How carbon monoxide affects the human body, symptoms of poisoning. Bright signs of carbon monoxide poisoning and help

Carbon monoxide poisoning

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

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

Poisoning is possible:

during fires;

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

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

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

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

when using low-quality air in breathing apparatus.

General information

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

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

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

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

Symptoms:

For mild poisoning:

headache appears

knocking in the temples,

dizziness,

chest pain,

dry cough,

lacrimation,

• possible visual and auditory hallucinations,

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

  tachycardia,

  increase in blood pressure.

for moderate poisoning:

drowsiness,

possible motor paralysis with preserved consciousness

for severe poisoning:

loss of consciousness, coma

convulsions,

involuntary discharge of urine and feces,

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

dilated pupils with a weakened reaction to light,

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

Help with carbon monoxide poisoning

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

First aid for carbon monoxide poisoning

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

Treatment of carbon monoxide poisoning

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

Carbon monoxide analysis

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

Qualitative Definition

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

quantitation

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

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

Carbon monoxide is a strong toxic substance that, when it enters the body, leads to disruption of the functioning of its organs and systems.

Carbon monoxide poisoning can occur in a variety of places. This substance is odorless, which undoubtedly increases its danger, since a person is not aware of its presence in the air.

The whole body is forced to work in conditions of severe oxygen deficiency. This leads to serious consequences: damage to the heart, brain, lungs, skeletal muscles.

The effect of carbon monoxide on the human body

First of all, it is necessary to consider its effect on the composition and functioning of the blood. This dangerous substance enters the human body through the respiratory tract into the lungs, which are well supplied with blood. It is here that the poison is quickly absorbed into the blood.

In the bloodstream, carbon monoxide seeks out red blood cells and binds to them. These blood cells, in turn, perform an important function - the respiratory. That is, they bind oxygen and carry it to all organs and tissues.

In case of poisoning, carboxyhemoglobin is formed in the blood, which is no longer able to perform this function. That is, red blood cells lose their ability to capture oxygen. In this case, a severe pathological condition develops - hypoxia, that is, oxygen starvation.

Carbon monoxide poisoning can occur under the following conditions:

• Household. Fires release large amounts of this dangerous gas. This happens when the interior is burning, in the decoration of which there is plastic, wiring and household appliances. When you stay for a long time in a closed garage where the car is running. In a traffic jam in calm weather. In case of leakage of domestic gas, as well as improper operation of furnace equipment;
• Production. Poisoning can occur in the gas and automotive industries. Where carbon monoxide is used for the synthesis of organic compounds.

It should be noted that children, pregnant women, the elderly and debilitated people are most sensitive to carbon monoxide. Let us consider in more detail the consequences of both individual body systems.

Influence on the work of the heart

In conditions of hypoxia, the heart turns on compensatory devices. That is, under any conditions, it tries to fulfill its main function - to supply the body with oxygen-enriched blood.

With the penetration of carbon monoxide into the blood, the concentration of oxygen in it is significantly reduced. In this case, the heart begins to distill blood at a faster rate through the systemic and pulmonary circulation. This leads to tachycardia - an increase in the number of heartbeats per minute.

At first, the tachycardia is moderate, but with severe poisoning or prolonged exposure to gas on the body, the pulse becomes frequent, but poorly filled. The heart rate reaches 130 - 140 beats per minute.

Against the background of severe tachycardia and hypoxia, the likelihood of developing myocardial infarction is high.

Consequences for the central nervous system

With the blood flow, the toxin enters the brain, where it has a negative effect on its various departments. At first, a person feels a severe headache, “cerebral vomiting” may occur, which occurs when the center of the brain responsible for digestion is irritated.

Carbon monoxide leads to a violation of the nervous regulation, which is manifested by dysfunction of various sensory organs:

• Hearing impairment (noise, ringing), decrease in its severity;
• Violation of visual function. There may be fog, flies before the eyes, blurry pictures, decreased visual acuity (may be significant).

With damage to the cerebellum, the victim has such pathological signs as a wobbly gait and discoordination.

In severe cases, a large volume of the brain is affected, which is manifested by such consequences as convulsive syndrome and coma.

Carbon monoxide and the respiratory system

Hypoxia provokes a violation of the respiratory system. There is hyperventilation of the lungs, that is, shortness of breath, which progresses over time. This is a compensatory mechanism. Thus, the lungs try to eliminate the lack of oxygen in the body.

If a person with carbon monoxide poisoning is not immediately helped, then his breathing becomes superficial, that is, unproductive. In this case, respiratory arrest and death of the victim may occur.

