Neef baraf qallalan, Nitrogen Frostbite dareere ah, iyo gubasho baraf ah¶

Qalabka Cryogenic iyo gaaska dareeraha ah, gaar ahaan ** Barafka qallalan (kaarboon dioxide adag, $ qoraalka {CO}_2 $, at $ -78.5 ^ cir text {C} / -109.3 ^\circ\text {F}\()**, ** Nitrogen dareere (\) text {LN}_2$ at \(-19t -320^\circ\text{F}\)), ** dareeraha Helium (\(-269^\circ\qoraal{C} / -452^\circ\text{F}\)), ** Ogsajiinta dareeraha ah (\(\text{LOX}\) at \(-183^\circ\text{C} / -297^\circ\text{C} / -297^F Cirquid{C} / -297^F) (\)-42^\circ\text{C} / -44^\circ\text{F}$)**, iyo ** difluoroethane "hawo qasacadaysan" boodh ama dhululubada nitrous oxide **, kuma jiraan shaybaarada warshadaha. Malaayiin qoys ayaa la kulma baraf qallalan iyo nitrogen dareere ah gudaha boostada-dalbashada hilibka barafaysan iyo sanduuqyada rarida cuntada, keenista kareemka, mashiinada ceeryaamada Halloween, macmacaanka "neefta masduulaayada" macmacaanka iyo cocktails qiiqa leh, xirmooyinka baabi'inta burooyinka maqaarka, iyo buufinta elektiroonigga ah.

Maaddooyinkani waxay abuuraan ** afar xaalad degdeg ah oo nafta halis gelisa** kuwaas oo u baahan gargaar degdeg ah oo gaar ah:

1. ** Neefta meel-ku-xiran iyo Narcosis Hypercapnic ***: Marka baraf qallalan uu hoos ugu dhaco gudaha baabuurka rakaabka ah ee xiran, van geynta, qaboojiyaha lagu lugeeyo, ama qolka jiifka yar, ama marka nitrogen dareere ah uu ku karkariyo wiishka ama qolka hoose, balaadhinta gaasta waxay barakicisaa ogsijiinta neefta halka kaarboon laba ogsaydh si toos ah u sunta dhiiga.
2. Xidhiidhka Cryogenic ee degdega ah
3. **Doolista xiidmaha mindhicirka ee ka yimaada dareeraha Nitrojiinka la liqay ama baraf qallalan **: Liqitaanka nitrogen dareere ah ee aan la soo bixin ee cocktail cusub ama barar, ama gelinta gabal baraf qalalan oo afka ah, waxay sababtaa qarxa 700-ilaa-800-laab daloolin).
4. Qaraxyada bambaanooyinka ee Cryogenic-Container-ku-xiran: Dhigista hadhaaga baraf qallalan ama nitrogen dareere ah gudaha dhalada soodhaha ee caagga ah ee si adag loo xidhxidhay, dhalo quraarad ah, ama qaboojiye xidhxidhan oo xidhxidhan waxay dhistaa cadaadis ka badan 700 ilaa 1,100 PSI, iyada oo ku qarxisa xoogga bam-gacmeedka kala daadsan.

Hagahan wuxuu bixiyaa samatabbixin tillaabo-tallaabo ah, dib-u-soo-celin, iyo borotokoollada kala-soocidda isbitaallada oo la jaan-qaadaya Machadka Qaranka ee Badbaadada Shaqada iyo Caafimaadka ee Mareykanka (NIOSH / CDC), Badbaadada Shaqada iyo Maamulka Caafimaadka (OSHA), Ururka Gaaska Cadaadiska ah (CGA), Ururka Caafimaadka duurjoogta (WMS), iyo Fulinta Caafimaadka iyo Badbaadada UK (HSE).

Hadda samee tan¶

Haddii aad ka jawaabayso xaalad degdeg ah oo ku lug leh baraf qallalan, nitrogen dareere ah, ama gaas dareere ah oo la cadaadiyo:

