Aspirin (Salicylate), Iron Pill, uye Blood Pressure Medication Overdose¶

Mukati mekabhati yese yemishonga yemhuri, dhirowa rekubikira, kana imba yekutandarira yasekuru nasekuru munogara makirasi mashanu emishonga yemumba uye yekuwedzera umo kumedza ** piritsi 1 kusvika ku5 (kana teaspoon imwe yemvura) kunogona kuuraya mwana mudiki ("Vaurayi vePiritsi Rimwe")**, uye uko kuwedzeredza kwemunhu mukuru kunokonzeresa nekukurumidza, kwakaoma metabolic uye kwakajairwa tsigiro yetsigiro yemoyo:

1. ** Salicylates (Aspirin, Pepto-Bismol / Bismuth Subsalicylate, uye Methyl Salicylate / Mafuta eWintergreen) **: Iyo isingabatanidzi mitochondrial oxidative phosphorylation, ichikonzera kurira munzeve (tinnitus), isingaregi hyperventilation, hyperthermia, cerepulmonary, cerepulmonary, cerepulmonary, cerepulmonary, neurosis edema.
2. Elemental Iron Supplements (Adult Ferrous Sulfate tablets and Prenatal Vitamins): Izvo zvinopenya zvakafanana necandy-coated chokoreti M&Ms or Skittles kuvana vadiki, inoshatisa dumbu rinoputika nekurutsa kwehemorrhagic vasati vapinda mukunyengera **6-to-24-awa "latent quiescent shockpato quiescent failure" pato quiescent phase.
3. Tricyclic Antidepressants (TCAs: Amitriptyline, Nortriptyline, Doxepin, Imipramine): Inowanzo kunyorerwa kwete yekuora mwoyo chete asiwo padanho rakaderera re **migraine kudzivirira, fibromyalgia, neuropathic nerve pain, kushaya hope, uye weti wehudiki , izvo zvinovharira cardiac fast sodium channels kuti ikonzere kamwe-kamwe, kugumbuka, Q , uye kuputika kukuru. arrhythmias mukati me60 kusvika ku120 maminetsi.
4. Calcium Channel Blockers (CCBs: Amlodipine, Nifedipine, Verapamil, Diltiazem): Iyo inoremadza L-mhando yecalcium migero mumoyo nemutsinga yeropa ichivharira kuburitswa kwepancreatic insulin, zvichikonzera **kuvhunduka kwakanyanya kwevasodilatory uye cardiogenic kwakabatana nechiratidzo hyperglycemia **.
5. Beta-Blockers (BBs: Propranolol, Metoprolol, Atenolol, Carvedilol, Sotalol): Izvo zvinokonzera yakaoma bradycardia (inononoka kurova kwemwoyo), hypotension, bronchospasm, uye hypoglycemia (pamwe ne sodium-channel seizures uye QRS kuwedzera nepropranolol, kana Torsades de Pointes neTorsades de Pointes).

Iyi yakazara emergency toxicology gwai rinopa zviito zvemumunda nekukurumidza, milligram-per-kilogiramu ine muchetura zvikumbaridzo, kiriniki staging, uye yakananga ICU antidotal therapies (IV Sodium Bicarbonate urinary alkalinization, Deferoxamine chelation, Yakakwira-Dose Insulin Euglycemic Therapy [HIET], Intramussional Intramul] Glucagon) yakabatana neAmerican Association of Poison Control Centers (AAPCC), American College of Medical Toxicology (ACMT), iyo EXTRIP Workgroup, uye UK National Poisons Information Service (NPIS).

Ita izvi ikozvino¶

Kana mwana kana munhu mukuru akamedza kuwandisa kweaspirin, wintergreen mafuta, mahwendefa esimbi, mapiritsi eBP (beta-blockers kana calcium channel blockers), kana tricyclic antidepressants:

