So biribi wɔ hɔ a esiw mogya a ɛbɛkɔ wo koma mu na afi mu no kwan? Eyi betumi ayɛ (Obstructive Shock)!

Sɛ mogya ntumi nkɔ yɛn nipadua nyinaa mu yiye, a ɛkyerɛ sɛ yɛn akwaa no nnya oxygen dodow a ɛho hia a, yɛtaa frɛ no ‘ahodwiriw’. Eyi si mpofirim. Ɛnnɛ yɛrebɛka ‘ahodwiriw’ soronko bi, nanso ɛho yɛ na kakra ho asɛm. Wɔfrɛ no `(Obstructive Shock)'. Sɛ yɛbɛka no tiawa a, nea ɛba wɔ saa asɛm yi mu ne sɛ biribi siw mogya a ɛkɔ yɛn koma mu no kwan na mogya a ɛretu fi koma no mu no, kyerɛ sɛ, `akwanside' bi ba. Esiane akwanside yi nti, koma no ntumi nyɛ adwuma yiye, mogya mmoroso tumi so tew mpofirim, na nipadua no nso tumi nni mframa pa. Eyi yɛ tebea a egye ntɛmpɛ paa , enti ɛho hia yiye sɛ wunya ayaresa ntɛm.

Enti dɛn ne saa `(Obstructive Shock)` yi? So yɛbɛkyerɛkyerɛ mu kakra bio?

Wo de susuw ho hwɛ, yɛn koma te sɛ nsu pɔmpɛ. Saa pɔmpɛ yi na ɛde mogya kɔ nipadua no nyinaa mu. Afei, sɛ nsu a ɛkɔ pɔmpɛ yi mu no siw wɔ paipu no mu, anaasɛ sɛ paipu a efi pɔmpɛ no mu no siw a, dɛn na ɛba? Nsu no nsen yiye, ɛnte saa? Ɛno ne nea ɛkɔ so wɔ `(Obstructive Shock)` mu.

Biribi siw mogya a ɛnam mogya ntini akɛse (a wɔfrɛ no `ntini akɛse`) a ɛka koma no bom no kwan. Eyi mma koma no ntumi nnya mogya a ɛdɔɔso, na entumi mfa mogya mfi mu nso. Nea afi mu aba ne sɛ akwaa a ɛho hia sen biara wɔ yɛn nipadua mu, amemene, asaabo, ne ahurututu mu no, nnya mframa pa a ɛdɔɔso. Eyi yɛ tebea a egye ntɛmpɛ a ɛde nkwa to asiane mu.

Nsonsonoe bɛn na ɛwɔ `(Cardiogenic Shock)` ne `(Obstructive Shock)` ntam?

Eyinom abien nyinaa yɛ aduruyɛ mu nsɛm a egye ntɛmpɛ, nanso nneɛma abien nti na ɛba.

Koma mu ahodwiriw ba bere a koma ntini no asɛe, te sɛ komayare, na koma no ntumi mfa mogya a ɛdɔɔso nkɔ nipadua no mu no. Koma no yɛ mmerɛw.

Nanso wɔ `(Obstructive Shock)` mu no, koma ntini no taa tumi yɛ yiye. Ɛnyɛ koma no na ɔhaw no wɔ, na mmom biribi foforo a ɛresiw koma no dwumadi kwan. Susuw nneɛma yi ho hwɛ:

• Sɛ mogya a ɛtɔ kɛse bi wɔ mogya ntini kɛse bi mu (ahurututu mu ntini) a ɛkɔ w’ahurututu mu a.
• Sɛ wɔde kotoku a nsu ahyɛ mu ma a atwa koma no ho ahyia (pericardial tamponade) piapia koma no a.
• Sɛ opira bi wɔ ahurututu no mu na nhyɛso a ɛwɔ koko no mu no kɔ soro kɛse a, sɛ nhwɛso no, wɔ tebea bi a wɔfrɛ no ``Tension pneumothorax'' mu.

Obstructive Shock yɛ bere a koma no ntumi nyɛ adwuma yiye esiane biribi a efi akyi te sɛ eyi nti.

Saa tebea yi abu so dɛn sɛ ``Obstructive Shock''? Ɔkwan bɛn so na ɛka nipadua no?

Abstructive Shock yɛ tebea a ɛntaa nsi ankasa sɛ wɔde toto shock ahorow afoforo ho a. Ɛtaa ka ayarefo a wɔn ho yeraw wɔn no mu 1% anaa 2% pɛ. Asɛmpa no ne sɛ ɛda adi sɛ wɔbɛsa no sen ahodwiriw ahorow afoforo, nanso sɛ wɔsa no ntɛm nkutoo a.

