ACE-Inhibitor Ɓuuɓri ɗemngal e ɓuuɓri gonndi e ɓuuɓri ƴiiƴam¶

Ɓuuɓri yaawndi, ndi alaa ko nafata e leppi, ɗemngal, e les hunduko, walla e nder reedu tawa alaa ko woni e mum so wonaa ɓuuɓri walla ɓuuɓri, ko ñawu nguu ina waawi bonnude nguurndam, tawi ko mooftugol bradykinin, wonaa yaltinde histamin. So tawii ñawɗo ƴettuɗo lekki tansiyoŋ joofɗo e "-pril" (hono lisinopril, enalapril, walla ramipril) walla ñawɗo mo ƴiiƴam ƴiiƴam (HAE) heɓi ɓuuɓri luggiɗndi, leɗɗe anafilaksi gonɗe e ƴiiƴam ko wayi no epinefrin, antihistamiin, e kortikosteroid ina keewi ustude ƴiiƴam ɗam. So tawii ko aan walla goɗɗo ɓadiiɗo ma heɓi mawnugol ɗemngal, caɗeele muusde ƴiiƴam, daande "potato hot" muusɗo, walla daande fooftere toownde, noddu limoore emergency nokku maa ɗoon e ɗoon e laawol limooje caɗtuɗe. Yiylo porotokolle laabi weeyo jowitiiɗi e... ɓuuɓri e anafilaksi, epiglottitis, croup, e ɓuuɓri gonndi e laawol henndu toowngol, e ɓuuɓri peritonsil e ɓuuɓri Ludwig.

Waɗde ɗum jooni¶

1. Noddu limoore emergency nokku maa ɗoon e ɗoon (911 e nder leyɗeele dentuɗe Amerik e Kanadaa, 112 e nder Dental Orop, 999 e nder Dental Dowlaaji Amerik) so tawii won ɓuuɓri ina toɗɗii ɗemngal, ɓuuɓri softunde, uvula, les hunduko, wuddu, walla daande. Hoto meeɗ nawde hoore maa to safrirde e nder ɓuuɓri hunduko walla daande, sabu laawol henndu ina waawi siifde e nder oto dilloowo e nder hojomaaji seeɗa.
2. Waɗde lekki kisnugol HAE (HAE) ɗoon e ɗoon so tawii ñawɗo oo ina jogii heen. So tawii neɗɗo oo ina anndi HAE walla ina heɓi ŋakkeende C1-esterase, wallu ɗum e waɗde hoore mum icatibant (30 miligaram e nder ɓalndu walla) ko ummii e plasma walla ko ummii e C1-esterase (C1-INH) walla ekalantiid jooni jooni. Kala leelgol hojomaaji 15 e rokkude safaara gonɗo e bradykinin ina addana ɓuuɓri ƴiiƴam ɓurndi luggiɗde.
3. Huftoraade oto-injektor epinefriin so tawii sabaabu ɓuuɓri ndii anndaaka walla so tawii ko ɓuuɓri, ɓuuɓri, walla ɓuuɓri ɓuuɓri. So tawii anjiyoedema gonɗo e bradikinin oo jaabaaki no moƴƴi e epinefrin, yiyooɓe ɓee mbaawaa sahaa kala anndude histamin anaphylaxie e nder anjiyokinin gadano so wonaa bradikin a. Hokkude epinefriin nder ɓalndu e nder ɓalndu yaajndu ina moƴƴi, ina hisna nguurndam so tawii ɓuuɓri ndii ina wayi no ko anafilaksi alerji.
4. Jooɗto ñawɗo oo ina tiiɗi walla ina ŋoŋɗi seeɗa yeeso e nder mbaydi gonndi e ŋoral. Woto meeɗ doole neɗɗo mo ɗemngal mum ɓuuɓngal walla daande mum ɓuuɓnata, yoo lelnu e dow ɓale mum. Teddeendi ina fooɗa ɗemngal mawngal, teddungal, caggal e dow ŋoral ɓalndu caggal so ina ŋoŋɗi, ɗoon e ɗoon ina haɗa henndu ruttaade. Hokkude ɗum koppi walla towel mbele ɓe mbaawa ɓuuɓde walla ɓuuɓnude ƴiiƴam, wonaa etaade ɓuuɓnude ɗum.
5. Woppu denndaangal ñawbuuli ƴiiƴam gonɗi e ACE, sakubitril-valsartan, ñawbuuli jabet gliptin, e ñawbuuli estirojin ɗoon e ɗoon. Addude butelaaji ñawɗo oo tigi rigi (haa teeŋti e lisinopril, enalapril, ramipril, benazepril, perindopril, kaptonapril) to suudu safrirdu, walla to suudu safrirdu junngo cafroowo.
6. Waɗde ñawɗo oo hay huunde e hunuko (NPO) e reenaade meemde walla ɓuuɓnude ɓalndu. Hoto rokku ɗum taƴe antihistamine, ndiyam, walla pillitol ɓuuɓngol ngam ɓuuɓnude so ɗemngal walla ƴiiƴam ina ɓuuɓna, sibu ɓuuɓde e aspiraade ina mbaawi saabaade ɓuuɓri gonndi e ƴiiƴam.
7. Jeertin safrooɓe e gollotooɓe triage emergency ɗoon e ɗoon wonde aɗa sikki anjiyoedema mo bradykinin ina ɗaɓɓi peewnugol fibreoptique intubation ko yaawi. Haalan ekipaaji resuscitation ɗii laaɓndal so tawii ñawɗo oo ina ƴetta inhibiteur ACE walla ina jogii HAE ko adii nde anestesiyoloji peewnata fibe optik surgical brocothy flexible ɗemngal ina soofa hunuko.

