Maganin kashe qwari, Organophosphate, da Aikin Gona Guba Na Farko¶

Mummunan bayyanar cututtuka ga aikin gona, masana'antu, ko tattarawar gida: musamman ** organophosphate kwari ** (irin su malathion, parathion, chlorpyrifos, diazinon), ** carbamate kwari ** (aldicarb, carbaryl, propoxur), ** organophosphate da jijiyoyi ** diquaphosphate , ** diquaphosphate da her ** diquaphosphate phosphide fumigants (aluminum ko zinc phosphide)**: rikicin guba ne mai barazana ga rayuwa. Ba kamar magungunan gida na yau da kullun waɗanda ke haifar da lahani kawai idan an haɗiye su, abubuwan organophosphates masu tattarawa da abubuwan jijiya suna ɗaukar sauri daidai ta hanyar ** cikakke, fata mara karye **, ta ** idanu ***, da ** shaƙar hazo ko tururi **, yana haifar da mummunar haɗari "guguwar cholinergic" a cikin mintuna.

Wannan jagorar tana ba da ceton filin mataki mataki-mataki da ka'idojin asibiti masu jituwa tare da umarni daga Hukumar Lafiya ta Duniya (WHO), Cibiyar Kula da Cututtuka da Cututtuka ta Amurka (CDC), Hukumar Kare Muhalli ta Amurka (EPA), Hukumar Kula da Abubuwan Guba da Rijistar Cututtuka (ATDR), da Sabis na Bayanai na Guba na Burtaniya (NPIS). Kare kanka da safar hannu na nitrile ko neoprene kafin a taɓa wanda ya kamu da cutar, cire rigar da aka jiƙa da maganin kashe qwari, wanke fata na tsawon mintuna 15, da samun gaggawar atropine da pralidoxime (2-PAM) suna ceton rayuka.

Yi wannan yanzu¶

Idan kai ko wani da ke kusa an fesa shi, ya zube, shaka, ko hadiye maganin kashe kwari na noma, maganin kwari, mai kashe ciyawa, ko fumigant hatsi:

1. Kare kanka da farko: KADA KA taɓa wanda aka jiƙa da maganin kashe qwari ko amainsu da hannaye da hannu: Matsar da iska da sama daga hazo mai fesa sinadarai, gajimare, ko rumbun adanawa nan da nan. Saka ** nitrile mai jure sinadarai, butyl rubber, ko safofin hannu na neoprene** (madaidaicin safofin hannu na latex na likitanci suna saurin shiga ta hanyar maganin organophosphate) kafin a taɓa wanda aka azabtar ko suturar su. Masu ceto waɗanda ke taɓa rigar organophosphate mai jikewa ko kuma fata ba sa hannu akai-akai suna faɗuwa daga guba na biyu.
2. Kira lambar gaggawa ta gida nan take: Kira 911 a Amurka da Kanada, 112 a cikin Tarayyar Turai, ko 999 a Burtaniya (ko duba mu lambobin gaggawa directory). Faɗa wa mai aikowa a fili: *"Waɗanda ake zargi da kashe magungunan noma ko guba na sinadarai na organophosphate: lalata HAZMAT da babban adadin Atropine da ake buƙata."
3. A cire kashi 100 cikin 100 na gurbatattun tufafi, takalma, da kayan ado: Cire tufafin da aka jika da magungunan kashe qwari yana kawar da ** 80 zuwa 90 bisa 100 na sinadari kafin ya jiqe ta cikin fata. Yi amfani da shears ko almakashi don yanke riga da wando maimakon cire su a kan wanda abin ya shafa (wanda ke goge sinadarai a idanu, hanci, da baki). Rufe duk tufafin da aka cire da takalmi na fata (fata na sha maganin kashe qwari har abada kuma ba za a taɓa iya gurɓata su ba) a cikin jakunkuna masu nauyi na filastik biyu.
4. A wanke fata da gashi da sabulu mai yawa da ruwan famfo na tsawon mintuna 15 cikakke: Sanya wanda abin ya shafa a karkashin ruwan sha, kogin lambu, ko tashar gaggawa ta gaggawa sannan a wanke daga kai har zuwa kafarsa da sabulu mai laushi ko abin wanke-wanke da ruwan dumi/sanyi na mintuna 15**. Ba da kulawa ta musamman ga folds fata, farce, gashi, da bayan kunnuwa. Kada a goge danyen fata da buroshi masu tauri, sannan kuma kada a yi amfani da ruwan zafi mai zafi wanda ke fadada hanyoyin jini da saurin sha dafin cikin jini. Idan maganin kashe qwari ya fantsama cikin idanu, a zubar da idanu da ruwan gudu ko ruwan gishiri na yau da kullun na tsawon mintuna 15 (duba raunin ido).
5. Ku kula da hanyar iska, kunna gefe, kuma KAR KU YI farfaɗo daga baki-da-baki: Wadanda abin ya shafa na Organophosphate sun nutse a cikin nasu ɗigon ruwa, gaɓoɓin buroshi ("bronchorrhea"), da amai. Sanya wanda abin ya shafa a sume ko ya zube a gefensu a matsayin murmurewa don haka kumfanin huhu ya zube daga baki. Idan zuciya ta daina ko numfashi ya daina, yi ** damtse kirji kawai da hannu kawai (CPR) ko amfani da abin rufe fuska-bag-valve (BVM)***: kada ku taɓa yin numfashin ceton baki-da-baki kai tsaye, wanda ke fallasa bakinku ga tururin maganin kashe qwari da amai.
6. ** Gudanar da autoinjector idan akwai (DuoDote / Mark I / Atropen): Idan lamarin ya shafi soja / masana'antun jijiya na masana'antu ko ƙungiyoyin amsawar aikin gona sanye take da ** DuoDote ko ATNAA (Atropine + Pralidoxime) ** autoinjector, allura kai tsaye ta cikin tsokar cinya ta waje nan da nan idan wanda aka azabtar ya nuna wahalar numfashi, kumburin tsoka, kumburin tsoka, ko kumburin tsoka kamewa.

Rashin gurɓacewar filin gaggawa da kuma jadawalin jigilar toxidrome¶

flowchart TD
    Start["Maganin Kwari da ake zargi, Maganin Kwari, Ganye, ko Bayyanar Wakilin Jijiya"] --> SceneSafe{"Shin wurin yana lafiya kuma masu ceto suna sanye da Nitrile/Neoprene PPE?"}

    SceneSafe -->|No: Vapor cloud, enclosed shed, or bare hands| Evac["Matsar da iska zuwa iska mai kyau nan da nan <br/> Saka safofin hannu na Nitrile/Neoprene (KADA KYAUTA LAtex) <br/> Kira 911 / 112 / 999 don HAZMAT & EMS"]

    SceneSafe -->|Yes: Upwind with chemical-resistant gloves| Decon["Cire Tufafi 80% -90% Nan da nan <br/>Yanke duk gurbatattun tufafi kuma a zubar da takalman fata<br/>A wanke fata & gashi da sabulu da ruwan sanyi/mai zafi na mintuna 15"]

    Evac --> Decon

    Decon --> ToxClass{"Gano Ajin Sinadarai ta Alamomi ko Label ɗin Kwantena"}

    ToxClass -->|Pinpoint pupils, profuse drooling/sweating, wet lung crackles,<br/>vomiting, diarrhea, slow pulse, muscle twitching| Chol["Organophosphate ko Carbamate ('Cholinergic Crisis') <br/> Wuri a gefen-kwance wurin dawowa don matse ruwan huhu <br/> Gudanar da Atropine (sau biyu na IV kowane 3-5 min har sai huhu ya bushe) <br/>+ Pralidoxime (2-PAM) don Organophosphates + Benzodiazepines"]

