Platypus Ankle Spur Envenomation ne Australia Funnel-Web Spider Atracotoxin Nhyɛso a Wɔde Siw Nkɔso Nhyɛso Nnuru¶

Australia yɛ awuduru abien a ɛyɛ soronko sen biara wɔ nnuruyɛ mu wɔ nnuruyɛ mu awuduru ho adesua mu, a ɛhwehwɛ mmara a ɛne aduru a wɔde kyekyere wɔn ho ansa na wɔakɔ ayaresabea no bɔ abira koraa: Australian Funnel-Web Spider (Genera Atrax ne Hadronyche, a ɛka Mouse Spider [Missulena]) ne onini **Platypus ** ho. (Ornithorhynchus anatinus, wiase no mu aboa a ɔnom nufusu a ne ho yɛ awuduru a ne ho yɛ hyew fã bi a ɔte nsu mu fã bi). Sydney Funnel-Web (Atrax robustus) anaa Northern Tree-Dwelling Funnel-Web (Hadronyche formidabilis) a ɛka obi no de delta-atracotoxins, peptide neurotoxins a ɛto nnipa voltage-gated sodium akwan a ɛbue mu na ɛkanyan fulminant, nkwa to asiane mu catecholamine ne cholinergic ahum wɔ mu Simma 10 kosi 60 (bere a ɛyɛ mmerɛw, tɛkrɛma a ɛyɛ mmerɛw, fifiri a ɛyɛ nwini ne nsu a ɛtɔ, mogya mmoroso a emu yɛ den, ahurututu mu ntini a ɛyɛ mmerɛw, ne koma a ɛhwe ase). Funnel-web ne mouse spider a wɔka no hwehwɛ sɛ wɔde Australian Pressure Immobilization Bandage (PIB) ka ho ntɛm ara a wɔde splint a ɛyɛ den ka ho, wɔbɛma ɔyarefo no ntumi nkɔ baabiara koraa, na wɔde CSL Funnel-Web Spider Antivenom bɛhyɛ mu ntɛm ara. Nea ɛne no bɔ abira no, sɛ mpataayifo bi a ɔrebue hama, kayaker, anaa wuram mmoa gyefo di platypus anini ho dwuma a, ɛde keratinous calcaneal (ankle) spurs abien a ɛyɛ tokuru a ɛwɔ n’akyi nan so te sɛ calipers no kɔ mu, na ɛde crural gland venom (a defensin-like peptides [vDLPs], C-type wom) gu mu natriuretic peptides [OvCNPs], ne ntini a ɛma ntini nyin). Platypus awuduru nkum nnipa da, enni anduru a ɛko tia awuduru, na ƐNSƐ sɛ wɔde Pressure Immobilization Bandage kyekyere DA; mmom no, ɛkanyan 10/10 hyperalgesia a ɛyɛ yaw, a ennyae ne nsa ne akwaa mu edema kɛse a agye dimmɔne sɛ ɛrentumi nnye morphine a wɔde fa ntini mu na ɛhwehwɛ ayaresabea mpɔtam ntini a esiw. Sɛ akɔre tuntum kɛse bi keka obi wɔ Australia anaasɛ platypus kanyan no a, frɛ wo mpɔtam hɔfo nɔma ahorow a egye ntɛmpɛ (000 wɔ Australia) ntɛm ara. Afei nso san hwɛ yɛn nuanom akwankyerɛ ahorow a ɛfa Okunafo Tuntum ne Redback vs Brown Recluse akɔre a wɔka wɔn, . ntontom ne akɔre a wɔka wɔn, na ɔwɔ ka obi.

Nea ɛsɛ sɛ woyɛ ntɛm ara ne sɛ wobɛhunu sɛ ebia wo ne Big Black Spider (Funnel-Web / Mouse Spider) anaa Platypus ankle spur** redi nkitaho: sɛ akɔre tuntum kɛseɛ biara a ɛbɛka no wɔ Australia apueeɛ anaa kesee fam a, ma nea wɔakum no no nyɛ dinn koraa, kyekyere broad elastic Pressure Immobilization Bandage (PIB) wɔ akuturuku no so na fa akwaa no nyinaa si fam-na-kɔ soro, splint akwaa no, na frɛ 000 ma Funnel-Web Spider Antivenom. Sɛ ɔbarima Platypus spur opira a, MMFA PIB nhyɛ mu, yi spurs no brɛoo, sling na ma nsa no ntumi nkɔ baabiara wɔ koma no mu, fa cool pack a wɔabɔ so (nsukyenee a ɛda hɔ da) gu so, na fa kɔ ayaresabea kɔhwehwɛ bupivacaine regional nerve block.

