Klonidini Patch walima Visine ɲɛ-ji-minɛn tali: Cɛmancɛ Alpha-2 Agonist ‘Opioid-Mimic’ Coma¶

Ni denmisɛnnin walima denmisɛn fitinin nana kɛnɛyaso la, a hakili tɛ a la, a bɛ sɔgɔsɔgɔ, a bɛ ninakili siɲɛ 6 dɔrɔn miniti kɔnɔ, ani ka classic pinpoint pupils (miosis) jira, dɔgɔtɔrɔso baarakɛla bɛɛ ni dɔgɔtɔrɔ bɛɛ bɛ miiri o yɔrɔnin bɛɛ la fentanyl walima eroyini opioïde tata hakɛ cayalenba la. Nka, du kɔnɔ baga filanan, min teliyalen don o cogo kelen na, o bɛ koma "opioïde-mimic" bɔ min bɛ se ka kɛ kelen ye ka fara bradycardie profonde (dusukun tantanni dɔɔni faratilen), farigan dɔgɔyali, ani tansiyɔn jiginni fila-fila: Central Alpha-2 Adrenergic Agonists and Imidazoline Decongestants. So miliyɔn caman kɔnɔ bi, klonidini (Catapres, Kapvay) ni guanfacine (Intuniv, Tenex) tɛ sɛbɛn bɛnbaw dɔrɔn ma tansiyɔn jiginni na, nka u bɛ di fana don o don furakisɛw walima tile 7 farikolo kɔkanna furaw (Catapres-TTS) ma denmisɛnnin fitininw ni funankɛninw ma Attention-Deficit/Hyperactivity Disorder (ADHD), autizmu spectrum sunɔgɔbaliya, tic disorders, ani den bangenenw ka opioid tali. O waati kelen na, sanuyaso kabiniw ni waribɔlanw kɔnɔ, ɲɛdimifura minnu tɛ sɔrɔ dɔgɔtɔrɔso la "get the red out" ani nugulafura minnu bɛ sɔrɔ tetrahydrozoline (Visine Original), oxymétazoline (Afrin, Visine L.R.), naphazoline (Clear Eyes), walima brimonidine (Alphagan, Lumify), ka sɔrɔ balikuw ka furakɛli kabiniw bɛ farikolo lafiyalan alpha-2 minɛ tizanidine (Zanaflex), baganw ka furakɛli/lafiya fura min tɛ sariya kɔnɔ xylazine ("Tranq"), walima sɔgɔsɔgɔ/sɔgɔsɔgɔninjɛ fura baclofen. Sabula tile 7 kulonidini farilaji "baarakɛlen" min filila binkɛnɛ na, o bɛ to sen na hali bi 50% to 75% a miligaramu bɛɛ lajɛlen na, denmisɛnnin min bɛ patɔrɔn dɔ sama ka bɔ u yɛrɛ bolo la (walima ka bɔ nɔgɔ la) k’a ɲimi walima k’a sin - walima denmisɛnnin min bɛ te kuuru tilancɛ dɔrɔn de munumunu (2 to 5 mL) of Visine eye drops - a bɛ hakɛba dɔ minɛ ka ɲɛsin kunsɛmɛ na miniti 15 fo miniti 45 kɔnɔ, ka cɛmancɛ hinɛ bɔli dabila ani ka koma, cyclique apnea (den bɛ ninakili jɔ yɔrɔ min na ni a tora a kelen na tuma o tuma, o kɔfɛ a bɛ kunun ka ninakili waati kunkurunnin kɔnɔ ni a yɛrɛyɛrɛla walima ni a sirilen don), sinus bradycardie jugumanba, ani tansiyɔn jiginni.

Ni denmisɛn walima baliku ye kulonidini furakisɛ dɔ ɲimi, ka kulonidini, guanfacine walima tizanidini furakisɛ wɛrɛw munumunu, walima ni a ye ɲɛda bilenman fura walima nugulafura dɔ min hali bi, aw bɛ aw ka sigida kɔrɔtɔko nimɔrɔ wele (911 Ameriki ani Kanada, 112 Erɔpu tɔnba bɛɛ kɔnɔ, 999 Angletɛri) an ka kɔrɔtɔko nimɔrɔw ɲɛbilasɛbɛn o yɔrɔnin bɛɛ, ka segin a kan opioid tata hakɛ caya kojugu ani nalokɔni kisi, . beta-blokɛri ni kalisiyɔmu kanali balilan tata hakɛ caya kojugu, ani denmisɛnw ni denmisɛnw ka CPR.

