Oxide ya Nitrous ('Gazi ya Galaxy' / Tank) Uburozi: Ubumuga butunguranye bwumugongo hamwe numunwa wa Cryogenic¶

Mu myaka itanu ishize, guhumeka bitari ubuvuzi bwa okiside ya nitrous ($ inyandiko {N} _2 inyandiko {O} $, "gaze iseka") ** yagize ihinduka riteye ubwoba ry’ikoranabuhanga ryuzuza ibyumba by’imitsi, ibice bitwika, hamwe n’ishami ryihutirwa muri Amerika y'Amajyaruguru, Uburayi, na Ositaraliya hamwe n’abangavu bafite ubuzima bwiza ndetse n’abasore bakuze badashobora kugenda mu buryo butunguranye. Amateka yashizwemo kuva muri garama ntoya ya garama 8 ya garama yamashanyarazi ("ikiboko" cyangwa "nangs") , okiside ya nitrous yidagadura ubu igurishwa cyane mumaduka yumwotsi, mububiko bworoshye, hamwe nabacuruzi bo kumurongo imbere yamabara meza, bombo ya garama ** 580 kugeza kuri garama 2000 ("litiro 2 kugeza kuri litiro 3.3" ya "Magic" munsi yamavuta "" ** Gazi "," Guteka nabi "," InfusionMax ", na" SmartWhip ". Ikigega kimwe cya garama 2000 gifite ihwanye na ** 250 ya charger ya whippet ya buri muntu **, ifasha abayikoresha guhumeka litiro amagana cyangwa ibihumbi bya litiro $ $ inyandiko {N} _2 inyandiko {O} $ ubudahwema muri wikendi imwe. Uku kwiyongera gukabije kwerekanwa gukurura ibintu bibiri byihutirwa byubuvuzi: ** ubukonje bukabije bwa cryogenic frostbite yumunwa, imigozi yijwi, nibibero byimbere ** (iyo amazi $ inyandiko {N} _2klzzwxh:0006iandiko {O} $ yaguka kuri -40 to -88 degrees Celsius [-40 to -126 degrees Fahrenheit] biturutse kuri tank nozzle cyangwa kumaguru), na ** Subacute Combined Degeneration (SCD) y'uruti rw'umugongo **, kumugara demyelination ya dorsal na spinal spinal inkingi zatewe na ** okiside ya chimique idasubirwaho ya atome ya cobalt imbere muri Vitamine B12 (cobalamin) **.

Igifata abarwayi, imiryango, ndetse n'abaganga bo mu byumba byihutirwa muri rusange ni umutego wo gusuzuma indwara ya laboratoire **: iyo umukoresha wa nitrous uremereye ageze mu ishami ryihutirwa afite ubunebwe mu ntoki no ku mano, "pin na inshinge" (paresthesias).total cobalamin) igaruka rwose NORMAL muri 30 kugeza 50% byimanza **. Kuberako nitrous oxyde ya chimique oxyde ya cobalt ya B12 kuva monovalent ikora Co+ Kuri biologiya yapfuye trivalent Co3+ * utarinze * gusenya impeta yo hanze ya cobalamin, imashini immunoassay yibitaro ibara molekile ya okiside, idakora ya B12 nkibisanzwe "mugihe uruti rwumugongo rwumurwayi rwicwa ninzara kandi ikica. Byongeye kandi, kubera ko okiside ya nitrous ihagarika enzyme ** methionine synthase **, urugero rwamaraso ya ** homocysteine ** ikirere kugera kuri prothrombotic (> 50 to 150+ umol/L). Niba uhuye nihutirwa nonaha, hamagara aho utuye nimero yihutirwa ako kanya, hanyuma ubaze abavandimwe bacu bayobora kuri guhumeka guhumeka no guhitana urupfu rutunguranye, gukoresha ibiyobyabwenge n'ibiyobyabwenge, na gushyigikira umwe mu bagize umuryango wabaswe.