1. Fonera 911/112/999 nekukasika kuti chero mwana amwe mafuta ewintergreen, mapiritsi eropa, tricyclics, kana iron, kana chero murwere aine zviratidzo: Shandisa yedu nhamba dze emergency directory. Kune mukuru asymptomatic kana mwana kwaunoda nekukurumidza milligram-per-kilogram triage calculation, fonera Poison Control (1-800-222-1222 muUnited States; NHS 111 / 999 kuUK; 13 11 26 kuAustralia) uchigadzirira kuenda kubazi rezvechimbichimbi.
2. **Svairai muromo wemwana kuti muwane mapiritsi asina kumedzwa uye tora bhodhoro rega rega uye blister pack **: Kana mwana mudiki akangoisa mapiritsi mumuromo make, shandisa munwe wekutsvaira kubvisa chero mapiritsi ari pamatama, verenga mapiritsi asara mubhodhoro, uye uuye nemidziyo chaiyo kuchipatara.
3. USAFANIRA kuita kuti vanhu varutse kumba uye USAMBOPA pasoda yekubikisa kana mukaka pasina chakanangana nePoison Control: Kuita kuti murwere akamedza arutse tricyclic antidepressants, propranolol, kana calcium channel blockers kune njodzi huru nekuti murwere anogona kuerekana arasika kana kubata mukati memaminitsi makumi matatu, achifemera marutsi mumapapu ake.
4. Nzwisisa mutemo wekuti "Activated Charcoal doesn't Bind Iron": Nepo chipatara marasha akabatidzwa anosunga aspirin, tricyclic antidepressants, beta-blockers, uye calcium channel blockers (uye inofanira kupihwa mukati meawa 1 kusvika 2, kana kuti inodzokororwa madosi eenteric-coated aspirin), klzzwxh:0023 iron is NOT activated charcoal. Radiopaque iron mapiritsi akanamira mumbu anoda kuchipatara Whole Bowel rigation (WBI) ine polyethylene glycol electrolyte solution (GoLYTELY)** uye intravenous Deferoxamine.
5. **Tsvaga Kuwedzerwa-Kuburitswa ("XL", "XR", "SR", "CD", "LA") kana zvinyorwa zveEnteric-Coated ("EC") pabhodhoro : Kuwedzeredza kwe ** yakawedzerwa-kuburitswa kweverapamil, diltiazem, nifedipine, metoprolol, kana enteric-yakavharidzirwa aspirin kusvika ku8 kwekutanga zviratidzo kwekutanga 6 zviratidzo zvekutanga Kukwira kunouraya kwezvinodhaka kupinda muropa. Yese yakawedzerwa-kuburit calcium channel blocker kana beta-blocker kumedzwa kunoda kusvika kumaawa makumi maviri nemana ekuramba achitariswa moyo muchipatara, kunyangwe murwere achitaridzika zvakanaka paawa 4.
6. ** Nyevedza Paramedics uye ER Vanachiremba nezve "Salicylate Intubation Trap"**: Kana murwere ane yakanyanya **aspirin (salicylate) chepfu ** ari kufema nekukurumidza uye zvakadzama (**30 kusvika 40 kufema paminiti **), kuti hyperventilation iri kuvachengeta vari vapenyu kuburikidza nekuputika carbon dioxide ($\text{CO}_2 $) kubva pakudonha ropa ravo. Kana murwere akaremara uye akaremara nokuda kwe endotracheal intubation uye akaiswa pane yakajairika inononoka kufefetera mwero, kamwe kamwe kumbomira mukufema kunokonzera ropa \(\text{pH}\) kudonha, kutyaira unionized salicylic acid yakananga pamhiri peropa-brain barrier uye kukonzeresa pakarepo kusungwa kwemoyo mukati me2 kusvika ku5 maminetsi eintuba.

Emergency triage uye antidote flowchart yemapiritsi epamba ane njodzi¶

flowchart TD
    Start["Kufungidzirwa Kwepiritsi Yemhuri Yakawandisa <br/>(Aspirin, Iron, Tricyclic Antidepressant, Beta-Blocker, kana Calcium Channel Blocker)"] --> Call["Dana 911 / 112 / 999 kana Kudzora Chepfu (1-800-222-1222) <br/> Tarisa Bhodhoro Kuti Uwane Simba (mg) + Yakawedzerwa-Kuburitswa (XR/XL/SR/EC) Mamiriro"]

    Call --> ClassCheck{"Ndeipi kirasi yemishonga yakamwiwa?"}

    ClassCheck -->|Salicylates: Aspirin, Enteric-Coated Aspirin,<br/>Pepto-Bismol, or Oil of Wintergreen| SalRule["SALICYLATE PROTOCOL (Tinnitus + Hyperventilation + Fever)<br/>1. Multi-Dose Activated Charcoal (inosunga aspirin concrements/bezoars)<br/>2. IV Sodium Bicarbonate (NaHCO3) kuchengetedza Ropa pH 7.45-7.55 & Weti pH 7.5-8.0<br/>+ aggressive IV Potassium (K+ > 4.0) kuitira kuti itsvo dzikwanise kuburitsa salicylate<br/>3. Dzivisa INUBATION kana zvichibvira; Emergency Hemodialysis kana> 100 mg/dL kana neuro/pulm zviratidzo"]

    ClassCheck -->|Elemental Iron: Adult Ferrous Sulfate/Gluconate/Fumarate<br/>or Prenatal Vitamins (Calculate Elemental Iron mg/kg)| IronRule["IRON PROTOCOL (Activated Charcoal HAABANDISI simbi)<br/>1. Abdominal X-Ray (KUB) kuona radiopaque iron mapiritsi mudumbu<br/>2. Whole Bowel Irrigation (PEG-ELS / GoLYTELY) kana mapiritsi eradiopaque aripo<br/>3. Dhirowa 4-to-6 Hour Peak Serum Iron Level + Ropa Gasi/Lactate<br/>4. IV Deferoxamine Chelation kana Serum Iron> 500 mcg/dL, Shock, kana Acidosis"]

