Atike Siwo Dzea Ame Ŋu ƒe Dodokpɔ Gã (‘Overamping’): Dzoxɔxɔ si gbɔ eme, Akɔtave, Kple Ʋuʋudedi ƒe Triage¶

To vovo na opioid ƒe agbɔsɔsɔ fũ, afisi ame tsɔa ta blewuu, trɔna blɔ, eye wòdzudzɔa gbɔgbɔ, dodzidzɔname ƒe agbɔsɔsɔ si gbɔ eme, si wonya le afisiafi le nuveviwɔame dzi ɖeɖe kpɔtɔ kple atikewɔwɔ kpata me be "overamping", nye dzi, ahɔhɔ̃, ʋukawo, kple ŋutilã ƒe dzoxɔxɔ ƒe kuxi sesẽ, si me lãmenugbagbeviwo ƒe dɔwɔwɔ fũ akpa. Ne ame aɖe no aɖi ƒe agbɔsɔsɔ si nye methamphetamine, powder cocaine, crack cocaine, MDMA ("ecstasy" / "molly"), amphetamine atikekui siwo ŋu se meɖe mɔ ɖo o, alo cathinones siwo wowɔ ("bath salts" / alpha-PVP / mephedrone), alo nyɔ ŋkeke geɖe le duɖimekeke si doa ŋusẽ ame me la, woƒe titina kple veveseseɖeamenu ƒe lãmekawo yɔa tsi kple dopamine, norepinephrine, kple serotonin. Dzi ƒe tsotso dzina ɖe edzi wu 140 va ɖo 180 le miniti ɖeka me, ʋu ƒe sisi dzina ɖe edzi va ɖoa afisi wòhea ʋusɔgbɔdɔ vɛ (220/130 mmHg+), dzitodzito me ʋukawo blana le acute vasospasm me, eye ŋutilã ƒe dzoxɔxɔ vevitɔ ate ŋu akɔ kabakaba wu 40.0 va ɖo 41.5 degree Celsius (104.0 va ɖo 106.7 degrees Fahrenheit).

Ne womewɔ atike nɛ o la, aɖi si doa ŋusẽ ame ƒe aɖi sesẽ wua ame to mɔnu ene siwo zɔna kabakaba dzi: dzoxɔxɔ si gbɔ eme vɔ̃ɖi (nuɖaɖa le ŋutinuwo me eye wòhea ʋukawo me ʋu ƒe sisi si kaka vɛ), aɖuɖɔtoe me ʋukawo ƒe ʋuʋu kple sodium-mɔ̃ ƒe mɔxexe (si hea dzitodzito me ʋukawo ƒe ʋuʋu sesẽ alo ventricular arrhythmia si wua ame vɛ le ame siwo le lãmesẽ me gɔ̃ hã me Ƒe 20 viwo), ʋu si dona le ahɔhɔ̃ me alo status epilepticus ƒe alɔ̃madɔmadɔ, kple rhabdomyolysis (ƒumelãwo ƒe gbagbã gã si gblẽa ayikuwo). Le ɣeyiɣi ma ke me la, esi wònye be fentanyl kple nitazenes siwo ŋu se meɖe mɔ ɖo o ƒo ɖi ablɔdzi cocaine, crack, methamphetamine, kple Adderall/MDMA atikekui siwo wozi ƒe alafa memamã gã aɖe fifia ta la, ele be atikewɔla ɖesiaɖe si zãa atike si doa ŋusẽ ame si adɔ alɔ̃ zi ɖeka, azu lãmetutudɔ, alo gbɔgbɔ blewu la naxɔ naloxone (Narcan) si le no me enumake. Nyanya alesi nàde vovototo susu me ƒe ʋuʋu fũ kple atikewɔwɔ kpata si ate ŋu ade eƒe agbe afɔku me, alesi nàfa dɔnɔ si doa ŋusẽ ame si le dzo dam le aɖabaƒoƒo ʋɛ aɖewo ko me, kple nusita mele be nàtsɔ ŋutilã me abla dɔnɔ si doa ŋusẽ ame si ƒe tagbɔ gblẽna ŋkume kple ŋku ɖe woƒe dɔgbo ŋu GBEÐE o xɔ agbe.

