Sepsis e septik shock : ñawu nguu ina waawi warde nguurndam¶

Sepsis ko jaabawol ɓanndu ɓurngol heewde, ina waawi warde neɗɗo so tawii ina wondi e ñawu. Ina waɗa so tawii ñawu nokkuyankeewu ngu njogi-ɗaa jooni nguu (ko wayi no ɓuuɓri ƴiiƴam, ñawu nguu e nder reedu, ɓuuɓri ɓalndu, ɓuuɓri dental, walla ñawu reedu) ina addana ƴiiƴam maa fof e nder reedu maa, ɓuuɓri ndi alaa ɗo haaɗi.

So wonaa tan bakteriiji, mborosaaji, walla mborosaaji gonɗi e nder ɓalndu maa, reenngo maa fuɗɗotoo ko bonnude ƴiiƴam maa, ƴiye maa, e terɗe maa mawɗe. So sepsis safraaka, ina yahra e waktuuji seeɗa haa wonta ɓuuɓri septik, ɓuuɓri ƴiiƴam yaajndi e mikroskoop, ŋakkeende terɗe keewɗe, e maayde. Sepsis ko ñawu nguu woni goonga e safaara, ina ɗaɓɓi jaawgol e yaawre no feewi no ñawu ɓernde walla mboros mboros nii.

Waɗde ɗum jooni¶

1. Noddu limngal emergency nokku maa ɗoon e ɗoon. Noddu 911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 to Dental Orop, 999 to leydi Angalteer, walla 000 to Ostarali (ƴeew fof limooje caɗtuɗe).
2. Wi'u konngol "sepsis" ngol e diisneteeɗo e safrooɓe. Haala laaɓndal: "Miɗo sikki sepsis." Huutoraade oon helmere laaɓtunde ina addana porotokolle jaawɗe ƴeewndo sepsis hade safrirde, ƴeewndo laktat to nokku toppitiiɗo, e humpito suudu safrirdu ɓurndu teeŋtude.
3. Ƴeewto maandeeji jeertinaango TIME e ƴeewndorɗe ɓanndu. Ƴeewto Tɓurgol nguleeki (feccere dow 38,3 degere Celsius / 101 degere Celsius walla hipotermi les 36,0 degere Celsius / 96,8 degere Celsius),maandeeentalM Fahrenheit (jiiɓru kesu, delirium, walla caɗeele ummital), e Extreme (ɓurtugol fooftere, ɓuuɓri dimmbotoondi, walla ɓalndu ɓuuɓndu, ɓuuɓndu).
4. Position neɗɗo oo ngam wallitde ƴiiƴam e foofde. So tawii o nanii ɓuuɓri, ɓuuɓri ƴiiƴam, walla ɓuuɓri ƴiiƴam, lelnu ɗum e dow ɓalewol mbele ƴiiƴam ina waawa yettaade ngaandi ; so tawii eɓe njogii ɓuuɓri tiiɗndi walla eɓe njiɗi foofde tawa ɓe ngoni ko e ɓuuɓde, ɓe mbaɗta hoore maɓɓe e koyɗe maɓɓe e dow 30 haa 45 degere.
5. Waɗde ɗe ɓuuɓɗe tawa ɗe ɓuuɓnaaki. Suuɗde neɗɗo mo ɓuuɓri diƴƴe (rigors) ɓuuɓnata, kono woto paccu ɗe e nder laabi teeŋtuɗi walla waɗde heen looɗe ice, ɗe ɓeydata baasal metabolism.
6. Hoto ndokku hay huunde e hunuko, peewnu doggol leɗɗe. Woto ndokku ñaamdu, ndiyam, walla ustooje nguleeki e hunuko, sabu sepsis ina heewi saabaade ɓuuɓri e ustude hakkille addanoowo ɓuuɓri ƴiiƴam. Moftu leɗɗe jooni ɗee kala, kaayitaaji cakkitiiɗi ɗii, e sahaa tigi-rigi mo maale puɗɗii ngam safrooɓe arooɓe.

