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ʻO ka hoʻoulu ʻana i ka hoʻoulu ʻana ('Overamping'): Hyperthermia, ʻeha o ka umauma, a me ka hoʻonāukiuki ʻana.

He ʻokoʻa nā helu ulia pōpilikia ma ka ʻāina. Hoʻohana kēia ʻaoʻao i ka 911, ka helu no ʻAmelika a me Kanada. Nui nā ʻāina ʻē aʻe i hoʻohana i ka 112, 999, a i ʻole ka helu ʻē aʻe. E huli i ka helu no kou ʻāina.

ʻAʻole like me ka opioid overdose, kahi e kunou mālie ai ke kanaka, huli i ka uliuli, a pau ka hanu ʻana, ʻo ka stimulant overdose, i ʻike nui ʻia ma ka hoʻohaʻahaʻa ʻino a me ka lāʻau lapaʻau ma ke ʻano he "overamping", he pilikia ikaika, hyper-metabolic o ka puʻuwai, ka lolo, nā kīʻaha koko, a me ka mahana o ke kino. Ke ʻai kekahi i kahi mea ʻawaʻawa o ka ** methamphetamine, pauka cocaine, crack cocaine, MDMA ("ecstasy" / "molly"), nā lāʻau amphetamine hewa ʻole, a i ʻole nā cathinones synthetic ("paʻakai ʻauʻau" / alpha-PVP / mephedrone) , a i ʻole ua ala no nā lā i ka holo hoʻoikaika ʻana, ** ʻo ko lākou kikowaena a me nā ʻōnaehana ʻano ʻole, serotonin. Piʻi aʻela ka puʻuwai puʻuwai ma mua o 140 a i ka 180 beats i kēlā me kēia minuke, ke piʻi nei ke koko i nā pae e hoʻoulu ai i ka hahau (220/130 mmHg+), pani ʻia nā aʻaʻaʻa coronary i vasospasm aʻe, a hiki ke piʻi koke ka wela o ke kino ma mua o 40.0 a 41.5 degere Celsius (104.0 a 106.7 degere Fahrenheit).

ʻAʻole i mālama ʻia, make ka mea ʻawaʻawa hoʻoikaika nui ma o ʻehā mau ʻano wikiwiki: Malignant hyperthermia (ke kuke ʻana i nā ʻōpū o loko a hoʻoulu i ka hoʻolaha ʻana o ka intravascular coagulation), koonary artery vasospasm a me ka sodium-channel blockade (hoʻokumu i ka myocardial infarction a i ʻole fatal ventricular arrhythmia a i ʻole he 20 mau makahiki o ka maʻi hemorrhoids) epilepticus seizures**, a me ka rhabdomyolysis (ka haʻihaʻi ʻana o ka ʻiʻo iwi iwi nui e hoʻopau ana i nā puʻupaʻa). I ka manawa like, no ka mea, ua hoʻohaumia ʻo ** fentanyl a me nitazenes i ka hapa nui o ka cocaine alanui, māwae, methamphetamine, a me Adderall/MDMA pills , ʻo kēlā me kēia mea hoʻohana i hoʻoulu ʻia e hiamoe koke, liʻiliʻi, a lohi paha i ka hanu pono e loaʻa koke iā ** intranasal naloxone (Narcan). ʻO ka ʻike pehea e hoʻokaʻawale ai i ka overamping psychological mai kahi pilikia olakino weliweli, pehea e hoʻomaʻalili ai i ka mea maʻi hoʻōla wela i nā minuke, a no ke aha ** ʻAʻole pono ʻoe e hoʻopaʻa kino i kahi maʻi hoʻoikaika hoʻohiwahiwa i ka maka i lalo i ko lākou ʻōpū** hoʻopakele ola.

E hana i kēia i kēia manawa

  1. E nānā mua i ka hanu ʻana a me ka pane ʻana: inā ʻaʻole ʻike ka mea hoʻohana i ka mea hoʻohana i ka mea hoʻohana i ka mea hoʻohana i ka hoʻoulu ʻana, ʻaʻohe, ʻūhā, a hanu mālie paha, e hoʻohana i ka Naloxone (Narcan) 4 mg nasal spray a hoʻomaka e hoʻopakele i ka hanu. ʻOiai inā ʻike ʻoe ua manaʻo wale lākou e hoʻohana i kahi mea hoʻouluulu, e hoʻohuli ʻo naloxone i ka fentanyl huna a ** ʻaʻole ia e hōʻeha i kekahi i loaʻa i kahi pilikia hoʻoikaika maʻemaʻe.
  2. E kelepona i kāu helu pilikia kūloko (911 ma US a me Kanada, 112 ma ka EU, 999 ma UK) inā loaʻa iā ia ka hae ʻulaʻula kino: ʻeha ʻeha a i ʻole ke kaomi ʻana, ka ʻili kumu e wela ana, ʻeha, ʻeha ʻeha, ʻeha ʻeha ʻeha, maka hina/lima nāwaliwali, a i ʻole ke kaohi ʻana. E nānā i kā mākou helu pilikia papa kuhikuhi.
  3. Inā e wela ana ka ʻili o ke kanaka, ʻulaʻula, a i ʻole he mea ʻino a wela loa, e hoʻomaka koke i ka hoʻolili ʻana i ka wā e kali ana i ke kaʻa kaʻa. Wehe i nā lole waho keu, e hoʻokomo ** i nā ʻeke hau a i ʻole nā ʻeke o nā lau ʻai maloʻo i uhi ʻia i ka lole lahilahi i loko o nā ʻāʻī, ka ʻāʻī, a me nā ʻaoʻao o ka ʻāʻī**, e hoʻoheheʻe ʻia i ka wai i ka wā e puhi ai i ka ʻili. ʻauʻau ʻauʻau (e mālama i ke poʻo ma luna o ka wai). Ke noho nei ka mahana wela ma luna o 40.5 degere Celsius (105 degere Fahrenheit) ke kumu o ka hoʻihoʻi ʻole ʻia o ka lolo a me ke kino.
  4. ** ʻAʻole e paʻa, pine, hog-tie, a i ʻole e noho ma luna o ke kua a i ʻole ka umauma o ka mea hoʻohana i ka mea hoʻohana i ka mea hoʻohana i ka mea hoʻohana i ka hoʻoulu ʻia ʻana me ka naʻaupō (ke kaohi ʻana).CO2). ʻO ka hoʻopaʻa ʻana iā lākou i lalo e hoʻopaʻa ʻia ko lākou diaphragm, hoʻonui i ke kiʻekiʻe o ka waiʻa koko, a hoʻoulu i ** ka hopu ʻana i ka naʻau make make koke ("restrain asphyxia") i loko o 60 kekona**.
  5. Inā ʻeha ke kanaka i ka ʻeha o ka umauma, ka ʻeha āwae/lima hema, a i ʻole ka wela anu ma hope o ka hoʻohana ʻana i ka cocaine a i ʻole ka meth, e hoʻonoho iā ia me ka ʻoluʻolu e hoʻomaha, e noho mālie loa, a hāʻawi i ka 162 i ka 325 mg o ka Aspirin chewable (koe ke ʻole ka maʻi a i ʻole ka hahau ʻana/ke koko). papa (pono nā kauka maʻi e hōʻalo i kekahi mau beta-blockers e hoʻomāhuahua ana i ka maʻi ʻaʻaʻa coronary).
  6. **Inā ʻoi aku ka maʻalahi o ke kanaka noʻonoʻo "overamp" ( hopohopo, jittery, paranoid, a luhi paha me ka ʻole o ka ʻeha o ka umauma, ʻaʻohe wela nui, a me ka hanu maʻamau), e hoʻoneʻe iā ia i kahi lumi anuanu, pouli, mālie.

