First aid for acid poisoning. What not to do in case of poisoning. Consequences and possible complications

Acid and alkali poisoning can be obtained not only during laboratory work with chemicals, but also during routine cleaning if you use aggressive substances. Even rubbing his hand in a soiled rubber glove eyes, you will feel pain, but even worse if such substances enter the stomach - ordinary running water is not enough here, emergency assistance will be required.

Poisoning by organic and inorganic acids

Acids and alkalis are cauterizing liquids that cause chemical burns and, as a result, chemical burn disease. When exposed to acids on the mucous membrane gastrointestinal tract, which are part of it, are folded.

Ingestion of cauterizing liquids into an empty stomach is fraught with reflex cardiac arrest. If these liquids come into contact with the skin, it is completely destroyed.

Inorganic acids are especially dangerous (sulphuric, hydrochloric, nitrogenous), which cause necrosis of tissues with the formation of a scab of a characteristic color (when exposed to sulfuric acid, the scab is black, when burned with nitric acid - yellow, hydrochloric - white). When ingested, they immediately appear sharp pains in the oral cavity, repeated vomiting with an admixture of blood, the patency of the esophagus is disturbed, edema and obstruction of the larynx develop, pain shock.

organic acids (acetic, oxalic) have a less pronounced cauterizing, but more pronounced toxic effect. In case of poisoning organic acids massive dissolution of red blood cells, toxic injury kidneys, liver, develops acute.

Help with acid and alkali poisoning should be provided immediately.

What to do with alkali poisoning: symptoms and help

When alkalis get on the mucous membrane of the gastrointestinal tract, the proteins that make up its composition dissolve, but in any case they lose all their properties, due to which the mucous membrane dies.

In case of poisoning with alkalis (ammonia, lime, caustic soda) occurs severe burn upper respiratory tract with swelling of the tongue, larynx, development of pulmonary edema. Another symptom of alkali poisoning is bronchospasm. When the skin is damaged, a chemical burn is formed.

What to do in case of alkali poisoning before the doctors arrive? Providing first aid for alkali poisoning, first of all, it is necessary to reduce the pain from the burn. For this, fentanyl (0.1 mg) and atropine (1 mg) are injected subcutaneously. And only after the pain is reduced, the stomach is washed cold water through a probe (the probe is generously lubricated with oil), followed by the introduction of Almagel A (50.0-70.0 ml) or milk (200.0 ml). After gastric lavage, a laxative is not administered.

The use of acids or alkalis to neutralize the active agent is contraindicated!

The patient is also given antihistamines(suprastin, tavegil), and if necessary, carry out artificial ventilation lungs (IVL). For local treatment burnt surface inside every hour give 20 ml of mixture: 10% emulsion sunflower oil- 200 ml, anestezin - 20 g, biomycin - 1 g.

What to do in case of poisoning with hydrocyanic and salicylic acid: first aid

Acute poisoning with hydrocyanic acid. Hydrocyanic acid (hydrogen cyanide) is a fast-acting poison, its toxic effect disrupts the activity of all body systems, first of all,. Poison is dangerous by any route of administration.

In case of poisoning, excitation, shortness of breath, come to the fore. Then there is oppression of consciousness, loss of sensitivity and reflexes. Arise involuntary urination and defecation. Death comes from paralysis of the brain.

With more mild intoxication the patient has salivation, a sensation of the smell of bitter almonds, metallic taste in the mouth, numbness of the mouth, inflammation of the mucous membrane of the eyes, difficulty in speech, nausea, vomiting.

Providing first aid for poisoning hydrocyanic acid, the patient is washed with water, eyes, face skin, antidotes are administered: anticyan (1 ml) subcutaneously or amyl nitrite is inhaled (5-8 drops). In case of respiratory failure, mechanical ventilation is mandatory.

Acute poisoning salicylic acid. The lethal dose of salicylic acid and its derivatives (aspirin, etc.) is 10-40 g.

