Ñawɗo Parkinson e nder safrirde : hol ko waɗi waasde heɓde Sinemet/Levodopa e sahaa mum walla heɓde Haldol ina addana neɗɗo ɓuuɓde¶

Ko ɓuri 300 000 neɗɗo wonduɓe e Rafi Parkinson (PD) ina naata e opitaaluuji hitaande kala ngam dañde caɗeele, ɓuuɓri hippoode, ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam, walla ɓuuɓri ƴiiƴam, walla seppooji baɗeteeɗi e sahaa kala, e wiɗtooji safaara ɗi Fooyre Parkinson waɗi ina kollita wonde 3 e nder 4 ñawɓe Parkinson ina mbaawi safreede e nder safrirde porotokolle. E nder suudu safrirdu tippudi walla Departemaa Emergency, politik gonɗo e safrirde ina jaɓi "leɗɗe gonɗe e hunuko" ina mbaawi waɗeede e kala nokku e nder window waktuuji 1 haa 2 ko adii walla caggal waktuuji potɗi (09:00 AM / 13:00 PM / 17:00 PM / 21:00 PM), walla jogaade denndaangal pillitol hunduko haa timma ("NPO / Nothing by Mouth") tawa ina fadi ƴeewndo ɓuuɓri walla seppo.

Wonande ñawɗo mo ñawu Parkinson ɓuuɓngu haa ɓurti, mo ngaandi mum majjii 80% e ƴiye mum peewnoowo dopamin, leeltude dose karbidopa/levodopa (Sinemet, Rytary, Madopar, Stalevo, Prolopa) e hay hojomaaji 30 haa 60 ko caɗeele safaara. E nder waktu gooto caggal dose ŋakkuɗo, ƴiye gonɗe e daande ñawɗo oo ina ɓuuɓta (dysphagie dépléminant dopamine), ina addana ɓe ɓuuɓde e ɓuuɓnude ƴiye maɓɓe e nder ƴiye maɓɓe (aspiration pneumonie), ɓe mbaawa wallude ƴiye maɓɓe e nder ƴiye maɓɓe rigidité plumbum-pipe naawɗo. Ko ɓuri bonde nii, ko woppude levodopa e nder waktuuji 12 haa 48, walla waɗde ñawɗo oo leɗɗe cafrooje ɓuuɓɗe walla agitaasiyoŋ, ɗe kaɗata dopamin (D2) jaɓɓotooɗe, ko wayi no haloperidol (Haldol), metoklopramiid (Reglan), poroklorperasin (Compazine), walla porometasin (Phenergan), ina addana Sindrome Parkinson-Hiperpirexie (PHS), ko ñawu nannduɗo e ñawu nguu, ngu a... 40°C+ (104°F+) nguleeki, ɓuuɓri ɓalndu (rabdomyolyse), ɓuuɓri ƴiiƴam, e maayde 4 haa 20 e nder teemedere. So tawii ñawɗo Parkinson ina wondi e ɓuuɓri no feewi, ɓuuɓri mawndi, waasde muñde, stridor, walla waylude hakkille, noddu limoore emergency nokku maa (911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 e nder Dental Orop fof, 999 e nder leydi Angalteer) walla ƴeewto men limooje caɗtuɗe regginorde. Ngam jowitiiɗe e caɗeele safrirde geriatric, ƴeew delirium opitaal e wallitde safaara wonande mawɓe, dysphagie : ɓuuɓde e ndiyam ɓuuɓɗam, ɓuuɓri aspiration, e kisal ñaamdu ɓuuɓndu, e polifarmasi, doseeji leɗɗe ɓurɗi heewde, doseeji ɗi ŋakki, e majjere yuɓɓinoowo pillitol.

