Imiti yica udukoko, Organofosifate, nuburozi bw’ubuhinzi Ubufasha bwa mbere¶

Guhura cyane nudukoko twangiza udukoko two mu rugo, cyane cyane ** udukoko twica udukoko twangiza ** (nka malathion, parathion, chlorpyrifos, diazinon), ** udukoko twangiza karbamate ** (aldicarb, karbaryl, propoxur), ** organophosphate nerivi ya fagitire **, ** bipyridyl herbicide; (aluminium cyangwa zinc fosifike) **: ni ikibazo cyangiza ubuzima. Bitandukanye n'uburozi busanzwe bwo murugo butera ingaruka gusa iyo bumize, ibinyabuzima byitwa organophosphates hamwe nu mitsi ya nervice byinjira vuba vuba binyuze muri ** uruhu rutameze neza, rutavunitse **, binyuze mumaso ya **, kandi binyuze muri ** guhumeka ibicu cyangwa imyuka **, bigatera "umuyaga wa cholinergique" wica.

Aka gatabo gatanga intambwe ku yindi gutabara mu murima hamwe na protocole y’amavuriro ihujwe n’amabwiriza yatanzwe n’umuryango w’ubuzima ku isi (OMS), Ikigo cyo muri Amerika gishinzwe kurwanya no gukumira indwara (CDC), Ikigo cy’Amerika gishinzwe kurengera ibidukikije (EPA), Ikigo gishinzwe kwandika uburozi n’indwara (ATSDR), hamwe n’ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS). Kwirinda uturindantoki twa nitrile cyangwa neoprene mbere yo gukoraho uwahohotewe wanduye, kwiyambura imyenda yatewe nudukoko, koza uruhu muminota 15, no kubona byihutirwa ** atropine ** na ** pralidoxime (2-PAM) ** ikiza ubuzima.

Kora ubu¶

Niba wowe cyangwa umuntu uri hafi watewe, ugasuka, guhumeka, cyangwa kumira imiti yica udukoko twangiza ubuhinzi, udukoko twica udukoko twica udukoko, uwica nyakatsi, cyangwa fumigant:

1. ** Irinde ubwa mbere: NTUKIGERE ukora ku muti watewe nudukoko twangiza udukoko cyangwa ibirutsi byabo ukoresheje amaboko yambaye ubusa **: Himura hejuru kandi uzamuke uve kure y’igicu cyangiza imiti, ibicu, cyangwa ububiko bwihuse. Shyira kuri ** nitrile irwanya imiti, butyl reberi, cyangwa uturindantoki twa neoprene ** (uturindantoki dusanzwe tworoheje two mu bwoko bwa latex winjizwa byihuse n'umuti wa organofosifate) mbere yo gukoraho uwahohotewe cyangwa imyenda yabo. Inkeragutabara zikora ku mashati yuzuye organofosifate cyangwa uruhu rwambaye ubusa akenshi zisenyuka kubera uburozi bwa kabiri.
2. ** Hamagara nimero yawe yihutirwa ako kanya **: Hamagara 911 muri Amerika na Kanada, 112 hirya yubumwe bw’ibihugu by’Uburayi, cyangwa 999 mu Bwongereza (cyangwa urebe ibyacu nimero yihutirwa ububiko). Bwira abohereje neza: * "Ukekwaho kwica udukoko twangiza udukoko twangiza udukoko twangiza imiti: HAZMAT kwanduza hamwe na Atropine ikabije."
3. ** Kuraho 100 ku ijana by'imyambaro, inkweto, n'imitako byanduye ako kanya **: Kuraho imyenda yanduye yica udukoko ikuraho ** 80 kugeza 90 ku ijana ** yimiti mbere yuko ishobora kunyunyuza uruhu. Koresha inkweto cyangwa imikasi kugirango ** ukate amashati nipantaro aho kubikurura hejuru yuwahohotewe ** (bihanagura imiti mumaso, izuru, numunwa). Funga imyenda yose yakuweho hamwe ninkweto zimpu (uruhu rwinjiza imiti yica udukoko burundu kandi ntishobora na rimwe kwanduzwa) mumifuka ibiri ya plastike iremereye cyane.
4. ** Koza uruhu n'umusatsi ukoresheje isabune nyinshi n'amazi atemba muminota 15 yuzuye **: Shira uwahohotewe munsi yo kwiyuhagira, shitingi yubusitani, cyangwa sitasiyo yihutirwa hanyuma ukarabe kuva kumutwe kugeza kumutwe ukoresheje isabune yoroheje yoroheje cyangwa ibikoresho byogejwe hamwe namazi meza / akonje muminota 15 ** **. Witondere byumwihariko uruhu rwuruhu, urutoki, umusatsi, ninyuma yamatwi. ** Ntugasukure uruhu rubisi ukoresheje uburoso bukomeye, kandi ntukoreshe amazi ashyushye **, yagura imiyoboro yamaraso yuruhu kandi byihutisha kwinjiza uburozi mumaraso. Niba imiti yica udukoko yamenetse mumaso, oza amaso amazi meza cyangwa saline isanzwe muminota 15 (reba ibikomere by'amaso).
5. ** Komeza inzira yumuyaga, hindukirira uruhande, kandi NTUKIGERE UKORA ubuzima bwo mu kanwa **: Abahohotewe na Organofosifate barohamye mumacandwe yabo menshi, mucus bronchial ("bronchorrhea"), no kuruka. Shira uwahohotewe utazi ubwenge cyangwa yunamye kuruhande rwabo mumwanya wa ** wo gukira ** kugirango ururenda rwibihaha ruvamo umunwa. Niba umutima uhagaze cyangwa guhumeka birangiye, kora ** amaboko-yogusunika igituza gusa (CPR) cyangwa ukoreshe umufuka-valve-mask (BVM) **: ** ntuzigere ukora guhumeka umunwa kumunwa guhumeka **, byerekana umunwa wawe kumyuka yica udukoko twica udukoko no kuruka.
6. ** Tanga autoinjector niba ihari (DuoDote / Mark I / Atropen) **: Niba ibyabaye birimo abakozi ba niveau ya gisirikari / inganda cyangwa itsinda ryita ku buhinzi rifite ibikoresho bya ** DuoDote cyangwa ATNAA (Atropine + Pralidoxime) ** autoinjectors, shyira mu mitsi yo mu kibero cyo hanze ako kanya niba uwahohotewe agaragaje ikibazo cyo guhumeka, guterura imitsi, gufata imitsi.

Umwanya wihutirwa wo kwanduza hamwe na toxidrome triage flowchart¶

flowchart TD
    Start["Ukekwaho kwica udukoko, udukoko twica udukoko, ibyatsi, cyangwa imitsi ya Nerv"] --> SceneSafe{"Ese ibibera bifite umutekano kandi abatabazi bambaye Nitrile / Neoprene PPE?"}

    SceneSafe -->|No: Vapor cloud, enclosed shed, or bare hands| Evac["Himura hejuru yumuyaga mwiza ako kanya <br/> Shyira uturindantoki twa Nitrile / Neoprene (NTAKINTU cyoroshye latex) <br/> Hamagara 911/112/999 kuri HAZMAT & EMS"]

    SceneSafe -->|Yes: Upwind with chemical-resistant gloves| Decon["Ako kanya 80% -90% Gukuraho Inkomoko <br/> Kata imyenda yose yanduye hanyuma ujugunye inkweto zuruhu <br/> Karaba uruhu & umusatsi ukoresheje isabune n'amazi akonje / tepid muminota 15"]

    Evac --> Decon

    Decon --> ToxClass{"Menya icyiciro cya shimi kubimenyetso cyangwa ikirango kirimo"}

    ToxClass -->|Pinpoint pupils, profuse drooling/sweating, wet lung crackles,<br/>vomiting, diarrhea, slow pulse, muscle twitching| Chol["Organophosphate cyangwa Carbamate ('Cholinergic Crisis')"]

    ToxClass -->|Swallowed blue/green foul-smelling liquid herbicide;<br/>severe burning mouth/throat Ulcers| Paraquat["Paraquat cyangwa Diquat Herbicide <br/> Isi yuzuye umunwa cyangwa Amakara ahita akora (niba mugihe cyisaha 1) <br/> HAMWE NA Oxygene yongeyeho keretse SpO2 <85% -88%"]

