Aspiriin (Salisilat), Pillol Njamndi, e Leɗɗe Ƴiiƴam Ɓooygol¶

E nder fotde kala kaɓirgal leɗɗe galle, e nder laylaytol suudu, walla e nder laylaytol mawniiko ina jooɗii e nder laylayti joy leɗɗe galleeji e ɓeydooje ɗo muusde tan 1 haa 5 taƴre (walla kaas gooto ndiyam) ina waawi warde cukalel tokosel ("One-Pill Killers"), e ɗo triple over ɓuuɓri ɓernde e ɗaɗi ndi toppitagol ballitoowol gaadoraangol waawaa waylude tawa alaa ko haɗi ɗum :

1. Salisilaat (Aspiriin, Pepto-Bismol / Subsalisilaat Bismut, e Salisilaat Metil / Nebam Wintergreen): Ko ɗum jibini fosforilaasiyoŋ oksidaatiif mitokondriyee, saabaade ɓuuɓri e nder noppi (tinnitus), hiperventilaasiyoŋ ɓuuɓɗo mo alaa ɗo haaɗi, hipertermi cerebral walla fataal cerebral, ɓuuɓri.
2. Ɓeydagol njamndi mboɗeeri (tablooji sulfaat njamndi mawɓe e witaaminuuji gonɗi e jibinannde): Ko nanndi e M&Ms walla Skittles sokolaaji ɓuuɓɗi e sukaaɓe tokosɓe, ina ɓuuɓna ɓalndu e ɓuuɓri ƴiiƴam hade mum naatde e su"dde foolde **6-cent by "la4-2 ŋakkeende hepatorenal e ɓuuɓri ɓernde.
3. Antidepresanuuji tati (TCAs: Amitriptilin, Nortriptilin, Doxepin, Imipramin): Ko ɓuri heewde e mum en ko ngam haɓaade mboros oo, kono kadi ko e doseeji tokoosi ngam **haɓde e mboros migraine, fibromyalgie, mboros nerve neuropathique, ŋakkeende ɗoyngol, e mboros biyeteeɗo cardium cukaagu ɓuuɓri, komaa, e ɓuuɓri ƴiiƴam yaajndi QRS e nder hojomaaji 60 haa 120.
4. Ɓooygol kalsiyum (CCBs: Amlodipine, Nifedipine, Verapamil, Diltiazem): Ko ngol ɓuuɓnata laabi kalsiyum L-type e nder ɓernde e ƴiiƴam tawa ina haɗa yaltinde insulin e nder pankreas, ina addana **shok vasodilatatoor e kardiyogenik luggiɗiiɗo e nder ƴiiƴam.
5. Beta-Bloqueurs (BBs : Propranolol, Metoprolol, Atenolol, Karvedilol, Sotalol): Ko ɗum addanta bradikardiya tiiɗɗo (ɓernde ina leeltina), ɓuuɓri ƴiiƴam, ɓuuɓri ƴiiƴam, e ɓuuɓri suukara (ina ɓeydoo heen ɓuuɓri sodium-kanaal e ɓuuɓri ƴiiƴam tawa ina yaaji e Torrandesol walla yaajde QRS).

Ndee ɗoo deftere tookeeji ɓuuɓɗi ina rokka golle ladde ko yaawi, limtooji tooke miligaram-e-kilooji laaɓtuɗi, limtooji safaara, e safaaraaji laaɓtuɗi e nder ICU (Alkalinisaasiyoŋ urinaire bikarbonaat sodium IV, kelaasiyoŋ deferoksamin, Euntrahimuglisemik Insulin [Intrahimuglycémique] The [Intralipid], e Glucagon) ina kawri e Fedde Ameriknaare toppitiinde ko fayti e tooke (AAPCC), e Duɗal Ameriknaagal Tookeeji Cafrirɗe (ACMT), e Goomu Gollorɗe EXTRIP, e Fedde Ngenndiije Dentuɗe toppitiinde ko faati e tooke (NPIS).

Waɗde ɗum jooni¶

So tawii cukalel walla mawɗo ina ɓuuɓna aspiriin, nebam ɗam, taƴe njamndi, pillitol ƴiiƴam (beta-bloqueurs walla bloqueurs de canal calcium), walla ñawbuuli tricycliques :