    ClassCheck -->|Tricyclic Antidepressants (TCAs): Amitriptyline,<br/>Nortriptyline, Doxepin, Imipramine| TCARule["TRICYCLIC ANTIDEPRESSANT (TCA) PROTOCOL (Fast Na+ Channel Blockade)<br/>1. 12-Lead ECG nekukasira: Tarisa kana QRS> 100 ms kana Terminal R wave muVR> 3 mm<br/>2. IV Sodium Bicarbonate Boluses (1-2 mEq/kg) kusvika QRS yatetepa <100 ms & pH 7.50-7.55<br/>3. Rapa Kubatwa CHETE neBenzodiazepines (HAIMBOPE Phenytoin); IV Lipid Emulsion kana refractory"]

    ClassCheck -->|Calcium Channel Blockers (CCBs: Verapamil, Diltiazem, Amlodipine)<br/>OR Beta-Blockers (BBs: Propranolol, Metoprolol, Sotalol)| CCBBBRule["CARDIOVASCULAR BLOCKADE PROTOCOL (24-Hr Monitoring yeXR/SR Pills)<br/>Tarisa Ropa Glucose: CCB Overdose = HYPERGLYCEMIA vs BB Overdose = HYPOGLYCEMIA<br/>1. IV Calcium Chloride/Gluconate + IV Glucagon (5-10 mg bolus, bypasses beta receptor)<br/>2. Vasopressors (Norepinephrine / Epinephrine) yeMAP> 65 mmHg <br/>3. High-Dose Insulin Euglycemic Therapy (HIET: 1 kusvika ku10 Units / kg / hr Regular Insulin + Dextrose)<br/>4. VA-ECMO kana IV Lipid Emulsion (Intralipid) yerefractory cardiogenic shock"]

Kuenzanisa Kukuru kwe5 High-Lethality Household Pill Overdose¶

Yakadzika Dive 1: Salicylate (Aspirin & Wintergreen Oiri) Chepfu¶

1. Kuziva iyo Salicylate Toxidrome (Acute vs. Chronic)¶

Salicylate chepfu inoitika muvanhu vaviri vakasiyana: (a) ** Kuwedzeredza kwakanyanya ** muvechiri kuyaruka, vechidiki vakuru, kana vadiki vanomedza bhodhoro re aspirin, Excedrin, kana Mafuta eWintergreen, uye (b) ** Chisingaperi ("kurapa") salicylate toxicity ** muvakuru vakura vanotora yakanyanya zuva nezuva dosi ye aspirin-Pemutool kana bilates aspirin kana bilates. manyoka kwemazuva akati kuti kana mavhiki sezvo kushanda kweitsvo dzavo kunoderera. Chronic salicylism inotakura huwandu hwekufa kwepamusoro pane kuwedzeredza zvakanyanya nekuti inowanzoonekwa zvisirizvo sepsis, mabayo, diabetic ketoacidosis, kana sitiroko/dementia.

• Chiratidzo Chekutanga Chekuyambira: Tinnitus (Kurira kana Kunzwa Kwakaoma): Salicylates inokanganisa masero ebvudzi recochlear uye spiral ganglion neurons. Kana mazinga e serum salicylate achipfuura ** 20 kusvika 30 mg / dL **, varwere vanoona ** kurira kwepamusoro-soro munzeve (tinnitus) kana kunyunyuta kuti manzwi anonzwika muffled **, achiperekedzwa nekusvotwa, kurutsa, uye diaphoresis (dikitira).
• Siginecha Acid-Base Fingerprint:
• Kutanga, salicylate inokurudzira zvakananga ** medullary breathing centre mu brain brain , zvichiita kuti murwere afeme zvakanyanya uye nokukurumidza ( hyperpnea uye tachypnea **), iyo inoputika $\text{CO}_2 $ uye inobudisa Primary Respiratory Alkalosis (yakakwirira ropa pH kare kare).
• Chechipiri, salicylate ** isingabatani nemitochondrial oxidative phosphorylation ** pasero rega rega riri mumuviri (senge dinitrophenol): masero anoshandisa okisijeni nehasha, anogadzira yakakura ** endogenous muviri kupisa (hyperthermia)** panzvimbo yeATP, uye inounganidza lactic acid, ketoacids, uye salicylic acid aprimary-Primary-Primary p. Metabolic Acidosis **.

