Beta-Blocker da Calcium Mai Kashe Tashoshin Calcium wuce kima: Rage Rage Rage Zuciya da Ragi¶

Beta-blockers da calcium channel blockers (CCBs) suna daga cikin magungunan cututtukan zuciya da aka fi ba da izini akai-akai a duk duniya, waɗanda miliyoyin manya ke amfani da su kowace rana don sarrafa hawan jini, angina, gazawar zuciya, arrhythmias na zuciya, migraines, da rawar jiki. Amma duk da haka a cikin matsanancin kiba, ko kuma lokacin da yaro mai ban sha'awa ya haɗiye ko da manya guda ɗaya ko biyu waɗanda aka ci gaba da sakin allunan, waɗannan nau'ikan magunguna guda biyu suna da mafi yawan cututtukan cututtukan cututtukan zuciya na cututtukan zuciya da aka ruwaito ga cibiyoyin sarrafa guba a duniya. Idan kuna zargin wani ya sha karfin hawan jini ko kwayar cutar bugun zuciya, ko kuma idan yaro zai iya sanya ko da kwamfutar hannu daya a bakinsu, kira lambar gaggawa ta gida (911 a Amurka da Kanada, 112 a fadin Tarayyar Turai, 999 a Burtaniya) ta hanyar mu. lambobin gaggawa directory kai tsaye. Saboda tsananin rugujewar zuciya na iya haɓaka cikin sauri ko buga sa'o'i bayan jinkirin asymptomatic na yaudara, bita guba na taimakon farko, gane likita gigice, kuma farfadowa na zuciya (CPR) yayin da ake jiran ma'aikatan lafiya.

Abin da ke sa beta-blocker da mai kariyar tashar calcium ta wuce gona da iri na musamman mayaudari shine haɗuwa da saurin rushewar hemodynamic tare da allunan da aka saki nan da nan da tsawan lokaci, jinkirin shiru na sa'o'i 6 zuwa 24 tare da tsawaita-saki (ER, XL, SR, CD, ko LA). Majinyacin da ya haɗiye dintsi na tsawaita-saki-verapamil, diltiazem, amlodipine, metoprolol, ko propranolol na iya shiga cikin sashen gaggawa da ke tattaunawa akai-akai tare da bugun jini na yau da kullun da hawan jini na al'ada, kawai don zamewa cikin bradycardia mai rikitarwa (mai haɗari jinkirin bugun zuciya), cikakken toshewar zuciya, babban kakin zuma 1 na bugun zuciya ko kamawa daga baya. osmotic shafi narke a cikin ƙananan gastrointestinal fili. Wannan jagorar ya ƙunshi ayyukan asibiti nan da nan, ƙwayar ƙwayar ƙwayar ƙwayar cuta ta yara, yadda za a bambanta beta-blocker daga ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar kuma glucose .

Yi wannan yanzu¶

1. Kira sabis na likita na gaggawa da sarrafa guba nan take: Kira 911 (Amurka da Kanada), 112 (EU), ko 999 (Birtaniya) nan da nan idan mutumin ya sha maganin wuce gona da iri da gangan, yana da dimuwa, bacci, ruɗe, ƙarancin numfashi, ko yana da jinkirin bugun jini ko ƙarancin hawan jini, ko kuma idan yaro ya haɗiye koda kwaya ɗaya. A cikin Amurka, kai ko mataimaki kuma zaka iya kiran Sarrafa Guba a 1-800-222-1222 yayin jiran motar daukar marasa lafiya don haka likitan likitanci zai iya faɗakar da sashin kulawar gaggawa na asibiti a gaba.
2. ** Tattara kowane kwalban kwaya, fakitin blister, da mai shirya kwaya na mako-mako **: Tabbatar da ainihin kwalabe ko fakitin foil don haka ma'aikatan lafiya da likitocin gaggawa su iya karanta sunan magani, ƙarfin milligram a kowace kwamfutar hannu, da ƙaramar sakin (kamar ER, XL, SR, XT, LA, CD, ko sakin gaggawa). Ƙididdige sauran ƙwayoyin idan zai yiwu kuma lura da ainihin lokacin agogon lokacin da aka haɗiye kwayoyin.
3. Ki kwantar da mutum a bayansa sannan a hana shi mikewa: Dukansu magungunan beta-blockers da na calcium channel blockers suna toshe karfin jiki wajen takure magudanar jini ko kuma hanzarta zuciya a tsaye. Tsaye ko tafiya zuwa mota na iya haifar da kwatsam kothostatic syncope ( suma), ciwon kai, ko kamawar zuciya nan take. A ajiye mutum a kwance (kwankwasa) tare da ɗaga ƙafafu kaɗan a kan matashin kai sai dai idan yana fama da numfashi daga wani ruwa a cikin huhu ( edema na huhu), wanda hakan zai sa kai da kafadunsa su tashi sama da digiri 30 zuwa 45.
4. **Kada ku taɓa fitar da mara lafiya zuwa asibiti da kanku ***: Domin kwatsam kwatsam (musamman tare da propranolol), toshewar zuciya na uku, da kama zuciya na iya faruwa ba tare da faɗakarwa a cikin abin hawa na sirri ba, koyaushe jira motar asibiti sanye take da masu lura da zuciya, atropine na ciki, calcium, glucagon, vasopressors, da pacutaneous pacutaneous pacutaneous.
5. Kada ka jawo amai ko bada abinci, nono, ko ruwa: Kada kayi qoqarin sanya majiyyaci ya yi amai. A cikin beta-blocker ko tashoshi na calcium ta wuce kima, gagging yana motsa jijiyar vagus, wanda ke sakin acetylcholine a kan kumburin sinoatrial da atrioventricular da aka rigaya kuma zai iya dakatar da zuciya nan da nan (vagal asystole). Rike ciki babu kowa idan sashen gaggawa yana buƙatar gudanar da gawayi da aka kunna, ban ruwa gabaɗayan hanji, ko shigar da sauri cikin sauri.
6. **Duba amsawa da numfashi kowane sakan 60 kuma shirya don CPR ***: Tsaya kusa da mutum. Idan sun kasa amsawa kuma suka daina numfashi akai-akai (ko kuma kawai suna haki), fara damfara ƙirji nan da nan a cikin adadin 100 zuwa 120 damfara a cikin minti ɗaya da zurfin 5 zuwa 6 centimeters (2 zuwa 2.4 inci) ga babba har sai likitocin sun karɓi aikin.

