Komawar Jurewa Bayan Haƙuri Haɗarin Rigakafin Kiɗa, Xylazine Sedation, da Sake Naloxone¶

Mafi ƙarancin taga na kwanaki 14 a rayuwar mutumin da ke fama da matsalar rashin amfani da opioid yana faruwa ** nan da nan bayan barin rukunin detox na kauracewa kawai, cibiyar gyara zama, shigar asibiti, ko kurkuku ko kurkuku ***. Bayanan cututtukan cututtukan da suka fito daga Hukumar Lafiya ta Duniya (WHO), Cibiyar Kula da Cututtuka da Cututtuka ta Amurka (CDC), da Ofishin Kula da Lafiya da rarrabuwa na Burtaniya sun nuna cewa a cikin makonni biyu na farko bayan saki daga ɗaurin kurkuku ko detox na marasa lafiya, haɗarin mutum na mutuwa daga haɗarin haɗari na opioid overdose yana ƙaruwa ** ninka sau 10 zuwa 40 masu amfani yau da kullun. Yayin da sha'awar tunanin mutum ya kasance mai tsanani, kawai ** 3 zuwa 7 kwanaki na kauracewa opioid yana kawar da rashin jin daɗin mai karɓar ra'ayi a cikin kwakwalwar kwakwalwa ***, yana sake saita juriyar numfashi zuwa na mutumin da ba shi da tushe. Idan mutumin ya ɗanɗana ɗan lokaci na damuwa, ya dawo ga tsohon kayansa, kuma ya ɗauki ko da ɗan guntun maganin da suka saba da shi, suna shan wahala nan take, kama numfashi mai mutuwa.

Rikicin wannan haɗari bayan haƙuri shine wadatar magungunan titi da ba a kayyade ba wanda ke ƙara karuwa tare da ** fentanyl ƙerarre ba bisa ƙa'ida ba, ultra-m benzimidazole opioids (nitazenes), magungunan dabbobi na alpha-2 adrenergic (xylazine / "tranq" da medetomidia benzo). (bromazolam). A cikin cakuda fentanyl-da-xylazine overdose, masu kallo da suka fesa akwatuna uku ko hudu na Naloxone (Narcan) a cikin hanzari suna jiran mutum ya zauna yayi magana yana yin kuskure mai mahimmanci: saboda naloxone kawai yana jujjuya sashin opioid kuma ba zai iya juyawa xylazine sedation ba, kan-gudanar da naloxone naloxone a zahiri yana haifar da rikice-rikice. Kwakwalwa, wanda shine ** numfashin ceto na ci gaba (numfashi 1 kowane dakika 5) hade da lokaci na 2-zuwa-3-minti naloxone sake gyarawa don ** maida numfashi**.

