Mkparịta ụka tracheal gụnyere itinye tube na-agbanwe agbanwe n'ime ikuku, site na akwara ụda olu, iji nye onye na-enweghị ike iku ume ume na ichebe ikuku ahụ site na ịmịnye ihe nke afọ.

Imirikiti ndị ọrịa chọrọ ikuku ụgbọ elu nwere ike ijikwa site na intubation tracheal, nke nwere ike ịbụ

• Orotracheal (ọkpọba etinyere site n'ọnụ)
• Nasotracheal (ọkpọba etinyere site na imi)

Orobusheal intubation ka mma maka intubation nasotracheal n'ọtụtụ oge ma rụọ ya site na laryngoscopy ma ọ bụ videolaryngoscopy.

A na-ahọrọ intubation Orotracheal na apnea na ndị ọrịa na-arịa ọrịa n'ihi na enwere ike ịrụ ya ngwa ngwa karịa intubation nasotracheal, nke edebere maka ịmụrụ anya, na-eku ume ndị ọrịa ma ọ bụ maka ọnọdụ ebe a ga-ezere ụzọ ahụ.

Epistaxis bụ nsogbu dị njọ nke intubation nasopharyngeal. Ọnụnọ nke ọbara na ikuku nwere ike ime ka echiche laryngoscopic kpuchie ma mee ka intubation dị mgbagwoju anya.

Tupu intubation tracheal

Ndị na-eme mgbanwe iji mepụta ikike ikuku na ikuku na ikuku oxygenate onye ọrịa tupu a na-egosi mbubata tracheal mgbe niile.

Ozugbo emere mkpebi ịbanye, usoro ịkwadebe bụ ndị a

• Ndozi ezi nke onye oria (lee onu ogugu na n'olu (Ọnọdụ maka oghere ikuku)
• Ventilation na 100% oxygen
• Nkwadebe nke dị mkpa ngwá (gụnyere ngwaọrụ mmịpụ)
• Mgbe ụfọdụ ọgwụ

Ventilation na 100% oxygen na-ewepu nitrogen na ndị ọrịa ahụike ma na-agbatị oge mmeghe nke ọma (mmetụta ahụ dị obere na ndị ọrịa nwere ọrịa cardiopulmonary siri ike).

Atụmatụ maka ịkọ laryngoscopy siri ike (eg Mallampati score, thyroid-mentum distance) abaghị uru na mberede.

Ndị nnapụta kwesịrị ịdị njikere mgbe niile iji usoro ọzọ (dịka nkpuchi laryngeal, valvụ mkpuchi nkpuchi, ịwa ahụ ikuku) ma ọ bụrụ na laryngoscopy anaghị aga nke ọma.

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N'oge njide ejiri obi, mkpịsị obi ekwesighi ịkwụsịtụ iji nwaa ịmịnye tracheal

Ọ bụrụ na ndị nnapụta enweghị ike ịmalite mgbe a na - eme mkpakọ (ma ọ bụ n'oge nkwụsịtụ dị mkpirikpi nke na - eme n'oge mgbanwe na - agbakwunye ndị nnapụta), a ga - eji usoro ụzọ ụgbọ elu ọzọ.

Ntughari aka kwesiri iji ngwa agha siri ike nke nghota ya ruru tonsils iji kpochapu ihe nzuzo na ihe ndi ozo site na ikuku.

A na-atụ aro tupu oge cricoid nrụgide (Sellick maneuver) tupu na n'oge intubation iji zere nchịkwa na-adịghị mma.

Otú ọ dị, usoro a nwere ike ghara ịdị irè karịa ka e chere na mbụ ma nwee ike imebi ọhụụ nke larynx n'oge laryngoscopy.

A na-enyekarị ndị na-arịa ọrịa maara ihe ma ọ bụ ndị nwere ọgụgụ isi ọgwụ laryngoscopy site na ọgwụ ndị na-eme ka ọ dị mfe, gụnyere ndị na-egbu mmụọ, ahụ ike, na mgbe ụfọdụ.