In case of an overdose, patients complain of dizziness, headaches, tinnitus, hearing and vision disorders, nausea, vomiting, abdominal pain, diarrhea, profuse sweating. Bleeding is also characteristic (, gastric, uterine, etc.). In severe poisoning, there is a violation of consciousness, convulsions.

What to do in case of salicylic acid poisoning in the first place? The patient needs to wash the stomach, followed by the introduction of liquid paraffin (50.0-100.0 ml) through the probe. Inside give a 5% solution drinking soda(400.0 ml), saline laxatives.

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Caustic alkalis include - ammonia, caustic soda (caustic) - caustic soda, caustic potash, slaked lime. Poisoning with ammonia is more common, less often with caustic soda (for example, as part of a cleaning agent sewer pipes- "Mole", etc.).

The damaging effect of alkalis differs from the action of acids, since when exposed to alkalis, tissue damage is more pronounced and extends deeper.

Alkalis loosen and soften tissues, cause a local cauterizing effect, leading to necrosis of superficial and deeper tissues. After absorption, alkalis begin to affect the blood and everything internal organs. Damage to the blood and nervous system occurs very quickly.

Symptoms of alkali poisoning (caustic soda, slaked lime, Krot, etc.)

Burns are the leading symptom of alkali poisoning. digestive tract. Signs of a chemical burn on the face, lips, oral mucosa: edema, hyperemia, erosion.

If the victim is conscious, then he complains about severe pain in the area of ​​the burn; expressed nausea, vomiting, abdominal pain.

At deep burns there is a danger of perforation of the esophagus with the development of repeated massive esophageal-gastric bleeding. The abdomen is swollen, with pressure - sharply painful (reactive peritonitis). As a result of a burn and swelling of the larynx, breathing is difficult and can be completely impaired. The symptoms of shock gradually increase.

If the patient survived after alkali poisoning, then in remote period(from the 3-4th week) cicatricial narrowing of the esophagus develops. One of the most frequent complications is aspiration pneumonia.

Emergency care for alkali poisoning (caustic soda, slaked lime, Krot, etc.)

1) In case of poisoning with caustic alkalis, emergency hospitalization in a toxicological intensive care unit is indicated.

2) gentle diet or hunger for 3-5 days. P the sufferer is given to swallow pieces of ice;

3) with laryngeal edema and the threat of asphyxia - sanitation of the oropharynx, inhalation of ephedrine, epinephrine (adrenaline), pulmicort (budesonide), or prednisolone or dexamethasone; in the absence of effect - tracheostomy, mechanical ventilation;

4) anesthesia narcotic analgesics: 1% morphine solution or 2% promedol solution; glucose-novocaine mixture intravenously drip (glucose 5% -300 ml + glucose 40% -50 ml + novocaine 2% 30-50 ml), hemostatic agents;

5) to relieve spasm - atropine or no-shpa;

6) emergency gastric lavage with cold water is shown in the first 6 hours through a probe lubricated with vegetable oil; after 12 hours from the moment of poisoning, gastric lavage is not advisable;

7) without a probe, gastric lavage with artificial induction of vomiting in case of poisoning with caustic liquids is dangerous and is not used. Inducing vomiting is contraindicated!;

8) respiratory analeptics;

9) forced diuresis with alkalization of the blood; detoxification therapy and rehydration, shock control;

10) mixture for local treatment - 200 ml of 10% emulsion of sunflower oil, 2 g of benzocaine, 2 g of chloramphenicol - 20 ml orally every 2 hours;

11) with significant blood loss - blood transfusion.

Acid poisoning is emergency conditions, which pose a great threat to the life of the patient. In such a situation, a lot depends on the timely and proper rendering emergency care. The algorithm for its implementation is important. Most often, poisoning occurs with acetic acid, less often with mineral (sulfuric, hydrochloric, etc.).

