Bokoa jo bo Tlhatlogang ka Bofefo, Bolwetse jwa Guillain-Barre, le Bothata jwa go Tlhatswa Mowa¶

Bokoa jwa mesifa jo bo tswelelang pele ka bonako jo bo gagabang go ya kwa godimo go tswa mo dinaong le maotong go ya kwa sehubeng (go swa ditokololo go go tlhatlogang mo Guillain-Barre Syndrome, kgotsa GBS) kgotsa jo bo koafatsang ka tshoganyetso diphuka tsa matlho, motlhagare, mometso, molala, le mesifa ya go hema (Myasthenic C tshoganyetso ya mesifa ya methapo e e tshosetsang botshelo. Go farologana le seterouku kgotsa go ema ga pelo, go palelwa ke go hema ga mesifa ga se gantsi go bakang go hema ka tsela e e gakgamatsang kgotsa go nna le palo e e kwa tlase ya okosejene kwa tshimologong; go na le moo, mesifa ya diaphragm le ya lebota la sehuba e koafala ka tidimalo go fitlha motho a sa kgone go ntsha mathe kgotsa go hema khabonetaeokosaete, mme seno se dira gore a se ka a kgona go hema ka tshoganyetso. Ditsi tsa thuso ya ntlha di ikaegile ka go lemoga go sa le gale, go tsamaisiwa ka bonako ka ambulense kwa Yuniting ya Tlhokomelo e e Tseneletseng (ICU), go ema ka tlhamalalo go folosa diaphragm, go tila dijo kgotsa diedi ka thata, le go dira Single-Breath Count Test fa thoko ga bolao go latedisa mesifa ya go hema pele ga bathusi ba kalafi ba goroga.

Dira se jaanong¶

1. Leletsa nomoro ya tshoganyetso ya lefelo la lona ka bonako fa bokoa jo bo tswelelang pele jwa letsogo bo tsamaya le go hema gope, go kometsa, kgotsa go fetoga ga lentswe. Letsa 911 kwa United States le Canada, 112 go ralala Yuropa, 999 kwa United Kingdom, kgotsa bona tsotlhe dinomoro tsa tshoganyetso. Bolelela moromedi ka tlhamalalo: "Molwetse o na le bokoa jo bo tswelelang ka bonako jwa mesifa [bo belaelwang gore ke jwa Guillain-Barre syndrome / Myasthenic Crisis] jo bo nang le kotsi ya go palelwa ke go hema ga diaphragm." Kopa ambulense ya tshegetso ya botshelo e e gatetseng pele.
2. Tshegetsa motho a tlhamaletse ka angle ya 45-degree go ya go 90-degree (o se ke wa nna sephaphathi ka mokwatla wa gagwe) ntle le fa a idibetse. Fa motho yo o nang le diaphragm e e bokoa a rapame a sephaphathi ka mokwatla wa gagwe (supine), dirwe tse di bokete tsa mpa di kgoromeletsa kwa godimo kgatlhanong le diaphragm ya makgwafo e e suleng ditokololo ka go fokotsa bokgoni jwa FVC go ya kwa godimo, go ** diperesente di le 25 go ya go di le 50 mme di dira gore motho a hupelwe ka bonako. Di boloke di ntse di tlhamaletse di tshegeditse tlhogo le molala.
3. Dira Teko ya go Bala Mowa o le Mongwe (SBCT) fa thoko ga bolao gone jaanong mme o kwale palo. Kopa motho go hema kwa teng thata ka fa a ka kgonang ka teng mme a bale kwa godimo go tswa go \(1\) go ya kwa godimo (\(1, 2, 3, 4...\)) ka lobelo lo lo tlhomameng lwa **palo e mebedi ya go hema ka motsotswana. Mogolo yo o itekanetseng o bala go fitlha go \(30\text{ go fitlha go }50\); go palelwa ke go bala go feta \(20\) ka mowa o le mongwe fela go supa bokoa jo bo masisi jwa mesifa ya go hema, mme go bala \(15\) kgotsa kwa tlase go supa tlhokego e e gaufi ya go tsenngwa ga ICU le go tsenngwa ga mowa ka metšhini.
4. Boloka motho a sa nwe sepe ka molomo (NPO) mme o mo thuse go kgwa mathe a a kokoantsweng. O se ka wa mo naya metsi, dijo, kgotsa dipilisi tsa molomo (go akaretsa le dipilisi tse di oketsegileng tsa pyridostigmine/Mestinon ka nako ya mathata). Bokoa jwa mesifa ya mometso le ya magalapa (bokoa jwa bulbar) bo dira gore diedi di ye ka tlhamalalo mo phaepeng ya phefo go tsena mo mafatlheng, mme pyridostigmine e e feteletseng e dira lero le lekima la bronchial le le tlalang mo tseleng ya mowa e e bokoa.
5. Ela tlhoko go itaya ga pelo le kgatelelo ya madi ka kelotlhoko go bona gore a go na le go fetoga ga pelo ka tshoganyetso (Autonomic Dysfunction). Mo bolwetseng jwa Guillain-Barre, tlhaselo ya masole a mmele gantsi e amoga tshireletso mo ditshikaneng tse di laolang pelo le ditshika tsa madi, go baka go itaya ga pelo ka tshoganyetso le go itaya ga madi ka tshoganyetso, go itaya ga pelo ka bonya (pelo e e bonya). O se ka wa letla motho yono gore a eme ka bonako.
6. Kgobokanya mabotlolo otlhe a melemo a ga jaana le hisitori ya tshwaetsego ya setlhopha sa bookelo. Kwala mokgotlhwane ope wa mala, letshololo, tshwaetsego ya go hema, kgotsa go enta mo dibekeng tse 1 go ya go tse 6 tse di fetileng (dilo tse di botlhokwa tse di bakang bolwetse jwa Guillain-Barre), mme o tlhole gore a molwetse yo o nang le Myasthenia Gravis o ne a newa melemo ya antibiotic a**indicontravenca bošeng jaana di-fluoroquinolone, di-macrolide, di-aminoglycoside, magenesiamo kgotsa dithibela-beta).

