Dikuatshika dia bintu bidi bikolesha mubidi ('Overamping'): Hyperthermie, Chest Pain, and Agitation Triage¶

Bishilangane na dikuatshika dia manga a opioide, mudi muntu ulekela kupuyakana, ulua bule, ne ulekela kupuyakana, dikuatshika dia stimulant, didi dimanyike bikole mu buanga bua dipuekesha dia njiwu ne dia lukasa bu "overamping", ndisama dia tshikisu dia muoyo, dia buongo, dia mijilu ya mashi ne dia luya lua mubidi. Padi muntu unua tshintu tshibi tshia methamphetamine, powder cocaine, crack cocaine, MDMA ("ecstasy" / "molly"), manga a amphetamine adi kaayi malelela, anyi synthetic cathinones ("bath salts" / alpha-PVP / mephedrone), anyi yeye muikale mutabale matuku a bungi ku tshintu tshidi tshimusaka bua kuenza mudimu, tshitupa tshia mubidi tshidi tshienza mudimu ne lungenyi luende tshidi tshienza mudimu bimpe muwule tente ne dopamine, norepinephrine, ne serotonin. Dikuma dia mutshima didi dipita pa 140 too ne ku 180 mu minite, mashi adi avula too ne ku tshipiminu tshidi tshikebesha disama dia stroke (220/130 mmHg+), mishipa ya mu mikolo idi ikanga mu vasospasme acute, ne luya lua mubidi ludi mua kubanda lukasa kupita 40.0 too ne ku 41.5 degre Celsius (104.0 too ne ku 106.7 degre Fahrenheit).

Padibu kabayi baondapa, disama dia stimulant dikole didi dishipa bantu ku diambuluisha dia mishindu inayi ya lukasa: hyperthermie malignant (udi uteka bitupa bia mubidi bia munda ne udi usaka mashi bua kutangalaka), vasospasme wa arterie coronaire ne dikanga dia njila wa sodium (udi ukebesha infarct myocardique aiguë anyi hythmie ventriculaire wa lufu 20-year-olds), intracerebral hemorrhagic stroke or status epilepticus seizures, ne rhabdomyolysis (dinyanguka dia mifuba ya bungi didi dinyanga mifuba). Pa kitatyi kimo, bualu fentanyl ne nitazenes idi kayiyi mianyishibue mpindieu idi inyanga tshitupa tshinene tshia cocaïne wa mu njila, crack, methamphetamine, ne mapilisi a Adderall/MDMA, muntu yonso udi unua manga adi akolesha mubidi udi ulua mu tshimpitshimpi tulu, mutekete, anyi kayi upuyakana udi ne bua kupeta naloxone (Naloxone) mu mpala diakamue. Kumanya mua kusunguluja dipanga dia lungenyi ne disama dia lufu didi mua kunyanga muoyo, mushindu wa kulengeja mubedi udi ne manga a kapia mu minite mikese, ne bua tshinyi kuena ne bua kuela mubedi udi ne manga adi asama mpala panshi mu difu diende kudi kusungila mioyo.