Wɔ esia fifia¶

1. Kpɔ gbɔgbɔ kple alesi wòwɔa nui kpɔ gbã: ne atike si doa ŋusẽ ame ƒe susu megale dɔ wɔm o, le hũ ɖem, le gbɔgbɔm, alo le gbɔgbɔm blewu la, do Naloxone (Narcan) 4 mg nasal spray eye nàdze xɔname gbɔgbɔ gɔme enumake. Zi geɖe la, wotsɔa fentanyl ƒoa ablɔdzi cocaine, methamphetamine, kple atikekui siwo wozi ɖe lãme na ame. Ne ènya be yewoɖoe be yewoazã atike si doa ŋusẽ ame ko hã la, naloxone atrɔ fentanyl ɣaɣla eye magblẽ nu le ame aɖe si ŋu atike si doa ŋusẽ ame dzadzɛ ƒe nɔnɔme kpata le o.
2. Ƒo ka na wò nutoa me xexlẽdzesi kpata (911 le United States kple Canada la, . 112 le EU me la, . 999 le UK) enumake ne ŋutilã me aflaga dzĩ AÐEKAKE le amea ŋu: akɔtave alo nyaƒoɖeamenu, ŋutigbalẽ vevi si se le eɖokui me be yexɔ dzo, alɔ̃madɔmadɔ, taɖuame sesẽ kpata, mo si le ɖiɖim/alɔ gbɔdzɔ, alo delirium si dzi womate ŋu aɖu o. Kpɔ míaƒe xexlẽdzesi siwo wozãna kpata nyatakakadzraɖoƒe.
3. Ne amea ƒe ŋutigbalẽ le dzo dam, eƒe ŋutigbalẽ le dzo dam, alo eƒe tagbɔ le ƒoƒom eye wòle dzo dam akpa la, dze aggressive active cooling gɔme ƔEYIƔI esime nèle dɔnɔdzikpɔʋua lalam. Ðe gotagomewu siwo sɔ gbɔ la ɖa, bla ice packs alo kotoku siwo me amagbe siwo wofa tsikpe ɖo siwo wotsɔ avɔ tsɛ tsyɔ la ɖe abɔta, akɔta, kple kɔ ƒe axawo, tsɔ tsi fafɛ ƒo woƒe ŋutigbalẽ ƒuƒlu la esime nèle a fesre si zɔna kabakaba to wo dzi, alo nyrɔ wo ɖe tsi fafɛ aɖe me (na ta nalé ɖe tsi tame). Aɖabaƒoƒo ɖesiaɖe ƒe dzoxɔxɔ si le titina ƒe dzoxɔxɔ si nɔa Celsius dzidzenu 40.5 (Fahrenheit dzidzenu 105) dzi la, egblẽa nu le ahɔhɔ̃ kple ŋutinuwo ŋu si womate ŋu atrɔ o.
4. MÈGAlé asi, abla, abla hog-tie, alo anɔ anyi ɖe atike si doa ŋusẽ ame ƒe akɔta alo akɔta si le ʋuʋum alo eƒe tagbɔ gblẽ la ƒe akɔta alo akɔta GBEÐE o (si te ŋu ɖua ame dzi bɔbɔe). Ame si le aɖi si doa ŋusẽ ame ƒe aɖi sesẽ me la ƒe metabolic acidosis si gbɔ eme eye wòhiã be wòakeke akɔta ƒe gli gã aɖe ɖe enu be wòaƒo carbon dioxide (CO2). Ne wotsɔ wo ƒo ŋkume ɖe anyi la, esia xea mɔ na woƒe akɔta, enaa acid ƒe agbɔsɔsɔ si le ʋu me dzina ɖe edzi, eye wònana dzi ƒe dɔmawɔmawɔ nyuie si wua ame kpata ("restraint asphyxia") le sɛkɛnd 60 me.
5. Ne amea ƒe akɔta le veve sem vevie, eƒe aɖu/miasi le veve sem, alo fifia fafɛ le eŋu le cocaine alo meth zazã vɔ megbe la, tsɔe ɖo anyi wòabɔbɔ, na wòanɔ anyi kpoo keŋkeŋ, eye nàna Aspirin si woate ŋu aɖu si ƒe kpekpeme nye 162 va ɖo 325 mg (negbe ɖe nulɔdɔ le eŋu alo ʋu ƒe sisi/ʋu le dodom le eŋu ko hafi). Mègana ame si ƒe akɔta le veve sem alo nado go gbeɖe o woawo ŋutɔ, eye ana kpekpeɖeŋunalawo nanya enumake be cocaine alo methamphetamine le ʋua me (ele be kɔdzi ɖɔktawo naƒo asa na beta-blocker aɖewo siwo nana dzitodzito me ʋukawo ƒe ʋuʋu gagblẽna ɖe edzi).
6. Ne amea le susu me "overamp" si fa wu (dzimaɖitsitsi, dzitsitsi, paranoid, alo ɖeɖiteameŋu kple akɔtave aɖeke, dzoxɔxɔ si gbɔ eme, kple gbɔgbɔ si sɔ me o) la, tsɔe yi xɔ si me fa miamiamia, si me do viviti, si me tomefafa le me. Na electrolyte nono fafɛ, tsilele fafɛ alo avɔ si wotsɔna klɔa nu, nuɖuɖu suesuesuewo ɖuɖu, kple anyinɔnɔ fafɛ, si me ʋɔnudɔdrɔ̃ o vaseɖe esime nusi doa ŋusẽ ame la nado off.

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Rapid Triage: Susuŋutinunya me Overamping Fafɛ vs. Atikewɔwɔ me Aɖi si Dea Agbe Afɔku Me¶

Le nuveviwɔame dzi ɖeɖe kpɔtɔ ƒe nuwɔna me la, nya "overamping" lɔ nu geɖe ɖe eme: tso vɔvɔ̃ si meɖea dzi ɖi o, si ƒe dzi gbãna le Adderall, meth, alo coke nono fũ vɔ megbe dzi va ɖo dzoxɔxɔ si gbɔ eme, ʋusɔgbɔdɔ, alo dzidɔ si wua ame dzi. Zã nyametsotsoti sia nàtsɔ ama nusiwo woate ŋu afa le aƒeme kple esiwo hiã kɔdzi ƒe ICU fifia.

