Faka'auha 'o e fanga ki'i manupuna, Organophosphate, mo e Ngoue Kemikale Fakakonahi 'Uluaki Tokoni¶

Ko e faka'ali'ali lahi ki he ngaahi faito'o konatapu fakangoue, ngaue'anga, pe fakatefito 'i 'api: tautautefito ki he ngaahi faito'o konatapu 'o e 'okani 'o e 'inisēkite (hange ko e malathion, parathion, kolopirifosi, diazinoni), ngaahi faito'o konatapu 'o e 'inisēkite 'o e carbamate (aldicarb, carbaryl, propoxur **'okani 'o e 'okani, 'okani 'o e 'okani, (paraquat mo e diquat), mo e ngaahi me'a faka'auha 'o e ukamea ('aluminiume pe 'o e sinisini): ko ha faingata'a'ia fakakona 'oku fakatu'utamaki ki he mo'ui. 'Oku kehe mei he ngaahi kona angamaheni 'o e 'api 'oku ne fakatupu pe 'a e maumau kapau 'oku folo, 'oku fakatefito 'a e organophosphates mo e ngaahi fakafofonga 'o e neave 'oku nau absorb vave 'a e totonu 'o fakafou 'i he ** kili 'oku haohaoa, 'ikai ke motuhia **, 'o fakafou 'i he ** mata **, pea 'i he ** manava 'o e kohu 'o e spray pe kohu **, 'o fakatupu ha neurological fakatupu mate 'i he "cholinergies mo.

'Oku 'omi 'e he fakahinohino ko 'eni 'a e sitepu-ki-he-sitepu 'o e mala'e 'o e fakahaofi mo e ngaahi polokalama fakakiliniki 'oku fakatatau ki he ngaahi fakahinohino mei he Kautaha Mo'ui 'a Mamani (WHO), 'a e ngaahi senita 'o e 'Iunaiteti Siteiti ki hono Pule'i mo e Pukepuke 'o e Mahaki (CDC), 'a e Potungaue Malu'i 'o e 'Atakai 'o e 'Amelika (EPA), 'a e Potungaue ki he Ngaahi Me'a Kona mo e Lesisita 'o e Mahaki (UKisNP 'a e Serviceons mo e Potungaue). Ko hono malu‘i koe ‘aki ‘a e ngaahi to‘ukupu nitrile pe neoprene ki mu‘a ke ke ala ki ha taha ‘oku ‘uli‘í, to‘o ‘a e ngaahi kofu kuo fakamomoko ‘aki ‘a e faito‘o konatapu, fufulu ‘a e kilí ‘i ha miniti ‘e 15, pea ma‘u ‘a e faito‘o fakavavevave atropine mo e pralidoxime (2-PAM) ‘oku fakahaofi ai ‘a e mo‘uí.

Fai ʻeni he taimí ni .¶

Kapau ko koe pe ko ha taha ofi atu kuo lulululu, lilingi, huhu, pe folo ha faitoʻo konatapu ngoue, faitoʻo konatapu ʻoku fakatefito, faitoʻo tāmate vao, pe fumigant ʻo e tengaʻi ʻakaú:

1. Malu'i koe 'uluaki: 'OUA 'E TEITEI ala ki ha taha kuo fakamomoko 'aki 'a e faito'o konatapu pe ko 'ene lua 'aki ho nima 'ata'ata: Hiki hake ki 'olunga mo hake 'o mama'o mei he kakapu 'o e spray kemikale, 'ao, pe ngaahi fale tauhi'anga koloa 'oku tapuni 'i he taimi pe ko ia. Tui kemikale-nitrile, butyl kapa, pe neoprene kofunima (ko e ngaahi kofunima fakafaito'o latex manifinifi angamaheni 'oku vave hono hū 'e he ngaahi me'a fakamolū organophosphate) kimu'a pea toki ala ki he tokotaha 'oku faingata'a'ia pe ko honau kofu. Ko e kau fakahaofi mo‘ui ‘oku nau ala ki he ngaahi kofukofu ‘oku fakamomoko ‘aki ‘a e organophosphate pe kili ‘o ‘ikai ha me‘a ‘oku nau fa‘a tō mei he kona hono uá.
2. Ta ki ho'o fika fakavavevave fakalotofonua 'i he taimi pe ko ia: Ta ki he 911 'i he 'Iunaiteti Siteiti mo Kanata, 112 'i he kotoa 'o e 'Iunioni 'Iulope, pe 999 'i he Pule'anga Fakatahataha (pe vakai'i 'emau ngaahi fika fakavavevave tohi fakahinohino). Tala mahino ki he tokotaha fekau: "Mahalo'i 'oku kona 'a e faito'o konatapu ngoue pe organophosphate kemikale: HAZMAT decontamination mo e Atropine tu'unga lahi 'oku fie ma'u." Ta mai foki ki he Pule'i 'o e Kona (1-800-222-1222 'i he 'Iunaiteti Siteiti) ke lau 'a e **E kemikale 'o e **E fakaʻilonga.
3. To'o 'a e peseti 'e 100 'o e ngaahi kofu, su, mo e ngaahi siueli 'oku 'uli'i 'i he taimi pe ko ia: Ko hono to'o 'o e ngaahi kofu kuo fakamomoko 'aki 'a e faito'o konatapu 'oku ne fakangata 'a e peseti 'e 80 ki he 90 'o e kemikale kimu'a pea toki lava ke fakamomoko 'o fakafou 'i he kili. Faka'aonga'i 'a e siisi pe siisi ke motuhi 'a e ngaahi kofukofu mo e ngaahi talausese kae 'ikai ko hono toho ia 'i he 'ulu 'o e tokotaha 'oku faingata'a'ia ('a ia 'oku ne holoholo'i 'a e kemikale 'i he mata, ihu, mo e ngutu). Silaʻi ʻa e ngaahi kofu kotoa pē kuo toʻó mo e ngaahi sū kiliʻimanu (ʻoku mimisi tuʻuloa ʻe he kiliʻimanu ʻa e ngaahi faitoʻo konatapu pea ʻoku ʻikai lava ke fakaʻauha) ʻi loto ʻi ha ngaahi kato pelesitiki mamafa ʻe ua.
4. Fufulu 'a e kili mo e 'ulu 'aki 'a e sopu lahi mo e vai tafe 'i ha miniti kakato 'e 15: Tuku 'a e tokotaha 'oku faingata'a'ia 'i lalo 'i ha kaukau, hose ngoue, pe emergency drench station pea fufulu mei he 'ulu ki he va'e 'aki ha sopu vai ma'ama'a pe ko e me'a fufulu ipu mo e vai mafana/mokomoko 'i he miniti 'e 15. Tokanga makehe ki he ngaahi fo‘i kili, ngaahi louhi‘i nimá, fulufulu‘i‘ulú, pea mo e tu‘a ‘o e telingá. 'Oua 'e fufulu 'a e kili mata 'aki 'a e ngaahi polosi fefeka, pea 'oua 'e ngaue'aki 'a e vai vela scalding, 'a ia 'oku ne fakalahi 'a e ngaahi halanga toto 'o e kili pea fakavave'i 'a e absorption 'o e kona ki he toto. Kapau naʻe puna ʻa e faitoʻo konatapu ki he matá, fufulu ʻa e matá ʻaki ha vai tafe maʻamaʻa pe saline angamaheni ʻi ha miniti ʻe 15 (vakai, lavea 'a e mata).
5. Tauhi 'a e halanga 'ea, tafoki 'i he tafa'aki, pea 'OUA 'E TEITEI fai ha fakaakeake ngutu ki he ngutu: 'Oku melemo 'a e kau ma'ukovia 'o e Organophosphate 'i honau 'uto lahi 'anautolu, 'uto 'o e 'uto ("bronchorrhea"), mo e lua. Tuku ha victim ta'e'ilo pe drooling 'i honau tafa'aki 'i he tu'unga fakaakeake koe'uhi ke frothy secretions 'o e ma'ama'a 'oku tafe mei he ngutu. Kapau ‘oku tu‘u ‘a e lotó pe ‘ikai ke toe mānava, fakahoko ‘a e ngaahi fakamālohi‘i ‘o e fatafatá ‘aki pē ‘a e nimá (CPR) pe ngaue'aki ha bag-valve-mask (BVM): 'oua 'aupito na'a ke fakahoko ha manava fakahaofi fakahangatonu mei he ngutu ki he ngutu, 'a ia 'oku ne faka'ali'ali ho ngutu ki he kohu mo e lua 'o e faito'o konatapu fakatupu mate.
6. Fakahoko ha autoinjector kapau 'oku ma'u (DuoDote / Faka'ilonga'i 'oku ou / Atropen): Kapau 'oku kau 'i he me'a na'e hoko 'a e kau fakafofonga 'o e neave fakakautau/ngaue'anga pe ngaahi timi tali fakangoue 'oku fakanaunau'i 'aki 'a e DuoDote pe ATNAA (Atropine + Pralidoxime) autoinjects, huhu fakafaito'o 'o fakafou 'i he uoua faingata'a 'o fakafou 'i he mānava, faka‘ilonga‘i ‘a e ngaahi fo‘i mata ‘o e fānau akó, tō lahi ‘a e huhu‘á, ngingila ‘a e uouá, pe puke.

