Aspirine (Salicylate), Ibinini by'icyuma, hamwe n'imiti ikabije y'amaraso¶

Imbere hafi ya kabine yubuvuzi bwumuryango, igikoni, igikoni, cyangwa ijoro rya sogokuru bicara ibyiciro bitanu byimiti yo murugo hamwe ninyongera aho kumira ** ibinini 1 kugeza kuri 5 gusa (cyangwa ikiyiko kimwe cyamazi) bishobora guhitana umwana muto ("Umuti umwe wica abicanyi") **, kandi aho kunywa birenze urugero bitera imbaraga zidasanzwe kandi zidakira zidakira.

1. ** Salicylates (Aspirin, Pepto-Bismol / Bismuth Subsalicylate, na Methyl Salicylate / Amavuta yo mu cyatsi)
2. ** Ibikoresho by'ibyuma bya Elemental (Ibinini bikuze bya Ferrous Sulfate na Vitamine zitwite) **: Bikaba bisa neza na shokora ya shokora M & Ms cyangwa Skittles yometse kuri bombo kubana bato, bikangirika mu gifu hamwe no kuruka kwa hémorhagie mbere yo kwinjira muburiganya ** 6-kugeza-24-isaha "byihuta byumutima".
3. ** Antidepressants ya Tricyclic (TCAs: Amitriptyline, Nortriptyline, Doxepin, Imipramine) **: Bikunze kugenwa gusa no kwiheba gusa ahubwo no kumupanga muke wo kwirinda ** migraine, fibromyalgia, ububabare bwubwonko bwa neuropathique, kudasinzira, hamwe no kuryama kwabana **, bikabuza umuyoboro wa sodiumi wihuta. mu minota 60 kugeza 120.
4. ** Umuyoboro wa Kalisiyumu (CCBs: Amlodipine, Nifedipine, Verapamil, Diltiazem) **: Bikaba bihagarika imiyoboro ya L yo mu bwoko bwa L mu mutima no mu mitsi y'amaraso mu gihe ibuza gusohora insuline ya pancreatic, itera ** vasodilatory na cardiogenic ihungabana hamwe na hyperglycemia **.
5. ** Beta-Blockers (BBs: Propranolol, Metoprolol, Atenolol, Carvedilol, Sotalol) **: Bitera ** bradycardia ikabije (umuvuduko ukabije wumutima), hypotension, bronchospasm, na hypoglycemia ** (hiyongereyeho sodium-umuyoboro hamwe na QRS yaguka hamwe na propranolol, cyangwa Torsades de Pointes.

Aka gatabo k’uburozi bwihutirwa butanga ibikorwa byihuse, miligarama imwe kuri kilo ntarengwa yuburozi, kubika amavuriro, hamwe nubuvuzi bwa antivotal ICU (** IV Sodium Bicarbonate inkari alkalinisation, Deferoxamine chelation, Dose-Dose Insulin Euglycemic Therapy [HIET], Intravenous Lipid Emulsion] .

Kora ubu¶

Niba umwana cyangwa umuntu mukuru yamize urugero rwinshi rwa aspirine, amavuta yicyatsi kibisi, ibinini byicyuma, ibinini byumuvuduko wamaraso (beta-blokers cyangwa calcium umuyoboro wa calcium), cyangwa imiti igabanya ubukana bwa tricyclic:

1. ** Hamagara 911/112/999 ako kanya kugirango umwana wese yinjize amavuta yicyatsi kibisi, ibinini byumuvuduko wamaraso, tricyclics, cyangwa fer, cyangwa niba umurwayi wese afite ibimenyetso **: Koresha ibyacu nimero yihutirwa ububiko. Ku muntu mukuru cyangwa umwana udafite ibimenyetso aho ukeneye kubara miligarama kuri kilo imwe, hamagara ** Kugenzura Uburozi (1-800-222-1222 muri Amerika; NHS 111/999 mu Bwongereza; 13 11 26 muri Ositaraliya) ** mugihe witegura kujya mubutabazi.
2. ** Ihanagura umunwa wumwana kubinini bitemewe kandi ukusanyirize icupa ryose hamwe nudupapuro twa blisteri **: Niba umwana muto ashyira ibinini mumunwa, koresha urutoki kugirango ukureho ibinini byose mumatama, ubare ibinini bisigaye mumacupa, hanyuma uzane ibikoresho byuzuye mubitaro.
3. ** NTUKIGERE utera kuruka murugo kandi NTUKIGERE utanga soda yo guteka cyangwa amata adafite icyerekezo cyo kugenzura uburozi **: Gutera kuruka kumurwayi wamize imiti igabanya ubukana bwa tricyclic **, propranolol, cyangwa calcium umuyoboro wa calcium ** ni bibi cyane kuko umurwayi ashobora guta ubwenge cyangwa gufata muminota 30, guhumeka kuruka mubihaha byabo.
4. ** Sobanukirwa n "" Amakara akoreshwa ntabwo ahuza icyuma "itegeko **: Mugihe ibitaro ** byakoreshaga amakara ** bihuza ** aspirine, antidepressants ya tricyclic, beta-blokers, hamwe na calcium umuyoboro wa calcium ** (kandi bigomba gutangwa mugihe cyamasaha 1 kugeza kuri 2, cyangwa mukigero cyinshi kuri aspirine yinjizwamo enterineti), ** amakara akoreshwa ntabwo ahuza ibyuma byibanze **. Ibinini bya radiopaque byometse mu gifu bisaba ibitaro ** Kuvomera amara yose (WBI) hamwe n'umuti wa polyethylene glycol electrolyte (GoLYTELY) ** hamwe na ** Deferoxamine **.
5. ** Shakisha Kwaguka-Kurekura ("XL", "XR", "SR", "CD", "LA") cyangwa ibirango bya Enteric-Coated ("EC") ku icupa **: Kurenza urugero rwa verapamil yagutse-kurekura, diltiazem, nifedipine, metoprolol, cyangwa enteric-cope ya enterinike ya mashyi ** ishobora kugira ** ya mbere ya zeru ** ishobora kugira ** ya mbere ya zeru ** ishobora kugira ** ya mbere ya zeru ** ishobora kugira ** ya mbere ya zeru ** ishobora kugira ** ya mbere ya zeru ** ishobora kugira ** ya mbere ya zeru ** itangira ibimenyetso bya zeru ** bishobora kuba byaragaragaye mbere ya zeru ya ** maraso. Buri kintu cyagutse-kirekura umuyoboro wa calcium cyangwa beta-blokeri bisaba ** kugeza kumasaha 24 yo gukurikirana umutima wumutima wibitaro **, nubwo umurwayi asa neza neza kumasaha ya 4.
6. ** Aburira Abaganga n'Abaganga ba ER kubyerekeye "Umutego wa Salicylate Intubation" : Niba umurwayi ufite uburozi bukabije bwa aspirine (salicylate) ** ahumeka byihuse kandi byimbitse ( 30 kugeza 40 guhumeka kumunota **), iyo hyperventilation ituma bakomeza kubaho bahumeka dioxyde de carbone ($ inyandiko {CO} _2 $). Niba umurwayi yicecekeye kandi akamugara kugirango yinjire muri endotracheal hanyuma ashyirwe ku gipimo gisanzwe gihumeka, ihagarara ritunguranye mu guhumeka ritera amaraso $ inyandiko {pH} $ kugabanuka, gutwara aside salicilique ihuriweho neza ihita yambukiranya inzitizi y'amaraso n'ubwonko kandi bigatuma ** ifata umutima ako kanya mu minota 2 kugeza kuri 5 uhereye intubation **.

Ibihe byihutirwa hamwe na antidote flowchart kubinini byo murugo bifite ibyago byinshi¶

flowchart TD
    Start["Ukekwaho ibinini byo murugo birenze urugero <br/> (Aspirine, Iron, Antidepressant ya Tricyclic, Beta-Blocker, cyangwa Umuyoboro wa Kalisiyumu)"] --> Call["Hamagara 911/112/999 cyangwa Kugenzura Uburozi (1-800-222-1222)"]

    Call --> ClassCheck{"Ni irihe somo ry'imiti ryarimo?"}

    ClassCheck -->|Salicylates: Aspirin, Enteric-Coated Aspirin,<br/>Pepto-Bismol, or Oil of Wintergreen| SalRule["SALICYLATE PROTOCOL (Tinnitus + Hyperventilation + Umuriro) <br/> 1. Amakara menshi akoreshwa namakara (ahuza aspirine concrements / bezoars) <br/> 2. IV Sodium Bicarbonate (NaHCO3) kugirango Amaraso pH 7.45-7.55 & Inkari pH 7.5-8.0 <br/> + Potasiyumu ya IV itera (K +> 4.0) kugirango impyiko zishobore gusohora salicylate <br/> 3. Irinde INTUBATION niba bishoboka; Hemodialysis yihutirwa niba> 100 mg / dL cyangwa ibimenyetso bya neuro / pulm"]

    ClassCheck -->|Elemental Iron: Adult Ferrous Sulfate/Gluconate/Fumarate<br/>or Prenatal Vitamins (Calculate Elemental Iron mg/kg)| IronRule["PROTOKO Y'ICYUMWERU (Amakara akoreshwa ntabwo ahuza icyuma) <br/> 1. Inda X-Ray (KUB) kubona ibinini bya radiopaque ibyuma mu gifu <br/> 2. Kuvomera amara yose (PEG-ELS / GoLYTELY) niba ibinini bya radiopaque bihari <br/> 3. Shushanya Amasaha 4 kugeza kuri 6 Amashanyarazi ya Serumu Urwego Urwego + Gazi Yamaraso / Lactate <br/> 4. IV Deferoxamine Chelation niba Serumu Iron> 500 mcg / dL, Shock, cyangwa Acidose"]

