Paraquat, Diquat, me te Whakakitenga Whakapapa patupatua: Whakakorea me te Tiakitanga Inamata¶
Emergency numbers differ by country. This page uses 911, the number for the United States and Canada. Many other countries use 112, 999, or another number. Find the number for your country.
Ko nga patu patu taru arumoni me te ahuwhenua (kai patu taru) mai i nga rehu maara maara a nga rangatira o te kainga ki te iti o te paitini, tae noa ki etahi o nga paihana ahumahi tino tere te pirau me te whakamate i te whenua. Ko te mea tuatahi i roto i enei ko Paraquat (1,1'-dimethyl-4,4'-bipyridinium dichloride, e hokona ana i raro i nga ingoa tohu ahuwhenua penei i te Gramoxone, Parazone, Firestorm, me Helmquat) me tona whanaunga matū Diquat (hokona i roto i nga momo patu taru arumoni me te wai, **Reglone, etahi ****Reglone, Reglone ranei, **** hangahanga), i te taha o nga rongoaa ahuwhenua Glyphosate-Surfactant (pērā i te Roundup Pro / 41% Concentrate) me Chlorophenoxy herbicides (2,4-D me Dicamba). Ko te horomia ahakoa tetahi waha kotahi (10 ki te 15 mira, 1 punetēpu ranei) o te 20% paraquat wai, ka ngongo ranei i te paraquat na roto i te kiri kua werohia, kua tapahia, kua mate whewhe ranei i te wa e rehutia ana te peketua me te kore he taputapu whakamarumaru, ka puta he wera kino o te korokoro me te esophagus, te necrosis korekore, me te ngongo ngongo. fibrosis e whakapoipoi ana i nga ngongo i roto i nga ra ki nga wiki.
Mena kua horomia e koe, e tetahi tangata ranei e tata ana tetahi otaota otaota, kua parahia he kai patu taru ki roto i nga kanohi, ki te kiri ranei, i inu aitua ranei te paraquat, te glyphosate ranei i ringihia ki roto i te pounamu inu, waea atu ki to nama ohorere (911 i te United States me Canada, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom) tau ohorere whaiaronga tonu, ka arotake paihana awhina tuatahi, weranga matū, a paihana pesticide organophosphate. Na te mea ** ia meneti o te whakaroa ka taea e te paraquat te pupuhi i a ia ano ki roto i nga pūtau pūkahukahu**, ka horoi tonu te kiri, ka horomia he whakangao-a-waha i roto i te 60 meneti tuatahi, me te kaore i te kaha o te hāora tāpiri noa ki te kore e puta te hypoxemia nui he mahi mate-mate ranei.
Mahia tenei inaianei¶
- Waea atu ki a 911 / 112 / 999 me te whakamohio i te waka tūroro he Paraquat pea: Ko te paraquat me nga patu patupatu totohe he tino mate ohorere mo te mate ohorere. Waea atu ki nga ratonga hauora whawhati tata me to Poison Control Center (1-800-222-1222 i te US) kia taea e te hōhipera whiwhi te whakarite Carcoal Whakahohe (he Fuller's Earth / Bentonite ranei) me te whakamohio i o raatau nephrology/hemoperfusion me nga roopu tiaki kaha i mua i to taenga mai.
- KORERO MO TE PARAQUAT: Me kii atu ki nga paramedics me nga kaimahi ER kia kaua e hoatu he hāora taapiri i nga wa katoa: Kaore i rite ki era atu ohotata hauora, ka hoatu he hāora taapiri (
O2) ki te tangata kaipahua paraquat he rite ki te riringi penehīni ki runga ahi. Ka patua e te Paraquat nga pūtau pūkahukahu mā te whakamahi i ngā rāpoi ngota hāora ki te whakaputa i nga rauropi kore utu superoxide (O2-). Ko nga kaimahi paramedic me nga kaimahi ruuma whawhati tata me kaore he hauora taapiri ki te kore te oximetry o te manawanui (SpO2) ka heke ki raro i te 85 ōrau ki te 88 ōrau (te pēhanga wāhanga o te hāoraPaO2 < 50 mmHg). - Tauhia nga kakahu poke katoa ka horoi i te kiri me nga kanohi mo te 15 ki te 20 meneti: Mena ka marara te paraquat, te diquat, te glyphosate ranei ki runga ki te kiri, ka whakamakuku ranei i roto i nga tarau, i nga putu ranei i te wa e rehu ana, whakakakahuhia nga karapu nitrile, rapa ranei, tangohia nga kakahu poke katoa, ka horoi marietia te kiri ki te **00 meneti te wai rere ** me te **2 wai rere. Kaua e mirohia te kiri ki te paraihe maro: ka pakaru te kiri i te arai epidermal ka mate te paraquat i roto i te toto. Horoihia nga kanohi kua pania ki te wai rere mahana mo te iti rawa 15 ki te 20 meneti.
- Kia mohio ki te "Matapihi 60-Minute koura" mo te here-waha (Activated Charcoal / Fuller's Earth): Ka tere te ngongo o te paraquat mai i te whekau iti, ka eke ki te taumata teitei o te toto i roto i te 60 ki te 120 meneti, muri iho ka panaia ki roto ki nga ngongo kaore he mea e taea te tango. Ko te kawe i te manawanui ki te ruuma ohorere i roto i te 60 meneti tuatahi ki te whiwhi 50 ki te 100 karamu o te Wao Whakahohe (ranei 15% Te Whenua o Fuller / 7% uku Bentonite kei hea nga taonga) ko te huarahi tino whai hua hei aukati i te mate. (Tuhipoka: I roto i nga waahi ahuwhenua tawhiti noa atu i nga whare haumanu, ka kii nga kawa mara o WHO mena karekau he waro rongoa, ka hoatu he uku kai/bentonite, he oneone pokekore ranei i roto i te wai kua whakamahia hei herenga mara mo te paraquat whakapumau, ahakoa he waro whakahohe a te hohipera i nga wa katoa).
