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Dry Ice Asphyxiation, Liquid Nitrogen Frostbite, le Cryogenic Burns

Linomoro tsa maemo a tšohanyetso li fapana ho ea ka linaha. Leqephe lena le sebelisa 911, nomoro ea United States le Canada. Linaha tse ling tse ngata li sebelisa 112, 999, kapa nomoro e ’ngoe. Fumana nomoro ea naha ea heno.

Lisebelisoa tsa cryogenic le likhase tse nang le mokelikeli, ka ho khetheha Dry Ice (solid carbon dioxide, \(\text{CO}_2\), at \(-78.5^\circ\text{C} / -109.3^\circ\text{F}\)), Nitrogen ea Liquid (\(\text{LN}_2\){C\ci\text^) ho \(-19 -320^\circ\text{F}\)), Liquid Helium (\(-269^\circ\text{C} / -452^\circ\text{F}\)), Mokelikeli oa Oksijene (\(\text{LOX}\) at \(-183^\circ\text{C} / -297 Liquid Propane** Empa Liquid Propane*** Empa Liquid Propane* (\) -42 ^\circ\text{C} / -44^\circ\text{F}$), le Compressed difluoroethane "air canned" dusters kapa nitrous oxide cylinders, ha li sa fella lilaboratoring tsa indasteri. Malapa a limilione a kopana le leqhoa le omileng le naetrojene e metsi ka har'a mabokose a ho romelloa ka poso, li-ice-cream, mochini oa moholi oa Halloween, lijo tse theolelang tsa "dragon's breath" le li-cocktails tse smoky, lisebelisoa tsa ho tlosa letlalo la letlalo le lisebelisoa tsa elektronike tse hloekisang.

Lintho tsena li theha maemo a tšohanyetso a mane a ikhethileng a behang bophelo kotsing a hlokang thuso ea pele e khethehileng hanghang:

  1. Confined-Space Asphyxiation and Hypercapnic Narcosis: Ha leqhoa le omileng le kokobela ka har'a koloi ea baeti e koetsoeng, van ea thepa, sehatsetsing, kapa kamore e nyenyane ea ho robala, kapa ha naetrojene ea metsi e bela ka lifting kapa kamoreng e ka tlaase, khase e atolohang e tlosa oksijene e hemang ha carbon dioxide e chefo ka ho toba maling.
  2. Instantaneous Cryogenic Contact Frostbite: Ho ama leqhoa le omileng ka letlalo le se nang letho, kapa ho fumana naetrojene e metsi kapa propane ea metsi e kenngoeng ka har'a tlelafo kapa boot, ho homisa lisele tsa motho tse tiileng ka metsotsoana, ho phatloha lera la sele ka likristale tsa leqhoa tse intracellular.
  3. Ho phatloha ha mala ho tsoa ho Nitrojene e Metsoang kapa Leqhoa le Omileng: Ho koenya naetrojene e sa tsoeng mouoane ka har'a lebenkele le lecha kapa lijo-thollo, kapa ho kenya leqhoa le omileng ka hanong, ho baka ** ho phatloha ho hoholo ha molumo oa makhetlo a 700 ho isa ho a 800** ka har'a mpa e futhumetseng e phatlohileng ka mpeng. (barotrauma perforation).
  4. Sealed-Contained Bomb Explosions: Ho beha leqhoa le omileng le setseng kapa naetrojene e metsi ka har'a botlolo ea soda ea polasetiki e tiisitsoeng ka thata, nkho ea khalase, kapa sepholi se notletsoeng ka latch ho haha ​​likhatello tse fetang 700 ho isa ho 1,100 PSI, tse phatlohang ka matla a seqhomane se arohaneng.

Tataiso ena e fana ka mehato ea mehato ea ho pholosa, ho futhumatsa, le ho hlahloba sepetlele ho tsamaisana le Setsi sa Sechaba sa United States sa Tšireletso le Bophelo bo Botle ba Mosebetsi (NIOSH / CDC), Occupational Safety and Health Administration (OSHA), Compressed Gas Association (CGA), Wilderness Medical Society (WMS), le UK Health and Safety Executive (HSE).

Etsa sena hona joale

Haeba u arabela boemong ba tšohanyetso bo amanang le leqhoa le omileng, naetrojene e nang le metsi, kapa khase e hatelitsoeng ka metsi:

  1. ** LE KA mohla u kene ka phaposing e se nang moea, e pholileng, kapa koloi e koetsoeng moo motho a oeleng haufi le leqhoa le omileng kapa naetrojene e metsi**: U tla tsoa ebe u shoa haufi le bona nakong ea metsotsoana e 20 ho isa ho e 60 ntle le Self-Contained Breathing Apparatus (SCBA). ** Pele **, bula mamati ohle a koloi, mamati a karache, kapa lifensetere tse kantle ho tsoa kantle ho tšela sebaka, letsetsa 911 / 112 / 999 ka rona. dinomoro tsa tshohanyetso directory, 'me u hulele motho ea hlokofalitsoeng moeeng o hloekileng ka ntle haeba u ka etsa joalo ntle le ho hema sepakapaka se koalehileng.
  2. Lokolla letlalo leha e le lefe le leqhoa hore le omelle leqhoa kapa tšepe e hatselang ka metsi a foofo (O SE KE oa le hahola): Haeba menoana, melomo, kapa leleme le hoamme ka potlako ho fihlela leqhoa le ommeng, phaephe e nang le naetrojene e metsi, kapa sejana sa tšepe, tšela metsi a foofo (\(37^\circ\text{C}\text{9text{3) ho } 98.6^\circ\text{F}\text{ho }102.2^\circ\text{F}\)) holim'a ntlha ea ho kopana ho qhibilihisa leqhoa ka bonolo. Ho hula letlalo le omeletseng holim'a libaka tsa cryogenic ho tabola epidermis eohle le letlalo la menoana.
  3. Tlosa lireng, lioache le liaparo kapa libutsi tse kolobisitsoeng ka cryogen hang-hang: Haeba metsi a naetrojene kapa propane ea metsi e hasana ka har'a tlelafo e hlephileng ea mosebetsi, sock, kapa boot, mokelikeli o qabeletsoe letlalong ebe o lahleheloa ke mosamo oa mouoane oa Leidenfrost. Hula glove kapa butle ka motsotsoana o le mong (ho sebelisa lithaole kapa lithaole tse omeletseng ho sireletsa matsoho a hau) 'me u thelle mehele eohle ea menoana pele ho ruruha ho qala.
  4. Lehame le futhumetseng le futhumetseng ka \(37^\circ\text{C}\text{ ho }39^\circ\text{C}\) (\(98.6^\circ\text{F}\text{ to }102.2^\circ\text{F}\)) metsi a futhumetseng a metsotso e 30 ho isa ho 15
  5. Lekola mocheso oa metsi ka thermometer kapa setsoe sa hau se sa tsoa kotsi pele. Le ka mohla u se ke ua sebelisa metsi a chesang a ka holimo ho \(40^\circ\text{C}\text{ to }42^\circ\text{C}\) (\(104^\circ\text{F}\text{ to }108^\circ\text sebelisa{F}\), sebata se omisang, se futhumatsang kapa se omisa sebata se futhumatsang{F}$), le ho omisa mocheso mello), e phehang linama tse shoeleng, tse hoammeng.
  6. ** LE KA mohla u se ke ua itlotsa kapa ua silila ho chesoa ha cryogenic**: Lisele tsa letlalo tse hatselitsoeng li tletse ka likristale tse nyenyane tsa leqhoa tse hlabang ka lehare; ho hohla sebaka seo ho sila likristale tseo ka har’a lera la sele le methapo ea mali, ho senya lisele tse ka beng li pholositsoe.
  7. Haeba motho a kwetse naetrojene e metsi kapa leqhoa le omileng (ka lebenkeleng, ka kopi ea moholi, kapa dessert), letsetsa 911 / 112 / 999 hang-hang 'me U SE KE UA qobella ho hlatsa kapa ho noa lino tse nang le carbonated: Lulisa motho eo a otlolohile kapa a itšetlehe ka pele hanyane hore khase e ntseng e atoloha e ka tsoa molomong, 'me u mo tsamaise hang-hang bakeng sa ts'oaetso ea esopha kapa CT scan. ho phatloha ha barotrauma le pneumoperitoneum**.
  8. Haeba botlolo e tiisitsoeng kapa pholileng e nang le leqhoa e ommeng e butsoela kapa e letsa mololi, tsoa ka phaposing hang hang: U SE KE UA feta 'me u leke ho qhaqha kepisi. Ho thothomela le letsoho la hao le le tšoarang ka mofuthu ho tla phatlola setshelo sefahlehong sa hao, ho baka maqeba a foufetseng le menoana e sithabetsang. Hlakola sebaka seo, koala lemati ka mor'a hao, 'me u se lumelle hore se phunye kapa se phunye ka mor'a sekoahelo se thata.

Hobaneng ha Ho Khanna ka Leqhoa le Omileng ka Koloi e Koetsoeng ho ka Baka Lefu le Bolaeang ka Metsotso e 15

K'hilograma e le 'ngoe (liponto tse 2.2) ea leqhoa le thata e ommeng e theohela ka ho toba 541 litres (19.1 cubic feet) ea carbon dioxide e hloekileng (\(\text{CO}_2\)). Ho fapana le mokelikeli oa naetrojene (e leng ntho e bonolo ea asphyxiant e mpang e hlapolla oksijene), carbon dioxide ke active systemic poison (hypercapnic intoxicant). Ha \(\text{CO}_2\) ka har'a cabin e koetsoeng ea koloi e nang le air conditioner e behiloeng "Recirculate" e phahama ho tloha ho e tloaelehileng. 0.04% (400 ppm) ho fihlela 3% to 5% (30,000 to 50,000 ppm), bapalami ba tšoaroa ke hlooho e otlang ka matla, ho tsekela, ho hema ka potlako le ho otla ha pelo ho otlang ka sekhahla; hang \(\text{CO}_2\) e fihla 7% to 10% (70,000 to 100,000 ppm), e baka **acidosis e matla ea ho hema, ho tsieleha, ho akheha ka hare ho 1 ho metsotso ea 2, le lefu **, esita le haeba ho ntse ho e-na le 19 lekholong ea oksijene e setseng ka koloing. Kamehla tsamaisa leqhoa le omileng ka kutung/booting kapa betheng ea teraka, kapa ka bonyane lifensetere tse peli tse theotsoeng tlase ka lisenthimithara tse 5 (2 inches) le taolo ea boemo ba leholimo e behiloe ho Fresh Outside Air (NEVER Recirculate).

Tlhekefetso ya maemo a tshohanyetso a cryogenic le “asphyxiation triage flowchart”

flowchart TD
    Start["Dry Ice (CO2), Liquid Nitrogen (LN2), kapa Compressed Cryogen Emergency"] --> SceneSafety["TŠEBELETSO EA TŠEBELETSO PELE: Na motho ea hlokofalitsoeng o ka koloing e koetsoeng,<br/>e kenang ka har’a pholileng, mokatong o ka tlaase, lifti, kapa phaposing e nyenyane?"]

    SceneSafety -->|Yes: Confined-Space Collapse| VentRescue["U SE KE UA KENA U NTLE HO SCBA / VENTILATION<br/>1. Bula mamati/lifensetere tsohle ho tloha kantle ho kenya moea o kenang<br/>2. Letsetsa 911 / 112 / 999 (Tlaleha Confined Space Cryogen Asphyxiation) <br/>3. Hang ha u le moeeng o hloekileng: Sheba ho otla ha pelo / ho hema -> Qala CPR + 100% Oxygen haeba apneic"]

    SceneSafety -->|No: Conscious Patient in Safe Air| InjuryType{"Ke kotsi ea mofuta ofe ea cryogenic e etsahetseng?"}