Bishiyar yanke shawara: Beta-blocker da mai hana tashoshi na calcium yawan yawan adadin kuzari¶

flowchart TD
    Start["Abubuwan da ake zargin Beta-Blocker (BB) ko Ciwon Tashar Calcium (CCB)."] --> CallEMS["Kira 911/112/999 da Kula da Guba na Yanki Nan da nan"]
    CallEMS --> Position["Rike Mara lafiya Kwance Let (Kada Ka Bar Ya Tsaya) kuma Ya Tara Duk Kwallan Kwayoyin"]
    Position --> CheckVitals{"Shin Marasa lafiya Ba Ya Amsa Ko Ba Ya Numfasawa A Ka'ida?"}

    CheckVitals -->|Yes| StartCPR["Fara Babban Ingantacciyar CPR (100-120/min) kuma Haɗa AED"]
    CheckVitals -->|No, Awake or Drowsy| IdentifyForm{"Bincika Label ɗin Kwalba: Sakin-Sai-Tsare (IR) vs Extended-Saki (ER / XL / SR / CD)?"}

    IdentifyForm -->|Immediate-Release (IR) or Liquid| EarlyWindow["Farawa A Tsakanin Minti 30 zuwa Sa'o'i 2: Saka idanu don Rapid Bradycardia, Hawan jini, ko Seizures"]
    IdentifyForm -->|Extended-Release (ER/XL/SR) or Amlodipine| DelayedWindow["Jinkirin Farko Har zuwa Sa'o'i 6 zuwa 24: Wajibi na Sa'o'i 24 ICU / Kulawa na Telemetry Ko da Asymptomatic"]

    EarlyWindow --> HospitalArrival["Asibitin ED na Asibiti: 12-Lead ECG, Point-of-Care Glucose jini, Serum Electrolytes, Lactate"]
    DelayedWindow --> HospitalArrival

    HospitalArrival --> GI_Decon{"Ana Gabatar A Cikin Sa'o'i 1-2 (IR) ko Amfani da Dogayen Sakin-Saki / Babban Nauyin Kwaya?"}
    GI_Decon -->|Yes, Airway Protected| GiveCharcoal["Gawayi Mai-Kashi Mai Kunnawa (1 g/kg har zuwa 50 g) + Bakin Hanji gabaɗaya (PEG) don Ƙarfafa-Saki"]
    GI_Decon -->|No or Intubated First| DiffClue{"Bincika Glucose na Jini na Fingerstick da Alamomin Kiwon Zuciya"}
    GiveCharcoal --> DiffClue

    DiffClue -->|Hyperglycemia (High Blood Sugar) + Hypotension| SuspectCCB["Ƙarfafan Mahimmanci don Mai Kashe Tashoshin Calcium (CCB) Guba (Tashoshin Calcium-Nau'i na Pancreatic L-Toshe)"]
    DiffClue -->|Hypoglycemia or Normal Sugar + Bradycardia / Seizures| SuspectBB["Ƙarfafan Mahimmanci don Beta-Blocker (BB) Guba (Katange Glycogenolysis; Duba QRS/QTc na Propranolol/Sotalol)"]

    SuspectCCB --> RescueProtocol["Ceto ICU na mataki-mataki: IV Crystalloids, Calcium IV (Chloride/Gluconate), Atropine, Norepinephrine/Epinephrine, Babban Maganin Insulin Euglycemic Therapy (HIET 1-10 U/kg/hr + Dextrose)"]
    SuspectBB --> RescueProtocol2["Mataki na ICU Ceto: IV Atropine, IV Glucagon Bolus + Jiko, IV Calcium, Catecholamine Vasopressors, Insulin Mai Girma (HIET), Sodium Bicarbonate idan QRS> 100 ms"]

