Mubedi wa Parkinson mu lupitadi: Bua tshinyi dipanga dia Sinemet/Levodopa anyi dipeta dia Haldol didi difikisha ku lufu¶

Bantu bapite pa 300,000 badi ne disama dia Parkinson (PD) batu babuela mu lupitadi tshidimu tshionso bua dikuluka, ditshibuka dia tshiadi, disama dia mu tshiadi, disama dia tshiadi, anyi dipanda dia pa tshibidilu, ne makebulula a mu lupitadi adibu benze kudi tshisumbu tshia Parkinson adi aleja ne: 3 pa bantu 4 badi ne disama dia Parkinson badi mu lupitadi badi ne ntatu idibu mua kuepuka buludiludi ku diambuluisha dia manga adibu bafila mu lupitadi mikenji. Mu nzubu wa lupitadi anyi mu tshibambalu tshia malu a mpukapuka, mikenji ya baminganga idi yanyishila bua kufila "manga a ku mishiku" muaba wonso mu 1-to-2-hour window kumpala anyi panyima pa dîba didibu balongolole (09:00 AM / 13:00 PM / 17:00 PM / 21:00 PM), anyi udi ulama mapilu onso a mukana ("NPO / Nothing by Mouth") padiye muindile dikonkonona dia dimina anyi dipanda.

Bua mubedi udi ne disama dia Parkinson dia pa tshibidilu anyi dikole udi buongo buende bujimije 80 pa lukama ya biamu bidi bipatula dopamine, kulekela kuangata dose wa carbidopa/levodopa (Sinemet, Rytary, Madopar, Stalevo, Prolopa) nansha mu minite 30 too ne ku 60 udi lutatu lua luondapu. Mu dîba dimue dia dipanga dia dose, misunyi ya mu nshingu ya mubedi idi ijika (dopamine-depletion dysphagia), bienza bua ikale ufua ne upuekesha mate ende mu mikolo yende (aspiration pneumonia ), mionji yabu ya dîyi kayena mua kubabikila bua kubambuluisha mu mikolo yabu ne misanshi mikole bukole bua tshiamu tshia plomb. Tshidi tshibi menemene, kuimanyika levodopa mu tshimpitshimpi munkatshi mua mêba 12 too ne ku 48, anyi kuela mubedi manga a pa tshibidilu a mu lupitadi adi akandamena disama dia mutshima anyi dia dibungama adi apangisha dopamine (D2) bipeta, bu mudi haloperidol (Haldol), metoclopramide (Reglan), prochlorperazine (Compazine), anyi promethazine (Phenergan), udi ufila Parkinsonism-Hyperpyrexia Syndrome (PHS), disama dia neuroleptic-malignant-like crisis ne 40°C+ (104°F+) luya, dinyanguka dia mifuba (rhabdomyolyse), dipanga dia mfyo, ne lufu lua bantu 4 too ne ku 20 pa lukama. Shi mubedi wa Parkinson mupeta disama dia tshimpitshimpi, luya lukole, kayi mua kumina, stridor, anyi dishintuluka dia lungenyi, ubikile nimero wa lupitadi lua muaba unudi (911 mu États-Unis ne mu Canada, 112 mu matunga masanga a ku Mputu, 999 mu Royaume-Uni) anyi tangila nomba ya tshimpitshimpi tshilaminu. Bua malu a tshimpitshimpi a mu lupitadi lua bantu bakulumpe, bala dibungama dia mu lupitadi ne diambuluisha dia malu a luondapu bua bakulakaje, disama dia tshiadi: dikuma dia mayi makese, disama dia tshiadi, ne dilama dia biakudia bia bungi, ne polypharmacy, dipitshisha dia manga, dijimija dia manga, ne bilema bia mulongolodi wa manga.

