ʻO Clonidine Patch a i ʻole Visine Eye-Drop Ingestion: ʻO ka Central Alpha-2 Agonist 'Opioid-Mimic' Coma¶

Ke lawe ʻia kahi keiki liʻiliʻi a i ʻole keiki liʻiliʻi i ke keʻena pilikia me ka ʻike ʻole, haʻalulu, hanu 6 manawa wale nō i ka minuke, a hōʻike ʻia ** nā haumāna maʻamau (miosis), e noʻonoʻo koke kēlā me kēia kauka lapaʻau a me ke kauka i kahi ** fentanyl a heroin opioid overdose . Eia nō naʻe, ʻo ka lua o ka lāʻau make o ka hale e like me ka wikiwiki e hoʻopuka i kahi ** ʻaneʻane like "opioid-mimic" coma i hui pū ʻia me ** bradycardia hohonu (ka lohi o ka puʻuwai puʻuwai), hypothermia, a me ke kahe koko biphasic: Central Alpha-2 Adrenergic Agonists and Imidazoline Decongestants. I loko o nā miliona o nā hale i kēia lā, ʻo ** clonidine (Catapres, Kapvay)** a me guanfacine (Intuniv, Tenex) ua kuhikuhi ʻia ʻaʻole i nā kūpuna wale nō no ke koko kiʻekiʻe, akā, ʻo ia hoʻi me nā papa i kēlā me kēia lā a i ʻole 7-lā ** transdermal skin patch (Catapres-TTS)** i nā keiki liʻiliʻi a me nā ʻōpio-AD no ka maʻi maʻi no Attention/HD nā maʻi moe spectrum, nā maʻi kino, a me ka wehe ʻana o ka opioid neonatal. I ka manawa like, aia i loko o nā keʻena lumi hale lole a me nā ʻeke ʻeke nā ʻōmole o ka mea kūʻai aku ** "e wehe i ka ʻulaʻula" vasoconstrictor maka kulu a me nā nasal sprays ** i loaʻa ka tetrahydrozoline (Visine Original), oxymetazoline (Afrin, Visine L.R.), naphazoline (Clear Eyes, Alphadine) a i ʻole nā lāʻau lapaʻau. ka alpha-2 muscle relaxant tizanidine (Zanaflex), ka lāʻau lapaʻau holoholona/illicit sedative xylazine ("Tranq"), a i ʻole ka lāʻau cough/spasticity baclofen. No ka mea, paʻa mau ka ʻili ʻili clonidine "hoʻohana" i 7 lā i hoʻolei ʻia i loko o ka ʻōpala 50% to 75% o kona waihona milligram a pau, he kamalii e huki ana i ka papa mai kona lima iho (a mailoko mai o ka opala) a nau a omo paha ia mea - a i ole ke keiki e ale wale i ka ** hapalua teaspoon (2 to 5 mL) o Visine eye drops* - hoʻomoʻo i ka nui nui i loko o ka lolo i loko o 15 a 45 minuke, e pani ana i ke kikowaena sympathetic outflow a me ka hoʻoulu ʻana ** coma, cyclic apnea (kahi e hoʻomaha ai ke keiki i ka manawa i waiho wale ʻia, a laila ala aʻe a hanu pōkole ke lulu ʻia a i ʻole ʻia), bradycardia kino nui, a me ka hypotension.

Ina ua nahu ke keiki a kanaka makua paha i ka clonidine patch, moni hou i ka clonidine, guanfacine, a tizanidine pills, ai ole ia i komo i kekahi mau kulu o na kulu maka hooluolu a i ole nasal spray, e kelepona i kou helu ulia pōpilikia (911 ma United States a me Canada, 112 ma o ka European Union, 999 ma United Kingdom) helu pilikia papa kuhikuhi koke, a nānā ʻO ka opioid overdose a me ka hoʻopakele naloxone, beta-blocker a me ka calcium channel blocker overdose, a CPR keiki a me ke keiki.

