Laryngospasm na Ụrụ olu (Mgbochi Laryngeal Inducible): Inspiratory Stridor, Larson's Jaw-Thrust Maneuver, na Panting Sniff Reset¶

Na mberede, enweghị ike ịdọrọ ikuku n'oge akpịrị nwere ike ịkpata ọgba aghara arụ ọrụ abụọ nwere njikọ chiri anya nke ụdọ olu: ** nnukwu reflex laryngospasm ** (ihe ike, enweghị afọ ojuju, zuru oke ma ọ bụ nso nso-mmechi nke ụda olu eziokwu na ụgha nke onye isi laryngeal dị elu na-arụ ọrụ) na ** VCD na-adịghị arụ ọrụ nke akụkụ iku ume nke mba ụwa. ** inducible laryngeal obstruction (ILO)** (mgbakwunye ụda olu na-aga n'ihu n'etiti ahịrị n'oge iku ume karịa imeghe ebe niile dịka ha kwesịrị). Ọ bụ ezie na ** laryngospasm zuru ezu ** bụ ihe anestetiiki na-eyi ndụ egwu, post-extubation, mmiri iri, ma ọ bụ acid-reflux airway mberede nke nwere ike mepụta hypoxia siri ike, bradycardia, ma ọ bụ nrụgide na-adịghị mma n'ime 60 ruo 120 sekọnd ma ọ bụrụ na agbajighị anụ ahụ, ** teta laryngeal na-adịghị mma. spasm arụ ọrụ na-amachi onwe ya na-ebute site na mmega ahụ siri ike, reflux acid, ikuku oyi, ísì kemịkalụ siri ike, ntapu imi imi, ma ọ bụ nrụgide siri ike nke a na-aghọtahiekarị dị ka ọnọdụ egwu ndụ asthmaticus ma ọ bụ anaphylaxis. N'ihi na ọnọdụ abụọ a na-eme ka glottic chink dị n'ogo nke larynx dị n'olu, ha na-emepụta ụda dị elu, ụda dị elu, egwu egwu ma ọ bụ egwu egwu ** mgbe ha na-eku ume (insupiratory stridor)** na onye ọrịa na-atụ aka ozugbo na akpịrị ha, n'adịghị ka ụkwara ume ọkụ nke bronchi, nke na-eme ka ụzọ ikuku dị ala n'ime obi na-eme ka ikuku na-eku ume. Ọ bụrụ na mmadụ na-etolite na mberede stridor, enweghị ike ikwu okwu ma ọ bụ iku ume, gosi egbugbere ọnụ na-acha anụnụ anụnụ (cyanosis), nwere olu ma ọ bụ ire ọzịza, ma ọ bụ na-efunahụ onwe ya, kpọọ mpaghara gị. nọmba mberede ozugbo (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom). Tuleekwa ntuziaka ndị otu anyị na ya asthma ọgụ, Epiglottitis, croup na stridor, na mmeghachi omume nfụkasị na anaphylaxis.

Ihe kacha mkpa gị ozugbo bụ ịlele akara ọkọlọtọ na-acha uhie uhie nke ezigbo ihe mgbochi ikuku ma ọ bụ anaphylactic (ịkpa ahụ nke mba ofesi, egbugbere ọnụ ma ọ bụ ire angioedema, mkpọnwụ, ma ọ bụ ịda mbà n'obi), tinye ** Larson's maneuver (nrụgide siri ike n'ime na elu elu na laryngospasm notch ozugbo n'azụ ntị ntị ma ọ bụrụ na ọ na-aga n'ihu n'ihu). na-eti onye ọrịa na-anabataghị ya ma ọ bụ mgbe ọ gbasasịrị ahụ, ma kụziere onye ọrịa na-amụ anya site na ** Double Nasal Sniff and Pursed-Lip Exhale (ma ọ bụ Panting Reset)** iji tọọrọ (mepee) ụdọ olu n'ime sekọnd.

