I-Laryngospasm kanye ne-Vocal Cord Dysfunction (Inducible Laryngeal Obstruction): I-Inspiratory Stridor, i-Larson's Jaw-Thrust Maneuver, kanye Nokusethwa Kabusha Kwephunga Lephunga¶

Ngokungazelelwe, okwesabekayo ukungakwazi ukudonsa umoya esikhathini esidlule umphimbo kungase kubangele izinkinga ezimbili ezisondelene ezisebenzayo zezintambo zezwi: i-acute reflex laryngospasm (ukuvalwa okunobudlova, okungahleliwe, okuphelele noma okucishe kuphelele kwezintambo zezwi zangempela nezingamanga ezixhunywe yi-laryngeal nerve ephezulu) kanye ne-vocal cordties* i-vocal cordity* ngokusemthethweni i-vocal cord** njengokuthi i-inducible laryngeal obstruction (ILO) (ukwengezwa okuxakayo kwezintambo zezwi ukuya emgqeni ophakathi ngesikhathi sokuhogela kunokuba zivuleke kakhulu njengoba kuvamile). Nakuba i-laryngospasm iyi-anesthetic esongela ukuphila, ngemva kokukhipha isisu, ukuminza, noma isimo esiphuthumayo somoya we-acid-reflux esingaveza i-hypoxia enzima, i-bradycardia, noma i-negative-pressure pulmonary edema phakathi kwamasekhondi angu-60 kuya kwangu-120 uma ingaphukile ngokomzimba, *ukuphaphama kwe-inducible inducible, i-laryngeal evimbelayo i-spasm ebangelwa ukuvivinya umzimba okunamandla kakhulu, i-acid reflux, umoya obandayo, iphunga lamakhemikhali elinamandla, ukuvuza kwangemuva kwekhala, noma ukucindezeleka okukhulu okuvamise ukutholwa ngokungeyikho njengesimo esisongela ukuphila i-asthmaticus noma i-anaphylaxis. Ngenxa yokuthi zombili izimo zinciphisa i-glottic chink ezingeni le-larynx entanyeni, zikhipha umsindo ophezulu, phezulu, umculo noma ukukhala uma uphefumula IN (i-inspiratory stridor) isiguli sikhomba ngqo emphinjeni, ngokungafani nesifo sesifuba somoya, esinciphisa imigudu yokuphefumula engezansi ngaphakathi kwesifuba futhi sibangele ukushaywa umoya ** ukukhala)**. Uma othile eba nokuququda kungazelelwe, engakwazi ukukhuluma noma ukuphefumula, ebonisa izindebe eziluhlaza okwesibhakabhaka (cyanosis), evuvuka intamo noma olimini, noma elahlekelwa ukwazi, shayela indawo yangakini izinombolo eziphuthumayo ngokushesha (911 e-United States naseCanada, 112 ngaphesheya kwe-European Union, 999 e-United Kingdom). Futhi buyekeza imihlahlandlela yethu engumngane ku isifuba somoya, i-epiglottitis, i-croup, ne-stridor, futhi ukungezwani komzimba kanye ne-anaphylaxis.

Okubalulekile kwakho ngokushesha ukuhlola izimpawu zefulegi elibomvu zokuvinjwa kwendlela yokuphefumula kwemishini noma i-anaphylactic (ukuminyanisa umzimba wangaphandle, i-angioedema yomlomo noma ulimi, ukuconsa, noma ukuncipha kokwazi), sebenzisa **Ukuqondisa kuka-Larson (ukucindezela okuqinile phakathi kokubili kwangaphakathi naphezulu kuyinotshi ye-laryngospasm khona kanye ngemuva kwenkezo yendlebe kuhlangene nokushaya kwendlebe okubuhlungu) isiguli esingasabeli noma ngemva kokululiswa, futhi uqeqeshe isiguli esiphapheme nge- I-Double Nasal Sniff and Pursed-Lip Exhale (noma Ukusetha Kabusha Ukuhefuzela) ukuze ubambe (uvule) izintambo zezwi ngemizuzwana nje.