Lekki kuulal : Triage ɓuuɓɗo leppi, ɗemngal, e anjiyoedema gonɗo e laawol henndu¶

flowchart TD
    Start["Ɓuuɓri ɓuuɓndi e leppi, ɗemngal, yeeso, walla daande"] --> AirwayCheck{"Ƴeewto Banngeeji Boɗeeji Laabi: Waylo daande, ɓuuɓri, stridor, ɓuuɓri foofaango, walla ɓuuɓri ɗemngal / les ɓuuɓri hunduko ?"}

    AirwayCheck -->|"EEY: Ɓooygol laawol henndu ina ɓadii"| CallEMS["1. Noddu 911 / 112 / 999 Ɗoon e ɗoon. 2. Joɗnde muñal tiiɗnde ina ŋoŋɗi yeeso. 3. Hokkude lekki kisnugol HAE (icatibant / C1-INH) so tawii HAE ina anndaa, walla Epinefrin so tawii sabaabu mum anndaaka."]

    AirwayCheck -->|"NO: Ɓuuɓri leppi yeeso walla yeeso tan"| MediatorCheck{"Ƴeewto Mekanisme : Hiisaaji (urticaire), ɓuuɓri tiiɗndi, walla fuɗɗoode ɗoon e ɗoon caggal nde ñaami, ɓuuɓri, walla antibiotik ?"}

    CallEMS --> HospitalPrep["Triage opitaal jeertinaango: Peewnugol ɓuuɓri nasotrakeal fiberoptik + ɓuuɓri krikotirotomi seppo ɗiɗo"]

    MediatorCheck -->|"EEY: Hives e ɓuuɓri ina woodi"| HistaminePath["ANGIYOEDEM / ANAFILAKSI : 1. Innde IM Epinefriin (0,3 haa 0,5 mg e ɓalndu bannge). 2. Hokkude ñawbuuli H1/H2 + kortikosteroid. 3. Laylaytol Departemaa Emergency ngam ƴeewde feere bifasik."]

    MediatorCheck -->|"NO: Ɓuuɓri ndi alaa nafoore walla tiiɗndi ndi alaa ko ɓuuɓnata ALAA hives"| DrugHistory{"Ƴeewto Leɗɗe & Taariindi Neɗɗo/Galle"}

    DrugHistory -->|"Ƴettude lisinopril, enalapril, ramipril, sakubitril-valsartan, walla ɓuuɓri DPP-4"| ACEIPath["Noddu EMS ngam ƴeewtaade laabi weeyo to Departemaa Emergency. 2. Woppude ACE haa abada. 3. Epinefriin/steroid ina moƴƴi ; ƴeewto-ɗee Plasma Fresh Frozen walla TXA e nder yahrude yeeso no feewi e laawol henndu."]

    DrugHistory -->|"Daartol ñawu nguu (HAE), taariindi ɓesngu, walla ñawu nguu ina jokki e reedu"| HAEPath["ƁURI HAƁDE C1-INH (HAE) : 1. Hokkude Ikatibant (30 mg) walla IV C1-Esterase ɗoon e ɗoon. 2. Naatde e Departemaa Emergency so tawii won ko woni e hunuko, e ɗemngal, walla e ƴiiƴam."]

Patofisiyoloji : Bradikinin e histamin e nder ɓuuɓri ƴiiƴam toowndi¶

Faamde hol ko waɗi won e ñawanɗe ɓuuɓɗe ɗemngal mawɗe ina njaaboo e nder hojomaaji seeɗa e epinefriin, won heen kadi ina njokki ɓuuɓde hay so tawii noon ina keewi doseeji epinefriin, antihistamin, e steroid ina ɗaɓɓi ƴeewtaade laabi ɗiɗi ceertuɗi biyokimikaaji jogorɗi jogaade permeabilite vaskulaare.

Laawol histamin e ƴiiƴam mast (anjiyoedema alerji)¶

E nder anjiyoedema alerji ɓooyɗo, alerji ko wayi no poroteyiin njuumri, tooke beeli, walla penisilin ina jokkondiri e ƴiye immunoglobulin E (IgE) e dow ƴiye mast e basofiil. E nder hojomaaji seeɗa, ɗeen ƴiye ina njuppa histamin, lewkotriyen, tiriptaas, e prostaglandin e nder ƴiye taariiɗe ɗum. Histamin ina nannga e jaɓɓotooɗe H1 e H2 e nder ƴiye caggal kapilaar, ina addana ɗum ɓuuɓde, ɓuuɓde no feewi, e ɓuuɓde ƴiye (urticaire walla hives). Sabu ɓuuɓri ƴiiƴam ina dartina ɓuuɓri adrenerjik beta-2 e ɓuuɓri ƴiiƴam alfa-1, epinefriin nder ɓalndu ina yaawi dartinde ɓuuɓri ƴiiƴam gonndi e histamin, tawi noon antihistamin e steroid ina kaɗa ɓuuɓri ɗiɗmiri.

