First aid in case of poisoning by certain poisons
1. Nitrogen oxides (irritant gases)
2. aconite (wrestler toxic, blue buttercup, Issyk-Kul root).
active principle - the alkaloid aconitine.A lethal dose - 1 g of plant, 5-10 ml of tincture.Neurotoxic (kurarepodobnoe), cardiotoxicity, antipyretic, which is caused by stimulant (in low doses) or inhibitory (at high doses) effects on the central nervous system of the peripheral nervous system, with ganglioblokiruyuschim effect.
Clinic. Nausea, vomiting, numbness of the tongue, lips, cheeks, fingertips, sensation of heat and cold in the extremities, transient blurred vision, dry mouth, thirst, headache, jerking of muscles of the face, tongue, limbs, loss of consciousness.Difficulty breathing, shortness of mixed type can be sudden respiratory arrest.Blood pressure decreased.In the initial stage - bradycardia, then paroxysmal tachycardia, fibrillation.
Emergency care .Ambu bag ventilation through the air, the call for the resuscitation team intubation.Bradycardia - intravenous atropine 0.1% to 1.0 ml sal
A. Ethyl alcohol, ethanol.
lethal single dose - 300 ml of 96% alcohol.
Different types of ethanol effects on the body are called alcohol intoxication, which is divided into acute and chronic.
Acute combines state of mild intoxication to deep coma.Status mild to moderate intoxication do not require medical care.In need of care patients in a state of alcoholic coma and suffering from chronic alcoholism at the sudden cessation of alcohol consumption, which is manifested withdrawal syndrome or alcoholic psychosis.
avoid tactical mistakes in the prehospital period, the term "alcoholic coma" is expanding.This diagnosis is the patient if there is no contact with him, expressed a protective reflex reaction to inhalation of ammonia: there is a grimace on his face, head movement, hands, legs, trying to get up, constricted pupils dilate.Muscle tone, tendon reflexes are reduced.A person sclera bloodshot, swollen.Hypersalivation, hyperhidrosis, hiccups, gagging, vomiting.The smell of alcohol from his mouth.Breathing - like a sleeping man.With further development of alcoholic coma is suppressed until the complete disappearance of protective reflex response, muscle tone, reflexes.Pupils dilated, may be transient anisocoria.The skin is cold, clammy sweat.Breathing weakened, with periods of apnea.Acrocyanosis, cyanosis of the mucous membranes.Reduced blood pressure, tachycardia.
Emergency care. Restoring patency of the upper airway, toilet mouth, duct.Atropine 0.1 ml of 1% solution to reduce the hypersalivation.
When violations of hemodynamics (blood pressure reduction, tachy or bradycardia) or intravenously polyglukin reopoligljukin 400 ml 5% glucose solution 400ml, 90-120 mg of prednisone.Glucose is a 40% - 20-40 ml intravenously;intravenously unitiol 5% - 5 ml, sodium thiosulfate, 30% - 20 ml.Vitamin intravenously vitamin C 5% - 10 ml glucose, B, - 4.6 ml, 10.8 ml BB intramuscularly.In order to correct the metabolic acidosis intravenous 200- 300 ml of sodium bicarbonate (4.3% solution) or 100-200 ml TRISamine.Gastric lavage followed by enterosorbent;however deep coma without intubation lavage is not recommended, it will be done in a hospital, where medical assistant hospitalizes patient.
B. Methyl alcohol (methanol, wood alcohol).Rapidly absorbed in the stomach and small intestine are metabolized mainly in the liver to form formaldehyde and formic acid, which cause the high toxicity of methanol ( "lethal synthesis").Toxic effects due to the inhibition of the central nervous system, the development of metabolic acidosis, lesions of the retina, optic nerve degeneration.Lethal dose if swallowed - 100 ml.
