Ðe nane le mɔ xem na ʋu ƒe sisi yi wò dzi me kple dodo le emea? Esia ateŋu anye (Obstructive Shock)!

Ne ʋu mezɔna nyuie le míaƒe ŋutilã katã me o, si fia be míaƒe ŋutinuwo mexɔa oxygen agbɔsɔsɔme si hiã o la, zi geɖe la, míeyɔnae be ‘ʋuʋudedi’. Esia dzɔna zi ɖeka. Egbea míele nu ƒom tso ‘dzidziƒoame’ ƒomevi tɔxɛ aɖe, gake mebɔ vie o ŋu. Woyɔa esia be `(Mɔxeɖenu ƒe Ʋuʋu)'. Kpuie ko la, nusi dzɔna le go sia mee nye be nane xea mɔ na ʋu ƒe sisi yi míaƒe dzi me eye ʋu si le dodom tso dzia me, si fia be `mɔxenu' aɖe dzɔna. Le mɔxenu sia ta la, dzia mete ŋu wɔa dɔ nyuie o, ʋu ƒe sisi ate ŋu aɖiɖi kpata, eye ɔksidzin ate ŋu anɔ ŋutilãa me. Esia nye nɔnɔme si hiã kpata ŋutɔ , eyata ele vevie ŋutɔ be woawɔ atike na ame kaba.

Eyata nukae nye `(Obstructive Shock)` sia? Ðe míagaɖe eme viea?

Bu eŋu kpɔ, míaƒe dzi le abe tsipɔmpi ene. Pɔmpi siae ɖoa ʋu ɖe ŋutilã bliboa me. Azɔ, nukae adzɔ ne tsi si gena ɖe pɔmpi sia me xe le pɔmpia me, alo ne pɔmpi si do le pɔmpia me xe? Tsia me sina nyuie o, alo? Emae nye nusi dzɔna le `(Obstructive Shock)` me.

Nane xea mɔ na ʋu ƒe sisi to ʋuka gã (siwo woyɔna be `ʋuka gãwo`) siwo doa ka kple dzia me. Esia wɔnɛ be dzia mete ŋu xɔa ʋu wòsɔa gbɔ o, eye mete ŋu tsɔa ʋu doa goe hã o. Nusi dona tso emee nye be míaƒe ŋutilã ƒe ŋutinu vevitɔwo kekeake, si nye ahɔhɔ̃, ayiku, kple lãkusi, mekpɔa oxygen si sɔ o. Esia nye nudzɔdzɔ kpata si ate ŋu ade ame ƒe agbe afɔku me.

Vovototo kae le `(Cardiogenic Shock)` kple `(Obstructive Shock)` dome?

Esiawo evea siaa nye atikewɔwɔ kpata, gake susu eve tae wodzɔna ɖo.

Dzitodzito ƒe ʋuʋu dzɔna ne dzitodzito me lãmekaa gblẽ, abe dzidɔ ene, eye dzia mete ŋu tsɔa ʋu si sɔ yia ŋutilãa me o. Dzia va gbɔdzɔna.

Gake le `(Obstructive Shock)` me la, dzi ƒe lãmeka ate ŋu anɔ nyuie zi geɖe. Menye dzia ŋue kuxia le o, ke boŋ nu bubu aɖe si le mɔ xem na dzia ƒe dɔwɔwɔ. Bu nya siawo ŋu kpɔ:

• Ne ʋu gã aɖe le ʋuka gã aɖe me (aklã me ʋuka) si kplɔa ame yia wò lãkusi me.
• Ne wotsɔ kotoku si me tsi yɔ fũu ƒo xlã dzia (pericardial tamponade) ƒo dzia.
• Ne abi aɖe le lãkusiwo ŋu eye nyaƒoɖeamenu si le akɔta ƒe do me dzi ɖe edzi ŋutɔ, le kpɔɖeŋu me, le nɔnɔme si woyɔna be ``Tension pneumothorax'' me.

Obstructive Shock nye ne dzia mete ŋu le dɔ wɔm nyuie o le gotagome nusi gbɔ wòtso abe esia ene ta.

Aleke gbegbee woyɔa nɔnɔme sia be ``Obstructive Shock''? Aleke wòkpɔa ŋusẽ ɖe ŋutilãa dzii?

Le nyateƒe me la, Obstructive Shock nye nɔnɔme si mebɔ kura o ne wotsɔe sɔ kple shock ƒomevi bubuwo. Zi geɖe la, edzea dɔnɔ siwo ƒe mo wɔ yaa ƒe 1% alo 2% ko dzi. Nya nyuiae nye be anɔ eme be woadae wu dzidziƒoame ƒomevi bubuwo, gake ne wodae kaba ko hafi.