The effect of gas on skeletal muscle

Muscles need a constant supply of oxygen. With its lack, they cease to function in full. The person experiences severe weakness. He cannot stand on his feet, they give way.

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In severe cases, muscle weakness is pronounced. A person is not able to get up, pick up even a light object, call for help.

Symptoms of poisoning

The clinical picture of poisoning in this case depends on the severity of the pathological process (the amount of carbon monoxide affecting the body and the time the person stays in adverse conditions).

There are 3 degrees of severity of carbon monoxide poisoning:

• The first or mild degree is manifested by headache, pressure in the temples and forehead, nausea, single vomiting. There is dizziness and slight weakness in the body. The person complains of rapid heartbeat and chest tightness. In rare cases, auditory hallucinations are recorded;
• The second or moderate severity is characterized by neurological symptoms. The patient has complete or partial paresis and paralysis. The victim is drowsy, his hearing is reduced;
• Third or severe degree. The patient is in critical condition and requires immediate medical attention. There are convulsions, loss of consciousness. Uncontrolled emptying of the bladder and bowels may occur. Breathing is shallow, pupils almost do not react to light. There is a high probability of death before arrival at the hospital.

First aid and subsequent recovery

A person who has received carbon monoxide poisoning needs first aid as soon as possible. The outcome of poisoning depends on this.

Algorithm for providing first aid to the victim:

• Stop the flow of carbon monoxide into the body. For this, a person must be taken out or taken out of the gas contamination zone;
• Provide access to oxygen. You should loosen tight clothes, remove the belt, tie, scarf, scarf, and so on. If a person is indoors, then you need to open the windows;
• Call an ambulance. Before the arrival of medical workers, provide assistance on their own;
• If a person is conscious, then you should give him hot and strong coffee or tea to drink;
• If consciousness is absent, check for pulse and respiration. If these indicators are not determined, then you should immediately begin to perform cardiopulmonary resuscitation (indirect heart massage and artificial respiration);
• To improve blood circulation, you need to rub the limbs, cheeks and chest of the patient;
• If a person is unconscious, pulse and breathing are determined, then it is necessary to give him a stable lateral position. That is, lay it on its side. This prevents the tongue from sinking and aspiration of the respiratory tract with vomit (in the presence of vomiting);
• In the presence of ammonia, they need to lubricate the whiskey and give the victim a sniff of cotton wool moistened with ammonia.

The ambulance team continues to provide assistance to the victim:

• Oxygen is supplied through an oxygen mask;
• It is necessary to introduce an antidote - Acizol. The solution is administered intramuscularly in a volume of 1 milliliter. This drug eliminates the negative effects of carbon monoxide. It is able to destroy the carboxyhemoglobin formed in the blood;
• To restore the functions of the cardiovascular and respiratory systems, the introduction of Caffeine subcutaneously is indicated;
• Carboxylase is administered intravenously. This drug is an enzyme that breaks down carboxyhemoglobin;
• Hospitalization of the victim in a hospital.

In the hospital, symptomatic therapy is carried out, and treatment with Acizol is also continued. The course of treatment with this drug is at least 7 days.

It should be remembered that carbon monoxide is a highly toxic substance. Therefore, the consequences of poisoning are very diverse.

Doctors distinguish 2 types of consequences that arise due to the toxic effects of this substance:

• Early occurs in the first few days after poisoning;
• Late - develop after a few weeks or months.

Early complications include:

• Prolonged headaches and impaired coordination;
• Violation of the functioning of the senses. There is a sharp decrease or a short absence of vision and hearing;
• ONMK (acute violation of cerebral circulation). This pathology develops due to ischemia of the meninges (oxygen starvation) or hemorrhage in violation of the integrity of the blood vessel. A stroke can be of varying severity. In severe cases, there is a coma and death of the patient;
• Cerebral edema is a pathological condition, which consists in the impregnation of the brain tissue with fluid from the blood vessels. This condition is very life threatening. The consequences of carbon monoxide poisoning for the brain are extremely severe: disruption of the central nervous system, damage to brain tissue and death;
• Pulmonary edema is an emergency condition that requires immediate resuscitation. The characteristic symptom is a violent cough with pink foam coming from the mouth, the patient begins to choke;
• Violation of the heart rhythm;
• Sudden cardiac arrest and, as a result, the death of the victim.

Late consequences are due to the fact that many organs and systems were damaged under the influence of carbon monoxide.