Ko e faka'auha 'o e mala'e fakavavevave mo e saati 'o e toxidrome triage¶

flowchart TD
    Start["Mahaloʻi ʻoku ʻi ai ha faitoʻo konatapu, faitoʻo ʻinisēkite, faitoʻo ʻakau, pe fakaʻaliʻali ʻo e neave"] --> SceneSafe{"‘Oku malu nai ‘a e feitu’u ‘oku hoko ai ‘a e me’a ni pea ‘oku tui ‘e he kau fakahaofi mo’ui ‘a e PPE Nitrile/Neoprene?"}

    SceneSafe -->|No: Vapor cloud, enclosed shed, or bare hands| Evac["Hiki hake ki he matangi ki he 'ea fo'ou 'i he taimi pe ko ia<br/>Tui 'a e ngaahi to'ukupu Nitrile/Neoprene ('OUA 'E TEITEI manifinifi 'a e latex)<br/>Ta ki he 911 / 112 / 999 ki he HAZMAT & EMS"]

    SceneSafe -->|Yes: Upwind with chemical-resistant gloves| Decon["To'o vave 'a e 80%-90% Ma'u'anga fakamatala<br/>Motuhi 'a e ngaahi kofu 'uli kotoa pe pea li'aki 'a e ngaahi sū kili'imanu<br/>Fufulu 'a e kili & 'ulu 'aki 'a e sopu mo e vai momoko/momoko 'i ha miniti 'e 15"]

    Evac --> Decon

    Decon --> ToxClass{"Faka'ilonga'i 'a e Kalasi Kemikale 'aki 'a e Ngaahi Faka'ilonga pe Faka'ilonga 'o e Koniteina"}

    ToxClass -->|Pinpoint pupils, profuse drooling/sweating, wet lung crackles,<br/>vomiting, diarrhea, slow pulse, muscle twitching| Chol["'Oku fokotu'u 'i he tafa'aki-tokoto 'a e tu'unga fakaakeake ke fakatafe 'a e vai 'o e ma'ama'a<br/>Fakahoko 'a e Atropine (liunga ua 'a e ngaahi faito'o IV 'i he min 'e 3-5 kotoa pe kae 'oua kuo momoko 'a e ma'ama'a) puke"]

    ToxClass -->|Swallowed blue/green foul-smelling liquid herbicide;<br/>severe burning mouth/throat Ulcers| Paraquat["Paraquat pe Diquat Herbicide<br/>Ko e kelekele 'o e fuller 'o e ngutu pe ko e malala 'oku faka'aonga'i 'i he taimi pe ko ia (kapau 'i loto 'i he houa 'e 1)<br/>TA'OFI 'a e 'Okisiseni fakalahi tukukehe kapau 'oku SpO2 < 85%-88%<br/>Hemodialysis / hemoperfusion fakavavevave 'i he ICU"]

    ToxClass -->|Garlic/rotten-fish odor after swallowing grain fumigant pellets;<br/>rapid shock and arrhythmias| Phosphide["‘Aluminiume / Sini Fosifaiti (‘Kona ‘a e Kasa Fosifini’)<br/>‘OUA ‘e ‘oatu ‘a e vai pe ngaahi me‘a huhu‘a ‘oku makatu‘unga ‘i he vaí ‘i he ngutú<br/>Faka‘atā ‘a e me‘alele fakahaofi mo‘uí/ED; pule'i 'a e 'ohovale 'o e loto & 'asitosi"]

    ToxClass -->|Sudden grand mal seizures with NO drooling/pinpoint pupils<br/>after flea/tick spray or agricultural spray| Pyreth["Organochlorine (Lindane/Endosulfan) or Pyrethroid<br/>15-minute soap wash (Vitamin E oil eases skin paresthesias)<br/>IV Benzodiazepines (lorazepam/diazepam) to stop GABA-block seizures"]

Pathophysiology of the "Cholinergic Storm": Organophosphates and Carbamates¶

Organophosphates (originally developed in the 1930s and 1940s as both agricultural insecticides and military nerve agents like Sarin, Soman, Tabun, and VX) and carbamates are the leading cause of fatal pesticide poisoning worldwide, responsible for over 100,000 deaths annually.