Enza nunku mpindieu¶

1. Tangila kumpala mushindu udi muntu upuyakana ne mushindu udiye wandamuna: bikala muntu udi unua manga adi akolesha mupuya kayi mumanye tshidiye wenza, udi utua mikemu, upuyakana, anyi upuyakana bitekete bitekete, umupeshe Naloxone (Narcan) 4 mg spray wa mu mishiku ne utuadije kupuyakana diakamue. Cocaïne wa mu njila, methamphetamine, ne manga a stimulant adibu bafina adi misangu ya bungi ne **feny. Nansha shi udi mumanye ne bavua basue kuenza mudimu ne tshintu tshidi tshikolesha, naloxone neapingaje fentanyl musokome ne kena mua kuenzela muntu udi ne disama dia tshimpitshimpi bibi to.
2. Bikila nimero ya njiwu ya muaba unudi (911 mu États-Unis ne mu Canada, 112 mu UE, 999 mu UK) diakamue pikala muntu ne tshimanyinu tshikunze tshia ku mubidi: disama dia mu tshiadi anyi disama dia tshiadi, dikoba dia munda didi dimueneka bu kapia, disama dia tshiadi, mutu usama bikole mu tshimpitshimpi, mpala mupueka/diboko ditekete, anyi dipanga dia lungenyi didi kadiyi mua kukokeshibua. Tangila nomba ya tshimpitshimpi tshilaminu.
3. Bikala dikoba dia muntu diosha, dikala dikunze, anyi udi ne tshiji tshikole ne udi ne luya lukole, utuadije kuenza mashika diakamue paudi muindile ambulanse. Umbusha bilamba bia pambelu bidi bipite bungi, wela **bibombi bia mashika anyi mifuku ya bisekiseki bia mashika bibuikila ne bilamba bitekete mu nshingu, mu tshiadi, mu nshingu ne mu nshingu, ne dikoba diabu didi kadiyi ne tshintu mayi mashika paudi wela ventilateur wa lubilu lua bungi pa mutu pabu, anyi ubabueje mu tshina tshia mâyi mashika (ikala ne mutu muimanyine pa mutu pa mayi). Mu minite yonso luya lua munda ludi lushala pa mutu pa 40.5 degre Celsius (105 degre Fahrenheit) ludi lunyanga buongo ne bitupa bia mubidi bidi kabiyi mua kupingana.
4. KAKUATA, kuela, kukanga, anyi kusomba pa mukolo anyi pa tshiadi tshia muena mudimu udi ne tshiji anyi udi ne tshiji tshikole (prone restrain). Muntu udi ne disama dia stimulant udi ne acidose métabolique mukole ne udi dijinga ne divulangana dinene dia tshimanu tshia tshiadi bua kumbusha dioxide de carbone (CO2). Kubakuata mpala panshi kudi kukandika diaphragme yabu, kubandisha bungi bua aside mu mashi, ne kufikisha ku dijika dia mutshima dia tshimpitshimpi ("asphyxie de restrain") mu tusunsa 60.
5. **Bikala muntu ne disama dia mu tshiadi, disama dia mu nshingu anyi dia ku dia bakaji, anyi disama dia mashika panyima pa yeye mumane kunua cocaïne anyi meth, umuteke musombe bimpe, umulame mupole, ne umupeshe 162 too ne ku 325 mg ya Aspirine udibu mua kudia (pa kumbusha yeye muikale ne disama dia tshiadi anyi udi ne disama dia mashi ** Kuena ne bua kuenza mudimu ne tshintu tshidi tshimusaka ku tshiadi anyi ku makasa). kudienzeja, ne ambila baminganga diakamue ne: cocaïne anyi methamphetamine udi mu buatu (baminganga ba mu lupitadi badi ne bua kuepuka amue manga adi apangisha mishipa ya muoyo bua kukola).
6. Bikala muntu udi ne "dikolesha" dia mu lungenyi (dibungama, dikankamika, dipanga dia lungenyi, anyi mutshioke kayi ne disama dia mu tshiadi, kayi ne luya lukole, ne mupuya muimpe), umuambule mu nzubu wa mashika, mîdima, mupole. Umupeshe maluvu a mashika adi ne electrolyte, douche wa mashika anyi tshilamba tshia kuowa mâyi, biakudia bikese, kakuyi ditalala, too ne padiye ufika ku dikalaku tshintu tshidi tshikolesha tshidi tshijika.

Rapid Triage: Mild Psychological Overamping vs. Life-Treatening Medical Toxicity¶

Mu mudimu wa dipuekesha dia njiwu, muaku "overamping" udi utangila malu a bungi: kumbukila ku tshipupu tshia buôwa tshidi katshiyi tshimpe, tshia buôwa panyima pa dinua dia bungi dia Adderall, meth, anyi coke, too ne ku hyperthermie wa lufu, stroke anyi disama dia mutshima. Ingidija mutshi wa mapangadika eu bua kutapulula tshidi mua kuikala tshitalala kumbelu ne tshidi tshikengela ICU wa mu lupitadi mpindieu.

flowchart TD
    A["Muntu udi mu kanyinganyinga kunyima kua diamba dia cocaïne, meth, crack, MDMA, anyi manga"] --> B{"Kabena bandamuna anyi badi bapuyakana bitekete bitekete anyi?"}
    B -->|YES: Limp, Blue Lips, Slow Breathing| C["BUA KUELA NE FENTANYL: Pesha Naloxone 4 mg Spray + Rescue Breaths + Bikila 911"]
    B -->|NO: Awake, Fast Heartbeat, Sweating, Agitated, or In Pain| D{"Bimanyinu bia lutatu lua luse lua Red-Flag anyi?"}
    D -->|Hot Skin > 39.5C/103F, Chest Pain, Seizure, Stroke Signs, Dark Urine, or Violent Delirium| E["BUALU BUA LUANGA: Bikila 911 / 112 / 999 diakamue"]
    D -->|NO Physical Red Flags: Jittery, Anxious, Racing Thoughts, Exhausted, Mild Paranoia| F["Mild/Moderate Overamping: De-Escalate in Cool, Quiet Room"]
    E --> G["1. Rapid Ice-Pack / Evaporative Cooling 2. Chewable Aspirine 325 mg if Chest Pain 3. Zero Prone Restraint"]
    F --> H["1. Kupuekesha minda ne kujima mizike 2. Mâyi mashika / Electrolytes ne biakudia bikese 3. Tshilamba tshia mashika 4. Tangila minite 15 yonso"]

