Denw ka fiɲɛbɔyɔrɔ kɔrɔtɔlenw, Ludwig ka Angina, ani Submandibular Swelling¶

Ludwig ka angina ye selilulisi ye min bɛ taa ɲɛ joona, min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la, min bɛ sɔrɔ da duguma ni kɔkolo yɔrɔ fila la, o bɛ sɔrɔ kɛmɛsarada la 80 fo 90 ni kɔ la, o bɛ sɔrɔ ɲin duguma ɲinbana fɛ min ma furakɛ (kɛrɛnkɛrɛnnenya la, dawolo filanan walima sabanan). Ikomi kolo duguma dawolo (mandible) bɛ funu bali ka bonya ka taa kɛnɛma walima duguma, sɔgɔsɔgɔninjɛ min bɛ bonya joona, o bɛ da duguma ni kan dawolo gɛrɛntɛ ka tilennen san fɛ da sanfɛla la ka segin kɔfɛ ka don dawolo la, o bɛ baga masin bɛɛ ka sɔgɔsɔgɔninjɛ ma lɛrɛ damadɔ kɔnɔ. Ni ɲindimi walima ɲinw bɔli bɛ mɔgɔ min na, ni funu gɛlɛn bɛ a fan fila bɛɛ la a dawolo kɔrɔ ("misi kɔ"), ni kan kɔrɔtalen don, ni a bɛ sɔgɔsɔgɔ, ni "pomitoro funteni" kan bɛ da a la, walima ni a tɛ se k’a da wuli (trismus), aw bɛ aw ka sigida wele kɔrɔtɔko nimɔrɔw o yɔrɔnin bɛɛ. Ni aw bɛ furakɛlikɛlaw makɔnɔ, aw bɛ fiɲɛbɔyɔrɔw laadilikanw lajɛ minnu bɛ tali kɛ o la peritonsillar abscess ani kɔdimi jugumanw, . epiglottitis, croup, ani fiɲɛbɔyɔrɔ sanfɛla stridor, ani ɲinw kɔrɔtɔko ni ɲinw gosilenw.

Ikomi girinya kelenpe de ye fanga ye min bɛ banabagatɔ dɛmɛ k’a kan fununen minɛ ka taa ɲɛfɛ dɔɔni ka bɔ a da kɔfɛ, i ka dɛmɛ fɔlɔ baara kelen min nafa ka bon kosɛbɛ, o ye ka banabagatɔ sigilen to a ka bololanɛgɛ jɔlen na ka a biri ɲɛfɛ dɔɔnin, i kana a wajibiya abada ka da a kɔ kan kun si la.

Aw bɛ o kɛ sisan¶

1. Aw ye aw ka sigida ka kɔrɔtɔko nimɔrɔ wele joona ani ka fiɲɛbɔyɔrɔ kɔrɔtɔlen dɔ fɔ. Aw bɛ 911 wele Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri, 000 Ɔsitarali, walima ka an ka lisi lajɛ kɔrɔtɔko nimɔrɔw. Aw bɛ a fɔ ka jɛya ko: "Ludwig ka angina / ɲinw fiɲɛbɔyɔrɔ kɔrɔtɔlen sigalen don: funu fan fila bɛ dawolo jukɔrɔ, kan kɔrɔtalen, sɔgɔsɔgɔninjɛ, kan dajilen, ani farati min bɛ fiɲɛbɔyɔrɔ barikama bali."
2. Aw bɛ banabagatɔ sigilen to bololanɛgɛ jɔlen na ani ka a biri dɔɔni ɲɛfɛ ("Tripod" walima "Sniffing" jɔcogo) waati bɛɛ. Aw kana banabagatɔ da abada min bɛ ni Ludwig ka angina ye walima ni ɲinw funu jugumanba bɛ a kɔ la, dilan kan, sofa kan, anpulu sɔgɔlan kan, walima dɔgɔtɔrɔso CT scanner tabali kan. Ni aw dalen bɛ a la, o bɛ kɛ sababu ye kan girinmanw, minnu bɛ sɔgɔsɔgɔ ani minnu fununen don, olu ka bin ka segin kɔfɛ ka ɲɛsin kɔfɛla kogo ma ni girinya ye, ka fiɲɛbɔyɔrɔ datugu sekɔndi damadɔ kɔnɔ ani ka dusukun tantanni daminɛ o yɔrɔnin bɛɛ.
3. A to banabagatɔ ka sɔgɔsɔgɔninjɛ daji tasa walima finimugu kɔnɔ, ani aw kana bolokɔnincininw, kan degunfɛnw, walima kuyɛriw don da la abada. Ikomi da duguma bɛ funu kosɛbɛ i n’a fɔ jiri ani a dawolo fasaw sirilen don sɔgɔsɔgɔninjɛ la (trismus), k’a ɲini ka ɲinw da wuli walima ka kan digi duguma ni kuyɛri ye, o bɛ farinya bila gagging, laryngospasm, walima joli bɔli min bɛ se ka fiɲɛbɔyɔrɔw datugu pewu teliya.
4. Aw ka NPO gɛlɛnw waleya (foyi kana kɛ da la: ji tɛ kɛ, dimimadafura jilama tɛ kɛ, banakisɛfagalanw kana kɛ a la). A fɔlɔ, munumunu bɛ bali ni masin ye ni kan kɔrɔtalen ye, o la ji walima furakisɛ o furakisɛ bɛ bɔn ka ɲɛsin fiɲɛbɔlan (fiɲɛbɔlan) ma, ka kɛ sababu ye ka mɔgɔ sɔgɔsɔgɔ. Filanan, banabagatɔ mago bɛna kɛ teliya la fibreoptique intubation wulilen walima opereli wulilen tracheostomie / cricothyrotomy opereli yɔrɔ la a selen dɔgɔtɔrɔso la.
5. Aw bɛ banabagatɔ hakili sigi, ka nɛnɛ, ani ka a lamaga, ani ka kamisɔn kɔli, kravati, ani nɛgɛfugulanw bɛɛ lajɔ. Jɔrɔ, kasi walima farikoloɲɛnajɛ bɛ ninakili teliya teliya, ka fiɲɛ nɔgɔlen (laminar) wuli ka tɛmɛ galaka dɔgɔyalen fɛ ka kɛ fiɲɛbɔ ɲagaminen ye min bɛ fiɲɛbɔyɔrɔ kogo fununnenw sama ka datugu (the Bernoulli / Venturi nɔ).
6. Aw kana tasumamugu walima jisuma buteliw kɛ kɔ walima kɔkili fununen kɛnɛma. Ni aw ye kɛnɛma funteni kɛ ɲɛda walima kɔdimi jugumanba la, o bɛ dɔ fara sigida joli siraw falenni ni farikolo yɔrɔw sɔgɔsɔgɔli kan kosɛbɛ, ka fiɲɛbɔyɔrɔw datugu teliya ani ka banakisɛ sama ka taa fari fan fɛ walima ka jigin kɔ fɛ ka taa disi la (decending necrotizing mediastinitis).

