Stimulant Overdose (‘Overamping’): Ɔhyew a ɛboro so, Koko mu Ɛyaw, ne Agitation Triage¶

Nea ɛnte sɛ opioid a wɔde di dwuma boro so, a obi de ne ti to fam nkakrankakra, dan bruu, na ogyae home no, nneɛma a ɛkanyan obi a ɔnom boro so a emu yɛ den, a wonim no kɛse wɔ nnuru a wɔde tew ɔhaw so ne nea egye ntɛmpɛ mu sɛ "overamping", yɛ basabasayɛ, hyper-metabolic ɔhaw a ɛfa koma, amemene, mogya ntini, ne nipadua mu hyew ho. Sɛ obi di awuduru dodow a ɛyɛ methamphetamine, powder cocaine, crack cocaine, MDMA ("ecstasy" / "molly"), amphetamine pills a mmara mma ho kwan, anaa cathinones a wɔayɛ ("bath salts" / alpha-PVP / mephedrone), anaasɛ wada nna pii wɔ stimulant run mu a, wɔn mfinimfini ne tema ntini ahorow no nsuyiri ne dopamine, norepinephrine, ne serotonin. Koma a ɛbɔ kɔ soro boro ɛbɔ 140 kosi 180 simma biara, mogya mmoroso kɔ soro kodu baabi a ɛma obi hwe ase (220/130 mmHg+), coronary arteries clamp shut wɔ acute vasospasm mu, na core nipadua no hyew betumi akɔ soro ntɛmntɛm asen 40.0 kosi 41.5 digrii Celsius (104.0 kosi 106.7 digrii Fahrenheit).

Sɛ wɔansa a, awuduru a emu yɛ den a ɛkanyan obi no nam akwan anan a ɛyɛ ntɛmntɛm so kum: ɔhyew a ɛyɛ hu (akwaa a ɛwɔ nipadua no mu a wɔnoa na ɛkanyan ntini mu ntini a ɛtrɛw a ɛtwetwe), akoma ntini mu ntini a ɛtwetwe ne sodium-channel blockade (ɛde koma mu ntini a ɛyɛ den anaasɛ ventricular arrhythmia a edi awu ba wɔ apɔwmuden mpo mu 20-mfe), intracerebral hemorrhagic stroke anaa status epilepticus seizures, ne rhabdomyolysis (nnompe mu ntini a ɛpaapae kɛse a ɛsɛe asaabo). Bere koro no ara mu no, esiane sɛ mprempren fentanyl ne nitazenes a mmara mma ho kwan no gu mmɔnten so cocaine, krak, methamphetamine, ne Adderall/MDMA nnuru a wɔahyɛ no den ɔha biara mu nkyem kɛse bi ho fĩ nti, ɛsɛ sɛ obiara a ɔde nnuru a ɛkanyan adwene di dwuma a ɔda mpofirim, ɔyɛ mmerɛw, anaasɛ ɔhome brɛoo no nya intranasal naloxone (Narcan) ntɛm ara. Nim a wunim sɛnea wobɛkyerɛ nsonsonoe a ɛda adwene mu overamping ne aduruyɛ mu ntɛmpɛ a ɛde nkwa to asiane mu ntam, sɛnea wobɛma ɔyarefo a ɔkanyan obi a ne ho yɛ hyew ayɛ no nwini wɔ simma kakraa bi mu, ne nea enti a ƐNSƐ DA sɛ wode honam fam de ɔyarefo a ɔkanyan adwenemhaw a n’anim kyerɛ fam wɔ wɔn yafunu so DA gye nkwa.