Yɛ eyi mprempren¶

1. Frɛ 000 ntɛm ara wɔ Australia (anaasɛ wo mpɔtam hɔ ntɛmpɛ nɔma fi yɛn wiase nyinaa nɔma ahorow a egye ntɛmpɛ directory). Ka kyerɛ ambulance dispatcher no ntɛm ara sɛ ebia akɔre tuntum kɛse bi (a wosusuw sɛ ɛyɛ Funnel-Web anaa Mouse Spider) na ɛkaa ɔyarefo no anaasɛ Platypus barima na ɛkanyan no. Sydney anaa dua mu Funnel-Web akɔre a ɔka no betumi ama mframa kwan a ɛde ne nkwa to asiane mu, ahurututu mu akisikuru, na ahwe ase wɔ simma 15 kosi 60 mu, titiriw wɔ mmofra mu.
2. SƐ ƐBƐYƐ AKWANKYERƐ AKWANKYERƐ KƐSE (Funnel-Web Atrax / Hadronyche anaa Mouse Spider Missulena): Fa Pressure Immobilization Bandage (PIB) ne splint gu so wɔ sikɔne 60 mu, na ma ɔyarefo no ntra hɔ koraa.
3. Fa aduru a ɛyɛ den a ne tɛtrɛtɛ yɛ sɛntimita 10 kosi 15** kyekyere baabi a wɔaka no denneennen wɔ baabi a woaka no yiye kan, afei fa mframa kɔ fam kɔ ​​nsateaa anaa nansoaa no so na fa mframa kɔ fam kosi asen anaa asen no mu nyinaa wɔ pintinn a wɔde di dwuma ma nansoaa a abubu (40 kosi 70 mmHg), na gyaw nsateaa anaa nansoaa no ano a wotumi hu sɛ wobɛhwɛ sɛ pink capillary san ahyɛ mu ma.
4. Fa aduru a ɛyɛ den (dua, nsɛmma nhoma a wɔabobɔw, anaa nkatanim) kyekyere ɔhonam akwaa a wɔabɔ no aduru no ho sɛnea ɛbɛyɛ a nkwaa no rentumi nkotow, na fa ambulance stretcher no bra ɔyarefo no nkyɛn (mma ɔyarefo no nnantew da, efisɛ ntini a wɔde pam no piapia delta-atracotoxin fi ntini a ɛwɔ mogya mu no mu kɔ mogya no mu).
5. MA MMARIMA PLATYPUS ANKLE SPUR INJURY: MFA Pressure Immobilization Bandage (PIB) anaa arterial tourniquet nhyɛ mu DA. Platypus crural awuduru yɛ adwuma wɔ mpɔtam hɔ wɔ nociceptive pain fibers ne capillary beds so ma ɛma akwaa a ɛho ahonhon kɛse, ɛyɛ den na microvascular leakage. Sɛ wɔde aduru a wɔde mia ade denneennen kyekyere nsa a wɔde platypus ayɛ ho a, ɛkyere awuduru peptide ahorow no wɔ mpɔtam hɔ, ɛma ɛyaw a ɛyɛ anifurae dedaw no mu yɛ den, na ɛde asiane ba sɛ ntini a ɛma mogya tu no sɛe.
6. Sɛ Platypus anini bi da so ara de n’akyi anantwi ntini abɔ nsa anaa nan bi so a, gyina aboa no nipadua mu duru so na trɛw n’akyi nan mu brɛoo na yi nhama a ɛkɔ mu no mu. Mma ntwe anaa ntetew wo nsa denneennen mfi platypus ho da aboa no de n’akyi nan kyekyere ne nsateaa anaa ne nsateaa ho na ɔde nhama abien a ɛkɔ akyiri a ne tenten yɛ sɛntimita 1.5 no kɔ mu te sɛ nsukyenee nhama, enti sɛ ɔtwe nusu a emu dɔ tetew ntini ne ntini ahorow mu.
7. Sɛ wopɛ Platypus spur kuru a: fa samina ne nsuo a ɛho tew hohoro ho brɛoo, yi nkaa, dɔn, ne nkapo nyinaa ntɛm ara, fa akwaa no home wɔ sling mu, na fa compress a ɛyɛ nwini anaa nsukyenee a wɔabɔ ho ban gu so (nsukyenee a ɛda hɔ kwa anaasɛ nsukyenee a ɛma awɔw ba da). Massive non-pitting swelling spreads from the hand up to the shoulder within 30 to Simma 90 na ɛbɛdan ring biara ayɛ no tourniquet a wɔde twa nsateaa.
8. Wɔ ayaresabea: bisa CSL Funnel-Web Spider Antivenom (ampoules 2 kosi 4 IV) ntɛm ara ANSA na woayi PIB no afi hɔ ama Funnel-Web a ɛka wo ho sɛnkyerɛnne biara; sɛ wopɛ Platypus spur a, bisa sɛ wɔmfa ultrasound kyerɛ no kwan ntɛm ara wɔ ɔmantam ntini a wɔde siw ano (0.5% bupivacaine/ropivacaine) efisɛ morphine ne opioids a wɔde fa ntini mu no ntumi nni platypus hyperalgesia so daa.

Gyinaesi dua: Australia Funnel-Web / Mouse Akɔre ne Ɔbarima Platypus ne Redback Akɔre a wɔpaw¶

flowchart TD
    A["Australiafo Awuduru a Wɔka anaa Spur Opira"] --> B{"Aboa bɛn na ɛde awuduru no bae?"}
    B -->|Large shiny black spider with massive downward fangs: Funnel-Web (Atrax / Hadronyche) or Mouse Spider (Missulena)| C["NEUROTOXIC EMERGENCY A ƐDE NKWA TO AHYƐDE: Ma boasetɔ no yɛ dinn koraa; frɛ 000 MPREMPREN"]
    B -->|Webbed semi-aquatic mammal in eastern Australian river/creek drove hind ankle spur into hand/leg| D["Platypus a ɔyɛ ɔbarima (Ornithorhynchus anatinus) a Ɛyɛ Nnua a Ɛma Nnua a Ɛyɛ Nnua"]
    B -->|Small black spider with red stripe on abdomen in dry shed/garden: Redback Spider (Latrodectus hasselti)| E["Latrodectism: MFA PIB nni dwuma; fa cool pack a wɔakyekyere no gu so; ayaresabea a wɔde nnuru a ɛma ɛyaw ano brɛ ase / Redback Antivenom"]
    C --> F["Fa Elastic Pressure Immobilization Bandage (PIB) gu nea wɔaka ne akwaa nyinaa so + Rigid Splint; MMFA hohoro baabi a wɔaka no"]
    F --> G["Ayaresabea ED Resuscitation Room: Ma PIB nkɔ so kosi sɛ IV access & CSL Funnel-Web Spider Antivenom (2 kosi 4 vials) bɛyɛ krado"]
    G --> H["Fa Antivenom + PEEP Ventilation ma ahurututu mu Edema + Atropine ma ahurututu mu yare + Nnuru a ekum mogya mmoroso"]
    D --> I["MFA PIB anaa tourniquet nhyɛ wo ho DA; yi spurs no brɛoo; yi ring/watches nyinaa fi hɔ ntɛm ara; fa samina ne nsu hohoro ho"]
    I --> J["Immobilize limb wɔ sling mu; fa compress a ɛyɛ nwini gu so; wɔde kɔ Ayaresabea ED ma 10/10 hyperalgesia a wontumi nsa"]
    J --> K["Ayaresabea Hwɛ: Ɔmantam Ntini a Wɔde Siw Ntini Mu (Wrist/Brachial Plexus Bupivacaine) + Nitrous Oxide/Ketamine + Kuru a wɔde gugu nnɔbae so & Nnuru a wɔde kum ɔyare mmoawa"]

