Sindoron Serotonin e Emergency Jokkondiral Leɗɗe Caɗtuɗe¶

Sindoron serotonin e sindrom neuroleptik malignant (NMS) ko ñawuuji safaaraaji baawɗi bonnude nguurndam, ɗo leɗɗe cafrorteeɗe, coftal ɓalli, walla geɗe ɓuuɓɗe, walla geɗe teskinɗe, ina addana neɗɗo ŋakkere nerwooji hakkundeeji dogdu, ɓuuɓri ɓalndu tiiɗndi walla ɓuuɓri ɓalndu toowndi, e nguleeki ɓalndu ɓurtuki Selsius (104,0 degere Celsius). So tawii noon mboros serotonin ina yaawi yaawde e nder waktuuji 2 haa 24 caggal nde neɗɗo ƴetti lekki kesiri, ɓeydi heen doosgal, walla hawri e geɗe ɗiɗi serotonin, mboros bonɗo neuroleptik ina heewi ƴellitaade seeɗa seeɗa e nder balɗe 1 haa 14 caggal nde neɗɗo fuɗɗii walla ɓeydi lekki kii (antipsy blocks) walla antipsy.

Ko ɓuri teeŋtude e maa ko yaawi e nder sahaa tuumaaɗo jokkondire leɗɗe caɗtuɗe ko noddude yah-ngartaa safrooɓe yahruɓe yeeso, dartinde kala ko ina jokki e njuɓɓudi kala lekki e ɓeydaare, fuɗɗoraade coofgol ɓuuɓngol yaajngol e ice-pack so tawii neɗɗo oo ina wuli nguleeki so tawii neɗɗo oo ina wuli jaw, reende laawol henndu e nder sahaaji seppooji e kala printomble as rigiut safrooɓe emergency ina mbaawi rokkude antidoteeji kemikal targeted ɗoon e ɗoon so ɓe ngarii e opitaal.

Waɗde ɗum jooni¶

1. Noddu sarwisaaji safaara ɓuuɓɗi ɗoon e ɗoon: Noddu limoore safaara ɓuuɓɗo nokku maa (911 to leyɗeele dentuɗe Amerik e Kanadaa, 112 e nder Dental Orop, 999 to leydi Angalteer, 000 to Ostarali) walla ƴeewto regginorde amen of limooje caɗtuɗe. To leyɗeele dentuɗe Amerik, aɗa waawi kadi noddude fedde toppitiinde ko fayti e tooke e 1-800-222-1222 so tawii ambulance ina woni e laawol. Rajo tuumaaɗo wonde ko ñawu serotonin walla ñawu neuroleptik bonngu e nguleeki e ɓuuɓri ɓalndu.
2. Woppu kala leɗɗe, ɓeydooje, e safaaraaji ɗi ngalaa doktoor ɗoon e ɗoon: Woto ndokku dose goɗɗo e kala leɗɗe ɓuuɓnooje, leɗɗe ɓuuɓnooje, triptan migraine, sirop ɓuuɓɗo, pillol ɓuuɓnoowo, walla leɗɗe ɓuuɓnooje leɗɗe. Hoto meeɗ etaade safrude ñawu nguu e asetaminofen (parasetamol), ibuprofen, walla aspiriin mo alaa ko soodata.
3. Fooɗtude nguleeki e fuɗɗaade cooyngal yaajngal so ina wuli: So tawii neɗɗo oo ina nana nguleeki e toɓɓere, ina ɓuuɓtoo no feewi, walla ina jogii nguleeki ɓurtuki 38,5 degere Celsius (101,3 degere Fahrenheit), ɓoorno comci teeŋtuɗi, mist ɗum en water nokku e co, ɓuuɓri ƴiiƴam ɓuuɓndi e nder wuttulo, e nder wuttulo, e banngeeji wuddu.
4. Dartoɗee e bannge maɓɓe e kisal, woto meeɗ haɗde terɗe ɓuuɓɗe: Wallu neɗɗo ɓuuɓɗo walla ɓuuɓɗo oo lelna e bannge mum e nder mbaydi cellal e dow leeso walla leeso ɓuuɓngo ngo woɗɗitoo ŋoral tiiɗngal. Hoto meeɗ jogaade les, jooɗaade, walla doole reentaade terɗe ɗe njirlotoo, ɗe njirlotoo, walla ɗe njirlotoo, sibu hare isometrik e reentaade ɓanndu ina yaawi yaawde ɓuuɓde ɓalndu, ina ɓeyda nguleeki ɓanndu.
5. Mooftu kala ko woni e leɗɗe, paɗe, e butelaaji ɓeydooji: Moftu denndaangal butelaaji restoraaji, paɗe ɓuuɓɗe, paɗe transdermal (ƴeewto ɓalndu e ɓalndu, e ɓalndu, e juuɗe, e koyɗe ngam ƴeewde so tawii ina woodi fentanil, selegiline, walla rivastigmine), saakuuji palastik ɗi ngalaa doktoor e leɗɗe cafrorteeɗe, illicit a sinmedics.
6. Ƴeewto foofaango e peewnugol CPR walla toppitagol seppooji: Jokku e sara neɗɗo oo ko juuti. So tawii seppo huuɓtodinngo waɗii, ɓuuɓna hoore maɓɓe, ɓuuɓna ɓe e bannge maɓɓe so jerking oo ustii. So tawii ɓe ngontii jaabaade, ɓe ngoppa foofde no haanirta nii, fuɗɗoo wuurtinde ɓernde e ɓuuɓri (CPR) ɗoon e ɗoon.