    ToxClass -->|Swallowed blue/green foul-smelling liquid herbicide;<br/>severe burning mouth/throat Ulcers| Paraquat["Paraquat ko Diquat Herbicide <br/> Ƙasar mai cika baki ko Gawayi Mai kunnawa nan da nan (idan cikin awa 1) <br/> BAYANI ƙarin Oxygen sai dai idan SpO2 <85% -88% <br/> Gaggawa ICU hemodialysis / hemoperfusion"]

    ToxClass -->|Garlic/rotten-fish odor after swallowing grain fumigant pellets;<br/>rapid shock and arrhythmias| Phosphide["Aluminum / Zinc Phosphide ('Phosphine Gas' Guba) <br/>KADA ku ba da ruwa ko ruwa na ruwa ta bakin <br/> motar asibiti / ED; sarrafa cardiogenic shock & acidosis"]

    ToxClass -->|Sudden grand mal seizures with NO drooling/pinpoint pupils<br/>after flea/tick spray or agricultural spray| Pyreth["Organochlorine (Lindane/Endosulfan) ko Pyrethroid <br/> Minti 15 na wanke sabulu (Vitamin E mai yana sauƙaƙa fatar fata) <br/>IV Benzodiazepines (lorazepam/diazepam) don dakatar da ciwon GABA-block"]

Pathophysiology na "Cholinergic Storm": Organophosphates da Carbamates¶

Organophosphates (wanda aka samo asali a cikin 1930s da 1940s a matsayin duka magungunan noma da magungunan jijiyoyi na soja kamar Sarin, Soman, Tabun, da VX) da carbamates sune manyan sanadin cutar gubar magungunan kashe qwari a duk duniya, wanda ke da alhakin mutuwar sama da 100,000 kowace shekara.

Yadda hana Acetylcholinesterase (AChE) ke mamaye tsarin jin tsoro¶

A cikin lafiyayyen jikin mutum, duk lokacin da jijiyoyi ke son gaya wa tsoka ta yi kwangila ko gland don fitar da ruwa, tashar jijiyar tana fitar da kwayar cutar kwayar cutar da ke dauke da kwayar cutar acetylcholine (ACh) a cikin tazarar synaptic. A cikin juzu'in millisecond bayan an isar da wannan saƙon, wani ƙwararriyar enzyme na kula da gida mai suna acetylcholinesterase (AChE) ta tsinke kwayar acetylcholine cikin rabi (zuwa choline da acetic acid), tana juya ** KASHE *** don haka tsoka zata iya shakatawa kuma gland ya daina ɓoyewa.

1. **Phosphorylation na "KASHE" sauyawa ***: Organophosphates da carbamates suna ɗaure kai tsaye zuwa wurin serine mai aiki na enzyme acetylcholinesterase, gaba ɗaya yana gurgunta enzyme.
2. ** Ambaliyar Acetylcholine mara iyaka *: Tare da "KASHE" canza karya, ƙarancin acetylcholine yana tarawa zuwa manya-manyan, matakan mai guba a cikin kowane synapse na cholinergic a cikin jiki: harba masu karɓa na muscarinic ** (gland parasympathetic glands, huhu, zuciya, idanu, gut), da ** nicotinic receptors central da juyayi tsokoki. tsarin ba ya tsayawa har sai huhun wanda abin ya shafa ya cika da ruwa kuma diaphragm dinsu ya shanye.
3. ** Me yasa Organophosphates ke dindindin ("Tsafa") yayin da Carbamates na ɗan lokaci ne ***:
4. Carbamate kwari (carbaryl [Sevin], aldicarb, propoxur, methomyl) suna samar da haɗin gwiwar carbamyl mai jujjuyawa ** tare da enzyme AChE wanda ba tare da bata lokaci ba yana fitar da kansa a cikin awanni 24 zuwa 48**.
5. ** Organophosphate kwari da jijiya agents ** (parathion, chlorpyrifos, malathion, diazinon, dichlorvos, fenthion) sun samar da wani dutse mai ƙarfi fosfour bond wanda ke jurewa sinadarai na dindindin da ake kira "Tsafa" (rasa kungiyar alkyl). Da zarar wani organophosphate-enzyme bond "shekaru" (wanda daukan ko'ina daga **2 minutes ga Soman jijiya wakili ** zuwa ** 12 zuwa 48 hours for noma kwari ***), da enzyme shi ne ** mutuwa har abada ***. Idan majiyyaci bai karɓi maganin sake kunnawa Pralidoxime (2-PAM) kafin tsufa ya cika ba, dole ne jikinsu ya kera sabbin ƙwayoyin enzyme daga karce sama da makonni 2 zuwa 6.