Yi wannan yanzu¶

1. Duba numfashi da amsawa da farko, sannan a kira lambar gaggawar gaggawa ta gida. Girgiza kafadar mutum da karfi, ki shafa guiwar ku gaggauce a tsakiyar kashin nono (sternum rub), sannan ki kalli kirjin sa na tsawon dakika 5. Idan ba su da amsa, ba numfashi, ko yin jinkirin, haki, snoring, ko gurguwar sauti ("mutuwar mutuwa", ƙasa da numfashi 8 a cikin minti daya) tare da shuɗi, purple, ko ashy-lebe da farce, buga 911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a cikin United Kingdom, ko duba a cikin United Kingdom. lambobin gaggawa directory.
2. ** A ba da kashi 1 na Naloxone (4 MG na Narcan spray na hanci ko 0.4 mg alluran intramuscular) nan da nan.** Saka bututun hancin naloxone gabaɗaya a cikin hanci ɗaya kuma danna plunger da ƙarfi tare da babban yatsa. Kada a fara fesa na'urar a cikin iska da farko, saboda kowace naúrar tana riƙe da kashi ɗaya kawai.
3. Fara Numfashin Ceto nan da nan (Numfashi 1 kowane 5 zuwa 6 seconds) kuma KAR KA tsaya yayin jiran naloxone ya yi aiki. Ka karkatar da kan mutum baya, ɗaga haɓinsu don buɗe hanyar iska, tsunkule hancinsu, rufe bakinka a kan nasu (amfani da abin rufe fuska ko garkuwar aljihu ko garkuwa idan akwai), sannan a ba da **2 a hankali numfashin kirji 6. seconds *** (10 zuwa 12 numfashi a minti daya). Idan ba su da bugun jini, fara cikakken CPR (matsawar kirji 30 zuwa numfashin ceto 2; duba mu yawan abin da ake amfani da shi na opioid kuma CPR jagora).
4. Duba numfashi a alamar minti 2-zuwa-3: idan har yanzu mutum baya numfashi kamar yadda aka saba (kasa da numfashi 10/minti), ba da kashi na biyu na Naloxone a cikin sauran hancin. Ci gaba da numfashin ceto tsakanin kowane kashi.
5. **DAINA ba da karin Naloxone da zarar mutum ya fara numfashi a hankali da kansa (10+ numfashi / minti), ko da sun kasance a sume daga Xylazine ("tranq"). kama. Idan ƙirjin su yana tashi yana faɗuwa sau 10 zuwa 16 a cikin minti ɗaya kuma launin leɓɓansu yana yin hoda, kada ku ci gaba da tura ƙarin kwalaye na Narcan cikin hancinsu, wanda ke haifar da amai mai ɗaukar nauyi da kumburin huhu. Mirgine su gefen su zuwa ** Matsayin Farfadowa ** kuma a ci gaba da lura da numfashin su har sai ma'aikatan lafiya sun zo.
6. ** Kula da jinkirin "Renarcotization" (fadowa a cikin abin da ya wuce kima) na akalla sa'o'i 3 zuwa 4.** Naloxone ya ƙare a cikin minti 30 zuwa 90 **, yayin da babban adadin fentanyl, nitazenes, ko methadone ya kasance a cikin jiki na ** 4 zuwa 12+ hours **. Kada ka bar wani rayayye shi kaɗai don "barci shi."

Bishiyar yanke shawara: Juyawar Abun Halitta na Zamani (Fentanyl + Xylazine / Nitazene) wuce gona da iri¶

Yi amfani da wannan taswirar ceto na asibiti mataki-mataki lokacin amsawa ga wanda bai amsa ba lokacin da opioids na roba ko "tranq dope" (fentanyl + xylazine) na iya shiga.

flowchart TD
    A["Mutum Ba Ya Da Hankali + Sannun Hankali, Haki, Hudu, ko Numfashin Ba Ya nan (<8 numfashi/min)"] --> B["Kira 911/112/999 Nan take + Gudanar da kashi na farko na Naloxone (4 MG Nasal Spray a Hanci 1)"]
    B --> C["Nan da nan Fara Numfashin Ceto: karkatar da kai, ɗaga haɓɓaka, tsuke hanci, ba da numfashi 1 kowane sakan 5"]
    C --> D{"Jira Minti 2 zuwa 3 Yayin Bada Numfashin Ceto: Shin mutum yana numfashi da kanshi yanzu (> = numfashi 10 / min)?"}
    D -->|"NO: Har yanzu baya numfashi ko haki (<8 numfashi/min)"| E["Gudanar da kashi na biyu na Naloxone (a cikin Nostril 2) + Ci gaba da Numfashin Ceto (numfashi 1 kowane sakan 5)"]
    E --> F{"Jira Wani Minti 2 zuwa 3: An dawo da numfashi?"}
    F -->|"NO (wanda ake zargin Fentanyl, Carfentanil, ko Nitazene)"| G["Gudanar da kashi na 3rd/4th Naloxone kowane minti 2-3 + Numfashin Ceto mara Katsewa / CPR har sai EMS ya isa."]
    D -->|"Ee: Numfasawa a hankali (10-16 numfashi/minti) da kuma leɓuna suna juya ruwan hoda, AMMA har yanzu mutum bai san komai ba/barci"| H["CO-EXPOSURE XYLAZINE / BENZO DA ake zargi: TSAYA bada ƙarin Naloxone; mirgine cikin Matsayin farfadowa kuma ci gaba da buɗe hanyar iska"]
    F -->|"E: An dawo da numfashi"| H
    H --> I["Kasance tare da haƙuri don 3 zuwa 4+ hours; kalli Renarcotization lokacin da Naloxone ya ƙare a Minti 30 zuwa 90"]