Waɗde ɗum jooni¶

1. **Naatnu leɗɗe Parkinson giɗo maa ɗee fof e nder butelaaji mum en asliiji ɗi farmasiiji mum en mbinndi e nder suudu safrirdu, naamndoɗaa cafroowo ER oo ɗoon e ɗoon ngam "Yamiroore ñawɗo oo e hoore mum ngam ƴettude leɗɗe" walla "Yamiroore ƴettugol leɗɗe ñawɗo oo e sahaa mum" farmasiiji keewɗi ndarnaaki doole keertiiɗe walla formulaaji yaajɗi ɗi karbidopa/levodopa (Rytary, Sinemet CR, entacapone, rasagiline, rotigotine patches) e nder masiŋ ER Pyxis, ina addana ɗum leeltude waktuuji 8 so wonaa tawa aɗa addana-ma butelaaji galleeji ɗii.
2. Hoolkiso wonde doktoor jaɓɓotooɗo oo ina naatna Carbidopa/Levodopa e nder ordinateer safrirde ndee hono "LEƊƊE ƊAƊƊAARE WAKKITI" e waktuuji waktuuji galle ñawɗo oo (e.g., 07:30, 11:00, 14:30, 18:00, 21:30), ALAA no opitaal gonɗo e mbaydi "TID / QID" (09:00, 13:00, 17:00, 21:00). E nder Centres for Medicare & Medicaid Services (CMS) sarɗiiji tawtoreede e opitaal, leɗɗe ɗe limtaaɗe e Time-Critical ina poti waɗeede e nder 15 haa 30 minit e nder waktuuji aadaaji laaɓtuɗi, tawa ina ɓura waktuuji 2 gonɗi e opitaal ɗii.
3. Ɗaɓɓu yo infirmiyee ER e farmasiyanke opitaal oo naata e "ALLERGIE DE DROUGES / ALERTE ABSOLUE DE CONTRAINDICATION" duumotooɗo e nder deftere safaara elektoronik jooni jooni wonande LEƊƊE ƊE ƊE ƊE ƊE ƊEƊƊI : Haloperidol (Haldol), Metoclopramide (Reglan), Prochlorperazine (Compazine), Promethazine (Phenergan), Droperidol (Inapsine), Risperidone (Risperdal), Olanzapine (Zyprexa), e Aripiprazole (Abilify). Waɗde ɗeen leɗɗe e nder Allergy Field ordinateer safrirde ina doola darnde elektoronik tiiɗnde so tawii hoɗɓe e jamma walla anestesiyoloji etiima yamirde Haldol ngam delirium walla Reglan / Compazine ngam ɓuuɓri caggal op.
4. So tawii opitaal oo waɗii ñawɗo oo e "NPO (Nothing by Mouth)" ngam seppo, ER workup, walla ekran swallow mo ŋakkaani, WOTO MEƊƊU ɗaccude leɗɗe maɓɓe dopamin ɗee njuumta tan. Ɗaɓɓu yo cafroowo oo yamir ɗoon e ɗoon gooto e ponti dopamin NPO tati kisal :
5. Cuɓal A: Waɗde Tuuba Nasogastrik (NG) ko juuti, ndokka karbidopa/levodopa mo ɓuuɓnaaka (IR) mo ɓuuɓnaaka e nder ndiyam (never crush extended-release CR/ER pills), WALLA
6. Cuɓal B: Waɗde Karbidopa/Levodopa ɓuuɓnoowo e hunuko (Parcopa) ko ɓuuɓnata e ɗemngal e ƴiiƴam, WALLA
7. Cuɓal C: Waɗde ɓuuɓri ɓalndu Rotigotin Dopamin Agonist ɓalndu (Neupro) ngam jogaade stimulaasiyoŋ dopamin gonɗo e fuɗɗoode tawa guurɗo oo ina heɓaani.
8. So tawii ñawɗo oo ina jogii ƴiiƴam luggiɗam (DBS) walla ƴiiƴam Duopa/Vyalev, haalan ɗum doktoor ER e seppo oo ɗoon e ɗoon. Hoto meeɗ accude electrocautery monopolar e nder seppo tawa aɗa waɗa ñawɗo oo e nder **Surgery Mode MRIs high ne-out Kartal ID kaɓirgal DBS ngam keeri Tesla/coil keertiiɗi, kadi hoto meeɗ momtude batiri DBS so wonaa tawa ko feewti e caɗeele teeŋtuɗe ɗe stimulation addata.
9. Tappirde walla hollir "Kaartal kisal opitaal / Kaartal jeertinaango safaara" laawɗungal Fooyre Parkinson (parkinson.org/hospital) e tappirde Lekki Leɗɗe ɗe njiɗaa, to dow hoore leeso safrirde ndee.

Lekki kuulal : Reende ñawɗo Parkinson gila nde ɓe naati e ER¶

flowchart TD
    A["Ñawɗo Parkinson arii e opitaal ER walla e opitaal Pre-Op"] --> B["Ɗatal 1: Juuɗe Nurse e Butelaaji Pill Saare + Ɗaɓɓaande 'Wakkati-Critical Exact-Minute Dosing' (E nder 15 Mins e Jadwal Saare)"]
    B --> C["Ɗatal 2: Naatnu ‘Haloperidol, Metoklopramid, Proklorperazin, Prometazin, Risperidon, Olanzapin’ e nder kaɓirgal jeertinaango EMR ALLERGI / CONTRINDICATION"]
    C --> D{"Mbele Ñawɗo oo ina waawi muñde pills timmuɗi jooni jooni?"}
    D -->|"Eey: Muusde Intact & Wonaa NPO"| E["Hokku Dose Saare laaɓnde e sahaa (Waɗde ndiyam ina tiiɗi; Nyaamdu Protein weeyo 30-60 Mins woɗɗi Levodopa)"]
    D -->|"Alaa: Ñawɗo oo ko 'NPO' ngam Opereeji WALLA Ɓooygol / Ekran Swallow mo ŋakki"| F{"Hol ko waɗi ɓe mbaawaa muñde pills timmuɗi?"}
    F -->|"1. Ɓoornugol sabu doosgal maɓɓe Levodopa cakkitiingal ngal leeltinaama (‘Dysphagie Off-État’)"| G["Ƴeewndo Karbidopa/Levodopa (Parcopa) walla Sinemet IR ɓuuɓɗo e nder ɓuuɓri -> Ƴeewto-ɗaa kadi ɓuuɓri 45 Mins CAGGAL e nder ngonka 'ON'"]
    F -->|"2. NPO tiiɗɗo ngam ustude ɓalndu, Intubation, walla Opereeji mawɗi"| H["WOTO ƁURI ƳEEWDE Dopamin : Waɗde tuuba NG ngam ɓuuɓnude karbidopa/levodopa IR ɓuuɓɗo walla waɗde ɓuuɓri rotigotin (Neupro) e nder ɓalndu."]
    E --> I{"Mbele ñawɗo oo ina heɓi ɓuuɓri >38,5°C, ɓuuɓri nanndundi e alluwal, jiiɓru, walla CK toowɗo?"}
    G --> I
    H --> I
    I -->|"EEY: Tuumaaɗo wonde ina wondi e ñawu Parkinson-Hiperpireksi (PHS)"| J["ƊAƊƊI ICU : Ɗoon e ɗoon fuɗɗoraade Levodopa e tuuba NG + ndiyam IV + coofgol kuuɓtodinngol + Dantrolen IV / Bromokriptin e hunuko"]
    I -->|"NO: Deƴƴuɗo"| K["Mobiliteer yaltude e leeso 3x/ñalngu e PT ngam haɗde hipotension ortostatik e dekondisiyoŋ"]

