Gila Monster kple Mexicotɔwo ƒe Beaded Lizard ƒe ɖuɖu ƒe ɖuɖu: Mɔ̃ɖaŋununya ƒe aɖuwo ɖuɖu, Exendin-4 Anaphylaxis, kple Yame ƒe Ʋukawo ƒe Ʋuʋudedi¶

Gila lã wɔadã (Heloderma suspectum, si dzɔ le Sonoran, Mojave, kple Chihuahuan dzogbe siwo le United States ƒe dzigbeɣetoɖoƒe kple Mexico ƒe dzieheɣetoɖoƒe) kple Mexican beaded lizard (Heloderma horridum kple Heloderma ƒomevi siwo do ƒome kplii le Mexico kple Guatemala katã) koe nye glidzaglidza aɖitɔ siwo le Amerika siwo wotsɔ dzra ɖo aɖi ƒe lãkusi tɔxɛ siwo le aɖu te kple aɖu siwo me do goglo. To vovo na da siwo woyɔna be rattlesnakes alo cobras, siwo doa aɖi le sɛkɛnd ɖeka ƒe akpa sue aɖe me to aɖu ƒe akpa si le etame ƒe asike siwo me do le me eye woɖea asi le woƒe lã lénuwo ŋu enumake la, Heloderma ʋetsuviwo mekpɔa lãmekawo ƒe aɖi-mimimɔ̃wo kple aɖu siwo me do le o. Ke boŋ aɖi sina yia dzi to ʋukawo ƒe dɔwɔwɔ me tso submandibular glands siwo le aɖu si le ete me to do siwo le ʋuʋu ɖi le aɖu siwo le ete kple esiwo le etame siaa dzi esime ʋetsuvi la tsɔa aɖu ƒe lãmeka siwo le abe bulldozer ene lénɛ ɖe anyi eye wòɖua amegbetɔ ƒe ŋutilã le ɣeyiɣi ƒe didime nu. Sɛkɛnd ɖesiaɖe si Gila lã wɔadã alo lãkle si wotsɔ dzonu wɔe gakpɔtɔ lé ɖe eŋu la naa aɖi geɖe gena ɖe ŋutigbalẽ ƒe ʋuka siwo vuvu me, eye ne woɖe mɔ lãkle kpekpea le xɔxlɔ̃m le asibidɛ alo asi ŋu matsɔe kpe ɖe eŋu o la, eʋãa aɖuɖɔtoe si me susu le si ƒoa aɖu siwo me woɖe do ɖo la va ɖoa akɔta kple lãkusiwo me. Ne aɖi nya ge ɖe ʋuka me ko la, helodermin, helospectin, gilpaterin, proteases siwo le abe kallikrein ene, kple exendin peptides (siwo dome exendin-4 le H. suspectum me hã le) hea vevesese sesẽ si le dzobibi me, edema si kaka kabakaba, vasodilation profound kallikrein-mediated vasodilation kple hypotensive shock, kple le 15 va ɖo 30 le alafa me le ɖoɖowɔɖi me aɖiwo, fulminant agbe afɔku angioedema le aɖe, nuyiwo, uvula, kple larynx kpe ɖe IgE-tome anaphylaxis vavãtɔ ŋu. Ne Gila lã wɔadã alo lãkle aɖe si wotsɔ dzonu wɔe ɖu ame aɖe la, ƒo ka na wò nutoa me tɔ xexlẽdzesi siwo wozãna kpata enumake. Dzro mía nɔviwo ŋuti mɔfiamegbalẽ siwo ku ɖe... nulɔdɔwo kple anaphylaxis, . da ƒe ɖuɖu, kple dzidziƒoame.

Nusi nàtsɔ aɖo nɔƒe gbãtɔ enumake enye be do alɔ ʋetsuvi la ƒe ŋutilã ƒe kpekpeme bliboa enumake ale be wòagahe ɖe abi la ŋu o, nàtsɔ nu gbadzɛ sesẽ aɖe alo ati si woda ɖe ŋgɔgbe aɖuwo megbe atsɔ aʋu aɖuawo le sɛkɛnd ʋɛ aɖewo me esime nèle abɔa hem do goe dzadzɛ (mègalé dzo ɖe asike te gbeɖe o eye mèganyrɔ ʋetsuvi la ɖe tsi me gbeɖe o), nàna lãmeka me epinephrine auto-injector enumake ne aɖe vuvu, eƒe ɖiɖi, stridor, alo taɖuame va dze edzi, eye nàtsɔ amesi ŋu wowɔ nuvevii la ayi dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ be woakpɔ yaƒoƒomɔ̃wo ta kaba, isotonic fluid resuscitation, kple plain-film X-rays be woakpɔ aɖu siwo gbã siwo le gbagbãm.

