Skip to content

Ihe ọṅụṅụ Nicotine Vape Liquid Liquid, Pouch Nicotine, na Patch Poison na ụmụaka na ndị okenye

Nọmba mberede dị iche na mba. Ibe a na-eji 911, nọmba maka United States na Canada. Ọtụtụ mba ndị ọzọ na-eji 112, 999, ma ọ bụ nọmba ọzọ. Chọta nọmba maka obodo gị.

Nicotine dị ọcha bụ otu n'ime neurotoxins botanical na-eme ngwa ngwa nke amaara na toxicology nke ụlọ ọgwụ, na-eme ozugbo na ndị na-anabata nicotinic acetylcholine gafee ụbụrụ, sistemụ akwara autonomic, gland adrenal, na skeletal muscle neuromuscular junctions. Ọ bụ ezie na sịga ọdịnala kpatara ọtụtụ ihe nchịkwa nsi ụmụaka na-akpọ maka ọtụtụ iri afọ, mmụba na-agbawa agbawa nke ** nicotine e-liquids na-etinye uche na mmiri ("ihe ọṅụṅụ vape" na 5% / 50 mg / mL nicotine nnu na-ejupụta karama) ***, obere akpa nicotine na-esi ísì ụtọ na-esi ísì ụtọ ** (dị ka ** ZYN, Rogue, na Veelo). 15+ mg kwa obere akpa), ** nicotine chịngọm na lozenges **, na ** transdermal nicotine patches ** (nwere ihe ruru 21 mg ruo 114 mg nke mkpokọta nicotine nchekwa kwa patch) agbanweela nsị nicotine ezinụlọ ka ọ bụrụ ihe mberede ahụike na-agbanwe ngwa ngwa. N'ihi na karama mmiri e-liquid na nicotine pouch tins na-esi ísì dị ka mkpụrụ osisi, mint, vanilla, ma ọ bụ afụ chịngọm ma na-ahapụkarị ya na tebụl kọfị, ebe a na-ehi ụra, ma ọ bụ ihe nkasi obi ụgbọ ala, ndị na-eto eto na-achọ ịmata ihe nwere ike ilo ma ọ bụ wụfuo dose nwere ike igbu n'ime sekọnd.

Ọ bụrụ na nwatakịrị ma ọ bụ okenye loro mmiri nicotine vape juice, rie ma ọ bụ loda nicotine obere akpa ma ọ bụ chịngọm, tinye otutu nicotine patches, ma ọ bụ wụfuru e-liquid na akpụkpọ ahụ ha, kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 n'ofe European Union, 999 na United Kingdom). nọmba mberede ndekọ ozugbo, ma nyochaa nsi mbụ enyemaka, enyemaka mbụ ọdịdọ, na ụmụaka na ụmụ ọhụrụ CPR. Ihe na-eme nnukwu nsị nicotine dị aghụghọ bụ ** ngwa ngwa biphasic toxidrome : mmalite ** Phase 1 hyper-cholinergic excitation oké ifufe (mgbawa mgbawa, ọsụsọ na-agbapụta, mkpọnwụ, ọbara mgbali elu, ọnụ ọgụgụ obi ngwa ngwa, mgbakasị ahụ, akwara anụ ahụ, na ** ihe ọdịdọ zuru oke n'ime nkeji iri). Mgbochi na-emebi emebi na ndakpọ *** (ọnụọgụ obi na-adị ngwa ngwa, nnukwu hypotension, coma, na ** ahụ mkpọnwụ nke diaphragm na akwara iku ume*).

Mee nke a ugbu a

  1. ** Kpọọ 911/112/999 ma ọ bụ Control Poison ozugbo ***: Kpọọ ndị ọrụ ahụike mberede ozugbo ma ọ bụrụ na nwatakịrị loro ego ọ bụla nke nicotine mmiri (ihe ọ juiceụ ụ vape), ilo ma ọ bụ rie ihe karịrị otu obere obere nicotine obere akpa / chịngọm, ma ọ bụ ọ bụrụ na nwatakịrị ọ bụla ma ọ bụ okenye na-amalite ịgba agbọ, ọsụsọ na-acha uhie uhie, ọsụsọ na-adịghị mma, akpịrị ịkpọ nkụ ike iku ume. Maka obere mkpughe asymptomatic, kpọọ Control Poison (1-800-222-1222 na US) ozugbo.
  2. Sachaa ọnụ wee lelee ahụ dum maka obere akpa nicotine zoro ezo ma ọ bụ patches : Ngwa ngwa leba anya n'ime ọnụ nwatakịrị ma ọ bụ onye ọrịa, ọkachasị n'etiti egbugbere ọnụ elu ma ọ bụ nke ala na chịngọm, wee were mkpịsị aka ekechiri na akwa iji wepụ ihe ọ bụla ** nicotine pouches (ZYN, Velo, On), ** ịta chịngọm,/tozen. Ọ bụrụ na onye ọrịa ahụ nwere mgbagwoju anya ma ọ bụ ọ naghị anabata ya, yipụ uwe ha wee lelee azụ, obi, ubu, ogwe aka, na apata ụkwụ maka ** transdermal nicotine patches ** (nke na-adịkarị translucent ma ọ bụ na-acha akpụkpọ anụ na-adị mfe).
  3. Sachaa nicotine mmiri mmiri wụfuru (ihe ọ juiceụ ụ vape) ma ọ bụ jiri ncha na mmiri dị jụụ saa ihe nrapado n'ahụ. Ọ bụrụ na e-mmiri wụsara n'aka nwata, ihu, olu, ma ọ bụ uwe elu, wepụ uwe niile emetọsịrị ngwa ngwa wee were mmiri dị nro na ncha dị nro sachaa akpụkpọ ahụ nke ọma maka nkeji iri ruo iri na ise. Ejila mmiri ọkụ (okpomọkụ na-agbasa arịa ọbara ma na-eme ka nicotine banye n'ọbara) yana ** ejikwala ihe na-egbu mmanya na-egbu egbu ​​(nke na-akpaghasị ihe mgbochi akpụkpọ ahụ ma na-abawanye nnabata).
  4. ** Ewelitela ọgbụgbọ ma ọ bụ nye mmiri mmiri ka ọ ṅụọ : Nicotine na-akpalite ebe a na-agbọ agbọ nke ụbụrụ ( mpaghara postrema*) ozugbo n'ime nkeji iri nri, yana ọ nwere ike bute ọdịdọ zuru oke na mberede ma ọ bụ enweghị mmụọ n'ime nkeji 10 ruo 20 **. Inweta vomiting ma ọ bụ ịwụsa mmiri/mmiri ara ehi n'ọnụ na-emepụta nnukwu ihe ize ndụ nke ọchịchọ nke akpa ume na-egbu egbu ma ọ bụrụ na onye ọrịa ahụ jidere na mberede ma ọ bụ daa mbà.
  5. ** Tinye onye na-agba ma ọ bụ onye iro ụra n'akụkụ ha (Nkwụghachi ọnọdụ) wee lelee iku ume ha anya **: N'ihi na nsi nke nicotine nke abụọ na-eme ka ahụ kpọnwụrụ akpọnwụ ** diaphragm na akwara ume iku ume ** (dị ka ọgwụ ahụ kpọnwụrụ akpọnwụ succinylcholine), onye ọrịa kwụsịrị ịma jijiji ma ọ bụ yie ka ọ "na-ada mbà n'obi mgbe ọ na-agbọ agbọ." Ọ bụrụ na ha anabataghị ma kwụsị iku ume, bido ozugbo CPR jiri iku ume nnapụta (30:2 maka ndị okenye ma ọ bụ ụmụaka na-anapụta otu; 15:2 maka CPR ụmụaka nwere nnapụta abụọ).
  6. ** Weta kpọmkwem karama vape, ngwaọrụ vape nke a ga-ewepụ, ma ọ bụ tin obere akpa n'ime ụlọ mberede ***: Gụọ akara maka ntinye uche nicotine *** (mg/mL ma ọ bụ %, na-echeta na 5% nicotine nhata 50 mg/mL) na ike ** obere akpa milligram ** (3 mg, 6 mg, 8 mg, 12 mg, or 15+ mg).