Tlhatlhobo ya tshoganyetso le setlhare sa ditshwetso tsa go hema ga methapo¶

Dirisa tšhate eno ya kalafi go farologanya bolwetse jwa Guillain-Barre, mathata a myasthenic, go gatelelwa ga mothapo wa lerapo la mokwatla, le di-neurotoxin tse di fologang (tse di jaaka botulism kgotsa go swa ditokololo ga dikgofa), le go lemoga go sa le gale gore go na le go palelwa ke go hema go go tlang.

flowchart TD
    Start["Bokoa jwa Mesifa jo bo Bogale kgotsa jo bo Tswelelang ka Bofefo<br/>mo Maotong/Matsogong ka Bobedi KGOTSA Diphuka tsa Matlho/Mometso/Molaleng"] --> AirwayScreen{"Sekerini sa Bulbara le sa Diaferamo sa Ka bonako:<br/>1. Palo ya Mowa o le Mongwe <= 20 (kgotsa <= 15 e e botlhokwa)?<br/>2. Lentswe la nko, puo e e sa tlhaloganyesegeng, kgotsa go gotlhola fa o metsa?<br/>3. Molala o o bokoa (tlhogo e wela kwa pele kgotsa ga e kgone go tsholetsa mosamo)?<br/>4. Ga o kgone go rapama o sa heme (Orthopnea)?<br/>5. Go nwela ga mpa mo teng ka nako ya go hema (Go hema ka go ikganetsa)?"}

    AirwayScreen -->|"EE: Mpho epe fela e le 1"| RespEmerg["GO PALELOGA GO HEMA GA MESIFA GO LE GAUFI:<br/>1. Leletsa 911 / 112 / 999 ka bonako go bona Ambulense ya ALS<br/>2. Dudisa molwetse A TSAMAYE ka didikirii tsa 45-90 (tshegetsa molala o o bokoa)<br/>3. NPO ka botlalo (go se sepe ka molomo; kgwa mathe mo koping/taulong)<br/>4. O SE KE wa naya melemo e e oketsegileng ya go okobatsa (Mestinon) kgotsa diokobatsi tse di okobatsang"]

    AirwayScreen -->|"NNYAA: Go hema le go kometsa ga jaana go sa senyega"| PatternCheck{"Tsela ya mmele<br/>le mokgwa wa bokoa ke ofe?"}

    PatternCheck -->|"GO TLHOTLHOMELA (Go tswa kwa tlase go ya kwa godimo):<br/>Go simolola ka go tlhotlhorega mo menwaneng/menwaneng -> bokoa jwa maoto a a lekalekanang<br/>-> go tlhatlogela kwa dinokeng/matsogong; go latlhegelwa ke ditshupo tsa ditshika;<br/>dibeke di le 1-4 morago ga letshololo kgotsa bolwetse jwa megare ya go hema"| SuspectGBS["GUILLAIN-BARRE SYNDROME (GBS):<br/>- Phetiso e e Potlakileng ya Lefapha la Maemo a Tshoganyetso gompieno<br/>- Boeletsa Palo ya Mowa o le Mongwe metsotso mengwe le mengwe e le 30-60<br/>- Tlhokomela go fetogafetoga ga BP e e ikemetseng le botlhoko jo bo tseneletseng jwa mokwatla/mo methapong"]

    PatternCheck -->|"OCULO-BULBAR E E FETOGOTSANG:<br/>Diphuka tsa matlho tse di welang (ptosis), pono e e gabedi, motlhagare/go tlhafuna go go bokoa,<br/>lentswe la nko, go wela ga molala; go nna maswe le go feta fa o dira ka natla kgotsa maitseboa;<br/>Myasthenia Gravis e e itsiweng kgotsa sebolayamegare/tshwaetsego e ntšha ya bosheng"| SuspectMG["GO BELAELWA GO GATELA / BOTHATA JWA MYASTHENIA GRAVIS:<br/>- Tshekatsheko e e Potlakileng ya Lefapha la Maemo a Tshoganyetso<br/>- Tlhola lenaane la melemo ya di-fluoroquinolone, di-macrolide, di-beta-blocker<br/>- Ipaakanyetse ICU IVPLEX kgotsa Phapantsho ya Plasma)"]

    PatternCheck -->|"GO FOLONGA (Go tswa kwa Godimo-Tlase) ka Dipupi tse di Tsepameng:<br/>Pono e e tlhomameng, dipupi di atolositswe, molomo o o omileng -> mometso -> matsogo -> maoto;<br/>go tlhoka go utlwa botlhoko; dijo tsa sešweng tse di tsenngwang mo makotikoting/tse di bolokilweng"| SuspectBot["GO BELAELWA GO BOTULISM KGOTSA GO SHWA WA DIKGOFA:<br/>- Batla mo letlalong la tlhogo/mola wa moriri/diphatlha tsa mmele go bona dikgofa tse di fitlhegileng tse di tletseng<br/>- Bona Kaedi ya Botulism & Neurotoxin; Leletsa 911 / 112 / 999"]

