ʻO ka Laryngospasm a me ka Hoʻopau ʻana i ke kaula leo (Inducible Laryngeal Obstruction): Inspiratory Stridor, Larson's Jaw-Thrust Maneuver, and the Panting Sniff Reset¶

ʻO ka hiki ʻole, weliweli ke huki ʻana i ka ea ma mua o ka ʻāʻī, hiki ke loaʻa mai ʻelua mau pilikia pili i ka hana o nā kaula leo: acute reflex laryngospasm (kahi hoʻopaʻapaʻa ikaika, makemake ʻole, piha a kokoke paha i ka pani ʻana o nā kaula leo ʻoiaʻiʻo a me ka wahaheʻe i hoʻopili ʻia e ke aʻalolo laryngeal kiʻekiʻe) a me ka vocal cord classified dysfunction i kēia manawa. inducible laryngeal obstruction (ILO) (ka hoʻokomo ʻana o nā kaula leo i ka laina waena i ka wā o ka hoʻohu ʻana ma mua o ka wehe ākea ʻana e like me ka mea maʻamau). ʻOiai ʻo complete laryngospasm he anesthetic weliweli i ke ola, post-extubation, drowning, or acid-reflux airway emergency e hiki ai ke hoʻoulu i ka hypoxia, bradycardia, a i ʻole ka edema pulmonary pressure negative i loko o 60 a i ka 120 kekona inā ʻaʻole nahā kino, ** ala ka laryngeal benign / obstruction ponoʻī) hoʻoulu ʻia e ka hoʻoikaika ikaika, reflux acid, ea anuanu, ʻala kemika ikaika, hoʻoheheʻe ma hope o ka ihu, a i ʻole koʻikoʻi koʻikoʻi i kuhi hewa pinepine ʻia ʻo ke ʻano he maʻi asthmaticus a i ʻole anaphylaxis. Ma muli o ka hōʻemi ʻana o nā kūlana ʻelua i ka ʻāʻī glottic ma ke kiʻekiʻe o ka larynx ma ka ʻāʻī, hoʻopuka lākou i ka leo nui, leo kiʻekiʻe, mele a i ʻole ke kani ʻana ** i ka hanu ʻana i loko (inspiratory stridor)** me ke kuhikuhi pololei ʻana o ka mea maʻi i ko lākou ʻāʻī, ʻokoʻa me ka bronchial asthma, ka mea e hōʻemi ai i nā ala ea haʻahaʻa i loko o ka umauma a hoʻopuʻu i ka hanu (WOOW) uwē)**. Inā loaʻa kekahi kanaka i ka stridor hikiwawe, ʻaʻole hiki ke ʻōlelo a hanu paha, hōʻike i nā lehelehe polū (cyanosis), pehu ka ʻāʻī a i ʻole ke alelo, a nalowale ka ʻike, e kelepona i kou wahi. helu pilikia koke (911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ʻEulopa, 999 ma United Kingdom). E nānā pū i kā mākou hoa alakaʻi ma hānō, epiglottitis, croup, a me stridor, a nā hopena maʻi a me anaphylaxis.

ʻO kāu hana mua, ʻo ia ka nānā ʻana i nā hōʻailona hae ʻulaʻula o ke keakea ʻana o ke ea maoli a i ʻole anaphylactic (ke ʻoki ʻana o ke kino haole, ka lehelehe a me ke alelo angioedema, drooling, a i ʻole ke emi ʻana o ka ʻike), e hoʻopili i klzzwxh:0006 ʻO ka laryngospasm ka mea maʻi i pane ʻole a ma hopo ka hoʻomaha ʻana, a e aʻo i ka mea maʻi e ala ana ma o ka Double Nasal Sniff and Pursed-Lip Exhale (a i ʻole Panting Reset) no ka hoʻoheheʻe ʻana (wehe) i nā kaula leo i loko o kekona.

