Carbon Monoxide Yangiza Uburozi, Pulse Oximeter Gusoma Ibinyoma, hamwe na Hyperbaric Oxygene Ibipimo¶

Umwuka wa karubone (CO) ni impumuro nziza, idafite ibara, uburyohe, kandi idatera uburakari bwa gaze yuburozi iterwa no gutwikwa kwuzuye kw’ibicanwa bishingiye kuri karubone (harimo moteri ya lisansi ishobora gutwara, amakara y’amakara, icyuma gishyushya imashanyarazi, ibyuma bifata amashyiga yafunzwe, umuriro uhagarara, imodoka zidakora). Kubera ko monoxide ya karubone ihuza na hemoglobine mu ngirangingo z'amaraso itukura ** inshuro 200 kugeza kuri 250 cyane kurusha ogisijeni **, igakora ** carboxyhemoglobin (COHb) **, kandi icyarimwe ikangiza uburozi bwo mu nda ** cytochrome c oxydease ** mu mutima no mu bwonko, bitera guhumeka kwa selile mbere yuko abahohotewe bamenya ko bari mu kaga. By'umwihariko, urugo rusanzwe cyangwa ambulance ** uburebure bwa kabiri-urutoki pulse oximeter NTIBISHOBORA kuvuga itandukaniro riri hagati ya carboxyhemoglobin na hemoglobine isanzwe ya ogisijeni, byerekana ibinyoma gusoma byizeza 98% kugeza 100% SpO2 nubwo uwahohotewe apfa azize hypoxia yica karubone **. Niba ukeka ko umwuka wa karubone uhura, hita uhita wimura umwuka mwiza wo hanze, hamagara numero yawe yihutirwa ukoresheje iwacu nimero yihutirwa ububiko, kandi usabe ibitaro ** CO-oximetry gupima gazi yamaraso ** na ** 100% bidasubirwaho cyangwa isuzuma rya ogisijeni ya hyperbaric **, hamwe nubuyobozi bwacu kuri rusange karubone monoxide hamwe no guhumeka umwotsi ubufasha bwambere, guhumeka cyanide ninganda, na methemoglobinemia.

Kora ubu¶

1. ** Kwimura abantu bose hamwe ninyamanswa mumazi meza yo hanze ako kanya **: Ntugume imbere kugirango ufungure amadirishya, ibyumba bihumeka, cyangwa ushakishe inkomoko yamenetse. Niba umuntu yaguye imbere mu nsi yo munsi, igaraje, inzu y’ubwato, cyangwa ikigega cy’inganda aho hashobora kuba harimo umwuka wa karubone mwinshi, ** fata umwuka wawe, ubikuremo gusa niba ushobora kubikora mu masegonda uvuye ku muryango utiriwe winjira mu kirere cyica, cyangwa ugategereza abashinzwe kuzimya umuriro bambaye ibikoresho byo guhumeka (SCBA) **.
2. ** Hamagara numero yawe yihutirwa uturutse hanze yinyubako **: Hamagara ** 911 ** muri Amerika na Kanada, ** 112 ** hakurya y’ubumwe bw’ibihugu by’Uburayi, ** 999 ** mu Bwongereza, ** 000 ** muri Ositaraliya, cyangwa urebe mpuzamahanga nimero yihutirwa ububiko. Saba ** ishami rishinzwe kuzimya umuriro (hamwe na gaze ya gaze ya gaze nyinshi) hamwe na Ambulance Yubuzima Bwambere (ALS) **.
3. ** NTUKIGERE wizera urutoki rusanzwe rwa okisimeteri (98% kugeza 100% SpO2) kugirango wirinde uburozi bwa CO **: Uburebure bwa kabiri-burebure bwa clip-on urutoki pulse oximeter bipima kwinjiza urumuri kuri nanometero 660 na nanometero 940. Kuberako carboxyhemoglobin ikurura 660 nm itara ritukura hafi ya yose ihwanye na oxyhemoglobine isanzwe, ** umurwayi ufite 40% byica carboxyhemoglobin azakomeza kwerekana 98% kugeza 100% SpO2 kurutoki rusanzwe rwa oximeter **. Gusa impuguke yihariye ** myinshi-yumurambararo wa pulse CO-oximeter (nka Masimo Rad-57) ** cyangwa ** laboratoire ya laboratoire ya gazi ya gazi CO-oximeter ** irashobora gupima karubasihemoglobine nyayo.
4. ** Koresha 100% ya ogisijeni ya Normobarike yuzuye ikoresheje mask idahwitse idahwitse **: Ntukoreshe urumogi ruto rutemba. Inkeragutabara zikimara kuhagera, buri murwayi ufite ibimenyetso bya CO wagaragaye, na ** buri murwayi utwite atitaye ku bimenyetso **, agomba gushyirwa kuri ** 100% ogisijeni kuri litiro 15 ku munota akoresheje mask ikigega kidahumeka neza ** (cyangwa intubation ya endotracheal hamwe na 100% FiO2 niba comatose). Guhumeka ogisijeni 100% bigabanya kurandura igice cyubuzima bwa monoxyde de carbone mumaraso kuva muminota ** 320 (amasaha arenga 5 kumyuka yicyumba) kugeza kuminota 74 kugeza 90 **.
5. ** Komeza umurwayi kuruhuka kumubiri byuzuye **: Ntukemere ko umuntu ukira imyuka ya karubone igenda cyangwa ngo yishyiremo imbaraga. Gukoresha imbaraga byongera ogisijeni ya myocardial ikenera mumitsi yumutima myoglobine na mitochondria bimaze kuba uburozi, bishobora gutera ischemia ikaze ya myocardial cyangwa arththmias.
6. ** Menya abakandida bafite ibyago byinshi byo kwimurwa byihutirwa Hyperbaric Oxygen Therapy (HBOT) **: Bwira inkeragutabara n’abaganga byihutirwa niba umurwayi yaba yaranataye ubwenge buke (syncope) **, urujijo, gufatwa, kubabara mu gatuza, ataxia, ** aratwite (ku cyiciro icyo ari cyo cyose cyo gutwita) **, cyangwa afite karubasi ya ogisijeni yo hejuru ya 20% cyangwa hejuru ya 25% kwimurira muri ** Hyperbaric Oxygene Urugereko **.

