Cone Snail Conotoxin Harpoon Sting, Sea Snake Myotoxicity, na Crown-of-thorns Starfish Plastertoxin Extraction¶

N'ofe coral reefs, ọdọ mmiri na mmiri dị n'ụsọ oké osimiri nke Indo-Pacific, Red Sea, Australia, na ebe okpomọkụ Eastern Pacific, divers, snorkelers, snorkelers, shells, and fishers chere ihu atọ dị iche iche nke mmiri mmiri na-enwe usoro mmerụ ahụ kpamkpam na iwu mgbochi ụlọ ọgwụ tupu ụlọ ọgwụ.* tulipa , na * Conus textile ), ** agwọ na-egbu egbu na oke osimiri ** (ezinụlọ * Hydrophiinae * na * Laticauda ), na ** Crown-of-thorns Starfish ** ( Acanthaster planci ). Mgbe onye na-anakọta na-ebuli elu geography cone snail ( Conus geographus ), ejula ahụ na-agbatị proboscis tubular ya wee gbaa ọkụ microscopic, oghere chitinous ** radular harpoon tooth (nwere ike ịpu akwa suut na uwe) nke na-etinye mmanya na-emekọrịta ihe nke ** alpha-, mu-, na omegaxine. Nke a "cabal" neurotoxic na-egbochi ndị na-anabata nicotinic acetylcholine, ọwa sodium skeletal muscle, na ọwa calcium presynaptic n'otu oge, na-akpali ** ngwa ngwa, na-agbadata mkpọnwụ ahụ na iku ume iku ume n'ime nkeji 15 ruo 60 n'enweghị ihe mgbochi ọ bụla dị adị. N'aka nke ọzọ, ata si n'ezi ** Snake Sea ** (Hydrophis / Enhydrina / * Aipysurus) na-abụkarị ** enweghị mgbu na ọ fọrọ nke nta ka ọ bụrụ ihe a na-adịghị ahụ anya** (obere pinpricks abụọ nwere ọzịza efu), ma ihe karịrị nkeji 30 ruo awa 6 ya ** phossolpholipase A2 myotovenized muscle (**) myolysis / rhabdomyolysis ***), na-eme ka agba agba agba, mmegharị ahụ na-egbu mgbu, ** coal-black myoglobinuric urine *, ** hyperkalemic cardiac arrest , na ahụ mkpọnwụ iku ume neurotoxic chọrọ ** CSL Sea Snake Antivenom. Ma ** Cone Snail snail and Snake Snake ata CHỌRỌ ka bandeeji nrụgide nrụgide Australia ozugbo (PIB) gbakwunyere splint . N'ụzọ dị iche, ịbanye ma ọ bụ na-ehichapụ megide ** Crown-of-thorns Starfish ** ( Acanthaster planci ) na-eme ka ọtụtụ 5 centimita calcium carbonate spines kpuchie na ** plastertoxins (steroidal saponins) n'ime akpụkpọ ahụ, na-akpata mgbu ọkụ, vomiting, na synovitis; Agaghị etinye ya na PIB, kama ọ chọrọ ** 45 C (113 F) imi mmiri na-ekpo ọkụ ** na ịwa ahụ / mmịpụta spain. Ọ bụrụ na ihe ọ bụla n'ime ihe ndị a na-ahụ maka mmiri agbụ mmadụ ma ọ bụ tara ya, kpọọ obodo gị nọmba mberede ozugbo. Nyochaakwa ntuziaka ụmụnna anyị na stingray barbs, oké osimiri urchin spines, na stonefish venom, jeliifish, na nnukwu mmerụ ahụ akụrụ na rhabdomyolysis.

Ihe kacha mkpa gị ozugbo bụ ** wepụ onye ahụ n'ime mmiri n'ụgbọ mmiri ma ọ bụ n'akụkụ osimiri ozugbo *** tupu ahụ mkpọnwụ emee ka mmiri rie ya, tinye bandeji ** wide elastic Pressure Immobilization Bandage (PIB) na splint siri ike ** maka ihe ọ bụla ** Cone Snail Sting or Sea Snake Aru**, guzoro njikere ịrụ ** ọnụ na-eku ume ma ọ bụ akpa-valve ma ọ bụrụ na ọ bụrụ na ọ na-anapụta ihe na-egbu egbu. ** Crown-of-thorns Starfish mmerụ ahụ **, gbanye akụkụ ahụ na ** mmiri ọkụ na 42 ruo 45 degrees Celsius (108 ruo 113 degrees Fahrenheit) maka nkeji 30 ruo 90 *** na-etinyeghị bandeeji nrụgide.