Ne womedae kaba o la, Obstructive Shock nana oxygen kple nunyiame aɖeke meganɔa ŋutilãa ƒe ŋutinu veviwo ŋu o. Esia ate ŋu ana ame ƒe ŋutinuwo nagblẽ eye ɣeaɖewoɣi la, ame naku gɔ̃ hã. Esia tae wòle vevie be nàdi atike na ame kaba.

Nukae nye `(Obstructive Shock)` ƒe dzesiwo?

Esia ƒe dzesiwo ateŋu aɖi ``Cardiogenic Shock'' tɔ vie.Kpɔe ɖa be esiawo ɖi nusi nènya nyuie hã:

• Yagbɔgbɔ ƒe tsɔtsɔme dzina ɖe edzi le mɔ si mesɔ o nu.
• Ʋu ƒe sisi ɖiɖina akpa (ʋusɔgbɔdɔ).
• Dzi ƒe tsotso dzina ɖe edzi ŋutɔ (`Tachycardia`). Abe ɖe nèƒu du teti koe nye ema ene.
• Seselelãme ƒe tɔtrɔ, ɖewohĩ blanuiléle alo dzimaɖitsitsi ate ŋu adzɔ.
• Aɖuɖɔ si dona ƒe agbɔsɔsɔ dzi ɖena kpɔtɔna ŋutɔ, alo menɔa anyi kura o.
• Ŋutilãa fa miamiamia eye fifia le eŋu.
• Ɣeaɖewoɣi la, ya ateŋu aƒo ƒu ɖe ŋutigbalẽa te (`Subcutaneous emphysema`). Esia fia be esena le eɖokui me abe kuɖɔ suesuesue siwo le ŋutigbalẽa te ene.
• Àte ŋu ase veve le akɔta alo ƒodo me.

Ne dzesi siawo dometɔ ɖeka alo esi wu nenema le ŋuwò la, ele vevie ŋutɔ be nàdi atikewɔlawo ƒe aɖaŋuɖoɖo enumake.

Nukae nye nusiwo hea `(Obstructive Shock)` vɛ?

Nu geɖewo li siwo gbɔ `(Obstructive Shock)` tsona. Na míakpɔ nusiwo nye vevitɔwo ɖa:

• `(Tension pneumothorax)` (aɖuɖɔtoe ƒe mumu): Esia dzɔna ne ya ge ɖe lãkusi me eye mete ŋu do o, si wɔnɛ be wòtsi lãkusia me. Emegbe lãkusia mu, si wɔnɛ be nyaƒoɖeamenu geɖe nɔa akɔta la me eye wònana dzia tea ƒoƒo.
• Vena cava compression syndrome: Ʋuka gãtɔ kekeake si le míaƒe ŋutilã me (vena cava) ƒe nutete. Zi geɖe la, esia ate ŋu adzɔ le fufɔfɔ ƒe nuwuwu lɔƒo, ne vidzĩa ƒe kpekpeme te ʋuka sia.
• Aklã (aklã) ƒe nutete ƒe dɔléle: Aklã ƒe tete ƒe dɔléle.
• `(High-PEEP ventilation)`: Nɔnɔme si me nyaƒoɖeamenu si le lãkusi me lolo akpa na amesi do ƒome kple yagbɔgbɔmɔ̃.
• Dɔdzẽ: Dɔdzẽ ƒomevi aɖewo siwo dona le akɔta ƒe do me hã ate ŋu axe mɔ na dzi alo ʋuka gãwo.
• Thromboembolism le aklã ƒe ʋuka me: Esia nye afɔku gã aɖe. Ne ʋuka aɖe si dzɔna le teƒe aɖe abe afɔ ene la vuvu eye wòtsi ʋuka aɖe me le lãkusi me la, esia xea mɔ na ʋua ƒe sisi tso dzia me yia lãkusi me.
• Pericardial tamponade: Tsi yɔa kotoku tsɛ si ƒo xlã dzia (pericardium) me fũ, si tea dzia. Esia wɔnɛ be dzia metena ɖe enu hekekena ɖe enu nyuie o.
• Aortic dissection: Aɖatsi si dona le aorta, si nye ʋuka gãtɔ kekeake si dona le dzia me.
• Aortic stenosis: Aortic valve ƒe ʋuʋu le dzia me. Esia wɔnɛ be esesẽna be ʋu nado le dzia me.
• Hypertrophic cardiomyopathy: Ʋu ƒe sisi ƒe mɔxexe le dzitodzito ƒe lãmeka ƒe ƒoƒo fũ ta.
• Constrictive pericarditis: Kpo si ƒo xlã dzia va ƒoa ke ɖe to, si wɔnɛ be esesẽna na dzia be wòawɔ dɔ faa.

