Gila Monster e ƴiye ƴiye Meksik : ƴiye ƴiye mekanik, anafilaksi Exendin-4, e anjiyoedema e laawol henndu¶

Monster Gila (Heloderma suspectum, jeyaaɗo e jeereende Sonoran, Mojave, e Chihuahuan to fuɗnaange-rewo Amerik e worgo-fuɗnaange Meksik) e ɓiɗɓe leɗɗe Meksik (Heloderma horridum e ko nanndi e mum en e nder Amerik e Gumalaus tan ina waɗi ƴiye tooke les-jawɗe keertiiɗe e ƴiye luggiɗe. Ina wayi no mborosaaji walla kobraaji, ɗi njuumtata tooke e nder feccere leƴƴannde rewrude e ƴiye hipodermik toowɗe, ɗoon e ɗoon ina njaltina ƴiye mum en, ƴiye Heloderma ngalaa mekanismeeji ɓuuɓɗi tooke e ƴiye ɓuuɓɗe. E nder ɗuum, tooke ina ilna dow e golle kapilaar ummoraade e ƴiye gonɗe e nder ƴiye les ɗee rewrude e ƴiye udditiiɗe e dow ƴiye les ɗee e dow ɗee fof tawa ƴiye ɗee ina ɓuuɓtoo les e ƴiye ƴiye nannduɗe e buldozer, ina ɓuuɓna e nder ɓalndu neɗɗo. Kala leƴƴannde ɓeydaande nde ƴiye Gila walla ƴiye beɗeeje keddii ina njokkondiri ina addana tooke ɓurɗe heewde ɓuuɓde e nder kapilaaruuji dermal lacerated, e accude ƴiye teeŋtuɗe ɗee ina njuutee e junngo walla e junngo, ina addana ɗum en ɓuuɓde ɓuuɓnde (reflexive biting lock) ɓuuɓnde dente ɓuuɓɗe ɗee les haa e nder periosteum e periosteum. So tooke naatii e ƴiiƴam, helodermin, helospektin, gilpaterin, poroteyiin nannduɗo e kallikrein, e peptideeji eksendin (ina heen eksendin-4 e nder H. suspectum) ina addana ɓuuɓri ɓuuɓndi, ɓuuɓri jaawndi, **e nder kallikrein luggiɗndi e vakrein 15 haa 30 e nder teemedere e tookeeji gonɗi e nder ɓalndu, anjiyoedema fulminant gonɗo e nguurndam ɗemngal, e leppi, e uvula, e ƴiiƴam e sara anafilaksi goonga mo IgE-mediated. So tawii won mo mboros Gila walla mboros beɗi ƴakki, noddu nokku maa limooje caɗtuɗe ɗoon e ɗoon. Kadi ƴeewto ardorde men banndiraaɓe e ɓuuɓri e anafilaksi, mboddi ina ƴakka, e sokla.

Ko ɓuri teeŋtude e maa ko wallitde teddeendi timmundi ɓanndu liɗɗi ɗii ɗoon e ɗoon mbele ina ŋoŋɗi e ɓuuɓri, pry jawdi ndii udditaa e nder leƴƴanɗe seeɗa huutoraade huunde tiiɗnde, ɓuuɓnde walla sawru waɗaaɗo caggal dente yeeso ɗee tawa aɗa yaltina tergal ngal e laaɓal (woto meeɗ jogaade neverster e nder waminige e chin). intramuscular epinephrine auto-injector ɗoon e ɗoon so tawii ɗemngal ina ɓuuɓna, ina ɓuuɓna, ina ɓuuɓna stridor, walla ina ɓuuɓna, ina nawta ñawɗo oo to departemaa toppitiiɗo ko fayti e cellal ngam hisnude ɗum ko yaawi, ngam wuurnude ɗum e ndiyam isotonik, e ƴeewndorɗe (rayons) ngam yiytude dente ɓuuɓɗe ɗe ɓuuɓnaaka.