Mee nke a ugbu a¶

1. ** Dụpụ onye ahụ n'ime mmiri n'elu ụgbọ mmiri, ọdụ ụgbọ mmiri, ma ọ bụ mmiri akọrọ ozugbo, ma kpọọ nọmba mberede mpaghara gị ma ọ bụ nnapụta mmiri Coast Guard.** Kpọọ 000 na Australia, 111 na New Zealand, 911 na United States, Canada, na Philippines, 118 na Japan, 1669 na Thailand, 112 n'ofe European Union. nọmba mberede. Ma cone eju conotoxins na oké osimiri agwọ neurotoxins na-akpata ** na-aga n'ihu na-eme ka ahụ mkpọnwụ iku ume na-aga n'ihu ** ebe onye ahụ ka maara nke ọma.
2. **MAKWA ỤJỌ ỤJỌ MA Ọ BỤ agwọ oké osimiri: Tinye Bandage Immobilisation Pressure (PIB) na splint siri ike n'ime 60 sekọnd, ma mee ka onye ahụ na-eme ihe na-enweghị isi.
3. Ejila AKWỤKWỌ saa ebe agwọ dị n'oké osimiri na Australia (ụlọ nyocha ụlọ ọgwụ nwere ike ịsacha akpụkpọ ahụ maka ngwa nchọpụta Venom ma ọ dị mkpa).
4. Kechie bandeeji obosara 10 ruo 15 centimita kwụsie ike n'elu ebe a na-agba ụta ma ọ bụ na-ata ahụhụ, wee kechie ya na mkpịsị aka ma ọ bụ mkpịsị ụkwụ ya ruo n'apata ma ọ bụ ukwu na ** 40 ruo 70 mmHg ** (mkpagide ejiri maka nkwonkwo ụkwụ gbajiri agbaji). Kee ** splint siri ike ** n'akụkụ aka ma buru onye ọrịa ahụ n'elu akwa akwa.
5. ** Lelee anya nku anya onye ahụ, okwu, ilo, na iku ume kwa nkeji 2 ọ bụla; ma ọ bụrụ na iku ume na-emighị emi ma ọ bụ na-akwụsị, na-amalite ozugbo nnapụta iku ume (ọnụ-na-ọnụ, akpa mkpuchi, ma ọ bụ bag-valve-mask)** N'ihi na e nwere ** NO antivenom maka a cone Snail sting **, artificial ventilation (napụta ume n'akụkụ osimiri / ụgbọ mmiri, sochiri ụlọ ọgwụ n'ibu ventilashion maka 12 ka 48 awa) bụ ihe na-azọpụta ndụ ruo mgbe ebighị ebi. conotoxins.
6. ** Adịla eleghara pinprick na-enweghị mgbu mgbe ị na-ejikwa ụgbụ azụ ma ọ bụ na-agagharị na mmiri Indo-Pacific okpomọkụ.** Ihe karịrị pasent 80 nke ** Snake Sea (Hydrophiinae) ata ahụhụ adịghị egbu mgbu kpamkpam ** ma gosipụtaghị ọzịza mpaghara, na-eduga ndị ọkụ azụ na ndị na-egwu mmiri ka ha leghara ntachi anya ruo mgbe awa 1 ruo 4 gachara, mgbe anya na-agbachi agbachi ** trisosis. mgbu, na agba aja aja/mmamịrị ojii (myoglobinuria)** pụtara.
7. ** Maka Okpueze-Ogwu STARFISH (* Acanthaster planci ) NDỊ NA-ECHICHE: E tinyela Bandage Pressure Immobilization Bandage.* Kama nke ahụ, jiri nwayọọ wepụ ọkpụkpụ ọkpụkpụ ọ bụla na-apụtaghị ìhè na-ejighi ike na-egwepịa ha, na-emikpu n'aka ma ọ bụ ụkwụ sụọ n'ime ** mmiri ọkụ na 42 ka 485 degrees Celsius (100 degrees Celsius) ruo nkeji 90 *** iji mee ka okpomọkụ-labile rụọ ọrụ ** plastertoxins ** na saponins.
8. ** N'ụlọ ọgwụ: maka aru Snake Sea, nye CSL Sea Snake Antivenom (ma ọ bụ equine Tiger Snake / Polyvalent cross-reacting antivenom) na ọgwụgwọ hyperkalemia na-eyi ndụ egwu (IV calcium gluconate, insulin + dextrose); maka mmerụ ahụ Crown-of-thorns, nweta ụzarị anụ ahụ dị nro ma ọ bụ ultrasound iji wepụta ndụmọdụ spine subdermal na-emebi emebi.

Osisi mkpebi: Ntụnye mkpuchi mmiri Indo-Pacific na enyemaka mbụ¶

flowchart TD
    A["Indo-Pacific Coral Reef ma ọ bụ Envenomation mmiri"] --> B{"Kedu ihe dị n'ime mmiri kpatara mmerụ ahụ?"}
    B -->|Picked up patterned cone shell; sharp harpoon sting followed by numbness, double vision, and spreading weakness| C["Cone Snail (Conus geographus / C. textile) Envenomation Conotoxin"]
    B -->|Paddle-tailed marine snake in net or reef; painless tiny pinpricks; delayed muscle ache, droopy eyelids, or dark urine| D["Oké Osimiri Snake (Hydrophiinae) ma ọ bụ Oké Osimiri Krait (Laticauda) Ata"]
    B -->|Large multi-armed spiny starfish on coral; multiple reddish brittle spines embedded in hand/foot + fiery pain & nausea| E["Okpueze-nke-ogwu Starfish (Acanthaster planci) mmerụ ahụ ọkpụkpụ azụ"]
    C --> F["Tinye Bandage Nrụgide Nrụgide (PIB) + Ngwa ngwa ngwa; mee ka onye ọrịa dị larịị ma ghara imegharị ya"]
    D --> F
    F --> G{"Enwere ptosis ọ bụla, okwu na-adịghị mma, ike ilo, ma ọ bụ iku ume na-emighị emi?"}
    G -->|Yes: Descending Flaccid Paralysis| H["Bido iku ume nnapụta ozugbo (Pocket Mask / BVM) + Kpọọ Nọmba Mberede / Nchebe Coast maka Intubation"]
    G -->|No: Early stage| I["Ụgbọ njem ụlọ ọgwụ ngwa ngwa ICU nwere PIB nọ n'ọnọdụ ruo mgbe ndị otu ntulite dị njikere"]
    H --> J{"Cone Snail vs Protocol Hospitallọ Ọgwụ Snake"}
    I --> J
    J -->|Cone Snail| K["Ọ BỤGHỊ Antivenom dị: Igwe ikuku ikuku maka awa 12 ruo 48 ruo mgbe conotoxins kpochapụrụ -> mgbake akwara zuru oke"]
    J -->|Sea Snake| L["Nye CSL Sea Snake Antivenom + 12-edu ndú ECG & Calcium/Insulin IV maka Hyperkalemia + Mmiri IV maka Myoglobinuria"]
    E --> M["Ọ dịghị mgbe itinye PIB; imikpu ụkwụ n'ime mmiri ọkụ 42 ruo 45 C (108 ruo 113 F) maka nkeji 30 ruo 90"]
    M --> N["Nlekọta ụlọ ọgwụ: mgbochi akwara mpaghara + X-ray/Ultrasound iji wepụ spines calcareous na-agbaji agbaji + Tetanus & ọgwụ nje Vibrio"]

