Nsi Tetrodotoxin na Saxitoxin: Pufferfish, Octopus nwere mgbanaka na-acha anụnụ anụnụ, na azụ azụ ahụ kpọnwụrụ akpọnwụ.¶

Tetrodotoxin (TTX) na saxitoxin (STX) so na neurotoxins na-abụghị protein na okike, nke nwere ike ime ka ahụ mkpọnwụ akwara na-arịgo ngwa ngwa na njide iku ume zuru oke n'ime nkeji 15 ruo 90 nke nri mmiri ma ọ bụ kọntaktị na-egbu egbu. Ma ekpughere ya sitere na iri nri pufferfish na-ezighi ezi (* fugu ), na-ata ahụhụ na-enweghị mgbu site na octopus na-acha anụnụ anụnụ ( Hapalochlaena * ụdị) n'ime ọdọ mmiri Indo-Pacific, ma ọ bụ iri bivalve shellfish (mussels, clams, oysters, scallops, ma ọ bụ geoducks) na-emerụ ahụ na-emerụ ahụ. (PSP), usoro na-eyi ndụ egwu bụ otu: mgbochi na-aga n'ihu nke ọwa sodium voltaji na akwara moto na akwara skeletal, na-ejedebe na mkpọnwụ diaphragmatic na njide obi hypoxic. N'ụzọ dị oke mkpa, n'ihi na tetrodotoxin ma ọ bụ saxitoxin adịghị agafe ihe mgbochi ụbụrụ ụbụrụ mmadụ n'ọtụtụ dị ukwuu, ** onye ahụ kpọnwụrụ akpọnwụ nke nwere ihe edoziri, ụmụ akwụkwọ na-eku ume na iku ume efu na-anọgide 100 pasent, na-amụ anya ma nwee ike ịnụ ma nụ ihe niile gbara ha gburugburu **. Ọ bụrụ na onye ọ bụla amalite igbu egbugbere ọnụ ma ọ bụ ire mgbe o risịrị nri mmiri ma ọ bụ jikwaa ndụ mmiri, kpọọ mpaghara gị nọmba mberede ozugbo ma jikere ịrụ iku ume nnapụta na-aga n'ihu (CPR). Nyochaakwa ntuziaka ụmụnna anyị na botulism, ciguatera, scombroid, na nsị neurotoxin, nsi mbụ enyemaka, na na-egbu mgbu.

Ihe kacha mkpa gị ozugbo bụ ịmata na ** ọnụọgụ ma ọ bụ ntụtụ na agịga nke egbugbere ọnụ na ire n'ime nkeji iri nri mmiri ma ọ bụ nri octopus bụ ịdọ aka ná ntị pụtara ìhè nke ahụ mkpọnwụ akwara iku ume na-abịa, tinye onye ahụ n'ọnọdụ mgbake n'akụkụ ma ọ bụrụ na ọ na-agbọ agbọ ma ọ bụ na-agbapụta, tinye ihe mgbochi Australian Pressure Immobilization ozugbo ma ọ bụrụ na ihe kpatara ya bụ ihe na-acha anụnụ anụnụ, na-acha anụnụ anụnụ. Ọnụ-na-ọnụ ma ọ bụ akpa-valve-mask ventilashion ventilashion ** oge iku ume na-aghọ nke na-emighị emi ma ọ bụ kwụsị.

Mee nke a ugbu a¶

1. *Kpọọ nọmba mberede nke mpaghara gị ozugbo na akara mbụ nke egbugbere ọnụ, ire, ma ọ bụ mkpịsị mkpịsị aka mgbe ị richara pufferfish, shellfish, ma ọ bụ invertebrates reef, ma ọ bụ mgbe ejirichara obere octopus. nọmba mberede. Gwa onye na-ezipụ ozi ahụ nke ọma: * "Tetrodotoxin a na-enyo enyo ma ọ bụ nsị azụ azụ azụ kpọnwụrụ akpọnwụ, nnukwu ihe ize ndụ nke ijide iku ume ngwa ngwa, ụzọ ikuku dị elu na ikuku ikuku chọrọ ozugbo."
2. **Kwụsị iri nri mmiri a na-enyo enyo ozugbo, dọọ ndị niile na-eri nri aka na ntị, ma chekwaa ihe atụ nke azụrụ ọhụrụ ma ọ bụ sie nri, azụ azụ, ma ọ bụ vomit n'ime akpa ejiri mechiri emechi maka nyocha ahụike ọha. ngwa ngwa nyocha ụlọ nyocha nke tetrodotoxin ma ọ bụ saxitoxin na-eduzi nlekọta ụlọ ọgwụ siri ike ma na-enyere ahụike ọha na eze mberede na-echeta akwa akwa azụ azụ emeru.
3. ** Ọ bụrụ na ekpughere ahụ bụ ata sitere na octopus nwere mgbanaka na-acha anụnụ anụnụ (ma ọ bụ cone snail) na ogwe aka ma ọ bụ ụkwụ, tinye bandeji siri ike nke siri ike (PIB) ozugbo wee gbasaa akụkụ ahụ kpamkpam.* aka na nchichi a na-eji maka nkwonkwo ụkwụ gbajiri agbaji (nke siri ike iji mee ka mmiri na-asọ mmiri nke lymphatic kwụsịlata na-ewepụghị akwara akwara), mee ka akụkụ ahụ ya ghara ịdị na-emegharị ahụ site n'ịgbatị ụkwụ siri ike, ma mee ka onye ọrịa ahụ dị jụụ.
4. **Emela ka agbọ agbọ, amanyela onye na-arahụ ụra ma ọ bụ onye na-asọ oyi ka ọ ṅụọ mmiri, mmiri ara ehi, ma ọ bụ unyi n'ụlọ, ma tụgharịa onye ọgbụgbọ n'akụkụ ha.
5. ** Nyochaa ịdị omimi iku ume na ọnụego ọ bụla 60 sekọnd, wee malite iku ume nnapụta na-aga n'ihu (ma ọ bụ CPR zuru oke ma ọ bụrụ na ọkpụkpụ efu efu) iku ume ngwa ngwa na-aghọ ihe na-emighị emi, ngwa ngwa, ma ọ bụ kwụsị. Ọ bụrụ na ị nweghị ike ịhụ ụbụrụ carotid n'ime sekọnd iri, malite zuru oke CPR na mkpakọ obi 30 ruo iku ume nnapụta 2.
6. ** Gwa onye ọrịa ahụ ahụ kpọnwụrụ akpọnwụ okwu n'ụzọ dị jụụ, na-emesi obi ike ma na-aga n'ihu, ma dọọ ndị na-ahụ maka ahụike na ndị dọkịta aka ná ntị na onye ahụ a na-ahụ anya na-amụba anya n'ime ahụ ya kpọnwụrụ akpọnwụ. A na-enye mgbatị ahụ nke ọma na analgesia n'oge intubation.