Clinic. Intoxication is weak, nausea, vomiting, and by the end of the first day - a characteristic syndrome: the combination of persistent headache with abdominal pain.Further develop impaired vision in the form of mist nets before the eyes flicker.After 1-2 days comes a sharp decline in visual acuity or blindness.Skin, mucous membranes dry, hyperemic with cyanotic shade.Excitation, seizures.Tachycardia, followed by a slowdown and cardiac arrhythmias.BP nada.Acute heart failure is progressing rapidly in conjunction with the central respiratory disorders.
Emergency care .Correction of respiration and circulation.Specific therapy - the introduction of the ethanol.The call after ZPZH (enteral gastric lavage) to inside a glass of vodka or intravenously with 5% ethanol solution (20 ml of 96% alcohol is introduced into a vial containing saline or glucose).
Alkalinization - sodium bicarbonate 3% 250-300 ml;vitamin B, and B (4-6 ml;.... ascorbic acid, a 5% 10-15 ml intravenously
B. Ethylene Glycol (EG) antifreeze, tasol, de-icing fluid, brake fluid are common in everyday life Death.EG dose -. 80-100 ml by mouth rapidly absorbed in the stomach, intestine, up to 30% in unchanged form excreted by the kidneys, and the rest is oxidized in the liver
After the EG occurs grogginess Then comes the period of an imaginary being, up to 12 hours...
neurotoxic period. symptoms of CNS lesions progress, then join the symptoms of respiratory disorders and the work of the cardiovascular system. Headache, dizziness, nausea, frequent vomiting. facial flushing. Mydriasis with decreased visual acuity. breath deep, noisy. bradycardia, decreased blood pressure. Whensevere poisoning, coma develops. cyanosis is growing, there is tachycardia, hypertension, and a stiff neck, positive Kernig symptoms Babinski.On the 2-5 th day of the clinic is dominated by renal disease symptoms - nephropathy, acute renal failure (oligo- and anuria, the increase in blood creatinine, urea).It nephrotoxic poisoning period.
Emergency care. Correction of respiration and circulation.ZPZH enterosorption, specific therapy - the introduction of ethanol orally or intravenously.
Mandatory introduction of intravenous calcium chloride 10% at least 20-30 ml.Intravenous sodium bicarbonate 300 3% 500 ml.
Help in case of poisoning with substitutes of alcohol is the same as for acute alcohol pathology.
4. Analgin (phenylbutazone, reopirin).In toxic doses have neurotoxic effects.Lowers blood clotting, inhibits the formation of blood.Perhaps metgemoglobinoobrazovanie.
Clinic.In this poisoning develop anxiety, agitation, heaviness in the head, tinnitus, dizziness, weakness, nausea, vomiting.The skin is pale, cold (reducing body temperature), wet.Tachycardia.If poisoning analginum urine from pink to red in color.Possible diarrhea.Sometimes develop anaphylactic reactions: skin rash with diffuse erythema, angioedema.In severe poisoning (especially in children) - coma, dilated pupils, skin cyanosis.General tonic convulsions, exciting the respiratory muscles.
Emergency care. Relief of seizures (Relanium 10-20 ml intravenously, intravenous diazepam 1-2 ml, 10-20 ml of GHB intravenously);ZPZH.Enterosorption.Symptomatic therapy.
5. amyl nitrite, sodium nitrite.
10. Tricyclic Antidepressants - timoleptiki;amitriptyline, melitramil (imitsin) azafen, fluacizine et al.
rapidly absorbed in the gastrointestinal tract.Excreted in the urine with 1-2 days.Toxic dose - 500 mg, lethal - 1200 mg.
Clinic. In mild cases - dry mouth, blurred vision, dizziness, weakness, agitation, urinary retention.Muscle twitching and hyperkinesis.In severe poisoning (1000 ml or more) - confusion until deep coma, seizures, convulsions klinikotonicheskih on epileptiform type.
bradi- and tachyarrhythmia, the patient requires continuous ECG monitoring.