Nhọrọ tube na nkwadebe maka intubation tracheal

Ọtụtụ ndị toro eto nwere ike ịnakwere ọkpọkọ nwere eriri dị n’ime nke ≥ 8 mm; akpa ndị a dị mma karịa ndị pere mpe n'ihi na ha

• Nwee obere iguzogide ikuku (belata ọrụ iku ume)
• Kwadoro nchicho nke ihe nzuzo
• Ekwe ka ịga nke bronchoscope
• Nwere ike inye aka ịkwụsị ventilashị

Maka ụmụ ọhụrụ na ụmụaka ruru afọ ≥ 1, a na-agbakọ ogo nke eriri a na-ekpuchi ekpuchi site na iji usoro (afọ onye ọrịa + 16) / 4; ya mere, onye ọrịa dị afọ 4 kwesịrị ịnara tube nke endotracheal nke (4 + 16) / 4 = 5 mm.

Nke ọkpọkọ ahụ nke usoro a tụrụ aro ga-belata 0.5 (1 tube) ma ọ bụrụ na ejiri mkpịsị ọkpọ.

Ihe eserese ma ọ bụ ngwaọrụ, dị ka Broselow pediatric Emergency tape ma ọ bụ Pedi-Wheel, nwere ike ịchọpụta ngwa ngwa laryngoscope kwesịrị ekwesị na tubes endotracheal maka ụmụ ọhụrụ na ụmụaka.

Maka ndị okenye (na mgbe ụfọdụ maka ụmụaka), a ga-etinye stylet siri ike na ọkpọkọ ahụ, na-elezi anya ịkwụsị mandrel 1-2 cm tupu ngwụcha ngwụcha nke eriri endotracheal ka ngwe nke ọkpọ ahụ wee dịrị nro.

Mgbe ahụ, a ga-eji mandrel mee ka ọdịdị nke ọkpọkọ ahụ kwụ ọtọ ruo na mmalite nke eriri ọnya; site na nke a, ọkpọ ahụ na-ehulata site na mkpokọta 35 Celsius n'ụdị osisi hockey.

Ihe omimi a na-eme ka ntinye tube ma gbochie ikpuchi echiche onye nnapụta banyere akwara ụda mgbe ị na-agafe.

Imejupụta ihe na -eme ka ihe na-eme ka ikuku nke endotracheal dị na ikuku maka njikwa balloon adịghị mkpa; ọ bụrụ na ejiri usoro a, a ghaghị ilezi anya wepụ ikuku niile tupu ntinye tube.

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Usoro nhazi maka traubal traubal

Inye ihe ịga nke ọma na nnwale nke mbụ dị mkpa.

Ugboro ugboro laryngoscopy (attempts 3 mgbalị) jikọtara ọnụ ọgụgụ dị elu nke hypoxemia dị mkpa, ọchịchọ, na njide ejiri obi.

Na mgbakwunye na nhazi ziri ezi, ụfọdụ ụkpụrụ ndị ọzọ dị mkpa maka ihe ịga nke ọma:

• Jiri anya nke uche gị hụ epiglottis
• Jiri nlezianya lee anya n'omume laryngeal dị elu (nke kachasị mma, ụda olu)
• Etinyela ọkpọkọ belụsọ na ntinye tracheal doro anya

A na-ejide laryngoscope n'aka aka ekpe, tinyekwa agụba n'ime ọnụ ma jiri ya mee ihe iji kpalie agba na ire elu wee pụọ na onye nnapụta, jiri anya nke uche hụ azụ pharynx.

Ọ dị mkpa izere ịkpọtụrụ ndị na incisors na ghara ịmanye elu nsogbu na laryngeal owuwu.

Nchọpụta nke epiglottis bụ ihe kachasị mkpa. Nchọpụta nke epiglottis na-enye onye ọrụ ohere ịmata akara ngosi dị n'okporo ụzọ ndị siri ike na idozi laryngoscope agụba n'ụzọ ziri ezi.

Epiglottis nwere ike ịdina na mgbidi azụ nke pharynx, ebe ọ na-ejikọ ya na membran mucous ndị ọzọ, ma ọ bụ na ọ ka na-emikpu n'ime ihe nzuzo na-enweghị ike imeju ikuku nke onye ọrịa na njide ejiri obi.