    PatternCheck -->|"SHARP SENSORY LEVEL + GO tshwarwa ga senya:<br/>Go utlwa botlhoko ka fa tlase ga mola o o rileng wa sehuba/letheka + botlhoko jo bo tseneletseng jwa mokwatla<br/>+ go sa kgone go rota kgotsa go utlwa botlhoko mo setulong"| SuspectCord["GO BELAELWA GO GATELELA GO BOTLHOKWA GA MOTHALO WA MOKGANG / CAUDA EQUINA:<br/>- Bona Cauda Equina le Kaedi ya Kgatelelo ya Mokwatla<br/>- Leletsa 911 / 112 / 999 go bona MRI ya tshoganyetso ya Mokwatla"]

Go tlhaloganya maemo a tshoganyetso a mabedi a konokono a mesifa¶

1. Bolwetse jwa Guillain-Barre (GBS): Tlhaselo e e Bogale ya Metshika e e Tlhatlogang¶

Guillain-Barre Syndrome (GBS) (e e itsiweng gape jaaka Bolwetse jo bo Botlhoko jwa Thurugo e e Fedisang Methapo, kgotsa AIDP, mmogo le diphetogo tsa axonal AMAN le AMSAN) ke tlhaselo e e bogale ya masole a mmele mo methapong e e kwa ntle le mothapo wa mokwatla. - Kafa e tlhotlhelediwang ka gone ("Go Etsisa ga Dimolekhule"): Mo diperesenteng di ka nna 70 tsa balwetse, GBS e simolola dibeke di le 1 go ya go di le 4 morago ga tshwaetsego e e tlwaelegileng, letshololo le le tumileng thata le le bakwang ke dijo le le bakiwang ke Campylobacter jejuni (gantsi go tswa mo dikokong tse di sa apewang sentle tsa mokgotlhwane, kgotsa dikoko tse di sa apewang sentle), kgotsa (CMV), mogare wa Epstein-Barr (EBV), Maekopolasema ya nyumoniae, mogare wa Zika, kgotsa SARS-CoV-2. Dilwantsha-ditwatsi tse di tlhagisiwang ke masole a mmele go lwantsha mogare di tsibogana ka phoso le di-lipid tsa ganglioside mo methapong ya motho e e kwa ntle, di apola myelin sheath e e sireletsang (jaaka go apola sethibela-motlakase sa rabara mo thapong ya motlakase) kgotsa di senya di-axon tsa methapo ka tlhamalalo. - GBS e tswelela jang: 1. Kgato ya Pele ya Dikutlo le Botlhoko (Diura go ya go Malatsi): Bontsi jwa balwetse ba lemoga la ntlha "diphini le dinalete" tse di lekalekanang (paresthesias) kgotsa go utlwa botlhoko mo menwaneng ya dinao le mo dintlheng tsa menwana, gantsi go tsamaya le botlhoko jo bo tseneletseng, jo bo botlhoko, jo bo tlhotlhoregang mo karolong e e kwa tlase ya mokwatla, mo maragong, le mo methapong ya dirope ( gantsi e sa lemogiwe sentle gore ke sciatica kgotsa disiki e e relelang). 2. Ascending Motor Paralysis (Malatsi go ya go Dibeke di le 2 go ya go di le 4): Bokoa jo bo lekalekanang bo simolola mo maotong ka bobedi (go kgopiwa mo dithibeng, bothata jwa go palama ditepisi kgotsa go ema go tswa mo setulong sa ntlwana) mme bo tlhatlogela kwa godimo ka iketlo mo diureng go ya go malatsi mo diropeng, kutu, matsogo, methapo ya sefatlhego ga a kgone go nyenya kgotsa go tswala leitlho lepe), mesifa ya go kometsa, mme kwa bofelong mesifa ya magareng ga ditlhaa le diaphragm. 3. Go Latlhegelwa ke Di-Reflex tsa Mothapo o o Tseneletseng (Areflexia): Fa ngaka e itaya mothapo wa lengole kgotsa wa khutshwane ka hamore ya reflex, reflex ga e yo kgotsa e a fokotsega thata. 4. Go sa Tsitsega ga Thulaganyo ya Methapo e e Ikemetseng: Go fitlha go peditharong ya balwetse ba GBS ba nna le go sa tlhomamang go go kotsi ga thulaganyo ya methapo e e sa itireleng, e e bakang go fetogafetoga go go feteletseng ga kgatelelo ya madi, go itaya ga pelo ka tshoganyetso ka bonya (bradycardia/asystole), go tshwara moroto, kgotsa bo ileus e e sulafetseng (stoppe). - Mofuta wa Miller Fisher Syndrome (MFS): Mofuta o o rileng wa GBS o o tsamayang go tswa kwa godimo go ya kwa tlase go na le go tswa kwa tlase go ya kwa godimo, o o tlhaolwang ke boraro jwa bogologolo jwa ophthalmoplegia (go sulafala ga matlho go go bakang pono e e masisi ya matlho gabedi), ataxia (go sa tlhomama thata ga matlho le **go tlhomama ga matlho). dipoelo).