flowchart TD
    Start["Ɓooygol, ɓuuɓri, ɓuuɓri, e ɓuuɓri ɓalndu walla ɓuuɓri caggal nde leɗɗe kuutortee"] --> Call["1. Noddu Sarwiisiiji Ƴellitaare (911 / 112 / 999) e Woppude Leɗɗe Denndaaɗe Ɗoon e ɗoon"]
    Call --> CheckTemp{"2. Mbele ɓalndu ina wuli jaw walla nguleeki ɓalndu ina ɓura 38,5 C (101,3 F)?"}
    CheckTemp -->|Yes| CoolNow["Ɓoornude comci, ɓuuɓnude ɓalndu e ndiyam cooyɗam, fan e semmbe, waɗde paɗe glaas e ŋoral e ŋoral"]
    CheckTemp -->|No| MonitorTemp["Waɗde suudu nduu ina cooynii e 18 haa 20 C (64 haa 68 F), Ittude Ɓoornugol, Ƴeewto Temp Kala Hojomaaji 5"]
    CoolNow --> NeuroSign{"3. Ƴeewtaade Toon Muscle e Pattern Reflex"}
    MonitorTemp --> NeuroSign
    NeuroSign -->|Rhythmic Ankle Jerks, Shivering, Wide Pupils, Fast Onset Under 24 Hours| SS["Tuumaaɗo e mboros serotonin : Reenaade reentaade, reenaade e dogde, mooftude leɗɗe serotonin"]
    NeuroSign -->|Lead Pipe Stiffness Everywhere, Slow Reflexes, Onset Over Days| NMS["Tuumaaɗo wonde ko mboros neuroleptik bonɗo : ƴeewto antipsikotiik walla leɗɗe kaɓtorɗe ɓuuɓri, ɓanndu cooyndu"]
    SS --> Airway{"4. Mbele Neɗɗo oo ina anndi ina reena laawol mum?"}
    NMS --> Airway
    Airway -->|Conscious but Agitated| Calm["Dim Lights, Haaldu e Deƴƴere, Woto NeverGive Ustooje Fever walla Fluids e Hunduko So Muusde Ina Ustii"]
    Airway -->|Unconscious or Seizing| Recovery["Roll e nder mbaydi cellal bannge, hoore kuɗol, fuɗɗoraade CPR so fooftere dartiima"]

Feere serotonin ceertunde, mboros neuroleptik bonɗo, e hipertermiiji tooke goɗɗi¶

So ñawɗo oo heɓii jiiɓru mawndu, nguleeki, ɓernde ina doga, e ɓuuɓri ɓalndu ina ŋakki caggal nde ƴetti leɗɗe, safrooɓe ɓee ina poti yaawde seerndude tookeeji nay baawɗi warde nguurndam : sindrom serotonin, sindrom neuroleptik malignant (NMS), tosimikompaty doseeji ɓurɗi heewde**. So tawii ballal gadanal prehospital wonande denndaangal nokkuuji nay ɗii ko fayti e ndeenka laabi weeyo, dartinde ñawɗo oo, e coofgol ɓanndu jaawngol, ƴeewtaade mbaadi keeriindi dille ɓalndu, ɓuuɓri ɓalndu, mawneeki almuudo, e daande ɓalndu ina rokka safrooɓe e safrooɓe emergency humpitooji teskinɗi e fuɗɗoode hoore.

Famde sifaaji tooke serotonin Hunter e denndaangal leɗɗe cafrorteeɗe¶

Serotonin (5-hidroksitiriptamin, walla 5-HT) ko huunde ɓuuɓnde e nder ɓalndu, baawnde reentaade nguleeki, reentaade ɓuuɓri ɓalndu, reentaade ɓuuɓri ƴiiƴam, e reentaade ɓuuɓri. Sindoron serotonin (ina wiyee kadi tooke serotonin) ina famɗi ɗo safrata ɗum ko doosgal safaara no woorunoo e lekki gooto ; e nder ɗuum, Fedde Adunaare Cellal (OMS), Fedde Ameriknaare toppitiinde ko fayti e nguura e leɗɗe (FDA), e Fedde toppitiinde ko fayti e leɗɗe e geɗe cellal to Dental Dowlaaji Amerik (MHRA) ina teeŋtina wonde tooke bonɗe ɓuri heewde heɓtaade ko nde leɗɗe ɗiɗi walla ko ɓuri ɗum, ɓeydooje serotonin rewrude e **mekanuuji biyokimikaaji ceertuɗi, walla teskaade dumunna lootgol doole.