Wɔ esia fifia¶

1. Do alɔ ʋetsuvi la ƒe kpekpeme enumake eye nàdae ɖe anyigba, kplɔ̃, alo wò abɔta si le ablɔɖe me la dzi. Mègana Gila lã wɔadã alo Mexicotɔwo ƒe lãkle si wotsɔ dzonu wɔe la nadze yame gbeɖe tso asibidɛ, asi, alo alɔnu si woɖu gbɔ o, eye mègadze agbagba gbeɖe be yeaʋuʋui alo atsɔe aƒu gbe o. Hehe hea abi la, eɖea lãkusiwo, eye wònaa ʋetsuvi la ƒe ametakpɔnu si léa nu ɖe ​​eŋu la wɔa dɔ ale be wòɖua nu goglo wu eye wòtsɔa aɖi geɖe si le abi te la dea aɖuɖɔtoeawo me.
2. Zã asike gbadza sesẽ aɖe tsɔ lã aɖuawo ɖe vovo le sɛkɛnd ʋɛ aɖewo ko me, eye nàhe ŋutilã ƒe akpa si woɖu la tẽ. Tsɔ ati sesẽ, gavi ƒe asiléƒe, bɔta hɛ, ga ƒe ʋuƒo, gaxɔgbalẽvi ƒe ƒuƒoƒo, alo ʋu si xea mɔ na ʋu ƒe sisi le aɖuawo ƒe megbe alo axadzi dome, tu aɖuawo ɖe wo nɔewo ŋu esime nèle lãgbalẽgoloa ƒe ta ƒe megbe lém sesĩe (do lãgbalẽ asigɛwo alo afɔkpa si woxatsa ne enumake le asi me), eye nàɖe asibidɛ si woɖu la le ʋuʋu kabakaba ɖeka me. Mègalé akaɖi alo dzobibi ɖe lãkle ƒe asike te gbeɖe o, eye mèganyrɔ lãklea kple wò asi ɖe tsigoe me gbeɖe o; dzoxɔxɔ kple tsinyenye ƒe nuteɖeamedzi hea ƒoƒo kple nuɖuɖu ɖuɖu dzitsitsi vɛ.
3. Ƒo ka na wò nutoa me xexlẽdzesi kpata enumake eye nàdoe kpɔ be yaƒoƒomɔ̃wo vuvu alo anaphylactic shock hã. Ƒo ka na 911 le United States kple Canada, 911 le Mexico, 112 le Europa Dukɔwo ƒe Habɔbɔ bliboa me, 999 le United Kingdom, 000 le Australia, alo nàlé ŋku ɖe míaƒe xexeame katã ƒe nyatakakadzraɖoƒe si nye xexlẽdzesi siwo wozãna kpata. Gblɔ na amesi tsɔe ɖo ɖa be aɖi Heloderma lãkle ɖu amesi ŋu wowɔ nuvevii si le afɔku gã aɖe me be aɖe kple lãkusi me ʋukawo ƒe ʋuʋu kabakaba kple ʋusɔgbɔdɔ ƒe dzidziɖedzi; aɖiwutike aɖeke meli si wodzrana na Heloderma aɖi o, eyata kɔdzi beléle kaba le vevie ŋutɔ.
4. Do Epinephrine Auto-Injector si wodona ɖe lãmeka me (EpiPen, 0.3 mg ame tsitsi / 0.15 mg ɖevi) ɖe gotagome titina enumake ne yaƒoƒomɔ̃ ƒe ʋukawo me ʋu ƒe sisi, anaphylaxis, alo ʋusɔgbɔdɔ ƒe dzesi aɖewo dze. Lé ŋku ɖe nuyi kple aɖe ƒe ʋuʋu alo vuvu ŋu nyuie, "potato dzodzoe" ƒe gbe si woxe, gbɔgbɔtsixe ƒe ʋuʋu sesĩe, aɖuɖɔ mimi sesẽ, aɖuɖɔtoe siwo kaka, ʋuʋudedi, alo taɖuame sesẽ. Esi wònye be bradykinin-releasing kallikreins kple immunogenic proteins (siwo dome exendin-4 kple phospholipase A2 hã le) siaa le Heloderma aɖi me ta la, yaƒoƒomɔ̃ si le etame ƒe nutsotso kabakaba ate ŋu adzɔ le miniti 15 va ɖo 45 me tso esime woɖui.
5. Ðe asigɛwo, gaƒoɖokuiwo, asigɛwo, kple awu sesẽwo katã ɖa le eƒe nugbɔ si woɖu la ŋu enumake, emegbe nàtsɔ tsi dzadzɛ si le sisim kple adzalẽ fafɛ ade tsi abi la nyuie. Vuvu dzea egɔme le miniti 5 va ɖo 15 me eye wòyia ŋgɔ yia asi kple abɔta dzi le gaƒoƒo ɖeka me, si trɔa asigɛ ɖesiaɖe wòzua ischemic tourniquet. Na abɔ kple afɔ si woɖu la nanɔ dzi si medea akpa aɖeke dzi o (megakɔe ɖe dzi wu dzia alo anɔ ƒoƒom ɖe anyime o).
6. MÈGADE ʋukawo me tourniquet, Pressure Immobilization Bandage (PIB), tsikpewo, cryotherapy, incisions, alo suction devices GBEÐE o. To vovo na Australia elapid dawo alo funnel-web spiders la, Heloderma ƒe aɖi me hyaluronidase, phospholipase A2, kple hemorrhagic metalloproteases si gblẽa nu le lãmenugbagbeviwo ŋu le. Ne wotsɔ aɖi si wotsɔ blaa aɖia alo tourniquet sesẽ la lée ɖe teƒea la, enaa enzyme siwo gblẽa nu la ƒoa ƒu ɖe asibidɛwo kple asi me, si hea compartment syndrome kple deep tissue necrosis vɛ.

Nyametsotsoti: Gila lã wɔadã kple beaded lizard ɖuɖu xɔname kple kɔdzi triage¶

flowchart TD
    A["Gila Monster alo Mexicotɔwo ƒe Beaded Lizard Bite"] --> B{"Ðe wogalé ʋetsuvi la ɖe ŋutigbalẽa ŋua?"}
    B -->|Yes: Jaws locked and chewing| C["Do alɔ ʋetsuvi ƒe ŋutilã ƒe kpekpeme gbadzaa le anyigba dzi enumake; MÈGANA wòahe ɖe ati ŋu alo atsɔ dzo/tsi asisi ɖe eŋu GBEÐE o"]
    B -->|No: Lizard already detached| D["Ʋuʋu meta 3 tso afima gbɔ; ɖe asigɛwo, gaƒoɖokuiwo, kple abɔta sesẽwo katã ɖa le abɔ kple afɔ si woɖu ŋu enumake"]
    C --> E["Tsɔ ati sesẽ, gavi ƒe asiléƒe, alo pry bar ƒo ɖe aɖuwo dome; lever ʋu eye nàhe abɔ kple afɔ tẽe"]
    E --> D
    D --> F{"Aɖe/nuyi ƒe vuvu, gbe si le ɖiɖim, stridor, ʋuʋudedi, aɖuɖɔtoe, alo alɔ̃madɔmadɔ aɖe li?"}
    F -->|Yes: Airway Angioedema or Anaphylactic Shock| G["Ƒo ka na 911 / Kpata ƒe Xexlẽdzesi FIFIA; do IM Epinephrine 0.3 mg ɖe akɔta gota; mlɔ anyi gbadzaa eye nàkɔ afɔwo ɖe dzi ne taɖuame"]
    F -->|No: Severe local burning pain and swelling only| H["De tsi abi kple adzalẽ kple tsi; na abɔ kple afɔ nanɔ dzi ƒe sɔsɔme; MÈGAZÃ tourniquet, PIB, alo tsikpe GBEÐE o"]
    G --> I["EMS ƒe tsɔtsɔ enumake: endotracheal intubation kaba hafi laryngeal edema naɖo eƒe kɔkɔƒe + IV crystalloids + vasopressors"]
    H --> J["Ʋuɖoɖo yi Kɔdzi Kpata Dɔwɔƒe be woalé ŋku ɖe aɖiŋutinunya ŋu gaƒoƒo 6 va ɖo 12 ya teti"]
    I --> K["Kɔdzidzikpɔkpɔ: Nutome lãmekawo ƒe mɔxexe alo IV fentanyl na vevesese + Soft-tissue X-ray na aɖu siwo me do le siwo wolé ɖe te + Tetanus & dɔlékuiwutikewo"]
    J --> K

