I-Overdose Evuselelayo ('Overamping'): I-Hyperthermia, Ubuhlungu Besifuba, kanye Ne-Agitation Triage¶

Ngokungafani ne-opioid overdose, lapho umuntu enqekuzisa ikhanda kancane, ajike abe luhlaza okwesibhakabhaka, futhi ayeke ukuphefumula, i-acute stimulant overdose, eyaziwa kabanzi ekwehliseni ingozi kanye nemithi ephuthumayo njengokuthi "i-overamp", iyinkinga enodlame, ye-hyper-metabolic yenhliziyo, ubuchopho, imithambo yegazi, nokushisa komzimba. Lapho othile edla umthamo owushevu we-*methamphetamine, i-powder cocaine, i-crack cocaine, i-MDMA ("i-ecstasy" / "molly"), amaphilisi e-amphetamine angekho emthethweni, noma ama-synthetic cathinones ("usawoti wokugeza" / alpha-PVP / mephedrone), noma ubephapheme izinsuku egcwele isivuseleli, i-dopamine iyaqhutshwa i-norepinephrine, ne-serotonin. Ukushaya kwenhliziyo kuyenyuka kudlule 140 kuya ku-180 ukushaya ngomzuzu, umfutho wegazi ukhuphukela kumazinga abangela unhlangothi (220/130 mmHg+), imithambo yenhliziyo iyavaleka ku-acute vasospasm, futhi izinga lokushisa lomzimba eliyinhloko lingakhuphuka ngokushesha lidlule 40.0 kuya ku-41.5 degrees Celsius (104.0 kuya ku-106.7 degrees Fahrenheit).

Ukushiywa kungalashwa, ubuthi obunamandla obuvuselelayo bubulala ngezindlela ezine ezisheshayo: i-hyperthermia eyingozi (ukupheka izitho zangaphakathi kanye nokucupha i-coagulation ye-intravascular coagulation), i-coronary artery vasospasm kanye ne-sodium-channel blockade (okubangela i-acute myocardial infarction noma i-ventricular ebulalayo ye-ventricular arrhythmia-year-old arrhythmia-20years) i-intracerebral hemorrhagic stroke noma isimo se-epilepticus seizures, kanye ne-rhabdomyolysis (ukuwohloka okukhulu kwemisipha yamathambo okubhubhisa izinso). Ngesikhathi esifanayo, ngenxa yokuthi i-fentanyl ne-nitazenes engekho emthethweni manje konakalisa iphesenti elikhulu le-cocaine yasemgwaqweni, i-crack, i-methamphetamine, namaphilisi acindezelwe e-Adderall/MDMA, noma yimuphi umsebenzisi ovuselelayo ozela ngokuzumayo, axhuge, noma aphuze ukuphefumula kufanele athole intranasal naloxone (Narcan) ngokushesha. Ukwazi ukuhlukanisa ukweqisa okungokwengqondo esimweni esiphuthumayo sezempilo esisongela ukuphila, indlela yokupholisa isiguli esishisayo esishisayo ngemizuzu, nokuthi kungani KUFANELE UNGALINGE uqinise isiguli esinezinhliziyo ezibuhlungu sibheke phansi esiswini kusindisa izimpilo.