Emergency care. solution aminostigmin 0.1% 1-2 ml intramuscular injection;bradycardia - atropine 0.1% 1 mL intramuscularly;intravenously.Violation of cardiac rhythm and conduction cropped depending on their type.Tube gastric lavage.Enterosorption.
11. Ataraktiki (benzodiazepines).
12. atropinopodobnye substances (atropine, belladonna, henbane, datura, Aeron, scopolamine, tsiklodol, all medicines containing atropine).
rapidly absorbed by any administration.Excreted in the urine, about 13% in unchanged form within 14 hours, selective toxic effects:. Psychotropic (holinoliticheskoe), due to the blockade of m-cholinoreactive systems.The first symptoms of poisoning appear within 30-60 minutes.
Clinic. I degree of poisoning (light).Lethargy, drowsiness, small voice products.Brief episodes of confusion.Disorders of attention, memory.Skin and mucous membranes dry, the normal color.Mydriasis (dilated pupils).The trend to an increase in blood pressure.
II degree (average).Psychotic disorders resembling beginning delirium, but unlike a true psychiatric disorders, stored in the self-orientation on the background of disorientation in time and place.The presence of visual hallucinations.Gross violations of memory on current events.Mydriasis is more pronounced.Increased tendon reflexes.Tachycardia, blurred rate, increased blood pressure.Hyperthermia to 39 ° C.
III degree (severe) can occur in two ways:
• by type atropinovogo delirium - psychotic constant changes, hallucinations are an aggressive, actively resists the action of medical staff;
• heavier version - comatose state with signs of cerebral edema.Trembling of the whole body, some twitching mimic muscles and limbs are replaced by generalized convulsions.Accrues cyanosis.Against the background of tachypnea - periodic Cheyne-Stokes respiration.Blood pressure decreased.
Emergency care.Correction respiratory disorders parallel introduction antagonists - aminostigmin (0.1% solution 1.2 ml intramuscularly or intravenously), or galantamine (0.1% 1.0 ml).Intravenous - 40% glucose solution 20 ml vitamin C (5% 10 ml solution).
For oral poisoning - washing stomach through a tube, heavily greased with Vaseline.Enterosorption.
15. acetylsalicylic acid (aspirin, askofen, asfen, tsitramon).
Rapidly absorbed in the digestive tract.About 80% is excreted in urine within 1-2 days.The lethal dose of about 30-40 Selective toxic effects: psychotropic, hemototoxic (anticoagulant), a stimulating effect on the central nervous system.
Clinic .Excitement, euphoria.Vertigo, tinnitus, hearing loss, diplopia.Noisy breath, frequent.Brad, soporous state, coma.Sometimes, subcutaneous hemorrhage, epistaxis, gastrointestinal, uterine.
Emergency care.Upon excitation intramuscularly seduksen 0.5% 2.4 ml or 10-20 mg intravenously relanium or Tisercinum 2.5% - 2 ml chlorpromazine or 2.5% - 2 ml intramuscularly.ZPZH.Enterosorption.
Intravenously - calcium chloride 10% - 10 ml;Dicynonum 1-2 ml;aminocaproic acid 100 ml (bleeding).
16. Acetone.Local irritant.When resorption at high doses - the narcotic effect with symptoms of toxic nephropathy.
Clinic .After the acetone is observed intoxication with abdominal pain, vomiting.Inhalation (most group among adolescents) vapor initially develops hallucinosis.Later stop hallucinations and euphoria manifested.Relatively early (after multiple doses) appears psycho-organic syndrome: blurred thinking, lethargy, confusion.
Emergency care. For oral poisoning - ZPZH, symptomatic therapy.Makers acetone inhalation for the purpose of euphoria, to be treated at the psychiatrist.
17. belladonna, henbane, bellasnon, bellaminal, Belloidum.