Aw bɛ o kɛ sisan¶

1. Aw bɛ telefɔni 911 / 112 / 999 wele joona - aw kana den bila ka taa dɔgɔtɔrɔso la ni aw yɛrɛ ka mobili ye: Cɛmancɛ alfa-2 agoniste (clonidine, guanfacine, tizanidine) ani imidazoline ɲɛdimifura (tetrahydrozoline / Visine, oxymetazoline / Afrin, naphazoline, brimonidine) bɛ kɛ sababu ye ka a bɔnɛ yɔrɔnin kelen hakili, ninakilidegun (fiɲɛ bilali), ani dusukun tantanni jugumanba miniti 20 fo miniti 60 kɔnɔ a dunni kɔfɛ. Aw bɛ baara kɛ ni anpulu ye tuma bɛɛ min bɛ wele ko Advanced Life Support (ALS) walasa dɔgɔtɔrɔso baarakɛlaw ka se ka ninakili ni dusukun tantanni dɛmɛ sira kan.
2. Aw bɛ da ko ni farikolojidɛsɛbanakisɛ minnu ɲimina walima minnu munumununa ANI ka den farikolo bɛɛ lajɛ ni farilaji dogolenw tɛ a la: Ni klonidini furakisɛ (Catapres-TTS-1, TTS-2, walima TTS-3) bɛ a la, aw bɛ den da kɔnɔna lajɛ (kan jukɔrɔ ani ɲɛda kɔnɔ) ni lanpan ye ani ka plastiki furakisɛ yɔrɔ o yɔrɔ tiɲɛ ni a ye bolokɔnincinin min bɛ ni ganw ye. O kɔfɛ, aw bɛ den ka finiw bɔ pewu ka sɔrɔ ka kɔ, a kamankun, a disi, a kɔkili ani a senw lajɛ ni yɔrɔ dɔ sirilen don a la (tuma caman na, a yɔrɔw bɛ wuli denmisɛnnin fari la ni u ni bangebaga walima a balimakɛ bɛ sunɔgɔ ɲɔgɔn fɛ). Aw bɛ fari yɔrɔ ko ni safinɛ ni ji ye (aw kana dɔlɔ walima asetɔni kɛ abada, o bɛ fari yɔrɔw da wuli ani ka dɔ fara kulonidini tali kan farikolo la).
3. Aw bɛ baara kɛ ni "Tactile and Verbal Stimulation" ye walasa ka "Early-Onset Cyclic Apnea" kɛlɛ ka aw to anpulu makɔnɔ: Klonidini ni Visine baga taamasiɲɛ kabakoma ni faratiba dɔ ye stimulus-dependent cyclic apnea: ni so bɛ sumaya waati min na mɔgɔ si ma maga den na, den bɛ bin kɔma jugumanba kɔnɔ, u dawolo bɛ jigin, ani u bɛ ninakili jɔ pewu (fiɲɛbɔ) ka sɔrɔ u dusukun tantanni bɛ jigin kosɛbɛ; o bɛɛ n’a ta n’i ye u kɔkiliw magaya, k’u senkɔniw sɔgɔsɔgɔ, walima ka kuma u fɛ ni kanba ye, u bɛ u ɲɛw da wuli waati kunkurunnin kɔnɔ ka ninakiliba caman kɛ ka sɔrɔ ka segin ka segin ninakilidegun na siɲɛ filanan na i ye u lawulili dabila. Aw bɛ to ka denmisɛnnin sunɔgɔlen dɔ lawuli ani ka kuma a fɛ ani ka a fiɲɛbɔyɔrɔ kɔrɔta fo ka se dɔgɔtɔrɔso baarakɛlaw ma.
4. Aw bɛ Naloxone (Narcan) tata hakɛ caman di ni ninakili bɛ kɛ dɔɔni dɔɔni walima ni a man dun (ani k’a faamu mun na a tata hakɛ danmadɔw ka teli ka dɛsɛ): Hali n’aw b’a dɔn ko baga ye klonidini, guanfacine, walima tizanidine ye (ani a tɛ opioïde ye), cɛmancɛ alfa-2 agonistew bɛ sumaya endorphines endogènes bɔ minnu bɛ ɲɔgɔn sɔrɔ ni opioïde sɔrɔbagaw ye. Hali ni standard ka dɔgɔ 0.4 mg naloxone tata hakɛ ka teli ka dɛsɛ banabagatɔ tilancɛ ɲɔgɔn na, Naloxone hakɛ caman bɛ tali kɛ joli la (2 mg to 10 mg IV bolus denmisɛnw ni balikuw bɛɛ la) bɛ banabagatɔ kunun, ka ninakilidegun kɔsegin, ka tansiyɔn ni dusukun tantanni ɲɛ fo ka se 50% fo 80% ma kulonidini tata hakɛ jugumanba la ka sɔrɔ a ma kɛ ni endotracheal intubation ye.
5. Aw kana fɔɔnɔ bila mɔgɔ la, wa aw kana ji, nɔnɔ walima charbon activé di so kɔnɔ abada: Ikomi sɛgɛn ni gag reflex bɔnɛ bɛ kɛ miniti 15 fo miniti 30 kɔnɔ, fɛn o fɛn bɛ don kɔnɔbara la so kɔnɔ, o bɛ kɛ sababu ye ka sɔgɔsɔgɔninjɛ faga joona.
6. Aw bɛ kɛnɛyaso jɛkuluw lasɔmi "Biphasic Blood Pressure Trap" (Early Paradoxical Hypertension -> Late Hypotension) la: Klonidini, guanfacine, walima Visine tata hakɛ cayalenba kɔfɛ dɔrɔn, joli hakɛ caman bɛ peripheral vascular alpha-2B ani alpha-1 receptors lawuli, o bɛ kɛ sababu ye ka waati kunkurunnin kɛ Tansiyɔn jiginni jugumanba (tansiyɔn jiginni paradoxical) ani reflex bradycardie min bɛ kɛ miniti 30 fo miniti 120 kɔnɔ, sani a ka kɛ sababu ye ka alfa-2A blocage central brainstem ka a ta ka banabagatɔ jigin tansiyɔn jiginni kuntaalajan (tansiyɔn jiginni) kɔnɔ. Aw bɛ dɔgɔtɔrɔw lasɔmi ko u kana tansiyɔn fura minnu bɛ mɛn sen na walima beta-blockers di abada o tansiyɔn jiginni daminɛ waati kunkurunnin kɔnɔ, n’o tɛ, banabagatɔ bɛna dusukun ni jolisiraw tiɲɛni sɔrɔ min tɛ se ka segin kɔ lɛri 1 o kɔfɛ ni tansiyɔn jiginni waati sera.

