First aid for acute poisoning. Principles of care for acute poisoning at the prehospital stage Emergency medical care for acute poisoning

1. Definition of the term "acute poisoning".

2. Views allergic reactions, principles of rendering emergency care.

3. Syndromic care for acute poisoning.

4. Principles of emergency care for allergic reactions.

5. Anaphylactic shock, clinical manifestations.

6. Algorithm for emergency care in anaphylactic shock.

GENERAL TREATMENT OF ACUTE POISONING
In clinical toxicology, therapeutic interventions general order play leading role in most acute poisonings.
General emergency measures for acute poisoning include:
- termination of further entry into the body and removal of unabsorbed poison;
- accelerated excretion of absorbed poison from the body;
- the use of specific antidotes (antidotes);
- pathogenetic and symptomatic therapy(restoration and maintenance of vital important functions organism, homeostasis, elimination individual symptoms and intoxication syndromes).

MEASURES AIMED AT THE TERMINATION OF FURTHER ENTRY INTO THE BODY AND THE REMOVAL OF UNABsorbed POISON:

a) in case of inhalation poisoning - putting on a gas mask, evacuation from the infected area, if necessary, rinsing the oropharynx and rinsing the eyes with water, sanitizing;
b) when poison gets on the skin - mechanical removal, treatment with special degassing solutions or washing with soap and water, if necessary, followed by complete sanitization;
c) with subcutaneous or intramuscular injection toxic doses of medicinal or poisonous substances - immobilization, local cold for 6-8 hours, injection into the injection site of 5 ml of a 0.5% solution of novocaine with 0.3-0.5 ml of a 0.1% solution of adrenaline;

d) if the poison gets into the eyes - immediately wash them with running water (10-15 minutes);

e) upon ingestion of poison (oral poisoning) - provocation of vomiting, gastric lavage, bowel cleansing, administration of adsorbents.
It is recommended, before taking these measures, to administer orally chemical antidote, precipitating the given toxic substance or inactivating it through oxidative reactions.
Provocation of vomiting the fastest method that can be applied immediately. Unfortunately, this method is not efficient enough. It is contraindicated in comatose states (immediate danger of asphyxia due to aspiration of gastric contents), in heart patients (may cause collapse), in elderly patients with atherosclerosis (danger of cerebral hemorrhage), in patients with emphysema (danger of pneumothorax) and in pregnant women ( risk of labor pains). Also, this method comparatively contraindicated in patients who have ingested concentrated corrosive substances in large quantities (danger of gastric perforation), in persons who have ingested oil distillates (danger of aspiration of a toxic substance into Airways followed by chemical pneumonia). In order to induce vomiting, subcutaneous administration of apomorphine at a dose of 6-9 mg can be used. Before the introduction of apomorphine, the patient is given 1-3 glasses of water. You can induce vomiting reflexively irritating the root of the tongue, after giving the patient 2 to 3 glasses of water. If possible, it is better to carry out gastric lavage.
Gastric lavage the most effective measure to remove unabsorbed toxic substances in the stomach. Gastric lavage is effective if used within the first 6 hours, and sometimes it is effective even 12 hours after poisoning. If gastric lavage is applied early, in the first hours, it has a decisive influence on the evolution of poisoning. However, gastric lavage is contraindicated and dangerous in case of poisoning with corrosive substances, because the introduction of the probe can cause hemorrhages or perforation of the esophagus and stomach. Before gastric lavage, life-threatening conditions, convulsions are eliminated, adequate ventilation of the lungs is provided, removable dentures are removed from the mouth. Victims who are in coma, as well as with probable orthostatic phenomena, the stomach is washed in a position on the left side. With sluggish swallowing and cough reflexes it is advisable to pre-intubate the trachea with a tube with an inflatable cuff.
Probe gastric lavage is carried out with 10-15 liters of water at room temperature (18-20 ° C) in portions of not more than 0.3 - 0.5 liters (so that the contents of the stomach do not enter the intestines) using a system consisting of a funnel with a volume of at least 0, 5 l, a connecting tube, a tee with a pear and a thick gastric tube (at least 1 cm in diameter). An indicator of the correct insertion of the probe is the release of gastric contents from the funnel, lowered below the level of the stomach. Washing is carried out according to the siphon principle. At the moment of filling with water, the funnel is at the level of the stomach, then it rises by 30-50 cm. Then the funnel descends, the washings are drained and the procedure is repeated. Air must not enter the system. If the patency of the probe is disturbed, the system is clamped above the tee and several sharp compressions of the rubber bulb are performed. The stomach is washed to "clean" water. For chemical research, the contents of the stomach or the first portion of the washings are taken.
After rinsing is completed, an adsorbent is introduced through the probe (3-4 tablespoons of activated carbon in 200 ml of water) and a laxative: oil (150-200 ml vaseline oil) or saline (20-30 g of sodium or magnesium sulfate in 100 ml of water; in case of poisoning with narcotic poisons, sodium sulfate should be used, and in case of psychomotor agitation, magnesium sulfate). Before removal from the stomach, the probe is pinched at the patient's mouth. After gastric lavage, a cleansing or siphon enema is performed.
If probe gastric lavage is not possible, then vomiting is caused by mechanical irritation of the pharynx after taking 3-5 glasses of water (repeat 2-3 times). This procedure is contraindicated in case of depression of consciousness, poisoning with cauterizing poisons, gasoline.
Laxatives useful not only for the removal of absorbed toxic substance, but also for the removal of products formed as a result of the biological transformation of already absorbed toxic substance or even toxic substance excreted through the bile or through the intestinal mucosa. These drugs are contraindicated in acute poisoning with corrosive substances.
Clothing impregnated with a toxic substance must be removed immediately in order to stop the process of transcutaneous absorption of the toxic substance. The skin should be well cleansed with soap and water by washing for at least 15 minutes, preferably in the shower.
Accelerating the elimination of toxic substances. For this purpose, forced diuresis, hemodialysis, peritoneal dialysis, hemoperfusion and artificial hyperventilation are used.
forced diuresis one of the main therapeutic measures currently used for poisoning with substances that are excreted through the kidneys.
Due to the fact that many factors are involved in the mechanism of renal excretion of toxic substances, a number of conditions are necessary for forced diuresis: normal functional ability kidneys; normal cardiocirculatory function; normal electrolytic balance; the toxic substance must be excreted mainly by the renal route, reach high serum concentrations, be free or have a very labile association with proteins, and have low lipid solubility.
Forced diuresis is indicated only in cases of poisoning with dialysable substances that are excreted through the kidneys.
Forced diuresis can be induced by administering hyperosmolar solutions (forced osmotic diuresis) or large quantities isotonic solutions, with or without the addition of furosemide. As an osmotically active substance urea, manitol is used. If the rate of intravenous perfusion of a hyperosmolar substance exceeds its excretion through the kidneys, the osmolarity of plasma and interstitial fluid increases. Under these conditions, osmotic plasma hypertension induced by iatrogenically can determine the transfer of water from the cellular sector to the interstitial or intravascular sector, causing cellular dehydration. This phenomenon can be avoided if the amount of hyperosmolar solutions perfused intravenously does not exceed 6 liters per day in women and 8 liters per day in men.
Forced diuresis includes three stages: water preload, diuretic administration, and replacement infusion of electrolyte solutions.
Preliminary water load is achieved by infusion of 1.5-2 liters of liquid (hemodez, 0.9% sodium chloride solution, 5% glucose solution, etc.). Then, a solution of mannitol (1-1.5 g per kg of body weight) is injected intravenously for 10-15 minutes or furosemide (lasix) - 80-200 mg (8-20 ml of a 1% solution), after which the infusion of electrolyte solution continues ( 4-5 g of potassium chloride, 6 g of sodium chloride, 10 g of glucose in 1 liter of water) in a volume corresponding to hourly diuresis. If necessary, after 6-8 hours the cycle is repeated. During the forcing of diuresis, 10-20 ml of a 10% solution of chloride or calcium gluconate is injected intravenously. In cases where urine output does not increase appropriately over a 5-hour period, Lasix is ​​administered intravenously at a dose of 200-400 mg or more. If the administration of Lasix does not cause diuresis, fluid perfusion is stopped and extrarenal cleansing methods are performed. Depending on the characteristics of the toxic substance, alkalizing compounds (a molar solution of sodium bicarbonate, until the pH of the urine reaches a value of 7.8-8.5) or compounds for acidification (ammonium chloride, initially at a dose of 1.5 g) are added to the perfused solutions. in the first 1,000 ml of the perfused solution, the pH of the urine should be around 5).
Forced diuresis is contraindicated in collapse, acute heart failure, chronic heart failure stage II-III, pulmonary edema, acute kidney failure(anuria). In case of poisoning with nephrotoxic poisons (ethylene glycol, salts heavy metals etc.), it is preferable to use Furosemnd (Lasix). When carrying out forced diuresis, a strict accounting of the amount of input and output fluid is necessary! You should not strive to obtain more than 8-10 liters of urine per day, which can cause irreversible shifts in the homeostasis of the body;
Hemodialysis one of the most effective methods which accelerates the elimination of toxic substances from the body.
peritoneal dialysis. With In order to accelerate the elimination of dialyzable toxic substances, peritoneal dialysis can be used. Compared with hemodialysis, peritoneal dialysis has the advantage that it is inexpensive, does not require sophisticated equipment, and is not difficult to perform. However, the disadvantage of this technique is that its effectiveness is much less than the effectiveness of hemodialysis and there may be various complications. Therefore, peritoneal dialysis is not widely used. It is provided with multiple injections into the abdominal cavity through a catheter (every 30-45 minutes after removal of the previous portion) 2-3 liters of sterile electrolyte solution heated to 37 ° C - dialysis fluid of the following composition: sodium chloride - 6 g, potassium chloride - 0.3 g, calcium chloride - 0.3 g, sodium bicarbonate - 7.5 g, glucose - 6 g per 1 liter of water. The operation of peritoneal dialysis is possible in conditions of any surgical department.
Currently, hemosorption has become widespread.

