Ho hema mosi le chefo ea carbon monoxide thuso ea pele¶

Ho hema mosi le chefo e matla ea carbon monoxide (\(\text{CO}\)) ke lisosa tse ka sehloohong tsa lefu mellong ea mohaho oa ka tlung le maemo a tšohanyetso a futhumatsang, a bolaeang palo e imenang hararo ho feta ea lelakabe le tukang ka ntle. Ha folofo ea thepa ea ka tlung, limmete tsa maiketsetso, lipolasitiki, patsi, kapa libeso li chesa kapa li kubella ka har'a phaposi e kentsoeng, li ntša likhase tse chesang haholo (\(150^\circ\text{C}\text{ to }500^\circ\text{C} / 300^\circ\text{F}\text{ to }900" text{ to }900 scopper throat. lintho tse bolaeang tsa chefo ea tsamaiso e sa bonahaleng: **carbon monoxide (\)\text{CO}\()** le **hydrogen cyanide (\)\text{HCN}$)**. Hobane motho ea tsoang mohahong o tletseng mosi kapa ho lutla ha carbon monoxide a ka bonahala a falimehile qalong ebe a oa ka mor'a metsotso e 30 ha pompo ea bona e chesitsoeng e kokobela kapa litlhōrō tsa cellular hypoxia, ho ntša moea o hloekileng ka potlako, ho ema ho otlolohile, 'me hang-hang karolo ea 100 lekholong ea oksijene e phallang haholo e tsoang ho ba fanang ka thuso ea bongaka maemong a tšohanyetso ke ea bohlokoa.

Tataiso ena e u tsamaisa mohato ka mohato ho tsoa sebakeng se sireletsehileng sa mahlatsipa ntle le ho ba lehlatsipa la bobeli, ho elelloa ho koaloa ha tsela ea moea e futhumetseng (stridor), ke hobane'ng ha li-oximeter tsa monoana oa pulse li fana ka leshano le bolaeang 99% ho bala nakong ea chefo ea carbon monoxide, ho etsa CPR ka phefumoloho ea pholoso bakeng sa ho tšoaroa ha asphyxial, le ho shebella metsi a liehang matšoafong ka lihora tse latelang tsa 48.

