Enyemaka mbụ na-egbu ọgwụ pesticide, Organophosphate na ọrụ ugbo¶

Mkpughe siri ike na ọgwụ ndị na-arụ ọrụ ugbo, ụlọ ọrụ mmepụta ihe, ma ọ bụ na-etinye uche na pesticides ezinụlọ: karịsịa ** organophosphate ụmụ ahụhụ ** (dị ka malathion, parathion, chlorpyrifos, diazinon), ** carbamate ụmụ ahụhụ ** (aldicarb, carbaryl, propoxur), ** organophosphate na ndị na-ahụ maka akwara *** , ** bicipyridyl phosphide fumigants (aluminom ma ọ bụ zinc phosphide) ***: bụ nsogbu toxicological na-eyi ndụ egwu. N'adịghị ka nsị ụlọ nkịtị nke na-akpata naanị mmerụ ahụ ma ọ bụrụ na iloro ya, organophosphates na ndị na-ahụ maka akwara na-abanye ngwa ngwa site na ** anya na-adịghị agbaji, site na ** anya ***, na site na ** inhalation nke alụlụ ịgba ma ọ bụ vapor **, na-ebute ọrịa na-egbu egbu "cholinergic oké ifufe" n'ime nkeji.

Ntuziaka a na-enye nzọpụta site na nzọụkwụ nzọụkwụ na usoro ọgwụgwọ kwekọrọ na ntụziaka sitere na Healthtù Ahụ Ike (wa (WHO), Ụlọ Ọrụ Na-ahụ Maka Nchịkwa na Mgbochi Ọrịa nke United States (CDC), US Environmental Protection Agency (EPA), Agency for Toxic Substances and Disease Registry (ATDR), na UK National Poiss Information Service (NP). Ichekwa onwe gị na nitrile ma ọ bụ neoprene gloves tupu imetụ onye merụrụ ahụ aka, yipụ uwe ndị nwere pesticide, ịsacha akpụkpọ ahụ maka nkeji iri na ise, na ịnweta ihe mberede atropine na ** pralidoxime (2-PAM)** na-azọpụta ndụ.

Mee nke a ugbu a¶

Ọ bụrụ na e jirila fesa gị ma ọ bụ onye dị nso, fesa ya, kuru ya, ma ọ bụ loda ọgwụ pesticide nke ọrụ ugbo, ọgwụ ahụhụ gbadoro ụkwụ, ogbugbu ahịhịa, ma ọ bụ ihe na-egbu ọka:

1. ** Buru ụzọ chebe onwe gị: Ejila aka efu metụ onye ihe na-egbu egbu egbu ma ọ bụ vootu ha aka**: Bulie elu na elu elu pụọ na alụlụ na-efesa kemịkalụ, igwe ojii, ma ọ bụ ebe nchekwa mechiri emechi ozugbo. Yiri ** nitrile na-eguzogide kemịkalụ, butyl roba, ma ọ bụ neoprene gloves** (ọkọlọtọ ọgwụ latex dị mkpa na-abanye ngwa ngwa site na ihe mgbaze organophosphate) tupu imetụ onye ahụ aka ma ọ bụ uwe ha aka. Ndị nnapụta na-emetụ uwe elu organophosphate tinye aka ma ọ bụ aka aka akpụkpọ anụ na-adakarị site na nsị nke abụọ.
2. **Kpọọ nọmba mberede mpaghara gị ozugbo ***: Kpọọ 911 na United States na Canada, 112 gafee European Union, ma ọ bụ 999 na United Kingdom (ma ọ bụ lelee anyị). nọmba mberede ndekọ). Gwa onye ozi ahụ n'ụzọ doro anya: *" A na-enyo enyo pesticide ugbo ma ọ bụ organophosphate chemical nsị: HAZMAT decontamination na nnukwu dose Atropine chọrọ."
3. ** Wepụ pasent 100 nke uwe, akpụkpọ ụkwụ na ọla ndị emetọọ ozugbo *: Iwepụ uwe ndị nwere pesticides na-ewepụ ** 80 na pasent 90 nke kemịkalụ tupu ọ banye n'ime akpụkpọ ahụ. Jiri mma ma ọ bụ mkpa iji ** bepụ uwe elu na uwe ogologo ọkpa kama ịdọpụ ha n'isi onye ahụ (nke na-ehichapụ kemịkalụ n'ofe anya, imi na ọnụ). Mechie uwe niile ewepụsịrị na akpụkpọ ụkwụ akpụkpọ anụ (akpụkpọ anụ na-etinye ọgwụ pesticides kpamkpam na enweghị ike imerụ ya) n'ime akpa rọba dị arọ abụọ.
4. ** Jiri nnukwu ncha na mmiri na-asọ asọ saa akpụkpọ ahụ na ntutu maka nkeji iri na ise zuru oke**: Debe onye ahụ n'okpuru ịsa ahụ, eriri ubi, ma ọ bụ ọdụ mmiri mberede ma were ncha mmiri dị nro ma ọ bụ efere efere na mmiri dị nro na-ekpo ọkụ na-asa ahụ site na isi ruo mkpịsị ụkwụ. Lezienụ anya na mpịachi akpụkpọ anụ, mbọ aka, ntutu na azụ ntị. Ejila brọsh siri ike hichaa akpụkpọ ahụ dị ndụ, ejikwala mmiri ọkụ na-ekpo ọkụ nke na-eme ka arịa ọbara akpụkpọ ahụ gbasawanye ma na-eme ka mmịnye nsi banye n'ọbara. Ọ bụrụ na ọgwụ pesticide fesara n'anya, were mmiri na-asọ asọ ma ọ bụ saline nkịtị were anya ya were nkeji iri na ise (lee. mmerụ anya).
5. ** Nọgide na-ekuku ụzọ ikuku, tụgharịa n'akụkụ, ma emela ka ọnụ na ọnụ pụta ***: Ndị Organophosphate na-eri mmiri na mmiri nke aka ha, imi nke bronchial ("bronchorrhea"), na vomit. Debe onye amaghị ihe ọ bụla ma ọ bụ nke na-agbapụta n'akụkụ ha n'akụkụ ** ọnọdụ mgbake ** ka ihe nzuzo ngụgụ na-asọ oyi na-apụ n'ọnụ. Ọ bụrụ na obi akwụsị ma ọ bụ iku ume akwụsị, mee ** naanị mkpịsị obi naanị aka (CPR) ma ọ bụ jiri akpa-valve-mask (BVM): ** emela iku ume iku ume ọnụ na ọnụ ozugbo, nke na-ekpughere ọnụ gị na vapor pesticide na-egbu egbu.
6. ** Na-elekọta autoinjector ma ọ bụrụ na ọ dị (DuoDote / Mark I / Atropen): Ọ bụrụ na ihe ahụ merenụ gụnyere ndị agha / ndị ọrụ akwara ozi ma ọ bụ ndị ọrụ ugbo nke nwere ** DuoDote ma ọ bụ ATNAA (Atropine + Pralidoxime) ** autoinjectors, gbanye ogologo site na apata ụkwụ mpụta ozugbo ma ọ bụrụ na onye ahụ a na-eme ihe na-eme ka ọ na-esiri ike iku ume, ume iku ume, ume iku ume, ume iku ume, ma ọ bụ ume iku ume. ọdịdọ.

Mwepu nke ubi mberede na eserese ntọhapụ toxidrome¶

flowchart TD
    Start["Ọgwụ nje a na-enyo enyo, ọgwụ ahụhụ, ahịhịa ahịhịa, ma ọ bụ ihe nnọchite akwara"] --> SceneSafe{"Ọnọdụ a ọ dị mma ma ndị nnapụta yi Nitrile/Neoprene PPE?"}

    SceneSafe -->|No: Vapor cloud, enclosed shed, or bare hands| Evac["Bulie elu ikuku dị ọhụrụ ozugbo<br/>Yiri Nitrile/Neoprene gloves (AGHỊGHỊ thin latex) <br/> Kpọọ 911 / 112 / 999 maka HAZMAT & EMS"]

    SceneSafe -->|Yes: Upwind with chemical-resistant gloves| Decon["Ngwa ngwa 80%-90% Mwepụ Isi iyi<br/>Bepụ uwe niile emetọọ ma tụfuo akpụkpọ ụkwụ akpụkpọ anụ<br/>Jiri ncha na mmiri dị jụụ / dị jụụ saa akpụkpọ ahụ & ntutu isi maka nkeji iri na ise."]