Mekanismeeji joy serotonerji ɗi njiylotoo¶

1. Reentaade ƴettugol serotonin e nder ɓuuɓri sinaptik: Reentaade ƴettugol serotonin cuɓaaɗo (SSRI ko wayi no fluoksetin, sertralin, escitalopram, sitalopram, paroksetin), reentaade ƴettugol serotonin-norepinefrin su**la,SNRIkse desvenlafaxine), ñawbuuli ɓuuɓɗi (TCAs ko wayi no amitriptilin, klomipramin, imipramin), won e ñawbuuli ɓuuɓɗi sintetik (tramadol, meperidin/petidin, fentanil, metadon, tapentadol), ñawbuuli ɓuuɓɗi ɓuuɓɗi (D St. Ɓoornugol John (Hiperikum perforatum), e ɓuuɓnoowo ɓalndu siklobenzapriin.
2. Haɗde ɓuuɓgol serotonin e oksidaas monoamin (MAOIs): Haɗde ɓuuɓri hakkille (fenelzin, tranilsipromin, isokarboksazid, moklobemid), haɗde ɓuuɓri MAO-B ñawu Parkinson (selegilin, rasagilin), ɓuuɓri safrirde e **antizoliin gonɗo e hunuko MAOI), e mbaydi seerndi e nder ƴiiƴam bulo metilen.
3. Ɓeydagol yaltinde serotonin mooftiraaɗo e nder presinaptik: Amfetamiin, dekstroamfetamiin, metilfenidaat, metamfetamiin, kokayin, MDMA (ekstaasi / Molly), e ɓuuɓri ɓuuɓri toowndi.
4. Udditgol toowngol gonngol e nder ɓalndu : Migren triptan (sumatriptan, risatriptan, zolmitriptan), alkaloyid ergot (dihidroergotamin), buspiron, litiyum, e hallusinogen (LSD).
5. Ɓeydagol sintesis serotonin ummoraade e ñamri: Doseeji toowɗi L-tiriptofan walla 5-HTP (5-hidroksitiriptofan) ñamri yeeyeteendi ngam wallitde ɗanngal walla miijo.

Ko ɓuri heewde e leɗɗe galleeji ina njiyloo mboros serotonin¶

• Fooyre "Sirop ɓuuɓɗo e ɓuuɓri": Neɗɗo ƴettuɗo SSRI walla SNRI ñalnde kala ngam depression walla anxiété ina nannga ɓuuɓri winndere, o ƴetta lekki ɓuuɓri e ɓuuɓri keewndi maale tawa ina waɗi dextromethorphan (DXM). Sabu DXM ina haɗa no feewi ƴellitgol serotonin, tee ina heewi renndude laawol enzim heeñere (CYP2D6) hono no ñawu nguu nii, ko noon kadi, tolno serotonin ina ɓeydoo e nder waktuuji seeɗa.
• Faandu "Njaajeendi caggal ñawu" : Ñawɗo mo sertraline walla duloxetine ina yilloyoo e safrirde toppitiinde ko yaawi ngam ñawu ɓalndu walla ɓuuɓri ɓalndu, o rokketee tramadol walla cyclobenzaprine, walla o huutoroo heddiiɓe e ñawu opioid e sara ñawu nguu e sahaa kala.
• Faandu "Antibiyotik Infeksiyoŋ": Ñawɗo ƴettuɗo kala lekki ɓuuɓki walla lekki Parkinson ina yamiree lekki linezolid ngam ñawu nguu ina waawi haɓtaade Staphylococcus aureus (MRSA) e nder ɓalndu walla e nder ƴiiƴam. Sabu linezolid ina haɗa oksidaas monoamin ustude serotonin, hawrude e SSRI walla SNRI ina addana neɗɗo mboros bonɗo, keewɗo warde.
• Fuɗɗude "Duuɓi loowdi": Ñawɗo ina woppa fluoxetine (Prozac) ina fuɗɗoo MAOI walla huunde woɗnde serotonerji toownde balɗe seeɗa caggal ɗuum. Sabu fluoxetine e metaboliit mum kuutortooɗo (norfluoxetine) ina njogii feccere nguurndam juutnde no feewi, safrooɓe ina ɗaɓɓi duuɓi loowdi 5 ko famɗi fof caggal nde ɓe ngoppi fluoxetine (e ko famɗi fof jonte 2 caggal nde ɓe ngoppi SSRI, SNRI, walla MAOI goɗɗi hade maɓɓe naatde e safaara.