Osisi mkpebi: nke a na-enyo enyo na mkpughe neurotoxin mmiri na njide iku ume¶

flowchart TD
    A["Nri nri mmiri na nso nso a ma ọ bụ kọntaktị ọdọ mmiri"] --> B{"Gịnị bụ isi mmalite mkpughe?"}
    B -->|Bite or handling of small octopus or cone snail| C["Octopus nwere mgbanaka na-acha anụnụ anụnụ TTX ma ọ bụ cone eju conotoxin"]
    B -->|Ate pufferfish, toadfish, globefish, or horseshoe crab eggs| D["Tetrodotoxin (TTX) na-egbu egbu"]
    B -->|Ate mussels, clams, oysters, scallops, or whelks| E["Nsi nke Shellfish kpọnwụrụ akpọnwụ (Saxitoxin)"]
    C --> F["Tinye Bandage Immobilization Pressure + splint aka ozugbo"]
    D --> G["Kwụsị nri, chekwaa nri nri, mee ka onye ọrịa nọrọ n'akụkụ"]
    E --> G
    F --> H{"Lelee ụzọ ikuku, ilo, na iku ume kwa sekọnd 60 ọ bụla"}
    G --> H
    H -->|Perioral tingling, slurred speech, drooling, weak cough| I["Kpọọ EMS ozugbo: nnukwu ihe ize ndụ nke njide iku ume na 15 ruo 60 min"]
    H -->|Shallow breathing, cyanosis, or respiratory arrest| J["Malite iku ume nnapụta ozugbo (1 iku ume ọ bụla 5 ruo 6 sec) ma ọ bụ CPR zuru oke"]
    I --> K["Debe NPO (ọ dịghị ihe ọ bụla site n'ọnụ), ịṅụ mmiri ma ọ bụ igbapu mmiri n'ọnọdụ mgbake"]
    J --> L["Mee ka obi sie onye ọrịa obi ike: ha na-amakwa 100% n'agbanyeghị ahụ mkpọnwụ"]
    K --> M["Hospitallọ ọgwụ ICU: Intubation endotracheal nwere ịhịa aka n'ahụ + ikuku ikuku 24 ruo 72"]
    L --> M

Pathology molecular: ka Tetrodotoxin (TTX) na Saxitoxin (STX) si eme ka ahụ kpọnwụrụ akpọnwụ¶

Ịghọta usoro cellular tetrodotoxin na saxitoxin na-akọwa ihe kpatara ọnwụ ji apụta ngwa ngwa na-enweghị nkwado ụgbọ elu yana ihe kpatara mgbake zuru oke na-esote ma ọ bụrụ na ikuku na-eku ume ruo mgbe nkwụsị nke akụrụ.

1. Guanidinium okwuchi mgbochi nke voltaji-gated sodium ọwa¶

Ma ** tetrodotoxin *** (319 Daltons) na ** saxitoxin ** (299 Daltons) bụ kọmpat, guanidinium alkaloids na-edozi mmiri nke jikọtara ya na njikọ nanomolar na ** saịtị 1 na oghere oghere extracellular nke chanel sodium voltaji-gated (NaV) ** na akwara sensọ mmadụ, akwara anụ ahụ na axkeletal.

• ** Igwe okwu molekụla dị na karama ahụ: *** Mgbe ụbụrụ na-eziga iwu ala akwara phrenic ka ọ gbakọta diaphragm, chanel sodium voltaji (NaV 1.1, NaV 1.2, NaV 1.4, NaV 1.6, na NaV 1.7) meghere n'akụkụ axon iji gbasaa ikike eletrik. Moiety guanidinium a na-akwụ ụgwọ nke ọma nke tetrodotoxin ma ọ bụ saxitoxin wedges n'ime nzacha nke mpụta selectivity (mgbanaka DEKA) nke ọwa sodium pore dị ka okwuchi anụ ahụ etinyere n'ime olu karama.
• ** Mkpuchi eletrik zuru oke: *** A na-egbochi ion sodium n'anụ ahụ ịbanye na axon. Iri irighiri akwara na-akwụsị ibunye mmetụ aka mgbe mbido mbụ nke nfụkasị (paresthesias), na irighiri akwara na akwara skeletal na-aghọ enweghị ike ịgba egbe, na-ebute ngwa ngwa ** ahụ mkpọnwụ skeletal skeletal ** flaccid.