Desizɔn jiri : Central Alpha-2 Agonist & Imidazoline ("Opioid-Mimic") baga dɔnni ani k’a ɲɛnabɔ¶

flowchart TD
    Start["Siga bɛ a la ko Alpha-2 Agoniste cɛmancɛ / Imidazoline bɛ sɔrɔ OR Denmisɛnw ka ‘Opioid-Mimic’ Coma ɲɛfɔbali (Pinpoint Pupils + Apnea + Bradycardie)"] --> SourceID{"Agent & Route Kɛrɛnkɛrɛnnenw dɔn"}

    SourceID -->|1. Clonidine (Catapres Pills or TTS Transdermal Patch) or Guanfacine (Intuniv ER / Tenex)| ClonidineGroup["Klɔnidini baga hakɛ dantɛmɛnen denmisɛnniw na : > miligaramu 0,1 (walima > miligaramu 0,005-0,01/kg) = Furakisɛ miligaramu 0,1 kelen walima TTS furakisɛ min bɛ ɲimi (A miligaramu 2,5, miligaramu 5,0, walima miligaramu 7,5 bɛɛ lajɛlen bɛ a la) -> A daminɛ miniti 30-60 (Guanfacine ER A bɛ mɛn fo lɛri 6-12)"]

    SourceID -->|2. Imidazoline Eye Drops / Nasal Sprays (Tetrahydrozoline [Visine], Oxymetazoline [Afrin], Naphazoline, Brimonidine [Alphagan/Lumify])| VisineGroup["A daminɛ teliya la kosɛbɛ (miniti 15 ka se miniti 45 ma): Ni aw bɛ 0,05% jilama (miligaramu 0,5-1) mililitiri 1-2 kɛ denmisɛnnin na, o bɛ kɛ sababu ye ka Koma jugumanba, farigan jugumanba, miyɔsi, fiɲɛbɔ, & dusukun tantanni bila mɔgɔ la"]

    SourceID -->|3. Tizanidine (Zanaflex), Dexmedetomidine (Precedex), or Xylazine ('Tranq' Adulterant in Illicit Fentanyl)| TizanidineGroup["Tizanidine bɛ QT janya & sugunɛbilenni fara a kan; Silazini bɛ farikolojidɛsɛ jugumanba bila mɔgɔ la + Alfa-2 Koma min bɛ se ka naloxone kɛlɛ, o ni Fentanili ninakili jɔli faralen ɲɔgɔn kan"]

    ClonidineGroup --> DeconStep["Nɔgɔ bɔli teliya la & fiɲɛbɔyɔrɔw lajɛ: 1. Aw bɛ fɛn o fɛn bɔ da la walima fari la & ka fari ko ni safinɛ/ji ye 2. Aw bɛ baara kɛ ni Tactile/Verbal Stimulation ye walasa ka fiɲɛ bila sɔgɔsɔgɔninjɛ la; Dɛmɛ fiɲɛbɔyɔrɔ/bɔrɔ-masque fiɲɛbɔli 3. Banakɔtaa bɛɛ ji (PEG-ES) DƆRƆN ni kulonidini yɔrɔ min ma tiɲɛ, o bɛɛ munumunu"]
    VisineGroup --> DeconStep
    TizanidineGroup --> DeconStep

    DeconStep --> NaloxoneTrial["NALOXONE TARIBA YE ƝƐNABƆLI (Ka ɲɛsin CNS Depression, Apnée, walima Hypotension/Bradycardie ma): - Aw bɛ Naloxone tata hakɛ caman di a ma: miligaramu 0,1/kg IV (walima miligaramu 2 ka se miligaramu 10 ma IV Bolus la denmisɛnw ni balikuw la) - Ni kununni/ninakili jaabi ɲuman don: Aw bɛ Naloxone IV pikiri kɛli daminɛ waati la 2/3 of Effective Wake-Up Dose per Hour (N’o tɛ, Endotracheal Intubation & Mechanical Ventilation) ."]