E hana i kēia i kēia manawa¶

1. E kelepona iā 911 / 112 / 999 koke - MAI hoʻokele i ke keiki i ka haukapila ma kahi kaʻa pilikino: Central alpha-2 agonists (clonidine, guanfacine, tizanidine) a me imidazoline maka kulu (**tetrahydrozoline / Visine, oxymetazoline / Afrin, naphazoline, a me ka hanu o ka hanu **) bradycardia i loko o 20 a 60 mau minuke o ka ʻai ʻana. E hoʻohana mau i kahi Ambulance Advanced Life Support (ALS) i hiki i nā mea lapaʻau ke kākoʻo i ka hanu a me ka puʻuwai ma ke ala.
2. E kāhili i ka waha no nā ʻāpana transdermal i ʻānau ʻia a moni ʻia a nānā i ke kino holoʻokoʻa o ke keiki no nā ʻili huna huna: Inā pili kahi ** clonidine patch (Catapres-TTS-1, TTS-2, a i ʻole TTS-3)**, e nānā i loko o ka waha o ke keiki (ma lalo o ke alelo a i loko o nā papalina) me ke kukui uila a wehe i kahi ʻāpana paʻi kiʻi lima. A laila, e wehe loa i ke kapa o ke keiki a nānā i ke kua, nā poʻohiwi, ka umauma, ka ʻāʻī, a me nā wāwae no kahi paʻa paʻa (hoʻololi pinepine ʻia nā ʻili ma ka ʻili o kahi kamaliʻi ke moe pū me ka makua a i ʻole ke kaikaina). Holoi i ka wahi o ka ʻili me ka kopa a me ka wai (ʻaʻole loa i ka waiʻona a i ʻole acetone, e wehe ana i nā pores o ka ʻili a hoʻonui i ka transdermal clonidine absorption).
3. E hoʻohana i ka "Tactile and Verbal Stimulation" e kūʻē i ka "Early-Onset Cyclic Apnea" i ka wā e kali ana i ke kaʻa kaʻa: ʻO kekahi o nā hōʻailona weliweli loa o ka clonidine a me ka Visine poisoning ʻo ** stimulus-dependent cyclic apnea : i ka manawa e noho mālie ai ka lumi a ʻaʻohe mea e hoʻopā i ke keiki, hāʻule ke keiki i loko o kahi hanu hohonu, ** hāʻule ka hanu i loko o ka hanu hohonu. oiai e emi ana ko lakou puuwai; akā, i ka ** ʻomi ʻana i ko lākou ʻāʻī, wili i nā kapuaʻi, a i ʻole e ʻōlelo leo nui iā lākou **, wehe pōkole lākou i ko lākou mau maka a lawe i kekahi mau hanu hohonu ma mua o ka hoʻihoʻi ʻana i ka apnea i ka lua o ka hoʻomaha ʻana iā lākou. E hoʻoikaika mau a kamaʻilio pū me kahi keiki hiamoe a hoʻomau i ko lākou ala ea e hāmama a hiki i ka wā e lawe ai ka poʻe lapaʻau.
4. Hoʻohana i ka Naloxone (Narcan) kiʻekiʻe inā lohi a pāpaʻu paha ka hanu (a hoʻomaopopo i ke kumu e hāʻule pinepine ʻole ai nā kumu liʻiliʻi maʻamau): ʻOiai ʻoe i ʻike i ka lāʻau ʻawaʻawa ʻo clonidine, guanfacine, a i ʻole tizanidine (a ʻaʻole * he opioid), hoʻokuʻu nā kikowaena alpha-2 agonists i nā endorphins lolo e launa pū me nā mea hoʻokipa opioid. ʻOiai liʻiliʻi maʻamau 0.4 mg ʻAʻole hāʻule pinepine ka naloxone i ka hapalua o nā mea maʻi, naloxone intravenous-nui (2 mg to 10 mg IV bolus i nā keiki a me nā mākua) hoala i ka mea maʻi, hoʻohuli i ka apnea, a hoʻomaikaʻi i ke kahe koko a me ka puʻuwai puʻuwai a hiki i 50% a hiki i ka 80% o nā overdoses clonidine koʻikoʻi me ka ʻole e koi ʻia i ka endotracheal intubation.
5. Mai hoʻokomo i ka luaʻi, a ʻAʻole loa e hāʻawi i ka wai, ka waiū, a i ʻole ka lanahu hoʻōla ma ka home: Ma muli o ka luhi a me ka nalo ʻana o ka gag reflex i loko o 15 a 30 mau minuke, ʻo nā mea a pau i hoʻokomo ʻia i loko o ka ʻōpū ma ka home e hana koke i ka maʻi maʻi maʻi maʻi.
6. E ao aku i ka hui o ka lumi ulia pōpilikia e pili ana i ka "Biphasic Blood Pressure Trap" (Early Paradoxical Hypertension -> Late Hypotension): Ma hope koke iho o ka nui o ka clonidine, guanfacine, a i ʻole Visine overdose, hoʻoulu ʻia ke koko kiʻekiʻe ** peripheral vascular alpha-2B a me alpha-1 receptors**, i ka manawa pōkole o ke koko kiʻekiʻe 30-minuke. hypertension) a me ka reflex bradycardia ma mua o ka hoʻopaʻa ʻana o ka brainstem alpha-2A blockade a hoʻokuʻu i ka mea maʻi i loko o ke koko haʻahaʻa lōʻihi (hypotension). E ʻōlelo aku i nā kauka ʻAʻole loa e hāʻawi i nā lāʻau noʻonoʻo lōʻihi a i ʻole beta-blockers i ka wā pōkole pōkole o ka hypertensive spike, a i ʻole e loaʻa ka mea maʻi i ka hāʻule ʻana o ka maʻi cardiovascular i hoʻokahi hola ma hope i ka wā e paʻa ai ka pae hypotensive.