2. Ihe kpatara obi ji na-eguzogide ọgwụ ruo mgbe hypoxia pụtara¶

Anụ ahụ skeletal mmadụ na akwara dị n'akụkụ na-egosipụta ** TTX-sensitive sodium channels** (NaV 1.4 na NaV 1.6 / NaV 1.7), bụ nke egbochiri site na obere mkpokọta nanomolar (1 ruo 10 nanomolar) nke tetrodotoxin. N'ụzọ dị iche, akwara obi mmadụ na-egosipụtakarị ** obi sodium channel isoform NaV 1.5 **, ebe otu amino acid dị iche (cysteine ​​​​na ngalaba I) na-eme ka ọwa obi obi ** 200 ruo 1,000 ugboro na-enwechaghị mmetụta na tetrodotoxin **. Na usoro nke na-eme ka diaphragm na akụkụ aka ya kpọnwụrụ akpọnwụ kpamkpam, ** obi onye ahụ na-aga n'ihu na-akụ aka n'onwe ya ** ruo mgbe enweghị ume na-akpata hypoxemia arterial siri ike na njide obi nke asphyxial (n'agbanyeghị oke nke 4 ingestion nwere ike ime ka ọmịiko vasomotor blockade, hypotension, na bradycardia).

3. Gịnị kpatara onye ahụ a tara ahụhụ ji nọrọ na-amụ anya 100% (Pseudocoma akpọchiri akpọchi)¶

N'ihi na ma tetrodotoxin na saxitoxin dị obere ** mmiri soluble (hydrophilic), molecules polar ** na-akwụ ụgwọ nke ọma na pH physiological (7.4), ha ** anaghị agafe ngwa ngwa ihe mgbochi ụbụrụ ụbụrụ mmadụ nwere lipid.

• Ọbụlagodi mgbe akwara ọkpụkpụ ọ bụla nke afọ ofufo dị n'ime ahụ bụ 100% kpọnwụrụ akpọnwụ na mgbochi parasympathetic na-akpata ** edozi, ụmụ akwụkwọ diated (mydriasis)* na nhụsianya corneal na-anọghị, ** onye ọrịa ahụ na-amụ anya nke ọma ma nwee ike ịnụ mkparịta ụka ọ bụla wee nwee mmetụta agịga ọ bụla ma ọ bụ agụba intubation ***.
• Ndị na-aza ajụjụ mbụ agaghị eme ** ọ dịghị mgbe *** ikwu okwu enweghị atụ n'akụkụ onye ọrịa ahụ, ga-apịa ma ọ bụ tee anya anya, ndị dọkịta mberede ga-enyerịrị ** ịgba ọgwụ mgbochi ọrịa na analgesia ** (propofol, midazolam, ma ọ bụ ketamine gbakwunyere fentanyl) tupu itinye ya na ikuku ikuku.

4. Okpomọkụ zuru oke na nkwụsi ike nke kemịkal¶

Ma tetrodotoxin na saxitoxin bụ ** okpomoku zuru oke na-akwụsi ike yana acid kwụsiri ike. Isi nri, frying, ime achịcha, uzuoku, nri nrụgide, isi nri *** (100 ruo 200 degrees Celsius, ma ọ bụ 212 ruo 392 degrees Fahrenheit), ** kefriza ** (-20 ruo -80 degrees Celsius, ma ọ bụ -4 ruo -112 degrees Fahrenheit), ma ọ bụ ** marinating na mmanya na-anọpụ iche, lemon ihe ọṅụṅụ na-anọpụ iche mmadụ, lemon ihe ọṅụṅụ. (pH 1.5 ruo 2.0) anaghị agbaji ha. Azụ pufferfish ma ọ bụ azụ azụ emerụrụ emerụ, na-esi isi na ụtọ ** 100 percent nkịtị na nke ọhụrụ ***.

Isi ọrịa mkpughe: Pufferfish, Octopus na-acha anụnụ anụnụ, na anụ ahụ akpọnwụ akpọnwụ¶

Pufferfish (Fugu) na ntinye Tetrodotoxin na-abụghị fugu¶

Ebe Tetrodotoxin na-ezo na pufferfish na ihe ndị ọzọ dị n'ime mmiri¶

Pufferfish (ezinụlọ * Tetraodontidae *, nke a maara dị ka * fugu * na Japan, * bok-eo * na Korea, * hetun * na China, na azụ azụ ma ọ bụ toadfish na mpaghara ndị na-asụ Bekee) na-enweta TTX site na nje bacteria na mmiri site na nri nri ma tinye ya n'ime protein na-ejikọta pụrụ iche n'ime akụkụ ahụ ha.