Late negative effects are most often observed from the nervous, cardiovascular and respiratory systems:

• Memory impairment. Amnesia develops, that is, memory loss;
• Decreased intellectual abilities of a person;
• Violation of the motor function of the upper and lower extremities up to paralysis;
• Blindness;
• Violation of the bladder and intestines. There is urinary incontinence, involuntary bowel movements;
• Myocardial infarction is characterized by an area of ​​necrosis in the heart muscle. This is an emergency condition that can be fatal (especially with a massive heart attack);
• Angina pectoris is an ischemic lesion of the heart;
• cardiac asthma. In this case, the patient is worried about shortness of breath, a feeling of tightness in the chest, an obsessive cough, and suffocation. An attack occurs during physical exertion and a horizontal position of a person;
• Pneumonia. They occur frequently and have a long course with complications.

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First aid for carbon monoxide poisoning: symptoms and treatment, consequences

Carbon monoxide poisoning refers to acute pathological conditions that develop as a result of the ingestion of a certain concentration of carbon monoxide into the human body. This condition is life-threatening and without qualified medical assistance can be fatal.

Carbon monoxide (CO, carbon monoxide) is a product of combustion and enters the atmosphere in any of its forms. Having no smell and taste, the substance does not manifest its presence in the air in any way, it easily penetrates through walls, soil and filter materials.

Therefore, excess CO concentrations can only be detected with the help of special devices, and in the worst case, in a rapidly developing clinic. In urban air, the main contribution to the concentration of this hazardous substance is made by exhaust gases from automobile internal combustion engines.

Action on the body

• CO enters the bloodstream 200 times faster than O2 and enters into an active bond with blood hemoglobin. As a result, carboxyhemoglobin is formed - a substance that has a stronger bond with hemoglobin than oxyhemoglobin (oxygen in combination with hemoglobin). This substance blocks the process of oxygen transfer to tissue cells, causing hemic type hypoxia.
• CO binds to myoglobin (a protein in skeletal and cardiac muscle), reducing the pumping function of the heart and causing muscle weakness.
• In addition, carbon monoxide enters into oxidative reactions and disrupts the biochemical balance in tissues.

Where are cases of CO poisoning possible?

• On fires.
• In production, where CO is used in the reactions of synthesis of substances (phenol, acetone).
• In gasified premises operating gas equipment (gas stoves, water heaters, heat generators) with insufficient ventilation or insufficient supply air required for gas combustion.
• Garages, tunnels and other poorly ventilated areas where vehicle exhaust fumes can accumulate.
• When you stay near busy highways for a long time.
• At the time of leakage of lighting gas at home.
• When untimely (early) closed stove barriers of the home stove, stove in the bath, fireplace.
• Prolonged use of a kerosene lamp in an unventilated area.
• The use of low-quality air in breathing apparatus.

Risk groups (with hypersensitivity to CO)

Signs of poisoning depending on the concentration of CO

• The brain and nerve cells are most sensitive to hypoxia, so headache, nausea, dizziness, etc. are a signal that nerve cells suffer from oxygen starvation.
• More severe neurological symptoms (convulsions, loss of consciousness) occur against the background of deep damage to the nervous structures up to irreversible.

The lack of oxygen begins to be compensated by more intense cardiac activity (tachycardia), however, the occurrence of pain in the heart suggests that the heart muscle is also experiencing hypoxia. Acute pain indicates a complete cessation of oxygen supply to the myocardium.

Respiratory symptoms

Increased respiration also refers to compensatory mechanisms, but damage to the respiratory center in severe poisoning leads to superficial, ineffective respiratory movements.

Skin symptoms

The red-blue shade of the scalp and mucous membranes indicates an increased, compensatory blood flow to the head.

Consequences of carbon monoxide poisoning

With mild and moderate degrees of severity of poisoning, the patient may be disturbed for a long time by headaches, dizziness, memory and intelligence loss, emotional instability, which is associated with damage to the gray and white matter of the brain.

Severe complications are most often irreversible and often lead to death:

• skin-trophic disorders (edema followed by tissue necrosis);
• subarachnoid hemorrhages;
• violation of cerebral hemodynamics;
• swelling of the brain;
• polyneuritis;
• impaired vision and hearing to complete loss;
• myocardial infarction;
• severe pneumonia complicating coma.

First aid for carbon monoxide poisoning

Pre-hospital care implies stopping the contact of the victim with poison gas and restoring vital functions. First aid for carbon monoxide poisoning should exclude the poisoning of someone who is trying to provide this very help. Ideally, you should put on a gas mask and only then go into the room where the victim is located.

• Remove or remove the injured person from the room where there is an increased concentration of CO. This is the measure that must be performed first of all, since pathological changes in the body intensify with each breath.
• Call an ambulance for any condition of the patient, even if he jokes and laughs. Perhaps this is a consequence of the action of CO on the vital centers of the central nervous system, and not a sign of health.
• With a mild degree of poisoning, give a person a strong sweet tea to drink, warm and ensure peace.
• In the absence or confusion of consciousness - lay on a flat surface on its side, unfasten the collar, belt, provide fresh air. Give a sniff of cotton wool with ammonia at a distance of 1 cm.
• In the absence of cardiac or respiratory activity, perform artificial respiration and massage the sternum in the projection of the heart.