2. Sei Urinary Alkalinization (IV Sodium Bicarbonate) uye Potassium Rescue Work ("Ion Trapping")¶

Salicylic acid iasidhi isina simba (\(\text{pK}_a = 3.0\)). Chete isina kubhadhariswa (isina-ionized) molecule (\(\text{HA}\)) inogona kuyambuka lipid cell membranes kuti ipinde muuropi kana kudzoserwa zvakare muropa kubva muitsvo tubules, nepo charged (ionized) salicylate ion (\(\text{A}^-\)) yakavharirwa kunze kwemasero:

• Sei kudonha kweropa pH kuchiuraya murwere: Kana ropa remurwere \(\text{pH}\) radonha kubva 7.45 pasi ku 7.20 (acidemia), iyo yakaenzana inochinja zvakanyanya kuruboshwe (\(\text{HA}\)), ichibvumira salicylic acid isingachaji kuti ibude muropa yakananga pamhiri peropa-brain barriers kupinda muuropi tishu, zvichikonzera cerebral edema, pfari, coma, uye rufu.
• Mai IV Sodium Bicarbonate (\(\text{NaHCO}_3\)) inoteya salicylate muropa nemuweti:
• Vanachiremba vekukurumidzira vanopa bolus ye ** 1 kusvika 2 mEq / kg IV Sodium Bicarbonate **, inoteverwa nekuwedzerwa kunoramba kuripo (3 ampules [150 mEq] ye8.4% Sodium Bicarbonate yakasanganiswa mu 1 Lita yeD5W yakasimwa pa 1.5 kusvika ku2 nguva yekuchengetedza mvura).
• Kusimudza iyo ** arterial ropa pH kusvika 7.45 kusvika 7.55 ** inodhonza salicylate * kunze * muuropi kudzokera muropa.
• Kusimudza ** weti pH kusvika 7.5 kusvika 8.0 ** ionize salicylate mukati me renal tubules saka haigoni kubatwa zvakare, ** kuwedzera kweitsvo kubuda kwe aspirin ne 10- kusvika ku20-fold **.
• Potassium (\(K^+\)) Mutemo: Haukwanise kupinza alkaline muweti kana potasium yemuropa iri shoma (\(\text{K}^+ <4.0\text{ mEq/L}\))**. Kana serum potassium yakadzikira, distal tubules eitsvo inobatirira pa potassium ions (\(K^+\)) nokurasa maion ehydrogen (\(H^+\)) muweti (paradoxical aciduria), ichichengeta weti iine acidic zvisinei nekuti waisa bicarbonate yakawanda sei. Naizvozvo, vanachiremba vanowedzera zvehasha 40 kusvika 60 mEq/L yePotassium Chloride kune IV zvinwiwa kuchengetedza serum \(\text{K}^+\) pakati 4.0 ne5.0 mEq/L.
• Kururamisa Hwakavanzwa Huropi Nzara ("CNS Neuroglycopenia"): Nekuti salicylates inomhanyisa cerebral glycolysis ichikanganisa kutakurwa kweglucose nepakati peropa-brain barriers, murwere ane salicylate poisoning anogona kuita **yakanyanya kuderera muuropi glucose level kunyangwe kana chigunwe chavo cheropa glucose chichiverenga yakajairika 090/d*1L * 1L. Chero murwere ane salicylate-chepfu ane kuvhiringika, delirium, kuletargy, kana pfari anogamuchira pakarepo IV Dextrose bolus (D50W kana D10W) zvisinei nemunwe wavo shuga yeropa.

3. Kana Emergency Hemodialysis Inosungirwa¶

Nekuda kwekuti aspirin ine vhoriyamu diki yekugovera, pakati hemodialysis inokurumidza kubvisa salicylate kubva muropa ichigadzirisa acidosis uye kuwandisa kwemvura. Per ** EXTRIP nhungamiro **, emergency hemodialysis inoratidzwa nekukurumidza kune:

1. Chimiro chepfungwa chakachinjwa (kuvhiringika, delirium, stupor, coma, kana pfari), KANA
2. Acute Respiratory Distress Syndrome (ARDS) / Non-cardiogenic pulmonary edema inoda kuwedzera oxygen, KANA
3. **Kukuvara kwakanyanya kana kusingaperi kweitsvo ** (iyo inodzivirira weti alkalinization kubva pakushanda), KANA
4. Serum Salicylate concentration \(> 100\text{mg/dL}\) (\(> 7.2\text{mmol/L}\)) mukunyanya kuwandisa (kana \(> 90\text{mg/dL}\) nekusashanda zvakanaka kweitsvo), kana \(> 60\text{mg/dL}\) zvisinei nechirwere chetachiona chakawanda IV bicarbonate.

