Dib-u-noqoshada Dulqaadka Kadib Khatar Xad-dhaaf ah, Xylazine Seedation, iyo Dib-u-qaadista Naloxone¶

Daaqadda kaliya ee ugu dhimashada badan 14-maalmood ee nolosha qofka qaba xanuunka isticmaalka opioid wuxuu dhacaa ** isla markiiba ka dib marka uu ka tago unugga detox-ka ee ka-hortagga kaliya, xarun dhaqancelin oo la deggan yahay, isbitaal gelitaan, ama xabsi ama xabsi ***. Xogta cudurrada faafa ee Ururka Caafimaadka Adduunka (WHO), Xarumaha Xakamaynta iyo Kahortagga Cudurrada ee Maraykanka (CDC), iyo Xafiiska Horumarinta Caafimaadka ee Boqortooyada Midowday (UK) waxay muujinayaan in inta lagu jiro labada toddobaad ee ugu horreeya ka dib markii laga sii daayo xabsiga ama sunta bukaan-jiifka, khatarta qofka ee u dhimanaya qiyaasta xad-dhaafka ah ee opioid ee shilalka ah waxay kordhisaa ** 10-laab ilaa 40-laab marka la barbardhigo isticmaalayaasha firfircoon maalin kasta. In kasta oo rabitaanka nafsiyeedku uu weli yahay mid daran, kaliya ** 3 ilaa 7 maalmood oo ka-hortagga opioid-ka ayaa meesha ka saaraya dareenka soo-dhoweeyaha noolaha ee jirridda maskaxda ***, dib-u-dejinta dulqaadka neefsashada ee qofka opioid-naive. Haddii qofkaas uu la kulmo daqiiqad walbahaar, ku soo noqdo sahaydiisii ​​hore, oo uu qaato xitaa qayb yar oo ka mid ah qiyaasta daawada sunta-ka-hortagga ah ee ay yaqaaneen, waxay isla markiiba la kulmaan xirmo neefsasho oo dilaa ah.

Khatarta dulqaadka ka dib waa sahayda dawooyinka waddooyinka ee aan nidaamsanayn ee sii kordheysa ee lagu daray ** fentanyl si sharci darro ah loo soo saaray , benzimidazole opioids (nitazenes), alfa-2 adrenergic sedatives (xylazine / "tranq") iyo medetomidines benzodines (bromazolam). Isku-darka fentanyl-iyo-xylazine isku-darka ah, kuwa taagan ee buufiyay saddex ama afar sanduuq oo ** Naloxone (Narcan) ** si isdaba joog ah oo isku xigta oo sugaya qofka inuu fadhiisto oo hadlo wuxuu sameeyaa khalad muhiim ah: sababtoo ah naloxone kaliya waxay ka noqotaa qaybta opioid mana ka celin karto suuxinta xylazine, si xad dhaaf ah u maamulida naloxone maskaxda, taas oo ah ** neefsasho samatabbixin joogto ah (1 neefsasho 5 ilbiriqsi kasta) oo lagu daray 2-ilaa-3-daqiiqo naloxone oo si adag dib loogu habeynayo ** soo celinta neefsashada.