    InjuryType -->|Ingestion of Liquid Nitrogen Cocktail / Dessert<br/>OR Swallowed Piece of Dry Ice| GiPerf["TŠEBELETSO EA TŠEBELETSO EA GASTRIC BAROTRAUMA (CALL 911)<br/>1. Boloka mokuli a lutse a otlolohile e le hore khase e ka ntša (belch) ntle <br/>2. Ha ho letho ka molomo (NPO); LE KA mohla u se ke ua etsa hore motho a hlatse<br/>3. Sepetlele sa Hang-hang CT + Ho buuoa ka Ho Oa ha Pneumoperitoneum<br/>+ Endoscopy bakeng sa 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["CRYOGENIC FROSTBITE PROTOCOL <br/>1. Haeba letlalo le khomaretse leqhoa le ommeng / tšepe: E lokolle ka metsi a foofo (37-39°C) <br/>2. Hlōla liatlana tse metsi/tse kopanetsoeng, likausi, libutsi, le mehele hang-hang<br/>3. Kenya ka har'a 37°C ho isa ho 39°C (98.6°F ho isa ho 102.2°F) a potolohang metsi ka metsotso e 15-30<br/>4. LE KA mohla itlotsa letlalo; tlohela marako a hlakileng a ntse a le teng; fana ka Ibuprofen (anti-thromboxane)"]

    InjuryType -->|Cryogenic Splash into the Eye<br/>(Liquid Nitrogen, Refrigerant Freon/R-134a, or Propane)| EyeBurn["OCULAR CRYOGENIC BURN PROTOCOLLE<br/>1. Nosetsa leihlo ka bonolo ka mocheso o foofo (37°C / 98.6°F) saline e sa hloekang kapa metsi bakeng sa metsotso e 15<br/>2. Haeba lintši li koalehile, li futhumale ka sekontiri se foofo sa saline ho fihlela se buleha<br/>3. LE KA mohla itlotsa leihlo; ikhurumetsa ka bonolo ka thebe ea mahlo e hloekisitsoeng 'me u ee ho Emergency Ophthalmology"]

Fisiks le Pathophysiology ea Likhase tsa Cryogenic le Liquids

Ho utloisisa hore na li-cryogens tse fapaneng li itšoara joang ho hlalosa hore na ke hobane'ng ha Dry Ice (\(\text{CO}_2\)) le Liquid Nitrogen (\(\text{LN}_2\)) li bolaea batho ka mekhoa e fapaneng ka ho feletseng ea khase, le hore na ke hobane'ng ha ho phatloha ha nakoana ha naetrojene e metsi letsohong le se nang letho hangata ho se kotsi ha ho phatloha ha monoana ka har'a tlelafo ho baka ho phunya.

1. Maemo a Katoloso ea Khase le Boima ba Khase: Carbon Dioxide (\(\text{CO}_2\)) vs. Nitrogen (\(\text{N}_2\))

Thepa ea 'Mele & Toxicological Leqhoa le Omileng le Tiileng (Carbon Dioxide / \(\text{CO}_2\)) Naetrojene e Metsi (\(\text{LN}_2\)) Oksijene e Metsi (\(\text{LOX}\)) Sehatsetsi se Hatelitsoeng / "Moea Oa Canned" Duster (1,1-Difluoroethane / Propane / \(\text{N}_2\text{O}\))
Mocheso o belang / Sublimation \(-78.5^\circ\text{C}\) (\(-109.3^\circ\text{F}\)) (e theoha ka ho toba ho tloha ho tiileng ho ya ho gase ka 1 atm) \(-195.8^\circ\text{C}\) (\(-320.4^\circ\text{F}\)) (e pheha ho tloha mokelikeli ho ea ho khase) \(-183.0^\circ\text{C}\) (\(-297.3^\circ\text{F}\)) (mokelikeli o moputsoa o mosehla oa cryogenic) \(-25^\circ\text{C}\text{ ho }-88^\circ\text{C}\) (\(-13^\circ\text{F}\text{ to }-127^\circ\text{F}\)) holim'a khatello e potlakileng ea adiabatic
Karolelano ea Katoloso (E tiileng/Mokelikeli ho ea ho Khase ka \(20^\circ\text{C}\)) 1 :845 ka bophahamo (1 kg leqhoa le omileng le tiileng = 541 Lilitha tsa \(\text{CO}_2\) e hloekileng) 1 : 694 ka bophahamo (1 Liter ea \(\text{LN}_2\) e bela 694 Litha tsa khase e hloekileng ea \(\text{N}_2\)) 1 :860 ka bophahamo (1 Liter ea \(\text{LOX}\) = 860 Litre tsa \(\text{O}_2\) e hloekileng) 1 : 250 ho isa ho 1 : 400 ha e fafatsoa ka ho kheloha joalo ka jete ea mokelikeli
Botšepehi ba Mouoane khahlano le Moea (\(\text{Air} = 1.00\)) \(1.53\) (53% BO boima ho feta moya): Lisinki fatše, maoto a likoloi, likamore tse ka tlaase le liforo, tse bipetsang bana, liphoofolo tsa lapeng le liphofu tse oeleng pele. \(0.97\) ha ho futhumetse, empa \(1.5\text{ho }4.0\times\) HEAVIER ho feta moea ha ho bata (\(-196^\circ\text{C}\)): Mohatsela \(\text{N}_2\) moholi o hulela fatše pele o tsoakana ka phaposing kaofela. \(1.14\) (Boima ho feta moya): Matamo a dibakeng tse tlase mme a tlatsa likhoele tsa liaparo. \(1.5\mongolo{ ho }2.3\) (Boima ho feta moya): Matamo a dibakeng tse tlase le matshwafong a ka hare ha o hema.
Mokhoa oa ho Asphyxiation le Matšoao a Temoso Active Hypercapnic Poisoning + Acidosis: E baka tlala e matla ea moea (dyspnea), ho tšoha, hlooho e opang, ho fufuleloa, le tachypnea 3% to 5%, ebe koma le ho ferekana ka 7% to 10% (leha \(\text{O}_2\) e ntse e le \(> 18\%\)). Silent Hypoxic Asphyxiation (ZERO Warning): Hobane ho phefumoloha ha motho ho bakoa ke \(\text{CO}_2\) e phahameng, eseng tlase \(\text{O}_2\), ho hema \(\text{N}_2\) e hloekileng e baka ZERO shortness of breath or choking sensation. Motho ea hlokofalitsoeng o ikutloa a tloaelehile ka ho feletseng, o nka ** 1 ho phefumoloha ha 2, 'me o oela ka metsotsoana e 8 ho isa ho e 15 **. Kotsi e Feteletseng ea Mollo le Ho phatloha: Ha e felise moea, empa liaparo kapa asphalt e fafalitsoeng ka \(\text{LOX}\) e fetoha seqhomane se phahameng se sa ameheng se phatlohang ho tloha mohatong oa boot kapa tlhase e tsitsitseng. Ho Sniffing Death Syndrome (Tlhahiso ea Myocardial): Difluoroethane le butane li etsa hore pelo e utloe adrenaline, e bakang instant Ventricular Fibrillation cardiac arrest hammoho le serame se matla sa molomo/se letsoho.
Meeli ea Exposure ea OSHA / NIOSH TWA (lihora tse 8): 5,000 ppm (0.5%).
STEL (15-metsotso): 30,000 ppm (3.0%).
IDLH (Hang-hang e Kotsi Bophelong/Bophelong): 40,000 ppm (4.0%).		 Sepakapaka se se Nang le Oksijene: Moea o tloaelehileng ke 20.9% O2.
OSHA Hazard: < 19.5% O2.
Coma le Lefu la Hanghang: < 6% to 10% O2.		 Kotsi ea Phallo e Ekelitsoeng ke Oksijene: Sepakapaka sefe kapa sefe > 23.5% O2. Acute Frostbite + Cardiac Arrhythmia ha motho a hema ka boomo ("lerōle" / "whippets") kapa sefafatsi sa letlalo se kentsoeng.