Desizɔn jiri : ɲinw dimi, ɲɛda fununi, ani Ludwig ka angina fiɲɛbɔyɔrɔw tigɛcogo¶

flowchart TD
    Start["Ɲɛw duguma dimi, ɲinw karilen, walima ɲinw bɔli kɔsa in na ni ɲɛda, dawolo walima dawolo jukɔrɔ funu ye"] --> AirwayScreen{"Taabolo 1: Aw ye Airway & Ludwig Angina Red Flags lajɛ: Funu bɛ dawolo fan fila bɛɛ jukɔrɔ, kan bɛ gɛrɛ sanfɛ, ka sɔgɔsɔgɔ, ka pɔmitɛri funteni kan dabila, trismus, walima tripode jɔlen jɔlen?"}

    AirwayScreen -->|"ƆWƆ ka ɲɛsin Drapeau Rouge ƝƐNABƆLI ma"| LudwigEmergency["FIƝƐLA KƆRƆBƆLI MIN BƐ BƐ KA ƝƐNAMAYA KƆLƆSI (LUDWIG ANGINA): Aw bɛ kɔrɔtɔko baarada wele (911 / 112 / 999) o yɔrɔnin bɛɛ"]

    AirwayScreen -->|"AYI: Funu dan ye ɲinw walima ɲɛda kelen dɔrɔn ma, munumunu ni kan bɛ kɛ cogo la, da dafalen"| LocalDental["Denso kɔnɔbara basigilen min tɛ gɛlɛya ye: Aw bɛ ɲinw furakɛla teliya la tile kelen sɛgɛsɛgɛli labɛn; aw bɛ a ko dɔɔni dɔɔni ni kɔgɔji sumalen ye, aw kana funteni kɛ ɲɛda la abada, ka taa ED la ni dawolo jukɔrɔ funu walima trismus daminɛna"]

    LudwigEmergency --> UprightRule["1. ƝƐNABƆLI JIGISƐN (Tripod / Sniffing Position): Aw kana banabagatɔ da abada ka a da sɔgɔsɔgɔninjɛ walima CT tabali kan; aw bɛ a to nɔgɔ ka bɔ ka taa ɲɛfɛ ka don tasa walima finimugu kɔnɔ"]

    UprightRule --> HandsOff["2. Aw bɛ fiɲɛbɔlan tanga: Aw bɛ NPO gɛlɛn kɛ (ji walima da kɔnɔ furakisɛw tɛ a la), aw kana kan degunfɛnw don a kɔnɔ abada walima ka dawolo da wuli, aw kana kɛnɛma sumayalanw don a la, ani aw kana kɔla lajɔ"]

    HandsOff --> HospitalOR["3. Dɔgɔtɔrɔso fila-fila fiɲɛbɔyɔrɔw ni opereli ɲɛnabɔli: Awake Flexible Fiberoptic Nasotracheal Intubation sigilen bɛ ka jɔ ni Simultaneous Prep for Awake Tracheostomy, IV Dexamethasone, Broad-Spectrum IV Antibiotics, ani Surgical Decompression ye"]

Farikoloɲɛnajɛ ni banakɔtaa: "Mylohyoid Line" sariya ani mun na ɲɛda duguma dawolo bɛ Ludwig ka angina bila mɔgɔ la¶

A ɲɛfɔra fɔlɔ san 1836 Alemaɲi dɔgɔtɔrɔ Wilhelm Friedrich von Ludwig fɛ (min y’a tɔgɔ da ko angina ka bɔ latigɛkan na angere, o kɔrɔ ye ko "ka sɔgɔsɔgɔ walima ka sɔgɔsɔgɔ," dusukun dimi tɛ), Ludwig ka angina ɲɛfɔlen don farikolo la ni sariya kɛrɛnkɛrɛnnen dɔ ye: o ye selilɛri ye min bɛ jɛnsɛn joona, min bɛ i n’a fɔ pankurun, min bɛ sɔrɔ gangrenous-serosanguinous cellulitis fɛ sɔgɔsɔgɔninjɛ yɔrɔ saba bɛɛ bɛ kɛ fan fila fɛ:

1. The Sublingual Space (da duguma, tilennen sanfɛ mylohyoid muscle).
2. Submylohyoid / Submaxillary Space (kɛrɛnkɛrɛnnenya la jukɔrɔ mylohyoid farikolo la numanbolo ni numan fɛ).
3. Submental Space (kɔnɔna cɛmancɛ jukɔrɔ).

