Ngaba kukho into ethintela ukuhamba kwegazi entliziyweni yakho? Oku kungaba yi-'(Obstructive Shock)'!

Xa igazi lingajikelezi kakuhle emzimbeni wethu, oko kuthetha ukuba amalungu ethu awafumani umlinganiselo ofunekayo weoksijini, sidla ngokuyibiza ngokuba 'yi-shock'. Oku kwenzeka ngequbuliso. Namhlanje siza kuthetha ngohlobo olukhethekileyo, kodwa olungaqhelekanga 'lo-shock'. Lubizwa ngokuba yi-'(Obstructive Shock)'. Ngamafutshane, okwenzekayo kweli tyala kukuba kukho into ethintela ukuhamba kwegazi entliziyweni yethu kwaye igazi liphuma entliziyweni, oko kukuthi, 'i-obstruction' iyenzeka. Ngenxa yoku kuthinteleka, intliziyo ayikwazi ukusebenza kakuhle, uxinzelelo lwegazi lunokwehla ngequbuliso, kwaye umzimba unokuphelelwa yioksijini. Le yimeko engxamisekileyo kakhulu , ngoko ke kubaluleke kakhulu ukufumana unyango ngokukhawuleza.

Ngoko ke yintoni le `(Obstructive Shock)`? Singakucacisa ngakumbi?

Khawucinge nje, intliziyo yethu ifana nempompo yamanzi. Le mpompo yiyo ethumela igazi emzimbeni wonke. Ngoku, kwenzeka ntoni ukuba amanzi angena kule mpompo avalekile kwipayipi, okanye ukuba umbhobho ophuma kwipompo uyavaleka? Amanzi awahambi kakuhle, akunjalo? Yiloo nto eyenzekayo kwi-`(Obstructive Shock)`.

Kukho into ethintela ukuhamba kwegazi kwimithambo yegazi emikhulu (ebizwa ngokuba yi-'great vessels') edibanisa intliziyo. Oku kuthintela intliziyo ekufumaneni igazi elaneleyo, kwaye ayikwazi ukulikhupha. Isiphumo kukuba amalungu abalulekileyo emzimbeni wethu, ingqondo, izintso, kunye nemiphunga, awafumani ioksijini eyaneleyo. Le yimeko engxamisekileyo esongela ubomi.

Yintoni umahluko phakathi kwe-`(Cardiogenic Shock)` kunye ne-`(Obstructive Shock)`?

Zombini ezi zinto ziimeko ezingxamisekileyo zonyango, kodwa zenzeka ngezizathu ezibini.

Umothuko wentliziyo uyenzeka xa izihlunu zentliziyo zonakele, njengokuhlaselwa yintliziyo, kwaye intliziyo ingakwazi ukupompa igazi elaneleyo emzimbeni. Intliziyo iba buthathaka.

Kodwa kwi-`(Obstructive Shock)` izihlunu zentliziyo zihlala zilungile. Ingxaki ayikho entliziyweni, kodwa yenye into ephazamisana nokusebenza kwentliziyo. Cinga ngezi zinto:

• Ukuba unehlwili legazi elikhulu kwimithambo yegazi emikhulu (umthambo wemiphunga) elikhokelela emiphungeni yakho.
• Ukuba intliziyo icinezelwe sisingxobo esizaliswe lulwelo esijikeleze intliziyo (i-pericardial tamponade).
• Ukuba kukho ukwenzakala emiphungeni kwaye uxinzelelo ngaphakathi kwesifuba luyanda kakhulu, umzekelo, kwimeko ebizwa ngokuba yi-"Tension pneumothorax".

I-Obstructive Shock kuxa intliziyo ingakwazi ukusebenza kakuhle ngenxa yesizathu sangaphandle esifana nesi.

Ixhaphake kangakanani le meko ibizwa ngokuba yi-"Obstructive Shock"? Ichaphazela njani umzimba?

I-Obstructive Shock yimeko engaqhelekanga xa ithelekiswa nezinye iintlobo zomothuko. Idla ngokuchaphazela kuphela i-1% okanye i-2% yezigulane zomothuko. Iindaba ezimnandi zezokuba kunokwenzeka ukuba inyangeke kunezinye iintlobo zomothuko, kodwa kuphela xa inyangwa ngokukhawuleza.