Leɗɗe safrirde kisal vs BANNED ngam ñawɓe rafi Parkinson¶

Tappirde walla hollir ndeeɗoo alluwal teskinngal e kala cafroowo safrirde, anestesiyoloji, infirmiyee ER, e farmasiyanke safrirde toppitiiɗo giɗo maa:

Ko waɗi leeltude hojomaaji 60 e Karbidopa/Levodopa ina addana "Spiral dow opitaal".¶

Infirmier en opitaal toppitiiɓe teemedde ñawɓe safaara kuuɓtodinɗo ina keewi anndude hol ko waɗi ɓesngu ñawɗo Parkinson ina hulɓinii nde... 10:00 AM levodopa pill haa jooni arii e 10:45 AM. Facciro "Spiral Dopamine Hospitaal" e infirmiyee dow leydi e infirmiyee charge ɗoon e ɗoon:

1. "Window terapi" ɓuuɓɗo e nder ñawu Parkinson jahruɗo yeeso¶

E fuɗɗoode ñawu Parkinson, ngaandi ina jogii haa jooni neeruuji substantia nigra keewɗi ngam mooftude dopamin e ustude pillol leelngol fotde waktuuji 3 walla 4. E hitaande 5 haa 10 ñawu Parkinson, ɗeen ƴiye mooftirɗe ina njalta : baawgol ñawɗo oo yahde, haalde, e ɓuuɓde fawii ko e feccere nguurndam plasma kala taƴre levodopa gooto, fotde hojomaaji 90.

So opitaal leeltinii doosgal fotde hojomaaji 60, geɗe nay bonɗe ina mbaɗa e doggol jaawngol :

1. Hojomaaji 45, Dimmbagol "Ɓoornugol", Kulhuli, e Distoniya Naawɗo: Toɓɓe dopamin e nder striatum ina ustoo. Ñawɗo oo ina heɓa diƴƴe fooftere tiiɗɗe, kulhuli nder reedu e disforiya (maande dopamin-drop kemikal nde gollotooɓe safrirde ɓee keewi wiyde ko « agitaasiyoŋ hakkille »), e ɓuuɓri ɓuuɓndi ɓuuɓndi e koyɗe, e calɗi, e daande.
2. Hojomaaji 60, "Dysphagie Off-State" (Muusgol ɓuuɓngol): Ɓoornugol ƴiiƴam e ƴiiƴam ina ɗaɓɓi dopamin ngam yuɓɓinde refleks ɓuuɓgol. So ñawɗo oo yanii e ngonka "OFF", ɓe natta waawde muñde e kisal, ɗum firti ko so infirmiyee oo gasii yahde e nder hojomaaji 90 caggal mum e koppi pills timmuɗi, ñawɗo oo jooni ina ɓuuɓtoo e pills ɗii.
3. Minut 75, Terapi Haala "NPO Trap": Sabu ñawɗo oo ina ɓuuɓtoo nde o yiɗi muñde pills mum en cakkitiiɗi e nder ngonka "OFF", safroowo oo ina waɗa ñawɗo oo e "NPO tiiɗɗo (Alaa ko woni e hunuko)" e yamirde yo o waɗ torrowation Pathology Haala-Ɗemngal (SLP) Sabu ñawɗo oo ko NPO jooni, infirmier oo ina jokki e... 14:00 PM, 18:00 PM, e 22:00 PM doseeji lewodopa kadi.
4. Waktu 12 haa 24, Ɓoornugol Akinetik Timmungol, Pneumonie Aspiration, e Delirium : So ñawɗo oo dañaani dopamin fof fotde waktuuji 12+, ñawɗo oo wonta ɓuuɓɗo haa laaɓa cer ("ɓurɗo ɓuuɓde e leeso"), ɓuuɓna ƴiiƴam mum poolgu e nder ɓuuɓri mum e aspiraasiyoŋ mum, ƴellitoo pneumonie opitaal- Parkinson-Hiperpireksi.

2. No ɓuuɓtorto-ɗaa "Trap NPO Ekran Swallow" to bannge leeso¶

So tawii infirmier walla doktoor wiyii: "Baaba maa ina ɓuuɓtoo e ndiyam ɓuuɓɗam e nder ER swallow screen, ɗum noon ko o NPO, o waawaa jogaade pills makko Sinemet," naat ɗoon e ɗoon e ɗee geɗe tati kilinik:

• Kuulal 1 (Woto meeɗ ƴeewndaade ɓuuɓri ñawɗo Parkinson so ina woni e ngonka "OFF"): Ƴeewtaade ɓuuɓri ñawɗo Parkinson so ina yahra e waktuuji 3 ngam levodopa ina ɗaɓɓi nde ɓe ŋakkata. Ñaago-ɗee cafroowo oo yo rokku dose gooto e karbidopa/levodopa (Parcopa) e dow ɗemngal, walla karbidopa/Levodopa ɓuuɓɗo ɓuuɓɗo (IR) jillondirɗo e kaas gooto e ɓuuɓri appel walla pudding, ɗaɓɓu hojomaaji 45 ngam dopamin oo wayla ƴiye gonɗe e daande ñawɗo oo "ON", e Spe **ndeen thengu-th ƴeewndo.
• Kuulal 2 (Lomtingol Kisal So tawii Pillitol Jaajngol Waawaa Ɓoornaade):
• WOTO MEƊƊU ɓuuɓnude walla ɓuuɓnude Karbidopa/Levodopa (Sinemet CR / ER) walla ɓuuɓnude Kapsuluuji ɓuuɓɗi (Rytary) so tawii ñawɗo oo waawaa muñde pills guurɗe. Nde Rytary kapsul ina waawi udditeede e hakkille, ɓuuɓri ndii ina ɓuuɓnee e dow ɓuuɓri appel tawa ɓuuɓri ndii ina ɓuuɓna, Sinemet CR tablooji ɗii ina poti wayleede e dose potɗo e Karbidopa/Levodopa (ko ɓuri heewde e doseeji miligaramuuji ɗii fof fotde 25 haa 30 e nder teemedere ngam humpitaade ɓeydagol IR e doseeji ɓurɗi heewde seeɗa) hade mum en ɓuuɓneede ngam waɗde tuuba NG.
• Kuulal 3 (Hiisaaji laaɓtuɗi waylude levodopa-e-NG-Tube e Rotigotine):
• So tawii ñawɗo Parkinson ina NPO no feewi ngam seppude reedu, ustude ɓalndu, walla ustude henndu mekanik e nder ICU, farmasiyanke e doktoor neurobiyoloji ina poti hiisaade Doseeji ñalnde kala potɗi e Levodopa (LEDD) mum en ngam waktuuji zero coktirgal dopamin majja :
• Protokol ɓuuɓgol ndiyam tuuba nasogastrik (NG): Ƴellitaare ɗoon e ɗoon (IR) Karbidopa/Lewodopa (25/100 mg) tablette ina ɓuuɓta e yaawre e nder 30 mL (1 fl oz) ndiyam ɓuuɓɗam (walla ndiyam karbonaat/asid askorbik) e nder hojomaaji 5 tawa ina ɓuuɓna ɗum no feewi tawa alaa ko ɗaɓɓi so wonaa ɓuuɓde no feewi. Flush tuuba NG e 30 mL ndiyam hade e caggal nde levodopa ɓuuɓɗo oo waɗtaa, e ɓuuɓnude tuuba NG ngam suuɗde ko famɗi fof hojomaaji 30 haa 45 caggal kala dose mbele reedu ina sooma lekki kii.
• Rotigotin gonɗo e nder ɓalndu (Neupro) Patch Bridge (So ɓalndu waawa huutoreede): So tawii ñawɗo oo ina jogii ileus paralitik, ɓuuɓri ɓalndu tokosiri, walla anastomosis ɓalndu ɓooyɗo ɗo hay ndiyam NG-tube waawataa ɓuuɓde, naamndo-ɗee doktoor neurobiyoloji yo waɗ 24 hours Rotigotine Transdermal Rotigotine Patch (Dopamine ANeupro, ina tawee e... 2 mg, 4 mg, 6 mg, e 8 mg/24 hr patches) ngam laɓɓinde ɓalndu e dow ɓalndu, e junngo dow, e reedu, walla e koyngal (yirtude nokkuuji ɗii ñalnde kala e ittude ɓalndu nduu e dow aluminium hade kala ƴeewndo MRI ngam haɗde ɓalndu nduu ɓuuɓde).
• Reentoɗee Protein ñamloowo e tuubaaji haɗde levodopa ɓuuɓde: Asideeji amino (protein) ñaamdu ina kaɓa e levodopa ngam nawde ɗum e nder ɓalndu e nder ƴiiƴam-ngaandi (large neutral amino acid transporter). So tawii giɗo maa ina waɗee e dow ndiyam jokkondirɗam waktuuji 24 nyaamde tuuba enteral (Jevity, Osmolite, Ensure) rewrude e tuuba NG walla PEG, poroteyiin toowɗo e nder ñamri tuuba oo maa haɗ 70% e levodopa maɓɓe ɓuuɓɗo oo yettaade ngaandi maɓɓe, acca ɗum en ɓuuɓde hay so tawii ina keɓa pills mum en. Ñaago-ɗee cafroowo e ñamloowo ñaamdu jogaade ñamri tuubaako fotde hojomaaji 60 HADE e hojomaaji 30 haa 60 CAGGAL kala dose levodopa potɗo waɗeede (walla waylude ñamri tuubaako bolus ñalnde kala/jamma potndi e saraaji windooji levodopa).

Ɓooygol ngaandi luggiɗndi (DBS) e pompe Duopa/Vyalev e nder safrirde¶

Ujunaaje ujunnaaje mawɓe wonduɓe e rafi Parkinson ina tuugnii e DBS) gonɗo e nder ɓalndu (peewnuɗo ɗum ko Medtronic, Abbott/St / Produodopa** Foskarbidopa/foslevodopa gonɗo e les ɓalndu fotde waktuuji 24). So ñawɗo jogiiɗo gooto e ɗeen kaɓirɗe naatii e Departemaa Emergency walla Operation Room, gollotooɓe e opitaal ɓe nganndaa hardware ina mbaawi saabaade ñawu ngaandi walla caɗeele ɓuuɓɗe e ustude dopamin.