Ta kple ta ƒe dɔdamɔnu ƒe tsɔtsɔ sɔ kple wo nɔewo: Heloderma Akpɔkplɔwo kple Dziehe Amerika Domelãwo kple Akpɔkplɔ Siwo Metsɔ Aɖi Le O¶

Esi wònye be zi geɖe la, amesiwo ŋu wowɔ nuvevii kple amesiwo wɔa dɔ le agble me le Amerika ƒe Anyieheɣetoɖoƒe, Mexico, kple lã siwo tana ƒe dɔwɔƒewo tɔtɔa Heloderma ƒe ɖuɖu si me aɖi le kple da si me aɖi le alo lãkle ƒe ɖuɖu si me aɖi mele o ta la, vovototodedeameme le nugbagbeŋutinunya kple aɖiŋutinunya me le vevie ŋutɔ:

Heloderma ƒe ɖuɖu ƒe ŋutilã ƒe wɔwɔme kple nusita sɛkɛndwo le vevie le aɖuwo ƒe ɖeɖeɖa me¶

Alesi aɖu siwo le ete siwo me ʋuʋudedi le kple aɖuɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔɖɔwo¶

Be nàse nusita wòle be woaɖe Gila lã wɔadã alo Mexicotɔwo ƒe lãkle si wotsɔ dzonu wɔe le sɛkɛnd ʋɛ gbãtɔwo me gɔme la, tsɔ eƒe aɖi ƒe ɖoɖoa sɔ kple da tɔ:

1. Submandibular Gland Architecture: Le Heloderma suspectum kple Heloderma horridum siaa me la, aɖi glands nye submandibular glands siwo ŋu wotrɔ asi le siwo le lower jaw (manible) me, si wɔnɛ be ʋuʋudedi le asike ŋu. Woma lãkusi ɖesiaɖe ɖe aɖu etɔ̃ alo ene me, eye lãkusi ɖesiaɖe sina toa eya ŋutɔ ƒe mɔ̃ me be wòaʋu ɖe nu me ƒe ʋuʋudedi me le gotagome aɖu siwo le aɖukpodzi ƒe gɔme la xa.
2. Aɖu siwo me ʋuʋudedi le kple ʋukawo ƒe dɔwɔwɔ: Gila lã wɔadã aɖe ƒe aɖu ɖaɖɛ siwo gbugbɔ ƒo xlãe la ade 35 va ɖo 40 le eƒe aɖuwo dzi. Aɖu siwo le ete kple esiwo le etame siaa tsɔa do goglo siwo didi ɖe woƒe ŋgɔgbe kple megbe, eye aɖi ƒe mɔ siwo goglo wu le aɖu siwo le ŋgɔgbe kple titina la dzi. Ne ʋetsuvi la ɖui la, aɖi ƒoa ƒu ɖe aɖu si le ete eye wòhenɛ yi dzi to aɖuawo ƒe dowo dzi to ʋukawo ƒe dɔwɔwɔ me yia amegbetɔ ƒe ŋutigbalẽ si vuvu la me tẽ.
3. Nusitae Hehe Kple Eɖuɖu Naa Aɖi ƒe Agbɔsɔsɔme Dzina Ðe Edzi: Esi lãmeka ƒe piston aɖeke meli si atsɔ aɖi aƒu gbe to mɔ̃ si me do le me o ta la, nip si wotsɔa ŋku léna kabakaba metsɔa aɖi aɖeke kloe yia teƒe bubu o (dry bite rate of 20 to 30 percent in brief nips). Gake ne Heloderma lé asibidɛ aɖe la, eƒe pterygoid kple temporalis aɖu ƒe lãmekawo tsia. Akpɔkplɔa wɔa axa ɖeka yi axadzi tutu kple aɖu ɖuɖu ƒe ʋuʋu le ɣeyiɣi ƒe didime nu, etsɔa aɖu siwo me do le la goglo wu to ŋutigbalẽ kple dijitaal nugowo me esime wònɔa aɖuɖɔtoeawo te mimim be yeatsɔ aɖi yeye akɔ abi ƒe aba la me.

================================================================================
   MECHANICAL JAW DETACHMENT PROTOCOL FOR CLAMPED HELODERMA LIZARDS
================================================================================

  [WRONG: Letting Lizard Hang]          [RIGHT: Support + Flat-Lever Pry]

       Bitten Hand                           Bitten Hand (Held Steady)
          |                                       |
      (Wound) <--- Gravity pulls down:        (Wound) <--- Pry stick / spoon
          |        Teeth saw into bone;           |        handle wedged behind
     [Lizard Head] reflexive jaw lock        [Lizard Head] front teeth to open
          |        pumps more venom               |
     [Heavy Body]                            [Heavy Body]
     (Dangling in                            ===============================
      mid-air)                               Supported FLAT on ground/table
                                             (Stops reflexive chewing lock)
================================================================================

Afɔɖeɖe ɖesiaɖe ƒe mɔ̃ si wotsɔna ɖea aɖuwo ɖa¶

Ne wobla Gila lã wɔadã aɖe alo Mexicotɔwo ƒe lãkle aɖe si wotsɔ dzonu wɔe ɖe wò asibidɛ, asi, alɔnu, alo afɔkpodzi ŋu la, wɔ ɖe ɖoɖo sia tututu dzi:

1. Afɔɖeɖe 1: Do alɔ lãkle ƒe ŋutilã le anyigba gbadza dzi enumake (Evelia 0 vaseɖe 2):
2. Lé ʋetsuvi la ƒe akɔta alo nàtsɔ wò asi si nèɖu la aɖo anyigba tẽ, agakpe, kplɔ̃dzi, alo wò ŋutɔ wò klo ale be lãklea ƒe ƒodo bliboa kple afɔ eneawo katã nanɔ anyi ɖe anyigba sesẽ aɖe dzi.
3. Nusitae esia wɔa dɔ: Ne lãkle se le eɖokui me be yeƒe afɔwo le anyigba sesẽ dzi eye wòdzudzɔ ʋuʋu le yame ko la, Heloderma lãkle siwo ade 30 va ɖo 40 le alafa me aʋu le wo ɖokui si eye woadze agbagba be yewoadzo ayi nutsyɔnu me.
4. Afɔɖeɖe 2: Tsɔ aŋe gbadza sesẽ aɖe ƒo ɖe ŋgɔgbe aɖuawo megbe eye nàʋui (Evelia 2 vaseɖe 10):
5. Ne ʋetsuvi la gakpɔtɔ le ƒoƒom la, na ame evelia (alo zã wò asi si le ablɔɖe me) nalé ʋetsuvi la sesĩe le ta/kɔ ƒe ƒoƒoƒe gbadzaa megbe tututu ale be wòagate ŋu atrɔ eƒe ŋutilã ɖe axadzi o (axadziʋuʋu aɖu siwo le gbagbãm le wò lãkusiwo me).
6. Tsɔ dɔwɔnu sesẽ ɖesiaɖe si le gbadzaa si li enumake: atiti sesẽ aɖe, gaku alo fɔkpa ƒe asiléƒe, bɔta hɛ, gavi si ƒe ta le gbadzaa, gaxɔgbalẽvi eve alo etɔ̃ ƒe ƒuƒoƒo, alo atikewɔwɔ ƒe ʋusɔgbɔdɔ.
7. Gbugbɔ lever la ɖe nu ƒe axadzi (le ŋgɔgbe aɖu siwo wotu sesĩe megbe), trɔ alo lever aɖuawo ɖe wo nɔewo ŋu le tsitrenu, eye zi alesi aɖuawo kɔ ŋutigbalẽa me ko la, he asibidɛ si woɖu la tẽe eye nàʋu meta 3 (afɔ 10) ya teti.
8. Afɔɖeɖe 3: Ne wò ɖeka koe le gbedadaƒo eye dɔwɔnu aɖeke mele asiwò o:
9. Da ʋetsuvi la ɖe anyigba gbadzaa, tsɔ wò klo alo afɔkpa ƒo eƒe ŋutilã blewu, tsɔ wò asi si le ablɔɖe me lé ta ƒe megbe, eye nàzã dzogbeti sesẽ alo kpe gbadzɛ aɖe atsɔ azi aɖuawo dzi woaʋu hafi ahe wò asi ado goe tẽ.
10. Nusitae Dukɔmeviwo ƒe Atikewɔwɔwo Nye Afɔku Eye Wode Se Ðe Wo Nu:
11. MÈGAlé dzo si le bɔbɔe wu, si me dzo le, alo dzo si le ʋuʋu ɖi la ɖe lãkle ƒe asike te GBEÐE o: Ne ètɔ dzo lãkle ƒe aɖu la, ena wò ŋutɔ wò asi biã le dzidzenu etɔ̃lia nu eye wòhea ƒoƒo sesĩe kple eɖuɖu si de to wu vɛ.
12. MÈGAnyrɔ ʋetsuvi la kple wò asi si nèɖu la ɖe tsi me GBEÐE o: Heloderma ʋetsuviwo ate ŋu alé woƒe gbɔgbɔ ɖe tsi te aɖabaƒoƒo 15 va ɖo 30 evɔ womaɖe asi le eŋu o, esime tsia klɔa nu me dɔlékuiwo kple aɖi siwo ƒo ƒu ɖe wò ʋuʋudedi siwo le ʋuʋu ɖi me.
13. MÈGAKƆ aha sesẽ, mɔ̃memi, alo amonia ɖe ʋetsuvi la ƒe nu me GBEÐE o: Atike siawo kɔa aɖuɖɔtoeawo me tẽe ɖe wò abi ƒuƒlu la me, si wɔnɛ be atikewo ƒe lãkusiwo vuvu vevie.

Heloderma aɖi ƒe dɔlélenutsiŋutete: Kallikreins, Helodermin, kple Exendin-4 Anaphylaxis¶

1. Vevesese si le veve sem le teƒea kple ʋuʋudedi si kaka kabakaba¶

Le aɖabaƒoƒo 2 va ɖo 5 me tso esime woɖu aɖi la, amesiwo ŋu wowɔ nuvevii la sea vevesese sesẽ aɖe si le bibim eye wònɔa ƒoƒom le afisi woɖui le si klẽna ɖe alɔ alo afɔ bliboa dzi le miniti 15 va ɖo 30 me. - Nusita vevesesea nu sẽ alea gbegbe: Heloderma ƒe aɖi me phospholipase A2, hyaluronidase ("kakaka" si ƒoa hyaluronic acid le lãmenugbagbeviwo godo ƒe matriki me), serotonin, kple kallikrein-like glycoproteins (gilatoxin le H. suspectum me kple horridum toxin le H. horridum) siwo ma kininogen ɖe bradykinin me. - Dɔnɔdzikpɔƒe ƒe dzedzeme: Zi geɖe la, abi la ɖea aɖu siwo me ʋu le dodom le kple aɖu siwo vuvu ƒe nɔnɔme si le abe gota afã alo V ene fiana, zi geɖe la, amadede trɔna blɔ ƒoa xlã aɖua ƒe dzesiwo. Tse edema kaka kabakaba tso asibidɛ si woɖu la dzi to asi dzi eye wòyi ŋgɔ le abɔta le gaƒoƒo 1 va ɖo 4 gbãtɔ me, eye nutome ʋumenugbagbeviɣidɔ si me kɔ le abɔta kple abɔta kpena ɖe eŋu. Zi geɖe la, vevesese sesẽ si le ƒoƒom la ɖoa eƒe kɔkɔƒe le gaƒoƒo 1 va ɖo 4 me eye ate ŋu anɔ anyi gaƒoƒo 12 va ɖo 48.

2. Kallikrein-bradykinin kple VIP-si le abe ʋusɔgbɔdɔ ƒe dzidziɖedzi ene¶

Le Gila lã wɔadã kple lãkle siwo ŋu beaded ɖuna ƒe alafa memama 15 va ɖo 30 me la, aɖi si sɔ gena ɖe ʋukawo kple ʋukawo me be wòahe systemic vasodilatory and cardiotoxic syndrome si ate ŋu ade ame ƒe agbe afɔku me vɛ le aɖabaƒoƒo 15 va ɖo 90 me: - Gilatoxin / Kallikrein Bradykinin Storm: Aɖi kallikreins naa bradykinin, si nye endothelial vasodilator sesẽ aɖe kple vascular permeability factor si nana arteriolar smooth muscle ɖiɖiɖeme kple capillary fluid ƒe sisi gã aɖe dona le ɖoɖo nu. - Helodermin kple Helospectin (VIP-like Peptides): Wo ame evea siaa H. suspectum kple H. horridum aɖiwo me helodermin kple helospectin, peptide siwo nye amegbetɔ ƒe Vasoactive Intestinal Peptide (VIP) ƒe wɔwɔme homologs. Peptide siawo blana ɖe ʋuka me VIP xɔlawo ŋu, wowɔa adenylate cyclase dɔ, wodoa lãmenugbagbeviwo me cyclic AMP (cAMP) ɖe dzi, eye wòhea profound systemic arterial vasodilation, severe hypotension (systolic ʋu ƒe sisi si ɖiɖina ɖe anyi wu 70 va ɖo 80 mmHg), reflex sinus tachycardia, drenching diaphoresis (sweating), flushing, intractable ʋuʋudedi, kple orthostatic syncope. - Direct Myocardial Ischemia and Rrhythmias: Dɔléle ŋuti nyatakakawo ŋlɔa dzitodzito ƒe blanuiléle si nɔa anyi ɣeyiɣi kpui aɖe, ST-segment kple T-wave ƒe masɔmasɔwo ɖe 12-lead ECG, conduction heheɖemegbe, eye ƒã hafi wobiaa dzitodzito me ʋu ƒe sisi alo dzitodzito me ʋukawo ƒe ʋuʋu si ʋusɔgbɔdɔ kple anaphylactic mediator ƒe dodo ƒo ƒu hena vɛ.