Ukuba ayinyangwa ngokukhawuleza, i-Obstructive Shock ithintela amalungu abalulekileyo omzimba ukuba angafumani ioksijini kunye nezondlo. Oku kunokukhokelela ekulimaleni kwamalungu omzimba kwaye ngamanye amaxesha nokufa. Yiyo loo nto kubalulekile ukufuna unyango ngokukhawuleza.

Zithini iimpawu ze-`(Obstructive Shock)`?

Iimpawu zoku zisenokufana noko nezo ze-"Cardiogenic Shock." Jonga ukuba ezi mpawu zivakala ziqhelekile na kuwe:

• Isantya sokuphefumla sinyuka ngokungaqhelekanga.
• Uxinzelelo lwegazi luyehla kakhulu (hypotension).
• Isantya sentliziyo sinyuka kakhulu (`iTachycardia`). Ngokungathi usandul' ukubaleka.
• Ukutshintsha kwemood, mhlawumbi ukudakumba okanye ixhala kunokubakho.
• Ubungakanani bomchamo oveliswayo buncitshiswe kakhulu, okanye abufumaneki kwaphela.
• Ulusu luvakala lubanda kwaye lubila.
• Ngamanye amaxesha umoya unokuqokelelwa phantsi kolusu (`Subcutaneous emphysema`). Oku kuthetha ukuba uvakala ngathi ngamaqamza amancinci phantsi kolusu.
• Usenokuba neentlungu esifubeni okanye esiswini.

Ukuba unenye okanye ngaphezulu kwezi mpawu, kubaluleke kakhulu ukufuna ingcebiso kagqirha ngokukhawuleza.

Zithini izizathu ze-`(Obstructive Shock)`?

Kukho izizathu ezahlukeneyo ze-`(Obstructive Shock)`. Makhe sibone ukuba zeziphi ezona ziphambili:

• `(I-Tension pneumothorax)` (ukuwa komphunga): Oku kwenzeka xa umoya ungena emphungeni kwaye ungakwazi ukuphuma, nto leyo ebangela ukuba uvaleleke ngaphakathi emphungeni. Emva koko umphunga uyawa, nto leyo ebangela uxinzelelo olukhulu esifubeni kwaye ibangele ukuba intliziyo iqale ukubetheka.
• I-Vena cava compression syndrome: Ukucinezelwa komthambo omkhulu emzimbeni wethu (i-vena cava). Oku kunokwenzeka rhoqo ekupheleni kokukhulelwa, xa ubunzima bomntwana bucinezela lo mthambo wegazi.
• Isifo sokucinezelwa kwemiphunga: Isifo sokucinezelwa kwemiphunga.
• `(Umoya ongenisa umoya ophezulu)`: Imeko apho uxinzelelo oluphezulu emiphungeni luphezulu kakhulu kumntu odibene ne-ventilator.
• Iithumba: Ezinye iintlobo zeethumba ezikhula ngaphakathi esifubeni zinokuthintela intliziyo okanye imithambo yegazi emikhulu.
• I-Thromboembolism kwi-pulmonary artery: Oku kuyingozi kakhulu. Ukuba ihlwili legazi elenzeka kwindawo efana nomlenze liyaqhekeka lize libambeke kwimithambo yegazi emiphungeni, liyayithintela igazi ukuba lingaphumi lisuka entliziyweni liye emiphungeni.
• I-Pericardial tamponade: Ingxowa encinci ejikeleze intliziyo (i-pericardium) izaliswe lulwelo, icinezela intliziyo. Oku kuthintela intliziyo ekucuthekeni nasekukhuleni ngokufanelekileyo.
• Ukuqhekeka kwe-aorta: Ukukrazuka kwi-aorta, umthambo wegazi omkhulu ophuma entliziyweni.
• I-Aortic stenosis: Ukuncitshiswa kwevalvu ye-aortic entliziyweni. Oku kwenza kube nzima ukuba igazi liphume entliziyweni.
• I-Hypertrophic cardiomyopathy: Ukuvaleka kokuhamba kwegazi ngenxa yokuqina kakhulu kwemisipha yentliziyo.
• I-Constrictive pericarditis: Ingxowa ejikeleze intliziyo iyajiya, nto leyo eyenza kube nzima ukuba intliziyo isebenze ngokukhululekileyo.