Tablo wa disungula dia lupitadi: Vert/Yellow Overamping vs. Red Sympathomimetic Emergency¶

Tshilumbu tshia njiwu tshidi mua kushipa muntu 1: Hyperthermie wa stimulant malignant ("Kuteka munda")¶

Tshintu tshia kumpala tshidi tshikebesha lufu lua lukasa lua methamphetamine, MDMA ("molly"), ne synthetic cathinone ("bath salt") i hyperthermie.

1. Bua tshinyi bintu bidi bikolesha mubidi bidi bienza bua luya lua mubidi lupite pa 41 degre Celsius (106 degre Fahrenheit)¶

Bintu bidi bikolesha mubidi bidi bibandisha tshioshelu tshia munda mua mubidi musangu umue eku bitshibula tshiamu tshia nzembu:

• Dipatuka dia kapia ka bungi: Dipita dia dopamine, serotonine, ne norepinephrine didi difikisha mifuba ya mifuba ku dienza mudimu bikole, dikanga dia mishiku, dibungama, ne dipanga dia mitokondrie (UCP-3), udi upatula kapia kakole ka munda (nangananga mu nzubu ya manaya ya butuku idi ne bantu ba bungi, idi ne kapia kakole, mu mafesto a mu muvu wa été anyi mu nzubu idi kayiyi ne luya luimpe).
• Dijimija dia luya: Musangu umua, norepinephrine udi usaka alpha-1 adrenergic peripheral vasoconstriction, udi ukanga mijilu ya mashi idi mu kikoba bua mashi a kapia kafiki pa mutu pa dikoba bua kuikala mashika.
• The 40.5C (105F) Multi-Organ Failure Threshold: Padi luya lua munda lupita 40.5 degrés Celsius (105 degrés Fahrenheit) mu minite mipite pa 20 to ne 30, proteyine ya mu selile idi inyanguka, tshibumba tshia mu mala tshidi tshinyanguka (tshibueja mashi mu mifuba ya munda mua mifuba) (rhabdomyolysis), ne tshiamu tshia mashi tshidi tshienda tshinyanguka (Disseminated Intravascular Coagulation / DIC), tshienza bua mashi apatuke mu bitupa bionso bia mubidi.

2. Mukenji wa dilengeja dia lukasa dia kumpala kua lupitadi¶

Kuindidi bua baminganga batuadije kuondopa mubedi udi ne manga a kapia, ne kupeshi acetaminophen (paracetamol / Tylenol) anyi ibuprofen/aspirin bua kukepesha luya lua manga to. Maluvu adi ambuluisha bua kujikija luya adi enza mudimu ku hypothalamus mu tshikondo tshia grippe infectieuse/bactérie ne adi enza zero bua hyperthermie muscle induced kudi manga (bibi menemene, acetaminophen udi wenza bua tshifu tshinyanguke lukasa padi hyperthermie, ne NSAIDs idi inyangakaja disama dia mfyo).

1. Ndaku muaba udi mashika makole: Ubueje muntu mu nzubu udi ne luya lua mashika anyi lupepele ludi ne mundidimbi ne umbusha bilamba bia bujitu, bilamba bia ku mutu, bifulu, ne bisabata too ne ku bilamba bia muinshi.
2. Ela bipese bia mashika pa mishipa minene: Weja bibombi bia mashika, mifuku ya bipese bia mashika, anyi bipese bia biakudia bia mashika mu tshilamba tshitekete tshia mâyi ne ubikuate bikole ku nshingu (mishipa ya carotid), ku maboko (mishipa ya mu tshiadi), ne ku bipese bia mu nshingu (mishipa ya tshiadi).
3. Dilengeja dia mashika ne tshiamu tshia mashika (anyi dibueja mu mayi mashika):
   • Ela tshiponji anyi upuekesha miaba minene ya kikoba ne mayi mashika (15 to 20 degrees Celsius / 60 to 68 degrees Fahrenheit) paudi uleja tshiamu tshia nzembu tshikole tshidiku (anyi tshipepele tshikole ne karton/bilamba) buludiludi pa dikoba diume. Dibutuka dia luya didi diumusha luya misangu muanda mutekete kupita lupepele lumuma.
   • Shi tshina tshia kuowa mâyi tshidiku diakamue ne muntu mubike (anyi bakuatshishi babidi ba bukole badi mua kukuata mutu bimpe pambelu pa mayi), ela tshitupa tshia mubidi ne bianza mu mayi mashika a mu pompi. (Tangila Disama dia luya ne ditshioka dia luya.)

