Diambuluisha dia kumpala dia manga a dishipa nawu nyama, Organophosphate, ne bintu bia mu madimi¶

Kuikala mu tshitupa tshikole tshia manga a madimi, a midimu, anyi a mu nzubu: nangananga maluvu a organophosphate (bu mudi malathion, parathion, chlorpyrifos, diazinon), carbamate insecticides (aldicarb, carbaryl, propoxur), organophosphate, herbicides herbicides (paraquat ne diquat)**, ne metal phosphide fumigants (aluminium or zinc phosphide): i tshilumbu tshia buanga tshidi mua kunyanga muoyo. Bishilangane na buanga bua mu nzubu budi anu buenza bibi padibu babumina, organophosphates mikole ne bintu bia mu mikolo bidi bikuata lukasa kupitshila ku dikoba dimpe, kadiyi ditshibuka, kupitshila ku mêsu, ne ku diambuluisha dia dipuekesha dia lupuishi anyi luya, bienza bua "tshipepele tshikole tshia cholinergic" tshidi tshishipa bantu mu minite mikese.

Mukanda ewu udi ufila mishindu ya kusungila bantu ne mishindu ya kuondopa bantu bilondeshile mikenji ya bulongolodi bua malu a bukola bua mubidi pa buloba bujima (OMS), tshibambalu tshia malu a masama a mu États-Unis (CDC), tshibambalu tshia malu a bukubi bua muaba udibu basombele tshia mu États-Unis (EPA), tshibambalu tshia malu a bintu bidi ne buanga ne masama (ATSDR), ne tshibambalu tshia malu a buanga tshia mu ditunga dia Grande-Bretagne (NPIS). Kudikuba ne bianza bia nitrile anyi neoprene kumpala kua kulenga muntu udi ne disama, kumbusha bilamba bidi ne manga a dishipa nawu nyama, kusukula dikoba munkatshi mua minite 15, ne kuangata atropine ne pralidoxime (2-PAM) bia lukasa kudi kusungila mioyo.

Enza nunku mpindieu¶

Shi wewa nansha muntu udi pabuipi nebe muele, muele, mupuekesha, anyi mumine manga a madimi, manga a dishipa dia bikunyibua, manga a lupela, anyi manga a ntete:

1. Dikuba dia kumpala: KUTEKI muntu udibu bashipe ne manga a dishipa nawu nyama anyi nsukadi yende ne bianza bitupu: Enda mu lupepele ne muulu kule ne lupuishi lua bintu bia tshimpitshimpi, matutu anyi nzubu ya dilamina bintu mikanga diakamue. Vwala maboko a nitrile, butyl rubber, anyi neoprene adi kaayi mua kukuata kudi bintu bia tshimpitshimpi (maboko a buanga a latex makese adi mua kubuela lukasa kudi bintu bia organophosphate) kumpala kua kulenga muntu udibu bashipe anyi bilamba biende. Bantu badi basungila bantu badi batenga bilamba bidi ne organophosphate anyi kikoba kabayi ne tshintu batu misangu ya bungi bakuluka bua disama dikuabu dia poison.
2. Bikila nimero ya njiwu ya muaba unudi diakamue: Bikila 911 mu États-Unis ne Canada, 112 mu Union européenne mujima, anyi 999 mu Royaume-Uni (anyi tangila nomba ya tshimpitshimpi tshilaminu). Ambila muntu udi utuma bintu patoke ne: "Mudimu udi wela meji ne: udi ne manga a dishipa nawu nyama anyi organophosphate: bidi bikengela kuenza mudimu ne manga a HAZMAT ne kuangata Atropine wa bungi." Bikila kabidi Poison Control (1-800-222-1222 mu États-Unis) bua kubala EPA Nomba wa difunda anyi tshimanyinu tshia tshintu tshidi tshienza mudimu.
3. Umbusha 100 pa lukama ya bilamba, bisabata, ne mabwe a mushinga adi ne bukoya diakamue: Kumbusha bilamba bidi ne manga a dishipa nawu nyama kudi kumbusha 80 too ne ku 90 pa lukama ya tshintu etshi kumpala kua kutshibueja mu dikoba. Wenza mudimu ne tshiseba anyi tshiseba bua kukosa bilamba ne pantalo pamutu pa kubikoka pa mutu pa muntu udibu bashipe (bidi bikupula bintu bia tshimpitshimpi ku mêsu, ku mishiku ne ku mishiku). Kanga bilamba bionso biumbusha ne bisabata bia tshiseba (tshiseba tshidi tshikuata manga a nyama bua kashidi ne katshiena mua kujimijibua nansha kakese) munda mua mifuku ya plastike mikole.
4. Sukula kikoba ne nsuki ne nsabanga ne mayi a bungi mu minite 15: Teka muntu udibu bashipe muinshi mua tshina tshia kuowa mâyi, mu tshina tshia mu budimi, anyi muaba wa kuowa mâyi a njiwu ne usukule ku mutu too ne ku makasa ne nsabanga wa mâyi mutekete anyi ne tshintu tshia kusukula natshi malonga ne mâyi a luya/mashika munkatshi mua minite 15. Teya ntema ya pa buayi ku milonda ya dikoba, ku minu, ku nsuki, ne kunyima kua matshi. Kusukudi dikoba dia tshianana ne broshe mikole, ne kuenzedi mudimu ne mayi a kapia, adi alengeja mijilu ya mashi ya dikoba ne adi ambuluisha bua kubuela lukasa mu mashi. Bikala manga a dishipa nawu nyama miele mu mêsu, sukula mêsu ne mâyi a mupuya anyi ne mâyi a mukele a pa tshibidilu munkatshi mua minite 15 (tangila mputa ya ku mêsu).
5. **Lama njila wa kapepe, kukudimuna ku luseke, ne KUENZI NANSHA MUSHINDU MU MUSHINDU MU MUSHINDU WA KUENZA BIDIMU **: Bantu badi ne disama dia organophosphate badi badina mu mate abu a bungi, mu tshisuku tshia mu mikolo ("bronchorrhea"), ne mu tshipupu. Teka muntu udi kayi mumanye tshidiye wenza anyi udi wela mâyi ku luseke luende mu muaba wa kuondopibua bua bintu bidi bipatuka mu mikolo bipatuke mukana. Shi mutshima wimana anyi kupuyakana, enza dikuma dia tshiadi anu ne bianza (CPR) anyi wenze mudimu ne tshilamba tshia kujika natshi mêsu (BVM): kuenji mupuya wa mukana ne mukana to, udi uteka mukana muebe mu luya lua manga adi ashipangana ne mupuya.
6. Ela tshiamu tshia autoinjector pikalaku (DuoDote / Mark I / Atropen): Shi bualu ebu budi butangila basalayi anyi bena mudimu ba mu midimu ya bianza badi ne DuoDote anyi ATNAA (Atropine + Pralidoxime) autoinjectors, ela tshiamu tshia autoinjector diakamue mu tshiadi tshia pambelu padibi bileja ne: muntu udi ne disama edi udi ne lutatu lua kupuyakana kumona mêsu, dipatuka dia mayi a bungi, dikankamika dia mifuba, anyi disama dia tshiadi.

Dilongolola dia tshimpitshimpi ne disungula dia toxidrome¶

flowchart TD
    Start["Bintu bidibu bela meji ne: bidi bishipa bikunyibua, bikunyibua, bikunyibua anyi bikunyibua bidi bishipa mijilu"] --> SceneSafe{"Muaba eu udi mu bukubi anyi ne basungidi badiku bavuale bilamba bia Nitrile/Neoprene anyi?"}

    SceneSafe -->|No: Vapor cloud, enclosed shed, or bare hands| Evac["Enda muulu bua kupeta kapepe kimpe diakamue<br/>Vuala bianza bia Nitrile/Neoprene (KUENA latex mukese to)<br/>Bikila 911 / 112 / 999 bua HAZMAT & EMS"]

    SceneSafe -->|Yes: Upwind with chemical-resistant gloves| Decon["Diakamue 80%-90% Diumusha dia tshifukilu<br/>Kosa bilamba bionso bidi ne bukoya ne ela bisabata bia tshiseba<br/>Sukula dikoba ne nsuki ne nsabanga ne mayi mashika/mashika munkatshi mua minite 15"]

    Evac --> Decon

    Decon --> ToxClass{"Manya tshitupa tshia bintu bia tshimuma bilondeshile bimanyinu anyi tshimanyishilu tshia tshintu"}