1. ** Akụkụ ahụ na-egbu egbu (imeju na ovaries):** N'ọtụtụ * Takifugu * ụdị eji na nri ndị Japan, ** imeju (kimo)* na ** ovaries / egg (roe) ** nwere mkpokọta tetrodotoxin na-egbu egbu, ebe ** 1 ruo 2 milligrams ** nke crystalline tetrodotoxin (gram ole na ole nke imeju mmadụ). ** eriri afọ** na akpụkpọ ahụ na-ebukwa ihe na-egbu egbu. Na Japan, iwu imeju pufferfish (* fugu kimo *) ka amachibidoro kemgbe 1984, na naanị ndị isi nri nwere ikike nwere ike ịkwadebe ụdị akwadoro; Ihe fọrọ nke nta ka ọ bụrụ ọnwụ niile * fugu * ndị Japan nke ọgbara ọhụrụ na-eme mgbe ndị na-amụ ihe na-akwadebe pufferfish n'ụlọ ma ọ bụ rie imeju amachibidoro.
2. ** Ụdị anụ ahụ na-emerụ emerụ na nke na-egbu egbu (Lagocephalus sceleratus na North American Puffers):*** N'ọtụtụ ụdị dị n'èzí aquaculture a na-achịkwa, anụ ahụ na-acha ọcha n'onwe ha nwere mkpokọta tetrodotoxin ma ọ bụ saxitoxin na-egbu egbu.
3. ** Toadfish na-agba agba (Lagocephalus sceleratus):** Azụ anụ ọhịa Indo-Pacific na-akpa ike nke si na Suez Canal banye n'Oké Osimiri Mediterenian ** (Greece, Turkey, Saịprọs, Israel, Lebanon, Egypt, Italy, Spain). O nwere oke tetrodotoxin n'ime ** anụ ahụ akwara, akụkụ ahụ na akpụkpọ ya, na-ebute nsị na-egbu egbu n'etiti ndị na-ahụ maka Mediterranean.
4. klwxh:0018 Sphoeroides nephelus ): Na United States (n'akụkụ Osimiri India nke dị na Florida na Gulf of Mexico na Atlantic Coast), pufferfish fillet na-akwakọba nnukwu ọkwa nke ** saxitoxin ** na tetrodotoxin n'ime anụ ahụ ha.
5. ** Ndị na-ahụ maka Tetrodotoxin na-abụghị Pufferfish:**
6. ** Mangrove Horseshoe Crab (* Carcinoscorpius rotundicauda*):** Achọtara na Thailand, Vietnam, Cambodia, na Malaysia; ọ fọrọ nke nta ka ọ dị ka nshịkọ akpụkpọ ụkwụ dị n'ụsọ oké osimiri (* Tachypleus gigas*) mana ọ na-ebu tetrodotoxin na saxitoxin na-egbu egbu n'ime akwa ya.
7. ** Gastropods Marine, Sea Slugs, na Newts:** Ejula ọnwa na-agbaji, eju ọdụ́, na opi dị n'Eshia na Europe na-akwakọba TTX na gland digestive ha na ụkwụ akwara; slug mmiri n'akụkụ isi awọ (* Pleurobranchaea maculata ) na-asachapụ n'akụkụ osimiri New Zealand na Australia nke nwere TTX na-egbu egbu; na ** ọhụrụ ọhụrụ akpụkpọ ahụ siri ike (Taricha granulosa)* na US Pacific Northwest na British Columbia na-ezobe tetrodotoxin na-egbu egbu na akpụkpọ anụ ahụ ha.

The Fukuda na Tani 4-Stage Clinical Grading System¶

Ndị ụlọọgwụ na-ahazi ọganihu tetrodotoxin site na iji 4-Stage Fukuda na Tani Grading Scale. ** Ọ bụrụ na egbugbere ọnụ nke 1 na-amalite n'ime nkeji 10 ruo 20 nke iri nri, ọganihu na njide iku ume nke Stage 4 nwere ike ime n'ime nkeji 30 ruo 60 **.

1. ** Ọkwa 1 (Early Sensory and GI Stage):** Mgbu egbugbere ọnụ, ire, na ntachi nke egbugbere ọnụ, ire, na mucosa ọnụ (dị ka nrịanrịa mpaghara eze), na-agbasa ruo n'ọnụ mkpịsị aka na mkpịsị ụkwụ, na hypersalivation (drooling), ọgbụgbọ, vomiting, epigastric mgbu, isi ọwụwa, na ọsụsọ.
2. ** Ọkwa 2 (Na-aga n'ihu Nhụjuanya na Early Motor/Bulbar adịghị ike):** Ọnwụ na-agbasa n'ihu, olu, ogwe na akụkụ aka, na-enwe mmetụta na ahụ na-ese n'elu n'etiti ikuku . Adịghị ike nke moto mbụ na-ebute ihe isi ike ịga ije (ataxia), ike njide adịghị mma, okwu na-adịghị mma ( dysarthria*), ihe isi ike ilo mmiri (dysphagia), nku anya na-agbada nwayọọ (ptosis), na mfu nke corneal reflex.
3. ** Ọkwa 3 (Ọrịa mkpọnwụ akpọnwụ akpọnwụ na iku ume na-abịa n'ihu):** Enweghị ike iguzo ọtọ, nọdụ ala, ma ọ bụ welie akụkụ ahụ ya, na-enwe mmetụta ntụgharị akwara miri emi (** areflexia**) na ụda olu (aphonia). Mkpọnwụ nke akwara intercostal na ike ọgwụgwụ nke diaphragm na-akpata ** iku ume na-emighị emi (hypoventilation) **, dyspnea, enweghị ike ụkwara, ikuku oxygen na-adaba (n'okpuru pasent 90), hypercapnia, cyanosis, na hypotension. Onye ọrịa na-amata nke ọma.
4. ** Ọkwa 4 (Njide iku ume zuru oke, enweghị obi mgbawa obi, na Pseudocoma):** Mkpọnwụ diaphragmatic zuru oke (apnea, iku ume efu efu). Enweghị iku ume nnapụta ozugbo ma ọ bụ ikuku ikuku, njide obi hypoxic na-abịa n'ime nkeji 3 ruo 5. Mgbochi nke ganglion ciliary na akwara cranial na-akpata ** debere, ụmụ akwụkwọ gbasasịrị agbaze (mydriasis)* na gag na-anọghị, ụkwara, corneal na oculocephalic reflexes, n'akụkụ hypotension arterial na sinus bradycardia. Ọ gwụla ma ụbụrụ hypoxia mere tupu ikuku ikuku amalite, ụbụrụ ụbụrụ na-amụ anya ma nwee ike ịnụ ihe n'ime ahụ na-enweghị mmegharị.