Yakadzika Dive 2: Iron Supplement Overdose uye iyo 5 Clinical Stages¶

1. Kuverenga Elemental Iron Dose neMunyu Type¶

Paunenge uchifonera Kudzora Chepfu kana kusvika kudhipatimendi rekukurumidzira mushure mekudya kwepiritsi resimbi, vanachiremba vanoverengera huturu zvichibva pa **milligrams ye ELEMENTAL IRON pakirogiramu yehuremu hwemuviri **, kwete huremu hwemilligram hwepiritsi yesimbi yemunyu:

2. The 5 Clinical Stages of Iron Poisoning (Ngwarira Nhanho 2)¶

1. Danho 1: Corrosive Gastrointestinal Phase (0.5 kusvika 6 Maawa Mushure meKudya):
2. Direct corrosive necrosis yemudumbu uye duodenal mucosa inokonzera ** kamwe kamwe, kurwadziwa kwakanyanya mudumbu, kurutsa kakawanda (kazhinji kuine ropa dzvuku rakajeka kana rima "coffee-ground" emesis), uye manyoka ane ropa kana dema.
3. Mutengo Wakakosha Wekuongorora: Kana mwana kana munhu mukuru akaita kurutsa pasina, manyoka zero, uye zero mudumbu kurwadza kwemaawa matanhatu mushure mekufungirwa kunwa iron, yakakosha systemic iron toxicity inobviswa zvinobudirira.
4. ** Nhanho 2: Iyo Inonyengedza Latent / Quiscent Phase (6 kusvika 24 Maawa Mushure meKudya)**:
5. Kurutsa kunomira uye mwana anoita seakadzikama kana kuti akarara, zvichiita kuti mhuri (navanachiremba vasina ruzivo rwokuzviwanira) vafunge kuti mwana ari kupora. Muzvokwadi, simbi yakasununguka iri kutorwa kubva muhutu muropa, kudarika simba rinosungirirwa re **transferrin ** uye mafashamo mumasero endothelial vascular, cardiac myocytes, uye ** hepatic periportal (Zone 1) hepatocytes **.
6. ** Danho rechitatu: Systemic Shock uye Metabolic Acidosis Phase (12 kusvika 48 Maawa Mushure meKudya)**:
7. Kukura kwechitatu-spacing yemvura, yakananga vasodilation, myocardial depression, uye iron-catalyzed kushandurwa kweferrous (\(\text{Fe}^{2+}\)) kuenda kuferric (\(\text{Fe}^{3+}\)) ions nekuburitswa kwemaproton (\(H^+\)) uye mitochondrial uncoupling hypovolemic shock/cardiogenic shock. high-anion-gap lactic acidosis, coagulopathy, lethargy, uye coma**.
8. ** Nhanho 4: Hepatotoxicity / Fulminant Chiropa Kukundikana Chikamu (2 kusvika 5 Mazuva Mushure meKudya) **:
9. Free radical lipid peroxidation mu Hepatic Zone 1 (periportal hepatocytes, masero ekutanga echiropa akarohwa nesimbi-yakazara portal vein ropa kubva muura) inokonzera **acute hepatic necrosis, jaundice, yakakwirira transaminases, hypoglycemia, uye kubuda ropa **.
10. ** Nhanho 5: Gastric Outlet Obstruction / Stricture Phase (2 kusvika 6 Vhiki Mushure meKudya)**:
11. Sezvo kupisa kwakadzika mukati memudumbu kuchipora nefibrosis uye mavanga, varwere vanogona kukudziridza pyloric stenosis / gastric outlet obstruction mavhiki mushure mekupona kunyanyisa kuwandisa, zvichiuya nekurutsa kusinga bilious mushure mekudya.

3. Hospital Decontamination (KUB X-Ray + Whole Bowel Irrigation) uye Deferoxamine Chelation¶

• Abdominal X-Ray (KUB): Mapiritsi esimbi akasimba akareba radiopaque (anopenya muchena wakajeka paEkisireyi yepadumbu isati yanyungudika). Kana mapiritsi asina kusimba kana kuti iron pharmacobezoar (muunganidzwa wemapiritsi akamira) achionekwa paX-ray, vanachiremba vanotanga Whole Bowel Irrigation (WBI) nekumhanya Polyethylene Glycol Electrolyte Lavage Solution (PEG-ELS / GoLYTELY) kuburikidza nechubhu yepanasogastric. 500 mL/hr muvana vadiki kana 1,500 to 2,000 mL/hr muvanhu vakuru kusvikira tsvina yetsvina yanyatsojeka uye kudzokorora X-ray kunoratidza pasina mapiritsi.
• ** Peak Serum Iron Level (Yakadhonzwa pa4 kusvika 6 Maawa Mushure meKudya)**:
• < 300 mcg/dL: Zvakajairwa / zvishoma muchetura.
• 300 to 500 mcg/dL: Pakati pehupfu (inoda IV fluid resuscitation uye kunyatsocherechedza).
• > 500 mcg/dL: Yakanyanya systemic toxicity inoda nekukurumidza Intravenous Deferoxamine Chelation.
• IV Deferoxamine Protocol: Deferoxamine inosunga ferric iron yakasununguka (\(\text{Fe}^{3+}\)) muropa kuti igadzire inonyungudika mumvura ferrioxamine, inobudiswa neitsvo uye inoita kuti weti yemurwere ive yakasiyana "vin rosé" (pinkish-orange salmon-salmon.) Inopinzwa mukati memutsinga pa 15 mg/kg/awa (kunyatsotarisisa chiyero chine chekuita ne hypotension kana pulmonary toxicity kana ikasiiwa kweanopfuura maawa makumi maviri nemana).

