Tetrodotoxin da Saxitoxin Guba: Pufferfish, Octopus mai Zobba mai launin shuɗi, da Shellfish na Nakasassu¶

Tetrodotoxin (TTX) da saxitoxin (STX) suna daga cikin mafi ƙarfin neurotoxins waɗanda ba su da sinadarai a cikin yanayi, waɗanda ke da ikon haifar da gurɓataccen gurɓataccen jijiyar jiki da sauri da kuma kama numfashi a cikin mintuna 15 zuwa 90 na cin abinci na ruwa ko tuntuɓar dafin. Ko bayyanarwar ta fito ne daga cin abincin da ba a shirya ba (* fugu ), fama da cizo mara radadi daga wata dorinar ruwa mai launin shuɗi ( Hapalochlaena * nau'in) a cikin tafkin ruwan tekun Indo-Pacific, ko cinye kifin bivalve (mussels, clams, oysters, scallops, ko geoducks) da ke haifar da gurɓataccen kifin da ke haifar da cutarwa. (PSP), tsarin barazanar rayuwa yana da kama da: ci gaba da toshewar tashoshi na sodium mai ƙarfin lantarki akan jijiyoyi na motsi da tsokoki na kwarangwal, yana ƙarewa a cikin inna na diaphragmatic da kama zuciya na hypoxic. Mahimmanci, saboda tetrodotoxin ko saxitoxin ba sa ketare shingen jini-kwakwalwar ɗan adam a cikin adadi mai yawa, masu gurɓatacce gaba ɗaya tare da ƙayyadaddun almajirai, fashe-fashe da kuma numfashin da ba a so ba ya kasance cikin sani kashi 100 cikin 100, a farke, kuma yana iya ji da jin duk abin da ke kewaye da su. Idan wani ya kamu da ciwon leɓe ko harshe bayan cin abincin teku ko kula da rayuwar ruwa, kira na gida lambobin gaggawa nan da nan kuma a shirya don ci gaba da numfashin ceto (CPR). Hakanan duba jagororin 'yan uwanmu akan botulism, ciguatera, scombroid, da kuma shellfish neurotoxin guba, guba na taimakon farko, kuma shakewa taimako.

Babban fifikonku na nan da nan shine gane cewa ** numbness ko fil-da-allura na lebe da harshe a cikin mintuna na cin abinci na ruwa ko cizon dorinar ruwa shine gargaɗin da ke gabatowar gurguncewar tsokar numfashi mai zuwa , sanya wanda abin ya shafa a cikin yanayin farfadowa na gefe idan suna amai ko bushewa, yi amfani da Matsi na Australiya Immobilization nan da nan idan dalilin ya kasance shuɗi ne, kuma an ba da damar yin amfani da shi. Baki-da-baki ko jakar-bawul-mask iskar ceton iska lokacin da numfashi ya zama marar zurfi ko tsayawa.

Yi wannan yanzu¶

1. **Kira lambar gaggawa ta gida nan da nan a alamar farko ta lebe, harshe, ko yatsa bayan cin abincin pufferfish, shellfish, ko reef invertebrates, ko kuma bayan sarrafa wata karamar dorinar ruwa. lambobin gaggawa. Faɗa wa mai aikowa a fili: "Waɗanda ake zargin tetrodotoxin ko gurɓataccen kifin kifi, babban haɗarin kama numfashi da sauri, ci gaba da iskar iska da iskar injin da ake buƙata nan take."
2. A daina cin abincin teku da ake zargi da gaggawa, a faɗakar da duk wanda ya raba abincin, sannan a ajiye ɗanyen kifi ko dafaffen kifi, kifin kifi, ko amai a cikin kwandon da aka rufe don gwajin gubar lafiyar al'umma. Kada a jefar da sauran abincin; saurin ganewar dakin gwaje-gwaje na tetrodotoxin ko saxitoxin yana jagorantar kulawa mai zurfi na asibiti kuma yana ba da damar tunawa da lafiyar jama'a na gaggawa na gurɓataccen gadajen kifin kifi.
3. **Idan bayyanar ta cizo ne daga dorinar dorinar ruwa mai launin shuɗi (ko katantan mazugi) a hannu ko ƙafa, a yi amfani da bandeji mai ƙarfi na matsa lamba (PIB) nan da nan kuma a tsaga gaɓoɓin gaba ɗaya gaba ɗaya. gaɓoɓin da aka yi amfani da shi don sprained idon sawu (mai ƙarfi don rage yawan zubar dafin lymph ba tare da yanke bugun jini ba), datse gaɓoɓin gaɓoɓi tare da tsatsa mai tsauri, kuma kiyaye mara lafiya gaba ɗaya.
4. **Kada ku jawo amai, kada ku tilasta wa mai barci ko mai zubewa ya sha ruwa, nono, ko gawayi a gida, sannan a juyar da mara lafiya a gefensu.
5. ** Kula da zurfin numfashi da ƙididdigewa kowane sakan 60, kuma fara ci gaba da numfashin ceto (ko cikakken CPR idan bugun jini ya ɓace) numfashin nan take ya zama mara zurfi, jinkirin, ko tsayawa. Idan ba za ku iya jin bugun carotid a cikin daƙiƙa 10 ba, fara cikakke CPR a bugun kirji 30 zuwa numfashin ceto 2.
6. *Yi magana cikin nutsuwa, kwantar da hankali, da ci gaba ga mai shanyayyen, kuma a faɗakar da ma'aikatan lafiya da likitoci cewa wanda aka azabtar yana cikin farke a cikin gurguwar jiki. Ana ba da kwanciyar hankali mai kyau da analgesia yayin shigar da ciki.