What to do in case of fire poisoning?

If it so happened that people were left in the burning room, you should not try to save them on your own - this will lead to an increase in the number of victims of the emergency and nothing more! You should immediately call the Ministry of Emergency Situations.

Even 2-3 breaths of CO poisoned air can be lethal, so no wet rags and filtration masks can protect a person who comes to the rescue. Only a gas mask can protect against the deadly action of CO!

Therefore, the rescue of people in such a situation should be trusted to professionals - the EMERCOM team.

Treatment

If a person is in a critical condition, the ambulance team carries out a set of resuscitation measures. In the first minutes, the antidote Acizol 6% is administered by intramuscular injection in a volume of 1 ml. The patient is taken to the hospital (intensive care unit).

In a hospital, the patient is provided with complete rest. They organize breathing with pure oxygen with a partial pressure of 1.5-2 atm or carbogen (95% oxygen and 5% carbon dioxide) for 3-6 hours.

Further therapy is aimed at restoring the functioning of the central nervous system and other organs and depends on the severity of the condition and the reversibility of the pathological reactions that have occurred.

Prevention of CO poisoning

• All work associated with the risk of CO poisoning should be carried out only in well-ventilated areas.
• Check dampers for stoves and fireplaces. Never close them when the firewood is not completely burned.
• Install autonomous gas detectors in rooms with a potential risk of CO poisoning.
• In case of possible contact with CO, take 1 capsule of Acizol half an hour before the likely contact with gas. Protection lasts 2-2.5 hours after taking the capsule.

Azizol is a domestic drug, a quick and effective antidote against acute carbon monoxide poisoning in lethal doses. It prevents the formation of carboxyhemoglobin substance and accelerates the excretion of CO from the body. As early as possible, intramuscular administration of Acizol to victims significantly increases their chances of survival and increases the effectiveness of subsequent resuscitation and medical measures.

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Carbon monoxide poisoning. First aid for poisoning.

2. Carbon monoxide poisoning in everyday life: malfunction of heating devices (fireplaces, stoves, etc.), leakage of household propane gas (propane contains 4-11% CO), prolonged burning of kerosene lamps, etc.

3. Poisoning during fires (buildings, transport cars, elevators, aircraft, etc.)

The manifestation of symptoms in case of carbon monoxide poisoning directly depends on its concentration in the inhaled air and on the duration of its exposure to the human body. So, with a concentration of carbon monoxide in the atmosphere of 0.02-0.03% and an exposure time of 4-6 hours, the following symptoms will appear: headache, dizziness, nausea, and impaired coordination of movements. And at a concentration of 0.1-0.2% and a duration of exposure of 1-2 hours, coma occurs, respiratory arrest and death is possible.

• From the concentration of carbon monoxide in the inhaled air
• From the duration of exposure to carbon monoxide on the human body
• From the degree of physical activity of the victim at the time of the action of the poison (the higher the load, the more severe the consequences of poisoning)
• Women are more resistant to carbon monoxide than men
• Poisoning is difficult to tolerate: malnourished people suffering from anemia, bronchitis, bronchial asthma, alcoholics, heavy smokers.
• Children, adolescents and pregnant women are especially sensitive to the action of the poison.