    ClassCheck -->|Tricyclic Antidepressants (TCAs): Amitriptyline,<br/>Nortriptyline, Doxepin, Imipramine| TCARule["TRICYCLIC ANTIDEPRESSANT (TCA) PROTOCOL (Kwihuta Na + Umuyoboro wihuta) <br/> 1. 12-Kuyobora ECG ako kanya: Reba niba QRS> ms 100 cyangwa Terminal R muri AVR> 3 mm <br/> 2. IV Sodium Bicarbonate Bolus (1-2 mEq / kg) kugeza QRS igabanije <100 ms & pH 7.50-7.55 <br/> 3. Kuvura Indwara GUSA hamwe na Benzodiazepine (NTIBIGEZE Phenytoin); IV Lipid Emulsion niba yanze"]

    ClassCheck -->|Calcium Channel Blockers (CCBs: Verapamil, Diltiazem, Amlodipine)<br/>OR Beta-Blockers (BBs: Propranolol, Metoprolol, Sotalol)| CCBBBRule["CARDIOVASCULAR BLOCKADE PROTOCOL (24-Hr Gukurikirana Ibinini bya XR / SR) IV Kalisiyumu Chloride / Gluconate + IV Glucagon (5-10 mg bolus, irenga beta reseptor) <br/> 2. Vasopressors (Norepinephrine / Epinephrine) kuri MAP> 65 mmHg <br/> 3. Ubuvuzi Bwinshi bwa Insuline Euglycemic Ubuvuzi (HIET: 1 kugeza 10 Units / kg / hr Insuline isanzwe + Dextrose) <br/> 4. VA-ECMO cyangwa IV Lipid Emulsion (Intralipid) yo guhungabana k'umutima"]

Kugereranya Umwigisha wa 5 Byinshi-Byica Urugo Ibinini Byinshi murugo¶

Kurohama 1: Salicylate (Aspirin & Amavuta yicyatsi kibisi) Uburozi¶

1. Kumenya uburozi bwa Salicylate (Acute na Chronic)¶

Uburozi bwa salicylate bubaho mubantu babiri batandukanye: (a) ** Kurenza urugero ** mu rubyiruko, abakuze bato, cyangwa abana bato bamira icupa rya aspirine, Excedrin, cyangwa Amavuta ya Wintergreen, na (b) ** Uburozi bwa salicylate karande ("therapy") bwa salicylate ** kubantu bakuze bafata dosiye ndende ya aspirine cyangwa bismuth subalicylate (Pepto subalicylate) ibyumweru nkuko imikorere yimpyiko igabanuka muburyo bworoshye. ** Salicylism idakira itwara umubare munini w'impfu zirenze urugero kurenza urugero kuko ikunze gusuzumwa nabi nka sepsis, umusonga, diabete ya ketoacidose, cyangwa stroke / dementia. **

• ** Ikimenyetso cyo Kuburira hakiri kare Ikimenyetso: Tinnitus (Impeta cyangwa Kutumva) **: Salicylates igira ingaruka ku ngirabuzimafatizo z'umusatsi wa cochlear na neuron spiral ganglion. Iyo serumu salicylate irenze ** 20 kugeza 30 mg / dL **, abarwayi bahura na ** bavuza amajwi menshi mumatwi (tinnitus) cyangwa binubira ko amajwi yumvikana **, aherekejwe no kugira isesemi, kuruka, na diaphoresis (kubira ibyuya).
• ** Umukono Acide-Base Urutoki **:
• Ubwa mbere, salicylate itera mu buryo butaziguye ikigo cy’ubuhumekero cya medullary mu bwonko , bigatuma umurwayi ahumeka cyane kandi byihuse ( hyperpnea na tachypnea **), bihuha $ inyandiko {CO} _2 $ kandi bigatanga ** Alkalose y’ibanze y’ubuhumekero ** (yazamuye amaraso pH hakiri kare).
• Icya kabiri, salicylate ** ikuramo mitochondrial oxyde fosifora ** kuri buri selile yo mumubiri (kimwe na dinitrophenol): ingirabuzimafatizo zikoresha ogisijeni cyane, zitanga ubushyuhe bukabije bwa endogenous umubiri (hyperthermia) ** aho kuba ATP, kandi ikegeranya aside ya lactique, ketoacide, na acide salicylic ubwayo, ikabyara icyarimwe ** Primary High-Anion.

