Clonidine Patch ma ọ bụ Visine Eye-Drop Ingestion: Central Alpha-2 Agonist 'Opioid-Mimic' Coma¶

Mgbe a na-ebute nwata ma ọ bụ nwata n'ime ụlọ mberede amaghị ihe ọ bụla, na-egbu mgbu, na-eku ume nanị ugboro 6 n'otu nkeji, na-egosipụta ** ụmụ akwụkwọ oge ochie (miosis)**, onye ọ bụla na-ahụ maka ahụike na dọkịta na-eche ozugbo maka ** fentanyl ma ọ bụ heroin opioid overdose . Otú ọ dị, nsi ụlọ nke abụọ, n'otu aka ahụ ngwa ngwa na-emepụta ** fọrọ nke nta ka ọ bụrụ "opioid-mimic" coma ** jikọtara ya na ** bradycardia (obere obi obi dị egwu), hypothermia, na ọbara mgbali elu biphasic : ** Central Alpha-2 Adrenergic Agonists na Imidazoline Decongestants . N'ime ọtụtụ nde ụlọ taa, ** clonidine ( Catapres, Kapvay)** na ** guanfacine (Intuniv, Tenex) na-edenye ọ bụghị naanị na nne na nna ochie maka ọbara mgbali elu, kamakwa dị ka mbadamba ụbọchị ma ọ bụ ụbọchị 7 ** transdermal skin patches ( Catapres-TTS ) na-eto eto na ụmụaka na ndị nọ n'afọ iri na ụma. (ADHD), nsogbu ihi ụra nke autism, nsogbu tic, na mwepụ opioid ọhụrụ. N'otu oge ahụ, igbe ime ụlọ ịwụ na obere akpa nwere karama mpịakọta nke n'elu-na-counter * "wepụ red out vasoconstrictor eye drops na nasal sprays * nwere ** tetrahyrozoline (Visine Orignal*), oxymetazoline (Afrin, Visine L.R.), naphazoline (Clear Eyes,* Almoni) kabinet na-ejide akwara alfa-2 na-enye ntụrụndụ ** tizanidine (Zanaflex)**, ọgwụgwọ ọgwụgwọ ọrịa anụmanụ/nke na-akwadoghị ọgwụ xylazine ("Tranq"), ma ọ bụ ọgwụ ụkwara/spasticity baclofen. N'ihi na **"ejiri" ụbọchị asaa nke clonidine akpụkpọ ahụ tụfuru n'ime ahịhịa ka na-ejide ya 50% to 75% nke mkpokọta milligram reservoir ***, nwa na-eto eto nke na-ewepụ ihe mgbochi n'ogwe aka ha (ma ọ bụ na-esi na ihe mkpofu) na-ata ma ọ bụ na-aṅụ ya - ma ọ bụ nwatakịrị na-eloda nanị ** ọkara teaspoon (2 to 5 mL) nke Visine anya na-adaba *** - na-etinye nnukwu dose ozugbo n'ime ụbụrụ ụbụrụ n'ime nkeji 15 ruo 45 **, na-emechi njedebe ọmịiko etiti na ịkpalite **coma, cyclic apnea (ebe nwatakịrị ahụ na-akwụsị iku ume mgbe ọ bụla ọ hapụrụ naanị ya, wee teta ma na-eku ume obere oge mgbe ọ na-ama jijiji ma ọ bụ tuo ya), oké sinus bradycardia, na hypotension bradycardia.

Ọ bụrụ na nwatakịrị ma ọ bụ okenye atala patch clonidine, loda extra clonidine, guanfacine, ma ọ bụ tizanidine pill, ma ọ bụ rie ya ọbụna ntakịrị ntanye nke ntanye anya enyemaka na-acha ọbara ọbara ma ọ bụ ịgba imi, kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom) site na European Union. nọmba mberede ndekọ ozugbo, na nyochaa oke ọgwụ opioid na nnapụta naloxone, beta-blockers na calcium channel blocker ịdoụbiga mmanya ókè, na ụmụaka na ụmụ ọhụrụ CPR.