Octopus na-acha anụnụ anụnụ (Hapalochlaena) na-ata ahụhụ na mmegide nrụgide Australia¶

Ịmata ihe e kere eke na ọnyà ọnyà dị jụụ¶

The -acha anụnụ anụnụ octopus ** nwere ụdị anọ dị nta nke genus * Hapalochlaena * ( H. maculosa * na ndịda Australia, * H. Lunulata * n'ebe ugwu Australia na Indo-Pacific si Indonesia na Philippines na Japan, * H. fasciata * tinyere n'ebe ọwụwa anyanwụ Australia, na * H. nierstraszi ): - ** Obere nha na ngosi ịdọ aka ná ntị: Ahụ ahụ bụ nha bọọlụ gọlfụ (4 ruo 6 centimeters, ma ọ bụ 1.5 ruo 2.5 sentimita asatọ), nwere ogologo ogwe aka nke 10 ruo 20 centimita (4 ruo 8 sentimita). Ha na-ezo n'ime karama, ite, sheshell, na ọdọ mmiri ndị na-emighị emi nke a tụfuru. Mgbe ha na-ezu ike, ha na-apụta na-acha aja aja; Naanị mgbe agbadoro ma ọ bụ bulie, na-eme chromatophores ha na-egbuke egbuke ** 50 ruo 60 mgbanaka na-acha anụnụ anụnụ ma ọ bụ n'ọnyá *. - ** Ata nkịtị na ogwu ogwu TTX ngwa ngwa: onu okuku chitin na-anọdụ n'okpuru webụ ogwe aka. Ata ya dị ntakịrị nke na ** ihe karịrị ọkara nke ndị ọ metụtara na-enwe ahụ mgbu efu ma ọ bụ naanị obere pinprick **, na-ahụ naanị 1 ruo 2 millimeter (0.04 ruo 0.08 inch) ntụpọ ọbara ma ọ bụ na-agbapụ na mkpịsị aka ma ọ bụ ụkwụ. Nje bacteria Symbiotic dị n'ime gland salivary dị n'azụ na-emepụta tetrodotoxin, nke a na-agbanye n'ime capillaries subcutaneous na lymphatics, na-akpata ** nkwụsị nke oge, ọhụụ na-adịghị mma, na njide iku ume n'ime nkeji 5 ruo 15 **.

Usoro nzọụkwụ site na nzọụkwụ Australian Pressure Immobilization Bandage (PIB).¶

N'adịghị ka nsị jeliifish ma ọ bụ nsị azụ azụ, ** a na-acha anụnụ anụnụ octopus ata (ma ọ bụ cone snail sting) bụ envenomation neurotoxic nke parenteral nke na-achọ mgbakasị ahụ ike ozugbo (PIB) ** kwa ** ANZCOR Ntuziaka 9.4.8 **:

1. ** Debe onye a na-ata ahụhụ kpamkpam wee dina ala:** Ije ije ma ọ bụ ịgbatị akụkụ ahụ na-eme ka mgbapụta akwara skeletal na-eme ka mmịnye TTX dịkwuo elu.
2. Asachala, bepụ, aṅụ, ma ọ bụ tinye ihe nlegharị anya akwara: Ebipụla mgbaba ọbara akwara ma ọ bụ egbula oge na-asa ọnya ahụ.
3. ** Tinye bandeeji 1 n'elu aru na bandeeji 2 n'elu akụkụ ahụ dum: ** Kechie bandeeji sara mbara (10 ruo 15 centimeters ma ọ bụ 4 ruo 6 sentimita asatọ n'obosara) nke ọma n'elu aru ahụ, wee kechie ya na mkpịsị aka ma ọ bụ mkpịsị ụkwụ ruo n'úkwù ma ọ bụ ukwu na esemokwu a na-eji maka nkwonkwo ụkwụ gbawara agbawa, 50mmH ruo 40mmH. Nyochaa njupụta capillary nke abụọ nke abụọ na mkpọpu dịpụrụ adịpụ.
4. ** Tinye splint siri ike wee hapụ ebe ahụ ruo mgbe ICU dị njikere: ** Kechie splint siri ike na aka gị, kaa akara ebe a na-ata ahụhụ na bandeeji ahụ, na ** ewepụla bandeeji ahụ ruo mgbe onye ọrịa ga-abanye n'ime ebe a na-emeghachi ụlọ ọgwụ na ngwa intubation dị njikere **.

Nsi na-egbu anụ Shellfish (PSP) na Saxitoxin¶

** Ihe nsi nke Shellfish (PSP)** na-eme n'akụkụ oke osimiri Pacific na Atlantic nke North America (Alaska, British Columbia, Washington, Oregon, California, Maine, Massachusetts na Maritime Canada), Chile, Argentina, UK, Europe, South Africa, Japan, Philippines, New Zealand na Australia.