    NaloxoneTrial --> HemodynamicPhase{"Biphasic Hemodynamique Response Fasa jumɛn bɛ yen?"}

    HemodynamicPhase -->|Phase 1: Early Paradoxical Hypertension + Reflex Bradycardia (Peripheral Alpha-2B/Alpha-1 Vasoconstriction, First 1-3 Hours)| EarlyHTN["KƆLƆSI: Aw kana tansiyɔn jiginni fura minnu bɛ mɛn sen na walima Beta-Blockers (A bɛna kɛ sababu ye ka mɔgɔ faga ni Fase 2 sera) - Aw bɛ HTN nɔgɔman/daman kɔlɔsi ni a ma furakɛ (a bɛ ban a yɛrɛ ma sanga 1-3 kɔnɔ) - Ni tansiyɔn jiginni gɛlɛya bɛ mɔgɔ ka ɲɛnamaya bila farati la: Aw bɛ Ultra-Short-Acting Titratable IV Sodium DƆRƆN kɛ Nitroprusside walima Fentolamine"]

    HemodynamicPhase -->|Phase 2: Dominant Central Sympatholytic Hypotension + Sinus Bradycardia / AV Block (Central Alpha-2A / Imidazoline-1 Blockade, Lasting 12-48 Hours)| LateHypo["1. Symptomatic Bradycardia: IV Atropine (0.02 mg/kg in Child [Min 0.1-0.5 mg]; 0.5-1 mg in Adult) -> Escalate to Epinephrine or Dopamine Infusion if Needed 2. Hypotension: 20 mL/kg IV 0.9% Normal Saline Crystalloid Bolus -> Direct Vasopressor Infusion (Norepinephrine or Epinephrine)"]

Banakisɛfagalanw: Alfa-2 cɛmancɛla agonistew bɛ opioidw ladege cogo min na ani ka tansiyɔn jiginni jaan bifasiki da¶

1. Mun na kulonidini ni visine bɛ kɛ sababu ye ka ɲɛkisɛw, kɔma ani fiɲɛbɔli jira ka ɲɛ (Locus Coeruleus Inhibition) .¶

locus coeruleus min bɛ kunsɛmɛnasumaya pons kɔnɔ, o ye cɛmancɛ cikan yɔrɔ ye min bɛ noradrenergic (norepinephrine) lawuli, ka kunun, ka ninakili, ani ka ɲɛkisɛw bonya hadamaden ka hakili la.

1. Alpha-2A autorecepteur présynaptique ka baarakɛcogo (Gi/o Protéines Couplage): U fila bɛɛ opioïde sɔrɔbagaw (mu-opioid) ani alpha-2A adrénergique (alpha-2A) bɛ sɔrɔ kɛrɛfɛ locus coeruleus senfagabana kan ani u bɛ potasiyɔmu/kalisiyɔmu taamasiɲɛw sira kelen tigitigiw tila ɲɔgɔn na selilu kɔnɔ (Gi/o proteine ​​coupling min bɛ adenylate cyclase bali, o bɛ da wuli kɔnɔna-labɛnni GIRK potasiyɔmu siraw ka hyperpolarize neuron, ani ka voltage-gated calcium channels bali).
2. Total Sympathetic Shutoff ("Opioid-Mimic" Toxidrome): Ni klonidini, guanfacine, tizanidine, xylazine, walima tetrahydrozoline (Visine) bɛ woyo ka don kunsɛmɛ na ka central presynaptic lawuli alpha-2A ani imidazoline-1 (I1) recepteurs minnu bɛ locus coeruleus ni rostral ventrolateral medulla la:
3. Norepinefirini bɔli kunsɛmɛ na, o bɛ jigin ka se zeru kɛrɛfɛ, o bɛ banabagatɔ bila kɔma la (o min bɛ kɔsegin cogo kɛrɛnkɛrɛnnen na segin damadɔ kɔnɔ dimi/magacogo lawulili waati ni dusukunnataw sira dɛmɛnanw bɛ tasuma don waati kunkurunnin kɔnɔ).
4. Parasimpatiki ton min tɛ sɔsɔ ka bɔ Edinger-Westphal nucleus la, o bɛ ɲɛda sɔgɔsɔgɔninjɛ gɛlɛya, ka pinpoint pupils (miosis) bɔ min tɛ se ka faranfasi ni fentanili walima eroyini ye.
5. Ninakilidegun yɔrɔw bɛ hinɛbaliya bɔnɛ, o bɛ kɛ sababu ye ka bradypnea ani cyclic apnea bila mɔgɔ la.
6. Ton efferent sympathique ka taa sinoatrial (SA) node, atrioventricular (AV) node, ani peripheral joli siraw la, o bɛ ban, ka sɔrɔ vagal parasympathetic tone bɛ fanga sɔrɔ, o bɛ kɛ sababu ye ka profound sinus bradycardie, AV heart block, systemic vasodilation (hypotation), ani hypothermie bila mɔgɔ la.

2. Mun na Nalokɔni tata hakɛ caman (2 mg to 10 mg IV) A bɛ baara kɛ Klonidini tata hakɛ cayalenba caman na¶

San tan caman kɔnɔ, dɔgɔtɔrɔw tun bɛ sɔsɔli kɛ ni naloxone (Narcan) bɛ baara kɛ kulonidini baga la barisa bana fɔlɔw bɛ fɔ ka baara kɛ ni tiny ye 0.1 mg to 0.4 mg dosew ye jaabiw jira minnu tɛ bɛn ɲɔgɔn ma. Bi denmisɛnw ka bagako sɛgɛsɛgɛliw y’a jira ko alfa-2 cɛmancɛ lawulili bɛ kɛ sababu ye ka beta-endorphines endogènes bɔli daminɛ kunsɛmɛ na, olu minnu bɛ baara kɛ ɲɔgɔn fɛ mu- ani delta-opioid minɛbagaw bɛ o kelen tigitigi kan Gi-locus coeruleus neurones minnu bɛ ɲɔgɔn sɔrɔ.