Acid poisoning occurs mainly for two reasons - due to domestic negligence and for suicidal intent. The first is more common among men, the second - among women. Sometimes children suffer too. Every person must remember necessary measures precautions when handling toxic substances in the home: store them separately from food products, clean in places inaccessible to children. The slightest negligence in an unfortunate set of circumstances can cost someone health or life.

Acids cause burns, tissue necrosis; the burned surface is covered with a poorly permeable crust (scab), which to some extent slows down the absorption of the toxic substance into the blood.

When taking acids inside, the symptoms of skin and mucous membrane lesions appear immediately. There are very strong pains in those places where the acid touched the mucous membrane of the mouth, esophagus and stomach.

For acid burns most the stomach suffers, as to its acidic environment the effect of the toxin itself is added. The destruction of the mucosa occurs almost instantly, which is why bleeding and vomiting quickly begin with an admixture of blood in the vomit. Due to pain, repeated vomiting, breathing is disturbed, the person makes short deep breaths, which can contribute to the entry of acid into the respiratory tract. The latter is very dangerous, since the respiratory mucosa is very sensitive to damage. A burn occurs at the site of exposure to acid, inner wall nasopharynx, larynx and trachea swells, blocking the lumen for oxygen access. This can lead to the death of the patient from suffocation.

Visually, in some cases, it is possible to determine which acid poisoned a person. Nitric acid binds to the protein to form a yellowish (light brown) compound, so the lips and mouth will be covered with an eschar of the appropriate shade, the vomit will also turn yellow-brown. Sulfuric and hydrochloric acids give dark scabs, vomit when poisoned by them - brown-black, with bloody streaks. Acetic acid poisoning is easy to identify by a gray-white coating on the lips and mouth, as well as by a characteristic odor.

With severe poisoning, the patient is able to die already in the first hours of poisoning, if shock develops against his background. If a person survives this milestone, the symptoms of poisoning change somewhat.

Bleeding may subside, vomiting may decrease, but salivation remains increased, due to which dehydration gradually sets in: the patient's skin becomes dry, he himself is lethargic, inhibited. When you try to drink water, vomiting often resumes.

Part of the acid is absorbed into the blood by this time, internal organs begin to suffer, primarily the liver, which is responsible for neutralizing toxic substances. skin acquires yellow, urine darkens or blood appears in it. If due to poisoning develops kidney failure, urine generally ceases to stand out. On the second - third days (in case of poisoning with strong acids earlier - sometimes almost immediately), due to the aggressive action of the acid, a hole may form in the wall of the stomach, and then the gastric contents enter the abdominal cavity. The phenomena of peritonitis join the numerous symptoms of poisoning: severe diffuse pains in the abdomen, an increase in its volume due to intestinal paresis, etc. By the same time, if acid has entered the respiratory tract, an infection develops in them. There are symptoms of tracheitis, bronchitis, pneumonia - fever, cough with the release of pus, blood and fragments of damaged tissues.

Acid poisoning carries many late complications. If the patient can be saved, he long years is being treated for complications such as scarring of the esophagus and stomach, recurrent tracheobronchitis, chronic kidney failure, severe liver problems, etc.

Usually, help has to be provided to a person who has just suffered from acid poisoning, or at most within a few hours ago.

Such acute situations You must remember the rules of first aid. When poisoning with acids, the patient should not be induced to vomit. Previously, it was believed that this is necessary, as it frees the stomach from acid and does not allow it to fully exert its effect on the body. Nevertheless, when evaluating the results of such assistance, it turned out that when inducing vomiting, the frequency of ruptures of the stomach and esophagus, the tissues of which are damaged by acid, is high. In addition, the risk of damage to large blood vessels increases, with massive bleeding. The patient is not allowed to give alkaline solutions inside, for example solution baking soda. Upon contact with acids, it gives abundant gas formation, and heat is released, which is also with highly likely can lead to rupture of the organ and bleeding. In case of poisoning with sulfuric acid, liquid should not be given to a person - when the acid comes into contact with water, a thermal reaction occurs, the solution heats up, which causes additional tissue damage. chemical burn damage. It is forbidden to take laxatives - the human intestine is several meters long, therefore this measure will do more harm than help: the damage will spread to the lower sections of the gastrointestinal tract, and the acids will be removed minimal amount. In addition, dehydration will worsen.