Bishiyar yanke shawara: wanda ake zargi da fallasa neurotoxin na ruwa da kamawar numfashi¶

flowchart TD
    A["Abincin abincin teku na kwanan nan ko tuntuɓar ruwan teku"] --> B{"Menene tushen fallasa?"}
    B -->|Bite or handling of small octopus or cone snail| C["Dorinar ruwa mai launin shuɗi TTX ko mazugi katantanwa conotoxin"]
    B -->|Ate pufferfish, toadfish, globefish, or horseshoe crab eggs| D["Ingested Tetrodotoxin (TTX) guba"]
    B -->|Ate mussels, clams, oysters, scallops, or whelks| E["Cinye Gurbin Kifin Shellfish (Saxitoxin)"]
    C --> F["Aiwatar da Matsi Immobilization Bandage + splint hannu nan da nan"]
    D --> G["Tsaya abinci, ajiye samfurin abinci, kiyaye haƙuri har yanzu a gefe"]
    E --> G
    F --> H{"Duba hanyar iska, hadiyewa, da numfashi kowane daƙiƙa 60"}
    G --> H
    H -->|Perioral tingling, slurred speech, drooling, weak cough| I["Kira EMS nan da nan: babban haɗarin kama numfashi a cikin 15 zuwa 60 min"]
    H -->|Shallow breathing, cyanosis, or respiratory arrest| J["Fara numfashin ceto nan take (numfashi 1 kowane 5 zuwa 6 seconds) ko cikakken CPR"]
    I --> K["Ajiye NPO (babu wani abu da baki), tsotsa ko magudanar ruwa a cikin murmurewa"]
    J --> L["Tabbatar da majiyyaci da ƙarfi: sun kasance a sane 100% duk da gurgunta"]
    K --> M["Asibitin ICU: Intubation endotracheal tare da kwantar da hankali + 24 zuwa 72 hr samun iska"]
    L --> M

Kwayoyin ilimin kwayoyin halitta: yadda Tetrodotoxin (TTX) da Saxitoxin (STX) suka gurgunta jiki¶

Fahimtar tsarin salula na tetrodotoxin da saxitoxin ya bayyana dalilin da yasa mutuwa ke faruwa da sauri ba tare da tallafin hanyar iska ba kuma dalilin da yasa cikakkiyar farfadowa ke biyo baya idan huhu ya sami iska har sai an cire renal.

1. Guanidinium abin toshe kwalaba na tashoshin sodium mai ƙarfin lantarki¶

Dukansu ** tetrodotoxin *** (319 Daltons) da ** saxitoxin ** (299 Daltons) sune m, guanidinium alkaloids mai narkewa da ruwa wanda ke ɗaure tare da kusancin nanomolar zuwa ** Site 1 akan buɗewar ƙurar ƙura ta ƙuruciya ta tashoshi na sodium mai ƙarfin lantarki (NaV)** akan jijiyoyi masu azanci na ɗan adam, jijiyoyi na jikin mutum, axons membranes.

• ** Kwalwar kwayar halitta a cikin kwalban: ** Lokacin da kwakwalwa ta aika umarni saukar da jijiyar phrenic don kwangilar diaphragm, tashoshin sodium mai ƙarfin lantarki (NaV 1.1, NaV 1.2, NaV 1.4, NaV 1.6, da NaV 1.7) buɗe tare da axon don yada yuwuwar aikin lantarki. Ingantacciyar ma'aunin guanidinium na tetrodotoxin ko saxitoxin wedges a cikin tacewa na waje (zoben DEKA) na tashar tashar sodium kamar kwalabe na zahiri da aka tura cikin wuyan kwalba.
• Cikakken shiru na lantarki: Ana toshe ions sodium a jiki daga shiga axon. Jijiyoyin ji suna daina watsa taɓawa bayan fashewar farko na ɓarna (paresthesias), kuma jijiyoyi na motsa jiki da tsokoki na ƙwanƙwasa sun zama marasa iya harba ƙarfin aiki, yana haifar da saurin ci gaba ** flaccid skeletal muscle paralysis **.