Waɗde ɗum jooni¶

1. Wallittu teddeendi ɓanndu ƴiye ɗee ɗoon e ɗoon, mbaɗtaa ɗum e dow leydi, e dow taabal, walla e junngo maa. Hoto meeɗ ɗaccude ƴiye Gila walla ƴiye Meksik ina njirloo e weeyo gila e junngo, junngo, walla junngo ɓuuɓngo, kadi hoto meeɗ etaade diwde walla ɓuuɓnude ɗum. Hanging ina fawa e dow gaañannde ndee, ina rippa ƴiye, ina huutoroo refleks (reflexe) ɓuuɓɗo (reflexe clamping) defense lizard ngam ɗum ɓeydoo luggiɗde e pompirde tooke submandibulaire ɓurɗe heewde e nder lacerations.
2. Pry jawdi ndii e nder leƴƴanɗe seeɗa huutoraade lefol ɓuuɓngol, e ɓuuɓnude feccere ɓanndu ɓuuɓndu nduu haa laaɓa cer. Wedge sawru tiiɗndu, junngo kaas, laɓi butel, spatula njamndi, kaayitaaji njulaagu, walla hemostat hakkunde caggal walla bannge jawdi ndii, ɓuuɓna jawdi ndii caggal tiiɗndi glowe leatherd walla towel follaango so tawii ko ɗoon e ɗoon e junngo), e ittude junngo ɓuuɓngo ngoo e dille goote jaawɗe. Hoto meeɗ jogaade fitirla walla lampa les ɓuuɓri ƴiiƴam, kadi hoto meeɗ ɓuuɓnude ƴiiƴam e junngo maa e nder ɓuuɓri ndiyam; nguleeki e stres ronkude ina addana thrashing e frantic ɓuuɓde.
3. Noddu limoore emergency nokkuure maa ɗoon e ɗoon e ƴeewde so tawii aɗa wondi e ɓuuɓri ƴiiƴam walla so tawii aɗa wondi e ɓuuɓri anafilaksi. Noddu 911 to leyɗeele dentuɗe Amerik e Kanadaa, 911 to Meksik, 112 to Dental Orop, 999 to leydi Angalteer, 000 to Ostarali, walla ƴeewto regginorde men winndereere nde limooje caɗtuɗe. Haalan diisneteeɗo oo wonde ñawɗo oo ina jogii mboros Heloderma tooke, ina heewi baasal e ɗemngal jaawngal e ƴiiƴam ƴiiƴam e ɓuuɓri ƴiiƴam ; alaa antivenom njulaagu ngam Heloderma tooke, ko ɗum waɗi toppitagol safrirde ko yaawi ina tiiɗi.
4. Injection Epinephrine Auto-Injector nder ɓalndu (EpiPen, 0.3 mg mawɗo / 0.15 mg cukalel) e nder ɓalndu hakkundeeru yaajndu ɗoon e ɗoon so tawii won maandeeji gonɗi e ƴiiƴam gonɗi e laawol henndu, anafilaksi, walla hipotension peeñii. Yiylo no feewi so tawii ko ɓuuɓri walla ɓuuɓri gonndi e ɓalndu nduu. daande, stridor inspirateur toowɗo, caɗeele ɓuuɓde ƴiiƴam, ɓuuɓri diƴƴe, ɓuuɓri ƴiiƴam, walla ɓuuɓri ƴiiƴam tiiɗndi. Sabu tooke Heloderma ina waɗi kalikreinuuji ɓuuɓnooji bradikinin e poroteyiinuuji ɓuuɓnooji (ina heen eksendiin-4 e fosfolipaas A2), uddugol laawol toowngol ngol ina waawi waɗde e nder hojomaaji 15 haa 45 caggal nde ɓuuɓol ngol waɗi.
5. Ittu denndaangal jokkere enɗam, waktuuji, jokkere enɗam, e comci tiiɗɗi e nder jokkere enɗam ɗoon e ɗoon, caggal ɗuum ɓuuɓna jokkere enɗam ndee no feewi e ndiyam laaɓɗam e saabunde ɓuuɓnde. Ɓuuɓri fuɗɗotoo ko e nder hojomaaji 5 haa 15, ina yahra dow junngo e junngo e nder waktu gooto, ina yahra e junngo e junngo e nder waktu gooto. Waɗde tergal ɓuuɓngal ngal ko e toɓɓere ɓernde neutral (wonaa toownde toownde dow ɓernde, wonaa kadi ɓuuɓnde les).
6. WOTO MEƊƊU waɗde ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam (PIB), ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam, walla ɓuuɓri ƴiiƴam. Ina wayi no mboɗeeri elapid Ostarali walla mborosaaji funeeɓe, tooke Heloderma ina waɗi Aphoc.morse,hyalu njamndiiji poroteyiin**. Nanngude tooke ɗee e nokku hee e mbaydi tiiɗndi walla e turniket ina addana enzim bonɗo e nder koppi e junngo, ina addana ɗum mboros biyeteeɗo sindrom kompartiment e nekrosis tissue profond.

Lekki kuulal: Gila monster e beɗi ƴiiƴam ƴiiƴam hisnude e triage opitaal¶

flowchart TD
    A["Gila Monster walla Meksiknaajo ɓuuɓɗo ɓuuɓɗo"] --> B{"Mbele lewru ina jokki e ɓuuɓde e ɓalndu?"}
    B -->|Yes: Jaws locked and chewing| C["Wallitde teddeendi ɓanndu lizard flat e dow leydi ɗoon e ɗoon; WOTO MEƊƊU ɗaccude ɗum ina fawa walla ina waɗa lampa/ndiyam"]
    B -->|No: Lizard already detached| D["Moƴƴinde meeteruuji 3; ittu denndaangal cirƴam, waktuuji, e juuɗe tiiɗɗe e tergal ɓuuɓngal ɗoon e ɗoon"]
    C --> E["Leggal tiiɗngal wedge, junngo kaas, walla pry bar hakkunde jawdi; lever udditaa e fawde tergal laaɓngal yaltude"]
    E --> D
    D --> F{"Kala ɓuuɓri ɗemngal/leppi, daande ɓuuɓnde, stridor, ɓuuɓri, hives, walla ɓuuɓri ?"}
    F -->|Yes: Airway Angioedema or Anaphylactic Shock| G["Noddu 911 / Limoore Emerjensi JOONI; ɓuuɓnude IM Epinefrin 0,3 mg e nder ɓalndu yaajndu ; lay flat e koyɗe ƴettaaɗe so diwɗi"]
    F -->|No: Severe local burning pain and swelling only| H["Ƴeewee ñawu nguu e saabunde e ndiyam ; jogaade tergal e tolno ɓernde; WOTO huutoro turniket, PIB, walla ice"]
    G --> I["Jaɓɓugol EMS ko yaawi : ɓuuɓnugol endotrakeal ko adii nde ɓuuɓri ƴiiƴam ina ɓuuɓta + kiristaloid IV + vasopressoruuji"]
    H --> J["Jaɓɓungal to Departemaa Emergency Hospitaal ngam ƴeewde tookeeji ko famɗi fof waktuuji 6 haa 12"]
    I --> K["Toppitagol safrirde : Blok nerf diiwaan walla fentanil IV ngam ñawu + Rajo-X soft-tissue ngam dente ɓuuɓɗe keɓtinaaɗe + Tetanus & antibiotik"]
    J --> K