    RescueProtocol --> RefractoryShock{"Girgiza kai ko Kame Zuciya Duk da Matsakaicin Maganin Lafiya?"}
    RescueProtocol2 --> RefractoryShock
    RefractoryShock -->|Yes| ECMO_Rescue["Nan da nan Veno-Arterial ECMO (VA-ECMO) Shawarwari, Lipid Emulsion na Jiki (20% Intralipid), ko Methylene Blue don Vasoplegia"]

Gano magungunan masu laifi: azuzuwan magunguna, sunaye, da ƙari¶

Knowing whether the ingested medication is a beta-blocker or a calcium channel blocker, and which subclass it belongs to, directly determines what complications the emergency team must anticipate.

1. Beta-adrenergic receptor blockers (Janar sunayen suna ƙarewa a cikin "-olol", "-alol", ko "-ilol")¶

Beta-blockers suna gasa da masu karɓar beta-1 adrenergic a cikin zuciya (jinkirin sinoatrial bugun jini, rage jinkirin nodal nodal, da rage raguwa) da masu karɓar beta-2 a cikin huhu, tasoshin jini, da hanta (wanda ke haifar da bronchospasm da sakin glucose). Takamaiman wakilai suna ɗauke da mugayen ƙwayoyin cuta marasa beta a cikin abin da ya wuce kima:

• ** Propranolol (Inderal, Inderal LA), Acebutolol (Sectral), Carvedilol (Coreg), da Labetalol (Trandate): Voltage-Gated Sodium Channel Blockade ***:
• Propranolol shine mafi munin beta-blocker a cikin tsananin wuce gona da iri. Saboda yana da yawa lipophilic (mai-mai narkewa), yana ƙetare shingen kwakwalwar jini cikin mintuna 20 zuwa 60 don haifar da suma kwatsam da gamammiyar bugun jini**. A lokaci guda, yana toshe ƙarfin lantarki mai sauri na zuciya ** tashoshi sodium **, yana faɗaɗa hadaddun QRS (> 100 zuwa 120 ms), yana samar da tashar tashar R a cikin gubar aVR, kuma yana haifar da arrhythmias na ventricular wanda ke buƙatar bugun jini na gaggawa ** hypertonic sodium bicarbonate ***.
• **Sotalol (Betapace, Sorine): Blockade Channel Potassium da Torsades de Pointes ***:
• Sotalol yana toshe zuciya na waje ** tashoshi na potassium , da alama yana tsawaita tazara ta QTc da kuma haifar da tachycardia polymorphic ventricular tachycardia (Torsades de Pointes), wanda ke buƙatar intravenous ** magnesium sulfate **, cikewar potassium, da motsa jiki.
• Masu hana Beta-1 na Cardioselective: Atenolol (Tenormin), Metoprolol (Lopressor, Toprol-XL), Bisoprolol (Zebeta), da Nebivolol (Bystolic)**:
• Zaɓin mai karɓa yana ɓacewa a cikin manyan allurai. Domin atenolol da sotalol suna da ruwa mai narkewa tare da ƙarancin furotin da ke daurewa da cirewar koda, sune abubuwan beta-blockers guda biyu waɗanda hemodialysis ke sharewa.

2. Calcium channel blockers (Ba Dihydropyridines vs. Dihydropyridines)¶

Calcium tashoshi blockers hana ƙarfin lantarki-gated ** L-type calcium tashoshi ** wanda ke motsa sinoatrial / atrioventricular nodal conduction, cardiac myocyte contraction, da jijiyoyin jini santsi tsoka sautin:

1. ** Non-Dihydropyridine ("Cardioselective") CCBs: Verapamil (Calan, Isoptin, Verelan) da Diltiazem (Cardizem, Cardizem CD, Cartia XT, Tiazac)**:
2. Haɗe tare da babban kusanci zuwa tashoshi nau'in L akan duka ** cardiac pacemaker / myocyte cell ** da ** na gefe na jini **, yana haifar da triad mai haɗari na ** mai tsanani bradycardia / AV block **, ** cardiogenic famfo gazawar **, da ** na gefe vasodilation **. Verapamil da diltiazem suna ɗauke da mafi girman mace-mace na duk abin da ya wuce kima na magungunan zuciya.
3. ** Dihydropyridine ("Vascular-Selective") CCBs (yana ƙarewa a "-dipine"): Amlodipine (Norvasc), Nifedipine (Procardia XL, Adalat CC), Felodipine (Plendil), da Nicardipine (Cardene)**:
4. Yi aiki da farko akan ** na gefe jijiyoyin jini santsi tsoka ***, haifar da zurfin ** arterial vasodilation da hypotension ** tare da farko tare da ** reflex sinus tachycardia ** (saurin zuciya). A cikin yawan allurai masu yawa, zaɓin zaɓi ya ɓace kuma toshewar zuciya yana haɓaka. Amlodipine yana da rabin sa'o'i 30 zuwa 50 (har zuwa sa'o'i 100 a cikin kari), yana buƙatar kwanaki na tallafin ICU.