    ToxClass -->|Garlic/rotten-fish odor after swallowing grain fumigant pellets;<br/>rapid shock and arrhythmias| Phosphide["Aluminium / Zinc Fosifide (Uburozi bwa 'Fosifine') gucunga umutima wumutima & acide"]

    ToxClass -->|Sudden grand mal seizures with NO drooling/pinpoint pupils<br/>after flea/tick spray or agricultural spray| Pyreth["Organochlorine (Lindane / Endosulfan) cyangwa Pyrethroid <br/> Gukaraba isabune yiminota 15 (Amavuta ya Vitamine E yoroshya paresthesiya yuruhu)"]

Pathophysiologiya ya "Cholinergic Storm": Organophosphates na Carbamates¶

Organophosphates (mu ntangiriro yakozwe mu myaka ya za 1930 na 1940 nk'udukoko twica udukoko twangiza ubuhinzi ndetse n’imiti ya gisirikare nka Sarin, Soman, Tabun, na VX) na karbamate ni byo biza ku isonga mu guteza uburozi bwica udukoko twica ku isi hose, bikaba byica abantu barenga 100.000 buri mwaka.

Ukuntu kubuza Acetylcholinesterase (AChE) kwuzuza sisitemu y'imitsi¶

Mu mubiri wumuntu muzima, igihe cyose imitsi ishaka kubwira imitsi kwandura cyangwa glande kugirango isohore amazi, terminal nervice irekura microscopique puff ya neurotransmitter ** acetylcholine (ACh) ** ikoresheje icyuho cya synaptic. Mugice cya milisegonda nyuma yubwo butumwa bumaze gutangwa, enzyme yihariye yo kwita kumurugo yitwa ** acetylcholinesterase (AChE) ** ikata molekile ya acetyloline mo kabiri (mo choline na acide acetike), ihindura switch ** OFF ** kugirango imitsi ishobore kuruhuka kandi glande ihagarike gusohora.

1. ** Fosifora ya "OFF" ihindura **: Organophosphates na karbamate bihuza neza na site ikora ya serine ikora ya enzyme ya acetylcholinesterase, ikamunga rwose enzyme.
2. ** Umwuzure udacogora wa Acetylcholine **: Hamwe na switch ya "OFF" ivunitse, acetylcholine idahwitse yegeranya kugeza murwego runini, rufite uburozi muri buri synaps ya cholinergique mumubiri: kurasa imitsi ya ** muscarinike ** (glande parasimpatique, ibihaha, umutima, amaso, amara), imitsi ya ** nicotinic nervice ** na skeletale ** ibihaha byuzuyemo amazi na diafragm paralize.
3. ** Impamvu Organophosphates ihoraho ("Gusaza") mugihe Carbamates ari iyigihe gito **:
4. ** Imiti yica udukoko twa Carbamate ** (carbaryl [Sevin], aldicarb, propoxur, methomyl) ikora ** isubizwa inyuma ya karbamyl ** hamwe na enzyme ya AChE ihita hydrolyzes ikarekura yonyine mu masaha ya ** 24 kugeza 48.
5. ** Udukoko twica udukoko twica udukoko nudukoko twitwa ** (parathion, chlorpyrifos, malathion, diazinon, dichlorvos, fenthion) bigize umusemburo ukomeye wa fosifore uhindura imiti ihoraho yitwa ** "Gusaza" ** (gutakaza itsinda rya alkyl). Iyo imiyoboro ya organophosphate-enzyme "imyaka" (ifata ahantu hose kuva ** iminota 2 kuri agent ya Soman nervice ** kugeza ** amasaha 12 kugeza 48 kumiti yica udukoko twangiza ubuhinzi **), enzyme yapfuye burundu **. Niba umurwayi atabonye imiti igabanya ubukana ** Pralidoxime (2-PAM) ** * mbere yuko * gusaza birangira, umubiri wabo ugomba gukora molekile nshya ya enzyme kuva kera kugeza ibyumweru 2 kugeza kuri 6.

