Cayayaanka, Organophosphate, iyo Sunta Kiimikada Beeraha Gargaarka Koowaad¶

Soo-gaadhista ba'an ee cayayaanka beeraha, warshadaha, ama uruursan qoyska: gaar ahaan ** organophosphate cayayaanka ** (sida malathion, parathion, chlorpyrifos, diazinon), ** cayayaanka carbamate ** (aldicarb, carbaryl, propoxur), ** organophosphate iyo walxaha dareemayaasha , ** bicipyrid Fumigants fosfide (aluminium ama zinc phosphide): waa qalalaase sun ah oo nafta halis gelisa. Si ka duwan sunaha guriga ee caadiga ah ee keena waxyeellada kaliya haddii la liqo, organophosphates xoogga leh iyo wakiilada neerfaha waxay si degdeg ah u nuugaan ** maqaar aan fiicneyn, oo aan dillaacin **, iyada oo la marayo ** indhaha ***, iyo ** neefsashada ceeryaamo buufin ah ama uumiga **, taasoo kicisa neerfaha " duufaan cholinergic" daqiiqado gudahood.

Hagahan waxa uu bixinayaa badbaadinta goobta tallaabo-tallaabo ah iyo borotokool caafimaad oo la jaan qaadaya awaamiirta Hay'adda Caafimaadka Adduunka (WHO), Xarumaha Xakamaynta iyo Kahortagga Cudurrada ee Maraykanka (CDC), Wakaaladda Ilaalinta Deegaanka ee Maraykanka (EPA), Wakaaladda Walxaha Sumaysan iyo Diiwaangelinta Cudurrada (ATDR), iyo Adeegga Macluumaadka Sunta ee Qaranka UK (NPIS). Ku ilaalinta naftaada nitrile ama galoofyada neoprene ka hor inta aanad taaban dhibbanaha wasakhaysan, iska bixida dharka sunta cayayaanka lagu qooyay, maydhista maqaarka 15 daqiiqo, iyo helitaanka degdega ah atropine iyo pralidoxime (2-PAM) waxay badbaadisaa nolosha.

Hadda samee tan¶

Haddii adiga ama qof u dhow lagu buufiyay, lagu daadiyay, lagu neefsaday, ama la liqay sunta cayayaanka beeraha, cayayaanka xoogga leh, dilaaga haramaha, ama qiiqa hadhuudhka:

1. **Marka hore nafta iska ilaali: Wligaa ha ku taaban dhibbane sunta lagu qooyay ama mataggooda gacmo qaawan ***: Dabayl kor iyo kora ka fogee ceeryaamo kiimikaad buufinta, daruuraha, ama meelaha wax lagu kaydiyo ee xiran isla markaaba. Xidho Nitrile u adkaysta kiimikaad, caag butyl, ama galoofyada neoprene (gac-gashiyada caatada ah ee caatada ah ee caatada ah ayaa si degdeg ah u gala dareerayaasha organophosphate) ka hor intaadan taaban dhibbanaha ama dharkooda. Samatabbixiyaasha taabta shaararka qooyay organophosphate ama maqaar gacmo qaawan ayaa had iyo jeer ka burbura sumowga labaad.
2. ** Isla markiiba wac lambarkaaga deg-degga ah ***: Wac 911 gudaha Mareykanka iyo Kanada, 112 guud ahaan Midowga Yurub, ama 999 gudaha Boqortooyada Ingiriiska (ama hubi annaga nambarada degdega ah hagaha). Si cad ugu sheeg diraha: *" Sunta cayayaanka beeraha laga shakiyo ama organophosphate suntan: HAZMAT sun-saarid iyo qiyaasta sare ee Atropine ayaa loo baahan yahay."
3. Boqolkiiba 100 ka saar dharka wasakhaysan, kabaha, iyo dahabka isla markiiba: Ka saarida dharka sunta cayayaanka lagu qooyay waxa ay meesha ka saaraysaa 80 ilaa 90 boqolkiiba kiimikaad ka hor inta aanay maqaarka dhex qooyn. Isticmaal xiirid ama maqas si aad shaarka iyo surwaalada iska jarto intii aad ka saari lahayd madaxa dhibbanaha (taas oo kiimikada ka tirtiraysa indhaha, sanka iyo afka). Ku xidh dhammaan dharka la baxay iyo kabaha maqaarka (maqaarku waxay si joogto ah u nuugtaa sunta cayayaanka waligeedna lama sumayn karo) gudaha bac labanlaab ah oo culus.
4. Maqaarka iyo timaha ku maydh saabuun badan iyo biyo socda 15 daqiiqo oo buuxda: Dhibbanaha dhig qubeyska hoostiisa, tuubada beerta, ama rugta biyaha degdega ah oo madaxa ilaa lugaha ku maydh saabuun dareere ah oo khafiif ah ama saabuun saxan ah iyo biyo diiran/qabow 15 daqiiqo. Fiiro gaar ah u yeelo laablaabashada maqaarka, cidiyaha faraha, timaha, iyo dhegaha gadaasheeda. Haku xoqin maqaarka ceeriin burush adag, hana isticmaalin biyo kulul oo kulul, kuwaas oo balaadhiya xididdada dhiigga ee maqaarka, soona dedejiya nuugista sunta ee dhiigga. Haddii sunta cayayaanka lagu shubo indhaha, ku nadiifi indhaha biyo socda ama milix caadi ah 15 daqiiqo (eeg dhaawacyada isha).
5. ** ilaali marin-haweedka, u leexo dhinaca, oo WALIGAA ha samayn dib-u-soo-nooleyn af-ka-af ah : Dhibbanayaasha Organofosfat waxay ku hafateen candhuuftooda aadka u badan, xabka bronchorhea ("bronchorrhea"), iyo matag. Dhig dhibbanaha miyir-beelka ah ama qulqulaya dhinacooda ** booska soo kabashada si dheecaannada sambabada ee xummada leh ay uga soo baxaan afka. Haddii wadnuhu istaago ama neefsashadu joogsato, samee gacmaha-kaliya cadaadiska laabta (CPRama isticmaal maaskaro-bag-valve-mask (BVM): ** waligaa ha samayn neefta badbaadinta afka-ka-afka ah ee tooska ah, taasoo afkaaga u soo bandhigta uumiga sunta cayayaanka ah ee dilaaga ah iyo matagga.
6. ** Maamul autoinjector haddii la heli karo (DuoDote / Mark I / Atropen): Haddii shilku ku lug yeesho millatariga / walxaha dareemayaasha warshadaha ama kooxaha jawaabta beeralayda ee ku qalabaysan ** DuoDote ama ATNAA (Atropine + Pralidoxime)* qalal

Sumaynta goobta degdega ah iyo jaantuska kala soocida sunta¶

flowchart TD
    Start["Ka Shakisanaanta Sunta-Cayaaraha, Cayayaanka, Dhirta, ama Wakiilka Dareemaha"] --> SceneSafe{"Goobtu ma nabdoon tahay oo samatabbixiyeyaashu ma xidhan yihiin Nitrile/Neoprene PPE?"}

    SceneSafe -->|No: Vapor cloud, enclosed shed, or bare hands| Evac["Isla markiiba dabaysha sare u qaad hawo nadiif ah <br/> Xidho galoofyada Nitrile/Neoprene (WEELIGAA caato ah) <br/> Wac 911 / 112 / 999 HAZMAT & EMS"]

    SceneSafe -->|Yes: Upwind with chemical-resistant gloves| Decon["Isla markiiba 80% -90% ka saarida isha<br/>Ka jar dhammaan dharka wasakhaysan oo iska tuur kabaha maqaarka<br/>Maqaarka iyo timaha ku maydh saabuun iyo biyo qabow/qan 15 daqiiqo"]

    Evac --> Decon

    Decon --> ToxClass{"Ku Aqoonso Nooca Kiimikada Calaamadaha ama Calaamadaha Koonteenarka"}

    ToxClass -->|Pinpoint pupils, profuse drooling/sweating, wet lung crackles,<br/>vomiting, diarrhea, slow pulse, muscle twitching| Chol["Organophosphate ama Carbamate ('Cholinergic Crisis') <br/> Dhig booska soo kabashada dhinac-jiifka ah si aad u daadiso dareeraha sambabada<br/>Maamulka Atropine (laba jeer qiyaasta IV 3-5 daqiiqo kasta ilaa sambabadu qalalaan) <br/>+ Pralidoxime (2-PAM) ee Organophosphates + Benzodiazepines"]