Danger

No ke aha o ka paio kino a me ke alo iho i lalo e pepehi ai i na kanaka i loko o ke ko'iko'i ho'oikaika kino. I ka wa ko'iko'i o ka methamphetamine, cocaine, a me ka paakai auau ho'ohihi i ka delirium, ho'opiha 'ia ke koko me ka lactic acid a me ka potassium (pH < 7.0, K+ > 6.5 mEq/L). ʻO ka mea wale nō e paʻa ai ka puʻuwai o ke kanaka, ʻo ia ka hanu wikiwiki a hohonu (Kussmaul-like hyperventilation) e puhi ana i ke kalapona ʻawaka. Inā hākōkō nā hoa, nā kiaʻi, a i ʻole nā ​​mea e kū ana i ke kanaka i ka papahele a kaomi i ko lākou kaumaha ma ke kua a i ʻole ka ʻōpū o ke kanaka, ʻaʻole hiki i ke kanaka ke hyperventilate. Piʻi ka pH koko i nā kekona, kahe ka potassium i ka puʻuwai, a kū ka naʻau i ka asystole a i ʻole pulseless electrical activity (PEA). E hoʻomaʻemaʻe i nā mea pōʻino mai ko lākou ala, e hāʻawi iā lākou i kahi ākea, e hoʻoluʻu i ka lumi, a kali i ka poʻe lapaʻau e lawelawe ** i ka hoʻomaʻamaʻa kino (IM midazolam, lorazepam, a i ʻole ketamine)** ma mua o ka mokomoko kino.

Hoʻoholo wikiwiki: Mild Psychological Overamping vs. Life-Treatening Medical Toxicity

Ma ka hana ho'ēmi pōʻino, uhi ʻia ka huaʻōlelo "overamping" i kahi kikoʻī ākea: mai kahi hōʻeha hōʻoluʻolu, jittery panic ma hope o ka lawe nui ʻana iā Adderall, meth, a i ʻole coke, a hiki i ka hyperthermia make, ka hahau ʻana, a i ʻole ka puʻuwai puʻuwai. E hoʻohana i kēia lāʻau hoʻoholo e hoʻokaʻawale i nā mea hiki ke hoʻomaha ʻia ma ka home mai nā mea e pono ai kahi ICU haukapila i kēia manawa.

flowchart TD
    A["Ke kanaka i ka pilikia ma hope o ka Cocaine, Meth, Crack, MDMA, a i ʻole Pills"] --> B{"ʻAʻole lākou i pane a i ʻole hanu lohi / ʻohu?"}
    B -->|YES: Limp, Blue Lips, Slow Breathing| C["SUSPECT FENTANYL CONTAMINATION: Hāʻawi iā Naloxone 4 mg Spray + Rescue Breaths + Call 911"]
    B -->|NO: Awake, Fast Heartbeat, Sweating, Agitated, or In Pain| D{"ʻO kekahi mau hōʻailona hōʻailona hōʻailona hōʻailona hōʻailona hōʻailona?"}
    D -->|Hot Skin > 39.5C/103F, Chest Pain, Seizure, Stroke Signs, Dark Urine, or Violent Delirium| E["KAHIKI LAPAAU: E kelepona iā 911 / 112 / 999 koke"]
    D -->|NO Physical Red Flags: Jittery, Anxious, Racing Thoughts, Exhausted, Mild Paranoia| F["ʻOi aku ka haʻahaʻa: E hoʻohaʻahaʻa i ka lumi malū, mālie"]
    E --> G["1. Puke hau wikiwiki / hoʻoluʻu hoʻoheheʻe 2. Aspirin Chewable 325 mg inā ʻeha ka ʻeha 3. ʻAʻohe ʻae ʻia."]
    F --> H["1. Nā kukui pohihihi a ho'opau i ke mele 2. Ka wai anuanu / Electrolytes & Snack 3. lole holoi malū 4. kia'i i kēlā me kēia 15 mau minuke"]

Papa Hana Hoʻonaʻauao: ʻOmaomao/Yellow Overamping vs. Red Sympathomimetic Emergency