Yenza lokhu manje¶

1. Hlola ukuphefumula nokusabela kuqala: uma umsebenzisi ovuselelayo equlekile, ehona, ehefuzela, noma ephefumula kancane, sebenzisa i-Naloxone (Narcan) 4 mg nasal spray bese uqala ukuphefumula kokuhlenga ngokushesha. I-cocaine yesitaladi, i-methamphetamine, namaphilisi avuselelayo acindezelwe avame ukungcoliswa ngokuphambene* **fentany. Ngisho noma wazi ukuthi bebehlose ukusebenzisa kuphela isikhuthazi, i-naloxone izohlehlisa i-fentanyl efihliwe futhi ngeke ilimaze othile onesimo esiphuthumayo esishukumisayo.
2. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo (911 e-US naseCanada, 112 e-EU, 999 e-UK) ngokushesha uma lowo muntu ENENOMA YIYIPHI ifulegi elibomvu elibonakalayo: ubuhlungu besifuba noma ingcindezi, isikhumba esiphakathi esizwa ukushisa, ukuquleka, ikhanda elibuhlungu kungazelelwe, ubuso obulengayo/ingalo ebuthakathaka, noma ukudangala okungalawuleki. izinombolo eziphuthumayo umkhombandlela.
3. Uma isikhumba somuntu sishisa, siguquguquka, noma sikhubaza futhi sishisa ngokweqile, qala ukupholisa kanzima NGOKUSHESHA ngenkathi usalinde i-ambulensi. Khumula izingubo zangaphandle eziningi, pakisha klzzwxh:0044 ukuwawela, noma uwacwilise okugeza okupholile (gcina ikhanda lisekelwe phezu kwamanzi). **Izinga lokushisa eliyisisekelo ngalinye ngomzuzu lihlala lingaphezu ku-40.5 degrees Celsius (105 degrees Fahrenheit) libangela ukulimala kobuchopho nesitho esingalungiseki.**
4. UNGALOKOTHI ubambe, uphine, ubophe ingulube, noma uhlale emhlane noma esifubeni somsebenzisi onyakazayo noma ovuselelayo (ejwayele ukuzibamba). Umuntu onobuthi obunamandla obushukumisayo une-acidosis ye-metabolic** eyedlulele futhi udinga ukunwetshwa okukhulu kwezindonga zesifuba ukuze akhiphe isikhutha (CO2). Ukuwaphina abheke phansi kunciphisa i-diaphragm yawo, kwenyuke amazinga e-acid egazini, futhi kubangela ukuboshwa kwenhliziyo okuyingozi okungazelelwe ("restraint asphyxia") phakathi kwamasekhondi angu-60.
5. Uma umuntu enezinhlungu esifubeni, emhlathini/engalweni yesokunxele, noma ejuluka ngendlela ebandayo ngemva kokusebenzisa i-cocaine noma i-meth, mhlalise ngokukhululeka, umgcine ezolile, futhi unikeze u-162 kuya ku-325 mg we-Aspirin ehlafunwayo (ngaphandle kwalapho engezwani naye noma eshaywa unhlangothi/wopha). Ungalokothi uvumele umuntu onobuhlungu besifuba obuvuselelayo ukuba ahambe azungeze noma akhiphe i-cocaine ngokushesha noma i-cocaine ebhodini** (odokotela basesibhedlela kufanele bagweme ama-beta-blocker athile abhebhethekisa i-coronary artery spasm).
6. Uma umuntu "enomfutho" obuthakathaka ongokwengqondo (ukukhathazeka, ukusangana, ukudideka, noma ukukhathala AKUKHO ubuhlungu besifuba, AKUKHO ukushisa ngokweqile, nokuphefumula okuvamile), mhambise egumbini elipholile, elimnyama, elithulile. Nikeza iziphuzo ezibandayo ze-electrolyte, ishawa epholile noma indwangu yokugeza, ukulunywa ukudla okuncane, kanye nokuba khona okuzolile, okungaguquki kuze kube yilapho usuhlubukile.

Ukuvivinya Okusheshayo: Ukweqisa Kwengqondo Okumaphakathi vs. Ubuthi Bezokwelapha Obusongela Impilo¶

Ezenzweni zokunciphisa ukulimala, igama elithi "ukweqisa" lihlanganisa i-spectrum ebanzi: kusukela ekuhlaselweni okungakhululekile, kwe-jittery panic ngemva kokuthatha i-Adderall, i-meth, noma i-coke eningi kakhulu, kuze kufike ekubulaweni kwe-hyperthermia, unhlangothi, noma isifo senhliziyo. Sebenzisa lesi sihlahla sesinqumo ukuhlukanisa lokho okungathuliswa ekhaya kulokho okudinga i-ICU yasesibhedlela njengamanje.

flowchart TD
    A["Umuntu Ocindezelekile Ngemva Kwe-Cocaine, Meth, Crack, MDMA, noma Amaphilisi"] --> B{"Ingabe Abaphenduli noma Baphefumula Kancane / Bayahona?"}
    B -->|YES: Limp, Blue Lips, Slow Breathing| C["SOLA UKUNGCOLA KWE-FENTANYL: Nikeza i-Naloxone 4 mg Spray + Rescue Breaths + Call 911"]
    B -->|NO: Awake, Fast Heartbeat, Sweating, Agitated, or In Pain| D{"Yiziphi Izimpawu Zenkinga Ye-Red-Flag Sympathomimetic?"}
    D -->|Hot Skin > 39.5C/103F, Chest Pain, Seizure, Stroke Signs, Dark Urine, or Violent Delirium| E["IZIPHUTHUMA ZOKWELAPHA: Shayela ku-911 / 112 / 999 Ngokushesha"]
    D -->|NO Physical Red Flags: Jittery, Anxious, Racing Thoughts, Exhausted, Mild Paranoia| F["Ukweqisa Okumaphakathi/Okulingene: Yehlisa Ukukhuphuka Egumbini Elipholile, Elithulile"]
    E --> G["1. I-Rapid Ice-Pack / Ukupholisa Ukuhwamuka 2. I-Aspirin Ehlafunwayo 325 mg Uma Ubuhlungu Besifuba 3. I-Zero Prone Restraint"]
    F --> H["1. Izibani Ezifiphele futhi Cisha Umculo 2. Amanzi Abandayo / Ama-Electrolyte & I-Snack 3. Indwangu Yokugeza Epholile 4. Gada Njalo Emaminithini angu-15"]