1. ** Weligaa ha galin qol aan hawo lahayn, qaboojiye-la-socod, ama baabuur xidhan oo uu qof ku dumay meel u dhow baraf qallalan ama nitrogen dareere ***: Waxaad ku dhiman doontaa oo aad agtooda ku dhiman doontaa 20 ilaa 60 ilbiriqsi gudahood iyada oo aan la helin Qalabka Neefsashada ee Is-Contained (SCBA). ** Marka hore, fur dhammaan albaabbada baabuurta, albaabbada garaashka, ama daaqadaha bannaanka ee dibadda si aad hawo uga gudbiso booska, wac *911/112/999 nambarada degdega ah tusaha, oo kaliya u jiid dhibbanaha hawo nadiif ah oo dibadda ah haddii aad sidaas samayn karto adigoon neefsan jawiga xaddidan.
2. Maqaar kasta oo barafaysan ku sii daa baraf ama birta qaboojinaysa adoo isticmaalaya biyo qandac ah (waligaa ha ka goynin engegan): Haddii faraha qaawan, dibnaha, ama carrabku si degdeg ah loogu qaboojiyo baraf engegan, tuubo nitrogen dareere ah, ama weel bir ah, ** ku shub biyo diirran (\(37^\circ\text{C}\text^{} 39) 98.6^\circ\text{F}\text{ to }102.2^\circ\text{F}\)) korka barta xiriirka** si aad u dhalaaliso curaarta barafka si tartiib ah. Maqaarka engegan oo ka soo saara dusha sare ee cryogenic waxay jeexjeexaysaa dhammaan epidermis iyo maqaarka faraha.
3. ** Isla markiiba ka saar faraantiyada, saacadaha, iyo kabaha cryogen- qooyay ama kabaha ***: Haddii nitrogen dareere ah ama dareeraha propane ay ku firdhiso gudaha galoofka shaqada ee dabacsan, sharabaadada, dareeruhu wuxuu ku xayiran yahay maqaarka wuxuuna luminayaa barkinta uumiga Leidenfrost ee ilaalinaya. Jiid galoofyada ama kabaha iska siib 1 ilbiriqsi gudahood (adiga oo isticmaalaya suumanka ama tuwaalada engegan si aad u ilaaliso gacmahaaga) oo ka siibo dhammaan faraantiyada faraha ka hor inta uusan bararku bilaaban.
4. **Si deg deg ah dib ugu diirin baraf-qabow \(37^\circ\text{C}\text{ to }39^\circ\text{C}\) (\(98.6^\circ\text{F}\text{ to}102.2^\circ\text{F}\)) biyo diirran 15 ilaa 30 daqiiqo
5. ** Ku tijaabi heerkulka biyaha heerkulbeeg ama xusulkaaga oo aan dhaawacmin marka hore dab), Kaas oo karsada kabuubyo, unug barafaysan.
6. ** Weligaa ha xoqin hana duugin gubashooyinka cryogenic ***: Unugyada maqaarka ee barafoobay waxaa ka buuxa kiristaalo barafka fiiqan oo fiiqan; xoqidda aagga waxay ku shiidaysaa kiristaalo iyada oo la sii marayo xuubabka unugyada iyo xididdada dhiigga, taasoo burburinaysa unug la badbaadin lahaa.
7. ** Haddii qof liqo dareeraha nitrogen ama baraf qallalan (kookkool, koob ceeryaamo ah, ama macmacaan), wac 911/112/999 isla markaaba hana ku qasbin matag ama ha siin cabitaan kaarboon leh daloolin iyo pneumoperitoneum**.
8. **Haddii dhalada xiran ama qaboojiyaha ay ku jiraan baraf qallalan ay soo baxayso ama hindhiso, isla markiiba qolka ka bax ***: **Ha dul marin oo isku day inaad furka furto. Nadiifi aagga, xidh albaabka gadaashaada, oo ha ka soo bixin dabool adag gadaashiisa.

Soo-gaadhista degdega ah ee cryogenic iyo jaantus socodka kala-soocidda neefta¶

flowchart TD
    Start["Baraf qallalan (CO2), Nitrojiin dareere ah (LN2), ama Gurmadka Cryogen la cufan"] --> SceneSafety["BADBAADADA MUUQAALKA KOWAAD: Dhibbanuhu ma ku jiraa baabuur xidhan, <br/> qaboojiye, qol hoose, wiish, ama qol yar?"]

    SceneSafety -->|Yes: Confined-Space Collapse| VentRescue["Ha galin la'aanteed SCBA / hawo-qaadid<br/>1. Ka fur dhammaan albaabbada/daaqadaha dibadda si aad hawo uga gudubto<br/>2. Wac 911 / 112 / 999 (Ka warbixi neefta oo ku xiran meel bannaan) <br/>3. Marka aad hawo cusub gasho: Hubi garaaca garaaca/Neefsashada -> Bilow CPR + 100% Ogsajiinta haddii ay xanuunsato"]

    SceneSafety -->|No: Conscious Patient in Safe Air| InjuryType{"Waa maxay nooca dhaawaca cryogenic dhacay?"}

    InjuryType -->|Ingestion of Liquid Nitrogen Cocktail / Dessert<br/>OR Swallowed Piece of Dry Ice| GiPerf["XAALADDA DEGDEGGA AH EE GASTRIC BAROTRAUMA (WAC 911)<br/>1. Bukaanka u fadhiiso mid toosan si uu gaasku u soo baxo<br/>2. Wax afka ah (NPO); Marna ha keenin matag<br/>3. Cisbitaalka degdega ah CT + Qalitaanka Qalliinka ee Pneumoperitoneum<br/>+ Endoscopy for Esophageal/Gastric Cryo-Necrosis"]

    InjuryType -->|Dermal Contact / Splash Burn on Hands, Feet, or Face<br/>(Dry Ice, Liquid Nitrogen, Propane, or 'Canned Air' Duster Spray)| SkinBurn["PROTOCOLKA CRYOGENIC FROSBITE<br/>1. Haddii maqaarku ku dhego baraf/bir qallalan: Ku sii daa biyo diirran (37-39°C)<br/>2. Isla markiiba iska saar gacan-gashiyada qoyan/meella wada jira, sharabaadada, kabaha, iyo faraantiga <br/>3. Ku quusi ​​37°C ilaa 39°C (98.6°F ilaa 102.2°F) biyaha wareegaya 15-30 daqiiqo<br/>4. Weligaa ha xoqin maqaarka; ka tag nabarro cadcad oo dhan; sii Ibuprofen (anti-thromboxane)"]

