Te tiēre pouaka, te wheke whakakai-puru, me te ngata konihi¶

Ko nga wai takutai Tropika me Indo-Kiwa, nga toka, me nga puna toka te kainga mo nga rauropi whakamate e toru rawa atu i te whenua: ko te Australian Box Jellyfish (Chironex fleckeri) me te Irukandji (Carukia barnesi), te momo tide-pool Blue-Rena kai konihi Marbled and Geography Cone Snails (Conus geographus, Conus textile, and Conus striatus). Kare i rite ki te tierere ngawari noa, ki te ngau moana ranei e pa ana ki te mamae o te rohe, ka taea e enei whakaraerae o te moana te aukati i te ngakau, ka tino pararutiki ranei te rewharewha i roto i te 2 ki te 20 meneti. Kia ora ai koe i te ngangau nui o te moana ngahuru me te whakaorite i nga momo momo ki te kawa mana tika: ko te wero i te Box Jellyfish me te Irukandji ka werohia ki te winika o te whare (waikawa acetic) i te mea KAUA e whakamahi i te wai maori, i te takai pehanga ranei i runga i nga tarau tiere, me te tono i te tere tonu Te Whakahoutanga o te PeeraTe Whakahoutanga Peetanga** Ka ngau a Te Wheke Blue-Ringed, Cone Snail, me te Sea Snake ki te wahi ka pangia e te neurotoxins te pararutiki me te kore e rereke te mahara.

Mahia tenei inaianei¶

1. Tangohia te tangata i mate mai i te wai ka waea atu ki nga ratonga hauora ohorere. Toia, ka rewa ranei te patunga ki runga i te onepu maroke, ki roto ranei i te poti i mua i te pararutiki me te mate ngakau ka paremo. Waea atu ki to rohe tau ohorere (000 i Ahitereiria, 911 i te United States me Canada, 112 puta noa i te Kotahitanga o Europi, 999 i te United Kingdom) me te whakamohio tonu i te pourewa kaitiaki takutai tata, te teihana whakaora moana ranei.
2. Tirohia te urupare me te manawa mo te 10 hēkona, ka timata te CPR, Whakaorangia Manawa ranei ki te hiahiatia. Meiha Chironex fleckeri nga wero tire o te pouaka ka mate ohorere te ngakau i roto i 2 ki te 5 meneti, i te wa e paopaohia ai e te puru-Ringed Octopus me te Cone Snail nga uaua manawa i roto i te **10. Mēnā karekau te pārurenga i te aro, karekau e manawa, tīmata CPR (30 te kopeketanga o te uma ki te 2 nga manawa whakaora) katahi ka kore e mutu kia tae mai ra ano nga kaiparapara.
3. MĀ TE PUAKA TIERE, IRUKANDJI RĀNEI: Whakanuia te wāhi wero ki te WIKA mo te 30 hēkona neke atu. Ringihia te winika nui o te whare (4% ki te 6% waikawa acetic, ka kitea i roto i nga porotaka ohorere ki te takutai whero, whero ranei puta noa i te raki o Ahitereiria me nga takutai wera) ki runga i nga taakaa e mau ana mo te 30 hēkona ka wetewete tonu (nematocysts). KAUA rawa e maka te wai hou, te huka tio ki runga i te kiri, te waipiro, te mimi ranei ki runga i te wero tire o te pouaka, kaua rawa hoki e mirimiri ki te onepu, ki te tauera ranei, ka puta te tini miriona nematocysts kore ahi ki te wero i te wea whakamate i te wa kotahi.
4. MO TE WEKE WHAKARANGI, TE NGATA KOE, TE NAKAHI MOANA RĀNEI: Hoatu tonutia he Taipene Whakarere Whakaoho (PIB). KAUA e whakamahi winika ki te ngau wheke, ki te wero ngata koeko ranei. Takaia he takai rapa nui ki runga i te wahi ngau, ka takai mai i nga maihao, maihao ranei ki runga ki te kaokao, ki te hiku ranei (i te mau tonu o te takai rekereke, 40 ki te 70 mmHg), kia noho tonu te peka, kia noho tapapa tonu te manawanui kia kore e neke ki te whakapoipo i te kawe o te mate whakamate.
5. Whakahauhia te pararutiki Wheke-Ringed Wheke me te Cone Snail pararutiki e mohio ana koe kei te oho ratou ka rongo i a koe. Tetrodotoxin (mai i te wheke whakakai puru) me te alpha-conotoxins (mai i nga ngata cone) ka tino mate ** he pararutiki anga koiwi ngohe**, ka kore e taea e te tangata i pa te manawa, te korero, te whakakorikori i ona maihao, ka taea te whakawha, te whakakorikori ranei i ona maihao dilated, engari kei te noho 100% o ratou roro te mohio, te oho, me te wehi. Korero marie ki a ratou i te wa e mahi ana i nga manawa whakaora, tiakina o ratou kanohi mai i te ra kanapa, kaua hoki e mutu te whakamahana.
6. Whakaritea te kawe tere mo te Chironex fleckeri Antivenom me te hau miihini ranei. I te raki o Ahitereiria me nga hohipera Indo-Pacific, ka tukuna e nga kaiparapara me nga taote ohorere te CSL Box Jellyfish Antivenom i roto i te toto, i roto ranei i te uaua mo te mate nui Chironex, me te whakarato i te konupora mo te konupora me te antihirukoru, te fentantensiyl, te konupora me te konupora.