Ozugbo achọtara epiglottis, onye ọrụ nwere ike iji otu n'ime usoro 2 bulie ya:

• Pdị usoro agụba dị mma: onye ọrụ na - eburu epiglottis na ngere nke laryngoscope
• Dezọ a na-akpọkarị agụ: onye na-eme ihe ahụ na-ebuli epiglottis n'ụzọ na-apụtaghị ihe ma na-ewepụ ya na ahịrị nke saịtị ahụ site na ịga n'ihu na agụba na ịpị njikọ njikọ hypoepiglottic

Successga nke ọma na agụba agụgharị na-adabere n'ọnọdụ ziri ezi nke ọnụ nke agụba na ndagwurugwu na ntụzịaka nke ike ibuli.

Eweli epiglottis site na iji usoro ọ bụla na-egosi usoro laryngeal azụ (carrylages arytenoid, interarytenoid incisura), glottis, na akwara ụda olu

Ọ bụrụ na a na-etinye ọnụ mmiri agụba miri emi nke ukwuu, akara ngosi nke larynx nwere ike ọ gaghị adị kpamkpam, oghere oesophageal gbara ọchịchịrị, nke nwere okirikiri nwere ike ihie ụzọ maka oghere nke glottis.

Ọ bụrụ na njirimara nke ihe owuwu siri ike, njikwa nke larynx na aka nri n'ihu olu (ikwe ka aka nri na aka ekpe rụọ ọrụ ọnụ) nwere ike ime ka echiche nke larynx dị mma.

Usoro ọzọ gụnyere ibuli isi elu (ibuli elu n'ogo nke occiput, ọ bụghị ndọtị atlanto-occipital), nke na-eme ka ihe dị egwu ma mekwaa ka ọhụhụ.

A naghị atụ aro ibuli elu nke ndị ọrịa na-enwe mmerụ ahụ ọnya cervical na ọ na-esiri ike na onye ọrịa siri ike (nke a ga-etinye n'ọnọdụ ma ọ bụ isi elu tupu oge eruo).

N'ọhụụ kachasị mma, a pụrụ ịhụ ụda olu nke ọma. Ọ bụrụ na ahụghị ụda olu, ma ọ dịkarịa ala, a ga-ahụkarị akara ngosi laryngeal dị n'azụ na a ga-ahụ ọnụ nke ọkpọkọ ka ọ na-agabiga interarytenoid incisura na cartilages na-esote.

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Ndị nnapụta kwesịrị ịghọta akara ala laryngeal nke ọma iji zere ịba ụba nke oesophageal nwere ike ịnwụ

Ọ bụrụ na ndị nnapụta amaghị nke ọma na ọkpọkọ ahụ na-agafe n'ime trachea, ekwesighi ịtinye ọkpọkọ ahụ.

Ozugbo enwetara ọhụụ kachasị mma, aka nri na-etinye eriri ahụ site na larynx n'ime trachea (ọ bụrụ na onye ọrụ ahụ ejiri aka nri tinye nrụgide na nkọlọ ihu, onye inyeaka kwesịrị ịnọgide na-etinye nrụgide a).

Ọ bụrụ na ọkpọkọ anaghị agafe ngwa ngwa, ntụgharị 90 Celsius nke ọkpọ ahụ nwere ike inyere ya aka ịgafe n'ụzọ dị mfe na mgbaaka tracheal ihu.

Tupu iwepu laryngoscope, onye na-arụ ọrụ kwesịrị ịlele na tube ahụ gafere n'etiti akwara ụda olu.

Omimi tube kwesịrị ekwesị na-adịkarị n'etiti 21 na 23 cm na ndị okenye na 3 ugboro hà nke tube endotracheal na ụmụaka (12 cm maka 4.0 mm nke endotracheal tube; 16.5 cm maka 5.5 mm endotracheal tube).

Na ndị okenye, ọkpọkọ na-agakarị na isi bronchus ziri ezi ma ọ bụrụ na ọ na-amaghị ama.

Ngwaọrụ ndị ọzọ maka intubation tracheal

A na-eji ngwa na usoro dị iche iche eme ihe maka ịmịnye nsogbu na laryngoscopy nke dara ada ma ọ bụ dịka ụzọ mbido intubation.

