First aid in acute poisonings
States arising from the ingestion of toxic substances (toxins) or a large number of other substances, causing pathological changes in organs and systems.
• endogenous, when the internal organs are affected as a result of serious illness (infection, cancer, liver disease, blood, etc.);
• exogenous when the poison comes from outside.
are the following routes of toxic substances in the body.
1. The oral route when the chemicals start to be absorbed already in the mouth, and then in the stomach, the intestines (particularly the fat-soluble compound).
2. The parenteral route (intravenously, intramuscularly, subcutaneously) - the fastest way to receipt of a toxic dose of drugs in the blood.
3. Inhaled way - poison gases, vaporous substances in the inspired mixture, as well as liquid substances in the form of aerosols.
4. Percutaneous way when poisonous substances blister relatively well penetrate the skin, are absorbed and provide obscherezorbtivnoe action.
5. Introduction of various t
Chronic poisoning develop gradually, under the influence of the same chemical that enters the body for a long time.acute poisoning manifestations of chronic poison entering the body contribute to phenomena such as cumulation, sensibiliztsiya, habituation and addiction.
cumulation referred to the accumulation in the body of the chemical or pharmacologically active substance.Pile is a substance that is slowly eliminated or neutralized.
Sensitization - a phenomenon in which the body produces increased sensitivity to re-enter the chemical.Most repeated administration of the same drug in the body seysibilizirovanny manifest allergic reactions.
Emergency First aid on the FAP, for all kinds of poisoning lies in the combined implementation of the following major activities:
• suction delay poison in the blood;
• that gets into disposal of toxic substances;
• accelerated clearance from the body;
• symptomatic therapy.
venom delay absorption into the bloodstream is performed depending on the route of toxic substances into the organism.When poisoning by toxic substances taken internally, mandatory and emergency measures are as follows.
1. Mechanical removal of poison:
• Gastric lavage through a tube, regardless of the patient's condition and the period that has elapsed since the reception of poison;
• appointment of emetics;
• appointment of laxatives (salt);
• bowel movements using a siphon enema.
2. Chemical destruction and neutralization of poison:
• with acid in cases of poisoning by alkalis;
• by alkali with acid poisoning;
• hydrogen sulphide water in case of poisoning with heavy metal salts.
3. Physical and chemical bonding venom (poison adsorption).The biggest absorbent properties are activated carbon (carbol) and white clay;and like overlying absorbent means may be used talc, starch, aluminum hydroxide, Almagelum, magnesium trisilicate.
inhalation poisoning should:
• remove the affected person from the atmosphere;with staff and the victim must have gas masks;
• start hyperventilation oxygen with the help of ventilator or clean air;
• conduct symptomatic treatment.
After contact with the toxic substance on the skin should be:
• wash the skin with running water;
• neutralize poison chemically neutralize acids and alkalis;
• at defeat poisonous substances blister skin further treated with a solution of bleach, a symptomatic therapy and evacuate the injured to the destination.
Neutralization vsosavshegosya poison includes the following activities:
• or specific antidotal therapy;
• symptomatic therapy or stimulation of physiological functions;
• methods accelerate the elimination of the poison from the body.
antidotal therapy has protivotoksicheskoe action.Symptomatic therapy aimed at maintaining blood flow (the introduction of cardiac glycosides, camphor) and respiration (analeptic agents - respiratory stimulants, artificial respiration, oxygen therapy).Transfusion of blood fluids or blood is carried out only under medical supervision.
Accelerate removal of toxic substances.In the most simple and FAP legkovypolnimym by diuresis (diabetes) is a water load.For this purpose, excessive drinking affected administered intravenously administered large amounts of isotonic solution (5% glucose solution, 0.85% sodium chloride solution).Diuretic (diuretic) tool can be used only on prescription.Diuretics are contraindicated in poisoning complications of acute renal failure (anuria).Acceleration of discharge venom contributes to strengthening the motor activity of the bowel with laxatives (salt) agents and enemas.
specific (aptidotnaya therapy)
antidote therapy in acute poisoning is carried out in the following directions.
1. inactivating effect on the physical and chemical state of the toxic substance in the gastrointestinal tract.For example, the introduction into the stomach of different sorbents: egg albumen, activated charcoal, synthetic adsorbents, which inhibit absorption of toxins.
2. The specific physico-chemical interaction with toxic substances in the blood, lymph (chemical antidotes parenteral action).For example, the use of unitiola, sodium thiosulfate to form soluble compounds and accelerate their excretion in the urine using a forced diuresis.