Kumenya ibice bitatu bya Cholinergic Toxidrome: DUMBBELS & Kuwa mbere kugeza kuwa gatanu¶

Kuberako acetylcholine irenze urugero irasa ibyiciro bitatu bitandukanye byakira icyarimwe, abaganga bashakisha amatsinda atatu yibimenyetso:

1. Kurenza urugero kwa Muscarinic Receptor: "DUMBBELS" cyangwa "SLUDGE + Umwicanyi Bs"¶

Imyuka ya muscarinike ihindura buri glande isohora amazi n'imitsi yoroshye mumubiri. Ibuka mnemonic ** DUMBBELS ** (cyangwa ** SLUDGE **):

• ** D: Impiswi na Diaphoresis **: Impiswi iturika y'amazi no gutobora, kuva ku mutwe kugeza ku ** ibyuya **.
• ** U: Inkari **: Gutakaza kubushake kugenzura uruhago.
• ** M.
• ** B.
• ** B.
• ** B. *.
• ** E: Emesis **: Kuruka ubudasiba no kuribwa mu nda bikabije.
• ** L: Lacrimation **: Gukomeza gutemba mumaso yombi.
• ** S: Amacandwe **: Amazi atemba ava mumunwa.

2. Kurenza urugero kwa Nikotinike: "Iminsi Yicyumweru" (MTWtFS)¶

Mugihe reseptor ya muscarinike itinda umutima kandi ikuzura ibihaha, icyarimwe icyarimwe cya ** nicotinic reseptors ** kumitsi ya skeletale na ganglia adrenal / sympathetic ganglia itera neuromuscular depolarisation ikumira. Ibuka iminsi yicyumweru (** M-T-W-t-F-S **):

• ** M: Mydriasis (idasanzwe yo kwimenyekanisha kwabanyeshuri)
• ** T.
• ** W.
• ** t: Guhinda umushyitsi na Hypertension **.
• ** F.
• ** S: Gufata no kubira ibyuya **.

3. Uburozi bwa sisitemu yo hagati yo hagati: Guhangayika, Koma, na Epilepticus¶

Lipid-soluble organophosphates yambuka inzitizi yubwonko bwamaraso byihuse, bigatera guhagarika umutima, guhagarika umutima, kuvuga nabi, urujijo, ataxia, kwiheba hagati yubuhumekero, koma yimbitse, hamwe nindwara ya cholinergic ya epilepticus ifata ** (ivurwa na ** benzodiazepine imitsi ** nka diazepam, lorazepam), cyangwa midazolam.

Kugereranya neza imiti yica udukoko twangiza ubuhinzi nudukoko two mu rugo¶

Ibitaro Antidote Porotokole Kuburozi bwa Organofosifate¶

Iyo umurwayi ufite organofosifate ikomeye cyangwa uburozi bwa karbamate ageze mubiro byihutirwa, amasegonda abara. Kuzura gukurikiza urukurikirane rukomeye: ** Kwanduza + Kurinda Umuyaga $ iburyo $ Atropine Doubling Regimen $ iburyo $ Pralidoxime (2-PAM) $ iburyo $ Benzodiazepines **.

1.¶

Mu gufata umutima bisanzwe cyangwa bradycardia yoroshye, abaganga batanga miligarama 0.5 kugeza kuri 1 ya atropine kugeza kuri miligarama ntarengwa. ** Mu burozi bukabije bwa organofosifate, miligarama 3 ni igitonyanga mu ndobo: abarwayi basaba buri gihe miligarama 20, 50, cyangwa ndetse na miligarama zirenga 100 za atropine yinjira mu masaha ya mbere ** kugirango babeho.