2. Sefi sa Leidenfrost Effect: Hobaneng Liatlana le Liaparo li Etsa Hore Naetrojene e Metsi e Chese ka makhetlo a 100 ho feta

Ha lerotholi le lenyenyane la Liquid Nitrogen (\(-196^\circ\text{C} / -320^\circ\text{F}\)) le thula lefutho, le hlobotseng, letlalong le omeletseng mme le thetheha hang-hang:

  • Hobane phapang ea mocheso lipakeng tsa letlalo la motho le futhumetseng (\(33^\circ\text{C}\)) le naetrojene e metsi (\(-196^\circ\text{C}\)) e feta \(229^\circ\text{C}\) (\(412^\circ\text{F}\)), bokaholimo bo ka ntle ba lerotholi le benyang ka har'a leqhubu la nitrogen hang-hang. Phello**). Ka metsotsoana e 0.5 ho isa ho e 1.5, lera leo le sa bonahaleng la khase le tšela lerotholi le tsoang letlalong le sa hatsetsang nama.
  • *Ha Leidenfrost Shield e Fana (Leidenfrost Shield)
  • Ka har'a li-gloves, likausi, lieta, kapa matsoho a k'hothone: Haeba naetrojene e metsi e fafatsa cuff e bulehileng ea glove ea cryogenic, kapa e kenella ka har'a hempe ea k'hothone, jeans ea denim kapa liteki, lesela ** le khopa le ho tšoasa $-196 ^\circ\text{C}*3 bakeng sa mokelikeli oa metsotsoana e 5 ho isa ho letlalo. Mosamo oa khase oa Leidenfrost o oa hang-hang, 'me letlalo, mesifa, methapo ea mali le lesapo le hoama joalo ka khalase ka mor'a metsotsoana.
  • Solid Dry Ice Contact: Hobane leqhoa le omileng ke sekoahelo se tiileng ho $ -78.5^\circ\text{C}$ e tšoaretsoeng ka thata khahlanong le letlalo ka khatello ea menoana (kapa e latsoa ka leleme le metsi), mongobo o holim'a letlalo o hoama hang-hang ho kena sekhomaretsing se tiileng, se tsamaisang serame se feteletseng ka ho toba ka har'a dermis e tebileng ntle le cushion ea khase e sireletsang.
  • Aerosol Sprays (Pressurized "Canned Air" Dusters, Liquid Propane, or Nitrous Oxide Chargers): Ha sesebelisoa sa elektroniki sa duster can (1,1-difluoroethane) se shebiloe se shebile fatše ebe se fafatsoa holim'a letlalo, kapa ha ho na le nitrous oxide (\(\text{N}_2")* cylinder tank (\)\text{N}_2") cylinder e kholo{N}_2)* e ts'oarehile lipakeng tsa lirope tse kahare tsa mosebelisi ha e ntse e ntša khase ka potlako, jete ea lebelo le phahameng kapa lerako la tšepe le leqhoa le hlobola mouoane ofe kapa ofe 'me o baka ** ho chesa ha serame se tebileng, se se nang bohloko, se botenya bo felletseng ba likhato tsa boraro le tsa bone ** nakong ea metsotsoana e 3 ho isa ho e 10.

Deep Dive 1: Mohato ka Mohato Thuso ea Pele bakeng sa ho Chesoa ke Leqhoa la Cryogenic (Letlalo, Matsoho, le Mahlo)

Ho sa tsotellehe hore na ho chesa ha cryogenic ho tsoa ho sebetsana le leqhoa le omileng ntle le li-tongs, ho qhalana ha naetrojene ea metsi, phapanyetsano ea tanka ea propane, kapa sefafatsi sa khase e hatelitsoeng, tšenyo ea lisele e latela sekhahla sa mekhahlelo e 'meli. \(\text{PGF}_{2\alpha}\), le Thromboxane \(\text{A}_2\) Microvascular Clotting)** nakong ya ho qhibidiha.

1. Porothokhole ea ho Futhumatsa Tšimo hang-hang (The \(37^\circ\text{C}\text{ to }39^\circ\text{C}\)Molao oa Bateng ea Metsi)

