So wo mogya betumi asɛe na worekɔ ‘ahodwiriw’ mu? Momma yɛnka ‘distributive shock’ ho asɛm!

Oh, ɛtɔ da bi a yebetumi akɔ ɔhaw kɛse mu mpofirim, ɛnte saa? Mmere bi wɔ hɔ a yɛte nka sɛ yɛrehwere yɛn nkwa na ɛyɛ den sɛ yɛbɛhome. Wɔ mmere a ɛte sɛɛ mu no, ebia na biribi a anibere wom rekɔ so wɔ yɛn nipadua mu. Ɛnnɛ yɛbɛka tebea biako a ɛte saa a ɛba mpofirim a ɛde nkwa to asiane mu ho asɛm. Ɛno yɛ tebea bi a wɔfrɛ no ‘Distributive Shock’ .

Dɛn ne ‘ahodwiriw a ɛma wɔkyekyɛ nneɛma’ yi? Sɛ yɛbɛka no tiawa a...

Sɛ yɛbɛka no tiawa a, distributive shock yɛ aduruyɛ mu tebea a egye ntɛmpɛ. Nea ɛkɔ so wɔ ha ne sɛ mogya ntini a ɛwɔ wo nipadua mu (beae a mogya kɔ) no yɛ kɛse dodo mpofirim, te sɛ rɔba afiri a wɔretrɛw mu. Ɛtɔ mmere bi a wɔsan frɛ eyi vasodilatory shock . Enti, sɛ mogya ntini no yɛ kɛse te sɛ eyi a, mogya no so tew kɛse mpofirim. Susuw ho sɛ sɛ nsu paipu yɛ kɛse a, nsu no bɛsen brɛoo.

Sɛ eyi ba a, dɛn na ɛba? W’akwaa atitiriw te sɛ wo koma, w’amemene, ne w’asaabo nnya mogya a ɛdɔɔso . Ɛnyɛ ɛno nko, na mmom ɛtɔ mmere bi a mogya no bi fi ase tu fi mogya ntini nketenkete (capillaries) yi mu. Eyi betumi ama mogya dodow a ɛwɔ wo nipadua mu no so atew. Eyi yɛ tebea a asiane wom kɛse, efisɛ yɛn akwaa hia mogya a wɔde ma bere nyinaa na ama ayɛ adwuma.

Ɛho hia paa: Sɛ wunya ‘ahodwiriw’ te sɛ eyi a, ɛho hia sɛ wohwehwɛ ayaresa ntɛm ara sɛnea wubetumi. Sɛ ɛnte saa a, ebetumi de nkwa ato asiane mu.

Dɛn ne ‘distributive shocks’ ahorow atitiriw?

‘Ahodwiriw a ɛkyekyɛ’ titiriw abiɛsa na ɛwɔ hɔ, na ɛsono nea enti a emu biara ba.

1. Septic Shock: Eyi ne nea ɛtaa ba. Mmoawa bi a ɛde ɔyare mmoawa ba na ɛde ba. Fa no sɛ, wowɔ kuru, ɛyɛ bɔne ankasa, mmoawa no trɛw wɔ wo nipadua nyinaa mu, na ɛbɛyɛ tebea bi a wɔfrɛ no ``Sepsis'', na wuntumi nni so. Ɛtɔ mmere bi a, biribi te sɛ ahurututu mu yare mpo betumi de tebea yi aba.

2. Anaphylactic Shock: Eyi fi akisikuru a emu yɛ den. Sɛ nhwɛso no, nnipa binom ho yɛ wɔn yaw kɛse wɔ biribi te sɛ atoko ho, ɛnte saa? Anaasɛ ɛba bere a nkoekoemmoa bi keka wɔn no. Obi a ɔwɔ ayamtu nso betumi anya saa tebea yi, sɛ ɛyɛ den ma no kɛse sɛ ɔbɛhome mpo a.

3. Neurogenic Shock: Eyi fi w’akyi berɛmo a ɛsɛe. Sɛ nhwɛso no, sɛ wobɔ wo ti bere a worehuruw akɔ nsu mu na wopira w’akyi berɛmo, anaasɛ wunya akwanhyia a emu yɛ den a ɛsɛe w’akyi berɛmo a, saa ‘ntini mu ahodwiriw’ yi betumi aba esiane nkɛntɛnso a enya wɔ ntini ahorow no so nti.