Triage sepsis emergency e doggol anndinde¶

flowchart TD
    Start["Infection tuumaaɗo walla tabitinaaɗo<br/>Pneumonie, UTI, ñawu, caggal jibinannde, walla ñawu viral"] --> Screen{"Ƴeewto Banndiraawo Boɗeejo Maale:<br/>Jiiɓru, fooftere yaawnde (>22/min),<br/>diƴƴe mawɗe, ɓalndu ɓuuɓndu, walla alaa ƴiiƴam?"}

    Screen -->|Yes, 1 or more present| Call911["Noddu Neldoowo Jaɓɓungal Ɗoon e ɗoon<br/>911 Amerik/Kanada, 112 UE, 999 Angalteer<br/>Hollu laaɓndal: ‘Miɗo sikki sepsis’."]
    Screen -->|No red flags yet| AgeCheck{"Mbele ñawɗo oo ko cukalel (<1 hitaande), reedu/caggal jibinannde,<br/>mawɗo (>65 hitaande), walla ko e kimoterapi ?"}

    AgeCheck -->|Yes, high-risk group| UrgentEval["Yiylo ƴeewndo safaara jaawɗo ñalnde wootere<br/>Nyawɓe wonduɓe e rafiiji keewɗi ina keewi waasde nguleeki<br/>Ƴeewto ngonka hakkille e fooftere waktu kala"]
    AgeCheck -->|No| Monitor["Hokku Infection Local no yamiraa<br/>Ƴeewto nguleeki e ndiyam kala waktuuji 4<br/>Ƴeewto ɗoon e ɗoon so tawii maale ɗee ɓeydiima bonde"]

    Call911 --> FirstAid["Stabilisaasiyoŋ hade safrirde<br/>Waɗde ñawɗo ina lelna walla ina semi ngam foofde<br/>Hoto rokku hay huunde e hunuko ; peewnugol doggol leɗɗe"]
    FirstAid --> HospitalBundle["Waktu Hospitaal-1 Sepsis Bundle<br/>Laktat ƴiiƴam e pinal ƴiiƴam<br/>Antibiyotik IV ɗoon e ɗoon e ndiyam IV"]

Patofisiyoloji : hol no ñawu nokkuyankeewu wontiri septik¶

Kippuuji safrooɓe ina njiyloo yahrude yeeso ñawu nguu e nder daawal fijirde ceertungal nde cirkulaasiyoŋ mikroo-vaskulaar oo ustata :

1. Infeksiyoŋ nokkuyankeewo¶

Ko wayi no bakteriiji (Escherichia coli, Stafilokokus, Streptokokus pneumoniae), mborosaaji (grippe, SARS-CoV-2), walla funeeɓe ina keewi e nokku keeriiɗo e nder ɓanndu. Ɓuri heewde fuɗɗoraade ko ɓuuɓri (pneumonie, ko ina wona feccere e sepsis fof), ɓuuɓri e ƴiye, ɓuuɓri ɓalndu (appendisit, divertikulitis, ɓuuɓri ƴiiƴam), e ɓalndu walla ƴiye softeende (cellulitis, pressure walla insurgical).

2. Sepsis sistemik e ɓuuɓri endoteliyal¶

So tooke mikroobiyoŋ e mbaydiiji molekulaaji jokkondirɗi e pathogen naatii e ƴiiƴam, reenngo ɓalndu ina yaltina ɓuuɓri mawndi, ndi wiyetee ko sitokineeji. Ndeeɗoo ɓuuɓri sitokine, e nokku ɗo heddotoo ɗoo, ina haɓa e endoteliyom (ɓurɗo ɓuuɓde e nder ɓalndu nduu fof). Ɓowɗi ƴiiƴam ina mbaɗta ɓuuɓde no feewi, ina addana ndiyam nder ƴiiƴam ɗam yaltude e nder ƴiiƴam ɗam, tawi noon oksidaa nitrik ina addana ƴiiƴam ɗam ɓuuɓde (vasodilatation systémique) ina ustoo ƴiiƴam ɗam.