1. Kuule tati teeŋtuɗe kisal safrirde ngam ƴellitde ƴiiƴam (DBS).¶

2. Ko foti waɗeede so tawii Pompe Infusion Duopa (PEG-J) walla Vyalev (Subcutanée) ina woppi golle e nder ER¶

• Woto meeɗ ɗaccude infirmiyee opitaal ina ustoo pompiyee Duopa walla Vyalev tawa alaa ko woni e mum so wonaa ponto hisnude oral/NG levodopa ɗoon e ɗoon:
• Ñawɗo e dow Duopa (carbidopa/levodopa enteral suspension) pompiyee walla Vyalev (foscarbidopa/foslevodopa) pompe leslese ina keɓa 100 e nder teemedere dopamin maɓɓe ñalnde kala tawa ina jokki e oon pompe.
• So tawii tuuba ɓalndu PEG-J ina ɓuuɓtoo/ina ɓuuɓtoo, so tawii pompiyee oo gasii kaset e nder ER, walla so tawii infirmiyee oo taƴii pompiyee oo ngam waɗde CT scan, yejjitii fuɗɗoraade ɗum, tolno levodopa plasma ñawɗo oo ina ustoo haa zero e nder 60 minit.
• Protokol hisnude ko yaawi: Loowde tuuba Duopa PEG-J ɓuuɓɗo oo no feewi e ndiyam ngulɗam tawa aɗa huutoroo siriŋ Luer-lock (never push against hard resistance). So tawii pompe walla kaset oo alaa e farmasi safrirde ndee, cafroowo oo ina foti hiisaade ɗoon e ɗoon ñawɗo oo fof e nder ñalawma + dose miligaram subaka bolus levodopa, rokka ɗum ko nanndi heen **Carbidopa/Levodopa mo neɗɗo yaltata e hunuko walla e nder tuuba NG-tube kala 2 haa 3 hojom kasetuuji ummoraade e galle.

Anndude e safrude "Sindoron Parkinson-Hiperpireksi" (PHS / Kiriis ƴettugol dopamin)¶

Sindoron Parkinson-Hiperpireksi (PHS), ina wiyee kadi Kiriis Akinetik walla Sindoron Nannduɗo e Neuroleptik (NMLS), ko ñawu nguu ɓuri bonde e ñawu Parkinson. Ina fuɗɗoo so tawii leɗɗe dopamineerji ñawɗo ɗee njoofnaama no feewi walla ustaama fotde waktuuji 12 haa 72 (e nder ngonka NPO, e nder seppo ɓalndu, e nder naatgol ICU, walla e nder butelaaji pillitol majjuɗi), so tawii ñawu nguu walla ŋakkeende ndiyam ina haɗa ɓuuɓri ɓalndu, walla so tawii lekki kaɗoowo dopamin (Haldol, Reglan) ina rokka.

flowchart TD
    A["Ñawɗo Parkinson oo ina ŋakki Levodopa fotde waktuuji >12 WALLA O heɓii lekki kaɗoowo dopamin (Haldol / Reglan / Compazine)"] --> B["Yeewtu maandeeji 4 gonɗi e ñawu Parkinson-Hyperpyrexie (PHS)"]
    B --> C["1. Ɓooygol ɓalndu 'Lead-Pipe' ɓurtungol & Akinesia (Waawaa diwde terɗe, haalde, walla muñde)"]
    B --> D["2. Hipertermi / Ɓooygol toowngol (38,5°C haa 41,0°C+ / 101,3°F haa 105,8°F+) Faamnaaka e ñawu nguu tan"]
    B --> E["3. Ɓooygol Otonomi (Ɓooygol ladde e nder ƴiiƴam, takikardiya >110 bpm, ɓuuɓri keewndi)"]
    B --> F["4. Waylude hakkille (Stupor, delirium tiiɗɗo, muus, koma) + Kinaas kreatin toowɗo e nder ƴiiƴam (CK >1 000-10 000 U/L)"]
    C --> G["POROTOKOOL ƊAƊƊI ICU ƊIƊI"]
    D --> G
    E --> G
    F --> G
    G --> H["1. Ɗoon e ɗoon, ngartiren Dopamin : Naatnu NG Tube e rokkude limre laaɓtunde e nder galle, hono Karbidopa/Levodopa (walla Patch Rotigotine / Apomorfin) ."]
    H --> I["2. Hidraasiyoŋ IV kristaloid (Haɗde rabdomiolisis ŋakkere ƴiiƴam) + Ɓoornugol coofngol (Antipiretikuuji hono Tylenol GOLLATAA e nguleeki ɓalndu-rigidite)"]
    I --> J["3. Hokkude IV Sodium Dantrolene (1 haa 2,5 mg/kg IV) ngam ustude ɓuuɓri ɓalndu + Bromokriptin e hunuko/NG (2,5 haa 10 mg TID)"]

• Ko waɗi Tylenol (Asetaminofen) haɗataa ñawu PHS: The... 40°C (104°F) nguleeki e nder mboros Parkinsonism-Hyperpyrexia ina heɓtoo ŋakkeende dopamin hipotalamus e ɓuuɓri ƴiiƴam ɓurndi heewde, ndi ustataako e nder ɓanndu nduu fof, wonaa tan sitokineeji ɓuuɓɗi. Ustooje nguleeki kuuɓtodinɗe (acetaminophen / ibuprofen) maa ustoy so wonaa tawa kippu oo artinii ɗoon e ɗoon levodopa e nder tuuba NG, cooynii ñawɗo oo e yaasi e ɓuuɓri cooyniindi/paɗe glaas, waɗti ɗum e ndiyam IV ɓuuɓɗam ngam yaltinde mioglobin e nder reedu, e rokkude IV Dantrolene (**Bromonicritine) walla p).