    ToxClass -->|Swallowed blue/green foul-smelling liquid herbicide;<br/>severe burning mouth/throat Ulcers| Paraquat["Paraquat ama Diquat Herbicide<br/>Dhulka buuxinta afka ama Dhuxul Dhaqdhaqaaqa isla markiiba (haddii 1 saac gudahood)"]

    ToxClass -->|Garlic/rotten-fish odor after swallowing grain fumigant pellets;<br/>rapid shock and arrhythmias| Phosphide["Aluminium / Zinc Fosfide ('Sumowga 'Phosphine Gaas')<br/>Ha siin biyo ama dareerayaasha biyaha ku saleysan afka<br/>Ambalaasta hawo-qaadka/ED; maamul shoog wadnaha iyo aashitada"]

    ToxClass -->|Sudden grand mal seizures with NO drooling/pinpoint pupils<br/>after flea/tick spray or agricultural spray| Pyreth["Organochlorine (Lindane/Endosulfan) ama Pyrethroid<br/>15-daqiiqo saabuun dhaqid (saliid Vitamin E waxa ay fududaysaa paresthesias maqaarka)<br/>IV Benzodiazepines (lorazepam/diazepam) si loo joojiyo qallalka GABA-block"]

Pathophysiology ee "Duufaanta Cholinergic": Organophosphates iyo Carbamates¶

Organophosphates (asal ahaan loo sameeyay 1930-meeyadii iyo 1940-meeyadii sida cayayaanka beeraha iyo wakiilada neerfaha militariga sida Sarin, Soman, Tabun, iyo VX) iyo carbamates ayaa ah sababta ugu weyn ee sumowga sunta cayayaanka ee adduunka oo dhan, mas'uul ka ah in ka badan 100,000 dhimasho sanadkii.

Sida xakamaynta acetylcholinesterase (AChE) u daadiyo habdhiska dareenka¶

Jirka caafimaadka qaba, mar kasta oo neerfiyuhu uu rabo inuu u sheego muruqa inuu isku ururiyo ama qanjidhada si uu u soo saaro dheecaanka, terminaalka neerfaha ayaa sii daaya finan yar oo neurotransmitter acetylcholine (ACh) guud ahaan farqiga synaptik. Qayb ka mid ah hal ilbiriqsi gudahood ka dib markii fariinta la dhiibo, enzyme gaar ah oo guriga lagu hayo oo la yiraahdo acetylcholinesterase (AChE) wuxuu googooyaa molecule acetylcholine nus (oo u rogaya choline iyo acetic acid), isagoo dami ** OFF** si muruqu u nasto qanjidhkana uu joojiyo sirta.

1. **Foosforyaalka "OFF" beddelka ***: Organophosphates iyo carbamates waxay si toos ah ugu xidhaan goobta serine ee firfircoon ee enzyme acetylcholinesterase, oo gebi ahaanba curyaamisa enzyme-ka.
2. ** Daadadka Acetylcholine ee aan joogsiga lahayn ***: Iyada oo "OFF" beddelka jaban, acetylcholine aan qummanayn ayaa ku urursata heerar sun ah oo ku dhex jira nooc kasta oo cholinergic synapse ee jirka: ridida ** muscarinic reseptors *** (qanjirrada parasympathetic, sambabada, wadnaha, indhaha, mindhicirka), ** nicotinic receptors central murqaha iyo xiidmaha. nidaamka *** aan joogsi lahayn ilaa sambabada dhibbanaha ay ka buuxsamaan dareere oo diaphragmkoodu uu curyaan.
3. **Waa maxay sababta Organophosphates ay joogto yihiin ("Gabow") halka karbomates ay yihiin kuwo ku meel gaar ah ***:
4. Carbamate cayayaanka (carbaryl [Sevin], aldicarb, propoxur, methomyl) waxay sameeyaan ** carbamyl bond oo la beddeli karo** oo leh AChE ensaymka kaas oo si iskiis ah u sii daaya oo iskiis u sii daaya 24 ilaa 48 saacadood.
5. ** Cayayaanka Organophosphate iyo walxaha dareemayaasha *** (parathion, chlorpyrifos, malathion, diazinon, dichlorvos, fenthion) waxay sameeyaan curaarta fosfooraska adag ee dhagaxa ah kaas oo mara isbeddel kiimiko oo joogto ah oo loo yaqaan "Gabow" (luminta koox alkyl ah). Marka organophosphate-enzyme bond "da'" (kaas oo qaadata meel kasta laga bilaabo ** 2 daqiiqo wakiilka Soman neerfayaasha ** ilaa ** 12 ilaa 48 saacadood ee cayayaanka beeraha ***), enzyme waa ** si joogto ah u dhintay weligiis. Haddii bukaanku aanu helin daawada dib-u-kicinta Pralidoxime (2-PAM) kahor gabowga, jidhkoodu waa inuu soo saaraa unugyo cusub oo enzyme ah oo xoqan 2 ilaa 6 toddobaad.