3. Ɓoornugol mikroo-vaskulaar e ŋakkeende golle terɗe¶

E oon sahaa gooto, kaskaade ɓuuɓɗo oo ina softina ƴiiƴam ɗam, ina waɗa ujunnaaje ujunnaaje ɓuuɓri fibriin mikroskoop e nder leɗɗe kapilaar tokoose (ko ɗum huunde waawnde ɓeydaade haa wonta Disseminated Intravascular Coagulation, walla DIC). Ɗeeɗoo ɓuuɓɗe ina kaɗa ƴiiƴam keewɗam oksijen yettaade terɗe, ina ñaama kadi ƴiiƴam ɓalndu e geɗe ɓuuɓɗe haa ƴiiƴam ɗam yalta e hoore mum e ɓuuɓri ɓalndu (purpura) feeña :

• Fuuɗal : Ɓuuɓri kapilaar ina ɓuuɓna saakuuji henndu pulmonaari (alveoli) e ndiyam keewɗam poroteyiin, ina addana ɗum ɓuuɓri ɓuuɓri (ARDS) e ɓuuɓri ƴiiƴam (hypoxemie) tiiɗndi.
• Ɓoornugol : Ɓoornugol ƴiiƴam ina addana ƴiiƴam ɓuuɓɗam (AKI), haɗde peewnugol ƴiiƴam (oliguria walla anuria) e accude uree e potaasiyom ina moofta e nder ƴiiƴam.
• Ngaandi : Ensefalopati septik ina bonna ƴiiƴam ngaandi e laaɓal ƴiiƴam-ngaandi, ina hollira no delirium akut, agitaasiyoŋ, haala ɓuuɓka, walla komaa.
• Ɓernde e heege : Ɓooygol miokardi ina usta yaltugol ɓernde, tawi noon ŋakkeende ɓuuɓri ina ɓeyda bilirubin, ina haɗa njuɓɓudi suukara no haanirta nii.

4. Sokkere septik¶

Ko septik woni faɗo ɓurngo warde e sepsis. Ko ɗum siforaa e safaara ko sepsis wonduɗo e ŋakkeende ƴiiƴam e mbayliigu cellal luggiɗngu, ɗo ƴiiƴam sistolik heddotoo ko ina famɗi no feewi (les 90 mmHg, walla ƴiiƴam gonɗam les 65 mmHg) hay so tawii noon ƴiiƴam ɗam ina ɓuuɓna ƴiiƴam ɗam, tawa ina ɓuuɓna ƴiiƴam ɗam mmol/L. E ooɗoo sahaa, ƴiye ɓalndu nattii waawde yaltinde walla huutoraade oksijen (hypoxie cytopathique), ɗum noon ina addana ɓalndu nduu ɓuuɓde e yaawde.

Yerondirde e infection localisée e sepsis systémique¶

Huutoro ndeeɗoo alluwal ƴeewndo safaara ngam seerndude jaabawol nguleeki kiiɗki e emergency sepsis baawɗo warde nguurndam.

Anndude sepsis atypique e nder duuɓi ɓurɗi heewde baasal¶

Ina jeyaa e ko ɓuri bonde e sepsis, wonde yimɓe waasɓe ina keewi hollirde nguleeki toowki kiiɗɗi. Fadde termometre ngam janngude toownde e cukalel, mawɗo, walla ñawɗo kanseer ina waawi bonnude nguurndam mum en.