    Evac --> Decon

    Decon --> ToxClass{"Chọpụta klaasị kemịkalụ site na mgbaama ma ọ bụ akara akpa"}

    ToxClass -->|Pinpoint pupils, profuse drooling/sweating, wet lung crackles,<br/>vomiting, diarrhea, slow pulse, muscle twitching| Chol["Organophosphate ma ọ bụ Carbamate ('Cholinergic Crisis') <br/>Ebe na n'akụkụ-edina mgbake ọnọdụ iji igbapu nku ume mmiri mmiri<br/>Administer Atropine (ugboro abụọ doses IV kwa 3-5 min ruo mgbe ngụgụ kpọrọ nkụ) <br/>+ Pralidoxime (2-PAM) maka Organophosphates + Benzodiazepines"]

    ToxClass -->|Swallowed blue/green foul-smelling liquid herbicide;<br/>severe burning mouth/throat Ulcers| Paraquat["Paraquat ma ọ bụ Diquat Herbicide <br/> Oral Fuller's Earth or Activated Charcoal ozugbo (ma ọ bụrụ n'ime awa 1) <br/> NA-ENWEGHỊ mgbakwunye oxygen ma ọ bụrụ na SpO2 <85% -88% <br/> Emergency ICU hemodialysis / hemoperfusion"]

    ToxClass -->|Garlic/rotten-fish odor after swallowing grain fumigant pellets;<br/>rapid shock and arrhythmias| Phosphide["Aluminom / Zinc Phosphide ('Phosphine Gas' nsi)<br/>Enyela mmiri ma ọ bụ mmiri mmiri sitere n'ọnụ<br/> Ventilate ụgbọ ihe mberede / ED; jikwaa cardiogenic ujo & acidosis"]

    ToxClass -->|Sudden grand mal seizures with NO drooling/pinpoint pupils<br/>after flea/tick spray or agricultural spray| Pyreth["Organochlorine (Lindane/Endosulfan) ma ọ bụ Pyrethroid<br/>Ncha ncha nkeji iri na ise (mmanụ vitamin E na-eme ka paresthesias akpụkpọ ahụ dị mfe)<br/>IV Benzodiazepines (lorazepam/diazepam) iji kwụsị ịgba mgba GABA-block"]

Pathophysiology nke "Cholinergic Storm": Organophosphates na Carbamates¶

Organophosphates (nke emebere na 1930 na 1940 dị ka ma ụmụ ahụhụ ndị ọrụ ugbo na ndị na-ahụ maka akwara ndị agha dị ka Sarin, Soman, Tabun, na VX) na carbamates bụ ihe kacha akpata nsị na-egbu egbu n'ụwa niile, na-akpata ọnwụ karịrị 100,000 kwa afọ.

Kedu ka mgbochi acetylcholinesterase (AChE) si emetụta usoro ụjọ ahụ¶

N'ime ahụ mmadụ dị mma, mgbe ọ bụla akwara chọrọ ịgwa akwara ka ọ gbakọọ ma ọ bụ gland iji zoo mmiri mmiri, akwara akwara na-ewepụta ihe nrịbama microscopic nke neurotransmitter ** acetylcholine (ACh)** gafee oghere synapti. N'ime ihe dị nta nke otu millisekọnd ka e zisachara ozi ahụ, enzyme pụrụ iche nke a na-akpọ acetylcholinesterase (AChE) na-egbutu molekul acetylcholine na ọkara (n'ime choline na acetic acid), na-atụgharị ** Gbanyụọ ** ka akwara wee nwee ike izuike na gland na-akwụsị nzuzo.

1. ** Phosphorylation nke "gbanyụọ" mgba ọkụ ***: Organophosphates na carbamates na-ejikọta ozugbo na saịtị serine na-arụ ọrụ nke enzyme acetylcholinesterase, na-eme ka enzyme ahụ kwụsị kpamkpam.
2. ** Iju mmiri Acetylcholine na-adịghị akwụsị akwụsị ***: Site na mgbanaka “gbanyụọ” agbajiri, acetylcholine na-emebibeghị na-agbakọba oke, ọkwa na-egbu egbu n'ime synapse ọ bụla nke cholinergic n'ime ahụ: na-agbapụ ndị na-anabata muscarinic ** ( glands parasympathetic, ngụgụ, obi, anya, eriri afọ), ** nicotinic receptors ga akwara na akwara akwara na akwara akwara. sistemu *** anaghị akwụsị akwụsị ruo mgbe ngụgụ onye ihe ahụ mere juputara na mmiri mmiri na diaphragm ha kpọnwụrụ akpọnwụ.
3. ** Gịnị kpatara Organophosphates ji adịgide ("Ịka nká") ebe Carbamates na-adịru nwa oge ***:
4. ** Carbamate ụmụ ahụhụ *** (carbaryl [Sevin], aldicarb, propoxur, methomyl) na-etolite njikọ carbamyl na-agbanwe agbanwe ** na AChE enzyme nke na-agbapụta onwe ya ozugbo wee wepụta ya n'ime awa 24 ruo 48 **.
5. ** Organophosphate ụmụ ahụhụ na ndị na-ahụ maka akwara *** (parathion, chlorpyrifos, malathion, diazinon, dichlorvos, fenthion) na-etolite njikọ nke phosphorus siri ike nke na-enwe mgbanwe kemịkalụ na-adịgide adịgide nke a na-akpọ "Ịka nká" (ọnwụ nke otu alkyl). Ozugbo njikọ organophosphate-enzyme "afọ" (nke na-ewe ebe ọ bụla site na ** 2 nkeji maka onye na-ahụ maka akwara Soman ** ruo ** awa 12 ruo 48 maka ụmụ ahụhụ ndị ọrụ ugbo *), enzyme ahụ na-anwụ anwụ ruo mgbe ebighị ebi. Ọ bụrụ na onye ọrịa ahụ enwetaghị ọgwụ mgbochi na-emegharị ahụ Pralidoxime (2-PAM) tupu ịka nká agwụchaa, ahụ ha ga-emepụta mkpụrụ ndụ enzyme ọhụrụ site na ọkọ n'ime izu 2 ruo 6.