Njiylawu kilinik hoore e hoore : Ɓowɗi Heloderma vs Ɓowɗi Pit Vipers Amerik worgo vs Ɓowɗi ɗi ngalaa tooke¶

Sabu mborosaaji e jaabtiiɓe laddeeji e nder Amerik worgo-fuɗnaange, Meksik, e nokkuuji reptileeji ina keewi jiiɓrude mborosaaji tooke Heloderma e mborosaaji rattlesnake walla mborosaaji mborosaaji ɗi ngalaa tooke, seerndude biomekaniseeji e tookeeji ina tiiɗi :

Anatomi ɓuuɓri Heloderma e ko waɗi leƴƴanɗe ina njogii nafoore e sahaa ɓuuɓgol jawdi¶

No grooved les niɓɓe e mekanik ɓuuɓɗo pompi tooke¶

Ngam faamde hol ko waɗi mboddi Gila walla mboddi Meksik ina foti pride e nder leƴƴanɗe seeɗa gadane ɗee, ƴeewndo-ɗen tooke mum e mboddi :

1. Arsitektuur ƴiiƴam les ƴiiƴam: E nder Heloderma suspectum e Heloderma horridum fof, ƴiiƴam tooke ko ƴiiƴam les ƴiiƴam baylaaɗam tawaaɗam e nder ɓuuɓri les (ɓuuɓri), ina waɗa ɓuuɓri e dow ƴiiƴam. Kala ƴiiƴam ina feccii e ɓuuɓri tati walla nayi, ɓuuɓri kala ina yalta e ɓuuɓri mum ngam udditaade e dow ŋoral hunduko saraaji ŋoral dente mandibulaaji yaajɗi.
2. Dental ɓuuɓngal e golle kapilaar: Monster Gila ina jogii ko ina tolnoo e 35 haa 40 dente ɓuuɓɗe, ɓuuɓɗe e nder ƴiye mum. Dente les ɗee e dow ɗee fof ina njogii ɓuuɓri luggiɗndi e dow ŋoral yeeso e caggal, tawa kadi ko ŋoral tooke ɓurngal luggiɗde e dow dente lesɗe yeeso e hakkundeeje. So mboros oo yanii, tooke ina moofta e nder ɓalndu les, ina fawa dow e dow ŋoral dental ngal e golle kapilaar, ina fawee e nder ɓalndu neɗɗo lacerated.
3. Ko waɗi fawde e ɓuuɓde ina ɓeyda doosgal tooke: Sabu alaa piston muskulaar ngam ɓuuɓnude tooke e nder tuuba ɓuuɓɗo, nip glancing yaawɗo ina ustoo fotde tooke (toɓɓere ɓuuɓnde yoornde 20 haa 30 e nder teemedere e nder nip juutɗo). Kono so Heloderma ina ɓuuɓtoo e junngo, ƴiye mum pterygoid e temporalis ina ɓuuɓtoo. Liɗɗi ɗii ina mbaɗa dille ɓuuɓɗe bannge-bannge e dille ɓuuɓɗe rimɗuɗe, ina njuppa dente ɓuuɓɗe ɗee haa ɓurta luggiɗde e ɓalndu e ƴiye dijital tawa ina ɓuuɓna ƴiye leslese ɗee ngam ɓuuɓnude tooke kese e nder leeso ñawu nguu.

================================================================================
   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)
================================================================================

Jaɓɓungal jawdi mekanik¶

So tawii mboddi Gila walla mboddi Meksik ina ɓuuɓtoo e junngo maa, e junngo maa, walla e koyngal maa, rewa e ngalɗoo laawol laaɓtungol :

