri 1 fo lɛri 2 o lɛri 2 ni GBS bɛ ka taa ɲɛ). - Jate \(20\text{ ka se }25\): Ninakili farikolo fanga dɔgɔyali joona (Kɔrɔtɔko ɲɛmɔgɔso ka jateminɛ ka kan ka kɛ joona). - Jateminɛ \(\le 15\) ka se \(20\) ma: A bɛ bɛn fogonfogon seko fangama (FVC) ma min bɛ \(15\text{ duguma ka se }20\text{ mL/kg}\) ma (Faraba: Aw bɛ 911 / 112 / 999 wele joona; a ka c’a la banabagatɔ mago bɛ ICU fiɲɛbɔyɔrɔw lakanani na). - Jiginni: Banabagatɔ min jate bɛ jigin ka bɔ \(35\) la tilelafana na ka se \(22\) ma 15h waati, o bɛ ka juguya joona, wa a ka kan ka kɛ ICU la sani su ka don.

2. Kɔkolo flexor barikantanya (Taamaʃyɛn "Kunkolo jigin / Pillow Lift") .¶

Farikolo minnu bɛ kun kɔrɔta ka bɔ barajuru kan walima ka dawolo minɛ san fɛ (cervical flexors and extensors, minnu bɛ sɔrɔ kɔnɔbara basigilen C2 fo C5 fɛ) olu ni kɔkolo nɛrɛmuguma sigida kelen tigitigi ni frenic nerve (C3, C4, C5) min bɛ diaphragme fanga di ("C3, 4, 5 bɛ diaphragm mara ɲɛnama"). - Sɛgɛsɛgɛli: Ni a tigi dalen bɛ degere 30 la, ni a tɛ se k’a kun kɔrɔta ka bɔ barajuru kan fo sekɔndi 5, walima ni a dawolo bɛ to ka jigin ka taa ɲɛfɛ a disi kan k’a sigilen to (kunkolo jigin), a bɛ se ka fɔ ko a dawolo bɛ fanga dɔgɔya a kɔ fasaw kɛrɛfɛ yɛrɛ.

3. Bulbar Weakness (Fiɲɛbɔyɔrɔ lakanani dɛsɛ taamasiɲɛw) .¶

Sani ɲɛgɛnɛsira ka tiɲɛ pewu, dawolo, kan, ani dawolo nɔgɔlen (bulbar palsy) barikantanya bɛ a tigi ka se tiɲɛ ka nɔgɔ bɔ a fogonfogon la: - Kan bɛ Yɛlɛma: U kan bɛ barika Bɔ nugukolo la ("ka kuma u nugu fɛ"), ka nɔgɔya, ka mankan Bɔ, walima ka sɔgɔsɔgɔ, kɛrɛnkɛrɛnnenya la u kumanen kɔ segin 30 kɔnɔ. - Nu kɔdimi: Ni u y’a ɲini ka ji min, ji bɛ segin ka bɔ u nugu fɛ barisa dawolo nɔgɔlen barikama tɛ se ka nugu sira datugu. - Sɔgɔsɔgɔ "bovine" barikama: Ni a ɲinina a fɛ a ka sɔgɔsɔgɔ ni fanga ye, sɔgɔsɔgɔ mankan bɛ bɔ, fiɲɛ bɛ bɔ a la, wa a barika ka dɔgɔn (a tɛ se ka sɔgɔsɔgɔninjɛ bɔ galaka la). - Sɛgɛn sɔgɔli (Myasthenia Gravis kɔnɔ): U dawolo bɛ sɛgɛn dumuni cɛmancɛ la, o b’u wajibiya k’u dawolo da n’u bolo ye.