Hadda samee tan¶

1. Ka hubi neefsashada iyo jawaab celinta marka hore, ka dibna wac nambarka degdega ah ee degaankaaga isla markaaba. Qofka garbaha si adag u rux, lugahaaga si xawli ah ugu xoq bartamaha lafahooda naaska (sternum xoq), oo ilaali laabta ilaa 5 ilbiriqsi. Hadday jawaabi waayaan, aysan neefsaneyn, ama ay sameynayaan oo kaliya aayar, xiiqsan, khuuraya, ama sanqadh gurracan ("dhimasho dhimasho", in ka yar 8 neefsasho daqiiqadii) leh bushimo buluug, guduud, ama xishood-cawlan iyo ciddiyihii, wac 911 gudaha Mareykanka iyo Kanada, 112 guud ahaan Midowga Yurub, 999 gudaha Boqortooyada Midowday nambarada degdega ah hagaha.
2. ** Isla markiiba maamul 1 dose oo Naloxone ah (4 mg Narcan buufinta sanka ah ama 0.4 mg duritaanka muruqa ah) isla markaaba. Ha ku buufin qalabka marka hore hawada, sababtoo ah cutub kastaa wuxuu hayaa hal mar oo keliya.
3. **Bilow Neefsashada Samatabbixinta isla markiiba (1 neefsasho 5 ilaa 6 ilbiriqsi kasta) hana joogsan inta aad sugayso naloxone inuu shaqeeyo ilbiriqsi *** (10 ilaa 12 neefsasho daqiiqadii). Haddii aysan lahayn garaaca garaaca wadnaha, bilow CPR buuxa (30 laabta oo cadaadin ah ilaa 2 neefsasho samatabbixin ah; eeg annaga xad dhaafka opioid iyo CPR hagayaal).
4. Ka hubi neefsashada calaamadda 2-ilaa-3-daqiiqo: haddii uusan qofku WELI u neefsanayn si caadi ah (in ka yar 10 neefsasho/daqiiqo), sii qiyaasta 2-aad ee Naloxone ee daloolka kale ee sanka. Sii wad neefsashada samatabbixinta inta u dhaxaysa qiyaas kasta.
5. ** JOOJI siinta Naloxone dheeri ah marka qofku bilaabo inuu si tartiib ah u neefsado naftiisa (10+ neefsasho/daqiiqo), xitaa haddii ay ka miyir beelaan Xylazine ("tranq"). xirid. Haddii laabtoodu kor u kacdo oo si joogto ah u dhacayso 10 ilaa 16 jeer daqiiqadii midabkooduna casaan yahay, ha ku sii shubin santuuqyo dheeraad ah oo Narcan sanka ah, taasoo keenta matag degdeg ah iyo barar sambabada. Dhinacooda u gal Booska Soo kabashada oo la soco neefsashadooda ilaa ay ka imanayaan dhakhaatiirta caafimaadka.
6. ** U fiirso dib u dhigista "Renarcotization" (ku soo noqoshada xad-dhaafka ah) ugu yaraan 3 ilaa 4 saacadood.** Naloxone waxay gashataa ** 30 ilaa 90 daqiiqo **, halka fentanyl, nitazenes, ama methadone-qaadashada sare ay ku jiraan jirka 4 ilaa 12+ saacadood. Waligaa ha ka tagin qof dib loo soo nooleeyay oo keli ah si uu "u seexdo."

Geedka Go'aanka: Dib u celinta Walaxda Casriga ah (Fentanyl + Xylazine / Nitazene)¶

Isticmaal shaxdan socodka samatabbixinta tillaabo-tallaabo ah marka aad u jawaabayso qof aan ka jawaabin marka ay ku lug yeelan karaan opioids synthetic ama "tranq dope" (fentanyl + xylazine).

flowchart TD
    A["Qofka Aan U Jawaabin + Qunyar, xiiqsan, Khuuraya, ama Neefsasho maqan (<8 neefsasho/daqiiqo)"] --> B["Isla markiiba wac 911/112/999 + Maamul qiyaasta 1aad ee Naloxone (4 mg Buufida Sanka ee sanka 1)"]
    B --> C["Isla markiiba u bilow Neefsashada Samatabbixinta: Madaxa leexi, garka kor u qaad, sanka qanjaruufo, sii 1 neef 5 ilbiriqsi kasta"]
    C --> D{"Sug 2 ilaa 3 Daqiiqo Markaad Bixinayso Neefta Samatabbixinta: Qofka hadda ma neefsanayaa iskiis (>=10 neefsasho/daqiiqo)?"}
    D -->|"MAYA: Wali ma neefsanayo ama ma neefsanayo (<8 neefsasho/daqiiqo)"| E["Maamul qiyaasta 2-aad ee Naloxone (gudaha sanka 2) + Sii wad Neefsashada samatabbixinta (1 neefsasho 5-tii ilbiriqsi kasta)"]
    E --> F{"Sug 2 ilaa 3 Daqiiqo oo kale: Neefsashada ayaa soo noqotay?"}
    F -->|"MAYA (Qiyaas Sare oo looga shakisan yahay Fentanyl, Carfentanil, ama Nitazene)"| G["Maaree 3rd/4aad Qiyaasta Naloxone 2-3 daqiiqo kasta + Neefsashada samatabbixin aan kala go' lahayn / CPR ilaa EMS ka timaado"]
    D -->|"HAA: Si tartiib ah u neefso (10-16 neefs/daqiiqo) iyo bushimaha oo casaan isu beddelaya, LAAKIIN qofku weli waa suuxsan yahay/ hurday"| H["XYLAZINE/BENZO CO-EXPOSURE: JOOJI siinta Naloxone dheeraad ah; gal booska Soo kabashada oo hawo mareenka fur"]
    F -->|"HAA: Neefsashada ayaa soo noqotay"| H
    H --> I["La joog bukaanka 3 ilaa 4+ saacadood; u fiirso Renarcotization marka Naloxone gafto daqiiqada 30 ilaa 90"]