Kubalulekile: Zonke ezi zinto ziyingxamiseko, ngoko ke bonana nogqirha ngokukhawuleza ukuba uneempawu.

Ungayibona njani into ethi `(Obstructive Shock)`?

Ugqirha wakho uza kuqala akuhlole. Baza kumamela intliziyo yakho kunye nemiphunga nge-stethoscope. Uxinzelelo oluthintelayo yimeko enokuba mandundu ngokukhawuleza, ngoko ke kubalulekile ukufumana uxilongo ngokukhawuleza.

Ukuze uxilonge ngokuchanekileyo isifo, kunokwenziwa ezi mvavanyo zilandelayo:

• I-Ultrasound: Oku kunokujonga izinto ezifana nentliziyo, imithambo yegazi emikhulu, kunye nokuba kukho ulwelo olujikeleze imiphunga.
• I-Echocardiogram (Echo): Oku kufana ne-ultrasound yentliziyo. Ingayibona ngokucacileyo indlela esebenza ngayo intliziyo, imeko yeevalvu, kunye nokuba kukho ulwelo olujikeleze intliziyo.
• I-computed tomography (CT) scan: Oku kungathatha imifanekiso eneenkcukacha zomngxuma wesifuba. Kunokunceda ekufumaneni izinto ezifana namahlwili egazi, iithumba, kunye nokuqhekeka kwe-aorta.
• I-Electrocardiogram (ECG okanye EKG): Oku kuvavanya ukusebenza kombane kwentliziyo. Kunokunceda ekufumaniseni ukuba kukho into engalunganga entliziyweni yakho.

Iphathwa njani i-Obstructive Shock?

Okokuqala, uza kunikwa ulwelo lwe-IV (njenge-saline - IV crystalloid fluids) kwaye uxinzelelo lwakho lwegazi kunye namanqanaba eoksijini aya kuhlolwa rhoqo. Emva koko, eyona nto ibalulekileyo kukufumana unobangela we-Obstructive Shock kwaye unyange loo nto.

Iindlela zonyango ziyahluka ngokuxhomekeke kwisizathu. Makhe sijonge imizekelo embalwa:

• Ukuba kukho ihlwili legazi (i-embolism), lisuswa ngotyando okanye ngokufaka i-cannula (i-catheter).
• Ukuba yivalvu ye-aortic encitshiswe kakhulu, iya kutshintshwa.
• Kwimeko yemisipha yentliziyo etyebileyo (hypertrophic cardiomyopathy), ubukhulu bungancitshiswa nokuba ngotyando okanye ngendlela ekhethekileyo kusetyenziswa utywala (i-catheter-based alcohol ablation).
• Bakunika amayeza okunyibilikisa amahlwili egazi.
• Ukuba kukho ulwelo olujikeleze intliziyo (i-pericardial tamponade) okanye i-tension pneumothorax, ulwelo okanye umoya uya kususwa (mhlawumbi kusetyenziswa ityhubhu encinci).
• Ukuba usebenzisa i-ventilator, ungayitshintsha indlela esebenza ngayo.
• Kwimeko efana ne-"Vena cava compression syndrome", indawo yomzimba iyatshintshwa.
• Ukuba uxinzelelo olukwimiphunga luphezulu, uxinzelelo luyancitshiswa ngenaliti okanye ngetyhubhu.

Ngawaphi amayeza asetyenziswayo?

Ngelixa unobangela unyangwa, unganikwa amayeza anjengala ukuze uzinzise imeko yakho:

• Ulwelo olufana ne-`IV` saline (`IV crystalloid fluids`).
• Amayeza okunyusa uxinzelelo lwegazi: `(Norepinephrine (Levophed®))`, `(Vasopressin (Vasostrict®))`, `(Phenylephrine (Vazculep® okanye Biorphen®))`.
• Ukuba umlinganiselo wegazi uphantsi, uza kunikwa igazi okanye iimveliso zegazi (ezifana neeseli ezibomvu zegazi kunye neplasma).