    InjuryType -->|Cryogenic Splash into the Eye<br/>(Liquid Nitrogen, Refrigerant Freon/R-134a, or Propane)| EyeBurn["Habka gubashada CRYOGENIC CAD<br/>1. Si tartiib ah ugu waraabi isha diirran (37°C / 98.6°F) milix ama biyo nadiif ah 15 daqiiqo<br/>2. Haddii daboolka indhaha la barafeeyo, ku diiri cadaadis milix ah oo diirran ilaa ay ka furmaan<br/>3. Weligaa isha ha xoqin; si dabacsan ugu dabool gaashaanka isha nadiifka ah oo aad dhakhtarka indhaha ee degdega ah"]

Fiisigiska iyo Pathophysiology ee Gaasaska Cryogenic iyo dareeraha¶

Fahamka sida ay u dhaqmaan noocyada kala duwan ee cryogens waxay sharraxaysaa sababta ** Baraf qallalan (\(\text{CO}_2\))** iyo ** Nitrogen-da dareeraha ah (\(\text{LN}_2\))** waxay dadka ku dilaan habab gaas oo gebi ahaanba kala duwan, iyo sababta ku firdhida nitrogen dareere ah ee gacanta qaawan ay inta badan waxyeello u la'dahay halka fawdada gudaha gacan-gashigu ay sababto in faraha la gooyo.

1. Heerarka Balaadhinta Gaaska iyo Cufnaanta: Kaarboon Dioxide (\(\text{CO}_2\)) vs. Nitrogen (\(\text{N}_2\))¶

2. Dabin Saamaynta Leidenfrost: Waa maxay sababta Gacan-gashiyada iyo Dharka ay 100 jeer uga daran yihiin Nitrogen-ka dareeraha ah.¶

Marka dhibco yar oo Liquid Nitrogen (\(-196 ^\circ\text{C} / -320^\circ\text{F}\)) ay ku firdhiso ** diirran, qaawan, maqaar engegan** oo isla markiiba ka rogan:

• Sababtoo ah kala duwanaanshaha heerkulka u dhexeeya maqaarka diirran ($ 33 ^ wareeg qoraalka {C}\() iyo nitrogen dareeraha (\)-196 ^{\circ\text{C}\() ayaa ka badan **\)229}\circ\text{C}$ (\(412^\circ\text{F}\))**, dusha sare ee dhibicda ayaa isla markiiba u soo ifbaxa gaaska dahaarka ah.* 0.5 ilaa 1.5 ilbiriqsi, lakabka gaaska yar-yar ayaa ka saaraya dhibicda dareeraha ah isla markaaba maqaarka qaawan iyada oo aan hilibku barafayn.
• ** Marka gaashaanka Leidenfrost uu fashilmo (barafka barafaysan ee degdega ah)**:
• Gloves, Socks, Shoes, ama Cotton Sleeves: Haddii nitrogen dareere ah uu hoos ugu firdhiyo katiinadda furan ee gacan-gelis dabacsan, ama qooya shaadh suuf ah, jiinis denim ah, ama kaboyaal, marada ** wicks oo dabinaysa \(-196 ^\circ\ qoraalka {C}\) si toos ah maqaarka uga soo horjeeda 5 ilaa 3 ilbiriqsi Barkinta gaasta ee Leidenfrost ayaa isla markiiba dunta, maqaarka, seedaha, xididada, iyo lafaha ayaa si adag u barafoobay sida muraayadda ilbiriqsiyo gudahood.
• ** Xidhiidhka Barafka Adag ee Qalalan ***: Sababtoo ah baraf qallalan waa xannibaad adag oo ah $ -78.5 ^\circ\text{C}$ si adag ayaa loogu hayaa maqaarka cadaadis farta ah (ama lagu leefay carrab qoyan), qoyaanka maqaarku wuxuu isla markiiba barafoobayaa isku-xidhka xabagta adag, isagoo si toos ah qabow aad u daran u galaya maqaarka qoto dheer iyada oo aan lahayn barkin gaas ah.
• ** Buufisyada Aerosol-ka ee Cadaadiska leh ( Roodhida "Hawada qasacadaysan" Dusters, Propane dareere ah, ama Chargers Nitrous Oxide) ***: Marka qashinka elektiroonigga ah (1,1-difluoroethane) kor loo hayo oo lagu buufiyo maqaarka, ama marka ** nitrous oxide weyn ($ text {N}2 ) lagu hayo inta u dhaxaysa taangi (*Otext{N}}$)) bowdada gudaha ee isticmaalaha marka ay si degdeg ah u soo dayso gaaska, jet-xawaaraha sareeyo ama gidaarka taangiga birta qaboojiya ayaa ka saara lakab kasta oo uumi ah oo ay gaadhsiiso ** qoto dheer, xanuun la'aan, dhumuc buuxda oo ah heerka saddexaad iyo heerka afraad barafku wuxuu ku gubtaa ** 3 ilaa 10 ilbiriqsi gudahood.