Gane kashi uku na Cholinergic Tooxidrome: DUMBBELS & Litinin-zuwa-Jumma'a¶

Saboda wuce haddi na acetylcholine yana ƙone nau'ikan masu karɓa daban-daban guda uku a lokaci guda, likitocin suna neman gungu daban-daban guda uku:

1. Muscarinic Receptor Overstimulation: "DUMBBELS" ko "SLUDGE + Killer Bs"¶

Ƙarfafawar muscarinic yana kunna kowane gland mai ɓoye ruwa da santsin tsoka a cikin jiki. Tuna abin tunawa DUMBBELS (ko ** SLUDGE ***):

• D: zawo da diaphoresis: Zawo mai fashewa da ruwa mai fashewa, kai-da-kafa ** zufa**.
• U: Fitsari: Rashin kulawar mafitsara na son rai.
• M: Miosis (Pinpoint Allibai): Dukan daliban biyu sun takure har zuwa kanana ** 1-millimita pinpoints**, suna haifar da dusashewa, blur hangen nesa da kuma radadin gindi (ciliary spasm).
• B: Bronchorrhea (Mai # 1 Killer): Glandan ɓangarorin da ke lulluɓi da bishiyar buroshi suna zuba lita na ruwa mai kumfa a cikin huhu, wanda a zahiri yakan sa majiyyaci ya nutse a cikin sigar huhunsu** daga ciki zuwa waje (jika mai jika da bubling rales a duk filayen huhu).
• B: Bronchospasm (Mai #2 Killer): Tsananin takurewar tsokar iska mai santsi yana haifar da hushi mai tsanani da rashin iya motsa iska.
• B: Bradycardia (Mai Kisan #3): Zurfafawar jijiya vagal tana rage saurin bugun zuciya zuwa bugun 30 zuwa 45 a minti daya, wanda ke haifar da hauhawar jini da kama zuciya na asystolic. (Tare, ** Bronchorrhea, Bronchospasm, da Bradycardia ** ana san su a cikin maganin gaggawa a matsayin ** "Killer Bs Uku"* saboda sune ainihin abin da ke kashe majiyyaci: da kuma abin da ** Atropine** ke juyawa).
• E: Emesis: Amai mara karewa da ciwon ciki mai tsanani.
• **L: Lacrimation ***: Ci gaba da tsagewa daga idanu biyu.
• S: Salihu: Zubowa daga baki.

2. Ƙwararrun Mai karɓa na Nicotinic: "Ranakun Mako" (MTWtFS)¶

Yayin da masu karɓa na muscarinic suna jinkirin zuciya kuma suna ambaliya huhu, haɓaka lokaci guda na ** masu karɓa na nicotinic ** akan tsokoki na kwarangwal da adrenal / ganglia mai tausayi yana haifar da toshewar depolarization na neuromuscular. Tuna kwanakin mako (M-T-W-t-F-S):