Sɛ wɔansa no ntɛm a, Obstructive Shock ma nipadua no akwaa a ɛho hia no nnya mframa pa ne aduannuru. Eyi betumi ama akwaa asɛe na ɛtɔ mmere bi mpo a owu. Ɛno nti na ɛho hia sɛ wohwehwɛ ayaresa a wontwentwɛn wo nan ase no.

Dɛn ne `(Obstructive Shock)` ho sɛnkyerɛnne?

Ebia eyi ho sɛnkyerɛnne no te sɛ ``Cardiogenic Shock'' de no kakra.Hwɛ sɛ eyinom te sɛ nea wunim anaa:

• Ahome a wɔhome no kɔ soro wɔ ɔkwan a ɛnteɛ so.
• Mogya mmoroso so tew dodo (hypotension).
• Koma a ɛbɔ kɔ soro kɛse (`Tachycardia`). Te sɛ nea woatu mmirika nkyɛe.
• Adwene mu nsakrae, ebia awerɛhow anaa dadwen betumi aba.
• Nsu dodow a ɛba no so tew kɛse, anaasɛ enni hɔ koraa.
• Wora no te nka sɛ awɔw ne fifiri ayɛ no.
• Ɛtɔ da bi a mframa tumi boaboa ano wɔ honam ani (`Subcutaneous emphysema`). Eyi kyerɛ sɛ ɛte sɛ ahurututu nketenkete a ɛwɔ honam ani.
• Ebia wobɛte wo koko anaa yafunu mu yaw.

Sɛ wowɔ saa sɛnkyerɛnne ahorow yi mu biako anaa nea ɛboro saa a, ɛho hia yiye sɛ wohwehwɛ aduruyɛfo afotu ntɛm ara.

Dɛn ne nneɛma a ɛde `(Obstructive Shock)` ba?

Nneɛma pii na ɛde `(Obstructive Shock)` ba. Ma yɛnhwɛ nea ɛyɛ atitiriw no:

• `(Tension pneumothorax)` (ahurututu no a ɛhwe ase): Eyi ba bere a mframa hyɛn ahurututu no mu na entumi mfi mu, na ɛma ɛkyere ahurututu no mu. Afei ahurututu no bubu, na ɛma nhyɛso kɛse ba koko no mu na ɛma koma no fi ase bɔ.
• Vena cava compression syndrome: Ntini a ɛsõ sen biara a ɛwɔ yɛn nipadua mu (vena cava) a ɛhyɛ no. Eyi betumi aba mpɛn pii wɔ nyinsɛn no awiei, bere a akokoaa no mu duru mia mogya ntini yi mu no.
• Ahurututu (ahurututu) mu nhyɛso ho yare: Ahurututu mu nhyɛso ho yare.
• `(High-PEEP ventilation)`: Tebea a nhyɛso a ɛwɔ ahurututu mu no yɛ kɛse dodo ma obi a ɔde ne ho abɔ mframa afiri ho.
• Akisikuru: Akisikuru ahorow bi a ɛba koko mu no nso tumi siw koma no anaa mogya ntini akɛse no kwan.
• Thromboembolism a ɛwɔ ahurututu mu ntini mu: Eyi yɛ asiane kɛse. Sɛ mogya a ɛtɔ gu baabi te sɛ nan no mu paapae na ɛkyere mogya ntini bi a ɛwɔ ahurututu no mu a, ɛmma mogya no ntumi mfi koma no mu nkɔ ahurututu no mu.
• Pericardial tamponade: Nsu hyɛ kotoku teateaa a atwa koma no ho ahyia (pericardium) no ma, na ɛmia koma no. Eyi mma koma no ntumi ntwitwiw na ɛntrɛw sɛnea ɛsɛ.
• Aortic dissection: Tete a ɛba aorta, mogya ntini kɛse a efi koma no mu.
• Aortic stenosis: Aortic valve a ɛyɛ teateaa wɔ koma no mu. Eyi ma ɛyɛ den sɛ mogya bɛsen afi koma no mu.
• Hypertrophic cardiomyopathy: Mogya a ɛsiw esiane koma no ntini a ɛyɛ den dodo nti.
• Constrictive pericarditis: Kotoku a atwa koma no ho ahyia no yɛ den, na ɛma ɛyɛ den ma koma no sɛ ɛbɛyɛ adwuma a enni ahofadi.