2. Me yasa zuciya ke da ɗan juriya har sai hypoxia ya faru¶

Tsokawar kwarangwal na ɗan adam da jijiyoyi na gefe suna bayyana ** TTX-tashoshin sodium mai hankali** (NaV 1.4 da NaV 1.6 / NaV 1.7), waɗanda aka toshe su ta hanyar ƙaramin adadin nanomolar (1 zuwa 10 nanomolar) na tetrodotoxin. Sabanin haka, tsokar zuciya ta ɗan adam tana bayyana yawanci ** tashar sodium na zuciya isoform NaV 1.5**, inda bambancin amino acid guda ɗaya (cysteine ​​​​a cikin Domain I) ya sa tashar zuciya ** 200 zuwa sau 1,000 ba ta kula da tetrodotoxin **. A cikin allurai waɗanda ke gurgunta diaphragm da gaɓoɓin gaba ɗaya, zuciyar wanda aka azabtar ta ci gaba da bugawa da kanta har sai rashin numfashi yana haifar da hypoxemia mai tsanani da bugun zuciya (duk da yawan shan kashi na Stage 4 na iya haifar da toshewar vasomotor mai juyayi, hauhawar jini, da bradycardia).

3. Me yasa wanda aka azabtar ya kasance a farke 100% kuma yana sane (Kulle-In Pseudocoma)¶

Saboda duka tetrodotoxin da saxitoxin ƙananan ne ** ruwa mai narkewa (hydrophilic), ƙwayoyin cuta na polar ** suna da inganci a pH physiological (7.4), ba sa saurin ketare shingen kwakwalwar ɗan adam mai wadatar lipid**.

• Ko da duk wata tsokar kwarangwal na son rai a cikin jiki ta zama gurgunta kashi 100 cikin 100 kuma tashe-tashen hankula na haifar da ** gyarayyun almajirai (mydriasis)** da rashi na corneal reflexes, majiyyaci ya kasance a farke kuma yana iya jin kowace zance kuma yana jin kowace sandar allura ko ruwan intubation.
• Masu ba da amsa na farko dole ne ** kar su taɓa yin maganganun rashin hankali a kusa da majiyyaci, dole ne su shafa ko shafa idanu, kuma likitocin gaggawa dole ne su ba da cikakken maganin kwantar da hankali da analgesia ** (propofol, midazolam, ko ketamine tare da fentanyl) kafin intubation da duk lokacin samun iska.

4. Cikakken zafi da kwanciyar hankali¶

Dukansu tetrodotoxin da saxitoxin sune ** gaba ɗaya zafi-barga da acid-barga**. ** tafasa, soya, yin burodi, tururi, matsa lamba-dafa abinci, gasa *** (100 zuwa 200 digiri Celsius, ko 212 zuwa 392 digiri Fahrenheit), ** daskarewa ** (-20 zuwa -80 digiri Celsius, ko -4 zuwa -112 digiri Fahrenheit), ko *marinating a cikin vinegar ko ruwan 'ya'yan itace mai tsaka tsaki * ruwan 'ya'yan itace na ɗan adam (pH 1.5 zuwa 2.0) baya rushe su. Gurbataccen kifin kifin kifi ko kyan gani, ƙamshi, da ɗanɗano 100 bisa ɗari na al'ada da sabo.

Manyan cututtuka masu fallasa: Pufferfish, Octopus mai launin shuɗi, da Shellfish na nakasassu¶

Pufferfish (Fugu) da shan Tetrodotoxin maras fugu¶

Inda Tetrodotoxin ke ɓoye a cikin kifin puffer da sauran halittun ruwa¶

Pufferfish (iyali * Tetraodontidae *, wanda aka sani da * fugu * a Japan, * bok-eo * a Koriya, * hetun * a China, da kifin kifi ko toadfish a cikin yankuna masu magana da Ingilishi) suna samun TTX daga ƙwayoyin cuta na ruwa ta hanyar sarkar abinci kuma suna mayar da hankali a cikin keɓaɓɓun sunadarai masu ɗaure a cikin gabobin su.

