I-Carbon Monoxide Poisoning Triage, I-Pulse Oximeter Ukufundwa Kwamanga, kanye Nemibandela Ye-Oxygen ye-Hyperbaric¶

I-Carbon monoxide (CO) iyigesi enobuthi engenaphunga, engenambala, ayinambitheki, futhi engacasuli ekhiqizwa ukushiswa okungaphelele kwamafutha asuselwa kukhabhoni (okuhlanganisa namajeneretha aphathekayo kaphethiloli, izishisi zamalahle, izifudumezi ze-propane, izishintshisi zokushisa eziqhekekile, oshimula abavinjiwe, imililo yezindlu ezibasiwe, kanye nezimoto ezibasayo). Ngenxa yokuthi i-carbon monoxide ibophezela ku-hemoglobin emangqamuzaneni abomvu egazi izikhathi ezingu-200 kuya kwezingu-250 eziqine kakhulu kunomoya-mpilo, kwakheka carboxyhemoglobin (COHb), futhi ngesikhathi esifanayo ifake ushevu ku-intracellular cytochrome c oxidase enhliziyweni nasebuchosheni, kubangela ukufiphala kwamaselula buthule ngaphambi kokuba izisulu zibone ukuthi zisengozini. Okubi kakhulu, ikhaya elijwayelekile noma i-ambulensi i-oximeter ye-wavelength yomunwe wamaza amabili NGEKE iwusho umehluko phakathi kwe-carboxyhemoglobin ne-hemoglobin ene-oksijini evamile, iveza amanga ukufundwa okuqinisekisayo okungu-98% kuya ku-100% SpO2 ngisho noma isisulu sibulawa i-carbon monoxide hypoxia ebulalayo. Uma usola ukuchayeka kwe-carbon monoxide, khiphela wonke umuntu emoyeni omusha wangaphandle ngokushesha, shayela inombolo yakho yasendaweni yezimo eziphuthumayo nge- izinombolo eziphuthumayo uhla lwemibhalo, kanye nesibhedlela esifunwa ukuhlolwa kwegesi yegazi le-CO-oximetry kanye nokuhlola okungaphefumuli kabusha okungu-100% noma ukuhlolwa kwe-oxygen ye-hyperbaric, eceleni kwemihlahlandlela yethu i-carbon monoxide evamile kanye nokuhogela intuthu usizo lokuqala, i-cyanide ne-industrial gas inhalation, futhi i-methemoglobinemia.

Yenza lokhu manje¶

1. Khipha bonke abantu nezilwane ezifuywayo emoyeni omusha wangaphandle ngokushesha: Ungahlali ngaphakathi ukuze uvule amafasitela, ukhiphe umoya amagumbi, noma useshe umthombo wokuvuza. Uma umuntu ewele ngaphakathi kwegumbi elingaphansi elivalekile, igaraji, ikhabethe lesikebhe, noma ithangi lezimboni lapho kungase kube khona ukugcwala okuphezulu kwe-carbon monoxide, bamba umoya wakho, uwukhiphe kuphela uma ungakwenza lokho ngemizuzwana usuka emnyango ngaphandle kokungena esimweni esiyingozi, noma ulinde izicishamlilo ezigqoke I-Self-Contained Breathing Apparatus (SCBA).
2. Shayela inombolo yakho yasendaweni yezimo eziphuthumayo ungaphandle kwesakhiwo: Dayela911 e-United States nase-Canada, 112 e-European Union yonkana, 999 e-United Kingdom, 000 e-Australia, noma ubone amazwe ethu ngamazwe izinombolo eziphuthumayo umkhombandlela. Cela kokubili uMnyango Wezomlilo (enezitholi ze-CO ezinegesi eningi) kanye Ne-Ambulensi Yokusekela Ukuphila Okuthuthukile (ALS).
3. UNGALOKOTHI uthembe ukufundwa kwe-oximeter yomunwe okuvamile (98% kuya ku-100% SpO2) ukuze kugwenywe ubuthi be-CO: Ama-oximeter ajwayelekile obude obungamaza amabili wokugunda emnweni akala ukumunca ukukhanya kuma-nanometer angu-660 nama-nanometer angu-940. Ngenxa yokuthi i-carboxyhemoglobin imunca ukukhanya okubomvu okungu-660 nm kucishe kufane ne-oxyhemoglobin evamile, isiguli esinezinga elibulalayo elingu-40% le-carboxyhemoglobin sisazobonisa u-98% kuya ku-100% SpO2 ku-oximeter yomunwe evamile. Kuphela ekhethekile i-multi-wavelength pulse CO-oximeter (njenge-Masimo Rad-57) noma igesi legazi elabhorethri yasesibhedlela i-CO-oximeter engakala i-carboxyhemoglobin yangempela.
4. Lawula umoya-mpilo we-normobaric ogeleza kakhulu ongu-100% usebenzisa imaski engaphefumuli kahle ebambayo ngokushesha: Ungasebenzisi i-cannula yamakhala egeleza kancane. Ngokushesha nje lapho abezimo eziphuthumayo befika, sonke isiguli esinezimpawu ze-CO, kanye sonke isiguli esikhulelwe kungakhathaliseki ukuthi sinaziphi izimpawu, kufanele sibekwe ku-100% komoyampilo ku-15 amalitha ngomzuzu nge-mask ye-reservoir eqinile engafakwanga ukuphefumula (noma i-endotracheal intubation ene-100% FiO2 uma i-comatose). Ukuphefumula i-oksijini engu-100% kunciphisa ukuqedwa kwesigamu sempilo ye-carbon monoxide egazini kusuka ku-320 imizuzu (ngaphezu kwamahora angu-5 emoyeni wegumbi) kwehle kuye kumaminithi angu-74 kuya kwangu-90.
5. Gcina isiguli siphumule ngokuphelele ngokomzimba: Ungavumeli umuntu owelulama ekuchayekeni kwe-carbon monoxide ahambehamba noma azikhandle. Ukuzikhandla ngokomzimba kwandisa isidingo somoya-mpilo we-myocardial kusisipha senhliziyo lapho i-myoglobin ne-mitochondria sezinoshevu, okungase kuqalise i-acute myocardial ischemia noma i-ventricular arrhythmias.
6. ** Khomba abantu abasengozini enkulu yokudluliselwa kwe-Hyperbaric Oxygen Therapy (HBOT) okuphuthumayo **: Tshela abezimo eziphuthumayo nodokotela bezimo eziphuthumayo ngokushesha uma isiguli sasinokulahlekelwa ukwazi okuncane (syncope) **, ukudideka, ukuthunjwa, ubuhlungu besifuba, i-ataxia, ** ukhulelwe (kunoma yisiphi isigaba sokukhulelwa) ** y noma izinga eliphezulu le-2% le-hemoglobin ye-2% noma i-2% yemoto ye-2% yemoto ephakeme noma ngaphezulu ngesikhathi sokukhulelwa), njengoba lezi kuyizinkomba zomhlaba jikelele ezijwayelekile zokudluliselwa kokuthi I-Hyperbaric Oxygen Chamber.