Tshilumbu tshia njiwu tshia lufu 2: Cocaine ne Methamphetamine Disama dia mu tshiadi (Disama dia mutshima ne disama dia mishipa)¶

Cocaïne ne methamphetamine bidi bijula ​​disama dia mutshima (disama dia mutshima), dishipa dia mutshima, ne dipanga dia mutshima dia tshimpitshimpi nansha kudi bantu ba bidimu 19 too ne ku 35 badi kabayi ne tshiamu tshia cholestérol mu mishipa yabu.

1. Disama dia mutshima dia misangu isatu dia cocaïne (ne Cocaethylene ne maluvu)¶

• Coronary Artery Vasospasm + Surging Oxygen Demand: Cocaine ne meth bidi bienza bua mishipa ya mutshima ituta bikole ne lukasa eku musangu umue bikanga mishipa ya muoyo, bienza bua mishipa ya muoyo ikale ne nzala ya oxygène.
• Direct Sodium-Channel Blockade (Only Cocaine): Cocaine i anesthesie ("caine") udi ukandika buludiludi cardiac fast sodium (Na+) njila, udi uvudija mudilu wa mutshima QRS tshikole ne tshidi mua kufikisha ku lufu tachycardie ventriculaire anyi ventriculaire fibrillation (udi baminganga ba mu lupitadi bondopa ne bicarbonate de sodium intravenous).
• Dikokangana dia mashi dia lukasa: Bintu bidi bikolesha mashi bidi bienza mudimu ne plakete, bienza bua mashi anyanguke mu tshimpitshimpi munda mua mushipa wa mashi udi wenda unyunguluka.
• Tshintu tshidi tshivudija Cocaethylene (Cocaine + Alcohol): Padi muntu unua maluvu padiye wenza mudimu ne lupuishi anyi cocaïne wa crack, tshifu tshia muntu tshidi tshishintulula manga abidi aa mu tshintu tshisatu tshidi tshienza mudimu mu lungenyi tshidibu babikila ne: cocaethylene. Cocaethylene udi na tshitupa tshia matuku a plasma misangu 3 too ne ku 5 kupita cocaine nkayende ne udi uvudija njiwu ya lufu lua tshimpitshimpi lua mutshima misangu 18 too ne ku 25.

2. Diambuluisha dia kumpala bua disama dia mu tshiadi (ne didimuija dia lupitadi lua Beta-Blocker)¶

1. Bikila 911 / 112 / 999 diakamue bua disama dia mu tshiadi didi dikuata, dikole, diosha, anyi dikole, dipanga dia mupuya, tuishi tua mashika, anyi disama didi difika ku nyima, ku nshingu, ku nshingu anyi ku diboko.
2. Kuenzeja muntu bua kuikisha ne kuikala ne ditalala: Teka muntu mu muaba muimpe wa kulala panshi (45 degrees) ne maboko makosa. Dikasa dionso didibu benda didi divudija catecholamines ne dijinga dia oxygène wa mu mutshima.
3. Pesha 162 too ne ku 325 mg ya Non-Enteric Chewable Aspirine: Pa kumbusha muntu udi ne allergie mulelela wa aspirine anyi uleja bimanyinu bia dipatuka dia mashi mu buongo/tshipupu anyi disama dia mukolo (dikosolola dia mu tshiadi), umuambile bua **tafuna ne kumina aspirine umue wa muntu mukole wa 325 mg (anyi aspirine ibidi too ne ku 18 mg) bua kuimanyika dienza dia platel munda mua mushipa wa mioyo. (Tangila Diambuluisha dia kumpala dia disama dia mutshima.)
4. Ambila ba mpanda-njila ne ba munganga ba mu lupitadi diakamue ne cocaïne anyi meth uvua muenze mudimu:
   • Mu disama dia mutshima didi kadiyi dia manga, baminganga ba lukasa badi bafila beta-blockers (bu mudi metoprolol anyi propranolol) mu mijilu.
   • Mu dikuatshika dia cocaïne anyi dia methamphetamine, difila dia beta-blocker mukezuke (beta-1 / beta-2 dikanga) didi mua kufikisha ku "dikolesha dia alpha-adrenergic didi kadiyi diluisha," mudi dikanga dia récepteurs beta dishiya récepteurs alpha miunzulula, bienza bua mishipa ya mu mikolo ikanga bikole ne tension ibandile bikole.
   • Paudi wambila munganga wa mu lupitadi bulelela ne: cocaïne anyi meth udi mu buatu, badi mua kuondopa disama dia mu tshiadi bimpe ku diambuluisha dia benzodiazepines (lorazepam anyi diazepam) bua kujikija luse lua munda, nitroglycerine wa muinshi mua muakulu anyi wa IV, ne calcium-channel blockers (apalti/mil) phentolamine.