Me yasa Sugar Jini (Hyperglycemia vs. Hypoglycemia) Alama ce mai Mahimmanci¶

Gwajin glukos na jini na ** gefen gadon gadon nan da nan* yana bambanta beta-blocker da sauri daga guba mai toshe tashar calcium kuma yana hasashen tsananin girgiza:

1. Me yasa yawan shan sinadarin Calcium Channel Blocker ke haifar da matsanancin hawan jini¶

Kwayoyin beta-tsibiri na Pancreatic suna buƙatar kwararar calcium ta hanyar tashoshin calcium irin na L-voltage-gated ** don sakin insulin cikin jini. Lokacin da ** verapamil, diltiazem, amlodipine, ko nifedipine** ke toshe waɗannan tashoshi, ** ɓoyewar insulin na endogenous yana tsayawa ** kuma juriya na tsarin insulin yana haɓaka: - Karkashin damuwa mai guba da girgiza, tsokar zuciya tana canza makamashin kuzarin ta dole daga fatty acids kyauta zuwa glucose. - Idan ba tare da insulin ba, tsokar zuciya da ke fama da yunwa ba za ta iya fitar da glucose daga cikin jini zuwa myocytes na zuciya ba. - Glucose na jini na jini yana hawa da sauri (sau da yawa ** 200 zuwa 400+ mg/dL [11.1 zuwa 22.2+ mmol/L]** a cikin marasa ciwon sukari), kuma matakin hyperglycemia yana daidaita kai tsaye tare da tsananin kisa da haɗarin mutuwa.

2. Me Yasa Beta-Blocker Yakan Kawo Ciwon Glycemia Da Masks Alamominsa.¶

Beta-blockers suna hana ** beta-2 adrenergic receptors ** a cikin hanta, toshe ** glycogenolysis ** da ** gluconeogenesis *. A jarirai, yara, da manya masu azumi, wannan yana haifar da hypoglycemia mai tsanani (sukari na jini da ke ƙasa da 70 MG/dL ko 3.9 mmol/L) yayin da lokaci guda yana lumshe alamun gargaɗin adrenergic (ƙarawa da bugun zuciya), yana haifar da kwatsam hypoglycemic coma ko seizures.

Litattafan Kwaya Guda Daya da Yara da Bam na Lokacin Saki¶

1. Me Yasa Baligi Kadai Kadai Zai Iya Kashe Yaro¶

Masu hana tashoshi calcium su ne ginshiƙan mambobi na lissafin yara "Pill One Can Kill": - Baligi guda ɗaya da aka ci gaba da fitarwa na verapamil (120 zuwa 240 mg), diltiazem CD (180 zuwa 360 MG), nifedipine XL (30 zuwa 90 mg), ko amlodipine (5 zuwa 10 MG) zuwa kilogiram na 5 zuwa 3 na iya hadiye ta 510 zuwa 2 lr. hauhawar jini mai jujjuyawa, cikakkar toshewar zuciya, da kamun zuciya mai kisa. - Saboda dorewa-saki sutura yana jinkirta sha, yaron da ya hadiye kwaya ɗaya da safe zai iya zama kamar al'ada duk rana kuma ya sami kamawar zuciya a cikin barcin daren. - Tsarin Yarjejeniyar Likitan Yara na Tilas: Duk wani yaro da aka sani ko wanda ake zargi da shigar da ko da madaidaicin tashar calcium tashar blocker ko beta-blocker ** dole ne a ɗauke shi da motar asibiti zuwa sashin gaggawa kuma a shigar da shi na aƙalla sa'o'i 24 na ci gaba da sa ido kan telemetry na zuciya ***, koda kuwa gaba ɗaya asymptomatic.

2. Ƙaddamar da Ƙaddamar-Saki Suffixes akan Kwalwar Kwaya¶

Lalacewar Gastrointestinal: Dakatar da Sha Kafin Rufewar Rufe¶

Saboda magungunan da aka dawwama suna iya matsewa cikin sannu-sannu pharmacobezoar kuma suna ɗaukar yawan mace-mace da zarar an sha, farkon ** ƙazantar gastrointestinal* yana da mahimmanci:

1. Kashi ɗaya da aka kunna gawayi (SDAC): Ana gudanar da shi a 1 g/kg (har zuwa 50 g) a cikin 1 zuwa 2 hours na shigar da gaggawa, ko ** har zuwa 4 zuwa 6+ hours** bayan tsawaita-sakin ciki, in dai mai haƙuri ya farka kuma ya kare a cikin jirgin sama (ko riga).
2. ** Ruwan Ciwon Hanji (WBI) : Ana gudanar da shi ta hanyar bututun nasogastric ta amfani da ** polyethylene glycol electrolyte solution (PEG-ELS) a ** 1.5 zuwa 2 L / hour a cikin manya *** (* 25 zuwa 40 ml / kg / awa a cikin yara ***) don manyan ingestions na ciyawa, nifetiase, nifetase, dillase, vertipamil, pinepamil. beta-blockers har sai da ruwan dubura ya fito fili. Contraindicated a cikin toshewar hanji, hanyar iska mara kariya, ko kafa mai tsananin girgiza tare da ileus.