1. Ɗatal 1: Wallitde ɓanndu lewru e dow leydi ɓuuɓndi ɗoon e ɗoon (Ɗiɗaɓol 0 haa 2):
2. Nanngu ɓanndu ɓiɗngel ngel walla mbaɗtu junngo maa ɓuuɓngo ngo dow leydi, dow haayre, dow taabal, walla e dow koppi maa mbele ɓiɗngel ngel redu mum fof e koyɗe mum nay fof ina njuuroo e dow leydi tiiɗndi.
3. Ko waɗi ɗum ina golla: So tawii ƴiye nanii koyɗe mum ina mballitoo e leydi tiiɗndi, ina ngoppa ŋoŋɗi e nder weeyo, fotde 30 haa 40 e nder teemedere ƴiye Heloderma ina ɓuuɓtoo e hoore mum, ina etoo ŋoŋɗude e nder ɓuuɓri.
4. Ɗatal 2: Wedge lever flat rigid caggal dente yeeso ɗee e pry uddita (Ɗiɗaɓo 2 haa 10):
5. So tawii ƴiye ɗee ina keddii e ɓuuɓde, ɗaɓɓu e neɗɗo ɗiɗaɓo (walla huutoroo junngo maa) yo nanngu ƴiye ɗee no feewi caggal jokkondire hoore/wuddu jaajɗe ɗee mbele ɗe mbaawa ɓuuɓnude ɓanndu mum banngeeji (banngeeji ɓuuɓnude siiseeji e dente ɓuuɓɗe nder ƴiye maa).
6. Ƴettu kala kuutorgal tiiɗngal, ɓuuɓngal, gonngal ɗoon e ɗoon : kaɓirgal leɗɗe tiiɗngal, kaɓirgal njamndi walla junngo forfetere, laɓi butel, ƴulɓe ɓutte, ɓuuɓri kaayitaaji ɗiɗi walla tati, walla hemostaatuuji safaara.
7. Siftor lefol ngol e nder ŋoral bannge hunduko (caggal dente yeeso ɗe coktirgal tiiɗngal), wirlo walla lefol ngol ina seernda ƴiye ɗee e dow ŋoral, e oon sahaa dente ɗee ina laaɓta ɓalndu nduu, ƴettu junngo ɓuuɓngo ngoo, yalta ko famɗi fof meeteruuji 3 (10 feet) woɗɗitaade.
8. Ɗatal 3: So tawii ko a gooto e nder jeereende tawa a alaa kuutorɗe:
9. Waɗde liggorde ndee ina ɓuuɓtoo e leydi, pinnu ɓanndu mum no feewi e koppi maa walla e paɗe maa, nanngaa caggal hoore ndee e junngo maa ɓuuɓngo, kuutoro-ɗaa feggere jeereende tiiɗnde walla feggere kaaƴe ɓuuɓɗe ngam doole ɓuuɓde gite ɗee hade maa yaltinde junngo maa no feewi.
10. Ko waɗi safaaraaji leñol ina bonna kadi ina haɗaa:
11. WOTO MEƊƊU jogaade fitirla, match, walla lampa udditiika les ɓuuɓri ƴiiƴam: Burde ƴiiƴam ƴiiƴam ina addana junngo maa ɓuuɓde tolno tataɓo, ina addana ɗum ɓuuɓde e ɓuuɓde no feewi.
12. WOTO MEƊƊU ɓuuɓnude ƴiye e junngo maa ɓuuɓngo e nder ndiyam: Heloderma ƴiye ina mbaawi jogaade foofaango mum en e les ndiyam fotde hojomaaji 15 haa 30 tawa aɗa woppa, ndiyam ɗam ina loota bakteriiji hunduko e tooke poolaaɗe e nder laceraaji maa udditiiɗi.
13. WOTO MEƊƊU werlaade alkol ɓuuɓɗo, bensin, walla amoniak e nder hunuko mboros oo: Ɗee kemikaaji ina werloo no feewi les ɓuuɓri dental e nder ɓuuɓri maa ɓuuɓndi, ina addana ƴiiƴam kemikal nekrosis tiiɗɗo.

Patofisiyoloji tooke heloderma : kalikrein, helodermin, e anafilaksi eksendin-4¶

1. Naafigaagal nokkuyankeewal e ɓuuɓri yaawndi saabaade¶

E nder 2 haa 5 minit e ɓuuɓri tooke, ɓuuɓri ndii ina heɓa ɓuuɓri ɓuuɓndi e ɓuuɓri ɓuuɓndi e nokku ɗo ɓuuɓri ndii woni ɗoo, ndi ɓuuɓnata junngo walla koyngal fof e nder hojomaaji 15 haa 30. - Ko waɗi nafoore ndee ina tiiɗi: Tooke Heloderma ina waɗi fosfolipaas A2, hialuronidaas ("faktor caakoowo" ɓuuɓnoowo asid hialuronik e nder ɓalndu), serotonin, e klzzwxh:00 ko ɓuuɓnata kininogen e nder bradikinin**. - Nafoore safaara: Gaañii oo ina heewi hollirde mbaadi semi-circulaire walla V-shaped, ɓuuɓri ƴiiƴam keewndi e ɓuuɓri ɓuuɓri, heewi wonde ko ɓuuɓri ɓuuɓri e saraaji maale ɓuuɓri. Edema tense ina yaaji e yaawre gila e junngo ɓuuɓngo e dow junngo haa e dow ŋoral e nder waktuuji 1 haa 4** gadani ɗ, ina wondi e limfadenopati diiwaan tedduɗo to ŋoral e ŋoral. Naamne ɓuuɓɗe ina keewi ustaade e nder waktuuji 1 haa 4, ina mbaawi kadi jogaade fotde waktuuji 12 haa 48.

2. Kalikrein-bradikinin e soklaaji ɓuuɓɗi nannduɗi e VIP¶

E nder 15 haa 30 e nder teemedere e mborosaaji Gila monster e beaded lizard, tooke keewɗe ina naata e nder ɓalndu e limfatik ngam ustude nguurndam sindrom vasodilatateur et cardiotoxique systémique e nder 15 haa 90 minit: - Gilatoksin / Kallikrein Henndu Bradykinin: Kallikrein tooke ina addana ɓuuɓri mawndi e nder ɓalndu bradikinin, ko huunde baawnde ustude ƴiiƴam e nder ɓalndu, ko ɗum addanta ɓalndu ɓuuɓde e ɓuuɓtude ƴiiƴam kapilaar. - Helodermin e Helospektin (Peptideeji nannduɗi e VIP): Kamɓe ɗiɗo fof H. tuumaaɗo e H. tooke horridum ina waɗi helodermin e helospektin, ko peptideeji baɗɗi sifaaji Peptiid ɓalndu ɓuuɓɗo (VIP) neɗɗo. Ɗeeɗoo peptideeji ina njokkondiri e jaɓɓotooɗe VIP ƴiiƴam, ina kuutoroo siklaas adenilat, ina ɓeyda AMP (cAMP) gonɗo e nder geese, ina addana ɓuuɓri ƴiiƴam luggiɗndi, ɓuuɓri ƴiiƴam (tansiyoŋ sistolik ina ustoo les 70 haa 80 mmHg), ina ustoo sinforekidiya (diayasrekidiya) . ɓuuɓri, ɓuuɓri ndi safraaka, e sinkope ortostatik. - Iskemii e aritmiiji miokardiiji toowɗi : Rajooji ñawɓe ina kollita ŋakkeende miokardiijo juutnde, ŋakkeende ST-segment e T-wave e ECG 12-lead, ŋakkeende jokkondire, e ŋakkeende ɗaɓɓaande infark miokardiijo walla anaphypospasm medialactic e vasospasm koronaari ummortooɗe.