Pūnaehana ʻOi aku ka maʻalahi a me ka haʻahaʻa (Monitor & De-Escalate in Cool Room) Koʻikoʻi Sympathomimetic Toxicity (KELA 911 / 112 / 999 KOWE)
Ka wela o ke kino a me ka ili ʻO ka ʻili mehana a me ka hou; maʻamau a piʻi iki paha ka mahana (< 38.5C / 101.3F); pane i ka peʻahi a me ka inu ʻoluʻolu ** ʻili wela wela (> 39.5C to 41.5C / 103F to 107F)**, pulu i ka hou a i ʻole maloʻo koke, ʻili ʻili; haalulu hiki ole ke hookiia
Puuwai & Puuwai ʻIke wikiwiki i ka puʻuwai (100 to 130 bpm) e hoʻolohi i ka wā e moe mālie a hanu mālie; ** ʻeha ʻeha ʻole o ka umauma** Ka ʻeha, ʻomi, a i ʻole ka ʻeha o ka umauma e ʻā ana i ka ʻāwae, ka ʻāʻī, ke kua, a i ʻole ka lima hema; ka haehae ʻana i ka ʻeha ma waena o nā ʻūhā poʻohiwi (aortic dissection); puʻuwai puʻuwai > 150 to 180 bpm a i ʻole ka puʻupuʻu kūlike
** Pūnaehana lolo a me nā neʻe ** ʻO nā manaʻo hoʻokūkū, wili niho (bruxism), hyper-vigilance, paranoia haʻahaʻa ("Ke nānā mai nei nā kānaka iaʻu?"), ʻike mau ʻo wai a ma hea lākou. Nā maʻi nui, ʻo ka "hekili" hikiwawe ke poʻo ʻeha loa o ke ola (ka lolo), ka hāʻule ʻana o ka ʻaoʻao a i ʻole ka nāwaliwali o ka lima (ka ʻāʻī), ** ka pau ʻana o ka ʻoiaʻiʻo / hauʻoli i ka delirium**
Nā ʻiʻo a me nā ʻōpū ʻO nā wāwae hoʻomaha ʻole, ka paʻa ʻana o ka iwi āpau, ka luhi i ka hiamoe ʻole Nā ʻiʻo ʻoʻoleʻa koʻikoʻi, hiki ʻole ke kū, a i ʻole ** ʻeleʻele ʻeleʻele / ʻulaʻula / ʻulaʻula mimi** (rhabdomyolysis e luku ana i nā puʻupaʻa)
** Ka hanu a me ka hoʻomaʻemaʻe ʻana ** ʻO ka hanu wikiwiki mai ka hopohopo; makewai a hiki ke inu i ka wai electrolyte Poko o ka hanu, ʻulaʻula frothy sputum ("crack lung" / acute pulmonary edema), a i ʻole ka luaʻi me ka huikau mai MDMA wai ʻona (hyponatremia)

Hoʻopilikia i ke ola 1: ʻO ka Hyperthermia hoʻoikaika kino ʻino ("Kuke Mai loko")

ʻO ka helu ʻekahi kumu o ka make wikiwiki ʻana i ka methamphetamine acute, MDMA ("molly"), a me ka cathinone synthetic ("paʻakai ʻauʻau") ʻoi aku ka nui o ka holo hyperthermia.

1. No ke aha e ho'āla ai ka wela o ke kino i ka 41 degere Celsius (106 degere Fahrenheit)

ʻO nā mea hoʻoikaika i ka manawa like e hoʻohuli i ka umu o loko o ke kino i ka wā e haki ana i kāna radiator:

  • Hana Wela Nui: ʻO ka nui o ka dopamine, serotonin, a me nā norepinephrine e hoʻoulu mau ai i ka hyperactivity muscle skeletal muscle, ka ʻāʻī ʻana o ka iwi āwae, ka haʻalulu, a me ka wehe ʻana o ka mitochondrial (UCP-3), e hoʻoulu ana i ka wela nui o loko (ʻoi loa ma ka lehulehu, nā hale pō wela, nā ʻahaʻaina kauwela, a i ʻole nā ​​keʻena hau maikaʻi ʻole).
  • Hoʻopau ʻia ka wela: I ka manawa like, hoʻāla ka norepinephrine i ka ** alpha-1 adrenergic peripheral vasoconstriction**, paʻa i nā kīʻaha koko i loko o ka ʻili i hiki ʻole i ke koko wela ke hiki i ka ʻili o ka ʻili e maʻalili.
  • ** ʻO ka 40.5C (105F) Multi-Organ Failure Threshold:** Ke ʻoi aku ka mahana o ke kumu ma mua o 40.5 degere Celsius (105 degere Fahrenheit) no ka ʻoi aku ma mua o 20 a i 30 mau minuke, hoʻopau ʻia nā protein cellular, wāwahi ka ʻōpū o ka ʻōpū (ka hoʻolei ʻana i ka endotoxins ʻōpū i loko o ke koko), ka ʻiʻo o ke koko (** ka ʻiʻo o ke koko), ka ʻiʻo o ke koko, ka ʻiʻo o ka ʻiʻo. hele i ka haywire (Disseminated Intravascular Coagulation / DIC), e make ai ke koko mai kēlā me kēia okana.

2. Kaʻina hoʻomaʻamaʻa wikiwiki ma mua o ka halemai

Mai ** ʻaʻole ** e kali i ka poʻe lapaʻau e hoʻomaka i ka hoʻomaha ʻana i kahi mea maʻi hoʻōla wela, a ** ʻaʻole loa e hāʻawi i ka acetaminophen (paracetamol / Tylenol) a i ʻole ibuprofen/aspirin e hoʻohaʻahaʻa i ke kuni hoʻoulu ʻana**. Hoʻohana nā lāʻau antipyretic fever ma ka hypothalamus i ka wā o ka maʻi maʻi maʻi a me ka maʻi maʻi maʻi a hana ** zero ** no ka hyperthermia muscle i hoʻokomo ʻia i ka lāʻau (ʻoi aku ka maikaʻi, ʻoi aku ka maikaʻi o ka acetaminophen i ka hāʻule ʻana o ka ate i ka wā hyperthermia, a me nā NSAID e hōʻeha i ka hōʻino ʻana o ka puʻupaʻa).