Sashe na 1: Ilimin Jiyya na Komawar Jurewa Bayan Haƙuri (Me yasa Kwanaki 5 na Kauracewa Sake Sake Haƙuri)¶

Iyalai da mutanen da ke cikin murmurewa galibi suna mamakin sanin cewa ** kammala karatun kwana 7 na detox ko gyare-gyare na kwanaki 28-kawai ba tare da maganin kulawa ba yana ɗaya daga cikin mafi girman haɗari ga mutuwa kwatsam**. Fahimtar yadda ** mu-opioid receptor (\(\mu\)-OR) rashin jin daɗi* ke aiki yana bayyana dalilin:

1. Yadda Haƙuri na Tsawon Lokaci ke Gina: A cikin mai amfani da opioid na yau da kullun, cibiyoyin numfashi na ƙwaƙwalwa (* pre-Bötzinger complex*, waɗanda ke sarrafa ƙimar numfashi ta atomatik da amsa hauhawar carbon dioxide \(\ rubutu{CO}_2\)) suna ci gaba da ambaliya tare da opioids. Don kiyaye mutum daga dakatar da numfashi, ƙwayoyin neurons suna da sinadarin phosphorylate kuma suna hana masu karɓar mu-opioid su, suna buƙatar ƙarin opioid sau 10 zuwa 50 don haifar da kama numfashi fiye da na mai amfani da farko.
2. Yaya Saurin Haƙurin Numfashi Ya ɓace: Ba kamar juriya ga euphoric sakamakon opioids (wanda ke tsayawa tsayin daka na tsawon watanni), **haƙuri ga ɓacin rai na numfashi na opioid yana juyawa cikin sauri cikin kwanaki 3 zuwa 7 kawai na kauracewa.
3. Tarkon Bayan-Detox: Lokacin da mutum ya gama detox na kwanaki 5, ya zauna a asibiti tsawon mako guda tare da kamuwa da cuta, ko ya yi kwana 10 a gidan yari ba tare da **Buprenorphine (Suboxone) ko Methadone ba, masu karɓar numfashin kwakwalwar su sun sake farfadowa gaba ɗaya yayin sha'awar tunaninsu (limbic dopamine mismatch) suna cikin kololuwar lokaci.
4. **Mafi mahimmanci, binciken Pavlovian neuropharmacology ya nuna cewa lokacin da mutum yayi amfani da opioids a cikin wani sabon wuri, wanda ba a sani ba ** (kamar ɗakin otal, gidan wanka, gidan wanka, ko ɗakin abokin abokinsa) maimakon ɗakin da suka saba, kwakwalwar su ba ta haifar da rashin jin daɗi na gida ba. bakin kofa.

Yadda Magani don Rashin Amfani da Opioid (MOUD) ke Karewa Daga Komawar Mutuwar¶

Wannan rashin haƙuri cikin sauri shine ainihin dalilin da ya sa Hukumar Lafiya ta Duniya (WHO), National Institute on Drug Abuse (NIDA), da American Society of Addiction Medicine (ASAM) ke ba da shawara mai ƙarfi game da ƙazanta ba tare da ci gaba da Medication for Opioid Use Disorder (MOUD):