Ịmata na akụkụ atọ Cholinergic Toxidrome: DUMBBELS & Monday-ruo-Friday¶

N'ihi na ngafe acetylcholine na-agba ọkụ atọ dị iche iche nke ndị nabatara n'otu oge, ndị dọkịta na-achọ ụyọkọ mgbaàmà atọ dị iche iche:

1. Muscarinic Nnabata Overstimulation: "DUMBBELS" ma ọ bụ "SLUDGE + Killer Bs"¶

Mkpali muscarinic na-atụgharị na gland ọ bụla na-ezobe mmiri na uru ahụ dị nro na ahụ. Cheta mnemonic DUMBBELS (ma ọ bụ ** SLUDGE ***):

• **D: afọ ọsịsa na diaphoresis ***: afọ ọsịsa mmiri na-agbawa agbawa na ịta mmiri, isi na mkpịsị ụkwụ ** ọsụsọ.
• U: mmamịrị: Mwepu njikwa eriri afọ na-amaghị ama.
• M: Miosis (Pinpoint Ụmụ akwụkwọ): Ụmụ akwụkwọ abụọ a na-amachita obere ntụtụ 1-millimita, na-eme ka ọ daa mbà n'obi, ọhụụ na-agbawa agbawa na mgbu brow na-egbu mgbu (spasm ciliary).
• **B: Bronchorrhea (Onye na-egbu egbu nke #1) ***: Akpụkpọ anụ ahụ na-ekpuchi osisi bronchial na-awụpụ lita mmiri dị nro, nke na-asọ oyi n'ime akpa ume, na-eme ka onye ọrịa na-eri mmiri na nzuzo nke ngụgụ onwe ha ** site n'ime ime (mmanya mmiri na-egbuke egbuke na ihe na-egbuke egbuke n'akụkụ abụọ ngụgụ).
• **B: Bronchospasm (Onye na-egbu #2) ***: Mkpọchi siri ike nke akwara dị nro nke ikuku na-eme ka iku ume siri ike na enweghị ike ibugharị ikuku.
• B: Bradycardia (Onye na-egbu #3): akwara vagal miri emi na-ebelata ọnụọgụ obi ruo 30 ruo 45 iti kwa nkeji, na-ebute hypotension na njide obi asystolic. * (Nkọwa, ** Bronchorrhea, Bronchospasm, na Bradycardia ** bụ ndị a maara na ọgwụ mberede dị ka "Three Killer Bs" n'ihi na ha bụ ihe na-egbu onye ọrịa n'ezie: na ihe ** Atropine ** na-atụgharị kpọmkwem).
• E: Emesis: Ọgbụgbọ na-adịghị akwụsị akwụsị na oke mgbaka afọ.
• **L: Lacrimation ***: Na-aga n'ihu na-adọwa site na anya abụọ.
• S: Salivation: mmiri na-asọ oyi na-agbapụta n'ọnụ.

