Causes and symptoms of carbon monoxide poisoning. Medical care for CO poisoning. How carbon monoxide poisoning occurs

Poisoning carbon monoxide one of the most common poisonings. It occurs due to the inhalation of air filled with smoke or carbon monoxide. The toxic effect on the human body of this colorless, odorless gas is undeniable, but the exact mechanism of its action has not yet been proven.

It is important to know that intoxication resulting from poisoning occurs with complications and negatively affects functionality internal organs and systems in both children and adults.

How does carbon monoxide poisoning happen?

Air saturation toxic fumes, due to their lack of organoleptic properties, to determine without special devices hard. Therefore, poisoning often occurs both at home and at work.

If you use heating columns with poor ventilation at home, faulty stove installations, then air saturation toxic substance can't be avoided. Also, intoxication of the body with poisonous gas is often observed as a result of a long stay in closed parking lots and garages with a large concentration of cars. The saturation of space, in such places, is as fast as possible. Sometimes symptoms of intoxication are observed in active smokers and lovers of hookahs.

For poisoning, it is enough to inhale air containing 0.1% CO2. The severity of intoxication is also affected by the time factor of CO impact on the body. There is also a certain risk group of people who have a process acute intoxication comes an order of magnitude faster.

The risk group includes:

• women during pregnancy;
• children;
• old men;
• young immunocompromised people after illness.

By international classification ICD-10 diseases, poisoning of this type is assigned the code T58.

Symptoms of carbon monoxide poisoning

Carbon monoxide binds red blood cells and prevents them from transporting oxygen to human organs and tissues. Thus, it inhibits mitochondrial respiration and the process of saturating the body with oxygen. The nervous system, respiratory organs suffer from a lack of oxygen, the work of the heart goes astray and the vascular tissue is deformed. Carbon monoxide poisoning is divided by physicians into three stages of severity. (stages below)

The first mild stage, with timely assistance, passes quickly and the symptoms subside without complications. The average and severe stages of intoxication provoke the development of the victim serious complications. With prolonged inhalation of air saturated with carbon monoxide, even death is possible.

Mild stage symptoms:

• pulsation in the temporal region, squeezing headache;
• blurred consciousness;
• noise or ringing in the ears;
• before fainting;
• mild nausea;
• decreased vision, tearfulness;
• throat discomfort, seizure-inducing cough
• hard breathing.

With more prolonged inhalation of carbon monoxide, symptoms rapidly worsen. On the initial stage poisoning, the concentration of carboxyhemoglobin in the body reaches 30%, then at the middle stage this figure reaches 40%.

Moderate symptoms:

1. temporary unconsciousness;
2. a feeling of stupor and a violation of general coordination in space;
3. severe shortness of breath;
4. cramps in the limbs;
5. insufficient oxygen supply to brain cells leads to hallucinations;
6. pressure in the chest area;
7. difference in the size of the pupils of the eyes;
8. temporary or permanent loss of hearing and vision.

If carbon monoxide poisoning continues, severe poisoning is diagnosed. It can be complicated by a rapid course, when a person dies in a few minutes.

Main symptoms:

1. falling into a coma, which can last several days;
2. severe convulsions leading to paralysis;
3. weak pulse and dilated pupils;
4. intermittent shallow breathing;
5. bluish skin and mucous membranes;
6. spontaneous excretion of urine and feces.

The above signs are characteristic of the three standard forms of carbon monoxide poisoning. Some victims show atypical symptoms that are not described above.

Non-standard symptoms:

• a sharp decrease in pressure to 70-50 mm Hg, which leads to fainting;
• excited state (euphoria) with hallucinations;
• a state of coma with a fatal outcome (rapid course).

First aid for gas intoxication

Only medical professionals can objectively assess the situation and its severity, so you need to immediately call an ambulance. Prior to her arrival, it is desirable to provide the victim with first aid, which will reduce the risk of complications.

Before the arrival of the doctors you need:

• neutralize the source that emits carbon monoxide;
• provide the victim with an influx of fresh air (help him go outside or open windows);
• release the person from tight clothing, unfasten the top buttons and loosen the belt to ensure better patency of clean air into the lungs;
• do not let the victim fall asleep, try to keep him conscious until the doctors arrive, using ammonia.
• when the victim regained consciousness, it is necessary to give him absorbent drugs, for example, Polysorb. It actively cleanses the body of toxic substances.

This should be first aid for carbon monoxide poisoning until the arrival of doctors. Next, the doctors themselves will diagnose, administer an antidote and decide on the need for hospitalization. The actions of physicians in case of carbon monoxide poisoning should be clear and quick.

They include the following manipulations:

1. using an oxygen mask to restore breathing;
2. the use of the drug Acizol, which is an antidote because it destroys carboxyhemoglobin molecules;
3. subcutaneous injections of caffeine to normalize the heart rhythm;
4. intravenous injections of the enzyme Carboxylase, which also destroys carboxyhemoglobin;
5. hospitalization of the victim complete examination and symptomatic therapy. The antidote is administered daily at 1 ml for a week.

Treatment at home is possible only in the case when an overdose of poisonous gas did not lead to serious consequences. The first degree of poisoning (lightened) in adults is removed quickly and does not carry any serious consequences in future. AT additional examination health in a hospital, after carbon monoxide poisoning, a certain category of victims needs.

This list includes:

• pregnant women;
• affected with comorbidities heart and blood vessels;
• adults with neurotic disorders;
• victims with low temperature body.

When is medical assistance required?