Help Steps	How?	What for?
Stop exposure to CO		Remove to fresh air, or Shut off the CO source, or Put on an oxygen mask or gas mask (with a hopcalite cartridge)	With every minute of carbon monoxide exposure to the body, the possibility of survival is reduced.
Ensure airway patency and adequate oxygen delivery		Remove the victim to the open air, or put on an oxygen mask (if any), or open windows and doors indoors. Examine and clear the airways, Loosen from tight clothing, tie, shirt Lay victim on side	For half an hour in the fresh air, the content of carboxyhemoglobin in the blood decreases by 50%. The position on the side prevents the tongue from sinking
Stimulate breathing and provide blood flow to the head, bring to consciousness		Give a sniff of ammonia (no closer than 1 cm from the nose) Rub the chest, put mustard plasters on the chest and back (if any) Give hot tea, coffee	Ammonia stimulates the respiratory center and brings out of unconsciousness. Rubbing the chest and mustard plasters improve blood circulation in the upper parts of the body, which increases cerebral circulation. Tea and coffee contain caffeine, which has a tonic effect on the nervous system, and also stimulates breathing.
If necessary, perform chest compressions and artificial respiration		One cycle: 2 breaths and 30 chest compressions. See Chest Compression and CPR	Provides blood circulation and oxygen delivery to organs and tissues. Supports the vital functions of the body until the arrival of medical help.
Provide peace, protect from unnecessary waste of energy		Lay on side Warm, protect from hypothermia, wrap up. But do not overheat the victim.	Lay down to reduce oxygen consumption. When hypothermia or overheating, the body spends a lot of energy to maintain the necessary balance.
		Oxygen 12-15 liters per minute, for 6 hours (delivered with: oxygen mask, oxygen tent, or mechanical ventilation). Acizol, ampoules 6% -1.0 ml, Capsules 120 mg. Treatment: 1 ml intramuscularly, as soon as possible after poisoning. Re-introduction after 1 hour. For prevention: 1 ml intramuscularly, 20-30 minutes before entering the danger zone.	Oxygen competes with CO for a place "on hemoglobin", thus, the more oxygen there is, the more chances it has to displace CO and take its natural place. Azizol is an antidote of carbon monoxide, accelerates the breakdown of the pathological compound - carboxyhemoglobin and promotes the addition of oxygen to hemoglobin. Reduces the toxic effect of CO on cells. It is also used as a prophylactic, several times reduces the harmful effects of carbon monoxide on the body.

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Carbon monoxide poisoning - symptoms, first aid, treatment, consequences

Carbon monoxide, or carbon monoxide (chemical formula CO) is an extremely toxic, colorless gas. It is an obligatory product of incomplete combustion of carbon-containing substances: it is determined in car exhaust gases, cigarette smoke, in smoke from fires, etc. Carbon monoxide has no smell, therefore it is impossible to detect its presence and evaluate the concentration in the inhaled air without instruments.

Poisonings that occur with the participation of carbon monoxide and smoke are quite relevant. The absence of color, the smell of gas, a very high percentage of death, declare that it is necessary to learn how to provide first aid in case of carbon monoxide poisoning. It is very important to provide emergency care in a timely manner and start treatment in order to avoid the most difficult health problems, as well as death.

Causes of intoxication

CO or carbon monoxide arises as a result of oxidation (incomplete combustion), then it enters the bloodstream and quickly comes into contact with hemoglobin. As a result of such processes, carboxyhemoglobin is formed. All this leads to oxygen starvation, which is very dangerous.

Carbon monoxide poisoning can occur in these emergencies:

• fire - natural, domestic;
• from exhaust gases;
• car interior or garage, at the time of engine operation;
• use of heating equipment, stoves, chimneys;
• the process of production of certain organic substances - acetone, and so on.

Symptoms and signs of damage

Signs of carbon monoxide poisoning is expressed in its negative impact on the human body. Oxygen starvation has a huge impact on the general health of a person, the state of the nervous system, respiration and blood circulation. The degree of damage depends on the amount of CO in the air, as well as the length of stay in a dangerous room. When a person breathes air containing 0.02 - 0.03% of the gas for about six hours, then the following consequences begin to appear:

• vomiting, nausea;
• dizziness and even fainting;
• headache;
• apathy, weakness, general malaise, confusion;
• the functioning of the heart is disturbed;
• there are problems with the respiratory system of the victim.

When the concentration of carbon monoxide increases to 0.1 - 0.2%, a coma may develop, which can provoke cardiac arrest and death. Poisoning is accompanied by alarming symptoms that signal that a terrible lesion of all internal organs is occurring.

For mild to moderate carbon monoxide poisoning, symptoms may include:

• severe nausea;
• periodic vomiting;
• lack of oxygen;
• discomfort;
• violation of cardiac activity;
• there is a strong pulsation in the temples;
• dizziness, fainting;
• specific noise in the ears, a film before the eyes;
• decreased hearing, vision;
• coordination in time, space is disturbed;
• clouding of consciousness;
• pulse quickens.

For a severe degree, the following painful symptoms and signs are characteristic:

• pulse about one hundred and thirty beats per minute, or very weak;
• loss of consciousness with the formation of a coma;
• convulsions;
• disturbed breathing;
• involuntary urination.

First of all, the brain suffers, due to the high susceptibility of the lack of oxygen. Headache, muscle weakness, irregular breathing, vomiting, trembling are the main signs of poisoning.

Atypical types of intoxication:

• fainting - there is a sharp and instant drop in blood pressure, which is accompanied by fainting, as well as blanching of the skin or mucous membranes;
• euphoric - gradually develops psychomotor overexcitation, which occurs with hallucinations or delusions, then clouding of the mind occurs, the heart stops and death occurs.