Vevietɔ: Nusiwo katã gbɔ wòtsona nye nudzɔdzɔ kpatawo, eyata yi ɖɔkta gbɔ enumake ne dzesiwo dze le ŋuwò.

Aleke woawɔ ade dzesi `(Obstructive Shock)`?

Wò ɖɔkta ado wò kpɔ gbã. Woatsɔ nuƒomɔ̃ aɖo to wò dzi kple wò lãkusi. Obstructive shock nye nɔnɔme si ate ŋu agblẽ ɖe edzi kabakaba, eyata ele vevie be woakpɔ dɔlélea kaba.

Be woate ŋu anya dɔlélea nyuie la, woate ŋu awɔ dodokpɔ siwo gbɔna:

• Ultrasound: Esia ate ŋu alé ŋku ɖe nuwo abe dzi, ʋuka gãwo, kple ne tsi le lãkusia ŋu hã ŋu.
• Echocardiogram (Echo): Esia le abe dzia ƒe ultrasound ene. Ete ŋu kpɔa dzia ƒe dɔwɔwɔ, ʋukawo ƒe nɔnɔme, kple ne tsi le dzia ŋu nyuie ŋutɔ.
• Computed tomography (CT) scan: Esia ate ŋu aɖe akɔta ƒe do ƒe foto tsitotsito. Ate ŋu akpe ɖe ame ŋu wòade dzesi nuwo abe ʋu ƒe sisi, dɔdzẽ, kple ʋuka si me ʋu sina tona ƒe ʋuʋu ene.
• Electrocardiogram (ECG alo EKG): Esia doa dzia ƒe elektrikŋusẽ ƒe dɔwɔwɔ kpɔna. Ate ŋu akpe ɖe ŋuwò nànya ne nane gblẽ le wò dzi ŋu.

Aleke wowɔa atike na Obstructive Shock?

Gbã la, woana tsi siwo wodona ɖe ʋuka me (abe saline - tsi siwo wotsɔa tsi wɔe le ʋuka me ene) wò eye woalé ŋku ɖe wò ʋu ƒe sisi kple oxygen ƒe agbɔsɔsɔ ŋu edziedzi. Emegbe, nu vevitɔ kekeakee nye be nàdi nusi gbɔ Mɔxexeɖedɔa tso eye nàda nusi gbɔ wòtso.

Atikewɔwɔ ƒe mɔnuwo toa vovo le nusi gbɔ wòtso nu. Na míalé ŋku ɖe eƒe kpɔɖeŋu ʋɛ aɖewo ŋu:

• Ne ʋu ƒe sisi (embolism) li la, woɖenɛ ɖa to amekoko me alo to ʋuka (catheter) dede eme me.
• Ne enye aortic valve si xaxa vevie la, woaɖɔlii.
• Le dzitodzito ƒe lãmeka si le ƒoƒom (hypertrophic cardiomyopathy) gome la, woate ŋu aɖe eƒe titrime dzi akpɔtɔ to amekoko alo mɔnu tɔxɛ aɖe si wozãna le aha sesẽ zazã me (catheter-based alcohol ablation).
• Wonaa atike wò be wòatsɔ alɔ ʋu ƒe sisi.
• Ne tsi ƒo xlã dzia (pericardial tamponade) alo tension pneumothorax la, woaɖe tsi alo ya la ɖa (ɖewohĩ woazã mɔ̃ sue aɖe).
• Ne èle yagbɔgbɔmɔ̃ dzi la, àte ŋu atrɔ eƒe ɖoɖowo.
• Le nɔnɔme abe ``Vena cava compression syndrome'' ene me la, wotrɔa ŋutilã ƒe nɔnɔme.
• Ne nyaƒoɖeamenu si le lãkusiwo me lolo la, wotsɔa aŋe alo mɔ̃ aɖe ɖea nyaƒoɖeamenua dzi kpɔtɔna.

Atike kawoe wozãna?

Esi wole nusi gbɔ wòtso la dam la, woate ŋu ana atikewo abe esiawo ene wò be wò nɔnɔmea nali ke:

• Lãmetsiwo abe `IV` saline (`IV kristalo tsiwo`).
• Atike siwo woatsɔ adzi ʋu ƒe sisi ɖe edzi: `(Norepinephrine (Levophed®))`, `(Vasopressin (Vasostrict®))`, `(Phenylephrine (Vazculep® alo Biorphen®))`.
• Ne ʋu ƒe xexlẽme mede wò o la, woana ʋu alo ʋumenu (abe ʋumenugbagbevi dzĩwo kple ʋumenugbagbevi dzĩwo ene) wò.

Aleke gbegbee nye lãme ahaya kaba le atikewɔwɔ vɔ megbe?