Quus qotodheer 1: Tallaabo-tallaabo Gargaarka Koowaad ee Gubashada Barafka Cryogenic (Maqaarka, Gacmaha, iyo Indhaha)¶

Haddii gubashada cryogenic ay ka timid maaraynta baraf qallalan oo aan lahayn suugo, dareere nitrogen ah, beddelka taangiga propane, ama buufin gaas cadaadis leh, dhaawaca nudaha ayaa raacaya qulqulka laba-heer ah: ** Marxaladda 1 (Si toos ah Ka-baxsan iyo Intracellular Ice Crystal Formation) ** inta lagu jiro qaboojinta, iyo ** Marxaladda 2 (Reperfusion Endothelial Thrombosis) \(\text{PGF}_{2\alpha}\), iyo Thromboxane \(\text{A}_2\) Dhiigxinjirow yar yar)** inta lagu jiro dhalaalid

1. Hab-maamuuska Dib-u-kulaynta Goobta degdega ah (Qoraalka \(37^\circ\text{C}\text{to}39^\circ\text{C}\) Water Bath Rule)¶

1. Maqaar kasta oo isku dheggan ku xoree biyo qandac ah: Haddii maqaarku uu ku dhego baraf qallalan ama bir qabow, ku shub biyo tuubo diiran ($37^\circ\text{C}\text{ to }39^\circ\text{C} / 98.6^\circ\text{F}\text{ ilaa }102.2{\njuk\n) leh.
2. **U diyaari qubeys biyo diirran oo wareegaya oo sax ah \(37^\circ\text{C}\text{ to }39^\circ\text{C}\)
3. Isticmaal heerkulbeeg haddii la heli karo, ama ku tijaabi biyaha gacantaada gudaha ee aan dhaawacnayn; Waa inay dareemaan ** si raaxo leh u qubeyska ilmaha oo diiran, marna kululayn ***.
4. Ku dhex geli faraha, gacanta, ama cagaha barafaysan biyaha qubeyska (ama si joogto ah u mari cadaadis biyo diirran oo la qaboojiyey oo gubanaya wejiga) ilaa 15 ilaa 30 daqiiqo ilaa unugyo cirro, adag, cadaan-cad ama buluug-cawlan uu isu beddelo ** casaan/casaan oo uu dareemo jilicsan oo jilicsan** caarada.
5. Marka ay biyuhu ka qaboojiyaan addimada barafaysan, ku dar xaddi yar oo biyo diirran dhinaca basinka (gacanta ka saar muddo kooban adigoo walaaqaya biyo diirran si aanay biyaha kulul waligood si toos ah ugu shubin maqaarka dhaawacan).
6. ** U diyaari bukaan-socod daran "Xanuun-xannuun Dib-u-soo-celin" oo sii ibuprofen afka**:
7. Iyadoo barafaysan, gubashada cryogenic waa ** gabi ahaanba kabuubyo iyo xanuun la'aan *** (taasi waa sababta ay dadku ku hayaan bawdada nitrous oxide cylinder barafaysan ama ku buufinaya difluoroethane cududdooda ma dareemaan inay la il daran yihiin gubashada heerka saddexaad).
8. Marka qulqulka dhiiggu soo noqdo inta lagu jiro dhalaalidda biyaha diirran, aaggu wuxuu bilaabi doonaa inuu garaaco oo aad u gubo.
9. Haddii bukaanku soo jeedo, awoodo inuu wax liqo, oo aanu lahayn xasaasiyad, cudur kelyo, ama taariikhda boogaha caloosha, tilmaamaha Wilderness Medical Society (WMS) waxay ku talinayaan in la siiyo ** Ibuprofen afka12 mg/kg/day la qaybiyaa laba jeer maalintii, sida caadiga ah 400 mg to 600 mg ee qof weyn
10. Sida loo maareeyo finanka Cryogenic (Clear vs. Hemorrhagic/Blood Blood):
11. 1 ilaa 24 saacadood gudahood kadib dhalaalidda gubashada cryogenic, nabaro waaweyn (bullaae) ayaa ku soo bixi doona maqaarka:
    • Kaniiniga dareeraha Jaallaha ah ee Cad ama Caano-Jaallaha ah Ku Fididda Farta Farta: Tilmaan ** dhaawac dusha sare ah ama qoto dheer oo qayb ahaan dhumucdiisuna waxay tahay** halkaasoo plexus vascular subdermal uu weli nool yahay. ** Ha daadin ama ha gooyn nabarrada nabarrada ah ee gudaha ku jira**; mari ** aloe vera jel saafi ah** (taas oo u shaqeysa sidii wakiilka maxaliga ah ee ka hortagga thromboxane) haddii la heli karo, dhig faashad qallalan oo nadiif ah farta ama suulasha dhexdooda si aysan isugu dhegi karin, oo si dabacsan ugu duub dhaymo nadiif ah oo weyn, aan ciriiri lahayn.
    • finan Madow ama Maqaar Madow ah oo Dhiig ka buuxo Marna ha daloolin ama ha dumin finan dhiigbaxa ah**, marka furashadooda waxay keentaa qallajin unug qoto dheer iyo caabuq labaad.