Deep Dive 3: Tricyclic Antidepressant (TCA) Overdose (Iyo 100-Millisecond QRS Rule)¶

** Amitriptyline, nortriptyline, doxepin, imipramine, clomipramine, uye desipramine ** inoramba yakarongedzerwa zvakanyanya kusingaperi kurwadziwa kwetsinga, migraine prophylaxis, kushaya hope, uye cyclic kurutsa. Mukuwedzeredza, murwere anogona kubva pakutaura zvakabatana muamburenzi kuenda ku ** generalized tonic-clonic seizures, coma, uye kusungwa kwemoyo mukati memaminitsi asingasviki makumi matatu **.

1. **Iyo 12-Lead ECG Ndiyo Yekutanga Diagnostic Tool **:
2. Nemhaka yekuti TCA mazinga eropa anotora mazuva kuti adzoke kubva kumarabhoritari ekutsvaga, vanachiremba vekukurumidzira vanogadzirisa TCA chepfu zvakananga kubva ku **12-lead ECG **:
   • ** Sinus tachycardia ** (kubva kune anticholinergic muscarinic blockade).
   • Kurudyi kweterminal 40 milliseconds ye frontal plane QRS axis: Inoonekwa nekukasika paECG se ine mukurumbira terminal R wave \(> 3\text{ mm}\) in lead aVR (uye an \(\text{R/S ratio} > 0.7\) in lead aVR) pamwe neyakadzama terminal S wave mune inotungamira I neVL.
   • Kuwedzera Nguva yeQRS:
   • \(\text{QRS} < 100\text{ ms}\): Ngozi isingakodzeri yekubatwa nepfari kana ventricular arrhythmias.
   • \(\text{QRS} \ge 100\text{ ms}\): 33 muzana yenjodzi yekubatwa nepfari (Chiratidzo chekutanga IV Sodium Bicarbonate nekukasika).
   • \(\text{QRS} \ge 160\text{ ms}\): 50 muzana yengozi yehupenyu-inotyisidzira ventricular tachycardia kana ventricular fibrillation.
3. Immediate Antidote: Intravenous Sodium Bicarbonate (\(\text{NaHCO}_3\)) Boluses:
4. Pose QRS yenguva painosvika kana kudarika 100 milliseconds, kana murwere akawedzera hypotension kana ventricular arrhythmia, vanachiremba vanokurumidza IV kusunda kwe 8.4% Sodium Bicarbonate (1 kusvika 2 mEq/kg pa bolus) maminetsi matatu kusvika mashanu ega ega kusvika QRS yatetepa uye ropa repazasi rakaderera* \(100m\)* ** 7.50 kusvika 7.55 **.
5. Inoshanda sei: Zvose kuwedzera kukuru kweextracellular sodium ions (\(\text{Na}^+\)) (iyo inokunda kuvharidzirwa kwemakwikwi ekukurumidza cardiac sodium channels) uye alkaline serum pH (iyo inowedzera mapuroteni kusunga uye inoderedza chikamu che ionized cheTCA chinosungirirwa kumutambo we cardiac conduction)
6. ** Yakanyanya Contraindication muTCA Kuwedzeredza **:
7. ** Usambopa Physostigmine ** ye anticholinergic delirium muTCA overdose (inokonzera kuuraya bradycardic / asystolic cardiac arrest).
8. ** USAFANIRA kupa Kirasi IA (procainamide), Kirasi IC (flecainide), kana Kirasi III (amiodarone) antiarrhythmics ** (vanowedzera sodium chiteshi blockade kana QT kurebesa; shandisa **IV Sodium Bicarbonate ** kutanga, uye **IV Lidocaine [Kirasi IB] ** kana ** 20% Intramulsion Intramulsion * Idlipidipidlipid).
9. usambopa Phenytoin yeTCA-induced seizures (phenytoin is also a sodium-channel blocker; rapa TCA pfari zvakasimba ne IV Benzodiazepines [lorazepam, diazepam, kana midazolam] plus IV Sodium Bicarbonate).