Ngwaọrụ ndị a gụnyere

• Igwe vidiyo laryngoscopes
• Laryngoscopes nwere enyo
• Ihe nkpuchi Laryngeal na lumen na-ekwe ka intubation tracheal
• Fibroscopes na ngwa anya
• Onye na-agbanwe tub

Ngwaọrụ ọ bụla nwere nkọwa nke ya; ndị nnapụta nwere ahụmịhe nke usoro laryngoscopic na-ebute intubation ekwesịghị iche na ha ga-enwe ike iji otu n'ime ngwaọrụ ndị a (ọkachasị mgbe ejiri curars) na-ebughị ụzọ mata ya.

Video-laryngoscopes na laryngoscopes nwere enyo na-eme ka ndị ọrụ na-elegharị anya na ire nke ire ma na-enyekarị ọhụụ laryngeal.

Otú ọ dị, ọkpọkọ ahụ chọrọ akụkụ dị ukwuu karị nke ịgafe ire ya wee nwee ike isiri gị ike ịgbanwe na ịtinye.

Fọdụ ihe mkpuchi laryngeal nwere ụzọ ntụgharị iji kwe ka intubation endotracheal.

Iji gafere eriri endotracheal site na mkpuchi laryngeal, ndị nnapụta kwesịrị ịma otú ha ga-esi mee ka mkpuchi ahụ dị mma karịa na adreus laryngeal; oge ụfọdụ enwere nsogbu nhịahụ na-agafe tube endotracheal.

Mgbanwe na-agbanwe agbanwe na ngwa anya dị mfe iji aka ya ma nwee ike iji ya na ndị ọrịa na-arịa ọrịa na-adịghị mma.

Agbanyeghị, ọzụzụ dị mkpa iji mata akara ngosi laryngeal na ọhụụ fibreoptic

E jiri ya tụnyere video-laryngoscopes na mirror laryngoscopes, fiberscopes na-esikarị ike ijikwa ma na-enwekarị nsogbu na ọnụnọ ọbara na ihe nzuzo; Ọzọkwa, ha anaghị ekewa ma kewaa anụ ahụ kama kama a ga-akpali ha site na ụzọ ọjọọ.

Ndị na-agbanwe tub (nke a na-akpọkarị gum elastic bougies) bụ ụdị ejiji siri ike enwere ike iji mee ihe mgbe ọhụụ nke larynx adịghị mma (dịka, epiglottis na-ahụ anya, mana oghere laryngeal abụghị).

N'ọnọdụ ndị dị otú ahụ, a na-ebufe onye mmeghe tinyere akụkụ ala nke epiglottis; site na nke a, itinye n'ime trachea nwere ike.

Ihe nzaghachi a na-atụ aro ka ị banye n'ime tracheal, a na-ahụta ya ka ọ na-adaba na mgbaaka tracheal.

Mgbe ahụ, a na-etinyezi tube endotracheal n'elu onye na-agbanwe tub ahụ n'ime trachea.

Mgbe ị na-agafe ọkpọkọ ihe ntanetị ma ọ bụ bronchoscope, ọnụ mgbe ụfọdụ na-ejedebe na nri ariepiglottic. Tụgharị ọkpọkọ 90 Celsius ọzọ na - emechi ụzọ na - ahapụkarị ọnụ ma nye ya ohere ịga n'ihu n'efu.

Mgbe ntinye

A na-ewepụ mandrel ahụ na ikuku ikuku ya na ikuku ikuku site na iji sirinji 10 mL; a na-eji manometer iji nyochaa na nrụgide cuff bụ <30 cm-H2O. Tubes endotracheal nke ziri ezi nwere ike ịchọ ọtụtụ <10 mL nke ikuku iji tinye nrụgide ziri ezi.

Mgbe ọnye ego buru ibu, a ga-enyocha ụzọ ntinye tube site na iji ọtụtụ ụzọ, gụnyere:

• Nnyocha na nkwado
• Nchọpụta Carbon dioxide
• Ngwaọrụ ịchọta intubation
• Mgbe ụfọdụ, akpọnwụ X-ray

Mgbe a na-edozi ọkpọkọ ahụ n'ụzọ ziri ezi, ikuku ventilashion kwesịrị ịmepụta mmụba nke obi, ezigbo vesicular na-atamu ntamu na ngụgụ abụọ, na-enweghị ịmepụta mkpagharị n'elu afọ.

Ikuku a kpochapụrụ kwesịrị ịnwe carbon dioxide ebe ikuku ikuku adịghị; nchọpụta carbon dioxide site na endimetric end-tidal carbon dioxide ngwaọrụ ma ọ bụ site na ebili mmiri na-akwado ọnyịnye tracheal.