Isihlahla sesinqumo: I-triage ye-Carbon monoxide poisoning, i-oxygen washout, nokudluliselwa kwe-hyperbaric¶

flowchart TD
    Start["Ukuchayeka Kwe-Carbon Monoxide (CO) Okusolwayo: I-CO Alarm Sounding, I-Generator/Heater/Vehicle Exhaust, I-House Fire, noma Abagibeli abaningi Abanekhanda elibuhlungu ngesikhathi esisodwa, isicanucanu, isiyezi, noma i-Syncope"] --> Evacuate["1. Khipha BONKE Abahlali Nezilwane Ezifuywayo Ubayise Emoyeni Omusha Wangaphandle Ngokushesha 2. Shayela ku-911 / 112 / 999 ukuze uthole Umnyango Wezomlilo (i-Hazmat/CO Meter) + I-Ambulensi ye-ALS 3. Gcina Izisulu Zihlezi Noma Zilele Ziphumule (Yehlisa Isidingo Senhliziyo O2)"]

    Evacuate --> OximeterTrap["UMTHETHO OBALULEKILE WOKUHLOLA: Unganaki Ama-Oximeter Ajwayelekile Okungu-2-Wavelength Finger Pulse (Amanga angu-98% kuya ku-100% SpO2). Sebenzisa i-7/8-Wavelength Rad-57 CO-Oximeter NOMA I-Hospital Venous/Arterial Blood Gas CO-Oximetry"]

    OximeterTrap --> StartNRB["Faka i-100% High-Flow Normobaric Oxygen (15 L/min nge-Tight Non-Rebreather Mask) NGOKUSHESHA (Yehlisa uhhafu wempilo ye-COHb ukusuka kumaminithi angu-320 emoyeni wegumbi wehle ufike kumaminithi angu-74 kuya kwangu-90). Uma kuvalelwe umlilo wesakhiwo / umule emlonyeni + ikhoma/ukwethuka, phatha ngokuhlanganyela i-Hydroxocobalamin (5 g IV) ye-Cyanide"]

    StartNRB --> LabDraw["I-Hospital ED Triage kanye nokuhlolwa kwe-STAT: - I-Venous noma I-Arterial Blood Gas ene-Spectrophotometric CO-Oximetry (COHb %) (Isisekelo esivamile: ngaphansi kuka-2 kuya ku-3% kwabangabhemi; 5 kuya ku-10% kwababhemayo bephakethe ngosuku) - 12-Lead ECG + High-Sensitivity Pregnancy Pregnancy Cardiac"]

    LabDraw --> HBOTCheck{"Ingabe Isiguli Sihlangabezana nanoma yisiphi isibonakaliso se-Hyperbaric Oxygen Therapy (HBOT: 2.5 kuya ku-3.0 ATA)? 1. Ukulahlekelwa ukwazi / i-syncope (ngisho kufushane, ngisho noma manje iphapheme) 2. Isimo sengqondo esishintshile, ukudideka, ukuthunjwa, i-ataxia, noma i-focal neuro deficit 3. Isiguli esikhulelwe esine-COHb 15% kuya ku-20% noma ngaphezulu NOMA noma yikuphi ukucindezeleka kwe-fetus / izimpawu zomama 4. I-Cardiac, i-levanic, i-Elevache i-arrhythmia) 5. I-acidosis enamandla ye-metabolic (pH ngaphansi kuka-7.20 noma i-lactate ephezulu) NOMA I-COHb ephelele engu-25% noma ngaphezulu"}