  1. Neʻe i ke Kaiapuni ʻoluʻolu loa: E lawe mai i ke kanaka i loko o kahi lumi ʻea a i ʻole ka makani i malu a wehe i nā pālule kaumaha, nā puʻupuʻu, nā pāpale, a me nā kāmaʻa i lalo.
  2. E hoʻopili i nā pūʻolo hau i nā hui ʻana o ke aʻa nui: ʻOpiʻi i nā ʻeke hau, nā ʻeke pahu hau, a i ʻole nā ​​pūʻolo meaʻai maloʻo i loko o kahi kāwele pulu lahilahi a hoʻopaʻa paʻa iā lākou ma ka ** ʻāʻī (carotid arteries), armpits (axillary arteries), a me nā ʻāʻī (femoral arteries)**.
  3. Ka hoʻoheheʻe ʻia-a-ka-peʻa hoʻoheheʻe ʻia (a i ʻole ka Kaʻia ʻana i ka wai anuanu):
    • E kāpīpī i nā wahi nui o ka ʻili ʻole me ka wai anuanu (15 to 20 degrees Celsius / 60 to 68 degrees Fahrenheit) ʻoiai e kuhikuhi ana i ka peʻahi uila ikaika loa (a i ʻole ka pehi ikaika ʻana me ka pahu pahu/kāwele) pololei ma ka ʻili pulu. Hoʻopau ka evaporation i ka wela ʻehiku manawa ʻoi aku ka wikiwiki ma mua o ka ea maloʻo.
    • Inā loaʻa koke kahi ʻauʻau ʻauʻau a ua ala ke kanaka (a i ʻole ʻelua mau mea kōkua ikaika e hiki ke hoʻopaʻa pono i ke poʻo i waho o ka wai), hoʻoinu i ka ʻōpū a me nā lālā i loko o ka wai piʻi anuanu. (E nana Heat stroke vs. wela wela.)

ʻEha Hoʻoweliweli ʻO ke Ola 2: Cocaine a me Methamphetamine ʻeha ʻeha (Ka Puʻuwai & Vasospasm)

Hoʻomaka ka cocaine a me ka methamphetamine i ka myocardial infarction (heart attack), aortic dissection, a me ka hopu puʻuwai koke ʻoiai i nā mea hoʻohana 19-a-35-makahiki i loaʻa ʻole ka cholesterol plaque i loko o ko lākou mau aʻa.

1. ʻO ka paʻi ʻekolu o ka naʻau o ka cocaine (a me Cocaethylene me ka waiʻona)

  • Koronary Artery Vasospasm + Surging Oxygen Demand: ʻO ka cocaine a me ka meth ka mea e paʻa ai ka ʻiʻo o ka naʻau a ʻoi aku ka wikiwiki i ka manawa like ** e pani ana i nā aʻaʻa coronary **, e pōloli ana i ka puʻuwai o ka oxygen.
  • Direct Sodium-Channel Blockade (Only Cocaine): ʻO ka cocaine kahi mea hoʻomaʻi maʻi kūloko ("caine") e ālai pono i ** ka sodium wikiwiki puʻuwai (Na+) nā ala**, hoʻomāhuahua i ka uila o ka puʻuwai QRS paʻakikī a hoʻoulu ʻia ** ventricular tachycardia a i ʻole ventricular fibrillation** (a nā kauka o ka haukapila e mālama ai me intravenous sodium bicarbonate).
  • Hoʻopiʻi ʻia ke koko i hoʻolalelale ʻia: Hoʻolaʻa nā mea hoʻoikaika i nā platelets, e hoʻoulu koke i ke koko i loko o ke aʻa coronary spasming.
  • Ka Cocaethylene Multiplier (Cocaine + Alcohol): Ke inu kekahi i ka waiʻona me ka hoʻohana ʻana i ka pauda a i ʻole ka cocaine māwae, e hoʻololi ke ake o ke kanaka i nā lāʻau ʻelua i loko o ke kolu, pūhui psychoactive ʻokoʻa i kapa ʻia ʻo cocaethylene. Loaʻa i ka cocaethylene ka hapalua o ke ola o ka plasma 3 a 5 mau manawa ʻoi aku ka lōʻihi ma mua o ka cocaine wale nō a hoʻonui i ka pilikia o ka make maʻi puʻuwai koke e 18 a i 25-fold.

2. He kōkua mua no ka ʻeha ʻeha o ka umauma (a me ka ʻōlelo aʻo a ka Halemai Beta-Blocker)

  1. Kahea koke iā 911 / 112 / 999 no ka ʻeha ʻana, kaumaha, wela, a ʻeha paha ka ʻeha o ka umauma, pōkole o ka hanu, ka hou anu, a i ʻole ka ʻeha e pā ana i ke kua, ka ʻāʻī, ka ʻāʻī, a i ʻole ka lima.
  2. E hoʻoikaika i ka hoʻomaha kino a me ka mālie: E hoʻonoho i ke kanaka ma kahi kūlana hoʻomaha ʻoluʻolu (45 degrees) me nā kuli e kukuli. ʻO kēlā me kēia ʻanuʻu e hele ai lākou e hoʻonui i nā catecholamine a me ka koi o ka myocardial oxygen.
  3. E hāʻawi i ka 162 i ka 325 mg o Non-Enteric Chewable Aspirin: Inā ʻaʻole i loaʻa i ke kanaka ka maʻi maʻi aspirin ʻoiaʻiʻo a i ʻole hōʻike i nā hōʻailona o ke koko o ka lolo/ka maʻi a i ʻole ka ʻeha hope (aortic dissection), e noi iā lākou ** e nau a ale i hoʻokahi kanaka makua 325 mg aspirin (a i ʻole ʻelua a ʻehā 81 mg pēpē pēpē i loko o ka platelet aspirin)** (E nana ʻO ke kōkua mua o ka puʻuwai.)
  4. ** E haʻi koke i nā Paramedics a me nā Kauka ER ua hoʻohana ʻia ka Cocaine a i ʻole Meth:**
    • I loko o kahi hō'eha pu'uwai ma'amau, hā'awi mau nā kauka pilikia i nā beta-blockers (e like me metoprolol a propranolol).
    • ** I loko o kahi cocaine a i ʻole methamphetamine overdose, hāʻawi i kahi beta-blocker maʻemaʻe (beta-1 / beta-2 blockade) hiki ke hoʻoulu i ka "hōʻeuʻeu alpha-adrenergic ʻole,"** kahi e hoʻopaʻa ʻia ai nā mea loaʻa beta e haʻalele i nā mea loaʻa alpha ākea ākea, e hoʻopaʻa paʻa ʻia nā aʻa coronary a paʻa loa ke kahe koko.
    • Ke haʻi ʻoe i ke kauka ER me ka ʻoiaʻiʻo aia ka cocaine a i ʻole ka meth ma luna o ka moku, mālama lākou i ka ʻeha o ka umauma me ka hoʻohana ʻana i ** benzodiazepines intravenous (lorazepam a i ʻole diazepam)** e hoʻomaha ai i ke kikowaena sympathetic drive, sublingual a i ʻole IV nitroglycerin, a me ** nā mea pale kaila-channel (diltiazem/verapamil)** a i ʻole **phentolamine.