Mee nke a ugbu a¶

1. ** Kpọọ 911 / 112 / 999 ozugbo - ebula nwatakịrị ahụ n'ụlọ ọgwụ n'ime ụgbọ ala nkeonwe : Central alpha-2 agonists (clonidine, guanfacine, tizanidine) na imidazoline eye drops ( tetrahydrozoline / Visine, oxymetazoline / Afrin, Afrin na-egbu egbu, nabruptzoline), na-akpata iku ume iku ume. njide (apnea), na bradycardia siri ike n'ime nkeji 20 ruo 60 ** nke ntinye. Na-eji ụgbọ ihe mberede Advanced Life Support (ALS) mgbe niile ka ndị na-ahụ maka ahụike nwere ike ịkwado iku ume na ọnụọgụ obi n'ụzọ.
2. Sachaa ọnụ maka ihe ntanye transdermal ọ bụla atachara ma ọ bụ loro wee lelee ahụ nwata ahụ niile maka patch akpụkpọ ahụ zoro ezo : Ọ bụrụ na ** clonidine patch (Catapres-TTS-1, TTS-2, ma ọ bụ TTS-3) metụtara, lelee n'ime ọnụ nwatakịrị ahụ (n'okpuru ire na n'ime ntì) jiri nkpịsị aka plastik kpuchie ya. Na-esote, ** yipụ uwe nwata ahụ kpamkpam wee lelee azụ, ubu, obi, azụ na ụkwụ maka patch rapaara (patches na-ebufekarị na akpụkpọ anụ nwata mgbe ya na nne ma ọ bụ nna ma ọ bụ nwanne na-ehi ụra). Jiri ** ncha na mmiri saa ebe akpụkpọ ahụ (ọ dịghị mgbe mmanya ma ọ bụ acetone, nke na-emepe oghere akpụkpọ ahụ ma na-abawanye absorption transdermal clonidine).
3. ** Jiri "Tactile and Verbal Stimulation" na-emegide "Early-Onset Cyclic Apnea" mgbe ị na-eche ụgbọ ihe mberede **: Otu n'ime ihe ịrịba ama kachasị dị ize ndụ nke clonidine na Visine nsi bụ ** ihe mkpali na-adabere na cyclic apnea : oge ụlọ ahụ dị jụụ na ọ dịghị onye na-emetụ nwa ahụ aka, nwa ahụ na-adaba n'ime ume miri emi, na-adaba n'ime ime nwa ahụ kpamkpam. (apnea) mgbe ọnụ ọgụgụ obi ha na-agbada; ma mgbe ị na-ete sternum ha, na-atụgharị ọbụ ụkwụ ha, ma ọ bụ na-agwa ha okwu n'olu dara ụda ***, ha na-emeghe anya ha nkenke ma na-eku ume dị iche iche tupu ha alaghachi azụ na apnea nke abụọ, ị kwụsịrị ịkpali ha. ** Na-aga n'ihu na-akpali akpali ma na-agwa nwatakịrịa-ehi ụra okwu ma mee ka ụzọ ikuku gbaghee oghe ruo mgbe ndị ọrụ ahụike ga-eweghara.
4. ** Na-elekọta Naloxone dị elu (Narcan) ma ọ bụrụ na iku ume na-adị ngwa ma ọ bụ na-emighị emi (ma ghọta ihe kpatara na obere obere doses na-adakarị) *: Ọbụna mgbe ị maara nsi bụ ** clonidine, guanfacine, ma ọ bụ tizanidine ** (na * ọ bụghị * opioid), Central alpha-2 agonists na-ahapụ endorphins ụbụrụ endogenous nke na-emekọ ihe na ndị na-anabata opioid. Mgbe ọkọlọtọ obere 0.4 mg Naloxone doses na-adakarị n'ihe dị ka ọkara nke ndị ọrịa, ** nnukwu ọgwụ Naloxone na-agba ọsọ (naloxone).2 mg to 10 mg IV bolus na ụmụaka ma ndị okenye) na-eteta onye ọrịa, na-atụgharị apnea, ma na-eme ka ọbara mgbali elu na ọnụ ọgụgụ obi dị elu ruo ** 50% ruo 80% nke nnukwu clonidine overdoses ** na-achọghị intubation endotracheal.
5. **Enyela ọgbụgbọ, na enyela mmiri, mmiri ara ehi, ma ọ bụ unyi na-arụ ọrụ n'ụlọ ***: N'ihi na ike ọgwụgwụ na mfu nke gag reflex iku n'ime nkeji 15 ruo 30, ihe ọ bụla etinyere n'ime afọ n'ụlọ na-emepụta ihe ize ndụ ozugbo nke oyi oyi na-egbu egbu.
6. ** dọrọ ndị otu ụlọ mberede aka na ntị banyere "Ọnyà mgbali ọbara Biphasic" (Early Paradoxical Hypertension -> Late Hypotension) : Ozugbo nnukwu clonidine, guanfacine, ma ọ bụ Visine overdose, ọbara dị elu na-akpali ** peripheral vaskụla alpha-2B na alpha-1 na-eme ka ndị na-anabata ya dị mkpụmkpụ nke 1 ** 0-mink. ọbara mgbali elu (paradoxical hypertension) na reflex bradycardia *** tupu Central brainstem alpha-2A mgbochi na-eweghara ma tụba onye ọrịa n'ime ** ogologo oge ala ọbara mgbali (hypotension). ** Dọkịta dọọ ndị dọkịta aka ná ntị ka ha ghara inye ọgwụ mgbali elu na-eme ogologo oge ma ọ bụ beta-blockers* n'oge mbelata ọbara mgbali elu ahụ dị mkpirikpi, ma ọ bụ onye ọrịa ga-enwe nkụchi obi na-enweghị mgbagha mgbe elekere 1 gachara mgbe usoro hypotensive dara.

