Poisoning when chemicals enter the body. What to do in case of chemical poisoning? Diagnosis of chemical poisoning

My name is Irina, I am 22 years old this moment in decree. It all started with my husband's trip to another city for a corporate party for 2 days. Arriving from there, he changed, began to be insolent to me. A little time passed and he went to his colleague in the evening to drink beer, he said that it would not be long. But as time went on, I started calling him, he says that I will be there soon, but the second hour passes and he is not there, when he came the time was 2 o'clock in the morning. We went to bed and the smell of women's perfume hits my nose, I ask him, he is silent. As a result, I find out that there was a girl there, their colleague came to them on a business trip from the city where the corp. party. Moreover, they met there before that they did not know each other. I threw a scandal. As soon as she arrived, he immediately began to write to her, I found her number on his phone under a different name. and I find out that I'm pregnant, he was delighted and everything seemed to be fine, but suddenly he was going to another city again, but already openly tells me that he was going to her. I asked him, I begged him on my knees, asked him to stop, think at least so that we would have a child. I decided to scare him and said that then I would have an abortion, to which he answered me - decide for yourself if you want to do it, if you want to leave it, I do not refuse the child. In general, he left right the day before our wedding anniversary for 1 year. The next day he arrived only in the evening and came to ask for forgiveness, I forgave him. But the calls continued to her, I did the details. Then I decided to call her myself, she just laughed, said that there was nothing between them. It lasted my whole pregnancy. But then for some reason they stopped communicating, I ask him, he is silent. something went between you, he said no, just a kiss. But I’m sure that they already had it at a corporate party, just like that he wouldn’t write to her as soon as she arrived, in itself my husband is very shy towards girls. Help me, I can’t forget all this, after that 2 years have passed, every day I remember what happened, how I was humiliated, as soon as I think that he was with another woman, everything inside is torn on fire and I want to break off relations with him, how I think that he will be with someone else - it becomes ill, but as soon as he comes home from work and I see him, I immediately forget everything. I want to cope with this pain and forgive, but it doesn’t work, sometimes it seems that I hate him more than I love him. I don’t know what should I do and live with it I don’t want to, and without it there will be no life.

Psychologists Answers

Irina, hello! Irina, it’s as if you were captured by memories (or something else that doesn’t let you in). As if one part of you wants to be with your husband, forgive everything and continue to live, the other comes into conflict, reminding you of what happened. You would very much like to get rid of these memories, from the burden of those emotions that you experienced then and live a calm life. It turns out that you still live “then”, in that situation, in those feelings. The burden of the past, experienced "then" emotions, feelings does not allow you to move on. Although, apparently, they have not yet been experienced, you are still living it. Irina, what is in this load, what kind of feelings? What is the leading feeling? (try to answer this question for yourself). Irina, they must be very painful. You write about humiliation, and this is a very strong experience and the most not accepted by us. Irin, if we were to work with you in person, I would suggest that you might explore this area of your feelings. Perhaps this would allow you to clarify and respond to those past feelings, thus moving into the present, and then you could comprehend your relationship with your husband. Change is still change. The situation itself requires changes, it will not work out differently, in the old way. But all this requires, of course, some inner work. What is blocking your wealth and more fulfilling relationships in your family now: resentment, anger, shame? (Irina, I'm just fantasizing now. Maybe something else). Irina, can't you forgive the humiliation you endured during that period? Irina, perhaps you need to restore your self-esteem? If so, what could it be for you? Irina, have you talked with your husband about what you experienced and how you felt. This is not to cause him a deep sense of guilt, but to speak out and restore contact between you. Irina, think about what could balance your feelings, your experience (maybe it will be some kind of action towards you on the part of your husband. It is useful for him to tell about this. This is a kind of price). Irina, when answering a letter, you always rely only on assumptions, there is no way to correct the direction of work. This is not always effective. Hope something helps you from my answer. Irina, try contacting

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

What causes chemical poisoning:

Some of the poisons are medications, 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-entry into the body in large numbers. 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, at small child ingesting 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 confusion, coma, impaired heart rate, shortness of breath 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 the vital important organs especially 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 bone marrow depression. Although this should be done, the possibility of poisoning can be disregarded when the patient's main manifestations are mild mental or neurological impairment, 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 a product that does not allow you to recognize it chemical composition. The bibliography at the end of this chapter lists a number of books that list the active constituents of substances used in households, 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 can cause the development of characteristic clinical signs, sufficient for strong assumptions about 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 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 chemical poisoning their presence is rather an exception.