PRINCIPLES OF EMERGENCY CARE FOR ACUTE POISONING

Emergency care for acute exogenous poisoning consists in the combined implementation of the following therapeutic measures: accelerated removal of toxic substances from the body (methods of active detoxification); urgent use of specific (antidote) therapy, which favorably changes the metabolism of a toxic substance in the body or reduces its toxicity; symptomatic therapy aimed at protecting and maintaining the body function that is predominantly affected by this toxic substance.

Diagnosis of acute poisoning is based on determining the type of chemical that caused the disease by clinical manifestations of "selective toxicity" and its subsequent identification by laboratory chemical-toxicological analysis.

Methods of active detoxification of the body. In case of poisoning with toxic substances taken orally, a mandatory and emergency measure is gastric lavage through a tube. For gastric lavage, 12-15 liters of water at room temperature (18-20 ° C) are used in portions of 300-500 ml. With severe intoxication in patients who are in unconscious(poisoning with hypnotics, phosphoroorganic insecticides, etc.), the stomach is washed again 2-3 times on the first day after poisoning, since due to a sharp slowdown in resorption in a state of deep coma, a significant amount of unabsorbed toxic substance can be deposited in the digestive tract. At the end of the lavage, 100-150 ml of a 30% solution of sodium sulfate or vaseline oil is injected into the stomach as a laxative. For the adsorption of toxic substances in the digestive tract, Activated carbon with water (in the form of gruel, one tablespoon inside before and after gastric lavage) or 5-6 tablets of Carbolen.

In a comatose state of the patient in the absence of cough and laryngeal reflexes, in order to prevent aspiration of vomit into the respiratory tract, the stomach is washed after preliminary intubation of the trachea with a tube with an inflatable cuff. The appointment of emetics (apomorsrin) and the induction of vomiting by irritation of the posterior pharyngeal wall is contraindicated in patients of early childhood (up to 5 years), in a soporous or unconscious state, as well as in persons poisoned by cauterizing poisons.