Qaybta 1: Cilmiga Neerfaha ee Dulqaadka Dib U Soo Noqoshada¶

Qoysaska iyo dadka soo kabsanaya ayaa inta badan la yaabay inay ogaadaan in ** ka qalin-jabinta 7-maalmood sun-saarista ama 28-maalmood ka-hortagga-kaliya baxnaanintu ay tahay mid ka mid ah daqiiqadaha ugu khatarta badan ee dhimashada degdega ah**. Fahmidda sida ** mu-opioid reseptor (\(\mu\)-OR) dareen-celinta** u shaqeyso waxay sharraxaysaa sababta:

1. Sida Dulqaadka Joogtada ah u Dhisayo: Isticmaale maalinle ah oo opioid ah, xarumaha neefsiga maskaxda (* pre-Bötzinger complex*, kaas oo koontaroolaya heerka neefsiga tooska ah kana jawaabaya kor u kaca carbon dioxide \(\text{CO}_2\)) ayaa si joogto ah u daadiya opioids. Si qofka looga ilaaliyo in uu neefta joojiyo, neurons-ku kiimiko ahaan phosphorylate oo ay dareensiiyaan mu-opioid reseptors-kooda, una baahan 10 ilaa 50 jeer ka badan opioid si ay u keenaan xirid neefsasho marka loo eego isticmaale markii ugu horeysay.
2. ** Sida dhakhsaha leh ee dulqaadka neefsiga u baaba'o:** Si ka duwan dulqaadka saamaynta euphoric* ee opioids (kaas oo sii jira bilo), ** dulqaadka niyad-jabka neef-mareenka ee uu keeno opioid si degdeg ah ayey dib ugu noqotaa 3 ilaa 7 maalmood gudahooda ee ka-hortagga**.
3. Dabinka Detox-ka-dabaynta: Marka qofku dhammeeyo sun-saarid 5-maalmood ah, uu isbitaal ku jiro toddobaad caabuqa, ama uu 10 maalmood ku qaato xabsiga degmada iyada oo aan la helin Buprenorphine (Suboxone) ama Methadone, daaweeyayaasha maskaxda ee neef-mareenka ayaa si buuxda u dareensiiyaa inta ay jecel yihiin nafsiyanlimbic dopamine mismatch) waxay marayaan meeshii ugu saraysay abid.
4. **Xitaa si aad u cajiib badan, Pavlovian neuropharmacology Studies ayaa muujinaya in marka qofku isticmaalo opioids ** cusub, meel aan la aqoon ** (sida qolka hudheelka, musqulka gaaska, ama qolka saaxiibka) halkii ay ka ahaan lahaayeen qolkooda caadiga ah, maskaxdoodu ma kicinayso qolalkooda hoose ee guriga. xadka xitaa ka sii dheer.