Aqoonsiga Saddexda Qaybood ee Cholinergic Toxidrome: DUMBBELS & Isniin-ilaa-Jimce¶

Sababtoo ah acetylcholine xad-dhaaf ah ayaa dabka ka qaada saddex qaybood oo kala duwan oo soo-qabayaal ah isku mar, dhakhaatiirtu waxay raadiyaan saddex calaamadood oo kala duwan:

1. Kordhinta soo dhaweynta muscarinic: "DUMBBELS" ama "SLUDGE + Killer Bs"¶

Kicinta muscarinku waxay daartaa qanjidh kasta oo dheecaanka siinaya iyo muruqa siman ee jidhka. Xusuusnow xasuus-qorka DUMBBELS (ama SLUDGE):

• D: Shuban iyo Diaphoresis: Shuban-biyood oo qarxa iyo qufac, madax-ilaa-lugo dhidid.
• U: Kaadida: Luminta xakameynta kaadiheysta si aan ula kac ahayn.
• M: Miosis (Ardayga Pinpoint): Labada ardayba waxay isku koobaan ilaa 1-milimitir bar-baaro yaryar**, taasoo keenaysa daciifnimo, aragga oo qallafsan iyo xanuun barar ah (ciliary spasm).
• B: Bronchorrhea (Killer #1): qanjidhada xabka ee ku dahaaran geedka bronki waxa ay ku shubaan litir oo dareere dhuuban ah sanbabada, macno ahaan waxa ay keenaysaa in bukaanku **ku qarqiyo dheecaanka sambabada ee iyaga u gaar ah
• B: Bronchospasm (#2 Dilaaga)**: Cidhiidhi ba'an ee marin hawomareenka muruqa oo siman taasoo keenta xiiq daran iyo awood la'aanta inay hawadu dhaqaaqdo.
• B: Bradycardia (Killer #3): Dareemaha siilka oo qota dheer oo hoos u dhigaya garaaca wadnaha ilaa 30 ilaa 45 garaac daqiiqaddii, taasoo keenta hypotension iyo xiritaanka wadnaha asystolic. * (Wadajir, ** Bronchospasm, Bronchospasm, iyo Bradycardia ** ayaa loo yaqaanaa dawada degdega ah sida "Saddex Killer Bs" sababtoo ah waxay yihiin waxa dhabta ah ee dila bukaanka: iyo waxa ** Atropine *** si gaar ah u beddelo.
• E: Emesis: matag aan kala joogsi lahayn iyo calool xanuun daran.
• L: Lacrimation: Ilmo joogto ah oo ka timaadda labada indhood.
• S: Candhuuf: Dheefaan baraf leh oo afka ka soo qubanaysa.

2. Kordhinta Soo Dhawaynta Nicotinic: "Maalmaha Todobaadka" (MTWtFS)¶

Halka kuwa qaata muscarinic ay hoos u dhigaan wadnaha oo ay daadiyaan sambabada, kicinta isku mar ah ee ** nicotinic reseptors *** ee murqaha lafaha iyo adrenal/ganglia adrenal / naxariista ayaa sababa xannibaadda depolarization neuromuscular. Xusuusnow maalmaha toddobaadka (M-T-W-t-F-S):