ntụnyere isi na isi: Cone Snails vs Sea Snakes vs Crown-of-thorns Starfish¶

N'ihi na ndị bi na mmiri mmiri atọ a nwere otu ebe obibi Indo-Pacific ma na-achọ ọgwụgwọ ụlọ ọgwụ dị iche iche, ntụnyere ụlọ ọgwụ dị oke mkpa:

Cone Snails (Conus geographus, C. tulipa, C. textile): Ọrụ Harpoon na Conotoxin Paralysis¶

1. Ihe kpatara ejula cone na-achụ azụ ji na-egbu mmadụ¶

Ụdị 800+ niile nke ejula cone mmiri (Genus * Conus *) bụ anụ anụ na-eri anụ nke na-achụ nta irighiri mmiri (vermivorous), mollusks ndị ọzọ (molluscivorous, dị ka ** Cloth-of-Gold Cone, * Conus textile ***), ma ọ bụ agile reef azụ (piscivorouse, onye na-eduzi ya). ** Tulip Cone, * Conus tulipa , na ** Striated Cone, * Conus striatus . - Ihe kpatara evolushọn Conus geographus na-egbu mmadụ: N'ihi na azụ nwere ike igwu mmiri n'otu ntabi anya ọdụ ya mgbe a kụchara ya, ejula cone na-achụ azụ mepụtara venom siri ike nke ga-eme ka ** kpochie sistemu neuromuscular nke vertebrate n'ihe na-erughị sekọnd abụọ. Ihe karịrị pasentị 70 nke ọnwụ cone mmadụ e dekọrọ n'ụwa niile bụ ihe kpatara Conus geographus. - ** Kedu ka Harpoon Radular si agbaji site na uwe aka na akpa: N'ime shea ya, eju cone na-emepụta quiver nke microscopic, oghere, ezé chitinous ( radiular ezé, 5 ruo 10 millimeters ogologo) dị ka obere whale harpoons jikọtara ya na bọlbụ venom muscular. Mgbe onye na-egwu mmiri ma ọ bụ onye na-egwu mmiri na-ebuli shei ahụ (ma ọ bụ tinye shea n'ime akpa ma ọ bụ akpa akpa), eju ahụ na-agbatị ** proboscis ** nke na-agafe n'ogologo ** ogologo nke shei ahụ ** wee gbaa harpoon jupụtara n'ọkụ ozugbo site na akpụkpọ mmadụ, uwe aka neoprene, ma ọ bụ obere mmiri mmiri.

================================================================================
   CONE SNAIL CONOTOXIN "MOTOR CABAL" AT THE HUMAN NEUROMUSCULAR JUNCTION
================================================================================

    [Presynaptic Motor Axon]
         |            |
         | [CaV2.2]   |<--- 1. OMEGA-CONOTOXINS (e.g. MVIIA / CVID)
         | Blocked    |        Block presynaptic N-type calcium channels so
         +------------+        acetylcholine (ACh) vesicles CANNOT release.
          (Synaptic Cleft)
         +------------+
         | [nAChR]    |<--- 2. ALPHA-CONOTOXINS (e.g. GI / MI)
         | Blocked    |        Competitively block postsynaptic nicotinic ACh
         |            |        receptors on the muscle motor endplate.
         | [NaV1.4]   |<--- 3. MU-CONOTOXINS (e.g. GIIIA)
         | Plugged    |        Physically plug skeletal muscle sodium channels
    [Skeletal Muscle / Diaphragm]  so no muscle action potential can fire.

  --> RESULT: Total Neuromuscular Blockade -> Flaccid Diaphragmatic Arrest
  --> CURE: Immediate PIB + Rescue Breathing / Mechanical Ventilation (12-48 hr)
================================================================================