    ToxClass -->|Pinpoint pupils, profuse drooling/sweating, wet lung crackles,<br/>vomiting, diarrhea, slow pulse, muscle twitching| Chol["Organophosphate anyi Carbamate ('Cholinergic Crisis')<br/>Uteke mu muaba wa kulala bua kuondopa bua kupatula mâyi a mu mikolo<br/>Ufila Atropine (kuvudija misangu ibidi mu IV kunyima kua minite 3-5 too ne padi mikolo miume)<br/>+ Pralidoxime (2-PAM) bua organophosphates + Benophadiaps bua tshipupu"]

    ToxClass -->|Swallowed blue/green foul-smelling liquid herbicide;<br/>severe burning mouth/throat Ulcers| Paraquat["Paraquat anyi Diquat Herbicide<br/>Oral fuller's earth anyi Activated Charcoal immediately (bikalabi mu dîba 1)<br/>KULEKELA Oxygène wa pa mutu pa kumbusha SpO2 < 85%-88%<br/>Emergency ICU hemodialysis / hemoperfusion"]

    ToxClass -->|Garlic/rotten-fish odor after swallowing grain fumigant pellets;<br/>rapid shock and arrhythmias| Phosphide["Aluminium / Zinc Phosphide ('Phosphine Gas' Poisoning)<br/>KUPEDI mayi anyi bintu bidi ne mayi ku mishiku<br/>Ela ambulance/ED kapepe; kulombola tshipupu tshia mutshima ne acidose"]

    ToxClass -->|Sudden grand mal seizures with NO drooling/pinpoint pupils<br/>after flea/tick spray or agricultural spray| Pyreth["Organochlorine (Lindane/Endosulfan) anyi Pyrethroid<br/>15-minute soap wash (Vitamin E oil eases skin paresthesias)<br/>IV Benzodiazepines (lorazepam/diazepam) to stop GABA-block seizures"]

Pathophysiology wa "Cholinergic Storm": Organophosphates ne Carbamates¶

Organophosphates (bavua benze mu bidimu bia 1930 ne 1940 bu manga a madimi ne manga a basalayi bu mudi Sarin, Soman, Tabun, ne VX) ne carbamates ke tshintu tshinene tshidi tshikebesha lufu lua bantu bapite pa 100 000 ku tshidimu.

Mushindu kayi udi dipangisha dia Acetylcholinesterase (AChE) dibuela mu tshitupa tshia mijilu¶

Mu mubidi wa muntu udi ne makanda a mubidi mimpe, dîba dionso didi mujilu musue kuambila musunyi bua kudikosa anyi kuambila glande bua kupatula mâyi, tshitupa tshia mujilu tshidi tshipatula mupuya mukese wa tshintu tshidi tshituma mijilu acetylcholine (ACh) mu tshitupa tshia synaptic. Mu tshitupa tshîpi tshia milisekonde kunyima kua mukenji au mumane kufidibua, enzyme kampanda wa pa buawu udibu babikila ne: acetylcholinesterase (AChE) udi ukosolola molecule wa acetylcholine mu bitupa bibidi (mu choline ne acid acétique), wenza bua tshiamu tshia nzembu OFF bua mubidi wikale mua kuikisha ne gland ikale ulekela kupatula bintu.