flowchart TD
    A["Ame Si Le Nuxaxa Me Le Cocaine, Meth, Crack, MDMA, alo Atikekuiwo zazã vɔ megbe"] --> B{"Ðe Womewɔa Nu O Alo Wole Gbɔgbɔm Blewu / Wole Aɖuɖɔtoe?"}
    B -->|YES: Limp, Blue Lips, Slow Breathing| C["WOBU BE FENTANYL ƑE ÐEÐEŊU: Na Naloxone 4 mg Spray + Xɔname Gbɔgbɔ + Yɔ 911"]
    B -->|NO: Awake, Fast Heartbeat, Sweating, Agitated, or In Pain| D{"Aflaga Dzĩ ƒe Veveseseɖeamenu ƒe Xaxa ƒe Dzesi aɖewo Lia?"}
    D -->|Hot Skin > 39.5C/103F, Chest Pain, Seizure, Stroke Signs, Dark Urine, or Violent Delirium| E["ATIKƆME Kpata: Ƒo ka na 911 / 112 / 999 Enumake"]
    D -->|NO Physical Red Flags: Jittery, Anxious, Racing Thoughts, Exhausted, Mild Paranoia| F["Mild/Moderate Overamping: De-Escalate le Xɔ Fafɛ, Tomefafa me"]
    E --> G["1. Fafa Kabakaba Ice-Pack / Evaporative Cooling 2. Chewable Aspirin 325 mg ne Akɔta Vevesese 3. Zero Prone Restraint"]
    F --> H["1. Dim Lights & Tsi Hadzidzi 2. Tsi Fafɛ / Electrolytes & Snack 3. Fafɛ Klɔƒe 4. Kpɔ Kpɔ Aɖabaƒoƒo 15 Ðesiaɖe"]

Dɔnɔdzikpɔƒe ƒe Triage Table: Green/Yellow Overamping vs. Red Sympathomimetic Emergency¶

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Kpata si Dea Agbe Afɔku Me 1: Dzoxɔxɔ Gã si Dzea Ame Dzi ("Nuɖaɖa Tso Eme") .¶

Nu gbãtɔ si nana ame kuna kabakaba le methamphetamine, MDMA ("molly"), kple cathinone si wowɔ ("bath salt") zazã fũ akpa me enye dzodzoetsitsi si si dzo.

1. Nusita atike siwo doa ŋusẽ ame nana ŋutilã ƒe dzoxɔxɔ veviwo wua Celsius dzidzenu 41 (Fahrenheit dzidzenu 106) .¶

Nusiwo doa ŋusẽ ame ƒe ŋutilã trɔa dzodoƒe si le eme la ɖe dzi le ɣeyiɣi ɖeka me esime wole eƒe dzoxɔxɔnamɔ̃a gbãm:

• Dzoxɔxɔ Gã: Dopamine, serotonin, kple norepinephrine si sɔ gbɔ akpa nana ƒunukpeƒeŋusẽ ƒe lãmekawo ƒe dɔwɔwɔ fũ akpa, aɖuwo ƒe ʋuʋu, ʋuʋu, kple mitochondria ƒe kadodo ɖeɖeɖa (UCP-3), si hea dzoxɔxɔ gã aɖe vɛ le lãmenugbagbeviwo ƒe dɔwɔwɔ me (vevietɔ le zãmodzakaɖeƒe siwo amewo sɔ gbɔ ɖo, siwo me dzoxɔxɔ le, dzomeŋɔli ƒe azãɖuɖuwo, alo xɔ siwo me ya megena ɖo nyuie o me).
• Blocked Heat Dissipation: Le ɣeyiɣi ma ke me la, norepinephrine hea alpha-1 adrenergic peripheral vasoconstriction sesẽ vɛ, clamping xea ʋuka siwo le ŋutigbalẽa me ale be hot core blood mate ŋu aɖo ŋutigbalẽa ƒe anyime be wòafa o.
• The 40.5C (105F) Multi-Organ Failure Threshold: Ne core temperature wu 40.5 degrees Celsius (105 degrees Fahrenheit) hena ɣeyiɣi si wu miniti 20 va ɖo 30 la, lãmenugbagbeviwo me proteinwo trɔna, dɔgboa ƒe mɔxenu la gblẽna (etsɔa dɔgboa me aɖi siwo le ʋu me ƒua gbe), ƒumelãwo ƒe lãmekawo ƒuna (rhabdomyolysis), eye ʋu ƒe sisi ƒe ɖoɖoa yia gbe me (Disseminated Intravascular Coagulation / DIC), si wɔnɛ be ʋu dona le ŋutinu ɖesiaɖe me wòwua ame.

2. Afɔɖeɖe ɖesiaɖe Do Ŋgɔ na Kɔdziyiyi Fafa Kabakaba ƒe Ðoɖowɔɖi¶

Mègalala **mègalala be kpekpeɖeŋunalawo nadze fafa na dɔnɔ si doa ŋusẽ ame si le dzo dam gɔme o, eye mègana acetaminophen (paracetamol / Tylenol) alo ibuprofen/aspirin gbeɖe be wòaɖe dzoxɔxɔ si doa ŋusẽ ame ƒe dzoxɔxɔ dzi akpɔtɔ o. Dzoxɔxɔnutsitikewo wɔa dɔ ɖe hypothalamus dzi le asrã/dɔlékui ƒe dzoxɔxɔ si xɔa ame me eye wowɔa zero na lãmekawo ƒe dzoxɔxɔ si atikewo hena vɛ (si gavloe wue nye be acetaminophen na aklã ƒe dɔmawɔmawɔ nyuie le dzoxɔxɔ si gbɔ eme me, eye NSAIDs nana ayiku ƒe dɔmawɔmawɔ nyuie gagblẽna ɖe edzi).