Laawol kalikrein-kinin e bradikinin (anjiyoedema mo alaa alerji)¶

E nder ƴiiƴam gonɗam e bradikinin, ƴiiƴam ɗam e histamin ina njogii darnde zero. Aybiiɗo oo ko bradikinin, ko peptiid gonɗo e ƴiiƴam, mo asid amino jeenay, mo njuɓɓudi jokkondiral kallikrein-kinin feewnata. So bradikinin jokkondirii e jaɓɓotooɗe bradikinin B2 e dow endoteliyoŋ ƴiiƴam, ina addana ɗum yaltinde oksidaa nitriik, sintesis prostasiklin, e fosforilaasiyoŋ kadheriin endoteliyoŋ ƴiiƴam (VE-cadherin). Ɗum ina usta jokkondire tiiɗɗe hakkunde ƴiye endoteliije, addana ndiyam ɗam ɓuuɓde e nder ɓuuɓri luggiɗndi e nder ɗemngal, e nder ƴiye, e nder yeeso, e nder ƴiye, walla e nder ɓalndu.

Sabu bradikinin ustata fiɓnde ɓuuɓnde histamin walla ɓuuɓri ɓalndu dowri, anjiyoedema gonɗo e bradikinin ina addana ɓuuɓri zero e ɓuuɓri zero. Laral walla ɗemngal ina nanndi e ɓuuɓri walla no woorunoo, ina nanndi e ɓuuɓri walla e leɗɗe tawa ina ɓuuɓna, ina maha e nder waktuuji 2 haa 12. Sabu bradikinin ina gollina no feewi e jokkere enɗam B2, difenhidramin, metilprednisolon e epinefrin mbaawataa uddude jokkondire gonɗe e nder ƴiiƴam ɗe zip mum en alaa.

No ACE reentortoo tooke bradykinin¶

E no woorunoo, bradikinin ina jogii feccere nguurndam fotde leƴƴanɗe 15 sabu ina yaawi ustude ɗum e Enzim waylowaylo anjiyotensin (ACE, ina wiyee kadi kininaas II) e aminopeptidaas P (APP), tawa ina waɗi ɓuuɓri gonndi e dipeptidilpeptidaas-4sin**in (DPP-4). - So ñawɗo ƴettii inhibiteur ACE (lisinopril, enalapril, ramipril, benazepril, kinapril, perindopril, kaptopril, fosinopril, walla trandolapril), lekki kii ina haɗa ACE waylude anjiyotensin I e anjiyotensiin II, ko ɗum kadi haɗata laawol brapokin ɓalndu ngol e sahaa gooto. - E nder 0,1 haa 0,7 e nder teemedere ñawɓe ɓee fof, e nder 1,5 haa 5 e nder teemedere ñawɓe ɓaleeɓe e Afriknaaɓe iwdi mum en (ɓe ɓuri heewde jogaade polimorfiisuuji renndo e nder aminopeptidase P walla neprilysin), enzimuuji baɗɗiiɗi ɗii mbaawataa laɓɓinde bradikinin mooftuɗo oo. - Toɓɓere Bradykinin ina ɓeydoo laabi 5 haa 10 e nder ƴiye hunduko, ina suɓaa e ɗemngal, e hunuko, e nokku les ɗemngal, e uvula, e ƴiye.

No Anjiyoedema ronkaa (HAE) e ŋakkeende C1-inhibitor keɓtinaande ngaddata ñawuuji¶

E nder Anjiyoedema ronkaande (HAE), ñawɓe ina ndokka mbayliigu ɓurngu mawnude e otosoom (walla mbayliigu nguu e nder 25% e ñawɓe ɓee) ina toɗɗii C1-esterase (C1-INH), mbayliigu protease serine mo heeñere waɗata. C1-INH woni fereeji gadani ɗi kaɗata Faktor XIIa e kallikrein plasma kuutorteeɗo. So tawii tolno C1-INH golloowo oo ina ustoo les 50 e nder teemedere e no woorunoo : 1. Ko ɓuuɓri ɓanndu tokosiri, golle dental, baasal, ɓuuɓri viral, walla ɓuuɓri estirojin ina addana Faktor XII waɗde Faktor XIIa. 2. Faktor XIIa mo ƴeewtaaka ina wayla prekalikrein e kalikrein plasma kuutortooɗo, mo feccata kininogen toowɗo (HMWK) ngam yaltinde ɓuuɓri mawndi bradikinin. 3. Nokkuuji tati HAE ina ngoodi : - HAE Tipe I (85 e nder teemedere): Toɓɓere poroteyiin antigen C1-INH ina famɗi, golle C1-INH ina famɗi, e komplement C4 ina famɗi. - HAE Tipe II (15 e nder teemedere): Tolno poroteyiin C1-INH mo waylaaka no woorunoo walla toowɗo, golle C1-INH ina pamɗi, e C4 ina pamɗi. - HAE e C1-INH no woorunoo (ina famɗi): C1-INH e C4 no woorunoo, e waylooji e nder Faktor XII (F12), plasminogen (PLG), anjiyopoyetin-1 (ANGPT1), walla kininogen-1 (KNG1) mo pregnancy walla estrogen ummini e semmbe. 4. Anjioedema keɓaaɗo (AAE): Fuɗɗotoo ko caggal duuɓi 40 tawa alaa taariindi galle, tawi ko ñawuuji limfoproliferatif B-cell (limfoma, CLL, walla MGUS) walla otoantibiotikuuji ñaamooɓe C1-INH e C1q poroteyiinuuji timmuɗi.