1. Noddu 911 / 112 / 999 ɗoon e ɗoon so tawii cukalel ina ñaama nebam ɗam, pillitol ƴiiƴam, tricyclics, walla njamndi, walla so tawii ñawɗo kala ina jogii maale: Huutoro men limooje caɗtuɗe regginorde. Wonande mawɗo walla cukalel mo alaa maale ñawu nguu ɗo njiɗɗaa hiisaade ko yaawi miligaram kala kiloo, noddu Kontrol tooke (1-800-222-1222 to leyɗeele dentuɗe Amerik; NHS 111 / 999 to leydi Angalteer; 13 11 26 to Ostarali) tawa aɗa hebla yahde to departemaa emergency.
2. Suuɓde hunduko cukalel ngel ngam ƴeewde pillitol ngol ɓuuɓnaaka e mooftude kala butel e ɓuuɓri: So tawii cukalel tokosel ngel waɗii tan ko taƴe e hunuko mum, huutoroo ɓuuɓri koppi ngam ittude kala pillitol ngol alaa ko bonnata e gite mum, limta pillitol heddiingol ngol e nder butelaaji ɗii, ngadda heen geɗe laaɓtuɗe to safrirde too.
3. WOTO MEƊƊI waɗde ɓuuɓri e nder galle e WOTO MEƊƊI rokkude soda walla kosam tawa aɗa jogii laawol Poison Control: Waɗde ɓuuɓri e ñawɗo mo ɓuuɓnata antidepressants tricycliques, propranolol, walla bloqueurs de canal calcium ina bonna no feewi sabu ñawɗo oo ina waawi waasde jogaade hakkille no feewi ɓuuɓri maɓɓe.
4. Faamde kuulal "Kuuɓal Ɓooyngal HAƁATAA Njamndi": So tawii kuuɓtodinngal opitaal ina haɓɓoo aspiriin, ñawbuuli trisiklik, ñawbuuli beta, e ñawbuuli kalsiyum (e ina foti rokkireede e nder waktuuji 1 haa 2), walla e nder doenteries activated). kuuraa WAƊATAA njamndi elemen. Tablooji njamndi mboɗeeri ɓuuɓɗi gonɗi e reedu ina ɗaɓɓi safrirde Irrigation Intestinale (WBI) e ɓuuɓri elektorolit polietilen glikol (GoLYTELY) e nder ƴiiƴam Deferoxamine.
5. **Ƴeewto-ɗee nate XL", "XR", "SR", "CD", "LA") walla nate ɓutte ("EC") e dow butelaaji: Doseeji ɓurɗi heewde **verapamil, diltiazem, nifedipine, metoprolol, walla aspiriin ɓutte 8urs ina mbaawi jogaade s8ym **8ym hade mum yaltinde ɗoon e ɗoon ɓuuɓri ñawu nguu e nder ƴiiƴam. Kala ñaamde ɓuuɓri kalsiyum walla ɓuuɓri beta ina ɗaɓɓi fotde waktuuji 24 ngam ƴeewde ɓernde e nder safrirde, hay so tawii ñawɗo oo ina wayi no moƴƴi no feewi e waktu 4.
6. Jeertin Safrooɓe e Safrooɓe ER ko fayti e "Fannde ɓuuɓnde Salisilaat": So tawii ñawɗo mo tooke aspiriin (salisilaat) tiiɗɗo ina foofa no feewi e no feewi (**30 haa 40 foofaango e nder hojomaaji **), ndeen hiperventilation ina wuurna ɓe e fufde pH maɓɓe to CO$2 gila e jippinde. So tawii ñawɗo oo ina seerti e ɓuuɓri ngam waɗde endotracheal intubation, o waɗtaa e dow njuuteendi ventilateur leelɗo no woorunoo, ɓuuɓri juutndi e nder foofaango ina addana ƴiiƴam \(\text{pH}\) ɓuuɓde, ina addana asid salisilik unionisée feewde e ɓuuɓri ƴiiƴam-ngaandi, ina addana kadi diane minutes to.25 minutes to ɓuuɓri.

Triage urgence e flowchart antidote ngam pillitol galleeji ɓurɗi heewde baasal¶

flowchart TD
    Start["Tuumaaɗo wonde ko ɓuri heewde e pillitol galle<br/>(Aspiriin, njamndi, mboros trisiklik, mboros beta, walla mboros kalsiyum)"] --> Call["Noddu 911 / 112 / 999 walla Tookeeji (1-800-222-1222)<br/>Ƴeewto Butel ngam semmbe (mg) + Ngonka Yaajde (XR/XL/SR/EC)."]

    Call --> ClassCheck{"Hol kalaas leɗɗe ɗe njuumri?"}

    ClassCheck -->|Salicylates: Aspirin, Enteric-Coated Aspirin,<br/>Pepto-Bismol, or Oil of Wintergreen| SalRule["PROTOKOL SALISILAAT (Tinnitus + Ɓooygol + Ɓooygol)<br/>1. Kuuɓal kuutorteengal e doseeji keewɗi (ina jokkondiri e ɓuuɓri aspiriin/bezoars)<br/>2. IV Bikarbonaat sodium (NaHCO3) ngam hisnude pH ƴiiƴam 7,45-7,55 & pH ƴiiƴam 7,5-8,0<br/>+ ɓuuɓɗo IV Potaasiyom (K+ > 4,0) ngam ƴiiƴam waawa yaltinde salisilat<br/>3. REENTO INTUBAASIYOŊ so ina waawi; Hemodiyaalisis ɓuuɓɗo so tawii >100 mg/dL walla maale neuro/pulme"]

    ClassCheck -->|Elemental Iron: Adult Ferrous Sulfate/Gluconate/Fumarate<br/>or Prenatal Vitamins (Calculate Elemental Iron mg/kg)| IronRule["PROTOKOL Njamndi (Kuuɓal kuuɓtodinngal HAƁATAA Njamndi)<br/>1. Rajo reedu (KUB) ngam yiyde pillitol njamndi mboɗeeri e nder reedu<br/>2. Ƴeewirde ɓalndu fof (PEG-ELS / GoLYTELY) so tawii pillitol rajo-paak ina woodi<br/>3. Siftor waktuuji 4 haa 6 ɓurɗi heewde njamndi e nder ƴiiƴam + Gaas ƴiiƴam/Laktat<br/>4. IV Kelaasiyoŋ deferoksamin so tawii njamndi > 500 mcg/dL, sok, walla asidosis"]