1. Phosphorylation of the "OFF" switch: Organophosphates ne carbamates badi balamakaja buludiludi ku tshitupa tshia serine tshia enzyme wa acetylcholinesterase, bienza bua enzyme ikale kayi wenza mudimu.
2. Mvula wa acetylcholine udi kauyi ujika: Padibu bashipa tshintu tshia "OFF", acetylcholine udi kayi munyanguke udi udisangisha too ne ku bungi bua bintu bidi ne buanga munda mua tshitupa tshionso tshia cholinergic mu mubidi: udi utuma muscarinic receptors (parasympathetic glandes, lungs, heart, eyes, eyes), ninicoscles (mifuba ya mifuba), ne mucles sympathetique ne système nerveux central kayi wimana too ne padi mifuba ya muntu udibu bashipe yuula ne mâyi ne diaphragme wende unyanguka.
3. Bua tshinyi Organophosphates idi ya kashidi ("Aging") kadi Carbamates idi ya tshitupa tshîpi:
4. Carbamate insecticides (carbaryl [Sevin], aldicarb, propoxur, methomyl) idi yenza reversible carbamyl bond ne enzyme AChE udi udikosolola ne upatuka nkayende mu 24 to ne 48 hours.
5. Maluvu a organophosphate ne bintu bidi bishipa mijilu (parathion, chlorpyrifos, malathion, diazinon, dichlorvos, fenthion) bidi bienza tshisumbu tshia phosphore tshikole tshidi tshienza dishintuluka dia kashidi didibu babikila ne: "Aging" (dijimija dia kasumbu ka alkyl). Dîba didi malanda a organophosphate-enzyme "akulakaja" (adi angata minite 2 bua Soman nerve agent** too ne ku mêba 12 too ne ku 48 bua manga a madimi), enzyme udi mufue kashidi. Shi mubedi kena upeta manga adi akolesha Pralidoxime (2-PAM) kumpala kua bukulakaje kujika, mubidi wandi udi ne tshia kuenza bintu bipiabipia bia enzyme ku ntuadijilu mu mbingu 2 too ne ku 6.

Kujingulula tshitupa tshisatu tshia Cholinergic Toxidrome: DUMBBELS & Monday-to-Friday¶

Bu mudi acetylcholine mupite bungi ufila mishindu isatu ya biamu bia kuangata nabi bintu musangu umue, baminganga badi bakeba bimanyinu bisatu bishilangane:

1. Muscarinic Receptor Overstimulation: "DUMBBELS" anyi "SLUDGE + Killer Bs"¶

Dikolesha dia muscarinic didi dienza mudimu ne glande yonso udi upatula mayi ne misunyi yonso ya mubidi. Vuluka mnemonic DUMBBELS (anyi SLUDGE):

• D: Disama dia tshiadi ne Diaphoresis: Disama dia tshiadi dia mayi ne dibuela dia mâyi, ku mutu too ne ku makasa difuka.
• U: Diela dia mashi: Dijimija dia tshisumi tshia dikokesha dia tshiadi.
• M: Miosis (Pinpoint Pupils): Both pupils constrict too ne tiny 1-millimeter pinpoints, udi wenza bua dimona dinyanguke, dinyanguke ne disama dia ku mpala (ciliary spasm).
• B: Bronchorrhea (The #1 Killer): Glandes mucus idi mibuikila mutshi wa bronchial idi ipongolola litre ya mayi matekete ne a mupuya mu mifuba, bienza bua mubedi ajimine mu mayi ende a mu mikolo kumbukila munda too ne pambelu (mutoyi wa mâyi udi umvuika ne mupuya wa mupuya mu bitupa bionso bibidi bia mifuba).
• B: Bronchospasm (The #2 Killer): Dipanga dia bukole dia mishipa ya mu njila wa lupepele didi difikisha ku dipuekesha dia luya lukole ne dipanga dia mushindu wa kuendesha luya.
• B: Bradycardia (The #3 Killer): Mushipa wa mutshima udi utekesha dikuma dia muoyo too ne ku 30 too ne ku 45 ku minite, udi ufikisha ku dipueka dia mashi mu mashi ne ku dijika dia mutshima dia asystolique. (Pamo, Bronchorrhea, Bronchospasm, ne Bradycardia mbimanyike mu buanga bua lukasa bu "Three Killer Bs" bualu ke bidi bishipa mubedi: ne tshidi Atropine upingaja).
• E: Emesis: Disama dia tshianana ne disama dia mu difu dikole.
• L: Lacrimation: Dipatuka dia binsonji ditungunuka dia ku mêsu onso abidi.
• S: Salivation: Mashi adi apatuka mukana.