Yɛ eyi mprempren¶

1. Di kan hwɛ sɛnea obi home ne sɛnea ɔyɛ n’ade: sɛ obi a ɔde nnuru a ɛkanyan obi di dwuma no nnim hwee, ɔrefefe, ɔrebɔ ahome, anaasɛ ɔrehome brɛoo a, fa Naloxone (Narcan) 4 mg aduru a wɔde petepete hwene mu ma na fi ase home a wɔde gye nkwa ntɛm ara. Street cocaine, methamphetamine, ne nnuru a wɔde kanyan nipadua no taa yɛ nea wɔde fentanyl abɔ mu. Sɛ mpo wunim sɛ na wɔabɔ wɔn tirim sɛ wɔde aduru a ɛkanyan adwene nkutoo bedi dwuma a, naloxone bɛdan fentanyl a ahintaw no akyi na renpira obi a ɔwɔ aduru a ɛkanyan adwene a ɛho tew ntɛm ara.
2. Frɛ wo mpɔtam hɔ ntɛmpɛ nɔma (911 wɔ U.S. ne Canada no, . 112 wɔ EU no, . 999 wɔ UK) ntɛm ara sɛ onipa no wɔ honam fam frankaa kɔkɔɔ BIARA a: ne koko mu yaw anaa nhyɛso, core skin a ɛte nka sɛ ɛyɛ hyew, akisikuru, tiyɛ a emu yɛ den mpofirim, anim a ɛrehwe ase/basa a ɛyɛ mmerɛw, anaasɛ delirium a wontumi nni so. Hwɛ yɛn nɔma ahorow a egye ntɛmpɛ directory a wɔde kyerɛw nsɛm.
3. Sɛ onipa no honam ani yɛ hyew, ne ho yɛ hyew, anaasɛ n’adwene mu yɛ no naa na ne ho yɛ hyew dodo a, fi ase yɛ aggressive active cooling Ntɛm ara bere a woretwɛn ambulance no. Yi akyi ntade a ɛboro so, fa ice packs anaa bags a nhabannuru a ayɛ nwini a wɔde ntama teateaa akata so gu abasa, asen, ne kɔn afã horow, fa nsu a ɛyɛ nwini gu wɔn honam ani a ɛda hɔ kwa no mu bere a worebɔ a fan a ɛde ahoɔhare kɛse twa wɔn so, anaasɛ fa gu aguaree a ɛyɛ nwini mu (ma wo ti gyina nsu so). Simma biara core temperature a ɛkɔ so boro Celsius digrii 40.5 (digrii Fahrenheit 105) no ma amemene ne akwaa sɛe a wontumi nsakra.
4. MMFA nkura, nkyekyere, nkyekyere mprako, anaa ntena obi a ɔde nnuru a ɛkanyan adwene a ɛyɛ basaa anaasɛ n’adwene mu yɛ no naa no akyi anaa ne moma so (prone restraint). Obi a ɔwɔ awuduru a emu yɛ den a ɛkanyan obi no wɔ metabolic acidosis a ɛtra so na ɛhwehwɛ sɛ wɔtrɛw ne koko fasu mu kɛse na ama wɔatumi abɔ carbon dioxide (CO2). Sɛ wode wɔn anim kyerɛ fam a, ɛto wɔn diaphragm no ano hye, ɛma mogya mu acid dodow kɔ soro, na ɛma koma no gyaee mpofirim a edi awu ("restraint asphyxia") wɔ sikani 60 mu.
5. Sɛ onipa no koko mu yaw a ɛyɛ mmerɛw, ne hwene/basa benkum mu yaw, anaasɛ ne fifiri a ɛyɛ nwini bere a ɔde cocaine anaa meth adi dwuma awie a, fa no tra ase yiye, ma no nyɛ komm koraa, na ma Aspirin a wotumi we 162 kosi 325 mg (gye sɛ ne ho yɛ no yaw anaasɛ ne koko mu yaw/mogya retu). Mma obi a ɔwɔ koko mu yaw a ɛkanyan obi no nantew anaasɛ ɔnyɛ adwuma da wɔn ankasa, na wɔbɛbɔ ayarehwɛfo amanneɛ ntɛm ara sɛ cocaine anaa methamphetamine wɔ hyɛn no mu (ɛsɛ sɛ ayaresabea nnuruyɛfo kwati beta-blockers bi a ɛma ahrawa mu ntini a ɛyɛ mmerɛw no yɛ kɛse).
6. Sɛ onipa no renya adwene mu "overamp" a ɛyɛ mmerɛw (adwennwene, ahopopo, paranoid, anaasɛ ɔbrɛ a NE koko mu yaw, Ɔhyew dodo, na ɔhome sɛnea ɛsɛ) a, fa no kɔ dan a ɛyɛ nwini, sum, na ɛhɔ yɛ dinn mu. Fa electrolyte anonne a ɛyɛ nwini, aguaree anaa ntama a wɔde horo nneɛma a ɛyɛ nwini, aduan nketenkete a wobɛka, ne baabi a ɛyɛ komm, a ɛnyɛ atɛn ma no kosi sɛ ade a ɛkanyan no no bɛhyɛ off.

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Rapid Triage: Adwene ne Nkate mu Overamping a Ɛnyɛ Den vs. Aduruyɛ mu Awudi a Ɛde Nkwa To asiane mu¶

Wɔ ɔhaw a wɔtew so ho adeyɛ mu no, asɛmfua "overamping" ka nneɛma pii ho: efi ehu a ɛnyɛ dɛ, a ɛyɛ basaa bere a wanom Adderall, meth, anaa coke pii akyi, kosi ɔhyew a ɛyɛ hu a edi awu, ɔyare a ɛma obi hwe ase, anaa komayare so. Fa saa gyinaesi dua yi yiyi nea wobetumi ama ayɛ komm wɔ fie ne nea ehia ayaresabea ICU mprempren.