    ClassCheck -->|Tricyclic Antidepressants (TCAs): Amitriptyline,<br/>Nortriptyline, Doxepin, Imipramine| TCARule["POROTOKOOL ƁURƊO ƁURDE ƁURDE ƁURDE ƁURDE ƁURDE ƁURDE ƁURDE ƁURDE (TCA) (Blokaade laawol Na+ jaawngol)<br/>1. 12-Ardo ECG ɗoon e ɗoon : Ƴeewto so tawii QRS > 100 ms walla mbaydi R timmundi e nder aVR > 3 mm<br/>2. IV Bolooji bikarbonaat sodium (1-2 mEq/kg) haa QRS ɓuuɓtoo < 100 ms & pH 7,50-7,55<br/>3. Safrude Ɓoornugol TAN e Benzodiazepines (Fenitoin ALAA); IV Emulsiyoŋ lipid so tawii ko ɓuuɓɗo"]

    ClassCheck -->|Calcium Channel Blockers (CCBs: Verapamil, Diltiazem, Amlodipine)<br/>OR Beta-Blockers (BBs: Propranolol, Metoprolol, Sotalol)| CCBBBRule["POROTOKOOL ƁURƊO ƁURDE ƁURDE (Monitoring 24-Hr pour des pills XR/SR)<br/>Ƴeewto Suukara e nder ƴiiƴam: CCB ɓurɗo heewde = HIPERGLISEMI vs BB ɓurɗo heewde = HIPOGLISEMI<br/>1. IV Kuloriid Kalsiyum/Glukonaat + IV Gukagon (bolus 5-10 mg, ina rewi e jaɓɓotooɗo beta)<br/>2. Ɓooygol ƴiiƴam (Norepinefriin / Epinefriin) ngam MAP > 65 mmHg<br/>3. Insulin ɓuuɓɗo (HIET: 1 haa 10 Unit/kg/h Insulin + Dekstroos)<br/>4. VA-ECMO walla Emulsiyoŋ Lipid IV (Intralipid) ngam ustude ɓuuɓri ɓernde"]

Master Njiylawu 5 Toowɗo-Letality Pill Galle ɓurɗo heewde¶

Diwgol luggiɗngol 1: Tooke salisilaat (Aspiriin & Nebam Ɓooyɗam).¶

1. Anndude Toksidrom Salisilaat (Akute vs. Kronik)¶

Tooke salisilat ina waɗa e nder yimɓe ɗiɗo ceertuɓe : (a) Doseeji ɓurɗi heewde e nder sukaaɓe, sukaaɓe mawɓe, walla sukaaɓe tokosɓe ɓe njuumtata ko e butelaaji aspiriin, Excedrin, walla Nebam Wintergreen, e (b) **Tooke salisilat juutɗe ("safaara") e nder tooke salisilat toowɗe walla bismut subsalisilaat (Pepto-Bismol) ngam ñawu nguu walla ɓuuɓri ƴiiƴam e nder balɗe walla jonte keewɗe nde tawnoo golle ƴiiƴam mum en ina ustoo no feewi. Salisilism ɓuuɓɗo ina jogii maayde ɓurnde heewde e doseeji ɓuuɓɗi sabu ina heewi seertude e sepsis, pneumonie, ketoasidosis jabet, walla stroke/dementia.

• Maande jeertinaango nanɗe arandeeje : Tinnitus (nanɗe ɓuuɓɗe walla ɓuuɓɗe) : Salisilaat ina waawi waylude no feewi ƴiye gaasaaji koɗki e neronuuji ganglion spiral. So tawii tolno salisilat e nder ƴiiƴam ina yaaji 20 haa 30 mg/dL, ñawɓe ɓee ina keɓa ɓuuɓri toowndi e nder noppi (tinnitus) walla ina ngulla wonde daande ina nanndi e muusgol, tawa ina wondi e ɓuuɓri, ɓuuɓri, e ɓuuɓri (diaphoresis).
• Siyno Asid-Base Koppi:
• Ko adii fof, salisilat ina ustoo no feewi cakkital fooftere medullaire e nder ɓalndu, ina addana ñawɗo oo foofde no feewi e yaawde (hiperpnee e takipnee), ɗum noon ina fuɗa \(\text{CO}_2\), ina addana Alkalosis fooftere adannde e dow pH toowɗo.
• Ɗiɗaɓere, salisilat ina ustoo fosforilaasiyoŋ oksidaatiif mitokondriyee e nder kala ƴiiƴam ɓanndu (hono no dinitrofenol nii) : ƴiiƴam ina ñaama oksijen e tikkere, ina yaltina nguleeki ɓanndu nder ɓanndu (hipertermi) mawngu e nokku ATP, ina moofta asid laktik, e asid laktik e hoore mum e sahaa gooto Asidosis metabolik gap toowɗo aniyon gadano.