Nsonsonoe bɛn na ɛwɔ ‘Distributive Shock’ ne ‘Hypovolemic Shock’ ntam?

N’abien nyinaa yɛ ‘ahodwiriw’ ahorow. Ɛno kyerɛ sɛ wɔ nsɛm abien no nyinaa mu no, yɛn akwaa a ɛho hia no nnya mogya ne mframa pa a ɛdɔɔso. Nanso, ɛsono nea ɛde ba.

• Distributive shock , sɛnea yɛadi kan aka no, fi mogya ntini a ɛyɛ kɛse dodo. Mpɛn pii no, ɔyare bi a wɔfrɛ no sepsis anaasɛ akisikuru a emu yɛ den na ɛde eyi ba.
• Hypovolemic shock yɛ bere a mogya anaa nsu afoforo dodow a ɛwɔ nipadua no mu no sua dodo. Sɛ nhwɛso no, sɛ wohwere mogya pii esiane opira kɛse bi nti, anaa sɛ wohwere nsu pii esiane akisikuru anaa ɔfe a emu yɛ den nti a, eyi betumi aba.

Sɛ yɛbɛka no tiawa a, wɔ ‘distributive’ mu no mogya ntini no yɛ akɛse, wɔ ‘hypovolemic’ mu no mogya/nsu a ɛwɔ nipadua no mu no so tew. Ate aseɛ?

‘Ahodwiriw a ɛkyekyɛ nneɛma’ yi abu so dɛn?

Ahodwiriw ahorow anan na yenim (`Hypovolemic`, `Cardiogenic Shock`, `Obstructive Shock` ne `Distributive Shock`). Wɔ saa anan yi mu no , nea ɛtaa ba ne `Distributive Shock` . Titiriw nea wɔfrɛ no `Septic Shock` no. Wɔ ɔman te sɛ Amerika mpo mu no, nnipa bɛyɛ ɔpepem biako nya `Septic Shock` afe biara. Ebetumi ato obiara.

Dɛn na ɛto nipadua a ɛwɔ ‘distributive shock’ no?

Sɛnea madi kan aka no, sɛ mogya ntini no yɛ kɛse dodo a, mogya mmoroso so tew. Afei mogya dodow a ɛkɔ akwaa no mu no bɛyɛ nea ɛnnɔɔso. Yɛn akwaa te sɛ mfiri. Ɛsɛ sɛ wonya pɛtro dodow a ɛfata (i.e. mogya ne oxygen) na ama wɔatumi ayɛ adwuma. Sɛ wɔnnya mogya, mframa pa, ne aduannuru a ɛdɔɔso a, akwaa no fi ase gyae adwumayɛ nkakrankakra. Yɛfrɛ eyi ‘akwaa a entumi nyɛ adwuma yiye’ . Sɛ akwaa no di nkogu saa a, ɛbɛyɛ asiane kɛse ma nkwa.

Dɛn ne eyi ho sɛnkyerɛnne?

Distributive shock ho sɛnkyerɛnne betumi ayɛ soronko kakra a egyina nea ɛde ba no so. Nanso, sɛnkyerɛnne ahorow bi wɔ hɔ a ɛtaa ba:

• Wora a ɛyɛ mmerɛw
• Koma a ɛbɔ ntɛmntɛm ne ahome a wɔhome
• Mogya mmoroso a ɛba fam (eyi ne sɛnkyerɛnne titiriw no) .
• Mfiase no nsa ne anan no yɛ hyew, afei ɛyɛ nwini na fifiri yɛ no.
• Huraeɛ
• Awɔw (awɔw a wɔte nka na wo ho popo) .
• Yafunu mu yaw
• Adwene a ɛyɛ basaa, te sɛ nea worehwere w’adwene
• Ɛwa
• Ahome a ɛyɛ tiaa
• Abofono
• Ɔfe a wɔfe
• Ɛyaw bere a woretow nsu no

Sɛ sɛnkyerɛnne ahorow yi mu biako anaa nea ɛboro saa da adi mpofirim a, ɛbɛyɛ papa sɛ woremfa nyɛ hwee, ɛnte saa?