- Kaua e whakapouri i te ruaki: Ko te paraquat, te diquat, me te glyphosate-surfactant wairewa he matū waiu waikura e wera ana i te waha, te pharynx, me te esophagus. Ma te akiaki i te tangata ki te kake, ki te ruaki ranei, ka hoki mai ano te waipatu patupatu ki runga ake i te esophagus mo te wa tuarua, ka tupono ki te pakaru o te esophageal me te wawata mate ki roto i nga puku.
- Kawea mai te ipu patu patupatu, whakaahuahia ranei te tapanga matū tika: Tangohia he whakaahua o te pouaka "Kai Whakahohe" me te Tau Rehita EPA kei runga i te ipu (kaore e mau i te ipu matū e turuturu, kua poke i roto i te waka waka tūroro mena ka hiri ki te kirihou taumaha). I roto i nga tau, ko nga tohu penei i te Roundup, Ortho, me Weedol kua huri i nga kai kaha i waenga i te paraquat, diquat, glyphosate, glufosinate, me te 2,4-D.
He aha te Oxygen Taapiri i Whakatere ai i te Mate i te Pahana Paraquat
Kia mohio nga paramedic, nēhi, me nga taote e tiaki ana i te manawanui paraquat ka kite tonu i tenei whakatupato: KAUA e whakahaere i te hauora taapiri (O2) ki te tūroro e mate ana i te paraquat poisoning he mea noa, he iti noa ranei te heke o te hāora (SpO2 >= 88%). Ka whakaemihia te paraquat i roto i te Momo I me te Momo II nga pūkahukahu alveolar mo te kuhanga 10 ki te 50 nga wa teitei ake i te rerenga toto, ka haere tonu i te redox cycling, ma te whakamahi i te oxygen intracellular (O2) me NADPH ki te hanga miriona o te superoxide whakamate (O2-) me te hydroxyl (OH.) nga rauropi kore utu e whakangaro ana i nga ngongo. Ko te tuku i te hāora ihu rere nui, te 100% hāora ranei ka whakatere ake i tenei tauhohenga mekameka tutoo-kore, ka tere te mate ** pulmonary fibrosis**. Ko te hāora tāpiritanga ka hoatu ** hei ine whakamarumaru, whakaora ranei ina SpO2 ka taka ki raro i te 85% ki te 88% (PaO2 < 50 mmHg)**.
Rakau whakatau: Paraquat, diquat, me te whakamau i te patu patupatu¶
flowchart TD
Start["E whakapaetia ana te Marangatanga o te patu patupatua (te horomi-a-waha OR RĀNEI Te Puhi Puhi Mata)"] --> Identify["Tirohia te Tapanga Ipu: Paraquat vs Diquat vs Glyphosate-Surfactant vs Glufosinate vs 2,4-D"]
Identify --> RouteSplit{"He aha te ara o te Whakaaturanga?"}
RouteSplit -->|Skin or Eye Splash (Especially Backpack Sprayer Leak or Broken Skin)| DermalCare["1. Rescuer Gloves on; Wewetehia nga kakahu katoa\n2. Horoi marietia te kiri ki te hopi me te wai mo te 15-20 min (KORE he ruku kino)\n3. Whakawai Mata 15-20 Min; Te Aromatawai a te Hohipera mo te Whakangao Punaha mena ka tapahia/ka tahuna te kiri"]
RouteSplit -->|Oral Ingestion (Intentional OR Accidental Storage in Drink Bottle)| ClassTriage{"Ko tehea mea kaha i horomia?"}
ClassTriage -->|1. Paraquat (Gramoxone, Parazone)| ParaquatPath["OHOWAHO TINO (Matapihi 1-Haora koura):\n1. KAUPAPA KAUPAPA OXYGEN (Pupuritia te SpO2 85-88% Ki te kore te PaO2 <50 mmHg)\n2. Waro Whakahohe Inamata (1 g/kg ki te 50-100 g) ranei te Fuller's Earth i roto i te 60 Min\n3. Ko nga Crystalloids IV + Te Hunga Wao Whakanuia / Hemodialysis i roto i nga haora 2-4\n4. Paihere ICU Immunosuppressive/Atioxidant (IV Methylprednisolone + Cyclophosphamide + NAC)"]
ClassTriage -->|2. Diquat (Reward, Reglone, Tribune)| DiquatPath["Tino Kawa + Renal + CNS Toxiness:\n1. Waro Whakahohe Inamata / Fuller's Earth + Agressive IV Fluid Resuscitation\n2. Aroturuki mo te Severe Paralytic Ileus (Te Puku Wai i roto i te Gut), Te Ngaru o te Takihi, Pontine Brainstem Infarction/Seizures\n3. Hemodialysis moata mo te Rahunga Renal (He iti ake te tango i te Pukahukahu i te Paraquat, Me karo tonu te O2 i te taikaha)"]
ClassTriage -->|3. Concentrated Glyphosate-Surfactant (41% Roundup Pro) or Glufosinate| GlyPath["Paipa Mitochondrial Caustic + Surfactant:\n1. KAUA E Whakahaua te Ruaki; Tirohia te Rererangi mo te Pharyngeal Edema\n2. Nga Waa IV Kariri mo te Hipovolemic/Cardiogenic Shock; Whakatikahia te Hiperkalemia Nui me te Acidosis Metabolic\n3. Hemodialysis moata ki te Puke ake te Oliguric Renal Failure, Acidosis, Rere Rerection ranei\n4. Mo te Glufosinate: Aroturuki 24-48h mo te Rooru o te Koma, Te Apnea, me te Pupuri Whakakore."]