For snake bites, subcutaneous or intramuscular injection of toxic doses of drugs, cold is applied locally for 6-8 hours. Also shown are the introduction of 0.3 ml of a 0.1% solution of adrenaline into the injection site and circular novocaine blockade of the limb above the site of ingestion of toxins. The imposition of a tourniquet on a limb is contraindicated.

The main method of conservative treatment of poisoning is the method forced diuresis, based on the use of osmotic diuretics (urea, mannitol) or saluretics (furosemide or lasix) and indicated for most intoxications, when the excretion of toxic substances is carried out mainly by the kidneys. The method includes three successive stages: water load, intravenous administration of a diuretic, and replacement infusion of electrolyte solutions. The hypovolemia developing in severe poisoning is preliminarily compensated for by intravenous injections of plasma-substituting solutions (polyglucin, hemodez) and 5% glucose solution in a volume of 1-1.5 liters. At the same time, the concentration of a toxic substance in the blood and urine, the level of electrolytes, and hematocrit are determined. Patients are given an indwelling urinary catheter to measure hourly urine output.

Urea in the form of a 30% solution or a 15% solution of mannitol is injected intravenously in a stream for 10-15 minutes at a dose of 1 g/kg. At the end of the administration of the osmotic diuretic, the water load is continued with an electrolyte solution containing 4.5 g of potassium chloride, 6 g of sodium chloride and 10 g of glucose per 1 liter of solution. The rate of intravenous administration of the solution should correspond to the rate of diuresis (800-1200 ml / h). This cycle, if necessary, is repeated after 4-5 hours until the poisonous substance is completely removed from the bloodstream and the osmotic balance of the body is restored. Furosemide is administered intravenously at a dose of 80-200 mg. It should be borne in mind that with its repeated use, significant losses of electrolytes (especially potassium) are possible; therefore, during and after treatment with forced diuresis, it is necessary to monitor the content of electrolytes (potassium, sodium, calcium) in the blood and hematocrit, followed by compensation for the detected violations of water and electrolyte balance.

The forced diuresis method is not used for intoxications complicated by acute cardiovascular failure (persistent collapse), congestive heart failure, impaired renal function with oliguria, azotemia. In patients older than 50 years, the effectiveness of forced diuresis is markedly reduced.

Plasmapheresis is one of the simplest and most effective means of detoxification. It is produced using either centrifuges or special separators. Usually about 1.5 liters of plasma is removed, replacing it with saline solutions. With the development of disseminated intravascular coagulation syndrome, the removed plasma must also be replaced with fresh frozen plasma in an amount of 0.5-1 l (at least).

Hemodialysis using the device, an artificial kidney is an effective method of treating poisoning with dialyzable toxic substances that can penetrate the semipermeable membrane of the dialyzer. The method is used as an emergency measure in the early toxicogenic period of poisoning, when the poison is determined in the blood in order to accelerate its removal from the body. In terms of the rate of purification of blood from poisons (clearance), hemodialysis is 5-6 times higher than the method of forced diuresis. Routinely, hemodialysis is widely used in the treatment of acute renal failure caused by various nephrotoxic poisons. A contraindication to the use of hemodialysis is acute cardiovascular failure (collapse, uncompensated toxic shock). The operation of hemodialysis is carried out in the departments of "artificial kidney" or specialized centers for the treatment of poisoning.

Peritoneal dialysis used to accelerate the elimination of toxic substances that have the ability to be deposited in adipose tissues or bind firmly to plasma proteins. The operation of peritoneal dialysis is possible in any surgical hospital. In acute poisoning, peritoneal dialysis is carried out by an intermittent method after suturing into abdominal wall a special fistula, through which a dialysis fluid of the following composition is injected into the abdominal cavity by means of a polyethylene catheter: sodium chloride - 8.3 g, potassium chloride - 0.3 g, calcium chloride -0.3 g, magnesium chloride - 0.1 g , glucose -6 g per 1 liter of distilled water; The pH of the solution is set depending on the type of reaction of the toxic substance by adding sodium bicarbonate (in an acidic reaction) to obtain its 2% solution or glucose (in an alkaline reaction) to obtain its 5% solution. Sterile dialysis fluid, heated to 37 ° C, is injected in an amount of 2 liters and replaced every 30 minutes. Peritoneal dialysis is not inferior to the forced diuresis method in terms of clearance of toxic substances and can be used simultaneously with it. An important advantage of this method is the possibility of its use without reducing effectiveness in terms of clearance even in acute cardiovascular failure.Peritoneal dialysis is contraindicated by a pronounced adhesive process in the abdominal cavity and long gestation periods.

Detoxifying hemosorption - perfusion of the patient's blood through a special column (detoxifier) ​​with activated carbon or another type of sorbent is an effective method for removing a number of toxic substances from the body.

The operation of replacing the blood of the recipient with the blood of a donor(OZK) is indicated for acute poisoning with certain chemicals that cause the formation of methemoglobin, a prolonged decrease in cholinesterase activity, massive hemolysis, etc. donated blood, but better with an appropriate amount of red blood cells. To remove blood from the victim, a large superficial vein of the thigh is catheterized; donated blood is transfused slight pressure also through a catheter into one of the cubital veins. A strict correspondence between the volume of injected and withdrawn blood is necessary; the replacement rate should be no more than 40-50 ml/min. To prevent thrombosis of catheters, 5000 units of heparin are administered intravenously. When using donor blood containing sodium citrate, 10 ml of a 10% solution of calcium gluconate is injected intramuscularly for every 1000 ml of transfused blood. After the operation, it is necessary to control and correct the electrolyte and acid-base state of the blood. The effectiveness of OZK in terms of clearance of toxic substances is significantly inferior to all the above methods of active detoxification. Surgery is contraindicated in acute cardiac vascular insufficiency.

Specific (antidote) therapy

1. An inactivating effect on the physicochemical state of a toxic substance in the digestive tract: for example, the introduction of sorbents (egg white, activated carbon, synthetic sorbents) into the stomach that prevent the resorption of poisons (chemical antidotes of contact action).