Etsa sena hona joale¶

1. Itšireletse pele , le ka mohla u se ke ua kena sebakeng se tukang kapa se tletseng CO e kentsoeng ntle le lisebelisoa tsa ho phefumoloha. Se ke oa mathela ka hare ho moaho o tletseng mosi, mokatong o ka tlaase kapa karacheng e koetsoeng e nang le jenereithara kapa koloi. carbon monoxide e sa bonahaleng le hydrogen cyanide li ka etsa hore mopholosi a idibe ka ho hema habeli. Hula mohlaseluoa feela haeba u ka fihla ho bona hang-hang ho tsoa monyako o butsoeng ha u ntse u lula tlaase ka tlas'a mosi.
2. *Suthela motho e mong le e mong moeeng o hloekileng o ka ntle bonyane limithara tse 15 ho isa ho tse 30 (maoto a 50 ho isa ho a 100). Ntša motho eo ka ho feletseng ka mohahong (eseng feela phasejeng kapa karacheng e bulehileng) sebakeng se bulehileng, se potolohang ka ntle hole le lipompo tsa mosi kapa liphaephe.
3. Letsa nomoro ea hau ea tšohanyetso ea sebakeng sa heno hang-hang 'me u kope oksijene e phallang haholo. Letsetsa nomorong ea hau ea tšohanyetso ea lehae (911 United States le Canada, 112 ho pholletsa le European Union, 999 United Kingdom) kapa u shebe boemo ba rona. dinomoro tsa tshohanyetso directory. Bolella motho ea tsamaisang thepa ka ho hlaka hore u na le mosi oa ho hema kapa motho ea hlasetsoeng ke chefo ea carbon monoxide kahoo ba romela ba fanang ka thuso ea bongaka maemong a tšohanyetso ba hlometseng ka 100% ea limaske tse sa rebreng, lisebelisoa tsa intubation, le li-antidotes tsa Cyanokit (hydroxocobalamin).
4. Lekola karabelo 'me u behe tsela ea moea ka nepo:
   • Ha o lemohile mme o hema: Lulisa motho a otlolohile kapa a otlolohile ka lehlakoreng la 45-to-90-degree angle (a itšetlehe hanyenyane ka mangole haeba a haelloa ke moea). Ho lula o otlolohile ho sebelisa matla a khoheli ho fokotsa 'metso le ho ruruha ha molumo oa lentsoe.
   • Ha ba ilibane empa ba hema ka tsela e tlwaelehileng: Ba phutholle ka lehlakoreng la bona ho Recovery Position hore maleme a bona a se ke a thiba phapu ya moya mme mahlatsa a tswe ka hanong.
   • Haeba o sa arabele mme o sa heme (kapa o hemelana feela): Qala **CPR hang-hang ka likhatello tsa sefuba tse 30 tse lateloang ke phefumoloho e 2 ea pholoso **.
5. *Hahlolla liaparo tse mo tlamang molaleng 'me u mo boloke a khutsitse ka ho feletseng. Hula likonopo melala ea hempe, thae, mabanta le libaki, 'me u se ke ua lumella motho eo ho tsamaea kapa ho ikitlaetsa. Ho sisinyeha ha 'mele ho eketsa lebelo la pelo le ho sebelisoa ha oksijene, ho potoloha carbon monoxide le cyanide kapele ho mesifa ea pelo le boko.
6. U se ke ua fana ka letho ka molomo (ho se na metsi, leqhoa, kapa lijo) haeba ba hema mosi o chesang. Esita le haeba ’metso oa motho o utloa o omme ’me o chesa, u se ke ua mo lumella ho noa metsi; ho koenya ka qoqothong e hlabang ho ka etsa hore ka tšohanyetso ho be le lehlabathe le bolaeang.laryngospasm) kapa ho etsa hore motho a hlatse ka tsela e bolaeang ha baoki ba fanang ka thuso ea bongaka maemong a tšohanyetso ba kenya tube ea phefumoloho ea tšohanyetso metsotsong hamorao.

Ho hema hang-hang ho tsuba le ho phalla ha CO ea thuso ea pele ea CO¶

Latela tatelano ena ea bongaka ho tloha ha u kopana le mosi kapa kotsi ea carbon monoxide.

flowchart TD
    A["Motho ea Hlasetsoeng ke Mollo Mosi, Mosi oa Mosi, kapa Alamo ea Carbon Monoxide"] --> B{"Na ho Sireletsehile ho Fihla Mohlaseluoa Ntle le ho Kena Mosi o Tebileng Kapa Khase e Koaletsoeng?"}
    B -->|"Che: Mollo o sebetsang kapa Khase e Lethal e Koetsoeng"| C["Lula Ka Ntle, Bula Menyako ea Kantle ho Tsoa Kantle Haeba ho khonahala, 'me u letse 911/999/112 bakeng sa bo-ralitima-mollo."]
    B -->|"E: Ho Sireletsehile ho Ntša"| D["Tsamaisa Mohlaseluoa Hang-hang ho Moeeng o Mocha oa Kantle (15 ho isa ho 30m / 50 ho isa ho 100 ft Hole)"]
    D --> E["Letsetsa 911 / 999 / 112 Hanghang: Tlaleha Mosi oa Inhalation / Chefo ea CO bakeng sa 100% Oxygen"]
    E --> F{"Na Mohlaseluoa oa Tseba 'me oa Phefumoloha ka Tsela e Tloaelehileng?"}
    F -->|"Ha a arabele ebile ha a phefumolohe (kapa ho hema)"| G["Qala CPR Hang-hang: Likhatello tsa Sefubeng tse 30 + Liphefumoloho tse 2 tse Feletseng tsa Pholoso"]
    F -->|"Ho sa tsebe letho, Empa ho Phefumoloha Hantle"| H["Theohela ka Lehlakoreng sebakeng sa ho Recovery (E Thibela Ho Hlatsa Ho Tsoha) & Shebella Sefofane"]
    F -->|"Kelello & Phefumoloho"| I["Lula U otlolohile ho 45 ho isa ho 90 Degrees, Lokolla Molala, U lule u khutsitse, u se ke ua Fana le ho noa"]
    I --> J{"Sheba Lifolakha tse Khubelu tsa Thermal Airway: Lentsoe le Hoarse, Soot in Mouth, kapa Stridor?"}
    J -->|"E: Ho Koaloa ha Sefofane"| K["Alert Dispatch That Airway Is Swelling Shut (ALS Intubation Priority) & Lula U Lutse U otlolohile"]
    J -->|"Che"| L["Lula u Futhumetse ka Likobo le Lipalangoang ho ea Lefapheng la Tšohanyetso bakeng sa CO-Oximetry & 48h Lung Check"]
    G --> L
    H --> L
    K --> L