Ndingaphila ngokukhawuleza kangakanani emva konyango?

Uninzi lwezizathu ze-Obstructive Shock kufuneka zinyangwe ngokukhawuleza , kuba kulapho amathuba okusinda aphezulu khona. Ngethamsanqa, ezi ndlela zonyango zisebenza ngokukhawuleza. Nangona kunjalo, nasemva kokunyanga unobangela, kuthatha ixesha ukuba umzimba uphinde uphile kwiziphumo ze-Obstructive Shock. Awunakubaleka nje wenze umsebenzi wakho.

Iyintoni imbono ye-`(Obstructive Shock)`?

Ukuba ayinyangwa, i-"Obstructive Shock" yimeko enokuba yingozi kubantu abaninzi. Ukuchacha kwakho emva konyango kuxhomekeke kwizinto ezahlukeneyo, kuquka:

• Yintoni imbangela ye-`(Obstructive Shock)`?
• Kuthathe ixesha elingakanani ukufumana unyango?
• Ziziphi ezinye izifo onazo?
• Unyango lwakho lube nempumelelo kangakanani?

Nangona kunjalo, njengoko bekutshiwo ngaphambili, amathuba okuphila kwi-"Obstructive Shock" aphezulu kunakwiintlobo eziqhelekileyo ze-"Shock" ezifana ne-"Septic Shock". Ke ngoko, kukho ithemba.

Ndingazinyamekela njani?

Emva kokuba ugqirha ekukhululile esibhedlele, kufuneka ulandele imiyalelo yakhe ngokuchanekileyo.

• Kuya kufuneka uphumle ekhaya okwethutyana ngaphambi kokuba ubuyele emsebenzini.
• Ufanele uthathe amayeza owanikwe ngugqirha wakho ngexesha elifanelekileyo . Ungayeki ukuthatha naliphi na iyeza ngokuthanda kwakho.
• Yiya rhoqo kwiindibano zokulandelela .

Ndifanele ndiphinde ndimbone ugqirha kwakhona? Ndingenza ntoni xa kukho imeko engxamisekileyo?

Ngoku uyazi ukuba yintoni ebangele '(Umothuko Othintelayo)' wakho. Lumka ukuba iimpawu ezinxulumene naloo ngxaki ziyavela kwakhona. Ukuba uneempawu ezinjalo kwakhona, okanye ukuba umntu kusapho lwakho ubona olu tshintsho kuwe, fowunela iNkonzo yeeAmbulensi zoMlilo ka-1990 (uMoya), ngoko nangoko, okanye uye kwigumbi likaxakeka lesibhedlele esikufutshane. Ixesha libaluleke kakhulu.

Ndingayibuza yiphi imibuzo ugqirha wam?

Ungabuza imibuzo efana nale:

• Kufuneka ndithathe amayeza owandinike wona ixesha elingakanani?
• Angakanani amathuba okuba ndiphinde ndibe nale meko?
• Ngaba oku kuya kuba nefuthe elide kumgangatho wobomi bam?
• Zeziphi iinguqu endimele ndizenze kwindlela enditya ngayo nakwindlela endizilolonga ngayo?

Okokugqibela, yintoni ekufuneka uyikhumbule (Umyalezo Wokuya Ekhaya)

I-Obstructive Shock yimeko engaqhelekanga kodwa enzulu kakhulu efuna unyango olungxamisekileyo. Kungoko ke, kubalulekile ukuqaphela iimpawu kwaye ufune unyango ngokukhawuleza. Nje ukuba oogqirha bafumanise unobangela we-Obstructive Shock, baza kuqalisa unyango olufanelekileyo.

Khumbula, uninzi lwabantu lunokuphila kwi-Obstructive Shock, kodwa kuthatha ixesha. Yiba nomonde, landela imiyalelo kagqirha wakho, kwaye uzinyamekele. Awuwedwa, kwaye kukho oogqirha, abahlengikazi, kunye nabantu obathandayo abanokukunceda.

Umothuko othintelayo, umothuko, isifo sentliziyo, uxinzelelo lwegazi, ioksijini, ukuvaleka, unyango olungxamisekileyo, imiphunga, intliziyo