3. Anjiyoedema ɓuuɓɗo e nder ƴiiƴam e anafilaksi Exendin-4 IgE¶

Hakkille kilinik maantinɗo Heloderma envenomation nanngoowo safrooɓe emergency ko anjiyoedema jaawɗo, mawɗo e ɗemngal, e leppi, e uvula, e palate soft, e larynx: - Mekanismeeji ɗiɗi (Bradikinin + IgE : 1. Anjioedema mo bradykinin-mediated: Hono no anjiyoedema mo ACE-inhibitor addata nii, tooke kallikrein ina ɓuuɓna leɗɗe kapilaaruuji les ɗemngal e gonɗi e nder reedu e bradikinin, ina addana ndiyam ɓuuɓɗam yaltude e nder ɗemngal e dow ƴiiƴam bi'ver e dow ƴiiƴam. 2. Anafilaksi poroteyiin eksendin-4 e tooke: Heloderma suspectum tooke ko ƴoogirde eksendin-4, ko 39 asid amin nannduɗo e glukagon-1 (GLP-1) gonɗo e ɓuuɓri jaɓɓotooɗo (ko sintetik di*ma tooke horridum ina waɗi eksendiin-3. Wondude e fosfolipaas tooke A2 e hialuronidaas, ɗeen peptideeji jananɗi ina mbaɗa alerjiiji baawɗi. Resooɓe reptileeji, herpetoloji zoo, walla mooftuɓe keeriiɗi ɓe mboros oo yani ko adii ina mbaawi heɓde shok anafilaksi ɓuuɓɗo mo IgE huutortoo, urtikaari kuuɓtodinɗo, bronkospasm, e ɓuuɓri ƴiiƴam e nder hojomaaji seeɗa. - Hipoglisemiya / batte insulinotropik Exendin-4: Nde tawnoo eksendin-4 ko agonist jaɓɓotooɗo GLP-1 baawɗo, mo feccere nguurndam mum ɓuri juutde e GLP-1 neɗɗo jibinannde, tooke gonɗe e nder ɓalndu ina mbaawi ustude darnde insulin gonɗo e nder ɓalndu, baawɗo ustude glukos. ɓuuɓri, e sahaa e sahaa fof hypoglycémie reactive ina ɗaɓɓi ƴeewndo glukos e nder ƴiiƴam e nder departemaa urgence.

Ballal gadanal ko adii opitaal e njuɓɓudi departemaa emergency opitaal¶

Doggol ƴeewndo hade safrirde (Hojomaaji 60 gadani)¶

• Seerndu liɗɗi ɗii e kisal e nder leƴƴanɗe e wallitde teddeendi ɓanndu mum e dow leydi e ɓuuɓnude jawdi ndii udditaa e sawru tiiɗndu, e junngo cukalel, walla e ŋoral kartal ; hoto meeɗ huutoraade yiite, ɓuuɓnude ndiyam, walla kemikal.
• WOTO war walla addu mboros tooke guurɗo e nder suudu safrirdu. Foto smartphone ƴettaaɗo e meeteruuji 3 (10 feet) ina heddi ngam tabitinde, kadi nde tawnoo alaa antivenom keeriiɗo e sifaaji, addude Heloderma guurɗo e nder conndi tan ina addana staffd mboros ɗiɗaɓo opitaal.
• Ƴeewto-ɗaa laawol henndu, foofaango, e cirkulaasiyoŋ (ABCs) kala hojomaaji 5 : Ƴeewto nder hunduko ngam yiytude ɓuuɓri uvular walla ɗemngal, heɗto so tawii ko hoarseness walla stridor, ƴeewto semmbe pulse radial.
• Waɗde Epinefriin nder ɓalndu (0,3 mg mawɗo / 0,15 mg cukalel e nder ɓalndu anterolateral) ɗoon e ɗoon e maande adannde ɓuuɓri ɗemngal/leppi, ɓuuɓri daande, stridor, ɓuuɓri ɓuuɓri, ɓuuɓri diffuse, walla ɓuuɓri ɓuuɓri. Fuɗɗito e nder hojomaaji 5 haa 15 so tawii maale ɗee ina njahra yeeso.
• Waɗtu ñawɗo oo e dow ŋoral (flat on back maɓɓe) e koyɗe toowɗe 30 santimeeteer (12 inch) so tawii o nanii ɓuuɓɗo, ɓuuɓɗo, ɓuuɓɗo, walla ɓuuɓɗo, so wonaa tawa omo ɓuuɓtoo walla omo ɓuuɓtoo no feewi sabu ɓuuɓri ƴiiƴam.
• Ittu denndaangal jeewte (ciɗe, waktuuji, jokkere enɗam) e tergal ɓuuɓngal ngal, loot ɓuuɓri ndii no feewi e saabunde e ndiyam ngulɗam, ɓuuɓna tergal ngal e mbaydi joorndi ndi alaa ko bonnata, ɓuuɓna tergal ngal e nder splint walla sling to neutre heart level.