Limooje emergency diiwaan e porotokolle agence¶

Huutoro ɗeeɗoo laabi neurologie laawɗuɗe, kisal ñawɗo e opitaal, e laabi ƴaañorgal ngam reende ñawɗo Parkinson mo opitaal e nder diiwaan maa:

• Leyɗeele dentuɗe Amerik:
• EMS / Rigidité acute walla ɓuuɓri laawol henndu: Noddu 911.
• Telefoŋ ballal fedde Parkinson (Infirmiyee & Annduɓe kisal safrirde): Noddu 1-800-4PD-INFO (1-800-473-4636) walla ƴettude Kit Kisal Hospitaal to ** .parkinson.org/hospital**. So tawii cafroowo safrirde saliima yamirde levodopa mo waktuuji keewɗi walla yamirii dopamin blocker mo alaa ko waawi, Parkinson’s Foundation Helpline ina waawi rokkude safroowo maa ɗereeji laawɗuɗi ƴeewndaaɗi e sehilaaɓe maa, jokkondirde e Wakiiliijo ñawɗo / Mawɗo safrooɓe safrirde ndee.
• Fedde Ameriknaare toppitiinde ñawu Parkinson (APDA): Noddaango 1-800-223-2732 (apdaparkinson.org).
• Komisiyoŋ Joint / CMS Hospitaal Wullitaango Kisal Ñawɓe: So tawii opitaal ina jokki e safrude leɗɗe Parkinson ɗe waktuuji keewɗi ina njogii, ɗaɓɓu ko yaawi jokkondirde e Gardiiɗo Risk Hospitaal / Awokaa Ñawɗo e Service de Consulte Neurologique In-House.
• Kanaada:
• Haawnaaki: Noddaango 911.
• Parkinson Kanadaa ("GOLLAL e sahaa®" Kit Hospitaal): Noddu 1-800-565-3000 walla njillu parkinson.ca ngam ƴettude ACT on Time® kaayitaaji jeertinaango leɗɗe safrirde e kartal leɗɗe cafrorteeɗe kisal/kisal (teeŋti noon e Kanadaa, Domperidone [Motilium] e Ondansetron [ 1 ].Zofran] ko leɗɗe ɗiɗi kisal ngam haɓaade ɓuuɓri wonande ñawɓe Parkinson, tawi... Maxolon [metoklopramid] e... Stemetil [proklorperazin] ina haɗaa no feewi).
• Dental Dowlaaji Dentuɗi:
• Haawnaaki: Noddaango 999 (walla 111 ngam wasiyaaji NHS ko yaawi).
• Parkinson's UK (Kampaañ "Heɓu ɗum e wakkati" & Yamiroore NHS ngam hokkugo nyawndiigu elektoronik): Noddu Laylaytol Ballal Parkinson's UK haa 0808 800 0303 (parkinsons.org.uk). E nder Kuulal NICE NG71 (Rafi Parkinson e nder mawɓe) e Jeertinaali kisal ñawɓe NHS Angalteer, denndaangal hoolaare safrirde NHS ina yamiree renndinde leɗɗe kaɓtooje Parkinson (co-careldopa / Sinemet, co-beneldopa / Madopar, rotigotine paɗe, apomorphine) hono Leɗɗe caɗtuɗe e sahaa njuɓɓinaaɗe e nder hojomaaji 30 e nder waktuuji galle ñawɗo oo, ngam newnude Leɗɗe ñawɗo oo e hoore mum (SAM) e nder suudu safrirdu nduu so ina waawi, e jokkondirde e **Infirmiyee Ƴeewndotooɗo ñawu Parkinson e nder suudu safrirdu **hos.4)
• Dental Orop:
• Haawnaaki: Noddaango 112. Ñaago-ɗee cafroowo jaɓɓoowo opitaal oo nde jokkondirta e ekipaaji neurologie opitaal oo ɗoon e ɗoon ngam waylude oral Madopar / Sinemet to taƴre ɓuuɓnde ɓuuɓnde (Madopar ɓuuɓnde / LT) rewrude e tuuba nasogastrik walla Rotigotin (Neupro) ɓuuɓri gonndi e ɓalndu so tawii ñawɗo oo waɗaama NPO (à jeun / nüchtern).
• Ostarali e Nuwel Selannde:
• Haawnaaki: Noddaango 000 (Ostarali) walla 111 (Leydi Selannde).
• Ostarali Parkinson ("Heɓ ɗum e sahaa" Porotokol opitaal): Noddu 1800 644 189 (parkinsons.org.au) walla Parkinson to leydi Nuwel Selannde to 0800 473 4636 (parkinsons.org.nz). To Ostarali e Nuwel Selannde, Maksolon (metoklopramid) e Stemetil (proklorperazin) ina kuutoree no feewi ngam safrude mborosaaji gadani e ED ; haalde safrooɓe wonɓe e ambulance hade maɓɓe ƴettude siriŋ ngam haɓaade ɓuuɓri, wonde ñawɗo oo ina jogii ñawu Parkinson, tee ina foti rokkeede Ondansetron TAN (Zofran) walla Domperidon (Motilium).
• Inndo e Asii-Pacifik:
• Haawnaaki: Noddaango 112 walla 108. Nde jaɓɓotoo ñawɗo Parkinson Taking Syndopa (levodopa/carbidopa) to opitaal leydi Indiya, ngadda paɗe strip galle ɗee to nokku safrooɓe ICU/ward e yamirde doktoor jooɗiiɗo oo yo meeɗ waɗde Perinorm (metoklopramiid), Stemetil (poroklorperasin), walla Serenace (haloperidol); ɗaɓɓaande Emset / Ondem (ondansetron) walla Domstal (domperidon) ngam ɓuuɓde e Qutipin (ketiapiin) so tawii ko sedaasiyoŋ ina haani.