2. Bothata jwa Myasthenic: Go Palelwa kwa Kgolaganong ya Mesifa ya Methapo¶

Myasthenia Gravis (MG) ke bolwetse jo bo amanang le masole a mmele jo mo go jone dilwantsha-ditwatsi (tse gantsi e leng dilwantsha-ditwatsi tse di lwantshanang le moamogedi wa acetylcholine [AChR] kgotsa dilwantsha-ditwatsi tse di lwantshanang le MuSK) di thibelang kgotsa di senya di-receptor tsa dikhemikhale tse dinnye mo ditlhaleng tsa mesifa. - Bokoa jo bo lapisang jwa letshwao: Ka gonne mesifa e na le di-receptor di le mmalwa tse di dirang, go ngotlega ga mesifa ga ntlha go ka utlwala go batlile go tlwaelega, mme tiriso e e boaboelediwang e fedisa kgolagano ka bonako (go lapa). Matshwao a bolwetse a nna bonolo thata mo mosong morago ga go ikhutsa mme a nna maswe le go feta moragonyana mo letsatsing kgotsa ka nako ya fa motho a ntse a bua, a tlhafuna kgotsa a lebile kwa godimo. - Bothata jwa Myasthenic ke eng: Bothata jwa Myasthenic ke go gakala go go ka tsenyang botshelo mo kotsing fa bokoa bo anamelang kwa mesifeng ya bulbar (mometso, leleme, magalapa, motlhagare) le mesifeng ya go hema (diaphragm le lebota la sehuba) e e tlhokang go tsenngwa mowa thata. Mo e ka nnang diperesente di le 15 go ya go di le 20 tsa balwetse ba ba nang le Myasthenia Gravis ba nna le bobotlana bothata bo le bongwe jwa myasthenia, mme mo balwetseng bangwe, bothata ke lekgetlo la ntlha fela fa go lemogiwa gore ba na le Myasthenia Gravis. - Dilo tse di tlwaelegileng tse di bakang Mathata a Myasthenic: - Ditshwaetso tse di bogale tsa mosele wa go hema kgotsa wa motlhapo le letshoroma. - Go ariwa, go utlwisiwa botlhoko thata mo maikutlong, go ima kgotsa go tshola ngwana. - Go simolola di-corticosteroid tsa selekanyo se se kwa godimo (prednisone e ka baka go gakala ga bokoa jwa MG ka nakwana mo malatsing a ntlha a le 5 go ya go a le 14). - Tsamaiso ya melemo e thibetsweng e thibelang phetiso ya mesifa (bona Lenaneo la Kotsi ya Melemo e ka tlase).

Papiso e e tseneletseng: Bolwetse jwa Guillain-Barre kgatlhanong le Bothata jwa Myasthenic kgatlhanong le Botulism kgatlhanong le Go Gatelelwa ga Mothapo wa Lerapo la Mokwatla¶

Ka gonne bokoa jo bo tseneletseng bo ka simolola mo mokwatleng, mo ditshikaneng tse di fa thoko, kgotsa mo kgolaganong ya mesifa ya methapo, dingaka di dirisa matshwao ano a a tlhaolang a a fa thoko ga bolao:

Tsela ya go lemoga go palelwa ke go hema ga mesifa e e didimetseng kwa gae (Pele ga Marothodi a Oximeter)¶

Mo mothong yo o nang le asma kgotsa nyumonia, go bonala sentle gore o na le bothata jwa go hema: o a tlhotlhora, a gotlholela kwa godimo, mme selekanyo sa okosejene sa gagwe se a fokotsega. Mo mothong yo o nang le bolwetse jwa Guillain-Barre kgotsa Myasthenia Gravis, mesifa e e dirang gore motho a heme kgotsa a gotlhole thata ke yone mesifa e e swa ditokololo. Ela tlhoko matshwao ano a matlhano a a rileng a ntlha a go palelwa ga bulbar le diaphragmatic:

1. Teko ya Palo ya Mowa o le Mongwe yo o Fa thoko ga Bolao (SBCT): Moemedi yo o Netefaditsweng wa Bokgoni jwa Makgwafo (FVC)¶

Mo ICU ya bookelo, dingaka di lekanya Bokgoni jwa Makgwafo jo bo Patelediwang (FVC) le Maatla a a sa Siamang a go Hema (NIF) di dirisa spirometer e e tshwarwang ka letsogo (go dirisa "Molao wa 20/30/40": go tlhokega go tsenngwa ga tšhupu fa Bokgoni jwa Makgwafo jo bo Patelediwang jwa go Hema bo wela kwa tlase ga \(20L/xi\)xt bokoa go feta \(-30\sekwalwa{ cmH}_2\sekwalwa{O}\), kgotsa Kgatelelo e e kwa Godimo ya go Hema e ka fa tlase ga \(40\sekwalwa{ cmH}_2\sekwalwa{O}\)). Kwa gae, Teko ya Palo ya Mowa o le Mongwe e tsamaisana ka tlhamalalo le Bokgoni jwa Makgwafo jo bo Patelediwang (palo nngwe le nngwe e e balwang e lekana le mo e ka nnang \(100\text{ go ya go }115\text{ milliliters}\) ya bokgoni jwa makgwafo): - Kafa o ka e dirang ka gone: Dira gore motho a nne a tlhamaletse, a heme kwa teng thata, mme a bale kwa godimo (\(1, 2, 3, 4, 5...\)) ka lobelo lwa dipalo di le 2 ka motsotswana (tshwantshanya letsogo la bobedi la tshupanako) go fitlha a tshwanelwa ke go hema gape. - Tsela ya go ranola maduo: - Bala \(> 30\): Polokelo e e tlwaelegileng ya mesifa ya go hema (tswelela go tlhola gape diura dingwe le dingwe di le 1 go ya go di le 2 fa GBS e tswelela). - Bala \(20\text{ go ya go }25\): Bokoa jwa mesifa ya go hema go sa le gale (Tshekatsheko ya Lefapha la Maemo a Tshoganyetso e a tlhokega ka bonako). - Bala \(\le 15\) go ya go \(20\): E tsamaisana le Bokgoni jwa Makgwafo jo bo Patelediwang (FVC) jo bo kwa tlase ga \(15\sekwalwa{ go ya go }20\sekwalwa{ mL/kg}\) (Kotsi e e Masisi: Leletsa 911 / 112 / 999 ka bonako; molwetse a ka tswa a tlhoka tshireletsotsela ya mowa ya ICU). - Downward trend: Molwetse yo palo ya gagwe e welang tlase go tswa go \(35\) ka nako ya sethoboloko go ya go \(22\) ka nako ya 3:00 PM o senyega ka bonako mme o tshwanetse go nna mo ICU pele ga bosigo.