2. Dikolesha dia tshiamu tshia nicotine: "Matuku a lumingu" (MTWtFS)¶

Padi biamu bia muscarine bitekesha mutshima ne bikumbaja mifuba, dikolesha dia musangu umue dia biamu bia nicotinic pa mifuba ya mifuba ne pa mifuba ya adrenal/sympathique didi difikisha ku dipangisha dia mifuba ya mifuba. Vuluka matuku a lumingu (M-T-W-t-F-S):

• M: Mydriasis (rare early sympathetic pupil dilation): Imue misangu itu imueneka kumpala kua muscarinic pinpoint miosis kukokesha.
• T: Tachycardia: Divulangana dia adrenaline dia kumpala didi mua kufikisha muoyo ku dikuma lubilu ne mashi a bungi kumpala kua vagal bradycardia kuangata muaba wende (kuena ne bua kupangisha atropine kudi mubedi udi ne mâyi ne udi wela mâyi anu bualu muoyo wende udi wenda lubilu mpindieu).
• W: Weakness (Flaccid Paralysis): Panyima pa dikolesha dia tshitupa tshîpi, tshitupa tshia mifuba tshidi tshinyanguka ne tshikanga, bienza bua mifuba ya mifuba ikale ne butekete bua bungi ne dinyanguka dia mifuba ya diaphragme ne ya intercostal breathing muscles.
• t: Diteketa ne disama dia mashi.
• F: Fasciculations (Worm-like Muscle Twitching): Visible rippling, worm-like twitches involuntary across the eyelids, tongue, browns, chest, and shoulders: a pathognomonic nicotine that atropine can’t fix (requires Pralidoxime / 2-PAM).
• S: Disama dia tshimpumpu ne difuka.

3. Bubi bua mu tshitupa tshia munkatshi tshia mijilu: tunyinganyinga, koma, ne nsombelu wa tshimpumpu¶

Ma organophosphates adi mu mafuta adi apitshila mu tshibuelelu tshia mashi ne buongo lukasa, adi akebesha tshiji, dipanga dia ditalala, ngakuilu mubi, dipanga dia lungenyi, ataxia, dipanga dia lungenyi, dipanga dia lungenyi, ne disama dia tshikisu dia cholinergic status epilepticus (diondapibua ne benzodiazépinesbu mudi diazepa, anyi diazdazolam).

Difuanyikija dinene dia manga a madimi ne manga a mu nzubu¶

Mikenji ya lupitadi bua kujikija disama dia organophosphate¶

Padi mubedi udi ne disama dikole dia organophosphate anyi dia carbamate ufika ku tshibambalu tshia malu a mpukapuka, masekonde adi ne mushinga. Dilengeja didi dilonda bulongame: Diumusha + Dikuba dia njila wa luya \(\rightarrow\) Atropine Doubling Regimen \(\rightarrow\) Pralidoxime (2-PAM) \(\rightarrow\) Benzodiazepines.

1. Mushindu wa kukumbaja Atropine misangu ibidi: Kufika ku "mapuapua maume," ki mbunene bua mulongi to¶

Mu disama dia mutshima anyi disama dia tshiadi, baminganga batu bafila 0.5 too ne ku 1 milligramme wa atropine too ne ku 3 milligramme. Mu disama dikole dia organophosphate, 3 milligrams i dipueka mu tshibombi: babedi batu dijinga ne 20, 50, anyi mene kupita 100 milligrams ya atropine mu mishipa mu meba makese a kumpala bua kuikala ne muoyo.

• Mushindu udi atropinization wa lukasa wenza mudimu:
• Baminganga batu batuadija ne dibueja dia lukasa dia 1 too ne ku 3 milligramme ya Atropine kudi bantu bakole (0.02 too ne ku 0.05 mg/kg kudi bana).
• Tangila tshiadi tshia mubedi ne tshiamu tshia kuteleja natshi mu minite yonso 3 anyi 5.
• Shi bronchie udi ne mayi (bronchorrhea), wheezing (bronchospasme), anyi hypotension/bradycardia (HR < 80 bpm). "Atropinization" udi ukumbajibua, ne pashishe kutuadija difila dia atropine mu tshiadi (10 pa lukama too ne ku 20 pa lukama lua dose mujima wa dibueja dia atropine ku dîba).
• Nshikidilu kayi mulelela wa Atropinization?:
• Kulengeja mifuba pa diteleja (kulekela kua bronchorrhea ne tshipupu tshia mupuya bua mubedi ikale mua kupuyakana ne kupeta kapepe kakuyi lutatu).
• Dikuma dia mutshima dipite pa 80 mu minite ne tshitupa tshia mashi tshidi tshipita pa 80 too ne ku 90 mmHg.
• Maboko maume (axillae).
• Mukenji wa mushinga mukole wa mu lupitadi: KULEKEDI nansha kakese bua kufila atropine anu bualu mêsu a mubedi adi avula anyi bualu mutshima wende udi ufika ku 110 beats ku minite bikala mifuba yende itshidi miule tente ne bintu bidi bipatuka mu mâyi. Divulangana dia mêsu ki ntshijadiki tshia kueyemena to (nangananga padibu bapongolola manga a dishipa nawu tuishi buludiludi mu mêsu), ne didi dikebesha hypoxia anyi taxiadia. Udi uondapa ne atropine too ne padi mifuba yuma.