ʻO ka lāʻau hoʻoholo: ʻike a mālama i ka Central Alpha-2 Agonist & Imidazoline ("Opioid-Mimic") Poisoning¶

flowchart TD
    Start["Manaʻo ʻia ʻo Central Alpha-2 Agonist / Imidazoline Exposure OR 'Opioid-Mimic' Coma Pediatric Unexplained (Pinpoint Pupils + Apnea + Bradycardia)"] --> SourceID{"E ʻike i ka Agena Kūikawā a me ke Alanui"}

    SourceID -->|1. Clonidine (Catapres Pills or TTS Transdermal Patch) or Guanfacine (Intuniv ER / Tenex)| ClonidineGroup["ʻO Clonidine Toxic Paepae i loko o ke keiki: > 0.1 mg (aiʻole > 0.005-0.01 mg/kg) = Hoʻokahi 0.1 mg Pill a i ʻole kekahi TTS Patch Chewed (Loaʻa iā 2.5 mg, 5.0 mg, a i ʻole 7.5 mg Total) -> Hoʻomaka 30-60 min (Guanfacine ER Hoʻopaneʻe)"]

    SourceID -->|2. Imidazoline Eye Drops / Nasal Sprays (Tetrahydrozoline [Visine], Oxymetazoline [Afrin], Naphazoline, Brimonidine [Alphagan/Lumify])| VisineGroup["Hoʻomaka wikiwiki loa (15 a 45 mau minuke): E like me ka liʻiliʻi o 1-2 mL o 0.05% Solution (0.5-1 mg) i loko o kahi kamaliʻi ke kumu o ka hohonu koma, hypothermia, miosis, apnea, a me Bradycardia."]

    SourceID -->|3. Tizanidine (Zanaflex), Dexmedetomidine (Precedex), or Xylazine ('Tranq' Adulterant in Illicit Fentanyl)| TizanidineGroup["Hoʻohui ʻo Tizanidine i ka QT Prolongation & Hepatotoxicity; Hoʻokumu ʻo Xylazine i nā maʻi ʻili necrotic koʻikoʻi + Naloxone-Resistant Alpha-2 Coma i hui pū ʻia me Fentanyl Respiratory Hopu."]

    ClonidineGroup --> DeconStep["Hoʻomaʻemaʻe koke a me ke ala ea: 1. Wehe i kekahi Patch mai ka waha a i ʻole ka ʻili a holoi i ka ʻili me ke kopa / wai 2. E hoʻohana i ka hoʻoulu ʻana i ka Tactile/Verbal Stimulation no Cyclic Apnea; Kākoʻo i ka ea/Bag-Mask Ventilation."]
    VisineGroup --> DeconStep
    TizanidineGroup --> DeconStep

    DeconStep --> NaloxoneTrial["HIGH-DOSE INTRAVENOUS NALOXONE TRIAL (No ka CNS Depression, Apnea, a i ʻole Hypotension/Bradycardia): - E hoʻohana i ka Naloxone High-Dose: 0.1 mg/kg IV (a i ʻole 2 mg a i 10 mg IV Bolus i nā keiki a me nā mākua) - Inā hoʻāla maikaʻi ʻia / pane hanu ma ka Doxone IV3 Infusion mau o Doxone IV3 Infusion Hola (A'ole, Endotracheal Intubation & Mechanical Ventilation)"]

    NaloxoneTrial --> HemodynamicPhase{"ʻO ka pae hea o ka pane ʻana o ka hemodynamic biphasic i kēia manawa?"}

    HemodynamicPhase -->|Phase 1: Early Paradoxical Hypertension + Reflex Bradycardia (Peripheral Alpha-2B/Alpha-1 Vasoconstriction, First 1-3 Hours)| EarlyHTN["'Ōlelo Aʻo: Mai hāʻawi i nā lāʻau antihypertensive lōʻihi a i ʻole Beta-Blockers (E hoʻopau i ka make i ka wā e paʻa ai ka Phase 2) - E nānā i ka HTN ʻoluʻolu a ʻaʻole i mālama ʻia (Hoʻoholo i ka manawa ma 1-3h) - Inā pilikia ka maʻi hypertension hoʻoweliweli: e hoʻohana ONLY Ultra-Shorttable-Aiʻole Phlamine."]