Sida daawada loogu talagalay Isticmaalka Opioid (MOUD) ay uga ilaaliso soo noqoshada dhimashada¶

Dulqaadkan degdega ah ee luminta ayaa ah sababta saxda ah ee Ururka Caafimaadka Adduunka (WHO), Machadka Qaranka ee Xad-gudubka Maandooriyaha (NIDA), iyo ** Society American of Addiction Medicine (ASAM)** waxay si adag ugu taliyaan ka hortagga sun-saaritaanka iyada oo aan la socon Daawaynta Xanuunka Isticmaalka Opioid (MOUD):

• Buprenorphine (Suboxone, Sublocade, Brixadi) iyo Methadone waxay ku hayaan mu-opioid reseptors-ka waxayna ilaaliyaan ** dulqaadka neefsiga** 24 saac maalintii.
• Sababtoo ah buprenorphine waxay leedahay xiriir aad u sarreeya oo ku xiran mu-opioid reseptor, haddii bukaan qaadanaya maalin kasta Suboxone (ama * Sublocade * duritaanka) uu leeyahay daqiiqad daciif ah oo uu hal mar siibo 70 boqolkiiba**.
• Taa beddelkeeda, haddii bukaanku doorto xannibaadaha aan-opioid-ka ahayn ** sii-daynta-sii-daynta Naltrexone (Vivitrol)**, waa la ilaaliyaa inta tallaalka 28-maalmood uu shaqeynayo, ** laakiin waa in looga digaa in haddii ay seegaan tallaalkooda bisha soo socota, dulqaadkooda opioid waa eber ***.

Qaybta 2: Xylazine ("Tranq"), Medetomidine, iyo Nitazenes oo ku yaal Jidka¶

Dhawrkii sano ee la soo dhaafay, keenista daroogada sharci darrada ah ee Waqooyiga Ameerika iyo qaybo ka mid ah Yurub waxay ka soo wareegtay heroin saafi ah ama fentanyl waxayna u beddeshay kakan ** isku darka walaxda** taas oo bedesha sida xad-dhaafka u ekaado ugana jawaabto gargaarka degdegga ah.

Shaxda Isbarbardhigga: Sinaystayaasha Waddada iyo Sida ay u Bedelaan Gargaarka Degdegga ah ee Xad-dhaafka ah¶

Sida loo daryeelo Xylazine ("Tranq") nabarrada maqaarka necrotic¶

Si ka duwan cirbadeynta bakteeriyada caadiga ah (taas oo ka dhacda kaliya meesha saxda ah ee irbad aan nadiif ahayn ay ka dhufatay maqaarka), ** xylazine waxay sababtaa vasoconstriction daran ***, xirida xididdada dhiigga yaryar ee maqaarka oo dhan iyo unug gaajaysan oo ogsijiin ah, taasoo keenta ** feeray, guduud-ilaa-madow necrotic ah boogaha, gacmaha kaliya boogaha, gacmaha iyo boogaha. khuurada ama qiiqa daroogada:

• Weligaa ha ku xoqin boogaha xylazine hydrogen peroxide, ku xoqin alkohol, ama warankiilo, kaas oo dila unugyada jilicsan ee cusub ee isku dayaya inuu bogsiiyo boogaha.
• Si tartiib ah maalin kasta hal mar ugu dhaq biyo qandac ah oo nadiif ah iyo saabuun khafiif ah ama cusbo nadiif ah, mari lakab qaro weyn ** cadar malab heer caafimaad ah, faashad xeroform petrolatum, ama batroolka cad cad (Vaseline)** si aad u qoydo sariirta dhaawaca, oo ku dabool suuf nadiif ah oo aan dheg lahayn (Telfa) iyo faashad dabacsan.
• **Raadi daryeel caafimaad oo degdeg ah *** haddii casaanku si degdeg ah ugu faafo boogaha, xariijimo guduudan oo kor u kaca addimada, qandhada ayaa soo baxda, ama lafo/ tendon ay ka muuqdaan saldhigga nabarka (khatarta lafo-beelka iyo sepsis; eeg our our sepsis iyo shoog septic hage).

