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AHLS 及 中毒救命 123 簡介

AHLS 及 中毒救命 123 簡介. 台中榮總急診部 張群岳 醫師. History. The University of Arizona Emergency Medicine Research Center 1994 Hazmat training program in Tucson, Arizona Standardized national course: 1997 AACT (American Academy of Clinical Toxicology): 1998. Mission of AHLS.

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AHLS 及 中毒救命 123 簡介

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  1. AHLS及中毒救命123簡介 台中榮總急診部 張群岳 醫師

  2. History • The University of Arizona Emergency Medicine Research Center • 1994 • Hazmat training program in Tucson, Arizona • Standardized national course: 1997 • AACT (American Academy of Clinical Toxicology): 1998

  3. Mission of AHLS To educate and train emergency and health care personnel in the knowledge and medical management of hazardous material exposures

  4. The Goal of the AHLS Provider Course The AHLS Provider Course is designed to provide an educational curriculum regarding the medical management of the most prevalent hazardous materials exposures

  5. The AHLS Team • AEMRC (Arizona Emergency Medicine Research Center) • Established in Oct. 1990 • Conduct research, training and education in emergency medicine, toxicology, EMS and injury prevention and control • Physicians, firefighters/paramedics, EMS agencies, and public health organizations • AACT (American Academy of Clinical Toxicology) • Founded in 1968 • Clinical and research toxicologists, physicians, veterinarians, nurse, pharmacists, etc.

  6. AHLS courses • AHLS Provider course • AHLS Instructor course

  7. AHLS Provider course (1) • 16 hours, two-day continuing medical education course • Didactic lectures • Interactive scenario discussion • Pre and post test

  8. AHLS Provider course (2) • Participants • All health care providers • Industrial, toxicology and military personnel • Certified paramedics, nurses, physician assistants, physicians, pharmacists, certified toxicologists • Course size • Maximum students: 100 • Student/faculty ratio: 25:1

  9. AHLS Provider course : Materials • Pre and posttests • Manual • Updated every four years • Research and Evaluation • Course Evaluation

  10. Six Sections of Course manual • General Principles of AHLS • Toxic Inhalations • Pesticide poisoning • Toxic Terrorism • Chemical, biological, radiological and nuclear terrorism • Corrosives and Solvents • Miscellaneous Toxicants • Hydrazines, HF, Semiconductor Gases, Ethylene Oxide, Carbon disulfide, mercury

  11. Components of Each Chapter • Objectives of the chapter • Names, Numbers and Sources of Exposure • Physical properties of the material • Routes of Exposure • Toxicodynamics • Signs and Symptoms • Targets of Toxicity - ABCDE • Treatment Decon Primary Survey and Resuscitation Poisoning Treatment Paradigm Alter Absorption Antidote Basics Change Catabolism Distribute Differently Enhance Elimination

  12. AHLS Instructor Course • A 6-hour, one-day continuing education course • Didactic lectures • Workshops • a posttest • Objects • Make aware of the policies and procedures of the AHLS program • The step by step approach on how to set up a course, get course approval and actually run the provider and instructor program • Introduction into adult education

  13. AHLS Instructor course : Participants and course size • Participants • AHLS provider • Completed and passed the full two days of the provider course including the posttest • Medical personnel • Course size • 100 students per course • Student/faculty ratio: 25:1

  14. AHLS Instructor course : Materials • Manual • Posttest • Course Evaluation

  15. 本土化 中毒救命123 ! • 洪東榮主任、黃世哲醫師、張群岳醫師、廖曜磐醫師、張櫻馨醫師 • 五大教育目標： • 了解有毒物質的重要性質和毒化災害的特性。 • 預防二次污染傷害及污染擴大的觀念。 • 熟悉、辨識五大類中毒症狀。 • 初步迅速、確切的評估和處置毒化物中毒病患。 • 了解解毒劑的適應症、禁忌症、副作用、劑量和途徑。