2.¶

Acide Salicylic ni aside idakomeye ($ inyandiko {pK} _a = 3.0 \(). Gusa molekile ya ** idashizwemo (idafite ionisiyonike) (\) inyandiko {HA} \() ** irashobora kwambuka uturemangingo twa lipide kugirango yinjire mu bwonko cyangwa igasubizwa mu maraso iva mu mitsi y'impyiko, mu gihe ** ya salicylate ya ion (\) inyandiko {A} ^ - $) ** ifatiwe hanze ya selile:

& $

• ** Kuki amaraso agwa pH yica umurwayi **: Niba amaraso yumurwayi $ inyandiko {pH} $ yaturutse 7.45 Hasi Kuri 7.20 .
• ** Uburyo IV Sodium Bicarbonate ($ inyandiko {NaHCO} _3 $) ifata salicylate mumaraso ninkari **:
• Abaganga byihutirwa batanga bolus ya ** 1 kugeza kuri 2 mEq / kg IV Sodium Bicarbonate , ikurikirwa no gushiramo ubudahwema ( 3 ampules [150 mEq] ya 8.4% Sodium Bicarbonate ivanze muri litiro 1 ya D5W ** yashizwemo inshuro 1.5 kugeza kuri 2 yo kubungabunga amazi).
• Kuzamura amaraso ya ** arterial pH kuri 7.45 kugeza 7.55 ** bikuramo salicylate * mu bwonko bigasubira mumaraso.
• Kuzamura ** inkari pH kuri 7.5 kugeza 8.0 ** ionize salicylate imbere yigituba cyimpyiko kugirango idashobora gusubirwamo, ** kongera impyiko zisohora aspirine inshuro 10 kugeza kuri 20 **.
• ** Potasiyumu ($ K ^ + \() Itegeko **: Ntushobora ** guhuza inkari niba potasiyumu yamaraso yumurwayi ari muke (\) inyandiko {K} ^ + <4.0 inyandiko {mEq / L} \() **. Iyo potasiyumu ya serumu iba mike, impyiko za kure zimpyiko zifata kuri potasiyumu (\) K ^ + \() mu guta ioni hydrogène (\) H ^ + $) mu nkari (** paradoxical acideuria **), ukagumana aside aside nubwo waba winjije bicarubone zingana iki. Kubwibyo, abaganga bongeye kongeramo ** 40 kugeza kuri 60 mEq / L ya Potasiyumu Chloride ** mumazi ya IV kugirango bagumane serumu $ inyandiko {K} ^ + $ hagati ya ** 4.0 na 5.0 mEq / L **.
• ** Gukosora inzara yubwonko bwihishe ("CNS Neuroglycopenia") **: Kubera ko salicylates yihutisha ubwonko bwa glycolysis mu gihe ibangamira ubwikorezi bwa glucose bwambukiranya inzitizi yubwonko bwamaraso, umurwayi ufite uburozi bwa salicylate ashobora kugira ** glucose yubwonko buke cyane nubwo glucose yamaraso yintoki yasomye 90 cyangwa 100 mg / dL **. Umurwayi wese ufite uburozi bwa salicylate ufite urujijo, delirium, ubunebwe, cyangwa gufatwa yakira ako kanya ** IV Dextrose bolus (D50W cyangwa D10W) ** hatitawe ku isukari y'amaraso y'intoki.

3. Iyo byihutirwa Hemodialysis ari itegeko¶

Kuberako aspirine ifite ubwinshi bwikwirakwizwa, rimwe na rimwe ** hemodialysis ** ikuraho vuba salicylate mumaraso mugihe ikosora asideose hamwe nuburemere bwamazi. Kuri ** Amabwiriza ya EXTRIP **, hemodialysis yihutirwa irerekanwa ako kanya:

1. ** Guhindura imitekerereze ** (urujijo, delirium, stupor, koma, cyangwa gufatwa), CYANGWA
2. ** Indwara ikabije yubuhumekero (ARDS) / Non-cardiogenic pulmonary edema ** isaba ogisijeni yinyongera, CYANGWA
3. ** Gukomeretsa impyiko zikomeye cyangwa zidakira ** (birinda alkalinisation yinkari gukora), CYANGWA
4. ** Serum Salicylate yibanze $> 100 inyandiko {mg / dL} $ ($> 7.2 inyandiko {mmol / L} $) muburyo bukabije burenze urugero ** (cyangwa ** $> 90 inyandiko {mg / dL} $ ** hamwe nimpyiko zangiritse), cyangwa ** $> 60 inyandiko {mg / dL} $ ** muri salicylism idakira, cyangwa urwego rwinshi rwinshi nubwo bikozwe na charicarite nyinshi.