Kora ubu¶

1. ** Hagarika GUHITAMO BYOSE NITROUS OXIDE MU GIHE CYANE ku kimenyetso cya mbere cyambere cyo gutitira, kunanirwa, cyangwa "pin na inshinge" mu mano, urutoki, cyangwa amaguru. kutamenya **.
2. ** Hamagara nimero yawe yihutirwa (911 muri Amerika / Kanada, 112 muri EU, 999 mubwongereza) Ako kanya niba umuntu uhumeka muri tank ya nitrous atezimbere ijwi rinini, ifirimbi / guhumeka neza (stridor), kubyimba / kubyimba iminwa cyangwa ururimi, kubabara mu gituza, guhumeka neza, cyangwa iminwa yubururu. okiside ya nitrous kuri -55 to -88 degrees Celsius (-67 to -126 degrees Fahrenheit) mu muhogo, bitera ** kwihuta kwa laryngeal frostbite kubyimba ** bifunga umuyaga ufunga muminota 30 kugeza 90, cyangwa umuvuduko ukabije ** barotrauma (ibihaha byacitse / pneumomediastinum) **.
3. ** Niba umukoresha wa nitrous afite ikibazo cyo gutsitara, intege nke mumaguru, kutabasha kugendera kumurongo ugororotse, guta ibirenge, kunanirwa, cyangwa ingorane zo kwihagarika, jya mubitaro byihutirwa uyu munsi kugirango utere inshinge byihutirwa Hydroxocobalamin (Vitamine B12) byihutirwa. uruti rw'umugongo myelin kurimbuka byihuta burimunsi kugeza umusemburo wa B12 usimbuye (1,000 mcg IM burimunsi / guhinduranya iminsi) iratangiye.
4. ** Bwira umuganga wihutirwa kugirango ategeke Acide Serum Methylmalonic (MMA), Plasma Yuzuye Homocysteine (tHcy), Holotranscobalamin (Active B12), hamwe na Sagittal / Axial Cervical & Thoracic Spine MRI.MMA) na homocysteine (tHcy) yazamuwe hejuru ya 98 ku ijana by'imanza **.
5. ** NTUKIGERE ufata ibinini bya Acide Folike (Folate / Vitamine B9) MBERE YO GUTANGA Vitamine B12.
6. ** Niba umuntu afite ibishishwa byera, imvi, cyangwa bikomeye bikonje cyangwa ibisebe byijimye byijimye ku bibero byimbere (kuva ufashe ikigega cya L 2 gikonjesha hagati yamaguru yabo), shyushya uruhu witonze mumazi y'akazuyazi (dogere selisiyusi 37 kugeza kuri 39,6 / 98,6 kugeza kuri dogere 102.2 Fahrenheit) hanyuma ushake uruhu rwakonje cyangwa ngo ushire ubushyuhe bwumye; "ikibero cyibiboko" gutwika cryogenic hafi yisi yose ** yimbitse yo mucyiciro cya gatatu (umubyimba wuzuye) yaka ** bisaba kubagwa no kubaga uruhu.

Igiti cyemezo: Acute Airway / Ihaha Cryogenic Trauma na Subacute B12 Umugongo wumugongo¶

Koresha iyi clinique triage flowchart kugirango utandukanye guhumeka ubuzima bwangiza ubuzima, ibihaha, cyangwa tromboembolique byihutirwa nibikomere byumugongo.