Igiti cyemezo: Uburozi bwa Carbone monoxide, gutabaza ogisijeni, hamwe no kohereza hyperbaric¶

flowchart TD
    Start["Ukekwaho Carbone Monoxide (CO) Kumenyekanisha: Ijwi rya CO Imenyekanisha, Generator / Ubushyuhe / Umunaniro w’ibinyabiziga, umuriro wo munzu, cyangwa abantu benshi bafite umutwe umwe icyarimwe, Isesemi, Kuzunguruka, cyangwa Syncope"] --> Evacuate["."]

    Evacuate --> OximeterTrap["AMATEGEKO YO KUNYAZA DIAGNOSTIC: IGNORE Igipimo cya 2-Umuhengeri w'urutoki rwa Oximeter (Ikinyoma 98% kugeza 100% SpO2). Koresha 7/8-Umuhengeri Rad-57 CO-Oximeter CYANGWA Ibitaro Venous / Arterial Blood Gas CO-Oximetry"]

    OximeterTrap --> StartNRB["Koresha 100% Yuzuye-Oxygene Normobaric (15 L / min ukoresheje Mask Tight Non-Rebreather Mask) AKANYA (Kugabanya COHb igice cyubuzima kuva 320 min kumyuka yicyumba kugeza kuri 74 kugeza 90 min). Niba ifunze umuriro wubatswe / soot mumunwa + coma / guhungabana, gufatanya kuyobora Hydroxocobalamin (5 g IV) kuri Cyanide"]

    StartNRB --> LabDraw["Kwipimisha Ibitaro ED Kwipimisha no Kwipimisha: - Umwuka wamaraso wa Venusi cyangwa Arterial hamwe na Spectrophotometric CO-Oximetry (COHb%) (Baseline bisanzwe: munsi ya 2 kugeza 3% mubatanywa itabi;"]

    LabDraw --> HBOTCheck{"Ese umurwayi ahura nikimenyetso icyo aricyo cyose cyo kuvura Hyperbaric Oxygene (HBOT: 2.5 kugeza 3.0 ATA)? . amashereka) CYANGWA COHb Yuzuye 25% cyangwa irenga"}

    HBOTCheck -->|"YEGO: Yujuje Ibipimo bya HBOT"| TransferHBOT["BYIHUTIRWA HYPERBARIC OXYGEN THERAPY (HBOT) PROTOCOL: - Komeza 100% O2 mugihe utegura kwimurira mu rugereko rwa Hyperbaric (byiza mu masaha 6 kugeza 24) - Kotsa igitutu kuri 2.5 kugeza 3.0 Atmospheres Absolute (ATA) ita COHb igice cya kabiri cyubuzima kugeza kuminota 15 kugeza 23 oxydease, ikanabuza beta-2 integrin leukocyte lipid peroxidation kugirango wirinde gutinda kwa Neurologiya Sequelae (DNS)"]