Ele be woada nusiwo gbɔ Obstructive Shock tsona dometɔ geɖe kaba , elabena ɣeyiɣi sia mee mɔnukpɔkpɔ si li be woatsi agbe la lolo wu. Dzɔgbenyuietɔe la, dɔdamɔnu siawo wɔa dɔ kabakaba. Gake ne woda nusi gbɔ wòtso gɔ̃ hã la, exɔa ɣeyiɣi hafi ŋutilãa haya tso Obstructive Shock ƒe ŋusẽkpɔɖeamedziwo me. Màte ŋu aƒu du atsa ko awɔ wò dɔ o.

Nukae nye mɔkpɔkpɔ na `(Obstructive Shock)`?

Ne womewɔ atike nɛ o la, ``Obstructive Shock`` nye nɔnɔme si ateŋu awu ame geɖe. Wò hayahaya le atikewɔwɔ vɔ megbe nɔ te ɖe nu geɖe dzi, siwo dometɔ aɖewoe nye:

• Nuka gbɔe `(Obstructive Shock)` tsona?
• Ɣeyiɣi didi kae wòxɔ hafi woxɔ atike?
• Dɔléle bubu kawoe le ŋuwò?
• Aleke gbegbee atikewɔwɔa kpɔ dzidzedze na wòe?

Ke hã, abe alesi míegblɔe va yi ene la, mɔnukpɔkpɔ si li be woahaya tso ``Obstructive Shock`` me lolo wu tso ``Shock`` ƒomevi siwo bɔ abe ``Septic Shock`` ene me. Eya ta mɔkpɔkpɔ li.

Aleke malé be na ɖokuinye?

Ne ɖɔktaa ɖe asi le ŋuwò le kɔdzi vɔ la, ele be nàwɔ ɖe woƒe mɔfiamewo dzi pɛpɛpɛ.

• Ahiã be nàɖi ɖe eme le aƒeme vie hafi atrɔ ayi dɔme.
• Ele be nàno atike si wò ɖɔkta ŋlɔ na wò ɖe game dzi pɛpɛpɛ . Mègadzudzɔ atike aɖeke nono le wò didi nu o.
• Yi ɣeyiɣi siwo woɖo ɖi na kplɔkplɔ ɖo edziedzi .

Ɣekaɣie wòle be magakpɔ ɖɔkta ake? Nukae wòle be mawɔ ne nɔnɔme kpata aɖe dzɔ?

Fifia ènya nusi he wò `(Obstructive Shock)` vɛ. Kpɔ nyuie ne dzesi siwo do ƒome kple kuxi ma gadze. Ne dzesi mawo gadze ŋuwò ake, alo ne wò ƒomea me tɔ aɖe de dzesi tɔtrɔ sia le ŋuwò la, ƒo ka na ƒe 1990 (Ya) Dɔnɔdzikpɔƒe enumake, alo yi kɔdzi si te ɖe ŋuwò ƒe xɔ si me wokpɔa dɔnɔwo gbɔ kpata le. Ɣeyiɣi nye nu vevitɔ.

Nya kawoe wòle be mabia nye ɖɔkta?

Àte ŋu abia nya siawo tɔgbe:

• Ɣeyiɣi didi kae wòhiã be mano atike si nèŋlɔ nam?
• Mɔnukpɔkpɔ kawoe li be nɔnɔme sia nagadze dzinye ake?
• Ðe esia akpɔ ŋusẽ ɖe nye agbenɔnɔ ƒe nyonyome dzi ɣeyiɣi didia?
• Tɔtrɔ kawoe wòle be mawɔ le nye nuɖuɖu kple kamedede ŋu?

Mlɔeba la, nusi dzi nàɖo ŋkui (Take-Home Message) .

Obstructive Shock nye dɔléle si mebɔ o gake wòsẽ ŋutɔ, si hiã be woawɔ atike nɛ kpata. Eyata ele vevie be nànya dzesiawo eye nàdi atike kaba. Ne ɖɔktawo nya ke ɖe nusi gbɔ Obstructive Shock tso ŋu ko la, woadze atikewɔwɔ si sɔ gɔme.

Ðo ŋku edzi be ame akpa gãtɔ ate ŋu ahaya tso Obstructive Shock me, gake exɔa ɣeyiɣi. Gbɔ dzi ɖi, wɔ ɖe wò ɖɔkta ƒe mɔfiamewo dzi, eye nàlé be na ɖokuiwò. Menye wò ɖeka koe o, eye ɖɔktawo, dɔnɔdzikpɔlawo, kple wò lɔlɔ̃tɔwo hã li siwo ate ŋu akpe ɖe ŋuwò.

` Obstructive Shock, dzidziƒoame, dzidɔ, ʋu ƒe sisi, oxygen, mɔxenu, atikewɔwɔ kpata, lãkusiwo, dzi