Symptoms of chemical poisoning. Chemical poisoning. Possible consequences of poisoning

Intoxication

Chemical poisoning is a complex of negative effects caused by the penetration of toxins into the gastrointestinal tract, as well as the respiratory organs.

It is also due to their contact with the surface of the skin, eyes, and mucous membranes.

Sources

Speaking about what chemical poisoning is, you need to go beyond the usual concepts of the sources that cause them and expand the list.

On the one hand, the sources of such intoxication can be means used both in everyday life and in industries:

On the other hand, they can be food products that contain poisons and toxic agents of various origins. Among them are poisonous mushrooms, plants, as well as animals, alcohol and surrogate drinks.

Manifestations of toxemia

Signs of poisoning largely depend on the amount and type of poisonous substance that has penetrated inside, as well as individual features the victim himself and the ways in which the toxic substance enters the body.

Thus, some toxins with a low degree of danger provoke disturbances, acting for a long period or re-entering the body in excessive quantities.

Others are so toxic that if one or two drops get only on the surface of the skin or mucous membranes, they can lead to serious complications.

It happens that normally non-toxic substances are poisonous for a group of people with a certain gene set.

Some poisons take effect after a few seconds, others - minutes, hours and even days.

And there are such toxic elements that do not provoke visible signs, until an irreversible violation of the activity of vital organs, especially the kidneys and liver, develops.

Basic features

Some of the symptomatic signs of chemical poisoning are similar.

So, with intoxication with chemically hazardous substances that have entered the body orally, the following symptoms occur:

• nausea;
• profuse vomiting and diarrhea (sometimes with blood masses caused by internal bleeding);
• stomach pain;
• fever;
• decrease in blood pressure;
• stagnation of blood masses in the lungs.

The cause of chemical poisoning may have been inhalation of fumes. In this case, the signs will be as follows:

With toxemia in pairs, burn foci on the mucous membrane of the respiratory organs are possible.

If intoxication occurred from contact with the skin of a poisonous liquid, then visible manifestations most often will be:

• skin hyperemia;
• local burn blisters;
• pain syndromes;
• interruptions in breathing and heart rate;
• dyspnea.

Characteristic features

In some cases, with toxemia from household chemicals, drugs, or drugs used in the workplace, characteristic clinical symptoms may develop that are sufficient for more solid and accurate assumptions about the chemical agent.

Among them:

• cyanide smell;
• staining of visible mucous membranes and skin in a cherry hue (in the presence of carboxyhemoglobin);
• constriction of the pupils;
• excessive activity of the gastrointestinal tract (with toxemia with insecticides, including cholinesterase inhibitors);
• lead border and complete paralysis or paresis of the extensor muscles (with chronic intoxication lead).

However, the listed signs of chemical poisoning are not always observed, and most often are an exception.

In the analysis of all fluids of the human body, there is a guarantee of the correct identification of the chemical agent that caused intoxication.

Relief measures

It is important for everyone to know what to do in case of chemical poisoning so that the circumstances that caused it are not taken by surprise. Help in case of poisoning with chemicals should begin to be provided even before the arrival of the medical team.

Pre-medical actions

Milk is a universal remedy for chemical poisoning

First aid for poisoning with chemically hazardous substances consists of the following steps:

• cleansing the stomach by taking a large amount of plain or salt water (3-5 glasses);
• provoking a gag reflex to almost pure waters;
• taking a small amount of milk or starch decoction, infusion of flaxseed;
• bowel cleansing by taking laxatives or enemas;
• with an increase in symptoms, when the likelihood of toxins entering the bloodstream is high, the intake of diaphoretic and diuretic drugs.

However, when first aid is provided for chemical poisoning, it should be understood that various toxic components require individual specific techniques and approaches to therapeutic measures.

Thus, acidic toxemia does not allow the use of lime or soda solutions that provide a softening and neutralizing effect.

It is impossible to wash for the reason that there is a risk of re-damage of the mucous membrane of the esophageal tract and oral cavity with poisons. It will cause internal bleeding pain shock and a quick death.

It is also forbidden to take laxatives used in other cases. This is due to the risk of even greater damage to the walls of the stomach, which received acid burns.

Means such as milk, decoctions, including gluten, as well as astringent components, jelly, are considered universal.

In case of intoxications belonging to a separate category, such as gas, gasoline vapors, etc., it is recommended to remove all clothing that is saturated with a toxic substance, rinse the respiratory tract with soda solution.

In case of exposure to gases, flush the respiratory tract

As an adsorbent, the intake of activated carbon is justified (1 tablet for every 10 kilograms of the patient's weight). This will prevent further penetration of toxins into the bloodstream, where they very quickly enter from the respiratory organs.

If poison gets on the skin, rinse them under running water for 15-20 minutes. This measure is necessary to prevent the penetration of the substance into the bloodstream.

professional methods

If chemical poisoning has occurred, the symptoms are not always sufficient to determine correct therapy. In such a situation, you need to know what basic principles and methods of managing these patients, details and direction of therapeutic measures for distinctive toxemias. The treatment course includes procedures such as:

• prevention of further absorption of toxins;
• removal of already adsorbed poisons;
• symptomatic treatment aimed at restoring blood circulation, liver and kidney function, respiratory activity, neurological failures;
• administration of antidotes.

The first 3 methods are justified in most cases of intoxication. The fourth is when determining the toxin agent and the presence of an antidote.

However, it is not superfluous to mention that there are no systemic antidotes for most toxic substances. And in order to carry out the necessary maintenance treatment, the procedure for determining the toxic agent is not mandatory. Therefore, attempts to search for it should not become an obstacle to conducting basic medical measures.

Among the procedures of symptomatic therapy, the following should be noted:

• connecting the patient to oxygen;
• washing the gastrointestinal tract through a flexible probe;
• intubation (at risk of suffocation), artificial respiration;
• introduction by drip of drugs that restore the work of the CCC and DS;
• introduction of antidotes.

In order to identify the affected systems and internal organs, it becomes necessary to make a detailed examination of the patient. To do this, they prescribe KLA, OAM, LHC, ECG, X-ray of the lungs, a blood test for toxins, ultrasound of internal organs.

If necessary, hemodialysis is carried out.

Complications

If one of you happened to be poisoned by such substances, and help was not provided immediately, as soon as the manifestation of the initial stage of intoxication was observed, then the symptoms develop into serious complications.

The consequences are expressed:

ethnoscience

There are many methods for removing toxins that traditional medicine offers. For example.

Chemical poisoning develops with direct contact of the skin and mucous membranes with toxic substances, with the ingestion of toxic compounds through the digestive and respiratory systems. Medicines, pesticides and drugs can cause intoxication of the body. household chemicals with careless handling. If symptoms of chemical poisoning appear, the victim is required to provide first aid in order to avoid severe consequences and lethal outcome.

Reasons for the development of chemical poisoning

Chemical poisoning develops in the human body due to the ingestion of harmful toxins:

Abuse medicines or pesticides when irrigating vegetation leads to a chronic form of intoxication. Toxic components gradually accumulate in the body, poisoning the cells as the concentration of toxins increases.

General symptoms and manifestations

Regardless of the route of penetration of toxins, chemical poisoning has the same clinical manifestations:

• nausea, vomiting;
• pain in abdominal cavity;
• shortness of breath, pulmonary edema;
• unnatural expansion and contraction of the pupils, muscle spasms, convulsions;
• dizziness, headache, increased sweating;
• pallor of the skin;
• toxic shock;
• allergic reactions up to the development of anaphylactic shock;
• disturbance of consciousness;
• incorrect work of the cardiovascular system (arrhythmia, myocardial infarction).

Symptoms of chemical poisoning depend in part on the absorption of the poisonous substance and the individual characteristics of the person.

First aid and treatment

If symptoms of chemical poisoning are detected, emergency care is required. The first action is a call to the ambulance brigade. Without the professional skills of medical personnel, toxins can damage organs up to and including death. Before the arrival of the ambulance, it is recommended to carry out pre-medical measures:

1. Limit or stop the flow of poisons into the body.
2. Use activated charcoal in the ratio of 1 tablet per 10 kg of body weight.
3. If toxic fumes are found, remove from the victim contact lenses and rinse with 2% soda solution.

The medical team needs to accurately describe the actions taken. In a medical facility, doctors administer an antidote that can fight the toxin. A poisonous substance is diagnosed using general blood and urine tests.

Poisoning by mouth

Intoxication when taken orally is characterized by contact with the mucous membranes of the mouth, esophagus, stomach. When administered orally to victims of alkalis, acids, it is strictly forbidden to wash the stomach or provoke vomiting. Repeated exposure to toxins increases damage to the mouth and esophagus. During gastric lavage, the diluted substance increases in volume, causing internal bleeding.

When intoxicating the body through the mouth, it is necessary to act according to a step-by-step algorithm:

1. In case of loss of consciousness, the poisoned person must be placed on a flat surface. The head is turned to one side so that the victim does not choke on vomit. In this position, the tongue will not be able to fall inward, blocking the access of air. If consciousness is present, it is necessary to find out possible cause poisoning.
2. If the poisoning occurred due to the use of drugs, the patient needs to be given a liter of warm water to drink. After draining the container, it is necessary to artificially provoke vomiting by pressing your fingers on the root of the tongue.
3. With an unknown substance, the victim is asked to drink 300-400 ml of water. The liquid will reduce the concentration of poisons, reducing the risk of negative effects on the gastrointestinal tract.

After providing first aid, it is necessary to continue to monitor the patient's condition and wait for the arrival of the ambulance.

Respiratory poisoning

In case of poisoning with vapors of toxic substances, it is required to bring the victim to clean air, and then follow the algorithm:

1. The chest is freed from restrictive clothing so that nothing interferes with free breathing.
2. In the absence of consciousness, it is necessary to put a person in a horizontal position on a hard, even surface. Turn the head of the victim to one side to avoid blockage of the airways and esophagus by vomit.
3. If the poisoned person is conscious, it is recommended to help to take a sitting position.

The patient is asked to drink water.

Skin contact with chemicals

If a toxic component comes into contact with the skin, it is required to rinse the site of intoxication with plenty of low-temperature running water for 15–20 minutes. The skin is cleansed of the remnants of a toxic substance that did not have time to penetrate into the bloodstream by diffusion. Cold water will relieve pain. In case of skin contact, the degree of poisoning and the manifestation of symptoms depend on the level of toxicity of the chemical.

Folk remedies and herbs for the treatment of poisoning

Folk remedies are used as additional measure to remove toxins:

1. Elecampane is recommended by traditional medicine specialists for liver damage. You need to pour 1 tbsp. l. dry mixture 250 ml of boiling water and leave to infuse for 15 minutes.
2. In case of poisoning with strontium, cobalt, they drink a decoction based on reed flowers and sunflower leaves. For 1 tsp. each collection accounts for 800 ml hot water. The liquid is infused for 20 minutes. Take on an empty stomach 4 times a day, 100 ml. Similar action in relation to toxins shows knotweed.
3. Relieve poisoning carbon monoxide a tincture of 100 g of cranberries and 200 g of lingonberries will help. Brewed in 300 ml of boiling water and taken 6 times a day, 50 ml each.