All cases acute poisoning with corresponding symptoms suggest the provision of emergency medical care. Depending on the general condition of the patient, he is placed in the intensive care unit or in intensive care. When first aid is provided, the victim may need to continue treatment aimed at restoring the work of all organs and systems.

Consequences and prevention

Carbon monoxide poisoning causes many unpleasant complications associated with health deterioration. Physicians divide them into two groups. Early Complications appear immediately after poisoning, and later - in weeks or even months.

Early complications:

1. regular headaches and dizziness;
2. retardation of movements and low sensitivity of the fingers and toes;
3. violation of the functioning of the intestines and urea;
4. deterioration of vision and hearing;
5. unbalanced mental state;
6. swelling of the brain and lungs;
7. violation of the outflow of blood and failures in the heart rhythm;
8. death due to cardiac arrest.

Late complications may appear after 30-40 days. The long time of manifestation of pathologies is due to the fact that they develop as the work of internal organs and systems worsens. Most often, pathologies are determined in the work of the heart, blood vessels, respiratory organs and the nervous system.

These include:

• decreased limb activity leading to paralysis;
• development of amnesia;
• heart attack (may cause cardiac arrest);
• ischemic disease of the heart muscle;
• cardiac asthma.

All of these diseases develop as a result of acute carbon monoxide poisoning and the provision of 1 help late.

What to do to protect yourself and your loved ones from poisoning? Number one on the list preventive measures- Strict adherence to fire safety regulations. People often carelessly follow these rules, causing accidents.

To exclude the possibility of carbon monoxide poisoning at work and at home, it is recommended to refuse to use broken gas and electrical equipment. It is not necessary to stay in a closed room where cars work for a long time. All industrial garages and basements must be equipped with a powerful ventilation system.

Video with Elena Malysheva about carbon monoxide

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Carbon monoxide poisoning (carbon monoxide) is a dangerous condition for human health and life. In case of carbon monoxide poisoning, first aid is required in as soon as possible and qualified treatment. Carbon monoxide is dangerous because it is colorless, odorless and tasteless. Therefore, it is very difficult, and sometimes impossible, to determine its presence in the atmosphere.

First aid for carbon monoxide poisoning

If a person has been poisoned with carbon monoxide, it is necessary to immediately provide him with first aid.

AT without fail an emergency medical team should be called, even if the patient's condition does not cause concern.

In case of carbon monoxide poisoning, it is necessary to provide first aid:

• Stop contact of the victim with toxic air. To do this, it is necessary to immediately withdraw or remove a person from the zone of pollution by combustion products. However, the person who provides assistance must take care of himself. That is, to protect your respiratory tract from the penetration of poison. To do this, put on a gas mask or cover your mouth and nose with a cloth moistened with water;
• When a person is outside the infection zone, assess his condition;
• If a person is conscious, then it is necessary to wrap him up, warm him up and give him hot sweet tea to drink. Wait with him for the arrival of the Ambulance, do not leave him alone;
• If the patient is unconscious or confused, then lay him on his side. This will prevent aspiration of vomit, if any. Control the pulse and breathing and give a sniff of a cotton swab moistened with ammonia;
• If there is no pulse or respiration, perform cardiopulmonary resuscitation. Mouth-to-mouth or mouth-to-nose is carried out, and mouth-to-nose for children under one year old. Resuscitation measures are performed until the pulse and breathing resume, or until the arrival of doctors.

For first aid for carbon monoxide poisoning, see the video:

Emergency assistance to the victim

Upon arrival of the ambulance team, first aid is provided in case of carbon monoxide poisoning.

First aid for carbon monoxide poisoning:

Groups of patients who are subject to mandatory hospitalization in a hospital:

• Patients who have had loss of consciousness, even for a short time;
• Hypothermia, that is, a person's body temperature is below normal (36.6 degrees);
• The existence of such anxiety symptoms like hallucinations, delusions, incoordination and motor activity;
• Patients who registered clinical death(stop breathing and heart);
• Children and pregnant women in any condition;
• People suffering from cardiovascular diseases.

Antidote for poisoning

An antidote is a remedy that significantly weakens or completely stops the toxic effect of a poison on the body.

Antidote for carbon monoxide poisoning is 6% Acizol. What is Azizol? It is a fast-acting drug that promotes:

• blocking the formation of carboxyhemoglobin. This is a substance that blocks the ability of the blood to carry oxygen around the body;
• Cleansing the body of a poisonous substance - carbon monoxide.

The antidote for poisoning with combustion products must be administered as early as possible, this will help to avoid dangerous complications.

Algorithm for the introduction of Acizol into the body of the victim:

• The introduction of the drug intramuscularly immediately or soon after the evacuation of the victim from the area of ​​contamination with combustion products. 1 milliliter of Acizol solution is introduced;
• Re-introduction of the antidote 1 hour after the first injection.

It is possible to use an antidote with preventive purpose. To do this, 1 milliliter of the drug is administered intramuscularly half an hour before entering the contaminated room.

How does carbon monoxide affect the body?

Carbon monoxide negatively affects the entire body. This substance quickly penetrates the blood of the victim, even after a couple of breaths.

How longer man breathes poisoned air, the more difficult his condition and the more likely development dangerous complications and death.

What happens in the body when it enters carbon dioxide into it?

• Carbon monoxide binds to hemoglobin in the blood. This creates carboxyhemoglobin. This compound prevents the binding and transfer of oxygen to the cells and tissues of the body. Which leads to hypoxia. First of all, the brain suffers, which is very sensitive to lack of oxygen;
• This toxic substance disrupts the biochemical balance and metabolic processes in tissues;
• It reacts with protein muscle tissue - myoglobin. This leads to disruption of the heart muscle, as the muscle tissue weakens and cannot fully pump blood. Nutrition is disrupted in tissues and organs.