    HemodynamicPhase -->|Phase 2: Dominant Central Sympatholytic Hypotension + Sinus Bradycardia / AV Block (Central Alpha-2A / Imidazoline-1 Blockade, Lasting 12-48 Hours)| LateHypo["1. Symptomatic Bradycardia: IV Atropine (0.02 mg/kg in Child [Min 0.1-0.5 mg]; 0.5-1 mg in Adult) -> Escalate to Epinephrine or Dopamine Infusion if Needed 2. Hypotension: 20 mL/kg IV 0.9% Normal Saline Crystalloid Bolus -> Direct Vasopressor Infusion (Norepinephrine or Epinephrine)"]

Pathophysiology: Pehea ʻo Central Alpha-2 Agonists e hoʻohālikelike ai i nā Opioids a hana i ka paʻi koko Biphasic.¶

1. No ke aha ʻo Clonidine a me Visine e hoʻomaka ai i nā haumāna, Coma, a me Apnea (Locus Coeruleus Inhibition)¶

ʻO ka locus coeruleus i loko o nā pons o ka brainstem ke kikowaena kauoha nui no ka noradrenergic (norepinephrine) hoʻāla, wakefulness, ka hanu hanu, a me ka dilation pupillary i loko o ka lolo kanaka.

1. Presynaptic Alpha-2A Autoreceptor Activation (Gi/o Hoʻohui ʻia ʻo Protein): ʻelua ʻelua ** opioid receptors (mu-opioid)** a me alpha-2A adrenergic receptors (alpha-2A) aia ma ka ʻaoʻao ʻaoʻao ma nā neurons o ka locus coeruleus a kaʻana like i ka like intracellular potassium/calcium signaling channels (Gi/o ʻO ka hui pū ʻana o ka protein e pale ai i ka adenylate cyclase, wehe i ka hoʻoponopono i loko GIRK nā ala pāpaʻa e hoʻomāhuahua i ka neuron, a e ālai i nā kahawai calcium i hoʻopaʻa ʻia i ka uila).
2. Total Sympathetic Shutoff ("Opioid-Mimic" Toxidrome): I ka wā e kahe ai ka clonidine, guanfacine, tizanidine, xylazine, a i ʻole tetrahydrozoline (Visine) i loko o ka lolo a hoʻoulu i ka ** presynaptic waena. alpha-2A a imidazoline-1 (I1) nā mea hoʻokipa** i loko o ka locus coeruleus a me rostral ventrolateral medulla:
3. ʻO ka hoʻokuʻu ʻana o Norepinephrine i loko o ka lolo e hāʻule i kahi kokoke-zero, e hoʻokomo i ka mea maʻi i loko o coma (e hoʻohuli kūʻokoʻa no kekahi mau kekona i ka wā o ka hoʻoulu ʻana i ka ʻeha/tactile ma ke ʻano o nā ala sensory ancillary i ke ahi pōkole).
4. ʻO ka leo parasympathetic kūʻē ʻole mai ka Edinger-Westphal nucleus e hoʻopaʻa i ka iris sphincter, e hoʻohua ai i pinpoint pupils (miosis) hiki ʻole ke hoʻokaʻawale ʻia mai ka fentanyl a me ka heroin.
5. Nalo nā kikowaena hanu medullary i ke aloha aloha, e hoʻoulu ai i bradypnea a me cyclic apnea.
6. Hoʻopau ʻia ka leo aloha ʻoluʻolu i ka node sinoatrial (SA), node atrioventricular (AV), a me nā kīʻaha koko peripheral, ʻoiai ka leo parasympathetic vagal, e hoʻoulu ai i ** sinus bradycardia hohonu, AV puʻuwai poloka, systemic vasodilation (hypotension), a me hypothermia**.

2. No ke aha ʻo Naloxone kiʻekiʻe (2 mg to 10 mg IV) Hana i loko o ka nui o Clonidine Overdoses¶

No nā makahiki he mau makahiki, ua hoʻopaʻapaʻa nā kauka inā hana ʻo naloxone (Narcan) i ka lāʻau ʻawaʻawa clonidine no ka mea nā hōʻike mua e hoʻohana ana i nā mea liʻiliʻi. 0.1 mg to 0.4 mg ua hōʻike ʻia nā hopena like ʻole. Hōʻike nā haʻawina toxicology pediatric hou e ** ka hoʻoulu ʻana o ka alpha-2 waena i ka hoʻokuʻu ʻana o nā beta-endorphins endogenous i loko o ka lolo**, e hoʻoikaika pū ai. mu- a delta-opioid receptors ma ka pololei like Gi- hui pū ʻia nā neurons locus coeruleus.