  16. 五大症狀 中毒救命123 ! • 剌激性氣體中毒症候群(irritant gas toxidrome) • 窒息劑中毒症候群(asphyxiant toxidrome) • 膽鹼激性中毒症候群(cholinergic toxidrome) • 腐蝕劑中毒症候群(corrosive toxidrome) • 碳氫化合物和鹵化碳氫化合物中毒症候群(hydrocarbon and halogenated hydrocarbon toxidrome)

  17. 主要章節架構： 中毒救命123 ! • 中毒救命123 1、除污 2、救命術 3、解毒劑 • 簡介 • 暴露途徑 • 毒物致病機轉 • 中毒症狀 • 主要影響部位 • 治療 1、除污 2、初步的評估和處置

  18. 章節-通論 中毒救命123 ! • 第一章：台灣毒化災害緊急應變處置和體系簡介(洪東榮) 2 • 第二章：有毒物質的辨識及性質(洪東榮) 14 • 第三章：毒化災傷病患的醫療處置(張群岳) 25 • 第四章：個人防護裝備和除污(黃世哲) 36 • 第五章：毒化災常見中毒症候群和其中毒機轉 47 • 第六章：解毒劑的認識與使用(廖曜磐) 58

  19. 章節-個論１ 中毒救命123 ! • 第七章：剌激性氣體(廖曜磐) 69 • 第八章：窒息劑(張櫻馨) 80 • 第九章：解毒劑詳述：氧氣(張櫻馨) 91 • 第十章：解毒劑詳述：高壓氧(HBO)(張櫻馨) 102 • 第十一章：解毒劑詳述：甲烯藍(methylene blue)(洪東榮) 113 • 第十二章：解毒劑詳述：解毒劑詳述：亞硝酸戊酯(amyl nitrite)(張櫻馨) 125 • 第十三章：解毒劑詳述：亞硝酸鈉(sodium nitrite)(張櫻馨) 136

  20. 章節 個論2 中毒救命123 ! • 第十四章：解毒劑詳述：硫代硫酸鈉(sodium thiosulfate)(黃世哲) 148 • 第十五章：膽鹼脂酵素(cholinesterase)抑制劑：有機磷和氨基甲酸鹽(carbamate)(張群岳) 160 • 第十六章：解毒劑詳述：Pralidoxime(張群岳) 172 • 第十七章：解毒劑詳述：Atropine(張群岳) 183 • 第十八章：除蟲菊精(pyrethrins)和類除蟲菊精(pyrethroids)(黃世哲) 194 • 第十九章：除草劑(herbicides)(黃世哲) 206 • 第二十章：腐蝕劑(corrosives)(黃世哲) 217 • 第二十一章：碳氫化合物和鹵化碳氫化合物(洪東榮) 228 • 第二十二章：氫氟酸(hydrofluoric acid)和氟化物(fluorides)(張櫻馨) 239 • 第二十三章：解毒劑詳述：Calcium Gluconate)(張櫻馨) 251 • 第二十四章：解毒劑詳述：Calcium Chloride(張櫻馨) 263 • 第二十五章：半導體氣體(張群岳) 275 • 第二十六章：聯氨(hydrazines)(廖曜磐) 286 • 第二十七章：解毒劑詳述：Pyridoxine(Vitamin B6)(廖曜磐) 297

  21. 課程 第一天 中毒救命123 !

  22. 課程 第二天 中毒救命123 !

  23. 中毒救命123 ! • 教材特色： • 將毒化物產生的症狀分為五大類 • 將「除污」、「初步的評估和處置」、「中毒救命123」，整理歸納成簡單易學的步驟 • 延用ACLS和ATLS的架構 • 已在中部地區舉辦過11場訓練課程，訓練學員超過720人。 • 教科書預計十二月完成。

  24. 未來 中毒救命123 ! • 與生物災害結合 • 加強恐怖攻擊處理課程 • 標準化的課程 • 授課方式調整 • 成立Joint committee 負責推廣及編修課程

  25. 謝謝 ! ! • Email: cjchang@vghtc.gov.tw

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