Chemical poisoning symptoms. Effective help with symptoms of chemical poisoning. Video: how not to get infected with chemistry right in the store

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Chemical poisoning

What is Chemical Poisoning -

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

What provokes / Causes of Chemical poisoning:

Some of the poisons are medications, substances used in the household, solvents, pesticides and other chemicals.

Symptoms of chemical poisoning:

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

The dose of the substance causing symptoms poisoning, very much also depends on age. For example, in a small child, the ingestion of more paracetamol is more likely to cause symptoms of poisoning than the same dose in an adult. For an elderly person, 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 confusion, coma, impaired heart rate, shortness of breath and marked agitation. Some poisons begin to act after a few seconds, while others take several hours or even days after they enter the body.

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

Diagnosis of chemical poisoning:

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

Poisoning is usually included in the differential diagnosis of coma, seizures, acute psychosis, acute hepatic or kidney failure and oppression 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.

In acute accidental poisoning, the 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, such actions allow you to install only tradename a product that does not allow you to recognize it chemical composition. The bibliography at the end of this chapter lists a number of books that list the active constituents of substances used in the household, agriculture, patent medicines, and poisonous plants. A small reference book of this type should be carried by every doctor in his portfolio. The latest information of this kind can also be obtained from the Centers for the Treatment of Poisoning and from representatives of the manufacturers of these substances. In chronic poisoning, it is often impossible to quickly determine the toxic agent from the anamnesis. The lesser urgency of therapeutic measures in these cases usually allows for the necessary thorough study of the patient's habits and condition. environment.

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

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

Treatment for chemical poisoning:

For proper treatment A patient with poisoning needs to know both the basic principles of managing such patients and the details of therapy for specific poisonings. The treatment process includes:

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

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

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

• Evacuation of stomach contents

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

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

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

Interference with absorption in the gastrointestinal tract.

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

Adsorption by activated carbon is a reversible process and the efficiency of adsorption of many poisons varies depending on the pH value. Acidic substances are 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 unadsorbed poison that has passed through the pylorus. In patients with good renal and cardiac function, this is best achieved by oral or intramuscular administration of osmotic laxatives. agents such as magnesia or sodium sulfate (10 - 30 g in a solution with a concentration of 10% or less).

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

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

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

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

• Bile excretion

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

• Urinary excretion

Acceleration of renal excretion is justified in cases of poisoning by a much larger number of poisons. renal excretion toxic substances depends on glomerular filtration, active tubular secretion and passive tubular resorption. The first two of these processes can be protected by maintaining adequate circulation and kidney function, but in practical terms, they cannot be accelerated. On the other hand, passive tubular resorption of many poisons plays important role in increasing the period of their action and it can often be reduced by readily available methods. In 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 the ionization in the tubular fluid of such organic acids as phenobarbital and salicylate. In contrast, the pKa of pentobarbital (8.1) and secobarbital (8.0) are so high that renal clearance does not increase markedly with an increase in urine pH within the physiological alkaline range. Alkalinization of urine is achieved by infusion of sodium bicarbonate at a rate determined by the pH value of urine and blood. Severe systemic alkalosis or electrolyte disturbances should be avoided. The combination of induced diuresis with alkalinization of the urine can increase the renal clearance of some 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, lowering the pH below its normal values ​​has been shown to increase the clearance of amphetamines, phencyclidines, fenfluramine, and quinine.

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

• Dialysis and hemosorption

Dialysis has been found to be effective in 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 removing large amounts of dialysable poisons from the body. For barbiturates, dialysis rates of 50–100 ml/min have been achieved, while the rate of excretion from the body is 2–10 times higher than with peritoneal dialysis or forced diuresis. With blood perfusion through activated charcoal or ion-exchange resin, even greater clearance rates of most poisons are achieved than with hemodialysis. Obviously, extracorporeal dialysis and hemosorption can be considered as the procedures of choice for rapid elimination poisons from the body of patients who have absorbed such amounts of poison that make their survival unlikely even if the best supportive therapy is provided. Since 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 disease states. Skillful supportive care can save the lives of many severely poisoned patients and keep their detoxifying and excretory mechanisms functioning until the poison concentration is reduced to safe levels. Symptomatic measures are especially important when the active poison belongs to the category of substances for which a specific antidote is unknown. Even when an antidote is available, 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 neither necessary nor difficult. Most patients with poisoning come out of a coma, as from a long anesthesia. During the unconscious period, careful care of the nurse and close observation of the patient are necessary. If the depression of the centers located in the medulla oblongata occurs as a result of circulatory or respiratory disorders, then it is necessary to immediately and vigorously begin measures to maintain these vital functions using 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 of seizures, it is often necessary to use 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 due to other causes, the choice of the most appropriate drug requires an analysis of hemodynamic disturbances, which is carried out after measuring the magnitude blood pressure.

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

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

Hypoxia. Poisoning can cause the development of tissue hypoxia through various mechanisms, and in one patient several of these mechanisms may 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 patency airways. 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, the imperative is to conduct artificial ventilation through appropriate mechanical means. In tissue hypoxia, the introduction of high concentrations of oxygen is always indicated. In cases where there is severe depression of the central nervous system, the introduction of oxygen often leads to respiratory arrest and must be accompanied by artificial ventilation.

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

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

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

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

Which doctors should you contact if you have Chemical poisoning:

• Surgeon
• Infectionist

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Other diseases from the group Injuries, poisoning and some other consequences of external causes:

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. Besides, clinical picture manifested according to individual characteristics of a person. Some toxins have a low level of toxicity and may only lead to certain impairments if they are exposed for a long time or are re-introduced in 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 severe 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 a 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 a 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.

Chemical poisoning 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 bad influence a couple of seconds after penetration, and some of them - after a couple of hours or days after the defeat of the body. There are toxins that do not lead to the development of visible symptoms until there is an irreversible violation of the functioning of vital 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. The clinical picture is 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. Medical care includes the following:

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

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:

1. Send the victim to the air.
2. Rinse eyes and body with water.
3. 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. In case of intoxication with petroleum products, it is forbidden to call vomiting reflex. If there is a suspicion of severe intoxication, then it is worth contacting medical assistance, 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 devices, and the leather industry.