• M: Mydriasis (bakananan yara masu tausayawa na farko): Wani lokaci ana ganinsu da wuri kafin muscarinic filaye miosis ya mamaye.
• T: Tachycardia: Tausayin adrenaline na farko na iya haifar da saurin bugun zuciya da hawan jini na ɗan lokaci kafin vagal bradycardia ya ɗauka (** kar a taɓa riƙe atropine a cikin rigar, majinyaci mai zubar da ruwa kawai saboda bugun zuciyar su yana da sauri a halin yanzu**).
• ** W: Rauni (Flacid Paralysis): Bayan ɗan taƙaitaccen ƙarfi, mahaɗar neuromuscular yana raguwa kuma yana kullewa, yana haifar da rauni mai zurfi na kwarangwal da ** inna na diaphragm da tsokoki na numfashi na intercostal.
• t: Girgizawa da Hawan jini.
• F: Fasciculations (Twitching-kamar Muscle Twitching): Tsagewar gani, tsutsotsi-kamar tsutsotsin da ba a so ba a fadin fatar ido, harshe, maruƙa, ƙirji, da kafadu: alamar nicotinic pathognomonic cewa ** atropine ba zai iya gyarawa** (yana buƙatar Pralidoxime / 2-PAM).
• S: Kamewa da zufa.

3. Tsarin Jijiya ta Tsakiya Guba: Damuwa, Coma, da Matsayin Epilepticus¶

Lipid-soluble organophosphates suna haye shingen kwakwalwar jini da sauri, suna haifar da tashin hankali, rashin natsuwa, rashin jin daɗin magana, ruɗani, ataxia, baƙin ciki na numfashi na tsakiya, zurfi mai zurfi, da tashin hankali ** cholinergic matsayi epilepticus seizures ** (an bi da tare da intravenous ** benzodiazepines**, kamar diazepam).

Kwatancen Jagora na Magungunan Gwari na Noma da Kwarin Gida¶

Ka'idojin Magance Asibiti don Guba Organophosphate¶

Lokacin da majiyyaci mai tsanani organophosphate ko carbamate guba ya isa sashen gaggawa, ƙidaya seconds. Farfadowa yana biye da tsari mai tsauri: ** Rashin gurɓatawa + Kariyar Jirgin sama \(\rightarrow\) Atropine Doubling Regimen \(\rightarrow\) Pralidoxime (2-PAM) \(\rightarrow\) Benzodiazepines**.

1. The Atropine Doubling Regimen: Titrating zuwa "Dry Lungs," BA Girman Almajiri¶

A daidaitaccen kamawar zuciya ko bradycardia mai sauƙi, likitoci suna ba da 0.5 zuwa 1 milligram na atropine har zuwa matsakaicin 3 milligrams. ** A cikin mummunan guba na organophosphate, 3 milligrams digo ne a cikin guga: marasa lafiya akai-akai suna buƙatar 20, 50, ko ma fiye da 100 milligrams na atropine na ciki a cikin 'yan sa'o'i na farko *** don kasancewa da rai.

• **Yadda saurin haɓaka atropinization ke aiki ***:
• Likitoci suna farawa da bolus na ciki na gaggawa na 1 zuwa 3 milligrams na Atropine a cikin manya (0.02 zuwa 0.05 mg/kg a cikin yara).
• Sake tantance ƙirjin majiyyaci tare da stethoscope kowane minti 3 zuwa 5**.
• Idan rigar bunchial crackles (bronchorrhea), wheezing (bronchospasm), ko hypotension / bradycardia.HR < 80 bpm) nace bayan minti 3 zuwa 5, NINKA na baya (misali: \(2\rubutu{mg} \rightarrow 4\text{mg} \rightarrow 8\text{mg} \rightarrow 16\text{mg} \rightarrow 32\text{mg}\) kowane 3 zuwa 5minutes) har sai an gama cika sa'a IV*" jiko (kashi 10 zuwa kashi 20 cikin 100 na jimlar adadin lodawa a kowace awa).
• ** Menene ainihin ƙarshen Atropinization? ***:
• ** Tsaftace huhu akan auscultation** (cikakkiyar dainawar ƙwayar cuta da hunhu don haka majiyyaci zai iya numfasawa kuma a ba shi iska ba tare da wahala ba).
• ** Yawan bugun zuciya sama da bugun 80 a minti daya** da systolic hawan jini sama da 80 zuwa 90 mmHg.
• ** Busassun hammata (axillae)**.
• Muhimmin ka'idar asibiti: klzzwxh:0054 **Kina maganin atropine har sahuhu ya bushe.**