Kwibira Byimbitse 2: Kurenza Icyuma Kurenza urugero na Stage 5 Clinique¶

1. Kubara Elemental Iron Dose Ubwoko bwumunyu¶

Iyo uhamagaye kurwanya uburozi cyangwa ugeze mu ishami ryihutirwa nyuma yo gufata ibinini byicyuma, abaganga babara uburozi bushingiye kuri miligarama ** za ELEMENTAL IRON kuri kilo yuburemere bwumubiri **, ntabwo uburemere bwa miligarama bwuzuye bwumunyu wicyuma:

2. Ibyiciro 5 byubuvuzi byuburozi bwicyuma (Witondere Icyiciro 2)¶

1. ** Icyiciro cya 1: Icyorezo cya Gastrointestinal Icyiciro (Amasaha 0.5 kugeza 6 Nyuma yo Kwinjira) **:
2. Necrosis itaziguye yo mu gifu na mucosa duodenal itera ** itunguranye, ububabare bukabije bwo munda, kuruka inshuro nyinshi (akenshi birimo amaraso atukura yijimye cyangwa "ikawa-yubutaka" yijimye), hamwe nimpiswi zamaraso cyangwa umukara **.
3. ** Amategeko y'ingenzi yo gushyingirwa **: Niba umwana cyangwa umuntu mukuru arwaye ** kuruka zeru, impiswi zeru, no kubabara mu nda zeru amasaha 6 yuzuye ** nyuma yo gukekwa gufata ibyuma, uburozi bukomeye bwa sisitemu burabujijwe.
4. ** Icyiciro cya 2: Icyiciro Cyibeshya / Icyiciro cya Quiescent (Amasaha 6 kugeza 24 Nyuma yo Kwinjira) **:
5. Kuruka birahagarara kandi umwana agaragara atuje cyangwa asinziriye, bituma imiryango (nabavuzi badafite uburambe) batekereza ko umwana akize. Mubyukuri, icyuma cyubusa kirimo gukurwa mu mara mu maraso, kirenze ubushobozi bwo guhuza ** transferrin ** no kwuzura mu ngirabuzimafatizo ya endoteliyale, myocytes yumutima, na ** hepatocytes ** ya hepatocytes **.
6. ** Icyiciro cya 3: Icyiciro cya sisitemu na Metabolic Acidose Icyiciro (Amasaha 12 kugeza 48 Nyuma yo Kwinjira) **:
7. Umwanya munini wa gatatu wamazi, vasodilasiyo itaziguye, kwiheba kwa myocardial, hamwe na fer-catalize ihindura ferrous ($ inyandiko {Fe} ^ {2 +} \() kuri ion ferric (\) inyandiko {Fe} coagulopathie, ubunebwe, na coma **.
8. ** Icyiciro cya 4: Hepatotoxicity / Icyiciro Cyuzuye Cyumwijima Icyiciro (Iminsi 2 kugeza 5 Nyuma yo Kwinjira) **:
9. Ubusa bwa lipide peroxidation yubusa muri ** Hepatic Zone 1 ** (hepatocytes ya periportal, selile yambere yumwijima yibasiwe namaraso yumuvuduko wamaraso uva mu mara) itera ** necrosis ikaze ya hepatike, jaundice, transaminase ikabije, hypoglycemia, no kuva amaraso **.
10. ** Icyiciro cya 5: Inzitizi yo Gusohora / Icyiciro gikomeye (Icyumweru 2 kugeza kuri 6 Nyuma yo Kwinjira) **:
11. Mugihe ruswa yaka cyane imbere mu gifu ikira fibrosis hamwe no gukomeretsa, abarwayi barashobora kurwara ** pyloric stenosis / gastric outlet obstblock ** ibyumweru ** nyuma yo kurokoka urugero rwinshi, bakerekana kuruka kwinshi kutari bili nyuma yo kurya.

3. Kwanduza ibitaro (KUB X-Ray + Kuvomera amara yose) hamwe na Deferoxamine Chelation¶

• ** Inda X-Ray (KUB) **: Ibinini bikomeye byabantu bakuze nibyuma ** radiopaque ** (birabagirana byera byera kuri X-ray yo munda isanzwe mbere yo gushonga). Niba ibinini bidahwitse cyangwa pharmacobezoar yicyuma (clump y ibinini byafashwe) bigaragara kuri X-ray, abaganga batangiza ** Irrose yo munda yose (WBI) ** bakoresheje ** Polyethylene Glycol Electrolyte Lavage Solution (PEG-ELS / GoLYTELY) ** binyuze mumiyoboro ya nasogastric kuri 500 mL/hr mu bana bato cyangwa 1,500 to 2,000 mL/hr mubantu bakuru kugeza imyanda y'urukiramende isobanutse neza kandi X-ray isubiramo yerekana ko nta binini bisigaye.
• ** Urwego rwo hejuru rwa Serumu Icyuma (Gushushanya kumasaha 4 kugeza kuri 6 Nyuma yo Kwinjira) **:
• < 300 mcg/dL: Uburozi busanzwe / buto.
• 300 to 500 mcg/dL: Uburozi buciriritse (busaba kuzura amazi ya IV no gukurikiranira hafi).
• > 500 mcg/dL: Uburozi bukabije bwa sisitemu busaba ako kanya ** Imiyoboro ya Deferoxamine Chelation **.
• ** IV Porotokole ya Deferoxamine **: Deferoxamine ihuza icyuma cya ferricike yubusa ($ inyandiko {Fe} ^ {3 +} $) mu maraso kugira ngo ikore amazi-fer ** ferrioxamine **, isohoka n’impyiko kandi ihindura inkari z’umurwayi ibara ryihariye ** "vin rosé" (pinkish-orange / salmon-umutuku) **. Yashizwemo imitsi kuri ** 15 mg / kg / isaha ** (ukurikiranira hafi hypotension ijyanye nigipimo cyangwa uburozi bwimpyiko iyo ushizwemo amasaha arenga 24).