Njiylawu kuuɓtodinɗo : Histamin e ACE-inhibiteur e Anjiyoedema ronkaagal¶

Nate kilinikuuji tiiɗɗi e nder anjiyoedema ACE-inhibiteur¶

Feere 1 : Teskaade lekki ƴettaaɗi e kisal duuɓi, waawaa wonde sabaabu¶

Ina jeyaa e miijooji ɓurɗi bonde ɗi ñawɓe e safrooɓe fof njogii, miijaade wonde alerji walla ñawu nguu ina waɗa tan e nder yontere adannde fuɗɗoraade restoraaji kesi. E nder ACE-inhibitor angioedema, so tawii ko ina tolnoo e 50 e nder teemedere e ñawɓe ɓee ina keɓa e nder balɗe 30 gadane puɗɗagol lisinopril walla enalapril, **50 e nder teemedere heddiiɗe ɗee ina keɓa lebbi, duuɓi, walla hay ko ɓuri duuɓi sappo caggal nde ñawɗo oo ƴetti pillol gootol tigi rigi ñalnde kala tawa ina wondi e ñawu nguu. Hit ɗiɗaɓo, ko wayi no golle dental tokoose, infection respiratoire supérieure virale, trauma snoring to uvula, fuɗɗoraade leɗɗe gonɗe e sahaa gooto, walla ustaare enzimuuji baɗɗiiɗi e duuɓi, ɗoon e ɗoon ina tippa ñawɗo oo e dow tolno bradykinin caggal duuɓi 8 e safaara dartiiɗo.

Faandaare 2 : Leɗɗe sinerji keewɗe ɓeydooje baasal ACE-inhibiteur anjiyoedema¶

Won e mbaydiiji leɗɗe ina kaɗa e sahaa gooto enzimuuji keewɗi baawɗi ustude bradykinin, ina addana ɗum en ɓeydaade heewde e ɓuuɓri ɗemngal e ɓuuɓri ƴiiƴam : 1. Sakubitril-Valsartan (Lekki ŋakkere ɓernde Entresto / ARNI): Sakubitril ina haɗa neprilisin (endopeptidase mo alaa ko woni e mum). Ƴettude sakubitril-valsartan e sahaa gooto e mboros ACE ina addana neɗɗo mooftude bradikinin bonɗo. Mandat kilinik: Waktuuji 36 loowdi tiiɗndi ina ɗaɓɓiree hakkunde dose cakkitiiɗo kala mboros ACE e dose gadano sacubitril-valsartan (e ko nanndi heen). Yanti heen, sakubitril-valsartan ina haɗee e kala mo nganndu-ɗaa ina wondi e ñawu nguu, tawi ina haɗa ACE. 2. Inhibiteeruuji DPP-4 ("Gliptins" ngam jabet fannu 2): Leɗɗe ko wayi no sitagliptin, saksagliptin, linagliptin, e alogliptin ina kaɗa dipeptidilpeptidaas-4 (DPP-4), woni enzim gadano gonɗo e ustude bradikinin e huunde P nde ACE haɗata. Ɓeydude gliptin e ñawɗo ƴettuɗo lisinopril walla ramipril ina ɓeyda baasal mboros oo fotde laabi 3 haa 4. 3. Inhibiteeruuji mTOR (Sirolimus e Everolimus e nder ñawɓe mbayliigu terɗe): Heɓooɓe mbayliigu ƴettuɓe sirolimus walla everolimus e bannge reenoowo ACE ina keɓa tolnooji toowɗi e ɓuuɓri ɗemngal tiiɗndi sabu ŋakkeende feewnitagol ɓuuɓri endoteliyal. 4. Aktivator plasminogen tissue recombinant (Alteplase / Tenecteplase pour AVC) : So ñawɗo stroke keɓɗo ƴettude ACE ina heɓa trombolise nder ƴiiƴam (tPA), jibinannde plasmin ina huutoroo no feewi kaskaade kallikrein-bradikinin. Haa e 5 e nder teemedere ñawɓe stroke wonɓe e inhibiteeruuji ACE ina keɓa anjiyoedema orolingual ɓuuɓɗo e nder hojomaaji 30 haa 120 caggal nde keɓi alteplase IV, ina heewi wonde asimetrik, ina ɓuri bonde e bannge gonɗo e ŋorol ngaandi iskemik. 5. Leɗɗe ɓuuɓɗe ɗe ngonaa steroid (AINE) : Ibuprofen, naproxen, e aspiriin ina mbaawi saabaade mbayliigu lewkotriyen e nder geese mast walla ɓeydude ɓuuɓri les ɓuuɓri ACE-inhibiteur.

Trap 3: Winndannde rewtinnde caggal nde joofni (haa jonte 6)¶

So ñawɗo oo heɓiino mboros biyeteeɗo anjiyoedema (anjiyoedema) gonɗo e ACE-inhibiteur, alaa e sago meeɗa ƴettude hay lekki e nder kalaas ACE-inhibitor hay dara e nder nguurndam mum (waylude lisinopril e enalapril walla ramipril maa addan ɗum mbaydi ngootiri sabu ko ɗum batte kemikal keertiiɗe e nder kalaas, wonaa batte kemikal keeriiɗo e nder kalaas). Hay caggal nde ACE oo dartinaa haa laaɓi, tolno kininase tissue ina ƴetta jonte ngam moƴƴinde ; ñawɓe ina keddii e baasal ngam heɓde ɓuuɓri ƴiiƴam walla ɗemngal haa jonte 4 haa 6 caggal nde ɓe keɓi pillol maɓɓe cakkitiingol. Waylude Bloqueur des récepteurs d’angiotensine (ARB) ko wayi no losartan walla valsartan ina foti waɗeede e hakkille tan ko e cafroowo caggal nde ɗum timmi, sibu ina teskaa e nder sahaa mbayliigu nguu, ko famɗi fof ko ina wona 2 haa 8 e nder teemedere (ko ina wona 2 haa 8 e nder teemedere) ina teskaa.