Agbanyeghị, n'oge njide ejiri obi na-adị ogologo oge (yabụ, na-enweghị obere ma ọ bụ na-enweghị ọrụ metabolism), carbon dioxide nwere ike ghara ịchọpụta ọbụlagodi ntinye tube. N'ọnọdụ ndị dị otú ahụ, enwere ike iji ngwaọrụ nchọpụta intubation oesophageal.

Ngwaọrụ ndị a na-eji bọlbụ inflatable ma ọ bụ sirinji buru ibu iji tinye nrụgide na-adịghị mma na tube endotracheal.

Akpịrị na-agbanwe agbanwe na-arụkọ ọrụ, obere ma ọ bụ enweghị ikuku na-agafe n'ime ngwaọrụ ahụ; n'ụzọ dị iche, traktị siri ike anaghị arụkọ ọrụ ọnụ, ikuku ikuku na-ebute na-egosi nkwanye tracheal.

Na enweghị njide ejiri obi, a na-ejikwa ụzarị ọkụ na-etinyekwa ntinye tube.

Mgbe nkwenye ziri ezi kwubiri, ekwesiri iji eriri eji ere ahia ma obu teepu teepu ahụ.

Ihe nkwụnye na-ejikọ eriri endotracheal na ite ikuku, na T-tube nke na-enye humidification na oxygen, ma ọ bụ site na igwe ikuku.

Ọkpụkpụ endotracheal nwere ike ịmegharị, ọkachasị na ọnọdụ mgbapụta ọgbaghara, yabụ ekwesịrị ilele ọnọdụ tube anya ugboro ugboro

Ọ bụrụ na ụda iku ume adịghị na aka ekpe, nsị nke isi bronchus ziri ezi yikarịrị ka pneumothorax dị elu, mana ekwesịrị ịtụle ha abụọ.

Intubation nke Nasotracheal

Ọ bụrụ na ndị ọrịa na-eku ume mgbe niile, enwere ike iji intubation nasotracheal na ọnọdụ mberede ụfọdụ, dịka mgbe ndị ọrịa nwere nkwarụ siri ike ma ọ bụ nkwonkwo ụbụrụ (dịka ọnya, edema, igbochi mmegharị) nke na-eme laryngoscopy siri ike.

Nasotracheal intubation na-contraindicated na ọrịa na-ama ma ọ bụ na-enyo enyo na midface ma ọ bụ okpokoro isi isi fractures.

N’akụkọ ihe mere eme, a na-ejikwa nsị n ’imi eme ihe mgbe enweghị ọgwụgwọ ma ọ bụ machibidoro ya (dịka na mpụga ụlọ ọgwụ, na ngalaba ụfọdụ na-ahụ maka ọnọdụ mberede) yana maka ndị ọrịa nwere tachypnoea, hyperpnoea na ọnọdụ ịnọ ọdụ (dịka ndị nwere nkụda mmụọ), onye nwere ike jiri nwayọọ nwayọọ na-ebute tub ahụ n'ime ikuku.

Otú ọ dị, nnweta nke ikuku na-enweghị mbibi (dịka, nrụgide ikuku dị elu abụọ), nnweta dị mma na ọzụzụ maka ọgwụ mgbochi intubation, na ngwaọrụ ikuku ọhụụ emeela ka ojiji nke nsị belata.

Ntụle ndị ọzọ gụnyere nsogbu ndị metụtara nsụchi imi, gụnyere sinusitis (mgbe niile mgbe ụbọchị atọ gasịrị), na eziokwu ahụ bụ na tubes nke oke zuru oke iji kwe ka bronchoscopy (dịka, ≥ 3 mm) enweghi ike ịtinye ya nasally.

Mgbe a na-eme intubation naso-tracheal, a ga-etinye vasoconstrictor (eg, phenylephrine) na ọgwụ anestetiiki (dịka, benzocaine, lidocaine) na mucosa imi na larynx iji gbochie ọbara ọgbụgba na belata nchedo nchedo.

Patientsfọdụ ndị ọrịa nwekwara ike ịchọ ọgwụ gwọọ, opiates, ma ọ bụ ọgwụ EV na-ekesa.