• ** Buprenorphine (Suboxone, Sublocade, Brixadi)** da Methadone sun shagaltar da masu karɓar mu-opioid kuma suna kula da babban ** jurewar numfashi ** 24 hours a rana.
• Saboda buprenorphine yana da alaƙa mai ɗauri na musamman ga mai karɓar mu-opioid, idan mai haƙuri yana shan Suboxone yau da kullun (ko kowane wata * Sublocade * allura) yana da rauni lokacin da ya zame sau ɗaya, ** buprenorphine ya riga ya kulle a kan masu karɓar kwakwalwar su ta jiki yana toshe mafi yawan titin fentanyl daga ɗaure , hana yin amfani da duk abin da ke haifar da fatalwa. kashi 70 cikin 100.
• Sabanin haka, idan mai haƙuri ya zaɓi mai hana opioid mai hana ** Extended-Release Naltrexone (Vivitrol)**, ana kiyaye su yayin da harbin kwanaki 28 ke aiki, ** amma dole ne a gargaɗe su cewa idan sun rasa harbin wata-wata na gaba, haƙurin su na opioid ba shi da komai.

Sashe na 2: Xylazine ("Tranq"), Medetomidine, da Nitazenes a cikin Titin Supply¶

A cikin shekaru da yawa da suka gabata, haramtattun magunguna a duk faɗin Arewacin Amurka da sassan Turai sun ƙaura daga tsantsar tabar heroin ko fentanyl zuwa hadadden hadaddiyar polysubstance ** wanda ke canza yadda yawan shan magunguna ke kama da amsa taimakon farko.

Teburin Kwatanta: Mazinata Titin Da Yadda Suke Canza Taimakon Farko Da Ya wuce kima¶

Yadda ake Kula da Xylazine ("Tranq") Raunukan Skin Necrotic¶

Ba kamar daidaitattun allurar ƙwayoyin cuta ba (wanda ke faruwa ne kawai a daidai wurin da allurar da ba ta dace ba ta huda fata), **xylazine yana haifar da vasoconstriction mai tsanani **, rufe ƙananan tasoshin jini a cikin fata da yunwar ƙwayar oxygen, yana haifar da ** buga-fita, purple-zuwa-baki necrotic a kan eschars da hannaye kawai. snort ko shan taba kwayoyi:

• Kada a taɓa raunukan xylazine da hydrogen peroxide, shafa barasa, ko bleach, wanda ke kashe sabon ƙwayar granulation mai rauni wanda ke ƙoƙarin warkar da ulcer.
• A rika wankewa a hankali sau daya a kullum da ruwan dumi mai tsafta da sabulu mai laushi ko kuma bakararre gishiri, sai a shafa mai mai kauri mai kauri na ** maganin shafawa na magani, Xeroform petrolatum gauze, ko farar man fetir (Vaseline)** don kiyaye raunin da ya samu, sannan a rufe shi da tamfashin da ba na sanda ba.Telfa) da kuma kunsa gauze maras kyau.
• A nemi kulawar gaggawa ta gaggawa idan jajayen ya yadu da sauri daga gyambon, jajayen ɗigon ya haura gaɓoɓin, zazzaɓi ya taso, ko kashi/ tendon ya bayyana a gindin rauni (hadarin osteomyelitis da sepsis; duba mu). sepsis da septic shock jagora).

Sashe na 3: "Manufa Yana Numfasawa, Ba Farka Ba" Naloxone Redosing Protocol¶

A zamanin xylazine da babban kashi na hanci naloxone formulations (kamar ** 4 mg Narcan **, ** 8 mg Kloxxado **, ko ** 5 MG Zimhi ), hukumomin kiwon lafiya na jama'a da ƙwararrun likitancin jaraba sun jaddada mahimmancin canji a cikin horon wuce gona da iri: ** Manufar gudanar da Naloxone shine dawo da isasshen numfashi (10 zuwa minti 10) don faɗakarwar numfashi. sani

Me yasa Yawan Gudanar da Naloxone Yakan haifar da cutarwa (Janyewar Hauka & Ciwon huhu)¶