2. Specific physical and chemical interaction with a toxic substance in the humoral environment of the body (chemical antidotes of parenteral action): for example, the use of thiol and complexing substances (unithiol, EDTL) for the formation of soluble compounds (chelates) with metals and their accelerated excretion in the urine by forced diuresis.

3. Beneficial modification of the biotransformation pathways of toxic substances through the use of antimetabolites: for example, the use of ethyl alcohol in methyl alcohol poisoning and ethylene glycol, which allows you to delay the formation in the liver of dangerous metabolites of these compounds ("lethal synthesis") - formaldehyde, formic or oxalic acid.

4. A beneficial change in the biochemical reactions that toxic substances enter into in the body (biochemical antidotes): for example, in case of poisoning with organophosphorus compounds, the use of cholinesterase reactivators (dipiroxime), which allow breaking the connection of poisons with enzymes.

5. Pharmacological antagonism in action on the same biochemical systems of the body (pharmacological antidotes). Thus, the antagonism between atropine and acetylcholine, prozerin and pachycarpine makes it possible to eliminate many of the dangerous symptoms of poisoning with these drugs. Specific (antidote) therapy retains its effectiveness only in the early "toxigenic" phase of acute poisoning and can be used only if a reliable clinical and laboratory diagnosis of the corresponding type of intoxication is obtained. Otherwise, the antidote itself may have a toxic effect on the body.

6. Use of antivenom sera to reduce the toxic effects of animal toxins (immunological antidotes): for example, anti-snake polyvalent serum.

Symptomatic therapy determined by the clinical manifestations of intoxication.

ELECTRIC INJURY. Damage can occur when two electrical wires are touched at the same time; in most cases, one of the poles is grounded, while touching the ungrounded pole with good contact with the ground is sufficient (water, wet shoes, nail soles, wet soil). The severity of the lesion is determined by the strength and direction of the current, the duration of exposure.

General manifestations when exposed to low voltage current (less than 500 V) are more pronounced than when exposed to high voltage current (more than 1000 V); local manifestations are more pronounced when exposed to high voltage current.

Symptoms. The general effect of the current is a sharp convulsive contraction of the muscles of the limb that was in contact with the current. At high voltage and current strength - loss of consciousness, respiratory arrest, arrhythmia, atrial fibrillation, asystole of the heart, sometimes myocardial fibrillation. Cardiac disturbances are possible even a few days after exposure to current (ECG), as well as thrombosis of the vessels of the affected limb. Sometimes the victim can be thrown away from the site of injury, resulting in severe damage to bones and internal organs. Local manifestations are due to the conversion of electrical energy into thermal energy with the development of burns. At the place of current entry and exit, perforated round "current marks" are formed, the center of which has a third-degree burn or may even be charred. These electrical marks are surrounded by skin torn in the form of a honeycomb (tissue fluid explodes at the moment of current).

Diagnosis put on the basis of an inspection of the scene and the presence of "metoktoka".

Treatment urgent. Exemption from the action of current, when breathing and heart stop - artificial respiration, closed heart massage. In all cases, emergency hospitalization. Treatment of burns according to general principles.

Complications. Myoglobinuria, with widespread muscle breakdown, anuria is possible.

The prognosis is always very serious, especially in elderly and senile people.

DROWNING AND RELATED CONDITIONS

Pathophysiology Approximately 90% of drowning victims aspirate water into the lungs. Aspiration of both fresh and salt water leads to severe hypoxemia as a result of a violation of the ratio of ventilation and perfusion and overflow of the lungs with venous blood. In drowning without aspiration, hypoxemia occurs as a result of apnea. Infected and polluted water worsens the situation due to obstruction of the bronchioles and infection by pathogens.

Other changes that occur with drowning and related conditions include plasma electrolyte disturbances and changes in blood volume, although these are very rare after successful resuscitation. A decrease in plasma osmolarity can cause acute hemolysis of red blood cells. An increase in the content of CO 2 in the body is less common than hypoxemia. Hypoxemia and, rarely, hemoglobinuria lead to impaired renal function.

Treatment in situations close to drowning

The fastest possible restoration of airway patency, respiration and blood circulation. It must be remembered that hypothermia is a protective factor of the central nervous system, and resuscitation should not be stopped until the victim is warmed.

Remove the victim from the water as quickly as possible. Provide head and neck immobilization if injury is suspected.

Airway protection by tracheal intubation if the patient is unconscious or loaded.

Correction of hypoxemia with supplemental oxygen through assisted ventilation (positive end-expiratory pressure) if needed.

Heart rate monitoring.

Providing access to a vein.

The study of plasma electrolytes, renal functions and CBS in dynamics.

The appointment of sodium bicarbonate in metabolic acidosis is indicated in severe cases.

Control of body temperature and warming the patient, if necessary.

Prognosis Factors adversely affecting survival: prolonged exposure to water, delay in initiation of effective cardiovascular resuscitation, marked metabolic acidosis, asystole and/or fixed dilated pupils on admission, low score (< 5) при оценке коматозного состояния по шкале Glasgow. Ни один критерий прогноза не абсолютен, и описано полное восстановление функций организма у пострадавших при наличии всех указанных факторов риска.