3. Yaƒoƒomɔ̃ ƒe ʋukawo ƒe ʋuʋu blibo kple Exendin-4 IgE anaphylaxis¶

Afɔku ɖedzesi aɖe si le Heloderma ƒe aɖi si léa atikewɔla siwo kpɔa nudzɔdzɔ kpatawo gbɔ le vome enye aɖe, nuyi, uvula, aɖu falɛfalɛ, kple aɖuɖɔtoe me ʋukawo ƒe ʋuʋu kabakaba, gã aɖe: - Mɔnu Eve (Bradykinin + IgE Mast Cell Degranulation): 1. Bradykinin-Mediated Angioedema: Abe alesi ACE-inhibitor-induced angioedema ene la, aɖi kallikrein ƒe dɔwɔwɔ tsɔa bradykinin yɔa sublingual kple laryngeal capillary beds me fũ, si wɔnɛ be non-pitting fluid extravasation kabakaba yia aɖe kple supraglottic yaƒoƒomɔ̃ me le amesi ŋu wowɔ nuvevii ƒe very first bite gɔ̃ hã me. 2. Exendin-4 kple Venom Protein Anaphylaxis: Heloderma suspectum aɖi nye dzɔdzɔmetsoƒe si tso exendin-4, si nye 39-amino-acid glucagon-like peptide-1 (GLP-1) receptor agonist (si wowɔ le nuwɔwɔ me wòzu amegbetɔ ƒe suklidɔtike exenatide), esime Heloderma horridum ƒe aɖi le eme exendin-3 ƒe ƒuƒoƒo. Ne wotsɔ aɖi phospholipase A2 kple hyaluronidase kpe ɖe duta peptide siawo ŋu wɔa dɔ abe nusiwo nana ame ƒe ŋutilã mewɔa dɔ nyuie o ene. Lã siwo tana dzikpɔlawo, lãwo dzikpɔƒe ƒe gbeŋutinunyalawo, alo ame ŋutɔ ƒe nuƒoƒoƒula siwo woɖu va yi ate ŋu axɔ explosive IgE-mediated anaphylactic shock, generalized urticaria, bronchospasm, kple laryngeal edema le aɖabaƒoƒo ʋɛ aɖewo ko me. - Hypoglycemia / Insulinotropic Effect of Exendin-4: Esi wònye be exendin-4 nye GLP-1 receptor agonist sesẽ aɖe si ƒe agbenɔƒe le plasma me didi wu amegbetɔ ƒe GLP-1 si wodzi ta la, systemic envenomation ateŋu aʋã glucose-dependent pancreatic beta-cell insulin secretion, ahe dɔgboa ƒe tsi ƒuƒlu ɖe megbe, eye wòawɔ akpa aɖe le nausea profound, ʋuʋudedi, kple ɣeaɖewoɣi suklidɔ si nu sẽ si hiã be woado ʋumesukli ƒe agbɔsɔsɔme kpɔ ɖe wo nɔewo yome le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ.

Kpekpeɖeŋunana gbãtɔ siwo wowɔna do ŋgɔ na kɔdziyiyi kple kɔdzi ƒe dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ ƒe dɔdzikpɔlawo¶

Do ŋgɔ na kɔdziyiyi ƒe ɖaseɖigbalẽ (Aɖabaƒoƒo 60 gbãtɔwo) .¶

• Ðe lãklea ɖa dedie le sɛkɛnd ʋɛ aɖewo me to eƒe ŋutilã ƒe kpekpeme dada ɖe anyigba gbadzaa dzi eye nàtsɔ ati sesẽ, gavi ƒe asiléƒe, alo gaxɔgbalẽvi ƒe nugbɔ aʋuʋu aɖuawo wòaʋu; mègazã dzo, tsi nyɔnyrɔ̃, alo atikewo gbeɖe o.
• MÈGAwu lãkle gbagbe si me aɖi le la alo atsɔe ava kɔdzi ƒe xɔ si me wowɔa dɔ kpata le me o. Smartphone foto si woɖe tso afisi didi meta 3 (afɔ 10) sɔ gbɔ be woaɖo kpe edzi, eye esi wònye be aɖi ƒomevi aɖeke meli si wua aɖi ƒomevi aɖeke o ta la, Heloderma gbagbe aɖe tsɔtsɔ va nugoe me koe hea afɔku evelia vɛ na kɔdzidɔwɔlawo.
• Dada Yaƒoƒo, Gbɔgbɔ, Kple Tsitretsitsi (ABCs) kpɔ le miniti 5 ɖesiaɖe me: Kpɔ nu me ɖa be uvular alo aɖe le vuvu hã, ɖo to hoarseness alo stridor, eye nàlé ŋku ɖe radial pulse strength ŋu.
• Do Epinephrine si wodona ɖe lãmeka me (0.3 mg ame tsitsi / 0.15 mg ɖevi ɖe anterolateral ata me) enumake le dzesi gbãtɔ si fia be aɖe/nuyi ƒe vuvu, ŋɔti ƒe tete, stridor, ʋuʋudedi, aɖuɖɔtoe si kaka, alo taɖuame si nu sẽ. Gbugbɔ wɔe le miniti 5 va ɖo 15 me ne dzesiawo le ŋgɔ yim.
• Tsɔ dɔnɔa nanɔ anyi (si le gbadzaa le woƒe akɔta) eye nàkɔ eƒe afɔwo ɖe dzi sentimeta 30 (inch 12) ne ese le eɖokui me be yegbɔdzɔ, yeƒe ta le ʋuʋum, yeƒe ta le ɣie, alo fifia ye le ʋuʋum, negbe ɖe wòle ʋuʋum vevie alo le agbagba dzem be yeagbɔ le tsitrenu le yaƒoƒomɔ̃ ƒe ʋuʋu ta ko hafi.
• Ðe atsyɔ̃ɖonuwo katã (sigɛwo, gaƒoɖokuiwo, asigɛwo) ɖa le abɔ si ɖu la ŋu, klɔ abi la blewu kple adzalẽ kple tsi si le sisim, tsɔ aŋe ƒuƒu si me dɔlékui mele o tsyɔ edzi, eye nàna abɔa nagaʋuʋu le aŋe alo aŋekotoku me le dzi ƒe ɖoɖo si mewɔa akpa aɖeke o me.