1. Ʋu Yi Teƒe Fafɛtɔ: Kplɔ amea yi xɔ si me ya fafɛ le alo ya si me vɔvɔli le me eye nàɖe awudziwui kpekpewo, hoodies, kposɔwo, kple afɔkpawo ɖa vaseɖe ete.
2. Tsɔ Ice Packs sisi ɖe Ʋukawo ƒe Ƒuƒoƒo Gãwo Ŋu: Xatsa tsikpe gbadzɛwo, tsikpe ƒe kotokuwo, alo nuɖuɖu babla siwo wofa tsikpe me ɖe afɔkpa tsɛ aɖe si me tsi le me eye nàbla wo ɖe kɔ (carotid arteries), abɔta (axillary arteries), kple groin creases (femoral arteries) ŋu sesĩe.
3. Evaporative Spray-and-Fan Cooling (alo Tsi Fafɛ-Nyrɔe):
   • Tsɔ tsi fafɛ ƒu gbe alo nàtsɔ tsi fafɛ asisi ɖe ŋutigbalẽ ƒuƒlu ƒe teƒe gãwo (15 to 20 degrees Celsius / 60 to 68 degrees Fahrenheit) esime nèle elektrik-fetu sesẽtɔ kekeake si li (alo tsɔ kakɛ/afɔkpawo tsɔm sesĩe) fia asi ŋutigbalẽ si xɔ dzo la tẽ. Dzoxɔxɔ ɖea dzoxɔxɔ ɖa kabakaba zi gbɔ zi adre wu ya ƒuƒu.
   • Ne tsileƒe li enumake eye amea le ŋudzɔ (alo kpeɖeŋutɔ sesẽ eve ate ŋu alé ta la ɖe tsia me dedie), nyrɔ akɔta kple abɔwo ɖe pɔmpi me tsi fafɛ me. (Kpɔ Dzoxɔxɔ ƒe ʋuʋu vs. dzoxɔxɔ ƒe ɖeɖiteameŋu.) .

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Kpata 2 si ate ŋu ade ame ƒe agbe afɔku me: Cocaine kple Methamphetamine Akɔtave (Dzidɔ & Vasospasm) .¶

Cocaine kple methamphetamine hea dzitodzito me dɔléle sesẽ (dzidɔ), aortic dissection, kple dzi ƒe dɔmawɔmawɔ kpata vɛ le ezãla siwo xɔ tso ƒe 19 va ɖo 35 siwo me ʋumemi ƒe ƒuƒoƒo aɖeke mele woƒe ʋukawo me o gɔ̃ hã me.

1. Cocaine (kple Cocaethylene si me aha sesẽ le) ƒe dzi ƒe ƒoƒo zi etɔ̃ .¶

• Coronary Artery Vasospasm + Surging Oxygen Demand: Cocaine kple meth nana dzitodzito ƒe lãmeka ƒoa sesĩe wu eye le ɣeyiɣi ɖeka me la, wole dzitodzito me ʋukawo ʋuʋum, si wɔnɛ be oxygen ƒe dɔ wua dzitodzito me lãmeka.
• Direct Sodium-Channel Blockade (Cocaine Ko): Cocaine nye atike si naa alɔ̃dɔdɔ le teƒea ("caine") si xea mɔ na dzitodzito me sodium si zɔna kabakaba (Na+) channels, keke dzia ƒe elektrikŋusẽ QRS sesẽ eye wòhea ventricular tachycardia alo ventricular fibrillation (si kɔdzi ɖɔktawo tsɔa sodium bicarbonate si wodona ɖe ʋuka me daa dɔe) si wua ame vɛ.
• Ʋu ƒe Ʋuʋu Kabakaba: Dɔlékuiwutikewo nana ʋumenugbagbevi dzĩwo wɔa dɔ, si wɔnɛ be ʋu sina zi ɖeka le dzitodzito me ʋuka si le ʋuʋum la me.
• The Cocaethylene Multiplier (Cocaine + Alcohol): Ne ame aɖe no aha esime wòle powder alo crack cocaine zãm la, amegbetɔ ƒe aklã trɔa atike eveawo wòzua susuŋudɔwɔwɔ ƒe atike etɔ̃lia si to vovo si woyɔna be cocaethylene. Cocaethylene ƒe agbenɔƒe afã le ʋumenugbagbevi dzĩ me didi wu cocaine ɖeɖe zi gbɔ zi 3 va ɖo 5 eye wòdzia ​​dzi ƒe ku kpata ƒe afɔkua ɖe edzi zi gbɔ zi 18 va ɖo 25.

