Igikoko ca Gila n’Ikinyamaswa c’Ikinyamasyo co muri Megizike: Gutagura Urusaya rw’Ivyuma, Exendin-4 Anaphylaxie, n’Ugutera Indwara y’Imitsi¶

Igikoko citwa Gila** (Heloderma suspectum, kivukira mu bugaragwa bwa Sonoran, Mojave, na Chihuahuan mu bumanuko bushira uburengero bwa Leta Zunze Ubumwe za Amerika no mu buraruko bushira uburengero bwa Megizike) be n’igikoko igikoko c’amabuye co muri Megizike (Heloderma horridum n’ibindi bikoko bifitaniye isano n’ivyo muri Megizike yose ifise utugingo ngengabuzima twihariye tw’ubumara two mu rwasaya rwo hasi be n’amenyo afise imirongo myinshi cane. Mu buryo butandukanye n’inzoka zitwa rattlesnakes canke cobras, zitera ubumara mu kanya nk’ako gukubita urugohe biciye mu mano y’imbere y’urusaya afise imyobo, zigaca zirekura umuhigo wazo, inzoka za Heloderma ntizigira uburyo bwo gufata ubumara bw’imitsi n’amano afise imyobo. Ahubwo, ubumara buratemba buja hejuru biciye ku gikorwa c’imitsi iva mu bihimba vyo munsi y’urwaya biri mu rwasaya rwo hasi biciye mu binogo vyuguruye ku menyo yo hasi n’ayo hejuru mu gihe umuserebanyi afata hasi n’imitsi y’urwasaya imeze nk’iya bulldozer maze agatagura mu mubiri w’umuntu. Isegonda yose y’inyongera igikoko ca Gila canke umuserebanyi w’amabuye aguma afatanye, bituma ubumara bwinshi bushobora kwinjira mu mitsi y’urukoba yacitse, kandi kureka uwo muserebanyi uremereye ukamanika ataco ushigikiye ku rutoke canke ku kiganza bituma habaho urufunguruzo rwo kurya rwo gusya amenyo afise imirongo gushika ku rubavu rw’amenyo. Iyo ubumara bumaze kwinjira mu mubiri, helodermine, helospectine, gilpaterine, proteases zimeze nk’iza kallikreine, n’ibindi bihimba vy’umubiri bita exendin (harimwo exendin-4 iri muri H. suspectum) biratuma umuntu agira ububabare bubabaje busha, akavyimba vyihuta, **akavyimba bikomeye cane. 15 gushika kuri 30 kw’ijana vy’ubumara butera umubiri, ubumara bushobora gutera ubuzima bw’umuntu, iminwa, uvula n’umuhogo hamwe n’ubumara nyakuri buterwa n’IgE. Iyo umuntu aryamye n’igikoko ca Gila canke umuserebanyi w’amabuye, hamagara uwo mu karere iwanyu . inomero z'ivyihutirwa ubwo nyene. Suzuma kandi uburongozi bwacu bw’abavukanyi ku ivyiyumviro vy'umubiri n'indwara y'umubiri, inzoka irya, na guhungabana.

Ico ushaka gukora ni ugushigikira uburemere bwose bw’umubiri w’umuserebanyi ubwo nyene kugira ngo ntumanike ku gikomere, gufungura urwaya mu masegonda makeyi ukoresheje ikintu gikomeye gisanzwe canke inkoni ishizwe inyuma y’amenyo y’imbere mu gihe ukura igihimba c’umubiri hanze neza (ntiwigere ufata urubeya munsi y’umuserebanyi ad intramuscular epinephrine auto-injector ubwo nyene iyo ururimi ruvyimba, ruvuza induru, ruvuza induru, canke rugira ibicurane, hanyuma ukajana uwo muntu mu bitaro vyihutirwa kugira ngo akingirwe inzira y’impwemu hakiri kare, asubize ubuzima mu mazi isotonique, n’imirasire y’izuba kugira ngo amenye aho amenyo yacitse.