Ọnyà mgbakọ na mwepụ '5% Vape': Ihe kpatara otu teaspoon ji nwee sịga 50 bara uru nke Nicotine Liquid

Ọtụtụ vapers na ndị nne na nna na-eche na karama ma ọ bụ pọd akpọrọ ** "5% Nicotine" (Nnu Nicotine) adịghị ike. N'okwu ọgwụ, ** 5% nicotine ruru 50 milligrams nke nicotine dị ọcha n'ime otu milliliter ọ bụla.50 mg/mL)**. - Otu ** 5 ml (1 teaspoon) ilo nke 5% e-mmiri na-ebunye ** miligram 250 nke nicotine mmiri gbazere , dakọtara na nicotine na-etinye uche nke ** ihe karịrị sịga 200 na-ese anwụrụ niile na-akụtu eriri afọ n'otu oge. - N'ime nwatakịrị 10-kilogram (ụnd 22), na-eloda ọbụna ** ọkara teaspoon (1 ka 2 ml) nke 5% (50 mg / ml) vape liquid ** (ma ọ bụ Mee N'onwe Gị) 100 mg/mL mixing base) na-ebuga 5 ruo 10 mg/kg nke nicotine mmiri dị ndụ ozugbo, nke nwere ike ịkpalite ihe ọdịdọ ike, ahụ ahụ mkpọnwụ iku ume, na njide obi n'ime nkeji 15 ruo 30 ***.

Osisi mkpebi: Nicotine e-mmiri, obere akpa, patch, na nsi ụtaba

flowchart TD
    Start["Suspected Nicotine Exposure (E-Liquid Vape Juice, Oral Pouches [ZYN/Velo], Gum, Patch, or Tobacco)"] --> ClearSource["1. Wepu ọnụ maka obere akpa / chịngọm/ụtaba\n2. Lelee akpụkpọ ahụ maka ihe nkpuchi zoro ezo\n3. Yipụ akwa na saa E-Liquid wụfuru n'ahụ ya na ncha na mmiri Lukewarm (Ọ dịghị mmiri ọkụ)"]

    ClearSource --> RouteSource{"Chọpụta ụdị ngwaahịa na ọnọdụ akara"}

    RouteSource -->|Liquid Nicotine (Vape Juice / Refill Bottle / Broken Pod) Ingested OR Any Symptomatic Patient| Urgent911["Kpọọ 911/112/999 ozugbo:\nMmalite ngwa ngwa (Nkeji 10 ruo 30) nke Vomiting, Seizures, and Respiratory Paralysis"]

    RouteSource -->|Oral Nicotine Pouch (ZYN/Velo/On), Gum, or Cigarette Butt in Asymptomatic Child| DoseCheck{"Nwata riri> 1 obere akpa / chịngọm ma ọ bụ > 1 Siga dum ma ọ bụ > 0.2 mg/kg?"}
    DoseCheck -->|Yes or Uncertain Count| UrgentED["Ntụle Ngalaba Mberede & Nleba anya elekere 4 ruo 6 (Ruo awa 12-24 ma ọ bụrụ na ejiri mebie emebi emebi)"]
    DoseCheck -->|Minor Brief Taste (< 1/2 Cigarette Butt or Brief Pouch Mouthing) + Zero Symptoms| PoisonCall["Kpọọ njikwa nsi (1-800-222-1222 na US) maka nlele ụlọ nke awa 4 ga-eduzi."]

    Urgent911 --> BiphasicTrack["Nlekọta ụlọ ọgwụ ICU maka Biphasic Nicotine Toxidrome"]
    UrgentED --> BiphasicTrack

    BiphasicTrack --> Phase1["PHASE 1 (N'isi: 15 Min ruo 1-2 Hours) - Nicotinic Nnabata Overstimulation:\nNausea, Projectile Vomiting, Pale Diaphoresis, Salivation/Bronchorrhea, Hypertension, Tachycardia, Agitation, Tremors, Fasciculations, Generalized Seizures"]

    Phase1 --> Phase2["PHASE 2 (N'ikpeazụ: 30 Min ruo 4+ Hours) - Nkwụghachi nke onye na-anabata ihe & Mgbochi Neuromuscular:\nBradycardia siri ike, Hypotension/Mjo, Lethargy/Coma, Anụ ahụ adịghị ike, Diaphragmatic Paralysis & Apnea"]