    HBOTCheck -->|"YEBO: Ihlangabezana nemibandela ye-HBOT"| TransferHBOT["URGENT HYPERBARIC OXYGEN THERAPY (HBOT) PROTOCOL: - Qhubeka ne-100% O2 ngenkathi uhlela ukudluliselwa ku-Hyperbaric Chamber (okulungile phakathi kwe-6 kuya kumahora we-24) - Ukucindezela ku-2.5 kuya ku-3.0 Atmospheres Absolute (ATA) yehla i-COHb isigamu se-plasma i-6 i-dissolves imizuzu engu-3 ye-plasma engu-3 I-O2 ukuze idlule i-hemoglobin, ihlukanise i-CO ku-cytochrome c oxidase, futhi ivimbe i-beta-2 integrin leukocyte lipid peroxidation ukuvimbela iDelayed Neurological Sequelae (DNS)"]

    HBOTCheck -->|"CHA: Izimpawu ezithambile kuphela (ikhanda elibuhlungu noma isicanucanu), ongakhulelwe, i-ECG evamile kanye nokuhlolwa kwe-neuro"| NormobaricWashout["100% NORMOBARIC OXYGEN WASHOUT PROTOCOL: - Qhubeka ngo-100% Non-Rebreather O2 okungenani amahora angu-4 kuya kwangu-6 kuze kube yilapho i-COHb ingaphansi kuka-2% kuya ku-5% futhi zonke izimpawu ziyaxazululeka - Umnyango Wezomlilo/Umbuso kufanele uhlole futhi uvale into esetshenziswayo engalungile ngaphambi kokuba noma ubani aphinde angene esakhiweni - Hlela ukulandelwa kwe-Neurology 4 I-Sequelae (DNS)"]

I-Pathophysiology: Indlela emithathu yobuthi be-carbon monoxide¶

Sekungamashumi eminyaka izincwadi zokufunda zifundisa ukuthi i-carbon monoxide ilimaza umzimba kuphela ngokuhlala phezu kwamangqamuzana e-hemoglobin. Ucwaningo lwesimanje lwe-toxicology kanye ne-hyperbaric medicine lufakazela ukuthi i-carbon monoxide empeleni ihlasela umzimba womuntu ngezindlela ezintathu ezihlukene, ezigqagqene, okuchaza ukuthi kungani amazinga egazi le-carboxyhemoglobin (COHb%) ehlobana kabi nobunzima bomtholampilo nokuthi kungani iziguli zingalimala unomphela ebuchosheni ngisho nangemva kokuba igazi lazo i-COHb% lehle libuyele kuqanda:

1. I-Hemoglobin Binding (200x to 250x Affinity) kanye Nomphumela We-Haldane (U-Shift Kwesobunxele)¶

I-tetramer ngayinye ye-hemoglobin emangqamuzaneni akho abomvu egazi inezindawo ezine zokubopha i-heme ezine-iron eziklanyelwe ukuthwala umoya-mpilo (O2) usuka emaphashini uye ezicutshini. I-Carbon monoxide ibophezela kulawo masayithi ane-ferrous (Fe2+) heme ene-200 kuya ku-250 ehlobene kakhulu kunomoya-mpilo*, yakhe carboxyhemoglobin (COHb).

Uma i-carbon monoxide ithatha indawo eyodwa noma ezimbili kwezine ze-heme ku-molecule ye-hemoglobin, ishintsha ukuma kwesakhiwo sephrotheni (i-allosteric modification / the Haldane Effect), ibangele amasayithi amabili noma amathathu asele aphethe umoya-mpilo ukubambelela kuma-molecule awo komoyampilo ngokuqina okwedlulele. Ku-oxyhemoglobin dissociation curve, lokhu kubangela ukuguquguquka okumangalisayo kwesokunxele (ukushintsha ijika lisuke kumumo we-sigmoidal ovamile we-S liye ku-hyperbola). Njengoba igazi ligeleza kuma-capillary alambile obuchopho nenhliziyo, i-hemoglobin yenqaba ukukhipha umoya-mpilo wayo osele, okubangela i-hypoxia yezicubu zamangqamuzana ejulile embi kakhulu kune-anemia elula yezinga elifanayo.

2. I-Direct Cardiac and Skeletal Muscle Poisoning nge-Myoglobin ("I-Myocardial Stun")¶

I-Carbon monoxide iphinde ibophezele ngokusondelana okuphezulu (cishe ** izikhathi ezingu-40 kuya kwezingu-60 ezinkulu kunomoya-mpilo **) ku-**myoglobin **, iphrotheni egcina umoya-mpilo ngaphakathi amaseli emisipha yenhliziyo (i-cardiomyocytes) kanye nemisipha yamathambo. - Lapho i-CO ibophezela ku i-myoglobin yenhliziyo (yakha i-carboxymyoglobin), ibulawa indlala imisipha yenhliziyo ye-beat-to-beat intracellular oxygen reserve, okubangela ukungasebenzi kahle kwe-myardial, ukungasebenzi kahle kwe-ventricular kwesokunxele noma kwesokudla, ischemia ye-subendocardial, ama-troponins enhliziyo aphakeme (okwenzeka ngoshevu ongaphezu kuka-30% we-CO) i-arrhythmias **. - Njengoba i-carboxyhemoglobin isuswa kancane egazini phakathi nokwelashwa komoya-mpilo, i-carbon monoxide egcinwe ekujuleni kwemisipha ye-myoglobin ingaphindela emuva egazini, noma iqhubeke nokucindezeleka kwenhliziyo ukufinyela izinsuku.