2. The Pharmacology nke Conotoxin "Motor Cabal" na Clinical ọganihu¶

Otu * Conus geographus * harpoon sting na-etinye ihe karịrị 100 dị iche iche disulfide-ọgaranya obere peptides (** conotoxins**), nke na-arụkọ ọrụ ọnụ n'usoro ihe ọmụmụ physiological abụọ ahaziri nke onye biochemist Baldomero Olivera kọwara: 1. ** The "Lightning-Strike Cabal" (Nerve Stunning ozugbo):*** Delta-conotoxins** na-egbochi inactivation ọwa sodium ebe kappa-conotoxins na-egbochi ọwa potassium na sensory na moto axons dị nso na saịtị ahụ, na-eme ka ọkụ ọkụ ozugbo achọpụtara dị ka ihe mgbaka siri ike sochiri n'ime nkeji nkeji. 2. ** The "Motor Cabal" (Mkpokọta Triple-Lock Neuromuscular Blockade):** N'adịghị ka cobra ma ọ bụ agwọ oké osimiri na-awakpo naanị otu ebumnuche na nkwụsị neuromuscular, * Conus geographus * venom na-emechi n'otu oge ** usoro atọ nke nnyefe neuromuscular : - ** Presynaptic Calcium Blockade (Omega-conotoxins): *** Na-egbochi voltaji-gated N-ụdị calcium ọwa (CaV2.2) na ọdụ akwara moto (peptide sitere na * Conus magus * nke ghọrọ ọgwụ mgbu intrathecal na-adịghị ala ala ** ziconotide ), na-egbochi acetylcholine exocytosis. - ** Ihe mgbochi nnabata nke Posttsynaptic (Alpha-conotoxins): Na-asọmpi na-egbochi ụdị anụ ahụ nicotinic acetylcholine nnabata (nAChR) na endplate moto (dị ka curare). - Muscle Membrane Sodium Blockade (Mu-conotoxins): N'ụzọ anụ ahụ, na-akụnye ọwa sodium skeletal muscle voltaji (NaV1.4) ya mere eriri akwara enweghị ike imebi ọbụlagodi ma acetylcholine na-ejikọ. - * (Rịba ama: * Conus geographus na-ezobekwa azụ pụrụ iche nke nwere ngwa ọgụ dị ka ** insulin venom [Con-Ins G1] na-ebelata glucose ọbara.) 3. ** Usoro ihe mgbaàmà mmadụ (Nkeji 10 ruo 60):** - ** Nkeji 1 ruo 15:** Ọnwụ na paresthesia na-agbasa ngwa ngwa site na mkpịsị aka aka ya gbagoro n'ogwe aka, na-esote ya ** ntughari oge ** gburugburu egbugbere ọnụ na ọnụ. - ** Nkeji 15 ruo 30 (Cranial Nerve Palsies):** ** Ọhụụ na-agba agba, diplopia (ọhụụ abụọ), ptosis bilateral (nyocha nku anya), dysarthria (okwu na-adịghị mma), na dysphagia (enweghị ike ilo mmiri mmiri), na-esonyere ya na mgbagha gag na-anọghị. - ** Nkeji 30 ruo 60 (Njide Diaphragmatic): Mkpọnwụ skeletal skeletal zuru oke na-agbadata na akwara intercostal na diaphragm, na-ebute ** hypercapnic nkịtị na njide iku ume iku ume ** n'ime nkeji 30 ruo awa 2 ma ọ bụrụ na enweghị ikuku. 4. ** Nlekọta ụlọ ọgwụ ICU nke Cone Snail Envenomation:** - ** Debe PIB n'ebe *** ruo mgbe onye ọrịa nọ n'ọnụ mmiri resuscitation nwere ngwa intubation ikuku dị njikere. - ** Intubation Endotracheal na Mechanical Ventiation:** Tinye ngwa ngwa maka mbelata mbọ iku ume, ịgbakọ ihe nzuzo ọnụ, hypoxia, ma ọ bụ hypercapnia. - ** Ọnwụnwa nke Anticholinesterase (Neostigmine):** Ọ bụ ezie na mu- na omega-conotoxins na-eme elu na ala nke onye na-anabata acetylcholine, ndị dọkịta nwere ike ịnwale nnwale kpachara anya nke ** neostigmine (0.04 mg / kg IV) nke atropine butere (0.6 mg IV)** na-aga n'ihu na-emegide ikpe ventilashị n'agbanyeghị na ọ bụrụ na ọ bụ ihe mgbochi na-emeri ihe mgbochi. na-anọgide bụ ezigbo ọgwụgwọ ịzọpụta ndụ**. Site na awa 12 ruo 48 nke ikuku ikuku, conotoxins na-ekewa ma onye ọrịa na-eme ** 100% mgbake akwara ozi zuru oke ***.

Agwo oke osimiri (Hydrophiinae) na oke osimiri (Laticauda): Aru enweghi mgbu, Myolysis, na Hyperkalemia¶

1. Ihe kpatara a na-atụfu anụ Snake Sea ruo mgbe mmamịrị ojii na agba akpọchiri pụtara¶

Ezi ** agwọ oke osimiri ** (ezinụlọ * Hydrophiinae , gụnyere agwọ Beaked Sea [Enhydrina schistosa / * Hydrophis schistosus], Olive Sea Snake [* Aipysurus laevis*], Stoke's Sea Snake [Hydrophis stoke-Snake] [Hydrophis platura]) na amphibious ** oke osimiri kraits *** (Genus * Laticauda*) nwere ụfọdụ n'ime egbu egbu egbu egbu egbu egbu nke agwọ ọ bụla n'ụwa. - ** Gịnị kpatara ndị ihe metụtara na-eleghara ata ahụ anya:** Agwọ oké osimiri nwere ogologo mkpirisi n'ihu oghere dị mkpụmkpụ (naanị ** 1.5 ruo 4 millimeters ogologo**) na venom ha enweghị metalloproteases na-agbaze anụ ahụ dị na olulu olulu. N'ihi nke a, agwọ agwọ dị n'oké osimiri na-adị ka ** obere pinprick na-enweghị mgbu na akwụkwọ ** 1 ruo 4 ntụpọ ntụpọ nwere ọzịza efu, ọbara ọbara efu, na mgbu efu na ebe a na-ata**. - ** Myotoxic + Neurotoxic Clinical Triad (mmalite nkeji 30 ruo awa 6):** Ọ bụ ezie na ihe dị ka pasent 50 ruo 70 nke ihe nchebe bụ "akọrọ" (ọ dịghị ihe ọ bụla a na-agbanye n'ọkụ), agwọ ọ bụla nke oké osimiri nke na-emepụta venom na-emepụta ọrịa systemic syndrome nke na-achịkwa ** mgbawa ahụ ike zuru ụwa ọnụ (rhabdomyolysis) ** n'akụkụ ** postsynaptic / presynaptic neurotoxicity : 1. N'ime nkeji 30 ruo 120, onye ọrịa ahụ na-etolite ** isi ike na mgbu na olu, akpịrị, na agba (trismus: enweghị ike imeghe ọnụ ya), na-esote ngwa ngwa site na mgbu na-egbu mgbu n'ofe nnukwu skeletal niile (ubu onye ọrịa na-agafe n'ụkwụ) mgbe ọ bụla, ọ bụrụ na ọ na-emegharị ahụ. ("pseudoparalysis" n'ihi oke ahụ dị nro ). 2. ** Coal-Black Myoglobinuric Urine (3 ruo 6 Hours): Venom phospholipase A2 (PLA2) myotoxins hydrolyze the phospholipid bilayers of skeletal muscle fibers na ahụ dum, na-atụfu nnukwu ** myoglobin, creatine kinase), 50,000,000,00000, aspartate aminotransferase (AST), potassium, na phosphate ** banye n'ọbara. N'ime awa 3 ruo 6, mmamịrị onye ọrịa na-atụgharị ** miri na-acha ọbara ọbara-aja aja na-acha oji (myoglobinuria), na-ebuli myoglobin nkedo n'ime tubules gbasara akụrụ na-ebute ** oliguric nnukwu akụrụ akụrụ (AKI). 3. ** Mgbochi obi hyperkalemic na-egbu egbu na mkpọnwụ iku ume na-adịghị mma: Nnukwu potassium ntọhapụ sitere na eriri akwara lysed na-akpata ** ngwa ngwa, hyperkalemia na-eyi ndụ egwu (serum K+ na-ebili n'elu 6.5 ruo 8.5 mEq / L)** n'ime awa 4 ruo 12 (ebili mmiri T dị elu, mgbagwoju anya QRS, gbasapụrụ agbagharị agbagharị agbaze, mgbagwoju anya QRS). asystole**), ebe alfa-neurotoxins na-ebute **bilateral ptosis, ophthalmoplegia, bulbar palsy, na iku ume iku ume.

