What to do if you inhale chemicals. Help with chemical poisoning. When poisons enter the stomach

Chemical poisoning develops when direct contact skin and mucous membranes with toxic substances, if poisonous compounds are ingested through the digestive and respiratory system. Can cause toxicity in the body medications, pesticides and products household chemicals with careless handling. If symptoms of chemical poisoning appear, the victim needs to provide first aid in order to avoid serious consequences and death.

Reasons for the development of chemical poisoning

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

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

General symptoms and manifestations

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

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

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

First aid and treatment

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

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

The medical team needs to accurately describe the actions taken. In a medical facility, doctors administer an antidote that can fight the toxin. Diagnosing a toxic substance with general analyzes blood, urine.

Poisoning by mouth

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

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

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

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

Respiratory poisoning

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

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

The patient is asked to drink water.

Skin contact with chemicals

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

Folk remedies and herbs for the treatment of poisoning

Folk remedies are used as additional measure to remove toxins:

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

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

Application herbal decoctions possible only after consultation with your doctor.

Possible Complications

Chemicals increase the risk of severe violations in the work of organs and can lead to death. Even during the period of treatment and rehabilitation, complications can occur. Type and shape negative consequences depend on the amount of poison that got inside, the route of penetration.

After intoxication, they can develop:

Internal bleeding due to damage to the gastrointestinal tract.
Hemolysis of erythrocytes (decay), leading to the occurrence of anemia and hypoxia (oxygen starvation) of cellular structures.
A sharp drop in blood pressure.
Arrhythmia, heart failure.
Failure of the central nervous system up to coma.
Acute condition with renal and liver failure. Leads to disruption water-salt balance organism.

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

Prevention of poisoning

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

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

Preventive measures must be taken to prevent intoxication with toxic compounds. Security measures are designed to prevent severe conditions non-recoverable, reducing the risk of death.

Chemical poisoning is a combination negative effects that arise due to the penetration of toxic components into the body. This can happen when in contact with the skin, eyes or mucous membranes. Chemical intoxication can be the result of taking certain medications when their dosage is exceeded.

The symptoms of chemical poisoning are determined by the type and concentration of the toxic substance that has entered the body. In addition, the clinical picture manifests itself taking into account the individual characteristics of a person. Some toxins are low level toxicity and can lead to certain impairment only with prolonged exposure or repeated penetration into the body at maximum concentration.

And there are substances that are so toxic that even if they penetrate in the amount of one drop, they can lead to serious complications. The toxicity of each component in a particular case is determined by the genetic characteristics of the victim. Normally defined non-toxic components have toxic effect for people with a specific genotype.

The dosage of the toxin that leads to symptoms of chemical poisoning is also determined taking into account the age of the victim. For example, if we are talking about small child, then if a large amount of paracetamol enters his body, this will lead to the development of symptoms of chemical poisoning, which cannot be said about adults. For the elderly, signs of intoxication will occur with the use of sedatives in high concentrations. In this case, in a middle-aged person, no deviations will be observed.

Poisoning chemicals may have a minor clinical picture, but all the symptoms lead to discomfort. The poisoned person feels the following changes:

dry mouth;
blurred vision;
painful sensations;
coma;
violation of the heart rhythm;
difficulty breathing;
excitation of a pronounced nature.

Certain toxins begin to exert their harmful effects a couple of seconds after they enter, and some of them after a couple of hours or days after they hit the body. There are toxins that do not lead to the development of visible symptoms until there is an irreversible disruption of the vital important organs.

cyanide poisoning

Cyanides include:

cyanic acid,
potassium cyanide,
sodium cyanide.

The poison enters the body through household and industrial means. For a quick form of hydrocyanic acid poisoning, symptoms visit the victim in a few seconds. In this case, convulsions, pressure surges, respiratory arrest, and death are observed.

If intoxication is of a slow form, then signs are observed after a few hours. Clinical picture presented as follows:

smell and taste of bitter almonds,
vomit,
headache,
rapid breathing,
chest pain,
oppressed consciousness.