• ** No ke aha e koi ʻia ai nā wai kiʻekiʻe**: ʻO ka pale ʻana i kēia hoʻoulu ʻana i ka endorphins e pono ai supratherapeutic high-dose Intravenous Naloxone (0.1 mg/kg IV, a i ʻole 2 mg to 10 mg IV huina bolus ma na kamalii a me na kanaka makua).
• I loko o nā ʻano lāʻau lapaʻau o nā keiki clonidine overdoses, lawelawe ** a hiki i 10 mg o IV naloxone ** ua ala koke ** 50% a i 80% o nā keiki comatose/apneic**, e mālama ana iā lākou mai ka intubation endotracheal a me ka hoʻokuʻu ʻana i ka ICU mechanical, me ka ʻaneʻane ʻaʻohe hopena ʻino i nā keiki hilinaʻi ʻole opioid. (E hoʻomanaʻo: ʻAʻole maikaʻi loa ka hopena o ka naloxone kiʻekiʻe i ka imidazoline eye-drop [Visine] a me xylazine poisoning ma mua o ka lāʻau lapaʻau clonidine poisonings, ʻoiai ʻo ka hoʻāʻo ʻana he palekana a paipai ʻia).

3. ʻO ka Biphasic Hemodynamic Trap: No ke aha i lilo ai ka Phase 1 Hypertension i Phase 2 Shock¶

Ma hope koke iho o ka ʻai ʻana i ka nui o ka clonidine, guanfacine, a i ʻole tetrahydrozoline, piʻi ka nui o ka lāʻau i loko o ka ** peripheral bloodstream** ma mua o ka hoʻohālikelike pono ʻana o ka lāʻau i ka pale koko-lolo i loko o ka lolo.

• Phase 1 (Mua 30 a i 180 Minutes - Peripheral Alpha-2B Vasoconstriction): Hoʻoulu pololei ʻia ka nui o ka plasma kiʻekiʻe ** postsynaptic peripheral alpha-2B a alpha-1 nā mea hoʻokipa** ma nā ʻiʻo ʻiʻo paheʻe vascular i loko o ke aʻa, e hoʻoulu ai i ka vasoconstriction peripheral ikaika, hypertension transient koʻikoʻi (e laʻa, BP 180/110 mmHg i ke keiki a i ole 230/130 mmHg i loko o kahi kanaka makua), ʻeleʻele maʻiʻo nā ʻūhā, a me ka baroreceptor-mediated reflex bradycardia.
• Phase 2 (Hula 2 a hiki i 48 - Central Alpha-2A Sympatholysis): I loko o 1 a 3 mau hola, puʻunaue hou nā pae lāʻau peripheral i loko o nā ʻiʻo a ʻo ka lolo waena. alpha-2A ʻO ka hoʻopaʻa ʻana e lawe i ke kauoha piha, e pani i ka leo aloha a me ka hoʻoulu ʻana i ke koko e ** hāʻule mai ke kiʻekiʻe kiʻekiʻe i loko o ka hypotension lōʻihi a me ka bradycardia**.
• Ka Iatrogenic Disaster: Inā mālama ke kauka lapaʻau ʻike ʻole i ke kiʻekiʻe kiʻekiʻe o ka Phase 1 me labetalol, metoprolol, propranolol, hydralazine, a i ʻole nifedipine, hiki mai ʻelua mau pōʻino: (1) wehe ka beta-blocker i ke koena beta-adrenergic kākoʻo i ka wā e waiho ana i ka peripheral alpha vasoconstriction a i ʻole 2 mau minuke ke kū ʻole i ka hypotension (2) mau minuke. ma hope aku, ʻaʻole hiki ke hoʻopau ʻia ka lāʻau antihypertensive lōʻihi, e hōʻeha ai i ka refractory cardiogenic a me vasodilatory shock.

Papa Hoʻohālikelike Master: Central Alpha-2 Agonists, Imidazoline Eye/Nasal Drops, a me Xylazine¶

Kaʻina hoʻokele hale maʻi ʻanuʻu¶

1. Decontamination: I ka manawa e hoʻohana ai i ka wai holoʻokoʻa no kahi Clonidine Patch i ʻai ʻia.¶

• ** ʻAi ʻAi a Spit-Out Patch a i ʻole Liquid Eye Drops**: Mai ** ʻaʻole ** e hana i ka ʻōpū o ka ʻōpū a i ʻole e hoʻohana i ka lanahu hoʻōla no nā hāʻule o ka maka tetrahydrozoline/oxymetazoline wai (e komo piha i loko o 15 a 30 mau minuke i ka wā e hoʻoulu ai ka lethargy i kahi pilikia kiʻekiʻe).
• Intact Clonidine Transdermal Patch Swallowed Whole: Aia ka Catapres-TTS patch i ke kua impermeable a me ka pā ana i ka nui o ka membrane i loko o 2.5 mg to 7.5 mg o ka clonidine ma'ema'e (25 a 75 manawa o ka nui o ka waha o ke kanaka makua) e hoomau ana i ka hoolele ana i ka clonidine i loko o ka opu a me ka opu no mau la. Inā ʻai ke keiki a makua paha i ka clonidine paʻa holoʻokoʻa, e hāʻawi iā Activated Charcoal (1 g/kg) (ma hope o ka hoʻopaʻa ʻana i ke ala ea inā hiamoe) a hoʻomaka i ka Whole-Bowel Irrigation (WBI) me ka Polyethylene Glycol Electrolyte Solution (PEG-ES, GoLYTELY ma 25 mL/kg/hr i na keiki a i ole 1.5 to 2 L/hr i loko o ka poʻe mākua ma o ka paipu nasogastric) a hiki i ka wā i hoʻopau ʻia ai ka ʻōpala paʻa paʻa i loko o ka effluent rectal.