Enza nunku mpindieu¶

1. **Ambula manga onso a muntu uudi munange a disama dia Parkinson mu milondo yende ya kumpala mifundapu mu farmasi mu nzubu wa lupitadi, ne lomba munganga wa mu lupitadi diakamue bua "Mukenji wa difila dia manga a mubedi nkayende" anyi "Mukenji wa tshikondo tshia mushinga mukole (15Misangu **Umbushe lupitalo ku nzubu ya lupitadi." misangu ya bungi mu nzubu ya manga kayena ne bukole bua pa buabu anyi manga adibu bapatula mutantshi mule a carbidopa/levodopa (Rytary, Sinemet CR, entacapone, rasagiline, rotigotine bipese) mu tshiamu tshia ER Pyxis, bifikisha ku dipanga dia mêba 8 pa kumbusha wewe mulue ne milondo ya ku nzubu.
2. Ujadike ne: munganga udi witaba udi ufunda Carbidopa/Levodopa mu ordinatere wa lupitadi bu "MUDIMU WA MUDIMU WA MUDIMU" pa dîba dia mubedi (e.g., 07:30, 11:00, 14:30, 18:00, 21:30), KAKUENA bu mudi lupitadi lua tshibidilu "TID / QID" (09:00, 13:00, 17:00, 21:00). Muinshi mua Centers for Medicare & Medicaid Services (CMS) Hospital Conditions of Participation, manga adibu bafunde ne: Time-Critical adi ne bua kufidibua mu minite 15 too ne ku 30 ya dîba dijalame, kupita tshikondo tshia luse tshia mêba 2 tshia lupitadi.
3. Lomba kudi munganga wa mu lupitadi ne muena manga wa mu lupitadi bua kufunda "ALLERGIE WA MANGA / ABSOLUTE CONTRAINDICATION ALERT" mu mukanda wa luondapu wa mu tshiamu mpindieu bua manga onso adi apangisha dopamine: Haloperidol (Haldol), Metoclopramide (Reglan), Prochlorperazine (Compazine), Promethazine (Phenergan), Droperidol (Inapsine), Risperidone (Risperdal), Olanzapine (Zyprexa), ne Aripiprazole (Abilify). Kuteka manga aa mu Allergy Field wa ordinatere wa lupitadi kudi kuenzeja bua kuimanyika tshiamu tshia nzembu pikala muntu udi wenza mudimu wa butuku anyi munganga wa anesthesie ukeba kulomba Haldol bua dibungama anyi Reglan / Compazine bua tshiji tshia panyima pa dipanda.
4. Bikala lupitadi luteka mubedi pa "NPO (Nothing by Mouth)" bua kumupanda, bua kuenza mudimu wa ER, anyi bua kuenza tshikebelu tshia dimina tshidi katshiyi tshikumbane, KULEKELEJI nansha kakese bua balekele manga abu a dopamine. Lomba munganga bua kulomba diakamue umue wa ku mishindu isatu ya NPO dopamine idi kayiyi ne njiwu:
5. Njila A: Ela Nasogastric (NG) Tube wa tshitupa tshîpi ne ufila immediate-release (IR) carbidopa/levodopa mu mayi (never crush extended-release CR/ER pills), ANYI
6. Mushindu B: Kufila Carbidopa/Levodopa udi unyanguka ku mishiku (Parcopa) udi unyunguluka pa ludimi ne mate, OR
7. Njila C: Ela tshiamu tshia Rotigotine Dopamine Agonist Skin Patch (Neupro) bua kulama dikankamija dia dopamine dia ku ntuadijilu padi tshifu katshiyi mua kufika.
8. Bikala mubedi ne tshiamu tshia Deep Brain Stimulation (DBS) anyi tshiamu tshia Duopa/Vyalev intestinal/subcutaneous pump, ambila munganga wa ER ne munganga wa dipanda diakamue. Kulekedi monopolar electrocautery mu tshikondo tshia dipanda kuyi muele DBS neurostimulator mu Mushindu wa dipanda, kulekedi nansha kakese mubedi ne MRIBS wa mu tshitupa tshikole kuyi utangila ** DBS Kalata ka ID** bua mikalu ya Tesla/coil, ne kujimiji bateri wa DBS nansha kakese, anu wewe mulongolole bua kujikija lutatu lua dyskinesie ludi lufumina ku dikankamija.
9. Tampa anyi uleje mukanda wa Parkinson's Foundation "Mukanda wa bukubi wa lupitadi / Karte ka didimuija dia luondapu" (parkinson.org/hospital) ne ufunda mukanda wa manga adi kaayi malelela buludiludi pa mutu pa bulalu bua lupitadi.

Mutshi wa mapangadika: Kukuba mubedi wa Parkinson kubangila ku dîba didiye ubuela mu nzubu wa luondapu¶

flowchart TD
    A["Mubedi wa disama dia Parkinson udi ufika ku lupitadi lua ER anyi kumpala kua dipanda"] --> B["Tshitupa 1: Kulama milondo ya manga ya ku nzubu + kulomba 'Dîba dia mushinga mukole dia minite mijalame' (mu minite 15 ya programe wa ku nzubu)"]
    B --> C["Tshitupa 2: Funda 'Haloperidol, Metoclopramide, Prochlorperazine, Promethazine, Risperidone, Olanzapine' mu EMR ALLERGY / CONTRAINDICATION Alert Box"]
    C --> D{"Mubedi udi mua kumina manga onso bimpe mpindieu anyi?"}
    D -->|"Eyowa: Kumina bimpe ne ki NPO to"| E["Fila manga a ku nzubu pa dîba (Lama mayi mu bululame; biakudia bidi ne proteyine mutantshi wa minite 30-60 kule ne Levodopa)"]
    D -->|"Tòo: Mubedi udi 'NPO' bua dipanda anyi bua dikuma / dipanga dia tshikebelu tshia dimina"| F{"Bua tshinyi kabena mua kumina manga onso?"}
    F -->|"1. Kufua bualu bua dose wabu wa ndekelu wa levodopa uvua mupangile ('Off-State Dysphagia')"| G["Udi mua kufila Carbidopa/Levodopa (Parcopa) anyi Crushed IR Sinemet mu tshisuku tshia mabele -> Teta kabidi bua kumina minite 45 pashishe mu nsombelu wa 'ON'"]
    F -->|"2. NPO mikole bua dikanga dia mala, dibueja dia munda, anyi dipanda dinene"| H["KULEKELA Dopamine: Ela NG Tube bua Crushed IR Carbidopa/Levodopa Suspension NANSHA Ela Transdermal Rotigotine Patch (Neupro)"]
    E --> I{"Mubedi uvua mupeta disama dia tshimpitshimpi >38.5°C, disama dia tshimpitshimpi, dipanga dia lungenyi anyi CK mubandile anyi?"}
    G --> I
    H --> I
    I -->|"EYOWA: Badi bela meji ne: udi ne disama dia Parkinson-Hyperpyrexie (PHS)"| J["ICU EMERGENCY: Tangila diakamue Levodopa ku diambuluisha dia NG Tube + IV Fluids + Active Cooling + IV Dantrolene / Oral Bromocriptine"]
    I -->|"NO: Mushindame"| K["Ikala upatuka pa bulalu 3x/dituku ne PT bua kuepuka dipueka dia mashi ne dijimija dia makanda a mubidi"]

