Ke kaumaha ʻoe, ua hoʻomaka koke anei kou puʻuwai e kuʻi wikiwiki ... ʻoi aku ka wikiwiki me ke kumu ʻole? Me he mea lā ua holo wale ʻoe, a i ʻole ua makaʻu maoli ʻoe, ʻeā? He mea maʻamau ka makaʻu iki i nā manawa e like me kēia. ʻO ka hapa nui o ka manawa, ua hoʻokumu ʻia kēia e ka piʻi koke ʻana o ka puʻuwai. I kēia lā, e kamaʻilio mākou e pili ana i kekahi mau ʻano maʻalahi, ʻaʻole lāʻau lapaʻau a nā kauka e hoʻohana ai e mālama i kēia.
He aha nā Vagal Maneuvers maoli?
I ka ʻōlelo maʻalahi, ʻo nā Vagal Maneuvers kekahi mau hana a mākou e hana ai me ko mākou kino. Hoʻoulu kēia i kahi aʻalolo e kaohi ana i ka helu o ko mākou puʻuwai. Kāhea mākou i kēia aʻalolo ʻo ke aʻalolo Vagus . He aʻalolo koʻikoʻi loa kēia e holo ana mai ko mākou lolo a i ko mākou ʻōpū.
E noʻonoʻo, ʻelua ʻōnaehana o ko kākou kino. ʻO kekahi e hoʻoikaika iā kākou, e hoʻomākaukau iā kākou no kahi pilikia. ʻO kekahi e hoʻomālielie iā kākou, e hoʻomaha iā kākou. Ua kapa ʻia kēia ʻōnaehana ʻelua ʻo ka Parasympathetic Nervous System . ʻO ka ʻāpana nui o kēlā ʻōnaehana ʻo ia ke aʻalolo Vagus. No laila, ke hoʻoulu iki kākou i kēia aʻalolo, hoʻouna ia i kahi hōʻailona i ka puʻuwai e ʻōlelo ana, "ʻAe, e lohi iki i kēia manawa." A laila lohi ka pacemaker maoli o ka puʻuwai, a hiki i ka puʻuwai wikiwiki ke hoʻi i ka maʻamau.
Akā he mea nui loa kēia: ʻOiai inā ʻike ʻoe e pili ana i kēia mau ʻano hana, mai hoʻāʻo iā ʻoe iho me ka ʻole o ke kūkākūkā ʻana me ke kauka. ʻOi aku ka palekana o ke kamaʻilio mua ʻana me kāu kauka a nīnau iā ia i ka mea e hana ai.
He aha kēia mau ʻano hana Vagal Maneuvers?
Aia kekahi mau ʻano hana a nā kauka e hoʻohana pinepine ai. Ua lohe paha ʻoe i hoʻokahi a ʻelua paha o kēia mau mea.
| Inoa o ka hana | Pehea e hana ai maʻalahi |
|---|---|
| Hoʻokele Valsalva | Ke paʻa nei i kou hanu a me ke kaomi ikaika ʻana, me he mea lā e kolohe ana ʻoe i loko o ka lua. |
| Luʻu ʻana | Ke hoʻoluʻu koke nei i ka maka i loko o ke pola wai hau. |
| Lomilomi Sinus Carotid | Lomilomi mālie ke kauka i kahi ʻāpana kūikawā ma ka ʻaoʻao o ka ʻāʻī. |
| ʻŪhū | Ka maneʻo ʻana i nā manawa he nui i ka lālani. |
| Ke hoʻāʻo nei e luaʻi (Gag Reflex) | E hoʻoulu mālie ana i ke kua o ka puʻu. |
| Kaomi ʻōpū i hoʻopili ʻia | E moe ma kou kua, e kulou i kou mau kuli a lawe mai iā lākou i kou umauma. |
No ke aha e hoʻohana ai i kēia mau ʻano hana?
ʻO ke kumu nui he kūlana i kapa ʻia ʻo Supraventricular Tachycardia (SVT) . ʻO kēia ka wā e hoʻonui koke ai nā hōʻailona uila e puka mai ana ma nā ʻaoʻao o luna o ka puʻuwai i ka helu o ka puʻuwai i ʻoi aku ma mua o 100 mau kuʻi i kēlā me kēia minuke. No kekahi kanaka me kēia kūlana, hoʻāʻo mua nā kauka i nā Vagal Maneuvers.
No ka mea,
- Ka pilikia haʻahaʻa: ʻOi aku ka palekana o kēia ma mua o ka hāʻawi ʻana i ka lāʻau lapaʻau a i ʻole ka hāʻawi ʻana i kahi haʻalulu uila (cardioversion).