How Acetylcholinesterase (AChE) inhibition floods the nervous system¶

In a healthy human body, whenever a nerve wants to tell a muscle to contract or a gland to secrete fluid, the nerve terminal releases a microscopic puff of the neurotransmitter acetylcholine (ACh) across the synaptic gap. Within a fraction of a millisecond after that message is delivered, a specialized housekeeping enzyme called acetylcholinesterase (AChE) chops the acetylcholine molecule in half (into choline and acetic acid), turning the switch OFF so the muscle can relax and the gland stops secreting.

1. Phosphorylation of the "OFF" switch: Organophosphates and carbamates bind directly to the active serine site of the acetylcholinesterase enzyme, completely paralyzing the enzyme.
2. Relentless Acetylcholine Flood: With the "OFF" switch broken, intact acetylcholine accumulates to massive, toxic levels inside every cholinergic synapse in the body: firing the muscarinic receptors (parasympathetic glands, lungs, heart, eyes, gut), the nicotinic receptors (skeletal muscles and sympathetic ganglia), and the central nervous system non-stop until the victim's lungs fill with fluid and their diaphragm paralyzes.
3. Why Organophosphates are permanent ("Aging") while Carbamates are temporary:
4. Carbamate insecticides (carbaryl [Sevin], aldicarb, propoxur, methomyl) form a reversible carbamyl bond with the AChE enzyme that spontaneously hydrolyzes and releases on its own within 24 to 48 hours.
5. Organophosphate insecticides and nerve agents (parathion, chlorpyrifos, malathion, diazinon, dichlorvos, fenthion) form a rock-solid phosphorus bond that undergoes a permanent chemical transformation called "Aging" (loss of an alkyl group). Once an organophosphate-enzyme bond "ages" (which takes anywhere from 2 minutes for Soman nerve agent to 12 to 48 hours for agricultural insecticides), the enzyme is permanently dead forever. If the patient does not receive the reactivating antidote Pralidoxime (2-PAM) before aging completes, their body has to manufacture brand-new enzyme molecules from scratch over 2 to 6 weeks.

Recognizing the Three-Part Cholinergic Toxidrome: DUMBBELS & Monday-to-Friday¶

Because excess acetylcholine fires three different sets of receptors at the same time, clinicians look for three distinct symptom clusters:

1. Muscarinic Receptor Overstimulation: "DUMBBELS" or "SLUDGE + Killer Bs"¶

Muscarinic stimulation turns on every fluid-secreting gland and smooth muscle in the body. Remember the mnemonic DUMBBELS (or SLUDGE):

• D: Diarrhea and Diaphoresis: Explosive watery diarrhea and drenching, head-to-toe sweating.
• U: Urination: Involuntary loss of bladder control.
• M: Miosis (Pinpoint Pupils): Both pupils constrict down to tiny 1-millimeter pinpoints, causing dim, blurry vision and aching brow pain (ciliary spasm).
• B: Bronchorrhea (The #1 Killer): The mucus glands lining the bronchial tree pour out liters of thin, frothy fluid into the lungs, literally causing the patient to drown in their own lung secretions from the inside out (audible wet crackles and bubbling rales across both lung fields).
• B: Bronchospasm (The #2 Killer): Intense constriction of airway smooth muscle causing severe wheezing and inability to move air.
• B: Bradycardia (The #3 Killer): Profound vagal nerve slowing of the heart rate down to 30 to 45 beats per minute, leading to hypotension and asystolic cardiac arrest. (Together, Bronchorrhea, Bronchospasm, and Bradycardia are known in emergency medicine as the "Three Killer Bs" because they are what actually kill the patient: and what Atropine specifically reverses).
• E: Emesis: Relentless vomiting and severe abdominal cramping.
• L: Lacrimation: Continuous tearing from both eyes.
• S: Salivation: Frothy drooling pouring from the mouth.

2. Nicotinic Receptor Overstimulation: "Days of the Week" (MTWtFS)¶

While muscarinic receptors slow the heart and flood the lungs, simultaneous stimulation of nicotinic receptors on skeletal muscles and adrenal/sympathetic ganglia causes neuromuscular depolarization blockade. Remember the days of the week (M-T-W-t-F-S):

• M: Mydriasis (rare early sympathetic pupil dilation): Occasionally seen early before muscarinic pinpoint miosis dominates.
• T: Tachycardia: Early sympathetic adrenaline surge can temporarily cause a fast heart rate and high blood pressure before vagal bradycardia takes over (never withhold atropine in a wet, drooling patient just because their heart rate is currently fast).
• W: Weakness (Flaccid Paralysis): After brief overstimulation, the neuromuscular junction depolarizes and locks up, causing profound skeletal muscle weakness and paralysis of the diaphragm and intercostal breathing muscles.
• t: Tremors and Hypertension.
• F: Fasciculations (Worm-like Muscle Twitching): Visible rippling, worm-like involuntary twitches across the eyelids, tongue, calves, chest, and shoulders: a pathognomonic nicotinic sign that atropine cannot fix (requires Pralidoxime / 2-PAM).
• S: Seizures and Sweating.