Lokacin da mai kallo ya sami wani a sume daga "tranq dope" (fentanyl + xylazine) kuma ya fesa ruwan Narcan na milligram 4-4 ( jimlar 16 mg) a cikin hanci a cikin dakika 60 saboda mutumin bai buɗe idanunsa ba tukuna:

1. Naloxone yana ɗaukar cikakken minti 2 zuwa 3 don tsomawa ta cikin mucosa na hanci kuma ya haye shingen jini-kwakwalwa. Yin fesa kashi na biyu ko na uku bayan dakika 30 kacal yana bata maganin kafin kashi na farko ya kai ga kwakwalwa.
2. **Da zarar an buge fentanyl daga masu karɓa na kwakwalwa (yawanci bayan allurai 1 ko 2), mutum zai sake numfashi, amma ya kasance a sume daga xylazine.
3. Idan kun ci gaba da fesa 3, 4, ko 5 ƙarin allurai na naloxone a cikin mai numfashi wanda xylazine ya lalatar da shi, kuna zazzage kashi 100 na bayanan opioids daga kowane mai karɓa a cikin jikinsu, yana haifar da ** Rikicin Opioid Mai Rikici ***:
   • Nan take amai da gudawa yayin da mutum ke cikin hayyacinsa daga xylazine*, hakan ya sa su haushin amai a cikin huhunsu ya shake.
   • Babban catecholamine (adrenaline) hawan jini wanda zai iya haifar da naloxone-induced non-cardiogenic edema na huhu (ruwa mai cika huhu) da arrhythmias na zuciya.
   • Matsananciyar ɓacin rai da tashin hankali wanda ke sa mutum ya gudu daga wurin da ** nan da nan a yi amfani da fentanyl mai yawa na titi mintuna 20 bayan haka don dakatar da cutar **, yana haifar da kisa na biyu fiye da lokacin da naloxone ya ƙare.

Abin da za a yi idan mutum yana da "Wooden Chest Syndrome" (Fentanyl Chest Wall Rigidity)¶

Lokacin da wani yayi allura ko shakar da sauri, babban bolus na roba na fentanyl ko nitazenes, zai iya haifar da lokaci-lokaci ** Rigidity Wall Rigidity ("Wooden Chest Syndrome")** a cikin dakika 60: - Igiyoyin muryar mutum (glottis) da haƙarƙari na tsaka-tsakin haƙarƙari/ tsokoki suna kulle da ƙarfi kamar allo. - Idan ka karkatar da kawunansu baya kana kokarin hura numfashin ceto a bakinsu, ** iska ba zata shiga ba kirjin ya ki tashi** duk da babu abinci ko wani abu a makogwaronsu. - ** Ayyukan gaggawa: *** ** Mai Gudanar da Naloxone (Narcan) nan da nan.** Ba kamar daidaitattun hanyoyin toshe hanyoyin iska ba, Ciwon Ƙirji na Ƙirji shine ƙwayar ƙwayar ƙwayar cuta ta neurochemical wanda masu karɓar mu-opioid suka haifar a cikin kwakwalwar kwakwalwa (locus coeruleus) kuma Naloxone yana buɗe shi da sauri **. Ci gaba da ƙoƙarin numfashin ceto a hankali tare da damtse kirji yayin da naloxone ke ɗaukar sama da daƙiƙa 90 zuwa 120; da zaran naloxone ya faɗo sashin kwakwalwa, igiyoyin murya da bangon ƙirji sun huta kuma numfashin ceton ku zai gudana cikin sauƙi.