flowchart TD
    A["Obi a Ɔhaw Wɔ Cocaine, Meth, Crack, MDMA, anaa Nnuru a Wɔde Di Dwuma Akyi"] --> B{"So Wɔnnyɛ Asɛm anaasɛ Wɔhome Nkakrankakra / Wɔrefefe?"}
    B -->|YES: Limp, Blue Lips, Slow Breathing| C["WOSUSUW sɛ FENTANYL MU NSƐM: Ma Naloxone 4 mg Spray + Rescue Breaths + Frɛ 911"]
    B -->|NO: Awake, Fast Heartbeat, Sweating, Agitated, or In Pain| D{"Red-Flag Sympathomimetic Ɔhaw Nsɛnkyerɛnne Bi Biara?"}
    D -->|Hot Skin > 39.5C/103F, Chest Pain, Seizure, Stroke Signs, Dark Urine, or Violent Delirium| E["ADURUYƐ HO NHYEHYƐE: Frɛ 911 / 112 / 999 Ntɛm ara"]
    D -->|NO Physical Red Flags: Jittery, Anxious, Racing Thoughts, Exhausted, Mild Paranoia| F["Mild/Moderate Overamping: De-Escalate wɔ Pia a Ɛyɛ Nwini na Ɛyɛ Komm mu"]
    E --> G["1. Nsukyenee-Pack / Evaporative Cooling Ntɛmntɛm 2. Chewable Aspirin 325 mg sɛ Koko mu Ɛyaw 3. Zero Prone Restraint"]
    F --> H["1. Dim Lights & Dum Nnwom 2. Nsuonwini / Electrolytes & Snack 3. Ntama a ɛyɛ nwini 4. Monitor Simma 15 Biara"]

Ayaresa mu Nkyekyɛmu Table: Green/Yellow Overamping vs. Red Sympathomimetic Emergency¶

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Ntɛmntɛm a Ɛde Nkwa To asiane mu 1: Malignant Stimulant Hyperthermia ("Nnoa a Wɔnoa Fi Mu") .¶

Ade a edi kan a ɛma owu ntɛmntɛm wɔ methamphetamine, MDMA ("molly"), ne cathinone a wɔayɛ ("bath salt") a wɔde di dwuma boro so mu ne runaway hyperthermia.

1. Nea enti a nneɛma a ɛkanyan nipadua no ma nipadua no mu hyew titiriw boro digrii Celsius 41 (digrii Fahrenheit 106) .¶

Nnuru a ɛkanyan nipadua no ma nipadua no mu fononoo no kɔ soro bere koro mu bere a ebubu ne radiator no:

• Ɔhyew a Wɔyɛ Kɛse: Dopamine, serotonin, ne norepinephrine a ɛboro so no kanyan nnompe mu ntini a ɛkɔ so yɛ adwuma boro so, anom a ɛyɛ den, ɛyɛ basaa, ne mitochondrial a ɛpaapae (UCP-3), a ɛma nipadua no mu hyew kɛse ba (titiriw wɔ anadwo agoprama ahorow a nnipa ahyɛ mu ma na ɛhɔ yɛ hyew, ahohuru bere mu afahyɛ ahorow, anaa adan a mframa ntumi nkɔ mu mu).
• Blocked Heat Dissipation: Bere koro no ara mu no, norepinephrine kanyan alpha-1 adrenergic peripheral vasoconstriction a emu yɛ den, clamping to mogya ntini a ɛwɔ honam ani ma enti mogya a ɛyɛ hyew a ɛwɔ honam ani no ntumi nkɔ honam ani nwini.
• The 40.5C (105F) Multi-Organ Failure Threshold: Sɛ core temperature boro 40.5 degrees Celsius (105 degrees Fahrenheit) bɛboro simma 20 kosi 30 a, nkwammoaa mu protein ahorow no sesa, dwensɔtwaa mu akwanside no sɛe (tow gut endotoxins gu mogya no mu), nnompe mu ntini no yew (rhabdomyolysis), na mogya a ɛtwetwe no kɔ haywire (Disseminated Intravascular Coagulation / DIC), na ɛde mogya a edi awu fi akwaa biara mu ba.

2. Anamɔn biara Pre-Hospital Rapid Cooling Protocol¶

Mma ntwɛn sɛ nnuruyɛfo a wɔboa nkurɔfo no mfi ase mma ɔyarefo a ɔde nnuru a ɛkanyan obi a ne ho yɛ hyew no nwini, na mma acetaminophen (paracetamol / Tylenol) anaa ibuprofen/aspirin da na ama atiridiinini a ɛkanyan obi no so atew. Nnuru a ɛko tia atiridiinini yɛ adwuma wɔ hypothalamus so wɔ atiridii/atiridii a ɛde ɔyare mmoawa ba mu na ɛyɛ zero ma ntini mu hyew a nnuru de ba (nea enye koraa no, acetaminophen ma mmerɛbo no di huammɔ ntɛmntɛm bere a ɔhyew a ɛboro so no yɛ kɛse, na NSAID ma asaabo a entumi nyɛ adwuma yiye no yɛ kɛse).