3. Central Nervous System Toxicity: Anxiety, Coma, and Status Epilepticus¶

Lipid-soluble organophosphates cross the blood-brain barrier rapidly, causing agitation, restlessness, slurred speech, confusion, ataxia, central respiratory drive depression, deep coma, and violent cholinergic status epilepticus seizures (treated with intravenous benzodiazepines like diazepam, lorazepam, or midazolam).

Master comparison of Agricultural Pesticides and Household Insecticides¶

Ngaahi polokalama fakafalemahaki ki he kona 'o e Organophosphate¶

‘I he taimi ‘oku a‘u atu ai ha mahaki ‘oku lahi ‘ene kona ‘i he organophosphate pe carbamate ki he potungāue fakavavevavé, ‘oku lau ‘a e ngaahi sekoní. Ko e fakaakeake ‘oku muimui ia ki ha hokohoko pau: Faka’auha + Malu’i ‘o e Halanga ‘Ea \(\mata’u\) Founga Fakalua ‘o e Atropine \(\mata’u\) Pralidoxime (2-PAM) \(\mata’u\) Benzodiazepines.

1. Ko e founga fakalua 'o e Atropine: Titrating ki he "Ma'ama'a momoko," 'IKAI ko e lahi 'o e tamasi'i ako .¶

‘I he ngaahi puke ‘a e lotó anga-mahení pe ko e bradycardia faingofuá, ‘oku ‘oange ‘e he kau toketaá ‘a e milikalami ‘e 0.5 ki he 1 ‘o e ‘atolopiní ‘o a‘u ki he lahi taha ‘o e milikalami ‘e 3. 'I he kona lahi 'o e organophosphate, 3 milikalami ko ha to 'i he pakete: 'oku fie ma'u ma'u pe 'e he kau mahaki 'a e 20, 50, pe na'a mo e laka hake 'i he 100 milikalami 'o e atropine 'i he 'uluaki ngaahi houa si'i ke nau kei mo'ui.

• Founga vave 'o e ngaue 'a e atropinization fakalahi:
• ‘Oku kamata ‘a e kau toketaá ‘aki ha fo‘i huhu‘a vave ‘o e 1 ki he 3 milikalami ‘o e Atropine ‘i he kakai lalahí (0.02 ki he 0.05 mg/kg ‘i he fānaú).
• Toe sivisivi'i 'a e fatafata 'o e mahaki 'aki ha me'a fanongo 'i he miniti 'e 3 ki he 5 kotoa pe.
• Kapau ‘oku ngingila ‘a e mafú (bronchorrhea), ngingila (bronchospasm), pe ko e ma‘ulalo ‘a e toto ‘o e mafú/bradycardia (HR < 80 bpm) kei hokohoko atu hili 'a e miniti 'e 3 ki he 5, LIUA 'a e faito'o kimu'a (hange ko 'eni: $2\tohi{ mg} \to'omata'u 4\tohi{ mg} \to'omata'u 8\tohi{ mg} \to'omata'u 16\tohi{ mg**} \to'omata'u 32\tohi{ mg**} \to'omata'u 32\tohi{ mg**e 'oku 'i he miniti 3 kotoa pe) til 3 a'usia, pea kamata leva ha hokohoko atu 'o e houa IV atropine infusion (peseti 'e 10 ki he peseti 'e 20 'o e tu'unga fakakatoa 'o e uta 'i he houa).
• Ko e ha e ngaahi ngata'anga mo'oni 'o e Atropinization?:
• Ma'a 'a e ma'ama'a 'i he auscultation (tuku kakato 'a e bronchorrhea mo e wheezing ke lava 'a e mahaki 'o manava mo 'ea 'o 'ikai ha feinga).
• Ko e tata 'a e loto 'oku 'i 'olunga 'i he 80 'i he miniti pea toto systolic 'i 'olunga 'i he 80 ki he 90 mmHg.
• Ngaahi 'uhiki 'oku momoko (axillae).
• Tu'utu'uni fakafaito'o mahu'inga: 'OUA 'E TEITEI tuku hono 'oatu 'o e atropine koe'uhi pe ko e dilate 'a e kau ako 'o e mahaki pe koe'uhi ko honau tu'unga 'o e loto 'oku a'u ki he 110 'i he miniti kapau 'oku kei fonu honau ma'ama'a 'i he ngaahi me'a 'oku 'i ai 'a e 'uha. 'Oku 'ikai ko ha ngata'anga falala'anga 'a e dilation 'o e tamasi'i ako (tautautefito kapau 'oku fakahangatonu 'a e faito'o fakatupu 'inisēkite hypoxies into itse or), takikātia. 'Oku ke faito'o 'aki 'a e atropine kae 'oua kuo momoko 'a e ma'ama'a.