Mee nke a ugbu a¶

1. ** Lelee ozugbo maka ọkọlọtọ uhie na-eyi ndụ egwu wee kpọọ nọmba mberede mpaghara gị ma ọ bụrụ na ọ dị.** Kpọọ 911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom, 000 na Australia, ma ọ bụ lelee akwụkwọ ndekọ aha zuru ụwa ọnụ nke anyị. nọmba mberede Ọ bụrụ na nke a bụ ihe omume mbụ nke stridor nke onye ahụ, ọ bụrụ na ha na-eri nri tupu ha amalite (nkpagbu), ọ bụrụ na ha nwere hives ma ọ bụ zaa aza egbugbere ọnụ ma ọ bụ ire (mmeghachi omume nfụkasị ahụọ bụrụ na ha nwere ahụ ọkụ na nkụda mmụọ (epiglottitis), ma ọ bụ ọ bụrụ na egbugbere ọnụ ha na-acha anụnụ anụnụ ma ọ bụ nwee mgbagwoju anya ma ọ bụ anabataghị ya.
2. ** Ọ bụrụ na Onye Teta nwere Spasm Vocal Cord (VCD / ILO) ma ọ bụ Post-Cough Paroxysmal Laryngospasm: Nọdụ ala ka ha kwụ ọtọ na ubu gbadara n'ihu wee gbochie ha ka ha na-esi n'ọnụ mepere emepe pụta.* mmetụta agụụ na-ekpochapụ ma kpochaa mucosa laryngeal.
3. ** Onye nkuzi "Ọnụ imi ugboro abụọ + Ogologo egbugbere ọnụ na-akpachapụ anya" (EILOBI / Respiratory Respiraining Reset):**
4. Nzọụkwụ A (Exhale Mbụ): Gwa onye ahụ ka ọ fesa ikuku nke fọdụrụ nwayọ site na nkenke ** egbugbere ọnụ a na-agba agba** (dị ka a ga-asị na ọ na-efegharị n'ọkụ kọfị dị warara ma ọ bụ na-efegharị ire ọkụ kandụl na-agbapụghị ya) maka 3 ruo 4 sekọnd. Iku ume megide egbugbere ọnụ na-akpachapụ anya na-emepụta ** 5 ruo 10 cmH2O nke nrụgide azụ (PEEP dị mkpa)** nke na-akpapụ ụdọ olu n'ike.
5. Nzọụkwụ B (The Nasal Sniff): Mee ka ha mechie ọnụ ha, mee ka agbà na akpịrị ha dị jụụ, werekwa ** ọsọ ọsọ abụọ dị nwayọọ n'imi n'ime imi** (dị ka a ga-asị na ọ na-esi ísì). Imi imi na-eme ka ụbụrụ ụbụrụ dị ike na-emegharị ahụ site na ** azụ cricoarytenoid muscle ** ( naanị akwara na-apụnara mmadụ nke larynx ) nke na-amanye ụdọ olu mepere emepe.
6. ** Nzọụkwụ C (The Panting / Straw Breath Alternative):** Ọ bụrụ na imi ha na-agbakọ, mee ka ha ** pant ngwa ngwa dị ka nkịta ** ka ire ha dị jụụ n'ala ọnụ, ma ọ bụ kuku ume nwayọọ nwayọọ site na oghere dị warara n'etiti egbugbere ọnụ na-egbu egbu ka ha na-amụba afọ ha (diaphragmatic ume).
7. ** Ọ bụrụ na Laryngospasm na-agbachi nkịtị zuru oke (Ekuku ikuku efu n'agbanyeghị Heaving Chest, ma ọ bụ Post-Anesthesia / Post-Reflux / Drowning Spasm): Mee ngwa ngwa LARSON.
8. Chọta ebe ** Larson's point ("laryngospasm notch")** n'akụkụ abụọ nke isi: obere ịda mbà n'obi nke ọkpụkpụ na-ejikọta ** n'ihu site na ramus na-arị elu (azụ azụ) nke ọkpụkpụ agba dị ala, n'azụ site na usoro mastoid n'azụ ntị, na nke ka elu site na isi nke okpokoro isi ***, n'azụ earlobe.
9. Tinye ntụnye aka nke ** etiti ma ọ bụ mkpịsị aka mkpịsị aka gị n'ime oghere abụọ ahụ ** wee pịa ** jiri ike banye n'ime etiti okpokoro isi wee gaa n'ihu / gbago n'ihu imi** n'otu oge na-ebuli agba nke ala ka ọ bụrụ ** ntugharị agba na-aga n'ihu.
10. Ntugharị nke Larson na-eji ígwè agbatị geniohyoid na thyrohyoid ligaments iji dọpụ epiglottis na ụdọ ụda ụgha dị iche iche ka ọ na-ebute mkpali akwara cranial siri ike nke na-agbaji vagal laryngospasm reflex arc n'ime 5 ruo 15 sekọnd.
11. ** Ọ bụrụ na onye ahụ mara ụkwara ume ọkụ yana ụda ụda olu: Jiri inhaler nnapụta ha salbutamol (albuterol) na spacer ma ọ bụrụ na ejighị n'aka, dị ka pasent 30 ruo 50 nke ndị ọrịa VCD nwere ụkwara ume ọkụ na-ejikọta ọnụ. a ga-emeghachi ọzụzụ n'akụkụ ojiji inhaler ọ bụla.
12. ** Were obere mmiri na-ekpo ọkụ n'ime ụlọ (naanị otu oge onye ahụ nwere ike ịdọrọ ume dị nro ma ghara ịkụnye nri) ma ọ bụ kpatụ obere akwụkwọ ("Mmmmmmm").* akwara cricoarytenoid.