Osisi mkpebi: Ịghọta na ijikwa Central Alpha-2 Agonist & Imidazoline ("Opioid-Mimic") nsị.¶

flowchart TD
    Start["A na-enyo enyo Central Alpha-2 Agonist / Imidazoline Mkpughe ma ọ bụ Ọrịa ụmụaka 'Opioid-Mimic' Coma na-akọwaghị (Ụmụ akwụkwọ Pinpoint + Apnea + Bradycardia)"] --> SourceID{"Chọpụta ihe nnọchite anya & ụzọ"}

    SourceID -->|1. Clonidine (Catapres Pills or TTS Transdermal Patch) or Guanfacine (Intuniv ER / Tenex)| ClonidineGroup["Ihe nrịbama Clonidine n'ime nwatakịrị:> 0.1 mg (ma ọ bụ> 0.005-0.01 mg / kg) = Otu mkpụrụ ọgwụ 0.1 mg ma ọ bụ TTS Patch ọ bụla atachara (nwere 2.5 mg, 5.0 mg, ma ọ bụ 7.5 mg ngụkọta) -> Mmalite 30-60 min (Guanfacine delayer)"]

    SourceID -->|2. Imidazoline Eye Drops / Nasal Sprays (Tetrahydrozoline [Visine], Oxymetazoline [Afrin], Naphazoline, Brimonidine [Alphagan/Lumify])| VisineGroup["Mmalite dị oke ngwa ngwa (Nkeji 15 ruo 45): Obere dị ka 1-2 ml nke 0.05% Ngwọta (0.5-1 mg) na nwata na-ebute Deep Coma, Hypothermia, Miosis, Apnea, & Bradycardia"]

    SourceID -->|3. Tizanidine (Zanaflex), Dexmedetomidine (Precedex), or Xylazine ('Tranq' Adulterant in Illicit Fentanyl)| TizanidineGroup["Tizanidine na-agbakwunye QT Prolongation & Hepatotoxicity; Xylazine na-ebute ọnya anụ ahụ siri ike nke Necrotic + Naloxone-Resistant Alpha-2 Coma jikọtara ya na njide iku ume Fentanyl."]

    ClonidineGroup --> DeconStep["Nleba anya ozugbo na ikuku ikuku: 1. Wepụ ihe mgbochi ọ bụla n'ọnụ ma ọ bụ akpụkpọ ahụ wee jiri ncha/mmiri saa akpụkpọ ahụ. Na-akwado ikuku ikuku/akpa-nkpuchi ventilashị 3. Ịgba mmiri n'afọ dum (PEG-ES) Naanị ma ọ bụrụ na ejiri Clonidine patch na-emebi emebi."]
    VisineGroup --> DeconStep
    TizanidineGroup --> DeconStep

    DeconStep --> NaloxoneTrial["Ọnwụnwa NALOXONE dị elu (maka ịda mbà n'obi CNS, Apnea, ma ọ bụ Hypotension / Bradycardia): - Na-elekọta Naloxone dị elu: 0.1 mg / kg IV (ma ọ bụ 2 mg ruo 10 mg IV Bolus na ụmụaka & ndị okenye) - Ọ bụrụ na edemede ọma / respiratory na-amalite na IV. 2/3 nke dose ịkpọte nke ọma kwa elekere (ma ọ bụghị ya, Intubation Endotracheal & Mechanical Ventilation)"]

    NaloxoneTrial --> HemodynamicPhase{"Kedu usoro nzaghachi Hemodynamic Biphasic dị ugbu a?"}