2. Nkwalite nnabata nke Nicotinic: "Ụbọchị nke izu" (MTWtFS)¶

Ọ bụ ezie na ndị na-anabata muscarinic na-ebelata obi ma na-ekpuchi ngụgụ, mkpali n'otu oge nke **nicotinic receptors *** na akwara skeletal na adrenal / ọmịiko ganglia na-akpata mgbochi depolarization neuromuscular. Cheta ụbọchị izu (M-T-W-t-F-S):

• M: Mydriasis (nke na-adịghị ahụkebe nke nwata na-enwe ọmịiko): A na-ahụkarị ya n'oge tupu muscarinic pinpoint miosis na-achị.
• ** T: Tachycardia : Mwakpo adrenaline na-enwe ọmịiko n'oge nwere ike ime ka ọnụ ọgụgụ obi ngwa ngwa na ọbara mgbali elu nwa oge tupu vagal bradycardia eweghara ( egbochila atropine na mmiri mmiri, onye ọrịa na-agba mmiri naanị n'ihi na ọnụọgụ obi ha dị ugbu a ngwa ngwa*).
• ** W: adịghị ike (Flacid Paralysis) ***: Mgbe obere mkpali gachara, nkwụsị nke neuromuscular na-emebi ma na-ekpochi ya, na-eme ka adịghị ike ọkpụkpụ dị ukwuu na ** mkpọnwụ nke diaphragm na intercostal ume iku ume **.
• t: ịma jijiji na ọbara mgbali elu.
• ** F: Fasciculations (Worm-dị ka Muscle Twitching): Ntugharị a na-ahụ anya, ikpuru-dị ka twitches na-adịghị achọ n'ofe nku anya, ire, nwa ehi, obi na ubu: akara nicotinic pathognomonic nke ** atropine enweghị ike idozi ** (chọrọ ** Pralidoxime / 2-PAM).
• S: Ọdụdọ na Ọsụsọ.

3. Central Nevous System Toxicity: Nchegbu, Coma, na Ọnọdụ Epilepticus¶

Lipid-soluble organophosphates na-agafe ihe mgbochi ụbụrụ ọbara ngwa ngwa, na-akpata mkpasu iwe, enweghị izu ike, okwu mkparị, mgbagwoju anya, ataxia, ịda mbà n'obi nke etiti iku ume, coma miri emi, na ihe ike ** cholinergic ọnọdụ epilepticus seizures ** benzodiazepines **, dị ka diazepam.

Ntụle nna ukwu nke ọgwụ mgbochi ọrịa ugbo na ọgwụ ụmụ ahụhụ ezinụlọ¶

Usoro mgbochi mgbochi ụlọ ọgwụ maka nsị Organophosphate¶

Mgbe onye ọrịa nwere oke organophosphate ma ọ bụ nsi carbamate rutere na ngalaba mberede, ọnụọgụ sekọnd. Resuscitation na-eso usoro siri ike: ** Mwepu + Nchedo ikuku \(\ rightarrow\) Atropine Doubling Regimen \(\rightarrow\) Pralidoxime (2-PAM) \(\rightarrow\) Benzodiazepines**.

1. The Atropine Doubling Regimen: Titrating to "Akọrọ akpa ume," Ọ BỤGHỊ Nha ụmụ akwụkwọ¶

Na njide ejiri obi obi ma ọ bụ bradycardia dị mfe, ndị dọkịta na-enye 0,5 ruo 1 milligram nke atropine ruo kacha nke 3 milligrams. N'ime nsi organophosphate siri ike, milligrams 3 bụ ọdịda na ịwụ: ndị ọrịa na-achọkarị 20, 50, ma ọ bụ karịa 100 milligrams nke atropine intravenous n'ime awa ole na ole mbụ *** ka ọ dị ndụ.

• ** Kedu ka atropinization na-abawanye ngwa ngwa na-arụ ọrụ ***:
• Ndị dọkịta na-amalite site na bolus intravenous ozugbo nke ** 1 ruo 3 milligrams nke Atropine ** n'ime ndị okenye (**0.02 ruo 0.05 mg / kg *** n'ime ụmụaka).
• Jiri stethoscope na-enyocha obi onye ọrịa kwa nkeji 3 ruo 5**.
• Ọ bụrụ na mmiri ara ehi na-ekpo ọkụ (bronchorrhea), iku ume (bronchospasm), ma ọ bụ hypotension / bradycardiaHR < 80 bpm) na-aga n'ihu mgbe nkeji 3 ruo 5 gachara, ** Ugboro abụọ dose gara aga ** (dịka ọmụmaatụ: \(2\text{mg} \rightarrow 4\text{mg} \rightarrow 8\text{ mg} \rightarrow 16\text{ mg} \rightarrow 32\text{ mg}\) ọ bụla 3 ruo 5 nkeji) ruo mgbe zuru ezu, IV" na-amalite na-aga n'ihu na a tropin hour. infusion (pasent 10 ruo pasent 20 nke mkpokọta nbudata kwa elekere).
• ** Kedu ihe bụ njedebe njedebe nke Atropinization? ***:
• ** Kpochapụ ngụgụ na auscultation *** (nkwụsị zuru oke nke bronchorrhea na iku ume ka onye ọrịa nwee ike iku ume na ikuku ikuku n'enweghị ike).
• Obi obi karịrị 80 iti kwa nkeji na systolic ọbara mgbali elu karịa 80 ruo 90 mmHg.
• ** Akụrụ akpọnwụ (axillae)**.
• ** Iwu ụlọ ọgwụ dị oke egwu *** : ** akwụsịla inye atropine naanị n'ihi na ụmụ akwụkwọ onye ọrịa na-agbasa ma ọ bụ n'ihi na ọnụọgụ obi ha na-eru 110 iti kwa nkeji ma ọ bụrụ na ngụgụ ha ka juputara na nzuzo mmiri mmiri. **Ị na-emeso atropine ruo mgbe ngụgụ kpọrọ nkụ.