Sashe na 4: Yadda Ake Amfani da Daidaitaccen Fentanyl, Xylazine, da Tushen Gwajin Nitazene¶

Rapid lateral-flow immunoassay test tube (Fentanyl Test Strips/FTS, Xylazine Test Strips/XTS, da Benzodiazepine/Nitazene Test Strips) tarkace ne marasa tsada wanda ke gano mazinata masu mutuwa zuwa sassa-da-biliyan a cikin mintuna 2. Koyaya, gwada kwaya ko foda ba daidai ba yana ba da ƙarya mara kyau *** saboda kurakuran masu amfani guda biyu: ** da "Chocolate Chip Cookie Effect" da ** the Methamphetamine/MDMA Over-Concentration Fase Positive**.

Bi wannan ainihin ** Mataki na 5-Tabbataccen Ƙa'idar Tabbatar da Magungunan Magunguna** (daga CDC, DanceSafe, da Makarantar Kiwon Lafiyar Jama'a ta Johns Hopkins Bloomberg):

Mataki 1: Kayar da "Chocolate Chip Cookie Effect" (Gwaɗa Gabaɗayan Dose)¶

Lokacin da haramtattun kwaya ko dillalan titi suka haxa miligram 1 na fentanyl a cikin foda don danna jabun oxycodone ("M30"), Xanax, ko magungunan Adderall, ** fentanyl baya haɗuwa daidai**. Rabin kwaya da aka matse na iya ƙunsar sifili fentanyl (kullun kuki), yayin da ɗan ƙaramin ɗan ƙaramin kwaya a gefe guda na ainihin kwaya ɗaya yana ƙunshe da wuri mai kisa mai milligram 2 na fentanyl zalla ( guntun cakulan). - Idan kawai ka goge wani ɗan ƙaramin kusurwa na millimita 1 daga maganin da aka matse don gwada shi, zaka iya rasa wurin hotspot na fentanyl cikin sauƙi kuma ka sami sakamako mai aminci na ƙarya. - Kyakkyawan Ayyuka: Murkushe ** gabaɗayan kwaya ko duka alluran da kuke shirin cinyewa** a cikin tarar, gauraye sosai a cikin injin dafa abinci mai tsafta, gilashin harbi, ko ƙaramin jakar filastik don haka ana rarraba kowane wuri a cikin samfurin.

Mataki 2: Ƙara Madaidaicin Adadin Ruwa (Mahimman Dokokin Dilution)¶

1. Idan kuna gwada Opioid Injectable (Narkar da duka harbin a cikin tukunyar jirgi): Bayan zana narkar da ruwan ku a cikin sirinji, ƙara ** milliliters 5 (1 teaspoon / 1 daidaitaccen ruwan ampoule na ruwa mara kyau)** na ruwa mai tsabta a cikin tukunyar da ba ta da komai don kurkar da ragowar, sannan a gwada wanda ya wanke ruwa.
2. Idan kuna gwada Crushed Pill ko Powder Residue: Canja wurin kusan ** milligrams 10 na gari mai gauraya sosai** (isa a rufe gashin kan Abraham Lincoln akan dinari na Amurka, ko kuma tip na maɓallin gida) cikin ƙaramin kofi:
   • Don Heroin, Oxycodone, Xanax, ko Cocaine: Add ** milliliters 5 (cokali 1)** na lallausan famfo ko ruwan kwalba da motsawa na tsawon daƙiƙa 15.
   • ** BAYANIN MAMAKI GA ARZIKI: Don Methamphetamine, MDMA (Ecstasy/Molly), ko Diphenhydramine:** Ku ** Dole ne a tsarma methamphetamine ko MDMA a cikin 30 milliliters (2 tablespoons / 1 ruwa oza / cikakken gilashin harbi) na ruwa ** kowace 10 MG na crystal. Idan ka narkar da methamphetamine ko MDMA a cikin 'yan saukad da ruwa kawai, mai da hankali mai motsa jiki yana amsawa tare da antibody a kan Fentanyl Test Strip kuma ya haifar da ** ƙarya tabbatacce ** (kuma babban taro na lidocaine ko diphenhydramine da aka yanke a cikin magungunan titi na iya tsoma baki tare da Xylazine Test Strips idan ba a diluted 1 MG kowace 5 mg).