• ** Uburyo bwihuse bwiyongera kuri atropinisation ikora **:
• Abaganga bavura batangirana na bolus yimitsi ihita ya ** 1 kugeza kuri miligarama 3 za Atropine ** mubantu bakuru (** 0.02 kugeza 0.05 mg / kg ** mubana).
• Ongera usuzume igituza cy'umurwayi ukoresheje stethoscope buri ** iminota 3 kugeza kuri 5 **.
• Niba imitsi ya bronchial itose (bronchorrhea), gutontoma (bronchospasm), cyangwa hypotension / bradycardia (HR < 80 bpm) komeza nyuma yiminota 3 kugeza kuri 5, ** SHAKA inshuro ebyiri ibipimo byabanjirije ** (urugero: $ 2 inyandiko {mg} iburyo 4 umwandiko {mg} iburyo 8 inyandiko {mg} iburyo 16 umwandiko {mg}
• ** Ni izihe mpanvu zukuri za Atropinisation? **:
• ** Sukura ibihaha kuri auscultation ** (guhagarika burundu bronchorrhea no kuzunguruka kugirango umurwayi ashobore guhumeka no guhumeka bitagoranye).
• ** Umutima utera hejuru ya 80 gukubita kumunota ** na ** umuvuduko wamaraso uri hejuru ya 80 kugeza 90 mmHg **.
• ** Amaboko yumye (axillae) **.
• ** Amategeko akomeye y’amavuriro **: ** NTUKIGERE ureka gutanga atropine kubera gusa ko abanyeshuri b’umurwayi baguka cyangwa kubera ko umuvuduko w’umutima wabo ugera ku gukubita 110 ku munota niba ibihaha byabo bikiri byuzuye ururenda rutose. ** Uvura hamwe na atropine kugeza ibihaha byumye. **

2. Pralidoxime (2-PAM / Obidoxime): Gufungura imitsi yamugaye¶

Kuberako atropine ihagarika gusa imitsi ya ** muscarinic ** (kumisha ibihaha no kugena umuvuduko wumutima) kandi ikagira ingaruka zeru kuri reseptor ya nicotinic skeletal imitsi **, umurwayi wa atropine yuzuye ufite ibihaha byumye arashobora gupfa azize diaphragm ya nicotinic na paralise yimitsi yubuhumekero **.

• ** Uburyo Oximes ikora **: ** Pralidoxime (2-PAM) ** (ikozwe kuri garama ** 1 kugeza kuri 2 garama IV hejuru yiminota 15 kugeza 30 ** mubantu bakuru, cyangwa ** 20 kugeza kuri 50 mg / kg ** mubana, ikurikirwa no guhora IV gushiramo 500 mg / isaha cyangwa 8 kugeza 10 mg / kg / isaha) ikora nka molekulari. Itera atom ya fosifore ya molekile ya organophosphate, ikayikuramo enzyme ya acetylcholinesterase na ** igarura ibikorwa byimisemburo yuzuye ya ** kumitsi ya skeletale ndetse na site ya muscarinike: mugihe itanzwe mbere yuko bidasubirwaho ** "gusaza" ** ifunga umurongo burundu.
• ** Kuburira intubation (Ntuzigere ukoresha Succinylcholine) **: Niba umurwayi wa organophosphate cyangwa karbamate bisaba intubation ya endotracheal yihuta, abaganga bagomba ** kutigera bakoresha imiti ya paralitike succinylcholine **, kuko succinylcholine isanzwe isenywa na plasma butyrylcholinesterase (pseudocholinesterase). Kuva umuti wica udukoko wangije imisemburo ya cholinesterase yose, ikinini kimwe cya succinylcholine gitera ** amasaha yamugaye igihe kirekire **. Ahubwo, ikoreshwa rya neuromuscular blokers (nka ** rocuronium **) irakoreshwa.

3. Kureba "Syndrome Hagati" (Nyuma yamasaha 24 kugeza 96)¶

Ndetse na nyuma yuko umurwayi arokotse ikibazo cya mbere cya cholinergique kandi bigaragara ko arimo gukira neza mubitaro, ** 10 kugeza 40% byabarwayi bafite uburozi bwa lipide-soluble organophosphates (nka fenthion, dimethoate, parathion, cyangwa chlorpyrifos) bahita bakura "Syndrome Intermediate" nyuma yiminsi 1 kugeza 4 (amasaha 24 kugeza 96).