Asibitin Stepwise da Ka'idodin Ceto ICU¶

Lokacin da majiyyaci ya haɓaka bradycardia na alama, tubalan gudanarwa, ko hauhawar jini daga beta-blocker ko tashar tashar calcium mai karewa, daidaitaccen wakili guda ɗaya na tallafin rayuwar zuciya na zuciya (ACLS) kamar atropine kaɗai kusan koyaushe suna kasawa saboda masu karɓa ko tashoshi masu nisa sun cika. Ƙungiyoyin kulawa mai zurfi suna tura wani ** Multi-pronged metabolism and hemodynamic ceto daurin lokaci guda ***:

Mataki 1: Tsananin Jirgin Sama, Ruwan Jiki, da Atropine¶

• ** Tsanani Mai Tsanani tare da Intubation Mai Sauri (RSI): Shigar da majiyyaci a cikin cardiogenic ko bugun jini yana kawar da motsin tausayi na endogenous kuma yana sauke dawowar venous ta hanyar samun iska mai inganci, wanda zai iya haifar da kamawar bugun zuciya na peri-intubation. Kafin intubating, likitocin gaggawa sun fara tura-dose epinephrine ko ci gaba da jiko na norepinephrine, suna ba da calcium na cikin jijiya, kuma suna amfani da ma'aikatan induction na hemodynamically (kamar ketamine ko etomidate).
• • Crystalloids na Intravenous na Judicious *: Gudanar da bolus na farko na ** 10 zuwa 20 ml / kg (500 zuwa 1,000 ml a cikin balagagge) na daidaitaccen crystalloid isotonic don gyara hypovolemia dangi daga vasodilation. Guji nauyin ruwa mai yawa-lita saboda tawayar ƙwanƙwasa ƙwayar zuciya da babban adadin insulin yana haifar da kumburin huhu da sauri.
• ** Atropine na ciki ***: Mai gudanarwa ** 0.5 MG zuwa 1 mg IV *** (ko ** 0.02 mg / kg a cikin yara ***, mafi ƙarancin 0.1 mg) kowane minti 3 zuwa 5 har zuwa ** 3 MG jimlar *** don alamar bradycardia azaman gada ta farko yayin da ake shirya calcium, glucagon, da insulin mai girma.

Mataki na 2: Gishiri na Calcium na Jiki (Chloride ko Gluconate)¶

Haɓaka ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ce ta hanyar L-type tashoshi wanda ba a rufe ba a cikin myocytes na zuciya da ƙwayoyin tsoka mai santsi, inganta haɓakar ƙwayar zuciya da hawan jini:

• 10% Calcium Chloride (Layin Tsakiya ko Kame Zuciya): Ya ƙunshi nau'ikan calcium sau uku a kowace millilita fiye da calcium gluconate.10 mL of 10% Calcium Chloride = 1 gram = 272 mg [13.6 mEq] elemental calcium). Ana gudanar da shi azaman ** 10 zuwa 20 ml (gram 1 zuwa 2) IV sannu a hankali sama da mintuna 5 zuwa 10 ** (ko ** 0.2 ml / kg a cikin yara **), maimaita kowane minti 10 zuwa 20 ko kuma ci gaba da jiko0.2 to 0.4 mL/kg/hour), yin niyya ga matakin calcium ionized kusan sau biyu na al'ada (2.0 zuwa 2.5 mmol/L). Calcium chloride yana haifar da necrosis na nama mai tsanani idan ya wuce gona da iri na IV.
• 10% Calcium Gluconate (Mai Amintacce don Layin IV na Wuta): Ya ƙunshi 90 mg (4.65 mEq) elemental calcium per 10 mL vial. Domin yana da kashi ɗaya bisa uku kamar yadda aka mayar da hankali, gudanar da ƙarar sau uku: ** 30 ml zuwa 60 ml (3 zuwa 6 grams) IV a kan minti 10 ** (ko ** 0.6 ml / kg a cikin yara **), maimaita kowane minti 10 zuwa 20 ko gudu a matsayin ci gaba da jiko (0.6 to 1.5 mL/kg/hour).
• • Banda *: Kada a taɓa ba da calcium ta cikin jijiya idan majiyyaci kuma yana da gubar digoxin.

Mataki na 3: Glucagon Mai Girma (Musamman don Beta-Blocker fiye da kima)¶

A cikin abin da ya wuce kima na beta-blocker, an toshe mai karɓar beta-1 adrenergic, yana hana catecholamines daga haifar da adenosine monophosphate na cyclic intracellular (cAMP).