2. Ụlọ ọgwụ Antivenom na Hyperkalemia Protocol maka Envenomation Snake Sea¶

1. ** Ngwa ngwa ụlọ ọgwụ PIB + Splint:** Tinye ihe siri ike ** Australian Pressure Immobilization Bandage (PIB)** na splint siri ike ozugbo na-enyo enyo na agwọ ọ bụla n'oké osimiri na-ata, ọ bụrụgodị na ata ya enweghị ihe mgbu na ahụ ahụ dị onye ọrịa ahụ nke ọma na mbụ.
2. ** CSL Sea Snake Antivenom (Ngwọta Na-ahụ Maka Ọgwụgwọ):**
3. Onye nchịkwa ** CSL Sea Snake Antivenom** (equine F (ab') 2 welitere megide * Enhydrina schistosa * / * Notechis scutatus , nke na-ewepụ ihe niile dị mkpa * Hydrophiinae * oké osimiri na * Laticauda * oké osimiri kraits) ozugbo nye onye ọrịa ọ bụla na-egosi ihe ịrịba ama mbụ nke sistemu (* trismusness, ptosis) CK, ma ọ bụ mmamịrị gbara ọchịchịrị**).
4. Idozi: Malite na **1 ampoule (1,000 unit) gbanyere 1:10 n'ime saline isotonic nyere IV ihe karịrị nkeji 20 ruo 30 ** (ya na epinephrine dị n'akụkụ akwa dị njikere maka anaphylaxis). Maka envenomation siri ike (mkpọnwụ akpọnwụ akpọnwụ, myoglobinuria siri ike, ma ọ bụ hyperkalemia), nye ** 3 ruo 10 ampoules IV ** ozugbo.
5. ** Iwu Antivenom Backup Emergency Backup:** Ọ bụrụ na CSL Sea Snake Antivenom adịghị adị nwa oge n'ụlọọgwụ dịpụrụ adịpụ, CSL Tiger Snake Antivenom na-arụ ọrụ dị ka ihe ngbanwe dị mma na-anọpụ iche.
6. ** Hyperkalemia ike ike na mweghachi nke Rhabdomyolysis:**
7. Nweta ozugbo ** 12-edu ECG* na stat blood gas/electrolytes. Ọ bụrụ na ** hyperkalemia (K+> 6.0 mEq/L)** ma ọ bụ mgbanwe ECG (oke T ebili mmiri / obosara QRS) dị:
   • ** Mee ka myocardium guzosie ike ozugbo:** Nye ** 10% Calcium Gluconate (10 ruo 30 ml IV karịa nkeji 5)** ma ọ bụ 10% Calcium Chloride (5 ruo 10 ml IV site na ahịrị etiti).
   • ** Mgbanwe potassium intracellularly:** Nyenye ** Insulin mgbe niile (10 nkeji IV) + 50 ml nke 50% Dextrose (25 g glucose), gbakwunyere ** elu-dose nebulized Albuterol (Salbutamol 10 ruo 20 mg) na ** sodium Bicarbonate (50 ruo 100 m)* acid.
   • ** Wepụ potassium ma chebe akụrụ: *** Nyenye ** isotonic crystalloids ike ike ** ka ọ nọgide na-amịpụta mmamịrị karịa 200 ml / elekere, wee malite ** hemodialysis mberede ** maka hyperkalemia refractory ma ọ bụ ọdịda akụrụ oliguric.