Buanga bua mu lupitadi budi kabuyi ne njiwu ne budibu bakandike bua babedi badi ne disama dia Parkinson¶

Tampa anyi uleje munganga yonso wa mu lupitadi, munganga wa anesthésie, munganga wa mu lupitadi ne munganga wa mu lupitadi udi ulama muntu uudi munange tablo eu:

Bua tshinyi dipanga dia minite 60 mu Carbidopa/Levodopa didi difikisha ku "Dipuekesha dia lupitadi"¶

Baminganga ba mu lupitadi badi balama bantu nkama ne nkama badi basama misangu ya bungi kabatu bamanye bua tshinyi bena mu dîku dia mubedi wa Parkinson batu batshioka padi 10:00 AM tshiamu tshia levodopa katshiena tshifika to 10:45 AM. Umvuija "Hospital Dopamine Spiral" kudi munganga udi panshi ne munganga udi ufuta diakamue:

1. Dikepela dia "Dididishi dia luondapu" mu disama dia Parkinson didi dienda dikola¶

Ku ntuadijilu kua disama dia Parkinson, buongo budi anu ne tuishi tua substantia nigra tua bungi tudi tushala ne muoyo bua kulama dopamine ne kukanda diondapangana dia panyima pa mêba 3 anyi 4. Mu tshidimu tshia 5 too ne tshia 10 tshia disama dia Parkinson, selile ya dilama idi ijika: bukole bua mubedi bua kuendakana, kuakula ne kumina budi bumanyine buludiludi pa tshitupa tshia minite 90 tshia plasma wa tshiamu tshionso tshia levodopa.

Padi lupitadi lulekela difila dia manga mu minite 60, malu anayi a njiwu adi enzeka lukasa lukasa:

1. Minute 45, "Dijimija" Dikankamika, Kanyinganyinga, ne Dystonia wa kanyinganyinga: Bipimu bia dopamine mu striatum bidi bipueka. Mubedi udi upeta dikankamika dikole dia dikisha, buôwa bukole bua munda ne dipanga dia lungenyi (tshimanyinu tshia dipueka dia dopamine tshidi misangu ya bungi tshimanyishibua bibi kudi bena mudimu ba mu lupitadi bu "dibungama dia mu lungenyi"), ne disama dia nsongo dia minu, dia bana ba ngombe ne dia nshingu.
2. Minute 60, "Off-State Dysphagia" (Frozen Swallowing): Mishipa ya mu tshiadi ne ya mu tshiadi idi ikengela dopamine bua kuenza mudimu wa dimina. Padi mubedi ubuela mu "OFF", kabena kabidi mua kumina bimpe to, bidi biumvuija ne: padi munganga ufika mu minite 90 panyima pa dîba ne dikopo dia manga onso, mubedi udi mpindieu ufua ku manga.
3. Minute 75, The Speech Therapy "NPO Trap": Bualu mubedi uvua ukokola pavuaye ukeba kumina manga ende a ndekelu mu nsombelu wa "OFF", munganga udi uteka mubedi pa "Strict NPO (Nothing by Mouth)" ne udi ulomba bua kuenza tshikebelu tshia Speech-Language Pathology (SLP) bua kumina malaba. Bu mudi mubedi mpindieu NPO, munganga udi ulama 14:00 PM, 18:00 PM, ne 22:00 PM levodopa kabidi.
4. Dîba dia 12 too ne ku 24, Dijika dia Akinetic dijima, Pneumonie wa Aspiration, ne Delirium: Padiye mupangile dopamine yonso munkatshi mua mêba 12+, mubedi udi ulua kayi ne tshia kuenza ("muela mu bulalu"), udi upuekesha bintu biende bia mukana mu mikolo yende, udi upeta disama dia pneumonie dia mu lupitadi ne dia spirale, ne uya ku mikolo Disama dia Parkinson-Hyperpyrexia.