Among the accidents requiring emergency health care, have become widespread acute poisoning. This is due to the fact that as a result of the formation huge amount substances used for domestic and medical purposes, the so-called "toxic situation" has developed all over the world.
According to the World Health Organization, in general, in European countries, one person per thousand of the population is admitted to hospitals with poisoning, and 1 percent of these patients die. Compare: hospitalization for myocardial infarction, one of the most common cardiovascular vascular diseases, is about 0.8 people per thousand population. The number of victims of acute poisoning far exceeds the number of deaths from traffic accidents.
Acute poisoning refers to diseases, the outcome of which depends on the quality of first aid and the timing of its provision. The time factor is crucial here. The peculiarities of the poisoning clinic required the creation of specialized services from the health authorities.
Poisoning is caused by the action of poisonous (toxic) substances. But what is poison? This is a compound that is foreign to the body, which negatively affects the course of normal biochemical processes and leads to disorder physiological functions up to death. The degree of toxicity depends on how much the substance is capable of disrupting the vital activity of the body in minimal doses - the lower the dose of the chemical compound that causes poisoning, the greater its toxicity. The same chemical substance, depending on the dose, can be both medicine and poison, which gave grounds to the famous physician of the Middle Ages, Paracelsus, to assert: everything is poison and nothing is devoid of poison.
Acute poisonings are usually divided into household (in our country they account for up to 80%), industrial (2%), biological and food. Household poisoning, in turn, are divided into alcoholic, accidental and suicidal.
Alcohol poisoning occur when overuse alcohol, accidental - caused by erroneous ingestion chemical substances and medical preparations; suicidal - the result of taking poisonous substances for the purpose of suicide (usually in mentally unbalanced individuals).
Occupational poisoning is most often caused by non-compliance with safety regulations, imperfection technological processes, as well as accidents at chemical plants and laboratories.
Biological poisoning develops when plant poisons enter the body and are bitten by poisonous insects and snakes.
Food poisoning is associated with the consumption of poor quality food.
The principle of first aid in acute poisoning. All measures are aimed at stopping the effects of toxic substances, quickly removing the poison from the body, maintaining the activity of its main organs (brain, heart, lungs, kidneys), for which the stomach is immediately washed (3-4 glasses of water per reception, the procedure is repeated 2 times) , after which the victim was urgently taken to the hospital.
Currently in major cities toxicological teams are sent to provide emergency assistance to the victims.

Alcohol poisoning (ethyl alcohol)- a narcotic poison, which, when taken in large doses, causes not only intoxication, but also acute poisoning.
Symptoms. Redness of the face. The pupils are constricted. Respiration slow, with gurgling in the trachea. The pulse is frequent, blood pressure is lowered. Excreted from nose and mouth a large number of mucus and saliva. Involuntary stool and urination. Short-term excitement is replaced by adynamia, convulsions, and then an unconscious state. Skin is pale, clammy cold sweat. Death may occur from paralysis of the respiratory center.
First aid. Urgently call a doctor. A tissue removes mucus from the mouth and nose. If the patient is conscious, they cleanse his stomach by giving 3-4 glasses of water and inducing vomiting by pressing a teaspoon on the root of the tongue. Then do oxygen inhalation, drink strong tea or coffee. Patients in an unconscious state gastric lavage is performed medical workers. Before they arrive, the patient is laid without a pillow, preferably on his stomach, his head is turned to the side to avoid getting vomit into the respiratory tract. They give you a sniff ammonia.

The body's reaction to taking the drug anti-alcohol drug Antabuse (Teturam).
Symptoms. After treatment with Antabuse, alcohol intake causes a sharp vegetative-vascular reaction: chills, shortness of breath, palpitations, a sense of fear of death, redness of the skin. The reaction ends gradually, and after 1-2 hours sleep occurs. In severe cases - fall blood pressure, loss of consciousness, vomiting, increased heart rate, sharp pallor of the skin.
First aid. Urgently call a doctor. Before his arrival, the patient is placed in a horizontal position. They give oxygen. If breathing is disturbed, artificial respiration is carried out "from mouth to mouth".

Atropine poisoning- an alkaloid contained in some wild plants (belladonna, dope, henbane). All parts of plants are poisonous.
Symptoms. The severity of poisoning depends on the amount of poison that has entered the body. With mild poisoning, dryness in the mouth is felt, swallowing is upset. The voice is hoarse, silent, vision is disturbed. The skin of the face turns red, shortness of breath, vomiting, sometimes delirium, hallucinations appear. The pulse is frequent. In severe poisoning, motor and mental excitement occurs, the pulse is weak, and blood pressure is lowered. The pupils are dilated and do not react to light. Available death due to paralysis of the respiratory center.
First aid. Urgently call a doctor. Before his arrival, the patient's stomach is washed. Washing is done until the appearance of "clean" water, without impurities of food debris. Then - plentiful inhalation of oxygen.
Hospitalization in the therapeutic (toxicological) department. Transportation on a stretcher in a prone position.

belladonna poisoning observed after the use of its fruits.
Symptoms. Excitation, visual hallucinations, redness of the skin, a sharp dilation of the pupils. The consciousness is confused, the pulse is frequent, the stomach is swollen. Seizures are possible.
First aid. Urgently call a doctor. The patient's stomach is washed with water at room temperature (1-2 liters) with induction of vomiting. Oxygen therapy.
Hospitalization in therapeutic department. Transportation on a stretcher in a prone position.

Antifreeze poisoning- an antifreeze mixture, which includes ethylene glycol, is typical for car drivers, since they are the ones who most often use it.
Symptoms. When antifreeze enters the body, a state of slight intoxication occurs. After 5-8 hours, severe abdominal pain and thirst develop. There are vomiting, up to the nose, dizziness. The pulse quickens. Pupils dilate, breathing is upset. Often vision deteriorates. The skin is dry, reddened. In severe poisoning - loss of consciousness, convulsions.
First aid. Urgently call a doctor. Before his arrival ~ abundant gastric lavage with water (1-2 liters per dose) with induction of vomiting.
Hospitalization in the therapeutic (toxicological) department. Transportation on a stretcher in a prone position.

Acetone poisoning. If the substance is ingested, symptoms characteristic of alcohol intoxication: vomiting, cyanosis of the skin, palpitations, redness of the mucous membranes. In case of poisoning with acetone vapors - headaches, fainting, irritation of the mucous membranes of the eyes and upper respiratory tract.
First aid. Urgently call a doctor. In case of internal poisoning - a strong lavage of the stomach with water at room temperature (drinking) with induction of vomiting; if acetone is inhaled, flush eyes with water. They give oxygen. In case of fainting, they offer to sniff ammonia.
Hospitalization in the therapeutic department. Transportation on a stretcher in a prone position.

