Ma hope o ka hoʻomanawanui hou ʻana i ka overdose pilikia, Xylazine Sedation, a me Naloxone Redosing¶

ʻO ka puka makani 14 lā make loa i loko o ke ola o ke kanaka me ka maʻi opioid hiki ke hana ** ma hope koke o ka haʻalele ʻana i kahi ʻāpana detox abstinence-wale nō, kahi keʻena hoʻoponopono hale noho, kahi komo i ka haukapila, a hale paʻahao paha . Hōʻike ka ʻikepili epidemiological mai ka World Health Organization (WHO), ka United States Centers for Disease Control and Prevention (CDC), a me ka UK Office for Health Improvement and Disparities i loko o nā pule mua ʻelua ma hope o ka hoʻokuʻu ʻia ʻana mai ka hale paʻahao a i ʻole detox maʻi maʻi, piʻi ka nui o ka make ʻana o ke kanaka mai ka overdose o ka opioid ulia pōpilikia ** 10-pālua i nā mea hoʻohana i kēlā me kēia lā. ʻOiai e paʻa mau ana ka makemake noʻonoʻo, ʻo 3 a 7 mau lā o ka ʻae ʻana i ka opioid e wehe i ka desensitization receptor biological i loko o ka lolo, e hoʻihoʻi hou i ka hoʻomanawanui ʻana o ka hanu i kahi kanaka naive opioid. Inā loaʻa kēlā kanaka i kahi manawa o ke koʻikoʻi, hoʻi i kā lākou lako kahiko, a lawe i kahi hapa o kā lākou maʻa pre-detox maʻamau, loaʻa koke lākou i ka hopu hanu make.

ʻO ka hoʻopiʻi ʻana i kēia pōʻino ma hope o ka hoʻomanawanui ʻana, ʻo ia kahi lako lāʻau lapaʻau ʻole i hoʻoponopono ʻia i hoʻomāhuahua ʻia me ** fentanyl i hana hewa ʻole ʻia**, ultra-potent benzimidazole opioids (nitazenes), nā mea hoʻomaha lāʻau alpha-2 adrenergic sedatives (xylazine / "tranq" a me medetomidine), a me nā benzodiazelams designer (). I ka hui ʻana o ka fentanyl-a-xylazine overdose, ʻo ka poʻe e kū ana e pīpī i ʻekolu a ʻehā paha pahu o Naloxone (Narcan) me ka wikiwiki e kali ana i ke kanaka e noho i luna a kamaʻilio e hana i kahi hewa koʻikoʻi: no ka mea, hoʻohuli wale ka naloxone i ka mea opioid a ʻaʻole hiki ke hoʻohuli i ka xylazine sedation. ʻO ka lolo, ʻo ia ka ** hanu hoʻopakele mau (1 hanu i kēlā me kēia 5 kekona) i hui pū ʻia me ka naloxone 2-a-3-minuke e hoʻihoʻi hou ʻia no ka ** hoʻihoʻi hanu **.