2. Waa maxay sababta Qiimaynta Cusbitaalka 24 saacadood gudahood ay u badbaadin karto faraha barafaysan (Iloprost & tPA)¶

Gubasho kasta oo qoto dheer oo ku lug leh **faraha, suulasha, gacmaha, wejiga, ama xubnaha taranka , ama gubasho kasta oo isu beddesha guduud mugdi ah, cawl, ama soo baxa finan dhiigu ka buuxo, waa in lagu qiimeeyaa ** xarun gubashada isbitaalka 12 ilaa 24 saacadood gudahood ka dib dhalaalid. Xarumaha gubashada casriga ah waxay isticmaalaan degdegga ah Iloprost xididka (prostacyclin vasodilator) ama catheter-directed/intravenous Tissue Plasminogen Activator (tPA) thrombolysis gudahooda 24 saac ee ugu horeeya ee dib u kululaynta si ay u milmaan xinjirowga dhiiga ee microvascular gudaha halbowlayaasha dhijitaalka ah, gooynta farta 6 ilaa 0 ka badan

Qoto dheer 2: Nitrojiin dareere ah oo la liqay ("Neefta Dragon's" macmacaanka & Cocktails qiiqa) iyo cunista barafka qalalan¶

Tobankii sano ee la soo dhaafay, baararka, carwooyinka, iyo makhaayadaha fayrasku waxay u adeegeen ** Koocktails oo ay ku jiraan sigaar cabbista nitrogen dareere ah ama qayb ka mid ah baraf qallalan **, iyo sidoo kale "Neefta Dragon" kubbadaha badarka oo lagu rusheeyey \(-196^\circ\text{C}\) nitrogen dareere si macmiilku u afuufo qiiqa uumiga cad ee sanka iyo afka.

1. Waa maxay sababta Liqitaanka Nitrogen-ka dareeraha ah uu dalool uga dillaaco gidaarka caloosha¶

Marka bakhaarle ku shubo nitrogen dareere ah cabitaan ama u adeego badarka dareeraha-nitrojiin-ku-shubato, badbaadadu waxay si buuxda ugu tiirsan tahay ** 100 boqolkiiba nitrogen dareeraha ah ee karkarinaya KA HOR inta aanu macmiilku koobka ama qaaddada saarin dibnaha** (qiiqa laftiisu waa wax aan dhib lahayn oo biyo qabow- uumiga ka soo baxa hawada qolka). Haddii xitaa ** 2 ilaa 5 millilitir (kala badh shaaha) ee nitrogen dareere ah ee aan la bixin** ay ku harto salka hoose ee dhalada ama lagu qooyay gudaha kubbadda badarka oo la liqo:

1. ** Instant Cryogenic Necrosis of the Mouth and Esophagus**: Dareeraha \(-196^\circ\text{C}\) wuxuu qaboojiyaa xuubka carrabka, pharynx, iyo hunguriga marka la taabto.
2. **Qarax 1: 694 Balaadhinta Volumetric Caloosha Diiran a 15 mL qaaddo liqidda waxay ku fidaysaa 10.4 litir oo gaas).
3. ** Perforation gastric Barotrauma iyo Pneumoperitoneum kacsan : Sababtoo ah sphincter hunguriga hoose iyo pyloric sphincter ma soo saari karaan 3.5 ilaa 10 litir oo gaas ah qayb ka mid ah ilbiriqsi, buufinta caloosha ayaa dhaaftay cadaadiskeedii dillaacay oo ** dillaacay ballaaran iyada oo la socota qalooca ka yar ama ka weyn ee caloosha. (pneumoperitoneum weyn), isku-buufinta cava hoose ee xididada iyo sambabada ( caloosha cilladda/xanuunka pneumoperitoneum), oo u baahan ** qalliin degdeg ah laparotomy (badanaa qayb ama gastrectomi oo dhan)* si loo badbaadiyo nolosha dhibbanaha.

2. Gargaarka Degdegga ah ee degdega ah ee cunista Cryogenic¶

• ** Isla markiiba wac 911/112/999** oo si cad u sheeg: *"Bukaanku wuxuu liqay nitrogen dareere ah (ama baraf engegan) wuxuuna leeyahay calool xanuun daran iyo kala duwanaansho, looga shakisan yahay dalool gastric."
• Bukaanku u dhig mid toosan ama horay u tiirsanaya: Tani waxay caawisaa gaas kasta oo soo hadhay ee balaadhinta caloosha ee kor ugu soo baxa hunguriga ( hunguriga) halkii ay ku qasbi lahayd gaas badan jeexjeexa derbiga caloosha caloosha.
• ** Waxba afka ha ku siin (NPO): ** Ha siinin biyo diirran oo aad cabto (marka nitrogen dareeraha ah ay caloosha ku jiraan, ku darida biyaha diirran waxay dedejisaa balaadhinta gaaska waxayna dareeraha ka soo saartaa gidaarka caloosha ee daloolsan ee peritoneum), oo ** waligaa ha keenin matag.
• Haddii gabal baraf qallalan uu ku dhego gudaha afka (carrabka ama dhabanka) oo aan * la liqin: ku shub biyo qandac ah oo yar oo afka ka dibna qofka horay u sii si uu u tufo biyaha iyo cadka qallalan ee la sii daayay isla markiiba dhulka si aysan u liqin.