Taƴre anatomiije ɗemngal e ƴiiƴam: Senngo Ishoo¶

E nder departemaa emergency, safrooɓe ina ƴeewtoo nokku ɗo ɓuuɓri ndii woni ɗoo e nder hunuko e daande, tawa ina tuugnii e pulse oximetry tan. Pulse oximetry (\(SpO_2\)) ko maande leelnde kulɓiniinde e nder ɓuuɓri ƴiiƴam toowndi: ñawɗo mo 90 e nder teemedere ƴiiƴam mum ɓuuɓɗam maa jogo ɓuuɓri oksijen 98 e nder teemedere e golloraade tikkere ngam ɓuuɓnude henndu rewrude e udditgol pinhole as $xiphye anddrop_2 maɓɓe tan ɓuuɓri ɓernde hipoksiik.

Ekipaaji laabi weeyo ɓuuɓɗi ina kuutoroo Ishoo Clinical Staging System ngam anndude hol baawɗo teskaade e nder suudu safrirdu huuɓtodinndu e hol baawɗo naatde e suudu safrirdu (ICU) ko yaawi e waɗde intubation awake proactive :

Ko waɗi ɓuuɓri gonndi e mbaydi jaawndi (RSI) ina waawi warde e nder ƴiiƴam ɗemngal e ƴiiƴam¶

E nder ko ɓuri heewde e caɗeele safaara ɗaɓɓooje tuuba foofaango, safrooɓe caɗeele ina mbaɗa Intubation rapide Sequence (RSI) tawa ina ndokka heen safaara jaawɗo (hono etomidaat walla ketamin) e safaara ɓuuɓnoowo ƴiiƴam (hono rokuronium walla suksinilkolin), ina ɗaminii apserngope e nder 4,5 hunduko ngo.

E nder daawal III walla IV anjiyoedema ɗemngal walla ƴiiƴam, RSI gonɗo e mbaydi gonndi e paralisis neuromuskulaar ko sabaabu mawɗo "Waawaa Intubaade, Waawaa Oksijenaade" (CICO) : 1. Maayde Toon Muscle Pharyngeal Upon Paralysis: So ñawɗo mo ɓuuɓri ɗemngal tiiɗndi walla ɓuuɓri supraglottic ina ummoo ina jooɗii ina tiiɗi, ina huutoroo no feewi ƴiye nder daande mum, e ƴiye mum, e ƴiye mum ngam jogaade ɓuuɓri tokosiri 3 milimeeteer udditiindi. So tawii ñawɗo oo ina lelnaa, toɓɓere ɓalndu ina majja, tawa kadi ko ɓuuɓri ɗemngal teeŋtungal e ɓuuɓri aryepiglottique boggy ina ɓuuɓtoo. 2. Failde laryngoscopie oral direct et vidéo : So ɗemngal yeesowal e les ɓuuɓri hunduko ina ɓuuɓna haa laabi ɗiɗi walla tati ɓuuɓri no woorunoo, ƴiiƴam ɗam wonta leɗɗe, ɗam ɗooftaaki. Suudu ɓanndu zero ina woodi e nder hunduko ngam naatnude ƴulɓe Macintosh walla layngoskoop wideyoo, ɗemngal ngal waawaa ɓuuɓde e nder nokku gonɗo les ɓuuɓri ngam yiyde ƴiye daande. 3. Fayre henndu supraglottik (LMA) e ɓuuɓri saak-valve-mask : Puɗɗagol henndu ummoraade dow e saak-valve-mask ina doola epiglottis ɓuuɓɗo oo les, tawi noon laabi henndu mask laryngeal (LMA) waawaa rewde e ɗemngal mawngal walla ƴeftude supraglottik ɓuuɓɗo.

Standard kaŋŋe : Intubaasiyoŋ nasotrakeal fiberoptik ummitinaaɗo e "setup ɗiɗo".¶

Nde laawol henndu foti seertude e ACE-inhibiteur tiiɗɗo walla HAE : - Waɗde ñawɗo oo jooɗo ina tiiɗi, ina foofa e hoore mum. - Peewnu "Double Setup": Ko adii nde memataa nofru walla daande e skop, cafroowo walla seppo ina waɗa maande membrane krikotiroyid e dow wuddu e pentol seppo, ina laɓɓina ɓalndu nduu e kulorheksidin, ina waɗa lidocaine nokkuyankeewo e dow membrane sur-gical ** kit krikotirotomi** sara leeso. - Topikalize ɓuuɓri nofru e ƴiiƴam : Vasokonstriktor (oksimetazolin) e anestetik nokkuure atomize (lidokain 4 e nder teemedere) ina mbaɗee e hunuko e ƴiiƴam ɓurɗam laaɓtude ngam haɗde gagging walla laryngospasm. - Awake Intubation Nasotracheal Flexible Fibreoptique: Rewrude e bronkoskoop fibreoptique flexible ɓuuɓɗo, jolɗo e tuuba endotracheal tiiɗtinaaɗo (\(6.0\text{ haa }7.0\text{ mm}\) njaajeendi nder) rewrude e nofru e laawol timmungol toe dow hunduko, steering gite rewrude e ƴiye daande hade kala lekki cemmbinki walla paralitik rokkireede.