E hana i kēia i kēia manawa¶

1. E nānā koke i nā hae ʻulaʻula weliweli a kāhea aku i kāu helu ulia pōpilikia inā loaʻa. Kāhea iā 911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom, 000 ma Australia, a i ʻole e nānā i kā mākou papa kuhikuhi honua o helu pilikia inā ʻo kēia ka manawa mua o ke kanaka o ka stridor, inā e ʻai ana lākou ma mua o ka hoʻomaka ʻana (ʻāʻī), inā loaʻa iā lākou nā hives a i ʻole nā lehelehe pehu a i ʻole ke alelo (nā maʻi maʻi), inā loaʻa iā lākou ke kuni a me ka drooling (epiglottitis), a i ʻole inā ʻulaʻula ko lākou mau lehelehe a huikau paha a pane ʻole paha.
2. **Inā loaʻa i kahi kanaka Ala ʻAha ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi ʻAi Ma hope o ka Cough Paroxysmal Laryngospasm: E noho pololei iā lākou me ka hāʻule ʻana o nā poʻohiwi i mua a hoʻopaʻa iā lākou mai ka hanu ʻana ma ka waha hāmama. hoʻomaloʻo i ka mucosa laryngeal.
3. E aʻo i ka "Double Nasal Sniff + Long Pursed-Lip Exhale" (EILOBI / Respiratory Retraining Reset):
4. ** KaʻAnuʻu A (Exhale Mua):** E ʻōlelo i ke kanaka e puhi mālie i ke ea i koe ma o ka ** lehelehe i ʻokiʻoki ʻia** (me he mea lā e puhi ana i ka mea hoʻoheheʻe kofe ololi a i ʻole e ʻā ana i ka lapalapa kukui me ka puhi ʻole ʻana) no 3 a 4 kekona. ʻO ka hanu ʻana i waho i nā lehelehe i ʻoki ʻia e hoʻokumu i ka 5 a 10 cmH2O o ka paʻi hope (intrinsic PEEP) e hoʻokaʻawale i nā kaula leo.
5. Step B (The Nasal Sniff): E pani i ko lākou waha, e hoʻomaha i ko lākou ʻāʻī a me ka ʻāʻī, a lawe ** ʻelua honi wikiwiki a mālie i loko o ka ihu** (me he mea lā e honi ana i ka pua). ʻO ka honi ʻana ma ka ihu e hoʻāla ai i ka manaʻo o ka lolo ma o ka ** hope cricoarytenoid muscle** (ka ʻiʻo abductor hoʻokahi o ka larynx) e hoʻokae ākea ai nā kaula leo.
6. Step C (The Panting / Straw Breath Alternative): Inā ʻeha ko lākou ihu, e hoʻohālua iā lākou ** e like me ka ʻīlio** me ka hoʻomaha ʻana o ko lākou alelo ma ka papahele o ka waha, a i ʻole ka hanu mālie ʻana ma kahi puka haiki ma waena o nā lehelehe ʻeke me ka hoʻonui ʻana i ko lākou ʻōpū (ka hanu diaphragmatic).
7. Inā Paʻi ʻo Silent Laryngospasm (Zero Airflow Me ka Haʻalulu ʻana o ka Puʻu, a i ʻole Post-Anesthesia / Post-Reflux / Drowning Spasm): E hoʻokō koke i ka MANEUVER a LARSON.
8. E huli i ka Larson's point ( "laryngospasm notch") ma nā ʻaoʻao ʻelua o ke poʻo.
9. E kau i ka piko o kou manawaena a i ʻole nā ​​manamana lima kuhikuhi i loko o nā ʻīpuka ʻelua a pēhi i me ka ikaika i loko i ke kikowaena o ka iwi poʻo a i mua/i luna i ka ihu me ka hāpai ʻana i ka ʻāwae lalo i loko o ka kuhi āwae mua ikaika.
10. ʻO ka hana a Larson e hoʻopololei i nā ligament geniohyoid a me kourohyoid e huki i ka epiglottis a me nā kaula leo wahaheʻe i kaʻawale i ka wā e hoʻoulu ai i ke aʻalolo cranial ikaika e uhaʻi ai i ka vagal laryngospasm reflex arc i loko o 5 a 15 kekona.
11. Inā ua ʻike ke kanaka i ka hānō a me ka hoʻopau ʻana i ke kaula leo: E hoʻohana i kā lākou hoʻopakele salbutamol (albuterol) inhaler me kahi spacer inā maopopo ʻole, no ka mea, hiki i ka 30 a hiki i ka 50 pakeneka o nā mea maʻi VCD e noho pū ana i ka hānō. Eia naʻe, e hoʻomaopopo i ka beta-2 agonist inhalers a me ka epinephrine ** ʻaʻole pono e hoʻomaha i ka hanu maʻemaʻe ** i ka hanu maʻemaʻe. hana ʻia me ka hoʻohana ʻana i ka inhaler.
12. **E inu liʻiliʻi i ka wai wela o ka lumi (hoʻokahi wale nō hiki i ke kanaka ke huki i ka hanu mālie a ʻaʻole ʻo ia i ka ʻai) a i ʻole e kani i kahi leo haʻahaʻa ("Mmmmmm").

Laau hoʻoholo lāʻau lapaʻau: stridor hoʻoulu, VCD/ILO, a me ka laryngospasm piha¶