Mun na duguma dawolo filanan ni sabanan (hakilitigiya ɲinw) de ye jalakidenw ye¶

Mun na ɲɛn ɲɛfɛla walima ɲɛda ɲɛfɛla fɔlɔ kɔnɔ, a ka ca a la, a bɛ kɛ sababu ye dɔrɔn ka ɲinw tobi yɔrɔ dɔ la da kɔnɔ, k’a sɔrɔ ɲɛ filanan duguma walima dawolo sabanan (hakilitigi ɲin) min bananen don, o bɛ Ludwig ka angina bila mɔgɔ ka ɲɛnamaya bila farati la? Jaabi bɛ sɔrɔ farikolo yɔrɔ kelen na min bɛ wele ko milohyoid muscle, o bɛ wuli i n’a fɔ hamakɛ ka tɛmɛ duguma dawolo kɔnɔna na walasa ka da farikolo dugumalan dilan:

• Ɲin minnu bɛ dawolo filanan ɲɛfɛ (sɔgɔsɔgɔninjɛ, kɔnɔw, ɲɛda ɲɛfɛla, ani tuma caman na dawolo fɔlɔ): Nin ɲɛfɛ ɲinw ju kunw (apices) bɛ sigi sanfɛ (sanfɛ) milohiyoyidi farikolo nɔrɔyɔrɔ la, min bɛ dawolo kɔnɔna na. Ni kuru dɔ bɔra o ɲinw ju la, kuru bɛ ​​kolo don farikolojidɛsɛ sanfɛ ka to da kɔnɔ (kan jukɔrɔla walima dawolo yɔrɔ).
• Dulu filanan ni sabanan duguma (70% fo 90% Ludwig ka angina banabagatɔw la): Dawolo filanan ni sabanan duguma ju kuncɛ jugumanw bɛ se ka jigin jukɔrɔ (a duguma) milohiyoyi farikolo nɔrɔli sira la, yɔrɔ min na kɔkolo kɔnɔna kolo bɛ kɛ papiye ye. Ni jiribolo dɔ min bɛ dawolo filanan walima sabanan duguma, o karilen don o kɔnɔna kolo finman in na, banakisɛw ni bagaw bɛ fili milohiyoyidi farikolo jukɔrɔ ka taa mandibular space kɔnɔ.
• Sokisɛ bɛ siri farikolo kɔkanna lamini na: Ikomi miloroyidi farikolo kɔkanna da bɛ jɛngɛ ka bɔ a yɛrɛ la i n’a fɔ rido min tɛ faso barika la min bɛ duguma yɔrɔ ni kankɔrɔla yɔrɔ faranfasi ka bɔ sanfɛyɔrɔ la, banakisɛ bɛ o yɔrɔnin bɛɛ lamini miloyiyɔdi farikolo kɔfɛla dan na ka don kankɔrɔyɔrɔ la ka tɛmɛ cɛmancɛla ka don kɔ fan dɔ fɛ, ka da duguma bɛɛ minɛ sow sɔgɔlen vise kɔnɔ.

[Sagittal / Cross-Section Anatomy of Ludwig's Angina]

     ROOF OF MOUTH (HARD & SOFT PALATE)
              |   |   |
   (Tongue is pushed UP and BACK into airway)
   [====== SWOLLEN TONGUE ======]
   [Sublingual Space (Above Mylohyoid)]  <-- Wraps around free posterior edge
   ------------------------------------  <-- MYLOHYOID MUSCLE SLING
   [Submandibular Space (Below Mylohyoid)] <-- Root of Lower 2nd/3rd Molar dumps here
   ====================================  <-- Unyielding Deep Cervical Fascia & Mandible

Mun na Ludwig ka angina ye "jiri selilɛri" ye sanni ka kɛ sɔgɔsɔgɔninjɛ nɔgɔman ye a daminɛ na¶

A tɛ i n’a fɔ ɲinw tobi yɔrɔ dɔ la min bɛ kɛ sababu ye ka sɔgɔsɔgɔninjɛ poyi nɔgɔlen, sɔgɔsɔgɔninjɛ kɛ tile damadɔ kɔnɔ, Ludwig ka angina daminɛ na, o ye selilɛri ye min bɛ jɛnsɛn teliya la, min bɛ kɛ i n’a fɔ necrotizing-style min bɛ sɔrɔ da kɔnɔ streptococci (Streptococcus viridans, Streptococcus anginosus/milleri kulu) ani banakisɛfagalanw da kɔnɔ anaerobes (Prevotella, Porphyromonas, Fusobacterium, Peptostreptococcus).