Quusidda qoto dheer 3: Kala-baxa indhaha ee Cryogenic iyo Gaaska Cadaadiska ah ee Wadnaha la nuugo¶

1. Nitrojiin dareere ah, qaboojiye (R-134a / R-410A), ama Propane splashes galay isha¶

In kasta oo qulqulka kooban ee nitrogen dareeraha saafiga ah ee kornea ah ay inta badan si dhib la'aan ah ugu dhejiso filimka jeexjeexa iyada oo loo marayo saamaynta Leidenfrost, buufinta cadaadiska sare ee ** baabuurta ama qaboojiyaha HVAC (Freon / R-134a / R-410A) ***, ** propane ** dareeraha ah, ama qulqulka nitrogen ee tooska ah ee dareeraha ah daboolka indhaha:

• **Haddii daboolka indhaha ay barafoobaan *: Weligaa ha xoogin ama ha saarin daboolka indhaha ee barafaysan iyagoo ku furaya faraha engegan, taas oo kicin karta marinka daboolka indhaha ee jilicsan ama jeexjeexa epithelium corneal. Bedelkeeda, dhig suufka faashad nadiifka ah ee lagu qooyay ** cusbo diirran oo nadiif ah oo caadi ah ama biyaha qasabada (\(37 ^\circ\text{C} / 98.6^\circ\text{F}\)) si tartiib ah isha xiran kor u dhaaf ama ku shub biyo khafiif ah oo milix diirran ah oo dhan jeedasha ilaa uu barafku dhalaali doono oo daboolka isha si siman u furmaan.
• ** Waraabi ilaa 15 daqiiqo haddii saliid qaboojiye ama waxyaabaha kiimikaad lagu daro ay jiraan ***: Qaboojiyaha baabuurta iyo qaboojiyaha waxay ka kooban yihiin polyalkylene glycol (PAG) ama saliidaha ester oo lagu daray hydrocarbons fluorinated. Marka la dhalaalayo, ku nadiifi isha furan si joogto ah milix nadiif ah oo diiran ama tuubo biyo ah 15 daqiiqo, labada indhood si dabacsan ugu dabool gaashaan difaac (si loo yareeyo dhaqdhaqaaqa isha ee la oggol yahay), isla markiiba u tag dhakhtarka indhaha ee degdegga ah.

2. "Cudurka Dhimashada Degdegga ah ee Uririnta" ee ka yimaadda Boodhka Gaaska ee la Dhibay iyo Aerosols Cryogenic¶

Marka dhalinyaradu ama dadka waaweyni ay neefsadaan 1,1-difluoroethane ("hawada qasacadaysan" boodhka kumbuyuutarka kumbuyuutarka), butane, propane, ama nitrous oxide (\(\text{N}_2\text{O}\))* si toos ah biibiile ama buufin:

• Cryogenic Hawadda Xiran (Laryngospasm iyo Glottic Edema): Ku buufida boodhka kombuyuutarka rogan ama haanta nitrous oxide ee si toos ah afka waxay qaboojisaa uvula, palate jilicsan, iyo xadhkaha codka \(-50 ^\circ\text{C}\text{C}-88^\}\). (\(-58^\circ\text{F}\text{to }-126^\circ\text{F}\)), taasoo keenaysa ** barar degdega ah oo barar ah iyo dhammaystirka xannibaadda sare ee marin-haweedka ** gudaha 15 ilaa 45 daqiiqo taas oo u baahan in tubbada endotracheal degdeg ah ka hor intaan marin hawadu bararsan.
• ** Dareenka Wadnaha Wadnaha ee Epinephrine (Fibrillada degdega ah ee Ventricular): Hydrocarbons halogenated sida difluoroethane waxay dareensiiyaan myocardium-ka wadnaha ilaa adrenaline endogenous (catecholamines). Haddii qofku naxo, ordo, ama la halgamo isla markiiba ka dib marka gaaska la nuugo, kor u kaca adrenaline ee kiciya ** isla markiiba Ventricular Fibrillation wadnaha oo istaaga ("Dhimashada dhuuqin degdega ah"). Samatabbixiyeyaashu waa inay bilaabaan ** isla markaaba CPR tayo sare leh oo ay dalbadaan Defibrillator Dibadeed Automated (AED)** iyagoo ka digaya dhakhaatiirta caafimaadka in xiritaanka uu ka dhashay dareen-celinta miyir-qabka Fibrillation ventricular).

Quus qotodheer 3: Maaraynta Badbaado leh, Gaadiidka, iyo Liiska Hubinta Tuurista ee Barafka Qalalan iyo Nitrojiinka dareeraha ah¶