    HBOTCheck -->|"OYA: Ibimenyetso byoroheje gusa (kubabara umutwe cyangwa isesemi), kudatwita, ibizamini bisanzwe bya ECG na neuro"| NormobaricWashout["100% NORMOBARIC OXYGEN NTA PROTOKO: - Komeza 100% Non-Rebreather O2 byibuze amasaha 4 kugeza kuri 6 kugeza COHb munsi ya 2% kugeza 5% kandi ibimenyetso byose bikemuke - Dept Fire / Utility igomba kugenzura no gufunga ibikoresho bidakwiriye mbere yuko umuntu wese yinjira mu nyubako - Gahunda iteganijwe 4-kugeza-6-icyumweru"]

Pathophysiology: Uburyo butatu bwuburozi bwa monoxyde de carbone¶

Mu myaka ibarirwa muri za mirongo, ibitabo byigishaga ko monoxyde de carbone ikomeretsa umubiri gusa ifata imyanya kuri molekile ya hemoglobine. Ubushakashatsi bw’uburozi bwa kijyambere hamwe n’ubushakashatsi bw’ubuvuzi bwa hyperbaric bwerekana ko monoxide ya karubone yibasira umubiri wumuntu binyuze muri ** uburyo butatu butandukanye, burenze urugero **, busobanura impamvu urugero rwa ** carboxyhemoglobin (COHb%) ruhuza nabi nuburemere bw’amavuriro ** n'impamvu abarwayi bashobora gukomeretsa ubwonko buhoraho nubwo amaraso yabo COHb% agaruka kuri zeru:

1. Guhuza Hemoglobine (200x kugeza 250x Affinity) hamwe na Haldane Ingaruka (Ibumoso)¶

Buri tetramer ya hemoglobine muri selile yawe itukura ifite ibibanza bine birimo ibyuma bihuza ibyuma bigenewe gutwara ogisijeni (O2) kuva mu bihaha kugera mu ngingo. Monoxide ya karubone ihuza izo mbuga za ferrous (Fe2 +) hamwe na ** inshuro 200 kugeza kuri 250 zirenze ogisijeni **, ikora ** carboxyhemoglobin (COHb) **.

Umwuka wa karubone umaze gufata kimwe cyangwa bibiri gusa kuri bine ya heme kuri molekile ya hemoglobine, ihindura imiterere yimiterere ya poroteyine (** allosteric modification / Ingaruka ya Haldane **), bigatuma ibibanza bibiri cyangwa bitatu bisigaye bitwara ogisijeni kuri ** bifatira kuri molekile ya ogisijeni ikabije cyane **. Kuri ** oxyhemoglobin gutandukanya umurongo **, ibi bitera impinduka idasanzwe ** ibumoso ibumoso ** (guhindura umurongo uva muburyo busanzwe bwa sigmoidal S ihinduka hyperbola). Mugihe amaraso atembera muri capillaries yinzara yubwonko numutima, hemoglobine yanze kureka ogisijeni isigaye, itera hypoxia tissue selile selile mbi cyane kuruta anemia yoroshye yo murwego rumwe.

2. Uburozi bwimitsi yumutima na skeletale binyuze muri Myoglobin ("Myocardial Stun")¶

Umwuka wa karubone kandi uhuza cyane (hafi ** inshuro 40 kugeza kuri 60 kurenza ogisijeni **) kugeza kuri ** myoglobin **, poroteyine ibika ogisijeni imbere muri selile yimitsi yumutima (cardiomyocytes) ** n imitsi ya skeletale. - Iyo CO ihujwe na ** cardiac myoglobin ** (ikora carboxymyoglobin), yicisha inzara imitsi yumutima wa ogisijeni yo mu bwoko bwa ogisijeni yo mu bwoko bwa ogisijeni, itera ** myocardial itangaje, ibumoso cyangwa iburyo idakora neza, ischemia ya subendocardial, hejuru ya troponine yumutima (ikabije iba hejuru ya 30% yuburozi bwa CO). - Nkuko carboxyhemoglobine isukurwa buhoro buhoro mumaraso mugihe cyo kuvura ogisijeni, monoxide ya karubone ibitse imbere mumitsi myoglobine irashobora ** gusubira mumaraso **, cyangwa igakomeza guhagarika umutima kumutima.