Chemical analysis of body fluids provides the most correct definition substance that caused poisoning. Some common poisons such as acetylsalicylic acid(aspirin) and barbiturates can be detected and even quantified with relatively simple laboratory research. 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 a timely manner to decide on initial treatment in 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 proper treatment A patient with poisoning needs 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 in part on absorption in the gastrointestinal tract, so it should be avoided. simultaneous reception activated carbon, which is an adsorbent. 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. At intravenous administration 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. Attempts to induce vomiting should not be made on victims who are in convulsive state, in patients with severe central nervous system depression or (because of 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 quantities(less than 100 ml) 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. At correct execution 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 removed from the body along with it. most poison. After that, 200 ml is injected into the stomach (less in children) warm water or liquid solution and aspirate 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 better adsorbed by acid solutions and therefore can be released in the small intestine. It is desirable that activated charcoal with adsorbed poison pass through the intestines 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 injection osmotic laxatives such as magnesium or sodium sulfate (10-30 g in solution at 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 heat generated during a chemical reaction can 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 absorption, measures that accelerate the elimination of a toxic agent and the body rarely have big influence to 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 by 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 important role in increasing the period of their action and it can often be reduced by readily available methods. In poisoning with drugs such as salicylic acid preparations and long-acting barbiturates, increased diuresis induced by the administration of large volumes of electrolyte solutions in combination with intravenous furosemide has been shown 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 the ionization in the tubular fluid of such organic acids as 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, lowering the pH below its normal 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 terms of excretion from the body large quantities dialysable poisons. 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. Careful care is needed during the unconscious period nurse and careful monitoring of the patient. If the oppression of centers located in medulla oblongata, occurs as a result of circulatory or respiratory disorders, then you need to immediately and vigorously begin measures to maintain these vital functions using chemicals 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, seizures are often necessary application anticonvulsants. Intravenous diazepam, phenobarbital, or phenytoin are usually effective.

Cerebral edema. Raise intracranial pressure due to cerebral edema is also hallmark the action of some poisons and the nonspecific consequence of other chemical poisonings. For example, cerebral edema is observed in case of poisoning with lead, carbon monoxide and methanol. Symptomatic treatment consists in the use of adrenocorticosteroids and, when necessary, in intravenous administration hypertonic solutions 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 disturbances, which is carried out after measuring the value of blood pressure.

cardiac arrhythmias. Disturbances in 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 patency airways. 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 clinical status or measurement of minute volume or gas composition blood, it is imperative to carry out artificial ventilation with the help of appropriate mechanical means. In tissue hypoxia, the introduction is always indicated. high concentrations oxygen. 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 renal 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 imbalances. Electrolyte and fluid imbalances are common signs chemical poisoning. They may be due to vomiting, diarrhoea, kidney failure, or therapeutic activities 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 violations and all kinds specific treatment 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 reducing the concentration of the 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.

Chemical poisoning, the symptoms of which are quite easy to determine, is a life-threatening lesion of the gastrointestinal tract, causing irreversible pathological consequences. Therefore, the sooner the victim seeks qualified medical care the better for him.