4. Kɔnɔbara ninakili ni farikolojidɛsɛ min bɛ ɲɔgɔn sɔsɔ¶

• Fiɲɛbɔ: A tigi bɛ siran yɔrɔnin kelen walima a b’a miiri ko a tɛ se k’a ninakili minɛ waati min na a sigilen bɛ dilan kan, barisa girinya tɛ a kɔnɔbara yɔrɔw sama tugun ka bɔ a ka ɲɛgɛnɛsira barikama sira fɛ.
• Finakili min bɛ kɛ ni paradoxical ye (Abdominal Paradox): A ka ca a la, ni aw ye ninakili kosɛbɛ, aw ka ɲɛgɛnɛsira bɛ gɛrɛ duguma ani aw kɔnɔbara bɛ taa kɛnɛ fɛ. Ni disidilan kɛra paralize ye, disi fasaw b’a ɲini ka fiɲɛ sama ka don a kɔnɔ ani ka tiɲɛ na disidilan min bɛ wele ko floppy diaphragme sama ka taa sanfɛ ka don disi la, o bɛ kɛ sababu ye ka kɔnɔbara sanfɛla ka jigin KƆNƆ fiyɛli waati. Nin ye kɔrɔtɔko dafalen ye min bɛ anpulu ta teliya la.

5. Gazi ɲuman sɔrɔli taamasiɲɛw kɔfɛ (Hypercapnia) .¶

Ni ninakili bɛ dɔgɔya kojugu walasa ka gazi ɲuman (\(CO_2\)) fiyɛ, aw bɛ aw janto ** ɲɛda sumaya (diaphoresis), dusukun tantanni teliya la, tansiyɔn jiginni dɔɔni, sɔgɔmada kungolodimi, jɔrɔ, lafiyabaliya, ani laban na sunɔgɔ barikama walima hakili ɲagami**. Aw kana jɔrɔnankofura walima sunɔgɔfura di banabagatɔ lafiyabali ma abada, GBS walima Myasthenia Gravis bɛ min na; u tɛ lafiya bawo u bɛ u da sɔgɔsɔgɔ dɔɔni dɔɔni gazi ɲuman wulilen fɛ.

Farati kɛrɛnkɛrɛnnenw Miyastɛni Gravis: Fura minnu man ɲi ani kolinɛriji gɛlɛya¶

1. Fura minnu bɛ se ka kɛ sababu ye ka mɔgɔ faga¶

Ni Myasthenia Gravis bɛ aw walima aw ka mɔgɔ kanulen dɔ la, don o don fura caman minnu bɛ di aw ma ani minnu tɛ sɔrɔ dɔgɔtɔrɔso la, olu bɛ se ka farikolojidɛsɛ yɔrɔ tɔw bali ani ka ninakilidegun barikama teliya lɛrɛ damadɔ kɔnɔ. Fura minnu daminɛna kɔsa in na, aw bɛ olu lajɛ tuma bɛɛ ka kɛɲɛ ni nin faratiba lisi ye min sigira sen kan Myasthenia Gravis Foundation of America (MGFA) fɛ ani diɲɛ hakililata laadilikanw fɛ:

2. Mun na aw man kan ka piridostigmine (Mestinon) wɛrɛ di a ma gɛlɛya waati¶

Banabagatɔ caman minnu bɛ ni Myasthenia Gravis ye, olu bɛ piridostigmine (Mestinon) ta don o don da la, o ye asetilkolinɛsitɛrizi balilan ye min bɛ asetilikolini hakɛ caya waati dɔɔni farikolo yɔrɔ la. Ni banabagatɔ ye gɛlɛya daminɛ ka munumunu walima ka ninakili, a ka ca a la, denbayaw bɛ kɔrɔbɔ ka Mestinon furakisɛ wɛrɛw mugumugu ani ka u di a ma. Aw kana nin kɛ abada gɛlɛya jugumanba waati la: 1. Fara min bɛ fiɲɛ bilali la: Ni galaka fasaw barika ka dɔgɔ, furakisɛw ni ji minni bɛ kɛ sababu ye ka sɔgɔsɔgɔninjɛ bila mɔgɔ la joona ani ka sɔgɔsɔgɔninjɛ bila mɔgɔ la. 2. Nɔgɔ bɔli (Muscarinic Overload): Piridostigmine bɛ sɔgɔsɔgɔninjɛ ni sɔgɔsɔgɔninjɛ nɔgɔw lawuli walasa u ka fɛnɲɛnamafagalanw bɔn minnu ka bon ni ji ye (sɔgɔsɔgɔninjɛ ni sɔgɔsɔgɔninjɛ) ka sɔrɔ ka fiɲɛbɔlanw fana gɛlɛya. Sɔgɔsɔgɔ barikama bɛ banabagatɔ min na, o tɛ se ka nin nɔgɔ ni nɔgɔ sanjiba in bɔ a la, wa a bɛ se ka jigin tiɲɛ yɛrɛ la u yɛrɛ ka fɛnɲɛnamafagalanw na. 3. Kilinerji gɛlɛya: Piridostigmine hakɛ tɛmɛnen tali bɛ farikolo yɔrɔw lawuli kojugu ani ka u depolarize fo u ka datugu ani ka dɛsɛ pewu (kolinerji gɛlɛya), o bɛ kɛ sababu ye ka paralizi juguya SLUDGE taamasiɲɛw kɛrɛfɛ: profuse Salivation, Lacrimation (tearing), Urination, Dsɔgɔsɔgɔninjɛ/kɔnɔbara basigilen, GI degun, Emesis (fɔɔnɔ), ɲɛnamini pinɛ (miosis), farikolojidɛsɛ (fasciculations), ani dusukun tantanni dɔɔni faratilen (bradycardia).