2. Ko waɗi alkalinisaasiyoŋ urine (IV bikarbonaat sodium) e golle hisnude potaasiyom ("Ion Trapping")¶

Asid salisilik ko asid ɓuuɓɗo (\(\tekst{pK}_a = 3,0\)). Ko molekul mo alaa ko woni e mum (mo alaa iyon) (\(\text{HA}\)) tan waawi taƴde ƴiye ƴiiƴam ngam naatde e ngaandi walla ruttaade e ƴiiƴam ummoraade e ɓuuɓri ƴiiƴam, tawi noon iyon salisilat ($\text{A}^-d outside)

• Ko waɗi pH ƴiiƴam ɓuuɓɗo ina wara ñawɗo: So ƴiiƴam ñawɗo oo \(\text{pH}\) ɓuuɓtii e... 7.45 les haa 7.20 (acidemia), ballondiral ngal ina wayloo no feewi feewde nano (\(\text{HA}\)), ina addana asid salisilik mo alaa ko woni e mum oo yaltude e ƴiiƴam, feewde e ƴiiƴam-ngaandi, naata e nder ƴiiƴam ngaandi, addana ɗum ɓuuɓri ngaandi, ɓuuɓri, dekoma, e.
• No Bikarbonaat sodium IV (\(\text{NaHCO}_3\)) nanngirta salisilat e nder ƴiiƴam e nder ƴiiƴam:
• Cafrooɓe urgence ina ndokka bolus 1 haa 2 mEq/kg IV Bikarbonaat Sodium, rewi heen ko ɓuuɓri jokkondire (3 ampul [150 mEq] Bikarbonaat Sodium 8,4% jillondirɗo e Liiteer 1 D5W ɓuuɓnaa e ɓuuɓri laabi 1,5 haa 2).
• Ɓeydude pH ƴiiƴam arteriyel haa 7,45 haa 7,55 ina addana salisilaat yaltude e ngaandi, artira e nder ƴiiƴam.
• Ɓeydude pH ƴiiƴam haa 7,5 haa 8,0 ina ionize salisilat nder ƴiiƴam haa ɗum waawa ɓuuɓde, ɓeydude yaltinde aspiriin e nder ƴiiƴam fotde laabi 10 haa 20.
• Kuulal Potaasiyom (\(K^+\)): A waawaa alkalinirde ƴiiƴam so tawii potaasiyom e nder ƴiiƴam ñawɗo oo ina famɗi (\(\tekst{K}^+ < 4.0\tekst{ mEq/L}\)). So potaasiyom e nder ƴiiƴam ina famɗi, ɓuuɓri ƴiiƴam ina jogoo iyon potaasiyom (\(K^+\)) tawa ina ɓuuɓna iyon hidrojen (\(H^+\)) e nder ƴiiƴam (asiduria paradoksaal), ina jogoo asid ƴiiƴam hay so aɗa waɗa bikarbonaat no feewi. Ko ɗum waɗi safrooɓe ina ɓeyda e dow semmbe 40 haa 60 mEq/L Kuloriid Potaasiyom e nder ƴiiƴam IV ngam hisnude serum \(\text{K}^+\) hakkunde 4,0 e 5,0 mEq/L.
• Feewnitde heege ngaandi suuɗnde ("CNS Neuroglycopenia"): Sabu salisilaat ina yaawi glikolisis ngaandi tawa ina bonna yah-ngartaa suukara e nder ƴiiƴam-ngaandi, ñawɗo mo tooke salisilaat ina waawi jogaade toɓɓere glukose ngaandi timmunde e nder ƴiiƴam mum ko woowaa 90 walla 100 mg/dL. Kala ñawɗo tooke salisilaat mo jiiɓru, delirium, letarji, walla seppooji ina heɓa ɗoon e ɗoon IV Dextrose bolus (D50W walla D10W) tawa ina ƴeewa suukara ƴiiƴam mum e koppi mum.

3. Nde Hemodiyaalisis Emergency Ko Waɗde¶

Sabu aspiriin ina jogii ɓuuɓri seeɗa, hemodialyse taƴoowo ina yaawi laɓɓinde salisilat e nder ƴiiƴam tawa ina feewna asidosis e ŋakkeende ndiyam. E dow kuulal EXTRIP, hemodialyse urgence ina hollitee ɗoon e ɗoon ngam:

1. Waylo ngonka hakkille (jiiɓru, delirium, ɓuuɓri, komaa, walla ɓuuɓri), OR
2. Sindrome de détresse respiratoire aiguë (ARDS) / Edema pulmonaire non cardiogène ina ɗaɓɓi oksijen ɓeydiiɗo, OR
3. Ɓuuɓri ƴiiƴam ɓuuɓndi walla ɓuuɓndi (ko haɗata alkalinisaasiyoŋ ƴiiƴam golloraade), WALLA
4. Njaajeendi Salisilaat e nder ƴiiƴam \(> 100\tekst{ mg/dL}\) (\(> 7,2\tekst{ mmol/L}\)) e nder doseeji ɓurɗi heewde (walla \(> 90\tekst{ mg/dL}\) e golle ƴiiƴam ŋakkuɗe), walla **\(> 60\d/ronic mg}li{m\)li toɓɓere hay so tawii ko kuuraa kuutorteeɗo e doseeji keewɗi e bikarbonaat IV.