Hoʻopilikia i ke ola 3: MDMA ("Molly" / "Ecstasy") ʻO ka ʻona wai vs. Dehydration

MDMA (3,4-methylenedioxymethamphetamine) ke lawe nei i kahi pōʻino hydration lua ʻokoʻa i pepehi i ka ʻahaʻaina ʻōpio a me ka poʻe i hele mai i ka hui i hoʻāʻo e "hana i ka mea kūpono" ma ke kaomi ʻana i nā galani wai maʻemaʻe.

+-------------------------------------------------------------------------+
|       THE MDMA ("MOLLY") HYDRATION RULE: ELECTROLYTES, NEVER GALLONS    |
|                                                                         |
|  WHY PLAIN WATER CAN KILL ON MDMA:                                      |
|  MDMA stimulates the brain to release huge amounts of Antidiuretic      |
|  Hormone (ADH / Vasopressin), causing SIADH: your kidneys are           |
|  chemically LOCKED and CANNOT produce urine to excrete excess water.    |
|                                                                         |
|  If a dancing or overheating MDMA user chugs 3 to 5 liters of plain     |
|  tap or bottled water in 2 hours, blood sodium (Na+) plummets below     |
|  120 mEq/L (Acute Dilutional Hyponatremia). Water rushes into brain     |
|  cells, causing fatal CEREBRAL EDEMA (brain swelling, vomiting,         |
|  seizures, brain herniation, and death), disproportionately affecting   |
|  young women due to estrogen's effect on the brain sodium pump.         |
|                                                                         |
|  SAFE MDMA FLUID RULE:                                                  |
|  1. Drink ONLY isotonic ELECTROLYTE solutions (sports drinks, ORS       |
|     packets, or salty broth), NEVER large volumes of plain water.       |
|  2. Limit intake to roughly 250 to 500 mL (1 to 2 cups) per hour        |
|     while dancing or sweating, and 250 mL/hour when resting.            |
|  3. If someone on MDMA starts vomiting, has a headache, seems confused, |
|     or has not urinated despite drinking, STOP ALL FLUIDS and call 911  |
|     for emergency hypertonic saline (3% NaCl) treatment.                |
+-------------------------------------------------------------------------+

Hoʻopilikia i ke ola 4: ʻO ka hoʻoulu ʻana i ka maʻi maʻi, Subarachnoid Hemorrhage, a me nā hopu ʻana.

No ka mea, ʻo ka methamphetamine, cocaine, crack, a me nā cathinones synthetic ke kumu i ka piʻi koke ʻana o ke kahe koko.200/120 to 260/150 mmHg) ma ka ʻaoʻao o ka ʻōpū koko a me ka puʻupuʻu platelet, ʻo ka maʻi ischemic acute a me ka hemorrhagic brain bleeds (intracerebral hemorrhage or ruptured cerebral aneurysm) he mau pilikia pōʻino pinepine o ka hoʻoulu ʻana i ka hoʻoulu ʻana, ʻoiai i ka poʻe i ka iwakālua a me kanakolu.

1. Ka ʻike ʻana i ka lolo a i ʻole ka hahau ʻana i ka lolo (BE-FAST)

Mai hoʻokuʻu i kahi poʻo poʻo koʻikoʻi, hina, a i ʻole ka haʻi ʻōlelo ʻino i ka wā o ka holo hoʻoikaika ʻana ma ke ʻano he "kiʻekiʻe wale" a nele paha i ka hiamoe:

  • ** ʻO ka ʻeha poʻo "Thunderclap" (Ruptured Aneurysm / Subarachnoid Hemorrhage):** Inā hopu koke ke kanaka nāna i puhi i ka poʻo, honi ka cocaine, a hoʻohana paha i ka methamphetamine i ko lākou poʻo a uē me ka ** ʻoi loa, ʻoi loa ka pahū o ke poʻo o ko lākou ola** (hiki i ka ʻeha nui loa i loko o 60 kekona), e hoʻoikaika i ka ʻāʻī i loko o 60 kekona. māmā, a hāʻule paha, ua haki paha kahi ipu koko ma ke kumu o ka lolo ma lalo o ke kahe koko catecholamine.
  • BE-FAST Nā Hae ʻulaʻula o ka maʻi neʻe:
    • B (Balance): Nalo hikiwawe ke kaulike, poniuniu, a hiki ole ke hele pololei.
    • E (Eyes): Pohaʻo koke, pālua, a nalowale ʻike ma hoʻokahi a ʻelua mau maka.
    • F (Face): Ke hāʻule nei kekahi ʻaoʻao o ka maka i ka wā i noi ʻia e ʻakaʻaka.
    • A (Arms): Hoʻokahi lima a wāwae paha i lalo a nāwaliwali paha i ka wā e paʻa ai.
    • S (Haʻiʻōlelo): Haʻiʻōlelo ʻāhuehue, huaʻōlelo ʻino, a i ʻole hiki ke hoʻomaopopo i nā huaʻōlelo maʻalahi.
    • T (Manawa): Kāhea 911 / 112 / 999 a mai hāʻawi i ka aspirin inā loaʻa ke poʻo o ka hekili a i ʻole ka lolo i manaʻo ʻia he koko (ʻoi aku ka ikaika o ka aspirin i ke koko intracranial).