2. Bokoa jwa Neck Flexor (Letshwao la "Go Roga Tlhogo / Go Tsholetsa Mosamo")¶

Mesifa e e tsholetsang tlhogo mo mosamong kgotsa e e tsholetsang seledu kwa godimo (di-flexor le di-extensor tsa molomo wa popelo, tse di tlamelwang ke medi ya methapo ya molomo wa popelo C2 go ya go C5) e na le lefelo le le tshwanang sentle la medi ya methapo ya lerapo la mokwatla le mothapo wa phrenic (C3, C4, C5) o o nayang dia" diaferamo e tshela"). - Teko: Fa motho a robetse ka angle ya 30-degree mme a sa kgone go tsholetsa tlhogo ya gagwe mo mosamong metsotswana e le 5, kgotsa fa seledu sa gagwe se nna se wela kwa pele mo sehubeng sa gagwe fa a ntse (go wela ga tlhogo), diaphragm ya gagwe e batla e koafatsa mesifa e e bapileng le molala wa gagwe.

3. Bokoa jwa Bulbar (Matshwao a go Palelwa ke go Sireletsa Tsela ya Mowa)¶

Pele ga diaphragm e palelwa gotlhelele, bokoa jwa mometso, leleme le magalapa a a boleta (bulbar palsy) bo senya bokgoni jwa motho jwa go boloka mathe a se mo mafatlheng a gagwe: - Lentswe le a fetoga: Lentswe la bone le utlwala ka tshoganyetso hypernasal ("go bua ka nko ya bone"), le le bonolo, le le tlhotlhoregang, kgotsa le sa utlwale sentle, bogolo jang morago ga go bua metsotswana e le 30. - Nasal regurgitation: Fa di leka go nwa metsi, seedi se boela se tswa ka nko ka gonne magala a a bokoa a a boleta ga a kgone go tswala tsela ya nko. - Go gotlhola go go bokoa ga "kgomo": Fa o kopiwa go gotlhola ka maatla, go gotlhola go utlwala go le khuti, go na le mowa, e bile go le bokoa (go sa kgone go ntsha mamina mo kgokgotsong). - Go lapa go tlhafuna (mo Myasthenia Gravis): Motlhagare wa tsone o a lapa mo gare ga dijo, o di pateletsa go tshegetsa seledu sa tsone se tswaletswe ka seatla.

4. Go Hema mo Mpeng go go Kganetsanang le go Hema ga Marapo¶

• Orthopnea: Motho o tshoga ka tshoganyetso kgotsa a ikutlwa a sa kgone go hema ka nako ya fa a repametse mo bolaong, ka gonne maatlakgogedi ga a tlhole a goga dirwe tsa gagwe tsa mpa go tswa mo tseleng ya diaphragm ya gagwe e e bokoa.
• Go Hema ka Tsela e e Kganetsanang (Abdominal Paradox): Ka tlwaelo, fa o hema kwa teng, diaphragm ya gago e a kgoromeletsa kwa tlase mme mpa ya gago e tsamaela kwa ntle. Fa diaphragm e sule ditokololo, mesifa ya sehuba e leka go gogela mowa mme tota e gogele diaphragm e e floppy kwa godimo mo sehubeng, mme seno se dira gore mpa e e kwa godimo e nwelele MO TENG fa o hema. Se ke maemo a tshoganyetso a a tlhokang dipalangwa tsa ambulense ka bonako.

5. Matshwao a Morago ga nako a go Boloka Khabonetaeokosaete (Hypercapnia)¶

Fa go hema go nna boteng thata go ka foka khabonetaeokosaete (\(CO_2\)), ela tlhoko go fufula mo phatleng (diaphoresis), go itaya ga pelo ka bonako, kgatelelo e e kwa godimo ya madi e e seng kalo, go opiwa ke tlhogo mo mosong, go tlhobaela, go sa iketle, mme kwa bofelong go otsela kgotsa go tlhakana tlhogo ka tshoganyetso. Le ka motlha o se ke wa naya molwetse yo o sa iketlang yo o nang le GBS kgotsa Myasthenia Gravis dipilisi tsa go tlhobaela kgotsa tsa go robala; ga di iketle ka gonne di hupelwa ka bonolo ka ntlha ya khabonetaeokosaete e e tlhatlogang.

Dikotsi tse di Kgethegileng tsa Myasthenia Gravis: Diokobatsi tse di sa Lebelelwang le Mathata a Cholinergic¶

1. Melemo e e ka Bakang Bothata jo bo Bolayang jwa Myasthenic¶

Fa wena kgotsa moratiwa wa gago a na le Myasthenia Gravis, melemo e mentsi ya letsatsi le letsatsi le e e rekwang kwa khaontareng e ka thibela dikopano tse di setseng tsa mesifa ya methapo mme ya dira gore motho a eme ka tshoganyetso mo diureng di se kae fela. Ka metlha tlhola seokobatsi sepe se se sa tswang go simololwa kgatlhanong le lenaane leno le le kotsi thata le le tlhomilweng ke Mokgatlho wa Myasthenia Gravis wa Amerika (MGFA) le dikaelo tsa boditšhabatšhaba tsa thuto ya methapo:

2. Goreng o SA Tshwanetse go Naya Pyridostigmine (Mestinon) e e oketsegileng ka Nako ya Mathata¶

Balwetse ba le bantsi ba ba nang le Myasthenia Gravis ba nwa pyridostigmine (Mestinon) letsatsi le letsatsi, e leng sethibela-seokobatsi se se oketsang selekanyo sa asetekoline ka nakwana mo seamogeding sa mesifa. Fa molwetse a simolola go kgaratlha go kometsa kgotsa go hema, gantsi malapa a ikutlwa a raelesega go thubaganya le go mo naya dipilisi tse dingwe tsa Mestinon. O se ka wa dira seno ka nako ya mathata a a masisi: 1. Kotsi ya go hema: Fa mesifa ya mometso e le bokoa, go metsa dipilisi le metsi go baka go hupelwa ka bonako le nyumonia ya go hema. 2. Morwalela wa Mamina (Muscarinic Overload): Pyridostigmine e tlhotlheletsa dikgeleswa tsa mathe le dikgeleswa tsa mamina tsa matshwafo go tshololela ditlhagisiwa tse dikima, tse di metsi (go tswa mathe le go tshologa ga matshwafo) fa gape e pitlaganya ditšhupu tsa matshwafo. Molwetse yo o gotlholang go go bokoa ga a kgone go tlosa morwalela ono wa mathe le mamina mme a ka nwela tota mo dilong tse a di ntshang. 3. Mathata a Cholinergic: Go nwa selekanyo se se feteletseng sa pyridostigmine go tlhotlheletsa go feta selekanyo le go dira gore di-receptor tsa mesifa di se ka tsa nna le maatla go fitlha di tswalega le go palelwa gotlhelele (mathata a cholinergic), go baka go swa ditokololo go go maswe le go feta mmogo le Matshwao a SLUDGE: go tlhotlhorega thata,**go tlhotlhorega **Go kgwa, **Go tsholola/go tshwarwa ke mpa, **Go tshwenyega thata mo maikutlong, Emesis (go kgwa), go tlhotlhorega ga matlho (miosis), go tlhotlhorega ga mesifa (go tlhotlhorega ga mesifa), le go itaya ga pelo go go bonya ka tsela e e kotsi (bradycardia).

Thuso ya potlako kgato ka kgato fa o letile ambulense¶

Kgato 1: Go Baya Tsela ya Mowa le Diaphragm ka Boemo jo bo Siameng¶

• Fa a tsogile mme a hema ka boene: Dula motho a tlhamaletse ka angle ya 45-degree go ya go 90-degree, kgotsa o dire gore a sekame go le gonnye kwa pele ka matsogo a gagwe a a kwa pele a iketlile mo tafoleng kgotsa mo mesamong (kemo ya dinao tse tharo) gore maatlakgogedi a goge diteng tsa mpa kwa tlase mme a neele maximuan to exp.
• Tshegetsa molala o o bokoa: Fa motho a na le bokoa jwa molala (tlhogo e wela kwa pele), baya taulo e e biditsweng ka bonolo ka fa morago ga molala wa gagwe kgotsa o tshegetse phatla le seledu gore phaephe ya phefo e se ka ya tswalega.
• Go samagana le mathe a a kgobokaneng: Naya motho taulo, dithishu, kgotsa kopi mme o mo laele gore a tshegele go le gonnye kwa pele mme a kgwe mathe kwa ntle go na le go leka go a kometsa.
• Fa e le gore o idibetse kgotsa o kgwa ka matlhagatlhaga: Di pitikolole ka bonako mo letlhakoreng la tsone go tsena mo boemong jwa go fola ka fa thoko mme o feele matlhatsa ape a a bonalang kgotsa mamina a makima go tswa kwa pele ga molomo.

Kgato 2: Dirisa "Teko ya Ice Pack" (Motlhala wa Boikgethelo wa go Tlhatlhoba Letlhokwa la Leitlho le le Lepelang)¶

Fa mongwe a ka nna le go wela ka tshoganyetso ga letlhokwa le le lengwe kgotsa ka bobedi jo bo kwa godimo (ptosis) mme o letetse tshekatsheko ya kalafi (ntle le go diega go leletsa mogala wa tshoganyetso fa go hema kgotsa go kometsa go amega): - Phuthela sephuthelwana sa aese kgotsa kgetsi ya dierekisi tse di gatseditsweng ka letsela le lesesane mme o e tshware ka bonolo mo godimo ga letlhokwa le le tswetsweng le le lepeletseng metsotso e le 2, morago ga moo o e tlose mme o lebe letlhokwa la leitlho ka bonako. - Se se rayang: Thempheretšha e e tsididi e fokotsa lebelo la enzyme (acetylcholinesterase) e e thubang acetylcholine. Fa letlhokwa le le lepeletseng le bulega ka bophara jo bo bonalang (le tokafala ka \(2\text{ millimeters}\) kgotsa go feta) metsotso e le mmalwa fela morago ga go tlosa sephuthelwana sa aese, ke letshwao le le siameng la bogologolo la Myasthenia Gravis (mo e ka nnang diperesente di le 80 tsa go nna bosisi). Bolelela ngaka ya phaposi ya maemo a tshoganyetso se o se lemogileng.