Signs and symptoms of intoxication

The clinical picture of poisoning depends on the severity of the patient's condition. Which, in turn, is closely related to the concentration of carbon monoxide in the air and the duration of its contact with a person. There are 3 degrees of severity of carbon monoxide poisoning: mild, moderate, severe.

Faster signs of poisoning occur in weakened people, children and pregnant women.

Causes of poisoning

You can get poisoned by carbon monoxide both at home and at work. In fact, danger can lie in wait anywhere at any moment. Intoxication can occur accidentally or intentionally (for the purpose of suicide).

Let's highlight some of the main causes of human poisoning with carbon monoxide:

• Inhalation of combustion products. Poisoning occurs during a fire, when a person is in a smoky room and inhales smoke;
• In production where this gas is actively used and safety precautions are violated. That is, gas leaks occur due to faulty equipment, poor ventilation or its complete absence, and so on;

• In places with a large congestion of cars. There accumulate traffic fumes, and prolonged exposure to them leads to poisoning. These places include: garages, busy highways, underground parking lots, tunnels;
• Domestic gas leakage in apartments and houses;
• Prolonged use of kerosene lamps in an unventilated area;
• In houses and rooms with stove heating in case of its malfunction or untimely closing of the damper.

Possible Complications

Poisoning does not pass without a trace, and even with mild intoxication there are certain consequences.

Complications that may occur with mild and moderate intoxication:

• chronic headaches and meteosensitivity, that is, a person feels worse due to weather changes;
• Frequent dizziness;
• Decline in cognitive abilities. That is, memory, attention, perception of new information worsens;
• Deterioration of vision;
• Emotional instability(frequent outbursts of anger, anger, which are replaced by apathy).

Complications that occur with severe intoxication:

• Hemorrhages in the brain;
• swelling of brain tissue;
• Acute myocardial infarction against the background of hypoxia;
• Inflammation respiratory tract (severe bronchitis, pneumonia);
• Coma is the most grave consequence poisoning, which can result in the death of the patient.

How to detect carbon monoxide indoors

It is not possible to detect carbon monoxide indoors without special devices, since it has no taste, no smell, no color.

You should be alert when you smell smoke (even barely perceptible) and if you feel worse without visible reasons(nausea, vomiting, weakness).

Gas analyzers are used to determine carbon monoxide in the air. Which can be purchased in specialized stores. However, most often they are installed in production or in private houses with stove heating.

Due to the difficulty of its detection, the Ministry of Emergency Situations recommends that all precautions be observed, namely:

• Keep ventilation in proper condition and periodically check its functionality;
• Monitor the serviceability of stoves, fireplaces, chimneys and gas equipment;
• Ventilate the room;
• Observe safety precautions at work.

Carbon monoxide is a fairly common form of body intoxication, which is characterized by a rapid and extremely severe course, causes damage to all organs and systems, and often ends in death. If the victim is provided with first aid at the scene of the accident in a timely and competent manner, the risk of developing severe complications can be significantly reduced. Adequate actions of others can save the victim from death.

Why is carbon monoxide dangerous?

Carbon monoxide is a poison of rapid and general toxic action. If its concentration in the air reaches 1.2% or more, then the death of the victim occurs within 3 minutes. The dangers of carbon monoxide are as follows:

1. It has neither color nor smell - a person simply will not feel his presence in the room.
2. Able to penetrate through soil layers, walls and any partitions.
3. It is not absorbed by porous materials, so even ordinary filtering gas masks do not protect against the toxic effects of carbon monoxide.

How carbon monoxide affects the body

First of all, the type of gas in question blocks the delivery of oxygen to organs and tissues - it is considered a blood poison, since red blood cells are primarily affected. Normally, these blood cells carry oxygen to organs and systems with the help of hemoglobin, and when carbon monoxide enters the body, it binds to hemoglobin, forming carboxyhemoglobin, which is considered a compound that is detrimental to the whole body. As a result, erythrocytes are not able to deliver oxygen to organs and tissues, the whole body experiences acute oxygen starvation(hypoxia).

Because nerve cells are the most sensitive to a lack of oxygen, then in case of carbon monoxide poisoning, they first appear characteristic symptoms lesions of the central nervous system -, impaired coordination,.

Another important point: carbon monoxide disrupts the functioning of the heart muscle and skeletal muscles. The fact is that this species When gas enters the body, it binds to the protein of the skeletal muscles and the heart muscle, and this is manifested by serious disturbances in the work of the heart - rapid breathing / heartbeat, weak pulse.

Symptoms of carbon monoxide poisoning

The intensity of the manifestations of symptoms depends only on how long carbon monoxide has been affecting the human body, and what was its concentration in the air - it is on the basis of these data that the degree of intoxication is established.

central nervous system

In mild to moderate poisoning, there will be:

• encircling nature with localization in the temples and forehead;
• nausea and;
• flickering of the image, "front sights";
• blurred consciousness;
• a sharp decrease in visual acuity and hearing;
• violation of coordination of movement;
• short term.

If there is a severe degree of carbon monoxide poisoning, then the victim will experience:

• loss of consciousness;
• coma;
• involuntary urination and defecation.

The cardiovascular system

Light and moderate degree of poisoning will be characterized by:

• increased heart rate and pulse;
• pressing pains in the anatomical location of the heart.