Sepsis jibinannde e sukaaɓe (cukalon e sukaaɓe)¶

Cukalel ngel duuɓi mum njahrata e lebbi 12 (haa teeŋti noon e sukaaɓe jibinaaɓe e balɗe 28 gadane nguurndam) ina njogii reenngo ɓalndu ngo alaa ko waawi, ina addana ñawuuji bakteriiji nokkuuji (ko wayi no Streptococcus Groupe B, E. coli, walla caɗeele mboros sinsitiyal fooftere) naatde e ƴiiƴam e meningeeji e yaawre. Ɗaɓɓu ballal ko yaawi so tawii cukalel walla cukalel hollitii:

• Reglementaasiyoŋ nguleeki mo aldaa e sago: Nguleeki reedu 38,0 degere Celsius (100,4 degere Fahrenheit) walla ko ɓuri ɗum e kala cukalel ngel duuɓi mum njahrata e lebbi 3, ko huunde nde alaa ɗo haaɗi, ko wayi no nguleeki ɓanndu tawa ina yahra e duuɓi 36,0 degere Celsius6.
• Lethargie et alteré ton: Cukalel ngel ɓuuɓri, ngel ŋoŋɗi, ngel saɗti umminde ngam ñamminde, walla ngel salii ñamri ɗiɗi jokkondirɗi.
• Bojji toowɗi walla leelɗi: Bojji toowɗi jokkondirɗi, ɗi mbelnaaki walla bojji leelɗi, ɓuuɓɗi, ɗi nanndaani no feewi e bojji no woorunoo.
• Caɗeele fooftere : ɓuuɓri nofru, ɓuuɓri gonndi e kala fooftere, ɓuuɓri ɓalndu (kosam ina suuɗa no feewi e saraaji ƴiye e ɓalndu), walla ɓuuɓri fooftere (apnea) duumotooɗo ko ɓuri leƴƴanɗe 15.
• Maandeeji perfusion e fontanelle: Laral ɓalewal, ɓuuɓngal, walla ɓuuɓngal e saraaji leppi, juuɗe e koyɗe cooyɗe hay so suudu ngulndu, nokku ɓuuɓɗo walla ɓuuɓɗo (fontanelle) dow hoore, walla ɓuuɓri ɓuuɓndi ndi ɓuuɓnataa e ɓalndu laaɓndu so a toɓɓii glass.

Sepsis yumma e caggal jibineede (reedu e haa jonte 6 caggal jibineede)¶

Reedu e jibinannde ina mbayla jaabawol immuniteer, ina sosa laabi anatomiiji ngam heɓde ñawu nguu caggal jibineede e nder reedu, walla e sesaare, e ɓuuɓri, walla e amniosentesis. Waylooji fijirde no woorunoo e nder reedu (ɓernde ɓurnde yaawde e fooftere ɓurnde yaawde) ina keewi suuɗde maale sepsis gadane. Yeewtu no feewi e nder reedu e balɗe 42 caggal jibineede ngam:

• Nafoore les reedu, pelɓi, walla reedu e ɓuuɓri wondude e ɓuuɓri ƴiiƴam (lochia).
• Boɗewol, ɓuuɓri, ɓuuɓri, walla seerndude geɗe e dow taƴre sesare walla gonɗi perineal.
• Boɗewol ɓalndu tiiɗngol e ɓuuɓri ɓalndu nanndundi e grippe (mastitis) ɓeydotoo ɗoon e ɗoon e jiiɓru, ɓuuɓri, walla fooftere yaawnde.
• Hipotermiya ɗoon e ɗoon, takikardiya duumotooɗo ko ɓuri 100 fiyngo e nder hojomaaji, walla ɓuuɓri gonndi e ɓalndu (ko ɗum huunde maantiniinde e fuɗɗoode sepsis puerperal streptococcal groupe A).

