I thisen kal dan a chhiat a, ‘shock’-ah i lut thei ang em? ‘Distributive shock’ chungchang hi han sawi ila!

Aw, a chang chuan harsatna lian tak kan nei thut thei a ni lawm ni? Kan chakna hloh tur anga kan inhriat a, thawk harsa kan tih chang a awm bawk. Hetiang hunah hian kan taksa chhungah thil pawi tak a thleng thei a ni. Vawiin hian chutiang dinhmun pakhat, nunna atana hlauhawm tak chu kan sawi dawn a ni. Chu chu ‘Distributive Shock’ tih condition a ni.

He ‘distributive shock’ hi eng nge ni? A awlsam zawngin...

A awlsam zawngin sawi ila, distributive shock hi medical emergency a ni. Heta thil thleng chu i taksaa thisen kalna kawng (thisen luangna hmun) chu a lian lutuk nghal a, rubber tube a inzawm khawm ang mai a ni. A chang chuan hei hi vasodilatory shock an ti bawk . Chuvangin, hetianga thisen kalna kawngte hi a lian chhoh chuan thisen sang chu a tlahniam thut mai a ni. Tui pipe a lian chuan tui a luang zawi zawk ang tih hi han ngaihtuah teh.

Hetiang thil a lo thlen hian eng nge thleng? I taksa peng lian ber berte, i thinlung, thluak, leh kal ang chite hian thisen an hmu tlem hle . Chu mai pawh ni lovin, a chang chuan heng thisen kalna kawng te tak te (capillaries) atang hian thisen thenkhat chu a chhuak tan thin. Hei hian i taksaa thisen awm zat a ti tlem thei a ni. Hei hi thil hlauhawm tak a ni a, a chhan chu kan taksa peng hrang hrangte hian an hnathawh theih nan thisen supply reng reng an mamawh a ni.

Pawimawh tak: Hetiang ‘Shock’ i tawk a nih chuan a rang thei ang bera inenkawlna zawn a pawimawh. Chutiang a nih loh chuan nunna atana hlauhawm a ni thei.

‘Distributive shock’ chi hrang hrangte chu engte nge ni?

‘Distributive shock’ hi chi thum a awm a, chungte chu chhan hrang hrang vangin a thleng vek a ni.

1. Septic Shock: Hei hi a tam ber chi a ni. Bacteria infection avanga lo awm a ni. Ngaihtuah teh, hliam i nei a, a chhe tak zet a, i taksaah hrik a darh a, chu chu ``Sepsis'' tih state a lo ni ta a, i thunun thei lo. A châng chuan pneumonia ang chi thil pawh hian he natna hi a thlen thei a ni.

2. Anaphylactic Shock: Hei hi allergy na tak avanga lo awm a ni. Entirnan, mi thenkhat chuan buhfai ang chi thil hi allergy na tak an nei a ni lawm ni? A nih loh leh rulhut thenkhatin an seh hian a thleng thin. Asthma vei pawhin he natna hi a nei thei a, thawk harsa tak tak pawh ni se.

3. Neurogenic Shock: Hei hi i ruhro (spinal cord) a chhiat avanga lo awm a ni. Entirnan, tuiah i zuang luh laiin i lu i vuak a, i ruhro i hliam a nih chuan, emaw, i ruhro tichhe thei khawpa accident na tak i tawk a nih chuan, he ‘neurogenic shock’ hi nervous system-a nghawng a neih avangin a thleng thei a ni.

‘Distributive Shock’ leh ‘Hypovolemic Shock’ hi eng nge an danglamna?

An pahnih hian ‘shock’ chi khat an ni. Chumi awmzia chu, chung pahnihah chuan kan taksa peng pawimawh tak takte hian thisen leh oxygen an dawng tlem hle tihna a ni. Amaherawhchu, a chhan erawh a danglam thung.