3. I-Mitochondrial Cytochrome c Oxidase Inhibition, Oxidative Stress, kanye ne-Brain Lipid Peroxidation¶

Cishe amaphesenti angu-10 kuya kwangu-15 womthwalo we-carbon monoxide womzimba uncibilika ngokuqondile kumaseli ezicubu, lapho ebophezela khona kunsimbi ye-heme eyinsimbi ye-mitochondrial cytochrome c oxidase (I-Complex IV yochungechunge lwezokuthutha lwe-electron): 1. Ukuvala kwe-ATP kanye Nokuhlinzwa Okukhulu Kwamahhala: Ukuvimbela I-Complex IV kumisa i-phosphorylation ye-oxidative (ukukhiqizwa kwamandla e-ATP yeselula) kuyilapho kubangela ukuthi ama-electron aphume ochungechungeni lwezokuthutha, okukhiqiza ukuqhuma okukhulu kwezinhlobo zomoya-mpilo osebenzayo (i-superoxide, i-peroxynitrite, ne-nitric oxide) ngaphakathi kwama-neurons e-endothelium yobuchopho. 2. I-Xanthine Oxidase ne-Neutrophil Adherence (Imbangela Yokulimala Kwengqondo Ebambezelekile): I-Peroxynitrite ne-endothelial nitric oxide yenza kusebenze ama-platelets nama-neutrophils (amangqamuzana amhlophe egazi). Ama-neutrophil acushiwe asebenzisa ama-beta-2 integrin ukuze anamathele ezindongeni zemithambo yegazi emincane ebuchosheni, lapho ewohloka futhi ekhulula i-myeloperoxidase (MPO). 3. I-Myelin Basic Protein Peroxidation: I-Myeloperoxidase ibangela i-lipid peroxidation ye-Myelin Basic Protein (MBP), igobolondo elivikelayo elizungeze imicu yezinzwa endaweni emhlophe ejulile kanye ne-basal ganglia yobuchopho. I-myelin eshintshiwe ngamakhemikhali ibonakala ngokuzumayo "njengeyangaphandle" yi-T-lymphocyte yesiguli, iqala ukuhlasela kancane kancane, okungapheli **ukuvuvukala okuzenzakalelayo kwe-autoimmune indaba emhlophe yobuchopho phakathi kwezinsuku ezi-2 kuya kwezingu-40 ezilandelayo **, okuyimbangela yebhayoloji ye- Delayed Neurological Sequelae (DNS).

Ithebula lokuqhathanisa: I-Pulse Oximetry vs. CO-Oximetry vs. I-Arterial Blood Gas ku-CO Poisoning¶

Ukuqonda ukuthi isibhedlela ngasinye noma idivayisi yangaphambi kwesibhedlela ilinganisa ini ngempela kuvimbela amaphutha abulalayo:

I-oxygen washout kinetics: Umoya wegumbi vs. 100% Normobaric Oxygen vs. Hyperbaric Oxygen (HBOT)¶

Ngenxa yokuthi umzimba awukwazi ukugawula i-carbon monoxide ibe yi-carbon dioxide, okuwukuphela kwendlela yokuqeda i-carbon monoxide emzimbeni ukuwuphefumula uphinde uyikhiphe ngamaphaphu ngokusebenzisa Umthetho Wesenzo SeMisa: ukukhukhula i-alveoli ngezingcindezi eziphezulu zomoya-mpilo ohlanzekile (PAO2) ukuze ukhiphe ukuncintisana ne-carbon monoxide futhi uyikhiphe ku-hemoglobin, i-hemeglond, i-hemoglond ne-myoglond sites.

Qhathanisa indlela ukukhishwa kwe-half-life ye-carboxyhemoglobin yehla ngokumangazayo kuzo zonke izigaba ezintathu zokulethwa komoyampilo:

Imibandela ye-Hyperbaric Oxygen Therapy (HBOT): Ubani Odinga Ukudluliselwa Kwegumbi?¶

Iqondaniswe ne- Undersea kanye ne-Hyperbaric Medical Society (UHMS), i- American Thoracic Society (ATS), I-European Committee for Hyperbaric Medicine (ECHM), kanye nengqophamlando Weaver et al. (I-New England Journal of Medicine) isilingo esilawulwa ngokungahleliwe ** (esibonise ukuthi izikhathi ezintathu ze-oxygen hyperbaric ku-2.0 kuya ku-3.0 ATA phakathi kwamahora angu-24 zinciphisa ukulandelana kwengqondo emavikini angu-6 kusukela ku-46.1% kwehle kuya ku-25.0%), odokotela abaphuthumayo bahlola zonke isiguli esine-CO-poisoned ye-Oxy** I-Hyperba eyodwa le mibandela elandelayo:

1. Umlando Wokulahlekelwa Ukuqaphela (Syncope) noma Ikhoma:
2. Noma yikuphi ukuquleka kwesikhashana, ukuba mnyama, noma ukungasabeli endaweni yesigameko noma ngesikhathi sokuthutha, ngisho noma isiguli sesivukile futhi sizizwa sijwayelekile ngokuphelele ngesikhathi sifika egumbini lezimo eziphuthumayo, kuyinkomba eyinhloko ye-HBOT ngoba i-syncope ibonisa i-cerebral hypoxia enamandla edlulayo futhi inengozi enkulu ye-Delayed Neurological Sequelae.
3. Noma yikuphi Ukushoda Kwezinzwa noma Isimo Sengqondo Esishintshile:
4. Ukudideka, ukudideka, ukucabanga kancane, ukulahlekelwa inkumbulo, ukuquleka, i-cerebellar ataxia (ukungakwazi ukuhamba umugqa oqondile wesithende kuya ozwaneni noma ukungahambi kahle komunwe kuya ekhaleni), ukuphazamiseka kokubuka, noma ubuthakathaka obugxile.
5. Ukukhulelwa (Ukuba Sengozini Okukhethekile Kwengane):
6. Kungani umbungu ongakazalwa "Iyi-Carbon Monoxide Magnet": I-Fetal hemoglobin (Hemoglobin F / HbF)isondelene kakhulu ne-carbon monoxide kune-Hemoglobin A yabantu abadala, futhi i-carbon monoxide iwela i-placenta kancane kodwa klzzwxh:0085 uhfu wempilo emoyeni wegumbi 7 amahora angu-9**, futhamazinga e-COHb yengane engashintshi akhuphuka 10% kuya ku-15% ephakeme kunamazinga kamama).
7. Ukwengeza, ngenxa yokuthi i-fetus HbF isivele ihlezi iye phambili ngakwesobunxele kwijika lokuhlukanisa umoya-mpilo, ukwengeza i-CO kubangela inhlekelele yezicubu ze-fetus hypoxia, ukubeletha, noma ukulimala okungapheli kobuchopho bengane (globus pallidus kanye ne-brainstem necrosis) ngisho noma umama enekhanda elincane kuphela.
8. Umthetho Wokwelapha Okhulelwe: Noma yimuphi wesifazane okhulelwe ochayeke ku-carbon monoxide udinga i-normobaric oxygen washout isikhathi eside kahlanu kunomuntu omdala ongakhulelwe, futhi i-HBOT iboniswa kunoma yisiphi isiguli esikhulelwe esinezinga le-COHb elingu-15% kuya ku-20% noma ngaphezulu, noma yiziphi izimpawu zemizwa kamama noma ukuhluka kwenhliziyo, nanoma yiziphi izimpawu zokuncipha kwenhliziyo, ukuphelelwa amandla kwengane. ngaphandle kwe-COHb yomama. I-oxygen ye-hyperbaric iphephe ngokuphelele ku-fetus.
9. Ukungasebenzi kahle kwenhliziyo noma i-Myocardial Ischemia:
10. Ubuhlungu besifuba (i-angina), i-ischemic ST-segment noma i-T-wave ishintsha ku-ECG ehamba phambili engu-12, ephakeme i-troponin yenhliziyo ezwela kakhulu, i-ventricular arrhythmias, noma i-hypotension/pulmonary edema.
11. I-Metabolic Acidosis Enzima noma I-High Absolute Carboxyhemoglobin Level:
12. Igazi le-Arterial pH ngaphansi kuka-7.20 noma liphakeme kakhulu i-serum lactate (uma livela emlilweni wesakhiwo, liphinde liphathe ngokuhambisana ne-cyanide poisoning* nge-intravenous hydroxocobalamin [Cyanokit, 5 grams IV]), NOMA izinga eliphelele lokungu-2% noma ngaphezulu* *5% izinga eliphezulu kakhulu **COH isiguli esinezimpawu), ** NOMA ** ikhanda eliqhubekayo / isicanucanu / ukudideka okuhluleka ukuxazulula ngemva kwamahora angu-4 we-100% umoya we-normobaric.

I-Delayed Neurological Sequelae (DNS): I-2-to-40-Day Post-Recovery Brain Crisis¶

Esinye sezici ezilimaza kakhulu nezingaqondakali kahle ngobuthi be-carbon monoxide yi-Delayed Neurological Sequelae (DNS) (ebuye ibizwe ngokuthi I-Delayed Encephalopathy after Acute Carbon Monoxide Poisoning [DEACMP]).