1. Tu Kɔ Beae a Ɛyɛ Nwini Sen Biara: Fa onipa no kɔ dan a mframa wom anaa mframa a sunsuma wom mu na yi ntade a emu yɛ duru, hoodies, kyɛw, ne mpaboa si fam kosi ase.
2. Fa Ice Packs gu Ntini Ntini Titiriw a Ɛka Ho: Fa mpopaho a ɛyɛ tratraa a ɛyɛ nsu kyekyere nsukyenee a wɔde ahyɛ mu, nsukyenee nkotoku, anaa nnuan a wɔahyɛ no nwini mu na fa hyɛ kɔn (carotid ntini), abasa (axillary arteries), ne groin creases (femoral arteries) ho denneennen.
3. Evaporative Spray-and-Fan Cooling (anaasɛ Nsuonwini a Wɔde Hyehyɛ):
   • Sponge anaa fa nsu a ɛyɛ nwini petepete honam ani mmeae akɛse a ɛda hɔ kwa (15 to 20 degrees Celsius / 60 to 68 degrees Fahrenheit) bere a ɔde anyinam ahoɔden fan a ano yɛ den sen biara a ɛwɔ hɔ (anaasɛ wode krataa/mpopaho rebɔ denneennen) kyerɛ honam ani a ɛyɛ nsu no so tẽẽ no. Nsu a ɛyɛ hyew no yi ɔhyew fi hɔ ntɛmntɛm sen mframa a ɛyɛ nwunu mpɛn ason.
   • Sɛ bathtub wɔ hɔ ntɛm ara na onipa no ada (anaasɛ aboafoɔ mmienu a wɔn ho yɛ den bɛtumi akura ti no mu dwoodwoo afiri nsuo no mu), fa wo honam ani ne wo nsa ne wo nan gu tap nsuo a ɛyɛ nwini mu. (Hwɛ Ɔhyew a ɛba vs. ɔhyew mu ɔbrɛ.) .

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Ntɛmntɛm a Ɛde Nkwa To asiane mu 2: Cocaine ne Methamphetamine Koma mu Ɛyaw (Koma Yare & Ntini a Ɛtwetwe) .¶

Cocaine ne methamphetamine kanyan koma ntini mu yare a emu yɛ den (komayare), aortic dissection, ne koma a ɛyɛ den mpofirim wɔ wɔn a wɔadi mfe 19 kosi 35 a wɔde di dwuma a wonni srade a ɛwɔ wɔn ntini mu mpo mu.

1. Cocaine (ne Cocaethylene a wɔde nsa ka ho) a ɛbɔ koma mprɛnsa .¶

• Coronary Artery Vasospasm + Surging Oxygen Demand: Cocaine ne meth ma koma ntini no bɔ denneennen na ɛyɛ ntɛmntɛm bere a bere koro no ara mu no ɛyɛ coronary arteries no mu a ɛyɛ mmerɛw, na ɛma koma ntini no kɔm de oxygen.
• Direct Sodium-Channel Blockade (Cocaine Nkutoo): Cocaine yɛ aduru a ɛma obi dwensɔ ("caine") a esiw koma mu ntɛmntɛm sodium (Na+) channels, a ɛtrɛw koma no anyinam ahoɔden mu QRS a ɛyɛ den na ɛkanyan ventricular tachycardia anaa ventricular fibrillation (a ayaresabea nnuruyɛfo de sodium bicarbonate a wɔde fa ntini mu sa).
• Mogya a Ɛtwetwe Ntɛmntɛm: Nnuru a ɛkanyan mogya mu nkwammoaa a ɛma mogya tu no yɛ adwuma, na ɛma mogya tu mpofirim wɔ ahrawa mu ntini a ɛreyɛ ayɛ mmerɛw no mu.
• The Cocaethylene Multiplier (Cocaine + Alcohol): Sɛ obi nom nsa bere a ɔde powder anaa crack cocaine redi dwuma a, onipa mmerɛbo no transesterify nnubɔne abien no ma ɛyɛ adwene mu aduru a ɛto so abiɛsa a ɛda nsow a wɔfrɛ no cocaethylene. Cocaethylene wɔ plasma fã nkwa nna ɛware sen cocaine nkutoo mmɔho 3 kosi 5 na ɛma asiane a ɛwɔ hɔ sɛ koma wu mpofirim no yɛ kɛse mpɛn 18- kosi 25.