Mekhoa e 3 ea likotsi ka nako e le 'ngoe ea ho hema mosi¶

Ke hobane’ng ha motho a ka tsoa mollong oa ntlo a se na letheba le le leng letlalong la hae ’me ka mor’a hora a ntse a hloleha ho phefumoloha hoo a ka behang bophelo kotsing? Hobane mosi oa mollo o ka tlung o hlasela 'mele oa motho ka **mekhoa e meraro e arohaneng ka nako e le' ngoe **:

Ho lemoha mocheso o ka holimo oa moea pele 'metso o ruruha¶

Ha e le hantle, moea o futhumetseng ha o fane ka mocheso o fokolang, kahoo ha motho a hema mosi o chesang, mamina a metsi a nko, molomo le 'metso a monya hoo e ka bang karolo ea 100 lekholong ea matla a mocheso pele moea o feta ka tlas'a methapo ea lentsoe (ntle le ntho e le 'ngoe e ka sehloohong: ** mouoane o chesang **, o kenyang mocheso oa moea o omileng ka makhetlo a 4,000 ho theosa le moea o omileng).

Kaha 'metso o ka holimo o monya mocheso oo kaofela, lisele tse pota-potileng epiglottis le lithapo tsa lentsoe lia phatloha 'me li ruruha ka mokelikeli (edema) ka potlako, joalo ka lekhopho le nyolohang letsohong le cheleng. Ho motho e moholo, karolo e moqotetsane ka ho fetisisa ea pompo ea moea (vocal cords)glottic opening) e bophara ba limilimithara tse seng kae feela (’me ho ngoana, boholo ba monoana oa bona o monyenyane). Hang ha ho ruruha ho fokotsa bophara ba tsela ea moea ka halofo, ho hanyetsa ho phefumoloha ho eketseha ** 16-fold ** (ka molao oa bone oa matla a Poiseuille).

Sheba mophonyohi e mong le e mong oa mollo hang-hang bakeng sa "5 Airway Burn Red Flags"¶

1. **Moriri oa nko o hlabetsoeng kapa ho chesoa ho pota-pota molomo, nko, litelu, kapa lintši **.
2. Sekhohlela se nang le carbonous: Mosi o motšo o koahetseng leleme, meno, kapa bokamorao ba 'metso, kapa ho tšoela mathe a masoeu/a makhooana a matšo.
3. Mahoashe kapa lentsoe le fetoha: Kopa motho eo hore a bolele lebitso la hae mme a heme. Haeba lentsoe la bona le utloahala le hlaba, le thothomela, le sa hlaka ("hot-potato voice"), kapa le theoha ho hoeshetsa, ho ruruha ho se ho qalile methapong ea lentsoe.
4. Ho thata ho metsa mathe (dysphagia) kapa ho rotha.
5. Inspiratory Stridor: Ho lla ho hlabang, ho letsa mololi, kapa ho phefumoloha ho utloahala ntle le stethoscope ha motho a hema ka. Stridor ke boemo ba tšohanyetso bo feteletseng ba bongaka, ho bolela hore pompo e se e ruruhile e koetsoe ka liperesente tse 70 ho isa ho tse 80 'me e ka koala ka botlalo ka mor'a metsotso e seng mekae.