O banakisɛw bɛ farikolo yɔrɔw tiɲɛ, fɛnɲɛnamafagalanw ani gazi minnu bɛ don farikolo yɔrɔw la minnu bɛ ɲɔgɔn cɛ joona ka tɛmɛ farikolo bɛ se ka u kogo kɛ ka kɛ kuru ye. O de kosɔn, n’i magara banabagatɔ dawolo duguma ni a kɔ sanfɛla la, a tɛ i n’a fɔ a bɛ nɔgɔya walima ka sɔgɔsɔgɔ; a bɛ kɛ i n’a fɔ a ka gɛlɛn i n’a fɔ fara, a bɛ jɔrɔ, wa a tɛ wuli i n’a fɔ jiribolo ("brawny or woody induration"), tuma dɔw la, gazi bugun fitiniw bɛ kɛ a la (subcutaneous crepitus) fari jukɔrɔ.

Ludwig ka angina taamasiɲɛ 6 kɔrɔlenw dɔnni kɛnɛyaso la¶

Banabagatɔ o banabagatɔ bɛ ni ɲin duguma dimi ye, ni a ɲɛda karilen don, ni pericoronite (banakisɛ bɛ a la ka ɲin ɲin min bɛ ka bɔ hakili ɲin kan), ni a ye ɲin bɔ kɔsa in na, walima ni a dawolo karilen don, ni nin taamasiɲɛ ninnu bɛ a la, faratiba bɛ o la ka bɔ a ka fiɲɛbɔyɔrɔ la:

Denso kɔnɔnatumu, Ludwig ka angina, peritonsillar abscess ani retropharyngeal abscess danfara cogo¶

Denw ni kɔ jugumanba banakisɛw taamasiɲɛw bɛ ɲɔgɔn kan i n’a fɔ galaka dimi, kɔ fununi, ani sumaya, nka u kelen-kelen bɛɛ bɛ farikolo yɔrɔ danfaralen dɔ ta ani farati kɛrɛnkɛrɛnnenw bɛ u la:

Jiginni bɛ jɛnsɛn ka don disi la: "Farakɛyɔrɔ" ani Descending Necrotizing Mediastinitis¶

Ni Ludwig ka angina ma dɔgɔya joona ani ka furakɛ ni banakisɛfagalanw ye minnu hakɛ ka ca joli la, mɔgɔfagala filanan min bɛ mɔgɔ faga sanfɛ fiɲɛbɔyɔrɔ sɔgɔsɔgɔninjɛ kɔfɛ, o ye a jɛnsɛnni duguma ka don disi la.

Kɔ kɔnɔ, kɔnɔbara basigilen jugumanba bɛ labɛn ka kɛ tubabufura jɔlenw ye. kɔfɛla yɔrɔ ani min tɔgɔ bɛnnen don ko "Alar / Danger Space" (Yɔrɔ 4) bɛ boli i n’a fɔ alifanta da wulilen, min tɛ sɔgɔsɔgɔ, ka bɔ kungolo da la, galaka ni dumunikɛminɛn kɔfɛ, ka jigin ka tɛmɛ barajuru dondaw fɛ ka don kɔfɛla cɛmancɛ la (disi cɛmancɛ la min kɔnɔ dusukun, jolisira belebelebaw, fiɲɛbɔlan, ani dumunikɛminɛnw (esophagus).

Janya ni tansiyɔn jugu min bɛ sɔrɔ disi kɔnɔ tuma o tuma ni banabagatɔ bɛ fiɲɛ sama, o bɛ banakisɛ caman sama ka jigin kɔ la ka don disi la, o bɛ kɛ sababu ye ka Descending Necrotizing Mediastinitis (DNM) lase mɔgɔ ma, o min bɛ taa ni a ye kɛmɛsarada la 20 fo 40% fagali hakɛ hali ni bi furakɛli gɛlɛnw kɛra.

Darapo bilenman minnu b’a jira ko ɲinw walima kɔdimi bɛ jigin disi la¶

• Fun bilenni, funteni ani fanga bɛ wuli ka jigin ka jigin kɔ ɲɛfɛ ka taa sanfɛla la (kɔnɔnakolow ni ɲɔgɔn cɛ dingɛ) ani ka taa disi sanfɛla kogo kan.
• Disidimi kura kɔdimi (sinkolo kɔfɛ) walima dimi min bɛ kɛ ɲɛdawolo la ni ninakili.
• Gazi sɔgɔsɔgɔninjɛ bɛ kɛ kɔ duguma walima disi kogo fari jukɔrɔ (subcutaneous crepitus) walima mankan min bɛ mɛn dusukun tantanni kan (Hamman ka taamasiɲɛ).
• Sɔgɔsɔgɔninjɛ min bɛ wuli ka caya, farigan yɛrɛyɛrɛli, dusukun tantanni teliya ka tɛmɛ 120 bpm kan, hakili ɲagami, ani tansiyɔn jigin (septic shock).