2. Hemodynamic a me ka Respiratory Rescue Sequence¶

1. Ea a me ka hanu mua (Hoʻoulu -> High-Dose Naloxone -> Intubation):
2. E noi i ka pulse oximetry mau, end-tidal capnography (ETCO2), a me ka nānā ʻana i ka naʻau, a hoʻohana i ka hoʻoikaika kino haʻahaʻa no ka apnea cyclic haʻahaʻa.
3. No ka hoʻomau ʻana i ka hypoventilation, apnea, a i ʻole ka coma hohonu, e hāʻawi iā ** High-Dose Intravenous Naloxone (0.1 mg/kg IV a hiki i 2 mg paʻi mua, hana wikiwiki i kēlā me kēia 2 minuke a hiki i ka huina o 10 mg IV). Inā hoʻihoʻi ka naloxone kiʻekiʻe i ka hanu a me ka hoʻāla ʻana, e hoʻomaka i kahi ** hoʻomau IV naloxone infusion ma 66% (ʻelua hapakolu) o ka maʻi bolus ala ala maikaʻi i kēlā me kēia hola; ina 10 mg ʻaʻole hiki ke hoʻihoʻi i ka ea kūpono, hana endotracheal intubation a me mechanical ventilation. (E akahele: I ka wā o ka hoʻokomo ʻana i ke kaʻina wikiwiki, hoʻomaʻamaʻa mua me IV Atropine 0.02 mg/kg no ka mea hiki i ka laryngoscopy a me ka succinylcholine ke hoʻomaka i ka hopu ʻia ʻana o ka vagal sinus i loko o kahi maʻi bradycardic clonidine mua).
4. Hoʻoponopono i ka Bradycardia (Atropine -> Epinephrine):
5. Mai mālama i ka asymptomatic mild bradycardia inā maʻamau loa ke kahe koko a me ka perfusion.
6. No ka bradycardia hōʻailona me ka hypotension a i ʻole ka hoʻoheheʻe maikaʻi ʻole, e hāʻawi i ka ** Intravenous Atropine (0.02 mg/kg i na keiki [ka palena iki 0.1 to 0.5 mg]; 0.5 mg to 1 mg i nā mākua, hiki ke hana hou a hiki i 3 mg). Inā hāʻule ka atropine, e hoʻomaka i kahi ** Intravenous Epinephrine (0.05 to 0.3 mcg/kg/min) a i ʻole Dopamine (5 to 15 mcg/kg/min) infusion a i ʻole e hoʻopili i ka transcutaneous pacing.
7. Managing Hypotension vs. Early Paradoxical Hypertension:
8. Haʻahaʻa haʻahaʻa: Hoʻoponopono 10 to 20 mL/kg boluses o 0.9% Normal Saline a i ʻole Lactated Ringer's a hoʻonoho i ka mea maʻi ma ke kūlana Trendelenburg/supine; inā mau ka hypotension, e hoʻomaka i ka Norepinephrine a i ʻole Epinephrine infusion. (Manaʻo: Tolazoline, he alpha-antagonist mōʻaukala, contraindicated a haʻalele ʻia no ka mea hiki ke hoʻohālikelike ʻia i ka arrhythmias hiki ʻole ke manaʻo ʻia, hypotension koʻikoʻi, a me ke koko GI; ** ʻAʻole loaʻa ʻo Yohimbine ** i loko o ka IV formulations pilikia).
9. Early Paradoxical Hypertension: E waiho i ka hypertension transient me ka mālama ʻole ʻia ke ʻole ka pōʻino o ke kino hope loa (hypertensive encephalopathy, aortic dissection, a i ʻole pulmonary edema), a ma ia hihia e hoʻokaʻawale WALE i ka ultra-short-acting ** Intravenous Sodium Nitroprusside (0.3 to 3 mcg/kg/min)** aiʻole Phentolamine (0.05 to 0.1 mg/kg IV i kēlā me kēia 10 min) no laila hiki iā ia ke pani i ka hāʻule koke o ke koko.