Dɛn ne nneɛma a ɛde ‘Distributive Shock’ ba?

Wɔ ahorow abiɛsa a yɛadi kan aka ho asɛm no akyi no, nneɛma afoforo pii wɔ hɔ a ɛde tebea yi ba.

• Sepsis a efi ɔyare mmoawa bi mu ba (eyi ne ade titiriw a ɛde ba) .
• Anaphylaxis, a ɛnam akisikuru a emu yɛ den so na ɛba (sɛ nhwɛso no, nnuan te sɛ atoko, nkoekoemmoa a wɔwe, nnuru bi, ayamtu a ɛma ɛyɛ den) .
• Ɔhyew a ɛyɛ hyew
• Pancreatitis a ɛyɛ yare
• Toxic Shock Syndrome (a ebetumi aba, titiriw wɔ mmea mu, esiane tampon a wɔde di dwuma nti) .
• Akyi berɛmo mu opira
• Nkwammoaa mu nyarewa
• Adrenal insufficiency (eyi ntaa mma kakra) .
• Capillary leak syndrome ( nsu a ɛtwetwe fi mogya ntini mu, eyi nso ntaa mma kakra) .
• Aduru a ɛma mogya ntini yɛ kɛse a wɔnom (Nnuru a wɔnom boro so) (eyi nso ntaa mma) .

Ɔkwan bɛn so na nnuruyɛfo hu eyi?

Sɛ wunya saa sɛnkyerɛnne ahorow yi a, ade a edi kan a oduruyɛfo bɛyɛ ne sɛ ɔbɛhwehwɛ wo mu yiye na wabisa wo w’ayaresa ho abakɔsɛm. Nanso, ebia obi a ne ho adwiriw no no rentumi mfa nsɛm biara mma wo. Wɔ tebea a ɛte saa mu no, obi a ɔka wo ho betumi aka wo ho asɛm akyerɛ oduruyɛfo no , sɛ ebia woanya anaphylaxis pɛn, ne nnuru a worenom. Saa nsɛm yi betumi aboa kɛse wɔ tebea no a wobehu mu.

Ɛno akyi no, oduruyɛfo no bɛhyɛ sɛ wɔnyɛ nhwehwɛmu pii, te sɛ:

• Mogya mu nhwehwɛmu: Hwɛ sɛ ɔyare mmoawa ne sɛnea akwaa no reyɛ adwuma.
• ECG (Electrocardiogram - EKG): Ɛhwɛ sɛnea koma no yɛ adwuma.
• Chest X-ray: Hwɛ sɛnea ahurututu no te.
• Ultrasound scan: Hwɛ koma, ahurututu, ne akwaa a ɛwɔ yafunu no mu. Wobetumi ayɛ eyinom bi wɔ mpa ho.

Ɔkwan bɛn so na wɔsa?

Esiane sɛ eyi yɛ tebea a egye ntɛmpɛ nti, wɔtaa fi ayaresa ase wɔ Emergency Room. Ɛno akyi no, wobetumi de wo akɔ Intensive Care Unit (ICU).

1. Ade a edi kan a woyɛ ne sɛ wobɛma wo nsu a wɔde fa IV mu. Wɔde nsu te sɛ nkyene gu ntini bi mu. Wɔyɛ eyi na ama wo mogya so atew kakra.

2. Nea edi hɔ no, yɛbɛkyerɛ nea ɛde ‘ahodwiriw’ no bae na yɛama no aduru a ɛfata.

3. Ɛtɔ da bi a , wobetumi de tube feeding adi dwuma , efisɛ nipadua no hia ahoɔden.