• ** Ubumuga butinze butunguranye **: Hatabayeho guhora gutemba cyangwa ibihaha bitose, umurwayi agira ubumuga bukabije bwa ** flexors ya ** ijosi ** (kutabasha gukura umutwe ku musego: ikimenyetso cyo kuburira hakiri kare), imitsi ya cranial **, ** imitsi yigitugu / imitsi yibibuno **, na ** imitsi yubuhumekero (diaphragm) **, bisaba guhita byinjira no guhumeka iminsi 5 kugirango uhindure imitsi 5.
• ** Organophosphate-iterwa na Neuropathie yatinze (OPIDN) **: Bibaho ** ibyumweru 1 kugeza kuri 3 ** nyuma yo guhura kwinshi, bigatera ububabare bwinyana, kunanirwa, gutitira, hamwe no "kubika-na-glove" guta ibirenge / kugabanuka kwintoki.

Nigute Ukoresha Autoinjectors: DuoDote, Mark I, na Atropen¶

Mubikoresho bya gisirikare, bishobora guteza akaga (HAZMAT), serivisi zubuvuzi bwihutirwa (EMS), hamwe n’ahantu h’ubuhinzi bw’inganda, abitabiriye ibisubizo bitwaje imashini zipakurura imizigo yagenewe gutanga ** Atropine ** na ** Pralidoxime (2-PAM) ** binyuze mu myenda mu kibero cy’inyuma mu masegonda make ya organofosifate cyangwa imitsi ya nervice.

Gukoresha Ubwoko Bwinshi na Autoinjector Ubwoko¶

1. ** Imashini zikuze (DuoDote cyangwa ATNAA / Mark I Kit) **:
2. Buri ** DuoDote ** autoinjector itanga ingunguru imwe itanga miligarama 2.1 za Atropine ** na ** miligarama 600 za Pralidoxime Chloride ** ikurikiranye binyuze murushinge rumwe (umusaza ** Mark I Kit ** akoresha inshinge ebyiri zitandukanye: Injeneri # 1 irimo mg 2 za Atropine, naho Injira # 2 irimo 600 mg Pralidoxime).
3. ** Ibimenyetso Byoroheje Kugereranya Ibimenyetso ** (abanyeshuri berekana neza, izuru ritemba, gutemba, gukomera mu gituza, isesemi, ariko umurwayi aracyagenda kandi avuga): Umuyobozi ** 1 DuoDote (cyangwa 1 Mark I nashizeho) ** mumatako yo hagati yinyuma (* vastus lateralis *). Tegereza iminota 10 kugeza kuri 15; niba ibimenyetso bidateye imbere, shakisha ubuvuzi bwinyongera.
4. ** Ibimenyetso Bikabije ** (kutamenya, guhungabana / gufatwa, ububabare bukabije bwubuhumekero / guhumeka, apnea, cyangwa paralise paralise): Ako kanya uhite utanga ** 3 DuoDote autoinjectors (cyangwa 3 Mark I yashyizeho) ikurikiranye byihuse ** mumatako yinyuma, wongeyeho ** 1 Diazepam (CANA 10 mg) cyangwa Midazo gufatwa ntibigaragara (nkuko abamugaye bafite ubumuga bwo mu mutwe bakunze guhura na epilepticus idahungabana mu bwonko).
5. ** Atropen y'abana Ibiro bishingiye ku bipimo **:
6. Abana bato bahuye na organofosifate cyangwa imitsi ya nervice bisaba uburemere buke bwa ** Atropen ** autoinjectors (iboneka muri ** 0,25 mg ** [ikirango cyumuhondo, kubana bato bari munsi yibiro 7/15], ** 0.5 mg **
7. ** Amategeko y'ingenzi arokora ubuzima **: Niba umwana afite ubuzima bwangiza ubuzima bwa organophosphate cyangwa nervice agent (uburozi bwibihaha, guhumeka, koma, cyangwa gufatwa) kandi umuntu mukuru gusa ** 2 mg Atropine / DuoDote ** autoinjector iraboneka kumwanya, ** utange autoinjector ukuze kumwana ako kanya **. Tachycardia ya Atropine by'agateganyo n'uruhu rwumye birashobora kurokoka rwose, mu gihe ifatwa ry'ubuhumekero bwa cholinergique ritavuwe ryica mu minota mike.