• **Weligaa ha rarin baraf qallalan ama dareeraha Nitrogen-ka gudaha qolka Rakaabka ah ee xidhan ***: Had iyo jeer dhig qaboojiyeyaasha barafka engegan ama weelasha nitrogen dareeraha ah ** jir/boot gooni ah, sariirta xamuulka qaada ee furan, ama van xamuulka oo ay kala soocaan madax weyn oo xiran *. Haddii aad leedahay SUV, hatchback, ama sedan halkaas oo jirdu hawada kula wadaagto qolka rakaabka, ** soo rogo ugu yaraan laba daaqadood 5 cm (2 inji) oo dhig marawaxada kontoroolka cimilada Fresh Outside Hawo mode (WELIVER recirculate) waditaanka oo dhan.
• **Weligaa ha ku kaydin baraf qallalan dhalo si adag loo xidhay, dhalo, ama qaboojiye hawo lahayn ***: Ku kaydi barafka qalalan oo keliya ** qaboojiyeyaasha dabacsan ee fidsan ee polystyrene (Styrofoam) ama laabta dahaaran Waligaa dabool ha ku xidhin dhalo caag ah ama weel galaas ah oo uu ku jiro baraf qallalan ("bam baraf qalalan" waa dambi ka jira xukuno badan wuxuuna sababaa dhaawacyo ba'an oo qarax ah).
• Weligaa ha ku kaydin baraf qallalan gudaha qaboojiyaha guriga ee aan hawo lahayn ama qaboojiyaha guriga dhexdiisa ah: Qaboojiyaha guriga dhexdiisa,\(-78.5^\circ\text{C}\) baraf qalalan ayaa ku talaabsada heerkulbeegga inuu dami qaboojiyaha qaboojiyaha. Qaboojiyaha ganacsiga lagu dhex socdo ama sagxadda hoose ee hawo liidata, baraf qallalan oo hoos u dhigaya ayaa si aamusnaan leh u dhisa wax dilaa ah *5% ilaa 10% \(\text{CO}_2\) daruur neef-qabatin oo weheliya sagxadda habeenkii.
• Sida Loo Tuuro Hadhaaga Barafka Qalalan (Weligaa Ha Ku Daadin Wasaskada Wasaska ama Daadiinka Musqusha):
• ** Waligaa ha ku dhex tuurin baraf qallalan saxanka jikada, qashin qubka, ama baaquli: \(-78.5^\circ\text{C}\) adag waxay qaboojisaa biyaha gudaha PVC ama birta P-dabin adag iyadoo balaarinaysa jabka gaaska oo dilaaca tuubooyinka tuubooyinka.
• **Qaabka Tuur Badbaadada leh ***: Dhig baraf engegan oo hadha gudaha sanduuqa Styrofoam furan ** dibadda meel hawo wanaagsan leh, meel hadh leh oo gebi ahaanba aan gaadhin carruurta iyo xayawaanka rabaayada ah ***, oo u oggolow inuu si dabiici ah hawada bannaanka ugu soo galo 24 saacadood.
• ** Xidho Gacmo-gashiyada Cryogenic-ka dabacsan (oo lagu riixay bannaanka ama gacmaha hoostooda si aanay dareeruhu u dhex gelin karin) iyo Ilaalinta Indhaha ***: Weligaa ha taaban baraf qallalan ama qalabka nitrogen dareeraha leh maqaar qaawan ama galoofyada qoyan ee dhagan. Xidho kabo suugo xidhan, surwaal dhaadheer oo daboolaya korka kabahaaga (waligaa ha xidhin lugaha surwaalka gudaha kabaha meesha nitrogen dareeraha ah ee daadanaya ay si toos ah hoos ugu daadan doonaan anqawgaaga), iyo ** galoofyada daboolan ee debecsan oo lagala soo bixi karo hal rux oo gacanta ah *** haddii dareere gudaha ku soo firdho.

Su'aalaha soo noqnoqda¶

Waxa aan helay sanduuq ka mid ah hilibka doofaarka ee la qaboojiyey oo lagu soo diray boostada oo uu ka buuxo baraf engegan, waxaanan faraheyga qaawan ku taabtay qeybta barafka engegan dhowr ilbiriqsi. Hadda farahaydu waa cad yihiin, kabuubyo yihiin, oo idhimayaan. Maxaan sameeyaa?¶

Waxaad haysaa baraf qalalan oo ka imanaya -78.5 darajo Celsius (-109.3 darajo Fahrenheit) Isla markiiba farahaaga dhex geli baaquli biyo qandac ah oo lagu tijaabiyay inay u dhexeeyaan 37 iyo 39 darajo Celsius (98.6 ilaa 102.2 darajo Fahrenheit, si raaxo leh u diirran sida biyaha qubeyska ee ilmaha, waligeed kululayn) 15 ilaa 20 daqiiqo ilaa balastarrada waxy-caddaan ay noqdaan casaan iyo jilicsan mar kale. Ha xoqin ama ha duugin farahaaga, maadaama xoqiddu ay unugyada maqaarkaaga ku shiiddo kiristaalo baraf ah. Haddii nabaro soo baxaan ka dib, ka tag iyaga oo dhan, si dabacsan ugu dabool faashad qallalan oo nadiif ah, oo qaado qiyaas ibuprofen oo aan farmashiyaha laga iibsan karin haddii aad si badbaado leh u qaadan karto NSAIDs. Raadso qiimayn caafimaad haddii maqaarku sii ahaanayo cawl, guduud, ama kabuubyo ka dib markaad dib u kululaato.

Waa maxay sababta ay dadku u dhaafaan digniin eber ah oo ka imanaya dareeraha nitrogen ee dareeraha ah, halka baraf engegan uu keeno neefsashada iyo argagaxa ka hor miyir-beelka?¶

Xarunta neefsashada ee maskaxdaadu dhab ahaantii ma cabbirayso inta ogsijiinta ku jirta dhiiggaaga si ay u kiciso rabitaanka neefsashada; beddelkeeda, waxay cabbirtaa kor u kaca heerarka kaarboon laba ogsaydh (CO2) iyo hoos u dhaca pH ee dhiigga. Marka baraf qallalan uu hoos ugu dhaco baabuurka xiran ama qolka, waxaad neefsataa xaddi badan oo CO2 ah, kaas oo isla markiiba kor u qaadaya dhiigaaga CO2 wuxuuna kiciyaa gaajo hawadu aad u daran, neefta oo degdeg ah, iyo madax xanuun garaaca ka hor inta aadan bixin 7% ilaa 10% CO2. Taas bedelkeeda, marka nitrogen dareere ah uu ku karkariyo qol xiran oo uu ku riixo heerka ogsijiinta hoos ka hooseeya 6% ilaa 10%, waxaad sii wadaysaa inaad neefsato CO2 adiga kuu gaar ah si caadi ah neef kasta. Sababtoo ah CO2 dhiigaagu waligiis ma kici, maskaxdaadu waxay dareemaysaa eber neefsasho iyo digniin eber: waxaad dareemeysaa gabi ahaanba fiicnaan ilaa ogsajiinta maskaxdaadu ay hoos uga dhacdo heerka miyirka oo aad madoobaato 8 ilaa 15 ilbiriqsi gudahood.