    Phase2 --> HospitalRescue["Nzọpụta ụlọ ọgwụ ezubere iche:\n1. Ihe ọdịdọ: IV Benzodiazepines (Lorazepam/Midazolam)\n2. Ihe nzuzo muscarinic/Bradycardia: IV Atropine (0.5-1 mg okenye / 0.02 mg/kg Nwa)\n3. Ahụ mkpọnwụ iku ume: mmalite endotracheal intubation + Igwe ikuku ikuku (Zere Succinylcholine)\n4. GI Decontamination: Unyi arụrụ ọrụ (maka obere akpa / mbadamba/patches eloro) + Mgbasa mmiri n'afọ dum ma ọ bụrụ na edoro patch"]

Pathophysiology: Ịghọta Biphasic Nicotine Tooxidrome

Kedu ihe kpatara onye nicotine na-egbu egbu ji malite na ** ọbara mgbali elu elu igwe, obi na-agba ọsọ, mgbakasị ahụ, na ọdịdọ ime ihe ike *, wee daa na mberede 30 ruo 90 nkeji mgbe e mesịrị na ** ọbara mgbali elu dị ize ndụ, ọnụma obi nwayọ, coma, na ahụ mkpọnwụ nke uru iku ume ha zuru oke?

1. Ebe Nicotinic Acetylcholine Nnabata (nAChRs) Na-ebi n'ime ahụ mmadụ

Nicotine bụ ihe nleba anya nke neurotransmitter ** acetylcholine (ACh)** ma na-ejikọ aka na-ahọrọ ya na ọwa ion nicotinic acetylcholine ligand-gated.nAChRs*** na saịtị anọ dị oke mkpa: 1. ** Sistemụ akwara etiti (ụbụrụ na ụbụrụ)***: Gụnyere chemoreceptor mpaghara na-akpata (mpaghara postrema) na medulla (na-akpata mgbawa n'oge), cortex (na-akpata mkpasu iwe, ịma jijiji, na ọdịdọ zuru oke), yana ebe iku ume. 2. Ganglia nwere ọmịiko na adrenal medulla: na-akpali akpali akwara ọmịiko postganglionic na gland adrenal iji tụfuo nnukwu mmụba nke *epinephrine na norepinephrine n'ime ọbara (na-akpata vasoconstriction n'oge, ** pallor akpụkpọ, ọbara mgbali elu, na tachycardia). 3. ** Parasympathetic Autonomic Ganglia ***: ụzọ vagal na-akpali akpali na ụzọ cholinergic nke na-akpata ** salivation bara ụba (drooling), lacrimation, bronchorrhea (ihe nzuzo ngụgụ mmiri), ọsụsọ (diaphoresis), ọnya afọ, vomiting na afọ ọsịsa. 4. ** Ọkpụkpụ akwara Neuromuscular Junctions (NMJ, Motor End-Plates) ***: Kpọmkwem otu ndị na-anabata nicotinic na eriri akwara skeletal na ** diaphragm ** nke na-ebute mkpụkọ akwara mgbe ị na-eku ume ma ọ bụ na-emegharị.

2. Ihe kpatara mkpali na-agbawa agbawa nke mbụ n'ime akụkụ nke abụọ ahụ mkpọnwụ (Depolarizing Blockade)

Mgbe ** acetylcholine nkịtị** na-ejikọta ya na onye na-anabata nicotinic na neuromuscular junction, ọ na-emepe ọwa sodium/calcium maka akụkụ dị nta nke millisecond iji kpalite mkpụkọ akwara wee * bibie ya ozugbo site na enzyme acetylcholinesterase.

N'ụzọ dị iche, ** nicotine enweghị ike imebi site na acetylcholinesterase *: - ** Usoro 1 (Agonist Hyper-Stimulation: Nkeji 10 ruo elekere 1 ruo 2): Mkpọchi Nicotine na ndị na-anabata nicotinic ma mee ka ọwa ion na-emeghe mgbe niile, na-agbapụ irighiri akwara na mọzụlụ n'akwụsịghị akwụsị. Onye ọrịa ahụ na-enweta ọgbụgbọ na-apụta, ọsụsọ na-acha odo odo, mkpọnwụ, ọbara mgbali elu, tachycardia, akwara anụ ahụ (ịgbara agbaji), na ọdịdọ tonic-clonic zuru oke. - Usoro 2 (Depolarization na-adịgide adịgide na Desensitization na Nnabata: Nkeji 30 ruo awa 4+)**: N'ihi na nicotine na-anabata ndị na-anabata nicotinic na-adịgide adịgide na akpụkpọ ahụ cell na-anọgide na-emebi emebi, ọwa sodium voltaji dị n'akụkụ efere moto ahụ enweghịke ịmaliteghachi n'onwe ya na nicotinic. desensitized, refractory mechiri emechi echi ** (** deparizing neuromuscular mgbochi **, yiri ngafe nke ịwa ahụ ahụ mkpọnwụ ahụ succinylcholine). - N'otu ogeautonomic ganglia na-egbochi ma draịva etiti ụbụrụ na-ada ada. Ọbara mgbali elu na-adaba ( hypension na shock *), ọnụ ọgụgụ obi na-adaba n'ime ** bradycardia ri ike ma ọ bụ ngọngọ AV ***, nsụhọ na-adaba na coma, na diaphragm na akwara intercostal na-aghọkwa flacd kpamkpam , na-akpata ọnwụ site na ** asphyxiation (apnea) ma ọ bụrụ na etinye onye ọrịa ahụ na ikuku ikuku.