Yenza lokhu manje¶

1. Hlola ngokushesha amafulegi abomvu asongela ukuphila futhi ushayele inombolo yakho yasendaweni yezimo eziphuthumayo uma ikhona. Dayela u-911 e-United States nase-Canada, 112 ku-European Union yonkana, 999 e-United Kingdom, 000 e-Australia, noma uhlole inkomba yethu yomhlaba wonke izinombolo eziphuthumayo uma lesi kuyisiqephu sokuqala somuntu se-stridor, uma ubedla ngaphambi nje kokuqala (ukuklinywa), uma benezidleke noma izindebe ezivuvukele noma ulimi (ukungezwani komzimba), uma benomkhuhlane kanye namathe (i-epiglottitis), noma uma izindebe zabo ziba luhlaza okwesibhakabhaka noma zididekile noma zingasabeli.
2. Uma Umuntu Ophapheme Ene-Vocal Cord Spasm (VCD / ILO) engazelelwe (VCD / ILO) noma i-Post-Cough Paroxysmal Laryngospasm: Bahlalise baqonde amahlombe ehliselwe phambili futhi ubavimbele ekuhefuzeleni ngomlomo ovulekile. Ukuhefuzela kakhulu ngomlomo ovuleke kakhulu kudala ukugeleza komoya onomsindo omkhulu phakathi kwe-vallinx, okumunca imbobo ndawonye umphumela** bese komisa i-laryngeal mucosa.
3. Qeqesha "I-Double Nasal Sniff + Long Pursed-Lip Exhale" (EILOBI / Ukusetha Kabusha Ukuqeqeshwa Kokuphefumula):
4. Isinyathelo A (Exhale Okokuqala): Tshela umuntu ukuthi akhiphe umoya wakhe osele kancane kancane ngezindebe ezicijile ezicinene (njengokungathi ufutha isivunguvungu sekhofi esiwumngcingo noma ngokucwayiza ilangabi lekhandlela ngaphandle kokulicisha) imizuzwana emi-3 kuya kwemi-4. Ukuphefumula ngokumelene nezindebe ezikhonjiwe kudala 5 ukuya ku-10 cmH2O yengcindezi yasemuva (i-PEEP yangaphakathi) ephusha izintambo zezwi zihlukane.
5. Isinyathelo B (Ukuhogela Kwekhala): Bacele bavale umlomo wabo, baxegise imihlathi nomphimbo, bese bethatha ukuhogela okubili okusheshayo, okuthambile NGENA ngamakhala (njengokungathi bahogela imbali). Ukuhogela ngekhala kwenza i-brainstem reflex enamandla nge-posterior cricoarytenoid muscle (umsipha okuwukuphela kwawo okhipha i-larynx) ophoqa izintambo zezwi ukuba zivuleke kakhulu.
6. Isinyathelo C (Indlela Ehlukile Yokuphefumula / Yokuphefumula Kotshani): Uma ikhala labo liminyene, zenze zihefuze ngokushesha njengenja nolimi lwazo zikhululeke phansi emlonyeni, noma zihogele kancane ngembobo ewumngcingo phakathi kwezindebe ezikhonjiwe kuyilapho benweba isisu sabo (ukuphefumula kwe-diaphragmatic).
7. Uma Ishaya Kahle I-Laryngospasm Ethule (I-Zero Airflow Naphezu Kokuguquguquka Kwesifuba, noma I-Post-Anesthesia / Post-Reflux / I-Drowning Spasm): Yenza I-LARSON'S MANEUVER ngokushesha.
8. Thola iphuzu elithi Larson's point ("i-laryngospasm notch") ezinhlangothini zombili zekhanda: ukucindezeleka kwamathambo amancane kuboshwe ngaphambili nge-ramus ekhuphukayo (umphetho ongemuva) womhlathi ongezansi, ngemuva kwenqubo ye-mastoid ngemuva kwendlebe, futhi ngaphezu kwalokho ngesisekelo sogebhezi, kwesokudla ngemuva kwendlebe.
9. Beka amathiphu eminwe yakho ephakathi nendawo noma yenkomba ekujuleni kwezinotshi bese ucindezela okuthi ungene phakathi ngamandla uqonde maphakathi nogebhezi futhi uye phambili/phezulu ngasekhaleni kanyekanye uphakamise umhlathi ongezansi uwenze isandla somhlathi oqinile oya phambili.
10. Ukuqondisa kuka-Larson kunweba imisipha ye-geniohyoid kanye ne-thyrohyoid ukuze idonse i-epiglottis kanye nezintambo zezwi ezingamanga ngenkathi icupha inzwa ye-cranial enamandla ephula i-vagal laryngospasm reflex arc phakathi kwemizuzwana emi-5 kuya kweyi-15.
11. Uma Umuntu Eyazi Isifuba Somoya Kanye Nokungasebenzi Kwentambo Yezwi: Sebenzisa i-salbutamol (albuterol) inhaler yabo yokutakula nge-spacer uma ungaqiniseki, kuze kufike kumaphesenti angu-30 kuya kwangu-50 eziguli ze-VCD ezinesifuba somoya. Nokho, qonda ukuthi ama-beta-2 agonist inhalers kanye ne-epinephrine dysfunge* e-purelex muscle ngakho-ke ukuqeqeshwa kabusha kokuphefumula kufanele kwenziwe ngokuhambisana nanoma yikuphi ukusetshenziswa kwe-inhaler.
12. Phumula kancane amanzi ezinga lokushisa legumbi (uma kuphela umuntu esekwazi ukudonsa umoya kancane futhi engaminyanisi ukudla) noma uhomuzele inothi eliphansi ("Mmmmmm"). Kokubili i-reflex ye-pharyngeal swallow reflex kanye nokuvungama kwephimbo eliphansi (phonation) setha kabusha i-brainstem ephazamisekile ye-laryngeal motor signaling kanye ne-relaxed hypertonic hypertonic muscle

Isihlahla sesinqumo somtholampilo: i-stridor ekhuthazayo, i-VCD/ILO, kanye ne-laryngospasm ephelele¶