Qaybta 3: "Hadafku waa Neefsasho, Ma toosayo" Naloxone Dib-u-habaynta Hab-maamuuska¶

Xilligii xylazine iyo qiyaasta sare ee naloxone naloxone sanka (sida 4 mg Narcan, 8 mg Kloxxado************), wakaaladaha caafimaadka dadweynaha iyo dhakhaatiirta ku taqasusay dawada balwadda waxay xooga saarayaan isbeddel muhiim ah oo ku saabsan tababbarka xad-dhaafka ah: ** Hadafka maamulida Naloxone waa in la soo celiyo neefta buuxda ee 10 daqiiqo (10 daqiiqo) miyir.**

Waa maxay sababta maamulka xad dhaafka ah ee Naloxone ay u keento waxyeelo¶

Marka qof ag joogey uu ka helo qof miyir daboolan "tranq dope" (fentanyl + xylazine) oo ku buufiyo afar 4-milligram Narcan buufin ah (16 mg wadarta guud) sanka 60 ilbiriqsi gudahood sababtoo ah qofku weli indhaha ma kala qaadin:

1. **Naloxone waxay qaadataa 2 ilaa 3 daqiiqo oo buuxa si ay u nuugo xuubka sanka ee sanka oo ay ka gudubto xannibaadda dhiigga iyo maskaxda.
2. **Markii fentanyl-ka laga soo dhufto xajiyayaasha maskaxda (sida caadiga ah 1 ama 2 qiyaasood ka dib), qofku wuxuu bilaabaa inuu mar kale neefsado, laakiin waxa uu weli suuxsan yahay xylazine.
3. Haddii aad sii wado ku buufinta 3, 4, ama 5 naloxone oo dheeraad ah qofka neefsanaya ee lagu suuxiyay xylazine, waxaad 100 boqolkiiba opioids-ka asalka ah ka jeexisaa soo-dhoweeye kasta oo jidhkooda ah, taasoo kicinaysa ** Rabshadaha Degdegga ah ee Opioid ka bixitaanka ***:
   • matag degdeg ah iyo shuban ** iyadoo qofku wali ka miyir qabo xylazine**, taasoo keenaysa inay ** matag sambabada ku xiiqaan oo ay ku neef qabatowdo**.
   • Catecholamine weyn (adrenaline) kor u kaca oo sababi karta ** naloxone-ku keeno bararka sambabada ee aan wadna xanuunka lahayn (dheecaan buuxinaya sambabada)** iyo wadna xanuunka wadnaha.
   • Cadaadis aad u daran oo jireed iyo kacsanaan taasoo qofka ku keenta inuu goobta ka cararo iyo ** isla markiiba isticmaal qiyaas aad u badan oo fentanyl waddo ah 20 daqiiqo ka dib si aad u joojiso jirrada**, taasoo keenta xad-dhaaf labaad oo dhimasho ah mar alla markii naloxone-ka-gabo.

Waxa la sameeyo haddii uu qofku qabo "Xanuunka xabadka qoryaha" (Fentanyl Chest Wall Rigidity)¶

Marka uu qof isku duro ama uu nuugayo si degdeg ah, bolus sare oo ah fentanyl synthetic ama nitazenes, waxay mararka qaarkood kicin kartaa Fentanyl-Induced Chest Wall Rigidity ("Wooden Chest Syndrome") gudaha 60 sekan: - Xadhkaha codka ee qofka (glottis) iyo feeraha intercostal/muruqa diaphragm waxay u qufulaan sida looxa oo kale. - Markaad madaxooda dib u soo celiso oo aad isku daydo inaad neef samatabbixin ah afka u geliso, hawo ma geli doonto oo laabta ayaa diidaysa inay kor u kacdo, inkasta oo aanay cunaha ku jirin cunto ama shay shisheeye. - ** Ficil degdeg ah:** ** Maamule Naloxone (Narcan) isla markiibalocus coeruleus) waxaana ** si degdeg ah u furay Naloxone**. Isku day inaad neefsato samatabbixin ah oo fudud oo ay weheliso cadaadin laabta halka naloxone uu nuugo in ka badan 90 ilaa 120 ilbiriqsi; isla marka naloxone ay ku dhufato jirridda maskaxda, xadhkaha codka iyo gidaarka laabta ayaa debcinaya neefta samatabbixinta ayaa si habsami leh u qulquli doonta.