With severe poisoning, symptoms characteristic of a severe degree of carbon monoxide intoxication will appear:

• significantly accelerated pulse - up to 130 beats per minute, but at the same time it is practically not palpable;
• the highest risk of rapid development.

Respiratory system

This section of the body suffers precisely because of the acute lack of oxygen at the time of carbon monoxide poisoning. If intoxication occurs in a mild to moderate degree, then a person will also experience rapid breathing. But in the case of a severe degree of poisoning with the type of gas in question, the victim's breathing will be intermittent, superficial.

Skin and mucous membranes

It is almost impossible to notice any pronounced changes on the skin and mucous membranes during carbon monoxide poisoning. The only thing that can appear with a mild and moderate degree of intoxication is their bright red or pronounced pink hue. With a severe degree of the condition under consideration, on the contrary, the skin and mucous membranes will be pale, with a barely noticeable pink tint.

In medicine, atypical forms of carbon monoxide poisoning are also distinguished. In this case, the following symptoms will be present:

1. swoon form- intense, pronounced pallor of the skin and mucous membranes, loss of consciousness.
2. Euphoric form- the patient is agitated, there are hallucinations, there may be unmotivated actions, loss of consciousness, coupled with heart and respiratory failure.

Consequences of carbon monoxide poisoning

The condition under consideration entails a number of complications, which in medicine are usually divided into early and late.

Early complications of acute carbon monoxide poisoning (first 2 days after the incident):

Late complications of carbon monoxide poisoning (2-40 days):

1. From the side of the central nervous system: memory loss, decreased intelligence, disorder motor functions, apathy, blindness, dysfunction pelvic organs, parkinsonism, paralysis.
2. From the side of cardio-vascular system: , cardiac asthma, mycoarditis different types, .
3. From the side respiratory system: swift .

To reduce the intensity of complications, to protect the victim from severe intoxication, you need to know how to act when a person who has been poisoned by carbon monoxide is detected.

First aid for carbon monoxide poisoning

The first thing to do when a victim is found is to call an ambulance team, and this must be done even if the victim himself speaks of his normal state of health. Remember important points:

And before the arrival of the ambulance brigade, you can and should provide the following assistance:

1. Stop the effect of carbon monoxide on the body of the victim. For this person to be brought to Fresh air, shut off the source of carbon monoxide (if possible), put on an oxygen mask or a special gas mask with a hopcalite cartridge on the poisoned person. The latest recommendations apply to those cases where such funds are "at hand".
2. Ensure the passage of oxygen through the respiratory tract. It is highly desirable to lay the victim on his side, after unbuttoning his tie, shirt, belt on his trousers, removing his sweater or jacket, jacket.
3. Bring to consciousness, provide a rush of blood to the brain. This goal can be achieved with ammonia- drop it on a cotton pad and bring it to the victim’s nose at a distance of at least 1 cm. You can rub your chest, and if you have mustard plasters “at hand”, put them on your back or chest (only outside the anatomical location of the heart). Give the victim to drink hot tea or coffee, if there is such an opportunity and the poisoned person has already regained consciousness.
4. If necessary, then you need to make the victim indirect massage hearts and artificial respiration. In this case, the cycle must be defined: 2 breaths and 30 chest compressions.
5. The victim should not waste his energy, he needs to provide peace. To do this, it is enough to lay the poisoned person on their side, cover them with a blanket or wrap them in a jacket / coat. Be sure to ensure that the victim does not overheat.

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Carbon monoxide poisoning (carbon dioxide poisoning) is acute pathology, which develops when toxic carbon monoxide enters the body. Without prompt, qualified first aid and quality medical treatment of carbon monoxide poisoning in the presence of primary symptoms, this problem often leads to death.

How exactly does carbon monoxide affect the body? What are the first symptoms of poisoning? What first aid can be given to the victim? You will read about this and much more in our article.

How does carbon monoxide affect the body?

Carbon monoxide is a special form of carbon monoxide and is most often formed during the incomplete combustion of various substances containing classical carbon. AT modern conditions, the vast majority of it is formed during the exhaust gases of cars with an engine internal combustion, however, there are also household and natural springs CO production.

Carbon monoxide itself, odorless and colorless, has good penetrating power, it easily seeps through the soil, partitions and even thin walls, while it is not absorbed by most simple porous materials, which makes the use of standard gas masks based on an atmospheric air filtration system ineffective (with the exception of complexes with the possibility of installing a hopcalite cartridge).

The main danger of CO for the body lies in the triple pathological effect of carbon monoxide on a number of systemically important processes:

• Blocking the delivery of oxygen to tissues and organs. CO actively interacts with blood hemoglobin, forming carboxyhemoglobin compounds, as a result of which erythrocyte masses partially or completely cease to carry oxygen to organs and tissues, which provokes almost instantaneous hypoxia;
• Violation of the heart muscle. CO binds to myoglobin, which leads to a deterioration in the work of the heart with characteristic manifestations - a weakening of the pulse, the appearance of shortness of breath and arrhythmia;
• Formation of muscle weakness. Carbon monoxide pathologically affects protein structures smooth muscle, which leads to their weakness, sometimes partial or even complete paralysis of the skeletal muscles.

Early signs of carbon monoxide poisoning

As modern medical statistics show, a person usually gets CO poisoning during prolonged inhalation of vehicle exhaust gases, especially in enclosed spaces, as well as in everyday life against the background of improper operation of heating devices operating on the principles of combustion, due to leakage of household gas, and so on.

A significant proportion of cases are associated with fires in enclosed spaces., transport wagons, airplanes, and so on, when a person dies not from thermal exposure as such, but due to very rapid CO poisoning with loss of consciousness and the lack of the possibility of self-evacuation.