Deep Dive 2: Ɓooygol njamndi e daawe 5 ñawu nguu¶

1. Hiisaade Dose Njamndi Elemen e sifaa Salt¶

So a noddii Poison Control walla a arii e departemaa emergency caggal nde neɗɗo ñaami pillol njamndi, safrooɓe ina limta tooke tuugiiɗe e miligaram ELEMENTAL IRON e kala kiloo teddeendi ɓanndu, wonaa teddeendi miligaram taƴre salte njamndi fof :

2. Daawe 5 gonɗe e ñawu nguu (Reento Daawe 2)¶

1. Daawe 1 : Faandaare ɓalndu ɓuuɓndu (0,5 haa 6 waktuuji caggal nde neɗɗo ñaami):
2. Nekrosis corrosive directe du reedu e mucosa duodenal ina addana nafoore reedu ɓuuɓnde, tiiɗnde, ɓuuɓnde keewnde (ina heewi wonde e ƴiiƴam boɗejam jalboojam walla ɓuuɓɗam "kafe-leydi" ɓalejam), e ɓuuɓri ƴiiƴam walla ɓaleeri tarde.
3. Kuulal Triage teeŋtungal: So tawii cukalel walla mawɗo ina heɓa ɓuuɓri, ɓuuɓri, e ɓuuɓri reedu fotde waktuuji 6 timmuɗi caggal nde tuumaama ina ñaama njamndi, tooke njamndi maantinɗe ina mbaawi safreede.
4. Daawe 2: Daawe cuuɗiiɗe / deƴƴuɗe fenaande (waktuuji 6 haa 24 caggal nde neɗɗo ñaami):
5. Muusde ina dartoo, cukalel ngel feeña ina calmina walla ina ɗaanii, ɗum addanta ɓesnguuji (e safrooɓe ɓe ngalaa humpito) miijaade wonde cukalel ngel ina selli. E goonga, njamndi mboɗeeri ina yalta e ɓalndu, ina naata e ƴiiƴam, ina ɓura mbaawka jokkondirde e transferrin, ina ɓuuɓtoo e nder geese endoteliije vaskulaare, e nder miositeeji ɓernde, e nder hepatositeeji periportal hepatik (Zone 1).
6. Daawe 3 : Faandaare Shok Sistemik e Asidosis Metabolik (Waktuuji 12 haa 48 caggal nde neɗɗo ñaami):
7. Ko ɓuuɓri tataɓiri mawndi e ndiyam, ɓuuɓgol ƴiiƴam toowngol, ɓuuɓgol miokardi, e waylude njamndi mboɗeeri (\(\text{Fe}^{2+}\)) e njamndi mboɗeeri (\(\text{Fe}^{3+}\)) tawa ina yaltina proton (\(H^+dri.f\)) e uncoupling soklaaji hipovolemik/renndinooji/kardiyojenik, asidosis laktik toowɗo aniyon-gap tiiɗɗo, koagulopati, letarji, e koma**.
8. Daawe 4 : Hepatotoksisite / Daawe ŋakkere heeñere fulminant (Balɗe 2 haa 5 caggal nde neɗɗo ñaami):
9. Peroksidaasiyoŋ lipid radikal gonɗo e nder Zone Hepatite 1 (hepatositteeji periportal, ko ƴiye heeñere gadane ɗe ƴiiƴam portal njamndi mboɗeeri fiyi e nder reedu) ina addana nekrosis hepatiik ɓuuɓɗo, ɓuuɓri ƴiiƴam, transaminaseeji toowɗi, ŋakkere suukara, e ƴiiƴam.
10. Daawe 5: Ɓoornugol / Daawe ɓuuɓɗe (Aset 2 haa 6 caggal nde neɗɗo ñaami):
11. No ɓuuɓri luggiɗndi e nder reedu sellirta e fibrose e ɓuuɓri nii, ñawɓe ina mbaawi heɓde stenosis pylorique / obstruction de sortie gastrique yontere caggal nde nguurdi e doseeji ɓurɗi heewde, ina mbaɗa ɓuuɓri ndi alaa ko woni e mum so wonaa ɓuuɓri caggal nde ñaami.

3. Dekontaminasiyoŋ e nder safrirde (Rajo KUB + Irigaasiyoŋ ɓalndu fof) e Kelaasiyoŋ Deferoksamin¶

• Rajo reedu (KUB) : Taƴe njamndi mawɗe tiiɗɗe ina keewi radiopaque (ina njalba daneejo jalboowo e rajo reedu laaɓɗo hade mum ɓuuɓde). So tawii pillitol ngol alaa ko bonnata walla farmakobezoar njamndi (ɓurɗo ɓuuɓde) ina yiyee e radiyoo, safrooɓe ɓee puɗɗotoo ko Irrigation intestinale entière (WBI) e dogginde Solution de lavage électrolite électrolique poliétilen glicole (PEG-ELS / GoLYTELY) e nder tube atsogastric 500 mL/hr e nder sukaaɓe tokosɓe walla 1,500 to 2,000 mL/hr e nder mawɓe haa ɓuuɓri reedu nduu laaɓa no feewi, tawa kadi ƴeewndorɗe (rayons X) puɗɗiiɗe hollitde alaa ko heddii e pillitol ngol.
• Toɓɓere njamndi ɓurnde mawnude e nder ƴiiƴam (ina ƴettaa e waktuuji 4 haa 6 caggal nde neɗɗo ñaami):
• < 300 mcg/dL: Tooke no woorunoo / ko famɗi fof.
• 300 to 500 mcg/dL: Tooke ɓuuɓɗe (ina ɗaɓɓi wuurtinde ndiyam IV e ƴeewndo ɓadiiɗo).
• > 500 mcg/dL: Tooke gonɗe e nder ɓalndu ina ɗaɓɓi ɗoon e ɗoon Kelaasiyoŋ Deferoksamin nder ƴiiƴam.
• IV Protokol Deferoksamin: Deferoksamin ina jokkondiri e njamndi mboɗeeri (\(\text{Fe}^{3+}\)) e nder ƴiiƴam ngam waɗde feriyoksamin ɓuuɓɗo e ndiyam, mo ƴiiƴam yaltinta, waɗta ƴiiƴam ñawɗo oo **"vin rosé" /**boɗeejo-boɗeejo) ceertuɗo. Ina waɗee e nder ƴiiƴam e 15 mg/kg/waktu (ina ƴeewa no feewi so tawii ina waɗi hipotension walla tooke pulmonaire jowitiiɗe e tolno so tawii ina waɗee ko ɓuri waktuuji 24).