2. Ka mālama ʻana i kahi hopu i hoʻoulu ʻia i ka wā e kali ana i ka paramedics

Hoʻohaʻahaʻa pololei nā mea hoʻoikaika i ka paepae hopu o ka lolo ma o nā hopena sodium-channel (cocaine), cerebral vasospasm, hyperthermia, a me hyponatremia (MDMA). ʻAʻole e like me ka epileptic seizure maʻamau e hoʻopau iā ia iho ma hope o 60 kekona, ke piʻi pinepine nei ka hopu ʻana i ka lāʻau i ke kūlana epilepticus mau ke ʻole e mālama ʻia me nā benzodiazepine intravenous a intramuscular (midazolam, lorazepam, a i ʻole diazepam):

  1. E hoʻomaʻemaʻe i ka papahele a e hoʻomoe i ke poʻo: E hoʻomāmā i ke kanaka ma luna o ka papahele, e hoʻoheheʻe i kahi ʻaʻahu peʻe a i ʻole ka uluna ma lalo o ko lākou poʻo, a hoʻolei i nā papaʻaina kope, nā mea wela, a me nā mea aniani mai ka hiki ʻole.
  2. E kau i nā pūʻulu hau ma ka ʻāʻī, nā ʻāʻī, a me ka ʻāʻī: Hoʻopuka ka mea maʻi hoʻouluulu ʻino i ka wela o ka ʻiʻo nui e hiki ai ke hoʻokuʻu i ka wela ma mua o 41 degere Celsius (106 degere Fahrenheit) i nā minuke; e hoʻomaka e hoʻoluʻu koke i ka ʻāʻī a me ka ʻāʻī i ka wā e hopu ana.
  3. Mai hoʻokomo i kekahi mea i loko o ko lākou waha a ʻaʻole hoʻi e hoʻopaʻa i ko lākou mau lālā ʻāʻī: ʻO ka hoʻoikaika ʻana i nā puna, nā ʻeke, a i ʻole nā manamana lima ma waena o nā niho paʻa e haki ai nā niho a paʻa i ke alaloa, a ʻo ka pine ʻana i nā lālā convulsing e haʻi i nā iwi a hoʻonui i ka haki ʻana o ka ʻiʻo (rhabdomyolysis).
  4. E ʻōwili i loko o ka Side-Lying Recovery Position i ka manawa e pau ai ka haʻi ʻana: E hoʻomaʻemaʻe i ke kohu a i ʻole ka luaʻi mai ka waha ma ka ʻōwili ʻana iā lākou ma ko lākou ʻaoʻao hema me ka ʻauwae i hili iki i luna i hiki iā lākou ke hanu a hiki i ka hōʻea ʻana mai o nā mea lapaʻau.

Hoʻohana mua ʻia ka hoʻohaʻahaʻa ʻino a me ka palekana o Mid-Binge: Kāohi i ka overamping a me ka Fentanyl Poisoning

No nā poʻe e hoʻohana nei i nā mea hoʻoulu a i ʻole nā ​​ʻohana o ka ʻohana e kākoʻo ana i kekahi i ka pilikia, ʻo nā hana hōʻike hōʻike hōʻemi hōʻemi e hōʻemi nui i ka hopena o ka overdose make:

ʻanuʻu hōʻemi ʻino No ke aha ia e hoopakele ai i na ola Kaʻina hana pololei
E ho'āʻo i kēlā me kēia pauka a i ʻole Pill me kahi Fentanyl Test Strip (FTS) me ka hoʻohana ʻana i ka dilution pololei ʻO ka hoʻohaumia ʻana o ka pauka cocaine, meth, a me nā lāʻau paʻi me ka fentanyl ke kumu nui o ka make ma waena o nā mea hoʻohana non-opioid. E hoʻoheheʻe 10 mg o ke koena i ** ma ka liʻiliʻi loa 5 mL (1 teaspoon) o ka wai no ka cocaine** a i ʻole ** 30 a i 50 mL (2 punetēpē / 1 kīʻaha kī) o ka wai no ka methamphetamine a i ʻole MDMA** ma mua o ke kuʻu ʻana i ka FTS no 15 kekona (ʻo ka meth concentrated meth/MDMA ke kumu i nā hopena maikaʻi ʻole ma FTS)
** Hōʻalo i ka hui ʻana i nā mea hoʻoikaika kino me ka waiʻona, nā Opioids ("Speedball" / "Goofball"), a i ʻole Viagra/Sildenafil** Hoʻokumu ka cocaine + waiʻona i ka cardiotoxic cocaethylene; stimulants + opioids mask respiratory depression a hiki i ka pau ʻana o ka mea hoʻoikaika wikiwiki; mea hoʻoulu + PDE5 inhibitors (Viagra/Cialis) a i ʻole nitrates ("poppers") ke kumu o ka hāʻule ʻana o ke koko make. Mai hoʻohui i nā mea hoʻoulu me nā nitrates a i ʻole nā lāʻau erectile dysfunction, a mālama ** ma kahi o ʻelua 4 mg Naloxone (Narcan) sprays e ʻike ʻia ma ka pākaukau ke hoʻohana ʻia kekahi mea alanui.
E hoʻoikaika i ka moe koi, hoʻomaʻemaʻe, a me nā meaʻai i kēlā me kēia 12 a 24 mau hola Hoʻonui nui ka pilikia o ka overamping ma hope o 24+ mau hola o ka hiamoe hiamoe, dehydration, a me ka pau ʻana o ka catecholamine. Inu 250 mL o ka wai electrolyte i kēlā me kēia hola, e ʻai i nā meaʻai protein/carbohydrate palupalu ma mua o ka hana hou ʻana, a hoʻōki i ka hana hou ʻana e ʻae i kahi pōʻai hiamoe piha.
Mai hoohana wale Inā loaʻa koke ka arrhythmia cardiac, hopu, a i ʻole fentanyl huna ʻia ʻoiai ʻoe ma hope o ka hale ʻauʻau paʻa a i ʻole ka puka lumi moe, ʻaʻohe mea hiki ke hāʻawi iā CPR a i ʻole Narcan. Wehe ʻia nā puka i ka wā e hoʻohana ai me nā hoaaloha, a i ʻole e kāhea i ka mea huna ** Mai hoʻohana wale i ka laina wela (1-800-484-3731 i ka US, 1-888-688-6677 ma Kanada)** no laila e noho ka mea hoʻohana ma ka laina me kou wahi