Dɛmɛ fɔlɔ min bɛ kɛ sani dɔgɔtɔrɔso ka taa ani so kɔnɔ: aw ka kan ka min kɛ (ani aw ka kan ka min kɛ abada) ka aw to EMS makɔnɔni na¶

1. Aw bɛ tripode jɔlen jɔ k’a sɔrɔ a ma danfara don a la: Aw bɛ banabagatɔ bila ka sigi sigilan walima anpulu da la ka a biri ɲɛfɛ degere 15 fo 30 ni a kunkolo sirilen don "sniffing position" la (a kɔ bɛ kɔrɔta dɔɔni ka taa ɲɛfɛ, a kunkolo bɛ kɔrɔta dɔɔni a kɔ la). Ni kɛnɛyabaarakɛlaw bɛ banabagatɔ ta, a ka kan ka sɔgɔsɔgɔninjɛ kɔkanna wuli fo ka se 75 fo 90 degere ma.
2. Aw bɛ basikɛti walima finimugu di a ma walasa ka a sɔgɔsɔgɔ ani ka a sumaya nɔgɔya la ni aw dege: Aw kana a ɲini banabagatɔ fɛ abada a k’a kun kɔrɔta ka segin kɔ walasa ka nɔgɔ munumunu. Ni EMS sera ni Yankauer ka sumayalan gɛlɛn ye, dɔgɔtɔrɔso baarakɛlaw bɛna nɔgɔ sama nɔgɔya la dɔrɔn ka bɔ ɲɛda ɲɛfɛla yɛrɛ la k’a sɔrɔ u ma kan kɔfɛla walima dawolo sɔgɔsɔgɔ (o bɛ ɲɛgɛnɛsiralabanaw bila mɔgɔ la).
3. Aw bɛ oksizɛni jilama di a ma dɔɔni dɔɔni (fiyɛli ni masike ma muɲu): Banabagatɔ sirannen min bɛ fiɲɛ kɛlɛ, o ka teli ka siran ni oksizɛni masike plastiki sirilen sirilen don a ɲɛda la, a bɛ kɛ i n’a fɔ u bɛ u dawolo. Ni aw ye oksizɛni jilama min bɛ taa kosɛbɛ, o minɛ da ni nugu kɛrɛfɛ (fiyɛli) o bɛ joli oksizɛni maracogo ɲɛ sani dɔgɔtɔrɔso ka fiɲɛbɔyɔrɔw ka don a la ka sɔrɔ a ma siran bila mɔgɔ la.
4. Mun na aw man kan ka banakisɛfagalan tolenw ta so kɔnɔ abada walasa ka dɔgɔtɔrɔso taa bila kɔfɛ: Banabagatɔ minnu ɲinw dimi ka jugu, olu ka teli ka amɔkisisilini furakisɛ tolen fila munumunu ka bɔ furamarayɔrɔ la ka sɔrɔ ka su makɔnɔ walasa ka a dɔn ni dawolo jukɔrɔ funu bɛ jigin. Fura minnu bɛ ta da la, olu tɛ se ka don tansiyɔnba kɔnɔ, banakisɛ caman bɛ min na, o bɛ kɛ teliya la, wa ka lɛri 8 makɔnɔ su fɛ dilan kan, o ye finɛtiri tigitigi ye, sunɔgɔ fiɲɛbɔyɔrɔw datuguli bɛ kɛ min bɛ mɔgɔ faga.

Dɔgɔtɔrɔso fiɲɛbɔyɔrɔw ɲɛnabɔli ("Double Setup") ani opereli decompression¶

Sani penisilini ni bi fiɲɛbanakisɛ fɛɛrɛw ka dabɔ, Ludwig ka angina ye banabagatɔ kɛmɛsarada la 50 ni kɔ faga (kɛrɛnkɛrɛnnenya la ni sɔgɔsɔgɔninjɛ ye). Ni dɔgɔtɔrɔso fiɲɛbɔyɔrɔw kɔlɔsili teliya la, banakisɛfagalanw tali jolisira fɛ, ani opereli fɛ ka u degun, saya hakɛ bɛ dɔgɔya ka se kɛmɛsarada la 5 fo 8 ma.

1. Mun na "Rapid Sequence Intubation (RSI)" sariyalen dagalen don Ludwig ka angina la¶

Dɔgɔtɔrɔso kɔrɔtɔko fanba la, dɔgɔtɔrɔw bɛ banabagatɔ sunɔgɔ ni hakiliɲagamifura ye jolisira fɛ ani ka a farikolo lamaga ni farikolojidɛsɛ fura ye (succinylcholine walima rocuronium) sani u ka ninakiliminɛn dɔ sɔgɔ da la (Rapid Sequence Intubation).

Ludwig ka angina la, ka banabagatɔ farikolo lamaga sani ninakiliyɔrɔ ka se fiɲɛbɔlan kɔnɔ lafiya la, o ye balawu ye min lakodɔnnen don kosɛbɛ ("Can't Intubate, Can't Ventilate"): - Fura min bɛ mɔgɔ farikolo tiɲɛ, o bɛ baara kɛ waati min na, banabagatɔ farikolo fanga tɛ ban min bɛ u kan fununen minɛ ka taa ɲɛfɛ, ani fiɲɛbɔyɔrɔ bɛ bin kɛmɛsarada la ka datugu (o la, bɔrɔ-valve-maskɛ tɛ se ka oksizɛni gɛrɛ a kɔnɔ). - O waati kelen na, k’a sababu kɛ trismus (dawolo datugulen) jugumanba ye ani da duguma kɔrɔtalen min ka gɛlɛn i n’a fɔ fara, dɔgɔtɔrɔ tɛ se ka da wuli walima ka kan digidigi ka jigin ni laringoscope bɔgɔlan ye walasa ka kanw ye, wa epiglottis bɛ funu ani ka bɔgɔbɔgɔ.