Mataki na 3: Tsoma Rigin na tsawon daƙiƙa 15 kuma Ka kwanta¶

1. Rike ƙarshen rike mai launi na Fentanyl Test Strip (da kuma daban Xylazine Test Strip), tsoma tip ɗin sha na ƙasa a cikin ruwa ** kawai har zuwa iyakar cika layin *** na ** 15 seconds **.
2. Ajiye tsiri a kan tsaftataccen wuri sannan a jira 2 zuwa 5minti kafin karantawa cikin haske mai kyau.

Mataki na 4: Karanta Layukan Daidai (Kishiyar COVID ko Gwajin Ciki)¶

Gasar gwajin maganin miyagun ƙwayoyi karanta MAGANIN KISHIYAR na cikin gida ko gwajin COVID-19:

• Layin ja/ruwan hoda guda ɗaya (Layin Babban Sarrafa kawai) = KYAU (HAɗari: Fentanyl ko Xylazine YANA NAN) Ko da babu layin na biyu sifili kwata-kwata, ** layi ɗaya = KYAU**.
• ** Layukan ja / ruwan hoda guda biyu (Ko da layin gwajin ƙasa ya yi rauni sosai kamar raɗaɗi) = NUGATIVE** (Ba a gano Fentanyl/Xylazine a cikin wannan samfurin ba).
• Layukan sifili (ko layin ƙasa kawai ba tare da babban layin sarrafawa ba) = JARRABAWAR WUTA (Sake gwadawa tare da sabon tsiri).

Sashe na 5: Kulawa Bayan Farfaɗowa, Gudanar da Fitar da Tsarkakewa, da Kallon Renarcotization na Sa'o'i 4¶

Da zarar mutum ya fara numfashi a hankali (numfashi 10 zuwa 16 a cikin minti daya) bayan Naloxone da numfashin ceto, gaggawar ba ta ƙare ba *. Abin da kuke yi a cikin ** mintuna 60 na farko bayan farfaɗowa yana tantance ko mutum ya tsira da rana ko kuma yana fama da matsanancin kisa na sakandare.

1. Yadda Ake Sarrafa Wanda Ya Tashi A Hannun Janyewar Hankali¶

Idan an yi amfani da nau'i-nau'i na Naloxone da yawa (ko kuma idan mutum yana da nauyin fentanyl na yau da kullum), za su iya farka da rashin tausayi, zubar da gumi, zubar da jini, rawar jiki, da kuma buƙatar barin nan da nan don amfani da ƙarin kwayoyi don dakatar da ciwo:

• Ka sauke cikin nutsuwa sannan ka bayyana abin da ya faru a cikin dakika 10: Tsaya baya mita 1 (kafa 3) don kada su ji sunkuyar da kai, ku yi magana cikin sanyin murya, ba ta yanke hukunci ba, sannan ku ce: *"Kin daina numfashi saboda yawan abin da ya wuce kima kuma mun ba ku Narcan don ceton rayuwar ku. Mummunan ciwon da kuke ji a halin yanzu yana toshewa daga Narcans 3 kawai. zuwa minti 45 kuma ciwon zai sauƙaƙa ta atomatik."
• ** Me ya sa dole ne ku roƙe su KADA su yi amfani da fentanyl a yanzu: ** Bayyana a fili: * "A yanzu, Narcan yana aiki kamar garkuwa na wucin gadi a kan masu karɓar kwakwalwar ku. Idan kun ɗauki wani bugun fentanyl a yanzu don ƙoƙarin doke Narcan, ba za ku ji shi da farko ba, amma a cikin minti 45 lokacin da Narcan zai yi rauni a kan kwakwalwar ku duka. lokaci kuma ku kashe ku."*
• ** Matsayin Xylazine / Benzodiazepine Co-Sedation:** Idan mutum yana numfashi kullum (numfasawa 12 a cikin minti daya) kuma yana da lebe / yatsa mai ruwan hoda, amma yana barci mai nauyi daga xylazine, mirgine su gefen hagu zuwa ** Matsayin Farfadowa ***, karkatar da haƙoransu ya ɗan ɗan hure su, a zubar da numfashi a gefe. har sai da ma'aikatan lafiya suka dauka.