Te Whakataurite i nga Karaehe Nui e Rima o te Whakamatea i roto i te Pahana Tangata¶
Ahakoa he maha nga patu patupatutaru e noho ana, e rima nga karaehe matū e korero ana mo te tata ki te katoa o nga mahi whakararu i nga mahi ahuwhenua me te patu taru o te whare puta noa i te ao:
| Te karaehe patupatu me nga mea kaha | Ingoa Waitohu noa me nga Hanga | Tikanga Toxic Tuatahi | Nga Whainga Okana Haumanu Matua me nga Tohu Whakamate | Antidote / Whakaora Hohipera Motuhake |
|---|---|---|---|---|
| 1. Paraquat (Bipyridylium Dichloride) (20% ki te 24% te kukū wai ahuwhenua; kua rāhuitia i EU/UK/Haina/Brazil, rāhuitia-whakamahi i US) |
Gramoxone SL, Parazone, Firestorm, Quik-Quat, Helmquat (Te wai pouri puru-matomato me te tapiri atu i te piro/maehe me te emetic). | Ko te tango i te polyamine-transporter hohe ki roto ** nga pūtau pūkahukahu alveolar**, whai muri i te paihikara redox e whakawhirinaki ana ki te NADPH ka huri O2 ki roto superoxide free radicals, e whakangaro ana i nga kiriuhi pūtau ma te lipid peroxidation. |
Te weranga o te waha/esophageal ("arero paraquat"), te mate ngongo ngongo renal acute (i roto i te 24-48h), te mate ate ate, me te te pulmonary fibrosis e kore e taea te huri haere (mate i roto i te 1 ki te 21 ra). | KORE O2 (SpO2 whainga 85-88%); Waro Whakahohe / Fuller's Earth i roto i te <1 haora; Waro Hemoperfusion / Hemodialysis i roto i te 2 ki te 4 haora; IV Methylprednisolone + Cyclophosphamide + High-Dose NAC / Huaora C / Salicylate. |
| 2. Diquat (Bipyridylium Dibromide) (2% ki te 37% te kakano wai; i hokona nuitia ki te wahi i aukatihia te paraquat) |
Reward, Reglone, Tribune, Weedol (nga hanga tawhito), Harvester (he whero-parauri ki te wai kowhai pouri). | Ka eke ki te redox cycling he rite ki te paraquat, engari karekau he roopu tango polyamine no reira kaore e tino kaha ki roto i nga ngongo; engari ka kino te waahanga GI, nga whatukuhu, me te roro. | Ka wera te kino o te GI, te ngaronga nui o te wai mokowhiti tuatoru ki roto i te paralyzed bowel (paralytic ileus), hypovolemic shock, tere acute renal failure, me brainstem (pontine) hemorrhage/infarction, coma, and seizures. | Waro Whakahohe / Fuller's Earth tonu; whakaora i te wai IV nui (te whakatika i nga rita kua ngaro ki roto i te kopu); Hemodialysis mo te wharanga o te whatukuhu whakapeka me te whakawātea electrolyte; karohia te hyperoxia. |
| 3. Glyphosate + Polyethoxylated Tallow Amine (POEA) Surfactant (1% ki te 2% Rere Riri-ki-Whakamahi vs. 41% Ahuwhenua Concentrate) |
Roundup (nga mahi ahuwhenua matarohia), Ranger Pro, Rodeo, Kaimuku | Ko te Glyphosate ake ka aukati i te tipu EPSP synthase (kei te ngaro i roto i te tangata), engari i roto i te ** kukū (> 41%) whakaurunga **, te POEA surfactant me te pāhare pāporo/isopropylamine tote tangata ka whakararu i te **mitochondrial oxidative phosphorylation mitochondrial oxidative ka wera te mucosa. | 1-2% Te Rehu Kainga: He ngawari te waha/te puku. 41% Concentrate (> 85 ki te 100 mL): Te weranga o te pharyngeal/te pupuhi o te hau, te ruaki e kore e taea te rongoa, te hyperkalemia nui (ina koa i roto i nga hangahanga K+-tote), te waikawa metabolic, te wiri refractory, me te rare renal acute. |
Ko te Whakangungu Whakamutunga Endotracheal moata ki te wera te stridor/pharyngeal; ** nga tioata IV kaitaua + nga kaitapahi hiko**; Hemodialysis moata mo te waikawa metabolic nui, te hyperkalemia, te wharanga whatukuhu whakapeka oliguric ranei. (Karekau he Waro Whakahohe mena he wera nui te wera). |
| 4. Glufosinate Ammonium (18% ki te 24% Concentrate) |
Whakamutunga, Whakawhirinaki, Tiati, Basta, Cheetah | Ko te tairitenga hanganga o glutamate e aukati ana i te glutamine synthetase, ka puta te kohinga haukinia i roto i nga pūtau** me te whakakorikori o te punaha nerve pokapū. | **Te wa 8-ki-24-haora asymptomatic te roa , ka whai ohorere ko ** koma hohonu, te hopu manawa o te puku (apnea), te amnesia retrograde, me te epilepticus whakakeke. | **Mandati 24-ki-48-haora ICU mātakitaki ** ahakoa i te tuatahi ara; moata Waro Whakahohe; te hau mihi moata ** mo te apnea pokapū; benzodiazepines/propofol mo te hopu; Hemodialysis i nga keehi kino. |