flowchart TD
    A["Hoʻomaka koke ka ʻāʻī o ka ʻāʻī, pilikia ka hanu ʻana i ka IN, a i ʻole ke kani ʻana o ka hoʻoulu ʻana."] --> B{"E nānā i ka ʻike, ka ea, a me nā hōʻailona anaphylaxis / kino ʻē"}
    B -->|Unconscious, cyanotic, silent chest with tracheal tug, or post-sedation/drowning| C["LARYNGOSPASM COMPLETE OR CHOKING: Kāhea iā EMS (911/112/999); hōʻoia ʻaʻohe kino ʻē; e hana koke i KA LARSON'S MANEUVER + Jaw Thrust + 100% O2 peaki maikaʻi (CPAP 10 a 20 cmH2O)"]
    B -->|Swollen lips/tongue, generalized hives, hypotension, or exposure to allergen| D["ANAPHYLAXIS A I ʻole ANGIOEDEMA: Hoʻokomo koke i ka Epinephrine Intramuscular (0.3 a i ka 0.5 mg) i ka ʻūhā waena o waho a kāhea iā EMS"]
    B -->|Fever, drooling, tripod posture, muffled hot-potato voice, or barking cough| E["EPIGLOTTITIS OR CROUP: E hoʻomau i ka hoʻomanawanui a me ka pololei; MAI nana i ka puu me ka puna; kelepona koke iā EMS"]
    B -->|Awake, alert, no hives/swelling, pointing to throat; loud inspiratory stridor triggered by exercise, cough, reflux, scent, or stress| F["ʻAi ʻia ka Laryngeal Obstruction (VCD / ILO) a i ʻole Awake Paroxysmal Laryngospasm"]
    F --> G["KaʻAnuʻu Hana 1: Noho pololei i mua iki; hāʻule nā ​​poʻohiwi; hoʻomaha i nā ʻiʻo a me ka ʻāʻī"]
    G --> H["KaʻAnuʻu Hana 2: Hoʻokuʻu lohi ma ka PURSED LIPS no 4 kekona (hana i ka paʻi hope maikaʻi e pana i nā kaula e wehe)"]
    H --> I["KaʻAnuʻu Hana 3: E lawe i 2 NASAL SNIFFS ma ka ihu (a i ʻole e ʻūlū e like me ka ʻīlio / hanu i ka mauʻu noʻonoʻo) me ka hoʻohana ʻana i ka hanu ʻōpū."]
    I --> J{"Ua hoʻoholo ʻia ka stridor a me ka ʻāʻī ʻāʻī i loko o 1 a 3 mau minuke?"}
    J -->|Yes (Typical VCD / Awake Laryngospasm resolution)| K["E inu mālie i ka wai; pale i nā mea hoʻoulu (reflux, ea anuanu, nā mea hoʻonāukiuki); hoʻonohonoho i ka laryngoscopy ma waho a me ka lāʻau ʻo Speech-Language Pathology (EILOBI)."]
    J -->|No: Stridor persists > 3 to 5 minutes, SpO2 drops below 92%, or severe distress| L["Kāhea iā EMS (911/112/999) no ka loiloi ʻana o ka 'Oihana Hoʻopilikia, nasolaryngoscopy maʻalahi, CPAP, a i ʻole Heliox (80:20 helium-oxygen)"]
    C --> M["Hoʻonui ʻia ka Halemaʻi / Anesthesia inā hāʻule ʻo Larson Maneuver + CPAP: IV Propofol (0.25 a i 0.8 mg/kg) a i ʻole IV Succinylcholine (0.1 a i 1.0 mg/kg) + intubation tracheal"]

Pathophysiology: Pehea e hana ai ka Larynx a me ke kumu i pani ai ke kaula leo¶

ʻO ka larynx kanaka (pahu leo) he ʻekolu hana koʻikoʻi koʻikoʻi: ** mālama i kahi ea hāmama no ka hanu ʻana , ** hoʻopuka i ka leo (phonation), a ** ma ke ʻano he puʻu sphincter pale e pale aku i ka meaʻai, ka wai, a me ka ʻōpū o ka ʻōpū mai ke komo ʻana i loko o ka māmā i ka wā e ʻai ai**.

ʻO ka neʻe ʻana o ka leo leo maʻamau vs Paradoxical Adduction (ILO) vs Complete Laryngospasm¶

1. Hū maʻamau:
2. I ka Inhalation (Breathing In): ʻO ke kikowaena hanu i loko o ka medulla oblongata ke ahi e hōʻailona ana i ke aʻalolo laryngeal hou e hoʻopaʻa i ka ** hope cricoarytenoid (PCA) muscle**, ka ʻiʻo wale nō i loko o ke kino holoʻokoʻa o ke kanaka e wehe (hopu) i nā kaula leo. ʻO nā kaula leo e koli ākea i kahi ʻano V ākea, e ʻae ana i ka lele ʻana o ka ea laminar i loko o ka trachea.
3. ** I ka wā o ka hoʻopuka ʻana (Hōʻana i waho):** Hoʻomaha iki nā kaula leo i ka laina waena (e hōʻemi ana i ka 10 a 30 pakeneka) no ka mālama ʻana i ke kaomi hoʻopau hopena maikaʻi.
4. Alai ʻia ka Laryngeal Inducible (Disfunction o VCD / VCD):
5. I nā poʻe maʻi me VCD / ILO (me ka Exercise-Induced Laryngeal Obstruction [EILO] i nā mea hoʻokūkū hoʻokūkū), ʻeha mau o ka laryngeal mucosa (mai ka laryngopharyngeal acid reflux, post-nasal drip, a i ʻole inhaled irritants) a i ʻole autonomic add-on hyper-reactivity ke kumu o ka muscle hyper-reactivity. thyroarytenoid, a me nā ʻiʻo interarytenoid**) e ʻoki ʻia ** me ka hoʻopaʻapaʻa i ka wā o ka inhalation** (a i ʻole e hoʻoheheʻe ʻia nā ʻāpana aryepiglottic ma luna o nā kaula i ka wā hoʻoikaika kino).
6. Ma kahi o ka wehe ʻana i ka V ākea i ka wā e hanu ai ke kanaka, ʻo ka mua ʻelua hapakolu o nā kaula leo e kuʻi pū i ka laina waena, e waiho wale ana i kahi ʻaoʻao liʻiliʻi ** hope o ke ʻano daimana ** ma ke kua o ka glottis kahi e puhi ai ka ea me kahi stridor hoʻoikaika kiʻekiʻe.
7. Laryngospasm Reflex Paʻa Loa:
8. Hoʻopili ʻia ma o ka lala i loko o ke aʻalolo laryngeal kiʻekiʻe (kahi lālā o ka Vagus Nerve, CN X), ʻo ka laryngospasm piha he mea hoʻonui i ka pale o ka lolo i hoʻolālā ʻia e mālama i ka wai a i ʻole ka luaʻi mai loko mai o ka māmā.
9. I ka wā e paʻa ai kahi kulu o ka ʻakika microscopic ʻōpū (laryngopharyngeal reflux / LPR), mānoanoa ma hope o ka ihu, ke koko, ka wai (i ka wā ʻauʻau ʻana a i ʻole ka maloʻo ʻana), a i ʻole ka ʻāʻī ʻana (e like me Bordetella pertussis ka ʻuhū whooping a i ʻole post-viral vagal neuropathy) e pā i ka ** laryngeal vostibular vostibule, hypersensitive laryngeal cord vestibule, folds), a hoʻopili ka aryepiglottic i nā ʻaelike a pau i loko o kahi spasm tetanic mau i ka manawa like**.
10. ʻAʻole like me ka pani ʻana maʻamau (ʻo ia ka 0.5 kekona), hoʻopaʻa ka reflex laryngospasm i ka glottis no 15 a 90 kekona ʻoiai ma hope o ka pau ʻana o ka mea hoʻonāukiuki.