No ƴeewtorto-ɗaa tookeeji serotonin Hunter e sara leeso¶

Tookeeji ɓuuɓɗi e nder winndere ndee kala ina kuutoroo Hunter Serotonin Toxicity Criteria (ko 84 e nder teemedere sensitive e 97 e nder teemedere keeriiɗo, ɓuri limtooji ɓooyɗi) ngam anndude mboros serotonin e kala ƴettuɗo mboros serotonin e nder yontere 5 ɓennunde ndee. Neɗɗo ina hawra e sarɗiiji ɗii so tawii ɓe kollitii kala gooto e ɗeeɗoo mbaydiiji joy maandeeji kilinik :

1. Spontaneous clonus: Jokkude, rimɗude, ɓuuɓde walla ɓuuɓde e nder fedde ƴiye (haa teeŋti e koyɗe, ƴiye, walla ƴiye) tawa hay gooto memataa tergal ngal.
2. Klonus inducible PLUS agitation WALLA ɓuuɓri keewndi (diaphoresis): So aɗa ɓuuɓna ballal koyngal neɗɗo oo dow feewde e ŋoral mum (dorsiflexion) e jogaade ɓuuɓri ɓuuɓndi, koyngal e ŋoral ina ɓuuɓta yeeso e caggal e junngo maa ko ɓuri 3 walla 4), walla ko ɓuuɓri hakkille walla ɓuuɓri ɓuuɓri.
3. Ocular clonus PLUS agitation OR profuse sweating: So a naamndiima neɗɗo oo yoo ƴeew yeeso no feewi walla rewa e junngo maa to bannge, gite mum ina kollita ɓuuɓri leelndi, jokkondirndi, ɓuuɓri bannge-bannge ("gaze ping-pong") walla ɓuuɓri jaawndi, tawa ina wondi e ɓuuɓri gonndi e ɓuuɓri.
4. Tremor PLUS hyperreflexia: Dimmbagol rimɗingol yiyteteengol e juuɗe e koyɗe tawa ina yahdi e ɓuuɓri gonndi e koppi e koyɗe.
5. Hipertoni (ɓuuɓri tiiɗndi) PLUS nguleeki ɓurtuki 38,0 degere Celsius (100,4 degere Fahrenheit) PLUS so tawii ko ɓuuɓri gite WALLA ɓuuɓri gonndi e gite: Ngolɗoo ɓuuɓri joyaɓiri ina hollita **ɓurtugol tiiɗngol e tookeeji serotonin gonɗi e nguurndam.

Anndude ñawu nguu (NMS) e ñawu nguu ina wiyee Parkinson¶

So tawii ko mboros serotonin ɓuri heewde e serotonin ina addana ɗum jokkondire nerwooje, sindrom bonɗo neuroleptik (NMS) ina addana ɗum **heege ɓuuɓnde, bonnde, e nder nokkuuji ɗiɗi teeŋtuɗi e nder ngaandi : laawol gonngol e ɓalndu ɓuuɓndu, a rigidité extrême so ina udditaa) e hipotalamus yeeso (ko reennata nguleeki ɓalndu core e tansiyoŋ otonomik).

Laawol ɗiɗi ceertuɗi e nder mboros bonɗo neuroleptik¶

1. Blokaade jaɓɓotooɗo dopamin (Classic NMS): Ina ummoo e fuɗɗoraade, ɓeydude doosgal, walla hawrude e leɗɗe ɓuuɓnooje jaɓɓotooɗe dopamin D2. So tawii ko leɗɗe cafrorteeɗe gonɗe e jibinannde adannde (haloperidol, flufenazin, kuloropromasin) ɓurɗe waawde bonnude, leɗɗe cafrorteeɗe gonɗe e jibinannde ɗiɗmere (risperidon, olanzapin, ketiyapin, paliperidon, aripiprazol, klozapin) ina ngadda kadi NMS. Ko ɓuri teeŋtude, ñawɓe heewɓe ɓe ngonaa hakkillaaji ina keɓa NMS e leɗɗe kaɗooje dopamin ngam haɓaade ɓuuɓri e ɓuuɓri reedu ɗe keewi jogaade e nder galleeji ngam haɓaade ñawu nguu, walla ñawu nguu, walla ñawu nguu, tawi ina jeyaa heen metoklopramid, proklorperazin, prometazine, e droperidol.
2. Ittugol dopamin (Sindrome Parkinson-Hyperpyrexie): Ina fuɗɗoo so ñawɗo Rafi Parkinson walla sindoron koyɗe ɗe ɓuuɓnaaki, ɗoon e ɗoon woppii ƴettude, timmii, walla waawaa muñde leɗɗe mum ñalnde kala lomtotooɗe dopamin (levodoropatine,ropigopa/ paɗe, walla amantadine), ko wayi no e sahaa mboros reedu walla e nder safrirde. So tawii ko e nder waktuuji 18 haa 72, ngaandi ñawɗo oo ina ŋakkiraa dopamin eksoojenik, ina ɓuuɓtoo e ngonka nannduka e ɓuuɓri ƴiiƴam, ɓuuɓri toowndi, e ɓuuɓri otonomi.