Wɔ beae a wɔhwɛ wɔn a wɔyare denneennen no, nnuruyɛfo ne ayarehwɛfo bɛkɔ so ahwɛ wo sɛnkyerɛnne ahorow a ɛho hia (koma a ɛbɔ, mogya mmoroso, ahome, ɔhyew). Wɔbɛhwɛ nso sɛ ebia ayaresa no mu nsunsuanso bɔne bi bɛba anaa. Sɛ ɛyɛ den ma w’ankasa sɛ wobɛhome a, ebia wɔde wo bɛka afiri a wɔde home (ahomegye afiri) ho .

Nnuru bɛn na wɔde di dwuma?

Aduru a wɔde ma ‘Distributive Shock’ no gu ahorow gyina nea ɛde ba no so:

• Nnuru a ɛma mogya tu:Wɔde eyinom ma na ama mogya mmoroso akɔ soro. Sɛ nhwɛso no, nnuru te sɛ `epinephrine`, `vasopressin`, `norepinephrine` anaa `phenylephrine`.
• Nnuru a ekum ɔyare mmoawa : Sɛ ɔyare mmoawa bi wɔ hɔ a.
• Antihistamines: Sɛ efi akisikuru a ɛma obi ho yɛ no hyew a.
• Steroids: Wɔ allergy anaa sepsis a emu yɛ den ho.
• Albuterol inhaler (te sɛ Accuneb® anaa Proair®HFA): Sɛ ahodwiriw no fi ayamtu a.

So ayaresa no mu nsunsuanso bɔne bi wɔ hɔ?

Yiw, nnuru bi betumi de ɔhaw nketenkete aba.

• Vasopressors: koma no bɔ a ɛnbɔ daa (arrhythmia), ahomegye a enni hɔ, ahurututu mu edema, koko mu yaw, koma no mu ntini a ɛma mogya tu no yɛ teateaa (eyi betumi ama obi anya komayare).
• Nnuru a ekum ɔyare mmoawa : Akisikuru, ɔfe.
• Albuterol: Dadwen, adwenemhaw, akisikuru.
• Nnuru a ɛko tia akisikuru: Dae, adwenemhaw, tiyɛ, koma a ɛbɔ ntɛmntɛm.

Nanso, nnuruyɛfo bɛhwɛ eyinom nyinaa na wɔama wo ayaresa a ɛfata sen biara. Adeɛ a ɛho hia paa ne sɛ wobɛgye wo nkwa.

Yɛbɛyɛ dɛn atew asiane yi so?

Ebia yɛrentumi nkwati biribiara a ɛde distributive shock ba. Sɛ nhwɛso no, ɔyare mmoawa ne ɔhyew. Nanso, nneɛma bi wɔ hɔ a yebetumi ayɛ de atew asiane a ɛwɔ saa ahodwiriw yi mu esiane nsɛm bi a wonim nti:

• Sɛ wowɔ aduan ho akisikuru a emu yɛ den , te sɛ atoko a, fa epinephrine auto-injector (te sɛ EpiPen® Auto-Injector anaa Adrenalin®) ka wo ho bere nyinaa. Hu sɛnea wode bedi dwuma pɛpɛɛpɛ.
• Sɛ wotaa nya ayamtu a ɛyɛ hyew a , fa wo albuterol anaa salbutamol inhaler no ka wo ho bere nyinaa. Mma ɛnsa.
• Sɛ wode tampons di dwuma a, nnyaw no nkyɛ dodo, efisɛ eyi betumi de Toxic Shock Syndrome aba, na ebetumi akɔ so ayɛ Distributive Shock.
• Mma nnhuruw nkɔ nsu a emu nnɔ anaa nsu a emu dɔ a wonnim mu. Ebetumi ama akyi berɛmo asɛe.
• Sɛ worenom nnuru a ɛma wo mogya ntini mu trɛw (bue) a, nnom pii. Fa dodow a wo duruyɛfo ka kyerɛ wo sɛ fa no nkutoo.

Sɛ ‘distributive shock’ ba a, dɛn na ɛba?

Sɛ nea ɛde ahodwiriw ba ne sepsis a, ebia wubehyia ɔhaw ahorow a ɛtra hɔ kyɛ. Nneɛma te sɛ ɔbrɛ, adaeso bɔne, ne aduan ho akɔnnɔ a ɛyera. Ɛmfa ho nea ɛde ba biara no, ɛsɛ sɛ wokɔ so kɔ wo duruyɛfo nkyɛn kɔhwɛ no. Ɛsɛ sɛ wonom nnuru a wo duruyɛfo akyerɛw ama wo no pɛpɛɛpɛ nso.