Thuto ea pele bakeng sa ho belaelloang hore tsela ea moea e cha:

• Boloka motho ea lutseng bolute a otlolohile (likhato tse 45 ho isa ho tse 90), le ka mohla u se ke ua li beha fatše ka mokokotlo, hobane ho robala ho eketsa phallo ea mali a venous molaleng le ho potlakisa ho ruruha ha 'metso.
• Fana ka lefela metsi, leqhoa, kapa lijo ka molomo (hlakola melomo e ommeng ka lesela le metsi feela).
• Letsetsa 911 / 999 / 112 hang-hang haeba stridor kapa mahoashe a qala ho ba teng e le hore moifo oa Advanced Life Support (ALS) a khone ho kena kapele pele sefofane se koala.

Carbon monoxide (CO) le Hydrogen Cyanide (HCN): "Mafahla a Chefo"¶

Le hoja mosi oa mollo o na le carbon monoxide le hydrogen cyanide, chefo e hloekileng ** carbon monoxide poisoning ** e boetse e etsahala letsatsi le leng le le leng ntle le mollo kapa mosi ho hang, ho tsoa lijenereithareng tse nkehang tsa peterole tse tsamaisoang ka likaracheng kapa haufi le lifensetere, liphaephe tse koetsoeng tsa sebōpi, licheso tsa metsi tsa khase tse nang le masoba a ka morao, li-grill tsa mashala ka tlung kapa li-heaters tse kentsoeng ka har'a koloi.

Hobaneng ha Carbon monoxide + Hydrogen Cyanide e le kotsi hakana hammoho¶

1. Carbon monoxide (\(\text{CO}\)) e otla ka makhetlo a mararo:
   • Taba ea pele, \(\text{CO}\) e tlama liathomo tsa tšepe tse hemoglobin e khubelu-blood-cell ** ka makhetlo a 200 ho isa ho a 250 ka thata** ho feta oksijene, e etsa carboxyhemoglobin (\(\text{COHb}\)) kahoo lisele tse khubelu tsa mali li sitoa ho nka oksijene matšoafong.
   • Ea bobeli, hang ha molek'hule e le 'ngoe ea \(\text{CO}\) e tlamella protheine ea hemoglobin, e fetola sebopeho sa libaka tse ling tse tharo tse tlamang oksijene (**the Haldane Effect / shift left of the oxyhemoglobin dissociation curve **), ho thibela mali hore a se ke a tlohela oksijene eo *e nang le eona * bokong le liseleng tsa pelo tse lapang.
   • Ntlha ea boraro, \(\text{CO}\) e tlama ho cardiac myoglobin ka har'a mesifa ea pelo ka boeona, e sithabetsa ka ho toba matla a ho pompa pelo le ho baka mafu a kotsi a arrhythmia.
2. Hydrogen Cyanide (\(\text{HCN}\)) ho notlelwa ha cellular:
   • Nako le nako ha bethe ea sejoale-joale, materase a foam a polyurethane, k'hapete, kapa lisebelisoa tsa polasetiki li kubella mollong oa ntlo, li ntša gase ea hydrogen cyanide.
   • Cyanide e hemang e kena maling 'me e tlamahane le ferric iron (\(\text{Fe}^{3+}\)) ka cytochrome c oxidase ka har'a mitochondria ea sele e 'ngoe le e 'ngoe, ebe e koala moea oa cellular oa aerobic ka metsotsoana. Esita le haeba oksijene e le teng maling, lisele ha li khone ho e sebelisa, ho qobella 'mele ho bolaea anaerobic lactic acidosis le ho putlama ka tšohanyetso.

Matšoao a chefo ea Carbon monoxide ka boemo ba mali ba COHb¶

Kamoo 100% ea Oxygen ea Bongaka le Hyperbaric Oxygen e bolokang boko¶

Ke hobane'ng ha motho ea hlasetsoeng ke carbon monoxide kapa mosi a sa khone ho "lula ka ntle mathuleng ka moea o hloekileng nako ea halofo ea hora ebe o khutlela liphateng" ho e-na le ho palama ambulense?