Ti ne ti ntotoho: Funnel-Web Akɔre ne Mouse Akɔre ne Male Platypus Spur ne Redback Akɔre¶

Esiane sɛ Australia mmoa a edi kan akwankyerɛ (ANZCOR Akwankyerɛ 9.4.2 ne 9.4.8) hyɛ sɛ wɔmfa akwan a ɛne ne ho bɔ abira a wɔde kyekyere nneɛma ho a egyina aboa no so nti, nsonsonoe a ɛda nkyɛnkyɛn no ho hia kɛse:

Australia Funnel-Web (Atrax & Hadronyche) ne Mouse Spiders (Missulena): Nyarewa ho nimdeɛ ne PIB Mfiri¶

1. Nea enti a Sydney ne Tree-Dwelling Funnel-Webs yɛ aduruyɛ mu nsɛm a egye ntɛmpɛ¶

Australia funnel-web spiders ahorow 35+ (Family Atracidae, genera Atrax ne Hadronyche) te kwae a ɛyɛ nwini, gullies, suburban rockeries, ne swimming pool skimmers wɔ apuei fam mpoano fi Queensland anafo fam apuei kɔ New South Wales (a Sydney Funnel-Web, Atrax ka ho robustus, a wohu wɔ Sydney akyirikyiri kilomita 160) kosi Victoria, Tasmania, ne Flinders Mmepɔw a ɛwɔ South Australia. - Dɛn nti na awɔw bere/osutɔbere mu mmarima a wɔkyinkyin keka: Anadwo a ɛyɛ hyew na ɛyɛ nwini wɔ osu kɛse akyi (November kosi April) no, Sydney Funnel-Webs mmarima a wɔn ho akokwaw fi wɔn amena a wɔde sirikyi ayɛ mu no kɔkyinkyin hwehwɛ mmea, wɔtaa hyɛn fam mpa mu, mpaboa, ntadehoro akuwakuw, anaasɛ wɔhwe ase wɔ akyi asuguarebea ahorow mu (baabi a wobetumi akyere mframa a ɛyɛ kurukuruwa bi a ɛwɔ wɔn yafunu mu nhwi mu na wɔtra ase bere a wɔde wɔn ho ahyɛ ɔtare no fam nnɔnhwerew 24 kosi 36, na ɛka obiara a ɔbɛfa wɔn a osusuw sɛ wɔamene wɔn).Awuduru a ɛyɛ ɔbarima Atrax robustus no yɛ awuduru ma primates mmɔho 5 kosi 6 sen mmea awuduru efisɛ onini nkutoo na ɛma **delta-atracotoxin-Ar1 dɔɔso (robustoxin) a wɔde di dwuma. Nea tumi wom kɛse mpo ne Northern and Southern Tree-Dwelling Funnel-Webs (Hadronyche formidabilis ne Hadronyche cerberea) a ɛwɔ NSW ne Queensland, a ɛde awuduru a emu yɛ den ba wɔ bɛboro ɔha biara mu nkyem 50 a wɔka no mu. - Paraxial Fang Mechanics: Nea ɛnte sɛ nnɛyi Araneomorph akɔre (te sɛ akunafo anaa orb-weavers) a wɔn sẽ twitwiw wɔn ho wɔ nkyɛnkyɛn te sɛ tweezers (diaxial), Mygalomorph akɔre (Atrax, Hadronyche, Missulena, ne tarantulas) wɔ massive paraxial fangs a ɛkyerɛ fam tẽẽ parallel to each other te sɛ twin pickaxes. Sɛ akɔre a ne tenten yɛ milimita 5 yi atumi akɔ mu a, funnel-web akɔre ma n’akyi nan so kɔ soro na ɔbɔ fam mpɛn pii, na mpɛn pii no ɔde ne ho hyɛ mu ma enti ɛsɛ sɛ wɔbɔ no anaasɛ wɔbɔ no brush.

2. Delta-Atracotoxin ahum a ɛde ne ho a ɛwɔ afã abien no¶

Sɛ delta-atracotoxin hyɛn mogya a ɛkɔ nipadua no mu no mu pɛ a, sɛnkyerɛnne ahorow no pae wɔ simma 10 kosi 30 mu wɔ mmofra mu (wɔ abakɔsɛm mu no, edi awu wɔ simma 15 pɛ mu wɔ abofra ketewa mu ansa na wɔakum antivenom) ne simma 15 kosi 90 wɔ mpanyimfo mu:

1. Ɔfa 1: Hyperacute Excitation Storm (Simma 10 kosi Nnɔnhwerew 4):
2. Nneuromuscular signs: Goosebumps (piloerection) ne mpɔtam hɔ ntini a ɛtwetwe wɔ baabi a wɔaka no no kɔ so ntɛmntɛm kɔ a ɛyɛ mmerɛw na ɛyɛ mmerɛw wɔ ano ne anofafa no ho (perioral paresthesia), tɛkrɛma a ɛtwetwe te sɛ nwansena a wotumi hu (lingual fasciculations), anim ntini a ɛyɛ mmerɛw, trismus (anom a ɛyɛ den), ne generalized nnompe mu ntini a ɛyɛ mmerɛw.
3. Cholinergic (Parasympathetic) Outpouring: Acetylcholine a ɛba kɛse no kanyan ropy nnompe pii (sialorrhea), tetew (nusu), fifiri a ɛyɛ nwini (diaphoresis), ahurututu mu nsu a ɛtwetwe pii, akisikuru, ɔfe, ne yafunu mu akisikuru.
4. Adrenergic (Sympathetic) Crisis ne Pulmonary Edema: Norepinephrine ne epinephrine a wɔayi no adi kɛse bere koro mu no de tachycardia a ɛtra so, malignant arterial hypertension (a ɛtaa boro 200/120 mmHg), asiane a ɛwɔ mogya a ɛbɛtɔ wɔ atiridii mu, ne fulminant acute pulmonary ba edema (neurogenic capillary leak ne acute left ventricular afterload failure a wɔaka abom), a ɛde nsu a ɛyɛ pink a ɛyɛ frothy hyɛ mframa kwan no ma na ɛde hypoxia ne coma a emu yɛ den ba.
5. Ɔfã 2: Catecholamine a Ɛyera Akyirikyiri ne Koma ne Ntini a Ɛhwe ase (Nnɔnhwerew 4 kosi 24):
6. Sɛ ɔyarefo no nya nkwa wɔ Phase 1 a enni antivenom a, presynaptic nerve terminals no sa wɔn catecholamines a wɔakora so no bere a acidosis ne myocardial stunning bɛhyɛ mu no Ɔyarefo no dan mpofirim fi mogya mmoroso a emu yɛ den mu kɔ profound, refractory hypotension, bradycardia, multi-organ failure, ne cardiac arrest.

================================================================================
   AUSTRALIAN PRESSURE IMMOBILIZATION BANDAGE (PIB) TECHNIQUE (ANZCOR 9.4.2)
   [Use ONLY for Funnel-Web / Mouse Spiders, Snakes, Cone Snails, Blue-Ringed Octopus]
   [NEVER use for Platypus Spur, Redback Spider, Stonefish, or Stingray]
================================================================================

  STEP 1: Broad Pressure over Bite       STEP 2: Wrap Whole Limb + Splint
  --------------------------------       ---------------------------------------
       |     |                                | \ / | <-- Wrap ALL the way up to
       |=====| <-- Wrap 10-15 cm wide         | / \ |     armpit or groin at
       |=====|     elastic bandage            | \ / |     40-70 mmHg (firm ankle
       |=====|     over bite site             | / \ |     sprain tension).
       |  *  |     first (DO NOT              | \ / |
       |     |     wash bite).           [SPLINT]==== <-- Bind rigid splint so
      /       \                               /     \     joints CANNOT bend;
     ( Fingers )                             ( Toes  )    keep patient STILL.
================================================================================

3. Ayaresabea a wɔde san nya nkwa ne CSL Funnel-Web Spider Antivenom protocol¶

1. Fa PIB no sie Kosi sɛ Wɔbɛma Nkateɛ:
2. Sɛ ɔyarefo no du baabi a wɔhwɛ ntɛmpɛ so a PIB wɔ hɔ a, MMFA aduru a wɔde kyekyere aduru no ho wɔ triage mu. Sɛ delta-atracotoxin bolus kɛse bi kyere akwaa ntini no mu a, sɛ wogyae aduru a wɔde kyekyere no ntɛm a, ɛma ahurututu mu akisikuru ne mogya mmoroso ho haw a ɛkɔ soro ntɛm ara a ɛyɛ hu ba wɔ simma 5 mu.
3. Fa IV nhama abien a ɛwɔ abura akɛse si hɔ, fa ECG/BP/SpO2 a wɔhwɛ so daa bata ho, siesie mfiri a wɔde hyɛ mframa kwan mu, na ma CSL Funnel-Web Spider Antivenom ampoules 2 ntwe nkɔ mpa no nkyɛn ansa na woayi PIB no afi hɔ.
4. CSL Funnel-Web Spider Nnuru a Wɔde Ko Tia Nnuru a Wɔde Di Dwuma:
5. Wɔde hyperimmune kraman IgG a wɔatew ho a wɔtetee no tia Atrax robustus awuduru a ɛyɛ anini (etu mpɔn kɛse wɔ Atrax, Hadronyche, ne Missulena ahorow nyinaa so, a akisikuru a ɛba fam koraa sɛ wɔde toto apɔnkɔ mu nnuru a ekum ɔyare mmoawa ho na ɛyɛe).
6. Dosing: Sɛ wopɛ sɛnkyerɛnne biara a ɛkyerɛ sɛ systemic envenomation (perioral tingling, tɛkrɛma fasciculations, fifiri, nnompe, mogya mmoroso, basabasayɛ), fa 2 ampoules (250 units) diluted wɔ 100 mL normal saline IV mu simma 15 kosi 20. Sɛ awuduru a emu yɛ den (ahurututu mu edema, coma, mogya mmoroso a emu yɛ den) a, fi ase de ampoules 4 IV ntɛm ara na san yɛ ampoules 2 simma 15 biara kosi sɛ autonomic ne neuromuscular sɛnkyerɛnne nyinaa besiesie.
7. Critical Care Airway ne Hemodynamic Mmoa:
8. Fa oxygen a ɛsen kɛse, CPAP, anaa endotracheal intubation a Positive End-Expiratory Pressure a ɛkorɔn (PEEP, 10 kosi 15 cmH2O) ma ahurututu mu edema.
9. Fa IV atropine (0.6 kosi 1.2 mg IV; 0.02 mg/kg wɔ mmofra mu) ma cholinergic ahurututu mu nsu a ɛremene ne nnompe a ɛtwetwe no nwo.
10. Fa ntini a ɛtrɛw a ɛyɛ adwuma tiawa, a wotumi yɛ no titratable (te sɛ sodium nitroprusside anaa phentolamine) sa Ɔfã 1 mogya mmoroso a ɛde nkwa to asiane mu, na MMFA beta-blockers a ɛyɛ adwuma bere tenten mma DA, a ɛde alpha-vasoconstriction a obiara nsɔre tia ba ntɛm na ɛma koma ne ntini a ɛhwe ase a edi awu ntɛmntɛm bere a ɔyarefo no dan kɔ Ɔfã 2 no mogya mmoroso a ɛba fam.