Severe chemical poisoning is characterized by convulsions, insufficient work of the heart and blood vessels, paralysis and death. Health care includes the following actions:

The injured person must be sent to fresh air.
Take off his clothes and put in a bag for later disposal.
Wash the person with soap and water, paying careful attention to the eyes.
For gastric lavage, use a 2% soda solution.
cook warm tea with sugar, because thanks to glucose it is possible to block the influence of hydrocyanic acid.
Drop amyl nitrite on a cotton swab, bring it to the patient's nose every 2 minutes.
Perform if necessary artificial respiration.

Solvent poisoning

Under understand chemical organic substances. The most common include:

acetone,
petrol,
ether,
alcohols,
dichloroethane,
solvent

They are able to penetrate as vapor into the lungs, and through the skin into the blood. Solvent intoxication can cause the development of narcotic symptoms.

Poisoning is manifested by the following symptoms:

irritation of the mucous membranes, accompanied by coughing and sneezing,
headache and dizziness,
salivation,
stomach ache,
vomit,
fainting,
convulsions.

Damage to the main organs - kidneys, liver, nervous and respiratory systems is not excluded.

First aid for poisoning is as follows:

Send the victim to the air.
Rinse eyes and body with water.
Give activated charcoal to drink.

It is forbidden to give a person hot and sweet drinks, vegetable oil. All these components only increase the absorbability of poisons. When intoxicated with petroleum products, it is forbidden to cause a gag reflex. If there is a suspicion of severe intoxication, then you should seek medical help, as this can result in complications such as bronchitis, hepatitis, pneumonia.

Arsenic poisoning

Arsenic intoxication can happen through negligence or when trying to commit suicide. The pollutant enters the body during the use of products that contain arsenic, when using pesticides, antifungal medicines with arsenic. This poisonous component is also used in the production of glass, electronic appliances, leather industry.

Arsenic intoxication is accompanied by the presence of a garlic odor on the breath, dehydration, and diarrhea. If arsenic vapor penetrated into Airways, it can lead to death. In case of arsenic poisoning, all organs are affected. It is impossible to get poisoned with a drug containing arsenic during dental treatment if the material was removed on time.

Help for chemical poisoning is standard:

Rinse the stomach. To do this, prepare 2 liters of water and dissolve 50 g of salt in it.
To remove poison from the skin, use soap and water.
Drinking activated charcoal does not make sense, since it does not help the absorption of the toxic component.

Sulfur poisoning

Sulfur compounds can be of various widows, among which are sulfur dioxide, hydrogen sulfide, carbon disulfide and sulfuric acids, salts. They enter the body through the respiratory tract, skin, digestive system. Intoxication with pure sulfur is very rare. Most often, poisoning occurs precisely with sulfur compounds.

In case of hydrogen sulfide poisoning, the following symptoms occur: pain in the eyes, pulmonary edema, shortness of breath, death. When intoxicated with carbon disulfide, a neurotoxic and psychotropic effect occurs: redness, burning, pain in the head, feeling of nausea, convulsions, fainting, coma, paralysis. Lethal outcome is not excluded. Sulfur dioxide intoxication is characterized by coughing, wheezing in the lungs, edema, and hemoptysis.

To provide first aid for chemical poisoning, the following plan should be followed:

Remove the person from the area of the poisonous substance.
Clean exposed skin with soap and water.
Wet a cotton pad with amyl nitrite and allow the victim to breathe.
In case of thermal injury caused by acid, wash the affected area with water and a weak solution of soda.
If there was thermal injury in front of your eyes, then rinse them with running water, and then with a 2% solution with soda.

Gas poisoning

Intoxication occurs as a result of inhalation of air with a mixture. The victim develops the following symptoms:

headache,
excitation,
nausea,
constriction of the pupils,
slow heart rate,
increased secretion of saliva,
decrease in blood pressure.

First aid for chemical poisoning is necessary according to the following plan:

Take the victim out of the room to create an influx of fresh air.
Give him a drink and a sorbent to remove all toxins.
If cardiac and respiratory arrest occurs, then do heart massage and artificial respiration.