Tetrad classique mo mboros bonɗo neuroleptik¶

NMS ina heewi feeñde e mbaydi anndinde e nder waktuuji 24 haa 72 :

• 1. Waylo-waylo ngonka hakkille (ina heewi wonde maande adannde): Ko adii nde nguleeki feeñata, ñawɗo oo wonta deƴƴuɗo no feewi, muumɗo (akinetic mutism), ɓuuɓɗo, ɓuuɓɗo, walla katatonik, ƴeewoowo mo alaa ko woni e mum, mo waasa jaabaade naamne, walla waylo-waylo e ɓuuɓri kulɓiniindi e delirium.
• 2. Generalized "lead-pipe" muscular rigidity: So aɗa etoo no feewi ɓuuɓnude walla fooɗtude wuttulo neɗɗo oo, walla junngo mum, walla koppi mum, tergal ngal ina haɓa e dille teeŋtuɗe, goote, ɗe ɓuuɓnataa e nder dille ɗee kala, no ɓuuɓnude tuuba plomb tiiɗɗo nii. So tawii diƴƴe gonɗe dow ɗee ina ngoodi, ina nanndi e rattude geɗe tiiɗɗe (rigidité cogwheel). Tiiɗnaare ƴiye daande e ƴiye jawdi (disfaaji e disartri) ina addana haala ɓuuɓde, ina addana ɓuuɓri tiiɗndi ɓuuɓde e ɓuuɓde e hunuko.
• 3. Hipertermiya: Nguleeki ɓanndu ina ɓeydoo dow 38,5 degere Celsius (101,3 degere Fahrenheit), ina heewi kadi ɓurde **40,0 haa 41,5 degere Celsius (104,0 haa 106,7 degere askelet askelined Fahrenheit) trifosfaat (ATP) ina jokki.
• 4. Instabilité nerveux autonome : Otopilot nder ɓanndu ina waasa jogaade doole : ɓernde ina doga haa ɓura 110 haa 140 fiyngo e nder hojomaaji, ƴiiƴam ina wayloo no feewi gila e tooweeki kulɓiniiki haa e lesɗingol kulɓiniingol e nder hojomaaji seeɗa, foofaango ina yaawi e ina famɗi (tachypnea dd). (diaphoresis), kadi neɗɗo oo ina waawi heɓde ɓuuɓri ƴiiƴam ɗoon e ɗoon.

Ballal gadanal ƴaañorgal e ƴaañorgal tawa ina fadi safrooɓe¶

Sabu mboros serotonin e mboros bonɗo neuroleptik fof ina mbara e nder kaskaaji tati timmuɗi ɗii (bonnugol ngaandi nguleeki ummoraade e nguleeki core ɓurki 41 degere Celsius / 105,8 degere Fahrenheit, ɓuuɓri ummoraade e ɓuuɓri ɓalndu tiiɗndi walla aspiraasiyoŋ ummoraade e carssidia disleased, e... tissue), toppitagol maa e nder ladde ina foti wonde ko yuɓɓo e ko yaawi.

Ɗatal 1: Hisnude nguleeki ko yaawi (Coofgol ɓuuɓngol e ɓuuɓngol)¶

So tawii ɓalndu neɗɗo oo ina wondi e nguleeki, ina ɓuuɓna, walla ina ɓuuɓna, walla so tawii termometre hunduko, timpani (noppi), walla tiinde ina jannga dow 38,5 degere Celsius (101,3 degere Fahrenheit), kala minit leelɗo ina addana nguleeki ɓalndu ɓeydaade toowde.

1. Strip away insulation: Ɗoon e ɗoon ittude ɓuuɓri, ɓuuɓri, jacket, ɓuuɓri, soseeji, e pantalon tedduɗo haa les. Woɗɗitin neɗɗo oo e windooji naange walla e radiyeeji, e nder suudu ɓurndu coofde, mbaɗtaa heen ƴulɓe (air conditionneur) haa ɓura.
2. Waɗde coofgol ɓuuɓngol jokkondirngol (mist e fan): Coofgol ɓuuɓngol ko feere ɓurnde yaawde kisal e nder galle so tawii lootorde ice ina woodi walla ina selli sabu agitaasiyoŋ walla baasal seppooji. Huutoro ɓuuɓri leɗɗe laaɓndi walla ɓuuɓri ɓuuɓri ngam ɓuuɓnude walla ɓuuɓnude ɓalndu neɗɗo oo, reedu mum, juuɗe mum, e koyɗe mum e ndiyam coofɗam walla ɓuuɓɗam (15 haa 20 degere Celsius / 59 haa 68 degere Fahrenheit) tawa ina yiɗi fanx electric askins maɓɓe (walla fannude ɗe e semmbe e karton tiiɗɗo walla e laylaytol). Henndu diwndu ina ɓuuɓna filmo ndiyam, ina yaltina nguleeki cuuɗiiki kii e nder ƴiiƴam ɓalndu tawa ina addana ɗum diƴƴe mawɗe.
3. Waɗde paɗe glace conductive targeted: Ɓoornude paɗe glace, saakuuji leɗɗe ɓuuɓɗe, walla saakuuji plastik resealable keewɗi glace e koppi ndiyam e nder toweluuji diƴƴe ɓuuɓɗe. Pack ɗi snugly e dow ƴiye mawɗe dow :
4. Banngeeji ɗiɗi ɗii fof wuddu (arteriiji karotiid, reenaade hoto meeɗ toɓɓude e ɓuuɓri henndu).
5. Ko ɗiɗo fof armpit (ɓiɗɓe ƴiye).
6. Banngeeji ɗiɗi ɗii fof ko groin (arteries femoral).
7. Tampere dartagol target: Ƴeewto nguleeki kala hojomaaji 5 so ina waawi. So nguleeki core ustiima haa 38,0 degere Celsius (100,4 degere Fahrenheit), ittu paɗe ice ɗee, ngoppa ɓuuɓde ngam waasde ɓuuɓde e nder hipotermi.