Ithebula Lokuhlola Lomtholampilo: I-Overapping Green/Yellow vs. Red Sympathomimetic Emergency¶

Isimo Esiphuthumayo Esisongela Impilo 1: I-Malignant Stimulant Hyperthermia ("Ukupheka Ngaphakathi")¶

Imbangela yokuqala yokufa okusheshayo ku-acute methamphetamine, MDMA ("molly"), kanye ne-synthetic cathinone ("usawoti wokugeza") ukweqisa kwezidakamizwa ngu-runaway hyperthermia*.

1. Kungani izikhuthazi zenza izinga lokushisa lomzimba lidlule ku-41 degrees Celsius (106 degrees Fahrenheit)¶

Izikhuthazi ngesikhathi esisodwa zivula isithando somlilo sangaphakathi somzimba ngenkathi zephula irediyetha yayo:

• Ukukhiqiza Ukushisa Okukhulu: I-dopamine eningi, i-serotonin, ne-norepinephrine kubangela ukushuba okuqhubekayo kwemisipha yamathambo, ukubopha imihlathi, ukuyaluza, kanye nokuqaqanjiswa kwe-mitochondrial (UCP-3), okukhiqiza ukushisa okukhulu kwangaphakathi (ikakhulukazi kuma-nightclub aminyene, ashisayo, emikhosini yasehlobo, noma emakamelweni angenawo umoya ohlanzekile).
• Ukukhipha Ukushisa Okuvinjiwe: Ngesikhathi esifanayo, i-norepinephrine ibangela i-alpha-1 adrenergic peripheral vasoconstriction, ukubopha kuvala imithambo yegazi esikhumbeni ukuze igazi elishisayo lingakwazi ukufinyelela endaweni yesikhumba ukuze liphole.
• I-40.5C (105F) I-Threshold Yokuhluleka Kwezitho Eziningi: Uma izinga lokushisa lingaphezu kuka-40.5 degrees Celsius (105 degrees Fahrenheit)* isikhathi esingaphezu kwamaminithi angu-20 ukuya kwangu-30, i-denature yamangqamuzana amaprotheni, umgoqo wamathumbu uyabhidlika (ukulahla i-gut endotoxins** emsipha igazi), futhi uhlelo lokujiyisa igazi luya ku-haywire (Disseminated Intravascular Coagulation / DIC), okubangela ukopha okubulalayo kuzo zonke izitho.

2. Isinyathelo ngesinyathelo Iphrothokholi Yokupholisa Ngokushesha Yangaphambi Kwesibhedlela¶

ungalindi ukuthi abezimo eziphuthumayo baqale ukupholisa isiguli esivusa ukushisa esishisayo, futhi ungalokothi unikeze i-acetaminophen (paracetamol / Tylenol) noma ibuprofen/aspirin ukuze wehlise imfiva evuselelayo. Amaphilisi e-Antipyretic fever asebenza ku-hypothalamus ngesikhathi somkhuhlane/imfiva yebhaktheriya futhi enza zero nge-hyperthermia yemisipha ebangelwa izidakamizwa (okubi nakakhulu, i-acetaminophen isheshisa ukungasebenzi kwesibindi ngesikhathi se-hyperthermia, futhi ama-NSAID abhebhethekisa ukwehluleka kwezinso).

1. Hambisa Endaweni Engaba Khona Ebanda Kakhulu: Letha lowo muntu egumbini eline-conditioner noma umoya onomthunzi bese ususa amahembe asindayo, izigqoko, izigqoko, nezicathulo wehlisele ezangaphansi.
2. Faka ama-Ice Pack Kumajunjana Amakhulu We-Arterial: Goqa amaphakethe eqhwa, izikhwama zama-ice cubes, noma amaphakheji okudla afriziwe ithawula elimanzi elincanyana futhi uwabophe uqine ngasentanyeni (imithambo ye-carotid), emakhwapheni (imithambo ye-axillary), kanye nama-groin creaches (imithambo yesifazane).
3. Ukupholisa Kwesifutho-Ne-Fan-Evaporative (noma Ukucwiliswa Kwamanzi Abandayo):
   • Isiponji noma fafaza izindawo ezinkulu zesikhumba esingenalutho ngamanzi apholile (15 to 20 degrees Celsius / 60 to 68 degrees Fahrenheit) ngenkathi ukhomba ifeni kagesi enamandla kakhulu etholakalayo (noma ukuphephetha ngamandla ngekhadibhodi/mathawula) ngqo esikhumbeni esimanzi. Ukuhwamuka kususa ukushisa ngokushesha okuphindwe kasikhombisa kunomoya owomile.
   • Uma ubhavu utholakala ngokushesha futhi umuntu ephapheme (noma abasizi ababili abaqinile bangabamba ikhanda ngokuphephile baphume emanzini), cwilisa umzimba kanye nezitho zomzimba emanzini ampompi apholile. (Bheka Ukushisa ngokumelene nokuphelelwa ukushisa.)