The primary symptoms of carbon monoxide poisoning directly depend on its concentration in the air, as well as the duration of exposure to CO on the body.

As the concentration of carbon monoxide in the blood increases, the following manifestations are noted:

• Decrease in the speed of psychomotor reactions;
• Performance degradation– both physical and mental;
• Dyspnea;
• Headache, increasing in intensity depending on the concentration of CO in the blood;
• Nausea, weakness, vomiting;
• Confusion and impaired coordination of small movements;
• The formation of hallucinations, fainting or fainting, weakening of the pulse.

The above primary symptoms characteristic of light and moderate degrees of poisoning. At severe forms pathology, the indicated symptoms can be combined and changed almost at lightning speed.

The main symptoms of poisoning

The main symptomatic complex of carbon monoxide intoxication includes a wide variety of negative manifestations.

Mild and moderate degree of intoxication

Mild and moderate forms of pathology (with a carboxyhemoglobin content in the blood from 20 to 50 percent), depending on the location of the lesion. Symptoms of mild to moderate carbon monoxide poisoning include:

• From the side of the central nervous system. A headache of a girdle character, at first mild, and later - of moderate strength and intensity. There may also be tinnitus, a decrease in the quality of vision and hearing, nausea with vomiting, impaired coordination of movement, blurred consciousness and its short-term loss. The above manifestations are almost always primary, since it is the central nervous system that first suffers from intoxication;
• . Increased heart rate, up to 90 beats per minute. Pain and pressure in the region of the heart, arrhythmia. These symptoms are formed by feedback with intensive work of the heart, trying to clear the bloodstream from carboxyhemoglobin and improve oxygen delivery to all body systems;
• . Mostly shortness of breath and rapid breathing. With a mild and moderate degree of poisoning, compensation mechanisms still operate as a back response of the body to a progressive lack of oxygen. This is the main symptom of such poisoning;
• From the skin and mucous membranes. Their redness is observed, which is the result of increased blood flow velocity.

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Severe degree of intoxication

As a rule, the lack of fast and correct in severe forms of carbon monoxide poisoning is fatal.

Symptoms of severe carbon monoxide poisoning:

• From the side of the central nervous system. Long term loss consciousness, convulsions, uncontrolled defecation and urination, coma. Formed at deep lesions nervous structures;
• From the side of the cardiovascular system. Increased heart rate, up to 130 beats per minute, while it is weakly palpable. severe arrhythmia against the background of a significant increase in the risk of myocardial infarction (with a complete stop of oxygen delivery to the heart muscle);
• From the respiratory system. Irregular and shallow breathing caused by systemic lesion the center of regulation of this function in the brain against the background of the development of generalized decompensation processes;
• From the skin and mucous membranes. blanching of these structures due to deep violation oxygen supply to peripheral systems.

Symptoms in atypical forms of poisoning

In some cases, carbon monoxide poisoning is diagnosed atypical symptoms with a special development mechanism:

Complications and consequences

In addition to pathological symptoms directly in the process of poisoning, the victim may develop various complications of the post-reactive period, even with the timely and complete provision of both first pre-medical and subsequent inpatient and resuscitation care.

Short term

Most of the consequences described below are formed 1-2 days after carbon dioxide poisoning:

• CNS. Lesions of the nervous periphery with limitation of motor activity and sensitivity, permanent pain syndrome in the head area, cerebral edema, malfunctions of the gastrointestinal tract and urinary system, the development of new and progression of chronic mental illness, impaired vision and hearing;
• Respiratory system. Pulmonary edema;
• The cardiovascular system. Violation of the coronary circulation and rhythm of the heart;

Medium term

Most of the consequences described below are formed 2-30 days after carbon monoxide poisoning:

• CNS, paralysis, various choreas. Systemic psychoses with memory loss, alternating with bouts of apathy, are also diagnosed. Less often - blindness and parkinsonism;
• Respiratory system. secondary pneumonia bacterial type, obstructive bronchitis;
• The cardiovascular system. Myocarditis, angina pectoris, myocardial infarction, cardiac asthma.

First aid

Timely and qualified provision of first aid in the vast majority of cases of carbon monoxide poisoning saves the life of the victim and significantly reduces the risk of developing numerous complications in the post-reactive period of the pathology.

The basic algorithm of first aid actions:

Carbon monoxide poisoning

Carbon monoxide poisoning- an acute pathological condition that develops as a result of the ingress of carbon monoxide into the human body, is dangerous to life and health, and without qualified medical assistance can lead to death.

Carbon monoxide enters the atmosphere during any type of combustion. In cities, mainly in the composition of exhaust gases from internal combustion engines. Carbon monoxide actively binds to hemoglobin, forming carboxyhemoglobin, and blocks the transfer of oxygen to tissue cells, which leads to hemic-type hypoxia. Carbon monoxide is also involved in oxidative reactions, disrupting the biochemical balance in tissues.

Poisoning is possible:

during fires;

in production, where carbon monoxide is used to synthesize a number of organic substances (acetone, methyl alcohol, phenols, etc.);

in garages with poor ventilation, in other unventilated or poorly ventilated rooms, tunnels, as the car exhaust contains up to 1-3% CO according to the standards and over 10% with poor adjustment of the carburetor engine;

when you stay on a busy road or near it for a long time. On major highways, the average concentration of CO exceeds the poisoning threshold;

at home in case of leakage of lighting gas and in case of untimely closed stove dampers in rooms with stove heating (houses, baths);

when using low-quality air in breathing apparatus.