2. Mushindu kayi wa kutshibula "Swallow Screen NPO Trap" ku luseke lua bulalu¶

Bikala munganga anyi munganga wamba ne: "Tatuebe uvua mukokola mu mayi makese mu tshikondo tshia dikonkonona dia ER, nunku udi NPO ne kena mua kunua manga ende a Sinemet," udi mua kubuela diakamue ne malu asatu aa:

• Mukenji 1 (Kuteta nansha kakese dimina dia mubedi wa Parkinson padiye mu nsombelu wa "OFF"): Kuteta dimina dia mubedi wa Parkinson padiye mumane kupita mêba 3 bua levodopa kudi kuleja ne: nebapangile. Lomba munganga bua kukupesha dose umua wa Orally Disintegrating Carbidopa/Levodopa (Parcopa) pa ludimi, anyi Crushed Immediate-Release (IR) Carbidopa/Levodopa misambakaja mu 1 lupongo lua tshiayi tshia applesauce anyi pudding, windile minite 45 bua dopamine avuije mishipa ya mu nshingu ya mubedi "ON", ne pashishe enza bua mumanyi wa malu a muakulu enze dikonkonona dia disama dia muakulu.
• Mukenji 2 (Dipingaja dia bukubi pikala manga a tshikondo tshile kaayi mua kunyangakaja):
• KUENA mua kutshibula anyi kutafuna Extended-Release Carbidopa/Levodopa (Sinemet CR / ER) anyi kutafuna Capsules ya dipatuka dia matuku a bungi (Rytary) pikala mubedi kayi mua kumina mapilu onso. Padi Rytary bibombi bidi mua kubuluibua bimpa ne kuela mabue pa tshintu tshia pome kuyi utafuna mabue, Sinemet CR Ma tablete adi ne tshia kukudimunyibua mu dose wa muomumue wa Immediate-Release (IR) Carbidopa/Levodopa (pa tshibidilu dipuekesha dia dose mujima wa miligrame ku 25 too ne ku 30 pa lukama bua kufila biodisponibilité wa IR wa bungi ne difila dia dose misangu mikese) kumpala kua kutshibula bua kuenza natshi NG tube.
• Mukenji 3 (Levodopa-to-NG-Tube ne Rotigotine Patch Conversion Calculations):
• Padi mubedi wa Parkinson kayi ne tshia kuenza mudimu wa dipanda dia mu difu, dikanga dia mala, anyi dienza dia kapepe mu ICU, munganga wa mu lupitadi ne munganga wa mitu badi ne bua kubala Levodopa Equivalent Daily Dose (LEDD) bua mêba a bungi a dopamine kajimijibue:
• Nasogastric (NG) Tube Liquid Suspension Protocol: Immediate-Release (IR) Carbidopa/Levodopa (25/100 mg) ma tablette adi anyanguka lukasa mu 30 mL (1 fl oz) wa mayi a mu pompi a luya lua mu nzubu (anyi mayi a gaze/dilongolola dia acide ascorbique) mu minite 5 ya kunyunguluka bitekete kakuyi dijinga dia kutshibula bikole. Sukula tshiamu tshia NG ne 30 mL wa mayi kumpala ne kunyima kua dibueja dia levodopa, ne ukanga tshiamu tshia NG bua kutshikuma munkatshi mua minite 30 anyi 45 kunyima kua difila dionso bua tshifu tshikuate manga.
• Transdermal Rotigotine (Neupro) Patch Bridge (When the Gut Cannot Be Used): Shi mubedi udi na ileus wa paralytic, obstruction ya mu mala makese, anyi anastomose wa mu tshifu udi kayi mua kubuela nansha mâyi a NG-tube, lomba munganga wa mitu bua kuela 24-hour Transdermal Rotigotine Dopamine Agonist Patch (Neupro, udi mu 2 mg, 4 mg, 6 mg, ne 8 mg/24 hr bipese) bua kusukula kikoba ku dikaya, ku diboko dia kuulu, ku difu, anyi ku tshiadi (kushintulula miaba dituku dionso ne kumbusha tshipese tshia aluminium kumpala kua kuenza MRI bua kuepuka dikoba dia kuosha).
• Ikala mudimuke bua proteyine ya kudia mu tube idi ipangisha dikuata dia levodopa: Acides aminées (protéines) ya mu biakudia idi iluangana buludiludi ne levodopa bua kupitshila mu tshimanu tshia mala ne mu tshibuelelu tshia mashi ne buongo (large neutral amino acid transporter). Shi muntu uudi munange udi muteka mu mayi a munda mua meba 24 didia dia mu tshiamu tshia munda (Jevity, Osmolite, Ensure) kupitshila ku tshiamu tshia NG anyi tshia PEG, proteyine ya bungi idi mu tshiamu etshi neyipangishe 70 pa lukama ya levodopa yabu mitshibule bua kufika mu buongo buabu, neyibashiye mu mashika nansha mudibu bapeta manga abu. Lomba munganga ne mumanyi wa malu a bidia bua kulama didia dia mu tshibombi munkatshi mua minite 60 KUMPALA ne minite 30 too ne ku 60 PANYIMA pa dose yonso wa levodopa udibu balongolole (anyi kushintulula ku didia dia mu tshibombi tshia bolus mu munya/butuku didibu balongolole pabuipi ne madidishi a levodopa).