The introduction of an antidote in a medical facility is mandatory.

The use of herbal decoctions is possible only after consultation with your doctor.

Possible Complications

Chemicals increase the risk of severe organ dysfunction and can be fatal. Even during the period of treatment and rehabilitation, complications can occur. The type and form of the negative consequences depend on the amount of poison that got inside, the route of penetration.

After intoxication, they can develop:

1. Internal bleeding due to damage to the gastrointestinal tract.
2. Hemolysis of erythrocytes (decay), leading to the occurrence of anemia and hypoxia (oxygen starvation) of cellular structures.
3. A sharp drop in blood pressure.
4. Arrhythmia, heart failure.
5. Failure of the central nervous system up to coma.
6. Acute condition in renal and hepatic insufficiency. It leads to a violation of the water-salt balance of the body.

Body intoxication chemical compounds can lead to disability. You can not ignore the symptoms of poisoning. The victim must be given first aid and first call the doctors.

Prevention of poisoning

Storage conditions and transport regulations for hazardous chemicals must be observed. When interacting and using with drugs, toxic substances, household chemicals, you must adhere to the safety rules:

1. Keep first aid kits, hazardous products (soda, vinegar, alcoholic beverages), cleaning chemicals out of the reach of children.
2. Do not use toxic substances in places where there is access to fire.
3. Before working in the laboratory and at an industrial enterprise, it is necessary to familiarize yourself with the instructions and safety measures.
4. It is recommended to follow a healthy diet so as not to expose the body to the danger of food poisoning.
5. Medications should be taken in accordance with the recommendations of the attending physician.

Preventive measures must be taken to prevent intoxication with toxic compounds. Safety measures are designed to prevent serious conditions that cannot be recovered, reduce the risk of death.

Poisoning- a set of adverse effects caused by the ingress of a toxic substance into the gastrointestinal tract and respiratory tract or by its contact with the skin, eyes or mucous membranes (polystyrene, vagina, etc.).

What causes chemical poisoning:

Poisons include some drugs, substances used in household, solvents, pesticides and other chemicals.

Symptoms of chemical poisoning:

Symptoms of poisoning depend on the type and amount of poison ingested, and the individual characteristics of the victim. Some poisons with low toxicity cause certain disorders only when long-term exposure or re-ingestion in large quantities. Other substances are so poisonous that even a single drop of such a poison on the skin can lead to dire consequences. The toxicity of a substance in each case also depends on the genetic characteristics of a person. Some normally non-toxic substances are toxic to people with a certain genotype (set of genes).

The dose of the substance causing symptoms poisoning, very much also depends on age. For example, in a small child, the ingestion of more paracetamol is more likely to cause symptoms of poisoning than the same dose in an adult. For an elderly person sedative from the group of benzodiazepines (seduxen, relanium, phenazepam) can be toxic in doses that do not cause any disturbance in a middle-aged person.

Symptoms of poisoning may be mild but unpleasant, such as itching, dry mouth, blurred vision, pain, or may be life-threatening, such as disorientation, coma, irregular heartbeat, difficulty breathing, and marked agitation. Some poisons begin to act after a few seconds, while others take several hours or even days after they enter the body.

There are poisons that do not cause obvious symptoms until there is irreversible damage to the function of vital organs, in particular the liver or kidneys. Thus the symptoms of poisoning are as innumerable as the number of poisons.

Diagnosis of chemical poisoning:

Optimal management of patients with poisoning requires a correct diagnosis. Although the toxic effects of some chemicals are very characteristics, most of the syndromes observed with poisoning may be due to other diseases.

Poisoning is commonly included in the differential diagnosis of coma, seizures, acute psychosis, acute liver or kidney failure, and depression. bone marrow. Although this should be done, the possibility of poisoning can be disregarded when the patient's main manifestations are mild mental or neurological disturbances, abdominal pain, bleeding, fever, hypotension, pulmonary congestion, or skin rash. In addition, the patient may not be aware of the effect of the poison on him, as is the case with chronic, latent poisoning, or after an attempted suicide or abortion, the patient will also not be inclined to agree with such a diagnosis. Physicians should always be aware of the various manifestations of poisoning and maintain a high degree of alertness to them.

In all cases of poisoning, an attempt should be made to identify the toxic agent. It is obvious that without such identification it is impossible to carry out specific therapy with antidotes. In cases of murder, suicide, or criminal abortion, the identification of poison can have legal implications. Where poisoning is the result of industrial exposure or therapeutic error, precise knowledge of the active agents is essential to prevent similar occurrences in the future.

For acute accidental poisoning active substance may be known to the patient. In many other cases, information can be obtained from relatives or acquaintances, by examining containers located at the site of poisoning, or by interviewing the patient's doctor or pharmacist. Often similar actions allow you to install only tradename product, which does not allow you to know its chemical composition. The list of references at the end of this chapter lists a number of books that list the active constituents of substances used in the household, agriculture, patent medicines and poisonous plants. A small reference book of this type should be carried by every doctor in his portfolio. The latest information of this kind can also be obtained from the Centers for the Treatment of Poisoning and from representatives of the manufacturers of these substances. In chronic poisoning, it is often impossible to quickly determine the toxic agent from the anamnesis. The lesser urgency of therapeutic measures in these cases usually allows for the necessary thorough study of the patient's habits and the state of the environment.

Some poisons may cause the development of characteristic clinical signs sufficient to strongly suggest an accurate diagnosis. With a thorough examination of the patient, a characteristic smell of cyanide can be detected; cherry staining of the skin and mucous membranes, revealing the presence of carboxyhemoglobin; pupillary constriction, drooling and hyperactivity of the gastrointestinal tract caused by insecticides containing cholinesterase inhibitors; lead border and paralysis of the extensor muscles, characteristic of chronic lead poisoning. Unfortunately, these typical signs are not always present, and in case of chemical poisoning, their presence is rather an exception.

Chemical analysis of body fluids provides the most correct identification of the substance that caused the poisoning. Some common poisons, such as acetylsalicylic acid (aspirin) and barbiturates, can be detected and even quantified with relatively simple laboratory tests. Detection of other poisons requires more complex toxicological studies, such as high-performance gas or liquid chromatography, which are carried out only in specialized laboratories. In addition, the results of toxicological studies are rarely available in time to decide on initial treatment for acute poisoning. However, samples of vomit, aspirated stomach contents, blood, urine, and feces should be retained for toxicology testing if diagnostic or legal issues arise. Chemical analysis of body fluids or tissues is particularly important in the diagnosis and assessment of severity. chronic poisoning. Ultimately, the results of such an analysis are useful for evaluating the long-term results of some types of therapy.

Treatment for chemical poisoning:

For the correct treatment of a patient with poisoning, it is necessary to know both the basic principles of managing such patients and the details of therapy for specific poisonings. The treatment process includes:

• prevention of further absorption of the poison;
• removal of the absorbed poison from the body;
• symptomatic supportive therapy or symptomatic treatment for circulatory disorders, respiratory disorders, neurological disorders and impaired renal function;
• introduction of systemic antidotes.

The first three steps apply to most types of poisoning. The fourth step is most often used only when the toxic agent is known and a specific antidote is available. Sometimes, however, when a patient is highly suspected of having an opiate overdose, they are given naloxone. It should be recognized that there are no specific antidotes for most poisons, and it is not necessary to know which toxic agent caused the poisoning in order to provide the necessary maintenance therapy. Thus, although the physician should always try to identify the active poison, these attempts should not delay the implementation of vital therapeutic measures. .

Prevention of absorption of ingested poisons. If an appreciable amount of poison has been swallowed, attempts should be made to minimize its absorption from the gastrointestinal tract. The success of such attempts depends on the time elapsed since the poison was ingested and on the site and rate of absorption.

• Evacuation of stomach contents

Always, if there are no specific contraindications, you should try to empty the stomach. These attempts can be very successful if made soon after the poison has been ingested. Significant amounts of poison can still be expelled from the stomach several hours after ingestion, as gastric emptying may be delayed as a result of gastric atony or pylorospasm. This occurs with poisoning with phenothiazines, antihistamines, and tricyclic antidepressants.

After swallowing many poisons, vomiting occurs spontaneously. In a smaller number of cases, it can be induced at home by mechanical stimulation of the back of the throat. Vomiting effect of ipecac syrup (the concentration should not exceed more than 14 times the concentration liquid extract), given in a dose of 15 - 30 ml, is more effective and safe even at home. Its action begins an average of 20 minutes after ingestion and depends partly on absorption in the gastrointestinal tract, so the simultaneous administration of activated charcoal, which is an adsorbent, should be avoided. A second dose of ipecac syrup should be given to the patient if he does not vomit 20 minutes after taking the first dose (after taking two doses, vomiting will develop in 90-95% of patients). If there is no scrap of ipecac syrup, every effort should be made to find it, even if this requires taking the patient to the hospital. Apomorphine administered intramuscularly at a dose of 0.06 mg/kg acts within 5 minutes, but may cause prolonged vomiting. When administered intravenously at a dose of 0.01 mg/kg, apomorphine induces vomiting almost immediately, with no subsequent effect on the central nervous system. Sometimes it is not possible to induce vomiting and valuable time should not be wasted waiting. An attempt to induce vomiting should not be made in victims who are in a convulsive state, in patients with severe depression of the central nervous system, or (due to the risk of perforation of the stomach or esophagus or due to aspiration of vomit into the trachea) in persons who have swallowed a potent caustic chemical or small amounts (less than 100 ml) of liquid hydrocarbons that are strong lung irritants (eg, kerosene, polish).

Compared to vomiting, gastric lavage is more preferable and acts immediately, but usually it does not contribute more effective removal poison from the stomach than vomiting. It can be performed in patients who are unconscious, the evacuation of the contents of the stomach reduces the risk of aspiration of vomit. Its performance, however, is contraindicated after ingestion of strong corrosive substances, because of the danger of perforation of damaged tissues. When performed correctly, gastric lavage carries a small risk of aspiration of stomach contents into the lungs. The patient should lie on his stomach with his head and shoulders down. Using a mouth expander, a gastric tube is introduced into the stomach, the diameter of which is sufficient to pass solid particles (30 gauge). If the functions of the central nervous system are depressed, if the insertion of the probe causes vomiting, or if a substance that is an irritant to the lungs has been swallowed, then it is reasonable to insert a cuffed endotracheal tube into the trachea before performing a gastric lavage. The contents of the stomach are aspirated with a large syringe, and with it most of the poison is removed from the body. After that, 200 ml (in children less) of warm water or liquid solution is injected into the stomach and aspirated until the aspirated liquid becomes clear.

Interference with absorption in the gastrointestinal tract.