Ivyo ubikore ubu¶

1. Sugikira uburemere bw’umubiri w’ico gikoko ubwo nyene maze ugishire hasi, ku meza, canke ukuboko kwawe kw’imbere kw’ubuntu. Ntukigere ureka igikoko ca Gila canke igikoko c’amabuye co muri Mexique kizunguruka mu kirere kivuye ku rutoke, ukuboko canke ukuboko kwarumye, kandi ntukigere ugerageza kugizunguruka canke kugijugunya. Gumanika bikwegera ku gikomere, bigatabura imitsi, kandi bikagira ubushobozi bwo kwikingira bw’umuserebanyi ku buryo bushobora gutagura cane kandi bugapompa ubumara bwinshi bwo munsi y’amano mu bikomere.
2. Pry the jaws apart mu masegonda make ukoresheje rigid flat lever, hanyuma ukwegere igihimba c'umubiri carumye kigororotse. Wedge inkoni ikomeye, igikoresho co gufata ikiyiko, imbugita y'amavuta, spatule y'icuma, ikirundo c'ikarata y'inguzanyo, canke hemostat hagati y'inyuma canke uruhande rw'urwaya, gusunika urwaya inyuma y'umutwe w'urukoba lzard ufungure canke igitambaro gipfutse nimba kiri hafi ubwo nyene), hanyuma ukureho urutoke rwarumye mu nzira imwe yihuta. Ntukigere ufata igikoresho co gucana canke urubeya munsi y’ikibuno c’ico gikoko, kandi ntukigere wibika igikoko n’ukuboko kwawe mu ndobo y’amazi; ubushuhe n’imibabaro yo kurohama bituma umuntu akubita n’ugutafuna cane.
3. Hamagara ku nimero y’ivyihutirwa yo mu karere kawe ubwo nyene maze usuzume nimba hariho ukuvyimba kw’inzira y’impwemu canke uguhungabana kw’umubiri. Hamagara 911 muri Leta Zunze Ubumwe za Amerika na Canada, 911 muri Mexique, 112 mu Bumwe bw’Uburayi bwose, 999 mu Bwongereza, 000 muri Australiya, canke usuzume urutonde rwacu rw’isi yose rwo inomero z'ivyihutirwa. Bwira uwurungitse ko uwo muntu afise ubumara bw’umuserebanyi Heloderma bushobora gutera ingorane nyinshi zo gutera ururimi n’amatwi vyihuta be n’uguhungabana kw’umutima; nta bumara bw’ubudandaji bwo gukingira ubumara bwa Heloderma, rero kwivuza hakiri kare ni ngombwa cane.
4. Uterere umuti witwa Epinephrine Auto-Injector (EpiPen, 0.3 mg umuntu akuze / 0.15 mg umwana) mu itako hagati y'inyuma ubwo nyene iyo hari ibimenyetso vy'indwara y'umutima, anaphylaxie, canke hypotension. Urabe neza ko ata n'umwe afise ububabare canke ububabare bw'umubiri. ijwi, uguhumeka kw’ijwi rirenga, kugorwa no kumira amacandwe, imizinga ikwiragiye, guhema canke guhumeka cane. Kubera ko ubumara bwa Heloderma burimwo kallikreines zirekura bradykinin n’amaproteine ​​atera ubudahangarwa bw’umubiri (harimwo exendin-4 na phospholipase A2), ugufunga vuba kw’inzira y’impwemu yo hejuru birashobora kubaho mu minota 15 gushika kuri 45 umuntu amaze kurya.
5. Kuraho impeta zose, amasaha, imiringa, n’impuzu zikomeye ku mpera y’umubiri warumye ubwo nyene, hanyuma uvomere neza igikomere n’amazi meza n’isabune yoroshe. Kuvyimba gutangura mu minota 5 gushika kuri 15, bigatera imbere gushika ku kiganza no ku kuboko kw’imbere mu gihe c’isaha iyo ari yo yose. Gumana igihimba c’umubiri carumye ku urugero rw’umutima rudafise aho rugarukira (ntikibe kiduze hejuru y’umutima canke ngo kibe kizunguruka hasi).
6. NTUKIGERE ukoresha igikoresho co gukingira imitsi, igikoresho co gukingira umutsi (PIB), igikoresho co gukingira umutsi, igikoresho co gucapura, canke ibikoresho vyo kunyonga. Ubutandukanye n’inzoka zo muri Ostraliya zitwa elapid canke ibisiga vy’urusenga rw’amazi, ubumara bwa Heloderma burimwo he phophoidac morse,hyalu ivy’ivyuma. Gufata ubumara aho hantu hakoreshejwe umugozi ushikamye canke umugozi uhagaze, bituma enzymes zishobora gusenyura zikora cane mu ntoke no mu kiganza, bigatuma umuntu agira indwara y’ibice vy’umubiri be n’ugupfa kw’imitsi y’umubiri.

Igiti c'ingingo: Gila igikoko n'umuserebanyi w'amabuye gukiza no gutoranya ibitaro¶

flowchart TD
    A["Gila Monster canke Mexique y'amabuye y'umuserebanyi"] --> B{"Mbega iyo nzige iracari ifashe ku ruhu?"}
    B -->|Yes: Jaws locked and chewing| C["Gushigikira uburemere bw’umubiri w’umuserebanyi busanzwe ku ruhande ubwo nyene; NTUZOKWIGEZE ureka ngo bimanike canke ngo ushireko urubeya/amazi"]
    B -->|No: Lizard already detached| D["Niwimuke kure metero 3; gukuraho impeta zose, amasaha, n'amaboko apfutse ku gice c'umubiri carumye ubwo nyene"]
    C --> E["Inkoni ikomeye, igikoresho co gufata ikiyiko, canke umugozi hagati y'urwaya; lever yugurure maze ukure amaguru agororotse hanze"]
    E --> D
    D --> F{"Hari ururimi/iminwa ivyimba, ijwi ry’agahomerabunwa, ijwi ry’agahomerabunwa, ijwi ry’agahomerabunwa, imitiba, canke gucika intege?"}
    F -->|Yes: Airway Angioedema or Anaphylactic Shock| G["Hamagara 911 / Inomero y’Ivyihutirwa UBU; gutera IM Epinephrine 0,3 mg mu itako ryo hanze; kuryama hasi amaguru aduzwe iyo ugira iseseme"]
    F -->|No: Severe local burning pain and swelling only| H["Guvomera igikomere n’amazi n’isabune; kuguma urugingo rw’umubiri ruri ku rugero rw’umutima; NTUKIGERE ukoresha igipfukisho, PIB canke barafu"]
    G --> I["Ugutwara EMS vuba: gutera umuti mu muhogo hakiri kare imbere y’uko edema y’amatwi igera ku mpera + IV crystalloids + vasopressers"]
    H --> J["Gutwara abantu mu bitaro mu gisata c'ivyihutirwa amasaha 6 gushika kuri 12 yo kwihweza ubumara"]
    I --> K["Ukwitaho mu bitaro: Guhagarika imitsi yo mu karere canke IV fentanyl ku bubabare + X-ray y'imitsi yoroshe ku menyo agumye afise imirongo + Tetanus n'imiti irwanya indwara"]
    J --> K

Igereranyo ry’ubuvuzi ry’umutwe ku mutwe: Inzoka zo muri Heloderma n’Inzoka zo muri Amerika y’Uburaruko n’Inzoka zitagira ubumara¶

Kubera ko abashikiwe n’ivyago n’abafasha mu mirima mu Bumanuko bushira Uburengero bwa Amerika, Mexique, no mu bibanza vy’ibikoko bikwega inda hasi kenshi bivanga ubumara bwa Heloderma n’ubumara bw’inzoka canke ubumara bw’inzoka butagira ubumara, gutandukanya ubuhinga bw’ibinyabuzima n’ubumara ni ikintu gihambaye cane:

Ubuhinga bw'umubiri w'ururimi rwa Heloderma n'igituma amasegonda ahambaye mu gihe c'ugutandukana kw'urwaya¶

Uko amenyo yo hasi afise imirongo n'ubuhinga bwo gutafuna bupompa ubumara¶

Kugira ngo utahure igituma igikoko citwa Gila canke umuserebanyi w’amabuye wo muri Megizike bitegerezwa gukurwa mu masegonda makeyi ya mbere, gereranya ubumara bwaco n’ubw’inzoka:

1. Ubwubatsi bw’Igihimba co munsi y’Iminwa: Mu bikoko vyose bibiri Heloderma suspectum na Heloderma horridum, igihimba c’ubumara ni igihimba c’irondoka gihinduwe kiri mu urwaya rwo hasi (igihimba c’irondoka), kigatuma haba igihimba c’irondoka kiri ku ruhande rw’ikibuno. Igihimba kimwekimwe cose kigabanywamwo ibice bitatu canke bine, kandi igihimba kimwekimwe cose kigasohoka mu muyoboro waco bwite kugira ngo kifunguke ku mfuruka y’akanwa iruhande y’ishingiro ry’amenyo y’inyuma y’amenyo y’inyuma.
2. Amenyo afise imirongo n’ibikorwa vy’imitsi: Igikoko citwa Gila gifise amenyo nka 35 gushika kuri 40 asongoye, asongoye mu rwasaya rwaco. Amenyo yo hasi n’ayo hejuru yose afise imirongo y’uburebure bwimbitse ku ruhande rwayo rw’imbere n’urw’inyuma, n’imirongo y’ubumara iri kure cane ku amenyo yo hasi yo hagati n’ayo hagati. Iyo umuserebanyi arya, ubumara burateranira mu rwasaya rwo hasi maze bukakwegwa hejuru ku nzira y’amenyo biciye ku gikorwa c’imitsi y’amenyo buja mu ruhu rw’umuntu rwacitse.
3. Igituma Gumanika no Gutagura Bigwiza Igitigiri c’Ubumara: Kubera ko ata piston y’imitsi yo gusohora ubumara biciye mu nzira y’umwobo, igihimba c’umubiri cihuta kuraba hafi nta bumara kirungika (igipimo c’ururimi rwumye c’ibice 20 gushika kuri 30 kw’ijana mu bihimba vy’umubiri bigufi). Ariko iyo Heloderma ifashe urutoke, imitsi yayo y’urwaya rwitwa pterygoïde na temporalis irafunga. Ico gikoko gikora igikorwa co gusya ku ruhande ku rundi no gutagura mu buryo bubereye, kigaca amenyo afise imirongo gushika kure cane biciye mu ruhu no mu mitsi y’amabara mu gihe gica gifyonda utugingo ngengabuzima two munsi y’amano kugira ngo gipompe ubumara bushasha mu gitanda c’ibikomere.

================================================================================
   MECHANICAL JAW DETACHMENT PROTOCOL FOR CLAMPED HELODERMA LIZARDS
================================================================================

  [WRONG: Letting Lizard Hang]          [RIGHT: Support + Flat-Lever Pry]

       Bitten Hand                           Bitten Hand (Held Steady)
          |                                       |
      (Wound) <--- Gravity pulls down:        (Wound) <--- Pry stick / spoon
          |        Teeth saw into bone;           |        handle wedged behind
     [Lizard Head] reflexive jaw lock        [Lizard Head] front teeth to open
          |        pumps more venom               |
     [Heavy Body]                            [Heavy Body]
     (Dangling in                            ===============================
      mid-air)                               Supported FLAT on ground/table
                                             (Stops reflexive chewing lock)
================================================================================

Intambwe ku yindi gutandukanya urwaya¶

Iyo igikoko ca Gila canke umuserebanyi w’amabuye wo muri Megizike afashe ku rutoke rwawe, ku kiganza, ku kuboko canke ku nkweto, ukurikize urutonde nyarwo:

1. Intambwe ya 1: Shigikira umubiri w'inzoka ku butaka buringaniye ubwo nyene (Ica kabiri 0 gushika kuri 2):
2. Fata umubiri w’ico gikoko canke ushire ukuboko kwawe kwariye hasi, ku rutare, ku meza, canke ku ivi ryawe bwite kugira ngo inda yose y’ico gikoko n’ibirenge vyose bine biruhuke ku kintu gikomeye.
3. Igituma ivyo bikora: Igihe umuserebanyi yumva ibirenge vyawo bishigikiwe n’ubutaka bukomeye, ugahagarika gutembagazwa mu kirere, nk’ibice 30 gushika kuri 40 kw’ijana vy’umuserebanyi Heloderma bica bifunguka ubwavyo maze bikagerageza gukwegakwega bikaja mu gipfukisho.
4. Intambwe ya 2: Ushire umugozi ukomeye inyuma y’amenyo y’imbere maze ufungure (Ica kabiri gushika kuri 10):
5. Nimba iyo nzige iguma ifashe, nusabe umuntu wa kabiri (canke ukoreshe ukuboko kwawe kw’ubuntu) afate iyo nzige neza inyuma y’aho umutwe n’izosi bihuriye kugira ngo ntishobore guhindukiza umubiri wayo mu ruhande (uguhindukiza mu ruhande inkere zikuye ku menyo asongoye imbere mu bihimba vy’imitsi yawe).
6. Fata igikoresho cose gikomeye kandi gisongoye gica kiboneka: inkoni y’ibiti ikomeye, ikiyiko c’icuma canke igikoresho co gufatako iforoma, icumu ry’amavuta, igikoresho co gukurako amavuta, ikirundo c’amakarata abiri canke atatu y’inguzanyo, canke ibikoresho vyo gukingira amaraso mu vy’ubuvuzi.
7. Niwinjize iyo lever mu mfuruka yo mu ruhande rw’akanwa (inyuma y’amenyo y’imbere yugarijwe neza), uhindure canke ushire iyo lever mu mfuruka y’urusaya mu buryo buhagaze, maze ako kanya amenyo akureho urukoba, ukure urutoke rwarumye rugororotse maze ugende nibura metero 3 (amafuti 10) kure.
8. Intambwe ya 3: Niwaba uri wenyene mu bugaragwa ata bikoresho ufise:
9. Shira iyo nzige hasi, ushire umubiri wayo mu buryo bwiyoroheje n’ivi canke inkweto yawe, ufate inyuma y’umutwe n’ukuboko kwawe kw’ubuntu, hanyuma ukoreshe inkoni ikomeye yo mu bugaragwa canke urusenga rw’ibuye ry’agaciro kugira ngo uhagarike urwaya rwayo imbere y’uko ukura ukuboko kwawe gugororotse.
10. Igituma Imiti y'Abanyagihugu Iteye Akaga Kandi Ibujijwe:
11. NTUKIGEZE ufata igikoresho co gucana, ikibiriti canke urubeya rwuguruye munsi y’ikibuno c’umuserebanyi: Guturira urusaya rw’umuserebanyi bituma ukuboko kwawe bwite gusha ku rugero rwa gatatu kandi bikagutera gukubita cane no gutafuna cane.
12. NTUKIGEZE ushira mu mazi inzoka n’ukuboko kwawe kwarumwe: Heloderma inzoka zishobora gufata impwemu zazo munsi y’amazi iminota 15 gushika kuri 30 zitazirekura, mu gihe amazi yoza imigera yo mu kanwa n’ubumara bukoranijwe mu bikomere vyawe vyuguruye.
13. NTUKIGEZE usuka inzoga zo gusiga, amavuta ya peteroli canke amoniya mu kanwa k’umuserebanyi: Ivyo bihimba bisuka bigororotse mu binogo vy’amenyo mu gikomere cawe kitagiramwo ibinure, bigatuma utugingo ngengabuzima dupfa cane.

Ivyerekeye uburwayi bw'ubumara bwa Heloderma: Kallikreine, Helodermine, na Exendin-4 Anaphylaxie¶

1. Ububabare bubabaje bwo mu karere n’ugukwiragira ningoga kw’ibisebe¶

Mu minota 2 gushika kuri 5 iyo umuntu arwaye ubumara, abarwaye baragira ububabare bukomeye cane bushasha kandi butera ubwoba aho barwaye bushika ku kuboko canke ukuguru kwose mu minota 15 gushika kuri 30. - Igituma ububabare bukomeye cane: Ubumara bwa Heloderma burimwo phospholipase A2, hyaluronidase (“ikintu gikwiragiza” gisenya aside hyaluronique mu nzira y’amaraso), serotonine, n’ibindi bitera umubiri H horridum)** zicapura kininojeni zigacika bradikinine. - Uko kigaragara: Igikomere gisanzwe kigaragaza igice c’uruziga canke gifise ishusho y’uruziga rwa V, aho amenyo menshi ava amaraso n’aho amenyo atabura, kenshi hakaba hariho ibara ry’ubururu hirya no hino y’ibimenyetso vy’amenyo. Igisebe gikomeye gikwiragizwa ningoga kuva ku rutoke rwarumye kijabuka ukuboko kigashika hejuru y’ukuboko kw’imbere mu masaha ya mbere 1 gushika kuri 4, kijana n’ububabare bw’amaraso buteye akaga ku nkoko no ku ntugu. Ububabare bukomeye butera ubwoba bushika ku masaha 1 gushika kuri 4 kandi bushobora kumara amasaha 12 gushika kuri 48.

2. Kallikrein-bradykinine n’uguhungabana kw’umutima nk’ukwa VIP¶

Mu 15 gushika kuri 30 kw’ijana vy’ibikoko vya Gila n’ibisiga vy’amabuye, ubumara buhagije bwinjira mu mitsi no mu maraso kugira ngo buvyure indwara y’imitsi y’umubiri n’ubumara bw’umutima ishobora gutuma umuntu apfa mu minota 15 gushika kuri 90: - Gilatoxin / Kallikrein Bradykinin Storm: Ubumara bwa kallikreins butera ibiturika vyinshi vy’umubiri vy’bradykinin, umuti ukomeye wo gutuma imitsi y’umubiri igira ubushobozi bwo guca mu mitsi y’umubiri, bigatuma imitsi y’imitsi y’amaraso irekura kandi amazi y’imitsi y’amaraso akava. - Helodermine na Helospectine (Ibinyabuzima bimeze nk’ivya VIP): Vyompi H. igikeka na H. horridum ubumara burimwo helodermin na helospectin, ni ukuvuga ubumara busa n’ubw’umuntu. Izo peptides zifatanya n’ibihimba vy’umubiri bifata VIP, zigatuma adenylate cyclase ikora, zigatuma AMP (cAMP) iri mu turemangingo ziduga, kandi zigatuma ugukura kw’imitsi y’amaraso, ugucika intege cane kw’amaraso (umuvuduko w’amaraso ugabanuka ukaja munsi ya 70 gushika kuri 80 mmHg), diaswerensicarchydia igabanuka munsi ya 70 gushika kuri 80 mmHg, gutukura, gukorora bidashobora gukira, n’ugucika intege kw’umubiri. - Ischemie y’umutima n’indwara y’umutima: Raporo z’abarwayi zivuga ko umuntu afise uguhagarika umutima kw’igihe gito, ubudasa bw’igice ca ST n’umuvuduko wa T ku ECG y’amabara 12, ugucererwa kw’ugutwara umutima, kandi gake cane bisaba ko umuntu agira infarction myocardique canke analyse mediatorbinlease biterwa n’ugusubira inyuma kw’imitsi y’umutima.