2. Pralidoxime (2-PAM / Obidoxime): Buɗe Gurasa Gurasa.¶

Saboda atropine kawai yana toshe masu karɓa na muscarinic ** (busar da huhu da gyaran bugun zuciya) kuma yana da ** tasirin sifili akan masu karɓar tsokar tsoka na nicotinic **, cikakken majinyacin atropinized tare da busassun huhu na iya mutuwa daga ** diaphragm nicotinic da gurɓataccen tsoka na numfashi **.

• **Yadda Oximes ke aiki ***: Pralidoxime (2-PAM) (wanda aka yi dashi a 1 zuwa grams IV akan 15 zuwa 30 mintuna ** a cikin manya, ko ** 20 zuwa 50 mg / kg ** a cikin yara, sannan ci gaba da jiko na IV na 500 mg / hour ko 8 zuwa 10 mg / kg/hour. Yana kai hari ga atom na phosphorus na kwayoyin organophosphate, yana cire shi daga enzyme acetylcholinesterase da ** maido da cikakken aikin enzyme na halitta ** a duka tsokoki na kwarangwal da wuraren muscarinic: idan an ba shi kafin wanda ba zai iya canzawa ba "tsufa" yana kulle haɗin gwiwa har abada.
• ** Gargadi na intubation (Kada ku taɓa amfani da Succinylcholine): Idan mai haƙuri na organophosphate ko carbamate yana buƙatar intubation na endotracheal mai sauri, likitocin dole ne ** kada su taɓa yin amfani da maganin gurguwar gurguwar succinylcholine, saboda yawanci ana rushe succinylcholine ta plasma butyrylcholinesterase (pseudocholinesterase). Tunda maganin kashe qwari ya lalata duk enzymes na cholinesterase, kashi ɗaya na succinylcholine yana haifar da ** sa'o'i na tsawan lokaci na inna ***. Madadin haka, ana amfani da masu hana neuromuscular marasa lalacewa (kamar rocuronium).

3. Kallon "Ciwon Matsakaici" (Sa'o'i 24 zuwa 96 Daga baya)¶

Ko da bayan majiyyaci ya tsira daga farkon rikicin cholinergic na Rana ta 1 kuma ya bayyana yana murmurewa da kyau a asibiti, ** 10 zuwa 40 bisa dari na marasa lafiya da guba ta hanyar organophosphates mai narkewa mai narkewa (kamar fenthion, dimethoate, parathion, ko chlorpyrifos) ba zato ba tsammani ya haifar da "Intermediate Syndrome" 14 zuwa 4days bayan kwanaki 6.

• Rashin jinkiri kwatsam: Ba tare da maimaituwa ba ko jikakken huhu, majiyyaci yakan haifar da matsananciyar inna na ** wuyansa flexors** (rashin iya ɗaga kansu daga matashin kai: alamar faɗakarwa ta farko), ** jijiyoyi na cranial ***, ** kusancin kafada / hip tsokoki ***, da ** na numfashi na numfashi (diaphragm) zuwa kwanaki 15 har sai sassan neuromuscular sun warke.
• ** Organophosphate-Induced Delayed Neuropathy (OPIDN) ***: Yana faruwa ** 1 zuwa 3 makonni ** bayan wasu abubuwan da suka bayyana, haifar da ciwon maraƙin maraƙi, rashin ƙarfi, tingling, da "stocking-and-glove" ƙafar digo / wuyan hannu.