Deep Brain Stimulation (DBS) ne Duopa/Vyalev pump mu lupitadi¶

Makumi a binunu bia bantu bakulumpe badi ne disama dia Parkinson badi beyemena Deep Brain Stimulation (DBS) neurostimulators (mienza kudi Medtronic, Abbott/St. Jude, anyi Boston Scientific) anyi pompi ya dibueja dia mashi mu mubidi (Duopa carbidopa/levodopa enteral gel ku diambuluisha dia PEG /V** tube Produodopa** 24-hour subcutaneous foscarbidopa/foslevodopa infusion). Padi mubedi udi ne tshimue tshia ku biamu ebi ubuela mu tshibambalu tshia malu a mpukapuka anyi mu nzubu wa dipanda, bena mudimu ba mu lupitadi badi kabayi bamanye tshiamu etshi badi mua kumutapa ku mpukapuka anyi kumukebela lutatu lua dilekela dopamine.

1. Mikenji isatu ya mushinga mukole ya bukubi bua lupitadi bua biamu bia Deep Brain Stimulation (DBS)¶

2. Tshia kuenza pikala Duopa (PEG-J) anyi Vyalev (Subcutaneous) Infusion Pump kayi wenza mudimu mu ER¶

• Kulekedi munganga wa mu lupitadi ujima tshiamu tshia Duopa anyi tshia Vyalev kuyi ne tshiamu tshia levodopa tshia ku mishiku/NG to:
• Mubedi udi pa Duopa (carbidopa/levodopa enteral suspension) pump anyi Vyalev (foscarbidopa/foslevodopa) pompe wa muinshi mua dikoba udi upeta 100 pa lukama ya dopamine wabu wa dituku dionso ku diambuluisha dia pompe au.
• Shi tshiamu tshia munda tshia PEG-J tshikanga/tshipatuka, pikala pompe mujikije kasete mu ER, anyi pikala munganga mupatule pompe bua kuenza CT scan ne mupue muoyo bua kumutuadija kabidi, bungi bua levodopa mu plasma wa mubedi budi bupueka ku zero mu minite 60.
• Mukenji wa disungila dia lukasa: Sukula tshiamu tshia Duopa PEG-J tshidi tshikanga bitekete bitekete ne mayi a kapia ku diambuluisha dia tshiamu tshia Luer-lock (never push against hard resistance). Shi tshiamu tshia nzembu anyi kasete katshienaku mu tshisalu tshia manga tshia mu lupitadi, munganga udi ne tshia kubala diakamue bungi buonso bua munya + bua mu dinda bua bolus milligramme ya levodopa ne kumupesha **carbidopa/Levodopa wa mukana anyi wa NG-tube Immediate-Release Carbidopa/Levodopa wa mukana anyi wa NG-tube kunyima kua mêba 2 too ne ku 3 ** too ne padi kasete kapia ka mu dîku kalua ne kasete ka mu diku nzubu.

Kumanya ne kuondopa "Disama dia Parkinson-Hyperpyrexia" (PHS / Dipanga dia Dopamine)¶

Disama dia Parkinson-Hyperpyrexia (PHS), didibu babikila kabidi ne: Akinetic Crisis anyi Neuroleptic Malignant-Like Syndrome (NMLS), ke disama dia mu lungenyi didi dishipa bantu bikole mu disama dia Parkinson. Didi dijuka padibu bimanyika anyi bapuekesha manga a mubedi mu tshimpitshimpi munkatshi mua mêba 12 too ne ku 72 (mu tshikondo tshia NPO, dipanda dia mala, dibuela mu ICU, anyi milondo ya manga idi mijimine), padi disama anyi dipanga dia mâyi mu mala dipangisha dibuela dia dopamine mu mala, anyi padi manga adi akanda dopamine (Haldol, Reglan) udi mufila.

flowchart TD
    A["Mubedi wa disama dia Parkinson mmupangile manga a Levodopa munkatshi mua mêba 12 anyi mmupete manga adi apangisha dopamine (Haldol / Reglan / Compazine)"] --> B["Tangila bimanyinu binayi bia disama dia Parkinson-Hyperpyrexie (PHS)"]
    B --> C["1. Dikolesha dia mifuba dia 'Lead-Pipe' dikole ne Akinesia (Kakuyi mushindu wa kunyungisha bianza, kuakula anyi kumina)"]
    B --> D["2. Kapia kakole / Kapia kakole (38.5°C too ne ku 41.0°C+ / 101.3°F too ne ku 105.8°F+) Kabiena biumvuija anu kudi disama to"]
    B --> E["3. Dipanga dia bupole (dishintuluka dia mashi mu mashi, tachycardie >110 bpm, difu dia bungi)"]
    B --> F["4. Dishintuluka dia lungenyi (dipanga dia lungenyi, dipanga dia lungenyi, dipanga dia lungenyi, dipanga dia lungenyi) + Serum Creatine Kinase mubandile (CK >1,000-10,000 U/L)"]
    C --> G["MUKENDE WA LUPILU LUA ICU"]
    D --> G
    E --> G
    F --> G
    G --> H["1. Pingaja diakamue dopamine: Ela NG Tube ne ufila programe wa ku nzubu wa Crushed Immediate-Release Carbidopa/Levodopa (anyi Rotigotine Patch / Apomorphine)"]
    H --> I["+"]
    I --> J["3. Ela IV Dantrolene Sodium (1 to 2.5 mg/kg IV) bua kujikija bukole bua mifuba + Oral/NG Bromocriptine (2.5 to 10 mg TID)"]