In case of acid poisoning, you can rinse your mouth with small amounts of water (except in case of poisoning with sulfuric acid), but do not let the patient swallow it. Inside, only substances containing proteins should be taken: milk or egg white in a small amount(no more than 150-200 ml), so as not to stretch the stomach too much. It is permissible to introduce a cooled mucous decoction of rice into the stomach. In case of poisoning with acetic acid, 2-3 tsp can be taken orally. antacids based on aluminum and magnesium hydroxide.

The patient during assistance should lie on his right side, and take something inside - in a sitting position.

If the victim has an active stomach bleeding, an ice pack is applied to the stomach, and everything that is given inside is cooled. In some cases (poisoning with acetic acid, hydrochloric acid) it is necessary to give a person to swallow medium-sized pieces of ice or frozen milk. If hemostatic agents are available, they should be used. To stop bleeding, 2 ml of a 12.5% ​​solution of etamsylate is injected intravenously or 1 ml of a 1% solution of vikasol into the muscle. You can also use 10 ml of a 10% calcium chloride solution, however, it should be remembered that it is injected only into a vein, and if it gets under the skin or into a muscle, necrosis (necrosis) of the tissues develops at the injection site.

In case of bleeding and vomiting, when the body is rapidly dehydrated, as an emergency measure, it is allowed to inject 0.9% sodium chloride solution or 5% glucose solution into the vein in an amount of not more than 400 ml. This should be done if the patient is rapidly losing fluid, help will not arrive soon and there is a person in the environment who knows the technique of intravenous infusion.

In case of acid poisoning, it is very important to try to anesthetize the victim as much as possible in order to prevent the development of shock. For obvious reasons, drugs for oral administration are not suitable in this case, therefore, only intravenous and intramuscular forms of drugs are used. So, you can enter intravenously drip 100 ml of a 0.25-0.5% solution of novocaine, having previously found out if the patient is allergic to this drug, or 2-4 ml of a 50% solution of metamizole sodium, 2 ml of tramadol or any other available analgesic.

Another most dangerous point is the possibility of suffocation due to swelling of the airways. If the victim has a severe hoarse breath, it is difficult for him to inhale - it means that the mucous membrane of the respiratory organs has suffered. Therefore, if he begins to suffocate and he does not have enough oxygen for independent breathing, you need to vital indications perform a tracheostomy - make a hole in the trachea through the front surface of the neck and insert a hollow tube into it so that the person can breathe. This should be done only by the person who owns this technique. Otherwise, damage may occur. large vessels neck, esophagus, fracture of the cartilage of the trachea and other complications that aggravate the condition of the victim.

If due to swelling of the mucous membrane of the larynx increases respiratory failure, and there is no opportunity to perform a tracheostomy, you can try to let the victim inhale menthol vapors or do inhalations with an ephedrine solution - they narrow blood vessels, which reduces swelling of the mucosa and makes breathing easier. But it should be remembered that this measure gives only a partial effect and the patient urgently needs specialized medical care.

If a person has dark urine, this indicates an increase in the acidity of the blood, which requires the introduction of 100-200 ml of a 4% sodium bicarbonate solution into a vein (drip).

Throughout all measures to provide emergency care every 10 minutes, control the pulse rate, the value blood pressure and the presence of consciousness in the victim. When signs of shock appear, anti-shock measures are taken.

Directory of emergency care Khramova Elena Yurievna

acid poisoning

acid poisoning

Acid poisoning refers to emergency conditions that pose a great threat to the life of the patient. In such a situation, a lot depends on the timely and correct provision of emergency care. The algorithm for its implementation is important. Most often, poisoning occurs with acetic acid, less often with mineral (sulfuric, hydrochloric, etc.).