• Distributive shock , kan sawi tawh ang khan thisen kalna kawng a lian lutuk vang a ni. Hei hi sepsis an tih infection emaw allergic reaction na tak emaw avanga lo awm a ni fo thin.
• Hypovolemic shock chu taksaa thisen emaw, tui dang emaw a tlem lutuk chuan a ni. Entirnan, hliam lian tak avanga thisen tam tak i hloh a nih chuan, emaw, luak chhuak nasa tak emaw, luak chhuak emaw avanga tui tam tak i hloh chuan a thleng thei a ni.

A awlsam zawngin ‘distributive’ ah chuan thisen kalna kawng a lian a, ‘hypovolemic’ ah chuan taksa chhunga thisen/fluid a tlahniam. Hrethiam e?

He ‘distributive shock’ hi engtiang chiahin nge a awm?

Shock kan hriat chi li a awm a (`Hypovolemic`, `Cardiogenic Shock`, `Obstructive Shock` leh `Distributive Shock`). Heng pali zingah hian a tam ber chu `Distributive Shock` a ni . A bik takin `Septic Shock` an tih chi hi. America ang ramah pawh kum tin mi maktaduai khat velin `Septic Shock` an vei thin. Tu chungah pawh a thleng thei.

‘Distributive shock’ nei taksaah eng nge thleng?

Ka sawi tawh ang khan thisen kalna kawng a lian lutuk chuan thisen sang a tlahniam thin. Tichuan taksa peng hrang hranga thisen kal zat chu a tlem ta hle a ni. Kan taksa peng hrang hrangte hi machine ang mai a ni. Hnathawh tur chuan fuel (i.e. thisen leh oxygen) dik tak an hmuh a ngai a ni. Thisen, oxygen leh nutrients an neih tlem chuan taksa peng hrang hrangte chuan hna an thawk tawh lo zauh zauh a. Hei hi ‘organ failure’ kan ti a ni. Hetianga taksa peng hrang hrangte a chhiat chuan nunna atana hlauhawm lian tak a lo ni ta a ni.

Hei hi eng symptoms nge ni?

Distributive shock symptoms hi a chhan a zirin a danglam deuh thei. Mahse, a lan chhuah dan tlangpui thenkhat chu:

• Vun a hring chhuak
• Thinlung thawk chak tak leh thawk hah
• Thisen sang hniam (hei hi a lan chhuah dan ber a ni) .
• Kut leh ke chu a tirah a lum a, chutah chuan a vawt a, a thawmhnaw a chhuak bawk.
• Khawsik
• Chills (khawsik leh khur chhuak) .
• Pum a na
• Buaina, hriatna hloh ang maia inhriatna
• Khuh
• Thâwk a tawi
• Luhai
• Luak chhuak
• Zun laiin natna

Heng symptom pakhat emaw a aia tam emaw a lo lang nghal a nih chuan ngaihthah loh a tha ber, a dik em?

‘Distributive Shock’ awm chhante chu engte nge ni?

A hmaa kan sawi tawh chi thum bakah hian hetiang dinhmun thlentu chhan dang engemaw zat a awm bawk.

• Sepsis hi bacteria infection avanga lo awm (hei hi a chhan ber a ni) .
• Anaphylaxis, allergy na tak (e.g., ei tur chi hrang hrang, rulhut chi, damdawi thenkhat, asthma exacerbations) avanga lo awm a ni.
• Kangmei chhuak
• Pancreatitis natna a ni
• Toxic Shock Syndrome (a bik takin hmeichhiaah tampon hman avanga lo awm thei) .
• Spinal cord hliam a awm
• Endocrine lama harsatna awm thei
• Adrenal insufficiency (hei hi a tlem deuh) .
• Capillary leak syndrome ( thisen kalna kawng atanga tui chhuak, hei pawh hi a tlem deuh) .
• Thisen kalna kawng tizau thei damdawi ei tam lutuk (Drug overdose) (hei pawh hi a tlem hle) .

Doctor-te hian engtin nge hei hi an hriat?