flowchart TD
    A["E whakapaetia ana mo te whakararu o te moana nui morearea"] --> B["Tango i te pärurenga i te wai kia kore e toromi me te Waea atu ki nga Ratonga Ohotata (000 / 911 / 112 / 999)"]
    B --> C{"Kei te manawa, kei te aro mai te patunga?"}
    C -->|"Karekau he manawa / No pulse"| D["Me timata tonu te CPR (30:2) me te Rescue Breathing (1 manawa ia 5 hēkona); tono AED & Antivenom"]
    C -->|"Te manawa e noho ana"| E{"Tautuhia te Kararehe Moana, te Tauira wero ranei"}
    E -->|"Pouaka Tire (Te ahua o te wepu, nga taratara piri, te mamae mamae)"| F["WHAKANUI KI TE WIKA mo te 30+ hēkona; KAUA e whakamahi i te wai hou, i te PIB ranei; kohia nga taratara kua ruia ki te winika; hoatu te tio i muri i te winika"]
    E -->|"Irukandji Jellyfish (He iti te wero tuatahi, ka 20-meneti te whakaroa i te pakaru o muri/mamae, te werawera, te ruaki)"| G["Te wahi wero ki te WIKA; kia ata noho te patunga me te takoto; tere ki te hōhipera mo te IV opioids me te mana whakaheke toto"]
    E -->|"Wheke-Ringed Blue (Te ngau iti kore mamae, te ngongo o te waha, te pararutiki haere)"| H["Hoatu PRESSURE IMMOBILIZATION BANDAGE (PIB) + Splint; whakarite mo te Whakaora Whakaora roa; whakatenatenahia te manawanui"]
    E -->|"Ngata Koo (Cone Snail)"| I["Hoatu PRESSURE IMMOBILIZATION BANDAGE (PIB) + Splint; whakawetohia te patunga; timata te Whakaoranga Manawa ka ngoikore te manawa"]

Wāhanga 1: Te tautuhi tere me te whakataurite haumanu o te Whaa Nui¶

I roto i nga wai wera (ina koa ki te raki o Ahitereiria mai i Oketopa ki Mei, Indonesia, Thailand, Philippines, Malaysia, Papua New Guinea, Whīti, puta noa i te whitiki reef Indo-Pacific), ma te wehewehe ko tehea rauropi i puta te envenomation ka whakatau mena ka eke koe ki te winika, ki te takai rapa ranei.

Te ripanga whakataurite matua mo te tātaritanga me te awhina tuatahi¶

Wāhanga 2: Ruku hōhonu: Pouaka Tire (Chironex fleckeri) me te oranga o Irukandji¶

1. He aha te winika e ora ai i runga i te Box Jellyfish (me te aha e mate ai te wai hou)¶

Ia mirimita o te Chironex fleckeri tentacle kua kikii ki nga miriona o nga kapene hapoon moroiti, ka utaina ki te puna ko nematocysts. I te wa e pupuhi ana te taraka ki te waewae o te kaihoe, 10% ki te 20% noa iho o nga nematocysts ka pupuhi i te wa tuatahi ka pa atu; ko te toenga 80% ki te 90% o nga nematocysts ka noho totika ki runga i te kiri ano he maina whenua kaokao.