2. Pralidoxime (2-PAM / Obidoxime): Ịkpọghe akwara kpọnwụrụ akpọnwụ¶

N'ihi na atropine naanị na-egbochi ndị na-anabata muscarinic ** (ịkpọnwụ ngụgụ na idozi ọnụọgụ obi) ma nwee mmetụta efu na ndị na-anabata akwara skeletal nicotinic **, onye ọrịa atropin zuru oke nwere ngụgụ akọrọ nwere ike ịnwụ na ** nicotinic diaphragm na ahụ mkpọnwụ iku ume.

• ** Olee otú Oximes si arụ ọrụ ***: ** Pralidoxime (2-PAM) *** (dosed na ** 1 ka 2 grams IV n'elu 15 ruo 30 nkeji ** na ndị okenye, ma ọ bụ ** 20 ruo 50 mg / kg ** na ụmụaka, na-esote IV infusion na-aga n'ihu nke 500 mg / hour ma ọ bụ 8 ruo 10 mg / kg / hour) na-arụ ọrụ ccular. Ọ na-awakpo atom phosphorus nke molecule organophosphate, na-adọpụ ya na acetylcholinesterase enzyme na ** iweghachi ọrụ enzyme eke zuru oke ** na akwara skeletal na saịtị muscarin: ọ bụrụhaala na enyere ya tupu enweghị ike ịgbanwe ya " ịka nká " na-emechi njikọ ahụ kpamkpam.
• ** ịdọ aka ná ntị intubation (ejila Succinylcholine emela) ***: Ọ bụrụ na onye ọrịa organophosphate ma ọ bụ carbamate chọrọ intubation endotracheal ngwa ngwa, ndị dọkịta agaghị eji succinylcholine ọgwụ kpọnwụrụ akpọnwụ, n'ihi na plasma butyrylcholinesterase (pseudocholinesterase) na-agbaji succinylcholine. Ebe ọ bụ na pesticide ahụ ebibila enzymes cholinesterase niile, otu dose nke succinylcholine na-akpata ** awa nke mkpọnwụ ahụ ogologo oge. Kama nke ahụ, a na-eji ndị na-egbochi neuromuscular na-adịghị emebi emebi (dị ka **rocuronium ***).

3. Ikiri maka "Ọrịa Intermediate Syndrome" (awa 24 ruo 96 ka e mesịrị)¶

Ọbụlagodi mgbe onye ọrịa lanarịrị nsogbu nke ụbọchị mbụ nke cholinergic ụbọchị 1 wee yie ka ọ na-agbake nke ọma n'ụlọ ọgwụ, ** 10 ruo 40 pasent nke ndị ọrịa merụrụ ahụ site na organophosphates dị oke lipid soluble (dị ka fenthion, dimethoate, parathion, ma ọ bụ chlorpyrifos) na mberede na-etolite "ọrịa Intermediate Syndrome" 1 ruo 4 ụbọchị:*

• ** Ahụ mkpọnwụ na-egbu oge na mberede ***: Na-enweghị mmiri mmiri na-emegharị ugboro ugboro ma ọ bụ ngụgụ mmiri mmiri, onye ọrịa ahụ na-etolite nnukwu ahụ mkpọnwụ nke ** olu na-emegharị emegharị ** (enweghị ike ibuli isi ha n'elu ohiri isi: akara ịdọ aka ná ntị mbụ), ** akwara cranial *, ** proximal ubu / hip mọzụlụ, na ** iku ume ume (diaphragm) na ume iku ume ozugbo. ruo ụbọchị 15 ruo mgbe nkwụsị nke neuromuscular gbakee.
• ** Organophosphate-Induced Delayed Neuropathy (OPIDN): Na-eme ** 1 ruo 3 izu ** mgbe ụfọdụ ekpughere, na-eme ka mgbu nwa ehi na-afụ ụfụ, nhụsianya, tingling, na "ịkwakọba-na-glove" ụkwụ ịdaba / nkwojiaka adịghị ike.