1. I-"Lucid Interval" (Izinsuku Ezi-2 kuya kwezingu-40 Ngemva Kokukhishwa Esibhedlela)¶

Kumaphesenti angu-15 kuya kwangu-40 abasinde kubuthi obubalulekile be-carbon monoxide, isiguli silulama ngokuphelele egumbini lezimo eziphuthumayo noma esibhedlela, siphuma sizizwa sijwayelekile ngamaphesenti angu-100, sibuyela emsebenzini noma esikoleni izinsuku ezingu-*2 kuya kwezingu-40 (isilinganiso samasonto amabili kuya kwangu-3: "isikhawu esicacile")**, bese kuthi kungazelelwe kuqale ukuwohloka kwemizwa okuqhubekayo, ukuwohloka nokuwohloka kwemizwa. i-lipid peroxidation ilimaza globus pallidus (basal ganglia) kanye nedeep periventricular cerebral white matter:

• Ukwehliswa Kwengqondo Nokuphatha: Ukulahlekelwa inkumbulo yesikhathi esifushane kakhulu, ukungakwazi ukugxilisa ingqondo, ukudideka, ukucubungula kwengqondo okunensayo (i-bradyphrenia), noma ukudideka okunjengokuwohloka komqondo okungagwegwesi.
• I-Parkinsonian Movement Disorders (I-Basal Ganglia / Globus Pallidus Injury): Isimo sobuso esifihle ubuso, unyakaza onyakazayo, ukundindizela ukuphumula, ukuqina kwemisipha ye-cogwheel, i-dystonia, i-chorea, noma ukulahlekelwa ibhalansi nokuwa njalo.
• Izinguquko Zobuntu Nokuphazamiseka Kwemizwelo: Ukucindezeleka okukhulu okungazelelwe, ukungakwazi ukuzibamba ngokomzwelo (ukukhala okungalawuleki noma ukucasuka), ukunganaki, ukukhathazeka, ukuphazamiseka kwengqondo, noma ukuthatheka.
• I-Focal Neurological Deficits: Ukungakwazi ukuzithiba komchamo noma indle, i-peripheral neuropathy, ubumpumputhe be-cortical, noma ubuhlungu bekhanda obungapheli nsuku zonke.

2. Indlela Yokuqapha Nokuphatha I-Neurological Sequelae Ebambezelekile¶

• Ukulandelela Okuphoqelekile Kwamaviki Angu-4-kuya Ku-6: Sonke isiguli esilashelwa ubuthi be-carbon monoxide obumaphakathi kuya kobukhulu kufanele sibe nokuhlolwa okuhleliwe kwemizwa kanye ne-neurocognitive amaviki angu-4 kuya kwangu-6 ngemva kokukhishwa.
• Okutholakele kwe-Brain MRI: Uma kuvela izimpawu ze-DNS, i-MRI yobuchopho ngokuvamile ibonisa i-symmetric hyperintenensity ye-T2/FLAIR kanye nokusabalalisa okukhawulelwe ku- bilateral globus pallidus (isiginesha ye-radiological yakudala yobuthi be-CO) bese isakaza i-subcortical white matter leukoencephalopathy.
• Isibikezelo Nokuvuselela: Ngokuvuselelwa kwe-neuro-rehabilitation, ukwelashwa kwengqondo, nemithi ehlosiwe (futhi kwezinye izikhungo, phinda i-hyperbaric oxygen ne-anti-inflammatory protocols), 50 kuya kumaphesenti angu-75 eziguli ezakha i-DNS zibonisa ukululama okukhulu phakathi nezinyanga ezingu-6 kuya kwezingu-12, nakuba ezinye zigcina inkumbulo engapheli noma imoto engapheli.

Izinombolo zezimo eziphuthumayo zesifunda kanye nezinqubomgomo ze-ejensi¶

• I-United States ne-Canada: Shayela u-911* ngokushesha usuka ngaphandle kwesakhiwo, noma ushayele Ukulawula Ubuthi ku-1-800-222-1222 (US) / 1-844-POISON-X (Canada) ukuze uthole ukubonisana nge-toxicology. Abezimo eziphuthumayo bangaphambi kwesibhedlela kanye nezibhedlela balandela ** Izikhungo Zokulawula Nokuvimbela Izifo (CDC) **, ** I-American College of Emergency Physicians (ACEP) **, ** I-American Thoracic Society (ATS) **, kanye ** I-Undersea ne-Hyperbaric Medical Society (UHMS) ** imihlahlandlela. Inethiwekhi ye-Divers Alert (DAN) / UHMS 24-Hour Emergency Hotline (+1-919-684-9111) ixhumanisa ukutholakala kwegumbi eliphuthumayo le-hyperbaric yonkana eNyakatho Melika.
• E-United Kingdom: Shayela u-999* ukuze uthole Isevisi Yomlilo Nezokuhlenga kanye Nesevisi Yezimo Eziphuthumayo (futhi ushayele Isevisi Yezimo Eziphuthumayo Kazwelonke Yegesi ku-0800 111 999 ngaphandle uma kuhilelekile umshini wegesi). Ukunakekelwa komtholampilo kulandela Isevisi Yemininingwane Yezobuthi Kazwelonke (NPIS / TOXBASE), NICE, kanye nemihlahlandlela ye British Hyperbaric Association (BHA).
• I-European Union: Dayela u-112* kuwo wonke amazwe angamalungu e-EU. Amaqembu ezibhedlela alandela ** I-European Committee for Hyperbaric Medicine (ECHM) ** izincomo zokuvumelana kwe-CO poisoning kanye nokudluliselwa kwe-HBOT.
• I-Australia ne-New Zealand: Shayela u-000* e-Australia noma 111 eNew Zealand (Isikhungo Sokwaziswa Ngobuthi: 13 11 26 e-Australia, 0800 764 766 eNew Zealand). Amayunithi emithi ye-hyperbaric asebenza ezibhedlela ezinkulu zemfundo ephakeme ngaphansi kwe-ANZCA / SPUMS (South Pacific Underwater Medicine Society) amaphrothokholi.
• I-India ne-Asia-Pacific: Dayela u-112* e-India, 995 e-Singapore, 119 e-Japan naseNingizimu Korea (lapho i-HBOT ihlanganiswe kabanzi ezikhungweni eziphuthumayo zamanyuvesi), noma 999 e-Hong Kong nase-Malaysia.