2. Mmoa a edi kan a wɔde ma wɔ koko mu yaw a ɛkanyan obi ho (ne Ayaresabea Beta-Blocker Kɔkɔbɔ) .¶

1. Frɛ 911 / 112 / 999 ntɛm ara sɛ wowɔ koko mu yaw biara a ɛyɛ mmerɛw, emu yɛ duru, ɛyɛ hyew, anaa ɛyɛ nnam, ahome a ɛyɛ tiaa, fifiri a ɛyɛ nwini, anaa ɛyaw a ɛhyerɛn kɔ akyi, kɔn, anom, anaa abasa so.
2. Enforce Complete Physical Rest & Calm: Fa onipa no tra baabi a ɛyɛ fɛ a ɔde ne ho bɛto fam fã (45 degrees) a wɔde nkotodwe abɔ. Anamɔn biara a wɔnantew no ma catecholamines ne myocardial oxygen a wɔhwehwɛ no yɛ kɛse.
3. Ma Non-Enteric Chewable Aspirin 162 kosi 325 mg: Gye sɛ onipa no wɔ aspirin ho akisikuru ankasa anaasɛ ɔda sɛnkyerɛnne ahorow adi sɛ mogya tu/akisikuru anaa akyi yaw a ɛtetew (aortic dissection), ma ɔnwe na ɔnmene ɔpanyin biako aspirin 325 mg (anaasɛ nkokoaa aspirin abien kosi anan 81 mg) na ama mogya nkwammoaa a ɛtwetwe wɔ ahrawa no mu no agyae ntini mu ntini. (Hwɛ Komayare mmoa a edi kan.) .
4. Ka kyerɛ Paramedics ne ER Doctors Ntɛm ara Sɛ Wɔde Cocaine anaa Meth Di Dwuma:
   • Wɔ komayare a ɛnyɛ nnuru a wɔtaa de di dwuma mu no, nnuruyɛfo a wɔhwɛ ntɛmpɛ so taa de beta-blockers (te sɛ metoprolol anaa propranolol) fa ntini mu ma.
   • Wɔ cocaine anaa methamphetamine a wɔnom boro so a emu yɛ den mu no, wɔde beta-blocker a ɛho tew ma (beta-1 / beta-2 blockade) betumi ama "alpha-adrenergic stimulation a wɔsɔre tia," baabi a sɛ wosiw beta receptors no ano a, ɛma alpha receptors no bue kɛse, na ɛma coronary arteries no kyekyere koraa na mogya mmoroso kɔ soro ma owu.
   • Sɛ woka kyerɛ ER oduruyɛfo no nokware sɛ cocaine anaa meth wɔ hyɛn no mu a, wɔde benzodiazepines a wɔde fa ntini mu (lorazepam anaa diazepam) de ma central sympathetic drive, sublingual anaa IV nitroglycerin, ne calcium-channel blockers (diltiazem/verapamil) anaa phentolamine a wɔde yɛ adwuma.

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Ntɛmntɛm a Ɛde Nkwa To asiane mu 3: MDMA ("Molly" / "Ecstasy") Nsu a Wɔnom ne Nsu a Ɛma Nsu a Ɛma Wom¶

MDMA ( .3,4-methylenedioxymethamphetamine) kura hydration asiane soronko bi a akunkum mmerante a wɔba afahyɛ ne kurow no ase a wɔbɔɔ mmɔden sɛ "wɔbɛyɛ ade a ɛteɛ" denam nsu a ɛnyɛ den galɔn pii a wɔde chugging so.

+-------------------------------------------------------------------------+
|       THE MDMA ("MOLLY") HYDRATION RULE: ELECTROLYTES, NEVER GALLONS    |
|                                                                         |
|  WHY PLAIN WATER CAN KILL ON MDMA:                                      |
|  MDMA stimulates the brain to release huge amounts of Antidiuretic      |
|  Hormone (ADH / Vasopressin), causing SIADH: your kidneys are           |
|  chemically LOCKED and CANNOT produce urine to excrete excess water.    |
|                                                                         |
|  If a dancing or overheating MDMA user chugs 3 to 5 liters of plain     |
|  tap or bottled water in 2 hours, blood sodium (Na+) plummets below     |
|  120 mEq/L (Acute Dilutional Hyponatremia). Water rushes into brain     |
|  cells, causing fatal CEREBRAL EDEMA (brain swelling, vomiting,         |
|  seizures, brain herniation, and death), disproportionately affecting   |
|  young women due to estrogen's effect on the brain sodium pump.         |
|                                                                         |
|  SAFE MDMA FLUID RULE:                                                  |
|  1. Drink ONLY isotonic ELECTROLYTE solutions (sports drinks, ORS       |
|     packets, or salty broth), NEVER large volumes of plain water.       |
|  2. Limit intake to roughly 250 to 500 mL (1 to 2 cups) per hour        |
|     while dancing or sweating, and 250 mL/hour when resting.            |
|  3. If someone on MDMA starts vomiting, has a headache, seems confused, |
|     or has not urinated despite drinking, STOP ALL FLUIDS and call 911  |
|     for emergency hypertonic saline (3% NaCl) treatment.                |
+-------------------------------------------------------------------------+

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Ntɛmpɛ a Ɛde Nkwa To asiane mu 4: Akisikuru a Ɛkanyan, Mogya a Ɛtɔ wɔ Subarachnoid, ne Akisikuru¶

Efisɛ methamphetamine, cocaine, crack, ne cathinones a wɔayɛ no ma ntini mu mogya mmoroso kɔ soro mpofirim denneennen (200/120 to 260/150 mmHg) a ɛka amemene mu mogya ntini a ɛyɛ mmerɛw ne mogya nkwammoaa a ɛboaboa ano ho no, ischemic stroke a emu yɛ den ne mogya a ɛtɔ amemene mu (mogya a ɛba amemene mu anaasɛ amemene mu ntini a ɛpaapae) yɛ ɔhaw ahorow a ɛtaa ba esiane nnuru a ɛkanyan mogya a ɛtwetwe boro so nti, wɔ nnipa a wɔadi mfe aduonu ne aduasa mpo mu.