Isimo Esiphuthumayo Esisongela Impilo 2: I-Cocaine ne-Methamphetamine Ubuhlungu Besifuba (I-Heart Attack & Vasospasm)¶

I-Cocaine ne-methamphetamine idala i-acute myocardial infarction (inhliziyo), i-aortic dissection, kanye ukuboshwa kwenhliziyo kungazelelwe ngisho nakubasebenzisi abaneminyaka engu-19 kuya kwengama-35 ubudala abangenalo i-cholesterol plaque emithanjeni yabo.

1. Ukushaywa kwenhliziyo kathathu kwe-cocaine (kanye ne-Cocaethylene enotshwala)¶

• I-Coronary Artery Vasospasm + Isidingo Esikhulayo Somoya-mpilo: I-cocaine ne-meth kubangela imisipha yenhliziyo ukuthi ishaye ngamandla futhi ngokushesha kuyilapho ngesikhathi esisodwa i-spacking imithambo yenhliziyo ivaleke, ibulawa indlala imisipha yenhliziyo yomoya-mpilo.
• I-Direct Sodium-Channel Blockade (I-Cocaine Kuphela): I-cocaine iyi-anesthetic yasendaweni ("caine") evimba ngokuqondile i-sodium esheshayo yenhliziyo (Na+) iziteshi, ukwandisa ugesi wenhliziyo QRS eyinkimbinkimbi futhi ebangela ukufa i-ventricular tachycardia noma i-ventricular fibrillation (odokotela basesibhedlela abaphatha nge intravenous sodium bicarbonate).
• Ukujiya Kwegazi Okusheshisiwe: Izivuseleli zenza ama-platelet asebenze, abangele amahlule egazi kungazelelwe ngaphakathi komthambo we-coronary ohlabayo.
• I-Cocaethylene Multiplier (I-Cocaine + Utshwala): Uma umuntu ephuza utshwala ngenkathi esebenzisa impushana noma i-crack cocaine, isibindi somuntu sikhipha izidakamizwa ezimbili zibe ingxenye yesithathu, ehlukile ye-psychoactive compound ebizwa ngokuthi cocaethylene. I-Cocaethylene ine-plasma half-life 3 izikhathi ezi-5 ubude kune-cocaine iyodwa futhi yandisa ingozi yokufa kwenhliziyo kungazelelwe ngo-18- kuya ku-25-fold.

2. Usizo lokuqala lobuhlungu besifuba obuvuselelayo (kanye Nesexwayiso Se-Beta-Blocker Yesibhedlela)¶

1. Shayela ku-911 / 112 / 999 ngokushesha nganoma yikuphi ukumpintshana, okusindayo, okushisayo, noma ubuhlungu besifuba obubukhali, ukuphelelwa umoya, umjuluko obandayo, noma ubuhlungu obuphuma emhlane, entanyeni, emhlathini, noma engalweni.
2. Phoqelela Ukuphumula Okuphelele Komzimba Nokuzola: Hlalisa umuntu endaweni enethezekile ehlaliswe uhhafu (45 degrees) eguqe ngamadolo. Isinyathelo ngasinye abahamba ngaso sandisa i-catecholamines kanye nesidingo se-myocardial oxygen.
3. Nika u-162 kuya ku-325 mg we-Non-Enteric Chewable Aspirin: Ngaphandle uma umuntu engezwani ne-aspirin yangempela noma ebonisa izimpawu zokopha kobuchopho/ukushaywa unhlangothi noma ubuhlungu obuklebhula iqolo (i-aortic dissection), menze *ahlafune futhi agwinye umuntu omdala oyedwa 325 mg aspirin (noma amabili kuya kwamane 81 mg wokumisa i-asprin plate ngaphakathi kwe-coronary art) (Bheka Usizo lokuqala lwesifo senhliziyo.)
4. Tshela Abezimo Eziphuthumayo kanye Nodokotela Be-ER Ngokushesha Ukuthi I-Cocaine noma I-Meth Yasetshenziswa:
   • Ekuhlaselweni kwenhliziyo okujwayelekile okungezona izidakamizwa, odokotela bezimo eziphuthumayo bavame ukunikeza ama-beta-blockers (njenge-metoprolol noma i-propranolol)* ngomthambo.
   • Ekuphuzeni ngokweqile kwe-cocaine noma kwe-methamphetamine, okunikeza i-beta-blocker emsulwa (beta-1 / beta-2 blockade) kungabangela "ukugqugquzelwa kwe-alpha-adrenergic okungaphikiswa," lapho ukuvimba ama-beta receptors kushiya ama-alpha receptors evulekile, okubangele imithambo yenhliziyo ukuthi ivaleke ngokuphelele kanye nomfutho wegazi unyuke kakhulu.
   • Uma utshela udokotela we-ER iqiniso ukuthi kugibele i-cocaine noma i-meth, baphatha izinhlungu zesifuba ngokuphepha besebenzisa i-intravenous benzodiazepines (lorazepam noma i-diazepam) ukuthulisa idrayivu yozwela emaphakathi, i-sublingual noma i-IV nitroglycerin, kanye **ne-calcium-channel blockers (diltiazem/**********veraphentolamine)