Diwgol luggiɗngol 3: Ɓooygol mboros trisiklik (TCA) (Kuulal QRS 100 milisekon)¶

Amitriptilin, nortriptilin, doksepin, imipramin, klomipramin, e desipramin ina keddii e yaajde ngam safrude ñawu nguu, ngam haɓaade ñawu nguu, ngam haɓaade ñawu nguu, e ŋakkere ɗanngal, e ɓuuɓri cirƴam. E nder doseeji ɓurɗi heewde, ñawɗo ina waawi yahde gila e haalde ko jokkondiri e nder ambulance haa e seerndi tonik-klonik kuuɓtodinɗo, komaa, e ɓuuɓri ɓernde e nder hojomaaji 30.

1. ECG 12-Lead Ko kuutorgal gadanal ngam ƴeewde ñawu nguu:
2. Sabu tolno ƴiiƴam TCA ina ƴetta balɗe ngam artude e laboratuwaaruuji ƴeewndo, safrooɓe emergency ina njuɓɓina tooke TCA to bannge ECG 12-lead :
   • Takikardiya sinus (ummoraade e ɓuuɓri muskarinik antikolinerjik).
   • Nguurndam ñaamo 40 milisekon e jokkorgal QRS yeesowal: Yiytetee ɗoon e ɗoon e ECG ko jokkorgal R maantiniingal \(> 3\text{ mm}\) e nder jokkorgal aVR (e jokkorgal \(\binndol{R/S.s} > 0.7\) e nder jokkorgal a ep aVR plus)
   • Yaajde dumunna QRS:
   • \(\text{QRS} < 100\text{ ms}\): Ko famɗi fof, ko ɓuuɓri walla ɓuuɓri ƴiiƴam.
   • \(\text{QRS} \ge 100\text{ ms}\): 33 e nder teemedere e baasal gonngal e ɓuuɓri huuɓtodinndi (Kollitgol fuɗɗoraade IV Bikarbonaat Sodium ɗoon e ɗoon).
   • \(\text{QRS} \ge 160\text{ ms}\): 50 e nder teemedere ina waawi wonde e mboros takikardiya walla fiɓnde mboros.
3. Antidote ko yaawi: Bikarbonaat sodium e nder ƴiiƴam (\(\text{NaHCO}_3\)) Bolus:
4. Kala nde duuɓi QRS njottii walla ɓurii 100 milisekon, walla so ñawɗo oo heɓii hipotension walla aritmi ventrikulaar, safrooɓe ɓee ina ndokka ɗum pusgol IV jaawngol 8,4% Bikarbonaat Sodium (1 haa 2 mEq/kg e ms.s e kala bolus)** kala 3 haa 5 minit Q0 low haa Q0 ƴiiƴam \(\binndol{pH}\) ina yettoo 7,50 haa 7,55.
5. No ɗum yahrata: Ko noon kadi, ɓeydagol mawngol iyon sodium ekstraselulaar (\(\text{Na}^+\)) (ko fooli ustaare gaadoraaɗe e laabi sodium ɓernde yaawɗi) e **pH serum alkaline Hojomaaji 10.
6. Ko ŋakki e TCA ɓurtuɗo:
7. WOTO MEƊƊU rokkude Physostigmine ngam delirium antikolinerjik e nder doseeji TCA ɓurɗi heewde (ina addana ɓernde ɓuuɓde/asistolik warde).
8. WOTO MEƊƊU rokkude ñawbuuli IA (prokainamid), IC (flekainid), walla III (amiodaron) ñawbuuli ɓuuɓɗi (ina ɓeyda ɓuuɓri ƴiiƴam walla juutgol QT; huutoro Bikarbonaat sodium IV IV ko adii, e Lidocaine IV [lidocaine IB2l]%d walla [Intralipid] so tawii ko ɓuuɓɗo).
9. WOTO MEƊƊU rokkude Fenitoin ngam ɓuuɓri gonndi e TCA (fenitoin kadi ko ɓuuɓri gonndi e sodium; safru ɓuuɓri TCA no feewi e Benzodiyazepiin IV [lorazepam, diyazepam, walla midazolam] e Bikarbonaat sodium IV).