• Ka aha mena ka ringihia e koe te Wai Hou ki runga i te Tire Tirenga Pouaka: Na te mea he tote te roto o te nematocyst moana, ka ringihia he wai tap hou, he wai inu pounamu ranei ki runga i te tentacle ka puta he ** ohorere te pehanga osmotic** puta noa i te pakitara kapi, ka pahū te ** miriona nematocysts kore ahi i te wa kotahi** ki te kiri. I roto i te tamaiti, i te pakeke ranei kua werohia nuitia, ma te horoi i te Chironex ki te wai hou, ka taea e koe te tango i te horopeta tuarua o te wea i roto i te 10 hēkona.
• He aha te Winika (4% ki te 6% Acetic Acid) e mahi: Ko te whakamau tonu i te tentacle mo ** neke atu i te 30 hēkona** me te winika noa o te whare ka whakarereke i te hanganga pūmua o te keu cnidocil me te pakitara capsule i runga i ia Chironex fleckeri me Carukia barnesi (Irukandji, 0% e toe ana) o te nemato. nematocysts ka tutakina tuturu** kia taea ai te hiki i nga taraka ki te horoi pai ki te wai moana.
• Pehea mena karekau he winika e waatea ana i te takutai mamao?
• ** KAUA rawa e tatari ki te timata i te CPR mena kei te mau te ngakau o te tangata kua pa ki te ngakau** (ahakoa kei te mau tonu nga tentacles ki o ratou uma, ki ona waewae ranei; tiakina o ringa ake ki te koti, karapu, ki nga nikau / matimati matotoru ranei o o ringaringa, he tino keratina me te aukati ki te kuhu).
• Mena kei te mohio te tangata karekau he winika i roto i te 1 meneti, horoia te waahi ki te WAITERE (te wai tote o te moana) ANAKE, kaua rawa he wai hou, ka whakamahi i te mapi, i te kaitao, i te taha kaari nama, i nga maihao karekau ranei (ka horoi tonu nga matimati matotoru ki te wai moana) ki te tango i nga riipene tentacle nui e toe ana. Kia tangohia nga taraka, pania he paeke huka i takai ki te kakahu maroke mo te 15 meneti i ia wa hei whakaiti i te mamae.

2. Te mohio me te ora "Irukandji Syndrome"¶

He rereke te ahua o te Chironex fleckeri, te Irukandji jellyfish (Carukia barnesi, Malo kingi, Malo maxima, me nga momo carybdeid e pa ana) he pere maramara te rahi o te pianati, te huka huka ranei (**1 ki te 2.5 henemita / 0.4 ki te 0.4). Na te mea he iti ake i te mata o te takutai "kupenga kupenga," ka taea e Irukandji jellyfish te rere tika i roto i nga papa o te takutai, ka werohia ranei nga kaihoe me nga kaikawe ki waho i te Great Barrier Reef (ina koa ka pa atu ki te waahi iti o te kiri kiri huri noa i te ngutu o runga, i te kaki ranei i waenga i te potae me te kanohi kanohi).

Ko te rarangi waahi e rua nga waahanga o Irukandji Syndrome:¶

1. Minute 0 (The Minor Prickle): I a koe e kaukau ana, e snorkeling ana ranei, ka rongo koe i te ngau ngawari, penei i te kutu moana, i te parai ranei ki te wai. Ka puta mai koe i te wai, karekau karekau he wepu, he taratara piri ranei, he kiri mawhero noa iho me nga "goosebumps" iti kua ara ake (piloerection) me te werawera o te rohe ki te waahi wero.
2. Minute 15 ki te 40 (Te Catecholamine Tsunami): Inaianei, me te mea ka patua e te hama, ka tupu te mate:
3. Te mamae, te pupuhi, te ngaru o te mamae i te tuara o raro (te rohe tapu), te uma, te puku, me nga peka e wha e kore e taea e tetahi tuunga te whakaora.
4. Te werawera nui, te oho, te wiri, me te nausea me te ruaki kore.
5. Te mahunga o te upoko me te whakaheke toto nui (kei te piki te pehanga toto ki runga ake i te 220/130 mmHg ki te 280/160 mmHg) me te tere o te ngakau (tachycardia).
6. He kare-a-roto tino whakamataku o te "Impending Doom", he awenga koiora o te tukunga nui o te noradrenaline e tangi ai te manawanui kua tata ki te mate inaianei.
7. Te Paheketanga o te ngakau / Te whakaheke toto i roto i te roro: I nga keehi tino kino (ina koa Malo kingi), na te kaha o te pehanga toto me te paitini catecholamine ka puta he neurogenic pulmonary edema (te wai mawhero e whakakii ana i nga pukahukahu), te ngakau mamae penei i te Takotsubo, te mate o te roro mate (stroke roro).