flowchart TD
    A["Ukuqala okungazelelwe kokuqina komphimbo, ubunzima bokuphefumula NGENA, noma i-stridor yokuphefumula ephezulu"] --> B{"Hlola Ukuqaphela, Ukugeleza komoya, kanye ne-Anaphylaxis / Izimpawu Zomzimba Wangaphandle"}
    B -->|Unconscious, cyanotic, silent chest with tracheal tug, or post-sedation/drowning| C["I-LARYNGOSPASM EQEDE NOMA UKUKUMA: Shayela i-EMS (911/112/999); qinisekisa ukuthi ayikho inhlangano yangaphandle; ngokushesha yenza I-LARSON'S MANEUVER + Jaw Thrust + 100% O2 ukucindezela okuhle (CPAP 10 kuya ku-20 cmH2O)"]
    B -->|Swollen lips/tongue, generalized hives, hypotension, or exposure to allergen| D["I-ANAPHYLAXIS NOMA I-ANGIOEDEMA: Jova i-Epinephrine ye-Intramuscular (0.3 ukuya ku-0.5 mg) ngaphandle kwethanga ngokushesha bese ushayela i-EMS"]
    B -->|Fever, drooling, tripod posture, muffled hot-potato voice, or barking cough| E["I-EPIGLOTTITIS NOMA CROUP: Gcina isiguli sizolile futhi siqondile; UNGAhloli umphimbo ngesipuni; shayela i-EMS ngokushesha"]
    B -->|Awake, alert, no hives/swelling, pointing to throat; loud inspiratory stridor triggered by exercise, cough, reflux, scent, or stress| F["I-Inducible Laryngeal Obstruction (VCD / ILO) noma i-Awake Paroxysmal Laryngospasm"]
    F --> G["Isinyathelo 1: Hlala uqonde uncike kancane phambili; lahla amahlombe; phumuza imihlathi nemisipha yentamo"]
    G --> H["Isinyathelo sesi-2: Khipha umoya kancane ngezindebe EZELELWE ngokuqinile imizuzwana emi-4 (kudala ingcindezi engemuva ukuze iphushe izintambo zivuleke)"]
    H --> I["Isinyathelo sesi-3: Thatha i-NASAL SNIFFS emi-2 ethambile ngekhala (noma phefumula njengenja / phefumula ngotshani obucatshangelwayo) usebenzisa ukuphefumula kwesisu"]
    I --> J{"Ingabe i-stridor nokuqina komphimbo kuxazulule phakathi kwemizuzu engu-1 ukuya kwemi-3?"}
    J -->|Yes (Typical VCD / Awake Laryngospasm resolution)| K["Thela amanzi kancane kancane; gwema izimbangela (reflux, umoya obandayo, irritants); hlela i-laryngoscopy yesiguli sangaphandle kanye ne-Speech-Language Pathology (EILOBI) therapy"]
    J -->|No: Stridor persists > 3 to 5 minutes, SpO2 drops below 92%, or severe distress| L["Shayela i-EMS (911/112/999) ukuze uthole ukuhlolwa koMnyango Wezimo Eziphuthumayo, i-nasolaryngoscopy eguquguqukayo, i-CPAP, noma i-Heliox (80:20 helium-oxygen)"]
    C --> M["Isibhedlela / I-Anesthesia Escalation uma i-Larson Maneuver + CPAP ihluleka: IV Propofol (0.25 kuya ku-0.8 mg/kg) noma i-IV Succinylcholine (0.1 kuya ku-1.0 mg/kg) + i-tracheal intubation"]

I-Pathophysiology: Indlela I-Larynx Esebenza Ngayo Futhi Kungani Izintambo Zezwi Slam Shut¶

I-larynx yomuntu (ibhokisi lezwi) yenza imisebenzi emithathu ebalulekile yebhayoloji: ukugcina umoya ovulekile wokuphefumula, ukukhiqiza izwi (ukukhala kwezwi), kanye ukusebenza njenge-valve ye-sphincter evikelayo ukuvimbela ukudla, uketshezi, ne-asidi yesisu ukuthi ingangeni emaphashini ngesikhathi sokugwinya.

Ukunyakaza kweVocal Cord okujwayelekile vs I-Paradoxical Adduction (ILO) vs Complete Laryngospasm¶

1. Ukuphefumula Okujwayelekile:
2. Ngesikhathi Sokuhogela (Ukuphefumula Ngaphakathi): Isikhungo sokuphefumula ku-medulla oblongata sibeka uphawu phansi kwenzwa ye-laryngeal ukuze ifinyeze umsipha i-posterior cricoarytenoid (PCA), okuwukuphela komsipha kuwo wonke umzimba womuntu ovula (ethumba) izintambo zezwi. Izintambo zephimbo zishwibeka ngokuhlukana zibe u-V obanzi, okuvumela ukugeleza komoya othulile ku-trachea.
3. Ngesikhathi Sokukhipha Umoya (Ukuphefumula): Izintambo zezwi zixega kancane ziye emgqeni ophakathi nendawo (zincipha ngamaphesenti angu-10 kuye kwangu-30) ukuze kugcinwe ingcindezi emaphakathi yokuphelelwa umoya.
4. I-Inducible Laryngeal Obstruction (I-Vocal Cord Dysfunction / VCD):
5. Ezigulini ezine-VCD / ILO (okuhlanganisa Ukuvinjwa Kwe-Laryngeal Okubangelwa Ukuzivocavoca [EILO] kubasubathi abaqhudelanayo), ukucasuka okungapheli kwe-laryngeal mucosa (kusuka ku-laryngopharyngeal acid reflux ethule, i-post-nasal drip, noma i-inhaled irritants) noma i-autonomic * i-autonomic muscle. i-cricoarytenoid, thyroarytenoid, kanye nemisipha ye-interarytenoid**) ukufinyela ngokuxakayo ngesikhathi sokuhogela (noma kubangele ukugoqa kwe-aryepiglottic ngenhla kwezintambo ukuthi kungene ngaphakathi ngesikhathi sokuzivocavoca okuphezulu).
6. Esikhundleni sokuvuleka ku-V obanzi lapho umuntu ephefumula, izingxenye ezimbili kwezintathu zephimbo zangaphambili zishwibeka ndawonye zibheke emgqeni omaphakathi, kushiye kuphela i-chink engemuva emise okwedayimane ngemuva kwe-glottis okukhala kuyo umoya one-stridor ekhuthazayo ephezulu.
7. I-Acute Complete Reflex Laryngospasm:
8. Ilamula nge-igatsha langaphakathi lomthambo we-laryngeal ophakeme (igatsha le-Vagus Nerve, CN X), i-laryngospasm iyi-reflex eyihaba, yakudala yokuvikela isiqu sobuchopho eklanyelwe ukugcina amanzi noma ukuhlanza kuphume emaphashini.
9. Lapho ithonsi le-microscopic esiswini acid (laryngopharyngeal reflux / LPR), amafinyila angemuva kwekhala, igazi, amanzi (ngesikhathi sokubhukuda noma ugwiliza), noma ukukhwehlela okunamandla (okufana ne-Bordetella pertussis ukukhwehlela noma i-post-viral vagal neuropathy) ishaya i-hypersensitive vocal izintambo (i-vestibular folds), kanye nokugoqa kwe-aryepiglottic konke kufinyela kube i-tetanic spasm eqhubekayo ngesikhathi esisodwa**.
10. Ngokungafani nokuvala okujwayelekile kokugwinya (okuthatha imizuzwana engu-0.5), i-reflex laryngospasm ivala i-glottis ivale imizuzwana engu-15 ukuya kwangu-90 ngisho nangemva kokuba into ecasulayo isihambile.