Hoʻohālikelike ʻaoʻao: Vocal Cord Dysfunction (ILO) vs Asthma Attack vs Anaphylaxis vs Haʻi Kino ʻē.¶

No ka mea a hiki i ka 40 pakeneka o nā poʻe maʻi me ka Vocal Cord Dysfunction ke kuhi hewa ʻia no nā makahiki he "refractory brittle asthma", i kekahi manawa e loaʻa i nā corticosteroids waha kiʻekiʻe kiʻekiʻe ʻole, intramuscular epinephrine injections, a i ʻole ka hopena endotracheal intubation, pono e ʻike kēlā me kēia mea pane a me nā mea maʻi i kēia mau hiʻohiʻona ʻano maʻamau:

Ke alakaʻi kikoʻī i kēlā me kēia ʻanuʻu no Larson's Maneuver (The Laryngospasm Notch Technique)¶

Ua wehewehe ʻia e ka anesthesiologist Dr. ʻO C. Philip Larson Jr. a hoʻomaikaʻi ʻia ma luna o ʻehā mau makahiki o ka hoʻomaʻamaʻa lapaʻau, Larson's maneuver ʻo ia ka hana kino non-pharmacological maikaʻi loa e haki i **laryngospasm hapa piha a koʻikoʻi paha ** (inā ma hope o ka hoʻokuʻu ʻia ʻana o ka maʻi anesthesia āpau, i ka wā o ke kaʻina hana hoʻomaha me ka ketamine, i ka wā o ka maloʻo ʻana i ka hoʻopakele ʻana i nā mea a pau, a i ka wā o ka hoʻōla ʻana o ka maʻi maʻi ʻaʻole hiki i ka maʻi maʻi ke hoʻōla nui ʻia).

Nā Hōʻailona Anatomical o ka Laryngospasm Notch (Larson's Point)¶

Ma nā ʻaoʻao ʻelua o ke poʻo, ma hope koke o nā ʻāʻī pepeiao, e noho ana kahi puʻuwai pyramidal hohonu i kapa ʻia ʻo laryngospasm notch: - Ka palena mua (Pale mua): Ka palena hope o ka ramus piʻi a me ka condyle o ka maʻi iwi (iwi āwae lalo). - Ka palena hope (Pale hope): Ka palena mua o ka iwi mastoid process o ka iwi kino ma hope o ka pepeiao. - Ka palena kiʻekiʻe (Puka): ʻO ka kumu o ka iwi poʻo ma lalo pono o ke awāwa hoʻolohe manaʻo o waho (kani pepeiao) a me ke kaʻina hana styloid. - ** He aha ka hohonu i loko o ka Notch: ** ʻO ka ** stylohyoid ligament **, ke kumu o ka ** aʻalolo maka (CN VII) **, nā lālā o ka ** glossopharyngeal (CN IX) a me nā aʻalolo vagus (CN X) **, a me ka ** parotid fascia **.

Pehea e hoʻokō ai i ka Maneuver a Larson ma 4 mau ʻanuʻu¶

1. E hoʻonoho iā ʻoe iho ma hope a i ʻole i mua i ka maʻi: E kū ma ke poʻo o ka moena (inā e moe ana ka mea maʻi) a i ʻole ma hope pono o ka mea maʻi e noho ana.
2. E hoʻokomo i kou mau manamana waena a i ʻole nā ​​manamana lima kuhikuhi i loko o nā ʻāpana Laryngospasm ʻelua: E hoʻoneʻe i nā pale o nā manamana waena ʻelua (a i ʻole nā ​​manamana lima kuhikuhi) ma hope pono o nā ʻāʻī pepeiao i loko o ka lua triangular palupalu ma waena o ka ʻaoʻao hope o ka iwi ā a me ka iwi mastoid, ma ka piko pono o ka ʻāwae kokoke i ke kahawai pepeiao.
3. E kaomi ikaika i loko (Medially) i ke kikowaena o ka iwi poʻo: E hoʻopili paʻa, hohonu i loko i ka pepeiao ʻē aʻe. Hoʻopuka kēia i kahi mea hoʻoulu periosteal ikaika a koi ma luna o ke kaʻina styloid a me nā lālā aʻalolo cranial.
4. Huki i mua a i luna (Anterior-Cephalad Jaw Thrust) I ka Ihu: I ka wā e kaomi ana i loko o ka notch, e hoʻokuʻi i kou mau manamana lima ma hope o ka ʻoki/ramus o ka iwi lima a ** hāpai i ka iwi ā lalo holoʻokoʻa me ka ikaika i mua (e hāpai i nā niho lalo i mua o nā niho o luna)**.