Oge Clinical & Ohere Oge Ihe ịrịba ama dị mkpa (Ọnụ Obi, Ọbara, iku ume) Nchọpụta Neurological & Muscular Ihe ịrịba ama nke eriri afọ & autonomic
** Usoro 1: Usoro mkpali Ọkachamara
( Mmalite: 10 ruo 30 nkeji ** mgbe mmiri mmiri / obere akpa; ọnụ ọgụgụ kacha elu n'ime ** 1 hour ***)		 Tachycardia (ọnụọgụ obi ngwa ngwa), ọbara mgbali elu** (ọbara mgbali elu), ** Tachypnea** (ume ngwa ngwa) na hyperpnea. Nchegbu, enweghị izu ike, isi ọwụwa, isi ọwụwa, mgbagwoju anya, ** ịma jijiji mara mma na-adịchaghị mma ***, ** akwara anụ ahụ **, na ** ọdịdọ tonic-clonic n'ozuzu ya. Ihe mgbawa n'oge na ọgbụgbọ na ọgbụgbọ (mgbe ọ bụ akara nke mbụ), afọ ọnya afọ, afọ ọsịsa, ** ọsụsọ na-atụ oyi na-atụ, ** akpụkpọ ahụ na-acha odo odo (pallor)**,* mmiri na-asọ oyi (salivation)**, na nzuzo mmiri nke bronchi.
** Usoro 2: Mgbochi na-emebi emebi & Ndakpọ n'usoro *
( Mmalite: nkeji 30 ruo awa anọ ***; na-adịru awa 4 ruo 24 ***)		 ** Bradycardia siri ike *** (ọnụọgụ obi nwayọ), ihe mgbochi AV, ** Hypotension miri emi na ujo **, hypoventilation na-emighị emi na-aga n'ihu na Apnea (ejide iku ume). Ike ike ọgwụgwụ, nzuzu, coma miri emi, mfu nke ntụgharị uche akwara miri emi (** areflexia**), na ** ịrịgo ma ọ bụ ahụ mkpọnwụ akwara zuru oke** (gụnyere mkpọnwụ nke ** diaphragm**). Ụmụ akwụkwọ nwere ike ịgafe site na mkpọnwụ (miosis) gaa na dilated (mydriasis); ụda eriri afọ na-ebelata ka mgbochi ganglionic na-amalite.

Tụnyere ngwaahịa Nicotine ọgbara ọhụrụ: Ihe kpatara ihe ọṅụṅụ Vape Liquid na obere akpa ji dị ize ndụ karịa mkpọ sịga

Ruo ọtụtụ iri afọ, ndị dọkịta na-ahụ maka ihe mberede chọpụtara na ụmụaka ndị riri otu sịga ma ọ bụ isi sịga na-adịkarịghị anwụ. Kedu ihe kpatara ** e-mmiri mmiri ọgbara ọhụrụ *** na ** obere akpa nicotine *** na-ebute nsi ka njọ?

Ngwaahịa Nicotine Ọdịnaya Nicotine a na-ahụkarị Ọsọ nke Absorption & Bioavailability Ihe kpatara ihe ize ndụ nsi ji dị iche
1. Nicotine Liquid ("Ihe ọṅụṅụ Vape" / E-Liquid Refill Bottle & Pods) 3 mg/mL ruo 24 mg/mL (Freebase) ma ọ bụ 25 mg/mL ruo 50 mg/mL [2.5% ka 5%] (Nicotine Salts); ruo 100 mg/mL (10%) na ntọala ngwakọta DIY. ** Otu karama 30 ml nke nnu 5% = 1,500 mg nke nicotine dị ọcha. ** ULTRA-RAPID (nkeji 5 ruo 15)** gafere mucosa ọnụ, afọ na ** akpụkpọ ahụ adịghị emebi emebi. Ugbua 100% etisasịwo na propylene glycol / akwukwo nri glycerin; **na-amịnye ozugbo site n'apata ọnụ na akpụkpọ ahụ *** tupu ebe ụbụrụ ụbụrụ enwee ike ịchụpụ ya. Ụtọ swiiti/mkpụrụ osisi na-agba ụmụaka ume ịṅụ ọtụtụ gulps.
2. Akpa Nicotine Oral (obere obere akpa ụtaba na-enweghị ụtaba)
(ZYN, Velo, On, Rogue, Fre, Kurwa / Iceberg)		 ** 3 mg, 4 mg, 6 mg, 8 mg, 12 mg, ma ọ bụ 15 mg kwa obere akpa ** na mkpọsa US/EU (obere akpa "oke" iwu na-akwadoghị/bubata nwere 30 mg ruo 50+ mg kwa obere akpa). ** Otu mpempe akpa 15 nke 6 mg ZYN = 90 mg.** RAPID gafee buccal/ọnụ mucosa (ihe ndị na-ebufe alkaline dị ka sodium carbonate na-ebuli pH ọnụ n'ọnụ 8.0-8.8 ịmanye nicotine jikọtara ọnụ ozugbo site na goms) + ** ntọhapụ GI na-adịgide adịgide ma ọ bụrụ na iloro ya **. N'adịghị ka akwụkwọ ụtaba na-acha aja aja na-eme ka nwatakịrị na-agba ọsọ ọsọ ọsọ, obere akpa cellulose na-atọ ụtọ (peppermint, citrus, coffee, berry) ma jiri ** alkaline pH buffers rụọ ya iji mee ka mmịkọ ngwa ngwa dịkwuo elu.
**3. Ngwunye Nicotine & Lozenges ***
(Nicorette, Kọmiti, Rogue)		 ** 2 mg ma ọ bụ 4 mg kwa ibe. Ntinye buccal ngwa ngwa ma ọ bụrụ na ata ya ** ma ọ bụ aṅụ; nnabata nwayọ nwayọ ma ọ bụrụ na iloro ya dum. Ịta ata na ịta ọtụtụ iberibe nicotine chịngọm ma ọ bụ mint na-atọ ụtọ na-ahapụ nicotine freebase gafee mucosa ọnụ alkaline tupu afọ mbụ gafere metabolism nwere ike ikpochapụ ya.
**4. Ihe mgbochi nicotine transdermal ***
(Nicoderm CQ, Habitrol)		 Akpọrọ aha dị ka 7 mg, 14 mg, or 21 mg / 24 hours, ma ** nke ọ bụla patch nwere n'ezie mkpokọta 15 mg na 114 mg nke nicotine ** (Ọbụna "eji" nke a tụfuru kwachie ka na-ejide 50% ruo 75% nke nicotine zuru ezu). ** Ntinye usoro efu na-aga n'ihu ** site na akpụkpọ anụ ma ọ bụ traktị GI karịa awa 12 ruo 24+ **. Ọnyà abụọ na-egbu egbu*: (1) Nwata na-eto eto na-ewepụta patch e ji eme ihe n'ihe mkpofu wee rapara ya n'akpụkpọ ahụ ya (ma ọ bụ loda ya); (2) Okenye na-agbalị ịkwụsị ise siga na-etinye ọtụtụ patches n'otu oge (ma ọ bụ na-ese anwụrụ mgbe ọ na-eyi patches). Ihe mgbochi iloro na-akpata ** nsi nke awa 24 dị ogologo.
5. Sịga ọdịnala, mkpọ sịga na sịga Sịga zuru oke: 10 mg to 20 mg.
** Ụkwụ sịga : 2 mg to 5 mg gbadoro anya na nyo.
 Mmiri mmiri sịga na-awụpụ mmiri* (ụtụ wụsara n'ime mmiri soda): ** Nsi dị ukwuu (nsi)10 to 30+ mg agbazere)**.		 ** Mfe ọnụ ọnụ obere ngwa ngwa *** site na flakes ụtaba acidic kpọrọ nkụ (oke imeju imeju na-ekpochapụ ihe dị ka 70%), PLUS ** ịgba agbọ nchebe ozugbo. Ewezuga: Iri mmiri/soda nke a na-etinye sịga n'ime ya na-amịkọrọ ngwa ngwa dị ka e-mmiri. Acid pH (5.5) ụtaba akpọnwụrụ akpọnwụ na-eme ka nicotine ionized n'ime afọ ka ọ na-amịkọrọ nwayọọ nwayọọ ma na-akpalite vomiting n'oge na-achụpụ akwụkwọ. ** Ya adịla mgbe ị ga-eche na mmiri e-liquid ma ọ bụ anwụrụ sịga na-eme ka isi sịga kpọrọ nkụ.**
6. Ọrịa ụtaba na-acha akwụkwọ ndụ akwụkwọ ndụ (mkpughe nke ugbo ala) Akwụkwọ ndụ akwụkwọ ndụ mmiri mmiri * Nicotiana tabacum* n'oge owuwe ihe ubi. **Mmiri transdermal (akpụkpọ ahụ) na-agbaze na igirigi ụtụtụ, mmiri ozuzo na ọsụsọ onye ọrụ. Ndị ọrụ ugbo na-egbute akwụkwọ ụtaba mmiri na-enweghị mmiri mmiri na-adịghị mmiri na gloves nitrile na-amịkọrọ ** 50 ruo 90 mg nke nicotine site na akpụkpọ ahụ ha **, na-etolite nnukwu vomiting, isi ọwụwa, pallor, sweating, na bradycardia.