Isimo Esiphuthumayo Esisongela Impilo 3: I-MDMA ("Molly" / "Ecstasy") Ukudakwa kwamanzi vs. Ukuphelelwa amanzi emzimbeni¶

I-MDMA (3,4-methylenedioxymethamphetamine) ithwala ingozi eyingqayizivele ye-hydration ephindwe kabili eye yabulala abasha befestiveli nabahambele iklabhu abazame "ukwenza okufanele" ngokugingqa amalitha amanzi angenalutho.

+-------------------------------------------------------------------------+
|       THE MDMA ("MOLLY") HYDRATION RULE: ELECTROLYTES, NEVER GALLONS    |
|                                                                         |
|  WHY PLAIN WATER CAN KILL ON MDMA:                                      |
|  MDMA stimulates the brain to release huge amounts of Antidiuretic      |
|  Hormone (ADH / Vasopressin), causing SIADH: your kidneys are           |
|  chemically LOCKED and CANNOT produce urine to excrete excess water.    |
|                                                                         |
|  If a dancing or overheating MDMA user chugs 3 to 5 liters of plain     |
|  tap or bottled water in 2 hours, blood sodium (Na+) plummets below     |
|  120 mEq/L (Acute Dilutional Hyponatremia). Water rushes into brain     |
|  cells, causing fatal CEREBRAL EDEMA (brain swelling, vomiting,         |
|  seizures, brain herniation, and death), disproportionately affecting   |
|  young women due to estrogen's effect on the brain sodium pump.         |
|                                                                         |
|  SAFE MDMA FLUID RULE:                                                  |
|  1. Drink ONLY isotonic ELECTROLYTE solutions (sports drinks, ORS       |
|     packets, or salty broth), NEVER large volumes of plain water.       |
|  2. Limit intake to roughly 250 to 500 mL (1 to 2 cups) per hour        |
|     while dancing or sweating, and 250 mL/hour when resting.            |
|  3. If someone on MDMA starts vomiting, has a headache, seems confused, |
|     or has not urinated despite drinking, STOP ALL FLUIDS and call 911  |
|     for emergency hypertonic saline (3% NaCl) treatment.                |
+-------------------------------------------------------------------------+

Isimo Esiphuthumayo Esisongela Impilo 4: I-Stimulant Stroke, I-Subarachnoid Hemorrhage, kanye Nokuquleka¶

Ngenxa yokuthi i-methamphetamine, i-cocaine, i-crack, ne-synthetic cathinones kubangela ukukhuphuka komfutho wegazi okungazelelwe,200/120 to 260/150 mmHg) eceleni kokuqina komkhumbi wegazi wobuchopho kanye ne-platelet clumping, i-acute ischemic stroke kanye nokopha kobuchopho okopha (i-intracerebral hemorrhage noma i-cerebral aneurysm ephukile) kuyizinkinga ezivame ukuba yinhlekelele zokweqisa isikhuthazi, ngisho nakubantu abaneminyaka engamashumi amabili nantathu.