2. Dɔgɔtɔrɔso sariyasen min bɛ wele ko Gold-Standard Hospital protocol: Awake Fiberoptic Intubation ni "Double Setup" ye.¶

O nɔ na, kɔrɔtɔko dɔgɔtɔrɔ, anestezikɛla, ani ENT / da-da-kɔrɔ-sɔgɔsɔgɔninjɛla bɛ taa ni banabagatɔ ye (a sigilen bɛ hali bi bololanɛgɛ jɔlen na) ka taa opereli yɔrɔ la walima lakununni yɔrɔ la walasa ka Awake "Double Setup" kɛ:

1. Fiɲɛbɔlan sɔgɔsɔgɔninjɛ + IV Dexamethasone: Ni banabagatɔ tora kunun pewu ani ka ninakili a yɛrɛ sigilen na, jɛkulu bɛ lidocaine nebulisé sisi nugu ni a dawolo la walasa ka fiɲɛbɔyɔrɔw reflexes sɔgɔsɔgɔ, ka dexamethasone intravenous (4 ka se miligaramu 10 IV) ani nebulized racemic epinephrine di a ma ka ɲɛgɛnɛsiralabanaw dɔgɔya.
2. Setup A (Awake Flexible Fiberoptic Nasotracheal Intubation): Anestezikɛla bɛ fibreoptic kamera scope fin, flexible min ka kan ka doni ni ninakililan ye, o siri nɔgɔya la ka tɛmɛ nuguda fɛ min bɛ sɔgɔsɔgɔ (a bɛ ɲinw datugulenw ni kan fununnenw tɛmɛn pewu), ka a ɲɛminɛ ni ɲɛ ye ka epiglottis fununenw lamini ka tɛmɛ kan sira fɛ juruw don fiɲɛbɔlan kɔnɔ, ka ninakiliminɛn sɔgɔ kamera skɔpi kan sani a ka hakiliɲagamifura si di a ma.
3. Setup B (Simultaneous Awake Surgical Airway Ready): O waati kelen na tigitigi, ENT walima joginda operelikɛla bɛ jɔ dilan kɛrɛ fɛ ni banabagatɔ kɔ ɲɛfɛla ko kaban ni banakisɛfagalan ye, ka a sɔgɔsɔgɔ ni sigida lidokayini ye, ka taamasiɲɛ kɛ ni opereli sɛbɛnnikɛlan ye, ka sɔgɔsɔgɔninjɛ da wulilen ni tracheostomy tube minɛ. Ni fibreoptique kamera tɛ se ka tɛmɛ galaka fununen fɛ walima ni laryngospasme kɛra, operelikɛla bɛ teliya la opereli kununnen tracheostomie walima cricothyrotomy kɛ segin 60 kɔnɔ.
4. Mun na fiɲɛbɔyɔrɔw kɔlɔsili bɛ na SANI CT scan ka kɛ: Banabagatɔ min bɛ ni sɔgɔsɔgɔninjɛ ye, ni sɔgɔsɔgɔninjɛ bɛ a la, walima ni a tɛ se ka da a la fo sekɔndi 60, o man kan abada ka ci kɛnɛyaso la ka taa a kɔ CT scan kɛ fo u ka ninakiliyɔrɔ ka siri a nɔ na.

3. Banakisɛfagalanw tali jolisira fɛ ani opereli tigɛcogo & ji bɔli¶

Ni ninakilida sirilen don dɔrɔn: - Broad-Spectrum Intravenous Intravenous Antibiotics: A bɛ di joona walasa ka aerobic streptococs, beta-lactamase-producing oral anaerobes, ani MRSA (banabagatɔw la minnu farati ka bon): a ka ca a la IV Ampicillin-Sulbactam (Unasyn) walima IV Seftriaxone + High-Dose Metronidazole (walima Piperacillin-Tazobactam / Clindamycin), ka fara IV Vancomycin kan ni MRSA farati bɛ a la. - Opereli fɛ decompression ani ɲinw bɔli: Ni CT ja y’a jira ko ji bɛ lajɛ, gazi, walima ni a ma ɲɛ joona, da ni ɲɛda walima ENT operelikɛlaw bɛ kɛnɛma tigɛtigɛ kɛ dawolo ni dawolo kɔrɔ (sɔgɔsɔgɔninjɛ ni hakili jukɔrɔla tigɛli), ka fascial yɔrɔw da wuli k’a jɛya ka tɛmɛ mylohyoid muscle fɛ walasa ka degun bɔ ani ka opereli bila jibɔyɔrɔw, ka sɔrɔ ka ɲinw duguma ɲinw bɔ minnu bananen don minnu ye gɛlɛya daminɛ.