1. Masu Mutuwar Gabobi (Hanta da Ovaries): A galibin nau'in Takifugu da ake amfani da su a cikin abincin Jafananci, ** hanta (kimo)** da ovaries/kwai (roe) suna ɗauke da kisa na tetrodotoxin, inda 1 zuwa 2 milligrams na crystalline tetrodotoxin (kadan giram na hanta ɗan adam ke kashewa). Hakanan hanji* da fata suma suna ɗauke da kisa. A Japan, an haramta yin hidimar hantar pufferfish (* fugu kimo *) tun daga 1984, kuma masu dafa abinci masu lasisi kawai za su iya shirya nau'ikan da aka yarda da su; Kusan duk mutuwar fugu ta Jafananci na zamani suna faruwa ne lokacin da masu son kifaye suka shirya kifin puffer a gida ko kuma suka ci hanta da aka haramta.
2. ** Nau'in Nama mai guba da mai guba (Lagocephalus sceleratus da Arewacin Amurka Puffers):** ** A cikin nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan kifaye da yawa a waje da tsarin kiwo, farin tsokar tsoka da kansu sun ƙunshi adadin tetrodotoxin ko saxitoxin**:
3. Toadfish (Lagocephalus sceleratus): Wani kifin Indo-Pacific mai mamayewa wanda ya yi ƙaura ta hanyar Suez Canal zuwa cikin ** Tekun Mediterranean ** (Girka, Turkiyya, Cyprus, Isra'ila, Lebanon, Masar, Italiya, Spain). Ya ƙunshi ɗimbin matakan tetrodotoxin a cikin ** tsokar tsoka ***, gabobin jiki, da fata, yana haifar da guba mai kashewa a tsakanin masu kama kifi na Rum.
4. klwxh:0036 Sphoeroides nephelus ): A cikin Amurka (tare da Kogin Indiya a Florida da Gulf of Mexico da Atlantic Coast), fillet ɗin pufferfish suna tara manyan matakan ** saxitoxin ** da tetrodotoxin a cikin tsokar tsoka.
5. ** Magungunan Tetrodotoxin marasa Pufferfish:**
6. ** Mangrove Horseshoe Crab (* Carcinoscorpius rotundicauda*):** An samo shi a Thailand, Vietnam, Cambodia, da Malaysia; yayi kusan kama da kaguwar doki na bakin teku (* Tachypleus gigas*) amma yana ɗauke da tetrodotoxin da saxitoxin mai kisa a cikin qwai.
7. Marine Gastropods, Sea Slugs, and Newts: Katantanwa na wata, katantan hauren giwa, da harsashi na ƙaho a Asiya da Turai suna tara TTX a cikin glandan su na narkewa da ƙafar tsoka; slug na gefen teku mai launin toka (* Pleurobranchaea maculata*) yana wanke kan rairayin bakin teku na New Zealand da Ostiraliya mai ɗauke da TTX mai mutuwa; da ** sabbin fata (Taricha granulosa)** a cikin Amurka Pacific Northwest da British Columbia suna ɓoye tetrodotoxin mai kisa daga fatar dorsal.

The Fukuda and Tani 4-Stage Clinical Grading System¶

Likitoci suna rarraba ci gaban tetrodotoxin ta amfani da 4-Stage Fukuda da Tani Grading Scale. Idan Stage 1 tingling lebe ya fara a cikin mintuna 10 zuwa 20 na cin abinci, ci gaba zuwa mataki na 4 kama numfashi na iya faruwa a cikin mintuna 30 zuwa 60.

1. Grade 1 (Farkon Sensory da GI Stage): Tingling, prickling, and numbness of lebe, harshe, da na baki mucosa (kamar hakori gida maganin sa barci), yada zuwa ga yatsa da yatsun kafa, tare da hypersalivation (drooling), tashin zuciya, amai, epigastric zafi, dizziness, da gumi.
2. ** Daraja na 2 (Ci gaba da Ƙaƙƙarwar Ƙarfafawa da Farkon Motar / Rauni na Bulbar):** Ƙunƙarar ta yaɗu a fuska, wuya, gangar jikin, da gaɓoɓi, tare da jin cewa jiki yana yawo a tsakiyar iska ***. Rashin raunin motsi na farko yana haifar da wahalar tafiya (ataxia), rashin ƙarfi mai ƙarfi, ƙarancin magana (dysarthria), wahalar haɗiye miyagu (dysphagia), ƙananan faɗuwar fatar ido (ptosis), da kuma asarar reflex na corneal.
3. ** Darasi na 3 (Mai tsananin naƙasasshe da gazawar numfashi mai gabatowa):** Cikakken rashin iya tsayawa, zama, ko ɗaga gaɓoɓi, tare da hasarar reflexes mai zurfi (areflexia) da kuma asarar murya (aphonia). Shanyewar tsokoki na intercostal da raunana diaphragm yana haifar da ** numfashi mara hankali (hypoventilation) **, dyspnea, rashin iya tari, faɗuwar iskar oxygen (kasa da kashi 90), hypercapnia, cyanosis, da hypotension. Majinyacin ya kasance cikin hayyacinsa gaba daya.
4. ** Darasi na 4 (Cikakken kamawar Numfashi, Rashin Lafiyar Jini, da Pseudocoma):** Cikakkiyar gurguwar gurguwar cuta (apnea, nunfashi na bazata). Ba tare da numfashin ceto nan da nan ba ko iskar injina, kamawar zuciya ta hypoxic yana faruwa a cikin mintuna 3 zuwa 5. Toshewar ganglion na ciliary ganglion da jijiyoyi na cranial yana haifar da ** kafaffen, ƙayyadaddun almajirai (mydriasis)* da gag, tari, corneal, da oculocephalic reflexes, tare da hypotension arterial da sinus bradycardia. Sai dai idan hypoxia na kwakwalwa ya faru kafin a fara samun iskar iska, kwakwalwar kwakwalwa ta kasance a farke kuma tana iya ji a cikin jiki mara motsi.