Nā helu ulia pōpilikia āpana a me nā protocols oihana¶

Nīnau pinepine¶

Pehea e ale ai i kekahi mau kulu o Visine maka kulu a i ʻole Afrin nasal spray e hoʻokomo i kahi keiki i loko o kahi coma?¶

ʻO nā hāʻule o ka maka ʻulaʻula ma luna o ka pākaukau (loaʻa ka tetrahydrozoline, naphazoline, a i ʻole brimonidine) a me 12-hola nasal decongestant sprays (i loaʻa ka oxymetazoline a i ʻole xylometazoline) no ka papa kemika i kapa ʻia ʻo imidazolines - ka ʻohana kemika like me ke koko a me ka lāʻau lapaʻau ADHD clonidine. Ke hoʻohana ʻia ma ke ʻano he kulu hoʻokahi i ka maka, hoʻopaʻa lākou i nā kīʻaha koko liʻiliʻi ma ka ʻāina. Eia nō naʻe, ke ale ʻia - ʻoiai i ka liʻiliʻi e like me ka 1 a i ka 2 milliliters (emi iho ma mua o ka hapalua teaspoon) - ua komo koke lākou mai ka ʻōpū a hele i ka pale koko-lolo e hoʻoulu ai i ke kikowaena alpha-2A a me ka imidazoline receptors i loko o ka lolo, e pani ana i ke kino o ke kino a me ka hoʻoulu ʻana i nā haumāna pinpoint, ka hanu hohonu a me ka hanu ʻana o ka puʻuwai. (apnea) i loko o 15 a 45 mau minuke.

ʻO ka hoʻokomo ʻana i ka maka Visine i loko o ka mea inu e hoʻoulu ai i ka maʻi maʻi e like me nā kiʻiʻoniʻoni, a i ʻole he moʻolelo?¶

He 100 pakeneka hoʻopunipuni a make hoʻi i ke kūlanakauhale. ʻAʻole ʻo Tetrahydrozoline (Visine) ke kumu i ka maʻi maʻi. Akā, ʻo ka hoʻoinu ʻana i ka mea inu me ka tetrahydrozoline a i ʻole ka oxymetazoline kulu maka e hāʻawi i ka neurotoxin a me ka hoʻohaʻahaʻa o ka puʻuwai puʻuwai e hoʻoulu ai i ka coma hohonu, hypothermia, bradycardia, hopu ʻana i ka hanu, a me ka make, a ua hoʻopaʻi ʻia ʻo ia ma ke ʻano he felony poisoning offense i ʻike maʻalahi ʻia e ka haukapila/MS blood test and LC-MS test.

No ke aha i ho'āla ai ʻo Naloxone (Narcan) i kahi keiki i hoʻomāhuahua i ka Clonidine ʻoiai ʻaʻole ʻo Clonidine he opioid?¶

Hoʻoulu ʻo Clonidine i ka alpha-2A adrenergic receptors i loko o ka locus coeruleus o ka brainstem, ka mea e kaʻana like i ka intracellular potassium a me ka calcium hōʻailona hōʻailona e like me ka mu-opioid receptors a hoʻoulu pū i ka hoʻokuʻu ʻana o nā endorphins maoli o ka lolo. ʻOiai nā kumu liʻiliʻi maʻamau o naloxone (`0.4 mg`) ua nāwaliwali loa i ka lanakila ʻana i kēia hopena, hōʻike nā haʻawina toxicology clinical i ka lawelawe ʻana i ka Naloxone intravenous kiʻekiʻe (`0.1 mg/kg`, a i ʻole `2 mg to 10 mg IV` ka huina) poloka i kēia hoʻoulu ʻana o ka opioid endogenous a hoʻāla koke i ka 50% a i ka 80% o nā keiki me ka koma clonidine koʻikoʻi a me ka apnea, e mālama pinepine iā lākou mai ka pono ʻana i kahi paipu hanu a me ka ventilator.

No ke aha he pilikia loa i ke kauka ke hāʻawi ʻana i ka lāʻau no ke koko ke hiki mua mai kahi maʻi overdose Clonidine a i ʻole Visine me ke koko kiʻekiʻe?¶