| 5. Chlorophenoxy Herbicide (2,4-D [2,4-Dichlorophenoxyacetic acid], Dicamba, MCPA, MCPP) |
Weed-B-Gon, Killex, Crossbow, Banvel | Ka wetewete i te phosphorylation oxidative, ka whakapōrearea i te pākia acetyl-CoA, ā, ka puta tika ** te paitini kiriuhi uaua kōhiwi (rhabdomyolysis nui)**. | Te ruaki, te mamae o te puku, myotonia, rhabdomyolysis nui (CK-te-rangi me te mimi myoglobinuric parauri pouri), hyperthermia, metabolic acidosis, coma, me te arrhythmias ventricular. | Ko te Sodium Bicarbonate Urinary Alkalinization (whakapikihia te pH mimi ki te 7.5 ki te 8.0 ka mau i te waikawa ngoikore 2,4-D i roto i te mimi, ka piki ake te waatea o nga whatukuhu 10-piki ki te 20-fold i te wa e tiaki ana i nga whatukuhu mai i te myoglobin) + Hemodialysis mo te tino paitini. |
Ruku Hohonu: Paihana Paraquat: Pathophysiology, Waahanga Haumanu, me te Ture Hauora¶
1. He aha te Paraquat e patu ana i nga Pukahukahu (The Polyamine Transporter Trap)¶
Ka kuhu te paraquat ki te rere toto mai i te whekau, ma te kiri pakaru ranei, ka tohatohahia ki nga whekau katoa, ka mate wawe i nga tubules renal proximal o nga whatukuhu me te ate. Heoi ano, ka pa ki nga pukahukahu he mate ahurei, he mate:
- Momo I me Momo II alveolar epithelial cell kei roto i te huhu o te tangata he punaha kawe membrane e whakawhirinaki ana ki te kaha e kiia nei ko te polyamine uptake system (ko te tikanga ka whakamahia ki te kawemai i nga polyamine endogenous penei i te putrescine me te spermine).
- No te mea ko te tawhiti i waenga i nga ngota hauota e rua ka utaina pai i runga i te ngota ngota paraquat (0.7 nanometers) he rite tonu te hanganga ki nga polyamines maori, ka pohehe te ngongo i te paraquat mai i te rerenga toto ki te rōnaki kukū nui, ka tae ki te kukū o te kiko pūkahukahu 10 ki te 50 nga wa teitei ake i nga taumata plasma i roto i nga haora.
- Kia mau ki roto i nga pūtau alveolar, paraquat (PQ2+) ka whakaae i te irahiko mai i NADPH (whakaahua e NADPH-cytochrome P450 reductase) kia riro hei paraquat monocation free radical (PQ.+).
- Ka whakawhitia e tenei tuwhena tona irahiko taapiri ki haora ngota (O2), he whakahou i te katote paraquat taketake (PQ2+) i te wa e hanga ana i te superoxide anion radical tino kino (O2.-), ** hauwai peroxide (H2O2), me rarohiko hydroxyl (OH.).
- Ka pau tenei paihara redox katoa nga tau NADPH** me te glutathioneka whakaoxidize i nga lipid membrane pūtau, ka puta te alveolitis (mamae pukahahu) i roto i te 24 ki te 72 haora, me te whakaihiihi i te tipu nui o ** fibroblasts me te collagen ** e huri ana i nga pukoro hau hauarangi o te pukahukahu kore (bremonarycomb) fibrosis) mo te 5 ki te 21 ra.
2. He aha te oranga o nga whatukuhu ka whakatau i te oranga o te Pukahukahu¶
Ko te paraquat kare i te kawa i roto i te tinana o te tangata; Neke atu i te 90 paiheneti o te paraquat kua kuhu ka peia karehia e nga whatukuhu na roto i te filtration glomerular me te hunanga ngongo hohe i roto i nga haora tuatahi 12 ki te 24 haora, mena ka mau tonu te mahi o te whatukuhu. - Heoi, ko te paraquat ka puta i te wa kotahi te acute tubular necrosis (ATN) o nga whatukuhu i roto i nga haora 24 tuatahi. - I te korenga o nga whatukuhu, ka mutu te whakaheke paraquat mimi, ka piki ake nga taumata paraquat plasma mo etahi ra, ka haere tonu nga ngongo ki te horoi i te paraquat mai i te toto kia tae ra ano te taumahatanga o te pulmonary pulmonary. - No reira, whakaora i te wē i roto i te toto kia mau tonu te whakaputanga mimi nui me te purenga toto extracorporeal ultra-moata (Charcoal Hemoperfusion or Hemodialysis ranei i roto i te 2 ki te 4 haora o te horomitanga) he mea nui ki te whakakore i te paraquat mai i te toto *i mua i te * ka mau te ngoikore o te whatu ki roto i te tinana.