Dɛmɛ fɔlɔ senfɛ-senfɛ ka a sɔrɔ aw bɛ anpulu makɔnɔ¶

Taabolo fɔlɔ : Fiɲɛbɔyɔrɔ ni fiɲɛ bilali cogo ɲuman na¶

• Ni u kununna ani ni u bɛ ninakili u yɛrɛ ma: Aw bɛ a tigi sigi a jɔlen na degere 45 fo degere 90, walima aw bɛ a to a ka a biri ɲɛfɛ dɔɔni ni u bolokɔniw bɛ lafiɲɛ tabali walima barajuru kan (tripod posture) o la girinya ka kɔnɔbara kɔnɔfɛnw sama ka jigin ani ka yɔrɔ caman di diaphragme ma walasa a ka bonya.
• Aw bɛ kɔ barikama dɛmɛ: Ni a tigi kɔ barika dɔgɔyara (kunkolo bɛ jigin ka taa ɲɛfɛ), aw bɛ finimugu kurulen dɔ bila a kɔ kɔfɛ nɔgɔya la walima ka a ɲɛda ni a dawolo dɛmɛ walasa fiɲɛbɔlan kana kinki.
• Ka ɲɛsin sɔgɔsɔgɔninjɛ lajɛlen ma: Aw bɛ finimugu, tissu walima tasa di a tigi ma ani ka a fɔ a ye ko a ka a yɛrɛ biri dɔɔni ɲɛfɛ ka daji daji bɔ sanni u k’a ɲini k’a munumunu.
• Ni aw hakili tɛ a la walima ni aw bɛ fɔɔnɔ kɛ kosɛbɛ: Aw bɛ u wuli joona u kɛrɛ fɛ ka don kɛrɛfɛla kɛnɛyayɔrɔ la ka fɔɔnɔ walima nɔgɔmugu yelen o nɔgɔmugu ye ka bɔ da ɲɛfɛ, aw bɛ o bɛɛ ko.

Taabolo 2nan : Aw bɛ "Ice Pack Test" (Diagnostic Clue optionnel pour les lèvres drooping) kɛ .¶

Ni mɔgɔ dɔ ye ɲɛkisɛ sanfɛla kelen walima a fila bɛɛ jigin yɔrɔnin kelen (ptosis) ani ni aw bɛ dɔgɔtɔrɔso jateminɛ makɔnɔ (k’a sɔrɔ aw ma kɔrɔtɔko weleli bila kɔfɛ ni ninakili walima a munumunu tiɲɛna): - Aw bɛ jisumamugu walima shɔni foroko dɔ siri finimugu finman dɔ la ka a minɛ nɔgɔya la ɲɛda datugulen min bɛ jigin, o kan fo miniti miniti 2, o kɔ aw bɛ a bɔ ka ɲɛkisɛ lajɛ o yɔrɔnin bɛɛ. - A kɔrɔ ye min ye: Nɛnɛ bɛ anzimu (acetylcholinesterase) sumaya min bɛ asetilkolini tiɲɛ. Ni ɲɛkisɛ min bɛ jigin, o dabɔra ka bonya kosɛbɛ (a bɛ ɲɛ ni \(2\text{ milimɛtɛrɛ}\) walima ka tɛmɛ o kan) miniti damadɔ kɔnɔ jisuma bɔlen kɔfɛ dɔrɔn, o ye Myasthenia Gravis taamasiɲɛ ɲuman kɔrɔlen ye (a bɛ se ka kɛ 80 ye kɛmɛsarada la). Aw ye min kɔlɔsi, aw bɛ o fɔ kɛnɛyaso dɔgɔtɔrɔ ye.