After providing 1 assistance, the victim needs medical assistance, and it includes:

Removal of poisons from the body.
Elimination of antidotes.
Elimination of symptoms of hypoxia.
Maintaining the functioning of organs and systems.
Performing infusion, oxygen therapy, symptomatic treatment and hemodialysis.

You can learn more about chemical intoxication and first aid from the video:

Chemical pollution and poisoning have a certain connection, since it is the state of the environment that has a huge impact on human health. From this we can conclude that ecology is an integral part of human life.

Infectious disease physician, private clinic"Medcentrservice", Moscow. Senior editor of the Poisoning Stop website.

Modern man daily uses many various means household chemicals, which are so effective and make life so easy that sometimes we forget about the danger and do not follow the rules for the use and storage of these substances. Due to the neglect of the recommendations of the manufacturer of washing powder or gel, a serious threat to the health of family members, especially children, can arise. It is better to know in advance what to do in such a situation.

Types of hazardous household chemicals:

cosmetic products (colognes, lotions) containing various alcohols(butyl, amyl, ethyl). Ingestion of such drugs causes severe alcohol poisoning, dizziness, vomiting, impaired breathing and heartbeat;
acids (hydrochloric, acetic, carbolic, oxalic, hydrofluoric). These substances are found in bath and toilet detergents, rust stain removers, and brake fluid. Such funds can cause serious burns of the skin and mucous membranes, up to burning the walls of the stomach;
alkalis ( ammonia, caustic soda, persol), cause poisoning;
products containing FOS (organophosphorus compounds). These are mainly insecticides (dichlorvos, chlorophos) and repellents, which can be poisonous to humans;
solvents (turpentine, acetone);
foaming liquids (shampoo, dishwashing liquid);
products that contain chlorinated hydrocarbons (used to remove fatty stains) that affect the kidneys and liver.
If a household cleaning product is in a prominent place, then it is very likely that a small child will want to taste a bright liquid from a beautiful bottle. However, adults can mistakenly take a sip instead of water. vinegar essence. In case of careless handling of powders, cases of their entry into the respiratory tract are not uncommon.

Symptoms of poisoning with household chemicals

Poisoning with household chemicals may be accompanied by the following symptoms:

dizziness, nausea and vomiting;
pain from chemical burn in the larynx, esophagus, stomach or respiratory tract;
foam from the mouth;
convulsions;
coughing and choking;
loss of self-control or loss of consciousness.

Why it is impossible to treat poisoning with folk methods

Our grandmothers treated food poisoning with simple folk methods:

watered the patient with a solution of potassium permanganate;
gave activated charcoal;
caused vomiting;
washed out the stomach with an enema.

In case of poisoning with household chemicals, the above methods of treatment are usually not suitable. Potassium permanganate (potassium permanganate) is the strongest oxidizing agent. If the powder does not dissolve well in water, and the whole crystal falls into the stomach (the mucous membrane of which is already burned), potassium permanganate additionally injures the mucous membrane.

Activated carbon - excellent remedy for minor digestive and lung problems food poisoning. AT serious cases when a person has swallowed a caustic or foaming liquid, activated charcoal in the usual dosage (1 tablet per 10 kg of the patient's weight) is useless. In order for the medicine to absorb the chemistry that got into the stomach, one would have to take coal at the rate of 1 tablet per kilogram of the weight of the poisoned person. For a person with a burned throat, this would be torture. In addition, in many cases, the victim should not take anything at all before being examined by a doctor.

It is impossible to induce vomiting if the patient has drunk a burning liquid: vomit, passing through the esophagus in the opposite direction, will only burn the mucous membrane even more and can injure the respiratory tract. If a foaming gel gets into the stomach, then with artificial stimulation of vomiting, the foam can clog the airways and provoke suffocation.

Do not recommend experts and gastric lavage with an enema. In this case, the caustic liquid from the stomach enters the small intestine and is quickly absorbed into the bloodstream, at the same time injuring the mucous membrane of its walls. Doctors do gastric lavage using a special probe.