Ɗatal 2 : Jokkondire kisal e haɗde tiiɗnaare reentaade ɓanndu¶

Ñawɓe tooke serotonin tiiɗɗe walla NMS ina keewi ɓuuɓde, ina kuli, ina ɓuuɓtoo, walla ina keɓa ɓuuɓri ƴiiƴam (myoclonus).

• Laɓɓin nokku oo e nokku ɗo ɓanndu nduu reentoo ɗoo: Moƴƴin taƴe kafe, koɗorɗe, lampaaji, e geɗe ɓutte, woɗɗitin neɗɗo oo. Taarno-ɗee ɗe e ɓuuɓri sofaaji, e ɓuuɓri, walla e ɓuuɓri ɓuuɓri e dow leydi mbele so koyɗe majji njirlotoo walla ɗe njirlotoo, ɗe mberloo padding softuɗo wonaa mobelaaji tiiɗɗi.
• Ustude ɓuuɓri ƴiiƴam: Annoore jalbooje dow hoore, daande mawnde, ɓuuɓri teleeji, e memondiral ɓanndu ɗoon e ɗoon ina addana ɓuuɓri hulɓiniindi ɓeydotoondi ɓuuɓri klonus e ɓuuɓri ɓalndu. Dim fitirla suudu nduu, ɓuuɓna teleeji e rajooji, mbaɗtaa neɗɗo gooto caliiɗo haalde e daande leelnde, deeƴnde, deeƴnde.
• Hutoro mbaydi cellal gonndi e bannge: So neɗɗo oo ina ɗaanii, ina muumɗi, ina ɓuuɓtoo, walla ina tiiɗi, ɓuuɓna ɗum no feewi e bannge mum. E nder mboros bonɗo neuroleptik, ɓuuɓri daande ina haɗa neɗɗo ɓuuɓde no haanirta nii ; lelnude e dow ɓalndu ina addana ƴiiƴam walla ɓuuɓri ɓuuɓndi ruttaade no feewi e nder ƴiiƴam, addana ɗum ɓuuɓri aspiration fatal walla asphyxie. Huutoro limce laaɓɗe cirƴaaɗe e junngo maa ngam momtude ƴiiƴam e les ŋoral hunduko maɓɓe.

Ɗatal 3 : Kuule ndiyam e jeertinaango laawol henndu¶

• Woto meeɗ rokkude ndiyam, nguura, walla pillitol e hunuko: Hay so neɗɗo oo feeñii ina ŋoŋɗi, dille tiiɗɗe, ɓuuɓri jawdi, walla ɓuuɓri gonndi e ƴiiƴam (lead-pipe rigidity) ina addana ɓuuɓri no feewi. Hoto eto waɗde ɓe yarde ndiyam walla njaram dingiral ngam safrude ŋakkere ndiyam ; safrooɓe maa mbaɗtu laabi nder ƴiiƴam (IV) ngam ustude ndiyam coofɗam kiristaloid isotonik e kisal.
• So wonaa ngam ittude Parkinson tan (e les njiimaandi safrooɓe): So tawii ñawɗo mo ñawu Parkinson anndaa oo heɓi NMS tan sabu ɓe keɓaani doseeji maɓɓe levodopa potɗi reweede ɗii, tee ina jokki e jeertaade no feewi, ina waawi kadi muñde e jam, naamndo-ɗee diisneteeɗo e nder safrirde ndee so tawii doktoor maɓɓe oo ina foti rokkeede nashetric walla doseeji maɓɓe. Hoto meeɗ doole pills e nder hunuko ñawɗo ɗaaniiɗo walla ɓuuɓɗo.
• Ƴeewto-ɗee njillu e nder ɓalndu : Rigidité tiiɗnde e nder NMS walla e nder mboros serotonin (sindrome serotonin) ina waawi uddude ƴiye hakkunde ƴiye hakkunde ƴiye e ƴiye (rigidité de la mur du thost), haɗa ɓalndu yaajde. Yeewtu keeci ɓuuɓɗi ɗii no feewi; so fooftere ndee wontii ɓuuɓnde, ɓuuɓnde, walla ɓuuɓnde (les foofaango 10 e nder hojomaaji), walla so leppi ɗii mbaɗti ɓuuɓde, jeertin neldoowo oo ɗoon e ɗoon, peewnitoo ngam waɗde fooftere hisnude e... CPR.

