First aid for acute poisoning

Conditions arising from the ingestion of toxic substances( poisons) or a large number of other substances that cause pathological changes in organs and systems.

Poisoning:

• endogenous when the internal organs are affected by a serious illness( infection, malignant tumor, liver disease, blood, etc.);

• exogenous, when the toxic agent comes from outside.

There are following ways of toxic substance entering into the body.

1. Oral route, when chemical compounds begin to be absorbed already in the oral cavity, then in the stomach, intestines( especially fat-soluble compounds).

2. The parenteral route( intravenously, intramuscularly, under the skin) is the fastest way of delivering a toxic dose of medications to the blood.

3. Inhalation route - poisoning with gaseous, vaporous substances in the inhaled mixture, as well as with liquid substances in the form of aerosols.

4. Percutaneous pathway, when the blister agents are relatively well penetrated through the skin, absorbed and have a general-resorptive effect.

5. Introduction of toxic substances into various body cavities( rectum, vagina).

Chronic poisoning develops gradually, under the action of the same chemical substance that enters the body for a long time. To the manifestation of acute poisoning with chronic intake of poison into the body contribute to such phenomena as cumulation, sensitization, addiction and addiction.

Accumulation is the accumulation in the body of a chemical or pharmacologically active substance. Accumulate a substance that is slowly excreted or rendered harmless.

Sensitization is a phenomenon in which an organism develops an increased sensitivity to a re-entering chemical substance. More often the repeated introduction of the same medicines into the seizibilized organism is manifested by allergic reactions.

Emergency first aid for FAP for all types of poisoning is concluded in the combined implementation of the following main activities:

• delay in the absorption of poison into the blood;

• neutralization of the absorbing toxic substance;

• accelerated removal of it from the body;

• symptomatic therapy.

Delayed absorption of poison into the blood is carried out depending on the pathway of the toxic substance into the body. When poisoning with toxic substances taken inside, mandatory and urgent are the following measures.

1. Mechanical removal of the poison:

• gastric lavage through the probe, regardless of the patient's condition and the period that has elapsed since the poison was taken;

• administration of emetics;

• the appointment of laxatives( salt);

• Emptying the intestines with a siphon enema.

2. Chemical destruction and neutralization of poison:

• with acid in case of alkali poisoning;

• with alkali during acid poisoning;

• hydrogen sulphide water for poisoning with salts of heavy metals.

3. Physicochemical binding of poison( adsorption of poison).The greatest adsorbent properties are activated carbon( carboline) and white clay;as enveloping and adsorbing agents, talc, starch, aluminum hydroxide, almagel, magnesium trisilicate can be used.

For inhalation poisoning should:

• Remove the victim from the affected atmosphere;while personnel and the victim must have gas masks;

• start hyperventilation of the lungs with oxygen using an artificial respiration device or clean air;

• carry out symptomatic treatment.

In case of toxic substance on the skin it is necessary: ​​

• wash the skin with running water;

• neutralize the poison by chemical means, neutralize acids and alkalis;

• In case of damage to the skin-blistering agents, skin areas should be treated with chloramine solution, symptomatically treated and evacuated to the intended person.

Neutralization of absorbed poison includes the following activities:

• specific or antidote therapy;

• symptomatic therapy or stimulation of physiological functions;

• methods to accelerate the excretion of poison from the body.

Antidote therapy has a counter-toxic effect. Symptomatic therapy is aimed at maintaining blood circulation( the introduction of cardiac glycosides, camphor) and respiration( analeptic drugs - respiratory stimulants, artificial respiration, oxygen therapy).Transfusion of blood-substituting fluids or blood is done only under medical supervision.

Acceleration of elimination of toxic substance. On the FAP, the most simple and easy-to-perform method of diuresis( diabetes) is the water load. To this end, the victim is prescribed a copious drink, intravenously injected large amounts of isotonic solutions( 5% glucose solution, 0.85% sodium chloride solution).Diuretic( diuretic) drugs can only be used as directed by a doctor. Diuretics are contraindicated in the complication of poisoning with acute renal failure( anuria).Accelerating the secretion of poison contributes to increased motor activity of the intestine with the help of laxatives( saline) remedies and enemas.

Specific( apitidotnaya therapy)

Antidote therapy for acute poisoning is carried out in the following directions.

1. Inactivating effect on the physical and chemical state of a toxic substance in the gastrointestinal tract. For example, the introduction of various sorbents into the stomach: egg white, activated charcoal, synthetic sorbents, which prevent the absorption of poisons.