Kgato 3: Tlhagiso e e Botlhokwa ya Bookelo ya Bathusi ba Kalafi le Dingaka (Tlhagiso ya Succinylcholine)¶

Fa molwetse yo o nang le Guillain-Barre Syndrome (kgotsa go swa ditokololo gope go go tseneletseng go go tsayang diura di feta 48 go ya go di le 72) a tlhoka go tsenngwa tšhupu ka tshoganyetso mo ambulenseng kgotsa kwa bookelong, **dingaka tsa tshoganyetso GA DI A tshwanela go dirisa seokobatsi se se fokotsang mesifa (**sucinethoni): - Goreng: Mesifa e e sa tlhomamang mo bolwetseng jwa Guillain-Barre e laola di-receptor tsa acetylcholine go ralala lera lotlhe la mesifa. Go naya succinylcholine go dira gore kanale nngwe le nngwe ya potasiamo mo mesifeng eo e latlhele potasiamo mo mading ka nako e le nngwe, e dira gore pelo e eme ka bonako, e e bolayang ya hyperkalemic mo metsotswaneng e le 60. Go na le moo, dingaka di dirisa diokobatsi tse di sa fokotseng mesifa (tse di jaaka rocuronium ka selekanyo se se fetotsweng). Go umaka "Go belaelwa gore o na le bolwetse jwa Guillain-Barre" ka tlhamalalo fa go neelwa molwetse go sireletsa molwetse mo tsibogong eno e e bolayang ya melemo.

Mokwalo o o tlhomameng wa tlhaeletsano wa 911 / 112 / 999 le Tlhopho ya Bookelo¶

Ka gonne molwetse yo o mo bolwetseng jwa Guillain-Barre jwa ntlha kgotsa Myasthenic Crisis gantsi o na le pulse oximeter e e tlwaelegileng gotlhelele (\(98\%\)) mme a bua ka tidimalo, badiri ba ba tlhaolang balwetse ka tshoganyetso ba ka nna ba nyatsa kafa ba leng gaufi ka gone le go ema ga go hema. Dirisa puo eno ya kalafi:

• Go belaelwa gore o na le Bolwetse jwa Guillain-Barre:

  "Ke tlhoka ambulense kwa [Atereseng e e tlhomameng]. Molwetse ke [Dingwaga] [monna/mosadi] yo o nang le go swa ditokololo go go tlhatlogang ka bonako le go tlhotlhorega go go simolotseng mo maotong [diura/malatsi a le X] a a fetileng mme jaanong go fitlheletse [dirope / matsogo / sefatlhego / go hema]]. [X] dibeke tse di fetileng, [gagwe] Palo ya Mowa o le Mongwe fela ke [Palo], mme [o] na le [bothata jwa go kometsa / go gotlhola go go bokoa / go palelwa ke go tsholetsa tlhogo mo mosamong Re belaela gore o na le Bolwetse jwa Guillain-Barre jo bo nang le go palelwa ga diaphragm."

• Go Belaelwa Mathata a Myasthenic:

  "Ke tlhoka ambulense kwa [Aterese e e tlhomameng] ka ntlha ya Bothata jwa Myasthenic. Molwetse o na le bolwetse jwa Myasthenia Gravis mme o nnile le bokoa jo bo masisi jwa go hema, go akaretsa le [go sa kgone go bua sentle mo nkong / go hupelwa ke mathe / tlhogo e e lepeletseng / go sa kgone go rapama sephaphathi]. pulse oximetry fela [o] tlhoka go sekasekwa ka bonako kwa ICU go ela tlhoko Bokgoni jwa Makgwafo jo bo Patelediwang (FVC), go tshegetsa go hema, le IVIG kgotsa plasmapheresis."

Lenaanenetefatso la go ipaakanyetsa bookelo fa o ntse o letetse EMS¶

• Rekoto e e kwadilweng ya maduo a Teko ya Palo ya Mowa o le Mongwe le dinako tsa tshupanako (sekao, "Palo ya 1:00 PM = 26; palo ya 2:30 PM = 17").
• Mola o o tlhomameng wa go tswelela ga bokoa (fa go tlhotlhorega go simolotse, fa go tsamaya go paletswe, fa go kometsa kgotsa puo e fetogile).
• Hisitori ya ditshwaetso dipe tsa bošeng, go tsenwa ke botlhole jwa dijo, kgotsa go enta mo dibekeng tse 6 tse di fetileng.
• Mabotlolo otlhe a melemo ya ga jaana (bogolo jang dibolayamegare dipe tse dišwa tse di simolotseng mo malatsing a le 7 a a fetileng, pyridostigmine/Mestinon, prednisone, azathioprine, mycophenolate, efgartigimod, kgotsa eculizumab).
• Tlhatlhobo e e bonako ya letlalo la tlhogo le mola wa moriri go bona kgofa e e gokeletsweng (bogolo jang mo baneng kgotsa mo batsamai ba ba nang le go swa ditokololo go go tlhatlogang ka bonako mme ba sa latlhegelwe ke maikutlo).

Dipotso tse di bodiwang kgapetsakgapetsa¶

Ke ka ntlha yang fa sedirisiwa sa go itaya ga pelo sa monwana se kgona go bala 98% ya okosejene fa motho yo o nang le bolwetse jwa Guillain-Barre kgotsa Myasthenia Gravis a le gaufi le go kgaotsa go hema?¶

Pulse oximeter e lekanya go tlala ga okosejene mo mading, e e nnang e tlwaelegile fa fela dikgetsi tsa mowa tse di mo teng ga mafatlha di le phepa. Mo bolwetseng jwa Guillain-Barre le mo mathateng a myasthenic, mafatlha a itekanetse, mme mesifa ya diaphragm le ya sehuba e nna bokoa thata go ka hema kwa teng (**go hema kwa teng**). Seno se dira gore selekanyo se se botlhole sa khabonetaeokosaete ($CO_2$) se kgobokane ka tidimalo mo mading fa dipalo tsa okosejene di sa ntse di balega 96% go ya go 98%; fa kgabagare diaphragm e sena go lapa gotlhelele, okosejene e a wela tlase mme pelo e a ema mo metsotsong e se kae fela.