3.¶

Hafi ya ** 10 kugeza kuri 15 ku ijana byumutwaro wa karubone monoxide yumubiri ushonga mu ngirabuzimafatizo za tissue **, aho uhuza na ferrous heme fer ya ** mitochondrial cytochrome c oxydease (Complex IV yumurongo wa transport wa electron) **: 1. ** ATP Shutdown na Radical Surge Kubuntu **: Guhagarika Complex IV ihagarika okiside fosifora (selile selile ATP itanga ingufu) mugihe itera electron gusohoka mumurongo wubwikorezi, bikabyara amoko menshi yubwoko bwa ogisijeni ikora (superoxide, peroxynitrite, na nitric oxyde) ** imbere mubwonko bwa neurone na endotelium. 2. ** Oxidase ya Xanthine na Neutrophil Yubahiriza (Impamvu yo Gutinda kwangirika k'ubwonko) **: Peroxynitrite na nitric oxyde nitricide ikora ** platine na neutrophile (selile yamaraso yera) **. Neutrophile ikora ikoresha ** beta-2 integin ** kugirango yizirike kurukuta rw'imitsi mito y'amaraso mu bwonko, aho itesha agaciro ikarekura ** myeloperoxidase (MPO) **. 3. ** Myelin Basic Protein Peroxidation **: Myeloperoxidase itera ** lipid peroxidation ya Myelin Basic Protein (MBP) **, icyatsi gikingira hafi ya fibre nervice yibintu byera byera hamwe na ganglia yibanze yubwonko. Myelin yahinduwe mumiti itunguranye igaragara nk "umunyamahanga" na T-lymphocytes yumurwayi, itera igitero cyihuta, kidahwema ** autoimmune inflammatory yibintu byera byubwonko muminsi 2 cyangwa 40 iri imbere **, impamvu nyayo yibinyabuzima ya ** Gutinda kwa Neurologiya Sequelae (DNS) **.

Imbonerahamwe yo kugereranya: Pulse Oximetry na CO-Oximetry na Gaz Amaraso ya Arterial muburozi bwa CO¶

Gusobanukirwa nibyo buri bitaro cyangwa ibikoresho byabanjirije ibitaro bipima birinda amakosa yica triage:

Oxygene yo gutabaza kinetics: Umwuka wo mucyumba na 100% Oxygene Normobaric na Hyperbaric Oxygene (HBOT)¶

Kubera ko umubiri udashobora guhinduranya monoxyde de carbone muri dioxyde de carbone, inzira ya ** yonyine yo gukuraho monoxide ya karubone mu mubiri ni uguhumeka neza binyuze mu bihaha ** ukoresheje ** Amategeko agenga ibikorwa **: kwuzuza alveoli hamwe n’umuvuduko mwinshi wa ogisijeni yera (PAO2) kugirango uhangane na monoxide ya karubone, na myoglobine, na myoglobine, na mitochlobine, na mitochlobine, na myoglobine.

Gereranya uburyo butangaje kurandura igice cya kabiri cyubuzima bwa carboxyhemoglobine gitemba hejuru yibice bitatu byo gutanga ogisijeni:

Ibipimo byo kuvura Hyperbaric Oxygene ivura (HBOT): Ninde ukeneye kwimura urugereko?¶

Yahujwe na ** Ubuvuzi bwa Undersea na Hyperbaric Medical Society (UHMS) **, Sosiyete ** y'Abanyamerika Thoracic (ATS) **, Komite ya ** ishinzwe ubuvuzi bwa Hyperbaric (ECHM) **, hamwe n’ikirangantego ** Ababoshyi n'abandi. .