Chronic carbon monoxide poisoning associated with prolonged exposure to carbon monoxide is considered very dangerous. As a result, there are problems with the endocrine, as well as the nervous system. Timely provision of emergency care and treatment is very important.

First aid

To avoid tragic consequences, it is urgent to start medical treatment in a hospital. Help for the above signs/symptoms:

• urgently call an ambulance;
• try to stop the harmful effects of carbon monoxide - move the victim to fresh air;
• provide oxygen supply - remove tight clothing from the victim, then lay it on its side;
• to return a person to consciousness - use the famous ammonia;
• use cold compresses, as well as rubbing, to restore, improve blood circulation;
• prepare hot coffee or tea;
• in the absence of breathing - it is necessary to perform an indirect heart massage, artificial respiration.

When a person has carbon monoxide poisoning, the treatment that is carried out in a hospital consists of a complex of therapeutic procedures, activities:

• symptomatic measures;
• oxygen therapy - for a similar procedure, an oxygen mask and pure oxygen are used;
• restoration of acid and alkaline balance.

Assistance in case of carbon monoxide poisoning, as well as treatment, should be provided by qualified specialists, since human life is at stake. If the signs are severe enough, especially in pregnant women, accompanied by a permanent loss of consciousness, urgent measures are needed. A special procedure is carried out, breathing with pure oxygen in a pressure chamber.

In addition to CO poisoning, emergencies occur every ten minutes around the world. As a result of which, people die from smoke poisoning. Intoxication occurs due to the penetration of smoke into the respiratory tract of the victim. Smoke consists of such toxic substances as:

• hydrogen cyanide (dangerous even in small quantities);
• carbon monoxide.

The main danger is smoke poisoning caused by the burning of the following substances:

• varnishes;
• plastic;
• rubber;
• foam rubber;
• plywood.

In the process of combustion, the above substances produce dioxin, as well as phosgene, which provoke the development of malignant tumors and allergic reactions.

• body weakness;
• drowsiness;
• nausea, vomiting;
• noise in ears;
• headache;
• dyspnea;
• heaviness in the head;

The intake of smoke into the human body is accompanied by serious manifestations after three to four hours. There is a high risk and danger to life. First aid for smoke ingestion is similar to that performed for a tragedy with carbon monoxide. It is necessary to call an ambulance, as well as provide qualified treatment in a hospital.

Preventive actions

To avoid carbon monoxide poisoning, you need to know certain rules:

• use high-quality, serviceable equipment designed for heating;
• if your house has stove heating, then do not forget to clean the chimney;
• regularly ventilate the room;
• observe safety measures in the car when the engine is running, especially in the cold season;
• be careful near the fire.

Awareness in such a topic will help you avoid tragic incidents and subsequent consequences. Be careful!

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

Why is carbon monoxide dangerous?

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

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

How carbon monoxide affects the body

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

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

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

Symptoms of carbon monoxide poisoning

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

central nervous system

In mild to moderate poisoning, there will be:

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

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

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

The cardiovascular system

Light and moderate degree of poisoning will be characterized by:

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

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

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

Respiratory system

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

Skin and mucous membranes

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

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

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

Consequences of carbon monoxide poisoning

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

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

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

1. From the side of the central nervous system: memory loss, decreased intelligence, impaired motor function, apathy, blindness, dysfunction of the pelvic organs, parkinsonism, paralysis.
2. From the side of the cardiovascular system:, cardiac asthma, various types of mycoarditis,.
3. From the respiratory system: rapid.

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

First aid for carbon monoxide poisoning

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

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

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

Carbon monoxide poisoning is one of the most common poisoning in everyday life, it is very dangerous and often leads to serious consequences and even death.

CO (carbon monoxide) is a product of incomplete combustion of organic substances. It is a colorless, tasteless and odorless gas, does not irritate the skin and mucous membranes, therefore it is not organoleptically determined in the air. The source of this poison can be any flame, running internal combustion engines, unregulated stove heating, damage to gas pipelines in apartments and other premises.

More often acute carbon monoxide poisoning is obtained in garages, apartments, fires, industrial accidents. In such cases, the concentration of CO can reach significant levels. So, in the exhaust gases of cars, it can exceed 3-6%.

Carbon monoxide has a high toxicity, which is determined by its concentration in the air. So, when a person is in a room where its concentration reaches 0.1% for 1 hour, he develops acute poisoning of moderate severity; severe - at a concentration of 0.3% for 30 minutes, and fatal - when a person inhales air with 0.4% CO for 30 minutes or 0.5% for only 1 minute.