Imibuzo ejwayelekile ukubuzwa¶

Kungani i-oximeter yomunwe wosizo lokuqala ifunde u-99% komoyampilo ngenkathi ilungu lomndeni wami linoshevu oyingozi we-carbon monoxide?¶

I-clip-on finger pulse oximeters ikhanyisa kuphela amaza okukhanya amabili (660 nm red kanye ne-940 nm infrared) ngomunwe. Ngenxa yokuthi i-carboxyhemoglobin ebomvu ekhanyayo (i-hemoglobin eboshelwe ku-carbon monoxide) imunca ukukhanya okubomvu okungu-660 nm kucishe kufane ne-hemoglobin ene-oksijini enempilo, i-oximeter ye-wavelength pulse oximeter ayikwazi ukuhlukanisa futhi ihlanganise ndawonye, ​​ibonise ukufundwa okungamanga kuka-98% kuya ku-100% SpO2 ngisho nalapho u-30% noma u-40% we-carbon monoxide evinjwe yi-carbon monoxide yomuntu. I-CO-oximeter ekhethekile kuphela engu-7-to-8-wavelength (njenge-Masimo Rad-57) noma igesi legazi elabhorethri yasesibhedlela i-CO-oximeter engakala i-carboxyhemoglobin yangempela.

Kushesha kangakanani ukuphefumula okungu-100% komoyampilo noma ukuya egumbini elinomfutho ophakeme kusula i-carbon monoxide egazini?¶

Uma umuntu onoshevu evele ephefumule umoya omusha wangaphandle (21%), kuthatha imizuzu engama-320 (ngaphezu kwamahora angu-5) ukususa uhhafu nje we-carbon monoxide egazini lakhe. Ukuwafaka ku-100% komoyampilo ngokusebenzisa imaski eqinile engadonseli ukuphefumula ngamalitha ayi-15 ngomzuzu ukusikeka okuqeda uhhafu wempilo ngokuphindwe kane, kwehle kuye kumaminithi angu-74 kuya kwangu-90. Ukubeka isiguli ngaphakathi kwegumbi le-Hyperbaric Oxygen Therapy (HBOT) elicindezelwe ku-2.5 kuya ku-3.0 Atmospheres Absolute (ATA) kunciphisa isigamu sempilo phansi ku-15 nje kumaminithi we-23 ngenkathi kuqedwa i-oksijini ehlanzekile eyanele ngqo ku-plasma yegazi ewuketshezi ukugcina ubuchopho nenhliziyo iphila ngaphandle kokudinga i-hemoglobin nhlobo.

Kungani abesifazane abakhulelwe bedinga ukwelashwa kwe-hyperbaric oxygen emazingeni aphansi e-carbon monoxide kunabanye abantu abadala?¶

I-hemoglobin yengane engakazalwa (I-Hemoglobin F) ibopha i-carbon monoxide iqine kakhulu kune-hemoglobin yabantu abadala, futhi i-carbon monoxide ithatha isikhathi esiphindwe ka-4 kuya kwezi-5 ukususa emgudwini wegazi lombungu kunomjikelezo wegazi likamama. Ngenxa yalokho, amazinga e-fetus carboxyhemoglobin akhuphuka ngo-10% kuya ku-15% ngaphezu kwezinga likamama futhi ahlale ephakeme ngokuyingozi amahora amaningi ngemva kokuba izinga legazi likamama selibuyele kwesijwayelekile, okubeka engcupheni yokuzala ingane eshonile noma ukulimala unomphela kobuchopho bengane. I-oxygen ye-hyperbaric iphephile ekukhulelweni futhi inconywa noma nini lapho isiguli esikhulelwe sinezinga le-COHb lika-15% kuya ku-20% noma ngaphezulu, noma yiziphi izimpawu zokucindezeleka kwemizwa noma kwe-fetus.