First aid for poisoning household chemicals

First of all, you need to call ambulance, explaining in detail to the dispatcher what poisoned the person. The packaging of the drunk product should be kept and given to the toxicologist.

The poisoned person must be removed from the room filled with vapors of a toxic chemical. The person who burned the respiratory tract toxic fumes or powder, rinse oral cavity flowing water.

If the poisonous substance has entered the stomach, but the patient is conscious, he is laid on his stomach, and his head is turned in such a way that in case of vomiting he does not accidentally inhale vomit and does not burn the respiratory tract. The patient, who has lost consciousness, opens his mouth slightly and pushes forward a little. lower jaw so he doesn't suffocate. If a person has removable dentures or braces, they should be removed from the mouth so that they do not oxidize due to the caustic liquid.

The patient should rinse his mouth thoroughly several times (preferably with running water): particles of household chemicals linger on the tongue and palate, and you need to try so that the remnants of the poison do not get into the stomach.

If caustic liquid gets into the eyes, they must be rinsed. Lips, chin, other parts of the body that have been in contact with acid or alkali should be kept in cold running water for at least 20 minutes. The only exceptions are hydrofluoric acid and quicklime. The skin area burnt with hydrofluoric acid should be gently blotted with a dry cloth (in no case should you rub or smear the substance), and then keep the burn area in cold running water for 20 minutes. The burn from quicklime is not moistened, but, after getting wet with a dry cloth, is smeared with glycerin.

Do not give the patient to drink if:

he was poisoned by a foaming liquid;
his stomach hurts (that is, perforation is possible).

In other cases, the patient should drink 2-3 glasses of water so that the concentration of the caustic liquid in the stomach decreases. Well envelops the walls of the stomach and stops the absorption of poison into the blood in case of acid poisoning egg white. For the same purpose, the patient can drink a glass of milk.

It is not recommended to independently try to carry out a neutralization reaction in the stomach of the victim: if he drank acid, give him soda, if alkaline, drink with a solution of vinegar. To do this, you need to know chemistry well, and any mistake will only worsen the condition.

To avoid poisoning, all household chemicals should be stored in their original packaging, in specially designated places that children and pets do not have access to.

Which Doctors Should You See If You Have Chemical Poisoning

What is chemical poisoning

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

What causes chemical poisoning

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

Symptoms of chemical poisoning

Symptoms of poisoning depend on the type and amount of poison ingested, and the individual characteristics of the victim. Some poisons with low toxicity cause some kind of damage only with prolonged exposure or repeated ingestion in 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, in a small child, the ingestion of more paracetamol is more likely to cause symptoms of poisoning than the same dose in an adult. For an elderly person, a sedative from the benzodiazepine group (seduxen, relanium, phenazepam) can be toxic in doses that do not cause any disturbance in a middle-aged person.

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

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

Diagnosis of chemical poisoning

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

In all cases of poisoning, an attempt should be made to identify the toxic agent. It is obvious that without such identification it is impossible to carry out specific therapy with antidotes. In cases of murder, suicide, or criminal abortion, the identification of poison can have legal implications. Where poisoning is the result of industrial exposure or therapeutic error, precise knowledge of the active agents is necessary 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 establish only the trade name of the product, which does not allow you to know its chemical composition. The list of references at the end of this chapter lists a number of books that list the active constituents of substances used in the household, agriculture, patent medicines and poisonous plants. A small reference book of this type should be carried by every doctor in his portfolio. The latest information of this kind can also be obtained from the Centers for the Treatment of Poisoning and from representatives of the manufacturers of these substances. In chronic poisoning, it is often impossible to quickly determine the toxic agent from the anamnesis. Less urgency medical measures in these cases, it usually allows for the necessary careful 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 of the gastrointestinal tract caused by insecticides containing cholinesterase inhibitors; lead border and paralysis of the extensor muscles, characteristic of chronic lead poisoning. Unfortunately, these typical signs are not always present and in 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. Other poisons require more complex toxicological studies such as gas or liquid chromatography to be detected. high resolution 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 at 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 especially important in diagnosing and assessing the severity of chronic poisoning. Ultimately, the results of such an analysis are useful for evaluating the long-term results of some types of therapy.