Ukuqhathanisa uhlangothi necele: Ukungasebenzi Kwe-Vocal Cord (ILO) vs Ukuhlasela Kwe-Asthma vs Anaphylaxis vs Ukuvinjwa Komzimba Wangaphandle¶

Ngoba kuze kube amaphesenti angu-40 eziguli ezine-Vocal Cord Dysfunction azihlonzwa kahle iminyaka ngokuthi zine-"refractory brittle asthma", ngezinye izikhathi zithola umthamo omkhulu we-oral corticosteroids, imijovo ye-epinephrine e-intramuscular, noma ngisho ne-endotracheal intubation ephuthumayo, wonke umeluleki ophuthumayo nesiguli kufanele bazi: lezi zici ezihlukanisayo zakudala.

Umhlahlandlela onemininingwane wesinyathelo nesinyathelo ku-Larson's Maneuver (I-Laryngospasm Notch Technique)¶

Kuchazwe udokotela obulala izinzwa uDkt. C. Philip Larson Jr. futhi wahlonishwa ngaphezu kwamashumi amane eminyaka yokusebenza komtholampilo, Ukuqondisa kukaLarson kuyindlela eyodwa ephumelela kakhulu engeyona eyekhemisi yokuphula i-laryngospasm eyingxenye ebukhali noma eqinile (kungakhathaliseki ukuthi kwenzeka ngemva kokukhishwa kwe-anesthesia jikelele, ngesikhathi sokulaliswa kwenqubo nge-ketamine, ngesikhathi sokuhlaselwa kwe-paxyry noma ukuhlaselwa kwe-laryngospasm. awukwazi ukuhogela nhlobo).

Izimpawu zomhlaba ze-Anatomical ze-Laryngospasm Notch (Iphuzu likaLarson)¶

Ezinhlangothini zombili zekhanda, ngokushesha ngemuva kwama-earlobes, kuhlezi ukucindezeleka okujulile kwe-pyramidal okubizwa ngokuthi laryngospasm notch: - Umngcele Wangaphambili (Udonga Lwangaphambili): Umngcele ongemuva we-ramus ekhuphukayo kanye ne-condyle ye-mandible (umhlathi ongezansi). - Umngcele Ongasemva (Udonga Olungemuva): Umngcele ongaphambili wethambo inqubo ye-mastoid yethambo lesikhashana elingemuva kwendlebe. - Umngcele Ophakeme (Uphahla): Isisekelo sogebhezi ngezansi nje komsele wokuzwa wangaphandle (umsele wendlebe) kanye nenqubo yesitayela. - Lokho Okulele Ngokujulile Ngaphakathi Kwenotshi: I-stylohyoid ligament, isiqu se-Facial nerve (CN VII), amagatsha e-glossopharyngeal (CN IX) kanye ne-vagus (CN X), kanye ne-parotid fascia.

Indlela Yokwenza I-Larson's Maneuver ngezinyathelo ezi-4¶

1. Zibeke Ngemva Noma Ubheke Isiguli: Yima enhlokweni yombhede (uma isiguli silele) noma ngemuva/eceleni kwesiguli esihlezi.
2. Faka Iminwe Yakho Ephakathi Noma Yenkomba Ekujuleni Kokubili Amanothi E-Laryngospasm: Shelelezisa amaphedi ayo yomibili iminwe ephakathi nendawo (noma iminwe yokukhomba) ngqo ngemva kwezindlebe ungene endaweni ethambile engunxantathu phakathi konqenqema olungemuva lomhlathi nethambo le-mastoid, ngakwesokudla phezulu komhlathi eduze nomsele wendlebe.
3. Cindezela Ngaphakathi Ngendluzula (Ngokumaphakathi) Ngaphakathi Kogebhezi: Faka ingcindezi eqinile, ejulile yangaphakathi uye kwenye indlebe. Lokhu kudala ukuvuselela okuqinile, okubukhali kwe-periosteal phezu kwenqubo ye-styloid namagatsha e-cranial nerve.
4. Ngasikhathi sinye Donsela Phambili Naphezulu (I-Anterior-Cephalad Jaw Thrust) Ubheke Ekhaleni: Ngenkathi ucindezela ungene phakathi kunotshi, xhuma iminwe yakho ngemuva kwe-engeli/iramu ye-mandible futhi uphakamise wonke umhlathi ongezansi uye phambili ngamandla (uphakamise amazinyo angezansi phambi kwamazinyo angaphezulu).