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

• Amerika ni Kanada: Aw bɛ 911 wele. Aw bɛ teliya ka taa ni a ye dɔgɔtɔrɔso la kɔrɔtɔko yɔrɔ la, ni anestezi bɛ kɛ sanga 24 kɔnɔ ani ka ENT / Oral and Maxillofacial Surgery (OMFS) furakɛ. Aw kana taa ɲinw furakɛli biro la walima ni aw bɛ taa dɔgɔtɔrɔso la min bɛ taa kɔrɔtɔ la ni sɔgɔsɔgɔninjɛ, kan caman cili, trismus, walima dawolo jukɔrɔ funu fan fila bɛ yen.
• Royaume-Uni: Aw bɛ 999 wele walasa ka anpulu sɔrɔ teliya la min bɛ wele ko Category ½ walima aw bɛ taa dɔgɔtɔrɔsoba la min bɛ mɔgɔ tɔɔrɔ kosɛbɛ Kɔrɔtɔko ɲɛmɔgɔso (A&E) ni ɲɛda ni ɲɛda ni ɲɛda opereli bɛ kɛ yɔrɔ la. Aw kana NHS 111 ɲinw furakɛli kɔrɔtɔlen makɔnɔ ni fiɲɛbɔyɔrɔ taamasiɲɛw bɛ aw la.
• Erɔpu tɔnba: Aw bɛ 112 wele UE jamanaw bɛɛ kɔnɔ ani ka fiɲɛbɔyɔrɔ kɔrɔtɔlen dɔ fɔ (angine de Ludwig faransikan na, Angina Ludovici / Mundbodenphlegmone Alemaɲikan na, angina de Ludwig Ɛsipaɲɔlikan na).
• Ɔsitarali ani Zelande kura: Aw bɛ 000 wele Ɔsitarali walima 111 Nuwɛlika.
• Endi ni Azi Pasifiki: I bɛ 112 (walima 108 Ɛndujamana na), 995 Singapuri, 119 Zapɔn ni Kore Dugu, walima 999 Mali ni Hong Kong. Aw bɛ taa dɔgɔtɔrɔso sabanan na, fiɲɛbɔyɔrɔ kɔrɔtɔlen ni ɲɛda opereli jɛkuluw bɛ sanga 24 kɔnɔ.

Ɲininkali minnu bɛ kɛ tuma caman na¶

Ɲɛdimi min ma furakɛ, o bɛ se ka wuli cogo di ka kɛ fiɲɛbɔyɔrɔ kɔrɔtɔlen ye min bɛ se ka mɔgɔ ka ɲɛnamaya bila farati la?¶

Jiginni dawolo filanan ni sabanan (hakilitigi ɲinw) juw bɛ taa fo duguma dawolo kolo kɔnɔ ka taa a fɛ milohiyoid farikolo nɔrɔli sira jukɔrɔ, o min bɛ kɛ da duguma. Ni dingɛ walima kuru min ma furakɛ o duguma dawolo dɔ la kelen na, o bɛ sɔgɔsɔgɔ ka tɛmɛ dawolo kɔnɔna kogo finman fɛ, da kɔnɔ banakisɛ juguw bɛ bɔn ka ɲɛsin dawolo jukɔrɔla yɔrɔ ma min bɛ dawolo jukɔrɔ, ka u lamini ka don kan jukɔrɔla yɔrɔ la kan jukɔrɔ fan fila bɛɛ fɛ. Ikomi dawolo kolo gɛlɛn ni kɔkolo fasa juguman bɛ funu bali ka bonya ka taa kɛnɛma, funu bɛ da duguma ni kan gɛrɛntɛ ka ɲɛ ka taa sanfɛ ani kɔfɛ fo ka se ka galaka datugu.

Mun na Ludwig ka angina bɛ mɔgɔ min na, o tigi man kan ka da a kɔ kan abada?¶

Ludwig ka angina la, kan ni da duguma bɛ funu fo ka se u girinya hakɛ siɲɛ fila walima saba ma, ka u gɛrɛntɛ ka taa sanfɛ da sanfɛla la. Ni a tigi sigilen bɛ a jɔlen na ka a biri ɲɛfɛ dɔɔni, girinya bɛ dɛmɛ ka kan basigilen girinman sama ka taa ɲɛfɛ dɔɔni ka bɔ a dawolo kɔ kogo la, ka yɔrɔ fitinin dɔ to fiɲɛ ka tɛmɛ. Ni a tigi dalen bɛ a kɔ la tuma min na, girinya bɛ kan fununen basigilen sama ka segin kɔfɛ ka don ɲɛgɛnɛsira la, o bɛ kɛ sababu ye ka fiɲɛbɔyɔrɔw datugu teliya la, ka kɛ makun ye, pewu ani ka dusukun jɔ miniti damadɔ kɔnɔ.

Lakɔlɔsili taamasiɲɛ fɔlɔ jumɛnw bɛ yen minnu b’a jira ko ɲinw bana bɛ ka jɛnsɛn kɔ yɔrɔ jugumanw na?¶

Lakɔlɔsili taamasiɲɛ jɔnjɔn minnu b’a jira ko ɲindimi nɔgɔman tɛmɛna ka kɛ kɔ kɔrɔtɔlen jugumanba ye, olu ye funu ye min bɛ jɛnsɛn dawolo duguma dan jukɔrɔ ka taa fan fila bɛɛ la dawolo jukɔrɔ (jiri funu min bɛ kɛ dawolo la), trismus (da da wuli ka gɛlɛn ka tɛmɛ bolokɔni fila kan), funu walima farikolo yɔrɔ nɔgɔlen kɔrɔtalen kan jukɔrɔ, dimi walima gɛlɛya sɔgɔsɔgɔninjɛ munumunu (sɔgɔsɔgɔninjɛ), ani "hot-potato" kan min bɛ dabila. Nin taamasiɲɛ ninnu dɔ la kelen bɛ taa teliya la dɔgɔtɔrɔso la kɔrɔtɔko yɔrɔ la, a man kan ka taa ɲinw furakɛli yɔrɔ la min bɛ kɛ tuma bɛɛ.