1. ** Amateka yo gutakaza ubwenge (Syncope) cyangwa Coma **:
2. Kunanirwa kwinzibacyuho, kwirabura, cyangwa kutitabira aho byabereye cyangwa mugihe cyo gutwara, ** nubwo umurwayi yaba yarabyutse akumva ari ibisanzwe rwose mugihe bageze mubyumba byihutirwa **, nikimenyetso cyibanze kuri HBOT kuko syncope yerekana hypoxia yubwonko bwinzibacyuho kandi ikagira ibyago byinshi byo gutinda kwa Neurologiya Sequelae.
3. ** Ibura rya Neurologiya cyangwa Imiterere yo mumutwe Yahinduwe **:
4. Urujijo, gutandukana, gutekereza buhoro, guta umutwe, ** gufatwa **, cerebellar ** ataxia ** (kudashobora kugenda umurongo ugororotse ukageza ku birenge cyangwa urutoki-ku zuru), guhungabana mumaso, cyangwa intege nke zo kwibanda.
5. ** Inda (Vulnerability idasanzwe) **:
6. ** Impamvu uruhinja rutaravuka ari "Carbone Monoxide Magnet" : Hemoglobine ya Fetal ( Hemoglobin F / HbF **) ifitanye isano rya ** na monoxide ya karubone kurusha Hemoglobine A **, kandi monoxide monoxyde ya carbone irenga umubyimba buhoro buhoro ariko ** ifata inshuro 4 kugeza kuri 5 kugirango ikure mu kirere cy'umwana wa ** amasaha **, hamwe na leta ihamye ya COHb urwego ruzamuka ** 10% kugeza 15% hejuru ya ** kurwego rwababyeyi).
7. Byongeye kandi, kubera ko uruhinja HbF rumaze kwicara ibumoso kuruhande rwa ogisijeni itandukanijwe, wongeyeho CO itera ibibyimba byo mu nda ibyara hypoxia, kubyara, cyangwa kwangirika kwubwonko buhoraho (** globus pallidus na necrosis yubwonko **) nubwo umubyeyi afite umutwe woroheje gusa.
8. ** Amategeko yo Kuvura Inda **: Umugore wese utwite uhuye na monoxyde de carbone bisaba ** inshuro eshanu zirenze urugero za ogisijeni ya ogisijeni ya Normobaric ** kuruta umuntu utwite utwite, kandi ** HBOT yerekanwa kumurwayi wese utwite ufite urugero rwa COHb rwa 15% kugeza kuri 20% cyangwa hejuru ya **, ibimenyetso byose by’imitsi y’ababyeyi cyangwa umutima, cyangwa ibimenyetso byose byerekana ko umubabaro wa nyababyeyi (tachycardia, kugabanuka). Hyperbaric ogisijeni ifite umutekano rwose ku mwana.
9. ** Imikorere mibi yumutima cyangwa Ischemia Myocardial **:
10. Ububabare bwo mu gatuza (angina), ischemic ST-segment cyangwa T-wave ihinduka kuri 12-yayoboye ECG, yazamuye ** yumutima mwinshi cyane umutima wa troponine **, arththmias ventricular, cyangwa hypotension / impyiko.
11. ** Acidose ikabije ya Metabolic cyangwa Carboxyhemoglobin Urwego Rwinshi **:
12. Amaraso ya Arterial ** pH munsi ya 7.20 ** cyangwa yazamutse cyane ** serumu lactate ** (niba bivuye mumuriro wubatswe munzu, nanone uvure muburyo bwogukoresha uburozi bwa cyanide ** hamwe na hydroxocobalamin yo mu maraso ** 100% ogisijeni ya Normobaric.

Gutinda kwa Neurologiya Sequelae (DNS): Ikibazo Cyubwonko Bwiminsi 2 -40¶

Kimwe mu bintu byangiza kandi byunvikana cyane muburozi bwa monoxyde de carbone ni ** Gutinda kwa Neurologiya Sequelae (DNS) ** (nanone bita ** Encephalopathie yatinze nyuma yuburozi bukabije bwa Carbone Monoxide [DEACMP] **).

1. "Intera ya Lucid" (Iminsi 2 kugeza 40 Nyuma yo Gusohoka Ibitaro)¶

Muri ** 15 kugeza 40 ku ijana by'abacitse ku icumu bafite ubumara bukomeye bwa karubone **, umurwayi yakize rwose mu cyumba cyihutirwa cyangwa mu bitaro, asohoka yumva ari ibisanzwe 100 ku ijana, asubira ku kazi cyangwa ku ishuri iminsi ** kugeza kuri 40 (impuzandengo y'ibyumweru 2 kugeza kuri 3: "intera ya lucid") **, hanyuma ahita atangira gukura, kwangirika kw'imitsi no mu mutwe byangiza umubiri wa autoimmune myelin. ganglia) ** na ** byimbitse ya periventricular cerebral ibintu byera **:

• ** Kumenya no Kugabanuka Kugabanuka **: Gutakaza cyane igihe gito cyo kwibuka, kudashobora gutumbira, gutandukana, gutinda gutunganya imitekerereze (bradyphrenia), cyangwa urujijo rusa nkurujijo.
• ** Imyivumbagatanyo ya Parkinsonian (Basal Ganglia / Globus Pallidus Injury) **: Kugaragara mu maso, guhindagurika, guhinda umushyitsi, gukomera kw'imitsi ya cogwheel, dystoniya, koreya, cyangwa gutakaza uburimbane no kugwa kenshi.
• ** Impinduka zumuntu hamwe nihungabana ryimyitwarire **: Kwiheba gukabije, gucika intege mumarangamutima (kurira cyangwa kutarakara), kutitabira, guhangayika, psychose, cyangwa impulsivité.
• ** Indwara yibanze ya Neurologiya **: Kudahagarika inkari cyangwa fecal, neuropathie periferique, ubuhumyi bwa cortical, cyangwa kubabara umutwe buri munsi.