• M: Mydriasis ( naadirka hore ee ardayda u naxariista): Mararka qaarkood hore ayaa loo arkaa ka hor inta aanu muscarinic pinpoint miosis xukumin.
• **T: Tachycardia ***: Qalliinka adrenaline ee hore u naxariisan wuxuu si ku meel gaar ah u keeni karaa garaaca wadnaha oo degdeg ah iyo dhiig karka ka hor inta uusan vagal bradycardia la wareegin
• ** W: Daciifnimo (Flacid Paralysis)**: Kacsi kooban ka dib, isgoysyada neuromuscular-ka ayaa depolarizes oo xira, taasoo keenta daciifnimo qoto dheer oo muruqa lafaha ah iyo ** curyaannimo diaphragm iyo murqaha neefsashada intercostal ***.
• t: Gariir iyo Dhiig kar.
• F: Fasciculations (Muruqa Dixirigu u eg): Dilaac muuqda, Dixiri la mid ah qallafsanaan ikhtiyaari ah oo ku yaal daboolka indhaha, carrabka, weylaha, laabta, iyo garbaha: calaamad nicotinic pathognomonic oo ** atropine uusan hagaajin karin** (waxay u baahan tahay ** Pralidoxime / 2-PAM**).
• S: Suuxdin iyo dhidid.

3. Sunta Hababka Dhexe ee neerfayaasha: Walaaca, Kooma, iyo Xaaladda Epilepticus¶

Organofosfateyaasha lipid-soluble waxay si degdeg ah uga gudbaan xannibaadda dhiigga-maskaxda, taasoo keenta kacsanaan, degenaansho la'aan, hadal qallafsan, jahawareer, ataxia, niyad-jabka dhexe ee neef-mareenka, miyir-beelka, iyo qalalaasaha xaalad kacsanaan ah ** (waxaa lagu daaweeyaa xididada xididka ** benzodiazepines**, sida diazepam).

Isbarbardhigga Master-ka ee Cayayaanka Beeraha iyo Cayayaanka Guriga¶

Hab-maamuuska ka-hortagga Cusbitaalka ee Sumowga Organophosphate¶

Marka bukaan qaba organophosphate ama karbamate sunta daran uu yimaado waaxda gargaarka degdega ah, ilbiriqsiyo ayaa tirinaya. Dib-u-soo-nooleynta waxay raacdaa taxane adag: ** Sun-saarid + Ilaalinta marin-haweedka \(\rightarrow\) Atropine Duubling Rejiment \(\rightarrow\) Pralidoxime (2-PAM) \(\rightarrow\) Benzodiazepines**.

1. Nidaamka labanlaabmay ee Atropine: Titrating to "Sambabada Qalalan," MAYA Cabbirka Ardayga¶

Xiritaanka caadiga ah ee wadnaha ama bradycardia fudud, dhakhaatiirtu waxay siinayaan 0.5 ilaa 1 milligram oo atropine ah ilaa ugu badnaan 3 milligaraam. ** Sumowga organofosfate ee daran, 3 milligram waa hoos u dhac ku jira baaldiga: bukaanadu waxay si joogto ah u baahan yihiin 20, 50, ama xitaa in ka badan 100 milligaraam oo atropine-ka xididada leh saacadaha ugu horreeya *** si ay u sii noolaadaan.

• ** Sida degdega ah ee kororka atropinization u shaqeyso ***:
• Dhakhaatiirtu waxay ku bilaabaan bolus faleebada oo degdeg ah 1 ilaa 3 milligaraam oo Atropine dadka waaweyn (0.02 ilaa 0.05 mg/kg carruurta).
• Dib u qiimee laabta bukaanka adigoo isticmaalaya stethoscope 3 ilaa 5 daqiiqo kasta.
• Haddii dillaaca bronki qoyan yahay (bronchorrhea), hiinraag (bronchospasm), ama hypotension/bradycardia (HR < 80 bpm) sii wad 3 ilaa 5 daqiiqo ka dib, LABABAY qiyaasta hore (tusaale: \(2\text{mg} \rightarrow 4\text{mg} \rightarrow 8\text{mg} \rightarrow 16\text{ mg} \rightarrow 32\text{ mg}\) 3 ilaa 5 daqiiqo kasta faleebo (boqolkiiba 10 ilaa 20 boqolkiiba wadarta xadiga rarida saacadiiba).
• ** Maxay yihiin qodobbada dhabta ah ee Atropinization?
• Sambabada ka nadiifi miyir-beelka (joojinta dhammaystiran ee bronchorrhea iyo xiiqidda si uu bukaanku u neefsado oo hawo la'aan loogu sii daayo).
• ** garaaca wadnaha oo ka sarreeya 80 garaac daqiiqaddii** iyo systolic blood pressure oo ka sarreeya 80 ilaa 90 mmHg.
• ** Kilkilaha qallalan (axillae)**.
• Xeerka kiliinikada ee muhiimka ah: **Ha joojin siinta atropine sababtoo ah ardayda bukaanku way fidayaan ama sababtoo ah garaaca wadnahooda ayaa gaaraya 110 garaac daqiiqaddii haddii sambabada ay wali ka buuxaan dheecaan qoyan. Waxaad ku daawaysaa atropine ilaa sambabadu ka engegaan.