Formation of carboxyhemoglobin

The danger to humans and animals arises from the inhalation penetration of carbon monoxide into the body and is determined to a large extent by the affinity of CO with iron-containing compounds: hemoglobin, myoglobin, cytochrome enzymes that form reverse complexes. In particular, CO, interacting with hemoglobin, converts it into a state of carboxyhemoglobin (sleep). It is able to carry oxygen from the lungs to the tissues. Moreover, in the presence of dormouse, the dissociation of oxyhemoglobin into O2 and hemoglobin decreases. This makes it difficult to transport oxygen to tissues and negatively affects the activity of organs and systems of the body, primarily the brain and heart.

In persons who breathe air containing 0.1% CO, the level of sleepiness in the blood can reach 50%. Such a high level of this compound is facilitated by a significant affinity (affinity) of CO with hemoglobin, which is 220 times higher than the affinity of O2. The dissociation of carboxyhemoglobin is 3600 times slower than that of oxyhemoglobin. Its stability in the body creates the basis for the development of hemic and tissue hypoxia.

The antagonist of carbon monoxide in the body is oxygen. At an air pressure of 1 atm., TCO from the body is about 320 minutes, with inhalation of 100% oxygen - 80 minutes, and in a pressure chamber (2-3 atm.) - decreases to 20 minutes.

Signs of carbon monoxide poisoning

Carbon monoxide poisoning is very dangerous because carbon monoxide is odorless and colorless. A person does not even understand that he is in mortal danger.
Signs of carbon monoxide poisoning are:

• drowsiness,
• vision and hearing problems
• headache,
• dizziness,
• dyspnea,
• noise in ears,
• nausea,
• indifference to danger
• loss of consciousness,
• convulsions.

Symptoms of poisoning

Manifestations of carbon monoxide intoxication are determined not only by its content in the air, but also by the duration of action and the intensity of breathing. Inhalation of CO at a concentration of 0.05% for 60 minutes leads to a mild headache. At the same time, the concentration of sleepyheads in the blood does not exceed 20%. Longer exposure or more intense inhalation can increase dormice levels by up to 40-50%. Clinically, this is manifested by significant headache, confusion, bright red coloration of the skin and mucous membranes. At a concentration of CO in the air of 0.1%, loss of consciousness occurs, breathing is weakened. Death is possible if the duration of action of the gas exceeds 1 hour. At the same time, the level of sleepiness can reach 60-90%. At a sleepiness level of less than 15%, there are no signs of acute poisoning.
The severity of acute carbon monoxide poisoning increases with overwork, blood loss, hypovitaminosis, if the victims have concomitant diseases, especially the cardiovascular and respiratory systems, at high air temperature, a decrease in the O2 content and an increase in CO2 in it.

The leading clinical signs of acute carbon monoxide poisoning are hypoxia and the appearance of symptoms in the following sequence:

• a) psychomotor disorders;
• b) headache and feeling of pressure in the temporal region;
• c) confusion and decreased visual acuity;
• d) tachycardia, tachypnea, loss of consciousness, coma;
• e) deep coma, convulsions, shock and respiratory arrest.

Degrees of acute intoxication

There are 4 degrees of severity of acute carbon monoxide poisoning CO: mild, moderate, severe and fulminant.

mild poisoning

Mild CO poisoning occurs when the level of dormice in plasma reaches 20-30%. There is a headache, dizziness, a feeling of heaviness and squeezing in the head, pulsation in the temples, tinnitus, drowsiness and lethargy. Possible euphoria with visual and auditory hallucinations, nausea, and sometimes vomiting. Often develops tachycardia, moderate hypertension, shortness of breath. Moderately dilated pupils react to light.

Moderate poisoning

Manifestations of acute poisoning of moderate severity occur when the level of sleepiness increases to 50%. Clinically, this is manifested by drowsiness, severe dizziness and headache, increasing weakness, impaired coordination of movements, and vomiting. Characteristic short-term loss of consciousness and memory, the appearance of convulsions, tonic contraction of the masticatory muscles (trismus). As with mild poisoning, the skin and mucous membranes remain bright red, the heartbeat and shortness of breath increase, and sometimes a coma develops.

severe poisoning

When the content of dormice in the blood exceeds 50%, the condition of the victims deteriorates sharply (severe degree of intoxication). In patients, consciousness may not be restored. There are such manifestations of CNS damage as hallucinations, delirium, clonic-tonic convulsions, paresis and paralysis, decerebral rigidity, hyperthermia, meningitis symptoms, and from the circulatory system - severe tachycardia, arrhythmias, angina pectoris, tachypnea. Breathing becomes pathological, like Cheyne-Stokes.
Urination and defecation are involuntary.