Arsenic intoxication is accompanied by the presence of a garlic odor on the breath, dehydration, and diarrhea. If arsenic vapor enters the respiratory tract, it can be fatal. 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:

1. Rinse the stomach. To do this, prepare 2 liters of water and dissolve 50 g of salt in it.
2. To remove poison from the skin, use soap and water.
3. 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:

1. Remove the person from the area of ​​the poisonous substance.
2. Clean exposed skin with soap and water.
3. Wet a cotton pad with amyl nitrite and allow the victim to breathe.
4. In case of thermal injury caused by acid, wash the affected area with water and a weak solution of soda.
5. If there is a thermal injury in the 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:

1. Take the victim out of the room to create an influx of fresh air.
2. Give him a drink and a sorbent to remove all toxins.
3. 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:

1. Removal of poisons from the body.
2. Elimination of antidotes.
3. Elimination of symptoms of hypoxia.
4. Maintaining the functioning of organs and systems.
5. 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.

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

Reasons for the development of chemical poisoning

Chemical poisoning can be caused huge amount substances. These can be medicines, cleaning products, cosmetics, chemicals in production, chemical weapons.

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

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

Possible consequences of poisoning

What complications and consequences can develop as a result of chemical poisoning? Various chemicals can lead to the development of severe disorders in all organs and systems, and death. The type of complication depends on the chemical.

Possible consequences of chemical poisoning include:

• Acute respiratory failure, burns of the upper and lower respiratory tract.
• chemical burn oral cavity, pharynx, esophagus and intestines.
• Acute renal and hepatic failure.
• Gastrointestinal bleeding.
• Toxic or anaphylactic shock.
• Stopping the heart.
• Burns of the skin of varying degrees.
• Acute pancreatitis.
• Damage to the nervous system, impaired consciousness to coma.
• Acute allergic reaction.
• DVZ syndrome.
• Hemolysis (decay) of red blood cells, followed by the development of anemia.

The main clinical manifestations of chemical poisoning

Poisoning by chemicals can be manifested different symptoms. They depend on the substance that has entered the body, and on the mechanisms of its action. With chemical poisoning, symptoms may appear immediately, or within a few hours. They can serve to damage various organs and systems.

The table below shows the first signs of chemical poisoning, depending on the way it enters the human body:

The above are the symptoms that appear in the very initial stage of chemical poisoning. Then, in the absence of medical emergency care, they develop into complications that were listed in the last part of the article.

What to do in case of chemical poisoning

In case of poisoning, you should immediately call an ambulance, describing the situation in detail to the dispatcher and naming the exact location of the patient. While the medics are on the way, give the victim first aid, as detailed below:

Poisoning by mouth

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

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

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

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

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

Respiratory poisoning

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

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

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

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

Skin contact with chemicals

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

First aid

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

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

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

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

Treatment

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

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

The survey may include:

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

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

Chemical poisoning is one of the most dangerous lesions of the body. They can be fatal. It is strictly forbidden to self-medicate. The sooner an ambulance is called, the greater the person's chances of survival and recovery. Poisoned patient needs a daily allowance medical supervision and the provision of qualified medical care.

Pesticides, hydrocyanic acid salts, solvents, acids, cleaning products, drugs and other substances containing active chemical agents can provoke chemical poisoning. Effective treatment for the symptoms of chemical poisoning depends on the route of entry, type of poison, dose, age and health of the person affected. To save life and health, it is important to competently provide first aid to the victim, take him to the hospital.

Pesticides

Pesticides are chemicals used to kill pests. Types of pesticides: repellents, insecticides, herbicides, growth regulators; attractants. They contain salts of heavy metals (copper, mercury), organochlorine (dust), organophosphorus, urea-containing substances.

In everyday life or agriculture, pesticide poisoning occurs when life safety rules are not followed. Pesticide poisoning occurs when poisons penetrate the skin, with food products, airborne, contact-household way.

Pesticide poisoning is characterized by a clinical picture that depends on the main toxin that is part of the pesticide:

First aid

If intoxication with pesticides occurs, you need:

• to ensure the cessation of the entry of poisons into the body;
• give protein, starch or Almagel a drink (they have enveloping properties and reduce absorption);
• as a sorbent, give activated carbon to drink (one tablet per kilogram of weight);
• rinse eyes 2% soda solution, wash skin with soap and water;
• induce vomiting if toxic substances are ingested.

cyanide poisoning

Types of cyanides: cyanic acid, potassium cyanide, sodium cyanide - salts of cyanic acid. Rosaceae seeds (plums, apricots, almonds) contain amygdalin, which decomposes to hydrocyanic acid.

The ways of getting into the body are household (potassium cyanide salts are part of artistic paints) and industrial (cyanides are used in electroplating, pesticides, plastics).
At quick form Intoxication with hydrocyanic acid literally in a few seconds convulsions occur, pressure rises and falls, breathing stops, death occurs. The slow form of hydrocyanic acid poisoning lasts up to several hours. Symptoms: smell and taste of bitter almonds, vomiting, headache, rapid breathing, chest pain, depressed consciousness.
With severe intoxication with a cyanide salt or cyanic acid, convulsions, cardiovascular insufficiency, paralysis, and death appear.

Help with intoxication with salt - potassium cyanide and hydrocyanic acid should be emergency:

• remove the victim to the air;
• remove clothes from the victim, put them in a bag for further disposal (if possible, use gloves or tongs);
• wash the victim with soap and water, rinse eyes well with clean water;
• wash the stomach with 2% soda solution;
• give warm tea with sugar to drink (glucose blocks the toxic effect of hydrocyanic acid); drip amyl nitrite onto a cotton swab (from the company's first aid kit for first aid in case of poisoning with potassium cyanide and hydrocyanic acid), give it a sniff every two minutes;
• if necessary, perform artificial respiration.

Solvent poisoning

Solvents are chemical organic substances. The main solvents include acetone, gasoline, ether, alcohols, chloro-, dichloroethane, solvent.

Penetrate into the lungs in the form of vapors, through the skin are absorbed into the blood. Solvent poisoning can cause narcotic symptoms.

Symptoms of intoxication: irritation of the mucous membranes, accompanied by coughing and sneezing, headache and dizziness, salivation, abdominal pain, vomiting, fainting, convulsions. Damage to the main organs is possible: liver, kidneys, cardiovascular, nervous, respiratory systems.