    HemodynamicPhase -->|Phase 1: Early Paradoxical Hypertension + Reflex Bradycardia (Peripheral Alpha-2B/Alpha-1 Vasoconstriction, First 1-3 Hours)| EarlyHTN["Ịdọ aka ná ntị: enyela Antihypertensives na-eme ogologo oge ma ọ bụ Beta-blockers (ga-eme ka ọ daa na-egbu egbu mgbe usoro nke abụọ na-akụtu) - Lelee HTN dị nro / na-adịghị mma (na-edozi ozugbo na 1-3h) - Ọ bụrụ na-eyi ndụ egwu egwu hypertensive Crisis: Jiri IV-Akụkụ nke Ultra-Nanị . Phentolamine"]

    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: Kedu ka Central Alpha-2 Agonists si ṅomie Opioids na Mepụta Ọnyà Ọbara Biphasic¶

1. Ihe kpatara Clonidine na Visine ji akpata Pinpoint ụmụ akwụkwọ, Coma, na Apnea (Locus Coeruleus Inhibition)¶

**Locus coeruleus *** dị na pons nke ụbụrụ ụbụrụ bụ etiti iwu etiti maka mkpali noradrenergic (norepinephrine), ịmụrụ anya, iku ume iku ume, na mmụba ụmụ akwụkwọ n'ime ụbụrụ mmadụ.

1. ** Presynaptic Alpha-2A Autoreceptor rụọ ọrụ (Gi/o Njikọta Protein) : Ma ** ndị na-anabata opioid (mu-opioid na ** alfa-2A adrenergic receptors (alpha-2A*** dị n'akụkụ n'akụkụ na neurons nke coeruleus locus wee kesaa ** kpọmkwem otu intracellular potassium/calcium channeling signaling.Gi/o njikọ protein nke na-egbochi adenylate cyclase, na-emepe ime imezi GIRK ọwa potassium na-eme ka neuron hyperpolarize na-egbochi ọwa calcium voltaji-gated)**.
2. ** Mkpokọta mkpuchi ọmịiko ("Opioid-Mimic" Tooxidrome)**: Mgbe clonidine, guanfacine, tizanidine, xylazine, ma ọ bụ tetrahydrozoline (Visine) na-abanye n'ime ụbụrụ ụbụrụ wee kpalie ** presynaptic etiti. alpha-2A na imidazoline-1 (I1) ndị na-anabata ya ** na mpaghara coeruleus na rostral ventrolateral medulla:
3. Ntọhapụ nke Norepinephrine na ụbụrụ na-adaba na nso-efu, na-atụba onye ọrịa n'ime coma (nke na-atụgharị n'ụzọ pụrụ iche maka sekọnd ole na ole n'oge mkpali na-egbu mgbu / nke na-emetụ n'ahụ dị ka ụzọ mmetụta mmetụta uche na-agba obere ọkụ).
4. Ụda parasympathetic na-enweghị mgbagha sitere na Edinger-Westphal nucleus na-egbochi sphincter iris, na-emepụta ụmụ akwụkwọ mara mma (miosis) ** enweghị ike ịmata ọdịiche dị na fentanyl ma ọ bụ heroin.
5. Ebe a na-ekuku ume nke medullary na-atụfu mbanye ọmịiko, na-akpata ** bradypnea na apnea cyclic ***.
6. A na-ewepụ ụda ọmịiko na-emetụ n'ahụ na oghere sinoatrial (SA), oghere atrioventricular (AV), na arịa ọbara dị n'akụkụ, ebe ụda parasympathetic vagal na-achịkwa, na-eme ka ** sins bradycardia miri emi, mgbochi obi AV, vasodilation systemic (hypotension), na hypothermia **.

2. Gịnị kpatara Naloxone dị elu (2 mg to 10 mg IV) Na-arụ ọrụ n'ọtụtụ ọgwụ Clonidine¶

Ruo ọtụtụ iri afọ, ndị dọkịta na-arụrịta ụka ma ** naloxone (Narcan) ** na-arụ ọrụ na nsị clonidine n'ihi na akụkọ mbụ na-eji obere ihe. 0.1 mg to 0.4 mg doses gosipụtara nsonaazụ na-ekwekọghị ekwekọ. Ọmụmụ toxicology ụmụaka nke oge a na-egosi na ** mkpali alfa-2 etiti na-ebute ntọhapụ nke beta-endorphins endogenous na ụbụrụ ụbụrụ ***, nke na-arụkọ ọrụ ọnụ. mu- na delta-opioid receptors n'otu aka ahụ Gi-neurons mpaghara coeruleus jikọtara ọnụ.