Diwgol luggiɗngol 4 : Ɓoornugol kalsiyum (CCB) e ɓuuɓol beta (BB).¶

1. No suukara ƴiiƴam seerndirta e sahaa gooto CCB e Beta-Blocker ɓurɗo heewde¶

So ñawɗo mo jaabaaki ina hollita bradycardie luggiɗnde (ɓurnde ɓuuɓde 30 haa 40 bpm) e hipotension tiiɗnde (tansiyoŋ 60/30 mmHg), ƴeewndo glukos e nder ƴiiƴam e junngo ina addana neɗɗo humpitaade ko yaawi :

• Bloqueur de canaux de calcium (CCB) Ɓooygol ina addana HIPERGLISEMIYA: Sabu ƴiiƴam beta pankreas ina ɗaɓɓi ɓuuɓri kalsiyom mbaydi L ngam yaltinde ɓuuɓri insulin e nder ƴiiƴam, ko ɓuri heewde e CCB ina addana **hipoinsulineemia akut e mgten0L2d) hay e ñawɓe ɓe ngalaa jabet. E goonga, tolno hipergliseemi ina jokkondiri no feewi e tiiɗnaare doseeji CCB.
• Beta-Blocker (BB) Ɓooygol ina addana HIPOGLISEMI walla Normoglisemi : Ɓooygol adrenerjik Beta-2 ina haɗa glikogenolisis hepatitis e yaltinnde glukos pankreas, ina addana suukara ŋakkere e nder ƴiiƴam (haa teeŋti e sukaaɓe).

2. Hol ko waɗi ñawbuuli euglisemik (HIET) ko ñawu laaɓtungu ngam haɓaade mboros ɓernde¶

E nder ngonkaaji gaadoraaɗi, ƴiiƴam ɓernde fooftere ina wuli ko adii fof asiduuji ɓuuɓɗi ɗi ngalaa kaalis ngam fuku. E nder dose ɓuuɓɗo walla ɓuuɓɗo beta, miokardi stres oo ina etoo waylude ɓuuɓri mum gila e asiduuji ɓuuɓɗi haa e glukoos, tawa kadi e oon sahaa ina heege insulin (ummoraade e ɓuuɓri kalsiyum pankreas mo sifaa L) e kalsiyum nder ɓalndu :

• No ñawu nguu (HIET) hisnirta ɓernde ŋakkunde:
• Cafrooɓe urgence ina ndokka Insulin IV keewɗo 1 Unit/kg (laabi 10 dose ketoasidosis jabet tippudi), rewi heen ko ɓuuɓri jokkondirndi **1 haa 10 Unit/kg/waktu Insulin De.W 000 gonɗo e nder ɓalndu, tawa ina yahdi e **insulin gonɗo e nder ɓalndu 0IV1 via D50 line) ngam ustude suukara e nder ƴiiƴam (euglisemie: 100 to 200 mg/dL) e ɓeydugol potaasiyom ngam hisnude serum \(\text{K}^+\) at 2.8 to 3.5 mEq/L.
• Insulin toowɗo ina gollira no inotrope moƴƴo doole : ina doola suukara e laktat to bannge miositeeji ɓernde heege rewrude e signaling PI3K/Akt, ina artira jokkondire kalsiyom nder geese, ina ɓeyda yaltugol ɓernde e tansiyoŋ e nder **30 haa 45 minit fuɗɗoraade w*ET Kalsiyum IV, Glukagon IV [bolus 5 haa 10 mg ngam ɓuuɓri beta], e Norepinefriin/Epinefriin, ɓuri fadde haa ñawɗo oo woni e ɓuuɓri ɓernde).

Naamne keewɗe naamneede¶

Ɓiɗɗo am mo duuɓi 2, ɓuuɓtii tablette am njamndi keewɗe ko adii jibineede, waktuuji ɗiɗi ko adii jooni. Hol ko waɗi doktoor emergency wiyi ɓe WAAWAA rokkude charbon activé no ɓe mbaɗata e tookeeji goɗɗi ɗii ?¶

Kuuɓal kuuɓtodinngal ina gollira e ɓuuɓnude molekule leɗɗe mawɗe baɗɗe karbon e nder ɓuuɓri mum mikroskoop, kono iyonuuji njamndiiji tokoosi (teeŋti noon e njamndi, litiyum, plumbum, potaasiyom, e sodium) njokkondirtaa e kuuɓtodinɗo hay dara. Hokkude cukalel kuuɓtodinngel ɓalewel kuuɓtodinngel ngel muumti taƴe njamndi ina moƴƴi, tee ina bonna toppitagol ngol, sibu ina suuɗa yiytere endoskopi, ina addana ɗum waawde seerndude ƴiiƴam kuuɓtodinɗam ɗam alaa ko bonnata e ƴiiƴam ɓalndu bonɗam ɗam njamndi addata. E nder ɗuum, safrooɓe ina ƴetta ƴeewndo reedu ngam yiytude pillitol njamndi mboɗeeri, ɓuuɓna ɗum e nder reedu, tawa ina huutoroo ɓuuɓri ɓalndu (Irrigation de poliéthylène glycol), ina ndokka ɓuuɓri Deferoxamine e nder ƴiiƴam so tawii ko njamndi mboɗeeri e nder waktuuji 4 haa 6 ina tooke.