3. Ko nga Reanga Hauora E Toru e Tiaki ana ki te Inenga o te Paraquat Ingestion¶
I horomia te horomia (mg/kg o Paraquat Ion) |
Rōrahi Ōrite o te 20% Te Wai (pērā i te Gramoxone) | Akoranga Haumanu, Te Whakawhanaunga Okana, me te Tohunga |
|---|---|---|
| Taupae 1: Te horomitanga ngawari-ki-te-wariu ( < 20 mg/kg o paraquat katote) |
He iti ake i te 7.5 mL (< 1.5 teaspoons) i roto i te pakeke 70 kg |
Te wera o te waha me te pharyngeal, te whakapairuaki, te ruaki, te diarrhea. Ko te ngoikoretanga o te whatukuhu, te ate ate ranei; ka ora katoa te nuinga o nga turoro ki te rongoa i roto i te haora tuatahi me te waro whakahohe me nga wai IV. |
| Tauhanga 2: Te horomitanga kino (Subacute Pulmonary Fibrosis) ( 20 to 40 mg/kg o paraquat katote) |
7.5 mL ki te 15 mL (1.5 teaspoons to 1 tablespoon / one mouthful) i roto i te pakeke 70 kg |
Ra 1 ki te 2: He weranga pseudomembranous nui o te arero ("paraquat tongue") me te esophagus, ruaki, mamae te horomia. Ra 2 ki te 5: Te ngoikore o te renal oliguric nui me te mate hepatitis. Ra 5 ki te 21: Ko te kohuke haere tonu, ko te kuhu mai o te pukahukahu rua, me te te pulmonary fibrosis korekore e arai ana ki te mate manawa mate hypoxemic i te nuinga o nga keehi. |
| Taupae 3: Te Korohanga Tino (Multiorgan Necrosis) ( > 40 to 50 mg/kg o paraquat katote) |
Neke atu i te 15 mL ki te 20 mL (> 1 tablespoon / multiple gulps) i roto i te pakeke 70 kg |
Ka tere te tiimata o te necrosis gastrointestinal ahi, ** te pakaru o te esophageal (mediastinitis)**, te nui te waikawa lactic-anion-gap nui, te wiri cardiogenic/vasoplegic, te necrosis cortical adrenal, te mate renal/hepatic whakapeka, te koma, me te **mate i roto i te 12 ki te 72 haora i mua i te paheketanga o te fibrosis. |
4. Nga Moomarie Paariki (Kiri) me te Paraquat Mata¶
Kaua rawa e whakahawea ki te kiri ki te paraquat: - Ahakoa e mau tonu ana, ka ata horo te kiri hauora i te paraquat, ka roa te pa atu ki nga tarau tarau, ki nga putu ranei (pēnei i te rehu peketua i te tuara o te kaiahuwhenua, te papa, me te kiri) ka pa te wera matū me te mate whewhe o te kiri. - Ina tahuna, ka tapahia, ka rakurakuhia, ka tukitukia ranei te stratum corneum o waho, ka tere te uru o te paraquat ki roto i te rerenga toto na roto i te kiri kua pakaru, a he maha nga mate mate o te fibrosis pulmonary i puta mai i te **puke-rehu-a-ira i te rehu ** karekau he maturuturunga iho i horomia. - Ka pakaru te kanohi me te paraquat kukū te take kua whakaroa, he nui te karu me te conjunctival epithelial sloughing ka eke ki runga i te 12 ki te 48 haora i muri i te rongonga, me 20-meneti te whakamakuku i te wai/te tote me te tiaki ophthalmology ohorere hei aukati i te nawe me te matapo.
Hohipera Stepwise me te Kawa ICU mo te Paraquat me te Diquat¶
- Te Rahui Hauora (
SpO2Whāia 85% ki te 88%): - Tuhia he tohu i te taha o te moenga ki runga ake i te mahunga o te turoro: "PARAQUAT POISONING: KAUA E WHAKAMAHI I TE OXYGEN TAPU KI TE KAUPAPA SPO2 <85% (PaO2 <50 mmHg)."
- Puritia te manawanui ki te manawa ** hau ruma (
FiO2 21%)** i te wa e taea ana. - Te Whakakorenga Tonu i te Waa (I roto i te 60 meneti):
- Whakahaere Waro Whakahohe (
1 to 2 g/kg, ranei50 to 100 gramsi roto i nga pakeke) ma te waha, ma te ngongo nasogastric ngohengohe ranei (he 15% Fuller's Earth [100 to 150 g] ranei 7% Bentonite me te cathartic penei i te mannitol/sorbitol ki te whakamahi uku). Ko nga rangahau paitini haumanu o naianei e whakapumau ana He rite tonu te whai hua o te Wao Whakahohe ki a Fuller's Earth a kei nga tari whawhati tata katoa; kaua e whakaroa te waro e tatari ana ki te kimi i te whenua o Fuller. - **Kati te horoi i nga wa katoa i muri i te horohanga paraquat na te nui o te tupono ka pa te esophageal perforation, mena ka mahia marietia ma te wawata nasogastric i roto i te 30 ki te 60 meneti o te horomitanga nui o te wai.