Farmakoterapi ɓuuɓɗo : No ɓuuɓri bradykinin dartinirtee¶

1. Ñawbuuli gadani ngam hisnude Angioedema (HAE) e ŋakkeende C1-INH keɓaaɗo¶

Laabi WAO/EAACI (Fedde Adunaare Allergie / Akademi Oropnaajo Allergie e Immunologie Clinique) ina yamiri wonde kala ñawɗo HAE ina foti jogaade ko famɗi fof doseeji ɗiɗi leɗɗe cafrorteeɗe ngam hisnude neɗɗo e kala sahaa, tawa ina heɓa safaara e sahaa kala ko ina wona 100 000 mbuuɗu :

• Icatibant (Firazyr): Ko antagonist jaɓɓotooɗo bradikinin B2 cuɓaaɗo sintetik, kaɗoowo bradikinin jokkondirde e jaɓɓotooɗe B2 endoteliyal. Hokkaama no **30 miligaram gooto (\(3\text{ mL}\)) e nder ɓalndu reedu (doseeji sukaaɓe ina tuugii e teddeendi gila e \(10\text{ haa }30\text{ mg}\)). Ñawɓe e terɗe galle ina njannginee no mbaɗata ɗum e nder galleeji hade ambulance oo arde. Doseeji puɗɗiiɗi ina mbaawi rokkireede caggal waktuuji 6 so ina haani (ko ɓuri heewde ko doseeji 3 e nder waktuuji 24). Ina haɗa yahrude yeeso ɓuuɓri e nder 15 haa 30 minit.
• Kosam gonɗam e ƴiiƴam (Berinert, Cinryze): Lomtotoo ko poroteyiin C1-INH neɗɗo mo ŋakkaani, ina uddita Faktor XIIa e kallikrein ƴiiƴam. Waɗde e nder ƴiiƴam e doosgal teddeendi \(20\tekst{ Yuɓɓooji hakkunde leyɗeele e kiloo}\) (\(20\tekst{ IU/kg}\)) e nder hojomaaji 5 haa 10.
• Inhibitor C1-Esterase neɗɗo (Ruconest): Ina waɗa **e nder ƴiiƴam e 50 dolaar\binndol{ UI/kg}\(** (fotde 4 200 dolaar\binndol{ UI}\)); ina haɗee e ñawɓe wonduɓe e alerji rabbit anndaaɓe.
• Ekalantiid (Kalbitor): Ko kallikrein plasma cuɓaaɗo jaɓaaɗo to Amerik wonande ñawɓe yahrooɓe e duuɓi 12 e ko ɓuri ɗum ; rokketee ko 30 miligaram rewrude e injections tati \(1\text{ mL}\) (\(10\text{ mg}\)) les ɓalndu e juuɗe safroowo baawɗo ƴellitde 3 haa 4 e nder teemedere e baasal mum anafilaksi.

2. Cuɓe jolngo ɗiɗaɓo so C1-INH walla Icatibant ngalaa¶

E nder opitaaluuji teeru walla anjiyoedema ACE-inhibitor ɗo biyoloji HAE targeted ndarnaaka, safrooɓe urgence ina kuutoroo geɗe ɗiɗi keewɗe : - Asid Traneksamik (TXA, \(1,000\text{ mg}\) IV e nder hojomaaji 10): Ina haɗa waylude pilasminogen e pilasmin, ina leeltina ɓeydagol sintesis Faktor XII e kalikrein-bradikinin. - Plasma keso ɓuuɓɗo (FFP, 2 yunit [\(10\tekst{ haa }15\tekst{ mL/kg}\)] IV): Pilasma dokkoowo ina waɗi C1-esterase inhibiteur golloowo e kininaas II (ACE) kuutortooɗo e enzimji aminopeptidaas ina ɓuuɓna P Anjiyoedema ina haɗa ACE. (E nder HAE, FFP huutortee tan ko so C1-INH e icatibant ngalaa).

Anndude mborosaaji reedu (Haɗde seppooji ɗi ngalaa nafoore)¶

So tawii noon ɓuuɓri ACE-inhibitor ina famɗi ɗo addanta ɓuuɓri ɓalndu ceertundi, Njaajeendi ɓuuɓri gonndi e ɓalndu (HAE) ina toɗɗii ɓuuɓri ɓalndu e nder ko ina ɓura 80 e nder teemedere ñawɓe. - Ɓuuɓri ɓalndu les ɓuuɓri ina haɗa ɓuuɓri ɓalndu, ina yaltina liiteeruuji ndiyam e nder ɓalndu (ascites acute), ina addana 10/10 ɓuuɓri kolik, ɓuuɓri ndi ustataako, ɓuuɓri ɓuuɓri, ɓuuɓri ndiyam, e ɓuuɓri hipovolemik. - The Surgical Trap: Sabu ñawɗo oo ina jogii reedu ɓuuɓndu e ƴiiƴam ɓalejam toowɗam (gila e hemoconcentration) tawa ɓuuɓri yeeso ina yiyee e oon sahaa, haa e tataɓal ñawɓe HAE ɓe nganndaaka ina mbaɗa laparotomiiji walla apendektomiiji ƴeewndotooɗi ɗi ngalaa nafoore. - No seerndirta: Ina wayi no peritonitis bakteriiji (ƴeew apendisit e peritonitis), ɓuuɓri reedu HAE ina heewi waasde nguleeki mawki, ina hollita ɓuuɓri ɓalndu (nafoore "stacked coin") e ascites e dow CT, ina safra e nder hojomaaji 30 haa 90 icatibant les ɓalndu walla C1-INH nder ƴiiƴam.