The reasons

Acid poisoning occurs mainly for two reasons - due to domestic negligence and for suicidal intent. The first is more common among men, the second - among women. Sometimes children suffer too. Any person is obliged to remember the necessary precautions when handling toxic substances in everyday life: store them separately from food, clean them out of the reach of children. The slightest negligence in an unfortunate set of circumstances can cost someone health or life.

Symptoms

Acids cause burns, tissue necrosis; the burned surface is covered with a poorly permeable crust (scab), which to some extent slows down the absorption of the toxic substance into the blood.

When taking acids inside, the symptoms of skin and mucous membrane lesions appear immediately. There are very strong pains in those places where the acid touched the mucous membrane of the mouth, esophagus and stomach.

With acid burns, the stomach suffers the most, since the action of the toxin itself is added to its acidic environment. The destruction of the mucosa occurs almost instantly, which is why bleeding and vomiting quickly begin with an admixture of blood in the vomit. Because of the pain, repeated vomiting, breathing is disturbed, the person takes short deep breaths, which can contribute to the entry of acid into the respiratory tract. The latter is very dangerous, since the respiratory mucosa is very sensitive to damage. A burn occurs at the site of exposure to acid, the inner wall of the nasopharynx, larynx and trachea swells, blocking the lumen for oxygen access. This can lead to the death of the patient from suffocation.

Visually, in some cases, it is possible to determine which acid poisoned a person. The nitric acid binds to the protein to form a yellowish (light brown) compound, so the lips and mouth will be scabbed with the appropriate hue, and the vomit will also turn yellow-brown. Sulfuric and hydrochloric acids give dark scabs, vomit when poisoned by them - brown-black, with bloody streaks. Acetic acid poisoning is easy to identify by a gray-white coating on the lips and mouth, as well as by a characteristic odor.

With severe poisoning, the patient is able to die already in the first hours of poisoning, if shock develops against his background. If a person survives this milestone, the symptoms of poisoning change somewhat.

Bleeding may subside, vomiting may decrease, but salivation remains intensified, due to which dehydration gradually sets in: the patient's skin becomes dry, he himself is lethargic, inhibited. When you try to drink water, vomiting often resumes.

Part of the acid is absorbed into the blood by this time, internal organs begin to suffer, primarily the liver, which is responsible for the neutralization of toxic substances. The skin turns yellow, the urine darkens or blood appears in it. If kidney failure develops due to poisoning, urine generally stops being excreted. On the second - third days (in case of poisoning with strong acids earlier - sometimes almost immediately), due to the aggressive action of the acid, a hole may form in the wall of the stomach, and then the gastric contents enter the abdominal cavity. The phenomena of peritonitis join the numerous symptoms of poisoning: severe diffuse pains in the abdomen, an increase in its volume due to intestinal paresis, etc. By the same time, if acid has entered the respiratory tract, an infection develops in them. There are symptoms of tracheitis, bronchitis, pneumonia - fever, cough with the release of pus, blood and fragments of damaged tissues.

Acid poisoning carries many late complications. If the patient can be saved, he is treated for many years due to such consequences as scarring of the esophagus and stomach, recurrent tracheobronchitis, chronic kidney failure, serious liver problems, etc.

Urgent care

Usually, help has to be provided to a person who has just suffered from acid poisoning, or at most within a few hours ago.

In such acute situations, you need to remember the rules of first aid. When poisoning with acids, the patient should not be induced to vomit. Previously, it was believed that this is necessary, as it frees the stomach from acid and does not allow it to fully exert its effect on the body. Nevertheless, when evaluating the results of such assistance, it turned out that when inducing vomiting, the frequency of ruptures of the stomach and esophagus, the tissues of which are damaged by acid, is high. In addition, the risk of damage to large blood vessels increases, with massive bleeding. The patient is forbidden to give alkaline solutions inside, such as a solution of baking soda. Upon contact with acids, it gives abundant gas formation, and heat is released, which is also very likely to lead to rupture of the organ and bleeding. In case of poisoning with sulfuric acid, liquid should not be given to a person - when the acid comes into contact with water, a thermal reaction occurs, the solution heats up, which causes additional tissue damage to the chemical burn. It is forbidden to take laxatives - the human intestine is several meters long, therefore this measure will do more harm than help: the damage will spread to the lower sections of the gastrointestinal tract, and the minimum amount of acid will be excreted. In addition, dehydration will worsen.