Toksikoloji opitaal e porotokol safaara ɓuuɓɗo¶

Sabu alaa antivenom njulaagu woodi ngam Heloderma suspectum walla Heloderma horridum, toppitagol safaara e nder safrirde ina foti daranaade ko yaawi, ustude ƴiiƴam, ustude ñawu nguu e nder diiwaan, e ittude dental ɓalli jananɗi :

1. Kisal laawol weeyo ko yaawi (Ko ɓuri teeŋtude):
2. Kala ñawɗo mo ɓuuɓri ɗemngal, ɓuuɓri les ɗemngal, daande muusnde, ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam, walla ɓuuɓri ƴiiƴam, ina ɗaɓɓi ko yaawi epinefriin IM/IV, antihistamin H1/H2 (difenhidramin + famotidin), **kortikosteroid IV.mg.5tazolon IV 10 mg IV), e konsultaasiyoŋ anestetik/ENT ko yaawi ngam ustude ɓuuɓri endotrakeal ko yaawi.
3. Perle teskinɗe: Sabu Heloderma anjiyoedema ina waɗi kallikrein-bradikinin mawɗo ko jiidaa e histamin, antihistamin e steroid kuutorteeɗi ina mbaawi waasde haɗde yaajde ɗemngal. Intubaasiyoŋ ko yaawi huutoraade laringoskopi wideyoo walla intubaasiyoŋ fiberoptik ummotooɗo e setup ɗiɗmo peewnaaɗo ngam krikotirotomi seppo emergency hade uddital glottic ɓuuɓde udditaade.
4. Uurtingol ƴiiƴam ngam ɓuuɓri kallikrein/helodermin:
5. Sosde laabi ɗiɗi ɓuuɓɗi e nder ƴiiƴam, ɓuuɓna bolusuuji kiristaloid isotonik (20 haa 30 mL/kg Normal Saline walla Lactated Ringer’s) ngam hebbinde leeso ƴiiƴam ɓuuɓɗam e haɓaade ɓuuɓri kapilaar nokku tataɓo.
6. So tawii hipotension ina jokki hay so tawii ko e nder ndiyam, fuɗɗoo waɗde ɓuuɓri jokkondirndi e vasopressor adrenergique direct : norepinefrin walla epinefrin tiitoonde ngam jogaade ɓuuɓri ƴiiƴam (MAP) ɓurndi 65 mmHg.
7. Hakkilantaagal Naafigaagal: Ko waɗi Blok Nerve Regional ina piytoo Opioids Doseeji Toowɗi Tan:
8. Nafoore ɓuuɓnde e ɓuuɓri Heloderma ina waawi ɗaɓɓude doosɗe opioid keewɗe e nder ƴiiƴam (ko yaltinta histamin, ina waawi bonnude hipotension).
9. So tawii ƴeewndo neurovaskulaar e tendon laaɓtungo e junngo walla junngo ɓuuɓngo ngoo winndaama, analgesia opitaal gonɗo e mbaydi kaŋŋe oo ko blok nerve dijital nokkuyankeewo walla blok nerve diiwaan gonɗo e junngo/juumre yeeso (blok nerve radial, médian, ou ulnar buva-5ca) ropivacaine ALAA epinefriin** (woto meeɗ waɗde epinefriin e nder ɓuuɓri nerwooji dijital saraaji ƴiye koppi). Blok diiwaan ina ustoo ñawu nguu e nder hojomaaji 5 haa 10 tawa ƴiiƴam ina ustoo.
10. X-Rays e ƴeewndo soft-tissue doole ngam dente ɓuuɓɗe:
11. Sabu dente Heloderma ina ɓuuɓna, ina subpleurodont, pecce dente gonɗe e nder 30 haa 50 e nder teemedere e ɓuuɓri ɓuuɓri.
12. Heɓde rajo-rajo (rayooji X) e/walla ultrason toɓɓere toownde e junngo walla junngo ɓuuɓngo e ñawɓe fof, sabu dente Heloderma kalsiyoŋaaji ko raajo-paque.
13. So junngo ngoo anestetikee e bolol nerve diiwaan, ndiyam ɓuuɓɗam ɗam ina heewi e saline normale sterile, ƴeewndoɗaa no feewi ɓuuɓri punndi ndii e pinngi laaɓtuɗi ngam ittude kala ko ina wona ɓuuɓri dental (woto meeɗ waɗde ɓuuɓri luggiɗndi wumre walla fasciotomies prophylactiques so wonaa tawa ko compartment excomment syndrome3).
14. Panel Laboratuwaar, ECG, e Profilaksi:
15. Heɓde ECG 12-lead e ƴeewndo ɓernde jokkondirngo, limto ƴiiƴam timmuɗo (CBC), panneel metabolism kuuɓtodinɗo (CMP) e glukos ƴiiƴam toɓɓere toppitiinde serial (ngam ƴeewtaade so tawii ko ŋakkere suukara e nder ƴiiƴam walla ŋakkere suukara e nder reedu), co, PTINTR profile, ƴiiƴam), e kinaase kreatin (CK).
16. Waɗde tooke tetanus / booster Tdap so ina haani, e winndude balɗe 5 haa 7 antibiyotikuuji gonɗi e hunuko baɗɗiiɗi e hunuko reptileeji ɗi ngalaa ƴiiƴam (Salmonella, Pseudomonas, Aeromonas, Serratim.p-positif) e ɓalndu nduu amoksisilin-klavulanaat (875/125 mg PO laabi ɗiɗi ñalawma kala) walla siprofloksasin e klindamisin / doksisiklin.
17. Tesko denndaangal ñawɓe ɓe ngalaa maale walla ɓe ngalaa maale seeɗa fotde ko famɗi fof waktuuji 6 haa 12 e nder suudu safrirdu, e jaɓde denndaangal ñawɓe wonduɓe e maale gonɗe e ɓalndu, hipotension, anjiyoedema, walla ɓuuɓri terɗe ɓeydotoondi, e nder suudu ƴeewndo walla ICU ko famɗi fof waktuuji 24.