  1. Lokolla letlalo lefe kapa lefe le khomaretsoeng ka metsi a foofo: Haeba letlalo le khomaretsoe ho omisa leqhoa kapa tšepe e batang, tšela metsi a pompong a foofo ($37^\circ\text{C}\text{ to }39^\circ\text{C} / 98.6^\circ\text{F}\text{ to }102.2.2 text on own.
  2. Lokisetsa bate ea metsi a futhumetseng hantle ka \(37^\circ\text{C}\text{ ho }39^\circ\text{C}\) (\(98.6^\circ\text{F}\text{ to }102.2^\circ\text{F}\)):
  3. Sebelisa thermometer haeba e le teng, kapa u leke metsi ka letsoho la hao le ka hare le sa lemala kapa setsoe; e lokela ho ikutloa **e phutholohile ho bath ea lesea e futhumetse, e sa chese **.
  4. Kenya menoana, letsoho, kapa leoto le leqhoa ka har'a bateng ea metsi (kapa u sebelise likhoele tsa metsi a futhumetseng a sa khaotseng ho hlasimolla sefahlehong) bakeng sa metsotso e 15 ho isa ho e 30 ho fihlela nama e putsoa, ​​e thata, e bosoeu kapa boputsoa bo boputsoa e fetoha ** bopinki bo boputsoa / bokhubelu 'me bo ikutloa bo le bonolo ebile bo le bonolo** ntlheng.
  5. Ha metsi a ntse a pholile ho tloha sethong se leqhoa, tšela metsi a fokolang ka thōko ho sekotlolo (ho tlosa letsoho hakhutšoanyane ha u ntse u fuduha ka metsi a futhumetseng e le hore metsi a chesang a se ke a tšela ka ho toba letlalong le lemetseng).
  6. ** Lokisetsa mokuli bakeng sa "Rewarming Throbbing Pain" e matla 'me u fane ka Ibuprofen ka molomo**:
  7. Le hoja e le leqhoa, ho chesa ha cryogenic ke ** ho felloa ke matla ka ho feletseng le ho hloka bohloko ** (ke ka lebaka leo batho ba tšoereng moqomo o batang oa nitrous oxide pakeng tsa lirope tsa bona kapa ba fafatsang difluoroethane matsohong a bona ha ba hlokomele hore ba tšoeroe ke mocheso oa tekanyo ea boraro).
  8. Ha phallo ea mali e khutla nakong ea ho qhibiliha ha metsi a futhumetseng, sebaka seo se tla qala ho otla le ho chesa haholo.
  9. Haeba mokuli a falimehile, a khona ho koenya, 'me a se na allergy, lefu la liphio, kapa histori ea liso tsa ka mpeng, tataiso ea Wilderness Medical Society (WMS) e khothalletsa ho fana ka Ibuprofen ea molomo.12 mg/kg/day e arotsoe habeli ka letsatsi, hangata 400 mg to 600 mg bakeng sa motho e moholo) ho e-na le acetaminophen kapa aspirin feela, hobane ibuprofen ka boikhethelo e thibela arachidonic acid / thromboxane \(\text{A}_2\) le prostaglandin \(\text{PGF}_{2\alpha}\) cascade e etsang hore methapo ea mali e marotholi e koalehe le ho bolaea letlalo.
  10. Mokhoa oa ho laola Maqhubu a Cryogenic (a Hlakileng vs. Hemorrhagic / A Tlatsitse Mali):
  11. Ka mor'a lihora tse 1 ho isa ho tse 24 ** ka mor'a ho qhibiliha ho chesoa ha cryogenic, maqeba a maholo (bullae) a tla hlaha letlalong:
    • Mahlaseli a Mokelikeli o Hlakileng kapa o Bosehla Ho Atolosetsa Menoaneng: Bontša kotsi ka holimo kapa e tebileng ea botenya moo plexus ea vascular e sa ntseng e phela. ** U SE KE UA phunya kapa ua khaola marako a setseng tšimong **; itlatsa gel e hloekileng ea lekhala (e sebetsang e le moemeli oa lehae oa anti-thromboxane) haeba e le teng, beha lesela le hloekisitsoeng le ommeng pakeng tsa monoana o mong le o mong kapa monoana e le hore li se ke tsa khomarelana, 'me u phuthele ka mokhoa o hlephileng ka seaparo se sengata se se nang sekoli se sengata.
    • **Letlalo le Lefifi kapa le Tlatsitse Mali (Hemorrhagic) ** (kapa letlalo le thata, le sa qhibiliheng le lesoeu le lulang le bata ka mor'a ho qhibiliha): Bontša ** kotsi e tebileng ea botenya bo tebileng ** ka har'a dermis ea reticular le subcutaneous vascular plexus. ** LE KA mohla u se ke ua phunya kapa ua senya mahlaseli a mali a hemorrhagic **, kaha ho a bula ho lebisa ho tebetseng ha lisele le tšoaetso ea bobeli.

2. Hobaneng Tekolo ea Sepetlele nakong ea Lihora tse 24 e ka Boloka Menoana e Hatselitsoeng (Iloprost & tPA)

Ho chesa ho hong le ho hong ho tebileng ho amanang le **menoana, menoana, matsoho, sefahleho, kapa litho tsa botona kapa botšehali **, kapa cheso leha e le efe e fetohang bopherese bo lefifi, e putsoa, kapa e hlaha mahlaseli a tletseng mali, e tlameha ho hlahlojoa **setsing sa ho chesa sepetlele nakong ea lihora tse 12 ho isa ho tse 24 ka mor'a ho qhibiliha **. Litsi tsa sejoale-joale tsa ho chesa li sebelisa ka potlako intravenous Iloprost (a prostacyclin vasodilator) kapa catheter-directed / intravenous Tissue Plasminogen Activator (tPA) thrombolysis nakong ea pele lihora tse 24 tsa ho futhumatsa hape ho qhibilihisa maqeba a mali a microvascular ka har'a methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ea methapo ho feta liperesente tse 5 ho feta menoana ea 5 ho feta menoana ea 5 ho feta menoana ea 5 le menoana ea maoto.

Deep Dive 2: Naetrojene e Metsing e Metsoeng (Lisetsethe tsa "Dragon's Breath" le Li-Cocktails tse Smoky) le Ho Kenngoa ha Leqhoa le Omileng

Lilemong tse leshome tse fetileng, li-bar, fairs, le lireschorente tsa vaerase li sebelelitse **li-cocktails tse tšetsoeng naetrojene e tsubang kapa sekotoana sa leqhoa le omileng , hammoho le libolo tsa lijo-thollo tsa "Dragon's Breath" tse kenngoeng ka \(-196\circ\text{C}\) liquid nitrogen hore moreki a khone ho ntša mouoane o mosoeu le mosi molomong oa hae.