Mawɓe mawɓe (hollirde delirium afebrile atypique)¶

Mawɓe yahrooɓe e duuɓi 65 e ko ɓuri ɗum ina mbaɗa ko ɓuri 60 e nder teemedere e denndaangal ñawɓe sepsis, kono haa 30 haa 40 e nder teemedere ñawɓe sepsis mawɓe meeɗaani dañde nguleeki. E nokku ɗo nguleeki toowki woni ɗoo, reenngo ɓalndu duumotooɗo ina heewi jaabaade e hipotermi walla nguleeki no woorunoo e sara ustaare neurobiyoloji e golle :

• Delirium acute e confusion : Mawɗo mo ñawu nguu anndaaka walla mo mboros oo yani e mum, ina waawi waasde anndude terɗe galle mum, ina waawi kadi waasde anndude terɗe galle mum, ina waawi kadi wontude ɓuuɓɗo mo alaa sifaa, ina wonta ɓuuɓɗo, walla ina wonta neɗɗo mo haalataa e nder waktuuji seeɗa.
• Doggol ngol faamnaaka e waasde diwde ɗoon e ɗoon : Waasde waawde yaltude e jappeere, ŋakkere reedu hesere, walla doggol ngol faamnaaka e dow leydi, ina heewi wonde maande adannde yiyteende e sepsis e nder mawɗo mo alaa semmbe.

Ñawɓe ɓe cellal mum en ŋakki e sepsis neutropenic¶

Ñawɓe keɓooɓe kemiterapi sitotoksiik ngam kanseer, keɓooɓe mbayliigu terɗe ƴettuɓe immunosuppresseurs, e yimɓe ƴettuɓe biyoloji walla kortikosteroid toowɗo, ina ŋakki no feewi ƴiiƴam ɓalejam (neutrophiles).

• Sepsis neutropenic ko ɓuuɓri minitaaji minit : E nder ñawɗo kemikal, jaŋtol nguleeki hunduko gootol ko 38,3 degere Celsius (101 degere Fahrenheit), walla nguleeki 38,0 degere Celsius (100,4 degere Celsius) sutaineing shi so alaa nguleeki ina ɗaɓɓi yahde to suudu safrirdu ngam heɓde antibiotik e nder ƴiiƴam ko yaawi e nder hojomaaji 60 (target "damal-to-needle").
• Hoto meeɗ rokkude parasetamol (asetaminofen) walla ibuprofen ngam maskude nguleeki e ñawɗo kemikal hade maa noddude liggey maɓɓe onkoloji walla yahde safrirde.

Ko waɗata e safrirde ndee : Bunde Sepsis Hour-1¶

So a arii e departemaa urgence, a wiyii aɗa sikki sepsis, safrooɓe ina kuutoroo kuutorɗe ƴeewndo jaawɗe ko wayi no qSOFA (Ƴeewndo jaawngo : tolno foofaango 22 walla ko ɓuri ɗum, mentaasiyoŋ wayliima, e tansiyoŋ sistolik 100 mmHg e War**AR2 UK) e huutoraade kampaañ sepsis wuurɗo waktu-1 Bundle:

• Pooɗondiral laktat serum : Ƴiiƴam jaawɗam ina fotnoo asid laktik mo ƴiye gonɗe e heege oksijen peewnata ; toɓɓe ɓurɗe 2 mmol/L ina kollita ŋakkere ƴiiƴam, toɓɓe ɓurɗe 4 mmol/L ina kollita soklaaji mawɗi.
• Pine ƴiiƴam hade antibiotik : Pine ƴiiƴam ɗiɗi (aerobik e anaerobik) e saraaji ƴiiƴam, ƴiiƴam, walla pine gaañiiɓe ina ƴettee ɗoon e ɗoon ngam laboratuwaaruuji mbaawa anndude ñawu nguu tigi rigi e sensitivite mum antibiotik tawa leeltaani safrude.
• Antibiyotikuuji gonɗi e nder ƴiiƴam ɗi mbaydi mum en yaajndi : Antibiyotikuuji IV baawɗi huutoreede ina mbaɗee e nder hojomaaji 60 gadani ɗii ngam haɗde bakteriiji ɗii ƴellitaade ɗoon e ɗoon.
• Uurtinde ndiyam kiristaloid jaawɗam : So tawii ko hipotension walla laktat 4 mmol/L walla ko ɓuri ɗum, infirmiyee en ina mbaɗa 30 mililiter e nder kiloo gooto e teddeendi ɓanndu, ɓuuɓri kiristaloid ballitoori (hono Lactated Ringer’s walla saline normal) e nder waktuuji 3 gadani ɗii.
• Ballal vasopressor e ƴeewndo iwdi : So tawii tansiyoŋ ina heddii e les tolno 65 mmHg hay so tawii ko ndiyam, ekipaaji toppitiiɗi cellal ina puɗɗoo waɗde infuseeji norepinefriin jokkondirɗi e yuɓɓinde seppooji jaawɗi ngam kala abscess, kaaƴe ƴiiƴam gonɗe e ñawu nguu, walla ƴiiƴam nekrotik.