1. Amemene mu mogya anaa akisikuru a nnuru a ɛkanyan obi ma ohu ( .BE-FAST) .¶

Mmu tiyɛ a emu yɛ den, hintidua, anaa kasa a ɛyɛ mmerɛw bere a woretu mmirika a ɛkanyan adwene no ngu da sɛ "ɛkɔ soro ara kwa" anaasɛ nna a wontumi nna:

• The "Thunderclap" Headache (Ruptured Aneurysm / Subarachnoid Hemorrhage): Sɛ obi a ɔnom crack kɛkɛ, ɔnom cocaine, anaasɛ ɔde methamphetamine dii dwuma mpofirim na ɔde tiyɛ a ɛyɛ hu sen biara, a ɛpae sen biara wɔ n'asetra mu (ɛduru yaw a ɛsen biara wɔ sikɔne 60 mu), a ne kɔn a ɛyɛ den ka ho a, . ɔfe, hann a wɔte nka, anaasɛ ahwe ase, ɛbɛyɛ sɛ mogya ntini bi a ɛwɔ amemene no ase no apaapae wɔ catecholamine mogya mmoroso a emu yɛ den ase.
• ** BE-FAST Ntini mu Akisikuru Red Flags:
  • B (Balance): Kari pɛ a ɛyera mpofirim, adwenemhaw, anaasɛ ontumi nnantew tẽẽ.
  • E (Aniwa): Aniwa a ɛyɛ kusuu mpofirim, ɛyɛ mmɔho abien, anaasɛ ɛyera wɔ aniwa biako anaa abien no nyinaa mu.
  • F (Anim): Anim no fã biako kɔ fam anaasɛ ɛte sɛ nea ɛyɛ mmerɛw bere a wɔka kyerɛ no sɛ serew no.
  • A (Abasa): Basa anaa nan biako kɔ fam anaasɛ ɛte sɛ nea ɛyɛ mmerɛw/ɛyɛ mmerɛw bere a wɔatrɛw mu no.
  • S (Speech): Ɔkasa a ɛyɛ mmerɛw, nsɛmfua a wɔakyinkyim, anaasɛ wontumi nte kasamu a ɛnyɛ den ase.
  • T (Bere): Frɛ 911 / . 112 / . 999 ntɛm ara na MMFA aspirin mma sɛ onipa no ti ayɛ no yaw a ɛte sɛ aprannaa anaasɛ wosusuw sɛ mogya retu n’amemene mu (aspirin ma mogya a ɛba ne tirim no mu yɛ den).

2. Akisikuru a nnuru a ɛkanyan obi de ba a wobedi ho dwuma bere a woretwɛn nnuruyɛfo a wɔboa nkurɔfo no¶

Nnuru a ɛkanyan amemene no brɛ amemene no akisikuru no ase tẽẽ denam sodium-channel effects (cocaine), amemene mu ntini a ɛtwetwe, ɔhyew a ɛboro so, ne hyponatremia (MDMA) so. Nea ɛnte sɛ akisikuru a wɔtaa de di dwuma a n’ankasa gyae wɔ sikani 60 akyi no, akisikuru a nnuru de ba no taa kɔ so kɔ tebea a ɛkɔ so yɛ akisikuru gye sɛ wɔde benzodiazepines a wɔde fa ntini mu anaa ntini mu (midazolam, lorazepam, anaa diazepam) sa yare:

1. Popa fam na fa cushion ne ti: Ma onipa no nyɛ mmerɛw wɔ fam, fa jacket anaa pillow a wɔabobɔw hyɛ ne ti ase, na pia kɔfe pon, ɔhyew, ne ahwehwɛ nneɛma kɔ baabi a obiara ntumi nkɔ.
2. Fa Nsukyenee Packs To Neck, Armpits, ne Groin: Ɔyarefo a ɔkanyan no ma ne ntini mu hyew kɛse a ebetumi apia core temperature a ɛboro digrii Celsius 41 (digrii Fahrenheit 106) wɔ simma kakraa bi mu; fi ase ma kɔn ne abasa no yɛ nwini ntɛm ara bere a wɔrekyere no.
3. Mfa biribiara nhyɛ wɔn anom da na nkura wɔn nsa ne wɔn anan a ɛrewosow no mu da: Sɛ wɔhyɛ nkankyee, sika kotoku, anaa nsateaa wɔ sẽ a ayɛ den ntam a, ɛbubu sẽ na esiw mframa kwan no, na sɛ wɔde pintinn gu fam a ɛwosow no a, ɛpaapae nnompe na ɛma ntini a ɛpaapae no yɛ kɛse (rhabdomyolysis).
4. Roll into the Side-Lying Recovery Position the moment the jerking stops: Popa nnompe anaa ɔfe fi ano denam bobɔw a wobɛbobɔw wɔ wɔn benkum so a wobɛdan akɔ soro kakra sɛnea ɛbɛyɛ a wobetumi ahome ahofadi kosi sɛ nnuruyɛfo a wɔboa nkurɔfo bɛba.