2. Uburyo bwo Gukurikirana no Gucunga Indwara ya Neurologiya yatinze¶

• ** Gutegekwa 4-kugeza-6-Icyumweru-Gukurikirana **: Buri murwayi wavuwe uburozi bwa monoxyde de carbone iringaniye kandi ikabije agomba kuba afite gahunda yo kwisuzumisha ya neurologiya na neurocognitive ** ibyumweru 4 kugeza kuri 6 nyuma yo gusohoka **.
• ** Ubwonko bwa MRI Ibisubizo **: Niba ibimenyetso bya DNS bigaragaye, ubwonko MRI busanzwe bwerekana hyperintensité ya T2 / FLAIR hamwe no gukwirakwizwa gukwirakwizwa muri ** globus pallidus ya ** (umukono wa radiologique ya classique ya uburozi bwa CO) no gukwirakwiza ** ibintu byera byera leukoencephalopathie **.
• ** Kumenyekanisha no gusubiza mu buzima busanzwe **: Hamwe na neuro-reabilité itandukanye, kuvura ubwenge, hamwe n'imiti igamije (no mu bigo bimwe na bimwe, subiramo hyperbaric ogisijeni na anti-inflammatory protocole), ** 50 kugeza 75 ku ijana by'abarwayi bafite DNS bagaragaza ko bakize cyane mu mezi 6 kugeza 12 **, nubwo bamwe bagumana kwibuka cyangwa guhora bafite moteri.

Inomero zihutirwa zo mukarere hamwe na protocole yikigo¶

• ** Amerika na Kanada **: Hamagara ** 911 ** ako kanya uturutse hanze yimiterere, cyangwa uhamagare ** Igenzura ryuburozi kuri 1-800-222-1222 ** (US) / ** 1-844-POISON-X ** (Kanada) kugirango ubone inama zuburozi. Inkeragutabara n’ibitaro mbere y’ibitaro zikurikiza ** Ibigo bishinzwe kurwanya no gukumira indwara (CDC) **, ** Ishuri Rikuru ry’Abanyamerika ry’Abaganga Bihutirwa (ACEP) **, ** Sosiyete y'Abanyamerika Thoracic (ATS) **, na ** Amabwiriza y’ubuvuzi bwa Undersea na Hyperbaric (UHMS) **. Umuyoboro wa ** Divers Alert Network (DAN) / UHMS Amasaha 24 Yumurongo Wihutirwa (+ 1-919-684-9111) ** uhuza ibyumba byihutirwa bya hyperbaric biboneka muri Amerika ya ruguru.
• ** Ubwongereza **: Hamagara ** 999 ** kuri serivisi ishinzwe kuzimya umuriro n’ubutabazi hamwe na serivisi ishinzwe ubutabazi (hanyuma uhamagare ** Ikigo cy’igihugu gishinzwe ubutabazi kuri 0800 111 999 ** uturutse hanze niba hari gaze irimo). Ubuvuzi buvura bukurikiza ** Serivisi ishinzwe amakuru y’uburozi (NPIS / TOXBASE) **, ** NICE **, na ** Ishyirahamwe ry’Abongereza Hyperbaric (BHA) ** amabwiriza.
• ** Umuryango w’ubumwe bw’ibihugu by’i Burayi **: Hamagara ** 112 ** mu bihugu byose bigize Umuryango w’ubumwe bw’ibihugu by’Uburayi. Amakipe yibitaro akurikiza ** Komite yu Burayi ishinzwe Ubuvuzi bwa Hyperbaric (ECHM) ** ibyifuzo byumvikanyweho kuburozi bwa CO no kohereza HBOT.
• ** Australiya na Nouvelle-Zélande **: Hamagara ** 000 ** muri Ositaraliya cyangwa ** 111 ** muri Nouvelle-Zélande (Ikigo gishinzwe amakuru y’uburozi: ** 13 11 26 ** muri Ositaraliya, ** 0800 764 766 ** muri Nouvelle-Zélande). Ibice byubuvuzi bwa Hyperbaric bikorera mubitaro bikuru bya kaminuza munsi ya ** ANZCA / SPUMS (Sosiyete yepfo yubuvuzi bw’amazi yo mu nyanja ya pasifika) ** protocole.
• ** Ubuhinde na Aziya-Pasifika **: Hamagara ** 112 ** mu Buhinde, ** 995 ** muri Singapuru, ** 119 ** mu Buyapani na Koreya y'Epfo (aho HBOT yinjizwa cyane mu bigo byihutirwa bya kaminuza), cyangwa ** 999 ** muri Hong Kong na Maleziya.