Te whakahaere awhina tuatahi mo te whakapae Irukandji Syndrome:¶

• Hoatuhia te waahi wero tuatahi ki te Winika mo te 30 hēkona ahakoa kua pahemo te 20 meneti, karekau he tahe e kitea: ka mau tonu nga whatiwhati tentacle piri moroiti ki te kiri ka rere tonu te wea ki roto i nga kiri.
• Waea atu ki a 000 / 911 / Marine Rescue i te wa tonu ka korero ki te tuku: "E whakapaetia ana ko Irukandji Syndrome me te mamae nui o te tuara/uma me te ruaki."
• Kia noho humarie, kia takoto marie ranei te turoro; whakarato i te whakamaarama hinengaro i nga wa katoa e whakamarama ana ko te ahua whakamataku o te mate e tata mai ana ko te paanga matū o te ware tire, a ma te rongoa o te hohipera e whakaora.
• Tuhipoka mo te Aspirin / Nitrates: Kaua e hoatu nga rongoa kaore i tohua ki te mara; Ko nga taote ohorere o te hohipera e whakahaere ana i te mamae o Irukandji me te takawhita me te ** titrated intravenous fentanyl, intravenous magnesium sulfate infusions, me te phentolamine, GTN ranei**.

Wāhanga 3: Ruku hōhonu: Wēke-Ringed Blue me te Cone Ngata paralysis neurotoxic¶

Ahakoa ka mate a Box Jellyfish ma te aukati tika i te uaua o te ngakau, ma te whakaoho ranei i te awha catecholamine, ko te Blue-Ringed Octopus me Venomous Cone Snails ka patu ma te tino rerekee, he tikanga nanakia: pure neuromuscular blockade e arahi ana ki te hopu manawa hypoxic.

Me pehea te ngau, te ngau ranei o te tangata¶

• Wiki-Ringed Wheke (Hapalochlaena momo): Tata ki te 90% o nga ngau ka puta ina kohia e te turuhi, te tamaiti, te kaihoe takutai ranei i tetahi anga kaotea tino ataahua, te anga turbo, te pounamu inu ranei kua makahia mai i te puna toka toka, onepu ranei, ka mau ki o ratou ringa, ka kuhu ranei ki roto i tana pute kauhoe-a-roto, he 5 inihi te opus. Ko te wheke he ngutu chitinous iti, koi heu ki tona taha ka taea te wero i te kiri o te tangata (me nga huu neoprene angiangi) me te tata kore mamae. Ko ona mowhiti kanapa hiko-puru ka whiti noa ina oho te kararehe, ka koki ranei.
• Nga Ngata Koe Hiona (Conus geographus, Conus textile, Conus marmoreus): Ka tikina e te hunga kairukui, te hunga snorkelers, me nga kaikohi anga mai i te papa o te toka, ka waiho ranei ki roto i te peeke kohi mata ka pehia ki o ratou hope, huha ranei. Mai i te pito whaiti o te anga, ka toro atu te ngata i te kikokiko, rite ki te noke, te proboscis ki te roa katoa o tona anga, ka tahuna he moroiti, he kowhao, ka whakakiia ** te niho hapoon chitinous** i te tere tere, Ka taea te kuhu ki nga karapu ruku angiangi me nga kaitiaki o te Lycra rash. Ko te Conus geographus (te Geography Cone) e mohiotia ana puta noa i te Moananui-a-Kiwa ko te "Cigarette Snail", mai i te korero pouri o te rohe, i muri i te werohanga, he nui te wa ki te momi mo te hikareti kotahi i mua i te mutu o te mahi o ou uaua manawa.

Te mahi-a-taahiraa o te Tikanga Whakakore Pehe (PIT / PIB)¶

No te mea ko te Tetrodotoxin (Wiki-Ringed Wheke) me nga Conotoxins (Nga Ngata) he neurotoxins iti, peptide ranei ka uru ki roto i nga whao lymphatic me nga capillaries venous me te kore e puta te necrosis kiko o te rohe ki te mau, Australian Resuscitation Council Guideline 9.4.8 te whakahau i te Pnique Resuscitation Council Guideline 9.4.8.