Yadda ake amfani da Autoinjectors: DuoDote, Mark I, da Atropen¶

A cikin soja, abubuwa masu haɗari (HAZMAT), sabis na likita na gaggawa (EMS), da wasu saitunan aikin gona na masana'antu, masu amsawa suna ɗaukar nauyin intramuscular autoinjectors wanda aka ɗora don sadar da ** Atropine ** da ** Pralidoxime (2-PAM) ** ta hanyar tufafi a cikin cinya ta waje a cikin dakika na organophosphate ko bayyanar jijiya.

Dosing ta Tsanani da Nau'in Autoinjector¶

1. ** Adult Autoinjectors (DuoDote ko ATNAA / Mark I Kit)**:
2. Kowane DuoDote autoinjector mai ganga guda yana ba da ** 2.1 milligrams na Atropine ** da ** 600 milligrams na Pralidoxime Chloride** a jere ta hanyar allura guda ɗaya (tsohuwar **Mark I Kit ** tana amfani da allura daban-daban: Injector #1 yana ɗauke da 2 mg Atropine, kuma Injector #2 yana ɗauke da 6x00 mg).
3. ** Alamomi masu sauƙi zuwa matsakaici ** (alalibai masu haske, hanci mai gudu, bushewa, ƙirjin ƙirji, tashin zuciya, amma haƙuri yana tafiya yana magana): Gudanar da ** 1 DuoDote (ko 1 Mark I saita)** zuwa cikin cinya ta tsakiya (vastus lateralis). Jira minti 10 zuwa 15; idan bayyanar cututtuka ba su inganta ba, nemi kulawar likita don ƙarin allurai.
4. **Alamomi masu tsanani *** (rashin hankali, raɗaɗi / tashin hankali, matsananciyar wahala na numfashi / haƙori, apnea, ko gurɓataccen gurɓatacce): Nan da nan ba da gudummawar ** 3 DuoDote autoinjectors (ko 3 Mark I sets) a cikin sauri jere ** a cikin cinya ta waje, da ** 1 Diazepam (CANA 10 mg) ko ma antijepam 10 mg. Kamun da ake gani ba a bayyane yake ba (kamar yadda guragu-maganin jijiyoyi sukan sha fama da rashin maƙarƙashiya a cikin kwakwalwa).
5. *Dogarin Nauyin Jiyya na Yara Atropen:
6. Yara ƙanana da aka fallasa ga organophosphates ko magungunan jijiya suna buƙatar ma'aunin nauyi ** Atropen ** autoinjectors (akwai a cikin ** 0.25 mg ** [lakabin rawaya, ga jarirai a ƙarƙashin 7 kg / 15 lbs], ** 0.5 mg *** [lakabin shuɗi, ga yara 7 zuwa 18 kg / 15 zuwa 40 lbs, label ja, 15 zuwa 15 lbs, 15 lbs ga yara, 15 zuwa 1.0 lbs] 41 kg / 40 zuwa 90 lbs], da kuma ** 2.0 mg *** (lakabin kore, sama da 41 kg / 90 lbs]).
7. ** Muhimmiyar ka'ida ta ceton rai *: Idan yaro yana da organophosphate mai barazanar rai ko guba mai guba (mai kumburin huhu, haƙori, coma, ko seizures) kuma balagagge kawai ** 2 mg Atropine / DuoDote ** autoinjector yana samuwa a wurin, ** gudanar da babban autoinjector ga yaro nan da nan. Atropine tachycardia na wucin gadi da busassun fata suna rayuwa gaba ɗaya, yayin da ba a kula da kamun lumfashi na cholinergic yana da mutuwa cikin mintuna.