Kungani I-Larson's Maneuver Isebenza (I-Dual Mechanical and Neurological Mechanism)¶

• I-Mechanical Supraglottic Unfolding: Ukudonsa umandible phambili ngenkani kwelula geniohyoid, mylohyoid, nemisipha ye-thyrohyoid kanye nomsipha we-hyoepiglottic, kudonsela ithambo le-hyoid nesisekelo solimi ngaphambili. Lokhu kwembula ngokomzimba ukugoqa kwe-aryepiglottic okuboshiwe futhi kudonsele izintambo zephimbo zamanga kude nezintambo zezwi zangempela.
• I-Central Autonomic / Vagal Reflex Interruption: Ingcindezi ejulile ejulile ngaphakathi kwenotshi ye-laryngospasm ivuselela imicu ye-somatic afferent ye-trigeminal (CN V), ebusweni (CN VII), kanye nezinzwa ze-glossopharyngeal (CN IX), ithumela umfutho omaphakathi owedlulele ku-nucleus ne-nucleus nucleus ku-nucleus ye-nucleus ye-nucleus tractus soli ivimbela i-hyperactive superior laryngeal nerve motor arc, ibangele izintambo zezwi ukuba zikhululeke futhi zishwibeke zivuleke phakathi** namasekhondi angu-15** (ngokuvamile okuhambisana nokububula okuzwakalayo noma ukugwinya).

Umhlahlandlela onemininingwane wesinyathelo ngesinyathelo we-Awake Vocal Cord Setha Kabusha Ukuphefumula (Ukuhogela, Ukukhefuzela, kanye ne-EILOBI)¶

Lapho osemusha, umsubathi, noma umuntu omdala ephapheme kakhulu futhi ebhekana nesiqephu esibucayi se-Vocal Cord Dysfunction (ILO)* noma post-cough / post-reflux paroxysmal laryngospasm (ebonakala njengokuqina komphimbo okwesabekayo kanye ne-spiratory stridor ephezulu kakhulu), musa ukucindezelwa okubuhlungu ngokuphelele. Esikhundleni salokho, baqondise kulezi zindlela zokuhlenga i-laryngeal ezisekelwe ebufakazini **: I-Speech-Language Pathology (SLP)

Iqhinga 1: Ukuhogela Kwekhala + Ukukhipha Izindebe Ezixutshwe ("Hofu-Ukuhogela-Futha")¶

1. Ukumisa Kabusha Isimo: Hlalisa umuntu aqonde onqenqemeni lwesihlalo, myeke abeke izingalo zakhe emathangeni akhe (ama-tripod noma akhululeke ancike phambili), asuse amahlombe akhe kude nezindlebe zakhe, futhi akhiphe amazinyo.
2. Exhale First Through Pursed Lips: Bafundise: "Ungazami ukumunca umoya khona manje. Gcoba izindebe zakho sengathi ushaya ikhwela bese uphephetha umoya owukhiphe kancane kancane imizuzwana emi-4: Sssssss noma Fffffff." Lo mfutho ovumayo wokuphelelwa umoya uphusha izintambo zezwi ezikhishwe ngezansi.
3. Ukuhogela Okukabili Kwekhala Ngaphakathi: Bafundise: "Gcina umlomo wakho uvaliwe futhi uthathe ukuhogela okubili okusheshayo, okulula phakathi kwekhala lakho, njengokuhogela i-rose: Hogela, hogela." Ukuhogela emakhaleni kusebenzisa kakhulu umsipha ngemuva we-cricoarytenoid, okuphoqa iphimbo elibanzi.
4. Phinda Imijikelezo emi-5 kuye kweyi-10: Phakathi nokuphefumula okungu-3 kuya kwemi-5, i-stridor enephimbo eliphezulu iyathambisa bese iyanyamalala.

I-Technique 2: Ukusetha Kabusha Ukuhefuzela (Lapho Ikhala Livinjiwe)¶

Uma umuntu enokuminyana emakhaleni noma engakwazi ukuhogela ngamakhala akhe: 1. Bavumele bavule umlomo kancane futhi baphumuze ulimi lwabo futhi bavuleke phansi emlonyeni ngemuva kwamazinyo angaphambili angezansi. 2. Mabathi bahefuzele ngokushesha nangokungajulile njengenja eshisayo (amabhulukwe angu-2 ukuya kwangu-3 angashoni ngomzuzwana) imizuzwana emi-5 ukuya kweyi-10, kulandelwe i-exhale edonsa kancane ngezindebe. 3. Ukuhefuzela ngokuqhubekayo kuvuselela i-brainstem yokuphefumula isigqi sokuphefumula ukuze kugcine umsipha we-cricoarytenoid wangemuva ufinyela, kuvimbele izintambo zezwi ekushayeni zivale maphakathi nomoya.