• Mun na a tata hakɛ caman ka kan: Ka nin endorphine endogène co-activation in bali, o bɛ supratherapeutic high-dose Intravenous Naloxone (0.1 mg/kg IV, walima 2 mg to 10 mg IV boloci bɛɛ lajɛlen denmisɛnninw ni balikuw bɛɛ la).
• Denmisɛnw ka kulonidini tata hakɛ cayalenba kɛnɛyaso la, a tali fo ka se 10 mg of IV naloxone kununni teliya la denmisɛn minnu bɛ comatose/apneic 50% fo 80%, o bɛ u kisi endotracheal intubation ni ICU mechanical ventilation ma, ni a bɛ se ka kɛ ko a nɔ jugu si tɛ denmisɛnniw na minnu tɛ opioïde ta. (Kɔlɔsili: Nalokɔni tata hakɛ caman bɛ se ka kɛ imidazoline ɲɛjibɔlan [Visine] ni xylazine baga la kosɛbɛ ka tɛmɛ furakɛli clonidine baga kan, hali ni kɔrɔbɔli tɛ kɛ tuma bɛɛ, wa a ka ɲi).

3. Biphasic Hemodynamic Trap: Mun na tansiyɔn jiginni fasa 1 bɛ wuli ka kɛ fasa 2 sɔgɔsɔgɔ ye¶

Klonidini, guanfacine walima tetarahidrozolini hakɛ caman munu kɔfɛ dɔrɔn, fura hakɛ min bɛ joli lamini na la, o bɛ caya sani fura ka se ka balansi dafalen kɛ joli-sɔgɔsɔgɔninjɛ sira fɛ ka don kunsɛmɛ na:

• Fase 1 (Miniti 30 fo 180 fɔlɔ - Alpha-2B Vasoconstriction périphérique): Ni joli la, a hakɛ caman bɛ joli la, o bɛ periférique postsynaptique lawuli k’a ɲɛsin a ma alpha-2B ani alpha-1 recepteurs kan joli siraw la minnu bɛ joli siraw la, o bɛ kɛ sababu ye ka banakisɛ lamini joli-sira-funu jugumanba bila mɔgɔ la, tansiyɔn jiginni jugumanba min bɛ mɛn sen na (misali la, BP 180/110 mmHg denmisɛnnin dɔ kɔnɔ walima 230/130 mmHg baliku la), a dakunw nɛnɛman jɛmanw, ani barorecepteur-mediated reflex bradycardie.
• Fase 2 (Lɛrɛ 2 ka se 48 ma - Central Alpha-2A Sympatholysis): Lɛrɛ 1 fo 3 kɔnɔ, furakisɛw hakɛ bɛ segin ka tila farikolo yɔrɔw la ka sɔrɔ cɛmancɛ la kunsɛmɛ na alpha-2A balili bɛ yamaruya dafalen ta, ka hinɛ ton datugu ani ka kɛ sababu ye ka tansiyɔn ** jigin ka bɔ tansiyɔn jugumanba la ka taa tansiyɔn jiginni kuntaalajan ni dusukun tantanni na**.
• Iatrogenic Disaster: Ni dɔgɔtɔrɔ min tɛ kunnafoni sɔrɔ, o ye tansiyɔn jiginni Fase 1 furakɛ ni labetalol, metoprolol, propranolol, hydralazine, walima nifedipine ye, balawu fila bɛ kɛ: (1) beta-blocker bɛ beta-adrénergique dɛmɛn tolen bɛɛ bɔ ka a sɔrɔ a bɛ peripheral alpha vasoconstriction to a ma kɛlɛ, walima (2) ni tansiyɔn jiginni cɛmancɛ Fase 2 sera miniti 60 o kɔfɛ, tansiyɔn jiginni fura min bɛ baara kɛ waati jan kɔnɔ, o tɛ se ka faga, o bɛ kɛ sababu ye ka dusukun ni joli siraw sɔgɔsɔgɔninjɛ min tɛ se ka furakɛ.

Tablo de comparaison master : Alpha-2 agonists centrales, Imidazoline ɲɛ/nutumuw, ani Xylazine¶

Dɔgɔtɔrɔso ɲɛnabɔli fɛɛrɛ min bɛ kɛ senfɛ-senfɛ¶

1. Nɔgɔ bɔli: Waati min na aw ka kan ka banakɔtaa bɛɛ ji kɛ kulonidini kunumugu la¶

• Patch chewed and Spit-Out Patch walima Liquid Eye Drops: Aw kana aw kana kɔnɔbara ko walima ka charbon activé di tetarahydrozoline/oxymétazoline ɲɛdimifura jilamaw ma (minnu bɛ minɛ pewu miniti 15 fo miniti 30 kɔnɔ ka sɔrɔ sɛgɛn bɛ fiɲɛ bila faratiba lase mɔgɔ ma).
• Intact Clonidine Transdermal Patch Swallowed Whole: Catapres-TTS patch dɔ bɛ ni kɔkanna ye min tɛ se ka don a kɔnɔ ani min bɛ se ka hakɛ kɔlɔsi, 2.5 mg to 7.5 mg ka kulonidini saniyalen (balikuw ka da la hakɛ siɲɛ 25 fo 75) min bɛna to ka kulonidini bɔ kɔnɔbara ni banakɔtaa kɔnɔ fo tile kɔnɔ. Ni denmisɛnni walima baliku ye kulonidini furakisɛ min ma tiɲɛ, o bɛɛ munumunu, aw bɛ Activated Charcoal (1 g/kg) (fiɲɛbɔyɔrɔ lakanani kɔfɛ ni sunɔgɔ bɛ a la) ani ka Banakɔtaa bɛɛ jibɔ (WBI) daminɛ ni Polyethylene Glycol Electrolyte Solution (PEG-ES, GoLYTELY ka baarakɛyɔrɔ la 25 mL/kg/hr denmisɛnw na walima 1.5 to 2 L/hr balikuw la nasogastric tube fɛ) fo ka se plastiki yɔrɔ min ma tiɲɛ, o tɛmɛn kɔkolo jibɔyɔrɔ la.