Cizon Octopus mai Zobba mai launin shuɗi (Hapalochlaena) da Cizon Matsalolin Australiya¶

Gane abin halitta da tarkon cizon shiru¶

Dorinar dorinar ruwa mai launin shuɗi ** ta ƙunshi ƙananan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan nau'ikan Hapalochlaena (* H. maculosa* a kudancin Ostiraliya, * H. Lunulata* a arewacin Ostiraliya da Indo-Pacific daga Indonesia da Philippines zuwa Japan, * H. fasciata * tare da gabashin Australia, da * H. nierstraszi ): - ** Karamin girma da nunin faɗakarwa:* Jiki yana da girman ƙwallon ƙwallon golf (santimita 4 zuwa 6, ko inci 1.5 zuwa 2.5), tare da tsawon santimita 10 zuwa 20 (inci 4 zuwa 8). Suna ɓoye a cikin kwalabe, gwangwani, ƙwanƙolin teku, da wuraren tafkuna masu zurfi. Lokacin hutawa, suna bayyana launin ruwan kasa; kawai lokacin da aka ɗaure su ko ɗagawa sai su yi walƙiya na chromatophores ** 50 zuwa 60 zobba masu launin shuɗi ko ratsi . - Cizon shiru da saurin allurar TTX: Bakin chitin yana zaune a ƙarƙashin yanar gizo na makamai. Cizon sa yana da kankanta wanda fiye da rabin wadanda abin ya shafa ke jin zafi ko kadan kawai, suna lura da digon jini mai tsawon milimita 1 zuwa 2 (0.04 zuwa 0.08 inch) na jini ko bugewa a kan yatsa ko kafa. Kwayoyin cututtukan da ke cikin glandan salivary na baya suna samar da tetrodotoxin, wanda ake allura a cikin capillaries na subcutaneous da lymphatics, yana haifar da ** numbness na lokaci-lokaci, hangen nesa, da kama numfashi a cikin mintuna 5 zuwa 15.

Mataki-mataki-mataki ƙa'idar Immobilisation Immobilisation Bandage (PIB).¶

Ba kamar jellyfish stings ko kashin kashin kifi ba, ** cizon dorinar ruwa mai launin shuɗi (ko mazugi mai katantanwa) cuta ce ta mahaifar neurotoxic da ke buƙatar Bandage Immobilization na gaggawa (PIB)** ta ** Jagoran ANZCOR 9.4.8**:

1. Kiyaye wanda abin ya shafa gaba daya kuma a kwance su: Tafiya ko jujjuya gaɓoɓi yana kunna famfon tsokar kwarangwal kuma yana haɓaka ɗaukar TTX lymphatic.
2. KADA a wanke, yanke, ko tsotsa, ko shafa aikin yawon shakatawa na jijiya: Kada a yanke kwararar jini na jijiya ko bata lokacin wanke rauni.
3. A shafa Bandage 1 a kan cizon da bandeji 2 sama da gaba ɗaya gaɓoɓin: Rufe bandeji mai faɗi (10 zuwa 15 centimeters ko 4 zuwa 6 inci faɗi) da ƙarfi akan cizon, sa'an nan kuma kunsa daga yatsu ko yatsu har zuwa hammata ko makwanci a tashin hankali da ake amfani da shi don sprained idon ƙafa, 50mmH zuwa ƙafa 40H. Tabbatar da cikawar capillary na daƙiƙa 2 da nisa.
4. A shafa tsatsa mai tsauri sannan a barshi a wuri har ICU ta shirya hanyar iska: A daure tsatsa mai tsauri a gabobin jiki, a sanya alamar cizo a kan bandeji, sannan kada a cire bandejin har sai majiyyaci yana cikin wurin farfado da asibiti tare da shirya kayan aikin intubation.

Guba Shellfish (PSP) da Saxitoxin¶

** Guba Shellfish (PSP)** yana faruwa tare da Tekun Pacific da Atlantic na Arewacin Amurka (Alaska, British Columbia, Washington, Oregon, California, Maine, Massachusetts, da Maritime Canada), Chile, Argentina, UK, Turai, Afirka ta Kudu, Japan, Philippines, New Zealand, da Ostiraliya.