Tshilumbu tshia njiwu tshia lufu 3: MDMA ("Molly" / "Ecstasy") Dikuatshika dia mayi ne dipanga dia mâyi mu mubidi¶

MDMA (3,4-methylenedioxymethamphetamine) udi ne njiwu ya pa buayi ya dipanga dia mayi idi mishipe bansonga badi babuela mu fete ne mu nzubu ya manaya bavua bateta "kuenza bualu buimpe" pa kunua galon ya mayi malelela.

+-------------------------------------------------------------------------+
|       THE MDMA ("MOLLY") HYDRATION RULE: ELECTROLYTES, NEVER GALLONS    |
|                                                                         |
|  WHY PLAIN WATER CAN KILL ON MDMA:                                      |
|  MDMA stimulates the brain to release huge amounts of Antidiuretic      |
|  Hormone (ADH / Vasopressin), causing SIADH: your kidneys are           |
|  chemically LOCKED and CANNOT produce urine to excrete excess water.    |
|                                                                         |
|  If a dancing or overheating MDMA user chugs 3 to 5 liters of plain     |
|  tap or bottled water in 2 hours, blood sodium (Na+) plummets below     |
|  120 mEq/L (Acute Dilutional Hyponatremia). Water rushes into brain     |
|  cells, causing fatal CEREBRAL EDEMA (brain swelling, vomiting,         |
|  seizures, brain herniation, and death), disproportionately affecting   |
|  young women due to estrogen's effect on the brain sodium pump.         |
|                                                                         |
|  SAFE MDMA FLUID RULE:                                                  |
|  1. Drink ONLY isotonic ELECTROLYTE solutions (sports drinks, ORS       |
|     packets, or salty broth), NEVER large volumes of plain water.       |
|  2. Limit intake to roughly 250 to 500 mL (1 to 2 cups) per hour        |
|     while dancing or sweating, and 250 mL/hour when resting.            |
|  3. If someone on MDMA starts vomiting, has a headache, seems confused, |
|     or has not urinated despite drinking, STOP ALL FLUIDS and call 911  |
|     for emergency hypertonic saline (3% NaCl) treatment.                |
+-------------------------------------------------------------------------+

Tshilumbu tshia lukasa tshidi mua kushipa muntu 4: Tshipupu tshia stimulant, dipatuka dia mashi mu tshiadi, ne disama dia tshiadi¶

Bualu methamphetamine, cocaïne, crack, ne cathinones ya tshiamu tshia mitaku idi ifila dikola dia tshimpitshimpi ne dia tshikisu dia tension wa mu mishipa (200/120 to 260/150 mmHg) pamue ne disama dia mishipa ya mu buongo ne disangisha dia plakete, tshipupu tshia mashi tshidi tshipatuka mu buongo ne mashi adi apatuka mu buongo (dipatuka dia mashi munda mua buongo anyi disama dia mu buongo didi ditshibuka) ke ntatu mikole idi misangu ya bungi ifumina ku dienza dia stimulant overamping, nansha kudi bantu ba bidimu makumi abidi ne makumi asatu.