2. Palalitokisimi (2-PAM / Opitokisimi): Fakaava 'a e ngaahi uoua 'oku palalisia¶

Koe'uhi 'oku poloka pe 'e he atropine 'a e muscarinic receptors (fakamomoa 'a e ma'ama'a mo e fakalelei'i 'o e tu'unga 'o e loto) pea 'oku 'ikai ha ola 'i he ngaahi receptors 'o e uoua 'o e hui 'o e nicotinic**, 'e lava ke kei mate ha mahaki 'oku atropinized kakato mo e ma'ama'a momoko 'i he nicotinic diaphragm mo e palalisia 'o e uoua 'o e manava.

• Founga ngaue 'a e Oximes: Pralidoxime (2-PAM) (faka'aonga'i 'i he 1 ki he 2 kalama IV 'i he miniti 'e 15 ki he 30 'i he kakai lalahi, pe 20 ki he 50 mg/kg 'i he fanau, pea hoko atu ki ha hokohoko atu 'o e IV 'o e 500 mg/houa/ mgk a cro.0). 'Oku ne 'ohofi 'a e 'atomi phosphorus 'o e organophosphate 'o e molecule, to'o ia mei he 'enisaimi 'o e acetylcholinesterase mo e ** fakafoki mai 'a e 'ekitiviti fakanatula kakato 'o e 'enisaimi ** 'i he ongo uoua 'o e hui mo e ngaahi feitu'u muscarinic: 'o kapau 'oku 'oatu ia kimu'a pea toki fakafoki "motu'a" loka'i 'a e fehokotaki'anga tu'uloa.
• Fakatokanga ki he faka'auha ('Oua 'aupito na'a ngaue'aki 'a e Succinylcholine): Kapau 'oku fie ma'u 'e ha mahaki 'o e organophosphate pe carbamate 'a e 'uhiki'i 'o e endotracheal vave-hokohoko, kuo pau ke 'oua 'aupito na'a ngaue'aki 'e he kau toketaa 'a e faito'o konatapu faka'auha, koe'uhi 'oku angamaheni 'aki hono holoki 'e he plasma butyrylcholinesterase (pse). Koe'uhi kuo faka'auha 'e he faito'o konatapu 'a e ngaahi 'enisaimi cholinesterase kotoa pe, 'oku fakatupu 'e ha tu'unga 'e taha 'o e succinylcholine houa 'o e palalisia lōloa. Ka, 'oku faka'aonga'i 'a e ngaahi poloka 'o e neave 'oku 'ikai ke depolarizing (hange ko e ** rocuronium **).

3. Sio ki he "Syndrome Fakavaha'apule'anga" (Houa 'e 24 ki he 96 kimui ange)¶

Na'a mo e hili ha mo'ui 'a e mahaki 'i he 'uluaki 'aho 1 cholinergic faingata'a'ia pea 'oku ngali 'oku fakaakeake lelei 'i he falemahaki, 10 ki he peseti 'e 40 'o e kau mahaki 'oku kona 'e he organophosphates 'oku fu'u lipid-soluble (hange ko e fenthion, dimethoate, parathion, pe chlorpyrifos) fakafokifā 'a e S4. (houa 'e 24 ki he 96) hili hono faka'ali'ali:

• Toloi fakafokifā 'a e palalisia: 'I he 'ikai ha toe drooling pe ma'ama'a 'oku 'i ai 'a e vai, 'oku fakatupulaki 'e he mahaki 'a e palalisia 'o e re flexors 'o e kia (ta'emalava ke hiki honau 'ulu mei he 'ulumotu'a: ko e faka'ilonga fakatokanga vave taha), neave 'o e 'ulu, proximal uma/uoua 'o e 'uhiki spiratory**, mo e g vave hono toe fakahu mo e 'ea fakamisini 'i he 'aho 'e 5 ki he 15 kae 'oua kuo toe fakaakeake 'a e ngaahi fehokotaki'anga neuromuscular.
• Organophosphate-fakatupu 'e he fakatoloi 'o e Neuropathy (OPIDN): Hoko 1 ki he 3 uike hili ha ngaahi faka'ali'ali pau, 'o fakatupu 'a e mamahi 'o e cramping 'o e 'uhiki'i pulu, 'ohovale, 'ohovale, mo e "sitoka-mo e-to'ukupu" va'e 'o e to'o/to'o 'o e nima vaivai.