No ke aha e hana ai ka Maneuver a Larson (Dual Mechanical and Neurological Mechanism)¶

• Mechanical Supraglottic Unfolding: ʻO ka huki ikaika ʻana i ke kua i mua e hohola i ka geniohyoid, mylohyoid, a me kourohyoid ʻiʻo a me ka hyoepiglottic ligament, e huki ana i ka iwi hyoid a me ke kumu alelo ma mua. Hoʻopuka kino kēia i nā ʻāpana aryepiglottic i hoʻopaʻa ʻia a huki i nā kaula leo hoʻopunipuni mai nā kaula leo maoli.
• ** Hoʻopiʻi ʻO Central Autonomic / Vagal Reflex Interruption: ** ʻO ke kaomi hohonu loa i loko o ka laryngospasm notch e hoʻoulu i nā aʻalolo afferent somatic o nā aʻalolo trigeminal (CN V), facial (CN VII), a me glossopharyngeal (CN IX), e hoʻouna ana i kahi manaʻo koʻikoʻi i ka nucleus tractus solitarius a me ka nucleus ambibita i loko o ka lolo. laryngeal nerve motor arc**, e hoʻomaha ai nā kaula leo a hāmama i loko o 5 a 15 kekona (pinepine ʻia me ke kani ʻana a i ʻole ke ale ʻana).

Ke alakaʻi kikoʻī i kēlā me kēia ʻanuʻu i ka Awake Vocal Cord Reset Breathing (Sniffing, Panting, and EILOBI)¶

Ke ala nui ka ʻōpio, ka mea pāʻani, a i ʻole ke kanaka makua a loaʻa iā ia kahi hanana koʻikoʻi o Vocal Cord Dysfunction (ILO) a i ʻole ** post-cough / post-reflux paroxysmal laryngospasm** (e hōʻike ʻia ana me ke ʻano o ka paʻa ʻana o ka ʻāʻī a me ka leo kiʻekiʻe kiʻekiʻe, mai hoʻokau i ka ʻeha ʻeha. Akā, e alakaʻi iā lākou ma kēia mau ʻano hana hoʻopakele laryngeal ma muli o **Speech-Language Pathology (SLP) **:

ʻAno 1: ʻO ka Nasal Sniff + Pursed-Lip Exhale ("Sniff-Sniff-Blow")¶

1. Hoʻoponopono Hou: E noho pololei i ke kanaka ma ka ʻaoʻao o ka noho, e hoʻomaha i ko lākou mau lima ma ko lākou ʻūhā (** tripod a i ʻole ka hoʻomaha ʻana i mua **), e hoʻokuʻu i ko lākou mau poʻohiwi mai ko lākou mau pepeiao, a holoi i nā niho.
2. ** Hoʻopuka Mua Ma o nā lehelehe Pursed: ** E aʻo iā lākou: * "Mai hoʻāʻo e omo i ka ea i kēia manawa. E ʻoki i kou mau lehelehe e like me ʻoe e kiki ana a puhi mālie i ka ea i puka mai i waho no 4 kekona: Sssssss a i ʻole Fffffff."
3. Pūlua Nasal Sniff In: E aʻo iā lākou: *"Pāʻa kou waha a lawe i ʻelua honi māmā māmā i loko o kou ihu, e like me ka honi ʻana i ka rose: Sniff, sniff."
4. E hana hou no 5 a 10 mau Poʻo: I loko o 3 a 5 hanu, palupalu a nalo ka stridor leo kiʻekiʻe.

ʻĀpana 2: Hoʻihoʻi hou ʻana i ka ʻuhū (Ke paʻa ka ihu)¶

Inā loaʻa ka ihu o ke kanaka a ʻaʻole hiki ke honi i kona ihu: 1. E hāmama iki ka waha a e hoʻomaha i ko lākou alelo me ka palahalaha ma ka papahele o ka waha ma hope o nā niho mua lalo. 2. E hoʻomoe iā lākou ** me ka wikiwiki a me ka pāpaʻu e like me kahi ʻīlio wela (2 a 3 pants pāpaʻu i kekona)** no 5 a 10 kekona, a ukali ʻia me ka hoʻoheheʻe ʻana i ka lehelehe lohi. 3. Hoʻoikaika mau ka ʻūhā i ka puʻupuʻu o ka hanu ʻana o ka lolo e hoʻopaʻa i ka ʻiʻo cricoarytenoid hope, e pale ana i nā kaula leo mai ka paʻa ʻana i waena o ka hanu.