E hana i kēia i kēia manawa¶

1. E nānā mua i ka hanu a me ka pane ʻana, a laila e kelepona koke i kāu helu pilikia kūloko. E lulu i nā poʻohiwi o ke kanaka me ka paʻa, e hamo i kou mau puʻupuʻu me ka wikiwiki ma waena o kona iwi umauma (sternum rub), a nānā i ko lākou umauma no 5 kekona. Inā ʻaʻole lākou i pane, ʻaʻole hanu, a i ʻole ke kani ʻana i nā leo lohi, ʻūhā, snoring, a i ʻole gurgling ("death rattle", emi iho ma mua o 8 hanu i kēlā me kēia minuke) me nā lehelehe uliuli, poni, a hina-hina a me nā manamana lima, e kelepona i 911 ma ʻAmelika Hui Pū ʻIa a me Kanada, 112 ma waena o ka European Union, 999 ma United Kingdom, a i ʻole e nānā helu pilikia papa kuhikuhi.
2. E hoʻokomo i ka 1 dosis o ka Naloxone (4 mg Narcan nasal spray a i ʻole 0.4 mg intramuscular injection) i kēia manawa. E hoʻokomo piha i ka nozzle o ka naloxone nasal spray i loko o ka puka ihu hoʻokahi a kaomi paʻa i ka plunger me kou manamana lima. Mai hoʻāʻo mua i ka mea hana i ka lewa, no ka mea, paʻa i kēlā me kēia pūʻulu hoʻokahi wale nō.
3. E hoʻomaka i ka hanu hoʻopakele koke (1 hanu i kēlā me kēia 5 a 6 kekona) a mai kū i ke kali ʻana i ka hana ʻana o ka naloxone. E hoʻi i ke poʻo o ke kanaka i hope, e hoʻokiʻekiʻe i ko lākou ʻauwae e wehe i ke ala ea, e kuʻi i ka puka ihu a pani, e hoʻopaʻa i kou waha ma luna o lākou (e hoʻohana i ka pale hoʻopakele pocket a i ʻole ka pale pale pale inā loaʻa), a hāʻawi i **2 e nānā i ka hanu 6 e ala aʻe i kēlā me kēia manawa, 2 nānā i ka hanu 6 e ala aʻe ** kekona (10 a 12 hanu no ka minuke). Inā ʻaʻohe puʻupuʻu, e hoʻomaka i ka CPR piha (30 pahu hoʻopaʻa i 2 hanu hoʻopakele; e ʻike i kā mākou ka nui o ka opioid a CPR alakaʻi).
4. E nānā i ka hanu ʻana ma ka hōʻailona 2-a-3-minuke: inā ʻaʻole i hanu maʻamau ke kanaka (e emi iho ma mua o 10 hanu/minuke), hāʻawi i ka lua o ka Naloxone ma ka puka ihu ʻē aʻe. E hoʻomau i ka hanu hoʻopakele ma waena o kēlā me kēia maʻa.
5. E ho'ōki i ka hāʻawi ʻana i ka Naloxone hou i ka manawa e hoʻomaka ai ke kanaka e hanu pono iā ia iho (10+ hanu/minuke), ʻoiai inā ʻaʻole ʻo ia i ʻike mai Xylazine ("tranq"). Inā loaʻa ka lāʻau lapaʻau i ka xylazine, medetomidine, a i ʻole bromazolam ma ka ʻaoʻao o ka fentanyl, ** e noho nui ke kanaka ma hope o ka hoʻomaha ʻana o ka hanu o ka hanu a me ka hiamoe ʻana** Inā piʻi a hāʻule mau ko lākou umauma he 10 a 16 mau manawa i kēlā me kēia minuke a ʻulaʻula ka waihoʻoluʻu o ko lākou lehelehe, mai hoʻomau i ka hoʻomoʻa ʻana i nā pahu hou o Narcan i loko o ko lākou ihu, ka mea e hoʻoulu ai i ka luaʻi a me ka edema pulmonary. E ʻōwili iā lākou ma ko lākou ʻaoʻao i loko o ka Recovery Position a mālama i ko lākou hanu ʻana a hiki i nā paramedics.
6. E kiaʻi no ka lohi ʻana i ka "Renarcotization" (e hāʻule hou i ka overdose) no ka liʻiliʻi o 3 a 4 mau hola. Pau ka Naloxone i 30 a 90 mau minuke, ʻoiai ʻo fentanyl, nitazenes, a i ʻole methadone kiʻekiʻe e noho i ke kino no 4 a 12+ hola. Mai waiho wale i kahi kanaka i ola hou e "moe."

ʻO ka lāʻau hoʻoholo: ka hoʻohuli ʻana i kahi polysubstance hou (Fentanyl + Xylazine / Nitazene) Overdose¶

E hoʻohana i kēia papa kuhikuhi holoʻokoʻa hoʻopakele lapaʻau i ka wā e pane aku ai i kahi kanaka pane ʻole i ka wā e komo ai nā opioid synthetic a i ʻole "tranq dope" (fentanyl + xylazine).