Mataki-mataki Dabarar allurar Autoinjector¶

• Mataki na 1: Duba aljihun cinya na waje: Da sauri jin cinyar tsakiyar waje don tabbatar da cewa ba kwa allura a cikin walat, maɓalli, wayar hannu, ko bel mai kauri.
• Mataki na 2: Cire hular aminci mai launin toka: Rike ganga DuoDote a hannunka tare da ** titin kore yana nuni zuwa ƙasa ** (kada ku taɓa sanya babban yatsan yatsa akan ƙarshen allurar kore). Cire hular aminci mai launin toka kai tsaye daga baya.
• **Mataki na 3: Ja da ƙarfi a kusurwa 90-digiri zuwa tsakiyar cinya ta waje ***: Swing da danna kore tip da ƙarfi a cikin cinyar waje mai nama tsakanin hip da gwiwa har sai kun ji kuma ku ji an danna bazara.
• Mataki na 4: Rike da ƙarfi a wurin na tsawon daƙiƙa 10 cikakke: Kidaya sannu a hankali zuwa 10 ("dubu ɗaya-ɗaya, dubu biyu-ɗaya...") don haka ɗakunan biyu (atropine da pralidoxime) ba komai gaba ɗaya cikin tsoka.
• Mataki na 5: Lanƙwasa allurar a cikin ƙugiya sannan a liƙa ta a kan ƙwanƙarar wanda abin ya shafa: Cire alluran kai tsaye waje, tausa cinyar na ɗan daƙiƙa kaɗan, sannan a lanƙwasa allurar da aka fallasa a cikin ƙugiya ta "J" a kan wani wuri mai wuyar gaske don haka za ku iya haɗa motar da ba ta da komai a cikin aljihun rigar wanda aka azabtar ko alamar triage. Wannan yana gaya wa masu zuwa da likitocin gaggawa da likitocin gaggawa a kallo nawa adadin atropine da 2-PAM mara lafiya ya rigaya ya karɓa.

Tambayoyin da ake yawan yi¶

*Wannan jagorar don dalilai ne na bayanai kuma baya maye gurbin ƙwararrun ƙwararrun likita ko horon hannu. Saboda tsananin gubar sinadarai na iya haifar da kama numfashi kwatsam, muna ba da shawarar ɗaukar ingantaccen taimako na farko da kwas na CPR ta Ƙungiyar Red Cross da Red Crescent Societies (IFRC), Ƙungiyar Red Cross ta ƙasa, St John Ambulance, ko ƙwararren mai ba da horo na gida.

An duba tushe¶

• Hukumar Lafiya ta Duniya (WHO): Kwayoyin Kula da Kiwon Lafiya na Maganin Cutar Kwari: Organophosphorus, Carbamate, da Ka'idodin Guba na Paraquat.
• Cibiyoyin Kula da Cututtuka da Rigakafi (CDC, Amurka) & Hukumar Kula da Abubuwan Guba da Rijistar Cututtuka (ATSDR): *Sharuɗɗan Gudanar da Magunguna don Ma'aikatan Jijiya da Magungunan Magungunan Magungunan Organophosphate * da * Jagorar Clinical Paraquat *.
• Hukumar Kare Muhalli ta Amurka (EPA, Amurka): Ganewa da Gudanar da Guba na Kwari (Bugu na shida).
• Sabis na Bayanin Guba na ƙasa (NPIS, United Kingdom) & Hukumar Tsaron Lafiya ta Burtaniya (UKHSA): TOXBASE Gudanar da Clinical Management of Organophosphates, Carbamates, Paraquat, da Metal Phosphides.

Jagora masu alaƙa¶

• Guba taimakon farko da sarrafa guba
• Ƙona mai tsanani da kuma zubar da sinadarin fata
• Hydrofluoric acid, mai cire tsatsa, da sinadarai na masana'antu yana ƙonewa
• Raunin ido da ban ruwa na ido na sinadarai
• CPR da numfashin ceto ga manya
• Lambobin gaggawa ta ƙasa