Akpụkpọ anụ (Dermal) na Protocol decontamination Protocol

N'ihi na nicotine un-ionized (freebase) bụ ma mmiri- na lipid-soluble, ** nicotine na-etinye uche na ya na-agafe ngwa ngwa site na mpụta stratum corneum nke anụ ahụ na-emebibeghị ozugbo banye n'ime capillaries dermal **, na-agafe kpamkpam mgbochi imeju 70% nke mbụ na-agafe metabolism:

  1. ** Mwepụ uwe ozugbo na ịsacha ncha na mmiri ọkụ**:
  2. Yiri nitrile ma ọ bụ latex gloves tupu imetụ mmadụ ma ọ bụ nwatakịrị etinyere na mmiri e-liquid ka ị ghara iji mkpịsị aka gị mebie onwe gị.
  3. Yipụ uwe elu niile, uwe ogologo ọkpa, sọks ma ọ bụ diaper niile ozugbo.
  4. Jiri nwayọ sachaa akpụkpọ ahụ ọ metụtara nke ọma na ** ncha efere dị nro ma ọ bụ ncha aka na mmiri mmiri dị ṅara ṅara ruo nkeji iri ruo iri na ise**.
  5. ** Ihe kpatara na ị gaghị eji mmiri ọkụ, mmanya mmanya ma ọ bụ mmanya aka sanitizer eme ihe ***:
  6. Enweghị mmiri ọkụ **: Mmiri ọkụ na-ebute akpụkpọ **vasodilation *** (ịgbasa arịa ọbara akpụkpọ anụ), nke na-eme ka ọnụ ọgụgụ nicotine na-abanye na mgbasa ozi usoro.
  7. Enweghị mmanya na-aba n'anya / ihe mgbaze ***: ịsacha mmanya na-egbu egbu ma ọ bụ aka sanitizer na-ewepụ lipids akpụkpọ ahụ ma na-eme ka ntinye transdermal dịkwuo elu.
  8. ** Enweghị ngwọta acidic ***: egbula oge ịgbalị iji mmanya mmanya ma ọ bụ ihe ọṅụṅụ lemon wepụ nicotine n'ahụ; ncha dị larịị na nnukwu mmiri ṅara n'ọkụ na-ewepụ ngwa ngwa propylene glycol/glycerin.
  9. ** Wepụ ihe mgbochi nicotine transdermal ***:
  10. Wepụ ihe mgbochi niile ozugbo, gbakọọ ha na ọkara na akụkụ ndị na-egbute ọnụ (nke mere na ọ dịghị nwatakịrị ma ọ bụ anụ ụlọ nwere ike imetụ ha aka), wee jiri ** mmiri nkịtị na ncha dị nro na-asa ebe akpụkpọ ahụ iji wepụ gel nicotine depot n'elu akpụkpọ ahụ. (Rịba ama: Ọbụlagodi mgbe ewepụchara patch, “ebe nchekwa akpụkpọ ahụ” nke nicotine etinyegoro n'ime epidermis ga-aga n'ihu na-abanye n'ọbara ọbara maka awa 2 ruo 6**.
  11. ** Mfesa anya (Anya)**:
  12. E-mmiri fesa n'ime anya na-ebute oke ọkụ, conjunctival redness, corneal epithelial ntụpọ, yana ** nicotine systemic absorption n'ofe ọwara ọzịza**. Were mmiri mgbata dị nro ma ọ bụ saline 0.9% mee ka anya mepere emepe gbaa anya maka 15 ruo nkeji 20 wee chọọ nyocha ihe mberede.