Heng symptoms i neih hian doctor-in a tih hmasak ber tur chu uluk takin a enfiah ang che a, i medical history a zawt ang che. Mahse, mi mangang tak chuan engmah a pe thei lo mai thei che. Chutiang dinhmunah chuan i bula awm tu emaw chuan doctor hnenah i allergy chungchang te, anaphylaxis i neih tawh leh neih loh te, eng damdawi nge i ei tih te a hrilh thei ang. He thu hi natna hriatchhuahna atan a \angkai hle thei a ni.

Chumi hnuah chuan doctor chuan test eng emaw zat a ti ang a, chungte chu:

• Thisen test: Infection awm leh awm loh leh taksa peng hrang hrangte hnathawh dan enfiah thin.
• ECG (Electrocardiogram - EKG): Thinlung hnathawh dan a enfiah thin.
• Chest X-ray: Chuap dinhmun enfiah thin.
• Ultrasound scan: Pum chhunga thinlung, lung leh taksa peng hrang hrangte en rawh. Chung zinga ṭhenkhat chu khum bulah tih theih a ni.

Engtin nge enkawl a nih?

Hei hi emergency a nih avangin Emergency Room-ah enkawl tan a ni fo thin. Chumi hnuah chuan Intensive Care Unit (ICU)-ah sawn i ni thei ang.

1. I tih hmasak ber chu IV fluids pek hi a ni. Saline ang chi fluid te hi vein pakhatah an pe thin. Hei hi i thisen sang tlem a tihhniam nan tih a ni.

2. A dawtah chuan ‘Shock’ awm chhan kan hriat chian ang a, damdawi \ha tak kan pe ang.

3. A chang chuan , tube feeding pawh hman theih a ni , taksain chakna a mamawh avangin.

Intensive care unit-ah chuan doctor leh nurse-te chuan i vital signs (heart rate, blood pressure, thawk dan, temperature) te chu an enfiah chhunzawm zel ang. Enkawlna atanga side effect awm leh awm loh an enfiah bawk ang. Nangmah chauha thawk harsatna i neih chuan thawkna machine (ventilator) nen i inzawm thei bawk .

Eng ang damdawi nge hman thin?

‘Distributive Shock’ damdawi pek dan hi a chhan a zirin a inang lo:

• Vasopressor te chu: 1.1.Hengte hi thisen sang tihsan nan pek thin a ni. Entirnan, damdawi `epinephrine`, `vasopressin`, `norepinephrine` emaw `phenylephrine` emaw ang chi te.
• Antibiotics : Infection a awm chuan.
• Antihistamines: Allergy avanga lo awm a nih chuan.
• Steroids: Allergy emaw sepsis na tak nei tan.
• Albuterol inhaler (Accuneb® emaw Proair®HFA ang chi): Shock hi asthma vang a nih chuan.

Enkawlna hian side effect a nei em?

Ni e, damdawi thenkhat hian side effect tenau te a thlen thei.

• Vasopressors: heartbeat mumal lo (arrhythmia), rilru hahdam lo, pulmonary edema, rilru na, thinlunga coronary arteries a zim (hei hian heart attack a thlen thei).
• Antibiotics : Luak chhuak, luak chhuak.
• Albuterol: Lungkhamna, luak chhuak, luak chhuak.
• Antihistamines: Mutthilh, luak chhuak, lu na, thinlung thawk chak.

Mahse, doctor-te chuan heng zawng zawng hi an en ang a, enkawlna \ha ber an pe ang che. A pawimawh ber chu i nunna chhanhim hi a ni.

Engtin nge he hlauhawmna hi kan tihtlem theih ang?