Since neither vomiting nor gastric lavage completely empties the stomach, attempts should be made to reduce absorption by administering substances that bind poisons that have entered the body. Many poisons are adsorbed by powdered activated carbon. High quality activated carbon can adsorb 50% by weight of many common poisons. Liquid activated charcoal (20-50 g in 100 * 200 ml) should be administered after gastric emptying.

Adsorption by activated carbon is a reversible process and the efficiency of adsorption of many poisons varies depending on the pH value. Acidic substances are adsorbed better by acid solutions and therefore can be released into small intestine. It is desirable that activated charcoal with adsorbed poison pass through the intestine as quickly as possible. This will also reduce intestinal absorption of any unadsorbed poison that has passed through the pylorus. In patients with good renal and cardiac function, this is best achieved by oral or intramuscular administration of osmotic laxatives. agents such as magnesia or sodium sulfate (10 - 30 g in a solution with a concentration of 10% or less).

Prevention of absorption of poison from other organs and systems. Most locally applied poisons can be removed from the body by copious washings with water. In certain cases, weak acids or alkalis, or alcohol in combination with soap, are more effective, but rapid and abundant washing with water must be carried out until these solutions are available to doctors. Chemical antidotes dangerous, because the effect of heat generated during chemical reaction may cause tissue damage.

The systemic distribution of injected poisons can be slowed down by applying cold compress or ice or apply a tourniquet proximal to the injection site.

After inhalation of toxic gases, vapors or dusts, remove the victim to clean air and maintain adequate ventilation. The patient cannot move, he should wear a protective mask.

Excretion of absorbed poison from the body. In contrast to preventing or slowing down absorption, measures that speed up the excretion of a toxic agent and the body rarely have a large effect on the peak concentration of the poison in the body. However, they can significantly reduce the time during which the concentration of many poisons remains above a certain level, and thereby reduce the risk of complications and tackle the life of the patient. When assessing the need to perform such measures, it is necessary to take into account the clinical condition of the patient, the properties and pathways of the metabolism of the poison and the amount of absorbed poison according to the anamnesis data and the results of determining its concentration in the blood. The introduction of some poisons can be accelerated various methods; the choice of method depends on the condition of the patient, the amount of poison in the body and the availability of experienced personnel and equipment.

• Bile excretion

Certain organic acids and active drugs are secreted into the bile in the opposite direction of the large concentration gradient. This process takes time and cannot be accelerated. However, intestinal absorption of substances already secreted into bile, such as glutethimide, can be reduced by the administration of activated charcoal every 6 hours. Cholestyramine (16 g per day) significantly accelerates its excretion (half-life from the blood is 80 days).

• Urinary excretion

The acceleration of renal excretion is justified in cases of poisoning much a large number poisons. Renal excretion of toxic substances depends on glomerular filtration, active tubular secretion and passive tubular resorption. The first two of these processes can be protected by maintaining adequate circulation and kidney function, but in practical terms, they cannot be accelerated. On the other hand, passive tubular resorption of many poisons plays an important role in increasing their duration of action and can often be reduced by readily available methods. In case of poisoning with drugs such as drugs salicylic acid and long-acting barbiturates, increased diuresis induced by the administration of large volumes of electrolyte solutions in combination with intravenous furosemide has been demonstrated to increase renal excretion.

Changing the pH of urine can also inhibit the passive reversible diffusion of some poisons and increase their renal clearance. The epithelium of the renal tubules is more permeable to uncharged particles than to ionized solutions. Weak organic acids and bases readily diffuse out of the tubular fluid in their non-ionized form, but are retained in the tubules if they are ionized. Acidic poisons are ionized only at a pH exceeding their pK. Alkalinization of urine sharply increases ionization in the tubular fluid of such organic acids like phenobarbital and salicylate. In contrast, the pKa of pentobarbital (8.1) and secobarbital (8.0) are so high that renal clearance does not increase markedly with an increase in urine pH within the physiological alkaline range. Alkalinization of urine is achieved by infusion of sodium bicarbonate at a rate determined by the pH value of urine and blood. Severe systemic alkalosis or electrolyte disturbances should be avoided. The combination of induced diuresis with alkalinization of the urine can increase the renal clearance of some acid poisons by a factor of 10 or more, and these measures have been found to be very effective in salicylates, phenobarbital, and 2,4-dichlorophenoxyacetic acid poisoning. Conversely, a decrease in pH below its usual values has been shown to increase the clearance of amphetamines, phencyclidines, fenfluramine, and quinine.

In conclusion, it should be noted that the renal excretion of certain poisons can be increased by highly specific methods. An example of this is the elimination of bromide from the body by the administration of chloride and chloruretics. These methods are discussed under the consideration of individual poisons.

• Dialysis and hemosorption

Dialysis has been found to be effective in eliminating many substances from the body, including barbiturates, borate, chlorate, ethanol, glycols, methanol, salicylates, sulfonamides, theophylline, and thiocyanate. Theoretically, it should accelerate the elimination from the body of any dialyzable toxin that is not irreversibly bound to the tissues. Its effectiveness does not extend to large molecules, non-dialysable poisons, and is reduced to a large extent by binding toxic substance with proteins or its solubility in fats.

Peritoneal dialysis can be easily performed in any hospital and can be done for a long time. However, its implementation in order to remove poisons from the body is justified only if the patient has impaired renal function, it is impossible to carry out hemodialysis or hemosorption, or forced diuresis cannot be applied.

Hemodialysis is undeniably more effective in removing large amounts of dialysable poisons from the body. For barbiturates, dialysis rates of 50–100 ml/min have been achieved, while the rate of excretion from the body is 2–10 times higher than with peritoneal dialysis or forced diuresis. With blood perfusion through activated charcoal or ion-exchange resin, even greater clearance rates of most poisons are achieved than with hemodialysis. Obviously, extracorporeal dialysis and hemosorption can be considered as the procedures of choice for rapid elimination poisons from the body of patients who have absorbed such amounts of poison that make their survival unlikely even if the best supportive therapy is provided. Since the necessary equipment and experienced staff for hemodialysis and hemosorption is not available in every hospital, consideration should be given to transferring such patients to a facility with such facilities.

Complex formation and chemical bonding. The excretion of certain poisons from the body is accelerated by chemical interaction. actions with other substances with subsequent excretion through the kidneys. These substances are considered systemic antidotes and are discussed under individual poisons.

supportive therapy. Most chemical poisonings are reversible, self-limiting disease states. Skillful supportive care can save the lives of many severely poisoned patients and keep their detoxifying and excretory mechanisms functioning until the poison concentration is reduced to safe levels. Symptomatic measures are especially important when the active poison belongs to the category of substances for which a specific antidote is unknown. Even when an antidote is available, vital signs should be prevented or controlled with appropriate supportive care.

A patient with poisoning may suffer from various physiological disorders. Most of these are not specific to chemical poisonings and the management of such patients is discussed elsewhere. This section briefly discusses only those aspects of maintenance therapy that are specifically relevant to the treatment of poisoning.

Depression of the central nervous system. Specific Therapy, aimed at combating the inhibitory effect of poisons on the central nervous system, is usually not necessary and difficult. Most patients with poisoning come out of a coma, as from a long anesthesia. During the unconscious period, careful care of the nurse and close observation of the patient are necessary. If the depression of the centers located in the medulla oblongata occurs as a result of circulatory or respiratory disorders, then it is necessary to immediately and vigorously begin measures to maintain these vital functions using chemical means and mechanical procedures. The use of analeptics in the treatment of patients with poison-induced central nervous system depression has been largely abandoned. It is certain that these substances should never be used to awaken consciousness, and it is doubtful that their use to hasten the recovery of spontaneous breathing and active reflexes has ever been justified. In contrast, the drug antagonist naloxone, administered intravenously in adequate doses, usually reverses the central nervous system depression associated with drug overdose.

Seizures. Many poisons (eg, chlorinated hydrocarbons, insecticides, strychnine) cause seizures due to their specific stimulating effect. In patients with poisoning, convulsions may also occur due to hypoxia, hypoglycemia, cerebral edema, or metabolic disorders. In such cases, these violations should be corrected as far as possible. Regardless of the cause of seizures, it is often necessary to use anticonvulsants. Intravenous diazepam, phenobarbital, or phenytoin are usually effective.

Cerebral edema. Raise intracranial pressure, caused by cerebral edema, is also a characteristic sign of the action of some poisons and a non-specific consequence of other chemical poisonings. For example, cerebral edema is observed in case of poisoning with lead, carbon monoxide and methanol. Symptomatic treatment consists of the use of adrenocorticosteroids and, when necessary, intravenous administration of hypertonic solutions of mannitol or urea.

Hypotension. The causes of hypotension and shock in the poisoned patient are numerous and often there are several causes at the same time. Poisons can cause inhibition of vasomotor centers in the medulla, block autonomic ganglia or adrenergic receptors, directly inhibit the tone of smooth muscles of arteries or veins, reduce myocardial contractility or induce the appearance of cardiac arrhythmias. Less specific is when the poisoned patient is in shock due to tissue hypoxia, extensive tissue destruction by corrosives, loss of blood and fluid, or metabolic disorders. If possible, these violations should be corrected. If the central venous pressure is low, then the first therapeutic action should be to replenish the volume of fluid in the body. Vasoactive drugs are often useful and sometimes necessary in the treatment of a poisoned patient who develops hypotension, especially in shock due to central nervous system depression. As with shock from other causes, choosing the most appropriate medicinal product requires analysis of hemodynamic disorders, which is carried out after measuring the value of blood pressure.

cardiac arrhythmias. Violations of the generation of an excitation wave or cardiac conduction in patients with poisoning occur as a result of the action of certain poisons on the electrical properties of the heart fibers or as a result of myocardial hypoxia or metabolic disorders in the myocardium. The latter need to be adjusted, and antiarrhythmic drugs are used according to indications, based on the nature of this arrhythmia.

Pulmonary edema. A patient with poisoning may develop pulmonary edema due to inhibition of myocardial contractility or damage to the alveoli by irritating gases or asphyxiated fluids. last view edema is less treatable and may be accompanied by laryngeal edema. Therapeutic measures include suctioning of exudate, giving high concentrations of oxygen under positive pressure, administration of aerosols of surfactants, bronchodilators, and adrenocorticosteroids.

Hypoxia. Poisoning can cause the development of tissue hypoxia through various mechanisms, and in one patient several of these mechanisms may act simultaneously. Inadequate ventilation may result from central respiratory depression, muscle paralysis or airway obstruction with accumulated secretions, laryngeal edema, or bronchospasm. Alveolar-capillary diffusion may be impaired in pulmonary edema. Anemia, methemoglobinemia, carboxyhemoglobinemia, or shock can impair oxygen transport. Inhibition of cellular oxidation may occur (eg, cyanides, fluoroacetate). For treatment, it is necessary to maintain adequate airway patency. The clinical situation and site of obstruction may indicate frequent suctioning, insertion of an oropharyngeal airway or endotracheal tube, or tracheotomy. If, despite normal airway patency, ventilation remains inadequate, as evidenced by the clinical condition or measurement of minute volume or blood gases, mechanical ventilation by appropriate mechanical means is imperative. In tissue hypoxia, the introduction of high concentrations of oxygen is always indicated. In cases where there is severe depression of the central nervous system, the introduction of oxygen often leads to respiratory arrest and must be accompanied by artificial ventilation.