• ** Injiniyanci ***: Glucagon yana ɗaure ga nasa mai karɓar glucagon na zuciya, yana kunna adenylyl cyclase da samar da cAMP na cikin salula gabaɗaya daga mai karɓar beta-1 don haɓaka ƙimar zuciya da raguwa.
• ** Protocol na Dosing ***: Gudanar da farkon IV bolus na 5 MG zuwa 10 MG na Glucagon a cikin manya (ko 0.05 zuwa 0.15 mg/kg a yara) sama da mintuna 1 zuwa 2. Saboda glucagon yana da ɗan gajeren rabin rayuwa na mintuna 8 zuwa 16, bi ingantaccen amsa nan da nan tare da ci gaba da jiko na IV a ** 2 MG zuwa 10 MG kowace awa **.
• Antiemetic Pre-Treatment: Babban adadin glucagon yana huta da ƙananan ƙwayar ƙwayar ƙwayar ƙwayar cuta kuma yana haifar da amai. Koyaushe kafin a yi magani tare da intravenous ondansetron (4 zuwa 8 mg IV) kuma a kare hanyar iska.

Mataki na 4: Catecholamine Vasopressors, Sodium Bicarbonate, da Magnesium¶

Jagororin toxicology na yanzu suna ba da shawarar fara babban adadin catecholamine infusions da wuri tare da ruwaye da alli:

• ** Epinephrine da Norepinephrine ***: Infused ta hanyar tsakiyar layi don samar da beta-1 adrenergic inotropic / chronotropic goyon baya (ga bradycardia da famfo gazawar) da kuma alpha-1 adrenergic vasoconstriction (ga dihydropyridine vasoplegic shock).
• ** Sodium Bicarbonate don Propranolol Widened QRS ***: Idan mai haƙuri ya yi amfani da propranolol, acebutolol, ko carvedilol kuma ECG ya nuna tazara mai faɗaɗa ** QRS tazara fiye da 100 zuwa 120 millise seconds *, gudanar ** 1 zuwa 2 mEq / kg Hypertonic Sodium Bicarbonate IV yana turawa zuwa ƙasa da QRS0 kunkuntar m. 7.45 zuwa 7.55.
• Magnesium sulfate don Sotalol Tsawon QTc: Idan majiyyaci ya sha sotalol kuma yana da QTc mai tsayi ko Torsades de Pointes, ana ba da 2 grams na Magnesium Sulfate IV sama da mintuna 5 zuwa 10, ya cika potassium zuwa 4.5 zuwa 5.0mEq/L, ko amfani da iskar zuciya.

Mataki na 5: Insulin Euglycemic Therapy (HIET): Matsakaicin Ceton Metabolic na Zinariya¶

High-Dose Insulin Euglycemic Therapy (HIET) ita ce ginshiƙin ceton magunguna don tsananin ƙaƙƙarfan abin toshe tashar calcium da kuma girgiza beta-blocker cardiogenic shock. Saboda HIET yana ɗaukar mintuna 15 zuwa 45 ** don isa ga mafi girman tasirin inotropic, fara shi da wuri da zarar an yi zargin tabarbarewar bugun zuciya ko girgiza:

1. ** Tsarin Aiki ***: Manyan allurai masu yawa na insulin sun shawo kan toshewar calcium na pancreatic da juriya na insulin, canza masu jigilar GLUT4 zuwa membrane na sel na myocardial don haka zuciya mai damuwa zata iya ƙona glucose / pyruvate don ATP, kai tsaye haɓaka intracellular sarcoplasmic reticulum calcium handling (ƙarfin haɓaka cardiac contractility), da inganta microvascular perfusion ta hanyar endooxideal syndoxide.
2. ** Binciken Glucose na Baseline da Potassium **: Idan matakin glucose na jini yana ƙasa da 200 mg/dL (11.1 mmol/L), a ba 25 zuwa 50 grams na IV Dextrose farko; idan sinadarin potassium yana kasa 3.0mEq/L, fara maye gurbin potassium.
3. ** Insulin IV Bolus na yau da kullun da Jiko na Ci gaba: Ba da ** 1 Raka/kg Insulin ɗan adam na yau da kullun IV bolus ** (misali, Raka'a 70 zuwa 80 a cikin babba), ana biye da shi ta hanyar ci gaba da jiko na yau da kullun na Insulin na yau da kullun wanda zai fara daga 1 Raka'a/kg/hour* kuma a ɗaga sama kowane minti 15 zuwa 3/0k. raunin zuciya da rugujewar nama suna farfadowa.
4. ** Haɗin Dextrose Co-jiko : Jiko ** D10W, D20W, ko D50W (ta hanyar tsakiyar layi) a ** 0.5 zuwa 1.0 g/kg/hour , bincika glucose na jini kowane minti 15 zuwa 30 don kula da euglycemia (110 zuwa 180 mm/dL) Infusions dextrose sau da yawa dole ne a ci gaba har zuwa awanni 24+ bayan dakatar da insulin yayin da sakin insulin na pancreatic na ciki ya dawo.
5. ** Kulawa da Potassium ***: Insulin mai yawan gaske yana canza potassium zuwa sel ba tare da lalata jimillar shagunan jiki ba. Bincika sinadarin potassium kowane sa'o'i 1 zuwa 2 kuma kiyaye matakan tsakanin 2.8 da 3.2mEq/L don gujewa sake dawowa hyperkalemia lokacin da aka yaye insulin.