Waa maxay sababta "taangiga oksaydhka nitrous-ka u gubtaa" ama "gubashada boodhka hawada qasacadaysan" ee bowdada gudaha ama gacmaha si aad u qoto dheer oo ay inta badan u baahan yihiin tallaalka maqaarka?¶

Marka dhululubo nitrous oxide ah oo weyn ama rogan difluoroethane "hawo qasacadaysan" boodhku si degdeg ah u soo daayo, balaadhinta gaasta adiabatic waxay hoos u dhigtaa gidaarka taangiga birta ama jet buufinta dareeraha ah ilaa inta u dhaxaysa -40 iyo -88 darajo Celsius (-40 ilaa -126 darajo Fahrenheit). Sababtoo ah qabowgu wuxuu qaboojiyaa dareemayaasha maqaarka ee maqaarka ilbiriqsiyo gudahood, iyo sababta oo ah nitrous oxide ama difluoroethane neefta isla markaaba waxay dabooshaa dareenka xanuunka, qofka haysta dhululubada barafaysan inta u dhaxaysa bowdadiisa gudaha ama ku buufinaya dareeraha maqaarkiisa wax xanuun ah ma dareemo halka maqaarka qoto dheer iyo dufanka subcutaneous ay si adag u qaboojinayaan dhowr daqiiqo. Dhaawacyadani waa dhumuc buuxda oo dhab ah (darajada saddexaad iyo afraad) gubashada dhaxan oo ay tahay in lagu qiimeeyo xarunta gubashada isbitaalka ee daryeelka dhaawaca qalliinka iyo tallaalidda.

Hagahan waxa loogu talagalay ujeeddooyin macluumaad mana beddelo daryeelka caafimaadka xirfadda ama tababarka badbaadada shaqada. Sababtoo ah gaaska cryogenic ee meelaha xaddidan ka soo daadanaya waxay sababi karaan xidhidh wadnaha oo degdeg ah, waxaanu si adag ugu talinaynaa qaadashada gargaarka degdega ah ee la aqoonsan yahay, CPR, iyo koorsada maamulka oksijiinta iyada oo loo marayo Xiriirka Caalamiga ah ee Laanqeyrta Cas iyo Ururada Bisha Cas (IFRC), bulshadaada Laanqayrta Cas ee qaranka, St John Ambulance, ama bixiye tababar maxalli ah oo shahaado haysta.

Ilaha la hubiyay¶

• Machadka Qaranka ee Badbaadada Shaqada iyo Caafimaadka (NIOSH, Mareykanka) & Xarumaha Xakamaynta iyo Kahortagga Cudurrada (CDC): NIOSH Pocket Guide ee Khatarta Kiimikada: Kaarboon Dioxide (Baraf Qallalan) iyo Nitrojiin Dareere ah / Xawilaadaha Ogsajiinta.
• Iskaashatada Gaaska Culayska ah (CGA): Buugga Badbaadada SB-2: Hawada Ogsajiinta La'aanta iyo P-12: Maaraynta Badbaadada ah ee dareeraha Cryogenic.
• Wilderness Medical Society (WMS): * Tilmaamaha Dhaqanka Kiliinikada ee Ka Hortagga iyo Daawaynta Baraf-Biiyaha (Dirir-Dirir-Dhiiriso Dib u Wareejin, Ibuprofen, Iloprost, iyo Protocols Thrombolytic)*.
• Maamulka Badbaadada Shaqada iyo Caafimaadka (OSHA, Mareykanka): * Xaashida Xaqiiqda OSHA: Qabashada Badbaado leh ee Barafka Qalalan (Kaarbon Dioxide Adag) iyo Nitrogen dareeraha ah*.
• Caafimaadka iyo Maamulka Sare ee Badbaadada (HSE, Boqortooyada Ingiriiska): * Isticmaalka Badbaado leh ee Nitrojiinka dareeraha ah iyo Gaasaska Cryogenic ee Martigelinta, Cunto-siinta, iyo Shaybaarada*.

Tilmaamaha la xidhiidha¶

• Hypothermia iyo dhaxan gargaar degdeg ah
• Gubashada, gubasho, iyo kulaylka ayaa guba gargaarka degdegga ah
• Kaarboon monoksaydh iyo qiiqa neefsashada gargaarka degdegga ah
• Cyanide, hydrogen sulfide, iyo gaaska warshadaha ee neefsashada gargaarka degdegga ah
• Qaraxyada limnic iyo daruuraha gaaska kaarboon laba ogsaydh ee foolkaanaha
• Nambarada degdega ah wadan ahaan