Otu esi eji Autoinjectors: DuoDote, Mark I, na Atropen¶

N'ime ndị agha, ihe ndị dị ize ndụ (HAZMAT), ọrụ ahụike mberede (EMS), na ụfọdụ ntọala ọrụ ugbo nke ụlọ ọrụ, ndị na-azaghachi na-ebu mmiri intramuscular autoinjectors nke e mere iji nyefee ** Atropine ** na ** Pralidoxime (2-PAM) ** site na uwe n'ime apata ụkwụ dị n'ime sekọnd nke organophosphate ma ọ bụ onye na-ahụ maka akwara.

Ọgwụ site na Severity na Autoinjector Ụdị¶

1. ** Ndị okenye Autoinjectors (DuoDote ma ọ bụ ATNAA / Mark I Kit) ***:
2. Onye ọ bụla ** DuoDote ** otu-barrel autoinjector na-ebuga ** 2.1 milligrams nke Atropine ** na ** 600 milligrams nke Pralidoxime Chloride ** n'usoro site na otu agịga (nke okenye ** Mark I Kit ** na-eji injectors abụọ dị iche iche: Injector #1 nwere 2 mg Atropine, yana injector #2 nwere 6x00 mg).
3. ** Mgbaàmà dị nro na nke adịghị agafe agafe ** (ụmụ akwụkwọ na-atụ anya, imi na-agba agba, mkpọnwụ, njigide n'obi, ọgbụgbọ, mana onye ọrịa ka na-eje ije ma na-ekwu okwu): Nlekọta ** 1 DuoDote (ma ọ bụ 1 Mark I set)** n'ime apata ụkwụ mpụta etiti (vastus lateralis). Chere 10 ruo 15 nkeji; ọ bụrụ na mgbaàmà adịghị mma, chọọ nlekọta ahụike maka usoro ọgwụgwọ ọzọ.
4. ** Mgbaàmà siri ike *** (amaghị ama, mgbakasị ahụ / ọdịdọ, nnukwu nsogbu iku ume / gasping, apnea, ma ọ bụ ahụ mkpọnwụ flaccid): ozugbo inye ** 3 DuoDote autoinjectors (ma ọ bụ 3 Mark I sets) n'usoro ngwa ngwa ** n'ime apata ụkwụ mpụta, gbakwunyere ** 1 Diazepam (CANA 10 mg) ma ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ dị, ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ bụrụ na ọ na-eme, ọ bụrụ na Mida 10 mg, vulzo, vulzot, vulzot, vulzot. ihe ọdịdọ a na-ahụ anya adịghị apụta ìhè (dị ka ndị na-ahụ maka akwara kpọnwụrụ akpọnwụ na-enwekarị ọnọdụ akwụkwụ na-adịghị mma na ụbụrụ).
5. ** Usoro ọgwụgwọ ụmụaka dabere na Atropen*:
6. Ụmụntakịrị ekpughere na organophosphates ma ọ bụ ndị na-ahụ maka akwara chọrọ nha nha ** Atropen ** autoinjectors (nke dị na ** 0.25 mg ** [akara edo edo, maka ụmụ ọhụrụ n'okpuru 7 kg / 15 lbs], ** 0.5 mg *** [labelụ anụnụ anụnụ, maka ụmụaka 7 ruo 18 kg / 15 ruo 40 lbs maka ụmụaka na-acha ọbara ọbara, * 8. 41 n'arọ / 40 ruo 90 lbs], na ** 2.0 mg *** [akwụkwọ ndụ akwụkwọ ndụ, maka ihe karịrị 41 n'arọ / 90 lbs]).
7. ** Iwu nchekwa ndụ dị mkpa ***: Ọ bụrụ na nwatakịrị nwere organophosphate na-eyi ndụ egwu ma ọ bụ nsị na-egbu akwara (nyocha ngụgụ, gasping, coma, ma ọ bụ ihe ọdịdọ) na naanị okenye ** 2 mg Atropine / DuoDote ** autoinjector dị na ọnọdụ, ** na-elekọta ndị okenye autoinjector nwata ozugbo. Atropine tachycardia nwa oge na akpụkpọ akọrọ na-adị ndụ kpamkpam, ebe njide iku ume cholinergic a na-agwọghị na-egbu egbu na nkeji.