Mataki na 6: Refractory Ceto: Pacing, Methylene Blue, Lipid Emulsion, da VA-ECMO¶

• Mai saurin jujjuyawa da motsa jiki: Ƙoƙari na bradycardia mai tsanani ko babban matakin AV, kodayake kamawar lantarki ko injina sau da yawa yakan gaza a cikin matsananciyar yunwar alli.
• ** Methylene Blue **: Gudanarwa (1 to 2 mg/kg IV over 20 minutes) don refractory dihydropyridine (amlodipine / nifedipine) vasoplegic shock don hana guanylyl cyclase da mayar da sautin jijiyoyin jini.
• ** Emulsion na Lipid na Jiki (20% Intralipid)**: Ana Gudanarwa (1.5 mL/kg IV bolus, sannan 0.25 mL/kg/min) don barazanar lipophilic miyagun ƙwayoyi mai guba (**verapamil, diltiazem, amlodipine, propranolol **) rashin amsa ga daidaitattun hanyoyin kwantar da hankali.
• Veno-Arterial ECMO (VA-ECMO): Cannulation na farko na VA-ECMO shine madaidaicin gada mai ceton rai don girgiza cututtukan zuciya ko kama zuciya, yana tallafawa wurare dabam dabam da iskar oxygen na kwanaki 3 zuwa 7 har sai an daidaita maganin.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

Tambayoyin da ake yawan yi¶

Wata kila yaro na ya sanya daya daga cikin magungunan hawan jini na kakan su a cikin bakinsa, awanni 4 sun shude, kuma suna ta yawo suna aiki gaba daya. Shin har yanzu muna buƙatar zuwa dakin gaggawa?¶

Ee, dole ne ku kai yaron zuwa sashin gaggawa na asibiti nan da nan ko kuma a kira 911. Baligi guda ɗaya wanda aka tsawaita-saki kwamfutar hannu na verapamil, diltiazem, nifedipine, ko amlodipine na iya zama mai mutuwa ga ƙarami. Saboda an ƙera suturar da aka ɗora don narkar da sannu a hankali a cikin ƙananan ƙwayar cuta sama da sa'o'i 12 zuwa 24, yaro zai iya kallon kashi 100 cikin 100 cikin koshin lafiya da wasa a cikin sa'o'i 6 zuwa 14 na farko sannan kuma ba zato ba tsammani ya sami cikakkiyar toshewar zuciya da kama zuciya yayin barci da dare. Duk yaron da aka sani ko wanda ake zargi da shigar da mai katse tashar calcium ko beta-blocker yana buƙatar aƙalla sa'o'i 24 na ci gaba da lura da zuciya a asibiti.

Me zai faru idan babba ya ɗauki kashi biyu bisa kuskure (kwayoyi biyu maimakon ɗaya) na magungunan hawan jini na yau da kullun?¶

Idan babba da gangan ya ɗauki kashi biyu na beta-blocker na yau da kullun (kamar metoprolol ko atenolol) ko mai hana tashar calcium (kamar amlodipine ko diltiazem), kira cibiyar kula da guba ta yanki (1-800-222-1222 a cikin Amurka) nan da nan tare da kwalban a hannu. A lokuta da yawa inda majiyyaci ya riga ya jure wa takardar sayan magani na yau da kullun kuma ba shi da mummunan toshewar zuciya, shan allunan guda biyu na nasu na yau da kullun yana haifar da dizziness kawai ko bugun bugun jini kaɗan kaɗan wanda za'a iya lura da shi lafiya bayan ƙwararren mai guba ya ƙididdige madaidaicin adadin milligram, sai dai idan mutumin yana da gazawar koda mai tsanani, yana ɗaukar duka beta-blocker da verapamil/diltiazem tare, ciwon zuciya tare, ciwon zuciya, ciwon kirji, ciwon kirji, ciwon zuciya, ciwon zuciya, ciwon kai, ciwon kai, ciwon zuciya, ciwon kai, ciwon zuciya. bugun 50 a minti daya.