I-Technique 3: I-EILOBI Breathing (I-Exercise-Induced Laryngeal Obstruction Biphasic Inspiration) Yabadlali¶

Ithuthukiswe ngokukhethekile ama-laryngologists emithi yezemidlalo yaseScandinavia kanye nezamazwe ngamazwe kubagijimi abaqhudelanayo, ababhukudi, abagibeli bamabhayisikili, nabagwedli abahlakulela ukuvalwa kwe-supraglottic noma okucwebezelayo ngokuzikhandla okukhulu (EILO): 1. Ngenkathi eqhubeka noma enciphisa igxathu lawo, umsubathi uhogela kuqala nge-amazinyo adonswe kancane noma izindebe ezigobekile (ukudala ukumelana nomlomo kancane) engxenyeni yokuqala yokuhogela, bese evula kahle umlomo ngenkathi enweba umbambo ongezansi nesisu (i-diaphragmatic excursion) ngaphandle kokuphakamisa intamo ye-clavicles noma intamo yangaphambili. 2. Okwenza kusebenze: Ukudala ukungezwani komlomo kancane ezindebeni kushintsha ukwehla kokucindezela kudlulele emlonyeni esikhundleni se-larynx, kuqeda ukumunca okunegethivu kwe-Bernoulli kuma-aryepiglottic folds kanye nezintambo zezwi.

I-Paroxysmal Laryngospasm Ehlobene Nokulala kanye Ne-Reflux (Ukuvuka Uhefuzele Ebusuku)¶

Okunye okwesabisa kakhulu okuhlangenwe nakho komuntu ukuthi i-laryngospasm ehlobene nokulala: umuntu uvuka eboshelwe ebuthongweni obukhulu phakathi kobusuku engakwazi nhlobo ukuhogela ngisho neconsi elilodwa lomoya, enze umsindo wokukhala ophakeme wokuphelelwa ithemba (noma ukuthula okuphelele) imizuzwana engu-15 kuya kwengu-45 futhi azizwe eqiniseka ukuthi usezokufa, umphimbo uvele ugcwale umoya.

• Imbangela Eyinhloko (I-Laryngopharyngeal Reflux Ethule / LPR): Lapho ilele isicaba ebusuku, ithonsi elincane elincane le-gastric acid ne-pepsin likhuphuka ngomminzo lidlule umhume womminzo ongenhla bese liconsela kumphimbo ongemuva (i-interarytenoid notch). Ngokungafani nomminzo (ongakwazi ukubekezelela ukuchayeka kwe-asidi kafushane), i-laryngeal mucosa inokuzivikela okucishe kube yi-zero carbonic anhydrase; iconsi elilodwa le-asidi livusa i-chemoreflex laryngospasm* esheshayo, enobudlova ukuze kuvikelwe amaphaphu.
• Ungakwephula Kanjani I-Nighttime Reflux Laryngospasm Attack:
• Sukuma noma uhlale phansi uqonde ngokushesha (kumisa ukuqhubeka kwe-acid reflux).
• Cindezela isifiso sokuhefuzela ngamandla ngomlomo ovulekile; ngokushesha ukhiphe ngezindebe ezikhonjiwe futhi uthathe ukuhogela okuncane kwamakhala.
• Uma nje kudlula umoya omncane, phuza amanzi amancane agcinwe endaweni yokulinda bese ugwinya. Isenzo sokugwinya sokugwinya sivusa ukumiswa kabusha kobuchopho okuvula ngokushesha i-laryngeal sphincter.
• Indlela Yokuvimbela Ukuhlasela Kwasebusuku: Misa konke ukudla neziphuzo okungenani emahoreni angu-3 ngaphambi kokulala, phakamisa ikhanda lombhedengamasentimitha angu-15 kuye kwangama-20 (amayintshi angu-6 ukuya kwangu-8) noma ulale emcamelweni ochezukile wedge (ukulala ngakwesobunxele kugcina i-gastroesophaction ngaphezu kwesisu), kanye ne-ENT yesisu i-gastroenterologist ye-proton pump inhibitor (PPI) kanye ne-alginate raft therapy.

Isibhedlela kanye ne-Anesthesia Management ye-Refractory Laryngospasm¶

Emnyangweni wezimo eziphuthumayo esibhedlela, egunjini labagula kakhulu, noma igumbi lokuhlinza (njengangemva kwe-tonsillectomy yezingane, i-endoscopy ephezulu, noma i-ketamine procedural sedation), uma i-laryngospasm ephelele inganqamuki phakathi kwemizuzwana engu-15 kuya kwengama-30 Ukuqondisa kukaLarson + ukuphakamisa isilevu, odokotela benza iphrothokholi yokukhuphuka ngokushesha ngaphambi kwe-hypoxia noma I-negative-pressure pulmonary edema (NPPE) ithuthukisa:

1. Khipha I-Irritant Stimulus: Kancane kancane ukumunca igazi, amathe, noma uketshezi oluphuma ku-hypopharynx ngenhla kwezintambo zezwi futhi ukhiphe noma iyiphi indlela yomoya ye-supraglottic noma indlela yokuphefumula yomlomo ekitaza i-glottis.
2. 100% Oxygen Continuous Positive Airway Pressure (CPAP 10 kuya ku-20 cmH2O) Ne-Tight-Handed Mask Mask Seal: Hlanganisa Ukuqondisa kukaLarson nokubamba imaski ye-C-E yezandla ezimbili eletha 100% komoyampilo ono-10 kuya ku-20 cmH20 womoya we-CPH2O ye-anesthesia eqhubekayo isikhwama. Gwema ukucindezela okunamandla kwesikhwama uma izintambo zivaliwe ngokuphelele, njengoba ukucindezela okungaphezulu kuka-25 cmH2O kuphoqa umoya wehle ngomminzo uye esiswini (ukuphefumula kwesisu), uphushele phezulu ku-diaphragm.
3. I-Sub-Hypnotic Intravenous Propofol (I-First-Line Pharmacological Breaker): Phatha ibholus encane efakwa emthanjeni ye-Propofol (0.25 kuya ku-0.8 mg/kg IV). Ukujula kwe-sedation nge-dose ephansi ye-propofol kuphula amaphesenti angu-75 kuya kwangu-85 we-refractory post-extubation noma i-sedation laryngospasms ngaphakathi kwemizuzwana engu-15 ngaphandle kokudinga ukukhubazeka noma ukuphinda kufakwe intubation.
4. I-Succinylcholine ye-Intravenous noma I-Intramuscular (I-Gold-Standard Neuromuscular Blockade): Uma i-hypoxia iba yimbi kakhulu (i-SpO2 yehla ngaphansi kwama-85%) noma i-bradycardia iqala naphezu kokuhamba kwe-propofol no-Larson:
5. I-Low-Dose IV Succinylcholine: 0.1 kuya ku-0.25 mg/kg IV ikhulula ngokushesha imisipha yephimbo eshaywayo phakathi kwamasekhondi angu-20 kuya kwangu-30 kuyilapho ngokuvamile ilondoloza ukuphefumula kwe-diaphragm okuzenzakalelayo.
6. I-Full-Dose IV Succinylcholine (1.0 kuya ku-2.0 mg/kg IV) noma i-IM Succinylcholine (4.0 mg/kg IM ku-deltoid noma i-quadriceps uma kungekho umugqa we-IV okhona): Ikhubaza ngokuphelele izintambo zezwi ukuze kungene umoya ophuthumayo kanye ne-endotracheal tropine intubation, i-endotracheal tropine intubation. mg/kg)** ezinganeni ezincane ukuvimbela i-hypoxic/succinylcholine-induced bradycardia enzima.
7. I-Heliox (80% Helium / 20% Oxygen) Ye-Severe Awake Refractory Stridor: Emnyangweni Wezimo Eziphuthumayo, iziguli ezine-stridor ephezulu ephapheme ephikelelayo zisabela ngokushesha kokuthi Heliox (80:20 noma 70:30 ingxube ye-helium-oksijeni) ngenxa yokuthi i-hevenlium ye-nitrogen, ne-densigen eyodwa inezinombolo eziphansi iguqula ukugeleza komoya okunezinxushunxushu kubuyele ekugelezeni kulaminar okubushelelezi kuyilapho kwephula umjikelezo wokumunca i-Bernoulli.

Izinombolo eziphuthumayo zesifunda kanye nemihlahlandlela yomtholampilo¶

• I-United States ne-Canada: Shayela u-911* nganoma iyiphi i-stridor yokuqala, i-cyanosis, i-anaphylaxis, noma i-laryngospasm engaphenduli. Landela i-American Thoracic Society (ATS), i-American College of Chest Physicians (CHEST), kanye I-American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) imihlahlandlela yokuqinisekisa i-laryngoscopy eguquguqukayo ye-Inducible Laryngeal Obstruction (ILO) kanye nokwelashwa kokuphefumula kabusha.
• E-United Kingdom: Shayela u-999* ukuze uthole i-stridor ebukhali enokucindezeleka kokuphefumula noma i-cyanosis. ** I-European Respiratory Society (ERS) / European Laryngological Society (ELS) / Royal Brompton Hospital** imihlahlandlela yokuvumelana ichaza i-Inducible Laryngeal Obstruction (ILO) kanye ne-Exercible-Induced Laryngeal Obstruction (EILO) futhi incoma i-laryngoscopy eqhubekayo ngesikhathi sokuzivocavoca (CLE) kanye nenkulumo yochwepheshe kanye nokwelashwa kolimi.
• I-European Union: Shayela u-112* kuwo wonke amazwe angamalungu e-EU. Landela okuhlanganyelwe ERS / ELS / ACCP Task Force Consensus Statement on Nomenclature and Diagnosis of Inducible Laryngeal Obstructions.
• I-Australia ne-New Zealand: Shayela u-000* e-Australia noma 111 eNew Zealand. Landela i-Thoracic Society of Australia and New Zealand (TSANZ) kanye ne-Australian and New Zealand College of Anesthetists (ANZCA) ama-algorithms okulawula inkinga ye-laryngospasm.

Imibuzo evame ukubuzwa¶

Ngingawubona kanjani umehluko phakathi kweVocal Cord Dysfunction (VCD/ILO) kanye nokuhlaselwa yisifuba somoya?¶

Umehluko ocace kakhulu ukuthi kulukhuni ukuphefumula NGAPHAKATHI noma UKUPHUMA, nalapho umsindo uvela khona: ku-Vocal Cord Dysfunction (inducible laryngeal obstruction), izintambo zezwi ezisentanyeni yakho ziyavaleka ngendlela exakayo lapho uhogela, okukwenza kuzwakale sengathi umoya ushaya udonga emphinjeni wakho ngomsindo wokukhala okuphezulu (i-stridor) ngenkathi iziqephu ziqala ukuma kanye nokuma kwe-oksijini phakathi nemizuzu embalwa. Ekuhlaselweni kwesifuba somoya, amashubhu amancane e-bronchial ekujuleni kwesifuba sakho aba mancane, okwenza kube nzima kakhulu ukuphefumula umoya NGAPHAMBILI ngokuhefuza okuphuma umoya esifubeni okudinga i-bronchodilator inhaler (salbutamol/albuterol) futhi kuthatha amahora ukuxazulula.