General information

Carbon monoxide poisoning ranks fourth in the list of the most frequently observed poisonings (after alcohol, drug and drug poisoning). Carbon monoxide, or carbon monoxide (CO), is found wherever conditions exist for the incomplete combustion of carbon-containing substances. CO is a colorless gas that has no taste, its smell is very weak, almost imperceptible. Burns with a bluish flame. A mixture of 2 volumes of CO and 1 volume of O2 explodes on ignition. CO does not react with water, acids and alkalis. Carbon monoxide is colorless and odorless, so carbon monoxide poisoning most often goes unnoticed. The mechanism of action of carbon monoxide on a person is that when it enters the blood, it binds hemoglobin cells. Then hemoglobin loses its ability to carry oxygen. And the longer a person breathes carbon monoxide, the less efficient hemoglobin remains in his blood, and the less oxygen the body receives. A person begins to suffocate, a headache appears, consciousness is confused. And if you do not go out into the fresh air in time (or do not take out the already unconscious person into the fresh air), then a lethal outcome is not ruled out. In case of carbon monoxide poisoning, sufficient for a long time so that hemoglobin cells can completely clear themselves of carbon monoxide. The higher the concentration of carbon monoxide in the air, the faster the life-threatening concentration of carboxyhemoglobin in the blood is created. For example, if the concentration of carbon monoxide in the air is 0.02-0.03%, then for 5-6 hours of inhalation of such air, a concentration of carboxyhemoglobin of 25-30% will be created, if the concentration of CO in the air is 0.3-0.5% , then the lethal content of carboxyhemoglobin at the level of 65-75% will be reached after 20-30 minutes of a person's stay in such an environment. Carbon monoxide poisoning can appear abruptly or slowly, depending on the concentration. At very high concentrations, poisoning occurs quickly, characterized by rapid loss of consciousness, convulsions and respiratory arrest. In the blood taken from the region of the left ventricle of the heart or from the aorta, a high concentration of carboxyhemoglobin is found - up to 80%. With a low concentration of carbon monoxide, symptoms develop gradually: muscle weakness appears; dizziness; noise in ears; nausea; vomit; drowsiness; sometimes, on the contrary, short-term increased mobility; then a disorder of coordination of movements; rave; hallucinations; loss of consciousness; convulsions; coma and death from paralysis of the respiratory center. The heart may still beat for some time after breathing has stopped. There have been cases of people dying from the consequences of poisoning even 2-3 weeks after the poisoning event.

Acute effects of carbon monoxide poisoning relative to ambient concentration in parts per million (concentration, ppm): 35 ppm (0.0035%) - headache and dizziness within six to eight hours of continuous exposure 100 ppm (0.01%) - minor headache after two to three hours of exposure 200 ppm (0.02%) - minor headache after two to three hours of exposure, loss of crit 400 ppm (0.04%) - frontal headache after one to two hours of exposure 800 ppm (0.08%) - dizziness, nausea and convulsions after 45 minutes of exposure; loss of senses after 2 hours 1600 ppm (0.16%) - headache, tachycardia, dizziness, nausea after 20 minutes of exposure; death in less than 2 hours 3200 ppm (0.32%) - headache, dizziness, nausea after 5-10 minutes of exposure; death after 30 minutes 6400 ppm (0.64%) - headache, dizziness after 1-2 minutes of exposure; convulsions, respiratory arrest and death in 20 minutes 12800 ppm (1.28%) - unconscious after 2-3 breaths, death in less than three minutes

Concentration 0.1 ppm natural level atmosphere (MOPITT) 0.5 - 5 ppm - average level in houses 5 - 15 ppm - next to a properly adjusted gas stove in a house 100 - 200 ppm - from exhaust gases from cars in the central square of Mexico City 5000 ppm - in smoke from a wood stove 7000 ppm - in warm exhaust gases of cars without a catalyst

The diagnosis of poisoning is confirmed by measuring the level of carbon monoxide in the blood. This can be determined by measuring the amount of carboxyhemoglobin compared to the amount of hemoglobin in the blood. The ratio of carboxyhemoglobin in the hemoglobin molecule can be up to 5% on average, in smokers who smoke two packs a day, levels up to 9% are possible. Intoxication appears when the ratio of carboxyhemoglobin to hemoglobin is above 25%, and the risk of mortality at a level of more than 70%.

Symptoms:

For mild poisoning:

headache appears

knocking in the temples,

dizziness,

chest pain,

dry cough,

lacrimation,

• possible visual and auditory hallucinations,

  redness of the skin, carmine-red color of the mucous membranes,

  tachycardia,

  increase in blood pressure.

for moderate poisoning:

drowsiness,

possible motor paralysis with preserved consciousness

for severe poisoning:

loss of consciousness, coma

convulsions,

involuntary discharge of urine and feces,

respiratory failure that becomes continuous, sometimes of the Cheyne-Stokes type,

dilated pupils with a weakened reaction to light,

sharp cyanosis (blue) of the mucous membranes and skin of the face. Death usually occurs at the scene as a result of respiratory arrest and a drop in cardiac activity.

Help with carbon monoxide poisoning

The first symptoms of poisoning can develop after 2 - 6 hours of exposure to an atmosphere containing 0.22-0.23 mg CO2 per 1 liter of air; severe poisoning with loss of consciousness and death can develop in 20 - 30 minutes at a CO concentration of 3.4 - 5.7 mg / l and after 1-3 minutes at a poison concentration of 14 mg / l. The first symptoms of poisoning are headache, heaviness in the head, tinnitus, nausea, dizziness and palpitations. With further stay in the room, the air of which is saturated with carbon monoxide, the victim begins to vomit, increases general weakness, severe drowsiness and shortness of breath appear. The skin turns pale. If a person continues to inhale carbon monoxide, his breathing becomes shallow, convulsions occur. Death occurs from respiratory arrest due to paralysis of the respiratory center.