Ko addata mborosaaji HAE e ko adii nde mboros oo waɗata¶

Ñawɓe HAE walla ŋakkeende C1-Inhibitor keɓaaɗo ina poti feewnude geɗe anndaaɗe mekanik e hormonuuji baɗooji Faktor XII : 1. Ittugol dental, Opereeji Hunduko, e Intubaasiyoŋ (Risk ɓurɗo mawnude): So tawii ko adii nde safaara oo waɗaaka, 20 haa 40 e nder teemedere ñawɓe HAE ina keɓa ɓuuɓri gonndi e nguurndam, e nder waktuuji 4 haa 48 caggal nde dental ƴettaa. Ñawɓe ina poti heɓde **profilaksi juutɗo (\(1,000\text{ haa }2,000\text{ IU}\) walla \(20\text{ IU/kg}\) e ƴiiƴam C1-INH keɓtinaaɗam e nder ƴiiƴam) waktuuji 1 haa 6 hade kala golle dental, opereeji hunduko, ecu dose to bannge leeso fotde waktuuji 48. 2. Leɗɗe estirojin: Leɗɗe gonɗe e hunuko e lomtingol hormon estirojin ina ɓeyda Faktor XII ina addana mborosaaji ; ko cuɓe ɗe progestin tan walla ɗe ngonaa hormon ɓuri yiɗeede. 3. Inhibiteurs ACE: Ina haɗaa no feewi e denndaangal ñawɓe HAE.

Limooje emergency diiwaan e porotokolle agence¶

So aɗa nodda ballal e nder ɓuuɓri ɗemngal, leppi, walla daande, haalan laaɓndal wonde ñawɗo oo ina jogii angioedema ɓuuɓri toowndi:

• Leyɗeele dentuɗe Amerik e Kanadaa: Noddu 911 ngam heɓde ambulance safrooɓe ballal nguurndam (ALS). E nder porotokolle FDA, AAAAI, e US HAEA, ngaddanee galleeji kaɓirɗe icatibant, Berinert, Cinryze, walla Ruconest e nder oto ngam safrooɓe walla safrooɓe cafrirɓe mbaawa rokkude ñawɗo oo lekki mum ɗoon e ɗoon.
• Dental Dowlaaji Dentuɗi: Noddu 999 (walla 112). E nder NHS, Diiso Wuurtinde UK, e BSACI, gollotooɓe e ambulance ina ndokka C1-INH walla icatibant mo ñawɗo oo jogii, ina njeertina Departemaa Emergency jaɓɓotooɗo oo e noddaango "Airway Standby" ngam anestetik e ENT mo noddata.
• Dental Orop: Noddu 112. WAO e EAACI ina wasiyoo jogaade kaayitaaji HAE Oropnaaɓe ɗemɗe keewɗe, ina ciftina doseeji C1-INH (20\(\binndi{ IU/kg}\) IV) e icatibant (30\(\binndi{ mg}\) SC) tuugiiɗi e teddeendi.
• Ostraali e Nuwel Selannde: Noddu 000 to Ostarali walla 111 to Nuwel Selannde e rewde peeje golle ASCIA ngam haɓaade ñawu nguu.
• Inndo e Asii-Pacifik: Noddu 112 to Inndo, 119 to Japon e Koree worgo, walla 995 to Singapuur. Ɗo C1-INH walla icatibant ndarnaaka, humpit cafroowo oo ko fayti e Asid Traneksamik nder ƴiiƴam (\(1\tekst{ g}\) IV) e Plasma ɓuuɓɗo keso (\(2\tekst{ unités}\) IV) porotokolle hisnude.

Ƴeew limooje caɗtuɗe ngam denndaangal limooje neldugol hakkunde leyɗeele.

Naamne keewɗe naamneede¶

Hol ko waɗi lisinopril walla ramipril ina waawi saabaade ɓuuɓri ɗemngal ɗoon e ɗoon caggal nde ƴettu-mi ɗum e jam fotde duuɓi joy ?¶

Anjiyoedema gonɗo e ACE-inhibiteur wonaa alerji immuno classique ; ko batte biyokimikaaji baɗɗe haɗde enzim ACE bonnoowo bradikinin. Aɗa waawi ƴettude lisinopril, enalapril, walla ramipril duuɓi keewɗi tawa enzimuuji baɗɗiiɗi ɗii ina pamɗi no feewi e ustude bradykinin, haa nde ɓuuɓri ɗiɗmiri tokosiri ko wayi no ɓuuɓri viral, golle dental, ɓuuɓri ɓuuɓri, walla ɓeydude ñawu jabet walla lekki ɓuuɓki ina ɓuuɓna ɗiin enzimuuji baɗɗiiɗi ɗii, ina addana ɗum en ɓuuɓri ɓuuɓndi.

Mbele miɗo foti huutoraade EpiPen haa jooni so tawii ɗemngal neɗɗo ina ɓuuɓna, mi anndaa so tawii ko alerji walla ko ACE inhibitor?¶

Eey, so tawii sabaabu ɓuuɓri ɗemngal walla daande anndaaka walla ina waawi wonde alerji, waɗ heen epinefriin nder ɓalndu e nder ɓalndu yaajndu, ɗoon e ɗoon caggal nde noddu-ɗaa 911, 112, walla 999. So tawii epinefriin haɗataa ɓuuɓri Angibikinin laaɓndi in, walla ACEibio Her hisnude nguurndam so tawii ɓuuɓri ndii ko anafilaksi mast-cell, kadi aɗa foti nawde haa jooni to suudu safrirdu ɗoon e ɗoon.