2. Pralidoxime (2-PAM / Obidoxime): Furitaanka murqaha curyaanka ah¶

Sababtoo ah atropine kaliya ayaa xannibaya ** muscarinic *** reseptors (qallajinta sambabada iyo hagaajinta garaaca wadnaha) waxayna leedahay ** saameyn eber ah oo ku saabsan daaweeyayaasha murqaha lafaha nicotinic **, bukaan si buuxda u atropinized oo leh sambabada qalalan ayaa wali u dhiman kara ** diaphragm nicotinic iyo curyaan muruqa neefsiga **.

• ** Sidee Oximes u shaqeeyaan ***: Pralidoxime (2-PAM) (oo lagu qiyaaso 1 ilaa 2 garaam IV in ka badan 15 ilaa 30 daqiiqo dadka waaweyn, ama 20 ilaa 50 mg/kg carruurta, oo ay ku xigto faleebo IV joogto ah oo ah 500 mg/saacaddii ama 8 ilaa 10 mg/kg/saacaddiiba. Waxay weerartaa atamka fosfooraska ee molecule organophosphate, iyada oo ka soo jiidaya enzyme acetylcholinesterase iyo dib u socelinta firfircoonida enzyme dabiiciga ah ee buuxa ee muruqyada lafaha iyo goobaha muscarinic: waase haddii la siiyo ka hor inta aan la bedeli karin "gabowga" wuxuu xiraa curaarta si joogto ah.
• ** Digniin ku shubasho (Weligaa ha isticmaalin Succinylcholine): Haddii bukaan-socodka organophosphate ama karbamate uu u baahan yahay isku-dabacyo degdeg ah xiniinyaha endotracheal, daaweeyayaasha waa inay ** waligood isticmaalin daawada curyaanka ah ee succinylcholine**, sababtoo ah succinylcholine waxaa sida caadiga ah u burburiya balasmaha butyrylcholinesterase (pseudocholinesterase). Maadaama sunta cayayaanka ay baabi'isay dhammaan enzymes cholinesterase, hal qiyaas oo succinylcholine ah ayaa sababa saacadaha curyaannimada daba dheeraatay. Taa baddalkeeda, xannibiyeyaasha neuromuscular-ka ee aan-depolarization-ka ahayn (sida **rocuronium ***) ayaa la isticmaalaa.

3. Daawashada cudurka "Intermediate Syndrome" (24 ilaa 96 saacadood ka dib)¶

Xitaa ka dib marka bukaanku ka badbaado dhibaatada cholinergic ee Maalinta 1 waxayna u muuqataa inay si fiican uga soo kabanayso isbitaalka, ** 10 ilaa 40 boqolkiiba bukaanada ku sumoobay organophosphates aadka u lipid-soluble (sida fenthion, dimethoate, parathion, ama chlorpyrifos) si lama filaan ah u soo baxa "Intermediate Syndrome" 14 ilaa 4 maalmood ka dib.

• ** Curyaannimo degdeg ah oo daahday ***: Iyada oo aan soo noqnoqoneynin sambabada ama sambabada qoyan, bukaanku wuxuu yeelanayaa curyaan ba'an ** qalloocyada qoorta *** (awood la'aanta inay madaxooda ka qaadaan barkinta: calaamadda digniinta ugu horreysa), ** neerfayaasha cranial ilaa 15 maalmood ilaa inta isgoysyada neuromuscular ka soo kabsanayaan.
• ** Organophosphate-Induced Delayed Neuropathy (OPIDN)***: Dhaca 1 ilaa 3 toddobaad ka dib soo-gaadhista qaarkood, taasoo keenta kubka xanuun, kabuubyo, xiirid, iyo "dhicista-iyo-gacmo-gashi" cagta hoos u dhaca/cudurka daciifnimo.