Founga hono fakaʻaongaʻi ʻo e ngaahi meʻa fakaʻauha ʻo e meʻalelé: DuoDote, Maʻake I, mo e Atropen .¶

'I he kau sotia, ngaahi naunau fakatu'utamaki (HAZMAT), ngaahi ngaue fakafaito'o fakavavevave (EMS), mo e ngaahi tu'unga ngoue fakangaue'anga pau, 'oku 'ave 'e he kau tali 'a e ngaahi autoinjectors intramuscular 'oku 'i ai 'a e puna-uta 'oku fakataumu'a ke 'oatu 'a e ** Atropine ** mo e ** Pralidoxime (2-PAM) ** 'o fakafou 'i he ngaahi kofu ki he nervs 'i tu'a 'o e 'okani expha 'o e hui pe ua.

Fakahoko 'e he mamafa mo e fa'ahinga 'o e Autoinjector .¶

1. Ngaahi huhu 'o e kakai lalahi (DuoDote pe ATNAA / Faka'ilonga'i I Kit):
2. 'Oku 'omi 'e he DuoDote takitaha 'a e autoinjector 'o e pa'ale 'e taha 2.1 milikalami 'o e Atropine mo e 600 milikalami 'o e Pralidoxime Chloride hokohoko 'o fakafou 'i ha tuitui 'e taha ('oku faka'aonga'i 'e he motu'a ange Ma'ake 'oku ou Kit 'a e ongo injectors kehekehe: 'Oku 'i ai 'a e injector mg2 mo e mg2ins A. Ko e Palalitoksimi).
3. Ngaahi Faka'ilonga Ma'ama'a ki he Fakafuofua (faka'ilonga'i 'a e fanau ako, tafe 'a e ihu, drooling, tight 'i he fatafata, 'uto, ka 'oku kei lue mo lea 'a e mahaki): Fakahoko 'a e 1 DuoDote (pe 1 Mark I seti) ki he lotolotonga 'o e tafa'aki 'o e 'uhiki 'i tu'a (vastus lateralis). Tatali miniti ʻe 10 ki he 15; kapau ‘oku ‘ikai ke fakalakalaka ‘a e ngaahi faka‘ilongá, kumi ki ha tokanga fakafaito‘o ki ha ngaahi faito‘o kehe.
4. Ngaahi Faka'ilonga Lahi (ta'e'ilo, mofi/mofi, faingata'a'ia lahi 'i he manava/ma'u, apnea, pe flaccid palalisia): Fakahoko vave 3 DuoDote autoinjectors (pe 3 Mark I seti) 'i he hokohoko vave ki he 'uhiki 'i tu'a, tanaki atu ki ai (0C pe)1 mg) anticonvulsant autoinjector neongo 'oku 'ikai ke mahino 'a e ngaahi mofi 'oku 'asi (hange ko e kau ma'ukovia 'o e neave-fakafofonga 'oku nau fa'a mamahi'ia 'i he tu'unga 'ikai mofi 'i he 'uto).
5. Fakamatala'i 'o e mamafa 'o e Atropen 'a e fanau:
6. Ko e fānau iiki ‘oku nau ma‘u ‘a e ngaahi me‘a fakatupu ‘o e ‘ōkani pe ngaahi me‘a neave ‘oku nau fiema‘u ‘a e ngaahi me‘a faka‘auha Atropen ‘oku fakafuofua‘i ‘a e mamafá (‘oku ma‘u ‘i he 0.25 mg [faka‘ilonga kulokula, ki he fanga ki‘i pēpē ‘oku si‘i hifo he 7 kg / 15 lbs], 0.5 mg [faka‘ilonga lanu pulū, ki he fānau ‘oku 7 ki he 18 mg kg / 1 lbs. fakaʻilonga, ki he fānau ʻoku kilo ʻe 18 ki he 41 / pauni ʻe 40 ki he 90], mo e 2.0 mg [fakaʻilonga lanumata, ki he kilo ʻe 41 tupu / pauni ʻe 90]).
7. Tu'utu'uni mahu'inga ki hono fakahaofi mo'ui: Kapau 'oku 'i ai ha ki'i tamasi'i 'oku fakatu'utamaki ki he mo'ui 'a e organophosphate pe ko e kona 'o e neave (ngaahi me'a 'oku 'i ai 'a e ma'ama'a 'oku 'i ai 'a e ma'ama'a, 'oho, koma, pe 'oho) pea ko ha tokotaha lahi pe 2 mg Atropine / DuoDote 'oku ma'u 'a e autoinjector 'i he feitu'u 'oku hoko ai 'a e me'a ni, **fakahoko 'e he tamasi'i 'a e **faito'o ki he 'Oku mo'ui kakato 'a e tachycardia fakataimi 'o e atropine mo e kili momoko, ka 'oku fakatupu mate 'a e puke 'o e manava cholinergic 'oku 'ikai faito'o 'i ha ngaahi miniti.