Nea ɛho hia: Nneɛma a ɛde ba yi nyinaa yɛ nea egye ntɛmpɛ, enti sɛ wowɔ sɛnkyerɛnne bi a, kɔ oduruyɛfo nkyɛn ntɛm ara.

Ɔkwan bɛn so na wobehu `(Obstructive Shock)`?

Wo duruyɛfo no bedi kan ahwɛ wo. Wɔde afiri a wɔde tie asɛm bɛtie wo koma ne w’ahurututu. Obstructive shock yɛ tebea a ebetumi asɛe ntɛmntɛm, enti ɛho hia sɛ wohu ntɛm ara.

Sɛnea ɛbɛyɛ na wɔahu yare no pɛpɛɛpɛ no, wobetumi ayɛ nhwehwɛmu ahorow a edidi so yi:

• Ultrasound: Eyi tumi hwɛ nneɛma te sɛ koma, mogya ntini akɛse, ne sɛ ebia nsu wɔ ahurututu no ho anaa.
• Echocardiogram (Echo): Eyi te sɛ koma no mu nnyigyei a ɛyɛ nwonwa. Etumi hu sɛnea koma no yɛ adwuma, sɛnea ntini ahorow no te, ne sɛ ebia nsu atwa koma no ho ahyia no pefee.
• Computed tomography (CT) scan: Eyi betumi atwa ahurututu no ho mfonini a ɛkɔ akyiri. Ebetumi aboa ma wɔahu nneɛma te sɛ mogya a ɛtɔ, akisikuru, ne aortic dissection.
• Electrocardiogram (ECG anaa EKG): Eyi sɔ sɛnea koma no mu anyinam ahoɔden yɛ adwuma hwɛ. Ebetumi aboa ma woahu sɛ ebia biribi asɛe wɔ wo koma mu anaa.

Ɔkwan bɛn so na wɔsa Obstructive Shock?

Nea edi kan no, wɔbɛma wo nsu a wɔde fa IV mu (te sɛ saline - IV crystalloid nsu) na wɔahwɛ wo mogya mmoroso ne oxygen dodow daa. Afei, ade a ɛho hia sen biara ne sɛ wubehu nea ɛde Obstructive Shock no ba na woasa saa ade a ɛde ba no.

Ɛsono akwan a wɔfa so sa yare no gyina nea ɛde ba no so. Momma yɛnhwɛ nhwɛso kakraa bi:

• Sɛ mogya a ɛtɔ (embolism) bi wɔ hɔ a, wɔde oprehyɛn anaasɛ wɔde kankyee (catheter) gu mu yi fi hɔ.
• Sɛ ɛyɛ aortic valve a ayɛ teateaa kɛse a, wɔbɛsesa.
• Wɔ koma ntini a ayɛ den (hypertrophic cardiomyopathy) mu no, wobetumi atew ne kɛse so denam oprehyɛn anaa ɔkwan titiriw bi a wɔde nsa di dwuma so (catheter-based alcohol ablation).
• Wɔma wo nnuru a wode bɛpete mogya a ɛretu.
• Sɛ nsu atwa koma no ho ahyia (pericardial tamponade) anaasɛ tension pneumothorax a, wobeyi nsu anaa mframa no afi hɔ (ebia wɔde afiri ketewaa bi bedi dwuma).
• Sɛ wowɔ mframa a wɔde ma so a, wubetumi asesa ne nhyehyɛe.
• Wɔ tebea te sɛ ``Vena cava compression syndrome'' mu no, nipadua no gyinabea sesa.
• Sɛ nhyɛso a ɛwɔ ahurututu mu no yɛ kɛse a, wɔde ade anaa afiri a wɔde fa nsu mu so tew nhyɛso no so.

Nnuru bɛn na wɔde di dwuma?

Bere a wɔresa nea ɛde ba no, wobetumi ama wo nnuru te sɛ eyinom na ama wo tebea no agyina:

• Nsuo te sɛ `IV` nkyene (`IV crystalloid nsuo`).
• Nnuru a ɛma mogya mmoroso kɔ soro: `(Norepinephrine (Levophed®))`, `(Vasopressin (Vasostrict®))`, `(Phenylephrine (Vazculep® anaa Biorphen®))`.
• Sɛ mogya dodow sua a, wɔbɛma wo mogya anaa mogya mu nneɛma (te sɛ mogya mu nkwammoaa kɔkɔɔ ne plasma).

Me ho bɛtɔ me ntɛm dɛn bere a wɔasa me yare awie no?