• ** Kedu ihe kpatara achọrọ nnukwu doses *: igbochi mmekọ ọrụ endorphin endogenous chọrọ ** supratherapeutic nnukwu dose Intravenous Naloxone0.1 mg/kg IV, ma ọ bụ 2 mg to 10 mg IV mkpokọta bolus na ụmụaka na ndị okenye).
• Na usoro ụlọ ọgwụ nke ụmụaka clonidine overdoses, na-enye ** ruo 10 mg nke IV naloxone ** na-akpọte ngwa ngwa ** 50% ruo 80% nke ụmụaka comatose/apneic **, na-egbochi ha pụọ ​​na intubation endotracheal na ikuku ikuku nke ICU, na-enwe mmetụta ọjọọ na ụmụaka na-abụghị opioid. * (Rịba ama: Naloxone dị elu na-adịchaghị irè na *imidazoline eye-dobe [Visine] ** na ** xylazine ** nsị karịa ọgwụ ** clonidine ** nsi, ọ bụ ezie na nnwale na-adị mma mgbe niile ma akwadoro ya).

3. Ọnyà Hemodynamic nke Biphasic: Ihe kpatara ọbara mgbali elu na-agba na agba nke abụọ¶

Ozugbo ilochara nnukwu clonidine, guanfacine, ma ọ bụ tetrahydrozoline, ntinye ọgwụ na ** n'ọbara ọbara ** na-agbapụta tupu ọgwụ ahụ emee nke ọma n'ofe mgbochi ụbụrụ ụbụrụ n'ime ụbụrụ ụbụrụ:

• ** Usoro 1 (Nke mbụ 30 ruo 180 nkeji - Peripheral Alfa-2B Vasoconstriction) ***: Nleta plasma dị elu na-akpali ozugbo ** postsynaptic peripheral alpha-2B na alpha-1 ndị na-anabata ya ** na mkpụrụ ndụ akwara dị nro na akwara na akwara, na-eme ka akụkụ vasoconstriction siri ike, ọbara mgbali elu na-agafe agafe (dịka ọmụmaatụ, BP). 180/110 mmHg na nwata ma ọ bụ 230/130 mmHg n'ime onye toro eto), nsọtụ dị jụụ na-acha uhie uhie, na bradycardia na-agbapụta baroreceptor.
• ** Usoro 2 (awa 2 ruo 48 - Central Alpha-2A Sympatholysis): N'ime awa 1 ruo 3, ọkwa ọgwụ dị n'akụkụ na-ekesa n'ime anụ ahụ ebe etiti ụbụrụ ụbụrụ. alpha-2A Mgbochi na-enye iwu zuru oke, na-emechi ụda ọmịiko ma mee ka ọbara mgbali elu ** na-agbada site na ọbara mgbali elu ruo ogologo oge hypotension na bradycardia **.
• ** Ọdachi Iatrogenic ***: Ọ bụrụ na onye dọkịta na-amaghị ihe na-agwọ ọbara mgbali elu nke Phase 1 na **labetalol, metoprolol, propranolol, hydralazine, ma ọ bụ nifedipine ***, ọdachi abụọ na-eme: (1) beta-blocker na-ewepụ nkwado beta-adrenergic ọ bụla fọdụrụ mgbe ọ na-ahapụ peripheral alpha vasoconstrip mgbe, ma ọ bụ 2 hypotension unposed (2 Ph. Nkeji 60 ka e mesịrị, enweghị ike gbanyụọ antihypertensive nke na-eme ogologo oge, na-akpata ** refractory cardiogenic na vasodilatory shock ***.

Tebụl ntụnyere nna ukwu: Central Alpha-2 Agonists, Imidazoline Eye/Nasal Drops, na Xylazine¶