Osisi mkpebi ụlọ ọgwụ: stridor inspiratory, VCD/ILO, na laryngospasm zuru oke.¶

flowchart TD
    A["Mkpọchi akpịrị na-amalite na mberede, ike iku ume IN, ma ọ bụ ihe mkpali dị elu"] --> B{"Lelee akọ na uche, ikuku ikuku, na anaphylaxis / akara nke ahụ mba ofesi"}
    B -->|Unconscious, cyanotic, silent chest with tracheal tug, or post-sedation/drowning| C["LARYNGOSPASM zuru oke ma ọ bụ ịma jijiji: Kpọọ EMS (911/112/999); nyochaa na ọ dịghị mba ọzọ ahu; mee ngwa ngwa LARSON'S MANEUVER + Jaw Thrust + 100% O2 nti nrụgide (CPAP 10 ruo 20 cmH2O)"]
    B -->|Swollen lips/tongue, generalized hives, hypotension, or exposure to allergen| D["ANAPHYLAXIS MA ọ bụ ANGIOEDEMA: Tinye Epinephrine intramuscular (0.3 ruo 0.5 mg) n'ime etiti apata ụkwụ ozugbo wee kpọọ EMS."]
    B -->|Fever, drooling, tripod posture, muffled hot-potato voice, or barking cough| E["EPIGLOTTITIS ma ọ bụ croup: mee ka onye ọrịa nọrọ jụụ ma kwụ ọtọ; eji ngaji nyochaa akpịrị; kpọọ EMS ozugbo"]
    B -->|Awake, alert, no hives/swelling, pointing to throat; loud inspiratory stridor triggered by exercise, cough, reflux, scent, or stress| F["Ihe mgbochi laryngeal inducible (VCD / ILO) ma ọ bụ Teta Paroxysmal Laryngospasm"]
    F --> G["Nzọụkwụ 1: Nọdụ ala kwụ ọtọ na-adabere ntakịrị n'ihu; dobe ubu; wetuo ike n'agba na akwara olu"]
    G --> H["Kwụpụ 2: Na-ekupụ ume nwayọọ nwayọọ site na egbugbere ọnụ PURUSED maka sekọnd 4 (na-emepụta ezigbo nrụgide azụ iji mee ka eriri mepee)"]
    H --> I["Kwụpụ 3: Were NASAL SNIFFS 2 dị nro banye n' imi (ma ọ bụ pan dị ka nkịta / kue ume site na ahịhịa echiche) na-eji iku ume afọ."]
    I --> J{"stridor na akpịrị akpịrị ekpebiela n'ime nkeji 1 ruo 3?"}
    J -->|Yes (Typical VCD / Awake Laryngospasm resolution)| K["Sip mmiri nwayọọ nwayọọ; zere ịkpalite (reflux, oyi ikuku, mgbakasị ahụ); hazie ọgwụgwọ laryngoscopy outpatient na ọgwụgwọ asụsụ-asụsụ (EILOBI)."]
    J -->|No: Stridor persists > 3 to 5 minutes, SpO2 drops below 92%, or severe distress| L["Kpọọ EMS (911/112/999) maka nyocha Ngalaba Mberede, mgbanwe nasolaryngoscopy, CPAP, ma ọ bụ Heliox (80:20 helium-oxygen)"]
    C --> M["Ụlọ ọgwụ / Anesthesia Escalation ma ọ bụrụ na Larson Maneuver + CPAP dara: IV Propofol (0.25 ruo 0.8 mg / kg) ma ọ bụ IV Succinylcholine (0.1 ruo 1.0 mg / kg) + tracheal intubation"]

Pathophysiology: Kedu ka Larynx si arụ ọrụ na ihe kpatara ụda olu ji mechie¶

Larynx mmadụ (igbe olu) na-arụ ọrụ atọ dị egwu nke ndu: ** ịnọgide na-enwe oghere ikuku maka iku ume **, ** na-emepụta ụda (phonation) **, na ** na-eme ihe dị ka valvụ sphincter nchebe iji gbochie nri, mmiri mmiri na afo acid ịbanye na ngụgụ n'oge ilo.

Nkịtị Vocal Cord Movement vs Paradoxical Adduction (ILO) vs Laryngospasm zuru ezu¶

1. ** iku ume nkịtị: ***
2. ** N'oge iku ume (na-eku ume): ** Ebe iku ume na medulla oblongata ọkụ na-egosi na akwara laryngeal na-emegharị ugboro ugboro ka ọ na-ebute akwara ** posterior cricoarytenoid (PCA) muscle **, naanị anụ ahụ n'ime ahụ mmadụ dum nke na-emepe (na-adọta) ụda olu **. Ụdọ olu na-efegharị obosara ka ọ bụrụ ụdị V sara mbara, na-enye ohere ịgbachi nkịtị, ikuku laminar n'ime trachea.
3. N'oge iku ume (na-eku ume): Ụdọ olu na-adaba ntakịrị n'etiti ahịrị (na-ebelata site na pasent 10 ruo 30) iji nọgide na-enwe nrụgide njedebe njedebe dị nro.
4. Mgbochi Laryngeal na-adịghị agwụ agwụ (adịghị arụ ọrụ eriri olu / VCD):
5. N'ime ndị ọrịa nwere VCD / ILO (gụnyere ** Mmega ahụ nke Laryngeal Obstruction [EILO]** na ndị na-eme egwuregwu na-asọmpi), mgbakasị ahụ na-adịghị ala ala nke mucosa laryngeal (site na laryngopharyngeal acid reflux nke na-agbachi nkịtị, ntapu imi imi, ma ọ bụ inhaled mgbakasị ahụ) ma ọ bụ autonomic hyperctoracreacre thyroarytenoid, na interarytenoid mọzụlụ**) na-agbakọ ** n'ụzọ na-adịghị mma n'oge iku ume ** (ma ọ bụ na-eme ka mpịakọta aryepiglottic dị n'elu eriri ahụ banye n'ime ime n'oge mgbatị ahụ kacha elu).
6. Kama imeghe n'ime obosara V mgbe onye ahụ na-eku ume, ụzọ ụzọ abụọ n'ụzọ atọ nke ụda olu na-ejikọta ọnụ n'etiti ahịrị, na-ahapụ naanị obere mgbanaka ** azụ diamond dị n'azụ glottis nke ikuku na-eji nnukwu mkpali na-akpali akpali.
7. ** Laryngospasm reflex zuru oke:**
8. Agbaghara site na ** ngalaba nke ime akwara laryngeal dị elu (alaka Vagus Nerve, CN X)**, laryngospasm zuru ezu bụ ikwubiga okwu ókè, ihe nchebe ụbụrụ nke oge ochie nke emebere iji mee ka mmiri ma ọ bụ vomit pụta na ngụgụ.
9. Mgbe eriri afọ microscopic acid (** laryngopharyngeal reflux / LPR**), imi imi post-imi, ọbara, mmiri (n'oge igwu mmiri ma ọ bụ mmiri iri), ma ọ bụ ụkwara na-eme ihe ike (dị ka * Bordetella pertussis * whooping ụkwara ma ọ bụ post-viral vagal neuropathy) na-akụta hypersensitive volery, ụdọ akwara ụgha. (folds vestibular), na aryepiglottic folds niile nkwekọrịta n'ime tetanic spasm na-adịgide adịgide n'otu oge.
10. N'adịghị ka mmechi ilo nkịtị (nke na-ewe 0.5 sekọnd), reflex laryngospasm na-emechi glottis maka sekọnd 15 ruo 90 ** ọbụlagodi mgbe iwe gachara.