Treatment of chemical poisoning

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

prevention of further absorption of the poison;
removal of the absorbed poison from the body;
symptomatic supportive therapy or symptomatic treatment for circulatory, 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 a few hours after ingestion, as gastric emptying may be delayed as a result of gastric atony or pylorospasm. This occurs with phenothiazine poisoning, 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. The emetic effect of ipecac syrup (the concentration should not exceed more than 14 times the concentration of the 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. When administered intravenously at a dose of 0.01 mg/kg, apomorphine induces vomiting almost immediately, with no subsequent effect on the central nervous system. Sometimes it is not possible to induce vomiting and valuable time should not be wasted waiting. An attempt to induce vomiting should not be made in victims who are in a convulsive state, in patients with severe central nervous system depression, or (due to the risk of perforation of the stomach or esophagus or due to aspiration of vomit into the trachea) in persons who have swallowed a potent caustic chemical or small 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, it is reasonable to introduce a cuffed endotracheal tube into the trachea before performing 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 (in children less) of warm water or liquid solution is injected into the stomach and aspirated until the aspirated liquid becomes clear.

Interference with absorption in the gastrointestinal tract.

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

Adsorption by activated carbon is a reversible process and the efficiency of adsorption of many poisons varies depending on the pH value. Acidic substances are adsorbed better by acid solutions and therefore can be released into small intestine. It is desirable that activated charcoal with adsorbed poison pass through the intestines as quickly as possible. This will also reduce intestinal absorption of any unabsorbed 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 by applying a cold compress or ice to the injection site, or by applying 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 various methods; the choice of method depends on the condition of the patient, the amount of poison in the body and the availability of experienced personnel and equipment.

Bile excretion

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

Urinary excretion

The acceleration of renal excretion is justified in cases of poisoning much a large number poisons. Renal excretion of toxic substances depends on glomerular filtration, active tubular secretion and passive tubular resorption. The first two of these processes can be protected by maintaining adequate circulation and kidney function, but in practical terms, they cannot be accelerated. On the other hand, passive tubular resorption of many poisons plays an important role in increasing their duration of action and can often be reduced by readily available methods. In case of poisoning with drugs such as drugs salicylic acid and long-acting barbiturates, increased diuresis induced by 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 ionization in the tubular fluid of such organic acids like phenobarbital and salicylate. In contrast, the pKa of pentobarbital (8.1) and secobarbital (8.0) are so high that renal clearance does not increase appreciably with increasing urinary pH at physiological alkaline limits. 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 acidic poisons by a factor of 10 or more, and these measures have been found to be very effective in salicylates, phenobarbital, and 2,4-dichlorophenoxyacetic acid poisoning. Conversely, a decrease in pH below its usual values has been shown to increase the clearance of amphetamines, phencyclidines, fenfluramine, and quinine.

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

Dialysis and hemosorption

Dialysis has been found to be effective in removing 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 the binding of the toxic substance to 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 not every hospital has the necessary equipment and experienced staff for hemodialysis and hemosorption, 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 painful conditions. 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, the possibility of a violation of the vital important functions or control them 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 depression of the centers located in the medulla oblongata occurs as a result of circulatory or respiratory disorders, then it is necessary to immediately and vigorously begin measures to maintain these vital functions using 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. Increased 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 depression of the vasomotor centers in the medulla, block the autonomic ganglia or adrenergic receptors, directly inhibit the tone of the smooth muscles of the 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. Violations of the generation of an excitation wave or cardiac conduction in patients with poisoning occur as a result of the action of certain poisons on the electrical properties of the heart fibers or as a result of myocardial hypoxia or metabolic disorders in the myocardium. The latter need to be adjusted, and antiarrhythmic drugs are used according to indications, based on the nature of this arrhythmia.