Sheba fisiks ea hore na ho nka nako e kae ho hlatsoa carbon monoxide ho tloha hemoglobin e chefo (the \(\text{COHb}\) Elimination Half-Life):

• Ho hema moea o tloaelehileng oa kamore ea ka ntle (\(21\%\text{ Oxygen}\) at 1 atmosphere): Halofo ea bophelo ba carboxyhemoglobin ke 4 ho lihora tse 6 (e bolelang hore mali a hao ke karolo ea 40 lekholong, ka mor'a lihora tse 5 u lutse mathuleng e ntse e le chefo ea 20 lekholong, e ntse e tsoela pele ho baka tšenyo ea lipid bokong bosiu bohle le peroxid ea pelo).
• Ho phefumoloha \(100\%\text{ High-Flow Medical Oxygen}\) ka thuso e tiileng ea paramedic Non-Rebreather Mask (\(15\text{ L/min}\)): E fokotsa halofo ea bophelo ka makhetlo a mane ho ea ho 60 ho isa metsotsong e 90.
• Ka hare ho Sepetlele Hyperbaric Oxygen Therapy (\(\text{HBOT}\)) Chamber (\(100\%\text{ Oxygen}\) at \(2.5\text{ to }3.0\text{ Atmospheres}\) of pressure): E fokotsa halofo ea bophelo ho fihlela ho 20 ho isa metsotsong e 30, e qhala ka ho toba mali a hloekileng a mali ntle le oksijene ea mali. ho hloka lisele tse khubelu tsa mali, le ho thibela lisele tse tšoeu tsa mali ho hlasela boko ba myelin (ho thibela **Delayed Neurological Sequelae / DNS **, lefu le senyang la ho lahleheloa ke mohopolo, ho thothomela ho kang Parkinson, le liphetoho tsa botho tse ka hlaselang 2 ho matsatsi a 40 ka mor'a chefo ea CO e sa phekoloang).

Antidote ea sepetlele bakeng sa chefo ea cyanide ea mollo (Hydroxocobalamin)¶

Ha lingaka tsa bongaka ba tšohanyetso kapa lingaka tsa tšohanyetso li phekola motho ea hlasetsoeng ea huloang ke mosi oa mosi oa ka tlung (ea nang le soot molomong, pherekano / koma, kapa lactate e phahameng ea mali), ba fana ka antidote e kenang methapo e bitsoang Hydroxocobalamin (Cyanokit), e leng selelekela sa ** B12a **. Hydroxocobalamin e tlama ka ho toba ho li-ion tse chefo tsa cyanide ka har'a mali ho etsa hore e se ke ea e-ba kotsi ka ho feletseng cyanocobalamin (ea kamehla Vithamine B12), e ntšoang ka mokhoa o sireletsehileng ka har'a moroto (ho fetola moroto oa mokuli le letlalo ka nakoana ntle le kotsi e pinki-e khubelu ka matsatsi a seng makae).

Ho phekola tšoaetso ea mahlo, letlalo le liaparo¶

Ha motho a phonyoha mollong o kubellang:

1. Mahlo a hloekisitsoeng ke mosi ka metsi a hloekileng kapa letsoai: Likhase tsa asiti le likaroloana tsa mosili tse koaletsoeng ka tlas'a lintši li baka conjunctivitis e matla ea lik'hemik'hale le ho chesoa ha cornea. Hang ha phefumoloho e tsitsitse, ka bonolo hlatsoa mahlo a hlabang ka metsi a pompo a hloekileng a foofo, metsi a nooang a libotlolong, kapa sesepa sa mahlo se sa hloekang ka letsoai metsotso e 10 ho isa ho e 15 ho tloha hukung e ka hare (haufi le nko) ho ea ka ntle, ’me u tlose lilense tsa ho ikopanya kapele kamoo ho ka khonehang.
2. Pholisa letlalo leha e le lefe le chang 'me u tlose liaparo tsa ka ntle tse kolobisitsoeng ke mosi: Haeba liaparo li chesa kapa li kubella, tlola ka metsi a pholileng a hloekileng ka metsotso e 20 (le ka mohla u se ke ua sebelisa leqhoa kapa botoro ha u chesa; bona ho chesa le ho chesa thuso ea pele tataiso). Hang ha u se u le kotsing, tlosa libaki kapa lijesi tse boima tse tletseng mosi oa polasetiki o chefo e le hore motho a khaotse ho hema lik'hemik'hale tse ntšang khase molaleng oa hae, 'me a li phuthele ka kobo e hloekileng e ommeng ho thibela hypothermia.