ʻĀpana 3: ʻO ka hanu ʻana o EILOBI (Hoʻoikaika i ka Laryngeal Obstruction Biphasic Inspiration) no nā ʻAlepa.¶

Hoʻolālā kūikawā ʻia e Scandinavian a me nā laryngologists lapaʻau haʻuki honua no nā mea holo hoʻokūkū, nā ʻauʻau kai, nā kaʻa kaʻa, a me nā mea hoe e hoʻomohala ana i ka pani supraglottic a i ʻole glottic i ka hoʻoikaika nui (EILO): 1. ʻOiai e hoʻomau ana a hoʻolohi paha i ka hele ʻana, hanu mua ka mea pāʻani ma o ** nā niho i hoʻohui ʻia a i ʻole nā lehelehe i ʻoki ʻia (e hana ana i ke kūpaʻa waha liʻiliʻi)** no ka hapa mua o ka inhalation, a laila wehe mālie ka waha i ka ** hoʻonui ʻana i ka iwi ʻaoʻao lalo a me ka ʻōpū (diaphragmatic excursion)** me ka hoʻokiʻekiʻe ʻana i ka ʻāʻī a i ʻole ka hoʻopaʻa ʻana i ka ʻāʻī. 2. No ke aha e hana ai: ʻO ka hoʻokumu ʻana i ke kūpaʻa waha liʻiliʻi ma nā lehelehe e hoʻoneʻe i ka hāʻule kaomi ** i mua i ka waha** ma kahi o ka larynx, e hoʻopau ana i ka hoʻoheheʻe Bernoulli maikaʻi ʻole ma nā ʻāpana aryepiglottic a me nā kaula leo.

ʻO Paroxysmal Laryngospasm e pili ana i ka hiamoe a me ka Reflux-Induced Paroxysmal Laryngospasm (E ala ana i ka hū ʻana i ka pō)¶

ʻO kekahi o nā mea weliweli loa o ke kanaka ʻo laryngospasm pili i ka hiamoe: ala ke kanaka me ka hoʻopaʻa ʻia ʻana mai ka hiamoe hohonu i ke aumoe ʻaʻole hiki iā ia ke hanu i hoʻokahi kulu o ka ea, e hana ana i ka leo kani leo kiʻekiʻe loa (a i ʻole ka hāmau ʻana) no 15 a 45 kekona me ka manaʻo ua kokoke lākou e make, ma mua o ka hāmama ʻana o ke kinoea.

• Ke kumu mua (Silent Laryngopharyngeal Reflux / LPR): Ke moe palahalaha i ka pō, hele kekahi micro-droplet o ka ʻakika ʻōpū a me ka pepsin i ka esophagus ma mua o ka sphincter esophageal luna a kulu ma ka larynx hope (ka interarytenoid notch). ʻAʻole like me ka esophagus (hiki ke ʻae i ka hōʻike ʻana i ka waika pōkole), ʻaneʻane ʻaʻohe pale carbonic anhydrase i ka laryngeal mucosa; ʻO kahi kulu hoʻokahi o ka waikawa e hoʻoulu koke i ka ** chemoreflex laryngospasm ** e pale ai i nā māmā.
• Pehea e wāwahi ai i ka hoʻouka ʻana o ka Laryngospasm i ka pō:
• E kū i luna a i ʻole e noho pololei i luna (hoʻopau hou i ka acid reflux).
• E hoʻopau i ka manaʻo e ʻuhū me ka ikaika ma ka waha hāmama; e puhi koke aku ma na lehelehe i puliki a lawe i na honi ihu.
• **I ka hala ʻana o kahi ʻeke liʻiliʻi o ka ea, e inu i hoʻokahi wai liʻiliʻi i mālama ʻia ma luna o ka pō a ale.
• Pehea e pale aku ai i ka hoouka ana i ka po: E hooki i na mea ai a me na wai a pau ma kahi o 3 mau hora ma mua o ka moe ana, e hookiekie i ke poo o ka moe ma ka 15 a 20 kenimika (6 a 8 iniha) ai'ole e moe ma ka uluna wedge (moe ma ka aoao hema e malama i ka gastroesophageal junction ma luna o ka puna wai o ka gastroesophageal junction) (PPI) a me alginate raft therapy.

Ka Halemai a me ka Anesthesia Management o Refractory Laryngospasm¶

Ma ke keʻena pilikia o ka haukapila, keʻena mālama koʻikoʻi, a i ʻole ke keʻena hana (e like me ka tonsillectomy pediatric, luna endoscopy, a i ʻole ketamine procedural sedation), inā ʻaʻole e haki ka laryngospasm holoʻokoʻa i loko o 15 a 30 kekona o Larson's maneuver + chin lift, hoʻokō nā kauka i kahi protocol escalation wikiwiki ma mua o ka hypoxia a i ʻole ʻO ka edema puʻupuʻu puʻuwai maikaʻi ʻole (NPPE) hoʻomohala:

1. Wehe i ka mea hoʻonāukiuki: Hoʻomoʻu mālie i ke koko, kohu, a i ʻole nā ​​mea huna mai ka hypopharynx ma luna o nā kaula leo a hoʻoneʻe i nā mea hana ea supraglottic a i ʻole ke ea waha e ʻoni ana i ka glottis.
2. 100% Oxygen Continuous Positive Airway Pressure (CPAP 10 a 20 cmH2O) me Tight Two-Handed Mask Seal: E hoʻohui i ka Larson's maneuver me ka lima lima C-E mask grip e hāʻawi ana 100% oxygen me 10 a 20 cmH2O o ka ʻeke ala kaapuni mau ʻole) E hōʻalo i ka ʻomi ikaika ʻana o ka ʻeke inā paʻa loa nā kaula, no ka mea, ʻo ke kaomi ʻana ma luna o 25 cmH2O e hoʻoikaika i ka ea i lalo o ka esophagus i loko o ka ʻōpū (gastric insufflation), e hoʻokuke ana i ka diaphragm.
3. Sub-Hypnotic Intravenous Propofol (First-Line Pharmacological Breaker): Hāʻawi i kahi bolus intravenous liʻiliʻi o Propofol (0.25 a 0.8 mg/kg IV). ʻO ka hoʻohaʻahaʻa ʻana me ka propofol haʻahaʻa haʻahaʻa e wāwahi i ka 75 a i ka 85 ka nui o ka refractory post-extubation a i ʻole sedation laryngospasms i loko o 15 kekona me ka ʻole e koi ʻia ka maʻi lolo a i ʻole ka hoʻokomo hou ʻana.
4. ** Intravenous or Intramuscular Succinylcholine (Gold-Standard Neuromuscular Blockade):** Inā ʻoi aku ka nui o ka hypoxia (Ke hāʻule nei ka SpO2 ma lalo o 85%) a i ʻole ke ulu ʻana o bradycardia me ka propofol a me Larson.
5. Low-Dose IV Succinylcholine: 0.1 a 0.25 mg/kg IV hoʻomaha koke i nā ʻiʻo o ke kaula leo striated i loko o 20 a 30 kekona me ka mālama pinepine ʻana i ka hanu diaphragm.
6. Full-Dose IV Succinylcholine (1.0 a i 2.0 mg/kg IV) a i ʻole IM Succinylcholine (4.0 mg/kg IM i loko o ka deltoid a i ʻole quadriceps inā ʻaʻohe laina IV): Hoʻopau loa i nā kaula leo no ka hoʻoulu ʻana i ka pilikia a me ka intubation endotracheal, i hui pū ʻia me IV Atropine mau keiki (0 kg). hypoxic/succinylcholine-induced bradycardia.
7. Heliox (80% Helium / 20% Oxygen) no ka Severe Awake Refractory Stridor: Ma ke Keʻena Emergency, ʻo ka poʻe maʻi me ka hoʻomau mau ʻana o ke ala ala ea e pane wikiwiki nei iā Heliox (80:20 a i ʻole 70:30 hui helium-oxygen) no ka mea he hoʻokahi-hiku ka nui o ka helium i loko o ka nui o ka nitrogen, hoʻololi ʻana i ka ea ma hope o Reynotic. kahe laminar i ka wā e haki ana i ka pōʻai hoʻoheheʻe Bernoulli.

Nā helu ulia pōpilikia a me nā alakaʻi lapaʻau¶

• ʻAmelika Hui Pū ʻIa a me Kanada: Kāhea iā 911 no kekahi ʻōniʻoniʻo, cyanosis, anaphylaxis, a i ʻole laryngospasm no ka manawa mua. E hahai i ka American Thoracic Society (ATS), American College of Chest Physicians (CHEST), a me American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) nā kuhikuhi no ka hōʻoia ʻana o ka laryngoscopy flexible o Inducible Laryngeal Obstruction (ILO) a me ka hoʻomaʻamaʻa hou ʻana o ka hanu.
• United Kingdom: Kāhea iā 999 no ka stridor koʻikoʻi me ka ʻeha hanu a i ʻole cyanosis. ʻO ka ** European Respiratory Society (ERS) / European Laryngological Society (ELS) / Royal Brompton Hospital** nā alakaʻi ʻōlelo aʻoaʻo i ka Inducible Laryngeal Obstruction (ILO) a me Exercise-Induced Laryngeal Obstruction (EILO) a paipai i ka laryngoscopy hoʻomau i ka wā hoʻoikaika kino (CLE) hoʻokolohua a me ka ʻōlelo loea a me ka lapaʻau ʻōlelo.
• European Union: Kāhea iā 112 ma nā mokuʻāina lālā a pau o EU. E hahai i ka hui ERS / ELS / ACCP Task Force Consensus Statement on Nomenclature and Diagnosis of Inducible Laryngeal Obstructions.
• Australia a me New Zealand: E kelepona iā 000 ma Australia a i ʻole 111 ma New Zealand. E hahai i Thoracic Society of Australia and New Zealand (TSANZ) a me Australian and New Zealand College of Anesthetists (ANZCA) laryngospasm crisis management algorithms.

Nīnau pinepine¶

Pehea e hiki ai iaʻu ke ʻike i ka ʻokoʻa ma waena o Vocal Cord Dysfunction (VCD / ILO) a me kahi hōʻeha hānō?¶

ʻO ka ʻokoʻa ʻoi aku ka paʻakikī o ka hanu ʻana i loko a i waho paha, a no hea mai ke kani: ma Vocal Cord Dysfunction (inducible laryngeal obstruction), pili nā kaula leo ma kou ʻāʻī i ka wā e hanu ai ʻoe, e like me ka paʻi ʻana o ka ea i ka paia ma kou ʻāʻī me ke kani leo kiʻekiʻe (stridor) i ka wā e hoʻomaka ai ka oxygen a kū i loko o nā minuke. I ka hoʻouka ʻia ʻana o ka hānō, ʻo nā paipu bronchial liʻiliʻi i loko o kou umauma haiki, ʻoi aku ka paʻakikī o ka hanu ʻana i ka ea OUT me ka hāwī ʻana o ka hanu ʻana i loko o ka umauma e koi ana i kahi mea hoʻohāhā bronchodilator (salbutamol/albuterol) a he mau hola e hoʻonā ai.