1. Ukubona ukopha kobuchopho okubangelwa isikhuthazi noma ukushaywa unhlangothi (BE-FAST)¶

Ungalokothi ucashise ikhanda elibuhlungu elibuhlungu, ukukhubeka, noma inkulumo engacacile phakathi nomdlalo ovuselelayo njengokuthi "ukuba phezulu" noma ukungalali:

• I-"Thunderclap" Ikhanda elibuhlungu (I-Aneurysm Ephukile / I-Subarachnoid Hemorrhage): Uma umuntu osanda kubhema i-crack, i-cocaine, i-cocaine, noma osebenzise i-methamphetamine ngokuphazima kweso ebamba ikhanda lakhe futhi akhale ebuhlungu kakhulu, ubuhlungu bekhanda elibuhlungu kakhulu empilweni yakhe (ukufinyelela ubuhlungu obukhulu phakathi nemizuzwana engu-60, ukuthukuthela, ukuzwela intamo), Ukugoqa, umkhumbi wegazi ongaphansi kobuchopho cishe uqhume ngaphansi komfutho wegazi owedlulele we-catecholamine.
• BE-FAST I-Neurological Stroke Red Flags:
  • B (Ibhalansi): Ukulahlekelwa ibhalansi kungazelelwe, isiyezi, noma ukungakwazi ukuhamba uqonde.
  • E (Amehlo): Ukufiphala okungazelelwe, okuphindwe kabili, noma ukulahlekelwa umbono kwelinye noma womabili iso.
  • F (Ubuso): Uhlangothi olulodwa lobuso luyashona noma luzizwa ndikindiki lapho licelwa ukuba limamatheke.
  • A (Izingalo): Ingalo eyodwa noma umlenze ukhukhulela phansi noma uzizwe ubuthakathaka/undikindiki lapho ubanjiwe.
  • I (Inkulumo): Inkulumo engacacile, amagama aphikisiwe, noma ukungakwazi ukuqonda imisho elula.
  • T (Isikhathi): Shayela 911 / 112 / 999 ngokushesha futhi UNGAMniki i-aspirin uma umuntu eduma ikhanda noma esolakala ukuthi wopha (i-aspirin yenza ukopha kube kubi kakhulu).

2. Ukuphatha ukuquleka okubangwa isikhuthazi ngesikhathi ulinde abezimo eziphuthumayo¶

Izikhuthazi zehlisa umkhawulo wokubanjwa kobuchopho ngokuqondile ngemiphumela ye-sodium-channel (i-cocaine), i-cerebral vasospasm, i-hyperthermia, ne-hyponatremia (MDMA). Ngokungafani nesifo sokuwa esivamile esizimela sodwa ngemva kwemizuzwana engu-60, ukuquleka okubangelwa izidakamizwa kuvame ukudlulela esimweni esiqhubekayo se-epilepticus ngaphandle kwalapho zelashwa nge-benzodiazepines efakwa emthanjeni noma e-intramuscular (midazolam, lorazepam, noma i-diazepam):

1. Sula phansi bese uguqa ikhanda: Yehlisa umuntu phansi, slayida ibhantshi eligoqiwe noma umcamelo ngaphansi kwekhanda lakhe, bese usunduza amatafula ekhofi, izifudumezi nezinto zengilazi ukuze zingafinyeleli.
2. Beka I-Ice Pack Entanyeni, Emakhwapheni, NaseGroin: Isiguli esivusa amadlingozi sikhiqiza ukushisa okukhulu kwezicubu okungaphusha izinga lokushisa eliyisisekelo lidlule ku-41 degrees Celsius (106 degrees Fahrenheit) ngemizuzu; aqale apholise intamo namakhwapha ngokushesha ngenkathi bebamba.
3. Ungalokothi ufake noma yini emlonyeni wabo futhi ungalokothi ubambe izitho zabo ezidlikizekayo: Ukuphoqa izinkezo, izikhwama zemali, noma iminwe phakathi kwamazinyo ahlangene kuphula amazinyo futhi kuvimbe indlela yokuphefumula, futhi ukucindezela izitho ezidlikizayo kuphuka amathambo futhi kwenza ukuwohloka kwemisipha kube kubi kakhulu (rhabdomyolysis).
4. Gquqela Endaweni Yokulala Eceleni lapho nje ukudlikiza kuma: Sula amathe noma uhlanze emlonyeni ngokuwagoqa ohlangothini lwesobunxele isilevu sitshekele phezulu ukuze bakwazi ukuphefumula ngokukhululeka kuze kufike abezimo eziphuthumayo.