Acute kidney failure. Renal failure with oliguria or anuria may develop in a patient with poisoning due to shock, dehydration, or electrolyte imbalance. In more specific cases, it may be due to the nephrotoxic effects of certain poisons (eg, mercury, phosphorus, carbon tetrachloride, bromate), many of which are concentrated and excreted by the kidneys. Kidney damage caused by poisons is usually reversible.

Electrolyte and water balance. Electrolyte and water imbalances are common signs of chemical poisoning. They may be due to vomiting, diarrhea, renal failure, or therapeutic measures such as bowel cleansing with laxatives, forced diuresis, or dialysis. These disorders can be corrected or prevented by appropriate therapy. Certain poisons are more specific, causing metabolic acidosis (eg, methanol, phenol, salicylate) or hypocalcemia (eg, fluoride compound, oxalate). These disorders and all types of specific treatment are described in the sections on individual poisons.

Acute liver failure. The primary manifestation of some poisonings (eg, chlorinated hydrocarbons, phosphorus, hipofen, certain fungi) is acute liver failure.

Administration of systemic antidotes. Specific antidote therapy is possible only in case of poisoning with a small number of poisons. Some systemic antidotes are chemicals that exert their therapeutic effect by lowering the concentration of a toxic substance. This is achieved by combining an antidote with a specific poison (eg, ethylenediaminetetraacetate with lead, dimercaprol with mercury, reagents having sulfhydryl groups with a toxic metabolite of acetaminophen) or by increasing the excretion of poisons (eg, choride or mercury diuretics for bromide poisoning). Other systemic antidotes compete with the venom for receptors at their site of action (eg, atropine with muscarine, naloxone with morphine, physostigmine reverses some of the anticholinergic effects of tricyclic antidepressants as well as antihistamines, belladonna and other atropine-like substances). Specific antidotes are discussed in the sections on individual poisons.

For various reasons, poisoning can occur with various chemicals: potent, poisonous, chemically hazardous, toxic and harmful to human health and life.

You need to know certain signs that a person has been poisoned by a poisonous substance. Medical assistance will certainly be provided in the hospital for the injured person, if, of course, we call an ambulance, but even this is not enough to reduce the risk of complications from poisoning.

It is necessary to know and be able to do what to do in the current dangerous situation and how to provide first emergency first aid at home, while the ambulance is on its way to the victim.

First aid: what to do

Ammonia poisoning

Ammonia is a gas with a pungent odor, almost twice as heavy as air. It is used in industry (when installing refrigerators, at sugar factories, at petrochemical and paint and varnish enterprises). It is used in the production of fertilizers and explosives. With water or air moisture forms ammonia. Ammonia enters the body through the respiratory tract or skin. It has an irritating and suffocating effect on the body and disrupts blood clotting. When a person is exposed to large doses of ammonia, death quickly occurs.

Symptoms of poisoning

When ammonia vapor is inhaled, there are signs of irritation of the mucous membranes of the eyes and respiratory tract. Their intensity depends on the concentration of the gas.

Ammonia causes lacrimation, runny nose, frequent sneezing, salivation, flushing of the face, sweating, convulsive cough, chest tightness. Sometimes it can cause laryngospasm and swelling of the vocal folds.

A person exposed to ammonia vapor experiences a feeling of suffocation, anxiety, dizziness, chest pain. Then the vomiting starts. The victim may lose consciousness, he develops convulsions. If exposure to vapors continues, severe muscle weakness sets in, signs of respiratory and circulatory disorders appear. Death occurs with symptoms of cardiovascular insufficiency.

Subsequently, after the cure, various neurological disorders may occur - memory loss, various tics, hearing loss and pain sensitivity, as well as clouding of the lens and cornea. Eventually, the victim may lose their sight.

How to survive?

If a person got into an area poisoned by ammonia, then he should go down to the basement or to the lower floor of the building (ammonia is lighter than air!). You cannot leave the area by running. You should try to walk at a slow pace, covering your mouth and nose with a scarf, gloves or a hat. Leaving the affected area, in no case should you take alcohol or smoke! When providing assistance to victims, you need to wear a protective suit, boots, gloves, gas mask.

First aid

1. Remove the victim from the affected area as soon as possible;
2. oxygen inhalation or fresh air;
3. rinse throat, nose and mouth clean water 10-15 minutes (preferably with the addition of citric or glutamic acid);
4. even if ammonia poisoning was mild, the victim must be provided with complete rest during the day;
5. drip into the eyes of a 0.5% solution of Dikain, close the eyes with a light-protective bandage or wear dark glasses;
6. if poison gets on the skin, rinse the contaminated area with water, apply a clean bandage;
7. if poison enters the stomach, rinse the stomach;
8. hospitalization of all victims is mandatory.

First aid in a hospital setting

1. Remove the victim from the toxic environment and wash the affected skin and mucous membranes of the eyes with plenty of water.
2. Give to drink warm milk with Borjomi or soda.
3. Silence mode.
4. With spasm of the glottis and the phenomenon of laryngeal edema, apply mustard plasters and a warm compress on the neck.
5. Hot foot baths are also effective.
6. Inhalation of vapors of citric or acetic acids, oil inhalation and inhalations with antibiotics.
7. Instill into the eyes every 2 hours a 30% solution of sodium sulfacyl, a 12% solution of Novocain or a 0.5% solution of Dicain. Into the nose - vasoconstrictors(3% solution of Ephedrine).
8. Inside - codeine (0.015 g), Dionine (0.01 g).
9. Intravenously or subcutaneously - Morphine, Atropine, with suffocation - tracheotomy.

Poisoning with these drugs is usually very severe and the prognosis is often poor.

Antifreeze poisoning: ethylene glycol

Symptoms and signs in case of poisoning with antifreeze, the following: the victim feels a slight intoxication, gradually increasing. Euphoria sets in (a feeling of joy, a feeling of freedom and complete happiness), facial hyperemia appears, wobbly gait, fussiness.

After some time, the patient begins to feel pain in the epigastric region. There is nausea, vomiting. After 6-8 hours, the second stage begins - the nervous one. After strong arousal drowsiness sets in, consciousness is darkened. Pupils sluggishly react to light, dilated. Involuntary urination and defecation. Deep noisy breathing. The amount of urine is reduced. In severe cases, this phase can end in the death of the patient. In milder cases of poisoning, consciousness gradually clears up, improves general state.

Treatment almost the same as with alcohol poisoning:

1. gastric lavage and saline laxative,
2. the fight against respiratory disorders and acidosis with a solution of sodium bicarbonate (soda), which is taken orally or injected intravenously.

Specific to given poisoning is the fight against impaired renal function. To do this, assign plentiful drink, osmotic diuretics or furosemide (0.04-0.12 g orally or 23 ml of a 1% solution in a vein or muscle).

When taking diuretics, the loss of water, potassium, sodium and chlorine from the body should be compensated by the concomitant administration of saline plasma-substituting solutions in an amount equal to or slightly greater than diuresis.

To prevent damage to the kidneys by calcium oxalate, it is necessary to prescribe intramuscularly magnesium sulfate, 5 ml of a 25% solution per day.

If there are signs of cerebral edema and meningeal symptoms, a lumbar puncture should be performed.

When ingesting more than 200 ml of poison - hemodialysis on the 1st day after poisoning, peritoneal dialysis. With the development of anuria, the prognosis is extremely unfavorable.

After first aid - hospitalization. In the first days after poisoning - a diet with a sharp restriction on the amount of protein.

Poisoning with belloid, bellaspon, bellataminal

There are three phases of poisoning: the phase of oppression of consciousness, the phase of excitation and the coma phase.

At mild poisoning symptoms such as stunning, dizziness, palpitations, skin flushing, dilated pupils are noted. The patient falls asleep and sleeps for 6-8 hours.

At more severe poisoning the patient develops drowsiness, vomiting appears. He falls asleep after 1-1.5 hours, and the dream is sound. During sleep, there are signs of psychosis with hallucinations and attempts to escape. After 2–3 hours, the patient calms down and sleeps for 10–12 hours. At this time, there are signs such as palpitations (pulse reaches 120 beats per minute), dry mucous membranes, moderate expansion pupils, hyperemia of the skin, slowing of breathing. Blood pressure drops to 80/40.

At severe poisoning a deep stunning of the patient with visual hallucinations is found, the pupils are dilated, the skin is hyperemic. Strongly expressed shortness of breath and tachycardia. Blood pressure drops to very low numbers. Body temperature is elevated. The patient quickly falls into a coma, hyperemia of the skin is replaced by pallor, tachycardia is replaced by bradycardia (rare heartbeats), body temperature rises to 40 ° C, pulmonary edema develops.

Death occurs from respiratory and cardiovascular failure.

First aid

1. As soon as possible and better to wash the stomach;
2. give a saline laxative, cleanse the intestines;
3. fresh air, if possible - inhalation of oxygen;
4. give a tablet of Panangin, if it is available in the medicine cabinet;
5. urgently deliver the victim to a medical facility - remember: delay in providing medical care dangerous to the life of the victim.

Emergency care in the hospital

1. Gastric lavage.
2. Forced diuresis.
3. Hemosorption.
4. When excited - antipsychotics (2.5% solution of chlorpromazine intramuscularly: up to 1 year - 0.15-0.2 ml, at the age of 1-2 years - 0.25 ml, 3-6 years - 0.4 ml, 7-9 years - 0.5 ml, 10-14 years - 0.6 ml 1-2 times).
5. With the development of coma, the tactics are the same as with barbiturate poisoning: breathing correction - oxygen therapy, artificial ventilation of the lungs, means that support cardiac activity (0.0.1% solution of Korglikon - 0.1–0.8 ml, 0.05 % solution of Strofantin - 0.1-0.4 ml).

Berthollet salt poisoning

It is used in medicine: for rinsing (2-5% aqueous solution) for stomatitis, tonsillitis, to prevent the appearance of mercury stomatitis in the treatment with mercury. The use inside, due to the high toxicity, is irrational. Simultaneous ingestion of potassium iodide and prescribing Berthollet salt in powders together with sulfur, coal, organic (tannin, sugar, starch, etc.) substances are contraindicated (during cooking - ignition, explosion).

Main symptoms in case of poisoning with Berthollet salt are: nausea, vomiting, icteric coloration of the skin, pain in the stomach and in the lumbar region, nosebleeds, blood in the urine, increased heart rate, hiccups.

The temperature rises to high numbers.

With severe poisoning - loss of consciousness. Toxic dose- 8-10 g, lethal - 10-30 g.