First aid for carbon monoxide poisoning

First of all, it is necessary to take the victim to fresh air (in warm time year to the street, in the cold - to a ventilated room, to the stairwell). The person is laid on his back and tight tight clothing is removed; The whole body of the victim is rubbed with vigorous movements; A cold compress is placed on the head and chest; If the victim is conscious, it is recommended to give him warm tea to drink; If a person is unconscious, you need to bring a cotton swab moistened with ammonia to his nose; In the absence of breathing, it is necessary to start artificial ventilation of the lungs and immediately call an ambulance. To prevent poisoning, it is recommended to take precautions at work, install a well-functioning ventilation system in garages, and close the damper in houses with a stove only after there are no blue lights left in the ashes.

Treatment of carbon monoxide poisoning

CO poisoning requires prompt removal of the poison from the body and specific therapy. The victim is taken out to fresh air, and upon arrival, medical workers are inhaled with humidified oxygen (in an ambulance using KI-Z-M, AN-8 devices). In the first hours, pure oxygen is used for inhalation, then they switch to inhalation of a mixture of air and 40-50% oxygen. In specialized hospitals, oxygen inhalation is used at a pressure of 1-2 atm in a pressure chamber (hyperbaric oxygenation). In case of respiratory disorders, before inhalation of oxygen, it is necessary to restore the patency of the respiratory tract (toilet of the oral cavity, the introduction of an air duct), to carry out artificial respiration up to tracheal intubation and artificial ventilation of the lungs. In case of hemodynamic disorders (hypotension, collapse), most often resulting from damage to the central nervous system, in addition to intravenous (bolus) analeptics (2 ml of cordiamine, 2 ml of 5% ephedrine solution), rheopolyglucin (400 ml) should be administered intravenously in combination with prednisolone (60-90 mg) or hydrocortisone (125-250 mg). Much attention in case of CO poisoning must be paid to the prevention and treatment of cerebral edema, since the severity condition of patients, especially with a prolonged disorder of consciousness, is determined cerebral edema developed due to hypoxia. On the prehospital stage patients are injected intravenously with 20-30 ml of 40% glucose solution with 5 ml of 5% solution ascorbic acid, 10 ml of a 2.4% solution of aminophylline, 40 mg of lasix (furosemide), intramuscularly - 10 ml of a 25% solution of magnesium sulfate. It is very important to eliminate acidosis, for which, in addition to measures to restore and maintain adequate breathing, it is necessary to inject 4% sodium bicarbonate solution intravenously (at least 600 ml). In a hospital with severe symptoms of cerebral edema (stiff neck, convulsions, hyperthermia), a neuropathologist conducts repeated lumbar punctures, craniocerebral hypothermia is necessary, in the absence of a special apparatus - ice on the head. In order to improve metabolic processes in the central nervous system patients, especially those with severe poisoning, are prescribed vitamins, especially ascorbic acid (5-10 ml of a 5% solution intravenously 2-3 times a day), vitamins B1, (3-5 ml of a 6% solution intravenously), B6 ​​(according to 3-5 ml of 5% solution 2-3 times a day intravenously). For the prevention and treatment of pneumonia, antibiotics, sulfonamides should be administered. Severe patients with CO poisoning need careful care; toilet needed body skin, especially back and sacrum, change of position of the body (turns to the side), heavy percussion chest(striking with the side surface of the palm), vibromassage, ultraviolet irradiation chest with erythemal doses (by segments). In some cases, CO poisoning can be combined with other serious conditions, which significantly complicate the course of intoxication and often have a decisive influence on the outcome of the disease. Most often, this is a burn of the respiratory tract that occurs when inhaling hot air, smoke during a fire. As a rule, in these cases, the severity of the condition of patients is due not so much to carbon monoxide poisoning (which can be mild or moderate), but to a burn of the respiratory tract. The latter is dangerous because in the acute period an acute respiratory failure due to prolonged, intractable laryngobronchospasm, and severe pneumonia develops on the next day. The patient is concerned about dry cough, sore throat, suffocation. Objectively noted shortness of breath (as in an attack of bronchial asthma), dry rales in the lungs, cyanosis of the lips, face, anxiety. In the event of toxic pulmonary edema, pneumonia, the condition of patients worsens even more, shortness of breath increases, breathing is frequent, up to 40-50 per minute, there is an abundance of dry and moist rales of various sizes in the lungs. Mortality in this group of patients is high. Treatment is mainly symptomatic: intravenous administration of bronchodilators (10 ml of a 2.4% solution of aminophylline with 10 ml of saline, 1 ml of a 5% solution of ephedrine, 60-90 mg of prednisolone 3-4 times or 250 mg of hydrocortisone 1 time per day, according to 1 ml of 5% solution of ascorbic acid 3 times a day). Of great importance is local therapy in the form of oil inhalations (olive, apricot oil), inhalations of antibiotics (penicillin 500 thousand units in 10 ml of saline), vitamins (1 - 2 ml of 5% ascorbic acid solution with 10 ml of saline); with severe laryngobronchospasm - 10 ml of a 2.4% solution of eufillin, 1 ml of a 5% solution of ephedrine, 125 mg of hydrocortisone in 10 ml physiological saline. At strong cough use codeine with soda (1 tablet 3 times a day). The second severe complication of CO intoxication is positional injury (compression syndrome), which develops when the victim lies unconscious (or sits) in one position for a long time, touching parts of the body (most often with limbs) of a hard surface (corner of the bed, floor) or crushing the limb with the weight of his own body. In areas subjected to compression, unfavorable conditions for blood and lymph circulation are created. At the same time, the nutrition of muscle and nervous tissue, skin, which leads to their death. The victim develops foci skin redness, sometimes with the formation of blisters filled with liquid (like burns), compaction of soft tissues, which are further aggravated by developing edema. The affected areas become sharply painful, enlarged, dense (up to stone density). As a result of the breakdown of muscle tissue, myoglobin (a protein that is part of muscle tissue) enters the bloodstream, if the injury zone is extensive, a large amount of myoglobin affects the kidneys: myoglobinuric nephrosis develops. Thus, the patient develops the so-called myorenal syndrome, which is characterized by a combination of trauma by position with renal failure. Treatment of patients with myorenal syndrome is long and is carried out in specialized hospitals, as it requires the use of various special methods(hemodialysis, lymphatic drainage, etc.). In the presence of severe pain you can enter painkillers - 1 ml of a 2% solution of promedol and 2 ml of a 50% solution of analgin subcutaneously or intravenously.