1. Kumanya dipatuka dia mashi mu buongo anyi disama dia tshiadi (BE-FAST)¶

Kulekedi mutu mukole, dilenduka, anyi ngakuilu mubi mu tshikondo tshia lubilu lua stimulant bu "dikala anu dia bungi" anyi dipanga dia tulu:

• Disama dia mutu dia "Thunderclap" (Ruptured Aneurysm / Subarachnoid Hemorrhage): Shi muntu uvua mufuma ku dinua makanya, munue cocaïne, anyi munue methamphetamine mu tshimpitshimpi mukuate mutu wende ne udila ne mutu mutambe bubi menemene mu nsombelu wende (udi ufika ku kanyinganyinga kakole mu sekonde 60), udi ulonda kudi disama dia nshingu kuela manyi, kumvua butoke, anyi dikuluka, mushipa wa mashi udi kuinshi kua buongo udi mua kuikala mupanduluke mu tshikondo tshia mashi a catecholamine makole.
• BE-FAST Bimanyinu bikunze bia disama dia mitu:
  • B (Balance): Dijimija dia tshimpitshimpi dia bulongame, disama dia tshiadi, anyi dipanga dia kuenda bululame.
  • E (Mesu): Dimona dia tshimpitshimpi, dia misangu ibidi, anyi dijimija dia mêsu mu dîsu dimue anyi onso abidi.
  • F (Mpala): Luseke lumue lua mpala ludi lupueka anyi ludi lumvua bu udi umvua bibi padibu bamulomba bua kuseka.
  • A (Maboko): Diboko dimue anyi dikasa didi dipueka panshi anyi didi didiumvua ditekete/dipanga bukole padibu badiolola.
  • S (Speech): Ngakuilu mubi, miaku minyanguke, anyi dipanga dia kumvua biambilu bipepele.
  • T (Dîba): Dibikila 911 / 112 / 999 diakamue ne KUPEDI muntu aspirine pikala muntu ne mutu usama bikole anyi wela meji ne: mashi adi apatuka mu buongo (aspirine udi unyanga dipatuka dia mashi mu buongo).

2. Kulama tshipupu tshidi tshifumina ku tshintu tshidi tshikolesha mubidi padibu bindile baminganga¶

Bintu bidi bikolesha mubidi bidi bipuekesha tshipiminu tshia disama dia buongo buludiludi ku diambuluisha dia sodium-channel effects (cocaïne), vasospasme wa mu buongo, hyperthermie, ne hyponatremie (MDMA). Bishilangane na tshipupu tshia tshimpitshimpi tshidi tshijika nkayatshi kunyima kua sekonde 60, tshipupu tshidi tshifumina ku manga tshitu tshienda tshikola too ne ku tshipupu tshia tshimpitshimpi pa kumbusha padibu batshiondopa ne manga a benzodiazepines (midazolam, lorazepam, anyi diazepam):

1. Umbusha panshi ne ulengeje mutu: Lekela muntu panshi, wela tshilamba anyi tshilamba tshia ku mutu muinshi mua mutu wende, ne wela mêsa a kafe, bintu bia kuenza nabi kapia ne bintu bia makala muaba udiye kayi mua kufika.
2. Teka bipese bia mashika ku nshingu, ku maboko, ne ku tshiadi: Mubedi udi ne tshintu tshidi tshikolesha mubidi udi upatula kapia kakole ka mubidi kadi mua kufikisha luya lua munda lua mubidi kupita 41 degrés Celsius (106 degrés Fahrenheit) mu minite mikese; tuadija kuenza mashika mu nshingu ne mu maboko diakamue padibu bakuma.
3. Kuteka tshintu nansha tshimue mukana muabu ne kuena ne bua kukuata bitupa biabu bia mubidi bidi bikuata panshi to: Kuenzeja bipese, tshibombi, anyi minu pankatshi pa meno adibu basuike kudi kutshibula meno ne kukanga njila wa luya, ne kuela bianza bidi bikuata panshi kudi kutshibula mifuba ne kunyangakaja dinyanguka dia mifuba (rhabdomyolyse).
4. Uteke mu muaba wa kulala ku luseke dîba didi dikankamika dijika: Umbusha mate anyi nsukadi mukana pa kubikunguluja ku luseke luabu lua dia bakaji ne tshibeku tshibandile kakese bua bobu kupuyakana bimpe too ne padi baminganga balua.