Ƴeewndo leɗɗe kuuɓtodinngo : ko mooftetee ngam safrooɓe¶

Cafrooɓe urgency mbaawaa suɓaade hakkunde siproheptadin (ngam mboros serotonin), dantrolen e bromokriptin (ngam mboros bonɗo neuroleptik), walla fisostigmin (ngam tooke antikolinerji) tawa ɓe nganndaa kala huunde naatnde e ɓanndu ñawɗo oo da13. So neɗɗo gooto ina heddii e sara ñawɗo oo ina cooyna, ina reena laawol mum, toɗɗaa neɗɗo ɗiɗaɓo ngam timminde ndeeɗoo ƴeewndo jaawngo :

• Ƴeewto ɓalndu ñawɗo oo tawa ina waɗi ɓuuɓri transdermal: Ƴeewto ɓalndu toowndu, ɓalndu, ɓalndu, juuɗe toowɗe, wuttulo, e koyɗe. Ƴeewtoɗee ɓuuɓri laaɓtundi walla ɓaleeri ina rokka fentanil (nafoore), selegilin (ɓuuɓri), rotigotin (rafi Parkinson), rivastigmin (ɓuuɓri), walla skopolamin (ɓuuɓri). So tawii ñawɗo oo ina wuli jaw ina tuuma tooke ummoraade e fentanil, selegiline, walla scopolamine, ɓuuɓna ɗum e junngo walla towel (follude banngeeji ɓuuɓɗi ɗii, waɗta ɗum e saak ngam safrooɓe), sibu ɓalndu ɓuuɓndu ina ɓeyda ɓuuɓri leɗɗe e nder ɓalndu haa 300 e nder teemedere. Woto meeɗ ittude ƴiiƴam rotigotin Parkinson, sibu ittude lomto dopamin ina bonna NMS.
• Sweep cuuɗi, suudu lootorde, poosuuji, e saakuuji ngam butelaaji ɗii fof: Moftu kala butelaaji restoraaji, yuɓɓinoowo pillitol yontere kala, e seedantaagal farmasi, tawa ina waɗi leɗɗe dartinaaɗe e nder yontereeji 5 cakkitiiɗi ɗii.
• Mooftu denndaangal geɗe ɗe njiɗaa soodde (OTC): Ƴeewto teeŋti noon e siropuuji ɓuuɓɗi, gelcaps binndaaɗi e "DM" (dextromethorphan), ballal ɗanngal jamma, antihistamines, pillitol ñawu nguu, e powder migraine.
• Moftu leɗɗe, nyaamdu, e ɓanndu: Yiylo St. Ɓoornugol John, 5-HTP, L-triptofan, SAM-e (S-adenosil-L-metionin), jinseng, sinefrin / oraas ɓuuɓɗo, yohimbin, termogenikuuji ɓuuɓnooji teddeendi, e ɓuuɓri hade golle.
• Winndu waktuuji laaɓtuɗi e waylooji doseeji: Winndu e dow ɓataake:
• Mbele won doktoor puɗɗinooɗo restoraaji kesi walla ɓeyduɗo doosgal miligaram e nder balɗe 14 jawtuɗe ɗee ?
• Mbele ñawɗo oo ina joofni walla ina woppi lekki safaara hakkille walla Parkinson e nder balɗe 7 jawtuɗe ɗee ?
• Hol waktu mo dose cakkitiiɗe ɗee ƴettaa hannde, mbele dose ɗiɗmere walla dose ɓurtunde anniya ina waawi waɗde ?

Caɗeele : rabdomiolisis, ŋakkeende ƴiiƴam, e ɓuuɓri nder ƴiiƴam saɗtunde¶

Famde ko waɗi opitaaluuji ina mbaɗa hipertermi (hiperthermie) jokkondirɗo e leɗɗe cafrorteeɗe, ko ɗum huunde ɓurnde himmude e nguurndam, ina wallita ɓesnguuji ɗii anndude ko waɗi hay maale ñawu nguu ina pamɗi walla ina pamɗi ina ɗaɓɓi ƴeewndo to departemaa emergency :

1. Rabdomyolyse e ɓuuɓri ɓernde hiperkalemik ɓuuɓndi : So fiɓnde ɓalndu doole mum ina ɓuuɓtoo walla ina ɓuuɓtoo tawa ina jokki fotde waktuuji e nguleeki ɓurtuki 39,5 degere Celsius (103,1 degere Fahrenheit), ƴiye ƴiye ɗee ina ɓuuɓta, ina ɓuuɓta (rabdomiolisis baɗaaɗo e golle e leɗɗe). Piɓaaji ɓalndu ɓuuɓɗi ina njippina potaasiyom keewɗo (ina addana ɓuuɓri ɓernde warde e nder hojomaaji seeɗa), kinaas kreatin (CK), e miyoglobin (poroteyiin boɗeejo-boɗeejo" mo ɓuuɓnata ɓuuɓri filtirde mikroskoop e nder reedu, ina addana ɗum ɓuuɓri ƴiiƴam ɓuuɓndi.
2. Asidosis metabolik : Ɓowɗi ɓuuɓɗi ina mbayloo e metabolism anaerobik, ina ɓuuɓna ƴiiƴam e asid laktik haa pH ƴiiƴam ina ustoo les tolnooji potɗi e ɓuuɓri ɓernde no woorunoo.
3. Coagulation intravasculaire disseminée (DIC): Nguleeki ɓalndu ɓurki 40,5 haa 41,0 degere Celsius (104,9 haa 105,8 degere Fahrenheit) ina ustoo poroteyiinuuji endoteliyal gonɗi e nder ƴiiƴam, ina addana ujunnaaje ujunnaaje ƴiiƴam ɓuuɓɗam e nder ɓalndu nduu fof geɗe, addanooje ƴiiƴam yaltude e hoore mum e nder reedu, e nder reedu, e nokkuuji IV.