ʻO ka hoʻoemi ʻana i ka pōʻino-hōʻemi ʻana i ka hoʻonui ʻana no ka overamping koʻikoʻi ʻole

Inā ua nānā ʻoe i kēlā me kēia mea ma ka papa hoʻāʻo ma luna a hōʻoia i ka ** ʻaʻohe ʻeha o ka umauma, ʻaʻohe kuni/ ʻili wela, ʻaʻohe hopu, ʻaʻohe hōʻailona stroke, a me ka hanu maʻamau**, ua loaʻa iā lākou kahi ** non-critical psychological/autonomic overamp** (hoʻomaka pinepine ʻia e ka lawe nui ʻana i ka mea hoʻoulu, hui pū ʻana i nā mea hoʻoulu me ka caffeine, a i ʻole ke ala ala no 726 hola).

1. Ka papa inoa hoʻopaʻapaʻa de-escalation kaiapuni a me ke kino

  1. Hoʻololi koke i ke Kaiapuni ʻIke:
    • E neʻe aku mai nā mele bass nui, nā lumi piha, nā kukui ʻālohilohi, a i ʻole nā kihi alanui pilikia i loko o kahi lumi moe mālie a mālie me nā kukui ʻālohilohi.
  2. E hooluolu i ka Nerve Vagus (Me ka Haalulu ole i ke Kino):
    • E kau i kahi lole holoi maloʻo ma luna o ko lākou lae, nā maka, a me ke kua o ka ʻāʻī, a i ʻole e ʻae iā lākou e lawe i kahi ʻauʻau ** ʻoluʻolu (ʻaʻole maloʻo loa)** i ka wā e noho ana a mālama ʻia paha.
  3. Hoʻomāmā me nā Electrolytes a me nā Carbohydrates maʻalahi:
    • ʻO ka hoʻoulu ʻana i nā binges e hoʻopau i ke koko koko, sodium, potassium, a me ka magnesium i ka wā e hoʻomaloʻo nui ai ka waha ("cottonmouth") a me ka wili ʻana o ka iwi āpau (bruxism).
    • Hāʻawi i nā ʻuʻu liʻiliʻi o ka mea inu electrolyte maloʻo, wai niu, waiu, a i ʻole ka lau ʻai huaʻai, a me nā meaʻai māmā a maʻalahi ke ale ʻia (ka maiʻa, yogurt, ʻāpala, a i ʻole ka hupa) a me kahi ʻāpana ʻōpala a i ʻole kahi kihi lole holoi maʻemaʻe e pale iā lākou mai ka haki ʻana i ko lākou mau mola mai ka paʻi ʻana o ka ʻāwae.
  4. E paipai i ka neʻe mālie a i ʻole ka hoʻomaha ʻana (ʻo kēlā me kēia manaʻo palekana iā lākou):
    • Ke manaʻo nei kekahi poʻe e overamping ana ke ʻōlelo ʻia e moe mālie; e holo mālie i loko o kahi lumi palekana, hoʻopololei, a noho pololei paha i ka wā e hoʻomaʻamaʻa ana i ka ** inhale 4-kekona / 6-kekona exhale hanu** e hoʻopau i ka ikehu kinetic hopohopo a hala ka piko.

2. Pehea e kamaʻilio ai me kekahi e loaʻa ana i ka paranoia hoʻoulu a i ʻole psychosis hiamoe-deprivation

Ma hope o 48 a 96 mau hola me ka hiamoe ʻole ma ka methamphetamine a i ʻole ka cocaine, a hiki i ka **40 a hiki i ka 60 pakeneka o nā mea hoʻohana e ʻike i ka psychosis i hoʻoulu ʻia i ka transient **: auditory hallucinations (he lohe hāwanawana a i ʻole lekiō mākaʻi ma waho), ʻike maka-nā kānaka i ka ʻike peripheral, tactile hallucinations ("meth mites" / nā puka makani.

  • Mai hoʻopaʻapaʻa a hoʻomāʻewaʻewa paha i kā lākou hoʻopunipuni, a mai hoʻohālike ʻoe ua ʻike ʻoe i ka hoʻopunipuni:
    • Hewa: "He pupule ʻoe, ʻaʻohe kanaka ma waho o ka puka makani, e noho i lalo" (hoʻoulu i ka huhū a hōʻoiaʻiʻo iā lākou he ʻāpana ʻoe o ka manaʻo).
    • Wrong: "ʻAe, ʻike wau i nā kiu ma waho" (hoʻonui i ko lākou weliweli).
    • Pono (Validate the emotion, ground in safety):* "Ke ike nei au i ka weliweli o keia manawa. Ua palekana oe maanei me a'u iloko o keia rumi, ua paa ka puka, a e noho ana au maanei a e makaala ia oe i kou noho ana a inu i keia wai anuanu."
  • Mālama ʻike ʻia kou mau lima, e kū ma kahi kihi 45-degere ma kahi o 2 mika (6 kapuaʻi) ka lōʻihi, a ʻaʻole e ālai i ka puka puka: ʻO ka mea palaka i manaʻo ʻia ua kihi ʻia ʻo ia i loko o kahi lumi me kekahi mea e ālai ana i ka puka e hopohopo a paʻa a hakakā paha. E noho lākou ma kahi e ʻike pono ai i ka puka.
  • E hōʻalo i ka hāʻawi ʻana i nā lāʻau lapaʻau "landing gear" i ʻōlelo ʻole ʻia: Mai hāʻawi i ka mea e hoʻonui ana i ka pahu "Xanax" alanui a i ʻole ka lāʻau opioid e hoʻomoe iā lākou; Hoʻopili nui ʻia nā kaola alprazolam alanui hoʻopunipuni me fentanyl, bromazolam, a me xylazine, e hoʻohuli ana i kahi overamp hoʻoulu ola i kahi hopu hanu make i ka wā e hiamoe ai nā mea a pau.