2. Specific physicochemical interaction with a toxic substance in the blood, lymph( chemical antivenin of parenteral action).For example, the use of unithiol, sodium thiosulfate to form soluble compounds and accelerated their excretion in the urine with the help of forced diuresis.

3. Advantageous change by biotransformation of toxic substances by using "antimetabolites".For example, the use of ethyl alcohol for poisoning with methyl alcohol and ethylene glycol makes it possible to delay the formation in the liver of the dangerous metabolites of these compounds - formaldehyde, formic and oxalic acids, to retard the so-called "lethal synthesis".

Specific( antidote) therapy remains effective only in the early phase of acute poisoning and can be used only with a reliable diagnosis of poisoning, otherwise the antidote can itself have a toxic effect on the body.

Symptomatic therapy:

1. Psycho-neurological disorders in acute poisoning are composed of a set of mental, neurological and somatovegetative symptoms due to a combination of direct toxic effects on various structures of the central and peripheral nervous system that developed as a result of intoxication and lesions of other organs, body systems, primarily- liver and kidneys. The most severe clinical manifestations of psychoneurological disorders in acute poisoning are acute intoxication psychosis and toxic coma. If the treatment of coma requires strictly differentiated measures, then the psychosis is overcome by the use of psychotropic drugs( aminazine, haloperidol, GHB, relanium, phenazepam) intramuscularly and intravenously.

2. Disturbances of respiration in acute poisoning are manifested in various clinical forms.

Aspiration-cucumber form most often occurs in a coma, as a result of tongue twisting, aspiration of vomit, and sharp hypersalivation. In these cases, it is necessary to remove the vomit from the oral cavity and throat, pharynx, remove the tongue, insert the airway with a suction or swab. With a sharp expressed salivation, 1 ml of 0.1% solution of atropine is injected, if necessary - again.

The central form of breathing disorders develops against the background of a deep coma and is manifested by the absence or apparent lack of independent breathing, which is caused by the damage to the innervation of the respiratory musculature. Medical assistant in these cases it is necessary to use artificial respiration, or Ambu bag, or KP-3M devices, it is necessary with the air duct inserted.

3. These disorders of cardiovascular system include exotoxic shock, observed with the majority of acute intoxications. It is manifested by a sharp drop in blood pressure, pale skin, tachycardia and shortness of breath. The bcc and plasma decreases, a decrease in the stroke and minute volume of the heart is observed. In such cases it is necessary to start infusion therapy - polyglucin 400 ml;repoliglyukin 400 ml with hormones.

When poisoning with cardiotoxic poisons, primarily acting on the heart( quinine, barium chloride, pachycarpine, glycosides, etc.), there may be a violation of the rhythm of the heart and the development of collapse. In such cases, along with other medications, 1-2 ml of 0.1% solution of atropine, 10 ml of a 10% solution of potassium chloride, are intravenously administered.

Toxic pulmonary edema occurs with burns of the upper respiratory tract with vapors of chlorine, ammonia, strong acids. When toxic edema should be administered intravenously prednisolone from 30 to 120 mg with 20-40 ml of 40% glucose, 80-100 mg of furosemide, 5-10 ml of 2.4% euphyllin in saline.

In addition to this, if possible, using an inhaler, aerosols with diphenhydramine, ephedrine, alupent, novocaine are used.

4. Renal damage( toxic nephropathy) occurs with nephrotoxic poisoning( antifreeze, thiols, dichloroethane, carbon tetrachloride, etc.) and hemolytic poisons( vinegar, copper sulfate).Special attention should be paid to the prevention of renal failure, which, in the final analysis, is adequately treated with poisoning. Hemosorption, hemodialysis is performed in hospitals;the task of the paramedic is to take into account how much the patient has allocated urine for a certain period of time, to evaluate its properties( color, transparency) and inform the doctor about it.

5. Liver involvement( toxic hepatopathy, hepatitis) develops in acute poisoning with "hepatic poisons"( dichloroethane, carbon tetrachloride), certain plant poisons( male fern, pale toadstool, conditionally edible fungi).

Clinically manifested by the increase and soreness of the liver, hysteria of the sclera and skin. In acute liver failure, anxiety, nonsense, alternating with drowsiness, apathy, coma usually join. Detect the phenomenon of hemorrhagic diathesis: nasal bleeding, hemorrhage in the conjunctiva, skin, mucous. In acute poisoning, liver damage is usually combined with renal function( hepatic-renal failure).

Apply vitamin therapy: multibion ​​100 ml intravenously drip, 2 ml of vitamin B6;nicotinamide, 1000 μg of vitamin B12

Unitiol 40-60 ml / day, up to 500-750 ml of 10% glucose with 16-20 units of insulin per day.