Iyini iDelayed Neurological Sequelae (DNS) ngemva kobuthi be-carbon monoxide, futhi ivela nini?¶

I-Delayed Neurological Sequelae (DNS) iwukulimala kwesibili kokuzivikela komzimba kanye ne-oxidative ebuchosheni okuhlasela amaphesenti angu-15 kuya kwangu-40 abasinde bobuthi obubalulekile be-carbon monoxide ngemva "kwesikhashana esicacile" esikhohlisayo sezinsuku ezingu-2 kuya kwezingu-40 (ngokujwayelekile amaviki angu-2 kuya kwangu-3) okuzizwa ujwayelekile ngokuphelele. Icutshungulwa ukulimala kokuqala kwe-carbon monoxide ku-mitochondrial cytochrome c oxidase kanye ne-neutrophil-mediated lipid peroxidation ye-brain myelin, i-DNS idala ukulahlekelwa inkumbulo kungazelelwe, ukudideka, izinguquko zobuntu, ukucindezeleka, noma ukuhambahamba nokuqhaqhazela okufana ne-Parkinson. Ukwelashwa okuphuthumayo kwe-hyperbaric oxygen phakathi kwamahora angu-24 wobuthi bokuqala kunciphisa kakhulu ingozi yokuthuthukisa i-DNS.

Uma othile esindiswa emlilweni wendlu enoshevu we-carbon monoxide, kungani odokotela benikeza ne-IV antidote ebizwa ngokuthi i-Hydroxocobalamin (Cyanokit)?¶

Imililo yesimanje yesakhiwo nezimoto ishisa amapulasitiki okwenziwa, amakhushini egwebu le-polyurethane, okhaphethi benayiloni, uvolo, nosilika, ikhipha igesi ebulalayo ye-hydrogen cyanide (HCN) eduze kwe-carbon monoxide. I-Cyanide ne-carbon monoxide zisebenza ngokubambisana ukuvala i-mitochondrial cytochrome c oxidase ebuchosheni nasenhliziyweni. Uma isisulu somlilo sine-comatose, ekuboshweni kwenhliziyo, i-hypotensive, noma i-lactic acidosis enzima (i-serum lactate ngaphezu kwe-8 kuya ku-10 mmol / L), odokotela bezimo eziphuthumayo bafaka ngokushesha amagremu angu-5 we-intravenous hydroxocobalamin (i-vitamin B12a egxilile, ebopha i-cyanide ku-vitamin B12 engenabungozi ekhishwe eceleni kwe-oxygen engu-100)

Lo mhlahlandlela uhlinzeka ngolwazi oluphuthumayo lwezemfundo futhi awuthathi indawo yokuhlolwa kochwepheshe bezokwelapha, ukucaciswa kwezinto eziyingozi zomnyango wezomlilo, noma ukubonisana nokulawulwa kobuthi. Ngenxa yokuthi ubuthi be-carbon monoxide bungabangela ngokushesha ukuquleka kanye nokuboshwa kwenhliziyo, sincoma ngokuqinile ukuthi ufake ama-alamu e-carbon monoxide aqinisekiswe ngebhethri e-UL/EN kuwo wonke amaleveli endlu yakho futhi uthathe usizo lokuqala oluqinisekisiwe kanye nesifundo se-CPR esivela kwa-Red Cross, i-St John Ambulance, noma umhlinzeki wokuqeqeshwa wasendaweni ogunyaziwe.

Iziqondiso ezihlobene¶

• I-Carbon monoxide nokuhogela intuthu usizo lokuqala
• I-Cyanide, i-hydrogen sulfide, negesi yezimboni usizo lokuqala
• I-Methemoglobinemia, igazi elinsundu likashokoledi, kanye ne-benzocaine noma ubuthi be-nitrate
• I-Carbon dioxide, i-ice sublimation eyomile, ne-liquid nitrogen asphyxiation
• CPR nokuphefumula kokuhlenga

Imithombo neziqondiso ezisemthethweni¶

• I-Undersea ne-Hyperbaric Medical Society (UHMS) kanye ne-American Thoracic Society (ATS, United States): Umhlahlandlela Wokujwayela Umtholampilo We-Carbon Monoxide Poisoning kanye Nezinkomba ze-Hyperbaric Oxygen Therapy kanye ne-*Weaver et al., I-Hyperbaric Oxygen ye-Acute Carbon Monoxide Poisoning (New England of Medicine) * I-New England.
• Izikhungo Zokulawula Nokuvimbela Izifo (CDC, United States): Isiqondiso Somtholampilo Se-Carbon Monoxide (CO) Poisoning Ngemva Kwenhlekelele: Izingibe zokuxilonga ze-wavelength pulse oximetry, i-CO-oximetry, nokulawulwa kokukhulelwa.
• I-American College of Emergency Physicians (ACEP, United States): Inqubomgomo Yomtholampilo: Izinkinga Ezibalulekile Ekuphathweni Kweziguli Ezikhulile Ezethula Kumnyango Wezimo Eziphuthumayo Nge-Acute Carbon Monoxide Poisoning.
• ** IKomidi LaseYurophu Lemithi Ye-Hyperbaric (ECHM): ** *I-European Consensus Conference on Hyperbaric Medicine Izincomo ze-Carbon Monoxide Intoxication kanye ne-Delayed Neurological Sequelae *.
• Isevisi Kazwelonke Yokwaziswa Ngobuthi (NPIS / TOXBASE) kanye Nesikhungo Sikazwelonke Sezempilo Nokunakekelwa Okuncomekayo (NICE, United Kingdom): I-Carbon Monoxide Poisoning: Ukuqashelwa, I-Normobaric Oxygen Washout, kanye Nezivumelwano Zokulandela.