Usoro Mberede ụlọ ọgwụ na ICU Ọgwụgwọ

Enweghị ** ọ nweghị kpọmkwem ọgwụ mgbochi nnabata nke na-atụgharị ma etiti na neuromuscular nicotinic toxicity n'otu oge; nlanarị na-adabere na ** ike ike, njikwa ICU na-akwado oge akọwapụtara ***:

1. Nchekwa ụgbọ elu na igwe ikuku ikuku (Ntinye nke nzọpụta #1)

N'ihi na ọnwụ nke nnukwu nsị nicotine fọrọ nke nta ka ọ bụrụ mgbe niile na-esite na ** Phase 2 iku ume ọdịda *** (njikọta nkụda mmụọ nke etiti iku ume, ọtụtụ ihe nzuzo nke bronchial, na ** depolarizing neuromuscular mkpọnwụ nke diaphragm **): - Mkpọbata Endotracheal nke mbụ: Ndị dibịa mberede na-abanye ma na-ekuku onye ọrịa ọ bụla na-egosi akara ike ọgwụgwụ ume iku ume, iku ume na-emighị emi, hypoxia, coma, ma ọ bụ ọnọdụ akwụkwụ na-emegharịghachi. - Iwu ọgwụ RSI dị oke egwu: Zere Succinylcholine ***: Mgbe ị na-eme Intubation Rapid Sequence (RSI) na onye ọrịa nwere nicotine nsi, ** zere iji Succinylcholine paralytic na-emebi emebi, nke na-eme otu ihe ahụ nicotinic receptor depolarization ma ọ bụ usoro mgbochi neurokal na-eme ka ọ dịkwuo njọ; jiri ihe mgbochi neuromuular na-adịghị emebi emebi ** (dị ka Rocuronium) kama. - ** Mgbanwe nke mkpọnwụ iku ume ***: Ọ bụrụhaala na a na-akwado onye ọrịa na igweentilaị nke nwere 100% nchebikuku oxygenation, imeju (CYP2A6 metabolism n'ime cotinine) na akụrụ na-ekpochapụ nicotine n'elu ** 4 ruo 24 awa **, na ** 100 pasent nke diaphragm na ike akwara na-alaghachi kpamkpam.

2. Ịchịkwa ihe ọdịdọ na mgbakasị oge nke mbụ

  • ** Ọgwụ mgbochi nke mbụ: Benzodiazepines na-abanye n'ime akwara : Onye nchịkwa ** Lorazepam (0.1 mg/kg IV, ruo 4 mg, Midazolam (0.1 to 0.2 mg/kg IV or IM, ma ọ bụ Diazepam ozugbo maka nhụsianya n'ozuzu nke nicotine kpatara ma ọ bụ oke mkpasu iwe.
  • ** Ọdụdọ Refractory Line nke Abụọ ***: Ọ bụrụ na ọkwa epilepticus na-aga n'ihu n'agbanyeghị benzodiazepines, gbasaa ozugbo gaa na *Phenobarbital , ** Propofol, ma ọ bụ ** Levetiracetam (na-ezere phenytoin, nke na-adịghị arụ ọrụ maka njide na-akpata nsị).

3. Ijikwa Biphasic Autonomic Instability (Atropine maka Muscarinic Overload vs. Vasopressors maka Phase 2 Shock)

  1. ** Atropine intravenous maka mgbaàmà Muscarin siri ike (Bronchorrhea, Salivation, na Phase 2 Bradycardia)**:
  2. N'ihi na nicotine na-akpali parasympathetic ganglia ịhapụ oke acetylcholine n'elu ** muscarinic receptors *** na ngụgụ, salivary glands, na sinoatrial/atrioventricular nodes, ndị ọrịa nwere ike iri mmiri na nzuzo nke ngụgụ mmiri nke ha (bronchorrhea) ma ọ bụ mepụta nnukwu obi mgbachi obi.
  3. Onye nchịkwa ** Atropine n'ime eriri afọ (0.5 mg to 2 mg IV na ndị okenye; 0.02 mg/kg IV na ụmụaka, kacha nta 0.1 mg***, na-emegharị kwa nkeji 5 ruo 10 ọ bụla ruo mgbe ihe nzuzo nke bronchi na-akpọnwụ na bradycardia symptomatic kwụsịrị.
  4. ** Ijikwa ọkwa 1 ọbara mgbali elu vs. Nkeji 2 Hypotension **:
  5. Ọ dịghị mgbe ọ gafechara ọgwụgwọ mmalite nke 1 ọbara mgbali elu ma ọ bụ tachycardia na Beta-blockers na-eme ogologo oge: N'ihi na ọbara mgbali elu nke Phase 1 na-adịru nwa oge ma na-atụgharị na mberede n'ime ** Phase 2 hypotension, bradycardia, na ujo n'ime nkeji 30 ruo 60 **, na-enye beta-blockers na-eme ogologo oge ma ọ bụ na-eme ka beta-blockerase (dị ka 1) ndakpọ nke obi na-enweghị ike ịgbake mgbe agba nke abụọ dara. Jiri nwayọ were ** IV benzodiazepines ** gwọọ ọgba aghara/ọbara mgbali elu nke 1 (ma ọ bụ infusions nke dị mkpụmkpụ na-eme naanị ma ọ bụrụ na nsogbu ọbara mgbali elu emee).
  6. ** Nkebi nke abụọ Hypotension na Shock *: Onye nchịkwa ** isotonic crystalloid boluses intravenous (20 mL/kg 0.9% Normal Saline) wee malite infusion vasopressor na-eme ihe ozugbo (Norepinephrine ma ọ bụ Epinephrine) ma ọ bụrụ na mgbochi ganglionic na-akpata hypotension vasoplegic/cardiogenic na-adịgide adịgide.

4. Iwu mkpochapụ nke eriri afọ site na ụdị ngwaahịa

  • Nicotine Liquid (Juice Vape): N'ihi na nicotine mmiri na-abanye n'ime nkeji ole na ole ma na-ebute vomiting na mberede na njide ngwa ngwa n'ime nkeji iri ruo nkeji iri abụọ , a na-egbochikarị ịcha afọ gastric ma ọ bụ unyi na-arụ ọrụ ọnụ n'ime ndị ọrịa nicotine na-enweghị mmiri na-enweghị mmiri, n'ihi oke agụụ nke ike ọgwụgwụ mberede. Ọ bụrụ na loro nnukwu mmiri mmiri na-egbu egbu n'ime nkeji 30, agụụ nasogastric na unyi na-arụ ọrụ (1 g/kg) na-elekọta ** mgbe endotracheal intubation ** na-echekwa ụzọ ikuku.
  • ** Akpa nicotine loro, chịngọm, lozenges, ma ọ bụ ihe mgbochi transdermal ***:
  • N'ihi na obere akpa, matrices chịngọm, na patches transdermal na-ahapụ nicotine na-aga n'ihu ruo ọtụtụ awa n'ime afọ na eriri afọ, ** Otu dose ma ọ bụ Multi-Dose Activated Charcoal (1 g/kg up to 50 g*** A na-egosi ma ọ bụrụ na onye ọrịa na-amụ anya ma na-echebe ụzọ ikuku ha (ma ọ bụ intubated).
  • Ọ bụrụ na nwatakịrị ma ọ bụ okenye ilo ** transdermal nicotine patches ** ma ọ bụ ọnụ ọgụgụ buru ibu nke nicotine pouches / chịngọm chịngọm **, ndị dọkịta mberede na-enye ** dum-bowel Irrigation na Polyethylene Glycol Electrolyte Solution (PEG-na-ewepụ ihe na-adịghị mma) eriri afọ tract.