• Bua tshinyi Tylenol (Acetaminophen) kena mua kuimanyika tshipupu tshia PHS to: 40°C (104°F) disama dia Parkinson-Hyperpyrexia Syndrome didi difumina ku dijimija dia dopamine wa mu hypothalamus ne ku dikosa dia mifuba ya mifuba idi kayiyi ishintuluka mu mubidi mujima, ki nganu kudi cytokines idi isama to. Bintu bidi bipuekesha kapia bia pa tshibidilu (acetaminophen / ibuprofen) nebipangile anu padi tshisumbu tshipingaja levodopa diakamue ku diambuluisha dia tshiamu tshia NG, tshipesha mubedi mashika pambelu ne bilamba bia mashika/bipese bia mashika, tshibueja mâyi a IV a bukole bua kupatula myoglobine mu mifuba, ne tshifila IV Dantrolene (muscle relaxant) anyi Bromocriptine (padogonist).

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

Ingidija mishindu eyi ya malu a mitu, ya bukubi bua babedi ba mu lupitadi, ne ya diambuluisha dia lukasa bua kukuba mubedi wa Parkinson udi mu lupitadi mu tshitupa tshienu:

• États-Unis:
• Emergency EMS / Acute Rigidity or Airway Choking: Bikila 911.
• Tshiamu tshia diambuluisha tshia Parkinson's Foundation (Nurse & Hospital Safety Specialists): Bikila 1-800-4PD-INFO (1-800-473-4636) anyi kuangata tshiamu tshia bukubi tshia lupitadi ku parkinson.org/hospital. Shi munganga wa mu lupitadi ubenga kulomba levodopa wa tshikondo tshikole anyi kulomba buanga budi kabuyi bukumbane bua kupangisha dopamine, telefone wa diambuluisha dia tshisumbu tshia Parkinson udi mua kukupesha mabeji a luondapu adibu bakonkonone kudi bena mudimu nebe bua munganga webe ne kukusangisha ne Muleji mpala wa babedi / Mulombodi wa malu a luondapu wa lupitadi.
• Tshisumbu tshia disama dia Parkinson tshia mu Amerike (APDA): Bikila 1-800-223-2732 (apdaparkinson.org).
• Joint Commission / CMS Hospital Patient Safety Complaints: Shi lupitadi ludi kaluyi lufila manga a Parkinson nansha mudi bena mu diku dilomba, lomba bua kuya diakamue ku luseke lua bulalu kudi Mulombodi wa malu a njiwu ya lupitadi / Mulombodi wa babedi ne Mudimu wa dikonkonona dia malu a mitu mu nzubu.
• Canada:
• Tshilumbu tshia lukasa: Bikila 911.
• Parkinson Canada ("ACT on Time®" Hospital Kit): Bikila 1-800-565-3000 anyi kutangila parkinson.ca bua kuangata ACT on Time® karte ka didimuija dia manga a lupitadi ne karte ka manga adi kaayi ne bukubi anyi adi kaayi ne bukubi (kumanya ne: mu Canada, Domperidone [Motilium] ne Ondansetron [Zofran] i manga abidi adi kaayi ne njiwu adi ambuluisha bua kujikija disama dia Parkinson, eku Maxolon [metoclopramide] ne Stemetil [prochlorperazine] ki mbimpe to).
• Bukalenge buobumue:
• Tshilumbu tshia lukasa: Bikila 999 (anyi 111 bua mibelu ya lukasa ya NHS).
• Parkinson's UK ("Get It On Time" Campaign & NHS Electronic Prescribing Mandate): Bikila Parkinson's UK Helpline ku 0808 800 0303 (parkinsons.org.uk). Muinshi mua NICE Guideline NG71 (Parkinson's disease mu bantu bakole) ne NHS England Patient Safety Alerts, nzubu yonso ya lupitadi ya NHS idi ne bukokeshi bua kuteka manga adi ambuluisha bua kujikija disama dia parkinson (co-careldopa / Sinemet, co-beneldopa / Madopar, rotigotine bipese, apomorphine) bu Maluvu adi akengela dîba adibu bafila mu minite 30** ya dîba dia ku nzubu kua mubedi, bua kuanyishila Difila dia manga nkayende (SAM) mu nzubu wa lupitadi padiku mushindu, ne bua kuyukila ne Munganga wa disama dia Parkinson (PDNS) mu mêba 24 a dibuela mu lupitadi.
• Buobumue bua matunga a ku Mputu:
• Tshilumbu tshia lukasa: Bikila 112. Lomba munganga wa mu lupitadi udi witaba bua kubikila bena mudimu ba mu lupitadi lua malu a mitu diakamue bua kukudimuna mukana Madopar / Sinemet ku tshintu tshidi mua kunyanguka (Madopar Dispersible / LT) ku diambuluisha dia tshiamu tshia nasogastric anyi Rotigotine (Neupro) transdermal patch pikala mubedi muenza NPO (à jeun / nüchtern).
• Australie ne Nouvelle-Zélande:
• Tshilumbu tshia lukasa: Bikila 000 (Australie) anyi 111 (Nouvelle-Zélande).
• Parkinson's Australia ("Get It On Time" Hospital Protocol): Bikila 1800 644 189 (parkinsons.org.au) anyi Parkinson's New Zealand ku 0800 473 4636 (parkinsons.org.nz). Mu Australie ne mu Nouvelle-Zélande, Maxolon (metoclopramide) ne Stemetil (prochlorperazine) badi benza mudimu bikole bu manga a kumpala a lupitadi ne a ED; ambila baminganga badi mu ambulanse kumpala kua bobu kupatula tshintu tshia kuondopa natshi mutshima ne: mubedi udi ne disama dia Parkinson ne udi ne bua kumupesha ANYI Ondansetron (Zofran) anyi Domperidone (Motilium).
• India ne Asia-Pacifique:
• Tshilumbu tshia lukasa: Bikila 112 anyi 108. Patudi tuangata mubedi wa disama dia Parkinson Syndopa (levodopa/carbidopa) ku lupitadi lua mu Inde, lua ne bintu bia ku nzubu buludiludi ku ICU/tshibambalu tshia baminganga ne ulombe munganga udi musombele bua kubenga kufila Perinorm (metoclopramide), Stemetil (prochlorperazine), anyi Serenace (haloperidol); dilomba Emset / Ondem (ondansetron) anyi Domstal (domperidone) bua kuela manyi ne Qutipin (quetiapine) pikala dikisha dikengela.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi bidi ne njiwu pikala lupitadi lufila Sinemet (carbidopa/levodopa) wa baledi banyi dîba dimue panyima pa dîba?¶