Ukunciphisa Ukulimala Ngaphambi Kokusebenzisa Nokuphepha Kwaphakathi Ne-Binge: Ukuvimbela Ukweqisa kanye Nobuthi Be-Fentanyl¶

Kubantu abathile okwamanje abasebenzisa izikhuthazi noma amalungu omndeni asekela othile osengozini, izinyathelo zokunciphisa ukulimala ezisekelwe ebufakazini zinciphisa kakhulu ingcuphe yokweqisa okubulalayo:

Isinyathelo Ngesinyathelo Sokunciphisa Ukulimala Kokukhuphuka Kokweqisa Okungabalulekile¶

Uma uhlole zonke izinto kuthebula lokunquma elingenhla futhi waqinisekisa ukuthi umuntu akanabuhlungu besifuba, akanawo imfiva/isikhumba esishisayo, akadlidliza, akanazimpawu zokushaywa unhlangothi, nokuphefumula okuvamile, uhlangabezana nobunzima obungabalulekile obungokwengqondo/obuzimele (ngokuvamile okubangelwa ukuthatha isikhuthazi esiningi kakhulu, ukuxuba izikhuthazi amahora angu-2, noma amahora angu-6 wokuvuka ne-caffeine).

1. Uhlu lokuhlola lokuncishiswa kwemvelo kanye nelokuphila¶

1. Shintsha Imvelo Yezinzwa Ngokushesha:
   • Suka emculweni we-bass onomsindo omkhulu, amagumbi aminyene, izibani ezikhanyayo, noma amakhona emigwaqo anengcindezi uye ekamelweni elipholile, elinokuthula elinokukhanya okuncane.
2. Pholisa Inzwa Yevagus (Ngaphandle Kokwethusa Umzimba):
   • Beka indwangu yokugeza epholile, emanzi phezu kwesiphongo sabo, amehlo, nangemuva kwentamo, noma ubavumele baphuze okufudumele-kuya-kuphole (okungakaze kube namakhaza abandayo) ishawa lapho behlezi noma begadiwe.
3. Hhayiza nge-Electrolyte kanye nama-Carbohydrates Alula:
   • Ukulunywa okuvuselelayo kwehlisa ushukela wegazi, i-sodium, i-potassium, ne-magnesium kuyilapho kubangela umlomo owomile kakhulu ("i-cottonmouth") nokugaya imihlathi (bruxism).
   • Nikeza ngokuphuza okuncane, okungaguquki kwesiphuzo se-electrolyte esipholile, amanzi kakhukhunathi, ubisi, noma i-smoothie yesithelo**, kanye nokudla okulula okuthambile, okulula ukukugwinya (ubhanana, iyogathi, ama-apulasi, noma umhluzi) kanye nocezu lwetshungama yokuhlafuna noma ikhona lendwangu yokuwasha ehlanzekile ukuze ubavimbele ekuqhekezeni ama-molars abo ekubambeni kwemihlathi.
4. Khuthaza Ukunyakaza Okumnene NOMA Ukuphumula (Noma Ikuphi Okuzizwa Kuphephile Kubo):
   • Abanye abantu abadla ngokweqile bazizwa bevaleleke uma betshelwa ukuthi balale bathule; ukuhamba kancane egumbini eliphephile, ukunwebeka, noma ukuhlala uqondile ngenkathi uzilolongela ukuhogela kancane kancane imizuzwana emi-4 / ukuphefumula kokukhipha umoya okuyimizuzwana engu-6 kushisa amandla ekinetic okwethuka kuze kudlule inani eliphakeme.

2. Ungakhuluma kanjani nomuntu ophethwe i-paranoia evuselelayo noma i-psychosis evimbela ukulala¶

Ngemva kwamahora angu-48 kuya kwangu-96 ngaphandle kokulala nge-methamphetamine noma i-crack cocaine, kufika ku-40 kuya kumaphesenti angu-60 abasebenzisi baba ne-psychosis yesikhashana ebangelwa i-stimulant-induced: ukubona izinto ezingekho (ukuzwa kuhleba noma imisakazo yamaphoyisa ngaphandle), ithunzi elibonakalayo, abantu ababonayo, ukubona izinto ezingekho emthethweni/okuthintekayo ("i-methmites"). ebuka amafasitela.

• Ungalokothi uphikisane noma uhlekise ukukhohlisa kwabo, futhi ungalokothi wenze sengathi ubona inkohliso:
  • Okulungile: "Uyahlanya, akukho muntu ngaphandle kwefasitela, hlala phansi" (evusa intukuthelo futhi abaqinisekise ukuthi uyingxenye yetulo).
  • Okulungile: "Oh yebo, ngibona nezinhloli ngaphandle" (enyusa ukwethuka).
  • Kunene (Qinisekisa umzwelo, uphansi ngokuphepha): *"Ngiyabona ukuthi kuthusa kanjani lokho njengamanje. Uphephile lapha kimi kuleli gumbi, umnyango ukhiyiwe, futhi ngizohlala khona lapha ngikugadele ngenkathi uhlezi phansi uphuze lamanzi abandayo."
• Gcina izandla zakho zibonakala, yima ku-engeli engu-45-degree okungenani amamitha angu-2 (amafidi angu-6), futhi ungalokothi uvimbele umnyango wokuphuma: Umuntu odidekile ozizwa evalelwe ekhoneni ekamelweni kunothile ovimbile umnyango uzothuka futhi abhawule noma alwe. Mabahlale lapho bengabona kahle umnyango.
• Gwema ukunikeza amaphilisi angakanqunywa emgwaqeni "igiya lokufikela": Ungalokothi unikeze umuntu oweqa ibha yomgwaqo "Xanax" noma iphilisi le-opioid ukuze alalise; Imishayo ye-alprazolam yasemgwaqweni ewumgunyathi iboshwe kakhulu nge-fentanyl, i-bromazolam, ne-xylazine, ephendula i-overamp yesikhuthazi esingasindiswa ibe ukuboshwa kokuphefumula okubulalayo ngenkathi wonke umuntu eyolala.