Sida loo isticmaalo Autoinjectors: DuoDote, Mark I, iyo Atropen¶

Milatari ahaan, walxaha halista ah (HAZMAT), adeegyada caafimaadka degdegga ah (EMS), iyo goobaha beeraha warshadaha qaarkood, jawaab-bixiyeyaashu waxay wataan autoinjectors gu' raran oo loogu talagalay in lagu bixiyo ** Atropine ** iyo ** Pralidoxime (2-PAM)** iyada oo loo marayo dharka bowdada dibadda ah ilbiriqsiyo gudahood soo-gaadhista organophosphate ama wakiilka dareemayaasha.

Qaadashada by darnaanta iyo Autoinjector Nooca¶

1. ** Qalabka Gawaarida ee Qaangaarka ah (DuoDote ama ATNAA / Mark I Kit) ***:
2. Mid kasta oo ** DuoDote ** hal foosto autoinjector ah wuxuu keenaa ** 2.1 milligaraam oo Atropine ** iyo ** 600 milligram ee Pralidoxime Chloride ** si isku xigta iyada oo loo marayo hal irbad (ka weyn ** Mark I Kit ** wuxuu isticmaalaa laba duriyaal oo kala duwan: Injector # 1 wuxuu ka kooban yahay 2 mg Atropine, iyo Pralidoxime #2) wuxuu ka kooban yahay 6x00 mg.
3. Calamadaha dhexdhexaadka ah iyo kuwa fudud (ardayda tilmaanta, diifka, qulqulka, laabta oo adkaata, lallabbo, laakiin bukaanku weli wuu socdaa oo hadlayaa): Maamul 1 DuoDote (ama 1 Mark I set) dhexda bowdada bannaanka ah (vastus lateralis). Sug 10 ilaa 15 daqiiqo; haddii astaamuhu aanay ka soo rayn, raadso daryeel caafimaad qiyaaso dheeraad ah.
4. Calaamadaha daran *** (miyir la'aan, gariir / suuxdin, neef-mareen-xanuun aad u daran / neefsi, apnea, ama curyaan jilicsan): isla markiiba maamul **3 DuoDote autoinjectors (ama 3 Mark I sets) si isdaba joog ah oo isku xigta ** bowdada dibadda ah, oo lagu daray ** 1 Diazepam (CANA 10 mg) ama xitaa Mida Suuxdin muuqata ma muuqdaan (maxaa yeelay dhibbanayaasha dareemayaasha curyaanka ah ayaa inta badan ku dhacda suuxdin maskaxeed oo aan gariiraynin).
5. ** Qiyaasta Ku Salaysan Culayska Atropen ee Carruurta ***:
6. Carruurta yaryar ee la kulma organophosphates ama walxaha dareemayaasha waxay u baahan yihiin miisaan-cabbir ** Atropen ** autoinjectors (oo laga heli karo ** 0.25 mg ** [calaamad huruud ah, dhallaanka ka yar 7 kg / 15 rodol], ** 0.5 mg *** [calaamad buluug ah, carruurta 7 ilaa 18 kg / 15 ilaa 40 lbs, 1k dark ilaa 1.0 mg. 41 kg / 40 ilaa 90 rodol], iyo **2.0 mg *** [calaamad cagaaran, in ka badan 41 kg / 90 rodol]).
7. Xeerka badbaadada nafta ee muhiimka ah: Haddii ilmuhu leeyahay organophosphate nafta halis gelisa ama sunta wakiilka neerfaha (dheecaan sambabada oo bararsan, xiiqsan, kooma, ama suuxdin) iyo qof weyn oo keliya 2 mg Atropine / DuoDote autoinjector ayaa laga heli karaa goobta, ** maamuli qofka weyn ee autoinjector ilmaha isla markiiba**. Tachycardia atropine ee ku meel gaadhka ah iyo maqaarka engegan ayaa si buuxda loo badbaadi karaa, halka joojinta neefsashada ee cholinergic ee aan la daweyn ay halis u tahay daqiiqado gudahood.