Sellinde e ñawu caggal sepsis (PSS)¶

Wuurde e sepsis ko fuɗɗoode laawol juutngol ngam moƴƴinde nguurndam. Haa e 50 e nder teemedere e daɗɓe e sepsis ina keɓa Post-Sepsis Syndrome (PSS), ko jiidaa e batte juutɗe e ɓanndu, e hakkille, e hakkille, baawɗe duumaade lebbi walla duuɓi caggal nde ɓe njalti safrirde :

• Caɗeele ɓalli : Lowre luggiɗnde e bonnugol nerf (loomre keɓtinaande e ICU walla polineuropati ñawu nguu), ɓuuɓri jokkondire duumiindi, ɓuuɓri fooftere, ɓuuɓri ƴiye, ɓuuɓri ƴiye, e ɓuuɓri ƴiiƴam walla ɓernde duumotoonde.
• Batte hakkille e miijooji : ŋakkeende ciftorgol, caɗeele hakkille ("foggo ngaandi"), ŋakkeende ɗoyngol, koyɗi jamma, ŋakkeende muñal e nder safaara, e ŋakkeende muñal caggal mboros (PTSD) baɗngal delirium e jokkude e safrirde toownde.
• Ɓeydagol baasal rewrude e ñawu nguu : Reenngo ɓalndu ina heddii e ŋakkere golle fotde lebbi caggal sepsis bonɗo, ɗum firti ko wuurɓe ina njogii baasal mawngal e naatde e safrirde ngam ñawu nguu ɗiɗaɓuru. Yenaneede wuurɓe ɓee ina keɓa ñawbuuli pneumocoque, grippe, e COVID-19 so cafroowo mum en laaɓtinii ɗum en, kadi safrude kala taƴre hesere walla maande urine ko yaawi.

Naamne keewɗe naamneede¶

Fuɗɗoode ƴeewtaama¶

• Kampaañ sepsis wuurɗo (Fedde safaara ɓuuɓɗo e Fedde Oropnaare safaara ɓuuɓɗo): Laabi hakkunde leyɗeele ngam haɓaade sepsis e septik shock.
• Fedde Adunaare Cellal (OMS) : Ciimtol winnderewol ko faati e ñawuuji e teddeendi sepsis.
• Nokkuuji Amerik ngam haɓaade ñawuuji e haɓaade ɗum en (CDC): Ko fayti e sepsis e heɓde yeeso e laabi safaara sepsis.
• Duɗal ngenndiwal cellal e toppitagol (NICE) to Angalteer : Sepsis tuumaaɗo : Anndinde, ƴeewtaade e ƴellitde ɗum ko yaawi (NG51) e Kuutorɗe safaara UK Sepsis Trust.
• Fedde Sepsis (Leyɗeele dentuɗe Amerik): Protokol anndinde TIME sepsis e ardorde mboros caggal sepsis.

Ardiiɓe jokkondirɓe¶

• Anndude e safrude soklaaji safaara
• Alerji tiiɗɗi e anafilaksi
• Gaañiiɓe, taƴe, e ɓuuɓri
• Dental ɓuuɓngal e ɓuuɓri dental
• Reggindo limooje emergency