Kwibira cyane 3: Kurwanya Tricyclic Antidepressant (TCA) Kurenza urugero (Amategeko ya Millisecond 100 QRS)¶

** Amitriptyline, nortriptyline, doxepin, imipramine, clomipramine, na desipramine ** ikomeza gutegekwa cyane kubabara imitsi idakira, migraine prophylaxis, kudasinzira, no kuruka cycle. Kurenza urugero, umurwayi arashobora kuva mukuvugana neza muri ambulance kugeza kuri ** rusange ya tonic-clonic gufatwa, koma, no gufatwa kumutima muminota itarenze 30 **.

1. ** 12-Iyobora ECG nigikoresho cyibanze cyo gusuzuma **:
2. Kubera ko amaraso ya TCA afata iminsi yo kugaruka muri laboratoire, abaganga byihutirwa bayobora uburozi bwa TCA kuri ** 12-bayobora ECG **:
   • ** Sinus tachycardia ** (uhereye kuri antikolinergique muscarinic kuziba).
   • ** Guhindura iburyo bwa terefone 40 milisegonda yindege yimbere QRS axis **: Reba ako kanya kuri ECG nka ** itumanaho rikomeye R umuyaga $> 3 inyandiko {mm} $ mukuyobora aVR ** (hamwe na $ inyandiko {R / S igereranyo}> 0.7 $ mukuyobora aVR) hiyongereyeho umurongo wimbitse S umurongo uyobora I na aVL.
   • ** QRS Igihe cyagutse **:
   • $ inyandiko {QRS} <100 inyandiko {ms} $: Ibyago bito byo gufatwa cyangwa kurwara imitsi.
   • ** $ inyandiko {QRS} ge 100 inyandiko {ms} $ **: ** 33 ku ijana ibyago byo gufatwa muri rusange ** (Kwerekana gutangira Sodium Bicarbonate ya IV ako kanya).
   • ** $ inyandiko {QRS} ge 160 inyandiko {ms} $ **: ** 50 ku ijana ibyago byo guhitana ubuzima bwa tachycardia yangiza ubuzima cyangwa fibrillation ya ventricular **.
3. ** Umuti uhita: Sodium Bicarbonate yinjira ($ inyandiko {NaHCO} _3 $) Bolus **:
4. Igihe cyose igihe ** QRS yamara igeze cyangwa irenga milisegonda 100 **, cyangwa mugihe umurwayi arwaye hypotension cyangwa arththmia yumuyaga, abaganga batanga umuvuduko wa IV wa ** 8.4% Sodium Bicarbonate (1 kugeza 2 mEq / kg kuri bolus) ** buri minota 3 kugeza kuri 5 kugeza ** ** QRS igabanutse munsi ya 100 ms ** na maraso $ **
5. .
6. ** Ibinyuranyo bikomeye muri TCA Kurenza urugero **:
7. ** NTUKIGERE uha Physostigmine ** ya anticholinergic delirium mukurenza urugero kwa TCA (itera gufata umutima wica bradycardic / asystolique yumutima).
8. ** NTUKIGERE Uha Icyiciro cya IA (procainamide), Icyiciro cya IC (flecainide), cyangwa Icyiciro cya III (amiodarone) antiarhythmics ** (bikabije guhagarika umuyoboro wa sodium cyangwa kwagura QT; koresha ** IV Sodium Bicarbonate ** ubanza, na ** IV Lidocaine [Urwego IB] ** cyangwa ** 20%
9. ** NTUKIGERE uha Phenytoin ** kubwo gufatwa na TCA (phenytoin nayo ni umuyoboro wa sodium-umuyoboro; kuvura neza TCA hamwe na ** IV Benzodiazepine [lorazepam, diazepam, cyangwa midazolam] ** wongeyeho ** IV Sodium Bicarbonate **).