Platypus a ɔyɛ ɔbarima (Ornithorhynchus anatinus) Ankle Spur Envenomation: Nyarewa a Ɛma Nnipa Ntini ne Ntini a Wɔde Siw Ntini Mu Hwɛ¶

1. Anatomy of the crural venom system ne bere mu awo tumi¶

platypus (Ornithorhynchus anatinus), a ɛwɔ nsubɔnten a ɛwɔ nsu pa mu, billabongs, ne nsubɔnten mu fi Queensland kɔ fam fa New South Wales, Victoria, ne Tasmania no yɛ mmoa a wɔnom nufusu a awuduru wom kakraa bi pɛ wɔ Asase so no mu biako. - Hena na ɔwɔ awuduru no: Wɔwo platypus mma mmarima ne mmea nyinaa a wɔwɔ akyi-ankle nkorabata a ɛyɛ mfitiasede, nanso ɔbea no nkorabata no san n’akyi wɔ n’asetra afe a edi kan no mu. Platypus anini a wanyin nkutoo na ɛkura keratinous calcaneal (ankle) spurs a ɛyɛ nnam, ɛyɛ kurukuruwa, tokuru (a ne tenten bɛyɛ milimita 12 kosi 15 [nsateakwaa 0.5 kosi 0.6]) a wɔde asisi tarsal nnompe a ɛboa a wotumi tu so wɔ akyi nan biara mu. - Crural Gland Seasonal Hypertrophy: Spur biara a ɛwɔ tokuru no nam ntini a ɛwɔ ɔfasuo a ɛyɛ den so na ɛka crural venom gland a ɛte sɛ asaabo a ɛwɔ asen atifi no so. Esiane sɛ platypuses anini yɛɛ wɔn awuduru ntini titiriw maa ɔbarima ne ɔbarima nsasesin mu akodi wɔ ahohuru bere mu awo bere mu (August kosi October wɔ Australia) nti, crural ntini no trɛw kɛse na ɛma awuduru dodow a ɛsen biara (ɛkɔ mililita 4 wɔ ɔhwe biara mu) fi adi wɔ awɔw bere awiei ne ahohuru bere mu. - Sɛnea nnipa nya nkannyan: Ɛkame ayɛ sɛ nnipa awuduru nyinaa ba bere a ɔpofoni bi a ɔwɔ adwempa bɔ mmɔden sɛ obeyi platypus a akyeakyea wɔ mpataayi afiri anaa yabby afiri a mmara mma ho kwan mu no hama, anaasɛ bere a wuram mmoa ho dwumayɛni bi de aboa no si n’ase. Platypus anini no kyekyere n’akyi nan abien no nyinaa twa nea wɔayɛ no bɔne no nsa, ne nsateaa, anaa n’asen ho na ɔde ankle spurs abien no nyinaa kɔ mu te sɛ calipers, na ɛbata ho denneennen na ɔde crural awuduru kɔ honam ani ne ntini a emu dɔ no mu mpɛn pii.

2. Nea enti a Platypus awuduru ma ɛyɛ yaw kɛse a ɛko tia morphine na ɛma ntini no sɛe asram pii¶

Nea ɛnte sɛ ɔwɔ anaa funnel-web spider awuduru a ɛdanee sɛ ɛbɛkum mmoa a wɔkyere wɔn we ntɛmntɛm denam ɔhome mu obubuafo anaasɛ coagulopathy so no, platypus awuduru a ɛyɛ anini no danee ma de ɛyaw a ɛma anifurae, a ɛmma wontumi nyɛ hwee ba mmarima a wɔne wɔn ho di asi so: 1. Peptide Cocktail soronko: Proteomic ne genomic nhwehwɛmu a wɔyɛe wɔ Ornithorhynchus crural awuduru ho no huu anyɛ yiye koraa no awuduru nkyerɛwee ahorow 83 a ɛsono emu biara wɔ protein mmusua 13 mu, a ornithorhynchus awuduru anan defensin-te sɛ peptides (vDLPs), ovCNPs (C-type natriuretic peptides), na ɛdi mu. ntini nyin factor (NGF), hyaluronidase, kallikrein-like serine proteases, ne L-to-D-peptide isomerase (a ɛdannan L-amino acid bi a ɛwɔ vDLPs ne natriuretic peptides N-awiei ma ɛbɛyɛ D-amino acid, na ɛma awuduru no tumi gyina nnipa proteases a ɛpaapae so ma ɛkɔ so yɛ adwuma wɔ kuru no mu nna kosi adapɛn pii). 2. Direct Nociceptor Activation and Morphine Resistance: Platypus awuduru peptides bue cation akwan tẽẽ wɔ onipa akyi ntini ganglion (DRG) C-fiber ne A-delta nociceptors, kanyan mpɔtam hɔ histamine ne bradykinin a wɔayi no adi kɛse, na ɛma ntini nyin factor sɛnkyerɛnne kɔ soro. Esiane sɛ saa nociceptive tuo yi twa standard mu-opioid receptor modulation ho hyia nti, clinical case series bɔ amanneɛ bere nyinaa sɛ morphine, pethidine (meperidine), anaa fentanyl a wɔde fa ntini mu dodow a ɛkɔ soro mpo mma ahotɔ a ɛnnɔɔso, na ɛma ɔyarefo no twitwiw ne ho wɔ yaw 10/10 mu bere a opioid de ma ɔhome mu adwenemhaw ne ɔfe. 3. Ayaresa Adesua (Acute Hyperalgesia, Allodynia, Edema, ne Bere Tenten Atrophy): - Simma 0 kosi 60: Ɛyaw a ɛyɛ hyew ntɛm ara wɔ spur punctures abien no so no hyerɛn kɔ abasa no nyinaa so kɔ axilla ne koko fasu no so. Edema a ɛyɛ den, ɛyɛ frɔmfrɔm, a ɛnyɛ pittting no ma nsateaa, nsa, ne anim abasa no hohoro ma ɛkame ayɛ sɛ ne kɛse mmɔho abien wɔ dɔnhwerew biako mu. - Nna 1 kosi 14: Profound mechanical and thermal allodynia (mframa a ɛyɛ hare anaa ntama a ɛka honam ani mpo kanyan ɛyaw a emu yɛ den) ne nsateaa a ɛbɔ/trɛw a ɛyera wɔ dwumadi mu. - Adapɛn 2 kosi Asram 3: Bere a central neurotoxicity anaa coagulopathy biara nni hɔ no, ayarefo taa nya hyperesthesia a ɛkɔ so tra hɔ, ɛyaw a ɛyɛ yaw, ne nnompe mu ntini a ɛbɔ wɔ mpɔtam hɔ a wɔsɛe no (atrophy) wɔ nsa ne anim ntini a ɛwɔ nipadua no mu (a awuduru myotoxic/proteolytic components ne nea wɔmfa nni dwuma na ɛyɛ ntamgyinafo) a ɛhwehwɛ asram pii of nsa physiotherapy na ama ne ho atɔ no.