First aid

• remove the injured person to the air;
• wash the body, rinse the eyes with running water;
• take activated charcoal tablets.

You can not drink hot sweet drinks, milk, vegetable oil - these products increase the absorption of poisons! Do not call with oil products!

If severe poisoning is suspected, you should consult a doctor in order to avoid the development of complicated bronchitis, pneumonia, hepatitis, and nephritis.

Arsenic poisoning

Arsenic poisoning can occur by negligence or by suicide.

Penetration into the body occurs when using products containing arsenic (part of food preservatives), when using pesticides, antifungal drugs with arsenic.
Arsenic is used in factories for the production of glass, electronic devices, the leather industry, and chemical industries.

Arsenic poisoning is characterized by a garlicky smell on the breath, dehydration, and stools that resemble rice water. When arsenic vapor enters the respiratory tract, rapid death can occur. In case of arsenic poisoning, all organ systems are affected: conduction in the heart muscle is disturbed, pulmonary edema and symptoms develop. respiratory failure, jaundice, erosion of the esophagus, bleeding, kidney damage.

It is impossible to get poisoned with an arsenic preparation during dental treatment if the toxic material is removed on time.

First aid is standard. You need to do a gastric lavage. To wash the stomach, you need to prepare two liters of water with salt (two teaspoons per liter of water). Remove poison from the surface of the skin by washing with soap. Activated charcoal does not need to be drunk, it practically does not help the absorption of the poison.

Sulfur poisoning

Types of sulfur compounds: sulfurous anhydrite (part of smog), hydrogen sulfide (formed in sewers), carbon disulfide of chemical enterprises, sulfuric acids and salts.
Penetrate through the respiratory tract, skin, digestive system. Pure sulfur poisoning is rare, most often poisoning with sulfur compounds is observed - a salt of sulfuric acid, oxides, sulfurous acid or sulfuric acid.

Symptoms of hydrogen sulfide poisoning: pain in the eyes, shortness of breath, pulmonary edema, death may develop.

Carbon disulfide has a neurotoxic and psychotropic effect: flushing, burning, headache, nausea, garlic smell, convulsions, loss of consciousness, coma, paralysis. May be fatal.

Symptoms of hydrogen sulfide poisoning: pain in the eyes, shortness of breath, symptoms of bronchitis, pulmonary edema, death may develop.

Symptoms of sulfur dioxide poisoning: cough, wheezing in the lungs, hemoptysis, edema.

First aid:

• Remove the injured person from the poisonous area.
• Wash exposed skin with soap and water.
• You can drop amyl nitrite on a cotton wool and let the victim breathe.
• Give a sniff of ammonia.
• In case of acid burns, it is necessary to wash the damaged area of ​​​​the body with clean water and rinse with a weak soda solution.
• In case of acid burns, the eyes should also be rinsed with plenty of running water, then rinsed with a 2% soda solution.

Gas poisoning

Poisoning occurs by inhalation of air with a mixture of butane and propane.

Symptoms of poisoning: headache, agitation, nausea, constriction of the pupils, slow pulse, salivation, decreased pressure

First aid:

• Remove the victim from the room, create an influx of fresh air.
• Give the patient a drink to remove toxins, a sorbent.
• If the heart and breathing stop, do heart massage and artificial respiration.

Health care

Help is directed to:

• removal of poisons from the body;
• the introduction of antidotes;
• maintaining the health of organs and organ systems;
• relieve symptoms of hypoxia;
• infusion, symptomatic therapy, oxygen therapy, hemodialysis.

Each type of poisoning has its own developed complex of medical treatment.

Prevention of poisoning

• Compliance with safety regulations.
• Study of instructions for use and precautions when working with toxic substances.

Folk remedies and herbs for the treatment of poisoning

• To remove lead salts and heavy metals from the body, you can prepare an infusion of horsetail (1:20), drink half a glass 3-4 times a day.
• Toxins are actively removed by infusion of knotweed (add a spoonful of grass to two glasses of water). Drink the infusion in the third part of a glass 2-3 times a day.
• Chronic mercury poisoning is treated with an infusion of 3 tablespoons of green walnuts, 5 tablespoons of horsetail. You need to take 2 dessert spoons of the collection, pour a liter of boiling water, let it brew and take 100 ml 6 times a day.
• In case of poisoning carbon monoxide recommended infusion of 100 g of cranberries and 200 g of cranberries. Steam in 300 ml of boiling water, insist, take 50 ml 6 times a day.
• In a glass of boiling water, insist 20 g of elecampane root for 20 minutes. Drink with liver intoxication in a tablespoon 4 times a day.
• If you burn your throat with chemicals, you need to drink oil solution St. John's wort: take 2 cups of olive oil per glass of flowers and leave for about a month.
• Antitoxic decoction. Insist 10 g of nettle in a glass of boiling water, drink 3 times a day for a tablespoon.

Food intoxication traditionally ranks at the top of the ranking among the most common types of intoxication. But this does not mean that poisoning with household chemicals is less dangerous. In some cases, such a sharp deterioration in well-being has a more serious negative effect on the body than food intoxications that have become habitual.

Another pitfall is the fact that this intoxication format is capable of provoking chronic diseases of almost all internal organs. A few days of malaise can come back to haunt not only hospitalization in intensive care, but also new disease that will stay with the victim for life.

Classification of detergents and cleaners

Most often, the reason for contacting a doctor in this case is ignoring the safety rules. This extends not only to the recommendation to keep the powders away from curious children, but also to the unwillingness to adhere to a certain pattern of behavior during their direct application. But all the same, curious children who try everything “by the tooth” become more often the victims of colorful bottles and bags.

In order to qualitatively provide first aid to a victim of any age, you must first figure out which category the poisonous agent belonged to. Schematically, all chemistry items used in everyday life can be divided into several large groups:

• cosmetics,
• preparations for the neutralization of pests,
• detergents;
• varnishes, paints;
• stain removers.

The main components of cosmetics are usually various alcohols. After penetrating inside, they immediately begin a destructive effect. Sometimes such intoxication does not make itself felt immediately, which adds problems to parents of curious children.

Somewhat less frequently, cases are recorded when insecticides became sources of toxins that entered the body in any way. These components are the basis for products aimed at combating insects and other pests. Due to organophosphorus compounds, the danger from human contact with them increases significantly.