2. Kpekpeɖeŋu gbãtɔ na akɔtave si doa ŋusẽ ame (kple Kɔdzi ƒe Beta-Blocker Nuxlɔ̃ame) .¶

1. Ƒo ka na 911 / 112 / 999 enumake ne akɔtave ɖesiaɖe si le ʋuʋum, si le kpekpem, si le bibim, alo esi le dzo dam, gbɔgbɔtsixe tsia ƒo, fifia fafɛ, alo vevesese si klẽna ɖe megbe, kɔ, aɖu, alo alɔnu.
2. Enforce Complete Physical Rest & Calm: Na amea nanɔ anyi ɖe nɔnɔme si me wòabɔbɔ nɔ afã kple afã me (45 degrees) kple klo siwo wobɔbɔ. Afɔ ɖesiaɖe si wozɔ la nana catecholamines kple dzitodzito me oxygen ƒe hiahiã dzina ɖe edzi.
3. Na Non-Enteric Chewable Aspirin mg 162 va ɖo 325: Negbe ɖe aspirin ƒe nulɔdɔ vavãtɔ le amea ŋu alo ɖe dzesiwo fia be ahɔhɔ̃ me ʋu le dodom/ʋuʋudedi alo akɔtave si le ʋuʋum (aortic dissection) ko la, na **na aɖu ame tsitsi ɖeka aspirin 325 mg (alo vidzĩ aspirin 81 mg eve va ɖo ene) be wòadzudzɔ ʋumenugbagbevi dzĩwo ƒe ʋuʋu le dzitodzito me ʋuka si me ʋu sina tona. (Kpɔ Dzidɔ ƒe kpekpeɖeŋunadɔ gbãtɔ.) .
4. Gblɔ Na Dɔnɔdzikpɔlawo Kple ER Ðɔktawo Enumake Be Wozã Cocaine alo Meth:
   • Le dzidɔ si wozãna ɖaa si menye atike o me la, ɖɔkta siwo kpɔa nudzɔdzɔ kpatawo gbɔ naa beta-blockers (abe metoprolol alo propranolol) le ʋuka me edziedzi.
   • Le cocaine alo methamphetamine zazã fũ akpa me la, nana beta-blocker dzadzɛ (beta-1 / beta-2 blockade) ateŋu ahe "unotposed alpha-adrenergic stimulation," afisi beta receptors xexe nana alpha receptors ʋuna, si wɔnɛ be dzitodzito me ʋukawo tsia keŋkeŋ eye ʋu ƒe sisi dzina ɖe edzi wòwua ame.
   • Ne ègblɔ na ER ɖɔkta nyateƒe be cocaine alo meth le ʋua me la, wodaa akɔtavea dedie to benzodiazepines siwo wodona ɖe ʋuka me (lorazepam alo diazepam) tsɔ naa central sympathetic drive, sublingal alo IV nitroglycerin, kple calcium-channel blockers (diltiazem/verapamil) alo phentolamine ƒe dɔwɔwɔ.

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Kpata si Dea Agbe Afɔku Me 3: MDMA ("Molly" / "Ecstasy") Tsi ƒe Mumu kple Tsikuɖiɖi¶

MDMA (3,4-methylenedioxymethamphetamine) tsɔa tsidede ƒe afɔku tɔxɛ aɖe si wu sɔhɛ azãɖuƒe kple klabu vala siwo dze agbagba be "yewoawɔ nu nyuitɔ" to tsi gbadza galɔn geɖe ƒoƒo me.

+-------------------------------------------------------------------------+
|       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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Kpata 4 lia si ate ŋu ade ame ƒe agbe afɔku me: Ʋusɔgbɔdɔ si doa ŋusẽ ame, Ʋu si dona le akɔta te, kple alɔ̃madɔmadɔ¶

Elabena methamphetamine, cocaine, crack, kple cathinones siwo wowɔ nana ʋukawo me ʋu ƒe sisi dzina ɖe edzi kpata sesĩe (200/120 to 260/150 mmHg) kpe ɖe ahɔhɔ̃mekawo ƒe ʋuʋu kple ʋumenugbagbevi dzĩwo ƒe ƒuƒoƒo ŋu la, ischemic stroke sesẽ kple ahɔhɔ̃ me ʋu si dona le ahɔhɔ̃a me (ʋu si dona le ahɔhɔ̃ me alo ahɔhɔ̃ me ʋuka si me ʋu le) nye kuxi sesẽ siwo dona enuenu le atike siwo doa ŋusẽ ame ƒe ʋu ƒe sisi fũu akpa me, le amesiwo xɔ ƒe blaeve kple blaetɔ̃ gɔ̃ hã gome.

1. Dzesidede ahɔhɔ̃ me ʋu alo ʋusɔgbɔdɔ si tso atike si doa ŋusẽ ame ƒe lãme (BE-FAST) .¶

Mègabu taɖuame sesẽ, nukikli, alo nuƒoƒo si me mekɔ o le duɖimekeke si doa ŋusẽ ame me gbeɖe be "wòle kɔkɔm ko" alo alɔ̃madɔmadɔ o:

• The "Thunderclap" Taɖuame (Ruptured Aneurysm / Subarachnoid Hemorrhage): Ne ame aɖe si no crack, snorted cocaine, alo zã methamphetamine teti koe lé eƒe ta eye wòdo ɣli kple taɖuame vɔ̃ɖitɔ kekeake, si wóna wu le woƒe agbe me (si ɖo vevesese gãtɔ kekeake gbɔ le sɛkɛnd 60 me), si kpe ɖe kɔ sesẽ aɖe ŋu la, ʋuka aɖe si le ahɔhɔ̃a ƒe gɔme ƒe ʋuʋu, kekeli ƒe seselelãme, alo mumu, anɔ eme be ʋuka aɖe si le ahɔhɔ̃a ƒe gɔme la gbã le catecholamine ƒe ʋu ƒe sisi si nu sẽ ta.
• ** ** .BE-FAST Ahɔhɔ̃mekawo ƒe Ʋusɔgbɔdɔ ƒe Aflaga Dzĩwo:**
  • B (Balance): Dadasɔ ƒe bu kpata, taɖuame, alo azɔlizɔzɔ dzɔdzɔe ƒe ŋutetemanɔamesi.
  • E (Ŋkuwo): Kasia ŋku ɖeka alo evea siaa ƒe ŋkume megakpɔa nu nyuie o, zi gbɔ zi eve, alo bu.
  • F (Mo): Mo ƒe akpa ɖeka ɖiɖina alo wòsena le eɖokui me be yeƒe lãme gbãna ne wobia tso esi be wòako alɔgbɔnu.
  • A (Abɔwo): Alɔ alo afɔ ɖeka ƒua du yia anyime alo wòsena le eɖokui me be yegbɔdzɔ/ele ʋuʋum ne wodoe ɖe dzi.
  • S (Nuƒoƒo): Nuƒoƒo si me mekɔ o, nya siwo me mekɔ o, alo nyagbe bɔbɔewo gɔmesese ƒe ŋutetemanɔamesi.
  • T (Ɣeyiɣi): Yɔ 911 / . 112 / . 999 enumake eye mègana aspirin ne dziɖegbe ƒe ta le amea ŋu alo wosusu be ahɔhɔ̃ me ʋu le dodom (aspirin nana ʋu si dona le tagbɔ me gagblẽna ɖe edzi).