• ** Dinoflagellate bioaccumulation:** Single-celled marine algae (Alexandrium catenella, Alexandrium tamarense, Gymnodinium catenatum, da Pyrodinium bahamense) hada ** saxitoxin (STX)** da 50+ gonyautoxin analogues. Bivalves masu ciyar da tacewa (** mussels, clams man shanu, reza clams, smallneck clams, lallausan harsashi, geoducks, oysters, scallops, and cockles ) suna tattara saxitoxin a cikin glandan su na narkewa da siphons. Gastropods ( whelks, katantan wata, abalone) da crustaceans (* Dungeness kaguwa, dutsen kagu, da hepatopancreas lobster ko tomalley*) suma suna tara saxitoxin mai mutuwa.
• Me yasa binciken ruwa na gani ya gaza: Shellfish yana tara saxitoxin mai mutuwa (sama da micrograms 80 a cikin gram 100 na nama) koda lokacin da ruwan teku yayi kama da 100 bisa 100 a sarari. Pacific man shanu clam (Saxidomus gigantea) yana riƙe saxitoxin a cikin siphon ɗinsa na har zuwa shekaru 1 zuwa 2 bayan furen algal ya ɓace, kuma cin ** gaba ɗaya ko roe-on scallops ** daga ruwan da ba a kula da shi yana ɗaukar cikakken haɗarin mutuwa na PSP.

Bambance-bambancen ganewar asali: TTX da Saxitoxin vs Ciguatera, Scombroid, Botulism, da Anaphylaxis¶

Prehospital da farfadowa na asibiti: ka'idar asibiti ta mataki-mataki¶

1. Matsayin hanyar iska nan da nan da numfashin ceto (Mataki na 1 zuwa 4)¶

• Kiyaye majiyyaci sosai NPO (babu komai da baki) kuma kada ku taɓa haifar da amai: Mara lafiya da ciwon kumburin kumburi ba zai iya kare bututun su ba kuma zai sha ruwa ko yin amai a cikin huhunsa. Sanya majiyyaci a matsayi na gefe (farfadowa) matsayi idan tashin zuciya ko hada baki ya faru.
• ** Ci gaba da numfashi na ceto da kuma Bag-Valve-Mask (BVM) samun iska:** Fara taimakon samun iska da zaran numfashin ya zama marar zurfi, mai rikitarwa, ko jinkirin (kasa da numfashi 8 a cikin minti daya), ko kuma idan mai haƙuri ba zai iya ƙidaya zuwa 5 a cikin numfashi ɗaya ba. Sanya wanda abin ya shafa ya kwanta a bayansu, yi wani ** karkatar da kai/dangare**, danka hanci, sannan ka isar da numfashin ceto 1 kowane dakika 5 zuwa 6 (numfashi 10 zuwa 12 a minti daya)** ga babba (ko ** numfashi 1 kowane dakika 2 zuwa 3** ga yaro), kallon tashin kirji. Sake duba bugun jini na carotid kowane minti 2; idan bugun jini ya ɓace, fara cika CPR (Matsi 30 zuwa numfashi 2).

2. Gudanar da ICU na asibiti: intubation, kwantar da hankali, da kawar da koda¶

1. Early Endotracheal Intubation with Mandatory Sedation: Monitor serial Negative Inspiratory Force (NIF) and Forced Important Capacity (FVC) alongside end-tidal carbon dioxide (EtCO2). Intubate zaɓaɓɓe idan FVC ta faɗi ƙasa 15 zuwa 20 ml/kg ko NIF ya raunana da ya wuce -25 zuwa -30 cmH2O, ko kuma nan da nan don haɗawar bulbar ko iska. Saboda majiyyaci yana sane gaba ɗaya a cikin gurɓataccen jiki, ba da maganin kwantar da hankali (etomidate, ketamine, ko propofol) kafin laryngoscopy kuma a ci gaba da ci gaba da kwantar da hankali da analgesia a duk lokacin samun iska.
2. Cuffed Airway Lavage Gastric Lavage and Activated Charcoal (A cikin Minti 60 Kawai): Domin shan baki yana gabatarwa a cikin awa 1, ** kawai bayan an sanya bututun endotracheal mai cuffed, likitoci na iya yin lavage nasogastric mai laushi tare da sanyawa ** kunna gawayi*** (1 g/5g0g) da saxitoxin.
3. ** Tallafi na Hemodynamic da Cire Renal: ** Bi da hypotension Grade 4 da bradycardia tare da ** isotonic IV crystalloid boluses , ** norepinephrine ** ko ** phenylephrine ** infusions, da ** IV atropine ** (0.5 zuwa 1.0 MG). ** Babu maganin maganin ɗan adam na kasuwanci da ke wanzu *** don tetrodotoxin ko saxitoxin (IV ** neostigmine ** 0.05 mg / kg tare da atropine ana amfani dashi lokaci-lokaci azaman haɗin gwiwa, amma baya maye gurbin samun iska). Dukkan gubobi biyu suna fitar da kodan ba su canzawa ta hanyar tacewa ta glomerular (ko share su ta hanyar hemodialysis a cikin gazawar koda). Numfashin kwatsam yakan dawo cikin awanni 12 zuwa 24, yana ba da damar yin extubation a cikin awanni 24 zuwa 72** ba tare da lalacewa ta dindindin ba.