Ntụle n'akụkụ n'akụkụ: Ụda olu adịghị arụ ọrụ (ILO) vs Asthma Attack vs Anaphylaxis vs Ahụhụ Mba Ọzọ¶

N'ihi na ihe ruru pasent 40 nke ndị ọrịa nwere Vocal Cord Dysfunction bụ ndị a na-achọpụtaghị ruo ọtụtụ afọ dị ka ha nwere "ụkwara ume ọkụ na-egbuke egbuke"**, mgbe ụfọdụ na-anata corticosteroids dị elu na-adịghị mkpa, intramuscular epinephrine injections, ma ọ bụ ọbụna mberede endotracheal intubation, onye ọ bụla na-azaghachi mberede na onye ọrịa kwesịrị ịma njirimara ndị a mara mma:

Ntuziaka nzọụkwụ site n'ụzọ zuru ezu na Larson's Maneuver (The Laryngospasm Notch Technique)¶

Ọkachamara nhụsianya kọwara Dr. C. Philip Larson Jr. na honed ihe karịrị afọ iri anọ nke omume ụlọ ọgwụ, ** Larson's maneuver ** bụ otu ụzọ kachasị dị irè na-abụghị ọgwụ na-ahụ maka ahụike iji mebie ** nnukwu laryngospasm zuru oke ma ọ bụ nke siri ike ** (ma ọ na-eme mgbe anesthesia extubation n'ozuzu ya gasịrị, n'oge usoro ịgbara mmiri na-eji ketamine, ma ọ bụ nnapụta doxy n'oge a na-akpọte ketamine, n'oge a na-eme mkpọtụ). laryngospasm ọgụ ebe onye ọrịa enweghị ike iku ume ma ọlị).

Akara ngosi Anatomical nke Laryngospasm Notch (Larson's Point)¶

N'akụkụ abụọ nke isi, ozugbo n'azụ ntị ntị, nọ n'oké ịda mbà n'obi nke pyramidal akpọrọ **laryngospasm notch *: - ** Akụkụ ihu (Mgbidi ihu): Oke azụ nke ** ramus na-arịgo na condyle nke mandible (ọkpụkpụ agba dị ala)**. - ** Ókè dị n'azụ (Mgbidi azụ): *** Akụkụ ihu nke ọkpụkpụ ** usoro mastoid ** nke ọkpụkpụ anụ ahụ n'azụ ntị. - ** Oke oke (elu ụlọ): ** Isi ** isi nke okpokoro isi ** dị n'okpuru ọwa ntị nke mpụga (akwa ntị) na usoro styloid. - ** Ihe dị omimi n'ime Notch: ** The ** stylohyoid ligament ***, ogwe nke ** akwara ihu (CN VII) **, alaka nke ** glossopharyngeal (CN IX) na vagus (CN X) irighiri akwara **, na ** parotid fascia ***.

Otu esi eme ihe omume Larson na usoro anọ¶

1. ** Ọnọdụ onwe gị n'azụ ma ọ bụ chere onye ọrịa ihu:** Guzo n'isi ihe ndina (ọ bụrụ na onye ọrịa ahụ dinara ala) ma ọ bụ ozugbo n'azụ/n'akụkụ onye ọrịa ahụ nọ ọdụ.
2. ** Tinye mkpịsị aka etiti gị ma ọ bụ ndenye n'ime ma ọ bụ Laryngospasm Notches: ** Gbanye mkpịsị aka nke mkpịsị aka abụọ n'etiti (ma ọ bụ mkpịsị aka mkpịsị aka) ozugbo n'azụ ntị ntị n'ime oghere triangular dị nro n'etiti azụ azụ nke ọkpụkpụ agba na ọkpụkpụ mastoid, nke dị n'elu agba n'akụkụ ọdụ ntị.
3. ** Pịa ike banye n'ime (na-agba ọsọ) n'ebe etiti okpokoro isi: *** Tinye nrụgide siri ike, nke dị omimi n'ime na ntị nke ọzọ. Nke a na-ebute mkpali periosteal siri ike, dị nkọ karịa usoro styloid na alaka akwara cranial.
4. ** N'otu oge dọrọ gaa n'ihu na elu (Anterior-Cephalad Jaw Thrust) N'ebe imi:** Mgbe ị na-agbanye n'ime n'ime notch, kụọ mkpịsị aka gị n'azụ akụkụ / ramus nke mandible na ** welie agbà ala dum n'ike n'ihu (na-ebuli ezé ala n'ihu ezé elu)**.