Okpueze Starfish (* Acanthaster planci *): Plastertoxin Spines, Mmiri ọkụ, na mmịpụta¶

1. Ọkpụkpụ akwara na ihe kpatara ndụmọdụ ejigidere na-akpata synovitis na-adịghị ala ala¶

The ** Crown-of-thorns Starfish *** (* Acanthaster planci ) bụ nnukwu asteroid corallivorous nocturnal (na-eto 25 ruo 45 centimeters gafee na 8 ruo 21 ogwe aka) kpuchie n'elu elu ya site na narị narị agịga dị nkọ, 4- ruo 5-centimeter caliumcarees (magnes). - ** Otu esi ewepụta venom ahụ: *** A na-ekpuchi ọkpụkpụ azụ ọ bụla n'ime obere akpụkpọ anụ na-acha uhie uhie na-acha uhie uhie ** nwere mkpụrụ ndụ glandular nke na-ezobe ** plastertoxins I na II ** (ezigbo phospholipase A2 enzymes nke bụ hemolytic, myotoxic, na òké-egbu egbu), ** (dị ka steroidaldeglycins). membranes cell na ịkpalite nnukwu histamine na prostaglandin), yana histamine dị ka amines. - ** Ihe kpatara spines ji agbaji: *** N'ihi na isi ọkpụkpụ azụ bụ ihe na-adịghị mma, nke na-adịghị ike nke calcium carbonate crystal (* stereom *), na-aga n'ihu ma ọ bụ na-agbanye megide * Acanthaster planci * na-eme ka ọkpụkpụ azụ dị iche iche site na akpụkpọ ụkwụ ma ọ bụ akpụkpọ anụ, ebe ** ndụmọdụ ndị na-egbuke egbuke na-apụ n'okpuru epidermis ma ọ bụ nsị na-egbu egbu n'ime akpụkpọ anụ ahụ. capsules. - ** Ọrịa ahụike: ngwa ngwa, ihe mgbu na-egbu mgbu na-agbapụta n'akụkụ aka, ọbara ọgbụgba na-agba ọsọ site n'ọtụtụ oghere oghere, edema mpaghara ngwa ngwa na ecchymosis, yana mmerụ ahụ dị n'ọkpụkpụ azụ, ** ọgbụgbọ sistemu, ọgbụgbọ ogologo oge, dizziness, paresthesias, na lymphadenitis mpaghara. Ọ bụrụ na a na-ahapụ ndụmọdụ spine calcareous subdermal na epithelium na-egbu egbu n'ime aka ma ọ bụ ụkwụ, onye ọrịa ahụ na-etolite ** granulomas nke mba ọzọ, nke abụọ * Vibrio * / * Mycobacterium marinum * ọrịa, na granulomatous tenosynovitis na-adịghị ala ala ma ọ bụ ọrịa ogbu na nkwonkwo **.

2. Nlekọta nzọụkwụ-site-nzọụkwụ nke mmerụ ahụ Starfish Crown-of-thorns¶

1. Enyekwala bandeeji na-egbochi nrụgide nrụgide (PIB): Ikpuchi bandeeji siri ike n'elu * Acanthaster* spines na-eme ka shards calcareous na-agbaji banye n'ime akwara na nkwonkwo ma tinye uche na saponins cytolytic na phospholipase A2 na mpaghara.
2. Mmikpu mmiri na-ekpo ọkụ ozugbo (ogo 42 ruo 45 Celsius [108 ruo 113 degrees Fahrenheit]):
3. Tinye aka, ụkwụ, ma ọ bụ aka ahụ tara akpụ n'ime ** mmiri ọkụ na-anabataghị (42 ruo 45 C / 108 ruo 113 F, jiri aka na-emerụghị ahụ nwalee) maka nkeji 30 ruo 90 ***.
4. Plastertoxins na ndị na-edozi ihe mgbu bụ ** okpomọkụ-labile **; Imikpu mmiri ọkụ ngwa ngwa na-ebelata ihe mgbu site na 9/10 ruo ọkwa a na-achịkwa n'ime nkeji 20 ruo 30.
5. ** Mgbochi akwara ụlọ ọgwụ, mpaghara redio/Ultrasound, yana mmịpụta ịwa ahụ:**
6. Agbalịla iji nkume gwepịa spines agbakwunyere ma ọ bụ kụba ha n'ime akpụkpọ ahụ (omume ndị Indo-Pacific na-emerụ ahụ nke na-akụrisị calcite porous n'ime narị irighiri micro-granuloma na-enweghị ike iwepụ), ma tinye ya na mmanya na-atụ anya igbari spines subdermal n'otu abalị.
7. N'ụlọ ọgwụ ma ọ bụ n'ụlọ ọgwụ, nye a ** mpaghara ma ọ bụ mpaghara akwara ngọngọ (lidocaine ma ọ bụ bupivacaine) **, nweta ** soft-anụ ahụ dị larịị-film X-ray na / ma ọ bụ elu-ugboro ugboro ultrasound ** (niile calcium carbonate * Acanthaster * spines bụ ** rediopaque na X-ray ***), na-eji a ịwa ahụ scalpel, na ezi na-arụ ọrụ na-arụ ọrụ na-arụ ọrụ ọ bụla. ma hichapụ anụ ahụ n'ọbọ integumentary nwere pigmenti gbara ọchịchịrị.
8. Na-agba mmiri nke ọma na saline nkịtị na-adịghị mma, hapụ oghere miri emi ka ọ na-agbapụta, nye ya ** tetanus booster , ma nye iwu ** doxycycline (100 mg PO ugboro abụọ kwa ụbọchị) ma ọ bụ ciprofloxacin (500 mg PO ugboro abụọ kwa ụbọchị) gbakwunyere amoxicillin-clavulanate* maka ụbọchị 5 ruo 7 iji kpuchie marine, Vibrini alginolyticus *, na * Aeromonas *** ụdị.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• Australia na New Zealand: Kpọọ ** 000** na Australia ma ọ bụ 111 na New Zealand, ma ọ bụ akụ mmiri na-azọpụta mmiri / Coast Guard na VHF Channel 16. Soro ** ANZCOR Ntuziaka 9.4.5 (Envenomation: Jellyfish Stings and Marine Envenomation)** na ** Ntuziaka 9.4.1 (Ara agwọ) ***: tinye ngwa ngwa ** Mgbalị Mgbochi Mgbochi Bandage (PIB) + splint ** maka ** Cone Snails na Sea Snakes *** na-etinye n'ime mmiri 4 na-enweghị mmiri. maka Crown-of-Thorns Starfish. Kpọọ ** Ụlọ Ọrụ Ozi Poisons Australia na 13 11 26 ** maka ** CSL Sea Snake Antivenom *** lọjistik.
• ** Ndịda ọwụwa anyanwụ Eshia na Japan (Philippines, Indonesia, Thailand, Malaysia, Vietnam, Okinawa/Japan):** Kpọọ ** 911** na Philippines, ** 112 / 119** na Indonesia, ** 1669** na Thailand, 999 na Malaysia, ** 115** na Vietnam, ma ọ bụ ** 119 / 118 () Japan Coast Guard. Na Okinawa na Amami (Japan), ebe * Conus geographus * (* Anboina ), * Laticauda * oke osimiri kraits (Erabu-umihebi), na * Acanthaster planci * ( Onihitode*) bụ ihe egwu ama ama, ụlọ ọgwụ prefectural na-echekwa ọgwụ mgbochi mmiri ma na-enye ikuku ikuku ICU ozugbo.
• ** United States (Hawaii, Guam, American Samoa, California/Southwest Coast, na Captive Reef Aquariums): *** Kpọọ ** 911 ** ma ọ bụ kpọtụrụ ** US Coast Guard na VHF Channel 16 *** US Poison Control na 1-800-222-1222**, na ihe na-ekpo ọkụ na-ekpo ọkụ na netwọk ** DAN. +1-919-684-9111**. Rịba ama na pelagic ** Oké Osimiri Na-acha odo odo-Bellied (Hydrophis platura)** na-asachapụ mgbe ụfọdụ n'ikpere mmiri na Southern California, Baja California, na osimiri Hawaii mgbe ihe omume ọkụ El Niño gasịrị; emetụla agwọ atọ tọrọ atọ aka n'ikpere mmiri.
• ** United Kingdom na European Union (Red Sea / Indo-Pacific Travelers & Reef Aquarists):** Kpọọ 999 na UK, 112 gafee EU, ma ọ bụ 123 n'Ijipt (ebe ezumike mmiri nke Oké Osimiri Uhie), wee jụọ ** NPIS / TOXBASE** maka nnukwu aquarium cone snail ma ọ bụ Aquarium cone snail.