(Uma wena noma othandiweyo wakho nilwa ne-methamphetamine, i-cocaine, i-crack, noma isidakamizwa esivusa amadlingozi, bona Ukusetshenziswa kwezidakamizwa nokuba umlutha wezidakamizwa: umhlahlandlela wosizo oluphuthumayo, Ukuvimbela ukuphinda futhi kudlule umthamo oweqile: imicu yokuhlola ye-fentanyl/xylazine kanye ne-naloxone, futhi Ukweseka ilungu lomndeni elinomlutha. Cabangela ukuthatha usizo lokuqala olugunyaziwe kanye nezifundo ze-CPR ezivela kwa-Red Cross, St John Ambulance, noma umhlinzeki wendawo.)

Imibuzo evame ukubuzwa¶

Imithombo ihloliwe¶

• Inhlangano Yenhliziyo YaseMelika (AHA, United States): Isitatimende Sesayensi Sokuphathwa Kobuhlungu Besifuba Okuhlobene Ne-Cocaine kanye Ne-Myocardial Infarction (I-Coronary vasospasm pathophysiology, i-sodium-channel blockade, i-benzodiazepine ne-nitroglycerin yomugqa wokuqala wokwelapha, nokugwema i-beta-blockade engaphikiswa).
• Ukuxhashazwa Kwezidakamizwa Nokuphathwa Kwezinsizakalo Zezempilo Yengqondo (SAMHSA) kanye Nesikhungo Sikazwelonke Sokuxhashazwa Kwezidakamizwa (NIDA / NIH, United States): Ukwelashwa Kokuphazamiseka Kokusetshenziswa Kwezidakamizwa (TIP 33 / Isiqondiso Somtholampilo), i-sympathomimetic toxidrome triage, kanye nokubandakanyeka kwe-fentanyl ezenzweni ezimbi.
• I-American College of Medical Toxicology (ACMT) kanye ne-American College of Emergency Physicians (ACEP): Ukuphathwa Komtholampilo Wobuthi Obunzima Be-Sympathomimetic, I-Delirium Ejabulisayo / Ukugubha Okukhulu, kanye ne-Drug-Induced Hyperthermia (Ukupholisa okusheshayo okuqhutshwayo/ukuhwamuka, ukugwema ukuthambekela kokuzithiba, i-asphyxia yokulawula).
• Inhlangano Kazwelonke Yokunciphisa Ukulimala (i-United States) kanye Nenhlangano Yenqubomgomo Yezidakamizwa: Ukubona Nokusabela Ekweqiseni Okushukumisayo (Ukuhlukanisa ukweqisa okungokwengqondo okuvela ezimeni eziphuthumayo zezokwelapha kanye nezinqubo eziphephile zokwehlisa izinga lokukhuphuka).
• I-European Monitoring Center for Drugs and Drug Addiction (EMCDDA / EUDA) & UK National Poisons Information Service (TOXBASE): Isiqondiso somtholampilo mayelana ne-MDMA-induced Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH / acute dilutional hyponatremia) kanye ne-cocaethylene cardiotoxicity.

Iziqondiso ezihlobene¶

• Usizo lokuqala lwe-opioid overdose
• Ukuvimbela ukuphinda futhi kudlule umthamo oweqile: imicu yokuhlola ye-fentanyl/xylazine kanye ne-naloxone
• Ukusetshenziswa kwezidakamizwa nokuba umlutha wezidakamizwa: umhlahlandlela wosizo oluphuthumayo
• Ukweseka ilungu lomndeni elinomlutha
• Usizo lokuqala lwesifo senhliziyo
• Ukushisa ngokumelene nokuphelelwa ukushisa
• Ukulimala kwezinso okukhulu, i-rhabdomyolysis, kanye nokuhlolwa komchamo omnyama
• Izinombolo eziphuthumayo