Usoro njikwa ụlọ ọgwụ nzọụkwụ-site-nzọụkwụ¶

1. Ntọhapụ: Mgbe a ga-eji ogbugba mmiri n'afọ zuru oke maka patch Clonidine loro.¶

• ** Atala ma ọ bụ wụsa anya mmiri ma ọ bụ mmiri mmiri na-asọpụ ***: Emela ** emela lavage gastric ma ọ bụ nye unyi na-arụ ọrụ maka mmiri mmiri tetrahydrozoline/oxymetazoline anya (nke na-amịkọrọ kpamkpam n'ime nkeji 15 ruo 30 ebe ike ọgwụgwụ na-emepụta nnukwu ihe egwu).
• ** Clonidine Transdermal patch loro ya dum : A * Catapres-TTS patch nwere nkwado na-enweghị ike ime ya yana akpụkpọ ahụ na-achịkwa ọnụego nwere 2.5 mg to 7.5 mg Clonidine dị ọcha (25 ruo 75 ugboro nke oke ọnụ nke okenye) nke ga-aga n'ihu na-etinye clonidine n'ime afọ na eriri afọ maka ** ụbọchị. Ọ bụrụ na nwatakịrị ma ọ bụ okenye loro ihe mgbochi clonidine na-adịghị emebi emebi, nye ya ** Ọrụ Unyi (Activated Charcoal).1 g/kg) (mgbe ị nwetasịrị ụzọ ikuku ma ọ bụrụ na ụra na-ehi ụra) wee malite ** dum-Bowel Irrigation (WBI) na Polyethylene Glycol Electtrolyte Solution (PEG-ES, GoLYTELY na 25 mL/kg/hr na ụmụaka ma ọ bụ 1.5 to 2 L/hr n'ime ndị okenye site na tube nasogastric)** ruo mgbe ihe mgbochi plastik na-adịghị emebi emebi na-agafe n'ime ikuku rectal.

2. Usoro nnapụta hemodynamic na iku ume¶

1. ** Ụzọ ụgbọ elu & iku ume mbụ (Mkpali -> Naloxone dị elu -> Intubation) ***:
2. Tinye oximetry pulse na-aga n'ihu, ** ngwụcha tidal capnography (ETCO2***, na nlekota nke obi, na iji mkpali anụ ahụ dị nro maka apnea cyclic dị nro.
3. Maka hypoventilation na-adịgide adịgide, apnea, ma ọ bụ coma miri emi, na-enye ** Oke-Dose Intravenous Naloxone0.1 mg/kg IV ruo 2 mg mbido mbụ, na-emegharị ngwa ngwa kwa nkeji 2 ruo ngụkọta 10 mg IV)**. Ọ bụrụ na naloxone dị elu na-eweghachi iku ume na mkpali, malite ** naloxone infusion IV na-aga n'ihu na 66% (ụzọ abụọ n'ụzọ atọ) nke ọgwụ mgbochi mkpali dị irè kwa elekere **; ọ bụrụ 10 mg anaghị eweghachi ikuku ikuku zuru oke, rụọ ọrụ ** endotracheal intubation na ikuku ventilashion *. * (akpachara anya: N'oge intubation usoro ngwa ngwa, were ọgwụ ** IV Atropine buru ụzọ mee ya 0.02 mg/kg n'ihi na laryngoscopy na succinylcholine nwere ike ịkpalite njide vagal sinus na onye ọrịa clonidine bradycardic ugbua).
4. ** Ijikwa BradycardiaAtropine -> Epinephrine***:
5. Agwọla bradycardia dị nro asymptomatic ma ọ bụrụ na ọbara mgbali elu na nsị bụ ihe nkịtị.
6. Maka ** symptomatic bradycardia na hypotension ma ọ bụ adịghị mma perfusion , na-enye ** Atropine intravenous.0.02 mg/kg n'ime ụmụaka [ kacha nta 0.1 to 0.5 mg]; 0.5 mg to 1 mg na ndị okenye, repeatable ruo 3 mg). Ọ bụrụ na atropine ada ada, malite ** Epinephrine intravenous (0.05 to 0.3 mcg/kg/minma ọ bụ Dopamine (5 to 15 mcg/kg/min) infusion *** ma ọ bụ tinye pacing transcutaneous.
7. ** Ijikwa Hypotension vs. Early Paradoxical hypertension **:
8. ** Hypotension ***: Onye nchịkwa **10 to 20 mL/kg boluses nke 0.9% Nkịtị Saline ma ọ bụ Lactated Ringer's ** ma tinye onye ọrịa na Trendelenburg / ọnọdụ ihu igwe; Ọ bụrụ na hypotension na-aga n'ihu, malite ozugbo ** Norepinephrine ma ọ bụ infusion Epinephrine **. * (Rịba ama: ** Tolazoline *, onye na-emegide akụkọ ihe mere eme alpha-antagonist, bụ ** contraindicated ma gbahapụ ya ** n'ihi na ọ na-ebute arrhythmias na-enweghị atụ, hypotension siri ike, na ọbara ọgbụgba GI; Yohimbine adịghị adị na usoro mberede IV).
9. Mrịba ọbara mgbali elu nke mbụ: Hapụ ọbara mgbali elu na-adịru nwa oge n'emeghị ọgwụgwọ ọ gwụla ma enwere nnukwu mmebi akụkụ akụkụ ahụ (hypertensive encephalopathy, aortic dissection, ma ọ bụ edema pulmonary), na nke a titrate naanị ultra-short-eme ** Sodium Nitroprusside intravenous.0.3 to 3 mcg/kg/min*** ma ọ bụ ** Phentolamine0.05 to 0.1 mg/kg IV kwa nkeji 10 ọ bụla)** ka enwere ike mechie ya ozugbo mgbada ọbara mgbali.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