Taabolo 3nan : Dɔgɔtɔrɔso lasɔmini jugumanba furakɛlikɛlaw ni dɔgɔtɔrɔw ye (Succinylcholine Ladilikan) .¶

Ni banabagatɔ min bɛ ni Guillain-Barre Syndrome ye (walima paralysie subacute denervate o paralysie subacute min bɛ mɛn ka tɛmɛ sanga 48 fo sanga 72 kan) ni a mago bɛ endotracheal intubation kɔrɔtɔlen na anpulu walima dɔgɔtɔrɔso la, kɔrɔtɔko dɔgɔtɔrɔw man kan ka farikolo lafiyalan depolarizing succinylcholine (suxamethonium) kɛ abada: - Mun na: Farikolo minnu ma farikolojidɛsɛ sɔrɔ Guillain-Barre syndrome la, olu bɛ asetilkolini minɛyɔrɔw wuli ka taa sanfɛ farikolo yɔrɔ bɛɛ la. Sukisinilikolini dili bɛ kɛ sababu ye ka potasiyɔmu sira bɛɛ min bɛ o farikolo yɔrɔw la, o bɛ potasiyɔmu fili joli la siɲɛ kelen, o bɛ kɛ sababu ye ka dusukun jɔli teliya la, min bɛ mɔgɔ faga segin 60 kɔnɔ. O nɔ na, ​​dɔgɔtɔrɔw bɛ farikolojidɛsɛ furaw kɛ minnu tɛ depolarize (i n’a fɔ rokuroniyɔmu ni u tata hakɛ ladilanna). Ni aw ye "Suspected Guillain-Barre syndrome" fɔ ka jɛya bolo dicogo la, o bɛ banabagatɔ tanga nin fura fagalen in ma.

Kumaɲɔgɔnya sɛbɛn tigitigi 911 / 112 / 999 ani Hospital Triage kan¶

Ikomi banabagatɔ min bɛ Guillain-Barre syndrome daminɛ na walima Myasthenic Crisis la, a ka ca a la, a ka teli ka kɛ ni pulse oximeter (\(98\%\)) ye min bɛ a cogo la pewu, wa a bɛ kuma ni dususuma ye, kɔrɔtɔko sɛgɛsɛgɛli baarakɛlaw bɛ se ka a dɔgɔya cogo min na u surunyalen don ninakilidegun na. Aw bɛ baara kɛ ni nin kɛnɛyaso kan tigitigi in ye:

• Ni siga bɛ Guillain-Barre Syndrome la:

  *"Ne mago bɛ anpulu la [Adrɛsi tigitigi]. Banabagatɔ ye [San] san [cɛ/muso] ye ni paralizi simetriki ye min bɛ wuli teliya la ani sɔgɔsɔgɔninjɛ min daminɛna senw na [lɛrɛ X/tile] tɛmɛnen kɔfɛ, wa sisan a sera [cɛya / bolokɔniw / ɲɛda / ninakili] ma. [A/A] tun bɛ [kɔnɔjabana / banakisɛbana dɔ] [X] dɔgɔkunw kɔnɔ ago Sisan yɛrɛ, [a ka] Ninakili kelen jate ye [Number] dɔrɔn de ye, wa [a] bɛ [gɛlɛya sɔrɔ munumunu la / sɔgɔsɔgɔ barikama / sebaliya ka kunkolo kɔrɔta ka bɔ barajuru kan].

• Ka ɲɛsin Crise Myasthenic Suspects ma:

  "Ne mago bɛ anpulu la [Exact Address] la Myasthenic Crisis kama. Banabagatɔ bɛ ni Myasthenia Gravis ye ani a ye bulbar ni ninakilidegun jugumanba sɔrɔ, i n'a fɔ [nugu kumacogo nɔgɔlen / sɔgɔsɔgɔninjɛ / kunkolo jigincogo / sebaliya ka da fla la]. [A/A] Single-Breath Count jigira ka se [Number]. Kana i jigi da pulse kan oximetry dɔrɔn [a] mago bɛ ICU jateminɛ na teliya la walasa ka Forced Lung Capacity (FVC) kɔlɔsili kɛ, ninakili dɛmɛni, ani IVIG walima plasmapheresis."