Limooje emergency diiwaan e porotokolle agence¶

• Leyɗeele dentuɗe Amerik e Kanadaa: Noddu 911 ɗoon e ɗoon ngam kala mboros Gila walla mboros mboros beɗi. Jokkondir e Koolaaɗo kuuɓal tooke Amerik e 1-800-222-1222 (jokkondirɗo e Fuɗnaange-rewo e Nokku humpito tooke e leɗɗe Arizona to Tucson walla Nokku humpito tooke e leɗɗe Banner to Phoenix) walla nokku toppitiiɗo tooke e nder diiwaan Kanadaa ngam porotokol safrirde.
• Meksik e Amerik hakkundeejo (Gwatemala): Noddu 911 e nder Meksik walla 122 / 123 e nder Guatemala. To leydi Meksik, safrooɓe ina mbaawi ƴeewtaade RETOMEX (Tookeeji boɗeeji Meksik) ngam heɓde ballal Heloderma horridum e Heloderma suspectum. Tooke mboros korona walla mboros pittaali Meksik waawaa ustude tooke Heloderma, alaa e sago ɗe ndokkee.
• Dental Leyɗeele: Noddu 999 ngam heɓde ambulance so tawii gardiiɗo to zoo walla to nokku mooftirɗo reptileeji jogiiɗi yamiroore ƴaañii. Doktoreeɓe ina poti ƴeewtaade NPIS / TOXBASE e Duɗal Liverpool to bannge safaara nokkuuji ɓuuɓɗi.
• Dental Orop: Noddu 112 ngam heɓugo ballal nyawndiigu ɓaawo nyawndiigu cappanɗe, e jokkindirgo bee nokkure ma lesdi ngam haɓugo bee porotokolle tookeeji ballooji.
• Ostarali e Nuwel Selannde: Noddu 000 to Ostarali walla 111 to Nuwel Selannde ngam heɓde ƴeewndorɗe reptileeji nanngaaɗi, jokkondir e Nokku humpito tookeeji Ostarali to 13 11 26 (walla Nokku toppitiiɗo tooke ngenndiije to Nuwel Selannde to 0800 74 76). Nandugol e mboddi jibinannde Ostarali, Bandage (PIB) FOTI WAƊDE e mboros Heloderma eksootik.

Naamne keewɗe naamneede¶

Hol ko waɗi mboddi Gila ina jogoo e ɓuuɓde e nokku ɗo fiyrata e woppude no mboddi nii?¶

Ina wayi no mboɗeeri, jogiindi ƴiye hipodermik toowɗe jokkondirɗe e ƴiye tooke ɗe ɓuuɓnata tooke e nder feccere leƴƴannde, ƴiye Gila e ƴiye ƴiye Meksik ina njogii ƴiye tooke e nder ƴiye mum en les tawa ngalaa kompresoruuji ƴiye. Tooke majji ina ilna e nder hunuko to dow ŋoral dente luggiɗɗe, ina fawee dow e nder ɓuuɓri ndii e golle kapilaar. Ngam rokkude doosgal tooke deenoowo, ƴiye ɗee ina poti ɓuuɓde e ƴiye mum doole, ɓuuɓna ɗum e nder ɓalndu ngam golloraade tooke ɗee e dow ƴiye dente ɗee haa ɗe mbaɗta ƴiye ƴiiƴam.

Hol ko woni laawol ɓurngol yaawde e kisal ngam heɓde monster Gila ngam yooɓtoraade junngo maa?¶

Ko adii fof, ɗoon e ɗoon, mballu teddeendi ɓanndu nduu e dow leydi, e dow taabal, walla e junngo maa ngo alaa ko woni e mum so wonaa ŋoŋɗi e nder weeyo gila e junngo maa, sibu ŋoŋɗi ina addana ŋoŋɗi ɗii ɓuuɓde e ɓuuɓde. Ko adii ɗuum, ɓuuɓna huunde tiiɗnde, ɓuuɓnde, ko wayi no sawru leɗɗe tiiɗndu, jokkere cukalel, laɓi butel, jokkere enɗam, walla ɓuuɓnude kaayitaaji njulaagu e nder bannge hunduko caggal dente yeeso ɗee, ɓuuɓna ƴiye ɗee, ɓuuɓna junngo maa haa laaɓa cer. Hoto meeɗ jogaade yiite les ɓuuɓri ƴiiƴam, hoto meeɗ ɓuuɓnude ɗum les ndiyam, sibu ɗiin ɗiɗi fof ina ngaddana ɓuuɓri ɓuuɓndi e ɓuuɓri ƴiiƴam ɓurndi bonde.