First aid

1. Cleanse the stomach with plenty of water;
2. put an ice compress on your head, give ice to swallow;
3. if possible, bleed;
4. water cold water along the spine:
5. urgent hospitalization.

First aid in the hospital

1. Give oxygen;
2. infuse intravenously with an alkaline saline solution;
3. inject a significant amount of diuretic solutions;
4. after sufficient dilution of the blood, prescribe a solution of Pilocarpine under the skin to remove the poison with saliva and sweat; in collapse - Camphor.

In case of poisoning with bartolet salt, acidic drinks, alcohol and its preparations are contraindicated.

Nitrogen dioxide or trioxide poisoning

Nitrous gases (nitrogen oxide, dioxide, trioxide) are formed by the interaction of nitric or nitrous acid with metals or organic materials. The lethal dose of nitrous gases is 0.005% when exposed for a minute.

After inhalation of these gases, burns of the upper respiratory tract, swelling of the vocal folds, and pulmonary edema are detected in the victim.

The picture of intoxication is the same as with chlorine poisoning.

First aid

In case of poisoning nitrous oxide or nitrous oxide the victim is taken out to fresh air, allowed to inhale carbogen, inside the heart means, glucose is injected intravenously (20–30 ml of a 40% solution), if necessary, bloodletting.

In case of poisoning nitrogen dioxide - the same measures as in case of nitric oxide poisoning, oxygen therapy, 10% solution of calcium chloride intravenously (5 ml). With the "gray" type of anoxemia, bloodletting is contraindicated.

1. Rinse eyes, nose and mouth with running water;
2. If the patient is tormented by a strong cough, give him a Codeine tablet or any antitussive drug;
3. In case of violation of the heart or lack of breathing - resuscitation (external heart massage, artificial respiration).

At sodium nitrite poisoning gastric lavage, Carbogen, drip injection of a 5% glucose solution, under the skin - an isotonic solution of sodium chloride, tonics (Camphor, Caffeine, Corazole), with a decrease in breathing - Lobelin.

After providing first aid, the victim should be hospitalized.

dichloroethane poisoning

Dichloroethane is widely used as an organic solvent, both in industry and in agriculture. In everyday life, dichloroethane has become widespread as an integral part of adhesives for plastic products.

Dichloroethane poisoning can occur through the gastrointestinal tract, through the respiratory tract and skin.

When poisoning through the mouth, dichloroethane is rapidly absorbed in the stomach, and absorption is accelerated if it is taken against the background of alcohol intoxication.

As a toxic substance, dichloroethane acts on the liver, central nervous system and heart.

In case of poisoning with this substance, its maximum concentration in the blood is observed after 3-4 hours.

Symptoms: patients complain of nausea, vomiting, profuse salivation, pain throughout the abdomen, diarrhea, headache. There is a sharp excitation of the central nervous system. In the final stage, renal and hepatic failure, renal coma, shock.

First aid

1. It is necessary to change the clothes of the victim or undress him, as the poison easily soaks the clothes and its vapors can increase the poisoning. Vapors of a poisonous substance can cause poisoning in those who provide assistance. This must be remembered.
2. Immediately call an ambulance, as a delay in the provision of medical assistance is deadly.
3. If the patient is conscious, flush the stomach with 4–6 liters of warm water. To induce vomiting, it is necessary to give the patient to drink 1-2 liters (as much as possible) of water, or cold tea, or coffee, and then irritate the root of the tongue with a finger. Repeat the procedure 2-3 times.
4. Give a laxative or enveloping substance (jelly, jelly). Vaseline oil (100-150 ml) can be successfully used as a laxative, since it is not absorbed in the intestine and actively binds fat-soluble toxic substances especially dichloroethane. It is possible to reduce the absorption of poison in the stomach with the help of enveloping substances (jelly, jelly).
5. In case of violation of the work of the heart and lungs - methods of resuscitation - indirect massage heart and artificial respiration.
6. Hospitalization required.

Precautionary measures

1. If the victim is unconscious, it is impossible to wash the stomach. It is urgent to call an ambulance.
2. Time is of the essence. The sooner assistance is started, the greater the likelihood of a positive outcome.

Kerosene poisoning

The inhalation of concentrated kerosene vapors and the ingestion of 20-50 g of kerosene lead to poisoning. Kerosene has a toxic effect in case of exposure to a large area of ​​the skin. In this case, the central nervous system may suffer.

Signs of poisoning are: severe weakness, pain all over the abdomen, diarrhea, rare pulse, dilated pupils.

First aid

First of all, you need to call a doctor who has poisoned to place where there is a flow fresh air to ensure good access to oxygen, make artificial respiration.

Treatment

Induce vomiting by any means. Give emetics in large quantities (salted warm water). After the patient vomits, give flaxseed decoction, milk, water with whipped protein, activated charcoal 2-3 tablets every hour, starch, salep for oral administration. Put a heating pad on your stomach and change it as it cools.

To support the cardiovascular system, you need to take Camphor, Cordiamin or Caffeine.

It is strictly forbidden to use adrenaline, emetics and alcoholic beverages.

To quickly restore all body functions, you should spend more time in the fresh air and follow a sparing diet.

With kerosene pneumonia, ACTH is prescribed (forty units every day) and injections of ascorbic acid (a five percent solution, intramuscularly, 10 ml).

Acid poisoning

In everyday life, poisoning with sulfuric and hydrochloric (“soldering”) acid most often occurs.

Then, according to the frequency of burns, hydrochloric, nitric acids and the so-called "royal vodka" - a mixture of hydrochloric and nitric acids follow.

When strong acids are taken orally, the victim quickly develops serious condition due to extensive burns of the mucous membrane of the mouth, pharynx, esophagus, stomach. This condition is aggravated by the fact that the decay products of acids, being absorbed into the blood, poison the body.

Symptoms

The mucous membrane of the lips, mouth, pharynx, posterior pharyngeal wall is burned, edematous, the burn sites are covered with plaque; a scab of various colors depending on the acid that caused the burn (gray-black with a burn with sulfuric acid, yellow with nitric acid, whitish with hydrochloric acid, light gray or brown with acetic acid).

Often there are burns to the skin of the face near the mouth and neck. There is a sharp pain in the burn area.

Swallowing and even the passage of liquid food is difficult (sometimes to complete obstruction). The secretion of saliva is sharply increased. Excruciating vomiting of sour masses mixed with blood is almost always observed. The victim is excited, groans. Severe pain in the stomach. Patients quickly develop pain shock. Respiratory disturbances (due to swelling of the larynx) and cardiac weakness are possible.

Warning

The minimum lethal doses when taken orally are: for nitric acid - 12 ml; sulfuric - 5 ml; salt - 15-20 ml; acetic - 25 ml; carbolic - 4–10 ml; lemon 30 g; oxalic - 5‑15 (30) g.

Urgent care

Inject subcutaneously 1–2 ml of a 1% solution of morphine (omnopon) and 0.5–1 ml of a 0.1% solution of atropine. Possibly early (within the first hour after taking the acid) and abundant gastric lavage warm water using a well-lubricated probe liquid oil. The admixture of blood in the wash water is not a contraindication to the continuation of the wash.

Gastric lavage later than 1 hour after taking acid is useless and even dangerous.

If it is impossible to make a gastric lavage, water with burnt magnesia (20.0 to 200.0) should be given to drink in separate sips. Inside, appoint vegetable oil in separate sips of 200 g per day, and from the next day - milk, egg whites, cow's butter, mucous decoctions.

To combat acidosis, it is necessary to inject a 4% solution of sodium bicarbonate intravenously or in a drip enema (500-1000-2000 ml). The amount and method of administration of sodium bicarbonate depends on which acids caused the poisoning (inorganic or organic) and what prevails in clinical picture diseases - local or general toxic effect.

500-1000 ml of the mixture is injected intravenously physiological saline sodium chloride and 5% glucose solution in equal proportions, 10 ml of 10% calcium chloride solution (or 10 ml of 10% calcium gluconate solution intramuscularly).

In case of poisoning oxalic acid or its salts calcium chloride intravenously must be administered in large quantities (10 ml of a 10% solution 2-3 times on the first day), since oxalic acid combines with ionized calcium and forms insoluble calcium oxalate. At the same time, you should assign diuretics(1-2 ml Novurite SC or 1 ml IV) to prevent blockage of the renal channels by calcium oxalate crystals.

Poisoning vinegar essence(70-90% acetic acid) has a more pronounced resorptive effect. Suction acetic acid into the blood causes a number of toxic manifestations, among which the most important are rapidly onset massive hemolysis of erythrocytes and hemoglobinuria. The urine of a patient with a high specific gravity, dark red (cherry) or almost black, contains a large number of protein, decayed erythrocytes and lumps hemoglobin. The latter clog (block) the renal tubules, causing the so-called excretory hemoglobinuric nephrosis with a typical clinical picture of acute renal failure (oliguria, anuria, hypertension, increased residual nitrogen blood, hyperkalemia). Hemolysis of erythrocytes is accompanied by bilirubinemia (increased indirect bilirubin), moderate jaundice and anemia.

Blood viscosity increases, favorable conditions are created for intravascular thrombosis and hemodynamic disturbances.

The resorption of acetic acid causes a sharp acidosis and a decrease in the alkaline reserves of the blood. Acidosis and hemolysis of erythrocytes largely determine the severity of the course and high mortality in the first 2 days after poisoning.

Emergency aid for poisoning with vinegar essence

The main emergency measures for poisoning with vinegar essence are intravenous administration of sodium bicarbonate. This achieves the restoration of normal acid-base balance, alkalization of the blood of urine and prevents blockage of the renal tubules, since in alkaline urine hemoglobin in renal tubules is not deposited and is easily excreted from the body. First, a jet (300-500 ml), and then a drip into a vein is injected with at least 2000 ml of a 4% sodium bicarbonate solution, 500 ml of a glucose-novocaine mixture (5% glucose solution and 0.25% solution of novocaine in equal amounts) and 500‑1000 ml saline solution fluids I.R. Petrov containing electrolytes (1.5% sodium chloride, 0.02% potassium chloride, 0.01% calcium chloride). To enhance diuresis, 150-200 ml of a 30% urea solution is injected intravenously (at a rate of 60-80 drops per minute), in its absence, 1 ml of Novurit is injected intravenously (or subcutaneously 1-2 ml). It is very important to administer sodium bicarbonate as early as possible.

In the first hours (day) of the disease, when the clinical picture may be dominated by the phenomena of shock and collapse, and in order to prevent them, intramuscular or intravenous drip (depending on the severity of the patient's condition) 15-30 mg of Prednisolone or 100-150 mg of Cortisone should be administered (hydrocortisone). 0.5–1 ml of a 3% solution of Prednisolone or 4–6 ml of microcrystalline hydrocortisone in 150–200 ml of saline is injected intravenously at a rate of 20–30 drops per minute.