One of the most dangerous scenarios is intoxication with liquids for cleaning metal surfaces like plumbing. Their composition in abundance offers acids and alkalis for better purification of the entrusted territory. But when they get inside, they provoke the most serious consequences.

No less dangerous are stain removers. This is explained by the chlorine-containing composition.

But, regardless of what specifically caused the poisoning with household chemicals, experts strongly recommend that you immediately seek help from specialists. The longer the victim delays with the consultation, the higher the risks of remaining disabled, or even losing their lives due to severe complications or anaphylactic shock, become.

The main reasons for chemical intoxication

Depending on what specifically served as the source of a sharp deterioration in well-being, the reasons will differ. But even taking into account the correction for the spectrum of action of household chemicals, most often young children become its victims. Adults are to blame for this, who did not remove bright bottles and bags in advance to places where the baby could not reach.

When choosing a place for the future storage of all household detergents and other similar purposes, it is necessary to take into account not only the accessibility of young family members to them. The chosen locker should be located away from areas where heaters are operating, or there is any other source of heat.

You should also ensure that all containers for subsequent storage are tightly sealed. It's about not only about liquid bottles that have corks. Loose products are best poured into separate containers with tight-fitting lids. You can find them in any economic department of the supermarket, or use those packages that are left over from other means.

Do not ignore the instructions for use, which are indicated on reverse side hazardous containers. If it says that you should work with the solution strictly in rubber gloves, you should not skimp on their purchase. Some liquids should be used with goggles at all. This applies to cases of washing plastic ceilings with chlorine-containing mixtures.

Separate attention must be paid to the mandatory ventilation of the room where work is carried out with various washing and cleaning solutions. And here it doesn’t matter whether ventilation will be carried out naturally at open window or a special ventilation system will work.

Not all fans of clean surfaces are aware that the frequent use of detergents provokes the accumulation of toxic components in the blood and tissues. This applies both to people whose professional activities are closely related to household chemicals, and ordinary housewives. Accumulating in the body, the elements will first gradually poison the cells imperceptibly, and then they will begin to manifest themselves more aggressively.

This will be expressed in:

• allergic reactions,
• skin inflammation,
• decrease in defenses.

Depending on the specifics of the means, other negative manifestations are possible, such as loss of concentration, increased irritability, or problems in terms of destabilizing the work of the lungs.

Much less common are cases when a person deliberately takes a poisonous substance inside. This is usually characteristic of people with some deviations in mental health or those who decide to commit suicide. If the powder or mixture was taken orally through negligence, then this is usually limited to a small dosage. With correctly provided first aid and subsequent hospitalization in a hospital, it will be possible to minimize the risks of possible complications.

Do not discount the situation when a poisonous substance enters the body without by oral route. We are talking about inhalation, ingestion through the skin or mucous membranes. In such a situation, the harm is no less tangible, and the algorithm for providing assistance changes dramatically.

But, regardless of how exactly the toxins caused damage to the body of the victim, they provoke an imbalance in the functioning of organs, tissues and cells. With the saddest development of the scenario, even respiratory arrest is possible.

The main and secondary signs of intoxication

In order to recognize poisoning with household chemicals in time and seek qualified help, you need to know exactly the main signs of intoxication. The classic clinical picture is as follows:

• nausea,
• vomit,
• pain syndrome in the abdomen,
• digestive disorders,
• lethargy,
• headache,
• cough,
• pain in the throat,
• impaired vision,
• foam at the mouth,
• convulsive syndrome,
• fainting.

All of the above applies to the standard set, but since all representatives of household chemicals have their own characteristics, attention should be paid to them.

So, plumbing fluids provoke not only nausea. They cause severe irritation of the respiratory tract, which ends with coughing and even suffocation.

Almost the same thing happens when exposed to chlorine-containing substances that block the normal functioning of the respiratory function and blood circulation.

The last point is explained by the fact that a number of toxins are killers for red cells. Because of this, the access of oxygen supply to the cells is almost completely blocked. If at this stage to delay the provision of assistance, then the picture will end with brain hypoxia.

Chemical vapor poisoning

With respiratory intoxication, foam from the mouth is not the worst outcome. Such poisoned people constantly faint, and also suffer from convulsive syndrome and muscle spasms.

Regardless of the name of the agent that served as a source of toxins, the victim must first get out into the fresh air. Having laid the patient on a flat surface, it is worth relieving him of all constricting parts of clothing such as scarves and ties. Usually the influx of fresh air brings to life even those who were previously in a swoon. Immediately after "waking up" they complain of dizziness and a sharp headache, pain in the eyes.

If, along with intoxication in pairs, poisons were ingested along the way, then a saline laxative should be immediately given to the patient. But to engage in gastric lavage in such cases is strictly prohibited. It is better to call an ambulance and make sure that the victim is conscious.

If you try to induce a gag reflex by artificial means, then this once again injures the esophagus and mucous membranes of the stomach, oral cavity. If the swelling is extensive, then this can cause respiratory arrest.

It will be possible to wash the stomach only after the patient is hospitalized. In a hospital setting, health workers use a probe and special flushing water.

Exposure to acid, alkali and organophosphorus agents

First characteristic symptom intoxication due to acids and alkalis, profuse vomiting appears. Moreover, the outgoing vomit will have bloody patches. This happens due to bleeding in the intestines. In the most dangerous scenario, even swelling of the larynx is possible, so it is extremely important to immediately deliver the patient to the hospital. In such victims, urine has a specific dark color or even a reddish tint.

With alkaline or acid intoxication, it is strictly forbidden to induce vomiting. Despite the fact that doctors usually forbid giving any medicine to a poisoned person, here, before the arrival of a team of specialists, the use of painkillers is allowed. But an attempt to block the effect of exposure to acid or alkali with a chemical antidote can be fatal.

With organophosphates, the primary care regimen is more similar to that recommended for exposure to turpentine or gasoline. First, the patient is taken to open air by getting rid of clothing that restricts breathing.

Experts say that, unlike many other toxins, it is organophosphorus solutions that are able to settle on clothes. Because of this, the victim may recover much longer than expected. If the patient is conscious, then it is recommended to him:

• remove contaminated clothing
• take a warm shower
• change into clean clothes.