Ajụjụ a na-ajụkarị¶

Kedu ihe kpatara eji akpọ Geography Cone Snail (* Conus geographus *) "eju sịga," kedu ka ị ga-esi lanarị nrị?¶

Na Indo-Pacific, Conus geographus nwetara aha otutu "snail sịga" site na ikwubiga okwu ókè na mgbe ị nwụsịrị, ị nwere naanị oge zuru ezu iji ṅụọ sịga tupu ejide iku ume. N'ezie ụlọ ọgwụ, harpoon radilar ya na-agbanye mmanya na-emekọrịta ihe nke alpha-, mu- na omega-conotoxins nke na-egbochi nnyefe neuromuscular na saịtị atọ dị iche iche, na-eme ka ahụ mkpọnwụ na-agbadata ma kwụsị diaphragm n'ime nkeji 15 ruo 60. Ọ bụ ezie na ọ dịghị ọgwụ mgbochi dị, ị nwere ike ịlanarị pasent 100 nke oge ahụ ma ọ bụrụ na ndị nnapụta na-etinye ngwa ngwa na-etinye nrụgide nrụgide na-adịghị mma (PIB), na-eku ume na-aga n'ihu n'ọnụ na ọnụ ma ọ bụ akpa-valve-mask iku ume mgbe iku ume na-ada mbà, ma tinye onye ọrịa ahụ na ikuku ikuku ụlọ ọgwụ maka awa 12 ruo 48 ruo mgbe ahụ na-ekpochapụ conotoxins.

Kedu ka agwọ na-egbu egbu ga-esi bụrụ nke na-enweghị mgbu na mbụ?¶

N'adịghị ka rattlesnakes ma ọ bụ cobras, agwọ oké osimiri (Hydrophiinae) malitere nsị kpọmkwem iji mee ka azụ na eels dị n'ime mmiri na-enweghị ike ime ka anụ ahụ na-agbaze enzymes nke na-ebute mgbu na ọzịza na-ere ọkụ na ebe a na-ata. Na mgbakwunye, fang n'ihu ha edobere na-adị naanị 1.5 ruo 4 millimeters ogologo. Arụ agwọ dị n'oké osimiri na-adị ka obere pinprick na-adịghị emerụ ahụ nke nwere ọzịza ma ọ bụ ọbara ọbara, ya mere ndị ọkụ azụ na ndị na-awagharị awa na-elegharakarị ya anya ruo mgbe nkeji iri atọ ruo awa anọ gachara mgbe agba ha gbachiri nke ọma (trismus), akwara ọkpụkpụ ha niile na-egbu mgbu nke ukwuu ịkwagharị, mmamịrị ha na-atụgharịkwa kol-oji site na mgbakasị ahụ dum.