5. Oge nleba anya n'ụlọ ọgwụ tupu mwepu nchekwa

  • **Nicotine Liquid (E-Liquid) ma ọ bụ chịngọm / obere akpa **: N'ihi na nicotine mmiri na mucosal na-amịkọrọ ngwa ngwa, ọ bụrụ na onye ọrịa na-anọgide ** 100 percent asymptomatic (enweghị vomiting, ọ̀tụ̀tụ̀ obi nkịtị, ọbara mgbali elu, ịmụrụ anya nkịtị) maka awa 4 ruo 6 mgbe ekpughere ya, a na-ewepụ ajọ nsị.
  • Obere obere akpa Nicotine loro, sịga / sịga zuru oke, ma ọ bụ patches transdermal **: N'ihi na matrices na-ahapụ matriks na patches nwere ike ị nweta nicotine na traktị GI dị ala ruo ọtụtụ awa, ndị ọrịa na-eloda patches ma ọ bụ nnukwu obere akpa chọrọ ** 12 ruo 24 awa nlele ụlọ ọgwụ **.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ

Mpaghara / Obodo Nọmba ụgbọ ihe mberede mberede Ahịrị enyemaka nchịkwa nsi nke mba Ndetu Protocol Clinical
United States & Canada *911 ** US ***: 1-800-222-1222 (Ụlọ Ọrụ Nsi America) / Canada: 1-844-POISON-X (1-844-764-7669) Iwu mgbochi nsi ụmụaka nke Nicotine na United States nyere iwu ka nkwakọ ngwaahịa na-eguzogide ụmụaka na arịa mmiri mmiri, ọ bụ ezie na pọd ndị a pụrụ ịtụfu ya na obere akpa ZYN/Velo ka na-eduga n'ịkpalite oku ụmụaka; 5% nnu (50 mg/mL) vapes na-emekarị.
United Kingdom 999 (ma ọ bụ 112) NHS 111 (Ọhaneze) / ** NPIS TOXBASE** (0344 892 0111 maka ndị ụlọ ọgwụ) Iwu UK TRPR na-ekpuchi ikike nicotine e-liquid e-liquid iwu na ** 20 mg / mL (2%) ** na nha tank na 2 mL, ọ bụ ezie na vapes ike dị elu na-akwadoghị iwu na 10 ruo 50 mg nicotine pouches na-enwetawanye site na NPIS.
European Union 112 Kpọtụrụ ụlọ ọrụ nsị nke mba site na 112 (dịka, Germany +49 30 19240, France 01 40 05 48 48) Ntuziaka ngwaahịa ụtaba EU (TPD) na-akwụ ụgwọ e-liquid na 20 mg/mL (2%), ebe obere akpa nicotine ọnụ siri ike ("ọcha snus") na N'onwe Gị 100 mg/mL bases na-ebute oke nsi.
Australia na New Zealand Australia: 000 / New Zealand: 111 Australia: 13 11 26 (Ebe Ozi Nsi) / New Zealand: 0800 764 766 (0800 POISON) Ọstrelia na-ekewa nicotine mmiri mmiri n'okpuru njikwa ndenye ọgwụ siri ike, n'agbanyeghị vapes enwere ike ibubata (50 mg/mL) na obere akpa na-achọkarị nleba anya n'Ebe Ozi nsi.
India & Asia-Pacific India: 112 (ma ọ bụ 108) /Japan/Singapore: 119/995 India: AIIMS National Poiss Information Center (1800-116-117 / 011-26589391) Mkpughe ụmụaka dị elu na ngwugwu ụtaba na-enweghị anwụrụ ọkụ ọnụ (gutka, khaini,zarda), chịngọm/akpa ego nicotine, na ọrụ ugbo ** Ọrịa ụtaba green ** n'etiti ndị na-ewe ụtaba.

Ajụjụ a na-ajụkarị

Kedu ihe kpatara ilo mmiri mmiri vape juice ma ọ bụ obere akpa nicotine ZYN ji dị ize ndụ nye nwatakịrị karịa iri nri sịga?

Mgbe nwatakịrị na-eri sịga kpọrọ nkụ ma ọ bụ sịga sịga, pH acidic nke akwụkwọ ụtaba akọrọ na-edobe ọtụtụ nicotine n'ụdị ionized nke na-amịkọrọ nwayọọ nwayọọ gafee afo, ebe uto ilu na iwe iwe na-ebute vomiting n'oge na-achụpụ ụtaba tupu ọgwụ na-egbu egbu abanye n'ọbara. N'ụzọ dị iche, mmiri mmiri vape ihe ọṅụṅụ (karịsịa 5% nicotine nnu, nke nwere 50 mg nke nicotine dị ọcha kwa milliliter) agbazelarị 100% na mmiri mmiri, na obere akpa nicotine (dị ka ZYN, Velo, ma ọ bụ On) nwere salts alkaline buffering nke emebere iji manye nicotine ngwa ngwa site n'ọnụ ọnụ na chịngọm. Ha abụọ na-atọ ụtọ dị ka mkpụrụ osisi ma ọ bụ mint kama ụtaba na-elu ilu, na-enye ohere ka nwatakịrị nweta ọgwụ ọdịdọ na-akpali ma ọ bụ iku ume n'ime nkeji 10 ruo 20.

Kedu ihe "nsi biphasic" pụtara na nsị nicotine?