If during washing it was noticed that a substance got into a certain area of ​​\u200b\u200bthe skin, this place is washed with ordinary soap.

Skin contact with formaldehyde-containing components

When exposed to the skin, toxins negative impact makes itself felt not immediately. But the absence of pronounced signs of damage to the epidermis or deep layers of the skin does not mean that everything is in order.

Doctors advise immediately after contact with the skin, thoroughly rinse the affected area with a solution of ammonia. If, in addition to splashing on open areas of the body, the patient inhaled poisonous vapors, then he should immediately leave the infected area.

In addition to washing the skin, care must be taken separately to rinse the throat, as well as the mouth and nasal cavity. Before the arrival of doctors, it is worth drinking a lot of mineral water like Borjomi, or warm milk with a little soda. Any other drinks should be excluded.

Particular attention should be paid to the patient's complaints about damage to the organs of vision. In this case, it is necessary to rinse the eyes with running, slightly warm water for at least twenty minutes.

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Chemical poisoning - First aid for chemical poisoning

In everyday life, a person is constantly in contact with toxic chemicals. Poisoning with them can occur with improper handling, non-compliance with the dosage and rules for safe use. This is a fairly serious type of poisoning, during which a person with untimely medical care may remain disabled or die.

What it is?

Chemical poisoning is the process of damage to the human body by toxic substances when they enter the bloodstream, stomach and intestines through the respiratory system.

Poisoning can occur by inhalation of vapors or ingestion of the product.

The main range of objects of human use that cause poisoning are listed below:

1. acetic acid. May cause severe poisoning if ingested or inhaled vapors;
2. paints and varnishes on an oil or acetone basis;
3. all types of solvents;
4. glue;
5. pesticides and herbicides (means for treating plants and destroying insects);
6. toxic aerosols;
7. means for the extermination of rodents;
8. acetone;
9. fuels and lubricants.

Almost all of them contain poisons that are harmful to the human body. Working with the above substances in closed rooms with poor ventilation, contact with mucous membranes, inhalation of vapors or ingestion, chemical poisoning occurs. Most often, this type of poisoning occurs when elementary safety rules are not observed when handling toxic substances.

Symptoms of pesticide poisoning

The manifestation of chemical poisoning. substances depends on the weight and age of the patient, the state of his health and the amount of poisonous agent that has entered the body.

Many toxic substances act on the body for a long period of time with minimal symptoms. It depends on the level of toxicity of the poison. The more toxic the poison, the more signs and faster they appear. And the more detrimental they affect the entire body. Often, the same poison will cause one person to experience chemical poisoning and the other experience nothing. This is due to the level of immunity, genetics and susceptibility to toxic substances.

For example, children are more susceptible to poisoning than adults. This is due to the fact that for 1 kg of child weight there is more poison than for an adult. And because of low level immunity and weakness of the body, an elderly person will be more susceptible to a toxic composition than a 30-year-old man.

The effects of poison and signs of chemical poisoning are very individual and depend on many factors, including those listed above. If people have previously suffered from allergies, bronchial asthma, then they are more sensitive to a pronounced smell, therefore, their body reacts faster to a toxic substance.

Signs of chem. poisoning depends on its severity

For mild types:

• dizziness;
• nausea, vomiting;
• redness, dryness, itching on the skin;
• tearing;
• nasal congestion;
• with moderate and severe poisoning;
• nausea, vomiting;
• temperature;
• swelling of the mucous membrane of the respiratory tract;
• angioedema;
• bronchospasm;
• convulsions;
• fainting;
• blurred vision;
• paralysis of the limbs;
• loss of speech;
• disorientation;
• hallucinations;
• coma;

In addition, poisoning with chemicals or other poisons can lead to burns of the mucous membranes, respiratory tract and esophagus. Lead to irreversible processes in the gastrointestinal tract. Lead to pulmonary edema, paralysis of the central nervous system. If the patient is not provided with timely medical assistance, the situation with poisoning can be fatal.

In case of severe poisoning, all these signs can occur simultaneously, aggravating the patient's state of health. Symptoms of chemical poisoning do not appear immediately. A person may feel unwell after a few hours or a few days. Poisoning can occur the next day. The more time passes from the moment of poisoning to the moment of diagnosis, the more difficult it is to help the poisoned person.

Some types of poisoning may not have visible signs at all. Toxins settle in the body and affect the functioning of the liver and kidneys. A person may not know that pesticides have damaged his health. This occurs most often with involuntary inhalation of chemical vapors. A person feels weakness, nausea, which quickly pass.

Depending on the poison, after the intake or use of which poisoning occurred, signs are also classified. Some poisons primarily affect the central nervous system and the brain, other respiratory tract and the gastrointestinal tract, and the musculoskeletal system. Depending on the type of poisoning, further actions also depend, such as providing assistance, diagnosing and selecting drug therapy.

First aid for poisoning

When providing first aid, it is important to understand the condition of the patient so as not to harm him. If the patient has convulsions, severe hallucinations, breathing problems, then he needs qualified medical assistance. In addition, when vomiting and cleansing the stomach, one must remember that the patient may choke on vomit or they will go into the respiratory tract.

With a coma or signs of hemorrhage, you should also not disturb the patient, so as not to worsen his condition. If the poisoning is not severe, then you can provide first aid to the poisoned person at home. It all depends on the toxicity and the amount of chemical used. If a person has been poisoned by vapors or touched the mucous membrane, it is necessary to provide access to fresh air, rinse the mucous membranes and skin with running water, take activated charcoal and seek medical help. In the event that chemicals have entered the body through the respiratory tract and esophagus, it is important to try as quickly as possible to eliminate further absorption of the poison and its remnants from the stomach.

To do this, it is necessary to induce an attack of vomiting by pressing on the inside of the larynx. The poison that got into the cavity of the stomach is initially absorbed only by one third. It takes several hours for the absorption of the remaining chemical. In this regard, it is necessary to quickly remove the contents of the esophagus and stomach.

To facilitate the withdrawal of vomit, you can drink more water. Water will bring out the contents of the stomach faster. You can also give the poisoned activated charcoal, it absorbs toxins very quickly and contributes to their successful removal from the body. More often, activated charcoal is used in powder or tablets, unlike liquid charcoal, it absorbs toxins better. In the absence of activated carbon, Polysorb or Polyphepan can be used. They also help to eliminate intoxication, but a little slower than coal.