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Harm-Reduction Pre-Use ne Mid-Binge Ahobammɔ: Overamping ne Fentanyl Awuduru a Wosiw Ano¶

Wɔ ankorankoro a wɔde nnuru a ɛkanyan obi di dwuma mprempren anaa abusua mufo a wɔboa obi a ɔwɔ asiane mu fam no, anammɔn a egyina adanse so a wɔde tew ɔhaw so no tew asiane a ɛwɔ hɔ sɛ wɔbɛnom boro so a edi awu no so kɛse:

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Anamɔn biara Harm-Reduction De-Escalation ma Overamping a Ɛnyɛ Nea Ɛho Hia¶

Sɛ woahwɛ biribiara a ɛwɔ triage table a ɛwɔ atifi hɔ no mu na woasi so dua sɛ onipa no nni koma mu yaw biara, onni atiridii/honam ani hyew, onni akisikuru, onni akisikuru ho sɛnkyerɛnne biara, na ɔhome a ɛfata a, ɔrenya adwene mu/autonomic overamp a ɛnyɛ den (a mpɛn pii no ɛkanyan denam nnuru a ɛkanyan adwene a wɔnom dodo kakra, nnuru a ɛkanyan adwene a wɔde fra caffeine, anaasɛ ɔdan ma 36 to nnɔnhwerew 72).

1. Nneɛma a atwa yɛn ho ahyia ne nipadua mu de-escalation nhwehwɛmu kratasin¶

1. Sesa Sensory Environment no Ntɛm ara:
   • Twe wo ho fi bass nnwom a ano yɛ den, adan a nnipa ahyɛ mu ma, akanea a ɛhyerɛn, anaa mmɔnten ntwea so a adwennwen wom ho kɔ mpa a ɛyɛ nwini na ɛhɔ yɛ dinn a kanea a ano yɛ den wom mu.
2. Cool the Vagus Nerve (A ɛnyɛ Shocking the Nipadua):
   • Fa ntama a ɛyɛ nwini na ɛyɛ nsuo gu wɔn moma so, wɔn ani, ne wɔn kɔn akyi, anaa ma wɔnguare nwini a ɛyɛ nwini-kɔ-nwini (awɔw a ɛnyɛ nwini da) bere a wɔte hɔ anaasɛ wɔhwɛ wɔn so no.
3. Nsuo a ɛwɔ Electrolytes ne Carbohydrates a ɛnyɛ den:
   • Nnuru a ɛkanyan obi a ɔnom boro so ma mogya mu glucose, sodium, potassium, ne magnesium so tew bere a ɛma ano yɛ kusuu kɛse ("cottonmouth") ne anom a ɛyɛ mmerɛw (bruxism).
   • Fa electrolyte anonne a ayɛ nwini, akutu nsu, nufusu, anaa nnuaba smoothie nketenkete a ɛyɛ pintinn ma, ne nnuan a ɛyɛ mmerɛw a ɛnyɛ den sɛ wobɛmene (banana, yogurt, apɔw-mu-teɛteɛ, anaa broth) ne chewing gum asinasin anaa ntama a ɛho tew a wɔde hohoro nneɛma no ntwea so na amma wɔanpaapae wɔn ntini mu esiane sɛ wɔn anom ntumi nkɔ mu nti.
4. Hyɛ Nkuran brɛoo ANAA Ahomegye (Biribiara a Ɛte Ahobammɔ Ma Wɔn):
   • Nnipa binom a wɔreyɛ overamping te nka sɛ wɔakyere wɔn sɛ wɔka kyerɛ wɔn sɛ wɔnda dinn koraa a; sɛ wo nantew brɛoo wɔ dan a ahobammɔ wom mu, wotrɛw wo ho, anaasɛ wotena hɔ gyina hɔ bere a woreyɛ adesua home brɛoo 4-second inhale / 6-second exhale breathing hyew ntini mu ahoɔden a ɛkanyan kosi sɛ nea ɛsen biara no bɛtwam.

2. Sɛnea wo ne obi a ɔwɔ adwenemhaw a ɛkanyan adwene anaasɛ nna a wontumi nna ho adwenemhaw bɛkasa¶

Bere a wɔde nnɔnhwerew 48 kosi 96 a wɔnna wɔ methamphetamine anaa crack cocaine so akyi no, wɔn a wɔde di dwuma no mu bɛyɛ ɔha biara mu nkyem 40 kosi 60 nya adwene mu yare a ɛba bere tiaa mu a nnuru a ɛkanyan obi de ba**: aso mu nsusuwii hunu (wɔte asɛm a ɛyɛ sereserew anaa polisifo radio wɔ abɔnten), aniwa so sunsuma-nnipa a wohu wɔn ho wɔ akyirikyiri, adwenemhaw a wɔde wɔn nsa ka ("meth mites" / formication under the skin), anaasɛ nea emu yɛ den paranoia sɛ nkurɔfo rehwɛ mfɛnsere mu.