• ** Dinoflagellate bioaccumulation:** Algae mmiri nwere otu cell (Alexandrium katenella, Alexandrium tamarense, Gymnodinium catenatum na Pyrodinium bahamense) na-emepụta ** saxitoxin (STX)** na 50+ gonyautoxin analogues. Bivalves na-enye nri (** mọsel, mkpọ bọta, agụba, clams obere olu, clams dị nro, geoducks, oysters, scallops na cockles *) na-etinye uche saxitoxin n'ime gland digestive na siphon. Gastropods na-eri anụ ( whlks, eju ọnwa, abalone *) na crustaceans ( Nshịkọ nshịkọ, nshịkọ, na hepatopancreas lobster ma ọ bụ tomalley ***) na-akwakọba saxitoxin na-egbu egbu.
• ** Gịnị kpatara nlele mmiri anya na-ada: *** Shellfish na-akwakọba saxitoxin na-egbu egbu (ihe karịrị 80 micrograms kwa gram 100 nke anụ) ọbụlagodi mgbe mmiri oke osimiri na-ele anya 100% kristal doro anya ***. Pacific butter clam (Saxidomus gigantea) na-ejigide saxitoxin na siphon ya maka ** ruo afọ 1 ruo 2 ** mgbe oge ntoju algal gachara, na iri nri ** dum ma ọ bụ roe-on scallops ** site na mmiri a na-enyochaghị na-ebu ihe egwu PSP zuru oke.

Nchọpụta dị iche iche: TTX na Saxitoxin vs Ciguatera, Scombroid, Botulism, na Anaphylaxis¶

Prehospital na ụlọ ọgwụ resucitation: nzọụkwụ-site-nzọụkwụ ụlọ ọgwụ protocol¶

1. Ndokwa ụzọ ikuku ozugbo na iku ume nnapụta (Nkeji 1 ruo 4)¶

• ** Debe onye ọrịa ahụ nke ọma NPO (ọ dịghị ihe ọ bụla n'ọnụ) ma ghara ịkpata vomiting:** Onye ọrịa nwere nkwarụ bulbar enweghị ike ichekwa trachea ha, ọ ga-achọkwa mmiri mmiri ma ọ bụ gbapụta n'ime ngụgụ ha. Debe onye ọrịa n'ọnọdụ ** mpụta nkwụghachi azụ (nweghachi)** ma ọ bụrụ na ọgbụgbọ ma ọ bụ ikpokọta mmiri na-apụta.
• ** Nku ume na-aga n'ihu na-eku ume na akpa-Valve-Mask (BVM) ventilashion: ** Malite inye aka ventilashion ozugbo iku ume na-emighị emi, paradoxical, ma ọ bụ nwayọọ (ihe na-erughị 8 ume kwa nkeji), ma ọ bụ ọ bụrụ na onye ọrịa enweghị ike ịgụta 5 n'ime otu ume. Debe onye ahụ n'azụ ya, mee ** isi-tilt / chin-lift , tuo imi, ma nyefee ** 1 iku ume nnapụta kwa 5 ruo 6 sekọnd (ume 10 ruo 12 kwa nkeji) maka okenye (ma ọ bụ ** 1 iku ume kwa 2 ruo 3 sekọnd ** maka nwatakịrị), na-ekiri maka ịrị elu obi. Na-elele pulse carotid kwa nkeji 2 ọ bụla; ọ bụrụ na atufuru efu, malite zuru oke CPR (mkpakọ 30 ruo iku ume 2).