1. Ke Hobane'ng ha ho Koenya Naetrojene e Metsi e Phatlang Mokoti ka Lebota la Mpa

Ha bartender e tšela naetrojene ea metsi ka har'a seno kapa a fana ka lijo-thollo tse kolobisitsoeng ka naetrojene, polokeho e itšetlehile ka ho feletseng ** karolo ea 100 lekholong ea metsi a nitrogen a belang PELE moreki a beha senoelo kapa khaba melomong ea hae ** (mosi ka boeona ke moholi o se nang kotsi oa metsi a batang a tsoang moeeng oa kamore). Haeba 2 ho isa ho limililithara tse 5 (halofo ea teaspoon) ea naetrojene e sa kang ea mouoane e sala e kopantsoe ka tlas'a khalase kapa e kolobisitsoe ka har'a bolo ea porous cereal ebe ea metsoa:

  1. Instant Cryogenic Necrosis of the Mouth and Esophagus: The \(-196^\circ\text{C}\) mokelikeli o homisa mucosa ea leleme, pharynx le esophagus ha e kopana.
  2. Explosive 1 : 694 Katoloso ea Volumetric ka Maleng a Mofuthu: Nako eo 5 limililithara tsa naetrojene e metsi e otlang lero le futhumetseng la gastric (\(37^\circ\text{C} / 98.6^\circ\text{F}\)) ka mpeng e koetsoeng, e benya ka matla ho nitrogen e ka tlase ho 3.5 gallone.5 Metsotsoana e 2 (le a 15 mL metsa ea khaba e atoloha ho 10.4 Lithara tsa khase).
  3. Gastric Barotrauma Perforation and Tension Pneumoperitoneum: Hobane karolo e ka tlase ea esophageal sphincter le pyloric sphincter ha e khone ho ntša lilithara tse 3.5 ho isa ho tse 10 tsa khase ka motsotsoana, libalune tsa mpa li feta khatello ea eona e phatlohileng 'me e buleha haholo haufi le lesoba le lenyenyane kapa le leholoanyane, le kobehang ka mpeng e kobehang (massive pneumoperitoneum), ho hatella vena cava e ka tlaase le matšoafo (abdominal compartment syndrome / tension pneumoperitoneum), le ho hloka ** laparotomy ea tšohanyetso ea opereishene (hangata ke gastrectomy e sa fellang kapa e felletseng)* ho pholosa bophelo ba motho ea hlasetsoeng.

2. Thuso ea Pele ea Hang-hang bakeng sa ho kenngoa ha Cryogenic

  • ** Letsetsa 911 / 112 / 999 hang-hang ** 'me u hlalose ka ho hlaka: "Mokuli o ile a koenya metsi a naetrojene (kapa leqhoa le omileng) 'me o na le bohloko bo boholo ka mpeng le ho tsieleha, ho belaelloang hore o na le phallo ea mpa."
  • ** Beha mokuli a lutse a otlolohile kapa a itšetlehe ka pele**: Sena se thusa khase leha e le efe e ntseng e atoloha e ka mpeng hore e tsoelle holimo ka 'metso ka ho ntša metsi (belching) ho e-na le ho qobella khase e ngata ho phunyeletsa lebota la mpa ho ea ka mpeng.
  • U se ke ua fana ka letho ka molomo (NPO): U se*** u fane ka metsi a futhumetseng hore a noe (hang ha naetrojene e metsi e le ka mpeng, ho eketsa metsi a futhumetseng ho potlakisa ho ata ha khase le ho hlatsoa mokelikeli ka lerako la mpa le phunyeletsoeng ka har'a peritoneum), 'me ** ha ho mohla ** e bakang ho hlatsa.
  • Haeba karoloana ea leqhoa le thata le omeletseng le khomaretsoe ka hare ho molomo (ho lelemeng kapa lerameng) 'me le e-s'o koetsoe: Tšela metsi a foofo ka hanong 'me u etse hore motho a sekamele pele ho tšoela metsi le leqhoa le tsoileng fatše hang-hang hore a se ke a le metsa.

Deep Dive 3: Ocular Cryogenic Splashes le Gas Compressed Inhalant Cardiotoxicity

1. Naetrojene e Metsi, Sehatsetsi (R-134a / R-410A), kapa Propane E Hlasela Leihlong.

Leha ho phatloha ha nakoana ha naetrojene ea metsi e hloekileng holim'a cornea hangata e tsoa ka mokhoa o se nang kotsi filiming ea ho taboha ka Leidenfrost, sehatsetsi se matla sa **koloi kapa sehatsetsi sa HVAC (Freon / R-134a / R-410A) **, ** propane ea metsi **, kapa naetrojene e qhibilihang ka ho toba. epithelium, stroma le mahlo a mahlo:

  • Haeba mahlo a hoamme a koalehile: Le ka mohla u se ke ua qobella kapa ua bula lintši tse hoammeng ka menoana e omeletseng, e leng se ka senyang lehlakore le boreleli la leihlo kapa ho tabola cornea epithelium. Ho e-na le hoo, beha lesela le hloekisitsoeng la gauze le kolobisitsoeng e foofo le letsoai le tloaelehileng kapa metsi a pompong (\(37^\circ\text{C} / 98.6^\circ\text{F}\)) butle holim'a leihlo le koetsoeng kapa tšela letsoai le foofo ka har'a marapo ho fihlela leqhoa le buleha hantle 'me lintši li buleha.
  • Nosetsa metsotso e 15 haeba oli ea sehatsetsing kapa metsoako ea lik'hemik'hale e le teng: Lihatsetsi tsa likoloi le tse futhumatsang moea li na le polyalkylene glycol (PAG) kapa oli ea ester hammoho le li-hydrocarbon tse fluorinated. Hang ha le qhibilihile, hlakola leihlo le butsoeng ka letsoai le foofo kapa metsi a pompong bakeng sa metsotso e 15, koahela mahlo ka bobeli ka thebe e sireletsang (ho fokotsa ho sisinyeha ha mahlo ka tumellano), 'me hang-hang u ee ngakeng ea mahlo ka tšohanyetso.