Kukepesha njiwu kumpala kua kuenza mudimu ne bukubi bua munkatshi mua dienza mudimu: Kuepuka dienza dia maluvu mapite bungi ne dikuatshika dia Fentanyl¶

Bua bantu badi benza mudimu ne bintu bidi bikolesha mubidi anyi bena mu dîku badi bakuatshisha muntu udi mu njiwu, bijadiki bidi bifila njiwu idi ikepesha bikole njiwu ya dikuatshika dia manga mapite bungi:

Dipuekesha dia njiwu ku kakese ku kakese bua dienza dia malu adi kaayi ne mushinga wa bungi¶

Shi udi mutangile tshintu tshionso tshidi mu tablo wa disungula udi kulu eku ne mujadike ne muntu udi kayi ne disama dia mu tshiadi, kena ne luya anyi kikoba kakole, kena ne disama dia tshimpumpu, kena ne bimanyinu bia stroke, ne udi ne mupuya muimpe, udi upeta non-critical psychological/autonomie overamp (misangu ya bungi udi ufumina ku dinua dia bintu bia bungi bidi bikolesha mubidi, disambakaja ne kafe, anyi dikala dia 36 72 meba).

1. Mukanda wa dikonkonona dia malu a muaba udibu basombele ne a mubidi¶

1. Shintulula muaba uudi umvua diakamue:
   • Ikala kule ne mizike mikole, nzubu miule tente ne bantu, miendu mitoke, anyi nseke ya njila idi ne kanyinganyinga, uya mu nzubu wa bulalu udi kayi ne mutoyi ne udi ne butoke bukese.
2. Kulengeja tshitupa tshia vagus (kuyi utshinyisha mubidi):
   • Teka tshilamba tshia mashika, tshia mashika pa mpala yabu, pa mêsu, ne panyima pa nshingu, anyi ubalekele bua kuowa mâyi a lukewarm-to-cool (never freezing cold) padibu basombe anyi padibu babatangila.
3. Hydrate na Electrolytes ne Simple Carbohydrates:
   • Didia dia bintu bidi bikolesha mubidi didi dijimija sukadi mu mashi, sodium, potassium, ne magnésium eku difikisha ku diuma dia mukana ("cottonmouth") ne ku disama dia tshiadi (bruxism).
   • Ufila tu-maluvu tukese tua maluvu a electrolyte mashika, mayi a nkunde, mabele, anyi smoothie wa bimuma, pamue ne biakudia bipepele, bipepele bua kumina (banana, yaourt, applesauce, anyi brouillon) ne tshitupa tshia tshintu tshia kutafuna anyi tshilamba tshia kuowa natshi mâyi tshikezuke bua kubenga kutshibula mishiku yabu.
4. Kankamija bantu bua kuendakana bitekete bitekete anyi bua kuikisha (tshionso tshidi tshimueneka tshimpe kudibu):
   • Bamue bantu badi ne bukole bua bungi batu badiumvua bakuate padibu babambila bua kulala anu bapuwe; kuendakana bitekete bitekete mu kazubu ka bukubi, kuolola, anyi kusomba mululame paudi wenza kuela mupuya bitekete bitekete mu tusunsa 4 / kupuya mupuya mu tusunsa 6 kudi kuosha bukole bua mubidi too ne padi tshibungu tshipita.

2. Mushindu kayi wa kuyukila ne muntu udi ne disama dia stimulant paranoia anyi psychose wa dipanga tulu¶

Panyima pa mêba 48 too ne ku 96 kabayi balale ne methamphetamine anyi crack cocaine, bantu batue ku 40 too ne ku 60 pa lukama batu bapeta disama dia lungenyi dia tshitupa tshîpi didi difumina ku bintu bidi bikolesha mubidi**: malu adibu bumvua (kumvua mêyi a mbila anyi rédio ya bampulushi pambelu), malu adibu bamona mu mundidimbi wa bantu mu tshimuenekelu tshia ku mpenga, malu adibu bamona ku bianza (memethamphetamine anyi crack" anyi mimicates mikole muinshi mua dikoba buôwa bua se: bantu badi batangila ku madidishi.