Iyini indlela kaLarson futhi ikuphi i-laryngospasm notch?¶

Ukuqondisa kuka-Larson kuyindlela engokomzimba ephuthumayo esetshenziselwa ukuphula i-laryngospasm enzima noma ephelele. I-laryngospasm notch (iphuzu lika-Larson) i-indentation encane emise okukanxantathu ngqo ngemuva kokubili kwezindlebe, ephakathi konqenqema olungemuva lomhlathi ongezansi (mandibular ramus) ngaphambili, ithambo le-mastoid ngemuva kwendlebe ngemuva, kanye nesisekelo sogebhezi phezulu. Ukucindezela ngokuqinile ngaphakathi phakathi kwekhanda neminwe yakho ephakathi ijule kuzo zombili izinqamu ngenkathi ngesikhathi esifanayo udonsa umhlathi ongezansi ngamandla uye phezulu (ukucindezela komhlathi) kwelula izicubu ze-laryngeal zivuleke futhi kubangele i-cranial nerve reflex ephumuza intambo yezwi ngemizuzwana.

Kungani ukuhogela ngamakhala akho futhi uphefumule ngezindebe ezikhonjiwe kumisa intambo yezwi?¶

Lapho izintambo zakho zezwi zishoshozela kancane kancane, ukuhefuzela kanzima ngomlomo ovulekile kudala i-vacuum enesivinini esikhulu (umphumela we-Bernoulli) emunca izintambo zezwi ziqine nakakhulu ndawonye. Ukukhipha umoya kancane ngezindebe eziboshwe ngokuqinile kudala ingcindezi engemuva esuka ngezansi ephusha izintambo zezwi, kuyilapho ukuthatha ukuhogela okubili okuthambile ngekhala kusebenze i-brainstem reflex eyakhelwe ngaphakathi evutha umsipha we-cricoarytenoid yangemuva, okuwukuphela komsipha emzimbeni odonsa izintambo zezwi zivuleke kakhulu.

Kungani ngezinye izikhathi ngivuka phakathi nobusuku ngihefuzela ngivale umphimbo?¶

Ukuvuka kungazelelwe ebuthongweni ungakwazi ukudonsa umoya imizuzwana engu-15 ukuya kwangu-45 ngomsindo we-stridor ophakeme kuyi-reflux laryngospasm yakudala ehlobene nokulala. Uma ulele uphansi, i-droplet encane ye-asidi yesisu kanye ne-enzyme yokugaya (laryngopharyngeal reflux) ingahamba ikhuphuke ngommizo wakho futhi ithinte izintambo zakho zezwi, ivuse i-reflex evikelayo esheshayo evala ibhokisi lezwi ukuze kugcinwe i-asidi emaphashini akho. Ukuhlala ibhawudi uqonde, uphefumule ngezindebe ezikhonjiwe, uhogela kancane ngekhala lakho, futhi ukuphuza kancane kusetha kabusha i-reflex phakathi nemizuzwana.

Imithombo nesiqondiso esisemthethweni¶

• I-European Respiratory Society (ERS), i-European Laryngological Society (ELS), kanye ne-American College of Chest Physicians (ACCP): Isitatimende Sokuvumelana Kwamazwe Ngamazwe Nge-Nomenclature, Diagnosis, and Management of Inducible Laryngeal Obstructions (ILO ne-EILO).
• Larson CP Jr. (I-Anesthesiology / Clinical Airway Management): I-Laryngospasm: Ukwelashwa Okungcono Kakhulu (Incazelo Eyisisekelo Ye-Laryngospasm Notch kanye Ne-Larson's Jaw-Thrust Maneuver).
• I-American Thoracic Society (ATS) kanye ne-American Academy of Allergy, Asthma, and Immunology (AAAAI): Ukwehluka Komtholampilo Nokuphathwa Ngokuhlanganyela Kokungasebenzi Kwe-Vocal Cord (Paradoxical Vocal Fold Motion) kanye Ne-Asthma.
• Inhlangano Yama-Anesthetists (United Kingdom) kanye ne-Australian and New Zealand College of Anesthetists (ANZCA): Perioperative Laryngospasm Crisis Management Algorithm (CPAP, Larson's Maneuver, Propofol, and Succinylcholine).
• I-Royal College of Speech and Language Therapists (RCSLT) kanye ne-American Speech-Language-Hearing Association (ASHA): Ukuqeqeshwa Kabusha Kokuphefumula kanye Nokwelashwa Kwe-EILOBI Ye-Inducible Laryngeal Obstruction.

Iziqondiso ezihlobene¶

• I-asthma attack treatment kanye ne-inhaler spacer technique
• I-Epiglottitis, i-croup, i-stridor, nokuvinjelwa komzila womoya ophezulu
• I-Negative-pressure pulmonary edema (NPPE) ngemva kokukhulula ukuminya noma i-laryngospasm
• Ukungezwani komzimba kanye nosizo lokuqala lwe-anaphylaxis
• Izinombolo zesimo esiphuthumayo ngezwe