2. Alɔ̃madɔmadɔ si atike si doa ŋusẽ ame ƒe susu hena vɛ dzi kpɔkpɔ esime wole kpekpeɖeŋunalawo lalam¶

Atike siwo doa ŋusẽ ame ɖea ahɔhɔ̃a ƒe alɔ̃madɔmadɔ ƒe dzidzenu dzi kpɔtɔna tẽ to sodium-channel effects (cocaine), ahɔhɔ̃mekawo ƒe ʋuʋu, dzoxɔxɔ si gbɔ eme, kple hyponatremia (MDMA) dzi. To vovo na asrãdɔ si wonya nyuie si nu tsona le eɖokui si le sɛkɛnd 60 megbe la, alɔ̃madɔmadɔ siwo atikewo hena vɛ la yia ŋgɔ enuenu va zua asrãdɔ si nɔa anyi ɖaa negbe ɖe wotsɔ benzodiazepines (midazolam, lorazepam, alo diazepam) si wodona ɖe ʋuka me alo esi wodona ɖe lãmekawo me da dɔ nɛ hafi:

1. Klɔ anyigba eye nàtsɔ akɔtaɖonu aɖo ta dzi: Na amea nadze anyigba, tsɔ jaketi alo akɔtaɖonu si woxatsa la ƒu gbe ɖe eƒe ta te, eye nàtu kɔfi kplɔ̃wo, dzoxɔxɔnamɔ̃wo, kple ahuhɔ̃enuwo ɖe afisi womate ŋu aɖo o.
2. Tsɔ Tsikpewo Da Ðe Kɔ, Abɔta, Kple Akɔta: Dɔnɔ si doa ŋusẽ lãmeka si le ʋuʋum la naa lãmekawo ƒe dzoxɔxɔ gã aɖe si ate ŋu ana dzoxɔxɔ si le eme la nagbɔ Celsius dzidzenu 41 (Fahrenheit 106) le aɖabaƒoƒo ʋɛ aɖewo ko me; dze kɔ kple abɔta fafa gɔme enumake esime wole nu lém.
3. Mègatsɔ naneke de woƒe nu me gbeɖe o eye nàlé woƒe abɔ kple afɔ siwo le ʋuʋum la ɖe asi gbeɖe o: Ne èzi gaku, gakotoku, alo asibidɛwo dzi le aɖu siwo le ʋuʋum dome la, egbãa aɖuwo eye wòxea yaƒoƒomɔ̃a, eye abɔ kple afɔ siwo le ʋuʋum la ƒoƒo ɖe anyi la, egbãa ƒuwo eye wònaa lãmekawo ƒe gbagbã gagblẽna ɖe edzi (rhabdomyolysis).
4. Roll into the Side-Lying Recovery Position the moment the jerking stops: Klɔ aɖuɖɔ alo ʋuʋudedi tso nu me to wo ƒoƒo ɖe woƒe miame kple asike si wokɔ ɖe dzi vie ale be woate ŋu agbɔ ya faa vaseɖe esime kpekpeɖeŋunalawo nava.

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Nuveviwɔame Dzi Ðeɖe Akpɔtɔ Do Ŋgɔ Na Zazã Kple Aɖuɖɔtoe Titina Dedienɔnɔ: Mɔxexe Ðe Aɖi Zazã Gbɔgbɔme Kple Fentanyl Aɖi Zazã Nu¶

Le ame ɖekaɖeka siwo zãa atike siwo doa ŋusẽ ame fifia alo ƒomea me tɔ siwo le kpekpem ɖe ame aɖe si le afɔku me ŋu gome la, afɔɖeɖe siwo wotu ɖe kpeɖodziwo dzi tsɔ ɖea nusiwo gblẽ le ame ŋu dzi kpɔtɔna ɖea afɔku si le atike muamewo zazã fũ si wua ame me dzi kpɔtɔna ŋutɔ:

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Afɔɖeɖe ɖesiaɖe ƒe Nuveviwɔame dzi ɖeɖe kpɔtɔ De-Escalation na Non-Critical Overamping¶

Ne èlé ŋku ɖe nu ɖesiaɖe si le triage table si le etame ŋu eye nèɖo kpe edzi be akɔta meve amea o, dzoxɔxɔ/ŋutilã si le dzo dam mele eŋu o, alɔ̃madɔmadɔ aɖeke mele eŋu o, ʋusɔgbɔdɔ ƒe dzesi aɖeke mele eŋu o, eye gbɔgbɔtsixe tsia eƒe gbɔgbɔ nyuie o la, ke ele susume/autonomic overamp si mehiã vevie o (zi geɖe la, edzea egɔme to atike si doa ŋusẽ ame ƒe agbɔsɔsɔ vie nono, atike siwo doa ŋusẽ ame kple caffeine tsakatsaka, alo ŋudzɔnɔnɔ hena 36 to gaƒoƒo 72).