Ihe kpatara Larson's Maneuver ji arụ ọrụ (Mechanical Mechanical and Neurological Mechanism)¶

• ** Mechanical Supraglottic Unfolding:** Ịkwalite mandible n'ike na-agbatị geniohyoid, mylohyoid, na akwara thyrohyoid na njikọ hyoepiglottic, na-adọkpụrụ ọkpụkpụ hyoid na isi ire n'ihu. Nke a n'ụzọ anụ ahụ na-ekpughere mpịaji aryepiglottic a kechiri anya wee dọpụ ụdọ ụda okwu ụgha pụọ ​​na ụdọ olu.
• ** Central Autonomic / Vagal Reflex Interruption: ** Mmetụta miri emi dị n'ime laryngospasm notch na-akpali somatic afferent fibers nke trigeminal (CN V), ihu (CN VII), na glossopharyngeal (CN IX) irighiri akwara, na-eziga mkpali dị mkpa nke etiti na nucleus traktị na-egbochi ụbụrụ ụbụrụ. moto akwara laryngeal hyperactive dị elu ***, na-eme ka ụdọ olu kwụsịtụrụ ma na-emeghe n'ime sekọnd 5 ruo 15 ** (na-esochi ude ma ọ bụ ilo).

Ntuziaka nzọụkwụ nke ọma maka Teta Vocal Cord Reset Breathing (Sniffing, Panting, and EILOBI)¶

Mgbe onye nọ n'afọ iri na ụma, onye na-eme egwuregwu, ma ọ bụ onye toro eto na-amụ anya ma na-enwe nnukwu ihe omume nke ** Vocal Cord Dysfunction (ILO)** ma ọ bụ ** post-cough / post-reflux paroxysmal laryngospasm ** (na-egosipụta dị ka akpịrị na-emenye ụjọ na ụda olu dị elu na-akpali akpali), emela ka ọ bụrụ nrụgide na-egbu mgbu. Kama, duzie ha site na usoro nnapụta laryngeal ** Okwu-Asụsụ Pathology (SLP) dabere na ihe akaebe ndị a:

Usoro 1: Imi imi + Pụrụ-Egbugbere Ekuku ("Sniff-Sniff-Blow")¶

1. ** Ndozigharị ọnọdụ:** Nọdụ ala ka onye ahụ kwụ ọtọ na nsọtụ oche, mee ka ha tụkwasị ụkwụ ha n'apata ụkwụ ha (** njem ma ọ bụ izu ike na-adabere n'ihu ***), tufuo ubu ha na ntị ha, ma tuchie ezé ha.
2. ** Na-ekupụ nke mbụ site na egbugbere ọnụ na-akpachapụ anya: ** Kụziere ha: * "Agbalịla ịmịnye ikuku ugbu a. Kpachapụ egbugbere ọnụ gị dị ka ị na-asụ ma fesa ikuku ị nwere nwayọọ nwayọọ maka 4 sekọnd: ​​Ssssss ma ọ bụ Fffffff."
3. ** Imi imi ugboro abụọ na:** Kụziere ha: * "Mechie ọnụ gị ma were ngwa ngwa abụọ, ọkụ na-esi n'imi imi gị, dị ka imiri rose: Sniff, sniff."
4. ** Tinyegharịa maka usoro 5 ruo 10:** N'ime iku ume 3 ruo 5, stridor dị elu na-adị nro wee pụọ.

Usoro 2: Ntọgharị Panting (Mgbe A Na-egbochi imi)¶

Ọ bụrụ na onye ahụ nwere mkpọchi imi ma ọ bụ enweghị ike imi imi ha: 1. Mee ka ha meghee ọnụ ha ntakịrị ma ** mee ka ire ha dị larịị ma gbasaa n'ala ọnụ n'azụ ezé ihu ala . 2. Mee ha ** pant ngwa ngwa na n'amaghị ama dị ka nkịta na-ekpo ọkụ (2 ruo 3 pant na-emighị emi kwa nkeji) maka 5 ruo 10 sekọnd, na-ekupụ egbugbere ọnụ nwayọọ nwayọọ na-esote. 3. Panting na-aga n'ihu na-akpali onye na-emepụta ihe na-eme ka ụbụrụ cricoarytenoid dị n'azụ nwee nkwekọrịta, na-egbochi ụda olu ka ọ ghara imechi n'etiti ume.