Mbele miɗo waawi waylude lisinopril mi waɗta ACE goɗɗo hono enalapril walla ramipril caggal nde mi heɓi ɓuuɓri leppi walla ɗemngal?¶

Alaa, a fotaani ƴettude hay lekki gooto e nder kalaas ACE-inhibitor haa abada. Sabu denndaangal leɗɗe joofɗe e "-pril" ina kaɗa enzim gooto tigi rigi (kininase II / ACE), waylude lisinopril feewde e enalapril walla ramipril ina addana neɗɗo baasal mawngal, sibu ina waawi saabaade mboros bonɗo ; cafroowo maa ina foti waylude ma e mbaydi leɗɗe ceertuɗe ko wayi no ɓuuɓri kalsiyum walla ƴeewtaade no moƴƴi ɓuuɓri ɓuuɓri anjiyotensin (ARB).

Hol no safrooɓe ƴeewtirta Hereditary Angioedema so tawii leppi am, ɗemngal am, walla reedu am ina keddii e ɓuuɓde tawa alaa ko ɓuuɓnata ?¶

Immunologist ina yamira ƴeewndorɗe ƴiiƴam tati keertiiɗe : **toɓɓere C4 timmunde** (toɓɓere ƴeewndo ɓurnde moƴƴude, ina famɗi e ko ɓuri 95 e nder teemedere ñawɓe HAE Tipe I e II), **toɓɓere poroteyiin antigenik C1-esterase (C1-INH)**, e **toɓɓere C1-esterase a**al a.C1-1 level** ngam ƴeewde so tawii ko anjiyoedema keɓaaɗo e mawɓe mawɓe). Piɗtaali ɓalndu walla panneeji IgE ɗi alerji ruttii ɗii mbaawaa yiytude HAE.

Hol ko waɗi ɓuuɓri ɗemngal ACE-inhibitor keewndi fuɗɗotoo ko e hakkunde jamma walla subaka law ?¶

Lelnude ina ɓeyda ɓuuɓri ƴiiƴam e nder hoore e wuddu, tawi noon kortisol jamma ina ustoo hakkunde hakkunde jamma e 4w00h e ɓuuɓri ɓuuɓndi e nder ɓalndu softundu e ɗemngal ummoraade e ɓuuɓri ina yaawi ɓuuɓde ndiyam bradykinin nokkuyankeewal e nder submukosa hunduko loowɗo.

Hol ko woni sahaa cellal so tawii ACE-inhibitor walla HAE ɓuuɓri ɗemngal yettiima e opitaal ?¶

So tawii leɗɗe kisnooje bradykinin ngalaa, ɓuuɓri ACE-inhibitor walla HAE ina ɓeydoo bonde fotde waktuuji 12 haa 24, ina ƴetta waktuuji 48 haa 72 ngam safrude ɗum, ko ɗum waɗi ñawɓe ɓuuɓɓe ina keewi heddaade e ventilateur e nder ICU fotde balɗe 2 haa 4 haa nde ƴeewndo cuff-leak larynx ina hollita. So icatibant les ɓalndu walla C1-INH e nder ƴiiƴam rokkaama ko yaawi, yahrude yeeso ina dartoo e nder hojomaaji 30, ɓuuɓri ndii ina safra e nder waktuuji 4 haa 12.

Ardiiɓe jokkondirɓe¶

• Alerji e anafilaksi
• Epiglottitis, kuroopu, stridor, e ɓuuɓri gonndi e laawol henndu toowngol
• Ɓuuɓri peritonsil, angina Ludwig, e ɓuuɓri wuddu luggiɗndi
• Ballal gadanal ɓuuɓngal e ɓuuɓgol laawol henndu

Fuɗɗoode e ardorde laawɗunde¶

• Fedde winndereere toppitiinde ko fayti e alerji (WAO) e Akademi Oropnaajo ko faati e alerji e cellal ɓalli (EAACI): Kuulal hakkunde leyɗeele WAO/EAACI ngam haɓaade ñawu nguu (Maurer et al., Allergie 2022; sosde C njuɓɓudiiji ko adii nde njuɓɓudi ndii waɗata).
• Akademi Ameriknaajo ko faati e safaara ɓuuɓɗo (AAEM) e Koldaa Ameriknaajo ko faati e safaara ɓuuɓɗo (ACEP, leyɗeele dentuɗe Amerik): *Bayyinaango e kuule nanondiral e ƴeewndo e njuɓɓudi ñawu nguu (Angioedema) gonɗo e ɓuuɓri (Departement fuIshoging of Emergency, Department of Emergency), **Bayyinaango e golle safaara e nanondiral antihistamiin/steroid, e porotokolle ɓuuɓɗe fiber optik ɓuuɓɗe).
• Fedde Amerik toppitiinde ko fayti e ñawu nguu (US HAEA) Goomu toppitiingu safaara: Kuule 2020 ngam haɓaade ñawu nguu (Busse et al., Jaaynde Allergie e Immunologie Clinique: E nder golle).
• Fedde Ameriknaare Ɓernde (AHA) e Fedde Ameriknaare Ɓoornugol (ASA, Amerik): Laabi ngam ƴellitde ñawɓe stroke iskemiik ɓuuɓɗo (njuɓɓudi gonndi e anjiyoedema bradikinin orolingual ɓuuɓɗo mo altebiplase/tenecteplase ACE nder ƴiiƴam addata e ñawɗo).
• Fedde Angalteer ngam Allergie e Immunologie Clinique (BSACI, Royaume-Uni) e Fedde Resuscitation UK: Laabi ngam ƴellitde ŋakkeende C1-Inhibitor e Angioedema ɓuuɓɗo e nder weeyo toowngo.