Lambobin gaggawa na yanki da ka'idojin hukumar¶

• Amurka da Kanada: Kiran kira 911 nan da nan ga duk wani da ake zargin pufferfish, shellfish, ko bayyanar neurotoxin na ruwa. Tuntuɓi ** Kula da Guba na Amurka a 1-800-222-1222** ko Cibiyar Guba ta Kanada, kuma bayar da rahoton gurbataccen kifin kifi ko siyar da kifin zuwa ga Ma'aikatar Lafiya ta Jiha da FDA (1-888-SAFEFOOD).
• ** Ostiraliya da New Zealand:** Kiran kira 000 a Ostiraliya ko 111 a New Zealand. Aiwatar da Bandage na Rashin Matsi (ANZCOR Guideline 9.4.8)** don duk wani cizon dorinar dorinar ruwa mai launin shuɗi ko cizon mazugi, kuma a kira ** Cibiyar Bayanin Guba ta Australiya (13 11 26)** ko ** Cibiyar Guba ta New Zealand (0800 764 766)**.
• ** United Kingdom:** Kiran kira 999 don motar asibiti ta rukuni 1 nan take. Likitoci suna tuntuɓar NPIS/TOXBASE kuma su sanar da Hukumar Tsaro ta Lafiya ta Burtaniya (UKHSA) da Hukumar Ka'idodin Abinci (FSA).
• Ƙungiyar Tarayyar Turai: Kiran kira 112 a duk ƙasashe membobin EU. Tare da Tekun Bahar Rum, bayar da rahoton duk wani shigar da kifin da aka yi da kunci na azurfa (Lagocephalus sceleratus) nan da nan don haka ƙungiyoyin jiragen sama na ICU sun shirya don saurin gurɓacewar tetrodotoxin.
• Japan, Koriya ta Kudu, da Asiya-Pacific: Dial 119 a Japan da Koriya ta Kudu, 995 a Singapore, 999 a Malaysia da Hong Kong, 1669 a Tailandia, ko 112/108 a Indiya. Rahoton da ake zargin fugu (Takifugu), kaguwar kaguwar doki na mangrove (Carcinoscorpius), ko gubar kifi nan da nan.

Tambayoyin da ake yawan yi¶

Me yasa mutumin da kifin pufferfish guba ko dorinar ruwa mai launin shuɗi zai iya ji kuma yana jin komai ko da ya yi kama da ƙayyadaddun yara?¶

Tetrodotoxin da saxitoxin ƙanana ne, tabbataccen caji, ƙwayoyin ruwa masu narkewa waɗanda ke toshe tashoshin sodium masu ƙarfin lantarki akan injin na gefe, na zahiri, da jijiyoyi masu zaman kansu a wajen kwakwalwa, suna gurgunta kowane tsokar kwarangwal ciki har da diaphragm, igiyoyin murya, fatar ido, da tsokoki iris waɗanda ke takura yara. Saboda waɗannan kwayoyin halitta na polar ba za su iya ketare shingen jini-kwakwalwa na lipid ba, kwakwalwar kwakwalwa ta kasance a farke. Matukar numfashin ceto ko na'urar iska ta injina tana kiyaye iskar oxygen da ke gudana zuwa kwakwalwa, gurguwar mara lafiya yana jin kowace kalma a cikin dakin kuma yana buƙatar cikakken tabbaci da kwantar da hankali a cikin jijiya yayin shigar.

Shin tafasa, soya, daskarewa, ko marinating pufferfish ko jajayen mussels a cikin ruwan lemun tsami yana lalata tetrodotoxin ko saxitoxin?¶

A'a. Dukansu tetrodotoxin da saxitoxin suna da ƙarfi-zafi da kuma alkaloids masu tsayayyen acid. Tafasa kifin a 100 digiri Celsius (212 digiri Fahrenheit), zurfi-soya, matsa lamba-dafa abinci, daskarewa, ko jiƙa a vinegar ko citrus ruwan 'ya'yan itace ba ya halaka ko raunana ko dai guba, kuma gurbataccen abincin teku kama, wari, da dandana gaba daya al'ada.

Me yasa kuke nannade Bandage Immobilization na Matsi akan cizon dorinar dorinar ruwa mai shuɗi, lokacin da ba za ku taɓa nannade ɗaya akan tsinin jellyfish ba?¶

Dorinar dorinar ruwa mai launin shuɗi tana allurar tetrodotoxin mai narkewa ta ruwa ta bakinta zuwa cikin kyallen jikin da ke ƙarƙashin jikin ta, inda dafin ke tafiya ta tasoshin lymph zuwa tsakiyar tsakiyar jini don gurɓata diaphragm cikin mintuna. Aiwatar da matsi mai ƙarfi mai ƙarfi mai ƙarfi akan cizon da sama da kafaɗar gaɓar gaɓoɓi yana rugujewar ƙwayar ƙwayar cuta ta sama kuma yana jinkirta gurɓacewar tsarin har sai kayan aikin iskar asibiti ya zo. Akasin haka, jellyfish nematocysts suna zaune a saman fata, inda rufe bandeji na matsa lamba yana murƙushe capsules marasa harbi kuma yana tilasta ƙarin dafin cikin fata.