He aha ka hana a Larson a ma hea ka laryngospasm notch?¶

ʻO ka maneuver a Larson kahi ʻenehana kino pilikia i hoʻohana ʻia e wāwahi i ka laryngospasm koʻikoʻi a i ʻole ka hoʻopau ʻana. ʻO ka laryngospasm notch (Larson's point) ʻo ia ke ʻano huinakolu liʻiliʻi ma hope pono o nā ʻāʻī pepeiao ʻelua, aia ma waena o ka ʻaoʻao hope o ka iwi āwae lalo (mandibular ramus) ma mua, ka iwi mastoid ma hope o ka pepeiao ma hope, a me ke kumu o ka iwi iwi ma luna. ʻO ka paʻi paʻa ʻana i ke kikowaena o ke poʻo me kou manamana lima waena i loko o nā ʻīpuka ʻelua a ʻo ka huki ʻana i ka iwi ā lalo me ka ikaika i mua a i luna (kahi ʻāʻī) e hohola i nā ʻiʻo laryngeal e hāmama a hoʻoulu i ke aʻalolo cranial e hoʻomaha ai i ke kaula leo i loko o kekona.

No ke aha e ho'ōki ai ka honi ʻana i kou ihu a me ka hanu ʻana ma nā lehelehe ʻaʻai?¶

I ka wā e paʻa ai kāu mau kaula leo, ʻo ka ʻūhā nui ʻana ma ka waha hāmama e hoʻokumu i kahi momi māmā loa (ka hopena Bernoulli) e omo ai i nā kaula leo ʻoi aku ka paʻa. ʻO ka puhi mālie ʻana i ka ea ma nā lehelehe paʻa paʻa e hoʻoulu ai i ka puʻe hope maikaʻi mai lalo e hoʻokaʻawale i nā kaula leo, ʻoiai ʻo ka lawe ʻana i ʻelua honi ʻoluʻolu i loko o ka ihu e hoʻāla ai i kahi reflex brainstem i kūkulu ʻia e puhi i ka ʻiʻo cricoarytenoid hope, ʻo ia wale nō ka ʻiʻo o ke kino e huki ākea i nā kaula leo.

No ke aha wau e ala ai i ka waena o ka pō me ka ʻūhā ʻana i ka ea me ka paʻa ʻana o koʻu ʻāʻī?¶

ʻO ke ala koke ʻana mai ka hiamoe ʻaʻole hiki iā ia ke huki i ka ea i loko no 15 a 45 kekona me kahi leo stridor kiʻekiʻe ʻo ia ka reflux laryngospasm pili i ka hiamoe. Ke moe ʻoe me ka palahalaha, hiki i kahi kulu liʻiliʻi o ka ʻōpū o ka ʻōpū a me ka digestive enzyme (laryngopharyngeal reflux) ke piʻi i kou esophagus a hoʻopā i kāu mau kaula leo, e hoʻoulu koke i kahi hoʻololi pale e pani koke i ka pahu leo ​​e mālama i ka waikawa mai kou mau māmā. ʻO ka noho pololei ʻana, puhi i waho ma nā lehelehe i ʻoki ʻia, honi mālie i kou ihu, a me ka inu ʻana i kahi wai liʻiliʻi e hoʻihoʻi i ka reflex i loko o kekona.

Nā kumu a me ke alakaʻi kūhelu¶

• European Respiratory Society (ERS), European Laryngological Society (ELS), a me American College of Chest Physicians (ACCP): International Consensus Statement on Nomenclature, Diagnosis, and Management of Inducible Laryngeal Obstructions (ILO and EILO).
• Larson CP Jr. (Anesthesiology / Clinical Airway Management): Laryngospasm: ʻO ka Lapaʻau maikaʻi loa (Foundational Description of the Laryngospasm Notch and Larson's Jaw-Thrust Maneuver).
• American Thoracic Society (ATS) and American Academy of Allergy, Asthma, and Immunology (AAAAI): Clinical Differentiation and Co-Management of Vocal Cord Dysfunction (Paradoxical Vocal Fold Motion) and Asthma.
• Association of Anesthetists (United Kingdom) and Australian and New Zealand College of Anesthetists (ANZCA): Perioperative Laryngospasm Crisis Management Algorithm (CPAP, Larson's Maneuver, Propofol, and Succinylcholine).
• Royal College of Speech and Language Therapists (RCSLT) and American Speech-Language-Hearing Association (ASHA): Respiratory Retraining and EILOBI Therapy for Inducible Laryngeal Obstruction.

Nā alakaʻi pili¶

• ʻO ka hoʻomaʻamaʻa ʻana i ka hānō a me ka ʻenehana inhaler spacer
• Epiglottitis, croup, stridor, a me ka ʻaʻa ʻana o ke ea o luna
• Negative-pressure pulmonary edema (NPPE) ma hope o ka hoʻokuʻu ʻana i ke koko a i ʻole laryngospasm.
• Nā hopena maʻi a me ke kōkua mua anaphylaxis
• Nā helu pilikia ma ka ʻāina