Depending on the circumstances, the clinical picture of acute intoxication may be supplemented by other manifestations. So, on fires, a burn of the upper respiratory tract, acute respiratory failure of the aspiration-obstructive type, sudden death (fulminant degree of poisoning) can develop. Victims instantly lose consciousness. Their breathing stops, and after 3-5 minutes their heart stops.

In addition, acute carbon monoxide poisoning in the toxicogenic phase can be complicated by pulmonary edema, myocardial infarction, and in the somatogenic phase - polyneuritis, pneumonia, impaired skin trophism, and acute kidney failure.

At the pre-medical stage, the diagnosis of acute CO intoxication is based on the results of clinical manifestations, anamnesis data, and an analysis of the circumstances at the scene. 5 ml of blood (with 1-2 drops of heparin) is transferred to the laboratory for analysis. Patients are evacuated to a hospital, preferably with a pressure chamber.

What to do about carbon monoxide poisoning

When we see a person in an unconscious state, first of all we need to assess what happened to him. In order to understand, one should study the environment of the victim.

If an unconscious person assumes that he has been poisoned by carbon monoxide, it is possible if:
1. The victim is in the garage with the car engine running.
2. The victim is at the stove.

A person poisoned by carbon monoxide will have difficulty breathing as long as he is conscious.

What to do?
First of all, don't panic.
When moving the victim, you must always remember about your own safety. Therefore, try not to breathe the air exhaled by the victim and the air in the room where there is a gas leak.
First step: fresh air
If a person has lost consciousness, he must be taken out to fresh air. If this is not possible, provide fresh air on site (switch off car, open garage door, window).

Second step: assessment of the victim's respiratory function
In case of unconsciousness, after providing fresh air, he should be given artificial respiration. In case of abnormality, immediately call an ambulance and then proceed with chest massage (30 compressions and 2 breaths).

Third step: waiting for help
If it was possible to restore proper breathing, we place the victim in a safe position and look forward to the arrival of medical help. While waiting, you can not leave the patient, you need to constantly check his condition. In addition, the patient should be covered - protected from hypothermia.

Emergency aid for intoxication

Emergency care is to immediately stop further penetration of carbon monoxide into the body of the victim and provide him with calmness, warmth and a high level of ventilation. To do this, you should immediately take it out of the contaminated room, provide access to clean air or oxygen. Bring a cotton swab moistened with ammonia to the nose, rub the chest, put heating pads on the legs, mustard plasters on the chest and back, give the victim hot tea or coffee to drink.

When breathing stops, it is necessary to resort to artificial ventilation of the lungs in the hyperventilation mode, the introduction of respiratory stimulants (lobelin hydrochloride 1 ml of 1% solution, cytiton 1 ml). The use of carbogen and methylene blue is contraindicated. It is also necessary to stop convulsions with anticonvulsants.

Pharmacological correction of cardiac disorders and prevention of threatening disorders of heart rhythm and conduction in acute carbon monoxide poisoning is carried out using unithiol 5-10 ml 5% solution, sodium thiosulfate 30-60 ml 30% solution, cytochrome C 25-50 mg vitamin E 1 ml 30% oil solution subcutaneously. It is advisable to infuse 5-10% glucose with insulin, B vitamins, ascorbic acid, glucocorticoids, for example, intravenously 90-120 mg of prednisolone hemisuccinate.

In the presence of hyperthermia, intravenous analgin injections of 2 ml of a 50% solution and craniocerebral hypothermia are indicated. With the appearance of an injection of mezaton 0.5-1 ml of a 1% solution, ephedrine hydrochloride 1 ml of a 5% solution. The stages of providing medical care to a victim of carbon monoxide are presented in the table.

Stages of medical care for victims of carbon monoxide poisoning(according to P. Kondratenko, 2001)

The most effective treatment for acute carbon monoxide intoxication is oxybarotherapy (at a pressure of 2.5 atmospheres for 30-90 minutes), since inhalation of O2 under pressure sharply accelerates the release of CO from the serum, contributes to the disappearance of hemocirculatory disorders, improves respiration and heart activity.

Chronic carbon monoxide toxicity

With chronic exposure to CO, poisoning is most common in the professional environment.

Main clinical manifestations

• cerebrasthenia,
• diencephaly,
• polyneuritis,
• angina attacks,
• thyrotoxicosis,
• impotence,
• pernicious anemia,
• polycythemia,
• splenomegaly and others. After severe poisoning, there are consequences - deterioration of memory and intelligence.

Treatment

Collecting the history that caused acute poisoning, stopping contact with CO, symptomatic treatment, cerebroprotective treatment with glucose-insulin infusions, B vitamins, enzyme preparations, physiotherapy, rehabilitation - physical and mental.