2. Nlekọta ụlọ ọgwụ ICU: intubation, sedation, na mkpochapụ gbasara akụrụ¶

1. ** Intubation mbụ nke endotracheal nwere mmanye ịhịa aka n'ahụ:** Nyochaa usoro Ngative Inspiratory Force (NIF) na ** Amanye Ikike Dị Mkpa (FVC)** n'akụkụ njedebe carbon dioxide (EtCO2). Intubate ahọrọ ma ọ bụrụ na FVC dara n'okpuru 15 ruo 20 ml/kg ma ọ bụ NIF na-ada mbà n'oge gara aga -25 ruo -30 cmH2O, ma ọ bụ ozugbo maka ikpokọta bulbar ma ọ bụ hypoventilation. ** N'ihi na onye ọrịa ahụ maara nke ọma n'ime ahụ ahụ kpọnwụrụ akpọnwụ, nye ọgwụ mgbochi induction (etomidate, ketamine, ma ọ bụ propofol) tupu laryngoscopy ma nọgide na-enwe mgbatị n'ime ya na analgesia na-aga n'ihu n'oge ikuku ikuku.
2. ** Akwụsịla ikuku gastric Lavage na Charcoal na-arụ ọrụ (n'ime nkeji 60 naanị): ** Maka ntinye ọnụ na-egosi n'ime awa 1, ** naanị mgbe etinyechara tube endotracheal cuffed ***, ndị dọkịta nwere ike ịrụ ọrụ nasogastric dị nro ma tinye unyi na-arụ ọrụ **), nke na-agbago gram 5 na-enweghị atụ. na saxitoxin.
3. ** Nkwado Hemodynamic na mkpochapụ gbasara akụrụ: *** Na-emeso hypotension ọkwa 4 na bradycardia na ** isotonic IV crystalloid boluses , ** norepinephrine ** ma ọ bụ ** phenylephrine ** infusions, na ** IV atropine ** (0.5 ruo 1.0 mg). ** Ọ dịghị ọgwụ mgbochi mmadụ na-ere ahịa dị maka tetrodotoxin ma ọ bụ saxitoxin (IV ** neostigmine** 0.05 mg/kg na atropine na-eji oge ụfọdụ eme ihe dị ka ihe mgbakwunye, mana anaghị edochi ikuku ikuku). A na-ewepụ nsị abụọ ahụ na-agbanweghị site na akụrụ site na nzacha glomerular (ma ọ bụ kpochapụ ya site na ** hemodialysis ** na ọdịda akụrụ). iku ume ozugbo na-alọghachi n'ime awa 12 ruo 24 **, na-enye ohere extubation n'ime awa 24 ruo 72 *** na-enwe mmebi akwara ozi na-adịgide adịgide.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States na Canada: Kpọọ 911 ozugbo maka mkpughe ọ bụla a na-enyo enyo na pufferfish, shellfish, ma ọ bụ mkpughe neurotoxin mmiri. Kpọtụrụ ** US Control Poison na 1-800-222-1222** ma ọ bụ mpaghara Canadian Poison Center, ma kọọ ahịa azụ azụ ma ọ bụ azụrụ emetọọ na *State Department of Health na FDA (1-888-SAFEFOOD).
• Australia na New Zealand: Kpọọ 000 na Australia ma ọ bụ 111 na New Zealand. Tinye bandeeji ** Mbelata nrụgide (ANZCOR Guideline 9.4.8)** maka octopus nwere mgbanaka na-acha anụnụ anụnụ ma ọ bụ cone snail ọ bụla, wee kpọọ Australian Poisons Information Center (13 11 26) ma ọ bụ ** New Zealand National Poisons Center (0800 764 766)**.
• United Kingdom: Kpọọ 999 maka ụgbọ ihe mberede Atiya 1 ozugbo. Ndị ụlọ ọgwụ na-enyocha NPIS/TOXBASE wee gwa UK Health Security Agency (UKHSA) na Food Standards Agency (FSA).
• European Union: Kpọọ 112 gafee mba ndị otu EU niile. N'akụkụ ụsọ oké osimiri Mediterenian, kọwapụta nrịba ọ bụla nke toadfish na-agba mgba mgba (Lagocephalus sceleratus) ozugbo ka ndị otu ụgbọ elu ICU na-akwado maka ahụ mkpọnwụ tetrodotoxin ngwa ngwa.
• Japan, South Korea, na Asia-Pacific: Kpọọ 119 na Japan na South Korea, 995 na Singapore, 999 na Malaysia na Hong Kong, 1669 na Thailand, ma ọ bụ 112/108 na India. Kpesa ndị a na-enyo enyo * fugu* (Takifugu), nshịkọ akpụkpọ ụkwụ inyinya mangrove (Carcinoscorpius), ma ọ bụ nsị azụ azụ ozugbo.

Ajụjụ a na-ajụkarị¶

Kedu ihe kpatara onye pufferfish ma ọ bụ octopus nwere mgbanaka na-acha anụnụ anụnụ ji ka na-anụ ma na-anụ ihe niile ọbụlagodi mgbe ọ na-ele anya ya na ụmụ akwụkwọ gbagoro agbaze?¶

Tetrodotoxin na saxitoxin dị ntakịrị, ebubo nke ọma, ụmụ irighiri mmiri na-eme ka mmiri na-egbochi ọwa sodium voltaji na moto mpụta, sensory, na akwara autonomic n'èzí ụbụrụ, na-eme ka ahụ ike ọ bụla skeletal gụnyere diaphragm, eriri olu, nku anya, na iris mọzụlụ na-egbochi ụmụ akwụkwọ. N'ihi na ụmụ irighiri ihe ndị a enweghị ike ịgafe mgbochi ụbụrụ ọbara lipid, ụbụrụ ụbụrụ ka na-amụ anya. Ọ bụrụhaala na iku ume nnapụta ma ọ bụ igwe na-eku ume na-eme ka ikuku oxygen na-eruba na ụbụrụ, onye ọrịa ahụ kpọnwụrụ akpọnwụ na-anụ okwu ọ bụla dị n'ime ụlọ ahụ ma na-achọ mmesi obi ike zuru oke na nkwụsị nke eriri afọ n'oge intubation.

Esi, frying, kefriza, ma ọ bụ na-agba mmiri pufferfish ma ọ bụ mọsel na-acha uhie uhie na mmiri lemon ọ na-emebi tetrodotoxin ma ọ bụ saxitoxin?¶

Mba. Ma tetrodotoxin na saxitoxin bụ ihe na-ekpo ọkụ na-ekpo ọkụ na acid-stable alkaloids. Azụ azụ̀ na-esi esi na 100 degrees Celsius (212 degrees Fahrenheit), frying miri emi, nrụgide-esi nri, kefriza, ma ọ bụ ịtinye na mmanya mmanya ma ọ bụ citrus ihe ọṅụṅụ adịghị emebi ma ọ bụ daa mbà ma ọ bụ nsi, na nri mmiri na-emerụ emerụ anya, na-esi ísì, ma na-atọ ụtọ kpamkpam.

Kedu ihe kpatara ị na-eji kechie bandeeji Nrụgide Nrụgide na nri octopus nwere mgbanaka na-acha anụnụ anụnụ, mgbe ị na-ekwesịghị kechie otu na nsị jeliifish?¶

Otu octopus nwere mgbanaka na-acha anụnụ anụnụ na-agbanye tetrodotoxin na-agbaze mmiri site n'ọnụ ya n'ime anụ ahụ dị n'okpuru anụ ahụ, ebe venom na-esi na arịa lymphatic na-aga n'ime ọbara nke etiti iji mebie diaphragm n'ime nkeji ole na ole. Itinye eriri nrụgide siri ike na-agbanwe agbanwe n'elu aru ya na n'elu akụkụ ahụ gbawara agbawa na-akụda lymphatic nke elu ma na-egbu oge ahụ mkpọnwụ sistemu ruo mgbe akụrụngwa ụgbọ elu ụlọ ọgwụ rutere. N'ụzọ dị iche, jeliifish nematocysts na-anọdụ ala n'elu akpụkpọ ahụ, ebe ịfụkọta bandeeji nrụgide na-egwepịa capsules na-agba agba na-adịghị ọkụ ma na-amanyekwuo nsị n'ime dermis.