2. "Sudden Sniffing Death Syndrome" ho tsoa ho Compressed Gas Dusters le Cryogenic Aerosols

Ha bacha kapa batho ba baholo ba hema ka compressed 1,1-difluoroethane ("canned air" computer keyboard dusters), butane, propane, kapa nitrous oxide (\(\text{N}_2\text{O}\)) ka kotloloho ho tsoa ho nozzle kapa balune:

  • Cryogenic Airway Obstruction (Laryngospasm and Glottic Edema): Ho fafatsa komporo e sothehileng ea duster kapa tanka ea nitrous oxide ka hanong ka kotloloho ho homisa lerumo, mahalapa a bonolo, le likhoele tsa lentsoe ka $ -50^\circ\text{C}\text{ to }-88^\circ\text{8{8}\ci\rctext{8}\(\ci\text{8}\) }-126^\circ\text{F}$), e bakang kapele ho ruruha ha oropharyngeal le tšitiso e felletseng ea moea o ka holimo nakong ea metsotso e 15 ho isa ho e 45 e hlokang ho kenngoa ha endotracheal ea tšohanyetso pele tsela ea moea e kokobela.
  • Tlhahiso ea Myocardial ho Epinephrine (Sudden Ventricular Fibrillation): Li-halogenated hydrocarbons tse kang difluoroethane li susumetsa myocardium ea pelo ho endogenous adrenaline (catecholamines). Haeba motho a tsielehile, a matha, kapa a sokola hang ka mor'a ho hema khase, ho phahama ho tloaelehileng ha adrenaline ho tsosang ho tšoaroa ha pelo hang-hang ha Ventricular Fibrillation ("Ho Sniffing Lefu"). Bapholosi ba tlameha ho qala ** CPR ea boleng bo phahameng hang-hang 'me ba sebelise Automated External Defibrillator (AED)** ha ba ntse ba lemosa baokameli ba liphallelo hore ho tšoaroa ho ne ho bakoa ke inhalant myocardial sensitization (sepetleleng, lingaka li qoba li-boluses tse tloaelehileng tsa epinephrine nakong ea ho tsosolosoa le ho fana ka intravenous beta-blocker* e kang ** breakamimolole* ** fibrillation ea ventricular refractory).

Deep Dive 3: Lenane la Tšebeliso e Sireletsehileng, Lipalangoang le ho Lahla Leqhoa le Omileng le Nitrogen e Metsi.

  • Le ka mohla U se ke U Tsamaisa Liqhoa Tse Omileng kapa Li-Nitrogen Dewars ka Ka Khabineng e Koetsoeng ea Bapalami: Kamehla beha li-coolers tse omeletseng kapa lijana tsa naetrojene tse metsi ka kutung/booting e arohaneng, betheng ea teraka e bulehileng, kapa vene ea thepa e arohaneng ka hlooho e koetsoeng. Haeba u na le SUV, hatchback, kapa sedan moo kutu e arolelanang moea le cabin ea baeti, ** theola bonyane lifensetere tse peli ka 5 cm (2 inches)** ebe u beha fene ea dashboard ea taolo ea boemo ba leholimo ho Fresh Outside Air mode (NEVER Recirculate) bakeng sa koloi eohle.
  • Le ka mohla U se ke Ua Boloka Leqhoa le Omileng ka Botlolong e Koetsoeng Hantle, kapa Jar, kapa Sepholi se Haufi: Boloka leqhoa le omileng feela ka sekoahelo se koahetsoeng ka sekoahelo sa polystyrene (Styrofoam) kapa lifuba tse nang le moea o kenang ka har'a lifuba tse lumellang hore \(\text{CO}_2\) ea khase e tsoang ka bolokolohi ho tsoa ka bolokolohi. Le ka mohla u se ke ua phunya sekoahelo holim'a botlolo ea polasetiki kapa nkho ea khalase e nang le leqhoa le omileng ("bomo e omileng ea leqhoa" ke tlōlo ea molao libakeng tse ngata 'me e baka likotsi tse tšabehang tsa ho phatloha).
  • Le ka mohla U se ke Ua Boloka Leqhoa le Omileng ka Ka har'a Sehatsetsi sa Ntlo se sa Se keng sa Fetola Moea kapa Mohatsela o ka Tlase oa Walk-In: Ka sehatsetsing,\(-78.5^\circ\text{C}\) leqhoa le omileng le qhekella thermostat hore e koale sehatsetsi sa sehatsetsing. Mokatong o ka tlase o pholileng o pholileng kapa o sa tsoetsoeng hantle ke moea o pholileng, leqhoa le omileng le thellang ho etsa hore ho be le serame se bolaeang 5% ho isa ho 10% \(\text{CO}_2\) asphyxiation cloud bosiung bo bong.
  • Mokhoa oa ho Lahla Leqhoa le Omileng le setseng ka Mokhoa o Sireletsehileng (Le ka mohla U se ke Ua Le Lahlela Tlas'a Sinki kapa Mokelikeli oa Matlwana):
  • O SE KA O KA lahlela leqhoa le omileng le setseng ka sinking ya kicheneng, ho lahlelang matlakala, kapa sekotlolong sa ntloana: The \(-78.5^\circ\text{C}\) solid e homisa metsi ka har'a PVC kapa cast- iron P-trap solid ha o ntse o atolosa ho robeha ha khase le ho phatlola lipeipi tsa metsi.
  • Mokhoa o Sireletsehileng oa ho Lahla: Beha leqhoa le omileng le setseng ka har'a lebokose la lona le bulehileng la Styrofoam **ka ntle sebakeng se nang le moea o pholileng, se nang le moriti se ke keng sa fihleloa ke bana le liphoofolo tse ruuoang lapeng **, 'me u se lumelle hore se theohe ka tlhaho moeeng o kantle ho feta lihora tse 24.
  • Apara Li-gloves tsa Cryogenic tsa Loose-Cuff (tse Sutumelletsoeng ka Ntle kapa ka Tlas'a Sleeves e le hore Mokelikeli o se ke oa Fetola Funnel In) le Tšireletso ea Mahlo: Le ka mohla u se ke ua tšoara leqhoa le omileng kapa lisebelisoa tsa naetrojene tse metsi tse nang le letlalo le se nang letho kapa liatlana tse metsi tse thata. Apara lieta tse koetsoeng, marikhoe a malelele a koahelang bokaholimo ba lirifi tsa hau (le ka mohla u se ke ua hula maoto a borikhoe ka hare lirifi moo metsi a nitrogen a qhalaneng a tla otloloha ho pota leqaqailaneng), le liatlana tse sirelelitsoeng tse hlephileng tse ka suthisoang ka ho tsukutloa ha letsoho hanngoe haeba mokelikeli o phalla ka hare.

Lipotso tse botsoang khafetsa

Ke ile ka fumana lebokose la li-steak tse hatselitsoeng ka poso tse tletseng leqhoa le omileng, 'me ka tšoara leqhoa le omileng ka menoana ea ka e se nang letho ka metsotsoana e seng mekae. Hona joale lintlha tsa menoana ea ka li tšoeu, li shoele bohatsu ebile lia hlaba. Ke etseng?