Ibibazo bikunze kubazwa¶

Kuki urutoki rwa pulse oximeter yasomye 99% ogisijeni mugihe umuryango wanjye wari ufite uburozi bukabije bwa karubone?¶

Ubusanzwe clip-on urutoki pulse oximeter yerekana gusa uburebure bubiri bwumucyo (660 nm umutuku na 940 nm infrared) ukoresheje urutoki. Kuberako carboxyhemoglobine itukura (hemoglobine ihambiriwe na monoxyde de carbone) ikurura urumuri rutukura rwa 660 nm hafi ya yose hamwe na ogisijeni nziza ya ogisijeni nziza, ntishobora kubatandukanya kandi ikabishyira hamwe, ikerekana gusoma ibinyoma bya 98% kugeza 100% SpO2 nubwo 30% cyangwa 40% bya monoglobine yumuntu. Gusa uburebure bwa 7-kuri-8-uburebure bwa CO-oximeter (nka Masimo Rad-57) cyangwa laboratoire ya laboratoire ya laboratoire CO-oximeter irashobora gupima karubasihemoglobine nyayo.

Ni kangahe guhumeka umwuka wa ogisijeni 100% cyangwa kujya mucyumba cya hyperbaric ukuraho monoxide ya karubone mu maraso?¶

Niba umuntu ufite uburozi ahumeka umwuka wicyumba cyo hanze (21% ogisijeni), bisaba impuzandengo yiminota 320 (amasaha arenga 5) kugirango ukureho kimwe cya kabiri cya monoxyde de carbone mumaraso yabo. Kubishyira kuri ogisijeni 100% ukoresheje mask idahwitse idahwitse kuri litiro 15 kumunota igabanya ibyo gukuraho igice cyubuzima inshuro enye, kugeza kuminota 74 kugeza 90. Gushyira umurwayi mu cyumba cya Hyperbaric Oxygene Therapy (HBOT) kotswa igitutu kugeza kuri 2,5 kugeza kuri 3.0 Atmospheres Absolute (ATA) igabanya igice cya kabiri cyubuzima kugeza ku minota 15 kugeza 23 gusa mugihe ushonga ogisijeni ihagije ihagije muri plasma yamaraso kugirango ubwonko n'umutima bikomeze bidakenewe na hemoglobine na gato.

Kuki abagore batwite bakeneye ubuvuzi bwa hyperbaric ogisijeni kurwego rwo hasi rwa monoxyde de carbone kurusha abandi bantu bakuru?¶

Umwana w'inda utaravuka hemoglobine (Hemoglobin F) ihuza monoxide ya karubone cyane kurusha hemoglobine ikuze, kandi monoxide ya karubone ifata inshuro 4 kugeza kuri 5 kugira ngo ikure mu maraso y'inda kuruta amaraso ya nyina. Kubera iyo mpamvu, urwego rwa karboxyhemoglobine rwarazamutse hejuru ya 10% kugeza kuri 15% hejuru y’urwego rw’umubyeyi kandi rugakomeza kuzamuka cyane mu masaha nyuma y’amaraso y’umubyeyi asubiye mu buryo busanzwe, bikagira ibyago byo kubyara cyangwa gukomeretsa ubwonko bw’uruhinja. Hyperbaric ogisijeni ifite umutekano mu gihe cyo gutwita kandi irasabwa igihe cyose umurwayi utwite afite urugero rwa COHb rwa 15% kugeza kuri 20% cyangwa irenga, cyangwa ibimenyetso byose byerekana ububabare bw’imitsi cyangwa ibyara.