Ajụjụ a na-ajụkarị¶

Kedu ka ilo mmiri mmiri ole na ole nke Visine anya ma ọ bụ ịgba imi Afrin ga-esi tinye nwatakịrị n'ime coma?¶

Anya na-enye aka na-acha ọbara ọbara-na-na-na-na-na-counter (nwere tetrahydrozoline, naphazoline, ma ọ bụ brimonidine) na 12-hour imi decongestant sprays (nwere oxymetazoline ma ọ bụ xylometazoline) so na klas kemịkal a na-akpọ imidazolines - kpọmkwem otu ezinụlọ kemịkal dị ka ọbara mgbali na ADHD ọgwụ clonidine. Mgbe etinyere ya dị ka otu dobe n'anya, ha na-egbochi obere arịa ọbara n'elu mpaghara. Otú ọ dị, mgbe loro - ọbụna n'ihe dị ka obere dị ka 1 ruo 2 milliliters (ihe na-erughị ọkara teaspoon) - a na-etinye ha ngwa ngwa site na afọ ma na-agafe ihe mgbochi ụbụrụ ọbara na-akpali ndị na-anabata Central alpha-2A na imidazoline na ụbụrụ ụbụrụ, na-emechi usoro nhụjuanya ọmịiko nke anụ ahụ ma na-eme ka ụmụ akwụkwọ pinpoint, obi na-adịghị ala ala, nke dị ize ndụ, ọnụ ọgụgụ obi na-adịghị ala ala, nke dị ize ndụ. iku ume (apnea) n'ime nkeji iri na ise ruo iri anọ na ise.

Ịtinye anya Visine n'ime ihe ọṅụṅụ mmadụ na-akpata afọ ọsịsa dị ka na fim, ka ọ bụ akụkọ ifo?¶

Ọ bụ 100 percent ụgha na-egbu egbu akụkọ ifo. Tetrahydrozoline (Visine) anaghị ebute afọ ọsịsa ma ọlị. Kama nke ahụ, iji tetrahydrozoline ma ọ bụ oxymetazoline wụsa ihe ọṅụṅụ nke mmadụ na-ebuga neurotoxin na-adịghị ahụkebe, nke na-adịghị ahụkebe nke na-akpata coma, hypothermia, bradycardia, njide iku ume, na ọnwụ, a na-ekpekwa ya ikpe dị ka mmejọ nsị LC nke ụlọ ọgwụ na nyocha ọbara na-achọpụta ngwa ngwa.

Kedu ihe kpatara Naloxone (Narcan) na-eteta mgbe ụfọdụ nwatakịrị na-aṅụbiga mmanya ókè na Clonidine n'agbanyeghị na Clonidine abụghị opioid?¶

Clonidine na-akpali ndị na-anabata alpha-2A adrenergic na mpaghara coeruleus nke ụbụrụ ụbụrụ, nke na-ekerịta otu ọwa intracellular potassium na calcium dị ka ndị na-anabata mu-opioid ma na-akpalite ntọhapụ nke ụbụrụ endorphins eke. Mgbe ọkọlọtọ obere doses nke naloxone (`0.4 mg`) na-esikarị ike imeri mmetụta a, nchọpụta toxicology nke ụlọ ọgwụ na-egosi na ị na-enye ọgwụ Naloxone dị elu.`0.1 mg/kg`, ma ọ bụ `2 mg to 10 mg IV` mkpokọta) na-egbochi mmekọ ọrụ opioid endogenous a ma na-eteta ngwa ngwa 50% ruo 80% nke ụmụaka nwere nnukwu clonidine coma na apnea, na-egbochikarị ha ịchọ ikuku iku ume na ikuku.

Gịnị kpatara o ji dị ize ndụ ka dọkịta na-enye ọgwụ mgbali ọbara mgbe onye ọrịa Clonidine ma ọ bụ Visine karịrị akarị na-ebu ụzọ bute ọbara mgbali elu?¶