Talaabo-Tallaabo Farsamada Duritaan ee Autoinjector¶

• **Tallaabada 1: Fiiri jeebka bowdada ee dibadda ***: Si dhakhso leh u dareen bowdada dhexe si aad u hubiso inaadan ku durin boorsada, furayaasha, casriga, ama suunka suunka qaro weyn.
• Tallaabo 2: Ka saar furka badbaadada cawl: Ku qabo foosto DuoDote feedhaha adigoo ** caarada cagaarka ah hoos u fiiqaysa** (waligaa suulka ha saarin cidhifka cirbadda cagaaran). Si toos ah uga soo jiid daboolka badbaadada cawl ee dhabarka.
• Tallaabada 3: Si adag u jab xagal 90-degree ah oo u gal bowdada dhexe: U lul oo si adag ugu cadaadi caarada cagaarka ah bowdada sare ee hilibleyda ah dhexda u dhaxaysa sinta iyo jilibka ilaa aad maqasho oo dareemayso gujinta guga.
• ** Tallaabada 4: Si adag u qabooji 10 ilbiriqsi oo buuxa ***: Si tartiib ah u tiriso ilaa 10 ("kun-kun, laba-kun-kun...") si labada qol (atropine iyo pralidoxime) ay si buuxda u faaruqiyaan muruqa.
• Tallaabada 5: irbadda u leexi jillaab oo ku dheji qoorta dhibbanaha: Si toos ah u soo bixi cirbadda, ku duug bowdada dhowr ilbiriqsi, oo ku leexi irbadda bannaanka ah jillaab "J" meel adag oo adag si aad ugu xirto autoinjector madhan jeebka shaadhka dhibbanaha ama summada kala soocidda. Tani waxay u sheegaysaa imaanshaha dhakhaatiirta caafimaadka iyo takhaatiirta xaaladaha degdegga ah iyagoo eegaya inta qiyaasood ee atropine iyo 2-PAM ee bukaanku horey u helay.

Su'aalaha soo noqnoqda¶

Hagahan waxa loogu talagalay ujeeddooyin macluumaad mana beddelo qiimaynta caafimaadka ee xirfadleyda ah ama tababarka gacan-ku-oolka ah. Sababtoo ah sunta kiimikada daran waxay sababi kartaa xirid degdeg ah oo neefsashada ah, waxaan kugula talineynaa inaad qaadato gargaarka degdegga ah ee la aqoonsan yahay iyo koorsada CPR iyada oo loo marayo Xiriirka Caalamiga ah ee Laanqeyrta Cas iyo Ururada Bisha Cas (IFRC), bulshadaada Laanqeyrta Cas ee qaranka, St John Ambulance, ama bixiye tabobar maxalli ah oo la aqoonsan yahay.

Ilaha la hubiyay¶

• Ururka Caafimaadka Adduunka (WHO): Maaraynta Kiliinikada ee Sumaynta Sunta Ba'an: Organophosphorus, Carbamate, iyo Tilmaamaha Sunta Paraquat.
• Xarumaha Xakamaynta iyo Kahortagga Cudurrada (CDC, United States) & Wakaaladda Walxaha Sumaysan iyo Diiwangelinta Cudurrada (ATSDR): * Tilmaamaha Maareynta Caafimaadka ee Wakiilada Dareemayaasha iyo Cayayaanka Organophosphate * iyo * Tilmaamaha Kiliinikada Paraquat*.
• Hay'adda Ilaalinta Deegaanka ee US (EPA, United States): Aqoonsiga iyo Maareynta Sumowga Sunta cayayaanka (Daabacaadda 6aad).
• Adeegga Macluumaadka Sumowga Qaranka (NPIS, Boqortooyada Ingiriiska) & Hay'adda Ammaanka Caafimaadka UK (UKHSA): TOXBASE Maareynta Kiliinikada ee Organophosphates, Carbamates, Paraquat, iyo Fosfide Birta.

Tilmaamaha la xidhiidha¶

• Sumeynta gargaarka degdegga ah iyo kala soocidda xakamaynta sunta
• Gubashada daran iyo maqaarka kiimikaad oo dareeraya
• Hydrofluoric acid, ka saara miridhku, iyo gubasho kiimikaad warshadeed
• Dhaawaca indhaha iyo waraabka isha kiimikaad
• CPR iyo neefsashada samatabbixinta ee dadka waaweyn
• Nambarada degdega ah wadan ahaan