What to do

First aid for poisoning chemicals consists in a simple algorithm of the following actions:

the first stage is the cleansing of the stomach from the harmful mass (you need to drink a lot of water, you can lightly salted and induce vomiting);
further, when the stomach is cleared, it is recommended to give the victim of chemical poisoning to drink some milk, starch broth, infusion flax seeds, or a simple protein solution. These funds perform an enveloping function and help protect the thin mucous membranes of the stomach from toxic injury;
if chemical poisoning has reached the phase in which the intestines are affected, it is necessary to give the victim a laxative drug. An enema will also be effective;
in the event that toxins have managed to penetrate into the bloodstream, it will be useful to take diaphoretics and diuretics. These funds will not be able to cope with the entire volume of toxic substances, but they will contribute to the removal of at least part of the toxic components through sweat and urine;
if the poisoning is of an acid origin, it will be useful to give the victim a lot of drink. It should be not only water, but also weak alkaline solutions(for example, lime and soapy water);
anyway, necessary measure in case of chemical poisoning, an ambulance is called. What measures to eliminate the consequences of toxic damage to the body would not be taken, anyway, a qualified examination in this case is a vital issue.

Symptoms

Signs of chemical poisoning are determined quite simply. Namely, it is:

However, it is worth remembering that various substances have the properties to cause a variable spectrum of clinical manifestations and sensations. It is important to understand that this type of intoxication is one of the most complex forms of damage to the gastrointestinal tract, and can lead to the most tragic consequences if the victim is not provided with timely and comprehensive medical care. Therefore, it is very important to familiarize yourself with at least its basic rules, and be able to distinguish between symptoms.

Dynamics and nature of first aid measures

What to do in case of chemical poisoning in the first place?

If the victim is conscious, he independently empties his stomach through vomiting. Otherwise, he needs some assistance.

If the person's condition allows, it is necessary to call him vomiting reflex using a simple and traditional method. To do this, let him drink two or three glasses of warm, slightly salted water, and then with two middle fingers we press a little on the root region of the tongue.

If the victim is unconscious, it is worth handling him even more carefully and carefully. The body should be given a position in which the head will be laid on its side. With certain manipulations lower jaw may sink a little. It should be returned to a position that will not threaten the health and well-being of the victim.

In the subsequent stages of first aid, attention should be paid to the slightest sign reaction of the victim to a particular pathogen. In the event of a sharp negative manifestations(spasms, sharp pains) should be discontinued immediately annoying factor, and give the victim a small dose of a neutral anesthetic.

As already noted, various sources of damage to the body require specific approaches to the implementation of therapeutic measures. For example, acid intoxication requires an extremely careful approach to the implementation of first aid measures. This type of chemical poisoning completely rejects chalk and soda solutions, which are often used as emollients and neutralizing agents. Taking a laxative is also strictly prohibited, since the action of drugs of this spectrum can be detrimental to the walls of the stomach, previously burned with acid.

At the same time, some means are quite universal. Healing for chemical poisoning of any type is the action of milk, as well as some decoctions containing gluten and special astringents that envelop the affected areas with a thin mucous film that prevents further erosion. In addition, such decoctions (jelly, for example) perfectly contribute to the restoration of intestinal microflora and minimize pain.

Chemical damage to the respiratory system: how to determine and what to do?

A separate category of chemical poisoning is the defeat of the respiratory tract. Its source, as a rule, is a variety of gases that have a damaging effect on organic tissues. For example, long-term contact with carbon monoxide, household fuel gas, gasoline fumes and many other chemicals common in everyday life.

This type of chemical poisoning is one of the most difficult - since it is not so easy to determine the source of the lesion and eliminate its effects.

Such poisoning is accompanied by such main symptoms:

Specialized assistance in the cases under consideration is, first of all, in eliminating the impact of the source of damage, and ensuring maximum access of the victim to fresh air. Naturally, you should immediately seek qualified medical help.

Clothing soaked with toxic substances should be removed immediately.

It is worth remembering that harmful substances from the respiratory system enter the bloodstream very quickly. Therefore, it is worth immediately taking care of minimizing their impact.

A few tablets of activated charcoal will help prevent the poison from entering the bloodstream.

Chemical poisoning is a serious condition that is life-threatening. It can be caused by the entry of a toxic substance into the body through the alimentary tract, inhalation, through the skin or mucous membranes. This article details the substances that can cause chemical poisoning, the main symptoms, clinical manifestations and first aid components for chemical poisoning.