Such assistance can be provided to patients who do not have breathing problems, convulsions and disorders in the musculoskeletal system. If such changes are present, then the patient should be placed in a horizontal position face down to remove vomit and wait for the ambulance to arrive.

If there is a medical facility nearby, it is necessary to transport the patient there for gastric lavage. For these purposes, a probe is inserted through the esophagus into the stomach, with which the contents of the stomach are emptied. But even after washing, there may be residual toxins in the stomach cavity. To remove them, you need to take activated charcoal.

It is important to understand that the life and health of the patient depends on the correct first aid. The bulk of the poison is absorbed in the first minutes, when it is necessary to provide assistance.

If the poisoning was weak, and the person feels a slight malaise in the form of dizziness and nausea, it is necessary to give him activated charcoal. Subsequently, you can take Enterosgel, Polysorb, Polyphepan for several days. Drink fresh milk daily and stay outdoors. But in any case, if the causes and circumstances of the poisoning are known, it is necessary to seek medical help and provide information to the doctor.

The situation is more complicated when those around the unconscious patient or the person himself do not understand what happened and the poisoning becomes known only in the doctor's office or after the ambulance arrives. This means that the patient will not receive timely assistance and the main part of the toxic substance that has entered the body has already been absorbed into the walls of the stomach and spread throughout the body. Consequently, the destructive process of organ damage by poisons has already been launched to the maximum.

Diagnosis of chemical poisoning

If the poisoning is known, then the diagnosis is made in the minimum version, visual inspection, analysis of blood, urine. Doctors in such cases see the picture more clearly and determine the tools to combat the disease. When determining the poison from which poisoning occurred, it is more clear what drug therapy should be applied. The esophagus, stomach and intestines are washed. Drug therapy is carried out to remove the poison from the body.

It is worse when doctors do not know about the poisoning and the etiology of the poison. In this case, the diagnosis is initially made on the basis of the patient's symptoms. Based on a biochemical analysis of blood, urine, gastric juice, a more accurate diagnosis occurs. But it takes a certain time, during which toxins have an even greater effect on the body. But unfortunately, with severe poisoning, with lost time during transportation and diagnosis, the patient may be in a coma or unconscious state, and maximum negative changes occur in the body.

Chemical poisonings fall into the category dangerous poisonings. In addition to death, a person runs the risk of remaining disabled after hemorrhage or paralysis suffered against the background of poisoning.

Timely diagnosis and treatment play a huge role in the final result after chemical poisoning.

Treatment Methods

In the treatment of chemical poisoning, classical drug and auxiliary therapy is used. This is a set of measures aimed at removing toxins from the body, eliminating negative consequences and restoring the patient.

The main therapy can be divided into several stages:

1. elimination of the process of absorption of a toxic substance;
2. measures to remove the toxic chemical;
3. drug elimination of symptoms of poisoning in the form of disruption of various organs (gastrointestinal tract, liver, kidneys, central nervous system, respiratory organs);
4. removal of systemic antidotes from the body. These stages of therapy are used for poisoning with almost any poisons and toxic substances.

But the last stage is only when the pesticide is known, with which the patient was poisoned due to the mechanism of action. The first stage includes the removal of vomit, active gastric lavage with a probe, absorption using activated charcoal in powder.

To quickly and successfully remove the absorbed poison, the patient is prescribed laxatives. When moving from the stomach to the intestines and through the rectum, activated charcoal is also effective against partially trapped toxins. The excretion of absorbed coal has practically no effect on the level of poison that has entered the bloodstream, but improves the general condition of the patient and reduces further intoxication. In case of poisoning certain types toxic substances in therapy, methods are used to accelerate the formation of bile, the work of the kidneys and bladder.

To cleanse the body of toxins in case of poisoning with ethyl alcohol, methanol and other poisons, dialysis and hemosorption are used. These are quite effective methods in the treatment of poisoning. But unfortunately, the equipment necessary for this can not be found in all medical institutions, which makes its use difficult. Depending on the etiology of the poison, when it enters the body, poisoning occurs, the choice of therapy, medicines and methods for removing toxins from the poison occurs. In addition to therapy aimed at combating toxins, concomitant diseases are treated, which were the result of poisoning. For example, the treatment of a burn of the respiratory tract and esophagus, the restoration of affected areas of the walls of the stomach and intestines, the maintenance of efficient liver and kidney function, the elimination of pulmonary edema, the raising of the protective functions of the body as a whole, etc. The most difficult cases are poisoning with highly concentrated poisons that instantly affect the body and are absorbed. For example, pesticides used to treat plants in the fields with the help of aviation. Sometimes in such cases, medical care is no longer effective.

Measures to prevent poisoning:

It is important to understand that a person can get chemical poisoning in standard living conditions if elementary safety rules are not followed. Toxic chemicals are found in almost all cleaning products, laundry products, grease removers, limescale removers, etc. Gasoline and diesel fuel that the driver encounters on a daily basis can also lead to severe poisoning. All paints and solvents that we use to paint windows, doors and fences in the country and at home are not safe. The vinegar essence used in home preparations can be fatal if consumed. Almost all aerosols from mosquitoes, flies and other insects are toxic. Even in the deodorant produced in an aerosol can, there is poison. Many types of drugs contain poisonous chemicals. Therefore, an overdose or the use of expired tablets can also lead to severe poisoning. A person almost every hour comes into contact with dangerous toxic substances and risks getting poisoned.

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Chemical poisoning

Poisons include certain drugs, household chemicals, solvents, pesticides, and other chemicals.

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 large quantities. Other substances are so poisonous that even a single drop of such a poison on the skin can lead to dire consequences. The toxicity of a substance in each case also depends on the genetic characteristics of a person. Some normally non-toxic substances are toxic to people with a certain genotype (set of genes).

The dose of a substance that causes symptoms of poisoning is also very dependent 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.

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

Poisoning is commonly included in the differential diagnosis of coma, seizures, acute psychosis, acute liver or kidney failure, and bone marrow depression. Although this should be done, the possibility of poisoning can be disregarded when the patient's main manifestations are mild mental or neurological 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.