2. Joli ni ninakili kisicogo¶

1. Fiɲɛbɔyɔrɔ & Ninakili fɔlɔ (Lawulili -> Naloxone hakɛ caman -> Intubation):
2. Aw bɛ oksimɛtiri min bɛ kɛ ka wuli ka bɔ a nɔ na, o kɛ, kapnografi laban-ji (ETCO2), ani dusukun kɔlɔsili, ani ka farikoloɲɛnajɛ nɔgɔmanw kɛ ni fiɲɛ bilali nɔgɔman ye.
3. Ni fiɲɛbɔli basigilen, ninakilidegun, walima kɔma jugumanba, aw bɛ Naloxone hakɛ caman kɛ joli la (0.1 mg/kg IV fo ka se 2 mg fɔlɔ puse, ka segin teliya la miniti 2 o miniti 2 fo ka se a bɛɛ lajɛlen ma 10 mg IV). Ni nalokɔni tata hakɛ caman bɛ ninakili ni wulicogo segin a cogo kɔrɔ la, aw bɛ nalokɔni pikiri kɛli daminɛ IV la ka taa a fɛ waati la 66% (tila tila sabanan fila) ka bɔ kunun bolus hakɛ nafama na lɛrɛ kelen kɔnɔ; ni 10 mg a tɛ se ka fiɲɛbɔcogo ɲuman segin a cogo kɔrɔ la, ka endotracheal intubation ani mechanical ventilation kɛ. (Aw ye aw janto: Ni aw bɛ tubabufura teliya ɲɔgɔn kɔ, aw bɛ kɔn ka fura kɛ ni IV Atropine ye 0.02 mg/kg barisa laryngoscopie ni succinylcholine bɛ se ka vagal sinus arrest bila mɔgɔ la min ka klonidini bɛ bradycardic kaban).
4. Bradycardie (Bradicardie) furakɛli (Atropine -> Epinephrine):
5. Aw kana dusukun tantanni misɛnni furakɛ ni taamasiɲɛ tɛ a la ni tansiyɔn ni pikirijikɛlan tɛ a cogo la pewu.
6. Ni kardiya taamasiɲɛw bɛ a la ni tansiyɔn jiginni walima pikirijikɛlan man ɲi, aw bɛ Atropine (Atropine) kɛ jolisira fɛ (0.02 mg/kg denmisɛnw na [minimum 0.1 to 0.5 mg]; 0.5 mg to 1 mg balikuw la, a bɛ se ka segin a kan fo ka se 3 mg). Ni atropini ma ɲɛ, aw bɛ Epinephrine intravenous (0.05 to 0.3 mcg/kg/min) walima Dopamine (5 to 15 mcg/kg/min) pikiri walima ka a kɛ farikolo la.
7. Tansiyɔn jiginni kunbɛnni ni tansiyɔn jiginni paradoxique fɔlɔ:
8. Tansiyɔn jiginni: Aw bɛ ** kɛ .10 to 20 mL/kg bolow minnu bɛ kɛ ni 0,9% Normal Saline walima Lactated Ringer’s** ye ani ka banabagatɔ bila Trendelenburg/supine jɔyɔrɔ la; ni tansiyɔn jiginni bɛ to sen na, aw bɛ Norepinephrine walima Epinephrine pikiri tilennen daminɛ. (Kɔlɔsili: Tolazoline, tariku kɔnɔ alfa-antagoniste, a man ɲi ani a bɛ bila barisa a bɛ kɛ sababu ye ka tansiyɔn jiginni jugumanba bila mɔgɔ la, tansiyɔn jiginni jugumanba, ani joli bɔli GI la; Yohimbine tɛ sɔrɔ IV kɔrɔtɔlen furakɛli la).
9. Tansiyɔn jiginni daminɛ na: Aw bɛ tansiyɔn jiginni waati kunkurunnin to a ma furakɛ fo ni farikolo yɔrɔ labanw tiɲɛni jugumanba kɛra (tansiyɔn jiginni kunsɛmɛnasumaya, aorte dissection, walima fogonfogonlabana), o cogo la aw bɛ titrate DƆRƆN ultra-short-acting Intravenous Sodium Nitroprusside (0.3 to 3 mcg/kg/min) walima Fɛntolamini (0.05 to 0.1 mg/kg IV miniti 10 o miniti 10) walasa a ka se ka da tansiyɔn jiginni teliya la.