Pulmonary edema. A patient with poisoning may develop pulmonary edema due to inhibition of myocardial contractility or damage to the alveoli by irritating gases or asphyxiated fluids. The latter type of edema is less treatable and may be accompanied by laryngeal edema. Therapeutic activities include exudate suction, high positive pressure oxygen, surfactant aerosols, bronchodilators, and adrenocorticosteroids.

Hypoxia. Poisoning can cause the development of tissue hypoxia through various mechanisms, and in one patient several of these mechanisms may operate simultaneously. Inadequate ventilation may result from central respiratory depression, muscle paralysis or airway obstruction with accumulated secretions, laryngeal edema, or bronchospasm. Alveolar-capillary diffusion may be impaired in pulmonary edema. Anemia, methemoglobinemia, carboxyhemoglobinemia, or shock can impair oxygen transport. Inhibition of cellular oxidation may occur (eg, cyanides, fluoroacetate). For treatment, it is necessary to maintain adequate airway patency. The clinical situation and site of the obstruction may indicate frequent suctioning, insertion of an oropharyngeal airway or endotracheal tube, or tracheotomy. If, despite a normal airway, ventilation remains inadequate, as evidenced by clinical condition or measurement of minute volume or gas composition blood, it is imperative to carry out artificial ventilation using 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 kidney failure. Renal failure with oliguria or anuria may develop in a patient with poisoning due to shock, dehydration, or electrolyte imbalance. In more specific cases, it may be due to the nephrotoxic effects of certain poisons (eg, mercury, phosphorus, carbon tetrachloride, bromate), many of which are concentrated and excreted by the kidneys. Kidney damage caused by poisons is usually reversible.

A poison or poison is a substance whose intake inside a person has a harmful and sometimes fatal effect. Some poisons only harm where they hit ( local action); others begin to act only when they are absorbed from the intestines and stomach into the blood (general action); still others combine general and local actions.

Most often poisoned by alkalis, acids, alcohol, arsenic, gases.

Signs of poisoning are vomiting, diarrhea, convulsions, loss of strength.

Vinegar essence. When poisoned with vinegar, pain is felt in the stomach and throughout the gastrointestinal tract. There is swelling of the mucous membrane of the pharynx and mouth, diarrhea, thirst.

When providing first aid, the victim should be given burnt magnesia (one tablespoon of magnesia per glass of water), activated charcoal, whipped protein, milk, water, decoctions of flaxseed or rice. Apply cold compresses to the stomach and neck area. Call a doctor.

acids- hydrochloric, nitrogen, sulfuric, etc. The action of these poisons is manifested on the mucous membrane of the lips, mouth, posterior pharyngeal wall, pharynx. These organs are swollen, burned, the burn site is covered with plaque; the scab has a different color, which depends on the acid ( yellow- with nitric acid, gray-black - with sulfuric acid, brown - with acetic acid, white - with hydrochloric acid).

Often there are burns around the neck and mouth. At the site of the burn, the victim feels pain, increased salivation, painful swallowing. The patient groans and is very agitated. There is severe pain in the stomach area.

rinse the stomach with warm boiled water(about 10 l) with the addition of soda or rinse the stomach with burnt water;
give activated charcoal, kefir, milk, starch decoction, egg white;
call an ambulance.

During poisoning with acids, it is forbidden to give emetics.
If the acid gets on the skin, then it is necessary to wash this area with water with the addition of chalk, slaked lime, alkali, magnesia. You can also use soapy water or milk.

If poisoning has occurred with carbolic acid, then lime sugar can be used. It can be cooked in the following way: 40 parts water, 16 parts sugar, 5 parts slaked lime. Mix everything and infuse three days, stirring constantly. Then filter and evaporate on a water bath.

alkalis.

When providing first aid, you need:

gastric lavage warm water(about 10 l) or a one percent solution of citric or acetic acid;
give the patient an enveloping agent every 10 minutes, give to drink lemon juice or a solution of citric acid;
call an ambulance.