1. Nutome kple ŋutilã ƒe dɔwɔwɔ ƒe de-escalation checklist¶

1. Trɔ Sidzenuwo ƒe Nɔnɔme Enumake:
   • Te ɖa le bass-haƒoƒo sesẽwo, xɔ siwo me amewo sɔ gbɔ ɖo, akaɖi siwo le keklẽm, alo ablɔdzi dzogoe siwo dzi nuteɖeamedzi le gbɔ yi xɔdɔme fafɛ si me tomefafa le si me akaɖiwo mekɔ o me.
2. Fa Vagus Nerve (Mawɔ Ʋuʋudedi na Ŋutilã):
   • Da avɔ fafɛ si xɔ dzo ɖe woƒe ŋgonu, ŋkuwo, kple kɔ megbe, alo na woaɖi tsi fafɛ si me fa miamiamia (vuvɔ si me tsikpe le gbeɖe o) esime wobɔbɔ nɔ anyi alo le ŋku lém ɖe wo ŋu.
3. Tsi kple Electrolytes kple Carbohydrates Blewuwo:
   • Atike siwo doa ŋusẽ ame ƒe agbɔsɔsɔ fũ ɖea sukli, sodium, potassium, kple magnesium le ʋu me dzi kpɔtɔna esime wònana nu me ƒuna vevie ("cottonmouth") eye wònaa aɖuwo ƒoa ƒu (bruxism).
   • Na elektrik-nunono si fa miamiamia, koklozitsi, notsi, alo atikutsetse smoothie nono suesuesue madzudzɔmadzudzɔe, tsɔ kpe ɖe numeɖenu falɛfalɛ siwo mimi bɔbɔe (akɔɖu, yogurt, akɔɖu, alo lãmi) kple aŋe si wotsɔ ɖua aŋe alo avɔ dzadzɛ ƒe dzogoe aɖe ŋu be woagagbã woƒe aɖuwo le aɖuwo ƒe ƒoƒo me o.
4. De Ʋuʋu Fafɛ ALOO Gbɔɖeme ƒe dzi ƒo (Amesi Si Wose le Wo ɖokui Me Le Dedie Le Wo Me):
   • Ame aɖewo siwo le ʋusɔgbɔdɔ wɔm fũu akpa la sena le wo ɖokui me be yewotsi mɔ̃ me ne wogblɔ na wo be woamlɔ anyi keŋkeŋ; azɔlizɔzɔ blewuu le xɔ si me dedienɔnɔ le me, kekeɖenudɔwɔwɔ, alo anyinɔƒe ɖe tsitrenu esime nèle gbɔgbɔ blewu si nye sɛkɛnd 4 / sɛkɛnd 6 ƒe gbɔgbɔ fiãa lãmekawo ƒe ʋuʋu ƒe ŋusẽ vaseɖe esime eƒe kɔkɔƒe nava yi.

2. Alesi woaƒo nu kple amesi le paranoia si doa ŋusẽ ame alo alɔ̃madɔmadɔ ƒe susu ƒe dɔléle le fu ɖem na¶

Le gaƒoƒo 48 va ɖo 96 alɔ̃madɔmadɔ le methamphetamine alo crack cocaine zazã me megbe la, ezãla siwo ade 40 va ɖo 60 le alafa me kpɔa susumedɔléle si doa ŋusẽ ame hena ɣeyiɣi kpui aɖe: tosese ƒe susumenuwo (sesese ƒe ɣlidodo alo kpovitɔwo ƒe radio le gota), nukpɔkpɔ ƒe vɔvɔli-amewo le nukpɔkpɔ le gota, asikaka susumenuwo ("meth mites" / ƒoƒo ɖe ŋutigbalẽ te), alo sesẽ paranoia be amewo le ŋku lém ɖe fesrewo nu.

• Mègahe nya kple woƒe ameflunya alo aɖu fewu le eŋu gbeɖe o, eye mègawɔ abe ɖe nèkpɔ alakpanuwɔwɔa hã ene gbeɖe o:
  • Vrong: "Èle tagbɔ gblẽm, ame aɖeke mele fesre godo o, nɔ anyi" (ehe dziku vɛ eye wòna woxɔe se be yenye nya la ƒe akpa aɖe).
  • Vrong: "Oh yeah, mekpɔ ŋkutsalaawo hã le gota" (escalates their terror).
  • Enyo (Validate the emotion, ground in safety): "Mekpɔ alesi gbegbe ema se le eɖokui me dziŋɔe fifia. Èle dedie le afisia kplim le xɔ sia me, wotu ʋɔtrua, eye manɔ afisia tututu eye makpɔ nyuie le ŋuwò esime nèbɔbɔ nɔ anyi nɔ tsi fafɛ sia nom."
• Na wò asiwo nadze, tsi tre ɖe dzogoe si ƒe didime nye dzidzenu 45 dzi meta 2 (afɔ 6) ya teti, eye nàxe mɔ si dzi nàto ado le eme gbeɖe o: Ame si ƒe susu mewɔa dɔ nyuie o si se le eɖokui me be yele dzogoe dzi le xɔ aɖe me kple ame aɖe si le ʋɔa xem la atsi dzodzodzoe eye wòaƒo ga alo awɔ avu. Na woanɔ anyi ɖe afisi woate ŋu akpɔ ʋɔtrua nyuie le.
• Ƒo asa na ablɔdzi "landing gear" atikekui siwo womeŋlɔ na wò o nana: Mègana ame aɖe si le ablɔdzi "Xanax" bar alo opioid atikekui aɖe ƒom fũu akpa be wòadɔ alɔ̃ gbeɖe o; wotsɔa fentanyl, bromazolam, kple xylazine blaa ablɔdzi alprazolam-ti aʋatsotɔwoe vevie, si trɔa atike si doa ŋusẽ ame ƒe agbɔsɔsɔ si woate ŋu atsi agbe wòazu gbɔgbɔtsixe si wua ame esime amesiame le alɔ̃ dɔm.