Shin akwai maganin kashe-kashe ko maganin kashe kifin tetrodotoxin, cizon dorinar dorinar ruwa mai launin shuɗi, ko gubar kifin mai shanyayye?¶

Babu wani maganin rigakafi na kasuwanci ko sinadarai da aka amince don amfanin ɗan adam akan tetrodotoxin ko saxitoxin. Madadin haka, tabbataccen magani na ceton rai yana nan da nan, samun iska ta wucin gadi ba tare da katsewa ba, yana farawa da baki-zuwa-baki ko jakar-bawul-mask numfashi numfashi a wurin da kuma canzawa zuwa intubation na endotracheal da iskar injin injin a cikin ICU na tsawon sa'o'i 24 zuwa 72 yayin da kodan ta zahiri tace guba mai narkewa mai narkewa a cikin fitsari.

Yaya saurin bayyanar cututtuka ke farawa bayan cin kifin kifin mai guba ko nakasassu, kuma yaushe kuka fita daga haɗari?¶

Tingling da numbness na lebe, harshe, da gumis yawanci suna farawa a cikin minti 5 zuwa 45 na cin gurɓataccen abincin teku (ko cikin minti 5 zuwa 15 na cizon dorinar ruwa mai launin shuɗi). Idan tingling ya fara a cikin ƙasa da mintuna 20, cikakken kama numfashi na iya tasowa cikin mintuna 30 zuwa 90. Idan mutum ya rayu a cikin sa'o'i 24 na farko tare da isassun iskar gas, farfadowa ya kusan cika a cikin kwanaki 1 zuwa 3 masu zuwa ba tare da lahani na dindindin ba.

Me yasa yake da haɗari a ci ganyen tomalley (mustard) kore ko launin ruwan kasa a cikin kaguwa ko lobsters yayin shawarwarin kifi?¶

Crabs da lobsters suna cin ganima a kan kututtukan ciyar da tacewa da kuma mussels a saman teku. Lokacin da bivalves ya ƙunshi saxitoxin daga dinoflagellate blooms, kaguwa yana maida hankali ga saxitoxin a cikin hepatopancreas, gabobin narkewa mai laushi ko launin ruwan kasa wanda aka sani da tomalley ko kaguwa mustard. Yayin da farar kaguwar ƙafar nama yawanci yakan rage cikin guba, cin hepatopancreas na iya sadar da maƙarƙashiya, mai yuwuwar kisa na gubar kifin kifi.

Tushen da jagorar hukuma¶

• Cibiyoyin Kula da Cututtuka da Rigakafin Cututtuka (CDC, Amurka): * Littafin Rawaya na CDC: Guba Abinci daga Toxins na Marine (Tetrodotoxin, Paralytic Shellfish Poisoning / Saxitoxin, Ciguatera, da Scombroid)* da * MMWR Case Rahotanni akan Pufferfish da Saxitoxin Guba*.
• ** Majalisar Resuscitation Majalisar Australiya (ANZCOR, Ostiraliya da New Zealand): *** * Jagoran ANZCOR 9.4.8: Envenomation, Fasahar Rashin Matsi* da * Jagoran 9.4.5: Envenomation, Blue-Ringed Octopus and Cone Shell*.
• Hukumar Lafiya ta Duniya (WHO) da Hukumar Abinci da Aikin Noma (FAO): Marine Biotoxins (Takardar Abinci da Gina Jiki ta FAO 80: Paralytic Shellfish Guba / Saxitoxin da Tetrodotoxin Clinical Management).
• Hukumar Abinci da Magunguna ta Amurka (FDA, Amurka): Littafin Bug mara kyau: Abubuwan da ke haifar da ƙwayoyin cuta da ƙwayoyin cuta na Abinci, Saxitoxin (Maganin Shellfish na Paralytic) da Tetrodotoxin.
• Ma'aikatar Lafiya, Kwadago da Jin Dadin Jama'a (MHLW, Japan): Sharuɗɗan Kula da Lafiya da Lafiyar Jama'a akan Pufferfish (Fugu) Tetrodotoxin Guba da Fukuda-Tani Staging.

Jagora masu alaƙa¶

• Botulism, ciguatera, scombroid, da kuma shellfish neurotoxin guba
• CPR da numfashin ceto ga manya
• Yara da jarirai CPR da shaƙewa
• Guba taimakon farko da sarrafa guba
• Lambobin gaggawa ta ƙasa