Bere a egye na obi ho atɔ no afi distributive shock mu no gyina sɛnea na emu yɛ den no so. Ebia ɛho behia sɛ wotra ayaresabea hɔ nna kakraa bi kosi adapɛn kakraa bi.

Nkwa dodow a wonya wɔ saa tebea yi mu no betumi ayɛ soronko fi 20% kosi 80%, a egyina nea ɛde ba no so. Sɛ wɔansa a, mpɛn pii no ebetumi akowie owu mu. Sɛ wohu yare no ntɛm na wɔsa no yare a, ɛno ne ɔkwan a eye sen biara a wobɛfa so agye obi nkwa. Wɔn a wɔn mfe akɔ anim, wɔn a wɔnom nsa, ne wɔn a wɔwɔ akwaa ahorow pii ho haw no wɔ asiane kɛse mu.

Sɛ wo nipadua no yɛ n’ade yiye wɔ IV mu nsu ho na w’akwaa kɔ so yɛ adwuma a, wowɔ hokwan kɛse sɛ wo ho bɛtɔ wo.

Sɛ madu fie a, mɛyɛ dɛn ahwɛ me ho?

Sɛ wufi ayaresabea ba fie a, hwɛ wo ho sɛnea wo duruyɛfo ka kyerɛ wo no. Ebia ebehia sɛ wotra fie nna anaa adapɛn kakraa bi na ama woagye w’ahome yiye ansa na woasan akɔ adwuma. Di wo nhyehyɛe a wode bedi akyi no so. Fa wo nnuru no sɛnea wɔakyerɛw ama wo no pɛpɛɛpɛ.

Sɛ wote nka sɛ worehyia ɔhaw bio bere a wowɔ fie a, frɛ wo duruyɛfo ntɛm ara.

Wɔ tebea a egye ntɛmpɛ mu: Ɛsɛ sɛ wɔde obiara a ɔwɔ distributive shock ho sɛnkyerɛnne kɔ baabi a wɔhwɛ wɔn a wɔwɔ ntɛmpɛ mu ntɛm ara. Enkosi sɛ ambulance no bɛba no, ma onipa a ne ho adwiriw no no da. Fa ntama kata wɔn so na ama wɔn ho ayɛ hyew, na ma wɔn nan so bɛyɛ nan biako na ama mogya no akɔ so yiye.

Nsɛm bɛn na ɛsɛ sɛ wubisa oduruyɛfo no?

Sɛ wuhyia saa tebea yi a, ɛbɛyɛ papa sɛ wubebisa wo duruyɛfo nneɛma te sɛ:

• So mewɔ asiane mu sɛ menya ‘distributive shock’ bio?
• Mpɛn ahe na ɛsɛ sɛ meba bɛyɛ nhyehyɛe a ɛbɛma wɔadi akyi?
• So menya nkɛntɛnso a ɛbɛkyɛ afi ‘Distributive Shock’ no mu?

Awiei koraa no, nea ɛsɛ sɛ wokae (Take-Home Message) .

Distributive Shock yɛ aduruyɛ mu tebea a egye ntɛmpɛ a ɛhwehwɛ sɛ wɔsa no ntɛm ara. Mmoa a wubenya ntɛm ara no ne hokwan a eye sen biara a wubetumi de agye wo nkwa. Egye bere ansa na wo ho atɔ wo, enti nya wo ho abotare. Bere a wowɔ fie no, fa wo nnuru sɛnea wo duruyɛfo akyerɛ wo no pɛpɛɛpɛ, na kɔ wɔn a wodi w’akyi daa. Sɛnea wubetumi ahu no, eyi yɛ tebea a emu yɛ den yiye. Enti ɛho hia sɛ wohu eyi.

` Distributive shock, septic shock, anaphylactic shock, neurogenic ahodwiriw, mogya mmoroso a ɛba fam, ahodwiriw ayaresa, sepsis Sinhala