(Inā ʻoe a i ʻole kekahi mea aloha e hakakā nei me ka methamphetamine, cocaine, crack, a i ʻole nā ​​mea hōʻeuʻeu i ka lāʻau lapaʻau, ʻike. Ka hoʻohana ʻana i ka lāʻau a me ka hoʻohui ʻana i ka lāʻau: alakaʻi kōkua pilikia, Ka hoʻihoʻi hou ʻana a me ka pale ʻana i ka nui: nā ʻāpana hoʻāʻo fentanyl/xylazine a me ka naloxone, a Kākoʻo ʻana i kekahi lālā o ka ʻohana me ka addiction. E noʻonoʻo e lawe i kahi kōkua mua a me ka papa CPR mai ke Keʻa ʻulaʻula, St John Ambulance, a i ʻole kahi mea lawelawe kūloko.)

Nīnau pinepine

Does Narcan (naloxone) work on a methamphetamine, cocaine, or crack overdose?

**Naloxone does NOT reverse the stimulant effects of pure methamphetamine or cocaine (such as racing heart, overheating, or agitation), because stimulants act on dopamine/norepinephrine receptors rather than opioid receptors.** HOWEVER, public health agencies (CDC, SAMHSA, and WHO) strongly instruct bystanders to **ALWAYS administer naloxone if someone who used cocaine, crack, meth, or MDMA is unresponsive and breathing slowly**, because a massive fraction of the illicit stimulant supply is contaminated with **fentanyl**. If they are unconscious and not breathing normally, it is almost certainly fentanyl contamination (or post-cardiac arrest), and naloxone plus rescue breathing can save their life with zero downside.

Why did my friend's urine turn dark brown like Coca-Cola the day after a heavy meth or MDMA binge?

Dark brown, tea-colored, or reddish-brown urine after stimulant use is the classic hallmark of **acute rhabdomyolysis**: severe overheating, muscle rigidity, and vasoconstriction have caused skeletal muscle fibers to break down and burst, dumping massive quantities of the muscle protein **myoglobin** into the bloodstream. Myoglobin clogs and poisons the microscopic filtering tubules of the kidneys, rapidly causing **acute kidney failure** and releasing fatal levels of **potassium (`hyperkalemia`)** into the heart. **Go to a hospital Emergency Department immediately** for aggressive intravenous fluid flushing (`200 to 300+ mL/hr` normal saline) to save their kidneys. (See [Acute kidney injury, rhabdomyolysis, and dark urine exertion triage](../first-aid/acute-kidney-injury-rhabdomyolysis-and-dark-urine-exertion-triage.md).)

Is it safe to throw someone having a stimulant overdose into an ice-cold shower by themselves to wake them up or cool them down?

**Never put an intoxicated, dizzy, or semi-conscious person into a shower alone, and avoid sudden freezing water if they are merely anxious rather than burning up with true hyperthermia.** If the person is truly burning hot (`> 39.5C / 103F`) with medical hyperthermia, you must actively cool them with ice packs at the neck/armpits/groin, cool water mist + fans, or a supervised cool bath while waiting for 911. However, putting an unsteady stimulant user alone in a shower frequently causes them to faint, slip on wet tile, and suffer a fatal traumatic brain bleed, or triggers sudden cold-shock vasoconstriction that spikes blood pressure during a cocaine chest-pain crisis.

What happens during the "Crash" (Days 1 to 5 after stopping a meth or cocaine binge), and when is it dangerous?

Unlike alcohol or benzodiazepine withdrawal, acute stimulant withdrawal (the **"crash"**) rarely causes physical withdrawal seizures, **but it carries an extreme risk of acute suicidal depression and profound hypersomnia (sleeping 16 to 24 hours a day)**. Because the binge exhausted the brain's vesicular stores of **dopamine and serotonin**, the person wakes up experiencing intense **anhedonia** (inability to feel any pleasure or hope), exhaustion, ravenous hunger, and crushing despair. During the first 72 hours of a stimulant crash, remove all firearms, lethal medications, and sharp hazards from the home, let them sleep and eat high-protein foods, check on their breathing every few hours while they sleep, and connect with the **988 Suicide & Crisis Lifeline** (US/Canada) or local crisis services if suicidal thoughts emerge.

Nānā ʻia nā kumu

  • ** American Heart Association (AHA, United States):** Scientific Statement on Management of Cocaine-Associated Chest Pain and Myocardial Infarction (Coronary vasospasm pathophysiology, sodium-channel blockade, benzodiazepine and nitroglycerin first-line therapy, a me ka pale ʻole i ka beta-blockade).
  • ** Hoʻohana i nā mea hoʻohana kino a me nā lawelawe olakino noʻonoʻo (SAMHSA) & National Institute on Drug Abuse (NIDA / NIH, ʻAmelika Hui Pū ʻIa): ** Hoʻomaʻamaʻa i nā maʻi hoʻohana ʻana i ka hoʻohana ʻana i nā maʻi (TIP 33 / Clinical Guidance), sympathomimetic toxidrome triage, a me ka hui pū ʻana o ka fentanyl i nā mea hoʻoikaika kino.
  • American College of Medical Toxicology (ACMT) a me American College of Emergency Physicians (ACEP): Clinical Management of Severe Sympathomimetic Toxicity, Excited Delirium / Severe Agitation, and Drug-Induced Hyperthermia (Rapid conductive/evaporative cooling, e pale aku i ka asphyxia prone restraint, a me rhabdomyolysis).
  • National Harm Reduction Coalition (United States) & Drug Policy Alliance: Ke ʻike a me ka pane ʻana i ka hoʻoulu ʻana i ka hoʻoulu ʻana (Ka hoʻokaʻawale ʻana i ka noʻonoʻo ʻana mai nā pilikia pilikia olakino a me nā hana palekana de-escalation).
  • European Monitoring Center for Drugs and Drug Addiction (EMCDDA / EUDA) & UK National Poisons Information Service (TOXBASE): Ke alakaʻi lapaʻau no ka MDMA-induced ** Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH / acute dilutional hyponatremia)** a me ka cocaethylene cardiotoxicity.

Nā alakaʻi pili