With the development of acute renal failure, hemodialysis using the “artificial kidney” apparatus can have a good effect. The remaining measures are the same as in case of poisoning with other strong acids.

Note: in case of poisoning with phenol and carbolic acid, the patient should not be given fats and milk!

In case of poisoning with acids, do not give emetics!

In all cases of acid poisoning introduce cardiovasotonic agents (Cordiamin, Caffeine, Camphor, with hypotension- Mezaton), apply oxygen inhalations, in shock and collapse- a set of relevant measures. Antibiotics are given to prevent infection. With swelling of the larynx, the patient can be prescribed inhalations of aerosols containing alkalis, Ephedrine, Novocaine and Penicillin (1 ml of a 5% solution of Ephedrine, 3 ml of a 1% solution of Novocaine, in which 300,000 units of Penicillin are dissolved, 3 ml of a 5% solution sodium bicarbonate).

In case of asphyxia, immediate tracheotomy is resorted to, and in cases of gastric perforation, surgical intervention is performed.

manganese poisoning

When potassium permanganate (potassium permanganate) gets into the mucous membranes, a chemical burn of tissues occurs and the content of manganese and potassium in the blood increases.

Symptoms

In case of poisoning through the gastrointestinal tract, patients complain of increased salivation, pain in the epigastric region, vomiting with blood streaks, and diarrhea. There are changes in the nervous system: psychomotor agitation and convulsions may occur. On the skin of the face in the area of ​​the mouth and lips, pinpoint burns with manganese crystals can be seen. mucous membranes oral cavity, gums, pharynx and pharynx brown-violet with bleeding erosion, swollen. In severe poisoning, victims may develop laryngeal edema (from a burn), laryngospasm, and respiratory failure.

Death from manganese poisoning can occur from shock, mechanical asphyxia, or from primary gastrointestinal bleeding.

Urgent care

1. Give the patient a large amount of warm water with activated charcoal, induce vomiting;
2. it is very effective to wash the stomach with 1% ascorbic acid or a mixture of the following composition: add 100 ml of 3% hydrogen peroxide and 200 ml of 3% acetic acid to 2 liters of water:
3. after gastric lavage, give the patient a drink of 0.5% solution of ascorbic acid and 0.5% solution of novocaine;
4. open doors and vents - provide the victim with access to fresh air;
5. give something to relieve pain;
6. if possible, inject subcutaneously 0.5-0.1% solution of Atropine;
7. treat the oral cavity and the skin around the mouth with a swab moistened with a 1% solution of ascorbic acid (ascorbic acid, reacting with manganese, forms non-toxic compounds, which are then easily excreted from the body);
8. in the absence of ascorbic acid, manganese crystals can be removed from tissues with a cloth moistened with a mixture of water, 3% hydrogen peroxide solution and 3% acetic acid (everything is taken in a ratio of 1:1:1);
9. be sure to call a doctor at home or take the patient to a medical institution.

Copper sulphate poisoning - copper

blue vitriol acts locally, irritates and cauterizes mucous membranes. It is a strong hemolytic poison.

Copper poisoning almost never intentional.

It usually occurs when cooking jam or various dishes in copper or poorly tinned dishes.

Main symptoms copper poisoning is nausea, vomiting of green masses, a metallic taste in the mouth, abdominal pain, frequent loose stools mixed with blood, dizziness, weakness. In very severe cases, there is a strong stomach bleeding, renal failure, shock may develop.

Treatment

1. Mandatory gastric lavage with plenty of water;
2. induce vomiting;
3. The antidote for copper sulphate poisoning is yellow blood salt. If present, give inside 1 tablespoon of a 0.1% solution;

In case of copper sulfate poisoning, do not give the victim oily and acidic foods!

1. folk medicine advises in case of copper sulfate poisoning to give inside sugar syrup with burnt magnesia and skimmed milk with egg white;
2. activated charcoal has a good effect (3-4 tablets every 20-30 minutes).

Poisoning with ammonia, alkalis, caustic soda, washing soda, potash

The most common alkalis in everyday life include caustic soda and ammonia.

Poisoning can occur when these substances are taken orally or when used improperly. Possibly alkaline poisoning if solutions are swallowed baking soda when gargling children or when improper treatment peptic ulcer and gastritis with alkaline preparations. Caustic alkaline substances have a strong cauterizing effect on the tissues of the body. Ammonia also has an irritating effect.

Alkali burns differ from acid burns in greater depth of injury. At the site of contact of the skin or mucous membrane with alkali, ulcerations are formed, covered with a scab.

Symptoms

Poisoning is accompanied by the following symptoms:

1. strong thirst,
2. salivation,
3. bloody vomit.

Characterized by the development of pain shock.

Signs of poisoning: burning pains in the mouth, pharynx, esophagus; choking, vomiting, often bloody, thirst, bloating, cold skin.

In case of poisoning with ammonia: sneezing, coughing, salivation and after 30 minutes diarrhea, and soon with blood; loss of consciousness, convulsions.

In case of alkali poisoning, all vital organs are affected, internal bleeding develops, which are associated with deep trauma to the walls of the gastrointestinal tract. This can lead to inflammation in the abdominal cavity and death. In case of ammonia poisoning, the respiratory center is depressed, and pulmonary and brain edema develops.

First aid

If alkali gets into the eyes, it is necessary to immediately rinse them under running water, drip a 2% solution of Novocain. In case of contact with caustic alkaline solutions on the skin, you should also wash the affected area under running water.

In case of superficial burns to neutralize alkalis and ammonia you can use a 2% solution of citric acid.

When taking alkalis inside, you need to rinse the stomach through a thick rubber tube.

First aid to the victim:

1. give milk or any diluted acid to drink plant origin(lemon, vinegar, crushed gooseberries, cranberries);
2. every 15 minutes give vegetable oil, milk.

Do not give the victim salts and soda, emetics!

Tobacco nicotine poisoning

The tobacco plant in its composition contains a strong poison - nicotine, under the influence of which the blood flow in the capillaries slows down.

Vessels are reduced during smoking and almost half an hour after it. Therefore, a person who smokes a cigarette every 30 minutes keeps his blood vessels in a constant spasmodic state.

In addition, by irritating the adrenal glands, nicotine causes them to secrete an increased amount of adrenaline, which leads to additional vasoconstriction and an increase in blood pressure. Constant vasospasm leads to a change in their walls and, ultimately, to angina pectoris.

Nicotine, like coffee or tea, is a "whip" for the heart, which, in order to restore normal blood supply to organs, must make 10-15 thousand more contractions per day. The heart wears out quickly, life is shortened.

Constant smoking, especially in the morning, leads to the development of gastric and duodenal ulcers, to a progressive deterioration of hearing and vision. Majority chronic diseases lung is caused by nicotine.

Acute nicotine poisoning is rare. This happens in cases where a child gets to cigarettes for the first time and smokes "to the dump" or a non-smoker gets into a very smoky room.

First aid for nicotine poisoning

First aid consists of:

• it is necessary to take a person to fresh air, unbutton his clothes, give oxygen access;
• every 15 minutes, the patient should be given ammonia-anise drops (15–20 drops per reception) or a tannin solution (1 tablespoon).

Fish poisoning

Poisoning with fish poison occurs after eating tissues and organs of fish containing poison.

The clinical picture of the disease depends on the type of fish and the conditions in which the poisoning occurred.

There are two main forms of poisoning: cholera-like and paralytic.

At cholera-like form poisoning, the patient experiences nausea, pain in the stomach and throughout the abdomen, vomiting, diarrhea, dry mouth, thirst, urinary retention, convulsions.

At paralytic form in the first place are the symptoms of damage to the central nervous system. In the initial stage, nausea, vomiting, diarrhea, dry mouth, thirst are observed. With an increase in phenomena, dry skin, a decrease in temperature, convulsions are observed, usually ending in partial or complete paralysis.

When the first symptoms of poisoning appear (usually after three to four hours), you should seek help from a medical facility.

Treatment

For successful treatment:

1. before the doctor arrives, it is necessary to wash the stomach as quickly as possible and with as much water as possible;
2. give a laxative (two tablespoons castor oil);
3. make a deep enema with two tablespoons of castor oil or freshly prepared strong chamomile infusion;
4. warm baths and general warming are useful;
5. every half an hour, the patient should be given inside a hot drink, strong tea, coffee, hot wine, compote and other drinks;
6. rub the body with a cloth soaked in vinegar or vodka;
7. traditional medicine advises using reed in case of poisoning with fish poison, for this the rhizome of the reed is carefully crushed, and the patient is given 4-6 tablespoons of the mixture inside for 5-6 hours.

Mercury poisoning and its compounds: sublimate, calomel, granosan

Poisoning with mercury compounds is characterized by both local irritant and general toxic effects.

Local signs of poisoning: severe salivation, copper-red coloration of the lips, oral cavity and pharynx, metallic taste in the mouth, bleeding gums, later - a dark border of mercury sulfite on the gums.

General symptoms: vomiting of blood, severe pain and pain in the stomach and intestines, fever, lack of urine, diarrhea with blood, pain in the joints and bones, convulsions.

First aid

1. Induce vomiting (ipecac, emetic root, drinking large amounts of water followed by induction of vomiting);
2. drinking a large amount of milk with protein (in case of severe poisoning, stir 15–20 egg whites in two glasses of milk or water and drink immediately;
3. after half an hour, drink the same portion (the procedure will cause vomiting and clear the stomach well);

Note: in case of poisoning with mercury and its compounds, the patient should never be given salt (including English salt).

1. every five minutes the patient should be given alkali, lime water, chalk, soda, magnesia;
2. in the absence of alkalis, give fresh or fresh milk;
3. often a good effect is obtained by taking a fine powder of charcoal in oatmeal water. Give in an hour for a tablespoon.

Treatment in case of intoxication with mercury and its compounds, it should be complex, differentiated, taking into account the severity of the pathological process.

1. at acute poisoning– immediate hospitalization;
2. with chronic intoxication - hospital treatment, in the initial stage - outpatient or sanatorium treatment. In case of occupational poisoning - transfer to another job.

Essential medicines:

1. unithiol
2. taurine
3. methionine
4. DMSA (dimercaptosuccinic acid, succimer, chemet).

Poisoning with compounds of heavy metals and arsenic

Compound poisoning heavy metals and arsenic have been known since ancient times. In the Middle Ages, sublimate and arsenic were the most common inorganic poisons that were used for criminal purposes, both in politics and in everyday life.

Mortality in case of poisoning with compounds of heavy metals and arsenic, which used to reach 85%, has now significantly decreased and amounts to 20-25% of all poisoned people.

The lethal dose of soluble mercury compounds is 0.5 g, calomel - 1-2 g, copper sulfate - 10 g, arsenic - 0.1-0.2 g.

Organic and inorganic compounds of heavy metals and arsenic are used in many industries as raw materials or by-products, and are used in agriculture as herbicides and insecticides (granosan, etc.). Arsenic and some heavy metals are found in various medicines.