Barbiturate poisoning(luminal, veronal, medinal, barbamil, nembutal and others sleeping pills).
Symptoms. Shortly after taking sleeping pills, a person develops weakness, drowsiness, and intoxication. Then comes deep dream passing into a coma. The pupils are constricted, do not react to light. Redness of the skin. Decline in cardiac activity. Mucus and saliva accumulate in the victim's mouth and nose. Involuntary bowel movements and urination. In the future, pulmonary edema, respiratory paralysis occurs.
First aid. Urgently call a doctor. The patient's stomach is washed with water at room temperature (1-2 liters) with induction of vomiting. The victim is laid in a horizontal position, the collar and belt are unfastened, the head is raised, and coffee or tea is given. Milk in such cases is contraindicated, since it accelerates the flow of the poisonous drug into the intestines and prevents its removal from the body. If the victim has lost consciousness, then only qualified medical assistance can save him. Before the arrival of the ambulance team, first of all, it is necessary to prevent the ingress of vomit into the respiratory tract, for which mucus is removed from the mouth with a napkin, dentures are removed, and the tongue is brought out. From time to time give ammonia to sniff. In case of respiratory arrest resort to artificial respiration "mouth-to-mouth" or "mouth-to-nose".

Gasoline poisoning occurs when its vapors are inhaled or the substance enters the stomach.
Symptoms. Nausea, vomiting, dizziness, increased heart rate. From the mouth - the smell of gasoline. Abdominal pain, diarrhea. In severe cases - convulsions, coma.
First aid. The victim is removed from the gassed room and a doctor is urgently called. If gasoline is ingested, the stomach is washed with water to induce vomiting. Oxygen therapy. When breathing stops, give artificial respiration.
Hospitalization in the therapeutic (reanimation) department. Transportation on a stretcher in a prone position.

Acid poisoning(nitrogen, acetic, sulfuric, hydrochloric, oxalic, formic, tartaric, carbolic). These substances also have a cauterizing effect, cause tissue necrosis, so they toxic effect enhanced by the absorption of toxic products of tissue decay.
Symptoms. Sharp pains in the mouth, along the esophagus and in the stomach. On examination, burns of the mucous membrane of the lips, tongue, and oral cavity are found. Profuse salivation, vomiting with an admixture of blood. Due to swelling of the larynx, breathing is disturbed, asphyxia is possible. Often there is shock, collapse. Death may occur due to acute cardiovascular insufficiency.
First aid. Urgently call a doctor. Abundantly wash the patient's stomach with water to induce vomiting. Remove mucus from the mouth with a tissue. If breathing is disturbed, artificial respiration "from mouth to nose" is done.

Poisoning with caustic alkalis(caustic soda, caustic potash, quicklime, ammonia, green soap). When alkalis are ingested, burns of the mouth, pharynx, esophagus and stomach also occur.
Symptoms. Pain in the mouth, pharynx, along the esophagus and in the abdomen. Sometimes esophageal-gastric bleeding. Swelling of the larynx, pain shock.
First aid- as with acid poisoning.

Arsenic poisoning. When it enters the stomach, a gastrointestinal form of poisoning develops.
Symptoms. Abdominal pain, vomiting, metallic taste in the mouth. The stool is loose and frequent.
In severe cases - coma, convulsions, respiratory paralysis.
First aid. Urgently call a doctor. Wash the patient's stomach with water at room temperature to induce vomiting. Artificial respiration - according to indications.
Urgent hospitalization in the therapeutic (reanimation) department. Transportation on a stretcher in a prone position.

Nicotine poisoning. Smoking a significant amount of cigarettes causes poisoning. The lethal single dose of nicotine is 120 grams. Poison affects internal organs and brain.
Symptoms. Headache, weakness, nausea, vomiting, diarrhea, salivation. Trembling in hands and feet. Sometimes - loss of consciousness. The pulse is slow at first, then quickened, the pupils are constricted, vision is disturbed. Seizures. Coma.
First aid. The victim is taken out or taken out to Fresh air. Wash the stomach. Apply oxygen therapy. Give coffee or strong tea. In severe cases, hospitalization in the therapeutic department.

Pachycarpine poisoning possible with an overdose of the drug.
Symptoms. Most often, they appear 2-3 hours after taking the drug inside: dizziness, a feeling of lack of air, dilated pupils, blurred vision, abdominal pain, psychomotor agitation, pallor of the skin. In the future, a disorder of consciousness develops, coma occurs. Possible cardiac arrest.
First aid. Urgently call a doctor. Wash the patient's stomach with water at room temperature to induce vomiting. If the victim is in a coma, gastric lavage is carried out only by medical workers. oxygen inhalation. In terminal conditions - resuscitation measures: artificial respiration, indirect massage hearts.
Hospitalization in the therapeutic (reanimation) department. Transportation on a stretcher in a prone position.

Carbon monoxide poisoning happens in everyday life and at work as a result of gas leakage.
Symptoms. Patients complain of dizziness, headache, nausea, vomiting, chest pain, dry cough, lacrimation. Redness of the skin. Often - visual and auditory hallucinations. In severe poisoning - shortness of breath, agitation, involuntary urination, defecation, weakening of cardiac activity, impaired cerebral circulation, coma. Death can occur from paralysis of the respiratory center.
First aid. The victim is taken out to fresh air. Do oxygen inhalation. They give you a sniff of ammonia. Urgently call a doctor. The upper respiratory tract is cleared of mucus and artificial respiration "mouth-to-mouth" or "mouth-to-nose" is performed.
Hospitalization in the therapeutic (reanimation) department. Transportation on a stretcher in a prone position.

Poisoning with chloroform (metaphos, karbofos) develops when these drugs enter the stomach, respiratory tract, or on the skin.
Symptoms. dizziness, nausea, vomiting, increased sweating, blurred vision, discharge of mucus from the mouth and nose. Shortness of breath, moist rales in the lungs. In severe cases - unconsciousness, convulsions, impaired breathing and cardiac activity.
First aid. Urgently call a doctor. The victim is removed from the affected area. Remove contaminated clothing. The mouth is rinsed with water, the contaminated skin is also washed. If a poisonous substance enters the stomach, it is washed with water at room temperature (5-6 times with 3-4 glasses of water) with induction of vomiting. For patients who are unconscious, gastric lavage is carried out only by medical workers. With a sharp difficulty in breathing, artificial respiration is carried out “from mouth to mouth” or “from mouth to nose”, having previously cleaned the upper respiratory tract from saliva and mucus with a napkin.
Hospitalization in the therapeutic (toxicological) department. Transportation on a stretcher, in the prone position (the head is turned to the side to prevent vomit from entering the respiratory tract).