• Kukokangane anyi kuseka lungenyi luabu lua dishima, ne kuena ne bua kuenza bu udi mumone lungenyi lua dishima to:
  • Bibi: "Udi mutshimbakane, kakuena muntu pambelu pa dididishi, ikala panshi" (udi ubajula tshiji ne ubajadikila ne: udi mu tshilumbu etshi).
  • Bibi: "Oh eyowa, ndi mmona batentekedi pambelu kabidi" (udi uvudija buôwa buabu).
  • Bua kuanyi (Validate the emotion, ground in safety): "Ndi mmona mudi bualu ebu buenza buôwa mpindieu. Udi mu bukubi apa nanyi mu nzubu eu, tshiibi ntshikanga, ne ndi nya kushala anu muaba eu bua kukutabalela paudi usomba ne unua mâyi mashika aa."
• Lama bianza biebe bimueneka, wimane mu angle wa 45-degree nansha 2 metre (6 feet) kule, ne kukanga tshiibi tshia kupatuka nansha kakese: Muntu udi ne buôwa udi udiumvua mubuikila mu nzubu ne muntu udi ukanga tshiibi neatekemene ne neakuluke anyi aluangana. Bashikame muaba udibu mua kumona tshiibi bimpe.
• Epuka kufila manga a "landing gear" a mu njila adi kaayi mafunda kudi munganga: Kupeshi muntu udi wenza mudimu bikole manga a "Xanax" a mu njila anyi manga a opioïde bua kumulala to; bintu bia dishima bia alprazolam bia mu njila bidi ne fentanyl, bromazolam, ne xylazine, bienza bua tshintu tshidi tshikolesha mubidi tshilue disama dia lufu padi muntu yonso uya kulala.

(Bikala wewe anyi muntu uudi munange udi uluangana ne dikuatshika dia manga a methamphetamine, a cocaïne, a crack anyi a manga adibu bakufundila, tangila Dikuatshika dia maluvu ne dikuatshika dia manga: bulombodi bua diambuluisha dia lukasa, Dipingana dia malu ne dikuba dia dikuatshika dia maluvu mapite bungi: biamu bia diteta bia fentanyl/xylazine ne naloxone, ne Kuambuluisha muena mu dîku udi ne tshilele tshia dikuatshika dia maluvu. Ela meji bua kulonga tulasa tua diambuluisha dia kumpala ne tua CPR tudibu bitabe kudi Croix-Rouge, St John Ambulance, anyi kudi mufidi wa diambuluisha wa muaba unudi.)

Nkonko itubu bela misangu ya bungi¶

Miaba mifumina¶

• American Heart Association (AHA, United States): Scientific Statement on Management of Cocaine-Associated Chest Pain and Myocardial Infarction (Coronary vasospasm pathophysiology, sodium-channel blockade, benzodiazepine and nitroglycerin first-line therapy, and avoidance of unblocked betaopopade).
• Substance Abuse and Mental Health Services Administration (SAMHSA) & National Institute on Drug Abuse (NIDA / NIH, United States): Treatment of Stimulant Use Disorders (TIP 33 / Clinical Guidance), sympathomimetic toxidrome triage, and fentanyl co-involvement illicit stimulants.
• Tshilongelu tshia mu Amerike tshia malu a buanga (ACMT) ne Tshilongelu tshia baminganga ba mu tshimpitshimpi tshia mu Amerike (ACEP): Dilama dia disama dia Sympathomimetic Toxicity, Excited Delirium / Severe Agitation, ne Drug-Induced Hyperthermia (Rapid conductive/evaporative cooling, avoidance of physicians, as restraint rhabdomyolysis management).
• Tshisumbu tshia ditunga tshia dipuekesha dia njiwu (États-Unis) ne tshisumbu tshia malu a manga: Dimanya ne diandamuna ku dikolesha dia malu adi asaka bantu ku dienza malu kampanda (Dishilangana dia dikolesha dia malu a mu lungenyi ne dia malu a njiwu ya luondapu ne mishindu ya dijikija lutetuku idi kayiyi ne njiwu).
• European Monitoring Center for Drugs and Drug Addiction (EMCDDA / EUDA) & UK National Poisons Information Service (TOXBASE): Clinical guidance on MDMA-induced Syndrome of Inapropriate Antidiuretic Hormone Secretion (SIADH / acute dilutional hyponatremie) and cocadiotoxicity.

Malu adi apetangana¶

• Diambuluisha dia kumpala dia dikuatshika dia opioïde
• Dipingana dia malu ne dikuba dia dikuatshika dia maluvu mapite bungi: biamu bia diteta bia fentanyl/xylazine ne naloxone
• Dikuatshika dia maluvu ne dikuatshika dia manga: bulombodi bua diambuluisha dia lukasa
• Kuambuluisha muena mu dîku udi ne tshilele tshia dikuatshika dia maluvu
• Diambuluisha dia kumpala dia disama dia mutshima
• Disama dia luya ne ditshioka dia luya
• Disama dia tshimpitshimpi, rhabdomyolyse, ne dienza dia mashi mafiike
• Nomba ya tshimpitshimpi