Mgbe edozi mucosa nke imi, a ga-etinyere cannula dị nasopharyngeal dị nro iji hụ na ikike zuru oke nke akụkụ imi ahọpụtara ahọrọ na ịmepụta ụzọ maka ọgwụ ọgwụ na-egbu egbu na pharynx na larynx.

Enwere ike tinye cannula nke nasopharyngeal site na enyemaka nke gel dị nro ma ọ bụ nke anestetiiki (dịka lidocaine).

A na-ewepu cannula nke nasopharyngeal mgbe pharyngeal mucosa natara ọgwụ ọgwụ.

Mgbe ahụ, a na-etinye tube naso-tracheal dịka 14 cm miri emi (dị n'elu aditus nke larynx n'ọtụtụ ndị okenye); n'oge a, ikuku ikuku kwesiri ibu auscultatory. Ka onye ọrịa ahụ na-ekuru ume, meghee akwara ụda olu, a na-agbanye tub ahụ ngwa ngwa n'ime trachea.

Mgbalị ntinye ntinye nke na-emezughị emee ka onye ọrịa nwee ụkwara.

Ndị na-arụ ọrụ aghaghị ịtụ anya ihe omume a, nke na-enye ohere ohere nke abụọ iji gafee ọkpọ ahụ site na glottis mepere emepe.

Ọkpụkpụ endotracheal na-agbanwe agbanwe na-agbanwe agbanwe na-eme ka ohere ịga nke ọma.

Fọdụ ndị ọrụ nzọpụta na-eme ka ọkpọkọ dị nro site na itinye ha na mmiri ọkụ iji belata ihe ize ndụ nke ọbara ọgbụgba na iji kwado ntinye.

Enwere ike ịgbakwunye obere mkpọrọhịhị, nke a na-ere ahịa na njikọta nke ọkpọkọ ahụ iji mee ka ụda nke ikuku pụta ìhè mgbe ọkpọkọ ahụ dị n'ọnọdụ kwesịrị ekwesị karịa larynx na trachea.

Nsogbu nke intubation tracheal

Nsogbu gụnyere

• Trauma ozugbo
• Ọgba aghara Oesophageal
• Mpụga tracheal ma ọ bụ stenosis

Laryngoscopy nwere ike imebi egbugbere ọnụ, ezé, ire na supraglottic na mpaghara subglottic.

Ntinye tub na esophagus, ma ọ bụrụ na amataghị ya, na-ebute ọdịda nke ikuku na ọnwụ ma ọ bụ mmerụ hypoxic.

Insufflation site na tube n'ime esophagus na-akpata regurgitation, nke nwere ike iduga inhalation, mebie ventilashị na-esote site na valvụ balloon na nkpuchi, na ọhụụ na-enweghị isi na mgbalị mgbagha na-esote.

Ọ bụla translaryngeal tube ga-emebi akwara ụda olu ruo n’ókè ụfọdụ; mgbe ụfọdụ ọnya afọ, ọrịa ischaemia na ụkwara ụda olu ogologo oge na-eme.

Subglottic stenosis nwere ike ime n'oge (ọ na-abụkarị izu 3-4).

M mbuze nke trachea dị obere. Ọ na - abụkarị ihe na - akpata nrụgide dị elu gabigara ókè.

Obere oge, ọbara ọgbụgba site na isi arịa (dịka akwara na-amaghị aha), fistulas (ọkachasị tracheoesophageal) na tracheal stenosis na-eme.

Ojiji nke olu dị elu, ekweisi na-adịghị ike na-eji tubes kwesịrị ekwesị ma na-atụkarị mgbatị (8 ọ bụla) ma na-edebe ya <30 cm-H2O belata ihe ize ndụ nke nsogbu necrosis nke ischemic, mana ndị ọrịa nọ n'oké ujo, nwere obere obi mmepụta ma ọ bụ site na sepsis na-adịkarị mfe.

Gụọ kwa:

Ntughari Ntughari Site na Nlekọta Nlekọta Flight Paramedics Na Victoria Australia

Isi Iyi:

MSD - Vanessa Moll, MD, DESA, Schoollọ Akwụkwọ Ọgwụ Mahadum Emory, Ngalaba Nkụnwụ Ahụ, Ngalaba Ọgwụ Nlekọta Ahụike