Food poisoning. A common source of poisoning are foods contaminated with microbes that produce strong toxins (poisons of a protein nature). Products can become contaminated both during storage and during cooking. Minced meat, minced meat and fish are most often infected.
Symptoms usually appear 2-4 hours after a meal, and sometimes a day later. Pain all over the abdomen, vomiting, diarrhea, body temperature rises sharply. The intoxication of the body is growing, expressed in the pallor of the skin, a drop in blood pressure, and a weakening of the pulse. In severe cases, muscle paralysis occurs, and cardiac activity is also disturbed.
First aid. Urgently call a doctor. Several times, before the appearance of water without food debris, the patient's stomach is washed with induction of vomiting. Give plentiful drink(water), abstain from food on the first day. The victim is warmed with heating pads. Hospitalization in the emergency room.

Botulism- poisoning after eating meat, fish, canned vegetables contaminated with bacteria.
Symptoms. After 2-8 days after eating contaminated food, abdominal pain, nausea, vomiting, and diarrhea appear. But main feature botulism - a lesion of the central nervous system: short-term excitement is replaced by depression, adynamia sets in, the voice disappears, swallowing is upset. In severe cases, intestinal paresis and Bladder, violation of respiratory and cardiac activity, vision. The disease progresses rapidly. If you do not provide urgent medical care, the patient may die in the next 5 days.
First aid. Urgently call a doctor. Abundantly wash the stomach of the victim.
The main treatment is the emergency administration of anti-botulinum serum, so the victim must be taken to the hospital as soon as possible. Transportation on a stretcher in a prone position.

Poisoning with poisonous mushrooms.
Symptoms poisoning manifests itself 6-8 hours after ingestion: abdominal pain, diarrhea, vomiting, dizziness. The temperature is lowered, vision is upset. With an increase in intoxication - shortness of breath, convulsions, delirium, loss of consciousness.
First aid. Urgently call a doctor. The victim's stomach is washed abundantly, after which he is given strong tea, covered with a blanket and warmed with heating pads.
Hospitalization in the therapeutic department. Transportation on a stretcher in a prone position.

Prevention of poisoning. The rules of personal hygiene, subject to their strict observance, reliably protect a person's life from toxic and infectious danger: you can not use medicines without a doctor's prescription; it is necessary to strictly comply with the requirements for the collection, storage and processing of food products; the instructions for handling chemicals must be followed carefully.

Tags: Acute poisoning, ethanol, antabuse, antifreeze, gasoline, strong acids, caustic alkalis, nicotine, carbon monoxide, food poisoning, botulism, poisonous mushrooms

Acute poisoning is a fairly common danger that can lie in wait for every person. That is why we must be aware of the measures to be taken in such cases. Properly rendered first aid can often save the victim's life. Poisoning is a special pathological condition human body, in which there is oppression of vital important organs and their functional activity under the influence of some toxins.

Toxins are everything toxic substances, which can have a detrimental effect on. The main ones include medicines that were taken in violation of the instructions, various low-quality food products, household chemicals, etc.
Household poisoning

Most often in everyday life, poisoning occurs with the following substances:

1. Medicines. Children who have taken medicines left within reach by adults, as well as people who wanted to commit suicide and for this took a large dose of potent drugs.

2. Means of household chemicals. Such poisoning is also characteristic of children, and in addition to those people who carried out certain work without proper observance of safety precautions.

3. poisonous plants. Both children and adults who ate them out of ignorance can get poisoned.
4. Poor quality products nutrition. The danger is expired food, as well as that which was stored in improper conditions.
Possible schemes of poisoning

Toxic substances can penetrate the human in completely different ways.
So the main route of entry is through the digestive system. Medications, household chemicals (pesticides and fertilizers), cleaning products and various solvents, vinegar, etc. penetrate through ingestion.

Some toxic elements, such as carbon monoxide and some fumes, can be poisonous if inhaled.

There is also a certain group of dangerous substances that can get into direct contact with the surface of the skin, such as poison ivy.

Symptoms

In acute poisoning, various symptoms can occur, which are very different from each other. However, there are common signs that manifest themselves in acute poisoning: nausea and / or vomiting, as well as a general depression. If a person has been poisoned by drugs, or some other substances that affect nervous system, he has increased anxiety as well as confusion.
The patient needs to provide first aid as soon as possible and take the necessary measures, regardless of the type of poisonous substance.
First aid

First of all, call the ambulance service. Answer the dispatcher's questions as calmly and clearly as possible. Before the arrival of the team of doctors, it is important to understand exactly how much of the poisonous substance got inside the body of the victim. In the event that a child is poisoned, he will not be able to give you the necessary information, so you need to check all household chemicals and all medicines yourself. It may well be that you can identify the substance that led to the poisoning.

If the symptoms were caused by inhalation of toxic elements, then you can only stop the victim from contact with the toxic substance and take him to fresh air.
If a person is poisoned through digestive tract, it is important to carry out a gastric lavage. For this purpose, it is necessary to dissolve a couple of potassium permanganate crystals in three liters of water and drink the resulting solution to the patient. After that, vomiting is caused by mechanical action on a point on the root of the tongue. It is important to remember that such manipulation cannot be carried out in relation to children under six years of age, in them it can cause reflex cardiac arrest.

In addition, vomiting should not be induced if a person has lost consciousness, as it can lead to asphyxia.
In the event that poisoning is caused by the ingestion of some chemicals into the body, gastric lavage is also carried out. If there is reliable information about what led to the poisoning, neutralizing substances should be given to the patient. For example, the action of acids is quenched by weak alkaline solution. To prepare it, dissolve a teaspoon of baking soda in half a glass of warm water. If alkaline substances were the cause of poisoning, milk should be given to the victim.