flowchart TD
    A["ʻAʻole i pane ʻole + lohi, ʻūhā, ʻūhū, a i ʻole ka hanu ʻana (<8 hanu/min)"] --> B["E kāhea iā 911 / 112 / 999 koke + e hoʻoponopono i ka 1st Naloxone Dose (4 mg Nasal Spray i ka Nostril 1)"]
    B --> C["E hoʻomaka koke i ka hanu hoʻopakele: E hoʻokuʻu i ke poʻo, e hoʻokiʻekiʻe i ka ʻauwae, e kuʻi i ka ihu, e hāʻawi i 1 hanu i kēlā me kēia 5 kekona"]
    C --> D{"E kali i 2 a 3 mau minuke i ka hāʻawi ʻana i nā hanu hoʻopakele: ke hanu nei ke kanaka iā ia iho i kēia manawa (>=10 hanu/min)?"}
    D -->|"ʻAʻole: ʻAʻole hanu a ʻūhā paha (<8 hanu/min)"| E["Hāʻawi i ka 2nd Naloxone Dose (ma ka Nostril 2) + E hoʻomau i ka hoʻopakele ʻana i ka hanu (1 hanu i kēlā me kēia 5 kekona)"]
    E --> F{"E kali hou i 2 a 3 mau minuke: Ua hoʻihoʻi ʻia ka hanu?"}
    F -->|"ʻAʻole (Fentanyl, Carfentanil, a i ʻole Nitazene i manaʻo ʻia)"| G["Hoʻoponopono i ka 3rd/4th Naloxone Dose i kēlā me kēia 2-3 mins + Uninterrupted Rescue Breathing / CPR a hiki i ka EMS."]
    D -->|"ʻAe: ʻO ka hanu mau ʻana (10-16 mau hanu/min) a ʻulaʻula nā lehelehe, AKA ʻaʻole naʻe ka ʻike a hiamoe ke kanaka."| H["XYLAZINE / BENZO CO-EXPOSURE MANAʻO: STOP ka hāʻawi ʻana i ka Naloxone hou; e ʻōwili i ke kūlana hoʻihoʻi a wehe i ke alaloa"]
    F -->|"ʻAe: Hoʻihoʻi hou ka hanu"| H
    H --> I["Noho me ka hoʻomanawanui no 3 a 4+ hola; E kiaʻi no Renarcotization i ka wā e pau ai ʻo Naloxone i ka Minute 30 a 90"]

Māhele 1: ʻO ka Neurobiology of Post-Tolence Relapse (No ke aha 5 mau lā o ka hōʻole ʻana i ka hoʻomanawanui)¶

Pīhoihoi pinepine nā ʻohana a me nā poʻe e ola ana i ka ʻike ʻana ʻo ** ʻo ka puka ʻana mai kahi detox 7 lā a i ʻole he 28-lā hoʻomaha hoʻomaha me ka mālama ʻole ʻana i ka lāʻau lapaʻau kekahi o nā manawa kiʻekiʻe loa no ka make hikiwawe**. Ma ka hoʻomaopopo ʻana i ka hana ʻana o mu-opioid receptor (\(\mu\)-OR) desensitization e wehewehe i ke kumu:

1. Pehea e kūkulu ai ka hoʻomanawanui maʻamau: I loko o kahi mea hoʻohana opioid ikaika i kēlā me kēia lā, hoʻopiha mau ʻia nā kikowaena hanu o ka lolo (ʻo ka pre-Bötzinger complex, ka mea e hoʻomalu ai i ka nui o ka hanu ʻana a pane i ka piʻi ʻana o ke kalapona kalapona i ke koko \(\text{CO}_2\)) e hoʻopiha mau ʻia me nā opioids. No ka pale ʻana i ke kanaka mai ka hoʻōki ʻana i ka hanu ʻana, hoʻomoʻo kemika nā neurons i kā lākou mu-opioid receptors, e koi ana i 10 a 50 mau manawa ʻoi aku ka opioid e hoʻopiʻi i ka hanu ma mua o ka mea hoʻohana mua.
2. ** Pehea ka wikiwiki o ka hoʻomanawanui ʻana o ka hanu:** ʻAʻole like me ka hoʻomanawanui ʻana i nā hopena euphoric o ka opioids (e mau ana ka puʻupuʻu no nā mahina), ** hoʻololi koke ka hoʻomanawanui ʻana i ke kaumaha o ka hanu i hoʻokomo ʻia i ka opioid i loko o 3 a 7 mau lā o ka haʻalele ʻana**.
3. Ka Pahele Post-Detox: Ke hoʻopau ke kanaka i ka detox 5 lā, noho i ka haukapila no hoʻokahi pule me kahi maʻi, a i ʻole he 10 mau lā i loko o ka hale paʻahao kalana me ka ʻole o Buprenorphine (Suboxone) a i ʻole Methadone, ʻo ko lākou lolo e hoʻihoʻi hou i ko lākou mau manaʻo.limbic dopamine mismatch) aia ma kahi kiʻekiʻe o nā manawa a pau.
4. ** ʻO ka "Familiar Environment" Conditioned Tolerance Loss:** ʻOi aku ka maikaʻi loa, hōʻike nā haʻawina neuropharmacology Pavlovian i ka wā e hoʻohana ai ke kanaka i ka opioids i kahi **hou, ʻike ʻole ʻia ** (e like me ka lumi hōkele, kahi lumi hoʻokele kino, a i ʻole ke keʻena o kahi hoaaloha) ma mua o ko lākou lumi maʻamau, ʻaʻole e hoʻomaka ko lākou lolo i kāna anticipatory homeostatic.