Mun na ne man kan ka tasumamugu walima komɛsi sumayalen bila dawolo walima kɔ fununnen kɛnɛma ka bɔ ɲinw kurulen na?¶

Ni aw ye tasumamugu walima jisuma buteli kɛ ɲɛda, dawolo walima kɔ kɛnɛma fari la, o bɛ joli siraw bonya ani ka funuji wɛrɛw sama ka don ɲɛda yɔrɔ jugumanw na, o bɛ fiɲɛbɔyɔrɔw funu teliya ani ka banakisɛ bila ka taa kɛnɛma ɲɛda fari fɛ (o bɛ farikolojidɛsɛbanakisɛ dɔ dilan) walima ka a jɛnsɛn ka taa a fɛ ka jigin kɔ la ka don disi la. Aw bɛ kɔ kɛnɛma nɛnɛ walima ka a to so funteni hakɛ bɛnnen na.

Mun na farati bɛ dɔgɔtɔrɔw bolo ka Ludwig ka angina banabagatɔ bila sunɔgɔ la sani u ka ninakiliminɛn bila?¶

Ni aw ye hakiliɲagamifura ni farikolojidɛsɛ furaw di jolisira fɛ sani aw ka ninakilida siri, o bɛ galaka ni kan fasaw lafiya, banabagatɔ kununna tun bɛ baara kɛ ni minnu ye walasa k’a ka fiɲɛbɔyɔrɔ da wuli, o bɛ kɛ sababu ye ka fiɲɛbɔyɔrɔ bɛɛ tiɲɛ walasa masike kana se ka oksizɛni bila a kɔnɔ da la ani ka kumakanw ye ni nɛgɛbere ye min bɛ wele ko standard blade. O la, anestezikɛlaw bɛ banabagatɔ sigi ka jɔ ani ka a kunun, ka nugu sɔgɔsɔgɔ ni lidokayini fiyɛli ye walasa ka fibre optique kamera sɛgɛsɛgɛlen dɔ bilasira ka tɛmɛ nugula fɛ ka don fiɲɛbɔlan kɔnɔ ka sɔrɔ operelikɛla dɔ jɔlen bɛ a kɔ la min labɛnnen don.

Yala Ludwig ka angina bɛ se ka kɛ baliku kɛnɛmanw na wa?¶

Awɔ. Hali ni sukarodunbana, farikolo tangacogo, ɲinw saniyabaliya, ani ɲinw ladonni sɔrɔbaliya bɛ dɔ fara o farati kan, Ludwig ka angina bana bɛɛ tilancɛ ka ca ni baliku fitiniw ni baliku cɛmancɛw ye minnu tun kɛnɛman don fɔlɔ, minnu si bɛ san 20 ni san 50 cɛ, a ka ca a la, o bɛ sɔrɔ hakili ɲin duguma (dakun sabanan) bananen walima min tɔɔrɔlen don walima kɔsa in na dawolo duguma bɔli fɛ.

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Difficult Airway Society (DAS, United Kingdom) & Royal College of Anesthetists (NAP4): Ladilikanw ka ɲɛsin kunkolo ni kɔ fiɲɛbɔyɔrɔ gɛlɛnw ni min datugulen don (fibreoptique nasotracheal intubation kununnen, ka i yɛrɛ tanga sigili ma kɛrɛfɛ, ani tracheostomie opereli fila-fila).
• Amerika ka anestezi dɔgɔtɔrɔw ka tɔn (ASA, Etazuni): ASA ka baarakɛcogo ɲɛfɔlenw san 2022 fiɲɛbɔyɔrɔ gɛlɛnw ɲɛnabɔli la (kununna intubation siraw kɔ yɔrɔ jugumanba banakisɛw ni trismus kama).
• Amerika ka banaw tɔnba (IDSA, Etazuni): Dɔgɔtɔrɔso ka baarakɛcogo ɲɛfɔlenw Odontogenic ni Deep Neck Space Infections (banakisɛ caman bɛ tali kɛ Streptococcus anginosus/viridans ni da kɔnɔ anaerobes la, ka fara MRSA kan).
• Amerika ka da ni ɲɛda operelikɛlaw ka tɔn (AAOMS) & Angilɛw ka da ni ɲɛda operelikɛlaw ka tɔn (BAOMS): Kɔrɔtɔlen triage ani decompression opereli fɛ submandibular, sublingual ani submental space infections (Ludwig’s Angina).
• Jamana ka kɛnɛyako ni ladonniko ɲɛtaa baarada (NICE) & NHS (Royaume-Uni): Donw ka sɔgɔsɔgɔninjɛ ni kɔkolo yɔrɔ jugumanba banakisɛw darapo bilenmanw ka ɲɛsin kɔrɔtɔko ɲɛmɔgɔso bilali ma teliya la.

Gafe minnu bɛ tali kɛ o ko la¶

• Peritonsillar abscess, Ludwig ka angina, ani kɔdimi jugumanw
• Epiglottitis, croup, stridor, ani sanfɛla fiɲɛbɔyɔrɔ balili jugumanba
• Denw ka kɔrɔtɔko, ɲin knocked avulsed, ani ɲinw dimi
• Kɔnɔnatumuw ka ɲɛgɛnɛsiralabanaw, ɲɛgɛnɛsiralabanaw ka joli-sira-funu, ani ɲɛda farati-sɔgɔsɔgɔninjɛ
• Sepsis ni septic shock dɔnni ani kɔrɔtɔko triage