Chpt 08中 Anticholinesterase drugs and cholinesterase reactivators抗胆碱酯酶药和胆碱酯酶复活药.pptVIP

Chapter 8 Anticholinesterase Drugs and Cholinesterase Reactivators Nicotinic findings [N样症状] may include : Muscle fasciculations (twitching), Fatigue, Paralysis, Respiratory muscle weakness, Diminished respiratory effort呼吸使力, Tachycardia, Hypertension. CNS findings 中枢症状 may include : Anxiety, Restlessness躁动不安, Confusion意识模糊, Headache, Slurred speech言语不清, Ataxia共济失调, Seizures, Coma, Central respiratory paralysis, Altered level of consciousness and/or hypotonia张力减退. Medical Care 医疗护理: Prehospital care Ensure airway support and ventilation and perform endotracheal intubation, if necessary, to support the patient before arrival. Perform endotracheal intubation in patients with respiratory failure. Prehospital care Circulatory support with intravenous (IV) access, fluids, and cardiac and pulse oximetry脉搏血氧饱和度monitoring can facilitate safe transport. Decontamination清除毒污is of the utmost importance in minimizing continued exposure. Decontamination involves removing all of the patients clothing and washing him or her with water and soap. Hospital and emergency department care Assess the patients airway, breathing, and circulation (ABCs). Secure the airway and perform cardiovascular resuscitation if needed. Endotracheal intubation may be necessary for airway protection and ventilatory support. Gastric decontamination with activated charcoal should be performed in cases of ingestion. Severe exposures require expeditious迅速的anticholinergic therapy. Atropine antagonizes the central and muscarinic effects by blocking these receptors. Atropine does not bind to nicotinic receptors; hence, muscular weakness, including respiratory muscle weakness, is not affected. Hospital and emergency department care Hospital and emergency department care Anticholinergic agents should be used in doses large enough to reverse the cholinergic signs. It is recommend to give atropine until signs of atropinization appears. These signs include warm, dry, flushed skin; dilated pupils;