Usoro 3: EILOBI iku ume (mmega ahụ na-eme ka ihe mgbochi Laryngeal na-egbochi Biphasic Inspiration) maka ndị na-eme egwuregwu.¶

Ndị Scandinavian na ndị ọkachamara na-ahụ maka ọgwụ egwuregwu mba ụwa mebere ya maka ndị na-agba ọsọ asọmpi, ndị na-egwu mmiri, ndị na-agba ígwè, na ndị na-akwọ ụgbọ mmiri bụ ndị na-emepụta supraglottic ma ọ bụ glottic mmechi na oke mgbalị (EILO): 1. Ka ọ na-aga n'ihu ma ọ bụ na-ebelata ije ha, onye na-eme egwuregwu na-eku ume na mbụ site na ** ezé gbatịpụrụ agbachapụ ma ọ bụ egbugbere ọnụ (na-emepụta ntakịrị nkwụsị ọnụ)** maka ọkara mbụ nke iku ume, wee meghee ọnụ nke ọma mgbe ** gbasaa eriri afọ na afọ (diaphragmatic excursion)** na-ebulighị clavicles ma ọ bụ na-akụda akwara. 2. Ihe kpatara o jiri na-arụ ọrụ: Ịmepụta ntakịrị nkwụchi ọnụ n'egbugbere ọnụ na-atụgharị nrụgide nrụgide ** na-aga n'ihu n'ọnụ ** kama na larynx, na-ewepụ nsị Bernoulli na-adịghị mma n'ofe aryepiglottic folds na ụda olu.

Paroxysmal Laryngospasm metụtara ụra na reflux (na-eteta n'ụra n'abalị)¶

Otu n'ime ihe kacha atụ egwu ụmụ mmadụ bụ ** laryngospasm metụtara ihi ụra **: mmadụ na-eteta n'ụra n'ụra n'etiti abalị kpamkpam enweghị ike ịmịnye otu ikuku nke ikuku, na-eme ka ụda mkpu dị elu na-achọsi ike (ma ọ bụ ịgbachi nkịtị) ruo 15 ruo 45 sekọnd n'ikpeazụ wee nwee mmetụta na ha ga-adaba n'oké olu, tupu akpịrị ịkpọ nkụ.

• ** Ihe kpatara ya (Silent Laryngopharyngeal Reflux / LPR):** Mgbe ị dinara ala n'abalị, obere micro-droplet nke gastric acid na pepsin na-aga elu esophagus gafere sphincter esophageal nke elu wee na-adaba na larynx azụ (nrịbama interarytenoid). N'adịghị ka esophagus (nke nwere ike ịnagide ikpughe acid dị nkenke), mucosa laryngeal nwere ihe fọrọ nke nta ka ọ bụrụ ihe nchebe carbonic anhydrase; otu ntapu nke acid na-ebute ngwa ngwa, ime ihe ike chemoreflex laryngospasm iji chebe ngụgụ.
• ** Otu esi agbaji mgbagha reflux abalị nke Laryngospasm:**
• ** Bilie ma ọ bụ nọdụ ala kwụ ọtọ ozugbo* (kwụsị reflux acid ọzọ).
• *Kwụsịnụ agụụ ike iku ume site n'ọnụ mepere emepe; Si n'egbugbere ọnụ e gbugbere ọnụ gbanye ozugbo ma were imi imi.
• *Ozugbo ntakịrị ikuku gafere, were otu obere mpụta mmiri nke dị n'ọdụ abalị wee loda.
• ** Otu esi egbochi mwakpo abalị: ** Kwụsị nri na mmiri ọ bụla ọbụlagodi ** 3 awa tupu ịlaba ụra , bulie isi ihe ndina elu site na ** 15 ruo 20 centimeters (6 ruo 8 sentimita) ma ọ bụ hie ụra n'elu ohiri isi na-achọsi ike (ịrahụ ụra n'akụkụ aka ekpe ** na-edebe gastroesophageal nke afọ ma ọ bụ onye na-ahụ maka mmiri mmiri n'elu mmiri mmiri), na-abanye n'ime ọdọ mmiri mmiri mmiri. inhibitor (PPI) na ọgwụgwọ raft alginate.

Ụlọ ọgwụ na nchịkwa anesthesia nke Refractory Laryngospasm¶

Na ngalaba mberede ụlọ ọgwụ, ngalaba nlekọta kpụ ọkụ n'ọnụ, ma ọ bụ ụlọ ịwa ahụ (dị ka mgbe ụmụaka tonsillectomy gasịrị, endoscopy elu, ma ọ bụ usoro ọgwụgwọ ketamine), ma ọ bụrụ na laryngospasm zuru ezu adịghị agbaji n'ime 15 ruo 30 sekọnd nke ** Larson's maneuver + chin lift ***, ndị dọkịta na-eme ngwa ngwa proxitocol ma ọ bụ edema akpa ume na-adịghị mma (NPPE) na-etolite:

1. Wepụ ihe mkpali mgbakasị ahụ: Jiri nwayọọ na-amịpụta ọbara, mmiri mmiri, ma ọ bụ ihe nzuzo sitere na hypopharynx n'elu eriri olu wee wepụ ngwaọrụ ikuku supraglottic ọ bụla ma ọ bụ ikuku ọnụ nke na-akụ glottis.
2. ** 100% Oxygen Continuous Positive Airway Pressure (CPAP 10 ka 20 cmH2O) na akara mkpuchi mkpuchi aka abụọ siri ike: ** Jikọta ** Ntugharị Larson ** ya na ihe mkpuchi C-E nke aka abụọ na-ebufe ** 100% oxygen na 10 ruo 20 cmH2O nke ikuku ikuku na-aga n'ihu (CPAP) akpa ogwugwu. Zere ime ihe ike na-eme ka akpa ahụ dị elu ma ọ bụrụ na a na-ekpochi eriri ndị ahụ kpamkpam, dị ka nrụgide n'elu 25 cmH2O na-eme ka ikuku na-agbada esophagus n'ime afọ (ụfụ gastric), na-ebuli elu na diaphragm.
3. ** Sub-Hypnotic Intravenous Propofol (Nke mbụ-akara ọgwụ na-emebi ọgwụ):** Na-elekọta obere bolus intravenous nke Propofol (0.25 ruo 0.8 mg/kg IV). Ịbawanye mgbatị ahụ na propofol dị ala na-agbaji pasent 75 ruo 85 nke refractory post-extubation ma ọ bụ sedation laryngospasms n'ime 15 sekọnd na-achọghị mkpọnwụ ma ọ bụ re-intubation.
4. ** Succinylcholine intravenous ma ọ bụ intramuscular (Gold-Standard Neuromuscular Blockade):** Ọ bụrụ na hypoxia na-akawanye njọ (SpO2 na-agbada n'okpuru 85%) ma ọ bụ bradycardia na-etolite n'agbanyeghị propofol na ụzọ Larson:
5. ** Obere-Dose IV Succinylcholine:** 0.1 ruo 0.25 mg/kg IV ozugbo na-eme ka akwara ụda olu gbawara agbawa n'ime 20 ruo 30 sekọnd ebe ọ na-echekwakwa iku ume diaphragm ozugbo.
6. ** Full-Dose IV Succinylcholine (1.0 ka 2.0 mg/kg IV) ma ọ bụ IM Succinylcholine (4.0 mg/kg IM n'ime deltoid ma ọ bụ quadriceps ma ọ bụrụ na ọ dịghị IV ahịrị dị): *** Kwụsị kpam kpam ụda olu maka ikuku ikuku mberede na endotracheal intubation. ụmụntakịrị iji gbochie oke hypoxic/succinylcholine kpatara bradycardia.
7. ** Heliox (80% Helium / 20% Oxygen) maka Severe Teta Refractory Stridor:** Na Ngalaba Mberede, ndị ọrịa nwere nnukwu teta n'ụra elu ikuku ikuku na-anabata ngwa ngwa na Heliox (80:20 ma ọ bụ 70:30 helium-oxygen Rey) * n'ihi na helium nwere ọnụ ọgụgụ dị nta nke nta nke nta nke nta nke nta nke nitrogen na ngwakọta nitrogen nke asaa. glottic ikuku na-alaghachi azụ n'ime ezigbo ** laminar na-erugharị ka ọ na-emebi usoro mmịpụta nke Bernoulli.

Nọmba mberede mpaghara na ntuziaka ụlọ ọgwụ¶

• United States na Canada: Kpọọ 911 maka stridor ọ bụla nke mbụ, cyanosis, anaphylaxis, ma ọ bụ laryngospasm na-adịghị anabata ya. Soro ** American Thoracic Society (ATS), ** American College of Chest Physicians (CHEST), na ** American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS)** ntuziaka maka nkwenye laryngoscopy na-agbanwe agbanwe nke Inducible Laryngeal Obstruction (ILO) na ọgwụgwọ iku ume.
• United Kingdom: Kpọọ 999 maka nnukwu stridor nwere nsogbu iku ume ma ọ bụ cyanosis. ** European Respiratory Society (ERS) / European Laryngological Society (ELS) / Royal Brompton Hospital ** ụkpụrụ nkwekọrịta na-akọwapụta Inducible Laryngeal Obstruction (ILO) na Mmega ahụ na-akpata Laryngeal Obstruction (EILO) ma na-akwado laryngoscopy na-aga n'ihu n'oge mgbatị ahụ (CLE) ule na ọkachamara okwu na ọgwụgwọ asụsụ.
• ** European Union: *** Kpọọ ** 112 ** gafee mba ndị otu EU niile. Soro nkwonkwo ERS/ELS / ACCP Task Force Consensus nkwupụta na Nomenclature na nchọpụta nke ihe mgbochi laryngeal inducible.
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand. Soro ** Thoracic Society of Australia na New Zealand (TSANZ)** na Australian na New Zealand College of Anesthetists (ANZCA) algorithms njikwa nsogbu laryngospasm.

Ajụjụ a na-ajụkarị¶

Kedu otu m ga-esi amata ọdịiche dị n'etiti Vocal Cord Dysfunction (VCD / ILO) na ọgụ ụkwara ume ọkụ?¶

Ihe dị iche iche doro anya bụ ma ọ na-esiri ike iku ume IN ma ọ bụ pụta, na ebe ụda si na-abịa: na Vocal Cord Dysfunction (inducible laryngeal obstruction), ụdọ olu dị n'olu gị na-emechi ihe na-adịghị mma mgbe ị na-ekuku ume, na-eme ka ọ dị ka ikuku na-akụtu mgbidi na akpịrị gị na ụda olu dị elu (stridor) na ikuku oxygen na-amalite na nkwụsịtụ n'ime nkeji oge. N'ime ọgụ ụkwara ume ọkụ, obere tubes nke dị n'ime obi gị dị warara, na-eme ka ọ sie ike iku ume ikuku site na iku ume iku ume n'ime obi nke chọrọ inhaler bronchodilator (salbutamol/albuterol) na-ewe awa iji dozie.