ʻO ka overdoses nui o ka clonidine, guanfacine, a i ʻole Visine ke kumu o ka pane "biphasic" maʻamau. I loko o nā minuke 30 a hiki i 120 mau minuke, ʻo nā kiʻekiʻe o ka lāʻau lapaʻau i loko o ke kahe koko e hoʻopaʻa pololei i nā kīʻaha koko peripheral (ma o nā mea hoʻokipa alpha-2B peripheral), e hoʻoulu ai i kahi manawa pōkole o ke koko kiʻekiʻe ma mua o ka pau ʻana o ka lāʻau lapaʻau i loko o ka lolo. Ke komo ka lāʻau lapaʻau i loko o ka lolo (Phase 2), hoʻopau ia i nā mea hoʻopuka aloha aloha, a hāʻule ke koko o ka mea maʻi i ke koko haʻahaʻa lōʻihi (hypotension) no nā hola 12 a hiki i 36 mau hola. Inā hāʻawi ke kauka i ka lāʻau hoʻopaʻa koko lōʻihi a i ʻole beta-blocker i ka wā pōkole pōkole o ke koko kiʻekiʻe, e loaʻa ana ka mea maʻi i ka pōʻino a hiki ʻole ke hoʻihoʻi ʻia i hoʻokahi hola ma hope o ka pae ʻana o ka Phase 2.

No ke aha e noho ai ke keiki i ale i ka Guanfacine (Intuniv) i ka haukapila no 24 mau hola ma hope o kona ala ʻana a pau ka hiamoe?¶

Loaʻa i ka guanfacine hoʻokuʻu lōʻihi (Intuniv) kahi manawa kūʻokoʻa, hoʻopunipuni i ka overdose: ʻoiai ke ʻike ʻia ka hiamoe a me ka hoʻomaha ʻana i loko o nā hola 2 a hiki i 6 mau hola a hoʻomaikaʻi pinepine ʻia e ka hola 8 a hiki i ka 12, nā hopena cardiovascular koʻikoʻi - kikoʻī hohonu orthostatic hypotension (maule i ke kū ʻana i luna), sinus bradycardia, a hoʻolōʻihi ʻia a hiki i ka hoʻolōʻihi ʻia ʻana. mau hola ma hope o ka ʻai ʻia ʻana o nā lāʻau. ʻO ka hoʻokuʻu ʻana i kahi keiki ma 6 a i ʻole 8 mau hola ma muli wale nō o ke ala ʻana hiki ke hopena i ka syncope lohi a me ka hiolo bradycardic ma ka home.

Nā alakaʻi pili¶

• ʻO ka hoʻomaopopo ʻana i ka overdose opioid a me ka hoʻokele naloxone (Narcan).
• Beta-blocker a me ka calcium channel blocker overdose triage
• ʻO ka make ʻana o ka nikotina, ka wai vape wai, a me nā mea ʻawaʻawa transdermal patch
• ʻO CPR keiki a me ke keiki pēpē a me ka hoʻopakele ʻana
• ʻO ke kōkua mua a me ka hoʻāʻo ʻana i ka lāʻau make

Nā kumu a me ke alakaʻi kūhelu¶

• ʻO ʻAmelika Hui Pū ʻIa o ka Lapaʻau Lapaʻau (ACMT) & ʻAmelika Hui Pū ʻIa: Alakaʻi ʻAi ʻAi Kūlohelohe ma Central Alpha-2 Agonist Overdose, Pediatric Clonidine Transdermal Patch Toxicity, a me High-Dose Naloxone Rescue.
• ʻO ka United States Food and Drug Administration (FDA) & Consumer Product Safety Commission (CPSC): *Ke Kūkākūkā Palekana Lapaʻau: Nā Hanaʻino Koʻikoʻi mai kaʻaiʻanaʻole i nā kulu o ka maka a me ka nasal Sprays (Tetrahydrozoline, Oxymetazoline, Naphazoline) e nā keiki *.
• American Academy of Pediatrics (AAP): Pediatric "One Pill Can Kill" Initiative: Clonidine, Guanfacine, a me Imidazoline Derivative Poisonings i nā kamaliʻi a me nā kamaliʻi.
• ʻOihana Hoʻonaʻauao ʻĀpana Lahui (NPIS, United Kingdom): TOXBASE Clinical Management Protocols for Clonidine, Guanfacine, Tizanidine, a me Imidazoline Decongestant Toxicity.
• Nā Centers for Disease Control and Prevention (CDC) & National Institute on Drug Abuse (NIDA): Alakaʻi Kauka no ka pane ʻana i ka Fentanyl i moe kolohe me Xylazine ("Tranq") Overdoses.

• ʻO kēia alakaʻi no nā kumu ʻike a ʻaʻole ia e pani i ka loiloi olakino pilikia pilikia, kūkākūkā Poison Control, a i ʻole ka mālama kino pediatric. No ka mea hiki i ka clonidine patches a me ka imidazoline eye drops ke hoʻoulu koke i ka apnea cyclic a me ka bradycardia koʻikoʻi i loko o nā minuke, ke paipai ikaika nei mākou e lawe i kahi kōkua mua lima a me ka papa CPR pediatric ma o ka International Federation of Red Cross and Red Crescent Societies (IFRC), kou lāhui Red Cross, St John Ambulance, a i ʻole kahi mea lawelawe kūloko.*