Sigidaw ka kɔrɔtɔko nimɔrɔw ani baaradaw ka sariyaw¶

Ɲininkali minnu bɛ kɛ tuma caman na¶

Ni aw ye Visine ɲɛjibɔlan walima Afrin nugulafura dɔɔni munumunu, o bɛ se ka den bila kɔma la cogo di?¶

Ɲɛkisɛ bilenni fura minnu bɛ sɔrɔ dɔgɔtɔrɔso la (tetarahidrozolini, nafazɔlini walima brimonidini bɛ minnu na) ani nugulatumu fura minnu bɛ kɛ lɛri 12 kɔnɔ (okisimɛtazɔlini walima zilometazɔlini bɛ minnu na) olu bɛ furakisɛ suguya dɔ la min bɛ wele ko imidazɔlini - o ye furakisɛ suguya kelen ye tigitigi ni tansiyɔn ni ADHD fura kulonidini ye. Ni u kɛra ɲɛ na i n’a fɔ jikuru kelen, u bɛ joli sira misɛnninw sɔgɔsɔgɔ u yɔrɔ la. Nka ni u mununna - hali ni u hakɛ ka dɔgɔn mililitiri 1 fo 2 ma (a tɛ se teminkutu tilancɛ ma) - u bɛ minɛ joona ka bɔ kɔnɔbara la ka joli-sɔgɔsɔgɔninjɛ balilan tigɛ walasa ka cɛmancɛ alfa-2A ni imidazoline minɛbagaw lawuli kunsɛmɛ na, ka farikolo ka hinɛ-minɛnw datugu ani ka kɛ sababu ye ka pinpoint pupils, deep coma, farigan dɔgɔyali, dusukun tantanni bɛ sumaya farati la (bradycardie), ani ninakili jɔli (fiɲɛ bilali) miniti 15 fo miniti 45 kɔnɔ.

Yala Visine ɲɛjibɔlanw bilali mɔgɔ dɔ ka minfɛn na, o bɛ kɔnɔboli bila mɔgɔ la i n’a fɔ filimuw la, walima o ye nsiirin ye wa?¶

O ye duguba kɔnɔ nsiirin ye min ye nkalon ye kɛmɛsarada la ani min bɛ mɔgɔ faga. Tetarasikilini (Visine) TƐ kɔnɔboli bila mɔgɔ la fewu. O nɔ na, ni aw ye mɔgɔ dɔ ka minfɛn kɛ ni tetarasikilini walima ɔkisimɛtazɔlini ɲɛjibɔlanw ye, o bɛ farikolojidɛsɛbanakisɛ ni dusukun ni jolisiraw degun fura sɔrɔ min tɛ kulɛri sɔrɔ, min tɛ diya, min bɛ kɛ sababu ye ka kɔma jugumanba, farigan jugumanba, dusukun tantanni, ninakilidegun, ani saya, wa a bɛ jalaki iko baga juguya kojugu min bɛ dɔn nɔgɔya la dɔgɔtɔrɔso ni kiritigɛlaw fɛ LC-MS/MS joli ni sugunɛ sɛgɛsɛgɛli.

Mun na Naloxone (Narcan) bɛ denmisɛn kunun tuma dɔw la min ye Clonidine ta ka tɛmɛ hali ni Clonidine tɛ opioid ye?¶

Klɔnidini bɛ alfa-2A adɛrɛnerji sɔrɔyɔrɔw lawuli kunsɛmɛnasumaya yɔrɔ la, minnu bɛ potasiyɔmu ni kalisiyɔmu taamasiɲɛw sira kelen tigitigi kɛ selilu kɔnɔ ni mu-opioïde sɔrɔyɔrɔw ye, wa u fana bɛ hakili yɛrɛ ka endorphines naturelles bɔli daminɛ. Hali ni nalokɔni hakɛ fitininw (`0.4 mg`) ka teli ka barika dɔgɔya kojugu walasa ka se sɔrɔ o nɔ in kan, kɛnɛyaso toxicologie sɛgɛsɛgɛliw y’a jira ko Naloxone hakɛ caman tali jolisira fɛ (`0.1 mg/kg`, walima `2 mg to 10 mg IV` total) bɛ nin opioid endogène co-activation in bali ani ka denmisɛnni 50% fo 80% kunun joona minnu bɛ ni kulonidini kɔma jugumanba ye ani ninakilidegun, a ka ca a la o bɛ u kisi ninakiliminɛn ni fiɲɛbɔlan ma.

Mun na farati ka bon dɔgɔtɔrɔ ma ka tansiyɔn fura di ni Clonidine walima Visine tata hakɛ cayalenba banabagatɔ fɔlɔ sera ni tansiyɔn jiginni ye?¶

Klonidini, guanfacine walima Visine tata hakɛ caya kojugu bɛ tansiyɔn jaabi klasiki "biphasic" bila mɔgɔ la. Miniti 30 fo miniti 120 fɔlɔw kɔnɔ, fura hakɛ caman sɔrɔli joli la, o bɛ joli siraw lamini (alpha-2B sɔrɔyɔrɔw fɛ), o bɛ kɛ sababu ye ka tansiyɔn jiginni jugumanba wuli waati dɔɔni kɔnɔ sani fura ka tɛmɛ ka ban ka don kunsɛmɛ na. Ni fura donna kunsɛmɛ na (Fase 2), a bɛ cɛmancɛ hinɛ bɔli bɛɛ datugu, wa banabagatɔ ka tansiyɔn bɛ bin ka taa tansiyɔn dɔgɔyali jan na (tansiyɔn jiginni) fo lɛri 12 fo lɛri 36 nataw. Ni dɔgɔtɔrɔ ye tansiyɔn fura walima beta-blokɛri di a ma min bɛ mɛn sen na o tansiyɔn jiginni daminɛ waati kunkurunnin kɔnɔ, banabagatɔ bɛna kirinni jugumanba sɔrɔ, min tɛ se ka wuli ka bɔ a nɔ na lɛrɛ kelen o kɔfɛ, ni Fasa 2 sera.