Ke dira jang Teko ya Palo ya Mowa o le Mongwe kwa gae, mme ke nomoro efe e e leng ya tshoganyetso?¶

Dira gore motho a nne a tlhamaletse, a heme kwa teng ka moo a ka kgonang ka teng, mme a bale kwa godimo go tswa go 1 go ya kwa godimo (1, 2, 3, 4...) ka lobelo lo lo tlhomameng lwa dipalo tse pedi ka motsotswana go fitlha a tshwanelwa ke go hema gape. Mogolo yo o itekanetseng gantsi a ka bala go fitlha go magareng ga 30 le 50; go sa kgone go fitlha go 20 go supa bokoa jo bo masisi jwa mesifa ya go hema jo bo tlhokang tlhokomelo ya ka bonako ya phaposi ya maemo a tshoganyetso, mme palo ya 15 kgotsa kwa tlase e supa go palelwa ke go hema go go gaufi go go tlhokang thuso ya ambulense le tshegetso ya tsela ya mowa ya ICU ka bonako.

Ke eng fa motho yo o nang le bolwetse jwa Myasthenia Gravis a sa tshwanela go nwa dipilisi tse di oketsegileng tsa Mestinon (pyridostigmine) fa a simolola go nna le bothata jwa go kometsa kgotsa go hema?¶

Go metsa dipilisi tse di nang le mesifa e e bokoa ya mometso go ka baka go hupelwa ka bonako le go gogela mo mafatlheng. Mo godimo ga moo, pyridostigmine e e feteletseng e dira gore dikgeleswa tsa mathe le mafatlha di tshololele ditlhatswana tse dikima tsa mamina tse molwetse yo o bokoa a sa kgoneng go di gotlhola, mme di ka tsosa "mathata a cholinergic" a tota a gakatsang go swa ditokololo ga mesifa.

Dingaka di ka bona jang pharologanyo fa gare ga bolwetse jwa Guillain-Barre le go gobala ga mokwatla fa e le gore ka bobedi jwa tsone di dira gore maoto a swa ditokololo?¶

Bolwetse jwa Guillain-Barre bo tlhasela ditshika tse di fa thoko, bo baka bokoa jo bo tlhatlogang go tswa mo menwaneng ya dinao go ya kwa godimo, go latlhegelwa ke di- reflex tsa ditshika tsa lengole le tsa dikhutshwane, le go tlhotlhorega mo maotong le mo diatleng kwantle ga mola o o bogale o o rapaletseng wa go tlhotlhorega mo mmeleng. Go farologana le seo, go gatelelwa ga mokwatla o o bogale gantsi go baka "boemo jwa maikutlo" jo bo tlhaolegileng mo sehubeng kgotsa mo mpeng jo ka fa tlase ga jone maikutlo otlhe a latlhegang, go sa kgone go rota go sa le gale (go boloka senya), le botlhoko jo bo masisi jwa mokwatla wa lefelo leo, jo bo netefadiwang ka bonako ke MRI ya mokwatla wa tshoganyetso.

Metswedi e tlhotlhomisitswe¶

• Sekolo sa Yuropa sa Thuto ya Methapo (EAN) le Mokgatlho wa Methapo e e Kwa Godimo (PNS): 2023/2024 Kaelo ya EAN/PNS ya go Tlhatlhoba le go Alafa Bolwetse jwa Guillain-Barré (Lekwalodikgang la Thulaganyo ya Methapo e e Kwa Godimo / Lekwalodikgang la Yuropa le alur).
• Motheo wa Amerika wa Myasthenia Gravis (MGFA, United States) & Kaelo ya Tumelano ya Boditšhabatšhaba: Kaelo ya Tumelano ya Boditšhabatšhaba ya Taolo ya Bolwetse jwa Myasthenia (Sanders le ba bangwe / Narayanaswami le ba bangwe, Thutofatso ya Methapo, go akaretsa le Lenaane la Diokobatsi tsa Tlhagiso la MGFA le Mathata a Bolwetse jwa Mothapo).
• Mokgatlho wa Tlhokomelo ya Methapo (NCS): Dikaelo tsa Taolo e e Bogale ya go Palelwa ke go Hema ga Methapo mo Bolwetseng jwa Guillain-Barré le Mathata a Myasthenic (netefatso ya molao wa 20/30/40 le Teko ya Palo ya Mowa o le Mongwe fa thoko ga bolao).
• Setheo sa Bosetšhaba sa Boitekanelo le Tlhokomelo ya Boleng jo bo kwa Godimo (NICE, United Kingdom) & Mokgatlho wa Baitseanape ba Methapo ba Borithane (ABN): Dikaelo tsa Tlhatlhobo ya Tshoganyetso ya Bokoa jo bo Botlhoko jwa Methapo le Bolwetse jo bo Belaelwang jwa Guillain-Barré.
• Mokgatlho wa Lefatshe Lotlhe wa Boitekanelo (WHO) & Disenthara tsa Taolo le Thibelo ya Malwetse (CDC, United States): Go Lemoga le go Ela Tlhokomela ga Bolwetse jwa Guillain-Barré le go Tlhatlhoba Bolwetse jwa Botulism ka Pharologano.

Dikaedi tse di tsamaelanang¶

• Botlhole jwa botlhole jwa methapo ya botulis, ciguatera, scombroid, le botlhole jwa methapo ya shellfish
• Letshwao la Cauda equina le difolaga tse dikhibidu tsa go gatelelwa ga mothapo wa lerapo la mokwatla
• Go lemoga seterouku (FAST) le go tsibogela maemo a tshoganyetso
• Thuso ya potlako ya go longwa ke dikgofa le segokgo
• Kaedi ya go tsosolosa pelo le makgwafo (CPR) le AED