Ɛsɛ sɛ wɔsa nneɛma a ɛde Obstructive Shock ba no pii ntɛm , efisɛ eyi ne bere a hokwan a ɛwɔ hɔ sɛ wobenya nkwa no yɛ kɛse. Nea eye ne sɛ, saa ayaresa ahorow yi yɛ adwuma ntɛmntɛm. Nanso, bere a wɔasa nea ɛde ba no mpo akyi no, egye bere ansa na nipadua no asan anya ahoɔden afi Obstructive Shock nkɛntɛnso no mu. Worentumi ntu mmirika nkɔyɛ w’adwuma kɛkɛ.

Dɛn ne anidasoɔ a ɛwɔ `(Obstructive Shock)` ho?

Sɛ wɔansa a, ``Obstructive Shock`` yɛ tebea a ebetumi akum nnipa pii. Sɛnea wo ho bɛtɔ wo wɔ ayaresa akyi no gyina nneɛma pii so, a nea ɛka ho ne:

• Dɛn na ɛde `(Obstructive Shock)` ba?
• Bere tenten ahe na egyee ansa na wɔrenya ayaresa?
• Nyarewa afoforo bɛn na wowɔ?
• Ayaresa no dii yiye dɛn maa wo?

Nanso, sɛnea yɛadi kan aka no, hokwan a ɛwɔ hɔ sɛ wobɛsan anya ahoɔden afi ``Obstructive Shock`` mu no dɔɔso sen nea efi ``Shock`` ahorow a ɛtaa ba te sɛ ``Septic Shock`` mu. Enti, anidaso wɔ hɔ.

Mɛyɛ dɛn ahwɛ me ho?

Sɛ oduruyɛfo no yi wo fi ayaresabea hɔ wie a, ɛsɛ sɛ wudi wɔn akwankyerɛ akyi pɛpɛɛpɛ.

• Ɛho behia sɛ wohome wɔ fie kakra ansa na woasan akɔ adwuma.
• Ɛsɛ sɛ wonom aduru a wo duruyɛfo akyerɛw wo no wɔ bere ano pɛpɛɛpɛ . Nnyae aduru biara a wobɛnom sɛnea wopɛ.
• Kɔ bere a wɔahyɛ sɛ wobɛhwɛ wo akyi daa .

Bere bɛn na ɛsɛ sɛ mesan kɔ oduruyɛfo nkyɛn bio? Dɛn na ɛsɛ sɛ meyɛ wɔ tebea a egye ntɛmpɛ mu?

Seesei wunim nea ɛde wo `(Obstructive Shock)` bae. Sɛ sɛnkyerɛnne ahorow a ɛfa saa ɔhaw no ho no san ba a, hwɛ yiye . Sɛ wosan nya sɛnkyerɛnne a ɛte saa bio, anaa sɛ obi a ɔwɔ w’abusua mu hu nsakrae yi wɔ wo mu a, frɛ 1990 (Mframa) Ambulance Service ntɛm ara, anaa kɔ ayaresabea a ɛbɛn wo no dan a wɔhwɛ ntɛmpɛ so. Bere yɛ ade titiriw.

Nsɛm bɛn na ɛsɛ sɛ mibisa me duruyɛfo?

Wubetumi abisa nsɛm te sɛ eyinom:

• Bere tenten ahe na ɛsɛ sɛ menom nnuru a wokyerɛw maa me no?
• Hokwan ahorow bɛn na ɛwɔ hɔ sɛ menya saa tebea yi bio?
• So eyi benya m’asetra so nkɛntɛnso bere tenten?
• Nsakrae bɛn na ɛsɛ sɛ meyɛ wɔ m’aduan ne m’apɔw-mu-teɛteɛ mu?

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

Obstructive Shock yɛ tebea a ɛntaa nsi nanso emu yɛ den yiye a ɛhwehwɛ sɛ wɔsa no ntɛm ara. Enti, ɛho hia sɛ wuhu sɛnkyerɛnne ahorow no na wohwehwɛ ayaresa ntɛm. Sɛ nnuruyɛfo hu nea ɛde Obstructive Shock ba pɛ a, wobefi ase ayɛ ayaresa a ɛfata.

Kae sɛ nnipa dodow no ara betumi anya ahoɔden afi Obstructive Shock mu, nanso egye bere. Nya abotare, di wo duruyɛfo akwankyerɛ akyi, na hwɛ wo ho yiye. Ɛnyɛ wo nko ara, na nnuruyɛfo, ayarehwɛfo, ne w’adɔfo wɔ hɔ a wobetumi aboa wo.

` Obstructive Shock, ahodwiriw, komayare, mogya mmoroso, oxygen, akwanside, ayaresa a egye ntɛmpɛ, ahurututu, koma