3. Indwara y'umutima n'indwara y'umutima¶

Igitera akaga k’ubuvuzi k’ubumara bwa Heloderma bufata abaganga b’ibihe vyihutirwa ni ugutera kw’ururimi, iminwa, uvula, ururimi rworoshe, n’ururimi rworoshe: - Uburyo bubiri (Bradykinin + IgE Gukuraho utugingo ngengabuzima): 1. Bradykinin-Mediated Angioedema: Nka kurya kw'indwara y'ibihaha iterwa n'imiti igabanya ubumara bwa ACE, ubumara bwa kallikrein burasesagura ibitanda vy'imitsi yo munsi y'ururimi n'iy'amatwi bifise bradykinin, bikaba bituma amazi atagira imyobo asohoka vuba cane mu rurimi no mu nzira y'umuyaga yo hejuru y'ururimi. 2. Exendin-4 n’ubumara bw’ubumara: Ubumara bwa Heloderma suspectum* ni bwo buva ku exendin-4, umuti ugira aside amino 39 umeze nk’umugera wa glucagon (GLP-1) mu gihe umuti wa ubumara bwa horridum* burimwo eksendini-3. Ivyo bihimba vy’umubiri bikorana n’ubumara bwitwa phospholipase A2 be n’ubw’ubumara bwa hyaluronidase, bikora nk’ibintu bikomeye bitera ubumara. Ababungabunga ibikoko bikwega inda hasi, abahinga mu vy’ibikoko vyo mu nzu y’ibikoko, canke abakoraniriza hamwe ibikoko vy’abantu ku giti cabo bari bararumwe mbere, barashobora kugira uguhungabana kw’umubiri guterwa n’IgE, uguhungabana kw’ibihaha muri rusangi, uguhungabana kw’ibihaha, n’uguhungabana kw’amaso mu minota mikeyi. - Hypoglycémie / Insulinotropic Effect of Exendin-4: Kubera ko exendin-4 ari umuti ukomeye GLP-1 receptor agonist ufise igice c’ubuzima bw’amaraso kuruta GLP-1 y’umuntu, ubumara bushobora gutuma insuline iva mu maraso iva kuri glucose isohoka. gukorora, n’ibihe bimwe bimwe reactive hypoglycémie bisaba ko umuntu asuzumwa isukari mu maraso mu bitaro vy’ibiza.

Imbere y'uko umuntu aja mu bitaro n'uburongozi bw'igisata c'ubuvuzi bw'ibihe vyihutirwa¶

Urutonde rw'ibintu umuntu akwiye gusuzuma imbere y'uko aja mu bitaro (Iminota 60 ya mbere)¶

• Ukureho umuserebanyi ata nkomanzi mu masegonda makeyi mu gushigikira uburemere bw’umubiri wawo ku kintu kimwe maze ugafungura urwaya rwawo n’inkoni ikomeye, igikoresho co gufata ikiyiko, canke uruhande rw’ikarita y’inguzanyo; ntukigere ukoresha umuriro, kwibika mu mazi canke imiti.
• NTUKICE canke ngo uzane umuserebanyi w’ubumara muzima mu cumba c’ubuvuzi c’ibitaro. Ifoto ya telefone ngendanwa yafashwe uri ku metero 3 (amafuti 10) irahagije kugira ngo umuntu yemeze, kandi kubera ko ata bumara bushobora gukingira ubwoko bumwe bumwe, kuzana Heloderma muzima mu gitereko bitera gusa ingorane yo kurya staffd y’ibitaro.
• Suzuma inzira y’impwemu, uguhema, n’ugutembera kw’amaraso (ABCs) buri minota 5: Raba imbere mu kanwa ko hariho ukuvyimba kw’ururimi canke kw’ururimi, wumvirize ko hariho uguhoza canke ukuboroga, kandi usuzume inkomezi z’umuvuduko w’amaraso.
• Uhe Epinephrine mu mitsi (0.3 mg y’umuntu mukuru / 0.15 mg y’umwana mu itako ry’imbere) ubwo nyene iyo ubonye ikimenyetso ca mbere c’ururimi/iminwa ivyimba, umuhogo uhagaze, stridor, uguhema, imizinga ikwiragiye, canke ugusinzira kw’umutima. Subiramwo mu minota 5 gushika kuri 15 nimba ibimenyetso vy’indwara bigenda biratera imbere.
• Ushire umurwayi mu mfuruka (apfutse ku mugongo) amaguru aduze amasentimetero 30 (inci 12) iyo yumva apfuye, afise ibicurane, afise ibara ry’agahama, canke afise ivyuya, kiretse iyo ariko araruha cane canke ariko aragorwa no guhema ahagaze kubera ububabare bwo mu nzira y’impwemu.
• Kura amabuye y’agaciro yose (impeta, amasaha, imiringa) ku gice c’umubiri carumye, woze igikomere neza n’isabune n’amazi atemba, upfuke n’igitambaro c’umye kitagiramwo ubumara, hanyuma ushire igihimba c’umubiri mu igipfukisho canke mu gipfukisho kiri ku rugero rw’umutima rudafise aho rugarukira.