18. Gasolines.Refers to a solvent such as drug action.Excreted unchanged via the lungs.
Clinic. After prolonged exposure to gasoline vapor (2 hours or more), there is a feeling of intoxication, headache, dizziness, nausea, tremor of the fingers and the triad of autonomic symptoms: bradycardia, hypotension, hypothermia.Hazardous vapors are inhaled poisoning gasoline high concentration, accompanied by loss of consciousness and its attendant complications from respiratory and cardiac activity.Ingestion of one or two sips gasoline during his "siphoning" mouth does not cause the consequences, but if there is aspiration inspiratory way, there is a painful cough, and a few hours developing "gasoline pneumonia";chest pain, cough, shortness of breath, fever, tachycardia, cyanosis;objective data from the lungs appear on the second day (weakened breathing, wheezing, etc.).With timely treatment "petrol pneumonia" pass without consequences.
19. benzodiazepine derivatives (CDD) (tranquilizers, ataraktiki).
means selectively eliminate the phenomenon of emotional instability, tension, fear, anxiety.
These include: sibazon (Relanium, seduksen) Phenazepamum, nozepam (oxazepam);reladorm, radedorm (eunoktin);meprobamate, elenium, rudotel (Medazepam), Rohypnol, etc. Grandaxinum.
absorbed in the stomach and small intestine.Metabolized in the liver.Excreted in the urine and feces.The lethal dose is different for different drugs, an average of 1-2, the selective toxic effects: psychotropic, neurotoxic due to inhibition of the central nervous system, weakening of the excitation processes subcortical structures.Alcohol and other psychotropic drugs enhance the effect of CDD.If poisoning is marked by all the degree of oppression of consciousness (from stupor to coma) with severe respiratory and circulatory functions, suction phenomenon due bronhorei and hypersalivation, the tongue, especially in a coma.
Emergency care. Airway.Correction of hemodynamics.ZPZH.Enterosorption.
Intravenously - Glucose 40% -s' - 20-40 ml of Vitamin C 5% 10 ml, Riboxinum 200-400 mg.Specific antagonist - flumazenil (1-2 mg intravenously or intramuscularly).
20. Boric acid ( "Borax", borax, sodium-traborat ones).The neurotoxic effect due to malabsorption of riboflavin (vita min
B2) by the liver, the degree of its binding to blood proteins.
Clinic .Nausea, vomiting, sharp pains in the abdomen, diarrhea.At long persistent vomiting and diarrhea - dehydration with generalized seizures.
Emergency care. Relief of seizures (seduksen, Relanium, Phenazepamum).ZPZH.Compensation for loss of electrolytes, dehydration infusion polyionic solutions - Ringer 500 ml Disol, Trisol 400 ml.Symptomatic therapy.
21. hemlock spotted.
22. Elder bridle.
24. Signposts poisonous (hemlock, hemlock water).
family umbrella.The most poisonous roots of plants, especially in late autumn and early spring.Contain tsikutotoksin.Rapidly absorbed from the gastrointestinal tract.The lethal dose - 50 mg per 1 kg of plant weight.The neurotoxic effects associated with the central nervous system excitation, m-cholinergic receptor blockade.
Clinic .Initial symptoms appear within 1.5-2 hours, sometimes after 30-40 minutes.Salivation, nausea, vomiting, abdominal pain, and diarrhea.Mydriasis, tachycardia, klonikotonicheskie convulsions with loss of consciousness.Blood pressure rises.Spastic syndrome goes into a coma with muscular atonia, areflexia.The skin is dry, mydriasis.Breathing shallow, rare.Collapse.
Emergency care. The excitation stage, with bradycardia - atropine intravenously 0.1% - 1-2 ml.Relief of seizures.Correction of respiratory and hemodynamic.ZPZH.Enterosorption.
27. Granosan.Organic mercury, a chemical used for seed treatment in agriculture.Frequent cases of mass poisoning after eating sunflower seeds treated granozanom.Enterotoxic, neuro- and hemototoxic action.