Qaybta 4: Sida Saxda ah ee loo Isticmaalo Fentanyl, Xylazine, iyo Nitazene Strips¶

Xariijimaha tijaabada socodka degdega ah ee difaaca jirka (Fentanyl Test Strips/FTS, Xylazine Test Strips/XTS,iyo Benzodiazepine/Nitazene Strips) waa xariijimo waraaqo ah oo raqiis ah oo lagu ogaanayo dadka sinaysta ee dilaaga ah ilaa qaybo-halkii bilyan 2 daqiiqo gudaheed. Si kastaba ha noqotee, tijaabinta kaniiniga ama budada waxay si khaldan u siinaysaa ** diidmo been abuur ah ** sababtoo ah laba khalad oo isticmaale oo caadi ah: ** Saamaynta Kukiga Shukulaatada ah "** iyo ** Methamphetamine/MDMA Wax-u-fiirsasho Dheeraad ah oo Been ah**.

Raac saxan 5-Tallaabo Shaybaarka-La Xaqiijiyay Hab-maamuuska Daawaynta (laga bilaabo CDC, DanceSafe, iyo Johns Hopkins Bloomberg School of Health Public):

Talaabada 1: Ka adkaato "Saamaynta Kukiyada Chip Chocolate" (Tijaabi qiyaasta oo dhan)¶

Marka madbacadaha kiniinka sharci darrada ah ama kuwa dariiqyada ka ganacsada ay ku daraan 1 milligram oo fentanyl ah budo buuxin ah si ay u cadaadiyaan oxycodone been abuur ah ("M30"), Xanax, ama kiniinada Adderall, ** fentanylku si siman uma qasin *. Nus ka mid ah kiniinka la tuujiyey waxa ku jiri kara eber fentanyl (cajiinka buskudka), halka qayb yar oo dhinaca kale ee isla kiniinka ka mid ah ay ku jirto meel halis ah oo 2-miligram ah oo ah fentanyl saafi ah (shukulaatada). - Haddii aad kaliya ka xoqdo gees yar oo 1-millimitir ah kaniiniga la riixay si aad u tijaabiso, si fudud ayaad u seegi kartaa fentanyl hotspot oo waxaad heli kartaa natiijo badbaado been ah. - ** Dhaqanka ugu Wanaagsan: Ku burburi **kiniinka oo dhan ama dhammaan qiyaasta aad qorshaynayso inaad isticmaashid

Talaabada 2: Kudar Qadarka Saxda ah ee Biyaha (Xeerka Qasmiga Muhiimka ah)¶

1. Haddii aad tijaabinayso Opioid la isku duro (Ku milmay tallaalka oo dhan makiinada): Ka dib markaad qiyaastaada milmay ku dartid saliingahaaga, ku dar 5 millilitir (1 qaado / 1 ampoule biyaha nadiifka ah ee caadiga ah) biyo nadiif ah mashiinka madhan si aad u biyo raaciso haraaga haraaga ah, oo tijaabi biyaha mayr.
2. Haddii aad tijaabinayso Kiniin Burbursan ama Haraaga Budada: Ku wareeji qiyaastii 10 miligram oo budo si fiican la isku daray ah (ku filan in aad timaha ku daboosho madaxa Abraham Lincoln ee lacagta Maraykanka ah, ama caarada furaha guriga) koob yar:
   • ** Heroin, Oxycodone, Xanax, ama Cocaine:** Ku dar 5 millilitir (1 qaado shaaha) tuubo cad ama biyo dhalada ah oo walaaq ilaa 15 sekan.
   • ** KA Reebayn Muhiim ah oo loogu talagalay Kiciyeyaasha: Loogu talagalay Methamphetamine, MDMA (Ecstasy/Molly), ama Diphenhydramine:** Adiga ** WAA INAAD ku milmaan methamphetamine ama MDMA 30 millilitir (2 qaado / 1 wiqiyadood / 1 wiqiyadood oo dareere ah / galaas tallaal buuxa ah) oo biyo ah ** 10 mg oo crystal ah. Haddii aad ku milanto methamphetamine ama MDMA dhowr dhibcood oo biyo ah, kicinta xoogga leh waxay la falgashaa antibody-ka ee Fentanyl Test Strip waxayna soo saartaa ** been abuur ah ** (iyo xaddi badan oo lidocaine ama diphenhydramine oo la gooyo daroogooyinka waddooyinka waxay faragelin karaan Xariijimaha Tijaabada Xylazine haddii aan lagu qasin 1 mL).