If alkali gets on the skin, it is necessary to wipe the skin area with a cloth, and then rinse with water with the addition of vinegar or lemon juice.

If a person fell into a pit with lime, then he must immediately be taken out of the pit, doused with water and put in a bath filled with warm water. The water in the bathroom should be changed as it gets dirty.

Antifreeze. Symptoms of antifreeze poisoning resemble intoxication: agitation, euphoria, headache, nausea, dizziness. Thirst appears, the victim feels pain in the stomach. On the early stage death can occur from CNS damage.

When providing first aid, you need:

rinse the stomach with warm water (about 10 liters) with the addition of tannin or activated charcoal;
make bloodletting;
call an ambulance.

Insecticides- chlorophos, thiophos, karbofos and others. If the substance gets on the skin, in the stomach and respiratory tract, poisoning occurs.

With inhalation poisoning, nausea, dizziness, visual disturbances, and mental agitation appear.
When insecticides enter digestive tract vomiting occurs, liquid stool, sweating increases, mucus appears from the mouth and nose.

There are three stages of insecticide poisoning.

During the first stage, the patient is agitated, complains of dizziness, chest tightness, and nausea. The person becomes more aggressive, he is haunted by fear and the patient refuses treatment. With further absorption of the toxic substance, salivation, sweating, vomiting appear, the pulse quickens, pain in the stomach occurs.

During the passage of the second stage, convulsions begin, the pupils narrow, the patient becomes inhibited, salivation and sweating increase. Gradually rises arterial pressure the patient falls into a coma.

During the third stage, paralysis may begin. The activity of the nervous system, respiration, and the activity of the heart are disturbed. The patient is in a coma.

When providing first aid, you need:

gastric lavage (the required volume of water is 10-15 liters, it is necessary to wash the stomach 3-4 times);
put an enema with the addition of glycerin;
take inside Vaseline oil(200 ml), a decoction of starch or flaxseed;
2-3 times give 1 tablespoon of burnt magnesia;
when breathing stops, give artificial respiration and indirect massage hearts;
call an ambulance.

Dichloroethane- can act on the heart, liver and nervous system. The maximum concentration of poison in the blood of the victim is reached 3-4 hours after it enters the body. In case of poisoning with dichloroethane, vomiting, nausea, salivation, abdominal pain, headache, diarrhea, and nervous system excitation appear. In the final stage, hepatic and renal failure and coma may develop.

When providing first aid, you need:

do multiple gastric lavage;
put a cleansing enema;
give vaseline oil (100 ml) inside;
perform artificial respiration and indirect heart massage;
call an ambulance.

Arsenic. In case of poisoning, vomiting, diarrhea are observed, dehydration of the body occurs, the work of the heart is weakened, collapse.

When providing first aid, you need:

induce vomiting to remove toxic products from the stomach (for this, the patient is given unlimited salted water to drink);
do a bowel lavage using clean water;
give the patient 1 tablespoon of burnt magnesia, with an interval of 5 minutes;
you can give a special antidote for arsenic;
call an ambulance.

Corrosive sublimate. In case of sublimate poisoning, vomiting with blood, pain in the stomach and intestines begins, the patient's temperature rises and urine output stops, pain in the joints and bones begins, convulsions may occur.

When providing first aid, you need:

induce vomiting in the victim;
give the patient milk egg white. If the poisoning is severe, then in two glasses of milk shake 20 egg whites and give the patient a drink all at once;
repeat the procedure after half an hour;
constantly give the patient chalk, magnesia, lime water to drink;
and never give the patient salt.

Treatment folk remedies after poisoning with sublimate, arsenic and other mineral poisons, it involves eating butter, milk, vegetable fat or charcoal.

In case of poisoning with mercury, sublimate, arsenic, red lead, it is advised to use sifted ash (pour 1 kg of ash with water (3 liters) and boil for 10 minutes). Drain the lye and give the patient 150 ml every 15 minutes. Drink one glass of fresh milk. Continue treatment until the pain in the stomach disappears.