- Kaikaha te Whakaora Crystalloid ki roto i te toto:
- Whakawhia nga tioata isotonic (
0.9% Normal SalineraneiLactated Ringer's) i 150 ki te 250 mL/haora ki te pupuri i te whakaputanga mimi tere (1.5 to 3 mL/kg/hour) me te whakanui i te paraquat renal i roto i nga haora 24 tuatahi. - Waro Moata Hemoperfusion (HP) ranei Hemodialysis (HD): Te Matapihi 2-ki-4-Haora:
- Ka taea e te Waowa (Hemodialysis High-Flux ranei) te whakawātea i te paraquat mai i te toto, engari i te wa e rere tonu ana te paraquat i roto i te plasma i mua i te raka ki roto i nga pūtau pūkahukahu.
- Hei whakapai ake i te oranga i roto i nga taitapa-whakamate-whakamate, Me timata te Whakamutunga Wao (Hemodialysis ranei) i roto i te 2 ki te 4 haora (kaore i muri i te 6 haora) i muri i te tangohanga, he maha tonu te whai i te Continuous Venovenous Hemofiltration (CVVH). Ka pahemo te 12 ki te 24 haora, kua iti kee nga taumata paraquat i roto i te toto na te mea kei roto te paitini i roto i nga ngongo, a ko te whakamaarama he awhina anake hei tautoko i te mate whatukuhu.
- Te Whakamaunga Tere mo te Taatari Moenga (Urine Sodium Dithionite Test & Plasma Nomogram):
- Urine Sodium Dithionite Colorimetric Test: Te taapiri 1 karamu o te konutai bicarbonate me te 1 karamu o te konutai dithionite ki 10 mL o te mimi o te manawanui ka whakaiti i te paraquat ki tana katote-tuwhera-kore puru (me te whakaiti i te diquat ki te katote kowhai-matomato kanapa).
- Mēnā ka huri te mimi i roto i te 6 ki te 24 haora i muri i te horohanga, ka kitea he taumahatanga paraquat tino nui me te nui o te mate.
- Mena kei te noho tonu te mimi maamaa, he koma kikorangi kikorangi ranei, he iti te urunga o te punaha, ka ora tonu.
- Nomogram Paraquat Plasma Ine (Proudfoot / Hart Nomograms): Te whakatakoto i te kuhanga paraquat plasma ine tika (
mcg/mLraneimg/L) ki nga haora mai i te whakamohiotanga e matapae ana ka ora. - Immunosuppressive and Antioxidant ICU Rescue Rescue:
- Hei whakakore i te kaha o te pulmonary alveolitis me te fibroblast collagen deposition, he maha nga pokapu paitini o te ao (otira puta noa i Ahia-Kiwa me te aratohu haumanu WHO/NPIS) ka whakahaere wawe i te immunosuppressive me te kawa antioxidant i roto i te paihana paraquat iti-ki-te kaha:
- Methylprednisolone Putu-a-roto (
15 mg/kg/dayranei1,000 mg IV daily for 3 days) + ** Cyclophosphamide ki roto i te toto** (15 mg/kg/day IV for 2 days), whai muri ko Dexamethasone (8 mg IV every 8 hours). - High-Dose Intravenous N-Acetylcysteine (NAC) (ki te whakaki i te glutathione intracellular), High-Dose Huaora C (Ascorbic Acid), ** Huaora E**, me te Sodium Salicylate (he chelates i te rino, he hamu i nga rauropi hydroxyl, me te aukati
NF-kappaBmumura pūkahukahu).
- Methylprednisolone Putu-a-roto (
- Mai mamae me te Tiaki Palliative:
- Ko te mate o te waha, te pharyngeal, me te esophageal whewhe ("paraquat tongue") ka puta te mamae nui; whakarato i te whakaora o te opioid intravenous (morphine or fentanyl) me te lidocaine he horoi waha viscous, me te pupuri i te manawanui ki te kore-ma-waha (NPO) me te kai maatanga matua mena he wera nui te esophageal.
Ko te Glyphosate-Surfactant ("Roundup") Poisoning Triage¶
Na te mea ko te glyphosate te patu patupatu i te nuinga o te ao, ka tino wehe nga pokapu paihana i waenga i nga nga rehu rangatira kua reri ki te whakamahi me nga whakaahua ahuwhenua:
- Karei Riri-ki-Whakamahi (RTU) Rehu (
1% to 2% Glyphosate): Ko te horomia ohorere a te tamaiti, pakeke ranei i te nuinga o te karekau noa iho te waha, te nausea ngawari, te ruaki, te mate korere ranei ka mutu ma te wai waha me te mataki. - Te Ahuwhenua / Tauhokohoko (
41% to 50%+ Glyphosate + 15% POEA Surfactant): - Ko te horomia neke atu i te 85 mL ki te 100 mL (3 hekere) o te 41% glyphosate-surfactant kukū he he ohorere tiaki tino mate mo te ora me te 10 ki te 30 paiheneti e mate ana i roto i nga horopeta o te whakaaro.
- I tua atu, ka whakamahi etahi hangahanga glyphosate arumoni kaha teitei Glyphosate Potassium Salt (
K+te tote) hei utu mo te tote isopropylamine: ka horomia he hua pāhare pāporo-glyphosate kukū ka puta he ** uta pāhare pāporo ** ka taea e ** ka mau i te ngakau hyperkalemic mate tere ** i roto i te 1 ki te 3 haora. - Whakahaere i te Hohipera: Me tere tonu te mahi nasopharyngoscopy me te whakatoo i te endotracheal moata mena kei te drooling, te stridor, te edema pharyngeal ranei; te whakaora i te pehanga toto me te ** crystalloids IV kaha me te norepinephrine **; me rongoa tonu te hyperkalemia me te IV calcium, insulin-dextrose, me te konutai bicarbonate; me te timata i te moata hemodialysis mena kei te mau tonu te waikawa metabolic refractory, te hyperkalemia, te wharanga whatukuhu whakapeka oliguric, te ohorere ranei.