Pehea e pale ai ka lāʻau lapaʻau no ka hoʻohana ʻana i ka Opioid Disorder (MOUD) i ka make hou ʻana¶

ʻO kēia nalowale wikiwiki o ka hoʻomanawanui ʻo ia ke kumu kūpono e aʻo ikaika ai ka World Health Organization (WHO), ka National Institute on Drug Abuse (NIDA), a me ka American Society of Addiction Medicine (ASAM) e kūʻē i ka detoxification me ka hoʻomau ʻole ʻana ** Medication for Opioid Use Disorder (MOUD)**:

• Buprenorphine (Suboxone, Sublocade, Brixadi) a me Methadone mālama i ka mu-opioid receptors a mālama i ke kiʻekiʻe respiratory tolerance 24 hola o ka lā.
• No ka mea, he kiʻekiʻe loa ka pilina paʻa o ka buprenorphine no ka mea hoʻopaʻa mu-opioid, inā he manawa nāwaliwali ka mea maʻi e lawe ana i ka Suboxone i kēlā me kēia lā (a i ʻole ka Sublocade injection) a paʻa hoʻokahi manawa, ** ua hoʻopaʻa ʻia ka buprenorphine i ko lākou lolo i ka hoʻopaʻa kino ʻana i ka hapa nui o ke alanui fentanyl mai ka hoʻopaʻa ʻana**, e pale ana i ka nui o ka hoʻohana ʻana i ka make.
• ʻO ka mea ʻē aʻe, inā koho ka mea maʻi i ka blocker non-opioid Extended-Release Naltrexone (Vivitrol), mālama ʻia lākou i ka wā e hoʻoikaika ai ka pana 28-lā, ** akā pono e ʻōlelo ʻia inā e haʻalele lākou i kā lākou pana ʻana i kēlā me kēia mahina, ʻaʻole kā lākou ʻae opioid **.

Mahele 2: Xylazine ("Tranq"), Medetomidine, a me Nitazenes ma ke alanui¶

I nā makahiki i hala iho nei, ua hoʻololi ka lako lāʻau lapaʻau ma ʻAmelika ʻĀkau a me nā ʻāpana o ʻEulopa mai ka heroin maʻemaʻe a i ʻole fentanyl i ka paʻakikī ** polysubstance mixtures ** e hoʻololi i ke ʻano o ka overdose a pane i ke kōkua mua.

Papa Hoʻohālikelike: ʻO ka poʻe moekolohe alanui a me ke ʻano o ko lākou hoʻololi ʻana i ke kōkua mua overdose¶

Pehea e mālama ai iā Xylazine ("Tranq") i nā ʻeha ʻili necrotic¶

ʻAʻole like me nā abscesses maʻamau maʻamau maʻamau (e loaʻa wale ma kahi kikoʻī kahi i hou ʻia ai ka nila unsterile i ka ʻili), ** ʻo ka xylazine ke kumu o ka vasoconstriction peripheral koʻikoʻi**, ka hoʻopaʻa ʻana i nā kīʻaha koko liʻiliʻi liʻiliʻi ma ka ʻili a me ka ʻiʻo pōloli o ka oxygen, e hoʻopiʻi ai i ka punch-out, poni-a-ʻeleʻele necrotic eschar ulcers ma ka poʻe, nā lima a me nā lāʻau lapaʻau wale nō.

• Mai holoi i nā ʻeha o ka xylazine me ka hydrogen peroxide, ka waiʻona, a i ʻole ka bleach, ka mea e pepehi ai i ka ʻiʻo granulation palupalu hou e hoʻāʻo nei e hoʻōla i ka maʻi maʻi.
• E holoi mālie i hoʻokahi lā i kēlā me kēia lā me ka wai ʻoluʻolu maʻemaʻe a me ka kopa maʻemaʻe a i ʻole ka paʻakai sterile, e hoʻopili i kahi papa mānoanoa o ka ** ʻaila ʻaila lāʻau lapaʻau, Xeroform petrolatum gauze, a i ʻole ka petroleum jelly keʻokeʻo keʻokeʻo (Vaseline)** e hoʻomaʻamaʻa i ka moena ʻeha, a uhi ʻia me kahi pā sterile non-stick (Telfa) a me ka wahī kāwele wehe.
• E ʻimi i ka lāʻau lapaʻau koʻikoʻi inā ʻike koke ʻia ka ʻulaʻula i waho o ka ʻeha, piʻi ka ʻulaʻula i ka lālā, ulu ke kuni, a i ʻole ʻike ʻia ka iwi/tendon ma ke kumu o ka ʻeha (pilikia o ka osteomyelitis a me ka sepsis; e ʻike i kā mākou sepsis a me ka ha'alulu ma'i alakaʻi).