3. Mmoa a edi kan a wɔde ma anammɔn anammɔn ne ayaresabea nhyehyɛe a wɔde ma wɔ Platypus awuduru ho¶

1. Field First Aid (Nea Ɛsɛ sɛ Woyɛ ne Nea Ɛnsɛ sɛ Woyɛ DA):
2. Tue nhama no dwoodwoo: Boa platypus no sɛnea ɛbɛyɛ a ɛrensensɛn wo nsateaa so, na trɛw n’akyi nan mu brɛoo kɔ abɔnten na ama ntini a ɛkɔ mu no agyae a worentetew wo honam mu.
3. MMFA Pressure Immobilization Bandage (PIB) anaa tourniquet nhyɛ mu DA: ANZCOR Akwankyerɛ 9.4.8 bara PIB pefee mma platypus spurs ɛfiri sɛ sɛ wɔkyere D-amino-acid-stabilized vDLPs ne proteases wɔ nsa mu a, ɛma hyperalgesia ne swelling mu yɛ den.
4. Hohoro na De-ring Ntɛm ara: Fa samina ne nsuo a ɛho tew hohoro spur punctures no, yi rings, watches, ne bracelets nyinaa wɔ simma 2 a edi kan no mu ansa na swelling no abɔ so, fa abasa no home wɔ supportive sling mu, na fa cool compress anaa ice pack a wɔde mpopaho abɔ mu (never bare ice) gu so.
5. Ayaresabea mu Ɛyaw (Ɔmantam Ntini a Wɔde Siw Ntini Sikakɔkɔɔ Gyinapɛn):
6. Sɛ wodu dwumadibea a wɔhwɛ ntɛmpɛ so a, fa Nitrous Oxide / Oxygen (Entonox) a wɔhome 50:50 anaa sub-dissociative IV Ketamine (0.1 kosi 0.3 mg/kg IV) + a wɔahyɛ no titrated IV fentanyl ma ntɛm ara sɛ bridge.
7. Yɛ Regional Nerve Block Ntɛm ara: Ayaresa biako pɛ a etu mpɔn sen biara a eyi platypus spur ɛyaw fi hɔ koraa wɔ simma 5 kosi 10 mu ne ultrasound-guided regional nerve block a ɛbɛn edematous zone (te sɛ axillary, infraclavicular, anaa supraclavicular brachial plexus block, anaasɛ wɔaka abom median, ulnar, ne radial forearm nerve blocks) a wɔde 0.5% bupivacaine a ɛyɛ adwuma bere tenten anaa 0.5% kosi 0.75% ropivacaine (a wɔtaa de si hɔ sɛ continuous perineural nerve block catheter nnɔnhwerew 48 kosi 72 a wɔde ma wɔ ayaresabea).
8. Akuru mu Nhwehwɛmu, Radiographs, ne Antibiotic Prophylaxis:
9. Sɛ akwaa no yɛ mmerɛw koraa fi ɔmantam ntini a wɔde siw ano no mu wie a, nya radiographs a ɛnyɛ den (X-rays) de yi keratin spur tips anaa periosteal chips a wɔakora so no afi hɔ, na fa sterile normal saline gugu brɛoo gugu puncture tracks a emu dɔ no so (nnyɛ n suture punctures no a wɔato mu).
10. Fa tetanus tebea (Tdap/Td) yɛ foforo na fa nnuru a ɛko tia ɔyare mmoawa a ɛtrɛw a ɛkata nsu pa Aeromonas hydrophila ne honam ani afifide (te sɛ ciprofloxacin 500 mg PO mprenu da biara a wɔde amoxicillin-clavulanate anaa flucloxacillin/clindamycin ka ho ma nnafua 5 kosi 7), na fa nsa ho ntɛm adwumayɛ mu ayaresa bere a edema a emu yɛ den no ano brɛ ase na amma nsa ntini a ɛwɔ nipadua no mu asɛe daa ne nkwaa a ɛyɛ den no ano.