Kwibira Byimbitse 4: Umuyoboro wa Kalisiyumu (CCB) na Beta-Blocker (BB) Kurenza urugero¶

1. Uburyo Isukari Yamaraso Itandukanya Ako kanya CCB na Beta-Blocker Kurenza urugero¶

Iyo umurwayi utitabye agaragaje ** bradycardia yimbitse (umuvuduko wumutima 30 kugeza 40 bpm) hamwe na hypotension ikabije (umuvuduko wamaraso 60/30 mmHg) **, isuzuma ryintoki yigitanda cyamaraso glucose itanga ibimenyetso byihuse byo gusuzuma:

• ** Umuyoboro wa Kalisiyumu (CCB) Kurenza urugero bitera HYPERGLYCEMIA **: Kuberako selile pancreatic beta selile isaba umuyoboro wa L wo mu bwoko bwa calcium kugirango urekure granules ya insuline mumaraso, kurenza urugero CCB itera ** hypoinsulinemia ikabije kandi ikagaragaza hyperglycemia (akenshi 200 kugeza 450 mg / dL) ** ndetse no mubarwayi badafite diyabete. Mubyukuri, urwego rwa hyperglycemia rufitanye isano nuburemere bwa CCB irenze urugero.
• ** Beta-Blocker (BB) Kurenza urugero bitera HYPOGLYCEMIA cyangwa Normoglycemia **: Beta-2 adrenergic kuzitira ibuza hepatike glycogenolysis na glucagon pancagonic irekura glucose, bigatuma ** isukari nke yamaraso ** (cyane cyane mubana).

2.¶

Mubihe bisanzwe, imitsi yumutima iruhuka yaka cyane cyane ** aside irike yubusa ** kumavuta. Mugihe gikabije cya calcium ya calcium cyangwa beta-blokeri irenze urugero **, myocardium ihangayikishijwe igerageza guhindura inkomoko yayo ya lisansi ikava kuri acide yibinure ikagera kuri ** glucose **, mugihe icyarimwe inzara ya insuline (biva mumyanya ya calcium yo mu bwoko bwa L yo mu bwoko bwa calcium) hamwe na calcium yo mu nda:

• ** Ukuntu Ubuvuzi Bwinshi bwa Insuline Euglycemic Therapy (HIET) burokora umutima unaniwe **:
• Abaganga byihutirwa batanga ** Bolus isanzwe ya insuline IV ya 1 Unit / kg ** (inshuro 10 isanzwe ya diyabete ya diyabete ya ketoacidose), ikurikirwa no guhora winjiza ** 1 kugeza 10 Units / kg / isaha ya Insuline isanzwe **, ihujwe na ** IV Dextrose yinjiza (D10W cyangwa D50W ukoresheje umurongo wo hagati) ** 100 to 200 mg/dL) hamwe na potasiyumu kugirango ibungabunge serumu $ inyandiko {K} ^ + $ kuri 2.8 to 3.5 mEq/L.
• Insuline ikabije ikora nka ** ikomeye ya inotrope **: ihatira glucose no kwonsa mu buryo butaziguye mu myanya myocytes yumutima yicishije inzara ikoresheje ibimenyetso bya PI3K / Akt, igarura imitsi ya calcium yo mu nda, kandi ikongera umusaruro w’umutima n’umuvuduko wamaraso mu minota ** 30 kugeza 45 ** (niyo mpamvu HIET igomba gutangira * kare * hamwe na ** IV Kalisiyumu **, ** IV Glucagon [5 na 10 mg]. ** Norepinephrine / Epinephrine **, aho gutegereza kugeza umurwayi yamaze gufatwa n'umutima).

Ibibazo bikunze kubazwa¶

Umwana wanjye wimyaka 2 yamize ibinini byanjye mbere yo kubyara hashize amasaha abiri. Kuki umuganga wibyumba byihutirwa yavuze ko badashobora gutanga amakara akora nkuko babikora kubundi burozi?¶

Amakara akoreshwa mukwamamaza molekile nini y’ibiyobyabwenge ishingiye kuri karubone mu byobo byayo bya microscopique, ariko ibyuma bito bito byashizwemo ibyuma (cyane cyane Iron, Litiyumu, Isasu, Potasiyumu, na Sodium) ntibishobora guhuza amakara na gato. Guha amakara yumukara umwana yamize ibinini byicyuma akora zeru kandi mubyukuri byangiza ubuvuzi muguhisha ibitekerezo bya endoskopique kandi bigatuma bidashoboka gutandukanya intebe yamakara itagira ingaruka no kuva kumaraso ya gastrointestinal. Ahubwo, abaganga bafata X-ray yo munda kugirango babone ibinini bya radiopaque, babisukure mu mara bakoresheje Ironderero Ryuzuye (polyethylene glycol solution), hanyuma batange chelation ya Deferoxamine niba urwego rw'icyuma rw'amaraso rw'amasaha 4 kugeza kuri 6 ari uburozi.