- Kumukūʻai haʻahaʻa: ʻAʻole pono kēia i nā lako kūikawā a i ʻole nā lāʻau lapaʻau.
- Hiki ke hana koke ʻia: Hiki ke hana koke ʻia ma ka haukapila a i ʻole ke keʻena lapaʻau.
He 20% a 40% ka holomua o kēia mau ʻano hana i ka hoʻihoʻi ʻana i ka helu puʻuwai maʻamau. I kekahi manawa, hiki i kēia mau ʻano hana ke kōkua i nā kauka e hoʻoholo pono i ke ʻano o ka maʻi puʻuwai (arrhythmia) āu.
Aia kekahi poʻe e pono ʻole ke hana i kēia mau kaʻina hana?
ʻAe, ʻoiaʻiʻo nō. E hoʻohana wale ke kauka i kēia mau ʻano hana inā paʻa kou kūlana. ʻO ia hoʻi, inā ʻaʻole ʻoe i loko o ka pilikia koʻikoʻi. Akā inā paʻa ʻole kou kūlana, ʻo ia hoʻi, inā loaʻa iā ʻoe nā hōʻailona ma lalo nei, ʻaʻole e hoʻohana ʻia kēia mau ʻano hana. I kēlā manawa, e kuhikuhi pololei lākou i nā lāʻau lapaʻau ʻē aʻe.
| ʻAʻole pono e hana ʻia nā Vagal Maneuvers (nā kūlana olakino paʻa ʻole) | |
|---|---|
| Ke koko haʻahaʻa | No ka mea, ke komo nei ke kino i ka haʻalulu. |
| ʻEha umauma | He hōʻailona paha kēia o ka hāʻule puʻuwai. |
| Pōkole o ka hanu | He hōʻailona ia ʻaʻole i loaʻa i ke kino ka nui o ka oxygen e pono ai. |
| ʻO ka nele o ke kahe koko i nā ʻōpū ʻē aʻe | Nā hōʻailona e like me ka huikau a me ka nalowale o ka ʻike. |
Inā loaʻa iā ʻoe kēia mau hōʻailona a ke kuʻi wikiwiki nei kou puʻuwai, ʻo ka mea maikaʻi loa e hana ai, ʻo ia ke hele koke i ka Emergency Department (ETU) o ka haukapila.
E wehewehe pōkole kākou pehea e hana ʻia ai nā ʻano hana nui.
1. Ka Hana ʻana o Valsalva
ʻO kēia ke ʻano hana i hoʻohana pinepine ʻia. ʻO ke ʻano o ka hana ʻana a ke kauka i kēia, ʻo ia ke hoʻomoe ʻana iā ʻoe ma luna o kahi moe, e hanu hohonu, e pani i kou waha a me kou ihu, a paʻa no kahi o 10-30 kekona me he mea lā e hoʻāʻo ana ʻoe e puhi i ka hanu. Pono ia e like me ʻoe e hoʻāʻo nei e puhi i loko o kahi paipu i paʻa.
Aia kekahi ʻano hana holomua ʻē aʻe o kēia. Ua kapa ʻia ʻo ia ʻo ka Modified Valsalva Maneuver . I loko o ia mea, i kou noho ʻana a hana i kēia paʻi ʻana, hoʻohaʻahaʻa koke ke kauka i kou kino luna ma luna o ka moena. I ka manawa like, hāpai ʻo ia i nā wāwae ʻelua a paʻa iā lākou no kahi o 45 kekona. Hoʻonui hou kēia i ka helu holomua.
No ka hana ʻana i kēia i nā keiki liʻiliʻi, haʻi aku nā kauka iā lākou e hoʻokomo i ko lākou manamana nui i loko o ko lākou waha a puhi a hiki i ka wā e puka ʻole ai ka ea.
2. Luʻu ʻana i ka Reflex
He mea ʻē paha kēia, ʻeā? Akā, he ʻano hana kūpono loa nō hoʻi ia. ʻO kāu hana ma ʻaneʻi, ʻo ia ke noho i lalo, hanu hohonu, paʻa i kou hanu, a hoʻokomo koke i kou maka holoʻokoʻa i loko o kahi kīʻaha i piha i ka wai hau. Makemake ʻoe e mālama i kou maka i loko o ka wai no ka lōʻihi e hiki ai.
Ma ke ʻano he koho ʻē aʻe i kēia, hiki iā ʻoe ke paʻa i kahi ʻeke wai hau a i ʻole kahi kāwele pulu anu loa i kou maka.