3. The favorable change by biotransformation of toxic substances through the use of "anti-metabolites'.For example, when applying ethyl alcohol and methyl alcohol poisoning will delay the formation of ethylene glycol in the liver metabolites of these compounds are hazardous - formaldehyde, formic acid and oxalic acid, so called delay "lethal synthesis".
specific (antidote) treatment remains effective only in the early phase of acute poisoning and can only be used for definite diagnosis of poisoning, antidote, otherwise he could have a toxic effect on the body.
1. Neuropsychiatric disorders in acute poisoning consist of a set of mental, neurological and somatovegetativnyh symptoms due to a combination of a direct toxic effect on the different structures of the central and peripheral nervous system, which developed as a result of intoxication and injuries of other organs, body systemsin the first place - the liver and kidneys.The most severe clinical manifestations of neuropsychiatric disorders in acute poisoning - acute intoxication and toxic psychosis, coma.If the treatment of coma requires strictly differentiated activities, the relief of psychosis is achieved by the use of psychotropic drugs (chlorpromazine, haloperidol, GHB, Relanium, Phenazepamum) intramuscularly and intravenously.
2. Respiratory acute poisonings appear in different clinical forms.
aspiration-obguratsionnaya form most often occurs in a coma as a result of tongue retraction, aspiration of vomit, severe hypersalivation.In these cases, suction swab or remove vomit from the oral cavity and throat, pharynx, display language, enter duct.When pronounced salivation injected 1 ml of 0.1% solution of atropine, if necessary - again.
central form of breathing disorders develop on the background of a deep coma and shows a lack or apparent lack of spontaneous breathing, which is caused by the defeat of the innervation of the respiratory muscles.Paramedics in these cases it is necessary to apply artificial respiration or Ambu bag or CP ZM-type devices, necessarily introduced with the duct.
3. For these violations of the cardiovascular system include exotoxic shock observed in the majority of acute intoxication.It manifests a sharp drop in blood pressure, pale skin, shortness of breath and tachycardia.Reduced plasma and bcc, a decrease in stroke and cardiac output.In such cases it is necessary to begin infusion therapy - polyglukin 400 ml;repoliglyukin 400 ml with hormones.
If poisoning cardiotoxic poisons, primarily operating in the heart (quinine, barium chloride, pahikarpin, glycosides, etc..), There may be a violation of the heart rate and the collapse of development.In such cases, together with other therapeutic agents administered intravenously 1.2 ml of a 0.1% atropine solution, 10 ml of 10% potassium chloride solution.
Toxic pulmonary edema occurs when the upper respiratory tract burns pairs of chlorine, ammonia, strong acids.When toxic to be administered intravenously edema prednisone 30 to 120 mg with 20-40 ml of 40% glucose 80-100 mg furosemide 10.5 ml of 2.4% strength saline to aminophylline.
In addition to this, if possible, with the aid of an inhaler used aerosols with diphenhydramine, ephedrine, alupenta, novocaine.
4. Kidney damage (toxic nephropathy) poisoning occurs when nephrotoxic (antifreeze, mercuric chloride, dichloroethane, carbon tetrachloride, etc.) And hemolytic poisons (vinegar, bluestone).It is necessary to pay special attention to the prevention of renal failure, which is carried out, in the end, an adequate treatment of poisoning.Hemosorption, hemodialysis is carried out in hospitals;paramedic task - to take into account how much the patient urine allocated for a certain period of time to evaluate its properties (color, transparency) and inform your doctor.
5. Liver damage (toxic hepatopathy, hepatitis) occurs in acute poisoning "liver poisons" (dichloroethane, carbon tetrachloride), some plant poisons (male fern, pale grebe, conditionally edible mushrooms).
clinically evident increase in morbidity and liver, hysterical sclera and skin.In acute liver failure is usually joined by anxiety, delirium, alternating with lethargy, apathy, coma.Discover the effects of hemorrhagic diathesis: nosebleeds, bleeding in the conjunctiva, skin, mucous membranes.In acute poisoning of liver damage are usually combined with the defeat of the kidneys (renal failure).
Apply vitamin therapy: multibion 100 ml intravenous infusion, 2 ml of vitamin B6;nicotinamide 1,000 micrograms of vitamin B12
Unitiol 40-60 ml / day., to 500-750 ml of 10% glucose with 16-20 units of insulin per day.