Ārai: Ko te #1 te take o te horomitanga patu patu patu kino¶
Kaua rawa e Ringihia te Kaipatu Taru ki roto i te wai, te houra, te ipu inu hakinakina ranei
Puta noa i te United States, Uropi, Amerika Latina, me Ahia, tata ki te 100 paiheneti o te paraquat mate, te diquat, me te paihana glyphosate tino kaha ka rite tonu te ahua: ka whakawhitia e te tangata te toenga wai otaota puru-matomato, parauri ranei ki roto i te wai kau **Gatorade, Coca-Cola, tio tio, ipu, kareti, wai karaka ranei i roto i te pounamu. Moenga, kei reira te tamaiti matewai, te hoa mahi ranei e inu ana i te inu kotahi. Kaua rawa e whakawhitia te patu patukiriri, otaota otaota ranei i roto i tana ipu kua tapaina taketake, ka kati i nga kakano ahuwhenua katoa ki roto i te rūnanga matū whai hau.
Nga nama ohorere a rohe me nga tikanga umanga¶
| Rohe / Whenua | Tau Ambulance Ohotata | Waea Awhina mo te Mana Paihana Motu | Nga Panui Kawa Haumanu Whaimana |
|---|---|---|---|
| Te Hononga o Amerika me Kanata | 911 | US: 1-800-222-1222 (Nga Poison Center o Amerika) / Canada: 1-844-POISON-X (1-844-764-7669) | Ko te US EPA e whakahau ana ko te Paraquat he Pesticide (RUP) Whakamahia Rahuitia me te whakawhiti punaha kati; Ko nga aratohu a te AAPCC/EPA e arataki ana i te waro whakakorikori tonu, e pupuri ana i te O2 (SpO2 < 88%), me te whakawhitiwhiti whakaaro mo te nephrology. |
| United Kingdom | 999 (ranei 112) | NHS 111 (Tumatanui) / NPIS TOXBASE (0344 892 0111 mo nga rata) | Ka whakakorehia te hoko paraquat me te diquat i te UK, ahakoa kei te noho tonu nga rakau whare witi; Ko te NPIS TOXBASE e whakarato ana i te whakamaoritanga nomogram mo te waewae whakakake, te whakamatautau urine dithionite, me nga tikanga aukati mate. |
| Uniana Pakeha | 112 | Whakapā atu ki te pokapū paihana ā-motu mā 112 (hei tauira, Tiamana +49 30 19240, Parani 01 40 05 48 48) | Ko te paraquat (mai i te 2007) me te diquat (mai i te 2018) kua whakakorehia puta noa i te EU; Ko te glyphosate, te glufosinate, me te 2,4-D kei te noho tonu i roto i nga whakaaturanga ahuwhenua. |
| Ahitereiria me Aotearoa | Ahitereiria: 000 / New Zealand: 111 | Ahitereiria: 13 11 26 (Poisons Information Centre) / New Zealand: 0800 764 766 (0800 POISON) | Paraquat (Gramoxone) ka noho tonu hei paihana S7 mo nga mahi ahuwhenua; Ko nga Aratohu Hauora o Ahitereiria e whakanui ana i te waro whakahohe a-waha i roto i te 1 haora me te karo i te hauora taapiri. |
| India me Ahia-Kiwa | India: 112 (ranei 108) / Sri Lanka/Thailand: 1990 / 1669 | India: AIIMS National Poisons Information Centre (1800-116-117 / 011-26589391) | Te taumahatanga a rohe o te paraquat (24% SL) me nga whakaaturanga glyphosate; te waro whakakorikori tonu/Fuller's earth, te whakaheke toto waro moata i roto i te 4 haora, me te pupuhi methylprednisolone/cyclophosphamide. |
Pātai auau¶
He aha te take me kaiponuhia e te hunga hauora me nga taote ohorere te hauora mai i te tangata i horomia te paraquat?¶
Ka patua e te Paraquat nga pūtau pūkahukahu na roto i te tukanga matū e kiia nei ko te redox cycling, e whakamahi ana i nga ngota ngota hāora i roto i nga pūkahukahu ki te hanga miriona o te superoxide kino me te hydroxyl free radicals. Na te mea ka kaha te ngongo o nga ngongo i te paraquat mai i te toto ki te 10 ki te 50 nga wa teitei ake i nga waahi katoa o te tinana, ma te tuku hauora taapiri ka nui atu te wahie ki taua tauhohenga matū me te tere tere ake te marumaru o te puku (pulmonary fibrosis). Ko nga roopu rongoa me pupuri nga turoro paraquat ki te hau noa i roto i te rūma me te hoatu noa i te hauora ki te heke iho te toto hāora (SpO2) ki raro i te 85 ki te 88 paiheneti (PaO2 ki raro i te 50 mmHg).
He aha te take i kiia ai te 60 meneti tuatahi i muri i te horomia o te paraquat ko te "Golden Hour"?¶
Ka tere te kuhu mai o te paraquat mai i te whekau iti, ka eke ki te taumata teitei i roto i te rerenga toto i roto i te 60 ki te 120 meneti, katahi ka panaia ki roto i nga pūtau pūkahukahu kaore e taea e te rongoa rongoa me te miihini whakaheke toto te whakahoki mai ki waho. Ko te horomia o te Waro Whakahohe (te uku ranei a Fuller's Earth / Bentonite) i roto i te 60 meneti tuatahi ka herea te paraquat wai ki roto i te puku me nga whekau i mua i te urunga ki roto i te rerenga toto, tera pea te rereketanga i waenga i te oranga me te fibrosis o te huhu mate.