Nnukwu nfefe nke clonidine, guanfacine, ma ọ bụ Visine na-ebute nzaghachi mgbali ọbara "biphasic". N'ime nkeji 30 ruo 120 nke mbụ, ọkwa ọgwụ dị elu n'ọbara na-egbochi arịa ọbara dị n'akụkụ (site na ndị na-anabata alpha-2B), na-eme ka mmụba ọbara mgbali elu nwa oge tupu ọgwụ ahụ agwụchaa ịbanye n'ime ụbụrụ ụbụrụ. Ozugbo ọgwụ na-abanye n'ụbụrụ (n'oge 2), ọ na-emechi ihe niile nke etiti ọmịiko, na ọbara mgbali elu onye ọrịa na-adaba n'ime ọbara mgbali elu ogologo oge (hypotension) maka awa 12 ruo 36 na-esote. Ọ bụrụ na dọkịta na-enye ọgwụ ọbara mgbali elu na-eme ogologo oge ma ọ bụ beta-blocker n'oge obere oge mmalite ọbara mgbali elu, onye ọrịa ahụ ga-enwe nnukwu ọdachi, akpata oyi na-enweghị mgbagha ka otu elekere gachara mgbe Oge 2 dara.

Kedu ihe kpatara nwata nke loro ogologo mwepụta Guanfacine (Intuniv) ga-anọ n'ụlọọgwụ awa iri abụọ na anọ ọbụlagodi mgbe o telitere wee kwụsị ile anya ụra?¶

Mgbatị guanfacine (Intuniv) nwere ihe pụrụ iche, nke aghụghọ na usoro iheomume nke ịdoụbiga mmanya ókè: mgbe iro ụra na ịhịa aka n'ahụ na-apụta n'ime awa 2 ruo 6 mbụ ma na-emekarị ka ọ dịkwuo site na elekere 8 ruo 12, mmetụta obi siri ike - kpọmkwem hypotension orthostatic (ịda mbà mgbe ị na-eguzo ọtọ), sinus bradyc 2 ugboro ugboro ruo ogologo oge na Q2. Mgbe awa 24 gachara ilo mkpụrụ ọgwụ. Ịchụpụ nwatakịrị n'ime awa 6 ma ọ bụ 8 nanị n'ihi na ọ mụrụ anya nwere ike ime ka syncope na-egbu oge na bradycardic daa n'ụlọ.

Ntuziaka emetụtara¶

• Opioid ịdoụbiga mmanya ókè yana nchịkwa naloxone (Narcan).
• Beta-blockers na calcium channel blocker na-ebelata dose ahụ
• Nsi nicotine, mmiri vape ihe ọṅụṅụ, na transdermal patch toxicity
• Ụmụaka na ụmụaka CPR na nnapụta na-egbu egbu
• Enyemaka mbụ nsi na nchikota nsi

Isi mmalite na nduzi ọchịchị¶

• Ụlọ akwụkwọ American College of Medical Toxicology (ACMT) & Ụlọ Ọrụ Nsi America: * Nduzi Ntuzi Ọgwụ Ọgwụ na Central Alpha-2 Agonist Overdose, Pediatric Clonidine Transdermal Patch Toxicity, na High-Dose Naloxone Rescue*.
• Nchịkwa nri na ọgwụ ọjọọ nke United States (FDA) & Consumer Product Safety Commission (CPSC): * Nkwukọrịta nchekwa ọgwụ: Ihe omume ọjọọ dị egwu sitere na ntinye ihe mberede nke anya n'elu-na-counter na imi imi (Tetrahydrozoline, Oxymetazoline, Naphazoline) site na ụmụaka*.
• Ụlọ Akwụkwọ American Academy of Pediatrics (AAP): Ụgwọ ụmụaka "Otu pill nwere ike igbu" Mmalite: Clonidine, Guanfacine, na Imidazoline Na-akpata nsị n'ime ụmụ ọhụrụ na ụmụntakịrị.
• Ọrụ Ozi Nsi nke Mba (NPIS, United Kingdom): TOXBASE Usoro nlekọta ahụike maka Clonidine, Guanfacine, Tizanidine, na Imidazoline Decongestant Toxicity.
• Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC) & National Institute on Drug Abuse (NIDA): * Nduzi nlekọta ahụike maka ịzaghachi Fentanyl Adulterated na Xylazine ("Tranq") nfefe.

• Ntuziaka a bụ maka ebumnuche ozi na anaghị edochi nyocha ahụike mberede ọkachamara, nyocha nrịbama, ma ọ bụ nlekọta ahụike ụmụaka. N'ihi na clonidine patches na imidazoline anya tụlee nwere ike ime ka mberede cyclic apnea na bradycardia siri ike n'ime nkeji nkeji, anyị na-akwadosi ike ka ị nweta enyemaka enyemaka mbụ na ụmụaka CPR site na International Federation of Red Cross and Red Crescent Societies (IFRC), Red Cross obodo gị, St John Ambulance, ma ọ bụ onye na-enye ọrụ mpaghara.