Ubumara bwo mu bitaro n'amabwirizwa y'ubuvuzi bwihutirwa¶

Kubera ko ata bumara bw’ubudandaji buhari bwo kurwanya Heloderma suspectum canke Heloderma horridum, ubuvuzi bw’ibitaro vyihutirwa bushingiye ku gukingira inzira y’impwemu hakiri kare, gusubiza ubuzima mu buryo bw’amaraso, guhagarika ububabare bwo mu karere, no gukuraho iryinyo ry’umubiri w’amahanga:

1. Ugucungera inzira y'impwemu vuba (Ikintu ca mbere):
2. Umurwayi wese afise ururimi rwo kuvyimba, ururimi rwo munsi y’ururimi, ijwi ryiwe rizimvye, amazi asohoka, ijwi ryiwe ridashobora gusohoka, canke ijwi ryiwe ry’agahomerabunwa, asabwa guca afata IM/IV epinephrine, imiti igabanya ububabare bwo mu mubiri (diphenhydramine + famotidine), imiti igabanya ububabare bwo mu mubiri (meti 10 mg IV), na ugutera umuti w’ububabare vyihutirwa/ugusaba ENT kugira ngo umuntu ashobore gutera umuti wo mu muhogo hakiri kare.
3. Isaro ry’agaciro: Kubera ko Heloderma angioedema irimwo igihimba kinini cane ca kallikrein-bradykinin kiretse histamine, imiti igabanya ububabare n’imiti igabanya ububabare ishobora kunanirwa guhagarika ukwaguka kw’ururimi. Intubate kare ukoresheje video laryngoscopy canke intubation fibre optique uvyuka ufise ubuhinga bubiri bwiteguriye ugukora cricothyrotomy y’ivyihutirwa imbere y’uko urufunguruzo rw’ururimi ruvyimba.
4. Ugusubiza ubuzima mu buryo bw'amaraso kubera ububabare bwa Kallikrein/Helodermin:
5. Gushinga imirongo ibiri y’imitsi y’amazi y’imitsi y’amazi y’imitsi y’amazi (isotonic crystalloid bolus) (20 gushika kuri 30 mL/kg y’umunyu usanzwe canke Lactated Ringer’s)** kugira ngo yongere yuzuze igitanda c’imitsi y’amaraso gifise imitsi myinshi no guhangana n’ugusohoka kw’imitsi y’amaraso mu kibanza ca gatatu.
6. Nimba umuvuduko w’amaraso uguma uhagaze naho woba uriko urasubirana amazi, tangura gutera umuti w’amaraso ugenda uhinduka: norepinephrine canke epinephrine ugereranijwe kugira ngo umuvuduko w’amaraso (MAP) ugume uri hejuru ya 65 mmHg.
7. Ugucungera ububabare: Kubera iki imitsi yo mu karere ishobora gutsinda imiti myinshi yonyene:
8. Ububabare bushasha bw’urumogi rwa Heloderma burashobora gusaba imiti myinshi y’ibitera ububabare (irekura histamine kandi ishobora gutuma umuvuduko w’amaraso ugabanuka).
9. Igihe isuzuma ry’imitsi n’imitsi ry’urutoke canke ukuboko kwarumye ryanditswe, umuti wo gukuraho ububabare wo mu bitaro ushingiye ku rugero rw’inzahabu ni uguhagarika imitsi y’aho hantu canke uguhagarika imitsi y’ikiganza/imbere y’ukuboko iyobowe n’ijwi ry’imbere (radial, median, canke unlar nerve bupine-5) ropivacaine ATA epinephrine** (ntiwigere utera epinephrine mu nzira y’imitsi y’urutoke ikikuje imitsi y’urutoke). Igikoresho co mu karere kirazimya ububabare bubabaje mu minota 5 canke 10 ata kugabanya umuvuduko w’amaraso.
10. Imishwarara y'imitsi yoroshe n'ugutohoza amenyo afise imirongo:
11. Kubera ko amenyo ya Heloderma ashobora gusenyuka kandi akagira subpleurodont, ibice vy’amenyo vyinjijwemwo biraboneka mu bice 30 gushika kuri 50 kw’ijana vy’amenyo y’ugutagura.
12. Uronke amasanamu y’ibihimba vy’umubiri vyoroshe (X-rays) na/canke amasanamu y’ibihimba vy’umubiri vy’incuro nyinshi y’urutoke canke ukuboko kwarumye ku barwayi bose, kuko amenyo ya Heloderma afise calcium ataboneka.
13. Igihe ukuboko kwamaze guterwa ububabare n’umuti wo mu karere, womera igikomere cane umunyu usanzwe utagiramwo ubumara maze ushiremwo ubugwaneza utugingo ngengabuzima two gutobora ukoresheje amapinze meza kugira ngo ukureho ibice vy’amenyo vyose vyagumye (ntiwigere ukora ibice vy’amenyo vy’ubupfumu canke gukora ibice vy’amenyo vy’ubupfumu kiretse iyo ari ubumuga bwo gutobora amenyo).
14. Ikigo ca Laboratwari, ECG, n'Ukwirinda:
15. Uronke ECG y’amabara 12 n’ugukurikirana umutima ubudasiba, uguharura amaraso yose (CBC), igipimo c’imibiri yose (CMP) n’isukari yo mu maraso y’uruhererekane (kugira ngo ukurikirane ko hariho ububabare bw’isukari mu maraso bufashwa na exendin-4 canke ububabare bw’amafyigo), co, no,PTT n’ibindi bihimba vy’umubiri), na ivyo bihimba vy’umubiri (CK).
16. Gutanga ubumara bwa tetanus / Tdap booster iyo bibereye, no kwandika imiti yo mu kanwa y’ubumara bwagutse y’imisi 5 gushika ku 7 ipfutse inkoni z’ibikoko bikwega inda hasi zidafise ubumara bwa Gram (Salmonella, Pseudomonas, Aeromonas, Serratiam-positivically) n’urukoba rwo mu kanwa rudafise Gram-negative, amokisisilini-klavulanati (875/125 mg PO kabiri ku musi) canke siporofloksasini hamwe n’imiti yitwa klindamisini / doksisiklini.
17. Niwihweze abarwayi bose batagira ibimenyetso canke bafise ibimenyetso bikeyi mu kiringo c’amasaha nibura 6 gushika kuri 12 mu kigo c’ubuvuzi bw’ibihe vyihutirwa, kandi wemere abarwayi bose bafise ibimenyetso vy’indwara, umuvuduko muto, angioedema, canke ukuvyimba kw’amaguru n’amaboko gutera imbere mu bitaro bigenzurwa canke mu bitaro vy’abarwayi bikomeye nibura amasaha 24.