• Mma wo ne wɔn nsusuwii hunu no nnye akyinnye anaasɛ nnni ho fɛw da, na mma wo ho nnyɛ wo ho sɛ wuhu nsusuwii hunu no nso da:
  • Wrong: "Woabɔ dam, obiara nni mfɛnsere no akyi, tena ase" (ɛkanyan abufuw na ɛma wogye di sɛ woyɛ plot no fã).
  • Wrong: "Oh yeah, mehu akwansrafoɔ no nso wɔ abɔnten" (ɛma wɔn ehu no yɛ kɛseɛ).
  • Right (Validate the emotion, ground in safety): "Metumi ahunu sɛdeɛ ɛno te nka seesei ara. Wo ne me wɔ ha wɔ dan yi mu, wɔato ɔpon no mu, na mɛtena ha yi ara na mahwɛ wo so berɛ a wote aseɛ na wonom nsuo nwini yi."
• Ma wo nsa nhu, gyina digrii 45 a anyɛ yiye koraa no mita 2 (anammɔn 6) wɔ akyirikyiri, na nsiw ɔpon a wɔde fi adi no da: Obi a ne ho yɛ hu a ɔte nka sɛ ɔde ne ho ahyɛ dan bi mu a obi a ɔresi ɔpon no mu no bɛbɔ hu na wabɔ bolt anaasɛ ɔbɛko. Ma wɔntra baabi a wobetumi ahu ɔpon no yiye.
• **Kwati sɛ wobɛma obi a ɔreyɛ overamping abɔnten so "Xanax" bar anaa opioid pill da sɛ ɔnkɔda; wɔde fentanyl, bromazolam, ne xylazine ahyɛ abɔnten so alprazolam nnua a ɛnyɛ nokware mu kɛse, na ɛdan aduru a ɛkanyan obi a wotumi tra ase a ɛboro so ma ɛbɛyɛ ɔhome a ɛyɛ hu bere a obiara da no.

(Sɛ wo anaa wo dɔfo bi repere wɔ methamphetamine, cocaine, crack, anaa nnuru a wɔkyerɛw ma obi a ɛkanyan obi ho a, hwɛ Nnubɔne a wɔde di dwuma ne nnubɔne a wɔde di dwuma: mmoa akwankyerɛ a egye ntɛmpɛ, . Nea ɛsan ba ne nea wɔde di dwuma boro so a wosiw ano: fentanyl/xylazine nhwehwɛmu nhama ne naloxone, na Abusua muni bi a ɔde ne ho ahyɛ mu a wɔbɛboa no. Susuw ho sɛ wobɛfa nsaano mmoa a edi kan ne CPR adesua a wɔagye atom afi Red Cross, St John Ambulance, anaa mpɔtam hɔ adwumayɛfo bi hɔ.)

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Nsɛm a wɔtaa bisa¶

Sources a wɔhwɛɛ mu¶

• Amerika Koma Fekuw (AHA, United States): Nyansahu mu Asɛm a Ɛfa Cocaine-Associated Chest Pain and Myocardial Infarction Ho Nhwehwɛmu (Coronary vasospasm pathophysiology, sodium-channel blockade, benzodiazepine ne nitroglycerin a edi kan a wɔde sa yare, ne beta-blockade a wɔmfa nsiw ano a wɔkwati).
• Nnuru a wɔde di dwuma ɔkwammɔne so ne adwenemyare ho adwumayɛbea (SAMHSA) & National Institute on Drug Abuse (NIDA / NIH, United States): Nnuru a wɔde di dwuma ɔkwammɔne so a wɔsa (TIP 33 / Clinical Guidance), sympathomimetic toxidrome triage, ne fentanyl a wɔde wɔn ho hyɛ nnuru a wɔde kanyan obi a mmara mma ho kwan mu.
• American College of Medical Toxicology (ACMT) ne American College of Emergency Physicians (ACEP): Ayaresa mu Dwumadie a ɛfa Sympathomimetic Toxicity a emu yɛ den, Excited Delirium / Severe Agitation, ne Drug-Induced Hyperthermia (Nnwini a ɛkɔ ntɛmntɛm/a ɛma nsuo yɛ hyew, kwati a wɔkwati sɛ obi bɛtumi ayɛ mmerɛw sɛ ɔbɛhome, ne rhabdomyolysis a wɔhwɛ so).
• National Harm Reduction Coalition (United States) & Drug Policy Alliance: Stimulant Overamping a wobehu na wɔayɛ ho mmuae (Nsonsonoe a wɔde bɛda adwene mu overamping ne aduruyɛ mu ntɛmpɛ ne de-escalation nneyɛe a ahobammɔ wom ntam).
• Europa Monitoring Center for Drugs and Drug Addiction (EMCDDA / EUDA) & UK National Poisons Information Service (TOXBASE): Ayaresa akwankyerɛ a ɛfa MDMA a ɛde ba Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH / acute dilutional hyponatremia) ne cocaethylene cardiotoxicity ho.

Akwankyerɛ ahorow a ɛfa ho¶

• Opioid a wɔnom boro so mmoa a edi kan
• Nea ɛsan ba ne nea wɔde di dwuma boro so a wosiw ano: fentanyl/xylazine nhwehwɛmu nhama ne naloxone
• Nnubɔne a wɔde di dwuma ne nnubɔne a wɔde di dwuma: mmoa akwankyerɛ a egye ntɛmpɛ
• Abusua muni bi a ɔde ne ho ahyɛ mu a wɔbɛboa no
• Komayare mmoa a edi kan
• Ɔhyew a ɛba vs. ɔhyew mu ɔbrɛ
• Asaabo mu opira a emu yɛ den, rhabdomyolysis, ne nsu a ɛyɛ sum mu mmɔdenbɔ triage
• Nnɔmba ahorow a egye ntɛmpɛ