Kedu ihe kpatara agwọ oké osimiri ji atụgharị mmamịrị gị oji wee kwụsị obi gị?¶

Venom agwọ mmiri nwere sistemu phospholipase A2 myotoxins nke na-ekesa n'ọbara ma gbazee mpụta nke eriri akwara skeletal n'ofe ahụ. Ka mkpụrụ ndụ akwara na-emeghe, ha na-atụba nnukwu protein myoglobin myoglobin na-acha aja aja na-acha nchara nchara n'ime ọbara, nke na-enyocha akụrụ wee mee ka mmamịrị ahụ gbaa ọchịchịrị na-acha ọbara ọbara-aja aja ma ọ bụ kol-oji (myoglobinuria). N'otu oge ahụ, mkpụrụ ndụ akwara na-agbawa na-atụba potassium intracellular dị ukwuu n'ime ọbara (hyperkalemia), nke nwere ike ịkpalite njide obi na-egbu egbu (ventricular fibrillation) n'ime awa ole na ole ma ọ bụrụ na ejiri CSL Sea Snake Antivenom agwọ ya, calcium gluconate intravenous, na insulin na glucose.

Ekwesịrị m iji bandeeji nrụgide nrụgide ma ọ bụ mmiri ọkụ maka ahịhịa Starfish Crown-of-thorns?¶

Jiri imi mmiri na-ekpo ọkụ (42 ruo 45 degrees Celsius [108 ruo 113 degrees Fahrenheit] maka nkeji 30 ruo 90), na etinyela Bandage Immobilization Pressure (PIB) na mmerụ ahụ Crown-of-thorns Starfish (Acanthaster planci). Ichichi bandeeji siri ike n'elu ọnya azụ̀ kpakpando na-akwanye spines calcium carbonate na-esighị ike banye na nkwonkwo gị na akwara gị ma na-ejide saponins na plastertoxins n'otu ebe. Ịbanye ụkwụ ma ọ bụ aka n'ime mmiri ọkụ na-eme ka plastertoxins ndị na-ekpo ọkụ na-ekpo ọkụ ma na-ebelata ihe mgbu ahụ ruo mgbe dọkịta nwere ike were X-ray ma jiri ịwa ahụ wepụ ndụmọdụ ọkpụkpụ azụ gbajiri agbaji.

Kedu ihe kpatara na ị gaghị ahapụ naanị okpueze gbajiri agbaji n'aka ma ọ bụ ụkwụ gị ka ọ gbazee n'onwe ha?¶

Ọ bụ ezie na okpueze Starfish spines bụ nke calcium carbonate porous, a na-ekpuchi ọkpụkpụ azụ ọ bụla na n'ọbọ anụ ahụ na-egbu egbu nke jupụtara na plastertoxins na saponins, gbakwunyere nje bacteria dị ka Vibrio na Mycobacterium marinum. Ọ bụrụ na ndụmọdụ spain gbajiri agbaji na akpụkpọ anụ na-egbu egbu na-anọgide na-agbakwunyere n'okpuru dermis gị ma ọ bụ n'ime mkpịsị aka ma ọ bụ nkwonkwo ụkwụ, ahụ ahụ na-etolite granuloma na-egbu mgbu na granulomatous synovitis na-adịghị ala ala nke nwere ike ime ka nkwonkwo ahụ sie ike. Shad ọ bụla agbakwunyere n'ọkpụkpụ azụ na-egosi na X-ray anụ ahụ dị nro ma a ga-ewepụrịrị ya n'okpuru akwara akwara.

Ejula cone nwere ike manye gị n'aka ma ọ bụ mgbe ị nọ n'ime akpa na-anakọta ntupu?¶

Ee. Ejila aka efu ma ọ bụ aka kpuchiri ebuli shei cone dị ndụ, na etinyekwala shei cone dị ndụ n'ime akpa mmiri mmiri ma ọ bụ akpa ntupu nke kwụgidere n'ụkwụ gị ma ọ bụ n'úkwù gị. Ejula cone piscivorous dị ka Conus geographus ma ọ bụ Conus striatus nwere ike ịgbatị proboscis ya na-agbanwe agbanwe na njedebe azụ nke shei ya wee gbaa harpoon radilar agịga ya dị nkọ ozugbo site na akpa akwa, uwe aka mmiri, na mmiri mmiri dị nro.

Isi mmalite na nduzi ọchịchị¶

• ** Council Resuscitation Council (ANZCOR, Australia na New Zealand): ** ANZCOR Ntuziaka 9.4.5 (Mmiri Envenomation: Cone Shell PIB Protocol vs Echinoderm Spine Management)* na * Ntuziaka ANZCOR 9.4.1 (Snake Bite / Sea Snake Protocol)*.
• ** Ntuziaka ọgwụgwọ: Toxicology na Toxinology (eTG Complete, Australia) & AVRU:** * Nlekọta ahụike nke Snake Sea (Hydrophiinae) Myotoxicity, Hyperkalemia, na CSL Sea Snake Antivenom; Cone Snail Paralysis; na Acanthaster planci Spine Debridement *.
• ** Nyocha gbasara anụ ahụ: *** * Ọwa Calcium, Channel Sodium, na Nicotinic Nnabata Conotoxins nke Piscivorous Conus Species * (Terlau & Olivera, * Nleba anya Physiological *).
• ** Òtù Na-ahụ Maka Ahụ Ike Ụwa (WHO): *** Ntuziaka maka njikwa agwọ agwọ: Snakes (Hydrophiinae na Laticauda), Rhabdomyolysis, Myoglobinuria, na Hyperkalemia*.
• ** Divers Alert Network (DAN) & Wilderness Medical Society (WMS): *** Ndụ mmiri dị ize ndụ: Indo-Pacific Cone Snails, Sea Snakes, and Crown-of-thorns Starfish*.

Ntuziaka emetụtara¶

• Barbs Stingray, spain urchin oké osimiri, na nsị azụ̀
• Mmeri akụrụ dị oke njọ, rhabdomyolysis, na mbelata mmamịrị gbara ọchịchịrị
• Ata agwọ na ihe mberede ihe mberede na-akpụ akpụ
• Botulism, ciguatera, scombroid, na nsị neurotoxin mmiri
• Nọmba mberede site na obodo