In acute accidental poisoning, the 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, such actions allow you to establish only the trade name of the product, which does not allow you to know its chemical composition. The bibliography at the end of this chapter lists a number of books that list the active constituents of substances used in the household, agriculture, patent medicines, and poisonous plants. A small reference book of this type should be carried by every doctor in his portfolio. The latest information of this kind can also be obtained from the Centers for the Treatment of Poisoning and from representatives of the manufacturers of these substances. In chronic poisoning, it is often impossible to quickly determine the toxic agent from the anamnesis. The lesser urgency of therapeutic measures in these cases usually allows for the necessary thorough study of the patient's habits and the state of the environment.

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

Chemical analysis of body fluids provides the most correct identification of the substance that caused the poisoning. Some common poisons, such as acetylsalicylic acid (aspirin) and barbiturates, can be detected and even quantified with relatively simple laboratory tests. Other poisons require more complex toxicological studies, such as high-performance gas or liquid chromatography, which are only performed in specialized laboratories. In addition, the results of toxicological studies are rarely available in time to decide on initial treatment for acute poisoning. However, samples of vomit, aspirated stomach contents, blood, urine, and feces should be retained for toxicology testing if diagnostic or legal issues arise. Chemical analysis of body fluids or tissues is 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.

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

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

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

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

• Evacuation of stomach contents

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

After swallowing many poisons, vomiting occurs spontaneously. In a smaller number of cases, it can be induced at home by mechanical stimulation of the back of the throat. 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 the simultaneous administration of activated charcoal, which is an adsorbent, should be avoided. A second dose of ipecac syrup should be given to the patient if he does not vomit 20 minutes after taking the first dose (after taking two doses, vomiting will develop in 90-95% of patients). If there is no scrap of ipecac syrup, every effort should be made to find it, even if this requires taking the patient to the hospital. Apomorphine administered intramuscularly at a dose of 0.06 mg/kg acts within 5 minutes, but may cause prolonged vomiting. When administered intravenously at a dose of 0.01 mg/kg, apomorphine induces vomiting almost immediately, with no subsequent effect on the central nervous system. Sometimes it is not possible to induce vomiting and valuable time should not be wasted waiting. An attempt to induce vomiting should not be made in victims who are in a convulsive state, in patients with severe 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 amounts (less than 100 ml) of liquid hydrocarbons that are strong lung irritants (eg, kerosene, polish).

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

Interference with absorption in the gastrointestinal tract.

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

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

Prevention of absorption of poison from other organs and systems. Most locally applied poisons can be removed from the body by copious washings with water. In certain cases, weak acids or alkalis, or alcohol in combination with soap, are more effective, but rapid and abundant washing with water must be carried out until these solutions are available to doctors. Chemical antidotes are dangerous because the heat generated by the 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 down absorption, measures that speed up the excretion of a toxic agent and the body rarely have a large effect on the peak concentration of the poison in the body. However, they can significantly reduce the time during which the concentration of many poisons remains above a certain level, and thereby reduce the risk of complications and tackle the life of the patient. When assessing the need to perform such measures, it is necessary to take into account the clinical condition of the patient, the properties and pathways of the metabolism of the poison and the amount of absorbed poison according to the anamnesis data and the results of determining its concentration in the blood. The introduction of some poisons can be accelerated by various methods; the choice of method depends on the condition of the patient, the amount of poison in the body and the availability of experienced personnel and equipment.

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).

Acceleration of renal excretion is justified in cases of poisoning by a much larger number of 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 poisoning with drugs such as salicylic acid preparations and long-acting barbiturates, the effectiveness of increased diuresis induced by the administration of large volumes of electrolyte solutions in combination with intravenous furosemide has been demonstrated in increasing renal excretion.

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

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

Dialysis 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 removing large amounts of dialysable poisons from the body. For barbiturates, dialysis rates of 50–100 ml/min have been achieved, while the rate of excretion from the body is 2–10 times higher than with peritoneal dialysis or forced diuresis. With blood perfusion through activated charcoal or ion-exchange resin, even greater clearance rates of most poisons are achieved than with hemodialysis. Clearly, extracorporeal dialysis and hemosorption may be considered the procedures of choice for the rapid elimination of poisons from the body of patients who have absorbed such amounts of poison as to make their survival unlikely even with the best supportive care. 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 disease states. Skillful supportive care can save the lives of many severely poisoned patients and keep their detoxifying and excretory mechanisms functioning until the poison concentration is reduced to safe levels. Symptomatic measures are especially important when the active poison belongs to the category of substances for which a specific antidote is unknown. Even when an antidote is available, vital signs should be prevented or controlled with appropriate supportive care.

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

Depression of the central nervous system. Specific therapy aimed at combating the inhibitory effect of poisons on the central nervous system is usually neither necessary nor difficult. Most patients with poisoning come out of a coma, as from a long anesthesia. During the unconscious period, careful care of the nurse and close observation of the patient are necessary. If the depression of the centers located in the medulla oblongata occurs as a result of circulatory or respiratory disorders, then it is necessary to immediately and vigorously begin measures to maintain these vital functions using chemical means and mechanical procedures. The use of analeptics in the treatment of patients with poison-induced central nervous system depression has been largely abandoned. It is certain that these substances should never be used to awaken consciousness, and it is doubtful that their use to hasten the recovery of spontaneous breathing and active reflexes has ever been justified. In contrast, the drug antagonist naloxone, administered intravenously in adequate doses, usually reverses the central nervous system depression associated with drug overdose.

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

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

Hypotension. The causes of hypotension and shock in the poisoned patient are numerous and often there are several causes at the same time. Poisons can cause 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 due to other causes, the choice of the most appropriate drug requires an 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 measures include aspiration of exudate, giving high concentrations of oxygen under positive pressure, the introduction of aerosols of surfactants, bronchodilators and adrenocorticosteroids.

Hypoxia. Poisoning can cause the development of tissue hypoxia through various mechanisms, and in one patient several of these mechanisms may 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 normal airway patency, ventilation remains inadequate, as evidenced by the clinical condition or measurement of minute volume or blood gases, mechanical ventilation by appropriate mechanical means is imperative. In tissue hypoxia, the introduction of high concentrations of oxygen is always indicated. In cases where there is severe depression of the central nervous system, the introduction of oxygen often leads to respiratory arrest and must be accompanied by artificial ventilation.