Doggol ƴeewndorɗe haɓaade ñawɓe e toppitiiɓe¶

So neɗɗo sellii e rafi serotonin walla rafi bonɗo neuroleptik, walla so tawii o ƴettii ñalnde kala leɗɗe ñawɗe hakkille, walla ñawbuuli, walla ñawbuuli gonɗi e ɓalndu, rewde jamirooje farmasiije tiiɗɗe ina haɗa ɗum ruttaade :

• Huftoraade farmasi gooto ngam kala restoraaji: Hebbinde restoraaji e nder caɗeele farmasi gooto ina addana farmasiyanke oo lowre otomaatik jokkondirnde e leɗɗe ngam hollirde denndaangal jokkondire serotonergik walla dopamin-blocking kulɓiniiɗe e nder annduɓe restoraaji ceertuɗi (hono safroowo hakkille, safroowo fisik e safroowo ñawu).
• Naamndo "Naamnal Serotonin" hade maa soodde kala lekki ɓuuɓki walla ñawu: Ko adii nde coodataa kala lekki ɓuuɓki, pillol alerji, walla ñamri ndi alaa ko waawi heen, hollu doggol leɗɗe maa to farmasiyanke, naamndoɗaa laaɓndal: *"Mbele ooɗoo lekki ina waɗi dextromethorsephant interactrosein walla huunde nde myC?" guaifenesin, ɓuuɓri nofru saline, walla toɓɓe njuumri e nokku ɓuuɓri "DM".
• Woto meeɗ woppude leɗɗe Parkinson walla antipsychotic e dow ɗoon e ɗoon: Waɗde sahaa kala, hebbin leɗɗe cafrorteeɗe ko famɗi fof balɗe 7 hade mum timmude, kadi pack reserve emergency balɗe 5 e nder restoraaji maa go-bag pack ɓuuɓɗo be kaayitaaji jokkondirɗi e sahaa ɓuuɓɗo.
• Yiylo ƴeewndo ko yaawi ngam anndude maale jeertinaango "prodromal" seeɗa: Ɓooygol serotonin seeɗa ina heewi fuɗɗoraade e dille juuɗe kese, ɓuuɓri ndi laaɓaani e fooftere, ɓuuɓri, ɓuuɓri koyɗe, e ɓuuɓri koyɗe hade nguleeki meeɗde feeñde. Noddude doktoor dokkuɗo ñawu nguu walla yillaade safrirde yaawnde e sahaa gonaaɗo oo ina addana neɗɗo waɗde doosgal kisal hade kiris timmuɗo fuɗɗaade.

Naamne keewɗe naamneede¶

Fuɗɗoode ƴeewtaama¶

• Boyer E.W., Shannon M (Jaaynde Angalteer keso ngam ƴeewtaade golle safaara): Sindoron serotonin e Sifaaaji tooke serotonin Hunter (Dunkley EJC e woɗɓe, QJM).
• Njuɓɓudi Amerik toppitiindi ko fayti e nguura e leɗɗe (FDA, Amerik): Jokkondiral kisal leɗɗe FDA e mboros serotonin e SSRI, SNRI, triptan, opioid (Fentanil, Tramadol), e Metilen Bulu / Linezolid.
• Fedde toppitiinde ko fayti e leɗɗe e geɗe cellal (MHRA) e Duɗal ngenndiwal toppitiingal cellal e toppitagol (NICE, Angalteer): Kesɗitingol kisal leɗɗe e anndinde e ƴellitde ñawu nguu e ñawu nguu.
• Fedde Ameriknaare toppitiinde ko fayti e hakkillaaji (APA) e Sarwiis humpito ko faati e ñawu nguu (NMSIS, Amerik): Kuule hakkunde leyɗeele ngam ƴeewde ñawu nguu e safrude ñawu nguu.
• Koldaa Ameriknaajo tookeeji safaara (ACMT) e nokkuuji toppitiiɗi tooke (Amerik): Hipertermi tookeeji, njuɓɓudi siproheptadin, e porotokolle coofgol ɓuuɓri hade safrirde.
• Fedde Adunaare Cellal (OMS) e Fedde Adunaare Fedde Croix-Rouge e Croix-Rouge (IFRC, International): Triage d’urgence des poisons acutes, de l’overdose des drogues, et des guides de l’aide gadane de seizure.

Ardiiɓe jokkondirɓe¶

• Tooke e leɗɗe overdose ballal gadanal
• Rabdomiolyse eksersiyoŋ, ɓuuɓri ƴiiƴam, e ɓuuɓri ɓalndu
• Seppooji e ɓuuɓri ballal gadanal
• Heat stroke e porotokolle coofgol nguleeki ɓuuɓki
• Limooje emergency e leydi