Yakadzika Dive 4: Calcium Channel Blocker (CCB) uye Beta-Blocker (BB) Overdose¶

1. Kusiyanisa Shuwa Yeropa Pakarepo Inosiyanisa CCB vs. Beta-Blocker Overdose¶

Kana murwere asingateereri achiratidza kudzika ** bradycardia (chiyero chemoyo 30 kusvika 40 bpm) uye hypotension yakanyanya (blood pressure 60/30 mmHg)**, cheki yeguchu yemunwe wepamubhedha inopa ruzivo rwekukurumidza kuongororwa:

• Calcium Channel Blocker (CCB) overdose inokonzeresa HYPERGLYCEMIA: Nekuti pancreatic beta masero anoda L-type calcium channel influx kuti abudise insulin granules muropa, yakanyanya CCB overdose inokonzera *acute hypoinsulinemia uye yakaratidza hyperglycemia (kazhinji 200 kusvika 450 mg/dL) kunyange kune vasina chirwere cheshuga. Muchokwadi, chiyero che hyperglycemia chinopindirana zvakananga nekuoma kweCCB overdose.
• Beta-Blocker (BB) Overdose inokonzera HYPOGLYCEMIA kana Normoglycemia: Beta-2 adrenergic blockade inhibits hepatic glycogenolysis uye pancreatic glucagon mediated glucose release, zvichikonzera shuga yeropa (kunyanya muvana).

2. Sei High-Dose Insulin Euglycemic Therapy (HIET) Ndiyo Inogadzirisa Antidote yeCardiovascular Shock¶

Mumamiriro ezvinhu akajairika, tsandanyama yemoyo yakazorora inopisa zvakanyanya **yemahara fatty acids ** yehuni. Munguva yakaoma ** calcium channel blocker kana beta-blocker overdose **, iyo yakasimbiswa myocardium inoedza kushandura tsime remafuta kubva kumafuta acids kuenda ku **glucose **, panguva imwe cheteyo ichifa nenzara ye insulin (kubva kupancreatic L-type calcium channel blockade) uye intracellular calcium:

• **Yakakwira-Dose Insulin Euglycemic Therapy (HIET) inonunura sei mwoyo uri kutadza **:
• Vanachiremba vekukurumidzira vanopa yakakura ** Regular Insulin IV bolus ye1 Unit/kg** (10 times a common diabetic ketoacidosis dose), inoteverwa nekuwedzerwa kunoramba kuripo kwe 1 kusvika 10 Units/kg/awa yeRegular Insulin, yakabatanidzwa ne concentrated **IV Dextrose to normal blood/D510/D 5100 shuga (euglycemia: 100 to 200 mg/dL) uye potassium supplementation kuchengetedza serum \(\text{K}^+\) at 2.8 to 3.5 mEq/L.
• High-dose insulin inoshanda se ** simba rakanaka inotrope : inomanikidza glucose uye lactate zvakananga munzara yemwoyo myocytes kuburikidza nePI3K / Akt kuisa chiratidzo, inodzorera intracellular calcium kubata, uye inowedzera kubuda kwemwoyo uye kuwedzerwa kweropa mukati me ** 30 kusvika kumaminitsi e45 ** (ndicho chikonzero HIET inofanira kutanga * kare kare CalciIV ** IV * IV * 1 , IV Calciumca * IV * 1 , IV * IV * 1) bolus ye beta-blockers], uye Norepinephrine/Epinephrine, pane kumirira kusvikira murwere atova mukusungwa kwemwoyo).

Mibvunzo inowanzo bvunzwa¶

Mwana wangu ane makore maviri okukura akamedza akati wandei emapiritsi angu epamuviri maawa maviri apfuura. Sei chiremba wemumba yekukurumidzira akati HAVAGANI kupa marasha akabatidzwa sezvavanoita kune dzimwe chepfu?¶

Mazimbe akabatidzwa anoshanda nekushambadza mamorekuru emuorganic kabhoni-based drug mamorekuru mumapores ayo asingaoneki, asi maioni madiki anochajiswa esimbi (kunyanya Iron, Lithium, Lead, Potassium, uye Sodium) haisungiri kumarasha akabatidzwa zvachose. Kupa marasha eblack activated charcoal kumwana akamedza mahwendefa esimbi hakuna kunaka uye kunokuvadza kuchengetwa nekuvharidzira maonero endoscopic uye kuita kuti zvisakwanise kusiyanisa chituru chemarasha chisingakuvadzi kubva kune ngozi inokonzerwa nesimbi inobuda mudumbu. Pane kudaro, vanachiremba vanotora X-ray yemudumbu kuti vaone mapiritsi esimbi eradiopaque, voaputisa nemuura vachishandisa Whole Bowel Irrigation (polyethylene glycol solution), vopa intravenous Deferoxamine chelation kana 4-to-6-hour iron level ine chepfu.