Reasons for the development of chemical poisoning

Chemical poisoning can be caused by a huge number of substances. These can be medicines, cleaning products, cosmetics, chemicals in production, chemical weapons.

The main reasons for the entry of these substances into the human body include:

Accidental or special ingestion of chemicals. Adults may attempt suicide in this way, and children may accidentally drink or eat good-smelling detergents.
The release of chemicals into the air, due to industrial accidents, or the use of mass chemical weapons.
Service negligence, or oversight, as a result of which solutions with chemicals got on the skin or mucous membranes.

Possible consequences of poisoning

What complications and consequences can develop as a result of chemical poisoning? Various chemicals can serve development severe violations from all organs and systems, and lethal outcome. The type of complication depends on the chemical.

Poisoning by mouth

Please note that if the patient is poisoned by alkalis or acids, it is strictly forbidden to wash his stomach and provoke vomiting. This can cause repeated chemical damage to the mucosa of the esophagus and oral cavity, lead to pain shock and internal bleeding, quick death.

If the person is unconscious, you should put him on the floor and turn his head to the side. This will save him from choking on his own vomit and from sinking his tongue.

If the victim is conscious, you should find out from him what exactly he was poisoned with. Below is the main algorithm of your actions:

If the poisoning was due to the use of medicines, let him drink a liter of water in one gulp, and provoke vomiting. In the case where he did not name you a chemical, or if it is an acid or alkali, gastric lavage is prohibited.
Give the person a drink of plain water (200-300 ml). The liquid will dilute the concentration of the chemical, and will reduce it Negative influence to the food channel.

That's all you can do before the paramedics arrive. It is forbidden to give a person any medicines, since you will not know how they will react with the contents of the stomach.

Respiratory poisoning

Remember that before providing first aid to the victim, first of all, you should take care of your safety. If the air is polluted with chemicals, put on a gauze bandage or a respirator.

In case of respiratory poisoning (through the respiratory tract), it is first necessary to remove the victim to clean air. If you are in danger and you cannot wear a mask, wait for the arrival of rescue assistance, do not endanger your life.

Once you are indoors (or outdoors) with unpolluted air, follow these guidelines:

Unfasten the man's tie, shirt, make sure nothing prevents him from breathing.
If the patient is conscious, sit him down; if he is unconscious, lay him on a hard, flat surface and turn his head to one side.
You can give him water to drink.

Skin contact with chemicals

If a chemical has entered skin rinse them under cold running water for 15-20 minutes. This will help cleanse the skin of the remnants of the substance that has not had time to be absorbed into the blood. Also, cold water ease the pain a bit.

First aid

Tell the members of the ambulance team what the person was poisoned with, what his first symptoms appeared, and how you provided him with first aid. After a quick assessment of the patient's condition, doctors will provide first aid, which is necessary for the patient to survive until hospitalization.

Depending on the symptoms and condition of the patient, the following assistance may be provided to him:

Connecting the patient to oxygen.
Intubation and initiation of artificial respiration.
Gastric lavage through a tube.
Intravenous administration of solutions, medications to normalize the functioning of the cardiovascular and respiratory systems.

Hospitalization is carried out as soon as possible. The patient is transported to the toxicology department or to the intensive care unit.

Treatment

The duration of treatment and prognosis depends on the patient's condition. In the hospital, he may be given antidotes for the chemical he has drunk (if they exist).

To determine the affected organs and systems, a detailed examination of the patient is carried out (in parallel with the provision of medical care).

The survey may include:

general blood test;
general urine analysis;
biochemical blood test;
electrocardiograms;
radiography of the lungs;
blood test for toxins;
ultrasound examination of internal organs.

At serious condition, the patient is placed in intensive care unit. He can undergo hemodialysis (blood purification). You can find out the prognosis for his life from the attending physician.

Chemical poisoning is one of the most dangerous defeats organism. They can be fatal. It is strictly forbidden to self-medicate. The sooner it is called Ambulance the greater the chance of survival and recovery. A poisoned patient needs daily medical supervision, and the provision of qualified medical assistance.