Mu disama dia Parkinson dia pa tshibidilu, buongo budi bujimija tusumbu tua bungi tudi tupatula ne tulama dopamine, bidi biumvuija ne: mubedi udi wimanyina buludiludi pa tshitupa tshia minite 90 tshia tshitupa tshionso tshia carbidopa/levodopa tshidibu balongolole bua kuendakana, kuakula ne kumina. Padi munganga wa mu lupitadi ulengulula difila dia manga mu minite 45 to ne ku 60, mubedi udi ubuela mu nsombelu wa "OFF" wa tshimpitshimpi: misunyi yende ya mu nshingu idi ikola nunku idi ikuata mate ne kayiyi kabidi mua kumina manga, mubidi wende udi unyanguka bikole, ne dipanga dia manga mutantshi mule didi mua kufikisha ku disama dia Parkinson-Hperxiaperysyndrome.

Mmalu kayi adibu batamba kuenza mu lupitadi adibu kabayi ne bua kupesha mubedi udi ne disama dia Parkinson?¶

Mubedi udi ne disama dia Parkinson kena ne tshia kupeshibua manga adi apitshila mu tshibuelelu tshia mashi ne buongo ne adi akanga D2 dopamine to. Mishindu ibidi ya njiwu mu lupitadi i manga adi apangisha disama dia tshiadi, nangananga Metoclopramide (Reglan / Maxolon), Prochlorperazine (Compazine / Stemetil), Promethazine (Phenergan), ne Droperidol, ne manga a tshimpitshimpi anyi a bukole bua bungi adibu bafila bua disama dia tshiadi, nangananga Haperidolidolidol (Risperdal), Olanzapine (Zyprexa), ne Aripiprazole (Abilify). Lomba munganga wa mu lupitadi bua kubueja manga onso aa mu kazubu ka Allergy/Contraindication ka ordinatere wa lupitadi diakamue padiye ufika.

Mmalu kayi adi ambuluisha muntu udi ne disama dia Parkinson mu lupitadi?¶

Bua disama dia tshiadi ne dia nsukadi, manga a mu lupitadi adi kaayi ne njiwu adi Ondansetron (Zofran), udi ukandika serotonin 5-HT3 pamutu pa dopamine (manya: kanusangishi Zofran ne apomorphine to), anyi Domperidone mu matunga adi kaayi a mu États-Unis. Shi mubedi wa Parkinson udi mu lupitadi upeta disama dia tshiadi tshikole, dimona dia malu mu mpukapuka, anyi dibungama didi kadiyi mua kujikija ne manga adi kaayi a dilongesha, manga adi kaayi ne njiwu adibu mua kuenza adi Pimavanserin (Nuplazid), Quetiapine (Seroquel) wa dose mukese anyi Clozapine (Clozaril), bualu kaena apangisha stritoral receptor dopamine to.

Lupitadi ludi ne tshia kuenza tshinyi pikala muledi wanyi udi ne disama dia Parkinson muteka pa "NPO (Nothing by Mouth)" bua dipanda anyi tshikebelu tshia dimina tshidi katshiyi tshikumbane?¶

Kulekedi tshisumbu tshia lupitadi tshilama anyi tshilekela manga a Parkinson bualu mubedi udi NPO to. Shi mubedi mupangile tshikebelu tshia dimina bualu levodopa wende uvua mufike panyima pa dîba, lomba munganga bua kumupesha Orally Disintegrating Carbidopa/Levodopa (Parcopa) ku ludimi anyi Immediate-Release Sinemet mutshibule mu lupongo lua tshiayi tshia applesauce, windile minite 45 bua mishipa ya mu nshingu ipingane panyima," "udi wamba ne: " Shi mubedi udi ne tshia kuenza mudimu wa dipanda anyi wa dibueja dia tshiamu tshia nzembu, munganga udi ne tshia kuteka tshiamu tshia nasogastric (NG) tshia tshitupa tshîpi bua kumupesha carbidopa/levodopa udi upatuka diakamue bilondeshile dîba, anyi kumuela tshiamu tshia transdermal Rotigotine (Neupro) dopamine agonist skin patch.