(Ne wò alo wò lɔlɔ̃tɔ aɖe le avu wɔm kple methamphetamine, cocaine, crack, alo atike siwo doa ŋusẽ ame ƒe numame si woŋlɔ na wò la, kpɔe ɖa Atike muamewo zazã kple atike muamewo zazã ƒe numame: kpekpeɖeŋunana kpata ƒe mɔfiame, . Dɔlélea gbugbɔgadzɔ kple mɔxexe ɖe atike si wozãna wògbɔa eme nu: fentanyl/xylazine dodokpɔ ƒe agbalẽviwo kple naloxone, kple Kpekpeɖeŋu nana ƒomea me tɔ si numame le. Bu kpekpeɖeŋunana gbãtɔ kple CPR ƒe nusɔsrɔ̃ si ŋu woda asi ɖo si wowɔna le asi me wɔwɔ tso Atitsoga Dzĩ Habɔbɔ, St John Ambulance, alo nutoa me dɔwɔƒe aɖe gbɔ ŋu kpɔ.)

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Nya siwo wobiaa amewo enuenu¶

Wolé ŋku ɖe dzɔtsoƒewo ŋu¶

• Amerika Dzi Habɔbɔ (AHA, United States): Dzɔdzɔmeŋutinunya me Nyatakaka tso Akɔtave kple Dzitodzito me Dɔléle si Do Ƒome Kple Cocaine Dzi Kpɔkpɔ Ŋu (Coronary vasospasm pathophysiology, sodium-channel blockade, benzodiazepine kple nitroglycerin ƒe atikewɔwɔ gbãtɔ, kple beta-blockade si ŋu wometsi tre ɖo o ƒoƒo asa na).
• Atike Vɔ̃ɖiwo Zazã Kple Susu ƒe Lãmesẽnyawo Gbɔkpɔha (SAMHSA) & Dukɔa ƒe Atike Vɔ̃ɖiwo Zazã Ŋuti Dɔwɔƒe (NIDA / NIH, United States): Atike Vɔ̃ɖiwo Zazã ƒe Dɔlélewo Dada (TIP 33 / Dɔnɔdzikpɔƒe ƒe Mɔfiame), sympathomimetic toxidrome triage, kple fentanyl ƒe gomekpɔkpɔ ɖekae le atike siwo doa ŋusẽ ame siwo ŋu se meɖe mɔ ɖo o me.
• Amerikatɔwo ƒe Atikewɔwɔ ƒe Aɖiŋutinunya ƒe Kɔledzi (ACMT) kple Amerikatɔwo ƒe Atikewɔlawo ƒe Kɔledzi si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ (ACEP): Aɖi si Le Veveseseɖeamenu Sesẽ, Dzidzɔkpɔkpɔ ƒe Tagbɔdɔ / Ʋuʋudedi Sesẽ, Kple Dzoxɔxɔ si Atike Vɔ̃ɖiwo Hena (Fafa kabakaba si kplɔa ame/yaƒoƒo, ƒoƒo asa na gbɔgbɔtsixetsixe si bɔbɔna, kple rhabdomyolysis dzikpɔkpɔ).
• Dukɔa ƒe Nuveviwɔame Dzi Ðeɖe Akpɔtɔ ƒe Habɔbɔ (United States) & Atike Vɔ̃ɖiwo Ŋuti Ðoɖowɔha: Dzesidede Ame Ŋu Kple Eŋuɖoɖo na Stimulant Overamping (Vovototodede susu me overamping kple atikewɔwɔ kpata kple de-escalation nuwɔna siwo le dedie dome).
• Europa ƒe Atike Vɔ̃ɖiwo Kple Atike Vɔ̃ɖiwo ƒe Numame Dzikpɔƒe (EMCDDA / EUDA) & UK Dukɔa ƒe Aɖiwo Ŋuti Nyatakaka Dɔwɔƒe (TOXBASE): Dɔdaƒe ƒe mɔfiame le MDMA-si hea Dzesi si nye Antidiuretic Hormone Secretion si Mesɔ O (SIADH / acute dilutional hyponatremia) kple cocaethylene cardiotoxicity ŋu.

Mɔfiame siwo do ƒome kplii¶

• Opioid zazã fũ akpa ƒe kpekpeɖeŋunana gbãtɔ
• Dɔlélea gbugbɔgadzɔ kple mɔxexe ɖe atike si wozãna wògbɔa eme nu: fentanyl/xylazine dodokpɔ ƒe agbalẽviwo kple naloxone
• Atike muamewo zazã kple atike muamewo zazã ƒe numame: kpekpeɖeŋunana kpata ƒe mɔfiame
• Kpekpeɖeŋu nana ƒomea me tɔ si numame le
• Dzidɔ ƒe kpekpeɖeŋunadɔ gbãtɔ
• Dzoxɔxɔ ƒe ʋuʋu vs. dzoxɔxɔ ƒe ɖeɖiteameŋu
• Ayiku ƒe abixɔxɔ sesẽ, rhabdomyolysis, kple aɖuɖɔtoe ƒe agbagbadzedze viviti ƒe vovototodedeameme
• Xexlẽdzesi siwo woatsɔ awɔ nudzɔdzɔ kpatawoe