Mbele ina woodi antivenom ngam haɓaade mboros Gila walla mboros mboros Meksik?¶

Alaa, alaa tooke njulaagu jaɓaaɗe e FDA walla winndereeje ngam huutoraade e nder safaara aadee ngam haɓaade mboros biyeteeɗo Heloderma suspectum (monstre Gila) walla Heloderma horridum (ɓuuɓɗo mboros Meksik). Sabu batte maayɗeele ina pamɗi e toppitagol jamaanu, safaara opitaal ina teskaa e reende laawol henndu jaawngol e anjiyoedema ɗemngal e daande, epinefrin nder ɓalndu walla nder ƴiiƴam, ndiyam kiristalloid nder ƴiiƴam e vasopresoruuji ngam ustude ƴiiƴam, blokaaji nerve regional ngam reentaade mboros bonɗo to reeth broken toys, e Xmo-.

Hol ko waɗi safrooɓe ina njamira sahaa kala waɗde radiyoo junngo maa caggal nde Gila monster ɓuuɓtii?¶

Monsters Gila e lizards beaded ina njogii dente ɓutte, ɓutte luggiɗe, ɗe ɓutte mum en ina ɓuuɓna e nder ɓalndu nduu, tawa ina ndartoo e nder ɓulli luggiɗɗi. So ƴiye ɗee njuumtii walla so ƴiye ɗee ƴettii junngo mum en, 30 haa 50 e nder teemedere ƴiye ɗee ina njokki e ɓuuɓde ƴiye goote walla ko ɓuri ɗum, ina njuutee e nder ɓalndu walla e nder ƴiye ƴiye. Sabu ɗeen dente kalsiyoŋ ina kollita laaɓndal e rafiiji softuɗi, safrooɓe ina ƴetta raajo, ina itta kala ƴiiƴam les ɓuuɓri nerve ngam haɗde granulomaaji ɓalli jananɗi tiiɗɗi e ñawuuji bakteriiji luggiɗɗi.

Hol no tooke Gila monster jokkondiri e leɗɗe jabet ngam ustude teddeendi, hol ko waɗi ɗum ina waɗi nafoore e ɓuuɓri ?¶

E kitaale 1990, wiɗtooɓe ɓee njiyti peptiid nannduɗo e hormon e nder tooke mboros Gila biyeteeɗo exendin-4, nannduɗo e peptiid-1 (GLP-1) nannduɗo e glukagon neɗɗo, wonti kadi tuugnorgal safaara jabet sintetik biyeteeɗo exenatide (e ɗum jibini kalaas GLP-receptor agonists). E nder ɓuuɓri Gila, eksendin-4 wondude e fosfolipase A2 e kallikrein ina mbaawi ustude ɓuuɓri insulin (waktuuji keewɗi ina addana ɓuuɓri suukara e nder ƴiiƴam e ɓuuɓri tiiɗndi) ina waawi kadi saabaade anafilaksi tiiɗɗo mo IgE-mediated e ɓuuɓri ɗemngal mawndi, haa teeŋti noon e reptileer wonɗo junngo walla mo reptile a feeñninde.

Mbele miɗo foti ɓoornaade Bande Immobilisation de Pression walla waɗde ice e dow ƴiiƴam monster Gila?¶

Alaa, woto meeɗ waɗde turniket, walla bannge ɓuuɓɗo (PIB), walla ɓuuɓol ɓuuɓngol e dow ƴiye Gila walla e ƴiye ƴiye Meksik. Sabu tooke Heloderma ina waɗi fosfolipase A2 bonnoowo ƴiye e enzim hyaluronidase baawɗo saabaade ɓuuɓri jaawndi, ɓuuɓnude junngo ina tiiɗa ina nannga tooke ɗee e nder koppi, ina ɓeyda ɓuuɓri e nder ɓuuɓri junngo, tawi noon ice ina addana ɓuuɓri tiiɗndi e dow top injurno injurno.

Fuɗɗoode e ardorde laawɗunde¶

• Nokku humpito tooke e leɗɗe Arizona (Duɗal jaaɓi-haaɗtirde Arizona, Amerik): Njuɓɓudi safaara tooke heloderma suspectum (Gila Monster) : Anjiyoedema e nder weeyo, Hipotension, ɓuuɓri ƴiiƴam diiwaan, e ƴettugol dente.
• Fedde Ameriknaare toppitiinde ko fayti e tooke (AAPCC) & ACMT (Dowlaaji Dentuɗi Amerik): Farmakoloji tooke helodermatidae (gilatoksin, helodermin, eksendin-4) e ƴeewndo ballitoowo ICU (Cantrell e woɗɓe; Hooker & Caravati, Annals Medicine of Emergen).
• Fedde safaara ladde (WMS): Laabi gollorɗi ngam safrude envenomations e nder nokkuuji jeereende Amerik worgo.
• Centres de contrôle et de prévention des maladies (CDC / NIOSH, Dental Dowlaaji Amerik): Reptileeji tookeeji Amerik: Anndinde e ballal gadanal wonande mborosaaji Gila.
• Tookeeji boɗeeji Meksik (RETOMEX, Meksik): Laawol ƴeewndo ñawu nguu e nder ɓalndu (Heloderma horridum) e ñawu nguu.

Ardiiɓe jokkondirɓe¶

• Alerji e anafilaksi toppitagol ko yaawi
• Anafilaksi rebond, reaksiyoŋaaji bifasik, e sahaa EpiPen ɗiɗaɓo
• Ɓoornugol mboddi e emergency reptile tooke
• Ɓoornugol daabaaji e haɗde ñawu nguu bonngu
• Limooje emergency e leydi