Ka taea e koe te pahana paraquat mate mai i te maringi noa ki to kiri me te kore e horomia?¶
Ae. Ko te paraquat kukū he matū pirau ka wera me te opupu te kiri ina pa ana. Mena ka rere te paraquat mai i te rehu peketua ki te tuara o te kaimahi, nga waewae, te hiku ranei, ka pakaru ranei ki runga i te kiri kua motu kee, kua wetekina, kua werohia, kua paheke ranei, ka tere haere i roto i te arai kiri kua pakaru ki roto i te toto, ka haere ki nga ngongo, ka rite tonu te mate o te fibrosis pulmonary fibrosis ki te horomia te mate. Mena ka pa te paraquat ki te kiri, wetekina nga kakahu katoa ka horoi ata ki te hopi me te wai rere mo te 15 ki te 20 meneti me te kore e tino miro (ma te miro ka waruhia te kiri ka tere ake te horo).
He aha te rereketanga i waenga i te rehu Roundup kua reri ki te whakamahi i te whare me te kakano Roundup ahuwhenua ki te horomia ohorere?¶
Kei roto i nga ipu rehu kari whare kua reri noa ki te 1% ki te 2% glyphosate kua diluhia ki te wai; ko te horomia iti aitua ko te nuinga o nga wa ka pa mai te mamae o te waha, te puku pouri ranei. He rerekee, kei roto i nga ipu patu patupatu ahuwhenua, arumoni ranei te 41% ki te 50% glyphosate i konatunatua ki nga wairewa kukū (pērā i te POEA) me etahi wa he tote pāhare pāporo. Ko te horomia neke atu i te 85 mL (tata ki te 3 hekere) o te 41% glyphosate-surfactant kua kaha te wera o te korokoro, te pupuhi o te hau, te pāhare toto tiketike (hyperkalemia), te waikawa metabolic, te ngoikore o te whatukuhu, me te ohorere e hiahia ana ki te tiaki kaha.
He aha te "arero paraquat" a ka puta mai?¶
Na te mea he matū kaha te paraquat me te diquat, ma te horomia ahakoa he iti te nui ka pa te wera matū o te waha, te arero, me te korokoro. I roto i te 24 ki te 48 haora i muri i te horomitanga, ka pupuhi te mata o te arero, ka pupuhi, ka mokemoke, ka kapi i nga papa necrotic ma-kowhai mamae me nga whewhe toto e mohiotia ana ko te "arero paraquat." Ahakoa ka tuwhahia e te manawanui te nuinga o te wai, ko te ahua o te weranga a-waha e whakapumau ana i te rongo me te hiahia kia uru wawe ki te hohipera ki te aro turuki i nga mahi o te whatukuhu me te paru.
Nga kaiarahi e pa ana¶
- Te pesticide Organophosphate, te raau nerve, me te paihana ngarara
- Te kai paihana kiore: Superwarfarin, bromethalin, me te zinc phosphide
- Ko te awhina tuatahi mo te paihana me te whakamatautau paihana
- Te wera me te wera i te awhina tuatahi (tae atu ki te weranga matū)
- Te whara o te whatukuhu, te rhabdomyolysis, me te whakamatautau mimi pouri
Nga puna me nga aratohu whai mana¶
- Te Tiaki Taiao o te United States (EPA): Te Whakaaetanga me te Whakahaerenga o te Paihana Pesticide (Tuhinga 6): Paraquat, Diquat, Glyphosate, me te Chlorophenoxy Herbicides.
- Whakahaere Hauora o te Ao (WHO) & Whakahaere Kai me te Ahuwhenua (FAO): Te Whakahaere Haumanu o te Paraquat me te Bipyridylium Herbicide Poisoning.
- Nga Pokapū Whakahaere me te Aukati Mate (CDC): Whakaritea me te Whakautu ohorere: Nga Meka Mo Nga Maamaa Paraquat Ohotata me te Whakamatea.
- Ratonga Whakamohio Paona Motu (NPIS, United Kingdom): TOXBASE Whakahaere Haumanu o Paraquat, Diquat, Glyphosate, me te Glufosinate Poisoning.
- EXTRIP (Maimoatanga Extracorporeal i roto i te Poisoning) & Nga Aratohu Toxicology Haumanu o te Ao: Hemoperfusion moata, Hemodialysis, me te Hauora Immunosuppressive i roto i te Paraquat me te Chlorophenoxy Herbicide Poisoning.
Ko tenei aratohu mo nga kaupapa korero me te kore e whakakapi i te aromatawai hauora ngaio, te korero mo te Mana Paihana, me te tiaki i te hohipera. Na te mea ka taea e te whakakitenga o te patu patu patupatu ka tere te wera o te huarahi rererangi, te ohorere, me te ngoikore o te manawa, e tino taunaki ana matou ki te tango i tetahi awhina tuatahi me te akoranga CPR kua whakamanahia i roto i te International Federation of Red Cross and Red Crescent Societies (IFRC), to hapori Whero Whero o te motu, St John Ambulance, tetahi kaiwhakarato rohe whaimana ranei.