U na le mocheso o phahameng oa serame oa cryogenic ho tloha ho -78.5 degrees Celsius (-109.3 degrees Fahrenheit) leqhoa le omileng. Hang-hang kenya menoana ea hao ka sekotlolong sa metsi a foofo a lekiloeng ho ba pakeng tsa likhato tse 37 le 39 tsa Celsius (98.6 ho isa ho 102.2 likhato tsa Fahrenheit, a futhumetseng hamonate joalo ka metsi a ho hlapa a lesea, a sa chese) ka metsotso e 15 ho isa ho e 20 ho fihlela matheba a masoeu a boka a fetoha a pinki hape a le bonolo hape. U SE KE UA HOLA kapa ho silila menoana ea hau, joalo ka ha ho hohla ho sila likristale tsa leqhoa tse sa bonahaleng ka har'a lisele tsa letlalo la hao. Haeba mahlaseli a hlaha ka mor'a moo, a tlohele a tiile, a koahele ka lesela le hloekileng le omeletseng, 'me u nke tekanyo ea ibuprofen e rekisoang haeba u ka noa li-NSAID ka mokhoa o sireletsehileng. Batla tlhahlobo ea bongaka haeba letlalo le lula le le thokoa, le pherese, kapa le le lerootho ka mor'a ho futhumatsa.

Ke hobane'ng ha batho ba felloa ke litemoso tsa lefela ho tsoa ha metsi a naetrojene a lutla, athe leqhoa le omileng le baka ho hema le ho tšoha pele ba akheha?

Setsi sa phefumoloho sa boko ba hao ha se hlile ha se lekanye hore na oksijene e kae maling a hao ho etsa hore u batle ho hema; ho e-na le hoo, e lekanya ho phahama ha maemo a carbon dioxide (CO2) le ho theoha ha pH ea mali. Ha leqhoa le omileng le theoha ka koloing kapa kamoreng e koetsoeng, o kenya likhahla tse phahameng tsa CO2, e leng hang-hang e phahamisa mali a hao a CO2 'me e baka tlala e matla, e tšosang ea moea, ho hema ka potlako, le hlooho e otlang pele u feta ka 7% ho 10% CO2. Ka lehlakoreng le leng, ha naetrojene e metsi e bela ka phaposing e koetsoeng 'me e theolela boemo ba oksijene ka tlase ho 6% ho isa ho 10%, u tsoela pele ho ntša CO2 ea hau ka tloaelo ka moea o mong le o mong. Hobane mali a hau a CO2 ha a tsohe, boko ba hau bo utloa eka moea o haelloa ke moea le tlhokomeliso: o ikutloa o phetse hantle ho fihlela oksijene ea boko e theohela ka tlase ho moeli oa kelello, 'me u tima ka metsotsoana e 8 ho isa ho e 15.

Ke hobane'ng ha "nitrous oxide tanka e chesoa" kapa "li-duster air duster tse tukang" liropeng tse ka hare kapa matsoho a tebile hoo hangata a hlokang li-grafts tsa letlalo?

Ha moqomo o moholo o hatelitsoeng oa nitrous oxide cylinder kapa inverted difluoroethane "moea o entsoeng ka makotikoting" o tsoa ka potlako, katoloso ea khase ea adiabatic e theola lebota la tanka ea tšepe kapa jete ea spray ea metsi ho pakeng tsa -40 le -88 likhato tsa Celsius (-40 ho -126 likhato tsa Fahrenheit). Hobane serame se homisa methapo ea kutlo letlalong ka mor'a metsotsoana e seng mekae, 'me kaha nitrous oxide kapa difluoroethane inhalation ka nako e le' ngoe e theola maikutlo a bohloko, motho ea tšoereng moqomo o batang pakeng tsa lirope tsa hae tse ka hare kapa a fafatsang mokelikeli letlalong ha a utloe bohloko ha karolo e tebileng ea dermis le mafura a subcutaneous a hoama ka metsotso e seng mekae. Likotsi tsena ke botenya ba 'nete ba ho chesoa ke serame (boemo ba boraro le ba bone) bo tlamehang ho hlahlojoa setsing sa ho chesa sepetlele bakeng sa tlhokomelo ea maqeba a ho buuoa le ho hlomathiseletsoa.

  • Tataiso ena ke ea merero ea tlhahisoleseling mme ha e nke sebaka sa tlhokomelo ea bongaka ea litsebi kapa koetliso ea polokeho mosebetsing. Hobane ho lutla ha khase ea cryogenic libakeng tse koaletsoeng ho ka baka ho ts'oaroa ha pelo ka tšohanyetso, re khothaletsa ka matla ho nka thupelo e netefalitsoeng ea thuso ea pele, CPR le oksijene ka International Federation of Red Cross le Red Crescent Societies (IFRC), sechaba sa hau sa Sefapano se Sefubelu, St John Ambulance, kapa mofani oa koetliso oa lehae ea netefalitsoeng.

Mehloli e hlahlobiloe

  • National Institute for Occupational Safety and Health (NIOSH, United States) & Centers for Disease Control and Prevention (CDC): * NIOSH Pocket Guide to Chemical Hazards: Carbon Dioxide (Dry Ice) le Liquid Nitrogen / Oxygen-Deficient Atmospheres *.
  • Compressed Gas Association (CGA): Safety Bulletin SB-2: Oxygen-Deficient Atmospheres le P-12: Tšoaro e Sireletsehileng ea Cryogenic Liquids.
  • Wilderness Medical Society (WMS): Litaelo tsa Boikoetliso ba Kliniki bakeng sa Thibelo le Kalafo ea Leqhoa (Ho futhumatsa ka potlako ho Bath ea Metsi a Mofuthu, Ibuprofen, Iloprost, le Thrombolytic Protocols).
  • Occupational Safety and Health Administration (OSHA, United States): Leqephe la 'Nete la OSHA: Tšoaro e Sireletsehileng ea Leqhoa le Omileng (Solid Carbon Dioxide) le Liquid Nitrogen.
  • Motsamaisi oa Bophelo bo Botle le Tšireletseho (HSE, United Kingdom): * Tšebeliso e Sireletsehileng ea Liquid Nitrogen le Ligase tsa Cryogenic ho Hospitality, Catering, le Laboratories*.

Litataiso tse amanang