Naamne keewɗe naamneede¶

Hol ko waɗi ina bonna so tawii safrirde ndee rokkii jibinannde am Sinemet (karbidopa/levodopa) waktu gooto?¶

E nder ñawu Parkinson mo alaa ɗo haaɗi, ngaandi ndii ina waasa ko ɓuri heewde e neeruuji peewnirɗi e mooftuɗi dopamin, ɗum firti ko ñawɗo oo tuugnii ko e feccere nguurndam juutɗam 90 minit kala taƴre karbidopa/levodopa toɗɗaande ngam yahde, haalde, e muñde. So tawii infirmiyee opitaal ina leeltina doosgal hay hojomaaji 45 haa 60, ñawɗo oo ina ɓuuɓtoo e ngonka "OFF" : ƴiye maɓɓe ina ɓuuɓtoo haa ɓe ɓuuɓtoo e ƴiiƴam maɓɓe, ɓe natta waawde muñde pillitol, ɓalli maɓɓe ina ɓuuɓtoo e rigidite muusɗo, kadi doseeji juutɗi ɗi ŋakkaani ina mbaawi saabaade Parkinsonpy fatal S.

Hol leɗɗe cafrorteeɗe ɓurɗe waawde huutoreede ɗe MEƊƊAANI rokkireede ñawɗo mo ñawu Parkinson ?¶

Ñawɗo mo ñawu Parkinson fotaani rokkeede leɗɗe taƴɗe ƴiiƴam-ngaandi, ɗe kaɗata jokkere enɗam D2 dopamin hakkundeejo. Kalaasuuji ɗiɗi ɓurɗi bonde e nder safrirde ndee ko leɗɗe kaɓtooje dopamin, teeŋti noon e Metoklopramid (Reglan / Maxolon), Proklorperazin (Compazine / Stemetil), Prometazin (Phenergan), e Droperidol, e leɗɗe cafrorteeɗe tipikal walla toowɗe baawɗe haɓtaade delpsikodolol (giHperiridolium), Risperidon (Risperdal), Olanzapin (Sipreksa), e Aripiprazol (Abilifi). Haa ER oo naatna ɗeeɗoo leɗɗe fof e nder ordinateer safrirde ndee, ɗoon e ɗoon so o arii.

Hol leɗɗe kaɓtorɗe ɓuuɓri e agitaasiyoŋ ƊI ƊI ƁURI moƴƴude e ñawɗo Parkinson gonɗo e opitaal ?¶

Wonande ɓuuɓri e ɓuuɓri, lekki ɓurki sellude e nder safrirde ko Ondansetron (Zofran), kaɗoowo ɓuuɓri serotonin 5-HT3, wonaa ɓuuɓri dopamin (tesko : woto hawru e Zofran e apomorfin), walla Domperidone e nder leyɗeele goɗɗe caggal Amerik. So tawii ñawɗo Parkinson gonɗo e opitaal oo ina wondi e ɓuuɓri mawndi, walla ɓuuɓri gonndi e ɓuuɓri, walla ɓuuɓri gonndi e ɓuuɓri ndi waawataa deeƴde e peeje ɗe ngonaa ñawbuuli, ko ɓuri heewde e safaaraaji ɗii ko Pimavanserin (Nuplazid), Quetiapine (Seroquel) mo doosgal mum famɗi, walla Clozapine (Clozapine) mo doosgal mum famɗi, sabu ɓe ngonaa strik (Clozaril).

Hol ko opitaal foti waɗde so tawii jibinannde am wondunde e rafi Parkinson waɗtaama e "NPO (Nothing by Mouth)" ngam seppo walla ƴeewndo ɓuuɓngo ngo ŋakkaani?¶

Hoto meeɗ accude ekipaaji safrirde tan ina njogii walla ina njuppa leɗɗe Parkinson sabu ñawɗo ko NPO. So tawii ñawɗo oo waawaano ƴeewde ekran muusɗo sabu levodopa mum ina leeli, naamndo-ɗee doktoor oo yo rokku mo karbidopa/levodopa (Parcopa) ɓuuɓɗo e hunuko e dow ɗemngal walla Sinemet ɓuuɓɗo e nder kaas teewu appel, ɗaɓɓu hojomaaji 45 haa ƴiiƴam daande mum "ON," reswate "back-st." So tawii ñawɗo oo ko NPO tiiɗɗo ngam seppo walla ɓuuɓnude, cafroowo oo ina foti waɗde tuuba nasogastrik (NG) mo ɓooyaani ngam rokkude ɗum ɓuuɓri karbidopa/levodopa ɓuuɓndi, ndi ɓuuɓri mum yaltinta ko yaawi, walla waɗde heen ɓuuɓri gonndi e ɓalndu Rotigotine (Neupro) gonnduɗo e ɓalndu nduu.