Kɔdzi ƒe aɖiŋutinunya kple atikewɔwɔ kpata ƒe ɖoɖowɔɖi¶

Esi wònye be aɖiwutike aɖeke meli si wodzrana na Heloderma suspectum alo Heloderma horridum o ta la, kɔdzi ƒe beléle kpata tɔa ŋku yaƒoƒomɔ̃wo ƒe dedienɔnɔ kaba, ʋumenugbagbeviɣidɔ, nutome vevesese ƒe mɔxexeɖedɔléle nu, kple dutatɔwo ƒe aɖuwo ɖeɖeɖa:

1. Yamemɔwo ƒe Dedienɔnɔ Enumake (Nu Vevietɔ):
2. Dɔnɔ ɖesiaɖe si ava kple aɖe ƒe vuvu, aɖe te ƒe ʋuʋu, gbe si me mekɔ o, ʋuʋudedi, nuɖuɖu ƒe vevesese, alo stridor la hiã be woado IM/IV epinephrine, H1/H2 antihistamines (diphenhydramine + famotidine), IV corticosteroids (methylprednisolone 125 mg IV alo dexamethasone 10 mg IV), kple alɔ̃dɔdɔ/ENT ƒe aɖaŋuɖoɖo kpata hena endotracheal intubation kaba.
3. Critical Pearl: Esi Heloderma angioedema lɔ kallikrein-bradykinin ƒe akpa gã aɖe ɖe eme tsɔ kpe ɖe histamine ŋu ta la, antihistamine kple steroid siwo wozãna ɖaa ate ŋu ado kpo aɖe ƒe keke ɖe enu nutsitsi. Do ʋuka kaba to video laryngoscopy alo awake fibeoptic intubation zazã me kple ɖoɖo eve si sɔ na amekoko kpata cricothyrotomy hafi glottic ʋuʋu natsi.
4. Ʋuŋusẽ ƒe Gbugbɔgadzɔ na Kallikrein/Helodermin Shock:
5. Ðo ʋuka me ka eve siwo me do gãwo le eye nàde isotonic crystalloid boluses (20 va ɖo 30 mL/kg Normal Saline alo Lactated Ringer’s) eme be nàgade ʋukawo ƒe aba si keke la me eye nàtsi yamenutome etɔ̃lia ƒe ʋukawo ƒe sisi nu.
6. Ne ʋusɔgbɔdɔ gakpɔtɔ li togbɔ be tsi gagbɔ agbe hã la, dze adrenergic vasopressor tẽ dodo ɖe lãme na ame atraɖii gɔme: norepinephrine alo epinephrine si wodzi ɖe edzi be ʋukawo ƒe ʋuʋu le mama dedie nu (MAP) nanɔ 65 mmHg dzi.
7. Vevesese Dzi Ðeɖe Akpɔtɔ Godoo: Nusita Nutome Lãmetsiŋusẽ ƒe Mɔxenuwo Ƒo Opioid Siwo Wozãna Le Agbɔsɔsɔme Gã Me Ðeka:
8. Vevesese si nu sẽ le Heloderma ƒe ɖuɖu me ate ŋu abia be woado opioids geɖe ɖe ʋuka me (siwo ɖea histamine ɖe go eye ate ŋu ana ʋusɔgbɔdɔ nagado gã ɖe edzi).
9. Ne wonya ŋlɔ asibidɛ alo asi si woɖu ƒe ahɔhɔ̃mekawo kple lãkusiwo me dzodzro nyuie ɖi ko la, kɔdzi ƒe vevesesenutsitike si wozãna le sika nu nye nutoa me digital nerve block alo ultrasound-guided regional wrist/forearm nerve block (radial, median, alo ulnar ulnar nerve block) si zãa bupivacaine alo ropivacaine si wɔa dɔ ɣeyiɣi didi 0.5% WITHOUT epinephrine (mègado epinephrine ɖe digital nerve block si ƒo xlã asibidɛ ƒe ʋukawo me gbeɖe o). Regional block tsia vevesese sesẽa le miniti 5 va ɖo 10 me evɔ ʋu ƒe sisi meɖiɖi o.
10. Sedziwɔwɔ Soft-Tissue X-Rays kple Exploration na Shed Grooved Aɖuwo:
11. Esi Heloderma aɖuwo gbãna eye woƒe aɖuwo me mekɔna o ta la, aɖu kakɛ siwo wotsɔ de eme la nɔa aɖu ɖuɖu ƒe alafa memama 30 va ɖo 50 me.
12. Na plain-film soft-tissue radiographs (X-rays) kple/alo high-frequency point-of-care ultrasound na asibidɛ alo asi si woɖu le dɔnɔwo katã me, elabena Heloderma aɖu siwo me calcified le la mexɔa radiopaque o.
13. Ne wonya tsɔ nutome lãmeka si xea mɔ na abi la fa abi ko la, de tsi abi la fũ kple dze si sɔ si me dɔlékui mele o eye nàtsɔ aŋetu nyuiwo adzro abi si wodo la me blewuu be nàɖe aɖu kakɛ siwo lé ɖe te la ɖa (mègawɔ aɖuɖɔtoe siwo me goglo ŋkumaʋumaʋui alo mɔxexeɖedɔléle nu ƒe fasciotomies gbeɖe o negbe ɖe woɖo kpe compartment syndrome dzi to manometry si wu 30 mmHg me hafi).
14. Nudokpɔƒe ƒe Dɔwɔha, ECG, kple Mɔxexe Ðe Enu:
15. Na 12-lead ECG kple dzitodzito dzi kpɔkpɔ atraɖii, ʋu ƒe xexlẽme blibo (CBC), comprehensive metabolic panel (CMP) kple serial point-of-care ʋumesukli (be woalé ŋku ɖe exendin-4-tome suklidɔ alo ayiku ƒe ʋusɔgbɔdɔ ŋu), coagulation profile (PT/INR, PTT, fibrinogen, platelets), kple creatine kinase (CK) ƒe ƒuƒoƒo.
16. Na tetanus toxoid / Tdap booster ne ehiã, eye nàŋlɔ dɔlékuiwutike siwo wozãna le nu me si ƒe dɔwɔwɔ keke ta si axɔ ŋkeke 5 va ɖo 7 ƒe ɖoɖo si atsyɔ nu lã siwo tana ƒe Gram-negative rods (Salmonella, Pseudomonas, Aeromonas, Serratia) kple ŋutigbalẽ me Gram-positive cocci, zi geɖe amoxicillin-clavulanate (875/125 mg PO zi eve gbesiagbe) alo ciprofloxacin kpe ɖe clindamycin / doxycycline ŋu.
17. Lé ŋku ɖe dɔnɔ siwo katã ŋu dzesi aɖeke mele o alo esiwo ƒe dzesiwo mesẽ tututu o ŋu hena gaƒoƒo 6 va ɖo 12 ya teti le dɔwɔƒe si kpɔa nudzɔdzɔ kpatawo gbɔ, eye nàxɔ dɔnɔ siwo katã ŋu dɔléle ƒe dzesiwo le le ɖoɖo nu, ʋusɔgbɔdɔ, ʋukawo ƒe ʋuʋu, alo abɔ kple afɔ siwo vuvu vivivi la ɖe dɔwɔƒe si ŋu wole ŋku lém ɖo alo ICU gaƒoƒo 24 ya teti.