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

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

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

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

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Symptoms and principles of first aid for chemical poisoning

Chemical poisoning can occur in hazardous industries, at home, during the fighting. Toxic compounds enter the body through food, drink, contaminated air. They can penetrate through the skin, mucous membranes, through the intestines, bronchi and lungs. In case of poisoning with chemicals, the symptoms can be different, because the toxins affect different systems and organs.

Signs of chemical poisoning

Signs of poisoning with chemical hazardous substances depend on the class of substances, the route of entry into the body. The main symptoms of chemical poisoning are:

1. Nausea and vomiting.
2. hallucinations.
3. Stomach ache.
4. Increased heart rate or cardiac arrest.
5. Constriction or dilation of the pupils (miosis and mydriasis).
6. Paleness of the skin, their cyanosis or yellowness.
7. Bleeding.
8. Respiratory failure: shortness of breath, suffocation.

What is the danger of poisoning with detergents: symptoms, consequences.

What to do in case of poisoning hydrochloric acid: signs and treatment.

With inhalation of toxic substances, coughing, mucus discharge from the nose, sputum discharge, bronchospasm and inability to exhale are possible. Toxic pulmonary edema is also possible. If the poison has entered the gastrointestinal tract, then with chemical poisoning, symptoms may include abdominal pain, heartburn, and vomiting. Each class of substances is characterized by an effect on certain bodies and systems, so the signs of chemical poisoning are specific.

There are many classes of chemical compounds that are toxic to the body. The most common of them:

1. Pesticides, herbicides, substances used in agriculture (see Nitrate poisoning).
2. Chemical warfare agents, gaseous compounds.
3. Medications (atropine, physostigmine, antidepressants, barbiturates, opioid analgesics).
4. Alcohol and ethyl alcohol substitutes.
5. Poisonous mushrooms, plants, animals.
6. Acids and alkalis.

Pesticides and chemical warfare agents contain organophosphorus compounds that are toxic to respiratory system. This chemical class compounds causes activation parasympathetic system by blocking the destruction of acetylcholine in the body. The accumulation of acetylcholine in the nerve endings leads to spasm of the bronchi, gastrointestinal tract, tearing and salivation, and diarrhea. Cardiac arrest is also possible.

Poisoning with certain drugs (Neostigmine, Physostigmine), as well as fly agaric (see Amanita poisoning) also causes activation of the cholinergic system, which can lead to pulmonary edema. One of the signs of poisoning is constriction of the pupils (miosis).

Anticholinergic drugs and belladonna alkaloids, on the contrary, cause pupil dilation. In this case, there are failures in the work of the heart - tachycardia.

Important! Alcohol and surrogates cause liver damage - toxic hepatitis. Methyl alcohol has a detrimental effect on the central and peripheral nervous system; in case of poisoning, blindness and deafness occur.

Hydrocarbons and alcohols are toxic to the liver. Their poisoning occurs with non-traditional methods of treatment (poisoning with kerosene), work at gas stations. Inhalation poisoning by them through the respiratory tract leads to damage to the central nervous system and hallucinations.

Aflatoxins from molds that grow on bread can cause cancer of the liver cells. Poisons of the pale toadstool are the cause of toxic hepatitis (see Poisoning of the pale toadstool).

Signs of chemical heavy metal poisoning include nervous system disorders, hearing loss, and double vision. Mental disorders are possible - with mercury poisoning, pathological shyness appears. When intoxicated with lead compounds, porphyria, kidney failure, and spasmodic pain in the intestines occur.

Poisoning with caustic compounds such as acids and alkalis can lead to ulcerative lesions of the gastrointestinal tract. When penetrating through ulcerative defects mucosal toxic substances ( acetic acid) in the blood is the destruction of blood cells. In this case, pallor of the skin and yellowness associated with the death of red blood cells and the release of bilirubin are possible.

Treatment of chemical poisoning

What to do in case of chemical poisoning? First of all, you need to stop the flow toxic substances into the body. Principles of assistance in case of chemical poisoning:

1. If poisoning occurred when chemical compounds entered the gastrointestinal tract, then you need to ask the victim or witnesses what poisoned the person.
2. In case of poisoning with caustic compounds such as acids or alkalis, it is forbidden to rinse the stomach in order to avoid damage to the esophagus, bleeding.
3. To dilute the concentration of the substance, it is recommended to drink a glass of water - this is the first aid for chemical poisoning through the stomach. Then you need to wait for medical help.
4. If gastrointestinal poisoning is caused by hydrocarbon compounds such as kerosene, turpentine, it is necessary to give a laxative (magnesium solution) to quickly remove toxic substances from the digestive tract.
5. First aid for chemical poisoning with asphyxiant compounds - it is necessary to stop their access to the body by removing the victim from the infection zone to fresh air or to a well-ventilated area. To return to a conscious state, ammonia is used, bringing it to the nose.

For any chemical poisoning, first aid is to stop the access of the poison. It is necessary to take the victim to the hospital as soon as possible. In a medical institution, in case of acid and alkali poisoning, the stomach is washed using a nasogastric tube and a Janet syringe connected to it. Acids are neutralized with a solution of soda, alkalis with a solution of various weak acids. Care must be taken in neutralization, since soda causes stretching of the walls of the stomach.

In case of poisoning with organophosphorus compounds in the composition of pesticides, cholinesterase reactivators are introduced - Dipiroxime, Alloxime or atropine-like agents - belladonna alkaloids. Glutamic acid is also used in complex therapy.

If poisoning with heavy metals has occurred, Dimercaprol, Thioctovaya is used to remove them from the body ( lipoic acid). In case of intoxication with morphine-like compounds, antidotes are drugs Naltrexone, Naloxone.

In case of intoxication in the hospital, detoxification therapy is carried out with the help of forced diuresis. Pour in crystalloid solutions and glucose solution with the addition of diuretics (Lasix).

There is also peritoneal dialysis: abdominal cavity poisonous compounds absorbed by the body are released, which are washed off with saline.

Hemodialysis is a procedure for purifying blood through carbon filters or semi-permeable polyethylene membranes. It is used for poisoning with chemical compounds that lead to kidney failure, for example, for lead poisoning.

Salmonella poisoning symptoms