Disama dia Parkinson-Hyperpyrexie (PHS) ntshinyi, ne mmunyi mundi mua kudimanya?¶

Disama dia Parkinson-Hyperpyrexie (didibu babikila kabidi ne: Akinetic Crisis anyi Neuroleptic Malignant-Like Syndrome) ndisama dia lukasa dia luondapu didi mua kunyanga muoyo didi dijuka padibu bimanyika levodopa wa muntu udi ne disama dia Parkinson mu tshimpitshimpi munkatshi mua mêba 12 anyi 48 anyi padibu bamupesha manga adi apangisha dopamine bu mudi Hallanlog anyi Hallanlog. Bidi bimueneka bu disama dia Neuroleptic Malignant Syndrome: dikolesha dia misunyi mikole mu mubidi mujima, luya lukole lua pa mutu pa 38,5 too ne ku 41 degre Celsius (101,3 too ne 105,8 degre Fahrenheit), dikuma dia muoyo dia lukasa ne mashi adi ashintuluka bikole, disama dia stupore anyi dia coma, kinine ne mashi adi afumina ku mifuba mikole (CK) dinyanguka. Bidi bikengela diambuluisha dia lukasa mu ICU, kutuadija kabidi levodopa ku diambuluisha dia NG tube, IV hydratation, cooling blankets, ne IV dantrolene anyi bromocriptine.

Bua tshinyi munganga kena mua kutshibula manga a Extended-Release Sinemet CR a baledi banyi anyi kusanganya levodopa ne manga adi ne proteyine ya bungi?¶

Kutshibula tshiamu tshia Carbidopa/Levodopa tshia matuku a bungi (Sinemet CR/ER) kudi kunyanga tshintu tshidi tshipatuka bitekete bitekete, kuela dose mujima musangu umue ne kufikisha ku disama dia dyskinesie didi dilonda kudi dinyanguka dia tshimpitshimpi dia mashinyi; pamutu pa nanku, munganga udi ne tshia kukudimuna dilomba edi mu tshiamu tshia Immediate-Release (IR) Carbidopa/Levodopa kumpala kua kutshibula. Kabidi, proteyine ya mu biakudia (amino acids) idi iluangana buludiludi ne levodopa bua kuyibueja mu mala ne kupitshila ku tshibuelelu tshia mashi ne buongo; Shi mubedi udi mu difila dia mayi a proteyine, badi ne tshia kuimana minite 60 kumpala ne minite 30 too ne ku 60 kunyima kua difila dia levodopa bua manga afika mu buongo.

Malu adi apetangana¶

• Dibungama dia mu lupitadi ne dikuba dia malu a luondapu bua bakulakaje
• Dysphagie: dikuma dia mayi makese, disama dia tshiadi, ne dilama dia biakudia bia bungi
• Polypharmacy, dipitshisha dia manga, dijimija dia manga, ne bilema bia mulongolodi wa manga
• Dipanga dia tshimpitshimpi mu bantu bakulumpe: UTI urosepsis mupuwe ne stroke ne bua tshinyi babedi bakulumpe kabatu ne luya

Miaba ne buludiki bua mbulamatadi¶

• Parkinson's Foundation: Hospital Care Recommendations & Hospital Safety Guide: Time-Critical Dopaminergic Dosing, Contraindicated Antiemetics/Antipsychotics, and Perioperative NPO Bridge Protocols (parkinson.org/hospital).
• UK National Institute for Health and Care Excellence (NICE): NICE Guideline NG71: Disama dia Parkinson mu bantu bakole, dibuela mu lupitadi, dilekela dia tshimpitshimpi dia levodopa, ne NPO Rotigotine/NG Tube Conversion.
• Tshilongelu tshia bena Amerika tshia malu a mitu (AAN) ne tshisumbu tshia pa buloba bujima tshia disama dia Parkinson ne dia dienda dia mubidi (MDS): Mibelu ya malu a luondapu bua kumanya ne kulama disama dia Parkinson-Hyperpyrexie (Akinetic Crisis).
• Tshibambalu tshia malu a manga adi kaayi ne njiwu (ISMP): Malu mimpe a manga adibu balongolole bua lupitadi: Kupangisha dipanga dia manga a Carbidopa/Levodopa adi ne mushinga wa bungi ne kupangisha manga adi kaayi ne njiwu a D2.
• American Geriatrics Society (AGS): Updated AGS Beers Criteria® for Potentially Inappropriate Medicament Use in Older Adults (Strict Avoidance of Typical/Atypical Antipsychotics and Atypical Antipsychotics and Metoclopramide in Parkinson's Disease).