Biphasic pụtara nsi na-eme n'ọkwa abụọ dị iche. N'ime oge 1 (nkeji 10 ruo 60 mbụ), nicotine na-eme ka ndị na-anabata nicotinic gafee ụbụrụ, gland adrenal, na mọzụlụ, na-eme ka mgbawa mgbawa, ọsụsọ na-acha oyi na-acha, mkpọ mmiri dị arọ, ọbara mgbali elu, ọnụ ọgụgụ obi ngwa ngwa, mmụgharị akwara, na njide zuru oke. N'ime oge 2 (nkeji 30 ruo awa 4 ka e mesịrị), ndị na-anabata ihe na-ekpo ọkụ na-ekpochi ma na-eme ka ọ ghara inwe mmetụta (depolarizing blockade), na-eme ka ihe ịrịba ama dị mkpa nke onye ọrịa na-atụgharị n'akụkụ nke ọzọ: obi dị nwayọọ nwayọọ nwayọọ, ọbara mgbali elu, coma, na mkpọnwụ nke diaphragm na ume iku ume.

Kedu ihe kpatara na a ga-eji ncha na mmiri na-ekpo ọkụ saa nicotine mmiri mmiri wụfuru n'anụ ahụ kama iji mmiri ọkụ saa?

Nicotine mmiri dị ọcha na-abanye ozugbo site na akpụkpọ ahụ dị mma, nke na-adịghị agbajikwa n'ime ọbara dị ka patch nicotine ahụike. Ọ bụrụ na ị na-asa akpụkpọ ahụ na mmiri ọkụ, okpomọkụ na-agbasa (na-agbasapụ) arịa ọbara dị na akpụkpọ ahụ, nke na-eme dị ka imeghe okporo ụzọ n'ime ọbara ma na-eme ka nsị nicotine dị ngwa ngwa ngwa. Na-eyipụ uwe ọ bụla nwere mmiri e-mmiri mgbe niile site na iji uwe aka wee saa akpụkpọ ahụ nke ọma na ncha dị nro na mmiri ṅara ṅara ma ọ bụ dị jụụ maka nkeji 10 ruo 15.

Ngwunye nicotine e ji eme ihe nke a tụbara n'ime ahịhịa nwere ike imebi nwata ma ọ bụ anụ ụlọ?

Ee. Ngwunye nicotine transdermal chọrọ nnukwu gradient iji kwanye nicotine nwayọ site na akpụkpọ mmadụ karịa awa 24. N'ihi nhazi ahụ, ihe nkedo akpọrọ "21 mg kwa awa 24" nwere n'ezie ihe ruru 50 mg ruo 114 mg nke nicotine zuru ezu n'ime mmiri mmiri ya, na mgbe onye toro eto na-ewepụ ya mgbe awa 24 gasịrị, ihe karịrị 50% ruo 70% nke nicotine ka na-ahapụ n'ime patch. Ọ bụrụ na onye na-eto eto ma ọ bụ nkịta na-ewepụta ihe eji eme ihe n'ime ihe mkpofu wee rapara ya n'akpụkpọ ahụ ya ma ọ bụ tachaa ma ilo ya, ọ nwere ike ịkpata nsị nicotine na-eyi ndụ egwu. Na-apịakọta patches ndị ejiri mee ihe mgbe niile n'otu akụkụ ma tụba ha n'ime akpa mechiri emechi na-agaghị erute ya.

Kedu ihe bụ Ọrịa ụtaba Green na otu esi agwọ ya?

Ọrịa ụtaba Green (GTS) bụ ajọ nsị nicotine transdermal nke na-adakwasị ndị ọrụ ugbo bụ ndị na-egbute akwụkwọ ụtaba na-acha akwụkwọ ndụ akwụkwọ ndụ na-adịghị edozi, karịsịa n'isi ụtụtụ mgbe igirigi kpuchiri akwụkwọ ya ma ọ bụ mgbe mmiri ozuzo gasịrị. Mmiri dị n'akwụkwọ ahụ na-agbaze nicotine anụ ahụ sitere n'elu osisi ahụ, nke na-esi na uwe elu na uwe ogologo ọkpa nke onye ọrụ na-amịnye ma na-amịnye ya ozugbo site na akpụkpọ ahụ ha (na-ebunye ihe dị ka sịga 30 ruo 50+ nke nicotine). Ndị ọrụ na-enwe ọgbụgbọ siri ike, ọgbụgbọ na-apụta, ọsụsọ na-acha ọkụ, isi ọwụwa, isi ọwụwa, na mgbanwe nke ọbara mgbali elu na ọnụ ọgụgụ obi. Enyemaka mbụ bụ ịpụ n'ọhịa, iyipụ uwe niile dị mmiri mmiri, iji ncha na mmiri na-ekpo ọkụ na-asa ahụ dum, izu ike n'ebe dị jụụ nke nwere mmiri ọnụ ma ọ bụ nke eriri afọ, na ịchọ nlekọta ahụike ma ọ bụrụ na vomiting, bradycardia, ma ọ bụ nsogbu iku ume.

Ntuziaka emetụtara

Isi mmalite na nduzi ọchịchị

  • Ndị otu American Association of Poison Control Centre (AAPCC) & erslọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC): Nicotine Liquid, E-Cigarette, na Oral Nicotine Pouch Exposure Surveillance and Triage Guidelines.
  • American Academy of Pediatrics (AAP): *Nkọwa ụlọ ọgwụ na nkwupụta amụma: E-Cigarettes, Liquid Nicotine Concentrates, and Pediatric Nicotine Prevention.
  • Ọrụ Ozi Nsi nke Mba (NPIS, United Kingdom): TOXBASE Nlekọta ahụike nke nsi nicotine dị oke njọ (E-Liquids, obere akpa Nicotine ọnụ, na Patches Transdermal).
  • World Health Organisation (WHO): Mmalite ụtaba efu na nchekwa kemịkalụ: Nnukwu nsị Nicotine na ntụzịaka ọrụ ọrịa ụtaba green.
  • Ụlọ ọrụ mba maka nchekwa na ahụike ọrụ (NIOSH / CDC): * Ngwọta ebe ọrụ: igbochi ọrịa ụtaba green (nsị nsị nke Nicotine) na ndị ọrụ ụtaba*.

*Nduzi a bụ maka ebumnuche ozi na anaghị edochi nyocha ahụike ọkachamara, ndụmọdụ nchịkwa nsi, ma ọ bụ nlekọta mberede ụlọ ọgwụ. N'ihi na nsi nicotine siri ike nwere ike ime ka ọdịdọ mberede na ahụ mkpọnwụ nke akwara iku ume na ụmụaka na ndị okenye, anyị na-akwadosi ike ka ị nweta enyemaka mbụ nke okenye na ụmụaka na ụmụaka na 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.