Usoro ntinye nzọụkwụ nke Autoinjector¶

• **Nzọụkwụ 1: Lelee akpa apata ụkwụ dị n'elu ***: Na-enwe mmetụta nke etiti apata ụkwụ ọsọ ọsọ iji jide n'aka na ị naghị agbanye n'ime obere akpa, igodo, smartphone, ma ọ bụ eriri eriri siri ike.
• ** Nzọụkwụ 2: Wepụ okpu nchekwa isi awọ ***: Jide barel DuoDote n'aka gị na ** n'ọnụ akwụkwọ ndụ akwụkwọ ndụ na-atụ aka mgbada ** ( etinyela isi mkpịsị aka gị n'elu njedebe agịga ndụ ndụ). Dịrị okpu ntọhapụ nke isi awọ ozugbo na azụ.
• **Nzọụkwụ 3: Jịba kwụsie ike n'ogo ogo 90 n'ime apata ụkwụ etiti mpụta ***: Gbanahụ ma pịa n'ọnụ akwụkwọ ndụ akwụkwọ ndụ nke ọma n'ime apata ụkwụ anụ anụ n'etiti úkwù na ikpere ruo mgbe ị nụrụ wee nwee mmetụta mmiri pịa.
• Nzọụkwụ 4: Jidesie ike maka 10 sekọnd zuru ezu: Gụo nwayọ ruo 10 ("otu puku na otu puku, abụọ na otu puku...") yabụ ụlọ abụọ ahụ (atropine na pralidoxime) tọgbọrọ kpamkpam n'ime akwara.
• **Nzọụkwụ 5: Tụgharịa agịga ahụ n'ime nko wee tụnye ya n'olu nke onye ahụ metụtara ***: Sepụta injector ozugbo, hichaa apata ụkwụ maka sekọnd ole na ole, wee gbadaa agịga ahụ ekpughere n'ime nko "J" n'elu elu siri ike ka ị nwee ike itinye autoinjector efu na akpa uwe onye ahụ aka ma ọ bụ mkpado triage. Nke a na-agwa ndị na-ahụ maka ahụike na ndị dọkịta mberede na-abịarute na nlele ole doses nke atropine na 2-PAM onye ọrịa natara.

Ajụjụ a na-ajụkarị¶

• Ntuziaka a bụ maka ebumnuche ozi na anaghị edochi nyocha ahụike ọkachamara ma ọ bụ ọzụzụ aka. N'ihi na nsị kemịkal siri ike nwere ike ime ka njide iku ume iku ume na mberede, anyị na-akwado ka ị nweta enyemaka enyemaka mbụ na CPR site na International Federation of Red Cross and Red Crescent Societies (IFRC), obodo Red Cross gị, St John Ambulance, ma ọ bụ onye na-enye ọzụzụ mpaghara.

enyochara isi mmalite¶

• Òtù Ahụ Ike Ụwa (WHO): Nchịkwa nlekọta ahụike nke ịṅụbiga mmanya ókè na-egbu egbu: Organophosphorus, Carbamate, na Paraquat Ntuziaka ntụ ntụ.
• Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC, United States) & Agency for Toxic Substances and Disease Registry (ATSDR): * Ntuziaka nlekọta ahụike maka ndị ọrụ akwara na Organophosphate Pesticides * na * Paraquat Clinical Guidance *.
• US Environmental Protection Agency (EPA, United States): Nkwenye na njikwa nke nsị ọgwụ pesticide (mbibi nke isii).
• Ọrụ Ozi Nsi nke Mba (NPIS, United Kingdom) & Ụlọ Ọrụ Nchebe Ahụike UK (UKHSA): TOXBASE Clinical Management of Organophosphates, Carbamates, Paraquat, na Metal Phosphides.

Ntuziaka emetụtara¶

• Enyemaka mbụ nsi na nchikota nsi
• Ọkụ siri ike na nsị kemịkal akpụkpọ
• Hydrofluoric acid, ihe na-ewepụ nchara, na kemịkalụ ụlọ ọrụ na-ere ọkụ
• mmerụ ahụ anya na mmiri ọgwụ anya mmiri
• CPR na iku ume nnapụta maka ndị okenye
• Nọmba mberede site na obodo