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

• United States kple Canada: Ƒo 911 enumake ne Gila lã wɔadã alo beaded lizard ɖuɖu ɖesiaɖe. Te ɖe US Poison Control ŋu le 1-800-222-1222 (si do ka le Anyieheɣetoɖoƒe yi Arizona Aɖi Kple Atike Ŋuti Nyatakaka Dɔwɔƒe le Tucson alo Banner Aɖi Kple Atike Ŋuti Nyatakaka Dɔwɔƒe le Phoenix) alo Canada Nutome Aɖi Dɔwɔƒe hena kɔdzi ƒe ɖoɖowo.
• Mexico kple Titina Amerika (Guatemala): Ƒo 911 le Mexico katã alo 122 / 123 le Guatemala. Le Mexico la, atikewɔlawo ateŋu akpɔ RETOMEX (Red Toxicológica Mexicana) hena Heloderma horridum kple Heloderma suspectum ƒe kpekpeɖeŋu. Mexicotɔwo ƒe dziɖegbe alo pit viper ƒe dɔlékuiwutikewo *meɖea * Heloderma aɖi ɖa o eye mele be woanae o.
• United Kingdom: Ƒo ka na 999 na dɔnɔdzikpɔʋu ne woɖu lãwo dzikpɔƒe alo lã siwo tana ƒe nuƒoƒoƒu si ŋu mɔɖegbalẽ le la dzikpɔla. Ele be atikewɔlawo nakpɔ NPIS / TOXBASE kple Liverpool School of Tropical Medicine gbɔ.
• Europa Dukɔwo ƒe Habɔbɔ: Ƒo ka na 112 hena atikewɔwɔ kpata ƒe dɔwɔnawo le aboyo me nuƒoƒoƒu ƒe ɖuɖu megbe, eye nàte ɖe wò dukɔa ƒe aɖidzikpɔkpɔ dɔwɔƒe ŋu hena aɖiŋutinunya ƒe ɖoɖo siwo akpe ɖe ŋuwò.
• Australia kple New Zealand: Ƒo ka na 000 le Australia alo 111 le New Zealand hena lã siwo tana siwo woɖe aboyoe, eye nàƒo ka na Australia Aɖiwo Ŋuti Nyatakaka Dɔwɔƒe le 13 11 26 (alo New Zealand Dukɔa ƒe Aɖi Dɔwɔƒe le 0800 764 766). To vovo na Australia da gbãtɔwo la, mele be woatsɔ Pressure Immobilization Bandage (PIB) asisi ɖe Heloderma ƒe ɖuɖu si mebɔ o ŋu o.

Nya siwo wobiaa amewo enuenu¶

Nukatae Gila lã wɔadã aɖe léa eɖokui ɖe asi heɖua nu le esi teƒe be wòaƒoe ahaɖe asi le eŋu abe da si le ʋuʋum ene?¶

To vovo na da siwo woyɔna be rattlesnakes, siwo ƒe aɖu ƒe akpa si le etame ƒe asike siwo me do le siwo do ƒome kple aɖi ƒe lãkusi siwo wotsɔ nyaƒoɖeamenu doa aɖi le sɛkɛnd ɖeka ƒe akpa sue aɖe me la, aɖi ƒe lãkusiwo le Gila lã wɔadãwo kple Mexicotɔwo ƒe lãkle siwo ƒe aɖuwo le ete siwo me lãmekawo ƒe nutete mele o. Woƒe aɖi sina yia nu me le aɖu siwo me do goglo la gɔme eye wohenɛ yia dzi yia abi la me to ʋukawo ƒe dɔwɔwɔ me. Be akpɔkplɔa nate ŋu atsɔ aɖi si aʋli eɖokui ta ana la, ele be wòatsɔ eƒe aɖu sesẽwo aƒoe eye wòaɖui le ŋutigbalẽa me le ɣeyiɣi ƒe didime nu be wòawɔ dɔ le aɖia ŋu le aɖuawo ƒe dowo me wòazu ʋuka siwo me ʋu le dodom le.

Mɔ kae le kabakaba wu eye wòle dedie wu si dzi nàto ana Gila lã wɔadã aɖe naɖe asi le wò asi ŋu?¶

Gbã la, do alɔ ʋetsuvi la ƒe kpekpeme bliboa ɖe anyigba, kplɔ̃ dzi, alo wò alɔ si le ablɔɖe me enumake ale be wòagahe ɖe yame tso wò asibidɛ dzi o, elabena ne èle ƒoƒom la, eʋãa aɖu ƒe ʋuʋu si me susu le eye wòɖua nu goglo wu. Eyome, tsɔ nu gbadza sesẽ aɖe abe ati sesẽ, gavi ƒe asiléƒe, bɔta hɛ, ʋuƒo si ƒe ta le gbadzaa, alo gaxɔgbalẽvi gbogbo aɖewo ƒu gbe ɖe nu ƒe axadzi le ŋgɔgbe aɖuawo megbe, ʋu aɖuawo, eye nàhe wò asi ado goe tẽ. Mègalé dzo ɖe ʋetsuvi la ƒe asike te gbeɖe o eye mèganyrɔe ɖe tsi te gbeɖe o, elabena wo ame evea siaa hea ƒoƒoe kple lãmenugbagbeviwo ƒe vuvu si vɔ̃ɖi wu vɛ.