Kedu ihe bụ ụzọ Larson na kedu ebe ọkwa laryngospasm dị?¶

Ntugharị Larson bụ usoro anụ ahụ mberede nke ejiri mebie laryngospasm siri ike ma ọ bụ zuru oke. The laryngospasm notch (Larson's point) bụ obere triangle yiri indentation ozugbo n'azụ ntị abụọ ntị, nke dị n'agbata azụ azụ nke ọkpụkpụ agba agba (mandibular ramus) n'ihu, ọkpụkpụ mastoid n'azụ ntị na azụ, na isi nke okpokoro isi n'elu. Iji mkpịsị aka etiti gị banye n'ime etiti isi na mkpịsị aka gị dị n'ime n'otu oge, na-adọta ọkpụkpụ agba nke ala n'ike n'ike gaa n'ihu na elu (mgbali agba) na-agbatị anụ ahụ laryngeal na-emeghe ma na-akpalite ụbụrụ cranial reflex nke na-eme ka ụda olu dị jụụ n'ime sekọnd.

Kedu ihe kpatara isi imi gị na iku ume site n'egbugbere ọnụ a na-akpachapụ anya ji akwụsị ụdọ olu?¶

Mgbe ụdọ olu gị na-emechi emechi, na-eku ume site n'ọnụ mepere emepe na-emepụta ohere dị elu (mmetụta Bernoulli) nke na-amịkọrọ ụdọ olu ọbụna karị ọnụ. Iji nwayọọ nwayọọ na-afụ ikuku site na egbugbere ọnụ na-akpachi anya na-emepụta nrụgide azụ dị nro site n'okpuru nke na-eme ka ụda olu dị iche iche dị iche iche, ebe ị na-eji imi abụọ dị nro banye na imi na-eme ka ụbụrụ ụbụrụ arụrụ arụ ọrụ nke na-eme ka uru ahụ cricoarytenoid dị n'azụ, bụ nanị uru ahụ dị n'ime ahụ nke na-adọta ụdọ olu n'èzí.

Gịnị mere m ji na-eteta mgbe ụfọdụ n'etiti abalị ka m na-ekuku ikuku na-emechi akpịrị m?¶

Iteta na mberede site n'ụra enweghị ike ịdọta ikuku n'ime sekọnd 15 ruo 45 site na iji ụda stridor dị elu dị elu bụ ihe na-emetụta ụra nke ọma na reflux laryngospasm. Mgbe ị na-edina ala, obere eriri afọ nke acid afo na digestive enzyme (laryngopharyngeal reflux) nwere ike na-aga elu esophagus gị ma metụ ụda olu gị aka, na-akpalite mmeghachi omume nchebe ozugbo nke na-emechi igbe olu iji mee ka acid pụọ na ngụgụ gị. Ịnọdụ ala kwụ ọtọ, na-afụpụta n'egbugbere ọnụ e kpara akpa, na-esikwa imi gị nwayọọ, na ịratụ mmiri n'ọnụ na-emezigharị ihe ahụ n'ime sekọnd.

Isi mmalite na nduzi ọchịchị¶

• ** European Respiratory Society (ERS), European Laryngological Society (ELS), na American College of Chest Physicians (ACCP):** * Nkwupụta nkwenye mba ụwa na Nomenclature, nchọpụta nchọpụta, na njikwa nke ihe mgbochi laryngeal inducible (ILO na EILO)*.
• ** Larson CP Jr. (Anesthesiology / Clinical Airway Management): *** * Laryngospasm: Ọgwụgwọ kachasị mma (Nkọwa ntọala nke Laryngospasm Notch na Larson's Jaw-Thrust Maneuver)*.
• ** American Thoracic Society (ATS) na American Academy of Allergy, Asthma, and Immunology (AAAAI):** Clinical differentiation and Co-Management of Vocal Cord Dysfunction (Paradoxical Vocal Fold Motion) na Asthma.
• ** Njikọ nke Anesthetists (United Kingdom) na Australian na New Zealand College of Anesthetists (ANZCA):** * Perioperative Laryngospasm Crisis Management Algorithm (CPAP, Larson's Maneuver, Propofol, na Succinylcholine)*.
• ** Royal College of Speech and Language Therapists (RCSLT) na American Speech-Language-Hearing Association (ASHA):** Mmeghachi ume iku ume na ọgwụgwọ EILOBI maka mgbochi laryngeal inducible.

Ntuziaka emetụtara¶

• Asthma wakpo ọgwụgwọ mberede na usoro inhaler spacer
• Epiglottitis, croup, stridor, na nnukwu mgbochi nke elu ikuku
• Ihe na-adịghị mma-nrụgide na-adịghị mma edema (NPPE) mgbe ọ kwụsịrị ịkụda ma ọ bụ laryngospasm.
• Mmeghachi omume nfụkasị na anaphylaxis enyemaka mbụ
• Nọmba mberede site na obodo