Intambwe-ku-ntambwe ya tekinike yo gutera inshinge¶

• ** Intambwe ya 1: Reba umufuka wibibero byinyuma **: Byihuse wumve ikibero cyo hagati cyo hagati kugirango umenye neza ko udatera inshinge, urufunguzo, terefone, cyangwa umukandara wijimye.
• ** Intambwe ya 2: Kuramo ingofero yumutekano wumukara **: Fata ingunguru ya DuoDote mumaboko yawe hamwe na ** icyatsi kibisi cyerekeza hepfo ** (ntuzigere ushyira igikumwe hejuru yicyatsi kibisi). Kuramo ingofero yumutekano wo kurekura neza inyuma.
• ** Intambwe ya 3: Jab ushikamye kuri dogere 90 muri ruguru rwagati rwinyuma **: Kanda hanyuma ukande icyatsi kibisi mumatako yinyama yinyuma hagati yibibuno n'amavi kugeza igihe wunvise ukumva ukanda isoko.
• ** Intambwe ya 4: Fata neza mumasegonda 10 yuzuye **: Kubara gahoro gahoro kugeza 10 ("igihumbi-igihumbi, bibiri-igihumbi ...") bityo ibyumba byombi (atropine na pralidoxime) byuzuye ubusa mumitsi.
• ** Intambwe ya 5: Bika urushinge mumufunzo hanyuma uyihambire kumukingo wuwahohotewe **: Kuramo inshinge neza, kanda massage yibibero mumasegonda make, hanyuma uhindure urushinge rwerekanwe mumatako "J" hejuru yubutaka bukomeye kugirango ubashe guhuza autoinjector irimo ubusa mumufuka w ishati yuwahohotewe. Ibi birabwira abagera ku nkeragutabara n’abaganga byihutirwa iyo urebye umubare wa atropine na 2-PAM umurwayi yamaze kubona.

Ibibazo bikunze kubazwa¶

• Aka gatabo kagamije gutanga amakuru kandi ntigasimbuza isuzuma ry'ubuvuzi bw'umwuga cyangwa amahugurwa y'intoki. Kubera ko uburozi bukabije bw’imiti bushobora gutera guhumeka mu buryo butunguranye, turasaba ko hajyaho ubufasha bwambere bwemewe n’amasomo ya CPR binyuze muri federasiyo mpuzamahanga y’umuryango utabara imbabare Croix-Rouge n’umuryango utabara imbabare (IFRC), umuryango w’igihugu cy’umuryango utabara imbabare Croix-Rouge, St John Ambulance, cyangwa ikigo cy’amahugurwa cyemewe. *

Inkomoko yagenzuwe¶

• Ishami ry'Umuryango w'Abibumbye ryita ku Buzima (OMS): * Imicungire y’ubuvuzi bw’uburozi bukabije bw’udukoko twangiza: Organofosifore, Carbamate, n’amabwiriza y’uburozi bwa Paraquat *.
• Ibigo bishinzwe kurwanya no gukumira indwara (CDC, Amerika) & Ikigo gishinzwe kurwanya uburozi no kwandikisha indwara (ATSDR): * Amabwiriza y’imicungire y’ubuvuzi ku mitsi y’imitsi n’imiti yica udukoko bita Organophosphate * na * Ubuvuzi bwa Paraquat *.
• Ikigo cyo muri Amerika gishinzwe kurengera ibidukikije (EPA, Amerika): * Kumenya no gucunga uburozi bwica udukoko (Edition ya 6) *.
• Ikigo cy’igihugu gishinzwe amakuru y’uburozi (NPIS, Ubwongereza) & Ikigo cy’Ubuzima gishinzwe ubuzima mu Bwongereza (UKHSA): * TOXBASE Ubuvuzi bw’amavuriro ya Organofosifati, Carbamates, Paraquat, na Metal Fosifide *.

Kuyobora¶

• Uburozi ubufasha bwambere hamwe nuburozi bwo kurwanya uburozi
• Gutwika bikabije no gutembera uruhu rwa chimique
• Acide Hydrofluoric, gukuramo ingese, hamwe n’imiti yaka inganda
• Gukomeretsa kw'amaso no kuhira amaso
• CPR no gutabara guhumeka kubantu bakuru
• Imibare yihutirwa ukurikije igihugu