Niki Gutinda kwa Neurologiya Sequelae (DNS) nyuma yuburozi bwa karubone, kandi bigaragarira ryari?¶

Gutinda kwa Neurologiya Sequelae (DNS) ni impanuka ya kabiri ya autoimmune na okiside yo mu bwonko yibasira 15-40 ku ijana by'abacitse ku icumu bafite ubumara bukomeye bwa monoxyde de carbone nyuma yo kubeshya "intera intera" y'iminsi 2 kugeza 40 (mubyumweru 2 kugeza kuri 3) bumva ari ibisanzwe rwose. DNS iterwa no kwangirika kwa karubone monoxide ya cytochrome c ya mitochondrial c oxydease na neutrophil-medrated lipid peroxidation yubwonko myelin, DNS itera kwibagirwa gitunguranye, urujijo, ihinduka ryumuntu, kwiheba, cyangwa kugenda kwa Parkinson no guhinda umushyitsi. Byihuse kuvura hyperbaric ogisijeni mugihe cyamasaha 24 uhereye uburozi bwambere bigabanya cyane ibyago byo kwandura DNS.

Niba umuntu yakuwe mu muriro wo mu rugo afite uburozi bwa karubone, kuki abaganga batanga antidote ya IV yitwa Hydroxocobalamin (Cyanokit)?¶

Inzu zigezweho zubatswe hamwe n’umuriro w’ibinyabiziga bitwika plastiki yubukorikori, imishino ya polyurethane, imyenda ya nylon, ubwoya, na silik, irekura gaze yica hydrogène cyanide (HCN) yica hamwe na monoxyde de carbone. Cyanide na karubone monoxide ikora muburyo bwo guhagarika mitochondrial cytochrome c oxydease mubwonko no mumutima. Niba uwibasiwe numuriro ari comatose, mugihe cyo gufatwa k'umutima, hypotensive, cyangwa afite aside irike ikabije (serum lactate iri hejuru ya mm 8/10 mmol / L), abaganga byihutirwa bahita binjiza garama 5 za hydroxocobalamin (vitamine B12a yibanze cyane, ihuza cyanide na vitamine B12 itagira ingaruka mu nkari) hamwe na ogisijeni 100%.

• Aka gatabo gatanga amakuru yuburezi bwihutirwa kandi ntigasimbuza isuzuma ryubuvuzi bwumwuga, ishami ry’umuriro rishobora gukuraho ibikoresho, cyangwa kugisha inama uburozi. Kubera ko uburozi bwa carbone monoxide bushobora gutera vuba ubwenge no gufatwa k'umutima, turasaba cyane ko hashyirwaho UL / EN yemejwe na bateri yatewe inkunga na karubone monoxide ya carbone monoxide kuri buri rwego rwurugo rwawe kandi ugafata ibyemezo byemewe byambere byihutirwa hamwe namasomo ya CPR uhereye kuri Croix-Rouge, Ambulance ya St John, cyangwa utanga amahugurwa yemewe. *

Kuyobora¶

• Umwuka wa karubone hamwe no guhumeka umwotsi ubufasha bwambere
• Cyanide, hydrogen sulfide, hamwe no guhumeka gaze munganda ubufasha bwambere
• Methemoglobinemia, shokora-maraso yijimye, na benzocaine cyangwa uburozi bwa nitrate
• Dioxyde de carbone, sublimation yumye, hamwe na azote ya azote
• CPR no gutabara guhumeka

Inkomoko nubuyobozi¶

• ** Sosiyete y'Ubuvuzi ya Undersea na Hyperbaric (UHMS) hamwe na Sosiyete y'Abanyamerika Thoracic (ATS, Amerika): **
• ** Ibigo bishinzwe kurwanya no gukumira indwara (CDC, Amerika): ** * Amabwiriza y’ubuvuzi y’uburozi bwa Carbone Monoxide (CO) Nyuma y’ibiza *: Imitego yo gusuzuma indwara y’imisemburo ibiri y’imisemburo, gusobanura CO-oximetry, no gucunga inda.
• ** Ishuri rikuru ry’abaganga bo muri Amerika ryihutirwa (ACEP, Amerika): ** * Politiki y’ubuvuzi: Ibibazo bikomeye mu micungire y’abarwayi bakuze bageza ku ishami ryihutirwa hamwe n’uburozi bukabije bwa Carbone Monoxide *.
• ** Komite y’ibihugu by’i Burayi ishinzwe ubuvuzi bwa Hyperbaric (ECHM): ** * Inama y’ibihugu by’i Burayi ku bijyanye n’ubuvuzi bwa Hyperbaric Ibyifuzo by’uburozi bwa Carbone Monoxide n’ubukererwe bwa Neurologiya *.
• ** Ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS / TOXBASE) n’ikigo cy’igihugu gishinzwe ubuzima n’ubuvuzi bwiza (NICE, Ubwongereza): ** * Uburozi bwa Carbone Monoxide: Kumenyekana, Gukaraba Oxygene Normobaric, hamwe na Porotokole ikurikirana *.