Ni ukubera iki ari bibi cyane gushira no gushyira umurwayi ufite uburozi bukomeye bwa aspirine (salicylate) kuri ventilateur ya mashini?¶

Umurwayi ufite uburozi bukabije bwa aspirine ahumeka inshuro 30 kugeza 45 kumunota hamwe numwuka mwinshi, uhumeka (hyperpnea) kugirango uhumure dioxyde de carbone kandi ugumane amaraso yabo pH alkaline nkeya (7.45 kugeza 7.52), ituma aside salicylique ioni mumaraso no hanze yubwonko. Mugihe umuganga atanze imiti igabanya ubukana hamwe nubumuga kugirango yinjizemo umuyoboro uhumeka, umurwayi areka guhumeka mumasegonda 60 kugeza kuri 90, kandi umuyaga usanzwe wumuyaga ntushobora guhuza igipimo kinini cya litiro 25 kugeza kuri 35 kumunota kumunota umurwayi yatangaga wenyine. Mu minota mike, CO2 yagumishijwe itera amaraso pH kugabanuka munsi ya 7.20, igahindura salicylate ionisiyumu muri salicylic salicylic itarishye ihita yinjira mubwonko no mumutima, bigatuma umutima utangira gufatwa. Kubwibyo, abahanga muburozi birinda kwinjiza abarwayi ba salicylate igihe cyose bishoboka kandi bagashyira imbere hémodialyse ako kanya.

Niba umwana muto amira gusa ibinini byongera umuvuduko ukabije wamaraso (nka Verapamil SR cyangwa Nifedipine XL) kandi bisa nkibyishimo 100% nyuma yamasaha abiri, dushobora kuguma murugo?¶

Oya: hamagara 911 hanyuma ujye mubitaro ako kanya. Kwagura-kurekura (SR, XL, XR, CD) umuyoboro wa calcium ya calcium na beta-blokers biri mubizwi cyane "Abicanyi umwe-bica" mubuvuzi bw'abana. Kuberako ibinini byakozwe muburyo bworoshye-polymer matrix cyangwa osmotic pomp shell, irekura hafi ibiyobyabwenge mumasaha 2 kugeza kuri 6, bityo umwana asa nkibisanzwe. Noneho, nyuma yamasaha 8 kugeza kuri 18, akenshi mu gicuku mugihe umwana asinziriye, ibiyobyabwenge bigera kumaraso yuburozi kandi bigatera bradycardia itunguranye, yica ndetse no gufatwa kumutima. Umwana wese amira ndetse numuyoboro umwe wagutse-urekura calcium umuyoboro bisaba amasaha 24 yuzuye yo gukurikirana umutima wumutima wibitaro.

• Aka gatabo kagenewe amakuru kandi ntigasimbuza ubuvuzi bw'umwuga cyangwa inama yo kurwanya uburozi. Kubera ko imiti yo mu rugo irenze urugero ku bana ndetse no ku bantu bakuru ishobora gutera gufatwa gitunguranye, gutakaza umwuka, no gufatwa k'umutima, turasaba cyane ko twafata ibyemezo by’ubuvuzi bw’abana n’abakuze byemewe ndetse n’amasomo ya CPR binyuze muri federasiyo mpuzamahanga y’umuryango utabara imbabare Croix-Rouge (IFRC), umuryango w’igihugu cya Croix Rouge, St John Ambulance, cyangwa utanga amahugurwa yemewe mu karere. *

Inkomoko yagenzuwe¶

• Ishuri Rikuru ry’Ubuvuzi ry’Abanyamerika (ACMT) & Ishyirahamwe ry’Abanyamerika rishinzwe kurwanya uburozi (AAPCC): * Amabwiriza ngenderwaho ya Salicylate, Iron, Tricyclic Antidepressant, Beta-Blocker, na Kalisiyumu Yangiza Uburozi *.
• EXTRIP (Ubuvuzi bwa Extracorporeal muburozi) Itsinda ryakazi: * Ibyifuzo bishingiye ku bimenyetso bifatika byo kuvura indwara zidasanzwe muri Salicylate na Tricyclic Antidepressant Poisoning (Annals of Medicine Emergency) *.
• Itsinda ry’impuguke zihuriweho n’uburozi bwa Kalisiyumu (* Ubuvuzi Bwita ku Buzima *): * Ibyifuzo by’ubwumvikane bwo gucunga imiyoboro ya Kalisiyumu Yangiza Uburozi hamwe n’ubuvuzi bukabije bwa Insuline Euglycemic (HIET) *.
• Ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS, Ubwongereza): * TOXBASE Porotokole yo gucunga ivuriro rya Salicylates, Umunyu wa Ferrous, Antidepressants ya Tricyclic, n’ibiyobyabwenge byumutima *.

Kuyobora¶

• Acetaminofen (paracetamol / Tylenol) irenze urugero hamwe nidirishya rya antidote yamasaha 8
• Uburozi ubufasha bwambere hamwe nuburozi bwo kurwanya uburozi
• Indwara ya Serotonine, syndrome de neuroleptic malignant, hamwe nibiyobyabwenge
• Indwara z'abana n'impinja CPR no kuniga
• Imibare yihutirwa ukurikije igihugu