3. Lomilomi Sinus Carotid
He mea kēia e hana wale ʻia e ke kauka. ʻAʻole ʻae ʻia ʻoe e hana ia mea iā ʻoe iho. No ka mea, pono ʻoe e ʻike pono i kahi e hana ai a kau i ka nui kūpono o ke kaomi.
Maanei, e hoʻomoe ke kauka iā ʻoe i lalo, e hoʻohuli i kou poʻo i kekahi ʻaoʻao, a e lomilomi mālie i ka sinus carotid ma ka ʻaoʻao o kou ʻāʻī me kona mau manamana lima no kahi o 5-10 kekona. Hiki i kēia ke hoʻolohi i ka helu o kou puʻuwai.
He aha ka mea e hana ʻia ma hope o kēia mau ʻano hana?
ʻO ka manaʻolana e hoʻi hou ka helu o ka puʻuwai i ka maʻamau. E hana hou ke kauka i kahi EKG (electrocardiogram) e ʻike ai inā ua hoʻi hou ke ʻano o ka puʻuwai i ka maʻamau.
Inā ʻaʻole holo pono kēia mau ʻano hana ma hope o ʻelua a ʻekolu paha mau hoʻāʻo ʻana, e hāʻawi ʻia paha iā ʻoe ka lāʻau lapaʻau. ʻO ke ʻano kēia, hiki ke hāʻawi ʻia ka lāʻau lapaʻau intravenous e kaohi i kou puʻuwai. I kekahi mau hihia, e kuhikuhi ʻia paha ʻoe no ka cardioversion, ʻo ia hoʻi ka hāʻawi ʻana i kahi haʻalulu uila.
Inā kūleʻa a ʻaʻole paha, inā kū mai kēia kūlana, hiki i kāu kauka ke kuhikuhi iā ʻoe i kahi cardiologist.
He aha nā pilikia a me nā pono o kēia?
Ua kamaʻilio mua mākou e pili ana i nā pono. ʻO ka pono nui, hiki iā ʻoe ke hoʻāʻo e kāohi i kou puʻuwai me ka ʻole o ka lāʻau lapaʻau, ma ke kumu kūʻai haʻahaʻa, a me ka pilikia haʻahaʻa.
No nā pilikia, ke hana pololei ʻia e ke kauka kūpono, he kakaikahi loa nā pilikia. ʻOiai inā loaʻa lākou, he manawa pōkole wale nō ia.
- Hypotension: Ka emi ʻana o ke koko koko no kekahi manawa.
- Bradycardia: Lohi loa ka wikiwiki o ka puʻuwai.
- I kahi manawa kākaʻikahi, hiki ke loaʻa nā pilikia ʻē aʻe o ka puʻuwai e like me Atrial Fibrillation a me Ventricular Fibrillation .
He haʻahaʻa loa ka pilikia o ka hahau ʻana me ka Carotid Sinus Massage, ma kahi o 1 i loko o 1,000. No kēia kumu, ʻaʻole hoʻohana nā kauka i kēia ʻano hana no ka poʻe me nā kūlana penei:
- Inā ua loaʻa iā ʻoe kahi hahau ma mua a i ʻole TIA (transient ischemic attack) .
- Inā loaʻa iā ʻoe ka maʻi ʻaʻa carotid .
- Inā ua loaʻa iā ʻoe kahi hāʻule puʻuwai i hala koke nei.
Leka Lawe-Home
- ʻO nā Vagal Maneuvers kahi ala laina mua, ʻaʻohe lāʻau lapaʻau no ka mālama ʻana i nā kūlana e like me SVT, kahi e hoʻonui ai i ka helu o ka puʻuwai.
- Hana kēia mau hana ma ka hoʻoulu ʻana i ke aʻalolo Vagus o ko mākou kino a me ka hoʻolohi ʻana i ka puʻuwai o ko mākou puʻuwai.
- Mai hoʻāʻo i kēia mau ʻano hana ma kāu iho me ka ʻole o ke aʻo ʻana a ke kauka. E nīnau i kāu kauka inā palekana lākou nou a he aha ke ʻano hana kūpono.
- Inā loaʻa iā ʻoe nā hōʻailona koʻikoʻi e like me ka ʻeha o ka umauma a me ka pōkole o ka hanu, e hele koke i ka ʻOihana Pilikia (ETU) o ka haukapila.
- Inā ʻaʻole holo pono kēia mau ʻano hana, pono paha ʻoe e ʻimi i ke kōkua lapaʻau a i ʻole nā lāʻau lapaʻau ʻē aʻe. He mea nui e hahai i nā ʻōlelo a kāu kauka.
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