2. Pralidoxime (2-PAM / Obidoxime): Unlocking Paralyzed Muscles¶

Bu mudi atropine anu ukandika muscarinic receptors (kuuma mifuba ne kulongolola dikuma dia mutshima) ne udi ne tshienzedi nansha tshimue pa nicotine skeletal muscle receptors, mubedi udi ne atropine mujima udi ne mifuba miume udi mua kufua ne diaphragme nicotinic ne paralize wa mifuba ya kupuyakana.

• Mushindu udi Oximes wenza mudimu: Pralidoxime (2-PAM) (udibu bafila ku 1 too ne ku 2 grame IV mu minite 15 too ne ku 30 kudi bantu bakole, anyi 20 too ne ku 50 mg/kg kudi bana, pashishe difila dia IV dia 500 mg/dîba anyi 8 too ne ku 10 mg/kg/dîba mu tshitupa tshimue crowbar. Udi uluisha atome wa phosphore wa molecule wa organophosphate, umukoka ku enzyme wa acetylcholinesterase ne upingaja mudimu mujima wa enzyme wa ku tshilelelu ku mifuba ya mifuba ne ku miaba ya muscarine: anu yeye mufila kumpala kua "kukulakaja" kukanga malanda kashidi.
• Didimuija dia dibueja dia tshiamu tshia nzembu (Kuenza mudimu ne Succinylcholine nansha kakese): Shi mubedi udi ne organophosphate anyi carbamate dijinga ne tshiamu tshia endotracheal tshia lukasa, baminganga badi ne tshia kuenza mudimu ne manga a paralytic succinylcholine, bualu succinylcholine utu unyanguka kudi plasma butyrylcholinesterase (psedostercholine). Bu mudi tshintu tshidi tshishipa nyama tshibutule enzyme yonso ya cholinesterase, dose umue wa succinylcholine udi ukebesha mêba a bungi a disama dia tshiadi. Pamutu pa nanku, badi benza mudimu ne bintu bidi kabiyi bipangisha mijilu (bu mudi rocuronium).

3. Kutangila "Syndrome intermédiaire" (24 too ne ku 96 meba pashishe)¶

Nansha mudi mubedi mupanduke ku disama dia cholinergie dia kumpala dia dituku dia kumpala ne umueneka bu udi ukola bimpe mu lupitadi, 10 too ne ku 40 pa lukama ya babedi badi ne disama dia organophosphates didi dinyanguka bikole mu mafuta (bu mudi fenthion, dimethoate, parathion, anyi chlorpyrifos) badi bapeta tshimpitshimpi disama dia "Inmediate Syndrome" too ne ku 14 too ne ku 4 (24) 96 meba) kunyima kua dimanyisha:

• Disama dia mu tshimpitshimpi: Padiku kakuyi dinyanguka dia mayi anyi mifuba miume, mubedi udi upeta disama dia mifuba ya mu nshingu (dipanga dia kubandisha mutu wende pa tshilamba tshia kulala: tshimanyinu tshia kumpala tshia didimuija), mijilu ya mu mutu, mijilu ya ku tshiadi/mifuba, ne **mifuba ya kupuyakana (mifuba ya kupuyakana, ya lukasa) dipingaja dia tshiadi ne dilengeja dia kapepe mu matuku 5 too ne ku 15 too ne padi mishipa ya mifuba ikola.
• Organophosphate-Induced Delayed Neuropathy (OPIDN): Udi wenzeka 1 to 3 weeks kunyima kua amue malu, udi ukebesha kanyinganyinga ka mu tshiadi, dipanga dia lungenyi, disama dia nsongo, ne dikuluka dia makasa dia "stocking-and-glove"/dikuluka dia tshianza.