Enwere ọgwụ mgbochi ma ọ bụ ọgwụ mgbochi maka tetrodotoxin pufferfish, ata anụ octopus nwere mgbanaka na-acha anụnụ anụnụ, ma ọ bụ nsị azụ azụ ahụ kpọnwụrụ akpọnwụ?¶

Enweghị ọgwụ mgbochi azụmahịa ma ọ bụ ọgwụ mgbochi kemịkalụ akwadoro maka ojiji mmadụ megide tetrodotoxin ma ọ bụ saxitoxin. Kama, ọgwụgwọ a na-azọpụta ndụ bụ ngwa ngwa, ikuku ikuku na-adịghị akwụsị akwụsị, na-amalite site n'ọnụ na ọnụ ma ọ bụ akpa-valve-mask na-eku ume na ebe ahụ ma na-atụgharị gaa na intubation endotracheal na ikuku ventilashion na ICU maka awa 24 ruo 72 mgbe akụrụ na-enyocha ihe na-eme ka mmiri na-agbaze n'ime mmamịrị.

Kedu ngwa ngwa mgbaàmà na-amalite mgbe ị richara pufferfish na-egbu egbu ma ọ bụ azụ azụ ahụ kpọnwụrụ akpọnwụ, oleekwa mgbe ị ga-esi n'ihe egwu pụta?¶

Mgbu egbugbere ọnụ, ire, na chịngọm na-egbu egbu na-amalitekarị n'ime nkeji 5 ruo 45 nke iri nri mmiri emerụrụ emerụ (ma ọ bụ n'ime nkeji 5 ruo 15 nke ọria octopus na-acha anụnụ anụnụ). Ọ bụrụ na tingling amalite n'ihe na-erughị nkeji 20, njide iku ume zuru oke nwere ike ịmalite n'ime nkeji 30 ruo 90. Ọ bụrụ na mmadụ na-adị ndụ n'ime awa 24 mbụ na ikuku ikuku zuru oke, mgbake na-agwụcha n'ụwa niile n'ime ụbọchị 1 ruo 3 na-esote na-enweghị mmebi akwara na-adịgide adịgide.

Kedu ihe kpatara o ji dị ize ndụ iri akwụkwọ ndụ akwụkwọ ndụ ma ọ bụ aja aja tomalley (mọstad) n'ime crabs ma ọ bụ lobsters n'oge ndụmọdụ azụ azụ?¶

Nshịkọ na lobsters na-eri anụ na nza na-enye nri nzacha na mọsel n'ala oke osimiri. Mgbe bivalves nwere saxitoxin sitere na dinoflagellate blooms, nshịkọ ahụ na-etinye uche na saxitoxin n'ime hepatopancreas ya, akụkụ ahụ na-eri nri dị nro ma ọ bụ aja aja nke a maara dị ka tomalley ma ọ bụ mọstad. Ọ bụ ezie na anụ ụkwụ nshịkọ na-acha ọcha na-anọgide na-adị obere na nsị, iri hepatopancreas nwere ike iwepụta nsị anụ ahụ nke nwere ike igbu egbu egbu.

Isi mmalite na nduzi ọchịchị¶

• ** Ụlọ Ọrụ Maka Nchịkwa na Mgbochi Ọrịa (CDC, United States): *** Akwụkwọ Yellow CDC: Nsi nri sitere na Toxins mmiri (Tetrodotoxin, Paralytic Shellfish Poisoning / Saxitoxin, Ciguatera, na Scombroid)* na * MMWR Clinical Case Reports na Pufferfish na Saxitoxin Poisoning*.
• ** Council Resuscitation Council (ANZCOR, Australia na New Zealand): ** Ntuziaka ANZCOR 9.4.8: Envenomation, Nrụgide Nrụgide Usoro * na * Ntuziaka 9.4.5: Envenomation, Blue-Ringed Octopus na Cone Shell *.
• ** Òtù Ahụ Ike Ụwa (WHO) na Òtù Na-ahụ Maka Nri na Ọrụ Ugbo (FAO):** * Mmiri Biotoxins (FAO Food and Nutrition Paper 80: Paralytic Shellfish Poisoning / Saxitoxin na Tetrodotoxin Clinical Management)*.
• ** Nchịkwa nri na ọgwụ US (FDA, United States): *** Akwụkwọ ahụhụ na-adịghị mma: Microorganisms pathogenic microorganisms na nsi eke eke, Saxitoxin (Paralytic Shellfish Poisoning) na Tetrodotoxin*.
• ** Ministry of Health, Work and Welfare (MHLW, Japan):** * Ntuziaka nlekọta ahụike na ahụike ọha na eze na Pufferfish (Fugu) Tetrodotoxin Poisoning na Fukuda-Tani Staging *.

Ntuziaka emetụtara¶

• Botulism, ciguatera, scombroid, na shellfish neurotoxin nsi
• CPR na iku ume nnapụta maka ndị okenye
• Ọrịa ụmụaka na ụmụ ọhụrụ CPR na ịma jijiji
• Enyemaka mbụ nsi na nchikota nsi
• Nọmba mberede site na obodo