Talaabada 3: Qufulka 15 ilbiriqsi oo si fid ah u jiifso¶

1. Qabashada gacanta midabka leh ee dhamaadka Fentanyl Strip (iyo mid gooni ah Xylazine Test Strip), dhex geli caarada nuugista hoose ee mawjadaha ah ee biyaha ** kaliya ilaa xariiqda buuxinta ugu badan**15 sekan.
2. Firiinka si siman u dul dhig meel nadiif ah oo sug 2 ilaa 5 daqiiqo ka hor inta aanad wax akhriyin.

Tallaabada 4: Si sax ah u akhri khadadka (Ka soo horjeedka tijaabada COVID ama Uurka)¶

Xarigga tijaabada daroogada ee tartanka ah ayaa akhriyay ** KA soo horjeedka saxda ah** ee uurka guriga ama baaritaanka COVID-19:

• **Hal khad cas/casaan ah (khadka koontaroolka sare oo kaliya) = TOOSA (KHATAR: Fentanyl ama Xylazine ayaa joogta).
• ** LABA xariiq oo casaan/casaan ah (Xitaa haddii xariiqda tijaabada hoose ay aad u daciifsan tahay sida xiniinyaha) = NEGATIVE** (Fentanyl/Xylazine laguma arag muunaddaas).
• ** Xariiqda eber (ama xariiqda hoose oo aan lahayn xariiq kontorool oo sare) = TIJAAB AAN AHAYN** (ku celi fiil cusub).

Qaybta 5: Daryeelka Soo noolaynta Kadib, Maaraynta Bixinta Degdega ah, iyo 4-Saac ee Dib-u-noqoshada Ilaalada¶

Marka qofku si tartiib ah u neefsado (10 ilaa 16 neefsasho daqiiqaddii) ka dib Naloxone iyo neefsashada samatabbixinta, xaaladdu ma dhammaan ** Waxa aad qabato 60-daqiiqo ee ugu horreeya ka dib soo noolaynta ayaa go'aamisa in qofku galabtii noolaado ama uu ku dhacay xad-dhaaf sare oo dhimasho ah.

1. Sida loo maareeyo qof ka soo kaca ka bixitaan degdeg ah oo degdeg ah¶

Haddii qiyaaso badan oo Naloxone ah la maamulo (ama haddii qofku leeyahay caado fentanyl maalinle ah oo culus), waxaa laga yaabaa inay soo toosaan jahwareer, dhidid, matag, gariir xoog leh, oo dalbanaya inay isla markiiba ka baxaan si ay u isticmaalaan daroogo badan si ay u joojiyaan xanuunka:

• ** Si deggan u deji oo u sharax wixii dhacay 10 ilbiriqsi gudahood:** Istaag 1 mitir (3 cagood) si aysan u dareemin gees gees, ku hadal hadal deggan oo aan caqli-gal ahayn, oo waxaad ku tidhaahdaa: "Waxaad joojisay neefsashada ka dib qiyaasta xad dhaafka ah waxaana ku siinnay Narcan si aad u badbaadiso noloshaada. ilaa 45 daqiiqo jirraduna si toos ah ayay u yarayn doontaa."
• Sababta ay tahay inaad uga codsato iyaga inayan isticmaalin fentanyl badan hadda:** Si cad u sharax: * "Hadda, Narcan wuxuu u dhaqmayaa sidii gaashaan ku meel gaar ah oo ku saabsan soo-dhoweynta maskaxdaada. Haddii aad qaadato kale oo fentanyl ah hadda si aad isku daydo inaad garaacdo Narcan, xitaa ma dareemi doontid marka ugu horeysa, laakiin 45 daqiiqo marka Narcansku si sax ah u xirto maskaxdaada isla markiiba waqti ku dili."*
• Haddii qofku si caadi ah u neefsanayo (12 neefsasho daqiiqadii) oo uu leeyahay bushimo casaan ah / caarado casuus ah, ** laakiin aad uga seexato xylazine, u rogo dhinaca bidix ee ** Booska soo kabashada**, gadhka u leexi buste si aad u daawato, candhuuftana dhinac u dhig si aad u ilaaliso ilaa ay la wareegaan shaqaalaha caafimaadka.