Me yasa likitocin gaggawa suke ba da allurai masu yawa na insulin ga majiyyacin da ba shi da ciwon sukari bayan yawan abin da ke hana tashar calcium?¶

Masu toshe tashoshi na Calcium suna gurgunta tashoshin calcium nau'in L a cikin zuciya da kuma pancreas, suna rufe sakin insulin na jiki yayin da lokaci guda ke tilasta tsokar zuciya mai damuwa don dogaro da glucose maimakon fatty acid don samun kuzari. Idan ba tare da insulin ba, tsokar zuciya da ke fama da yunwa ba za ta iya ɗaukar glucose daga jini ba kuma ta rasa ikon matseta. Sanya insulin na yau da kullun (Raka'a 1 zuwa 10 a kowace kilogiram a kowace awa, har zuwa sau 10 sama da adadin masu ciwon sukari) tare da maida hankali kan sukarin jini (dextrose) yana ƙarfafa kuzari kai tsaye a cikin ƙwayoyin tsokar zuciya, yana haɓaka sarrafa calcium na cikin salula, kuma yana dawo da ƙarfin bugun zuciya fiye da kusan kowane magani.

Me yasa propranolol yayi la'akari da haɗari mafi haɗari a cikin matsanancin ƙwayar cuta fiye da sauran beta-blockers kamar metoprolol ko atenolol?¶

Ba kamar beta-blockers masu narkewa da ruwa waɗanda ke zama mafi yawa a cikin jini, propranolol yana da mai-mai narkewa sosai (lipophilic) kuma yana toshe tashoshin sodium mai saurin wutan lantarki a cikin zuciya da kwakwalwa. Saboda yana ƙetare shingen kwakwalwar jini da sauri, babban abin da ya wuce kima na propranolol zai iya haifar da suma kwatsam da tashin hankali gabaɗaya a cikin mintuna 20 zuwa 60 na hadiye kwayoyin. A lokaci guda kuma, toshewar tashar sodium-tashar ta yana faɗaɗa hadaddun wutar lantarki na QRS na zuciya kuma yana haifar da arrhythmias mai mutuwa, yana buƙatar sodium bicarbonate na cikin gaggawa na gaggawa baya ga daidaitattun jiyya na beta-blocker.

Shin hemodialysis (na'urar dialysis na koda) na iya tace beta-blockers ko masu hana tashar calcium daga cikin jini?¶

Ga kusan dukkanin masu hana tashar calcium (verapamil, diltiazem, amlodipine, nifedipine) da mafi yawan beta-blockers (propranolol, metoprolol, carvedilol, labetalol), hemodialysis BA IYA cire miyagun ƙwayoyi ba saboda waɗannan magunguna suna daure sosai ga sunadaran jini kuma suna rarraba cikin kitsen jiki da kyallen takarda. Duk da haka, akwai wasu muhimman abubuwa guda biyu: Atenolol da Sotalol suna da ruwa mai narkewa, suna da ƙananan nau'in furotin, kuma kodan suna share su, don haka hemodialysis na gaggawa zai iya cire duka atenolol da sotalol daga cikin jini, musamman ma marasa lafiya da ciwon koda.

Jagora masu alaƙa¶

• Aspirin (salicylate), kwayar ƙarfe, da tricyclic antidepressant fiye da kima
• Digoxin toxicity, rawaya-kore hangen nesa halos, da cardiac arrhythmia triage
• Guba taimakon farko da sarrafa guba
• Ganewa da magance girgizar likita
• Ciwon zuciya na zuciya (CPR) da jagorar AED

Tushen da jagorar hukuma¶

• Kwalejin Kiwon Lafiya ta Amurka (ACMT) & Ƙungiyar Cibiyoyin Kula da Guba ta Amirka (AAPCC): *Shawarwari na Ƙwararru na Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru.
• Ƙungiyar Zuciya ta Amirka (AHA): * 2023 Mayar da hankali Sabuntawa da Sharuɗɗa don Farfaɗowar Jiki da Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararrun Ƙwararru (Beta-Blockers da Calcium Channel Blockers)*.
• European Resuscitation Council (ERC): Guidelines for Resuscitation: Cardiac Arrest in Special Circumstances: Toxicologic Emergencies.
• EXTRIP (Extracorporeal Treatments in Poisoning) Workgroup: Systematic Review and Recommendations for Extracorporeal Treatment in Beta-Blocker and Calcium Channel Blocker Poisoning.
• Sabis na Bayanin Guba na ƙasa (NPIS, United Kingdom) & Hukumar Lafiya ta Duniya (WHO): TOXBASE Gudanar da Clinical na Kula da Lafiyar Magungunan Kwayoyin Jiki na Zuciya da Babban Kashi na Insulin Euglycemic Therapy Protocols.

*Wannan jagorar don dalilai ne na bayanai kuma baya maye gurbin ƙwararrun ƙwararrun likita, shawarwarin Kula da Guba, ko kulawa mai zurfi na asibiti. Saboda yawan maganin cututtukan zuciya na iya haifar da asarar hankali da kama zuciya, muna ba da shawarar yin amfani da ƙwararrun hannu-kan taimakon farko da kuma hanyar CPR ta Ƙungiyar Red Cross da Red Crescent Societies (IFRC), Ƙungiyar Red Cross ta kasa, St John Ambulance, ko mai ba da sabis na gida.