Mahele 3: "Ke hanu nei ka pahuhopu, ʻaʻole e ala ana" Naloxone Redosing Protocol¶

I ka wā o ka xylazine a me ka nui o ka naloxone naloxone formulations (e like me 4 mg Narcan, 8 mg Kloxxado, a i ʻole 5 mg Zimhi), ʻo nā keʻena olakino olakino a me nā loea lapaʻau addiction e hoʻoikaika i ka hoʻololi koʻikoʻi i ka hoʻomaʻamaʻa overdose: ** ʻO ka pahuhopu o ka lawelawe ʻana i ka Naloxone ʻo ka hoʻihoʻi ʻana i ka hanu a hiki i ka 10 mau minuke. makaala piha.**

No ke aha e hoʻopilikia ai ka hoʻohana nui ʻana i ka Naloxone¶

I ka wā e ʻike ai ka mea kū i ka ʻike ʻole ʻia mai "tranq dope" (fentanyl + xylazine) a hoʻolei i ʻehā mau pahu Narcan 4-miligram (16 mg ka nui) i loko o ko lākou ihu i loko o 60 kekona no ka mea ʻaʻole i wehe ke kanaka i kona mau maka:

1. ** Lawe ʻo Naloxone i 2 a 3 mau minuke e komo i loko o ka mucosa ihu a hele i ka pale koko-lolo.** ʻO ka pīpī ʻana i ka lua a i ʻole ke kolu ma hope o 30 kekona wale nō e pau ai ka lāʻau ma mua o ka hiki ʻana o ka lāʻau mua i ka lolo.
2. I ka wā i hoʻokuʻu ʻia ai ka fentanyl mai nā mea e loaʻa ai ka lolo (maʻa mau ma hope o 1 a i ʻole 2 mau puʻupuʻu), hoʻomaka ke kanaka e hanu hou, akā ʻaʻole ʻike ʻia mai ka xylazine.
3. Inā hoʻomau ʻoe i ka pīpī ʻana i 3, 4, a i ʻole 5 mau kau hou o ka naloxone i loko o kahi mea hanu i hoʻopaʻa ʻia e ka xylazine, e ʻoki ʻoe i ka 100 pakeneka o nā opioid hope mai kēlā me kēia mea hoʻokipa i loko o ko lākou kino, e hoʻoulu ai i ka violent Precipitated Opioid Withdrawal:
   • ʻO ka luaʻi a me ka maʻi maʻi hikiwawe ** ʻoiai ʻaʻole ʻike ʻia ke kanaka mai ka xylazine**, e hoʻoheheʻe ai i ka luaʻi i loko o ko lākou mau akemāmā a ʻehaʻeha**.
   • Ke piʻi nui nei ka catecholamine (adrenaline) hiki ke hoʻoulu i ka naloxone-induced non-cardiogenic pulmonary edema (wai hoʻopiha i nā māmā) a me nā arrhythmia naʻau.
   • ʻO ka ʻeha nui o ke kino a me ka haʻalulu e hoʻoheheʻe ai ke kanaka mai kahi hanana a ** hoʻohana koke i kahi ʻano nui o ke alanui fentanyl 20 mau minuke ma hope e hoʻopau ai i ka maʻi**, e hoʻoulu ai i ka lua o ka make i ka wā e pau ai ka naloxone.

He aha ka hana inā he "Wooden Chest Syndrome" ke kanaka (Fentanyl Chest Wall Rigidity)¶

Ke hoʻokomo a hoʻomake paha kekahi i kahi bolus kiʻekiʻe o ka fentanyl synthetic a i ʻole nitazenes, hiki iā ia ke hoʻoulu i kekahi manawa Fentanyl-Induced Chest Wall Rigidity ("Wooden Chest Syndrome") i loko o 60 kekona: - ʻO nā kaula leo o ke kanaka (glottis) a me nā ʻiʻo intercostal rib/diaphragm ua paʻa paʻa e like me ka papa. - Ke hoʻi ʻoe i ko lākou poʻo i hope a hoʻāʻo e puhi i ka hanu hoʻopakele i loko o ko lākou waha, ** ʻaʻole e komo ka ea a hōʻole ka umauma i luna , ʻoiai ʻaʻohe meaʻai a mea ʻē paha i loko o ko lākou puʻu. - Hana koke: Hoʻoponopono koke i ka Naloxone (Narcan). ʻAʻole like me nā keakea ala ea maʻamau, ʻo Wooden Chest Syndrome kahi maʻi ʻiʻo neurochemical i hoʻoulu ʻia e nā mu-opioid receptors i loko o ka lolo (locus coeruleus) a ** wehe koke ʻia e Naloxone. E ho'āʻo mau i nā hanu hoʻopakele mālie ma ka ʻaoʻao o ka hoʻopaʻa ʻana i ka umauma i ka wā e komo ai ka naloxone ma luna o 90 a 120 kekona; i ka wā e pā ai ka naloxone i ka lolo, hoʻomaha nā kaula leo a me ka paia o ka umauma a holo mālie kou hanu hoʻopakele.