Carbon monoxide analysis

To diagnose acute carbon monoxide poisoning, the content of either carboxyhemoglobin (HbCO) in the blood or carbon monoxide CO in the exhaled air should be immediately determined.

Qualitative Definition

For analysis use whole blood treated with heparin or other stabilizer that prevents it from clotting. Approximately three times the volume of 1% tannin solution is added to diluted samples (1: 4) of the studied and normal blood. Normal blood acquires a gray color, and blood containing carboxyhemoglobin does not change. A similar test is carried out with the addition of formalin. Wherein normal blood takes on a dirty brown color, and the test blood containing carboxyhemoglobin retains its color for several weeks. In the absence of these reagents in the laboratory, a 30% sodium hydroxide solution can be used, which is added to blood samples diluted 1: 100 with water. Blood that does not contain carboxyhemoglobin acquires a green-black color. In the presence of carboxyhemoglobin, pink color blood. Carboxyhemoglobin can be detected in the blood using a microdiffusion method based on the reaction with palladium chloride and spectrophotometrically.

quantitation

The quantitative determination of carboxyhemoglobin (Hb CO) in the blood is based on the fact that both oxyhemoglobin (Hb O 2) and methemoglobin can be reduced by sodium dithionite, and Hb CO does not interact with this reagent. For the determination, an aqueous solution of ammonia (1 ml/l) is required; solid sodium dithionite Na 2 S 2 O 4 2H 2 O (stored in a desiccator); cylinder with pure gaseous CO or a mixture of CO and nitrogen; cylinder with gaseous oxygen or compressed air. It is possible to obtain CO by the interaction of concentrated sulfuric and formic acids. For determination, 0.2 ml of blood is added to 25 ml of ammonia solution and mixed thoroughly. The sample is divided into 3 approximately equal portions A, B and C. Portion A is stored in a stoppered tube. A portion of blood B is saturated with carbon monoxide until oxygen is completely replaced by CO (i.e., to obtain 100% Hb CO), blowing gas through the solution for 5–10 minutes. Portion C is saturated with oxygen by blowing pure oxygen or compressed air through the solution for 10 min to completely replace CO with oxygen (0% HbCO). To each solution (A, B, C) add a small amount (about 20 mg) of Na 2 S 2 O 4 2H 2 O and 10 ml of ammonia solution and mix. Remove the spectrum in the visible region or measure the absorption at 540 and 579 nm. As a reference solution, a solution of sodium dithionite in an aqueous solution of ammonia is used. The percentage of saturation with carboxyhemoglobin can be calculated using the following formula: HbCO (%) \u003d ( (A 540 / A 579 solution A) - (A 540 / A 579 solution C) * 100%) / ( (A 540 / A 579 solution B) - (A 540 / A 579 solution C)), taking into account that (A 540 / A 579 solution B) = 1.5, which corresponds to 100% HbCO, (A 540 / A 579 solution C) = 1.1, which corresponds to 0% HCO. The measurements are carried out in the region of maximum difference between the absorption of Hb CO [λ max (Hb*CO) =540 nm] and the point of equal absorption of Hb CO and Hb O 2 (579 nm, isosbestic point). The presence on the spectrum of solution A of two almost symmetrical peaks ("rabbit ears") - feature carbon monoxide poisoning. Conclusion

More than 140 substances can be found in polymer combustion products, that is, people are poisoned by the combined effect of many volatile poisons. The multifactorial influence during fires complicates the forensic chemical examination of the blood of the dead. In most cases, the blood test is limited to the detection of carbon monoxide. In the vast majority of cases, poisoning occurs through the fault of the victims themselves: improper operation of heating stoves, gas water heaters, smoking in bed (especially when drunk), leading to a fire; keeping matches in places accessible to children; a long stay in a closed garage where the car is with a running engine, a long rest (sleep) in a car with the heater and engine turned on, even if the car is outdoors. It is especially important to conduct conversations and lectures with the population on the prevention of carbon monoxide poisoning in the autumn-winter season. In conclusion, it should be said that, despite significant advances in the study of the problems of the mechanism of action of poisons, the biochemical mechanism of action of all toxic substances is far from fully disclosed. Many complex issues of the interaction of various chemical agents with various enzymes have not yet been resolved.