Distributive shock thlentu zawng zawng hi kan pumpelh thei lo mai thei. Entirnan, hri kai leh kang. Mahse, thil hriat chhuah thenkhat avanga he shock hlauhawmna tihtlem nan hian kan tih theih thenkhat a awm a:

• Food allergy na tak , buhfai ang chi i neih chuan epinephrine auto-injector (EpiPen® Auto-Injector emaw Adrenalin® ang chi) keng fo ang che. A hman dan tur chiang takin hre rawh.
• Asthma flare-ups i neih fo chuan , i albuterol emaw salbutamol inhaler chu engtik lai pawhin i bulah dah reng ang che. A tlakchham tir suh ang che.
• Tampons i hman chuan rei lutukah dah suh, hei hian Toxic Shock Syndrome a thlen thei a, Distributive Shock-ah a kal thei a ni.
• Tui thuk lo emaw, tui thuk hriat lohah emaw zuang lut suh. Spinal cord a tichhia thei a ni.
• I thisen kalna kawng tizau (hawng) thei damdawi i ei a nih chuan ei tam lutuk suh. I doctor-in a tih zat chauh ei rawh.

‘Distributive shock’ a lo awm chuan eng nge thleng ang?

Shock thlentu chu sepsis a nih chuan hun rei tak chhung harsatna i nei thei. Chauhna, mumang tha lo, leh ei duh lohna ang chi thil. Eng pawh ni se, i doctor hnenah follow-up appointment neih chhunzawm zel tur a ni. I doctor-in damdawi a pek ang chiah kha i ei tur a ni bawk.

Distributive shock atanga dam leh hun chhung hi a nasat danah a innghat. Damdawi inah ni engemaw zat atanga kar tlemte chhung i awm a ngai mai thei.

Hetiang natna avanga damchhuahna rate hi 20% atanga 80% thleng a inang lo thei a, a chhan a zirin a ni. Enkawl loh chuan thihna a thlen fo thin. A hmaa hriatchhuah leh enkawl hi nunna chhanhimna tha ber a ni. Kum upa lam, zu in thin te, taksa peng hrang hrang lama harsatna nei te hi an hlauhawm zawk a ni.

I taksain IV fluids a dawng tha a, i taksa peng hrang hrangte a thawk chhunzawm zel a nih chuan i dam leh theihna chance tha tak i nei a ni.

In ka thlen hnuah engtin nge ka in enkawl ang?

Damdawi in atanga i haw hnuah i doctor-in a sawi angin i in enkawl ang. Hnathawh i thawh leh theih nan chawlh hahdam tha turin ni engemaw zat emaw, kar engemaw zat emaw in lama awm a ngai mai thei. I follow-up appointment te chu vawng reng ang che. I damdawi ei tur chu a tih ang chiah khan ei thin ang che.

In lama awm laiin harsatna i tawk leh ang tih i hriat chuan doctor ko nghal rawh.

Emergency-ah: Distributive shock symptom nei apiang chu emergency room-ah hruai nghal tur a ni. Ambulance a lo thlen hma chuan shock tu chu muttir tir rawh. An lum theih nan blanket-in khuh la, thisen kal chak nan an ke chu feet khat vel chawi sang rawh.

Doctor hnenah eng zawhna nge i zawh tur?

Hetiang dinhmun hi i neih chuan i doctor hnenah hetiang thil hi zawt la a tha ang:

• ‘Distributive shock’ neih leh theihna hlauhawmah ka awm em?
• Follow-up appointment atan engzat nge ka lo kal ngai?
• ‘Distributive Shock’ atang hian hun rei tak chhung nghawng ka nei ang em?

A tawp berah chuan hriat reng tur (Take-Home Message) .

Distributive Shock hi medical emergency a ni a, enkawl vat ngai a ni. A rang thei ang bera tanpuina dawn hi i nunna chhanhimna hun tha ber a ni. Dam leh tur chuan hun a duh a, chuvangin nangmah leh nangmah i dawhthei ang. In lama i awm laiin i damdawi ei tur chu i doctor-in a tih ang chiah khan ei la, follow-up-ah kal fo bawk ang che. I hmuh angin hei hi natna khirh tak a ni. Chuvangin hei hi hriat chian a pawimawh.

` Distributive shock, septic shock, anaphylactic shock, neurogenic shock, thisen sang hniam, shock enkawlna, sepsis Sinhala