If all symptoms were caused by the penetration of toxins through skin, you should remove them with a napkin, and then rinse the skin area with running water. The contact point must then be covered with a clean cloth.
Information for doctors

Prepare a brief medical history for emergency personnel to help them. It is necessary to indicate the age of the victim, whether he has any health characteristics and allergic reactions to drugs. It is important to clarify the time and circumstances of the poisoning, the type of toxins, the ways they get into

Poisoning- a painful condition caused by the introduction of toxic substances into the body.

Poisoning should be suspected when healthy man suddenly feel unwell immediately or after a short time after eating or drinking, taking medicine, as well as cleaning clothes, dishes and plumbing with various chemicals, treating the room with substances that destroy insects or rodents, etc. Suddenly, general weakness may appear, up to loss of consciousness, vomiting, convulsive conditions, shortness of breath, the skin of the face may turn pale or turn blue. The suggestion of poisoning is reinforced if one of the described symptoms or a combination of them occurs in a group of people after a joint meal or work.

Causes of poisoning can be: medicines, food products, household chemicals, plant and animal poisons.

Poisonous substance can enter the body different ways: through gastrointestinal tract, respiratory tract, skin, conjunctiva, with the introduction of poison by injection (subcutaneously, intramuscularly, intravenously).

The damage caused by the poison may be limited to the site of the first direct contact with the body ( local action), which is very rare. Most often, the poison is absorbed and exerts on the body general action(resorptive), manifested by a predominant lesion of individual organs and systems of the body.

General principles of first aid for poisoning

• 1. Call an ambulance.
• 3. Measures to remove from the body, not absorbed poison.
• 4. Methods for accelerating the removal of already absorbed poison.
• 5. Use of specific antidotes (antidotes).

1. In case of any acute poisoning, you must immediately call " ambulance". To provide qualified assistance it is necessary to determine the type of poison that caused the poisoning. Therefore, it is necessary to save all the secretions of the affected person for presentation to the ambulance personnel, as well as the remains of the poison found near the victim (tablets with a label, an empty vial with a characteristic odor, opened ampoules, etc.).

2. Resuscitation measures essential in cardiac and respiratory arrest. Proceed to them only in the absence of a pulse on carotid artery, and after removing the vomit from oral cavity. These measures include mechanical ventilation (ALV) and chest compressions. But not all poisonings can be done. There are poisons that are released with exhaled air (FOS, chlorinated hydrocarbons) from the respiratory tract of the victim, so resuscitators can be poisoned by them.

3. Removal from the body of poison that has not been absorbed through the skin and mucous membranes.

a) When the poison enters through the skin and conjunctiva of the eye.

If poison gets on the conjunctiva, it is best to rinse the eye clean water or milk so that the wash water from the affected eye does not get into the healthy one.

When poison enters through the skin, the affected area should be washed with a jet tap water within 15–20 minutes. If this is not possible, the venom should be removed mechanically with a cotton swab. It is not recommended to intensively treat the skin with alcohol or vodka, rub it with a cotton swab or washcloth, as this leads to the expansion of skin capillaries and increased absorption of poisons through the skin.

b) When poison enters through the mouth it is urgent to call an ambulance, and only if this is not possible, or if it is delayed, only then can one proceed to gastric lavage with water without a tube. The victim is given several glasses to drink. warm water and then induce vomiting by irritation of the root of the tongue and fauces with a finger or a spoon. The total volume of water should be large enough, at home - at least 3 liters, when washing the stomach with a probe, use at least 10 liters.

For gastric lavage, it is better to use only clean warm water.

Tubeless gastric lavage (described above) is ineffective, and in case of poisoning with concentrated acids and alkalis it is dangerous. The fact is that the concentrated poison contained in the vomit and gastric lavage re-contacts with the affected areas of the mucous membrane of the oral cavity and esophagus, and this leads to a more severe burn of these organs. It is especially dangerous to carry out gastric lavage without a tube for small children, since there is a high probability of aspiration (inhalation) of vomit or water into the respiratory tract, which will cause suffocation.

Forbidden:

• 1) induce vomiting in an unconscious person;
• 2) induce vomiting in case of poisoning with strong acids, alkalis, as well as kerosene, turpentine, as these substances can additionally cause burns of the pharynx;
• 3) wash the stomach with an alkali solution ( drinking soda) in acid poisoning.

This is due to the fact that when acids and alkalis interact, gas is released, which, accumulating in the stomach, can cause perforation of the stomach wall or pain shock.

In case of poisoning with acids, alkalis, salts of heavy metals, the victim is given a drink enveloping means. This is jelly, an aqueous suspension of flour or starch, vegetable oil, whipped in boiled cold water egg whites(2-3 proteins per 1 liter of water). They partially neutralize alkalis and acids, and form insoluble compounds with salts. With subsequent gastric lavage through a tube, the same means are used.

Highly good effect obtained by injecting activated charcoal into the stomach of a poisoned person. Activated carbon has a high sorption (absorbing) ability to many toxic substances. The victim is given it at the rate of 1 tablet per 10 kg of body weight or coal suspension is prepared at the rate of 1 tablespoon of coal powder per glass of water. But it must be remembered that sorption on carbon is not strong, if it is in the stomach or intestines for a long time, the toxic substance can be released from the microscopic pores of activated carbon and begin to be absorbed into the blood. Therefore, after taking activated charcoal, it is necessary to introduce a laxative. Sometimes, in first aid, activated charcoal is given before gastric lavage, and then after this procedure.

Despite gastric lavage, part of the poison can enter the small intestine and be absorbed there. To speed up the passage of poison through the gastrointestinal tract and thereby limit its absorption, saline laxatives (magnesium sulfate - magnesia) are used, which are best administered through a tube after gastric lavage. In case of poisoning with fat-soluble poisons (gasoline, kerosene), vaseline oil is used for this purpose.

To remove poison from the large intestine, cleansing enemas are indicated in all cases. The main fluid for bowel lavage is pure water.

4. The implementation of methods for accelerating the removal of absorbed poison requires the use of special equipment and trained personnel, therefore they are used only in a specialized department of the hospital.

5. Antidotes are applied medical staff ambulance or the toxicology department of the hospital only after determining the poison that poisoned the victim

Children get poisoned mainly at home, all adults should remember this!