Mpɔtam hɔ ntɛmpɛ nɔma ne adwumakuw no nhyehyɛe ahorow¶

• Australia (New South Wales, Queensland, Victoria, Tasmania, Australia Kesee Fam, ACT): Ɔde ne nsa kyerɛɛ ne so, na ɔde ne nsa kyerɛɛ ne so bio.
• Frɛ 000 ntɛm ara sɛ akɔre tuntum kɛse biara aka anaasɛ platypus awuduru a emu yɛ den (anaasɛ 112 fi telefon a wokura kyin a ɛwɔ nsɛnkyerɛnne a ɛyɛ mmerɛw so).
• Di Australian Poisons Information Center ho nkɔmmɔ wɔ 13 11 26 ( nnɔnhwerew 24 da biara wɔ Australia nyinaa) na fa oduruyɛfo a ɔresa yare a egye ntɛmpɛ no ne awuduru ho ɔbenfo a ɔwɔ ayaresabea no nni nkitaho tẽẽ ma CSL Funnel-Web Spider Antivenom dosing anaa platypus regional analgesia protocols.
• Di ANZCOR Akwankyerɛ 9.4.2 (Awuduru: Akɔre a Wɔka) ma Funnel-Web ne Mouse Akɔre (PIB + splint) ne ANZCOR Akwankyerɛ 9.4.8 (Awuduru: Nhyɛso a Wɔde Simma Nkɔ) akyi de kyerɛ sɛ wɔkasa tia PIB denneennen wɔ Platypus ne Redback awuduru mu.
• New Zealand: Frɛ 111 ma ntɛmpɛ na frɛ New Zealand Ɔman Awuduru Asoɛe wɔ 0800 764 766.
• United Kingdom, European Union, United States, ne Canada (Zoological & Exotic Collections): Frɛ 999 (UK), 112 (EU), anaa 911 (US/Canada), na di nkitaho ne US Poison Control wɔ 1-800-222-1222 anaa UK NPIS (TOXBASE). Ɛsɛ sɛ mmoa yɛmmea, nhwehwɛmu dan, anaa amanne kwan so nhwehwɛmubea biara a ɛkura Australia Atrax / Hadronyche funnel-web spiders hwɛ CSL Funnel-Web Spider Antivenom a ne bere nwiei so wɔ beaeɛ hɔ anaa wɔ mpɔtam hɔ ayaresabea a wɔakyerɛ sɛ wɔmfa wɔn ho nhyɛ mu na wɔtete adwumayɛfoɔ wɔ Pressure Immobilization Bandaging ntɛm ara.

Nsɛm a wɔtaa bisa¶

Dɛn nti na wokyekyere Pressure Immobilization Bandage a ɛyɛ den wɔ Funnel-Web akɔre a wɔaka no so, nanso MMFA Platypus spur anaa Redback akɔre a wɔaka no so DA?¶

Sydney anaa Tree-Dwelling Funnel-Web akɔre de delta-atracotoxin, neurotoxin a edi awu ntɛmntɛm a ɛfa ntini a ɛma mogya tu no mu kɔ mogya mu na ɛma ahurututu mu akisikuru a ɛde nkwa to asiane mu ba na ɛma koma no gyaee wɔ simma 15 kosi 60 mu, bere a ɛkame ayɛ sɛ ɛnsɛe mpɔtam hɔ ntini biara. Sɛ wɔkyekyere Pressure Immobilization Bandage (PIB) a ɛyɛ den na wɔde hama bɔ akwaa no mu a, ɛma ntini a ɛsen no gyae na ɛkyere neurotoxin no dwoodwoo wɔ akwaa no mu kosi sɛ wɔde CSL Funnel-Web Antivenom bɛma wɔ ayaresabea. Nea ɛne eyi bɔ abira no, Platypus awuduru a ɛyɛ anini ne Redback akɔre awuduru yɛ adwuma wɔ mpɔtam hɔ ma ɛyaw a emu yɛ den ne ntini a ɛho ahonhon (a ntini mu awuduru a edi awu ntɛmntɛm nni mu); PIB a ɛyɛ den a wɔde kyekyere Platypus spur so no kyere ɛyaw peptide ahorow a ɛwɔ nsa no mu na ɛma ɛyaw ne ɔfe a ɛyɛ yaw no yɛ kɛse koraa.

Mɛyɛ dɛn ahu sɛ ebia akɔre tuntum bi a ɔwɔ Australia hia Pressure Immobilization Bandage?¶

Australia mmoa a edi kan ho akwankyerɛ (ANZCOR Akwankyerɛ 9.4.2) de mmara a ɛnyɛ den a egye nkwa a wɔfrɛ no "Big Black Spider" di dwuma: sɛ obiara a ɔwɔ Australia (titiriw wɔ apuei anaa anafo mpoano ne mmepɔw so) no, akɔre tuntum a ne kɛse yɛ mfinimfini kosi kɛse, a ne tenten boro sɛntimita 1.5 (a ne tenten bɛboro sɛntimita 1.5) ka no a, fa no di dwuma ntɛm ara sɛ obi a obetumi adi awu Funnel-Web anaa Mouse Spider denam Pressure Immobilization Bandage ne rigid splint a wode bɛhyɛ mu na woafrɛ 000. Ɛho nhia sɛ wobɛkyerɛ Funnel-Web bi sɛ ɛda nsow wɔ Mouse Spider anaa Trapdoor Spider a ɛwɔ afuw mu no ho, efisɛ PIB a wode bɛhyɛ mu no yɛ ahobammɔ koraa ma wɔn nyinaa na sɛ ɛyɛ Funnel-Web a, egye nkwa.