Mua kwingidija autoinjectors: DuoDote, Mark I, ne Atropen¶

Mu malu a busalayi, bintu bia njiwu (HAZMAT), midimu ya luondapu ya lukasa lukasa (EMS), ne imue miaba ya madimi, bantu badi bambuluisha badi ne biamu bia kuela nabi mubidi bidi ne tshiamu tshia ressort bienza bua kufila Atropine ne Pralidoxime (2-PAM) ku diambuluisha dia bilamba mu tshiadi tshia pambelu mu tusekonde tukese panyima pa dienza dia organophophose anyi dia nerve.

Difila dia manga bilondeshile bukole ne mushindu wa autoinjector¶

1. Adult Autoinjectors (DuoDote anyi ATNAA / Mark I Kit):
2. Tshiamu tshionso tshia DuoDote tshidi ne tshibombi tshimue tshidi tshifila 2.1 milligrams ya Atropine ne 600 milligrams ya Pralidoxime Chloride mu bulongame ku diambuluisha dia tshiamu tshimue (tshiamu tshia kale tshia Mark I Kit tshidi tshienza mudimu ne biamu bibidi bishilangane: Injector #1 udi ne 2 mg ya Atropine, ne Injector #1 udi ne 2,0 mg Pralidoxime).
3. Bimanyinu bikese anyi bia pa tshibidilu (bimanyinu bia mêsu, muulu udi upatuka, dipatuka dia mâyi, disama dia mu tshiadi, disama dia muoyo, kadi mubedi utshidi anu wenda ne wakula): Ela 1 DuoDote (anyi 1 Mark I set) mu tshiadi tshia pambelu tshia pankatshi (vastus lateralis). Bindile minite 10 to ne 15; pikala bimanyinu kabiyi bienda bikola, keba munganga bua kupeta manga makuabu.
4. Bimanyinu bikola (dipanga lungenyi, disama dia tshiadi, disama dia mupuya, dipanga dia luya, anyi disama dia tshiadi): Diakamue, ela **3 DuoDote autoinjectors (anyi 3 Mark I sets) mu tshitupa tshia pambelu tshia tshiadi, ne 1 Diazem (1010) CA (100) anyi Mizoda mg) anticonvulsant autoinjector nansha mudi bipupu bidi bimueneka kabiyi bimueneka patoke (bu mudi bantu badi ne disama dia nerve-agent badi ne disama dia nsukadi batu misangu ya bungi bapeta disama dia non-convulsive epilepticus mu buongo).
5. Pediatric Atropen Weight-Based Dosing:
6. Bana bakese badibu bapeta kudi organophosphates anyi kudi bintu bia mu mikolo badi dijinga ne biamu bia Atropen bidi ne bujitu (bidi mu 0.25 mg [tshimanyinu tshia jaune, bua bana ba muinshi mua 7 kg / 15 lbs], 0.5 mg [tshimanyinu tshia bule, bua bana ba bidimu 7 too ne ku 18 kg / 15 too ne ku 14 lbs, ** 0,0 mg. [tshimanyinu tshikunze tshifiike, bua bana 18 too ne ku 41 kg / 40 too ne ku 90 lbs], ne 2.0 mg [tshimanyinu tshia vert, bua kilo mipite pa 41 / 90 lbs]).
7. Mukenji wa mushinga wa kusungila muoyo: Shi muana udi ne disama dia organophosphate anyi dia tshintu tshidi mua kumushipa (malu adi apatuka mu mikolo, dipuekesha dia mikolo, disama dia koma, anyi disama dia tshiadi) ne anu tshiamu tshia 2 mg Atropine / DuoDote tshia muntu mukole tshidiku, mupeshe muana tshiamu tshia nzembu diakamue. Atropine tachycardia wa tshitupa tshîpi ne dikoba diume bidi mua kupanduka, kadi disama dia cholinergic didi kadiyi diondapibua didi mua kushipa muntu mu minite mikese.