Inomero z'ivyihutirwa zo mu karere n'amategeko y'ibigo¶

• Amerika na Canada: Hamagara 911 ubwo nyene ku gikoko cose ca Gila canke umuserebanyi w’amabuye. Baza US Poison Control kuri 1-800-222-1222 (ihuye mu Bumanuko bushira Uburengero na Ikigo c’Amakuru y’Ubumara n’Ibiyayuramutwe co muri Arizona i Tucson canke Ikigo c’Amakuru y’Ubumara n’Ibiyayuramutwe ca Banner i Phoenix) canke Ikigo c’Intara ya Canada kijejwe ubumara bw’ibitaro.
• Mexique na Amerika yo hagati (Guatemala): Hamagara kuri 911 hirya no hino muri Mexique canke 122 / 123 muri Guatemala. Muri Mexique, abaganga barashobora kurondera RETOMEX (Igikoko c’ubumara butukura co muri Mexique) ku bijanye n’ubufasha bw’indwara y’ibicurane* n’indwara y’ibicurane*. Ubumara bw’inzoka y’i Mexique canke bw’inzoka y’ibinogo nti bushobora gukuraho ubumara bwa Heloderma kandi ntibutegerezwa guhabwa.
• Ubwongereza: Hamagara 999 kugira ngo ubone imodoka itwara abarwayi iyo umucungezi wo mu nzu y’ibikoko canke mu bibanza vy’ibikoko bikwega inda hasi bifise uruhusha aryamwe. Abaganga bakwiye kwibaza NPIS / TOXBASE n’ishure ry’ubuvuzi ry’i Liverpool**.
• Ubumwe bw'Uburayi: Hamagara 112 kugira ngo ubone ubuvuzi bwihutirwa bukurikira indwara y'ubumara, kandi ushikire ikigo cawe co mu gihugu kijejwe kugenzura ubumara kugira ngo ubone amategeko afasha mu bijanye n'ubumara.
• Ostraliya na Nouvelle-Zélande: Hamagara 000 muri Australiya canke 111 muri Nouvelle-Zélande ku bijanye n’ibikoko bikwega inda hasi bifashwe nk’inyagano, hanyuma uhamagare Ikigo c’amakuru y’ubumara co muri Australiya kuri 13 11 26 (canke ikigo c’igihugu c’ubumara co muri Nouvelle-Zélande kuri 0800 74 76). Udakunze inzoka zo muri Australiya, umugozi wo gukingira umuvuduko (PIB) NTIGUTEGEREZWA gushirwa ku ndwara y’akataraboneka Heloderma.

Ibibazo bikunda kubazwa¶

Ni kuki igikoko ca Gila gifata kigatagura aho gukubita no kurekura nk’inzoka y’inzoka?¶

Mu buryo butandukanye n’inzoka zitwa rattlesnakes, zifise amano y’imbere y’urusaya afise imyobo ahuye n’ibihimba vy’ubumara bifise umukazo bitera ubumara mu gice c’isegonda, ibikoko vy’ibikoko vyitwa Gila be n’ibisiga vy’amabuye vyo muri Megizike birafise utugingo ngengabuzima tw’ubumara mu rwasaya rwavyo rwo hasi ata n’imitsi ifata ubumara. Uburozi bwavyo buja mu kanwa ku ntango y’amenyo afise imirongo myinshi cane, bugakwegwakwegwa buja hejuru mu gikomere biciye ku gikorwa c’imitsi y’amaraso. Kugira ngo iyo nzige itange ubumara bwo kwikingira, itegerezwa gufata hasi n’urwaya rwayo rukomeye maze igatagura mu buryo bubereye urukoba kugira ngo ikoreshe ubumara bujanye n’imirongo y’amenyo bube utugingo ngengabuzima tuva amaraso.

Ni ubuhe buryo bwihuta kandi butekanye bwo gutuma igikoko ca Gila kirekura ukuboko kwawe?¶

Ubwa mbere, uce ubwo nyene ushigikira uburemere bwose bw’umubiri w’ico gikoko hasi, ku meza, canke ukuboko kwawe kw’ubuntu kugira ngo ntikimanike mu kirere ku rutoke rwawe, kuko gumanikwa bituma urusaya rufunga kandi rugatagura cane. Hanyuma, ushire ikintu gikomeye gisanzwe nk’inkoni y’ibiti ikomeye, igikoresho co gufata ikiyiko, icumu ry’amavuta, igikoresho co gukurako amavuta, canke ikirundo c’amakarata y’inguzanyo mu ruhande rw’akanwa inyuma y’amenyo y’imbere, ufungure urwaya, hanyuma ukure ukuboko kwawe gugororotse. Ntukigere ufata urubeya munsi y’ikibuno c’umuserebanyi kandi ntukigere uwushira munsi y’amazi, kuko ivyo vyose bitera gukubitwa n’inzoka n’ugutabura kw’imitsi nabi kuruta.

Hari ubumara bwo gukingira igikoko ca Gila canke umuserebanyi w’amabuye wo muri Mexique?¶

Oya, nta bumara bw’ubudandaji bwemejwe na FDA canke bwo ku rwego mpuzamakungu bushobora gukoreshwa mu vy’ubuvuzi ku bantu ku ndwara y’ibikoko vyitwa Heloderma suspectum (igikoko citwa Gila) canke Heloderma horridum (igikoko c’amabuye co muri Megizike). Kubera ko ingaruka z’urupfu zidakunze kuboneka mu gihe c’ubuvuzi bw’ivyihutirwa bwo muri iki gihe, ubuvuzi bw’ibitaro bwibanda ku gukingira vuba inzira y’impwemu ububabare bw’ururimi n’umuhogo, epinephrine yo mu mitsi canke mu mutsi, amazi y’imitsi y’amazi n’imiti igabanya umuvuduko w’amaraso, gukingira imitsi y’akarere ku bubabare bukomeye, no gukingira imitsi y’akarere iyo umuntu afise ububabare bukomeye, no gukingira imitsi y’akarere iyo umuntu afise ububabare bukomeye.