In case of acid poisoning, you can rinse your mouth with small amounts of water (except in case of poisoning with sulfuric acid), but do not let the patient swallow it. Inside, only substances containing proteins should be taken: milk or egg white in a small amount (no more than 150-200 ml), so as not to stretch the stomach too much. It is permissible to introduce a cooled mucous decoction of rice into the stomach. In case of poisoning with acetic acid, 2-3 tsp can be taken orally. antacids based on aluminum and magnesium hydroxide.

The patient during assistance should lie on his right side, and take something inside - in a sitting position.

If the victim has active gastric bleeding, an ice pack is applied to the stomach, and everything that is given inside is cooled (for the rules for using the ice pack, see Chapter 18). In some cases (poisoning with acetic, hydrochloric acids), it is necessary to allow a person to swallow small pieces of ice or frozen milk. If hemostatic agents are available, they should be used. To stop bleeding, 2 ml of a 12.5% ​​solution of etamsylate is injected intravenously or 1 ml of a 1% solution of vikasol into the muscle. You can also use 10 ml of a 10% calcium chloride solution, however, it should be remembered that it is injected only into a vein, and if it gets under the skin or into a muscle, necrosis (necrosis) of the tissues develops at the injection site.

In case of bleeding and vomiting, when the body is rapidly dehydrated, as an emergency measure, it is allowed to inject 0.9% sodium chloride solution or 5% glucose solution into the vein in an amount of not more than 400 ml. This should be done if the patient is rapidly losing fluid, help will not arrive soon and there is a person in the environment who knows the technique of intravenous infusion.

In case of acid poisoning, it is very important to try to anesthetize the victim as much as possible in order to prevent the development of shock. For obvious reasons, drugs for oral administration are not suitable in this case, therefore, only intravenous and intramuscular forms of drugs are used. So, you can enter intravenously drip 100 ml of a 0.25-0.5% solution of novocaine, having previously found out if the patient is allergic to this drug, or 2-4 ml of a 50% solution of metamizole sodium, 2 ml of tramadol or any other available analgesic.

Another most dangerous point is the possibility of suffocation due to swelling of the airways. If the victim has heavy hoarse breathing, he can hardly breathe, it means that the respiratory mucosa has suffered. Therefore, if he begins to choke and he does not have enough oxygen for independent breathing, it is necessary, for health reasons, to carry out a tracheostomy - to make a hole in the trachea through the front surface of the neck and insert a hollow tube into it so that the person can breathe. This should be done only by the person who owns this technique. Otherwise, damage to the large vessels of the neck, esophagus, fracture of the cartilage of the trachea and other complications that aggravate the condition of the victim are possible.

If respiratory failure increases due to swelling of the mucous membrane of the larynx, and there is no opportunity to perform a tracheostomy, you can try to let the victim inhale menthol vapors or inhale with a solution of ephedrine - they constrict blood vessels, which reduces swelling of the mucous membrane and makes breathing freer. But it should be remembered that this measure gives only a partial effect and the patient urgently needs specialized medical care.

If a person has dark urine, this indicates an increase in the acidity of the blood, which requires the introduction of 100–200 ml of a 4% sodium bicarbonate solution into a vein (drip).

Throughout all measures to provide emergency care, the pulse rate, blood pressure and the presence of consciousness in the victim are monitored every 10 minutes. When signs of shock appear, anti-shock measures are taken (see Chapter 2).

POISONING See article INTOXICATION.