The clinical picture in case of poisoning with compounds of heavy metals and arsenic is varied and depends on many reasons: on the state of the victim's body, on the dose taken, on the type of poison, etc., but in any case, the gastrointestinal tract is primarily affected. Patients develop a metallic taste in the mouth, pain when swallowing, along the esophagus, abdominal pain, nausea, and vomiting. In severe cases, diarrhea occurs and gastrointestinal bleeding occurs.

Taking large doses of arsenic leads to a pronounced lesion of the central nervous system: general convulsions appear, a state of stupor (severe stunning), collapse, coma.

First aid

Remove toxic foods from the stomach. Induce vomiting (ipecac, vomit, plenty of warm salted water, etc.)

In case of poisoning with arsenic and heavy metal compounds, you should not give the patient any acidic drinks and ammonia!

1. every five minutes, give the patient burnt magnesia 1 teaspoon (to obtain a solution, one and a half tablespoons of magnesia are dissolved in 200 ml of water).
2. If there is a special "arsenic antidote" available, which is often found in special first aid kits, then give it to the patient every five minutes, 1 tablespoon;
3. rinse the intestines. Make a deep enema with clean water;
4. keep the patient warm.

This site has a separate page dedicated to children's first aid kit.
Traditional medicine advises in case of poisoning with arsenic, sublimate, yar and other mineral poisons to take cow's milk, cow butter, wood oil, vegetable fat, powdered charcoal.

A specialized remedy for herbalists and healers for poisoning with arsenic and salts of heavy metals - lobia seed juice.

Juice is squeezed from fresh seeds and given to the patient to drink 2-3 tablespoons. It is advisable to drink juice three to four times a day. Fast for 2-3 days. Can I drink tea with mint or St. John's wort.

Help and antidotes for arsenic poisoning: reception aqueous solutions sodium thiosulfate, gastric lavage, milk and cottage cheese intake; specific antidote - unithiol.

Sulfur poisoning: sulfur dioxide, sulfur dioxide

Sulfur compounds are used in refrigeration, food, leather and pulp industries. At home, they are used as disinfectants, bleaching and preservatives.

Sulfur dioxide is a strong irritant, as it forms sulfuric and sulphurous acids upon contact with water. The gas enters the body through the respiratory tract.

Symptoms of sulfur dioxide poisoning are the same as for chlorine poisoning - tear and salivation, irritation and pain in the eyes, shortness of breath and suffocation, convulsive cough, nausea, vomiting.

First aid

1. Remove the patient to fresh air;
2. unfasten clothes, provide oxygen;
3. put a wet towel on the forehead and back of the head;
4. call a doctor.

First aid

1. In case of contact with skin, mucous membranes - rinsing with running water.
2. If ingested - gastric lavage through a tube.
3. antidote therapy.
4. Forced diuresis.
5. Oxygen therapy, hyperbaric oxygen therapy.
6. Symptomatic therapy.
7. Specific (antidote) therapy for hydrogen sulfide poisoning.
8. Amyl nitrite - inhalation 0.2 ml for 30 seconds every minute.
9. Sodium thiosulfate is contraindicated.
10. Hospitalization in a poison control center.

Symptomatic drug therapy

1. For convulsions - diazepam 10 mg IV.
2. Drugs that improve metabolism and blood supply to the brain and peripheral nervous system (for example, Pyridoxine, Pyritinol).
3. With an indomitable cough - Codeine inside.
4. Bronchodilators.
5. Corticosteroids (Prednisolone 2–5 mg/kg IV).
6. In case of hydrogen sulfide poisoning - 10 ml of 10% solution of calcium chloride or calcium gluconate IV.
7. Antibiotics.

In case of carbon disulfide poisoning, encephalopolyneuritis is formed after coming out of a coma. With functional disorders of the central nervous system, even at the initial stage, it is necessary to transfer to work that excludes contact with carbon disulfide. With pronounced forms, the ability to work is steadily reduced.

Vinegar poisoning

When ingesting vinegar essence by mistake or for the purpose of poisoning, burning pain in the throat and stomach. The patient thrashes about in pain. Appears severe vomiting, often with an admixture of blood, severe thirst, diarrhea, swelling of the oral mucosa and pharynx. Pain comes quickly. Arises severe burn mucous membranes. Severe pain makes it impossible to swallow even liquids. During inhalation, saliva along with air, entering the respiratory tract, can cause suffocation. Therefore, saliva is urgently removed with a gauze swab wound around a finger. Since salivation is usually strong, saliva should be removed constantly. In case of suffocation and violation of the activity of the heart, the victim is given artificial respiration.

First aid

In case of poisoning, first of all, it is necessary to carry out repeated, thorough rinsing of the mouth with water. It is important not to swallow water!

Then - gastric lavage through a tube.

In case of poisoning with "cauterizing" poisons, in no case should the stomach be washed by inducing vomiting! The stomach is washed only through a probe, to clean washings (8-10 liters of cold water).

Before insertion, the probe is liberally lubricated with vaseline oil. If sulfuric acid was used as a cauterizing poison, then it is forbidden to rinse with water. This can lead to the fact that a thermal burn will be added to a chemical burn!

Even if there is an admixture of blood in the wash water, you should still continue washing. In the first hours of acetic acid poisoning, there is usually no damage. large vessels stomach.

This may lead to mechanical damage stomach due to excessive gas formation.

The optimal solution for neutralizing acetic acid in the stomach is Almagel.

If possible, an anesthetic solution should be administered to the patient intramuscularly or intravenously before washing.

In the absence of medicines and / or in the absence of skills in inserting a probe, or, even worse, in the absence of the probe itself, before the arrival of the ambulance team, allow the victim to swallow ice cubes with smooth edges and give him a few sips sunflower oil or better Almagel.

Inside it is necessary to give burnt magnesia (1 tablespoon per glass of water), whipped protein, activated charcoal, water, milk, mucous decoctions of rice and flaxseed, lime water, decoctions of flaxseed, rice, barley. Ice compresses on the neck and stomach. Drink cold water. Hospitalization of the patient is required.

Poisoning by organophosphorus compounds: insecticides

Organophosphorus compounds are widely used in agriculture as insecticides and herbicides for the treatment of grain and leguminous crops, vineyards and orchards.

These include drugs such as thiophos, karbofos, chlorophos, etc. Poisoning occurs when these substances enter the skin, respiratory tract and stomach.

There are three stages in organophosphate poisoning.

AT first stage the patient is agitated, complains of a feeling of tightness in the chest, dizziness, nausea, decreased vision. Mental disorders appear - the patient becomes aggressive, often refuses treatment, he is haunted by a feeling of fear.

As the poisonous substance is absorbed into the blood, the patient develops sweating, salivation, vomiting, increased blood pressure, and increased heart rate. There are cutting pains in the stomach.

On the second stage poisoning, convulsions appear, the patient is inhibited, the pupils are narrowed, salivation and sweating increase, the patient often falls into a coma, convulsive twitches of individual muscle groups appear, blood pressure rises even more, diarrhea increases, urination becomes more frequent.

Third stage- stage of paralysis. The patient is in a coma. The activity of the heart, respiratory center, nervous system is sharply disturbed.

First aid

The main thing in treatment is the removal of a poisonous substance from the body;

1. in case of poisoning through the mouth, it is necessary to rinse the stomach as soon as possible. The stomach is washed 3-4 times with 5-6 liters of water;
2. vaseline oil 100–200 ml is given inside, flaxseed or hempseed decoction, starch decoction, almond milk;
3. saline laxative (magnesium sulfate - 50 g);
4. instead of the usual emetic, the patient is given 5-7 grains of copper sulfate in a decoction of flaxseed;
5. as an antidote, give 1 tablespoon of burnt magnesia with water several times (in the absence of magnesia, you can give 5-10 drops of purified turpentine with an equal amount of Hoffmann drops;
6. in case of phosphorus poisoning, the patient should be given as much as possible egg white mixed with water;
7. cleansing enema of warm water with the addition of a small amount of glycerin;
8. when breathing and cardiac activity stop - indirect heart massage and artificial respiration.
9. in case of contact with organophosphorus substances on the skin, wash the affected areas with soap and water, 2% soda solution, treat with chloramine or ammonia.
10. remove poison-contaminated clothing.
11. if FOS gets into the eyes, they are washed with a 1% solution of soda or clean water.

Medical assistance

1. Gastric lavage through a probe with a solution of potassium permanganate (1:5000), after lavage - the introduction of vaseline oil into the stomach (100 ml twice).
2. Symptomatic therapy.
3. Hemodialysis.
4. Surgical - excision of the necrotic bone mass, removal of sequesters.

In case of contact with eyes, rinse.

Chlorine, phosgene and fluorine poisoning

When exposed to humans low concentrations of chlorine there is redness of the conjunctiva, soft palate and pharynx, shortness of breath, hoarseness of the voice, a feeling of tightness in the chest.

AT high concentration of chlorine causes difficulty in breathing, excruciating shortness of breath, salivation, pain in the eyes, dry cough, lacrimation. Sometimes there is nausea and vomiting. The patient is agitated or very depressed. Soon - usually 15-20 minutes after contact with the poison - all symptoms disappear. There comes a period of imaginary well-being, which lasts from half an hour to 36 hours. The duration of the latent period is important for diagnosing the severity of poisoning - the shorter the latent period, the stronger the poisoning. During the latent period, the general condition of the victim improves. Then, as this period ends, signs of toxic pulmonary edema come to the fore, the first precursors of which are: dry cough, shortness of breath, tightness and pain behind the sternum, general weakness, weakness, dizziness and headache. Gradually, the cough becomes stronger and more painful, chest pains increase, breathing becomes more and more difficult. There is a cyanosis of the skin and mucous membranes, breathing becomes superficial. Chills begin, coughing intensifies. A large amount of sputum begins to stand out (up to 1.5 liters per day). The victim is excited, rushing about. He is tormented by fear and hopelessness. The face is bluish-red. Arterial pressure falls more and more, collapse develops and the patient dies from paralysis of the respiratory center.

The clinical picture of phosgene and fluorine poisoning is similar.

In high concentrations, chlorine, phosgene and fluorine can lead to lightning death of the poisoned person.

After a short breath, the victim begins to suffocate, rush about, tries to run, but loses consciousness, falls, his face turns blue, the pulse becomes thready. There comes a reflex stop of breathing.

First aid

1. withdraw or remove the victim from the affected area;
2. provide him with an influx of fresh air (unbutton outerwear, open windows, doors);
3. when assisting the victim, try not to poison yourself and apply personal protective measures (protective suit, gloves, gas mask, rubber boots);
4. you need to keep in mind that if poisoning occurs in a building, then in case of ammonia poisoning, you need to go down to the first floor or to the basement (ammonia is much lighter than air and its vapors rise up); in case of poisoning with chlorine, phosgene, sulfur dioxide, fluorine - go upstairs, to the fifth floor and above;
5. ensure complete physical rest for all victims;
6. rinse eyes, mouth and nose with 2% soda solution or clean water for 10 minutes;
7. if the poison is swallowed, rinse the stomach;
8. All victims must be hospitalized.