Hol ko waɗi ina saɗti waɗde intubaasiyoŋ e waɗde ñawɗo tooke aspiriin (salisilat) tiiɗɗo e dow ventilatoor mekanik ?¶

Ñawɗo tooke aspiriin tiiɗɗo ina foofa laabi 30 haa 45 e nder hojomaaji 10 tawa ina foofa luggiɗde, ina ɓuuɓna (hyperpnée) ngam fuɗde gaas karbonik e jogaade pH ƴiiƴam mum alkali seeɗa (7,45 haa 7,52), ko ɗum addanta asid salisilik iyoneede e nder ƴiiƴam e yaltude e bra. So doktoor rokkii leɗɗe cemmbinɗe e paralitik ngam waɗde heen tuuba fooftere, ñawɗo oo ina woppa foofde fotde leƴƴanɗe 60 haa 90, tee ventilatoor mekanik gonɗo e mbaydi kuuɓtodinndi waawaa yahdude e ɓuuɓri mawndi ndi ñawɗo oo waɗatnoo e hoore mum, fotde 25 haa 35 liiteer e nder hojomaaji. E nder hojomaaji seeɗa, CO2 keɓaaɗo ina addana pH ƴiiƴam ustaade les 7,20, ɗum wayla salisilat iyon, waɗta ɗum asid salisilat mo alaa ko woni e mum, ruttoo e nder ngaandi e ɓernde, addana ɓernde ustaade ɗoon e ɗoon. Ko ɗum waɗi, tookeeji ina kaɗa waɗde intubaasiyoŋ e ñawɓe salisilaat kala nde mbaawi, ina teeŋtina hemodiyaalisis ko yaawi e nokku mum.

So tawii cukalel tokosel ina ɓuuɓna tan GOOTOL ƴiiƴam ɓuuɓɗam (hono Verapamil SR walla Nifedipine XL) tawa ina nanndi e 100% weltaare e semmbe waktuuji ɗiɗi caggal ɗuum, mbele eɗen mbaawi jooɗaade e galle ?¶

Alaa: noddu 911, njahaa to safrirde ɗoon e ɗoon. Ko ɓuri anndeede e « warooɓe pillitol gootol » e nder safaara sukaaɓe, ko ɓuuɓri kalsiyum e ɓuuɓri beta (SR, XL, XR, CD) ɓuuɓndi. Sabu tablet oo ina waɗi innde polimer (matrix) ɓuuɓɗo, walla e nder ɓalndu pompe osmotik, fotde 100 000 mbuuɗu ina yaltina lekki e nder waktuuji 2 haa 6 gadani ɗii, ɗum noon cukalel ngel ina nanndi e no woorunoo nii. Ndeen, waktuuji 8 haa 18 caggal ɗuum, heewi wonde ko e hakkunde jamma tawa cukalel ngel ina ɗaanii, lekki kii ina yettoo ƴiiƴam tooke, ina addana ɗum ɓuuɓde no feewi, ɓuuɓde e ɓuuɓde ɓernde. Kala cukalel ngel ɓuuɓnata hay so ko ɓuuɓol kalsiyum gootol, ina ɗaɓɓi waktuuji 24 timmuɗi ngam ƴeewde ɓernde mum e nder safrirde.

Ndee ɗoo tinndinoore ko ngam humpitaade, lomtinaani ballal safaara karallaagal walla jokkondiral Poison Control. Sabu leɗɗe galleeji ɓurɗe heewde e sukaaɓe e mawɓe ina mbaawi saabaade ɓuuɓri, ɓuuɓri ƴiiƴam, e ɓuuɓri ɓernde, eɗen mbaawi wasiyaade no feewi ƴettude ballal gadanal sukaaɓe e mawɓe e kursus CPR rewrude e Fedde Adunaare Croix-Rouge e Sociétés de la Croix-Rouge (IFRC), nokku mon St John Red Crossi ambulance hokkoowo.

Fuɗɗoode ƴeewtaama¶

• Koolaaɗo kuuɓal Ameriknaajo tookeeji safaara (ACMT) & Fedde Ameriknaare toppitiinde ko fayti e tooke (AAPCC): Laabi gollorɗi ngam tookeeji salisilaat, njamndi, trisiklik, beta-blocker, e kalsiyum kanaal.
• EXTRIP (Safaaraaji ekstrakorporeeji e nder tooke) Goomu golle: Wasiyaaji tuugiiɗi e hujjaaji ngam safrude ekstrakorporeeji e tooke salisilaat e trisiklik (Annals of Emergency Medicine).
• Goomu nanondiral annduɓe ko faati e tooke ɓuuɓɗe kalsiyum (Lekki cafrirki): Wasiyaaji kawral ngam ƴellitde tooke ɓuuɓɗe kalsiyum e safaara ɓuuɓɗo insulin toowɗo (HIET).
• Sarwiis ngenndiijo humpito tookeeji (NPIS, Royaume-Uni): Protokolle njuɓɓudi safaara TOXBASE ngam salisilaat, salte ferrous, antidepressants tricyclic, e leɗɗe ɓernde.

Ardiiɓe jokkondirɓe¶

• Asetaminofen (parasetamol / Tilenol) ɓurtuɗo e windoore antidote waktuuji 8
• Tooke ballal gadanal e triage ngam haɓaade tooke
• Sindoron serotonin, sindoron bonɗo neuroleptik, e jokkondiral leɗɗe
• CPR sukaaɓe e cukalel e ɓuuɓri
• Limooje emergency e leydi