Hol ko woni ñawu Parkinson-Hiperpyrexie (PHS), hol no nganndir-mi ɗum ?¶

Sindoron Parkinson-Hiperpireksi (ina wiyee kadi Kiriis Akinetik walla Sindoron Neuroleptik Nannduɗo e Sindoron Neuroleptik) ko ñawu nguu ina waawi bonnude nguurndam, ngu ummotoo ko nde levodopa ñawɗo Parkinson oo dartinaa e sahaa gooto fotde waktuuji 12 haa 48 walla nde ɓe ngoni e lekki Halblomine no feewi. Ina nanndi e « Neuroleptic Malignant Syndrome » : ɓuuɓri ƴiiƴam no feewi e nder ɓanndu nduu fof, ɓuuɓri toowndi ɓurndi 38,5 haa 41 degere Celsius (101,3 haa 105,8 degere Fahrenheit), ɓuuɓri ɓernde jaawndi e ɓuuɓri ƴiiƴam e wild ƴiiƴam Kreatin Kinaas (CK) ummoraade e ɓuuɓri ɓalndu. Ina ɗaɓɓi toppitagol ICU ko yaawi, fuɗɗoraade levodopa e nder tuuba NG, ɓuuɓri IV, ɓuuɓri coofndi, e IV dantrolene walla bromocriptine.

Hol ko waɗi infirmiyee waawataa ɓuuɓnude taƴe Sinemet CR ɗe jibinannde am yaltinta walla jillondirde e levodopa e ñamri tuubaaji toowndi protein?¶

Taƴde taƴre Karbidopa/Levodopa (Sinemet CR/ER) ina bonna ƴiiƴam mum ɓuuɓɗam, ina duppa doosgal ngal fof laawol gootol, ina addana ɗum diskinesi mo alaa ɗo haaɗi, rewi heen ko ɓuuɓri mooftirndi no feewi ; e nder ɗuum, doktoor oo ina foti waylude yamiroore ndee e taƴe Karbidopa/Levodopa (IR) hade mum ɓuuɓde. Yanti heen, poroteyiin ñaamdu (asideeji amino) ina haɓa e levodopa no feewi ngam heɓde ɗum e nder ɓalndu e nder ƴiiƴam e ngaandi ; so tawii ñawɗo ina woni e ñamri tuubaaji ndiyam jokkondirɗi, ñamri ndii ina foti dartineede fotde hojomaaji 60 hade mum, e hojomaaji 30 haa 60 caggal kala dose levodopa mbele lekki kii ina waawa yettaade ngaandi.

Ardiiɓe jokkondirɓe¶

• Delirium opitaal e wasiyaaji safaara wonande mawɓe
• Disfaaji : ɓuuɓde e ndiyam ɓuuɓɗam, ɓuuɓri aspiraasiyoŋ, e kisal ñaamdu ɓuuɓndu
• Polifarmasi, doseeji leɗɗe ɓurtuɗi, doseeji ŋakkuɗi, e majjere yuɓɓinoowo pillitol
• Jiiɓru ɓuuɓndu e nder mawɓe : urosepsis UTI silsil vs stroke e hol ko waɗi ñawɓe mawɓe ina ŋakkira nguleeki

Fuɗɗoode e ardorde laawɗunde¶

• Foundation Parkinson: Wasiyaaji toppitagol safrirde & doggol kisal safrirde: Doseeji dopaminergik gonɗi e sahaa, antiemetikuuji/antipsikotiikuuji ɗi njiɗaa, e porotokolle ponto NPO perioperatif (parkinson.org/hospital).
• Duɗal ngenndiwal cellal e toppitagol (NICE) to leydi Angalteer : Kuulal NICE NG71 : Ñawu Parkinson e nder mawɓe, naatgol e opitaal ɓuuɓngol, haɗaade ƴettugol Levodopa e nder sahaa gooto, e waylude tuuba NPO Rotigotine/NG.
• Akademi Ameriknaajo ko faati e neurologie (AAN) & Fedde winndereere toppitiinde ko faati e ñawu Parkinson e dille (MDS): Laabi gollorɗi ngam anndude e ƴellitde ICU ñawu Parkinson-Hyperpyrexie (Kiriis Akinetik).
• Institut pour les pratiques sécurisées de médicaments (ISMP): Golle ɓurɗe moƴƴude ngam kisal leɗɗe jowitiiɗe e opitaaluuji: Haɗde woppude karbidopa/levodopa gonɗo e sahaa e haɗde antagonisteeji D2 ɗi njiɗaa.
• Fedde Ameriknaare toppitiinde ko fayti e ñawɓe mawɓe (AGS): Kesɗitinaa AGS Beers Criteria® ngam huutoraade leɗɗe potɗe huutoreede ɗe moƴƴaani e mawɓe (Reentaade no feewi antipsikotiikuuji tippudi/atipikal e metoklopramide e nder ñawu Parkinson).