It is also necessary to carry out the following activities:

1. instillation into the eyes of vaseline or olive oil, and for pain in the eyes - 2-3 drops of a 0.5% solution of Dikain;
2. application of an eye ointment to prevent infection (0.5% synthomycin, 10% sulfacyl) or 2-3 drops of 30% Albucid, 0.1% zinc sulfate solution and 1% boric acid solution - 2 times a day;
3. the introduction of Hydrocortisone 125 mg / m, Prednisolone 60 mg / in or / m.

Medical assistance

Regardless of the degree of damage to all victims, it is necessary to provide maximum rest and warming, bring them to a sitting or semi-sitting position.

Inhalation of bronchodilators (Salbutamol, etc.), warm milk with Borjomi or drinking soda, inhalation of a sprayed 1–2% solution of sodium hyposulfite for 1–2 days or a 2% solution are shown. drinking soda 2-3 times for 10-15 minutes, inhalation of a 10% solution of menthol in chloroform, the use of non-narcotic anti-inflammatory drugs (Ibuprofen), intravenous ascorbic acid 5%. Solution, 50 ml (ingestion of 3 g of the drug is possible), expectorants (Bromhexine, etc.). With difficulty breathing - Teofedrin, Eufillin, inhalations of Solutan 2-3 times a day or Salbutamol, warm soda or water inhalations. With spasm of the glottis - heat on the neck and the introduction of Atropine 0.1-1.0% subcutaneously. When coughing - codeine 0.015 g, 1 tablet 3 times a day.

With bronchospasm - the introduction of a 10% solution of calcium chloride, 5-10 ml intravenously, oxygen therapy. To prevent joining secondary infection use broad-spectrum antibiotics (Ampicillin, Gentamicin, etc.). With persistent bronchospasm, no effect from previous treatment - Atropine 0.1-1.0% intramuscularly, Prednisolone 30-60 mg intravenously, Orciprenaline 0.5% intramuscularly, tracheostomy.

If the clinical manifestations of chlorine poisoning suggest a moderate and even more severe degree of damage, then medical observation is carried out during the day in order to timely detect signs of incipient pulmonary edema. During this period, fluid intake is limited, and food intake is prohibited, strict bed rest is indicated. X-ray studies lungs are carried out every 2-3 hours.

In the latent period, all activities are aimed at preventing pulmonary edema and stopping early signs of development. respiratory failure. Among these measures highest value given oxygen therapy, IVA, hydration of the trachea and bronchi, correction of obstructive processes (bronchodilators, mucolytics, expectorants, toilet bronchial tree, aspiration of edematous fluid, massage). Correction of cardiovascular activity, anti-inflammatory therapy and prevention of infectious complications are ongoing.

Oxygen therapy is started at the first signs of hypoxemia in order to reduce the hyperfunction of the respiratory and cardiovascular systems. It allows you to normalize or reduce the frequency of breathing, tachycardia, lower blood pressure, reduce pathological symptoms from the central nervous system. However, traditional oxygen therapy is effective only in the initial period.

ADRENALIN IS CONTRAINDICATED, WHICH IN HIGH DOSES IS ABLE TO CAUSE PULMONARY EDEMA.

To prevent intravascular thrombus formation, anticoagulants (anticoagulants) are used, and measures are taken to normalize blood viscosity (introduction of hypertonic or isotonic glucose solutions).

For the treatment and prevention of pneumonia, bacteriostatic drugs (antibiotics, sulfonamides), expectorants are used, banks, mustard plasters.

Convalescents should do breathing exercises.

Alkali poisoning

The main strong alkalis are caustic soda (caustic soda) and caustic potash (potassium hydroxide). Alkali poisoning leads to deeper local tissue damage than acid poisoning.

When alkali gets into the gastrointestinal tract, there are severe pains in the mouth, in the esophagus and stomach. Excruciating vomiting almost always occurs, often with an admixture of blood. Burns of the oral mucosa cause profuse salivation, and a sharp pain makes it impossible to swallow. Therefore, just as with acid poisoning, saliva should, if possible, be removed with the help of gauze swab wrapped around a finger.

In case of poisoning with concentrated alkalis, it is urgent to rinse the stomach with plenty of warm water (up to Yul) or with a 1% solution of acetic or citric acid. Washing is desirable to do in the first hours after poisoning. To neutralize the alkali, the patient is given to drink lemon juice, a solution of citric acid, enveloping agents. Water the patient every 5-10 minutes (1 tablespoon).

If alkali gets on the skin or mucous membranes, then it must be immediately wiped off with a piece of cloth, and then washed off with plenty of water with vinegar or lemon juice. For washing, you can use a 1% solution of any acid that is at hand.

If a person accidentally gets into a bath or a pit with lime, he should be pulled out as soon as possible, poured over with water from a hose and put in a bath with warm water. Water should be replaced as it gets dirty. In the future - treatment, as with chemical burns.

Symptoms of strong alkali poisoning similar to the symptoms of poisoning with strong acids. The mechanism of action is similar - cauterization (necrosis, protein coagulation, scab formation). The cauterizing effect of alkalis is more pronounced than that of acids, and is characterized by the formation of a loose, spreading deep scab and significant ulceration, and subsequently more severe cicatricial narrowing of the esophagus and stomach. The resorptive action of alkalis is less pronounced.

The minimum lethal dose when taken orally is for caustic sodium and potassium - 5 g, for ammonia - 3-4 (10) ml.

Emergency care is the same, except intravenous administration sodium bicarbonate and the use of diuretics. When washing the stomach, it is recommended to slightly acidify the water with acetic acid. If it is impossible to wash the stomach, a 1% solution of citric, tartaric or acetic acid is prescribed orally (each

5 - 10 minutes for an hour on a tablespoon). Swallow pieces of small ice.

Ethylene glycol poisoning: methinol

Ethylene glycol is a compound with an alcohol-fusel smell, which is part of antifreeze, antifreeze, brake fluid and some antistatic agents.

When ingested, it is rapidly absorbed in the stomach and small intestine. It is excreted by the kidneys unchanged or in the form of oxalates. When oxidized in the liver, ethylene glycol forms toxic products that cause poisoning of the body. The toxicogenic stage lasts up to 5 days. The lethal dose is 100–150 ml.

Symptoms

A person who has taken ethylene glycol develops lung symptoms drunkenness good health. Sometimes there is vomiting and diarrhea. After 10-12 hours of the latent period, headache, dizziness, thirst, nausea, vomiting, severe pain in the abdomen, lower back (like renal colic) and muscles appear. The skin becomes dry, hyperemic, the mucous membranes are bluish-pale. Vision is deteriorating. The pupils are dilated. There is shortness of breath, breathing is noisy, rare. The number of heartbeats increases sharply, blood pressure drops. Clonic convulsions appear.

Death can occur on the first day after poisoning from paralysis of the respiratory center.

First aid

1. Gastric lavage and plenty of fluids. The following mixture should be added to the washing water as an adsorbent: tannin - 1 part, activated carbon - 2 parts, burnt magnesia - 1 part. In the absence of all components, you can use each of them separately. You can use a 2% solution of sodium bicarbonate (soda) followed by ingestion of 30 g of magnesium sulfate in 100 ml of water. Inside - 200 ml of a 30% solution of ethyl alcohol or vodka (with a history of the fact of taking poison), 3-5 g of sodium bicarbonate in 100 ml of water;
2. give the victim 2-3 egg whites, kefir, milk or jelly 2-3 cups;
3. give the victim a laxative;
4. after first aid - hospitalization.

Medical urgent care in a medical facility

With preserved consciousness - gastric lavage through a thick tube with a 2% solution of sodium bicarbonate, followed by the introduction of 30 g of magnesium sulfate in 200 ml of water (if not previously administered) and 3-5 g of sodium bicarbonate in 100 ml of water, siphon enema.

Inside or intravenously ethyl alcohol according to the scheme intravenously 10-20 ml of a 10% solution of calcium chloride (gluconate).

IV 400 ml of 5% glucose solution with 5-10 ml of 5% ascorbic acid solution and 8 units of insulin, glucose-novocaine mixture (400 ml of 5% glucose solution with 25 ml of 2% novocaine solution), 400 ml of polyglucin, 400 ml of gemodez, 10 ml of a 2.4% solution of aminophylline, 80-120 mg of furosemide (lasix), 50-100 mg of prednisolone or 100-200 mg of hydrocortisone.

Intramuscularly, 2-4 ml of a 6% solution of thiamine bromide and a 5% solution of pyridoxine hydrochloride (do not inject in one syringe).

With the development of cerebral edema, coma - an ice pack on the head, intravenously 40 ml of 40% glucose solution with 4-6 ml of 5% ascorbic acid solution and 8 units of insulin, 50 ml of 30% sodium thiosulfate solution, 10 ml of a 2.4% solution of eufillin, up to 300-500 mg of furosemide (lasix), taking into account the previously administered dose, 50-100 mg of prednisolone or 100-200 mg of hydrocortisone, 2-4 ml of a 6% solution of thiamine bromide and 2-4 ml of a 5% solution of pyridoxine hydrochloride, if not administered (do not inject in one syringe!), Oxygen inhalation. Relief of psychomotor agitation by intramuscular injection of 10 ml of a 25% solution of magnesium sulfate. Craniocerebral hypothermia, spinal puncture and extraction of 10–15 ml of CSF, dehydration therapy, eufillin, plasma, albumin, piracetam, steroid hormones, cytochrome C, sodium hydroxybutyrate, tracheal intubation and mechanical ventilation, oxygen inhalation.

Repeated (2-3 times a day) gastric lavage and intestinal lavage (preferably through a permanent two-way probe). Antidote therapy with ethyl alcohol (at the rate of 1.5–2 g/kg of body weight per day) and calcium gluconate (chloride) during the first 2–3 days. Forcing diuresis with the simultaneous introduction of a 4% solution of sodium bicarbonate in volume.

With increasing hepatic and renal insufficiency - infusion therapy (including from 1 to Zl / day trans-umbilically), plasma alkalization, intravenous glucose-novocaine mixture, aminophylline, osmotic diuretics (mannitol at the rate of 1-1.5 g / kg of body weight body) in combination with furosemide (Lasix), lipoic and glutamic acid, a complex of B and C vitamins, cytochrome C, hemosorption in combination with program hemodialysis.

Evacuation to a medical institution (hospital), which has the possibility of hemodialysis, by ambulance, in the supine position on a stretcher (in coma - in the main lateral position with the breathing tube inserted), accompanied by a doctor. On the way to continue infusion therapy, if necessary - the introduction ethyl alcohol, calcium gluconate (chloride), furosemide (lasix), anticonvulsants (magnesium sulfate, phenazepam), oxygen inhalation.