Mushindu wa kuela tshiamu tshia autoinjector tshia tshitupa ku tshitupa¶

• Tshitupa 1: Tangila tshibombi tshia pambelu tshia tshiadi: Tangila lukasa tshitupa tshia pambelu tshia tshiadi bua kujadika ne: kuena wela mu tshibombi tshia makuta, mu nshinga, mu telefone wa bianza anyi mu tshibombi tshinene tshia mukaba to.
• Tshitupa 2: Umbusha tshilamba tshia bukubi tshia gris: Kuata tshibombi tshia DuoDote mu tshianza tshiebe ne nsongo ya vert mutangile panshi (kuteke tshianza tshiebe tshinene pa mutu pa lushingu lua vert nansha kakese). Koka tshilamba tshia bukubi tshia gris buludiludi kunyima.
• Tshitupa 3: Ela bikole ku 90-degree mu tshitupa tshia pambelu tshia tshiadi: Ela ne ufina tshitupa tshia vert bikole mu tshitupa tshia pambelu tshia tshiadi tshidi ne nyama pankatshi pa tshiadi ne dikasa too ne paudi umvua ne umvua dikuma dia tshiamu tshia nsongo.
• Tshitupa 4: Ikala ne bukole bua sekonde 10: Bala bitekete bitekete too ne ku 10 ("tshinunu tshimue, tshinunu tshibidi...") bua nzubu yonso ibidi (atropine ne pralidoxime) ikale mipatuke mu mubidi.
• Tshitupa 5: Koka lushinge mu tshibombi ne utshikuate ku tshiadi tshia muntu udibu bashipe: Koka tshintu tshia kuela mu tshibombi tshia muntu udibu bashipe**: Koka tshintu tshia kuela mu tshingoma buludiludi, ulengeje tshitupa tshia ku tshianza mu tusunsa tukese, ne ukose lushinge ludi lupatuke mu tshibombi tshia "J" pa tshintu tshikole bua wewe kumona mua kuela tshintu tshia kuela mu tshibombi tshidi katshiyi ne tshintu pa tshibombi tshia tshilamba tshia muntu udibu bashipe anyi pa tshimanyinu tshia triage. Ebi bidi bileja ba munganga badi bafika ne ba mu lupitadi lua lukasa lukasa bungi bua dose ya atropine ne 2-PAM idi mubedi mumane kupeta.

Nkonko itubu bela misangu ya bungi¶

Mukanda ewu udi bua kufila ngumu ne kawena upingana pa muaba wa dikonkonona dia malu a luondapu anyi dilongesha dia ku bianza to. Bu mudi disama dia tshimpitshimpi didi mua kufikisha ku dipanga dia mupuya, tudi tukulomba bua kulonga tulasa tua diambuluisha dia kumpala ne tua CPR ku diambuluisha dia International Federation of International Croix-Rouge and Red Crescent Societies (IFRC), société wa Croix-Rouge wa mu ditunga diebe, St John Ambulance, anyi mufidi wa dilongesha wa muaba unudi.

Miaba mifumina¶

• Bulongolodi bua makanda a mubidi pa buloba bujima (OMS): Dilama dia disama dia dikuatshika dia bintu bidi bishipa nyama: Mikenji ya dikuatshika dia manga a organophosphorus, carbamate ne paraquat.
• Bibambalu bia diluisha ne dikuba dia masama (CDC, États-Unis) ne Tshibambalu tshia bintu bidi ne buanga ne difunda dia masama (ATSDR): Mibelu ya dilama dia manga bua bintu bidi bishipa mijilu ne manga a organophosphate ne Mibelu ya luondapu ya Paraquat.
• Tshibambalu tshia dikuba dia buloba tshia mu États-Unis (EPA, États-Unis): Dimanya ne dilama dia bintu bidi bishipa nyama (tshibejibeji tshia 6).
• Tshibambalu tshia malu a buanga tshia mu ditunga (NPIS, Royaume-Uni) ne Tshibambalu tshia malu a bukola bua mubidi tshia mu UK (UKHSA): TOXBASE Clinical Management of Organophosphates, Carbamates, Paraquat, and Metal Phosphides.

Malu adi apetangana¶

• Diambuluisha dia kumpala dia poison ne disungula dia diluisha poison
• Kuosha bikole ne dinyanguka dia kikoba
• Acide hydrofluorique, tshintu tshidi tshiumusha mvinyo, ne bintu bia kuosha bia mu midimu
• Disama dia mêsu ne dilengeja dia mêsu ne manga
• CPR ne dipuekesha dia mupuya bua bantu bakole
• Nomba ya njiwu bilondeshile ditunga