Founga huhu 'o e Autoinjector 'o e sitepu-ki-he-sitepu¶

• Sitepu 1: Siaki 'a e kato 'o e 'uhiki 'i tu'a: Ongo'i vave 'a e 'uhiki 'i loto-tu'a ke fakapapau'i 'oku 'ikai ke ke huhu ki ha kato pa'anga, ngaahi kī, smartphone, pe matolu 'o e fusi 'o e fusi.
• Sitepu 2: To'o 'a e pulou malu'i hina: Puke 'a e pa'ale DuoDote 'i ho'o nima mo e mu'omu'a lanumata 'oku tuhu ki lalo ('oua 'aupito na'a ke 'ai ho'o tuhu 'i he ngata'anga 'o e tuitui lanumata). Toʻo hangatonu ʻa e pulou tukuange maluʻi hina mei he tuʻá.
• Sitepu 3: Jab fefeka 'i ha tuliki 90-tikilī ki he lotolotonga 'o e 'uhiki 'i tu'a: Ta'alo mo lomi'i 'a e tumu'aki lanumata fefeka ki he meaty 'o e 'uhiki 'i tu'a midway 'i he vaha'a 'o e hip mo e tuliki kae 'oua kuo ke fanongo mo ongo'i 'a e kiliki 'o e puna.
• Sitepu 4: Puke ma'u 'i he feitu'u 'i he sekoni kakato 'e 10: Lau māmālie ki he 10 ("taha-taha-afe, ua-taha-afe...") ko ia 'oku fakatou 'ata'ataa 'a e ongo loki (atropine mo e pralidoxime) ki he uoua.
• Sitepu 5: Piko 'a e tuitui ki ha matau pea pin ia ki he kola 'o e victim: To'o 'a e injector hangatonu ki tu'a, milimili 'a e 'uhiki 'i ha ngaahi sekoni si'i, pea piko 'a e tuitui 'oku fakahaa'i ki ha "J" matau ki ha funga fefeka koe'uhi ke ke lava 'o hook 'a e autoinjector 'ata'ataa ki he victim pocket or's. ‘Oku tala heni ki he kau toketā fakafaito‘o mo e kau toketā fakavavevave ‘oku nau a‘u maí ‘i ha‘anau sio pē ki he lahi ‘o e ngaahi tu‘unga ‘o e ‘atolopiní mo e 2-PAM kuo ‘osi ma‘u ‘e he mahakí.

Ngaahi fehu'i 'oku toutou 'eke .¶

This guide is for informational purposes and does not replace professional medical evaluation or hands-on training. Because severe chemical poisonings can cause sudden respiratory arrest, we recommend taking an accredited first aid and CPR course through the International Federation of Red Cross and Red Crescent Societies (IFRC), your national Red Cross society, St John Ambulance, or a certified local training provider.

Kuo vakaiʻi ʻa e ngaahi maʻuʻanga fakamatalá¶

• World Health Organization (WHO): Clinical Management of Acute Pesticide Intoxication: Organophosphorus, Carbamate, and Paraquat Poisoning Guidelines.
• Centers for Disease Control and Prevention (CDC, United States) & Agency for Toxic Substances and Disease Registry (ATSDR): Medical Management Guidelines for Nerve Agents and Organophosphate Pesticides and Paraquat Clinical Guidance.
• US Environmental Protection Agency (EPA, United States): Recognition and Management of Pesticide Poisonings (6^th Edition).
• National Poisons Information Service (NPIS, United Kingdom) & UK Health Security Agency (UKHSA): TOXBASE Clinical Management of Organophosphates, Carbamates, Paraquat, and Metal Phosphides.

Ngaahi fakahinohino fekau'aki¶

• Ko e tokoni 'uluaki kona mo e triage pule'i 'o e kona .
• Vela lahi mo e kemikale 'o e kili .
• Hydrofluoric acid, rust remover, and industrial chemical burns
• Lavea 'a e mata mo e fakaviviku kemikale 'a e mata .
• CPR mo e manava fakahaofi ki he kakai lalahi .
• Ngaahi fika fakavavevave 'i he fonua