2. Canjawar Rana ɗaya zuwa Buprenorphine Bayan Farfaɗowar Naloxone¶

Sassan gaggawa na asibiti da EMS "Cibiyoyin Gada" yanzu suna ba da ** Buprenorphine Induction bayan wuce gona da iri ** daidai a cikin dakin gaggawa bayan jujjuyawar wuce gona da iri, da kuma ** Low-Dose Buprenorphine Micro-Induction (Hanyar Bernese)** ga mutanen da ke amfani da fentanyl titi waɗanda ke jin tsoron cirewa da sauri: - Maimakon jira sa'o'i 36 a cikin azaba, ** Hanyar Bernese ** yana farawa da ƙananan ƙananan allurai na buprenorphine (0.25 mg to 0.5 mg sau ɗaya ko sau biyu a rana) yayin da mai haƙuri yana ci gaba da kashe cikakkun agonists, sannu a hankali yana gina kariyar kariyar buprenorphine akan masu karɓar kwakwalwa sama da kwanaki 5 zuwa 7 har zuwa cikakke. 12 mg to 16 mg An kai adadin yau da kullun tare da cirewar sifili.

Tambayoyin da ake yawan yi¶

An duba tushe¶

• ** Cibiyoyin Kula da Cututtuka da Cututtuka (CDC) da Abuse Abuse and Mental Health Services Administration (SAMHSA, United States):** * Kayan aikin rigakafin Opioid Overdose Rigakafin*, jagorar asibiti akan haɗin gwiwar fentanyl da xylazine ("tranq") ba bisa ƙa'ida ba, da bayanan filin kwatanta akan 4 mg na naxlo na 4 mg na vs.
• Hukumar Kiwon Lafiya ta Duniya (WHO, Internationalasashen Duniya): * Gudanar da Al'umma na Opioid Overdose* (Ka'idojin ceton iska, naloxone titration, bayan ɗaurin kurkuku / haɗarin mace-mace bayan-detox, da kulawar matsayi).
• ** Kwalejin Kiwon Lafiya ta Amurka (ACMT) da Cibiyar Nazarin Kiwon Lafiya ta Amurka (AACT):** Bayanin Matsayin Haɗin gwiwa akan Hana Fuskar Fentanyl da Fentanyl Analog ga Masu Amsar Gaggawa (Kyautatawa dermal / iska fentanyl wuce gona da iri).
• ** Cibiyar Nazarin Magunguna ta Kasa (NIDA / NIH) da Makarantar Kiwon Lafiyar Jama'a ta Johns Hopkins Bloomberg:** Tabbacin dakin gwaje-gwaje na Fentanyl Test Strips (FTS) da Xylazine Test Strips (XTS), ka'idojin dilution don hana methamphetamine / MDMA abubuwan karya, da neurobiology na saurin jurewa na numfashi.
• Ofis don Inganta Lafiya da Rarraba (OHID) da Sabis na Kiwon Lafiya na ƙasa (NHS, United Kingdom): Faɗakarwar kare lafiyar marasa lafiya na ƙasa akan m roba benzimidazole opioids (nitazenes) da xylazine rauni management.

Jagora masu alaƙa¶

• Opioid wuce gona da iri taimakon farko
• CPR (Resuscitation na zuciya)
• Amfani da abu da jarabar ƙwayoyi: jagorar taimakon gaggawa
• Janyewar barasa mai tsanani, Delirium Tremens (DTs), da kuma maganin kashe-kashen magani
• Katsewar benzodiazepine kwatsam da haɗarin kamawa
• Tallafawa dan uwa da jaraba
• Sepsis da septic shock
• Lambobin gaggawa