Ni kuki abaganga bama basaba ko bagupima ukuboko kwawe inyuma y’aho igikoko ca Gila kikurumiye?¶

Ibikoko vy’ibikoko bita Gila be n’ibikoko vy’ibisiga vy’amabuye birafise amenyo asongoye kandi afise uturongo twinshi, ashobora gushirwa ahantu h’imbere mu rwasaya aho gushirwa mu binogo vy’amagufa vyimbitse. Iyo umuserebanyi arya canke iyo uwurwaye akuye ukuboko kwabo, 30 gushika ku 50 kw’ijana vy’ivyo barwaye bisiga igice kimwe canke vyinshi vy’iryinyo vyavunitse vyinjiye imbere cane mu rukoba canke mu bihimba vy’imitsi. Kubera ko ayo menyo afise calcium yerekanwa neza ku bipimo vy’imishwarara y’imitsi yoroshe, abaganga barafata imishwarara y’imitsi maze bagakuraho igice cose kiri munsi y’igipfukisho c’imitsi kugira ngo ntihagire ivyuma bikomeye vy’umubiri w’amahanga biva ku bihimba vy’umubiri vy’amahanga be n’indwara zikomeye ziterwa n’imigera.

Ni gute ubumara bw’igikoko ca Gila bufitaniye isano n’imiti yo kugabanya ibiro y’indwara y’igisukari, kandi ni kubera iki ivyo bihambaye mu gihe umuntu arya?¶

Mu myaka ya 1990, abashakashatsi barabonye umuti usa n’umusemburo mu bumara bw’igikoko citwa Gila witwa exendin-4, wigana umusemburo usa n’umusemburo w’umuntu witwa glucagon-1 (GLP-1) maze uba ishimikiro ry’umuti w’indwara y’igisukari witwa exenatide (kandi ni wo watumye habaho umugwi w’aba GLP-1). Mu gihe umuntu arwaye igikoko citwa Gila, exendin-4 hamwe n’ivyo bita phospholipase A2 be na kallikreins birashobora gutuma insuline irekurwa (rimwe na rimwe bigatuma isukari mu maraso igabanuka kandi umuntu akaruha cane) kandi birashobora gutuma umuntu agira ububabare bukomeye buterwa n’IgE be n’ukuvyimba kw’ururimi kwinshi, canecane iyo umuntu afise ururimi rwinshi. gushirwa ahabona.

Noba nozingira umugozi wo gukingira umukazo canke nshira barafu ku gikoko ca Gila?¶

Oya, ntukigere ushirako igikoko citwa Gila canke igikoko co mu bwoko bwa Mexique gifise amabuye y’agaciro. Kubera ko ubumara bwa Heloderma burimwo enzymes phospholipase A2 na hyaluronidase zishobora kwonona utugingo ngengabuzima zituma umuntu avyimba vuba, gupfuka ukuboko neza bifata ubumara mu ntoke kandi bikongera umukazo imbere mu bice vy’ibiganza, mu gihe barafu itera ububabare bukomeye ku mitsi yo hejuru n’ubukonje bwo hejuru.

Amasoko n'ubuyobozi buzwi¶

• Ikigo c’amakuru y’ubumara n’imiti co muri Arizona (Kaminuza ya Arizona, muri Leta Zunze Ubumwe za Amerika): Ubuvuzi bw’ubumara bwa Heloderma suspectum (Gila Monster) Ubumara: Ubumara bw’imitsi y’impwemu, Ugutera umuvuduko muto, Ugufunga imitsi mu karere, no gukura amenyo.
• Ishirahamwe ry’Abanyamerika ry’Ibigo Bijejwe Gucungera Ubumara (AAPCC) & ACMT (Leta Zunze Ubumwe za Amerika): Imiti y’ubumara bw’ibikoko bita Helodermatidae (Gilatoxin, Helodermin, Exendin-4) n’Ivy’Ugufasha mu Gutoranya ICU (Cantrell n’abandi; Hooker & Caravati, *Annals of Emergen).
• Ishirahamwe ry'ubuvuzi bwo mu bugaragwa (WMS): Ingingo ngenderwako zo kuvura ubumara mu bidukikije vyo mu bugaragwa bwo muri Amerika y'Uburaruko.
• Ibigo bijejwe kugenzura no kwirinda indwara (CDC / NIOSH, Leta Zunze Ubumwe za Amerika): Ibikoko bikwega inda hasi bifise ubumara vyo muri Leta Zunze Ubumwe za Amerika: Kumenya no gufasha ibikoko vy’ibikoko vyitwa Gila.
• Ubumara butukura bwo muri Megizike (RETOMEX, Mexique): Igitabu c'ubuvuzi bw'ibikoko vyo mu mazi (Heloderma horridum) n'igikoko co mu mazi.

Inyobora zifitaniye isano¶

• Ivyiyumviro vy'umubiri n'ubuvuzi bwihutirwa bwa anaphylaxie
• Anaphylaxie yo gusubira inyuma, inyishu zibiri, n’igihe ca kabiri ca EpiPen
• Inzoka zirumye n'ibikoko bikwega inda hasi bifise ubumara vyihutirwa
• Ukuryama n'ibikoko no kwirinda indwara zikomeye z'ibikomere
• Inomero z'ivyihutirwa hakurikijwe igihugu