So Funnel-Web akɔre betumi atra ase ankasa wɔ akyi asuguarebea bi ase na waka wo?¶

Aane. Wɔ ahohuru bere ne osutɔbere anadwo a ɛhɔ yɛ hyew na osu tɔ kɛse mu no, Funnel-Web akɔre anini a wɔkyinkyin taa hwe ase wɔ akyi atare mu. Esiane sɛ nhwi a ɛyɛ den a ɛmma nsu ntumi nkɔ wɔn yafunu so a ɛkyere mframa a ɛyɛ sini bi twa wɔn home mu mpaapaemu (nhoma mu ahurututu) ho hyia nti, Funnel-Web akɔre betumi atra ase bere a ɔde ne ho ahyɛ ɔtare a chlorine wom ase nnɔnhwerew 24 kosi 36. Mfa nsa da hɔ mfa akɔre tuntum "a wɔamene no" mfi ɔtare fam anaa skimmer adaka mu da; fa asau anaa nhama a ne nsa tenten di dwuma bere nyinaa.

So platypus anini ne mmea nyinaa wɔ ntini a awuduru wom?¶

Dabi, platypus onini a wanyin nkutoo na awuduru wom. Wɔwo platypus nkokoaa anini ne mmea nyinaa a wɔwɔ ankle spur nkorabata nketenkete, nanso ɔbea no ntini no hwe ase ansa na wadi afe biako. Onini nkutoo na onya keratin ntini a ɛyɛ tokuru a ne tenten yɛ sɛntimita 1.5 wɔ akyi nansoaa abien no nyinaa mu a ɛne asen mu awuduru ntini (crural glands) wɔ abusuabɔ, a ɛhohoro na ɛde awuduru a ɛsen biara ba wɔ ahohuru bere mu awo bere (August kosi October) mu ma mmarima a wɔne wɔn di asi no ko.

Dɛn nti na morphine a wɔde fa ntini mu no ntumi nsiw ɛyaw a ɛwɔ platypus a ɛyɛ ɔbarima a ne nansoaa mu ntini mu no ano?¶

Platypus awuduru a ɛyɛ mmarima no kura peptide ahorow a ɛte sɛ defensin (a D-amino acid isomerase na ɛma ɛyɛ den sɛnea ɛbɛyɛ a nnipa enzymes ntumi nsɛe no), natriuretic peptides, ne ntini a ɛma ntini nyin a ɛtow ɛyaw ntini a ɛwɔ nsa no mu (nociceptors) no tẽẽ na ɛma wɔte nka wɔ akwan horow a mu-opioid agyefo no nnya so nkɛntɛnso no mu. Ayaresabea amanneɛbɔ kyerɛ sɛ morphine a wɔde fa ntini mu dodow a ɛkɔ soro mpo ntumi nsiw ɛyaw a ɛyɛ hyew 10/10 ne sɛnea obi te nka kɛse (allodynia) no ano. Mmom no, nnuruyɛfo yɛ regional nerve block (wɔde bupivacaine gu nsateaa anaa brachial plexus ntini ho) de siw anyinam ahoɔden ɛyaw nsɛnkyerɛnne no kwan wɔ nipadua mu sɛ ɛnkɔ soro abasa no nkɔ amemene no mu.

So awuduru bi wɔ hɔ a wɔde ko tia platypus spur sting?¶

Dabi, nnuru a ekum awuduru biara nni hɔ a wɔde ko tia platypus awuduru, na wɔankyerɛw nnipa biara a wowuwu fi platypus spur mu da. Ayaresabea ayaresa twe adwene si ɔmantam no mu ntini a wɔde siw ano a wɔde kum nipadua no ntɛm ara (mpɛn pii no wɔde catheter a ɛkɔ so nna pii), nitrous oxide anaa ketamine a wɔmfa nni dwuma pii, kuru a wɔde gugu so nsu, tetanus ne nnuru a ekum ɔyare mmoawa a wɔde siw ano, ne nsa a wɔde sa apɔw-mu-teɛteɛ a wɔde sa ntini a ɛho ahonhon ne bere tiaa mu ntini a wɔsɛe no a ebetumi akɔ so adapɛn kosi asram pii no so.

Fibea ne aban akwankyerɛ¶

• Australia Resuscitation Council (ANZCOR, Australia ne New Zealand): ANZCOR Akwankyerɛ 9.4.2 (Awuduru: Akɔre a Wɔka) ne ANZCOR Akwankyerɛ 9.4.8 (Awuduru: Nhyɛsoɔ a Wɔde Simma Nkɛntɛnso).
• Ayaresa Akwankyerɛ: Awudisɛm ne Awudisɛm (eTG Complete, Australia) & AVRU: Funnel-Web Spider (Atrax / Hadronyche) awuduru, CSL Funnel-Web Antivenom, Mouse Spider Triage, ne Platypus Envenomation a wɔhwɛ so.
• Australia Aduruyɛ Nsɛmma Nhoma (MJA): Funnel-Web Spider Envenomation (Isbister ne afoforo, MJA) ne Platypus Awuduru: Ɔmantam Ntini a Wɔde Siw Ano Ho Dwumadi (Fenner, Williamson, & Myers, MJA).
• Seqirus / CSL Behring (Australia): Aguadi ho nsɛm a ɛfa Funnel-Web Spider Antivenom (Krabi IgG a wɔatew ho) ho.
• Abɔde & Genome Nhwehwɛmu: Peptides a ɛte sɛ Defensin ne L-to-D Peptide Isomerase a ɛwɔ Platypus (Ornithorhynchus anatinus) Venom mu (Whittington ne afoforo; Torres ne afoforo).

Akwankyerɛ ahorow a ɛfa ho¶

• Black Widow ne Redback vs Brown Recluse akɔre a wɔaka wɔn ho nhwehwɛmu
• Nwansena ne akɔre ka mmoa a edi kan
• Ɔwɔ a wɔka ne mmoa a wɔwea fam a awuduru wom a egye ntɛmpɛ
• Scorpion, centipede, ne arthropod a awuduru wom a wɔde keka wɔn
• Nnɔmba a egye ntɛmpɛ sɛnea ɔman biara te