flowchart TD
    A["Ibihe Byihutirwa cyangwa Ibimenyetso Nyuma ya Oxide ya Nitrous ('Galaxy Gas' Tank / 'Whippets')"] --> B{"Hoba hariho ACUTE Airway, Guhumeka, Imitsi, cyangwa Ibimenyetso bya Frostbite kurubu?"}
    B -->|"YEGO: Kutitabira, iminwa yubururu, ijwi rinini / umuhanda, umunwa wuzuye, umunwa wijimye, kubabara mu gatuza, cyangwa inyana yabyimbye"| C["UBUZIMA BUHITAMO: Hamagara 911/112/999 Noneho"]
    B -->|"NTA kibazo gikomeye cyo guhumeka ikirere: Kuzunguza amaboko / ibirenge, amaguru atuje, kugenda udahagaze, kugwa, guta ibirenge, ijosi rya Lhermitte, cyangwa paranoia"| D["NEUROLOGICAL SPINAL CORD YIHUTIRWA (Subacute Combined Degeneration)"]
    C --> E{"Ni izihe ngorane zikomeye zirahari?"}
    E -->|"Iminwa / ururimi rwijimye, ijwi ryijimye, gutemba, cyangwa umuhanda nyuma yo guhumeka muri tank nozzle"| F["CRYOGENIC AIRWAY FROSTBITE: Komeza wicare uhagaze; ED kanguka fiboptic intubation MBERE yuko umuhogo ubyimba"]
    E -->|"Ububabare butunguranye bwo mu gatuza, guhumeka neza, kubyimba ijosi / guturika, cyangwa kubyimba uruhande rumwe kubyimba / kubabara umutwe"| G["BAROTRAUMA CYANGWA HOMOCYSTEINE YAMBARA AMARASO: ED Chest X-Ray (Pneumothorax / Pneumomediastinum) + CT Pulmonary Angiogram / Ubwonko bwa CT (PE / CVST)"]
    E -->|"Ibara ryera / ryijimye ryakonje ku bibero by'imbere bivuye gufata tank"| H["DEEP 3-DEGREE CRYOGENIC YATwitse: Ongera ushyushye mumazi 37-39 C (99-102 F); Gutwika Centre yoherejwe (akenshi ikenera uruhu)"]
    D --> I["GUSUBIZA BYIHUTIRWA ED / NEUROLOGY UYU MUNSI: 1. Zeru N2O ikoreshe 2. Tangira Hydroxocobalamin 1.000 mcg IM ako kanya 3. Tegeka Serum MMA + Homocysteine (SI B12 gusa) + Cervical / Thoracic Spine MRI"]

Igice cya 1: Uburyo Oxide Nitrous Yangiza Uruti rwumugongo & Triggers Amaraso (Mechanism ya Cobalt Oxidation)¶

Urubyiruko rwinshi rwibwira ko okiside ya nitrous ntacyo itwaye rwose kuko abavuzi b'amenyo n'abaganga babyara bakoresha "gaze iseka" kugirango analgesie igufi. Nyamara, oxyde nitrous itangwa ivanze na 30 kugeza 50% bya ogisijeni muburyo bumwe, mugihe abakoresha tank yimyidagaduro bahumeka ** 100 ku ijana $ $ inyandiko {N} _2 inyandiko {O} $ ** inshuro nyinshi muminsi, ibyumweru, cyangwa ukwezi.

1. Oxidisiyasi yimiti idasubirwaho ya Vitamine B12 ya Cobalt Core (Co+ Kuri Co3+)¶

Umuntu ** Vitamine B12 (cobalamin) ** ikubiyemo atom imwe ya ** cobalt atom ** hagati yimpeta ya korin. Kugirango ukore nka cofactor enzymatique muri sisitemu yimitsi yumuntu no mumagufwa yamagufa, iyo atome ya cobalt ** igomba kuguma muri monovalent yagabanutse (Co+) leta **.

Iyo okiside ya nitrous ($ inyandiko {N} _2 inyandiko {O} $) ikwirakwira mu maraso no mu ngingo, ihita ikora kandi ** bidasubirwaho ** hamwe na cobalt yagabanutse ya vitamine B12:

Co+ (Active Reduced B12) + N2O ---> Co2+ ---> Co3+ (Inactive Oxidized B12) + N2

Bimaze guhumeka kuri trivalent **Co3+ leta **, molekile ya Vitamine B12 idakora burundu kandi irasohoka, ihagarika inzira ebyiri zingenzi za B12 zishingiye kumisemburo ya B12 mumubiri wumuntu:

1. ** Synthase ya Cytoplasmic Methionine (MS) Inzira (Methylcobalamin): **
   • Mubisanzwe, ** methionine synthase ** ikoresha methyl-B12 kugirango yimure itsinda rya methyl kuva 5-methyltetrahydrofolate kuri ** homocysteine **, irema ** methionine ** na ** S-adenosylmethionine (SAM) **.
   • ** Igisubizo 1 (Gusenyuka kwa Myelin): ** SAM ni umuterankunga wa methyl usabwa kugirango abungabunge poroteyine ** myelin ** na fosifatidylcholine mumashanyarazi yimitsi yumugongo nu mitsi ya peripheri. Nta SAM, myelin sheaths unravel and vacuolate (** Subacute Combined Degeneration **).
   • ** Igisubizo cya 2 (Lethal Hyperhomocysteinemia & Amaraso Yamaraso): ** Kuberako homocysteine idashobora guhinduka methionine, uburozi ** homocysteine (tHcy) yegeranya micromole 50 kugeza 200+ kuri litiro ** mumaraso. Indwara ya hyperhomocysteinemia ikuraho ingirabuzimafatizo ya endoteliyale kandi igakora caskade yambaye, igatera ** itabigenewe ya Deep Vein Thrombose (DVT), Embolism nini cyane.PE), Cerebral Venous Sinus Thrombose (CVST), na acute arterial stroke / myocardial infarction ** mubyangavu bafite ubuzima bwiza hamwe nimyaka 20.
2. ** Mitochondrial Methylmalonyl-CoA Mutase (MMCoAM) Inzira (Adenosylcobalamin): **
   • Mubisanzwe, adenosyl-B12 ihindura ** L-methylmalonyl-CoA ** muri ** succinyl-CoA ** kuri cycle ya Krebs hamwe na synthesis ya aside irike isanzwe.
   • ** Igisubizo: ** Iyo $ inyandiko {N} _2 inyandiko {O} $ idakora B12, ** aside methylmalonic (MMA.

2. Kuki Ibitaro Bisanzwe Serumu B12 Kwipimisha Amaraso Nibisanzwe (Kandi Niki Gutegeka Ahubwo)¶

Iki nikintu kimwe cyingenzi cyamavuriro gusangira na muganga wawe: ** serumu isanzwe ya Vitamine B12 (> 200 to 900 pg/mL cyangwa > 148 pmol/L) NTIBIGENDE HANZE uburozi bwa nitrous-oxyde.

• ** Impamvu Ikizamini Cyibeshya: ** Ibipimo bisanzwe bya laboratoire y'ibitaro bipima * serumu cobalamin yose * mukuramo B12 kuri poroteyine zihuza no gupima impeta yo hanze ikoresheje chemiluminescence. Imashini ** ntishobora gutandukanya ibikorwa bigabanutse Co+ B12 kandi yapfuye, nitrous-okiside Co3+ B12 ** kuzenguruka mu maraso mbere yo gukuramo impyiko (cyangwa niba umurwayi aherutse kumira ibinyobwa bitera imbaraga cyangwa ibinini B12 byo mu kanwa).
• ** Ikibaho cya Zahabu-Ikoreshwa rya Biomarker Panel: **

Igice cya 2: Kumenya iterambere rya Subacute ihuriweho hamwe ()SCD)¶

Sisitemu ya Nitrous-oxyde iterwa na nervice sisitemu yangiza ikomatanya ** inkingi ya dorsal myelopathie ** (gutakaza umwanya no guhindagurika), ** corticospinal tract myelopathie ** (intege nke za spastique), na ** sensorimotor peripheral axonal neuropathie **. Hatabayeho guhagarika ako kanya $ inyandiko {N} _2 inyandiko {O} $ hamwe n’umusimbura wa B12, abarwayi batera imbere byihuse binyuze mu byiciro bine by’amavuriro:

1. Icyiciro-by-Icyiciro Ibimenyetso bya Neurologiya Iterambere¶

1. ** Icyiciro cya 1: Paresthesiya Yitaruye ("Umuburo wo Kuburira"): **
   • Kudahuzagurika, gutitira, cyangwa "pin na inshinge" bitangirira kumutwe w'amano n'imipira y'ibirenge, kuzamuka hejuru y'ibirenge no kumurika no kugaragara mu ntoki (** gukwirakwiza-no-gants **). Abakoresha bata ibintu cyangwa baharanira gukanda amashati cyangwa kwandika kuri terefone.
2. ** Icyiciro cya 2: Inkingi ya Dorsal Yatakaye, Ikimenyetso cya Romberg, n'ikimenyetso cya Lhermitte: **
   • Kuberako inkingi ya ** dorsal (fasciculus gracilis na cuneatus) ** itwara imyanya ihuriweho (** proprioception **) hamwe no kunyeganyega mubwonko, umuntu ** ntaba azi aho ibirenge byabo biri mumwanya atarebye hasi hasi **.
   • ** Ikimenyetso cyiza cya Romberg: ** Barashobora kwihagararaho bareba kurukuta, ariko mugihe bafunze amaso (cyangwa binjiye mubyumba byijimye cyangwa kwiyuhagira), baranyeganyega bikagwa hejuru (** sensory ataxia **).
   • ** Ikimenyetso cya Lhermitte: ** Kunama umusaya imbere ugana mu gituza byohereza gitunguranye, giteye ubwoba ** "amashanyarazi" cyangwa urusaku rwinshi rurasa urutirigongo mumaguru yombi **.
3. ** Icyiciro cya 3: Intege nke za moteri, Ikirenge cyibirenge byombi, hamwe nubumuga bwibimuga: **
   • Demyelination ikwirakwira mu gice cya ** corticospinal tract ** no munsi ya axon ya moteri, bigatuma ** igabanuka ryibirenge byombi ** (amano akurura hasi, bisaba intambwe ndende "intambwe yo kugenda"), intege nke zamaguru, amaguru akomeye, ivi ryihuta ryihuta hamwe na ** reaction ya moteri ya neuron paradsor). Mu minsi mike, umuntu ntashobora kwihagararaho adafashijwe.
4. ** Icyiciro cya 4: Uruhago rwigenga / Ubumuga bwo munda, Atrophy optique, na psychologiya ya Megaloblastique: **
   • Kugumana inkari za Neurogenic cyangwa kutarenza urugero, kutagira fecal, kudakora neza, kudakora neza kwerekwa hagati (** B12 optic neuropathie ), kwiheba gukabije, kubura kwibuka, cyangwa psychose ikaze ya paranoide ( "ibisazi bya megaloblastique" **).

2.¶

Kuberako umunwa wa Vitamine B12 mu kanwa (cyanocobalamin) kugira imitekerereze idahwitse (-1%.IM) Hydroxocobalamin **:

+-------------------------------------------------------------------------+
|       GOLD-STANDARD CLINICAL TREATMENT FOR NITROUS OXIDE                |
|       NEUROTOXICITY (SUBACUTE COMBINED DEGENERATION)                    |
|                                                                         |
|  1. COMPLETE CESSATION OF NITROUS OXIDE (MANDATORY):                    |
|     Inhaling N2O even ONCE during treatment oxidizes and destroys       |
|     the injected Vitamin B12 inside your body within minutes.           |
|                                                                         |
|  2. INTRAMUSCULAR HYDROXOCOBALAMIN (OR METHYLCOBALAMIN) PROTOCOL:       |
|     - Standard ABN Regimen: 1,000 micrograms (1 mg) IM injection        |
|       EVERY OTHER DAY for at least 2 weeks (or 1,000 mcg IM DAILY       |
|       for 5 to 14 days in severe paralysis), followed by 1,000 mcg IM   |
|       weekly for 4 to 8 weeks, until neurological improvement plateaus. |
|     - High-dose oral Methylcobalamin (2,000 mcg/day sublingual) may     |
|       be added ONLY as an adjunct after IM loading has begun.           |
|                                                                         |
|  3. ADJUNCTIVE ORAL METHIONINE (IF AVAILABLE):                          |
|     Oral L-Methionine (1 gram three times daily) directly supplies      |
|     the missing downstream product of blocked methionine synthase,      |
|     accelerating myelin repair while B12 regenerates apoenzymes.        |
|                                                                         |
|  4. CHECK FOLATE, IRON & POTASSIUM (NEVER GIVE FOLATE BEFORE B12):      |
|     Monitor serum potassium during the first 48 hours of B12 replacement|
|     (rapid hematopoiesis can cause transient hypokalemia) and give      |
|     folic acid ONLY AFTER the first IM Hydroxocobalamin injection.      |
+-------------------------------------------------------------------------+

Igice cya 3: Cryogenic Frostbite Yaka ("Ikibero cya Whippet" & Freeway Freezing) na Asphyxiation¶

Ihinduka riva mumashanyarazi ya garama 8 ikagera kuri ** 580-garama, garama 640, na garama 2000 ("litiro 2") silinderi yicyuma ** yateje icyorezo cyumubano ukomeye wa kirogenike no guhumeka **.

1. Impamvu 2-litiro ya Nitrous Tanks Yamanutse Kuri -55 to -88 Degrees Celsius (-67 to -126 Degrees Fahrenheit)¶

Imbere ya tank ya nitrous yubucuruzi, $ inyandiko {N} _2 inyandiko {O} $ ibaho nkamazi yagabanijwe mu kuringaniza hamwe numwuka wacyo. Mugihe umukoresha yuzuza inshuro nyinshi imipira (cyangwa guhumeka kuva nozzle), amazi abira akuramo ubushyuhe bukabije ** bwihishwa bwumuyaga ** biturutse kurukuta rwibyuma bya silinderi hamwe numuringa / plastike nozzle.