Ðe aɖi aɖe li na Gila lã wɔadã alo Mexicotɔwo ƒe lãkle si wotsɔa dzonu ɖua?¶

Ao, dɔlékuiwutike aɖeke meli si dzi FDA da asi ɖo le asitsanyawo me alo le dukɔwo dome si woate ŋu azã le atikewɔnyawo me atsɔ atsi Heloderma suspectum (Gila lã wɔadã) alo Heloderma horridum (Mexicotɔwo ƒe lãkle si wotsɔ dzonu wɔe) ƒe ɖuɖu nu o. Esi wònye be ƒã hafi nusiwo wua ame mebɔ le egbegbe beléle kpata me o ta la, kɔdzidɔdamɔnua ku ɖe yaƒoƒomɔ̃wo takpɔkpɔ kabakaba tso aɖe kple ŋɔti me ʋukawo ƒe ʋuʋu me, epinephrine si wodona ɖe lãmekawo me alo esi wodona ɖe ʋuka me, crystalloid tsi siwo wodona ɖe ʋuka me kple ʋuka siwo tea ʋukawo me hena ʋu ƒe sisi ƒe ɖiɖi, nutome lãmekawo ƒe mɔxexe ɖe vevesese sesẽ nu, kple X-ray wɔwɔ be woaɖe aɖu siwo gbã la ɖa ŋu.

Nukatae ɖɔktawo bia ɣesiaɣi be woawɔ X-ray na wò asi le Gila lã wɔadã aɖe ƒe ɖuɖu vɔ megbe?¶

Gila lã wɔadãwo kple lãkle siwo ƒe aɖuwo le dzo dam eye woƒe aɖuwo le goglo eye wotsɔa siminti blaa aɖu ƒe ememe tsɔ wu be woatsɔ wo abla ɖe ƒu goglowo me. Ne ʋetsuvi la le nu ɖum alo ne amesi ŋu wowɔ nuvevii la he woƒe asi ɖa la, aɖu 30 va ɖo 50 le alafa me gblẽa aɖu kakɛ ɖeka alo esi wu nenema si gbã ɖi si gena ɖe ŋutigbalẽa alo lãkusi ƒe akɔta goglo. Esi wònye be aɖu siawo siwo me calc le dzena nyuie le lãkusi falɛfalɛwo ƒe X-ray me ta la, ɖɔktawo ɖea radio dzi fotowo eye woɖea kakɛ ɖesiaɖe le lãmeka aɖe te be woaxe mɔ ɖe dutatɔwo ƒe granulomas sesẽwo kple dɔlékuiwo ƒe dɔlékui goglowo nu.

Aleke Gila lã wɔadã ƒe aɖi do ƒome kple suklidɔ ƒe lolo dzi ɖeɖe kpɔtɔ ƒe atikewo, eye nukatae ema le vevie ne woɖui?¶

Le ƒe 1990-awo me la, numekulawo ke ɖe peptide aɖe si le abe lãmetsiŋusẽ ene ŋu le Gila lã wɔadãwo ƒe aɖi me si woyɔna be exendin-4, si srɔ̃a amegbetɔ ƒe glucagon-like peptide-1 (GLP-1) eye wòva zu nusi dzi wotu suklidɔtike si wowɔ si nye exenatide (eye wòʋã GLP-1 receptor agonists ƒe hatsotso). Le Gila lã wɔadã ŋutɔŋutɔ ƒe ɖuɖu me la, exendin-4 kpe ɖe phospholipase A2 kple kallikreins ŋu ate ŋu ana insulin nado (si ana sukli naɖiɖi le ʋu me eye wòaɖe aɖuɖɔ vevie ɣeaɖewoɣi) eye ate ŋu ahe anaphylaxis sesẽ si IgE-to vɛ kple aɖe ƒe vuvu gã aɖe vɛ, vevietɔ le lã siwo tana si léa lã siwo tana ƒe dɔlékuiwo gbɔ kpɔla siwo se le wo ɖokui me le esi woɖu wo alo woɖu wo va yi ta.

Ðe wòle be maxatsa Pressure Immobilization Bandage alo atsɔ tsikpe ade Gila lã wɔadã aɖe ƒe ɖuɖu dzia?¶

Ao, mègatsɔ tourniquet, Pressure Immobilization Bandage (PIB), alo tsikpe ƒe agba asisi ɖe Gila lã wɔadã alo Mexicotɔwo ƒe akpɔkplɔ si wotsɔ dzonu wɔe ƒe ɖuɖu ŋu gbeɖe o. Esi wònye be phospholipase A2 kple hyaluronidase enzymes siwo gblẽa nu le lãmenugbagbeviwo ŋu siwo nana teƒea vuvu kabakaba ta la, asi babla sesĩe léa aɖia ɖe asibidɛwo me eye wònaa nyaƒoɖeamenu ɖe ​​asibidɛawo me dzina ɖe edzi, gake tsikpe nana ʋukawo me xena vevie eye vuvɔ gblẽa nu le aɖia tame.

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Arizona Aɖi kple Atikewo Ŋuti Nyatakaka Dɔwɔƒe (Arizona Yunivɛsiti, United States): Heloderma suspectum (Gila Monster) ƒe Aɖi ƒe Dɔlélewo Dzikpɔkpɔ le Dɔdaƒe: Yame ƒe Ʋukawo ƒe Ʋukawo ƒe Ʋuʋu, Ʋusɔgbɔdɔ, Nutome Lãmetsiwo ƒe Mɔxexe, kple Aɖuwo ɖeɖe.
• Amerikatɔwo ƒe Aɖinuwo Dzikpɔƒewo ƒe Habɔbɔ (AAPCC) & ACMT (United States): Helodermatidae Aɖi Atikeŋutinunya (Gilatoxin, Helodermin, Exendin-4) kple Kpekpeɖeŋunana ICU Triage (Cantrell et al.; Hooker & Caravati, Anals of Emergency Medicine).
• Wilderness Medical Society (WMS): Nuwɔna ƒe Mɔfiamewo na Aɖiwo dada le Dziehe Amerika Dzogbenutowo me.
• Dɔlélenutsitsi Kple Mɔxexe Ðe Enu Dɔwɔƒewo (CDC / NIOSH, United States): United States ƒe Aɖi Siwo Tana: De dzesi kple Kpekpeɖeŋu Gbãtɔ na Gila Lã wɔadãwo.
• Aɖi Dzĩ Mexicana (RETOMEX, Mexico): Guía de Tratamiento de Mordedura de Lagarto Enchaquirado (Heloderma horridum) y Monstruo de Gila.

Mɔfiame siwo do ƒome kplii¶

• Nulɔdɔwo kple anaphylaxis beléle kpata
• Rebound anaphylaxis, biphasic reactions, kple EpiPen ƒe ɣeyiɣi evelia
• Da ƒe ɖuɖu kple lã siwo tana siwo me aɖi le ƒe nɔnɔme kpatawo
• Lãwo ƒe ɖuɖu kple abi ƒe dɔlékui sesẽwo xɔxɔ nu
• Xexlẽdzesi siwo woxɔna kpata le dukɔwo nu