Dɔgɔtɔrɔso labɛnni sɛgɛsɛgɛli sɛbɛn ka sɔrɔ ka EMS makɔnɔ¶

• Finakili kelen jate sɛgɛsɛgɛli jatew sɛbɛnnen ni waati waatiw ye (misali la, "1:00 PM jate = 26; 2:30 PM jate = 17").
• Barikɛbaliya taabolo waati tigitigi (ni kirinni daminɛna, ni taama ma ɲɛ, ni munumunu walima ni kuma Changé).
• Bana, dumuni baga, walima boloci minnu kɛra kɔsa in na, olu tariku dɔgɔkun 6 tɛmɛnenw kɔnɔ.
• Fura buteli minnu bɛ kɛ sisan (kɛrɛnkɛrɛnnenya la banakisɛfagalan kura minnu daminɛna tile 7 tɛmɛnenw na, piridostigmine/Mestinon, prednisone, azathioprine, mycophenolate, efgartigimod, walima eculizumab).
• Aw bɛ kunsigi ni kunsigi lajɛ joona ni wulu nɔrɔlen don a la (kɛrɛnkɛrɛnnenya la denmisɛnw walima taamakɛlaw la minnu ka paralizi bɛ jiginni teliya la ani u tɛ dusukunnataw tiɲɛ).

Ɲininkali minnu bɛ kɛ tuma caman na¶

Mun na bolokɔnincinin bɛ se ka oksizɛni 98% kalan ni Guillain-Barre syndrome walima Myasthenia Gravis bɛ mɔgɔ min na, o bɛ ninakili dabila da la?¶

Pulse oximeter bɛ oksizɛni hakɛ suman joli la, o min bɛ to a cogo la ni fiɲɛbɔyɔrɔw jɛlen don fogonfogon kɔnɔ. Guillain-Barre syndrome ni myasthenic crisis la, fogonfogonw bɛ kɛnɛya, nka diaphragme ni disi fasaw bɛ fanga dɔgɔya kojugu fo u tɛ se ka ninakili kosɛbɛ (**hypoventilation**). O bɛ kɛ sababu ye ka gazi ɲuman ($CO_2$) baga hakɛ caya joli la k’a sɔrɔ oksizɛni hakɛ bɛ kalan hali bi 96% fo 98%; ni ɲɛgɛnɛsira labanna ka ban pewu, oksizɛni bɛ jigin kosɛbɛ ani dusukun tantanni bɛ tugu o kɔ miniti damadɔ kɔnɔ.

Ne bɛ se ka ninakili kelen jate sɛgɛsɛgɛli kɛ cogo di so kɔnɔ, ani nimɔrɔ jumɛn ye kɔrɔtɔko ye?¶

Aw bɛ a tigi bila a jɔlen na, ka ninakili kosɛbɛ a seko la, ka jate kɛ ni kanba ye ka bɔ 1 la ka taa sanfɛ (1, 2, 3, 4...) ni teliya ye min bɛ kɛ ni jateden fila ye segin kɔnɔ fo a ka kan ka ninakili wɛrɛ ta. A ka ca a la baliku kɛnɛman bɛ se ka jate fo san 30 ni san 50 cɛ; ni sebaliya ka se san 20 ma, o b’a jira ko ninakilidegun jugumanba bɛ a la min ka kan ka ladon joona kɛnɛyaso la, ani ni jate kɛra 15 ye walima ka tɛmɛ o kan, o b’a jira ko ninakilidegun bɛ ka surunya min bɛ anpulu ni ICU fiɲɛbɔyɔrɔw dɛmɛ teliya la.