1. ** "Ikibero Cyibiboko" (Byimbitse Byuzuye-Ubunini-Imbere-Ikibero Cryogenic Frostbite): **
   • Abakoresha bicaye ku buriri cyangwa ku ntebe y'imodoka basanzwe bafata uburemere 2,000-gram silinderi yicyuma hagati yubusa cyangwa ibyuya byambaye ** ibibero byimbere ** kugirango ikomeze ikigega gihamye mugihe uhinduranya nozzle.
   • ** Impamvu Abakoresha batumva uruhu rwabo rukonje: ** Icya mbere, okiside ya nitrous ni analgesic ikomeye ya dissociative (gukora kumanuka inzira ya noradrenergic / opioid ibuza inzira no guhagarika ** NMDA glutamate reseptors ** kimwe na ketamine). Icya kabiri, nkuko uruhu rwibibero rwagati rugabanuka hepfo -2 degrees Celsius (28 degrees Fahrenheit), imitsi yububabare buterwa no kubura anesthesia ikonje.
   • Mugihe isomo rirangiye ** nyuma yiminota 15 kugeza 45 nyuma , ikigega cyicyuma gitwikiriwe nubukonje bwera kandi gikonjeshwa rwose kuruhu rwibibero byimbere. Iyo zimaze gukonja, uruhu rukura ** byombi, ibisa na nerotic eschars hamwe na bullae nini ya hemorhagie ** igera cyane mumavuta yo munsi y'ubutaka ( 3- na 4-dogere ya dogere yuzuye yubukonje **).
   • ** Imfashanyo Yihutirwa Yambere & Gutwika Ikigo Kuburira: ** Shyushya gahoro gahoro ikibero cyakonje ukoresheje ** kizenguruka amazi ashyushye kuri 37 to 39 degrees Celsius (98.6 to 102.2 degrees Fahrenheit)** kuminota 20 kugeza 30. ** Ntukigere usiba cyangwa ngo ukore massage ahantu hafunzwe ** (kristu yo mu bwoko bwa ice kristal yamenaguye utugingo ngengabuzima iyo uyisweye) kandi ** ntuzigere ukoresha icyuma gishyushya cyangwa umusatsi **. Shakisha isuzuma kuri ** Centre yo gutwika akarere ** mumasaha 24 kugeza 48; gutinda kubitaho bikunze kuganisha ku cyiciro cya kabiri * Pseudomonas * cyangwa * Staphylococcus * kwandura na sepsis bisaba kubagwa kwinshi no kubaga uruhu.
2. ** Umunwa, Pharyngeal, na Laryngeal Frostbite + Barotrauma: **
   • Gushyira iminwa mu buryo butaziguye kuri tank nozzle cyangwa ikariso ya cream itera gukonjesha ako kanya iminwa, ururimi, umunwa woroheje, hamwe n'umugozi w'ijwi, hamwe n'akaga ko gaze umuvuduko ukabije wacika muri mediastinum (** pneumomediastinum **). Guhindura amajwi ayo ari yo yose, kubabara mu muhogo, kubyimba ijosi, cyangwa ingorane zo kumira nyuma yo gukoresha tank bisaba ** isuzuma ryihutirwa ry’ishami ryihutirwa **.

2.¶

Mugihe okiside ya B12 idakira ihagarika uruti rwumugongo, ** urupfu rukabije ruturutse kuri okiside ya nitrous hafi ya yose iterwa na hypoxic asphyxiation yihuta **:

• ** Gusimbuza Oxygene ya Alveolar: ** Guhumeka 100% oxyde ya nitrous isubira inyuma utiriwe uhumeka neza umwuka wicyumba hagati yo guhumeka usohora ogisijeni mu bihaha, bikagabanya kwiyuzuza ogisijeni ya arterial (SpO2) munsi ya ** 50 ku ijana mu masegonda 30 kugeza kuri 60 **, bitera gufatwa na hypoxic, arththmias, no gupfa mu bwonko.
• ** Ingaruka yo Kwibanda & Diffusion Hypoxia (Ingaruka ya Fink): ** Kuberako $ inyandiko {N} _2 inyandiko {O} $ ni ** inshuro 34 zishonga mumaraso kurusha azote **, iyo guhumeka bihagaze, umubyimba munini wa $ inyandiko {N} _2 inyandiko {O} $ wihuta uva muri capillaries yibihaha ugasubira muri ogisijeni ya alooli yose hamwe.CO2, ifunga disiki yubwonko kugirango ihumeke).
• ** Ntuzigere Uhumeka Imodoka, Ikariso, cyangwa N'isakoshi / Mask ihambiriye mu maso: ** Gufungura cyangwa kumenagura silindiri ya garama 2000 imbere muri sedan ifunze yuzuza akazu k’imodoka yuzuye, ihumeka $ inyandiko {N} _2 inyandiko {O} $ gaze (ari yo 1.5 times heavier than air), guhumeka abantu bose imbere mugihe barenganye.

• (Niba wowe cyangwa uwo ukunda urwana no gukoresha ku gahato ibigega bya nitrous cyangwa ibindi bihumeka, reba Uburozi buhumeka hamwe n '' Urupfu rutunguranye ', Gukoresha ibiyobyabwenge nibiyobyabwenge: ubuyobozi bwihutirwa, na Gufasha umwe mu bagize umuryango wabaswe. Tekereza kurangiza ubufasha bwambere bwemewe hamwe namahugurwa ya CPR kuva muri Croix-Rouge, Ambulance ya St John, cyangwa utanga ubutabazi bwaho.) *

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

Mugihe ugaragarije ishami ryihutirwa ryibimenyetso bya nitrous oxyde ya neurologiya cyangwa ubukonje, vuga neza ubunini bwa ** numubare wibigega bikoreshwa muricyumweru ** (urugero, *MMA), Homocysteine (tHcy), na IM Hydroxocobalamin **.

Ibibazo bikunze kubazwa¶

Kuyobora¶

• Uburozi bwa Inhalant na 'Urupfu rutunguranye': kuki adrenaline itera fibrillation ventricular fibrillation
• Gukoresha ibiyobyabwenge nibiyobyabwenge: ubuyobozi bwihutirwa
• Gufasha umwe mu bagize umuryango wabaswe
• Kurenza urugero ('overamping'): hyperthermia, kubabara mu gatuza, hamwe na triage
• Inomero zihutirwa

Inkomoko nubuyobozi¶

• ** Ishyirahamwe ry’aba Neurologiste b'Abongereza (ABN) & Clinical Practice Consensus (Ubwongereza): ** * Nitrous Oxide-iterwa na Subacute iterwa no kugabanuka kwa Cord: Gusuzuma no gucunga ishami ryihutirwa (Intramuscular Hydroxocobalamin, Acide Methylmalonic, Homocysteine, na Folate Precautions) *.
• ** Ikigo cy’ubumwe bw’ibihugu by’i Burayi (EUDA / cyahoze cyitwa EMCDDA): ** * Gukoresha imyidagaduro ya Oxide ya Nitrous: Gukura impungenge kuri Cilinders nini, Cobalt-B12 Oxidation Myelopathie, Thromboembolism ya Venogene, na Cryogenic Frostbite Yaka *.
• ** Ikigo cy’Amerika gishinzwe ibiryo n’ibiyobyabwenge (FDA) & Ibigo bishinzwe kurwanya no gukumira indwara (CDC): ** * Ubujyanama bw’ubuzima rusange: Ntugahumeke Ibicuruzwa bya Oxide ya Nitrous ("Galaxy Gas" / Flavoured Whipped Cream Chargers): Ibyago byo kumugara, Amaraso, Frostbite, na Asphyxiation *.
• ** Serivisi ishinzwe amakuru y’uburozi mu Bwongereza (NPIS / TOXBASE) & Ishyirahamwe ry’abatwika mu Bwongereza: ** * Ubuyobozi bw’ubumara bukabije bwa Nitrous Oxide no Guhuza Cryogenic Frostbite Yaka Biturutse kuri Cylinders *.
• ** Ishuri Rikuru ry’Ubuvuzi ry’Abanyamerika (ACMT) & Ishuri Rikuru ry’Abanyamerika (Neurologiya) (**):