2. Isku-maalin isku mid ah oo loo wareego Buprenorphine Ka dib Soo noolaynta Naloxone¶

Waaxyaha xaaladaha degdega ah ee isbitaalka iyo EMS "Bridge Clinics" waxay hadda bixiyaan ** Ka-dhaafitaanka Buprenorphine Induction ** isla qolka gargaarka degdega ah ka dib qiyaasta xad-dhaafka ah, iyo sidoo kale ** Qiyaas-hooseeya Buprenorphine Micro-Induction (Habka Bernese) ** loogu talagalay dadka isticmaala fentanyl waddooyinka kuwaas oo ka baqaya ka bixitaan degdeg ah: - Halkii aad ku sugi lahayd 36 saacadood oo xanuun ah, ** Habka Bernese ** wuxuu ku bilaabmaa qiyaas yar oo yar oo buprenorphine ah (0.25 mg to 0.5 mg hal ama laba jeer maalintii) inta uu bukaanku wali ka siibyo agonists buuxa, si tartiib tartiib ah u dhisaya lakabka difaaca ee buprenorphine ee soo-qabayaasha maskaxda muddo 5 ilaa 7 maalmood ah ilaa ay buuxsamaan. 12 mg to 16 mg qiyaasta maalinlaha ah waxaa lagu gaarayaa eber degdeg ah.

Su'aalaha soo noqnoqda¶

Ilaha la hubiyay¶

• ** Xarumaha Xakamaynta iyo Kahortagga Cudurrada (CDC) iyo Ku Xad-gudubka Walaxda iyo Maamulka Adeegyada Caafimaadka Maskaxda (SAMHSA, Mareykanka):** * Qalabka Ka-hortagga Xad-dhaafka ah ee Opioid*, hagid caafimaad oo ku saabsan ka-qaybgalka fentanyl iyo xylazine ("tranq") ee sida sharci-darrada ah loo soo saaray, iyo xogta goobta barbardhigga ee 4 mg vs.
• Ururka Caafimaadka Adduunka (WHO, Caalamiga ah): * Maareynta Bulshada ee Opioid-ka Xad-dhaafka ah* (Bartakoolka hawo-mareenka samatabbixinta, naloxone titration, xabsiga ka dib/ka-dib-detox-ka halista dhimashada, iyo daryeelka booska soo kabashada).
• ** Kulliyadda Maraykanka ee Sunta Caafimaadka (ACMT) iyo Akademiyada Maraykanka ee Cilmi-baarista Sunta (AACT):** * Bayaanka Wadajirka ah ee Ka Hortagga Fentanyl-ka Shaqada iyo Fentanyl Analog ee Ka-jawaabayaasha Degdegga ah*
• ** Machadka Qaranka ee Xad-gudubka Maandooriyaha (NIDA / NIH) iyo Dugsiga Johns Hopkins Bloomberg ee Caafimaadka Dadweynaha:** Xaqiijinta shaybaadhka ee Fentanyl Test Strips (FTS) iyo Xylazine Test Strips (XTS), qawaaniinta milanka si looga hortago methamphetamine/MDMA been-abuurka beenta ah, iyo neurobiology ee luminta dulqaadka neefsiga ee degdega ah.
• Xafiiska Horumarinta Caafimaadka iyo Kala-duwanaanshaha (OHID) iyo Adeegga Caafimaadka Qaranka (NHS, Boqortooyada Ingiriiska): Digniinaha badbaadada bukaan-socodka qaranka ee ku saabsan opioids benzimidazole synthetic (nitazenes) iyo maaraynta boogaha xylazine.

Tilmaamaha la xidhiidha¶

• Opioid xad dhaaf ah gargaarka degdega ah
• CPR (dib u soo kicinta wadnaha sambabada)
• Isticmaalka maandooriyaha iyo qabatinka maandooriyaha: hagaha gargaarka degdega ah
• Aalkolada oo aad u daran, Delirium Tremens (DTs), iyo kala soocida sunta-caafimaadka
• Joojinta degdega ah ee benzodiazepine iyo khatarta suuxdinta
• Ku taageerida xubin qoyska ka mid ah qabatinka
• Sepsis iyo shoog septic
• Nambarada degdega ah