Mahele 4: Pehea e hoʻohana pono ai i ka Fentanyl, Xylazine, a me Nitazene i nā ʻāpana hoʻāʻo.¶

ʻO nā ʻāpana hoʻāʻo immunoassay holo wikiwiki (Fentanyl Test Strips / FTS, Xylazine Test Strips / XTS, a me Benzodiazepine / Nitazene Test Strips) he mau pepa kūʻai kūʻai ʻole e ʻike ai i nā mea moe kolohe make a hiki i nā ʻāpana-per-biliona i loko o 2 mau minuke. Eia nō naʻe, ʻo ka hoʻāʻo ʻana i ka pila a i ʻole ka pauka hewa e hāʻawi i kahi hewa hewa ʻole no nā mea hoʻohana hewa ʻelua: ka "Chocolate Chip Cookie Effect" a me ka Methamphetamine/MDMA Over-Concentration False Positive.

E hahai i kēia 5-Step Laboratory-Verified Drug Checking Protocol (mai ka CDC, DanceSafe, a me Johns Hopkins Bloomberg School of Public Health):

KaʻAnuʻu Hana 1: E lanakila i ka "Chocolate Chip Cookie Effect" (E ho'āʻo i ka Dose holoʻokoʻa)¶

Ke hoʻohui ʻia ka 1 milligrams o ka fentanyl i ka pauka hoʻopiha e kaomi i ka oxycodone hoʻopunipuni ("M30"), Xanax, a i ʻole Adderall pills, ʻaʻole hui like ka fentanyl. Loaʻa paha i ka hapalua o ka pila i kaomi ʻia ʻaʻole fentanyl (ka paila kuki), aʻo kahi kiko liʻiliʻi ma kēlā ʻaoʻao o ka pila like pono i loaʻa kahi wahi wela 2-miligram o ka fentanyl maʻemaʻe (ka puʻupuʻu kokoleka). - Inā ʻoki wale ʻoe i kahi kihi 1-milimita liʻiliʻi mai kahi pila i kaomi ʻia e hoʻāʻo ai, hiki iā ʻoe ke nalo i ka piko pele fentanyl a loaʻa ka hopena palekana hoʻopunipuni. - Hoʻomaʻamaʻa maikaʻi loa: E ʻoki i ka palapala holoʻokoʻa a i ʻole ka pauka holoʻokoʻa āu e manaʻo ai e ʻai i loko o kahi pauka maikaʻi, hui pū ʻia i loko o kahi kīʻaha maʻemaʻe, kīʻaha kī, a i ʻole ʻeke liʻiliʻi liʻiliʻi no laila e puʻunaue ʻia kekahi piko wela ma ka laʻana.

KaʻAnuʻu Hana 2: Hoʻohui i ka nui pololei o ka wai (Critical Dilution Rule)¶

1. Inā ʻoe e hoʻāʻo ana i kahi Opioid Injectable (Hoʻoheheʻe i ka pana holoʻokoʻa i loko o kahi kīʻaha): Ma hope o ka huki ʻana i kāu mea i hoʻoheheʻe ʻia i loko o kāu syringe, e hoʻohui i ka 5 milliliters (1 teaspoon / 1 ampoule wai maʻemaʻe maʻamau) o ka wai maʻemaʻe i loko o ka pahu kuke ʻole e holoi i ke koena i koe, a hoʻāʻo i kēlā wai holoi.
2. Inā ʻoe e hoʻāʻo nei i kahi Pill Crushed a i ʻole Pauda Koena: E hoʻololi ma kahi o 10 milligrams o ka pauka i hui maikaʻi ʻia ( lawa e uhi i ka lauoho ma ke poʻo o ʻAberahama Lincoln ma kahi peni US, a i ʻole ka piko o ke kī hale) i loko o kahi kīʻaha liʻiliʻi:
   • No Heroin, Oxycodone, Xanax, a i ʻole Cocaine: E hoʻohui i 5 milliliters (1 teaspoon) o ka paipa maʻemaʻe a i ʻole ka ʻōmole wai a hoʻoulu ʻia no 15 kekona.
   • ** KA HOʻOPIʻI NO KA NUI: No ka Methamphetamine, MDMA (Ecstasy/Molly), a i ʻole Diphenhydramine: ** Pono ʻoe e hoʻoheheʻe i ka methamphetamine a i ʻole MDMA i loko o 30 milliliters (2 punetēkē / 1 auneke wai / kahi aniani kī piha) o ka wai** no 10 mg o ka kristal/pada. Inā hoʻoheheʻe ʻoe i ka methamphetamine a i ʻole MDMA i loko o nā kulu liʻiliʻi wale nō o ka wai, hiki ke hoʻololi i ka mea hoʻoulu ʻia me ka antibody ma kahi Fentanyl Test Strip a hoʻopuka i ka fase positive (a me nā kiʻekiʻe o ka lidocaine a i ʻole ka diphenhydramine i ʻoki ʻia i nā lāʻau lapaʻau hiki ke hoʻopilikia i nā Xylazine Test Strips inā ʻaʻole i hoʻoheheʻe ʻia i 10 mg).