Sei zvine njodzi kupinza uye kuisa murwere ane yakanyanya aspirin (salicylate) chepfu pane mechanic ventilator?¶

Murwere ane chepfu yeAspirin anofema 30 kusvika ka45 paminiti nemweya wakadzika, wekufema (hyperpnea) kuti ubvise carbon dioxide uye kuchengeta ropa ravo pH zvishoma alkaline (7.45 kusvika 7.52), iyo inochengetedza salicylic acid ionized muropa uye kunze kweuropi. Kana chiremba achinge apa mishonga yekurodza neyakaoma mitezo kuti aise chubhu yekufema, murwere anomira kufema kwemasekonzi makumi matanhatu kusvika makumi mapfumbamwe, uye mwero wemuchina wekufemesa haukwanise kuenderana nehukuru hwe25-to-35-liter-per-miniti yekufemesa murwere aigadzira ega. Mukati maminetsi, CO2 yakachengetwa inoita kuti ropa pH ridzikire pazasi 7.20, kushandura ionized salicylate kuita uncharged salicylic acid inomhanya yakananga muuropi nemumoyo, zvichikonzera kusungwa kwemoyo kamwe kamwe. Naizvozvo, toxicologists vanodzivirira intubating salicylate varwere pese pazvinogoneka uye vanoisa pamberi ipapo hemodialysis panzvimbo.

Kana mwana mudiki akamedza piritsi IMWE chete rakawedzerwa-kuburitsa ropa reBP (seVerapamil SR kana Nifedipine XL) uye achitaridzika 100% achifara uye aine simba maawa maviri gare gare, tinogona kugara kumba here?¶

Kwete: fonera 911 uye enda kuchipatara nekukurumidza. Kuwedzerwa-kusunungurwa (SR, XL, XR, CD) calcium channel blockers uye beta-blockers ndevamwe vanozivikanwa zvikuru "One-Pill Killers" muvana. Nekuti piritsi racho rakagadzirwa mune inononoka-kuburitsa polymer matrix kana osmotic pombi goko, inoburitsa inenge isina mushonga mukati memaawa maviri kusvika matanhatu ekutanga, saka mwana anotaridzika seakajairika. Zvadaro, maawa 8 kusvika ku18 gare gare, kazhinji pakati peusiku mwana akarara, mushonga wacho unosvika muropa rine chepfu uye unotanga kamwe kamwe, bradycardia inouraya uye kusungwa kwemwoyo. Mwana wese anomedza kunyange kamwe-yakawedzerwa-kuburitsa calcium channel blocker inoda maawa makumi maviri nemana akazara ekuenderera mberi kwechipatara chekuongorora mwoyo.

*Gwairi iri nderezvinangwa zveruzivo uye haritsivi rubatsiro rwekurapa rwenyanzvi kana kubvunza Poison Control. Nekuti kuwandisa kwemishonga yemumba muvana nevakuru kunogona kukonzeresa kubatwa nekukurumidza, kurasikirwa nemhepo, uye kusungwa kwemoyo, isu tinokurudzira zvakasimba kutora yakatenderwa yevana uye yevakuru rubatsiro rwekutanga uye CPR kosi kuburikidza neInternational Federation yeRed Cross neRed Crescent Societies (IFRC), yako yenyika Red Cross nzanga, St John Ambulance, kana yakasimbiswa yemuno kudzidzisa mupi.

Kwatariswa¶

• American College of Medical Toxicology (ACMT) & American Association of Poison Control Centers (AAPCC): * Dzidzira Mazano eSalicylate, Iron, Tricyclic Antidepressant, Beta-Blocker, uye Calcium Channel Blocker Poisoning *.
• EXTRIP (Extracorporeal Treatments in Poisoning) Boka rekushanda: * Uchapupu-hwakavakirwa Mazano eExtracorporeal Treatment muSalicylate uye Tricyclic Antidepressant Poisoning (Annals of Emergency Medicine) *.
• Nyanzvi Consensus Panel pamusoro peCalcium Channel Blocker Poisoning (* Critical Care Medicine *): * Consensus Recommendations for Management of Calcium Channel Blocker Poisoning uye High-Dose Insulin Euglycemic Therapy (HIET) *.
• National Poisons Information Service (NPIS, United Kingdom): TOXBASE Clinical Management Protocols yeSalicylates, Ferrous Salts, Tricyclic Antidepressants, uye Cardiovascular Drugs.

Mazano anoenderana¶

• Acetaminophen (paracetamol / Tylenol) overdose uye 8-awa antidote hwindo.
• Chepfu yekutanga rubatsiro uye chepfu yekudzora triage
• Serotonin syndrome, neuroleptic malignant syndrome, uye kusangana kwezvinodhaka
• CPR yevana uye yevacheche nekudzipwa
• Nhamba dzenjodzi nenyika