========================================================================
HOW TO APPLY A PRESSURE IMMOBILIZATION BANDAGE (BLUE-RINGED OCTOPUS,
CONE SNAIL, AND SEA SNAKE ONLY ,  NEVER FOR JELLYFISH OR STONEFISH)
========================================================================
STEP 1 (Pad & Direct Pressure): If you have no bandage immediately at
hand, press the flat of your palm firmly directly over the bite/sting
site while someone fetches elastic bandages (or strips of clothing/towels).

STEP 2 (Bandage 1 ,  Over the Site): Apply a wide (10 to 15 cm / 4 to 6 in)
heavy elastic compression bandage directly over the bite/sting site
for 3 to 4 overlapping turns.

STEP 3 (Bandage 2 ,  Full Limb Wrap): Starting at the very end of the
limb (just above the fingers or toes, leaving the fingertips/toes
exposed to check circulation), wrap upward continuously all the way to
the armpit or groin.
  * Target Pressure: Firm like wrapping a sprained ankle (40-55 mmHg on
    an arm, 55-70 mmHg on a leg). You should NOT be able to slide a
    finger easily under the bandage, BUT the fingertips/toes must stay
    pink with normal capillary refill (< 2 seconds) and a palpable pulse.
    This is NOT an arterial tourniquet.

STEP 4 (Rigid Splint & Total Immobilization): Bind a rigid splint (dive
fin, surfboard fin/leash, paddle shaft, rolled towel, or stick) along
the limb so the elbow/wrist or knee/ankle joints CANNOT bend. Any muscle
contraction acts as a lymphatic pump that pushes venom past the bandage.

STEP 5 (Mark the Bite Site): Use a pen, marker, or piece of tape on the
OUTSIDE of the bandage to mark the exact spot of the bite/sting so
hospital staff can take a swab if needed without unwrapping the entire
bandage prematurely.
========================================================================

Wāhanga 4: Te Whakarereke i nga Tarai Moana (Stonefish, Lionfish, Stingrays, Crown-of-Thorns)¶

Na te mea he maha nga wa ka takahia e te hunga kauhoe me nga kairuku kaikawe ki nga ika paihana o raro kei roto i nga wai ngaru i te waahi e noho ana nga Tierere Pouaka me nga Wheke puru-Ringed, me mohio koe ki te wehewehe i te Heat-Labile Protein Spine Envenomation (Stonefish, Lionfish, Bullrout, Scorpionfish, Stingray, Stingray, Stingray, Stingray)

Pātai auau¶

Kua tirohia nga puna¶

• Australian Resuscitation Council (ARC) & New Zealand Resuscitation Council (ANZCOR) (Ahitereiria / Aotearoa): ANZCOR Guideline 9.4.5 , Envenomation: Jellyfish Stings (winika dousing for tropical Box Jellyfish and Irukandji, tino aukati i te PIB mo te tire me te wai weraPIB mo te tire me te wai wera Bluebottle stings) me ANZCOR Aratohu 9.4.8 , Envenomation: Pressure Immobilisation Technique (PIT) (PIB whakahauanga mo Blue-Ringed Octopus, Cone Shell, me te Sea Snake envenomation; he aukati mo te Stonefish me te Jellyfish).
• CSL Seqirus / Australian Venom Research Unit (AVRU), Te Whare Wananga o Melbourne (Ahitereiria): *Clinical Toxinology Resources and Antivenom Handbook: Chironex fleckeri Box Jellyfish Antivenom Indications, Irukandji Syndrome Management, Hapalochlaena (Blue-Ringed Octopus) Tetrodotoxin Enparalysis.
• Surf Life Tiaki Ahitereiria (SLSA) & Queensland Hauora (Ahitereiria): Nga Aratohu Whakahaerenga Ngaru Moana Moana me nga Kawa Whakamutunga Winika Ohotata ki Takutai.
• Divers Alert Network (DAN) (United States / International): Morearea Te Ora Moana: Invertebrates Venomous (Box Jellyfish, Irukandji, Cone Snails, Blue-Ringed Octopus) and Venomous Fish Spine Hot-Water Immersion Protocols.
• World Health Organization (WHO) (International): He Aratohu mo nga Taiao Wai Whakataetae Haumaru: Te Tai takutai me te Wai-Maori Raorao Moana Hikaka.

Nga kaiarahi e pa ana¶

• Ka werohia te tiēre
• CPR (Whakaora Cardiopulmonary Resuscitation)
• Toremi
• Nga tauhohenga mate mate me te anaphylaxis
• Ruku moana me nga aitua i raro i te wai
• Nga wai ohotata me nga wai o te moana
• Ko nga nama ohorere ma te whenua