KaʻAnuʻu Hana 3: Hoʻopaʻa i ka Strip no 15 kekona a kau i ka papahele¶

1. E paʻa ana i ka hope lima kala o ka Fentanyl Test Strip (a me kahi Xylazine Test Strip) ʻokoʻa, e hoʻoluu i ka ʻaoʻao o lalo o ka nalu i loko o ka wai a hiki wale i ka laina hoʻopiha piha no 15 kekona.
2. E kau i ke kaula ma kahi maʻemaʻe a kali ** 2 a 5 mau minuke** ma mua o ka heluhelu ʻana ma lalo o ke kukui maikaʻi.

KaʻAnuʻu Hana 4: E heluhelu pololei i nā Laina (Ke kū'ē i kahi ho'āʻo COVID a i ʻole ka hāpai ʻana)¶

Heluhelu ʻia nā palapala hoʻāʻo lāʻau hoʻokūkū THE EXACT OPPOSITE o kahi hāpai home a i ʻole hoʻāʻo COVID-19:

• KEKAHI laina ʻulaʻula/ʻulaʻula hoʻokahi (Laina Mana Kiʻekiʻe wale nō) = POSITIVE (PIʻO: Fentanyl a i ʻole Xylazine PRESENT). ʻOiai inā ʻaʻohe laina ʻelua, 1 laina = POSITIVE.
• ** ʻElua laina ʻulaʻula/ʻulaʻula (ʻOiai ʻo ka laina hoʻāʻo ma lalo e like me ka hāwanawana) = NEGATIVE ** (ʻAʻole ʻike ʻia ka Fentanyl/Xylazine i kēlā hāpana).
• Nā laina ʻaʻohe (a i ʻole laina lalo wale nō me ka laina ʻole o luna) = INVALID TEST (E hoʻāʻo hou me kahi kāʻei hou).

Mahele 5: Ka mālama ʻana ma hope o ke ola hou ʻana, ka mālama ʻana i ka hoʻihoʻi hou ʻana, a me ka 4-Hour Renarcotization Watch¶

I ka manawa e hoʻomaka hou ai ke kanaka e hanu me ka mālie (10 a 16 mau hanu i kēlā me kēia minuke) ma hope o ka Naloxone a me ka hanu hoʻopakele, ʻaʻole i pau ka pilikia. ʻO kāu mea e hana ai i loko o 60 mau minuke mua ma hope o ke ola hou ʻana e hoʻoholo ai i ke ola ʻana o ke kanaka i ka ʻauinalā a i ʻole ka loaʻa ʻana o ka lua make.

1. Pehea e hooponopono ai i ke kanaka e ala ana i ka hoohuoi ana¶

Inā hāʻawi ʻia nā ʻano nui o Naloxone (a i ʻole inā he fentanyl koʻikoʻi ke kanaka i kēlā me kēia lā), ala lākou me ka ʻole, pulu i ka hou, luaʻi, haʻalulu nui, a koi e haʻalele koke e hoʻohana i nā lāʻau hou e hoʻopau i ka ʻeha:

• E hoʻohaʻahaʻa mālie a wehewehe i ka mea i hana ʻia i loko o 10 kekona: Kū i hope i 1 mika (3 kapuaʻi) i ʻole lākou e ʻike i ke kihi, e ʻōlelo me ka leo mālie, ʻaʻole hoʻohewa, a ʻōlelo: "Ua hoʻōki ʻoe i ka hanu ʻana mai ka overdose a hāʻawi mākou iā Narcan e hoʻopakele i kou ola. 45 mau minuke a e maʻalahi ka maʻi. "
• ** No ke aha ʻoe e noi aku ai iā lākou ʻAʻole e hoʻohana hou i ka fentanyl i kēia manawa: ** E wehewehe pono: * "I kēia manawa, ke hana nei ka Narcan me he pale pale manawaleʻa ma kou lolo. oe."*
• Ke hoʻonoho ʻia no ka Xylazine / Benzodiazepine Co-Sedation: Inā hanu maʻamau ke kanaka (12 hanu i kēlā me kēia minuke) a he mau lehelehe ʻulaʻula / manamana lima, akā e hiamoe nui mai ka xylazine, e ʻōwili iā lākou ma ko lākou ʻaoʻao hema i loko o ka Ke Kūlana Hoʻōla, e hoʻoluli iki i ko lākou ʻauwae i mua, e hoʻomoe iā lākou i ka ʻaoʻao mehana. a hiki i ka lawe ʻana o ka poʻe lapaʻau.

2. Hoʻololi i ka lā hoʻokahi i ka Buprenorphine ma hope o ka hoʻāla hou ʻana o Naloxone¶

Ke hāʻawi nei nā keʻena pilikia o ka haukapila a me EMS "Bridge Clinics" i ka ** Post-Overdose Buprenorphine Induction ** i loko o ke keʻena pilikia ma hope o ka hoʻihoʻi ʻana i ka overdose, a me ** Low-Dose Buprenorphine Micro-Induction (ka Bernese Method) ** no ka poʻe e hoʻohana ana i ka fentanyl alanui e makaʻu nei i ka haʻalele ʻana. - Ma kahi o ka kali ʻana i 36 mau hola i ka ʻeha, hoʻomaka ka Bernese Method me nā micro-doses liʻiliʻi o buprenorphine (0.25 mg to 0.5 mg hoʻokahi a ʻelua paha i ka lā) ʻoiai e hoʻopau ana ka mea maʻi i nā agonists piha, e kūkulu mālie i kahi papa pale o ka buprenorphine ma luna o ka lolo ma luna o 5 a 7 mau lā a hiki i ka piha. 12 mg to 16 mg Loaʻa ka nui o kēlā me kēia lā me ka wehe ʻole ʻana o ka precipitated.

Nīnau pinepine¶

Nānā ʻia nā kumu¶

• Nā Center for Disease Control and Prevention (CDC) and Substance Abuse and Mental Health Services Administration (SAMHSA, United States): Opioid Overdose Prevention Toolkit, alakaʻi hoʻomaʻamaʻa e pili ana i ka fentanyl a me ka xylazine ("tranq") i hana hewa ʻole ʻia, a me ka ʻikepili kahua hoʻohālikelike ma 4 mg vs. 8 mg intranasal naloxone.
• World Health Organization (WHO, International): Community Management of Opioid Overdose (Rescue ventilation protocols, naloxone titration, post-incarceration / post-detox mortality risk, and recovery position care).
• American College of Medical Toxicology (ACMT) a me American Academy of Clinical Toxicology (AACT): Joint Position Statement on Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders (Refuting passive dermal/airborne fentanyl overdose myths).
• **National Institute on Drug Abuse (NIDA / NIH) a me Johns Hopkins Bloomberg School of Public Health: ** Ke hōʻoia ʻana o ke keʻena Laboratory o Fentanyl Test Strips (FTS) a me Xylazine Test Strips (XTS), nā lula dilution e pale aku i ka methamphetamine/MDMA i nā hopena maikaʻi ʻole, a me ka neurobiology o ka hoʻomanawanui ʻana o ka hanu wikiwiki.
• Ke Keʻena no ka Hoʻomaikaʻi ʻana i ke Ola a me nā Disparities (OHID) a me ka National Health Service (NHS, United Kingdom): Nā mākaʻikaʻi palekana hoʻomanawanui no ka potent synthetic benzimidazole opioids (* nitazenes *) a me xylazine hoʻoponopono ʻeha.

Nā alakaʻi pili¶

• Opioid overdose kōkua mua
• CPR
• Ka hoʻohana ʻana i ka lāʻau a me ka hoʻohui ʻana i ka lāʻau: alakaʻi kōkua pilikia
• ʻO ka wehe ʻana i ka waiʻona koʻikoʻi, Delirium Tremens (DTs), a me ka hoʻāʻo detox lāʻau
• Hoʻopau koke i ka benzodiazepine a me ka pilikia o ka hopu ʻana
• Kākoʻo ʻana i kekahi lālā o ka ʻohana me ka addiction
• ʻO Sepsis a me ka haʻalulu septic
• Helu pilikia