Mun na den min ye Guanfacine (Intuniv) min bɛ bɔ waati jan kɔnɔ, o ka kan ka to dɔgɔtɔrɔso la lɛri 24 kɔnɔ hali ni u kununna ka sunɔgɔbaliya dabila?¶

Guanfacine min bɛ bɔ waati jan kɔnɔ (Intuniv) bɛ ni waatibolodacogo kɛrɛnkɛrɛnnen ye, min bɛ mɔgɔ lafili, a tata hakɛ caya kojugu: hali ni sunɔgɔbaliya ni lafiya bɛ bɔ lɛri 2 fo lɛri 6 fɔlɔ kɔnɔ, wa a ka teli ka ɲɛ ka se lɛri 8 fo lɛri 12 ma, dusukun ni jolisiraw nɔ jugumanba - kɛrɛnkɛrɛnnenya la tansiyɔn jiginni jugumanba (sɔnsɔnni ni a jɔlen don), sinus bradycardie, ani QTc janyalen - a ka teli ka kɛ Aw kana a caya fo lɛri 12 fo lɛri 24 furakisɛw kununni kɔfɛ. Ni den bɔra kɛnɛyaso la lɛri 6 walima lɛri 8 kɔnɔ k’a sababu kɛ u kununna dɔrɔn, o bɛ se ka kɛ sababu ye ka sinkɔrɔkɛrɛdimi bila kɔfɛ ani ka dusukun tantanni bila so kɔnɔ.

Gafe minnu bɛ tali kɛ o ko la¶

• Opioid tata hakɛ tɛmɛnen dɔnni ani nalokɔni (Narcan) tali
• Beta-blokɛri ni kalisiyɔmu kanali bloki fura tata hakɛ cayalenba sɛgɛsɛgɛli
• Nikotini baga, vape ji jilama, ani farikolo yɔrɔw toxicité
• Denmisɛnw ni denmisɛnninw ka CPR ani sɔgɔsɔgɔninjɛ kisi
• Bagabɔ dɛmɛ fɔlɔ ni baga kɛlɛli triage

Sosow ani ɲɛmɔgɔyaso ka bilasiralikan¶

• Ameriki ka dɔgɔtɔrɔso toxicologie (ACMT) & Ameriki ka bagajiw ɲɛnabɔli jɛkuluw: Toxicologie guidance dans la toxicologie centrale alpha-2 agoniste overdose, pediatric clonidine transdermal patch toxicity, and high-dose naloxone Rescue.
• Etazuni ka dumuniko ni furako ɲɛmɔgɔso (FDA) & Consumer Product Safety Commission (CPSC): Dɔrɔgu lakanani kumaɲɔgɔnya: Ko juguba minnu bɛ sɔrɔ ɲɛkisɛw ni nugulafura (Tetrahydrozoline, Oxymetazoline, Naphazoline) tali la balawu fɛ.
• Ameriki denmisɛnw ka kɛnɛyako kalanso (AAP): Denmisɛnw ka "furakisɛ kelen bɛ se ka mɔgɔ faga" fɛɛrɛ: Kulonidini, Guanfacine ani Imidazoline bɔlenw baga denyɛrɛniw ni denmisɛnninw na.
• Jamana ka bagajiw kunnafonidiso (NPIS, Angletɛri): TOXBASE ka kɛnɛyako ɲɛnabɔli sariyaw kulonidini, Guanfacine, Tizanidine ani Imidazoline decongestant toxicité kan.
• Banaw kɛlɛli ni u kunbɛnni baaradaw (CDC) & National Institute on Drug Abuse (NIDA): Dɔgɔtɔrɔso ka laadilikanw ka ɲɛsin fentanili min sɛgɛsɛgɛra ni Xylazine ("Tranq") hakɛ cayalenba ye.

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Nin gafe in ye kunnafonidi ye, wa a tɛ kɛ dɔgɔtɔrɔso kɔrɔtɔlenw ka furakɛli kɔrɔtɔlenw, Poyi kunbɛnni ladilikanw, walima denmisɛnw ka furakɛli gɛlɛnw nɔ na. Ikomi kulonidini furakisɛw ni imidazɔlini ɲɛdimifura bɛ se ka kɛ sababu ye ka ninakilidegun barikama kɛ ani ka dusukun tantanni jugumanba bila mɔgɔ la miniti damadɔ kɔnɔ, an b’a ɲini aw fɛ kosɛbɛ ko aw ka bololabaarakɛlaw ka dɛmɛ fɔlɔ ni denmisɛnw ka CPR kalan kɛ min lakodɔnnen don, ka tɛmɛn Croix Rouge ni Kɔrɔji bilenman tɔnba (IFRC) fɛ, aw ka jamana Croix Rouge tɔnba fɛ, St John Ambulance, walima sigida furakɛlikɛla min ka lakɔliso sɛbɛn bɛ a bolo..