The 24-to-48-Hour e Liehile Matšoafo Edema Watch¶

Esita le haeba ngaka ea tšohanyetso e ka tlosa mokuli ea nang le mosi o fokolang hore a khutlele hae ka mor'a lihora tse 'maloa tsa ho shebella oksijene, **likhase tse chefo tsa lik'hemik'hale tse kang phosgene le hydrochloric acid li na le nako e patehileng ea "nako-bomo" ea lihora tse 12 ho isa ho tse 48 ** pele ho ruruha ha matšoafo ho tebileng ho phahama.

Beha motho leihlo ka hloko bakeng sa matsatsi a latelang a 2 a tletseng (le libekeng tse 4 tse tlang bakeng sa liphetoho tsa methapo ea kutlo ea carbon monoxide). Khutlela Lefapheng la Tšohanyetso hang-hang haeba leha e le efe ea matšoao ana a lemosang a hlaha:

• Ho haelloa ke moea ho hocha kapa ho ntseng ho mpefala ha u phomotse kapa ha u tsamaea ka phapusing.
• Ho se khone ho robala betheng (orthopnea) ntle le ho utloa eka oa bipetsa kapa oa khohlela.
• Ho tsubella, ho tlama ha sefuba, kapa melumo e kolobileng ya ho tsubella/ho phuphusela ha o hema.
• Ho khohlela mamina a pinki, a lerootho, kapa a methalo ea mali (letšoao la khale la hore mokelikeli oa pulmonary edema o lieha ho kena ka har'a mekotla ea moea).
• Feberu, mohatsela, kapa sekhohlela se teteaneng se botala bo bosehla (pneumonia ea baktheria ea bobeli ka mor'a tšenyo ea mosi ho cilia ea moea).
• **Ho opa ha hlooho ho hocha, ho felloa ke mohopolo, pherekano, ho tsekela, ho teneha, kapa ho leka-lekana ho sa tsitsang ** matsatsi kapa libeke ka mor'a ho pepeseha ha carbon monoxide. Bakeng sa ho thibela ho lutla le mello nakong e tlang, hlahloba rona ho dutla ha carbon monoxide le dialamo le ho phonyoha le ho pholoha ha mollo wa ntlo batataisi.

Lipotso tse botsoang khafetsa¶

Mehloli e hlahlobiloe¶

• American Heart Association (AHA, United States) le American Red Cross (United States): * Tataiso ea First Aid le Cardiopulmonary Resuscitation * , Smoke Inhalation, Carbon Monoxide / Cyanide Asphyxial Arrest, le Oxygen Administration.
• National Health Service (NHS, United Kingdom), St John Ambulance (United Kingdom), le UK Health Security Agency (UKHSA, United Kingdom): Smoke Inhalation le Carbon Monoxide Poisoning First Aid, Delayed Pulmonary Edema Red Flags, le Hyperbaric Referral Criteria.
• Centers for Disease Control and Prevention (CDC, United States) le Agency for Toxic Substances and Disease Registry (ATSDR, United States): Clinical Guidance on Carbon Monoxide (\(\text{CO}\)) Poisoning, Pulse Oximetry Limitations, Pregnancy Fetal Risk, le Hydrogen Cyanide ($\text{SHCN) Fire-Toxi}
• American Burn Association (ABA, United States) le British Burn Association (United Kingdom): Advanced Burn Life Support (ABLS) , Inhalation Injury Triage, Supraglottic Thermal Edema, le Early Intubation Indications.
• Undersea le Hyperbaric Medical Society (UHMS, International / United States) le Komiti ea Europe ea Hyperbaric Medicine (ECHM, European Union): Lipontšo tsa Hyperbaric Oxygen Therapy (\(\text{HBOT}\)) ka Acute Carbon Monoxide Poisoning le Thibelo ea Delayed Neurological Sequelae.

Litataiso tse amanang¶

• Ho chesa le ho chesa thuso ea pele
• CPR le AED tataiso ea mohato ka mohato
• Ho dutla ha carbon monoxide le dialamo
• Ho baleha mollo oa ntlo le ho pholoha
• Linomoro tsa maemo a tshohanyetso ho ea ka linaha