Mun na Myasthenia Gravis bɛ mɔgɔ min na, o man kan ka Mestinon (pyridostigmine) furakisɛ wɛrɛw ta ni a daminɛna ka gɛlɛya sɔrɔ a munumunu walima ninakili la?¶

Fura minnu dawolo fasaw barika ka dɔgɔn, ni aw ye olu munumunu, o bɛ se ka kɛ sababu ye ka u sɔgɔsɔgɔ joona ani ka u fiyɛ fogonfogon la. Ka fara o kan, piridostigmine tɛmɛnen bɛ kɛ sababu ye ka sɔgɔsɔgɔninjɛ ni fogonfogonw ka nɔgɔmugu bɔn, banabagatɔ barikama tɛ se ka minnu sɔgɔsɔgɔ, wa a bɛ se ka kɛ sababu ye ka “kolinɛriji gɛlɛya” bila mɔgɔ la min bɛ farikolojidɛsɛ juguya tiɲɛ na.

Dɔgɔtɔrɔw bɛ se ka danfara don cogo di Guillain-Barre ka bana ni kɔkolo jogin cɛ ni u fila bɛɛ ye senw farikolo tiɲɛ?¶

Guillain-Barre ka bana bɛ bin farikolo yɔrɔw kan, ka fanga dɔgɔya ka wuli ka bɔ senkɔniw na ka taa sanfɛ, ka gɛnɛgɛnɛ ni senkɔniw sɔgɔsɔgɔninjɛ bɔnɛ, ani ka senw ni bolow sɔgɔsɔgɔ ni sɔgɔsɔgɔninjɛ tilennen tɛ farikolo la. O ni kɔkolo degun jugumanba tɛ kelen ye, a ka ca a la, o bɛ kɛ sababu ye ka "nivo sensory" danfaralen dɔ bila disi walima kɔnɔbara la, dusukunnata bɛɛ bɛ tunun min jukɔrɔ, koli tɛ se ka kɛ joona (sugunɛbilenni tali), ani kɔkolodimi jugumanba min bɛ kɛ yɔrɔ la, o min bɛ tiɲɛ o yɔrɔnin bɛɛ ni kɔkolo MRI kɔrɔtɔlen ye.

Sosow sɛgɛsɛgɛra¶

• Erɔpu ka hakiliɲagami kalanso (EAN) ani farikoloɲɛnajɛ tɔnba (PNS): 2023/2024 EAN/PNS ka laadilikan min ɲɛsinnen bɛ Guillain-Barré ka bana sɛgɛsɛgɛli n’a furakɛli ma (Journal of the Peripheral Nervous System / European Journal of Neurology, van Doorn et al.).
• Myasthenia Gravis Foundation of America (MGFA, Etazuni) & Duniya Bɛnkansɛbɛnw Ladilikan: Duniɲa ka bɛnkansɛbɛn ɲɛminɛcogo min bɛ ɲɛsin Myasthenia Gravis furakɛli ma (Sanders ni a ɲɔgɔnnaw / Narayanaswami ni a ɲɔgɔnnaw, Neurology, MGFA ka lasɔmini furaw lisi ani Myasthenic Crisis protocols fana sen bɛ o la).
• Neurocritical Care Society (NCS): Ladilikanw ka ɲɛsin ninakilidegun furakɛli jugumanba ma Guillain-Barré Syndrome ni Myasthenic Crisis la (20/30/40 sariya tiɲɛni ani dilan kɛrɛfɛ Single-Breath Count Test).
• Jamana ka kɛnɛyako ni ladonniko ɲɛtaa baarada (NICE, Angletɛri) & Angletɛri hakililabaarakɛlaw ka tɔnba (ABN): Sɔgɔsɔgɔninjɛ fanga dɔgɔyali jugumanba ani Guillain-Barré Syndrome suspected Triage Emergency Guidelines.
• Diɲɛ kɛnɛyatɔn (OMS) & Banaw kɛlɛli ni u kunbɛnni baaradaw (CDC, Etazuni): Guillain-Barré ka bana ni botulisimu danfara sɛgɛsɛgɛli kɛnɛyaso la.

Gafe minnu bɛ tali kɛ o ko la¶

• Botulisi, ciguatera, scombroid ani jɛgɛw ka neurotoxine baga
• Cauda equina syndrome ani kɔkolo degun jugumanba darapo bilenmanw
• Atɛki dɔnni (FAST) ani kɔrɔtɔko jaabi
• Tiki ni sɔgɔsɔgɔninjɛ bɛ dɛmɛ fɔlɔ kɛ
• Dusukun ni fogonfogon lakununni (CPR) ani AED ɲɛminɛbaga